ENTRESTO

"Staff Nurse, saya nak order Lytic Cocktail satu!" Regimen Lytic Cocktail for severe hyperkalemia (In Sequence!) (with cardiac monitoring) 1) IV (slow bolus) Ca Gluconate 10%, 10mls over 5 mins STAT 2) IV (bolus) D50%, 50mls STAT 3) IV (bolus) Insulin Regular (Actrapid) 10iu STAT IV Ca gluconate 10% a. NOT for hyperkalemia secondary to digoxin toxicity b. effect should be seen in few min (onset: 5 min) & lasts 30-60 min c. may be repeated once or twice PRN d. works as membrane stabilizer = restore normal gradient between threshold potential and resting membrane potential c. Complication to observe - hypercalcemia IV D50% a. May not require if patient severe hyperglycemia, DKA or HHS b. In conjunction with insulin to prevent hypoglycemia IV Insulin regular a, Facilitate glucose uptake into cell, resulting intracellular K+ shift b. Complication to observe - hypoglycemia (that's why give D50) Emergency treatment of hyperkalemia (other than

When to suspect high risk MRSA and S. viridans    in neutropenic fever?  Do all neutropenic fever initial treatment shall be added up with IV Vancomycin? Those are the risk factors: 1) Mucositis 2) Skin infection 3) History of colonization with MRSA 4) Recent prophylaxis using fluoroquinolones 5) Catheter-site infection Reserve the vancomycin use for institutions with high rate of MRSA or S. viridans . Source: BMJ (Oct 2018)

DILUTION PROTOCOL for mida-fentanyl may vary from other health institution. Preparation for each dosage form: 1. Inj Midazolam : 5mg/1ml and 15mg/3ml 2. Inj Fentanyl : 100mcg/2ml Dilution: |||||||  30MG MIDAZOLAM |||||| + ||||||  300MCG FENTANYL |||||| dilute in  30ML NORMAL SALINE in 50ML syringe For every 1ml/hr,  1mg/hr midazolam + 10mcg/ml fentanyl  is administered. Infusion starting dose : 3 ml/hr Titrate to the desired effect Bolus dose may be required for faster effect ( 3 - 5 mls), followed by infusion dose. Source: ETD HSAJB