ENTRESTO

Mida-Morphine for sedation may vary from other healthcare institution. Preparation available in KKM: 1) Midazolam injection: 5mg/ml, 15mg/3ml 2) Morphine Injection: 10mg/ml Dilute: ||| Midazolam 30mg (6ml) ||| + ||| Morphine 30mg (3ml) ||| in 21ml Normal Saline (qs. 30ml) in 50cc syringe ~ ~ ~ Midoazolam 1mg/ml and Morphine 1mg/ml   1. May give loading dose of 0.05 mg/kg midazolam 2. Start at 0.06 mcg/kg/hr of midazolam 3. Dose range: 0.06 - 2 mg/kg/hr 4. May increase by 1ml/hr every 20 minutes till target RASS -2 to +1 achieved     Source: Medication Reconstitution & Medication Dilution Reference 2013 HSAJB

Shock Index: - An early bedside assessment - to quickly identify septic/ dengue patients early for resuscitation - Is HR divided by SBP - Normal range: 0.5 - 0.7 - SI > 1.0 is a/w significant poor clinical outcome with acute respiratory failure - SI value is inversely proportionate with CI, SV, & MAP. - SI value in most cases raise in proportionate with lactate. How this two correlates? - Shock state (as a response of HR > SBP) causes cellular hypoxia, increase in norepinephrine release, resulting anaerobic respiration      - increase in lactate production! (HYPERLACTATEMIA) Source of information is cited by:  Berger, T., Green, J., Horeczko, T., Hagar, Y., Garg, N., Suarez, A., … Shapiro, N. (2013). Shock index and early recognition of sepsis in the emergency department: pilot study.   The West J. of Em Med ,   14 (2), 168–174. doi:10.5811/westjem.2012.8.11546