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STAT NSTEMI

Aspirin 300mg PO Clopidogrel 300mg PO GTN 2 puffs sublingual if BP>90 Morphine 5/10mg IV Cyclizine 50mg PO/IV Fondaparinux 2.5mg SC Bisoprolol 1.25mg if BP>90 O2 if hypoxic Aspirin 300mg PO GTN 2 puffs sublingual if BP>90 Morphine 10mg IV Cyclizine 50mg IV Bisoprolol 1.25mg if BP>90 Clopidogrel 300mg PO O2 if hypoxic

REGULAR
Aspirin 75mg PO OD Clopidogrel 75mg PO OD Bisoprolol 1.25mg Fondaparinux 2.5mg SC Atorvastatin 80mg PO ON Ramipril 1.25mg PO BD TEDS 1 pair TOP

PRN
Morphine 5-10mg 2-4 hourly IV/IM/PO Cyclizine 50mg IV/IM/PO TDS Naloxone 100-200 mcg every 2 mins, max 10mg, IV GTN 2 puffs/every 15 mins (keep systolic >90mmHg) Lactulose 10ml 12 hourly PO

FLUIDS

EXTRAS
No ramipril in renal failure.

STEMI

Aspirin 75mg PO OD Clopidogrel 75mg PO OD Bisoprolol 1.25mg Simvastatin 40mg PO ON Ramipril 1.25mg BD TEDS 1 pair TOP

Paracetamol 1g 6 hourly PO Morphine 5-10mg 2-4 hourly Cyclizine 50mg IV/IM/PO 8 hourly Naloxone 100-200 mcg every 2 mins, max 10mg IV Lactulose 10ml 12 hourly PO GTN 2 puffs s/l every 15 mins (keep systolic >90mmHg)

Stop Calcium channel blocker. Stop Beta-blocker if haemodynamically unstable.

ASTHMA

Salbutamol 5mg nebs /O2 Ipratropium bromide 0.5mg nebs Hydrocortisone 100mg IV Oxygen 15/L min via nonrebreather mask (keep sats >92%, for review after nebs)

COPD

Salbutamol 5mg nebs /air Ipratropium bromide 0.5mg nebs

Oxygen 15/L min via nonrebreather mask (keep sats >92%, for review after nebs) Salbutamol 5mg nebs 4 hourly (review daily) Ipratropium bromide 0.5mg nebs QDS (review daily) Prednisolone 40mg PO OD AM - cross off todays dose (5-7 days) Enoxaparin 40mg S/C OD TEDS 1 pair TOP Peak flow meter 4 hourly Oxygen 24% via venturi mask (review after ABG, keep pa02 >8kpa)

Salbutamol inhaler 100mcg 2 puffs PRN/QDS

Stop respiratory depressants e.g. zopiclone Consider antibiotics if chest infection 500mg amoxicillin TDS for 1 week PO or erythromycin 500mg QDS for 7 days

Salbutamol 5mg nebs 1-2 hourly

Stop respiratory depressants e.g. zopiclone

Hydrocortisone 100mg IV Doxycycline 200mg PO and Amoxicillin 500mg PO OR Erythromycin 500mg PO Oxygen 24% via venturi mask (review after ABG, keep pa02 >8kpa)

Salbutamol 5mg nebs 4 hourly Ipratropium bromide 0.5mg nebs QDS Saline 0.9% 5ml nebs QDS Prednisolone 40mg PO OD (5days) Doxycycline 100mg OD PO 6 days and Amoxicillin 500mg TDS PO for 7 days OR Erythromycin 500mg TDS PO 7days Enoxaparin 40mg S/C OD TEDS 1 pair TOP Oxygen 15/L min via nonrebreather mask (keep sats >92%, for review) Frusemide 40mg PO OD Ramipril 1.25mg PO BD Enoxaparin 40mg S/C OD TEDS 1 pair TOP

ACUTE LVF

Diamorphine 2.5mg IV slowly Frusemide 40mg IV over 20-30mins Cyclizine 50mg IV GTN 2 puffs sublingual Oxygen 15/L min via nonrebreather mask (keep sats >92%, for review) Diclofenac 75mg PO OR/ Morphine & Cyclizine

Paracetamol 1g 6 hourly PO Morphine 5-10mg, 2-4 hourly Cyclizine 50mg IV/IM/PO 8 hourly Naloxone 100-200 mcg every 2 mins, max 10mg IV Lactulose 10ml 12 hourly PO GTN 2 puffs s/l every 15 mins (keep systolic >90mmHg)

No FLUIDS!! Glyceryl Trinitrate 50mg in 50mls 0.9% saline at a rate of 0.1-2ml/min (keep systolic > 90)

Stop NSAID Stop B-Blocker Stop Calcium Channel blocker No TEDS in peripheral vascular disease

RENAL COLIC

GOUT

Indomethacin 100mg PO OR Naproxen 750mg PO OR Colchicine 500 mcg PO (IF NSAID CI)

Paracetamol 1g QDS PO Dicolfenac 75mg BD /50mg TDS PO Enoxaparin 40mg S/C OD TEDS 1 pair TOP Indomethacin 100mg PO BD OR Naproxen 250mg PO TDS OR Colchicine 500mcg TDS PO if NSAID CI (Stop if diarrhoea, max 6mg)

Morphine 5-10mg, 2-4 hourly Cyclizine 50mg IV/IM/PO 8 hourly Naloxone 100-200 mcg every 2 mins, max 10mg IV Lactulose 10ml 12 hourly PO Codeine phosphate 30-60mg 6 hourly PO Cyclizine 50mg 8 hourly IV/IM/PO Lactulose 10ml 12 hourly PO

Diclofenac not in upper GI bleed. Stop other NSAIDs Stop thiazide diuretic. Allopurinol - dont start but can carry on. Stop aspirin.

Omperazole 20mg OD PO Paracetamol 1g QDS PO Enoxaparin 40mg S/C OD TEDS 1 pair TOP

FRACTURE NOF

Paracetamol 1 g PO Morphine 5mg IV Cyclizine 50mg IV Cefuroxime 1.5mg IV STAT (60mins before op) 0.9% Saline or gelofusin if shocked Oxygen 15/L min via nonrebreather mask (keep sats >92%, for review) Omeprazole 40mg IV Cyclizine 50mg IV Gelofusin 500mls IV over 30 mins (if haemodynamically unstable) IF PUT HERE, DO NOT PUT IN FLUID SECTION)

UPPER GI BLEED

Paracetamol 1g QDS PO Codeine Phosphate 3060mg QDS Enoxaparin 40mg S/C OD (withhold if going to theatre next day) TEDS 1 pair TOP (Alendronic acid 70mg once weekly) not acutely Adcal D3 1 tablet BD PO Omeprazole 40mg PO/IV TEDS 1 pair TOP Paracetamol 1g QDS PO Oxygen if hypoxic

Morphine 5-10mg, 2-4hourly, IV/IM/PO (Naloxone 100-200 mcg every 2 mins, max 10mg IV) Cyclizine 50mg IV/IM/PO 8 hourly Lactulose 10ml 12 hourly PO

Pt is NBM so needs maintenance fluids: 0.9% saline, 8 hourly, IV, plus 20mmol of KCL. Dextrose 5%, 8 hourly, IV plus 20mmol of KCL. Dextrose 5%, 8 hourly, IV.

Continue bisphosphonates

Paracetamol 1g 6 hourly PO Cocodamol 30/500 QDS max Cyclizine 50mg TDS IV/IM/PO

Gelofusin 500mls IV over 30 mins (if haemodynamically unstable) Fluids - 4hourly, 6hourly, 6hourly

Stop steroids if not high dose Stop NSAID Stop Aspirin Stop ISMN

PYELONEPHRITIS

Paracetamol 1g PO Gentamicin 5mg/kg if severe sepsis/septic shock 1L NS over 1 hour if shocked

Paracetamol 1g QDS PO Co-amoxicav 1.2g TDS IV / 625mg TDS PO (for 10-14 days, review after 48 hours) (PENICILLIN allergy gentamicin 5mg/kg IV divided into 3 doses)(125mg

Morphine 5-10mg, 2-4hourly, IV/IM/PO Naloxone 100-200 mcg every 2 mins, max 10mg IV Cyclizine 50mg IV/IM/PO 8 hourly

Stop ACEI and NSAIDs

UNCOMPLICATED UTI

ARF AND HYPERKALAEMIA

10% Calcium gluconate 10ml Salbutamol nebuliser 5mg Salbutamol nebs

TDS in 70kg man) IF pregnant cefuroxime 250mg BD Non pregnant and CA: Trimethoprim 200mg PO BD Non pregnant and HA: Ciprofloaxacin 500mg PO BD Pregnant and CA: Cefalexin 250mg PO QDS Calcium resonium 15g PO in water TDS-QDS

10U insulin in 50ml 50% dextrose over 5-15mins Maintenance fluids if urine output >30 NS over 1 hour Insulin according to FIXED RATE sliding scale Dont add K+ to first bag 0.9% NS over 4hours, then 6hrs, 10% dextrose when BM <15 Dextrose OVER 2 HOURS, DEXTROSE OVER 4 HOURS NS OVER 8 HOURS

DKA

HYPERCALCAEMIA (Disodium pamidronate )


FLUIDS FIRST!!! ONLY GIVE PAMINDRONATE AS A LAST RESORT.

PNEUMONIA

Oxygen 15/L min via nonrebreather mask (keep sats >92%, for review) Paracetamol 1g

CURB 65 <3: Amoxicillin 500mg TDS IV/PO plus Doxycycline 200mg OD for 7 days. If pen allergy doxycycline alone. Paracetamol 1g 6 hourly PO Oxygen 15/L min via nonrebreather mask (keep sats >92%, for review)

Cyclizine 50mg IV/IM/PO 8 hourly Salbutamol nebuliser 5mg 0.9% saline nebs

Stop respiratory depressant Carefully if penicillin allergy!

CURB 65 >3: Co-amoxiclav 1.2g IV plus Doxycycline 200mg (cross off first dose on regular) Paracetamol 1g

CURB 65 3: Co-amoxiclav 1.2g TDS IV/PO plus Doxycycline 200mg OD for 7 days. If pen allergy vancomycin 1g BD IV plus ciprofloxacin 400mg BD IV/750mg BD PO for 7 days Benzylpenicillin 1.2g IV QDS Flucoxacillin 1g IV QDS OR Clindamycin 300mg IV QDS OR Clarithromycin 500mg IV BD IF PENICILLIN ALLERGIC For 7 days Paracetamol 1g QDS PO Metronidazole 500mg PO TDS (14 days, review in 48 hours) Vancomycin 125mg QDS PO for 7-10days if very sick Enoxaparin 40mg S/C OD Actimel 1 pot PO OD

CELLULITIS

Benzylpenicillin 1.2g IV Flucoxacillin 1g IV Paracetamol 1g PO (Cross off first dose

Codeine phosphate 30-60mg 6hourly PO Cyclizine 50mg IV/IM/PO 8 hourly

C.DIFFICILE

Paracetamol 1g 6 hourly PO

Fluids!! Give faster if dehydrated 1L NS STAT over 1 hour if shocked

Stop codeine phosphate Stop loperamide Stop clindamycin Stop diuretics

MENINGITIS

Ceftriaxone 4g IV Paracetamol 1g PO Cyclizine 50mg PO Oxygen 15/L min via nonrebreather mask (keep sats >92%, for review)

Ceftriaxone 2g IV OD (5-10 days, review after 48 hours) If penicillin allergic Chloramphenicol 50100mg/kg in 4 divided doses Around 850mg IV Paracetamol 1g QDS PO Enoxaparin 40mg S/C OD TEDS 1 pair TOP

Codeine phosphate 30-60mg 6hourly PO Cyclizine 50mg IV/IM/PO 8 hourly

Stop sedatives Consider amoxicillin 2g QDS IV if age >60/ immunocompromised to cover listeria