常用點滴醫囑

HHS or DKA
=RI line : N/S 500ml + RI 50U + KCl 10meq run 40ml/hr
=Line 2: N/S 500ml run 100ml/hr

=IF F/S < 250mg/dL, RI line run 10ml/hr

=IF Na > 150meq/dL, N/S→half saline

=ABG stat

=Osmo(B)/Na/K/Cl, BUN/Cr stat

=Osmo(U) stat

=F/S q2hrs

IF F/S <250mg/dL and Osmo(B) < 290, F/S q6h

=Venous gas q4h x 2 (DKA)

Dengue fever

=TPR and BP q8h

=IVF, keep line open

=CBC/DC, S/R, U/R stat

=CXR

=PT, APTT stat

=DIC profile:D-Dimer, 3P’, Fibrinogen(susp DHF)

=ABG (susp DHF)

=Abd echo (susp DHF)

=CBC/DC qd

AMI

=NTG 1# SL stat

=Morphin 3~5mg IV push

=O2 NC 2L/min

=Aspirin(324mg) 1# po

=On EKG monitor

=Complete EKG (If II, III, aVF有finding=>做R’t side EKG)

=CK-MB, Troponin I, Myoglobin

=Heparin 5000U IV bolus

=Heparin 20000U + N/S 500ml run 20ml/hr↑↓ 3ml/hr to keep APTT prolong 1.5~2.0 index

=Check APTT q6h

Unstable Angina

=Aspirin(100) 1# qd

=Inderal(10) 1# tid

=Captopril 1# tid

=Isordil(10) 1# tid

=Heparin

Enoxaprin 1PC stat + Q12H

=O2 NC 2L/min

=EKG if chest pain

=Check CPK, LDH isoenzyme

Angina

Anti-platelet:

Clopidogrel(Plavix), Aspirin

Anti-ischemia:

NTG 3# SL無效(5 mins, 5mins 給 NTG)

↓

Morphine, β-blocker, Ca+2 channel blocker, ACEI(or ARB)→IABP

BP < 100 不可給ACEI

BP< 90 or HR <50不給NTG

Low mocular weight Heparin 1mg/kg bid SC

↓

12hrs內

New LBBB or ST-elevation( 0.1mV以上, 2個Lead)

→給thrombolytic Tx : t-PA or Aggrastat(GIIa/IIIb inhibitor)

CADP (連續可攜式腹膜透析；Continuous Ambulatory Peritoneal Dialysis) peritonitis order

1. Check Dialysate Routine + Gram stain + Acid fast stain

2. Check Dialystate culture(需、厭氧)，留抽50ml sample x 2PC(檢驗需註明*請離心後再種於培養上*)

3. B/C x2 times if BT > 38℃

4. Check CBC/DC, sugar stat

5. Medication

(1) Anuria(< 100ml/day)

=Cefazoline 500ml/L loading dose then 125mg/L in each exchange

=GM 8mg/L loading dose then 4mg/L qd

(2) 有urine(>100ml/day)

=Cefazoline 500ml/L loading dose then 125mg/L in each exchange

=Ceftazidime 250mg/L loading dose then 125mg/L in each exchange

6. Heparin 1000u/L per bag x 3 days

7. Check dialysate routine + gram stain qd x 3 days if admission

抽胸水 and 腹水：

Pleural routine, Gram stain, TP, LDH , Glu, Bacteria culture, TB smear and culture, CEA, cytology

Sedation

Dormicum(15mg) 2PC + 54ml run 5ml/hr 上下 1ml/hr

Pleuroparietopexy(Pleurodesis)

Osytetracyclin 4 vial + 2% 10cc xylocaine→dilute成50cc by N/S

Seizure

Dilantin(100mg/5ml) 6Amp + N/S 70ml run >30mins

Dilantin 1PC q8h IVD

Arrhythmia

Amiodarone 2Amp in 200ml N/S run > 60mins

Amiodarone 6Amp in D5W 500ml run 20ml/hr

Cardiogenic shock

Dobutamin 500mg(2PC) in D5W 250ml run 5~10 gtt/min

幫助氣管插管及與人工呼吸器的協調

Cisatracurium 10PC in N/S 500ml run 10ml/hr

High dose Losec

Losec 1PC in N/S 100ml run 20ml/hr

低血磷

Neutral phosphate 15ml qid po

[說明]

• Dopamine多巴胺：Dopamine有三位主顧：α1、β1和Dopamine接受器。不管濃度多少，Dopamine都會同時刺激三個接受器，然而不同濃度會引致不同的主要效應。
1. 低濃度的Dopamine對Dopamine接受器的刺激最大，主要效應是舒張腎血管床（Renal Vascular Bed）血管璧肌肉，增加腎臟的血液供應
2. 中濃度的Dopamine對β1接受器的刺激最大，主要效應是增強心肌收縮力
3. 高濃度的Dopamine對α1接受器的刺激最大，主要效應是收縮血管𤩹肌肉，引致血管收縮Vasoconstriction。
4. 中濃度的Dopamine是Inotrope(正向肌力，即為強心劑)，高濃度的Dopamine是Vasopressor
• Dobutamine（多保他命）：Dobutamine是人工合成藥物，並不是天然產物。Dobutamine主要刺激β1接受器，增強心肌收縮力。換言之，Dobutamine是Inotrope。
• 在Septic Shock（敗血性休克）中，週邊血管舒張（Vasodilation），使用高濃度的Dopamine可引致血管收縮（Vasoconstriction），穩定血壓。
• 在Cardiogenic Shock（心因性休克）中，心臟收縮力不佳，使用Dobutamine可增強心肌收縮力，維持Cardiac Output，從而穩定血壓。
• Cisatracurium ：為一高選擇性及競爭性的非去極化神經肌肉阻斷劑。可作為全身麻醉之輔助劑或加護病房使用，用以鬆弛骨骼肌，幫助氣管插管及與人工呼吸器的協調。