IV Phenylephrine
Cara Dilute :
SC / IM / Slow IV / Continue Infusion
Slow IV :
Dilute 10mg dalam 9ml water for injection (jadikan 10ml)
Continue Infusion :
Dilute 10mg dalam 500ml NS / D5%
Contoh
Doktor order IV Phenylephrine 100mcg stat slow IV
Berat pesakit A : 62kg
1vial = 10mg = 1ml
10mg dilute dalam 9ml WFI = 10mg/10ml
1mg = 1ml
1000mcg = 1ml
(1000/10)mcg = (1/10)ml
100mcg = 0.1ml
Sunday, 21 August 2016
IV Noradrenaline
Cara Dilute :
Wad biasa : 0.03 x berat badan dalam 50ml D5% run 1ml/Hr = 1mcg/kg/min
* larutan glucose diperlukan untuk mengelakkan oksidasi yg berlebihan & kehilangan keberkesanan
* repeat BP hourly, keep MAP > 68
Contoh :
Doktor order Noradrenaline infusion, start from 0.02mcg/kg/min.
Berat pesakit A = 62kg
Kandungan yang diperlukan : 0.03 x 62kg = 1.86mg
Ampule yang diperlukan : 1.86/4 x 4 = 1.86
Dilute dalam 50ml D5%
Run 2ml/Hr
Kepekatan yang lebih tinggi digunakan di wad jagaan rapi sahaja
Cara Dilute :
Wad biasa : 0.03 x berat badan dalam 50ml D5% run 1ml/Hr = 1mcg/kg/min
* larutan glucose diperlukan untuk mengelakkan oksidasi yg berlebihan & kehilangan keberkesanan
* repeat BP hourly, keep MAP > 68
Contoh :
Doktor order Noradrenaline infusion, start from 0.02mcg/kg/min.
Berat pesakit A = 62kg
Kandungan yang diperlukan : 0.03 x 62kg = 1.86mg
Ampule yang diperlukan : 1.86/4 x 4 = 1.86
Dilute dalam 50ml D5%
Run 2ml/Hr
Kepekatan yang lebih tinggi digunakan di wad jagaan rapi sahaja
- pemantauan terperinci
- penjagaan kritikal :
4mg (1 ampule) - 32mg (8 ampule) in 50ml D5%
IV Dobutamine (Dobutrex)
Cara Dilute :
1 vial = 250mg/20ml
Dose 2.5 - 15mcg/kg/min
Dilution (single strength) :
1. Amount of drug (mg) = 3 x weight (kg) = a
2. Amount of drug (ml) = a x 20 = b
250
3. Dilute b (ml) with NS/D5%, up to 50ml
4. Final concentration (mg/ml) : a/50
** max concentration = 5mg/ml
Contoh :
Mr Abu has become hypotensive, Doktor order dobutamine infusion to be run at a rate of 5mcg/kg/min
Berat pesakit : 75kg
Cara kira (single strenght) :
1. Amount of drug (mg) = 3 x 75kg = 225mg
2. Amount of drug (ml) = 225mg x 20ml = 18ml
250mg
3. Dilute 18ml dalam 50ml D5% / NS (dalam syringe)
4. Final concentration = 225mg/50ml = 4.5mg/ml
5. 1mcg/kg/min = 1ml/Hr
5mcg/kg/min = 5ml/Hr
1 vial = 250mg/20ml
Dose 2.5 - 15mcg/kg/min
Dilution (single strength) :
1. Amount of drug (mg) = 3 x weight (kg) = a
2. Amount of drug (ml) = a x 20 = b
250
3. Dilute b (ml) with NS/D5%, up to 50ml
4. Final concentration (mg/ml) : a/50
** max concentration = 5mg/ml
Contoh :
Mr Abu has become hypotensive, Doktor order dobutamine infusion to be run at a rate of 5mcg/kg/min
Berat pesakit : 75kg
Cara kira (single strenght) :
1. Amount of drug (mg) = 3 x 75kg = 225mg
2. Amount of drug (ml) = 225mg x 20ml = 18ml
250mg
3. Dilute 18ml dalam 50ml D5% / NS (dalam syringe)
4. Final concentration = 225mg/50ml = 4.5mg/ml
5. 1mcg/kg/min = 1ml/Hr
5mcg/kg/min = 5ml/Hr
IV Dopamine (Intropin)
Cara Dilute :
1 vial = 200mg/5ml
Dose-dependent effects :
1. Low (0.5-2mcg/kg/min)
2. Intermediate (2-10mcg/kg/min)
3. High (>10mcg/kg/min)
Dilution (berat pesakit <60kg) :
1. Amount of drug (mg) = 3 x weight(kg) = a
2. Amount of drug (ml) = 3 x 5 = b
200
3. Dilute b (ml) dalam 50ml NS / D5%
4. Final concentration (mg/ml) = a/50
** max concentration = 4mg/ml
5. Administration rate : 1mcg/kg/min = 1ml/Hr
Dilution (berat pesakit >60kg / Intensive Care Ward)
1. Dilute 5ml (200mg) dalam 50ml NS / D5%
2. Final concentration : 4mg/ml = 4000mcg/ml
3. ?kg x ?mcg/kg/min x 60 min = ?ml/Hr
4000mcg/ml
Contoh
Mr Ali has become hypotensive, Doktor order dopamine infusion to be run at a rate of 3mcg/kg/min
Berat pesakit : 75kg
1. Dilute 1 vial dopamine (200mg/5ml) dalam 50ml NS / D5%
2. Final concentration : 4mg/ml = 4000mcg/ml
3. 75kg x 3mcg/kg/min = 3.4ml/Hr
4000mcg/ml
Cara Dilute :
1 vial = 200mg/5ml
Dose-dependent effects :
1. Low (0.5-2mcg/kg/min)
2. Intermediate (2-10mcg/kg/min)
3. High (>10mcg/kg/min)
Dilution (berat pesakit <60kg) :
1. Amount of drug (mg) = 3 x weight(kg) = a
2. Amount of drug (ml) = 3 x 5 = b
200
3. Dilute b (ml) dalam 50ml NS / D5%
4. Final concentration (mg/ml) = a/50
** max concentration = 4mg/ml
5. Administration rate : 1mcg/kg/min = 1ml/Hr
Dilution (berat pesakit >60kg / Intensive Care Ward)
1. Dilute 5ml (200mg) dalam 50ml NS / D5%
2. Final concentration : 4mg/ml = 4000mcg/ml
3. ?kg x ?mcg/kg/min x 60 min = ?ml/Hr
4000mcg/ml
Contoh
Mr Ali has become hypotensive, Doktor order dopamine infusion to be run at a rate of 3mcg/kg/min
Berat pesakit : 75kg
1. Dilute 1 vial dopamine (200mg/5ml) dalam 50ml NS / D5%
2. Final concentration : 4mg/ml = 4000mcg/ml
3. 75kg x 3mcg/kg/min = 3.4ml/Hr
4000mcg/ml
Saturday, 20 August 2016
Sunday, 7 August 2016
Bronchoscopy
Checklist Persediaan Di Dalam Wad Untuk Prosedur Bronchoscopy :
1. Consent ditandatangani.
2. Inform Scope Room.
3. Berpuasa 6 jam sebelum prosedur.
4. Gigi palsu ditanggalkan.
5. Barang kemas/duit/telefon tidak dibawa ke Scope Room.
6. Ubat rutin diambil kecuali ubat kencing manis.
7. Pesakit dihantar dengan katil.
8. Pesakit dipasang IV line.
9. Filem xray dan old notes dibawa bersama.
10. Neb combivent sebelum hantar ke Scope Room.
Checklist Persediaan Di Dalam Wad Untuk Prosedur Bronchoscopy :
1. Consent ditandatangani.
2. Inform Scope Room.
3. Berpuasa 6 jam sebelum prosedur.
4. Gigi palsu ditanggalkan.
5. Barang kemas/duit/telefon tidak dibawa ke Scope Room.
6. Ubat rutin diambil kecuali ubat kencing manis.
7. Pesakit dihantar dengan katil.
8. Pesakit dipasang IV line.
9. Filem xray dan old notes dibawa bersama.
10. Neb combivent sebelum hantar ke Scope Room.
Colonoscopy Dan Sigmoidoscopy
Checklist Persediaan Di Dalam Wad Untuk Prosedur Colonoscopy Dan Sigmoidoscopy :
1. Consent ditandatangani.
2. Inform Scope Room.
3. Berpuasa 12 jam sebelum prosedur.
4. Bowel prep dilakukan (fortrans, Fleet Enema).
5. Gigi palsu ditanggalkan.
6. Barang kemas/duit/telefon tidak dibawa ke Scope Room.
7. Ubat rutin diambil kecuali ubat kencing manis.
8. Pesakit dihantar dengan katil.
9. Pesakit dipasang IV line.
10. Pesakit memakai kain sarung (tanpa seluar dalam).
Checklist Persediaan Di Dalam Wad Untuk Prosedur Colonoscopy Dan Sigmoidoscopy :
1. Consent ditandatangani.
2. Inform Scope Room.
3. Berpuasa 12 jam sebelum prosedur.
4. Bowel prep dilakukan (fortrans, Fleet Enema).
5. Gigi palsu ditanggalkan.
6. Barang kemas/duit/telefon tidak dibawa ke Scope Room.
7. Ubat rutin diambil kecuali ubat kencing manis.
8. Pesakit dihantar dengan katil.
9. Pesakit dipasang IV line.
10. Pesakit memakai kain sarung (tanpa seluar dalam).
OGDS (Oesophagogastroduodenoscopy)
Checklist Persediaan Di Dalam Wad Untuk Prosedur OGDS:
1. Consent ditandatangani.
2. Inform Scope Room.
3. Berpuasa 6 jam sebelum prosedur.
4. Gigi palsu ditanggalkan.
5. Barang kemas/duit/telefon tidak dibawa ke Scope Room.
6. Ubat rutin diambil kecuali ubat kencing manis.
7. Pesakit dihantar dengan katil.
8. Pesakit dipasang IV line.
Checklist Persediaan Di Dalam Wad Untuk Prosedur OGDS:
1. Consent ditandatangani.
2. Inform Scope Room.
3. Berpuasa 6 jam sebelum prosedur.
4. Gigi palsu ditanggalkan.
5. Barang kemas/duit/telefon tidak dibawa ke Scope Room.
6. Ubat rutin diambil kecuali ubat kencing manis.
7. Pesakit dihantar dengan katil.
8. Pesakit dipasang IV line.
ERCP (Endoscopic Retrograde Cholangio-Pancreatography)
Checklist Persediaan Di Dalam Wad Untuk Prosedur ERCP:
1. Consent ditandatangani.
2. Inform Scope Room.
3. Berpuasa 6 jam sebelum prosedur.
4. Gigi palsu ditanggalkan.
5. Barang kemas/duit/telefon tidak dibawa ke Scope Room.
6. Pesakit dihantar dengan katil.
7. Pesakit memakai seluar panjang.
8. Baju dalam ditanggalkan bagi pesakit wanita.
9. Pesakit dipasang IV line.
10. Ubat rutin diambil kecuali ubat kencing manis.
11. Premeds IV Flagyl 500mg diberi 1/2 jam sebelum hantar ke Scope Room.
12. IV Cefobid 1gm dibawa bersama ke Scope Room.
Checklist Persediaan Di Dalam Wad Untuk Prosedur ERCP:
1. Consent ditandatangani.
2. Inform Scope Room.
3. Berpuasa 6 jam sebelum prosedur.
4. Gigi palsu ditanggalkan.
5. Barang kemas/duit/telefon tidak dibawa ke Scope Room.
6. Pesakit dihantar dengan katil.
7. Pesakit memakai seluar panjang.
8. Baju dalam ditanggalkan bagi pesakit wanita.
9. Pesakit dipasang IV line.
10. Ubat rutin diambil kecuali ubat kencing manis.
11. Premeds IV Flagyl 500mg diberi 1/2 jam sebelum hantar ke Scope Room.
12. IV Cefobid 1gm dibawa bersama ke Scope Room.
Troli Kecemasan / Emergency Trolley / Crash Cart
Senarai semak troli kecemasan :
A) Bahagian Atas :
1. Mesin defibrillator -1
2. Lampu Suluh -1
3. Gel ECG -1
4. Steteskop -1
5. Ambu Bag - 2 (with 2 mask size medium)
6. Laryngoscope Handle -1
7. Larynoscope Curved Blade - 4
8. Larynoscope Straight Blade - 0
9. IN Stopper - 5
10. Simple Airway - 2 size 3, 2 size 4
11. Margill Forcep -1
12. Tongue Depressor (metal) - 1
13. Lignocaine Gel - 1
14. Cloth Tape - 1
15. Battery C - 2
16. 3 way connector biru - 5
B) Bahagian Tepi :
1. Tong Oksigen - 1
2. Branula 14G - 5
3. Branula 16G - 5
4. Branula 18G - 5
5. Branula 20G - 5
6. Branula 22G - 5
7. Needle 19G - 10
8. Needle 21G - 10
9. Needle 23G - 10
10. Syringe 1cc - 5
11. Syringe 5cc - 10
12. Syringe 10cc - 10
13. Syringe 20cc - 10
14. Syringe 50cc - 5
15. Sharp Bin -1
C) Laci Pertama (ubatan) :
1. Inj. Adrenaline 1mg/ml - 10
2. Inj. Atropine 1mg/ml - 10
3. Inj. Calcium gluconate 10% 10ml - 1
4. Inj. Chlorpheniramine 10mg/ml - 2
5. Inj. Dextrose 50% - 2
6. Inj. Hydrocortisone 100mg - 2
7. Inj. Naloxone 0.4mg/ml - 5
8. Inj. Amiodarone 150mg/3mg -3
9. Inj. Sodium Bicarbonate 8.4%/50ml - 2
10. Inj. Frusemide 20mg/2ml - 2
11. Inj. Magnesium Sulphate 2.47g/5ml - 1
12. Inj. Water For Injection - 10
13. Inj. Lignocaine 2% - 1
14. Inj Noradrenaline 4mg/4ml - 2
15. Inj Adenosine 6mg/2ml - 2
* Jangan letak Inj. Potassium Chloride 10mg/ml dalam troli kecemasan, risiko Cardiac Arrest kalau tersalah bagi.
D) Laci Kedua :
1. ECG leads
2. Alcohol Swab - 1 box
3. Sticker
4. Apron - 5
5. Gauze -10
E) Laci Ketiga :
1. Endotracheal tube size 7.0 - 3
2. Endotracheal tube size 7.5 - 3
3. Endotracheal tube size 8.0 - 3
4. Suction Yankeur size adult - 2
5. Suction Yankeur size child - 2
6. Suction Cathetar size 14fr - 5
7. Suction Cathetar size 16fr - 5
8. IVD tubing set - 5 set
9. Ryle's Tube size 14fr - 2
10. Introducer (stylet) size medium -1
11. Introducer (stylet) size large - 1
12. Nasal Prong - 2
13. Ventrimask - 2
14. High Flow Mask -2
15. Oxygen Tubing - 2
F) Laci Keempat :
1. Normal Saline 0.9% 500ml - 3
2. Dextrose 5% 500ml - 1
3. Hartman's 500ml - 2
4. Gelafundin 500ml - 2
5. Water For Irrigation 500ml - 2
6. Extension Plug - 1
7. Disposible Glove - 1 box
8. Face Mask 3 ply - 1 box
Senarai semak troli kecemasan :
A) Bahagian Atas :
1. Mesin defibrillator -1
2. Lampu Suluh -1
3. Gel ECG -1
4. Steteskop -1
5. Ambu Bag - 2 (with 2 mask size medium)
6. Laryngoscope Handle -1
7. Larynoscope Curved Blade - 4
8. Larynoscope Straight Blade - 0
9. IN Stopper - 5
10. Simple Airway - 2 size 3, 2 size 4
11. Margill Forcep -1
12. Tongue Depressor (metal) - 1
13. Lignocaine Gel - 1
14. Cloth Tape - 1
15. Battery C - 2
16. 3 way connector biru - 5
B) Bahagian Tepi :
1. Tong Oksigen - 1
2. Branula 14G - 5
3. Branula 16G - 5
4. Branula 18G - 5
5. Branula 20G - 5
6. Branula 22G - 5
7. Needle 19G - 10
8. Needle 21G - 10
9. Needle 23G - 10
10. Syringe 1cc - 5
11. Syringe 5cc - 10
12. Syringe 10cc - 10
13. Syringe 20cc - 10
14. Syringe 50cc - 5
15. Sharp Bin -1
C) Laci Pertama (ubatan) :
1. Inj. Adrenaline 1mg/ml - 10
2. Inj. Atropine 1mg/ml - 10
3. Inj. Calcium gluconate 10% 10ml - 1
4. Inj. Chlorpheniramine 10mg/ml - 2
5. Inj. Dextrose 50% - 2
6. Inj. Hydrocortisone 100mg - 2
7. Inj. Naloxone 0.4mg/ml - 5
8. Inj. Amiodarone 150mg/3mg -3
9. Inj. Sodium Bicarbonate 8.4%/50ml - 2
10. Inj. Frusemide 20mg/2ml - 2
11. Inj. Magnesium Sulphate 2.47g/5ml - 1
12. Inj. Water For Injection - 10
13. Inj. Lignocaine 2% - 1
14. Inj Noradrenaline 4mg/4ml - 2
15. Inj Adenosine 6mg/2ml - 2
* Jangan letak Inj. Potassium Chloride 10mg/ml dalam troli kecemasan, risiko Cardiac Arrest kalau tersalah bagi.
D) Laci Kedua :
1. ECG leads
2. Alcohol Swab - 1 box
3. Sticker
4. Apron - 5
5. Gauze -10
E) Laci Ketiga :
1. Endotracheal tube size 7.0 - 3
2. Endotracheal tube size 7.5 - 3
3. Endotracheal tube size 8.0 - 3
4. Suction Yankeur size adult - 2
5. Suction Yankeur size child - 2
6. Suction Cathetar size 14fr - 5
7. Suction Cathetar size 16fr - 5
8. IVD tubing set - 5 set
9. Ryle's Tube size 14fr - 2
10. Introducer (stylet) size medium -1
11. Introducer (stylet) size large - 1
12. Nasal Prong - 2
13. Ventrimask - 2
14. High Flow Mask -2
15. Oxygen Tubing - 2
F) Laci Keempat :
1. Normal Saline 0.9% 500ml - 3
2. Dextrose 5% 500ml - 1
3. Hartman's 500ml - 2
4. Gelafundin 500ml - 2
5. Water For Irrigation 500ml - 2
6. Extension Plug - 1
7. Disposible Glove - 1 box
8. Face Mask 3 ply - 1 box
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