MISCELLANEOUS Flashcards
(30 cards)
BPSD
PHARMACOLOGICAL MANAGEMENT
HALOPERIDOL 0.25-0.5 MG PO/IM (CONTRAINDICATED IN LBD)
LORAZEPAM 0.5 MG PO
MIDAZOLAM 1-2 MG IM
DELIRIUM TREMENS
CLINICAL MANIFESTATIONS
AUTONOMIC INSTABILITY AGITATION CONFUSION TREMOR PARANOID IDEATION ACCENTUATED RESPONSE TO EXTERNAL STIMULI HALLUCINATIONS
WERNICKE’S ENCEPHALOPATHY
TRIAD
CONFUSION
OPHTHALMOPLEGIA
ATAXIA
WERNICKE’S ENCEPHALOPATHY
TREATMENT
THIAMINE 100 MG IVI TDS FOR 5/7
DELIRIUM
DEFINITION
DISTURBANCE OF COGNITION CHARACTERISED BY ACUTE/SUBACUTE ONSET, FLUCTUATING LEVEL OF CONSCIOUSNESS, INATTENTION AND/OR DISTRACTIBILITY AND IMPAIRED LEVELS OF ALERTNESS
DELIRIUM
INITIAL INVESTIGATIONS
SEPTIC SCREEN - UA, MSU, CXR, BLOOD CULTURES
BLOOD TESTS - FBE, UEC, LFTS, CMP, CRP, BSL, TROPONIN
ECG
BLADDER SCAN
CTB IF RECENT FALL/HEAD INJURY OR ? STROKE
? ABG
? PR/AXR
ELDERLY PATIENT WITH DELIRIUM
PHARMACOLOGICAL AGENTS
HALOPERIDOL 0.25-0.5 MG PO/IM
RISPERIDONE 0.25-0.5 MG PO
OLANZAPINE 2.5 MG PO
FLUIDS
FLUID COMPARTMENTS
TBW = 60% × BODY WEIGHT TBW = ECF (1/3) + ICF (2/3) ECF = INTRAVASCULAR FLUID (25%) + INTERSTITIAL FLUID (75%)
FLUIDS
NORMAL DAILY WATER REQUIREMENTS
0-10 KG - 4 ML/KG/HR
10-20 KG - 40 ML/HR + 2 ML/KG/HR FOR EACH KG > 10 KG
> 20 KG - 60 ML/KG/HR FOR EACH KG > 20 KG
FLUIDS
NORMAL DAILY K REQUIREMENTS
1 MMOL/KG/DAY
HYPERKALAEMIA
ECG FEATURES
- PEAKED T WAVES
- DEPRESSED ST SEGMENTS
- PROLONGED PR INTERVALS
- WIDE QRS SEGMENTS (INTRA-VENTRICULAR BLOCK)
- VF
HYPERKALAEMIA
TREATMENTS
50% CA GLUCONATE IV OVER 5 MINS 10% GLUCOSE 25 ML IV +/− ACTRAPID 10 U 8.4% BICARBONATE 50-100 ML IV VENTOLIN 5 MG NEB (LASTS 0.5 HR) RESONIUM 15-60 G Q4/24 PRN PO/PR (TAKES 1 HR TO WORK) DIURETICS +/− IVF IV DIALYSIS
CT DRAINAGE
FASTING GUIDELINES
NBM 6 HRS PRIOR TO PROCEDURE
CT ABDO/SPINE/PELVIS/BRAIN
FASTING GUIDELINES
NBM 4 HRS PRIOR TO PROCEDURE
MILD/MODERATE ALCOHOL WITHDRAWAL E.G. > 6 STANDARD DRINKS/DAY
MANAGEMENT
AWS Q4H
DIAZEPAM PRN PO Q2H 10 MG FOR AWS SCORE OF 4-5, OR 20 MG FOR AWS SCORE OF > 5 (MAX 80 MG/24 HRS)
THIAMINE 100 MG TDS
SEVERE ALCOHOL WITHDRAWAL E.G. PREVIOUS WITHDRAWAL SEIZURES OR DELIRIUM TREMENS, > 15 STANDARD DRINKS/DAY
MANAGEMENT
AWS Q2H UNTIL AWS SCORE STABLE AND < 4, THEN Q4H
DIAZEPAM STAT PO 10 MG FOR AWS SCORE OF 4-5, OR 20 MG FOR AWS SCORE OF > 5 (CONTINUE EVERY 1-2 HRS UNTIL AWS SCORE < 4)
THIAMINE 300 MG IVI
DIAZEPAM
CONTRAINDICATIONS
LIVER FAILURE
RESPIRATORY FAILURE
ALCOHOL WITHDRAWAL
APPROACH TO TAPERING DIAZEPAM
DIVIDE AMOUNT OF DIAZEPAM GIVEN IN LAST 24 HRS INTO REGULAR TDS OR QID DOSES, THEN REDUCE BY 10 MG OR 25%/DAY
ALCOHOL WITHDRAWAL SEIZURE
MANAGEMENT POST-SEIZURE
DIAZEPAM 20 MG STAT, FOLLOWED BY ANOTHER DOSE 2 HRS LATER
AWS Q2H
POSTURAL HYPOTENSION
CLINICAL FEATURES
> 20 MMHG FALL IN SBP
10 MMHG FALL IN DBP
SYMPTOMS OF CEREBRAL HYPOPERFUSION
CT BRAIN
INDICATIONS
FALL WITH HEAD INJURY
HISTORY OF FALL, BUT UNCLEAR IF HEAD INJURY, AND ON ANTICOAGULANTS
NEW FOCAL NEUROLOGY
REDUCED LEVEL OF CONSCIOUSNESS OR GCS SCORE OF < 9
DROP IN GCS SCORE OF > 2 FROM BASELINE
DELIRIUM AND > 65 YRS OF AGE
PERSON RESPONSIBLE
HIERARCHY
- APPOINTED GUARDIAN
- SPOUSE
- CARER
- FRIEND/RELATIVE
- HEALTH PROFESSIONAL
OPIOID DOSING
SC MORPHINE:PO MORPHINE
2:1
OPIOID DOSING
SC HYDROMORPHONE:PO HYDROMORPHONE
2:1
