atsp (asked to see patient) booklet

7292019 ATSP (asked to see patient) Booklet

httpslidepdfcomreaderfullatsp-asked-to-see-patient-booklet 124

ATSP Re

Dr Frances Bennett

Dr Gillian Jackson





Page 2 Introduction

Page 3 ABDOMINAL PAIN

Page 4 AGITATIONCONFUSION

Page 5 BLOOD IN CATHETER BAG - Example o documentation

Page 6 DECREASED GCS

Page 7 DYING PATIENT

Page 8 FALLSCOLLAPSE

Page 9 FLUID REVIEW amp INSULIN SLIDING SCALE

0 HAEMATEMESISCOFFEE GROUND VOMITMALAENA

Page 11 HIGH EWS (General Assessment)

Page 12 HYPERKALAEMIA (stable patient)

Page 13 LOW URINE OUTPUT (catheterised patient)

Page 14 SHORTNESS OF BREATH

Page 15 TACHYCARDIAPALPITATIONS

Page 16 COMMONLY PRESCRIBED DRUGS

Page 18 PRESCRIBING OUT OF HOURS

Page 20 General Hints and Tips or seeing patients out o hours

1

Contents



Introduction

Dear all new FY1s

We know how daunting starting lie as a newly qualied junior doctor can be particularly

i you start your rst shit on-call or working nights During our oundation experience in

medicine we ound that medical school had prepared us well or emergency situations

with numerous courses like ILS AIMS and similar with the main emphasis being on ABCDE

and managing acute presentations

When you are asked to see patients on hospital wards this sort o training only gets you

so ar itrsquos a great structure to start with but oten the presentations are not that acute anda basic ABCDE assessment just isnrsquot enough

The aim o this teaching material is NOT TO TEACH you medicine you already know It

is there as a guide and prompt to help you out in situations you havenrsquot covered as a

student and to make sure you are a sae practitioner The material has already been trialled

in Pennine Acute Trust with positive and constructive eedback rom both experienced

clinicians and junior doctors so we think we have most eventualities covered

The individual case scenarios have been presented to you in a lay out which should help

with your documentation as well as assessment and management plan or the patient Thepresentation on blood in the catheter bag is set out as an example o good documentation

whereas the other examples are shortened versions with emphasis on the most important

aspects o each presenting complaint Make sure you donrsquot just read them mindlessly

you still always need to think about your course o action regarding ABCDE initially You

should also be able to come up with diferentials and take an appropriate history or most

scenarios which is why we have not included detailed prompts or this We have ocussed

on the areas which ourselves and our colleagues struggled with initially

Whenever you have an encounter with a patient it really is important that you document

what you have done in a systematic way This is to rstly protect yoursel rom a legalperspective should any harm come to the patient and secondly to help your colleagues

who are in charge o their care You will understand this soon enough or yoursel

We hope you nd this booklet useul and that it provides you with the majority o

inormation yoursquoll need when you are ATSPrsquod

I you have any urther eedback or us on the material or anything you would like to add

please eel ree to contact us with your suggestions

Gillian and Fran

A note rom the authors



Initial Assessment

Examination

History

Investigations

Plan Hint

Medication Review

ATSP Re ABDOMINAL PAIN

A V P U

ABCDE

Is this patient acutely unwell

Are they post-op

ABDO EXAM

PR EXAM i appropriate (ie i there is history o haematemesismeleana i you suspect obstruction

or i you think the patient may be aecally loaded)

VASCULAR EXAM ndash eel the pulses

1 SOCRATES - CHECK BOWELS

Associated symptoms should include

urinary and gynae

3 PMHx including

bullalcoholconsumption

bullconstipationdiarrhoea

bullPreviousabdopelvicsurgery

bullBPH

REASON FOR ADMISSIONand most recent proceduresoperations

Consider

bullBloods-FBCUampEincCa2+LFTamylase

coag X-match i signs o bleed

bullAXRerectCXR

bullECG

bullDipstickurineMSUorCSU

bullStoolsample(Cdiffifonabx)

Discuss need or abdo USS with senior

Depends on working diagnosisimpression

bull KeepNBMuntildiagnosismade

bull IVaccess+-FLUIDS

bull Analgesiabull MonitorBPampurineOPCatheterise

bull ConsiderNGTifvomiting

bull Keepdetailsandcheckonthemlater

Most in-hospital abdo pain is not anemergency and this plan will be a bitexcessive or the majority o casesConstipation andor pre-existing chronic

pathology is the leading cause o abdo painin this group o patients unless they arepost-op Symptomatic treatment is mostoten suicient

Unless this is an ACUTE situation youshould ocus on symptom control whenout o hoursConsider holding bullNSAIDSifsuspectgastritisGORbullOPIATESifconstipatedConsider startingbullOMEPRAzOLEPRNGAVISCONbullAnalgesiandashPainladder(notNSAIDS)

Try BUSCOPAN(seeBNF)foranycramp

like colicky sounding painbullLaxativesorenemaifconstipatedOnly use an enema i patient is aecally loadedbullAntibioticsifsuspectUTI-checkprevious

MSUs

Foranon-acutesituationthinkaboutcommon

causes or in-hospital abdominal painbullConstipation - remember this may present as

overlow incontinence

bullUrinary retention

bullPre-existing pathology eg partial obstruction

CholecystitisPancreatitisGastritis(ulcerGORD

inective causes)

bullUTI (catheterised)

bullInection eg Cdi

If ACUTE ABDO ie perforation or bleedbull BP+feelthepulsebull IVAccessampbloodsbull ErectCXR+AXRbull SeniorHELP



Initial Assessment

Examination

History

Investigations

Plan

Medication Review

4

Is patient in PAINFluid balanceTEMPAMTGCSSEPTICLRTIUTI

ABCDE

BM

bullChestandAbdoExam

bullNEUROLOGICAL EXAM - Likely to be limited

bullExposureforsource o sepsis including venous access catheters woundssores

bullSignsofhead trauma especially i patient has allen

bullSmellyUrine

Isthispersonnormallylikethis

Anyhistoryofdementia

HowWhenhavetheychanged

Any precipitants eg medsalcohol

withdrawal

Consider (according to clinical picture)

bullBloodsFBCUampEsincCa2+LFTs

bullDipstick MSU- check previous ones

too

bullCultures (i temperature has spiked)

bullCXR

bullABG i patient unwell

bullCT head (senior decision)

Only use sedation i you think the patient is putting

themselves or others at risk of harm NOT if they are just

being disruptive

DO NOT SEDATE PATIENTS WHO HAVE FALLEN AND MAY

HAVE SUFFERED A HEAD INJURY

bullRegular(2-4hrly)nursingobsinwelllitroom

bullTreatsuspectedcause+-analgesiaifnecessary

bullRegular ward staf must review bloods try and elicit

cause or change in moodAMT

bullOnceserious cause exluded bullForsleeplessness - Zopiclone 375-75mg PO

bullForagitation - Diazepam 5mg PO

- Haloperidol check BNF for indications and doses

Notorious drugs that cause conusion

bullOPIATES especially TRAMADOL

bullBENZODIAZEPINES

bullGELOFUSINE

bullINSULIN (too much)

THINK ABOUTRISKFACTORS or

- Sepsis - Lungs skin UTI recent surgery

- Hypoxia - PE pneumonia respiratory depression

- Pain (including constipation urinary retention)

- CVATIA

- Hypoglycaemia

Treat the reversible causesbeoreprescribing any sedatives

Reducing Regimen o

CHLORDIAZEPOXIDE or

ALCOHOL WITHDRAWAL

Day 1 and 2 20-30mgQDS

Day 3 and 4 15mgQDS

Day 5 10mgQDS

Day 6 10mgBDDay 7 10mgNocte

ATSP Re AGITATIONCONFUSION



Examination

History

Investigations Medication Review

Investigations History

Name o DrMelanieCrowtherFY1Bleep1234

A V P U

Speaking ull sentences

RR 17

Sats 98 on air

Description

Chest clearGoodbilatAE

JVP Not raised

CRTlt2secs

Mucus membranesMoist well hydrated

+0HS

CalvesSot and non tenderNo oedema

Further relevant examinations

Inspection of catheter sitebull Noevidenceoftrauma

Appearance of urinebull 520mlinbagbull Bloodstainedbuttranslucentbull Noclots

BS normal Sot and non-tenderNo organomegalyNo ascites

Bladder not palpable

A

B

C

D

E

Patient Details NAME DOB Hosp No

EXAMPLE OF DOCUMENTATION

ATSP Re BLOOD IN CATHETER BAG

HR 86 reg

BP-lying13972

-standing13274

Fluidbalance

IN 1500ml12hr

OUT 1200ml12hr

Temp372

AMT1010

BM NA

Agitationmood no change

Any relevant PMHx eg TURP No

Past Hx o same thing None previously

When was catheter put in Catheter inserted

37 ago

Any record o diculties Doctor was called

to perorm as several nurses struggled to pass

tube

Why was pt catheterised Urinary retentionAny immediate distress or raised EWS No

I III

ABDOEXAM

prev now prev now

Hb 111 Na 138

WC 89 K 42

Plt 435 Cr 198

MCV 89 Ur 98

INR 11 CRP 57

Consider holding

Clexane and PO anticoags

MUST CHECK WITH SENIOR FIRST

Patients may be on anticoagulants

eg or AVR

1) Ensure IV access2) SendbloodsFBCUampECROSS MATCHCLOTTING3) Regularobs(2-4hourly)4) Strictuidbalancerecording (maintainurineopgt30mlshr)

5) Change catheter bag (to re-measurewith time)

6) Dipstick urine and send or CSU

SIGNED M Crowther GMC 7895432

Bloods

PlanMedication Review



Initial Assessment

Examination

History

Investigations

Plan

Medication Review

ATSP Re DECREASED GCS

ABCDE AIRWAY amp OXYGENGCSPUPILSBM

ChestandAbdoExam(Quickfullassessment)

NEUROLOGICAL EXAM

bullReexesincplantars

bullPUPILS

COLLAPSESEIZURE - TRAUMA

DRUG TOXICITY

HYPOGLYCAEMIA

Look at medical notes yoursel

Commonly hypoglycaemia or opiate toxicity

but must rule out any serious acute events

Think about RISK FACTORS or

bullSepsis

bullStrokeorMI

bullLowBM

bullDrugtoxicity(opiatessedatives)

bull RenalFailure


bullBloods

bullDipstickUrine

bullCXR

bullECG

bullABG

Treatsuspectedcause+-analgesiaifnecessary

bullOpiate ODNaloxonerdquoNarcanrdquo400mcgIVandrepeatuntilresponsive

In opioid toxicity reversal with naloxone produces instantaneous results once it has reached therapeutic levels

Remember it is very short acting and the patient may require a naloxone IVI depending on the amount and

natureoftheopiateODRefertotheBNForlocaltrustpolicyforthisanddiscusswithaseniorrst

bullLow blood sugars get senior helpifcausingsignicantlyreducedGCSNeedtoconsider10-25dextrose

IVIsIfGCS14+givelucoadeandcheckBMin30minsNursesshouldalreadyhavegivensomethingcalled

HYPOSTOP i patient is known diabetic beore calling you as it does not require a prescription

bullBenzodiazepinesunlikelywithin-hospitalpatientsbutthereversingagentisFLUMAzENILYoushould

never be using this on your own and most wards do not stock it anyway

Regular(2-4hrly)nursingobsinwelllitroom

IfyouareinANYDOUBTorsuspectanacuteeventhasoccurredyouMUSTseekSENIORHELP

IMMEDIATELY

Notorious drugs that cause sedation

bull OPIATES (OD)

bull BENZODIAZEPINES

6



History

Initial Assessment and Examination

Ater Death

Medications or symptom control

ATSP Re DYING PATIENT

A V P U

A - isthisobstructedArethereexcesssecretions

B - isrespirationregularoragonal

C - ispatienttachycardicThis may be only sign o painD - isthepatientagitatedoruncomfortable

- ispatientvomitingorconausea

- isthepatienthavingseiures

E - isthepatientitchy

Arethefamilyawareofthesituation

Whataretheirinstructionsaboutbeingcontactedifpatientdeteriorateseginmiddleofthenight

HaspatientbeenassignedtoLCPanddocumentationallinorder

Go and see the body

Document Your name and bleep numberbull ldquoCalledtoconrmdeathNovitalsignsrdquoStatetime o death

bull Fixedanddilatedpupils

bull Norespiratoryeortfor3minutes

bull Nopulseorheartsounds

bull DOCUMENT WHETHER OR NOT PATIENT IS FITTED WITH PACEMAKER RADIOACTIVE IMPLANT

bull YoudoNOTneedtoputacauseofdeathifyoudonrsquotknowthepatientunlessalreadyclearly

documented in notesbull YouDONOTneedtowriteadeathcerticate

bull WhetherornotNoKinformed

bull RIP

bull Painbreathlessness MorphineNB DIAMORPHINE is commonly stated as drug o choice in prescribing guidancebut oten hospitals donrsquot stock it I this is the case you can still use this inormation butensure you MULTIPLY the dose o diamorphine by 15 or a morphine equivalent (EgStateddoseDiamorphine10mgSC24hrsthenmorphineequivalentwouldbe15mgSC24hrs)

bull NauseavomitingLevomepromaine

bull Secretions Glycopyroniumbull RestlessnessagitationMidaolam

bull Itchiness Chlorpheniramine(Piriton)

See ldquoICP or the Care o the Dying Prescribing Guidance V 40rdquo or your trust equivalent or detailsRemember Some patients at the end o lie do not require heavy sedation or maximum pain relietailor your prescription according to your assessment and listen to the nurse caring or themWrite these meds up as PRN or via a syringe driver i itrsquos necessary (ie nurses constantlyadministering)Do NOT put patients on the Care o the Dying Pathway (ie withdraw lie-prolongingmedications)ndash this is a consultantrsquosMDT decision




History

Investigations

Plan

Medication Review

ATSP Re FALLSCOLLAPSE

ABCDE

GCS

BM

ForHead Trauma ensure you document

the ollowing

1 Mechanism o injury

2AnyLOCReducedGCSConfusion

3AnyvomitingorSeiuresymptoms

4HeadexaminationegBruising

LacerationBoggy swellings

Signsoftrauma

bullHeadandneck

bullHIPS

Neuroexam

Lying-StandingBP

RISK FACTORS or

bullMechanicalFalls

bullStroke

bullLowBM


bullArrhythmiasbullSeiure

bull Infection

bullAlwaystakeaFALLS HISTORY but remember

you are ocussing on making the patient SAFE

rather than diagnosing a cause or their all

Oten none are needed (always do a lying

and standing BP though)

Depend on history and exam ndingsConsider

bullECG

bullBloods

bullDipstick

bullCThead(senior must be inormed)

bullRegularnursing+-neuroobsifindicatedbullAddressunderlyingcauseifappropriate

Wounds Most can be glued or steristripped I concerned send patient to AampE

Consider withholding the ollowing

bull Antihypertensives

bull Sedatives until head trauma ruled out

bull Warfarin i patient is at risk o allsagain ie undetermined cause o alls

or unsteady on eetdementia Check

with senior rst patient may have articial

valve replacement

bull Inorm nursing staf o any changes



Assessment or repeat prescription

History

Sliding scale or IV insulin

High BM

1 The REASONfortheiruids(NBMslidingscaleunwellsepticunsafeswallow)

2FLUIDstatusndashcheckforoverloaddehydrationInput-Outputchart

3 CHECK UampEpayingattentiontoK+requirementsDonrsquotjustrewriteuidswithoutchecking

mostrecentUampEsIfnobloodsforgt48hrsandonregularuids repeat uampersquos beore represcribing

Write a blood card or next appropriate monitoring so it doesnrsquot get missed4ChecktheKARDEX or PO electrolyte supplements and diuretics I patient is receiving diuretic

anduidssimultaneouslythencontactseniorforadvice

Duringon-callyouwillnormallybeaskedtore-writetheslidingscaleontheuidchartBMsare

monitored every hour by nursing staf and inusion rate is altered accordingly

In the inusion pump

bull50mlsNsaline+50unitsACTRAPIDinsulin

bullKClmayalsobeaddeddependingonthepatientrsquoslevelsIflt3add20mmolif3-5add10mmol

BloodGlucoseLevelmmolL Standardscale Augmentedscale

Units o insulinhour Units o insulinhour

lt4 0 0 4-7 1 2

71-11 2 4

111-17 4 8

171-22 6 12

gt22 8 16

Stopinfusionfor30minutesthencheckBMagainRestartslidingscaleatslowerrateof05mmolhour

Stopping the insulin inusion completely can be especially dangerous in patients with type 1 diabetes

A high BM is oten nothing to worry about during an oncall shit It is usually because the patientrsquosnormal blood sugar control regime has been disrupted due to acute illness changes to routine or acombinationMake sure you1 Check BM charts or previous readings and whether this is new or them or not2 Check urine or ketones3 Do ABG i patient looks unwell I this is the case they are likely to have a high EWS so manage

appropriately4 Document your ndings and action taken (if any)

Ifpatientisnotonaslidingscaleyoucanprescribe10unitsactrapid(evenifNIDDM)tobringtheBMdown but donrsquot start messing around with their normal blood glucose control it is not an emergencysituationandcanbedealtwithduringwardhoursbyspecialiedteamswhohavealotofexperienceinthese cases

Ensurepatientisnotuidrestrictedforanyreasonieheartfailureoedemaandascites

ATSP or FLUID REVIEW



Initial Assessment

Examination

History

Investigations

Plan

Medication Review

ATSP Re HAEMATEMESISCOFFEE GROUND VOMITMALAENA

A V P U

ABCDE

Chest Exam

ABDO EXAM

bullAnysignsofperforationTender

bullPR EXAM ndashALWAYScheckforevidenceYOURSELFevenHaematemesisCGV

IV Access and bloods

Work out EWSBP lying and standing

IfpthashadsignicantupperGIbleed

1 A signicant posturaldrop(gt20mmHg)in BP is oten the rst sign2Theureawillusuallybecomeproportionally higher than creatinineoten with little other evidence o renalailure

bullRememberHbwonrsquotdropimmediately afteraGIbleed-thereforenormalHbisnt

reassuring

RISK FACTORS or GI BleedbullGastricirritantmedications

(NSAIDS)bullAlcoholALDbullLackofgastro-protective

medicationbullUlcersbull ReuxGORDbull Persistentvomitingbull Endoscopystentingproceduresbull Postabdosurgery

Mandatory bullBloods-FBCUampEincludingCa2+ LFTINRandclottingX-match send as URGENTConsider bullAXRerectCXR bullUrgentendoscopyifHbhastaken

massive drop rom previous or is verylow ie lt7 Seniors denitely need tobe inormed beore considering this

WITHOLD

bullAny anti-coagulants

bullNSAIDS

CONSIDER

bullAntiemetic

bullPPI(lansopraoleisindicatedfor

patients on aspirin and clopidogrel

omepraoleifnot)

bull KeepNBMuntilwardteamassessmentuntilyouaresatisedthepatientisstablebull IVaccess+-FLUIDSbull Regularnursingobs-recheckonehourlaterand2hourlythereafterbull FluidbalanceMonitorurineOPandmaintaintogt30mlhrbull Keepdetailsandcheckonthemlater

NB Patients are not normally transused blood products over night unless it is an emergency IVuidswillpreventhypovolaemiaanditsconsequencesIfyouthinkyourpatientlooksabitdryoris slightly tachycardic etc then stay on the sae side and run through some saline (unless otherwisecontraindicated)

ue Haematemesis or Malaena is a medical emergency and will oten be accompanied with a high EWSeat accordingly i this is the case In-hospital patients oten suer simple coee ground vomits without

any systemic disruption but must still be considered as a potenital emergency



Medication Review

Initial Assessment Examination Possible CAUSES to consider

Investigations-depend on scoring parameters

Medication Review

Plan

History - ALWAYS look in the notes

Impression

ATSP Re HIGH EWS (General Assessment)NB always ask nurses or VALUES OF PARAMETERS and what they are COMPARED TO NORMAL

TrustguidelinesindicateforFY1sEWS3ndashAssessmanageandreassessactionsafter30minutes

EWSgt5ndashSeniormustbeinformedafterinitialassessmentndashattheveryleastjusttomakesuretheyareaware

RR

Sats

HR

BP

Fluid balance

Temp

AMT

BM

Agitationmood

GCS

CHEST-THOROUGH

clinical respiratory exam

is vital to guide urther

management

HS

JVP

Calves

Mucus membranes

CRT

bull PEbull HA Pneumoniabull Failure ndash heart lungsbull MI

bull Decompensated heart ailure

bull Acutedecompensated Renal failure

bull Dehydrationbull Sepsis or inection

bull Perorationbull AAA

bull Peritonitisbull DVT (look for one- a DVT wonrsquot cause high

EWS on its own)bull Source of sepsis (lines cellulitis catheter etc)

A

B

C

D

E

Considerbull CXRbull ABGbull Routinebloods+-CULTURESforsepticscreen

i temp spiked

bull X-matchifsuspectpatientisbleedingbull ECGbull UrineDipstick

ReviewKardexforanyIATROGENIC causes o above eg NSAIDSwararin bleedIsthepatientoversedatedSYMPTOM controlbull Isthepatientinpain- analgesiabull Isthepatientvomiting- antiemetic (IVIM)

bull IsthepatientdehydratedndashIV luidsbull IsthepatientsepticndashWhatisthesource

- Antibiotics (see trust guidance)Should the patient have been on

prophylacticLMWH-PE

Has the patient suered an acute

event

Has anything CHANGED and HOW

WHYhasthishappened

A high EWS can oten resolve with SYMPTOM control Eg bring the BP up and tachyhigh RR mayresolve1 Regular nursing obs2 Treatsuspectedcause3 Strictfluidbalance+-catheterisationifpatientisunwellenough4 Analgesiaandgeneralsymptomcontrol5 Reviewyourtreatmentaction-hasithadaneffectSenior review i worried

SEPTIC SCREEN

bull CXRbull UrineDipstick bull Cultures Blood Urine (MSU) Sputum

Stoolbull Swabs rom likely sources eg wound bedsore throat eye cannula catheterdrain site



Initial Assessment

Investigations

Plan

Medication Review

Examination

History

ATSP Re HYPERKALAEMIA (stable patient)

A V P U

ABCDE ECG

CHEST and CVS

Hydration

Unwellorstable

Fluidbalance

- Is this acute

- Is it a chronic accumulation

- Does the patient have CRF

- CARDIAC history

- LOOK at FLUID Px charts

- Is patient diabetic

- Symptoms eg palpitationsdizziness

bull ECG

bull ABG - helpul i you suspect a spurious

result

bull BloodsndashRepeatsampleifunsureof

accuracy o hyperkalaemia eg haemolysis

Hyperkalaemia treatment

bull Iflt7andWITHOUTECGchanges

Insulin and dextrose IVI- reer to local trust policy or exact instructions I unable to ind then

10unitsactrapidin50mlof50dextroseover10mins

bull Ifgt65WITHECGchanges

Salbutamol 5mg neb

Insulin and dextroseIVIthenINFORMASENIORaspatientmaywellneed

Calcium gluconate10mlof10IVover5minforcardiacprotectionEnsurepatientison

cardiac monitoring Calcium resonium PO15mgQDSCausesconstipationsowriteupalaxativePRN

Hold medications as appropriate (see above)

REPEAT BLOODS post treatment

bull Diuretics-K+sparingorlosingbull ACEA2RBinbitorsegramipril

losartan

bull NSAIDS

bull IVFluids

bull PotassiumsupplementsIVPO

bull Nutritionaldrinks

ECG

ECGchangesinhyperkalaemia

bullArrythmias

bullProlongedPRintervalwithflattened

Pwaves

bullWideQRSwithslurrySTsegment

bullTalltentedTTraves

I patient is symptomaticunstable this is a medical EMERGENCY and needs a senior doctor involved



Initial Assessment

Assessment o uid balance

Examination

Investigations

History

Plan

ATSP Re LOW URINE OUTPUT (catheterised patient)

ABCDE

CATHETER- IS IT BLOCKED

1Checktheuidchartandworkouttotalinputandoutput(usuallyover24hrsbutpatientis commonly post-op so calculate rom the time since they returned rom theatre i this is the case)2Remembertheurineoutputshouldbe05mlkghrDonrsquot orget to account or parenteral eeds stoma output and insensible losses

Fluid balance over 4 hours eg post opInput 500ml Output Urine 100ml Insensiblelosses 200ml Stoma 500mlTOTAL 500ml TOTAL 800ml

FLUID BALANCE=-300mliepatientisDRY

CHEST-isthepatientuidoverloadedABDO EXAM bullTenderUrinaryretentionNotepost-opileuscancauseurinaryretention bullStomasitendashisitinfectedLook or acute serious pathologies and try to correct these

bullAlwaysremembertolookatthenotes This problem is commonly seen in post op

surgical patientsbullCheckwhichoperationtheyrsquovehad and any important details on the op notes

beore you speak to senior docbullEnsurethatthepatientisnotuid restrictedegCCFascites

Consider

bullBloods-FBCandUampEstomonitorrenalfunction bullAXR bullDipstickurineMSUorCSU bullStoolsample(Cdiifonabx) bullSepticscreenDiscuss the need or imaging with senior i suspecting intra-abdominal sepsis

bullOftenallthatrsquosneededisauid challenge o 500ml saline particularly i the patient is dry (negative uidbalance)Getnursestorunitthroughstatandcheckopnomorethan1hrlaterIfpatientissimply

dehydrated their urine op should have picked up rom this CAUTION IN CCFCRF patients

bullCorrectunderlyingcauseoncediagnosedbullMonitorBPampurineOP(maintainurineopto05mgkghranddocumentthisinstruction)bullConsiderdiuretics(statdose40mgfurosemideIV) i you think the patient is uid overloaded (usually with positiveuidbalance)howeverusewithcautionandalwayscheckpreviousU+ErsquosConsultwithseniordoc

beore doing this you could easily exacerbate the problem

Think about RISK FACTORS orbullDehydrationLookforpotentialuidlosseseg

vomiting diarrhoea poor oral intake high stomaoutput

bullUrinaryobstructionegnatureofopco-morbiditiesbullInfectionSepsisbullDrugseganticholinergics

SEPTIC



Make a very quick decision as to whether or not you are confdent in treating this patient on your own

Patients who are short o breath can deteriorate very quickly indeed Call or a Senior immediately i you are unsure

Medication Review

Examination

History

Investigations- dependingon scoring parameters

Plan

Medication Review

ATSP Re SHORTNESS OF BREATH

A V P U

ABCDE

OXYGEN (highowinitially)ABG

THOROUGH exam is vital to guide management

Hydration assessment

- Onset

- Duration

- Exacerbating or relieving actors

- Check clerking proorma or

co-morbidities

bullABGndashimmediatelythenrepeatbullCXRCheckmostrecentoneDonrsquot

be araid to repeat CXR i things havechanged clinically Order a portable ilm

i you eel the patient is too unstable to betransported - discuss this with the nurses bullECGbullCulturesBloodandsputumif

appropriate andor check previous orsensitivities

bullRepeatbloods

bull Staywithpatientuntilyouarehappytheyarestable

bull Regularnursingobs(2hourly)

bull KeepawatchfuleyeontheirbloodsCXRetc

CALL FOR SENIOR HELP IF YOU ARE UNSURETHESE PATIENTS CAN DETERIORATE VERY QUICKLY INDEED

Patients with anxiety exacerbatingtheir respiratory disease are otengiven Oramorph by the nursingsta Be wary o this as you dontwant to be causing respiratorydepression in eg COPD patientsAsk a senior i unsure

Is patient on thromboprophylaxisWhat can I givebull ThinkaboutyourchoicesforOxygen

Therapy depending on patientrsquos chronic diseasestatusandABGresult

bullWheezeSalbutamol5mgneb+- atrovent500mcgneb(canbegivenwith O2)bullLRTICAPHAP Antibiotics (check

protocol)bullPulm OedemaFurosemide40mgIV

JVP and ankles

Calves Thighs

Anaphylaxis

Pneumothorax

Comparesatstonormalcomparewithchronicdiseasestatus

Cardiacorrespiratorycause

Ask about ASSOCIATED FEATURES and RISK

FACTORS or

DVTPE

Overload eg recent transusionluid therapy

MI

Infection(hospitalacquired)

Anxiety AsthmaCOPD exacerbation

Recent surgery (atelectasis)



Initial Assessment

Examination

History

Investigations - depending on scoring parameters and clinical judgement

Plan - very diferent or acutely unwell patients and those who are stable

Medication Review

ATSP Re TACHYCARDIAPALPITATIONS

A V P U

ABCDE ECG

TACHYARRYTHMIAS ARE A MEDICAL EMERGENCY If patient has developed a new tachyarrhythmia

on ECG (SVTFast AF) a senior needs to be involved Make sure you perform the following

Chest and Abdo Exam

Fluidbalance-ispatientdehydrated

Mandatory

bullECG

Consider

bullRoutinebloods+-CULTURESfor

septic screen i spiked temperature bullX-matchifsuspectpatientisbleeding

bullUrineDipstick

1IVaccess+-fluidsandbloods2Followtachycardiaalgorithmifappropriate-seniorshouldreallybeinvolvedinthis3Regularnursingobs(candotemponlyevery30minshalfhourifyouthinkhaveRFsforsepsis)4TreatsuspectedcauseoftenthisisactuallySYMPTOMCONTROLandyoumayfindthatsimple

stable tachycardias resolve once you have the ollowing under controlbull PAIN bull DEHYDRATION

bull AGITATION bull SEPSIS

bull ANXIETY bull VOMITING

IATROGENIC causes o tachycardiabull SALBUTAMOLoverusebull EYEDROPSegPHENYLEPHRINEbull THEOPHYLLINEtoxicitybull DIPYRIDAMOLE

MEDICAL MANAGEMENTbull Considerdigoxin 250mcg in

elderly patients or bisoprolol 25 mgunless otherwise contra indicated (low BP

Asthma) once cause has been identiied(senior discussion)

bullIsthepatientsymptomatic

bullCARDIAC HISTORY

bullPreviouscardiachistoryandRISKFACTORSfor

MIAFArrhythmias

bullPreviousECGs

bullFor arrhythmias IS THIS NEW Assume it is

unless proven otherwise

bullLookatKardexforanyanti-arrhythmic

medications or clues

bullHowmuchteaandcoffeehasthepatienthad

bullHas patient been on any drugs which put thematincreasedriskoftheaboveEgWarfarin

NSAIDs- bleed Should the patient have been onprophylacticLMWH-PE

Possible reasons or simple tachycardia

bull Painbull Anxietybull Sepsisbull Hypovolaemia ndash bleeddehydrationbull PEbull MIbull Medication side FX

EXPOSEor sources o sepsis

PULSEREGULARORIRREGULAR



You will oten get called to the wards to prescribe drugs or common in-patient complaints

Always eye-ball a patient beore doing so- the nurses may have the diagnosis wrong

DonrsquotforgettocheckforALLERGIESPMHandRENALFUNCTION(ifindicated)LookatKARDEXor any obvious interactions

Most drugs you will prescribe on-call should be written in the PRN or lsquoonce onlyrsquo section i you

do not know the patient

ANALGESIA MEDICATION ROUTE DOSAGE MAXDAY

PARACETAMOL POIV 500mgndash1g QDS

IBUPROFEN PO 200-400mg TDS

DICLOFENACrsquoVoltarolrsquo POIM 50mg TDS

PR 100mg TDS

CO-CODAMOL

(8500OR30500) PO 1-2TABLETS QDS

CO-DYDRAMOL(10500) PO 1-2TABLETS QDS

CODEINEPHOSPHATE POIM 30-60mg QDS

BUSCOPAN POIV 10-20mg QDS

QUININE PO 200mg ON

TRAMADOL PO 50-100mg QDS

MORPHINE IVPO 5-10mg STAT

NB Opiates can cause nauseavomiting and constipation Always Prescribe a PRN antiemetic and simple laxative

ANTI-EMETICS METOCLOPRAMIDErsquoMaxalonrsquo POIMIV 10mg TDS

(dopamineantagonist-worksdirectlyonGIT)

CYCLIZINE POIV 50mg TDS

(antihistaminendashworkscentrally)

PROCHLORPERAZINElsquoStemetilrsquoPO 10- 20mg TDS

lsquoBuccastemrsquo BUCCAL 3-6mg BD

(dopamineantagonist-workscentrallyonchemoreceptortriggerone)

DOMPERIDONE PO 10-20mg QDS

(actscentrallyonchemoreceptortriggerone)

ONDANSETRON POIMIV 8mg TDS

(5HT3 antagonist)

GASTIC REFLUX GAVISCON PO 5-10ml TDS

RANITIDINE PO 150mg BD

OMEPRAzOLE PO 20mg OD

COMMONLY PRESCRIBED DRUGS and doses

Caution NSAIDs in

asthmaPUCRF

Pts with

renal colic

respond

well to PR

dicloenac

Quinineisusedor night-timeleg crampscommon inhospital ptsMake sure youexamine frst- itmay be a DVT

Buscopan is an anti-

spasmodic and works

on smooth muscle

Greatforcramping

abdo pain

You can try most o these

in various combinations i

previous attempts to control

symptoms have ailed

Metoclopramideshould notbe used postGIsurgeryfor

3 days It canalso causesextra-pyramidalreactions andoculogyric

crises Bewareo this thoughthe antidoteis procyclidine5-10mgIVIM

Ondansetron is very

expensive Its otenreserved or chemo

patients donrsquot use it as

rst-line



SOB SALBUTAMOL NEB 5mg STATPRN

IPRATROPIUM BROMIDE (Atrovent) NEB 500mcg STATPRN

PREDNISOLONE PO 30-40mg STATOD

(3-5days max)

HYDROCORTISONE IV 200mg STAT(i acute SOB or angiodema)

FUROSEMIDE POIV 40-80mg STAT

ORAMORPH PO 5mg

LAXATIVES

Stimulants SODIUMDOCUSATE PO 50-200mg TDS

BISOCODYL PO 5-10mg BD

SENNA PO TT (15mg) BDTDSOsmotic MOVICOL PO 1-2sachets BDTDS

LACTULOSE PO 15ml BD

I aecal loading GLYCERINESUPPOSITORY PR T STATPRN

PHOSPHATE ENEMA PR T STATPRN

ITCHRASH CHLORPHENAMINE PO 4mg TDS

(alsoknownasldquoPiritonrdquo)

AGITATION DIAzEPAM POSLOWIV 5-10mg

SLEEPLESSNESS ZOPICLONE PO 375-75mg

AGGRESSION HALOPERIDOL CheckBNFforindicationsanddoses

ALCOHOL

WITHDRAWAL CHLORDIAzEPOXIDE(reducingregimen)

Day1and220-30mgQDS

Day3and415mgQDS

Day510mgQDS

Day610mgBD

Day710mgNocte

SIMPLE UTI TRIMETHOPRIM PO 200mg BD

NITROFURANTOIN PO 50mg QDS

CEPHALEXIN PO 500mg BD

FOR ALL OTHER INFECTIONS REFER TO YOUR LOCAL ANTIBIOTIC POLICY-YOUWILLSOONLEARNMOSTOFTHEMOFFBYHEART

Salbutamol causes

tachycardia

Use oramorph with caution in COPD pts It works well in anxious patients to control their breathing

In-hospital patients are oten constipated oten due to decreased activity and medications Try tackling

constipation using dierent pharmacological approaches ie donrsquot Px movicol i already on lactulose

Write in lsquovariable dosersquo section o kardex near the back



Wararin

Digoxin

PRESCRIBING OUT OF HOURS

You will oten get bleeped to prescribe wararin or patients you donrsquot know especially over the

weekendevenings i your colleagues havenrsquot done them

CHECK PATIENT IS NOT BLEEDING

Areyouprescribingmaintenanceorloadingdose

LOADING this is the regimen prescribed initially until INR stable and in target range Old school says10mg10mg5mgcheckINR(Day4)

MAINTENANCE usual dose once INR established to keep within target range Check yellow book or

regular prescriptions

bullOnceanINRhasbeenobtainedforoneofyourpatientsmakesureyouprescribethewarfarinfor

about3-4daysthenre-checkMarkopenbracketsonwarfarinchartstoindicatewhenyouwantthe

nextINRtobechecked(usuallybetween3-4daysintheinitialperiodormorefrequentlyifthereare

difculties establishing a maintenance dose)

bullINR is too high (lt4 or lt5 i target is 3-4) - DO NOT OMIT just reduce the dose (1mg) and re-

checkINRatleast48hrsafterasittakesbetween48-72hrsforyourchangetohaveaneect

bull I INR is gt4 (or gt5 i target is 3-4) and patient not actively bleeding prescribe Vitamin K 1mg IV

and OMIT the next dose o wararin

Reason or LT wararin Tx AF 2-3

RecurrentDVT 2-3

PE 2-3

RecurrentPE 3-4

Prostheticheartvalve 3-4

Check kardex or INTERACTIONS

Common onesbull ClarithromycinErythromycin

bull Rifampicin

I actively bleeding check with Senior or advice on urther action

You will occasionally get bleeped to review digoxin levels

Toxicity is very worrying and would normally require the use o lsquoDigibindrsquo which is basically

anantidote for digoxinODYouwillneed toget anECGand assessthepatient clinicallybefore

proceedinggetting senior help

Sub-therapeutic levels are common They are not so worrying but you should clinically assess

the patient in particular their CVS paying particular attention to their pulse as you will denitely get

asked about this i you ask or senior help

I digoxin levels are out o range make sure you check their K+ and keep a regular eye on it as this

needs to be stable or digoxin to be a sae and eective choice o therapy



Gentamicin

Usually prescribed in severeneutropenic sepsis (OD regimen) = 5-7mgkgmax480mg

You may get bleeped to check the gentamicin levels o ward patients and subsequently prescribe

the next dose

Theblood levelneedstobe taken6-14hoursafter thestartof thefrst IVI You are basically

looking or the levels to be within therapeutic range I they are not you need to reer to the

Hartord Normogram This is a chart which indicates WHEN the next dose should be according

to how out o range the levels are You DO NOT change the DOSE just the TIMING o the next

one(either2436or48hrslater)Makesureifyouhavebeenaskedtotakethebloodyourself

you note exactly how many hours post IVI the blood has been taken on the blood card it may be

another o your peers who has to review the level

Toxicity may

cause

Deaness

tinnitus

Nystagmus

Vertigo

RenalFailure

Monitor UEs

DAILY

ForpatientswithINFECTIVE ENDOCARDITIS (TDS regimen) = 1mgkg per dose

Therst levelthatneeds toberecordedisafter the3rd4thdoseensuringatleast24hoursof

treatmentisgivenItshouldbetaken1hourpostIVIiethePEAKorPOSTlevelandbebetween

3-5mgL A trough or PRE Dose level is taken approx 1 hour beore any administered dose and

should be lt1mgL The reason or this is that they are on a TDS regimen so renal unction needs

to be closely monitored It is important that gentamicin levels do not rise to toxic amounts

which is more common in patients with renal impairment

14

13

12

11

10

9

8

7

6

5

4

32

1

06 7 8 9 10 11 12 13 14 15 16

Time between start of infusion and sample draw (hours)

Nicolau DP Freeman CD Belliveau PP Nightingale CH Ross JW Quintiliani R Experience with

a once-daily aminoglycoside program administered to 2184 adult patients Antimicrob Agents

Chemo 1995293650-655

Hartford Once Daily Dosing Nomogram

(GentTobra 7mgkg

L e v e l ( m c g m l )

q48h

q36h

q24h



General Hints and Tips or seeing patients out o hours

When answering your bleep fnd out

1 Reason or bleep

2Quickbackgroundinfo

3 FurtherrelevantclinicalinfoegOBSERVATIONS and compare these to how they normally runI itrsquos a patient with high EWS just inorm a senior to make them aware and ready or action

4WhattheywantyoutoDO(PURPOSE o call)

5 Ask or the ollowing things to be ready when you arrive

bullNotes

bullKardex

bullObschartnursingle

bullEquipmentegcannulasbloodscatheteretc

6GiveappropriateinstructionsiftheyneedtodoanythingacutelybeforeyouarriveForexamplei

reason or bleep is Haematemesis ask or IV access and bloods to be taken or i a patient has

spiked a temp o gt38˚C get the nurses or night practitioner to do cultures beore you arrive Itsaves a lot o time and afng around once you are on the ward

7 Decide where this lies in your list o priorities or whether it is a job nurse practitioners can do

to help you

NB Try not to have arguments with nurses on the phone some o them are just starting out like

you and may also be petried sometimes they need reassurance too

When you get there

Findthenursewhobleepedyou(orrequestedthebleep)andgetamoredetailedaccountof

whatrsquos going on

Eye-ball the patient beore delving into notes or looking on the computer ollowing the standard

ABCDE assessment It wonrsquot take you long to gure out i they are acutely unwell unstable or

not

Once you have done your initial assessment and any immediate management document what

you have done using a logical and systematic approach This way you wonrsquot orget anything You

will also look really slick and competent plus you might nd you paint yoursel a picture o whatrsquos

going on even i you were clueless initially

Sit down at a computer with the nursing le and medical notes and go straight or the clerking It

should give you a succinct list o PC and other co-morbidities to create a more complete clinical

pictureFlickthroughthewardnotesandndanythingyoucanreaditmaybeofsomeuseLook

at the last entry in particular as there may be a plan o what to do should the situation you have

been bleeped or arises

Check PACS and the lab system or any recent imaging or tests NB ALWAYS compare recent results

to previous ones Just go down the lists looking or cultures unusual blood tests INRs etc and

document what you nd Sometimes the best summaries o a patient are created when someone

manages them on-call Be thorough at the beginning but i you are hard pushed or time reer back to the help sheets- they are designed to make you SAFE not to make you a brilliant diagnostician

whocancowboytheirwaythroughFY1lsquoHousersquostyle



HaveagoodbrowsethroughtheKARDEXlookingatwhichmedsmayhavecontributedtothe

situation which may have prevented it i they had been given and which ones you might need

toinitiatetomakesurethepatientisSAFE

Once you have all this inormation create a PROBLEM list and rom this document yourIMPRESSION o the situation Write a PLAN and document whether you involved a senior and

their name and grade Also document the amount o time you were there sometimes you need

tostaywithapatienttoseeifyourtreatmentworkseguidsforlowBPmeanwhileyoucan

scribble down everything yoursquove done to save time

Whenever you are assessing a patient think to yoursel

lsquoWhat do I need to DO to make sure this patient is SAFErsquo I this patient deteriorates or

dies unexpectedly and you were the last doctor to see them you need to make sure your

documentation is adequate Your management appropriate or not will mean nothing i it

has not been written down in the eyes o the law

In summary

bullAnsweryourbleepinasystematicway-itwillhelpyouprioritiseandbecomemoreecient

bullDelegatecertaintaskstonursesdonrsquotbeafraidofaskingthemyouarepartofaTEAM

bullPrioritiseyourjobsanddonrsquotbeafraidtoo-loadsomeontoyourwardSHOYOUaretheone

whogetsbleepedrstsoyouwillbeaskedtodoEVERYTHING

bullWhenyougettoapatient

1 ABCDE approach ALWAYS

2Documentyourinitialassessmentandmanagement 3Reviewthenursingleforobschartuidbalancewarfarinchartsuidprescriptions

4Reviewmedicalnotesandclerkingthensummarise

5ReviewKARDEX

6 Problem list

7 Impression

8 ACTION PLAN (use tick boxes or investigations you have ordered)

9 Keep their details (sticker on handover sheet) and make sure you check on them

later or handover to day team

ALWAYS MAKE SURE YOU ARE SAFE IF IN ANY DOUBT WHATSOEVER YOU MUST INFORMA SENIOR



Disclaimer

Copyright

Production

Contacts

The fndings and conclusions in this document are those o the authors who are

responsible or its content All inormation is to be interpreted on an idividual basisin context with the clinical situation to which it reers The inormation is not a

replacement or local guidelines and protocols nor is it a document with any legal

standing No statement in this document can be construed as an ocial position o

the North Western Deanery or NHS Northwest

copyGillianJacksonampFrancesBennett2011

BookdesignedbyAndrewPowellMedicalIllustrationatRoyalBoltonHospitalRef48355

Franmbennettgmailcom

gljacksonhotmailcouk





Introduction

Page 3 ABDOMINAL PAIN







Page 10 HAEMATEMESISCOFFEE GROUND VOMITMALAENA









1

Contents



Introduction

Dear all new FY1s




























Gillian and Fran




Initial Assessment

Examination

History

Investigations

Plan Hint

Medication Review


A V P U

ABCDE


Are they post-op

ABDO EXAM






urinary and gynae

3 PMHx including




bullBPH


Consider



bullAXRerectCXR

bullECG















MSUs







inective causes)


bullInection eg Cdi




Initial Assessment

Examination

History

Investigations

Plan

Medication Review

4


ABCDE

BM





bullSmellyUrine





withdrawal




too


bullCXR





being disruptive












bullBENZODIAZEPINES

bullGELOFUSINE






- CVATIA

- Hypoglycaemia


Reducing Regimen o

CHLORDIAZEPOXIDE or

ALCOHOL WITHDRAWAL


Day 3 and 4 15mgQDS

Day 5 10mgQDS





Examination

History




A V P U


RR 17

Sats 98 on air

Description


JVP Not raised

CRTlt2secs


+0HS







A

B

C

D

E




HR 86 reg

BP-lying13972

-standing13274

Fluidbalance

IN 1500ml12hr

OUT 1200ml12hr

Temp372

AMT1010

BM NA





37 ago



tube


I III

ABDOEXAM

prev now prev now

Hb 111 Na 138

WC 89 K 42

Plt 435 Cr 198

MCV 89 Ur 98

INR 11 CRP 57

Consider holding




eg or AVR





Bloods




Initial Assessment

Examination

History

Investigations

Plan

Medication Review




NEUROLOGICAL EXAM


bullPUPILS


DRUG TOXICITY

HYPOGLYCAEMIA





bullSepsis

bullStrokeorMI

bullLowBM


bull RenalFailure


bullBloods

bullDipstickUrine

bullCXR

bullECG

bullABG













IMMEDIATELY


bull OPIATES (OD)


6



History


Ater Death



A V P U










Go and see the body









bull RIP









History

Investigations

Plan

Medication Review


ABCDE

GCS

BM


the ollowing






Signsoftrauma

bullHeadandneck

bullHIPS

Neuroexam

Lying-StandingBP

RISK FACTORS or

bullMechanicalFalls

bullStroke

bullLowBM



bull Infection







bullECG

bullBloods

bullDipstick










valve replacement





History


High BM









In the inusion pump





lt4 0 0 4-7 1 2

71-11 2 4

111-17 4 8

171-22 6 12

gt22 8 16










Initial Assessment

Examination

History

Investigations

Plan

Medication Review


A V P U

ABCDE

Chest Exam

ABDO EXAM








reassuring






WITHOLD


bullNSAIDS

CONSIDER

bullAntiemetic



omepraoleifnot)







Medication Review



Medication Review

Plan


Impression




RR

Sats

HR

BP

Fluid balance

Temp

AMT

BM

Agitationmood

GCS

CHEST-THOROUGH



management

HS

JVP

Calves

Mucus membranes

CRT








A

B

C

D

E


i temp spiked





prophylacticLMWH-PE


event


WHYhasthishappened


SEPTIC SCREEN





Initial Assessment

Investigations

Plan

Medication Review

Examination

History


A V P U

ABCDE ECG

CHEST and CVS

Hydration

Unwellorstable

Fluidbalance

- Is this acute



- CARDIAC history




bull ECG


result








Salbutamol 5mg neb







losartan

bull NSAIDS

bull IVFluids



ECG


bullArrythmias


Pwaves






Initial Assessment


Examination

Investigations

History

Plan


ABCDE









Consider









SEPTIC





Medication Review

Examination

History


Plan

Medication Review


A V P U

ABCDE




- Onset

- Duration



co-morbidities





bullRepeatbloods










JVP and ankles

Calves Thighs

Anaphylaxis

Pneumothorax




FACTORS or

DVTPE


MI






Initial Assessment

Examination

History



Medication Review


A V P U

ABCDE ECG



Chest and Abdo Exam


Mandatory

bullECG

Consider



bullUrineDipstick










bullCARDIAC HISTORY


MIAFArrhythmias

bullPreviousECGs























PR 100mg TDS

CO-CODAMOL





QUININE PO 200mg ON














(5HT3 antagonist)





Caution NSAIDs in

asthmaPUCRF

Pts with

renal colic

respond

well to PR

dicloenac



spasmodic and works

on smooth muscle

Greatforcramping

abdo pain




symptoms have ailed




Ondansetron is very



rst-line






(3-5days max)



ORAMORPH PO 5mg

LAXATIVES












ALCOHOL


Day1and220-30mgQDS

Day3and415mgQDS

Day510mgQDS

Day610mgBD

Day710mgNocte





Salbutamol causes

tachycardia







Wararin

Digoxin


















RecurrentDVT 2-3

PE 2-3

RecurrentPE 3-4




bull Rifampicin













Gentamicin



the next dose








Toxicity may

cause

Deaness

tinnitus

Nystagmus

Vertigo

RenalFailure

Monitor UEs

DAILY








14

13

12

11

10

9

8

7

6

5

4

32

1

06 7 8 9 10 11 12 13 14 15 16




Chemo 1995293650-655


(GentTobra 7mgkg


q48h

q36h

q24h





1 Reason or bleep





bullNotes

bullKardex







to help you



When you get there


whatrsquos going on



not





























In summary









5ReviewKARDEX

6 Problem list

7 Impression







Disclaimer

Copyright

Production

Contacts












Page 2 Introduction

ABDOMINAL PAIN







Page 10 HAEMATEMESISCOFFEE GROUND VOMITMALAENA









1

Contents



Introduction

Dear all new FY1s




























Gillian and Fran




Initial Assessment

Examination

History

Investigations

Plan Hint

Medication Review


A V P U

ABCDE


Are they post-op

ABDO EXAM






urinary and gynae

3 PMHx including




bullBPH


Consider



bullAXRerectCXR

bullECG















MSUs







inective causes)


bullInection eg Cdi




Initial Assessment

Examination

History

Investigations

Plan

Medication Review

4


ABCDE

BM





bullSmellyUrine





withdrawal




too


bullCXR





being disruptive












bullBENZODIAZEPINES

bullGELOFUSINE






- CVATIA

- Hypoglycaemia


Reducing Regimen o

CHLORDIAZEPOXIDE or

ALCOHOL WITHDRAWAL


Day 3 and 4 15mgQDS

Day 5 10mgQDS





Examination

History




A V P U


RR 17

Sats 98 on air

Description


JVP Not raised

CRTlt2secs


+0HS







A

B

C

D

E




HR 86 reg

BP-lying13972

-standing13274

Fluidbalance

IN 1500ml12hr

OUT 1200ml12hr

Temp372

AMT1010

BM NA





37 ago



tube


I III

ABDOEXAM

prev now prev now

Hb 111 Na 138

WC 89 K 42

Plt 435 Cr 198

MCV 89 Ur 98

INR 11 CRP 57

Consider holding




eg or AVR





Bloods




Initial Assessment

Examination

History

Investigations

Plan

Medication Review




NEUROLOGICAL EXAM


bullPUPILS


DRUG TOXICITY

HYPOGLYCAEMIA





bullSepsis

bullStrokeorMI

bullLowBM


bull RenalFailure


bullBloods

bullDipstickUrine

bullCXR

bullECG

bullABG













IMMEDIATELY


bull OPIATES (OD)


6



History


Ater Death



A V P U










Go and see the body









bull RIP









History

Investigations

Plan

Medication Review


ABCDE

GCS

BM


the ollowing






Signsoftrauma

bullHeadandneck

bullHIPS

Neuroexam

Lying-StandingBP

RISK FACTORS or

bullMechanicalFalls

bullStroke

bullLowBM



bull Infection







bullECG

bullBloods

bullDipstick










valve replacement





History


High BM









In the inusion pump





lt4 0 0 4-7 1 2

71-11 2 4

111-17 4 8

171-22 6 12

gt22 8 16










Initial Assessment

Examination

History

Investigations

Plan

Medication Review


A V P U

ABCDE

Chest Exam

ABDO EXAM








reassuring






WITHOLD


bullNSAIDS

CONSIDER

bullAntiemetic



omepraoleifnot)







Medication Review



Medication Review

Plan


Impression




RR

Sats

HR

BP

Fluid balance

Temp

AMT

BM

Agitationmood

GCS

CHEST-THOROUGH



management

HS

JVP

Calves

Mucus membranes

CRT








A

B

C

D

E


i temp spiked





prophylacticLMWH-PE


event


WHYhasthishappened


SEPTIC SCREEN





Initial Assessment

Investigations

Plan

Medication Review

Examination

History


A V P U

ABCDE ECG

CHEST and CVS

Hydration

Unwellorstable

Fluidbalance

- Is this acute



- CARDIAC history




bull ECG


result








Salbutamol 5mg neb







losartan

bull NSAIDS

bull IVFluids



ECG


bullArrythmias


Pwaves






Initial Assessment


Examination

Investigations

History

Plan


ABCDE









Consider









SEPTIC





Medication Review

Examination

History


Plan

Medication Review


A V P U

ABCDE




- Onset

- Duration



co-morbidities





bullRepeatbloods










JVP and ankles

Calves Thighs

Anaphylaxis

Pneumothorax




FACTORS or

DVTPE


MI






Initial Assessment

Examination

History



Medication Review


A V P U

ABCDE ECG



Chest and Abdo Exam


Mandatory

bullECG

Consider



bullUrineDipstick










bullCARDIAC HISTORY


MIAFArrhythmias

bullPreviousECGs























PR 100mg TDS

CO-CODAMOL





QUININE PO 200mg ON














(5HT3 antagonist)





Caution NSAIDs in

asthmaPUCRF

Pts with

renal colic

respond

well to PR

dicloenac



spasmodic and works

on smooth muscle

Greatforcramping

abdo pain




symptoms have ailed




Ondansetron is very



rst-line






(3-5days max)



ORAMORPH PO 5mg

LAXATIVES












ALCOHOL


Day1and220-30mgQDS

Day3and415mgQDS

Day510mgQDS

Day610mgBD

Day710mgNocte





Salbutamol causes

tachycardia







Wararin

Digoxin


















RecurrentDVT 2-3

PE 2-3

RecurrentPE 3-4




bull Rifampicin













Gentamicin



the next dose








Toxicity may

cause

Deaness

tinnitus

Nystagmus

Vertigo

RenalFailure

Monitor UEs

DAILY








14

13

12

11

10

9

8

7

6

5

4

32

1

06 7 8 9 10 11 12 13 14 15 16




Chemo 1995293650-655


(GentTobra 7mgkg


q48h

q36h

q24h





1 Reason or bleep





bullNotes

bullKardex







to help you



When you get there


whatrsquos going on



not





























In summary









5ReviewKARDEX

6 Problem list

7 Impression







Disclaimer

Copyright

Production

Contacts












Introduction

Dear all new FY1s




























Gillian and Fran




Initial Assessment

Examination

History

Investigations

Plan Hint

Medication Review


A V P U

ABCDE


Are they post-op

ABDO EXAM






urinary and gynae

3 PMHx including




bullBPH


Consider



bullAXRerectCXR

bullECG















MSUs







inective causes)


bullInection eg Cdi




Initial Assessment

Examination

History

Investigations

Plan

Medication Review

4


ABCDE

BM





bullSmellyUrine





withdrawal




too


bullCXR





being disruptive












bullBENZODIAZEPINES

bullGELOFUSINE






- CVATIA

- Hypoglycaemia


Reducing Regimen o

CHLORDIAZEPOXIDE or

ALCOHOL WITHDRAWAL


Day 3 and 4 15mgQDS

Day 5 10mgQDS





Examination

History




A V P U


RR 17

Sats 98 on air

Description


JVP Not raised

CRTlt2secs


+0HS







A

B

C

D

E




HR 86 reg

BP-lying13972

-standing13274

Fluidbalance

IN 1500ml12hr

OUT 1200ml12hr

Temp372

AMT1010

BM NA





37 ago



tube


I III

ABDOEXAM

prev now prev now

Hb 111 Na 138

WC 89 K 42

Plt 435 Cr 198

MCV 89 Ur 98

INR 11 CRP 57

Consider holding




eg or AVR





Bloods




Initial Assessment

Examination

History

Investigations

Plan

Medication Review




NEUROLOGICAL EXAM


bullPUPILS


DRUG TOXICITY

HYPOGLYCAEMIA





bullSepsis

bullStrokeorMI

bullLowBM


bull RenalFailure


bullBloods

bullDipstickUrine

bullCXR

bullECG

bullABG













IMMEDIATELY


bull OPIATES (OD)


6



History


Ater Death



A V P U










Go and see the body









bull RIP









History

Investigations

Plan

Medication Review


ABCDE

GCS

BM


the ollowing






Signsoftrauma

bullHeadandneck

bullHIPS

Neuroexam

Lying-StandingBP

RISK FACTORS or

bullMechanicalFalls

bullStroke

bullLowBM



bull Infection







bullECG

bullBloods

bullDipstick










valve replacement





History


High BM









In the inusion pump





lt4 0 0 4-7 1 2

71-11 2 4

111-17 4 8

171-22 6 12

gt22 8 16










Initial Assessment

Examination

History

Investigations

Plan

Medication Review


A V P U

ABCDE

Chest Exam

ABDO EXAM








reassuring






WITHOLD


bullNSAIDS

CONSIDER

bullAntiemetic



omepraoleifnot)







Medication Review



Medication Review

Plan


Impression




RR

Sats

HR

BP

Fluid balance

Temp

AMT

BM

Agitationmood

GCS

CHEST-THOROUGH



management

HS

JVP

Calves

Mucus membranes

CRT








A

B

C

D

E


i temp spiked





prophylacticLMWH-PE


event


WHYhasthishappened


SEPTIC SCREEN





Initial Assessment

Investigations

Plan

Medication Review

Examination

History


A V P U

ABCDE ECG

CHEST and CVS

Hydration

Unwellorstable

Fluidbalance

- Is this acute



- CARDIAC history




bull ECG


result








Salbutamol 5mg neb







losartan

bull NSAIDS

bull IVFluids



ECG


bullArrythmias


Pwaves






Initial Assessment


Examination

Investigations

History

Plan


ABCDE









Consider









SEPTIC





Medication Review

Examination

History


Plan

Medication Review


A V P U

ABCDE




- Onset

- Duration



co-morbidities





bullRepeatbloods










JVP and ankles

Calves Thighs

Anaphylaxis

Pneumothorax




FACTORS or

DVTPE


MI






Initial Assessment

Examination

History



Medication Review


A V P U

ABCDE ECG



Chest and Abdo Exam


Mandatory

bullECG

Consider



bullUrineDipstick










bullCARDIAC HISTORY


MIAFArrhythmias

bullPreviousECGs























PR 100mg TDS

CO-CODAMOL





QUININE PO 200mg ON














(5HT3 antagonist)





Caution NSAIDs in

asthmaPUCRF

Pts with

renal colic

respond

well to PR

dicloenac



spasmodic and works

on smooth muscle

Greatforcramping

abdo pain




symptoms have ailed




Ondansetron is very



rst-line






(3-5days max)



ORAMORPH PO 5mg

LAXATIVES












ALCOHOL


Day1and220-30mgQDS

Day3and415mgQDS

Day510mgQDS

Day610mgBD

Day710mgNocte





Salbutamol causes

tachycardia







Wararin

Digoxin


















RecurrentDVT 2-3

PE 2-3

RecurrentPE 3-4




bull Rifampicin













Gentamicin



the next dose








Toxicity may

cause

Deaness

tinnitus

Nystagmus

Vertigo

RenalFailure

Monitor UEs

DAILY








14

13

12

11

10

9

8

7

6

5

4

32

1

06 7 8 9 10 11 12 13 14 15 16




Chemo 1995293650-655


(GentTobra 7mgkg


q48h

q36h

q24h





1 Reason or bleep





bullNotes

bullKardex







to help you



When you get there


whatrsquos going on



not





























In summary









5ReviewKARDEX

6 Problem list

7 Impression







Disclaimer

Copyright

Production

Contacts












Initial Assessment

Examination

History

Investigations

Plan Hint

Medication Review


A V P U

ABCDE


Are they post-op

ABDO EXAM






urinary and gynae

3 PMHx including




bullBPH


Consider



bullAXRerectCXR

bullECG















MSUs







inective causes)


bullInection eg Cdi




Initial Assessment

Examination

History

Investigations

Plan

Medication Review

4


ABCDE

BM





bullSmellyUrine





withdrawal




too


bullCXR





being disruptive












bullBENZODIAZEPINES

bullGELOFUSINE






- CVATIA

- Hypoglycaemia


Reducing Regimen o

CHLORDIAZEPOXIDE or

ALCOHOL WITHDRAWAL


Day 3 and 4 15mgQDS

Day 5 10mgQDS





Examination

History




A V P U


RR 17

Sats 98 on air

Description


JVP Not raised

CRTlt2secs


+0HS







A

B

C

D

E




HR 86 reg

BP-lying13972

-standing13274

Fluidbalance

IN 1500ml12hr

OUT 1200ml12hr

Temp372

AMT1010

BM NA





37 ago



tube


I III

ABDOEXAM

prev now prev now

Hb 111 Na 138

WC 89 K 42

Plt 435 Cr 198

MCV 89 Ur 98

INR 11 CRP 57

Consider holding




eg or AVR





Bloods




Initial Assessment

Examination

History

Investigations

Plan

Medication Review




NEUROLOGICAL EXAM


bullPUPILS


DRUG TOXICITY

HYPOGLYCAEMIA





bullSepsis

bullStrokeorMI

bullLowBM


bull RenalFailure


bullBloods

bullDipstickUrine

bullCXR

bullECG

bullABG













IMMEDIATELY


bull OPIATES (OD)


6



History


Ater Death



A V P U










Go and see the body









bull RIP









History

Investigations

Plan

Medication Review


ABCDE

GCS

BM


the ollowing






Signsoftrauma

bullHeadandneck

bullHIPS

Neuroexam

Lying-StandingBP

RISK FACTORS or

bullMechanicalFalls

bullStroke

bullLowBM



bull Infection







bullECG

bullBloods

bullDipstick










valve replacement





History


High BM









In the inusion pump





lt4 0 0 4-7 1 2

71-11 2 4

111-17 4 8

171-22 6 12

gt22 8 16










Initial Assessment

Examination

History

Investigations

Plan

Medication Review


A V P U

ABCDE

Chest Exam

ABDO EXAM








reassuring






WITHOLD


bullNSAIDS

CONSIDER

bullAntiemetic



omepraoleifnot)







Medication Review



Medication Review

Plan


Impression




RR

Sats

HR

BP

Fluid balance

Temp

AMT

BM

Agitationmood

GCS

CHEST-THOROUGH



management

HS

JVP

Calves

Mucus membranes

CRT








A

B

C

D

E


i temp spiked





prophylacticLMWH-PE


event


WHYhasthishappened


SEPTIC SCREEN





Initial Assessment

Investigations

Plan

Medication Review

Examination

History


A V P U

ABCDE ECG

CHEST and CVS

Hydration

Unwellorstable

Fluidbalance

- Is this acute



- CARDIAC history




bull ECG


result








Salbutamol 5mg neb







losartan

bull NSAIDS

bull IVFluids



ECG


bullArrythmias


Pwaves






Initial Assessment


Examination

Investigations

History

Plan


ABCDE









Consider









SEPTIC





Medication Review

Examination

History


Plan

Medication Review


A V P U

ABCDE




- Onset

- Duration



co-morbidities





bullRepeatbloods










JVP and ankles

Calves Thighs

Anaphylaxis

Pneumothorax




FACTORS or

DVTPE


MI






Initial Assessment

Examination

History



Medication Review


A V P U

ABCDE ECG



Chest and Abdo Exam


Mandatory

bullECG

Consider



bullUrineDipstick










bullCARDIAC HISTORY


MIAFArrhythmias

bullPreviousECGs























PR 100mg TDS

CO-CODAMOL





QUININE PO 200mg ON














(5HT3 antagonist)





Caution NSAIDs in

asthmaPUCRF

Pts with

renal colic

respond

well to PR

dicloenac



spasmodic and works

on smooth muscle

Greatforcramping

abdo pain




symptoms have ailed




Ondansetron is very



rst-line






(3-5days max)



ORAMORPH PO 5mg

LAXATIVES












ALCOHOL


Day1and220-30mgQDS

Day3and415mgQDS

Day510mgQDS

Day610mgBD

Day710mgNocte





Salbutamol causes

tachycardia







Wararin

Digoxin


















RecurrentDVT 2-3

PE 2-3

RecurrentPE 3-4




bull Rifampicin













Gentamicin



the next dose








Toxicity may

cause

Deaness

tinnitus

Nystagmus

Vertigo

RenalFailure

Monitor UEs

DAILY








14

13

12

11

10

9

8

7

6

5

4

32

1

06 7 8 9 10 11 12 13 14 15 16




Chemo 1995293650-655


(GentTobra 7mgkg


q48h

q36h

q24h





1 Reason or bleep





bullNotes

bullKardex







to help you



When you get there


whatrsquos going on



not





























In summary









5ReviewKARDEX

6 Problem list

7 Impression







Disclaimer

Copyright

Production

Contacts












Initial Assessment

Examination

History

Investigations

Plan

Medication Review

4


ABCDE

BM





bullSmellyUrine





withdrawal




too


bullCXR





being disruptive












bullBENZODIAZEPINES

bullGELOFUSINE






- CVATIA

- Hypoglycaemia


Reducing Regimen o

CHLORDIAZEPOXIDE or

ALCOHOL WITHDRAWAL


Day 3 and 4 15mgQDS

Day 5 10mgQDS





Examination

History




A V P U


RR 17

Sats 98 on air

Description


JVP Not raised

CRTlt2secs


+0HS







A

B

C

D

E




HR 86 reg

BP-lying13972

-standing13274

Fluidbalance

IN 1500ml12hr

OUT 1200ml12hr

Temp372

AMT1010

BM NA





37 ago



tube


I III

ABDOEXAM

prev now prev now

Hb 111 Na 138

WC 89 K 42

Plt 435 Cr 198

MCV 89 Ur 98

INR 11 CRP 57

Consider holding




eg or AVR





Bloods




Initial Assessment

Examination

History

Investigations

Plan

Medication Review




NEUROLOGICAL EXAM


bullPUPILS


DRUG TOXICITY

HYPOGLYCAEMIA





bullSepsis

bullStrokeorMI

bullLowBM


bull RenalFailure


bullBloods

bullDipstickUrine

bullCXR

bullECG

bullABG













IMMEDIATELY


bull OPIATES (OD)


6



History


Ater Death



A V P U










Go and see the body









bull RIP









History

Investigations

Plan

Medication Review


ABCDE

GCS

BM


the ollowing






Signsoftrauma

bullHeadandneck

bullHIPS

Neuroexam

Lying-StandingBP

RISK FACTORS or

bullMechanicalFalls

bullStroke

bullLowBM



bull Infection







bullECG

bullBloods

bullDipstick










valve replacement





History


High BM









In the inusion pump





lt4 0 0 4-7 1 2

71-11 2 4

111-17 4 8

171-22 6 12

gt22 8 16










Initial Assessment

Examination

History

Investigations

Plan

Medication Review


A V P U

ABCDE

Chest Exam

ABDO EXAM








reassuring






WITHOLD


bullNSAIDS

CONSIDER

bullAntiemetic



omepraoleifnot)







Medication Review



Medication Review

Plan


Impression




RR

Sats

HR

BP

Fluid balance

Temp

AMT

BM

Agitationmood

GCS

CHEST-THOROUGH



management

HS

JVP

Calves

Mucus membranes

CRT








A

B

C

D

E


i temp spiked





prophylacticLMWH-PE


event


WHYhasthishappened


SEPTIC SCREEN





Initial Assessment

Investigations

Plan

Medication Review

Examination

History


A V P U

ABCDE ECG

CHEST and CVS

Hydration

Unwellorstable

Fluidbalance

- Is this acute



- CARDIAC history




bull ECG


result








Salbutamol 5mg neb







losartan

bull NSAIDS

bull IVFluids



ECG


bullArrythmias


Pwaves






Initial Assessment


Examination

Investigations

History

Plan


ABCDE









Consider









SEPTIC





Medication Review

Examination

History


Plan

Medication Review


A V P U

ABCDE




- Onset

- Duration



co-morbidities





bullRepeatbloods










JVP and ankles

Calves Thighs

Anaphylaxis

Pneumothorax




FACTORS or

DVTPE


MI






Initial Assessment

Examination

History



Medication Review


A V P U

ABCDE ECG



Chest and Abdo Exam


Mandatory

bullECG

Consider



bullUrineDipstick










bullCARDIAC HISTORY


MIAFArrhythmias

bullPreviousECGs























PR 100mg TDS

CO-CODAMOL





QUININE PO 200mg ON














(5HT3 antagonist)





Caution NSAIDs in

asthmaPUCRF

Pts with

renal colic

respond

well to PR

dicloenac



spasmodic and works

on smooth muscle

Greatforcramping

abdo pain




symptoms have ailed




Ondansetron is very



rst-line






(3-5days max)



ORAMORPH PO 5mg

LAXATIVES












ALCOHOL


Day1and220-30mgQDS

Day3and415mgQDS

Day510mgQDS

Day610mgBD

Day710mgNocte





Salbutamol causes

tachycardia







Wararin

Digoxin


















RecurrentDVT 2-3

PE 2-3

RecurrentPE 3-4




bull Rifampicin













Gentamicin



the next dose








Toxicity may

cause

Deaness

tinnitus

Nystagmus

Vertigo

RenalFailure

Monitor UEs

DAILY








14

13

12

11

10

9

8

7

6

5

4

32

1

06 7 8 9 10 11 12 13 14 15 16




Chemo 1995293650-655


(GentTobra 7mgkg


q48h

q36h

q24h





1 Reason or bleep





bullNotes

bullKardex







to help you



When you get there


whatrsquos going on



not





























In summary









5ReviewKARDEX

6 Problem list

7 Impression







Disclaimer

Copyright

Production

Contacts












Examination

History




A V P U


RR 17

Sats 98 on air

Description


JVP Not raised

CRTlt2secs


+0HS







A

B

C

D

E




HR 86 reg

BP-lying13972

-standing13274

Fluidbalance

IN 1500ml12hr

OUT 1200ml12hr

Temp372

AMT1010

BM NA





37 ago



tube


I III

ABDOEXAM

prev now prev now

Hb 111 Na 138

WC 89 K 42

Plt 435 Cr 198

MCV 89 Ur 98

INR 11 CRP 57

Consider holding




eg or AVR





Bloods




Initial Assessment

Examination

History

Investigations

Plan

Medication Review




NEUROLOGICAL EXAM


bullPUPILS


DRUG TOXICITY

HYPOGLYCAEMIA





bullSepsis

bullStrokeorMI

bullLowBM


bull RenalFailure


bullBloods

bullDipstickUrine

bullCXR

bullECG

bullABG













IMMEDIATELY


bull OPIATES (OD)


6



History


Ater Death



A V P U










Go and see the body









bull RIP









History

Investigations

Plan

Medication Review


ABCDE

GCS

BM


the ollowing






Signsoftrauma

bullHeadandneck

bullHIPS

Neuroexam

Lying-StandingBP

RISK FACTORS or

bullMechanicalFalls

bullStroke

bullLowBM



bull Infection







bullECG

bullBloods

bullDipstick










valve replacement





History


High BM









In the inusion pump





lt4 0 0 4-7 1 2

71-11 2 4

111-17 4 8

171-22 6 12

gt22 8 16










Initial Assessment

Examination

History

Investigations

Plan

Medication Review


A V P U

ABCDE

Chest Exam

ABDO EXAM








reassuring






WITHOLD


bullNSAIDS

CONSIDER

bullAntiemetic



omepraoleifnot)







Medication Review



Medication Review

Plan


Impression




RR

Sats

HR

BP

Fluid balance

Temp

AMT

BM

Agitationmood

GCS

CHEST-THOROUGH



management

HS

JVP

Calves

Mucus membranes

CRT








A

B

C

D

E


i temp spiked





prophylacticLMWH-PE


event


WHYhasthishappened


SEPTIC SCREEN





Initial Assessment

Investigations

Plan

Medication Review

Examination

History


A V P U

ABCDE ECG

CHEST and CVS

Hydration

Unwellorstable

Fluidbalance

- Is this acute



- CARDIAC history




bull ECG


result








Salbutamol 5mg neb







losartan

bull NSAIDS

bull IVFluids



ECG


bullArrythmias


Pwaves






Initial Assessment


Examination

Investigations

History

Plan


ABCDE









Consider









SEPTIC





Medication Review

Examination

History


Plan

Medication Review


A V P U

ABCDE




- Onset

- Duration



co-morbidities





bullRepeatbloods










JVP and ankles

Calves Thighs

Anaphylaxis

Pneumothorax




FACTORS or

DVTPE


MI






Initial Assessment

Examination

History



Medication Review


A V P U

ABCDE ECG



Chest and Abdo Exam


Mandatory

bullECG

Consider



bullUrineDipstick










bullCARDIAC HISTORY


MIAFArrhythmias

bullPreviousECGs























PR 100mg TDS

CO-CODAMOL





QUININE PO 200mg ON














(5HT3 antagonist)





Caution NSAIDs in

asthmaPUCRF

Pts with

renal colic

respond

well to PR

dicloenac



spasmodic and works

on smooth muscle

Greatforcramping

abdo pain




symptoms have ailed




Ondansetron is very



rst-line






(3-5days max)



ORAMORPH PO 5mg

LAXATIVES












ALCOHOL


Day1and220-30mgQDS

Day3and415mgQDS

Day510mgQDS

Day610mgBD

Day710mgNocte





Salbutamol causes

tachycardia







Wararin

Digoxin


















RecurrentDVT 2-3

PE 2-3

RecurrentPE 3-4




bull Rifampicin













Gentamicin



the next dose








Toxicity may

cause

Deaness

tinnitus

Nystagmus

Vertigo

RenalFailure

Monitor UEs

DAILY








14

13

12

11

10

9

8

7

6

5

4

32

1

06 7 8 9 10 11 12 13 14 15 16




Chemo 1995293650-655


(GentTobra 7mgkg


q48h

q36h

q24h





1 Reason or bleep





bullNotes

bullKardex







to help you



When you get there


whatrsquos going on



not





























In summary









5ReviewKARDEX

6 Problem list

7 Impression







Disclaimer

Copyright

Production

Contacts












Initial Assessment

Examination

History

Investigations

Plan

Medication Review




NEUROLOGICAL EXAM


bullPUPILS


DRUG TOXICITY

HYPOGLYCAEMIA





bullSepsis

bullStrokeorMI

bullLowBM


bull RenalFailure


bullBloods

bullDipstickUrine

bullCXR

bullECG

bullABG













IMMEDIATELY


bull OPIATES (OD)


6



History


Ater Death



A V P U










Go and see the body









bull RIP









History

Investigations

Plan

Medication Review


ABCDE

GCS

BM


the ollowing






Signsoftrauma

bullHeadandneck

bullHIPS

Neuroexam

Lying-StandingBP

RISK FACTORS or

bullMechanicalFalls

bullStroke

bullLowBM



bull Infection







bullECG

bullBloods

bullDipstick










valve replacement





History


High BM









In the inusion pump





lt4 0 0 4-7 1 2

71-11 2 4

111-17 4 8

171-22 6 12

gt22 8 16










Initial Assessment

Examination

History

Investigations

Plan

Medication Review


A V P U

ABCDE

Chest Exam

ABDO EXAM








reassuring






WITHOLD


bullNSAIDS

CONSIDER

bullAntiemetic



omepraoleifnot)







Medication Review



Medication Review

Plan


Impression




RR

Sats

HR

BP

Fluid balance

Temp

AMT

BM

Agitationmood

GCS

CHEST-THOROUGH



management

HS

JVP

Calves

Mucus membranes

CRT








A

B

C

D

E


i temp spiked





prophylacticLMWH-PE


event


WHYhasthishappened


SEPTIC SCREEN





Initial Assessment

Investigations

Plan

Medication Review

Examination

History


A V P U

ABCDE ECG

CHEST and CVS

Hydration

Unwellorstable

Fluidbalance

- Is this acute



- CARDIAC history




bull ECG


result








Salbutamol 5mg neb







losartan

bull NSAIDS

bull IVFluids



ECG


bullArrythmias


Pwaves






Initial Assessment


Examination

Investigations

History

Plan


ABCDE









Consider









SEPTIC





Medication Review

Examination

History


Plan

Medication Review


A V P U

ABCDE




- Onset

- Duration



co-morbidities





bullRepeatbloods










JVP and ankles

Calves Thighs

Anaphylaxis

Pneumothorax




FACTORS or

DVTPE


MI






Initial Assessment

Examination

History



Medication Review


A V P U

ABCDE ECG



Chest and Abdo Exam


Mandatory

bullECG

Consider



bullUrineDipstick










bullCARDIAC HISTORY


MIAFArrhythmias

bullPreviousECGs























PR 100mg TDS

CO-CODAMOL





QUININE PO 200mg ON














(5HT3 antagonist)





Caution NSAIDs in

asthmaPUCRF

Pts with

renal colic

respond

well to PR

dicloenac



spasmodic and works

on smooth muscle

Greatforcramping

abdo pain




symptoms have ailed




Ondansetron is very



rst-line






(3-5days max)



ORAMORPH PO 5mg

LAXATIVES












ALCOHOL


Day1and220-30mgQDS

Day3and415mgQDS

Day510mgQDS

Day610mgBD

Day710mgNocte





Salbutamol causes

tachycardia







Wararin

Digoxin


















RecurrentDVT 2-3

PE 2-3

RecurrentPE 3-4




bull Rifampicin













Gentamicin



the next dose








Toxicity may

cause

Deaness

tinnitus

Nystagmus

Vertigo

RenalFailure

Monitor UEs

DAILY








14

13

12

11

10

9

8

7

6

5

4

32

1

06 7 8 9 10 11 12 13 14 15 16




Chemo 1995293650-655


(GentTobra 7mgkg


q48h

q36h

q24h





1 Reason or bleep





bullNotes

bullKardex







to help you



When you get there


whatrsquos going on



not





























In summary









5ReviewKARDEX

6 Problem list

7 Impression







Disclaimer

Copyright

Production

Contacts












History


Ater Death



A V P U










Go and see the body









bull RIP









History

Investigations

Plan

Medication Review


ABCDE

GCS

BM


the ollowing






Signsoftrauma

bullHeadandneck

bullHIPS

Neuroexam

Lying-StandingBP

RISK FACTORS or

bullMechanicalFalls

bullStroke

bullLowBM



bull Infection







bullECG

bullBloods

bullDipstick










valve replacement





History


High BM









In the inusion pump





lt4 0 0 4-7 1 2

71-11 2 4

111-17 4 8

171-22 6 12

gt22 8 16










Initial Assessment

Examination

History

Investigations

Plan

Medication Review


A V P U

ABCDE

Chest Exam

ABDO EXAM








reassuring






WITHOLD


bullNSAIDS

CONSIDER

bullAntiemetic



omepraoleifnot)







Medication Review



Medication Review

Plan


Impression




RR

Sats

HR

BP

Fluid balance

Temp

AMT

BM

Agitationmood

GCS

CHEST-THOROUGH



management

HS

JVP

Calves

Mucus membranes

CRT








A

B

C

D

E


i temp spiked





prophylacticLMWH-PE


event


WHYhasthishappened


SEPTIC SCREEN





Initial Assessment

Investigations

Plan

Medication Review

Examination

History


A V P U

ABCDE ECG

CHEST and CVS

Hydration

Unwellorstable

Fluidbalance

- Is this acute



- CARDIAC history




bull ECG


result








Salbutamol 5mg neb







losartan

bull NSAIDS

bull IVFluids



ECG


bullArrythmias


Pwaves






Initial Assessment


Examination

Investigations

History

Plan


ABCDE









Consider









SEPTIC





Medication Review

Examination

History


Plan

Medication Review


A V P U

ABCDE




- Onset

- Duration



co-morbidities





bullRepeatbloods










JVP and ankles

Calves Thighs

Anaphylaxis

Pneumothorax




FACTORS or

DVTPE


MI






Initial Assessment

Examination

History



Medication Review


A V P U

ABCDE ECG



Chest and Abdo Exam


Mandatory

bullECG

Consider



bullUrineDipstick










bullCARDIAC HISTORY


MIAFArrhythmias

bullPreviousECGs























PR 100mg TDS

CO-CODAMOL





QUININE PO 200mg ON














(5HT3 antagonist)





Caution NSAIDs in

asthmaPUCRF

Pts with

renal colic

respond

well to PR

dicloenac



spasmodic and works

on smooth muscle

Greatforcramping

abdo pain




symptoms have ailed




Ondansetron is very



rst-line






(3-5days max)



ORAMORPH PO 5mg

LAXATIVES












ALCOHOL


Day1and220-30mgQDS

Day3and415mgQDS

Day510mgQDS

Day610mgBD

Day710mgNocte





Salbutamol causes

tachycardia







Wararin

Digoxin


















RecurrentDVT 2-3

PE 2-3

RecurrentPE 3-4




bull Rifampicin













Gentamicin



the next dose








Toxicity may

cause

Deaness

tinnitus

Nystagmus

Vertigo

RenalFailure

Monitor UEs

DAILY








14

13

12

11

10

9

8

7

6

5

4

32

1

06 7 8 9 10 11 12 13 14 15 16




Chemo 1995293650-655


(GentTobra 7mgkg


q48h

q36h

q24h





1 Reason or bleep





bullNotes

bullKardex







to help you



When you get there


whatrsquos going on



not





























In summary









5ReviewKARDEX

6 Problem list

7 Impression







Disclaimer

Copyright

Production

Contacts













History

Investigations

Plan

Medication Review


ABCDE

GCS

BM


the ollowing






Signsoftrauma

bullHeadandneck

bullHIPS

Neuroexam

Lying-StandingBP

RISK FACTORS or

bullMechanicalFalls

bullStroke

bullLowBM



bull Infection







bullECG

bullBloods

bullDipstick










valve replacement





History


High BM









In the inusion pump





lt4 0 0 4-7 1 2

71-11 2 4

111-17 4 8

171-22 6 12

gt22 8 16










Initial Assessment

Examination

History

Investigations

Plan

Medication Review


A V P U

ABCDE

Chest Exam

ABDO EXAM








reassuring






WITHOLD


bullNSAIDS

CONSIDER

bullAntiemetic



omepraoleifnot)







Medication Review



Medication Review

Plan


Impression




RR

Sats

HR

BP

Fluid balance

Temp

AMT

BM

Agitationmood

GCS

CHEST-THOROUGH



management

HS

JVP

Calves

Mucus membranes

CRT








A

B

C

D

E


i temp spiked





prophylacticLMWH-PE


event


WHYhasthishappened


SEPTIC SCREEN





Initial Assessment

Investigations

Plan

Medication Review

Examination

History


A V P U

ABCDE ECG

CHEST and CVS

Hydration

Unwellorstable

Fluidbalance

- Is this acute



- CARDIAC history




bull ECG


result








Salbutamol 5mg neb







losartan

bull NSAIDS

bull IVFluids



ECG


bullArrythmias


Pwaves






Initial Assessment


Examination

Investigations

History

Plan


ABCDE









Consider









SEPTIC





Medication Review

Examination

History


Plan

Medication Review


A V P U

ABCDE




- Onset

- Duration



co-morbidities





bullRepeatbloods










JVP and ankles

Calves Thighs

Anaphylaxis

Pneumothorax




FACTORS or

DVTPE


MI






Initial Assessment

Examination

History



Medication Review


A V P U

ABCDE ECG



Chest and Abdo Exam


Mandatory

bullECG

Consider



bullUrineDipstick










bullCARDIAC HISTORY


MIAFArrhythmias

bullPreviousECGs























PR 100mg TDS

CO-CODAMOL





QUININE PO 200mg ON














(5HT3 antagonist)





Caution NSAIDs in

asthmaPUCRF

Pts with

renal colic

respond

well to PR

dicloenac



spasmodic and works

on smooth muscle

Greatforcramping

abdo pain




symptoms have ailed




Ondansetron is very



rst-line






(3-5days max)



ORAMORPH PO 5mg

LAXATIVES












ALCOHOL


Day1and220-30mgQDS

Day3and415mgQDS

Day510mgQDS

Day610mgBD

Day710mgNocte





Salbutamol causes

tachycardia







Wararin

Digoxin


















RecurrentDVT 2-3

PE 2-3

RecurrentPE 3-4




bull Rifampicin













Gentamicin



the next dose








Toxicity may

cause

Deaness

tinnitus

Nystagmus

Vertigo

RenalFailure

Monitor UEs

DAILY








14

13

12

11

10

9

8

7

6

5

4

32

1

06 7 8 9 10 11 12 13 14 15 16




Chemo 1995293650-655


(GentTobra 7mgkg


q48h

q36h

q24h





1 Reason or bleep





bullNotes

bullKardex







to help you



When you get there


whatrsquos going on



not





























In summary









5ReviewKARDEX

6 Problem list

7 Impression







Disclaimer

Copyright

Production

Contacts













History


High BM









In the inusion pump





lt4 0 0 4-7 1 2

71-11 2 4

111-17 4 8

171-22 6 12

gt22 8 16










Initial Assessment

Examination

History

Investigations

Plan

Medication Review


A V P U

ABCDE

Chest Exam

ABDO EXAM








reassuring






WITHOLD


bullNSAIDS

CONSIDER

bullAntiemetic



omepraoleifnot)







Medication Review



Medication Review

Plan


Impression




RR

Sats

HR

BP

Fluid balance

Temp

AMT

BM

Agitationmood

GCS

CHEST-THOROUGH



management

HS

JVP

Calves

Mucus membranes

CRT








A

B

C

D

E


i temp spiked





prophylacticLMWH-PE


event


WHYhasthishappened


SEPTIC SCREEN





Initial Assessment

Investigations

Plan

Medication Review

Examination

History


A V P U

ABCDE ECG

CHEST and CVS

Hydration

Unwellorstable

Fluidbalance

- Is this acute



- CARDIAC history




bull ECG


result








Salbutamol 5mg neb







losartan

bull NSAIDS

bull IVFluids



ECG


bullArrythmias


Pwaves






Initial Assessment


Examination

Investigations

History

Plan


ABCDE









Consider









SEPTIC





Medication Review

Examination

History


Plan

Medication Review


A V P U

ABCDE




- Onset

- Duration



co-morbidities





bullRepeatbloods










JVP and ankles

Calves Thighs

Anaphylaxis

Pneumothorax




FACTORS or

DVTPE


MI






Initial Assessment

Examination

History



Medication Review


A V P U

ABCDE ECG



Chest and Abdo Exam


Mandatory

bullECG

Consider



bullUrineDipstick










bullCARDIAC HISTORY


MIAFArrhythmias

bullPreviousECGs























PR 100mg TDS

CO-CODAMOL





QUININE PO 200mg ON














(5HT3 antagonist)





Caution NSAIDs in

asthmaPUCRF

Pts with

renal colic

respond

well to PR

dicloenac



spasmodic and works

on smooth muscle

Greatforcramping

abdo pain




symptoms have ailed




Ondansetron is very



rst-line






(3-5days max)



ORAMORPH PO 5mg

LAXATIVES












ALCOHOL


Day1and220-30mgQDS

Day3and415mgQDS

Day510mgQDS

Day610mgBD

Day710mgNocte





Salbutamol causes

tachycardia







Wararin

Digoxin


















RecurrentDVT 2-3

PE 2-3

RecurrentPE 3-4




bull Rifampicin













Gentamicin



the next dose








Toxicity may

cause

Deaness

tinnitus

Nystagmus

Vertigo

RenalFailure

Monitor UEs

DAILY








14

13

12

11

10

9

8

7

6

5

4

32

1

06 7 8 9 10 11 12 13 14 15 16




Chemo 1995293650-655


(GentTobra 7mgkg


q48h

q36h

q24h





1 Reason or bleep





bullNotes

bullKardex







to help you



When you get there


whatrsquos going on



not





























In summary









5ReviewKARDEX

6 Problem list

7 Impression







Disclaimer

Copyright

Production

Contacts












Initial Assessment

Examination

History

Investigations

Plan

Medication Review


A V P U

ABCDE

Chest Exam

ABDO EXAM








reassuring






WITHOLD


bullNSAIDS

CONSIDER

bullAntiemetic



omepraoleifnot)







Medication Review



Medication Review

Plan


Impression




RR

Sats

HR

BP

Fluid balance

Temp

AMT

BM

Agitationmood

GCS

CHEST-THOROUGH



management

HS

JVP

Calves

Mucus membranes

CRT








A

B

C

D

E


i temp spiked





prophylacticLMWH-PE


event


WHYhasthishappened


SEPTIC SCREEN





Initial Assessment

Investigations

Plan

Medication Review

Examination

History


A V P U

ABCDE ECG

CHEST and CVS

Hydration

Unwellorstable

Fluidbalance

- Is this acute



- CARDIAC history




bull ECG


result








Salbutamol 5mg neb







losartan

bull NSAIDS

bull IVFluids



ECG


bullArrythmias


Pwaves






Initial Assessment


Examination

Investigations

History

Plan


ABCDE









Consider









SEPTIC





Medication Review

Examination

History


Plan

Medication Review


A V P U

ABCDE




- Onset

- Duration



co-morbidities





bullRepeatbloods










JVP and ankles

Calves Thighs

Anaphylaxis

Pneumothorax




FACTORS or

DVTPE


MI






Initial Assessment

Examination

History



Medication Review


A V P U

ABCDE ECG



Chest and Abdo Exam


Mandatory

bullECG

Consider



bullUrineDipstick










bullCARDIAC HISTORY


MIAFArrhythmias

bullPreviousECGs























PR 100mg TDS

CO-CODAMOL





QUININE PO 200mg ON














(5HT3 antagonist)





Caution NSAIDs in

asthmaPUCRF

Pts with

renal colic

respond

well to PR

dicloenac



spasmodic and works

on smooth muscle

Greatforcramping

abdo pain




symptoms have ailed




Ondansetron is very



rst-line






(3-5days max)



ORAMORPH PO 5mg

LAXATIVES












ALCOHOL


Day1and220-30mgQDS

Day3and415mgQDS

Day510mgQDS

Day610mgBD

Day710mgNocte





Salbutamol causes

tachycardia







Wararin

Digoxin


















RecurrentDVT 2-3

PE 2-3

RecurrentPE 3-4




bull Rifampicin













Gentamicin



the next dose








Toxicity may

cause

Deaness

tinnitus

Nystagmus

Vertigo

RenalFailure

Monitor UEs

DAILY








14

13

12

11

10

9

8

7

6

5

4

32

1

06 7 8 9 10 11 12 13 14 15 16




Chemo 1995293650-655


(GentTobra 7mgkg


q48h

q36h

q24h





1 Reason or bleep





bullNotes

bullKardex







to help you



When you get there


whatrsquos going on



not





























In summary









5ReviewKARDEX

6 Problem list

7 Impression







Disclaimer

Copyright

Production

Contacts












Medication Review



Medication Review

Plan


Impression




RR

Sats

HR

BP

Fluid balance

Temp

AMT

BM

Agitationmood

GCS

CHEST-THOROUGH



management

HS

JVP

Calves

Mucus membranes

CRT








A

B

C

D

E


i temp spiked





prophylacticLMWH-PE


event


WHYhasthishappened


SEPTIC SCREEN





Initial Assessment

Investigations

Plan

Medication Review

Examination

History


A V P U

ABCDE ECG

CHEST and CVS

Hydration

Unwellorstable

Fluidbalance

- Is this acute



- CARDIAC history




bull ECG


result








Salbutamol 5mg neb







losartan

bull NSAIDS

bull IVFluids



ECG


bullArrythmias


Pwaves






Initial Assessment


Examination

Investigations

History

Plan


ABCDE









Consider









SEPTIC





Medication Review

Examination

History


Plan

Medication Review


A V P U

ABCDE




- Onset

- Duration



co-morbidities





bullRepeatbloods










JVP and ankles

Calves Thighs

Anaphylaxis

Pneumothorax




FACTORS or

DVTPE


MI






Initial Assessment

Examination

History



Medication Review


A V P U

ABCDE ECG



Chest and Abdo Exam


Mandatory

bullECG

Consider



bullUrineDipstick










bullCARDIAC HISTORY


MIAFArrhythmias

bullPreviousECGs























PR 100mg TDS

CO-CODAMOL





QUININE PO 200mg ON














(5HT3 antagonist)





Caution NSAIDs in

asthmaPUCRF

Pts with

renal colic

respond

well to PR

dicloenac



spasmodic and works

on smooth muscle

Greatforcramping

abdo pain




symptoms have ailed




Ondansetron is very



rst-line






(3-5days max)



ORAMORPH PO 5mg

LAXATIVES












ALCOHOL


Day1and220-30mgQDS

Day3and415mgQDS

Day510mgQDS

Day610mgBD

Day710mgNocte





Salbutamol causes

tachycardia







Wararin

Digoxin


















RecurrentDVT 2-3

PE 2-3

RecurrentPE 3-4




bull Rifampicin













Gentamicin



the next dose








Toxicity may

cause

Deaness

tinnitus

Nystagmus

Vertigo

RenalFailure

Monitor UEs

DAILY








14

13

12

11

10

9

8

7

6

5

4

32

1

06 7 8 9 10 11 12 13 14 15 16




Chemo 1995293650-655


(GentTobra 7mgkg


q48h

q36h

q24h





1 Reason or bleep





bullNotes

bullKardex







to help you



When you get there


whatrsquos going on



not





























In summary









5ReviewKARDEX

6 Problem list

7 Impression







Disclaimer

Copyright

Production

Contacts












Initial Assessment

Investigations

Plan

Medication Review

Examination

History


A V P U

ABCDE ECG

CHEST and CVS

Hydration

Unwellorstable

Fluidbalance

- Is this acute



- CARDIAC history




bull ECG


result








Salbutamol 5mg neb







losartan

bull NSAIDS

bull IVFluids



ECG


bullArrythmias


Pwaves






Initial Assessment


Examination

Investigations

History

Plan


ABCDE









Consider









SEPTIC





Medication Review

Examination

History


Plan

Medication Review


A V P U

ABCDE




- Onset

- Duration



co-morbidities





bullRepeatbloods










JVP and ankles

Calves Thighs

Anaphylaxis

Pneumothorax




FACTORS or

DVTPE


MI






Initial Assessment

Examination

History



Medication Review


A V P U

ABCDE ECG



Chest and Abdo Exam


Mandatory

bullECG

Consider



bullUrineDipstick










bullCARDIAC HISTORY


MIAFArrhythmias

bullPreviousECGs























PR 100mg TDS

CO-CODAMOL





QUININE PO 200mg ON














(5HT3 antagonist)





Caution NSAIDs in

asthmaPUCRF

Pts with

renal colic

respond

well to PR

dicloenac



spasmodic and works

on smooth muscle

Greatforcramping

abdo pain




symptoms have ailed




Ondansetron is very



rst-line






(3-5days max)



ORAMORPH PO 5mg

LAXATIVES












ALCOHOL


Day1and220-30mgQDS

Day3and415mgQDS

Day510mgQDS

Day610mgBD

Day710mgNocte





Salbutamol causes

tachycardia







Wararin

Digoxin


















RecurrentDVT 2-3

PE 2-3

RecurrentPE 3-4




bull Rifampicin













Gentamicin



the next dose








Toxicity may

cause

Deaness

tinnitus

Nystagmus

Vertigo

RenalFailure

Monitor UEs

DAILY








14

13

12

11

10

9

8

7

6

5

4

32

1

06 7 8 9 10 11 12 13 14 15 16




Chemo 1995293650-655


(GentTobra 7mgkg


q48h

q36h

q24h





1 Reason or bleep





bullNotes

bullKardex







to help you



When you get there


whatrsquos going on



not





























In summary









5ReviewKARDEX

6 Problem list

7 Impression







Disclaimer

Copyright

Production

Contacts












Initial Assessment


Examination

Investigations

History

Plan


ABCDE









Consider









SEPTIC





Medication Review

Examination

History


Plan

Medication Review


A V P U

ABCDE




- Onset

- Duration



co-morbidities





bullRepeatbloods










JVP and ankles

Calves Thighs

Anaphylaxis

Pneumothorax




FACTORS or

DVTPE


MI






Initial Assessment

Examination

History



Medication Review


A V P U

ABCDE ECG



Chest and Abdo Exam


Mandatory

bullECG

Consider



bullUrineDipstick










bullCARDIAC HISTORY


MIAFArrhythmias

bullPreviousECGs























PR 100mg TDS

CO-CODAMOL





QUININE PO 200mg ON














(5HT3 antagonist)





Caution NSAIDs in

asthmaPUCRF

Pts with

renal colic

respond

well to PR

dicloenac



spasmodic and works

on smooth muscle

Greatforcramping

abdo pain




symptoms have ailed




Ondansetron is very



rst-line






(3-5days max)



ORAMORPH PO 5mg

LAXATIVES












ALCOHOL


Day1and220-30mgQDS

Day3and415mgQDS

Day510mgQDS

Day610mgBD

Day710mgNocte





Salbutamol causes

tachycardia







Wararin

Digoxin


















RecurrentDVT 2-3

PE 2-3

RecurrentPE 3-4




bull Rifampicin













Gentamicin



the next dose








Toxicity may

cause

Deaness

tinnitus

Nystagmus

Vertigo

RenalFailure

Monitor UEs

DAILY








14

13

12

11

10

9

8

7

6

5

4

32

1

06 7 8 9 10 11 12 13 14 15 16




Chemo 1995293650-655


(GentTobra 7mgkg


q48h

q36h

q24h





1 Reason or bleep





bullNotes

bullKardex







to help you



When you get there


whatrsquos going on



not





























In summary









5ReviewKARDEX

6 Problem list

7 Impression







Disclaimer

Copyright

Production

Contacts














Medication Review

Examination

History


Plan

Medication Review


A V P U

ABCDE




- Onset

- Duration



co-morbidities





bullRepeatbloods










JVP and ankles

Calves Thighs

Anaphylaxis

Pneumothorax




FACTORS or

DVTPE


MI






Initial Assessment

Examination

History



Medication Review


A V P U

ABCDE ECG



Chest and Abdo Exam


Mandatory

bullECG

Consider



bullUrineDipstick










bullCARDIAC HISTORY


MIAFArrhythmias

bullPreviousECGs























PR 100mg TDS

CO-CODAMOL





QUININE PO 200mg ON














(5HT3 antagonist)





Caution NSAIDs in

asthmaPUCRF

Pts with

renal colic

respond

well to PR

dicloenac



spasmodic and works

on smooth muscle

Greatforcramping

abdo pain




symptoms have ailed




Ondansetron is very



rst-line






(3-5days max)



ORAMORPH PO 5mg

LAXATIVES












ALCOHOL


Day1and220-30mgQDS

Day3and415mgQDS

Day510mgQDS

Day610mgBD

Day710mgNocte





Salbutamol causes

tachycardia







Wararin

Digoxin


















RecurrentDVT 2-3

PE 2-3

RecurrentPE 3-4




bull Rifampicin













Gentamicin



the next dose








Toxicity may

cause

Deaness

tinnitus

Nystagmus

Vertigo

RenalFailure

Monitor UEs

DAILY








14

13

12

11

10

9

8

7

6

5

4

32

1

06 7 8 9 10 11 12 13 14 15 16




Chemo 1995293650-655


(GentTobra 7mgkg


q48h

q36h

q24h





1 Reason or bleep





bullNotes

bullKardex







to help you



When you get there


whatrsquos going on



not





























In summary









5ReviewKARDEX

6 Problem list

7 Impression







Disclaimer

Copyright

Production

Contacts












Initial Assessment

Examination

History



Medication Review


A V P U

ABCDE ECG



Chest and Abdo Exam


Mandatory

bullECG

Consider



bullUrineDipstick










bullCARDIAC HISTORY


MIAFArrhythmias

bullPreviousECGs























PR 100mg TDS

CO-CODAMOL





QUININE PO 200mg ON














(5HT3 antagonist)





Caution NSAIDs in

asthmaPUCRF

Pts with

renal colic

respond

well to PR

dicloenac



spasmodic and works

on smooth muscle

Greatforcramping

abdo pain




symptoms have ailed




Ondansetron is very



rst-line






(3-5days max)



ORAMORPH PO 5mg

LAXATIVES












ALCOHOL


Day1and220-30mgQDS

Day3and415mgQDS

Day510mgQDS

Day610mgBD

Day710mgNocte





Salbutamol causes

tachycardia







Wararin

Digoxin


















RecurrentDVT 2-3

PE 2-3

RecurrentPE 3-4




bull Rifampicin













Gentamicin



the next dose








Toxicity may

cause

Deaness

tinnitus

Nystagmus

Vertigo

RenalFailure

Monitor UEs

DAILY








14

13

12

11

10

9

8

7

6

5

4

32

1

06 7 8 9 10 11 12 13 14 15 16




Chemo 1995293650-655


(GentTobra 7mgkg


q48h

q36h

q24h





1 Reason or bleep





bullNotes

bullKardex







to help you



When you get there


whatrsquos going on



not





























In summary









5ReviewKARDEX

6 Problem list

7 Impression







Disclaimer

Copyright

Production

Contacts





















PR 100mg TDS

CO-CODAMOL





QUININE PO 200mg ON














(5HT3 antagonist)





Caution NSAIDs in

asthmaPUCRF

Pts with

renal colic

respond

well to PR

dicloenac



spasmodic and works

on smooth muscle

Greatforcramping

abdo pain




symptoms have ailed




Ondansetron is very



rst-line






(3-5days max)



ORAMORPH PO 5mg

LAXATIVES












ALCOHOL


Day1and220-30mgQDS

Day3and415mgQDS

Day510mgQDS

Day610mgBD

Day710mgNocte





Salbutamol causes

tachycardia







Wararin

Digoxin


















RecurrentDVT 2-3

PE 2-3

RecurrentPE 3-4




bull Rifampicin













Gentamicin



the next dose








Toxicity may

cause

Deaness

tinnitus

Nystagmus

Vertigo

RenalFailure

Monitor UEs

DAILY








14

13

12

11

10

9

8

7

6

5

4

32

1

06 7 8 9 10 11 12 13 14 15 16




Chemo 1995293650-655


(GentTobra 7mgkg


q48h

q36h

q24h





1 Reason or bleep





bullNotes

bullKardex







to help you



When you get there


whatrsquos going on



not





























In summary









5ReviewKARDEX

6 Problem list

7 Impression







Disclaimer

Copyright

Production

Contacts















(3-5days max)



ORAMORPH PO 5mg

LAXATIVES












ALCOHOL


Day1and220-30mgQDS

Day3and415mgQDS

Day510mgQDS

Day610mgBD

Day710mgNocte





Salbutamol causes

tachycardia







Wararin

Digoxin


















RecurrentDVT 2-3

PE 2-3

RecurrentPE 3-4




bull Rifampicin













Gentamicin



the next dose








Toxicity may

cause

Deaness

tinnitus

Nystagmus

Vertigo

RenalFailure

Monitor UEs

DAILY








14

13

12

11

10

9

8

7

6

5

4

32

1

06 7 8 9 10 11 12 13 14 15 16




Chemo 1995293650-655


(GentTobra 7mgkg


q48h

q36h

q24h





1 Reason or bleep





bullNotes

bullKardex







to help you



When you get there


whatrsquos going on



not





























In summary









5ReviewKARDEX

6 Problem list

7 Impression







Disclaimer

Copyright

Production

Contacts












Wararin

Digoxin


















RecurrentDVT 2-3

PE 2-3

RecurrentPE 3-4




bull Rifampicin













Gentamicin



the next dose








Toxicity may

cause

Deaness

tinnitus

Nystagmus

Vertigo

RenalFailure

Monitor UEs

DAILY








14

13

12

11

10

9

8

7

6

5

4

32

1

06 7 8 9 10 11 12 13 14 15 16




Chemo 1995293650-655


(GentTobra 7mgkg


q48h

q36h

q24h





1 Reason or bleep





bullNotes

bullKardex







to help you



When you get there


whatrsquos going on



not





























In summary









5ReviewKARDEX

6 Problem list

7 Impression







Disclaimer

Copyright

Production

Contacts












Gentamicin



the next dose








Toxicity may

cause

Deaness

tinnitus

Nystagmus

Vertigo

RenalFailure

Monitor UEs

DAILY








14

13

12

11

10

9

8

7

6

5

4

32

1

06 7 8 9 10 11 12 13 14 15 16




Chemo 1995293650-655


(GentTobra 7mgkg


q48h

q36h

q24h





1 Reason or bleep





bullNotes

bullKardex







to help you



When you get there


whatrsquos going on



not





























In summary









5ReviewKARDEX

6 Problem list

7 Impression







Disclaimer

Copyright

Production

Contacts














1 Reason or bleep





bullNotes

bullKardex







to help you



When you get there


whatrsquos going on



not





























In summary









5ReviewKARDEX

6 Problem list

7 Impression







Disclaimer

Copyright

Production

Contacts
























In summary









5ReviewKARDEX

6 Problem list

7 Impression







Disclaimer

Copyright

Production

Contacts












Disclaimer

Copyright

Production

Contacts










atsp (asked to see patient) booklet

Documents