Clnical orientation programme in pharmacotherapeutics

•EMERGENCY TRAUMA CENTER

R.M.D RATHNAYAKEMD/PH/2011/38

objectives•To describe the general procedures

followed in the unit

•To list the common clinical investigations

•To describe the available Drugs and their storage conditions in the unit

EMERGENCY TRAUMA CENTER (ETC)•The trauma center is a hospital

equipped and staffed to provide comprehensive emergency medical services to patients suffering

•traumatic injuries,• medical emergencies,• poisoning,• snake bites….etc.

General Procedures• Admission All the patients who are admitted to the ETC are

categorized by determining the priority of patients' treatments based on the severity of their condition

•Mainly 4 categories.1. CAT 1 examine by a physician immediately2. CAT 2 examine by a physician within 10 min3. CAT 3 examine by a physician within 30 min4. CAT 4 examine by a physician within 1hr

• CAT 1 CAT 2

• CAT 3

• CAT 4

Some patients will be sent to surgery procedures according to their condition.

Admit to the WARDs

Admit to the TREATMENT BAY

Admit to the RESUS

•Patients who are needed to do cardio pulmonary resuscitation(revive from unconciousness) is done at RESUS to restore spontaneous blood circulation and breathing in a person who is in cardiac arrest.

•Airway management is done by Rapid Sequence Intubation.

•Patients with following clinical conditions are given early medication attention.

Chest pain▫ Acute coronary syndrome▫ Significant cardiac arrhythmia▫ Aortic dissection▫ Pneumothorax▫ Pulmonary embolism

Acute SOB▫ Pneumonia▫ Asthma moderate/severe▫ Exacerbation COPD

Fever▫ Septicemia▫ Leptospirosis

Snake bites poisoning

Common Clinical Investigations• Full Blood Count• Blood Urea• Serum electrolytes• Creatinine• C-RP• Culture and ABST• ECG• Chest X-Ray• USS• Echocardiogram• CBS• RBS• CT Scan

Available drugs and their storage conditionsDrug cupboardDrugs in the cupboard are stored under the controlled temperature (21-250C) within the RESUS area.

Cardiac Drugs

Other Oral Drugs

Other Parenteral Drugs

IV antibiotics

Dopamine Aspirin Diazepam AcyclovirKCl Nitroglycerine Ranitidine AmpicillinVerapamil Omeprazole Dexamethaso

neCloxacillin

Atropine Clopidogrel Neurobion Co – Amoxiclave

Frusemide Tramadol Ondansetrone

Cefataxime

GTN Metformin Snake venom CefuroximePropanalol Diclofenac

sodiumanti serum Clarithromy

cinEpinephrine Atenolol Chlophenira

mine Meropenem

Isoprenaline Nimodipine Pantaprazole ImipenemHydrolazine Glibenclamide VancomycinAdenosine Losartan K GentamycinAmioderone Activated

charcoalClindamycin

•RefrigeratorsDrugs in the two refrigerators are stored under temperature 2-80C within the RESUS area.

Lidocaine inj.Thiopental sodium for inj.r- human erythropoietin inj.Heparin inj.Vasopressin inj.Oxytocin inj.Normal immunoglobulin IVStreptokinase for inj. Domperidone sup:Human Insulin for inj.Human AlbuminDiazepam rectal tube

•Drugs for Rapid Sequence Intubation Drug boxes which are allocated to each bed for RSI are stored in the refrigerator under 2-80C. Name of the drug Route

Thiopental Sodium inj. IV

Suxamethonium IM/IV/IV infusion

Midazolam IM/IV

Ketamine Slow IV/deep IM

Atracurium IV only

Tetanus Toxoid IM

•Drugs for each patient according to their treatment regime is placed along their bed sides in each trolley.

•Two separate trolleys for Injectable drugs and Oral drugs are allocated in the treatment bays under the room temperature (Below 30oC).

Emergency trolley

Emergency trolleyDrug category Drugs RouteSymphathomimetics Adrenaline

Noradrenaline Isoprinaline Dopamine Dobutamine

Anticholinergics Atropine Antiarrythmics Ameodarone

Adenosine Vasodilators GTN

Hydralazine Parenteral

Cardiac glycosides Digoxin CCB Verapamil

Beta blockers Metaraminol

Diuretics Frusemide

Category Name of the Drug

Route

Antihistamines Chlopheneramine Promethazine

Opioid antagonists Naloxone

Benzodiazepines DiazepamMidazolam

Parenteral

Anticonvulsants Calcium gluconate

IV fluids 5% Dextrose8.4%w/v NaHCO3

Electrolites KCl

•CLINICAL ORIENTATION PROGRAMME IN PHARMACOTHERAPEUTICS

• • CARDIOLOGY UNIT

Objectives•To describe the general procedures

followed in the unit

•To list the common clinical investigations

•To describe the available Drugs and their storage conditions in the unit

Cardiology unit•Consists of a hospital ward,• Coronary Care Unit

(CCU) • Cardiac Intensive

Care Unit(CICU) • Cath Lab.

specialized in the care of patients with•Myocardial Infarction• unstable angina• cardiac dysrhythmia and • various other cardiac conditions that

require continuous monitoring and treatment

The Cardiology Unit receives adult and elderly patients from;

the Emergency Trauma Centertransfers from other facilitiesdirect admissions from the Cardiology

Clinicintra-hospital transfersPatients also move from the Intensive

Care Unit to the Cardiology Inpatient Unit.

Common DiagnosesThe Cardiac and Intensive Coronary Care Units

treat patients for:Myocardial InfarctionHypertensionArrhythmia managementUnstable anginaCongestive heart failureMyocarditisHeart catheterizationPacemaker placements

General Procedures Professional interventions include:

Assessment, planning, implementation and evaluation of therapeutic regimes

•Invasive physiologic monitoring such as arterial blood pressure, central venous pressure, pulmonary artery monitoring, cardiac output measurement and ECG monitoring including ST segment analysis

•Pre- and post-cardiac procedural care•Administration of vasoactive and

therapeutic medications

Diagnostic tests•Angiogram/Angiography(Arteriogram)•Echocardiogram•Exercise ECG

Common clinical investigations•Serum Ferritin•Free T4

•TSH•C-RP•Troponin I.•SE (Na+, K+)•Lactate Dehydrogenase(LDH)•Hydroxy Butyrate Dehydrogenase(HBDH)

Cont…….

•BP•Urea Reduction Ratio•FBS•WBC•Hb•PLT

Available drugs and their storage conditions• Drug cupboard

Drugs in the cupboard are stored according to the alphabetical order, under the room temperature (Below 30oC).

Category Name of the Drug RouteAntibiotics Amoxicillin

CloxacillinMetronidazoleO.Penicillin

Anti arrhythmic Amiodarone OralAntacids Aluminium Hydroxide(Aludrox)Anti TB Rifampicin

Isoniazide

Category Name of the drug RouteBeta blockers Atenolol

CarvedilolPropanolol

Antiplatelets AspirinClopidogrel

Statins AtorvastatinACE inhibitors Captopril

EnalaprilSuppliments Cal. Lactate Oral

Folic acidVitamin B-complexVitamin CVitamin A & D

Anti psychotics CarbamazepineCarbimazolePhenytoin Na

Anticoagulants Warfarin Na

Category Name of the drug Route

Calcium channel Blockers Diltiazem

Nifedipine SR

Verapamil

Anti emetics Domperidone

Metoclopramide

Prochlorperazine

H2 Histamine antagonist Famotidine

Diuretics Frusemide OralHCT

Spiranolactone

Immunosuppressants Dexamethasone

Prednisolone

NSAIDs Diclofenac Na

Ibuprofen

Cardiac Glycosides DigoxinHormones Thyroxine

Category Name of the drug Route

Hypoglycaemics Glibenclamide

Metformin

Tolbutamide

Nitrates ISMN

ISDN

Electrolytes KCl

Angiotensin receptor blockers

Losartan K

Anxiolytics Chlordiazepoxide

Diazepam OralAntihelmintics Mebendazole

Antihypertensives Methyldopa

Proton Pump Inhibitors Omeprazole

Alfa blockers Prazosin

Analgecics Paracetamol

Antihistamines Chlorpheniramine

Beta agonists Salbutamol

•RefrigeratorDrugs are stored in the refrigerator under

the temperature 2-8oC.

Name of the drug RouteAmpicillinFrusemideDobutamineDopamine ParenteralGTNCiprofloxacinAmiodarone

Category Name of the drug Route01.

Hypoglycaemics Insulin(Mixtard) IV

02.

Anticoagulants Heparin IV

Emergency trolleyDrugs are stored under the room temperature (below 300C).

Name of the drug RouteAdrenalineAtropineAmiodaroneDopamineDobutamine ParenteralCalcium gluconateHydrocortisoneFrusemideNaHCO3

Chlorpheniramine

Drugs in the Coronary Intensive Care Unit are stored in racks under controlled temperature 21-250CName of the Drug Route

MorphineMidazolamPromethazineNaloxoneDobutamineGTNAdrenalineFrusemide ParenteralAtropineNoadrenalineDopamineAmiodaroneVit KMetachlopramide