Therapeutic Handbook - GGC Prescribing

More documents

Recommendations

Info

Tachycardia – treatment algorithm (with pulse)Reproduced with the kind permission of the Resuscitation Council (UK) www.resus.org.ukResuscitation and Anaphylaxis• Assess using the ABCDE approach• Give oxygen if appropriate and obtain IV access• Monitor ECG, BP, SpO 2, record 12-lead ECG• Identify and treat reversible causes (e.g. electrolyte abnormalities)YES / UnstableSynchronised DC Shock*Up to 3 attempts• Amiodarone IV 300 mg over 10 - 20minutes and repeat shock;followed by:• Amiodarone 900 mg IV over 24 hoursAdverse features?• Shock• Syncope• Myocardial ischaemia• Heart failureNO / StableIs QRS narrow (< 0.12 sec)?Broad QRS -Is rhythm regular?Narrow QRS -Is rhythm regular?IrregularSeek expert helpPossibilities include:• AF with bundle branch block– treat as for narrow complex• Pre-excited AF– consider amiodarone• Polymorphic VT(e.g. torsades de pointes –give magnesium IV 2 gover 10 minutes)IrregularIrregular Narrow ComplexTachycardiaProbable atrial fibrillationControl rate with:• Beta-blocker or diltiazem• Consider digoxin oramiodarone if evidence ofheart failure.Regular – next pageRegular – next page*Attempted electrical cardioversion is always undertaken under sedation or general anaesthesia.Page 22
Broad QRS – continuedNarrow QRS – continuedRegularIf Ventricular Tachycardia(or uncertain rhythm):• Amiodarone IV 300 mgover 20 - 60 minutes;then 900 mg over 24 hoursIf previously confirmed SVT withbundle branch block:• Give adenosine as forregular narrow complextachycardiaRegular• Use vagal measures• Adenosine 6 mg rapid IVbolus;if unsuccessful, give 12 mg;if unsuccessful give further12 mg• Monitor ECG continuouslySinus rhythm restored?Resuscitation and AnaphylaxisYESNOProbable re-entryparoxysmal SVT:• Record 12-lead ECG insinus rhythm• If recurs, give adenosineagain and consider choiceof anti-arrhythmicprophylaxisSeek expert helpPossible atrial flutter• Control rate(e.g. beta-blocker)Page 23
Page 4: ContentsEditorial GroupAcknowledgem
Page 8 and 9: AppendicesAppendix 1 - Nicotine Rep
Page 10 and 11: AcknowledgementsA huge number of pe
Page 12 and 13: Summary of Major changes in Therape
Page 14 and 15: On discharge• As the discharge pr
Page 16: Other examples• Sevredol 10 mg ta
Page 19 and 20: Antiplatelets and anticoagulants:In
Page 21 and 22: non-Formulary medicines, a complete
Page 23 and 24: Quick guide to using the handbookWh
Page 25 and 26: Sections1. Resuscitation and Anaphy
Page 27 and 28: Section 1Resuscitation and Anaphyla
Page 29 and 30: Continued from previous page2. Adre
Page 31: Peri-arrest ArrhythmiasGeneral advi
Page 35 and 36: Guidelines on Blood TransfusionThis
Page 37 and 38: Management of Major Haemorrhage(See
Page 39 and 40: Hospital Specific Information on Ma
Page 41 and 42: Table continued from previous pageG
Page 43 and 44: Assessment / MonitoringAKI stage I
Page 45 and 46: Section 2Drug Overdose and Toxicity
Page 47 and 48: Treatment of Paracetamol OverdoseTh
Page 49: Management of paracetamol overdose
Page 52 and 53: Lithium toxicityNormal range 0.4 -
Page 54 and 55: Management of DyspepsiaGastrointest
Page 57 and 58: Table continued from previous pageR
Page 59 and 60: Management of Gastroduodenal Ulcers
Page 61 and 62: Management of Upper Gastrointestina
Page 63 and 64: Post endoscopy continuedb. Arrange
Page 65 and 66: General management and treatment op
Page 67 and 68: - SAAG can differentiate ascites re
Page 69 and 70: General management and drug therapy
Page 71 and 72: Drug therapy• Unless contraindica
Page 73 and 74: Consider:• Serum caeruloplasmin,
Page 75 and 76: Section 4Cardiovascular SystemCardi
Page 77 and 78: Table 1 - Indicators of patients at
Page 79 and 80: Continued from previous pageIf the
Page 81 and 82: Diagnosis and Treatment of VenousTh
Page 83 and 84:
Wells Clinical score should be util
Page 85 and 86:
IV Drug Misusers• Given their cha
Page 87 and 88:
Drug therapy / treatment options co
Page 89 and 90:
RivaroxabanRivaroxaban is an oral d
Page 91 and 92:
Diagnosis of VTE in pregnancy• If
Page 93 and 94:
Referral of Patients to Anticoagula
Page 95 and 96:
Reversal of Anticoagulant TherapyIn
Page 97 and 98:
General management and drug therapy
Page 99 and 100:
Elective admissions - Risk Stratifi
Page 101:
Elective admissions - restarting an
Page 104 and 105:
Suspected Acute Coronary Syndrome (
Page 106 and 107:
If patient is for PPCI go to Box 1.
Page 108 and 109:
Drugs for acute coronary syndrome /
Page 110 and 111:
Secondary Prevention of Coronary He
Page 112 and 113:
Cardiovascular SystemTroponin posit
Page 114 and 115:
Atherosclerotic arterial disease is
Page 116 and 117:
Algorithm for Cardioversion of AFSt
Page 118 and 119:
Cardiovascular SystemVentricular ra
Page 120 and 121:
Prevention of stroke / thromboembol
Page 122 and 123:
Drugs for atrial fibrillation conti
Page 124 and 125:
CPAP in cardiogenic pulmonary oedem
Page 126 and 127:
Management of HypertensionCardiovas
Page 128 and 129:
General management and drug therapy
Page 130 and 131:
Cardiovascular SystemGeneral manage
Page 132 and 133:
Management of Acute Stroke 3Transie
Page 134 and 135:
Secondary prevention of stroke and
Page 136 and 137:
Cardiovascular SystemPage 126
Page 138 and 139:
Guidelines for Blood Gas AnalysisRe
Page 140 and 141:
Respiratory SystemNext consider aci
Page 142 and 143:
Management of Acute Severe Asthmain
Page 144 and 145:
Management of Acute Severe Asthma i
Page 146 and 147:
Management of Chronic ObstructivePu
Page 148 and 149:
Acute Exacerbation of Chronic Obstr
Page 150 and 151:
Treatment options continued• If p
Page 153 and 154:
Step 4 - Initiation of NIVAIM = To
Page 155 and 156:
Investigation of Unilateral Pleural
Page 157 and 158:
Investigation of unilateral pleural
Page 159 and 160:
General management• Oxygen as app
Page 161 and 162:
Management of PneumothoraxIntroduct
Page 163 and 164:
Management of StridorIntroductionSt
Page 165 and 166:
Initial Management of Superior Vena
Page 167 and 168:
Section 6Central Nervous SystemCent
Page 169 and 170:
Analgesics for acute painSTEP 3STEP
Page 172 and 173:
Analgesics for acute pain - prescri
Page 174 and 175:
Management of Postoperative Nausea
Page 177 and 178:
Management of Acutely Disturbed Pat
Page 179 and 180:
Pharmacological Management - Patien
Page 181 and 182:
Guidance on Night SedationPatients
Page 183 and 184:
Management of Alcohol Withdrawal Sy
Page 185 and 186:
Continued from previous pageUnable
Page 187 and 188:
Continued from previous pageImporta
Page 189 and 190:
Flow diagram for use with Hospital
Page 191 and 192:
Continued from previous pageMethado
Page 193 and 194:
Management of Suspected Subarachnoi
Page 195 and 196:
Sampling requirements for the Bioch
Page 197 and 198:
Referral to Neurosurgical Unit cont
Page 199 and 200:
Management of Status EpilepticusInt
Page 201 and 202:
OtherInitiating Long-term Anti-epil
Page 203 and 204:
Continued from previous page2. 'Top
Page 205 and 206:
Decision making algorithm for the a
Page 207 and 208:
Drug therapy / treatment optionsNil
Page 209 and 210:
Section 7InfectionsInfectionsPage 1
Page 211 and 212:
• In patients with sepsis -- Star
Page 213 and 214:
Gentamicin and Vancomycin: Reducing
Page 215 and 216:
IV-Oral Antibiotic Switch Therapy (
Page 217 and 218:
Alert Antibiotic Policy(The full ve
Page 219 and 220:
Table 1 - Alert Antibiotics continu
Page 221 and 222:
Infection Management GuidelinesSeve
Page 223 and 224:
Sepsis Source Unknown (not immunoco
Page 225 and 226:
Table continued form previous pageI
Page 227 and 228:
Table continued from previous pageE
Page 229 and 230:
UTI in non-pregnant women Antibioti
Page 231 and 232:
UTI in pregnant women Antibiotic Th
Page 233 and 234:
Table continued from previous page
Page 235 and 236:
Catheter-related UTI Antibiotic The
Page 237 and 238:
Table continued from previous pageU
Page 239 and 240:
Table continued from previous pageU
Page 241 and 242:
Pneumonia(Also see page 148 for man
Page 243 and 244:
Table continued from previous pageC
Page 245:
Pneumonia (continued from previous
Page 248 and 249:
InfectionsTable continued from prev
Page 250 and 251:
Treatment of Clostridium difficile
Page 252 and 253:
InfectionsSkin and soft tissue infe
Page 254 and 255:
InfectionsSkin and soft tissue infe
Page 256 and 257:
Central nervous system infectionsBa
Page 258 and 259:
Meningitis Contacts• All suspecte
Page 260 and 261:
Viral infectionsViral Encephalitis
Page 262 and 263:
Guideline updated 11/10/13Genito-ur
Page 264 and 265:
Genito-urinary infections (continue
Page 266 and 267:
Patients with absent or non-functio
Page 268 and 269:
MRSA Eradication Policy• In newly
Page 270 and 271:
InfectionsDosage regimens for antib
Page 272 and 273:
Gentamicin dosing guidelines (For p
Page 274 and 275:
Step 2 continued from previous page
Page 276 and 277:
Vancomycin dosing guidelines (For p
Page 278 and 279:
Continued from previous page - If t
Page 280 and 281:
B. Vancomycin continuous infusionSt
Page 282 and 283:
Vancomycin - continuous infusion re
Page 284 and 285:
InfectionsPage 274
Page 286 and 287:
Management of Diabetic Ketoacidosis
Page 288 and 289:
Endocrine System5. Signs of cerebra
Page 290 and 291:
Assessment / monitoring• Glucose
Page 292 and 293:
Important points1. This regimen is
Page 294 and 295:
Diabetes therapy continued• Retro
Page 296 and 297:
Insulin Sliding Scale (Not for use
Page 298 and 299:
Management of HypoglycaemiaIntroduc
Page 300 and 301:
Endocrine SystemContinued from prev
Page 302 and 303:
Oral antidiabetic drugs continued3.
Page 304 and 305:
Other InformationGeneral advice on
Page 306:
Guideline updated 18/09/13Managemen
Page 309 and 310:
Page 311 and 312:
Management of hypomagnesaemia in ad
Page 313 and 314:
Page 315 and 316:
Page 317 and 318:
Management of Hyponatraemia• Earl
Page 319 and 320:
Section 10Musculoskeletal and Joint
Page 321 and 322:
Treatment optionsManagement of acut
Page 323 and 324:
Treatment options continuedNSAIDs a
Page 325 and 326:
Section 11Palliative CarePalliative
Page 327 and 328:
Analgesic Step LadderStep 1: Mild P
Page 329 and 330:
Opioid Conversion ChartThis is advi
Page 331 and 332:
Palliative Care - SymptomsSee BNF,
Page 333 and 334:
Table continued from previous pageP
Page 335 and 336:
Management of symptoms present in l
Page 337 and 338:
Section 12Oncological EmergenciesOn
Page 339 and 340:
Malignant Spinal Cord Compression (
Page 341 and 342:
Raised intracranial pressure in can
Page 343 and 344:
Treatment /drug therapy continued5.
Page 345 and 346:
N.B.• Laboratory TLS = > 2 labora
Page 347 and 348:
• Avoid serum CA125 testing as it
Page 349 and 350:
AppendicesAppendicesPage 339
Page 351 and 352:
Appendix 2Preparation of Intravenou
Page 353 and 354:
Glyceryl Trinitrate (GTN) infusionG
Page 355 and 356:
Table 2 - Other drugsDrug Time to s
Page 357 and 358:
Appendix 5Normal ImmunoglobulinsNor
Page 359 and 360:
Drug MisuseHospital Liaison Addicti
Page 361 and 362:
Outpatient Parenteral Antibiotic Th
Page 363 and 364:
IndexPage 353
Page 365 and 366:
AnticoagulantsIn treatment of VTE/P
Page 367 and 368:
CiprofloxacinAlert Antibiotic Polic
Page 369 and 370:
EEmergency sedationGeneral principl
Page 371 and 372:
Hyoscine butylbromideIn palliative
Page 373 and 374:
Mesalazine, oralIn inflammatory bow
Page 375 and 376:
PhenytoinDosing and monitoring guid
Page 377 and 378:
TeicoplaninDosing and monitoring...
Page 379 and 380:
Notes
Page 381 and 382:
Notes
Page 384:
© NHS Greater Glasgow and ClydeAug
show all

Therapeutic Handbook - GGC Prescribing

Create successful ePaper yourself

Delete template?

Save as template?