Routine Prescriptions James Bonnington

‘Routine prescriptions’ No patient is standard Always think before you prescribe Medication Infusions Parameters

Medication VTE prophylaxis Stress related mucosal damage Analgesia Incidence of DVT 13-31% (U/S) PE at post mortem 27% LMWH  Incidence 50% Enoxaparin 40mg (20 mg GFR <30) Mechanical ? monotherapy effective Flowtrons IVC filter VTE prophylaxis Stress related mucosal damage Analgesia Paracetamol Bowel management Opiates cause constipation Sodium docusate 200mg bd + Senna 10ml bd NG Eye protection Celluvisc 1% tds Plus lacrilube nocte 74-100% of patients 25% GI bleed 0.6-4% with treatment Barrier protection Sucralfate H2 antagonist Ranitidine 50mg tds IVI  VAP ? Tachyphylaxis after 48 hours PPI Omeprazole/lansoprazole Little evidence C Diff ? Feed

Infusions Insulin – sliding scale Sedation/analgesia Alfentanil and propofol as default Alfentanil and midazolam if AKI Morphine and Midazolam if longer Remember infusion strength and bolus doses Vasopressors/inotropes Noradrenaline Remember set limit (1 ml/kg/h) Potassium Unless contraindicated Maintenance fluid Usually required first 24 hours Prescribe for 24 hours if possible Plasmalyte Nutrition Feed as soon as possible mmo/l Hartmann’s Plasma-Lyte 148 Na 133 140 Cl 111 98 K 5 Ca 2 Mg 1.5 Lactate 29 Acetate 27 Gluconate 23 Osmolarity 279 mOsm 294 mOsm

Parameters As a minimum SaO2 PaCO2 TV MAP U/O Specific