1. Routine Prescriptions
James Bonnington

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

3. 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

4. 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

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