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Acute exacerbation of COPD

Assess the severity of the patient (History, signs and symptoms, vitals, ABG, CXR)

Administer Nebulization Duolin without O2 (3 times)

Administer Nebulization Buedecort without O2 STAT

Methylprednisolone 125 mg IV STAT

If SpO2 still

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Mild Anaphylaxis (only skin reactions)Inj.Avil 45mg IV st

Inj.Ranitidine 50mg IV stT.Prednisolone 60mg PO st

Observe for at least 2 hours

Moderate AnaphylaxisInj. Adrenaline 0.5mg of 1:1,000 IM, every 5 minutes, titrate to effects (0.01ml/kg

in paediatrics)

Severe AnaphylaxisInj.Adrenaline 0.1 mg IV, only if severe hypotension / life-threatening shock

(0.1ml/0.1mg of 1:1000 in 10ml NS, give over 5-10 minutes)

Closely watch for chest pain or arrhythmias

Anaphylaxis

Dr.Binu Ramesh ,MD, DM , Dr.Rehman & Arunshree-R

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Common for moderate and severe anaphylaxis

IVF - 1 to 2 L of Crystalloid bolus (20ml/kg in paediatrics)

Inj.Avil 45mg IV st

Inj.Ranitidine 50mg IV st

Inj.Methylprednisolone 125mg IV st (1-2mg/kg in paediatrics)

Bronchospasm: Nebulized Levo-salbutamol 1.2mg.Nebulized Ipratropium 0.5mg.

Refractory Bronchospasm: Inj. Aminophyline 5.6 mg/kg IV over 20 minutesOr

Inj.Magnesium 2gm over 30 minutes (25-50mg/kg in paediatrics)

Refractory Hypotension: Inj.Glucagon 1-5mg IV over 5 minutesfollowed by 5-15 g/min continuous infusion

Inj.Dopamine 10-15 g/kg/min IV infusion (after discontinuing adrenaline)

Anaphylaxis (contd)

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SNAKE BITE

ASV- If the patient has evidence of envenomation, then 10 vials ofASV administered over 1 hour, diluted in 5-10ml/kg NS / 5D

Adrenaline is made ready in two syringes of 0.5 mg in 1:1000 for IMadministration if symptoms of any adverse reaction appear. Repeatevery 5-10 minutesIf symptoms appear, ASV is temporarily suspended and thenrecommenced Neostigmine 1.5-2.0mg IV with Atropine 0.6mg IV,Observe for 1 hour

Neostigmine Test for Neurotoxic envenomation - Neostigmine 1.5-2.0mg IV with Atropine 0.6mg IV, Observe for 1 hour

Dr.Binu Ramesh ,MD, DM , Dr.Rehman & Arunshree-R

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Eclampsia

Keep a wedge on right side of patient / turn the patient to left lateral position

Maintain Airway, Breathing, Circulation

GRBS & ABG analysis

Magnesium sulphate 4 gms iv in 100 ml NS over 15 minutes, followed by 1 gm/hour

for 24 hours

Watch out for toxicity (respiratory depression, loss of deep tendon reflex, decreased urine

output)

Dr.Binu Ramesh ,MD, DM , Dr.Rehman & Arunshree-R

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Status EpilepticusAirway, Breathing, Circulation

Inj. Lorazepam 0.1 mg/kg or 4 mg IV (Can be repeated once if no response in 5 min)

OR

Inj. Diazepam 0.15 mg/kg or 5 - 10 mg IV

Inj. Phenytoin 20-30 mg/kg IV @ 50 mg/min

OR

Inj. Fosphenytoin 20-30 mg/kg/PE @ 150 mg/min

Refractory Status Epilepticus (Any one drug below)

Inj. Valproate 20 - 30 mg/kg loading dose @ 5mg/kg/min (in patients already on valproate)

Inj. Levetiracetam 1000 mg IV

Inj. Phenobarbital 20 mg/kg @ 60 mg/min

Inj. Propofol 2 5 mg/kg IV loading dose + infusion @ 2-10mg/kg/hr

Inj. Midazolam 0.2 mg/kg IV loading dose + infusion @ 0.5 -2 mg/kg/hr

Inj. Ketamine 1.5 mg/kg bolus + 0.01 -0.05 mg/kg/hr

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Atropine 2-5 mg IV every 10-15 mins - to reverse muscarinic symptoms

End point - drying of respiratory secretions and normal pupil size

Pralidoxime (PAM) or obidoxime 1-2 gm IV over 30-60 mins to reverse nicotinic symptoms

(should not be given in carbamate poisoning)

Organo-Phosphorous Poisoning

Methanol Poisoning

Loading dose : 10 ml/kg of 10% EtOH in 5% Dextrose IV over 30 min OR give PO/NG

Maintenance: 1-2 ml/kg/hrDr.Binu Ramesh ,MD, DM , Dr.Rehman & Arunshree-R