sertraline 215 service provision 16 severe acute respiratory syndrome (SARS) 487 Sevredol see morphine, sinus rhythm 572 sinus tachycardia 250, 251 sinusitis 359, 361 SIRS (systemic sore throat 461 sotalol 188 space-occupying lesions 355 spastic gait 136 specialist registr ars 66 specialties in medicine 51 specialty training 43, 47 infl ammatory response syndrome) 481 oral sexual harassment 34 sexually transmitted infections 465 sitagliptin 329 Situational Judgment Tests (SJT) 5 sharps 13 situational syncope 443 Sj gren \200\231s syndrome 593 applications 44 career structure 45 needle-stick injuries 106, 228 _OHFP.indb 639 _OHFP.indb 639 30/05/2014 16:19 30/05/2014 16:19 640 INDEX in-patient Stevens-Johnson syndrome 418 competition 48 \200\2239 fi xed-term preparation 111 instruments 113 operating theater 114 \200\223 Stokes-Adams attacks 347 stomas 121 stones appointments 67 options 46 \200\2237 recruitment process 44 15 post-operative care 116, gallbladder 319 kidney 588 specifi c gravity of urine 590 118 post-operative stool culture 309 STOP (surgical termination of pregnancy) 503 Spencer Wells forceps 113 spermatocele 463 spherocytes 393 spider naevi 131 SPIKES model 22 spinal problems 117 pre-operative assessment 107 \200\2238 strabismus 143 strains 435 strangulated terminology 110 theater lists 112 watching hemorrhoids 303 strangulated hernia 290, anesthesia 558 anatomy 149 cord compression 356, operations 115 see also operating 462 theater; and specifi c procedures strangulation of bowel 292 streptokinase 198, 536 stress 357 curvature 356 examination 149 shock 476, 477, 481 stenosis 355 tracts 136 tuberculosis 491 surgical instruments 113 surveillance 487 \200\230Surviving Sepsis \200\231 campaign 481 s utures 436, 560 \200\2231 materials 561 removal 561 size 561 causes 35 work-related 34 stridor 284 stroke (CVA) 350 \200\2233 ABCD2 score 352 Bamford spinothalamic tract 136 Spiriva 275 spirometry 586 \200\2237 spironolactone 215, 333 sple nomegaly 131 spondylarthropathies 452 spondylolisthesis 357 spondylolysis 357 spondylosis 3 57 spontaneous bacterial classifi cation 251 driving regulations 605 emergency care 350 SVC (superior vena cava) obstruction 283 SVT (supraventricular tachycardia) 250, 251, 253 swabs 411 swallowing, stro ke patients 352 swelling, limb 449 \200\22351 Symbicort 216, 275 symbols and study expenses 58 study leave 58 subarachnoid hemorrhage 360 subclavian artery 535 subclavian vein 535 subconjunctival peritonitis (SBP) 316 sprains 435 hemorrhage 428 whiplash injury 440 subcutaneous (SC) injection 524 \200\2235 squamous-cell carcinoma (SCC) 422 abbreviations xix \200\223xxxii subdural haematoma 343, ssDNA antibodies 593 ST elevation myocardial infarction see STEMI patient notes 76 prescriptions 169 sympathectomy 89 Synacthen see 438 substance abuse 365 driving regulations 605 ST segment 573 stable angina 242, 246 Staphylococcus aureus cellulitis 412, 446 toxic shock 480 suction 230 suicide 484 sulfasalazine 216 sulphonylureas 216, 329 superfi cial tetracosactide syncope 362, 442 cardiac 442 driving regulations 605 vasovagal attacks 260, statins 215 status asthmaticus 214 status epilepticus 195, 199, thrombophlebitis 445 superior vena cava (SVC) 347, 442 syndrome of inappropriate obstruction 283 206, 212 ADH secretion (SIADH) 386 synovial fl uid 557 syphilis 465 syringe drivers 88 systemic infl ammatory response syndrome (SIRS) 481 systemic lupus Stemetil see phenothiazine STEMI 242, 244, 574 supervised learning events (SLEs) 9 suprapubic catheter 548 supraventricular cardiac markers 243, 567 ECG changes 578, 580 thrombolysis 350, 536 tachycardia (SVT) 250, 251, 253 steppage gait 136 stereotypy 162 sterilization 501 steristrips \204 436 steroids see surgery (career) 57 surgery (clinical) bowel preparation 109, erythematosus (SLE) 453, 457 189 checklist 111 elective 119 \200\22320 skin manifestations 419 corticosteroids systemic rheumatic disease 452 stethoscope 14 HFP End.indd 640 OHFP End.indd 640 30/07/2014 16:04 30/07/2014 16:04 641 INDEX TIA (transient ischaemic attack) 352, 605 time management 18 timetables 17, 609, 611 TIMI ( Thrombolysis in systemic sclerosis tendon refl exes 134 tenecteplase 198, 536 TENS (transcutaneous electrical nerve stimulatio n) 89 tension headache 359 tension pneumothorax 279 terbutaline 217, 273 autoantibodies 593 limited 593 systems review 125 Myocardial Infarction) risk score 245 T T wave 573 t-PA (tissue plasminogen timolol 188 tinea inhaler 275 terlipressin 300 termination of pregnancy corporis 416, 489 cruris 416 faciei 416 pedis 416 tinzaparin 218 tiotropium 218 inhaler 275 tirofi ban 218 tissue forceps 113 tissue glue 436 tissue plasminogen activator) 350 T3 571 T4 205 \200\2236, 334 tachyarrhythmias 248 \200\223 (TOP) 503 terminology, surgical 110 testes 54 cancer 464 ectopic 464 torsion 290, 463 atrial fi brillation 250, 251, 252, 259, 572 atrial fl utter 253, 572 broad complex 251 causes 248 chemical tetanus 487 immunization 164, 436 \200\2237 tetracosactide (Synacthen ) 217 activator (t-PA) 350 cardioversion 531 defi brillation 228, 231, TLC (total lung tetracycline 217 thalassaemia 393, 397 theater see operating capacity) 586 Todd \200\231s paresis 346 tolbutamide 216 tonometer 143 torsade de pointes 2 51, 532 \200\2233 ECG 251 emergency care 248 \200\2239 narrow complex 251 supraventricular theater theater lists 112 theophylline 218 thiamine see vitamin B1 thiazolidinediones 329 t hiopental 344 third degree (complete) heart block 259, 261 254 tachycardia 250, 251, 253 treatment 253 ventricular fi brillation 251 ventricular total anterior circulation stroke (TACS) 351 total iron-binding capacity total lung capacit y (TLC) 586 third-space fl uids 380 thought insertion 162 throat, examination 144 thrombocytopenia 405 heparin-induced 406 thrombolysis 350, 536 Thrombolysis in Myocardial Infarction (TIMI) risk score 245 thrombophlebitis, superfi cial 445 tachycardia 250, 251, 254 TACS (total anterior total parenteral nutrition (TPN) 102 Toxbase 492 toxic epidermal necrolysis circulation stroke) 351 Tamifl u see oseltamivir tamoxifen 216 tamsulosin 217 target cells 393 tax issues 41 Tazo cin see piperacillin with tazobactam TB see tuberculosis teaching 60 \200\2232 (TEN) 418 toxic shock 480 Toxoplasma gondii 489 TPN (total parenteral nutrition) 102 trache a, CXR 583 traction-countertraction thromboprophylaxis 407 thyroglossal cyst 459 thyroid technique 563 training 16 medical students 63 core 43, 46 less than full-time 42 specialty see specialty disease 334 \200\2235 dysfunction and team assessment of behavior (TAB) 9 hypertension 263 TED stockings 108 Tegretol see training function test 571 hormones 571 hyperthyroidism 334, training fellowships 64 TRALI (transfusion- associated lung injury) 401 carbamazepine teicoplanin see vancomycin telangiectasia 139 temazepam 176, 217 temperature conversion 419, 571 hypothyroidism 334, 419, 497, 571 tramadol 87, 91, 219 transcutaneous electrical nerve stimulation (TENS) 89 transfer factor 587 transfusion 398 \200\223403 lump 459 subclinical disease 335 chart 602 temporal (giant-cell) arteritis 361 visual loss 429 thyroid peroxidase antibodies 593 thyrotoxic storm 334 thyrotropin receptor antibodies 593 TEN (toxic epidermal necrolysis) 418 Tenckhoff catheter 373 tendon hammer 14 ABO blood groups 398 complications 401 crossmatching 400 thyroxine 571 OHFP End.indd 641 OHFP End.indd 641 30/07/2014 16:04 30/07/2014 16:04 642 INDEX typhoid fever 487 typhus fever 487 culture 591 diabetes mellitus 590 dipstick tests 484, 590 haematuria 374 high output 372 lo w output 378 \200\2239 microscopy 590 osmolality 591 proteinuria 375 tests 590 \200\2231 to xicology 591 urobilinogen 318 urogenital prolapse 464 urogenital system 155 urokinase 198 u rological system elective 400 emergency 400 Jehovah \200\231s Witnesses 403 massive 401 red cells 400 transf usion reactions 402 when to transfuse 401 transfusion reactions 402 transfusion-associated lung injury (TRALI) 401 transient ischaemic attack U U+E see urea and electrolytes U wave 573 UK Foundation Program see Foundation Program ulcerative colitis 309 ulcers 139 (TIA) 352 driving regulations 605 transient loss of arterial 424 leg 424 Marjolin 422 neuropathic 424 peptic 290, 294, 300 venous 424 consciousness see seizures disorders 377 examination 154 \200\2235 procedures 546 \200\2238 transverse plane 77 trauma 434 \200\2237 advanced trauma life support 232 urostomy 121 urticaria 139, 418 ulnar burns 466 \200\2239 dislocations 435 falls 442 \200\2233 fractures see fractures head injur y 438 \200\2239 neck injury 440 \200\2231 soft tissue injuries 435 wounds 436 entrapment 448 pulse 128 ultrasound 85 UMN (upper motor blood transfusion 401, 402 uterine leiomyoma see fi broids neuron lesions) 353 uterine prolapse 464 uveitis, acute anterior 427 unconsciousness 362 unfractionated heparin 201, 406 unstable angina 246 upper airway traveler \200\231s diarrhea 306 treatment expectations 19 tremor, fl apping 313 Treponema p allidum 465 tricyclic antidepressants 89 V vaccination see obstruction 587 upper GI bleeds 299 \200\223300, immunization 304 vaginal bleeding 496 \200\2239 overdose 494 trifl uoperazine 185 trigeminal nerve (V) 133 trigeminal neuralgia 359 triglyc erides triiodothyronine 571 trimethoprim 219 trochlear nerve (IV) 133 trolleys 228, 510 tro ponins 243, 567 Trousseau \200\231s sign 388 TTOs/TTAs see discharge causes 300 Rockall risk scoring system 299 causes 496, 497 vaginal delivery 554 \200\2235 vaginitis 497 vagus nerve (X) 133 valproate 220 valsartan 18 7 valvulae conniventes 589 valvular heart disease 129 vancomycin 179, 220 vanillylmandelic acid (VMA) 333 varicella zoster virus (VZV) 414, 489 varices, oesophageal 300 varicocele 46 3 vascular dementia 343 vascular liver disease 314 vasculitis 452 urea and electrolytes 568 upper motor neuron lesions (UMN) 353 urate crystal arthropathy see gout urea pregnancy 504 urea and electrolytes (U+E) 107, 568 abnormalities 568 summaries tuberculosis (TB) 487, urethral 489, 491 catheterisation 546 \200\2237 gastrointestinal 491 genitourinary 491 immunization 491 meningeal 491 miliary 491 pulmonary 491 spinal 491 synovial fl uid 557 urethrocele 464 urinary incontinence 377 urinary retention 379 acute 377 chronic 377 see also low urine output skin manifestations 419 vasopressin see antidiuretic hormone urinary tract vasovagal attacks 260, antibiotics 179 X-ray 588 see also renal disease urinary tract infection 484 347, 442 tubes, blood 517 tumor lysis syndrome 375 tuning fork tests 144 tunnel vision 431 tympanic membrane 145 type 1 diabetes 325, 328 type 2 diabetes 325, 329 vault prolapse 464 venepuncture 514 \200\22315 venlafaxine 220 venous access 231 venous ins uffi ciency 450 venous stasis 417 venous ulcers 424 dipstick tests 590 recurrent 484 urine biochemistry 591 HFP End.indd 642 OHFP End.indd 642 30/07/2014 16:04 30/07/2014 16:04 643 INDEX Wood \200\231s light 411 work rota 12 work-related problems 34 working hours 18 workplace-b ased vomiting see nausea and ventilation, non- invasive 274 vomiting Ventolin see salbutamol ventricular fi brillation von Willebrand (vWF) disease 405 VT (ventricular (VF) 251 assessments (WPBA) 8 \200\22310 tachycardia) 250, 251, 254, 581 ventricular rhythm 572 ventricular tachycardia (VT) 250, 251, 254 workplace stress 34 wound glue 436 wounds 436 VZV (varicella zoster virus) 414, 489 ECG 581 Venturi mask 230 verapamil 190, 253 vertebral collapse abrasions 139, 436 advice for patients 561 bites 437 care of 118 cleaning 436 dehiscence 11 8 full thickness 436 incisional 139, 436 infection 179, 649 lacerations 139, 436 superfi ci al 436 sutures 436, 560 \200\2231 tetanus W Waldenstr m \200\231s fracture 356, 357 vertigo 362, 363 macroglobulinaemia 396 benign positional 363 driving regulations 605 wards 12 cover equipment 17 daily duties 69 dress code 14 rounds 70 \200\2231 veruccas 421 vesicles 139 vestibular neuronitis 363 vestibulocochlear nerve warfarin 221, 406, 407 drug interactions 407 and surgery 108 (VIII) 133 VF (ventricular fi brillation) 251 vicryl sutures 561 violent patients 105, 364 viral exanthema 415 viral h aemorrhagic fever 487 warts 421 Waterhouse-Friderichsen immunization 436 \200\2237 wrist syndrome 413 anatomy 151 examination 151 WCC see white cell count weakness 354 weals 139 Weber \200\231s test 144 websites 600 \200 \2231 Wegener \200\231s viral hepatitis see hepatitis viral skin infections 414 \200\22315 visual acuity 143 X X-rays 85 driving regulations 605 visual disturbances 431 driving regulations 605 granulomatosis 452 abdominal (AXR) 588 \200\2239 cervical spine 594 \200\2235 chest see chest X-ray skeletal 5 96 \200\2237 xanthochromia 592 weight conversion table 603 Weil \200\231s disease 317 Wellcome Trust 600 Wells score 278, 450 Wenkebach block 259 Wernicke \200\231s visual fi eld testing 142 visual loss gradual 430 registration of 430 sudden 429 see also specifi c conditions Y Yellow Card Scheme 171 yellow fever 487 encephalopathy 362 vitamin A 103 vitamin B1 103, 218, 344 vitamin B2 103 vitamin B3 103 vitamin B5 103 vitamin B6 103 vitamin B7 103 vitamin B9 103 wet gangrene 447 whiplash injury 440 white cell count (WCC) 566 pregnancy 504 Z Zenker diverticulum 459 Ziehl-Nielsen (ZN) white cells CSF 592 urine 590 stain 491 zinc 103 zolpidem 221 zopiclone 176, 221 Zoton see lansoprazole Zyban see bupropion defi ciency 395 vitamin B12 103 defi ciency 395 WHO pain ladder 86 WHO Surgical Safety Checklist 115 whooping cough 487 Wilson \200\231s di sease 317 winged needle 521 Wolff-Parkinson- vitamin C 103 vitamin D 103 vitamin E 103 vitamin K see phytomenadione White (WPW) syndrome 253 vitreous hemorrhage 429 vitreous humor 143 VMA (vanillylmandelic women obstetric acid) 333 volume status 380 Voluntary Services examination 158 \200\2239 reproductive system 156 \200\2237 urogenital system 155 Overseas (VSO) 600 OHFP End.indd 643 OHFP End.indd 643 30/07/2014 16:04 30/07/2014 16:04 644 NOTES OHFP.indb 644 OHFP.indb 644 30/05/2014 16:19 30/05/2014 16:19 645 NOTES _OHFP.indb 645 _OHFP.indb 645 30/05/2014 16:19 30/05/2014 16:19 646 COMMON ADULT DRUG DOSES Common adult drug doses Typical doses for common indications for adults with normal BMI and renal function are given. For more details and other indications see Chapter 5. Users are advised to always check local prescribing guidelines and formularies and to consult the BNF when prescribing drugs. Analgesia BNF 4.7 Amitriptyline (neuropathic) Codeine (weak opioid) Ibuprofen (NSAID) Parac etamol Respiratory BNF 3 Salbutamol (short acting B-agonist) Salmeterol (long acting B-agonist) St eroid and combination inhalers 1 \200\2232 puff s INH PRN (metered dose inhalers) 2 puff s/12h INH (metered dose inhalers) Multiple, non- interchangeable formulations \200\223 see chapter 5 and BNF 3.2 18microgra ms/24h INH 10mg PO nocte (titrated up to 75mg) 30 \200\22360mg/4h PO/IM (max 240mg/24h) 200 \200\22340 0mg/6 \200\2238h PO (max 2.4g/24h) 1g/4 \200\2236h PO/IV (max 4g/24h) 2.5 \200\2235mg/4h IV or 5 \200\22310mg/4h IM/SC or eg Oramorph 5 \200\22310mg/4h PO 50 \200\223100mg/4h PO/ I M/IV (max 600mg/24h) Tiotropium (long acting anticholinergic) Gastroenterology BNF 1 Bisacodyl (stimulant laxati ve) Gaviscon (antacid) Fybogel (bulk forming laxative) Glycerin (stimulant laxative) Hy oscine butylbromide (antimuscarinic) Lactulose (osmotic laxative) Movicol (osmotic laxati ve) Omeprazole (PPI) 20 \200\22340mg/24h PO Phosphate enema (stimulant laxative) Ranitidine (H2-antagonist) Senna (stimulant laxative) Miscellaneous Chlorphenamine (sedating antihist amine) Zopiclone (hyponotic) Morphine (strong opioid) 5 \200\22310mg/nocte PO or 10mg/mane PR 10 \200\22320ml PRN PO (eg after meals) 1 sachet/12 h PO Tramadol (moderate opioid) Antiemetics BNF 4.6 Cyclizine (antihistamine) Metoclopramide (antidopaminergic) Ondanestron (5HT3 antagonist) Prochlorperazine (phenothiazine) Cardiovascular BNF 2 Amlodipine (Ca2+- channel blocker) Aspirin (antiplatelet) Atenolol (B-blocker) Bisoprolol (B-blocker) 50mg/8h PO/IV/IM 1 suppository/PRN PR (max 4/24h) eg Buscopan 20mg/6h PO 10mg/8h PO/IV/IM 4 \200\2238mg/8h PO/ IV/IM 10mg/8h PO/IV/IM 10 \200\22315ml/12h PO 1 \200\2233 sachets/24h PO for HTN: 5 \200\22310mg/24h PO long-term prophylaxis: 75mg/24h PO for AF or angina: 50 \200 \223100mg/24h PO for heart failure: 1.25mg/24h PO initially (max 10mg/24h) long term prophy laxis: 75mg/24h PO for heart failure: 40mg/24 PO initially (max 80 \200\223120mg/24h) for f ailure or HTN: 1.25mg/24h PO initially (max 10mg/24h) for AF or angina: 40 \200\223120mg/8h PO 20 \200\22340mg PO nocte 1/PRN PR 150mg/12h PO 2 tablets/nocte PO 4mg/4 \200\2236h PO (max 24mg/24h) Clopidogrel (antiplatelet) Furosemide (loop diuretic) 3.75 \200\2237.5mg/24h PO Ramipril (ACEi) Verapamil (Ca2+- channel blocker) Simvastatin (statin) OHFP.indb 646 OHFP.indb 646 30/05/2014 16:19 30/05/2014 16:19 647 COMMON ADULT DRUG DOSES Empirical antibiotic choices BNF 5.1 Choices suitable for patients with penicillin allergies are given in italics. For MRSA colo nized patients alternative regimens may be required. Always consult local guidelines and th e BNF. Respiratory infections Amoxicillin Community 500mg \200\2231g/8h PO acquired pneumonia: or: doxycycline 200mg PO CURB65=0 \200\2231 STAT then 100mg/24h PO Amoxicillin 1g/8h PO/ Commu nity IV + clarithromycin acquired 500mg/12h PO/IV pneumonia: CURB65=2 or: doxycycline 200mg PO STAT then 100mg/24h PO Co-amoxiclav 1.2g/8h IV + clarithromycin 500mg/12h IV or: vancom ycin 1g/12h IV + ciprofl oxacin 200mg/12h IV Co-amoxiclav 1.2g/8h IV or: clarithromycin 500 mg/12h PO/IV Skin and soft tissue infections Cellulitis, infected eczema and simple wound infections (MR SA-ve) Cellulitis, infected eczema and simple wound infections (MRSA+ve) Cellulitis around IV cannula sites or other prosthesis Flucloxacillin 1g/6h PO/IV4 or: clarithromycin 500mg/12h PO/IV doxycycline 200mg PO STAT th en 100mg/24h PO or if severe: vancomycin 1g/12h IV As for MRSA-ve cellulitis if non-severe. If severe: vancomycin 1g/12h IV + Tazocin 4.5g/8h IV or: vancomycin 1g/12h IV + ciprofl oxacin 200mg/12h IV Co-amoxiclav 625mg/8h PO or co-amoxiclav 1.2g/8h IV or: clarithromycin 500mg/12h PO + ciprofl oxacin 500mg/12h PO + metro- nidazole 400mg/8h PO Co-amoxiclav 625mg /8h PO or: metronidazole 400 mg/8h PO + doxycycline 200mg/24h PO Co-amoxiclav 1.2g/8h IV4 o r: clarithromycin 500mg/12h IV + ciprofl oxacin 200mg/12h IV + metronidazole 500mg/8h IV Community acquired pneumonia: CURB65 \211 3 Hospital acquired pneumonia (non-severe)1 Hospital acquired pneumonia (severe)1 COPD (PO th erapy) Cellulitis in diabetics and wound infections following dirty surgery Tazocin 4.5g/8h IV or: vancomycin 1g/12h IV + ciprofl oxacin 200mg/12h IV Amoxicillin 500 mg/8h PO or: doxycycline 200mg PO STAT then 100mg/24h PO Co-amoxiclav 1.2g/8h IV + clarithr omycin 500mg/12h IV or: vancomycin 1g/12h IV + ciprofl oxacin 200mg/12h IV Infected animal bites COPD (IV therapy) Wound infections following trauma surgery or cellulitis around diabetic ulcers Bone + joint infections Acute osteomyelitis or septic arthritis2 CNS infections Community a cquired meningitis Co-amoxiclav 1.2g/8h IV or: vancomycin 1g/12h IV + ciprofl oxacin 400mg/12h IV Urinary tract infections UTI (PO therapy) including pyelonephritis Co-amoxiclav 625mg/8h PO or: ciprofl oxacin 500mg/12h PO Co-amoxiclav 1.2g/8h IV or: gentam icin 5mg/ kg/24h IV Ceftriaxone 2g/12h IV + vancomycin 1g/12h IV3 or: chloramphenicol 25mg/ kg/6h IV + vancomyc in 1g/12h IV UTI (IV therapy) including pyelonephritis 1 Where aspiration likely, add in metronidazole 400mg/8h PO or 500mg/8h IV. 2 Hospital acqu ired cases and prosthetic joints will require more aggressive initial regimens. 3 Add amoxi cillin 2g/4h IV if pregnant or immunocompromised or age>50yr to cover listeriosis (or: co-trimoxazole 15mg/kg/6h IV if penicillin allergy). 4 If MRSA suspected, add doxycycline 200mg/24h PO or vancomycin 1g/12h IV. _OHFP.indb 647 _OHFP.indb 647 30/05/2014 16:19 30/05/2014 16:19 Drug doses Emergency adult drug doses Only use this page if you are ALS/ILS trained; otherwise contact a senior and turn to the appropriate emergency page. Doses are appropriate for an otherwis e healthy 70kg adult. \200\230Max freq \200\231 shows maximum frequency drugs should be us ed in an emergency. Dose Max freq Route Cardiac and shock Adenosine 6, 12, 12mg 5min Fast IV Adrenaline, anaphylaxis 0.5ml 1:1000 (0.5mg) 5min 73min IM Adrenaline, arrest 10ml 1:10,000 (1mg) IV Atropine, bradycardia 0.5mg, 3mg max 1min IV Atropine, arrest 3mg (no longer recommended) Once IV Aspirin 300mg Once PO Calcium gluconate 10% 10ml in 2min, 50ml max 15min IV Clopidogrel 300mg Once PO Diamorphine 2.5mg 5min IV Digoxin infusion 500micrograms in 30min (b p196) Once IV Morphine 5mg 5min IV Verapamil 5mg in 2min, 15mg max 5min IV Respiratory Aminophylline1 5mg/kg in 20 min Once IV Furosemide 40 \200\223120mg (1mg/kg) Once IV GTN infusion 10 \200\223200micrograms/min Systolic >90 Infusion IV Isosorbide dinitrate 2 \200\22310mg/h Systolic >90 Infusion IV Hydrocortisone 200mg Once IV Ipratropium 500mcg 4h Neb Magnesium 2g (8mmol) over 15 min Once IV Salbutamol, infusion 250micrograms over 10 min Once IV Salbutamol, neb 5mg Continuous Neb Neuro and epilepsy Glucose 10%, 20%, 50% 200, 100, 50ml respectively Check glucose IV Diazepam 10mg, 30mg max 5min IV/PR Lorazepam 4mg, 12mg max 5min IV Naloxone 0.4mg, 10mg max 3min IV Phenytoin infusion 20mg/kg at <50mg/min Once IV 1 Do not give loading dose of IV aminophylline if patient taking oral theophylline (unless plasma levels known). OHFP.indb 648 OHFP.indb 648 30/05/2014 16:19 30/05/2014 16:19 ADULT ADVANCED LIFE SUPPORT ALGORITHM (2010) Adult Advanced Life Support Algorithm (2010) Unresponsive? Not breathing or only occasional gasps Call resuscitation team CPR 30:2 Attach defibrillator/monitor Minimize interruptions Assess rhythm Shockable (VF/Pulseless VT) Non-shockable (PEA/Asystole) Return of spontaneous circulation 1 Shock Immediately resume CPR for 2 min Minimize interruptions Immediately resume CPR for 2 min Minimize interruptions Immediate post cardiac arrest treatment \200 Use ABCDE approach \200 Controlled oxygena tion and ventilation \200 12-lead ECG \200 Treat precipitating cause \200 Temperature control/ therapeutic hypothermia Reversible Causes During CPR Hypoxia \200 Hypovolaemia \200 Hypo-/hyperkalaemia/metabolic \200 Hypothermia Ensure high-quality CPR: rate, depth, recoil \200 Plan actions before interrupting CPR \200 Give oxygen \200 Consider advanced airway and capnography \200 Continuous chest c ompressions when advanced airway in place \200 Vascular access (intravenous, intraosseous ) \200 Give adrenaline every 3 \200\2235 min \200 Correct reversible causes Thrombosis - coronary or pulmonary \200 Tamponade - cardiac \200 Toxins \200 Tension pneumothorax Adult Advanced Life Support algorithm; 2010 guidelines. Reproduced with the kind permission of the Resuscitation Council (UK). _OHFP.indb 649 _OHFP.indb 649 30/05/2014 16:19 30/05/2014 16:19