Dr Iliana9

Forwarded from Deleted Account

What are HO can do or need to know before informing your MO in certain common conditions?

Disclaimer : What I am writing is only serve as a guide on what HO can initially do before informing or while awaiting your MO to attend patient. Further managements depends on pt case, progress and clinical conditions.

As a rule for HO especially during oncall:
1. Always inform your MO no matter how your MO would respon for any patient with issue or problems.

2. Never proceed with your own managements if you are unsure about it. Always to consult.

3. Always to check and to know the vital sign during the event:
- blood pressure, pulse rate, SpO2, temperature.

Common conditions:

A. Patient desaturated - unable to maintain SpO2 > 95%
1. Always to ascultate the lungs first
- for silent chest/ rhonchi - consider neb.salbutamol/combivent stat
2. Repeat ABG stat
3. Put on O2 support/upgrade patient O2 support.
4. CXR if indicated
5. If patient in impending respiratory collapse - prepare for intubation

B. Hypoglycemia
1. If patient symptomatic (usually DXT < 2.5)
- Consider IV D50% 50cc stat
- Repeat DXT after 1 hour - if still low can consider another D50% (cautious with pt with restriction of fluid)
- If normal, maintain with IVdrip D10% with hourly DXT monitoring

2. If patient asymptomatic
- If can tolerate orally - can encourage oral intake (e.g: milo)
- If patient can't tolerate orally - consider for IV D50%
- Repeat DXT after 1 hour

Remember: to withold first any OHA or insulin regime during the hypoglycemic attack.

C. Hyperglycemia
1. Check if it was taken just post- meals, if just immediately post meals can recheck back after 1 hour
2. Consider insulin if indicated.
3. If highly suspicious for DKA /HHS (especially in patient with ongoing infection) - send for venous blood gas (look for metabolic acidosis) and urine sample(look for urine ketone). Blood ketone sampling if available.

D. Collapse or drop in GCS
- Check for vital signs - correct what is needed.
- ALWAYS check for the blood glucose level
- Assess pt based on ABCDE, follow the BLS protocol. If patient had no pulse:
- immediately start CPR
- put on cardiac monitoring
- prepare for crash intubation.

E. Hypotension
1. Always repeat BP manually
2. Check for patient hydration, any sign of intravascular volume loss - GI loss, bleeding, check also for any sign of sepsis.
3. Do an ECG for patient of highly suspicious having cardiac problems.
4. Some MO allow for HO to order fluid resus/challenge first (run 1 pint of NS or Hartmann), some MO need the HO to inform first - so know your MO well.

F. Hypertension
1.always to repeat BP manually.
2. Check and watchout for any symptoms of hypertensive bleed (raised of ICP)
3. Review back patient medication
4. Adjustment or any adding up anti-hypertensive meds, always need with your MO consultation.

G. Tachy/bradycardia
1. always check for any associated symptoms (e.g: chest pain, palpitation)
2. Do an ECG stat to rule out acute emergency conditions.
3. Check the medications that can cause tachy/bradycardia.
4. Check patient temperature, hydration.
5. Post operative - check for any sign of bleeding or sepsis.
6. Be careful in dengue patient with tachycardia - as is a sign of compesated shock, always to assess pt clinical condition.

H. Low urine output
1. Normal urine output:
Adult : 0.5 - 1cc/kg/hr
Paediatric : 1cc/kg/hr
2. Always flush the CBD and check for any blockage.
3. Check the BP and hydration status as hypoperfusion can lead to low urine output.
4. Check for any sign of profuse bleeding or sepsis.
5. Can allow fluid resus/challenge if indicared and permissible.

Kalau ada salah, boleh betulkan.
Moga bermanfaat.

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