Emergency notes: Emergency Drugs : http://nteciis02:3388/iHosp/ndh_icu/Public/Process/Guideline_Protocol/Clinical %20Guideline/CG%20pdf/CG_A01Analgesia%20Sedation%20and%20Use%20of %20Muscle%20Relaxant.pdf A55 QMH AED Drug manuals: http://hkwc.home/webapps/Dept/A&E/index.

htm A58 Emergency Protocols: AHA 2010: http://circ.ahajournals.org/content/122/18_suppl_3/S729.figures-only http://kwhwebc.home/ http://www.resus.org.uk/pages/cpatpc.htm#perf PWH vicinity protocol http://ntec.home/ihospital/ihosp_main.asp?hosp=pwh&dept=Admin Emergency Fluids: Hartmann: http://www.fastbleep.com/medical-notes/other/15/31/205 Hartmanns solution is an isotonic physiological solution with electrolyte composition similar to ECF Advantages: Cheap and readily available Safe and free of side effects (if used correctly) Disadventages: Higher volumes needed to restore intravascular volume Hartmanns solution is contraindicated in diabetes mellitus (gluconeogenic), renal failure (risk of hyperkalemia) and liver failure (risk of lactic acidosis) http://journal.ics.ac.uk/pdf/1001013.pdf
Recommendation 1: for resusctiation
Due to the risk of inducing hyperchloraemic acidosis in routine practice, when crystalloid resuscitation or replacement is indicated, balanced salt solutions, eg Ringers lactate/acetate or Hartmanns solution should replace 0.9% saline, except in cases of hypochloraemia, eg from vomiting or gastric drainage. Evidence level 1b*

Recommendation 26: for acute kidney injury

Balanced electrolyte solutions containing potassium can be used cautiously in patients with AKI closely monitored on

HDU or ICU, in preference to 0.9% saline. If free water is required, 5% dextrose or dextrose-saline should be used. Patients developing hyperkalaemia or progressive AKI should be switched to non-potassium containing crystalloid solutions such as 0.45% saline or 4% dextrose/0.18% saline. Ringers lactate versus 0.9% saline for patients with AKI: Evidence level 1b*

D50: not for paedi However, D W is an extremely hyperosmolar solution and can lead to significant irritation and extravasation injury, especially in children with small veins. Therefore, in younger children, 2-4 cc/kg of D W or 5-10cc/kg of D10W is preferred over D W.
50 25 50

http://www.acep.org/content.aspx?id=31374 Equipment defribillator: Monophasic vs biphasic: NDH ICU dept 3.1.1 Monophasic waveform defibrillation (traditional defibrillators) provides a shock with flow of electrical current moving in one direction (from one paddle to the other) 3.1.2 Biphasic waveform defibrillation (provided as an option on newer defibrillators) provides a shock with the flow of electrical current moving first in one direction and then in the opposite direction. 3.1.3 Advantages of biphasic over monophasic waveform defibrillation are as follows: 3.1.3.1 Biphasic waveform defibrillation achieves successful defibrillation at significantly lower energy levels than monophasic waveform defibrillation. 3.1.3.2 Biphasic waveform defibrillation causes less myocardial damage than monophasic waveform defibrillation at all energy levels. This is because biphasic waveforms have a lower peak current than monophasic waveforms. 3.1.4 The ACLS 2000 guidelines recommend using the same energy dose for defibrillation whether using monophasic or biphasic waveform defibrillation. The optimal energy doses for biphasic waveform defibrillation have not yet been determined. However, a study published in 2002, after the ACLS 2000 guideline, demonstrated that biphasic waveforms defibrillation was significantly more effective than monophasic waveform defibrillation at terminating ventricular fibrillation with return of spontaneous

circulation (biphasic - 83% versus monophasic - 54%).