Clnical orientation programme in pharmacotherapeutics
•EMERGENCY TRAUMA CENTER
R.M.D RATHNAYAKEMD/PH/2011/38
objectives•To describe the general procedures
followed in the unit
•To list the common clinical investigations
•To describe the available Drugs and their storage conditions in the unit
EMERGENCY TRAUMA CENTER (ETC)•The trauma center is a hospital
equipped and staffed to provide comprehensive emergency medical services to patients suffering
•traumatic injuries,• medical emergencies,• poisoning,• snake bites….etc.
General Procedures• Admission All the patients who are admitted to the ETC are
categorized by determining the priority of patients' treatments based on the severity of their condition
•Mainly 4 categories.1. CAT 1 examine by a physician immediately2. CAT 2 examine by a physician within 10 min3. CAT 3 examine by a physician within 30 min4. CAT 4 examine by a physician within 1hr
• CAT 1 CAT 2
• CAT 3
• CAT 4
Some patients will be sent to surgery procedures according to their condition.
Admit to the WARDs
Admit to the TREATMENT BAY
Admit to the RESUS
•Patients who are needed to do cardio pulmonary resuscitation(revive from unconciousness) is done at RESUS to restore spontaneous blood circulation and breathing in a person who is in cardiac arrest.
•Airway management is done by Rapid Sequence Intubation.
•Patients with following clinical conditions are given early medication attention.
Chest pain▫ Acute coronary syndrome▫ Significant cardiac arrhythmia▫ Aortic dissection▫ Pneumothorax▫ Pulmonary embolism
Acute SOB▫ Pneumonia▫ Asthma moderate/severe▫ Exacerbation COPD
Fever▫ Septicemia▫ Leptospirosis
Snake bites poisoning
Common Clinical Investigations• Full Blood Count• Blood Urea• Serum electrolytes• Creatinine• C-RP• Culture and ABST• ECG• Chest X-Ray• USS• Echocardiogram• CBS• RBS• CT Scan
Available drugs and their storage conditionsDrug cupboardDrugs in the cupboard are stored under the controlled temperature (21-250C) within the RESUS area.
Cardiac Drugs
Other Oral Drugs
Other Parenteral Drugs
IV antibiotics
Dopamine Aspirin Diazepam AcyclovirKCl Nitroglycerine Ranitidine AmpicillinVerapamil Omeprazole Dexamethaso
neCloxacillin
Atropine Clopidogrel Neurobion Co – Amoxiclave
Frusemide Tramadol Ondansetrone
Cefataxime
GTN Metformin Snake venom CefuroximePropanalol Diclofenac
sodiumanti serum Clarithromy
cinEpinephrine Atenolol Chlophenira
mine Meropenem
Isoprenaline Nimodipine Pantaprazole ImipenemHydrolazine Glibenclamide VancomycinAdenosine Losartan K GentamycinAmioderone Activated
charcoalClindamycin
•RefrigeratorsDrugs in the two refrigerators are stored under temperature 2-80C within the RESUS area.
Lidocaine inj.Thiopental sodium for inj.r- human erythropoietin inj.Heparin inj.Vasopressin inj.Oxytocin inj.Normal immunoglobulin IVStreptokinase for inj. Domperidone sup:Human Insulin for inj.Human AlbuminDiazepam rectal tube
•Drugs for Rapid Sequence Intubation Drug boxes which are allocated to each bed for RSI are stored in the refrigerator under 2-80C. Name of the drug Route
Thiopental Sodium inj. IV
Suxamethonium IM/IV/IV infusion
Midazolam IM/IV
Ketamine Slow IV/deep IM
Atracurium IV only
Tetanus Toxoid IM
•Drugs for each patient according to their treatment regime is placed along their bed sides in each trolley.
•Two separate trolleys for Injectable drugs and Oral drugs are allocated in the treatment bays under the room temperature (Below 30oC).
Emergency trolley
Emergency trolleyDrug category Drugs RouteSymphathomimetics Adrenaline
Noradrenaline Isoprinaline Dopamine Dobutamine
Anticholinergics Atropine Antiarrythmics Ameodarone
Adenosine Vasodilators GTN
Hydralazine Parenteral
Cardiac glycosides Digoxin CCB Verapamil
Beta blockers Metaraminol
Diuretics Frusemide
Category Name of the Drug
Route
Antihistamines Chlopheneramine Promethazine
Opioid antagonists Naloxone
Benzodiazepines DiazepamMidazolam
Parenteral
Anticonvulsants Calcium gluconate
IV fluids 5% Dextrose8.4%w/v NaHCO3
Electrolites KCl
•CLINICAL ORIENTATION PROGRAMME IN PHARMACOTHERAPEUTICS
• • CARDIOLOGY UNIT
Objectives•To describe the general procedures
followed in the unit
•To list the common clinical investigations
•To describe the available Drugs and their storage conditions in the unit
Cardiology unit•Consists of a hospital ward,• Coronary Care Unit
(CCU) • Cardiac Intensive
Care Unit(CICU) • Cath Lab.
specialized in the care of patients with•Myocardial Infarction• unstable angina• cardiac dysrhythmia and • various other cardiac conditions that
require continuous monitoring and treatment
The Cardiology Unit receives adult and elderly patients from;
the Emergency Trauma Centertransfers from other facilitiesdirect admissions from the Cardiology
Clinicintra-hospital transfersPatients also move from the Intensive
Care Unit to the Cardiology Inpatient Unit.
Common DiagnosesThe Cardiac and Intensive Coronary Care Units
treat patients for:Myocardial InfarctionHypertensionArrhythmia managementUnstable anginaCongestive heart failureMyocarditisHeart catheterizationPacemaker placements
General Procedures Professional interventions include:
Assessment, planning, implementation and evaluation of therapeutic regimes
•Invasive physiologic monitoring such as arterial blood pressure, central venous pressure, pulmonary artery monitoring, cardiac output measurement and ECG monitoring including ST segment analysis
•Pre- and post-cardiac procedural care•Administration of vasoactive and
therapeutic medications
Diagnostic tests•Angiogram/Angiography(Arteriogram)•Echocardiogram•Exercise ECG
Common clinical investigations•Serum Ferritin•Free T4
•TSH•C-RP•Troponin I.•SE (Na+, K+)•Lactate Dehydrogenase(LDH)•Hydroxy Butyrate Dehydrogenase(HBDH)
Cont…….
•BP•Urea Reduction Ratio•FBS•WBC•Hb•PLT
Available drugs and their storage conditions• Drug cupboard
Drugs in the cupboard are stored according to the alphabetical order, under the room temperature (Below 30oC).
Category Name of the Drug RouteAntibiotics Amoxicillin
CloxacillinMetronidazoleO.Penicillin
Anti arrhythmic Amiodarone OralAntacids Aluminium Hydroxide(Aludrox)Anti TB Rifampicin
Isoniazide
Category Name of the drug RouteBeta blockers Atenolol
CarvedilolPropanolol
Antiplatelets AspirinClopidogrel
Statins AtorvastatinACE inhibitors Captopril
EnalaprilSuppliments Cal. Lactate Oral
Folic acidVitamin B-complexVitamin CVitamin A & D
Anti psychotics CarbamazepineCarbimazolePhenytoin Na
Anticoagulants Warfarin Na
Category Name of the drug Route
Calcium channel Blockers Diltiazem
Nifedipine SR
Verapamil
Anti emetics Domperidone
Metoclopramide
Prochlorperazine
H2 Histamine antagonist Famotidine
Diuretics Frusemide OralHCT
Spiranolactone
Immunosuppressants Dexamethasone
Prednisolone
NSAIDs Diclofenac Na
Ibuprofen
Cardiac Glycosides DigoxinHormones Thyroxine
Category Name of the drug Route
Hypoglycaemics Glibenclamide
Metformin
Tolbutamide
Nitrates ISMN
ISDN
Electrolytes KCl
Angiotensin receptor blockers
Losartan K
Anxiolytics Chlordiazepoxide
Diazepam OralAntihelmintics Mebendazole
Antihypertensives Methyldopa
Proton Pump Inhibitors Omeprazole
Alfa blockers Prazosin
Analgecics Paracetamol
Antihistamines Chlorpheniramine
Beta agonists Salbutamol
•RefrigeratorDrugs are stored in the refrigerator under
the temperature 2-8oC.
Name of the drug RouteAmpicillinFrusemideDobutamineDopamine ParenteralGTNCiprofloxacinAmiodarone
Category Name of the drug Route01.
Hypoglycaemics Insulin(Mixtard) IV
02.
Anticoagulants Heparin IV
Emergency trolleyDrugs are stored under the room temperature (below 300C).
Name of the drug RouteAdrenalineAtropineAmiodaroneDopamineDobutamine ParenteralCalcium gluconateHydrocortisoneFrusemideNaHCO3
Chlorpheniramine
Drugs in the Coronary Intensive Care Unit are stored in racks under controlled temperature 21-250CName of the Drug Route
MorphineMidazolamPromethazineNaloxoneDobutamineGTNAdrenalineFrusemide ParenteralAtropineNoadrenalineDopamineAmiodaroneVit KMetachlopramide