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CBG Coverage CBG Coverage: Actrapid Sliding Scale

This document contains instructions for various intravenous medication drips and infusions, including: 1. Actrapid sliding scale for coverage of insulin based on blood glucose levels. 2. Instructions for several medication drips including Burinex, Calcium Gluconate, Cordarone, Bricanyl, Diazepam, Dormicum, Epinephrine, and others. 3. Concentrations, infusion rates, and maximum rates are provided for drips like Dobutamine, Dopamine, Fraxiparine, Furosemide, Glucose-Insulin-HCO3. 4. Bolus and maintenance dosing regimens are listed for

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Serious Leo
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238 views

CBG Coverage CBG Coverage: Actrapid Sliding Scale

This document contains instructions for various intravenous medication drips and infusions, including: 1. Actrapid sliding scale for coverage of insulin based on blood glucose levels. 2. Instructions for several medication drips including Burinex, Calcium Gluconate, Cordarone, Bricanyl, Diazepam, Dormicum, Epinephrine, and others. 3. Concentrations, infusion rates, and maximum rates are provided for drips like Dobutamine, Dopamine, Fraxiparine, Furosemide, Glucose-Insulin-HCO3. 4. Bolus and maintenance dosing regimens are listed for

Uploaded by

Serious Leo
Copyright
© © All Rights Reserved
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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Actrapid Sliding Scale

CBG Coverage
CBG ≤200 no coverage
Coverage 201-250 3 units
<160 no coverage 251-300 5
161-200 3 301-350 7
201-249 5 351-400 8
250-299 7 401-450 9
300-349 9 451-500 11
350-399 11 >500 12 & refer
400-449 13
450-499 14
≥500 15 &
refer

Burinex Drip Calcium-Glucose Drip


Burinex 3 amps in 54cc Ca gluconate 4 amps in 500cc
PNSS D5W x 24hr
x 10 cc/hr see to it that the patient has no
beta-blocker

Calcium Gluconate Drip Cordarone Drip


Calcium Gluconate 4 amps Cordarone 4 amps + 500cc PNSS
(10mg/amp) in 500cc D5W x 60 cc/hr x 1st 6 hours
x 24hr Subsequently 25 cc/hr

Cordarone 150 mg IV now


Cordarone 4 amps + 500cc D5W x
Bricanyl Drip 24H
Bricanyl 5 amps in 500cc Cordarone 4 amps + 500cc D5W x
D5W 25 μgtts/min x 6H, then 12 cc/hr
x 24H

Increase to 30-40 cc/hr

Bricanyl 2.5 mg/tab TID


Diazepam Drip
Diazepam 10 mg/100cc D5W
Diazepam 20 mg/100cc D5W

Initial: 50-100 mg IV
Max: 60 mg/day

Diazepam 50 mg in 100cc PNSS x 6 cc/hr to titrate to control


seizure, hold for BP < 90/60 mm Hg

Dormicum Drip
Dormicum 3 amps (1.5 mg/amp) + 500cc PNSS x 2 mg/hr

Epinephrine Drip
Epinephrine 5 amps (5 mg) + 500cc D5W to run for 6 cc/hr

Dobutamine Drip Dopamine Drip


Dobutamine 250 Dopamine 2 amps (400 mg) +
mg/amp + D5W 250cc x 250cc D5W
___ μgtts/min (max: 10-20 mg/kg/min)
(max rate: 60
μgtts/min) Renal Vasocons: 0-5
mg/kg/min
Rate drip: Inotropic: 5-10 mg/kg/min
Drip mcg x kg BW Vasoconstriction: > 10
16.6 mg/kg/min

For patients w/ CHF: Rate (μgtts/min):


Dobutamine 2 amps mg/kg/min x BW
(500 mg) + 13.3 or 26.6
D5W 250 cc
(max rate: 30
μgtts/min)
Fraxiparine Drip Furosemide Drip
Fraxiparine 2 amps in 1 L D5W or Furosemide 3 amps +
D5NSS 54cc PNSS in a soluset x
10 cc/hr
88 “U”/kg BW or 0.1 cc/kg x 24H
Furosemide 80 mg in
Fraxiparine 80cc PNSS via soluset x
85 cc/kg or 0.1 cc/10 kg 10 cc/hr

Furosemide Drip Furosemide-Albumin


(Dr. Caro) Drip
25% Albumin 50cc +
In a soluset: Furosemide 3 amps + Furosemide 20mg to run
54cc PNSS x 10cc/hr for 4hrs
Or
D5W 250cc + Furosemide Albumin 50cc + PNSS
250mg/amp x 5-30 μgtts/min 950cc + Furosemide
Conc: 1 mg/mL 100mg x 24hrs
Or
PLR 500cc + 18 amps Furosemide x Albumin 100cc +
18-20 μgtts/min Furosemide 40mg to run
for 4-6hrs

Dr. Caro:
Furosemide 60mg +
PNSS 54cc x 10cc/hr
SD: Plasbumin 25%
100cc to run for
6 hrs
Glucose-Insulin-HCO3 Drip Glucose-Insulin Drip
D5W 150cc + D50W 1 vial + (Hyperkalemia ≥ 6)
NaHCO3 1 amp + Actrapid 8
units to run for 6 or 8 or 12 In a soluset, 50cc D50W + Actrapid
hrs 8-10 units x 1hr x 3 cycles

Repeat K post-drip CBG monitoring qHourly while on


drip
Glucose
HGT < 60 – D50W 1 amp Repeat K 1 hr after the last cycle
HGT < 40 – D50W 2 amps
Target FBS 60-90, RBS 80-
120

Heparin Drip Heparin for Flushing


D5W 250cc + Heparin 10,000 > 500 ‘U’ Heparin in 100 mL PNSS
units x 10-20 μgtts/min via
infusion pump
Hepamerz Drip
Conc.: 50 U/mL < 4 amps in 500cc D5W x 12hrs BID
Drip of 500-1000 ‘U’ ~ 10-20
μgtts/min
OR IVIG
In a soluset, Heparin 4cc in LD: 2 g/kg given in 5-6hrs in 3-5
36cc D5W (Heparin 1000 days
IU/cc) MD: 400 mg/kg or 0.4g/kg
OR
Heparin 5000 ‘U’ IV initially,
then 4000 ‘U’ in 36cc PNSS via Insulin Drip
soluset x 1000 ‘U’/hr PNSS 250cc + Humulin R 50 ‘u’

LD: 3000-5000 ‘U’ slow IV Conc.: 0.2 ‘U’/mL

LD = 80 U/kg Drip of 5-50 μgtts/min ~ 1-10 ‘u’


MD = 18 U/kg Humulin

APTT det’n q6h


APTT 1.5-2x the baseline
Isoket Drip
Isoket 10mg/amp (1amp) + Toradol Drip
PNSS 90cc x 10 μgtts/min (1 Toradol 30mg + PNSS 80cc via
mg/hr) soluset x 8H
Toradol 100mg + PNSS 80cc x
10cc/H
Miacalcic Drip
Miacalcic 2 amps (200 IU) + Tramadol Drip
D5W 250 cc x 15H Tramadol 100mg + PNSS 80cc x 10
μgtts/min

NaHCO3 Drip Trental Drip


NaHCO3 2 amps (50cc/amp) in Trental 4amps in PNSS 500cc x 24H
D5W x 24H
or Zantac Drip
NaHCO3 3 amps in 100cc D5W Zantac 5amps in D5W 500cc x 16H
x 24H
Zithromax Drip
Zithromax 500mg in 90cc IVF via
soluset to run for 5H

Nicardipine Drip
- 5mg/10ml
Mannitol (prep 20%) Mannitol-
Dose: Amt given (cc)x0.2/kBW Furosemide Drip:
- Nicardipine
LD: 1-2 g/kg 10mg in 90cc PNSS Mannitol
or D5W in250cc
a soluset
+
to run
MD: forg/kg
0.5-1 10cc/hr, titrate by increments of 5 μgtts/min
Furo 100mg x 10
to maintain BP at ____ mmHg μgtts/min
Action: 30mins OR
- Max
Peak: of 150 cc/hr at 15mg/hr (0.5
2hrs mk/BW),
Mannitol give
36cc +
initial bolus of 2mg IVTT, titrate to BP ___
Furo 240mg (24mL)
Complications: x 6H
Lidocaine
- rebound Drip in ICP
increase
-give
- IV 50 asexpansion
volume blous, then start drip as follows:
1 g in 250cc
pulmonary D5W at 15cc/hr (1mg/h)
edema MgSO4 Drip
increase by increments of 15
CHF D5W 250cc +
- DHN MgSO4 2g x
LD: 1mg/H
- Hypernatremia 20 cc/H
Conc: 4mg/cc
Drip: 1-4mg/min
Conc: 250mg/mL x
10 amps
(2.5 g/amp)

Morphine Drip
MoSO4 10 mg/amp (1 amp) + PNSS 60cc in a soluset x
10 μgtts/min

MoSO4 1 amp (16mg/amp) + PNSS 50cc x 6 μgtts/min


Midazolam Drip ( Dr. Beltran )
(2mg/H)
0.3mcg per kg per minute.
30 mg
PRN: midazolam
1-3mg in 50 cc D5W to run at 3 ugtts per
MoSO4 SQ
min. Titrate by increments of 1 ugtts every 15 minutes
as needed.
Nimotop Drip
Nimotop ½ vial + D5W 500cc x 24H
Noradrenaline (Levophed) Drip
- 2mg Noradrenaline/2ml amp
- D5W 250cc
Nootropil Drip+ Levophed 1amp x 15-60 μgtts/min
- conc: 12g
Nootropil 8mcginNoradrenaline/ml
60cc x 24H
- drip of 2-8 mcg Noradrenaline ~ 15-60 μgtts/min

Levophed 2 amps (2 mg/mL/amp) in D5W 250cc x 10


μgtts/min

Levophed 4 amps in D5W 500cc x ___ μgtts/min

Pantoloc Drip
- maintain GI acidity to stabilize clot
- Pantoloc 80mg IV bolus then 5 amps in PNSS 1L x
24H for 3 days
Octreotide (Sandostatin) Drip
- prep: 0.5 mg/mL
- 0.2 mg/mL IV bolus, give for 1 min, then start drip as ff: 4
amps + remaining 0.03 mg in 500cc PNSS x 24H

Sandostatin Drip
- sandostatin 0.5mg/amp 0.2mL now then drip as ff: 0.8mL in
D5W 500cc x 8H
- ff by 2 amps sandostatin 0.5mg/amp + D5W or D5NSS 1L x
24H

Solumedrol Drip
Solumedrol 2g + D5W 500cc x 20 μgtts/min

Somatostatin Drip
Somatostatin 250mcg IV bolus then 2amps (3mg/amp) + PNSS
1L x 24H for 5 days w/o interruption

Streptokinase Drip Terbutaline (Bicanyl)


Streptokinase 1.5M units + D5W Drip
90cc x 100cc/H (1H running rate) D5W 250cc + Bricanyl
via soluset 5amps x 10-30
μgtts/min
Give prior: Benadryl 50mg ivtt
Solucortef 250mg ivtt
Thiamine Drip:
APTT monitoring q6H 50-100mg IV (for 40-50
y.o.)
Burn Replacement:
4 ml/kg in 1st 24H: ½ 1st 8 H
½ next 16 H
Start initially w D5LR--- D5NSS
Prednisone Tapering
Prednisone 20 mg/tab 1 tab p BF
1 tab p lunch x 3 days
1 tab p BF, ½ tab p lunch x 3 days
1 tab p BF x 3 days
Then DC

Dilantin Drip 500 mg IVTT as LD via slow IVTT c PNSS as


mainline to be given at 110 mg/min then 300 mg IV Q6H

RHD Prophylaxis Ampicillin 2 g + Gentamycin 2 mg/kg

RITUXIMAB 90-120 meqs/kg


1st infusion, 50 mg/hr—100mg/hr
Max 400 mg/H
SE: pulmonary events, rapid tumor lysis
MOA: Binds to CD20 in pre B and mature B Lymp

Myoclonic seizure
Clonazepam – 0.02 mg/KBW

Lumbar Puncture
Send CSF for exam
1 Sugar, protein
2 centrifuge x 1 H at 1000 cpm
Sediment AFB, india ink, GS, CS
3 Cell Ct/Diff
4 save specimen: centrifuge x 1 H at 1000 cpm then exam
supernantant for CALAS

Flat on bed x 6H
NPO x 4H
Monitor Vs Q4H

Prepare materials
Spinal needle gauge 23
LP set
Manometer
Sterile test tube # 4
OS
Betadine
Lidocaine 2 %
Syringe 3 cc with guage 23 needle #2
Plaster

POST LP ORDERS (Dr Beltran)


Flat on bed x 6H
Monitor NVS Q30 mins x 4H until stable
NPO x 4H
For RBS
Include Na, K, Ca

Send CSF for analysis


tt1 sugar protein
tt2 centrifuge at 1000 cpm x 1 H
a. Sediment- gs, cs, afb, india ink, sabouraud
b. Supernatant- CALAS if avail
tt3 cell ct, diff ct
tt4 cell cytology

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