Housemanship Survival Guide
💡 A Friendly Reminder
Most managements involves informing MO. However, please do something before informing. At least, you know the diagnosis and stabilise patient. Learn to listen properly and write FAST.
🍬 Hypoglycemia
DXT/Reflo < 4
- Omit insulin.
- Encourage orally (sweets, bread with jam).
- DXT < 3 with symptoms, give 20-50cc D50% then repeat DXT after 30 minutes.
🫁 Shortness of Breath (SOB)
- Examine lungs & SpO2.
- Determine causes.
- If intubated, check if ETT dislodged or too deep.
- Start NPO2/FM/HFM.
- If known case of COPD to start VM.
- Keep SpO2 > 95%.
- If rhonchi – Neb salbutamol or combivent STAT, IV hydrocortisone 200mg STAT.
- If significant SOB with SpO2 drop, take ABG.
- Inform MO.
🚨 Asystole
- Manual bagging 15L/min (even for ventilated patient).
- Straighten bed & commence CPR.
- Inform MO. Transfer acute.
- Vital signs, DXT & cardiac monitoring.
- 2 large bore branulas at least pink.
- Run 1 pint NS fast if no contraindications.
- Prepare IV adrenaline (1mg every 5 mins).
- Prepare intubation kit.
- Keep bp >90/60, map >65.
- Strict I/O via CBD. For inotropes if low BP.
- IV Ranitidine 50mg TDS to prevent gastric ulcer.
- RTF, start clear fluid 50cc & increase accordingly (increase 50cc if tolerates x3 to max of 300cc). Refer dietician.
📉 Hypotension
BP < 90/60 or MAP < 65
- Determine causes: sepsis, UTI, hypovolemia, cardiogenic etc.
- Run 1 pint NS fast if no contraindication such as fluid overload.
- If still low, for another try and inform MO.
- IVI noradrenaline (inotrope) if BP is still low & adjust accordingly.
- BP monitoring every 30 minutes.
- KIV add another intrope if low despite high dose 1st inotrope.
💎 Hypokalemia
K+ = Potassium < 2.5
- ECG STAT to look for hypokalemic changes.
- 1g KCl in 100cc NS in 1 hour or 2g KCl in 200cc NS over 2 hours (according to K+ level) with continouos cardiac monitoring.
- Add KCl in drip if any, mist KCl 15ml TDS / Tab Slow k 600mg/1.2g OD.
- K+ > 4: Off K supplements.
- RP 1 hour post correction. RP CM.
Calculation:
K+ Requirement = Deficit + Maintenance
Deficit = [ (4 – patient’s K) x weight x 0.4 ] / 13.3
Maintenance = weight / 13.3
Example: Patient requires 5g of potassium. Patient is on 2pint IVD. Add 1g KCl per pint and oral supplementation mist KCl 1g TDS (Total: 2g + 3g = 5g).
Deficit = [ (4 – patient’s K) x weight x 0.4 ] / 13.3
Maintenance = weight / 13.3
Example: Patient requires 5g of potassium. Patient is on 2pint IVD. Add 1g KCl per pint and oral supplementation mist KCl 1g TDS (Total: 2g + 3g = 5g).
⛔ Caution given to ESRF patient
☢️ Hyperkalemia
K+ > 5.5
- ECG STAT to look for hyperkalemic changes.
- Perindopril can cause hyperkalemia.
- Off K supplements.
- Lytic Cocktail.
- Oral kalimate 5-10g TDS.
- Off kalimate once K+ < 5.
- K+ 1 hour post correction. RP CM.
Lytic Cocktail:
10cc of 10% calcium gluconate in 10 minutes with cardiac monitoring (10 minutes).
50cc D50% glucose.
10 unit Actrapid.
50cc D50% glucose.
10 unit Actrapid.
💔 Chest Pain
- ECG STAT. Inform MO. Vital signs.
- If BP stable (>90/60), S/L GTN, maximum 3 times.
- If persistent pain to start IV Morphine with IV Maxolon.
- If persists, start IVI GTN.
- Take troponin earliest 3 hours post chest pain.
🧠 Fit
- Left lateral. Remove dangerous objects.
- High flow mask 10L/min.
- Vital signs & DXT.
- Inform MO. Insert branula.
- Monitor vital signs, fit, GCS, behavioral & alcohol chart (if relevant).
📉 GCS Drop
- Vital signs & DXT.
- Inform mo. Transfer acute.
- Determine causes.
🛡️ Aggressive Behavior
- Approach calmly.
- Ask help from security guards or male staff.
- Inform MO.
- IM haloperidol 5mg STAT.
- 4 point restraints. Refer PSY.
🩸 Hematemesis
- Get a sample of vomit if possible.
- PR examination to look for malenic stool.
- Vital signs to look for compensated or decompensated shock.
- Inform MO.
- If significant blood loss to insert 2 branula with FBC, RP, coag profile & GSH.
- IV tranexamic acid 1g STAT, then 500mg TDS.
- IV pantoprazole 40mg.
- If worsens, KIV IVI Pantoprazole.