|.Alr Way Management ‘Type of Airway Support: _ settings: {Titrate F102 tokeep Saturation > __%) lon VV ECMO: Lung Protective Strategy (PAC Rate-10 Pressure- 10 PEEP- 20 Fio2- 21%) 1. Medication Orders © Local Applications ‘Artificial Eye Drops Local Application TID ‘Artificial Eye Cintment Local Application TID Chlorhexedine 0.2% mouthwash local appliation 10 Dexpanthenol (Panthenol 5%) Local Application TID Petroleum Topical Ointment (Vaseline) Local Apalication TID B Sitostrol (8 Sitosterol 0.25% 30gm Ointment) Local Application 110 7. Mupirocin 2% Ointment (1 Application Each Nostr) BID for $ Days (afaansa 8. Chlorhexedine 4% Topical Soltion Local Application OD for 5 Days (masa) ‘= IVMedication Infusions -Inotropes (common) 4. Noradrenaline_mcg/ke/min IV Infusion 8 mg in SOml NS (Total SOr!) Comment: Titrate 0.01-3 meg/ke/min to keep MAP > 65mm 2. Phenylephrine _mce/kg/min 'V Infusion SOmg in Som Normal Saline or 100, In SOmt NS. (Total $m) Comment: Ttrate 05-9 mep/ka/min to keep MAP >65mmHg 3. Vasopressin _0.03-0.08 unit /min!V Infusion 400 unit in 50m NS 4. Dobutamine _mcg/kg/min lV Infusion 250 mg in 100 ml NS Dose 2:20 megyig/min titrate MAP >65 5, Levosimendan _mce/ke/min IV Infusion 125 mgin 250 mi DS (0.05-0.2mcg/kg/minif hypotension happened combined with noradrenaline infusion = Antihypertensive medications 4 Labetalol 20 mg bolus every 10 min for total of 300mg Continuous infusion 2-6 me/min (100 ma/ 100 mi NS, titrate to keep systolic PH between 140-160 = Antiarrhythmic 1 Amiodarone Bolus 250 mg, repeated another time (300 mg Max), then 900 mg in 50 ml 15% (central line for 24 hr, or 800 mg in 500 ml DS% peripherally Digoxin 0.25 ~0.5 mg in 50 ml NSIV once. Then BID - Sedations and Paralysis (common) 4. Fentanyl_meg/ke/br IV Infusion 2,500%meg in 30m (concentrated total 50m) Comment: Titrate 1-10 mcg/kg/hr to keep RASS score -1-2orif on Paralysis BIS of 40-60 2. Remifentanil mcg/kg/hr IV Infusion 10 mg in SOml Comment: Titrate 0,010.25 meg/ke/min to keep RASS sore -1 2 or if on Paralysis IS of 40-60 3. Midazolam 0.01-1.7mcg/k/min IV infusion 30mg in SOml Normal saline or ‘45mg in Sl Normal Saline Comment: Ttrate 0.3-1.7mee/ke/min to keep RASS sore orf on Paralysis BS of 40-60 4. Propofol meg/ke/min IV Infusion 600mg in 60m (concentrated total 60m!) Comment: Ttrate 5-50 meg/kg/min to keep RASS score 1 -2orif on Paralysis 81 of 40-60 5. Dexmedetomidine (Precedex) __mcg/kg/hr1V Infusion 400mg in SOml "Normal saline (Tetal Som] Comment: Titrate 0.2.5 meg/kg/hrto keep RASS score 0-1 otf on Paralysis BIS of 40-60 6. Clatracurium meg/ke/min IV Infusion 100mg in SOml (concentrated tt 50m) Comment: Titrate 0.2-1.5 meg/kg/min to keap PNS TOF 2/4, Respiratory Inhalants Salbutarol 100 meg/ puff 6-8 puff inher a6hr PRN for shortness of breath Ipratropium 20 meg/puff 6-8 inh MDI Inh, CID, DVT Prophylaxis Enoxaparin 40 me SCOD Heparin $000 unt SC 8-12 hrs ‘Stress ulcer Prophylaxis Esomeprazole 40 mg NGT 0D Pantoprazate 40 mg IV OD Electrolyte replacement Poa ‘Na lvcerophosphate 20 mmol in 100ml NS over 4s POL 30 mmol in 50 mi NS (central line, over & he. © Potassium chloride 20 mmol in 100ml SWI over Lr (central line}, (xis stock) [Mg Magnesium suiphated 2 gm in 50-100 mI Ns over 1 hr (Cacaleium gluconate 2 gm in 50 mi NS over 1 hr ies 4. Tazozin 5 gem IV Q6-8 hrs 45 gm in 100 mI NS 2. Ceftriaxone 2 gm in 100 mi NS 3, Meropenem 1 gm IV QBhr (gm inS0 mi NS, 2 gm in 100 mi) 4. Clarithromycin $00 mg IV 81D (500 mg in 250 mi NS s. 6 2 “Amplcilin/slbactam 3 gm iv QShr (3gm in 100 mI NS) Linezolid 600 mV BID (600 mg in 300 mI NS) \Vancomiein dose 20mg/kg) grin 160 mI NS central ine, 4gm in 250 mi peripherally 8 Amikacin 15-20 mg/kg ( S00mg in 100 ml NS, 1250mg/250 mi NS) 9. Gentamicin 7 mg/kg (300 mg in 100ml NS, SCO mgin $00 rl NS) 20. Moxifloxacin 400 mg (400 mg in 250 rl) Bowel regimen 4, Movieol2 sachets NGT BID, 2. Senna tab 2tab NGT ID 3. Docusate 109mg NGT BID Prokinetic 1, Metoclopramide 10 mg W 8hr 2. Erythromycin 250 mg NGT Gh Agitation 1. Haloperidol SmgiV QS hr 2 Quetispine 50 mg NGT BID Anti-Seizure: 1, Levetracetam 2 gm in 150 mi NS then Lem in 100 miINS BID 2. Sodium Valproate loading 20-40me/ke: L¢m in 100 ml NS BID, Continuous infusion dose 100-150 mg/hr;2400mg in 250 mi NS 3. Phenytoin 15-20 mg/kg 1500 in 300 ml NS then 100 mg in 100 mal NS Wwashe Hyperosmotic therapy 4. Mannitl 20% (100m in 500 ml) dose tgm /ag Stat, then 0.25 gm 144.06 hrs 2. Hypertonic chloride 3% in S00 mi Lmi/kg continuous infusion Fluid 4 Plasma protein faction 125 gm in 250 ml Int 2. Ringer lactate $00 mi 3. Sodium chloride $00 ml int- bolus IL Laboratory Orders 2. MRSA Nasal Swab 2. Candida Auris Screening 3. CMP Q.22 hourly 4, Coagulation Profile (PT, PTT, INR) Q.12 hourly 5.c8CQ 12 hourly W. Feeding Order pe offeed_then start with 10mi/ hour titrate every 4 hours by 10 ml {up unt 40m as tolerated. V. Type of isolation __Standard Precaution __Droplet Islation _Airborne Isolation contact isolation _ Protective Isolation Contact + Airborne Isolation Vi. Referrals _PT_Dietcian _Infetious Disease _ Nephrology cardiology interventional Radiology Vascular _ECMO/Proning _Wound Care VIL Miscellaneous VTE _Medication Reconciliation Prepared by: FMD/MM.