快速鍵

1. Amiodaron 6 amps + NS 500cc run 34cc/hrs for 6 hours then run 17cc/hr for 18hr

2. Levophed 4amps + D5W 250cc intravenous dripping by pump control, please adjust dose +-1 gett prn to keep SBP > 90 mmhg, max dose 20gett/hr

3. Dopamin run 15 gett/hr by pump control, +- 3gett/hr, to keep SBP >90 mmhg, Max 40 gett/hr, Min 0 gett/hr

4. Midazolam 10A(50mg) + NaCl 40cc[1mg/cc], run 6cc/hr, RANGE 0~10, +/- 2GTT

5. K3PO4 3cc(12meq)+NaCl 100 cc run >6 hr

6. KCl loading: Nacl 250cc +KCL 10meq run > 4 hours

7. Nexium 2A +250 Nacl run 20cc/hr

<ACTH stimulation test>
1. 簽署Cosyntropin(Teracosactide)自費同意書以及病人委託書
    (家屬可以代簽,一份留存病歷,一份傳回至2F門診糖尿病中心)
2. 完成此檢查前,請勿使用steroid (Prednisolone至少停用24小時)
3. NPO since 0:00 on _____(日期) till blood tests done
4. Lying on bed for 30 minutes since 8:30 till the test done
   check ACTH/Cortisol at AM 9:00 on ______(日期)
5. Then Cosyntropin(Teracosactide) 0.25mg/1ml/Amp IV push
6. Check Cortisol after Cosyntropin injection 30mins later
7. Check Cortisol after Cosyntropin injection 60mins later
8. 請確實在該時間點完成抽血

<Adrenal tumor>
@ Urine全部都留24小時：Cr, Na, K, Cortisol, VMA, Cata, 17KS, 17OHC
@ 病人禁用spirolactone, furosemide, B-blocker, ACEI, ARB, steroid, Tricyclic antidepressant, CCB(dihydropyridine類),
Pseudoephedrine(decongestion)
@ 可用 a-Blocker, non-dihydropyridine CCB (Diltiazem, Isoptin), Hydralazine

<<Saline infusion test>>
1. 請病人平躺
2. stat 抽Aldosterone and Renin activity before N/S hydration
3. N/S 2L run 4hr
4. 抽 Aldosterone and renin activity after N/S hydration
5. On EKG monitor, check BP and HR Q15 mins during test
6. If patient complained of SOB, chest discomfort, headache, etc...
    ==> please call Dr to see if the test should be stoped.

<會診單>
Suggestion:
--Control underline disease as your experience
--OAD@@@@@
--Insulin@@@@
--Sliding scale
    Surestep qid with sliding scale
    200~250(1U) 251~300(2U) 301~350(3U) 351-400(4U) 401-450(5U) >451(6U)
    Surestep at 21:00 without sliding scale
--Hypoglycemic education, 如有飢餓, 冒冷汗等低血糖症狀,請立即測量血糖, 再進食. If blood glucose <60 mg/dl:
  1. 50% glucose, 3 vials, Iv stat.
  2. Call resident Dr. stat.
  3. Follow up surestep 15 minutes later.
  4. Hold insulin.
--May check HbA1c, cholesterol, LDL, TG, HDL
--May consult dietitian for diet suggestion if necessary
--If sugar level is still unstable, contact us if need