This week we have some Emergency Department Scenarios kindle prepared by
Dr Jonathon Hurley ED Specialty Trainee @DrJHurley
Scenario 1: A patient attends the Emergency Department with a severe acute exacerbation of asthma. You are asked to prescribe aminophylline (a bronchodilator drug) as an infusion for him. He weighs 120kg and has not taken theophylline previously. Aminophylline is diluted with normal saline.
Q1: Prescribe this correctly on an infusion chart, in a 250mL bag over 30 minutes.
Q2: Describe how you would make this up.
Scenario 2: A young male is brought in to the resuscitation room having been found unresponsive. On examination his respiratory rate is 4 and he has pinpoint pupils, and you suspect an opiate overdose. He responds to 1mg of naloxone, and you decide to start a naloxone infusion.
Q3: What is the initial rate of the infusion?
Q4: The nursing staff make 2mg of naloxone up to a volume of 50mL. What rate should this be run at?
Scenario 3: A woman is brought to the department in status epilepticus. She has had two doses of benzodiazepine without improvement and you are asked to prescribe a phenytoin loading infusion for her. You estimate her weight to be 50kg.
Q5: What dose of phenytoin is required?
Q6: What volume should this be diluted to if the concentration is not to exceed 10mg/mL (as per the BNF)?
Q7: What is the fastest time that this can be given over?
Q8: What rate should you prescribe your infusion at? Use the volume and time that you have calculated.
In order to get some prescribing resources out there we intend to publish a series of prescribing problems on the website. The problems will appear at least weekly with the "answers" appearing a couple of days later. We'll use the standard exam stationery available on the LSE, but also available below in case you haven't got access to the LSE.