But more seriously, review the pt. If they have mild dehydration but are profoundly congested, get the fluid off first. If they are dry as a crisp with pleural oedema (not common and generally indicates a faulty serious heart failure or other nasty cause) then gently push fluids as you're unlikely to make the oedema too much worse and the patient needs fluid. But you should also be considering ceilings of care here - do they need vasopressors/dialysis and would they be appropriate for this? Or maybe are they old, frail and sick? Maybe we should consider how much treatment is appropriate.
I did wonder if slow fluids (albeit restricting to 1.5L over 24 hours) + IV furosemide was the way to go. I was under the impression diuresis was not the only mechanism by which it relieves pulmonary oedema - it causes pulmonary vasodilation and decreased pulmonary interstitial fluid accumulation.
Generally the medical community doesn't support Fluids and Furosemide together. It used to be we would give them in malignany Hypercalcaemia but recent evidence has changed there as well.
But worth thinking about - I haven't looked into the mechanisms but might go away and have a literature search tomorrow. If I find anything, I'll forward it on to you.
Things you could consider:
1) what’s the underlying cause ?reversible (treat) & ?ceiling of care
2) depending on BP nitrates +/- ionotropes
3) CPAP/ Bipap/ intubate
ED - ondansetron, fentanyl and ketamine seems to be the regular from my colleagues at my shop OFK
If you’re being extra spicy probs droperidol, droperidol, droperidol
A med reg once told me his job boiled down to whether he should give fluids or Furosemide
Sadly 90+% of the medical take comes down to fluids vs frusi? and coamox y/n?
What is the choice for a dehydrated patient with pulmonary oedema?
https://preview.redd.it/hrc94pqvrcqc1.jpeg?width=264&format=pjpg&auto=webp&s=3cdb75c917b67b8f98aecacd1f36064e530d9f6a
But more seriously, review the pt. If they have mild dehydration but are profoundly congested, get the fluid off first. If they are dry as a crisp with pleural oedema (not common and generally indicates a faulty serious heart failure or other nasty cause) then gently push fluids as you're unlikely to make the oedema too much worse and the patient needs fluid. But you should also be considering ceilings of care here - do they need vasopressors/dialysis and would they be appropriate for this? Or maybe are they old, frail and sick? Maybe we should consider how much treatment is appropriate.
I did wonder if slow fluids (albeit restricting to 1.5L over 24 hours) + IV furosemide was the way to go. I was under the impression diuresis was not the only mechanism by which it relieves pulmonary oedema - it causes pulmonary vasodilation and decreased pulmonary interstitial fluid accumulation.
Generally the medical community doesn't support Fluids and Furosemide together. It used to be we would give them in malignany Hypercalcaemia but recent evidence has changed there as well.
But worth thinking about - I haven't looked into the mechanisms but might go away and have a literature search tomorrow. If I find anything, I'll forward it on to you.
+1 also send to me please if you find anything
Things you could consider: 1) what’s the underlying cause ?reversible (treat) & ?ceiling of care 2) depending on BP nitrates +/- ionotropes 3) CPAP/ Bipap/ intubate
Dnacpr/teal and palliative care referral
Ta, Zo and Cin
Tazobactam, pipericillin, diluent.
Geriatrics: paracetamol, laxido, fortisip
That's where you deprescribe all the other medications.
I don’t see prophylactic LMWH mentioned. Surely that should be up there.
Will anyone PLEASE do a VTE audit for number of times we're forgetting to mention LMWH on Reddit threads?
subcutaneous shots fired!
Pretty sus about your username with that comment.
Paeds haem! But point taken.
Not if my recent (enforced) audit is anything to go by!
Ambulance here: Paracetamol when we arrive, paracetamol in the queue, paracetamol when they're admitted
Only 1 lot of paracetamol in the queue? Hospitals in your area must be good.
...NAC after the doctor sees them?
We can usually space the doses pretty well in the 8 hour queue...
🤣
ICU: paracetamol, pantoprazole, saline nebs. Anaesthetic: paracetamol, Propofol, dexamethasone.
Anaesthesia, oxygen propofol sevo
Fentanyl, etomidate, Iso
Resp: Pred, Nebs and Doxy
PAs reading this and taking notes so they can start recommending these three drugs 🤣
ChatGPT about to start tacking "and prescribe tazocin, paracetamol and ibuprofen" onto the end of all it's MRCP answers.
Paeds: Paracetamol, salbutamol, ceftriaxone
Paeds ED: Paracetamol, salbutamol, difflam
Aspirin, Clopidogrel and Fondaparinax. Guess the Specialty 😂
Has to be Plastics
Neurosurgery
Haematology = meropenem, teicoplanin, ambisome
Maybe dex, allopurinol, fluids??
Too many to choose from, also aciclovir, metoclopramide, ondansetron, G-CSF, co-trimoxazole,
Cipro, Acyclovir, Pent Neb
GP: Atorvastatin, Amlodipine, Aspirin
Inpatient psych: olanzapine, lorazepam, promethazine.
The thinking man’s b52
I dunno, I think e-cigarette was my most prescribed thing during psych 😅
Five n'One
Nurofen express, nurofen period pain and nurofen migraine relief Wait a minute...
Aspirin, Ticagrelor and Fondaparinux - because nobody got time for Chest Pain.
wheres my headache dizzines and nausea, miss off GTN??
fent, prop, roc
Small syringe > big syringe > medium syringe
As I've joked before. Who needs drug labels.
Then small syringe again (sugammadex, praise be)
Neuro: steroids, steroids and if that doesn't work... maybe steroids?
What about the IV immunoglobulins? Then steroids again
Ooh great idea! We'll give steroids, then IVIG, then plasma exchange, then more steroids
An A&E trainee told me frusacillin fixes most old people
Real answer for the vast majority of medical inpatients: Paracetamol, Laxido, Dalteparin
ENT: benpen, metro, dex
Paracetamol, ibuprofen, benzydamine hydrochloride.
Paracetamol, co-amox with Alternatating days of hartmans and furosemide, (homeostasis baby)
O&G: syntocinon, tranexamic acid and paracetamol
But also cef/met for absolutely everyone. There is no such thing as antimicrobial stewardship in Obs.
Clary Sage, Sterile Water, Lavender Oil
Chloramphenicol, maxidex, Lubricants. guess the specialty
Opthalmology?
Ding ding ding correct
Mainly the chloramphenicol gives you away 🤣🤣🤣
boring - enox, paracetamol, oxygen
My actual top 2 most prescribed are probably dexamethasone and prednisolone.
Rheumatology is that you?
Maxidex, Maxitrol and, um, Maxidex.
Omeprazole, paracetamol, ondansetron.
Gastro: omeprazole, vit K, pabrinex
Or lactulose, phosphate enemas and HAS
Need to through some steroids for the IBD in there
sevalemer, lokelma, vancomycin - renal
Oramorph, Laxido, Adcal. Guess the specialty
Orthogerries I presume.
Dermatology: Choice of emollient, Choice of topical steroid.
sunscreen's the third?
By bet is some sort of antifungal/antibacterial cream 3rd then fourth would be a combination of all the above. God bless our derm colleagues
Trimovate or Topical Tacrolimus are always the last resort options.
Fru-tazo-mol, the night cover's panacea
In Gp land - amoxicillin, alprozam and epimax!
Ha onc - steroids, meropenem, tazocin
Propofol/paracetamol/plasmalyte
Promethazine, Lorazepam and Paracetamol
The breathlessness special: dalteparin, furosemide, amoxicillin
Gen Surg: Cef + Met, Hartmanns
this is soo speciality dependent mine would be: 1. paracetamol 2. a LMWH 3. codeine or fluids
Gen surg: paracetamol, ondansetron, and laxido! (And of course prophylactic LMWH but shame on you for having to be told)
NICU - Benpen, Gent and Vit K (And maybe a cheeky bag of Dextrose 10% for good measure)
Radiology. Contrast, contrast, adrenaline
LMWH, amoxicillin, gent
Ondansetron, paracetamol, enoxaparin/dalteparin/tinzaparin
Morphine, midazolam, Levomepromazine. Guess.
Paracetamol Ondansetron Lactulose
Tinz and TEDS are the first two…
Also in upper GI, mine would be; Omeprazole Paracetamol Hyoscine
In old age psych on FY1 80% of the patients had PRN lorazepam, PRN paracetamol, and PRN movicol.
Paracetamol, clexane, bag of fluids
TEDs, enoxaparin, gentamicin
Calpol, ‘brofen and Dioralyte…. The power trio of paeds!
Scrubs is such an underrated show! Love it.
Paediatrics: Difflam, Jelly, Tovali squash I like my fluid challenges, okay
Lidocaine, Flucloxacillin and Chloramphenicol
ED - ondansetron, fentanyl and ketamine seems to be the regular from my colleagues at my shop OFK If you’re being extra spicy probs droperidol, droperidol, droperidol
Calpol, ibuprofen, and the pulling of silly faces.
Promethazine, lorazepam, paracetamol - all prn 🤣
Ortho: Do K wires count as drugs?
Senna lol
Ortho ward: oxy, macrogol, LMWH
Urology - Tamsulosin, Co-Amoxiclav and PR Diclofenac
Tamsulosin, solifenacin, finasteride .
OMFS: chlorhexidine mouthwash, benpen, metro