The Run Down

<table border="1" cellpadding="0" cellspacing="0" style="width: 100%"><thead><tr><th scope="col">Call</th><th scope="col">Causes - major threat to life</th><th scope="col">Worrying factors</th><th scope="col">Immediate management</th></tr></thead><tbody><tr><th scope="row">IV Catheters</th><td> </td><td> </td><td>An IV catheter should only be inserted when there is a specific indication. It should not be inserted ‘just in case’ it is needed later.IV catheters should be monitored routinely as part of ward rounds and routine clinical examinations.IV catheters should be removed as soon as there is no clinical need, if the catheter has ‘tissued’, or if there is any concern about infection.Further information about iv catheters is in the Intravenous Catheters – Peripheral clinical guideline on Hippo.Please also refer to the course on Venepuncture, Cannulation and Phlebotomy Programme on Ko Awatea Learn</td></tr></tbody></table>

IV Catheters - common ward call

<table border="1" cellpadding="0" cellspacing="0" style="width: 100%"><thead><tr><th scope="col">Call</th><th scope="col">Causes - major threats to life</th><th scope="col">Worrying factors</th><th scope="col">Immediate management</th></tr></thead><tbody><tr><th scope="row">&nbsp;Confusion&nbsp;&nbsp;</th><td>Myocardial infarctionDelirium vs. dementiaDrugsFluid imbalanceHypoxiaMetabolic causesPre-existingStrokeTraumaDelirium tremensIntracranial massMeningitisSepsis/infectionToxins/heavy metals</td><td>DrowsyFeverFocal neurologyHistory of alcoholismHypoxiaTime of onset</td><td>History and examinationSeptic screen + delirium screen if appropriate Orientation questionsDay, date, month, season, yearBuilding, floor, roomName months backwards or count back from 20Prime MinisterDOB, full name, address Consider ETOH withdrawal scaleRemember, withdrawal is much more dangerous than benzos!If agitated, see “psych/aggression’ belowAsk yourself whether an urgent CT is indicated (considering history and exam)Document GCS, orientation, and use of aids: hearing aids, glasses, and clock</td></tr></tbody></table>

Confusion - common calls

<table border="1" cellpadding="0" cellspacing="0" style="width: 100%"><thead><tr><th scope="col">Call</th><th scope="col">Cause - major threat to life</th><th scope="col">Worrying factors</th><th scope="col">Immediate management</th></tr></thead><tbody><tr><th scope="row">&nbsp;Constipation&nbsp;</th><td>Drugs – regular opioids (but no regular laxatives charted)LifestylePost op ileusElderlyDehydrationImmobilityObstruction</td><td>Nausea/vomitingNew abdominal distensionNot passing flatus</td><td>Exclude:• Pregnancy• Cancer• Hypothyroidism• HypercalcaemiaConsider PR examAre they on clozapine?&nbsp; &nbsp; &nbsp;If so, this is an emergency&nbsp; &nbsp; &nbsp;AXR&nbsp; &nbsp; &nbsp;Call Psych RegistrarIf clinical suspicion of bowel obstruction, then request AXR, otherwise AXR not usually needed.&nbsp; &nbsp; &nbsp;1. Stimulant (Laxsol® 2 tabs bd)&nbsp; &nbsp; &nbsp;2. Softener: Lactulose is good for acute setting – 20 mL bd&nbsp; &nbsp; &nbsp;3. Consider Lax-Sachet or Micolette® or Fleet® enema&nbsp; &nbsp; &nbsp;4. Bulking agent (Konsyl D®) (note these are largely preventative, not overly effective once constipated)Avoid oral Fleet if there is obstruction and probable faecal loading as there is a risk of perforation.Avoid stimulant laxatives (Laxsol®) in patients who are post-bowel surgery.Record stool chart</td></tr></tbody></table>

Constipation - common ward call

<table border="1" cellpadding="0" cellspacing="0" style="width: 100%"><thead><tr><th scope="col">Call&nbsp;</th><th scope="col">Causes - major threat to life</th><th scope="col">Worrying factors</th><th scope="col">Immediate management</th></tr></thead><tbody><tr><th scope="row">Chest Pain</th><td>InfectionMusculoskeletal painRefluxAortic dissectionMyocardial infarctionPulmonary embolismPneumothoraxTamponade</td><td>ECG changesHypotensionNauseaReduced GCSSOBSudden onset sweatingTachycardia/bradycardia</td><td>ECGConsider troponinsFull blood count, electrolytesConsider aspirin 300 mg STATConsider glyceryl trinitrate (GTN) trial – 1 sprayManual BP both arms if aortic dissection likelyCheck calves – look for pitting oedema, erythema, and measure calf circumference bilaterallyCalculate Well’s score&nbsp; &nbsp; &nbsp;Consider D dimer (discuss with cardio or gen med first).&nbsp; &nbsp; &nbsp;Please noted that if patient is post-op, D-dimer will be elevated and unlikely to be helpful.CXR</td></tr></tbody></table>

Chest pain - common ward call

<table border="1" cellpadding="0" cellspacing="0" style="width: 100%"><thead><tr><th scope="col">Call</th><th scope="col">Causes - major threat to life</th><th scope="col">Worrying factors</th><th scope="col">Immediate management</th></tr></thead><tbody><tr><th scope="row">Decreased urine output</th><td>Blocked catheterDrugsHypovolemia/dehydrationRetentionSepsisHyperkalaemiaRenal failure&nbsp; &nbsp; &nbsp;• Pre-renal&nbsp; &nbsp; &nbsp;• Renal&nbsp; &nbsp; &nbsp;• Post renal</td><td>&lt;0.5 mL/kg/hrHyperkalaemiaHypotensionIncreased creatinine</td><td>Note: UO approximately 0.3 mL/kg/h often acceptable if patient is D1 post-op. But ensure that this is not due to hypovolaemia.Examine abdomen – is there a palpable bladder?Bladder scan&nbsp; &nbsp; &nbsp;• IDC (or in/out catheter) if &gt;500 mL on scan&nbsp; &nbsp; &nbsp;• Constipation can often be a common cause of urinary retentionCheck previous electrolytes + creatinine&nbsp; &nbsp; &nbsp;• If abnormal, discuss with Reg&nbsp;&nbsp; &nbsp; &nbsp;• Hyperkalaemia: ECG, and consider cardiac monitoring&nbsp;Clinically dehydrated or low bladder volume&nbsp; &nbsp; &nbsp;• Plasmalyte® challenge&nbsp; &nbsp; &nbsp;• NB renal failure/heart failure: discuss with Reg first (consider 250 mL)If blocked catheter – flush (nurses do)NB – nurses can put in IDCs. Ring and ask for this.&nbsp; &nbsp; • Female nurses do female catheters and male nurses can do male catheters.&nbsp; &nbsp; • Any issues with IDC call CNA then Urology</td></tr></tbody></table>

Decreased Urine output - common ward call

<table border="1" cellpadding="0" cellspacing="0" style="width: 100%"><thead><tr><th scope="col">Call</th><th scope="col">Causes - major threat to life</th><th scope="col">Worrying factors</th><th scope="col">Immediate management</th></tr></thead><tbody><tr><th scope="row">Diarrhoeaacute &lt;2 weeks</th><td>HIVInfectionDrugs (especially antibiotics)LaxativesOverflow diarrhoea</td><td>HypovolemicWatery onlyBlood?</td><td>Bloods: creatinine and electrolytes.If suspect overflow (watery):&nbsp; &nbsp; &nbsp;• Do AXR&nbsp; &nbsp; &nbsp;• Don’t give loperamide etc.If suspect infection: isolation&nbsp; &nbsp; &nbsp;• Ask for stool specimen to be sent off. Request C.diff screen if patient has recently been on antibioticsRehydration&nbsp; &nbsp; &nbsp;• Oral fluids&nbsp; &nbsp; &nbsp;• IVF • Electral® sachetsRecord stool chartRemember faecal losses of electrolytes may be as high as 100 mmol/L Na+ and 5-15 mmol/L K+ per litre of stool.Antibiotics are not necessary for the majority of infective diarrhoeas</td></tr></tbody></table>

Diarrhoea - common ward call

<table border="1" cellpadding="0" cellspacing="0" style="width: 100%"><thead><tr><th scope="col">Calls</th><th scope="col">Causes - major threat to life</th><th scope="col">Worrying factors</th><th scope="col">Immediate management</th></tr></thead><tbody><tr><th scope="row">Falls / Collapse</th><td>Delirium/dementiaEnvironmentalHypotensivePostural hypotensionVasovagal/syncopeMedicationsArrhythmiaHypoglycaemiaHypoxiaMyocardial infarctionPulmonary embolismSeizureStroke</td><td>BleedingChest painDecreasedGCSFocal neurologyHypotensionIncontinencePalpitations/tachycardia</td><td>Address both the cause and consequences of fall/ collapse.History is key.Neuro, cardiovascular and respiratory exams, look for other injuries.Bloods – FBC, electrolytes + creatinine, +/- CRP, +/- coags, +/- tropsECGCardiac monitoring for 24 hours if ?arrhythmiaIf suspected head injury or unwitnessed fall:&nbsp; &nbsp; &nbsp;• Consider frequency of neuro obs; can be as often as q15min&nbsp; &nbsp; &nbsp;• HR, BP, RR, O2 sats, GCS&nbsp; &nbsp; &nbsp;• CT headCoags if:&nbsp; &nbsp; &nbsp;• Age &gt;65&nbsp; &nbsp; &nbsp;• Suspected head injury&nbsp; &nbsp; &nbsp;• Anticoagulation&nbsp; &nbsp; &nbsp;• Fall from height &gt;1 mIf suspected fracture request x-rays&nbsp;&nbsp;&nbsp; &nbsp; &nbsp;• Keep patient NBM&nbsp; &nbsp; &nbsp;• check x-ray when done and discuss with ortho</td></tr></tbody></table>

Falls or Collapse - common ward calls

<table border="1" cellpadding="0" cellspacing="0" style="width: 100%"><thead><tr><th scope="col">Call</th><th scope="col">Causes - major threat to life</th><th scope="col">Worrying factors</th><th scope="col">Immediate management</th></tr></thead><tbody><tr><th scope="row">&nbsp; Fever&nbsp;&nbsp;</th><td>AspirationAtelectasis (D1-2 post-op)Infection&nbsp; &nbsp; &nbsp;• IDC&nbsp; &nbsp; &nbsp;• Chest&nbsp;&nbsp; &nbsp; &nbsp;• Wound&nbsp; &nbsp; &nbsp;• Drain&nbsp; &nbsp; &nbsp;• IV access site&nbsp; &nbsp; &nbsp;• Post surgicalSepsis Shock</td><td>Chest painConfusionHypotensionPersistent tachypnoeaSignificant decrease in satsTachycardia/BradycardiaRigorsImmuno-compromised</td><td>Full septic screen&nbsp; &nbsp; &nbsp;• MSU/CSU&nbsp; &nbsp; &nbsp;• CXR&nbsp; &nbsp; &nbsp;• Peripheral or catheter blood culture (before Abx administration, if possible)&nbsp; &nbsp; &nbsp;• FBC&nbsp; &nbsp; &nbsp;• Electrolytes&nbsp; &nbsp; &nbsp;•&nbsp;Sputum&nbsp; &nbsp; &nbsp;• Wound swabsIf hypoxic then do ABG Management&nbsp; &nbsp; &nbsp;• IVF resus&nbsp; &nbsp; &nbsp;• Registrar review&nbsp; &nbsp; &nbsp;• Antibiotics&nbsp; &nbsp; &nbsp;•&nbsp;Cooling cares (fan, cold flannel)Check paracetamol is charted regularly</td></tr></tbody></table>

Fever - common ward calls

<table border="1" cellpadding="0" cellspacing="0" style="width: 100%"><thead><tr><th scope="col">Call</th><th scope="col">Causes - major threat to life</th><th scope="col">Worrying factors</th><th scope="col">Immediate management</th></tr></thead><tbody><tr><th scope="row">Hypertension</th><td>Anxiety/painCardiac causesDrugsPre-existingAortic dissectionEclampsiaHypertensive encephalopathyMyocardial infarctionPulmonary oedemaRaised ICPStrokeAutonomic dysreflexia</td><td>BradycardiaChange in mental stateChest painDBP &gt;120 mmHgSBP &gt;200 mmHgHeadache/vomitingVisual changesPregnancy</td><td>Old or new?GCS Treat if: symptomatic or SBP &gt;180.&nbsp; &nbsp; &nbsp;• Review: usual anti-hypertensives&nbsp; &nbsp; &nbsp;• Consider: different anti-hypertensive (felodipine ER 2.5 mg STAT or perindopril 4 mg STAT), or larger dose of current anti-hypertensive&nbsp; &nbsp; &nbsp;• Ring Gen Med if unsure&nbsp; &nbsp; &nbsp;• If there is evidence of persistent HTN and patient asymptomatic, document in the notes and request team to address this in the morning</td></tr></tbody></table>

Hypertension - common ward call

<table border="1" cellpadding="0" cellspacing="0" style="width: 100%"><thead><tr><th scope="col">Calls</th><th scope="col">Causes - major threat to life</th><th scope="col">Worrying factors</th><th scope="col">Immediate Management</th></tr></thead><tbody><tr><th scope="row">Hypotension</th><td>Cardiac causesDrugsPosturalSepsisDehydrationArrhythmiaMyocardial infarctionShockBleeding</td><td>Back painChest painDecreased satsDizzinessFebrileLow urine output/AKIObvious bleedingReduced GCSStridorTachycardia/bradycardia</td><td>Old or new?GCSExamination&nbsp; &nbsp; &nbsp;• Manual BP&nbsp; &nbsp; &nbsp;• Is the HR greater than the systolic BP?&nbsp; &nbsp; &nbsp;• Examine and assess patient’s fluid statusReview fluid balance chartReview medication.&nbsp; &nbsp; &nbsp;• Consider withholding&nbsp; &nbsp; &nbsp;• anti-hypertensives (ring Reg)&nbsp; &nbsp; &nbsp;• Consider IVF (caution heart failure or renal failure)&nbsp; &nbsp; &nbsp;• Consider fluid challenge of 500 mL</td></tr></tbody></table>

Hypotension - common ward calls

<table border="1" cellpadding="0" cellspacing="0" style="width: 100%"><thead><tr><th scope="col">Call</th><th scope="col">Causes - major threat to life</th><th scope="col">Worrying Factors</th><th scope="col">Immediate management</th></tr></thead><tbody><tr><th scope="row">Hyperglycaemia</th><td>Infection/acute illnessNon-compliancePost-op SteroidsStressDKAHHSMyocardial infarctionSepsis</td><td>AcidosisChest painKetones in urineReduced GCSVomiting</td><td>Consider Novorapid® if BSL &gt;15 (see Diabetes chapter for dosing guidance)Recheck BSL in 30 mins.Note: a normal BSL isn’t vital, &lt;15 may be adequate.Review usual BSLs – don’t lower by too much.After managing an episode of hyperglycaemia (if patient clinically stable), write in notes requesting team to address this issue in the morning.Consider Diabetes Nurse Specialist referral</td></tr></tbody></table>

Hyperglycaemia

<table border="1" cellpadding="0" cellspacing="0" style="width: 100%"><thead><tr><th scope="col">Call</th><th scope="col">Causes - major threat to life</th><th scope="col">Worrying factors</th><th scope="col">Immediate management</th></tr></thead><tbody><tr><th scope="row">Hypoglycaemia</th><td>AlcoholIncreased exerciseInsulinMissed mealsOral hypoglycaemicsAcute liver failureSepsis</td><td>Patients not known to have diabetesRecurrent episodesReduced GCS</td><td>Check GCS.Nurses should already have followed insulin chart/hypo instructions and given something.Clearly document for hypoglycaemics to be withheld.Give 10% glucose IV and get patient to eat a snack or Hypo-Fit® (orange) oral gel 18 g</td></tr></tbody></table>

Hypoglycaemia - common ward calls

<table border="1" cellpadding="0" cellspacing="0" style="width: 100%"><thead><tr><th scope="col">Call</th><th scope="col">Causes - major threat to life</th><th scope="col">Worrying factors</th><th scope="col">Immediate management</th></tr></thead><tbody><tr><th scope="row">Pain</th><td>Inadequate analgesiaNew pathologySurgical complicationsMyocardial infarctionPulmonary embolism</td><td>HypertensionNot going away with simple analgesiaPersistent tachycardiaThunderclap headacheWorsening pain</td><td>SOCRATESConsider referral or discussion with Registrar Prescribe analgesia&nbsp; &nbsp; &nbsp;• Paracetamol&nbsp; &nbsp; &nbsp;• Tramadol&nbsp; &nbsp; &nbsp;• Celecoxib&nbsp; &nbsp; &nbsp;• Morphine/oxycodone&nbsp; &nbsp; &nbsp;• Morphine “as per IV protocol”&nbsp; &nbsp; &nbsp;• Renal failure: fentanyl “as per IV protocol”Note: avoid NSAIDs, codeine, tramadol in the elderlyIf needing more than this, discuss with Reg or Pain TeamCall a code if worried about opiate overdose, especially respiratory depression</td></tr></tbody></table>

Pain - common ward call

<table border="1" cellpadding="0" cellspacing="0" style="width: 100%"><thead><tr><th scope="col">Call</th><th scope="col">Causes - major threat to life</th><th scope="col">Worrying factors</th><th scope="col">Immediate management</th></tr></thead><tbody><tr><th scope="row">Psychiatric aggression</th><td>Delirium</td><td> </td><td>Do they have a management plan?Non-pharmacological measuresConsider code orange&nbsp; &nbsp;• Security, duty manager and psych liaison come to thisRing a Psych Reg for dosing advice if they need haloperidol, etc.&nbsp; &nbsp; &nbsp;• Lorazepam 0.5-1 mg&nbsp; &nbsp; &nbsp;• Haloperidol 0.5 mg (contraindicated in Parkinsonism)&nbsp; &nbsp; &nbsp;• Caution, under dosing is safer than overdosing&nbsp; &nbsp; &nbsp;• Be safe: do not see patients alone</td></tr></tbody></table>

Psychiatric Aggrression - common ward calls

<table border="1" cellpadding="0" cellspacing="0" style="width: 100%"><thead><tr><th scope="col">Call</th><th scope="col">Causes - major threat to life</th><th scope="col">Worrying factors</th><th scope="col">Immediate management</th></tr></thead><tbody><tr><th scope="row">&nbsp; Rash&nbsp;&nbsp;</th><td>Allergic reaction (drug eruption)EczemaHeat rashInfectious – scabies, etc.Grover’s DiseaseShinglesErythroedemaStevens-Johnson syndrome</td><td>BlisteringInvolvement of oral mucosaLarge areaPeeling of skin/desquamating</td><td>Are they systemically unwell?&nbsp; &nbsp; &nbsp;• If so, have a low threshold to call DermSTOP administration of drug causing allergyRing derm if:&nbsp; &nbsp; &nbsp;• Desquamating&nbsp; &nbsp; &nbsp;• And/or oral mucosa involved Consider anti-histamine for itch:&nbsp; &nbsp; &nbsp;• Loratidine 10 mg or cetirizine 10 mg&nbsp; &nbsp; &nbsp;• Consider an emollient for dry skin&nbsp; &nbsp; &nbsp;• Aqueous cream can worsen rashes, fatty cream may be betterDermnet is a great and regularly updated resource.CLEARLY DOCUMENT new allergic reaction on med chart and in notes so that team pharmacist can be aware in the morning</td></tr></tbody></table>

Rash - ward call

<table border="1" cellpadding="0" cellspacing="0" style="width: 100%"><thead><tr><th scope="col">Call</th><th scope="col">Causes - major threat to life</th><th scope="col">Worrying factors</th><th scope="col">&nbsp;Immediate management</th></tr></thead><tbody><tr><th scope="row">Seizure</th><td>Status epilepticus</td><td>&gt;10 min</td><td>Code RedCheck blood glucose, if &lt;5 give IV glucoseIV medication is preferred as IM absorption is erratic&nbsp; &nbsp; &nbsp;Lorazepam (1st choice) - 4 mg IV push over 2 min&nbsp; &nbsp; &nbsp;Midazolam - 10 mg IV or IMIf you have not dealt with this before, call the Med Reg.</td></tr></tbody></table>

Seizure - common ward call

<table border="1" cellpadding="0" cellspacing="0" style="width: 100%"><thead><tr><th scope="col">Call</th><th scope="col">Causes - major threat to life</th><th scope="col">Worrying factors</th><th scope="col">Immediate management</th></tr></thead><tbody><tr><th scope="row">Short of breath</th><td>BronchospasmInfectionAnaphylaxisArrhythmiaAspirationCardiac tamponadeMyocardial infarctionPulmonary embolismPulmonary oedemaTension pneumothoraxUpper airway obstruction</td><td>ConfusionChest painFatigueFebrileHypotensionReduced satsTachycardia/bradycardiaRR &gt;30 breaths/min</td><td>If anaphylactic, follow anaphylaxis guidelinesO2 to keep sats above 94% (If COPD aim for 88-92%).If hypoxic – do ABGCXRECGConsider septic screenFrusemide for pulmonary oedema&nbsp; &nbsp; &nbsp;• e.g. 40-80 mg IV STAT dose (depends if they are frusemide naïve or not)&nbsp; &nbsp; • Record respiratory rate</td></tr></tbody></table>

Short of breath - common ward calls

<table border="1" cellpadding="0" cellspacing="0" style="width: 100%"><thead><tr><th scope="col">Call</th><th scope="col">Causes - major threat to life</th><th scope="col">Worrying factors</th><th scope="col">Immediate managements</th></tr></thead><tbody><tr><th scope="row">Swollen Legs</th><td>DVTOedema – heart failureDependent Cellulitis</td><td>ConfusionChest painFatigueFebrileHypotensionReduced satsTachycardia/BradycardiaTachypnoea</td><td>History&nbsp; &nbsp; • Screen for PE symptoms&nbsp; &nbsp; • Risk factors for DVT – do a Well’s Score&nbsp; &nbsp; • Check if patient has been on thromboprophylaxisExamination&nbsp; &nbsp; • Soft calves?&nbsp; &nbsp; • Signs of heart failure or varicose veins&nbsp; &nbsp; • ErythemaTalk to a Reg before doing a D-dimer</td></tr></tbody></table>

Swollen Legs - common ward calls

<table border="1" cellpadding="0" cellspacing="0" style="width: 100%"><thead><tr><th scope="col">Call</th><th scope="col">Causes - major threat to life</th><th scope="col">Worrying factors</th><th scope="col">Immediate management</th></tr></thead><tbody><tr><th scope="row">Tachycardia</th><td>Cardiac arrhythmiasDrugsHypovolaemia/ dehydrationInadequate pain reliefRenal failureSepsisHeart failureHypoxiaMyocardial infarctionShock</td><td>Chest painDecreased satsDistended neck veinsFebrileHypotensionIncreased RRSweatingTachycardia &gt;130 bpm</td><td>Are they hypotensive? – get a manual BPIs the HR &gt; the systolic BP?ECG – to check rhythm; consider flexi monitoringReview fluid balance chartDiscuss with General Medicine or Cardiology</td></tr></tbody></table>

Tachycardia -common ward calls

<table border="1" cellpadding="0" cellspacing="0" style="width: 100%"><thead><tr><th scope="col">Call</th><th scope="col">Causes - major threat to life</th><th scope="col">Worrying factors</th><th scope="col">Immediate management</th></tr></thead><tbody><tr><th scope="row">Upper Gastro Intestinal bleed</th><td>Mallory WeissUlcerationCarcinomaVarices</td><td>Age (&gt;60 yrs)ClotsCo-existing illnesses (cardiac, renal, liver, metastatic cancer)ConfusionHb &lt;90 g/LKnown varices/evidence of cirrhosisShockMelaena or fresh bloodAnticoagulated</td><td>ABCs/haemodynamic stability&nbsp; &nbsp; &nbsp;• Fluid resus +/- code if neededPR exam – to look for melaenaCheck Hb, coags, LFTs, G+HStop anticoagulationRockall scoreCall Gastro early&nbsp; &nbsp; &nbsp;• ?timing of scope&nbsp; &nbsp; &nbsp;• Omeprazole&nbsp; &nbsp; &nbsp;• Record stool chart</td></tr></tbody></table>

UGI Bleed - common ward calls

<table border="1" cellpadding="0" cellspacing="0" style="width: 100%"><thead><tr><th scope="col">Call</th><th scope="col">Causes - major threat to life</th><th scope="col">Worrying factors</th><th scope="col">Immediate management</th></tr></thead><tbody><tr><th scope="row">Vomiting</th><td>Drugs (including anaesthetic induction agents)InfectionUpper GI bleedBlood lossBowel obstructionDiabetic ketoacidosisMeningitisMyocardial infarctionRaised ICP</td><td>Abdominal injuryHead injuryHypotensionReduced GCSRequiring 3 or more anti-emeticsBlood in vomitFeaculent vomit</td><td>Metoclopramide 5-10 mg PO/IV tds/prn (Do not give in Parkinson’s disease)Cyclizine 50 mg po/IV tds/prnOndansetron 4-8 mg po/IV tds/prnDomperidone 10 mg po tds/prnIf bowel obstruction suspected:&nbsp; &nbsp; • AXR • IV fluids for replacement&nbsp; &nbsp; • NBM&nbsp; &nbsp; • Consider NGT</td></tr></tbody></table>

Vomiting - common ward calls

This guide will help you when your brain freezes and you have nurses seeking your help. Remember, this is not a complete guide; simply some suggestions to help focus you.

Common ward calls

IV Catheters

Confusion

Constipation

Chest Pain

Decreased Urine Output

Diarrhoea

Falls / Collapse

Fever

Hypertension

Hypotension

Hyperglycaemia

Hypoglycaemia

Pain

Psychiatric Aggression

Rash

Seizure

Short of breath

Swollen legs

Tachycardia

Upper GI Bleed

Vomiting