Protocol Detail
WARFARIN OVERDOSE/ TOXICITY
Overdose of the oral anticoagulant warfarin (Coumadin), or drug interactions with warfarin, can lead to toxicity. Similarly, toxicity can result from exposure to superwarfarins, which are long-acting anticoagulants used in rodenticides. ... Warfarin is the most common oral anticoagulant in current use
Diagnosis
Target INR is usually 2-4.
Mean effective half-life is 40 hours.
Need to establish:
· Patients need for Warfarin (e.g inadvertent toxicity vs. intentional overdose),
· Actual INR &
· Establsih presence of active significant bleeding (significant volume, clinical compromise, haematemasis, intracranial bleed, ruptured Abdominal Aortic Aneurysm or dissection).
Management
1. ABC’s, Resuscitation as indicated,
2. IV access,
3. FBC, U&E’s, INR, Group & hold/ cross match as indicated,
4. Warfarin NOT NEEDED:
· Normal INR:
a. Give charcoal if ingested in previous 1 hour,
b. Check INR 24-48 hours.
· Increased INR no bleeding:
a. Vitamin K 5-10 mg IV,
b. Monitor,
c. Review & check INR in 24-48 hours & give further Vitamin K as indicated.
· Increased INR & significant bleeding:
a. Vitamin K 5-10 mg IV,
b. Prothrombinex – HT 20-50 Units IV &
c. FFP 10-15 mls/kg.
5. Warfarin NEEDED & INR INCREASED:
· Life threatening bleeding
a. Prothrombinex- HT 20-50 Units vials IV initially,
b. Vitamin K 5-10 mg IV,
c. FFP 10-15 mls/kg
· No life threatening bleeding (Consider risk of bleeding above) & INR:
a. INR <5.0: Lower or ,omit next dose, resume at lower dose when therapeutic,
b. INR 5.0-9.0: Stop Warfarin, Vitamin K 0.5 mg IV or 1.0 mg if high risk (see below), check INR within 24 hours, resume Warfarin at reduced dose when INR <5.
c. INR >9.0: Stop Warfarin, Vitamin K 1.0 mg IV, consider FFP & Prothrombinex- HC if high risk (see below), check INR after 6-12 hours, resume Warfarin when INR < 5.0.
High clinical risk factors for bleeding:
· Age >65,
· Uncontrolled HTN,
· History of GI bleed, active peptic ulcer, hepatic insufficiency,
· Thrombocytopaenia (<50x/L),
· Underlysing malignancy,
· Stroke,
· Renal insufficiency,
· Renal insufficiency,
· Recent trauma,
· Excessive alcoholic intake,
· NSAID’S, COX-I use.
Recent Protocols
COVID 19
COVID 19 is a disease caused by the most recently discovered coronavirus which is a large family of corona viruses causing illnesses. In humans it causes Respiratory infections for example Severe Acute Respiratory Disease (SARs) PRESENTATION Fever 77-98% Cough 46-82% Myalgia/Fatigue 11-52% Shortness of breath 3-31% Incubation period 14 days, most people develop symptoms between 5-6ays from exposure Stage1 (Early infection). Stage 2. Stage 3(Hyperinflation phase) Viral response---------------------------Pulmonary Phase----------------------Host Response *Anyone presenting with flu like symptoms should be assumed to be a COVID 19 case until proven otherwise*
SUICIDAL IDEATION
Suicidal ideation, also known as suicidal thoughts, is thinking about or having an unusual preoccupation with suicide.
SPINAL CORD INJURY
Emergency signs and symptoms of a spinal cord injury after an accident may include: Extreme back pain or pressure in your neck, head or back. Weakness, incoordination or paralysis in any part of your body. Numbness, tingling or loss of sensation in your hands, fingers, feet or toes. Loss of bladder or bowel control.
SNAKE ENVENOMATION
snake envenomation causes headache, a thick feeling of the tongue, thirst, sweating and vomiting
SEROTONIN SYNDROME
Serotonin syndrome (SS) is a group of symptoms that may occur following use of certain serotonergic medications or drugs. The degree of symptoms can range from mild to severe. Symptoms include high body temperature, agitation, increased reflexes, tremor, sweating, dilated pupils, and diarrhea.
