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Treatment by Complaint

One really difficult thing when it comes to time management is getting PerfectServes or calls about small issues that cloud your memory when you’re trying to focus on the big issues. Realistically we won’t JUST have septic shock - we will have constipation, and increased secretions, and nausea. Patients have real complaints that affect their morale and mood. This isn’t a end-all-be-all list of treatments, but for anyone who is new to the hospital/ICU this helps give you a head start to knowing how to treat the little things.


Constipation

  • Docusate Sodium (colace) capsule or rectal

  • Dulcolax

  • Miralax

  • Senokot

  • Fleet enema

  • Milk of magnesia

Diarrhea

  • Imodium

  • Bismuth sulfate (pepto-bismol)

Indigestion/Acid Reflux/Increased TF residual

  • Tums (calcium carbonate)

  • Metoclopramide (Reglan) - can give IV for incr RF residual

  • Pantoprazole (Protonix)

  • Ranitidine (Zantac) syurup or tab

  • Sucralfate (Carafate) tablet

Nausea/Vomiting

  • IV/PO Zofran

  • Reglan

  • Phenergan: can make people sleepy

  • Add aspiration precautions in the instance of actual vomiting

Cough

  • Robitussin - antitussive + expectorant

  • Benzonatate (Tessalon) capsule - antitussive

  • Mucinex - expectorant

Wheezing/SOB

  • Duo-nebs if no issues w/HR

  • Xopenex if issues with HR (must order as non-formulary)

Loss of Appetite

  • Dronabinol (Marinol) capsule (specifically in AIDS)

  • Megestrol (Megace) -watch in patients with CHF/volume overload

Essential Hypertension

  • Usually HTN is preceded by something (pain, anxiety) - make sure you treat any preceding factors prior to fixing HTN

  • Restart home meds if able

  • PRNs:

    • IV Hydralazine (5, 10 or 20)

    • IV Metoprolol (if HR can tolerate)

Mild Itching/Allergy

  • Both H1/H2 blockers: Benadryl, Pepcid

  • Hydrocortisone cream

Hiccups (Intractable)

  • thorazine

Pain

  • Always assess mental status prior to giving analgesia, and always ask where their pain is

  • “What do they take at home?”

    • PO: Tylenol for mild pain, Tramadol or Percocet for severe pain

    • IV: morphine

    • Chest pain: IV morphine for dilation of cardiac vessels, nitroglycerin in setting of ACS as long as BP can tolerate

    • Unable to take opioid: Ketorolac (Toradol)

    • Nerve pain (e.g. “shooting” pain): gabapentin

Anxiety

  • PO Xanax PRN (typically 0.25 mg QHS or more frequently)

  • IV Ativan (be very careful in setting of respiratory issues - causes respiratory depression)

Headache

  • Ask if they have a history of migraines

  • “What do they take at home?”

  • PO: Tylenol

  • Migraines: Triptan drugs (i.e. sumatriptan)

Delirium

  • The best way to treat delirium is non-pharmacologically (see P/A/D podcast)

  • Non-BZDs are ideal. Should only use drugs if you absolutely have to

    • Haldol IV

    • Seroquel PO

    • Zyprexa sublingual

    • IM drugs in cases of violence/threat: Geodon, Ativan, Haldol

Increased Secretions on Vent

  • Two issues come into play: inability to cough up secretions (physical component) and secretions themselves

    • Mucomyst nebs - not the best but taste gross and makes people cough

    • Scopolamine patch - thickens secretions, can be counter-productive

  • Can use chest physiotherapy to help break up secretions

  • Mobilize, mobilize, mobilize

Insomnia

  • Restoril

  • Ambien

  • Benadryl (avoid in elderly - they can become psycho)

  • Trazodone - also an antidepressant

  • Melatonin if available - only at some hospitals

Fever

  • Tylenol - PO or rectal

  • Ice packs and cooling blanket on patient

  • If severe enough: think malignant hyperthermia, can place icycath to cool