Management
Generic Steroid | Equivalent dose (mg) | Anti-inflammatory Potency | Mineralocorticoid potency | Oral dosing forms (tablet in mg) | Duration of Action (hours) |
Cortisone | 25 | 0.8 | 0.8 | tab: 25 | 8-12 |
Hydrocortisone | 20 | 1 | 1 | tab: 5, 10, 20 | 8-12 |
Prednisone | 5 | 4 | 0.8 | tab: 1, 2.5, 5, 10, 20, 50 | 12-36 |
Prednisolone | 5 | 4 | 0.8 | tab: 10, 15, 30 | 12-36 |
Methylprednisolone | 4 | 5 | 0.5 | tab: 4, 8, 16, 32 | 12-36 |
Dexamethasone | 0.75 | 30 | 0 | tab: 0.5, 0.75, 1, 1.5, 2, 4, 6 | 36-54 |
Betamethasone | 0.6 | 30 | 0 | solution: 0.6mg/5ml (118mL) | 36-54 |
Fludrocortisone | - | 15 | 150 | tab: 0.1mg | 24-36 |
|
AED Step | Description |
1st Line | Lorazepam 0.1mg/kg IV @ <2mg/min |
2nd Line |
Give either simultaneously with above or 1 minute after lorazepam infusion completes:
|
3rd Line |
7% chance of success at stopping seizure:
|
Consider: skip 3rd line → intubate → start midazolam, pentobarbital or propofol |
Step | Description |
1 | Check airway |
2 | Elevate head of the bed to 30o |
3 |
Osmotic therapy with mannitol 1gm/kg IV or 10-20ml of 23.4% saline
|
4 | If resistant / sudden IC-HTN is present → STAT non-contrast head CT |
5 | Drain 3-5ml of CSF if intraventricular catheter is present |
6 | Ensure patient is sedated and paralyzed |
7 | Hyperventilation with bag valve mask (to PaCO2 30-35mmHg) |
8 | Induced coma with pentobarbital 100mg IV or thiopental 2.5mg/kg IV |
Time (Hours from symptom onset) |
IV tPA |
IA tPA (Consider after IV tPA failure) |
Mechanical Embolectomy (Consider after IV tPA failure) |
|
1 | ✓ | ✓ | ✓ | |
2 | ✓ | ✓ | ✓ | |
3 | ✓ | ✓ | ✓ | |
4 | ✓ | ✓ | ✓ | |
5 | Up to 4.5hr | ✓ | ✓ | |
6 | - | ✓ | ✓ | Verify perfusion prior to procedure |
7 | - | - | ✓ | |
8 | - | - | ✓ | |
>9 | - | - | - |
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