WELCOME NEW INTERNS!

Welcome to your first day! Here's some pointers for you. :) For more humor, check out A Cartoon Guide to Becoming a Doctor

SCHEDULES FOR UPCOMING YEAR

We are currently working on schedules for the upcoming year and trying to accomodate requests. We will be asking for elective and vacation preferences shortly, and then we will start scheduling clinics, conferences, etc. We appreciate your patience in this process.

Miten and Reena

ICU morning rounds template

Template by Dr. Dhillon
CAM score to assess ICU delirium
Document available on the RESOURCES page under the INPATIENT folder

As we're counting down the days for inpatient HealthConnect going live, here are some links you'll love. Links may be accessible only at work though

KP HealthConnect Ambulatory - What's New


KP HealthConnect Inpatient - What’s New

Announcements

1) Please notify Dr. Lischner before your vacation so he can cover your clinic inbox while you are away
2) Holiday Party at Dr. Patton's house on Saturday, Dec 12, starting at 6:30pm. Check your Lotus Notes for her address.
3) Please continue to check CIPS regularly for your clinics
4) All research electives must be approved by Dr. Baudendistel or Dr. Brickner prior to the first date of the elective. There is also a research description form that you must fill out, the form is on Reslounge.com. (go to Resources then scroll all the way down to below the iPhone screen for "Joy's Forms")
5) Jason will start as chief starting Tuesday, Dec. 8th

Pressor dosing

FYI for those in ICU: Weight Based dosing for Pressors won't be instituted yet until new pumps arrive. Please use Pressor dosing as indicated in our current ICU admit orders.

Weight Based dosing for Pressors

Weight Based dosing for Vasopressors

See twitter link on right for quick link to table

Kaiser Oakland and Richmond hospitals will be implementing Baxter pumps programmed with a clinical library intended to provide additional safety features for medications delivered by continuous infusion.with weight based dosing to deliver medications. With the implementation of this clinical library, the dosing parameters for three vasopressor drugs will change. Three vasopressors in particular have significant importance and thus require attention. Significant changes are summarized below:

• Medications affected: epinephrine (Adrenalin), phenylephrine (Neo-Synephrine), and norepinephrine (Levophed).
• All three medications will need to be ordered as Dosing for all three medications will now be weight based in Mmicrogram/kg/min (mcg/kg/min). Previous dosing was mcg/min.
• Orders should read according to the following guideline: “Start norepinephrine at 0.05 mcg/kg/min IV, titrate to maintain MAP greater than ____.”
• Maximum infusion doses will now be weight specific, according to dosing charts which are readily available in ICU, PACU, ED and the Inpatient Pharmacy.
• Shaded areas on the dosing chart are reserved for high doses and are considered unusual and atypical.
• If a patient requires dosing of one of these pressors that is in the shaded area of the chart, a critical care physician should be consulted.

Specific Dosing charts are available in the ICU, PACU, ED. Please ask the nurse in charge.

Physicians who will order these medications are generally critical care specialists

Medication	Usual Starting Dose	Standard Concentration
Epinephrine (Adrenalin)	0.04 to 0.08 mcg/kg/min Titrate by 0.01 to 0.02 mcg/kg/min Max dose: See dosing chart	8 mcg/ml (2 mg/250 ml D5W)
Phenylephrine (Neo-Synephrine)	0.5 to 1 mcg/kg/min Titrate by 0.4 mcg/kg/min to SBP or MAP per MD order Max dose: See dosing chart	160 mcg/ml (40 mg/250 ml D5W or NS)
Norepinephrine (Levophed, Levarterenl)	0.2 mcg/kg/min Titrate by 0.05 mcg/kg/min increments to meet MAP or BP goals Max dose: See dosing chart	16 mcg/ml (4 mg/250ml D5W)

10/28/2009

Inpatient Pharmacy

KM/AH