急诊常用处方.doc

急诊常用处方   急症处理：  1. 高热              10%~25%安乃近2~3滴每侧滴鼻            复方氨基比林   2ml     im   st！            柴胡           2~4ml   im   st！            口服可选用阿司匹林，复方阿司匹林，对乙酰氨基酚（扑热息痛）及吲哚美辛（消炎痛）            冬眠疗法：氯丙嗪  25mg  im  st！                      异丙嗪  25mg  im  st！  2. 上消化道出血         A. 积极补充血容量      （1）右旋糖酐-40  500ml  静滴                            （2）输入足量全血，另开通路     B  止血药              （1）肝硬变食道胃底静脉曲张破裂出血                                    5% 葡萄糖  500ml                                                                静滴0.2~0.4U/分                                    垂体后叶素  6~8U                                  10% 葡萄糖       10ml                                                               静脉推注 即继而以25~50ug/小时的速度持续静滴                                 奥曲肽（善得定）  0.1ml                            （2）消化性溃疡出血                                      处方一：   生理盐水  20ml                                                                                    静推   每12小时一次                                                 雷尼替丁  0.15                                     处方二：   生理盐水            20ml                                                                                    静推  QD                                                奥美拉唑（洛赛克）  40mg                                     处方三：   去甲肾上腺素        8mg                                                                                  分次口服或经胃管注入胃内                                                冰盐水              150ml                                    处方四：   生理盐水            20ml                                                                                  口服4~6小时/次                                               凝血酶              2000u  注：同时可以应用酚磺乙胺（止血敏）、氨基己酸、氨甲苯酸（止血芳酸）等常规止血药。  3. 过敏性休克   处方一：   肾上腺素             1mg     皮下注射   st！                             极严重时             生理盐水  10ml                                                                                  静推  st！                                                  肾上腺素  1mg                  处方二：   生理盐水             10ml                                                                                  静推  st！                             地塞米松             5~10mg                             或生理盐水             250ml                                                                                        静滴  st！                             氢化可的松           200~400mg                               （1）        扩容                                             低分子右旋糖酐     500ml     静滴   st！               （2）        保持呼吸道通畅，给氧，必要时行气管内插管或气管切开               （3）        抗组胺药物应用，如异丙嗪，苯海拉明等  4. 颅内高压症     （1）  脱水治疗                              处方  氢氯噻嗪   75mg  Tid                                        螺内酯     60mg  Tid                                       间断静脉注射呋塞米                  病情危重者用                             50%葡萄糖  40~60ml  静推  每6小时一次                            或20%甘露醇  200ml    静滴  每8小时一次                            脱水治疗用至颅高压症状控制                 （2）  地塞米松   10~20mg  静推  QD                 （3）  低温疗法   常在人工冬眠下行物理降温，体温降至34~36度，根据病情需要维持3~5日                 （4）  脑室穿刺引流   只适用于侧脑室扩大者                 （5）  病因治疗                 （6）  颅内高压危象--------脑疝的处理                        A. 50%葡萄糖   60ml  静推  st！                          20%甘露醇   200~250ml  静推  st！                        B. 侧脑室穿刺可用于抢救颅高压危象，尤其为中线或后颅窝                        C. 前囟门未闭的小儿，可从此穿刺                        D. 病因治疗  5. 咯血      （1）小量咯血，如痰中带血，无需特殊处理，可给予卡巴克洛（安络血）10mg ，肌注，BID。主要为病因治疗      （2）大量咯血者          嘱其安静休息，勿紧张，酌情给予镇静及止咳药物          取患侧卧位，轻轻咳出气管内积血          药物  处方一   10%葡萄糖  40ml                                                      静推  st！ 慢！                         垂体后叶素  5U               处方二   10%葡萄糖  500ml                                                    静注  st！                        垂体后叶素  10~40                        同时辅以氨基己酸、酚磺乙胺、氨甲苯酸等常规止血药。  6. 心脏骤停于心肺复苏    （一） 心脏复苏的药物治疗                          1. 心室静止或心肌电—机械分离                          处方 肾上腺素1mg静推或心腔内注射，每3~5分钟重复一次                               阿托品1~2mg 静推或心腔内注射，每3~5分钟重复一次                               甲氧明（甲氧胺）20mg静推或心腔内注射                               血管紧张素（加压素）40U 静脉注射，5分钟后重复一次                         2. 室颤或触不到脉搏的室性心动过速                             利多卡因50~100mg 静推或心腔内注射，每5分钟重复一次，重量不超过3mg/kg。或溴苄胺125~250mg静推或心腔内注射，每5分钟重复一次。                             肾上腺素1mg 静推或心腔内注射，每3~5分钟重复一次                             若利多卡因无效可试用胺碘酮250mg 缓慢静注，速度不超过50mg/分。  复苏后心律失常的处理：因急性心肌梗死并发的室性快速心律失常，宜用利多卡因1~4mg/分静滴。缺钾所致的心律失常必须补钾。奎尼丁晕厥时的扭转性室速应选用异丙肾上腺素静滴或25%的硫酸镁10ml 静注，以后以1mg/分 静滴，维持24小时心率大于130次/分，应用异丙肾上腺素0.5~1mg，溶于5~10%葡萄糖溶液500ml中静滴。  休克病人可给予多巴胺75~100mg 或可拉明20~80mg 加入500ml 溶液中静滴，应注意纠正代谢性酸中毒。                         （二） 防止脑水肿                               1. 人工冬眠疗法                               处方：    异丙嗪     25mg                                           氯丙嗪     25mg        静滴 必要时6~12小时重复                                         5%葡萄糖  250ml