Hypomagnesaemia: Hyponatremia: Hypokalaemia:

- IVI MgSO4 1 ampule in 100cc NS - If no ROF, give IV drip NS 3-4 Fast correct:
over 1 hour pints/24 hour - 1g KCl in 100cc NS over 1 hour @
- 2g KCl in 200cc NS over2 hours
Hypocalcaemia: Hyperkalaemia (>5.5mmol/L): * Mild: Mixt KCl 15ml TDS for 3 days
- ECG - ECG + Lytic cocktail bolus (do not (potassium chloride 1g/10ml mixt)
- IVI CaCO3 1 ampule in 100cc NS mix), give slowly – write in med chart * Tab slow-release K 600mg SR 2-3 tab
over 1 hour @  10ml 10% Calcum Gluconate OD @ T slow K 1.2g BD/TDS
- IVI Calcium Gluconate 1 ampule in (in 10 minutes) - Check TFT, RP, VBG, UFEME
100cc NS over 4 hours  50ml Dextrose 50% (in 10 - Monitor v/s
* Mild: Tab CaCO3 500mg BD/TDS minutes) - ECG
 IV actrapid 10units (fast) - Inform if symptomatic
Hypophosphatemia: * If still high, repeat lytic cocktail 
- IVI KH2PO4 1 ampule in 100cc NS Peritoneal dialysis?? Haemodialysis??
over 4 hours * Oral: Tab Kalimate 10g stat & TDS

Fast AF: Asystole: If BP drop:

- Nasal prong O2 (NpO2) - 2 large bore branula - No ROF, run fast 250cc NS for 15-30
-Continuous cardiac monitoring - Run fluid minutes & repeat BP
- IV Digoxin (if HF) 0.25mg every - Intubation (can repeat 2x  inform MO)
2hr, up to 1.5g within 24hr - Cardiac compression (30:2) - KIV Gelafundin (colloid) @ inotrope
- Metoprolol 25mg/100mg BD -IV Adrenaline 1mg every 3-5 minutes - Grey branula at neck/femoral line
(absence of HF) (no limit) - IV Noradrenaline 0.2mcg/kg/min
- KIV IVI Amiodarone 300mg over -IV Atropine 1mg every 3-5 mins (3x) Postural hypotension:
30mins Systolic>20mmHg,Diastolic>10mmHg
- KIV cardioversion if hemodynamic Chest pain (if MI suspected)
not stable - ECG stat SVT:
- CE, Trop T, CKMB - Cardiac massage, if fail
Notes: - Oxygen - IV Adenosine (every 1-2 mins) 6mg
- Cardioversion: in pulseless VT & VF - S/L GTN then 12mg then 12mg
- CPR: Asystole & PEA - Aspirin crush 300mg - If not reverted, IVI Amiodarone
- Plavix (Clopidogrel) 75mg 300mg over 30 minutes

Upper GI Bleeding: Dengue1: Dengue2:

- 2 large bore branula - Dengue fever day __, __ warning - N haematocrit:
- Run fluid signs, in __ phase (if defervescence Male: >45; Female: >40
- FBC, Coag profile, GXM 4pint blood phase point taken at __˚C), V/S, on - Raised haematocrit in active smoker
- IV Pantoprazole (PPI) 80mg stat drip __cc/kg/H, latest FBC reviewed. - & obese pt is normal
and IVI 8mg/hr - Next FBC at __am/pm, cont drip - If pt took PCM, take Temp > 6hours
- Inform MO __cc/kg/h after that, to count defervescence
* WARNING SIGN: phase (< 38˚C)
Anaphylaxis: - Tender liver - Abdominal pain - Dengue IgM & IgG positive high
- IV Hydrocortisone 200mg - Mucosal bleed risk DHF (If systemic bleeding, give IV
- IV Piriton 10mg - Persistent vomiting ≥3x + diarrhea Traxenamic acid 500mg TDS)
- IV Maxolon 10mg stat & TDS ≥3x/24 hr
- Oxygen - Fluid accumulation(ascites/pleural E) - Ideal Body Weight in Dengue:
- IV fluid - Restlessness/altered conscious level Male: (Ht-152.4) x 0.91 + 50
- If BP drop,IV/IM Adrenaline 1:1000 - Inc haematocrit, reduced platelet Female: (Ht – 152.4) x 0.91 + 45
Hypertension drugs: Antibiotic (no renal impairment): Antibiotic (no renal impairment):
- T Adalat 10mg/20mg TDS - T Augmentin 625mg BD - T Doxycycline 200mg stat & 100mg
- T Atenolol 50mg/100mg OD - IV Augmentin 1.2g TDS BD 7/52
- T Amlodipine 5mg/10mg OD - T Acyclovir 400/800mg 5x/day - T EES 400mg/800mg BD
- T Bisoprolol 1.25/2.5/5mg/10mg OD - T Azithromycin 500mg OD - IV Fluconazole 200mg OD
- T Captopril 25mg/50mg BD/TDS - IV Azithromycin 500mg OD - IV Imipenem 500mg TDS/QID
- T Carvedilol 12.5mg/25mg OD - T Bactrim II/II BD - IV Meropenem 500mg TDS/QID
- T Enalapril 5/10/20mg OD - IV Benzyl Penicillin 1MU/2MU 6hrly - IV Metronidazole 500mg TDS
- T Felodipine 5/10mg OD/BD - C/IV Cloxacillin 500mg/1g QID - T Metronidazole 400mg TDS
- T Hydrochlorothiazide 25/50mg OD - IV Cefepime 1/2g BD - T Penicillin V 500mg TDS/QID
- T Irbesartan 150/300mg OD - IV Cefuroxime 750mg/1.5g TDS - IV Rocephin (Ceftriaxone) 1/2g OD
- T Losartan 50/100mg OD - T Cefuroxime 500mg BD - IV Sulperazone 1/2g BD/QID
-T Metoprolol 50/100mg OD/BD - T Clarithromycin 500mg BD - IV Tazosin 4.5g TDS
-T Prazosin 1/2/3mg BD/TDS - T Ciprofloxacin 400mg BD - T Unasyn 375mg BD
-T Perindopril 2/4/8mg OD - IV Cefotaxime 2g TDS - IV Unasyn 1.5g TDS
-T Termisartan 40/80mg OD - IV Cefobid (Cefoperazone Na)1gmBD - IV Vancomycin 1g BD

Meningitis dose: Anemic workup:

Anti TB regime: (Intensive phase) - IV Rocephin 2g BD - Blood folate + B12: fill in the form &
- Isoniazide 5mg/kg OD - IV Acyclovir 500mg TDS yellow bottle
- Rifampicin 10mg/kg OD - IV Benzyl Penicillin 4MU 4 hrly - FBP (full blood picture): fill in the
- Ethambutol 15/kg OD form & purple bottle
- Pyrazinamide 25mg/kg OD GIT medications: - FBC + RETICULOCYTE: purple bottle
- Pyridoxine 10mg OD - IV/T Maxolon (metoclopramide) - Iron + TIBC: yellow bottle
10mg stat & TDS - Ferritin: yellow bottle
Painkiller: - IV Ranitidine (histamine-2 blocker) - Coombs test (direct, indirect): red B
- C Celecoxib 200mg OD 50mg TDS - PT/APTT/INR: blue bottle
- T PCM 1g QID - T Ranitidine 150mg BD - BCM: stool occult blood test
- C Ponstan 500mg TDS - IV/T Pantoprazole 40mg OD/BD - Parasitology: Stool FEME (stool ova
- C Tramadol 50mg TDS - IV/T Nexium (esomeprazole-PPI) and cyst)
- T Voltaren 50mg TDS 40mg OD/BD *Thalassemia (HBANA:HEM:HB
- Syrup MMT 15ml TDS ANALYSIS): Hb %, fill form, purple B

Pleural tap: CSF:

* 7 urine container-red bottle Lumbar puncture: - CSF biochemistry
* prior to pleural tap, send - serum - CSF biochem: pH, glucose, protein - CSF FEME/Latex
RBS, CE/ LFT/ serum LDH/urine FEME - CSF FEME/Latex - C&S of CSF
- BCM: body fluid for biochemistry - C&S CSF - Latex Cryptococcus Antigen
- Body fluid for FEME - Latex Cryptococcus antigen (CSF) - Serology: CSF for Treponema
- TB smear: other specimen - Microscopy specimen for gram stain Pallidum (VDRL)
- TB C&S: non sputum - TB smear other specimen - Cyto non gynae
- C&S: pleural fluid - TB C&S non sputum - TB C&S non sputum
- Cyto non gynae - Microbiology TB PCR - TB smear –other specimen
-Microscopy specimen for gram stain - Serology: CSF for Treponema
Pallidum (VDRL) PTB workup:
Septic workup: - Fungal PCR - TB C&S, AFB 3x, CRP/ESR, Mantoux
- C&S blood: aerobe & anaerobe - Cyto non gynae test
- C&S urine/sputum, Urine FEME - BCM: Body fluid for biochemistry PTB confirmed 1st workup:
- ESR & CRP - Body fluid for FEME - HIV, FBS, LFT, refer eye
- Blood osmolality
Peritoneal tap (straw colour): DIC workup:
- C&S peritoneal fluid (DIVC REGIME: 6 cryoprecipitate, 4 Stroke workup:
- BCM complement 3&4* FFP: red bottle, 2 PLT) - ECHO, USG carotid Doppler, FBS, FSL
- Anti-nuclear antibody* - FBC
- Anti-Rheumatoid factor* - PT/APTT/INR: blue bottle Young stroke workup:
- Alpha fetoprotein (HTAA)* - Fibrinogen - ECHO, CTD & Thrombophilia screen,
- Microscopy: specimen for G stain - D-dimer: blue bottle, consult with (cerebral angiography if bleed)
- BCM: body fluid for biochemistry haematology MO
- Body fluid for FEME Connective Tissue Ds screening:
- Cyto non gynae Hyponatremia workup: - Anti-rheumatoid factor
- TB C&S: non sputum - Urine Na+ spot, urine & serum - BCM: complement C3 and C4
- TB smear other specimen osmolality, TFT, lipid, glucose (+/- - ESR, CRP
- Blood for total protein morning cortisol) - ANA (antinuclear antibody)
* If drain >1L, inject 200mL human *If +ve result send autoimmune
albumin 20%, within 1 day (max HypoK+ periodic paralysis workup: hepatitis ix: Smooth ms, IGG, IGM,
extract 6L, consult with MO) - Urine pH, Urine K+ spot, TFT, ABG Anti-mitochondrial

Common Formula:
Secondary Hypertension workup: - Plasma osmolality: Prog post MI (TIMI risk score):
- Serum renin/aldosterone: sp sign?, 2(Na++K+) + Urea + Glucose History:
office hour - Anion Gap: (Na++K+) – (Cl+HCO3) - Age >65 years old
- Serum cortisol - Corrected Ca: - ≥3 CAD (HPT/DM/Hyperlipidemia/
- TFT (40-albumin) x 0.02 + serum calcium active smoker/family history of
- Urine catecholamine - Estimated GFR: premature death or CAD)
- 24H urine cortisol (140- age) x Wt divide by (creat x 72) - Known CAD (stenosis > 50%)
- 24H urine protein - Absolute Neutrophil Count (ANC): - Aspirin use in past 7 days
- U/S KUB (WCC X neutrophil) divide by 100 Presentation:
- Pulse P: Syst–Dist(narrow<30mmHg) - >2 angina episode/24 hours
Hepatitis B confirmed 1st workup: - SAAG: Sr alb – Alb level of ascitic F -Raised CE
- Hbe Ag, Hbe Ab, HBV viral load, - MAP: [(2 x diastolic)+systolic] / 3 - ST deviation ≥0.5mm in ECG
AFP, TFT, USG HBS Keep MAP > 65 (N 70-110) * Each point has a risk score of 1,
max:6/7=19% death/MI

Killip Classification – Severity STEMI CHA2DS2VAS Score in AF CURB65 risk level of mortality in CAP
S1: no clinical sign HF (no crackles, * To assess risk of stroke & to decide - Confusion
no S3, well perfused) either to start anticoagulant or not - Urea ≥7mmol/L @ 20mg/dL
S2: crackles <50% of lung field (has - CCF = 1 - Respiratory rate ≥30 bpm
S3 heart sound, increased JVP) - Hypertension = 1 - BP: Systolic<90; Diastolic ≤60mmHg
S3: crackles >50% of lung field (acute - Age ≥75 years old = 2 - Age ≥65 years old
pulmonary edema) - DM = 1 * Each point has a risk score of 1
S4: cardiogenic shock/hypotension - Stroke/TIA/Thromboembolism = 2 0-1: outpatient
(systolic <90, evidence peripheral - Vascular disease = 1 2: short inpt/supervised outpatient
vasoconstriction -oliguria, cyanosis, - Age 65-74 years old = 1 3: inpatient
sweating) - Sex: female = 1 4-5: inpatient/ICU
* Score ≥1-2: start anticoagulant
* Score ≥2: annual risk stroke 2.2%
 AKIN Staging for AKI Seizure:
Serum Creatinine - Left lateral position

Bilirubin (µmol/L): <34, 34-51, >51; Mnemonic:

SI: increase ≥26.5 μmol/l (≥0.3 mg/dl) - Oxygen
OR increase to 1.5–2.0-fold from - IV Valium (Diazepam) 5mg stat
baseline - Check GCS level, duration fit,

ABEIPA; Albumin (g/L): >35, 28-35, <28

S2: increase >2.0–3.0-fold from post fit episode?
baseline - Check glucometer
S3: increase >3.0-fold from baseline - FBC, Ca, Mg, PO4, RP, LFT, Coag, CE
OR serum creatinine ≥354 μmol/l - Plain CT brain
(≥4.0 mg/dl) with an acute increase of * If keep on fit, IV Phenytoin loading
at least 44 μmol/l (0.5 mg/dl) OR need dose 15-20mg/kg (ask MO first)
for RRT
Urine output Parkinson:
S1: <0.5 ml/kg/h for 6 h - Ask MO first
S2: <0.5 ml/kg/h for 12 h - T Benzhexol 2mg TDS
S3: <0.3 ml/kg/h for 24 h OR anuria
for 12 h OR need for RRT

Hypoglycemia (if GCS low):

Hemorrhagic Stroke: CCF: - D50% 50ml stat & maintenance
- Same as Ischemic Stroke b t BP - IV Lasix 40mg TDS D10% 1-2 pint /24 H
must kept <140/90 by giving antiHPT - ROF 500CC or 1 L/ 24 H - Monitor glucometer hourly x4, then
/ IVI Labetolol - Strict I/O chart 2 Hourly x2, then 4 Hourly if stable
* If pt asthma or contraindicated for - Old medications - Withhold OHA
Labetolol IVI Isoket - Glucometer QID - Watchout hypoglycemia sx-
- After 3 days, start oral anti-HPT; - Oxygen support, NP? Depends on pt sweating, giddiness, tremor, fitting
Captopril Perindopril to improve SpO2 level
compliance - ECG HHS: Plasma osm>320; glucose≥33;
- If BP 140/90, can off Isoket, give T severe dehydration; pH>7.3;HCO3>18
Felodipine 10mg stat and BD or any Inform Dr if:
other anti-HPT -BP >160/100, BP <90/50, HR >120, RR DKA: Glucose≥14; pH<7.3; HCO3>15;
>30<10 ketonaemia@ketonuria

Uncontrolled DM: CAP: AECOAD secondary to URTI:

- 5 point glucometer monitoring - Septic workup - Septic workup
- Strict diabetic diet - IV Augmentin 1.2gm stat and TDS - Continue nasal prong
- KIV to change insulatard to mixtard - T Azithromycin 500mg stat and OD - Neb Combivent 4 Hourly
if not controlled - IV Hydrocortisone 200mg stat and - IV Hydrocortisone 200mg stat and
- Insulin sliding scale, keep NBM 100mg QID for 1 day 100 mg QID for 1 day
- Next day change to T Prednisolone - MDI Berodual 2 puff TDS
Cellulitis: 30mg OD for 5/7 - MDI Budesonide 2 puff BD
- Septic workup - If got rhonchiNeb Combivent 4 - T Augmentin 625mg BD for 5 days
- Unasyn 1.5mg stat and TDS @ IV hourly/ 6 hourly ascess severity - IV drip NS if dehydrated, no ROF
Cloxacillin 1g QID
- T Tramal 50mg PRN/TDS HAP: SpO2 drop (tracheostomy tube):
* don’t give PCM - IV Tazocin 4.5 g TDS for 1 week - ABG
- T Maxolon 10mg PRN/TDS (piperacillin & tazobactam) - CXR (TRO pneumothorax)
- Others same as CAP - Regular suction
- TRO dislodge
Alleged Chorox Poisoning: Leptospirosis: Infective AGE:
- IVD 2 pint NS/24 Hours - Notification - Septic workup and stool culture
- IV Ranitidine 50mg stat and TDS - Septic workup - IV Cefuroxime 750mg TDS
- Refer psychiatric - Lepto serology - No ROF, 4 pints: 3 pints NS and 1
- Urine for drug and UPT test - BFMP 3x :blood film malaria parasite pint D5% /24 H
- If urine pregnancy test –ve, start T - Meliodosis serology - ORS per purge
Alprazolam 0.5mg BD - IV drip NS 3-4 pint/24 H if NO ROF - Correct electrolytes
- To put pt nearby nursing counter - Monitor I/O chart - T / IV Maxolon 10mg TDS
- To accompany pt if she goes - IV Rocephine (Ceftriazone) 2g stat - T Ranitidine 150mg BD @ T
anywhere, toilet and OD @ IV Penicillin 1.5 MU 6 hrly Omeprazole 40mg OD
- Watchout for any potential harmful
behavior

Meliodosis: Catheter-related bloodstream UTI:

- Due to Burkholderia pseudomallei infection (CRBSI): - Ask MO first choice and dose abx
- IV Fortum for 2 weeks - Septic workup: peripheral, red, blue - Septic workup
- Then T Doxycycline 100mg BD and T line - T Cefuroxime 250mg BD for 1 week
Bactrim III/III BD for 20 weeks - IV Fortum (Ceftazidime) 1g stat & OD @ IV cefuroxime 1.5gm stat and then
- IV Cloxacillin 1 g QID 750mg TDS
Idiopathic Thrombocytopenic - T Ranitidine 150mg BD?
Purpura (ITP): Thrombophlebitis (branula):
- Ask MO first - Off the branula Pyelonephritis:
- IV Dexamethasone 0.6mg/kg/day - MgSO4 LA - Do renal punch
for 4/7 - T Cloxacillin 500mg QID for 5 days - Septic workup
- IV Cefuroxime 1.5g stat and 750mg
TDS

Antidote:
Gout: Meningitis: - Heparin = Protamine sulfate
- T Colchicine 0.5mg OD/ TDS (till - Straight leg raising test, neck - Warfarin = Vit K
diarrhea) stiffness - Opiod = Naloxone
*Don’t give Allopurinol in acute - Septic workup - Benzodiazepine = Flumazenil
attack (if never take Allopurinol - IV Rocephine 2g stat and OD - PCM = N acetyl cystein
before) when stable T Allopurinol - IV Acyclovir 500mg stat and TDS - Mg = Calcium gluconate
150mg OD - IV Phenytoin 100mg TDS for fitting - Organophosphate = Atropine
- T Tramal 50mg TDS/ PRN - Fit chart
- T Maxolon 10 mg TDS/PRN - GCS chart

Schizophrenia/Bipolar/Mania:
- T Olanzapine 5mg BD
Investigation Bottle: Investigation Bottle: Ix that need to be put in ice:
- FBC: purple - Ca Mg PO4: yellow - ABG/VBG: put in ice & water
- FBP: purple, fill in the form - Amylase: yellow - Parathyroid hormone, Ammonia: put
- HbA1c: purple - ABG/VBG: use 1cc syringe and in ice only
- RP (after office hour) / BUSEC flush with heparin then flick the - PACKED CELL , Fresh Frozen Plasma
(weekend): yellow syringe with finger for a few times (FFP), Cryoprecipitate: in ice
- Fasting Glucose: grey - To order CD4/CD8, Dengue - Platelet: no need ice
- Fasting Lipid: yellow Combo, Dengue Rapid Test: need to
- CE/CK: yellow d/w MO Combo investigations:
- PT/APTT/INR: blue - All serology, for example Lepto - BCM: RP + LFT
- Coombs test: pink serology , Dengue serology, - BCM: BUSE CREAT +CE
- GSH: pink Meliodosis serology, HIV, HepB, - BCM: CE + LFT
- Thyroid Function Test: yellow HepC: yellow bottle - BCM: RP + LFT + CE + Ca Mg PO4
- TDM: yellow - Meliodosis serology: fill in the form * If been asked to repeat electrolyte:
- LFT: yellow - TB C&S: fill in the form BCM - Ca Mg PO4 + Alb ( to calculate
* If weekendorder AST+ALT+ALP+ corrected Ca)
Total Bilirubin, ideally Albumin too

CT Imaging: LO1:
-If allergic/asthma, Tab Prednisolone - Inform by staff nurse pt asystole / LO2:
30mg 12H & 2H before CT scan pulse not palpable, attended stat at - Time of death, cause of death
- If renal impairment, for (NAC) N- __am/pm - Pronounced to family members, family
Acetylcysteine 1.2g BD for 3 days - Pupil fixed dilated, no palpable member understood, no further
(start 1 day before) pulses(carotid/femoral/radial/ question asked
brachial) *if DIL NAR- inform MO, record time of
Lumbar Puncture: - Auscultate lung: no heart/breath death
-CT brain first (contraindicated if sound heard (if on ventilator- (Print out 2 copy in the system: GEN-
hydrocephalus, mass, papillaedema, transmitted sound?) laporan pemeriksaan ke atas kematian
bleeding tendency) (MO), isi sijil kematian and slip
-Chest no spontaneous breathing kematian)
Before any invasive procedure: *no issue DIL NAR (death in line no
- FBC, Coagulation profile, GSH for active resuscitation), do CPR
- CPR done for 30mins, given
adrenaline 3x, no __(repeat sx LO)

Drug and Indication/MOA1: Drug and Indication/MOA2:

- T Isordil/Isoket (Isosorbide - Vaseline cream: Dry lips Drug and Indication/MOA3:
Dinitrate)10mg TDS: Dilates blood V - Aqueous cream LA PRN: Dry skin - T Bromhexine/ Bisolvont 8mg TDS
- T Vastarel (Trimetazidine) Renal - Calamine cream/lotion LA PRN: - T Piriton 4 mg PRN/TDS (s/e: sleepy)
dose 20mg BD; N dose 20mg TDS: Itchiness of skin - T/IV Maxolon 10mg stat and TDS
Preventive treatment of episodes of - Miconazole 2% cream LA PRN/ OD/ - IM Stemetil I/I OD stat (12.5mg) @ T
angina pectoris BD: Fungal infection – tinea pedis/ 20mg stat: Severe nausea/vomiting
- T Traxenamic acid 1g stat & 500mg corporis/ capitis) - T/IV Tramal 50mg stat and TDS/ PRN
TDS: Epistaxis/hemoptysis in dengue - Nystatin: Tx candidiasis of skin and - T Hematinic I/I OD ( Ferrous fumarate
(treat or prevent excessive blood loss) mucous membrane, protect candida 1 tablet 200mg OD, Folic acid 5mg, Vit B
- Nasonex I/I OD spray: Nose block, overgrowth during steroid/ complex, Vit C complex 100mg OD)
sinusitis antimicrobial therapy - T Neurobion Vit B1/B6/B12 (Folic acid)
- Traxenamic acid gargle: sore throat - MgSO4 paste: Blister, small wound - Syr MMT 15ml TDS: Gastritis
- Bonjela (Choline salicyclate 8.7% & - Orudis/ Ketoprofen gel (NSAIDs) LA - Syr Lactulose 15ml TDS (oral)
Cetylkonium Cl 0.01%): Mouth ulcer PRN/BD/QID: Sprain/trauma/edema - Ravin enema I/I stat (per reactal)
- Hydrocortisone cream 1% LA / BD tendinitis/bruises (careful in asthma)
ACS:
- S/C Fondaparinux 2.5mg stat & OD Prior to HD:
@ S/C Clexane (LMWH) 20/40/60mg ACS with u/l AF (d/w MO) - Take PT/APTT/INR, BUSEC/RP, FBC
OD; If eGFR <20-30, Clexane also for - ACS tx + T Digoxin 0.25mg OD (TDM Prior to RRT/HD initiation/IJC
DVT prophylaxis drug) insertion:
- T Aspirin 300mg stat & 150mg OD - T Bisoprolol 1.25mg OD - moderate *Take viral serology screening
@ T Cardiprin 100mg OD (1 tablet) to severe CCF + to ACEi and Diuretic Send serology: Hep Bs Antigen:
- T Plavix (Clopidogrel) 300mg stat & - Take INR, if to start Warfarin need to - Serology Heb B antigen
75mg OD; if d/c for 6 weeks d/w pt first either can come to TCA - Serology Hep B antibody
- T Simvastatin 40mg ON INR blood taking or not - Serology Hep C screening
- T Ranitidine(Zantac) 150mg OD/BD - T Warfarin 5/5/3 mg OD - Serology HIV screening (ask verbal
@ T Omeprazole 40mg OD-if *AF/VF if unstable  shock consent)
gastritis (cardioversion); criteria unstable = Send serology: Syphilis RPR:
* (IV Ranitidine 50mg stat and TDS) poor perfusion, low BP, ongoing chest - RP/LFT/FLP/Ca, Mg, P04/TFT/CTD
@ (IV Omeprazole 40mg OD) pain, hypotension, poor perfusion, Workup:
- S/L GTN I/I PRN pulmonary edema - ESR/C3&C4/Anti-nuclear antibody/
- Daily ECG & CK - stat if chest pain *AF if stable>48 Hours, can consider Rheumatoid factor/urine FEME/
* DON’T give OHA in sepsis/UA/MI/ to start anticoagulant Urine PCI (protein:creatinine index)/
NSTEMI, give actrapid if glucose >10 US KUB

Ischemic Stroke:
- CT brain + GCS chart Asthma Medications:
- NBM w IVD 2pint NS/24H(if no Reliever: - MDI Budesonide 2 puff BD (Red)
ROF) - β2 agonist (bronchodilator)=Ventolin - MDI Salbutamol 2 puff PRN (Blue)
- Strict I/O chart, CBD? depends on @ Salbutamol (SABA), Fenoterol - MDI Berodual 2 puff TDS
pt - Combivent = Albuterol + (Green/White)=Ipratropium+Fenoterol
- IV Ranitidine 50mg stat and TDS Ipratropium bromide (anticholinergic) - Seretide (Purple) = Salmeterol +
- Glucometer QID Controller: Fluticasone propionate
- Monitor BP, KIV to start anti-HPT if - β2 agonist (LABA) = Salmeterol, - Beclazone (Brown)= Beclomethasone
BP >220/110 Formoterol - Flixotide (Orange) = Fluticasone
* After 2 weeks, can start anti-HPT - Corticosteroid = Beclomethasone, - Atrovent(AVN)=Ipratropium bromide
either CCB/ACEi; before 2 weeks not Budesonide, Fluticasone -Symbicort = Budesonide
give any anti-HPT if BP not >220/110 - Aminophylline = Theophylline 160mcg+Formoterol fumarate 4.5mcg
(to protect penumbra area) - Cromoglicate (mast cell stabilizer)
- Insert Ryles tube-if absent gag - Leukotriene R antagonist = * If neb already been given for many
reflex /fail swallowing test Zafirlukast, Montelukast (anti-inflam) times but the patient still not
- Refer stroke - Anti-IgE monoclonal Antibody = improve IVI Aminophylline 250mg in
rehab/physio/dietician /speech Omalizumab 1 pint NS over 8 hour (MOA =
therapy (for swallowing test) bronchodilator by relaxing smooth ms)
Pleural Tap:
- Indicated as CXR showed massive pleural effusion Notes:
- Consent taken from pt, done by Dr (name) under aseptic technique - Inotrope need to be insert in large
- LA given prior to branula insertion, grey branula was used line (femoral/neck line), d/w MO first
- Tapping done at right/left lung - Maxolon cannot give to pt <18 YO
- Drained out __litre, clear/straw/ cloudy/pus color of fluid - Malena: oily black stool
- Specimen sent to lab
- Procedure was uneventful
- v/s post tapping, bp/pr/rr/sp02
- Plan: portable CXR post tap