GENERAL

PRACTIONER
HANDBOOK

ARJUNNATARAJK
Dearst
udent
s,

Thi
sbookisashowofgr
ati
tudet
omystudent
swhomademyl
i
fe
col
our
ful
,enj
oyabl
eandmemor
abledur
ingmy3year
satMKCG.

Ibel
i
eveallofy
ouwi
l
lbecomesuccessf
uldoct
orsandIhopet
his
smal
lbookwi
llhel
p.

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twanttobef
orgot
tenbyt
heMKCGcampus.Soki
ndl
y
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tontoyourj
uni
ors.

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edthi
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ousref
erencestot
hebestof
myknowledge.Butwheneveryouar einatreat
mentdi l
emmaalways
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lowyouri
nsti
ncts.

Asmyst udentsknow,Iam opentodoubts,cr

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ici
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thy
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on.I
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hecontenti
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eetoWhatsapp(8089345201)
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Ar
jun
bhai
 FEVER
 Or
alT>98.
90F(
atAM)orT>99.
90F(
atPM)
Di
ff
erent
ialdi
agnosi
soff
everwi
thchi
ll
sandr
igor
 UTI  Lept
ospi
rosi
s
 Mal
ari
a  Dengue
 Pneumoni
a  Meni
ngi
ti
s
 Cel
l
uli
ti
s  Tonsi
l
li
ti
s
 Abscess  TB
I
nfl
uenza

Tr
eat
ment
 Tepi
dspongi
ng
 Tab.Par
acet
amol
500mgor650mgst
at
I
fcannott
akeor
all
y
I
nj.Fev
ast
in300mgI
M(150mg/
ml)st
atOR
I
nj.Par
acet
amol
1gI
Vinf
usi
onov
er1hour(
Moni
torBP)
 Chi
l
dren
 10-
15mg/
kg/
doseupt
othr
icedai
l
y
I
nfant
sandsmal
lchi
l
dren
 Supposi
tor
ies-av
ail
abl
eas80,
125,
170,
250mg
InChr
oni
cli
verdi
seasepat
ient
supt
o2g/
dayofpar
acet
amoli
s
saf
e.
I
fal
l
ergi
ctopar
acet
amol
 Mephenami
caci
d
 Pi
roxi
cam
  Di
clof
enac/
Acecl
ofenac
 DoBRE,
ESR/
CRP,
MPI
CTandURE.
I
finf
ect
ioni
ssuspect
ed,
giv
eant
ibi
oti
cs.
InChi
ldr
en,i
ffeveri
saccompani
edbyr ashes,espv esicul
arormacul
o
papul
arsuspectChi
ckenpoxorMeaslesrespectiv
ely.Inmeasles,t
he
chi
ldi
susuall
ysickl
ooki
ngwit
h,r
ashesstart
ingfrom face.
Ot
herant
ipy
ret
ics
 TI
bugesi
corbr
ufen200/
400/
600mg1-
0-1(
ibupr
ofen)
 TMef
tal
250mg/
5001-
1-1(
mef
enami
caci
d)
 TPi
rox/
Dol
onex20mg1-
0-0(
pir
oxi
cam)
Forchi
l
dren
 Sy
pIbupr
ofen(100/
5)(
8-10mg/
kg/
dosex3t
imes)
o Maypreci
pit
ateaspir
ini
nduced ast
hma,so don’
tgi
vet
o
ast
hmati
cordyspnoei
cpt
s
 Sy
pMef tal(
50/
5or100/5)(gener
all
ynotused<6mont
hs)
(8
mg/kg/
dosex3ti
mesaday)
Forpr
egnantl
adi
es-Par
acet
amolonl
y
Ant
ibi
oti
cs
Not
e:I
ngener
al,
formi
l
dinf
ect
ionsusemi
l
derant
ibi
oti
cs
Ant
ibi
oti
cdose I
ndi
cat
ions
Amoxi
cil
l
in500mg1-
1-1 Br
onchi
ti
s
Si
nusi
ti
s
Ampi
cil
l
in500mg1-
1-1-
1 Ot
it
ismedi
a
UTI
Amox i
cil
l
in+clavulanicaci
d625mgor RTI
375mg1- 0-1or1-1-1
UTI
(Augmentin/
MoxCV/ Novacl
av)
Dent
ali
nfect
ions
 Ski
n and sof
t t
issue
i
nfect
ions
Ki
dtab–228mg
I
ntr
a-abdomi
nal
inf
ect
ions
Catscr
atches
Chi
l
dren dose – 20mg/
kg/
dose
BD/
TDS I
nfect
edani
mal
/humanbi
tes
Cephal
exi
n500mg1-
1-1-
1 Boneandj
ointi
nfect
ions
Phar
yngi
ti
s
Ski
nandsof
tti
ssue
Tonsi
l
li
ti
s
UTI
Azi
thr
omy ci
n 500 mg OD (
best1 hr RTI
bef
orefood)
Ski
ninf
ect
ion
STD
Roxi
thr
omy
cin150mgBD
PI
D

Cl
ari
thr
omy
cin500mgBD
Cef
adr
oxi
l500mgBD RTI
UTI
Cef
podoxi
me500mgBD Ski
ninf
ect
ion

Cef
urox
ime500mgBD
Cef
ixi
me200mgBD RTI
UTI
Bi
l
iar
yinf
ect
ion
Ci
prof
loxaci
n500mgBD UTI
Bone and sof
t t
issue
i
nfect
ion
 Gast
roent
eri
ti
s
Nor
fl
oxaci
n400mgBD UTI
Gast
roent
eri
ti
s
Of
lox
aci
n200mgBD Gast
roent
eri
ti
s
Chr
oni
cbr
onchi
ti
s
ENTi
nfect
ions
Ent
eri
cfev
er(
400mgBD)
Lev
ofl
oxaci
n500mgBDor750mgOD LRTI

(Avoi
duseifpossi
blebecausei
t’
sa
secondl
i
neTBdrug)
Sul
famethoxazol
e 800 mg + UTI
Tri
methopri
m 160mg
Di
arr
hea
Ani
mal
bit
es
Bonei
nfect
ion

Commonl
yusedant
ibi
oti
csi
nchi
ldr
en
Sy
p.Amoxi
cil
l
in(
125/
5or250/
5) 30-50 mg/
kg dail
y i
n di
vi
ded
dosesQ8HorQ12H

Sy
p.Amoxi
cil
l
in+cl
avul
ani
caci
d
I
nPr
act
ice15mg/
kg/
doseQ8H
(
400+57)
/5ml
156(
125+31)
/5ml
228(
200+28)
/5ml
312(
250+62)
/5ml
Sy
p.Ampi
cil
l
in(
125/
5or250/
5) 50-100 mg/
kg/
dai
l
y i
n di
vi
ded
dosesQ6H
Sy
p. Azi
thr
omy
cin (
100 /
5 or 10mg/
kg/
day
200/
5)
Sy
p.Cef
ixi
me(
50/
5or100/
5) 8 mg/kg/
day i
n di
vi
ded doses
Q12H
Syp. Sept
ran (sul
famet
hoxazol
e 6-
10 mg/kg/24 hr
(TMP)di
vi
ded
200+tri
methopr
im 40) i
nto2doses
Sy
p.Cl
ari
thr
omy
cin(
125/
5) 15mg/
kg/
dayi
n2di
vi
deddoses
Sy
p.Cef
podoxi
me(
50/
5or100/
5) 10mg/
kg/
dayi
n2di
vi
deddoses
Sy
p.Cephal
exi
n(125/
5or250/
5) 50-
100mg/
kgdayi
n3or4doses
Sy
p.Cef
uroxi
me(
125/
5) 30mg/
kg/
dayi
nint
o2-
3doses

Ant
ibi
oti
csi
npr
egnancy
 Amoxi
cil
l
in
 Cephal
ospor
ins
 Ampi
ci
ll
i
n&cl
oxaci
l
li
ncombi
nat
ion
 Amoxi
cil
l
in&cl
avul
anat
ecombi
nat
ion
 Az
ithr
omy
cin
Vi
tami
ns
Usual
dose:
1tabODorBD
 TBepl
exf
ort
e(sy
pav
ail
abl
e)(
vitBcompl
exwi
thf
oli
caci
d,v
itC,
)
 TBicozinc(
sypav
ail
abl
e)(
vitBcompl
exwi
thFol
i
caci
d,v
itC,Zn
sul
phate)
 CBecosul
es(
sypav
ail
abl
e)(
vitBcompl
exwi
thFol
i
caci
d,v
itC)
 C Nutrol
i
nBpl us(
sypav
ail
abl
e)(
vitBcompl
exwi
thFol
i
caci
d,
l
actobaci
ll
us)
 TPol
ybi
on(
sypav
ail
abl
e)(
vitBcompl
exwi
thFol
i
caci
d,v
itC)
 TNeur
obi
onf
ort
e(sy
pav
ail
abl
e)(
vitBcompl
ex)
 TBC(
β-car
otene,
vitE,
vitC-
ant
ioxi
dant
s)
  TCel
i
n500mgOD(
vitC)
 TBecozy
m CFor
teOD(
vitB+v
itC)
Forchi
l
dren
 Sy
p/DpsAt
oZ(
vitA,
vi
tBcompl
ex,
vitC,
vi
tD,
Fe,
Se,
i
odi
ne)
 Sy
pZi
ncov
it(
vitA,
vi
tBcompl
ex,
vitD,
vi
tE,
Cu,
Se,
Zn,
i
odi
ne)
,
 Sy
p/DpsDel
i
ces(
VitA,
B,D,
E,ami
noaci
ds,
ant
ioxi
dant
s)
 Sy
post
o-pol
ybi
onD(
VitB12,
VitD3,
Ca2+)
 OH-D3 /Ul
tra D3 /
Bon D li
ghtdps(
400 I
U/ml
)(
Vit
ami
n D3 or
chol
ecal
cif
erol
)1ml ODf
orinfant
s
I
ronpr
epar
ati
ons(
canbegi
veni
npr
egnancy
)
 TAut
ri
n(f
efumar
ate+f
oli
caci
d+b12+c)OD
 TFef
ol-
Z(f
esul
ph+f
oli
caci
d+b12+c+Zn)OD
 Sy
pVi
tcof
ol(
fef
umar
ate+f
oli
caci
d+b12)
 Tor
ofer–XT(0-
1-0)
(el
ement
alFe+f
oli
caci
d)Dps/
Sypav
ail
abl
e

Ant
iul
cer
ant
s
 T Rant
ac/
zinet
ac/
aci
l
oc150mg1-
0-1(
rani
ti
dine)
(30mi
nbef
ore
f
ood)
o Peddose2mg/
kg/
dosex2PO
o Sy
prant
ac75/
5
 TPant
oci
d40mg1-
0-0(
pant
opr
azol
e)(
30mi
nbef
oref
ood)
o Peddose:
1mg/
kg/
dosePOOD
 T Rabici
p/happi
/Razo 20 mg 1-
0-0 (
rabepr
azol
e-f
ast aci
d
suppr
essi
on)
oI
njr
abi
cip20mgi
vod
 C Omez20mg1-
0-0empt
yst
omach(
omepr
azol
e)(
1hrbef
ore
meal
)
  TLanzol
e30mg1-
0-0(
lansopr
azol
e)
 Syp Digene 2tsp tds (
Simet
hicone+Mg(
OH)
2+Al
(OH)
2+ Na
car
boxy
met hy
lcel
lul
ose)
 SypGelusi
lMPS2t
spt
ds(
Simet
hicone+Mg(
OH)
2+Al
(OH)
2+MgAl
si
l
icat
e)
 Sy
pRant
acMPS2t
spt
ds(
Magal
drat
e+Si
met
hicone)
 Sy
pMucai
negel
2tspTDS(
Mg(
OH)
2+Al
(OH)
2+oxet
hazai
ne)
 Syp Tri
cai
ne MPS 2t
sp TDS(
Simet
hicone+Mg(
OH)
2+Al
(OH)
2
+oxet
hazai
ne)
 Sy
pSucr
alf
ate15ml
TDS(
ulcerpr
otect
ive)
Forpr
egnantwomen
 Di
gene2t
spt
ds
 Gel
usi
lMPS2t
spt
ds
VOMI
TING
I
nj.Ondanset
ron4mgI
Vst
atOR
I
nj.Met
ocl
opr
ami
de10mgI
M st
atOR
I
nj.Pr
omet
hazi
ne(
Phener
gan)25mgI
M st
at
HEADACHE
 Tab.Par
acet
amol
500mgor650mgst
atOR
 Tab.Acecl
ofenac100mgst
atOR
I
nj.Di
cl
ofenac75mgI
M st
at
HI
CCUPS
 Tab.OrI
nj.Met
ocl
opr
ami
de10mgI
M st
atOR
 Tab.Bacl
ofen10mgst
at
I
ntr
act
abl
ehi
ccups
 Chl
orpr
omazi
ne25-
50mgst
at
DRYCOUGH
  Gi
vecoughsuppr
essant
s
 Syp Vi
scodyne D 10 mlt
ds (
tri
pol
i
dine hcl
+ pseudoephedr
ine
+dext
romethor
phan)
 SypActi
fedDM 10mlt
ds(
tri
pol
i
dinehcl+pheny
lpr
opanol
ami
ne+
dext
romethor
phan)
 Sy
pPi r
it
on/Di
l
o-Dx/sol
vi
ncough/Chest
onCS10mlt
ds(
CPM +
DM )
 SypAscori
l-
C/Li
nct
uscodei
ne/
codi
star/
cor
ex10mlt
ds(
Codei
ne
Phosphat
e+CPM)
 Sy
pAl
ex10ml
tds(
CPM+Pheny
lephr
ine+DM Hbr
)
 Sy
pAscor
il
-D10ml
tds(
tri
pol
i
dinehcl
+pheny
lephr
ine+DM)
 Syp Ambrol
i
te-
D 10 ml t
ds (
pseudoephedr
ine hcl +DM
hbr
+cet
ri
zi
ne)
 Sy
pZedex10ml
tds(
bromhexi
nehcl
+DM hbr
)
 Al
exPaedi
atr
icDr
ops/
Sol
vi
nCol
dDr
ops(
CPM+Pheny
lephr
ine)
 Fl
ucol
dDr
ops(
pheny
lpr
opanol
ami
ne+CPM)
 Sy
pZer
otuss(
lev
ocl
oper
ast
inef
endi
zoat
e)
 Sy
pBenadr
yl(
diphenhy
drami
ne)
 Sy
p.Ascor
ilD(
Dex
tromet
hor
phan)
 Sy
p.Reswas(
Chl
orpheni
rami
nemal
eat
e+l
evodr
opr
opi
zi
ne)
 Sy
p.Gr
il
inct
us(
CPM +dext
romet
hor
phan)
 TChest
on-
DT(
CPM+pheny
lpr
opanol
ami
ne+BH)
 TCodi
fos(
codei
ne)10ml
Not
e:Codei
nec/
Iinast
hmat
icsandchi
l
dren
 Forpr
egnantl
adi
es
o Sy
pAscor
il
,
o Sy
pGr
il
inct
us
  Fordi
abet
ics
o Pr
oduct
ivecough-
Ascor
ilSF,
Macber
y-XT;
o Dr
ycough
 Robit
ussin CF(DM hbr + guai
phenesi
n+
psuedoephedr
ine)
 Tusq-
Dx(
DM hbr+CPM +pheny
lephr
inehy
drochl
ori
de)
 Al
exSF
 Zer
otuss-SF

WETCOUGH
Advi
seanX-raychest,
AFBsputum f
orot
her
wiseunexpl
ainedCough>2-3
weeksnotrespondingtoant
ibi
oti
csorcoughwithhaemoptysi
s/chest
pai
n/PUO/
wei ghtl
oss.
Adv
iseadequat
ehy
drat
iont
ohel
pexpect
orat
ion.
 Syp Ascor
il+/Capexbron /Br o-
Zedex10mlt
ds (
ter
but
ali
ne
sul
phate+bromhexi
ne+guai
phenesi
n)
 Sy
pAst
hal
i
nexpect
orant10ml
tds(
sal
but
amol
+guai
phenesi
n)
 Syp Ambr oli
te-
S 10 ml t
ds ( sal
but
amol +ambr
oxol hcl
+
guai
phenesin)
 Sy
pAmbr
odi
l
-S2t
spt
dsx3day
s(sal
but
amol
+ambr
oxol
hcl
)
 Sy
pAscor
il
-LS(
lev
osal
but
amol
+ambr
oxol
+Guai
ph)
 Sy
pGr
il
inct
usBM or(
ter
but
ali
nesul
phat
e+br
omhexi
ne)
 Sy
pMucol
i
te/
ambr
oli
te/
Ambr
odi
l10ml
tdsx3day
s(Ambr
oxol
)
 TMucol
i
te/
ambr
odi
l(ambr
oxol
)30mgt
ds
 TBr
omex(
BH)8mgbd/
tds
 TMuci
nac200/
600mgbd/
tds(
acet
ylcy
stei
ne)
ANALGESI
CS
  T Vover
an/Dicl
onac/Dicl
oran 50 mg bd (Di
clof
enac sodi
um)
(
Jonacsupposit
ory12.5mg, 100mgav
ail
abl
e)
 TIbugesi
c/Br
ufen400-600mgtds(
Ibupr
ofen)(otherTr
adeNames:
-bruf
en,I
bufl
ammar)(100mg/
5ml suspavail
able)
 TMeftal250-
500mgtds(
Mefenamicaci
d)(
otherTN:
-Ponst
an,
Medol
)(100mg/5ml
suspavai
l
able)
 TDol
oki
nd100mgbd(
acecl
ofenac)(
otherTN:
-Acecl
o,Zer
odol
)
 TKet
anov10mgQi
d(Ket
orol
ac)
 TPi
rox20mgOD(
pir
oxi
cam)(
Dol
onexNT)
 Ti
ndoci
d/ar
ti
cid25-
50mgBD-
QID(
indomet
haci
n)
 TEt
oshi
ne/
etody60-
120mgOD(
etor
icoxi
b)
Av
oidNSAI
D’s
 Dengue  Cer
ebr
alhemor
rhage
 Sev
erel
i
verdi
sease  GIbl
eedi
ng
 CKD  CAD
Saf
eral
ter
nat
ive–Tab.Napr
oxen250/
500mgBD

Opi
oidAnal
gesi
cs
 TTr
ambaxorTr
amazac(
tramadol
)50mgt
ds
 TFor
twi
n25mgQi
d(Pent
azoci
n)
Combi
nat
ions
 TUl
tr
acetorPal
i
texorDol
zer
ooracuv
in(
Tramadol
+P’
mol
)
 TDy
napar(
Dicl
ofenac+p’
mol
)(I
njav
ail
abl
e)
 T Zer
odol-P or acecl
o pl
us or Hi
fenac-
P or Dol
oki
nd-
Plus
(
Acecl
ofenac+P’
mol )
 TDur
apai
n(Di
clof
enacsodi
um SR+Tr
amadol
IR)
 TI
bugesi
cPl
us/
combi
fl
am (
ibupr
ofen+P’
mol
)
 Forpr
egnantl
adi
esgi
veP’
molonl
y
Tramadolmaycausenausea,di
zzi
ness,sl
eepi
ness,sweat
ing,l
ower
ing
ofsei
zuret
hreshol
d.Gi
vephener
ganorondanset
ronalongwit
hit
.
ABDOMI
NALPAI
N
Commoncauses
Renal
cal
cul
i Gast
roent
eri
ti
s
Appendi
cit
is Chol
ecy
sti
ti
s
Pancr
eat
it
is GERD
I
ntest
inal
obst
ruct
ion UTI
/Py
elonephr
it
is/
Cyst
it
is
Pept
icul
cer Mesent
eri
cischemi
a
I
ncaseofr
enal
col
i
cther
ewi
l
lbecol
i
ckypai
nradi
ati
ngf
rom t
hel
oint
o
gr
oin
Al
labdomi
nalpai
nabov
ethel
evelofumbi
l
icus,r
uleoutI
NFERI
OR
WALLSTEMI.
Al
sor
uleoutDKAi
nal
lcases.
Examinat
ionofgeni
tour
inar
ysystem i
nmenshouldbeper
for
medi
nal
l
casesofa/cabdominal
paintorot
/ esti
cul
art
orsi
on.
I
nfemal
esr
uleoutr
upt
uredect
opi
cpr
egnancy
.
Rel
evanti
nvest
igat
ions
ECG S.amy
laseandLi
pase
CBC X-
ray abdomen er
ectv
iew and
KUB
Ur
ineRout
ine
USGabdomenandpel
vi
s
Bl
oodsugar
CECTabdomen

I
njVov
eran1ampI
M ATD(
Dicl
ofenac)
I
njTr
amadol
1ampI
M orI
V(+Phener
ganorondanset
ron)
 InjBuscopan 1 amp I
M ATD (
hyosci
ne but
ylbr
omi
de,ant
i
spasmodic)
I
njcy
clopam 2ccI
M(Di
cycl
omi
neHCl
,ant
ispasmodi
c)
I
njDr
otav
eri
ne40mgI
M st
at
I
njPant
op40mgI
V orRabepr
azol
e20mgI
V
 Tv
over
an50mg1-
0-1
 TBuscopan10mgt
ds
 TCyclopam (
Dicy
clomi
neHCl20mg+P/
L500mg)1-
1-1(
SOSi
n
pr
egnancy)
 TZer
odol
spas/
acecl
ospas(
acecl
o+dr
otav
eri
ne)
;
 Forchi
l
dren:
o Syp Cyclopam (Di
cycl
omi
ne 10 mg+ si
met
hicone)
(10/
5)
(gener
all
ynotused)
 <6mont
hs-0.
5mg/
kg/
dosex3t
imes
 >6mont
hs-upt
o5mg/
dose
 Chi
l
dren10mg/
dose
o TJuni
orLanz
oleOD
I
fpai
nisv
eryv
erysev
ere:
I
njFor
twi
n1ampI
M +I
njPhener
gan1ampI
M
FEBRI
LESEI
ZURES
Agegr
oup→ 6mont
hst
o6y
rs.
Cl
i
nicalf
eat
ures
 Maypr esentwit
hf rankfi
tsormor ecommonl yupr
oll
i
ngofey es,
l
ossofconsci ousness,theymayal sovomitorhaveincr
eased
secreti
ons(foam att he mouth).The bodymaygo st i
ff
,t hen
generall
ytwi
tchorshake(convulse)
.Theseizur
enor
mallyl
astsf or
l
esst hanfi
veminutes.
 Thechi
l
d'st
emper
atur
eisusual
l
ygr
eat
ert
han38°
C(100.
4°F)
.
Tr
eat
ment
I
njDiazepam 0.2mg/kg I
Vt o be gi
ven ver
y sl
owlyt
o av
oid
r
espi
rator
y depr
essi
on (perrectum can be gi
ven)-May be
r
epeatedaft
er3-
5minutesi
fneededOR
I
njLora0.1 mg/kg I
V at1mg/
minMayber
epeat
ed af
ter3-
5
minut
esi
fneededOR
 Di
azepam supposi
tory0.5mg/kgPR(
perr
ect
um)(
addi
ti
onal0.
25
mg/kgaf
ter10mi nifneeded)
Note:Incaseofrespi
rat
orydepr
essi
ongi
vepai
nfulst
imul
usorambu
bagforf
ewmi nut
es.
 Tepi
dspongi
ng+P’
mol
.
 CheckGRBS.
 Ox
ygeni
nhal
ati
on.
 Cl
othi
ngar
oundt
heneckshoul
dbel
oosened.
 Semi
proneposi
ti
onandt
hroatsuct
ioni
ng
 Pr
otectt
hechi
l
dfr
om i
njur
y.
 Moni
torVi
tal
s.
Pr
escr
ipt
ionondi
schar
geaspr
ophy
laxi
s:
 Sy
pP’
mol
)(125/
5)Qi
d
 Sy
pDi
azepam (
2/5)f
orf
ir
st2day
soff
ever
o 0.
2-0.
3mg/
kg/
dosex3t
imes
o T.
Val
i
um/
cal
mpose2/5/
10mg
 TFr
isi
um (
clobazam)
oI
fdi
azepam f
ail
s
o 5/
10/
20mg-0.
5-1mg/
kg/
dayi
n2di
vi
deddoses
o Abov
e3y
rst
artwi
th5mgOD.
 Tepi
dspongi
ngSOS
Theabovethr
eei
nst
ruct
ionst
obef
oll
owedf
orf
ir
st2day
swhenev
er
ther
eisf
ever
.
Allchi
ldr
enbel ow 1y
r-1and1/ 2yrpresent
ingwithfi
rstepisodeof
febr
il
eseizuresshoul
dber
efer
redtohi
ghercenteraf
teri
nit
ialt
reat
ment
asLPisindicated.
VOMI
TING
Commoncauses
Gast
roent
eri
ti
s Ur
emi
a
Mi
grai
ne Dengue
Dr
ugs Appendi
cit
is,
Pr
egnancy Py
elonephr
it
is
Foodpoi
soni
ng Hy
pokal
emi
a
Al
cohol
i
cgast
ri
ti
s MI
Renal
col
i
c CVA
Pept
icul
cer Rai
sedI
CT
Vi
ral
hepat
it
is Hy
per
tensi
veencephal
opat
hy
Chol
ecy
sti
ti
s DKA
Laby
rint
hinedi
sor
der
s Poi
soni
ng

I
nvest
igat
ions
 Li
keabdomi
nal
pai
n
 NCCThead
Tr
eat
ment
I
njEmeset(
2mg/
1ml
)(0.
1mg/
kg/
dose)(
Ondanest
ron)4mg/
8mg
I
V
I
njPer
inor
m(Met
ocl
opr
ami
de)(
5mg/
1ml
)10mgI
M
I
njSt
emet
il(
prochl
orper
azi
ne)12.
5mgI
M
 I
njPhener
gan(
Promet
hazi
ne)(
25mg/
1ml
)25mgI
M
Gi
veaPPIal
ongwi
thi
t-I
njPant
op40mgI
V
Or
almedi
cines-15-
30mi
nbef
oremeal
s–BDorTDSorSOS
 TDomst
al(
Domper
idone)10mg(
5mg,
10mgDTTabav
ail
abl
e)
 TEmeset(
Ondanset
ron)4/
8mg
 TPer
inor
m(met
ocl
opr
ami
de)
10mg
 TPhener
gan(
promet
haz
ine)25mg
Forchi
l
dren:
-
 Sy
pDomst
al(
1mg/
1ml
)(0.
2mg/
kg/
dosex3t
imes)
 Sy
pGr
andem (
Grani
set
ron)(
1mg/
5ml
)(0.
2mg/
kg/
dosePO)
 Sy
pEmesetorVomi
ki
nd(
2mg/
5ml
)
o >5y
rs-4mg/
dosePOTDS
o <5y
rs-1mg/
kg/
doseBD/
TDS
ForPr
egnantl
adi
es:
-
 TDoxi
nat
e(Doxy
lami
ne+Py
ridoxi
ne)
 TPer
inor
m
 TPr
egni
doxi
n(Mecl
i
zineHCl
)
 TEmeset
I
njEmeset(
IV)canbegi
ven
Note:-Per
inor
m maypr
oduceext
rapy
rami
dalsy
mpt
oms–t
reat
edwi
th
I
nj.Phener
gan.
Phener
gan–cont
rai
ndi
cat
edi
nchi
l
dren
LOOSESTOOLS
 Fi
nd out whether iti s di
arr
hoea, pseudodi
arr
hoea, f
ecal
i
ncont
inencef
rom hi
stor
y.
 Aet
iol
ogy
 oI
nfect
ion
o Dr
ugs(
cer
tai
nant
ibi
oti
cs/
PPI
)
oI
nfl
ammat
orybowel
disease
o Toxi
n
o Foodi
ntol
erance
o Di
ver
ti
cul
osi
s
Tr
eat
ment
 C ZedottorRedot
il100mg (
racecadot
ri
l1.
5 mg/
kg/
dose i
n
chi
l
dren)BD/
TDS
 T Nutr
oli
nB/C Vi
zyl
ac/
C Dar
olac(
lact
obaci
l
luscombi
nat
ions)
BD/TDS
 TCy
clopam/Buscopan1SOSf
orabdomi
nal
pai
n
 ORS
o Dosageaf
tereachpur
ge:
<6mont
hs:
50ml
or1/
4gl
ass
o 6mont
hs-
2year
s:50-
100ml
(1/
4-1/
2gl
ass)
o 2y
ear
s-5y
ear
s:100-
200ml
(1/
2-1gl
ass)
o >5y
ear
s:asmuchasabl
etodr
ink
I
fchil
dvomi t
s,wai
tfor10min&t
henr
esumef
eedi
ng.Al
sogi
vePl
ent
y
ofor
alfl
uids(homeavai
l
abl
e)
Forchi
l
drengi
veZi
nc
 10mgdai
l
yforage2-
6mont
hs
 20mgdai
l
yfor>6mont
hs
 Bel
ow2mont
hszi
nci
snoti
ndi
cat
ed
 Sy
pZi
ncov
it(
5mg/
5ml
)
Forsev
eredi
arr
heai
nadul
ts
 Lopami
de2mg(l
oper
ami
de)2t
absst
at,t
hen1t
abaf
tereach
epi
sode
  Cont
rai
ndi
cat
edi
nchi
l
dren,
ifhi
stor
yoff
everandi
npr
egnancy

ForPr
egnantl
adi
es:
-
 Or
alf
lui
ds
 ORS
 Dar
olacsachet
Chi
l
d-hooddi
arr
hea/
ADD
Nodehy
drat
ion
 Wel
lal
ert  50-
100mlORS(
if<2y
r)per
pur
ge
 Ey
esnor
mal
 100-200mlORS(
if2-
10y
r)
 Tear
spr
esent
perpurge
 Mout
h&t
onguemoi
st
 For>10 y
rs as much as
 Nor
mal
thi
rst want
ed
 Ski
npi
nchgoesbackqui
ckl
y  General
l
y,gi
veoneteaspoon
ever
y1-2minut
es.
Somedehy
drat
ion
 Rest
less  75ml
/kgORSi
n4hr
I
rr
it
abl
e I
fdehydr
ati
onsubsi
des-10-
20ml
/kgaft
ereachst
ool
 Ey
essunken
I
fnotr
epeat75ml
/kgORS
 Tear
sabsent
i
n4hr
 Mout
h&t
onguedr
y
 Thi
rst
y&dr
inkeager
ly
 Ski
npi
nchgoessl
owl
y
Sev
eredehy
drat
ion
 Let
har
gicorunconsci
ous I
VFRi
ngerLact
ate30ml
/kg
i
n½hrfol
lowedby70ml
/kg
 Ey
esv
erysunken&dr
y
  Tear
sabsent i
nnext2½hr

 Mout
h&t
onguev
erydr
y I
ninf
ants<12mont
hs1hr&
5hrr
especti
vel
y
 Dr
inks poor
lyorunabl
eto
dr
ink
 Ski
n pi
nch goesbackv
ery
sl
owly

Dy
sent
ry-macr
oscopi
cbl
ood,
pus,
mucus,
foulsmel
l
 TCi
ploxTZ1-
0-1x5day
s(ci
plox+t
ini
dazol
e
 T.Of
lox-
OZ(
ofl
oxaci
n200mg+or
nidazol
e500mg)
 Gi
ver
acecadot
ri
landpr
epr
obi
oti
csal
so
 Cor
rectdehy
drat
ion
I
nPEDI
ATRI
Ccases–Gi
vecef
ixi
me
ANAPHYLAXI
S
 Acuteonsetr
espi
rator
ydi st
ress(eg,stri
dor,wheezi
ng,dy
spnea,
i
ncreasedwor
kofbreathi
ng,persi
stentcough,cy
anosi
s)
 Vomi
ti
ng
 Abdomi
nal
pai
n
 Hy
pot
ensi
on
 Dy
srhy
thmi
a
 Chestpai
n
 Col
l
apse
Tr
eat
ment
 Placepati
enti
nrecumbentposi
ti
on,i
ftol
erat
ed,andel
evat
elower
extremi
ti
es.
 Gi
veI
M epi
nephr
ine(
1mg/
mLpr
epar
ati
on)(
1/1000di
l
uti
on)
o 0.
3to0.
5mgi
ntr
amuscul
arl
y,pr
efer
abl
yint
hemi
d-out
er
 t
high.
o Canr epeatev
ery5t
o15mi
nut
es(
ormor
efr
equent
ly)
,as
needed.
oI
fsy mptomsar enotrespondingto2-3dosesepi
nephr
ine
i
nject
ions,
prepar
eIVepinephr
inefori
nfusi
on
 Oxygen:Gi
ve8t
o10L/
minut
evi
afacemaskorupt
o100%oxy
gen,
asneeded.
 Normalsal
iner
api
dbol
us:r
api
dinf
usi
onof1t
o2l
i
ter
sIV.Repeat
,
asneeded.
 Nebul
isat
ionwi
thsal
but
amol-2.
5to5mgi
n3mLsal
i
ne.Repeat
,
asneeded.
Adj
unct
ivet
her
api
es:
 H1anti
hist
amine:di
phenhydr
ami
ne25t
o50mgI
V(f
orr
eli
efof
ur
ti
car
iaandit
chingonl
y).
 H2ant
ihi
stami
ne:
rani
ti
dine50mgI
V.
 Gl
ucocor
ti
coi
d:met
hyl
predni
sol
one125mgI
V.
Tr
eat
mentofr
efr
act
orysy
mpt
oms:
 Epi
nephr
inei
nfusi
on-begi
nni
ngat0.
1mcg/
kg/
minut
ebyi
nfusi
on
pump.
 Vasopr
essor
s
o Nor
adr
enal
i
ne–8t
o12mi
crog/
min
o Dopami
ne–2t
o20mi
crog/
kg/
min
 Glucagon: Pat
ient
s on bet a-
blockers may not respond t
o
epinephr
ineand can be giv
en glucagon 1 t
o 5 mg IV ov
er5
minutes,fol
l
owedbyinfusi
onof5t o15mcg/ minut
e.
PATI
ENTWI
THWHEEZE
 Moni
torSpO2,
wor
kofbr
eat
hing,
Respi
rat
oryr
ate.
 Rul
eoutFB,
irr
espect
iveofage(
takeCXR)
Tr
eat
ment
 Gi
veO2t
okeepSpO2at88–92%
 Nebul
i
sat
ion
o Sal
but
amol
 2.5-5mg i n3-4ccNS +O2x3t imesat20mi n
i
nt er
valsi
nmoder ateandsever
ecases(orl
esseri
f
thereiscl
i
nical
improvement
).
 Chi
l
dren-0.
5ml
for<5y
rs,
1ml
for>5y
rs.
oI
prat
ropi
um br
omi
de
 0.
5mg
 <5y
r-125mcg(
0.5ml
)
 >5y
r:-250mcg(
1ml
)(12.
5mcg/
kg/
dose)
o Duol
i
n(l
evosal
but
amol
+ipr
atr
opi
um)
 Lev
osal
but
amol
dosei
shal
fofsal
but
amol
I
Vst
eroi
ds–i
fnotr
eli
evedbynebul
i
sat
ion
oI
njMet
hypr
edni
sol
one125mgi
n100ml
NSov
er20mi
n
oI
njHy
drocor
ti
sone100–200mgI
V
I
VMgSO4
o Nor
olei
nCOPD
o Canbet
ri
edi
nBr
onchi
alast
hma
o 2gI
Vov
er20mi
n
 Ter
but
ali
ne
o Nor
olei
nCOPD
o Canbet
ri
edi
nBr
onchi
alast
hma
o 0.
25mgI
M/SC
o Mayber
epeat
edev
ery20mi
nforamaxi
mum of3doses
 Epi
nephr
ine
o Nor
olei
nCOPD
 o Canbet
ri
edi
nBr
onchi
alast
hma
o 0.
3-0.
5mgI
M/SCi
n1/
1000di
l
uri
on
o Mayber
epeat
edev
ery20mi
nforamaxi
mum of3doses
 Non-
inv
asiv
ev ent
il
ationormechani
calv
ent
il
ati
oni
fpat
ientdoesn’
t
r
espondtoabovetreatment
.
I
Vant
ibi
oti
cs–i
fsuspect
edi
nfect
ion
o Cef
tri
axone1gI
VBDATD
o Cef
otaxi
me1gI
VTDSATD
o Augment
in1.
2gI
VBDATD
o Pi
per
aci
l
li
n+Tazobact
am 4.
5gI
VTDS
NOTE
 Gi
veei
thert
erbut
ali
neorepi
nephr
inenotbot
h
 No rol
efori
nhal
ed cor
ti
cost
eroi
din ei
therCOPD orBr
onchi
al
ast
hma
 Nor
olef
order
iphy
ll
inei
nei
therCOPDorBr
onchi
alast
hma
I
nhal
ed salbut
amol
,sal
met
rol
,ipr
atr
opi
um br
omi
de,ar
e saf
e i
n
pr
egnancy
.
For chil
dren wi
th sev
ere dy
spnoea,admi
nist
er st
eroi
ds af
ter 1st
nebul
izati
on
I
njHy
drocor
ti
sone(
10mg/
kgst
at&4mg/
kgQ6H)I
V
I
njMet
hyl
pred(
2mg/
kgst&1mg/
kgQ6H)I
V
Di
schar
geadv
ice
 Ant
ibi
oti
csi
fsuspect
edi
nfect
ion(
Augment
inorAzi
thr
omy
cin)
I
nhal
ers
o Ast
hal
i
n,Vent
orl
i
n(bot
hSal
but
amol
)
o Budecor
torPul
micor
torRhinocor
t(Budesoni
de)
-st
artwi
th
400or200mcgBD&st epdown
o Ser
ofl
o/Esi
fl
o/combi
ti
de(
sal
met
erol
+fl
uti
casone)
,
 o Aer
ocor
t(l
evosal
bu+becl
omet
hasone)
o Rot
ahal
erormet
ereddosei
nhal
er(
MDI
)maybeused.
 Br
onchodi
l
ator
s
o TDeri
phy
ll
inr
etar
d150mg/
300mg1-
0-0x5-
10day
saf
ter
f
ood
o SypDeri
phyl
li
n(50/
5etophy
ll
ine46.
5andt
heophy
ll
ine12.
75)
(5mg/
kg/dosePOBD/TDS)
o TABPhy
ll
ine(
acebr
ophy
ll
ine)100mgBD
o Sy
pABphy
ll
ine50mg/
5ml
 2-
5yr
s2.
5ml
bd/
tds
 >5y
r5ml
bd
o TDoxophy
ll
ine400mg1-
0-0
 Bet
tercar
diac&CNSsaf
etypr
ofi
l
e
 Or
alst
eroi
ds
o Pr
edni
sol
one20-
40mgODat8am af
terf
oodf
or5-
10day
s
o Alway
s gi
ve OD dose i
nthe mor
ning t
o av
oid HP axi
s
suppr
essi
on
Theophy
ll
ineder
ivat
ivesar
econt
rai
ndi
cat
edi
nsei
zur
epat
ient
s.
DogBi
te
(al
socat
,bandi
coot
,monkey
,cat
tl
es,
bat
s,wi
l
dani
mal
s)
Cat
egor
y Ty
peofcont
act Tr
eat
ment
I 1.Touchi
ng or f
eedi
ng of None
ani
mals
2.Li
cksoni
ntactski
n
3.Contactofi nt
actskin wit
h
secret
ions/excr
eti
onsofrabi
d
animal/humancase
I
I 1.Ni
bbl
i
ngofuncov
eredski
n Woundmanagement
 2.Mi
norscratchesorabr
asi
ons Ant
i-
rabi
esv
acci
ne
wi
thoutbl
eeding
I
II 1.Singleormul ti
plet
ransdermalWoundmanagement
bites orscr at
ches,licks on
Rabi
es
brokenskin
i
mmunoglobuli
n
2.Contami nat
ion of mucous
Anti
-r
abi
esvacci
ne
membr ane with sali
v a (
i.e.
l
icks)

Woundmanagement
Washi
ngofwound(s)shoul
dbecar
ri
edoutassoonaspossi
ble
wi
thsoapandwat
er.
Do’
s
1.Washwi
thr
unni
ngwat
er
2.Washt
hewound(
s)wi
thsoapandwat
er
3.Appl
ydi
sinf
ect
ant–pov
idonei
odi
ne,
alcohol
4.I
nfi
lt
rat
e i
mmunogl
obuli
n into the dept
h and ar
ound t
he
wound(
s)i
nCat
egor
yII
Iexposures
5.TTandant
ibi
oti
cpr
ophy
laxi
sifneeded
Don’
t’
s
1.Toucht
hewound(
s)wi
thbar
ehand
2.Appl
yir
ri
tant
sli
kesoi
l
,chi
l
ies,
oil
,l
ime,
her
bs,
chal
k,bet
ell
eav
es,
et
c
3.Caut
eri
sat
ionofwound
4.Sut
uri
ng–shoul
dbeav
oidedasf
araspossi
ble

Rabi
esI
mmunogl
obul
i
n(RI
G)
1.Cat
egor
yII
Iexposur
e
2.I
fimmunocompr
omi
sed–cat
egor
yIIandI
IIexposur
es
Dosi
ng
Equi
neRabi
esI
mmunogl
obul
i
n(ERI
G)–300I
U/ml
–40I
U/kg
HumanRabi
esI
mmunogl
obul
i
n(HRI
G)–150I
U/ml
–20I
U/kg
Skintestmaybedonebutitshoul
dbeadmini
ster
edr
egar
dlessoft
he
resul
tofski
ntestwi
thal
lpr
epar
ati
onsr
eadyt
omanageanaphyl
axi
s.
Admi
nist
rat
ion
 Maxi
mum doseshoul
dbei
nfi
l
trat
edi
ntoandar
oundt
hewound/
s.
 Mul
ti
pleneedl
einj
ect
ionsi
ntot
hewound(
s)shoul
dbeav
oided.
 RestofRIGremaini
ng,i
sadminist
eredbydeepI
Minj
ect
ionata
si
tedi
stantf
rom t
hevacci
nei
njecti
onsit
e.
RIGisadminist
eredonlyonce,pr
eferabl
ywithi
n24hoursafterthe
exposur
e(onday0alongwit
hthefi
rstdoseofanti
-r
abi
esv
acci
ne).
IfRIG wasnotadmini
ster
ed when ARV wasbegun,i
tcan be
t
h
admini
ster
eduptot
he7 dayaf tert
headmini
str
ati
onofthef
ir
st
doseofARV.
Si
deef
fect
s
 Anaphy
laxi
s
 Ser
um si
ckness-7t
o10day
saf
teri
nject
ion(
onl
ywi
thHRI
G)
Ant
i-
rabi
esv
acci
ne
1.Cel
lcul
tur
evacci
nes(
CCVs)–I
D
2.Pur
if
iedduckembr
yov
acci
ne(
PDEV)–I
M
I
D-Updat
edThaiRedCr
ossSchedul
e(2-
2-2-
0-2)
.
0.
1mlofr
econst
it
utedv
acci
neperI
Dsi
te
2sit
esperv i
sit(oneoneachdel
toi
dar
ea,ani
nchabov
ethe
i
nser
ti
onofdel
toidmuscl
e)
Gi
venonday
s0,
3,7and28
 Donotr
ubt
hei
nject
ionsi
te.
 Donotappl
yany
thi
ngt
othei
nject
ionsi
teCompl
etet
hecour
seof
 v
acci
nat
ion.
I
ntr
a-muscul
ar(
IM)Regi
men-Essenr
egi
men
Day
s0,
3,7,
14and28
I
deal
sit
e
 Adul
ts–Del
toi
d
 Chi
l
dren–Ant
erol
ater
alt
high
Managementofr
e-exposur
einpr
evi
ousl
yvacci
nat
edi
ndi
vi
dual
s
 Gi
veonl
ytwoboost
erdosesonday
s0and3.
I
ntr
amuscul
arl
y(0.
5ml
/1ml
)or
 CCVsi
ntr
a-der
mal
l
y(0.
1ml
at1si
te)
 Pr
operwoundt
oil
etshoul
dbedone
 Tr
eat
mentwi
thRI
Gisnotr
equi
red.
Pr
e-Exposur
ePr
ophy
laxi
s(Pr
EP)
I
M or0.
1ml
IDonday
s0,
7andei
therday21or28.
NOTE
 Bi
tewoundsshouldn’
tbeimmedi
atel
ysut
ured;i
fnecessar
yput
mi
nimum noofloosesut
ures.
I
deall
yitshoul
dbedone24-
48hr
slat
erundert
hecov
erofant
i-
r
abiesserum l
ocal
l
y.
 Rabi
esv
acci
ne&RI
Gar
enotcont
rai
ndi
cat
edi
npr
egnancy
.
I
NJURY
DocumentasMLCi
fneededandpol
i
cei
nti
mat
ionshoul
dbedone.
 Cl
eani
ng&Dr
essi
ng(
woundt
oil
et)
oI
deal
l
ywi
thNS
o Betadi
ne,H202,cet
ri
mide,sav
lon(
cet
ri
mide+chl
orhexi
dine)
forcont
aminat
edwounds
o Lookf
oranyf
orei
gnbodyi
nthewoundandr
emov
ethem
 I
njTT0.
5ml
IM
I
njTet
glob(
Immunogl
obul
i
n,t
etanus)250I
UdeepI
M
o Fordeep,
lar
geandcont
ami
nat
edwounds
 Exci
seal
ldev
ital
i
sedt
issues
I
fneeded,sut
uret
hewoundwi
thoutanydeadspacei
nsi
det
he
wound.
Sut
uremateri
als-usual
lysil
k,ny
lon,
prol
ene(
non-
absor
babl
e)orcat
gut
,
vi
cry
l,monocr
yl(absor
bable)
.
 Usual
l
yski
nissut
uredwi
th3-
0ny
lonor4-
0(smal
l
er)
.
 Sut
ureshoul
dnotbet
oot
ight
.
 Gi
veadequat
esuppor
t/i
mmmobi
l
izat
ionoft
her
egi
on.
Don’
tsut
urei
f
Under
lyi
ngt
endoni
scut
,
Under
lyi
ngbonei
sfr
act
ured(
Conf
ir
m byXr
aybef
oresut
uri
ng)
Causedbydogbi
te(
especi
all
yst
raydogs)orhumanbi
te
Pri
marysutur
ing (done wit
hin 6 hrs)shoul
dn’
tbe done i
fther
eis
edema/
inf
ecti
on/devit
ali
sedti
ssues/hematoma.
Her
edel
ayedpr
imar
ysut
uri
ng(
48hr
s-10day
s)canbedone.
Thi
sti
mei
sal
l
owedf
ort
heoedema/
hemat
omat
osubsi
de.
Secondar
ysut
uri
ng(
10-
14day
s)i
sdonei
ninf
ect
edwounds.
Ant
ibi
oti
cs
 Augment
in/
Cef
ixi
me
 Met
rogy
lisgi
venf
orcont
ami
nat
edwounds
 Local
appl
i
cat
ion
o Mupi
roci
n
o Fusi
dicaci
d
o Megaheal
(col
l
oidal
sil
ver
)
 o Neospor
inpowder
(neospor
in,
pol
ymy
xinB,
baci
tr
aci
nZn)
 Forbuccal
mucosal
inj
ury
o Met
rogy
lDGgel
orDent
ogel
Anal
gesi
cs+Ser
rat
iopept
idase(
ant
i-
inf
lammat
ory
)
 CLy
serD/
Lizol
e-D(
Dicl
ofenac+ser
rat
iopept
idase)BD
 TZymof
lam-
D/Al
anz-
D(di
clof
enac,t
rypsi
n,br
omel
ain,r
utosi
de)
BD
 Sy
pibugesi
cforchi
l
dren
 TChy
mor
alf
ort
eTDS(
try
psi
n,chy
mot
rypsi
n)
 TZymof
lam/Rut
oheal/
Enzomac(t
rypsi
n,br
omel
ain,r
utosi
de)
TDS
Changet
hedr
essi
ngoncei
n2day
s.I
nspectt
hesut
uredwoundi
n48hr
s.
Tet
anuspr
ophy
laxi
sinwoundmanagement
Mi
norwounds
If3ormoreprevi
ousdoses:noneedt
ovacci
nat
eunl
ess≥10y
ear
s
sincel
astdose.
I
funcer
tai
nh/
opr
evi
ousv
acci
nat
ionorf
ewert
han3doses:gi
ve
v
acci
ne
Lar
ge,
deeporcont
ami
nat
edwounds
 3ormor
epr
evi
ousdoses:
giv
evacci
nei
f≥5y
ear
ssi
ncel
astdose
I
funcer
tai
nh/oprevi
ousvacci
nati
onorfewert
han3doses:gi
ve
v
acci
ne&tetanusI
mmunoglobul
in(TI
G)
Not
e:Thepr
acti
ceofgi
vi
ngI njTTever
y6mont
hsi
swr
ong,asf
requent
TTmaydecr
easeimmuneresponse.
Si
mpl
esut
ure Mat
tresssut
ure
Super
fi
cial
wounds Deepwounds
Face Scal
p(al
way
sshav
ehai
r)
Neck Li
mbs
Forphl
ebi
ti
s,t
hrombophl
ebi
ti
s,swel
l
edupi
nject
ionsi
tes,
haemat
oma:
 Thr
ombophobOi
nt(
hepar
insodi
um)
 TSer
rat
iopept
idase
 War
m compr
esses
 Restt
othepar
t
Forper
ior
bit
alecchy
mosi
s(bl
ackey
e)&subconj
uct
ivalhemor
rhagedue
totr
auma:
 Moxi
fl
ox/
gat
if
lox/
cipl
oxey
edr
ops
 Col
dcompr
ess
 TSer
rat
iopept
idase
I
ntr
aumai
nvol
vi
ngearaur
icl
e:
 Onl
yski
nisappr
oxi
mat
ed&sut
uredwi
th5.
0or4.
0pr
olene
 Don’
ttoucht
hecar
ti
lage
ABRASI
ON
I
njTT0.
5ml
IM st
ati
findi
cat
ed.
 Cleani
ng(wi
thbetadi
ne)anddressi
ngwit
hananti
biot
icointmenti
f
needed.(
Don’
tdresswit
hbetadineasi
tdelay
sepi
thel
izat
ion)
 Largeabrasionsorskinlosslesi
onsmaybedr essedwi t
hcuticel
l
(non medicat ed)
,cut
icel
l-
c orbactigras (
chl
orhexi
dine),j
elonet
(nonmedi catedparaf
fingauzedressing)
,cuti
cel
lplus(poly
my xin
B,baci
tr
aci n,neomyci
n)
 T-bactoint,Metrogyl
-P Gel,Megaheal(coll
oidalsil
ver),Sepgard
oint
ment( fer
acryl
um),Neospor i
n powder/oint[zinc bacit
racin,
neomy cin sul phate, pol ymyxin B sul phate], heal ex
spray(Benzocai
ne+poly v iny
l pol ymer), cet r
imide, Sav lon
(cetr
imide+chlor
hexidi
ne),Neospori
n-Hf
orL/ A
 Or
alant
ibi
oti
cs,
ifDi
abet
ic/mul
ti
pleabr
asi
ons
 Anal
gesi
cs+Ser
rat
iopept
idase
 I
NCI
SSI
ON&DRAI
NAGE
 Di
agnosedbasedonFl
uct
uat
ion.
I&DbyHi
l
ton’
smet
hod
 Askpat
ientt
oli
edownt
oav
oidshocki
nducedbypai
n.
 St
artanI
Vfl
uid.
 Cleant
heareafrom cent
ret
oper
ipher
ywi
thbet
adi
ne(
2rounds)
andspi
ri
t(l
astr
ound).
Inf
il
trat
el i
gnocai
ne ar
ound t
he ar
ea.(
Don’
tuse l
i
gnocai
ne +
adrenal
ine)
.
I
nci
sionputpar
all
elt
oneur
ovascul
arst
ruct
ures.
 Pr
essatr
ootwi
thcot
ton,
til
lfr
ankbl
oodcomes.
 Cl
eanwel
lwi
thbet
adi
ne.
 Dr
esswi
thGM (
gly
cer
ineMagsul
f)t
oreduceedemaatt
hesi
te.
CheckRBSandmanageaccor
dingl
y.
 Ant
ibi
oti
c(Cef
ixi
meorMoxcl
av)f
or5-
7day
s
 Al
ter
nat
edaydr
essi
ng
SUTUREREMOVAL
 Cl
eanwi
thbet
adi
neandspi
ri
t.
 Cutcl
oset
oski
nusi
ngBl
adeno.11or10.
 Av
oidt
hreadf
rom out
sideent
eri
ngi
nsi
de.
 Remov
eint
ermi
tt
entsut
urest
opr
eventGapi
ng.
Day
sofsut
urer
emov
al
 Thy
roi
d-5day
s I
ngui
nal
-8-
9day
s
 Scal
p-5day
s  Knee-10day
s
 Abdomi
nal
-10day
s  Ankl
e,f
oot
-14day
s
 Li
mbs–5day
s
 BURNS
 At
tendonl
yifbur
ns<15%.
 Ref
erl
argeBur
nst
osur
ger
y.
DoCBC,
LFT,
RFT,
elect
rol
ytes.
 PutI
Vli
nebef
oreedemadev
elops.
 Rule outinhal
ati
onalinj
ury( burns i
n cl
osed space,f
ir
e wor
k
acci
dents,
andhighv el
oci
tyexplosion)
.
 Rapi
dpr
imar
ysur
veyi
sper
for
medt
oassesst
heABCs.
I
njf
ort
win1ccI
M orTr
amadol
(&Phener
ganf
orbot
h)f
orpai
n
 Cl
eangentl
ywit
hcopiousvolumeofcol
dwaterfor20mi
nut
es,as
i
twil
lmini
mizedegr
eeofburns,t
henwit
hbet
adine.
 Smearant
isept
icoi
ntmentl
i
ke
o Sof
ramy
cin(
framy
cet
in)f
orf
ace
o Si
l
ver
ex(
sil
versul
fadi
azi
ne)f
ort
runk&l
i
mbs
o Fusi
dicaci
doi
nt(
fuci
din-
L,f
uci
bact
,fusi
der
m)
I
njTTandt
etgl
obi
findi
cat
ed.
 OralAnt
ibiot
ics(
IV ant
ibi
oti
csl
i
kecef
otaxi
m and met
rogy
lfor
sever
eburns)
I
Vfl
uids(
RingerLact
atei
spr
efer
red)usi
ngPar
kland’
sfor
mul
a
o 4ml
/%bur
n/kgbodywt
/24hr
s
o Hal
fgi
vendur
ingf
ir
st8hour
s
o Remai
ninghal
fgi
vendur
ingnext16hour
s
I
njPant
opt
opr
eventcur
li
ng’
sul
cer
.
 Forsev
erebur
nsgi
veO2,
RT,
CBD&measur
eur
ineout
put
.
I
mpor
tant
 Anyconst
ri
cti
ng cl
othi
ng and j
ewel
ryshoul
d be r
emov
ed t
o
 prev
entthesei
temsf r
om exer
ti
ngat
our
niquetl
i
keef
fectaf
ter
thedev
elopmentofbur
nedema.
 Don’
tappl
yicet
obur
ns.
 Gi
vecol
dwatercompress,l
argebl
i
ster
smaybeder
oof
edwi
tha
st
eri
l
eneedl
eoraspi
rated.
 Leav
ebl
i
ster
sont
hepal
msorsol
esi
ntact
.
I
mmobi
l
izat
ioni
ssuggest
edf
orupperl
i
mbbur
ns.
 Forchemi
caland ey
ebur
nsi
rr
igat
ewi
th copi
ousv
olumeof
water
.

CHESTTRAUMA
Rapi
dlyf
atalcondi
ti
ons Pot
ent
ial
l
yfat
alcondi
ti
ons
 Tensi
onpneumot
hor
ax  Si
mpl
epneumot
hor
ax
 Fl
ail
chest  Ri
bfr
act
ureandcont
usi
on
 Openpneumot
hor
ax  Bl
untcar
diaci
njur
y
 Massi
vehemot
hor
ax  Tr
aumat
icasphy
xia
 Car
diact
amponade  Thor
acol
umbar v
ert
ebr
al
i
njur
y
 Engor
gedneckv
eins
 Scapul
ar/
ster
nal
fract
ure
 Hy
pot
ensi
on
 Esophageal
per
for
ati
on
 Muf
fl
edhear
tsounds
 Subcut
aneousemphy
sema
 Di
aphr
agmat
icr
upt
ure
 Pul
monar
ycont
usi
on

Di
agnosi
s:hi
stor
y,phy
sical
exami
nat
ion,
chestX-
rayorCT.
I
mmedi
atel
yref
ert
hepat
ientt
ohi
ghercent
erwi
thoutanydel
ay
I
NCESSANTCRYI
NGOFI
NFANTS/
CHI
LDREN
 Commoncauses
I
ntest
inal
col
i
c  Di
scomf
ortf
rom wetdi
aper
 Nasal
block  Feel
i
ngcol
d
 Hunger  Babyneedst
obehel
d
 Wor
ms  Earache
 Const
ipat
ion  Loosest
ool
s
 Ov
erf
eedi
ng I
ntususcept
ion
 Aer
ophagy  GERD
 Foodi
ntol
erance I
nfect
ion l
i
ke meni
ngi
ti
s,
AOM

 Removeallcl
othi
ngandexaminealll
imbs,t
runk,back,or
if
icesf
or
i
nsectbi
temarkorinf
ect
ion/
dischar
ge.
 Adv
icer
egar
dingpr
operf
eedi
ngoft
hebaby
.
 Feeding,
Bur
ping&car
ryi
ngt
hebabyupr
ighti
nshoul
dermaybr
ing
rel
ief
.
 Adequat
ebr
eastf
eedi
ng:15-
20mi
nsucki
ng,t
hen2-
3hr
ssl
eepor
rest
.
Tr
eat
ment
 Col
i
cai
ddr
opsorsy
rup(
simet
hicone,
Dil
loi
l
,fennel
oil
)
oI
ndi
cat
ions
 Col
i
c
 Fl
atul
entdy
spepsi
a
 GERD
o Dose
 <6m –5-
10dr
ops
 6–12m –10–20dr
ops
  >1y
ear–wei
ght
/4ml
 Sal
i
nenasal
dropsf
ornasal
block
 Nebul
i
sat
ionwi
th3%sal
i
ne–3ml
fornasal
block
 SypPedicl
ory
l(Tr
icl
ofos)wt
/2mlf
ormaki
ngt
hebabysl
eepso
thatwecanexami
ne.
LARYNGO-
TRACHEO-
BRONCHI
TIS(
VIRALCROUP)
Cl
ini
calfeat
ures:a/
c st
ri
dor
,bar
king cough,hoar
seness,r
espi
rat
ory
di
str
ess
 Ox
ygeni
nhal
ati
on
 Adequat
ehy
drat
ion
I
njdexamet
hasone0.
6mg/
kgI
Vst
at
 Nebul
i
sewi
thbudesoni
de1mg
 Forsev
erecasesnebul
i
sewi
thadr
enal
i
ne1:
1000,
2-5ml
IV anti
biot
ics for bact
eri
al cr
oup (
ampi
cil
l
in or 3r
d gen
cephal
ospori
ns)
ALLERGY/
PRURI
TUS/
URTI
CARI
A(HI
VES)
/INSECTBI
TEREACTI
ON
 Lookforof
fendi
ngfoodordr
ugs(
cut
aneousdr
uger
upt
ion)
,insect
bi
te,par
asi
teset
c.
 Lookf
orst
ri
dor
/wheezeandhy
pot
ensi
on.
 Lookf
oranaphy
laxi
sandmanageaccor
dingl
y.

Condi
ti
onsassoci
atedwi
thgener
ali
zedpr
uri
tuswi
thoutar
ash
 Obst
ruct
ivej
aundi
ce  Hy
perorhy
pot
hyr
oidi
sm
 Fedef
ici
ency  DM
 Ly
mphoma  Gout
 Car
cinoma  HI
V
 CKD  Seni
l
epr
uri
tus
 I
nvest
igat
ions
 CBC,
ESR  LFT
 Ur
ea,
elect
rol
ytes  PSmear
 TFT  Al
l
ergyt
est
ing

I
njAv
il1ampI
M orI
njAt
arax(
hydr
oxy
zine)1ampI
M st
at
I
njHy
drocor
ti
sone100-
200mgi
vst
at
 TPi
ri
ton(
CPM)2/
4/8mgBD/
TDS
o 0.
1mg/
kg/
dose
 TCet
ri
zi
ne10mg0-
0-1(
poorant
ipr
uri
ti
cact
ion)
 TAt
arax10-
25mg1-
1-1
o Sy
pat
arax10/
5-2mg/
kg/
dayi
n3di
vi
deddoses
 TLev
ocet10mg(
0-0-
1)(
lev
ocet
ri
zi
ne)
 TAv
il25/
50mg0-
0-1
 TRantac150( 1-
0-1)[
H2blocker
shaveadjuv
antbenef
ici
alact
ion
i
ncertai
ncausesofurti
car
ia,whodon’
tadequat
elyr
espondtoH1
ant
agonistal
one]
 TWy sol
one(
predni
sol
one)0.
5mg/
kgOD/x3day
sforsev
ere
cases.
 TWy
sol
one(
predni
sol
one)5/
10/
20/
40mgav
ail
abl
e
 Sy
pomnacor
ti
l5mg/
5ml
Dps5mg/
1ml
avai
l
abl
e
 T Def
lazacor
t(cor
ti
max)1/
6/12 mg orSy
p Dezacor6mg/
5ml
av
ail
able
 Cal
ami
neLot
ion(
cal
ami
ne+Znoxi
de)
Forchi
l
dren
 Sy
pAt
arax10/
5orDr
ops6mg/
5ml
(2mg/
kg/
dayi
n3di
vi
deddoses)
 Sy
pAv
il(
15/
5)(
0.5mg/
kg/
doseBD/
TDS)
Forpr
egnantl
adi
es
 Chl
orpheni
rami
nemal
eat
e
 Cet
ri
zi
ne
 Di
phenhy
drami
ne
EPI
STAXI
S
Commoncauses
 Tr
auma  Sept
alper
for
ati
on
 Sy
stemi
cHTN  Li
ver
/ki
dneydi
sease
 URTI  A/
cgener
ali
nfect
ion
 For
eignbody  Vi
tami
nkdef
ici
ency
 DNS  Mal
i
gnancy
 Dr
yingofmucosa  At
her
oscl
erosi
s
 Dr
ugs
I
nvest
igat
ions
 CBC,
ESR  RFT
 aPTT,
PT-
INR  LFT
 BTandCT  X-
rayPNS(
wat
er’
svi
ew)
 Per
ipher
alsmear

 Keepheadel
evat
ed
 Av
oidexer
ti
onbl
owi
ngofnosef
or24t
o48hr
s
 St
opof
fendi
ngdr
ugs(
ant
ipl
atel
ets/
ant
icoagul
ant
s)
 Cont
rol
hyper
tensi
on
 Cl
osenosebypi
nchi
ngandbr
eat
hvi
amout
hfor5-
10mi
nut
es
 Col
dcompr
esst
onasal
area
 Keepi
cecubesi
nhandker
chi
efov
ernose
 If bl
eeding sti
llpresent
,a cot t
on gauze impr
egnated wi
th
adrenal
ine&lignocai
neisinser
ted&nosepinchedforanot
her10
minutes.
 UseGelf
oam (
absorbabl
egel
ati
ncompr
essedsponge)i
fdi
scr
ete
bl
eedi
ngpoi
ntident
if
ied.
I
fnotcont
rol
led,
Giv
eInjTr
anexa(
tranexami
caci
d)500mgsl
owI
V
orEt
amsyl
ateIV
 OralAnti
biot
ics(e.
gaugment
inorcef
ixi
me)ort
opi
calant
ibi
oti
cs
t
opr ev
entsinusi
ti
s
 Gi
veant
i-
all
ergi
csf
ormi
l
dsedat
ionl
i
keav
ilorcet
ri
zi
nei
frequi
red
 TCoskl
ot250/
5001-
1-1(
etamsy
lat
e)orTTr
anexa500mgBD/
TDS
Not
e:i
fnotcont
rol
l
ed,
pressur
epacki
ngoft
henose&r
efert
oENT.
NASOPHARYNGI
TIS/COLD/ACUTECORYZA
 TCet
ri
zi
ne(
aler
id/
okacet
/cet
zine)5mg1-
0-1
 TLev
ocet
ri
zi
ne(
hat
ri
c)5mg(
SypHat
ri
c2.
5/5)OD
 TAv
il25mg1-
1-1
 TRupanex(
Rupat
adi
ne)10mgODx3day
s
 TPi
ri
ton4mgTDS(
chl
orpheni
rami
ne)
 TAl
l
egr
a120/
180mgOD/
BD(
fexof
enadi
ne)
Forpedi
atr
iccase:
 T ceti
ri
zi
ne/ Syp al
eri
d/cet
zine (
Cet
ri
zi
ne) (
5mg/
5ml
)(0.
25
mg/kg/
doseHS/BD)
o 6-
12mont
hs:
2.5mgOD
o 12mont
hs-6y
rs
 T-mi
nic/
lexDps (CPM 2mg/ 1ml
,pheny
lephr
ine)& T-
mini
c sy
p
(CPM 2mg/5ml
,pheny
lephr
ine)
 Lev
ocet
ri
zi
nei
sef
fect
iveathal
fthedoseofcet
ri
zi
neor0.
1mg/
kg
HS
I
fnasalcongest
ion:
-
 St
eam i
nhal
ati
on
 Sal
ineNasaldr
opsorDecongest
ant
sli
kenasi
vi
on(
oxy
met
azol
i
ne)
orotr
ivi
n(xy
lomet
azol
i
ne)
Forseasonalal
l
ergi
crhi
nit
is:
 TOdimontLC/MontekLC/Romi
l
ast
-L/Mont
icope(
mont
elukast
10+l
evocet
ri
zi
ne5)
.
 T.
Mont
elukastLCPed(
mont
e4+LC2.
5)
 Sy
pMont
ina-
L/r
omi
l
ast
-L(
Mont
e4mg+LC2.
5mgper5ml
)
 Mont
air4mgsachet
o <6y
r:4mgt
aborsachetOD
o >6y
r:5mgOD
o >12y
rs:
10mg
 TAl
l
egr
a-M(
fexof
enadi
ne+mont
elukast
)
 Nasal
decongest
ant
se.
gnasi
vi
on,
otr
ivi
n
 Topi
cal
ster
oids(
Nasal
spr
ay)
o Rhinocort
,BudenaseAQ,budecor
tnasalspr
ayonepuf
fBD
(budesoni
de)
o Combi
naseAQN-
spr
ay(
azel
ast
ine+f
lut
icasone)
o Azel
ast(
azel
ast
ine)
o Momef
lonasal
spr
ay(
momet
asone)
o Fl
uti
cone/
flomi
st/
flut
if
lonasal
spr
ay(
fl
uti
casone)
o Rhi
nase/
Becl
ateNasal
Spr
ay/
Drops(
becl
omet
hasone)

 Nasaldecongest
ant
sshouldnotbeusedmor
ethan3day
sina
r
owasi tmaycausereboundcongest
ion.
 Nasal decongest
ant
s shoul
d be used v
ery caut
iousl
yin
 hy
per
tensi
vepat
ient
s.
Forpr
egnantl
adi
es:Cet
ri
zi
ne,chl
orpheni
rami
ne,ot
ri
vi
nandnasi
onar
e
saf
e
I
n chi
ldr
en giv
eSal ineNasaldr
opsorNasi
vi
on-
P;don’
tgi
ve
Nasi
vi
on(onlyforadult
s)
Pr
ecaut
ionsi
nal
l
ergi
crhi
nit
is:
 Av
oidcar
pet
s
 Wool
encl
othi
ng
 Furpet
sli
kecat
s&dogs
 Keephousedustf
ree

I
fcol
d+f
ever
:-
 TWi
kory
lorSi
narestTusq-
PorAlex-P1-
1-1(
Syp&dropsav
ail
abl
e)
(
Pmol+Pheny
lephri
neHCl+Chlorpheni
rami
nemal
eate)
 T Ri
nost
atorFlucol
d(Sypanddr
opsav
ail
abl
e)1-
1-1(
P’mol+
Pheny
lpr
opanol
amine+CPM)
 T Nasivi
on (Pmol + Pheny
lephr
ine HCl + Caf
fei
ne +
Di
phenhy
drami
neHCl
)
 THat
ri
c3(
Pmol
+pseudoephedr
ine+CPM)
Forcol
d+f
ever+cough
 Syp Fl
uzetorAl ex-
P(Pmol+ Pheny
lephr
ine HCl+ CPM +
Dext
romethor
phan)
 Syp Nasocar
e Pl
us or Pedi
a-3(
Pmol
+Pseudoephedr
ine HCl
+CPM+DM)
 Syp Si
narest(
Pmol+ Pheny
lephr
ine HCl+ CPM+ Na ci
tr
ate
+menthol
)
Not
e:TSi
nar
estAF-wi
thoutPar
acet
amol
(Sy
pordr
opsav
ail
abl
e)
SORETHROAT
 Commoncauses
 Acut
ephar
yngi
ti
s-80%v
iral  Ul
cer
s
 Ret
rophar
yngeal &  Tr
auma
par
aphary
ngeali
nfect
ions)
 Ref
err
edpai
nduet
oangi
na
 Mal
i
gnancy
 Ref
luxesophagi
ti
s

 Ant
ibi
oti
csi
fanyassoci
atedi
nfect
ion.(
Azi
thr
omy
cin/
Augment
in)
 Anal
gesi
cs–par
acet
amol
 St
eam i
nhal
ati
on
 Pl
ent
yoff
lui
ds
 War
m sal
inegar
glex3t
imes/
dayorBet
adi
negar
glei
n10mlof
war
m wat
erTDS
 Thr
oatl
ozenges
Ref
erper
it
onsi
l
larabscesst
oENT,
asi
trequi
resI&D
PAROTI
TIS
Commonl
yduet
ost
one.
 Anti
bioti
cse. g.Augment
in/Cephal
exi
n.I
fno r
esponsegi
veI
V
cephalosppr
ins
 Ant
i-
inf
lammat
orydr
ugs
 Adequat
ehy
drat
ion,
oral
hygi
eneandl
ocal
heatappl
i
cat
ion
 L/
AofI
cht
hammol
Gly
cer
inet
oreduceedema.
 Li
mej
uice&ot
herCi
tr
usf
rui
tst
opr
omot
esal
i
var
ysecr
eti
on
I
ncasesofMumps(
vir
alPar
oti
ti
s)
 Hy
drat
ion
 Rest
 Anal
gesi
cs
 Hot
/col
dcompr
essesov
ert
hepar
oti
d(t
orel
i
evepai
n).
 Foodwhi
chpr
omot
esal
i
var
yfl
owshoul
dbeav
oided.
 Compl
i
cat
ions:
o Or
chi
ti
s
o Oophor
it
is
o Pancr
eat
it
is
o Asept
icmeni
ngi
ti
s
 Adv
isescr
otal
suppor
t&col
dcompr
essesf
oror
chi
ti
s
LARYNGI
TIS
Cl
i
nicalf
eat
ures
 Hoar
seness  Hemopt
ysi
s
I
nabi
l
ityt
ospeak  Dy
spnea
 Dr
ysor
ebur
ningt
hroat Incr
eased pr
oduct
ion of
sali
va
 Cough
 Sensat
ionofswell
i
ngi
nthe
 Dy
sphagi
a
areaofthel
ary
nx
 Fev
er

 Voi
cer
est
 St
eam i
nhal
ati
on
 Coughsuppr
essant
s
 Pl
ent
yofor
alf
lui
ds,
 Ant
ibi
oti
cs(
e.gAzi
thr
omy
cin)i
fduet
obact
eri
ali
nfect
ion
 Pant
opr
azol
eifduet
oGERD

Ot
hercausesofhoar
senessofv
oice
 Vocal
cor
dnodul
es  Smoki
ng
  Thy
roi
ddy
sfunct
ion  Car
cinomal
ary
nx
 Al
l
ergi
es  Tr
auma
I
nhalat
ion of r
espi
rat
ory  GERD
t
ractir
ri
tant
s
 Post
nasal
dri
p

GLOBUSSENSATI
ON/
GLOBUSPHARYNGEUS(
FEELI
NGOFLUMPI
N
THETHROAT)
Commoncauses
 GERD Inadequate rel
axat
ion of
swallowingmuscl
es
I
nfl
ammat
ionoft
het
hroat
 Hyper
trophyoft
hebaseof
 Post
nasal
dri
p
t
ongue
 St
ress/
psy
chogeni
c
 Lar
yngophar
yngeal
ref
lux
 Smoki
ng

 TPant
op40mgODf
orGERD/
LPRD
 ENTconsul
tat
ion
TONSI
LLI
TIS
 Cl
i
nical
feat
ures
o Sor
ethr
oat
,fev
er,
ody
nophagi
a
o Enl
argedt
enderj
ugul
odi
gast
ri
cly
mphnodes
o Lookf orcongesti
on,enl
argementoftonsi
lsandt
onsil
swi
th
purul
entmat eri
alatthecrypt
s(fol
li
cular
)&membr aneov
er
thetonsil
s(membr anous)
.
Tr
eat
ment
 Anti
biot
ics l
i
ke Amox
yci
l
li
n,Azi
thr
omy
cin ori
frecur
rentgi
ve
Augment i
n
 Anal
gesi
cs
  War
m sal
i
negar
gle,
bedr
estandpl
ent
yofor
alf
lui
ds
Tonsi
l
liti
sorpharyngi
ti
si nchil
drenareusual
l
yduet ost
rept
ococci
.If
nottreated pr
operl
y with anti
biot
ics,r
heumat
ic hear
tdisease or
gl
omer ul
onephr
iti
smayr esul
t.

A/
CBRONCHI
OLI
TIS
 Cl
i
nical
feat
ures
o Cy
anosi
s
o Respi
rat
orydi
str
ess
o Pr
olongedexpi
rat
ion
o Fi
necr
eps&r
honchi
 Tr
eat
ment
o Oxy
gen
oI
Vfl
uids
o Ant
ibi
oti
cs(
cephal
ospor
ins)
o Nebul
i
sat
ion(
wit
hadr
enal
i
ne,
3%Nor
mal
Sal
i
ne,
ast
hal
i
n)
o Sal
i
neNasal
Drops
QUI
NSY
 Cl
i
nical
feat
ures
o Sor
ethr
oat
o Fev
er
o Dy
sphagi
a
o Tr
ismus,
o Muf
fl
edspeech/
hotpot
atov
oice
oI
nflamed orophar
ynx, swol
l
en t
onsi
l
,uv
ula pushed t
o
opposi
tesi
de.
Tr
eat
ment
  Takeswab&sentf
orpusC&S
I
Vfl
uids
I
Vant
ibi
oti
cs(
cephal
ospor
in+/
-met
roni
dazol
e)x7-
10day
s
 Anal
gesi
cs
I
njDexona8mgI
Vsi
ngl
edose
 Ref
ert
oENTf
orDr
ainageofpus
A/
CEPI
GLOTTI
TIS
 Cl
i
nical
feat
ures
o Fev
er
o Sor
ethr
oat
o Dy
spnea
o Rapi
dlypr
ogr
essi
ver
espi
rat
oryobst
ruct
ion
o Dr
ool
i
ngofsal
i
va
o Hy
per
ext
endedneck
X-
rayl
ater
alv
iew:swol
l
enepi
glot
ti
s-t
humbsi
gn
Tr
eat
ment
 Ox
ygen
I
Vant
ibi
oti
cs(
3rdgener
ati
oncephal
ospor
in)
 Adequat
ehy
drat
ion
At onguebladeori ndi
rectlaryngoscopyexaminati
onshoul
dnotbe
done in chil
dren with suspected epigl
ott
it
is as i
tmightinduce
l
aryngospasm.
I
n severe cases endot
racheali
ntubat
ion ort
racheost
omymaybe
needed.

FOREI
GNBODYI
NNOSE
Af
orei
gnbodymustal
way
sbeexcl
udedi
nachi
l
dwi
thuni
l
ater
alnasal
di
schar
ge.
 Cl
i
nical
feat
ures
o Nasal
block
o Pai
n
o Bl
oodst
aineddi
schar
ge
Tr
eat
ment
 Forproceduralsedat
ion,i
nchi
l
drengiveSypPedi
clor
yl(
tri
clof
os
Na)(500/5)0.5ml/
kg(upto50mg/kgcanbegi
ven)
.
 Keepheadat45/
90degr
ee
 At
temptonl
yifFBcanbeseen
 Takef
rom bel
owupwar
ds
 MostoftheFBcanber emovedbyusingaEust
achiancat
het
er
whi
chispassedgent
lypastt
heFB&draggedal
ongthefl
oor
.
 Gi
veAnt
ibi
oti
csi
ftr
aumai
spr
esent
NASALBONEFRACTURES
Cl
i
nicalf
eat
ures I
nvest
igat
ions
 Tr
aumat
icepi
staxi
s  Digi
talx-
rayNasalboner
ight
andleftl
ater
alvi
ew
 Edema
 Ecchy
mosi
s
 Cr
epi
tat
ion
 Subcut
aneousemphy
sema
Rul
eoutCSFr
hinor
rhea
Lookf
orsept
alhemat
oma
Ifther
eis#&i fnosei
sswol
l
en,r
educt
ioni
sper
for
medaf
ter
edemasubsi
des(~1week)
 Gi
veant
iot
icsandnasi
vi
onnasal
drops
 FURUNCLEOFTHENOSE
 War
m compr
esses
 Sy
stemi
cant
ibi
oti
csl
i
kecephal
exi
n,ampi
cloxoraugment
in
 T-
bactoi
ntf
orLA
 Anal
gesi
cs
 I&Doft
heabscess
Not
e:thefur
uncl
eshouldnotbesqueezedduet
othedangerofspr
ead
ofi
nfect
iont
othecav
ernoussi
nus.

SI
NUSI
TIS
Causes Cl
i
nicalf
eat
ures
 URTI  Headache
 Tr
auma  Mal
aise
 Toot
hinf
ect
ion  Nasal
block
 Tr
auma  Pur
ulentr
hinor
rhea
 Fev
er
 PNSt
ender
ness
 Et
hmoidi
ti
s – l
i
d edema,
l
acri
mati
on
 X-
rayPNSwat
er’
svi
ew,
openmout
h
 Forf
ront
alsi
nust
akel
ater
alv
iew
 NCCTi
fdoubti
nX-
ray

Tr
eat
ment
 T.Cet
ri
zi
ne/T.CPM
 Anal
gesi
cs
  Ant
ibi
oti
cs:
amoxcl
av/
azi
thr
o/doxy
/cef
uroxi
meaxet
il
 St
eam inhal
ati
onwi t
hAmr ut
anjan/vi
cks/Tinct
ureBenzoi
n,15-
20
minut
esafternasal
decongest
ionforbett
erpenetr
ati
on.
 Nasal Decongestant
s: Nasivi
on (0.05%) [ oxymetazol
i
ne]
,
Otr
ivi
n(0.
1%)
,Otr
ivi
nP(.05%)[
xyl
omet
azol
i
ne]drops/spray
.
 Local
heatt
otheaf
fect
edsi
nus
NASALPOLYP
 Ant
ial
l
ergi
cs(
oral
ornasal
spr
aycanbeused)
 Anal
gesi
cs
 Ant
ibi
oti
csi
fther
eisev
idenceofi
nfect
ion
 ENTconsul
tat
ion
OTALGI
A(EARACHE)
Causes
 Acut
eot
it
ismedi
a  My
ringi
ti
sbul
l
osa
 CSOM  Mast
oidi
ti
s
 Fur
uncl
e  Eust
achi
ant
ubeobst
ruct
ion
I
mpact
edwax  Ext
radur
alabscess
 Ot
it
isext
erna  Referr
edcausesl i
kecari
es
tooth,ul
cerat
ivelesi
ons of
 Ot
omy
cosi
s
oralcavi
tyort
ongue
 Tr
auma
 Acut
etonsi
l
li
ti
s
 Her
peszost
er
 Per
it
onsi
l
larabscess

Tr
eat
ment
 Anal
gesi
cs
 Eardr
ops
o Ot
ogesi
c(pol
yet
hyl
enegl
ycol
,di
bucai
ne,
dihy
droxy
met
hyl
 car
bami
de,
gly
cer
in)
 EarAnt
isept
icPr
epar
ati
ons
o Ci
ploxdr
ops(
cipr
ofl
oxaci
n)
o Zenf
loxdr
ops(
ofl
oxaci
n)
o Ot
obi
oti
c-SF(
ofl
oxaci
n+cl
otr
imazol
e+l
i
gnocai
ne)
o Candi
d/sur
faz(
clot
ri
mazol
e,
li
docai
ne)
 Pr
epar
ati
onswi
thst
eroi
ds
o Otocin-
O/ Ot obi
oti
c plus/ Clot
ri
n-AC (
ofl
ox, l
i
docai
ne,
beclomethasone,
clot
ri
mazole)
o Candi
biot
ic(
chl
orampheni
col
,l
idocai
ne,
becl
o,cl
otr
i)
,
o Otobi
oti
c(Neomy
cin + Becl
omet
hasone + cl
otr
imazol
e+
l
ignocai
ne)
 ENTconsul
tat
ion
WAXI
NTHEEAR
I
mpactedwaxcancauseear ache,i
tchi
ness,r
efl
excough,di
zzi
ness,
v
ert
igo,t
inni
tusandsomehear
ingl
oss
 Dewax /Soli
wax /
clear
wax/
waxolve/
otor
ex/Waxoni
l
(par
adichlorobenzene+terpent
ine+benzocai
ne+chl
orbut
ol)e/
d
TDSf orsofteni
ngx5day s
 Sy
ringet
heearaf
teraf
ewday
s.
 Earbudsshoul
dnotbeusedt
oremov
eimpact
edwax.Theyar
efor
thepi
nnaonly.
 Ast
hewaxsof
tensdeaf
nessmayi
ncr
ease.

FOREI
GNBODYI
NEAR
Li
vi
ng
I
nsect
sshoul
dbekil
l
edf i
rstbyi
nst
il
li
ngorspr
ayi
ngl
i
gnocai
neor
nor
malsal
i
neoroi
ldrops.
  Theni
tcanber
emov
edusi
ngacr
ocodi
l
efor
cepsorbysuct
ion.
I
fa/
wanyi
nfect
iongi
vecombi
der
m earpack.
Non-
li
vi
ng
 Smal
l
,ir
regul
arFB’
scanber
emov
edwi
thf
orceps&sy
ringe.
 Forcepsshoul
dnotbeusedt
oremov
esmoot
hobj
ect
s,ast
hey
tendtomoveinwar
ds.
 Dosy
ringi
ngonl
yfornon-
swel
l
ingFB.
 Af
terFBr
emov
al,
exami
neTM.
TRAUMATOEXTERNALAUDI
TORYCANAL
 Most
lybyi
nst
rument
ati
onei
therbypat
ientorphy
sici
an.
I
fbl
eedi
ng+
o R/
ofaci
alNer
vepal
sy
o TakeHRCTt
empor
albone
o Gi
veI
njTr
anexa
 Minorl
acerati
onsheal,whil
emaj orl
acer
ati
onsshouldbet
reated
bypacki
ngt heexternalcanalwithmedi
catedwicks&ant
ibioti
c
st
eroi
ddropstopreventcanalst
enosi
s.
 Adv
icenott
ousecot
tont
ippedappl
i
cat
orsl
i
keearbuds.
A/
COTI
TISEXTERNA
 Ant
ibi
oti
cs.Eg:
-ampi
clox/
amoxy
clav
/ci
plox
 Anal
gesi
cs
 Local
heat
 Earpackof10%i
cht
hammol
gly
cer
ineorant
ibi
oti
cst
eroi
dcr
eam
o Combi
derm (
Clot
ri
mazol
e, becl
omet
asone di
propi
onat
e,
neomy
cin)
.
Remov
ethepackaf
ter24-
48hour
s.
 Ci
ploxeardr
opsTDS(
forassoci
atedbact
eri
ali
nfect
ion)
 OTOMYCOSI
S(FUNGALI
NFECTI
ONOFEARCANAL)
 Cl
i
nical
feat
ures
oI
tchi
ng
o Pai
n
o Wat
erydi
schar
gewi
thmust
yodor
o Earbl
ockage
o Hear
ingl
oss
Tr
eat
ment
 Eart
oil
et/
suct
ion/
moppi
ng
 Medi
cat
ed earpack/
wicks (e.g Combiderm orBestopi
c-N or
Si
gmader
m-N:becl
omethasone,cl
otr
imazole,neomy
cin)f
or24-
48
hr
s
 Af
ter24-
48hour
sCandi
de/
d
 Anal
gesi
cs
 Or
al Anti
biot
ics (
if associ
ated bact
eri
al i
nfect
ion) -
> e.
g.
Amoxy
clav
 Av
oidant
ibi
oti
ce/
d
 Precaut
iont
opr
eventwat
erf
rom ent
eri
ngt
heearandearmustbe
keptdry
VERTI
GO
 Maybecent
ral
orper
ipher
al
 Per
ipher
alv
ert
igoi
smor
esev
ere
Cent
ralcauses Per
ipher
alcauses
 CVA  Meni
ere’
sd/
s
 Mi
grai
ne  BPPV
 Epi
l
epsy  Headt
rauma
  Mul
ti
pleScl
erosi
s  Dr
ugs
 Tumour
s  Laby
rint
hit
is

 CheckBPandGRBS
I
njStemetil(
prochl
orper
azi
ne)12.
5 mg I
M (
can be gi
ven i
n
pr
egnancy
).
 Tst
emet
il5mg1-
0-1
 TVer
ti
n/Bet
aver
t(Bet
ahi
sti
ne)16/
32mgBD/
TDSor
 TSt
uger
on(
cinnar
izi
ne)25mgTDS/75mgHS.
Bet
ahi
sti
neC/
Iinast
hmat
icsandpept
icul
cerdi
sease
 Nev
ergi
vef
ormor
ethan4weeks.
 Wi
thdr
awasear
lyaspossi
ble.
PERFORATI
ONOFTYMPANI
CMEMBRANE
Cl
i
nical
feat
ures:
pai
n,bl
eedi
ngandhear
ingl
oss
 Uncompl
i
cat
edper
for
ati
onusual
l
yheal
sbyi
tsel
f
 Per
for
ati
onsnotheal
edby3mont
hscanber
epai
red
Tr
eat
menti
sai
medatcont
rol
l
ingot
orr
hoea
 Sy
stemi
cant
ibi
oti
cs&Anal
gesi
cs/Ant
ihi
stami
nes
 Keepeardr
y
 Eardr
opsar
eav
oided
 ENTconsul
tat
ion
TI
NNI
TUS
Causes
 Wax  Hy
pot
ensi
on
 Fl
uidi
nmi
ddl
eear  Hy
pogl
ycemi
a
 Ot
it
ismedi
a  Mi
grai
ne
  Ot
otoxi
cdr
ugs  Epi
l
epsy
 Anemi
a  Ar
ter
ioscl
erosi
s
 HTN  Psy
chogeni
c

 TBi
l
ovasTDS(
ginkgobi
l
oba)
STRI
DOR
Hi
ghpitchednoisybr
eathi
ngcausedbyl
argeai
rwayobst
ruct
ion,
usual
l
y
t
helar
ynxandt r
acheaassoci
atedwit
hdy
spnea.
 St
ri
dorisi
ndi
cat
iveofapotent
ialmedi
calemer
gencyandshoul
d
al
wayscommandatt
ent
ion.
 Whereverpossi
ble,at
tempt
s shoul
d be made t
oimmedi
atel
y
est
abli
shthecauseoft
hestr
idor
.
Causes
 For
eignbody
,  Acut
elar
yngi
ti
s
 Vocal
cor
dedema  Di
pht
her
ia
 Tracheal compr
essi
on by  Per
it
onsi
l
larabscess
tumor
I
MN
 Funct
ional l
ary
ngeal
dyski
nesia
 Epi
glot
ti
ti
s

I
fduet
oai
rwayedema:
 Nebul
izat
ionwit
hracemi
cadrenal
i
ne/epi
nephr
ine(0.5to0.75ml
of2.
25%r acemi
cadr
enal
i
neaddedto2.5to3ml ofnormal
sali
ne)
 Dexamet
hasone4-
8mgI
Vq8-12h
 Ox
ygenbyf
acemask
 Pr
oppedupposi
ti
on
I
mmedi
atel
yref
ert
hepat
ientt
oENT/
sur
ger
y.
 AOM
 A/
cinf
ect
ionofmi
ddl
eearcav
ityusual
l
yfol
l
owi
nganURTI
.
Cl
i
nicalf
eat
ures
 Ear
ache
 Deaf
ness
 Ti
nni
tus
 Fev
er
 Vomi
ti
ng
 Sei
zur
e
Tr
eat
ment
 Anti
biot
ics:Amoxcl
av/ azi
thr
o/Cephal
exi
n/Cef
ixi
me/
Cef
uroxi
me
axet
il
 Oraldecongestant
s+ant
ihi
stami
nes+ant
ipy
ret
ics(
e.gWi
kor
yl/
Hatr
ic-
3/Nasivi
on)
 Nasi
vi
on nasal dr
ops TDS (
chi
l
dren <2 y
rs: Sal
i
ne ND,
>2yr
s:Nasi
vi
on-
PND) .
 Av
oideardr
ops
 Dr
ylocal
heatt
orel
i
evepai
n
 Eart
oil
et/
suct
ioni
fdi
schar
gepr
esent
 Keepeardr
y

PERI
CHONDRI
TISOFPI
NNA
 Secondar
yt olacerati
ons,hemat
oma & surgi
cali
nci
sions,ear
pi
erci
ng(especi
all
ypierci
ngoft
hecar
ti
lage)
.
Inf
lammation ofthe pi
nna i
sf oll
owed by abscess f
ormati
on
betweenthecarti
l
age&t heperi
chondr
ium wit
hnecrosisofthe
carti
l
age,asthecart
il
agesurvi
vesonlyonbloodsupplyfrom t
he
 per
ichondr
ium.
Cl
i
nicalf
eat
ures
 Fev
er,pai
nfulr
edear
,fl
uiddr
aini
ngf
rom t
hewoundandswol
l
en
ear
 Di
agnosedbyhi
stor
yoft
raumat
otheearandr
ed,
ver
ytenderear
Tr
eat
ment
I
Vant
ibi
oti
csasear
lyaspossi
ble;
Inj
Cipl
ox,
Inj
Met
rogy
lx7day
s
 TLy
ser
-D
 Dai
l
ylocal
dressi
ngsatear
lyst
agewi
thT-
bact
 Onceabscesshasformed,i
nci
sionismadeal
ongt
henat
uralf
old
&thedevi
tal
izedcar
ti
lagei
sremoved.
CONSTI
PATI
ON
Causes
 Phy
siol
ogi
cal  DM
I
BS I
ntussuscept
ion
 Dr
ugs  Neur
ologi
c
 Lackoff
iberandwat
er  Car
cinoma
 Anor
ect
aldi
sease  Mot
il
it
ydi
sor
der
 Met
abol
i
c

 TDul
col
ax/
Ger
bisa5mg/
10mg/
20mgHS(
bisacody
l)
o 5mgHSf
orchi
l
d>6y
rs
o 0.
3mg/
kgHSf
orchi
l
d<6y
rs
o Supposi
tor
y
 5mgi
f<2y
 10mgi
f>2y
  Canbegi
veni
npr
egnancy
)
 Sy
pCr
emaf
fi
n5ml
-15ml
HS(
Liqui
dpar
aff
in,
MgOH2)
 Sy
pSmut
horCr
emaf
fi
npl
us(
Lpar
aff
in,
Napi
cosul
fat
e,MgOH2)
 Sy
pLooz/
Duphal
ac(
Lact
ulose)(
10/
15)
oI
nfant
s:2.
5-10ml
/day
,0.
5ml
/kg/
dose
o >2y
rwi
th5ml
x2
o >5y
r10ml
x3
 Proct
ocl
ysi
s enema can al
so be gi
ven (
aft
erchecki
ng bowel
sounds)
Forpr
egnantl
adi
es
 Dul
col
axsupposi
tor
yx2HS
 Di
etaryf
ibr
es(
cyberpowder1-
2tspi
n50-
100mlofwat
er/
frui
t
j
uice/
mil
k)
I
spaghul
a(car
diol
ax2t
spi
nagl
assofwat
erod/
bd)
 Lact
ulose
BI
TTERTASTEI
NMOUTH
 St
opt
hedr
ugi
fany
,causi
ngi
tanduseent
eri
ccoat
edt
abl
ets
 Di
gene2t
spQ4H
 Chewcar
damom
 Pl
ent
yofor
alf
lui
ds
ANOREXI
A
Causes
 Gast
ri
ti
s  Dr
ugs
 Car
cinoma  Al
cohol
 TB  Fev
er
 CCF  Hy
per
par
athy
roi
dism,
  Renal  Psy
chogeni
c
 Respi
rat
oryf
ail
ure

 Sy
pPr
act
in(
2/5)1t
spt
dsx½hrbef
oremeal
s(Cy
prohept
idi
ne)
o 0.
25-0.
5mg/
kg/
24hrdi
vint
o3.2-
6yr
s
 TApet
one/TPract
in/TCi
plact
in2mgor4mg½hrbef
oremeal
s
(
Cypr
ohept
idi
ne)
HI
CCUPS/
SINGULTUS
Causes
I
WMI  Chol
ecy
sti
ti
s
 DKA  Al
cohol
ingest
ion
 Aor
ti
caneur
ysm  Per
icar
dit
is
 Medi
ast
ini
ti
s  Pneumoni
a
 CVA  Empy
ema
 Renal
/l
iv
er/
respi
rat
ory  Esophageal
obst
ruct
ion
fai
l
ure
 Hepat
it
is
 Li
verabscess

 Mucai
ne gel 2t
sp Q2-
4H (
oxet
hazai
ne,
Mg hy
drox,
Alumi
nium
hy
drox)
 TPer
inor
m
 TCy
clopam/Buscopan
 TBacl
ofen(
mostef
fect
ive)5or10mgOD/
BD
I
ntr
act
abl
ehi
ccups
o TCPZ25or50mg(
Chl
orpr
omazi
ne)
Sev
erehi
ccups
I
njMet
ocl
opr
ami
de2ccI
M
 I
njHal
oper
idol
2-10mgI
M
CONTI
NOUSBELCHI
NG/
FLATULENCE
Rul
eoutI
.W.
M.I
.
 Askpat
ientt
oeatsl
owl
y
 Av
oidaer
ateddr
inks/
tal
ki
ngdur
ingmeal
s,chewi
nggumset
c
 Adv
iset
ocl
oset
hemout
hwhi
l
ebel
chi
ng
 Avoidgasf ormi
ngf oodssuchascabbage,caul
i
flower
,beans,
peas,oni
ons,nut
s,appl
e,cucumberet
c
Tr
eat
ment
 TPer
inor
m 10mgBD/
TDS
 Gel
usi
lorDi
gene
 Ar
ist
ozy
meCaporSy
pbd/
ti
daf
termeal
s
EPI
GASTI
CPAI
N
Causes
 Oesophagi
ti
s  Bi
l
iar
ycol
i
c
 Oesophageal
spasm  Acut
epancr
eat
it
is
 Gast
ri
ti
s  Acut
ecor
onar
ysy
ndr
ome
 Duodeni
ti
s  Aor
ti
cdi
ssect
ion
 Pept
icul
cerdi
sease  Hepat
it
is
 Gast
ri
cvol
vul
us  Chol
ecy
sti
ti
s
 Chol
angi
ti
s
DYSPEPSI
A&FORWEI
GHTGAI
NINCHI
LDREN
 SypCar
micide2.
5–5mltdsinchil
dren& 5–10mlt
dsi
nadul
ts
[
sodi
um ci
tr
ate+ci
tr
icaci
d+al
cohol
]
 CAr
ist
ozy
me1t
ds[
diast
ase,
pepsi
n]
o Di
ast
asei
sadi
gest
iveenzy
me;
alsohasant
if
lat
ulentact
ion.
 o Ar
ist
ozy
meSy
p&dr
opsav
ail
abl
e
RECTALBLEEDI
NG/
HEMATOCHEZI
A
Causes
 Hemor
rhoi
ds  Pol
yp
 Fi
ssur
e  Di
ver
ti
cul
osi
s
 Fi
stul
a I
nfect
iousdi
arr
hea
 Rect
alt
rauma  Meckel
’
sdi
ver
ti
cul
um
 Rect
alFB  Angi
ody
spl
asi
a
 Pr
oct
it
is I
ntussuscept
ion
 Car
cinoma  Dr
ugs
I
BD  Coagul
ati
ondi
sor
der
 Ur
emi
a

 Sur
ger
yconsul
tat
ionandPRexami
nat
ion
ANALI
TCHI
NG
Causes
 Wor
minf
ect
ion  Der
mat
it
is
 Di
etar
yir
ri
tant
s  Di
arr
hea
 Anx
iet
y  Poorhy
giene

 TMebex100mgBDx3day
s(Sy
pmebex100/
5,dosesameas
adul
t)
 T Al
bendazol
e 400 mg atni
ght& r
epeataf
ter2 weeks (
for
Ent
erobi
usVermicul
ari
s)
o Forchi
l
d<2y
rs-200mg.
Not
e:Al
bendazol
eC/
Iinpr
egnancy&l
act
ati
on
  Tav
il25mgHS&SOS
JOI
NTSPRAI
N
 Commonl
yinv
olv
eankl
e&wr
istj
oint
s
 C/
F:pai
n,swel
l
ing,
rest
ri
cti
onofmov
ement
,cont
usi
on
Tr
eat
ment
 RICE -rest,ice appl
i
cat
ion,compr
essi
on usi
ng dr
essi
ng/
crepe
bandages),
elevat
ion
 Cr
epebandagesi
ze(
incm)
o Adul
t:knee15,
ankl
e10,
wri
st8
o Chi
l
dren:
knee10,
ankl
e8,
wri
st6
 Anal
gesi
cs
PAI
NOFMUSCLESPASM /MUSCULOSKELETAL/
OSTEOARTHRI
TIC
PAIN
 Formentwit
hhotwat
erbag3timesperdayf
orc/
cpai
n;l
ocali
ce
appli
cat
ionf
ora/
cinf
lammat
ion
 Di
clonac / v
olini (di
clof
enac)
/ ket
orol
/ket
anov (
ket
orol
ac)
,
Dol
onex/pi
rox(pir
oxi
cam)forLA
 TI
bugesi
cpl
usBD
 TPir
ox20mgOD/ Ket
orol10mgTDS/Et
oshi
ne(
etor
icoxi
b)60mg
/90mgor120mgOD
 TBi
danzenorFl
anzenorLy
serf
ort
e10mgt
ds(
ser
rat
iopept
idase)
 TChy
mor
alf
ort
eTDSbef
oref
ood(
try
psi
n,chy
mot
rypsi
n)
 Tz
ymof
lam/
Rut
oheal
(tr
ypsi
n,br
omel
ain,
rut
osi
de)i
fcont
usi
on+.
I
njMy
ori
l(t
hiocol
chi
cosi
de)4mgI
Mformuscl
espasm
Muscl
erel
axant
s+NSAI
Dcombi
nat
ions
 TRobi
nax500mgQi
d(met
hocar
bamol
)
 TMy
ori
l2/
4/8mg(
Thi
ocol
chi
cosi
de)
  TI
bugesi
c-M(
Ibupr
ofen+met
hocar
bamol
)
 TXy
kaaMR4/
8mg(Pmol
+Thi
ocol
chi
cosi
de)
 TRobi
naxol
(met
hocar
bamol
350+Pmol
250)
 TAcecl
o-MR(
acecl
o+Pmol
+chl
orzoxazone)
 TEt
oshi
neMR(
etor
icoxi
b+Thi
ocol
)
 TZer
odol
TH(
acecl
o+t
hiocol
)
NECKPAI
N
Causes
 Cer
vical
spondy
losi
s  Car
oti
dar
ter
ydi
ssect
ion
 Psy
chogeni
c  St
ress
 Acut
eMI  Pr
olongedpost
ures
 Br
achi
alpl
exopat
hy  Whi
plash
 Pancoastt
umourofl
ungs  RA
 Ret
rophar
yngeal
abscess  Tor
ti
col
l
is
 Anky
losi
ngspondy
li
ti
s

Thecommonneckpai
nradi
ati
ngt
oonear
miscer
vicalspondy
losi
swi
th
radi
cul
opat
hy.
I
njVov
eran2ccI
M ATDi
fver
ysev
erepai
n
 Tv
over
an50mgBDaf
terf
ood
 Voli
ni/
Vover
an(dicl
ofenac)orPiroxgel/dolonexgel(pi
roxi
cam)
orThioxgel(Di
clo+t hiocol
chi
coside,met
hylsal
i
cyl
ate,menthol
)
forLA
 Neckcol
l
ar
 Or
thoconsul
tat
ion
X-
RAYVI
EWS
 AP and l
ater
al -
 Ankl
e/el
bow/
shoul
der
/hi
p/knee/
for
ear
m/l
eg/
wri
st/
spi
ne
 AP/
obl
i
que-Foot
/hand
 Chest
-PAv
iew
 Acr
omi
ocl
avi
cul
arJoi
nt-APv
iew
 Pel
vi
swi
thbot
hhi
ps-APv
iew
BACKPAI
N
Causes
 Muscul
oli
gament
ousspr
ain  Aor
ti
cdi
ssect
ion
 Ost
eoar
thr
it
isofspi
ne  Py
elonephr
it
is
 Spondy
lol
i
sthesi
s  Mal
i
gnancy
 Degener
ati
ve  Pancr
eat
it
is
 Ver
tebr
alcol
l
apse  Her
peszost
er
 Renal
col
i
c  Anky
losi
ngspondy
li
ti
s
I
Vdi
scpr
olapse  My
eloma
Factor
sindi
cat
ingser
ious  Wei
ghtl
oss
pathol
ogy
 Fev
er
 Ni
ghtpai
n
 Cancerhi
stor
y
 El
der
lyper
son

 Gi
veanal
gesi
cs
 Muscl
erel
axant
 Vov
eranorpi
roxgel
forLA
 Or
thoconsul
tat
ion
HEELPAI
N
Causes
 Pl
ant
arf
asci
ti
s  St
ressf
ract
ures
 Achi
l
lest
endoni
ti
s  Bur
sit
is
 Heel
spur
s

 X-
rayf
oot–AP/
obl
i
que
 Anal
gesi
cs
 MCRsandal
s
FI
RSTAI
DINFRACTURES
 Anal
gesi
c
Ift
her
eisanopenwoundnearthef
ract
uresi
te,
cleani
tthor
oughl
y
andcoveri
twi
thst
eri
l
edressi
ng.
o Noat
temptshoul
dbemadet
oputt
hebonel
yi
ngouti
nsi
de.
I
mmobi
l
iset
hel
i
mbwi
thaSpl
i
nt
o Spli
ntshoul
dbel ongenoughtofi
xonej
ointabov
e&one
j
ointbel
owthesuspest
ed#site.
 Fortraumatichead orneckinj
ury
,suspecta cer
vicalfr
act
ure
unl
essot herwi
sepr ov
ed& appl
yacer v
icalcol
l
ar(prefer
abl
ya
Phi
ladelphi
acoll
ar)
.
o A backboar
d/ spi
neboard can be used t
o st
abi
l
ize t
he
r
emainderofthespinalcol
umn
o Ref
ert
hepat
ientt
oor
thoassoonaspossi
ble.
ANAEMI
A
 Sy
mpt
omsandsi
gns
o Exert
ionaldyspnoea,lethargy,fat
igue,weakness,pall
or,
tachy
cardia,dizzi
ness,loss ofconcentrat
ion,headache,
hypotensi
on,t
innit
us,gl
ossit
is,
angul
archei
losis,
koi
lony
chia
I
nvest
igat
ions
o CBC,r
edcel
lindi
ces,r
eti
cul
ocy
tecount
,per
ipher
alsmear
,s
 f
err
it
inandBonemar
rowbi
opsy(
ifunexpl
ained)
I
rondef
ici
encyanemi
a
 Dexorange(
containsf
err
icammoni
um ci
tr
ate,cy
anocobal
ami
ne
andfoli
caci
d)15-30mlBD
o Chi
l
dren2-
5yr
s5ml
BD
o 5-
12y
rs10ml
BD
 CapDexor
angeCapBD
 TOr
ofer–XTBD(
element
alFe+f
oli
caci
d)(
Drops/
Sypav
ail
abl
e)
I
ronsupplement
sneedt
obet
akenf
orsev
eralmont
hsf
ori
ron
def
ici
ency
.
I
ronsuppl
ement
smaycausedar
kst
ool
sandgast
ri
ti
s
 Alli
ronsuppl
ement
sar
ebestgi
veni
nempt
yst
omacht
omaxi
mize
absorpt
ion
Megal
obl
ast
icanemi
a
 TFab12OD(
cyanocobal
ami
n15mi
crogr
am +f
oli
caci
d5mg)
FALL/
IMPAI
REDCONSCI
OUSNESS
CommonCauses
 Hy
pogl
ycemi
a  Sei
zur
e
 Hy
pot
ensi
on  Al
cohol
int
oxi
cat
ion
 Acut
ecor
onar
ysy
ndr
ome  Dehy
drat
ion
 Ar
rthy
mias  Accel
erat
edHy
per
tensi
on
 CVA/
TIA  Hy
ponat
remi
a

 Checkv
ital
sandsecur
eIVl
i
ne
 CheckGRBS
 TakeECG
 CTscant
orul
eoutCVA/
headi
njur
y
  Tr
eatunder
lyi
ngcause
I
NSOMNI
A
 Br
iskwal
kint
heev
eni
ng
 Hotbat
hbef
oresl
eep
 Readi
ngi
nbed
Usedr
ugsasl
astr
esor
t.
 TNi
tr
estorZol
fr
esh10or5mgHS(
Zol
pidem)
I
fassoci
atedwi
thanxi
etygi
ve
o TCl
onazepam 0.
5mgHS
o TLor
a/At
ivan2mg(
lor
azepam)
o TAl
prax0.
5mgHS(
alpr
azol
am)
ALCOHOLWI
THDRAWAL
I
njLor
azepam 4mgI
M orsl
owI
Vst
at
I
njThi
ami
ne1ampI
M ori
n100ml
NSI
Vst
at
 TLor
a2mg1-
1-2or1-
1-1-
2or
 TLi
bri
um (
Chl
ordi
azepoxi
de)10mg/
25mg10-
10-
25mgx5-
7day
s
 TThi
ami
ne100mgOD/
BD(
TBenal
gis)x5-
7day
s
 TBacl
ofen5mg1-
1-1(
todecr
easecr
avi
ng)
A/
CALCOHOLI
CINTOXI
CATI
ON
Rul
eouthy
pogl
ycemi
aandSDH
I
njPant
opandondem t
opr
eventv
omi
ti
ngandaspi
rat
ion
I
njThi
ami
ne100mgi
n100ml
NSst
at
o Always give bef
ore dext
rose t
o pr
event Wer
nicke’
s
encephal
opathy
 Cor
recthy
pogl
ycemi
a
 Mai
ntenanceoff
lui
d&el
ect
rol
yti
cbal
ance
  Tt
hiami
ne1-
0-1x5-
7day
s
 Tl
i
bri
um 10/
25(
1-1-
2)x5t
o7day
s
HYPOTENSI
ON
 Est
abl
i
sh2l
argebor
eIVl
i
nes
I
dent
if
ycause
o MI
o Hear
tfai
l
ure
o Sepsi
s
o Bl
oodl
oss
o Dehy
drat
ion
I
VF–NSr
api
dlyf
ordehy
drat
ion
 Nor
adr
enal
i
nei
nfusi
onf
orhear
tfai
l
ure
o 0.
05–0.
4mi
crogr
am/
kg/
min
 Ant
ibi
oti
csf
orsepsi
s
 Bl
oodt
ransf
usi
oni
fbl
oodl
oss
OEDEMA
Gener
ali
sed Local
i
zed
 CCF I
nfect
ion
 CLD  Tr
auma
 CKD  Bur
ns
 My
xedema I
nsectbi
tes
 Hy
poal
bumi
nemi
a
Uni
l
ater
all
owerl
i
mbedema  Fi
l
ari
asi
s
 Cel
l
uli
ti
s
 DVT
 Gout
I
nvest
igat
ions  CBC,
URE
 LFT,
RFT
 CXR
 TFT
 Echo
 USGDoppl
erofl
owerl
i
mbs

 Cel
l
uli
ti
s
o Compl
etebedr
est
o Li
mbel
evat
ion
o Ant
ibi
oti
csandanal
gesi
cs
 DVT
o Ref
erf
orhepar
int
her
apy
 Fi
l
ari
asi
s
o DEC150mgBDf
or14day
s
o Li
mbel
evat
ion
o Anal
gesi
cs
 Renal
o Gener
ali
sedoedemamor
eonf
ace&i
nthemor
ning.
o Dour
ineexami
nat
ion
o TDy
tor10mg(
1-0-
0)(
Tor
asemi
de)
o TLasi
x40mg(
1-0-
0)(
Fur
osemi
de)

HYPOGLYCEMI
A
Cl
i
nicalFeat
ures
 Sweat
ing I
nabi
l
ityt
oconcent
rat
e
  Tr
embl
i
ng  Sei
zur
e
 Pal
pit
ati
on  Nausea
 Hunger  Ti
redness
 Anx
iet
y  Headache
 Conf
usi
on I
rr
it
abi
l
ity
 Dr
owsi
ness  Anger
 Speechdi
ff
icul
ty I
ncor
dinat
ion

 CheckGRBS
I
fpat
ientcant
akeor
all
y–gi
ve20gofgl
ucosei
n1gl
asswat
er
I
fpat
ientcan’
ttakeor
all
y
o Gi
ve25%Dex
trose100ml
rapi
dIVpush
o Fol
l
owedby5%Dext
rosei
nfusi
onat100ml
/hr
 GRBSshoul
dber
epeat
edev
ery10mi
nut
esunt
il>100mg/
dL
 Obser
vef
or24hour
s
Not
e:Al
lcasesofunexpl
ainedhy
pogl
ycemi
ashoul
dhav
eanECGt
aken.
 Fori
nfant
s:2ml
/kg25%dext
rose
 Chi
l
dren:
4ml
/kg25%dext
rose
URI
NARYTRACTI
NFECTI
ON
Cl
i
nicalf
eat
ures
 Fev
erwi
thchi
l
ls
 Bur
ningsensat
iondur
ingmi
ctur
it
ion
 Fr
equency
 Abdomi
nal
pai
n
 Fl
ankpai
n+r
enal
angl
etender
ness-Py
elonephr
it
is
I
nvest
igat
ions
  CBC
 URE
 RFT
 Ur
ineC/
S
o Must f
or recur
rent i
nfect
ion,chil
dren,pregnancy,DM,
i
ndwel
li
ngcathet
er,ol
derpeopleandf
ailur
eofini
ti
alther
apy
Tr
eat
ment
 Sendf
orC/
Sbef
oregi
vi
ngant
ibi
oti
cs
 Pl
ent
yofor
alf
lui
ds
 TP’
mol
500mgTDS/
SOS
 TCy
clopam 10mgSOS(
forur
eter
ic/
renal
col
i
c)
 Ant
ibi
oti
cs
o TNorf
lox400mg1-
0-1X5-7day
sforuncompl
i
cat
edUTI(
for
mengivef
or10-
14days)
o T Ni
ftas 100 mg (
nit
rof
urant
oin)1-
0-1(
ifr
esi
stantor
r
ecur
rentUTI)
o Ot
her
s–Cef
ixi
me,
Cot
ri
moxazol
e,Amoxy
clavet
c
 SypCitr
alka/
Alkasol(DiNahydrogenci
tr
ate)10mli
n1gl
asss
waterTDS(canbegi v
eninpr
egnancy)
 TPy
ridi
um (
phenazopy
ridi
ne)200mg1-
1-1x2day
s
o Ur
inar
yanal
gesi
c
o Pr
oducesr
eddi
shdi
scol
orat
ionofur
ine.Sowar
nabouti
t
o Nott
obeusedf
ormor
ethan2day
s
o C/
Iinpr
egnancy
 TUr
iki
nd/
Uri
spas(
Flav
oxat
e)2001-
1-1x3day
s
o Fordy
suria,ur
gency,noctur
ia,supr
apubi
cpai
n,f
requency&
i
ncont
inenceandbladderspasm
I
npedi
atr
iccases
 Gi
vecef
ixi
meorcot
ri
moxazol
e.
 Ref
erallpedi
atr
icUTItopediat
rici
anf
orworkup(MCU,USGetc)
,
as chi
l
d below 5 yrs(especi
al l
y<2 yrs)arevul
nerabl
efor
per
manentrenaldamagefol
lowingUTI
.
HEMATURI
A
Commoncauses
 UTI  Ant
icoagul
ant
s/ant
ipl
atel
ets
 Py
elonephr
it
is  Gl
omer
ulonephr
it
is
 Tr
auma  Ur
ethr
alFB
 Hemor
rhagi
ccy
sti
ti
s  Renal
inf
arct
ion
 Nephr
oli
thi
asi
s  My
ogl
obi
nur
ia
 A/
cpr
ost
ati
ti
s  Hemogl
obi
nur
ia
 Ur
ethr
alst
ri
ctur
e
I
nvest
igat
ions  CBC
 URE
 RFT
 USG
Adv
iseMedi
ci
ne/
Nephr
ology
/Ur
ologyconsul
tat
ion.

HYPERVENTI
LATI
ON
Commoncauses
 St
ressoranxi
ety I
nfect
ion
 St
roke  Hear
t/l
ungdi
sease
 Headi
njur
y  Pr
egnancy
 DKA  Sev
erepai
n
  Met
abol
i
caci
dosi
s

Foranxi
etyi
nduced
 Br
eat
hint
oapaper
/pl
ast
icbag
 TCl
onazepam 0.
5mgst
at
 Pr
oppedupposi
ti
on
NOCTURNALLEGCRAMPS
Commoncauses
 Per
ipher
alar
ter
ydi
sease  Hy
per
/hy
pot
hyr
oidi
sm
 Spi
nal
stenosi
s  CKD
 Dr
ugsl i
kest
ati
ns,di
uret
ics,  Ci
rr
hosi
s
st
eroi
ds
 El
ect
rol
yteabnor
mal
i
ties
 Dehy
drat
ion
 Vi
tami
ndef
ici
ency

 Pl
ent
yofor
alf
lui
ds
 Anal
gesi
cs
 CapMeganeur
onODPl
us0-
0-1
 TShel
cal
OD
 Cev
ion400mgOD
 TGabapent
in(
Gabant
in)100mg0-
0-1
 Forper
ipher
alar
ter
ial
disease
o TPent
oxi
fi
ll
yi
ne400mg1-
1-1
STATUSEPI
LEPTI
CUS
Occurrence ofSeizures formoret han 5 mi
n orf i
ts occur
ri
ng i
n
successionwit
houtregai
ningconsci
ousnessi
nbetween.
 Commoncauses
 Hy
pogl
ycemi
a  Meni
ngi
ti
s/Encephal
i
tis
 St
oppi
ngAEDs I
CSOL
 Hy
ponat
remi
a  Headi
njur
y

Gener
almeasur
es
 Mai
ntai
nai
rway-t
hroatsuct
ioni
ngi
fneeded,
O2i
nhal
ati
on
 Est
abl
i
shI
Vli
ne
I
fact
ivesei
zur
eIfact
ivesei
zur
ekeept
heheadt
urnedt
oonesi
de
wi
thf
acepoint
eddownwards
o Don’
tkeepthepat i
enti
nlef
tlat
eralposi
ti
onwasi
tmayl
ead
t
oshoulderdi
slocati
on
 Makethepat
ienti
nlef
tlat
eralposi
ti
ononcesei
zur
eepi
sodei
s
st
opped
 CheckGRBSf
orev
erypat
ientandcor
rectr
api
dly
Tr
eat
ment
I
nfi
rstI
V
I
njLor
azepam 0.
1mg/
KgI
V
o Max4mg/
dose
o Rat
eofi
nject
ion2mg/
min
o Rapi
dinj
ect
ionwi
l
lcauser
espi
rat
orydepr
essi
on
 Al
ter
nat
ive
oI
njDi
azepam 0.
15mg/
kgI
V
o Max10mg/
dose
o Rat
e5mg/
min
I
fNOI
Vaccess
oI
nj.Mi
daz10mgI
M
I
fnoresponseaf
ter1mi ve2nd doseofLor
ngi azepam pl
usanyoneof
t
hefol
lowing
I
njPheny
toi
n20mg/
kgatr
ateof25-
50mg/
minI
VOR
I
njFospheny
toi
n20mg/
kgatr
ateof100-
150mg/
min
I
njLev
eti
racet
am 50mg/
kgatr
ateof300mg/
min(
Max4500mg)
I
njVal
proat
e30mg/
kgatr
ateof10mg/
kg/
min
I
fnor
esponse
 Gi
veasecondl
i
nedr
ugnotgi
venpr
evi
ousl
y
HAEMOPTYSI
S
Commoncauses
 TB  Br
onchi
alCA
 A/
cLVF  FB
 MS  Par
asi
tes
 Br
onchi
ect
asi
s  Asper
gil
l
oma
 Pul
monar
yembol
i
sm  Hemophi
l
ia
 Br
onchi
ti
s  Leukemi
a
 Lungabscess  Ant
icoagul
ant
s/ant
ipl
atel
ets
 Suppur
ati
vepneumoni
a
I
nvest
igat
ions  CBC
 Coagul
ati
onpr
ofi
l
e
 Sput
um C/
S
 Sput
um AFB
 ECG
 ChestX-
ray
 HRCTt
hor
ax
  Reassur
epat
ient
 Absol
utebedr
est
 Pr
eventaspi
rat
ion;
tur
nheadt
oonesi
de
I
njTr
anexa/
Ethamsy
lat
e500mgI
Vst
atandSOS
 Ant
i-
tussi
ves
o Dext
romet
hor
phan
o Lev
odr
opr
opi
zi
ne
 Anxi
oly
tics
 Br
onchodi
l
ator
s
 Bloodt
ransf
usi
oni
fsy
stol
i
cBPl
esst
han90mmHgormassi
ve
hemopt
ysis
Ref
ert
oPhy
sici
an/
Pul
monol
ogi
st.
DYSLI
PIDEMI
A
 Checkf
ast
ingl
i
pidpr
ofi
l
e
 Secondar
ycausesofdy
sli
pidemi
a
o Hy
pot
hyr
oidi
sm
o CKD
o Nephr
oti
csy
ndr
ome
o Al
cohol
i
sm
o DM
o St
eroi
ds
o OCPs
 St
ati
nther
apycancauser
isei
nli
verenzy
mesandmuscl
epai
n
o Gi
veTEv
ionLCODf
ormuscl
epai
n
Tr
eat
ment I
ndi
cat
ion
Hi
ghi
ntensi
tyst
ati
ns  CVA
  TI
A
Tar
getLDL<70mg/
dL  POAD
 ACS
T.At
orv
a40-
80mgODOR  Aor
ti
caneur
ysm
T.Rosuv
ast
ati
n20-
40mgOD  LDL>90mg/
dl

Moder
atei
ntensi
tyst
ati
ns  LDL – 70-
190 mg/
dl +
Diabet
es

Tar
getLDL<100mg/
dL  LDL–70-
190mg/
dl+HTN

T.At
orv
a20-
40mgODOR
T.Rosuv
ast
ati
n10-
20mgOD
Recheckaf
ter6weeks
I
finadequat
eresponse
 Changest
ati
nOR
 AddEzet
imi
be10mgOD(
Ezent
ia/
Ezedoc)OR
 AddPCSK9i
nhi
bit
ors(
notav
ail
abl
eatt
het
imeofwr
it
ing)
o Al
i
rocumab,
Evol
ocumab
I
ndi
cat
ionsf
ort
reat
ingHy
per
tri
gly
cedemi
a
 TG>500mg/
dl
 ACS
 Pancr
eat
it
is

St
ati
nsorf
enof
ibr
atesar
egi
ven
 CLi
picar
d200mgOD
 HYPERURI
CEMI
A
Commoncauses
 CKD  Puri
ne ri
ch diet – meat,
seaf
ood, dr i
ed peas,
 Al
cohol
mushroom et
c
 Hy
pot
hyr
oidi
sm
 Obesi
ty

Tr
eat
ment
 TAl
l
opur
inol
(Al
ori
c/Al
ri
k/Ci
plor
ic)
o St
artat100mgOD
o Ti
tr
ateweekl
ytomaxi
mum of300mgdai
l
y
 TFebuxost
at(
Febuci
p/Febur
ic)
o 40–80mgOD
 TCol
chi
cine(
forpr
ophy
laxi
s)
o 0.
5to1mgperday
o Maycausedi
arr
hea
STEROI
DTAPERI
NG
Ifster
oids ar
et aper
ed too qui ckl
y,withdr
awalsy mptoms can
occur,suchasjoi
ntpain,f
atigue,dizzi
ness,musclepai
n,vomit
ing,
short
nessofbr eat
h,faint
ing,headaches,low bloodsugar,f
ever,
nauseaet c
t
aper
ingi
snotnecessar
yinshor
tter
mther
apy(
14day
sorl
ess)
 Gradualwi
thdr
awalofsy
stemi
ccor
ti
cost
eroi
dsi
sadv
isabl
ein
pati
ents
o Recei
vedmor
ethan2weekst
reat
ment
o Hi
stor
yofadr
enal
suppr
essi
on
o Repeat
edcour
sesofst
eroi
ds
 o Recei
veddosesatni
ght
o Recei
ved Pr
edni
sol
one >40mg dail
y or equi
val
ent (
e.g.
dexamet
hasone6mg)f
oranylengt
hofti
me
Pr
edni
sol
onet
aper
ing
 Adecr
easei
ndosei
susual
l
ymadeev
ery3day
s
 Reducedoseby2.5-t
o5.0-
mgdecrementsev
ery3–7daysunti
l
physi
ologi
cdose(
5to7.5mgofpr
edni
sol
oneperday
)isr
eached.
Dexamet
hasonet
aper
ing
 Reduct
ioni
ndoseof2-
4mgev
ery3day
s

HYPOTHYROI
DISM
Cl
i
nicalf
eat
ures
 Col
dint
oler
ance  Hoar
seness Car
pal t
unnel
sy
ndrome
 Fat
igue
 Deaf
ness
 Poormemor
y
 Hy
pov
ent
il
ati
on
 Const
ipat
ion
 Per
icardi
al or pl
eur
al
 Menor
rhagi
a
ef
fusions
 My
algi
as

Di
agnosi
s
 El
evat
edTSH+l
owFT4l
evel
 Subcl
i
nical
hypot
hyr
oidi
sm
o FT4–nor
mal
+el
evat
edTSH
o DoAnt
i-
TPOant
ibody
Tr
eat
ment
I
ndi
cat
ionsf
ort
reat
ment
 o TSH>10
o TSH5-
10i
f
 Sy
mpt
omat
ic
 TPO+
 Goi
tr
e
 Car
diacdi
sease
 Pl
anni
ngf
orpr
egnancy
o Subcl
i
nical
hypot
hyr
oidi
sm
 TPO+v
e
 Goi
tr
e
 TSH>6
 Car
diacdi
sease
 Sy
mpt
omat
ic
 Thy
roxi
nei
sthedr
ugofchoi
cet
aken30mi
nbef
orebr
eakf
ast
St
art
ingdoseoft
hyr
oxi
ne
Replacementdose in a pat
ient 1.
6100μg/
kg/
day
posttotal
thy
roi
dect
omy

Age<60y
rs+nocar
diacdi
sease 100μg/
day
Age>60y
rs 50μg/
d
Car
diacdi
sease 25μg/
d

Fol
l
ow-
up
 Goal
–TSHi
nlowerhal
fofr
efer
encer
ange
 TSHshoul
dbemeasur
ed6t
o8weeksaf
teri
nit
iat
ionoft
her
apy
 Thedoseofthyroxineshoul
dthenbeadjustedin12-t
o25-μg
i
ncrement
sati
ntervalsof6to8weeksunt
ilTSHisnor
mal.
  Thereaf
ter
,annualTSH measur
ementi
s adequat
eto moni
tor
ther
apy.
 Pr
egnancy
o Requi
resupt
o50%hi
gherdose
o Tar
getTSH
 <2.
5in1stt
ri
mest
er
n2ndand3rdt
 <3i ri
mest
er
SENSORYDI
STURBANCES
Pins& needl
es,pri
cking,bandli
ke,l
ight
ningpain,kni
feli
ke,twi
sti
ng,
pull
i
ng,
tight
ening,
burning,
achi
ng,numbness,ot
herrawsensat
ions
 TCar
bamazepi
ne200mg1-
1-1(
Tegr
it
al,
Epi
l
ep,
Zen,
Mazet
ol)
 TAmi
tr
ypt
il
li
ne10mgHS(
Ami
tr
yn)
 TDul
oxet
ine30mg(
Dul
ane)0-
0-1or
 CMaxgal
i
n(Pr
egabal
i
n)75/
150mgOD
 CGabant
in(
gabapent
in)300mgod
 C Maxgal
in-
M/Pr
egast
ar M (
pregabali
n + met hyl
cobal
ami
n),
GabamaxGol
d/Pr
egast
arPl
us(
Bcompl ex,pr
egabal
in)
 TNur
oki
nd-
G(Mecobal
ami
n+Gabapent
in)
 TBCorNeur
obi
onef
ort
eorot
hermul
tiv
itami
nswi
thVi
tB12
 TBenal
gis(
Benf
oti
ami
ne)100mg1-
1-1
Benal
giscanbegivenf
orsci
ati
ca,
diabet
icneur
opat
hyandot
herpai
nful
ner
vecondit
ions.
BELL’
SPALSY
Al
way
sdoCTheadt
or/
oCVAandi
nspecteart
or/
oASOM.
Tr
eat
ment
 Pr
edni
sol
one
o 60-
80mgODf
or5day
s
 o Taperov
ernext5day
s
 Acy
clov
ir–400mgf
ivet
imesdai
l
yfor10day
s
 Justt
earey
edr
ops1dr
opQ2Hont
heaf
fect
edey
e
 Chl
orampheni
coloi
ntmentwi
thpaddi
ngoft
heaf
fect
edey
eat
ni
ght
I
fnoi
mpr
ovementaf
ter10day
sref
erf
orsur
gical
decompr
essi
on.
MI
GRAI
NE
 Thr
obbing/pul
sati
ngunilat
eralheadachelast
ing4-72hour
swi
th
aur
a,nausea,vomit
ing,
photophobiaandphonophobi
a.
Tr
eat
ment–Acut
eat
tack
NSAI
DS Par
acet
amol
500/
650mg
Napr
oxen500mg
I
njDi
clof
enac50mgI
M ATD
I
njKet
orol
ac25mgI
M ATD
Tr
ipt
ans T Headset (
Sumat
ri
ptan +
Napr
oxen)
Vasograi
n (PCM + Caff
eine +
Prochl
orper
azi
ne+Er
got
amine)
Ant
i-
emet
ics I
njPer
inorm(
Met
ocl
opr
ami
de)10
mgIM st
at
I
nj.St
emet
il1ampI
M st
atATD
Lastr
esor
t I
nj.Tr
amadol
50mgI
M OR
I
nj.Dexona8mgI
V

Pr
ophy
laxi
s
 Forpat
ient
shav
e>3at
tackspermont
h
 T.Fl
unar
izi
ne10mgHS[
T.si
bel
i
um/
Fine/
Flugr
aine]OR
 T.I
nder
al20mg1-
0-1[
Propr
anol
ol]OR
 TSodi
um v
alpr
oat
e200mg0-
0-1
 TAmi
tr
ipt
yli
ne10/
25mgHS
 Cont
inuef
or3mont
hs
I
fat
tacksar
econt
rol
taperandst
op
CARI
ESTOOTH
 Anal
gesi
cs-
>Br
ufen
 Ant
ibi
oti
cs-Amoxi
cil
l
in,
Met
roni
dazol
e
 Dent
alconsul
tat
ion
GUM ABSCESS
 Ant
ibi
oti
cs-Amoxi
cil
l
in,
Met
roni
dazol
e
 Anal
gesi
cs+Vi
tC
 War
m sal
i
negar
gle
 Ref
ert
odent
istf
orI&D
GI
NGI
VITI
S
 Cl
ohexPl
usor
alr
inse(
chl
orhexi
dine)
 Vi
tC
 Ant
ibi
oti
cs
 Anal
gesi
cs
HALI
TOSI
S
Commoncauses
 Gi
ngi
vi
ti
s  Ur
emi
a
 Pooror
alHy
giene  DKA
 Smoki
ng  Br
onchi
ect
asi
s
 Dr
ymout
h  Lungabscess
 Car
iesToot
h  At
rophi
crhi
nit
is
  Hepat
icf
ail
ure  Al
cohol

 Met
rogy
lDGgel
[chl
orhexi
dinegl
uconat
e,met
roni
dazol
e]OR
 Hexi
dinemout
hwashOR
 Bet
adi
neMout
hGar
gle
 TMet
rogy
l400mg1-
1-1maybegi
venf
orsev
erecases.
 Mai
ntai
npr
operor
alhy
giene
 Tonguecl
eani
ngt
wicedai
l
y
 Hol
ding2cur
ryl
eav
esi
nthemout
hfor5-
7mi
nut
esdecr
easesbad
br
eath
APHTHOUSULCERS
 Vi
tB12+Vi
tC+Ant
ioxi
dant
s
 Adequat
ehy
drat
ion
 Dol
ogel
forpai
norDol
ogesi
cgel
(hasLi
gnocai
ne)
 Dent
ogel
(li
gnocai
ne+chol
i
nesal
i
cyl
ate)
 LexanoxQI
D(Aml
exanox,
ant
i-
inf
lammat
ory
)
 Chl
orhexi
dinemout
hwash/bet
adi
nemout
hwash
 Kenacor
t/or
away
s/Tessor
alpast
eforLA(
tri
amci
nol
one)
 Sy
pSucr
alf
ate10mLPOswi
shandspi
t/
swal
l
owQI
D
Bi
opsyoft
heul
cermaybeneeded,
ifi
tdoesn’
theal
.
I
ncasesofher
pet
icgi
ngi
vost
omat
it
is:
 Rx-
>gi
venasabov
e+
 T.Acy
clov
ir400mg4t
imesdai
l
yx5day
s
ORALCANDI
DIASI
S(ORALTHRUSH)
 Candi
dmout
hpai
nt[
clot
ri
mazol
e]
 Chl
orhexi
dineor
alr
inse
 Vi
tC
DRYMOUTH(
XEROSTOMI
A)
Commoncauses
 Ant
i-
hist
ami
nes I
ll
-f
it
ti
ngdent
ures
 Cl
oni
dine  Fungal
inf
ect
ionofmout
h
 Met
hyl
dopa  Dehy
drat
ion
 TCA  Radi
other
apy
 Ant
i-
par
kinsoni
andr
ugs  HI
Vinf
ect
ion
 Br
onchodi
l
ator
s  DM wi
thpol
yur
ia

 Tr
eat
mentofunder
lyi
ngcause
 Sugarf
reechewi
nggum
 Av
oidsal
ty/
dryf
oods/
alcohol
/caf
fei
neet
c
 E-sal
i
v aoralspray3to4t i
mes(Nacarboxymethy
lcel
l
ulose,
sorbi
tol
,KCl,NaCl,
Mgcl
2,CaCl2,
Kdi
hydr
ogenPO4)
OPTHALMOLOGY
 Whateverbet heophthal
micsol
uti
on,notmor ethanadropneeds
tobei nstil
l
edi nt
ot heconj
uncti
valsacatat i
mebecauset he
conj
unct i
valsachol dsonly10-
15mi cr
oli
ter
soff lui
datati
me&
theaveragev olumeofonedropis60mi cr
oli
ter
.
 Onl
ythefr
equencyofinst
il
lat
ionneedst
obeadj
ust
eddependi
ng
ont
hecli
nical
condi
ti
on.
I
faneyedrop&aney eointmenthastobeinst
il
ledatt
hesame
t
ime,
inst
il
lthedr
opf
ir
stf
ollowedbyoint
ment
.

CONJUNCTI
VITI
S
Bact
eri
al Vi
ral
 Conj
unct
ival congest
ion  Conj
unct
ival
congest
ion
 wi
thmat
ti
ngofl
ashes  Wat
erydi
schar
ge
 Mucopur
ulentdi
schar
ge  Gr
it
tysensat
ion
 Gr
it
tysensat
ion
 Nor
mal
pupi
l

Tr
eat
ment
 Moxi
fl
ox/
Gat
il
oxey
edr
ops1dr
opQ1H-
Q4Haspersev
eri
ty
 Fr
equentWashi
ng
 Dar
kgl
asses,
ifphot
ophobi
a
 Nev
erpad&bandage
 Toci
n( tobr
amy ci
n)eyeoi
ntatni
ghtt
o pr
eventgl
uei
ng oft
he
eyel
ashesinthemorni
ng
I
fsev
ere-
>Ant
ihi
stami
nes,
Anal
gesi
cs,
Ant
ibi
oti
cs[
Oral
]e.
gCi
plox
Not
e:nor
olef
orpr
ophy
lact
ict
opi
calant
ibi
oti
csi
nunaf
fect
edey
e.
I
nchi
l
drengi
vet
obr
amy
cine/
d
SCLERI
TIS
 Sy
stemi
cther
apyi
sal
way
srequi
red
 Or
alNSAI
Dsl
i
kei
ndomet
haci
n(100mgOD)
 St
eroi
d+Ant
ibi
oti
cse/
d
o Bet
nesol
-N[bet
amet
hasone sodi
um phosphat
e,neomy
cin
sul
phat
e]e/
d
o Toba-
DM [
dex
amet
hasone,
tobr
amy
cin]e/
d
o Micr
ofl
ox-
DX [
cipr
ofl
oxaci
n hy
drochl
ori
de,dexamet
hasone]
e/
d
SUPERFI
CIALPUNCTUATEKERATI
TIS
Mai
nlyduet
ovi
ral
inf
ect
ions,
sogi
veAcy
clov
ir.
 Aci
vi
rorZov
iraxorHer
per
exey
edr
ops1dr
opQ4H
  Topi
cal
ster
oids
 Tobramyci
n[ ey
ebrex
,toba,
toci
n]or moxi
fl
ox (
mil
fl
ox) e/
dto
prev
ent20inf
ecti
on.
 Ar
ti
fi
ci
alt
ear
sli
keRef
reshey
edr
ops.
CORNEALULCER
Cl
i
nicalf
eat
ures
 Redness,pai
n,wat
eri
ng,phot
ophobi
a,r
edness,f
orei
gn body
sensat
ion
 Al
way
srul
eoutDM
Tr
eat
ment
 Pad&bandage
 Hotf
oment
ati
on
 Dar
kgoggl
es
 Moxi
fl
ox/
Cipl
ox/Tobr
aey
edr
ops
 Vi
tC
 Anal
gesi
cs&ant
ii
nfl
ammat
orydr
ugs
 1%at
ropi
neor2%homat
ropi
nee/
dTDSt
orel
i
eveci
l
iar
yspasm
I
fthecornealulceri
snotrespondingtoabovetreatmentintwoday s’
t
imeortheulcerismorethanonemm si zeatthet i
meofpr esent
ati
on
f
ort
if
iedanti
biot
iceyedr
ops(cefazoli
n&gent
amy ci
n)shouldbegiven.
For
ti
fi
edCef
azol
i
ne(
Ref
li
n)e/
d1dr
opQ1H-
Q2H
I
ti sprepar
ed byadding 5-
10 ccdi
stil
led wat
eri nt
o avi
alof
i
nject
ioncef
azol
ine500mgt ogetast
rengthof50-100mg/ml
 Thesolut
ionshouldbekepti
nr ef
ri
gerat
or&every3rddayf
resh
e/dshoul
dbepr epar
edascefazoli
neisnotstabl
einaqueous
sol
uti
on.
For
ti
fi
edgent
ami
ci
n(13.
6mg/
ml)e/
dQ1H-
Q2H
 Pr
epar
edbyr
econst
it
uti
nggent
ami
cin(
0.3%)e/dwi
thgent
ami
cin
 (
40mg/
ml)i
nject
ion.
I
nject2mLofgentamyci
n,40mg/mL,di
rect
lyi
ntoa5-
mLbot
tl
eof
gentamy
cin0.
3%,opht
halmicsol
uti
on
Neverprescri
besteroi
dey edropsifcor
nealul
ceri
ssuspect
ed,asi
t
wil
lleadtorapi
dcornealper
for
ation.
 Ref
ert
oopht
hal
mol
ogi
st

FUNGALCORNEALULCER
Cl
i
nicalf
eat
ure
 Pain,water
ing,phot
ophobi
a,bl
urr
edv
isi
on,r
ednessofey
e&FB
sensati
on
Tr
eat
ment
 Nat
amy cin(5%)e/
d(Nat
amet
)hour
lydur
ing dayt
ime & Q2H
dur
ingnight
OR
Ket
oconazol
e ey
e dr
ops (
Phy
tor
al)orVor
iconazol
e e/
d x 6-
8
weeks
 At
ropi
nee/
dTDS
 T.Fl
ucan/Sy
scan150mgOD[
Fluconazol
e]x2weeks
 Anal
gesi
cs
 Vi
tami
ns
 Hotf
oment
ati
on
 Dar
kgoggl
es(
forphot
ophobi
a)
 Ref
ert
oopht
hal
mol
ogi
st
SI
MPLEALLERGI
CCONJUNCTI
VITI
S
  Ant
ihi
stami
nes,
NSAI
Dsandcol
dcompr
ess
 Wi
nol
ap/
Opt
ihi
stpat(
olopat
adi
ne)0.
1%e/
d1dr
opTDS
 Dexamet
hasonee/
d0.
05%QI
D(Sol
odex-
J,Low-
Dex)
Ster
oide/dshoul
dbeusedonl
yinsev
ere&non-
responsi
vecases&f
or
shortdur
ati
on.
HORDEOLUM I
NTERNUM,
EXTERNUM,
CHALAZI
ON
I
tisanacut
efocal
inf
ect
ion(
usual
l
yst
aphy
lococcal
)inv
olv
ingei
thert
he
 Gl
andsofZei
s(ext
ernal
hor
deol
um,
orst
yes)
 Mei
bomi
angl
ands(
int
ernal
hor
deol
a)
Mosthor
deol
aev
ent
ual
l
ypoi
nt&dr
ainbyt
hemsel
ves.
Tr
eat
ment
 Ant
ibi
oti
cey
eOi
nt/
drops[
moxi
fl
ox/
tobr
a]t
obeappl
i
edt
oaf
fect
ed
l
idmargi
n
 P’
mol
/br
ufen
 Hotspongi
ng
 Or
alant
ibi
oti
csi
fsev
ere;
Amoxy
clav
/Ci
plox
BLEPHARI
TIS
Inf
lammat or
yd/
sofey
eli
dusual
l
ychr
oni
c&i
nvol
vest
hepar
twher
ethe
eyelashesgr
ow.
Tr
eat
ment
 St
eroi
d+ant
ibi
oti
cey
eoi
ntappl
i
cat
ionatl
i
dmar
ginBD f
or2
weeks
o Ci
plox+dex
amet
hasone(
Cipl
ox-
D)
o Tobr
amy
cin+dexa(
Tobar
en-
D)
 Ant
ibi
oti
ce/
d
 Or
alant
ibi
oti
cs
 Tr
eatscal
pdandr
uff
 CORNEALABRASI
ON
Cl
i
nicalf
eat
ures
 Pai
n,wat
eri
ngofey
es,
phot
ophobi
a
Tr
eat
ment
 Washwi
thNSi
fFB’
sar
epr
esent
Inst
il
lHomat
ropi
neey
edr
ops(
T.NHomi
de)f
oll
owedbyant
ibi
oti
c
eyeoint
ment
 Pad&Bandage
I
nst
il
lant
ibi
oti
cey
edr
opseg.Moxi
fl
oxQ4Hathome
 Ref
ert
oopht
hal
mol
ogi
st
A/
CDACROCYSTI
TIS
 Br
oadspect
rum ant
ibi
oti
csl
i
keci
plox
 Anal
gesi
cs
 Local
hotcompr
ess3-
4ti
mesaday
 I&Di
fabscesspoi
nts
FOREI
GNBODYEYE
 Commonl
yseenont
hecor
nea.
Ifpati
enthasFBsensati
on&FBcan’tbel
ocal
i
zed,
ever
ttheupper
eyeli
dtor/ouppert
arsal
conj
unct
ival
FB.
 Copi
ousirr
igat
ionshoul
dbedonewi
th1pi
ntnor
malsal
i
nei
ncase
ofmult
ipl
eFBint hecul
desac.
Remov al done under sl
i
tlamp exami
nat
ion wi
th st
ri
ct asept
ic
precauti
ons.
 Anaest
hetizethe conj
unct
ivalsac wit
h 0.
5 % pr opar
acai
ne
(pr
efer
red)or4%Xyl
ocai
netwiceat5minut
esi
nter
val
.
 Ey
eli
dsar
esepar
atedwi
thspecul
um orusi
ngt
humb&i
ndexf
inger
.
 Remov
ethecor
neal
FBwi
tha23G/25G/
26Gneedl
e.
  Whil
eremov i
ngtheFB,theneedleshoul
dbehel dpar
all
elt
othe
cor
nealsur
facet
opreventacci
dent
alpenet
rat
ion.
 Af
terr
emov al
,insti
lladr
opofhomat
ropi
ne,appl
yant
ibi
oti
cey
e
dr
ops/
oint
ment, pad&bandage.
Ref
ert
oopht
hal
mol
ogi
st.
BLUNTI
NJURYTOEYEBALL
 Formil
di nj
uri
est
opi
calcy
cloplegi
cs.Eg:
-Homat
ropi
nee/
dBD&
topi
cal
steroi
dsQI
Dwouldsuff
ice
I
fIOPi
srai
sed,
TAcet
azol
ami
de250mgTDSi
sal
sogi
ven
 Theey
eispat
chedt
opr
otectt
heey
efr
om f
urt
hert
rauma
I
npenet
rat
ingi
njur
ies,
woundhast
ober
epai
redunderLA/
GA.
 Gent
lypadt
heey
ewi
thouti
nst
il
li
nganye/
doroi
ntment
 Broadspect
rum par
ent
eralant
ibi
oti
csshoul
dbest
art
edeg.Ci
plox,
genta
Ref
ert
oopht
hal
mol
ogi
st.
A/
CCONGESTI
VEGLAUCOMA
I
tisanopht
hal
micemer
gency
Cl
i
nicalf
eat
ures
 Pai
nint
heaf
fect
edey
e  Tenderstony har
d ey
e on
pal
pati
on
 Headache
 Shal
l
owAC
 Vomi
ti
ng
 Mid-
dil
ated vert
ical
l
y ov
al
 Congest
edey
e
non-
reacti
ngpupi
l
 Haz
ycor
nea

I
OPmustbel
ower
edi
mmedi
atel
y.
I
VManni
tol
20%,
200ml
in20mi
nut
es
 TDi
amox(
acet
azol
ami
de)250mgTDS
  Dexamet
hasonee/
dQ4Ht
otackl
euv
eit
is
 Ti
mol
ole/
d0.
5%BD
Ref
ert
oopht
hal
mol
ogy
.
A/
CIRI
DOCYCLI
TIS
Cl
i
nicalf
eat
ures
 Acut
eredey
e  Ci
rcumcor
neal
congest
ion
 Moder
atet
osev
erepai
n  Smal
l sl uggi
shl
y act
ing
i
rr
egul
arpupil
 Wat
eri
ng
 Ci
l
iar
ytender
ness
 Phot
ophobi
a
 Def
ect
ivev
isi
on

 At
ropi
nee/
dTDS
 Predni
sol
oneacetat
ee/dQ2H-Q4H dependi
ngonsev
eri
tyt
obe
taper
edoveraper
iodof4-
6weeks
 Dar
kgoggl
es
I
RRI
TABLEBOWELSYNDROME
Cl
i
nicalf
eat
ures
 Recur
rentabdomi
nal
pai
na/
wdef
ecat
ion
 Changei
nconsi
stencyofst
ool
s
 Changei
nfr
equencyofst
ool
s
 Alter
nat
ingepi
sodesofdiar
rhea&const
ipat
ion,mucusi
nst
ool
s,
feeli
ngofi
ncomplet
edef
ecati
on
 Nof
ever
/bl
oodi
nst
ool
s/ni
ghtsy
mpt
oms/
wei
ghtl
oss
Alwaysr ul
eoutpat
hol
ogi
calcondi
ti
onsbydoi
ngUGIendoscopyand
colonoscopy.
Tr
eat
ment–I
BS–Di
arr
hea
 Di
et:
avoi
dexcesst
ea,
cof
fee,
fri
edf
oodet
c.
  Expl
aint
henat
ureoft
hei
l
lnesst
ost
ressf
ulsi
tuat
ions.
 T Normaxin 1-1-
1 or 1-
0-1 (
chl
ordi
azepoxi
de + cl
i
dini
um
br
omide+di
cycl
omine)
 CEconor
m(sacchar
omy
cesBoul
ardi
i
)2501-
0-1
 TLopr
ami
de2mg0-
0-1
I
BS-
C
 Fr
uit
sandv
eget
abl
eswi
thadequat
ewat
eri
ntake
 Sy
pSor
bil
i
ne20ml
BD/
TDS(
Tri
chol
i
cci
tr
ate+Sor
bit
ol)
 Sy
pLact
ulose20ml
BD/
TDS
Medi
cine/
Gast
roent
erol
ogyconsul
tat
ion
LI
VERABSCESS
Cl
i
nicalf
eat
ures
 Fev
erwi
thchi
l
lsandr
igor I
nter
cost
alt
ender
ness
 Jaundi
ce  Dr
ycough
 Tenderhepat
omegal
y  Pai
nint
her
ightshoul
der
 CBC
 LFT
I
nvest
igat
ions  Bl
oodC/
S
 St
ool
R/Ef
oramoebi
asi
s
 USGabdomen
 CXR

Forpy
ogeni
cli
verabscess
I
njCef
tri
axone/
Cef
otaxi
me±gent
amy
cinf
or2weeks
Foramoebi
cli
verabscess/
Amoebi
asi
s:
I
njMet
rogy
l750mgi
vQ8Hx7-
10day
sPLUS
  TFur
ami
de(
Dil
oxani
de)5001-
1-1x10day
s(Lumi
nal
agent
)
Needl
easpi
rati
onf
orl
argeabscessori
fther
esponset
ochemot
her
apy
i
snotprompt.
SCRUBTYPHUS
Cl
i
nicalf
eat
ures
 Hi
ghgr
adecont
inuousf
ever
 HSM &l
ymphadenopat
hy
 Eschari
nahi
ddenwetar
eaoft
hebody
.
I
nvest
igat
ions
I
gM Scr
ubt
yphus
Tr
eat
ment
 CDoxy
cycl
i
ne100mgBDx7-
14day
sOR
 TAzi
thr
omy
cin500mgODf
or3day
s
RHEUMATOI
DARTHRI
TIS
Cl
i
nicalf
eat
ures
 Joi
ntpai
n–smal
lj
oint
s>l
argej
oint
s
 Ear
lymor
ningst
if
fness(
>30mi
n)
 Joi
ntswel
l
ingandt
ender
ness
 Rheumat
oidnodul
es
 Def
ormi
ti
es
I
nvest
igat
ions
 El
evat
edESR,
CRP
 RF+v
e
 Ant
iCCPant
ibody+v
e
Tr
eat
ment
 Educat
ion,Exer
cise,Di
et (
li
pidl
ower
ing di
et,f
ibr
eri
ch)
and
 phy
siot
her
apy
.
 NSAI
Ds
oI
ndomet
haci
n25/
50mg1-
1-1
o Lor
nox
icam 4-
8mg1-
0-1
o Et
ori
cox
ib90-120mgOD
o Napr
oxen250/
500mgBD
 Nor
olef
orl
ongt
erm st
eroi
duse
Ref
ert
ophy
sici
an/
rheumat
ologi
stt
ost
artDMARDs
SUSPECTEDDENGUE
Cl
i
nicalf
eat
ures
 Fev
er  Conj
unct
ival
congest
ion
 Headache  Rash
 Gast
roent
eri
ti
s Mucosal
bleedi
ng

 My
algi
a
 CBC
 PCV
I
nvest
igat
ions  NS1ant
igen+v
e–day4
I
gM +v
e–day6
nd
I
gG+v
e–2 week

Not
e:-Plat
eletcountwi l
lfal
lwit
hin24-
48hour
saf
terf
eversubsi
des.
Thi
sist
hemostcr it
icalperi
od.
Tr
eat
ment
 Tempchar
t,I
/Ochar
t,Pl
atel
etcountchar
t,RFT,
PCVchar
t
 TP’
mol
650mgSOS
 Av
oidI
Minj
ect
ions
  Adequat
ewat
eri
ntake2-
3L/
day
 TAzee500mgODi
fsuspect
edRTI
Ifpl
atel
etcount<50,000orfal
lby>50%wi
thi
n24hour
sref
ert
ohi
gher
cent
erwithbloodbankfaci
l
ity.
SUSPECTEDMENI
NGI
TIS
Cl
i
nicalf
eat
ures
 Fev
er  Cr
ani
alner
vedef
ici
ts
 Vomi
ti
ng  Neckst
if
fness
 Headache  Ker
nig’
s/br
udzi
nski
’
ssi
gn
 Sei
zur
es  Ext
ensorpl
ant
arr
esponse
 Al
ter
edsensor
ium
 CBC
 PCV
I
nvest
igat
ions  NS1ant
igen+v
e–day4
I
gM +v
e–day6
I e–2ndweek
gG+v

Tr
eat
ment
 Ant
i-
pyr
eti
cs
st
InjDexamet
hasone 10 mg I
V st
at20 mi
n bef
ore1 dose of
anti
biot
ic
I
nj.Cef
tri
axone2gI
Vst
atATDorI
nj.Taxi
m 2gI
Vst
ataf
terATD
I
VF–NS
I
njLor
a/Pheny
toi
nifsei
zur
e
 Ry
le’
stube/
cat
het
her
 Ot
hersuppor
ti
vemeasur
e
Ref
ert
ohi
ghercent
ref
orCTbr
ainandLumbarpunct
ure.
ENTERI
CFEVER
Cl
i
nicalf
eat
ures
 Fev
er  Abdomi
nal
pai
n
 Headache  Const
ipat
ion f
oll
owed by
di
arr
hea
 Dr
ycoat
edt
ongue
 Bl
oodi
nst
ool
s
 HSM
 CBC – l eukopeni
a wi
th
rel
ati
vel
ymphocyt
osi
s

I
nvest
igat
ions  Wi
dal
test
 O>1/
160
 H>1/
320
 Bl
oodC/
S

Tr
eat
ment
I
njCef
tri
axone2gI
VODx10-
14day
sOR
I
nj.Of
loxaci
n400mgI
VBDx5-
7day
sOR
 TAzi
thr
omy
cin500mg1-
0-1x5day
sOR
 TCef
ixi
me400mg1-
0-1x14day
s
 Suppor
ti
vecar
e
Ref
eri
fbl
oodi
nst
ool
soral
ter
edsensor
ium ori
nshock.
TETANUS
Cl
i
nicalf
eat
ures
 Tr
ismus
 Toni
cspasms
 Opi
sthot
onus
  Hi
stor
yofi
njur
y/wound
Tr
eat
ment
 Wounddebr
idement
I
njMet
roni
dazol
e500mgI
VQ6-
8hr
lyx7-
10day
s
 Keepi
naqui
et,
dar
kroom wi
thmi
nimal
handl
i
ng
 O2i
nhal
ati
onSOS
I
njTel
glob5000I
UIM atdel
toi
dorant
erol
ater
alaspectoft
high
o Eachv
ial
cont
ains250I
U.So20v
ial
sar
erequi
red.
I
njDi
azepam 10-
30mgI
VQ4Hormor
efr
equent
lyasneeded
I
njTT3dosesat
least2weeksapar
t
o Gi
venatasi
tef
arawayf
rom t
etanusI
g
 Suppor
ti
vecar
e–I
VF,
RTF,
car
eofbl
adder
Ref
eri
f
 Needf
ormechani
cal
vent
il
ati
on
 Sedati
on al
one i
s notsuf
fi
cient– pat
ientmay need muscl
e
rel
axants
 Aut
onomi
cdy
sfunct
ion–ar
rhy
thmi
as/
shock
I
NFECTI
VEENDOCARDI
TISPROPHYLAXI
S
I
ndi
cat
ions
 Pr
ost
het
ichear
tval
ves
 Pr
iorendocar
dit
is
 Unrepai
redcyanoti
ccongeni
talhear
tdi
sease,i
ncl
udi
ngpal
l
iat
ive
shuntsorcondui
ts
 Complet
elyrepai
redcongeni
talhear
tdef
ect
sdur
ingt
he6mont
hs
af
terr
epair
I
ncomplet
elyrepair
ed congeni
talheartdi
sease wi
thr
esi
dual
def
ect
sadjacentt
opr ost
het
icmater
ial
  Val
vul
opat
hydev
elopi
ngaf
tercar
diact
ranspl
ant
ati
on
Pr
ocedur
esf
orwhi
chpr
ophy
ll
axi
sisr
ecommended
 Alldent
alproceduresthatinvol
vemani
pul
ati
onofgi
ngi
valt
issue
ortheperi
api
calregionofteet
horper
for
ati
onoft
heor
almucosa
 Respi
rat
oryt
ract
oI
nvasive pr
ocedures oft he respi
rator
yt r
actthatinvol
ve
i
nci
sion orbi opsy oft he respir
atory mucosa,such as
t
onsil
lect
omyoradenoi dectomy
o Rout
ineprophyl
axisforbr
onchoscopyi
snotrecommended
unl
esstheprocedur
einvol
vesi
ncisi
onofther
espi
rat
oryt
ract
mucosa
 Sur
gicalprocedur
est hati
nvol
vei
nfect
edski
n,ski
nst
ruct
ure,or
musculoskel
etalt
issue
Pr
ophy
ll
act
icr
egi
mens
STANDARDORALREGI
MEN
 Amoxi
ci
ll
i
n:2gPO1hbef
orepr
ocedur
e
I
NABI
LITYTOTAKEORALMEDI
CATI
ON
 Ampi
cil
l
in:
2gI
VorI
M wi
thi
n1hbef
orepr
ocedur
e
PENI
CILLI
NALLERGY
 Cl
ari
thr
omy
cinorazi
thr
omy
cin:
500mgPO1hbef
orepr
ocedur
e
 Cephal
exi
n:2gPO1hbef
orepr
ocedur
e
 Cl
i
ndamy
cin:
600mgPO1hbef
orepr
ocedur
e
PENI
CILLI
NALLERGYUNABLETOTAKEORALLY
 Cef
azol
i
ncorcef
tri
axone:
1gI
VorI
M 30mi
nbef
orepr
ocedur
e
 Cl
i
ndamy
cin:
600mgI
VorI
M 1hbef
orepr
ocedur
e

Pr
ophyl
act
icant
ibi
oti
csf
orI Eprevent
ionshouldbeadmini
ster
edina
si
ngl
edosebeforetheprocedur
e.Ift hedosagei
sinadver
tent
lynot
administ
eredbef
oret
hepr
ocedur
e,i
tmaybegi
venupt
o2hour
saf
ter
theprocedur
e

TBPROPHYLAXI
S
I
n<6y
ear
s->TI
NH10mg/
kgODX6mont
hs.
I
nadul
ts,
ther
eisnopr
ovenbenef
itf
orpr
ophy
laxi
s.

UPPERGIBLEED
Commoncauses
 Pept
icul
cer
 Var
iceal
bleedi
ng
 Vascul
armal
for
mat
ionsofst
omach
 Cast
omach
Tr
eat
ment
 Est
abl
i
sh2l
argebor
eIVl
i
nes
 NPO
 RTaspi
rat
ion
I
njPant
op80mgI
Vst
att
hen8mg/
hrI
Vinf
usi
on
I
njTr
anexami
caci
d500mgI
Vst
at
I
fHb<7g/
dl–gi
vePRBCt
ransf
usi
on
 Forv
ari
ceal
bleed
oI
njOctreot
ide 50 mi
crogr
am I
V st
at and t
hen 25-
50
micr
og/
hrOR
oI
njSomatost
ati
n250μgasabol
usf
oll
owedbyani
nfusi
onof
250μg/
hrOR
oI
njTel
ri
pressi
n2mgI
V4-
6hr
ly
I
njVi
tK10mgI
M/I
V
 I
njCef
tri
axone1gI
VOD
Ref
ert
hepat
ientf
orUGIendoscopy
.
HEPATI
CENCEPHALOPATHY
Fact
orswor
seni
ngHE
 Ur
aemi
a  Hy
ponat
remi
a
 Sedati
ves, Hy pnot
ics or I
nfect
ions
Anti
depressant
s
 Const
ipat
ion
 GIBl
eedi
ng
 Di
arr
hea
 Excessi
vepr
otei
nint
ake
 Devel
opment of
 Lar
gev
olumepar
acent
esi
s por
tosyst
emi
cshunt
s
 Hy
pokal
emi
a
 CBC
 LFT,
PT/
INR
I
nvest
igat
ions  RFT,
S.el
ect
rol
ytes
 RBS
 USGA/
P
 UGIEndoscopy
 ECG

Tr
eat
ment
I
fassoci
atedUGIbl
eed–t
henmanageaccor
dingl
y.
I
njThi
ami
ne100mgI
VOD–i
fal
cohol
i
c
I
nser
tRy
le’
stube
 Sy
pLact
ulose30ml
BD/
TDS(
ti
tr
atedt
o2-
3sof
tst
ool
s/day
)
 TRi
fagut(
Rfax
imi
ne)550mg1-
0-1
 TNor
fl
ox400mgBDorI
njCef
tri
axone1gI
VODATD
 I
njHepamer
z(L-
orni
thi
neL-
aspar
tat
e)5g(
10ml
)ivBDi
fRFTi
s
nor
mal
 Di
et
o Rest
ri
ctPr
otei
ns–gi
vev
eget
abl
e/di
arypr
otei
ns
o Fl
uidi
ntakeshoul
dbesucht
hatt
hedai
l
ywei
ghtl
ossi
snot
moret
han1kg.
o Car
bohy
drat
eri
chdi
et
 Cor
rectel
ect
rol
yei
mbal
ance
o Hy
pokal
emi
a(K+<3.
5mEq/
L)
I
fS.K+>2. 5giv
eSy pPot
klor(
Pott
asium chl
ori
de)1-
2
meq/kg/dayi
n1gl asswat
er(15ml=20meq=1. 5g)i
f
nor
mal uri
neoutput
.
 Moni
torS.K+ev
ery4hr
.Moni
torECG,
uri
neout
put
.
I
fS.K+<2.
5-gi
veI
VKCl10meq/
l/hri
fur
ineout
puti
s
nor
mal
.
o Hy
pocal
cemi
a
I
njCalci
um gl
uconat
e 10 ml10% sl
ow i
vov
er10
minut
es
o Hy
ponat
remi
a
 Fl
uidr
est
ri
cti
on
Ref
ert
ohi
ghercent
ref
orasci
ti
cfl
uidst
udyandf
urt
hermanagement
.
VI
RALHEPATI
TIS
Cl
i
nicalf
eat
ures
Pr
odrome – 2-
3 weeks pr
iort
o  Jaundi
ce
j
aundi
ce
 Right upper quadr
ant
Fever
,mal ai
se,anor
exi
a,nausea, abdomi
nal
pain
headache
 AST/
ALT>1000I
U/L
I
nvest
igat
ions  Ant
iHepAI
gM
 HbsAgandI
gM ant
iHbs+v
e
 Ant
iHbC
 Ant
iHDV
 Ant
iHEV

Tr
eat
ment
 HepAandE
o Keeppati
enti
nisol
ati
onasi
tist
ransmi
tt
edt
hroughf
eco-
oral
rout
e
o Di
sposewast
efr
om t
hepat
ient
spr
oper
ly
o Washcl
othesandut
ensi
l
sfr
om t
hepat
ientsepar
atel
y
o Pr
operhandwashi
ng
o Onl
yconser
vat
iveRx
o Pr
egnantladi
eswi
thHepEhav
ehi
ghmor
tal
i
ty–Ref
ert
o
hi
ghercent
re
 HepBandD
o Conser
vat
ivet
reat
ment
oI
ndi
cat
ionsf
orant
ivi
ral
ther
apy
I
NR>2
 Acut
eli
verf
ail
ure
 Bi
l
irubi
n>10mg/
dl
o Ref
ert
ohi
ghercent
eri
fant
ivi
ral
ther
apyi
sindi
cat
ed
I
fchr
oni
chepat
it
is–r
efert
ohi
ghercent
erf
orant
ivi
ral
ther
apy
.
Conser
vat
iveRx
 Absol
utebedr
est
,av
oidal
cohol
 Pr
otei
nandf
atr
est
ri
cted,
car
bohy
drat
eri
chdi
et
  C Livosil B 1-0-
1 ( Si
ly
mar i
n, her
b der
ivat
ive used as
hepat
oprot
ect
ive+mult
ivi
tamins)
 TUdihep/
Udi
l
iv/
Ursochol(
Ursodeoxy
chol
i
caci
d/ur
sodi
ol)300mg
1-
0-1
oI
fsuspect
edchol
est
asi
s
I
njVi
tK1ampI
VODx3day
sifcoagul
opat
hyi
ssuspect
ed
 Par
acet
amol
<2g/
day
 Fev
er
ADD/
GASTROENTERI
TIS
Cl
i
nicalf
eat
ures
 Fev
er  Di
arr
hea
 Abdomi
nal
discomf
ort  Vomi
ti
ng
 CBC
 RFT
I
nvest
igat
ions  El
ect
rol
ytes
 St
ool
R/E
 St
ool
C/S

Tr
eat
ment
I
VF–NS/
RL
 Pl
ent
yofor
alf
lui
ds/
ORS
I
njCi
plox200mgI
VBD[
Cipr
ofl
oxaci
n]orTCi
plox500mg
I
njMet
rogy
l500mgi
vQ8H[
Met
roni
dazol
e]orTMet
rogy
l400mg
t
ds
 PPI
I
njCy cl
opam /Buscopan1ampI
M SOS[
dicy
clomi
ne/hy
osci
ne
but
ylbromide]
  TRedot
il100mg1-
1-1[
Racecadot
ri
l]
 CBi
fi
lac/
VIzy
lac1-
0-1
MALARI
A
Cl
i
nicalf
eat
ures
 Highgradef
everwi
thchi
l
ls  Jaundi
ce
andri
gor
 Hepat
ospl
enomegal
y
 Headache
 Conv
ulsi
ons
 Per
ipher
alsmear
 MPI
CT
I
nvest
igat
ions  CBC
 LFT,
RFT
 El
ect
rol
ytes

Tr
eat
ment
Referi
fev
idenceofanyor
gandamage(
AKI
,ARDS,acut
eli
ver
fai
l
ure)
Lookf
orhy
pogl
ycemi
aandt
reatpr
ompt
ly
Fal
cipar
um + abl
e Ar
tesunat
e(4mg/
kg)OD f
or3day
s
tot
akeor al
l
y
+
Sul
fadoxi
ne (
25 mg/kg)
/py r
imet
hami
ne (
1.25
mg/kg)asasingl
edoseonday1

Ar
tesunat
eSPKi
t
Falcipar
um + Art
esunat
e-2.4mg/ kgst
atIVfoll
owedby2. 4
unabl e to take mg/kgat12and24handthendai
lyfor5-
7days
orall
y (
sev
ere
mal ari
a)
Forchi
ldr
enweighi
ng<20kg,giv
e3mg/ kgper
 dose
Mal
ari
ae/
oval
e/v
iva Chl
oroquine(10mgofbase/kgst
atf
oll
owedby
x 5mg/ kgat12,24,
and36h)
Mal
ariae/
ov al
e/vi
va ACT
x– ifchl oroqui
ne
r
esi
stant
Radi
cal treat
ment Chl
oroquine/
ACT
forP.v i
vax orP.
+
oval
einf
ecti
on
Pri
maquine(0.5mgofbase/
kg)ODx14day
s

CheckG6PDl
evel
sbef
orest
art
ingpr
imaqui
ne.
C/
IinG6PDdef
ici
ency
.

I
NFLUENZA/H1N1
Cl
i
nicalf
eat
ures
 Fev
er  My
algi
a
 Sor
ethr
oat  Cough
 Headache  Fat
igue
Tr
eat
ment
 Ant
ipy
ret
ics,
anal
gesi
csandcoughmedi
cat
ions
 TOsel
tami
vi
r75mgBDx5day
s(Tami
fl
u/Fl
uvi
r)
 Pr
ophy
laxi
s
o TOsel
tami
vi
r75mgODx10day
s
PNEUMONI
A
Cl
i
nicalf
eat
ures
 Highgradef
everwi
thchi
l
ls  Dy
spnea
andri
gor
 Hemopt
ysi
s
  Chestpai
n  Anor
exi
a
 Coughwi
thsput
um  Al
ter
edsensor
ium
 CBC
 LFT,
RFT
I
nvest
igat
ions  El
ect
rol
ytes
 CXR
 ABG
 Bl
oodC/
S

Tr
eat
ment
OPt
reat
ment
 TAz
ithr
omy
cin500mgODOR
 TCl
ari
thr
omy
cin500mgBDOR
 TDoxy
cycl
i
ne100mgBD
I
PRx
I
njCef
tri
axone1gI
VBDATD+
 T/
Inj
Azi
thr
omy
cin500mgI
VODorLev
ofl
ox750mgOD
Pseudomonasi
nfect
ion
I
njPi
ptaz4.
5gI
VQ8H+Lev
ofl
ox750mgOD
Aspi
rat
ionpneumoni
a
I
njCef
tri
axone1gI
VBD+I
njLev
ofl
ox750mgOD+I
njMet
rogy
l
500mgIVQ8H

FI
LARI
ASI
S
 TDEC150mg1-
0-1x12day
s(DecetBD)+Doxy100mg1-
0-1(
Kil
l
Wol
bachi
a)
  Pr
ophy
laxi
s
o TDEC300mg+al
bandazol
e400mgonedosey
ear
ly
CHRONI
CLOWERLI
MBI
SCHEMI
A
 Footcar
e
oI
nspectt
hef
ootdai
l
yforacci
dent
ali
njur
y
o Ensur
ecl
eanl
i
nessoff
oot
,socks,
footwear
o Lookf
oranyul
cer
ati
onori
nfl
ammat
ion,
avoi
dti
ghtshoes
o Av
oidov
erheat
ing/
cool
i
ngoff
oot
o Don’
twal
kbar
efoot
ed
 St
opsmoki
ng
 Losewei
ght
,ifov
erwei
ght
/obese
 Lookf
orhy
per
li
pidemi
a,anemi
aandT2DM
 TTr
ent
al400mg1-
1-1(
Pent
oxi
fyl
l
ine)
 TPl
etoz50-
100mg1-
0-1(
Cil
ast
azol
)(C/
IinCCF)
 TNi
ali
p375mg1-
1-1(
Nicot
ini
caci
d)
 Cont
rol
ofDM
Surgeryconsul
tat
ioni
fev
idenceofadv
ancedi
schemi
a(r
estpai
nand
gangrene)
.
LUMPS
Exami
net
hel
ump/
swel
l
ingaswel
last
her
egi
onal
lymphnodes.
I
fthel
umpi
sanode,
exami
nei
tsar
eaofdr
ainage.
Al
soexami
net
heci
rcul
ati
on&ner
vesuppl
ydi
stal
toanyl
ump.
Commoncauses
 Li
pomas  Gangl
i
a
 Cy
sts  Neur
ofi
bromas
 Ly
mphnodes  Kel
oids
  Sebaceouscy
sts  Gr
anul
oma
 Fi
bromas  Bur
sa
 Abscess  War
ts
 Rheumat
oidnodul
es  Papi
l
loma
 Der
moi
dcy
sts  Der
moi
dcy
sts
 CBC
I
nvest
igat
ions  FNAC
 USG–Doppl
er

 Sur
ger
yconsul
tat
ion.
HEADI
NJURY
 Askf
orh/
oLOC,
vomi
ti
ng,
sei
zur
e,bl
eedi
ngf
rom ear
,nosemout
h.
 Assesssi
zeofpupi
landpupi
l
lar
yreact
ion.
 Assessl
evel
ofconsci
ousnessusi
ngGCS.
 Exami
net
hescal
pforwound,
def
ormi
ty,
tender
ness.
 Obser
vef
orbl
eedi
ngorCSFl
eakf
rom earornose.
 Otherevi
dence of# ofbase ofskul
lincl
udes Raccoon ey
es,
Batt
le’
ssi
gn.
Note:-I fBP isl ow,sear ch f
orothercauses ofhypotensi
on l
i
ke
i
ntraabdominalbl
eeding,becausehy
potensi
onisveryunl
ikelyi
napure
headinjur
y.
Incaseoftachy
car
dia,
lookf
orot
heri
njur
iesl
i
kebl
untt
raumaabdomen,
chesti
njur
yand#pelvi
s.
 Suspectassoci
atedcervi
calspi
neinj
uryi
nanunconscioushead
i
njurypt.Somanipul
ati
onoftheneckshoul
dbemini
mi zed&with
special
care.
 Acer
vical
col
l
armaybeappl
i
edt
il
lacer
vical
inj
uryi
srul
edout
.
  Anyinsulttothebrai
ni smani
festedassignsofr
aisedICTli
ke
br
adycardia, det
eri
orat
ion i
n t he lev
el of consci
ousness,
hyper
tension.
Incaseofal t
eredlev elofconsciousnessr/oothercausesl i
ke
al
coholi
sm,meni ngi
tis,hy per
/hy
poglycemia,epi
l
epsy,met aboli
c
abnor
malit
y,drugint
oxi cat
ion,
poi
soningetc.
Tr
eat
ment
 Secur
e2I
Vli
nes.
 Sut
urethe scal
p wounds att
he ear
li
estas i
tcan r
esul
tin
si
gni
fi
cantbl
oodloss.
 Moni
torv
ital
s
I
fpat
ienti
sst
abl
edoaNCCTbr
ainwi
thbonewi
ndow
 Ant
imeni
ngi
ti
cregi
me(
ifskul
l#orpneumocephal
uset
c)
oI
njCef
tri
axone2gI
VQ12H
oI
njAmi
kaci
n500mgI
VQ12H
oI
njMet
rogy
l500mgI
VQ8Hx21day
s
I
njManni
tol
20%100ml
IVQ8H
o Cont
rai
ndi
cat
edi
nEDH,
pneumocephal
us
I
fsei
zur
es–I
njLor
aandI
njEpt
oin100mgi
vQ8H
 St
artI
Vfl
uidsi
fthepat
ienti
sinshock,
butav
oidf
lui
dov
erl
oad.
 RepeatCTi
fGCSf
all
s.
Note:Avoiddext
rosecontaini
ngIVfl
uidsespeci
ally5%D,asitcanrai
se
ICT.Applyri
gidorphil
adelphianeckcoll
arforallheadinj
urypt’
suntil
cervi
calspi
neX-r
ayhasruledoutanyabnormalit
ies.
A/
CCHOLECYSTI
TIS
Cl
i
nicalf
eat
ures
 Upperabdomi
nal
pai
n  Fev
er
 Nausea  Jaundi
ce
  Vomi
ti
ng
 CBC
 LFT,
RFT
I
nvest
igat
ions  USGA/
P
 CECTabdomen

Tr
eat
ment
 Bedr
est
 NPO/
RTaspi
rat
ion
I
VF
 Ant
i-
emet
ics
 Anal
gesi
cs
 Ant
ibi
oti
cs
o 3rdgencephal
ospor
in/
Pipt
az+Met
rogy
l
Ref
erf
orsur
ger
yconsul
tat
ion.
A/
CAPPENDI
CITI
S
Cl
i
nicalf
eat
ures
 Per
iumbil
icalpai
nr adi
ati
ng  Reboundt
ender
ness
tor
ightl
owerquadrant
 Pai
nonper
cussi
on
 Nausea&Vomi
ti
ng
 Ri
gidi
tyandguar
ding
 Anor
exi
a
 Di
arr
hea/
const
ipat
ion
 CBC
 LFT,
RFT
I
nvest
igat
ions  USGA/
P
 CECTabdomen
Tr
eat
ment
 Bedr
est
 NPO/
RTaspi
rat
ion
I
VF
 Ant
i-
emet
ics
 Anal
gesi
cs
 Ant
ibi
oti
cs
o 3rdgencephal
ospor
in/
Pipt
az+Met
rogy
l
Ref
erf
orsur
ger
yconsul
tat
ion.
A/
CPANCREATI
TIS
Cl
i
nicalf
eat
ures
 Abdomi
nal
pai
n  Fev
er
 Tender
ness  Jaundi
ce
 Guar
ding  Hemat
emesi
sormel
ena
 Di
stensi
on  Dy
spnea
 Nausea  Tachy
pnea
 Vomi
ti
ng  Di
mini
shedbowel
sounds
 Di
arr
hea  Lef
tsi
debasal
lungcr
eps
 Hy
pot
ensi
on
 CBC
 LFT,
RFT
I
nvest
igat
ions  Samy
lase/
Lipase
 SCal
cium
 Li
pidpr
ofi
l
e
 USGA/
P
 CECTabdomen
Tr
eat
ment
 Bedr
est
 NPO/
RTaspi
rat
ion
I
VF
 Ant
i-
emet
ics
 Anal
gesi
cs
 PPI
 Ant
ibi
oti
cs–notgener
all
yindi
cat
ed
Ref
erf
orsur
ger
yconsul
tat
ion.
A/
CINTESTI
NALOBSTRUCTI
ON
Commoncauses
 Adhesi
on I
ntussuscept
ion
 Her
nia  Vol
vul
us
 Car
cinoma
 Abdomi
nal
pai
n
 Di
stensi
on
Cl
i
nicalf
eat
ures  Vomi
ti
ng
 Const
ipat
ion
 Vi
sibl
eper
ist
alsi
s
Examine herni
al ori
fi
ce t
o r /
o
herni
alobst
ruct
ion/
str
angul
ati
on.

Do PR exami
nat
iont
or/
orect
al
pat
hol
ogy .
I
nvest
igat
ions  CBC
  LFT,
RFT
 El
ect
rol
ytes
 Er
ectX-
rayabdomen
 USGabdomen

Tr
eat
ment
 Bedr
est
 NPO/
RTaspi
rat
ion
I
VF
 Ant
i-
emet
ics
 Anal
gesi
cs
 Ant
ibi
oti
cs
o 3rdgencephal
ospor
in/
Pipt
az+Met
rogy
l
Ref
ert
osur
ger
yforear
lysur
gical
int
erv
ent
ion.
PERI
TONI
TIS
Local
i
zed-duet
oinf
lammat
ionofunder
lyi
ngv
iscer
a.
Gener
ali
zed-duet
oper
for
ati
on/
hemor
rhage.
Cl
i
nicalf
eat
ures
 Guar
ding  Si
l
entabdomen
 Sev
eret
ender
ness  Reboundt
ender
ness
 Ri
gidi
ty
 CBC
 LFT,
RFT
I
nvest
igat
ions  El
ect
rol
ytes
 Amy
lase/
Lipase
 Er
ectX-
rayabdomen
  USGA/
P
 CECTabdomen

Tr
eat
ment
 Bedr
est
 NPO/
RTaspi
rat
ion
I
VF
 Ant
i-
emet
ics
 Anal
gesi
cs
 Ant
ibi
oti
cs
o 3rdgencephal
ospor
in/
Pipt
az+Met
rogy
l
Ref
ert
osur
ger
yforear
lysur
gical
int
erv
ent
ion.
TESTI
CULAR/
SCROTALPAI
NORSWELLI
NG
Commoncauses
 A/
cepi
didy
moor
chi
ti
s  Hy
drocel
e
 Test
icul
art
orsi
on  Var
icocel
e
I
ngui
nal
her
nia  Sper
mat
ocy
te
I
nvest
igat
ions  USGDoppl
erscr
otum
Thesuddenonsetoft esti
cularpai
ni nayoungmanorchi
l
dsuggest
s
testi
cul
ar t or
sion, a t r
ue ur ol
ogi
c emergency
. Immediat
e
surgery
/ur
ologi
cconsultat
ionisrequir
ed.
Swelli
ng,r
etracti
on,and sev
ere di
scomf
ortar
eimpor
tantsi
gnsof
test
icul
art
orsion.
Testiculart
orsi
onoccursuni
lateral
ly&mayf ol
l
oworbepr eci
pit
atedby
exercise ormay occurspont aneously.Thi
sleads tot he abr
upt
cessat i
onofbl oodfl
ow &t esti
cularischemi
a&i nf
arct
ion,whichis
l
ikel
yt obei r
rev
ersi
bleaft
er12hr s.
PI
LES
  Si
tzbat
hfor20mi
nut
est
wicedai
l
y;
 Fi
brer
ichdi
et
 Pl
ent
yofor
alf
lui
ds
 Ant
ibi
oti
csandNSAI
D’sf
oracut
eat
tack
 Proct
osedyl oint (But
yl ami
ne Benzoat
e + Fr
amy
cet
in
+Hydrocor
ti
soneacet
ate)
 Shi
eld(
Hydr
ocor
ti
sone,
li
docai
ne,
Znoxi
de,
all
ant
oin)
 Anov
ate(
becl
omet
hasone+pheny
lephr
ine+l
i
docai
ne)
 Smut
hcr
eam (
cal
cium dobesi
l
ate,
li
gnocai
ne,
hydr
ocor
ti
sone,
Zn)
 Sy
pCr
emaf
fi
n30ml
HS
 T Venusmin/
Venux 300 TDS (
Diosmi
n)orDaf
lon (
diosmi
n+
hesper
idi
n)TDS
 TCal
dob(
Cal
cium dobesi
l
ate)OD/
BD
Suger
yconsul
tat
ion.
FELON(
WHI
TLOW ORTERMI
NALPULPSPACEI
NFECTI
ON)
Cl
i
nicalf
eat
ures
 Thr
obbi
ngpai
n
 Redswol
l
enwar
mtenderpul
porf
ingert
ip
Tr
eat
ment
 War
m wat
erorsal
i
nesoaks
 I&Di
fpus+
o Usingami dli
ne/mi
dlat
erali
nci
siont
hatadequat
elydi
vi
des
thefi
broussepta
o Donotdi
vi
dev
ert
ical
fasci
alst
rands(
sept
a)
o Theinci
sionshoul
dnotcrosst
hedistali
nterphal
angeal(DI
P)
j
ointtopreventf
ormat
ionofaflexi
oncont r
actur
eatt heDIP
fl
exi
oncrease.
 o Pr
obingisnotcar
ri
edoutproxi
mall
ytoav
oidext
ensi
onof
i
nfect
ioni
ntot
hefl
exort
endonsheat
h.
o Packgauzel
oosel
yint
othewoundt
opr
eventski
ncl
osur
e.
o Appl
yaloosedressi
ng,
spl
i
ntt
hef
inger
,andel
evat
ethehand
abov
etheheart
.
 Updat
etet
anusi
mmuni
zat
ion
 TMoxcl
av/
Ampi
cloxx5-
7day
s
 TLy
serDBD
 CMegapen1-
1-1-
1
Ref
ert
osur
ger
yofanycompl
i
cat
ionsdev
elop
 Ski
nnecr
osi
s
 Sept
icar
thr
it
is
 Ost
eomy
eli
ti
s
 Tenosy
nov
iti
s
I
nfect
ioninvol
vi
ngl i
tt
lefingershouldbetr
eat
edaggr
essi
vel
yast
he
i
nfect
ioncanspreadtothepalm ofhand.
SKI
NULCERS
Cl
i
nicalf
eat
ures
 Venousst
asi
s  Mal
i
gnancy
 Ar
ter
ial
insuf
fi
ciency I
nfect
ion(
TB,
syphi
l
is)
 DM  Tr
auma(
pressur
e)
 Ly
mphoedema  Dr
ugs
 Vascul
i
tis  Py
oder
ma
Diabeti
culcersmostoft
enoccuront
hepat
ient
’sheeloront
hepl
ant
ar
surfaceofthemetat
arsalheads.
Venousstasi
sulcer
smostoft
enoccuront hemedi
alaspectoft
he
pat
ient
’sl
owerlegorankl
e&ar
eassoci
atedwit
hc/
cedema.
Arter
iali
nsuf
fici
encyulcerstendtooccurdi
stal
l
yont
het
ipsoft
he
toesoratornearthel
ateralmall
eol
us.
I
nvest
igat
ions  CBC
 LFT,
RFT,
Elect
rol
ytes
 Ul
cerbi
opsy
 C/
Soful
cerbase
 X-rayofaff
ect
edpar
ttol
ook
forosteomyel
i
tis
 ChestX-
rayt
or/
oTB
 Doppl
erofl
i
mbs

Tr
eat
ment
 Opt
imi
zenut
ri
ti
on
 St
opsmoki
ng
 Cor
rectanemi
a,pr
otei
n&v
itami
ndef
ici
ency
 Anal
gesi
cs
 Gi
ver
estt
othepar
t
 Clean wounds ar
et r
eat
ed with mi
nimaldebr
idement& damp
gauzeorhydrogel
baseddressi
ngs
 Ul
cercleaningisdoneusi
ngNor
malSal
i
ne(
bet
ter& i
deal
)or
di
l
utedpovidoneI
odi
ne.
Anti
septi
csol
uti
onssuchashydr
ogenper
oxide,Pov
idone-
iodi
neetc
shouldnotberout
inel
yusedast
heyaretoxi
ct oti
ssues& impede
heal
ing.
 Oxum Spr
ay(
super
-oxi
disedsol
uti
on)
/Megahealoi
ntmentcanbe
used
Pati
ent
swithsuspect
edinf
ecteddi
abeti
cfootulcershouldbeadmitt
ed
fori
mpati
entwoundcare&broadspect
rum ant
ibi
oti
ctherapydi
rect
edat
bot
hgr
am +v
eandgr
am –v
eor
gani
sms.
Inf
ectedwoundsr equi
reat hor
oughexpl
orati
onwi t
hdrai
nageof
allabscess cavit
ies & debri
dementof infect
ed,necr
oti
c or
devi
tali
zedt
issues.
 Woundcul
tur
esshoul
dbeobt
ainedpr
iort
oini
ti
ati
onofant
ibi
oti
cs.
I
ntheacut
ephasepar
ent
eral
treat
menti
sindi
cat
ed.
o Mi
l
dinf
ect
ions–1-
2weeksofant
ibi
oti
cs
o Sev
erei
nfect
ions–2-
4weeksofant
ibi
oti
cs
o Ost
eomy
eli
ti
s–4-
6weeksofant
ibi
oti
cs
 Topi
cal
ant
ibi
oti
csmaybegi
venf
ori
nfect
edul
cer
s.
 Anti
biot
icsar
enotr
equi
redonceheal
thygr
anul
ati
ont
issuesar
e
for
med.
 Oncegranul
ates,def
ecti
scl
osedwi
thSecondar
ysut
uri
ng,ski
n
gr
aft
,fl
aps.
PRESSUREULCERS
Pr
event
ion
 Skincar
e:ski
nshoul
dbekeptwellmoist
uri
zed,
butpr
otect
edf
rom
excessi
vecont
actwi
thext
raneousf
lui
ds.
 Takecar
edur
ingt
ransf
erst
oav
oidf
ri
cti
on&shearst
ress.
 Fr
equentr
eposi
ti
oni
ngatami
nimum ofev
ery2hour
s.
 Bowel
&bl
addercar
e.
 Appr
opr
iat
esuppor
tsur
faces:
air
/wat
ermat
tresses.
Tr
eat
ment
 Debri
dement, wound cl
eansi
ng, dr
essi
ngs (
e.g. sof
ra t
ull
e)
ensur
ingwoundbaseremainsmoi
st
 Sy
stemi
cant
ibi
oti
cther
apy
 Nut
ri
ti
on(
highpr
otei
ndi
et,
vit
ami
nsespeci
all
yvi
tC)
.
DEWORMI
NG
Sy
mpt
omsofwor
minf
est
ati
on
 Abdomi
nal
pai
n
 Bl
oodi
nst
ool
s
 Wei
ghtl
oss
 Rashes
 Anal
itchi
ng
Ti
ming
I
nanor
mal
chi
l
ddewor
mingusual
l
ydone>1y
r.
I
nachi
l
dwi
thpi
ca,
9mont
h.
 Repeatev
ery6mont
hsupt
o6y
rsandt
henev
ery1y
rupt
o12y
r.
 Maybei
nev
ery2y
rsi
nadul
ts.
Af
terdewor
ming,
giv
evi
tami
ns/
Iron/
Appet
izer
.
 Notgi
veni
ncaseoff
ever
I
deall
y do stoolRE f
orov
a/par
asi
tes,t
hen deci
de t
he best
dewormingt
herapy
 Adv
icet
ocutnai
l
sregul
arl
y.
Tr
eat
ment
 Al
bendaz
ole[
Bandy
,Zent
el,
Bendex400,
Albend]
o 400mgHS/
Repeaton15t
hday–f
orEnt
erobi
usv
ermi
cul
ari
s
o Sy
p200mg/
5ml
avai
l
abl
e
 Bel
ow2y
rs-200mgHS
 ≥2y
rs-400mgHS
 Mebendazol
e[hookwor
minf
est
ati
on]
o TMebex100mgBDX3day
s
o Sy
pMebex100mg/
5ml
 CALCULATI
ONOFRATEOFFLUI
DINFUSI
ON
Rout
ineI
Vset 1ml
=16dr
ops
Mi
crodr
ipset 1ml
=60dr
ops

Dr
opr
atepermi
nut
efr
om f
lui
dvol
umet
obei
nfusedi
nonehour
:
 Vol
umei
nml
/hour÷4=Dr
opr
ate/
minut
e
Formor
ethanonehour
:
 Vol
umet
obei
nfused(
inml
)=Dr
opr
ate/mi
nut
e
 Dur
ati
onofi
nfusi
oni
nhour
sx4
Dr
opr
atepermi
nut
efr
om f
lui
dvol
umet
obei
nfusedi
n24hour
s:
 Fl
uidi
nli
tr
e/24hour
sx10=Dr
opr
ate/
minut
e
Per
fectmet
hodt
ocal
cul
atef
lui
dvol
umef
rom dr
opr
atei
n24hr
s:
 Dr
opr
atex96=v
olumei
nml
per24hr
s
DERMATOLOGY
I
n dermatol
ogynat
ure oft
reat
mentdepends on t
he st
age of
di
sease.
 Mor eacutethecondit
ion,lessstrongt
helocalappl
icat
ions,e.g.
Lotions f
or a/c condit
ions,creams for sub a/c condit
ions,
creams/oi
ntmentsforc/ccondit
ions.
 Ar
easneartheey
es&geni
tal
sshoul
dbet
reat
edwi
thmi
l
dst
rengt
h
pr
epar
ati
ons.
 Hydrati
on of t
he ski
n bef
ore t
opi
cal appl
i
cat
ion enhances
absorpt
ion.
 CalamineLoti
oncancausedrynessofski
n&ther
ebymayl
eadt
o
i
tching.Soi
tsusei
snowl i
mit
edt our
ti
cari
a.
Ant
if
ungal
s:
 Sebi
fi
ncr
eam [
ter
binaf
ine,
benzyal
cohol
]
  Candi
d,Sur
faz,
Canest
en,
Canazol
e[Cl
otr
imazol
e]
 Candi
dB,
Cloci
p-B[
Clot
ri
mazol
e+Becl
omet
hasone]
 Ket
ovat
ecr
eam,
nizr
alcr
eam [
Ket
oconazol
e]
 Nizral shampoo, Phy
tor
al shampoo, Dandof
f
soluti
on[
Ket
oconazol
e]
 Fungi
topgel
,Candi
statCr
eam [
Miconazol
e]
Ant
if
ungal
s+Ant
ibact
eri
als+St
eroi
d:
 Cl
obenat
eGM cr
eam [
clobet
asol
,gent
ami
cin,
miconazol
e]
 Cloci
p NB cream [
becl
omet
hasone, cl
otr
imazol
e, neomy
cin,
chlor
ocr
esol
]
 Sigmaderm, candi
der
ma [
becl
omet
asone, cl
otr
imazol
e,
gentamyci
n]
 Bet
nov
ateGM [
bet
amet
hasone,
gent
amy
cin,
miconazol
e]
 Sur
faz-
SN(
clot
ri
maz
ole+bet
amet
hasone+neomy
cin)
 Tot
alder
m +(
ofl
ox,
orni
dazol
e,t
erbi
naf
ine,
clobet
asol
)
St
eroi
d+ant
ibact
eri
al/
ant
if
ungal
 Di
pgent
a,Gent
opi
c[bet
amet
hasone,
gent
amy
cin]
 EumosoneG[
clobet
asone+gent
amy
cin]
 Tenov
ateG[
clobet
asol
+gent
amy
cin]
 EumosoneM [
clobet
asone+mi
conazol
e]
Ant
ibact
eri
als:
 T-
bact
/Bact
roban(
mupi
roci
n2%)
 Fut
op/
fuci
din(
fusi
dicaci
d)
 Si
somi
cincr
eam
 Neospor
inoi
nt
PARONYCHI
A
A/
Cpar
ony
chi
aiscommonl
ybact
eri
al(
Staph)
.
 I
fsof
tti
ssueswel
l
ingispresentwit
houtf
luct
uance,t
hei
nfect
ion
mayr
esol
vewit
hwarm soaks3-4t
imesdai
ly.
I
fabscess,
doI&D.
o Dr
aint
hepusbymaki
ngani
nci
sionov
ert
heepony
chi
um.
oI
fther
eisaf
loat
ingnai
l
,remov
alofnai
li
srequi
red.
 Ant
ibi
oti
cs+anal
gesi
cs
o Ampi
clox/
amoxi
clav
/cephal
exi
n/doxy
cycl
i
ne
o T.Ly
serD1-
0-1X5day
s
o Fuci
dinorT-
bactoi
ntf
orLA
C/
cpar
ony
chi
aiscommonl
yduet
ofungali
nfect
ion
 Fl
ucos150mgonceweekl
yX6mont
hs[
fl
uconazol
e]
 Topi
cal
ant
if
ungal
s
o Dakt
ari
n(mi
conazol
e)orOny
lacnai
ll
acqer(
cicl
opi
rox)
o Appl
yov
ert
heaf
fect
ednai
l
satbedt
ime
o Shoul
dbeappl
i
edst
art
ingf
rom t
heski
nadj
acentt
othenai
l
bed
o Uset
hebr
ushpr
ovi
dedt
oappl
yint
ocr
evasses&r
idges
o Cutnai
ls weekl
y& r ub ov
ert
he nai
l
s usi
ng accessor
y
pr
ovi
dedonceeveryweek
I
NTERTRI
GO
I
nfl
ammat
ionoft
hebodyf
olds.Maybebact
eri
al/
fungal
/vi
ral
.
CommonlyCandi
dai
nfect
ion,butt
her
emaybesuper
imposedbact
eri
al
i
nfect
ion.
Commonsi
tes
 Lat
eral
twoi
nter
digi
tal
spaces
I
nnert
highs
 Geni
tal
i
a
  Undert
hebr
east
s
 Under
sideoft
hebel
l
y
 Behi
ndt
heear
s.Somet
imes
Tr
eat
ment
 T.Fl
ucos150mgonceweekl
yx1mont
h
 Aci
derm G forL/
A x 10 day
s[bet
amet
hasone,gent
amy
cin,
cl
otr
imazol
e]
 CCarofi
t1-
0-0x1mont
h[v
itC,v
itE,zi
ncsul
phat
e,bet
acar
otene,
car
rot
]
PYODERMA
 Ant
ibi
oti
cs -
>
Ampicl
ox/ci
plox/
amoxcl
av/
doxy
cycl
i
ne/
cephal
ospor
ins
 Anal
gesi
cs,
ant
ihi
stami
nes
 T-
bact/
Fut
op/
Neospor
inOi
ntf
orLABD
 Sal
i
newashi
ng–Onet
spsal
tin2gl
assesofwat
er
 Goodhy
giene
DANDRUFF
 Warm oi
lMassage;aft
er10mi n,appl
yNizr
al2%shampooont
o
scal
pforaper
iodoftenminut
es;thenwashawayal
ltheoi
l
.
 Repeatt
wiceort
hri
ceweekl
yx2mont
hs
Ot
heropt
ions
 Dancl
earshampoo
 KTCmedi
cat
edshampoo
 Scal
pe/
Dandr
opshampoo[
Ket
oconazol
e+Znpy
rit
hione]
I
onax-
T[Coal
tar+Sal
i
cyl
i
caci
d]
o Reli
evesi
tchi
ng&f l
aki
ngi
ndandr
uff
,sebor
rhei
cder
mat
it
is&
psori
asi
softhescal
p.
 ACNEVULGARI
S
 Washt
hef
acewi
thsoap&hotwat
er2-
3ti
mesaday
.
 Av
oidexcessi
veexposur
etosun.
 Per
sol
-ACGelorBenz
ac-AC2.
5% -5% [
benzoy
lper
oxi
de]–f
or
bl
ackheads
o Appl
y;wai
tfor2mi
n&t
henwashof
f
o St
artasoncedai
l
y,dur
ingdayt
ime
 Cl
i
ndacAgel
[cl
i
ndamy
cin]f
ori
nfl
ammat
ory&pust
ularl
esi
on
 CDoxycy
cli
ne1001-
0-1x10day
sorTAzi
thr
omy
cin500mgodx
5day
s
Ot
herdr
ugsused:
 Az
elai
caci
d2%orAdapel
ene0.
1%gel
(adaf
eri
n,der
iva)
 Der
iva-
CMSgel
(adapel
ene+cl
i
ndamy
cin)
TIsotret
inoi
n 10 or20 mg (
Isot
ret
)(0.
5mg/
kg/
day
)atni
ght
(
ter
atogenic)
Wit
hal lant
i-
acnecreamslookf
ori
rr
it
ati
on,dr
yness,r
edness,i
tchi
ng,
bur
ningever
y10-15days.
ALOPECI
A
Commoncauses
 Poornut
ri
ti
on  SLE
 Ti
neacapi
ti
s  Di
abet
es
 Hy
per
/hy
pot
hyr
oidi
sm  Dr
ugs(
eg.St
eroi
ds)
 Pr
egnancy  Excessi
vedandr
uff
 CBC
 LFT,
RFT
I
nvest
igat
ions  El
ect
rol
ytes
 TSH,
FT4
  S.Fer
ri
ti
n

Tr
eat
ment
 TXt
ragl
oODx1mont
h(bi
oti
n,
L-met
hioni
ne,
L-cy
stei
ne)
 TKeraglo-
MenorKer
agl
oev
a(gammal
enol
eni
caci
d,mul
ti
vi
tami
n,
nat
uralext
ract
s)
 Pr
oAnagenShampoo
ForAl
opeci
aar
eat
a:
 Di
prov
atescal
plot
ion(
bet
amet
hasone)oncedai
l
y
 Fl
ucor
tlot
ion(
fl
uoci
nol
one)oncedai
l
y
Forandr
ogenet
ical
opeci
a:
 Mi
noxi
dil
topi
cal
sol
uti
onBD.2%f
orwomen,
5%f
ormen
 Tr
adename:
Hai
r4U/
Mor
r/Mor
r-
F
(
TN:
hai
r4U,
mor
r,mor
r-
F)
CORNS&CALLOSI
TIES
 Usual
l
ytheygobyt
hemsel
ves,
oncet
hei
rr
it
ati
ngf
act
ori
sav
oided.
 Usepr
operf
it
ti
ngf
oot
wearorMCRf
oot
wear
s.
 Ker
atol
yti
cagent
s
o Sali
cyl
icacid40%padsandpl
ast
erorsol
uti
on:Appl
y&l
eav
e
for4-
5day s.
o Al
soused-40%ur
eacr
eam,
and12%l
act
icaci
dcr
eam.
o Cl
eanoderm/duof
il
m (
sal
i
cyl
i
c aci
d+ l
act
ic aci
d)
l
oti
on/sol
uti
on
Not
e:Pati
ent
swi t
hper
ipher
alneur
opat
hiesshoul
dav
oidt
heuseof
t
opi
calsal
i
cyl
icaci
d.
 Car
nat
ionDecor
ncor
ncaps(
sal
i
cyl
i
caci
d)
o Tobekepti
nposi
ti
onwi
tht
hecor
nforf
ewday
s
 o Tober
eappl
i
edagai
nti
l
lthecor
ndr
opsout
CONTACTDERMATI
TIS
Def
init
ivet
reat
mentofall
ergi
ccont actdermatit
isi
st heident
if
icat
ion
andremovalofanypot
ent
ialcausalagents;ot
herwi
se,thepati
entisat
i
ncreasedr
iskf
orchr
oni
correcurrentder
mat i
ti
s
 Wetcompr
esses/
sal
i
nesoaks
 Emoll
i
ents-Emoder
m/nov
asof
torcal
ami
nemaybebenef
ici
ali
n
chr
oniccases.
 TCPM 4mg1-
0-1
 Topi
calcl
obet
asol(
oint
mentfordryscal
i
ng l
esi
ons;l
oti
on or
cr
eam f
orweepi
ngar
easofder
mati
ti
s).
Forsevereacuteall
ergiccontactder
matit
isorwidespr
eadandsevere
chroni
c dermati
ti
s,sy stemic gl
ucocor
ti
cost
eroi
ds may be requi
red
(admini
ster
edfor2weeks) .
EXCESSI
VESWEATI
NG/
HYPERHYDROSI
S
Commoncauses
 Hy
pogl
ycemi
a  Rheumat
icf
ever
 MI  Gout
 Def
erv
escencei
nfev
er  Al
cohol
 Hy
per
thy
roi
dism  Anxi
ety
 Vasov
agal
att
acks

Tr
eat
ment
 Al
dryl
oti
onf
orLAHS(
alumi
nium chl
orohy
drat
e)or
 Losweatpowderf
orLA(
miconazol
e,chl
orhexi
dine)
STASI
SDERMATI
TIS
Duet
ovenousst
asi
sont
hel
owerpor
ti
onsofl
egs.
 Wetcompr
esses/
sal
i
nesoaksf
or5mi
nut
es(
10t
easpoonsal
tin
 20gl
assofwat
er)
 Emoll
i
entsl
i
ke Emoder
m/Nov
asof
t(whi
te sof
tpar
aff
in,l
i
qui
d
par
aff
in)
 TCal
dob500mgOD(
Ca2+Dobesi
l
ate)
 Topi
calcor
ti
cost
eroi
dsl
i
ket
ri
amci
nol
one0.
1% (
T.N:Leder
cor
t
oi
nt)
 Dai
l
yuseofel
ast
icst
ocki
ngs.
 Rai
sel
egendofbedatni
ghtby15cm (
2br
icks)
.
PEDI
CULOSI
S
 Ant
ibi
oti
csl
i
keAmpi
clox
 Medi
car
e,Zer
omi
te[
Per
met
hri
n1%]
o Massagei
ntoscal
p,Bat
haf
ter10mi
n&t
hencomb
o Repeataf
ter7-
10day
stoki
l
lni
ts
 TI
vermect
in12mgsi
ngl
edoset
obet
akenonempt
yst
omach(
0.2
mg/
kg)
 Ant
i-
inf
lammat
ory-
>br
ufen
 TRant
ac/Omepr
azol
e
 TCel
i
n500mgOD/BD
Li
ceul
ceri
nAxi
l
la-Per
met
hri
nCr
eam f
orL/
A.
I
nfest
ati
onsoft
heey
elashesandey
ebr
ows-Pet
rol
atum oi
ntment
RI
NGWORM I
NFECTI
ONOFSKI
N(TI
NEA/
DERMATOPHYTOSI
S)
Topicalt herapyisindi
cat
ed f
orli
mited i
nfect
ionofthebody
,gr
oin,
superfi
cialinvol
vementoft
hebear
dregion,
palms&soles
 Ni
zral
(ket
oconazol
e2%)or
 Exi
fi
ne(
ter
binaf
ine1%)or
 Fungi
top(
miconazol
e2%)or
 Candi
d(cl
otr
imazol
e1%)or
  Whi
tf
iel
doi
ntment(
benzoi
caci
d6%,
sal
i
cyl
i
caci
d3%)
Dur
ati
onofthet
her
apyi
s4t
o6weeksor2weeksmor
eaf
tercl
ear
ance
ofl
esi
ons.
TI
NEAVERSI
COLOR(
PITYRI
ASI
SVERSI
COLOR)
Azol
es,
Ter
binaf
ine,
Cicl
opi
roxol
ami
ne&sel
eni
um sul
fi
dear
eused.
Ket
oconazol
e cr
m/sol
n/Mi
conazol
e/Cl
otr
imazol
e ev
ery ni
ght f
or 2
weeks.
 Eachappl
i
cati
oni
sall
owedtoremai
nont
heski
nforatl
east10
minut
espri
ort
obei
ngwashedof
f.
I
nresi
stantcases,
over
nightappl
i
cat
ioncanbehel
pful
.
I
ncasesofext
ensi
veTi
neav
ersi
col
or
 Ket
oconazol
esol
uti
on(
Nizr
al)t
obeappl
i
ed15mi
nbef
oret
aki
ng
bat
h,t
wiceweekl
y.
 Af
terbat
hanyoft
heabov
epr
epar
ati
onsmaybeappl
i
edl
ocal
l
y.
Sy
stemi
cther
apy
:
 TFl
uconazol
e400mgst
at.Repeataf
ter2weeksi
frequi
red.
SEBORRHOEI
CDERMATI
TIS
 Ni
zral
shampoof
orscal
p&bodywasht
wiceweekl
y.
 Ket
o-Bcr
eam f
orLA(
ket
oconazol
e+bet
amet
hasone)x5day
s

SCABI
ES
Per
met
hri
n5%l
oti
oni
stheDOC.
I
tisappli
edfrom t
heneckdown,usual
l
ybeforebedt
imeandl
eft
onforabout8to14hour
s,t
henwashedoffi
nthemorni
ng.
 Mi
l
dinf
ect
ion–oneappl
i
cat
ion
 Moder
atet
osev
erecases-anot
herdosei
sty
pical
l
yappl
i
ed7t
o
14day
slat
er
Al
lcl
othes,
towel
s&bedsheet
set
cshoul
dbewashedwel
l
(ideal
l
yinhot
wat
er)&dr
iedi
nsunori
fpossi
blei
ronedwel
l
.
I
deal
l
y,t
reatal
lfami
l
ymember
satat
ime
 Scabi
esmayal
sogeti
nfect
ed,
soi
nsuchcases,
giv
eant
ibi
oti
cs
 Ant
ihi
stami
nes
Anot
heropt
ioni
sT.I
ver
mect
in200mcg/
kgsi
ngl
edose.

I
TCHI
NGDUETOPRI
CKLYHEATI
NSUMMER(
MILI
ARI
ARUBRA)
 Bat
h2t
imesperday
,av
oidt
ightcl
othi
ng
 Spr
inkl
eNy
cil
powderorCandi
ddust
ingpowderBD
 TCet
ri
zi
ne10mgHSx5day
s
 TVi
tC500mgBD
 Emoder
m/Cal
ami
nel
oti
on/
oint
ECZEMA
Theterm eczemaisal
mostsynony
mouswithder
mat
it
is.Theyreferto
di
sti
ncti
vereacti
onpat
ter
nsoft
heskin,
whi
chmaybeduetoav ar
ietyof
a/corc/ccauses.
Maybeoft
wot
ypes:
1.Dr
yEczema-
>wi
thoutoozi
ng
2.WetEczema-
>wi
thoozi
ng(
maybei
nfect
ed,
r/oT2DM)
Sev
eral
types-
>At
opi
c,Sebor
rhei
c,I
rr
it
ant
,Al
l
ergi
cet
c.
Tr
eat
ment
 Ant
i-
hist
ami
nes
 Sal
i
nesoaks/
wetcompr
esses
 Topi
cal
Bet
amet
hasoneorBecl
omet
hasone
 Mul
ti
vi
tami
ns
 Ant
ibi
oti
csl
i
keAmpi
cloxi
fneeded
In casesoffungali
nfect
ions,asev
idenced bysev
erepr
uri
tus,gi
ve
antif
ungal
s.
 T.Calci
um Dobesi
lat
e500mgBDasadj
uvantt
her
apyi
npt
’swi
th
venousulcer
s&stasi
sder
mat
it
is
PSORI
ASI
S
 Di
psali
c/ bet novat
e-S/ betasal
i
c/ Sal
topi
c l
oti
on/
oint
ment
[
betamethasone,sal
i
cy l
i
caci
d]OR
Di
provat
eMFcr eam [betamet
hasone,l
act
icaci
d,sal
i
cycl
i
caci
d,
ur
ea,sodi
um l
act
ate]bdforL/A
 Ant
ihi
stami
nest
opr
eventscr
atchi
ng
 TCal
ci
um OD/
BD
l
i
qui
dpar
aff
inf
orLA
 Foracut
epsor
iasi
s–TDoxy
 Cet
ri
lakmi
l
dshampoof
orscal
p(cet
ri
mide)
Note:Dryscalycondi
ti
onslikePsor
iasis,Atopicdermati
ti
s,Icht
hyosis
requi
res moi
stur
izi
ng cream e.
g El
ov era cream to be appl
ied af
ter
bathi
ng[vi
tE,al
oevera]
.
STRETCHMARKS,
STRI
AE,
CRACKEDNI
PPLES,
DARKCI
RCLES
 Al
ovi
t-
AFcr
eam f
orL/
A.[
lact
icaci
d,v
itami
nE,
sunf
loweroi
l
,al
oe]
 Ant
ioxi
dant
s
o CEv
ion400mg/
TCar
ofi
t/Tant
oxi
dODx1mont
h
FI
SSURI
NGOFSOLES(
ATHLETE’
SFOOT/
TENI
APEDI
S)
 Keept
hef
ootdr
y.
 Fomenti
nhotwaterf
or10mins,2ti
mesdaily
,foll
owedbydr
ying
andappl
i
cat
ionofant
ibi
oti
c&ker
atol
yti
coi
ntments.
 Moi
stur
excr
eam (
urea,
lact
icaci
d,pr
opy
lenegl
ycol
,l
iqui
dpar
aff
in)
f
orLA
OR
 Sal
ytar
-ws/
Sal
i
cyl
i
x-SF(
sal
i
cyl
i
caci
d)t
obeappl
i
edont
hehar
d
ski
nonly
I
fsecondar
yinf
ect
ion:
Sur
faz–SNorcandi
d-Bf
orLA
Note:Ifinf
lamedorswol
l
en,gi
veant
ibi
oti
cs,ant
i-
inf
lammat
orydr
ugs,
st
eroids
PREMATUREGRAYI
NGOFHAI
R
Commoncauses
 Vi
tB12def
ici
ency
 Thy
roi
dd/
s
 FAdef
ici
ency
 Chemot
her
apy
 Usi
ngel
ect
ri
cdr
yer
s/concent
rat
edhai
rdy
es
Tr
eat
ment
 TCur
lzv
it1-
0-0(
cont
ainsPABA)
 Al
tr
isGel
forLA(
Mel
i
tane)
HERPESZOSTER
 T Acycl
ovi
r8001-
1-1-
1-1x7-
10day
s(ef
fect
iveonl
yifst
art
ed
wi
thin72hour
s)
 Ot
herant
ivi
ral
s–T.Val
acy
clov
ir1gm TDSx7day
s
 Anal
gesi
csl
i
keI
bupr
ofenorP’
mol
 Neur
opat
hicpai
n–TGabapent
in300mgOD
 Cal
ami
nef
orLA;
T-bactf
orLA;
Acy
clov
ircr
eam f
orLA
 Or
alAnt
ibi
oti
csi
fsecondar
yinf
ect
ion
 Rest
 Forposther
pet
icneur
algi
a:TGabapent
in300mgOD
I
CTHYOSI
S
 Av
oidusi
ngst
rongsoaps/
excesssunexposur
e.
  Af
terabath,appl
yemol
l
ient
sormoi
stur
izer
stopr
eventscal
i
ng&
dr
yness.
 Moi
stur
excr
eam f
orLA
Ot
hert
opi
calpr
epar
ati
ons:
 Ret
ino-
Acr
eam (
tret
inoi
n)
 Dai
vonexoi
ntf
orLA(
cal
cipot
ri
ol)
 Ker
ali
noi
nmentf
orLA(
sal
i
cyl
i
caci
d,benzoi
caci
d,hy
drocor
ti
sone)
 Copri
derm (Bet
amet
hasone,ur
ea,l
act
ic aci
d,pr
opy
lene gl
ycol
,
sal
icy
li
cacid)

HYPERPI
GMENTATI
ONOFSKI
N
 Av
oidper
fumes,
hai
rdy
eset
c.
 Tr
eatanemi
aifpr
esent
.
 Reducesunexposur
e:Appl
ySunscr
eenagent
s
o Sperlot
ionforLA30mi nbefor
egoingout
side(
oct
inoxat
e,
avobenzone,oxy
benzone,
zincoxi
de)
o Ski
nli
te cream (Hy
droqui
none, Tr
eti
noi
n, Momet
asone
Fur
oate)atni
ght
 Forli
ps:Usemoi
stur
izerorEmoder
m Oi
ntf
orLA(whi
tesof
t
par
aff
in)
ForKel
oids&hy
per
trophi
cScar
s:
 OpexaGel
(Di
met
hicone,
ascor
byl
tet
rai
sopal
mit
ate)
 Cont
ract
ubexgel
(hepar
in,
al
lant
oin)
 Ret
ino-
A(Tr
eti
noi
n)LAODatni
ght
.
WARTS
 Sal
i
cyl
i
x-SF12%cr
eam (
sal
i
cyl
i
caci
d)f
orLAOR
I
miquad/
Nil
war
tcr
eam (
imi
qui
mod)f
orLAonal
ter
nat
eday
s
 o Washaf
ter8hour
s.
DRYSKI
N/XERODERMA
Commoncauses
 Zn & essent
ialf
att
y aci
d  Topi
cal pr
epar
ati
ons
def
ici
ency cont
aini
ngal
cohol
 End-
stager
enal
disease  Det
ergent
s
 Hy
pot
hyr
oidi
sm  Har
shbat
hingsoaps
 HI
V  Vi
tami
nA/
Ddef
ici
ency
 Mal
i
gnanci
es  Sj
ogr
en’
ssy
ndr
ome

 Emol
i
ent
s/moi
stur
izer
se.
gEmoder
m/El
over
a/Nov
asof
tforLA
 Adequat
ehy
drat
ion
HERPESSI
MPLEX
 Acy
clov
ircr
eam (
Zov
irax)f
orLA
 TAcy
clov
ir4001-
1-1x7-10day
s
Der
mat
ologyconsul
tat
ion.
HAND-
FOOT-
MOUTHDI
SEASE
Cl
i
nicalf
eat
ures
 Fev
er
 Ski
nlesions/r
ash f
oll
owed byvesi
cularsor
es wit
h bl
i
ster
s on
pal
msoft hehands,solesoft
hefeet
,butt
ocks,ar
oundthenose,
mouthandlips
 HFMDusual
l
yresol
vesoni
tsownaf
ter7–10day
s.
Tr
eat
ment
 Ant
ihi
stami
nes
 Ant
ipy
ret
ics
 Adequat
efl
uidi
ntake,
pref
erabl
yCol
dfl
uids.
  Av
oidspi
cyf
oods.
 Soot
hingl
oti
onsl
i
kecal
ami
nel
oti
onf
orr
ashes.
DYSCHROMI
AINCHI
LDREN
Mostcommonl
yhy
popi
gment
ati
onoff
ace
 Dewor
m
 Mult
ivi
tami
ns,Cal
cium suppl
ement
s&l
eaf
yveget
abl
es&mi
l
kin
di
et
 Advi
setouseDermadewbabysoap(
gly
cer
in,
al
oev
era,
coconutoi
l
)
orDove/
Pearssoapf
orbat
hing.
 Moist
uri
zersli
keel
over
a/cet
aphi
llot
ionf
orLAt
obeappl
i
edj
ust
af
terbat
hing.
I
fnoi mpr
ovement-Eumosonecr
eam (
clobet
asone)f
orLA x1
week.
CHI
CKENPOX/
VARI
CELLA
I
nfectionisbyexposuretorespi
rator
ydroplets,ordi
rectcont
act
wit
hl esi
ons,withi
naper i
odlasti
ngfrom threedayspr i
ortothe
onsetoftherash,t
ofourdaysaft
ertheonsetoftherash.
 Cent
ri
pet
all
ydi
str
ibut
edv
esi
cles.
 Keept
heski
ncl
eanbyf
requentshower
s.
 Av
oidv
igor
ousr
ubbi
ng.
Tr
eat
ment
 TAcycl
ovi
r800mg(
Zov
irax200,
400,
800mgav
ail
abl
e)(
1-1-
1-1-
1)
x7days
 TCPM
 TRant
ac
 Cal
ami
neLot
ionf
ororMupi
roci
nOi
ntf
orLAont
othev
esi
cles.
I
fsecondar
yinf
ect
ion:
Amoxi
clav
/Azi
thr
omy
cin
Not
e:Acy
clov
irf
orchi
l
dren-20mg/
kgQI
Dor80mg/
kg/
daydi
vint
o5
doses,
Zov
irax(
400/
5)
BALANI
TIS(
BALANOPOSTHI
TIS)
 Gent
leret
racti
onoftheforeski
ndai
l
yandsoaki
nlukewar
m wat
er
t
ocleanpenisandfor
eskin.
 Av
oidsoapswheni
nfl
ammat
ioni
spr
esent
.
 Useamoi
stur
isi
ngcr
eam/
oint
ment(
emol
l
ient
)tocl
ean,
inst
eadof
soap.
 Cl
otr
imazol
eLAf
orcandi
dial
bal
ani
ti
s.
 Ant
ibi
oti
coi
ntment
sli
keneospor
in,
ifbact
eri
ali
nfect
ionsuspect
ed.
 Mil
d Ster
oids l
ike Betamet
hasone 0.
05% f
ori
nfl
ammat
ion i
n
addi
ti
ontoanti
biot
iccreams.
Note:Ster
oidcr
eamsshoul
dn’
tbeusedal
one,asi
tmaywor
sent
he
i
nfecti
on.
NON-
SPECI
FICURETHRI
TISI
NMEN
 TAzi
thr
omy
cin1gm,
singl
eor
aldoseor
 TDoxy
cycl
i
ne100mgBDx7-
14day
sor
 TLev
ofl
ox500mgODx7day
sor
 TOf
lox300mgPObdx7day
s
PHOTODERMATI
TIS
 Av
oidSunexposur
e
 Appl
ySunbanl
oti
on20mi
nut
esbef
oregoi
ngout
.
 Bet
amet
hasonef
orLAatni
ghtf
or1-
2weeks.
 TCet
ri
zi
ne10mgHS
COMMONPSYCHI
ATRI
CDI
SORDERS
Not
e:I
deal
l
yal
way
sref
ert
hepat
ientt
oaPsy
chi
atr
ist
.
BI
POLARDI
SORDER
Mani
cepi
sode
 I
naggr
essi
vept
’s:
Inj
Hal
oper
idol
5mgI
M,orI
njLor
a2mgI
M
Or
aldr
ugs
 TVal
proat
e5001-
0-1[
Lit
hium i
stheDOC]
 TOl
anzapi
ne5mg0-
0-1
 TRi
sper
idone1or2mg1-
0-1
 THal
oper
idol
5mg1-
0-1
 TQuet
iapi
ne100mg0-
0-1
 TLor
a1mg0-
0-1
Depr
essi
onepi
sode
 TEsci
tal
opr
am 5mg0- 0-1x2weeks;aft
er2weeks10mgHSx
2weeks(T.
N-Nexi
to,
stal
opam,
szetal
o,ci
lent
ra,
cit
el,
cit
ofast
)
 TCl
onazepam 0.
5mg0-0-1x2weeks;aft
er2weeks0.25mgHS
x2weeks(T.
N-Clonot
ri
l,
clonaf
it
,epi
zam,l
onazep,
ri
vot
ri
l)

OBSESSI
VECOMPULSI
VEDI
SORDER
 TFluoxet
ine200-
0-1orSer
tral
i
ne50mg0-
0-1orEsci
tal
opr
am
(
SSRIs)
 T Quet
iapi
ne 100 mg 0-
0-1 orRi
sper
idone orOl
anzapi
ne (
for
augmenti
ngSSRIs)
 Ant
ianxi
etyagent
sli
keNi
tr
azepam 100-
0-1(
foraugment
ati
on)
GENERALI
ZEDANXI
ETYDI
SORDERS(
GAD)
Charact
erizedbyexcessi
ve,uncont
rol
labl
eandoftenir
rat
ional
wor
ryt
hat
i
s,apprehensiv
eexpectat
ionabouteventsoract
ivi
ti
es
 Cogni
ti
vebehav
iort
her
apy
 Phar
macot
her
apy
o SSRI
s:E.
g.Esci
tal
opr
am 10mg1-
0-0
o SNRI
s:TDul
oxet
ine201-
0-0
 o TCA:
Tami
tr
ipt
yli
ne101-
0-1x2weeks
SCHI
ZOPHRENI
A
I
fpat
ienti
saggr
essi
ve:
oI
njLor
a2mgI
M orsl
owI
V
oI
njHal
oper
idol
5mgI
M +Phener
gan12.
5mgI
M st
at
 Ant
i-
psy
chot
ics:
o TRi
sper
idone1mg1-
0-1
o TOl
an15mg0-
0-1
o TQuet
iapi
ne251-
0-
 Depot inject
ions: Fluanxol (
fl
upent
ixol
) gi
ven f
or c/
c
schi
zophr
enicsevery2-
4weeks.
 TPar
kin2mgBD(
tri
hexy
pheni
dyl
)
o To pr
event dystoni
c movements/ext
rapyr
ami
dal
sy
mpt
oms/akat
hisi
aassoci
atedwi
thant
ipsychot
ics
OBSTETRI
CS&GYNECOLOGY
MENORRHAGI
A
Age<20y
ear
s R/
Ohemat
ologi
cal
causes
TTr
anexaMF1-
1-1or
T Sy lat
e 500 mg 1-
1-1
(
ethamsyl
ate)
I
ronsuppl
ement
s
20-
40y
ear
s TTr
anexaMF/
Sil
ate
>40y
ear
s Ref
ert
oGy
necol
ogi
stf
orD%C

AMENORRHEA
Commoncauses
 Pr
egnancy(
DoUr
inePr
egnancyTest
)
  Lact
ati
on
 Hy
pot
hyr
oidi
sm
 Hy
per
prol
act
inemi
a
I
nvest
igat
ions
 TSH/
FT4
 SPr
olact
inl
evel
s
 CT/
MRIf
orassessi
ngpi
tui
tar
y
Tr
eat
ment
 Cor
recthy
pot
hyr
oidi
sm
I
fthy
roi
d&pi
tui
tar
yst
atusnor
mal
,i
nducewi
thdr
awal
bleedi
ngwi
th
 T Meprate or Pr
over
a or Modus 10mg OD/
BD X 5-
10dy
s
[
Medroxypr
ogest
eroneAcet
ate]
.
 Usual
l
yper
iodsmayoccuri
n1wk.
 Howev
er,
ifi
tfai
l
sdoFSHl
evel
est
imat
ion
oI
fFSHi
slow-Pi
tui
tar
ylesi
on
oI
fFSHi
shi
gh-Ov
ari
anl
esi
on
Ref
ert
oGy
necol
ogi
st.
DI
SCHARGEPV
Whi
ti
shdi
schar
ge-Vul
vov
agi
nalCandi
diasi
s
 Candi
dV6cr
eam or
 Cansof
tCLv
agi
nalt
ab(
cli
ndamy
cin+cl
otr
imazol
e)1PVHSx1
weekor
 TFl
uconazol
e150mgsi
ngl
edoseor
 AFkit( f
luconazol
ex1 morni
ng+ azit
hromyci
nx1 af
ter
noon+
or
nidazol
ex2ni ght)si
ngl
edaydosef
orbothpar
tner
s
Gr
eeni
shy
ell
owpur
ulentdi
schar
ge-Tr
ichomonasi
nfect
ion
 Tr
eatbot
hpar
tner
s
  TMet
roni
dazol
e500mgTDSx7day
sor
 TTi
nidazol
e2gsi
ngl
edose
Forbact
eri
alv
agi
nosi
s
 TMet
roni
dazol
e500mgBDor
all
yx7day
s
 TCl
i
ndamy
cin300mgBDx7day
s
PELVI
CINFLAMMATORYDI
SEASE
Ri
skf
act
ors Cl
i
nicalf
eat
ures
 Mul
ti
plesexual
fact
ors  Bil
ater
al l
ower abdomi
nal
pai
n
I
UDi
nser
ti
on
 Abnor
mal
vagi
nal
dischar
ge
 Bact
eri
alv
agi
nosi
s
 Menomet
ror
rhagi
a
 Cer
vici
ti
s
 Post
coi
tal
bleedi
ng
 Fev
er
I
nvest
igat
ions  CBC,
ESR,
CRP
 USGA/
P
Tr
eat
ment I
njCeft
ri
axone250mgI
M si
ngl
e
dose
+
TOf
lox4001-
0-1x14day
s
+
TMet
rogy
l500mg1-
0-1x14day
s

POSTPONEMENTOFPERI
ODS
 TPr
imol
ut-
N5mg1-
0-1[
Nor
ethi
ster
one]
o St
art3-
5day
sbef
oreexpect
eddat
eofper
iods
o Cont
inueupt
oneededper
iod
 POST-
COI
TALCONTRACEPTI
ON
 Wi
thi
n72hr
s
o I-
PILL1t
abst
at&1t
ab12hour
slat
er[
Lev
onor
gest
rel
]
o TMif
epristone600mg(200mgx3)foll
owed2daysl
aterbyT
Mi
soprostol4mg[TMisoprost
]assi
ngledose.
I
UCDi
nser
ti
onwi
thi
n5day
s
Trade name of Mi
epr
ist
one:T.Mt
pil
l
,T.Unwant
ed,T.Mi
fegest
(Cost
~1000r
s)
I
NJECTABLECONTRACEPTI
VES
InjDepotPr
overa(Medroxy
progest
eroneAcetat
e)150mgdeepI
M
every90daysduri
ngfi
rst5daysofmenstrual
cycle
OR
I
njNor
ist
erat(
noret
hist
eroneenant
hat
e)200mgdeepI
M dur
ing
f
ir
st5daysofmenst
rualcycl
eat2monthsi
nter
val
DYSMENORRHEA(
PAI
NFULMENSTRUATI
ON)
I
njCy
clopam/
Vov
eran1ampI
M st
atATD
 TMef
tal
-Spas(
Mef
enami
caci
d+di
cycl
omi
ne)
 TDr
oti
n-M(
Drot
aver
ine+Mef
enami
caci
d)
Not
e:I
fpat
ientdoesn’
trespondt
othet
reat
ment
,suspectendomet
ri
osi
s.
ENHANCEMENTOFLACTATI
ON
 CLact
are2-
2-2x5day
s(Aspar
agusr
acemosus200mg,wi
thani
a
somni
fer
a100mget
c)
 TPer
inor
m 10mg1-
1-1x5day
s
SUPPRESSI
ONOFLACTATI
ON
 T.B-
long(
pyr
idoxi
ne)100mg2-
2-2
MENOPAUSE
 Nut
ri
ti
ousdi
etwi
thpr
otei
ns
 Wei
ghtbear
ingexer
cises
 TCal
ci
um +Vi
tami
nD
 Papsmear/Br
eastexami
nat
ion
 TEsci
tal
opr
am 10mg0-
0-1
BLEEDI
NGPVI
NPREGNANCY
 Al
way
sref
ert
oGy
necol
ogi
sti
mmedi
atel
y.
DRUGSC/
IINLACTATI
ON
 Ci
plof
loxaci
n  Amphet
ami
ne
 Fl
uconaz
ole  Et
hosucci
mide
I
odi
des I
ndomet
haci
n
 Ket
oconazol
e  Ant
i-
cancerdr
ugs
 Met
for
min  Chl
orampheni
col
 Tet
racy
cli
ne  Er
got
ami
ne
 Ami
l
ori
de  Ami
odar
one

DRUGSTOBEUSEDWI
THSPECI
ALPRECAUTI
ONI
NLACTATI
ON
 ACEI  Ephedr
ine
 Acy
clov
ir  Fur
osemi
de
 Ami
nogl
ycosi
des  Losar
tan
 Aml
odi
pine  Met
ocl
opr
ami
de
 Ampi
cil
l
in  Met
roni
dazol
e
 Amoxi
ci
ll
i
n  Mont
elukast
 Ant
iconv
ulsant
s  Mor
phi
ne
 Ant
ihi
stami
nes  Nal
dixi
caci
d
 Azi
thr
omy
cin  Ni
fedi
pine
 Bet
abl
ocker
s  Nor
fl
oxaci
n
  At
orv
ast
ati
n  Omepr
azol
e
 Cor
ti
cost
eroi
ds  Penci
l
li
ns
 Cot
ri
moxazol
e  Rani
ti
dine
 Tr
amadol  Theophy
ll
ine
 Di
azepam  Car
bamazepi
ne
 Ket
orol
ac

HYPEREMESI
SGRAVI
DARUM
Di
ff
erent
ialdi
agnosi
s
 Vesi
cul
armol
e  Hy
per
thy
roi
dism
 Mul
ti
plepr
egnancy I
rr
it
abl
eBowel
Syndr
ome
 Hepat
it
is  Nephr
oli
thi
asi
s
 Appendi
cit
is  Pancr
eat
it
is
 Bi
l
iar
ydi
sease  Pept
icul
cerdi
sease
 DKA  Acut
ePar al
yti
cIl
eus/
Bowel
Obst
ruct
ion
 Esophagi
ti
s
 Hy
per
par
athy
roi
dism
 Fat
tyLi
ver
 Gast
roent
eri
ti
s
 GERD
 CBC,
PCV
 LFT,
RFT
I
nvest
igat
ions  El
ect
rol
ytes
 β-
hCG
 TSH,
FT4
 URE
  Ur
ineacet
one
 USGA/
P

Tr
eat
ment
I
njEmesetI
VSOS
I
Vfl
uids
 TDoxi
nat
e(doxy
lami
ne+py
ridoxi
ne)
CYCLI
CMASTALGI
A
 Vi
tE200-
600mgOD(
Evi
on)
 NSAI
Ds(
oral
&topi
cal
)
 Pr
operBr
eastSuppor
t
 CCodesof
t500mgBD/
TDS(
Eveni
ngpr
imr
ose)
Ref
ert
oSur
geont
ooutanyl
ump.
ECLAMPSI
A
Cl
i
nicalf
eat
ures
 Sei
zur
es  Pr
otei
nur
ia
 Hi
ghBP
 CBC,
 LFT,
RFT
I
nvest
igat
ions  El
ect
rol
ytes
 PT-
INR
 aPTT

Tr
eat
ment
 Lef
tlat
eral
posi
ti
on,
prot
ectai
rway
,admi
nist
erOxy
gen.
 Ensur
ewi
debor
eIVaccess
 I
njMagnesi
um sul
phat
e20% sol
uti
on,6gsl
ow I
Vov
er15-20
minut
es.
o Maintenancet
her
apyi
sgi
venasi
njMgSO41g/
hri
nfusi
onf
or
24hrs.
o Af
tereach4hr,Checkur i
neoutput,RR&examineKneej
erk
&monitorf
oradver
seeffectsofMgSO4l i
keur
inar
yret
ent
ion,
muscl
eweakness,respi
rator
ydist
ress.
Not
e:Ineclampsi
cpat ientswi
thlow BP ordecr
easeduri
neoutput,
MgSO4shouldbewithheld,I
Vfl
uidsadmi
nist
ered&sei
zur
escont
roll
ed
wi
thDi
azepam orl
orazepam.
Warnthe ptoft
he war
m f
eel
i
ng t
hatwi
l
lbe f
eltwhen MgSO4 i
s
admi
nist
ered.
POLYTRAUMAPATI
ENT
Allpat
ientspresenti
ngpolytraumamustbeassumedtohaveinj
uri
esto
thecervi
calspine,unlessotherwi
sepr
ovedandstr
ictat
tent
ionmustbe
givent
oi mmobi l
izat
ionoftheneck.
 UpperAir
wayi
s est
abl
i
shed & mai
ntai
ned wi
th cer
vicalspi
ne
cont
rol
.
 Breathi
ng (ort
he adequacy ofai
rexchange)i
s ev
aluat
ed &
establi
shed.
 Ci
rcul
ati
on-bl
oodpr
essur
eisev
aluat
ed&cor
rect
ed,
&bl
eedi
ngi
s
ar
rest
ed.
 Defi
cit
s ofneur
ologi
cfunct
ion ar
eident
if
ied & t
reat
menti
s
i
nit
iat
ed.
Ai
rway
Ift
hepati
entcanspeaknor
mal
l
y,ar
easonabl
eai
rwaypr
obabl
y
exi
sts.
 Pat
ient
swithouti
nspi
rat
oryeff
ort&t
hosewit
haGCSscor eof8or
l
essrequi
reint
ubat
iontoest
abli
sh&secur
eafunct
ional
air
way.
I
njurytot he l
ary
nx/tr
achea can occurf r
om eitherbl
untor
penet
rat
ingtr
auma;subcut
aneousemphy sema,ai
rwayobst
ruct
ion,
 dysphoni
a,l
ackoft
hyr
oidcar
ti
lagepr
omi
nencear
eseeni
nsuch
tr
auma.
 Tr
acheost
omyi
sneededi
nthepr
esenceofunst
abl
eai
rway
.
 Phar
ynxmustbeassessedt oexcludelocalobst
ruct
ionr
elat
edto
post
eriormov ementoft hetongueort hepresenceofswelli
ng,
bl
eeding,secr
eti
ons,orgast
ri
ccontents.
 Rigi
dsuct i
on& manualextr
act
ionshoul
dbeusedt
ocl
eart
he
pharynxofanyf
orei
gnbody.
 Obst
ructi
on ofairway caused by post er
iormov ementoft he
t
onguemaybequi cklycorrectedbytheinsert
ionofanoralai
rway
&orthehead-t
il
tchin-
li
fttechnique(i
fnonecki nj
ury
)orjaw-
thr
ust
maneuver(i
fnecki
njuryissuspected).
Br
eat
hing
 Aft
eran airwayissecured & v
enti
lat
ion wi
th O2 i
nit
iat
ed,t
he
adequacyofai
rexchangemustbeassessed.
 LookforRR>30/ mi
n,unequalchestmov ement
s,gr
osstracheal
devi
ati
on,f l
appingchestwounds.Bil
ateral&symmetri
cbr eath
sounds(bestheardi
naxil
la)shoul
dbepr esenti
mmediat
elyafter
i
ntubat
ionorotherai
rwayestabl
i
shment.
 When probl
ems associated with endotrachealintubati
on are
excl
uded & v enti
l
ation/oxygenati
on r emains i nadequate,
hemothor
ax,si
mple/
tensionpneumot horax,flai
lchest,aspi
rat
ion
etcmustbeconsi
der
ed&cor r
ectedifpresent.
Ci
rcul
ati
on
 Bl
oodpr
essur
eisev
aluat
ed&bl
eedi
ngar
rest
ed.
 Eval
uati
ng t he patient
’s pulse, ski
n colour,& l evel of
consci
ousnesscanbeper f
ormedv er
yquickl
y&i tcanprovi
dea
rapi
dbedsideassessmentoftheadequacyofci
rcul
ati
on.
 Ext
ernal
bleedi
ngshoul
dbecont
rol
l
edbydi
rectpr
essur
e.
I
Vaccessshoul
dbeest
abl
i
shedusi
ng16Gcannul
a.
I
Vfl
uids&bl
oodr
epl
acementshoul
dbedone.
Def
ici
tofneur
ologi
cfunct
ionar
eident
if
ied&t
reat
menti
nit
iat
ed.
Init
ial
lythe pati
ent’
s ov eral
lneur
ologic st
atus may be simpl
y
classif
ied as al
ert
,r esponsi
vetov erbalstimul
i,responsi
veto
painfulst
imuli
,orunresponsivet
oallst
imuli.
 UseGCS.
 Rapidly rever
sibl
e causes of CNS depr essi
on, incl
udi
ng
hypoglycemi
a,wernickeencephal
opathy
,opi
ateoverdosemustbe
considered&prophylact
ical
l
ytr
eated.
Exposur
e
 Pati
ent
s may be undr
essed (
mai
ntai
n pr
ivacy
)forcompl
ete
eval
uat
ion.
Secondar
yassessment
 The post
eri
orneck,back,chest& abdomen ar
einspect
ed &
pal
patedf
orlocal
ski
ndisr
upti
onort
enderness.
 Pat
ientwi
thi
ntr
a-abdomi
nalbl
eedi
ng ori
njur
yrequi
re ur
gent
l
aparot
omy
.
 Assessmentofv
isi
onmaybeunder
takeni
nconsci
ouspat
ient
s.
 Bi
lat
eralequalbr
eat
hsounds& hear
tsoundsshoul
dagai
nbe
ev
aluated.
 Thegeni
tal
i
aar
eexami
ned.
 Theext
remit
iesareexaminedforev
idenceofhemat
oma,
crepi
tus,
def
ormi
ty,&peri
pheralpul
ses.
 Perf
orm CCT( chestcompressi
ontest
),PCT(
pel
vi
ccompr
essi
on
test
),SLR(
str
aightlegr
aisetest
).
 Lookf
ort
ender
ness/
crepi
tat
ionsofr
ib.
 Look for spine t
ender
ness/ l
ong bone i
njur
ies,pal
pat
efor
peri
pheral
pulses.
 Lookf
ori
ntr
a-or
ali
njur
ies.
 Lookf
orBat
tl
e’
ssi
gn&Racooney
e.
  Cat
het
eri
sei
fpti
sint
ubat
edorGCSi
sdet
eri
orat
ing.
 Gi
veI
njTT(
ifi
ndi
cat
ed)
,IVf
lui
ds(
avoi
ddext
rose,
giv
eNS/
RL)
 Anal
gesi
cs-avoi
dtramadolasitmaycausedr owsi
ness&t
hus
mayint
erf
erewi
thcl
i
nical
assessmentofpat
ient
 Fr
act
uresar
eal
i
gned&spl
i
nted.
Radi
ologi
calst
udi
esar
edoneaf
tert
hepat
ienti
sst
abi
l
ised.
 Chestx-
rayPAv
iew
 X-
rayCspi
neAP/
lat
eral
view
 USSabdomen
 CTBr
ain
 X-
raypel
vi
swi
thbot
hhi
ps
 CTBrai
nwithC-
Spi
nescreeningmaybedonei
npat
ient
swi
thhead
i
njur
y&suspect
edcer
vicalspi
neinj
ury
.
HANGI
NG
 Alwaysassumether
eiscer
vicalspi
nei
njur
y–Appl
yPhi
l
adel
phi
a
coll
arunt
ilX-
rayi
sdone
 Ox
ygenbyf
acemaskat8L/
min
I
fSpO2<90%/
GCS<9-gof
ori
ntubat
ion/
tracheost
omy
I
njManni
tol
20%100ml
IVst
atov
er20mi
nut
es
I
njMethyPr edni
solone1gi
n100mlNSov
er30mi
nIVst
at(
to
pr
eventt
rachealedema)
I
njEpt
oin100mgI
VQ8H(
forpr
event
ion&cont
rol
ofsei
zur
e)
I
njPant
op
I
nser
tRy
le’
stubeandFol
ey’
scat
het
er
 Ant
ibi
oti
cs–I
njCef
tri
axone+Met
rogy
lifaspi
rat
ioni
ssuspect
ed
Ref
ert
ohi
ghercent
ref
ormedi
cine/
neur
osur
ger
yconsul
tat
ion.
Regi
steral
lhangi
ngcasesasMLCandsendPol
i
cei
nti
mat
ion.
Note:Aggressi
ve behav
iour i
s due t
o hy
poxi
a & shoul
d pr
ompt
venti
l
ator
ymanagement.
DROWNI
NG
Cl
i
nicalf
eat
ures
 Dy
spnea
 Al
ter
edconsci
ousness
 Hy
pot
ensi
on
 Tachy
car
dia/
arr
hyt
hmi
as
 Sedi
ment
sinor
alcav
ity
Tr
eat
ment
I
mmobi
l
iset
heneckwi
thhar
dcer
vical
col
l
ar
 Remov
ethewetcl
othi
ngandwr
apt
hev
ict
imi
nwar
mingbl
anket
s
 Ai
rway
o 100%O2bymask
o Ai
rwaysuct
ion
o Mayneedmechani
cal
vent
il
ati
on
I
njMet
hyl
predni
sol
one1gI
Vst
at
 Ant
ibi
oti
cs-I
njCef
tri
axone+I
njMet
rogy
l
I
njManni
tol
20%100ml
over20mi
nut
es
I
njLasi
x40mgI
Vst
at
I
njEpt
oin100mgI
VQ8H
 Nebul
i
sat
ionwi
thsal
but
amol
+budesoni
de+i
prat
ropi
um
Ref
ert
ohi
ghercent
ref
ormedi
cineconsul
tat
ion.
Regi
steral
ldr
owni
ngcasesasMLCandsendPol
i
cei
nti
mat
ion.
ELECTRI
CALI
NJURI
ES
Cl
i
nicalf
eat
ures
  Ent
ry&exi
tbur
ns
 Haemor
rhagebehindt
heintactt
ympanum i
sanoccasi
onalf
eatur
e
i
nl i
ght
ning i
njur
y;perf
orati
on ofthe t
ympani
c membr ane i
s
common.
 Hi
ghener
gyelect
ri
cali
njur
ycausesmassi
vemuscl
edamagewi
th
myogl
obi
nur
ia.
 Vent
ri
cul
arf
ibr
il
lat
ionmayoccur
.
I
nmal
esbur
nsmayoccuront
heunder
sur
faceoft
hescr
otum.
I
nvest
igat
ions
 CBC
 ECG
 LFT,
RFT,
Elect
rol
ytes
 UREf
ormy
ogl
obi
n
 CPK
 ABG
Tr
eat
ment
 Admi
nist
erOxy
gen
 Moni
torECGf
orar
rhy
thmi
a
 Cer
vical
spi
nei
mmobi
l
izat
ion
 Pr
ovi
depai
nrel
i
ef
I
VF-RL10ml
/kg/
hrx3hour
s
o Hydrat
ioni
sthekeyt
oreducet
hemor
bidi
tyofel
ect
ri
cal
i
njur
y
I
njManni
tol
20%100ml
IVov
er20mi
naf
terhy
drat
ion
o Provi
desdiuresi
sf orpr
eventi
onofa/ ctubul
arnecr
osi
s&
renal
fai
l
ure,secondaryt
omy oglobi
nur
ia
 Lookf
ormet
abol
i
caci
dosi
s–Gi
vesodi
um bi
car
bonat
eifneeded
  Fasci
otomy may be needed t o improv
e ci r
culati
on i
n
ci
rcumferent
ial bur
ns or when compar
tment syndrome i
s
suspect
ed.
Ref
ert
ohi
ghercent
ref
ormedi
cine/
sur
ger
yconsul
tat
ion.

SNAKEBI
TE
I
nvest
igat
ions
 20mi
nwhol
ebl
oodcl
ott
ingt
est
 CBC
 RFT
 El
ect
rol
ytes
Si
gnsofenv
enomat
ion/
Indi
cat
ionsofASV
 Bi
tesi
te–pai
n,edema,
tender
nessandbl
eedi
ng
 Anybl
eedi
ngmani
fest
ati
on–gum bl
eedi
ng,epi
staxi
s,hemat
uri
a
et
c
 20mi
nut
ewhol
ebl
oodcl
ott
ingt
est–abnor
mal
 Feat
uresofneur
otox
ici
ty
o Pt
osi
s
o Di
plopi
a
o Dy
sphagi
a
o Al
ter
edsensor
ium
o Si
ngl
ebr
eat
hcountt
est–nor
mal
>30
Tr
eat
ment
 Nev
erappl
ytour
niquet
oI
fal
readyappl
i
ed,
thenr
eleaset
hepr
essur
esl
owl
y
 Bi
tesi
teshoul
dbepr
oper
lycl
eaned
I
njTT0.
5ml
IM st
at
I
njCef
tri
axone+Met
rogy
l
I
njASV10v
ial
sin1pi
ntNSov
er1hour
o St
artwi
th10dr
opspermi
nut
eforf
ir
st5mi
nut
es
o Lookf
orbr
onchospasm andhy
pot
ensi
on(
anaphy
laxi
s)
o Theni
ncr
easei
nfusi
onr
atet
ofi
nishi
n1hour
I
fanyev
idenceofanaphy
laxi
s
oI
njHy
drocor
t200mgI
Vst
at
oI
njAv
il1ampI
M st
at
oI
VF–NSr
api
dbol
us
oI
njAdr
enal
i
ne-(
1mg/
mLpr
epar
ati
on)(
1/1000di
l
uti
on)
 0.
3t o0.5mgi
ntr
amuscul
arl
y,pr
efer
abl
yint
hemi
d-
out
erthi
gh.
 Canrepeatev
ery5t
o15mi
nut
es(
ormor
efr
equent
ly)
,
asneeded.
If sy
mptoms ar e not r
espondi
ng t
o 2-3 doses
epi
nephr
ine i
nject
ions,pr
epareIV epi
nephr
ine f
or
i
nfusi
on
 Forv
ascul
otoxi
csnakebite–do20mi nWBCTaf
ter6hour
sof
ASVinf
usi
onandreassesst
hepat
ient
oI
ndi
cat
ionsf
orf
urt
her10v
ial
ASV
 Abnor
mal
20mi
nWBCT
 Pr
ogessi
onofl
ocal
swel
l
ing/
signs
 Bl
eedi
ngmani
fest
ati
ons
o Usuall
y30v ial
sofASVi st
hemaxi
mum neededdosef
or
vascul
otoxi
csnakebi
tes
 Neur
otoxi
csnakebi
te
o Gi
ve20v
ial
sASVi
nthef
ir
sthour
oI
njNeost
igmi
ne0.
5mgev
ery15mi
nti
l
lpt
osi
simpr
ovesand
 t
it
rat
e
oI
njAtropi
ne 0.6 mg ever
y15 mi
n and t
it
rat
eto pr
event
muscari
nicsi
deeffect
s
Ref
erneur
otoxi
csnakebi
tesandAKIpat
ient
stohi
ghercent
re.
ACS-
STEMI
 Loadi
ngdose
o TDi
spi
ri
n(Aspi
ri
n)325mgt
ochew
o TCl
opi
drogel
300mgst
at
o TAt
orv
ast
ati
n80mgst
at
 Pai
nmanagement
o O2i
fSpO2<90%orpat
ienti
sdy
spnei
c
o TNi
tr
ogl
ycer
in0.
4mgev
er5mi
nupt
o3dosessubl
i
ngual
 Cont
rai
ndi
cat
ions
 SBP<90mm Hg
 RVMI
 TakenSi
l
denaf
ili
nlast48hr
s
oI
njMet
opr
olol
IV5mgev
er5mi
nupt
o3doses
 Cont
rai
ndi
cat
ions
 PR<60/
min
 SBP<100mm Hg
 Hear
tbl
ocks
 COPD
 Sev
erepul
monar
yedema
o TCl
onazepam 0.
5/1mgst
at
oI
njMor
phi
ne2-
4mgev
ery5mi
n
 NOTPREFERRED
 Inf
eri
orwal
lMIandRVMI–gi
veI
Vfl
uidsaspat
ient
swi
l
lgoi
nto
shock
o Nor
adr
enal
i
nei
sgi
veni
fnotr
espondi
ngt
oIVF
 Ant
eri
orwal
lMI
o Pat
ientmayhav
ehi
ghBP
o St
artNTGi
nfusi
onandt
it
rat
e
I
fpatientpr
esentswit
hin12hour
sofonsetofchestpai
n– pat
ient
needsthr
ombolysi
sorPCI
.
Ref
eral
lpat
ient
stocar
diol
ogi
staf
terst
abi
l
izat
ion.
HYPERKALEMI
A
K+>5.
5mEq/
L
Cl
i
nicalf
eat
ures
 Muscl
eweakness/
cramps
 Par
aest
hesi
a
 Ar
rhy
thmi
as
 ECGchanges
o Tal
lpeakedTwav
es
o Pr
olongedPRandQRS
o Lossofpwav
e
o Si
newav
epat
ter
n
Tr
eat
ment
Hy
per
kal
emi
cemer
gency
 K>6.
5meq/
L I
njCagluconate10%10ml
over10minut
esIV
 ECGchanges
InjRegInsul
in5unit
sin50
 Sy
mpt
omat
ic
mlof50%dext roseIVover
30mi n(CheckGRBSbefore
andafter
)
  Nebul
i
sat
ion wi
th
sal
but
amol
K+r
emov
al
 K-
bind/K-
str
ynsachet(
cal
cium pol
yst
yrenesul
fonat
e)5-
10mgi
n
15ml sor
buli
ne
 Di
uret
ics
 Hemodi
aly
sis

Not
e–Sor
bul
i
necancausei
ntest
inalnecr
osi
s.
STROKE
 Est
abl
i
shI
Vli
nei
mmedi
atel
y
 Fol
ey’
scat
het
eri
fur
inar
yincont
inence
 CheckGRBSandECGi
mmedi
atel
y
o Hy
pogl
ycemi
acanmi
micst
rokesy
mpt
oms
o ACScanpr
esentwi
thLOC
 Oncepat
ienti
sst
abi
l
ized–sendf
orNCCTbr
ain
I
nser
tRy
le’
stubei
fther
eisdy
sphagi
a
I
fCTshowsI
Cbl
eed
I
njManni
tol
20%100ml
over20mi
nIVst
at
I
njPant
op
I
njLor
a/Pheny
toi
nSOS
o Onl
yifsei
zur
esar
epr
esent
o Don’
tgi
veaspr
ophy
laxi
s
I
fBP>220/
110mm Hg
oI
njLabet
alol
20mgI
Vov
er5mi
n
o TTel
misar
tan40-
80mgv
iaRy
le’
stube
 o KeepBPbel
ow220/
110mm Hg
I
fSAH–TNi
modi
pine30mg2-
2-2-
2
 Par
acet
amol
iff
everi
spr
esent
I
VF–NSaccor
dingt
ovol
umest
atus
I
fGRBS>180mg/
dl–I
njRegi
nsul
i
n
I
fCTshowsi
nfar
ct
 TAspi
ri
n300mgst
atand75mgOD
 TCl
opi
drogel
75mgOD
 TAt
orv
a20-
40mgOD
I
njPant
op
I
njManni
tol
–ifcer
ebr
aledema
I
njLor
a/Pheny
toi
n
I
VF–NS
 KeepGRBS<180mg/
dl
 ReduceBPi
f>220/
110mm Hg–wi
thsameagent
s
 Aggr
esi
vel
ytr
eatf
ever
NEEDLESTI
CKI
NJURI
ES
I
mmedi
atecar
e
 Forneedl
est
icki
njur
ies& f
orski
nexposur
e:washwi
thsoap&
water
.
 Formucousmembr anesplashe.gey es:maket heptli
edown,
opentheconcernedeye&al l
ow1pi ntofNS( connect
edtoanI
V
set
)torunfr
eelyint
otheconjunct
ival
sac.
Tr
eat
ment
Exposur
etoHepat
it
isBposi
ti
vepat
ient
 Notv
acci
nat
ed HBI
G0.
06ml
/KgI
M
I
njEnger
ixB1ml
IM at0,
1and6
 Pr
evi
ousl
yvacci
nat
ed Ant
iHbs>10mI
U/ml
–NoRx
AntiHbs<10mI U/
ml– HBI
G+
vacci
ne3doses
Exposur
etoHCVsour
ce
 CheckAnt
i-
HCVant
ibodyandLFTat0,
3&6mont
hs
Exposur
etoHI
Vsour
ce
 Dobasel
i
neBRE,URE,LFT,RFT,HBsAg,ant
iHCVandELI
SAf
or
HI
V
 Ef
fect
ivei
fadmi
nist
eredwi
thi
n72hr
sofexposur
e
 Basi
cregi
men
TZidol
am (
zidov
udi
ne300mg+l
ami
vudi
ne150mg)1-
0-1X
4weeks
 Ext
endedbasi
cregi
men
TI
ndi
nav
ir400mg2-
2-2OREf
avi
renz600mgOD+basi
c
r
egi
menX4weeks
 TDomst
al10mgSOS
 Repeati
nvest
igat
ionsat4weeks,
3mont
hsand6mont
hs
 Weekl
yHbmoni
tor
ing(
zidov
udi
ne-hemat
ologi
cal
toxi
cit
y)
 Ref
ert
oARTcent
re

POI
SONI
NG
 Earl
yident
if
icat
ion of t
he t
oxi
c subst
ance sav
es t
ime &
decr
easest
oxici
ty.
I
fpossibl
e,ret
ri
evet
hecont
aineroft
heof
fendi
ngsubst
ancef
or
i
dent
if
icati
on.
 Hy
pogl
ycemi
amustbeexcl
udedi
nal
lcomat
osepat
ient
s.
 Sentgast
ri
clav
agesampl
efort
oxi
col
ogi
calst
udy
.
 Regi
sterasMLCandsendpol
i
cei
nti
mat
ion.
Cont
rai
ndi
cat
ionsf
orgast
ri
clav
age
I
ngest
ionofcor
rosi
ves(
aci
ds,
alkal
i
s,oxi
dant
s)
 Vol
ati
l
ehy
drocar
bons(
ker
osene,
pet
rol
).
Unprot
ectedair
wayinacomat
osepat
ient
:fi
rstper
for
mint
ubat
ion&
thenper
formlavage.

Pr
imar
ycar
e
 Ai
rway
o Assessai
rwayf
orobst
ruct
ion
o Remov
eor
alsecr
eti
ons
oI
fthepat
ienti
scomat
ose,
inser
tor
ophar
yngeal
air
way
(OPA)
o Nur
set
hepat
ienti
nlef
tsemi
proneposi
ti
on
 Br
eat
hing
o Mostpoisons t
hatdepr
ess consci
ousness al
so i
mpai
r
r
espi
rat
ion
oI
fbr
eat
hingi
sinadequat
e,i
ntubat
e&v
ent
il
ate
 Ci
rcul
ati
on
o Est
abl
i
shv
enousaccess
o Connectpat
ientt
oanECGmoni
tor
o Cor
recthy
pot
ensi
onwi
thI
Vfl
uids
o Checkf
orancor
recthy
pogl
ycemi
a
 Decont
ami
nat
ion
o Terminate topi
cal exposur
e to poi
son by removi
ng
contaminat
edclot
hing&washingski
nwi
thsoap&wat
er.
o Terminateingest
ed exposureto poi
son by per
for
ming
gastr
iclav
agewithaRyl
e’stube
  Usewat
ermi
xedwi
that
ingeofKMnO4
I
nst
il
l200ml
ofwat
erandt
henaspi
rat
e
 Repeatt
il
ltheaspi
rat
eiscl
ear
 Tr
eatsei
zur
eandhy
per
ther
mia
 Cont
inuousRTaspi
rat
ion
Det
ect&cor
recthy
pogl
ycemi
a,sei
zur
es(
BZDpr
efer
redov
erpheny
toi
n)
&
hy
per
ther
mia
Conti
nousRTaspi
rat
ion,mai
ntai
nNPO f
or48hr
s;r
esumef
eedi
ngon
day3.
Emer
gencyant
idot
eadmi
nist
rat
ion
Ot
her
s
1.
IVF5%D2pi
nts&DNS3pi
nts
2.
Inj
taxi
m 1gi
vQ8H
3.
Inj
Met
roni
dazol
e500mgi
vQ8H
Car
eofcomat
osept
:car
eofbl
adder
,bowel
,ey
es,ski
n,j
oint
s&buccal
mucosa.
Prev
enti
onofaspi
rat
ioni
ntol
ungs:f
requentchangei
nposi
ti
on,cl
ear
ing
ofai
rways,
t
hroatsuct
ion.
Treat
mentofcompl
i
cat
ions-pul
monar
yedema,cer
ebr
aledema,a/
c
renal
fai
l
ure&
hepat
icf
ail
ure.Cont
inousO2i
nhal
ati
on&assi
stedv
ent
il
ati
oni
fneeded.
Psy
chi
atr
yconsul
tat
iononDay5.
80
OPpoi
soni
ng
Inv
:S.Pseudochol
i
nest
erase,st
omach wash sampl
efort
oxi
clol
ogy
analy
sis.
1.
Decont
ami
nat
eski
n-changecl
othi
ng;
washwi
thsoap&wat
er.
I
nduceemesi
s,i
fthepti
sconsci
ousst
omachwashi
sdonewi
thsal
t
wat
er;i
f
unconsci
ouspt
,RTwashi
sgi
ven.
2.
4thhour
lyt
emp/
BPchar
t
Hour
lypul
se,
atr
opi
ne,
pupi
lchar
t
Cont
inousRTaspi
rat
ionf
or48hr
s,CBD,
NPOf
or48hr
s,
Car
eofcomat
osept
:car
eofbowel
,bl
adder
,ey
es,ski
n,j
oint
s&buccal
mucosa.
Prev
enti
onofaspi
rat
ioni
ntol
ungs:f
requentchangei
nposi
ti
on,cl
ear
ing
ofai
rways,
t
hroatsuct
ion.
Rest
rai
nthepti
fneeded;
giv
eint
ermi
tt
entt
hroatsuct
ion;
star
tref
eedi
ng
by72hrsi
f
consci
ous&bowel
sounds+.
3.
Injat
ropi
ne30-
40mgi
vst
(formoder
atepoi
soni
ng)&100mgi
vst(
for
l
if
e
thr
eatening);oral
ter
nat
ivel
y1-
3gi
vbol
us,t
hent
it
rat
eaccor
dingt
o
persi
stenceof
br
onchor
rhoeabygi
vi
ngt
hedoubl
eoft
hepr
evi
ousl
yuseddoseev
ery5
minut
esti
ll
at
ropi
nisat
ioni
sachi
eved.
Checkforsignsofat
ropi
nisat
ion-dr
yski
n,mucousmembr
ane,f
ever
,
tachy
car
dia,
di
latedpupil
s.Mai
ntai
nat
ropi
nisat
ionf
or5-
7 day
s,t
il
ltheef
fectof
poisonweansof
f.
I
njatr
opine50mgi n500ml5D16dr
opspermi
nut
e(ov
er8hr
s)q8h,
wi
thoutproduci
ng
psy
chot
icbehav
iour
.
4.
InjPr
ali
doxi
me(
Aldopam)25-
50mg/
kgi
vbol
us(1-
2gi
n100mlNSi
v
ov
er20mi n,
t
hen500mgbd)
5.
TDi
steni
l101-
1-1(
act
ivat
edchar
coal
)
6.
Inj
taxi
m 1gi
vq8hATDasPx.
7.
Inj
Met
rogy
l500mgi
vq8H.
8.
Inj
pant
oci
d40mgi
vod
9.
IVF5D2pi
nts,
NS3pi
nts.
10.
Inj
hal
oper
idol
5mgi
vst&sosi
fvi
olentbehav
iour
.
11.
Sypcr
emaf
fi
n30ml
tds.
Odol
l
um poi
soni
ng
Expl
ainpr
ognosi
s
I
nv:
ECG,
toxi
col
ogi
cal
anal
ysi
sofgast
ri
caspi
rat
e
1.
Ift
hepthasbr
ady
car
dia,
giv
einj
atr
opi
ne1or2ampi
vst&
I
njAt
ropi
ne1.
2mgi
vsosi
ftheHR<50/
min
2.
Stomachwashi
fthepti
sconsci
ous
3.
RTA/
CBD
4.
Sypcr
emaf
fi
n30ml
tds
5.
TDi
steni
l101-
1-1
6.
Inj
Rant
ac/
Pant
op
7.
IVFasnecessar
y.
Al
so addr
ess t
wo associ
ated compl
i
cat
ions:hy
per
kal
emi
a & hear
t
bl
ocks.
81
Adul
tGl
asgowcomaScal
e
Ey
eOpeni
ng
Response
Spont
aneous-
-openwi
thbl
i
nki
ng4
Openst
over
bal
command,
speech,
orshout3
Openstopai
n,notappl
i
edt
oface(
aper
ipher
alpai
nst
imul
us,suchas
squeezi
ng
thelunul
aareaoft
hepat
ient
'sf
inger
nai
lismor
eef
fect
ivet
hanacent
ral
sti
mulussuchas
at
rapezi
ussqueeze,
duet
oagr
imaci
ngef
fect
).2
None1
Ver
bal
Response
Ori
ented(
Pati
entr
espondscoher
ent
lyand appr
opr
iat
elyt
o quest
ions
suchasthe
pat
ient
’snameandage,
wher
etheyar
eandwhy
,they
ear
,mont
h,et
c.)5
1.Conf usedconv
ersat
ion,butabl
eto answerquest
ions(
Thepat
ient
respondsto
quest
ionscoher
ent
lybutt
her
eissomedi
sor
ient
ati
onandconf
usi
on.
)4
2.I
nappropr
iat
eresponses,wor
dsdi
scer
nibl
e(Random orexcl
amat
ory
ar
ti
cul
ated
speech,but no conv
ersat
ionalexchange.Speaks wor
ds but no
sentences.
)3
I
ncompr
ehensi
blespeech(
Moani
ngbutnowor
ds.
)2
None1
Mot
or
Response
Obey
scommandsf
ormov
ement6
Pur
posef
ulmov
ementt
opai
nfulst
imul
us(e.
g.,br
ingshandupbey
ond
chi
nwhen
supr
a-or
bit
alpr
essur
eappl
i
ed.
)5
Withdr
awsf
rom pai
n(Absenceofabnor
malpost
uri
ng;
unabl
etol
i
fthand
pastchi
nwi
th
supr
a-or
bit
alpai
nbutdoespul
lawaywhennai
l
bedi
spi
nched)4
Abnormal(
spast
ic)f
lexi
on,decor
ti
cat
epost
ureaccent
uat
ed bypai
n
(f
lexor
response:i
nternalr
otat
ionofshoul
der
,fl
exi
onoff
orear
m andwr
istwi
th
clenchedfi
st,l
eg
ext
ensi
on,
plant
arf
lex
ionoff
oot
)3
Extensor(ri
gid)r
esponse,decer
ebr
ate post
ure accent
uat
ed bypai
n
(extensor
r
esponse:adduct
ionofar
m,i
nter
nalr
otat
ionofshoul
der
,pr
onat
ionof
f
orear
m and
ext
ensi
on at el
bow,flexi
on of wr
ist and f
inger
s,l
eg ext
ensi
on,
pl
antar
fl
exi
onoffoot
)2
None1
I
ndi
vi
dualel
ement
saswel
last
hesum oft
hescor
ear
eimpor
tant
.Hence,
t
hescor
e
i
sexpr
essedi
nthef
orm eg.
"GCS9=E2V4M3at07:
35"
.
Gener
all
y,br
aini
njur
yiscl
assi
fi
edas:
Sev
ere,
wit
hGCS<8-
9
Moder
ate,
GCS8or9–12(
cont
rov
ersi
al)
Mi
nor
,GCS≥13.
82
Abscesses
Cut
aneousabscesseswi
tht
ruef
luct
uance(t
heper
cept
iont
hatt
ruepus
i
scontai
ned
wit
hinthetissues)ar
ebestt
reat
edwi
thr
out
inei
nci
sionanddr
ainage.
Localcut
aneous
i
nfect
ionwi
thoutf
luct
uancewi
l
lnotbenef
itf
rom I&D.
Thesepat
ient
s
shoul
dbe
i
nstr
uct
ed to appl
yheatt
othe ar
ea 4-
6ti
mesperday
,recei
ve an
appr
opr
iat
e
anti
staphyl
ococcalant
ibi
oti
csuchascl
oxaci
l
li
norcephal
exi
n,andbe
reev
aluatedin24
t
o48hrs;pat
ient
sshoul
dbet
oldt
hatatt
hatt
imet
heabscessmaybe
r
eadyf
orI&D
Note:ReferDeep and l
arge abscessest
o a sur
geon.Pat
eint
swho
appearsy
stemi
cal
ly
i
ll
withhighf
everorr
igor
s,t
hosewi
thext
ensi
veabscesses,
ort
hosewi
th
di
abetesor
other i
mmunocompromi
sing condi
ti
ons shoul
d be consi
der
ed
candi
dat
esf
orhospi
tal
admi
ssi
onandsur
gical
consul
tat
ion
Themet
hodempl
oyedi
sHi
l
ton’
smet
hod
Askt
hePtt
oli
edownt
oav
oidshocki
nducedbypai
n.
The ar
ea overl
yi
ng and sur
roundi
ng t
he abscess i
s pr
epar
ed wi
th
pov
idone-
iodi
ne.
Localanaesthesi
aispr
ovi
deddependi
ngont
hesi
zeanddept
hoft
he
abscess.Lar
ge
abscessesaregi
venci
rcumf
erent
ialf
iel
danaest
hesi
awhi
chr
equi
re5t
o
10mi nfort
he
areatobecomeanaest
het
ized.
Smal
ltomoder
atesi
zedabscessesar
e
adequat
ely
anaesthet
izedsi
mpl
ybydi
rect
lyi
nst
il
li
ngt
heanaest
het
icagental
ong
thetr
acttobe
i
nci
sed.Li
gnocai
nei
sinf
il
tr
atedsuper
fi
cial
l
yint
heov
erl
yi
ngski
nti
l
l
bl
anchi
ngi
sseen.
Actualinci
si
onshoul
d pr
oceed al
ong nor
malski
nli
nest
o mi
nimi
ze
subsequentscar
f
ormat
ion.
Alwaysremembert
omakeanadequat
einci
sionf
orcompl
etei
nit
ialor
conti
nued
drai
nage.
Theinci
sionshoul
dbeofadequat
elengt
htoal
l
owexpl
orat
ion
andsubsequent
drai
nageoftheabscessov
ert
henextsev
eralday
s.Cl
eanwel
lwi
th
betadi
ne.
Ani
nci
si
on
i
smadei nt
otheskin(
ont
hepoi
ntofmaxi
mum t
ender
ness)&deep
f
aci
a.Af
teri
nci
sion,
asmuchpurul
entmat
eri
alshoul
dber
emov
edaspossi
blebypr
essi
ngat
ther
ootwi
th
cott
onorexpl
orat
ionwi
thar
ter
yfor
ceps,t
il
lfr
ankbl
oodcomes.Asi
nus
for
cepsi
s
passedthr
ought
heopeni
ngi
nthedeepf
asci
atowar
dst
hesi
teoft
he
suspect
ed
abscess.Oncethepusi
sseencomi
ngout
,thebl
untsi
nusf
orcepsi
s
openedtoenlar
ge
theopeni
ng,& to br
eakt
hel
ocul
es.Oncet
hepusi
sremov
ed,t
he
bleedi
ngf
rom t
he
granul
ati
ontissuei
sst
oppedbyat
ightpackofr
oll
ergauzesoakedi
n
betadi
neoint
ment
orGM(gl
ycer
ineMagSul
fat
e)orH2O2t
oreduceedemaatt
hesi
te.The
twoendsoft
he
rol
lergauz
ear
ekeptoutoft
hecav
itybef
oredr
essi
ngsot
hatt
hewhol
e
packis
subsequent
lyt
akenout&not
hingi
slef
tinsi
de.
Thepacki
sremov
edaf
ter
48hrsand
r
epeatpacki
ngmaybedonewi
tht
her
oll
ergauzesoakedi
nXy
locai
ne
j
ell
ytomini
mise
pai
n.Nof
urt
hert
ightpacki
ngi
snecessar
y.
Str
ess the need f
or24-
48 hrf
oll
ow-
up i
n pat
ient
s wi
th si
gni
fi
cant
abscessaspuscan
r
ecol
l
ect
.
Inst
it
uteant
ibi
oti
ctr
eat
mentf
or3t
o5day
sorr
ecommendhospi
tal
admissi
onin
pat
ient
swithsi
gni
fi
cantcel
l
uli
ti
s,sy
stemi
cev
idenceofi
nfect
ion,or
compromi
seoft
he
i
mmunesy
stem (
incl
udi
ngDM)
Anappropr
iat
eanal
gesi
cshoul
dbepr
ovi
dedt
opat
ient
sfor24t
o36hr
s
i
fneeded.
Not
e:Nev
eri
nci
seacel
l
uli
ti
sast
her
eisr
iskofbact
araemi
a
Exci
sionofnai
l
Compl
eteExcisi
on ofnai
lmaybe r
equi
red i
n manycondi
ti
onsl
i
ke
tr
auma,
inf
ect
ionetc
Thepr
ocedur
eisqui
temut
il
ati
ngandi
sbet
teri
fref
err
edt
oasur
geon.
Anaest
hesi
aoft
hedi
giti
sachi
evedt
hroughdi
git
albl
ockwi
thl
i
gnocai
ne.
I
frequi
red
i
nci
sionsar
eput
,or
ient
edpr
oxi
mal
l
yasacont
inuat
ionofLNF.Thenai
l
i
sgrasped&
r
otat
edout
war
dsbot
hfr
om medi
alandl
ater
alsi
de.
83
Di
git
alNer
veBl
ock
Digi
talblocksar
eex
tremel
yusef
ulf
oranest
het
izi
ngt
hedi
git
,ther
eby
faci
l
itat
ingthe
repai
roflacerat
ions,par
ony
chi
adr
ainage,nai
lremov
alandsoon.Each
digi
tissuppl
ied
by two dorsaland pal
mar ner
ve br
anches.To obt
ain adequat
e
anest
hesi
a,all4
br
anchesmustbeanest
het
izedwi
thl
ocal
inst
il
lat
ion.
Asmal
lgaugeneedl
eisi
nser
teddor
sal
l
y,i
ntot
hewebspaceandshoul
d
t
oucht
he
peri
ost
eum atthebaseoft
hepr
oxi
malphal
anx;af
terwi
thdr
awi
ngt
he
needl
esli
ght
ly,
1.0to 1.5 mlofanest
het
ic agent
,usual
l
y 1% l
i
gnocai
ne wi
thout
epi
nephr
ine/
adr
enal
i
ne,
i
sthen inj
ect
ed.Withoutwi
thdr
awi
ng t
he needl
e,i
tmay t
hen be
r
edi
rect
edtowardt
he
plant
arcor
nerunt
ili
tispal
pabl
eont
hepal
marsur
faceandasi
mil
ar
volumeof
anest
heti
cagenti nj
ect
ed.Thi
spr
ocedur
emustber
epeat
ed on t
he
opposi
tesideoft
he
di
gitandwi
l
lpr
oducet
otal
anest
hesi
awi
thi
n10-
15mi
nut
es.
Fornai
lremov
al,
wingbl
ockmayal
sobegi
ven.
Bi
tesandSt
ings
C/f
-pain,edema,war
mth,t
ender
nessov
erst
ingsi
te,nausea,v
omi
ti
ng,
ur
ti
car
ialrash,
tachy
pnoea,wheezi
ng,r
espi
rat
oryar
rest
,hy
pot
ensi
on,shock,ai
rway
obstr
uct
iondueto
l
ary
ngeal
edema
Usual
ly encount
ered are cases i
nvol
vi
ng snake,
honey
bees,
wasps,
spi
ders,
scor
pion,et
c.
Pati
ent
swi th no hi
stor
yofangi
oedema,br
onchospasm,ur
ti
car
ia or
anaphy
laxi
sshould
beobserv
edf
or1t
o2hr
sandcar
eful
l
ymoni
tor
edf
orev
idenceof
ev
olv
ing
anaphyl
axi
s.Thewoundmustbeexami
nedf
orast
inger
,whi
chshoul
dbe
removedby
gentl
escrapi
ng wi
thbl
adet
o pr
eventf
urt
herenv
enomat
ion.Do not
graspwi
thfor
ceps
orfi
nger
sinor
dert
oav
oidex
pressi
ngmor
evenom f
rom t
hepoi
sonsac
i
ntothe
ski
n.The wound shoul
d be t
hor
oughl
y cl
eaned,t
etanus pr
ophy
laxi
s
administ
eredi
f
appropr
iate,andi
ceappl
i
ed.Pat
ientwhor
emai
nasy
mpt
omat
ic2hr
s
aft
ertheinjur
y
maybedischar
gedwi
thi
nst
ruct
ionst
oret
urni
mmedi
atel
yifshor
tness
ofbr
eat
h,
wheez
ing,gener
ali
zedpr
uri
tus,or
ophar
yngealswel
l
ing,orr
ashoccur
s.
I
nscorpi
on
st
ings,
adv
iseel
evat
ionf
or24t
o48hr
s
Rx
Check ai
rway,Injav i
l
,Injef
cor
li
n,I
njadr
enal
i
ne(
ifbr
onchospasm)
,
removest
ings,appl
yice,
el
evat
eext
remi
tyt
oli
mitedema
Scorpi
onsti
ngsarever
ypai
nful
,soi
nfi
l
trat
ethear
eawi
thl
i
gnocai
ne2%
thr
oughthepunct
ure
wound.
Lookf
orsy
stemi
csy
mpt
oms.I
fpr
esentr
efer
.
Snakebi
te-
fi
rstai
d
I
fanext
remi
tyi
sinv
olv
ed,i
tshoul
dbepl
acedi
nneut
ralposi
ti
onbel
ow
t
hehear
t;
i
ntr
avenousaccessshoul
dn’
tbeest
abl
i
shedi
nthebi
tt
enext
remi
ty.
Woundsshoul
dn’t
beinci
sedandor
alsuct
ioni
snotr
ecommended.Thepl
acementofan
ar
teri
al
i
nterr
upti
ng tourni
queti
s notadv
ised;al
ter
nat
ivel
y compr
essi
on or
constr
ict
ionbands
whichareplacedpr
oxi
mal
l
yar
oundt
hebi
tt
enext
remi
tyandi
nter
rupt
venousand
l
ymphaticf
lowmaybehel
pful
.Thebandi
spl
acedsot
hataf
ingersl
i
ps
undert
heband
anddistalart
eri
alpul
sat
ionsar
eeasi
l
ypal
pat
ed.Bandsmaybemade
fr
om clothi
ng,r
ope,
r
ubber glov
es etc.O2 shoul
d be admi
nist
ered and t
he pat
ient
t
ranspor
tedassoonas
possi
ble.
84
CARDI
OPULMONARYRESUSCI
TATI
ON(
CPR)
Fi
rstconf
irm car
diacar
rest
;absenceofr
epi
rat
oryef
for
ts,absenceof
majorpul
seli
ke
car
oti
disdiagnosti
cofcar
diopul
monar
yar
rest
.I
fpul
se+,open t
he
ai
rway&gi
veventi
lat
ion.
Heal
thcareprovi
der
s,shoul
dper
for
m al
l3component
sofCPR(
chest
compressi
ons,ai
rway,
andbr
eathing)
.Foranunconsci
ousadul
t,CPRi
sini
ti
atedusi
ng30chest
compr
essions.
Per
form the head-
ti
ltchi
n-l
i
ftmaneuv
ert
o open t
he ai
rway and
det
erminei
fthepati
enti
s
br
eat
hing.Bef
orebegi
nni
ngv
ent
il
ati
ons,r
uleoutai
rwayobst
ruct
ionby
l
ooki
nginthe
pati
ent’
smout hforaf
orei
gnbodybl
ocki
ngt
hepat
ient
’sai
rway
.CPRi
n
thepresenceofan
ai
rwayobst
ruct
ionr
esul
tsi
ninef
fect
ivev
ent
il
ati
on/
oxy
genat
ionandmay
l
eadtoworseni
ng
hy
poxemi
a.
Posi
ti
oni
ng
CPRi
smosteasi
l
yandef
fect
ivel
yper
for
medbyl
ayi
ngt
hepat
ientsupi
ne
onar
elat
ivel
y
har
dsur
face,
whi
chal
l
owsef
fect
ivecompr
essi
onoft
hest
ernum.
Thehealt
hcarepr
ovi
dergi
vi
ngcompr
essi
onsshoul
dbeposi
ti
onedhi
gh
enoughabov
ethe
pat
ientt
oachievesuff
ici
entl
ever
age,sot
hatheorshecanusebody
wei
ghttoadequat
ely
compr
esst
hechest
.
Chestcompr
essi
on
Theheelofonehandi
spl
acedont
hepat
ient
’sst
ernum,andt
heot
her
handi
splacedon
topoft hef i
rst
,fi
ngersi
nter
laced.Theel
bowsar
eext
endedandt
he
prov
iderleansdir
ect
ly
overt
hepat i
ent.Thepr
ovi
derpr
essesdown,compr
essi
ngt
hechestat
l
east2inches.The
chesti
sreleasedandal
l
owedt
orecoi
lcompl
etel
y.
Chestcompr
essi
ons
aretobedeli
vered
atar
ateofatl
east100compr
essi
onspermi
nut
e.
Wi
ththehandskepti
npl
ace,
thecompr
essi
onsar
erepeat
ed30t
imesat
ar
ateof100/mi
n.
Thekeythi
ngt
okeepi
nmi
ndwhendoi
ngchestcompr
essi
onsdur
ing
CPRist
opushf
ast
andhard.Careshoul
dbet
akent
onotl
eanont
hepat
ientbet
ween
compr
essions,
asthi
s
pr
event
schestr
ecoi
landwor
sensbl
oodf
low.
Aft
er30compressi
ons,
2br
eat
hsar
egi
ven(
seeVent
il
ati
on)
.Ofnot
e,an
i
ntubat
edpat
ient
shouldr
ecei
vecont
inuouscompr
essi
onswhi
l
event
il
ati
onsar
egi
ven8-
10timespermi
nute
or1br eat
h/6-
8seconds.Thi
sent
ir
epr
ocessi
srepeat
edunt
ilapul
se
ret
urnsorthepat
ient
i
str
ansf
err
edt
odef
ini
ti
vecar
e.
Whendonepr
oper
ly,CPR canbequi
tef
ati
gui
ngf
ort
hepr
ovi
der
.If
possi
ble,
inor
dert
ogi
ve
consi
stent,hi
gh-qual
i
tyCPRandpr
eventpr
ovi
derf
ati
gueori
njur
y,new
provi
dersshould
i
nterveneev
er y2-3mi
nut
es(
ie,pr
ovi
der
sshoul
dswapout
,gi
vi
ngt
he
chestcompressora
r
estwhi
l
eanot
herr
escuercont
inuesCPR)
.
Vent
il
ati
on
I
fthepati
enti
snotbreat
hing,2v
ent
il
ati
onsar
egi
venv
iat
hepr
ovi
der
’s
mouthorabagval
ve-
mask(
BVM)
.
Themout
h-t
o-mout
htechni
quei
sper
for
medasf
oll
ows:
Thenostri
l
soft hepati
entar
epi
nchedcl
osedt
oassi
stwi
thanai
rt
ight
seal
.Theprov
iderput
shis
mout
hcompletel
yovert
hepat
ient
’smout
h.Thepr
ovi
dergi
vesabr
eat
h
f
orappr
oxi
mately1
secondwit
henoughfor
cetomaket
hepat
ient
’schestr
ise.Ef
fect
ive
mouth-
to-
mout
hventi
l
ati
on
i
s det
ermined byobservati
on ofchestr
ise dur
ing each exhal
ati
on.
Fai
l
uretoobser
v echestr
ise
i
ndicat
esani nadequat
emout
hsealorai
rwayoccl
usi
on.Asnot
ed,2
suchexhal
ati
onsshould
begi
veninsequenceaf
ter30compr
essi
ons(
the30:
2cy
cleofCPR)
.
Whenbr
eathsar
e
compl et
ed,compressi
onsarer
est
art
ed.I
fav
ail
abl
e,abar
ri
erdev
ice
(pocketmaskorfaceshiel
d)
shoul
dbeused.
Morecommonl
y,aBVM canbeused,whi
chf
orcesai
r
i
ntothel
ungswhent
he
bagissqueezed.Severaladj
unctdev
icesmaybeusedwi
thaBVM,
i
ncl
udi
ngoropharyngeal
andnasophar
yngealai
rway
s.TheBVM ori
nvasi
veai
rwayt
echni
quei
s
per
for
medasf
oll
ows:
The
provi
derensures a t
ightsealbet
ween t
he mask and t
he pat
ient
’s
face.
Thebagissqueezedwit
h
onehandforapproxi
matel
y1second,
for
cingatl
east500mLofai
rint
o
thepat
ient
’sl
ungs.Next
,
theprovi
derchecksf
oracar
oti
dorf
emor
alpul
se.I
fthepat
ienthasno
pulse,
chest
compr
essi
onsar
ebegun.
85
Fl
uidBal
anceandI
Vfl
uidt
her
apy
Fl
uidr
equi
rement
I
nanormalper
sonfl
uidr
equi
rementov
er24hri
sroughl
y2500ml
.
Nor
mal
dai
lyl
osses
arethroughuri
ne(
1500ml
),st
ool
(200ml
),&i
nsensi
blel
osses(
800ml
).
Thisrequi
rement
i
snor
mal
l
ymett
hroughf
ood(
1000ml
)&dr
ink(
1500ml
).
I
ntr
avenousfl
uidsaregi
veni
fsuf
fi
cientf
lui
dscan’
tbegi
venor
all
y.
About2500mlfl
uid
cont
aini
ngr
oughl
y100mmolNa+&70mmolK+per24hrar
erequi
red.
Thusagood
r
egi
menis2Lof5%Dex
troseand1Lof0.
9%sal
i
neev
ery30hrwi
th20
mmolofK+
perl
i
treoff
lui
d.
Rememberthatallcannul
aecar
ryar
iskofMRSAi
nfect
ion,soal
way
s
resumeor
alfl
uid
i
ntakeassoonaspossi
ble.
Insi
ckpt’
s,don’
tfor
gett
oincl
udeaddi
ti
onalsour
cesoff
lui
dlosswhen
cal
cul
ati
ngdail
y
f
lui
drequi
rement
s,suchasdr
ains,
fev
er,
ordi
arr
hoea
Assessi
ngf
lui
dbal
ance
Under
fi
ll
ed
Tachycardi
a,post
uraldr
opi
nBP,↓capi
l
lar
yref
il
lti
me,↓ur
ineout
put
,
coolperi
pheri
es,
dr
ymucousmembr
ane,
↓ski
ntur
gor
,sunkeney
es
Ov
erf
il
led
Pitt
ing edema oft he sacr
um,ankl
es,orev
en l
egs & abdomen,
tachypnoea,
bibasal
cr
epi
tat
ions,
pul
monar
yedemaonCXR,
↑JVP
Pot
tasi
um i
nIVf
lui
ds
Pot
tasi
um canbegi
venwi
th5% dext
rose,or0.
9% sal
i
ne,usual
l
y20
mmol/Lor
40mmol
/L.
K+mayber et
ainedi
nrenalf
ail
ure,sobewar
egi
vi
ngt
oomuchI
V.GI
fl
uidsar
eri
chin
K+,soincreasedf
lui
dlossf
rom t
hegut
(egdi
arr
hoea,v
omi
ti
ng,hi
gh-
out
putstoma,
i
ntest
inal
fist
ula)wi
l
lneedi
ncr
easedK+r
epl
acement
.
Themaxi
mum concent
rat
ionofK+t
hati
ssaf
etoi
nfusev
iaaper
ipher
al
l
inei
s40
mmol
/L,
atamaxi
mum r
ateof20mmol
/h.
Not
e
El
der
lypt
’sar
emor
epr
onet
ofl
uidov
erl
oad,
sogi
vei
vfl
uidswi
thcar
e
Pancr
eat
it
is:
aggr
essi
vef
lui
dresusci
tat
ioni
srequi
redi
na/
cpancr
eat
it
is
Fever
,burns:lar
ge amount
s off
lui
d can be l
ostunseen t
hrough
tr
anspi
rat
ion.
Li
verfai
l
ure:t
hesept
’sof
tenhav
ear
aisedt
otalNa+,sor
est
ri
ct0.
9%
sal
ine
Hear
tfai
l
ure:
useI
Vfl
uidswi
thcar
etoav
oidf
lui
dov
erl
oad.
Shock:
resusci
tat
ewi
thcol
l
oidor0.
9%sal
i
nev
ial
argebor
ecannul
ae.
Hyper
tonicdext
rose(
10% or50%)
:ir
ri
tantt
ovei
ns,so i
nfusi
onsi
tes
i
nspected&fl
ushed
wi
th0.
9%sal
i
neaf
teruse.
I
nchi
l
dren-Mai
ntenancer
equi
rement
Upt
o10kg:100ml
/kg/
24hr
;10-
20kg:1000ml+50ml
/kg/
24hrf
ort
he
wei
ghtabov
e10
kg;mor
ethan20kg:1500ml+20ml
/kg/
24hrf
ort
hewei
ghtabov
e20
kg.
Addapprox.1ml15% KCl
(=2mEq)per100mlf
lui
dsl
i
keNS.I
sol
yte-
P
al
readycont
ains
K+,
&henceK+neednotbeaddedt
oisol
yte-
P.
I
ncaseofsigni
fi
cantdehy
drat
ion,
poorpul
seet
c.,
giv
eNS20-
30ml
/kg&
r
eassess.
DI
ARRHEA
 ORS
 Or
alf
lui
ds
I
V–RLorNSi
fpat
ientcannott
akeor
all
y

CONSTI
PATI
ON
 Sy
p.Lact
ulose20-
30ml
stat(
Duphal
ac/
Looz)OR
 Sy
p.Lact
it
ol20–30ml
stat(
Gut
clear
/Tor
rel
ax)OR
 Sy
p.Sodi
um pi
cosul
fat
e10-
20ml
stat(
Col
ax)OR
 Sy
p.Sor
bit
ol20-
30ml
stat(
Sor
bil
i
ne)
I
fint
ract
abl
e–ev
acenema
ABDOMI
NALPAI
N
 Askaboutur
inat
ion,
checkf
orbl
adderandgi
vecat
het
eri
fneeded.
  Gast
ri
ti
s
I
nj.Pant
opr
azol
e40mgI
Vst
atOR
I
nj.Rabepr
azol
e20mgI
Vst
atOR
 Sy
p.Sucr
alf
ate10-
20ml
stat
 Spasmot
icpai
n
VERTI
GO/
DIZZI
NESS
 CheckBP.
 Tab.Ci
nnar
izi
ne25mgst
at(
Stuger
one/
Stugi
l
)OR
 Tab.Bet
ahi
sti
ne16mgst
at(
Ver
ti
n/Ver
ti
star
)OR
I
nj.Pr
ochl
orper
azi
ne12.
5mgI
M st
at(
Stemet
il
)
CHESTPAI
N
 DoECG.
 Angi
na
 BP>90mm Hg–sublingual
nit
rogl
ycer
in0.
4mgev
ery5mi
n
formaxi
mum 3t
imes
 Gast
ri
ti
s–chestbur
n–seeabov
e
 Cost
ochondr
it
is
 Tab.Par
acet
amol
500mgor650mgst
at
 Tab.Acecl
ofenac100mgst
atOR
I
nj.Di
cl
ofenac75mgI
M st
at
DYSPNEA
 Ast
hma/
COPD
 O2i
fSpO2<92%-mai
ntai
nbet
ween88–92%
 Nebuli
sati
onsal
but
amol2.
5mgev
ery20mi
nto1hour
lyas
neededfor3t
imes
 Nebul
isat
ionipr
atr
opi
um br
omi
de0.
5mgev
ery20mi
nto1
hour
lyasneededfor3ti
mes
 Inj
.Hydrocort
isone100-
200 mg I
V st
at(
ifpat
ienti
snot
alr
eadyonsteroids)
 Hear
tfai
l
ure
 Pr
oppedupposi
ti
on
 O2i
fSpO2<90%
I
fBP>100mm Hggi
veI
nj.Lasi
x40-
80mgst
at
I
nj.Dobut
ami
ne–i
fBP–70-
100mm Hg
 0.
5–1mi
crogr
am/
kg/
mini
nit
ial
l
y
 Then2-
20mi
crogr
am/
kg/
min
 Max–40mi
crogr
am/
kg/
min
 Onev
ial
is250mg
 Mi
xin500ml
NS
 St
artat5mi
crodr
ops/
min(
60mi
crogr
am/
min)
 AddI
njNor
adr
enal
i
nei
fBP<70mm Hg
 0.
05–0.
4mi
crogr
am/
kg/
min
 Oneampoul
eis2mg
 Mi
x 2 amp i n 500 ml NS and st
art at 30
mi
crodr
ops/
min
SEI
ZURE
 Don’
tpl
acepat
ienti
nlef
tlat
eral
posi
ti
oni
fact
ivesei
zur
e.
 Al
way
scheckf
orhy
pogl
ycemi
a.
I
nj.Lor
azepam 0.
1mg/
kg(
max4mg)atr
ateof2mg/
min
I
fnoI
Vaccess
I
nj.Mi
dazol
am 10mgI
M
 Wai
tfor1mi
n–i
fnotcont
rol
l
edgi
vel
orazepam agai
npl
us
I
nj.Pheny
toi
n20mg/
kgat25-
50mg/
min
 1amppheny
toi
n=100mg
  50kgpat
ient–10ampsmi
xedi
n500ml
NSov
er30mi
ns
I
RRI
TABLEPATI
ENT
 At
ropi
nepsy
chosi
s
I
nj.Lor
a(samedose)onl
yonceOR
I
nj.Hal
oper
idol5mgI
M(Ser
enace)+I
nj.Phener
gan25mg
I
M stat
 Li
verdi
sease
I
nj.Hal
oper
idol5mgI
M(Ser
enace)+I
nj.Phener
gan25mg
I
M stat
BLOODTRANSFUSI
ON
 Shoul
dbest
art
edwi
thi
n30mi
nofi
ssuef
rom bl
oodbank.
 Shoul
dbef
ini
shedwi
thi
n3hour
sofi
ssuef
rom bl
oodbank.
 Pl
atel
etsandFFPshoul
dbegi
veni
mmedi
atel
yandr
api
dly
.
 Veri
fy pati
ent’
s name,age,bl
ood gr oup,date ofi
ssue and
regi
str
ati
onnumberwi t
htheadmissi
ont icket
,bl
oodpr
oductand
thepaperatt
achedwit
hthebl
oodproduct.
 Pr
emedi
cat
ion
Inj
.Lasi
x20-
40mgI Vifpat
ientHb<7gm%orpat
ienthas
evi
denceoff
lui
dov
erl
oad
I
nj.Av
ilandst
eroi
dar
enotr
ecommendedr
out
inel
y
 St
artbl
oodt
ransf
usi
onat10dr
ops/
minandmoni
torv
ital
s
I
ffev
er–gi
vepar
acet
amol
andcont
inuet
ransf
usi
on
I
fshi
ver
ing–moni
torf
orhy
pot
ensi
onandbr
onchospasm
 St
opt
ransf
usi
on
I
nj.Av
il22.
75mgI
M st
at
I
nj.Hy
drocor
ti
sone200mgI
Vst
at
 Cal
lPG/
RPondut
y
 I
fanaphy
laxi
s
I
nj.Adr
enal
i
ne0.
5mgof1/
1000I
Minant
erol
ater
alt
high
 Canber
epeat
edev
ery5-
15mi
nasneeded
I
fnotr
espondi
ng
I
nj.Adr
enal
i
ne0.
1mgI
V
 Di
l
ute1ampi
n9ml
NSandgi
ve1ml
oft
hatI
V
 Not
e
 Past
ethesl
i
pint
headmi
ssi
ont
icket
 Name,
age,
sex
 Regdno
 Bl
oodgr
oup
 Bl
ooduni
tno
 Dat
eofcol
l
ect
ion
 Dat
eofexpi
ry
 Dat
eandt
imeoft
ransf
usi
on
 Pr
emedi
cat
ion–i
fany
 Afterver
if
yingandcrosschecki
ngtheabov edetai
lsbl
ood
tr
ansfusi
onstar
tedat10drops/
minon--
--
--at--
--
--
-.
 Noi
mmedi
ater
eact
ions.
I
fanyr
eact
ion
 St
opt
ransf
usi
on
 Cal
lHS/
PG/
RPondut
y
I
nj.Av
il22.
75mgI
M st
at
I
nj.Hy
drocor
ti
sone200mgI
Vst
at
DEATHDECLARATI
ONNOTE
Putdat
eandt
imebef
oreev
erynot
eandsi
gnaf
terev
erynot
e.
Pat
ientgaspi
ng Adv
Pul
se–f
eebl
e  CPRst
art
ed
BP–notr
ecor
dabl
e Inj
.Adr
enal
i
ne0.
5-1mgI
V
CVS–S1andS2muf
fl
ed stat

Chest – bi l
ater
al di
mini
shed
br
eathsounds
CNS – Pupil– bil
ater
all
ydil
ated
andsl
uggishl
yreacti
ngtoli
ght
.
Pl
ant
ar–bilat
eral
l
ynon-
r
esponsi
ve
Af
ter5mi
n
Pat
ientgaspi
ng Adv
Pul
se–notpal
pabl
e  Cont
inueCPR
BP–notr
ecor
dabl
e Inj
.Adr
enal
i
ne0.
5-1mgI
V
CVS–S1andS2–muf
fl
ed stat

Chest – bil
ater
all
y di
mini
shed
br
eathsounds
CNS–Pupil–bil
ater
all
ydi
l
ated
andsl
uggi
shl
yreacti
ngtol
ight
.
Pl
ant
ar–bilat
eral
l
ynon-
r
esponsi
ve

Af
ter5mi
n
Pat
ientnotr
espondi
ng Adv
Pul
se–notpal
pabl
e  Cont
inueCPR
BP–notr
ecor
dabl
e Inj
.Adr
enal
i
ne0.
5-1mgI
V
CVS–S1andS2–notaudi
ble stat
Chest – bil
ater
all
y di
mini
shed
br
eathsounds
CNS–Pupil–bil
ater
all
ydi
l
ated
andsl
uggi
shl
yreacti
ngtol
ight
.
Plantar – bi
l
ater
all
y non-
responsi
ve
Af
ter5mi
n
Pat
ientnotr
espondi
ng Adv
Pul
se–notpal
pabl
e  St
opCPR
BP–notr
ecor
dabl
e
CVS–S1andS2–notaudi
ble
Chest–noaudi
blebr
eat
hsounds
bi
lat
eral
l
y
CNS–Pupil
–bi
l
ater
all
ydi
l
ated
andf
ixed
Plantar – bi
l
ater
all
y non-
responsi
ve
Cor
neal
ref
lex–absent

Despi
tetheabover
esusci
tat
ionmeasur
es,thepatient
’scondi
ti
oncoul
d
notberevi
vedandt
hepati
entwasdecl
aredcli
nical
l
ydeadon- -
--
-at
--
--
-.
Putsi
gnat
ureanddat
e.
Wr
it
einf
rontoft
het
icket
 Pat
ientdecl
aredcl
i
nical
l
ydeadon-
--
--at-
--
--
-.
ForMLCdeat
hs–i
nfor
mtheRPondut
y.Hewi
l
ldoal
lfor
mal
i
ties.
Forot
herdeat
hs–fi
llt
helowestsl
i
pcont
aini
ngonl
ythepati
entbi
odata,
dat
eandt i
meofadmissi
onanddeath.(
Crosscheckwit
hanyI dent
ity
car
dandthenfi
ll
up)
Fi
l
lfor
mforambul
ance.