Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
For
Intern Doctors
Dedicated
To
Dr. Kakoli Dey (SM-2)
Who always inspire me in all situation
from her mind & soul.
INDEX
Medicine
1
SL No.
Topics
Acute Severe Bronchial Asthma
Page No.
COPD / Corpulmonale
Pneumonia
Lung Abscess
Pleural Effusion
Bronchiectesis
Pneumothorax
RTI
Pulmonary TB
10
11
10
12
Sedative poisoning
10
13
Anti-Depression Poisoning
11
14
-Blocker Poisoning
11
15
Dutura/Stupefy/Street Poising
12
16
CuSO4 Poisoning
12
17
Corrosive/Chemical Poisoning
( Acid/Alkali/Savlon/Herpic/Shampoo/Bleaching powder)
12
18
OPC POISONING
13
19
14
20
14
21
Acute PUD
14
22
Haematemesis/Malaena
15
23
Haemoptysis
15
24
16
25
Non-Ulcer Dyspepsia
16
26
Anti Flatulent
16
27
GERD
16
28
17
29
IBS(Diarrhoea predominant)
17
30
Tropical spore
17
31
Apthus Ulcer
17
32
Oral Thrush
17
33
Liver Abscess
18
34
18
35
CLD
19
36
Hepatic Encephalopathy
19
37
Acute Pancreatitis
20
38
20
39
21
40
CRF/CKD
21
41
AGN
22
42
NS
22
43
Hypernatraemia
23
44
Hyponatraemia
23
45
24
46
Hypokalemia
24
47
Hypoglycemia
24
48
25
49
Rickettsial fever
25
50
Dengue fever
25
51
Malaria
26
52
26
53
Kala-Azar
27
54
PKDL
27
55
27
56
Meningitis
28
57
Epilepsy
28
58
29
59
Tension Headache
29
60
30
61
Vertigo/BPPV
30
62
CVD/Stroke
31
63
TIA
32
64
Raised ICP
32
65
Bell's Palsy
32
66
33
67
Hyperthyroidism
33
68
33
69
Anaemia
34
70
Aplastic Anaemia
34
71
34
72
Macrocytic Anaemia
34
73
Lymphoma
35
74
Hodgkin Lymphoma
36
75
Aleukaemic Leukaemia
36
76
ALL
37
77
CML
37
78
Musculoskeletal Pain
38
79
Lumbo Sciatica
38
80
Septic Arthritis
38
81
39
82
RA
39
83
JRA
39
84
Tetanus
40
85
GBS
40
86
DKA
41
Psychiatry
1
Schizophrenia
43
43
44
44
44
45
Depressive illness
45
Somatoform disorder/HCR/FD
45
Scabies
46
Acne Vulgaris
46
46
Psoriasis
47
Tinea
47
Onychomycosis
47
Contact/Allergic Dermatitis
48
Urticaria/Drug reaction
48
Eczema
48
10
Impetig Eczema
48
11
S.Blephritis
49
12
49
13
Insect Bite
49
14
49
15
Alopecia
49
16
Measles
50
17
Gonococcal Urethritis
50
18
Erectile dysfunction
50
Skin
19
Black Spot/wrinkle
50
Cardiology
1
AMI
51
IHD
52
CCF
53
AF (Atrial Fibrillation)
53
VF (Ventricular fibrillation)
53
54
VT (Ventricular Tachycardia)
54
Ischemic Cardiomyopathy
55
Hypertension (HTN)
56
Paediatrics
1
Dosage of Drug
61
Fluid Mx
64
66
LBW/Preterm Baby
67
Umbilical Sepsis
67
68
Rh Incompatibility
68
Neonatal Jaundice
68
Acute RTI
69
10
UTI
69
11
Meningitis
70
12
Oral Thrush
70
13
Febrile Convulsion
71
14
Tetanus
71
15
AGN
72
16
NS
72
17
Asthma
73
18
Ascariasis
73
19
Diarrhoea
74
20
Near drowing
76
21
Malaria
77
22
Enteric Fever
77
23
78
24
Kerosene Poisoning
80
25
Dose of dopamine
81
SURGERY
1
Head Injury
83
83
84
84
85
86
87
Abscess
87
Ulcer
88
10
88
11
89
12
89
13
89
14
90
15
Peri-Anal Abscess
90
16
91
17
91
92
92
92
93
Viral Keratitis
93
Ocular Injury
93
Epistaxis
94
F.B Larynx/Trachea
94
F.B Pharynx/Oesophagus
94
Acute Epiglottitis
95
Hanging
95
DNS
95
CSOM
96
Traumatic Rupture Of TM
96
Sub-mandibular Growth
96
10
96
11
Rhinosporidiosis
97
12
Nodular Goitre
97
13
Cervical Lymphadenopathy
97
14
Parotid Abscess
98
15
Maxillary Sinusitis
98
EYE
ENT
OBSTETRICS
1
Indication of C/S
100
101
101
Eclampsia
102
102
Retained Placenta
103
IUD
103
Obstructed Labour
104
APH
105
10
PPH
105
11
Hyperemisis Gravidarum
106
12
Shock
106
PV Bleeding
107
Incomplete Abortion
107
Threatened Abortion
108
DUB/Fibroid Uterus
108
Genital Prolapse
108
Ectopic Pregnancy
109
Perineal Tear
109
VVF
109
PID
110
10
110
11
111
12
111
GYNAE
Medicine
1|P a ge
Bronchial Asthma
COPD
Pneumothorax
LVF/AMI
DKA
Pulmonary edema/Thrombo embolism
CRF/ARF/Uremia
Emotional/HCR/FD
Diet: Normal
Bed rest with propped up position
O2 Inhalation stat & SOS (high conc.)
Nebulization with windel plus stat & 6 hrly
Inj. Cotson/Oradexon
1 vial IV stat & 6 hrly
Or
Tab. Cortan(prednisolon) 5mg
6+0+0 ( 10 days)
Asmasol/Sulprex inhaler
2 puff TDS
Bexitrol F/ Ticamate inhaler
2 puff BD
Antibiotic if evidence of infection
Cap. Omeprazole 20mg
1+0+1 (B/M)
IV fluid 5% DA @ 30 d/m- To correct K+
If response poor then
Inj. Aminophyllin
2amp + 5% DA 500cc
IV at 8 d/m
In some case Montelukast 10mg
0+0+1
Clue to Dx Breathlessness
H/O previous attack/allergy
Young pt
Night awaking
Wheeze,ronchi,
Vesicular breath sound with
prolong expiration
2|P a ge
COPD / Corpulmonale
Diet: normal
3|P a ge
Pneumonia
Bed rest
O2 inhalation
Tab. P/C
1+1+1
Tab. Moxin 500mg
1+1+1
OR
Tab. Moxclav 625mg (2 wks)
1+1+1
+
Tab. Clarin 500mg (2 wks)
1+0+1
Cap. Omeprazole 20mg
1+0+1 (B/M)
If severe pain
Inj. Anadol 100mg
1 amp im stst
Then, cap. anadol 50mg
1+0+1
In severe case
Inj. Ceftriaxone 2gm (1 vial IV BD)/ Inj. Fimoxiclav 1.2 gm (1 vial IV 8 hrly)
+
Tab. Clarin 500mg (2wks)
1+0+1
Investigation CBC
RBS
CXR P/A view
MT
Lung Abscess
Bed rest
Cap. Amoxicillin + Metronidazole
OR
Inj. Ceftriaxone 1gm Daily (10 days)
+
Inj/Tab. Metronidazole TDS (4-6 wks)
If not response- Antibiotics according to CS
-USG Guided percutaneous aspiration
Tab. Multivitamin
1+0+1
Postural drainage with 2times daily deep inspiration & forceful expiration
Pleural Effusion
Bed rest
O2 inhalation if necessary
Pleural fluid aspiration
Up to 1.5L in one setting
Rx of underlying causeTB,Malignancy,pneumonia,etc
Investigation CXR
CBC
Sputum- AFB,cytology
MT
Pleural fluid analysis
FNAC or Bipsy from LN
(pleural biopsy confirmatory)
5|P a ge
Bronchiectesis
Diet. Normal
Bed rest
Cap. Ciprofloxacin 500mg
1+0+1
OR
Inj. Ceftazidim 500mg/inj. Flucoxacillin/Inj. Amoxicillin
Cap. omeprazole 20mg
1+0+1
Tab. Prednisolon
SymptomaticCreap/Oedema- Tab. Fusid plus (1+1+0)
Fever- Tab P/C: 1+1+1
Pain. Kitorolac 10 mg: 1+0+1
Partial pneumonectomy may be done
Pneumothorax
If asymptomatic (<1/3 collapse)- Bed rest at propped up position
-
Withdraw cause
RTI
Diet. Normal
Cap. Amoxocillin 500mg(1+1+1)-7 days
OR
Tab. Levofloxacin 500mg (0+0+1)-7 days
OR
Tab. Azithromycin 500mg (0+0+1)-5 days
OR
Tab. Gemiflox 325mg (1+0+1)-5days
Tab. P/C 500mg (1+1+1)
Tab. Loratidin 10mg (0+0+1)
6|P a ge
Pulmonary TB
Catagory Indication
CAT-1
New smear positive
New smear negative PTB
Extra PTB
Pleural effusion, pericardial
Meningeal
Spinal,intestinalTB,
dessiminiated TB
CAT-2
Relapse
Treatment after deafult
Treatment failure
Rx Regimen
Intensive Phase (daily)
4FDC- 2 month
Continuation phase (daily)
2FDC- next 4 month
Composition of FDC
4FDC- INH 75mg + Rifampicin 150mg + Pyrazinamid 400mg + Ethambutol 275mg
2FDC- INH 75mg + Rifampicin 150 mg
Dose of FDC
FDC
4FDC
2FDC
Weight(K.G)
< 27
30-37
38-54
55-70
>70
30-37
< 50
>50
Dose
acc. to body wt
2
3
4
5
1 Rmactazid 300mg
1 Rmactazid 450mg
2 Rmactazid 300mg
Dose of streptomycin
Weight in KG
Inj. Streptomycin(1amp= 1gm)
Tab. Ethambutol 400mg
30-37
500mg
2
38-54
750mg
3
55-70
1000mg
4
Dose of Streptomycin Should not exceed 759mg daily after the age 70yrs
7|P a ge
Diet. Normal
Tab. Rimstar 4FDC- 2 month
3+0+0 (Before meal) from 11/2/11 to 10/4/11
Tab. Remactazid 450mg- next 4 month
1+0+0 (Before meal) from 11/4/11 to 10/8/11
Tab. Pyrovate- 6 month
0+0+1
Cap. Omeprazole 20mg
1+0+1
Tab. Cortan 10mg ( to prevent pleural adhesion)
2+2+0 .......................1 month
2+11/2+0 ..................1wk
11/2+11/2+0 ...............1wk
11/2+1+0 .................. 1wk
1+1+0 .......................1wk
1+1/2+0 ....................1wk
1/2+1/2+0 ................1wk
1/2+0+0 ....................1wk
Tab. calcium 500mg- 2 month
1+0+0
Diet. normal
Inj. Streptomycin (1gm)-2month
2/3 amp IM daily
from 11/2/11 to 10/4/11
Tab. Rimstar 4FDC- Next 3 month
3+0+0
from 11/4/11 to 10/7/11
Tab. remactazid 450mg - Next 5 month
1+0+0
from 11/7/11 to 10/12/11
Tab. Pyrovate- 6 month
0+0+1
Cap. omeprazole 20mg
1+0+1 (B/M)
Tab. Calcium 500mg(1+0+0)- 2month
8|P a ge
Poisoning
Snake bite (poisonous)
** inj. cotson, Inj. Avil, Inj. Adrenalin should be kept during given anti-venom as
anaphylactic reaction may occur
**Take written informed consent from pt attendant & inform the pt 50% chance to die due
to reaction of anti-venom and 100% chance to die without anti-venom.
Clue to poisonous snake bite Bite mark 2 fangs
Drowsy, restlessness, dribbling of saliva
Resp. difficulty
Ptosis/lid drop
Broken neck sign
Unconsciousness
Blood coagulation test: Take few ml fresh venous blood in test tube after 10min if clot occur
it non-poisonous. If clot not occur it indicate poisonous.
9|P a ge
Bed rest
Reassurance
Inf. NS 1000cc
IV @ 20d/m stat
Cap. Moxin(1+1+1)/ cephradin(1+1+1+1)
Cap. omeprazole 20mg
1+0+1 (B/M)
Inj. TT
1 amp IM stat (in one arm)
Inj. TIG
1 amp IM stat (in another arm)
If pt complain pain Tab. P/C
Never given- inj. Oradexon, Inj. Avil & NSAID
(Observe the pt 24hrs if no S/S of poisonous then discharge the pt)
Sedative poisoning
Anti-Depression Poisoning
-Blocker Poisoning
Investigation ECG
RBS
S.Creatine
S. Electrolytes
11 | P a g e
Dutura/Stupefy/Street Poising
Investigation ECG
RBS
S.Creatine
S. Electrolytes
** Always try to avoid costly drug & investigation as pt attendant are not available.
CuSO4 Poisoning
Diet. Liquid
Inf. 5% DNS 1000cc
IV @ 20 d/m
Inj. Cefuroxime 1.5gm
1vial IV TDS
Cap. Omeprazole
1+0+1
Tab. Rex (anti-oxidant)- b.coz Liver is affected by metabolism
1+0+1
Corrosive/Chemical Poisoning
( Acid/Alkali/Savlon/Herpic/Shampoo/Bleaching powder)
Do not give stomach wash/NG suction & don't try to induce vomiting
Diet. NPO TFO
Inj. Ceftriaxone 1gm
1 vial IV stat & BD
Inj. Omeprazole 40mg
1 vial IV stat & BD
If pain- Inj. Anadol/Inj. Ketorolac/Inj. nalbun-2
If pt ingest chemical other than acid & alkali
Syp. Entacid plus
2 TSF TDS
May give liquid paraffin
12 | P a g e
OPC POISONING
Stomach wash
Diet. NPO TFO
Inj. NS/ 5% DNS 1000cc
20 d/m IV stat
Inj. Ceftriaxone 1gm
1 vial IV stat & BD
Inj. Omeprazole 40mg
1 vial IV stat & BD
Inj. Atropin
3 amp IV stat & double the dose every 10 min interval up to atropinization
If restless/convulsion
Inj. Sedil 1amp IV stat
If still restless
Inj. perol 1amp IM stat
On Discharge
Tab. prokind 15mg- 15 days
1+1+1
Tab. Tryptin 25mg- 2 month
0+0+1
Cap. Omeprazole 20mg-1month
1+0+1
13 | P a g e
Acute PUD
14 | P a g e
Haematemesis/Malaena
O2 inhalation if needed
Inj. Moxacil
1 vial IV stat & TDS
Inj. Omeprazole 40mg
1 vial IV stat & BD
If portal HTN
-Tab. Indever 40mg
1/2 + 0 + 1/2
Inj. konakion 10ml
1 amp slow IV drip for 3 days
Inj. Xamic/Caprolysis/Traxyl
1 amp slow IV stat & 6 hrly
Record vital sign
Immediate arrange for Blood transfusion
Haemoptysis
Diet. Normal
Inj. HS 1000cc
IV 20 d/m
Cap. Moxin 500mg (never give ciprofloxacin if you suspect TB as it mask the AFB)
1+1+1
Cap. Omeprazole 20mg
1+0+1 (B/M)
Inj. frabex/inj. traxyl
1 amp IV stat & then
InvestigationTab. frabex/traxyl
CBC
CXR
1+1+1
MT
Tab. sedil
Sputum for AFB & malignant cell
0+0+1
RBS
S.creatinine
15 | P a g e
Non-Ulcer Dyspepsia
Anti Flatulent
Syp. flatameal DS
1/2 TSF TDS
Tab. Flatameal DS
1-2 tab TDS
GERD
Non drug Rx of GERD
Drug Rx
16 | P a g e
IBS(Diarrhoea predominant)
Liver Abscess
Diet. Normal
Tab. Ciprofloxacin 500mg
1+0+1
Tab. Metronidazole 400mg
2+2+2
Cap. Omeprazole 20mg
1+0+1 (B/M)
Tab. Anadol 50mg (If pain)
1+1+1
If pt toxic
-Inj. Ciprofloxacin 100ml
1 bag IV BD
-Inj. Metronidazole
11/2 bag IV TDS
Diet. normal
Complete bed rest
Syp. D-luc
2 TSF TDS
Cap. omeprazole 20mg
1+0+1 (B/M)
Tab. Omidon
1+1+1 (B/M)
Inj. Konakion 10mg
1 amp IV stat & daily for 5 days
Other are symptomatic
Investigation USG of W/A
SGPT
PT
S.Bilirubin
HBsAg
18 | P a g e
CLD
Without encephalopathy
Hepatic Encephalopathy
Acute Pancreatitis
20 | P a g e
CRF/CKD
21 | P a g e
AGN
NS
22 | P a g e
Electrolytes imbalance
Hypernatraemia
It occur due to decrease body water, If we correction body fluid Hypernatraemia will be
correct, so we have to know fluid requirement.
Formula to find fluid requirement
Free water (in Littre)= (S.Na+ - 140) 0.5 wt in KG
140
** If Serum Na+ 160 mmol/L & weight 60 kg then
FW(L)= (160-140) 0.5 60
140
=2L
Rx
Hyponatraemia
Mild (125-135)
Moderate (110-125)
Severe (<110)
Nice To Know
100cc 0.9% NaCl solution = 155 mmol/L Na+
1000cc 3% NaCl solution = 512 mmol/L Na+
500cc 3% NaCl solution = 256 mmol/L Na+
23 | P a g e
Hypokalemia
Mild (3-3.5)
Dietary advice- Intake more fruit such as banana, fruit juice, Dab water.
Moderate (2-2.9)
Sup Electro K/ KT
2 TSF TDS
OR
Tab KT
1+0+1
Severe (<2)
Hypoglycemia
24 | P a g e
Fever
Enteric Fever/ Typhoid
Diet. normal
Inj. Ceftriaxone 2gm- 7 days
1 vial IV stat & BD
OR
Tab. Azithronycin 500mg-7 days
1+0+1
Cap. Omeprazole 20mg
1+0+1 (B/M)
Tab. Omidon
1+0+1
Tab. P/C 500mg
1+1+1
Tepid sponging
Napa suppository
1 stick P/R when temp >101o F
Investigation CBC
Urine R/M/E
Blood culture- 1st wks
Widal test- 2nd wks
Tipple Ag
MP & ICT
USG of W/A
Rickettsial fever
Dengue fever
Malaria
Investigation
26 | P a g e
Kala-Azar
PKDL
Bet rest
Diet. Normal
Cap. Omeprazole 20mg
1+0+1 (b/m)
Tab. Omidon 10mg
1+1+1
Tab. P/C
1+1+1
Napa Suppository 500mg
1stick P/R if temp > 101o F
If suspect RTI-Tab. Azithromycin 500mg (0+0+1)
If suspect UTI- Tab. Ciprofloxacin 500mg/Cefuroxime 500mg (1+0+1)
If suspect TB don't give Ciprofloxacin before AFB result come
27 | P a g e
Meningitis
Epilepsy
28 | P a g e
again 1 tab,
In severe attack
Tension Headache
29 | P a g e
Tab. Cinaron
1+1+1
Tab. Stemetil/Vergon
1+1+1
Tab. P/C
1+1+1
Vertigo/BPPV
30 | P a g e
CVD
Stroke
Diet. NG feeding
200ml 2 hrly
TIA
Raised ICP
Bell's Palsy
32 | P a g e
Hyperthyroidism
Tab. Neomercazole
3+3+3-3 wks
2+2+2-5 wks
1+0+1- Continue
Tab. Tenoloc 50mg
1+0+1
Tab. Indever 10mg
1+1+1
33 | P a g e
Anaemia
Nice to know
(Our target to reach Hb level 10g/dl)
1 unit blood correct 5% HB or 1g/dl
Ferus Sulphate( Orally) If we give 200 mg 8 hrly it correct Hb level 1g/ld/wks
1st wks for erythropoisis stimulation, So it take more than one wks as g/dl we have to
correct
After correction it takes more than 6 month for adequate storage.
Aplastic Anaemia
Supportive Rx
Specific Rx
Macrocytic Anaemia
Tab. Folfetab
1+0+1- 3 wks
Then, 1+0+0 per week for life long
Inj. Cyanomin (1000 gm)
1 amp IM on alternative day for 9 month
Then, 1 amp IM 3 monthly for life long
34 | P a g e
Lymphoma
Chemotherapy Schedule
Dosage of drug
Pre-requisition
Pt
well hydrate
cycle
, 4-6 wks
Rx
Inf. 5% DA 500cc
IV stat 60 d/m
Inj. Onaseron
1 amp IV stat
Inj. Neotack
1 amp IM stat
Inj. Alcristin 1ml ( vincristin sulphate)
2 vial IV slowly stat
Inj. endoxan 1gm ( Cyclophosphamide) 1 vial + 5% DA 500cc
IV 60 d/m
Inj. zovidox 50mg (Doxurubicin HCL) 11/2 vial + 5% DA 500cc
IV 60 d/m
Tab. Cortan 20mg
3+2+0 (A/M)
Tab. Esloric 100mg /Allopurinol( for increase uric acid secretion)
1+0+1
35 | P a g e
Hodgkin Lymphoma
Bag-1
Bag-2
Bag-3
Aleukaemic Leukaemia
Diet. Normal
Inj. Cefipime 1gm
1 vial IV stat & BD
Inj. Metronidazole 100ml
1 bag IV stat & TDS
Immediate Blood Transfusion
Tab. F/S
0+1+0
Cap. Omeprazole 20mg
1+0+1
Povisep mouth wash- Gurgle 2 times daily
36 | P a g e
ALL
Supportive:
Diet: neutropenic
Correction of anaemia: Fresh blood transfusion (Target HB% is 10gm/dl)
Correction of infection- Board spectrum antibiotic
Tab. Esloric - 1+0+0 (for hyperuracemia)
Cap. Omeprazole
If Pain- Cap. Anadol
Spcific: Chemotherapy
Curative: Bone Marrow transplantation
CML
Supportive:
Diet: neutropenic
Correction of anaemia: Fresh blood transfusion (Target HB% is 10gm/dl)
Correction of infection- Board spectrum antibiotic
Tab. Esloric - 1+0+1 (for hyperuracemia)
Cap. Omeprazole
Tab. Filwel gold: 1+0+1
Tab. Foltab: 0+0+1
Spcific: Chemotherapy
Curative: Bone Marrow transplantation
37 | P a g e
Musculoskeletal Pain
Lumbo Sciatica
Septic Arthritis
38 | P a g e
Advice
RA
JRA
39 | P a g e
Tetanus
Diet. Soft
O2 inhalation SOS
Isolation room (dark & soundless room)
Inj. C-Penicillin(5 Lac)
2 vial IV stat & 6 hrly
Inf. 5% DA 1000cc + Inj. sedil 10 amp
IV stat @ 15 d/m
Inj Rolac 30mg
1 amp IM stat & SOS
Inj. TIG 250 IU
10 amp IV slowly stat
Inj. Tetavax
1 amp IM stat
Tab. Metro
1+1+1
Closed wound should be opened up & washed with H2O2
GBS
Bed rest
O2 inhalation
Plasma Exchange (plasmapheresis)
IV -globulin (400 mg/kg/day)-5 days
Inj. Octagam- (1 vial-50ml)
Prednisolone(60-80mg)-7 days
Physiotherapy
Measure for airway, pressure sore & venous thrombosis
Clue to Dx
DKA
Basic Principal of DKA Management
1.
2.
3.
4.
fluid replacement
the administration of short-acting (soluble) insulin
potassium replacement
the administration of antibiotics if infection is present
Rx:
None in first L of i.v fluid unless plasma potassium < 3.0 mmol/L
When < 3.5 mmol/L, give 20 mmol/hr
When plasma potassium is 3.5-5.0 mmol/L, give 10 mmol/hr
When plasma potassium is >5.0 mmol/L Stop giving potassium
Continuous catheterization
Change posture 2 hrly
Clue to Dx
Unconsciousness/semi consciousness
Drowsy/Disoriented
Feature of dehydration
Respiratory distress may be present
Known diabetic pt
Low BP, Trachycardia,
Planter: may be bilateral extensor
Drop calculation:
Total fluid
d/m=
4 hrs
42 | P a g e
Psychiatry
Schizophrenia
1+0+1
Tab. Telazine
1+1+1
Tab. Tryptin 10mg
0+0+2
Tab. Indever
1+1+1
Tab. Pase 0.5
0+0+1
43 | P a g e
Tab. Rivotril
0+0+2- for 7 days
Then, 0+0+11/2- for 7 days
Then, 0+0+1- for 7 days
Then, 0+0+1/2-for 7 days
F/U- 1 month later
44 | P a g e
Tab.Promitil 25mg
0+0+1- 3 days
Then, 1+0+1
Tab. Indever
1+1+1
Tab. Rivotril 0.5 mg
0+0+2- 10 days
Then, 0+0+1
Depressive illness
Adnor 75mg
0+0+1
Tab. Amit/tryptin 25mg
1+0+2
Tab. Deprex
0+0+1
F/U- after 21 days
Somatoform disorder/HCR/FD
Diet . NG feeding
Inj. Ranitidin
1 amp IM stat & TDS
Inj. Dormicum
1/2 amp IM (if no H/O asthma/COPD)
On discharge
Tab. Frenxit/Anfree
1+0+0- 2 month
OR
2+0+0- 1 month
Cap. Omeprazol- 15 days
1+0+1 (b/m)
45 | P a g e
Skin
Scabies
Scaper/Scabex/scabicid Cream
Acne Vulgaris
46 | P a g e
Psoriasis
Sastid bar
Fungitar shampoo
Tinea
Onychomycosis
Cap. fungata
Afun/Clarizole lotion
47 | P a g e
Contact/Allergic Dermatitis
Urticaria/Drug reaction
Eczema
Impetig Eczema
48 | P a g e
S.Blephritis
Betnovate-CL oint.
Insect Bite
Antibiotic
Anti-histamine
Diprobet/Mexiderm oint.
Alopecia
Dermas cream 1%
Xenovet cream
Tab. Multivit
1+0+1
49 | P a g e
Measles
Gonococcal Urethritis
Erectile dysfunction
Black Spot/wrinkle
50 | P a g e
Cardiology
AMI
MI with Bradycardia
MI with LVF
IHD
Diet. Normal
Nitrosol/Anril Spray
2 puff S/L stat & SOS
OR
Tab. Anril/Angicard 0.5 (If pt poor)
1 tab S/L stat & SOS
Cap. Omeprazole 20mg
1+0+1 (B/M)
Tab. Anclog plus/Lopirel plus
0+1+0 (A/M)
Tab. Atova
0+0+1
Tab.Monocard 20mg (mononitrate)
1+1+0
OR
Tab. Nidocard-RTD/Trocer 2.6 (GTN)
1+0+1
Tab. Metacard MR ( Trimetazidim)
1+0+1
Tab.Epam/sedil 5mg
0+0+1
If HTN
Tab. Remoril/Ripril 2.5 (ACEI)
0+0+1
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CCF
AF (Atrial Fibrillation)
Digoxin contra-indicated in
AMI
Digoxin(Cardiac glycoside)
force of contraction
O2 demand
Ischemia
VF (Ventricular fibrillation)
53 | P a g e
Bed rest
O2 inhalation Stat
Inj. Osiden/Adicard (Adenosine)
2 amp IV rapidly stat ( within 2 second)
Tab. Veracal 40mg ( verapamil)
1+1+1
Inj. sedil
1 amp IM stat
If not response
Inj. Veracal 10mg
IV slowly over 5-10min
If not response- DC chock
VT (Ventricular Tachycardia)
Bed rest
O2 inhalation Stat
Inj. 2% Lignocaine
3-5 cc bolus stat over 1 min
If not control- repeat after 5-10 min
If normal- Mantanance by
Inj. 2% Lignocaine 100cc + 5% DA 400cc
IV @ 5-10 d/m for 24 hrs
Then, 2% lignocaine for next 24 hrs
Tab. Amiodaronr
Tab. Pacet 200mg
1+1+1-for 7 days
1+0+1-for 7 days
1+0+0- Maintenances dose
If no Improvement- DC shock
54 | P a g e
Ischemic Cardiomyopathy
55 | P a g e
Hypertension (HTN)
Classification
BHS Classification:
Category
BP
Optimal
Systolic BP (mmHg)
Diastolic BP (mmHg)
< 120
< 80
Normal
< 130
85
High normal
130-139
85-89
Hypertension
Grade 1 (mild)
140-159
90-99
Grade 2 (moderate)
160-179
100-109
Grade 3 (severe)
180
110
Isolated systolic
hypertension
Grade 1
140-159
< 90
Grade 2
160
< 90
JNS Classification:
Category
BP
Normal
Systolic BP (mmHg)
Diastolic BP (mmHg)
90-119
60-79
Pre-hypertensive
120-139
80-89
Stage-1
140-159
90-99
Stage-2
>160
>140
>100
<90
Hypertensive
Isolated systolic
hypertension
HTN
Primary/Essential HTN
95% unknown cause
Secondary HTN
Alcohol
Obesity
Renal
Endocrine
Drugs- OCP, Steroids, NSAID
56 | P a g e
HTN
Rx
Management
Non Drug Therapy/ Life style Modification
Drug Therapy
Step-1: single drug
Step-2: Combination
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With Co-morbidity
HTN with HF
Loop diuretic
ACE Inhibitor
(Don't use - Blocker in HF, but carvedilol may use in stable HF)
HTN with DM
If S.creatinine >3mg/dl130/80 mmhg
Rx
If S.creatinine normalACEI intolaret
140/90 mmhg
Rx
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Resistance HTN
Diuretc add
Pt steroids/OCP/NSAID
, appropiate combination
F/U
NB.
orally Rx
But Suddenly BP
drug change
Target goal
brain
Ischemia
eg. Diuretc
, dose
single drug
maximum dose
effect
minimum
target goal
try
drug
combination
use
Investigation:
ECG
RBS
Lipid profile
S.creatinine
S.electrolytes
S.urea
Urine R/M/E
Other disease related investigation if present
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Paediatrics
60 | P a g e
Dosage of Drug
Inj.Gentamycin
5mg/kg/day (80mg/2ml, 20mg/1ml)
Neonate: < 3kg-Once daily
>3kg BD
Child: 8 hrly
Azithromycin
10-20mg/kg/day
1 TSF = 200mg
Erythromycin
50mg/kg/day 6 hrly)
1 TSF = 125mg
Ciprofloxacin
Neonate: 10mg/kg/day (BD)
Child: 30mg/kg/day (BD)
1 TSF = 250mg
Metronidazole
30mg/kg/ (TDS), 10mg/kg/dose
1 TSF = 200mg
Inj 1 bag= 500gm/100ml
day 6 ml/kg/day (TDS), 2ml/kg/dose
Cloxacillin
50-100mg/kg/day ( 6 hrly)
Inj. 250, 500mg
Cap. 250, 500mg
Drop. 20 drop = 125mg = 1.25 ml
Flucloxacillin
50-100mg/kg/day (6 hrly)
1 TSF = 125mg
Cap. 250, 500mg
Tetracycline
50mg/kg/day (6 hrly)
Cap. 250, 500mg
Co-trimoxazole
10mg/kg/day
1 TSF = 40mg
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Cefaclor
20mg/kg/day
Cap. 250mg, 500mg
Ofloxacin
15mg/kg/day (12 hrly for 10 days)
1 tab. 200, 400mg
Co-Amoxiclave
25mg/kg/dose (8 hrly)
1 TSF = 125mg
Tab. 250, 500mg
Aldendazole
<2y: 200mg single dose
>2y: 400mg single dose
Tab. 200, 400mg
1 TSF = 200mg
Mebendazole
100mg BD for 3 days
OR
500mg single dose
1 TSF = 100mg
Use: > 2 years of age
Simethicon
15mg/kg/dar (BD)
1ml = 67mg
1ml/5kg = 3 drop/kg
Domperidone
0.4mg/kg/dose
1 TSF = 5mg
1 tab = 10mg
Supp. 15, 30mg
Odansetron
0.2mg/kg/dose (8-12 hrly)
1 TSF = 4mg
1 Tab = 4mg, 8mg
Inj. 1 ml = 2mg
Electro-K
4 mmol/kg/day
1 TSF = 10 mmol
Inj. Konakion (2/10 mg mm)
Neonate: 2 mg mm
1amp P/O stat or 1/2 amp IV stat & 1,5,25
day
Vit-A/Cap. retinol fort
50 thou,1lac,2lac unit
<5month: 50 thousand
5mnt-1yrs: 1lac unit
>1yrs: 2lac Unit
Promethazine/Phenargan
Tab: 10mg (BD)
Syp. 2-5y: 5-15mg
5-10y: 10-25mg
5mg/5ml
Inj. >5y: 6.25-12.5mg (IM)
Adult: 25-50mg (IM/IV)
25mg/1ml
50mg/2ml
Ranitidine
10mg/kg/day
1 TSF = 75mg
1 amp = 50mg/2ml
Zinc
<6 month: 3mg/kg/day
>6 month: 5mg/kg/day
Tab. 10,20mg
Folic acid/Folison
Upto 1 yrs: 0.5mg/kg/day
1-5y- 5mg/kg/day
6-12y- 10mg/kg/day
1 Tab = 5mg
Pheniramine maleate/Avil
Tab. 22.7mg
75mg at bed time
Inj. 50mg/2ml
25-50mg IM/ slow IV (BD)
Syp. 1 TSF = 15mg
5-22.5mg (BD/TDS)
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Hydrocortisone (100mg/2ml)
5mg/kg/dose (6 hrly)
Dexamethasone
0.4mg/kg/dose
OR
1 mg/kg/day
1 amp = 1ml = 5mg
Tab. 0.5mg
Prednisolone
1-2mg/kg/day
1 1ab. 5, 20 mg
Aminophylline/Filin
LD: 0.2ml/kg/dose
(dilute with equal amount water)
MD: 0.7ml/kg/day
1 amp = 5ml = 125mg
1ml = 25mg (Order- .....ml/100ml saline)
Tab. 100mg
Frusemide
2mg/kg/day
1 Tab = 40mg
Inj 1 amp = 20mg/2ml
Spironolactone
3mg/kg/day
1 Tab = 25mg
Frusemide + Spironolactone
Tab. 20mg + 50mg
Tab. 40mg + 50mg
Fusid plus, Edeloss plus
Nefedipine
0.5mg/kg/dose
1 Tab = 10mg
Theophyllin
10mg/kg/day (6 hrly)
1 TSF = 120mg
Tab. Asmanyl 300mg SR
Sulbutamol
0.4mg/kg/day (TDS)
1 TSF = 2mg
Nebulization dose: 0.2mg/kg/dose + Norsol
Ventolin nebule 1ml = 1mg
Ventolin solution = 5mg
1 Tab = 2mg, 4mg
Diazepam
P/O: 1mg/kg/day (BD/TDS)
P/R: 0.5mg/kg/dose
Ongoing febrile convulsion:
Inj. Sedil (0._ + .....ml D/W)
Ketorolac
< 10 kg: Inj. 10mg 1 amp
10-20kg: Inj. 30mg 1/2 amp
>20kg: Inj. 30mg 1amp
kg
63 | P a g e
Paracetamol
15/kg/dose (TDS)
Paedi drop = 1ml = 80mg
1 drop = 5mg
Suppo. 60,125,250,500mg
Aspirin
50mg/kg/day
As antirheumatc
100mg/kg/day (6 hrly)
Chloroquine 250mg
25mg/kg; 3 days
Day dose: 1st = 10mg/kg
2nd = 10mg/kg
3rd = 5mg/kg
Avloquin, jsochlor
Quinine
10mg/kg/day (TDS)
Jasoquine)
Diclofen:1-3mg/kg/day (BD)
Suppo.12.5mg, 50mg
Inj. 75mg/3ml
Tab. 25, 50mg
Formula feeding (Biomeal, Lactogen)
Upto 6 month : I
Upto 1 yrs
: II
>1 yrs
: III
In case of acute watery diarrhoea give lactogen free milk
Gastro-fix
O-lac
Baby saline- 5% DA + 0.225% NaCl
Hartsol Plus : 5% DA + H/S
Libott-S junior: 5%DA + 0.45% NaCl
Libott-25: 25% DA
Fluid Mx
1st day- 60ml/kg/day
2nd day- 80ml/kg/day
3rd day- 100ml/kg/day
4th day- 120ml/kg/day
5th day- 140ml/kg/day
5th day-2nd month- 150ml/kg/day
Drop calculation:
24 hrs
Formula:
Total Fluid in ml
4 hrs
500ml fluid 6 hrs
= 20 d/m
1000ml fluid in Adult
10 d/m takes 24 hrs
20 d/m takes 12 hrs
30 d/m takes 8 hrs
60 d/m takes 4hrs
Fluid
1st day: 10% DA
2nd day: 3yrs: APN, electrodex, Baby saline
>3 yrs: Libott-s junior, H/S Plus
NB:
65 | P a g e
If convulsion:
kg
ml stat
kg
ml
Dilute
Hypomagnesemia:
Metabolic acidosis:
Sodibicarb (7.5%)
Mix 1ml of NHCO3 with 1ml of 10% DA
Then, give 1ml/kg IV slowly over 5min
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LBW/Preterm Baby
Umbilical Sepsis
Clinical feature:
Discharge
Red & inflammed periumbilical area
Foul smell
Fever
Delayed cord falling
67 | P a g e
Rh Incompatibility
Exchange transfusion
Neonatal Jaundice
Physiological Jaundice:
Rx
Phototherapy
IndicationIf S.bilirubun in-
Conjugated(Direct):
Neonatal hepatitis
Extrahepatic biliary atresia
Inborn error of metabolism
Unconjugated(Indirect):
Physiological jaundice
Breast milk jaundice
Crigler-Najjar syndrom
Ongoing haemolysis
Hypothirodism
Acute RTI
O2 inhalation
Inj. Ceftriaxone: 50-100mg/kg/day
P/C: 15mg/kg/day
1ml = 15 drop = 80mg
1 TSF syp = 5ml = 120mg
Nasal drop: 1 drop 8 hrly in both nostril
Danger sign:
Stop feeding well
Convulsion
Abnormally sleep
Stridoe,wheez
Fever or low body temp
Bronchodilator: Salbutamol
Oral-0.4mg/kg/dose (8 hrly)
1 TSF = 2mg = 5ml
1 Tab- 2mg, 4mg
Nebulization: 0.15-0.3mg/kg/dose
1 nabule = 2.5mg
1ml solution = 5mg salbutamol
OR
<5 yrs = 0.5ml/dose
>5 yrs = 1ml/dose
Amynophyllin: LD- 5mg/kg over 20min
Then 0.5mg/kg/hrs
1ml = 25mg
Hydrocortisone: 3-4mg/kg/dose (6 hrly)
1 vial = 100mg
Prednisolone: 1-2mg/kg/day (TDS)
1 Tab. = 5mg
No Pneumonia:
No sign of pneumonia
Cough & cold
Pneumonia:(Only for 2month-5yrs)
Fast breathing >40 breathing
Severe pneumonia:
Pneumonia + Chest Indrawing
In case <2 month only fast
breathing ,>60 breathing is called
severe pneumonia
Very severe disease:
Severe pneumonia + Danger sign
UTI
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Meningitis
Clinical feature:
Onset is acute
Headache, nausea, vomiting, fever, restlessness, irritability, neck pain, poor
feeding, seizure, coma
Fever, photophobia, neck rigidity, kernig's sign, brudzinki's sign, stupor,coma,
bulge frontanalles
Rx
Casative Organism:
0-2month:
E.coli
S.Agalactic
Listeria monocytogen
S.pneumonia
H.influenza
2-6 yrs:
S.pneumonia
H.influenza
n.meningitidis
6 yrs:
S.pneumonia
N.meningitidis
All age:
TB
Oral Thrush
Dx:
Vomiting
Rx:
Nystat Oral drop
15 drop orally apply twice daily
70 | P a g e
Febrile Convulsion
3ml
Tab. Sedil
1mg/kg/day (TDS)
Syp. P/C: 15mg/kg/dose
Napa suppo: 15/mg/kg/dose ( if temp >101o F)
Syp. Amoxicillin
50mg/kg/dose (TDS)
1 TSF = 120mg
OR
Syp. Cefotim- 8mg/kg/dose (BD)
Reassurance
Advice
Criteria:
Age: 6 month to 6 years, peak 18 month
Family history +ve
Male>Female
Infection: 90% cases
o Pharyngitis
o Otitis Media
o UTI
o Pneumonia
o Roseola
Seizure occur with a rapid rise of
temparature
Onset within 24 hrs of illness
Type- Generalized tonic clonic
Duration 15 min
Tetanus
NPO TFO
IV infusion 5% or 10% DA
Inj. TIG
1 amp in each buttock stat
Inj. C-penicillin
1 lac unit/kg/day (6 hrly)
Inj. Sedil- 3mg/kg/dose IV ( 6 hrly)
OR
Inj. midazolam-0.2mg/kg
71 | P a g e
AGN
Bed rest
Fluid restriction:
Body surface area 400 ml + previous day output
Antibiotic:
Phenoxymethyl penicillin: 50mg/kg/day (6 hrly)
1 Tab = 125mg, penvik fort 1 tab = 250mg
Control of Oedema: Salt restriction, no added salt
Tab. fusid- 2-4mg/kg/day (BD)
1 tab = 40mg
Control of BP: Tab. Nifin 10mg (0.0.6mg/kg/day)
NS
Bed rest
Salt & water restriction if Oedema present
Tab. Frusemide
1-2mg/kg/day (BD)
+
Tab. Spironolactone
2-3mg/kg/day (BD)
Prednisolone
60mg/m2 body surface area/day in 3 divided dose until urine become protein free.
Then, 60mg/m2/day single dose every alternate day for 3-6 month
If frequent relapse
-Prednisolone 2mg/kg/day until urine become protein free for consecutive 3 day
followed by alternate day 0.5-1mg/kg/day fro wks
-Cyclophosphamide
2mg/kg/day (8 hrly)
Antibiotic
Phenoxymethyl penicillin
50mg/kg/day (6 hrly)
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Asthma
Sulbutamol
Oral: 0.2mg/kg/day (TDS)
Syp. 1 TSF = 2mg, Tab. = 2mg, 4mg
Inhaler: 2 puffs 12 hrly
Nebulization: 0.15-0.3mg/kg/dose
1 Nabule = 2.5 mg
1ml solution = 5mg
Sulmeterol: 2 puff 12 hrly
Hydrocortisone: 3-4mg/kg/dose (4-6 hrly)
1 vial = 100mg
Prednisolone: 1-2 mg/kg/day (TDS)
1 Tab = 5mg
Aminophylline: LD- 5mg/kg followed by 0.5mg/kg/hrs
1 ml = 25mg
Beclomethasone: 1-2 puff 6 hrly
Fluticasone: 50-100gm (BD)
MgSO4: 25-50mg/kg (Inj. 5ml = 2.5mg)
Kititifen: 1mg BD with food (asthma with allergic reaction)
1 Tab = 1mg
Ascariasis
Levamisole
3mg/kg/dose (single dose)
1 TSF = 40mg
1 Tab = 40mg
Adult dose- 3 tab stat
OR
Mebendazole
100mg 12 hrly for 3 days
1 TSF = 100mg
OR
Pyrantel pamoate
11mg/kg/dose (single dose)
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Diarrhoea
Trait
No dehydration
Some
Severe
Appearance
Well,alert
Restless,irritable
Uncoscious,irritable
Thurst
normal
Drink eagerly
Unable to drink
Skin pinch
Goes quickly
Slowly(2sec)
Very slowly
Eye
Not shunken
shunken
shunken
No sign of dehydration
Home Mx: 3 golden triad
1)More fluid:
<2 yrs:10-20 TSF (50-100ml) after each motion
>2-5 yrs: 20-40 TSF (100-200ml) after each motion
> 5 yrs: as much he drinks
2)More food
3)Referral knowledge
74 | P a g e
kg
IV correction if:
Some dehydration + 3 or more vomiting + high purging rate(15 purging/hrs)
+ Impending paralytic ilium(abdominal distension) + lactose Intolerance
Drop calculation:
75 wt
4 4(hrs)
= .... d/m
Drug:
If desentry:
Syp. Cotrimoxazole/Ciprofloxacin/Azithromycin/Cephradin/Cefixim/Flucloxacillin
75 | P a g e
Severe dehydration
IV fluid 100ml/kg
Then 70ml/kg in
5 hrs
21/2 hrs
Near drowing
CPR if necessary
High flow O2 inhalation
Left lateral position
Keep the baby warm
IV fluid- NS
If convulsion: Inj. Berbit (1ml + 9ml D/W)
o LD:
kg
ml stat
Pathophisiology:
Ischemic-anoxic
injury
Pulmonary
aspiration
Hypothermia
Cardiac arrest
Cerebral oedema
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Malaria
Day 4- Primaquine
1mg/kg/dose (single dose)
Enteric Fever
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Grade of malnutrition
G-1, mild
G-2, moderate
G-3, severe
With oedema
Kwashiorkor
Marasmic Kwashiorkor
Without oedema
Undernutrition
Marasmur
Level of nutrition
Normal
Borderline
Malnourished
Level of Malnutrition
Normal
Marginal
Mild
Moderate
severe
78 | P a g e
Management of PEM
1) Prevention of hypoglycemia
2) Prevention of hypothermia
3) Correction of dehydration if present
Re-So-Mal (rehydration solution for malnourished)
70-100ml/kg over 12 hrly
Starting 5ml/kg every 30 min for 2 hrs
Then, 5-10 ml/kg/hrs orally or NG
Preparation of Re-So-Mal
ORS 1 pack in litre of water
+
25gm sucrose
+
20ml of mineral mix solution/ syp. electro-k (2 TSF)
4) Rx of septic shock
Inj. Ampicillin (100mg/kg/day)
Inj. gentamycin (7.5mg/kg/day)
5) Dietary Rx
Total energy requirement is 100kcl/kg/day
Fluid requirement is 100ml/kg/day
Feeding should be given 2 hrly ( 12 feeding)
Feeding should be F-75
F-75: 100 ml of fluid contain 75 kcl of energy
79 | P a g e
Example
Suppose the wt of the baby is 5 kg
So, total fluid requirement is = 5 130 = 650 ml
In, F-75 diet
100 ml contain 75 kcl
So, 1 ml contain 75/100 kcl
So, 650 ml contain (75 650)/100 ml
= 487.5 kcl
In, 12 feeding,
Per feeding fluid require (650 12) = 54.11 ml or 55ml
And energy require (487.5 12) = 40.65 kcl
So the fluid should be made by 55ml of D/W containing 40.65 kcl energy
Energy available
1 TSF milk
=20 kcl
1 TSF sugar
=20 kcl
1 ml soyabin oil = 9 kcl
So, we should made the fluid with
(3/4 TSF of milk + 3/4 TSF of sugar + 1 ml of soyabin oil) = 40.65 kcl energy
6) Correction of Vitamin deficiency
Vit-A supplementary is given (Day-1,Day-2,Day-3)
Dose: <6month: 50 thousand
6mnt-1yrs: 1lac unit
>1yrs: 2lac Unit
(Cap. retinol forte, 1 cap = 50,000 unit)
Folic acid supplementation
Day 1 - 5mg orally, then 1mg daily
Multivit drop- 10 drops/day
Kerosene Poisoning
NPO TFO
O2 inhalation
IV infusion: Inf. baby saline
Antibiotic: Inj/Oral amoxycillin
Inj. Ranitidine- 5mg/kg/dose (8-12 hrly)
1 TSF = 75 mg
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Dose of dopamine
10 g/kg/min
Example
If wt 20kg
Then, 20 10 = 200 g/min
= 200 60 g/hrs
= (200 60)/1000 mg/hrs
= 12 mg/hrs
We know
40 g = 1 ml
So, 1 g = 1/40 ml
So, 12 = (1 12)/40 = 0.3 ml
How to give?
20 ml/kg/hrs in NS
If wt is 20 kg, 20 20 = 400ml
+
0.3 ml (dopamine)
= 400.3 ml/hrs
Drop calculation
We know,
Total fluid/(4 hrs)
So, 400.3ml/(4 1 hrs) = 100 d/m
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SURGERY
82 | P a g e
Head Injury
NPO TFO
O2 inhalation if needed
Inf. N/S 3000cc
IV stat @ 30 d/m
Inj. Ceftriaxone 1 gm
1 vial IV stat & daily/BD
Inj. Omeprazole 40mg
1 vial IV stat & BD
Inj. Ketorolac 30 mg
1 amp IM stat & BD/TDS
Inj. Oradexon
1 amp IV stat & 6 hrly
Inj. Berbit
1 amp IM stat & 1/2(0.5) amp BD
Catheterization if necessary
Inj. TT
1 amp IM stat
Inj. TIG
1 amp IM stat
83 | P a g e
NPO TFO
Inf. H/S 3000cc
IV stat @ 30 d/m
Inj. Ceftriaxone
1 vial IV stat & daily/BD
Inj. Omeprazole 40 mg
1 vial IV stat & BD
Inj. Ketorolac 30mg
1 amp IM stat TDS
Inj. TT
1 amp IM stat
Inj. TIG
1 amp IM stat
Then stich given on necessary site
Suture material: -prolin/Silk (cutting body)- for skin
-Vicryl (R/B)- for muscle
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Investigation:
Plane X ray of abdomen in erect posture including both dome of diaphragm
USG of W/A
Blood for Grouping & cross matching
85 | P a g e
NPO TFO
NG suction half hourly
Inf. HS 2000cc + 5% DNS 1000cc
Iv stat 30 d/m
Inj. Cefuroxime
1 vial IV stat & BD/TDS
Inj. Metronidazole
1 Bottle IV stat & TDS
Inj. Omeprazole
1 vial IV stat & BD
Inj. Algin
1 amp IM stat & TDS
OR
Inj. Butapan- 1 amp IM stst & TDS
+
Inj. Nospa- 1 amp IM stat & TDS
In case of biliary ascariasis
3 levamisol tab stat
Investigation:
USG of HBS
S. amylase
Acute Abdomen
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Investigation:
Abscess
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Ulcer
Drug:
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Main Mx is operative
Initial catheterization
Tab. Uromax/Maxrin (0.4mg)
0+0+1
Tab.Ciprofloxacin
Tab. Omeprazole
Sympypmatic
Main Mx is Operative
But initial:
Diet. Normal
Avoidance of smoking
Cap. cephradin 500mg- 1=1+1+1
Cap. Omeprazole 20mg- 1+0+1 (b/m)
Tab. Oxifil CR 400mg- 1+0+1
Tab. cinaron- 1+1+1
Tab. diclofecac- if pain
Tab. Sedil- 0+0+1
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Tab. Metronidazole
1+1+1
Cap. Omeprazole
1+0+1 (b/m)
Tab. Algin/Clofenac- If pain
Tab. F/S
1+0+1
Tab. Levamisol- 3 tab stat
Syp. Avolac
4 TSF BD
Hip bath
3 times daily & after defeacation
Anustat Ointment
Apply before & after defeacation
Peri-Anal Abscess
90 | P a g e
91 | P a g e
EYE
Age related Cataract (ARC)
Diet. Normal
Cloramphenicol E/D: 1 drop 6 hrly
Tab. Ranitidin 150mg: 1+0+1 (b/m)
Tab. Sedil: 0+0+1
Tab. Ibuprofen: 1+0+1 (a/m)
Tab. B/C: 1+0+1
Diet. Normal
Cloramphenicol / Moxifloxacin E/D: 1 drop 6 hrly
Cap. Amoxycillin 500mg: 1+1+1 OR Cap. Lebac 500mg: 1+1+1+1
Tab. Ranitidin 150mg: 1+0+1 (b/m)
Tab. Sedil: 0+0+1
Tab. B/C: 1+0+1
Diet. normal
Pilo E/D (Intensive Pilocarpine therapy)
1 drop every min for 5 min
1 drop every 5 min for 15 min
1 drop every 15 min for 30 min
1 drop every 30 min for 2 hrs
Then, 1 drop 12 hrly
Sonexa E/D: 1 drop 4 hrly
Tab. Acemox (Acetazolamide)
1+1+1+1
Tab. Electro-K
1+1+1
Timopress/Temo E/D
1 drop 12 hrly
Tab.Ranitidin
1+0+1 (B/M)
Tab. Ketorolac/Diclofenac
OR
1 drop 4 hrly
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Bed rest
Use sun glass, Avoid water
Diet. Normal
Natamycin E/D: 1 drop 3 hrly
Moxifloxacin E/D: 1 drop 3 hrly
Atropin E/D: 1 drop 3 hrly
Cotrimazole E/O: at bed time
Tab. Levofloxacin 500mg: 0+1+1
Tab. Fluconazole 50mg: 0+1+0
Tab. Ranitidin: 1+0+1 (b/m)
Tab. Ketorolac 10mg: 1+0+1 (a/m)
Tab. Vit-C: 1+0+1
Tab. Sedil: 0+0+1
If Hypopion present:
Viral Keratitis
Diet. Normal
Clovir E/D: 1 drop 6 hrly 3 wks
Cloramphenicol E/D: 1 drop 4 hrly
Atropin E/D: 1 drop8 hrly
Analgesics
Tab. Ranitidin
Tab. B/C
Tab. Ceevit
Ocular Injury
Bed rest
Haemostasis if needed
Give eye pad after proper dressing with giving antibiotic oint.
Tab. Antibiotic
Tab. Ranitidin
Tab. Ketorolac
Tab. Sedil
Tab. Vit-C
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ENT
Epistaxis
F.B Larynx/Trachea
O2 inhalation
Inj. Dexamet- (to prevent laryngeal Oedema)
1 amp IV stat & 6 hrly
IV Infusion
Antibiotic
Analgesics
H2 Blocker
F.B Pharynx/Oesophagus
NPO TFO
IV infusion
Omeprazole
Analgesics
H2 blocker
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Acute Epiglottitis
Inj. Amoxycillin/Flucoxacillin
Inj. Ranitid/Omeprazole
Tab. Histacin: 1+0+1
Tab. Sedil: 0+0+1
Clue to Dx:
Hoarsness of voice
Dysphagia
O/E- Epiglottis
Thick
Swollen
Inflam
Hanging
1st to see stridor: If present- Tracheostomy
NPO TFO
O2 inhalation
IV infusion
Inj. dexamet- To prevent laryngeal oedema
1 amp IV stat & 6 hrly
Inj. Ceftriaxone 1gm
Inj. Omeprazole 40mg
Inj. Ketorolac
Inj. Berbit: 1 amp IM stat & 1/2 amp BD
DNS
Cap. Amoxycillin
Cap. Omeprazole
H2 blocker
Analgesics
Antazole Nasal drop( 0.1% )- 3 drops in each nostril BD
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CSOM
Tab. Ciprofloxacin
Tab. P/C
Cap. Omeprazole
H2 blocker
Gentin HC ear drop- 3 drops in each ear 3 times daily
Traumatic Rupture Of TM
Inj. cefradin
Inj. Ranitidin
Inj. Diclofenac
Tab. Histacin: 1+0+1
Tab. Omidon:1+0+1
Tab. Sedil: 0+0+1
Gentin HC ear drop: 3 drop 3 times daily in effected ear
Sub-mandibular Growth
Cap. Amoxycillin
Cap. Omeprazole
Tab. Levamisol- 3 tab stat
Tab. Histacin: 1+0+1
Tab. F/S: 0+1+0
Povisep mouth wash: 3 TSF in 1 glass of water then gargle 3 times daily
Cap. Amoxycillin
Cap. Omeprazole
Tab. Levamisol- 3 tab stat
Tab. P/C
H2 blocker
Antazole Nasal drop- 3 drops in each nostril BD
96 | P a g e
Rhinosporidiosis
Nodular Goitre
Tab. Ciprofloxacin
1+0+1
Cap. omeprazole
1+0+1 (b/m)
Tab. Histacin: 1+0+1
Tab. sedil
0+0+1
Tab. B/C
1+0+1
Tab. F/S
1+0+1
Advice:
USG of thyroid
Cervical Lymphadenopathy
Tab. Ciprofloxacin
1+0+1
Cap. omeprazole
1+0+1 (b/m)
Tab. Histacin: 1+0+1
Tab. sedil: 0+0+1
Tab. F/S: 1+0+1
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Parotid Abscess
Maxillary Sinusitis
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FTP
FTP with PET
FTP with Eclampsia
Post partum Eclampsia
Obstructed Labour
APH
PPH
Shock
IUD
Retained Placenta
Common Pt in Gynae
PV bleeding
Incomplete Abortion/ threaten Abortion
DUB
Genital Prolapse
Perineal tear
Ectopic Pregnancy
VVF
Indication of C/S
100 | P a g e
OBS
Inj. Piton 4 amp in drip/ 2 amp IM & 2 amp in drip (Just after delevery of the baby)
Tab. Isovent/Cytomis 600mg
1 tab P/R stat
If PPH- Inj. Urgot 1amp IM stat
Diet. Normal
Tab. Pantoprazole
Tab. Sardopa (alfa-methyldopa): 1+1+1
If not controlled then given dose (2+2+2) even (2+2+2+2)
(Target BP- Systolic: 130-140 mmhg, Diastolic: 90-100 mmhg)
Tab. Nidipin SR (Nifedipin): 1+0+1
Tab. Sedil: (0+0+1) OR Tab. Berbit 30mg: (0+0+1)
101 | P a g e
Eclampsia
Finding:
BP raised
Oedema
Convulsion
Unconscious
NPO TFO
O2 inhalation (if needed)
Inf. H/S 1000ml
IV @ 20 d/m
Inj. Sedil: 1-2 amp dilute with 5cc D/W
IV slowly over 5 min
Inf. Nalepsin (mag sulph)
1st bag IV running
2nd bag 12 d/m
3rd bag 6 d/m
(24 hrs from last convulsion)
Inj. Cephradin 500mg
1 vial IV stat & 6 hrly
Inj. pantoprazole 40mg
1 vial IV stat & BD
Continuous catheterization
Maintain PTR chart
Rx
102 | P a g e
Retained Placenta
Not try to remove placenta without blood & senior.
General Mx
Open IV channel
Blood grouping & cross matching
Ready match blood transfusion
Catheterization
Specific Mx
IUD
Diet. Normal
Cap. Cephradin 500mg: 1+1+1+1
Tab. Pantoprazole 20mg: 1+0+1 (b/m)
Tab. Cytomis: 1/2 +0+ 1/2
OR
Inj. Cytomis 4 amp in 1000cc H/S in drip
Tab. F/S: 1+0+1
Tab. B/C: 1+0+1
Wait for expulsion of dead baby
103 | P a g e
Obstructed Labour
(Failed medical induction, Try to done delivery at home)
History:
Pt party
delivery
)?
saline or Vasofix
labour pain
history positive
pt party
history
Findings:
Vulvular swelling/Oedema
Distended bladder
P/V: Rupture membrane
Head of the baby obstructed
NPO TFO
IV infusion 5% DA- 30 d/m
Inj. Ceftriaxone 1gm/ Inj. Cefradin 500mg
Inj. Ranitidine
Urgent continuous catheterization
Pls. maintain PTR chart
Rx
Advice:
Counseling
Blood grouping & cross matching
Ready for Urgent C/S
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APH
NPO TFO
Inf. H/S 1000cc + 5% DA 1000cc
IV stat @ 30 d/m
Inj. Cefradin 500mg: 6 hrly
Inj. Ranitidin: IV 1 amp stat & BD
If pain: Inj. Algin 1amp IM stat & TDS
If bleeding present: Inj. Traxyl 1 amp IV 8 hrly
Catheterization
Maintain PTR chart
Blood transfusion if necessary
If bleeding not control- Ready to pt for emergency C/S by taking written informed
concent
PPH
NPO TFO
Inf. H/S 1000cc + 5% DA 1000cc
IV stat @ 30 d/m
Inj. Urgot
1-2 amp IM stat
Inj. Cefradin 500mg: 6 hrly
Inj. Ranitidin: IV 1 amp stat & BD
If pain: Inj. Algin 1amp IM stat & TDS
If bleeding present: Inj. Traxyl 1 amp IV 8 hrly
Catheterization
Maintain PTR chart
Blood transfusion if necessary
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Hyperemisis Gravidarum
NPO TFP
Inf. HS 2000cc + 5% DA 1000cc
(With 1 amp vit B-50 forte + 1 amp ascoson in each bag)- IV @ 30 d/m
Inj. Pantoprazole 40mg
1 amp IV stat & 12 hrly
Inj. Emistat
1 amp IV stat & 8 hrly & sos
Or
Inj. Paloxy- 1 amp stat
Inj. Sedil. 1 amp IM stat
Shock
If pulse not palpable & BP not recordable Then, Dopamine drip given
Inf. 5% DA 500cc + 2 amp dopamine
IV stat 6-8 d/m
If hypovolumic shock due to loss of excessive blood
Then, blood transfusion done
also give Inf. H/S 2000ml
30 d/m IV stat
If bleeding then, Inj. traxyl- 1 amp I/V 8 hrly
Otherwise conservative Rx conyinue
If U/O nil & BP normal then : Inj. Lasix 2 amp
Nice to know
delivery
drug
Gynae
PV Bleeding
Advice:
Incomplete Abortion
If huge P/V bleeding present then Rx as above but antibiotic must be Ciprofloxacin &
Metronidazole Combination.
Otherwise Rx will be as below
Diet. Normal
Tab. ciprofloxacin 500mg: 1+0+1
Tab. Metronidazole: 1+1+1
Tab. Pantoprazole 20mg: 1+0+1 (b/m)
Tab. Algin: 1+1+1
Cap. Traxyl: 1+1+1
Tab. F/S: 1+0+1
Tab. B/C: 1+0+1
Advice:
107 | P a g e
Threatened Abortion
Diet. Normal
Cap. Cefradin 500mg: 1+1+1+1
Tab. Pantoprazole 20mg: 1+0+1 (b/m)
Tab. Algin: 1+1+1
Tab. F/S: 1+0+1
Tab. B/C: 1+0+1
If bleeding-Cap. Traxyl: 1+1+1
DUB/Fibroid Uterus
Diet. Normal
Tab. ciprofloxacin 500mg: 1+0+1
Tab. Metronidazole: 1+1+1
Tab. Omeprazole 20mg: 1+0+1 (b/m)
Tab. Algin: 1+1+1 (If pain)
Tab. F/S: 1+0+1
Tab. B/C: 1+0+1
Genital Prolapse
Diet. Normal
Tab. ciprofloxacin 500mg: 1+0+1
Tab. Metronidazole: 1+1+1
Tab. Omeprazple 20mg: 1+0+1 (b/m)
If constipation then, Syp. Avolac: 3 TSF TDS
If pain-Tab. Algin: 1+1+1
Cap. Traxyl: 1+1+1
Tab. F/S: 1+0+1
108 | P a g e
Ectopic Pregnancy
** In case of rupture ectopic pregnancy 1st asses the pt feature of shock & treat the pt acc.
to pt condition
Perineal Tear
Perineal tear should be repair within 24 hrs otherwise 3 months later.
VVF
Diet. Normal
Tab. Ciprofloxacin 500mg: 1+0+1
Cap. Omeprazole 20mg: 1+0+1 (b/m)
Tab. F/S: 1+0+1
Tab. B/C: 1+0+1
109 | P a g e
PID
Adequate rest
Analgesic
Antibiotic- Amoxicillin/Doxycycline/Tretracycline
NPO TFO
IV channel open & all drug should be given parenterally
Inj. Ceftriaxone 1gm
1 vial IV stat & daily
Inj. Metronidazole 100ml
1 bottle IV stat & TDS
Investigation:
Inj. Omeprazole 40mg
High vaginal swab for gram stain
& c/s
1 vial IV stat & BD
Urine for R/M/E
Voltalin Suppository
Blood for c/s (if fever present)
1 stick P/R stat & SOS
After 6 hours
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111 | P a g e