CAP - Community acquired pneumonia

Ix

-Fbc

-buse /creat/lft/po4/mg/ca

-blood c+s

-sputum c+s

-CXR (if not yet done from ED)

Plan

-v/s monitoring 4hourly

-iv augmentin 1.2g tds

-t azithromycin 500mg od

-ivd (if no fluid overload signs)

AEBA

Ix

-Fbc

-buse /creat/lft/po4/mg/ca

- CXR (if not yet done from ED)

-ABG

-sputum c+s

Plan

-v/s monitoring 4hourly

-PEFR chart

-neb combivent 4hourly

-neb pulmicort 200mg 6hourly

-Iv hydrocortisone 200mcg stat, then 100mcg qid (1 day)

-t. prednisolone 30mg od (3 days)

-keep spo2 >95%

-mdi salbutamol 2p prn

-mdi budesonide 2p bd

-(plus )mdi berodual 2p bd (in case of AECOAD)

PCP

IX

-Fbc

-buse /creat/lft/po4/mg/ca

-blood c+s

-sputum c+s

-sputum PCP

- CXR (if not yet done from ED)

Plan

-v/s monitoring 4hourly

-iv augmentin 1.2g tds

-t azithromycin 500mg od

-ivd (if no fluid overload signs)

PTB

IX

-Fbc

-ESR

-buse /creat/lft/po4/mg/ca
-blood c+s

-sputum c+s

-sputum AFB/Ogawa/Bactec

-CXR (if not yet done from ED)

-montoux test

Plan

- Refer Chest team, KIV start anti TB Rx (treatment)

ACS (unstable angina and NSTEMI)

IX

-Fbc

-buse /creat/lft/po4/mg/ca

-CE x 3

-trop T

-ecg

- CXR (if not yet done from ED)

Plan

-v/s monitoring 4hourly

-ECG on chest pain

-daily ECG

-t. simvastatin 20mg on

-t. cardiprin 100mg od

-s/c fondaporinoux 2.5mg od (3 days) ! if no contraindication

-refer cardio

-s/l gtn 1/1 prn

Fluid overload 2ndary to CCF/CKD

IX

-Fbc

-buse /creat/lft/po4/mg/ca

- CXR (if not yet done from ED)

-ecg (for CCF)

- full renal work up (for CKD, if not yet investigated); USG KUB, Hep B/C, HIV

Plan

-v/s monitoring 4hourly

-restriction of fluid

-daily weight

-iv lasix (20/40/60mg) od/bd/tds or oral lasix

-prop up patient

-keep spo2 >95%

-echo appointment (for CCF)

-strict i/o chart

CVA

IX

-Fbc

-buse /creat/lft/po4/mg/ca

-CT brain (if not yet done in from ED)

Plan

-v/s monitoring 4hourly

-t. simvastatin 20mg on

-t. cardiprin 100mg od

-gcs chart

-limb physio

-ryles tube feeding (if not tolerate orally well/ absent gag reflex)

Dengue fever

IX

-Fbc

-buse /creat/lft/po4/mg/ca

-blood c+s

-dengue serology

-protein NS1 (1st week of illness)

-BFMP x3

Plan

-v/s monitoring 4hourly

-ivd ( quantity according to ideal weight of patient)

-encourage orally

-watch out for bleeding tendency

-fbc tds

-notify dengue

Malarial infection (plasmodium vivax)-commonly

IX

-Fbc
-buse /creat/lft/po4/mg/ca

-blood c+s

-dengue serology

-BFMP x3

-G6PD

-ecg

-cxr

Plan

-v/s monitoring 4hourly

-ivd ( quantity according to ideal weight of patient)

-t chloroquinine 600mg stat

-then t. chloroquinine 300mg 6 hour later

-then t. chloroquinine 300mg od (2 day)

-if G6PD negative, start t. primaquinine 30mg od for 2 weeks

-if G6PD deficiency, start t. primaquinine 30mg weekly for 8 weeks

-notify malarial infection