RX Protocol PDF

Treatment Protocol
For
Intern Doctors
Dedicated
To
Dr. Kakoli Dey (SM-2)
Who always inspire me in all situation
from her mind & soul.
Special Thanks To:

Dr. Pintu (SM-2)
Dr. Dilruba (SM-2)
I am also grateful to my respected Sir, senior, colleague & friends of SMCH & SBMCH
Edited By: Dr. Md. Anwarul Azim (SM-2)

INDEX
Medicine
SL No. Topics Page No.

1 Acute Severe Bronchial Asthma 2
2 COPD / Corpulmonale 3
3 Pneumonia 4
4 Lung Abscess 5
5 Pleural Effusion 5
6 Bronchiectesis 6
7 Pneumothorax 6
8 RTI 6
9 Pulmonary TB 7
10 Snake bite (poisonous) 9
11 Snake bite (Non-poisonous) 10
12 Sedative poisoning 10
13 Anti-Depression Poisoning 11
14 β-Blocker Poisoning 11
15 Dutura/Stupefy/Street Poising 12
16 CuSO4 Poisoning 12
17 Corrosive/Chemical Poisoning 12
( Acid/Alkali/Savlon/Herpic/Shampoo/Bleaching powder)
18 OPC POISONING 13
19 Acute Gastritis (Food poisoning) 14
20 Chronic Gastritis/Gastric ulcer 14
21 Acute PUD 14
22 Haematemesis/Malaena 15
23 Haemoptysis 15
24 Mallory weiss syndrome 16
25 Non-Ulcer Dyspepsia 16
26 Anti Flatulent 16
27 GERD 16
28 Ulcerative Colitis (Bloody Diarrhoea) 17
29 IBS(Diarrhoea predominant) 17
30 Tropical spore 17
31 Apthus Ulcer 17
32 Oral Thrush 17
33 Liver Abscess 18
34 Acute Viral hepatitis 18
35 CLD 19
36 Hepatic Encephalopathy 19
37 Acute Pancreatitis 20
38 Hepato Cellular Carcinoma 20
39 Fatty change of Liver 21
40 CRF/CKD 21
41 AGN 22
42 NS 22
43 Hypernatraemia 23
44 Hyponatraemia 23
45 Hyperkalemia (K > 5.5 mmol/L) 24
46 Hypokalemia 24
47 Hypoglycemia 24
48 Enteric Fever/ Typhoid 25
49 Rickettsial fever 25
50 Dengue fever 25
51 Malaria 26
52 Cerebral Malaria/Severe Malaria 26
53 Kala-Azar 27
54 PKDL 27
55 Fever Under Evaluation/UTI/RTI 27
56 Meningitis 28
57 Epilepsy 28
58 Acute Migraine attack 29
59 Tension Headache 29
60 Vertigo with Headache 30
61 Vertigo/BPPV 30
62 CVD/Stroke 31
63 TIA 32
64 Raised ICP 32
65 Bell's Palsy 32
66 Mumps & Orchitis 33
67 Hyperthyroidism 33
68 Steven Jonson Syndrome 33
69 Anaemia 34
70 Aplastic Anaemia 34
71 Fe Chelating agent in Thalassaemic PT 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 Low Back Pain 39
82 RA 39
83 JRA 39
84 Tetanus 40
85 GBS 40
86 DKA 41
Psychiatry
1 Schizophrenia 43
2 GAD (Generalized Anxiety Disorder) 43
3 OCD (Obsessive Compulsive Disorder) 44
4 PPP (Post Partum Psychosis) 44
5 SRD (Substance related disorder)/Sleeping Pill 44
6 ASD (Acute Stress Disorder) 45
7 Depressive illness 45
8 Somatoform disorder/HCR/FD 45
Skin
1 Scabies 46
2 Acne Vulgaris 46
3 Seborrhoeic Dermatitis/ Seborrhoeic Folicuitis 46
4 Psoriasis 47
5 Tinea 47
6 Onychomycosis 47
7 Contact/Allergic Dermatitis 48
8 Urticaria/Drug reaction 48
9 Eczema 48
10 Impetig Eczema 48
11 S.Blephritis 49
12 White Discharge from Breast 49
13 Insect Bite 49
14 Skin Wart/Hard skin 49
15 Alopecia 49
16 Measles 50
17 Gonococcal Urethritis 50
18 Erectile dysfunction 50
19 Black Spot/wrinkle 50
Cardiology
1 AMI 51
2 IHD 52
3 CCF 53
4 AF (Atrial Fibrillation) 53
5 VF (Ventricular fibrillation) 53
6 SVT (Supra Ventricular tachycardia) 54
7 VT (Ventricular Tachycardia) 54
8 Ischemic Cardiomyopathy 55
9 Hypertension (HTN) 56
Paediatrics
1 Dosage of Drug 61
2 Fluid Mx 64
3 Birth asphyxia/Neonatal Sepsis/Neonatal Convulsion 66
4 LBW/Preterm Baby 67
5 Umbilical Sepsis 67
6 Neonate Of HBsAg +ve mother 68
7 Rh Incompatibility 68
8 Neonatal Jaundice 68
9 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 PEM (Protein Energy Malnutrition) 78
24 Kerosene Poisoning 80
25 Dose of dopamine 81
SURGERY
1 Head Injury 83
2 Physical assault (P/A) 83
3 Massive cut Injury or P/A 84
4 Small cut injury 84
5 Acute case of intestine/ Acute Emergency 85

(Intestinal perforation/ Intestinal obstruction/ Volvolus/
Strangulation/ Intussusception/ Acute appendicitis/ Obstructed
hetnia)
6 A case of Hepato-Biliary system 86

(Acute cholecystitis/ Acute cholelithiasis/ Acute choledocolithiasis/
Acute pancreatitis/ Biliary ascariasis/ Obstructive jaundice)
7 Accidental fall from height 87
8 Abscess 87
9 Ulcer 88
10 Retention of Urine/ Structure urethra 88
11 BEP (Benign Enlargement Of Prostate) 89
12 Hernia & Hydrocele 89
13 PVD(Peripheral vascular Disease) 89
14 Haemorrhoids /Anal fissure/rectal prolapse 90

15 Peri-Anal Abscess 90
16 Gut Preparation for Surgery 91
17 Gut Preparation for IVU 91
EYE
1 Age related Cataract (ARC) 92
2 Chronic Dacrocystitis (CDC) 92
3 Acute Congestive Glaucoma 92
4 Fungal Corneal Ulcer 93
5 Viral Keratitis 93
6 Ocular Injury 93
ENT
1 Epistaxis 94
2 F.B Larynx/Trachea 94
3 F.B Pharynx/Oesophagus 94
4 Acute Epiglottitis 95
5 Hanging 95
6 DNS 95
7 CSOM 96
8 Traumatic Rupture Of TM 96
9 Sub-mandibular Growth 96
10 Nasal Mass With HIT 96
11 Rhinosporidiosis 97
12 Nodular Goitre 97
13 Cervical Lymphadenopathy 97
14 Parotid Abscess 98
15 Maxillary Sinusitis 98
OBSTETRICS
1 Indication of C/S 100
2 FTP with Normal Finding/Normal Labour 101
3 FTP with PET 101
4 Eclampsia 102
5 Post Partum Eclampsia 102
6 Retained Placenta 103
7 IUD 103
8 Obstructed Labour 104
9 APH 105
10 PPH 105
11 Hyperemisis Gravidarum 106
12 Shock 106
GYNAE
1 PV Bleeding 107
2 Incomplete Abortion 107
3 Threatened Abortion 108
4 DUB/Fibroid Uterus 108
5 Genital Prolapse 108
6 Ectopic Pregnancy 109
7 Perineal Tear 109
8 VVF 109
9 PID 110
10 Post Conductive order(In Obs)/Post Expulsive Order(In Gynae) 110
11 Bowel Preparation On 1st day 111
12 Bowel Preparation On 2nd & 3rd day 111

Dedicated to Dr.Kakoli Dey
Medicine
1|P a ge
A Patient with Breathlessness

Commonly:
 Bronchial Asthma
 COPD
 Pneumothorax
 LVF/AMI
 DKA
 Pulmonary edema/Thrombo embolism
 CRF/ARF/Uremia
 Emotional/HCR/FD
Acute Severe Bronchial Asthma

 Diet: Normal
 Bed rest with propped up position Clue to Dx-
 O2 Inhalation stat & SOS (high conc.)  Breathlessness
 Nebulization with windel plus stat & 6 hrly  H/O previous attack/allergy
 Inj. Cotson/Oradexon  Young pt
 Night awaking
1 vial IV stat & 6 hrly
 Wheeze,ronchi,
Or  Vesicular breath sound with
Tab. Cortan(prednisolon) 5mg prolong expiration
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
2|P a ge
COPD / Corpulmonale
 Diet: normal
 Bed rest with propped up position

Clue to Dx COPD-
 O2 Inhalation with low conc.  Breathlessness
 Nebilization with windel plus stat & 6 hrly  H/O cigarette smoking
 Inj. Cotson/Oradexon  Old age(>40yrs usually)
1 vial IV stat & 6 hrly  No H/O asthma usually
Or  Crep +++,ronchi,wheeze
 Tongue cyanosis, eye
Tab. Cortan(prednisolon) 5mg
congested
6+0+0 ( 10 days)  Lip pursing
 Tab. Moxclave/Fimoxyclave 625mg
1+1+1 Clue to Dx Corpulmonale
Or  If COPD present with
Levofloxacin 500mg (0+0+1)/ Ciprofloxacin Oedema
(1+0+1)
 Asmasol/Sulprex inhaler
2 puff TDS
 Bexitrol F/ Ticamate inhaler
2 puff BD
1+0+1 (B/M)
 If more Crep/Oedema present
Inj. Lasix/fusid
2amp iv stat then 1amp iv BD ( 8am & 4pm)
Inj. KT
1 amp iv in drip stat
 If mild crep/ less severe

Tab. Fusid plus
1+1+0
 Tab. Contin 200mg
1+0+1
** Syp. electro K ( If only Fusid use)

2tsf tds
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
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
Clue to dx-
 High grade fever
 Short history ( days to week)
 Chest pain with or without cough/
despnoea
Investigation-
 CBC
 RBS
 CXR P/A view
 MT
 Sputum for AFB
4|P a ge
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
Clue to Dx-
 Fever with Cough
 Hemoptysis
 Foul smell sputum
 Chest pain/despnoea
 Wt loss/anorexia/ clubbing(10-14 days)
 CXR
Pleural Effusion
 Bed rest
 O2 inhalation if necessary Investigation-
 CXR
 Pleural fluid aspiration
 CBC
Up to 1.5L in one setting  Sputum- AFB,cytology
 Rx of underlying cause-  MT
TB,Malignancy,pneumonia,etc  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
 Symptomatic-
Creap/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
If symptomatic (<1/3 Collapse)- Immediate insertion of percutanuous wide bore needle

(Usually 2nd or 3rd intercostal space at midvlavicular line)
Symptomatic with >1/3 collapse- Water seal drainage (At the 5th/6th IC in mid axillary line
with tip in the apical direction)
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 Rx Regimen

CAT-1  New smear positive Intensive Phase (daily)
 New smear negative PTB 4FDC- 2 month
 Extra PTB Continuation phase (daily)
 Pleural effusion, pericardial 2FDC- next 4 month
 Meningeal
 Spinal,intestinalTB,
dessiminiated TB
CAT-2  Relapse Intensive Phase (daily)

 Treatment after deafult 1st 2 month- Inj. streptomycin IM
 Treatment failure daily
Next 3 month- Remistar FDC
Continuation phase (daily)
Next 5 month-
remactazid+Ethambutol
Composition of FDC
4FDC- INH 75mg + Rifampicin 150mg + Pyrazinamid 400mg + Ethambutol 275mg
2FDC- INH 75mg + Rifampicin 150 mg
Dose of FDC
FDC Weight(K.G) Dose

4FDC < 27 acc. to body wt
30-37 2
38-54 3
55-70 4
>70 5
2FDC 30-37 1 Rmactazid 300mg
< 50 1 Rmactazid 450mg
>50 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
CAT-1 ( WT-45 kg)
 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
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
 ।
 , , ,
।

CAT-2 (WT-45 kg)
 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
1+0+1 (B/M)
 Tab. Calcium 500mg(1+0+0)- 2month
8|P a ge
Poisoning
Snake bite (poisonous)
 Diet: NPO TFO

 Bed rest
 Reassurance
 O2 inhalation if needed
 Inf. 5% DA 1000cc+ 5% DND 2000cc
IV 30 d/m stat
 Inj. Ceftriaxone 2gm
1 vial IV stst & daily
 Inj. Omeprazole 20mg
1 vial IV stat & BD
 Inj. TT
1 amp IM stat (in one arm)
 Inj. TIG
1 amp IM stat (in another arm)
 Inj. Polyvalent anti-venom 10 vial(every vial dilute with 10ml D/W) + 5% DA 100ml
IV @ 60d/m
 Catheterization
 Additional Rx acc. to neurotoxic feature
-Inj. Atropin
1 amp IV stat
-Inj. Neostigmine- if muscle paralysis
 Monitoring Vital sign
** 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
Snake bite (Non-poisonous)
 Bed rest
 Reassurance
 Inf. NS 1000cc
IV @ 20d/m stat
 Cap. Moxin(1+1+1)/ cephradin(1+1+1+1)
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
 Stomach wash if pt comes within 4-6hrs

 Diet. NPO TFO
 Inf. NS/DNS 1000cc
IV @ 20d/m stst
 Inj. ceftriaxone 1gm
1vial IV stat & BD
1 vial IV stat & BD
 Inj. Lasix ( if BP stable)
2 amp IV stat then 1 amp BD ( 8am & 4pm)
 If pt unconscious
-NG suction
- Continuous catheterization
 Monitor Vital sign
** Diazepam lethal dose more then 50/60 tab
Investigation
 S.Creatinine
 SGPT
10 | P a g e
Anti-Depression Poisoning
 Stomach wash if pt comes within 12hrs

 Diet. NPO TFO
 Inf. NS/DNS 1000cc
IV @ 20d/m stst
 Tab. Ultracarbon
20 tab stat
 Inj. ceftriaxone 1gm
1vial IV stat & BD
1 vial IV stat & BD
 Inj. Lasix ( if BP stable)
2 amp IV stat then 1 amp BD ( 8am & 4pm)
 If pt unconscious
-NG suction
- Continuous catheterization
β-Blocker Poisoning
 Stomach wash if pt comes within 1hrs

 Inf. 5% DNS 1000cc (prevent hypoglycemia)
IV @ 20 d/m stat
1 vial IV stat & BD Investigation-
 Inj. Omeprazole 40mg  ECG
1 vail IV stat & BD  RBS
 Symptometic  S.Creatine
 Convulsion  S. Electrolytes
Inj. sedil 1amp IM/IV stst
 Bronchospasm
Nebulization
 Bradycardia
Inj. atropin 1 amp 8hrly
 Hypoglycemia
-Inj. libot-25 100ml
-Inj. 10% DA 1000ml as maintenance dose
 Hypotension- Inj. Glucagon
11 | P a g e
Dutura/Stupefy/Street Poising
 Diet. NG Feeding 2hrly/NPO TFO

 O2 inhalation if needed Investigation-
 Inj. NS 1000cc  ECG
20 d/m IV stat  RBS
 Inj. Amoxycillin  S.Creatine
1vial IV stat & 8 hrly  S. Electrolytes
 Inj. Ranitid
1 amp IV stat & 8 hrly
 Continuous catheterization
 Monitor vital sign
** 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
1 vial IV stat & BD
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
Atropin Doubling dose-
 Diet. NPO TFO 1st give 3amp IV stat then
 Inj. NS/ 5% DNS 1000cc  Next 10min 6amp
20 d/m IV stat  Next 10min 12amp
 Inj. Ceftriaxone 1gm  Next 10min 24amp
 Next 10min 48amp
1 vial IV stat & BD
 Continue Up to
 Inj. Omeprazole 40mg atropinization
1 vial IV stat & BD
 Inj. Atropin
3 amp IV stat & double the dose every 10 min interval up to atropinization
 Inj. Pam-A 500mg ( Pralidoxime)

2 amp IV slowly over 10 min
 Maintain atropin chart
 Maintenance dose- If atropinization occur then (If loading dose 150amp)
-Inj. Atropin 45amp + NS 955 ml (total 1000ml)
IV @ 10 d/m
-Inj. PAM-A (May be given in current channel or another channel)
2amp+ NS/DNS 1000ml

Sign of Atropnizatio-
 If restless/convulsion  Pupil- Dilated
 Pulse- >80 b/m
Inj. Sedil 1amp IV stat
 BP- > 110/80 mm hg
 If still restless
 Dry Axilla
Inj. perol 1amp IM stat  Clear lung
Maintenance dose-
*Atropin 30% of total loding
dose in 24 hours.
On Discharge (If total loading dose is 150 amp
 Tab. prokind 15mg- 15 days Then 30% of 150 amp is 45amp)
1+1+1 So pt get 45amp in 24hrs as
maintenance dose
 Tab. Tryptin 25mg- 2 month
*Pralidoxime 8-10 mg/kg/hrs
0+0+1 OR
 Cap. Omeprazole 20mg-1month 2amp in 1000ml NS/DNS
1+0+1
13 | P a g e
Acute Gastritis (Food poisoning)

 Inf. NS/ Cholera Saline 1000cc
IV @ 30 d/m
 Inj. ciprofloxacin 100ml
bag IV stat & BD
 Inj. Metronidazole
1 bottle IV stat & TDS
1 vial IV stat & BD
 Inj. Emistat/Onaseron
1 amp IV stat & sos
Chronic Gastritis/Gastric ulcer

 Pylotrip strip- 7-10 days
1 strip(4 tab) BD
 Then Tab. Lansoprazole- 2 month
1+0+1
OR
 Cap. Amoxycillin 500mg(1+1+1)/ Clarithromycin 500mg(1+0+1)- 7-14 days

 Tab. Metronidazole 400mg- 7 days
1+1+1
 Cap. omeprazole 20mg- 2 month
1+0+1
Acute PUD
 Diet. NPO TFO
 Inf. 5% DA 1000cc + Inf. 5% DNS 1000cc
IV @ 20 d/m
 Inj. Maxpro 40mg
1 vial IV stat & BD
 Inj. Algin
1 amp IM stat & TDS
 Inj. Emistat/ Onaseron
1 amp IV stat & SOS
14 | P a g e
Haematemesis/Malaena
 Complete bed rest
 NPO TFO
 Inf. HS 2000cc + Inf. 5% DA 1000cc
IV running
 O2 inhalation if needed Investigation-

 1st choice-Endoscopy of
 Inj. Moxacil
UGIT
1 vial IV stat & TDS  Blood grouping & cross
 Inj. Omeprazole 40mg matching
1 vial IV stat & BD  CBC
 If portal HTN  PBF
-Tab. Indever 40mg  USG og HBS & pancrease
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
1+0+1 (B/M)
 Inj. frabex/inj. traxyl
1 amp IV stat & then Investigation-
 Tab. frabex/traxyl  CBC
1+1+1  CXR
 Tab. sedil  MT
 Sputum for AFB & malignant cell
0+0+1
 RBS
 S.creatinine
15 | P a g e
Mallory weiss syndrome

 Tab. Gastralfet 500mg- 14 days
2+2+2+2+2+2 ( Chewing 30min before meal & don't eat anything next 30min after
chewing)
 Cap. Omeprazole 20mg- 1 month
1+0+1
Non-Ulcer Dyspepsia
 Diet. sweet,fat,milk restricted
 Tab. Tryptin 25mg
0+0+1
1+0+1 (B/M)
 Tab. Omidon 10mg
1+1+1 (B/M)
 Tab. Entacid/Marlox
1+1+1 (A/M)
 Psychotherapy
Anti Flatulent
 Syp. flatameal DS
1/2 TSF TDS
 Tab. Flatameal DS
1-2 tab TDS
GERD
 Non drug Rx of GERD

 Wt reduction, stop smoking, avoid fatty food



 Drug Rx
1+1+1 (B/M)
1+0+1 (B/M)
16 | P a g e
Ulcerative Colitis (Bloody Diarrhoea)
 Tab. Cortan 10mg

2+2+0
 Tab. Salazin 500mg ( Sulfasalazine)
1/1+0+1/2- 1st wk
1+0+1- 2nd wk
2+0+2- continue
 ORS as per need
IBS(Diarrhoea predominant)
 ORS- As per need

 Tab. Alve (Alverine)
1+1+1
OR
Cap. Imotil 200mg (Loperamide)
1+1+1
 Tab. Triptin 25mg
0+0+1
Tropical spore
 Cap. Atetra 250mg-28 days

1+1+1+1
 Tab. Folison 5mg- 1 yrs
0+0+1
 Correction of dehydration/electrolytes imbalance
Apthus Ulcer
 Tab.precodil (prednisolon) 5mg

1 tab TDS at lacerated site
 Apsol/Meoral oral paste
Apply 3-4 times daily
 Viodin/arodin mouth wash 3 times daily
 Tab. Cevit 250mg
1+0+1
Oral Thrush
 Micoral/Gelora oral gel- Apply TDS in affected area

 Syp. flugal- 1 TSF TDS
17 | P a g e
Liver Abscess
 Diet. Normal
 Tab. Ciprofloxacin 500mg
1+0+1
 Tab. Metronidazole 400mg
2+2+2
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
Acute Viral hepatitis

 Diet. normal
 Syp. D-luc
2 TSF TDS
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
 Diet. Salt restricted

1+0+1
1+0+1 (b/m)
 Tab. fusid plus
1+1+0
 Syp. D-luc/Avolac
3TSF TDS
 Draw ascitic fluid 2L every day or alternative day
 Maintain I/O chart
 If complain abdominal pain/fever
-Inj. ceftriaxone 1gm
1 vial IV BD
 If abdominal pain
-Inj. anadol 100mg-1 amp IM stat
-Inj. algin- 1 amp IV stat
Hepatic Encephalopathy
 Diet. protein, Diruretics, fruits, sedative(except midazolam) restricted
 NG feeding
 Inf. 5% DA 1000ml
IV 20 d/m
1 vial IV stat & daily Investigation-
SGPT
 syp. Metronidazole
S.Bilirubin
4 tsf tds PT
 Inj. Ranitid S.albumin, AG ratio
1 amp IV stat & 8 hrly HBsAg
 Syp. D-luc/Avolac USG of W/A
3 tsf tds Asitic fluid study
 Inj. konakion 10mg
1 vial IV daily for 3-5 days
 If pt restless consult with senior & give
-Inj. Dormicum 7.5mg
1/2 amp IM/IV stat
19 | P a g e
Acute Pancreatitis
 Diet. NPO TFO

 Inf. NS 1000cc + Inf. 5% DNS 200cc
IV @ 20 d/m stat
 Inj. ceftriaxone 1g (BD)/ Inj. Ceforoxime 1.5g (TDS)
 Inj. Omeprazole 40mb
1 vial IV stst & bd
 Inj. Ketorolac 30mg
1 amp IM stat and BD
Investigation-
 CBC with ESR
 USG of HBS with Pancrease
 ECG
 S. amylase- if within 24hrs
 Urinary amylase- > 24hes
 Before discharge
-RBS
-S. Calcium
Hepato Cellular Carcinoma
 Diet. salt, protein restriction

 Inf. 10% DA 1000cc
IV 10 d/m
 Tab. Famotidin 20mg
1+0+1
 Cap. Amoxycillin
 Tab. verosprium 25mg
 Percutaneous Ethanol Inj.- If tumor is small
20 | P a g e
Fatty change of Liver
 Diet. Low fat diet

1+0+1(B/M)
 Tab. Algin/viseralgin
1+1+1
 Tab. Todol
1+1+1
 Tab. Alben DS
0+0+1
 If increase TIG level- Tab. Lipirel 200mg
CRF/CKD
 Diet. fruit, protein, dub water restricted

1+0+1(B/M)
 Tab. Fusid 40mg (don't use fusid plus to avoid hyperkalamia)
1+1+0
 Inj. fusid if generalize swelling
 Tab. dicaltrol/calcitrol
0+1+0
 Tab. calbo 500mg
1+0+1
 Tab. Folic acid
1+0+1
 Tab. Amlodipin-If HTN
 Antibiotc-If infection
 Loatidin 10mg-If purities
21 | P a g e
AGN
 Diet. Protein, fruits restriction(to avoid hyperkalamia)

 Fluid. 500ml + previous day out
 Tab. (Phenoxy methyl penicillin)/ Pen-V/Oracin 250mg
1+1+1+1
1+0+1 (b/m)
 Tab. fusid 40mg (don't use fusid plus to avoid hyperkalamia)
1+1+0 - 5 days
1+0+0 - 5 days
 Tab. Omidon 10mg - 7 days
Clue to Dx-
1+1+1
 HTN
 Tab. deslor 10mg ( If itching)  Oedema- peri orbital,leg,sacral
0+0+1  Visuble haematuria
 Tab. Amlodipin 5mg (If HTN)  Oligura/uremia
1+0+0  Mild to moderate proteinuria
 Other Symptomatic (24 hrs urinary protein <3.5 gm
 Maintain BP chart
 Maintain Heat coagulation test
NS
 Diet. Normal(salt & fluid restriction)

 Fluid. 500ml + previous day out
 Antibiotc- Amoxycillin/Cefixim/Ceftriaxone
1+0+1
 Tab. Atova Clue to Dx-
0+0+1  Generalize oedema
 Tab. Cortan 5mg  Massive proteinuria- >3.5
gm/24hrs
4+4+0
 Hypo-albuminaemia- < 30gm/L
 Tab. Calbo 500mg  Hyperlipidaemia- >220 mg/dl
0+1+0
 Tab. Fusid plus- If massive Oedema
 Other Symptomatic
 Maintain BP chart
 Maintain Heat coagulation tes
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
 If pt stable & conscious- drinking more water at least 2L extra water

 In hospital- 5% DA 2000cc
IV 20 d/m
 repeat S.electrolytes
Hyponatraemia
Mild (125-135)
 Orally take table salt +ORS
Moderate (110-125) Na+ requirement for hyponatraemia

WT in KG ×0.5(F) or 0.6(M) × deficit
 Inf. 0.9% NaCl by calculating Na+ requirement **If a male 60kg wt, S.Na+ 120 mmol/L
(Max 2L/day) Then Na+ requirement is
 Added salt 60 × 0.6 × (140-120)
=720 mmol/L
Severe (<110)
 Inf. 3% NaCl by calculating Na+ requirement

(Max 1L/Day) **Not correct more then 10-12 mmol/L
in every 24hrs, rapid correction causes
Nice To Know Osmotic Demyelination syndrom
 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
Hyperkalemia (K > 5.5 mmol/L)

 Diet fruit restriction
 Inf. 25% Nutridex 100ml/Libot-25 + 5 unit Maxulin-R (daily for 5days)
IV @ 8-10 d/m
 Inj. Ca gluconate (10ml) dilite with 10ml D/W (daily for 5days)
IV slowly over 10min
 ** If hyperkalemia with compelet Heart block
-Inf. 5% DA 500cc + 2amp Isolin (Isoprinalin) IV stat - to prevent bradycardia
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)
 Inj. KT 2amp + Inf. NS 1000cc

IV @ 15 d/m
 Advice- repeat S.Electrolytes1
Hypoglycemia
 LD-Inj. 25% glucose/libot-25/nutridex
IV running stat Clue to Dx-
 MD- inf. 10% DA 1000cc  H/O insulin intake
 Missed meal
20 d/m up to 24 hre
 Hypotension
 Inj. Decason  Cold calm skin
1 amp IV stat & 6 hrly  Shallow resp.
 Repeat Blood glucose
24 | P a g e
Fever
Enteric Fever/ Typhoid
 Diet. normal
 Inj. Ceftriaxone 2gm- 7 days
Investigation-
1 vial IV stat & BD
 CBC
OR
 Urine R/M/E
Tab. Azithronycin 500mg-7 days  Blood culture- 1st wks
1+0+1  Widal test- 2nd wks
 Cap. Omeprazole 20mg  Tipple Ag
1+0+1 (B/M)  MP & ICT
 Tab. Omidon  USG of W/A
1+0+1
 Tab. P/C 500mg
1+1+1
 Tepid sponging
 Napa suppository
1 stick P/R when temp >101o F
Rickettsial fever
 Cap. A-tetra/Tetra A/Tetrax 500mg- 7days
1+1+1+1
+
Tab. Azithromycin 500mg
1+0+0
 Cap. Omeprazole 20mg
 Tab. P/C 500
1+1+1
 Napa suppository
1 stick P/R when temp >101o F
Dengue fever
 Tab. Azithromycin 500mg- 3 days

1+0+0
 Tab. P/C 500mg
1+1+1
 Volume replacement if dehydrate/Shock
 Platelet/blood transfusion if platelet count < 30,00
25 | P a g e
Malaria
 Tab. Jasoquin 300mg (Quinine sulphat)- 7 days
2+2+2 (A/M)
 On 3rd day-
-Tab. Malaride ( salfadoxime + pyrol)
3 tab stat
 On 4th day-
-Tab. Jesoprim (Primaquine)
3 tab stat
1+0+1
 Inf. 5% DNS 1000cc- (To prevent hypoglycemia, because anti-malarial drug causes
hypoglycema)
IV 20 d/m
Investigation
 HB%, CBC with ESR
 MP/ICT for malaria
Cerebral Malaria/Severe Malaria

 Inf. 25% glucose/Nutridex 100ml
IV running stat
 Inj. Ceftriaxone 2gm ( In severe malaria whatever the Dx have to give Ceftriaxone)
1 vial IV BD
 LD- Tnf. 10% DA 500cc + Inj. Jasoqine 4 amp (20mg/kg over 4 hrs)
IV stat 30 d/m
 MD- Inf. 10% DA 500cc + Inj. Jasoqine 2 amp (10mg/kg over 4 hrs)
IV 30 d/m 8 hrly
26 | P a g e
Kala-Azar
 Inj. Na-Stibogluconate/Stibatin (100mg/ml)
20mg/kg/day for 28 days
PKDL
 Inj. Na-Antimony gluconate (SAG)
20mg/kg/day for 20 days per cycle
Duration- 6 cycle with 10 days interval between cycles
Fever Under Evaluation/UTI/RTI

 Bet rest
 Diet. Normal
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
 Inj. Ceftriaxone 2gm- 14 days
1 vial IV stat & BD
 Inj. Dexamet
1+0+1 (B/M)
 Tab. P/C 500mg
1+1+1
 Napa suppo
1 stick P/R if temp > 101o F
 If convulsion-
Inj. Sedil 5mg
1 amp IM stat & SOS
OR
Tab. Berbit 30mg
0+0+1
 Syp. Diphedan 100mg
1 TSF TDS
Epilepsy
 Tab. Tegretol 200mg (carbamazepine)
1+1+1
OR
Tab. valex/Epilim/Encorate (Na-Valporate)
1+0+1
 Tab. Neuro-B
1+0+1
1+0+1 (b/m)
 Tab. Rivotril (0.5mg)
0+0+1
 Tab. bardinal 30mg
1+0+1
 If severe
o Inj. Berbit-1/2 amp IM stat & SOS
o Inj. Peridol- 1 amp IM/IV stat & BD/TDS
o Inj. Perkinil- 1 amp IM/IV stat & BD/TDS
28 | P a g e
Acute Migraine attack

 Tab. Rizat 5mg (Rizatriptan)
1 tab stat orally, 10 min again 1 tab,
 Tab. Migranil/pizo 0.5mg (pizotifen)
0+0+1
 Tab. Tufnil 200mg (Tolfenamic acid)
1+0+1
 Tab. Norium 10mg (Flunarizine)- 6 month
0+0+1 (
 Tab. Tryptin- Continue
0+0+1
 Tab Indever 10mg- if trachycardia present
1+0+1
For Classical migraine
 Tab. P/C: (1+1+1) Or Naproxen (1+0+1)

 Tab. Omeprazole 20mg
1+0+1 (b/m)
1+1+1 (b/m)
In severe attack
 Inj. Ketorolac 30mg- 1 amp IM stat

 Tnj. Ranison- 1 amp IM stat
 Inj. sedil- 1 amp IM stat
Tension Headache
 Tab. naprosyn 500mg (1+0+1) OR Tab. P/C 500mg (1+1+1)- 2 days

 Tab. Omidon 10mg- 2 days
1+1+1
 Cap. Omeprazole 20mg- 2 days
1+0+1 (b/m)
 Tab. Sedil 5mg/Tab. Dormitol 7.5mg
1 tab stat
 Prophylaxis
- Tab. Tryptin 10mg (0+0+1)
- Tab. frenxit (1+1+0)
29 | P a g e
Vertigo with Headache

 Tab. Cinaron
1+1+1
 Tab. Stemetil/Vergon
1+1+1
 Tab. P/C
1+1+1
Vertigo/BPPV
 Tab. Stemetil/Vergon- 15 days
1+1+1
 Tab. Perkinil- 15 days
1/2 + 1/2 + 1/2
30 | P a g e
CVD
Stroke
 Diet. NG feeding
200ml 2 hrly
 O2 inhalation stat & SOS

 Inf. NS 1000cc Clue to Dx
IV 20 d/m stat  Sudden Onset
 Unconscious/semi-
 Inj. Dexamet
conscious/conscious
1 amp IV stat & 6 hrly  Aphasia
 Inj. Omeprazole- 1 vial IV stat & BD  Hemi/mono paresis
 Antibiotc- if needed  Planter-Unilateral extensor
- Inj. Ceftriaxone 1gm In Infarctive
1 vial IV stat & BD  Usually conscious
 aphasia
OR
 Hemi/mono paresis
- Inj. Moxin 500mg In Haemorragic
1 vial IV TDS  Unconsciousness
 Continuous catheterization  H/O Headache/vomiting/HTN
 Change posture 2 hrly  Neck rigidity in sub-arachnoid
 If Pt with HTN, BP > 180/120 mm of hg Hge
- Tab. Ramoril/Ripril 5mg (Ramipril)
0+0+1
 If Infarctive stroke
 Tab. Cavinton/cerevas 5mg- 3 month
1+1+1
 Tab. Anclog plus/ Ecospirin plus- continue
0+1+0
 Tab. Atova 10mg- continue
0+0+1 Investigation-
 Steroid omit  CT scan of brain
 If Haemorrhagic stroke  RBS
 Steroid given for 5 days then omit  S.Creatinine
 S.Electrolytes
 If venticular extention
 S.Lipid profile
- Tab. Nimocal 30mg- for 21 days  ECG
2+2+2+2+2+2
 If Brain atrophy with Oedema
- Inf. 20% mannitol/Osmosol 500ml
1/2 bag running & then 1/2 bag 8 hrly for 3 days
** Anti-platelet drug is contra-indicated in Haemorrhagic stroke
31 | P a g e
TIA
1+0+1 (b/m)
 Tab. Anclog plus/Ecospirin plus
0+1+0
 Tab. Atova/Tiginor 10 mg
0+0+1
 Tab. Ramoril- if HTN
Raised ICP
 Inj. Mannitol/manisol 500ml
1/2 bag running & 1/2 bag 8 hrly for 48 hrs
Bell's Palsy
1+0+1 (B/M)
 Tab.Virux 400mg- 7 days
2+2+2+2+2
 Tab. Cortan 20mg (1mg/kg)- 7 days
21/2+0+0 (A/M)
 Tab. Neuro-B
1+0+1
 Eye care
- SQmycetin E/D- 1 drop TDS
- SQmycetin E/O- apply at bed time
- Use eye glass & eye pad during sleep
 Physiotherapy
32 | P a g e
Mumps & Orchitis

 Tab. deltason 20mg
2+0+0 (A/M)
 Tab. P/C 500mg
1+1+1
 Tab. cefuroxime 500mg
1+0+1
3gm IV stat & daily
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
Steven Jonson Syndrome

 Diet. NPO TFO
 Inf. 5% DA 1000cc + Inf. 5% DNS 2000cc
IV 30 d/m
 If secondery infection- Inj. Ceftriaxone -1 vial IV daily
 Inj. Dexamet
 Micoral oral gel
Apply locally 3 times
 Sonexa E/D
1 drop 4 hrly
 Sonexa E/O
At bed time (both eye)
 Haematropin E/D
1 drop 8 hrly
 Tab. Vasco 250mg
1+1+1
33 | P a g e
Anaemia
 Blood transfusion at least 4 unit (If HB% 6 g/dl)
OR
Tab. Folfetab (1+1+1)/Tab ZIF-CI (1+0+1)
(5 wks for correction + 6 mnt for storage, total 7 mont)
 Rx of primary cause
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
 Bed rest- chance of HF, to avoid trauma

 Fresh blood transfusion up to storage
 Inj. cefuroxime IV form ( IM is contraindicated)
Specific Rx
 Marrow stimulating agent

 Bone marrow transplantation
Fe Chelating agent in Thalassaemic PT
 Inj. desferal 500mg 2 vial + Inf. 0.9% NaCl 1000cc

IV @ 20 d/m
Macrocytic Anaemia
 Tab. Folfetab
1+0+1- 3 wks
Then, 1+0+0 per week for life long
 Inj. Cyanomin (1000 µgm)
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
 Vincristin- 1.4 mg/m2

 Cyclophosphamide- 750 mg/m2
 Doxorubicin HCL- 50 mg/m2
 Prednisolon- 2 mg/kg/day
Pre-requisition
 Pt well hydrate
 Liver & Renal function
Duration
 21 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

+
Inj.Onaseron 4 amp
Inj. Oradexon 2 amp
Inj. Ranitid 2 amp
IV @ 60 d/m
 Inj. Vincristin 1ml
2 vial IV stat slowly
Bag-2

+
Inj. Doxorubicin 70mg (50mg & 10mg available)
IV @ 60 d/m
Bag-3

+
Inj. Endoxan 1gm
IV @ 40 d/m
 Tab. Cortan- 5 days
2+2+1
 Tab. Esloric 100mg- 7 days
1+0+1
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
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
1+0+1 (B/M)
 Tab. Indomet
1+0+1
OR
Indomet suppository 100mg
1 stick P/R stat & BD
OR
Tab. Naprox/Naprosyn 500mg
1+0+1
 Tab. Myolax/Tolperison HCL 50mg
1+1+1
 Tab. Caldil
1+0+1
Lumbo Sciatica
 Tab. Myolax 50mg- 7 days
1+1+1
1+0+1 (B/M)
 Tab. Naprosyn 500mg
1+0+1 (A/M)
OR
Tab. Rolac 10mg
1+0+1(A/M)
 Tab. aristovit-M- 2 month
0+0+1
Septic Arthritis
 Inj. Aflox 500mg- 2 wks (** Inj. Flucloxacillin 2gm 6 hrly)
 Then,
Cap Flubex 500mg- 4 wks
1+1+1+1
38 | P a g e
Low Back Pain

 Tab. beclo 10mg- 7days
1+1+1
 Then
Tab. Myolex 50mg- 7 days
1+1+1
 Cap. Omeprazole 20mg- 15 days
1+0+1 (B/M)
 Tab. tenorex- 7days
1+0+1 (A/M)
Advice



RA
1+0+1 (B/M)
 Cap.Indomet 25mg
1+1+1 (A/M)
 Tab. MYX 2.5mg-3 tab weekly single dose
 Tab. Folison-3 tab weekly single dose
 Tab. prednisolone 5mg
6+0+0 (A/M)
JRA
 Tab. MTX 2.5 mg- 3 tab weekly
 Tab. Folison 5mg ( 1 day after MTX)
1+0+1 per week
 Cap. omeprazole
1+0+1 (B/M)
 Cap. Servimeta 25mg
1+1+1
39 | P a g e
Tetanus
 Diet. Soft
 O2 inhalation SOS
 Isolation room (dark & soundless room)
 Inj. C-Penicillin(5 Lac)
 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 ɣ-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
 Ascending type of paralysis
 More marked proximal than distal
 Symmetrically
 Sensory intact
 Jerk- diminished/loss
 Bowel/bladder nit involved
 All 4 limbs may paralyzed
40 | P a g e
DKA
Basic Principal of DKA Management
1. fluid replacement
2. the administration of short-acting (soluble) insulin
3. potassium replacement
4. the administration of antibiotics if infection is present
Rx:
 Diet. NPO TFO

 NG suction
 O2 inhalation
Fluid: Total fluid 6 litre over 24 hrs
 1st NS 1000cc over 1/2 hrs

 2nd NS 1000cc over 1hrs hrs-
 3rd NS 1000cc over 2 hrs
 4th Ns 1000cc over 4hrs
Then when RBS <15 mmol/L
 1st 5% DA 1000cc over 8 hrs

 2nd 5% DA 1000cc over 8 hrs
If still dehydrate start 5%DNS
Short acting soluble Insulin: via microburet set
 Inj. NS 100ml + Inj. Actraoid HM(u-100)- 24 unit

− 6 unit/hrs initially- IV @ 24 µd/m
− 3 unit/hrs when blood glucose <15 mmol/l - IV @ 12 µd/m
− 2 unlt/hrs when blood glucose <10 mmol/l- IV 8 µd/m
Alternative
 10-20 unit Insulin IM stat
Then,
− 6 unit IM hrly initially
− 3 unit IM hrly when blood glucose <15 mmol/l
− 2 unit IM hrly when blood glucose <10 mmol/l
 Check blood glucose hourly initially; if no reduction in first hour, rate of insulin
infusion should be increased
 Aim for fall in blood glucose of 3-6 mmol/L (approximately 55-110 mg/dL) per hour
41 | P a g e
If pt able to take oral food then switchover to subcutaneous as
 Inj. Actrapid HM u-100,s-100

8+8+6 SC 15min before meal
If RBS >10-15 mmol/l then again start insulin drip
Antibiotic:
 Inj. Ceftriaxone 1gm- 1 vial IV stat & BD
Inj . Ranitidin- 1 amp IV stat & 8 hrly
Correction of K: Inj. K-T (1 amp = 20 mmol/l)
− 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 Drop calculation:

 Unconsciousness/semi consciousness
 Drowsy/Disoriented Total fluid
 Feature of dehydration d/m=
 Respiratory distress may be present
4 × hrs
 Known diabetic pt
 Low BP, Trachycardia,
 Planter: may be bilateral extensor
42 | P a g e
Psychiatry
Schizophrenia
 Inj. Fenazine 25mg

1 amp IM ( )
Then,
Tab. sizodon/resodon 2mg
0+0+1-for 2 days,then
0+0+2- continue
 Tab, Opsonil 50mg
0+1+1
 Tab. Perkinil
1+1+1
Pase 0.5- 15 days
0+0+2
 Tab.Promitil 5mg ( )
1+0+1
GAD (Generalized Anxiety Disorder)

 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
OCD (Obsessive Compulsive Disorder)

 Tab. Clofranil 25mg
0+0+1
Then. 0+0+2
Then, 0+0+3
 Tab. Disopan 0.5
0+0+1
 If palpation- tab. Indever
1+1+1
PPP (Post Partum Psychosis)

 Tab. Peridol 5mg
1+1+1
 Tab. Perkinil 25mg
1+1+1
 Tab. Opsonil
0+0+1
SRD (Substance related disorder)/Sleeping Pill

 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
ASD (Acute Stress Disorder)

 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
 Tab. Azithromycin /Flufloxacin
 Tab. Histacin
1+0+1
 Bactrocin ointment
 Scaper/Scabex/scabicid Cream
। ।
- । ,
।

Acne Vulgaris
 Tab. azithromycin 500mg
0+0+1-
, ।
 Scbionex jell/ Acne bar - /
Seborrhoeic Dermatitis/ Seborrhoeic Folicuitis

 Tab. Oflacin 200mg- 10 days
1+0+1
 Tab. Telfast/Fenadin 180mg- 15 days
0+0+1
 Bactrocin/bectroderm oint.
46 | P a g e
Psoriasis
 Tab. Oflacin 200mg
1+0+1
 Tab.Telfast 180mg
0+0+1
 Olive Oil
 Xenovet Oint. + Eucera cream + 5% salicylic acid
 Sastid bar
 Xenovet Scalp / Dermovet cream
 Fungitar shampoo
-
Tinea
 Cap. fungata- 1 month
0+0+1
 Xfin cream- 1 month
 Tab. Telfast 180mg- 1 month

0+0+1
 Tab. Multivit
Onychomycosis
 Cap. fungata
 Afun/Clarizole lotion
47 | P a g e
Contact/Allergic Dermatitis
 Tab. Azithromycin 500mg
 Tab. Telfast
 Diprobet/Mexiderm oint. + Eucera cream
Urticaria/Drug reaction
 Tab. Azithromycin 500mg
 Tab. Momentor
1+0+0
 Tab. Cortan- 10 days
 Cap. Omeprazole
 Tab. Monas(Montelukast) 10mg
0+0+1
Eczema
 Tab. Terbucef 250mg-10 days
1+0+1
 Tab. Telfast
 Xenovet oint. + Eucera cream
Impetig Eczema
1+0+1
 Tab. Telfast
 Bactrocin oint.
48 | P a g e
S.Blephritis
 Betnovate-CL oint.
White Discharge from Breast

1+0+1
 Tab. Telfast- 10 days
0+0+1
 Tab. Multivit- 1 month
1+0+1
Insect Bite
 Antibiotic
 Anti-histamine
 Diprobet/Mexiderm oint.
Skin Wart/Hard skin

 Duofilm lotion (salisylic acid)
 Tab. Telfast- 10 days

0+0+1
Alopecia
 Dermas cream 1%
 Xenovet cream
 Tab. Multivit
1+0+1
49 | P a g e
Measles
 Tab. Azith 500mg- 5days
1+0+1
1+0+1
 Tab. Deslor
 Tab. P/C
 Tab. Emistat/Domin (If complain vomiting)
Gonococcal Urethritis
 Inj. Ceftriaxone 1gm- For 3 days
 1 vial IV stat & daily
1+0+1 (b/m)
 Cap. Doxicap- 7 days
1+0+1
 Tab. Loratin
0+0+1
Erectile dysfunction
 Tab. Silagra/Vegorex 25mg/50mg/100mg (sildenafil citrate)-short acting
OR
Tadalis/Intimate 5mg/10mg/20mg (Tadalafil)- Long acting
Once daily (Contraindicated in IHD)

 Cap. Pirulin ( spirolina)- 2 month ↓ Libido/↓ sexual desire in women
Reproductive age:
1+0+1
 Tab. Femastin 1mg:Once
 Tab. Frenxit daily
0+0+1 Post-menopausal:
 Tab. Renorma 2.5mg: Once
daily
(It also prevent Post-menopausal
Osteoporosis)
Black Spot/wrinkle
 White Objective Pen
50 | P a g e
Cardiology
AMI

 O2 inhalation stat & SOS
 Diet. Liquid
 Nitrosol/Anril Spray
2 puff S/L stat & SOS
OR
Tab. Anril/Angicard 0.5 (If pt poor)
1 tab S/L stat & SOS
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
 Inj. Morphin 1 amp + 14cc D/W then
5 ml IV stat slowly, if not relief then 3 ml IV slowly 10 min interval can be given
within 1/2 hrs at same time BP must check if fall must stop morphin
 Inj. Emistat
1 amp IM/IV 15 min before giving morphin
 Inj. cardinex/Claxane (60mg or 80mg)- if pt comes > 12 hrs
1 syringe S/C stat & BD
If pt comes within 12 hrs
 Inj. Cotson 1 amp IV stat Then

Inj. Straptase (streptokinase) 1 vial + Inf. 5% DA 100cc
IV @ 25 d/m stat (No IM inj. in next 24 hrs of streptokinase)
 Inj. Cardinex/Claxane (60mg or 80mg)- after 24 hrs of inj. streptokinase
1 syn S/C BD
51 | P a g e
If BP fall <80/50 mm of Hg- Pt goes to shock
 Inj. Dopamin 2amp + 5% DA 500ml

IV stat @ 6-8 d/m
 Inj. cotson-2 vial IV stat
MI with Bradycardia
 HR >40 b/m- 1 amp atropin IV stat & SOS

 HR <40 b/m- 2 amp atropin IV stat & SOS
MI with LVF
 Inj. Fusid-2amp/4amp IV stat & SOS

 Cap. Cephradin 500mg (1+1+1+1)
OR
Tab. Ciprofloxacin (1+0+1)
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
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
52 | P a g e
CCF
 Bed rest with propped up position
 Diet. Liquid
 O2 inhalation stat & SOS Clue to Dx
 Inj. Cotson  Dysnoea
 Basal creps
2 vial IV stat
 Leg oedema
 Inj. Fusid  Chest pain- May
2 amp IV stat & BD complain
 Cap . omeprazole 20mg
1+0+1 (b/m)
 Tab. Nidocard 2.6
1+0+1
 Antibiotc-Amoxocillin/Ciprofloxacin/Cephradin
 Agoxin 0.25mg (Digoxin)-May use
0+0+1/2 ( Fri & sat day off)
 Anti-hypertensive- If HTN
AF (Atrial Fibrillation)
 Tab. Lanoxin 0.25mg (Digoxin) Digoxin contra-indicated in

3+0+0- for 5 days AMI
Then, 1+0+0- Friday & Saturday off Digoxin(Cardiac glycoside)
↓
↑ force of contraction
↓
↑O2 demand
↓
Ischemia
VF (Ventricular fibrillation)
 DC Shock 200 joules

 If not control another 300 joules
 If control- 2% Lignocaine 100cc + 5% DA 400cc
IV @ 5-8 d/m for 24 hrs
 After 24 hrs
Tab. Pacet 200mg
1+1+1
53 | P a g e
SVT (Supra Ventricular tachycardia)

 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
 Tab. Anclog 75mg
0+1+0
 Tab. Monocard 20mg
1+1+0
1+0+1 (b/m)
 Tab. Fusid plus
1+0+0
 Tab. Cardopil 25mg
1/2 +0+1/2
 Tab. Lanoxin/Agoxin (0.25)
1/2 +0+ 1/2 ( Fri & sat day off)
 Tab. Angicard/Anril 0.5mg
1 tab S/L
55 | P a g e
Hypertension (HTN)
Classification
BHS Classification:
Category Systolic BP (mmHg) Diastolic BP (mmHg)

BP
Optimal < 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 Systolic BP (mmHg) Diastolic BP (mmHg)

BP
Normal 90-119 60-79
Pre-hypertensive 120-139 80-89
Hypertensive
Stage-1 140-159 90-99
Stage-2 >160 >100
Isolated systolic >140 <90
hypertension
HTN
Primary/Essential HTN Secondary HTN

95% unknown cause Alcohol
Obesity
Renal
Endocrine
Drugs- OCP, Steroids, NSAID
56 | P a g e
HTN ?
 At least 2 clinical visits

 At least 2 times BP measure (5 min interval)
Rx
 Asses the pt life style/Risk factor

 To identify secondary cause
 To identify target organ
Management
Non Drug Therapy/ Life style Modification
 Wt reduction: Try to BMI <23

 Exercise: Daily minimum 30min/
 Reduce salt intake: up to 6 gm daily
 Reduce alcohol intake
 Intake K+, Ca++ containing food: Milk
Drug Therapy
Step-1: single drug
 Age <55 yrs: (ACE Inhibitor)

 Age>55 yrs: Thiazide(1st line), ACE inhibitor (2nd line), Ca++ Channel Blocker (3rd
line)
Step-2: Combination
 Age <55 yrs: ACE Inhibitor + Ca++ Channel Blocker

 Age>55 yrs: ACE Inhibitor + Thiazide
Step-3: ACE Inhibitor + Thiazide + + Ca++ Channel Blocker
Step-4: Previous 3 drug + additional 4th drug (β- Blocker)
57 | P a g e
With Co-morbidity
 HTN with stable Angina

− β- Blocker
− Ca++ Channel Blocker
 HTN with ACS (Acute coronary syndrome)
− β- Blocker/ ACE Inhibitor (short acting Captopril)
 OMI
− β- Blocker + ACE Inhibitor
(β- Blocker is 1st choice in IHD)
 HTN with HF
− Loop diuretic
− ACE Inhibitor
(Don't use β- Blocker in HF, but carvedilol may use in stable HF)
 HTN with DM
If S.creatinine >3mg/dl- 130/80 mmhg Rx
If S.creatinine normal- 140/90 mmhg Rx
ACEI intolaret ARB (Angiotensin receptor blocker) use
** ACEI use if S.creatinine <3mg/dl
 HTN with CVD
− ACE Inhibitor
− If one more then thiazide
Malignant HTN/Hypertensive emergency
When HTN associate with end organ damage
 Inj. Lebecard (Labetalol)- 2mg/min (1 amp = 10ml=50mg)

5% DA 90 ml + 1amp
IV @ 60 d/m
OR
 Inj. GTN (safer)- 100µ/min
5% DA 500ml + 1 amp
IV @ 15 d/min
Isolated HTN: >140/<190 (Usually in old age)
 Ca++ Channel Blocker
58 | P a g e
Resistance HTN
 If BP not decrease in use of 3 drugs combination + Diuretic

 Re exclude secondary cause
 BP measurement right or wrong ?
 Pt salt intake
 Diuretc add , appropiate combination
 Pt steroids/OCP/NSAID
F/U- Target goal - F/U
NB.
 target organ damage orally Rx slowly (minimum 48-72hrs) BP

। But Suddenly BP brain Ischemia
 drug change , dose । eg. Diuretc effect minimum
 Target goal single drug maximum dose try । target goal

130 mmhg but BP not decrease or 150 mmhg drug combination
use
Investigation:
 ECG
 RBS
 Lipid profile
 S.creatinine
 S.electrolytes
 S.urea
 Urine R/M/E
 Other disease related investigation if present
59 | P a g e
Paediatrics
60 | P a g e
Dosage of Drug
Inj. Ampicillin (IV 500mg/5ml) Inj.Gentamycin

Dose: 100mg/kg/day 5mg/kg/day (80mg/2ml, 20mg/1ml)
( kg ml) Neonate: < 3kg-Once daily
In Septicemia: 200mg/kg/day >3kg BD
In Meningitis: 400mg/kg/day Child: 8 hrly
Neonate: 12 hrly, Child: 6 hrly divided dose
Inj. Ceftazidim IV/IM Azithromycin
100mg/kg/day 10-20mg/kg/day
250,500,1gm vial 1 TSF = 200mg
Cefotaxim IM/IV Erythromycin
50-100mg/kg/day 50mg/kg/day 6 hrly)
In severe case: 200mg/kg/day 1 TSF = 125mg
250mg/5ml, 500mg/5ml, 1gm/10ml
Ceftriaxone IV/IM Ciprofloxacin
50-100mg/kg/day Neonate: 10mg/kg/day (BD)
Meningitis,Enteric fever- 100mg/kg/day Child: 30mg/kg/day (BD)
1 TSF = 250mg
Amoxycillin Metronidazole
50mg/kg/day (TDS) 30mg/kg/ (TDS), 10mg/kg/dose
1 TSF = 120mg 1 TSF = 200mg
Tab. 250mg, 500mg, 875mg Inj 1 bag= 500gm/100ml
day 6 ml/kg/day (TDS), 2ml/kg/dose
Tab. phenoxymethyl penicillin
50mg/kg/day (6 hrly). 1 Tab. 250,500mg
Cephradin Cloxacillin
30-50mg/kg/day ( 4 hrly) 50-100mg/kg/day ( 6 hrly)
1 TSF = 125mg Inj. 250, 500mg
Drop. 100mg/ml/15 drop Cap. 250, 500mg
1 drop = 7mg Drop. 20 drop = 125mg = 1.25 ml
Tab. 250, 500 mg
Cefixime Flucloxacillin
10mg/kg/day 50-100mg/kg/day (6 hrly)
1 TSF = 100mg 1 TSF = 125mg
In Enteric fever- 20mg/kg/day Cap. 250, 500mg
Cefuroxime Tetracycline
20mg/kg/day (BD) 50mg/kg/day (6 hrly)
1 TSF = 125mg Cap. 250, 500mg
Tab. 125, 250, 500mg
Cefpodoxime Co-trimoxazole
10mg/kg/day 10mg/kg/day
1 TSF = 40mg 1 TSF = 40mg
61 | P a g e
Cefaclor Ofloxacin
20mg/kg/day 15mg/kg/day (12 hrly for 10 days)
Cap. 250mg, 500mg 1 tab. 200, 400mg
Co-Amoxiclave Aldendazole
25mg/kg/dose (8 hrly) <2y: 200mg single dose
1 TSF = 125mg >2y: 400mg single dose
Tab. 250, 500mg Tab. 200, 400mg
1 TSF = 200mg
Domperidone Mebendazole
0.4mg/kg/dose 100mg BD for 3 days
1 TSF = 5mg OR
1 tab = 10mg 500mg single dose
Supp. 15, 30mg 1 TSF = 100mg
Use: > 2 years of age
Odansetron Simethicon
0.2mg/kg/dose (8-12 hrly) 15mg/kg/dar (BD)
1 TSF = 4mg 1ml = 67mg
1 Tab = 4mg, 8mg 1ml/5kg = 3 drop/kg
Inj. 1 ml = 2mg
Electro-K Ranitidine
4 mmol/kg/day 10mg/kg/day
1 TSF = 10 mmol 1 TSF = 75mg
1 amp = 50mg/2ml
Inj. Konakion (2/10 mg mm) Zinc
Neonate: 2 mg mm <6 month: 3mg/kg/day
1amp P/O stat or 1/2 amp IV stat & 1,5,25 >6 month: 5mg/kg/day
day Tab. 10,20mg
Vit-A/Cap. retinol fort Folic acid/Folison
50 thou,1lac,2lac unit Upto 1 yrs: 0.5mg/kg/day
<5month: 50 thousand 1-5y- 5mg/kg/day
5mnt-1yrs: 1lac unit 6-12y- 10mg/kg/day
>1yrs: 2lac Unit 1 Tab = 5mg
Promethazine/Phenargan Pheniramine maleate/Avil
Tab: 10mg (BD) Tab. 22.7mg
Syp. 2-5y: 5-15mg 75mg at bed time
5-10y: 10-25mg Inj. 50mg/2ml
5mg/5ml 25-50mg IM/ slow IV (BD)
Inj. >5y: 6.25-12.5mg (IM) Syp. 1 TSF = 15mg
Adult: 25-50mg (IM/IV) 5-22.5mg (BD/TDS)
25mg/1ml
50mg/2ml
62 | P a g e
Hydrocortisone (100mg/2ml) Frusemide

5mg/kg/dose (6 hrly) 2mg/kg/day
1 Tab = 40mg
Inj 1 amp = 20mg/2ml
Dexamethasone Spironolactone
0.4mg/kg/dose 3mg/kg/day
OR 1 Tab = 25mg
1 mg/kg/day
1 amp = 1ml = 5mg
Tab. 0.5mg
Prednisolone Frusemide + Spironolactone
1-2mg/kg/day Tab. 20mg + 50mg
1 1ab. 5, 20 mg Tab. 40mg + 50mg
Fusid plus, Edeloss plus
Aminophylline/Filin Nefedipine
LD: 0.2ml/kg/dose 0.5mg/kg/dose
(dilute with equal amount water) 1 Tab = 10mg
MD: 0.7ml/kg/day
1 amp = 5ml = 125mg
1ml = 25mg (Order- .....ml/100ml saline)
Tab. 100mg
Theophyllin Inj. Phenobarbitone (1ml + 9ml D/W)

10mg/kg/day (6 hrly) 1 amp = 1ml = 200mg
1 TSF = 120mg LD: kg ml stat
Tab. Asmanyl 300mg SR MD: 1/8th of loading dose 12 hrly
LD: 20mg/kg/dode
MD: 5mg/kg/day
Sulbutamol Diazepam
0.4mg/kg/day (TDS) P/O: 1mg/kg/day (BD/TDS)
1 TSF = 2mg P/R: 0.5mg/kg/dose
Nebulization dose: 0.2mg/kg/dose + Norsol Ongoing febrile convulsion:
Ventolin nebule 1ml = 1mg Inj. Sedil (0._ + .....ml D/W)
Ventolin solution = 5mg kg
1 Tab = 2mg, 4mg If wt 2kg = 0.2ml, If 12kg = 1.2ml
then dilute 3ml
If necessary repeat the dose 2-3 times 10-15
Ketorolac
min interval.
< 10 kg: Inj. 10mg 1 amp
Inj. 10mg/2ml
10-20kg: Inj. 30mg 1/2 amp
Supp. 10mg
>20kg: Inj. 30mg 1amp
63 | P a g e
Paracetamol Beclofen (Skeletal muscle relaxant)

15/kg/dose (TDS) 0.7mg/kg/day (6 hrly)
Paedi drop = 1ml = 80mg 1 Tab = 10mg
1 drop = 5mg
Suppo. 60,125,250,500mg
Aspirin Chloroquine 250mg
50mg/kg/day 25mg/kg; 3 days
As antirheumatc Day dose: 1st = 10mg/kg
100mg/kg/day (6 hrly) 2nd = 10mg/kg
3rd = 5mg/kg
Avloquin, jsochlor
Diclofen:1-3mg/kg/day (BD) Quinine
Suppo.12.5mg, 50mg 10mg/kg/day (TDS)
Inj. 75mg/3ml Jasoquine)
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 If age 10yrs & wt 25(10+10+5) kg

Then,
4th day- 120ml/kg/day
1st 10kg = 10 × 100 = 1000ml
5th day- 140ml/kg/day 2nd 10kg = 10 × 50 = 500ml
3rd 5kg = 5 × 20 = 100ml
5th day-2nd month- 150ml/kg/day Total = 1000 + 500 + 100 = 1600ml/day
>2 month & 1st 10 kg of total wt 100ml/kg/day
For next 10 kg 50ml/kg/day
For next 10kg 20ml/kg/day
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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
 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:
**In Head Injury
<25 kg-Baby saline
 20% of fluid shoule be reduced in >25 kg- N/S
 Birth asphyxia
 Any stressful condition
 20% fiuid should be added in
 Preterm
 LBW
 If preterm/LBW with Stress/ Birth asphyxia no add or reduction
65 | P a g e
Birth asphyxia/Neonatal Sepsis/Neonatal Convulsion

 Fluid: EBF/NG/IV Inf. According to age
 O2 Inhalation stat & SOS ( suction if necessary)
 Inj.Ampicillin (500mg/5ml)
100mg/kg/day (200mg/kg/day in septicemia)
 Inj. Cefotaxim (500mg/5ml)
100mg/kg/day
OR
Inj. Genyamycin (1amp = 80mg/2ml)
1wks 5mg/kg/day, 2nd wks 7.5mg/kg/day (neonate single dose, Child TDS)
 Keep the baby warm
 Maintain PTR
If convulsion:
 Inj. Barbit (1ml + 9ml D/W)

LD: kg ml stat
MD: 1/8th of loading dose 12 hrly
Hypoglycemia:
 10% DA 5ml/kg IV slowly for 2-3min

Then, 10% DA for 2 days acc. to age
Hypocalcaemia: (1st day- baby of diabetic mother)
 IV or Oral 10% Ca-gluconate

5ml/kg/24hrs
OR
1ml/kg ( kg ml Dilute
Then, IV slowly Over 20min
 500 IU Vit-D P/O per day
Hypomagnesemia:
 Mag-sulph 50% solutionb (IM)

0.2ml/kg/dose
Metabolic acidosis:
 Sodibicarb (7.5%)
Mix 1ml of NHCO3 with 1ml of 10% DA
Then, give 1ml/kg IV slowly over 5min
66 | P a g e
LBW/Preterm Baby
 Airway clearance with suction
 O2 Inhalation stat & SOS
 Fluid: EBF/NG/IV Inf. According to age
 Inj.Ampicillin (500mg/5ml)
Dose: 100mg/kg/day - Prophylactic
200mg/kg/day- septicemia
400mg/kg/day- meningitis
 Inj. Cefotaxim (500mg/5ml)
100mg/kg/day
OR
Inj. Genyamycin (1amp = 80mg/2ml)
1wks 5mg/kg/day, 2nd wks 7.5mg/kg/day (neonate single dose, Child TDS)
 Inj. konakion
2mg orally at birth
Then, 2mg orally 4-7days later
 Multivitamin & folic acid- from 2nd wks of life
10-15 drops once or twice daily
 Iron- After 6-7 wks
2-3 mg/kg/day
 Wt record on alternative day
Umbilical Sepsis
 Cleaning with sprit/genlion violet(1% viola)
 Inj. Ampicillin- 200mg/kg/day
 Inj. Gentamycin- 5mg/kg/dose (single dose)
 Rx of fever by P/C
Clinical feature:
 Discharge
 Red & inflammed periumbilical area
 Foul smell
 Fever
 Delayed cord falling
67 | P a g e
Neonate Of HBsAg +ve mother

 Hb Ig (Hepabig)- 100 IU in 0.5ml IM within 12hrs
+
 HB vaccine(Engerix B 10 µg in 0.5ml vial
3 dose 0,1,6 month IM in the anterolateral thigh
Rh Incompatibility
 Exchange transfusion
1st child Mother:
Rh (-ve) mother & Rh (+ve) child
Give Anti D to mother within 48 hrs
**This anti D reacted wtih Rh antigen, thereby prevent antibody formation, So 2nd baby is not
affected
Neonatal Jaundice
Physiological Jaundice:
 Develop after 2-3 days Conjugated(Direct):

 Unconjugated  Neonatal hepatitis
 Resolved before 10 days  Extrahepatic biliary atresia
 Inborn error of metabolism
Rx Unconjugated(Indirect):
 Physiological jaundice
Phototherapy  Breast milk jaundice
 Crigler-Najjar syndrom
Indication-  Ongoing haemolysis
 Hypothirodism
If S.bilirubun in-
Term baby: 10-12mg/dl or more
Preterm baby: 15mg/dl or more
Investigation:
S.bilirubin: Direct & Indirect
68 | P a g e
Acute RTI
 O2 inhalation Danger sign:

 Inj. Ceftriaxone: 50-100mg/kg/day  Stop feeding well
 P/C: 15mg/kg/day  Convulsion
 Abnormally sleep
1ml = 15 drop = 80mg
 Stridoe,wheez
1 TSF syp = 5ml = 120mg  Fever or low body temp
 Nasal drop: 1 drop 8 hrly in both nostril
 Bronchodilator: Salbutamol
Oral-0.4mg/kg/dose (8 hrly)
1 TSF = 2mg = 5ml
1 Tab- 2mg, 4mg No Pneumonia:
 Nebulization: 0.15-0.3mg/kg/dose  No sign of pneumonia
1 nabule = 2.5mg  Cough & cold
Pneumonia:(Only for 2month-5yrs)
1ml solution = 5mg salbutamol
 Fast breathing >40 breathing
OR Severe pneumonia:
<5 yrs = 0.5ml/dose  Pneumonia + Chest Indrawing
>5 yrs = 1ml/dose  In case <2 month only fast
 Amynophyllin: LD- 5mg/kg over 20min breathing ,>60 breathing is called
Then 0.5mg/kg/hrs severe pneumonia
Very severe disease:
1ml = 25mg
 Severe pneumonia + Danger sign
 Hydrocortisone: 3-4mg/kg/dose (6 hrly)
1 vial = 100mg
 Prednisolone: 1-2mg/kg/day (TDS)
1 Tab. = 5mg
UTI
 Ciprofloxacin ( 10-20mg/kg/day )-BD
OR
Ofloxacin (15mg/kg/day)-BD
OR
Cefixime (10mg/kg/day)-BD
OR
Azithromycin (20mg/kg/day)-Once daily
 More intake of water
 Regular emptying of bladder
69 | P a g e
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
 Inj. Ceftriaxone 100mg/kg/day- Casative Organism:

Once daily IV for 15 days 0-2month:
Or  E.coli
 S.Agalactic
Inj. Ampicillin 400mg/kg/day (6 hrly)
 Listeria monocytogen
 Inj. Cefotaxime 200mg/kg/day (6hrly)  S.pneumonia
 Inj. dexamethasone(oradexon)  H.influenza
0.4mg/kg/dose (BD)
 P/C: 15mg/kg/dose 2-6 yrs:
 Rx of complication:  S.pneumonia
 H.influenza
Increase intracranial pressure
 n.meningitidis
-IV mannitol 0.5-1g/kg infusion
+ 6 yrs:
-Inj. Lasix 1mg/kg/dose (BD)  S.pneumonia
1 amp = 40mg = 2ml)  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
 Per rectal Sedil
kg
If wt 7kg = 0.7ml
then dilute 3ml (0.7ml + 2.3ml D/W)
 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 Criteria:
 Age: 6 month to 6 years, peak 18 month
OR  Family history +ve
Syp. Cefotim- 8mg/kg/dose (BD)  Male>Female
 Reassurance  Infection: 90% cases
o Pharyngitis
 Advice
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: Body surface area
Phenoxymethyl penicillin: 50mg/kg/day (6 hrly) Wt(kg) × 4 + 7
1 Tab = 125mg, penvik fort 1 tab = 250mg Wt(kg) + 90
 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)
72 | P a g e
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: 50-100µgm (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
73 | P a g e
Diarrhoea
 Acute- <14 days

 Persisten- >14 days
 Dysentry- Passes of bloob
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
 Many watery stool

 Repeated vomiting
 Mark thrust
 Eating & drinking poorly
 Fever & loose stool
74 | P a g e
Some sign dehydration
ORS: 75mg/kg over 4 hrs
OR
( 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:
 <6 month: Syp. Erythromycin -40-50mg/kg/day (6 hrly)

Eromycin paedi drop 1 drop = 40mg (1 ml = 15 drop)
>6 month: Syp. Azithromycin- 10-20mg/kg/day Once daily (1 TSF = 200mg)
 Syp. Zinc: 2-3 mg/kg/day 8 hrly (1 TSF = 10mg)
 Syp. Electro-k: 3mmol/kg/day 8-12 hrly (1 TSF = 10mg)
 Syp. Odansetrone:0.2mg/kg/dose 8-12 hrly
(1 TSF = 4mg, 1 Tab = 4mg/8mg, Inj. 1ml = 2mg)
 Syp. Metronidazole: 30mg/kg/day 8 hrly (1 TSF = 200mg)
 Vit-A:
 < 6 month: 50 thousand
 6 month- 1 yrs: 1 lac unit
 >1 yrs: 2 lac unit
If desentry:
Syp. Cotrimoxazole/Ciprofloxacin/Azithromycin/Cephradin/Cefixim/Flucloxacillin
75 | P a g e
Severe dehydration
 IV fluid 100ml/kg
**Under 1 yrs correction should be done within 6 hrs
Age First give 30ml/kg in Then 70ml/kg in

<1 yrs 1 hrs 5 hrs
>1 yrs/Older 0.5 hrs (30 min) 21/2 hrs
 <6 month: Syp. Erythromycin -40-50mg/kg/day (6 hrly)

Eromycin paedi drop 1 drop = 40mg (1 ml = 15 drop)
>6 month: Syp. Azithromycin- 10-20mg/kg/day Once daily (1 TSF = 200mg)
OR
 Syp. cefaclor/Loracef : 20mg/kg/day 12 hrly (1ml = 40mg)
OR
 Syp. Ofloxacin: 15mg/kg/day 12 hrly for 10 days
Near drowing
 CPR if necessary
 High flow O2 inhalation
 Left lateral position
 Keep the baby warm Pathophisiology:
 IV fluid- NS  Ischemic-anoxic
 If convulsion: Inj. Berbit (1ml + 9ml D/W) injury
 Pulmonary
o LD: kg ml stat
aspiration
o MD: 1/8th of loading dose 12 hrly  Hypothermia
 Antibiotic: Inj. amoxicillin  Cardiac arrest
50mg/kg/day 3 divided dose  Cerebral oedema
Near drowning: If pt does not died within 24 hrs
Drowning: If pt must be died within 24 hrs
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Malaria
 Tab. Chloroquine(jasochlor): 25mg/kg/dose- 3 days schedule

 1st day- 10mg/kg/dose Single dose (A/M)
 2nd day- 7.5mg/kg/dose single dose (A/M)
 3rd day- 7.5mg/kg/dose single dose (A/M)
 4th day- Tab. Primaquine: 1mg/kg single dose
Treatment Failure malaria
 Day 1- Quinine (jasoquine)

10mg/kg/dose (TDS)
Jasoquine 1 tab = 300mg
 Day 2- Quinine
10mg/kg/dose (TDS)
 Day 3- Quinine
10mg/kg/dose (TDS)
+
Sulphadoxime & Pyramethamine
Sulphadoxime: 25mg/kg
Pyramethamine: 1.25mg/kg single dose
 Day 4- Primaquine
Enteric Fever
 Inj. Ceftriaxone: 100mg/kg/day- for 14 days

OR
 Inj. Ceftriaxone: 100mg/kg/day- for 7 days
+
Oral. Cefixim: 10mg/kg/day 12 hrly (1 TSF = 100mg)
 Syp. P/C
 Tepid sponging
77 | P a g e
PEM (Protein Energy Malnutrition)

Diagnostic criteria for PEM
 Wt for age: Gomez Classification:
Wt for age Grade of malnutrition

76-90 G-1, mild
61-75 G-2, moderate
<60 G-3, severe
 Welcome trust classification:
Wt for age With oedema Without oedema

60-80 Kwashiorkor Undernutrition
<60 Marasmic Kwashiorkor Marasmur
 Classification based on MUAC
Circumference Level of nutrition

>13.5 cm (green) Normal
12.5-13.5 cm (yellow) Borderline
<12.5 cm (red) Malnourished
 Classification based on BMI
BMI = Wt in kg/m2 of height or length
BMI Level of Malnutrition

>20 Normal
18.5-20 Marginal
17-18.4 Mild
16-16.9 Moderate
<16 severe
78 | P a g e
Management of PEM
1) Prevention of hypoglycemia
 If pt conscious: give 50ml of 10% glucose or F-75 Diet

2-3 hrly by mouth
 If pt unconscious: give 5ml/kg 10% glucose IV
Followed by 10% glucose by NG tube
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
80 | P a g e
Dose of dopamine
10 µg/kg/min
Example
If wt 20kg
Then, 20 × 10 = 200 µg/min
= 200 × 60 µg/hrs
= (200 × 60)/1000 mg/hrs
= 12 mg/hrs
We know
40 µg = 1 ml
So, 1 µg = 1/40 ml
So, 12 µ = (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
1 vial IV stat & BD
 Inj. Ketorolac 30 mg
1 amp IM stat & BD/TDS
 Inj. Oradexon
 Inj. Berbit
1 amp IM stat & 1/2(0.5) amp BD
 Catheterization if necessary
If cutting wound present then,
 Inj. TT
1 amp IM stat
Inj. TIG
 1 amp IM stat
**Investigation: CT scan of Brain
Physical assault (P/A) (

 Cap. cephradin 500mg/ flucloxacillin 500
1+1+1+1
1+0+1 (b/m)
 Tab. ketorolac 10mg/Diclofenac 50mg
83 | P a g e
Massive cut Injury or P/A

 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
Small cut injury

 Cap. Cephradin 500mg/Flucloxacillin 500mg
1+1+1+1
1+0+1 (b/m)
 Tab. Ketorolac/ Diclofenac ( Inj. Ketorolac if complain more pain)
 Tab. Ceevit 250mg
1+1+1
 Inj. TT
1 amp IM stat
 Inj. TIG
1 amp IM stat
84 | P a g e
Acute case of intestine/ Acute Emergency

(Intestinal perforation/ Intestinal obstruction/ Volvolus/ Strangulation/ Intussusception/
Acute appendicitis/ Obstructed hetnia)
 NPO TFO & NG suction (must) half hourly

 Inf. HS 2000cc + 5% DNS 1000cc
Iv stat 30 d/m
1 vial iv stat daily/BD
OR
Inj. Ciprofloxacin
1 bag IV stat & BD
1 Bottle IV stat & TDS
 Inj. Omeprazole
1 vial IV stat & BD
 Inj. Anadol
1 amp IM stat & BD
OR
Inj. Algin
1 amp IM stat & TDS
 In case of Intestinal obstruction H/O no defecation for prolong times then give
glycerine suppository 4 stick P/R stat
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
A case of Hepato-Biliary system

(Acute cholecystitis/ Acute cholelithiasis/ Acute choledocolithiasis/ Acute pancreatitis/
Biliary ascariasis/ Obstructive jaundice)
 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
1 Bottle IV stat & TDS

Investigation:
 Inj. Omeprazole
 USG of HBS
1 vial IV stat & BD  S. amylase
 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
Acute Abdomen
 Acute Exacerbation of PUD

 Acute Cholecystitis
 Acute Cholelithiasis
 Acute cholidocolithiasis
 Acute Appendicitis
 Acute Pancreatitis
 Acute Intestinal Obstruction
 Acute Intestinal Perforation
 Volvolus, strangulation, Intussusception
 Obstructed hernia
 Obstructive jaundice
 Biliary Ascariasis
86 | P a g e
Accidental fall from height

 Diet. If pt unconsciousness then NPO TFO with Inf. NS
If conscious then diet Normal
 Tab. Cefuroxime 500mg (1+0+1)/ Tab. Cephradin 500mg(1+1+1+1)
1+0+1 (b/m)
 Tab. Naprosyn/onap/Naprox
1+1+1 (a/m)
 Tab. Myotil (muscle relaxant)
1+0+1
Investigation:
 Plain X-ray of L/S spine both view

 Sometimes X-ray of T/L both view
Abscess
 Incision & drainage
 Cap. flucloxacillin 500mg
1+1+1+1
+
Cap. Cephradin 500mg
1+1+1+1
1+0+1 (b/m)
 Tab. Ketorolac 10mg/Diclofenac 50mg
1+1+1
 Regular dressing
87 | P a g e
Ulcer
 Cap. flucloxacillin 500mg
1+1+1+1
OR
Cap. Cephradin 500mg
1+1+1+1
1+0+1 (b/m)
 Tab. Ketorolac 10mg/Diclofenac 50mg
1+1+1
Retention of Urine/ Structure urethra

Main Mx is:
 Try to catheterization- to try for 1 time

 Supra pubic puncture (by saline set)
 Supra pubic cystostomy
Drug:
 Tab. ciprofloxacin 500mg

1+0+1
1+0+1 (b/m)
 If pain, Tab. Ketorolac/Diclofenac
88 | P a g e
BEP (Benign Enlargement Of Prostate)

 Main Mx is operative
 Initial catheterization
 Tab. Uromax/Maxrin (0.4mg)
0+0+1
 Tab.Ciprofloxacin
 Tab. Omeprazole
 Sympypmatic
Hernia & Hydrocele

 Main Mx is Operative
But initial:
 Tab. Levamisol- 3 Tab stat

 Inj. Titavax- 1 amp IM stat
 Cap. Omeprazole- 1+0+1 (b/m)
 Symptomatic Rx
PVD(Peripheral vascular Disease)

 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
89 | P a g e
Haemorrhoids /Anal fissure/rectal prolapse

 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
 Cap. Cephradin 500mg/Flucloxacillin 500 mg
1+1+1+1
1+1+1
 Cap. Omeprazole
1+0+1 (b/m)
 Tab. Ketorolac/Clofenac
1+0+1
 Hip bath
3 times daily & after defeacation
90 | P a g e
Gut Preparation for Surgery

(Colostomy closure, Hemicolectomy & Other)
For 3 days
 Low residual diet (Bread, Milk, liquid diet)

 Syp. Lactolose
4 TSF BD
1+0+1
1+1+1
 Enema simplex 2 times (12 hrly)
On previous day of OT morning
Gut Preparation for IVU

X-Ray KUB
For 3 days
 Low residual diet (Bread, Milk, liquid diet)

 Tab. Ultracarbon
2+2+2
 Tab. Laexena
0+0+2
OR
Syp. Lactolose/Avolac/Inolac
4 TSF BD
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
Chronic Dacrocystitis (CDC)

 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. B/C: 1+0+1
Acute Congestive Glaucoma

 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 OR 1 drop 4 hrly
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
92 | P a g e
Fungal Corneal Ulcer

 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
If Hypopion present:
 Tab. Acemox: 1+1+1+1

 Tab. Electro-K: 1+1+1
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
93 | P a g e
ENT
Epistaxis
 Pressure over the Ala of the nose
 Ice over the nasal bridge (If H/O trauma)
 Inj. Traxyl-3 amp IV stat & SOS
 Antazol 0.1%/Rhinozol nasal drop
5 drop in each nostril 3 times daily
 IV nfusion- H/S 1000cc
 Antibiotc- Inj. Amoxycillin/Cloxacillin
 Tab. Lorfast- 0+0+1
 Tab. Sedil- 0+0+1
 BP measure if pt hypertensive
F.B Larynx/Trachea
 O2 inhalation
 Inj. Dexamet- (to prevent laryngeal Oedema)
 IV Infusion
 Antibiotic
 Analgesics
 H2 Blocker
Advice: X-ray soft tissue neck A/P & lateral view.
F.B Pharynx/Oesophagus
 NPO TFO
 IV infusion
 Omeprazole
 Analgesics
 H2 blocker
Advice: X-ray soft tissue neck A/P & lateral view.
94 | P a g e
Acute Epiglottitis
 Inj. Amoxycillin/Flucoxacillin Clue to Dx:
 Inj. Ranitid/Omeprazole  Hoarsness of voice
 Tab. Histacin: 1+0+1  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
 Inj. Ketorolac
 Inj. Berbit: 1 amp IM stat & 1/2 amp BD
DNS
 Cap. Omeprazole
 H2 blocker
 Analgesics
 Antazole Nasal drop( 0.1% )- 3 drops in each nostril BD
95 | P a g e
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
 Gentin HC ear drop: 3 drop 3 times daily in effected ear
Sub-mandibular Growth
 Cap. Omeprazole
 Tab. F/S: 0+1+0
 Povisep mouth wash: 3 TSF in 1 glass of water then gargle 3 times daily
Nasal Mass With HIT

 Cap. Omeprazole
 Tab. P/C
 H2 blocker
 Antazole Nasal drop- 3 drops in each nostril BD
96 | P a g e
Rhinosporidiosis
 Tab. Dapsone 100mg
1+0+0
 Cap. omeprazole
1+0+1(b/m)
 Tab. sedil
0+0+1
 Tab. B/C
1+0+1
 Antazole nasal drop 0.1% - 3 drops in each nostril 3 times daily
Nodular Goitre
Advice:
1+0+1
 USG of thyroid
 Cap. omeprazole  T3, T4, TSH
1+0+1 (b/m)  FNAC of thyroid
 Tab. sedil
0+0+1
 Tab. B/C
1+0+1
 Tab. F/S
1+0+1
Cervical Lymphadenopathy
1+0+1
 Cap. omeprazole
1+0+1 (b/m)
 Tab. sedil: 0+0+1
 Tab. F/S: 1+0+1
97 | P a g e
Parotid Abscess
 Cap. Cephradin 500mg
1+1+1+1
 Inj. Genyamycin: 8 hrly
 Tab. Neotack
1+0+1 (b/m)
 Tab. diclofenac
1+0+1 (a/m)
 Tab. Sedil
0+0+1
Maxillary Sinusitis
 Cap. Cephradin- 7 days
1+1+1+1
 Tab. Alatrol- 7 days
0+0+1
 Tab. Pantid 20mg- 15days
1+0+1
 Antazole nasal drop 0.1%
drop in each nostril 3 times daily
 Tab. P/C
1+0+1
98 | P a g e
Gynae & Obstetrics
99 | P a g e
GYNAE & OBSTETRICS

Common pt in Obs
 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
 Previous H/O C/S

 Obstructed labour & failed medical Induction (FMI)
 Post dated pregnancy
 Eclampsia
 RM with Oligohydramnios if AFI <8 (on USG)
 Less foetal movement
 Presentation
 Breech
 transverse
100 | P a g e
OBS
FTP with Normal Finding/Normal Labour
 Wait for NVD (Give NVD list to the pt)

 Cap. Cephradin 500mg: 1+1+1+1
 Tab. Pantoprazole 20mg
 Advice: Blood for grouping & cross matching
During active stage of labour
 Inf. H/S 1000 cc

 IV @ 20 d/min
 Inj. Algin
2 amp IM stat
 Emptying of bladder by catheter
After delivery & expulsion of placenta
 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
FTP with PET
Finding:
 BP raised
 Oedema
Rx
 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
Rx
 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
 Inj. pantoprazole 40mg
1 vial IV stat & BD
 Maintain PTR chart
** Catheterization must be done before Nalepsin give
Advice:
 Arrange 2 or 3 bags blood

 Counseling to the pt party that pt & baby's condition are not good, anything can happen
 C/s list give & Pt ready to C/S
Post Partum Eclampsia
Almost same as Eclampsia treatment
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
 If bleeding- placenta should be delivered by 2 amp oxitocin IM stat & uterine

message
 If placenta Separated & retained- Control cord traction
 If placenta unseparated- Manual removal of placenta by G/A
 If placenta retained with sepsis- Intra uterine swab for C/S & board spectrum
antibiotic
 If only morbid adherent placenta- Only antibiotic
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
Advice: Arrange blood if necessary
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
Rx
 NPO TFO
 IV infusion 5% DA- 30 d/m
 Inj. Ceftriaxone 1gm/ Inj. Cefradin 500mg
 Inj. Ranitidine
 Urgent continuous catheterization
 Pls. maintain PTR chart
Advice:
 Counseling
 Blood grouping & cross matching
 Ready for Urgent C/S
104 | P a g e
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
 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
 Blood transfusion if necessary
105 | P a g e
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
 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 ( ) breast milk suppressive

drug
Tab. bromodil: 1+0+1
 After C/S if complain cough
Tab. Bexidal/Tab. Purisal (1+0+1)
OR
Syp. Ofcof/Ambrox : 2 TSF TDS
 After delivery Breast milk
Tab. Omidon: 2+2+2
Tab. Hollyseed/Lactogen: 1+0+1 (if pt rich)
106 | P a g e
Gynae
PV Bleeding
 Diet. NPO TFO

 Inf. H/S 2000cc + 5% DA 1000cc
IV stat @ 30 d/m
 Inj. Cefradin: 6 hrly
 Inj. Ranitidin: 12 hrly
 Inj. Traxyl: 8 hrly
 Inj. algin: 8 hrly - (If pain)
 Blood transfusion immediately
Advice:
 USG of pregnancy profile (if pregnant)

OR
USG of lower abdomen
 Blood grouping & cross matching
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. Algin: 1+1+1
 Cap. Traxyl: 1+1+1
 Tab. F/S: 1+0+1
 Tab. B/C: 1+0+1
Advice:
 Blood for grouping & cross matching

 USG of lower abdomen
 Arrange blood
107 | P a g e
Threatened Abortion
 Diet. Normal
 Cap. Cefradin 500mg: 1+1+1+1
 Tab. Algin: 1+1+1
 Tab. F/S: 1+0+1
 Tab. B/C: 1+0+1
 If bleeding-Cap. Traxyl: 1+1+1
Advice: USG of Pregnancy profile
DUB/Fibroid Uterus
 Diet. Normal
 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
Advice: USG of Lower abdomen
Genital Prolapse
 Diet. Normal
 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
 Tab. Metronidazole 500mg: 1+1+1
 Tab. Ranitidin/Pantoprazole: 1+0+1 (b/m)
 Tab. Diclofenac
 Tab. F/S: 1+0+1
 Tab. B/C: 1+0+1
** 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.

 Tab. Ranitidin/Pantoprazole: 1+0+1 (b/m)
 Tab. Diclofenac
 Tab. F/S: 1+0+1
 Tab. B/C: 1+0+1
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
If not response within 48 hrs then hospitalization
 NPO TFO
 IV channel open & all drug should be given parenterally
1 vial IV stat & daily
 Inj. Metronidazole 100ml
1 bottle IV stat & TDS Investigation:
 Inj. Omeprazole 40mg  High vaginal swab for gram stain
1 vial IV stat & BD & c/s
 Voltalin Suppository  Urine for R/M/E
 Blood for c/s (if fever present)
1 stick P/R stat & SOS
Post Conductive order(In Obs)/Post Expulsive Order(In Gynae)
 NPO For 6 hrs

 Inf. H/S 1000cc: IV stat @ 30 d/m + 4 amp piton
 Inj. cefradin: 1 vial IV stat
 Inj. Metronidazole: 1 bottle IV stat
 Inj. Ranitidin: 1 amp IV stat & slowly
 Inj. Diclofenac: 1 amp IM stat
 Cap. Retinol fort (50000 IU): 4 cap P/O stat
After 6 hours
 Diet. Soft then normal

 Tab. Ranitidin/Omeprazole: 1+0+1 (b/m)
 Tab. Diclofenac: 1+1+1 or 1+0+1
 Tab. Ceevit 250mg: 1+0+1
 For Baby: Inj. Konakion(2mg mm) per orally stat
110 | P a g e
Bowel Preparation On 1st day

 Non residual diet (ORS/Coconut water/Glucose water)
1+0+1
 Tab. Metronidazole
1+1+1
 Tab. Ranitidine
1+0+1 (b/m)
 Tab. Duralex
2+2+2
 Tab. Laexena
0+0+2
Bowel Preparation On 2nd & 3rd day

 NPO (except glucose water & medication)
 Inf. Cholera saline 400mg
IV @ 40 d/m
 Inf. Manitol 500ml
1 glass at morning & 1 glass at night (Oral)
 Inj. Ciprofloxacin 100 ml
1 bag IV stat & BD
 Inj. metronidazole
1 bottle IV stat & TDS
 Inj. Omeprazole
1 vial IV stat & BD
 Tab. Duralex
2+2+2
 Tab. Laexena
0+0+2
111 | P a g e

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Treatment Protocol

Special Thanks To:

Edited By: Dr. Md. Anwarul Azim (SM-2)

SL No. Topics Page No.

10 Snake bite (poisonous) 9

11 Snake bite (Non-poisonous) 10

19 Acute Gastritis (Food poisoning) 14

20 Chronic Gastritis/Gastric ulcer 14

24 Mallory weiss syndrome 16

34 Acute Viral hepatitis 18

38 Hepato Cellular Carcinoma 20

39 Fatty change of Liver 21

45 Hyperkalemia (K > 5.5 mmol/L) 24

48 Enteric Fever/ Typhoid 25

52 Cerebral Malaria/Severe Malaria 26

55 Fever Under Evaluation/UTI/RTI 27

58 Acute Migraine attack 29

60 Vertigo with Headache 30

66 Mumps & Orchitis 33

68 Steven Jonson Syndrome 33

71 Fe Chelating agent in Thalassaemic PT 34

81 Low Back Pain 39

2 GAD (Generalized Anxiety Disorder) 43

3 OCD (Obsessive Compulsive Disorder) 44

4 PPP (Post Partum Psychosis) 44

5 SRD (Substance related disorder)/Sleeping Pill 44

6 ASD (Acute Stress Disorder) 45

3 Seborrhoeic Dermatitis/ Seborrhoeic Folicuitis 46

12 White Discharge from Breast 49

14 Skin Wart/Hard skin 49

6 SVT (Supra Ventricular tachycardia) 54

3 Birth asphyxia/Neonatal Sepsis/Neonatal Convulsion 66

6 Neonate Of HBsAg +ve mother 68

23 PEM (Protein Energy Malnutrition) 78

2 Physical assault (P/A) 83

3 Massive cut Injury or P/A 84

4 Small cut injury 84

5 Acute case of intestine/ Acute Emergency 85

6 A case of Hepato-Biliary system 86

7 Accidental fall from height 87

10 Retention of Urine/ Structure urethra 88

11 BEP (Benign Enlargement Of Prostate) 89

12 Hernia & Hydrocele 89

13 PVD(Peripheral vascular Disease) 89

14 Haemorrhoids /Anal fissure/rectal prolapse 90

16 Gut Preparation for Surgery 91

17 Gut Preparation for IVU 91

1 Age related Cataract (ARC) 92

2 Chronic Dacrocystitis (CDC) 92

3 Acute Congestive Glaucoma 92

4 Fungal Corneal Ulcer 93

10 Nasal Mass With HIT 96

1 Indication of C/S 100

2 FTP with Normal Finding/Normal Labour 101

3 FTP with PET 101

5 Post Partum Eclampsia 102

6 Retained Placenta 103

8 Obstructed Labour 104

11 Hyperemisis Gravidarum 106

2 Incomplete Abortion 107

3 Threatened Abortion 108

4 DUB/Fibroid Uterus 108

5 Genital Prolapse 108