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

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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

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 Dedicated to Dr.Kakoli Dey

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
 Cap. Omeprazole 20mg
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

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 Dedicated to Dr.Kakoli Dey

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

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

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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)

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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)

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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

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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
 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

 ।
 , , ,
।


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
 Cap. omeprazole 20mg
1+0+1 (B/M)
 Tab. Calcium 500mg(1+0+0)- 2month

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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.

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Snake bite (Non-poisonous)

 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

 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
 Inj. Omeprazole 40mg
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

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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
 Inj. Omeprazole 40mg
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

β-Blocker Poisoning

 Stomach wash if pt comes within 1hrs

 Inf. 5% DNS 1000cc (prevent hypoglycemia)
IV @ 20 d/m stat
 Inj. Ceftriaxone 1gm
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

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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
 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

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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
 Continuous catheterization
 Maintain atropin chart
 Monitor Vital sign
 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

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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
 Inj. Omeprazole 40mg
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

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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
 Cap. Omeprazole 20mg
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

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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
 Cap. omeprazole 20mg
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
 Tab. Omidon 10mg
1+1+1 (B/M)
 Cap. Omeprazole 20mg
1+0+1 (B/M)

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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

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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

Acute Viral hepatitis

 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

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CLD
Without encephalopathy

 Diet. Salt restricted

 Tab. Ciprofloxacin 500mg
1+0+1
 Cap. Omeprazole 20mg
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
 Inj. Ceftriaxone 2gm
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

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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

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Fatty change of Liver

 Diet. Low fat diet

 Cap. Omeprazole 20mg
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

 Cap. omeprazole 20mg
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

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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
 Cap. Omeprazole 20mg
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 I/O chart
 Maintain BP chart
 Maintain Heat coagulation test

NS

 Diet. Normal(salt & fluid restriction)

 Fluid. 500ml + previous day out
 Antibiotc- Amoxycillin/Cefixim/Ceftriaxone
 Cap. Omeprazole 20mg
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 I/O chart
 Maintain BP chart
 Maintain Heat coagulation tes

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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+

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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

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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

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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
 Cap. Omeprazole 20mg
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
 Continuous catheterization

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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
 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

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Meningitis
 Inj. Ceftriaxone 2gm- 14 days
1 vial IV stat & BD
 Inj. Dexamet
1 amp IV stat & 6 hrly
 Cap. Omeprazole 20mg
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
 Cap. Omeprazole 20mg
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

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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)
 Tab. Omidon 10mg
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)

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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

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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

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TIA
 Cap. Omeprazole 20mg
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
 Cap. Omeprazole 20mg
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

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Mumps & Orchitis

 Tab. deltason 20mg
2+0+0 (A/M)
 Tab. P/C 500mg
1+1+1
 Tab. cefuroxime 500mg
1+0+1
 Inj. Ceftriaxone 3gm
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
 Inj. Omeprazole 40mg
 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

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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

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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

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Hodgkin Lymphoma
Bag-1

 Inf. 5% DNS 500cc

+
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

 Inf. 5% DNS 500cc

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

Bag-3

 Inf. 5% DNS 500cc

+
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
 Cap. Omeprazole 20mg
1+0+1
 Povisep mouth wash- Gurgle 2 times daily

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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

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Musculoskeletal Pain
 Cap. Omeprazole 20mg
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
 Cap. Omeprazole 20mg
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)
4 vial IV stat & 6 hrly
 Then,
Cap Flubex 500mg- 4 wks
1+1+1+1

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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
 Cap. Omeprazole 20mg
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

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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 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

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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

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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

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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

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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

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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)

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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.

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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

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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
 Tab. Terbucef 250mg-10 days
1+0+1
 Tab. Telfast
 Bactrocin oint.

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S.Blephritis
 Betnovate-CL oint.

White Discharge from Breast

 Tab. Terbucef 250mg-10 days
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

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Measles
 Tab. Azith 500mg- 5days
1+0+1
 Cap. Omeprazole 20mg
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
 Cap. Omeprazole 20mg
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

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Cardiology
AMI

 Complete bed rest

 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
 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
 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

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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
 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
 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

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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

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Ischemic Cardiomyopathy
 Tab. Anclog 75mg
0+1+0
 Tab. Monocard 20mg
1+1+0
 Cap. Omeprazole 20mg
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

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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

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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)

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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

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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

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Paediatrics

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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

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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

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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

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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
 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:
**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

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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

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LBW/Preterm Baby
 Keep the baby warm
 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

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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

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Acute RTI
 Keep the baby warm

 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

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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

 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

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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

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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)

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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: 50-100µgm (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
11mg/kg/dose (single dose)

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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

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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

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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
1mg/kg/dose (single dose)

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

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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

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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

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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 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

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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

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
 Cap. Omeprazole 20mg
1+0+1 (b/m)
 Tab. ketorolac 10mg/Diclofenac 50mg

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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
 Cap. Omeprazole 20mg
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

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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
 Inj. Ceftriaxone 1gm
1 vial iv stat daily/BD
OR
Inj. Ciprofloxacin
1 bag IV stat & BD
 Inj. Metronidazole
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

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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
 Inj. Metronidazole

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

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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)
 Cap. Omeprazole 20mg
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
 Cap. Omeprazole 20mg
1+0+1 (b/m)
 Tab. Ketorolac 10mg/Diclofenac 50mg
 Tab. Ceevit 250mg
1+1+1
 Regular dressing

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Ulcer
 Cap. flucloxacillin 500mg
1+1+1+1
OR
Cap. Cephradin 500mg
1+1+1+1
 Cap. Omeprazole 20mg
1+0+1 (b/m)
 Tab. Ketorolac 10mg/Diclofenac 50mg
 Tab. Ceevit 250mg
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
 Cap. Omeprazole 20mg
1+0+1 (b/m)
 If pain, Tab. Ketorolac/Diclofenac

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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

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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
 Tab. Metronidazole 400mg
1+1+1
 Cap. Omeprazole
1+0+1 (b/m)
 Tab. Ketorolac/Clofenac
 Tab. Ceevit 250mg
1+0+1
 Hip bath
3 times daily & after defeacation

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Gut Preparation for Surgery

(Colostomy closure, Hemicolectomy & Other)

For 3 days

 Low residual diet (Bread, Milk, liquid diet)

 Syp. Lactolose
4 TSF BD
 Tab. Ciprofloxacin 500mg
1+0+1
 Tab. Metronidazole 400mg
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

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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. Sedil: 0+0+1
 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

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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
 Tab. Sedil: 0+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

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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)
1 amp IV stat & 6 hrly
 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.

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Acute Epiglottitis
 Inj. Amoxycillin/Flucoxacillin Clue to Dx:
 Inj. Ranitid/Omeprazole  Hoarsness of voice
 Tab. Histacin: 1+0+1  Dysphagia
 O/E- Epiglottis
 Tab. Sedil: 0+0+1
 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

Nasal Mass With HIT

 Cap. Amoxycillin
 Cap. Omeprazole
 Tab. Levamisol- 3 tab stat
 Tab. P/C
 H2 blocker
 Antazole Nasal drop- 3 drops in each nostril BD

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Rhinosporidiosis
 Tab. Dapsone 100mg
1+0+0
 Cap. omeprazole
1+0+1(b/m)
 Tab. Histacin: 1+0+1
 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
 Tab. Ciprofloxacin
Advice:
1+0+1
 USG of thyroid
 Cap. omeprazole  T3, T4, TSH
1+0+1 (b/m)  FNAC of thyroid
 Tab. Histacin: 1+0+1
 Tab. sedil
0+0+1
 Tab. B/C
1+0+1
 Tab. F/S
1+0+1

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
 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

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Gynae & Obstetrics

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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

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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)

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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
1 vial IV stat & 6 hrly
 Inj. pantoprazole 40mg
1 vial IV stat & BD
 Continuous catheterization
 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

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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

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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

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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 ( ) 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)

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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. 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:

 Blood for grouping & cross matching

 USG of lower abdomen
 Arrange blood

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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

Advice: USG of Pregnancy profile

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

Advice: USG of Lower abdomen

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

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Ectopic Pregnancy
 Cap. Cefradin 500mg: 1+1+1+1
 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.

 Cap. Cefradin 500mg: 1+1+1+1

 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

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

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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
 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
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

 Cap. Cefradin 500mg: 1+1+1+1
 Tab. Metronidazole 500mg: 1+1+1
 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

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Bowel Preparation On 1st day

 Non residual diet (ORS/Coconut water/Glucose water)
 Tab. Ciprofloxacin 500mg
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

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