CARDIOLOGY

ACUTE MI (STEMI)
- Admit to ICU
- *Acute MI, ST-elevation, — wall, Killips —, day —
- Diet: NPO first 12-24hrs, LSLF
- VS: q1 and record; Temp q4
- I&O q shift
- CBR w/ no bathroom privileges
- High back rest
- Anti-embolic stockings
- IVF: D5W 500cc x 10cc/hr
- Dx: CK-MB, Trop I, ECG stat then rpt after 12hrs, CXR semi-sitting, CBC PC, Na, K, Ca, Mg,
RBS, BUN, Crea, UA, PT/PTT, LP, 2DEDS once stable
- Tx:
1. O2 at 2-4lpm to maintain sats of >95%
2. NTG (defer if SBP <90mmHg) 0.4ml SL up to 3 doses stat q5 and PRN then ISDN
(Isoket drip) x24-48hrs until chest pain subsides then shift to Transderm-Nitro 5 patch or
ISMN 60mg OD AM or ISDN 10-20mg TID (6-12-16). Avoid in pts w/ hx of Viagra use in
the past 24hrs
3. Morphine 4mg IV stat and PRN q30min up to 3 doses (defer if SBP <90mmHg) if with
inferior wall MI, give only 2-3mg IV b/c of risk of arrhythmia)
4. Aspirin 325mg tab stat dose then 80mg tan BID PC + Clopidogrel 300mg tab LD then
75mg tab ODPC or Ticagrelor 90mg tab 180mg LD then 1 tab BID
5. PCI w/in first 12hrs with large ANTERIOR WALL STEMI or INFERIOR WALL MI w/
ANTERIOR WALL (V1-V3) reciprocal changes
6. Large anterior wall MI, AFib, persistent chest pain or w/ LV thrombus:
a. UF (Regular) Heparin 60u/kg (max 4000u) IV bolus then 12u/kg infusion (max
1000u/hr) i.e. Heparin 4000 u IV bolus then Heparin drip: D5W 200ml + Heparin
10,000u at 14ugtts/min(700u/hr). Check PTT q12 target of 1.5-2x the control.
Give Heparin for 2-5 days then overlap with Warfarin for 3 months if desired
b. LMWH: Enoxaparin at 0.75-1mg/kg q12 x 5days (i.e. Enox 0.4ml SC BID) or
Fondaparinux Na 2.5mg SC OD X 5-8days
7. All pts w/o CI to BB. Most beneficial in pts w/ tachycardia, anterior wall MI, HTN,
recurrent ischemic pain, AFib. Avoid in pts w/ mod-severe CHF, wheezing, AV blocks
and HR<55. THR 55-60bpm. Metoprolol 50mg 1/2 - 1 tab q8-12
8. ACEi in all patients w/ anterior wall MI. Beneficial in pts Killips II or more, LV EF <40,
large anterior wall MI, CHF, HTN, DM or CKD. Captopril 25mg 1/4 tab q12 x 2 days then
1/2 tab q12 defer for SBP <100mmHg. BP spikes: 1/2 - 1 tab PO or SL
9. Atorvastatin 20mg OD or Simvastatin 20mg ODHS or Rosuvastatin 10mg ODHS
10. Diazepam 2-5mg tab BID for anxious pts
11. Lactulose 30cc ODHS
12. Prophylactic H2 Blockers and antacids
Others:
1. Furosemide 40mg tab 20-40mg IV stat for frank CHF
2. Lidocaine drip: for high grade ventricular arrythmias post MI
3. Amiodarone PO or drip: For persistent high-grade ventricular arrhythmias
4. Avoid CCB post MI
5. CoQ10 10mg cap 1 cap TID or TMZ 35mg MR tab BID

NSTEMI w/o congestion

1. Metoprolol 50mg 1/2 - 1 tab BID or
2. Diltiazem 30mg BID-TID

NSTEMI w/ pulmo congestion

1. ACEi
2. Diuretics PRN
Avoid CCB in HF

NSTEMI
Dx: 12LECG, Trop I
TIMI scoring
Tx:
1. Nitrates. ISDN 5mg tab q5 x 3doses. Isoket drip in first 48hrs (5-10mcg/kg/min)
2. Bb. Metoprolol succinate, bisoprolol or carvedilol
3. Verapamil/diltiazem if bb CI
4. ACEi. Captopril 6.25-12.5 mg q8
5. Aspirin 165-325mg LD then 80-160mg OD MD
6. If not at risk for bleeding: Clopidogrel 300-600mg LD then 75mg OD OR Ticagrelor 180mg LD
then 90mg BID OR Prasugrel 60mg LD then 10mg OD
7. Anticoagulation. UFH (mainstay) 60U/kg IV bolus then 12U/kg infusion (1000U/hr) for 48 hrs
or until PCI OR Enoxaparin 30mg IV LD then 1mg/kg SC q12 during hospitalization or until PCI
OR Fondaparinux 2.5mg SC OD during hospitalization or until PCI
8. High intensity statin. Ator 80, Rosu 40

Bradycardia (Symptomatic/Arrhythmic)
If w/ hypotension, altered sensorium, signs of shock, chest discomfort, acute HF
Tx:
1. Atropine 0.5mg bolus q3-5mins Max: 3mg
2. Dopamine 2-20mkm
3. Epinephrine 2-10mkm

Dyslipidemia
Dx: TC, HDL-C, TG
Formulas:
 A. Non-HDL-C = TC - HDL-C
B. LDL-C(mg/dL) = TC - HDL-C - (TG/5) OR LDL-C (mmol/L) = TC - HDL-C - (TG/2.2)

NEUROLOGY
STROKE
A> Stroke, CVD infarct vs bleed; Hypertensive emergency

ER
* CBG
* O2 at 2-4lpm
* PNSS x 12hrs
* Nicardipine drip (10mg + 90PNSS) titrate by 5cc/hr (0.5mg/hr) q15 until target MAP 110-130
is achieved (max 15mg/hr)
* STAT Plain Cranial CT (MRI-DWI)
* Ecg, CBC, PT, PTT, Na, K, Crea
* Refer to Neuro

For admission
A> CVD infarct, (i.e. LMCA territory); Hypertensive emergency; (comorbids)
* Please admit to ICU under the service of Dr. ____
* Please secure consent for this admission
* NPO temporarily
* Maintain IVF: PNSS 1L to run for 12 hours
* Continue Nicardipine drip: 10mg + 90cc PNSS to titrate accordingly until target MAP is
achieved
* Give Aspirin 80mg/tab 2 tabs now then 2 tabs daily for 14 days
* Keep MAP at 110-130
* Keep SO2 >95%
* Give HR 4u SC if CBG >180
* Give Paracetamol 300mg IV PRN for T > 37.8 C
* Start Citicholine 1g IV q12

A> ICH, (location); Hypertensive emergency

* Please admit to ICU under the service of Dr. ____
* Please secure consent for this admission
* NPO temporarily
* Maintain IVF: PNSS 1L to run for 12 hours
* Continue Nicardipine drip: 10mg + 90cc NSS to titrate accordingly to keep MAP ~110mmHg or
SBP ~160mmHg (ok to do aggressive SBP lowering to 110-140 but WOF decreased CPP)
* Start Mannitol 20% (100g/500ml) 150cc every 4 hours
* Give Diazepam 5mg IV for frank seizure
* Mannitol dose: 0.5-1.5g/kg every 3-6 hours
● Loading dose: 1cc/kg
● Maintenance dose: 0.5cc/kg
* Doses up to 1.5g/kg are appropriate when treating a deteriorating patient because of mass
effect
* Keep MAP at 110-130mmHg
* Keep SO2 >95%
* Give HR 4u SC if CBG >180
* Give Paracetamol 300mg IV PRN for T > 37.8 C
* Start Citicholine 1g IV q12
* Start Lactulose 30cc at night
* Elevate head at 30-45 degrees

GASTROENTEROLOGY
ACUTE DIARRHEA
A> W/ Mild DHN
*Diet: BRAT (Banana, Rice, Apple, Tea) diet; no dairy products
*VS q4
*I&O: Bowel Movement q shift & record (character, frequency & amount)
*IVF: D5NSS 1L x 8 hrs; D5NR 1L x 8 hrs
*Dx: Na, K, BUN, Crea, UA, FA
Stool CS for persistent diarrhea or IC (w/ TCBA for cholera suspect);
Colonoscopy/proctosigmoidoscopy if w/ bleeding
*Tx:
•HNBB 10mg TID PRN/Mebevirine HCl 100mg TID-QID PRN
•Loperamide 2mg PRN not to exceed 6 caps per day for 48hrs (​avoid in amebiasi​s)
•Racecadotril 100mg cap TID x 3d
•Probiotics: Erceflora 1 vial BID-TID x 3d

If febrile, gross blood in stool, toxic looking, elderly w/ comorbids or WBC >16
a. W/o vomiting: Cipro 500mg BID X 3-5d or Norfloxacin 400mg BID x 3-5d or Co-tri forte
tab BID x 3-5d
b. W/ vomiting: IV antibx
c. Amebiasis suspect: Secnidazole 500mg 2 tab initially then 2 tabs w/in 4hrs or
Metronidazole 500mg QID x 7d

SPECIFIC TX
Amebiasis
Metronidazole 500mg TID x 7-10d
Salmonella/C. jejuni/ETEC
Ciprofloxacin 500mg tab BID x 5d
Shigella
Co-trimoxazole forte tab BID x 3d
C. difficile
Metronidazole 500mg tab TID x 10-14d
Y. enterocolitica
Cipro 500mg BID x 3 doses

CHOLERA/SEVERE DHN
*Diet: BRAT
*VS q1, postural BP, temp q4
*Insert IFC, I&O q1
*Monitor BM (character, frequency, amount)
*Cholera prec
*IVF: D5LR 1L, fast drip 300cc then consume remaining in 4 hr
Replace v/v of bowel movement
*Dx: CBC, Na, K, Cl, BUN, Crea, ABG if acidotic, FA, Stool C/S using TCBS, UA

Tx:
1. Hydrate. ORS 2 tabs in 200cc water as desired if w/o vomiting
2. Doxycycline 100mg, 3 tabs single dose PO (​avoid in children <8y/o​) or Co-tri forte tab
BID x 3d or Cipro 500mg 2 tabs single dose or Cipro 200-400mg IV q12 (w/ renal
dosing)
3. Correct electrolyte imbalances

UGIB
*Omeprazole 80mg/IV bolus then start Omeprazole drip 40mg/IV in 90cc PNSS/D5LR to run for
5 hours (8mg/hr) for 72hrs
*Tranexamic Acid 1g TIV now
*Hold antiplatelets for now
*Maintain on NPO for 24hrs
*May start clear liquids once with no bleeding
*CBC, PT/PTT, DRE

LGIB
*CBC, PT/PTT, DRE
*Hold antiplatelets for now
*Fluid resuscitation
*Consider blood transfusion
No medications indicated for LGIB
BELL’S PALSY
Dx: CBC, CRP, Plain cranial CT
Tx:
1. Prednisone 1mg/kg for 5 days then taper less 10mg per day for another 10 days
2. Acyclovir 400mg/tab 5x/day for 7 days
3. Na hyaluronate

PULMONOLOGY
Bronchial Asthma in Acute Exacerbation
Diet: regular with SAP
VS q1 until stable
IVF: D5NM x 12hrs; D5NR x 12hrs
Dx: CXR, CBC, K, RBS, Crea, Sputum GS/CS, ABG, ECG
Tx:
1. Nebulization w/ Salb, Salb + Ipra, Ipra q8
2. Antibiotics
3. Steroids
a. Acute: Hydrocort 250mg IV then 100mg IV q4-6 x 4 doses or continuous as
warranted
b. Stable: oral
i. Prednisone 20mg/tab 1 tab BID x 3d then taper as follows:

AM 3PM No. of days

1 1 x3

1 1/2 x3

1 0 x3

1/2 0 x3

stop

ii. Methylprednisolone 16mg 1 tab BID x3d then taper

 AM 3PM No. of days

1 1 x3

1 1/2 x3

1 0 x3

1/2 0 x3

stop

4. Aminophylline (add on)

a. Acute: if not controlled by NAS, 5-6mg/kg bolus then drip
b. Stable: shift to Theophylline SR 125-250mg tab BID or Doxofylline 400mg tab
BID
5. Omeprazole IV

Bronchial Asthma Maintenance Therapy (GINA 2019)

1. As needed ICS-formoterol
2. Budesonide + Formoterol 80/160mcg per 4.5mcg MDI 1-2puffs BID
3. Daily low-dose ICS
4. Low-dose ICS-LABA
5. Medium-dose ICS-LABA
6. High-dose ICS-LABA
● Salmeterol + Fluticasone 50 per 100/250/500mcg inhaler 2 puffs BID

INFECTIOUS DISEASES
Animal Bite
-Tetanus toxoid/Tvac 0.5ml TIM
-ATS 1,500u/25kg or HTIg 250IU TIM
PVRV 0.5ml TIM
ERIG (200IU/ml at 5ml/vial): 40IU/kg infiltrate wound then may or may not give the rest TIM

Acute Tonsillopharyngitis
Regular diet
IVF: D5NM x 8hrs
Dx: CBC, throat swab GSCS, ASO titer
Tx:
1. OP:Pen VK 500mg cap TID-QID x 10d or Amox 500mg cap TID x 10days or Azith
500mg OD x 3d
2. In-patient: Pen G IV or Clindamycin IV or Co-amox IV
3. Consider tonsillectomy for recurrent/chronic

Dengue Fever
● Diet: DAT except dark-colored and acidic food
● D5NM x 8hrs; D5NSS or D5LR for shock
● Dx: CBC PC, PT, PTT, AST, ALT, NS1 Ag, IgG, IgM, UA, CXR
● Tx: Omeprazole, BT if indicated

Typhoid Fever
● Regular diet
● IVF: D5NM x 8hrs
● Dx: CBC (usually normal), PC, Typhi dot (4 days or longer), Malarial smear, CXR, UA,
BUS C/S
● Tx:
● Uncomplicated
○ Chloramphenicol 3-4gm/d PO in 4 divided doses x14d (50-100mg/kg) except if w/
low WBC (<4)
○ Co-tri forte or double-strength tab BID x 14d
○ Amox 4-6gm/d q8 x 14d
● Complicated
○ Ceftriaxone 3g IV OD X5-7d
○ Ciprofloxacin 500mg/tab BID x7-10d
○ Ofloxacin/Pefloxacin 400mg/tab BID x7d

STI (Gonorrhea and Chlamydia)

Dx: STI Panel, HIV test, HCV (for IV drug users**)
Ceftriaxone 250mg IM
Azithromycin 1gm PO

Bacterial Conjunctivitis
PND ointment qid
If with suspected corneal abrasion don’t give with dexa
Chloramphenicol or Tobramycin eye drops 1-2drops qid

Otitis Externa
Polymyxin B + Neomycin + Dexamethasone otic drops 3-4gtts BID x 7 days
Paracetamol q6 for pain
Acute Otitis Media/Otitis Media with Effusion (major sx is hearing loss in OME)
Paracetamol/ Ibuprofen
Carbocisteine 500mg q8 for cough induced OM avoid in PUD
Amoxicillin 500 q8 ; 1gm q8 (high dose)
Co-amox 375
Cefalexin 250/500mg q6 w food
Cefuroxime 250/500mg BID w food
Azith/Clarith 500 OD x3d/500 BID w food
Clindamycin
Ff up
Perforated TM
Ofloxacin otic drops 3-4 drops TID x 2 weeks

Vaginal Thrush/Candidiasis
Clotrimazole (Canesten) TID
Miconazole vaginal suppository (Micotran) insert 1 supp high into vagina one night before
retiring

OR

Fluconazole 150mg single dose

Clotrimazole (Canesten)

OR
Canesten TID
Itraconazole 100mg/tab 2tabs BID x 3d
Ketoconazole 400mg BID x 3d

Mixed Vaginal Infections (Candida, Trichomonas, Anaerobe)

Neo-penotran vag supp (Metro/miconazole 500/100) BID x 7 days
Neo-penotran forte (750/200) OD x 7d
Neo-penotran forte-L (750/200/100) OD x 7d

Oropharyngeal Candidiasis
Fluconazole 400mg on day 1; 200mg OD for 7-21days until in remission

ANAPHYLAXIS
Epi 0.01ml/kg, 0.5ml max IM
Diphenhydramine 1mg/kg IM 50mg max (Cetirizine, Hydroxyzine)
Salb neb if w/ wheezing
Hydrocortisone 5mg/kg or Methylprednisolone 2mg/kg

Hypersensitivity Reactions
- Dx: CBC
- Tx: Diphenhydramine 50mg TIV, Hydrocortisone 250mg TIV
- THM: Any antihistamine + tapering prednisone
Prednisone 5mg/tab. Start with 30mg tapering down 5mg daily until 21 tablets consumed. To be
taken with meals

Day 1 6 tabs

Day 2 5 tabs

Day 3 4 tabs

Day 4 3 tabs

Day 5 2 tabs

Day 6 1 tab then d/c

Shock
Shortcut: (Mkm x weight x 60 x diluent) / 1000 x dosage x #amps
*NE 10; mkm 1-1.2
*Dobu 250; mkm 5-20
*Dopa 200; mkm 5-20

**Norepinephrine
2/4/6/8/10 (usually 8 or 10) / 250 (reg) or 100 (HF) x 1000 = factor
(.1 to 1.2 / factor) x 60 x weight
*start NE drip 10mg in 100ml D5W or 10mg in 250cc D5W
**Dopamine
(Weight x mkm (1 to 20; usually 10)) / 13.3 x 4(no. of amps)
**Dobutamine
(Weight x mkm (1 to 20; usually 10) / 16.6 x 4(no. of amps)

ISDN drip
Isoket drip 90cc PNSS + 10mg x 10cc/hr

Hyponatremia
1. Change in Na:
● 254 {304 if concentrated} - actual Na / ((factor) x weight + 1)
2. 8 / change in Na x 1000 / 24
Yung 254 is Na content ng PNSS (154) + 100meqs NaCl

Factor:
*0.55 elderly male
*0.45 elderly female
*0.5 non elderly female
*0.6 non elderly male
**Start NaCl drip: 1L PNSS + 100meqs (150meqs if concentrated) NaCl to run at (rate) cc/hr;
repeat Na 6hrs post hook

Hypernatremia
*Water deficit = (Na-140/140) x weight x .5 = water deficit
*Water deficit + 720 (insensible loss; if febrile 1000) = total water deficit
*Change in Na = (actual Na - 77) / (weight x .6 if male .5 if female .5 elderly male .45 elderly
female + 1)
*(8/change in Na x 1000) / 24 = cc/hr

Hypokalemia
Use drip if <2 (.4); tab if >3 (.1)
Drip​: KCl drip 40meqs + 80cc PNSS to run for 8 hours
Fast correction​: KCl tab 2 tabs now then q2 for 3 cycles
3.5 - (actual K) / .27(constant) x 100

Hyperkalemia
GI solution: D50/50 + 10u HR x 3 cycles to run for 30 mins to 1hr
Salbutamol + ipratropium neb q15 x 3 cycles
Furosemide 40/80mg IV after last neb
*check K after 1hr of furo
Calcium gluconate: 10ml of 10% calcium gluconate infused over 2-3 mins; if hypercalcemic: in
100ml of 5% dextrose water infused for 20-30 mins
Mannitol
1mg/kg loading dose then .5mg/kg; every 3 days shift; every 4,6,8 hours tapering
AAA
Target BP <100; HR 50-60s

METABOLIC ALKALOSIS
Treat HCO3 if:
-AKI pH <7.2 and HCO3 <15
**HCO3 deficit = (KgBW x base deficit 0.4) x (desired-actual)
**if CKD (0.6); desired 18
Give 1/2 of calculated dose, slow IV push over 30-45 mins; repeat ABG after 5 mins
-CKD pH <7.2 and HCO3 <10
HCO3 deficit = (KgBW x 0.7) x (10-plasma HCO3)

NV:
HCO3 24
PCO2 40
**Intubate if: retained CO2 by 50% and <90% O2 sat

Nicardipine drip
10mg in 90cc PNSS to run at a rate of 10mgtts/min
Amiodarone drip
150mg/3ml SIVP then
360mg in 250ml D5W to run for 6hrs then
540mg in 250ml D5W to run for 18hrs

Type 2 Diabetes Mellitus

Insulin Sliding Scale using HR
4u 200-250
6u 251-300
8u 301-350
Refer to MROD >330

Maintenance Therapy using Insulin 70/30 (Humulin N):

1. Body Weight x 0.5 = A
2. A divided by 3 = PM dose
3. PM dose x 2 = AM dose

Shifting from Insulin 70/30 to Insulin glargine​ (better kasi isang tusok na lang instead of 2 pero
mas mahal):
(AM + PM dose) divided by 2 = glargine dose

Titrate by 2u up or down depending on CBGs taken TID pre meals

Liver cirrhosis
Coagulopathy - vitamin k 10mg/IV q8 x 3 dosws
Propanolol 40mg/tab od
25% human albumin + 40mg furosemide to run for 1 hr q12
8% amino acid 500ml/IV to run for 12hrs

ARRHYTHMIAS
Give Digoxin 0.25mg/amp 1/2 amp now (2-3x); recheck after 15 mins
Give Verapamil 2.5 to 5mg/IV now
Give Amiodarone 150mg/IV bolus now then give (1mg/kg x 6hours) 1x60x6hrs=360mg in 250cc
D5W to run for 6hrs (0.5mg/kg x 18hours) 0.5x60x18=540mg in 1L to run for 18hrs

Corrected Calcium
(Normal alb (40)- actual albumin) x 0.02 + actual Ca
Bicarbonate deficit
(Goal-actual) x 0.4 x weight

Grading System
Burch wartofsky thyroid
Barcelona HCC
Child Pugh Cirrhosis
TIMI STEMI/NSTEMI
Killip STEMI
CHADSVASC and HASBLED AF
NIHSS ICH
ABCD TIA
Forrest Ulcer^
BISAP/Ranson pancreatitis
PEDIS DM foot
QSOFA sepsis
CURB 65 pneumonia

Liver cirrhosis
Coagulopathy - vitamin k 10mg/IV q8 x 3 doses
Propanolol 40mg/tab od (varices) goal PR:50-60 or 25% dec in baseline
25% human albumin + 40mg furosemide to run for 1 hr q12
8% amino acid 500ml/IV to run for 12hrs
Spironolactone 50 mg/tab OD
Omeprazole 40mg/cap ODAC
Metoclopramide 10mg/IV
Lactulose 30cc ODHS
Livamin sachet TID
Indications for NIV:
1)ARF caused by COPD
2)Acute Cardiogenic Pulmonary Edema
3)Extubation in COPD px
4)Immunocompromised
Guidelines:
-mod to severe respi distress
-tachypnea >24 COPD; >30 CHF
-use of accessory muscles & paradoxical breathing
-ABG <7.35 and paO2 >45; paO2/FiO2 <200mmHg
*CPAP: hypoxemia
*BIPAP: hypoxemia and hypercarpnia
*Initial setting:
-IPAP: 8-12 cm h2o; max 20-25; inc IPAP by 2cm
if persis hypercapnea
-EPAP: 3-4 cm h2o; max 10-15; inc IPAP and EPAP by 2 if persis hypoxemia
-O2 at 2-5L
-keep pulmo support >5cm h2o and spo2 >92%

Osteoporosis
<2.5 SD in the lumbar spine, femoral neck and hip

Exudative PE (at least 1)

*PF protein/serum protein >0.5
*PF LDH/serum LDH >0.6
*PF LDH more than 2/3 normal upper limit for serum

Procedure more invasive than thoracentesis i.e. CTT:

*loculated PF
*PF pH <7.20
*PF glucose <3.3 mmol/Lb(<60mg/dL)
*positive gram stain or CS of PF
*pres of gross pus in pleural space

6 cardinal sx of SHOCK:
Reduced MAP <60
Tachypnea
Tachycardia
Cold clammy extremities
Oliguria
Altered sensorium

PAOD
Dx: ABI <0.9
Tx: Cilostazol 50 BID then inc to 100 BID (headache)

THYROID HORMONES
**Inc TSH (NV 0.5 to 5)
-dec FT3, FT4: overt hypo
-normal FT3, FT4: subclinical
-normal T4 (mild hypo); (+)TPO Ab plus sx = TREAT
-low T4 (primary hypo)
-TPO Ab (+) autoimmune; (-) IDA
**Normal TSH (pituitary dis)
Tx: levothyroxine (1.6 mcg/kg BW); 100-150 mcg 30mins ODAC
-Graves 75-125 mcg/dl
-<60 w/o heart dis 50-100 mcg/dl
*reassess after 6-8 wks
*If still w INC TSH: add 12.5 to 25mcg
*46 weeks restore to euthyroid state
*HYPER: check TSH; monitor peripheral hormones
*HYPO: check and monitor TSH
CAUSES:
Reduce thyroxine levels: lithium, iodine, amiodarone
Dec absorption: succralfate, FeSO4; cholestyramine
Inc metab: rifam, phenobar, carbama

PTB / Extrapulmonary TB
2 months HRZE 4 months HR
Hepatobiliary TB lifetime

Diet: ASPEN Guidelines

KCAL
Critically ill 10-25kcal/kg/day
Standard activity 25-30kcal/kg/day
Build up 30-40kcal/kg/day
AKI 20-30kcal/kg/day

TOTAL CHON
Standard px 0.8-1g/kg/day
Critically ill 1.5-2g/kg/day
Severe CHON loss >2g/kg/day
AKI/CKD not on HD 0.8 to 1 g/kg/day
CKD on HD 1.1-1.5g/kg/day
Low salt diet <2.5g/kg/day
Reg salt diet (normal) 4-6g/day
High salt for hyponat 6-9g/day

CHO FAT
Minimal fat 80% 20%
Stressed 70% 30%
Septic 50% 50%

1:1 calories = fluids

2:1 calories = dec fluids

HEART FAILURE:
Complete cardiac diagnosis: structural/etiology, anatomy, physiology and functional
classification
Causes of Acute Decompensation: Infection, elec imbalance,
SCD: rEF (35%) or (30% if

CAP-MR
HF, COPD, MI, BA, CVD, PE

C.difficle
S/sx: colitis, >7 days, florrid
Dx: C.difficile toxin assay (antigen and toxin); stool CS
Tx: Metro 500mg/IV q8; Vanco 500mg/IV per orem every 6 hrs and 500mg+PNSS 100ml as
retention enema every 6hrs (given for ileus and reach other areas of the colon)

Ab associated diarrhea
-prev hx of Ab, hx of intolerance, self limiting, neg colitis, improve w/in 7 days
Massive hemoptysis - >200 to 600ml in 24hrs

COPD 2017 Guidelines

*if sx still persists
A SABD or LABD (short/long)
B LABA/LAMA (long) LAMA + LABA
-Initial relief (LABA vs LAMA)
-Presistent (LABA/LAMA)
-Severe(dual)
C LAMA LAMA + LABA / LABA + ICS
*triple tx not recommended
D LAMA + LABA LAMA + LABA + *ICS
*triple tx recommended
*if still w exacerbation = roflumilast / macrolide (azith) and remove ICS
**CAT score >10 is symptomatic

Fluid Challenge Test

2-3L in 20-30mins hypovolemic shock
30ml/

MANNITOL
Weight / 0.2
Give as loading dose then half dose q6 or q8
Max taper q8(half life max 8), min dose 75
0.5-1.5gm/kg/dose
Contraindicated in: CHF, renal failure and pulmonary edema
If px does not improve w/in a week, compute for osmolar gap; if >20 use hypertonic saline

HTN
First line: ARBS, ACE, thiazide
>40 yrs old, start w/ CCB as add on but not mono (RAAS)

HYPERTENSIVE URGENCY & EMERGENCY

Urgency:​ ​no end organ dmg, oral meds, lower BP in 1-2d
Emergency: changes in sensorium, papilledema, HF, use IV drugs, lower BP in a few hours
NPO temporarily until stable
BP q15 once stable
CBR w/o bathroom privileges

Dx: CBC, Crea, K, 12L ECG, UA, CXR, Fundoscopy

Tx:
Oral
1. Captopril 25mg ½-1tab SL or PO q30
2. Clonidine 75-150mcg SL or PO q1
3. Nifedipine 5-10mg SL or PO (bite and swallow punctured cap) q30 then 5-10mg PO or
SL q6-8hr or Nifed 30mg PO OD-BID max. CI in patients w/ AMI or UA
IV (NAIC)
1. Nicard drip
2. Hydralazine: 5-10mg IV q3-6hr or 25-50mg PO QID
3. ISDN IV (in pts with CAD)
4. Clonidine IV: may give 1amp (150mcg/1ml) SC, IM or IV w/ patient supine

ENT/ORL-HNS
Epistaxis
- CBC, PBS, PT/PTT
- If HTN: control BP
- Cold compress
- Nasal packing
- Tranexamic Acid 500mg TIV up to 1.5g
- NETCELL
THM:
Tranex 500mg q8 x 7 days then PRN
Oxymetazoline 0.05% nasal spray 2 sprays per nostril BID x 3days only

Hiccups
- Metoclopramide
- Chlorpromazine

Acid Peptic Disease

Omep, Pantop
Metoc
HNBB
Tramadol
Gaviscon

Alcohol Intoxication

PEDIATRICS
SVI, AGE, Rhinitis, UTI o Pneumonia? Ano ba talaga?
Acute gastroenteritis​ - loose stool, fever, abdominal pain, vomiting

Acute gastrointestinal upset​- GI symptoms except loose stools (ex vomiting with fever or
abdominal pain but NO loose stools)

Systemic Viral Illness​- any 2 organ system involved (GIT, GUT, Pulmo)

Acute nasopharyngitis​- cough and colds, fever, post nasal drip, congested turbinates,
hyperemic pharyngeal walls, clear breath sounds, no retractions

Acute rhinitis​ - colds only, could have low grade fever but no cough, clear breath sounds

Acute febrile illness, Urinary tract infection​ - If the only symptom is fever and GIT, PULMO
PE are normal. Especially for 2y/o and below common ang uti sa kanila na ang only
presentation lng ay fever. So magrerequest tayo ng urinalysis

Pneumonia​ - cough and colds, fever, with adventitious breath sounds

Vomiting (not post-tussive)

usually caused by hyperacidity
Tx:
-Maalox 2tsp 30 mins after meals and at bedtime
-Domperidone 5mg/5ml 0.3mg/kg in 3 divided doses TID
-Metoclopramide 5mg/5ml 5ml TID prn for vomiting
Anti-spasmodics
Not for children < 6yrs:
-Dicycloverine 10mg/5ml ½-1tsp TID; 10mg/tab 1-2tabs 15mins before feeding TID-QID
-HNBB 20mg/ml, 5mg TID IV

Dengue Fever
Paracetamol
Increase OFI
Hct and PC monitoring
BT if plt <= 10; whole blood or prbc for profuse bleeding or clinical deterioration unresponsive to
iv resu; ffp or cryopre for dic
W/o ws isotonic (nss, lr) holliday segar
W/ ws 5-7mkh x 1-2hrs, 3-5mkh x 2-4hrs, 2-3mkh

OBSTETRICS AND GYNECOLOGY

Emergency Contraception
Up to ​72hrs​ post contact only
Tx: Lady or Nordette pills 4 tabs now then 4 tabs after 12 hours
Instruct nyo na active pills ang itetake, hindi nya iinumin yung placebo pills ha! Saka hayaan nyo
syang mahilo at magsuka suka, hilig kasi sa unprotected sex eh

SURGERY
Suture Size and Timing of Removal

Acute Appendicitis
Uncomplicated: Cefoxitin 2g IV then 1g q8
Cefuroxime 1.5g then 750mg q8
Complicated: PipTaz or Cipro + Metro

Paronychia (abscess of the nails)

- I&D (​I assume marunong na kayo mag-digital or ring block​)
- Tapos piga piga, paduguin nyo, if kailangan, debride yung excess skin
- Tx: Cloxa, Mupirocin TID x10d

Ketorolac drip
Kertorolac 30m/2ml amp, 4 amps in 250cc D5W to run at 5mg/hr for 24hr (10-11ugtts/min)