E.N.T.

Wax:

ear blockage after water entery, pain, release of blockage after ear stretching

Rx: wax Aid (soda glycerine) 8drops TDS+ airtal 100mg BD

Otomycosis:

Itching, ear blockage, pain, History of seborrhic dermatitis, external ear crusting

Rx: Dermosporin Ear drop 3drops TDS+ pain killer

For recurrent otomycosis: cortisporin tube

Acute otitis Externa:

d/t wax or otomycosis

Patient complaints pain after pressing tragus, swelling & narrowing of meatus,

Rx: Tab. Cipro 500mg BD for 7days+ pain killer

Acute otitis Media:

Pain after rhinopharingitis, serous discharge

Rx: tab.augmentin 1g BD+ pain killer+ Xynocine Nasal spray 3 puffs TDS for not more than 5days

CSOM:

Purulent & smelly Discharge, hearing loss

Rx: tab. Cipro 500mg BD+ dexatop ear drops 4 TDS/keunoxy 0.4% 4drops BD+ antipyretics

ASOM: Acute history

Tab.Augmentin 1g BD

Medicine Key Points

                   Medicine Key Points

• All patients presenting with new-onset oedema should have a urinalysis.
• Hypothyroidism should be considered in the differential diagnosis of any patient pre- senting with fatigue.
• FEVER AND SHORTNESS OF BREATH= Consider PNEUMONIA.
• CHEST PAIN, SHORTNESS OF BREATH & PALE Consider ANEMIA, go with CBC.
• ADPKD patients may present with loin pain or haematuria.
• Rheumatoid arthritis tends to spare the distal interphalangeal joints. Anaemia and ESR correlate with disease activity. NSAIDs may adversely affect renal function.
• Irritable Bowel Syndrome= Abdominal Pain+Bloating+Periods of frequent defaecation alternate with periods of relative constipation+ Stress(Headache+Menstrual irregularties)
• Carcinoid Tumor: Diarrhea, Abdominal Cramps, Facial Flushing, someimes Asthmatic Wheeze.
• Hypertension:
• Pheochromocytoma: High BP with paroxysmal symptoms of sweating, palpitations and anxiety.
• Coarctation of Aorta: High BP with radiofemoral delay.
• Conn's Syndrome: High BP with low Serum potassium.
• Glomerulonephritis: High BP with Hematuria & Proteinuria.
• Renovascular Disease: High BP with moderately raised creatinine.
• Retrosternal Pain & relation of pain to lying flat and bending with Normal ECG suggestive of GERD.
•  if Calcium increases and phosphate decreses then think about PTH.

Migraine

Tab. Imigran 50mg TID

Migraine

Excessive Sweating

Tab. Arinac BD for 5 days

Excessive Sweating

Irritable Bowel Syndrome

Irritable Bowel Syndrome= Abdominal Pain+Bloating+Periods of frequent defaecation alternate with periods of relative constipation+ Stress(Headache+Menstrual irregularties)

Tab ITP 1 bd

Cap Risek 20mg 1 before breakfast

Mevulake sache 1 hs mixed with water or milk

If depression element,

Tab fluoxetine 1 od

Diarrhea

Diarrhea:  BLOODY????

• Cap. Imodium 2mg BD/Entox-P
• Smecta Sachet 3g TDS/Mavolake
• Tab. Flagyl 400mg TDS in bloody diarrhea
• Tab.Cipro 500mg BD
• Tab. Nospa Forte BD
• Use ORS
• IV Fluids in case of severe dehydration or low urine output.

Hemoptysis

Hemoptysis

• Bed rest
• Tab. Lexilium/Relaxin 3mg/Citanew OD
• Cap. Transamin 500mg TID

Adv:

CBC, CXR,Sputum for AFP, HRCT

Skin Ointments

Betagenic Cream

For Dermatitis and allergic rash

Healit cream

Superficial skin bruises

Cutis Lotion

Fungal Infection

Lotrix/Scabion/Scabrid Lotion

Scabies

Melas-H

Antibaterial oitment

Quench cream

Burn

Urology

Urology:

• Solfy (soliflnacin) 10mg OD

Urinary Frequency/Incontinence

Contraindication: urinary/gastric retention

• Maxflow (Tamsolusin) 0.4mg HS (2 weeks)

BPH, Urinary obstruction d/t calculus

Only for obruction at 2/3 of ureter or below

• Antibiotic of choice

Cipro 500mg BD

RFT's derranged than Cefixime

• Furadantin 100mg BD

UTI prophylaxis

• Citro-Soda Sachet for acidic urine
• Crane care Sachet for alkaline urine

Paediatrics

Colic Drops 

Antispasmodic

ZincIT in diarrhea

Gutcare sachet

Diarrhea

Myteka 4mg sachet below 6yr

Myteka 5mg chewable tablet 6-14yr

Cefotaxime+Amikacin

GIT/UTI

Constipation in child below 5yr

Lexoberan syrup 1TS TDS

Universal fomula to calculate drops/min of any drug in M/B

Universal fomula to calculate drops/min of any drug in M/B

100*Dose*weight / amount of drug in M/B

Dose= mg/kg/hr or IU/kg/hr

Weight= kg

Amount of drug= mg or IU

Heparin:

 ampuole strength= 5000 IU/ml

Dose =IHD dose 60 IU/kg stat (not more than 4500 IU)

maintanance= 12-18 IU/kg/hr

Isoket:

Ampuole strenth= 10mg 

Dose = Antiischemic dose = 0.8-2 mg/hr

Antihypertensive dose= more than 2mg/hr

Dopamine: 

acts on alpha 1,2. Beta 1,2. Dopamine 1,2 receptors

Ampuole strength= 200mg

Dose:2-20 microgram/kg/min

Low dose =2-6mcg/kg/min acts only on dopamine receptors on kidneys

4-10mcg/kg/min acts on dopamine and beta receptors

>10-20mcg/kg/min acts on alpha beta n dopamine

Dobutamine:

Acts only on Beta 1,2 receptors

Ampuole strength= 250mg

Dose: same doses as that of dopamine

Norepinephrine:

Ampuole=4mg

Dose:

Acute hypotension and cardiac arrest=

 initial dose 8-12 mcg/min

Maintanance dose= 2-4 mcg/min

Septic shock:

0.01-3 mcg/kg/min

Phenylephrine:

Ampuole=10mg (1ml)

Dilute it in 20ml and make 500mcg/ml then dilute 1ml of this dilution in 10ml and make 50mcg/ml

Stat dose=150mcg

Infusion= 50mcg/min

Insulin:

DKA, HHS

initial 0.1U/kg stat IV

Maintanance: 0.1U/kg/hr

Indication of Bicarbonate Replacement

Indication of Bicarbonate Replacement:

• Definite use: if pH <7.10/7.20
• Renal Failure
• Hyperkalemia
• Acidosis in diarrhea
• RTA

Bicarbonate Replacement Formula:

HCO3- to be given:Base Deficit✖️Weight/20

(Baseline HCO3-= 24mEq/L)

e.g. If,

• Weight: 60kg
• ABG results are:
  • pH= 7.20
  • PaCO2= 25 
  • HCO3=12 
  • PaO2= 89

HCO3- to be given= (24-12)✖️60/2

= 12✖️60/2

=720/2

=360 mEq/L

Bicarbonates are divided in 3 equal doses:

=360/3

=120mEq/L

Two doses are given with an interval of 12hours, third dose is missed, because it is compensated by body itself.

Insulin Calculation on Sliding Scale

Insulin Calculation on Sliding Scale:

Total Insulin=weight/2

e.g. Insulin=90/2

Insulin=45 units

2/3 Regular= 30 units

1/3 NPH=15 units

Regular Insulin will be given in three divided doses in TDS

30/3=10+10+10

NPH will be given in two divided doses in BD

15/2=8+8

This is fixed insulin for 150mg/dl BSL.

For every 50mg/dl rise in BSL we will add 2 units to regular Insulin.

Urinar Tract Infection

Urinary Tract Infection:

Signs & Symptoms:

• Renal Colic/Flank pain radiating to groin
• Dysuria
• Urinary urgency and frequency
• Blood in Urine
• Fever
• Tachycardia
• Suprapubic Tenderness

Workup:

• Urine Complete
• USG KUB
• In females exclude Contraceptive induced UTI

Emergency:

• Inj. Nalbin/Maxolon
• Inj. Nospa
• Inj. Rocephin 1g
• 1L fluid

Rx:

• Tab. Cipro 500mg BD for 5 Days

OR

• Tab. Cefspan 400mg OD for 5 days
• Tab. Furadatin 100mg (Nitrofurantoin)
• Tab. Nospa Forte BD for 3 Days
• Citro-Soda Sachet BD
• Tab. Febrol for Fever

Pregnancy:

• Tab. Cefspan 400mg OD for 5 days

Treat Renal Stones If present

Use plenty of water

Avoid Meat n Tomato

ASTHMA

❄️ASTHMA❄️

"It is reversible bronchoconstriction"

Symptoms:

• Cough
• Wheezing
• Shortness of breath
• Chest Tightness

Emergency:

• Inj. Solocortif 250-500mg
• Inj. Aminophyline 250mg
• Inj. Rocephin 1g
• Nabulize ē;
  • Atem (Ipratropium)
  • Clenil (Beclomethasone)
  • Ventoline (Beta agonist) Not in tachycardia
  • N-Acetylcysteine (Expectorant)
• Humidifies Oxygen
  • Mask>> 6L/min
  • Nasal Pronges>> 3L/min

History: Triggers are Pollen, stress, excercise, cold, smoke, dust, Family History.

Examination: 

• Auscultation>>Rhonchi>Spasm
• SPO2
• Prolonged Expiration

Investigations:

• CBC ē ESR (Eosinophils Raised)
• CXR (InterCostal Space Widening)
• PFT's (dec. FEV)

Rx:

• Avoid Triggers.
• Tab. Myteka 10mg OR Tab. Montica 10mg
• Rotacap Combivair Inhaler 200/6, 400/6 in BD (Budesonide/Formoterol)   OR 
• Rotacap Tiovair Inhaler in OD (Tiotrpium 18mcg)
• Tab. Deltacortril 10mg (Prednisone) 6 Tabs OD

HEMORRHOIDS

Hemarrhoids

Rx

•Tab. Daflon 500mg

2+2+2 (1st 4 days)

2+2 (Next 3 days)

1+1 (Next 7 days)

•Syp. Duphalac

2+2

•Ispaghul Husk

•Lignocaine gel

Apply before defecation

•Tab. Ibert fort

1+1

•Sitz Bath

•Use Plenty of Fluids

•Use Fresh Vegetables & Fruits

SHOCK

⚡️⚡️SHOCK ⚡️⚡️

Definition:

Hypoperfusion of an organ

Signs:

• BP Systolic<90mmHg, Diastolic<60mmHg
• Tachycardia
• Skin changes

BP=CO✖️PR

CO=SV✖️HR

__________________________________

Types of Shock:

Hypovolumic Shock: Blood Loss, Vomiting, Diarrhea, Dehydration

Diagnosis is on History, CVP<8, Chest Auscultation

Rx:

• 1L Blood loss is replaced with 1L of colloid or 3L of crytalloid.
• In Hypovolumic shock 2-3L of fluid can be given.
• After 2-3L, fluid can be given according to UOP, CVP & Chest Auscultation.
• Norepinephrine >>> alpha & Beta

Cardiogenic Shock: MI, Ischemia, Valvular Heart Disease,

Diagnose on ECG changes

Rx:

• fluid 200-300ml

Inotropic Support:

• Dopamine & Dobutamine

Acts,

• At low dose on Dopa receptors
• At medium dose on Dopa & Beta receptors
• At high dose on Dopa, Beta & Alpha receptors

Obstructive Shock: Physical Obstruction around Heart. e.g. Myocarditis, Endocarditis, Pericardial Effusion.

Rx: Relieve the cause.

Neurogenic/Vasovagal Shock: Stress, Trauma

Rx: Leg Elevation>>> "Bradycardia"

Anaphylactic Shock:

Reaction>> Mediators>> Vasodilation & Bronchoconstrition

Rx: 

• Norepinephrine acts at;
  • Alpha: inc. Peripheral Resistance
  • Beta: inc. Heart Rate
• Phenyephrine acts at;
  • Alpha: inc. Peripheral Resistance

Septic Shock: 

Bacteria>> Exotoxins>> Mediators>> Vasodilation

• Skin will be warm only in Septic shock.

Rx: 

• Norepinephrine acts at;
  • Alpha: inc. Peripheral Resistance
  • Beta: inc. Heart Rate
• Phenyephrine acts at;
  • Alpha: inc. Peripheral Resistance
• Inj. Rocephin 1g for gram -ve