Treatment

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Partho Shil, 5th Batch, MATS, Jhenaidah.The Treatment Book
Contents
AMI........................................................................................................................................................... 8
IHD......................................................................................................................................................... 10
CCF......................................................................................................................................................... 11
AF (Atrial Fibrillation) .............................................................................................................................. 11
VF (Ventricular fibrillation)....................................................................................................................... 12
SVT (Supra Ventricular tachycardia).......................................................................................................... 12
VT (Ventricular Tachycardia).................................................................................................................... 12
Ischemic Cardiomyopathy ......................................................................................................................... 13
Acute PUD............................................................................................................................................... 14
Haematemesis/Malaena............................................................................................................................. 14
Haemoptysis............................................................................................................................................. 15
Mallory weiss syndrome............................................................................................................................ 15
Non-Ulcer Dyspepsia................................................................................................................................ 15
GERD...................................................................................................................................................... 16
Ulcerative Colitis (Bloody Diarrhoea) ........................................................................................................ 16
IBS(Diarrhoea predominant)...................................................................................................................... 16
Tropical sprue........................................................................................................................................... 16
Apthus Ulcer............................................................................................................................................ 16
Oral Thrush.............................................................................................................................................. 17
Acute Tonsillitis/Pharyngitis...................................................................................................................... 17
Pre-operative order for tonsillectomy: ........................................................................................................ 17
Post-Operative Order for tonsillectomy: ..................................................................................................... 18
Epistaxis .................................................................................................................................................. 18
F.B Larynx/Trachea.................................................................................................................................. 19
F.B Pharynx/Oesophagus .......................................................................................................................... 19
Acute Epiglottitis ...................................................................................................................................... 19
Hanging ................................................................................................................................................... 20
DNS......................................................................................................................................................... 20
CSOM ..................................................................................................................................................... 20
Traumatic Rupture Of TM......................................................................................................................... 21
Sub-mandibular Growth ............................................................................................................................ 21
Nasal Mass With HIT................................................................................................................................ 22
Rhinosporidiosis ....................................................................................................................................... 22
Nodular Goitre.......................................................................................................................................... 22
Cervical Lymphadenopathy ....................................................................................................................... 23
Parotid Abscess ........................................................................................................................................ 23
Maxillary Sinusitis .................................................................................................................................... 23

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Acute Conjunctivitis ................................................................................................................................. 24
Ocular Injury ............................................................................................................................................ 24
Stye/Chalazion: ........................................................................................................................................ 24
Age related Cataract (ARC)....................................................................................................................... 25
Pre-operative order for cataract surgery:..................................................................................................... 25
Post Operative order for Cataract surgery: .................................................................................................. 26
Chronic Dacrocystitis (CDC)..................................................................................................................... 26
Acute Congestive Glaucoma...................................................................................................................... 27
Viral Keratitis........................................................................................................................................... 27
Fungal Corneal Ulcer................................................................................................................................ 28
Common Causes of Breathlessness ............................................................................................................ 29
Acute Severe BronchialAsthma ................................................................................................................. 29
COPD / Corpulmonale .............................................................................................................................. 30
Pneumonia ............................................................................................................................................... 31
Lung Abscess........................................................................................................................................... 31
Pleural Effusion........................................................................................................................................ 32
Bronchiectesis .......................................................................................................................................... 32
Pneumothorax .......................................................................................................................................... 33
RTI.......................................................................................................................................................... 33
Pulmonary TB.......................................................................................................................................... 34
Poisoning ................................................................................................................................................. 35
Snake bite (poisonous)........................................................................................................................... 35
Snake bite (Non-poisonous)................................................................................................................... 36
Sedative poisoning ................................................................................................................................ 36
CuSO4 Poisoning.................................................................................................................................. 37
Anti-Depression Poisoning .................................................................................................................... 37
β-Blocker Poisoning.............................................................................................................................. 38
Dutura/Stupefy/Street Poising ................................................................................................................ 39
Acute Gastritis (Food poisoning) ........................................................................................................... 39
OPCPOISONING................................................................................................................................ 40
Acute PUD............................................................................................................................................... 41
Haematemesis/Malaena............................................................................................................................. 41
Haemoptysis............................................................................................................................................. 42
Mallory weiss syndrome............................................................................................................................ 42
Non-Ulcer Dyspepsia................................................................................................................................ 43
GERD...................................................................................................................................................... 43
Ulcerative Colitis (Bloody Diarrhoea) ........................................................................................................ 43
IBS(Diarrhoea predominant)...................................................................................................................... 44

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Tropical sprue........................................................................................................................................... 44
Apthus Ulcer............................................................................................................................................ 44
Oral Thrush.............................................................................................................................................. 44
Liver Abscess........................................................................................................................................... 45
Acute Viral hepatitis ................................................................................................................................. 45
CLD (Without encephalopathy) ................................................................................................................. 46
Hepatic Encephalopathy............................................................................................................................ 46
Acute Pancreatitis ..................................................................................................................................... 47
Hepato Cellular Carcinoma........................................................................................................................ 47
Fatty change of Liver................................................................................................................................ 47
CRF/CKD................................................................................................................................................ 48
AGN........................................................................................................................................................ 48
NS........................................................................................................................................................... 49
Electrolytes imbalance .............................................................................................................................. 49
Hypernatraemia .................................................................................................................................... 49
Hyponatraemia...................................................................................................................................... 50
Hyperkalemia (K > 5.5 mmol/L) ............................................................................................................ 50
Hypokalemia ........................................................................................................................................ 50
Hypoglycemia....................................................................................................................................... 51
Fever........................................................................................................................................................ 51
Enteric Fever/ Typhoid.......................................................................................................................... 51
Rickettsial fever.................................................................................................................................... 51
Dengue fever........................................................................................................................................ 52
Malaria................................................................................................................................................. 52
Cerebral Malaria/Severe Malaria............................................................................................................ 52
Kala-Azar............................................................................................................................................. 53
PKDL................................................................................................................................................... 53
Fever Under Evaluation/UTI/RTI........................................................................................................... 53
Meningitis ................................................................................................................................................ 54
Epilepsy ................................................................................................................................................... 54
Acute Migraine attack............................................................................................................................... 55
Tension Headache..................................................................................................................................... 55
Vertigo with Headache.............................................................................................................................. 56
Vertigo/BPPV .......................................................................................................................................... 56
Raised ICP ............................................................................................................................................... 56
TIA.......................................................................................................................................................... 56
CVD/Stroke.............................................................................................................................................. 57

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Bell's Palsy............................................................................................................................................... 58
Mumps & Orchitis .................................................................................................................................... 58
Hyperthyroidism....................................................................................................................................... 58
Steven Jonson Syndrome........................................................................................................................... 59
Anaemia................................................................................................................................................... 59
Aplastic Anaemia ..................................................................................................................................... 59
Iron Chelating agent in Thalassaemic PT.................................................................................................... 60
Macrocytic Anaemia ................................................................................................................................. 60
Lymphoma ............................................................................................................................................... 60
Chemotherapy Schedule ........................................................................................................................ 60
Hodgkin Lymphoma ................................................................................................................................. 61
Aleukaemic Leukaemia ............................................................................................................................. 61
ALL......................................................................................................................................................... 62
CML........................................................................................................................................................ 62
Musculoskeletal Pain ................................................................................................................................ 62
Lumbo Sciatica......................................................................................................................................... 63
Septic Arthritis ......................................................................................................................................... 63
Low Back Pain ......................................................................................................................................... 63
JRA......................................................................................................................................................... 63
RA........................................................................................................................................................... 64
Tetanus.................................................................................................................................................... 64
GBS......................................................................................................................................................... 64
DKA........................................................................................................................................................ 65
Fracture.................................................................................................................................................... 66
Joint Sprain .............................................................................................................................................. 66
GAD (Generalized Anxiety Disorder) ........................................................................................................ 67
OCD (Obsessive Compulsive Disorder) ..................................................................................................... 67
PPP (Post Partum Psychosis) ..................................................................................................................... 67
SRD (Substance related disorder)/Sleeping Pill........................................................................................... 67
Depressive illness ..................................................................................................................................... 68
Somatoform disorder/HCR/FD .................................................................................................................. 68
Drugs used in Skin and VD ....................................................................................................................... 69
Anti-histamine and Anti-pruritic: ........................................................................................................... 69
Topical corticosteroid:........................................................................................................................... 69
Topical antifungal preparation: .............................................................................................................. 69
Systemic antifungal:.............................................................................................................................. 69
Topical anti-bacterial:............................................................................................................................ 69
Topical Anti-viral:................................................................................................................................. 69

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Drug list by Indication:.............................................................................................................................. 70
For the treatment of Eczema and Psoriasis: ............................................................................................. 70
For the treatment of Fungal Infection:..................................................................................................... 70
For the treatment of Inflammatory fungal infection:................................................................................. 70
For the treatment of Acne:..................................................................................................................... 70
For the treatment of scabies: .................................................................................................................. 70
For the treatment of Bacterial infection:.................................................................................................. 71
For the treatment of Inflammatory bacterial infection: ............................................................................. 71
For the treatment of mixed inflammatory infection:................................................................................. 71
For the treatment of viral infection: ........................................................................................................ 71
For the prevention of itching & dry skin condition:.................................................................................. 71
For protecting skin & to prevent diaper rash:........................................................................................... 71
For use as topical anti-histamine and skin protectant:............................................................................... 71
For preventing hairfall and regrowing hair: ............................................................................................. 71
For treating hyperkeratotic condition: ..................................................................................................... 71
Scabies................................................................................................................................................. 71
Acne .................................................................................................................................................... 72
Tinea Corporis ...................................................................................................................................... 72
Eczema................................................................................................................................................. 72
Impetig Eczema .................................................................................................................................... 73
Seborrhoic Dermatitis............................................................................................................................ 73
Alopecia ............................................................................................................................................... 73
Measles................................................................................................................................................ 74
Gonococcal Urethritis............................................................................................................................ 74
Erectile dysfunction .............................................................................................................................. 74
A.Follow up of a patient............................................................................................................................ 75
B.Post-Operative Order of Circumcision .................................................................................................... 76
Abdominal Pain: Order on admission ......................................................................................................... 77
Head Injury .............................................................................................................................................. 78
Physical assault (P/A)............................................................................................................................... 79
Massive cut Injury or P/A.......................................................................................................................... 79
Small cut injury ........................................................................................................................................ 80
Acute Abdomen:....................................................................................................................................... 80
Acute case of intestine/Acute Emergency................................................................................................... 81
A case of Hepato-Biliary system................................................................................................................ 82
Accidental fall from height ........................................................................................................................ 83

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Abscess.................................................................................................................................................... 83
Ulcer........................................................................................................................................................ 84
Retention of Urine/Stricture urethra ........................................................................................................... 84
BEP (Benign Enlargement of Prostate)....................................................................................................... 85
Hernia & Hydrocele.................................................................................................................................. 85
PVD(Peripheral vascular Disease).............................................................................................................. 85
Haemorrhoids /Anal fissure/rectal prolapse................................................................................................. 86
Peri-Anal Abscess..................................................................................................................................... 86
Gut Preparation for Surgery....................................................................................................................... 87
Gut Preparation for IVU............................................................................................................................ 87
Pro-forma for Follow up of a patient: ......................................................................................................... 88
Post-operative Follow upof a patient: Example ........................................................................................... 88
Follow up of an ANC patient: Example ...................................................................................................... 89
Full Term Pregnancy with LAP (O/A)........................................................................................................ 90
Order for induction ................................................................................................................................... 91
Secondary wound infection (O/A).............................................................................................................. 92
Confinement Note:.................................................................................................................................... 93
Post-natal order:........................................................................................................................................ 94
Pre-operative Order of LSCS..................................................................................................................... 95
Pre-operative order of D& C...................................................................................................................... 96
Pre-operative order of Vaginal Hysterectomy ............................................................................................. 97
OT Note of LSCS..................................................................................................................................... 98
OT Note of Secondary Wound Closure....................................................................................................... 99
Post-operative Order of LSCS...................................................................................................................100
Post-operative order of D & C..................................................................................................................101
Post-operative order of Vaginal Hysterectomy...........................................................................................102
Post-operative order of Abdominal Hysterectomy......................................................................................103
Hyperemesis Gravidarum .........................................................................................................................104
IUD (O/A)...............................................................................................................................................105
Commonly Used Symptomatic Drugs in 1st
trimester Pregnancy:................................................................106
Advice on ANC (Bangla) .........................................................................................................................107
Advice on discharge for NVD/LSCS(Bangla) ............................................................................................108
Advice on discharge for D & C (Bangla) ...................................................................................................109
Advice on discharge for Vaginal Hysterectomy (Bangla)............................................................................110
Blood Transfusion ...................................................................................................................................111
Indications of Blood Transfusion...........................................................................................................111
Contra-indication of Blood Transfusion:................................................................................................111
Complications of Blood Transfusion: ....................................................................................................112

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Screening of Blood (Donor):.................................................................................................................112
Blood Grouping:..................................................................................................................................113
Blood Transfusion order...........................................................................................................................114

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AMI
 Complete bed rest
 O2 inhalation stat & SOS
 Diet. Liquid
 Nitrosol/Nitroglycerine Spray
2 puff S/L stat & SOS
OR
 Tab. Glyceryl Trinitrate
(Nitroglycerine,Nidocard) 0.5 (If pt poor)
tab S/L stat & SOS
 Cap. Omeprazole 20mg
1+0+1 (A/C)
 Tab. Anclog plus/Lopirel plus
0+1+0 (P/C)
 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 (Trimetazidine)
1+0+1
 Tab.Diazepam/sedil 5mg
0+0+1
 Inj. Morphine 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 ½ hours at same time BP must check if fall must stop
morphine
 Inj. Ondansetron 8mg
1 amp IM/IV 15 min before giving morphine
 Inj. cardinex/Enoxaprin (60mg or 80mg)-
if pt comes > 12 hours
1 syringe S/C stat & BD
If pt comes within 12 hours,
 Inj. Cotson 1 amp IV stat, Then
 Inj. Streptase (streptokinase)
1 vial + Inf. 5% DA 100cc
IV @ 25 d/m stat (No IM inj. in next 24 hours of streptokinase)
 Inj. Cardinex/Enoxaprin (60mg or 80mg)- after 24 hours of
inj. streptokinase
1 syn S/C BD
If BP fall <80/50 mm of Hg- Pt goes to shock,

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 Inj. Dopamine 2 amp + 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. Frusemide-2amp/4amp IV stat & SOS
 Cap. Cephradin 500mg (1+1+1+1)
OR
 Tab.Ciproflox acin 500 mg
(1+0+1)

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IHD
 Diet. Normal
 Nitrosol/Nitroglycerine Spray
 2 puff S/L stat & SOS
OR
 Tab. Glyceryl Trinitrate (Nitroglycerine,Nidocard) 0.5 (If pt poor)
1 tab S/L stat & SOS
1+0+1 (B/M)
 Tab. Anclog plus/Lopirel plus
0+1+0 (A/M)
 Tab. Atova
0+0+1
 Tab.Monocard 20mg (mononitrate)
1+1+0
OR
 Tab. Nidocard-RTD/Trocer 2.6 (GTN)
1+0+1
 Tab. Metacard MR ( Trimetazidine)
1+0+1
 Tab.Diazepam/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
 Inj. Cotson
2 vial IV stat
 Inj. Frusemide
2 amp IV stat & BD
 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)
3+0+0- for 5 days
Then, 1+0+0- Friday & Saturday off
Digoxin contra-indicated in AMI
Digoxin(Cardiac glycoside)
↓
↑ force of contraction
↓
↑O2 demand
↓
Ischemia

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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 hours
 After 24 hours
Tab. Pacet 200mg
1+1+1
SVT (Supra Ventricular tachycardia)
 Bed rest
 O2 inhalation Stat
 Inj. Osiden/Adicard (Adenosine)
1 amp IV rapidly stat ( within 2 sec)
 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- Maintain by
 Inj. 2% Lignocaine 100cc + 5% DA 400cc
 IV @ 5-10 d/m for 24 hours
 Then, 2% lignocaine for next 24 hours
 Tab. Amiodaron
 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
1+0+1 (b/m)
 Tab. Frusemide + Spironolactone (Frusemide 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. Glyceryl Trinitrate (Nitroglycerine,Nidocard) 0.5mg
1 tab S/L

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Acute PUD
 Diet. NPO TFO
 Inf. 5% DA 1000cc + Inf. 5% DNS 1000cc
IV @ 20 d/m
 Inj. Maxpro 40mg
vial IV stat & BD
 Inj. Algin
1 amp IM stat & TDS
 Inj. Emistat/ Ondansetron
1 amp IV stat & SOS
Haematemesis/Malaena
 NPO TFO
 Inf. HS 2000cc + Inf. 5% DA 1000cc
IV running
 O2 inhalation if needed
 Inj. Moxacil
1 vial IV stat & TDS
 Inj. Omeprazole 40mg
1 vial IV stat & BD
If portal HTN
 Tab. Propranolol 40mg
1/2 + 0 + 1/2
 Inj. Vitamin K1 10ml (konakion)
1 amp slow IV drip for 3 days
 Inj. Tranexamic Acid 500mg (Traxyl)
1 amp slow IV stat & 6 hourly
 Record vital sign
 Immediate arrange for Blood transfusion

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Haemoptysis
 Diet. Normal
 Inj. HS 1000cc
IV 20 d/m
 Cap. Amoxicillin 500mg (never give ciprofloxacin if you suspect TB
as it mask the AFB)
1+1+1
1+0+1 (1/2 hour a/c)
1 amp IV stat & then
 Tab. Tranexamic Acid 500mg (Traxyl)
1+1+1
 Tab. Diazepam (0+0+1 )
Mallory weiss syndrome
 Tab. Sucralfate 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. Amitriptyline 25mg
0+0+1
 Cap. omeprazole 20mg
1+0+1 (1/2 hour a/c)
 Tab. Domperidone 10mg
1+1+1 (1/2 hour a/c)
 Tab. Aluminium Hydroxide +Magnesium Hydroxide/Marlox
1+1+1 (A/M)
 Psychotherapy
 Anti Flatulent
Syp. flatameal DS 1/2 TSF TDS, or
 Tab. Flatameal DS
1-2 tab TDS

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GERD
 Non drug Rx of GERD
Wt reduction, stop smoking, avoid fatty food
 Drug Rx
 Tab. Domperidone 10mg
1+1+1 (1/2 hour a/c)
1+0+1 (1/2 hour a/c)
Ulcerative Colitis (Bloody Diarrhoea)
 Tab. Prednisolone 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 sprue
 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 (prednisolone) 5mg
1 tab TDS at lacerated site
 Apsol/Meoral oral paste
Apply 3-4 times daily
 Viodin/arodin mouth wash 3 times daily
 Tab. Vitamin - C 250mg
1+0+1

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Oral Thrush
 Micoral/Gelora oral gel- Apply TDS in affected area
 Syp. flugal- 1 TSF TDS
Acute Tonsillitis/Pharyngitis
 Diet: Liquid diet
 Tab. Phenoxymethyl Penicillin 250mg
1+1+1+1 for 7 days
 Tab. Ketotifen 1mg
0+0+1
 Tab. Paracetamol 500mg
1+1+1 (p/c)
 Povidone Iodine 1% Mouth wash
2 tsf mixed with 1 glass of water 8 hourly for 7 days.
 Tab. Ranitidine 150mg
1+0+1 (1/2 hour a/c)
 Warm water gargling In case of Chronic/recurrent tonsillitis the treatment
option is surgical (Tonsillectomy).
Pre-operative order for tonsillectomy:
 Diet: NBM from 10 pm
 Inf. Hartsol (1000cc)
I/V @ 10d/min
 Inj. Ceftriaxone 1gm
1 vial IV stat 1 hour before surgery
 Tab. Diazepam 5mg
1 tab (at 10 pm)
 Take written informed consent.
 Please sent the patient OT @8.00 am on…..(date of next day)
[N.B. Before operation Pre-anesthetic checkup, BT,CT must be checked]

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Post-Operative Order for tonsillectomy:
 Diet: NPO for 6 hours
 Inf. 5% DNS (1000cc)
IV @20 drops/min
 Inj. Ketorolac 30mg
1 amp IM stat & SOS
1 vial IV stat & 12 hourly. After 6 hours, (Fresh order)
 Diet: Ice cream to liquid to normal.
 Cap. Cephradin 500mg
1+1+1+1
 Tab. Ketorolac 10mg
1+1+1 (p/c)
1+0+1 (1/2 hour a/c)
 H₂O₂ solution
2 tsf mixed with 1/2 glass of water, then gargle 3 times daily.
 Please monitor all vital sign regularly.
Epistaxis
 Pressure over the Ala of the nose (Not less than 8 minutes)
 Ice over the nasal bridge (If H/O trauma)
 Nasal packing:
Anterior nasal pack Or Posterior nasal pack
 Inj. Tranexamic Acid (If bleeding not controlled by above measure)
3 amp IV stat & SOS
 Xylometazoline 0.1% nasal drop
5 drops in each nostril 3 times daily
 IV Infusion- Hartsol 1000cc (If patient in shock)
 Tab. Loratadine 10mg
0+0+1
0+0+1

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F.B Larynx/Trachea
 O2 inhalation
 Inj. Dexamethasone- (to prevent laryngeal Oedema)
1 amp IV stat & 6 hrly
 Inf. 0.9% NaCl
IV @ 10drops/min
 Cap. Flucloxacillin 250mg
1+1+1+1
1+1+1
1+0+1
 Advice: X-ray soft tissue neck A/P & lateral view.
F.B Pharynx/Oesophagus
 NPO TFO
 Inf. 5% DNS
IV @ 3 0drops/min
 Cap. Phenoxymethyl Penicillin 250mg
1+1+1+1
1+1+1
1+0+1
Advice: X-ray soft tissue neck A/P & lateral view.
Acute Epiglottitis
 Inj. Flucloxacillin 250mg
6 hourly for 7 days
 Inj. Ranitidine 50mg
12 hourly for 2 days, then
1+0+1 for 15 days
 Tab. Chlorpheniramine 4mg
1+0+1
 Tab. Diazepam
0+0+1

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Hanging
1st to see stridor: If present-
Tracheostomy
 NPO TFO
 O2 inhalation 2-4 L/min stat & SOS
 Inf. 0.9% NaCl
I/V @ 30 drops/min
 Inj. Dexamethasone-( To prevent laryngeal oedema )
1 ampule IV 12 hourly
1 amp IV 12 hourly for 3 days
 Inj. Phenobarbitone 200mg
1 amp IM stat & 1/2 amp BD
DNS
Symptomatic Treatment:
 Xylometazoline Nasal drop( 0.1% )- 3 drops in each nostril BD
1+0+1 (1/2 hour a/c)
 Anti-histamine
 Analgesics
Surgical Treatment:
 Septoplasty
CSOM
 Tab. Ciprofloxacin 500mg
1+0+1
1+1+1
1+0+1 (1/2 hour b/m)
1+0+1 (1/2 hour a/c)
 Gentamycin HC ear drop
3 drops in each ear 3 times daily

22
Traumatic Rupture Of TM
 Inj. Cephradin 500mg
1 vial IV x BD
 Inj. Ranitidine 50mg
1 amp x BD
 Inj. Diclofenac 75mg
2/3rd amp IM/IV x BD
1+0+1
 Tab. Omidon 10mg
1+0+1
0+0+1
 Gentamycin HC ear drop
3 drop 3 times daily in effected ear
Sub-mandibular Growth
 Cap. Amoxicillin 500mg
1 cap x 8 hourly for 7 days
1+0+1 (1/2 hr a/c)
 Tab. Levamisole
3 tab stat
1+0+1
1+1+1
 Povidone Iodine 1% mouth wash
3 TSF in 1 glass of water then gargle 3 times daily

23
Nasal Mass With HIT
1+1+1 for 7 days
 Tab. Levamisol
3 tab stat
 Tab. Paracetamol
1+1+1
1+0+1
 Xylometazoline Nasal drop
3 drops in each nostril BD
Rhinosporidiosis
 Tab. Dapsone 100mg
1+0+0
 Cap. omeprazole
1+0+1(b/m)
1+0+1
0+0+1
1+0+1
 Xylometazoline nasal drop 0.1%
3 drops in each nostril 3 times daily
Nodular Goitre
 Tab. Ciprofloxacin
1+0+1
1+0+1 (b/m)
 Tab. Chlorpheniramine 4mg: 1+0+1
0+0+1
 Tab. B/C
1+0+1
1+0+1
 Advice:
1. FNAC of thyroid, 2. USG of thyroid, 3. T3, T4, TSH

24
Cervical Lymphadenopathy
1+0+1 for 7 days
1+0+1 (1/2 hour b/m)
1+0+1
0+0+1
1+0+1
Parotid Abscess
 Cap. Cephradine 500mg
1+1+1+1
 Inj. Gentamycin
1 vial x 8 hrly for 7 days
1+0+1 (b/m)
 Tab. diclofenac
1+0+1 (a/m)
0+0+1
Maxillary Sinusitis
 Cap. Cephradine- 7 days
1+1+1+1
 Tab. Cetirizine 10mg- 7 days
0+0+1
 Tab. Omeprazole 20mg - 15days
1+0+1
 Xylometazoline nasal drop 0.1%
1 drop in each nostril 3 times daily
o 1+0+1

25
Acute Conjunctivitis
 Diet: Normal
 Use dark glass
 Moxifloxacin eye drop
- 1 drop in both eye 4 hourly
 Ketotifen eye drop
- 1 drop in both eye twice daily.
 Tab. Paracetamol 500 mg
- 1+1+1 (after meal)
Note: Special attention to avoid steroid eye drop in conjunctivitis.
Ocular Injury
 Bed rest
 Haemostasis if needed
 Moxifloxacin E/D (0.5%)
- 1 drop in B/E 6 hourly
 Ciprofloxacin Eye ointment
- Apply topically twice daily.
 Ketorolac E/D (0.5%)
- 1 drop topically x QDS
 Tab. Diclofenac 50mg 1+1+1 (P/C)
- 1+0+1 (1/2 hour a/c)
 Tab. Clonazepam 0.5 mg 0+0+1
 Tab. Vit-C (1+0+1)
If open wound present,
 Inj. TT 1 amp I/M stat in one arm
 Inj. TIG 1 amp I/M stat in opposite arm.
Investigation: X-Ray Skull B/V
Stye/Chalazion:
 Diet: Normal
 Hot compression over affected site
 Cap. Flucloxacillin 500mg
1+1+1+1
 Tab. Diclofenac (50mg)
1+1+1
1+0+1 (1/2 hour a/c)
 Epilation of eye lid if needed or if pus point present.
 Removal of chalazion by Chalazion clamp

26
Age related Cataract (ARC)
 Diet. Normal
 Chloramphenicol E/D
- 1 drop 6 hourly
- 1+0+1 (b/m)
- 0+0+1
 Tab. Ibuprofen 200mg
 1+0+1 (a/m)
 Tab. Vitamin C 250mg
- 1+0+1
 Treatment option is Surgical
Pre-operative order for cataract surgery:
 NBM from 10.00 pm (before the day of operation)
 Tab. Acetazolamide 250mg
2 tab at night & 2 tab at next morning
 Tab. Potassium Chloride 600mg
1 tab at night & 1 tab at next morning
1 tab at night
 Tropicamide 0.5% E/D
1 drop every hourly on next morning on affected eye
 Ketorolac E/D
1 drop every hourly from next morning
 Moxifloxacin E/D
1 drop every hourly from next morning
 Please take informed written consent
 Cut the eye lash of affected eye
 Please sent patient to OT at 9.00 am

27
Post Operative order for Cataract surgery:
For 1st 24 hours:
 Diet: Normal
 Tab. Ciprofloxacin 500mg (1+0+1)
½ + ½ + ½
½ + ½ + ½
 Tab. Paracetamol 500mg (1+1+1)
1+0+1 ( ½ hour a/c)
 Tab. Diazepam 5mg (0 + 0 + 1)
After 24 hours (Fresh order):
 Diet: Normal
 Tropicamide E/D
1 drop x 2 hourly
 Ketorolac E/D
1 drop 6 hourly
 Moxifloxacin E/D
1 drop x 8 hourly
 Betamethasone E/D
1 drop 2 hourly
Chronic Dacrocystitis (CDC)
 Diet. Normal
 Moxifloxacin 0.5% E/D
1 drop 8 hourly
1+1+1 OR
 Cap. Lebac 500mg
1+1+1+1
1+0+1 (b/m)
0+0+1
 Tab. Vitamin C 250mg
1+0+1

28
Acute Congestive Glaucoma
 Diet. normal
 Pilocarpine 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
- 1 drop every 30 min for 2hours
- Then, 1 drop every 12 hourly
 Dexamethasone 0.1% E/D
- 1 drop 4 hourly
- 1+1+1+1
- 1+1+1
 Timolol 0.25% E/D
- 1 drop 12 hourly
- 1+0+1 (B/M)
- 1+0+1 (P/C)
Viral Keratitis
 Diet. Normal
 Acyclovir E/D
- 1 drop 6 hourly for 3 weeks
 Chloramphenicol E/D
- 1 drop 4 hourly
 Atropine E/D
- 1 drop 8 hourly
- 1+1+1
- 1+0+1 (1/2 hour a/c)
 Tab. Vitamin-C 250mg
- 1+0+1

29
Fungal Corneal Ulcer
 Bed rest
 Use sun glass, Avoid water
 Diet. Normal
 Natamycin 5% E/D
1 drop 3 hourly
 Moxifloxacin 0.5% E/D
1 drop 3 hourly
 Atropine 1% E/D
1 drop 3 hourly
 Clotrimazole 1% E/O
at bed time
 Tab. Levofloxacin 500mg
0+1+1
 Tab. Fluconazole 50mg
0+1+0
1+0+1 (b/m)
1+0+1 (a/m)
 Tab. Vitamin-C 250mg
1+0+1
 Tab. Diazepam 5mg (0+0+1 )
If Hypopion present:
1+1+1+1
1+1+1

30
Common Causes of Breathlessness
 Bronchial Asthma
 COPD
 Pneumothorax
 LVF/AMI
 DKA
 Pulmonary edema/Thrombo embolism
 CRF/ARF/Uremia
 Emotional/HCR/FD
Acute Severe BronchialAsthma
 Diet: Normal
 O2 Inhalation stat & SOS (high conc.)
 Nebulization with windel plus stat & 6 hrly
 Inj. Hydrocortisone
(Cotson)/Dexamethasone (Oradexon)
1 vial IV stat & 6 hrly Or
 Tab. Cortan(prednisolon) 5mg
6+0+0 ( 10 days)
 Asmasol/Sulprex inhaler
2 puff TDS
 Bexitrol F/ Ticamate inhaler 2 puff BD
 Antibiotic if evidence of infection (Cap. Amoxicillin + Clavulanic Acid
(Moxaclav) 625mg 1 cap 8 hourly)
1+0+1 (1/2 hour a/c)
 IV fluid 5% DA @ 30 d/m- To correct K+
 If response poor then
 Inj. Aminophyllin
2amp + 5% DA 500cc IV at 8 drops/min
 In some case - Montelukast 10mg
0+0+1

31
COPD / Corpulmonale
 Diet: normal
 O2 Inhalation with low conc. (2-3 L/min)
 Nebulization with windel plus stat & 6 hrly
 Inj. Hydrocortisone
(Cotson)/Dexamethasone (Oradexon)
1 vial IV stat & 6 hrly, Or
 Tab. Cortan(prednisolon) 5mg
6+0+0 ( 10 days)
 Tab. Amoxicillin + Clavulanic Acid
(Moxaclav)/Fimoxyclav 625mg
1+1+1 Or
 Levofloxacin 500mg (0+0+1)/Ciprofloxacin 500mg
(1+0+1)
 Asmasol/Sulprex inhaler
2 puff TDS
 Bexitrol F/ Ticamate inhaler
2 puff BD
1+0+1 (1/2 hour a/c)
If more Crep/Oedema present,
 Inj. Lasix/fusid
2 amp 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

32
Pneumonia
 Bed rest
 O2 inhalation
 Tab. Paracetamol 500 mg (ACE/Napa)
1+1+1
 Tab. Amoxicillin 500mg
1+1+1
OR
 Tab. Moxclav 625mg (2 wks)
1+1+1
+
 Tab. Clarin 500mg (2 wks)
1+0+1
1+0+1 (1/2 hour a/c)
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
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

33
Pleural Effusion
 Bed rest
 O2 inhalation if necessary
 Pleural fluid aspiration
Up to 1.5L in one setting
 Rx of underlying causeo TB,Malignancy,pneumonia,etc
Bronchiectesis
 Diet. Normal
 Bed rest
 Cap. Ciprofloxacin 500mg
1+0+1
 OR, Inj. Ceftazidim 500mg/inj.Flucoxacillin/Inj. Amoxicillin
1+0+1
 Tab. Prednisolon
 Symptomatico
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

34
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. ACE
(1+1+1)
 Tab. Loratidin 10mg
(0+0+1)

35
Pulmonary TB
 Composition of FDC
 4FDC- INH 75mg + Rifampicin 150mg +Pyrazinamid 400mg + Ethambutol 275mg
 2FDC- INH 75mg + Rifampicin 150 mg
 Dose of FDC
 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
 CAT-1 ( WT-45 kg)
 Diet. Normal
 Tab. Rimstar 4FDC- 2 month
3+0+0 (Before meal) from 11/2/11 to 10/4/11 Tab. Remactazid 450mg- next 4 month
1+0+0 (Before meal) from 11/4/11 to 10/8/11
 Tab. Pyrovate- 6 month 0+0+1
1+0+1
 Tab. Cortan 10mg ( to prevent pleural adhesion)
2+2+0 .......................1 month
2+11/2+0 ..................1wk
11/2+11/2+0 ...............1wk
11/2+1+0 .................. 1wk
1+1+0 .......................1wk
1+1/2+0 ....................1wk
1/2+1/2+0 ................1wk
1/2+0+0 ....................1wk
 Tab. calcium 500mg- 2 month
1+0+0
 CAT-2 (WT-45 kg)
 Diet. normal
 Inj. Streptomycin (1gm)-2month
2/3 amp IM daily from 11/2/11 to 10/4/11
 Tab. Rimstar 4FDC- Next 3 month
3+0+0 from 11/4/11 to 10/7/11
 Tab. remactazid 450mg - Next 5 month
1+0+0 from 11/7/11 to 10/12/11
 Tab. Pyrovate- 6 month 0+0+1
1+0+1 (1/2 hour a/c)
 Tab. Calcium 500mg(1+0+0)- 2month

36
Poisoning
Snake bite (poisonous)
 Diet: NPO TFO
 Bed rest
 Reassurance
 Inf. 5% DA 1000cc+ 5% DND 2000cc
IV 30 d/m stat
vial IV stst & daily
vial IV stat & BD
 Inj. TT
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
amp IV stat
-Inj. Neostigmine- if muscle paralysis
 Monitor Vital sign regularly
 ** inj. Hydrocortisone (Cotson), Inj. Avil, Inj. Adrenalin should be kept during
given antivenom 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.

37
Snake bite (Non-poisonous)
 Bed rest
 Reassurance
 Inf. NS 1000cc .......... IV @ 20d/m stat
 Cap. Amoxicillin(1+1+1)/ OR
 Cephradin (1+1+1+1)
 Cap. omeprazole 20mg 1+0+1 (1/2 hour a/c)
 Inj. TT
1 amp IM stat (in one arm)
 Inj. TIG
1 amp IM stat (in another arm)
 If pt complain pain
Tab. Paracetamol 500 mg (ACE/Napa)
 Never give- inj. Dexamethasone (Oradexon),
Inj. Avil & NSAID
 (Observe the pt 24hrs if no S/S of poisonous then discharge the pt)
Sedative poisoning
 Stomach wash if pt comes within 4-6hrs
 Diet. NPO TFO
 Inf. NS/DNS 1000cc IV @ 20d/m stst
 Inj. ceftriaxone 1gm
1vial IV stat & BD
1 vial IV stat & BD
 Inj. Lasix ( if BP stable)
1 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

38
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
Anti-Depression Poisoning
 Stomach wash if pt comes within 12hrs
 Diet. NPO TFO
 Inf. NS/DNS 1000cc
IV @ 20d/m stst
 Tab. Ultracarbon
20 tab stat
 Inj. ceftriaxone 1gm
1vial IV stat & BD
1 vial IV stat & BD
 Inj. Lasix ( if BP stable)
2 amp IV stat then 1 amp BD ( 8am & 4pm)
 If pt unconscious
-NG suction
-Continuous catheterization

39
β-Blocker Poisoning
 Stomach wash if pt comes within 1hrs
 Inf. 5% DNS 1000cc (prevent hypoglycemia)
IV @ 20 drops/min stat
1 vial IV stat & BD
1 vial IV stat & BD
 Symptomatic
o Convulsion -Inj. sedil 1amp IM/IV stat
o Bronchospasm - Nebulization
o Bradycardia -Inj. atropine –(1 amp 8hrly)
o Hypoglycemia -Inj. 25% DA 100ml, then
o -Inj. 10% DA 1000ml as maintenance dose
o Hypotension
 Inj. Glucagon (5-10mg over 10 mins)
Corrosive/Chemical Poisoning
(Acid/Alkali/Savlon/Herpic/Shampoo/Bleaching powder)
 Do not give stomach wash/NG suction &don't try to induce vomiting
 Diet. NPO TFO
1 vial IV stat & BD
1 vial IV stat & BD
 If pain- Inj. Anadol/Inj. Ketorolac/Inj.nalbun-2
 If pt ingest chemical other than acid & alkali
 Syp. Entacid plus
2 TSF TDS
 May give liquid paraffin

40
Dutura/Stupefy/Street Poising
 Diet. NG Feeding 2hrly/NPO TFO
 Inj. NS 1000cc
20 d/m IV stat
 Inj. Amoxycillin
1vial IV stat & 8 hrly
 Inj. Ranitid
amp IV stat & 8 hrly
 Continuous catheterization
 Monitor vital sign
** Always try to avoid costly drug & investigation as pt attendant are not available.
Acute Gastritis (Food poisoning)
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) OR,
 Tab. Clarithromycin 500mg
(1+0+1)- 7-14 days
 Tab. Metronidazole 400mg- 7 days
1+1+1
 Cap. omeprazole 20mg- 2 month
1+0+1

41
OPC POISONING
 Stomach wash
 Diet. NPO TFO
 Inj. NS/ 5% DNS 1000cc
20 d/m IV stat
1 vial IV stat & BD
 Inj.Omeprazole 40mg
1 vial IV stat & BD
 Inj. Atropin
3 amp IV stat & double the dose every 10 min interval up to atropinization
 Inj. Pam-A 500mg ( Pralidoxime)
2 amp IV slowly over 10 min
 Maintain atropin chart
 Maintenance dose- If atropinization occur then (If loading dose 150amp)
 -Inj. Atropin 45amp + NS 955 ml (total 1000ml)
IV @ 10 d/m
• Inj. PAM-A (May be given in current channel or another channel)
2amp+ NS/DNS 1000ml
If restless/convulsion
• Inj. Sedil 1amp IV stat
• If still restless
• Inj. perol 1amp IM stat
On Discharge
• Tab. prokind 15mg- 15 days 1+1+1
• Tab. Tryptin 25mg- 2 month
0+0+1
• Cap. Omeprazole 20mg-1month
1+0+1
*Atropin 30% of total loding dose in 24hours. (If total loading dose is 150 amp
Then 30% of 150 amp is 45amp) So pt get 45amp in 24hrs as maintenance dose
*Pralidoxime 8-10 mg/kg/hrs OR 2amp in 1000ml NS/DNS

42
Acute PUD
 Diet. NPO TFO
 Inf. 5% DA 1000cc + Inf. 5% DNS 1000cc
IV @ 20 d/m
 Inj. Maxpro 40mg
vial IV stat & BD
 Inj. Algin
amp IM stat & TDS
 Inj. Emistat/ Onaseron
1 amp IV stat & SOS
Haematemesis/Malaena
 NPO TFO
 Inf. HS 2000cc + Inf. 5% DA 1000cc
IV running
 Inj. Moxacil
1 vial IV stat & TDS
1 vial IV stat & BD
 If portal HTN
 Tab. Indever 40mg
1/2 + 0 + 1/2
 Inj. Vitamin K1 10ml (konakion)
1 amp slow IV drip for 3 days
1 amp slow IV stat & 6 hrly
 Record vital sign
 Immediate arrange for Blood transfusion

43
Haemoptysis
 Diet. Normal
 Inj. HS 1000cc
IV 20 d/m
 Cap. Amoxicillin 500mg (never give ciprofloxacin if you suspect TB as
it mask the AFB)
1+1+1
1+0+1 (1/2 hour a/c)
1 amp IV stat & then
 Tab. Tranexamic Acid 500mg (Traxyl)
1+1+1
 Tab. sedil (0+0+1 )
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

44
Non-Ulcer Dyspepsia
 Diet. sweet,fat,milk restricted
 Tab. Tryptin 25mg
0+0+1
1+0+1 (1/2 hour a/c)
1+1+1 (1/2 hour a/c)
 Tab. Entacid/Marlox
1+1+1 (A/M)
 Psychotherapy
 Anti Flatulent
Syp. flatameal DS 1/2 TSF TDS, or
 Tab. Flatameal DS
1-2 tab TDS
GERD
 Non drug Rx of GERD
 Wt reduction, stop smoking, avoid fatty food
 Drug Rx
1+1+1 (1/2 hour a/c)
1+0+1 (1/2 hour a/c)
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


45
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 sprue
 Cap. Atetra 250mg-28 days
1+1+1+1
 Tab. Folison 5mg- 1 yrs
0+0+1
 Correction of dehydration/electrolytesimbalance
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

46
Liver Abscess
 Diet. Normal
1+0+1
 Tab. Metronidazole 400mg
2+2+2
1+0+1 (1/2 hour a/c)
 Tab. Anadol 50mg (If pain)
1+1+1
If pt toxic
 -Inj. Ciprofloxacin 100ml
1 bag IV BD
 -Inj. Metronidazole
11/2 bag IV TDS
Acute Viral hepatitis
 Diet. normal
 Syp. D-luc
2 TSF TDS
1+0+1 (1/2 hour a/c)
 Tab. Omidon
1+1+1 (1/2 hour a/c)
 Inj. Konakion 10mg
1 amp IV stat & daily for 5 days
 Other are symptomatic

47
CLD (Without encephalopathy)
 Diet. Salt restricted
1+0+1
1+0+1 (1/2 hour a/c)
 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
vial IV stat & daily
 syp. Metronidazole
4 tsf tds
 Inj. Ranitid
amp IV stat & 8 hrly
 Syp. Lactulose (Avolac)
3 tsf tds
 Inj. konakion 10mg
vial IV daily for 3-5 days
 If pt restless consult with senior & give
 -Inj. Dormicum 7.5mg
1/2 amp IM/IV stat

48
Acute Pancreatitis
 Diet. NPO TFO
 Inf. NS 1000cc + Inf. 5% DNS 200cc
IV @ 20 d/m stat
 Inj. ceftriaxone 1g (BD)/ Inj. Cefuroxime 1.5g (TDS)
 Inj. Omeprazole 40mb
1 vial IV stst & bd
1 amp IM stat and BD
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
Fatty change of Liver
 Diet. Low fat diet
1+0+1(1/2 hour a/c)
 Tab. Algin/viseralgin
1+1+1
 Tab. Todol
1+1+1
 Tab. Alben DS
0+0+1
 If increase TIG level- Tab. Lipirel 200mg

49
CRF/CKD
 Diet. fruit, protein, dub water restricted
1+0+1(1/2 hour a/c)
 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
 Loratidin 10mg-If pruritus
AGN
 Diet. Protein, fruits restriction (to avoid hyperkalemia)
 Fluid. 500ml + previous day out
 Tab. (Phenoxy methyl penicillin)/ Pen-V/Oracin 250mg
1+1+1+1
1+0+1 (1/2 hour a/c)
 Tab. fusid 40mg (don't use fusid plus toavoid hyperkalamia)
1+1+0 - 5 days
1+0+0 - 5 days
 Tab. Omidon 10mg - 7 days 1+1+1
 Tab. deslor 10mg ( If itching) 0+0+1
 Tab. Amlodipin 5mg (If HTN) 1+0+0
 Other Symptomatic
 Maintain BP chart
 Maintain Heat coagulation test

50
NS
 Diet. Normal(salt & fluid restriction)
 Fluid. 500ml + previous day out
 Antibiotc-Amoxycillin/Cefixim/Ceftriaxone
1+0+1
 Tab. Atova
0+0+1
 Tab. Cortan 5mg
4+4+0
 Tab. Calbo 500mg
0+1+0
 Tab. Fusid plus- If massive Oedema
 Other Symptomatic
 Maintain BP chart
 Maintain Heat coagulation test
Electrolytes imbalance
Hypernatraemia
 It occur due to decrease body water, If we correct body fluid Hypernatremia 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 = 2 L
 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

51
Hyponatraemia
 Mild (125-135)
Orally take table salt +ORS
 Moderate (110-125)
Inf. 0.9% NaCl by calculating Na+requirement (Max 2L/day)
 Added salt
 Severe (<110)
Inf. 3% NaCl by calculating Na+requirement (Max 1L/Day)
 Nice To Know
1. 100cc 0.9% NaCl solution = 155 mmol/L Na+
2. 1000cc 3% NaCl solution = 512 mmol/L Na+
3. 500cc 3% NaCl solution = 256 mmol/L Na+
Hyperkalemia (K > 5.5 mmol/L)
 Diet fruit restriction
 Inf. 25% Nutridex 100ml/Libot-25 + 5unit 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 complete 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
@ 15 d/m
 Advice- repeat S.Electrolytes

52
Hypoglycemia
 Loading Dose
 Inj. 25% glucose/libot-25/nutridex
running stat
 Maintenance Dose
 Inf. 10% DA 1000cc
10 d/m up to 24 hrs
 Inj. Decason
 Repeat Blood glucose
Fever
Enteric Fever/ Typhoid
 Diet. normal
 Inj. Ceftriaxone 2gm- 7 days
vial IV stat & BD
OR,
 Tab. Azithronycin 500mg-7 days
1+0+1
1+0+1 (1/2 hour a/c)
 Tab. Omidon
1+0+1
1+1+1
 Tepid sponging
 Napa suppository
1 stick P/R when temp >101o F
Rickettsial fever
 Cap. A-tetra/Tetra A/Tetrax 500mg
1+1+1+1........ -7days +
 Tab. Azithromycin 500mg
1+0+0
1+1+1
 Napa suppository
1 stick P/R when temp >101o F

53
Dengue fever
 Tab. Azithromycin 500mg- 3 days
1+0+0
1+1+1
 Volume replacement if dehydrate/Shock
 Platelet/blood transfusion if platelet count < 30,00
Malaria
On 1st day
 Tab. Jasoquin 300mg (Quinine sulphat)- 7 days
2+2+2 (A/M)
On 3rd
 -Tab. Malaride ( salfadoxime +pyrol)
1 tab stat
On 4th day
 Tab. Jesoprim (Primaquine)
1 tab stat
1+0+1
 Inf. 5% DNS 1000cc- (To prevent hypoglycemia, because anti-malarial drug
causes hypoglycema)
IV 20 d/m
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

54
Kala-Azar
 Inj. Na-Stibogluconate/Stibatin (100mg/ml)
20mg/kg/day for 28 days
PKDL
 Inj. Na-Antimony gluconate (SAG)
20mg/kg/day for 20 days per cycle
Duration- 6 cycle with 10 days interval between cycles
Fever Under Evaluation/UTI/RTI
 Bet rest
 Diet. Normal
1+0+1 (1/2 hour a/c)
1+1+1
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

55
Meningitis
 Inj. Ceftriaxone 2gm- 14 days
 1 vial IV stat & BD
 Inj. Dexamet
1+0+1 (1/2 hour a/c)
1+1+1
 Napa suppo (15mg/kg/dose)
1 stick P/R if temp > 101o F
 If convulsion- Inj. Sedil 5mg
1 amp IM stat & SOS
OR,
 Tab. Berbit 30mg
0+0+1
 Syp. Diphedan 100mg
1 TSF TDS
Epilepsy
 Tab. Tegretol 200mg (carbamazepine)
1+1+1
OR
 Tab. valex/Epilim/Encorate (Na-Valporate)
1+0+1
 Tab. Neuro-B
1+0+1
1+0+1 (1/2 hour a/c)
 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

56
Acute Migraine attack
 Tab. Rizat 5mg (Rizatriptan)
 1 tab stat orally, if not reduce, after 10 min again 1 tab, If still not reduce,
 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 (Avoid 2 days per week)
 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 (1/2 hour a/c)
1+1+1 (1/2 hour a/c)
 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. Paracetamol 500 mg.....(ACE/Napa)
(1+1+1)- 2 days
 Tab. Omidon 10mg- 2 days
1+1+1
 Cap. Omeprazole 20mg- 2 days
1+0+1 (1/2 hour a/c)
 Tab. Sedil 5mg/Tab. Dormitol 7.5mg
1 tab stat
 Prophylaxis
(0+0+1)
 Tab. frenxit
(1+1+0)

57
Vertigo with Headache
 Tab. Cinaron
1+1+1
 Tab. Stemetil/Vergon
1+1+1
1+1+1
Vertigo/BPPV
 Tab. Stemetil/Vergon- 15 days
1+1+1
 Tab. Perkinil- 15 days
1/2 + 1/2 + 1/2
Raised ICP
 Inj. Mannitol/manisol 500ml
1/2 bag running & 1/2 bag 8 hrly for 48 hrs
TIA
1+0+1 (1/2 hour a/c)
 Tab. Anclog plus/Ecospirin plus
0+1+0
 Tab. Atova/Tiginor 10 mg
0+0+1
 Tab. Ramoril- if HTN

58
CVD/Stroke
 Diet. NG feeding
200ml 2 hrly
 Inf. NS 1000cc
 IV 20 d/m stat
 Inj. Dexamet
 Inj. Omeprazole- 1 vial IV stat & BD
Antibiotc- if needed
1 vial IV stat & BD
OR,
 Inj. Amoxicillin 500mg
1 vial IV TDS
 Change posture 2 hrly
If Pt with HTN, BP > 180/120 mm of hg
 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
 Steroid omit
If Haemorrhagic stroke,
 Steroid given for 5 days then omit
If venticular extention
 Tab. Nimocal 30mg- for 21 days
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

59
Bell's Palsy
1+0+1 (1/2 hour a/c)
 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
Mumps & Orchitis
 Tab. deltason 20mg
2+0+0 (A/M)
 Tab. Paracetamol 500 mg (ACE/Napa)
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

60
Steven Jonson Syndrome
 Diet. NPO TFO
 Inf. 5% DA 1000cc + Inf. 5% DNS 2000cc
IV 30 d/m
 If secondery infection- Inj. Ceftriaxone -1vial IV daily
 Inj. Dexamet
 Inj. Omeprazole 40mg Micoral oral gel
Apply locally 3 times
 Sonexa E/D
drop 4 hrly
 Sonexa E/O
At bed time (both eye)
 Haematropin E/D
drop 8 hrly
 Tab. Vasco 250mg
1+1+1
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 months)
 Rx of primary cause
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

61
Iron 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
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 must be well hydrated
 Check for Liver & Renal function
 Duration
 After 21 days 1 cycle, 4-6 wks
Rx
 Inf. 5% DA 500cc IV stat 60 d/m
 Inj. Onaseron
amp IV stat
 Inj. Neotack
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) 11/2vial + 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

62
Hodgkin Lymphoma
 Bag-1
+
 Inj.Onaseron 4 amp
 Inj. Dexamethasone (Oradexon) 2amp
 Inj. Ranitid 2 amp
@ 60 d/m
 Inj. Vincristin 1ml
2 vial IV stat slowly
 Bag-2
+
 Inj. Doxorubicin 70mg (50mg & 10mg available) IV
@ 60 d/m
 Bag-3
+
 Inj. Endoxan 1gm
@ 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
vial IV stat & BD
 Inj. Metronidazole 100ml
1 bag IV stat & TDS
 Immediate Blood Transfusion
 Tab. F/S
0+1+0
1+0+1
 Povisep mouth wash- Gurgle 2 times daily

63
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
Treatment of chronic phase:
 Imatinib—400 mg daily.
 If no response to imatinib,
 ▪ —desatinib or nilotinib or
▪ allogenic bone marrow transplantation should be considered.
 Hydroxyurea or alpha interferon are still useful.
 Bone marrow transplantation from HLA matched sibling donor (usually below
40 years and in early chronic phase).
Treatment of accelerated phase and blastic crisis:
 Treatment is difficult, imatinib is indicated if the patient has not received it.
 Hydroxyurea can be effective.
 Low dose cytarabine can be given.
Musculoskeletal Pain
1+0+1 (1/2 hour a/c)
 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

64
Lumbo Sciatica
 Tab. Myolax 50mg- 7 days
1+1+1
1+0+1 (1/2 hour a/c)
 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
Low Back Pain
 Tab. beclo 10mg(1+1+1)- 7days
Then,
 Tab. Myolex 50mg (1+1+1)- 7 days
 Cap. Omeprazole 20mg- 15 days
1+0+1 (1/2 hour a/c)
 Tab. tenorex- 7days
1+0+1 (A/M)
Advices:
 Full rest for 7 days
 Don’t work by bending forward
 Don’t lift heavy weight
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

65
RA
1+0+1 (1/2 hour a/c)
 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)
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
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

66
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 liter 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
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

67
Fracture
 Diet: Normal
 Inf. Hartsol or 5% DNS (1000cc)
IV @ 10 d/min
 Tab. Cefixime 200mg
1 + 0 + 1
 Tab. Diclofenac 50mg
1+ 1 + 1
1 + 0 + 1 ( ½ hr a/c)
 Tab. Calcium 500mg
0 + 0 + 1
 Complete bed rest with immobilization affected limb.
If open fracture present –
 Inj. TT
1 amp IM stat at one arm
 Inj. TIG
1 amp IM stat at another arm
If displaced fracture –
Usually open reduction & internal fixation (ORIF) done.
If non-displaced fracture –
Usually close reduction by traction & counter traction.
Joint Sprain
 Diet: Normal
 Bed rest
1 + 1 +1
1 + 0 +1 ( ½ hr a/c)
 Tab. Calcium 500mg
0 + 0 +1
 Immobilize the limb by elastic compression stocking with crepe bandage.

68
GAD (Generalized Anxiety Disorder)
 Tab. Telazine
1+1+1
0+0+2
 Tab. Indever
1+1+1
 Tab. Pase 0.5
0+0+1
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
 2. 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
 2. F/U- 1 month later

69
Depressive illness
 Adnor 75mg
0+0+1
 2. Tab. Amit/tryptin 25mg
1+0+2
 Tab. Deprex
0+0+1
 F/U- after 21 days
Somatoform disorder/HCR/FD
 Diet . NG feeding
 2. 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)

70
Drugs used in Skin and VD
Anti-histamine and Anti-pruritic:
 Diphenhydramine HCl & Zinc Acetate
Topical corticosteroid:
 Clobetasol Propionate
 Clobetasone Butyrate
 Betamethasone Dipropionate
 Fluticasone Propionate
 Hydrocortisone Acetate
 Halobetasol Propionate
Topical antifungal preparation:
 Miconazole Nitrate
 Oxiconazole
 Terbinafine Hydrochloride
 Clotrimazole
 Ciclopirox Olamine
Systemic antifungal:
 Fluconazole
 Itraconazole
 Terbinafine
Topical anti-bacterial:
 Mupirocin
 Neomycin Sulphate
 Bacitracin Zinc
 Polymyxin B Sulphate
 Silver Sulfadiazine
 Gentamycin
 Retapamulin
Topical Anti-viral:
 Aciclovir

71
Drug list by Indication:
For the treatment of Eczema and Psoriasis:
 Clobetasol Propionate (Cream & Ointment) [Dermasol]
 Clobetasol Propionate (Scalp Solution) [Dermasol-S]
 Betamethasone Dipropionate (Cream & Ointment) [Diprobet]
 Fluticasone Propionate (Cream) [Ticas]
 Clobetasone Butyrate (Cream & Ointment) [Ezex]
 Hydrocortisone Acetate (Cream) [Topicort]
 Tacrolimus 0.03% & 0.1% (Ointment) [Remus]
 Halobetasol Propionate (Cream &Ointment) [Helobet]
 Calcipotriol (Ointment) [Dyvon]
 Betamethasone Dipropionate +Calcipotriol (Ointment & Topical Suspension)
[Dyvon Plus]
 Betamethasone + Salicylic Acid (Lotion) [Prosalic]
For the treatment of Fungal Infection:
 Ciclopirox Olamine (Cream)[Clopirox]
 Clotrimazole (Ointment) [Afun]
 Miconazole Nitrate (Cream) [Fungidal]
 Terbinafine Hydrochloride (Cream) [Xfin]
 Oxiconazole (Cream) [Oxifun]
For the treatment of Inflammatory fungal infection:
 Miconazole Nitrate +Hydrocortisone Acetate (Cream) [Fungidal-HC]
 Clotrimazole + Betamethasone Dipropionate (Cream) [Oni]
 Econazole Nitrate + Triamcinolone Acetonide (Cream) [Pevitin]
For the treatment of Acne:
 Adapalene (Cream & Gel) [Fona]
 Adapalene + Benzoyl(Gel) [Peroxide Fona Plus]
 Clindamycin Phosphate & Tretinoin (Gel) [Clinface]
 Erythromycin (lotion) [Eromycin]
For the treatment of scabies:
 Permethrin (Cream) [Scabex]

72
For the treatment of Bacterial infection:
 Retapamulin (Ointment) [Retabac]
 Mupirocin (Ointment) [Bactrocin]
 Neomycin Sulphate & Bacitracin
Zinc (Ointment & Powder) [Nebanol]
 Neomycin Sulphate, Bacitracin
Zinc & Polymyxin B Sulphate (Ointment) [Nebanol Plus]
 Silver Sulfadiazine (Cream) [Burna]
 Gentamycin (Ointment) [Genacyn]
For the treatment of Inflammatory bacterial infection:
 Fusidic Acid & Hydrocortisone Acetate (Cream) [Fusitop-HC]
 Betamethasone Dipropionate & Neomycin Sulphate (Cream)
[Betameson-N]
For the treatment of mixed inflammatory infection:
 Clobetasol Propionate, Neomycin Sulphate & Nystatin (Cream & Ointment)
[Dermasol-N]
For the treatment of viral infection:
 Aciclovir (Cream) [Virux]
 Aciclovir & Hydrocortisone (Cream) [Virux HC]
For the prevention of itching & dry skin condition:
 Light liquid paraffin & White soft paraffin (Cream) [Emolent]
 Urea (Cream) [Equra]
For protecting skin & to prevent diaper rash:
 Zinc Oxide (Ointment) [De-rash]
For use as topical anti-histamine and skin protectant:
 Diphenhydramine HCl & Zinc Acetate (Cream) [Togent]
For preventing hairfall and regrowing hair:
 Minoxidil 5% (Topical Solution) [Splendora]
For treating hyperkeratotic condition:
 Salicylic Acid (Cream) [Salicid]
Scabies
1. Scaper/Scabex/scabicid Cream or Elimate Plus Lotion

73
Apply to whole body from neck to sole avoiding the head. For single time, can be apply
after 7 days if needed. (Should be treated all family member simultaneously.)
2. Cap. Fluclox (250mg/500mg)
1+1+1+1 For 7 days
3. Tab. Rupin (10mg)
1+0+1 for 5 days
4. Bactrocin ointment
Apply Locally over the affected site 2 times daily
Acne
1. Tab. Azithromycin 500 mg
0+0+1 for 3 days, then gap for 4 days
Continue up to 4-6 weeks in this way.
2. Adapalene (0.3%) [Fona Gel]
Apply once daily at night.
3. Cap. E-cap (200mg)
0+0+1 for 20 days.
4. Albendazole (400mg)
1 tab tonight then 1 tab after 1 week.
5. Acne bar soap
- Clean face and affected side 2 times daily.
Tinea Corporis
1. Tab. Terbinafine (250 mg) [Mycofree]
0+0+1 for 14 days
2. Tab. Rupatadine (10mg) [Rupin]
0+0+1 for 14 days
3. Terbinafine cream [Mycofree cream]
2 times daily for 14 days
4. Tab. Albendazole (400mg) [Alben-DS]
Stat & after 7 days @night (2)
Investigation:
1. FBS
2. 2HPBS
Advice:
1. Avoid hot environment
2. Sweating to be controlled
Eczema
• Tab. Terbucef 250mg
1+0+1 - 10 days

74
• Tab. Fexofenadine 120mg
0+0+1 - 7 days
• Xenovet ointment + Eucera cream
(Mixed, then apply locally 2 times daily.)
Impetig Eczema
 Tab. Terbucef 250mg-10 days
1+0+1
 Tab. Fexo
0+0+1
 Bactrocin ointment
Apply locally 2 times daily.
Seborrhoic Dermatitis
1. Dan-K shampoo [Ketoconazole]
3 times per week. Every alternate day
2. Prosalic lotion [Betamethasone + Salicylic Acid]
2 times daily in the scalp
3. Cap. Itra (100mg) [Itraconazole]
0+0+1 (15 days)
4. Tab. Zimax(500mg) [Azithromycin]
0+0+1 (7 days)
5. Tab. Rupin (4mg) [Rupatadine]
1+1+1 for 7 days
6. Tab. Alben DS(400mg) [Albendazole]
▪ 1 tab tonight then
▪ 1 tab after 7 days.
Alopecia
 Dermas cream 1%Apply locally once daily
 Xenovet cream Apply locally once daily
 Tab. Multivit
1+0+1

75
Measles
 Tab. Azith 500mg- 5days
1+0+1
1+0+1
 Tab. Deslor
 Tab. P/C
 Tab. Emistat/Domin (If complain vomiting)
Gonococcal Urethritis
 Inj. Ceftriaxone 1gm- For 3 days
1 vial IV stat & daily
1+0+1 (b/m)
 Cap. Doxicap- 7 days
1+0+1
 Tab. Loratin
0+0+1
Erectile dysfunction
 Tab. Silagra/Vegorex 25mg/50mg/100mg (sildenafil citrate)-short acting
OR
 Tadalis/Intimate 5mg/10mg/ 20mg (Tadalafil) - Long acting
Once daily (Contraindicated in IHD)
 Cap. Pirulin ( spirolina)- 2 month
1+0+1
 Tab. Frenxit
↓ Libido/
↓ sexual desire in women
Reproductive age:
 Tab. Femastin 1mg:
Once daily
Post-menopausal:
 Tab. Renorma 2.5mg:
Once daily
(It also prevent Post-menopausal Osteoporosis)
0+0+1

76
Surgery
A.Follow up of a patient
Date..........................
MFU:
Time.................AM/PM
o Anemia:
o Pulse:
o BP:
o Temp:
o Heart/Lungs:
o Bowel/Bladder:
o P/A:

77
B.Post-Operative Order of Circumcision
.................................................... Hospital Limited
(This is just an example of a hospital)
DOCTOR’S RECORD SHEET Sl. No.
Name of the Patient......................... Bed No............ Under Dr........................
Date & Time Post-operative order on 18-07-2017 @ 10.00 AM
1. Diet: Normal
2. Syrup Cef-3 (Cefixime)
… tsf x 2 times daily x P/C x 7 days.
3. Syrup Inflam (Ibuprofen)
... Tsf x 3 times daily x p/c x 3- 4 days. (If pain)
4. Diclofenac Suppository 12.5/25/50 mg
1 stick x P/R x 2 times daily x for 3 days.
5. Syrup Alcet (Levocetrizine Dihydrochloride)
…. Tsf x 1 time daily x full stomach (night) x for
10 days.
6. Mupiderm Ointment (Mupirocin)
Apply locally in the area of circumcision x 2
times daily for 10 days.
7. Syrup Pogo (Multivitamin with Cod Liver Oil)
…. tsf x once daily x P/C x for 1 month.
Signature

78
Abdominal Pain: Order on admission
 Diet: NPO TFO
 NG suction 2 hourly
 Inj. Normal saline 1000 ml
+
 Inj. Hartman 1000 ml
IV @ 30 drops / min
Inj. Ciprocin IV 200mg [Ciprofloxacin]
1 bag iv 12 hourly
 Inj. Metronidazole 500mg
1 bag iv 8 hourly
 Inj. Omeprazole 40 mg
1 vial iv stat and 12 hourly
 Inj. Tiemonium Methylsulphate 5 mg [Algin / norvis]
2 amp iv stat and 8 hourly if (cramping pain)
 Diclofenac Sodium Suppository (50 mg) [Voltalin]
1 stick P/R stat & 12 hourly
[If pt. is vomiting stop metronidazole,
if still vomiting add- Inj. Ondansetron 8mg [Emistat]
1 amp iv stat and 8 hourly]

79
Head Injury
 NPO TFO
 Inf. N/S 3000cc
IV stat @ 30 d/m
 Inj. Ceftriaxone 1 gm
1 vial IV stat & daily/BD
1 vial IV stat & BD
 Inj. Ketorolac 30 mg
1 amp IM stat & BD/TDS
 Inj. Oradexon
 Inj. Phenobarbitone
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

80
Physical assault (P/A)
 Cap. Cephradin 500mg/ Flucloxacillin 500 mg
1+1+1+1
1+0+1 (1/2 hour A/C)
 Tab. ketorolac 10mg/Diclofenac 50mg
1+1+1 (p/c)
Massive cut Injury or P/A
 NPO TFO
 Inf. H/S 3000cc -IV stat @ 30 d/min
 Inj. Ceftriaxone 1g
1 vial IV stat & daily/BD
 Inj. Omeprazole 40 mg
1 vial IV stat & BD
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: -proline/Silk (cutting body)- for skin
 -Vicryl (R/B)- for muscle

81
Small cut injury
 Cap. Cephradin 500mg/Flucloxacillin 500mg
1+1+1+1
1+0+1 (1/2 hour a/c)
 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
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

82
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/min
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 5mg
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:
o Plane X ray of abdomen in erect posture including both dome of
diaphragm
o USG of W/A
o Blood for Grouping & cross matching

83
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/min
 Inj. Cefuroxime
1 vial IV stat & BD/TDS
 Inj. Metronidazole
1 Bottle IV stat & TDS
 Inj. Omeprazole
1 vial IV stat & BD
 Inj. Algin 5mg
1 amp IM stat & TDS
OR
 Inj. Butapan
1 amp IM stst & TDS
+
 Inj. Drotaverine
1 amp IM stat & TDS
In case of biliary ascariasis
 Tab. Levamisole 3 tab stat
Investigation:
o USG of HBS
o S. amylase

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