Emergency maxillofacial trauma patient
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Retrobulbar hemorrhage is a rare condition characterized by sudden bleeding behind the eye that can increase pressure in the orbital space and potentially lead to irreversible vision loss if not treated; central retinal artery occlusion lasting over 105 minutes has been shown to cause irreversible optic nerve damage. Basic wound care principles for trauma patients include cleaning and irrigating the wound, using absorbable sutures for deep tissue and non-absorbable sutures for skin closure, and instructing patients to clean the wound daily.
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Tear function tests
The tear film provides several important functions for the eye, including polishing the corneal surface, trapping and flushing out debris, and reducing friction during eye movement. Several tests are used to evaluate the tear film and diagnose dry eye, including the BUT test, NIBUT test, Schirmer's test, fluorophotometry, phenol red thread test, Rose Bengal staining test, and tear osmolality test. Each test measures different aspects of the tear film and has defined normal and dry eye results.
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The document summarizes techniques for evaluating the tear film, which has three layers: an outer lipid layer, intermediate aqueous layer, and inner mucous layer. Non-invasive techniques discussed include tear break-up time tests, lipid layer evaluation using interferometry, and inferior tear meniscus height measurements. Invasive techniques involve Schirmer's tests to evaluate tear secretion, fluorescein and rose bengal staining of the ocular surface, and conjunctival impression cytology to examine goblet cell density. The document provides details on procedures and normal results for each evaluation method.
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This document describes techniques for evaluating the tear film, including vital staining, tear break-up time testing, and the Schirmer test. Vital staining with fluorescein or rose bengal/lissamine green identifies disruptions or deficiencies in the tear film and ocular surface epithelium. Tear break-up time evaluates the stability of the tear film and should be over 10 seconds for a normal result. The Schirmer test measures tear production, with values over 10mm with anesthesia and over 15mm without anesthesia considered normal. Interpretation of results from these tests can provide information about conditions like dry eye syndrome or keratoconjunctivitis sicca.
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This document discusses the diagnosis and management of dry eye disease. It outlines tests to evaluate tear secretion, volume, clearance, and ocular surface damage. Diagnostic tests include Schirmer's test, phenol red thread test, tear meniscus height, fluorescein clearance, and impression cytology. Management involves identifying and eliminating exacerbating factors, supplementing tears, retaining tears, anti-inflammatory therapies like cyclosporine, and new drugs that stimulate tear secretion or have mucolytic properties. The goals are to eliminate causes, replace tears, maintain moisture, increase tear secretion, inhibit inflammation, and reestablish the tear film.
Diagnosis & management of dry eye
The document discusses various diagnostic tests for dry eye disease, including:
1. Tear film break-up time (TBUT) and non-invasive TBUT to measure tear film stability.
2. Schirmer test to measure tear production.
3. Rose Bengal and lissamine green staining to examine the ocular surface.
4. Tear meniscus height, phenol red thread test, and interferometry to analyze the tear film and lipid layer.
Devices like the Keratograph 5M, TearScope, and Lipiview ocular surface interferometer can help evaluate meibomian glands, non-invasive TBUT, and lipid layer thickness.
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etiology:-Chemical injuries occur as a result of acid, alkali, or neutral agents.Alkalis being responsible for 60%.
pathophysiology:-Alkali agents are lipophilic and therefore penetrate tissues more rapidly than acids.the damaged tissues then secrete proteolytic enzymes, which lead to further damage.Acids are generally less harmful than alkali .
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Dry eye disease is a multifactorial disease that results in discomfort and visual disturbance from tear film instability and damage to the ocular surface. It is characterized by increased tear film osmolarity and ocular surface inflammation. Diagnostic tests evaluate symptoms, signs of ocular surface damage, tear film breakup time, and tear osmolarity. Treatments include artificial tears, anti-inflammatory drugs like cyclosporine A and corticosteroids, essential fatty acids, and autologous serum for severe cases.
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Dry eye diagnosis and management
For interesting videos on Ophthalmology please checkout my YouTube channel
https://youtu.be/OY2kEYW0c7k
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Dry eye occurs when there is inadequate tear production or function, resulting in an unstable tear film and ocular surface disorder. It can be caused by conditions that reduce tear production such as Sjogren's syndrome, vitamin A deficiency, Stevens-Johnson syndrome, or medications. Other causes affect the tear film layers, like meibomian gland dysfunction reducing the outer lipid layer. Symptoms include dryness, burning, and blurred vision. Treatment focuses on replacing tears, improving ocular surface health, addressing underlying causes, and escalating care based on severity through the DEWS treatment guidelines.
Dry eye
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Dry eye
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3. LAYERS OF TEAR FILM It consist of three layers: 1.Lipid layer 2.Aqueous layer 3.Mucoid layer 1.LIPID LAYER
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Management of retinal detachment....
This document provides information on the management of retinal detachment. It begins with definitions of key terms like scleral buckling and the various surgical procedures used to reattach the retina like scleral buckling, vitrectomy, and pneumatic retinopexy. It then describes the surgical steps for procedures like scleral buckling in 3 sentences or less, including conjunctival peritomy, slinging the rectus muscles, cryotherapy or retinopexy, placement of explants and sutures, and drainage of subretinal fluid. The document also summarizes techniques for pneumatic retinopexy including use of gases like sulfur hexafluoride and properties of silicone oil used as an
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Dry eye
This document provides an overview of dry eye disease. It defines dry eye as a multifactorial disease resulting from tear deficiency or excess evaporation, causing symptoms like eye discomfort. Diagnostic tests evaluate tear secretion, stability, and damage to the ocular surface. Clinical features include irritation, redness, blurred vision, and staining of the cornea or conjunctiva. Dry eye exists on a spectrum of severity and has many predisposing factors like age, gender, medication use, contact lens wear, surgery, and autoimmune diseases.
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This document discusses the diagnosis and management of dry eye disease. It outlines tests to evaluate tear secretion, volume, clearance, and ocular surface damage. Diagnostic tests include Schirmer's test, phenol red thread test, tear meniscus height, fluorescein clearance, and impression cytology. Management involves identifying and eliminating exacerbating factors, supplementing tears, retaining tears, anti-inflammatory therapies like cyclosporine, and new drugs that stimulate tear secretion or have mucolytic properties. The goals are to eliminate causes, replace tears, maintain moisture, increase tear secretion, inhibit inflammation, and reestablish the tear film.
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The document discusses various diagnostic tests for dry eye disease, including:
1. Tear film break-up time (TBUT) and non-invasive TBUT to measure tear film stability.
2. Schirmer test to measure tear production.
3. Rose Bengal and lissamine green staining to examine the ocular surface.
4. Tear meniscus height, phenol red thread test, and interferometry to analyze the tear film and lipid layer.
Devices like the Keratograph 5M, TearScope, and Lipiview ocular surface interferometer can help evaluate meibomian glands, non-invasive TBUT, and lipid layer thickness.
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Chemical (alkali and acid) injury of the conjunctiva and cornea is a true ocular emergency and requires immediate intervention.
Epidemiology:>-Chemical injuries to the eye represent between 11.5%-22.1% of ocular traumas.
etiology:-Chemical injuries occur as a result of acid, alkali, or neutral agents.Alkalis being responsible for 60%.
pathophysiology:-Alkali agents are lipophilic and therefore penetrate tissues more rapidly than acids.the damaged tissues then secrete proteolytic enzymes, which lead to further damage.Acids are generally less harmful than alkali .
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Medical treatment
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Review-making dry eyes wet
Title: Making dry eyes wet
Author: Dr. Zia ul Mazhry
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PURPOSE: to review current management options to treat dry eyes especially evaluation of Genteal gel and Systane eye drops as novel new combinations.
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Consultant Eye Surgeon and Head of Eye Department
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210 Feroz Pur Road Lahore
0300 440 1151
Dry eye final
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Dr. Monika Soni presented on the topic of tear film at the upgraded department of ophthalmology at MGMMC & MYH Indore. The presentation discussed the anatomy and physiology of tear film, including the three layers of the tear film, mechanisms of tear secretion and distribution, functions of the tear film, tests to evaluate tear film such as tear breakup time, Schirmer's test, and osmolarity. A variety of glands contribute secretions to form and maintain the tear film, which is essential for maintaining a clear cornea and proper vision.
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Silicone oil has a combination of physical and chemical properties. Physical parameters which affects the function of silicone oil, namely specific gravity, buoyancy, surface tension, and viscosity.
Indications of using silicone oil are retinal detachment with proliferative vitreoretinopathy, giant retinal tears, severe proliferative diabetic retinopathy, macular hole, retinal detachment due to viral retinitis, complicated pediatric retinal detachment, retinal detachment associated with choroidal coloboma, retinal detachment due to trauma, and endophthalmitis.
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Management of complications using silicone oil depends on the types of complications that occur.
Dry eye ppt by dr dildar
Dry eye disease is a multifactorial disease that results in discomfort and visual disturbance from tear film instability and damage to the ocular surface. It is characterized by increased tear film osmolarity and ocular surface inflammation. Diagnostic tests evaluate symptoms, signs of ocular surface damage, tear film breakup time, and tear osmolarity. Treatments include artificial tears, anti-inflammatory drugs like cyclosporine A and corticosteroids, essential fatty acids, and autologous serum for severe cases.
Dry Eye Treatment - Artificial Tears and Punctal Plugs
Dr. Emil Chynn was the 1st eye surgeon in NYC to have LASIK himself (in 1999) but switched to the safer, noncutting SafeSight procedure in 2005 to avoid the night glare and dry eyes he and his patients had after LASIK. By avoiding cutting a flap, Dr. Chynn avoids cutting the corneal nerves, which causes dry eyes--so no dry eyes after LASEK!
Dry eye diagnosis and management
For interesting videos on Ophthalmology please checkout my YouTube channel
https://youtu.be/OY2kEYW0c7k
Dry eye
Dry eye is a condition where a person lacks sufficient tears to lubricate and nourish the eye. It can be caused by decreased tear production due to aging, medications, surgery, or medical conditions. Increased tear evaporation may also cause dry eye due to factors like wind, smoke, less blinking, or eyelid problems. Risk factors include being over 50, female, having a diet low in vitamin A, wearing contact lenses, or long-term computer use. Symptoms include eye dryness, irritation, pain, blurred vision, and fatigue. Treatment focuses on replacing tears through eye drops, plugging tear ducts, or using tear-stimulating medications. Lifestyle changes like blinking more, using humidifiers, and omega
dry eye
Dry eye is a common condition that affects millions worldwide and is a leading cause of visits to eye care practitioners. It has no cure. Dry eye occurs through a vicious cycle where tear film instability and hyperosmolarity cause inflammation of the ocular surface. The definition of dry eye involves tear film instability, hyperosmolarity of tears, and inflammation and damage of the ocular surface. Exposure of epithelial cells to hyperosmolar tears can cause cell damage, death, and further inflammation through various pathways. Diagnosis involves measuring tear osmolarity, which is typically higher in dry eye patients than normal individuals.
Dry eyes
The document discusses dry eye, defining it as a disorder of the tear film due to reduced tear production or excessive evaporation, causing damage to the ocular surface. It describes the layers of the tear film and their functions in lubricating the eye and protecting it. Symptoms of dry eye are discussed. Diagnostic tests for dry eye including tear break-up time, ocular surface staining, and Schirmer test are summarized. Management strategies are outlined for mild, moderate, and severe dry eye, including artificial tears, anti-inflammatory therapies, punctal plugs, and systemic treatments.
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Blepharitis is a common ocular disease seen and managed in the OPD. This presentation tries to cover the overview of the disease and its management.
Dry eye: An Overview
Dry eye occurs when there is inadequate tear production or function, resulting in an unstable tear film and ocular surface disorder. It can be caused by conditions that reduce tear production such as Sjogren's syndrome, vitamin A deficiency, Stevens-Johnson syndrome, or medications. Other causes affect the tear film layers, like meibomian gland dysfunction reducing the outer lipid layer. Symptoms include dryness, burning, and blurred vision. Treatment focuses on replacing tears, improving ocular surface health, addressing underlying causes, and escalating care based on severity through the DEWS treatment guidelines.
Dry eye
This document discusses the management of dry eye. It begins by defining dry eye as a multifactorial disease resulting in ocular discomfort and potential damage due to increased tear film osmolarity and ocular surface inflammation. Dry eye is commonly seen in clinical practice and can range from mild to severe. The document then discusses the anatomy and physiology of tear production, the tear film layers, contributing factors, classifications, signs and symptoms, diagnostic tests, and treatment strategies including artificial tears and anti-inflammatory therapies. Treatment is tailored based on dry eye severity levels with the goal of alleviating symptoms and preventing complications.
Dry eye
Dry eye, also known as keratoconjunctivitis sicca, is a condition caused by inadequate tear production or unstable tear film. It results in ocular irritation, redness, and visual disturbance. The tear film consists of an outer lipid layer, middle aqueous layer, and inner mucin layer. In chronic dry eye, tears have increased salts and decreased proteins and lipocalins. Treatment focuses on lubricating the eyes, managing underlying conditions like blepharitis, and occasionally punctal plugs or anti-inflammatory drugs. Diagnosis involves tests of tear production, stability, and ocular surface staining to determine the best lubricating and anti-inflammatory treatments.
Tear film
Tear film
1. TEAR FILM
2. The outer most layer of the cornea. It is the exposed part of the eyeball. FUNCTION It provide smooth optical surface It serves to keep the surface of cornea and conjunctiva moist. It serves as a lubricant for the preocular surface and lids It transfer oxygen from the air to the cornea Prevent infection due to the presence of antibacterial substance like lysozymes,and other protein. It wash away debris and irritants Provides pathway to WBC in case of injury.
3. LAYERS OF TEAR FILM It consist of three layers: 1.Lipid layer 2.Aqueous layer 3.Mucoid layer 1.LIPID LAYER
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Dry Eye Treatment - Artificial Tears and Punctal Plugs
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Similar to Emergency maxillofacial trauma patient
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This document describes the intracapsular cataract extraction (ICCE) technique. It was widely used for about 100 years before modern extracapsular techniques. ICCE involves rupturing the zonules to remove the entire lens and capsule through the corneal incision. It is now rarely used as it has been replaced by extracapsular techniques. The document outlines the steps of ICCE including conjunctival flap preparation, corneoscleral incision, lens delivery methods like cryoextraction, and closure. Postoperative care and potential complications are also discussed.
OCULAR INJURIES
This document discusses ocular injuries from external trauma. It describes both open globe injuries, which involve a full thickness wound to the eye wall, and closed globe injuries, where the eye wall is not fully penetrated but internal damage still occurs. Specific types of open injuries include penetrating injuries from a sharp object passing through once, and perforating injuries where the object passes through twice. Closed globe injuries can lead to conditions like hyphaema (blood in the anterior chamber) and various lens, vitreous, and retinal injuries. Treatment depends on the type and severity of injury but may include antibiotics, patching, and surgery in more severe cases.
Corneal injury
The cornea is the clear outer layer of the eye that focuses light. Corneal injury or abrasion occurs when the cornea's surface is damaged. Common causes include chemical burns, contact lens overuse, dust, and scratches. Symptoms include eye pain and sensitivity to light. Treatment involves antibiotic eye drops to prevent infection along with pain medication. Patching the eye is not recommended as it does not improve healing and can increase pain. Close follow up is needed to monitor for complications like infection or ulcer.
Management of cataract
The document summarizes techniques for managing cataracts through both extracapsular and intracapsular lens extraction. Phacoemulsification using small incisions and foldable intraocular lenses is now the mainstay technique. Larger incision techniques are used for dense cataracts. Specific techniques are described for iris management, vitreous presentation, and intraocular lens implantation depending on whether the lens capsule is removed. Complicated cases involving zonular dehiscence, uveitis, or compromised epithelium require modified approaches to protect delicate eye tissues and structures.
RETINAL%20DETACHMENT.pptx
Retinal detachment occurs when the neurosensory retina separates from the underlying pigment epithelium, cutting it off from its blood supply and causing vision loss. It is usually caused by tears in the retina from posterior vitreous detachment. Symptoms include floaters, flashes of light, and blurred or lost vision. Diagnosis is made through examination with an ophthalmoscope. Treatment involves sealing retinal tears with laser or cryotherapy and reattaching the retina surgically using scleral buckling or vitrectomy. Patients require positioning and eye drops post-operatively to prevent further detachment.
esthetic facial surgery (Blepharoplasty, Forehead & Brow Procedures
This document summarizes blepharoplasty and forehead/brow lift procedures. It begins with an overview of blepharoplasty, describing the anatomy of the eyelids and changes that occur with aging. Upper and lower blepharoplasty techniques are then explained in detail, including skin excision, fat removal, and closure methods. Risks such as hematoma, asymmetry, and lagophthalmos are reviewed. The document concludes by discussing forehead and brow lift anatomy and techniques like the coronal and anterior hairline approaches, which allow access to muscles like the corrugator for weakening. Surgical planning and exposure are emphasized to achieve natural, youthful results.
keratoprosthesis
Keratoprosthesis is a surgical procedure that replaces a severely damaged or diseased cornea with an artificial cornea to restore vision. The first attempts at keratoprosthesis in humans date back to the mid-19th century, but most implants failed. Modern keratoprosthesis designs like the Boston KPro and AlphaCor KPro sandwich a donor corneal graft between plastic plates. Complications can include melting/extrusion of the implant, infection, glaucoma, retinal detachment, and formation of membranes behind the implant. Close post-operative monitoring is required to manage complications and maintain vision with keratoprosthesis implants.
KERATOPROSTHESIS
Keratoprosthesis is a surgical procedure that replaces a severely damaged or diseased cornea with an artificial cornea to restore vision. The first successful keratoprosthesis implantation in a human was in 1859. Modern devices like the Boston KPro (types 1 and 2), AlphaCor KPro, and osteo-odonto keratoprosthesis are commonly used today. The Boston KPro uses a donor corneal graft sandwiched between a front and back plate made of polymethyl methacrylate. The AlphaCor is made of a biocompatible polymer and integrates with surrounding tissues. Complications include melts and extrusion, infection, glaucoma, retroprosthetic membranes, and retinal
Corneal surgery
This document discusses corneal surgery, including corneal refractive surgery and corneal transplant surgery. It describes the different types of corneal refractive surgery, which include flap surgery techniques like LASIK as well as surface procedures like PRK. Corneal transplant surgery, also called keratoplasty, is described as replacing damaged corneal tissue with donor tissue. The different types of keratoplasty like penetrating keratoplasty and lamellar keratoplasty are mentioned. The document provides details on donor corneal preparation and storage, surgical techniques, potential complications, and post-operative care for corneal transplant surgery.
Corneal surgery
This document discusses corneal surgery, including corneal refractive surgery and corneal transplant surgery. It describes the different types of corneal refractive surgery, which include flap surgery techniques like LASIK and surface procedures like PRK. Corneal transplant surgery, also called keratoplasty, is described as replacing damaged corneal tissue with healthy donor tissue. The common techniques used are penetrating keratoplasty and lamellar keratoplasty. The document outlines the donor corneal preparation and storage methods, as well as the surgical techniques and potential complications of corneal transplant surgery.
viscoelasic
This document discusses viscoelastic substances used in ophthalmic surgery. It begins with an introduction and history of viscoelastic use, noting sodium hyaluronate was the first substance used in 1972. An ideal viscoelastic is described as being easily inserted and removed while protecting delicate tissues. Viscoelastic properties of viscosity, viscoelasticity, pseudoplasticity and surface tension are explained. Common compositions include sodium hyaluronate, chondroitin sulfate and hydroxypropyl methylcellulose. Viscoelastic are classified as high viscosity cohesives, lower viscosity dispersives, or viscoadaptive. Clinical uses include cataract surgery, glaucoma surgery, and keratoplasty. Complications
Keratoplasty
Dr. Karan Bhatia provides an overview of keratoplasty (corneal transplantation). There are different types including penetrating keratoplasty (replacing the full thickness of the diseased cornea), partial thickness lamellar keratoplasty, and rotational keratoplasty. Penetrating keratoplasty has been the standard procedure but carries risks. The history and techniques of penetrating keratoplasty are described in detail including pre-operative evaluation, donor cornea excision, recipient cornea trephination, suturing, and post-operative management. Potential complications are also reviewed. Lamellar keratoplasty is introduced as an alternative to penetrating keratoplasty to reduce risks
Treatment of retinal detachment
This document discusses various techniques for repairing retinal detachments, including cryotherapy, laser photocoagulation, pneumatic retinopexy, scleral buckling, and vitrectomy. Cryotherapy uses temperature to induce inflammation and seal retinal breaks, while laser photocoagulation uses targeted burns. Pneumatic retinopexy employs an intravitreal gas bubble. Scleral buckling places an explant on the sclera to push the retina back into position. Vitrectomy surgically removes the vitreous gel to relieve traction on retinal breaks. Each technique has benefits and risks, and the optimal approach depends on factors like break location and extent of detachment. Advances in small-gauge
corneal-surgery-PRANAV KOHLI.pptx
corneal-surgery
Corneal transplantation, also known as corneal grafting, is a surgical procedure where a damaged or diseased cornea is replaced by donated corneal tissue (the graft). When the entire cornea is replaced it is known as penetrating keratoplasty and when only part of the cornea is replaced
Ectropion
Ectropion
It is an outward turning of the eyelid margin . This more frequently affects the lower eyelid.Upper eyelid ectropion is uncommon.Classified in 5 types
1)Congenital 2) Involutional 3) Paralytic 4) Cicatricial 5) Mechanical
Involutional ectropion is more common.Congenital ectropion is very rare.
Symptoms Epiphora :- excessive tearing.Excessive dryness.
Foreign body sensation Irritation.Burning.Redness.Chronic conjunctivitis KeratinizationCorneal exposure
Grading
Lid margin is out rolled and depending on out rolling ectropion can be classified as under:
Grade I –only punctum is everted
Grade II –lid margin is everted and palpebral conjunctiva is visible
Grade III –fornix is also visible
Etiological factors
Horizontal lid laxity:-can be demonstrated by pulling the central part of the lid 8 mm or more from the globe, with a failure to snap back to its normal position on release without the patient first blinking.
Medial canthal tendon laxity
demonstrated by pulling the lower lid laterally and observing the position of the inferior punctum If the lid is normal the punctum should not be displaced more than 1–2 mm
Lateral canthal tendon laxity
characterized by a rounded appearance of the lateral canthus and the ability to pull the lower lid medially more than 2 mm.
>Normally, the displacement should only be 0-2 mm.
Treatment
1 medical therapy
2 surgical therapy
Complications of.........
Some potential complications from cataract surgery include: corneal abrasion from Schiotz tonometry; retrobulbar hemorrhage from retrobulbar block requiring pressure bandaging; oculocardiac reflex from retrobulbar block treated with atropine; perforated globe risk minimized with gentle injection; subconjunctival hemorrhage requiring no treatment. Posterior dislocation of the lens during retrobulbar block requires postponing surgery and managing as a posterior dislocation.
Extracapsular cataract extraction
Extracapsular cataract extraction (ECCE) is a type of eye surgery where the lens is removed while leaving the elastic capsule partially intact to allow implantation of an intraocular lens. This contrasts with intracapsular cataract extraction where the whole lens and capsule are removed. ECCE can be performed conventionally through a 10-12mm incision or with smaller incisions using phacoemulsification. Potential complications include posterior capsule tear, dropped nucleus, vitreous loss, raised intraocular pressure, and late complications such as cystoid macular edema and glaucoma. Careful surgical technique and postoperative management can help reduce risks.
Non incisional, non laser refractive surgery
This document discusses various refractive surgical procedures including:
1. Epikeratophakia and intracorneal rings for corneal refractive procedures
2. Clear lens extraction and phakic IOLs for lenticular refractive procedures
It provides details on indications, contraindications, surgical techniques and complications for these procedures.
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Emergency maxillofacial trauma patient
- 2. C EMERGENCY Role of oral & maxillofacial resident TRAUMA PATIENT
- 3. C
- 9. كويس إنت
- 32. Retrobulbar hemorrhage is a rare entity characterized by an acute increase in pressure in the orbital space (for example, orbital compartment syndrome) due to sudden bleeding behind the eye; this can potentially lead to irreversible visual loss from damage to the optic nerve and/or retina. Central retinal artery occlusion of 105 min or longer produced irreversible optic nerve damage, and occlusion greater that 240 min produced near total optic nerve atrophy
- 34. Basics 1. Clean the wound from dust , soil & dead tissue. 2. Irrigate wound with saline. 3. Don’t put betadine inside open wound. 4. Don’t put H2o2 inside open wound. 5. Use absorbable suture material in deep tissue. 6. Use non-absorbable suture monofilament in the skin. 7. Close wound in multi layers. 8. Don’t leave dead space. 9. We use 5/0 or 6/0 prolene suture in skin layer. 10.We use 3/0 vicryl suture in deep layer , subcutaneous layer & oral cavity. 11.Instruct patient to clean the wound day after day.
- 36. According to patient needs and his case. 1. Cefotax 1 g vial / 12hrs for gram negative 2. Unictam 1.5 g vial / 12hrs 3. Flagyl 500 mg drip / 8hrs 4. Ketolak ampule IM / 12hrs 5. Zantac ampule / 12hrs 6. Dexamethasone amp / once daily