Anaphylactic shock
Adrenaline 0.5 ml sc / im
Hydrocortisone 200 mg iv
Diphenhydramine 25-50 iv/im
Hypoglycemia
Oral glucose
Fruit juice
50 ml of 50% iv Glucose
Glucagon
Acute Myocardial infarction
•Attach a Cardiac monitor
•Administer Oxygen if oxygen saturation is <94%
•Establish iv access
•Nitroglycerin 0.5 mg sublingual
•Morphine 5 mg iv with an Antiemetic to relieve chest pain
•Aspirin 150 mg oral to chew
•Clopidogrel 300 mg (unless coronary artery bypass surgery is contemplated)
•Thrombolysis using streptokinase 1.5 million units as an infusion over 1 hour (within 12 hrs of onset of symptoms)
OR
Percutaneous transluminal coronary angioplasty
Febrile convulsions
Diazepam 2.5 ml (5mg) rectally
Tetany
10ml of 10% calcium gluconate slow iv and
Desferrioxamine 10-15 mg/kg/hour iv infusion
Streptococcal pharyngitis
Benzathine penicillin G 1.2 million units im single dose
Acute Rheumatic fever
•Benzathine penicillin G 1.2 million units im single dose
•Tab Aspirin 100 mg/kg/day in four divided doses for 4-6 weeks and taper gradually
•Tab Prednisolone 40-60 mg/day (to be given if there is cardiac involvement, taper the dose gradually)
Scurvy
Tab Ascorbic acid 500 mg BD (twice a day)
Rickets
Capsule Alfacalcidiol 1 microgram daily
Thyroid storm/crisis
- Tablet Propranolol 40-80 mg every 6 hours
- Tablet Propylthiouracil 250 mg every 6 hours
- Sodium ipodate 500 mg oral daily
- Lugol’s iodine 10 drops oral every 8 hours
- Hydrocortisone 100 mg iv every 8 hours
- Supportive measures
Myxoedema coma
Tablet Levothyroxine sodium 50-100 microgram daily on an empty stomach before breakfast.
Treatment is to be taken lifelong.
Hemophilus influenza meningitis and Meningococcal meningitis
Cefotaxime 2 gram iv every 6 hours for 10-14 days
OR
Ceftriaxone 2 gram iv every 12 hours for 10-14 days
Giardiasis
Tablet Metronidazole 400 mg oral thrice a day for 7 days
Acute amoebic dysentery
Tablet Metronidazole 400 mg oral thrice a day for 7 days
And
Tablet Diloxanide furoate 500 mg oral thrice a day for 7 days
Hepatic amoebiaisis
Tablet Metronidazole 800 mg oral thrice a day for 10 days
And
Tablet Diloxanide furoate 500 mg oral thrice a day for 10 days
Diabetic ketoacidosis
•Fluid replacement: 1-2 litres of isotonic saline iv rapidly over 1 hr
•Insulin: Regular insulin iv/im given 1 hour after starting iv fluid replacement. Goal is to maintain blood sugar around 200 mg/dl
•Potassium replacement
•Sodium bicarbonate in patients with pH< 7 (severe acidosis)
10 ml of 7.5 % sodium bicarbonate diluted in 50 ml of normal saline). Stop the infusion when pH reaches 7.2
•Treatment of cerebral edema: Avoid excess hydration, mannitol infusion and mechanical ventilation
•Give regular insulin subcutaneously before stopping iv insulin. Start oral feeds when nausea and abdominal pain subside.
Snake bite
RIGHT approach
Reassure the patient
Immobilise the bitten limb
Get to the nearest Hospital
Tell the doctor about the symptoms
•Clean the site of bite and Elevate the bitten limb
•Maintain ABC (airway, breathing, circulation)
•If signs of envenomation are present, then administer ASV (antisnake venom)
Dose- infusion of 60-100 ml ASV with normal saline at a rate of 1 ml/min
If anaphylactic reaction occurs to the ASV, treat it with adrenaline, hydrocortisone and chloropheniramine maleate
•Additional treatment for neurotoxic snake bites: Neostigmine (0.5 mg iv) with atropine (to reduce the cholinergic effects of neostigmine).
Organophosphorous poisoning
•Wash the site of exposure with soap and water
•Gastric lavage within 1 hour of ingestion
Activated charcoal
•Benzodiazepine for convulsions
•Atropine 1.8-3 mg iv, doubling the dose every 5 mins till signs of atropinisation appear.
After atropinisation, set up an infusion at an hourly dose of 10% of the total loading dose given initially.
•Pralidoxime 30 mg/kg over 24 hours followed by an infusion 9 mg/kg/hour
–Mrunali Gondane
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