Easy GP notes

[Link] IRFAN P
MBBS (61st batch-Govt Medical College Kozhikode)

This notes is not alternative to any text books or attending clinics/[Link] notes will be
helpful for house surgeons mainly & will give you a generalized idea for general practice in
[Link] paediatric dose of common medicines.
Influenza/H1N1

Antipyretic
Analgesic
Cough med if +
Abs in infection (2°)
+
T Tamiflu 75mg BD ×5days
Prophylaxis
T Oseltamivir 75mg OD ×10days

Constipation

T Dulcolax 5mg/10mg/20mg HS
or
Syp Looz(lactulose) 15ml to 30ml HS
Children
Syp Looz : 1-4yr =2.5ml HS
5-10yr=7.5ml HS
>10yr=15ml HS

Abdominal pain

Adult
Inj Cyclopam 1amp IM stat
or 2cc
T Cyclopam TID or T Buscopan 10mg TID
T Pantoprazole 40mg OD
Child
<6yrs - Syp Colicaid age ml BD can be given
>6yrs- syp Cyclopam (10/5) 2-5 ml BD or TID can be given
#Cyclopam generally not used in <6M

Abdominal pain in paediatrics

NPO
IVF DNS/Iso P ______ml over 24hrs
•1st 10kg-1000ml(100ml/kg)
•10-20kg-1000ml+50ml/kg
•>20-1500ml+20ml/kg
AXR erect
↓
Loaded colon -Evac enema stat
>2yr-full dose
1-2yr-half dose
<1yr not give,instead use T Dulcolax P suppository 10mg stat
Inj Rantac wt mg IV stat
Inj Buscopan wt/2 mg IV stat (0.5mg/kg/dose)
Pmol suppository (15mg/kg/dose)stat -80mg,170mg,250mg available usually( generally not
recommended for <5kg)
Jonac suppository wt mg stat-available as 12.5, 25, 50
Keep under observation, do routine investigations
Take USG abd if necessary-if appendicitis or intussusception refer to higher centres for admission
If mesenteric lymphadenitis -T DEC 2mg/kg/dose ×21days (available as 50mg ,100mg tab)
If pain resolved already- [Link] 5ml HS×1week
Fibre rich diet
T Cyclopam 1/2 sos
R/W if pain persist.
UTI

Inj Cyclopam 1amp IM stat

T Cefixime 200mg BD ×3-5 days (can be used in pregnancy)
or
T Norflox 400mg BD ×3-5 days (usually avoided in pregnancy)
or
T Oflox 200mg BD× 3days
T Pantoprazole 40mg OD
Syp Citralka 2tsp in 1 glass water TID
Drink plenty of water
(Usually given if PC>5 , Bacteruria + )
(Urine C&S can be advised before taking Abs& change Abs according to report)

Gastritis

Inj Emeset 1amp IV stat

Inj Pantoprazole 1amp IV stat
T Pantoprazole 40mg OD ×3-5 days
Mucaine gel (antacid+anaesthetic)

Chest pain

History is important and check vitals

Loding dose
Inj Pantoprazole 40mg IV stat
T Isordil 5mg S/L stat
T Clopidogrel 300mg stat
T Ecospirin 300mg stat
T Atorva 40mg stat
Refer to higher centres for further management

Renal colic/Calculi (loin pain usually)

Inj Cyclopam 1amp IM stat

T Cyclopam TID
T Pantoprazole 40mg OD
Syp Citralka 2tsp in 1 glass water TID

Worm infestation

T Albendazole 400mg 1 HS, repeat 1 after 2weeks

(C/I in pregnancy & lactation)
(<2yrs~Syp Albendazole (200/5) 5ml HS, repeat after 2week )

Oral ulcers

T Supradyn OD× 10days

Oraways gel or Tess CS oral gel TID
Chlorhexidine oral wash HS
Halitosis

Betadine gargle/ hexidine mouthwash

Hygiene

Tinea

Miconazole ointment for L/A

Dandruff

Ketoconazole shampoo for L/A (Nizoral shampoo)

Diarrhea

ORS
Plenty of oral fluids
T Pantoprazole 40mg OD ×3 days
T Cefixime 200mg BD ×3 days
Avoid milk/milk products
Ask to report if blood stain.

IVF 1 pint RL stat in required cases

If pain , Inj Cyclopam 1amp IM stat
T Cyclopam TID
C Enuff(Racecadotril) 100mg BD(C/I in pregnancy, lactation,entero-invasive diarrhea characterised
by fever and blood, Diarrhea caused by broad spectrum Abs)
T Pantoprazole 40mg OD
Darolac Sachet/C Vizylac(probiotic can add when Abs given)

Bloody diarrhea
ORS
T Ciplox 500mg BD
C Vizylac BD

Diarrhea in children
<6M-ORS
Syp Zinc(20/5) 2.5 ml OD×14 days
Syp Nutrolin B 5ml OD× 7days
<3yrs,>6M-ORS
Syp Zinc (20/5)5ml OD ×14 days
Syp Nutrolin B 5ml OD×7 days
ORS 10ml/kg after each purge

Abdominal colic

Inj Cyclopam 1amp IM stat

T Cyclopam TID
T Ciplox 500mg BD
T Pantoprazole 40mg BD
C Vizylac BD
Vomiting

Adult
Inj Emeset(ondansetron) 1amp IV stat
Inj Pantoprazole 1amp IV stat
If BP ↓ - IVF RL/Isolyte P +DNS
T Emeset 4mg BD
or
T Domstal(Domperidone) 10mg BD ×2days
Children
Use ORS when necessary.
Syp Emeset(2/5) 0.1mg/kg/dose BD
or
wt/4 ml BD
Or

Syp Domstal(1/1) 0.2mg/kg/dose BD/TID

(We can use Domstal in indigestion)

Hyperemesis gravidarum

Inj Emeset 1amp IV stat

IVF DNS 1pint stat
T Emeset 4mg SOS

Hypotension

IVF 1pint NS or RL or DNS

Conjunctivitis

Ciplox eye drops 2°QID× 5days

or
Oflox e/d 1°QID ×5 days

Burns

Inj TT 0.5 ml IM stat

T Zerodol P BD
T Pantoprazole 40mg OD
C Mox 500mg QID
Silverex ointment for L/A

Paediatrics burn Mx
Burns-palms,soles,neck, joint involvement,>15% Burns, face, perineum -need admission in higher
centres
IVF Parklands formula
RL/NS- 4ml/kg/%burns , first half over 8hrs,next half over 16hrs.
Silverex cream for L/A (use soframycin oint for L/A in face)
Jonac or Pmol suppository
Inj Pethidine wt mg sos
Inj Phenergan wt/2 mg sos
For discharge-plenty of oral fluids
Silverex cream/soframycin for face
Syp Mox(250/5) 15mg/kg/dose TID for 5 days
Syp Pmol(250/5) 15mg/kg/dose TID for 5 days
R/A 2days

Allergy, Itching, Urticaria

Inj Avil 1amp IM stat

Inj Efcorlin 1amp IV stat
or
Inj Dexona 1amp IV stat
T Avil 25mg BD ×2days
T Wysolone 5mg TID ×2days
Calamine lotion for L/A

Allergy in children

Syp Cetirizine(5/5) age ml HS

(0.2mg/kg/dose HS)
(Cetirizine avoided in <2yrs)
Syp Wysolone(5/5) age mg TID(if severe)
Calamine lotion for L/A
( Otherwise can also use Syp Atarax(10/5) 2mg/kg/day in 3-4 divided doses
Or Syp Avil(15/5) 0.5mg/kg/dose ×3

Infected wound

T Septid D BD
T Ampiclox 500mg QID
T Pantoprazole 40mg OD
Mupirocin ointment

Wasp sting or unknown insect bite

Inj TT 0.5ml IM stat

T Avil 25mg BD ×2days
T Wysolone 5mg TID ×2days
Mupirocin ointment for L/A

HTN

>160/90mmHg on 2 occassions 1-4 weeks apart unless it is hypertensive urgency or emergency

Hypertensive urgency- >180/120 (should give medication,oral drugs can be given here , IV drugs
are C/I)
Hypertensive emergency- >180/120 with acute organ damage (here also should give medication)
(Emergency IV drugs only when -pulm oedema,stroke,IC bleed, acute renal failure)

Safe medicines
Amlodipine 2.5 or 5mg starting dose (can be given as HS dose- 24hr action drug , usually given
upto 10mg maximum)
Losartan 25mg (in young male if creatinine normal)
we can use Telmisartan 40mg (24hr action drug)
Enalapril 2.5 or 5mg
Bisoprolol 2.5 or 5mg (beta blocker, 12hr action,always start with low dose)
Renal failure given drugs -Amlodipine,Clonidine(100microgram)

*Don't give Nicardia/Lasix to reduce hypertension in an asymptomatic patient as it will cause

sudden decrease in blood perfusion to organs leading to end organ damage.
*a/c reduction in BP only necessary in hypertensive emergency like MI with HTN, stroke with HTN,
hypertensive encephalopathy etc.

HTN protocol
If SBP≥180 and/or DBP ≥110 refer to higher centres after starting treatment
If SBP≥160-179 and/or DBP ≥100-109
Do basic Ix: ECG, S creatinine
Start LSM
Start drug Rx
If SBP ≥140-159 and/or DBP ≥90-99
Start LSM
(LSM- salt restrictions,reduce weight, regular exercise, no alcohol and smoking)

If high BP high
Start drug Rx
Amlodipine 5mg(CCB)
↓ 1month
If BP high
Add Telmisartan 40mg(ARB) with amlodipine 5mg
↓1month
If BP high
Intensify Telmisartan to 80mg with Amlodipine 5mg
↓1month
If bp high
Intensify Amlodipine to 10mg with Telmisartan 80mg
↓
If bp high
Add Chlorthalidone 12.5mg(diuretic) along with amlo 10 and telmi 80
↓
If BP high
Confirm compliance to Rx
If confirmed refer to specialist

Anxiousness/Sleeplessness

T Alprax 0.25mg HS mainly for anxiety

T Zolpidem 5mg HS or 10mg HS mainly for Sleeplessness (DOC for Insomnia)
or
T Clonazepam 0.5 mg HS(Insomnia a/w anxiety)
or
Inj Phenergan 1amp IV stat

Bodyache

T Brufen 200mg BD
T Ultracet BD can also be used
Fatigability

T Supradyn OD×1month
T Iron OD(if pallor) ×1month
Do CBC - if anemia
[Link] BD (ferrous fumarate,vit c, folic acid, vit b12)

Generalized weakness

IVF 1pint NS stat

↓ observation
Plenty of oral fluids

Vertigo(thalakarakkam)

Check GRBS&BP, if both normal

Inj stemetil 1amp 1M stat ATD
T stemetil 5mg BD & T Vertin 8mg BD ×2days
or
Inj stemetil
T Vertin 8mg TID or (16mg BD→8mg TID taper over 1week)
T Cinnarizine 25mg HS× 5days
T Pantoprazole 40mg OD

*ENT Cx if not relieved

Myalgia

T Zerodol P BD
or
T Aceclofenac 100mg BD
T Pantoprazole 40mg OD

Tooth ache

T Zerodol P BD, T Moxclav 625mg BD, T Pantoprazole 40mg OD

or T Chymoral plus. OMFS Cx if necessary

Earache

T Zerodol P BD
T Pantoprazole 40mg OD
Ciplox ear drops 2°QID
Fever,tenderness-sighns of infection-add T Moxclav 625mg BD ×3 days

Dry eyes/hot climate/allergic

Lubrex eye drops(CMC e/d)

Can also use HPMC e/d
Dysmenorrhoea

T Cyclopam,T Pantoprazole

Hyperlipidemia

If LDL>130 ,Triglycerides>500 (Otherwise advise life style modification only )

Atorvastatin or Rosuvastatin 10 or 20mg OD ×15 days
Life style modification

Menorrhagia

T tranexamic acid 250mg TID ×3 days

T Cyclopam
T Pantoprazole

Motion sickness

T Avomine 25mg (min 45 mint before journey)

Hiccups

Inj Reglan 1amp IM stat

T Baclofen 10mg BD(or 5/10mg TID) ×2days (most effective)
T Reglan 10mg BD 2 days
Mucain gel 2tsp Q4H

Belching

Rule out IWMI

T Pantoprazole 40mg OD×1week
Syp Sucralfate 2tsp BD×5days

Continuous belching/flatulence

T Perinorm TID
Gelusil MPS
C Aristozyme BD/TID after meals

Psychiatry patient if violent

Inj Phenergan 1/2 amp IV stat (promethazine)

Inj Serenace 1amp IV stat (haloperidol)

Old age related chronic joint/muskuloskeletal pain

Avoid NSAIDs
T Ca 500mg OD
T Paracetamol
T Gabapentin 100mg OD
T Neurobion 1OD
Fungal nail

T Fluconazole 150mg HS× 1week

Ketoconazole lotion for L/A

Hypopigmented macules

Evion cream for L/A

T MVT OD

Molluscum

10%KOH

Scabies

Permithrin 5% L/A
Benzyl benzoate BD

Conviulsion

Check GRBS
Left lateral position and O2
Inj Lorazepam 4mg IV stat or Inj diazepam 10mg IV stat over 2mints

Inj eptoin 600mg in 100ml NS over 20 minutes

(Inj eptoin 100mg IV stat if not controlled)

Pulm oedema

Propped up
O2
Inj Lasix 40mg IV stat
Inj Dexona 1amp IV stat

Varicella

T Acyclovir 800mg 5times daily× 7 days

Children- syp Acyclovir (200/5)or (400/5)
Acyclovir 20mg/kg/dose×QID ×5days

For pain & inflammatory swelling

T Chymoral forte BD

Very severe pain

Inj Tramadol 1amp IM stat
+
Inj Emeset 1amp IV stat

Hyperurecemia

T Febuxostat(40/80) 1-0-0 × 5days

(Monitor S Creatinine)

Trigeminal neuralgia

DOC-Carbamazepine 200mg TID × 5 days

or
T Gabapentin 300mg OD×5 days

Shivering

Hypothermia-cover with warm blankets, non alcoholic beverages to prevent dehydration

Post op (blood or saline infusion induced rigor) Antihistamines

Inj Avil 1amp IM stat-for shivering
Inj Dexona or Efcorlin 1amp IV stat
Inj Tramadol 1amp IV stat-for Post op shivering

Measles cases

Vit A prophylaxis for 2 consecutive days

Upto 6M =50,000 IU
6M-1yr=1,00,000 IU
>1yr =2,00,000 IU

FB paediatrics

For ingestion
Button battery,sharp objects like pin,hairpin -admission in higher centres
To look for FB
Take Xray neck AP,L
CXR-PA
AXR erect
Keep NPO,IVF
Coin/round objects-check FB position in Xray,evac enema if needed.

For Aspiration
↓
Auscultate-air entry (↓/N)
↓
CXR-PA,CXR-lat
↓
Check whether collapse
Suturing in Paediatrics
L/A -lignocaine(plain)
For face- 4-0 ethilon
Otherwise 3-0 ethilon use

On D/D
Syp Mox ×5days
Betadine ointment for L/A
Alternate C&D
Syp Pmol 3days
R/A 1week for S/R

For I/D in paediatrics

Just prick (pus→blood)
On D/D
Alternate C&D,Abs, analgesics, R/A 2days

Head injury in paediatrics-usually h/o fall or RTA

RTA(MLC)
A/h/o RTA(____vs_____) @'place' on 'date' @'time'(am/pm)
Brought by Mr_______s/o
address, phone number
IDmark -2
c/o injury to _____
Check for h/o LOC/vomiting/seizure/ENT bleed

O/E- check vitals

GCS
P/A,chest
L/E- LW-size with site
Abrasion
Contusion
Range of movements
Adv
NPO
IVF
Jonac/Pmol suppository
CT head /CXR-PA / USG abd/ Xray pelvis AP
Check for #
for fall cases ,
A/h/o fall ______
h/o LOC/vomiting/seizure/ENT bleed

Adv
CT head ,neuro observation , Pmol suppository
###
Xray foot/hand(R/L) AP, Oblique
Xray knee/elbow/hip/shoulder-AP, Lat
Xray pelvis AP
USG abd,pelvis
USG scrotum+Doppler

For sedation can use Syp Pedichloryl (wt/2) ml stat, Max dose 10ml.

Tremor (LFT,RFT,TFT,S/E)

Essential tremor
T ciplar 40mg BD ×5day(beta blocker, gradually tapered)
Stress induced
T Alprax 0.25mg BD
C Gabapentin 300mg OD
Parkinsonism
T Syndopa BD(carbidopa+levodopa)

Chronic alcoholic with tremors

Inj Lorazepam 1amp deep IM or slow IV stat

Inj Thiamine 1amp IV stat
T Lora 2mg 1-1-2/1-1-1-2 ×5-7 days
T Thiamine 100mg OD/BD ×5-7 days
T Baclofen 5mg TID(to ↓ cravings)

Severe nausea

Inj Stemetil 1 amp IM stat or Inj Phenergan 25mg 1M stat

T stemetil 5mg sos

Hypoglycemia (thalarcha/thalakarakkam)

Clinical features -sweating, tachycardia, pounding heart,hunger, anxiety, disoriented,drowsy,speech

difficulty, seizure, nausea, headache,dizziness,anger, incoordinations)
GRBS <50-60 IVF D25 100ml or 75ml infusion, then D5 maintanence
60-70 IVF D5 1pint
70-75 IVF DNS 1pint

GRBS repeat every 10mints until >100mg/dL

All case of unexplained hypoglycemia-take ECG

Infants-D25 2ml/kg
Children-D25 4ml/kg

If RBS<40, D10 , keep under observation.

Hyperglycemia

Polyurea,polydipsia,wt loss, fatigue

FBS≥126mg/dL
RBS≥200mg/dL
OGTT ≥200mg/dL after 2hrs of 75gm of glucose load
HbA1C≥6.5
DM protocol
T Metformin 500mg OD+LSM(lifestyle modification)
↓ 1month
If not controlled
T Metformin 500mg BD+LSM
↓ 1month
If not controlled
T Metformin 1g BD +LSM
↓ 1month
 If not controlled
Add T Glimipiride 1mg OD to the above
↓ 1month
If not controlled
Increase T Glimipiride dose to 1mg BD
↓ 1month
If not controlled
Increase Glimipiride dose to 2mg BD
↓1month
Refer if not controlled+ complications
If no complications add T Pioglitazone 7.5mg OD in addition to Metformin and
Glimipiride(Pioglitazone can given upto 15mg OD daily if still not controlled after 1month )
(Pioglitazone avoided in cardiac failure,fluid overload patients)
↓ if still not controlled
Add insulin
(4-4-2 S/C → 6-6-4 S/C)
(T2DM- insulin 0.2U/kg starting dose)

Backpain

T Zerodol P BD
T Pantoprazole
Diclofenac gel for L/A
(Turpentine oil for L/A available in health centres)
T Duloxetine 30mg HS
Refer for ortho Cx

Arthralgia

Inj Ketonav 1amp IM stat ATD (only for severe pain, C/I in CKD- risk of AKI)
T Zerodol P BD
T Pantoprazole
Diclofenac gel for L/A

Anemia

Cap Autrin BD after meals

Syp dexorange ,2-5 yrs=5ml after food
5-12 yrs=10ml after food

Cheilitis/angular stomatitis

(Iron or vit b12 def or infection)

C Berocin CZ BD ×5days , then HS for 5days
T Septran BD × 2weeks

Migraine

Inj Migranil 1mg over 2-3 mints IV stat ( C/I in pregnancy, lactation,HTN, CAD) or T Migranil 2tab
stat f/b same after 30mints if needed.
Inj Pmol 2cc/1cc IM stat.
Inj stemetil 1amp IM stat or inj Phenergan 25mg if severe nausea.
T Alprax 0.25mg/0.5mg stat (if refractory migraine)

or

Inj Pmol infusion or Inj Pmol 2amp in 100 ml NS

IVF NS 1 pint stat
T Zerodol P BD
T Pantoprazole
T propranolol 20mg BD(only of necessary)

or
T Headset BD×3days
or
T Snapit BD×3days(sumatriptan85+naproxen500)
or
T Sumatriptan 25mg BD ×3 days
or
T Migranil EC BD ×3days (ergometrine 1mg caffeine 100mg)

Migraine prophylaxis (Atleast>3 episode/month)

T Propranolol 20mg BD (C/I in BA,CCF,POVD,severe bradycardia)
T Flunarizine 10mg HS ×2weeks
T [Link] 200mg HS×1week f/b BD to continue
T Amitriptyline 25mg HS

Breathlessness

Adult
Neb with duolin + budecort + O2 stat
Inj Dexona 1amp IV stat
Inj Deriphyllin 1amp IV stat
T Deriphyllin R 150mg BD×3days
T Cetirizine 10mg or Levocetirizine 5mg ×3days

Febrile Seizure(6M to 6yrs)

Pmol suppository stat

80-small babies
170- large babies
250
Tepid sponging
O2 inhalation &keep ↓observation
If symptoms improve syp Pmol
syp Cefixime
T Frisium(clobazam) 5mg BD
Rectal diazepam 0.3-0.5 mg /kg
Rectal Lorazepam or IV Lorazepam 0.1mg/kg

Prophylaxis of febrile Seizure

T Frisium 5mg 1/2 BD for first 3 days of fever , clobazam=0.5mg/kg/dose BD

Trauma following fall

Inj TT 0.5 ml IM stat
T Ampiclox 500mg QID ×5 days
T Pantoprazole 40mg OD×5 days
T Septid D BD
Suturing,C&D,S/R advise
For pain-pmol/Zerodol P

Changing periods/delay in periods

Primolut N 5mg BD ×5 days before the expected bleeding period upto desired rate .

Anaphylactic shock

Inj Adrenaline 0.5mg IM/S.C

(1ml 1amp of 1:1000 solution 1mg/ml)
(Children 0.01ml/kg don't exceed 0.5ml/dose)
IV hydrocort 100-200mg(10mg/kg in children,Max 100 in severe cases)
Chlorpheniramine(10-20mg) IM or slow IV

Upper GI bleed

NPO
Ryles tube aspiration
Inj Octreotide 50µg IV stat
↓
25µg/hr infusion till 4hrs after bleeding stops
Inj Pantoprazole
IVF 2DNS,2NS,2D5 in 24hrs
Blood transfusion or FFP sos
Inj Vit K 1amp(10mg) IV/SC OD ×3days
Bowel wash with lactulose BD
Syp Lactulose 30ml TID (if not NPO)
Inj Taxim 1g IV Q8H

Hyponatremia

S. Sodium < 135 mEq/L

Patients with acute hyponatremia( developing over 48 hours or less) are subject to
cerebral edema, which is the primary cause of morbidity & death.
Clinical features :Headache, confusion, lethargy, agitation, obtundation, coma or status epilepticus,
anorexia, muscle cramps

In acute hyponatremia, the therapeutic goal is to increase the S. sodium level rapidly by 4-6 mEq/L
over the first 1-2 hours, especially in patients with seizures, severe confusion, coma or signs of
brainstem herniation. Administer hypertonic saline(3%) to rapidly correct sodium level towards
normal, but only enough to arrest the symptoms. However it should be reserved for life threatening
cases, since there is the risk of pontine myelinosis.
Asymptomatic: Oral NaCl supplementation
Symptomatic: IV correction
Oxygen inhalation to patients with lethargy or obtundation
Manage seizures, if present
Rate of correction is over 48 hours. Correct half the deficit in 24 [Link] at a rate not to
exceed 10-12 mEq/L in the first 24 hours and not to exceed 18 mEq/L in the first 48 hours.
Exception to the rule would be pts with Na+ <105mEq/L with symptoms such as status
epilepticus.
Usually given as 3% NS 100ml over 4-6 hours.
In euvolemic & hypervolemic hyponatremia, restrict fluid & give T Natrise (tolvaptan).
In hypovolemic hyponatremia give IV NS, care being taken to avoid rapid raise in S. Na+ level.
( One litre of NS contains 154 mEq of Na+ &One litre of 3% NS contains 513 mEq of Na+)

Hyperkalemia(S. K+ >5.0 mEq/L)

Clinical features: muscle weakness/cramps, paraesthesia, hypotonia, focal deficits.

ECG: tall peaked T waves,prolonged PR & QRS, loss of P waves,sine wave pattern.
Nebulisation with salbutamol Q8H
Inj Ca gluconate 10% 10 ml over 10 min IV Q8H(only if ECG changes are present).
Inj RI 8U in 25% D 100 ml iv Q8H.
K-bind 1/3 rd sachet(5mg) in 10 ml sorbiline TID

Heat rash /Pricky heat

Advice plenty of water intake and 2/3 times daily wash

Nycil powder can be given -avoid in infants
Clotrimazole dusting powder is also effective

Cellulitis

Usually Oedema below knee a/w pain , fever+

Oedema,redness, tenderness present
Do routines and CRP

Severe cases need admission

Inj Pmol for pain
T Chymoral forte /T SRP
GM dressing
T Pantoprazole 40mg OF
Inj Ceftriaxone 1gm IV TID/BD ×3days
(If patient uncooperative or denies admission give cefuroxime 500mg BD/TID with Linezolid
600mg BD for 3days)

Surgery case taking in casualty

Date
Time
(Worksite injury,RTA,DSH -MLC
Check whether fall→LOC
Hanging-medicine case
Trauma cases-head,chest,abd)
A/h/o RTA
_____vs_____(eg bike vs pedestrian). |time,date,place of
incident
 |brought by:name,no.
,relation
|ID mark(2) blackmole
Victim is ______
S/I to head/chest/abd (describe like eg. L side of head, ant aspect of chest )
Now c/o pain ____
( Negative history •head-LOC, Vomiting, seizure, ENT bleed
•chest-chest pain, breathing difficulty
•abd-abd pain

O/E- patient conscious, oriented or drowsy

GCS
Vitals PR,BP,SpO2. 2R. NR- no
reaction
Moving 4limbs ,spinal tenderness? Pupil -----. SR-slow
reaction
2R. 1 small ,3big
Chest :AEBE
Chest clear
CCT(chest compression test)- ant/lateral/posterior
( eg CCT +ve on R lateral aspect of chest)
P/A - soft ,tender/non tender
PCT(pelvic compression test) - (+/-)
L/E : head to toe all wounds
Lacerated wound (3D)
Abrasion (2D)
Contusion~black colour
Teeth gone?
ENT bleed?

If head injury suspect - IV fluids, vitals check, CT head with C spine screening
EFAST(extended focussed assessment sonography for trauma)
USG abd + SOT(screening of thorax)
Polytrauma xray
Chest Xray +
Xray C,DL,LS spine -AP,Lat
Pelvic with B/L hip -AP
Routine investigations
Some points for casualty Mx *****
•all diabetic patients check GRBS
• Paracetamol C/I in severe liver disease,renal impairment.
•DKA can present as abd pain
•for a/c pancreatitis send S Amylase,S Lipase investigations & for C/C cases send S Ca, LDH in
addition to this
•cholecystitis-murphys sign? , LFT,CBC
•for perforation-AXR
•female patients with abd pain -do beta HCG
•MANTRELS score for appendicitis , check whether≥7
1 M-migration of RIF pain
1 A-anorexia
1 N-nause&vomiting
2 T-tenderness(RIF)
1 R-rebound tenderness
1 E-elevated temp
2 L-Leukocytosis
1 S-shift to left of WBC
•do URE in abd pain cases
•blunt trauma chart-BP,PR, SpO2, AG(abd girth), Hb(Q4H), U/O
•renal colic cases -loin pain+
 Pmol> Tramadol> Dynapar AQ 100ml NS IV ATD
•for active bleeding (for blunt trauma cases also)- Tranexa 1g IV stat
•trauma patients-TT give
Green cannula prefered
Tetglobin 250 IU IM stat ATD(contaminated wound , FB, gun shot etc)
•for sutures
S/C with 2-0 Vicryl
Skin with 3-0 ethilon or 3-0 nylon
Give Amoxclav 625mg BD×5 days
Chymoral forte TID ×2days
Pmol 650mg TID×2-3 days depending on pain
Pantoprazole 40mg OD×5days
Suture removal
Face/neck- 5days
Scalp-7days
Body trunk-10days
UL/LL-14days

Useful paediatrics doses

Syp Pmol (125/5) wt×0.6 ml Q6H

(250/5) wt×0.3 ml Q6H
(15mg/kg/dose)
(Paracetamol C/I in infants<2kg)
Syp Salbutamol (2/5) wt/4 ml TID
0.1mg/kg/dose TID , Max 5ml per dose usually given.

Syp Cetirizine (5/5) age ML HS (0.2mg/kg/dose-HS)

Pantop 1mg/kg/dose OD
Syp Mox (125/5) or (250/5)=15mg/kg/dose TID
Syp Cefixime (50/5) → wt/2 ml BD
(100/5)→ wt/4 ml BD
(5mg/kg/dose BD)
Syp Azithromycin (50/5) or (100/5)→ 10mg/kg/dose OD
(100/5)→wt/2 ml OD
Syp Moxclav (228.5/5) →wt/2 ml BD
(457/5)→wt/4 ml BD
(20mg/kg/dose BD)
Syp Zincovit : 1yr-1ml OD
4yr-4ml OD
5yr-5ml OD
Syp Ambroxol (15/5) or (30/5) : <2yr=7.5mg BD
2-5yr=7.5mg BD/TID
6-12yr=15mg BD
Syp Rantac(75/5)→2mg/kg
Syp Colicaid age ML BD
Syp Cyclopam (10/5)→ <6=2.5 ml BD
6-12=5ml BD
Syp Pedichloryl (wt/2) ml stat , Max 10ml
For children- antiulcerant→T Junior Lanzole 15mg BD(1mg/kg/dose) or
T Pantoprazole or Syp/T Rantac
For pregnant - antiulcerant→Digene 2tsp TID or Gelusil MPS 2tsp TID