RX Protocol

Treatment Protocol
For
Intern Doctors
Dedicated
To
Dr. Kakoli Dey (SM-2)
Who always inspire me in all situation
from her mind & soul.
Special Thanks To:

Dr. Pintu (SM-2)
Dr. Dilruba (SM-2)
I am also grateful to my respected Sir, senior, colleague & friends of SMCH & SBMCH
Edited By: Dr. Md. Anwarul Azim (SM-2)
INDEX
Medicine
1
SL No.
Topics
Acute Severe Bronchial Asthma
Page No.
COPD / Corpulmonale
Pneumonia
Lung Abscess
Pleural Effusion
Bronchiectesis
Pneumothorax
RTI
Pulmonary TB
10
Snake bite (poisonous)
11
Snake bite (Non-poisonous)
10
12
Sedative poisoning
10
13
Anti-Depression Poisoning
11
14
-Blocker Poisoning
11
15
Dutura/Stupefy/Street Poising
12
16
CuSO4 Poisoning
12
17
Corrosive/Chemical Poisoning
( Acid/Alkali/Savlon/Herpic/Shampoo/Bleaching powder)
12
18
OPC POISONING
13
19
Acute Gastritis (Food poisoning)
14
20
Chronic Gastritis/Gastric ulcer
14
21
Acute PUD
14
22
Haematemesis/Malaena
15
23
Haemoptysis
15
24
Mallory weiss syndrome
16
25
Non-Ulcer Dyspepsia
16
26
Anti Flatulent
16
27
GERD
16
28
Ulcerative Colitis (Bloody Diarrhoea)
17
29
IBS(Diarrhoea predominant)
17
30
Tropical spore
17
31
Apthus Ulcer
17
32
Oral Thrush
17
33
Liver Abscess
18
34
Acute Viral hepatitis
18
35
CLD
19
36
Hepatic Encephalopathy
19
37
Acute Pancreatitis
20
38
Hepato Cellular Carcinoma
20
39
Fatty change of Liver
21
40
CRF/CKD
21
41
AGN
22
42
NS
22
43
Hypernatraemia
23
44
Hyponatraemia
23
45
Hyperkalemia (K > 5.5 mmol/L)
24
46
Hypokalemia
24
47
Hypoglycemia
24
48
Enteric Fever/ Typhoid
25
49
Rickettsial fever
25
50
Dengue fever
25
51
Malaria
26
52
Cerebral Malaria/Severe Malaria
26
53
Kala-Azar
27
54
PKDL
27
55
Fever Under Evaluation/UTI/RTI
27
56
Meningitis
28
57
Epilepsy
28
58
Acute Migraine attack
29
59
Tension Headache
29
60
Vertigo with Headache
30
61
Vertigo/BPPV
30
62
CVD/Stroke
31
63
TIA
32
64
Raised ICP
32
65
Bell's Palsy
32
66
Mumps & Orchitis
33
67
Hyperthyroidism
33
68
Steven Jonson Syndrome
33
69
Anaemia
34
70
Aplastic Anaemia
34
71
Fe Chelating agent in Thalassaemic PT
34
72
Macrocytic Anaemia
34
73
Lymphoma
35
74
Hodgkin Lymphoma
36
75
Aleukaemic Leukaemia
36
76
ALL
37
77
CML
37
78
Musculoskeletal Pain
38
79
Lumbo Sciatica
38
80
Septic Arthritis
38
81
Low Back Pain
39
82
RA
39
83
JRA
39
84
Tetanus
40
85
GBS
40
86
DKA
41
Psychiatry
1
Schizophrenia
43
GAD (Generalized Anxiety Disorder)
43
OCD (Obsessive Compulsive Disorder)
44
PPP (Post Partum Psychosis)
44
SRD (Substance related disorder)/Sleeping Pill
44
ASD (Acute Stress Disorder)
45
Depressive illness
45
Somatoform disorder/HCR/FD
45
Scabies
46
Acne Vulgaris
46
Seborrhoeic Dermatitis/ Seborrhoeic Folicuitis
46
Psoriasis
47
Tinea
47
Onychomycosis
47
Contact/Allergic Dermatitis
48
Urticaria/Drug reaction
48
Eczema
48
10
Impetig Eczema
48
11
S.Blephritis
49
12
White Discharge from Breast
49
13
Insect Bite
49
14
Skin Wart/Hard skin
49
15
Alopecia
49
16
Measles
50
17
Gonococcal Urethritis
50
18
Erectile dysfunction
50
Skin
19
Black Spot/wrinkle
50
Cardiology
1
AMI
51
IHD
52
CCF
53
AF (Atrial Fibrillation)
53
VF (Ventricular fibrillation)
53
SVT (Supra Ventricular tachycardia)
54
VT (Ventricular Tachycardia)
54
Ischemic Cardiomyopathy
55
Hypertension (HTN)
56
Paediatrics
1
Dosage of Drug
61
Fluid Mx
64
Birth asphyxia/Neonatal Sepsis/Neonatal Convulsion
66
LBW/Preterm Baby
67
Umbilical Sepsis
67
Neonate Of HBsAg +ve mother
68
Rh Incompatibility
68
Neonatal Jaundice
68
Acute RTI
69
10
UTI
69
11
Meningitis
70
12
Oral Thrush
70
13
Febrile Convulsion
71
14
Tetanus
71
15
AGN
72
16
NS
72
17
Asthma
73
18
Ascariasis
73
19
Diarrhoea
74
20
Near drowing
76
21
Malaria
77
22
Enteric Fever
77
23
PEM (Protein Energy Malnutrition)
78
24
Kerosene Poisoning
80
25
Dose of dopamine
81
SURGERY
1
Head Injury
83
Physical assault (P/A)
83
Massive cut Injury or P/A
84
Small cut injury
84
Acute case of intestine/ Acute Emergency

(Intestinal perforation/ Intestinal obstruction/ Volvolus/
Strangulation/ Intussusception/ Acute appendicitis/ Obstructed
hetnia)
85
A case of Hepato-Biliary system

(Acute cholecystitis/ Acute cholelithiasis/ Acute choledocolithiasis/
Acute pancreatitis/ Biliary ascariasis/ Obstructive jaundice)
86
Accidental fall from height
87
Abscess
87
Ulcer
88
10
Retention of Urine/ Structure urethra
88
11
BEP (Benign Enlargement Of Prostate)
89
12
Hernia & Hydrocele
89
13
PVD(Peripheral vascular Disease)
89
14
Haemorrhoids /Anal fissure/rectal prolapse
90
15
Peri-Anal Abscess
90
16
Gut Preparation for Surgery
91
17
Gut Preparation for IVU
91
Age related Cataract (ARC)
92
Chronic Dacrocystitis (CDC)
92
Acute Congestive Glaucoma
92
Fungal Corneal Ulcer
93
Viral Keratitis
93
Ocular Injury
93
Epistaxis
94
F.B Larynx/Trachea
94
F.B Pharynx/Oesophagus
94
Acute Epiglottitis
95
Hanging
95
DNS
95
CSOM
96
Traumatic Rupture Of TM
96
Sub-mandibular Growth
96
10
Nasal Mass With HIT
96
11
Rhinosporidiosis
97
12
Nodular Goitre
97
13
Cervical Lymphadenopathy
97
14
Parotid Abscess
98
15
Maxillary Sinusitis
98
EYE
ENT
OBSTETRICS
1
Indication of C/S
100
FTP with Normal Finding/Normal Labour
101
FTP with PET
101
Eclampsia
102
Post Partum Eclampsia
102
Retained Placenta
103
IUD
103
Obstructed Labour
104
APH
105
10
PPH
105
11
Hyperemisis Gravidarum
106
12
Shock
106
PV Bleeding
107
Incomplete Abortion
107
Threatened Abortion
108
DUB/Fibroid Uterus
108
Genital Prolapse
108
Ectopic Pregnancy
109
Perineal Tear
109
VVF
109
PID
110
10
Post Conductive order(In Obs)/Post Expulsive Order(In Gynae)
110
11
Bowel Preparation On 1st day
111
12
Bowel Preparation On 2nd & 3rd day
111
GYNAE
Dedicated to Dr.Kakoli Dey
Medicine
1|P a ge
A Patient with Breathlessness

Commonly:
Bronchial Asthma
COPD
Pneumothorax
LVF/AMI
DKA
Pulmonary edema/Thrombo embolism
CRF/ARF/Uremia
Emotional/HCR/FD
Acute Severe Bronchial Asthma
Diet: Normal
Bed rest with propped up position
O2 Inhalation stat & SOS (high conc.)
Nebulization with windel plus stat & 6 hrly
Inj. Cotson/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. Omeprazole 20mg
1+0+1 (B/M)
IV fluid 5% DA @ 30 d/m- To correct K+
If response poor then
Inj. Aminophyllin
2amp + 5% DA 500cc
IV at 8 d/m
In some case Montelukast 10mg
0+0+1
Clue to Dx Breathlessness
H/O previous attack/allergy
Young pt
Night awaking
Wheeze,ronchi,
Vesicular breath sound with
prolong expiration
2|P a ge
COPD / Corpulmonale
Diet: normal

Clue to Dx COPDO2 Inhalation with low conc.
Breathlessness
Nebilization with windel plus stat & 6 hrly
H/O cigarette smoking
Inj. Cotson/Oradexon
Old age(>40yrs usually)
No H/O asthma usually
Crep +++,ronchi,wheeze
Or
Tongue cyanosis, eye
Tab. Cortan(prednisolon) 5mg
congested
6+0+0 ( 10 days)
Lip pursing
Tab. Moxclave/Fimoxyclave 625mg
1+1+1
Clue to Dx Corpulmonale
If COPD present with
Or
Oedema
Levofloxacin 500mg (0+0+1)/ Ciprofloxacin
(1+0+1)
Asmasol/Sulprex inhaler
2 puff TDS
Bexitrol F/ Ticamate inhaler
2 puff BD
1+0+1 (B/M)
If more Crep/Oedema present
Inj. Lasix/fusid
2amp 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
3|P a ge
Pneumonia
Bed rest
O2 inhalation
Tab. P/C
1+1+1
Tab. Moxin 500mg
1+1+1
OR
Tab. Moxclav 625mg (2 wks)
1+1+1
+
Tab. Clarin 500mg (2 wks)
1+0+1
1+0+1 (B/M)
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
Clue to dx High grade fever

Short history ( days to week)
Chest pain with or without cough/

despnoea
Investigation CBC
RBS
CXR P/A view
MT
Sputum for AFB

4|P a ge
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
Clue to Dx Fever with Cough

Hemoptysis
Foul smell sputum
Chest pain/despnoea
Wt loss/anorexia/ clubbing(10-14 days)
CXR
Pleural Effusion
Bed rest
O2 inhalation if necessary
Pleural fluid aspiration
Up to 1.5L in one setting
Rx of underlying causeTB,Malignancy,pneumonia,etc
Investigation CXR
CBC
Sputum- AFB,cytology
MT
Pleural fluid analysis
FNAC or Bipsy from LN
(pleural biopsy confirmatory)
5|P a ge
Bronchiectesis
Diet. Normal
Bed rest
Cap. Ciprofloxacin 500mg
1+0+1
OR
Inj. Ceftazidim 500mg/inj. Flucoxacillin/Inj. Amoxicillin
Cap. omeprazole 20mg
1+0+1
Tab. Prednisolon
SymptomaticCreap/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
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. P/C 500mg (1+1+1)
Tab. Loratidin 10mg (0+0+1)
6|P a ge
Pulmonary TB
Catagory Indication
CAT-1
New smear positive
New smear negative PTB
Extra PTB
Pleural effusion, pericardial
Meningeal
Spinal,intestinalTB,
dessiminiated TB
CAT-2
Relapse
Treatment after deafult
Treatment failure
Rx Regimen
Intensive Phase (daily)
4FDC- 2 month
Continuation phase (daily)
2FDC- next 4 month
Intensive Phase (daily)

1st 2 month- Inj. streptomycin IM
daily
Next 3 month- Remistar FDC
Continuation phase (daily)
Next 5 monthremactazid+Ethambutol
Composition of FDC
4FDC- INH 75mg + Rifampicin 150mg + Pyrazinamid 400mg + Ethambutol 275mg
2FDC- INH 75mg + Rifampicin 150 mg
Dose of FDC
FDC
4FDC
2FDC
Weight(K.G)
< 27
30-37
38-54
55-70
>70
30-37
< 50
>50
Dose
acc. to body wt
2
3
4
5
1 Rmactazid 300mg
1 Rmactazid 450mg
2 Rmactazid 300mg
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
7|P a ge

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 (B/M)
Tab. Calcium 500mg(1+0+0)- 2month
8|P a ge
Poisoning
Snake bite (poisonous)
Diet: NPO TFO

Bed rest
Reassurance
O2 inhalation if needed
Inf. 5% DA 1000cc+ 5% DND 2000cc
IV 30 d/m stat
Inj. Ceftriaxone 2gm
1 vial IV stst & daily
Inj. Omeprazole 20mg
1 vial IV stat & BD
Inj. TT
1 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
1 amp IV stat
-Inj. Neostigmine- if muscle paralysis
Monitoring Vital sign
** inj. cotson, Inj. Avil, Inj. Adrenalin should be kept during given anti-venom 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.
Clue to poisonous snake bite Bite mark 2 fangs
Drowsy, restlessness, dribbling of saliva
Resp. difficulty
Ptosis/lid drop
Broken neck sign
Unconsciousness
Blood coagulation test: Take few ml fresh venous blood in test tube after 10min if clot occur
it non-poisonous. If clot not occur it indicate poisonous.
9|P a ge
Snake bite (Non-poisonous)
Bed rest
Reassurance
Inf. NS 1000cc
IV @ 20d/m stat
Cap. Moxin(1+1+1)/ cephradin(1+1+1+1)
1+0+1 (B/M)
Inj. TT
1 amp IM stat (in one arm)
Inj. TIG
1 amp IM stat (in another arm)
If pt complain pain Tab. P/C
Never given- inj. 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)
2 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

Investigation
S.Creatinine
SGPT
10 | P a g e
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
Monitor Vital sign
-Blocker Poisoning
Stomach wash if pt comes within 1hrs

Inf. 5% DNS 1000cc (prevent hypoglycemia)
IV @ 20 d/m stat
1 vial IV stat & BD
1 vail IV stat & BD
Symptometic
Convulsion
Inj. sedil 1amp IM/IV stst
Bronchospasm
Nebulization
Bradycardia
Inj. atropin 1 amp 8hrly
Hypoglycemia
-Inj. libot-25 100ml
-Inj. 10% DA 1000ml as maintenance dose
Hypotension- Inj. Glucagon
Investigation ECG
RBS
S.Creatine
S. Electrolytes
11 | P a g e
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
1 amp IV stat & 8 hrly
Continuous catheterization
Monitor vital sign
Investigation ECG
RBS
S.Creatine
S. Electrolytes
** Always try to avoid costly drug & investigation as pt attendant are not available.
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
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
12 | P a g e
OPC POISONING
Stomach wash
Diet. NPO TFO
Inj. NS/ 5% DNS 1000cc
20 d/m IV stat
1 vial IV stat & BD
1 vial IV stat & BD
Inj. Atropin
Atropin Doubling dose1st give 3amp IV stat then

Next 10min 6amp
Next 10min 12amp
Next 10min 24amp
Next 10min 48amp
Continue Up to
atropinization
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
Monitor Vital sign
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
Sign of Atropnizatio Pupil- Dilated

Pulse- >80 b/m
BP- > 110/80 mm hg
Dry Axilla
Clear lung
Maintenance dose*Atropin 30% of total loding
dose in 24 hours.
(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
13 | P a g e
Acute Gastritis (Food poisoning)
Inf. NS/ Cholera Saline 1000cc

IV @ 30 d/m
Inj. ciprofloxacin 100ml
bag IV stat & BD
Inj. Metronidazole
1 bottle IV stat & TDS
1 vial IV stat & BD
Inj. Emistat/Onaseron
1 amp IV stat & sos
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)/ Clarithromycin 500mg(1+0+1)- 7-14 days

Tab. Metronidazole 400mg- 7 days
1+1+1
Cap. omeprazole 20mg- 2 month
1+0+1
Acute PUD
Diet. NPO TFO

Inf. 5% DA 1000cc + Inf. 5% DNS 1000cc
IV @ 20 d/m
Inj. Maxpro 40mg
1 vial IV stat & BD
Inj. Algin
1 amp IM stat & TDS
Inj. Emistat/ Onaseron
1 amp IV stat & SOS
14 | P a g e
Haematemesis/Malaena
Complete bed rest

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. konakion 10ml
1 amp slow IV drip for 3 days
Inj. Xamic/Caprolysis/Traxyl
1 amp slow IV stat & 6 hrly
Record vital sign
Immediate arrange for Blood transfusion
Investigation 1st choice-Endoscopy of

UGIT
Blood grouping & cross
matching
CBC
PBF
USG og HBS & pancrease
Haemoptysis
Diet. Normal
Inj. HS 1000cc
IV 20 d/m
Cap. Moxin 500mg (never give ciprofloxacin if you suspect TB as it mask the AFB)
1+1+1
1+0+1 (B/M)
Inj. frabex/inj. traxyl
1 amp IV stat & then
InvestigationTab. frabex/traxyl
CBC
CXR
1+1+1
MT
Tab. sedil
Sputum for AFB & malignant cell
0+0+1
RBS
S.creatinine
15 | P a g e
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
Non-Ulcer Dyspepsia
Diet. sweet,fat,milk restricted

Tab. Tryptin 25mg
0+0+1
1+0+1 (B/M)
Tab. Omidon 10mg
1+1+1 (B/M)
Tab. Entacid/Marlox
1+1+1 (A/M)
Psychotherapy
Anti Flatulent
Syp. flatameal DS
1/2 TSF TDS
Tab. Flatameal DS
1-2 tab TDS
GERD
Non drug Rx of GERD
Wt reduction, stop smoking, avoid fatty food
Drug Rx
Tab. Omidon 10mg

1+1+1 (B/M)
1+0+1 (B/M)
16 | P a g e
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
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 spore
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 (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
17 | P a g e
Liver Abscess
Diet. Normal
Tab. Ciprofloxacin 500mg
1+0+1
Tab. Metronidazole 400mg
2+2+2
1+0+1 (B/M)
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
Complete bed rest
Syp. D-luc
2 TSF TDS
1+0+1 (B/M)
Tab. Omidon
1+1+1 (B/M)
Inj. Konakion 10mg
1 amp IV stat & daily for 5 days
Other are symptomatic
Investigation USG of W/A
SGPT
PT
S.Bilirubin
HBsAg
18 | P a g e
CLD
Without encephalopathy
Diet. Salt restricted

1+0+1
1+0+1 (b/m)
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
Investigation1 vial IV stat & daily
SGPT
syp. Metronidazole
S.Bilirubin
4 tsf tds
PT
Inj. Ranitid
S.albumin, AG ratio
HBsAg
USG of W/A
Syp. D-luc/Avolac
Asitic fluid study
3 tsf tds
Inj. konakion 10mg
1 vial IV daily for 3-5 days
If pt restless consult with senior & give
-Inj. Dormicum 7.5mg
1/2 amp IM/IV stat
19 | P a g e
Acute Pancreatitis
Diet. NPO TFO

Inf. NS 1000cc + Inf. 5% DNS 200cc
IV @ 20 d/m stat
Inj. ceftriaxone 1g (BD)/ Inj. Ceforoxime 1.5g (TDS)
Inj. Omeprazole 40mb
1 vial IV stst & bd
Inj. Ketorolac 30mg
1 amp IM stat and BD
Investigation CBC with ESR

USG of HBS with Pancrease
ECG
S. amylase- if within 24hrs
Urinary amylase- > 24hes
Before discharge
-RBS
-S. Calcium
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
20 | P a g e
Fatty change of Liver
Diet. Low fat diet

1+0+1(B/M)
Tab. Algin/viseralgin
1+1+1
Tab. Todol
1+1+1
Tab. Alben DS
0+0+1
If increase TIG level- Tab. Lipirel 200mg
CRF/CKD
Diet. fruit, protein, dub water restricted

1+0+1(B/M)
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
Loatidin 10mg-If purities
21 | P a g e
AGN
Diet. Protein, fruits restriction(to avoid hyperkalamia)

Fluid. 500ml + previous day out
Tab. (Phenoxy methyl penicillin)/ Pen-V/Oracin 250mg
1+1+1+1
1+0+1 (b/m)
Tab. fusid 40mg (don't use fusid plus to avoid hyperkalamia)
1+1+0 - 5 days
1+0+0 - 5 days
Tab. Omidon 10mg - 7 days
Clue to Dx1+1+1
HTN
Tab. deslor 10mg ( If itching)
Oedema- peri orbital,leg,sacral
0+0+1
Visuble haematuria
Tab. Amlodipin 5mg (If HTN)
Oligura/uremia
Mild to moderate proteinuria
1+0+0
(24 hrs urinary protein <3.5 gm
Other Symptomatic
Maintain I/O chart
Maintain BP chart
Maintain Heat coagulation test
NS
Diet. Normal(salt & fluid restriction)

Fluid. 500ml + previous day out
Antibiotc- Amoxycillin/Cefixim/Ceftriaxone
1+0+1
Clue to DxTab. Atova
Generalize oedema
0+0+1
Massive proteinuria- >3.5
Tab. Cortan 5mg
gm/24hrs
4+4+0
Hypo-albuminaemia- < 30gm/L
Tab. Calbo 500mg
Hyperlipidaemia- >220 mg/dl
0+1+0
Tab. Fusid plus- If massive Oedema
Other Symptomatic
Maintain I/O chart
Maintain BP chart
Maintain Heat coagulation tes
22 | P a g e
Electrolytes imbalance
Hypernatraemia
It occur due to decrease body water, If we correction body fluid Hypernatraemia 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
=2L
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
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
Na+ requirement for hyponatraemia

WT in KG 0.5(F) or 0.6(M) deficit
**If a male 60kg wt, S.Na+ 120 mmol/L
Then Na+ requirement is
60 0.6 (140-120)
=720 mmol/L
Severe (<110)
Inf. 3% NaCl by calculating Na+ requirement

(Max 1L/Day)
Nice To Know
100cc 0.9% NaCl solution = 155 mmol/L Na+
1000cc 3% NaCl solution = 512 mmol/L Na+
500cc 3% NaCl solution = 256 mmol/L Na+
**Not correct more then 10-12 mmol/L

in every 24hrs, rapid correction causes
Osmotic Demyelination syndrom
23 | P a g e
Hyperkalemia (K > 5.5 mmol/L)
Diet fruit restriction

Inf. 25% Nutridex 100ml/Libot-25 + 5 unit 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 compelet 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

IV @ 15 d/m
Advice- repeat S.Electrolytes1
Hypoglycemia
LD-Inj. 25% glucose/libot-25/nutridex

IV running stat
MD- inf. 10% DA 1000cc
20 d/m up to 24 hre
Inj. Decason
Repeat Blood glucose
Clue to Dx H/O insulin intake

Missed meal
Hypotension
Cold calm skin
Shallow resp.
24 | P a g e
Fever
Enteric Fever/ Typhoid
Diet. normal
Inj. Ceftriaxone 2gm- 7 days
1 vial IV stat & BD
OR
Tab. Azithronycin 500mg-7 days
1+0+1
1+0+1 (B/M)
Tab. Omidon
1+0+1
Tab. P/C 500mg
1+1+1
Tepid sponging
Napa suppository
1 stick P/R when temp >101o F
Investigation CBC
Urine R/M/E
Blood culture- 1st wks
Widal test- 2nd wks
Tipple Ag
MP & ICT
USG of W/A
Rickettsial fever
Cap. A-tetra/Tetra A/Tetrax 500mg- 7days

1+1+1+1
+
Tab. Azithromycin 500mg
1+0+0
Tab. P/C 500
1+1+1
Napa suppository
1 stick P/R when temp >101o F
Dengue fever
Tab. Azithromycin 500mg- 3 days

1+0+0
Tab. P/C 500mg
1+1+1
Volume replacement if dehydrate/Shock
Platelet/blood transfusion if platelet count < 30,00
25 | P a g e
Malaria
Tab. Jasoquin 300mg (Quinine sulphat)- 7 days

2+2+2 (A/M)
On 3rd day-Tab. Malaride ( salfadoxime + pyrol)
3 tab stat
On 4th day-Tab. Jesoprim (Primaquine)
3 tab stat
1+0+1
Inf. 5% DNS 1000cc- (To prevent hypoglycemia, because anti-malarial drug causes
hypoglycema)
IV 20 d/m
Investigation
HB%, CBC with ESR

MP/ICT for malaria
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
26 | P a g e
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 (b/m)
Tab. Omidon 10mg
1+1+1
Tab. P/C
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
27 | P a g e
Meningitis
Inj. Ceftriaxone 2gm- 14 days

1 vial IV stat & BD
Inj. Dexamet
1+0+1 (B/M)
Tab. P/C 500mg
1+1+1
Napa suppo
1 stick P/R if temp > 101o F
If convulsionInj. 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 (b/m)
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
28 | P a g e
Acute Migraine attack
Tab. Rizat 5mg (Rizatriptan)

1 tab stat orally,
10 min
again 1 tab,
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 (
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 (b/m)
Tab. Omidon 10mg
1+1+1 (b/m)
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. P/C 500mg (1+1+1)- 2 days

Tab. Omidon 10mg- 2 days
1+1+1
Cap. Omeprazole 20mg- 2 days
1+0+1 (b/m)
Tab. Sedil 5mg/Tab. Dormitol 7.5mg
1 tab stat
Prophylaxis
- Tab. Tryptin 10mg (0+0+1)
- Tab. frenxit (1+1+0)
29 | P a g e
Vertigo with Headache
Tab. Cinaron
1+1+1
Tab. Stemetil/Vergon
1+1+1
Tab. P/C
1+1+1
Vertigo/BPPV
Tab. Stemetil/Vergon- 15 days

1+1+1
Tab. Perkinil- 15 days
1/2 + 1/2 + 1/2
30 | P a g e
CVD
Stroke
Diet. NG feeding
200ml 2 hrly
O2 inhalation stat & SOS

Clue to Dx
Inf. NS 1000cc
Sudden Onset
IV 20 d/m stat
Unconscious/semi Inj. Dexamet
conscious/conscious
Aphasia
Inj. Omeprazole- 1 vial IV stat & BD
Hemi/mono paresis
Planter-Unilateral extensor
Antibiotc- if needed
In Infarctive
- Inj. Ceftriaxone 1gm
Usually conscious
1 vial IV stat & BD
aphasia
OR
Hemi/mono paresis
- Inj. Moxin 500mg
In Haemorragic
1 vial IV TDS
Unconsciousness
H/O Headache/vomiting/HTN
Neck rigidity in sub-arachnoid
Change posture 2 hrly
Hge
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
Investigation Steroid omit
CT scan of brain
RBS
If Haemorrhagic stroke
S.Creatinine
Steroid given for 5 days then omit
S.Electrolytes
If venticular extention
S.Lipid profile
- Tab. Nimocal 30mg- for 21 days
ECG
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
31 | P a g e
TIA

1+0+1 (b/m)
Tab. Anclog plus/Ecospirin plus
0+1+0
Tab. Atova/Tiginor 10 mg
0+0+1
Tab. Ramoril- if HTN
Raised ICP
Inj. Mannitol/manisol 500ml

1/2 bag running & 1/2 bag 8 hrly for 48 hrs
Bell's Palsy

1+0+1 (B/M)
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
32 | P a g e
Mumps & Orchitis
Tab. deltason 20mg

2+0+0 (A/M)
Tab. P/C 500mg
1+1+1
Tab. cefuroxime 500mg
1+0+1
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
Steven Jonson Syndrome
Diet. NPO TFO

Inf. 5% DA 1000cc + Inf. 5% DNS 2000cc
IV 30 d/m
If secondery infection- Inj. Ceftriaxone -1 vial IV daily
Inj. Dexamet
Micoral oral gel
Apply locally 3 times
Sonexa E/D
1 drop 4 hrly
Sonexa E/O
At bed time (both eye)
Haematropin E/D
1 drop 8 hrly
Tab. Vasco 250mg
1+1+1
33 | P a g e
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 mont)
Rx of primary cause
Nice to know
(Our target to reach Hb level 10g/dl)
1 unit blood correct 5% HB or 1g/dl
Ferus Sulphate( Orally) If we give 200 mg 8 hrly it correct Hb level 1g/ld/wks
1st wks for erythropoisis stimulation, So it take more than one wks as g/dl we have to
correct
After correction it takes more than 6 month for adequate storage.
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
Fe 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 gm)
1 amp IM on alternative day for 9 month
Then, 1 amp IM 3 monthly for life long
34 | P a g e
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
well hydrate
Liver & Renal function

Duration
21
cycle
, 4-6 wks
Rx
Inf. 5% DA 500cc
IV stat 60 d/m
Inj. Onaseron
1 amp IV stat
Inj. Neotack
1 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) 11/2 vial + 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
35 | P a g e
Hodgkin Lymphoma
Bag-1
Inf. 5% DNS 500cc

+
Inj.Onaseron 4 amp
Inj. Oradexon 2 amp
Inj. Ranitid 2 amp
IV @ 60 d/m
Inj. Vincristin 1ml
2 vial IV stat slowly
Bag-2
Inf. 5% DNS 500cc

+
Inj. Doxorubicin 70mg (50mg & 10mg available)
IV @ 60 d/m
Bag-3
Inf. 5% DNS 500cc

+
Inj. Endoxan 1gm
IV @ 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
1 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
36 | P a g e
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
Supportive:
Diet: neutropenic
Correction of anaemia: Fresh blood transfusion (Target HB% is 10gm/dl)
Correction of infection- Board spectrum antibiotic
Tab. Esloric - 1+0+1 (for hyperuracemia)
Cap. Omeprazole
Tab. Filwel gold: 1+0+1
Tab. Foltab: 0+0+1
Spcific: Chemotherapy
Curative: Bone Marrow transplantation
37 | P a g e
Musculoskeletal Pain

1+0+1 (B/M)
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
Lumbo Sciatica
Tab. Myolax 50mg- 7 days

1+1+1
1+0+1 (B/M)
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)

Then,
Cap Flubex 500mg- 4 wks
1+1+1+1
38 | P a g e
Low Back Pain
Tab. beclo 10mg- 7days

1+1+1
Then
Tab. Myolex 50mg- 7 days
1+1+1
Cap. Omeprazole 20mg- 15 days
1+0+1 (B/M)
Tab. tenorex- 7days
1+0+1 (A/M)
Advice
RA

1+0+1 (B/M)
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)
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
39 | P a g e
Tetanus
Diet. Soft
O2 inhalation SOS
Isolation room (dark & soundless room)
Inj. C-Penicillin(5 Lac)
Inf. 5% DA 1000cc + Inj. sedil 10 amp
IV stat @ 15 d/m
Inj Rolac 30mg
1 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 -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
Clue to Dx
Ascending type of paralysis

More marked proximal than distal
Symmetrically
Sensory intact
Jerk- diminished/loss
Bowel/bladder nit involved
All 4 limbs may paralyzed
40 | P a g e
DKA
Basic Principal of DKA Management
1.
2.
3.
4.
fluid replacement
the administration of short-acting (soluble) insulin
potassium replacement
the administration of antibiotics if infection is present
Rx:
Diet. NPO TFO

NG suction
O2 inhalation
Fluid: Total fluid 6 litre over 24 hrs
1st NS 1000cc over 1/2 hrs

2nd NS 1000cc over 1hrs hrs3rd 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 d/m
3 unit/hrs when blood glucose <15 mmol/l - IV @ 12 d/m
2 unlt/hrs when blood glucose <10 mmol/l- IV 8 d/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
41 | P a g e
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
Change posture 2 hrly
Clue to Dx
Unconsciousness/semi consciousness
Drowsy/Disoriented
Feature of dehydration
Respiratory distress may be present
Known diabetic pt
Low BP, Trachycardia,
Planter: may be bilateral extensor
Drop calculation:
Total fluid
d/m=
4 hrs
42 | P a g e
Psychiatry
Schizophrenia
Inj. Fenazine 25mg

1 amp IM (
Then,
Tab. sizodon/resodon 2mg
0+0+1-for 2 days,then
0+0+2- continue
Tab, Opsonil 50mg
0+1+1
Tab. Perkinil
1+1+1
Pase 0.5- 15 days
0+0+2
Tab.Promitil 5mg (
1+0+1
GAD (Generalized Anxiety Disorder)
Tab. Telazine
1+1+1
Tab. Tryptin 10mg
0+0+2
Tab. Indever
1+1+1
Tab. Pase 0.5
0+0+1
43 | P a g e
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
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
F/U- 1 month later
44 | P a g e
ASD (Acute Stress Disorder)
Tab.Promitil 25mg
0+0+1- 3 days
Then, 1+0+1
Tab. Indever
1+1+1
Tab. Rivotril 0.5 mg
0+0+2- 10 days
Then, 0+0+1
Depressive illness
Adnor 75mg
0+0+1
Tab. Amit/tryptin 25mg
1+0+2
Tab. Deprex
0+0+1
F/U- after 21 days
Somatoform disorder/HCR/FD
Diet . NG feeding
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)
45 | P a g e
Skin
Scabies
Tab. Azithromycin /Flufloxacin

Tab. Histacin
1+0+1
Bactrocin ointment
Scaper/Scabex/scabicid Cream
Acne Vulgaris
Tab. azithromycin 500mg

0+0+1
Scbionex jell/ Acne bar -
Seborrhoeic Dermatitis/ Seborrhoeic Folicuitis
Tab. Oflacin 200mg- 10 days

1+0+1
Tab. Telfast/Fenadin 180mg- 15 days
0+0+1
Bactrocin/bectroderm oint.
46 | P a g e
Psoriasis
Tab. Oflacin 200mg

1+0+1
Tab.Telfast 180mg
0+0+1
Olive Oil
Xenovet Oint. + Eucera cream + 5% salicylic acid
Sastid bar
Xenovet Scalp / Dermovet cream
Fungitar shampoo
Tinea
Cap. fungata- 1 month

0+0+1
Xfin cream- 1 month
Tab. Telfast 180mg- 1 month
0+0+1
Tab. Multivit
Onychomycosis
Cap. fungata
Afun/Clarizole lotion
47 | P a g e
Contact/Allergic Dermatitis

Tab. Telfast
Diprobet/Mexiderm oint. + Eucera cream
Urticaria/Drug reaction

Tab. Momentor
1+0+0
Tab. Cortan- 10 days
Cap. Omeprazole
Tab. Monas(Montelukast) 10mg
0+0+1
Eczema
Tab. Terbucef 250mg-10 days

1+0+1
Tab. Telfast
Xenovet oint. + Eucera cream
Impetig Eczema

1+0+1
Tab. Telfast
Bactrocin oint.
48 | P a g e
S.Blephritis
Betnovate-CL oint.
White Discharge from Breast

1+0+1
Tab. Telfast- 10 days
0+0+1
Tab. Multivit- 1 month
1+0+1
Insect Bite
Antibiotic
Anti-histamine
Diprobet/Mexiderm oint.
Skin Wart/Hard skin
Duofilm lotion (salisylic acid)
Tab. Telfast- 10 days

0+0+1
Alopecia
Dermas cream 1%
Xenovet cream
Tab. Multivit
1+0+1
49 | P a g e
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
0+0+1
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)
Black Spot/wrinkle
White Objective Pen
50 | P a g e
Cardiology
AMI
Complete bed rest

Diet. Liquid
Nitrosol/Anril Spray
2 puff S/L stat & SOS
OR
Tab. Anril/Angicard 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 ( Trimetazidim)
1+0+1
Tab.Epam/sedil 5mg
0+0+1
Inj. Morphin 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 1/2 hrs at same time BP must check if fall must stop morphin
Inj. Emistat
1 amp IM/IV 15 min before giving morphin
Inj. cardinex/Claxane (60mg or 80mg)- if pt comes > 12 hrs
1 syringe S/C stat & BD
If pt comes within 12 hrs
Inj. Cotson 1 amp IV stat Then

Inj. Straptase (streptokinase) 1 vial + Inf. 5% DA 100cc
IV @ 25 d/m stat (No IM inj. in next 24 hrs of streptokinase)
Inj. Cardinex/Claxane (60mg or 80mg)- after 24 hrs of inj. streptokinase
1 syn S/C BD
51 | P a g e
If BP fall <80/50 mm of Hg- Pt goes to shock
Inj. Dopamin 2amp + 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. Fusid-2amp/4amp IV stat & SOS

Cap. Cephradin 500mg (1+1+1+1)
OR
Tab. Ciprofloxacin (1+0+1)
IHD
Diet. Normal
Nitrosol/Anril Spray
2 puff S/L stat & SOS
OR
Tab. Anril/Angicard 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 ( Trimetazidim)
1+0+1
Tab.Epam/sedil 5mg
0+0+1
If HTN
Tab. Remoril/Ripril 2.5 (ACEI)
0+0+1
52 | P a g e
CCF

Diet. Liquid
Clue to Dx
Dysnoea
Inj. Cotson
Basal creps
2 vial IV stat
Leg oedema
Inj. Fusid
Chest pain- May
2 amp IV stat & BD
complain
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
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 hrs
After 24 hrs
Tab. Pacet 200mg
1+1+1
53 | P a g e
SVT (Supra Ventricular tachycardia)
Bed rest
O2 inhalation Stat
Inj. Osiden/Adicard (Adenosine)
2 amp IV rapidly stat ( within 2 second)
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- Mantanance by
Inj. 2% Lignocaine 100cc + 5% DA 400cc
IV @ 5-10 d/m for 24 hrs
Then, 2% lignocaine for next 24 hrs
Tab. Amiodaronr
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
54 | P a g e
Ischemic Cardiomyopathy
Tab. Anclog 75mg

0+1+0
Tab. Monocard 20mg
1+1+0
1+0+1 (b/m)
Tab. Fusid 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. Angicard/Anril 0.5mg
1 tab S/L
55 | P a g e
Hypertension (HTN)
Classification
BHS Classification:
Category
BP
Optimal
Systolic BP (mmHg)
Diastolic BP (mmHg)
< 120
< 80
Normal
< 130
85
High normal
130-139
85-89
Hypertension
Grade 1 (mild)
140-159
90-99
Grade 2 (moderate)
160-179
100-109
Grade 3 (severe)
180
110
Isolated systolic
hypertension
Grade 1
140-159
< 90
Grade 2
160
< 90
JNS Classification:
Category
BP
Normal
Systolic BP (mmHg)
Diastolic BP (mmHg)
90-119
60-79
Pre-hypertensive
120-139
80-89
Stage-1
140-159
90-99
Stage-2
>160
>140
>100
<90
Hypertensive
Isolated systolic
hypertension
HTN
Primary/Essential HTN
95% unknown cause
Secondary HTN
Alcohol
Obesity
Renal
Endocrine
Drugs- OCP, Steroids, NSAID
56 | P a g e
HTN
At least 2 clinical visits

At least 2 times BP measure (5 min interval)
Asses the pt life style/Risk factor

To identify secondary cause
To identify target organ
Rx
Management
Non Drug Therapy/ Life style Modification
Wt reduction: Try to BMI <23

Exercise: Daily minimum 30min/
Reduce salt intake: up to 6 gm daily

Reduce alcohol intake
Intake K+, Ca++ containing food: Milk
Drug Therapy
Step-1: single drug
Age <55 yrs: (ACE Inhibitor)

Age>55 yrs: Thiazide(1st line), ACE inhibitor (2nd line), Ca++ Channel Blocker (3rd
line)
Step-2: Combination
Age <55 yrs: ACE Inhibitor + Ca++ Channel Blocker

Age>55 yrs: ACE Inhibitor + Thiazide
Step-3: ACE Inhibitor + Thiazide + + Ca++ Channel Blocker

Step-4: Previous 3 drug + additional 4th drug (- Blocker)
57 | P a g e
With Co-morbidity
HTN with stable Angina

- Blocker
Ca++ Channel Blocker
HTN with ACS (Acute coronary syndrome)
- Blocker/ ACE Inhibitor (short acting Captopril)
OMI
- Blocker + ACE Inhibitor
(- Blocker is 1st choice in IHD)
HTN with HF
Loop diuretic
ACE Inhibitor
(Don't use - Blocker in HF, but carvedilol may use in stable HF)
HTN with DM
If S.creatinine >3mg/dl130/80 mmhg
Rx
If S.creatinine normalACEI intolaret
140/90 mmhg
Rx
ARB (Angiotensin receptor blocker) use
** ACEI use if S.creatinine <3mg/dl

HTN with CVD
ACE Inhibitor
If one more then thiazide
Malignant HTN/Hypertensive emergency

When HTN associate with end organ damage
Inj. Lebecard (Labetalol)- 2mg/min (1 amp = 10ml=50mg)

5% DA 90 ml + 1amp
IV @ 60 d/m
OR
Inj. GTN (safer)- 100/min
5% DA 500ml + 1 amp
IV @ 15 d/min
Isolated HTN: >140/<190 (Usually in old age)
Ca++ Channel Blocker
58 | P a g e
Resistance HTN
If BP not decrease in use of 3 drugs combination + Diuretic

Re exclude secondary cause
BP measurement right or wrong ?
Pt salt intake
Diuretc add
Pt steroids/OCP/NSAID
F/U- Target goal
, appropiate combination
F/U
NB.
target organ damage
orally Rx
But Suddenly BP
drug change
Target goal
brain
Ischemia
eg. Diuretc
, dose
single drug
slowly (minimum 48-72hrs) BP
maximum dose
130 mmhg but BP not decrease or 150 mmhg
effect
minimum
target goal
try
drug
combination
use
Investigation:
ECG
RBS
Lipid profile
S.creatinine
S.electrolytes
S.urea
Urine R/M/E
Other disease related investigation if present
59 | P a g e
Paediatrics
60 | P a g e
Dosage of Drug
Inj. Ampicillin (IV 500mg/5ml)

Dose: 100mg/kg/day
(
kg
ml)
In Septicemia: 200mg/kg/day
In Meningitis: 400mg/kg/day
Neonate: 12 hrly, Child: 6 hrly divided dose
Inj. Ceftazidim IV/IM
100mg/kg/day
250,500,1gm vial
Cefotaxim IM/IV
50-100mg/kg/day
In severe case: 200mg/kg/day
250mg/5ml, 500mg/5ml, 1gm/10ml
Ceftriaxone IV/IM
50-100mg/kg/day
Meningitis,Enteric fever- 100mg/kg/day
Amoxycillin
50mg/kg/day (TDS)
1 TSF = 120mg
Tab. 250mg, 500mg, 875mg
Tab. phenoxymethyl penicillin
50mg/kg/day (6 hrly). 1 Tab. 250,500mg
Cephradin
30-50mg/kg/day ( 4 hrly)
1 TSF = 125mg
Drop. 100mg/ml/15 drop
1 drop = 7mg
Tab. 250, 500 mg
Cefixime
10mg/kg/day
1 TSF = 100mg
In Enteric fever- 20mg/kg/day
Cefuroxime
20mg/kg/day (BD)
1 TSF = 125mg
Tab. 125, 250, 500mg
Cefpodoxime
10mg/kg/day
1 TSF = 40mg
Inj.Gentamycin
5mg/kg/day (80mg/2ml, 20mg/1ml)
Neonate: < 3kg-Once daily
>3kg BD
Child: 8 hrly
Azithromycin
10-20mg/kg/day
1 TSF = 200mg
Erythromycin
50mg/kg/day 6 hrly)
1 TSF = 125mg
Ciprofloxacin
Neonate: 10mg/kg/day (BD)
Child: 30mg/kg/day (BD)
1 TSF = 250mg
Metronidazole
30mg/kg/ (TDS), 10mg/kg/dose
1 TSF = 200mg
Inj 1 bag= 500gm/100ml
day 6 ml/kg/day (TDS), 2ml/kg/dose
Cloxacillin
50-100mg/kg/day ( 6 hrly)
Inj. 250, 500mg
Cap. 250, 500mg
Drop. 20 drop = 125mg = 1.25 ml
Flucloxacillin
50-100mg/kg/day (6 hrly)
1 TSF = 125mg
Cap. 250, 500mg
Tetracycline
50mg/kg/day (6 hrly)
Cap. 250, 500mg
Co-trimoxazole
10mg/kg/day
1 TSF = 40mg
61 | P a g e
Cefaclor
20mg/kg/day
Cap. 250mg, 500mg
Ofloxacin
15mg/kg/day (12 hrly for 10 days)
1 tab. 200, 400mg
Co-Amoxiclave
25mg/kg/dose (8 hrly)
1 TSF = 125mg
Tab. 250, 500mg
Aldendazole
<2y: 200mg single dose
>2y: 400mg single dose
Tab. 200, 400mg
1 TSF = 200mg
Mebendazole
100mg BD for 3 days
OR
500mg single dose
1 TSF = 100mg
Use: > 2 years of age
Simethicon
15mg/kg/dar (BD)
1ml = 67mg
1ml/5kg = 3 drop/kg
Domperidone
0.4mg/kg/dose
1 TSF = 5mg
1 tab = 10mg
Supp. 15, 30mg
Odansetron
0.2mg/kg/dose (8-12 hrly)
1 TSF = 4mg
1 Tab = 4mg, 8mg
Inj. 1 ml = 2mg
Electro-K
4 mmol/kg/day
1 TSF = 10 mmol
Inj. Konakion (2/10 mg mm)
Neonate: 2 mg mm
1amp P/O stat or 1/2 amp IV stat & 1,5,25
day
Vit-A/Cap. retinol fort
50 thou,1lac,2lac unit
<5month: 50 thousand
5mnt-1yrs: 1lac unit
>1yrs: 2lac Unit
Promethazine/Phenargan
Tab: 10mg (BD)
Syp. 2-5y: 5-15mg
5-10y: 10-25mg
5mg/5ml
Inj. >5y: 6.25-12.5mg (IM)
Adult: 25-50mg (IM/IV)
25mg/1ml
50mg/2ml
Ranitidine
10mg/kg/day
1 TSF = 75mg
1 amp = 50mg/2ml
Zinc
<6 month: 3mg/kg/day
>6 month: 5mg/kg/day
Tab. 10,20mg
Folic acid/Folison
Upto 1 yrs: 0.5mg/kg/day
1-5y- 5mg/kg/day
6-12y- 10mg/kg/day
1 Tab = 5mg
Pheniramine maleate/Avil
Tab. 22.7mg
75mg at bed time
Inj. 50mg/2ml
25-50mg IM/ slow IV (BD)
Syp. 1 TSF = 15mg
5-22.5mg (BD/TDS)
62 | P a g e
Hydrocortisone (100mg/2ml)
5mg/kg/dose (6 hrly)
Dexamethasone
0.4mg/kg/dose
OR
1 mg/kg/day
1 amp = 1ml = 5mg
Tab. 0.5mg
Prednisolone
1-2mg/kg/day
1 1ab. 5, 20 mg
Aminophylline/Filin
LD: 0.2ml/kg/dose
(dilute with equal amount water)
MD: 0.7ml/kg/day
1 amp = 5ml = 125mg
1ml = 25mg (Order- .....ml/100ml saline)
Tab. 100mg
Frusemide
2mg/kg/day
1 Tab = 40mg
Inj 1 amp = 20mg/2ml
Spironolactone
3mg/kg/day
1 Tab = 25mg
Frusemide + Spironolactone
Tab. 20mg + 50mg
Tab. 40mg + 50mg
Fusid plus, Edeloss plus
Nefedipine
0.5mg/kg/dose
1 Tab = 10mg
Theophyllin
1 TSF = 120mg
Tab. Asmanyl 300mg SR
Inj. Phenobarbitone (1ml + 9ml D/W)

1 amp = 1ml = 200mg
LD:
kg
ml stat
MD: 1/8th of loading dose 12 hrly
LD: 20mg/kg/dode
MD: 5mg/kg/day
Sulbutamol
0.4mg/kg/day (TDS)
1 TSF = 2mg
Nebulization dose: 0.2mg/kg/dose + Norsol
Ventolin nebule 1ml = 1mg
Ventolin solution = 5mg
1 Tab = 2mg, 4mg
Diazepam
P/O: 1mg/kg/day (BD/TDS)
P/R: 0.5mg/kg/dose
Ongoing febrile convulsion:
Inj. Sedil (0._ + .....ml D/W)
Ketorolac
< 10 kg: Inj. 10mg 1 amp
10-20kg: Inj. 30mg 1/2 amp
>20kg: Inj. 30mg 1amp
kg
If wt 2kg = 0.2ml, If 12kg = 1.2ml

then dilute
3ml
If necessary repeat the dose 2-3 times 10-15
min interval.
Inj. 10mg/2ml
Supp. 10mg
63 | P a g e
Paracetamol
15/kg/dose (TDS)
Paedi drop = 1ml = 80mg
1 drop = 5mg
Suppo. 60,125,250,500mg
Aspirin
50mg/kg/day
As antirheumatc
Beclofen (Skeletal muscle relaxant)

0.7mg/kg/day (6 hrly)
1 Tab = 10mg
Chloroquine 250mg
25mg/kg; 3 days
Day dose: 1st = 10mg/kg
2nd = 10mg/kg
3rd = 5mg/kg
Avloquin, jsochlor
Quinine
10mg/kg/day (TDS)
Jasoquine)
Diclofen:1-3mg/kg/day (BD)
Suppo.12.5mg, 50mg
Inj. 75mg/3ml
Tab. 25, 50mg
Formula feeding (Biomeal, Lactogen)
Upto 6 month : I
Upto 1 yrs
: II
>1 yrs
: III
In case of acute watery diarrhoea give lactogen free milk
Gastro-fix
O-lac
Baby saline- 5% DA + 0.225% NaCl
Hartsol Plus : 5% DA + H/S
Libott-S junior: 5%DA + 0.45% NaCl
Libott-25: 25% DA
Fluid Mx
1st day- 60ml/kg/day
2nd day- 80ml/kg/day
3rd day- 100ml/kg/day
4th day- 120ml/kg/day
5th day- 140ml/kg/day
5th day-2nd month- 150ml/kg/day
If age 10yrs & wt 25(10+10+5) kg

Then,
1st 10kg = 10 100 = 1000ml
2nd 10kg = 10 50 = 500ml
3rd 5kg = 5 20 = 100ml
Total = 1000 + 500 + 100 = 1600ml/day
>2 month & 1st 10 kg of total wt 100ml/kg/day

For next 10 kg 50ml/kg/day
For next 10kg 20ml/kg/day
64 | P a g e
Drop calculation:
24 hrs
Formula:
Total Fluid in ml
4 hrs
500ml fluid 6 hrs
= 20 d/m
1000ml fluid in Adult
10 d/m takes 24 hrs
20 d/m takes 12 hrs
30 d/m takes 8 hrs
60 d/m takes 4hrs
Fluid
1st day: 10% DA
2nd day: 3yrs: APN, electrodex, Baby saline
>3 yrs: Libott-s junior, H/S Plus
NB:
**In Head Injury

<25 kg-Baby saline
>25 kg- N/S
20% of fluid shoule be reduced in

Birth asphyxia
Any stressful condition
20% fiuid should be added in
Preterm
LBW
If preterm/LBW with Stress/ Birth asphyxia no add or reduction
65 | P a g e
Birth asphyxia/Neonatal Sepsis/Neonatal Convulsion
Fluid: EBF/NG/IV Inf. According to age

O2 Inhalation stat & SOS ( suction if necessary)
Inj.Ampicillin (500mg/5ml)
100mg/kg/day (200mg/kg/day in septicemia)
Inj. Cefotaxim (500mg/5ml)
100mg/kg/day
OR
Inj. Genyamycin (1amp = 80mg/2ml)
1wks 5mg/kg/day, 2nd wks 7.5mg/kg/day (neonate single dose, Child TDS)
Keep the baby warm
Maintain PTR
If convulsion:
Inj. Barbit (1ml + 9ml D/W)

LD:
kg
ml stat
MD: 1/8th of loading dose 12 hrly

Hypoglycemia:
10% DA 5ml/kg IV slowly for 2-3min

Then, 10% DA for 2 days acc. to age
Hypocalcaemia: (1st day- baby of diabetic mother)
IV or Oral 10% Ca-gluconate

5ml/kg/24hrs
OR
1ml/kg (
kg
ml
Dilute
Then, IV slowly Over 20min

500 IU Vit-D P/O per day
Hypomagnesemia:
Mag-sulph 50% solutionb (IM)

0.2ml/kg/dose
Metabolic acidosis:
Sodibicarb (7.5%)
Mix 1ml of NHCO3 with 1ml of 10% DA
Then, give 1ml/kg IV slowly over 5min
66 | P a g e
LBW/Preterm Baby
Keep the baby warm

Airway clearance with suction
O2 Inhalation stat & SOS
Fluid: EBF/NG/IV Inf. According to age
Inj.Ampicillin (500mg/5ml)
Dose: 100mg/kg/day - Prophylactic
200mg/kg/day- septicemia
400mg/kg/day- meningitis
Inj. Cefotaxim (500mg/5ml)
100mg/kg/day
OR
Inj. Genyamycin (1amp = 80mg/2ml)
1wks 5mg/kg/day, 2nd wks 7.5mg/kg/day (neonate single dose, Child TDS)
Inj. konakion
2mg orally at birth
Then, 2mg orally 4-7days later
Multivitamin & folic acid- from 2nd wks of life
10-15 drops once or twice daily
Iron- After 6-7 wks
2-3 mg/kg/day
Wt record on alternative day
Umbilical Sepsis
Cleaning with sprit/genlion violet(1% viola)

Inj. Ampicillin- 200mg/kg/day
Inj. Gentamycin- 5mg/kg/dose (single dose)
Rx of fever by P/C
Clinical feature:
Discharge
Red & inflammed periumbilical area
Foul smell
Fever
Delayed cord falling
67 | P a g e
Neonate Of HBsAg +ve mother
Hb Ig (Hepabig)- 100 IU in 0.5ml IM within 12hrs

+
HB vaccine(Engerix B 10 g in 0.5ml vial
3 dose 0,1,6 month IM in the anterolateral thigh
Rh Incompatibility
Exchange transfusion
1st child Mother:

Rh (-ve) mother & Rh (+ve) child
Give Anti D to mother within 48 hrs
**This anti D reacted wtih Rh antigen, thereby prevent antibody formation, So 2nd baby is not
affected
Neonatal Jaundice
Physiological Jaundice:
Develop after 2-3 days

Unconjugated
Resolved before 10 days
Rx
Phototherapy
IndicationIf S.bilirubun in-
Conjugated(Direct):
Neonatal hepatitis
Extrahepatic biliary atresia
Inborn error of metabolism
Unconjugated(Indirect):
Physiological jaundice
Breast milk jaundice
Crigler-Najjar syndrom
Ongoing haemolysis
Hypothirodism
Term baby: 10-12mg/dl or more

Preterm baby: 15mg/dl or more
Investigation:
S.bilirubin: Direct & Indirect
68 | P a g e
Acute RTI
Keep the baby warm
O2 inhalation
Inj. Ceftriaxone: 50-100mg/kg/day
P/C: 15mg/kg/day
1ml = 15 drop = 80mg
1 TSF syp = 5ml = 120mg
Nasal drop: 1 drop 8 hrly in both nostril
Danger sign:
Stop feeding well
Convulsion
Abnormally sleep
Stridoe,wheez
Fever or low body temp
Bronchodilator: Salbutamol
Oral-0.4mg/kg/dose (8 hrly)
1 TSF = 2mg = 5ml
1 Tab- 2mg, 4mg
Nebulization: 0.15-0.3mg/kg/dose
1 nabule = 2.5mg
1ml solution = 5mg salbutamol
OR
<5 yrs = 0.5ml/dose
>5 yrs = 1ml/dose
Amynophyllin: LD- 5mg/kg over 20min
Then 0.5mg/kg/hrs
1ml = 25mg
Hydrocortisone: 3-4mg/kg/dose (6 hrly)
1 vial = 100mg
Prednisolone: 1-2mg/kg/day (TDS)
1 Tab. = 5mg
No Pneumonia:
No sign of pneumonia
Cough & cold
Pneumonia:(Only for 2month-5yrs)
Fast breathing >40 breathing
Severe pneumonia:
Pneumonia + Chest Indrawing
In case <2 month only fast
breathing ,>60 breathing is called
severe pneumonia
Very severe disease:
Severe pneumonia + Danger sign
UTI
Ciprofloxacin ( 10-20mg/kg/day )-BD

OR
Ofloxacin (15mg/kg/day)-BD
OR
Cefixime (10mg/kg/day)-BD
OR
Azithromycin (20mg/kg/day)-Once daily
More intake of water
Regular emptying of bladder
69 | P a g e
Meningitis
Clinical feature:
Onset is acute
Headache, nausea, vomiting, fever, restlessness, irritability, neck pain, poor
feeding, seizure, coma
Fever, photophobia, neck rigidity, kernig's sign, brudzinki's sign, stupor,coma,
bulge frontanalles
Rx
Inj. Ceftriaxone 100mg/kg/dayOnce daily IV for 15 days

Or
Inj. Ampicillin 400mg/kg/day (6 hrly)
Inj. Cefotaxime 200mg/kg/day (6hrly)
Inj. dexamethasone(oradexon)
0.4mg/kg/dose (BD)
P/C: 15mg/kg/dose
Rx of complication:
Increase intracranial pressure
-IV mannitol 0.5-1g/kg infusion
+
-Inj. Lasix 1mg/kg/dose (BD)
1 amp = 40mg = 2ml)
Casative Organism:
0-2month:
E.coli
S.Agalactic
Listeria monocytogen
S.pneumonia
H.influenza
2-6 yrs:
S.pneumonia
H.influenza
n.meningitidis
6 yrs:
S.pneumonia
N.meningitidis
All age:
TB
Oral Thrush
Dx:
Vomiting
Rx:
Nystat Oral drop
15 drop orally apply twice daily
70 | P a g e
Febrile Convulsion
Per rectal Sedil

kg
If wt 7kg = 0.7ml
then dilute
3ml
(0.7ml + 2.3ml D/W)
Tab. Sedil
1mg/kg/day (TDS)
Syp. P/C: 15mg/kg/dose
Napa suppo: 15/mg/kg/dose ( if temp >101o F)
Syp. Amoxicillin
50mg/kg/dose (TDS)
1 TSF = 120mg
OR
Syp. Cefotim- 8mg/kg/dose (BD)
Reassurance
Advice
Criteria:
Age: 6 month to 6 years, peak 18 month
Family history +ve
Male>Female
Infection: 90% cases
o Pharyngitis
o Otitis Media
o UTI
o Pneumonia
o Roseola
Seizure occur with a rapid rise of
temparature
Onset within 24 hrs of illness
Type- Generalized tonic clonic
Duration 15 min
Tetanus
NPO TFO
IV infusion 5% or 10% DA
Inj. TIG
1 amp in each buttock stat
Inj. C-penicillin
1 lac unit/kg/day (6 hrly)
Inj. Sedil- 3mg/kg/dose IV ( 6 hrly)
OR
Inj. midazolam-0.2mg/kg
71 | P a g e
AGN
Bed rest
Fluid restriction:
Body surface area 400 ml + previous day output
Antibiotic:
Phenoxymethyl penicillin: 50mg/kg/day (6 hrly)
1 Tab = 125mg, penvik fort 1 tab = 250mg
Control of Oedema: Salt restriction, no added salt
Tab. fusid- 2-4mg/kg/day (BD)
1 tab = 40mg
Control of BP: Tab. Nifin 10mg (0.0.6mg/kg/day)
Body surface area

Wt(kg) 4 + 7
Wt(kg) + 90
NS
Bed rest
Salt & water restriction if Oedema present
Tab. Frusemide
1-2mg/kg/day (BD)
+
Tab. Spironolactone
2-3mg/kg/day (BD)
Prednisolone
60mg/m2 body surface area/day in 3 divided dose until urine become protein free.
Then, 60mg/m2/day single dose every alternate day for 3-6 month
If frequent relapse
-Prednisolone 2mg/kg/day until urine become protein free for consecutive 3 day
followed by alternate day 0.5-1mg/kg/day fro wks
-Cyclophosphamide
2mg/kg/day (8 hrly)
Antibiotic
Phenoxymethyl penicillin
72 | P a g e
Asthma
Sulbutamol
Oral: 0.2mg/kg/day (TDS)
Syp. 1 TSF = 2mg, Tab. = 2mg, 4mg
Inhaler: 2 puffs 12 hrly
Nebulization: 0.15-0.3mg/kg/dose
1 Nabule = 2.5 mg
1ml solution = 5mg
Sulmeterol: 2 puff 12 hrly
Hydrocortisone: 3-4mg/kg/dose (4-6 hrly)
1 vial = 100mg
Prednisolone: 1-2 mg/kg/day (TDS)
1 Tab = 5mg
Aminophylline: LD- 5mg/kg followed by 0.5mg/kg/hrs
1 ml = 25mg
Beclomethasone: 1-2 puff 6 hrly
Fluticasone: 50-100gm (BD)
MgSO4: 25-50mg/kg (Inj. 5ml = 2.5mg)
Kititifen: 1mg BD with food (asthma with allergic reaction)
1 Tab = 1mg
Ascariasis
Levamisole
3mg/kg/dose (single dose)
1 TSF = 40mg
1 Tab = 40mg
Adult dose- 3 tab stat
OR
Mebendazole
100mg 12 hrly for 3 days
1 TSF = 100mg
OR
Pyrantel pamoate
73 | P a g e
Diarrhoea
Acute- <14 days

Persisten- >14 days
Dysentry- Passes of bloob
Trait
No dehydration
Some
Severe
Appearance
Well,alert
Restless,irritable
Uncoscious,irritable
Thurst
normal
Drink eagerly
Unable to drink
Skin pinch
Goes quickly
Slowly(2sec)
Very slowly
Eye
Not shunken
shunken
shunken
No sign of dehydration
Home Mx: 3 golden triad
1)More fluid:
<2 yrs:10-20 TSF (50-100ml) after each motion
>2-5 yrs: 20-40 TSF (100-200ml) after each motion
> 5 yrs: as much he drinks
2)More food
3)Referral knowledge
Many watery stool

Repeated vomiting
Mark thrust
Eating & drinking poorly
Fever & loose stool
74 | P a g e
Some sign dehydration

ORS: 75mg/kg over 4 hrs
OR
(
kg
IV correction if:
Some dehydration + 3 or more vomiting + high purging rate(15 purging/hrs)
+ Impending paralytic ilium(abdominal distension) + lactose Intolerance
Drop calculation:
75 wt
4 4(hrs)
= .... d/m
Drug:
<6 month: Syp. Erythromycin -40-50mg/kg/day (6 hrly)

Eromycin paedi drop 1 drop = 40mg (1 ml = 15 drop)
>6 month: Syp. Azithromycin- 10-20mg/kg/day Once daily (1 TSF = 200mg)
Syp. Zinc: 2-3 mg/kg/day 8 hrly (1 TSF = 10mg)
Syp. Electro-k: 3mmol/kg/day 8-12 hrly (1 TSF = 10mg)
Syp. Odansetrone:0.2mg/kg/dose 8-12 hrly
(1 TSF = 4mg, 1 Tab = 4mg/8mg, Inj. 1ml = 2mg)
Syp. Metronidazole: 30mg/kg/day 8 hrly (1 TSF = 200mg)
Vit-A:
< 6 month: 50 thousand
6 month- 1 yrs: 1 lac unit
>1 yrs: 2 lac unit
If desentry:
Syp. Cotrimoxazole/Ciprofloxacin/Azithromycin/Cephradin/Cefixim/Flucloxacillin
75 | P a g e
Severe dehydration
IV fluid 100ml/kg
**Under 1 yrs correction should be done within 6 hrs

Age
<1 yrs
>1 yrs/Older
First give 30ml/kg in

1 hrs
0.5 hrs (30 min)
Then 70ml/kg in
5 hrs
21/2 hrs
<6 month: Syp. Erythromycin -40-50mg/kg/day (6 hrly)

Eromycin paedi drop 1 drop = 40mg (1 ml = 15 drop)
>6 month: Syp. Azithromycin- 10-20mg/kg/day Once daily (1 TSF = 200mg)
OR
Syp. cefaclor/Loracef : 20mg/kg/day 12 hrly (1ml = 40mg)
OR
Syp. Ofloxacin: 15mg/kg/day 12 hrly for 10 days
Near drowing
CPR if necessary
High flow O2 inhalation
Left lateral position
Keep the baby warm
IV fluid- NS
If convulsion: Inj. Berbit (1ml + 9ml D/W)
o LD:
kg
ml stat
o MD: 1/8th of loading dose 12 hrly

Antibiotic: Inj. amoxicillin
50mg/kg/day 3 divided dose
Pathophisiology:
Ischemic-anoxic
injury
Pulmonary
aspiration
Hypothermia
Cardiac arrest
Cerebral oedema
Near drowning: If pt does not died within 24 hrs

Drowning: If pt must be died within 24 hrs
76 | P a g e
Malaria
Tab. Chloroquine(jasochlor): 25mg/kg/dose- 3 days schedule

1st day- 10mg/kg/dose Single dose (A/M)
2nd day- 7.5mg/kg/dose single dose (A/M)
3rd day- 7.5mg/kg/dose single dose (A/M)
4th day- Tab. Primaquine: 1mg/kg single dose
Treatment Failure malaria
Day 1- Quinine (jasoquine)

10mg/kg/dose (TDS)
Jasoquine 1 tab = 300mg
Day 2- Quinine
10mg/kg/dose (TDS)
Day 3- Quinine
10mg/kg/dose (TDS)
+
Sulphadoxime & Pyramethamine
Sulphadoxime: 25mg/kg
Pyramethamine: 1.25mg/kg single dose
Day 4- Primaquine
Enteric Fever
Inj. Ceftriaxone: 100mg/kg/day- for 14 days

OR
Inj. Ceftriaxone: 100mg/kg/day- for 7 days
+
Oral. Cefixim: 10mg/kg/day 12 hrly (1 TSF = 100mg)
Syp. P/C
Tepid sponging
77 | P a g e
PEM (Protein Energy Malnutrition)

Diagnostic criteria for PEM
Wt for age: Gomez Classification:
Wt for age
76-90
61-75
<60
Grade of malnutrition
G-1, mild
G-2, moderate
G-3, severe
Welcome trust classification:

Wt for age
60-80
<60
With oedema
Kwashiorkor
Marasmic Kwashiorkor
Without oedema
Undernutrition
Marasmur
Classification based on MUAC

Circumference
>13.5 cm (green)
12.5-13.5 cm (yellow)
<12.5 cm (red)
Level of nutrition
Normal
Borderline
Malnourished
Classification based on BMI

BMI = Wt in kg/m2 of height or length
BMI
>20
18.5-20
17-18.4
16-16.9
<16
Level of Malnutrition
Normal
Marginal
Mild
Moderate
severe
78 | P a g e
Management of PEM
1) Prevention of hypoglycemia
If pt conscious: give 50ml of 10% glucose or F-75 Diet

2-3 hrly by mouth
If pt unconscious: give 5ml/kg 10% glucose IV
Followed by 10% glucose by NG tube
2) Prevention of hypothermia
3) Correction of dehydration if present
Re-So-Mal (rehydration solution for malnourished)
70-100ml/kg over 12 hrly
Starting 5ml/kg every 30 min for 2 hrs
Then, 5-10 ml/kg/hrs orally or NG
Preparation of Re-So-Mal
ORS 1 pack in litre of water
+
25gm sucrose
+
20ml of mineral mix solution/ syp. electro-k (2 TSF)
4) Rx of septic shock
Inj. Ampicillin (100mg/kg/day)
Inj. gentamycin (7.5mg/kg/day)
5) Dietary Rx
Total energy requirement is 100kcl/kg/day
Fluid requirement is 100ml/kg/day
Feeding should be given 2 hrly ( 12 feeding)
Feeding should be F-75
F-75: 100 ml of fluid contain 75 kcl of energy
79 | P a g e
Example
Suppose the wt of the baby is 5 kg
So, total fluid requirement is = 5 130 = 650 ml
In, F-75 diet
100 ml contain 75 kcl
So, 1 ml contain 75/100 kcl
So, 650 ml contain (75 650)/100 ml
= 487.5 kcl
In, 12 feeding,
Per feeding fluid require (650 12) = 54.11 ml or 55ml
And energy require (487.5 12) = 40.65 kcl
So the fluid should be made by 55ml of D/W containing 40.65 kcl energy
Energy available
1 TSF milk
=20 kcl
1 TSF sugar
=20 kcl
1 ml soyabin oil = 9 kcl
So, we should made the fluid with
(3/4 TSF of milk + 3/4 TSF of sugar + 1 ml of soyabin oil) = 40.65 kcl energy
6) Correction of Vitamin deficiency
Vit-A supplementary is given (Day-1,Day-2,Day-3)
Dose: <6month: 50 thousand
6mnt-1yrs: 1lac unit
>1yrs: 2lac Unit
(Cap. retinol forte, 1 cap = 50,000 unit)
Folic acid supplementation
Day 1 - 5mg orally, then 1mg daily
Multivit drop- 10 drops/day
Kerosene Poisoning
NPO TFO
O2 inhalation
IV infusion: Inf. baby saline
Antibiotic: Inj/Oral amoxycillin
Inj. Ranitidine- 5mg/kg/dose (8-12 hrly)
1 TSF = 75 mg
80 | P a g e
Dose of dopamine
10 g/kg/min
Example
If wt 20kg
Then, 20 10 = 200 g/min
= 200 60 g/hrs
= (200 60)/1000 mg/hrs
= 12 mg/hrs
We know
40 g = 1 ml
So, 1 g = 1/40 ml
So, 12 = (1 12)/40 = 0.3 ml
How to give?
20 ml/kg/hrs in NS
If wt is 20 kg, 20 20 = 400ml
+
0.3 ml (dopamine)
= 400.3 ml/hrs
Drop calculation
We know,
Total fluid/(4 hrs)
So, 400.3ml/(4 1 hrs) = 100 d/m
81 | P a g e
SURGERY
82 | P a g e
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. Berbit
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
Physical assault (P/A) (
Cap. cephradin 500mg/ flucloxacillin 500

1+1+1+1
1+0+1 (b/m)
Tab. ketorolac 10mg/Diclofenac 50mg
83 | P a g e
Massive cut Injury or P/A
NPO TFO
Inf. H/S 3000cc
IV stat @ 30 d/m
Inj. Ceftriaxone
1 vial IV stat & daily/BD
Inj. Omeprazole 40 mg
1 vial IV stat & BD
Inj. Ketorolac 30mg
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: -prolin/Silk (cutting body)- for skin
-Vicryl (R/B)- for muscle
Small cut injury
Cap. Cephradin 500mg/Flucloxacillin 500mg

1+1+1+1
1+0+1 (b/m)
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
84 | P a g e
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/m
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
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:
Plane X ray of abdomen in erect posture including both dome of diaphragm
USG of W/A
Blood for Grouping & cross matching
85 | P a g e
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/m
Inj. Cefuroxime
1 vial IV stat & BD/TDS
Inj. Metronidazole
1 Bottle IV stat & TDS
Inj. Omeprazole
1 vial IV stat & BD
Inj. Algin
1 amp IM stat & TDS
OR
Inj. Butapan- 1 amp IM stst & TDS
+
Inj. Nospa- 1 amp IM stat & TDS
In case of biliary ascariasis
3 levamisol tab stat
Investigation:
USG of HBS
S. amylase
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
86 | P a g e
Accidental fall from height
Diet. If pt unconsciousness then NPO TFO with Inf. NS

If conscious then diet Normal
Tab. Cefuroxime 500mg (1+0+1)/ Tab. Cephradin 500mg(1+1+1+1)
1+0+1 (b/m)
Tab. Naprosyn/onap/Naprox
1+1+1 (a/m)
Tab. Myotil (muscle relaxant)
1+0+1
Investigation:
Plain X-ray of L/S spine both view

Sometimes X-ray of T/L both view
Abscess
Incision & drainage

Cap. flucloxacillin 500mg
1+1+1+1
+
Cap. Cephradin 500mg
1+1+1+1
1+0+1 (b/m)
Tab. Ketorolac 10mg/Diclofenac 50mg
Tab. Ceevit 250mg
1+1+1
Regular dressing
87 | P a g e
Ulcer
Cap. flucloxacillin 500mg

1+1+1+1
OR
1+1+1+1
1+0+1 (b/m)
Tab. Ketorolac 10mg/Diclofenac 50mg
Tab. Ceevit 250mg
1+1+1
Retention of Urine/ Structure urethra

Main Mx is:
Try to catheterization- to try for 1 time

Supra pubic puncture (by saline set)
Supra pubic cystostomy
Drug:
Tab. ciprofloxacin 500mg

1+0+1
1+0+1 (b/m)
If pain, Tab. Ketorolac/Diclofenac
88 | P a g e
BEP (Benign Enlargement Of Prostate)
Main Mx is operative
Initial catheterization
Tab. Uromax/Maxrin (0.4mg)
0+0+1
Tab.Ciprofloxacin
Tab. Omeprazole
Sympypmatic
Hernia & Hydrocele
Main Mx is Operative
But initial:
Tab. Levamisol- 3 Tab stat

Inj. Titavax- 1 amp IM stat
Cap. Omeprazole- 1+0+1 (b/m)
Symptomatic Rx
PVD(Peripheral vascular Disease)
Diet. Normal
Avoidance of smoking
Cap. cephradin 500mg- 1=1+1+1
Cap. Omeprazole 20mg- 1+0+1 (b/m)
Tab. Oxifil CR 400mg- 1+0+1
Tab. cinaron- 1+1+1
Tab. diclofecac- if pain
Tab. Sedil- 0+0+1
89 | P a g e
Haemorrhoids /Anal fissure/rectal prolapse
Tab. Metronidazole
1+1+1
Cap. Omeprazole
1+0+1 (b/m)
Tab. Algin/Clofenac- If pain
Tab. F/S
1+0+1
Tab. Levamisol- 3 tab stat
Syp. Avolac
4 TSF BD
Hip bath
3 times daily & after defeacation
Anustat Ointment
Apply before & after defeacation
Peri-Anal Abscess
Cap. Cephradin 500mg/Flucloxacillin 500 mg

1+1+1+1
1+1+1
Cap. Omeprazole
1+0+1 (b/m)
Tab. Ketorolac/Clofenac
Tab. Ceevit 250mg
1+0+1
Hip bath
3 times daily & after defeacation
90 | P a g e
Gut Preparation for Surgery

(Colostomy closure, Hemicolectomy & Other)
For 3 days
Low residual diet (Bread, Milk, liquid diet)

Syp. Lactolose
4 TSF BD
1+0+1
1+1+1
Enema simplex 2 times (12 hrly)
On previous day of OT morning
Gut Preparation for IVU

X-Ray KUB
For 3 days
Low residual diet (Bread, Milk, liquid diet)

Tab. Ultracarbon
2+2+2
Tab. Laexena
0+0+2
OR
Syp. Lactolose/Avolac/Inolac
4 TSF BD
91 | P a g e
EYE
Age related Cataract (ARC)
Diet. Normal
Cloramphenicol E/D: 1 drop 6 hrly
Tab. Ranitidin 150mg: 1+0+1 (b/m)
Tab. Sedil: 0+0+1
Tab. Ibuprofen: 1+0+1 (a/m)
Tab. B/C: 1+0+1
Chronic Dacrocystitis (CDC)
Diet. Normal
Cloramphenicol / Moxifloxacin E/D: 1 drop 6 hrly
Cap. Amoxycillin 500mg: 1+1+1 OR Cap. Lebac 500mg: 1+1+1+1
Tab. Ranitidin 150mg: 1+0+1 (b/m)
Tab. Sedil: 0+0+1
Tab. B/C: 1+0+1
Acute Congestive Glaucoma
Diet. normal
Pilo 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 2 hrs
Then, 1 drop 12 hrly
Sonexa E/D: 1 drop 4 hrly
Tab. Acemox (Acetazolamide)
1+1+1+1
Tab. Electro-K
1+1+1
Timopress/Temo E/D
1 drop 12 hrly
Tab.Ranitidin
1+0+1 (B/M)
Tab. Ketorolac/Diclofenac
OR
1 drop 4 hrly
92 | P a g e
Fungal Corneal Ulcer
Bed rest
Use sun glass, Avoid water
Diet. Normal
Natamycin E/D: 1 drop 3 hrly
Moxifloxacin E/D: 1 drop 3 hrly
Atropin E/D: 1 drop 3 hrly
Cotrimazole E/O: at bed time
Tab. Levofloxacin 500mg: 0+1+1
Tab. Fluconazole 50mg: 0+1+0
Tab. Ranitidin: 1+0+1 (b/m)
Tab. Ketorolac 10mg: 1+0+1 (a/m)
Tab. Vit-C: 1+0+1
Tab. Sedil: 0+0+1
If Hypopion present:
Tab. Acemox: 1+1+1+1

Tab. Electro-K: 1+1+1
Viral Keratitis
Diet. Normal
Clovir E/D: 1 drop 6 hrly 3 wks
Cloramphenicol E/D: 1 drop 4 hrly
Atropin E/D: 1 drop8 hrly
Analgesics
Tab. Ranitidin
Tab. B/C
Tab. Ceevit
Ocular Injury
Bed rest
Haemostasis if needed
Give eye pad after proper dressing with giving antibiotic oint.
Tab. Antibiotic
Tab. Ranitidin
Tab. Ketorolac
Tab. Sedil
Tab. Vit-C
93 | P a g e
ENT
Epistaxis
Pressure over the Ala of the nose

Ice over the nasal bridge (If H/O trauma)
Inj. Traxyl-3 amp IV stat & SOS
Antazol 0.1%/Rhinozol nasal drop
5 drop in each nostril 3 times daily
IV nfusion- H/S 1000cc
Antibiotc- Inj. Amoxycillin/Cloxacillin
Tab. Lorfast- 0+0+1
Tab. Sedil- 0+0+1
BP measure if pt hypertensive
F.B Larynx/Trachea
O2 inhalation
Inj. Dexamet- (to prevent laryngeal Oedema)
IV Infusion
Antibiotic
Analgesics
H2 Blocker
Advice: X-ray soft tissue neck A/P & lateral view.
F.B Pharynx/Oesophagus
NPO TFO
IV infusion
Omeprazole
Analgesics
H2 blocker
Advice: X-ray soft tissue neck A/P & lateral view.
94 | P a g e
Acute Epiglottitis
Inj. Amoxycillin/Flucoxacillin
Inj. Ranitid/Omeprazole
Tab. Histacin: 1+0+1
Tab. Sedil: 0+0+1
Clue to Dx:
Hoarsness of voice
Dysphagia
O/E- Epiglottis
Thick
Swollen
Inflam
Hanging
1st to see stridor: If present- Tracheostomy
NPO TFO
O2 inhalation
IV infusion
Inj. dexamet- To prevent laryngeal oedema
Inj. Ketorolac
Inj. Berbit: 1 amp IM stat & 1/2 amp BD
DNS
Cap. Amoxycillin
Cap. Omeprazole
H2 blocker
Analgesics
Antazole Nasal drop( 0.1% )- 3 drops in each nostril BD
95 | P a g e
CSOM
Tab. Ciprofloxacin
Tab. P/C
Cap. Omeprazole
H2 blocker
Gentin HC ear drop- 3 drops in each ear 3 times daily
Traumatic Rupture Of TM
Inj. cefradin
Inj. Ranitidin
Inj. Diclofenac
Tab. Omidon:1+0+1
Tab. Sedil: 0+0+1
Gentin HC ear drop: 3 drop 3 times daily in effected ear
Sub-mandibular Growth
Cap. Amoxycillin
Cap. Omeprazole
Tab. F/S: 0+1+0
Povisep mouth wash: 3 TSF in 1 glass of water then gargle 3 times daily
Nasal Mass With HIT
Cap. Amoxycillin
Cap. Omeprazole
Tab. P/C
H2 blocker
Antazole Nasal drop- 3 drops in each nostril BD
96 | P a g e
Rhinosporidiosis
Tab. Dapsone 100mg

1+0+0
Cap. omeprazole
1+0+1(b/m)
Tab. sedil
0+0+1
Tab. B/C
1+0+1
Antazole nasal drop 0.1% - 3 drops in each nostril 3 times daily
Nodular Goitre
Tab. Ciprofloxacin
1+0+1
Cap. omeprazole
1+0+1 (b/m)
Tab. sedil
0+0+1
Tab. B/C
1+0+1
Tab. F/S
1+0+1
Advice:
USG of thyroid
T3, T4, TSH

FNAC of thyroid
Cervical Lymphadenopathy
Tab. Ciprofloxacin
1+0+1
Cap. omeprazole
1+0+1 (b/m)
Tab. sedil: 0+0+1
Tab. F/S: 1+0+1
97 | P a g e
Parotid Abscess

1+1+1+1
Inj. Genyamycin: 8 hrly
Tab. Neotack
1+0+1 (b/m)
Tab. diclofenac
1+0+1 (a/m)
Tab. Sedil
0+0+1
Maxillary Sinusitis
Cap. Cephradin- 7 days

1+1+1+1
Tab. Alatrol- 7 days
0+0+1
Tab. Pantid 20mg- 15days
1+0+1
Antazole nasal drop 0.1%
drop in each nostril 3 times daily
Tab. P/C
1+0+1
98 | P a g e
Gynae & Obstetrics
99 | P a g e
GYNAE & OBSTETRICS

Common pt in Obs
FTP
FTP with PET
FTP with Eclampsia
Post partum Eclampsia
Obstructed Labour
APH
PPH
Shock
IUD
Retained Placenta
Common Pt in Gynae
PV bleeding
Incomplete Abortion/ threaten Abortion
DUB
Genital Prolapse
Perineal tear
Ectopic Pregnancy
VVF
Indication of C/S
Previous H/O C/S

Obstructed labour & failed medical Induction (FMI)
Post dated pregnancy
Eclampsia
RM with Oligohydramnios if AFI <8 (on USG)
Less foetal movement
Presentation
Breech
transverse
100 | P a g e
OBS
FTP with Normal Finding/Normal Labour
Wait for NVD (Give NVD list to the pt)

Cap. Cephradin 500mg: 1+1+1+1
Tab. Pantoprazole 20mg
Advice: Blood for grouping & cross matching
During active stage of labour
Inf. H/S 1000 cc

IV @ 20 d/min
Inj. Algin
2 amp IM stat
Emptying of bladder by catheter
After delivery & expulsion of placenta
Inj. Piton 4 amp in drip/ 2 amp IM & 2 amp in drip (Just after delevery of the baby)
Tab. Isovent/Cytomis 600mg
1 tab P/R stat
If PPH- Inj. Urgot 1amp IM stat
FTP with PET

Finding:
BP raised
Oedema
Rx
Diet. Normal
Tab. Pantoprazole
Tab. Sardopa (alfa-methyldopa): 1+1+1
If not controlled then given dose (2+2+2) even (2+2+2+2)
(Target BP- Systolic: 130-140 mmhg, Diastolic: 90-100 mmhg)
Tab. Nidipin SR (Nifedipin): 1+0+1
Tab. Sedil: (0+0+1) OR Tab. Berbit 30mg: (0+0+1)
101 | P a g e
Eclampsia
Finding:
BP raised
Oedema
Convulsion
Unconscious
NPO TFO
O2 inhalation (if needed)
Inf. H/S 1000ml
IV @ 20 d/m
Inj. Sedil: 1-2 amp dilute with 5cc D/W
IV slowly over 5 min
Inf. Nalepsin (mag sulph)
1st bag IV running
2nd bag 12 d/m
3rd bag 6 d/m
(24 hrs from last convulsion)
Inj. Cephradin 500mg
Inj. pantoprazole 40mg
1 vial IV stat & BD
Maintain PTR chart
Rx
** Catheterization must be done before Nalepsin give

Advice:
Arrange 2 or 3 bags blood

Counseling to the pt party that pt & baby's condition are not good, anything can happen
C/s list give & Pt ready to C/S
Post Partum Eclampsia

Almost same as Eclampsia treatment
102 | P a g e
Retained Placenta
Not try to remove placenta without blood & senior.
General Mx
Open IV channel
Blood grouping & cross matching
Ready match blood transfusion
Catheterization
Specific Mx
If bleeding- placenta should be delivered by 2 amp oxitocin IM stat & uterine

message
If placenta Separated & retained- Control cord traction
If placenta unseparated- Manual removal of placenta by G/A
If placenta retained with sepsis- Intra uterine swab for C/S & board spectrum
antibiotic
If only morbid adherent placenta- Only antibiotic
IUD
Diet. Normal
Cap. Cephradin 500mg: 1+1+1+1
Tab. Pantoprazole 20mg: 1+0+1 (b/m)
Tab. Cytomis: 1/2 +0+ 1/2
OR
Inj. Cytomis 4 amp in 1000cc H/S in drip
Tab. F/S: 1+0+1
Tab. B/C: 1+0+1
Wait for expulsion of dead baby
Advice: Arrange blood if necessary
103 | P a g e
Obstructed Labour
(Failed medical induction, Try to done delivery at home)
History:
Pt party
delivery
)?
saline or Vasofix
labour pain
history positive
pt party
history
Findings:
Vulvular swelling/Oedema
Distended bladder
P/V: Rupture membrane
Head of the baby obstructed
NPO TFO
IV infusion 5% DA- 30 d/m
Inj. Ceftriaxone 1gm/ Inj. Cefradin 500mg
Inj. Ranitidine
Urgent continuous catheterization
Pls. maintain PTR chart
Rx
Advice:
Counseling
Ready for Urgent C/S
104 | P a g e
APH
NPO TFO
Inf. H/S 1000cc + 5% DA 1000cc
IV stat @ 30 d/m
Inj. Cefradin 500mg: 6 hrly
Inj. Ranitidin: IV 1 amp stat & BD
If pain: Inj. Algin 1amp IM stat & TDS
If bleeding present: Inj. Traxyl 1 amp IV 8 hrly
Catheterization
Maintain PTR chart
Blood transfusion if necessary
If bleeding not control- Ready to pt for emergency C/S by taking written informed
concent
PPH
NPO TFO
Inf. H/S 1000cc + 5% DA 1000cc
IV stat @ 30 d/m
Inj. Urgot
1-2 amp IM stat
Inj. Cefradin 500mg: 6 hrly
Inj. Ranitidin: IV 1 amp stat & BD
If pain: Inj. Algin 1amp IM stat & TDS
If bleeding present: Inj. Traxyl 1 amp IV 8 hrly
Catheterization
Maintain PTR chart
Blood transfusion if necessary
105 | P a g e
Hyperemisis Gravidarum
NPO TFP
Inf. HS 2000cc + 5% DA 1000cc
(With 1 amp vit B-50 forte + 1 amp ascoson in each bag)- IV @ 30 d/m
Inj. Pantoprazole 40mg
Inj. Emistat
1 amp IV stat & 8 hrly & sos
Or
Inj. Paloxy- 1 amp stat
Inj. Sedil. 1 amp IM stat
Shock
If pulse not palpable & BP not recordable Then, Dopamine drip given
Inf. 5% DA 500cc + 2 amp dopamine
IV stat 6-8 d/m
If hypovolumic shock due to loss of excessive blood
Then, blood transfusion done
also give Inf. H/S 2000ml
30 d/m IV stat
If bleeding then, Inj. traxyl- 1 amp I/V 8 hrly
Otherwise conservative Rx conyinue
If U/O nil & BP normal then : Inj. Lasix 2 amp
Nice to know
delivery
breast milk suppressive
drug
Tab. bromodil: 1+0+1

After C/S if complain cough
Tab. Bexidal/Tab. Purisal (1+0+1)
OR
Syp. Ofcof/Ambrox : 2 TSF TDS
After delivery Breast milk
Tab. Omidon: 2+2+2
Tab. Hollyseed/Lactogen: 1+0+1 (if pt rich)
106 | P a g e
Gynae
PV Bleeding
Diet. NPO TFO

Inf. H/S 2000cc + 5% DA 1000cc
IV stat @ 30 d/m
Inj. Cefradin: 6 hrly
Inj. Ranitidin: 12 hrly
Inj. Traxyl: 8 hrly
Inj. algin: 8 hrly - (If pain)
Blood transfusion immediately
Advice:
USG of pregnancy profile (if pregnant)

OR
USG of lower abdomen
Incomplete Abortion
If huge P/V bleeding present then Rx as above but antibiotic must be Ciprofloxacin &
Metronidazole Combination.
Otherwise Rx will be as below
Diet. Normal
Tab. ciprofloxacin 500mg: 1+0+1
Tab. Metronidazole: 1+1+1
Tab. Algin: 1+1+1
Cap. Traxyl: 1+1+1
Tab. F/S: 1+0+1
Tab. B/C: 1+0+1
Advice:
Blood for grouping & cross matching

USG of lower abdomen
Arrange blood
107 | P a g e
Threatened Abortion
Diet. Normal
Cap. Cefradin 500mg: 1+1+1+1
Tab. Algin: 1+1+1
Tab. F/S: 1+0+1
Tab. B/C: 1+0+1
If bleeding-Cap. Traxyl: 1+1+1
Advice: USG of Pregnancy profile
DUB/Fibroid Uterus
Diet. Normal
Tab. Omeprazole 20mg: 1+0+1 (b/m)
Tab. Algin: 1+1+1 (If pain)
Tab. F/S: 1+0+1
Tab. B/C: 1+0+1
Advice: USG of Lower abdomen
Genital Prolapse
Diet. Normal
Tab. Omeprazple 20mg: 1+0+1 (b/m)
If constipation then, Syp. Avolac: 3 TSF TDS
If pain-Tab. Algin: 1+1+1
Cap. Traxyl: 1+1+1
Tab. F/S: 1+0+1
108 | P a g e
Ectopic Pregnancy

Tab. Metronidazole 500mg: 1+1+1
Tab. Ranitidin/Pantoprazole: 1+0+1 (b/m)
Tab. Diclofenac
Tab. F/S: 1+0+1
Tab. B/C: 1+0+1
** In case of rupture ectopic pregnancy 1st asses the pt feature of shock & treat the pt acc.
to pt condition
Perineal Tear
Perineal tear should be repair within 24 hrs otherwise 3 months later.

Tab. Ranitidin/Pantoprazole: 1+0+1 (b/m)
Tab. Diclofenac
Tab. F/S: 1+0+1
Tab. B/C: 1+0+1
VVF
Diet. Normal
Tab. Ciprofloxacin 500mg: 1+0+1
Cap. Omeprazole 20mg: 1+0+1 (b/m)
Tab. F/S: 1+0+1
Tab. B/C: 1+0+1
109 | P a g e
PID
Adequate rest
Analgesic
Antibiotic- Amoxicillin/Doxycycline/Tretracycline
If not response within 48 hrs then hospitalization
NPO TFO
IV channel open & all drug should be given parenterally
1 vial IV stat & daily
Inj. Metronidazole 100ml
Investigation:
High vaginal swab for gram stain
& c/s
1 vial IV stat & BD
Urine for R/M/E
Voltalin Suppository
Blood for c/s (if fever present)
1 stick P/R stat & SOS
Post Conductive order(In Obs)/Post Expulsive Order(In Gynae)
NPO For 6 hrs

Inf. H/S 1000cc: IV stat @ 30 d/m + 4 amp piton
Inj. cefradin: 1 vial IV stat
Inj. Metronidazole: 1 bottle IV stat
Inj. Ranitidin: 1 amp IV stat & slowly
Inj. Diclofenac: 1 amp IM stat
Cap. Retinol fort (50000 IU): 4 cap P/O stat
After 6 hours
Diet. Soft then normal

Tab. Ranitidin/Omeprazole: 1+0+1 (b/m)
Tab. Diclofenac: 1+1+1 or 1+0+1
Tab. Ceevit 250mg: 1+0+1
For Baby: Inj. Konakion(2mg mm) per orally stat
110 | P a g e
Bowel Preparation On 1st day
Non residual diet (ORS/Coconut water/Glucose water)

1+0+1
Tab. Metronidazole
1+1+1
Tab. Ranitidine
1+0+1 (b/m)
Tab. Duralex
2+2+2
Tab. Laexena
0+0+2
Bowel Preparation On 2nd & 3rd day
NPO (except glucose water & medication)

Inf. Cholera saline 400mg
IV @ 40 d/m
Inf. Manitol 500ml
1 glass at morning & 1 glass at night (Oral)
Inj. Ciprofloxacin 100 ml
1 bag IV stat & BD
Inj. metronidazole
Inj. Omeprazole
1 vial IV stat & BD
Tab. Duralex
2+2+2
Tab. Laexena
0+0+2
111 | P a g e

RX Protocol

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RX Protocol

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Treatment Protocol

Special Thanks To:

Edited By: Dr. Md. Anwarul Azim (SM-2)

Snake bite (poisonous)

Snake bite (Non-poisonous)

Acute Gastritis (Food poisoning)

Chronic Gastritis/Gastric ulcer

Mallory weiss syndrome

Ulcerative Colitis (Bloody Diarrhoea)

Acute Viral hepatitis

Hepato Cellular Carcinoma

Fatty change of Liver

Hyperkalemia (K > 5.5 mmol/L)

Enteric Fever/ Typhoid

Cerebral Malaria/Severe Malaria

Fever Under Evaluation/UTI/RTI

Acute Migraine attack

Vertigo with Headache

Mumps & Orchitis

Steven Jonson Syndrome

Fe Chelating agent in Thalassaemic PT

Low Back Pain

GAD (Generalized Anxiety Disorder)

OCD (Obsessive Compulsive Disorder)

PPP (Post Partum Psychosis)

SRD (Substance related disorder)/Sleeping Pill

ASD (Acute Stress Disorder)

Seborrhoeic Dermatitis/ Seborrhoeic Folicuitis

White Discharge from Breast

Skin Wart/Hard skin

SVT (Supra Ventricular tachycardia)

Birth asphyxia/Neonatal Sepsis/Neonatal Convulsion

Neonate Of HBsAg +ve mother

PEM (Protein Energy Malnutrition)

Physical assault (P/A)

Massive cut Injury or P/A

Small cut injury

Acute case of intestine/ Acute Emergency

A case of Hepato-Biliary system

Accidental fall from height

Retention of Urine/ Structure urethra

BEP (Benign Enlargement Of Prostate)

Hernia & Hydrocele

PVD(Peripheral vascular Disease)

Haemorrhoids /Anal fissure/rectal prolapse

Gut Preparation for Surgery

Gut Preparation for IVU

Age related Cataract (ARC)

Chronic Dacrocystitis (CDC)

Acute Congestive Glaucoma

Fungal Corneal Ulcer

Nasal Mass With HIT

FTP with Normal Finding/Normal Labour

FTP with PET

Post Partum Eclampsia

Post Conductive order(In Obs)/Post Expulsive Order(In Gynae)

Bowel Preparation On 1st day

Bowel Preparation On 2nd & 3rd day

Dedicated to Dr.Kakoli Dey

Dedicated to Dr.Kakoli Dey

A Patient with Breathlessness

Acute Severe Bronchial Asthma

Dedicated to Dr.Kakoli Dey