Hypomagnesaemia:
- IVI MgSO4 1 ampule in 100cc NS
over 1 hour
Hypocalcaemia:
- ECG
- IVI CaCO3 1 ampule in 100cc NS
over 1 hour @
- IVI Calcium Gluconate 1 ampule in
100cc NS over 4 hours
* Mild: Tab CaCO3 500mg BD/TDS
Hypophosphatemia:
- IVI KH2PO4 1 ampule in 100cc NS
over 4 hours
Fast AF:
- Nasal prong O2 (NpO2)
-Continuous cardiac monitoring
- IV Digoxin (if HF) 0.25mg every
2hr, up to 1.5g within 24hr
- Metoprolol 25mg/100mg BD
(absence of HF)
- KIV IVI Amiodarone 300mg over
30mins
- KIV cardioversion if hemodynamic
not stable
Notes:
- Cardioversion: in pulseless VT & VF
- CPR: Asystole & PEA
Upper GI Bleeding:
- 2 large bore branula
- Run fluid
- FBC, Coag profile, GXM 4pint blood
- IV Pantoprazole (PPI) 80mg stat
and IVI 8mg/hr
- Inform MO
Anaphylaxis:
- IV Hydrocortisone 200mg
- IV Piriton 10mg
- IV Maxolon 10mg stat & TDS
- Oxygen
- IV fluid
- If BP drop,IV/IM Adrenaline 1:1000
Hyponatremia:
- If no ROF, give IV drip NS 3-4
pints/24 hour
Hyperkalaemia (>5.5mmol/L):
- ECG + Lytic cocktail bolus (do not
mix), give slowly – write in med chart
 10ml 10% Calcum Gluconate
(in 10 minutes)
 50ml Dextrose 50% (in 10
minutes)
 IV actrapid 10units (fast)
* If still high, repeat lytic cocktail 
Peritoneal dialysis?? Haemodialysis??
* Oral: Tab Kalimate 10g stat & TDS
Asystole:
- 2 large bore branula
- Run fluid
- Intubation
- Cardiac compression (30:2)
-IV Adrenaline 1mg every 3-5 minutes
(no limit)
-IV Atropine 1mg every 3-5 mins (3x)
Chest pain (if MI suspected)
- ECG stat
- CE, Trop T, CKMB
- Oxygen
- S/L GTN
- Aspirin crush 300mg
- Plavix (Clopidogrel) 75mg
Dengue1:
- Dengue fever day __, __ warning
signs, in __ phase (if defervescence
phase point taken at __˚C), V/S, on
drip __cc/kg/H, latest FBC reviewed. -
- Next FBC at __am/pm, cont drip
__cc/kg/h
* WARNING SIGN:
- Tender liver - Abdominal pain
- Mucosal bleed
- Persistent vomiting ≥3x + diarrhea
≥3x/24 hr
- Fluid accumulation(ascites/pleural E)
- Restlessness/altered conscious level
- Inc haematocrit, reduced platelet
Hypokalaemia:
Fast correct:
- 1g KCl in 100cc NS over 1 hour @
- 2g KCl in 200cc NS over2 hours
* Mild: Mixt KCl 15ml TDS for 3 days
(potassium chloride 1g/10ml mixt)
* Tab slow-release K 600mg SR 2-3 tab
OD @ T slow K 1.2g BD/TDS
- Check TFT, RP, VBG, UFEME
- Monitor v/s
- ECG
- Inform if symptomatic
If BP drop:
- No ROF, run fast 250cc NS for 15-30
minutes & repeat BP
(can repeat 2x  inform MO)
- KIV Gelafundin (colloid) @ inotrope
- Grey branula at neck/femoral line
- IV Noradrenaline 0.2mcg/kg/min
Postural hypotension:
Systolic>20mmHg,Diastolic>10mmHg
SVT:
- Cardiac massage, if fail
- IV Adenosine (every 1-2 mins) 6mg
then 12mg then 12mg
- If not reverted, IVI Amiodarone
300mg over 30 minutes
Dengue2:
- N haematocrit:
Male: >45; Female: >40
- Raised haematocrit in active smoker
& obese pt is normal
- If pt took PCM, take Temp > 6hours
after that, to count defervescence
phase (< 38˚C)
- Dengue IgM & IgG positive high
risk DHF (If systemic bleeding, give IV
Traxenamic acid 500mg TDS)
- Ideal Body Weight in Dengue:
Male: (Ht-152.4) x 0.91 + 50
Female: (Ht – 152.4) x 0.91 + 45
Hypertension drugs:
- T Adalat 10mg/20mg TDS
- T Atenolol 50mg/100mg OD
- T Amlodipine 5mg/10mg OD
- T Bisoprolol 1.25/2.5/5mg/10mg OD
- T Captopril 25mg/50mg BD/TDS
- T Carvedilol 12.5mg/25mg OD
- T Enalapril 5/10/20mg OD
- T Felodipine 5/10mg OD/BD
- T Hydrochlorothiazide 25/50mg OD
- T Irbesartan 150/300mg OD
- T Losartan 50/100mg OD
-T Metoprolol 50/100mg OD/BD
-T Prazosin 1/2/3mg BD/TDS
-T Perindopril 2/4/8mg OD
-T Termisartan 40/80mg OD
Anti TB regime: (Intensive phase)
- Isoniazide 5mg/kg OD
- Rifampicin 10mg/kg OD
- Ethambutol 15/kg OD
- Pyrazinamide 25mg/kg OD
- Pyridoxine 10mg OD
Painkiller:
- C Celecoxib 200mg OD
- T PCM 1g QID
- C Ponstan 500mg TDS
- C Tramadol 50mg TDS
- T Voltaren 50mg TDS
Pleural tap:
* 7 urine container-red bottle
* prior to pleural tap, send - serum
RBS, CE/ LFT/ serum LDH/urine FEME
- BCM: body fluid for biochemistry
- Body fluid for FEME
- TB smear: other specimen
- TB C&S: non sputum
- C&S: pleural fluid
- Cyto non gynae
-Microscopy specimen for gram stain
Septic workup:
- C&S blood: aerobe & anaerobe
- C&S urine/sputum, Urine FEME
- ESR & CRP
Antibiotic (no renal impairment):
- T Augmentin 625mg BD
- IV Augmentin 1.2g TDS
- T Acyclovir 400/800mg 5x/day
- T Azithromycin 500mg OD
- IV Azithromycin 500mg OD
- T Bactrim II/II BD
- IV Benzyl Penicillin 1MU/2MU 6hrly
- C/IV Cloxacillin 500mg/1g QID
- IV Cefepime 1/2g BD
- IV Cefuroxime 750mg/1.5g TDS
- T Cefuroxime 500mg BD
- T Clarithromycin 500mg BD
- T Ciprofloxacin 400mg BD
- IV Cefotaxime 2g TDS
- IV Cefobid (Cefoperazone Na)1gmBD
Meningitis dose:
- IV Rocephin 2g BD
- IV Acyclovir 500mg TDS
- IV Benzyl Penicillin 4MU 4 hrly
GIT medications:
- IV/T Maxolon (metoclopramide)
10mg stat & TDS
- IV Ranitidine (histamine-2 blocker)
50mg TDS
- T Ranitidine 150mg BD
- IV/T Pantoprazole 40mg OD/BD
- IV/T Nexium (esomeprazole-PPI)
40mg OD/BD
- Syrup MMT 15ml TDS
Lumbar puncture:
- CSF biochem: pH, glucose, protein
- CSF FEME/Latex
- C&S CSF
- Latex Cryptococcus antigen (CSF)
- Microscopy specimen for gram stain
- TB smear other specimen
- TB C&S non sputum
- Microbiology TB PCR
- Serology: CSF for Treponema
Pallidum (VDRL)
- Fungal PCR
- Cyto non gynae
- BCM: Body fluid for biochemistry
- Body fluid for FEME
- Blood osmolality
Antibiotic (no renal impairment):
- T Doxycycline 200mg stat & 100mg
BD 7/52
- T EES 400mg/800mg BD
- IV Fluconazole 200mg OD
- IV Imipenem 500mg TDS/QID
- IV Meropenem 500mg TDS/QID
- IV Metronidazole 500mg TDS
- T Metronidazole 400mg TDS
- T Penicillin V 500mg TDS/QID
- IV Rocephin (Ceftriaxone) 1/2g OD
- IV Sulperazone 1/2g BD/QID
- IV Tazosin 4.5g TDS
- T Unasyn 375mg BD
- IV Unasyn 1.5g TDS
- IV Vancomycin 1g BD
Anemic workup:
- Blood folate + B12: fill in the form &
yellow bottle
- FBP (full blood picture): fill in the
form & purple bottle
- FBC + RETICULOCYTE: purple bottle
- Iron + TIBC: yellow bottle
- Ferritin: yellow bottle
- Coombs test (direct, indirect): red B
- PT/APTT/INR: blue bottle
- BCM: stool occult blood test
- Parasitology: Stool FEME (stool ova
and cyst)
*Thalassemia (HBANA:HEM:HB
ANALYSIS): Hb %, fill form, purple B
CSF:
- CSF biochemistry
- CSF FEME/Latex
- C&S of CSF
- Latex Cryptococcus Antigen
- Serology: CSF for Treponema
Pallidum (VDRL)
- Cyto non gynae
- TB C&S non sputum
- TB smear –other specimen
PTB workup:
- TB C&S, AFB 3x, CRP/ESR, Mantoux
test
PTB confirmed 1st workup:
- HIV, FBS, LFT, refer eye
Peritoneal tap (straw colour):
- C&S peritoneal fluid
- BCM complement 3&4*
- Anti-nuclear antibody*
- Anti-Rheumatoid factor*
- Alpha fetoprotein (HTAA)*
- Microscopy: specimen for G stain
- BCM: body fluid for biochemistry
- Body fluid for FEME
- Cyto non gynae
- TB C&S: non sputum
- TB smear other specimen
- Blood for total protein
* If drain >1L, inject 200mL human
albumin 20%, within 1 day (max
extract 6L, consult with MO)
Secondary Hypertension workup:
- Serum renin/aldosterone: sp sign?,
office hour
- Serum cortisol
- TFT
- Urine catecholamine
- 24H urine cortisol
- 24H urine protein
- U/S KUB
Hepatitis B confirmed 1st workup:
- Hbe Ag, Hbe Ab, HBV viral load,
AFP, TFT, USG HBS
Killip Classification – Severity STEMI
S1: no clinical sign HF (no crackles,
no S3, well perfused)
S2: crackles <50% of lung field (has
S3 heart sound, increased JVP)
S3: crackles >50% of lung field (acute
pulmonary edema)
S4: cardiogenic shock/hypotension
(systolic <90, evidence peripheral
vasoconstriction -oliguria, cyanosis,
sweating)
DIC workup:
(DIVC REGIME: 6 cryoprecipitate, 4
FFP: red bottle, 2 PLT)
- FBC
- PT/APTT/INR: blue bottle
- Fibrinogen
- D-dimer: blue bottle, consult with
haematology MO
Hyponatremia workup:
- Urine Na+ spot, urine & serum
osmolality, TFT, lipid, glucose (+/-
morning cortisol)
HypoK+ periodic paralysis workup:
- Urine pH, Urine K+ spot, TFT, ABG
Common Formula:
- Plasma osmolality:
2(Na++K+) + Urea + Glucose
- Anion Gap: (Na++K+) – (Cl+HCO3)
- Corrected Ca:
(40-albumin) x 0.02 + serum calcium
- Estimated GFR:
(140- age) x Wt divide by (creat x 72)
- Absolute Neutrophil Count (ANC):
(WCC X neutrophil) divide by 100
- Pulse P: Syst–Dist(narrow<30mmHg)
- SAAG: Sr alb – Alb level of ascitic F
- MAP: [(2 x diastolic)+systolic] / 3
Keep MAP > 65 (N 70-110)
CHA2DS2VAS Score in AF
* To assess risk of stroke & to decide
either to start anticoagulant or not
- CCF = 1
- Hypertension = 1
- Age ≥75 years old = 2
- DM = 1
- Stroke/TIA/Thromboembolism = 2
- Vascular disease = 1
- Age 65-74 years old = 1
- Sex: female = 1
* Score ≥1-2: start anticoagulant
* Score ≥2: annual risk stroke 2.2%
Stroke workup:
- ECHO, USG carotid Doppler, FBS, FSL
Young stroke workup:
- ECHO, CTD & Thrombophilia screen,
(cerebral angiography if bleed)
Connective Tissue Ds screening:
- Anti-rheumatoid factor
- BCM: complement C3 and C4
- ESR, CRP
- ANA (antinuclear antibody)
*If +ve result send autoimmune
hepatitis ix: Smooth ms, IGG, IGM,
Anti-mitochondrial
Prog post MI (TIMI risk score):
History:
- Age >65 years old
- ≥3 CAD (HPT/DM/Hyperlipidemia/
active smoker/family history of
premature death or CAD)
- Known CAD (stenosis > 50%)
- Aspirin use in past 7 days
Presentation:
- >2 angina episode/24 hours
-Raised CE
- ST deviation ≥0.5mm in ECG
* Each point has a risk score of 1,
max:6/7=19% death/MI
CURB65 risk level of mortality in CAP
- Confusion
- Urea ≥7mmol/L @ 20mg/dL
- Respiratory rate ≥30 bpm
- BP: Systolic<90; Diastolic ≤60mmHg
- Age ≥65 years old
* Each point has a risk score of 1
0-1: outpatient
2: short inpt/supervised outpatient
3: inpatient
4-5: inpatient/ICU
 AKIN Staging for AKI
Serum Creatinine
Bilirubin (µmol/L): <34, 34-51, >51; Mnemonic:
SI: increase ≥26.5 μmol/l (≥0.3 mg/dl)
OR increase to 1.5–2.0-fold from
baseline
ABEIPA; Albumin (g/L): >35, 28-35, <28
S2: increase >2.0–3.0-fold from
baseline
S3: increase >3.0-fold from baseline
OR serum creatinine ≥354 μmol/l
(≥4.0 mg/dl) with an acute increase of
at least 44 μmol/l (0.5 mg/dl) OR need
for RRT
Urine output
S1: <0.5 ml/kg/h for 6 h
S2: <0.5 ml/kg/h for 12 h
S3: <0.3 ml/kg/h for 24 h OR anuria
for 12 h OR need for RRT
Hemorrhagic Stroke: CCF:
- Same as Ischemic Stroke b t BP - IV Lasix 40mg TDS
must kept <140/90 by giving antiHPT - ROF 500CC or 1 L/ 24 H
/ IVI Labetolol - Strict I/O chart
* If pt asthma or contraindicated for - Old medications
Labetolol IVI Isoket - Glucometer QID
- After 3 days, start oral anti-HPT; - Oxygen support, NP? Depends on pt
Captopril Perindopril to improve SpO2 level
compliance - ECG
- If BP 140/90, can off Isoket, give T
Felodipine 10mg stat and BD or any Inform Dr if:
other anti-HPT -BP >160/100, BP <90/50, HR >120, RR
>30<10
Uncontrolled DM: CAP:
- 5 point glucometer monitoring - Septic workup
- Strict diabetic diet - IV Augmentin 1.2gm stat and TDS
- KIV to change insulatard to mixtard - T Azithromycin 500mg stat and OD
if not controlled - IV Hydrocortisone 200mg stat and
- Insulin sliding scale, keep NBM 100mg QID for 1 day
- Next day change to T Prednisolone
Cellulitis: 30mg OD for 5/7
- Septic workup - If got rhonchiNeb Combivent 4
- Unasyn 1.5mg stat and TDS @ IV hourly/ 6 hourly ascess severity
Cloxacillin 1g QID
- T Tramal 50mg PRN/TDS HAP:
* don’t give PCM - IV Tazocin 4.5 g TDS for 1 week
- T Maxolon 10mg PRN/TDS (piperacillin & tazobactam)
- Others same as CAP
Seizure:
- Left lateral position
- Oxygen
- IV Valium (Diazepam) 5mg stat
- Check GCS level, duration fit,
post fit episode?
- Check glucometer
- FBC, Ca, Mg, PO4, RP, LFT, Coag, CE
- Plain CT brain
* If keep on fit, IV Phenytoin loading
dose 15-20mg/kg (ask MO first)
Parkinson:
- Ask MO first
- T Benzhexol 2mg TDS
Hypoglycemia (if GCS low):
- D50% 50ml stat & maintenance
D10% 1-2 pint /24 H
- Monitor glucometer hourly x4, then
2 Hourly x2, then 4 Hourly if stable
- Withhold OHA
- Watchout hypoglycemia sx-
sweating, giddiness, tremor, fitting
HHS: Plasma osm>320; glucose≥33;
severe dehydration; pH>7.3;HCO3>18
DKA: Glucose≥14; pH<7.3; HCO3>15;
ketonaemia@ketonuria
AECOAD secondary to URTI:
- Septic workup
- Continue nasal prong
- Neb Combivent 4 Hourly
- IV Hydrocortisone 200mg stat and
100 mg QID for 1 day
- MDI Berodual 2 puff TDS
- MDI Budesonide 2 puff BD
- T Augmentin 625mg BD for 5 days
- IV drip NS if dehydrated, no ROF
SpO2 drop (tracheostomy tube):
- ABG
- CXR (TRO pneumothorax)
- Regular suction
- TRO dislodge
Alleged Chorox Poisoning:
- IVD 2 pint NS/24 Hours
- IV Ranitidine 50mg stat and TDS
- Refer psychiatric
- Urine for drug and UPT test
- If urine pregnancy test –ve, start T
Alprazolam 0.5mg BD
- To put pt nearby nursing counter
- To accompany pt if she goes
anywhere, toilet
- Watchout for any potential harmful
behavior
Meliodosis:
- Due to Burkholderia pseudomallei
- IV Fortum for 2 weeks
- Then T Doxycycline 100mg BD and T
Bactrim III/III BD for 20 weeks
Idiopathic Thrombocytopenic
Purpura (ITP):
- Ask MO first
- IV Dexamethasone 0.6mg/kg/day
for 4/7
Gout:
- T Colchicine 0.5mg OD/ TDS (till
diarrhea)
*Don’t give Allopurinol in acute
attack (if never take Allopurinol
before) when stable T Allopurinol
150mg OD
- T Tramal 50mg TDS/ PRN
- T Maxolon 10 mg TDS/PRN
Schizophrenia/Bipolar/Mania:
- T Olanzapine 5mg BD
Leptospirosis:
- Notification
- Septic workup
- Lepto serology
- BFMP 3x :blood film malaria parasite
- Meliodosis serology
- IV drip NS 3-4 pint/24 H if NO ROF
- Monitor I/O chart
- IV Rocephine (Ceftriazone) 2g stat
and OD @ IV Penicillin 1.5 MU 6 hrly
Catheter-related bloodstream
infection (CRBSI):
- Septic workup: peripheral, red, blue
line
- IV Fortum (Ceftazidime) 1g stat & OD
- IV Cloxacillin 1 g QID
Thrombophlebitis (branula):
- Off the branula
- MgSO4 LA
- T Cloxacillin 500mg QID for 5 days
Meningitis:
- Straight leg raising test, neck
stiffness
- Septic workup
- IV Rocephine 2g stat and OD
- IV Acyclovir 500mg stat and TDS
- IV Phenytoin 100mg TDS for fitting
- Fit chart
- GCS chart
Infective AGE:
- Septic workup and stool culture
- IV Cefuroxime 750mg TDS
- No ROF, 4 pints: 3 pints NS and 1
pint D5% /24 H
- ORS per purge
- Correct electrolytes
- T / IV Maxolon 10mg TDS
- T Ranitidine 150mg BD @ T
Omeprazole 40mg OD
UTI:
- Ask MO first choice and dose abx
- Septic workup
- T Cefuroxime 250mg BD for 1 week
@ IV cefuroxime 1.5gm stat and then
750mg TDS
- T Ranitidine 150mg BD?
Pyelonephritis:
- Do renal punch
- Septic workup
- IV Cefuroxime 1.5g stat and 750mg
TDS
Antidote:
- Heparin = Protamine sulfate
- Warfarin = Vit K
- Opiod = Naloxone
- Benzodiazepine = Flumazenil
- PCM = N acetyl cystein
- Mg = Calcium gluconate
- Organophosphate = Atropine
Investigation Bottle:
- FBC: purple
- FBP: purple, fill in the form
- HbA1c: purple
- RP (after office hour) / BUSEC
(weekend): yellow
- Fasting Glucose: grey
- Fasting Lipid: yellow
- CE/CK: yellow
- PT/APTT/INR: blue
- Coombs test: pink
- GSH: pink
- Thyroid Function Test: yellow
- TDM: yellow
- LFT: yellow
* If weekendorder AST+ALT+ALP+
Total Bilirubin, ideally Albumin too
CT Imaging:
-If allergic/asthma, Tab Prednisolone
30mg 12H & 2H before CT scan
- If renal impairment, for (NAC) N-
Acetylcysteine 1.2g BD for 3 days
(start 1 day before)
Lumbar Puncture:
-CT brain first (contraindicated if
hydrocephalus, mass, papillaedema,
bleeding tendency)
Before any invasive procedure:
- FBC, Coagulation profile, GSH
Drug and Indication/MOA1:
- T Isordil/Isoket (Isosorbide
Dinitrate)10mg TDS: Dilates blood V
- T Vastarel (Trimetazidine) Renal
dose 20mg BD; N dose 20mg TDS:
Preventive treatment of episodes of
angina pectoris
- T Traxenamic acid 1g stat & 500mg
TDS: Epistaxis/hemoptysis in dengue
(treat or prevent excessive blood loss)
- Nasonex I/I OD spray: Nose block,
sinusitis
- Traxenamic acid gargle: sore throat
- Bonjela (Choline salicyclate 8.7% &
Cetylkonium Cl 0.01%): Mouth ulcer
- Hydrocortisone cream 1% LA / BD
Investigation Bottle:
- Ca Mg PO4: yellow
- Amylase: yellow
- ABG/VBG: use 1cc syringe and
flush with heparin then flick the
syringe with finger for a few times
- To order CD4/CD8, Dengue
Combo, Dengue Rapid Test: need to
d/w MO
- All serology, for example Lepto
serology , Dengue serology,
Meliodosis serology, HIV, HepB,
HepC: yellow bottle
- Meliodosis serology: fill in the form
- TB C&S: fill in the form
LO1:
- Inform by staff nurse pt asystole /
pulse not palpable, attended stat at
__am/pm
- Pupil fixed dilated, no palpable
pulses(carotid/femoral/radial/
brachial)
- Auscultate lung: no heart/breath
sound heard (if on ventilator-
transmitted sound?)
-Chest no spontaneous breathing
*no issue DIL NAR (death in line no
for active resuscitation), do CPR
- CPR done for 30mins, given
adrenaline 3x, no __(repeat sx LO)
Drug and Indication/MOA2:
- Vaseline cream: Dry lips
- Aqueous cream LA PRN: Dry skin
- Calamine cream/lotion LA PRN:
Itchiness of skin
- Miconazole 2% cream LA PRN/ OD/
BD: Fungal infection – tinea pedis/
corporis/ capitis)
- Nystatin: Tx candidiasis of skin and
mucous membrane, protect candida
overgrowth during steroid/
antimicrobial therapy
- MgSO4 paste: Blister, small wound
- Orudis/ Ketoprofen gel (NSAIDs) LA
PRN/BD/QID: Sprain/trauma/edema
tendinitis/bruises (careful in asthma)
Ix that need to be put in ice:
- ABG/VBG: put in ice & water
- Parathyroid hormone, Ammonia: put
in ice only
- PACKED CELL , Fresh Frozen Plasma
(FFP), Cryoprecipitate: in ice
- Platelet: no need ice
Combo investigations:
- BCM: RP + LFT
- BCM: BUSE CREAT +CE
- BCM: CE + LFT
- BCM: RP + LFT + CE + Ca Mg PO4
* If been asked to repeat electrolyte:
BCM - Ca Mg PO4 + Alb ( to calculate
corrected Ca)
LO2:
- Time of death, cause of death
- Pronounced to family members, family
member understood, no further
question asked
*if DIL NAR- inform MO, record time of
death
(Print out 2 copy in the system: GEN-
laporan pemeriksaan ke atas kematian
(MO), isi sijil kematian and slip
kematian)
Drug and Indication/MOA3:
- T Bromhexine/ Bisolvont 8mg TDS
- T Piriton 4 mg PRN/TDS (s/e: sleepy)
- T/IV Maxolon 10mg stat and TDS
- IM Stemetil I/I OD stat (12.5mg) @ T
20mg stat: Severe nausea/vomiting
- T/IV Tramal 50mg stat and TDS/ PRN
- T Hematinic I/I OD ( Ferrous fumarate
1 tablet 200mg OD, Folic acid 5mg, Vit B
complex, Vit C complex 100mg OD)
- T Neurobion Vit B1/B6/B12 (Folic acid)
- Syr MMT 15ml TDS: Gastritis
- Syr Lactulose 15ml TDS (oral)
- Ravin enema I/I stat (per reactal)
ACS:
- S/C Fondaparinux 2.5mg stat & OD
@ S/C Clexane (LMWH) 20/40/60mg
OD; If eGFR <20-30, Clexane also for
DVT prophylaxis
- T Aspirin 300mg stat & 150mg OD
@ T Cardiprin 100mg OD (1 tablet)
- T Plavix (Clopidogrel) 300mg stat &
75mg OD; if d/c for 6 weeks
- T Simvastatin 40mg ON
- T Ranitidine(Zantac) 150mg OD/BD
@ T Omeprazole 40mg OD-if
gastritis
* (IV Ranitidine 50mg stat and TDS)
@ (IV Omeprazole 40mg OD)
- S/L GTN I/I PRN
- Daily ECG & CK - stat if chest pain
* DON’T give OHA in sepsis/UA/MI/
NSTEMI, give actrapid if glucose >10
ACS with u/l AF (d/w MO)
- ACS tx + T Digoxin 0.25mg OD (TDM
drug)
- T Bisoprolol 1.25mg OD - moderate
to severe CCF + to ACEi and Diuretic
- Take INR, if to start Warfarin need to
d/w pt first either can come to TCA
INR blood taking or not
- T Warfarin 5/5/3 mg OD
*AF/VF if unstable  shock
(cardioversion); criteria unstable =
poor perfusion, low BP, ongoing chest
pain, hypotension, poor perfusion,
pulmonary edema
*AF if stable>48 Hours, can consider
to start anticoagulant
Prior to HD:
- Take PT/APTT/INR, BUSEC/RP, FBC
Prior to RRT/HD initiation/IJC
insertion:
*Take viral serology screening
Send serology: Hep Bs Antigen:
- Serology Heb B antigen
- Serology Hep B antibody
- Serology Hep C screening
- Serology HIV screening (ask verbal
consent)
Send serology: Syphilis RPR:
- RP/LFT/FLP/Ca, Mg, P04/TFT/CTD
Workup:
- ESR/C3&C4/Anti-nuclear antibody/
Rheumatoid factor/urine FEME/
Urine PCI (protein:creatinine index)/
US KUB

Ischemic Stroke:
- CT brain + GCS chart Asthma Medications:
- NBM w IVD 2pint NS/24H(if no Reliever: - MDI Budesonide 2 puff BD (Red)
ROF) - β2 agonist (bronchodilator)=Ventolin - MDI Salbutamol 2 puff PRN (Blue)
- Strict I/O chart, CBD? depends on @ Salbutamol (SABA), Fenoterol - MDI Berodual 2 puff TDS
pt - Combivent = Albuterol + (Green/White)=Ipratropium+Fenoterol
- IV Ranitidine 50mg stat and TDS Ipratropium bromide (anticholinergic) - Seretide (Purple) = Salmeterol +
- Glucometer QID Controller: Fluticasone propionate
- Monitor BP, KIV to start anti-HPT if - β2 agonist (LABA) = Salmeterol, - Beclazone (Brown)= Beclomethasone
BP >220/110 Formoterol - Flixotide (Orange) = Fluticasone
* After 2 weeks, can start anti-HPT - Corticosteroid = Beclomethasone, - Atrovent(AVN)=Ipratropium bromide
either CCB/ACEi; before 2 weeks not Budesonide, Fluticasone -Symbicort = Budesonide
give any anti-HPT if BP not >220/110 - Aminophylline = Theophylline 160mcg+Formoterol fumarate 4.5mcg
(to protect penumbra area) - Cromoglicate (mast cell stabilizer)
- Insert Ryles tube-if absent gag - Leukotriene R antagonist = * If neb already been given for many
reflex /fail swallowing test Zafirlukast, Montelukast (anti-inflam) times but the patient still not
- Refer stroke - Anti-IgE monoclonal Antibody = improve IVI Aminophylline 250mg in
rehab/physio/dietician /speech Omalizumab 1 pint NS over 8 hour (MOA =
therapy (for swallowing test) bronchodilator by relaxing smooth ms)
Pleural Tap:
- Indicated as CXR showed massive pleural effusion Notes:
- Consent taken from pt, done by Dr (name) under aseptic technique - Inotrope need to be insert in large
- LA given prior to branula insertion, grey branula was used line (femoral/neck line), d/w MO first
- Tapping done at right/left lung - Maxolon cannot give to pt <18 YO
- Drained out __litre, clear/straw/ cloudy/pus color of fluid - Malena: oily black stool
- Specimen sent to lab
- Procedure was uneventful
- v/s post tapping, bp/pr/rr/sp02
- Plan: portable CXR post tap