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Med Handnote PDF
Med Handnote PDF
- IVI MgSO4 1 ampule in 100cc NS - If no ROF, give IV drip NS 3-4 Fast correct:
over 1 hour pints/24 hour - 1g KCl in 100cc NS over 1 hour @
- 2g KCl in 200cc NS over2 hours
Hypocalcaemia: Hyperkalaemia (>5.5mmol/L): * Mild: Mixt KCl 15ml TDS for 3 days
- ECG - ECG + Lytic cocktail bolus (do not (potassium chloride 1g/10ml mixt)
- IVI CaCO3 1 ampule in 100cc NS mix), give slowly – write in med chart * Tab slow-release K 600mg SR 2-3 tab
over 1 hour @ 10ml 10% Calcum Gluconate OD @ T slow K 1.2g BD/TDS
- IVI Calcium Gluconate 1 ampule in (in 10 minutes) - Check TFT, RP, VBG, UFEME
100cc NS over 4 hours 50ml Dextrose 50% (in 10 - Monitor v/s
* Mild: Tab CaCO3 500mg BD/TDS minutes) - ECG
IV actrapid 10units (fast) - Inform if symptomatic
Hypophosphatemia: * If still high, repeat lytic cocktail
- IVI KH2PO4 1 ampule in 100cc NS Peritoneal dialysis?? Haemodialysis??
over 4 hours * Oral: Tab Kalimate 10g stat & TDS
Common Formula:
Secondary Hypertension workup: - Plasma osmolality: Prog post MI (TIMI risk score):
- Serum renin/aldosterone: sp sign?, 2(Na++K+) + Urea + Glucose History:
office hour - Anion Gap: (Na++K+) – (Cl+HCO3) - Age >65 years old
- Serum cortisol - Corrected Ca: - ≥3 CAD (HPT/DM/Hyperlipidemia/
- TFT (40-albumin) x 0.02 + serum calcium active smoker/family history of
- Urine catecholamine - Estimated GFR: premature death or CAD)
- 24H urine cortisol (140- age) x Wt divide by (creat x 72) - Known CAD (stenosis > 50%)
- 24H urine protein - Absolute Neutrophil Count (ANC): - Aspirin use in past 7 days
- U/S KUB (WCC X neutrophil) divide by 100 Presentation:
- Pulse P: Syst–Dist(narrow<30mmHg) - >2 angina episode/24 hours
Hepatitis B confirmed 1st workup: - SAAG: Sr alb – Alb level of ascitic F -Raised CE
- Hbe Ag, Hbe Ab, HBV viral load, - MAP: [(2 x diastolic)+systolic] / 3 - ST deviation ≥0.5mm in ECG
AFP, TFT, USG HBS Keep MAP > 65 (N 70-110) * Each point has a risk score of 1,
max:6/7=19% death/MI
Killip Classification – Severity STEMI CHA2DS2VAS Score in AF CURB65 risk level of mortality in CAP
S1: no clinical sign HF (no crackles, * To assess risk of stroke & to decide - Confusion
no S3, well perfused) either to start anticoagulant or not - Urea ≥7mmol/L @ 20mg/dL
S2: crackles <50% of lung field (has - CCF = 1 - Respiratory rate ≥30 bpm
S3 heart sound, increased JVP) - Hypertension = 1 - BP: Systolic<90; Diastolic ≤60mmHg
S3: crackles >50% of lung field (acute - Age ≥75 years old = 2 - Age ≥65 years old
pulmonary edema) - DM = 1 * Each point has a risk score of 1
S4: cardiogenic shock/hypotension - Stroke/TIA/Thromboembolism = 2 0-1: outpatient
(systolic <90, evidence peripheral - Vascular disease = 1 2: short inpt/supervised outpatient
vasoconstriction -oliguria, cyanosis, - Age 65-74 years old = 1 3: inpatient
sweating) - Sex: female = 1 4-5: inpatient/ICU
* Score ≥1-2: start anticoagulant
* Score ≥2: annual risk stroke 2.2%
AKIN Staging for AKI Seizure:
Serum Creatinine - Left lateral position
Antidote:
Gout: Meningitis: - Heparin = Protamine sulfate
- T Colchicine 0.5mg OD/ TDS (till - Straight leg raising test, neck - Warfarin = Vit K
diarrhea) stiffness - Opiod = Naloxone
*Don’t give Allopurinol in acute - Septic workup - Benzodiazepine = Flumazenil
attack (if never take Allopurinol - IV Rocephine 2g stat and OD - PCM = N acetyl cystein
before) when stable T Allopurinol - IV Acyclovir 500mg stat and TDS - Mg = Calcium gluconate
150mg OD - IV Phenytoin 100mg TDS for fitting - Organophosphate = Atropine
- T Tramal 50mg TDS/ PRN - Fit chart
- T Maxolon 10 mg TDS/PRN - GCS chart
Schizophrenia/Bipolar/Mania:
- T Olanzapine 5mg BD
Investigation Bottle: Investigation Bottle: Ix that need to be put in ice:
- FBC: purple - Ca Mg PO4: yellow - ABG/VBG: put in ice & water
- FBP: purple, fill in the form - Amylase: yellow - Parathyroid hormone, Ammonia: put
- HbA1c: purple - ABG/VBG: use 1cc syringe and in ice only
- RP (after office hour) / BUSEC flush with heparin then flick the - PACKED CELL , Fresh Frozen Plasma
(weekend): yellow syringe with finger for a few times (FFP), Cryoprecipitate: in ice
- Fasting Glucose: grey - To order CD4/CD8, Dengue - Platelet: no need ice
- Fasting Lipid: yellow Combo, Dengue Rapid Test: need to
- CE/CK: yellow d/w MO Combo investigations:
- PT/APTT/INR: blue - All serology, for example Lepto - BCM: RP + LFT
- Coombs test: pink serology , Dengue serology, - BCM: BUSE CREAT +CE
- GSH: pink Meliodosis serology, HIV, HepB, - BCM: CE + LFT
- Thyroid Function Test: yellow HepC: yellow bottle - BCM: RP + LFT + CE + Ca Mg PO4
- TDM: yellow - Meliodosis serology: fill in the form * If been asked to repeat electrolyte:
- LFT: yellow - TB C&S: fill in the form BCM - Ca Mg PO4 + Alb ( to calculate
* If weekendorder AST+ALT+ALP+ corrected Ca)
Total Bilirubin, ideally Albumin too
CT Imaging: LO1:
-If allergic/asthma, Tab Prednisolone - Inform by staff nurse pt asystole / LO2:
30mg 12H & 2H before CT scan pulse not palpable, attended stat at - Time of death, cause of death
- If renal impairment, for (NAC) N- __am/pm - Pronounced to family members, family
Acetylcysteine 1.2g BD for 3 days - Pupil fixed dilated, no palpable member understood, no further
(start 1 day before) pulses(carotid/femoral/radial/ question asked
brachial) *if DIL NAR- inform MO, record time of
Lumbar Puncture: - Auscultate lung: no heart/breath death
-CT brain first (contraindicated if sound heard (if on ventilator- (Print out 2 copy in the system: GEN-
hydrocephalus, mass, papillaedema, transmitted sound?) laporan pemeriksaan ke atas kematian
bleeding tendency) (MO), isi sijil kematian and slip
-Chest no spontaneous breathing kematian)
Before any invasive procedure: *no issue DIL NAR (death in line no
- FBC, Coagulation profile, GSH for active resuscitation), do CPR
- CPR done for 30mins, given
adrenaline 3x, no __(repeat sx LO)
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