.

Medical treatment
.Snake bite**
investigation CBC,RBS,urea & electrolyte, cardiac -1
enzyme(pt may have MI),ABG.pt and Appt(as coagulation
is very important),EKG and CXR
.putpatient on monitor and oxygen by nasal cannula -2
phenergan 250 mg IM --3
hydrocortisone 500mg IV \6 hr -4
dextrose 500 ml \6 hr -5
anti-venom (stored in 2-8 C) and have indication and if -6
.given the patient should stay in hospital for 5 to 10 days
.blood for grouping and cross match for 2 units-7
urine catheter-8
observe vital signs \4 hr-9
omeprazole 50 mg iv-10
rocephine 1 g \12hr-11
-12

.Acute renal failure**

investigation CBC,RBS,urea & electrolyte(especially -1
.K),urine analysis and urine for Na
IV fluids which depend on-2
if patient has no cardiac failure or cardiopulmonary#
system stable give N\S 5oo cc\6hr
if patient has fragile cardiopulmonary systems first put#
.central line and fluids given depend on CVP reading
lasix(furosomide)80 mg IV\8hr-3
.put patient on input output chart-4
 insert foly catheter-5
urea & electrolyte \8 hr-6
treat electrolyte abnormality especially hyperkalemia-7
((up 5.5 meq
search for causes of ARF is it pre, post or renal problem-8
special consideration(if patient with ARF has**
hypertension you should be treated by antihypertensive
drugs that do not lower renal blood flow as clonidine or Ca
blocker put if hypertensive crisis happen you should
( .treated with IV labetalol or sodium nitroprusside

.Hyperkalemia**
first you should confirm it is true hyperkalemia or-1
pseudo by repeated drown blood without tourniquet or
confirmed the hyperkalemia by EKG changes. Then stop K
if already given to patient and any alkali drugs
.put patient on monitor and insert foly catheter-2
management depend on 3 parts-3
First part (acute management) for protect heart from
*hyperkalemia
cc Ca gluconate (10%) over 2-3 minutes and can be 10*
repeated if EKG changes does not improve after 5-10
.minutes
ampules (50 g for each one) of dextrose saline (50%) + 2*
10 units of regular insulin IV.put if the patient is
.hyperglycemic treated only by regular insulin 10-20 units
Second part for shifting the K from extra to intracellular*
ampules of Na bicarb (8.4% each one contain 50 meq 3*
Na bicarb) added to 1L of 5% dextrose saline (this
treatment should reserve for patient how has
.(hyperkalemia and acidosis
 Beta agonist (albuterol) nebulizer 10-20 mg mixed with*
.10 cc normal saline every 4 hr
Third part for eliminating K from body by*
Cation exchange resins as Kayexalate by two routes *
by mouth give 50 g resin mixed with 100 mL 20%-1
sorbitol to prevent constipation
by enema give 50 g resin in 150 mL tap water-2
.lasix 80 mg IV and repeated as needed*
Dialysis should be reserved for patients with renal failure *
and those with severe life-threatening hyperkalemia.
.Hemodialysis removes K faster than peritoneal dialysis

.Hypokalemia**
(Rocky Mountain Spotted Fever (RMSF **
If patient stable treat as outpatient with close follow up
put if patient unstable treat in hospital as mortality rate 15
%
Doxycycline 100 mg IV q 12 hr till 2 days of patient
become afebrile or for 7 days. Pregnant and lactating
female and children less than 8 years treated with
.chloramphenicol

.pseudomonal infection**
cefepime 2g q 12 hr or-1
ceftazidime 2 g q-2
8 hr
ciprofloxacin 400 mg q 8 hr-3
.levofloxacin 750 mg daily-4

Pulmonary edema**
put pt on sitting position-1
oxygen therapy by polymask 6 lit-2
 sublingual angised-3
introduce catheter and take basic investigation-4
(CBC,RBS,urea and electrolyte,ABG)and put pt on monitor
lasix 80 mg IV over minutes and can repeated till total-5
dose not exceed 200 mg\day
introduce catheter (note if urine output is good this is-6
meaning u are in foreword correction but if no urine output
(u are in bad condition
prepare GTN(Gglycride trinitrate)5 mg +45cc normal-7
saline put in infusion rate on 6 ml\hr
look for accelerator factor of PE like-8
High BP winch should correctly slowly by Na nitroprusside
MI which management as known
Tachy or brady arrhythmia which should manage
accordingly
Hypotension or shock winch should be treated by
inotropics like dobutamine
Hypoxia and hypercapnia which resistant to non invasive
means should intubated
Note\morphine can used 2.5 mg IV to reduce anxiety
.and also dilate pulmonary and systemic veins
**Organophosphate poisoning
introduce 2 large pore cannula and give iv fluid 500cc-1
normal saline over 5 minutes
begin atropinization of pt with atropine give initial-2
testing dose of 1 mg and look for reverse reaction if no
hypersensitivity found begin with 2 mg atropine over 5
min and repeated till pt atropinization appear as (dry
mouth, tachycardia, flushing,and dilated pupil)the
average pt need 40 mg\d for recovery put some pt need
. up to 1500 mg
start with gastric lavage.introduce NGT and confirmed-3
in stomach and start to give water 500cc over 10 min
and then connected to bag repeat this operation till the
fluid outcome from the stomach are clear no particle of
.poisoning seen. This may take 8 lit to reach
Special consideration-4
 Respiratory failure-------intubate the pt-5
Seizure treated by Diazepam 5-15 mg IV q5-10 minutes-6
as needed
**Otitis externa
flucloxacillin(floxapen) 250 mg 1*4*2 weeks-1
otosporin-2
(hydrocortisone+neomycin+polymyxinsulfate)use for
infection and eczematous otitis externa 3*3*7
panadol 500 mg 1*2*3-3
**Otitis media
amoxicillin 500 mg 1*3*7 if after 3 days no-1
improvement shift to augmentin 500 mg 1*3*7 or
1*3*14
panadol 500mg 1*2*3-7
.acute exacerbation of asthma**
ventolin nebulizer 5 cc mixed with 5 cc normal-1
saline and nebulizer the patient
atrovent-2
aminophllin (take care from this use) 1 ampule-3
10 cc mixed with 10 cc normal saline given through
20 min
.Pyelonephritis**
vertigo**
(Medication (Drugs
Diazepam (Valium): 2.5–5 mg IV q8h or 2–10 mg PO q8h•
Diphenhydramine (Benadryl): 25–50 mg IV, IM, or PO q6h•
Meclizine (Antivert): 25 mg PO q6h PRN•
Promethazine (Phenergan): 12.5 mg IV q6h or 25–50 mg IM, PO, or PR•
q6h