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1. If alive animal, at first desensitized with lidocaine then pull it out
2. Treatment in ear
1. Drop Polymyxin-NH 4 drops tds for 3 days
3. Imaging:
1. Bilateral Nasal X-rays
2. Neck x-ray AP Lateral
3. CXR AP lateral
4. CT scan if not seen in x-rays
4. Rigid endoscopy for pulling out specially batteries
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1. use Heimlich to evacuate the body
2. Use x-rays
3. Rigid endoscopy and bronchoscopy is needed
1. Treatment for 2 month
1. oint mupirocin 2% bid
1. oint zinc oxide 20% tds
2. Cap cefalexin 500 mg qid for 5-7 days
3. Serum N/S for irrigation
2. there is no need for treating pseudofolliculitis
#
1. Children with good condition
1. Syrup hydroxyzine 5cc bid #1
2. oint betamethasone 0.1% bid #1
2. Anaphylactic shock
1. adults
1. Amp epinephrine 1:1000 0.3-0.5cc SQ or IM repeat every 5 min
2. Amp methylprednisolone 250 mg IV stat
3. Tab prednisolone 20 mg #25 2tab/day first week, 1tab/day in 2nd week, 1/2tab/day in 3rd week
4. Tab cetirizine 10 mg bid #30
2. Children
1. Amp epinephrine 1:1000 0.01cc/kg SQ or IM repeat every 5min
2. Amp methylprednisolone 250 mg IV stat
3. Tab prednisolone 20 mg #25 2tab/day first week, 1tab/day in 2nd week, 1/2tab/day in 3rd week
4. Tab cetirizine 10 mg bid #30
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1. Who to admit?
1. all <28 days/old
1. admit for IV Ab therapy
2. sepsis w/u
2. 1-3 m/o
1. if have good condition, NL lab data ⇒ no need for Ab therapy
2. if ill or abnormal lab data ⇒ admit for IV ab therapy
3. 3-36 m/o
1. if <38 C fever ⇒ acetaminophen + daily F/U
2. if >38 C fever ⇒ acetaminophen + daily F/U + Ab therapy + check
1. ESR, CRP
2. U/A, U/C
3. B/C
4. CBC, diff
3. Ab therapy
1. Cefixime 8mg/kg
1. or Co-amoxiclav 80mg/kg/day
4. sepsis w/u if lab data was abnormal
2. Acetaminophen in pediatrics: 10mg/kg
1. Tab 325, 500 mg in older>6y/o
2. susp 120mg/5ml 1/2*w cc
3. susp 125, 325 mg q6h
4. Drop 100mg/ml 2*w drop
5. Soft gel cap 325, 500 mg in older >6y/o
3. Ibuprofen 5-10mg/kg/dose tds
1. tab 200, 400 mg
2. susp 100mg/5ml
3. in Musculoskeletal disease is useful due to anti-inflammatory effect
4. no use in infancy
4. FUO
1. OPD: >3 weeks
2. Inpatient: > 1 week
1. Febrile seizure
1. >38-39 C
2. in 6m/o to 60m/o
3. presents as GTC
4. only one time in 24 hours
5. last less than 15 minutes
2. Check
1. brain CT without contrast
2. BUN, Cr
3. Na, K, Mg, Ca, P
4. BS
5. Trauma Hx
6. ECG for arrhythmias
7. Hx of seizure or poisoning
3. Management
1. LLP positioning
2. open airways
3. O2 therapy
4. Amp Diazepam 0.5mg/kg rectal/nasal if needed up to 3 times
1. or Amp diazepam 0.2mg/kg IV
2. or Amp midazolam 0.2mg/kg nasal
5. If not controlled:
1. Amp Phenytoin 20mg/kg in N/S
1. do not infuse in DW
2. Amp phenobarbital 20mg/kg
3. Drip Midazolam 0.05-0.2mg/kg/hr
4. do not use diazepam for infants
5. Discharge the pt with
1. Syrup acetaminophen 120mg/5ml w/2cc qid
2. Tab diazepam 0.3mg/kg tds for 2 days #20 (tab 2, 5, 10 mg)
1. or syrup diazepam 2mg/5l
2. or supp diazepam 5mg
6. prognosis:
1. if there is no risk factor: 10% chance of seizure
7.
#
1. Typical case:
1. a child with ear’s pain
2. a swimmer with ear’s pain
2. Approach
1. at first check tympanic membrane
1. intact: Dx ⇒ External Otitis
2. perforated: refer the pt to the specialist
2. if the canal is full of debris, try to clean it at first to take a look at the membrane
3. Treatment
1. pH lowering agents:
1. Otic drop Boric acid 2% 5drop qid
2. or Otic drop acetic acid 2% 5drop qid
2. Pain killer
1. Susp ibuprofen 100mg/5cc, 5mg/kg or 1-2cc/kg/d qid
2. Susp acetaminophen 120mg/5cc weight/2 cc qid
3. Tab acetaminophen 500 mg qid
3. Anti biotics
1. Otic drop ciprofloxacin 3% 4 drops qid
2. or Otic drop ofloxacin 3% 4drops qid
3. or Cap ciprofloxacin 500 mg bid #10
1. for DM pt, immunodeficient pt or severe disease
4. Steroids
1. otic drop dexamethasone 0.1% 4drops tds
2. or Otic drop betamethasone 0.1% 4drops tds
5. Steroids and Ciprofloxacin can be prescribed even in perforated membrane
1. Otic drop Polymyxin-NH 4drops tds (neomycin, hydrocortisone, polymyxin B)
1. do not use in perforated membrane
2. Otic drop ciprosonate 4drops tds
6. Anti fungal
1. prescribe in refractory cases, immunodeficiency, DM
2. Solution clotrimazole 1% bid
3. or Cream ketoconazole 1% bid
4. A common prescription:
1. Otic drop Boric acid 2% 5drops qid
2. Susp acetaminophen 120mg/5cc w/2 qid
3. Otic drop ciprofloxacin 3% 4drops qid
4. Otic drop dexamethasone 0.1% 4drops tds
1. Check out drug Hx and possibility of MDD
2. Treatment
1. Tab sildenafil 50mg #30 1 hour before intercourse
2. Tab bupropion 75, 100, 150mg #30 qd
3. Supplement for men:
1. Vigorexin
2. Libidofem
3. Macavit M
4. Supplement for women
1. Provestra
2. Macavit F
3. Ferto lad
1. Orders:
1. IV line fix
2. Check CBC, PT,PTT, INR, Blood group, Rh
3. IV infusion 1 lit N/S
4. Reserve 2 bags P.C (isogroup, isoRh, cross matched, 4u<7 y/o and 2u <9 y/o)
5. Bilateral nasal x-ray for Fx
6. Spray Lidocaine 2% 2puff + Spray oxymetazoline 0.05% 2puff
2. Discharge with:
1. oint tetracycline 3% tds for 10 days #1
1. or Vit A-D tds
2. or Vaseline tds
2. Spray oxymetazoline 0.05% PRN
1. Nasal drop phenylephrine 0.5% in patient without HTN
2. or Nasal drop naphazoline 0.05% in patient with HTN
3. use Tampon with Oint tetracycline and Drop phenylephrine for 48 hours
4. use nasal spray sesalin q4h in adults and <12 y/o bid for dry mucosa in nose
1. Symptoms:
1. in 6-12 y/o
2. very acute and dangerous course
3. high grade fever
4. sore throat
5. dyspnea
6. dysphagia
7. drooling
8. less common: croup like baring cough
9. usually no prior URI symptoms
2. Orders:
1. Neck x-ray AP and Lateral (for thumb sign)
2. Intubation and proper airway as needed
3. Amp ceftriaxone 50-75 mg/kg/day bid for 7 days
1. or amp cefotaxime 100-200mg/kg/day q6h
2. or amp meropenem 60 mm/kg/day q8h