Epididymitis
#
1. Treatment
1. Vial ceftriaxone 250mg #1 IM
2. Tab acetaminophen 500mg #20 qid
3. Tab doxycycline 100mg #30 bid
4. R/O torsion if highly suspicious with CDSono
Archive
Elbow dislocation
#
1. No need for imaging
2. Maneuver
1. child sits in parents hug
2. take with one hand the elbow
3. take with your other hand the wrist
4. pull the wrist to yourself and simultaneously, external rotate (supination) the forearm
5. child can move his arm in 15 minutes painlessly
3. Use Ibuprofen for pain
4.
Eczema
#
1. Treatment
1. Avoid allergens
2. cold compress
3. Topical corticosteroids
1. oint hydrocortisone 1% tds for 7 days
2. Oint Triamcinolone 0.1% tds (more potent)
4. PO steroids in severe cases
1. Tab prednisolone 20 mg for 5 days
5. Anti pruritus
1. Tab hydroxyzine 25 mg qd
1. or syrup hydroxyzine 2mg/kg/day
6. Antiseptic if there is infection
1. Cap cefalexin 250, 500 mg qid
1. or tab erythromycin 400 mg qid
2. or oint mupirocin tds
7. for washing
1. Soap glycerin PRN
Early ejaculation
#
1. treatment
1. Start and stop method
2. women on top method
3. Tab fluoxetine 20mg #30 30mins before intercourse
1. or Tab daxpoxetine 30mg #30 1 hour before intercourse
2. or cap Dyan-max #60 qd
4. Spray lidocaine #1 before intercourse
5.
Ear’s Wax
#
1. Otic drop Glycerin Pheniqen 3drops tds for 1 week #1
2. olive oil can be used too
3. Refer the pt to ENT man after 1 week for suctions
Dyslipidemia and hyperlipidemia
#
1. Check
1. LDL, HDL, Cholesterol, TG
2. check every 5 years
3. check 6-8 weeks after treating the pt
2. Primary prevention
1. If LDL>190
1. ASCVD>10% ⇒ moderate dose Statin
2. ASCVD 5-10% ⇒ discuss starting drugs
3. ASCVD<5% ⇒ only F/U
4. Repeat checkups after 6-8 weeks of treatment
5. Goal: decrease 50% in LDL level
3. Statins:
1. Tab Atorvastatin (10, 20, 40mg) start with 10-40 mg , max 80 mg/day
2. tab Lovastatin 20 mg, start with 20-40 mg max 80 mg/day
3. tab Rosuvastatin (5, 10, 20 mg) start with 10-20 mg max 40 mg/day
4. Fibrates
1. Tab Gemfibrozil (450, 600 mg) bid
2. tab Gemfibrozil 300 mg bid max 1200 mg /day
3. cap fenofibrate (100, 200 mg ) qd, start with 50-100 mg/day max 200 mg qd
5. Bile chelators:
1. Powder cholestyramine 4gr bid before meal
2. tab nicotinic acid 100 mg tds or qid
3. tab ezetimibe 10 mg qd (block bile absorption)
4. tab fish oil bid
6. Approach:
1. First line drugs
1. Statins: tab atorvastatin 40 mg po qd #30
1. Statins are more effective on LDL
2. may cause myositis ⇒ check CPK, ALT, AST, ALP
3. may cause rise LFT
4. check LFT, TSH, FBS, CK, lipid profile before starting drugs
2. Fibrates: Cap gemfibrozil 300 mg bid #90
1. do not prescribe with statins
2. more effective on TG
3. start with one of them
2. 2nd line drugs: if first line was not effective, add these drugs
1. tab nicotinic acid 100 mg tds #130
1. first week 1 pill
2. 2nd week 2 pills
3. 3rd week 3 pills
2. Tab Niacin 50mg qd up to 2gr/day
3. tab fish oil bid effective on TG
4. Powder cholestyramine 4gr bid with food
DKA
#
1. Orders:
1. imp: DKA
2. ACT: CBR
3. Vital signs: close observation
4. Diet: NPO
5. Condition: urgent
6. IV line 2* fix
7. CVS q1h
8. ECG
9. POM & CHM
10. O2 therapy if SpO2<94%
11. internal folly fix + check intake & output
12. Check
1. CBC, diff
2. Na, K, Ca, P, Mg
3. VBG, ABG
4. U/A, U/C, BUN, Cr
5. BS, HbA1c
6. C-Peptide
7. TSH, T3, T4
8. ANTI-TTG IgA
9. CRP, ESR,
10. ALP
11. B/C
13. Check BS q1h
14. check VBG q2h
15. Check k q4h
16. Check Na, K, Mg, Ca, P, BUN q4h
17. IV hydration
1. start with serum N/S 10-20 cc/kg IV infusion in 1 hours, repeat if diuresis was not started (distract it from the whole fluid that should be given)
2. start 1000/10kh + 50/20 kg+ 20/kg cc IV maintenance
3. add deficit: 10cc*w*10-7%
18. Potassium
1. k<3.2 : 80meq/lit kcl
2. 3.2<k<4.5: 40meq/lit kcl
3. 4.5<k<5.5: 20meq/lit kcl
4. k>5.5: no KCl added
19. Insulin
1. only start when k>3.3
2. Serum HS 500cc + 0.1 unit/kg regular insulin ?cc/hr IV infusion
3. after resolving DKA, start insulin with 1unit/kg/day (1/3 basal, 2/3 regular) SQ with 30 minutes at least overlap with IV insulin
20. HCO3
1. if pH<6.9
2. NaHCO3 (100mmol) in 400cc/2hr H2O + 20meq KCl IV infusion
21. if + Headache, refractory vomiting, decreased LOC (in favor of brain edema)
1. Mannitol 1gr/kg/15min, repeat 30 mins later if no response seen
2. Types of fluids:
1. start hydration with N/S
2. give insulin in HS
3. BS<250 mg/dl ⇒ HS + DW5%
4. 150<BS<200 ⇒ HS + DW7.5%
5. 100<BS<150 ⇒ HS + DW10% + insulin 1/2
6. BS<100 ⇒ HS + DW12.5% + insulin 1/2
3. DKA criteria
1. BS>200
2. VBG: pH<7.3, HCO3<15
3. BHOP>3
4. Ketonuria
4. Resolved DKA criteria
1. pH>7.3
2. HCO3> 15
5. Goal of BS:
1. children: 150-180 mg/dl
2. adult: 100-150 mg/dl
6.