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1. Treatment
1. behavioral treatment
2. night bells
3. continue treatment for 6 months
4. Syrup lactulose 1-3cc/w bid
1. or syrup glycerin
2. or syrup MOM 1-2cc/w bid
2. if refractory, check
1. Total Alb, anti TTG Ab, serum IgA
2. TSH, T3, T4
3. CBC
4. K, Ca
5. U/A
3. infants can have low defecation up to 1 time/ week
#
1. check:
1. CBC, FBS, Ca, P, PTH, ESR, TSH, OB
2. Abdominal X-ray & Chest X-ray
2. Treatment
1. Bulking agents:
1. Sachet psyllium qd or bid #30
2. Osmotic
1. Sachet PEG 10 mg qd #20
1. long-term use may cause electrolyte imbalance
2. Syrup lactulose 10mg/15ml #1 15-30 cc bid
1. cause bloating
2. in pregnancy and CKD is safe
3. Supp glycerin qhs #10
4. Susp MOM #1 weight*2 cc or 15-30 cc qd or bid
3. provocative
1. Supp Bisacodyl 5, 10 mg qhs #5
2. syrup Figan 5cc qd #1
3. Syrup Caster oil
4. Syrup senalin
4. for long-term treatment, Lactulose and PEG are good choices
5. For children or pregnant females use Lactulose or Glycerin
6. Do not use Lactulose in DM and Bowel obstruction
7.
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1. For FEVER:
1. Acetaminophen
1. Tab 325-500 mg (10-15 mg/kg) q6h
2. Susp 120mg/5ml 1/2Weight cc
3. Susp 125-325 q6h
4. Drop 100mg/ml 2*W drop
5. Soft gel Cap 325-500
2. Ibuprofen 100mg/5ml (5mg/kg or 1-2cc/kg/d) q6h
3. Elixir Diphenhydramine 12.5mg/5cc w/4 ccq6h (very sedative) (useful in 6m – 2 y/o)
4. Syrup hydroxyzine 10mg/5cc w/4 cc q8h (very sedative)
1. or Tab hydroxyzine 10-25 mg tds
5. Elixir Loratadine 5mg/5ml 5cc bid or qd
6. or Tab loratadine 5 mg qd
7. Tab cetirizine 5, 10 mg bid or qd
8. Syrup ketotifen 1 mg/5ml (6m-2y/o 2.5 cc — > 2 y/o 5 cc) bid
9. or tab ketotifen 1 mg bid
2. Decongestant
1. do not use for long-term, or alone, or >12y/o
2. Nasal drop phenylephrine 0.25% or 0.5% tds
3. syrup pseudoephedrine 30mg/5cc w/4 cc qid
4. or cap pseudoephedrine 30mg qd
5. nasal drop Naphazoline 0.5% qid
3. Dry Cough
1. tab Dextromethorphan 15 mg
2. or Syrup dextromethorphan 0.4cc/kg/day qid or 2.5 cc tds
3. or Oral drop dextromethorphan 4mg/ml
4. or Syrup dextromethorphan-phenylephrine
4. Wet cough
1. Syrup expectorant 0.5cc/kg/d or w/6 cc tds
2. syrup guaifenesin 100mg/5cc w/4 cc in <4 y/o tds
3. Syrup bromhexine 4mg/5cc 2.5 cc tds
4. Syrup prospan 5 cc q8h #1
5. Syrup Ivora 5 cc q8h #1
5. If dyspnea
1. Spray salbutamol PRN
2. Spray fluticasone bid (Fixotide & Fixonate)
3. Spray Mometasone bid (Asmanex & Nasonex)
6. Combined Drugs:
1. Adult cold qid (include antihistamine)
2. Cold stop qid #30 (include antihistamine)
3. tab corizan qid #30
4. Syrup pediatric grape w/4cc qid
7.
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1. Consider:
1. 100% O2 therapy
2. if carboxyHb >25% in NL people or >15% in pregnant pt ⇒ use hyperbaric O2
3. consider early intubation
4. CXR
5. ECG
#
1. Course
1. Low grade fever
2. Papules ⇒ vesicles ⇒ pustules ⇒ crust formation
3. lasting about 1 week
2. No use of
1. Aspirin ⇒ Ray syndrome
2. Ibuprofen ⇒ Toxic shock syndrome
3. Treatment
1. Elixir diphenhydramine 12.5mg/5cc #1 2.5cc tds
2. Syrup hydroxyzine 10mg/5cc #1 5cc bid
3. Susp acetaminophen 120mg/5cc w/2cc qid #1
4. Daily bath
5. If:
1. Age >12y/o
2. immunodeficiency
3. corticosteroids use
4. pulmocutaneous lesions
5. Long-term salicylate use
1. Tab acyclovir 400 mg 2 tab q6h (20mg/kg/day, max dose 800 mg q6h for 5 days)
1. or tab valacyclovir 1000 mg tds (20mg/kg/day)
#
1. ECG in all males >39 and females> 34
2. DDx:
1. Pericarditis: st-elevation in all leads except AVR
2. Aortic dissection: type of pain, HTN
3. Pulmonary embolism: high HR, high RR, chest pain, S1Q3T3
4. pneumothorax: dyspnea, abnormal auscultation
5. esophageal rupture: post vomiting
3. in ECG:
1. st-elevation ≥ 2mm in precordial leads and ≥ 1mm in other leads at least in 2 leads representative of one area
2. tall R in V1 and V2 in posterolateral MI
3. Pathologic q wave: widening > 1 mm
4. LBBB + MI: (Scarbosa rules)
1. >10mm same arrows as QRS
2. >5mm against arrows of QRS
3. st-depression >1mm in V1-V3
4.
1. Approach
1. wash with any kind of water handy with 9 lits at least
2. For anesthesia
1. Drop opht tetracaine 0.5% 1-2drop SD
3. Painkiller
1. Amp MS 4mg IV
2. Amp ketorolac 30mg IV
4. Refer with:
1. Drop tear opht artificial 0.5% q5min
2. Drop opht betamethasone q2h
3. Drop opht chloramphenicol q6h
#
1. Ex: Meibomian glands obstruction
2. Symptoms:
1. Pain
2. bulging
3. redness
3. treatment
1. warm compress
2. baby shampoo #1 tds
3. oint erythromycin 0.5% #1 qid
4. drop tear opht artificial 0.5% #1 qid
#
1. symptoms
1. pain while intercourse
2. Abnormal bleeding
3. discharge
4. hypogastric pain
2. Etiology
1. Neisseria
2. Chlamydial
3. Treat both the pt and her partner
1. Cap metronidazole 500 mg #28 bid
2. Tab azithromycin 500mg #4 each one 1 gr stat (can be prescribed in pregnancy with erythromycin)
3. other option:
1. Cap cefixime 400mg #2 each one 400 mg
2. Tab doxycycline 100mg #28 for both
#
1. Erysipelas
1. sharp border
2. painful
3. strep
2. Cellulitis
1. dermis and subcutaneous are involved
2. vague border
3. staph
4. mostly in DM, malnutrition, immunodeficiency, trauma, fly bite
3. Treatment: if high risk, start IV treatment then change into PO treatment
1. Cold compress
2. Cap mefenamic acid tds
3. Vial ceftriaxone 1gr (50-75mg/kg) qd
1. or Vial cefazolin 1gr q8h (100mg/kg/day)
4. Vial vancomycin 1gr q12h (15mg/kg/day)
1. or cap cefalexin 500 mg qid
2. or susp cefalexin 250, 125mg/5ml
3. or tab erythromycin 400 mg
4. or tab penicillin 500 mg qid
5. treat for 7 days, start with IV then change to Po
6. always consider necrotizing fasciitis
4. Prophylaxis for recurrent cellulitis
1. Cap penicillin v 500 mg q12h #30
5. for septal cellulitis, always admit and use IV antibiotics
1. diplopia
2. proptosis
3. vision loss