Tonsillectomy
#
1. Indications:
1. nasal congestion
2. chronic oral respiration
3. nigh snoring
4. growth retardation
5. recurrent otitis media
6. chronic sinusoidal infections
2. Refer the pt to ENT man
Archive
Thyroid dysfunction
#
1. lab data requested:
1. TSH only for screening
2. TSH, T3, T4
2. Hypothyroidism
1. actual: high TSH, low T3/T4
2. subclinical: high TSH, NL T3/T4
3. Tx:
1. Tab levothyroxine 50-100 ugr qd
2. start with 1.6 ugr/kg daily, calculate weekly dose
3. if PMHx + for HF or age>60 y/o
1. start with 25 ugr qd
4. check every 2 month and add or decrease 1/4 to 1/2 of tab
3. Hyperthyroidism ⇒ REFER ALL PT
1. tab methimazole 5 mg q12h #100
2. tab propranolol 20 mg q8h #100
3. side effects of methimazole told written to the pt
1. urticaria, rash
2. jaundice, bleeding
3. fever, chills
4. headache
Temporal arteritis
#
1. Tab prednisolone 50 mg qd #4
2. tab ASA 80 mg qd #30
3. Tab Ca-D qd #30
4. always REFER the PT
Sun burn
#
1. almost always as 1st degree burn
2. Treatment
1. for mild burn
1. Oint Zinc oxide BID
2. for severe cases with bullae, edema and exfoliation
1. Indomethacin 90mg
2. Propylene glycol 45cc
3. Absolute ethanol 45cc
4. PO pain killer
Snake bites
#
1. Check
1. CBC, Na, K, U/A. Ca, BUN
2. PT, PTT, INR, AST, ALT, ALKP, Fibrinogen, Fibrin
3. CXR, ECG
4. blood group, Rh
2. Anti-venom
1. mild bite ⇒ 5-10 vials
2. severe bite ⇒ 10-20 vials
1. each vial diluted in 10 cc tap water then in 250 cc N/S infused in 4 hours (50 cc/hr ⇒ 124 cc/hr ⇒ 250 cc/hr)
3. Hypersensitivity and fever
1. Amp epinephrine 0.5-1 cc or 0.01cc/kg for children IV
2. Acetaminophen PO
4. Consider fasciotomy in case of compartment syndrome
Sinusitis
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1. Symptoms
1. Headache
2. Feeling of پری
3. thick mucosal discharge
4. fever
5. Hx of URI more than 10 days ago
6. a period of resolving symptoms then worsening of them
2. Treatment
1. Amp ceftriaxone 50mg/kg IV stat
2. Susp amoxicillin 250mg/5ml w/2cc bid for 10 days #1
1. or susp co-amoxiclav 457mg/5ml w/2 bid
3. Syrup acetaminophen 120mg/5ml w/2cc qid
4. Elixir diphenhydramine 12.5mg/5ml w/3cc qid #1
1. syrup guaifenesin qid
3. Trade Name
1. Susp Farmentin 643 w/3 #1 bid (co-amoxiclav)
2. susp Faramox 400mg/5ml (200mg/5ml) (Amoxicillin)
4. As tab
1. Tab co-amoxiclav 625mg tds for 2 weeks
2. Tab amoxicillin 500mg tds for 2 weeks
5. in case of Penicillin hypersensitivity:
1. Levofloxacin 20mg/kg/day
1. or Tab clindamycin 300mg tds for 3 weeks (30mg/kg/day)
6. If no response to treatment, refer to ENT man
Shigellosis
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1. symptoms
1. Abdominal pain
2. 70% mucosal diarrhea
3. 40% bloody diarrhea
4. N/V
5. 30% fever
6. at first diarrhea is watery and massive but then became bloody but more frequent
2. Dx: S/E, Leukocyte and PMN in stool
3. Treatment
1. Syrup azithromycin first day 12mg/kg/day then 6mg/kg/day for 4 days
1. or Amp ceftriaxone 50mg/kg/dose IV SD
2. or Syrup cefixime 8mg/kg/day (syrup 100mg/5ml)
3. or Tab ciprofloxacin 500mg bid for 5 days
2. Syrup zinc sulfate bid
1. 2.5 cc for <6m/o
2. 5 cc for >6m/o
3. Powder ORS
4. Syrup acetaminophen 10mg/kg 120mg/5ml w/2 cc qid
4. in case of failure of treatment
1. Metronidazole 20mg/kg/day tds
Seborrheic dermatitis
#
1. For dandruff
1. Shampoo ketoconazole 2% qd then weekly
2. Shampoo selenium sulfide 2.5% qd then weekly
2. for Face:
1. Oint clotrimazole 1%
2. cream ketoconazole 2%
3. For pruritus and inflammation
1. Lotion Clomit only for scalp
2. Oint hydrocortisone 1% bid for other areas
4. Very refractory cases
1. Cap fluconazole 150 mg weekly #4
1. or cap itraconazole 100 mg bid for 1 week #14
Scorpion’s bite
#
1. Check
1. CBC, diff, Na, K, ABG
2. AST, ALT, ALKP, PT, PTT, INR
3. H&M, Pulse oximetry
2. topical lidocaine for pain control
3. Diazepam for anxiety and seizure control
4. Anti-scorpion serum in:
1. children
2. systemic sign
3. Gadim scorpion هفت دم
1. 1 vial if asymptomatic
2. 3-6 vial if symptomatic
1. dilute each vial in 250cc N/S
3. if came with arrest ⇒ 6 vial stat without dilution