Archive
Knee dislocation
#
1. immediate reduction in crash scene
2. Popliteal vessels and nerves must be evaluated before and after reduction
3. If after reduction, pulses were still week and unpalpable, do Angiography
Kawasaki disease
#
1. symptoms
1. >5days fever
2. non purulent conjunctivitis
3. oral erythema
4. strawberry tongue
5. submandibular lymphadenopathy
6. erythema multiform
2. Refer the pt
Iron poisoning
#
1. usually a young woman used it to suicide or a child using wrong bottle of iron drug
2. Common pills’ dosage
1. Amp venofer 20 mg/ml
2. Cap ferfolic 60 mg
3. Cap ferrous sulfate 100 mg
4. Tab ferrous sulfate 36 mg
5. Drop ferrous sulfate 25 mg/ml
3. poisoning ⇒ ≥ 450 mg/dl serum level
4. Orders:
1. charcoal
2. deferoxamine 10-15 mg/kg/hr use in form of IV, IM, PO
1. max dose 6 gr/day due to urine color change
2. D/C deferoxamine if
1. acidosis resolved
2. become asymptomatic
3. negative x-rays
Iron deficiency in women
#
1. Symptoms:
1. mostly malaise and weakness
2. Treatment
1. Tab ferrous sulfate #100 qd for prophylaxis and tds for treatment
1. or cap Hematinic #100 qd for prophylaxis and tds for treatment
2. Tab acid folic 1mg #100 qd for prophylaxis and tds for treatment
3. in refractory cases:
1. Cap fefol #100 qd or tds
Iron deficiency
1. <8 y/o ⇒ Hb<11 and MCV<70
>8 y/o ⇒ Hb<12 and MCV<80
2. Physiologic anemia
1. in term infants start in 6-10 w/o with Hb: 9-11
2. in preterm infants start in 4-8 w/o with Hb: 7-9
3. Treatment
1. children
1. as prophylaxis
1. tab ferrous sulfate qd #30
2. or Drop ferrous sulfate 2drop/kg/day (40mg/5 ml)
2. as treatment
1. Tab ferrous sulfate 3 tabs daily #100 max dose 15 mg/day
2. Drop ferrous sulfate 4drops/kg/day for 8 weeks
2. Pregnancy
1. before pregnancy use tab ferrous sulfate 1 tab qd
2. as treatment of anemia: 200 mg Elemental iron ::: Ferrous sulfate 325mg 3 tabs qd
3. IV therapy
1. no po tolerate
2. GIB
3. malabsorption
4. .23*weight*(15-Hb) + 500 mg in N/S over 60-90 mins
| High MCV, High RDW | high MCV, NL RDW | low MCV, High RDW | Lowe MCV, NL RDW |
| — | — | — | — |
| Folate deficiency
B12 deficiency | Aplastic anemia | Iron deficiency | Minor thalassemia
Chronic disease |
Invagination
#
1. symptoms
1. 6-35 m/o
2. severe crampy pain lasting for 20 minutes
3. asymptomatic intervals
4. worsening pain
5. vomiting
6. mucosal-bloody stool
7. sausage shape mass in exam
2. Dx: Sonography
3. Visit pediatrics or surgeon
Insomnia
#
1. Treatment
1. Elixir diphenhydramine 12.5mg/ml #1 before sleep one spoon
1. available for >2y/o and pregnant
2. Tab melatonin 3 mg 1/2 tab before sleep #10 for children
3. For intermittent sleep
1. Tab lorazepam 10 mg qhs#30
2. or tab zolpidem 5mg qhs #30
4. For pt who cannot start sleep
1. Cap flurazepam 15 mg qhs #30
2. or Tab flurazepam 30 mg qhs #30
5. Tab doxepin 10 mg qhs #30
2. D/C drugs after 2-3 weeks of use and correction of sleeping
3. Do not D/C benzo without tapering
Influenza
#
1. Treatment
1. Cap oseltamivir 30 mg for 7 days
1. or syrup oseltamivir 60 mg/5/ml
2. or cap Flubivir 75 mg
3. or cap Tamiflu 30/45/75 mg
1. Symptom therapy only
1. Serum N/S 500-1000 cc IV infusion
2. Amp apotel 1gr (10-15mg/kg) INF
3. Amp ketorolac IV
4. Amp B-complex
2. Approach
1. if suspicious of pneumonia, take CXR
2. Vaccination in high risk group:
1. Vaccine Influvac #1
1. >3y/o 1 Amp
2. <1y/o 1/2 amp
3. <12y/o for first time, repeat 1 month later
4. for pregnancy, in 2nd and 3rd trimester
5. safe in breast feeding
6. contra indicated in dose who are sensitive to Egg’s protein
2. may cause GBS
3. use in
1. health care workers
2. old age
3. immunodeficient
4. chronic disease
Infantile Icterus
#
1. High risk group
1. icterus in first 24 hours
2. >15% direct bili
3.
1. Check
1. Bilirubin Total and Direct
2. CBC, diff
3. retic count, Blood group and Rh (infant and mother)
4. PBS
5. G6PD
6. Direct coombs
7. TSH, T3, T4
8. U/A, U/C
9. BS
2. Prolong Icterus
1. >2 weeks in term
2. >3weeks in preterm
3. Deciding for phototherapy or blood exchange is on specialists
