Archive
Tonsillectomy
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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
Pre-eclampsia and eclampsia
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1. Definitions:
1. >20weeks HTN ⇒ Gestational HTN
2. <20weeks HTN ⇒ chronic HTN
1. 30% chance of eclampsia
2. check BP every 2-3 week till 30w then weekly
3. check CBC, diff, AST, ALT, ALKP, Na, K, Ca, P, BUN, Cr, Urine 24hr (Protein and Cr), Acid uric
3. BP<140/90 ⇒ is acceptable in pregnant pt
4. 140/90<BP<160-100 ⇒ no treatment but may be a pre eclampsia
1. Hx of blurred vision, headache, N/V, epigastric pain
2. Check CBC, diff, AST, ALT, ALKP, U/A
1. look for proteinuria, thrombocytopenia, abnormal LFT
3. OB/GYN visit
2. Management of pre-eclampsia (BP>140/90 + symptomatic)
1. mild:
1. >37w ⇒ delivery
2. <37w ⇒ watchful waiting
2. severe: (severe headache is very important BP>16-/100, proteinuria>5gr/dl or +3)
1. >34w ⇒ delivery
2. 32w< <34w ⇒ 48 hours on steroids then delivery
3. <32w ⇒ watchful waiting
3. BP treatment
1. treat all BPs>160/100
2. Amp labetalol 20mg IV
1. repeat with 40mg IV and then 80mg IV (max 220mg)
2. or Amp hydralazine 5-10mg IV
1. repeat with 20 mg IV, max 30 mg
3. goal of BP: SBP≥150, DBP≥100-90
4. ACI are contraindicated
4. Eclampsia: seizure
1. LLP
2. O2 with mask 8-10 lit/min, oral airway
3. DIAZEPAM IS CONTRAINDICATED
4. Amp MgSO4 4-6gr in 100cc N/S over 20 mins then 2gr/hr for 24 hours
1. vial 20%: 20cc
2. max speed: 1gr/min
5. Amp MgSO4 5gr IM + Lidocaine 0.5cc in each buttock
6. if not stopped after 15 mins:
1. Amp MgSO4 2gr in 2 min IV
7. if still not stopped
1. Amp phenytoin 1gr in N/S over 1 hr (max 50mg/min) then 500mg po 10h later
5. If MgSO4 poisoning:
1. decreased Patellar reflex
2. Decreased BP
3. Decreased RR
4. Treat with;
1. Resuscitation stuff
2. Amp Ca Gluconate 10% bedside
3. Amp MgSO4 2gr
Needle stick
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1. check HBsAg, HIV Ab, HCV Ab
2. Check HBs AG:
1. if >10 ⇒ OK
2. if <10 ⇒ consider booster and Immunoglobulin
3. Vaccination for HBV ⇒ 0-1-6 months
4. Let the wound bleed for 5 minutes
Knee dislocation
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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
Iron deficiency in women
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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 |