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1. If alive animal, at first desensitized with lidocaine then pull it out
2. Treatment in ear
1. Drop Polymyxin-NH 4 drops tds for 3 days
3. Imaging:
1. Bilateral Nasal X-rays
2. Neck x-ray AP Lateral
3. CXR AP lateral
4. CT scan if not seen in x-rays
4. Rigid endoscopy for pulling out specially batteries
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1. use Heimlich to evacuate the body
2. Use x-rays
3. Rigid endoscopy and bronchoscopy is needed
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1. Who to admit?
1. all <28 days/old
1. admit for IV Ab therapy
2. sepsis w/u
2. 1-3 m/o
1. if have good condition, NL lab data ⇒ no need for Ab therapy
2. if ill or abnormal lab data ⇒ admit for IV ab therapy
3. 3-36 m/o
1. if <38 C fever ⇒ acetaminophen + daily F/U
2. if >38 C fever ⇒ acetaminophen + daily F/U + Ab therapy + check
1. ESR, CRP
2. U/A, U/C
3. B/C
4. CBC, diff
3. Ab therapy
1. Cefixime 8mg/kg
1. or Co-amoxiclav 80mg/kg/day
4. sepsis w/u if lab data was abnormal
2. Acetaminophen in pediatrics: 10mg/kg
1. Tab 325, 500 mg in older>6y/o
2. susp 120mg/5ml 1/2*w cc
3. susp 125, 325 mg q6h
4. Drop 100mg/ml 2*w drop
5. Soft gel cap 325, 500 mg in older >6y/o
3. Ibuprofen 5-10mg/kg/dose tds
1. tab 200, 400 mg
2. susp 100mg/5ml
3. in Musculoskeletal disease is useful due to anti-inflammatory effect
4. no use in infancy
4. FUO
1. OPD: >3 weeks
2. Inpatient: > 1 week
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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.
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1. Chest compression
1. 100-120/min
2. respiration 2 ::: 15 compression
2. Defibrillation:
1. unsynchronized start with 2j ⇒ 4 ⇒ 6 ⇒ 8 ⇒ 10j
3. Doses:
1. Amp Epinephrine
1. IV: 0.1 cc/kg or 0.01 mg/kg (max 1 mg) from 1/1000
2. Intra thecal: 0.1 cc/kg or 0.1 mg/kg (max 10 mg) from 1/10,000
2. Amp Amiodarone in VT with Pulse
1. IV: 5 mg/kg infused in 30-60 min *3times
3. Amp Lidocaine 1 mg/kg
4. Amp Adenosine in PSVT
1. start with 0.1mg/kg (max 6mg)
2. repeat with 0.2 mg/kg (max 12mg)
5. Amp procainamide in VT with Pulse with LOW BP (about 70-90 in different ages) 15 mg/kg
4. Hydration with 20 cc/kg crystalloids or N/S
5. Intubation
1. size <2 y/o ⇒ small finger, adult: 7-8
2. fixation: youth 12+(age/2), adult male 23, female 21
6.
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1. chest compression and respiration:
1. 100-120/min, 1/3 of chest wall diameter, for 2 minutes
2. 30 compression ::: 2 respiration
2. course:
1. cc + resp ⇒ shock ⇒ cc + resp ⇒ shock + epi ⇒ cc + resp ⇒ shock + epi + amiodarone
3. Doses:
1. Amp epinephrine 1mg/kg IV repeat every 3-5 minutes
2. Amp amiodarone 150 mg/3ml IV
1. first dose 300 mg
2. 2nd dose 150 mg
3. do not use in PEA
4. Defibrillation
1. unsynchronized in PEA
2. 200 j
#
1. PO drugs:
1. LD
2. HD
3. Yasmin
4. Yaz
5. Cyproterone compound
6. Rokin
2. Start from firs day of menstruations qd for 21 days
then rest for 7 days
then start the next cycle
3. if one night missed, double next dose
if 2 nights missed, triple the dose
if more than 2 nights missed, start a new cycle and use another contraceptive way
4. IV drugs:
1. Amp Depo-Provera (DMPA) #1 IM
1. in the 5 days of menstruations
2. repeat every 3 months
5. In breast feeding period
1. Tab contraceptive LD #21
1. or Amp DMPA #1 q3m
2. Tab minipill #30 qd
6. For emergency:
1. Tab levonorgestrel 1.5mg #1 stat
1. or Tab HD #4 2 tab q1h
2. or Tab LD #8 4tabs q12h
3. or Tab Ulipristal 30mg SD #1 available for 120hrs post sex
2. can be used in 72hrs post intercourse
3. if have N/V in 3 hrs post taking the pills, repeat the dose
4. IUD in 7 days
7. For weddings or Mecca
1. Start contraceptive 3-4 days after finishing the menstruations till when she wants
2. high risk of stroke
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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. 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.