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. Drugs classification:
1. Class 1: use for VT
1. procainamide
2. Lidocaine
2. Class 2: B-blockers
3. Class 3: Amiodarone ⇒ for VT and SVT and AF
4. Class 4: Calcium channel blockers
2. Bradycardia: <50-60 bpm
1. Amp atropine 0.5 mg IV, repeat q5min, max 3 mg
2. if no response, Amp dopamine 5-10 ugr/min IV infusion
3. 1st degree heart block: no Tx
4. 2nd and 3rd degree heart block:
1. Amp dopamine 10-10 ugr/kg/min
2. or Amp epinephrine 2-10 ugr/kg/min
5. 2nd degree due to BB or CCB:
1. Amp glucagon 5-10 mg stat then 2-5 mg/hr infusion
6. Sinus tachycardia:
1. look for underlying cause rather than treating the mere tachycardia
7. Atrial flutter: 250-350 HR, sawtooth appearance
1. if unstable: 50-100 j cardioversion
2. if stable: Echo for clot formation if >48 hrs is passed
1. Amp heparin 5,000 u IV stat then 1000 u/hr IV infusion
2. Amp Diltiazem 20 mg IV over 2 mins then 5-15 mg/hr, repeat with 25 mg if no response seen
3. if HF +: Amp Digoxin 0.25 mg IV in 5 mins repeat q2hr (max 1.5 mg)
4. if no response: Amp MgSO4 4 gr in 4 mins
8. PSVT: regular, 200-180 HR, AVNRT
1. Vagus massage, cold water, gag reflex
2. Amp adenosine 6,g IV push then 12 mg IV (Amp 3mg/ml)
9. AF: 400 HR + 120-170 ventricular response
1. instable: synchronized cardioversion 120-200j
2. stable:
1. Amp digoxin 1/2 amp stat slowly
2. start anticoagulants using CHA2DS2 Vacs scoring system
10. VT: wide complex, regular, 15-200 HR
1. unstable: unsynchronized or synchronized cardioversion 100-200j
2. stable:
1. Amp procainamide 100mg + 10cc D/W (25-50 mg/min) then 3mg/min infusion
2. or Amp Amiodarone 150 mg + 50 cc D/W in 10 mins then 1 mg/hr infusion for 6 hrs
3. or Amp lidocaine 1.5 mg/kg IV then 2-4 mg/kg IV infusion
3. if polymorphic VT:
1. Amp MgSO4 2 gr + 50 cc D/W in 15 mins infusion then 1-2 gr/hr infusion
11. PVSs:
1. Tab metoprolol 50 mg bid
2. Tab propranolol 20 mg tds
3. Tab Concor (bisoprolol) 5 mg qd
4. Tab verapamil 40 mg tds
5. tab diltiazem 60 mg tds
#
1. Refer all:
1. 3rd degree burn
2. >20% of 2nd degree burn
3. electrical, chemical, respiratory burn
4. hand, foot, perinium, face, joint burn
5. 2nd and 3rd degree burn in elderly and children
6. burn + PMHx
7. Burn + trauma
2. Treatment
1. IV therapy
1. w*%*4, half in 8 hours and rest of it in 16 hours
2. keep Urine output >0.5cc/kg/hr in child and >1cc/kg/hr in adult
2. Consider ECG in electrical burn
3. Consider intubation in smoke burn
3. Treatment of mild burns
1. immediate cooling with water
2. Cream silver sulfadiazine bid
3. Oint fibrinolysin tds
4. Serum N/S for irrigation
5. Cap mefenamic acid
6. tab hydroxyzine 25mg
7. cap cefalexin 500 mg qid if infected
8. tetanus vaccination
#
1. For breast
1. >20y/o ⇒ yearly by pt
2. 20-40 y/o ⇒ every 3 years by physicians in high risk pt
3. >40/yo ⇒ yearly mammography in NL population and yearly MRI in high risk pt
4. perform the examination in 7th day of cycle
2. For cervix
1. start 3 years after first sex or at age 21
2. 21-29 y/o ⇒ liquid base pap smear every 1-2 year
3. >30y/o ⇒ if last 3 exams were NL, continue pap smear q3y
4. >70y/o ⇒ if last 3 exams were NL, no need for more examination
1. Mild aggression
1. Tab risperidone 2mg
1. or tab lorazepam 2mg
2. or tab olanzapine 5mg ⇒ do not use with lorazepam (any benzo)
2. Severe aggression but not psychotic
1. Amp lorazepam 0.5-2mg IV or IM (not available in Iran)
2. Amp Midazolam 2.5-5mg IV or IM
1. repeat every 3-5 mins
3. Severe aggression and psychotic
1. Amp haloperidol 2.5-10mg IV or IM
1. or Amp dropridol 2.5-5mg IV or IM
4. If drug fails, restrain the pt with 5 man
1. check pulses and hydration every 15mins
2. contraindicated in
1. CVD
2. Orthopedics
3. Metabolic disorders
4. Infections
