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Clinical Orders1st Edition

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Standard Format For Writing Admission

Orders

Admit:

Attending/Service/Unit/Resident/Inpatient/LOS in days

List Admitting Intern and Pager number

List Admitting Resident and pager number

List Admitting Attending

Diagnosis:

List the main diagnosis and any other that are pertinent to the care of the patient

Condition:

This indicates to the nursing staff and PR folks how sick the patient is

Serious, Guarded, Critical, Stable, good, fair etc.

DO NOT PUT CONDITION AS STABLE! Use "Fair". If they are stable, send them home

Vitals:

This is how frequently YOU want vital signs checked. This can be every 15 minutes, hourly,

every 4 hours, every 12 hours, daily or whatever you choose. If you put “per routine” you

better know what that Means.

q4h, q shift, routine, per ICU protocol.

Activity:

This refers to limitations on activity

Bed rest, bed rest with bathroom privileges, ad lib , amb TID, up to chair, No restrictions

Diet:

What you want the patient to eat

Regular, NPO, Diabetic 1800 Cal ADA, Cardiac prudent, Renal (60g prot, 40 meq K, 2 gm Na),

clears advance to soft, Advance as tolerated, no added salt ,ADA (diabetic), low sodium, clear

liquid, Heart Healthy Diet

ADC VAD NISMAL

ADC VAN DISMAL represents

an organized way to guide

your orders. The included

orders are just illustrative

examples

ADC VAN DISMAL

Admit

Diagnosis

Condition

Vitals

Activity

Diet

Nursing

IVF

Specials

Meds

Allergies

Labs

Ad lib :

at pleasure" and "at one's

pleasure, as much as one

desires, to the full extent of

one's wishes

Amb :

ambulate, walk

Nursing:

What you want the nurses to routinely do Accurate input and output values, daily weight,

calorie counts, CR (cardiorespiratory) monitor, pulse oximetry, Notify MD BP, HR, ICP, Temp

(list parameters) etc.

• Strict I/O’s, daily weights, Foley to gravity, O2 requirement; 1:1 Observation, Neuro

check q4h

• Wound care: Dressing changes, DVT stockings, etc;

• Respiratory care: updrafts, endotracheal suctioning, spirometry, incentive spirometer,

etc.

• Precautions: Aspiration precautions, fall precaution, seizure precautions

• Protocols: Hypoglycemia protocol, bedsore prevention, incentive spirometer.

IVF:

You should indicate the fluid and the rate that it is to run i.e.

2 lit NS + 20 mEq/L of KCl tra (to run at) 14 cc/hr

Specials :

Specialists or Consults

Meds:

These are the medications the patient will be receiving Include the name, dose, route and

frequency .Oxygen is a medication! Just because it comes out of the wall does not mean it is

routinely used. If you want the patient on oxygen list it here, how you want it delivered

(mask, nasal cannula etc.).

At your stage of training you should not get into the habit of writing prn (as needed) orders.

If a patient needs a medication YOU should evaluate that patient and determine for yourself

if the order is needed. Later on when you have developed clinical acumen, you may be able to

anticipate that certain medications will be needed based upon the natural history of the

disease.

• Norco 7.5 mg PO Q6H PRN Pain

• Clonidine 0.2 mg PO Q6H PRN SBP>180

• Metoprolol INJ 10 mg q6h PRN SBP >180

• Hydralazine INJ 10 mg IV q6h PRN SBP>180

• Acetaminophen 500 mg PO q4h PRN temp >101.4

• Diphenhydramine 25 mg IV q4h PRN itching or insomnia

Allergies:

specific medications, NKDA, etc

Labs:

These are the labs that need to be drawn now and those that need to be obtained routinely.

You should only order labs whose abnormal or normal results will change your treatment

plan. Ordering a lab just because you want to see the result is poor form AND you may get an

abnormal result and now YOU must explain why the result is abnormal. You can also order

other ancillary studies under this heading such as x-rays, ECG, EEG, etc. Whenever you order

one of these studies you need to write down in the order sheet the indication for the study.

Do not put “because I want it”.

studies, radiology or imaging: CBC, Chemistries, X-rays, MRI/CT, ECG, Pulse ox, Ca, Mg,

Phos, etc

NKDA:

Not Known Drug Allergy

STEMIAdmit : CCU Admission , Dr () services,

Dx : STEMI

cond : fair

Vitals : q1h

Act : CBR

Diet : NPO till stable then Heart Healthy Diet

Please :

1. ECG at arrival & 1h later

2. Cardiac Monitoring

3. IVF maintenance

4. Cardiologist Consult

5. IV Nitro 5 mg in 100 cc DW 5%, 10drop/min (10 Mcg/min) (if SBP>90 mmHg)

6. ASA Tab 325 mg PO stat & 80 mg po qd

7. Plavix or Osvix Tab 300 mg PO stat ( if age<70 yo) & 75 mg PO QD

8. Atorvastatin Tab 80 mg PO qhs

9. Morphine Inj 3 mg IV stat ( if HR>60, SBP>100, no Heart Block)

Or

Pethidine Inj 25 mg IV stat

10.Clemastine inj 1 Amp IV stat before SK

11.Streptokinase 1500000 unit in 100cc N/S during 30 min

12.Captopril Tab 12.5mg PO TID ( if SBP >100 mmHg & no Hx of Angioedema)

Or

Metoral Tab 25 mg PO BID (if SBP > 100 mmHg & PR > 60/min & no Wheeze)

Or

Inderal Tab 20 mg PO TID (if SBP > 100 mmHg & PR > 60/min & no Wheeze)

Or

Diltiazem Tab 30 mg PO TID (If BB contraindic. & if SBP > 100 mmHg & PR > 60/min)

13.Pantoprazole Tab 40 mg PO QD

14.MOM Syrup 30cc PO TID

15.Oxazepam Tab 10mg PO QHS (age<55 yo)

Or

Haloperidol Tab 0.5mg PO QHS (age>55 yo)

16.O2 Nasally 3lit/min if O2 sat<90%

17.Allergy to specific drug

18.CBC, BUN, Cr, Na, K, FBS

19.PT, INR, PTT, TG, Chol, LDL, HDL

20.CPK, LDH, Troponin

USA/NSTEMI

Admit : CCU Admission , Dr () services,

Dx : USA, NSTEMI

cond : fair

Vitals : q1h

Act : CBR


Please :



3. IVF maintenance


5. IV Nitro 5 mg in 100 cc DW 5%, 10drop/min (10 Mcg/min) (if SBP>90 mmHg)


7. Heparin Inj 60 unit/kg IV stat & 12 unit/kg/h IV Infusion

Or

Enoxaparin Inj 60 mg SQ BID

8. Atorvastatin Tab 80 mg PO qhs

9. Morphine Inj 3 mg IV stat ( if HR>60, SBP>100, no Heart Block)

Or

Pethidine Inj 25 mg IV stat

10.Captopril Tab 12.5mg PO TID ( if SBP >100 mmHg & no Hx of Angioedema)

Or

Metoral Tab 25 mg PO BID (if SBP > 100 mmHg & PR > 60/min & no Wheeze)

Or

Inderal Tab 20 mg PO TID (if SBP > 100 mmHg & PR > 60/min & no Wheeze)

Or

Diltiazem Tab 30 mg PO TID (If BB contraindic. & if SBP > 100 mmHg & PR > 60/min)




Or



15.Allergy to specific drug




19.PTT qd

RVMI or inf MIAdmit : CCU Admission , Dr () services,

Dx : RVMI

cond : fair

Vitals : q1h

Act : CBR


Please :


2. ECG c leads V6R & V2R


4. IVF maintenance

5. If SBP < 90 mmHg only Hydration (N/S 1000cc free stat)


7. If SBP < 90 mmHg stat Dopamine 3-20 Mcg/kg/min


9. Plavix or Osvix Tab 300 mg PO stat ( if age<70 yo) & 75 mg PO QD

10.Atorvastatin Tab 80 mg PO qhs

11.Clemastine inj 1 Amp IV stat before SK

12.Streptokinase 1500000 unit in 100cc N/S during 30 min




Or



17.No IV Nitro, No Morphine, No Beta-Blocker




Heart Failure/Pulmonary Edema

Admit : CCU Admission , Dr () services,

Dx : heart failure, pulmonary edema

cond : fair

Vitals : q1h

Act : CBR


Please :

1. ECG


3. Put the pt in semi-sitting position

4. Internal folley if needed

5. Check I/O

6. IVF maintenance


If SBP > 100 mmHg :

8. IV Nitro 5 mg in 100 cc D5W, 10drop/min (10 Mcg/min)

[according to BP and pt situation increase dosage +10 mcg/min every 5 min]

9. Lasix Inj 80mg IV stat (Max: 100mg/6h & 240mg/24h) [if K > 3]

10.Morphine Inj 3 mg IV stat ( if HR>60, SBP>100, no Heart Block)

[according to BP and pt sutiotion repeat after 10 min]

11.Captopril Tab 12.5mg PO TID ( if SBP > 100 mmHg & no Hx of Angioedema)

If SBP < 100 mmHg :

12.Dopamine Inj 3-20 Mcg/kg/min

13.Lasix & IV Nitro & Morphine After SBP > 100 mmHg

14.Heparin Inj 60 unit/kg IV stat & 12 unit/kg/h IV Infusion [if ABNL Cr]

Or

Enoxaparin Inj 60 mg SQ BID [if NL Cr]

15.ASA Tab 80 mg po qd

16.Atorvastatin Tab 40 mg PO qhs

17.Pantoprazole Tab 40 mg PO qd


19.O2 Nasally 3-5 lit/min

20.No Beta-Blocker


22.Check BUN, Cr, Na, K, FBS daily

23.PT, PTT, INR, TG, Chol, LDL, HDL


25.LFT (SGOT, SGPT, ALP)

26.U/A

27.CXR after stable

28.ABG

29.D-Dimer , BNP

Depressed ST in ECG

D - Drooping valve (MV prolapse)

E - Enlargement of the left ventricle

P - Potassium low

R - Reciprocal ST Depression (eg. inf MI)

E - Encephalon (intracerebral Hemorrhage)

S - Subendocardial infarct

S - Subendocardial ischemia

E - Embolism (pulmonary)

D - Dilated cardiomyopathy

S - Shock

T - Toxicity (Digitalis/Quinidine)

Sinus Tachycardia

Consider PTE and Tamponade

Choice : Metoral 50 mg po stat

Wide QRS

If unstable : sock 200 j

If stable : amiodarone

1. Amiodarone 150 mg in 100 cc D5W in 30 min

2. Amiodarone 300 mg in 500 cc D5W in 6 hr

3. Amiodarone 450 mg in 500 cc D5W in 18 hr

Narrow QRS

If unstable : sock 200 j

If stable : amiodarone, adenosine, BB, CHB, Digoxin

AF

Choice :

Digoxin 0.5 mg (1 amp) IV stat slowly

Metoral 50 mg po stat

Next dose : 20 min later if not respond

2nd line :

Verapamil 5 mg (1 amp) IV slowly stat

3rd line :

Cardioversion

PSVT

Choice :

Adenosine 6 mg (1 amp) IV stat shoot + 20 cc n/s shoot

می تونیم از. و بعد دست مریض رو باال می گیریم n/sیک سه راهی وصل می کنیم اول آدنوزین می زنیم پشتش

تا آمپول ۳حداکثر . همون اول دو تا آمپول بزنیم

2nd : verapamil 5 mg IV stat

3rd : cardioversion 100-150 j

HTN Emergency

Admit :

Dx : HTN Emergency

Cond : fair to good

Vitals : q1h

Act : CBR


Please :

1. ECG


3. IVF maintenance


5. Captopril 50 mg stat ch 30 min later

Or

IV nitro 5-10 mcg/min till SBP > 80% MAP (if ischemia)

Or

Lasix 80 mg Iv or IM stat (CHF)

Or

Labetalol 20 mg IV stat & 2 mg/min infusion (dissection)

Or

Nitroprusside 1-3 mcg/kg/min infusion (emergency)

6. Diazepam Amp 2.5 mg stat slowly [if there is indication]

.نیتروپروساید به نور حساس استدور سرم آلومینیوم بپیچین

HTN OPD

Pearl TNG + Captopril 25 mg stat

30 mins later check BP

If Bp is still elevated admit the pt and start Iv Nitro

Work up after Dx is made :

1. KUB Sono

2. Bun, Cr

3. Na, K

4. CXR

5. TSH, T4

6. Echo

Managing HTN

A : ACE + ARB

B : BB

C : CCB

D: Diuretic

Choice :

• ACEI : Captopril, Enalapril

• ARB : Losartan, Valsartan

: ساعت شروع کنید ۸کیپتوپریل هر low doseبا

• Capto 25 ½ q8h

Or

• Losartan 25 mg bid

:شروع می کنیم Diureticیک هفته بعد داروی دوم یک

• Tab Triamtren-H

Or

• Tab HCTZ 50 mg qd

ها باید صبح ها باشد نه شب Diureticمصرف

یا افزودن دوز داروهای قبل Beta Blockerیک هفته بعد اضافه کردن

• BB : tab metoral 50 mg , ½ tab BID

points :

CVA : Amlodipine

CHF : A+B

Diabetic : A

If there is tachycardia :

Beta blocker

If Renal problems :

ACE

If there is Edema:

HCTZ

Do not prescribe Thiazides for

young women

Do not prescribe Beta Blocker for

Elderly pts

DVT

Admit :

Dx : DVT

Cond :

Vitals : q1h

Act :

Diet :

Please :

1. ECG


3. Leg elevation

4. IVF maintenance


6. Heparin 5000 unit IV stat then 1000 u/hr infusion

7. Warfarin 5 mg po stat

8. Amp Pethidine 25 mg IV PRN [if pain]

9. CBC, Bun, Cr, Na, K , Bs

10.PT, PTT, INR

11.Check PTT q6h

12.D-Dimer

13.Color Doppler Sono

Heparin in DVT : 80 unit/kg stat, 18 unit/kg/hr infusion

Warfarin Toxicity

Admit :

Dx : warfarin toxicity

Cond : fair to good

Vitals :

Act :

Diet :

Please :

1. ECG

2. Transfer 3 bag FFP

3. IVF maintenance


5. Amo Vit K #1 IV stat

6. CBC, Bun, Cr, Na,K, BS

7. Brain CT Scan

8. Pt, PTT, INR now & 6 hour later, then check qd

When you change warfarin dosage:

Check PT 3 days later

If OK

Check PT 1 wk Later

If OK

Check Pt 1 month later

زمانی هپارین قطع می شود که

روز گذشته باشد۵

INR > 1.8و

Tell the pt not to consume green

foods because there

Vit-K in them.

Vertigo

Vertigo

Admit :

Dx : choose according to above approach

cond : depends on condition

Vitals : depends on condition

Act : depend on condition

Diet : depends on condition

Please :

1. ECG

2. IVF 500cc N/S in 24h

3. Promethazine Inj ½ Amp (25 mg) IV stat

4. Ondansetron Inj 1 Amp IV PRN

5. Betahistine Tab 16 mg PO Q8h

6. Cinnarizine Tab 25 mg PO stat

7. Diazepam 5 mg slowly IV

8. lipid profile

9. CBC, BUN, Cr, Na, K, BS

• Tab Dimenhydrinate / diphenhydramine 50 mg QD

• Tab promethazine

• Tab plasil

• Tab betahistine

• Tab cartan (dexa)

Syncope/Faint

Syncope/Faint

Admit :

Dx :

Cond :

Vitals :

Act :

Diet :

Please :

1. TILT

2. Pulse oximetry

3. Cardiac monitoring

4. BS Glucometry

5. ECG

6. Serum N/S 50 cc iv stat

7. CXR

8. CBC, Bun, Cr, Na, K

9. R/O seizure

10.R/O aorta dissection

WOBBLER for ECG assessment in syncope

Abnormality ECG Section

W Wolff parkinson white P, PR

O Obstructed AV pathway PR

B Bifascicular block QRS

B Brugada ST

LLeft ventricular hypertrophy

(consider AS, HOCM)QRST

E Epsilon wave ST

RRepolarization abnormality

(long QT, short QT)QT

Agitation/Hysteric

Admit :

Dx :

Cond :

Vitals :

Act :

Diet :

Please :

1. ECG

2. Bs Glucometry

3. Amp diazepam 5 mg iv stat

4. Amp haloperidol 5 mg IM stat

5. R/O other disease

Headache

Headache

Admit :

Dx :

Cond :

Vitals :

Act :

Diet :

Please :

1. O2 nasally 6-8 lit/min

2. Iv line N/S 500cc

3. Amp Apotel 1 gr stat q20min in 150 cc N/S

4. If SAh : amp morphine 3-5 mg

5. Amp metoclopramide #1 in bottle

6. Amp dexamethasone #1 in bottle

7. Amp diazepam #1 in bottle

8. Imaging (Brain CT/MRI)

9. CBC, BUN,Cr, Na, K, BS

10.U/A

If migraine headache :

• Amp dexa #1 IM

• Amp promethazine #½ IM

Alarm sign:

Acute & severe

Associated with vomiting,fever,trauma

Awakening

Early morning

Neurologic deficit

Neck rigidity

Near 1st episode

Progressive

Positional

Always unilateral

Seizure

Seizure

Admit :

Dx : seizure

Cond :

Vitals :

Act :

Diet :

Please :


2. ECG

3. ABG

4. BS Glucometry

5. IVF N/S 500cc stat

6. Amp diazepam 5-10 mg IV stat if convulsion

7. CBC, BUN,Cr, Na, K, BS

8. Brain CT Scan if

1. First experience

2. Persistent headache

3. Long postictal period

4. Fever

5. Age > 45

CVAAdmit :

Dx :

Cond :

Vitals :

Act :

Diet :

Please :


2. ECG

3. ABG

4. BS Glucometry

5. Pulse oximetry


7. NGT if unable to po feeding

8. IVF N/S maintenance

9. If not hemorrhage : Tab ASA 325 mg stat then 80 mg po qd

10.Atorvastatin Tab 80 mg qhs or 40 mg BID

11.Labetalol 10 mg IV stat if BP > 220/120

12.Apotel for headache

13.CBC, BUN,Cr, Na, K, BS

14.TG, Chol, LDL, HDL

15.CK-MB Troponin

16.CXR

17.Brain CT Scan

18.Brain MRI s gad c DWI

19.Echocardiography

20.Color doppler of Both carotid & vertebral Artery

21.Intubation if needed

22.CPR if needed

Hemorrhagic CVA :

Avoid ASA

Phenytoin 750 mg iv infusion

N/S consult

If BP > 180

Amlodipine 5 mg for blood

pressure control

WeaknessIf neurologic sign : approach to CVA

If not : approach to infection, cardiac, metabolic problems

Admit :

Dx :

Cond :

Vitals :

Act :

Diet :

Please :


2. ECG

3. ABG

4. BS Glucometry

5. Pulse oximetry


7. NGT if unable to po feeding

8. IVF N/S maintenance

9. Serum N/S 500-2000 cc if shock with check rales

10.Amp ceftriaxone 1 gr if sepsis

11.Amp apotel 1gr stat

12.CBC, BUN,Cr, Na, K, BS

13.PT, PTT, INR if SIRS+

14.Troponin if needed

15.U/A, U/C r/o sepsis

16.B/C R/o sepsis

17.CXR

Decreased LOC

Decreased LOC

Admit :

Dx : hypotension, hypothermia, hypoglycemia

Cond :

Vitals :

Act :

Diet :

Please :

1. BS Glucometry

2. ABG

3. ECG

4. Folley


6. Pulse Oximetry < 90 : intubate

7. Collar in trauma

8. Free hydration

9. Phenytoin 15-20 mg / kg c 25 /min

10.Antibiotic [if fever]

11.CBC, BUN, Cr, Na, K, BS

12.TSH, T4

13.Culture if Sepsis

14.CXR (aspiration pneumonia)

15.Brain CT Scan

Intubation if sign & symptoms of

herniation :

• semi-setting ,

• mannitol,

• hyperventilation

Dextrose naloxone may need (TNGO)

Multiple Sclerosis (Pulse Therapy)Admit :

Dx : Pulse therapy

Cond :

Vitals :

Act :

Diet :

Please :


2. ECG

3. Ranitidin 150 mg PO BID

4. Methylprednisolone 500 mg in 500 cc D5W during 4 hour BID x2day

5. LFT

6. U/A, U/C

7. ESR, CRP

8. Ck K & BS QD

Snake/Scorpion Bite

Admit :

Dx : snake bite / scorpion bite

Cond : fair to good

Vitals : q1h

Act : CBR

Diet :

Please :


2. ECG

3. Inform physician ASAP if INR > 2

4. Washing the wound

5. Apply ice pad locally

6. Td 0.5 cc IM

7. Vial anti venom #3 IV infusion (max: 8-10 vial)

[If manifestations consist for 6 hours add 2 vial more]

8. Keflin 1 gr IV stat

9. Amp dexamethasone #1 [½ if age < 10]

10.Amp chlorpheniramine #1 [½ if age < 10]

11.Amp metoclopramide #1 [½ if age < 10]

12.Tab acetaminophen 500

13.Cap cephalexin 50 mg q6h


15.LFT

16.PT, PTT, INR q8h

17.U/A BID

Alarm signs :

Hematuria

Convulsion

Decreased LOC

Bleeding

If INR > 2 :

Transfer 1 bag FFP

Anti venom indication :

Swelling

Coagulative problems

Progressive local symptoms

If U/A shows blood :

Hydrate the pt because of ATN

Do not order ibuprofen and

narcotics

Skin test before anti-venom :

Test venoum if allergy : 10x dilate in

n/s , 0.2 cc sq for 30 min

Insect Bite

1. Pull out the bite

2. tab / syrup hydroxyzine

3. Oint CALAMINE-D #1

4. Tab antihistamine #10

Domestic animal Human Bite

1/ washing the wound

2/ do not suture fast (wait)

Infection prophylaxis :

Dog bite :

• Co-amoxiclav x3 day

Cat bite :

• Cephalexin 500 qd for 3 days

Human bite :

• Cephalexin or Co-amoxiclav for 7-14 days

پیشگیری از کزاز و هاری در تمامی بیماران

Poisoning Admit :

Dx :

Cond : emergent

Vitals : q1h

Act : CBR

Diet :

Please :

1. BS Glucometry

2. ECG

3. Pulse oximetry


5. O2 supplement 6-8 lit/min

6. NG Washing

7. ABG (VBG)

8. Internist consult

9. IVF maintenance

10.Serum N/S 500cc IV stat

11.Charcoal 1 gr/kg + sorbitol 70% 1 gr/kg

12.Consider Antidote


14.PT, PTT, INR

ABC

If lithium ,alcohol, heavy metal and

non-halogen hydrocarbon :

[there is no need for NG washing

and charcoal sorbitol]

Do not release acetaminophen

poisoning rapidly.

Consider cardiac arrhythmia

CO Poisoning

Admit :

Dx : CO poisoning

Cond : emergent

Vitals : q1h

Act : CBR

Diet : NPO

Please :

1. Put the pt in supine position

2. BS Glucometry

3. ECG

4. ABG (VBG)

5. Pulse oximetry [it shows false data]

6. CO Oximetry


8. O2 supplement 10 lit/min (hyperbaric O2 if indicated)

9. amp apotel 1 gr over 20 min

10.amp ondansetron 4 mg IV stat

11.Observe for 4 hours

12.Internist consult

13.IVF maintenance

14.Serum N/S 500cc IV stat


Hypocalcemia

Admit :

Dx : severe hypocalcemia (ca : 5.5) e.g after post-parathyroidectomy

Cond :

Vitals : heart monitoring

Act :

Diet :

Please :

1. ECG (consider QT prolongation)

2. Nephrologist consult

3. Ca-gluconate 10% 2 vial in 100 cc D5W% infusion in 20 min with heart monitoring

(consider bradycardia)

4. Ca-gluconate 10% 6 vial in 500 cc D5W% infusion in 6 hour

5. Calcitriol cap | 2 cap | po stat & tid

6. Ca-carbonate 1 gr po tid (with meals)


8. Check K qd

9. Check Ca, P bid

10.PTH

Alcohol Poisoning

1. IVF | D5W 500 cc⅓ ⅔ | D5W 500 cc⅔ | D5W 500 cc

2. Amp metoclopramide #1

3. Amp diazepam #1

4. Amp ranitidine 50 mg

5. Amp vit B-complex

Methadone Poisoning

Admit :

Dx :

Cond :

Vitals :

Act :

Diet :

please

1. Heart monitoring

2. pulse oximetry

3. ECG

4. NGT

5. IVF 3000 c in 24 hour⅓ ⅔ | D5W 500 cc⅔ | D5W 500 cc

6. charcoal 1gr/kg + sorbitol

7. amp naloxone 2 amp stat

8. Infusion naloxone 10 amp in 100 cc ½ in 10 hr ⅔ | D5W 500 cc


10.U/A

Anaphylaxis

Admit : ICU admission

Dx : anaphylaxis

Cond : emergent

Vitals : q15min

Act : CBR

Diet : NPO

please

1. cardiac monitoring

2. pulse oximetry

3. VBG(serial)

4. ECG

5. Iv line 2 large bore

6. IVF 1000 cc N/s free

7. O2 Supply 6-8 lit/min

8. Epinephrine 1:1000 0.5 cc IM stat q5min

9. Amp Hydrocortisone 200 mg IV stat

10.Amp Ranitidine 50 mg IV Q8h

11.Amp Chlorpheniramine 10 mg IV stat

12.Diphenhydramine 50 mg q6h

13.Hydroxyzin 1 Tab po stat

14.spray salbutamol 6 puff q20min x3 if dyspnea

15.Salbutamol 8 puff q20min or ventolin 2.5 mg c nebulizer q20min

16.CBC, BUB, Cr, Na, K, Bs

17.Pt, PTT, INR

18.U/A

19.ESR

20.Troponin, CKMB

21.CXR

Hypoglycemia

Admit :

Dx :

Cond :

Vitals :

Act :

Diet : NPO

Please

1. ABG

2. BS Glucometry

3. Heart monitoring & pulse oximetry

4. Check BS q30 min x4 then q1hr x2, q2hr x2, q6hr

5. ECG stat and 1 hour later

6. Serum DW 10% 100 cc/hr infusion hold in bs>300

7. Vial DW 50% 1 gr/kg stat #3 if BS < 70

8. Vial DW 50 % stat if BS < 100

9. BS glucometry DW 50% بعد از اتمام

10.Internist consult

11.Amp glucagon

12.Ceftriaxone 1gr BID

13.Pantoprazol 40 mg BID

14.CBC, Bun, Cr, electr , BS

15.PTT, PTT INR

16.Troponin

ساعت بستری شود۲۴بیمار حداقل

BS > 150 x3

Can give po glucose instead of IV

glucose (but if the pt is full alert)

DKA

Admit : Endocrinologist or internist service

DDx : DKA, HHS

Cond : Emergent

Vitals :

Act :

Diet : NPO

Please

1. ECG

2. Check I/O

3. IVF 1000cc N/S stat (repeatable,max 2500cc)

Then

if BS>250 IVF 500cc HS/hr

if BS<250 IVF 125cc HS+125cc DW5% /hr

4. Regular Insulin

if BS>250 0.1 IU/kg stat & 0.1 IU/kg/h

if BS<250 0.05 IU/kg/

1. Optimal rate of glucose decline is 100mg/dL/h

2. Do not allow the blood glucose level to fall below 200 mg/dL during the first

4-5h of treatment

5. If 3.5<K<5.2 :

1. IV KCl inf. 15-30 meq/h

1. if K>5.2 then hold KCl inf.

2. if K<3.3 then hold insulin inf.

6. CBC, BUN, Cr, Na, K

7. Check BUN, Cr, Na, K Q4h

8. Check And Chart BS Q1h

9. U/A

10.ABG stat & Q4h

11.Endocrinologist Consult

Renal Colic

Admit :

Dx :

Cond :

Vitals :

Act :

Diet :

Please

1. IVF 500 cc n/s with :

2. amp ketorolac 30 mg IV stat

3. amp morphin 3-5 mg IV stat

4. Supp diclofenac (50-100 mg) rectally stat & q6h if needed

5. Amp apotel 1gr (100 cc N/S in 20-30 min)

6. Amp hyoscine 10 mg

7. Amp aminophylline 250 mg

8. CBC, bun, cr, Na, K, Ca,

9. U/A if not k/c of renal stone (first time)

10.KUB x-ray

11.KUB Sonography

12.bedside ultrasound ( r/o hydronephrosis)

Alarm sign :

Fever, anuric, pregnancy

When discharge :

Cap naproxen 500 mg #10

Tab tamsulosin 0.4 mg #20 QD

Supp diclofenac 100 mg #10

Consider :

25-50 mg pethidine , diclofenac amp ,

diazepam amp

Pneumonia

Admit :

Dx :

Cond :

Vitals :

Act :

Diet :

please

1. ECG

2. VBG

3. Sputum for gram stain & culture

4. IV line

5. Serum N/S 1 lit

6. IVF 1000 cc N/s in 1 hour if in shock

7. O2 supplement 6-8 lit/min

8. Spray salbutamol 4 puff stat (if COPD)

9. Cap azithromycin 500mg stat and daily (after po)

10.Amp ceftriaxone 1gr stat and q12h

11.CBC, Diff, BUN, Cr, Na, K

12.PT PTT INR if sepsis

13.CRP, ESR

14.CXR

15.B/C

16.U/A & U/C

vanco, cipro considered

Admission indication :

• Adult : CURB 65

• Age < 6 month :

• immune def,

• toxic,

• distress,

• dehydration,

• vomiting,

• low

Allergic Bronchitis [Severe Cough]

Admit :

Dx :

Cond :

Vitals :

Act :

Diet :

please

1. Amp aminophylline 500 mg in 200 cc D5W% in 30 min

Then

Aminophylline 250 mg in 100 cc D5W% in 30 min TID

2. Amp hydrocortisone 200 mg IV stat and 100 mg IV q6-8h

3. Tab airokast 10 mg po bid

4. Diphenhydramine syrup 5 cc po tid

5. Acetaminophen codeine 300/25 2 tab po bid

6. Pseudoephedrine syrup 5 cc po tid

Attack of Asthma

Admit :

Dx :

Cond :

Vitals :

Act :

Diet :

please

1. IV line

2. O2 6-8 lit/min so2>95

3. Spray salbutamol 6-12 puff q20 min x3

4. Spray atrovent 8-12 puff q20min x3

5. Tab prednisolone 50 mg [po stat]

6. amp methylprednisolone 40-60 mg stat if can nor be on po regimen or

amp hydrocortisone 200 mg IV stat

7. amp aminophylline 250 mg (1 amp) IV infusion

8. amp MGSO4 2 gr over 20 min (if not respond to previous order)

9. antibiotics if infection


11.CXR

UTI

Admit :

Dx :

Cond :

Vitals :

Act :

Diet :

• Cipro tab 500 mg bid x 3-5 days [choice]

• Tab cotrimoxazole 480 mg tid [معموال جواب نمیده]

• Tab nitrofurantoin 100 mg

• Syrup cefixime 100 mg wt/5 q6h [for ped]

: برای سوزش ادرار

• Syrup dicyclomine for ped

• Tab hyoscine 10 mg q6-8hr for adults

• Tab phenazopyridine 100 mg tid

Alarm sign:

• Fever

• Flank pain

• Chills

• Pediatric

• Male

• Pregnancy

Multiple Trauma

Multiple TraumaAdmit : ICU admission if very ill

Dx :

Cond :

Vitals : q 30 min then q3h if stable

Act : CBR

Diet : NPO

please


2. Pulse Oximetry

3. Foley catheter fixed

4. Chart I/O

5. ECG

6. ABG

7. NG tube fixed (contraindicated in skull base fx)

8. Reserve 6 units PC

9. IV line * 2 (large bore)

10.serum NS 1000cc IV free repeat another 1 liter if unstable

11.supplemental O2 4-5 lit/min

12.Amp Ranitidine 50 mg / IV / bd

13.Tetanus prophylaxis (if applicable)

14.CBC serial q6h

15.Check Na, K, BUN, Cr, BS,

16.PT, PTT, INR,

17.U/A

18.CXR

19.Pelvic X-ray (AP)

20.Neck view (AP & Lat) including C7-T1

21.FAST

22.Orthopedic X-rays (if applicable)

23.Brain CT scan (if GCS<15, head trauma, vomiting, amnesia)

24.Orthopedic consult (if applicable)

25.Neurosurgery consult (if applicable)

Primary survey

A: can speak normally , no cx midline tenderness

B: symmetrical NL BS without decrease s, o2 sat, emphysema

C: FAST, BP, External Bleeding, abdomen soft without tenderness, gross hematuria

D: GCS : decrease LOC, PTEA, FND, Seizure. N/V, Pupil

E: Expose (axilla/perineum/back) laceration. Laceration, pelvic fx, limb fx, pain and tenderness

F: int foley

G: NG-T

H: Hx of mechanism

I: imaging

Secondary :

Allergy

Medication

Past hx and pregnancy

Last mael

Environment

Penetrating wound with

pneumothorax

Admit :

Dx :

Cond :

Vitals : q 30 min then q3h if stable

Act : CBR

Diet : NPO

please

1. Reserve 2 bag p.c

2. Ext foley

3. BGRh cross match

4. G.S Consult

5. Pulse oximetry

6. Keflin 1 gr IV q6h

7. Gentamicin 80mg IV stat

8. Toxoid 0.5 cc

9. Fentanyl 50 mcg IV stat

10.Chest tube insertion

11.Chest tube dressing

12.CXR after stable & 6 hour later

13.Routine lab data

14.VBG

Head Injury

Head Injury [If Depressed FX]

Admit :

Dx : depressed skull Fx

Cond : emergent

Vitals : q1h

Act : CBR

Diet : NPO

please

1. Iv line

2. Head elevation 30

3. Check GCS q1h

4. BS Glucometry

5. Neurosurgeon consult

6. Amp ondansetron 0.15ng/kg PRN

7. Amp apotel 15 mg/kg for preventing fever

8. Dilantain 15-20 mg/kg stat and of loading dose for maintenance ⅓ ⅔ | D5W 500 cc

9. Brain CT scan without contrast

GI Bleeding

GI BleedingAdmit : Reserve ICU bed (if very ill)

Dx :

Cond : critical

Vitals : q30min

Act : CBR

Diet : NPO

please

1. Cardiac monitoring + Pulse Oximetry (if very ill)

2. NG tube + washing up to clearance

3. Foley cath fixed

4. Chart I/O

5. CV line + CVP control q1h

6. ECG

7. ABG

8. Supplemental O2 4 lit/min

9. Reserve 6 units of PC, 6 units of FFP

10.Transfuse PC if massive gross bleeding or not responsive to crystalloids

11.Transfuse FFP if INR > 1.5

12.Transfuse PLT if PLT < 100,000

13.Visit for Internal Medicine Resident (emergent endoscopy)

14.Serum NS 1000 cc / IV / stat free (repeatable)

15.GI consult

16.Amp Pantoprazole 80 mg IV stat then 8 mg/ hour infusion

17.Octreotide 50-100 mcg IV stat then 25-50 mcg infusion

18.CBC q6h

19.Na, K, BUN, Cr, BS,

20.PT, PTT, INR

21.LFT

22.CXR (portable)

23.Endoscopy

24.Abdominal sonography (R/O cirrhosis)

Bowel ObstructionAdmit :

Dx :

Cond :

Vitals :

Act :

Diet : NPO

Please

1. NG Tube

2. Internal folley

3. Chart I/O

4. ABG

5. ECG

6. Cardiac monitoring & Pulse oximetry (if very ill)

7. Serum NS 1000 cc / IV / stat free (more stat serum if needed)

8. Reserve 6 units of PC

9. Supplemental O2 (3-4 lit/min)

10.IVF

11.Cardiology consult

12.Amp Ranitidine 50 mg / IV / BID

13.Amp Ceftriaxone 1 gr / IV / BID

14.Vial Metronidazol 500 mg / IV / q8h

15.CBC, Na, K, BUN, Cr, BS,

16.PT, PTT, INR,

17.U/A

18.CXR (upright)

19.Abdominal X-ray (supine & upright)

20.Abdominopelvic sonography (CT scan may also be indicated)

Abd.X-ray (supine)>> not necessary (if

clinical Dx is highly suspected)

Gravindex :

The test detects the prevention of

agglutination of HCG-coated latex

particles by HCG present in the urine

of pregnant women (also known as

BHCG Test)

Acute Appendicitis

Admit :

Dx :

Cond :

Vitals : q6h

Act : CBR

Diet : NPO

Please

1. ECG

2. Serum NS 1000 cc / IV / stat free

3. Serum maintenance

4. Cardiology consult if age > 40 Y/O

5. OB/GYN consult if gynecologic problems may not be ruled out

6. Gravindex (for women)

7. CBC, diff, Na, K, BUN, Cr, BS

8. U/A

9. Abdominopelvic sonography (esp. for women)

10.CXR

After Diagnosis is made:

1. Ready for OR (shave, gown)

2. stat serum if dehydrated

3. analgesic (e.g. Morphine 5 mg / IM / stat)

4. stat dose of ABs for prophylaxis (Ceftriaxone & Metronidazole)

Jaundice

Constipation

:داروهای گیاهی که بیمه نیستن ولی مفید هستن:

• Powder Bran 250 mg #3 TID

قاشق چای خوری : هر بار یک قاشق غذاخوری در یک لیوان آب حل می کند و میخوره و در اطفال

• Powder psyllium 3.5 mg #3

Branطرز مصرف مثل

• Powder sorbitol 5 gr #3 یک بسته پودر با یک لیوان آب هر روز صبح ناشتا مصرف می کند

➢ Tab C-lax

➢ Syrup mom #1 5-20 cc TID

➢ Syrup lactulose

➢ Supp bisacodyl 10 mg

➢ Tab bisacodyl 5 mg # 30 سال ممنوع۶زیر

alarm sign :

Decreased wt

age > 50

Anemia

Rectal bleeding

درصد موارد۱۰

هیپرتیروئید، کاسنر، افسردگی

:آموزش گالبی، انجیر، آلو، سبزیجات

مایعات زیاد

دقه پیاده روی۲۰تحرک روزانه

Diarrhea

Diarrhea OPD Management :

• Tab Loperamide 2 mg #20

تا قرص۸دو قرص بعد از هر بار دفع حداکثر

• Tab Diphenoxylate #30 q6h

ساعت۶یک قرص هر از

In pediatrics :

• Tab dicyclomine 10 mg #30

ماه ممنوعه۶زیر

If there is indication in adults :

• Tab ciprofloxacin 500 mg BID #30

سال ممنوع۱۸زیر

If there is indication in pediatrics :

• Tab cotrimoxazole 120, 480 mg #30

• Powder QRS

با قاشق چای خوری بدین

لیولن یک پاکت ۴آب جوشیده خنک شده

اگه تهوع داره متوکلوپرامید بهش بدین

تا میخوره بهش بدین

Giardiasis

Metro

15-20 mg/kg.day x3 day

250 mg TID

Amebiasis

Metro 30-50 /kg x7days

Tab Metronidazole 250 mg TID

یودوکینو ن نش نونیکودوی د خو نونیکودوی دشن ب اگ نونیکودوی دشن بوخ ه

Colitis

shigellosis

Cefixime 8 mg/kg/day

Cipro (adult)

Alarm sign :

• Age > 70 + abd pain

• Immune deficiency

• Recently AB-therapy

• T > 38.5

• Bloody Diarrhea

لوپراماید حس خوب و نعشگی دارد و بدون

.نسخه داده نمی شود

دیفنکوسیالت حاوی آتروپین است برای

تا آنجا که. جلوگیری از سواستفاده معتادان

.می توان از تجویز آن خودداری نمود

Vibrio

< 9 : cotri

>9 : tetra

اسهال خونی بدون تب رو درمان نکنین مگر

EHECآنتموبوا ببینید و گرنه s/eاینکه توی

داره HUSهس و شانس

اسهال غیر خونی درمان نمیشه به جز ویا و

ژیاردیا

ش نونیکودوی دشن بوخ هاسهال خونی با تب باال درمان می

Sore Throat

Biliary Disorders

1. NPO

2. CVS q4-6h

3. NG tube fixed (if N/V is significant)

4. Foley cath fixed (if ill or aged)

5. Chart I/O (if ill or aged)

6. Serum NS 1000 cc / IV / stat

7. Serum half Saline 1 lit / IV / tds

8. CBC, Na, K, BUN, Cr, BS, PT, PTT, INR, AST, ALT, ALP, Bil (T,D), Amylase

9. Amp Ranitidine 50 mg / IV / bd

10. Amp Pethidine 25 mg / IM / qid

11. Amp Ceftriaxone 1 gr / IV / bd

12. Vial Metronidazol 500 mg / IV / qid

13. Amp metoclopramide 10 mg / IV / stat (if vomits)

14. Abdominal X-rays (supine & upright)

15. Abdominopelvic sonography (liver, GB, biliary tracts)

16. ECG

17. CXR (upright)

If Cholangitis is your working diagnosis, add:

1. CVS q3h

2. Reserve ICU bed

3. Supplemental O2

4. Cardiac monitoring & Pulse Oximetry

5. ABG

6. Chart T

7. Visit for Infectious Disease Resident

8. Visit for Internal Medicine Resident for “GI consultation for emergent ERCP”

9. Check and Chart CVP q2h (stat serum according to CVP)

10. Reserve 6 units PC & 6 units FFP

11. Amp Vit K & FFP transfusion (if INR > 1.5)

12. Cardiology Consult

If Pancreatitis is your working diagnosis, add:

1. Reserve ICU bed (if severe)

2. Supplemental O2 (if severe)

3. Cardiac monitoring & Pulse Oximetry (if severe)

4. VBG, LDH, Amylase, Lipase, Ca (calculate Ranson’s Criteria)

5. CBC serial q8h (if severe)

6. Chart T

7. Abdominal X-ray (supine & upright)

8. Abdominopelvic CT scan with IV/oral contract (Pancreas Protocol)

9. stat serum according to output or CVP


11. Visit for Internal Medicine Resident

پانکراتیت حاد یک بیماری طبی است، مگر

در صورت بروز عوارض در پانکراتیت شدید و

بنابراین الزم است بیمار در سرویس. نکروزان

مشترک داخلی ـ جراحی بستری گردد و

روزانه از جهت معاینه شکم و بررسی بروز

.عوارض، توسط یک جراح ویزیت شود

Back Pain

PE & DVT

Needle Stick Exposure

Anemia

Vaccination

Electrical shock injury

Admit :

Dx :

Cond :

Vitals :

Act :

Diet :

Please

1. Ecg now & 1 hour later

2. O2 nasally


4. Ophthalmologist consult

5. 1000 cc ringer in 2 hour

6. Td if burn

7. Routine lab data

8. CPK LDH

9. u/A

Intertrochanteric Femur FX

Admit :

Dx :

Cond :

Vitals :

Act :

Diet :

Please

1. skin traction 3 kg

2. internal folley

3. prep 2 bag p.c

4. cardiologist consult [if needed]

5. Enoxa 40 mg qd sq

6. Ranitidine 50mg UV BID

7. amp pethidine 25 mg PRN

Lower EXT FX (pelvic, femur, …) :

enoxa 40 SQ QD

Pt c shoulder joint dislocation :

1. 150 mg thiopental IV stat

2. Reduction

Generalized Peritonitis

Admit :

Dx :

Cond :

Vitals : q1h

Act :

Diet : NPO

Please

1. Cardiac monitoring & Pulse oximetry (if very ill)

2. Supplemental O2

3. ECG

4. ABG

5. Foley cath fixed, Chart I/O


7. Cardiology consult (for males > 40 y/o and females > 45 y/o)

8. Serum NS 1000 cc / IV / stat (or more stat serum depending on hydration state)

9. Amp Ceftriaxone 1 gr / IV / bd

10. Vial Metronidazol 500 mg / IV / qid

11. Amp Ranitidine 50 mg / IV / bd

12. CBC, Na, K, BUN, Cr, BS,

13. PT, PTT, INR,

14. Amylase, LFT,

15. UA

16. CXR (upright)

17. Abdominal X-rays (upright & supine)

18. Abdominopelvic sonography

Hemoptysis

Admit :

Dx :

Cond :

Vitals :

Act :

Diet :

Please

1. IVF 500 cc N/S q8h

2. Ceftriaxone 1gr II q12h

3. Clindamycin 600 mg IV q8h

4. Dextromethorphan 10 cc po q6h

5. Salbutamol 2 puff q6h

6. Atrovent 2 puff q8h

7. Hydrocortisone 100 mg IV TID

8. Routine lab data

9. Pt, PTT, INR

10. VBG

11. CXR : look for cavity

Wound & Laceration

1. Irrigation & dressing

2. Suture the wound ( consider indication & contraindication )

3. X-ray may needed

4. Toxoid 0.5 cc stat

5. AB for extremity : cipro 500 #20 q12h, cephalexin 500 #30 q6h (OPD)

6. AB inpatient :

1. > 1cm : keflin 1gr ,

2. >5 cm : genta 80mg

7. Tetabulin 250 unit sq

Diabetic Foot

Admit :

Dx :

Cond :

Vitals :

Act :

Diet : Diabetic

please

1. Change dressing BID

2. Smear & culture of discharge

3. Ck BS q6h

4. Amp ceftriaxone 1gr q12h iv

5. Amp clindamycin 600 mg q8h IV

6. Foot x-ray (AP-LAt)

Post Tonsillectomy Bleeding

Admit :

Dx :

Cond :

Vitals : q1h

Act :

Diet : NPO

please

1. head elevation

2. Cold neck compression patch طرف گردن۲در هر

3. Cold liquid Gargle

4. Pack c gauze soaked c amp Tranexamic acid

5. Prep 2 bag P.C

6. Hydrate c 1000 cc N/S stat

7. IVF maintenance

8. Amp Keflin 1gr q6h

9. Amp Tranexamic acid 1 amp IM stat


11.Ck HB q6h

12.PT, PTT, INR

Dacryocystitis

Admit :

Dx :

Cond :

Vitals :

Act :

Diet :

please

1. Smear & culture of eye discharge

2. IVF 100 cc in 24 hour

3. Cefepime 1gr iv q8h

4. Clindamycin 600 mg IV q8h

5. Cloxacillin 1 gr IV q6h

6. Ranitidine 50 mg iv q8h


8. PNS CT s contrast

Optic Neuritis/AION

Admit :

Dx :

Cond :

Vitals :

Act :

Diet :

please

1. ECG

2. ASA 80 & Atorvastatin 80

3. Methylprednisolone 500 mg in 500 cc DW5% in 4 hour BID x3day

[check BP and HR q1h]


5. Dsdna, lupus anticoagulant

6. C3, C4, ANA, C-ANCA, P-ANCA

7. ESR, CRP

8. Check BS & K QD

9. Brain MRI c & s GAD

10. Cervical MRI c & s GAD

11. CDS of carotid and vertebral

12. Echo

Pt K/C of HTN & HLP came with LT

eye blindness R/O lt optic neuritis

R/O AION :

(Anterior ischemic optic neuropathy)

Pt with FND symptoms and Brain CT

Shows ICH

Admit :

Dx :

Cond :

Vitals :

Act :

Diet :

please

1. Check GCS & pupil q1h

2. Head elevation

3. Phenytoin 125 mg q8h

4. Manitol 20% 400 cc in 45 min then 40 cc q6h

5. Transfer to ICU

Thermal Trauma (Burn)

Admit :

Dx :

Cond : Emergency

Vitals :

Act : CBR

Diet : NPO

Please

1. Washing c silver sulfadiazine

2. Debriding with mild soap and water

3. Sterile dressing

4. ECG

5. IV line large gauge

6. Ringer 1 lit free

7. Ringer lactate 4 cc / kg / % BSA (½ in 8 hour and ½ in next 16hr)

8. Keflin 1 gr iv stat

9. Pethidine 50 mg iv stat

10. Midazolam 2 mg iv stat

11. Toxoid 0.5 cc IM stat

12. CBC, elect

13. echarotomy

14. ABG

15. CXR

16. U/A

17. Stablish airway : inhalation injury

Oint silver-sulfadiazine #1

• Cephalexin 500 mg po q6h

• Ibuprofen

Varicella (Chicken Pox)

Admit :

Dx :

Cond :

Vitals :

Act :

Diet :

Please

1. Isolate room c negative pressure

2. Serum 500 cc q8h⅓ ⅔ | D5W 500 cc⅔ | D5W 500 cc

3. Syrup diphenhydramine 7.5 cc q6h

4. Tab loratadine 1 tab q12h

5. Amp ranitidine 50 mg IV q8h

6. Amp acyclovir 500mg in 500 cc N/S in 4 hour IV q8h

7. Tab acyclovir if age > 13

8. Amp Apotel

9. Oint calamine-D روزانه بعد از حمام

10. Tab cephalexin (250-500) q6h if ofoonat poosti


12. BUN Cr QD

13. OB Sono if pregnant

مصرف مایعات- گواهی یک هفته - حمام روزانه

Dental Abscess

• IVF 2000 cc N/S in 24 hours⅓ ⅔ | D5W 500 cc⅔ | D5W 500 cc

• Ceftriaxone 1 gr IV q12h

• Metronidazole 500 mg IV q8h

Bell's palsy

1. Amp acyclovir 500 mg q8h in 500 cc n/s

2. Tab prednisolone 50 mg QD

3. Brain CT & PNS CT Scan

Angioedema

1. Amp hydrocortisone 100 mg IV tid

2. Amp clemastin 2 mg IV tid

Or

Amp chlorpheniramine 10mg tid iv

Birth Control

• Tab ocp (LD/HD) #21 یک بسته یا

)موثرتره( روز و بعد یک هفته استراحت ۲۱از روز شروع خونریزی تا قاعدگی تا اتمام و بعد یک هفته استراحت۵از روز

در ماه اول یک روش جایگزین حتما استفاده شود

• Tab OCP Triphasic BWY

Emergency contraception

• Tab OCP HD #4

ساعت ۷۲اثر تا / ساعت بعد۱۲دو قرص / دو تا قرص در اسرع وقت

• Tab OCP LD #8 قرص در اسرع وقت۴

ساعت بعد۱۲ قرص ۴

تهوع زیاد میده

• Tab OCP triphasic #یک بسته

قرص سفید یکی۴

ساعت بعد۱۲ قرص سفید دیگر ۴

• Tab levonorgestrel 750 mcg #2

)بیشترین موفقیت( قرص یک جا بدون تکرار ۲

Tab ondansetron

Tab metoclopramide واسه تهوع در کنارش میدیم

Premature Ejaculation

Tab sertraline 25, 50, 100

شش ساعت قبل یک دونه میخوره sex هفته روی یکی میخوره بعد از آن قبل از ۳

Tab tramadol 25mg یک ساعت قبل از سکس

on & off: مفید ترین روش روش های غیر دارویی را برای مریض ارائه دهید

Vit D deficiency

Check 25(OH)

< 20 ng/ml : def

20-30 : insufficiency

Vitamin D3 (cholecalciferol) pearl 50,000 IU #10 هفته سپس ماهی یک عدد۸هفته ای یک عدد به مدت

Ck 25 (OH) D after treatment if < 20 ng/ml : repeat Txاگه بازم باال نیومد مشاوره گوارش جهت سو جذب

ماه بعد چک کرد۴-۳ می توان از ابتداا با ماهی یک عدد شروع کرد و ۳۰-۲۰در گروه

.نیاز به ویتامین دی دارند IU 800افراد بالغ روزانه

. احمال توکسیسیته وجود دارد۱۰۰در صورت افزایش بیشتر از

Epistaxis

• Oint tetracycline #1 طرفه برای دو روز ۲انجام تامپون •

• Cephalexin q6h

• Drop phenylephrine #1 اگر مسن نیست و فشار خون ندارد

Enterobiasis

• Tab mebendazole 100 mg # 2xFM

Or

• Tab albendazole 400 mg # 4

• Syrup hydroxyzine 10 mg/ 5 cc (wt/4) #1

Or

• Tab hydroxyzine 10 q6h #10

Generalized pain in elderly patients

• Tab naproxen 250, 500 #30 TID

• Amp vit-D #3 monthly

• Tab Ca-D #100 qd

• Gel piroxicam #1

• Tab prednisolone 5 mg #30 qd

• Tab Amitriptyline 25mg #100 qhs

Alarm signs :

HTN

Head trauma

Bilateral

On coagulate drug

Opium quitting

• Tab amitriptyline 10,25 mg bid

Or

• Imipramine

• Tab clonazepam 1 or 2 mg qhs

• Serum therapy B-complex, vit-b, vit-c

• Tab folic acid 1 mg

• Tab ibuprofen 400 mg q4-6h

PMS

• Cap fluoxetine 10, 20 #100 qd روز دوم سیکل ۱۴در

• Tab alprazolam 0.5, 1 mg #30 روز۱۴فقط همون

• Tab ca-carbonate #100 bid روز۱۴همان (یکی صبح یکی شب (

• Tab aldactone 25 mg #14 روز۱۴همون

برا اونایی که ورم می کنن

Hiccups

Choice :

• Amp chlorpromazine 25mg in 100 cc N/S

2nd:

• Amp Haloperidol 5 mg IM

3rd :

• Amp metoclopramide IM

بای پریدین: در صورت ایحاد بی قراری های هالوپریدول و متلکلوپرامید

Cornمیخچه: اگر فشار عمودی درد

زگیل: اگر از بغل درد

شست و شو با آب گرم و خشک

Zinc oxide دور زخم

:محلول ضد میخچه را با گوش پاک کن روی محل

Lactic Acid 16.7% + Salicylic Acid 16.7% + Flexible Collodion base Up to 100%بانداژ

Hair loss

• Cap zinc 50 mg #100

• Susp minoxidil (2% for F)(5% for M) #1 بار روی اسکالپ۲روزی یک یا

ماه بعد۴شروع اثر

ساعت بعد موها شسته نشه۴تا

• Or foam minoxidil

• For male : tab finasteride 1 mg #100 QDبرای فردی که زنش قصد بارداری داره ممنوعه

Anorexia

• Tab cyproheptadine 4 mg #30 QD

• Cap Zinc 50 mg #100 QD

• Syrup Multivitamin

H.pylori Infection

• Cap tetracycline 250 mg #100 ساعت۶ قرص هر ۲

• Tab bismuth 120 mg #56 ساعت۶ قرص هر ۲

• Tab clarithromycin 500 mg BID

• Tab amoxicillin 250 mg ساعت۶یک گرم هر

• Cap omeprazole 20 mg #28 به همه بدید، صبحانه ناشتا یه دونه

• Tab metronidazole 250 mg #56

Choice : MBTO منو ببر تهران االغ

هفته ای است۲درمان

امپروزال+ دارویی است ۴درمان

دارویی است۳دنباله درمان

Cough

• Syrup dextromethorphan for dry cough سرفه ی تک تک

ساعت ۶ سی سی هر ۵

• Dextromethorphan-p همراه با سودوافدرین هست

اثر ضد احتقانی

در صورتی که مریض التهاب داره، آبریزش داره

در مریض فشار خون ممنوعه

روز ممنوع۲بیش از

دکسترومتورفان چون آثار اپوعید داره برای معتادنی خوبه

• Syrup/tab Bromhexine q6h

• For pediatric cough به شدت خلط آور است

برونشیت، آسم، نومونی

• Syrup expectorant برای سرفه هایی که هم خلط دارن و هم عالئم آلرژیک

اثر خلط آوری: گایفنازین

اثر ضد احتقان: سودوافدرین

اثر آنتی هیستامین : کلروفنیرآمین

• Syrup guaifenesin برای سرفه های سرماخوردگی

سال ممنوع۴زیر

• Syrup diphenhydramine

برای سرفه های فارنژیت

به شدت خواب آور

Alarm sign : duration > 3 wk

Pharyngitis

• Vial penicilline

< 27 kg 600.000 benzatin

> 27 kg 1.200.000 benzatin

<27 : #1 6.3.3

>27 : #2 6.3.3

• Tab penicillin V 500 TID x10 #30

• Tab erythromycin 400 mg TID x10 days #30

در صورت حساسیت

• Tab syrup acetaminophen

Common Cold

Adult :

• Tab coldstop #30 ساعت ۶ قرص هر ۲

• Coldstop :

500 mg acetaminophen

30 mg pseudoephedrine

25 mg diphenhydramine

:گرفتگی بینی مخصوصا اطفال

• Drop Nacl

: ماه ۶بچه های باالی

• Pediatric grip syrup

:برای همه

• Eff -tab Vit-c آب میوه طبیعی

پرهیز از آب میوه بازاری و نوشابه و اینا

سوپ و ایاها

مصرف مایعات فراوان

باکتریال

تب/ گلودرد شدید / شروع سریع و حاد

تهوع و درد شکم/ سردرد / متوسط تا شدید

/اریتم واضح گلو/ پتشی روی کام / لنفادنوپاتی

وایرال

همراهی با سرفه،/ تب کمتر/ شروع آهسته

اسهال/ کانژکتیویت، کورایزا

Alarm sign :

Epiglottitis, distress, drooling,

extra tonsil inflammation &

exuda

Erectile Dysfunction

• Tab sildenafil 25, 50 , 100تک دوز یک ساعت قبل از نزدیکی

یا نیتروکانتین بخوره TNGمریض نباید داروهایی مثه

• Tab viagra 50 این خارجیه گرون تر و بهتره

یک ساعت قبل از نزدیکی

Sinusitis1st choice:

• Cap co-amoxiclav 625mg #42 TID x2wk

2nd choice :

• Tab cefixime 400 mg BID #28

• Tab ibuprofen 400 mg #30

• Drop phenylephrine 0.5% #1

روز ۳حداکثر

ساعت یک قطره در هر سوراخ بینی ۱۲هر

• Serum physiology

• Tavanex 750 mg po QD

Choice :

• Amoxicillin (80-90mg/kg) سینوزیبت بدون عارضه

روز پس از رفع عالئم۷تا

:موارد نیاز به کوآموکسی سال۲زیر

نگهداری در مهدکودک

ماه گذشته۳مصرف آنتی بیوتیک در

) ساعت باید تب و کم و ترشحات بینی کاهش یابد ۴۸در عرض ( ساعت اول ۷۲عدم پاسخ به داروهای قبلی در

روز ۱۰سرماخوردگی بیش از

سرفه شبانه طول کشیده : بچه ها

Cefepime 1 gr IV q8h

Metronidazole 500 mg IV q8h

Nasal spray fluticasone 2 puff q8h

Nasal spray nacl 2 puff q6h

Pantoprazol 40 mg qd po

PNS CT

Otitis Media (AOM)

• Syrup amoxicillin 125-50 mg 80-90 mg/kg

• Syrup ibuprofen

• Drop dexamethasone

• Syrup co-amoxiclav

• Amp ceftriaxone 50 mg/kg درمان تک دوز سفتریاکسون معادل چند روز شربت است

Brucellosis

• Cap doxy 300 mg q12h

• Cap rifampin 300 mg q12h

• Amp panto 40 mg qd

Pediatric Dosage syrup

cefixime 100 mg wt/5 q12h

hydroxyzine wt/4

cephalexin

125 wt/4

q6h250 wt/8

ondansetron wt/4 q8h

salbutamol wt/2 q6h

azithromycin

100 wt/4

qd200 wt/8

erythromycin 200 Wt /4 q6h

cotrimoxazole Wt /2 Q12h

Amoxicilline

125 wt

q8h250 wt/2

400 wt/3

co-amoxiclav

156 wt

q8h312 wt/2

Diphenhydramine wt/3 q6h

Acetaminophen 125 wt/2 q6h

Brufen wt/2

pencllin-v 250 wt/2 q6-8h

Expectorant 0.5 cc/kg/24hr q8h

Promethazine 0.4 cc/kg/24hr q6h

Drop

Drop Acetaminophen 8 drop/kg/24hr Wt x 2

Drop Dextromethorphan 8 drop/kg/24hr q6h

Drop plasil 2 drop/kg/24hr wt/2 q8h

Drop Rifampin 2 drop/kg/24hr

Drop Dimethicone 3 drop/kg/24hr q8h

Drop ferrous sulfate 1-2 drop/kg/24hr Max : 15 drop

Drop Nistatin 20-40 drop q6h

Syrups with dosage of 1 cc/ kg

[consider dividing]

• Syrup amoxicillin 250 q8h

• Syrup ampicillin 250 q6h

• Syrup cephalexin 250 q6h

• Syrup erythro 200 q6h

• Syrup penicillin-v 250 mg q6h

• Syrup pediatric grip q6h

• Syrup dicyclomine q6h [above 6 m/o]

• Syrup hydroxyzine q6h

• Syrup brufen q6-8h

Medication : Take with Food

• Clindamycin

• Co Amoxiclav

• Baclofen

• Statins (nights)

• Danazol

• Sulfonamides

• NSAIDs

Medication : Take with plenty of water

• Alendronate

• Laxative

• Almgs

• Doxycycline

• Vitamins and supplements

• Ca (night)

• L-Carnitine

• Glucosamine

Medication : Before Breakfast

• PPIs

• Alendorante

• levothyroxine

Medication : Before Meals

• Bisacodyl

• Penicillin

• Bismuth

• Cardiac drugs

• Levodopa

• Methotrexate

• Loratadine

• Clidinium-C

• Digoxine

• Warfarin

• Captopril

• Rifampin

• Tetracycline

• Sucralfate

Antihistamines

• Tab loratadine 10 mg qd/bid

• Tab cetirizine 10 mg qd/bid

• Tab fexofenadine (Telfast) 60,120,180 qd/bid

اثری ندارد QTروی . تنها دارویی که می توان با ماکرولید ها داد•

• Tab cyproheptadine 4 mg

• Anorexia nervosa

• Carcinoid syndrome

• Cold hives

• Tab Hydroxyzine 10 mg

تنها آنتی هیستامین که می توان زیر یک سال داد•

• Amp chlorpheniramine

• Amp clemastin

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