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   General Case No 6.Emergency Treatment          

               Treatment on non-admission in Medicine

  1. Fever/ Headache

Tab. Napa 500 mg

1+1+1 (A/M)

Or,

Supp. P/C (Renova 500mg), if fever more than 101℉

1 S/P/R stat & sos.

  • Constipation

Syr. Lactulose (Avolac)

4 TSF TDS

Or,

Supp. Glysup 2.3gm

5 S/P/R stat and sos.

Or,

Tab. Ezylife 10 mg (Sodium Picosulfate)

0+0+1

  • Restlessness

Inj. Haloperidol 5 mg/ml (Perol)

1 amp I/M stat

Inj. Procyclidine 10mg/2ml (Perkinil)

1 amp IV stat

Or,

Inj. Milam

½ amp IM stat (According to clinical condition of the patient)

  • Convulsion,

Inj. Diazepam 10mg/ 2ml (Sedil/ Easium)

1 amp IV mixed with 10cc D/W very slowly stat or,

Inj. Phenobarbitone 200mg (Barbit)

1 amp IM stat and BD.

Or,

Phosphenytoin/ Fosphen (2 ml/150mg)

(4 amp +D/A D/W)I/V stat over 10  min

If not, after 15 minutes,

(2 amp+D/A D/W) I/V stat over 5 min.

  • Bleeding per nose, ear or hematuria,

Inj. Tranexamic acid / Xamic 500 mg

1 amp I/V stat and TDS.

  • Acidity,

Inj. Omeprazole 40 mg (Omep)

1 vial I/V stat

  • Vomiting,

Inj. Emistat 8 mg (Ondansetron)

I amp I/V stat.

Inj. Paloxi 0.075mg/1.5ml (Palonosetron)

1 amp IV stat.

  • Abdominal pain,

Tab. Algin 50 mg

1+1+1

OR, 

Inj. Algin 30 mg (Tiemonium methyl sulphate)

1 amp I/M stat.

Or,

Inj. Anadol/ Tranal 100mg (Tramadol Hydrochloride)

1 amp I/M stat.

  • Hiccough

Tab. Beclofen/ Beklo 10 mg

1+1+1

Or,

Tab. Opsonil 50 mg (Chlorpromazine Hydrochloride)

1+0+1

Or,

Inj. Opsonil

1 amp IV stat & sos.

  1. Sudden respiratory distress,
  2. O2 inhalation.
  3. O-P suction.
  4. Bed rest in propped up position.
  5. Nebulization with Windel plus solution

Stat & 6 hourly.

  • Inj. Cotson 100 mg

2 vial I/V stat.

  1. Non productive cough,

Tab. Butamirate Citrate / Mirakof SR 50 mg

1+1+1

Or,

Tab. Chlorpheniramine/ Piriton 4 mg

1+1+1

  1. Productive cough,

Syr. Ambroxol/ Ambrox 

2 TSF -TDS

Or,

Syr. Bromhexine/ Mucolyt

2 TSF-TDS

  1. Lungs creps:

Inj. Frusemide/ Lasix

2 amp I/V stat & sos.

  1. Musculoskeletal pain,

Tab. Esomiprazole 20 mg+Naproxen 500mg/ Neso 500/20

1+0+1 (20 minutes before meal)

Or,

Ketorolac (Torax) 10 mg/ Diclofenac (Diclofen)50 mg (In case of dental pain Rito 90mg 1+0+1)

1+1+1 (A/M)

With,

Cap. Omeprazole 20 mg

1+0+1 (1/2 hour before meal)

Or,

Inj. Ketorolac/ Toradolin 30 mg

1 amp I/M stat & BD.

Or,

Supp. Voltalin (Diclofenac sodium) 12.5 mg

1 S/P/R stat and sos.

Or,

Supp. Ultramal 100 mg (Tramadol Hydrochloride)

  1. Muscle pain,

Tab. Myolax 100mg/ 50 mg (Tolperisone hydrochrolride)

1+1+1

Or,

Inj. Myolax 100 mg/ml

1 amp I/M BD.

  1. Chest pain,

After ECG, if features of ACS,

*High flow oxygen

*Tab.Lopirel plus (Aspirin 75mg+Clopidogrel 75 mg)

4 tab stat.

*Refer to Cardiology

  1. Insomnia/ Patient in stress.

Tab. Rivotril (Clonazepam) 0.5 mg

0+0+1

  1.  In case of shock,

ABCD management.

Maintenance of circulation,

If hypovolemic, BT or Hartmann infusion.

If cardiogenic,

  • Inf. N/S 500 ml +Inj. Dopamine 2 amp

I/V stat @ 8 drops/ min.

  • Inf. N/S 500 ml+ Inj. Dobutamine 2 amp

I/V stat @ 8 drops/ min.

Things to buy,

IV cannula 20 G—–(4)

Micropore 1”—–(1)

Saline set——-(2)

Inf. N/S 500 ml——-(2)

Inj. Dopamine 250 mg/5 ml——-(2)

Inj. Dobutamine 250 mg/5 ml——(2)

Trichannel stop cock——–(1)

  1. Vertigo,

Tab. Cinnarizine+Dimenhydrinate/ Revert

1 tab stat & sos

Or, Tab. Prochlorperazine/ Stemetil 5 mg

1+1+1

  • HTN Crisis/ Emergency/ Encephalopathy,
  • Diet: Full but salt restricted.
  • Bed rest.
  • Inj. Frusemide 20 mg/ 2 ml/ Lasix

2 amp I/V stat.

  • Inj. Midazolam 15 mg/ 3 ml/ Dormitol

1 amp I/M stat

  • Tab. Bromazepam 3 mg/ Siesta

0+0+1

  • Cap. Esomeprazole 20 mg

1+0+1 (1/2 hour before meal)

If not controlled,

Inj. Labetalol 5 mg/ml 5amp +Inf. N/S 500 ml IV stat @15 d/min. Check BP at 20 min interval if DBP less than or equal 90 mmHg stop drip.

  • Diarrhoea,

ORS,

1 sachet dissolved in ½ L. As much as patient can intake.

And/or

Inf. C/S 2L

I/V stat @ 20 d/min.

  • Hypoglycemia,

Inf. 25% Dextrose/ 25% Nutridex

I/V stat @ running.

But,

In case of hyperglycemia, you have to adjust the dose of insulin.

  • Acute retention of urine,

If bladder is palpable, then massage, if not, N/S, if not Lasix, If not Catheterization.

  • Anxiety,

Tab. Frenxit (Flupentixol+ Melitracen)

1+0+1

  • Urinary frequency,

Tab. Toltrex 2 mg (Tolterodine Tartrate)

  • Hyperkalemia
  • Nebulization with Sulprex solution, stat & 6 hourly.
  • Inj.Actrapid-(U-100, S-100)

(5 unit in 25% Nutridex 100ml

12 unit in 25% Nutridex 250 ml)

100 ml I/V @ 30 drop/ min stat & 6 hourly.

  1. Inj. Ca gluconate (10 cc+10 cc D/W)

I/V @ slowly over 10 min daily.

  1. Inj. Lasix 20 mg

2amp I/V stat & BD.

  1. Kayoxalate powder sachet mixed with ½ glass of water-BD.
  2.  Hypokalemia
  3. If, Potassium less than 2.5 mmol/ L.

Inf. N/S 1L +Inj. KT 2 amp

I/V @ 32 microdrop/ min or 8 drop/ min.

  1. If, Potassium more than 2.5 mmol/ L,

Syr. KT or electro K

  1. TSF+ ½ glass water-TDS.
  2. Hyponatremia
  3. Mild hyponatremia,

Tab. NaCl

1+1+1

  • Moderate hyponatremia,

Inf. N/S (1 L)

I/V @ 20 drop/ min daily.

Tab. NaCl

2+2+2

  • Severe hyponatremia (Serum sodium <115 mmol/L with clinical feature)

Inf. 3% NaCl

I/V @ 10 drop/ min stat (Sodium <10 mmol/L daily)

  • Hypernatremia,
  • With Dehydration,

Inf. 0.9% NaCL(@ running) till adequate hydration

Then,

Inf. 5% DA or, 0.45% N/S or both.

  • With no dehydration,

Inf. 5% DA  Diuretics

  • With hypervolumia,

Inf. 5% DA.

In renal pathology-Dialysis.

In case of DM/ its complications, neutralize 5% DA 1L with 20IU Insul-R (Regular short acting Insulin)

  • Blood transfusion reaction,

Stop BT.

Inj.Cotson 2 ml

1 vial IV stat.

Inj. Avil 2 ml

1 amp IV stat. 

Call Doctor On Duty.

  • Headache,anxiety=Tab. Reelife/ Limbix (Amitryptyline+Chlordiazepoxide)

1 tab stat and then ½+0+1

Anxiety=

Esita (Esitalopram 10 mg)

0+0+1

  • Anorexia=Susp. Apetiz 40 mg/ml
  • TSF-TDS

Syr. Gavisol

  • TSF-TDS
  • Idiopathic pulmonary fibrosis=

Cap. Pulfibro 267 mg (Pirfenidone)

1+1+1 (D1-D7) then, Clinician opinion.

  • Variceal bleeding,

Inf. DA 1L+Inj. Stilamin (Somatostatin)3 mg/amp 2 amp 40 ml IV stat Then IV @ 10 drop/min for 5 days.

  • Peptic ulcer, Chronic gastritis-

Susp. Ulfate 1 mg/ ml

1 TSF-4 hourly. (After meal)

  • Spasticity, Painful muscle spasm,

Tab. Relentus 2 mg (Tizanidine)

0+0+1

  • Anxiety, Pain from diabetic neuropathy, Neuropathic pain associated with spinal cord injury,

Tab. Pregabalin 50 mg (Neurolin)

1+0+1

Neuropathic pain, depression,

Tab. Amilin 25 mg (Amitryptyline hydrochloride)

0+0+1/2 for 7 days then 0+0+1-Continue

  • Secondary skin infection,

Oint. Bactrocin 2%

Applied locally 12 hourly.

  • Peripheral neuralgia/ Myalgia,

Tab. V3N

1+0+1

Raiyyan Tahsan Date: 5-02-2025 Wednesday Time:-5-42-45 Pm

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