DENGUE FEVER

y.o/malay/
UL:

Fever X /7
On & off
+ Athralgia & myalgia
Vomiting X /7
>3x/day
Diarrhea X /7
>3x/day
abdominal pain
Reduce oral intake, able to drink cups of water today
Hx of jungle tracking & swim in pool/river
Living in degue prone area:
Cough & runny nose:
Sore throat:

o/e alert, conscious, crt < 2 sec, good pulse volume, warm peripheries, hydration

BP:
HR:
RR:
Temp:
SpO2:

Lungs: Clear
CVS: S1 S2 no murmur
PA: Soft non tender

WCC: /PLT: /HCT: /Hb:

IMP:

PLAN
CHEST PAIN

y.o/MALAY/
U/L

Central chest pain started on @ 0000H,

Burning/priciking in nature,
Radiating?
P/S:
a/w dyspnea/ failure symptoms

family hx with IHD:

otherwise :
no fever,
UTI or URTI sx
No abdominal pain
Tolerating well

o/e alert, conscious, crt < 2 sec, good pulse volume, warm peripheries, hydration

BP:
HR:
RR:
Temp:
SpO2:

Lungs: Clear
CVS: S1 S2 no murmur
PA: Soft non tender

Plan
Allow discharge with medications.
TCA stat if symptoms worsen.
PEADS FEVER

Y.O/Malay/
Born term, vaccination up to age

Fever x /
Chills and rigors:
Documented temp:

Cough x /7
Chesty cough with whitish sputum

Runny nose x /

Oral intake

o/e alert, conscious, crt < 2 sec, good pulse volume, warm peripheries, hydration

BP:
HR:
RR:
Temp:
SpO2:

Lungs:
CVS: S1 S2 no murmur
PA: Soft non tender

Plan
AGE

Y.O/Malay/
Born term, vaccination up to age

c/o: Diarrhoea - frequency/day –

mucous?blood?
Vomiting - frequency/day - food particles/blood/bile
Reduced intake - usual feeding (Oz), current feeding
Less active?
Fever?
Outside food? Fam with similar sx?

o/e alert, conscious, crt < 2 sec, good pulse volume, warm peripheries, hydration

BP:
HR:
RR:
Temp:
SpO2:

Lungs:
CVS: S1 S2 no murmur
PA: Soft non tender

Plan
Trauma

O/E
*Airway*
No hoarseness of voice, no stridor, no foreign body, ROM neck full, no cervical tenderness

*Breathing*
Trachea central, neck vein not distended, no chest wall bruises, equal chest rise, no open wound

*Circulation*
Crt<2 sec in b/l UL and LL, warm peripheries, good pulse volume, distal pulse palpable, pink

*Disability*
GCS: 15/15
Pupil 3/3 reactive

*Exposure*
Document all abrasion/ any visible wound or deformity

Chest spring - negative

Pelvic spring - negative

BP:
HR:
RR:
Temp:
SpO2:

Lungs: clear
CVS: S1 S2 no murmur
PA: Soft non tender

IMP:

PLAN
MEDICATION

MMLIST OF IMPORTANT DRUGS & DOSES

S/c Fondaparinox 2.5mg OD/7.5mg OD

S/c Heparin 5000u BD/7500u BD
S/c Morphine 5mg/7.5mg TDS
S/c Clexane 40mg/60mg OD
T Ranitidine 150mg BD
IV Ranitidine 50mg TDS
Mist calminative 15mls TDS
Mist Na Citrate 15mls/30mls OD
T EES 400mg BD
T Zinnat 250mg BD
T Ponstan 500mg TDS
T Voltaren 50mg TDS
T Papase 11/11 TDS
T Gelusil 11/11 TDS
IV Maxolon 10mg TDS
C Celebrex 200mg BD /400mg OD
C Tramal 50mg/75mg TDS
T Arcoxia 90mg OD
Syp MMT 15mls TDS
Syp Benadryl 15mls TDS
T Piriton 4mg/8mg TDS
IV hydrocortisone 200mg stat, 100mg QID
T Cilostazol (claudication pain) 100mg OD
T Aspirin 150mg OD/300mg STAT
IM nubain 20mg stat
T/IV Bisolvon 8mg TDS
T Labetolol 100mg TDS
T Adalat 10mg TDS
T Methyldopa 250mg TDS
Ural sachet 1/1 BD/TDS
IV/T lasix 20/40/80 mg BD
IM/IV Pethidine 50mg
T Rocaltriol 0.25 mcg OD
T calcium lactate 600mg BD
T levenogestrel 1.5mg stat
Inj Ertapenem 1gm OD
Inj Piptaz 3.375g
T/IV Tranexamic acid 500-1000mg TDS
IV Tramal 50 mg/75mg TDS
IV Maxolon 10 mg TDS
IV Cefuroxime 1.5 stat, 750mg TDS
IV Unasyn 1.5g STAT and TDS
IV Cefobid 2g stat, 1g BD
IV Ceftriaxone 2g stat, 2g/1g OD
IV Cefepime 2g stat, 1g BD
IV Meropenem 500mg tds/qid
IV Imipenem 500mg tds/qid
IV Ampicillin 2gm Stat 1gm QID
IV Cloxacillin 1g STAT, 1g/500mg QID
IV Flagyl 500mg TDS
IV Augmentin 1.2g STAT, TDS
T Augmentin 625 mg BD
T Unasyn 375mg BD
T Doxycycline 200mg stat, 100mg bd
T Cloxacillin 500mg QID
T Azithromycin 500mg OD
T Flagyl 400mg TDS
C Tramal 50mg/75mg TDS
T Maxolon 10mg TDS
T Doxazosin 4mg OD
T Finasteride 5 mg OD
T Cardura 4mg ON
T Hytrin 4mg ON

LYTIC COCKTAIL
IV Actrapid 10u STAT
IV ca gluconate 10% 10cc in 10 minutes
IV Dextrose 50% 50cc

FAST CORRECT
IV KCL 2g/1g in 200cc/100cc over 1 hour/2 hour
IV KH2PO4 1 ampoule in 250cc NS/4H
IV Mgso4 1 ampoule in 100cc NS/4H

SEDATION
Midazolam 0.1mg/kg
Syrup chlorhydrate 50mg/kg

OAC/PAC REGIME
C Omeprazole 40mg BD
T Ampxicillin 1g BD
T Clarithromycin 500mg BD
Then C Omeprazole 40mg OD

HEMATINICS
T FeSO4 200/400mg OD/BD
T Vit B Co I/I, II/II OD/BD
T Folate I/I, II/II OD/BD

BOWEL PREP
2 days before - low residual diet
1 days before:
RP normal - fleet phosphosoda 45ml BD x 1/7
RP abnormal - Foltran 2L/3L
On day of scope:
Ravin enema II/II stat
Or fleet enema I/I stat
Do PR!

Tab. Daflone ll/ll TDS 4/7

Tab. Daflone ll/ll BD 3/7
Tab. Daflone ll/ll OD 1/52