INTERNSHIP CHEAT SHEET

MADRID NOTES

FOR TRAUMA CASES

→ Noi – Nature of incident PRESCRIPTION
→ Poi - Place of incident For patients with wound injury
→ DOI – Date of incident → ATS 1500 “u”
Adult # 4
→ TOI – Time of incident
Pedia #3
→ Tetanus toxoid 0.5 ml
→ Nespi –No external signs of physical injury #1
(For medicolegal cases only external visible signs are allowed) → + Antibiotic of your choice (5days / 7 days depends on
the AOC)
Primary survey → Cefuroxime 750 mg/vial #2
→ Airway - Patent? Stridor? Loading dose: 1500 grams
→ Breathing – RR, equal chest rise bilateral, SpO2 Gauze 4x4 #15
→ Circulation – CRT, BP, Pulse rate, Strong peripheral pulses?
→ Disability – GCS 15 (E4V5M6) , Pupils Home medications
→ Cefuroxime 500 mg BID x 7 days
→ Exposure
→ Celecoxib 200 mg q 12 hours for pain
→ Mupirocin ointment BID x days
Secondary sur vey
→ Allergies Follow up: After 7 days at Surgery OPD for removal of
→ Medications sutures.
→ Past Medical History
→ Last meal taken For wound that needs suturing
→ events
Head/Scalp Silk1 /0 with cutting needle
Face Nylon 3/0-4/0 with cutting needle
HEAD TRAUMA Forehead Silk 4/0 with cutting needle
→ Request for CT Scan of the head, Plain contrast Nylon 5/0 with cutting needle
→ Give Head trauma slip and advise to seek medical treatment if the Upper Extremities Silk 3/0 with cutting needle
said symptoms occur Lower Extremities Silk 2/0 with cutting needle

→ Nylon 3.0 with cutting needle

- Scalp
Fracture - Wrist
→ Open Fracture – ADMIT the patient - Palm
→ Closed wound Cast then TCB every Monday 8-10 am at ORTHO - Sole
day - Deep laceration

Prescription for casting

→ Wading sheet #4
→ Plaster of paris #3
→ Elastic bandage

RADIOGRAPHIC GUIDE
HEAD :
Hand
→ Skull APL
→ APO view
→ Water’s view – maxillofacial
→ Towne’s view – base of skull
→ Nasal – STL foot :
→ Mandibular APL → APO view
 → Panoramic view
chest extremities:
→ Chest PA (Adult) → APL view
→ Chest AP (Child)
→ T cage – Back
pelvis:
→ Apicolordotic view
→ Frog leg
→ AP Lateral
nose:
→ STL Rib fracture
→ Lefor t’s Water view → T-cage

FOR TRAUMA SERIES

→ Cervical APL - Cervical APL
→ Tcase - Chest Xray PA
→ Chest Xray PA - T-Cage APO
→ Pelvic AP - Pelvic AP
→ Shoulder / Ar m APL to include elbow
→ Forearm APL
→ Thigh APL and Leg APL to include ankle and knee
→ Hand
→ Foot APO

Other surgical cases

DM FOOt Abdominal pain
- Cane vinegar Take note of the
- Zonrox - Onset
- H2O2 - Location
- Distilled water - Duration
- Asepto syringe - Character
- Aggravating factors
burn - Radiation
- 0.9 NaCl (Irrigating solution) - Timing
- Silver sulfadiazine - Severity
- Gauze 4x4 #25
- Roll gauze ABDOMINAL PAIIN CONSIDERING ACUTE APPENDICITIS
ALVARADO SCORE
casting
- Wading sheet PARAMETERS SCORING
4 inches upper extremities M Migratory right iliac fossa pain 1
6 Inches in lower extremities A Anorexia 1
N Nausea or vomiting 1
- Elastic bandage T Tenderness: right iliac fossa 2
4 inches upper extremities R Rebound tenderness right iliac fossa 1
6 Inches in lower extremities
E Elevated Temperature / Fever ≥36.3°C 1
L Leukocy tosis ≥10 × 109 cells/L 2
- Plaster of Paris
4 inches upper extremities S Shift to the left of neutrophils 1
Score: < 3– low likelihood of Appendicitis
6 Inches in lower extremities
4-6 consider fur ther imaging
>7 high likelihood of appendicitis
9-10 almost certain
 History and pe
GENERAL DATA: VIII: Intact gross hearing
This is a case of ____________ , 20 years of age, Female, Single, Roman IX, X: (+) gag reflex, uvula midline
Catholic, Unemployed, Born on October 20 1990 at Nueva Ecija. 1st time to be XI: Able to shrug shoulders with equal force.
admitted in our institution. XII: Able to protrude her tongue and at midline, no fasciculation’s or
atrophy noted
CHIEF COMPLAINT: Reflex: (-) Babinski reflex, (-) Kernigs sign, (-) Brudzinski sign, (-) for
meningeal signs, (-) for other pathological reflexes
HISTORY OF PRESENT ILLNESS:
REVIEW OF SYMPTOMS:
PAST MEDICAL HISTORY: General: (-) weight loss, (-) chills, (-) fatigue, (-) loss of
(-) HTN (-) Asthma since when? meds? compliance appetite
(-) DM (-) Goiter
(-) PTB (-) Previous surgery Skin: (-) color change, (-) sores, (-) rash, (-) scaling,
(-) bleeding, (-) itching
HEENT: (-) headache, (-) neck stiffness, (-) colds,
FAMILY HISTORY
(-) nasal discharge, (-) bleeding gums,
(-) HTN (-) Asthma (-) PTB
(-) DM (-) Goiter (-) Cancer (-) oral ulcer, (-) neck mass, (-) hoarseness
RESPI: (-) cough, (-) dyspnea, (-) shortness of breath, (-)
pleuritic chest pain
PERSONAL SOCIAL HISTORY CVS: (-) chest pain, (-) palpitation, (-) orthopnea, (-)
(-) Smoker paroxysmal nocturnal dyspnea,
(-) Alcohol drinker (-) easy fatigability
GIT: (-) dysphagia, (-) hematemesis, (-) nausea, (-)
PHYSICAL EXAMINATION vomiting, (-) diarrhea, (-) constipation, (-) melena
Patient is conscious, coherent, ambulatory, not in cardiorespiratory distress
GUT: (-) dysuria, (-) hematuria, (-) retention,
Vital Signs: (-) incontinence, (-) frequency, (-) urgency
BP: CR: RR: T: Ht: Wt: BMI: Musculoskeletal: (-) myalgia, (-) arthralgia, (-) arthritis,
Skin: No lesions, no masses, soft, warm to touch (-) backache
HEENT: Anicteric sclera, pink palpebral conjunctiva, no Endocrine: (-) polyuria, (-) polydipsia, (-) polyphagia,
nasoaural discharge, no tonsillopharyngeal (-) heat / cold intolerance
congestion, no cervical lymphadenopathy Hematologic: (-) pallor, (-) easy bruising
Chest: Symmetrical chest expansion, no retraction, no Neuropsych: (-) seizure, (-) dizziness, (-) tremors,
lagging, equal vocal and tactile fremitus, clear breath (-) depression,
sounds
Cardiovascular Adynamic precordium, normal rate, regular rhythm, GLASGOW COMA SCALE
PMI at 5th ICS LMCL, no murmur
Abdomen Flabby abdomen, normoactive bowel sounds, soft, CATEGORY BEST
tympanitic, nontender to deep and light palpation
RESPONSE
Extremities Grossly normal extremities, no deformities, no
external signs of cyanosis, no pallor, no edema, full EYE OPENING
equal peripheral pulses Spontaneous 4
To speech 3
NEUROLOGICAL: To pain 2
CEREBRUM: Alert, relaxed, cooperative, coherent, oriented to time, place and None 1
person VERBAL
CEREBELLAR: Can do rapid, alternating movement, finger to nose and heel to Oriented Babble 5
shin Confused Irritable 4
GRADING MUSCLE STRENGTH Inappropriate words Cries to 3
0 No muscular contraction detected pain
1 Barely detectable trace of contraction Moans Moans 2
2 Active movement, gravity eliminated None None 1
3 Active movement against gravity and some resistance MOTOR
4 Active movement against gravity and some resistance Follows commands 6
5 Active movement against gravity with full resistance Localizes to pain 5
Withdraws to pain 4
CRANIAL NERVES: Abnormal Flexion 3
I: able to smell coffee
II, III: 2 to 3 mm pupils, reactive to light Abnormal Ex tension 2
III, IV, VI: Intact EOM. No Ptosis Noted None 1
V: Intact Sensation on V1-V3,
VII: No Facial Assymetry
 DIABETIC FOOT ULCER FLUIDS

WAGNER CLASSIFICATION SYSTEM Holiday-Segar Method

- Assess ulcer depth and the presence of osteomyelitis and gangrene
Grade 0 Pre or post ulcerative lesion, completely epithelialized
First 10 kg x 100
Grade 1 Partial/full thickness ulcer, superficial wound Next 10 kg x 50
Grade 2 Penetrates the tendon or capsule Succeeding kilogram x 20
Grade 3 Deep with osteitis Total in ml. Divided by 24 hours = ugtts/min then divided by 4
Grade 4 Partial foot gangrene
Grade 5 Whole foot gangrene
MEDICATIONS

MEDICATION COMPUTATION FREQUENCY

Paracetamol 300 mg/amp
Cefuroxime 750 mg/ vial
Metronidazole 500 mg/vial
Ranitidine 50 mg/amp
Pedia ( Weight x 10)/
dose
( Weight x50 ) / 3
( Weight x 50 ) / 3
( Weight x 1 ) / dose
Every 4 hours of PRN for temp > Eg. Weight: 20 kg
37.8 degrees Celsius 20 kg x10 =200
200 mg TIV for temp > 37.8 degrees
Celsius
Loading dose (IM/IV) every 8 hours Eg. Weight: 20 kg
(20 kg x50) / 3 = 333.33
350 mg TIV or IM as LD or q8
Loading dose (IM/IV) every 8 hours Eg. Weight: 20 kg
(20 kg x50) / 3 = 333.33
350 mg TIV or IM as LD or q8
Every 8 hours TIV while on NPO Weight: 20 kg
20 kg x 1 = 20
20 mg TIV every 8 hours

AMOXICILLIN SYRUP PARACETAMOL SYRUP

125 mg/ 5ml (Weight x 30) x 5 / 125 125 mg/ 5ml [(Weight x 10) x 5 ] / 125
3
250 mg/ 5ml (Weight x 30) x 5 / 250 250 mg/ 5ml [(Weight x 10) x 5 ] / 250
3
CLOXACILLIN SYRUP IBUPROFEN SYRUP
125 mg/ 5 ml (Weight x 30) x 5 / 125 200 mg/ 5ml [(Weight x 10) x 5 ] / 200
4
250 mg/ 5 ml (Weight x 30) x 5 / 250
4

CEFUROXIME SYRUP
250 mg/ 5 ml (Weight x 30) x 5 / 250
3
COAMOXICLAV
312. 5/5 ml (Weight x 30) x 5 / 312. 5
2