RX Protocol Kakoli 2nd Edition

Dr.
Md Anwarul Azim
Treatment Protocol
For
Intern Doctors
Edited By:
Dr. Md. Anwarul Azim (SM-2)
1st Edit: 2012

2nd Edit: 2014
Special Thanks to My respected Sir, senior, colleague & friends of SMCH & SBMCH .
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Dr. Md Anwarul Azim
INDEX
Medicine
SL No. Topics Page No.

1 Acute Severe Bronchial Asthma 11
2 COPD / Corpulmonale 12
3 Pneumonia 13
4 Lung Abscess 14
5 Pleural Effusion 14
6 Bronchiectesis 15
7 Pneumothorax 15
8 RTI 15
9 Pulmonary TB 16
10 Snake bite (poisonous) 18
11 Snake bite (Non-poisonous) 19
12 Sedative poisoning 19
13 Anti-Depression Poisoning 20
14 β-Blocker Poisoning 20
15 Dutura/Stupefy/Street Poising 21
16 CuSO4 Poisoning 21
17 Corrosive/Chemical Poisoning 21
( Acid/Alkali/Savlon/Herpic/Shampoo/Bleaching powder)
18 OPC POISONING 22
19 Acute Gastritis (Food poisoning) 23
20 Chronic Gastritis/Gastric ulcer 23
21 Acute PUD 23
22 Haematemesis/Malaena 24
23 Haemoptysis 24
24 Mallory weiss syndrome 25
25 Non-Ulcer Dyspepsia 25
26 Anti Flatulent 25
27 GERD 25
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Dr. Md Anwarul Azim
28 Ulcerative Colitis (Bloody Diarrhoea) 26
29 IBS(Diarrhoea predominant) 26
30 Tropical spore 26
31 Apthus Ulcer 26
32 Oral Thrush 26
33 Liver Abscess 27
34 Acute Viral hepatitis 27
35 CLD 28
36 Hepatic Encephalopathy 28
37 Acute Pancreatitis 29
38 Hepato Cellular Carcinoma 29
39 Fatty change of Liver 30
40 CRF/CKD 30
41 AGN 31
42 NS 31
43 Hypernatraemia 32
44 Hyponatraemia 32
45 Hyperkalemia (K > 5.5 mmol/L) 33
46 Hypokalemia 33
47 Hypoglycemia 33
48 Enteric Fever/ Typhoid 34
49 Rickettsial fever 34
50 Dengue fever 34
51 Malaria 35
52 Cerebral Malaria/Severe Malaria 35
53 Kala-Azar 36
54 PKDL 36
55 Fever Under Evaluation/UTI/RTI 36
56 Meningitis 37
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Dr. Md Anwarul Azim
57 Epilepsy 37
58 Acute Migraine attack 38
59 Tension Headache 38
60 Vertigo with Headache 39
61 Vertigo/BPPV 39
62 CVD/Stroke 40
63 TIA 41
64 Raised ICP 41
65 Bell's Palsy 41
66 Mumps & Orchitis 42
67 Hyperthyroidism 42
68 Steven Jonson Syndrome 42
69 Anaemia 43
70 Aplastic Anaemia 43
71 Fe Chelating agent in Thalassaemic PT 43
72 Macrocytic Anaemia 43
73 Lymphoma 44
74 Hodgkin Lymphoma 45
75 Aleukaemic Leukaemia 45
76 ALL 46
77 CML 46
78 Musculoskeletal Pain 47
79 Lumbo Sciatica 47
80 Septic Arthritis 47
81 Low Back Pain 48
82 RA 48
83 JRA 48
84 Tetanus 49
85 GBS 49
86 DKA 50
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Dr. Md Anwarul Azim
Psychiatry
1 Schizophrenia 52
2 GAD (Generalized Anxiety Disorder) 52
3 OCD (Obsessive Compulsive Disorder) 53
4 PPP (Post Partum Psychosis) 53
5 SRD (Substance related disorder)/Sleeping Pill 53
6 ASD (Acute Stress Disorder) 54
7 Depressive illness 54
8 Somatoform disorder/HCR/FD 54
Skin
1 Scabies 55
2 Acne Vulgaris 55
3 Seborrhoeic Dermatitis/ Seborrhoeic Folicuitis 55
4 Psoriasis 56
5 Tinea 56
6 Onychomycosis 56
7 Contact/Allergic Dermatitis 57
8 Urticaria/Drug reaction 57
9 Eczema 57
10 Impetig Eczema 57
11 S.Blephritis 58
12 White Discharge from Breast 58
13 Insect Bite 58
14 Skin Wart/Hard skin 58
15 Alopecia 58
16 Measles 59
17 Gonococcal Urethritis 59
18 Erectile dysfunction 59
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Dr. Md Anwarul Azim
19 Black Spot/wrinkle 59
Cardiology
1 AMI 60
2 IHD 61
3 CCF 62
4 AF (Atrial Fibrillation) 62
5 VF (Ventricular fibrillation) 62
6 SVT (Supra Ventricular tachycardia) 63
7 VT (Ventricular Tachycardia) 63
8 Ischemic Cardiomyopathy 64
9 Hypertension (HTN) 65
Paediatrics
1 Dosage of Drug 70
2 Fluid Mx 73
3 Birth asphyxia/Neonatal Sepsis/Neonatal Convulsion 75
4 LBW/Preterm Baby 76
5 Umbilical Sepsis 76
6 Neonate Of HBsAg +ve mother 77
7 Rh Incompatibility 77
8 Neonatal Jaundice 77
9 Acute RTI 78
10 UTI 78
11 Meningitis 79
12 Oral Thrush 79
13 Febrile Convulsion 80
14 Tetanus 80
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Dr. Md Anwarul Azim
15 AGN 81
16 NS 81
17 Asthma 82
18 Ascariasis 82
19 Diarrhoea 83
20 Near drowing 85
21 Malaria 86
22 Enteric Fever 86
23 PEM (Protein Energy Malnutrition) 87
24 Kerosene Poisoning 89
25 Dose of dopamine 90
SURGERY
1 Head Injury 92
2 Physical assault (P/A) 92
3 Massive cut Injury or P/A 93
4 Small cut injury 93
5 Acute case of intestine/ Acute Emergency 94

(Intestinal perforation/ Intestinal obstruction/ Volvolus/
Strangulation/ Intussusception/ Acute appendicitis/ Obstructed
hetnia)
6 A case of Hepato-Biliary system 95

(Acute cholecystitis/ Acute cholelithiasis/ Acute choledocolithiasis/
Acute pancreatitis/ Biliary ascariasis/ Obstructive jaundice)
7 Accidental fall from height 96
8 Abscess 96
9 Ulcer 97
10 Retention of Urine/ Structure urethra 97
11 BEP (Benign Enlargement Of Prostate) 98
12 Hernia & Hydrocele 98
13 PVD(Peripheral vascular Disease) 98
14 Haemorrhoids /Anal fissure/rectal prolapse 99
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Dr. Md Anwarul Azim
15 Peri-Anal Abscess 99
16 Gut Preparation for Surgery 100
17 Gut Preparation for IVU 100
EYE
1 Age related Cataract (ARC) 101
2 Acute/Acute on Chronic Daryosistitis 101
3 Chronic Dacryocystitis (CDC) 102
4 Ocular Injury 102

5 Acute Congestive Glaucoma 103
6 Fungal Corneal Ulcer 103
7 Viral Keratitis 104
ENT
1 Epistaxis 105
2 F.B Larynx/Trachea 105
3 F.B Pharynx/Oesophagus 105
4 Acute Epiglottitis 106
5 Hanging 106
6 DNS 106
7 CSOM 107
8 Traumatic Rupture Of TM 107
9 Sub-mandibular Growth 107
10 Nasal Mass With HIT 107
11 Rhinosporidiosis 108
12 Nodular Goitre 108
13 Cervical Lymphadenopathy 108
14 Parotid Abscess 109
15 Maxillary Sinusitis 109
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Dr. Md Anwarul Azim
OBSTETRICS
1 Indication of C/S 111
2 FTP with Normal Finding/Normal Labour 112
3 FTP with PET 112
4 Eclampsia 113
5 Post Partum Eclampsia 113
6 Retained Placenta 114
7 IUD 114
8 Obstructed Labour 115
9 APH 116
10 PPH 116
11 Hyperemisis Gravidarum 117
12 Shock 117
GYNAE
1 PV Bleeding 118
2 Incomplete Abortion 118
3 Threatened Abortion 119
4 DUB/Fibroid Uterus 119
5 Genital Prolapse 119
6 Ectopic Pregnancy 120
7 Perineal Tear 120
8 VVF 120
9 PID 121
10 Post Conductive order(In Obs)/Post Expulsive Order(In Gynae) 121
11 Bowel Preparation On 1st day 122
12 Bowel Preparation On 2nd & 3rd day 122
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Dr. Md Anwarul Azim
Medicine
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Dr. Md Anwarul Azim
A Patient with Breathlessness

Commonly:
 Bronchial Asthma
 COPD
 Pneumothorax
 LVF/AMI
 DKA
 Pulmonary edema/Thrombo embolism
 CRF/ARF/Uremia
 Emotional/HCR/FD
Acute Severe Bronchial Asthma

 Diet: Normal
 Bed rest with propped up position Clue to Dx-
 O2 Inhalation stat & SOS (high conc.)  H/O previous attack/allergy
 Nebulization with windel plus stat & 6 hrly  Young pt
 Inj. Cotson/Oradexon  Night awaking
 Wheeze,ronchi,
1 vial IV stat & 6 hrly
 Vesicular breath sound with
Or prolong expiration
Tab. Cortan(prednisolon) 5mg
6+0+0 ( 10 days)
 Asmasol/Sulprex inhaler
2 puff TDS
 Bexitrol F/ Ticamate inhaler
2 puff BD
 Antibiotic if evidence of infection
 Cap. Omeprazole 20mg
1+0+1 (B/M)
 If response poor then
Inj. Aminophyllin
2amp + 5% DA 500cc
IV at 8 d/m
 In some case -
Montelukast 10mg
0+0+1
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Dr. Md Anwarul Azim
COPD / Corpulmonale
 Diet: normal
 Bed rest with propped up position

Clue to Dx COPD-
 O2 Inhalation with low conc.  H/O cigarette smoking
 Nebilization with windel plus stat & 6 hrly  Old age(>40yrs usually)
 Inj. Cotson/Oradexon  No H/O asthma
1 vial IV stat & 6 hrly  Crep +++,ronchi,wheeze
Or  Tongue cyanosis, eye
congested
Tab. Cortan(prednisolon) 5mg
 Lip pursing
6+0+0 ( 10 days)
 Tab. Moxclave/Fimoxyclave 625mg Clue to Dx Corpulmonale
1+1+1  If COPD present with
Or Oedema
Levofloxacin 500mg (0+0+1)/ Ciprofloxacin
(1+0+1)
 Asmasol/Sulprex inhaler
2 puff TDS
 Bexitrol F/ Ticamate inhaler
2 puff BD
1+0+1 (B/M)
 If more Crep/Oedema present
Inj. Lasix/fusid
2amp iv stat then 1amp iv BD ( 8am & 4pm)
Inj. KT
1 amp iv in drip stat
Or
 If mild crep/ less severe
Tab. Fusid plus
1+1+0
 Tab. Contin 200mg
1+0+1
** Syp. electro K ( If only Fusid use)

2tsf tds
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Dr. Md Anwarul Azim
Pneumonia
 Bed rest
 O2 inhalation
 Tab. P/C
1+1+1
 Tab. Moxin 500mg
1+1+1
OR
Tab. Moxclav 625mg (2 wks)
1+1+1
+
Tab. Clarin 500mg (2 wks)
1+0+1
1+0+1 (B/M)
 If severe pain
Inj. Anadol 100mg/Inj. clofenac
1 amp im stst
Then, cap. anadol 50mg
1+0+1
 In severe case
Inj. Ceftriaxone 2gm (1 vial IV BD)/ Inj. Fimoxiclav 1.2 gm (1 vial IV 8 hrly)
+
Tab. Clarin 500mg (2wks)
1+0+1
Clue to dx-
 High grade fever
 Short history ( days to week)
 Chest pain with or without cough/
despnoea
Investigation-
 CBC
 RBS
 CXR P/A view
 MT
 Sputum for AFB
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Dr. Md Anwarul Azim
Lung Abscess
 Bed rest
 Cap. Amoxicillin + Metronidazole
OR
Inj. Ceftriaxone 1gm Daily (10 days)
+
Inj/Tab. Metronidazole TDS (4-6 wks)
 If not response-
- Antibiotics according to CS
-USG Guided percutaneous aspiration
 Tab. Multivitamin
1+0+1
 Postural drainage with 2times daily deep inspiration & forceful expiration
Clue to Dx-
 Fever with Cough
 Hemoptysis
 Foul smell sputum
 Chest pain/despnoea
 Wt loss/anorexia/ clubbing(10-14 days)
 CXR
Pleural Effusion
 Bed rest
 O2 inhalation if necessary Investigation-
 CXR
 Pleural fluid aspiration
 CBC
Up to 1.5L in one setting  Sputum- AFB,cytology
 Rx of underlying cause-  MT
TB,Malignancy,pneumonia,etc  Pleural fluid analysis
 FNAC or Bipsy from LN
(pleural biopsy confirmatory)
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Dr. Md Anwarul Azim
Bronchiectesis
 Diet. Normal
 Bed rest
 Cap. Ciprofloxacin 500mg
1+0+1
OR
Inj. Ceftazidim 500mg/inj. Flucoxacillin/Inj. Amoxicillin
 Cap. omeprazole 20mg
1+0+1
 Tab. Prednisolon
 Symptomatic-
Creap/Oedema- Tab. Fusid plus (1+1+0)
Fever- Tab P/C
Pain- Tab. Ketorolac
 Partial pneumonectomy may be done
Pneumothorax
If asymptomatic (<1/3 collapse)- Bed rest at propped up position
- Withdraw cause
If symptomatic (<1/3 Collapse)- Immediate insertion of percutanuous wide bore needle

(Usually 2nd or 3rd intercostal space at midvlavicular line)
Symptomatic with >1/3 collapse- Water seal drainage (At the 5th/6th IC in mid axillary line
with tip in the apical direction)
RTI
 Diet. Normal
 Cap. Amoxocillin 500mg(1+1+1)-7 days
OR
Tab. Levofloxacin 500mg (0+0+1)-7 days
OR
Tab. Azithromycin 500mg (0+0+1)-5 days
OR
Tab. Gemiflox 325mg (1+0+1)-5days
 Tab. P/C 500mg (1+1+1)
 Tab. Loratidin 10mg (0+0+1)
15 | P a g e
Dr. Md Anwarul Azim
Pulmonary TB
Catagory Indication Rx Regimen

CAT-1  New smear positive Intensive Phase (daily)
 New smear negative PTB 4FDC- 2 month
 Extra PTB Continuation phase (daily)
 Pleural effusion, pericardial 2FDC- next 4 month
 Meningeal
 Spinal,intestinalTB,
dessiminiated TB
CAT-2  Relapse Intensive Phase (daily)

 Treatment after deafult 1st 2 month- Inj. streptomycin IM
 Treatment failure daily
Next 3 month- Remistar FDC
Continuation phase (daily)
Next 5 month-
remactazid+Ethambutol
Composition of FDC
4FDC- INH 75mg + Rifampicin 150mg + Pyrazinamid 400mg + Ethambutol 275mg
2FDC- INH 75mg + Rifampicin 150 mg
Dose of FDC
FDC Weight(K.G) Dose

4FDC < 27 acc. to body wt
30-37 2
38-54 3
55-70 4
>70 5
2FDC 30-37 1 Rmactazid 300mg
< 50 1 Rmactazid 450mg
>50 2 Rmactazid 300mg
Dose of streptomycin
Weight in KG Inj. Streptomycin(1amp= 1gm) Tab. Ethambutol 400mg

30-37 500mg 2
38-54 750mg 3
55-70 1000mg 4
Dose of Streptomycin Should not exceed 759mg daily after the age 70yrs
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Dr. Md Anwarul Azim
CAT-1 ( WT-45 kg)
 Diet. Normal
 Tab. Rimstar 4FDC- 2 month
3+0+0 (Before meal) from 11/2/11 to 10/4/11
 Tab. Remactazid 450mg- next 4 month
1+0+0 (Before meal) from 9/4/11 to 8/8/11
 Tab. Pyrovate- 6 month
0+0+1
1+0+1
 Tab. Cortan 10mg ( to prevent pleural adhesion)
2+2+0-1 month
2+11/2+0-1wk
11/2+1+0-1wk
1+1+0- wk
1+1/2+0-1wk
1/2+1/2+0-1wk
1/2+0+0-1wk
 Tab. calcium 500mg- 2 month
1+0+0
উপদেশ-
 নিয়নিত ঔষধ খাবেি ।

 প্রস্রাে এর রং হলুদ হবল, চ াখ হলুদ ন ংো বখ ঝাপসা চদখবল, নিরায় েযথা হবল, চপবে েযথা হবল ডাক্তাবরর সাবথ চ ািাব াি রবেি
।
 নি েস্থ স্বাস্থয িবেক্স ো ব্রা অনিস চথব ঔষধ সংগ্রহ রবেি
CAT-2 (WT-45 kg)
 Diet. normal
 Inj. Streptomycin (1gm)-2month
2/3 amp IM daily from 11/2/11 to 10/4/11
 Tab. Rimstar 4FDC- Next 3 month
3+0+0 from 9/4/11 to 8/7/11
 Tab. remactazid 450mg - Next 5 month
1+0+0 from 7/7/11 to 6/12/11
 Tab. Pyrovate- 6 month
0+0+1
1+0+1 (B/M)
 Tab. Calcium 500mg- 2month
1+0+0
17 | P a g e
Dr. Md Anwarul Azim
Poisoning
Snake bite (poisonous)
 Diet: NPO TFO

 Bed rest
 Reassurance
 O2 inhalation if needed
 Inf. 5% DA 1000cc+ 5% DND 2000cc
IV 30 d/m stat
 Inj. Ceftriaxone 2gm
1 vial IV stst & daily
 Inj. Omeprazole 20mg
1 vial IV stat & BD
 Inj. TT
1 amp IM stat (in one arm)
 Inj. TIG
1 amp IM stat (in another arm)
 Inj. Polyvalent anti-venom 10 amp + 5% DA 100ml
IV @ 60d/m
 Catheterization
 Additional Rx acc. to neurotoxic feature
-Inj. Atropin
1 amp IV stat
-Inj. Neostigmine- if muscle paralysis
 Monitoring Vital sign
** inj. cotson, Inj. Avil, Inj. Adrenalin should be kept during given anti-venom as
anaphylactic reaction may occur
**Take written informed consent from pt attendant & inform the pt 50% chance to die due
to reaction of anti-venom and 100% chance to die without anti-venom.
Clue to poisonous snake bite-

 Bite mark 2 fangs
 Drowsy, restlessness, dribbling of saliva
 Resp. difficulty
 Ptosis/lid drop
 Broken neck sign
 Unconsciousness
 Blood coagulation test: Take few ml fresh venous blood in test tube after 10min if clot occur
it non-poisonous. If clot not occur it indicate poisonous.
18 | P a g e
Dr. Md Anwarul Azim
Snake bite (Non-poisonous)
 Bed rest
 Reassurance
 Inf. NS 1000cc
IV @ 20d/m stat
 Cap. Moxin(1+1+1)/ cephradin(1+1+1+1)
1+0+1 (B/M)
 Inj. TT
1 amp IM stat (in one arm)
 Inj. TIG
1 amp IM stat (in another arm)
 If pt complain pain Tab. P/C
 Never given- inj. Oradexon, Inj. Avil & NSAID
(Observe the pt 24hrs if no S/S of poisonous then discharge the pt)
Sedative poisoning
 Stomach wash if pt comes within 4-6hrs

 Diet. NPO TFO
 Inf. NS/DNS 1000cc
IV @ 20d/m stst
 Inj. ceftriaxone 1gm
1vial IV stat & BD
1 vial IV stat & BD
 Inj. Lasix ( if BP stable)
2 amp IV stat then 1 amp BD ( 8am & 4pm)
 If pt unconscious
-NG suction
- Continuous catheterization
 Monitor Vital sign
** Diazepam lethal dose more then 50/60 tab
Investigation
 S.Creatinine
 SGPT
19 | P a g e
Dr. Md Anwarul Azim
Anti-Depression Poisoning
 Stomach wash if pt comes within 12hrs

 Diet. NPO TFO
 Inf. NS/DNS 1000cc
IV @ 20d/m stst
 Tab. Ultracarbon
20 tab stat
 Inj. ceftriaxone 1gm
1vial IV stat & BD
1 vial IV stat & BD
 Inj. Lasix ( if BP stable)
2 amp IV stat then 1 amp BD ( 8am & 4pm)
 If pt unconscious
-NG suction
- Continuous catheterization
β-Blocker Poisoning
 Stomach wash if pt comes within 1hrs

 Inf. 5% DNS 1000cc (prevent hypoglycemia)
IV @ 20 d/m stat
1 vial IV stat & BD Investigation-
 Inj. Omeprazole 40mg  ECG
1 vail IV stat & BD  RBS
 Symptometic  S.Creatine
 Convulsion  S. Electrolytes
Inj. sedil 1amp IM/IV stst
 Bronchospasm
Nebulization
 Bradycardia
Inj. atropin 1 amp 8hrly
 Hypoglycemia
-Inj. libot-24 100ml
-Inj. 10% DA 1000ml as maintenance dose
 Hypotension- Inj. Glucagon
20 | P a g e
Dr. Md Anwarul Azim
Dutura/Stupefy/Street Poising
 Diet. NG Feeding 2hrly/NPO TFO

 O2 inhalation if needed Investigation-
 Inj. NS 1000cc  ECG
20 d/m IV stat  RBS
 Inj. Amoxycillin  S.Creatine
1vial IV stat & 8 hrly  S. Electrolytes
 Inj. Ranitid
1 amp IV stat & 8 hrly
 Continuous catheterization
 Monitor vital sign
** Always try to avoid costly drug & investigation as pt attendant are not available.
CuSO4 Poisoning
 Diet. Liquid
 Inf. 5% DNS 1000cc
IV @ 20 d/m
 Inj. Cefuroxime 1.5gm
1vial IV TDS
 Cap. Omeprazole
1+0+1
 Tab. Rex (anti-oxidant)- b.coz Liver is affected by metabolism
1+0+1
Corrosive/Chemical Poisoning
( Acid/Alkali/Savlon/Herpic/Shampoo/Bleaching powder)
 Do not give stomach wash/NG suction & don't try to induce vomiting
 Diet. NPO TFO
1 vial IV stat & BD
1 vial IV stat & BD
 If pain- Inj. Anadol/Inj. Ketorolac/Inj. nalbun-2
 If pt ingest chemical other than acid & alkali
Syp. Entacid plus
2 TSF TDS
 May give liquid paraffin
21 | P a g e
Dr. Md Anwarul Azim
OPC POISONING
 Stomach wash
Atropin Doubling dose-
 Diet. NPO TFO 1st give 3amp IV stat then
 Inj. NS/ 5% DNS 1000cc  Next 10min 6amp
20 d/m IV stat  Next 10min 12amp
 Inj. Ceftriaxone 1gm  Next 10min 24amp
 Next 10min 48amp
1 vial IV stat & BD
 Continue Up to
 Inj. Omeprazole 40mg atropinization
1 vial IV stat & BD
 Inj. Atropin
3 amp IV stat & double the dose every 10 min interval up to atropinization
 Inj. Pam-A 500mg ( Pralidoxime)

2 amp IV slowly over 10 min
 Maintain atropin chart
 Maintenance dose- If atropinization occur then (If loading dose 150amp)
-Inj. Atropin 45amp + NS 955 ml (total 1000ml)
IV @ 10 d/m
-Inj. PAM-A (May be given in current channel or another channel)
2amp+ NS/DNS 1000ml

Sign of Atropnizatio-
 If restless/convulsion  Pupil- Dilated
 Pulse- >80 b/m
Inj. Sedil 1amp IV stat
 BP- > 110/80 mm hg
 If still restless  Dry Axilla
Inj. perol 1amp IM stat  Clear lung
Maintenance dose-
*Atropin 30% of total loding
dose in 24 hours.
On Discharge (If total loading dose is 150 amp
 Tab. prokind 15mg- 15 days Then 30% of 150 amp is 45amp)
1+1+1 So pt get 45amp in 24hrs as
maintenance dose
 Tab. Tryptin 25mg- 2 month
*Pralidoxime 8-10 mg/kg/hrs
0+0+1 OR
 Cap. Omeprazole 20mg-1month 2amp in 1000ml NS/DNS
1+0+1
22 | P a g e
Dr. Md Anwarul Azim
Acute Gastritis (Food poisoning)

 Inf. NS/ Cholera Saline 1000cc
IV @ 30 d/m
 Inj. ciprofloxacin 100ml
bag IV stat & BD
1 vial IV stat & BD
 Inj. Emistat/Onaseron
1 amp IV stat & sos
Chronic Gastritis/Gastric ulcer

 Pylotrip strip- 7-10 days
1 strip(4 tab) BD
 Tab. Lansoprazole- 2 month
1+0+1
OR
Cap. Amoxycillin 500mg(1+1+1)/ Clarithromycin 500mg(1+0+1)- 7-14 days

 Tab. Metronidazole 400mg- 7 days
1+1+1
 Cap. omeprazole 20mg- 2 month
1+0+1
Acute PUD
 Diet. NPO TFO
 Inf. 5% DA 1000cc + Inf. 5% DNS 1000cc
IV @ 20 d/m
 Inj. Maxpro 40mg
1 vial IV stat & BD
 Inj. Algin
1 amp IM stat & TDS
 Inj. Emistat/ Onaseron
1 amp IV stat & SOS
23 | P a g e
Dr. Md Anwarul Azim
Haematemesis/Malaena
 Complete bed rest
 NPO TFO
 Inf. HS 2000cc + Inf. 5% DA 1000cc
IV running
 O2 inhalation if needed Investigation-

 1st choice-Endoscopy of
 Inj. Moxacil
UGIT
1 vial IV stat & TDS  Blood grouping & cross
 Inj. Omeprazole 40mg matching
1 vial IV stat & BD  CBC
 If portal HTN  PBF
-Tab. Inever 40mg  USG og HBS & pancrease
1/2 + 0 + 1/2
 Inj. konakion 10ml
1 amp slow IV drip for 3 days
 Inj. Xamic/Caprolysis
1 amp slow IV stat & 6 hrly
 Record vital sign
 Immediate arrange for Blood transfusion
Haemoptysis
 Diet. Normal
 Inj. HS 1000cc
IV 20 d/m
 Cap. Moxin 500mg (never give ciprofloxacin if you suspect TB as it mask the AFB)
1+1+1
 Inj. frabex/inj. traxyl
1 amp IV stat & yhen Investigation-
 Tab. frabex/traxyl  CBC
1+1+1  CXR
 Tab. sedil  MT
 Sputum for AFB & malignant cell
0+0+1
 RBS
 S.creatinine
24 | P a g e
Dr. Md Anwarul Azim
Mallory weiss syndrome

 Tab. Gastralfet 500mg- 14 days
2+2+2+2+2+2 ( Chewing 30min before meal & don't eat anything next 30min after
chewing)
 Cap. Omeprazole 20mg- 1 month
1+0+1
Non-Ulcer Dyspepsia
 Diet. sweet,fat,milk restricted
 Tab. Tryptin 25mg
0+0+1
1+0+1 (B/M)
 Tab. Omidon 10mg
1+1+1 (B/M)
 Tab. Entacid/Marlox
1+1+1 (A/M)
 Psychotherapy
Anti Flatulent
 Syp. flatameal DS
1/2 TSF TDS
 Tab. Flatameal DS
1-2 tab TDS
GRED
 Non drug Rx of GERD
 Wt reduction, stop smoking, avoid fatty food
 চপে ভবর খাবেি িা
 ২ ো োনলশ নদবয় চশাবেি
 খাওয়ার পর পর চশাবেি িা
 Drug Rx
 1+1+1 (B/M)
 1+0+1 (B/M)
25 | P a g e
Dr. Md Anwarul Azim
Ulcerative Colitis (Bloody Diarrhoea)
 Tab. Cortan 10mg

2+2+0
 Tab. Salazin 500mg ( Sulfasalazine)
1/1+0+1/2- 1st wk
1+0+1- 2nd wk
2+0+2- continue
 ORS as per need
IBS(Diarrhoea predominant)
 ORS- As per need

 Tab. Alve (Alverine)
1+1+1
OR
Cap. Imotil
1+1+1
 Tab. Triptin 25mg
0+0+1
Tropical spore
 Cap. Atetra 250mg-28 days

1+1+1+1
 Tab. Folison 5mg- 1 yrs
0+0+1
 Correction of dehydration/electrolytes imbalance
Apthus Ulcer
 Tab.precodil (prednisolon) 5mg

1 tab TDS at lacerated site
 Apsol/Meoral oral paste
Apply 3-4 times daily
 Viodin/arodin mouth wash 3 times daily
 Tab. Cevit 250mg
1+0+1
Oral Thrush
 Micoral/Gelora oral gel- Apply TDS in affected area

 Syp. flugal- 1 TSF TDS
26 | P a g e
Dr. Md Anwarul Azim
Liver Abscess
 Diet. Normal
 Tab. Ciprofloxacin 500mg
1+0+1
 Tab. Metronidazole 400mg
2+2+2
1+0+1 (B/M)
 Tab. Anadol 50mg (If pain)
1+1+1
 If pt toxic
-Inj. Ciprofloxacin 100ml
1 bag IV BD
-Inj. Metronidazole
11/2 bag IV TDS
Acute Viral hepatitis

 Diet. normal
 Syp. D-luc
2 TSF TDS
1+0+1 (B/M)
 Tab. Omidon
1+1+1 (B/M)
 Inj. Konakion 10mg
1 amp IV stat & daily for 5 days
 Other are symptomatic
Investigation-
 USG of W/A
 SGPT
 PT
 S.Bilirubin
 HBsAg
27 | P a g e
Dr. Md Anwarul Azim
CLD
Without encephalopathy
 Diet. Salt restricted

 Tab. Ciprofloxacin 500mg
1+0+1
1+0+1 (b/m)
 Tab. fusid plus
1+1+0
 Syp. D-luc
3TSF TDS
 Draw ascitic fluid 2L every day or alternative day
 Maintain I/O chart
 If complain abdominal pain/fever
-Inj. ceftriaxone 1gm
1 vial IV BD
 If abdominal pain
-Inj. anadol 100mg-1 amp IM stat
-Inj. algin- 1 amp IV stat
Hepatic Encephalopathy
 Diet. protein, Diruretics, fruits, sedative(except midazolam) restricted
 NG feeding
 Inf. 5% DA 1000ml
IV 20 d/m
1 vial IV stat & daily Investigation-
SGPT
 syp. Metronidazole
S.Bilirubin
4 tsf tds PT
 Inj. ranitid S.albumin, AG ratio
1 amp IV stat & 8 hrly HBsAg
 Syp. D-luc USG of W/A
3 tsf tds Asitic fluid study
 Inj. konakion 10mg
1 vial IV daily for 3-5 days
 If pt restless consult with senior & give
-Inj. Dormicum 7.5mg
1/2 amp IM/IV stat
28 | P a g e
Dr. Md Anwarul Azim
Acute Pancreatitis
 Diet. NPO TFO

 Inf. NS 1000cc + Inf. 5% DNS 200cc
IV @ 20 d/m stat
 Inj. ceftriaxone 1g (BD)/ Inj. Ceforoxime 1.5g (TDS)
 Inj. Omeprazole 40mb
1 vial IV stst & bd
 Inj. Ketorolac 30mg
1 amp IM stat and BD
Investigation-
 CBC with ESR
 USG of HBS with Pancrease
 ECG
 S. amylase- if within 24hrs
 Urinary amylase- > 24hes
 Before discharge
-RBS
-S. Calcium
Hepato Cellular Carcinoma
 Diet. salt, protein restriction

 Inf. 10% DA 1000cc
IV 10 d/m
 Tab. Famotidin 20mg
1+0+1
 Cap. Amoxycillin
 Tab. verosprium 25mg
 Percutaneous Ethanol Inj.- If tumor is small
29 | P a g e
Dr. Md Anwarul Azim
Fatty change of Liver
 Diet. Low fat diet

1+0+1(B/M)
 Tab. Algin/viseralgin
1+1+1
 Tab. Todol
1+1+1
 Tab. Alben DS
0+0+1
 If increase TIG level- Tab. Lipirel 200mg
CRF/CKD
 Diet. fruit, protein, dub water restricted

1+0+1(B/M)
 Tab. Fusid 40mg (don't use fusid plus to avoid hyperkalamia)
1+1+0
 Inj. fusid if generalize swelling
 Tab. dicaltrol/calcitrol
0+1+0
 Tab. calbo 500mg
1+0+1
 Tab. Folic acid
1+0+1
 Tab. Amlodipin-If HTN
 Antibiotc-If infection
 Loatidin 10mg-If purities
30 | P a g e
Dr. Md Anwarul Azim
AGN
 Diet. Protein, fruits restriction(to avoid hyperkalamia)

 Fluid. 500ml + previous day out
 Tab. (Phenoxy methyl penicillin)/ Pen-V/Oracin 250mg
1+1+1+1
1+0+1 (b/m)
 Tab. fusid 40mg (don't use fusid plus to avoid hyperkalamia)
1+1+0 - 5 days
1+0+0 - 5 days
 Tab. Omidon 10mg - 7 days
Clue to Dx-
1+1+1
 HTN
 Tab. deslor 10mg ( If itching)  Oedema- peri orbital,leg,sacral
0+0+1  Visuble haematuria
 Tab. Amlodipin 5mg (If HTN)  Oligura/uremia
1+0+0  Mild to moderate proteinuria
 Other Symptomatic (24 hrs urinary protein <3.5 gm
 Maintain BP chart
 Maintain Heat coagulation test
NS
 Diet. Normal(salt & fluid restriction)

 Fluid. 500ml + previous day out
 Antibiotc- Amoxycillin/Cefixim/Ceftriaxone
1+0+1
 Tab. Atova Clue to Dx-
0+0+1  Generalize oedema
 Tab. Cortan 5mg  Massive proteinuria- >3.5
gm/24hrs
4+4+0
 Hypo-albuminaemia- < 30gm/L
 Tab. Calbo 500mg  Hyperlipidaemia- >220 mg/dl
0+1+0
 Tab. Fusid plus- If massive Oedema
 Other Symptomatic
 Maintain BP chart
 Maintain Heat coagulation test
31 | P a g e
Dr. Md Anwarul Azim
Electrolytes imbalance
Hypernatraemia
It occur due to decrease body water, If we correction body fluid Hypernatraemia will be
correct, so we have to know fluid requirement.
Formula to find fluid requirement
Free water (in Littre)= (S.Na+ - 140) × 0.5 × wt in KG
140
** If Serum Na+ 160 mmol/L & weight 60 kg then
FW(L)= (160-140) × 0.5 × 60
140
=2L
Rx
 If pt stable & conscious- drinking more water at least 2L extra water

 In hospital- 5% DA 2000cc
IV 20 d/m
 repeat S.electrolytes
Hyponatraemia
Mild (125-135)
 Orally take table salt +ORS
Moderate (110-125) Na+ requirement for hyponatraemia

WT in KG ×0.5(F) or 0.6(M) × deficit
 Inf. 0.9% NaCl by calculating Na+ requirement **If a male 60kg wt, S.Na+ 120 mmol/L
(Max 2L/day) Then Na+ requirement is
 Added salt 60 × 0.6 × (140-120)
=720 mmol/L
Severe (<110)
 Inf. 3% NaCl by calculating Na+ requirement

(Max 1L/Day) **Not correct more then 10-12 mmol/L
in every 24hrs, rapid correction causes
Nice To Know Osmotic Demyelination syndrom
 100cc 0.9% NaCl solution = 155 mmol/L Na+
 1000cc 3% NaCl solution = 512 mmol/L Na+
 500cc 35 NaCl solution = 256 mmol/L Na+
32 | P a g e
Dr. Md Anwarul Azim
Hyperkalemia (K > 5.5 mmol/L)

 Diet fruit restriction
 Inf. 25% Nutridex 100ml/Libot-25 + 5 unit Maxulin-R (daily for 5days)
IV @ 8-10 d/m
 Inj. Ca gluconate (10ml) dilite with 10ml D/W (daily for 5days)
IV slowly over 10min
 ** If hyperkalemia with compelet Heart block
-Inf. 5% DA 500cc + 2amp Isolin (Isoprinalin) IV stat - to prevent bradycardia
Hypokalemia
Mild (3-3.5)
Dietary advice- Intake more fruit such as banana, fruit juice, Dab water.
Moderate (2-2.9)
 Sup Electro K/ KT
2 TSF TDS
OR
Tab KT
1+0+1
Severe (<2)
 Inj. KT 2amp + Inf. NS 1000cc

IV @ 15 d/m
 Advice- repeat S.Electrolytes1
Hypoglycemia
 LD-Inj. 25% glucose/libot-25/nutridex
IV running stat Clue to Dx-
 MD- inf. 10% DA 1000cc  H/O insulin intake
 Missed meal
20 d/m up to 24 hre
 Hypotension
 Inj. Decason  Cold calm skin
1 amp IV stat & 6 hrly  Shallow resp.
 Repeat Blood glucose
33 | P a g e
Dr. Md Anwarul Azim
Fever
Enteric Fever/ Typhoid
 Diet. normal
 Inj. Ceftriaxone 2gm- 7 days
Investigation-
1 vial IV stat & BD
 CBC
OR
 Urine R/M/E
Tab. Azithronycin 500mg-7 days  Blood culture- 1st wks
1+0+1  Widal test- 2nd wks
 Cap. Omeprazole 20mg  Tipple Ag
1+0+1 (B/M)  MP & ICT
 Tab. Omidon  USG of W/A
1+0+1
 Tab. P/C 500mg
1+1+1
 Tepid sponging
 Napa suppository
1 stick P/R when temp >101o F
Rickettsial fever
 Cap. A-tetra/Tetra A/Tetrax 500mg- 7days
1+1+1+1
+
Tab. Azithromycin 500mg
1+0+0
 Cap. Omeprazole 20mg
 Tab. P/C 500
1+1+1
 Napa suppository
1 stick P/R when temp >101o F
Dengue fever
 Tab. Azithromycin 500mg- 3 days

1+0+0
 Tab. P/C 500mg
1+1+1
 Volume replacement if dehydrate/Shock
 Platelet/blood transfusion if platelet count < 30,00
34 | P a g e
Dr. Md Anwarul Azim
Malaria
 Tab. Jasoquin 300mg (Quinine sulphat)- 7 days
2+2+2 (A/M)
 On 3rd day-
-Tab. Malaride ( salfadoxime + pyrol)
3 tab stat
 On 4th day-
-Tab. Jesoprim (Primaquine)
3 tab stat
1+0+1
 Inf. 5% DNS 1000cc- (To prevent hypoglycemia, because anti-malarial drug causes
hypoglycema)
IV 20 d/m
Investigation
 HB%, CBC with ESR
 MP/ICT for malaria
Cerebral Malaria/Severe Malaria

 Inf. 25% glucose/Nutridex 100ml
IV running stat
 Inj. Ceftriaxone 2gm ( In severe malaria whatever the Dx have to give Ceftriaxone)
1 vial IV BD
 LD- Tnf. 10% DA 500cc + Inj. Jasoqine 4 amp (20mg/kg over 4 hrs)
IV stat 30 d/m
 MD- Inf. 10% DA 500cc + Inj. Jasoqine 2 amp (10mg/kg over 4 hrs)
Iv 30 d/m 8 hrly
 Contineous catheterization
35 | P a g e
Dr. Md Anwarul Azim
Kala-Azar
 Inj. Na-Stibogluconate/Stibatin (100mg/ml)
20mg/kg/day for 28 days
PKDL
 Inj. Na-Antimony gluconate (SAG)
20mg/kg/day for 20 days per cycle
Duration- 6 cycle with 10 days interval between cycle
Fever Under Evaluation/UTI/RTI

 Bet rest
 Diet. Normal
1+0+1 (b/m)
 Tab. Omidon 10mg
1+1+1
 Tab. P/C
1+1+1
 Napa Suppository 500mg
1stick P/R if temp > 101o F
 If suspect RTI-Tab. Azithromycin 500mg (0+0+1)
 If suspect UTI- Tab. Ciprofloxacin 500mg/Cefuroxime 500mg (1+0+1)
 If suspect TB don't give Ciprofloxacin before AFB result come
36 | P a g e
Dr. Md Anwarul Azim
Meningitis
 Inj. Ceftriaxone 2gm- 14 days
1 vial IV stat & BD
 Inj. Dexamet
1+0+1 (B/M)
 Tab. P/C 500mg
1+1+1
 Napa suppo
1 stick P/R if temp > 101o F
 If convulsion-
Inj. Sedil 5mg
1 amp IM stat & SOS
OR
Tab. Berbit 30mg
0+0+1
 Syp. Diphedan 100mg
1 TSF TDS
Epilepsy
 Tab. Tegretol 200mg (carbamazepine)
1+1+1
OR
Tab. valex/Epilim/Encorate (Na-Valporate)
1+0+1
 Tab. Neuro-B
1+0+1
1+0+1 (b/m)
 Tab. Rivotril (0.5mg)
0+0+1
 Tab. bardinal 30mg
1+0+1
 If severe
o Inj. Berbit-1/2 amp IM stat & SOS
o Inj. Peridol- 1 amp IM/IV stat & BD/TDS
o Inj. Perkinil- 1 amp IM/IV stat & BD/TDS
37 | P a g e
Dr. Md Anwarul Azim
Acute Migraine attack

 Tab. Rizat 5mg (Rizatriptan)
1 tab stat orally, নদ িা বি 10 min পর again 1 tab, তারপরও িা িবল আর নদে িা
 Tab. Migranil/pizo 0.5mg (pizotifen)
0+0+1
 Tab. Tufnil 200mg (Tolfenamic acid)
1+0+1
 Tab. Norium 10mg (Flunarizine)- 6 month
0+0+1 (সপ্তাবহ ২নদি োদ)
 Tab. Tryptin- Continue
0+0+1
 Tab Indever 10mg- if trachycardia present
1+0+1
For Classical migraine
 Tab. P/C: (1+1+1) Or Naproxen (1+0+1)

 Tab. Omeprazole 20mg
1+0+1 (b/m)
1+1+1 (b/m)
In severe attack
 Inj. Ketorolac 30mg- 1 amp IM stat

 Tnj. Ranison- 1 amp IM stat
 Inj. sedil- 1 amp IM stat
Tension Headache
 Tab. naprosyn 500mg (1+0+1) OR Tab. P/C 500mg (1+1+1)- 2 days
 Tab. Omidon 10mg- 2 days
1+1+1
 Cap. Omeprazole 20mg- 2 days
1+0+1 (b/m)
 Tab. Sedil 5mg/Tab. Dormitol 7.5mg
1 tab stat
 Prophylaxis
- Tab. Tryptin 10mg (0+0+1)
- Tab. frenxit (1+1+0)
38 | P a g e
Dr. Md Anwarul Azim
Vertigo with Headache

 Tab. Cinaron
1+1+1
 Tab. Stemetil/Vergon
1+1+1
Vertigo/BPPV
 Tab. Stemetil/Vergon- 15 days
1+1+1
 Tab. Perkinil- 15 days
1/2 + 1/2 + 1/2
39 | P a g e
Dr. Md Anwarul Azim
CVD
Stroke
 Diet. NG feeding
200ml 2 hrly
 O2 inhalation stat & SOS

 Inf. NS 1000cc Clue to Dx
IV 20 d/m stat  Sudden Onset
 Unconscious/semi-
 Inj. Dexamet
conscious/conscious
1 amp IV stat & 6 hrly  Aphasia
 Antibiotc- if needed  Hemi/mono paresis
- Inj. Ceftriaxone 1gm  Planter-Unilateral extensor
1 vial IV stat & BD In Infarctive
OR  Usually conscious
 aphasia
- Inj. Moxin 500mg
 Hemi/mono paresis
1 vial IV TDS In Haemorragic
 Continuous catheterization  Unconsciousness
 Change posture 2 hrly  H/O Headache/vomiting/HTN
 If Pt with HTN, BP > 180/120 mm of hg  Neck rigidity in sub-arachnoid
- Tab. Ramoril/Ripril 5mg (Ramipril) Hge
0+0+1
 If Infarctive stroke
 Tab. Cavinton/cerevas 5mg- 3 month
1+1+1
 Tab. Anclog plus/ Ecospirin plus- continue
0+1+0
 Tab. Atova 10mg- continue
0+0+1 Investigation-
 Steroid omit  CT scan of brain
 If Haemorrhagic stroke  RBS
 Steroid given for 5 days then omit  S.Creatinine
 S.Electrolytes
 If venticular extention
 S.Lipid profile
- Tab. Nimocal 30mg- for 21 days  ECG
2+2+2+2+2+2
 If Brain atrophy with Oedema
- Inf. 20% mannitol/Osmosol 500ml
1/2 bag running & then 1/2 bag 8 hrly for 3 days
** Anti-platelet drug is contra-indicated in Haemorrhagic stroke
40 | P a g e
Dr. Md Anwarul Azim
TIA
1+0+1 (b/m)
 Tab. Anclog plus/Ecospirin plus
0+1+0
 Tab. Atova/Tiginor 10 mg
0+0+1
 Tab. Ramoril- if HTN
Raised ICP
 Inj. Mannitol/manisol 500ml
1/2 bag running & 1/2 bag 8 hrly for 48 hrs
Bell's Palsy
1+0+1 (B/M)
 Tab.Virux 400mg- 7 days
2+2+2+2+2
 Tab. Cortan 20mg (1mg/kg)- 7 days
21/2+0+0 (A/M)
 Tab. Neuro-B
1+0+1
 Eye care
- SQmycetin E/D- 1 drop TDS
- SQmycetin E/O- apply at bed time
- Use eye glass & eye pad during sleep
- Physiotherapy
41 | P a g e
Dr. Md Anwarul Azim
Mumps & Orchitis

 Tab. deltason 20mg
2+0+0 (A/M)
 Tab. P/C 500mg
1+1+1
 Tab. cefuroxime 500mg
1+0+1
3gm IV stat & daily
Hyperthyroidism
 Tab. Neomercazole
3+3+3-3 wks
2+2+2-5 wks
1+0+1- Continue
 Tab. Tenoloc 50mg
1+0+1
 Tab. Indever 10mg
1+1+1
Steven Jonson Syndrome

 Diet. NPO TFO
 Inf. 5% DA 1000cc + Inf. 5% DNS 2000cc
IV 30 d/m
 If secondery infection- Inj. Ceftriaxone -1 vial IV daily
 Inj. Dexamet
 Micoral oral gel
Apply locally 3 times
 Sonexa E/D
1 drop 4 hrly
 Sonexa E/O
At bed time (both eye)
 Haematropin E/D
1 drop 8 hrly
 Tab. Vasco 250mg
1+1+1
42 | P a g e
Dr. Md Anwarul Azim
Anaemia
 Blood transfusion at least 4 unit (If HB% 6 g/dl)
OR
Tab. Folfetab (1+1+1)/Tab ZIF-CI (1+0+1)
(5 wks for correction + 6 wks for storage, total 7 month)
 Rx of primary cause
Nice to know
(Our target to reach Hb level 10g/dl)
 1 unit blood correct 5% HB or 1g/dl
Ferus Sulphate( Orally)-
 If we give 200 mg 8 hrly it correct Hb level 1g/ld/wks
 1st wks for erythropoisis stimulation, So it take more than one wks as g/dl we have to
correct
 After correction it takes more than 6 month for adequate storage.
Aplastic Anaemia
Supportive Rx
 Bed rest- chance of HF, to avoid trauma

 Fresh blood transfusion up to storage
 Inj. cefuroxime IV form ( IM is contraindicated)
Specific Rx
 Marrow stimulating agent

 Bone marrow transplantation
Fe Chelating agent in Thalassaemic PT
 Inj. desferal 500mg 2 vial + Inf. 0.9% NaCl 1000cc

IV @ 20 d/m
Macrocytic Anaemia
 Tab. Folfetab
1+0+1- 3 wks
Then, 1+0+0 per week for life long
 Inj. Cyanomin (1000 µgm)
1 amp IM on alternative day for 9 month
Then, 1 amp IM 3 monthly for life long
43 | P a g e
Dr. Md Anwarul Azim
Lymphoma
Chemotherapy Schedule
Dosage of drug
 Vincristin- 1.4 mg/m2

 Cyclophosphamide- 750 mg/m2
 Doxorubicin HCL- 50 mg/m2
 Prednisolon- 2 mg/kg/day
Pre-requisition
 Pt চ well hydrate বর নিবত হবে

 Liver & Renal function ঠি আবে ন িা চদবখ নিবত হবে
Duration
 21 নদি পরপর এব ো cycle নদবত হবে, 4-6 wks নদবত হবে
Rx
 Inf. 5% DA 500cc
IV stat 60 d/m
 Inj. Onaseron
1 amp IV stat
 Inj. Neotack
1 amp IM stat
 Inj. Alcristin 1ml ( vincristin sulphate)
2 vial IV slowly stat
 Inj. endoxan 1gm ( Cyclophosphamide) 1 vial + 5% DA 500cc
IV 60 d/m
 Inj. zovidox 50mg (Doxurubicin HCL) 11/2 vial + 5% DA 500cc
IV 60 d/m
 Tab. Cortan 20mg
3+2+0 (A/M)
 Tab. Esloric 100mg /Allopurinol( for increase uric acid secretion)
1+0+1
44 | P a g e
Dr. Md Anwarul Azim
Hodgkin Lymphoma
Bag-1

+
Inj.Onaseron 4 amp
Inj. Oradexon 2 amp
Inj. Ranitid 2 amp
IV @ 60 d/m
 Inj. Vincristin 1ml
2 vial IV stat slowly
Bag-2

+
Inj. Doxorubicin 70mg (50mg & 10mg available)
IV @ 60 d/m
Bag-3

+
Inj. Endoxan 1gm
IV @ 40 d/m
 Tab. Cortan- 5 days
2+2+1
 Tab. Esloric 100mg- 7 days
1+0+1
Aleukaemic Leukaemia
 Diet. Normal
 Inj. Cefipime 1gm
1 vial IV stat & BD
 Inj. Metronidazole 100ml
1 bag IV stat & TDS
 Immediate Blood Transfusion
 Tab. F/S
0+1+0
1+0+1
 Povisep mouth wash- Gurgle 2 times daily
45 | P a g e
Dr. Md Anwarul Azim
ALL
Supportive:
 Diet: neutropenic
 Correction of anaemia: Fresh blood transfusion (Target HB% is 10gm/dl)
 Correction of infection- Board spectrum antibiotic
 Tab. Esloric - 1+0+0 (for hyperuracemia)
 Cap. Omeprazole
 If Pain- Cap. Anadol
Spcific: Chemotherapy
Curative: Bone Marrow transplantation
CML
Supportive:
 Diet: neutropenic
 Correction of anaemia: Fresh blood transfusion (Target HB% is 10gm/dl)
 Correction of infection- Board spectrum antibiotic
 Tab. Esloric - 1+0+1 (for hyperuracemia)
 Cap. Omeprazole
 Tab. Filwel gold: 1+0+1
 Tab. Foltab: 0+0+1
Spcific: Chemotherapy
Curative: Bone Marrow transplantation
46 | P a g e
Dr. Md Anwarul Azim
Musculoskeletal Pain
1+0+1 (B/M)
 Tab. Indomet
1+0+1
OR
Indomet suppository 100mg
1 stick P/R stat & BD
OR
Tab. Naprox/Naprosyn 500mg
1+0+1
 Tab. Myolax/Tolperison HCL 50mg
1+1+1
 Tab. Caldil
1+0+1
Lumbo Sciatica
 Tab. Myolax 50mg- 7 days
1+1+1
1+0+1 (B/M)
 Tab. Naprosyn 500mg
1+0+1 (A/M)
OR
Tab. Rolac 10mg
1+0+1(A/M)
 Tab. aristovit-M- 2 month
0+0+1
Septic Arthritis
 Inj. Aflox 500mg- 2 wks (** Inj. Flucloxacillin 2gm 6 hrly)
 Then,
Cap Flubex 500mg- 4 wks
1+1+1+1
47 | P a g e
Dr. Md Anwarul Azim
Low Back Pain

 Tab. beclo 10mg- 7days
1+1+1
 Then
Tab. Myolex 50mg- 7 days
1+1+1
 Cap. Omeprazole 20mg- 15 days
1+0+1 (B/M)
 Tab. tenorex- 7days
1+0+1 (A/M)
Advice
 ৭ নদি পূিন নেশ্রাবি থা বেি

 সািবি ঝু ব চ াি াজ রবেি িা
 ভানর নজনিস ওঠািািা রবেি িা
RA
1+0+1 (B/M)
 Cap.Indomet 25mg
1+1+1 (A/M)
 Tab. MYX 2.5mg-3 tab weekly single dose
 Tab. Folison-3 tab weekly single dose
 Tab. prednisolone 5mg
6+0+0 (A/M)
JRA
 Tab. MTX 2.5 mg- 3 tab weekly
 Tab. Folison 5mg ( 1 day after MTX)
1+0+1 per week
 Cap. omeprazole
1+0+1 (B/M)
 Cap. Servimeta 25mg
1+1+1
48 | P a g e
Dr. Md Anwarul Azim
Tetanus
 Diet. Soft
 O2 inhalation SOS
 Isolation room (dark & soundless room)
 Inj. C-Penicillin(5 Lac)
 Inf. 5% DA 1000cc + Inj. sedil 10 amp
IV stat @ 15 d/m
 Inj Rolac 30mg
1 amp IM stat & SOS
 Inj. TIG 250 IU
10 amp IV slowly stat
 Inj. Tetavax
1 amp IM stat
 Tab. Metro
1+1+1
 Closed wound should be openedup & washed with H2O2
GBS
 Bed rest
 O2 inhalation
 Plasma Exchange (plasmapheresis)
 IV ɣ-globulin (400 mg/kg/day)-5 days
Inj. Octagam- (1 vial-50ml)
 Prednisolone(60-80mg)-7 days
 Physiotherapy
 Measure for airway, pressure sore & venous thrombosis
Clue to Dx
 Ascending type of paralysis
 More marked proximal than distal
 Symmetrically
 Sensory intack
 Jerk- diminished/loss
 Bowel/bladder nit involved
 All 4 limbs may paralyced
49 | P a g e
Dr. Md Anwarul Azim
DKA
Basic Principal of DKA Management
1. fluid replacement
2. the administration of short-acting (soluble) insulin
3. potassium replacement
4. the administration of antibiotics if infection is present
Rx:
 Diet. NPO TFO

 NG suction
 O2 inhalation
Fluid: Total fluid 6 litre over 24 hrs
 1st NS 1000cc over 1/2 hrs

 2nd NS 1000cc over 1hrs hrs-
 3rd NS 1000cc over 2 hrs
 4th Ns 1000cc over 4hrs
Then when RBS <15 mmol/L
 1st 5% DA 1000cc over 8 hrs

 2nd 5% DA 1000cc over 8 hrs
If still dehydrate start 5%DNS
Short acting soluble Insulin: via microburet set
 Inj. NS 100ml + Inj. Actraoid HM(u-100)- 24 unit

− 6 unit/hrs initially- IV @ 24 µd/m
− 3 unit/hrs when blood glucose <15 mmol/l - IV @ 12 µd/m
− 2 unlt/hrs when blood glucose <10 mmol/hrs- IV 8 µd/m
Alternative
 10-20 unit Insulin IM stat
Then,
− 6 unit IM hrly initially
− 3 unit IM hrly when blood glucose <15 mmol/l - IV @ 12 µd/m
− 2 unit IM hrly when blood glucose <10 mmol/hrs- IV 8 µd/m
 Check blood glucose hourly initially; if no reduction in first hour, rate of insulin
infusion should be increased
 Aim for fall in blood glucose of 3-6 mmol/L (approximately 55-110 mg/dL) per hour
50 | P a g e
Dr. Md Anwarul Azim
If pt able to take oral food then switchover to subcutaneous as
 Inj. Actrapid HM u-100,s-100

8+8+6 SC 15min before meal
If RBS >10-15 mmol/l then again start insulin drip
Antibiotic:
 Inj. Ceftriaxone 1gm- 1 vial IV stat & BD
Inj . Ranitidin- 1 amp IV stat & 8 hrly
Correction of K: Inj. K-T (1 amp = 20 mmol/l)
− None in first L of i.v fluid unless plasma potassium < 3.0 mmol/L
− When < 3.5 mmol/L, give 20 mmol/hr
− When plasma potassium is 3.5-5.0 mmol/L, give 10 mmol/hr
− When plasma potassium is >5.0 mmol/L Stop giving potassium
Continuous catheterization
Change posture 2 hrly
Clue to Dx Drop calculation:

 Unconsciousness/semi consciousness
 Drowsy/Disoriented Total fluid
 Feature of dehydration d/m=
 Respiratory distress may be present
4 × hrs
 Known diabetic pt
 Low BP, Trachycardia,
(drop চ 4 নদবয় গুি রবল µd
 Planter: may be bilateral extensor
পাওয়া াবে)
51 | P a g e
Dr. Md Anwarul Azim
Psychiatry
Schizophrenia
 Inj. Fenazine 25mg

1 amp IM (পাোর িভীর িাংবস)
Then,
Tab. sizodon/resodon 2mg
0+0+1-for 2 days,then
0+0+2- continue
 Tab, Opsonil 50mg
0+1+1
 Tab. Perkinil
1+1+1
Pase 0.5- 15 days
0+0+2
 Tab.Promitil 5mg (অনস্থর লািবল)
1+0+1
GAD (Generalized Anxiety Disorder)

 Tab. Telazine
1+1+1
 Tab. Tryptin 10mg
0+0+2
 Tab. Indever
1+1+1
 Tab. Pase 0.5
0+0+1
52 | P a g e
Dr. Md Anwarul Azim
OCD (Obsessive Compulsive Disorder)

 Tab. Clofranil 25mg
0+0+1
Then. 0+0+2
Then, 0+0+3
 Tab. Disopan 0.5
0+0+1
 If palpation- tab. Indever
1+1+1
PPP (Post Partum Psychosis)

 Tab. Peridol 5mg
1+1+1
 Tab. Perkinil 25mg
1+1+1
 Tab. Opsonil
0+0+1
SRD (Substance related disorder)/Sleeping Pill

 Tab. Rivotril
0+0+2- for 7 days
Then, 0+0+11/2- for 7 days
Then, 0+0+1- for 7 days
Then, 0+0+1/2-for 7 days
 F/U- 1 month later
53 | P a g e
Dr. Md Anwarul Azim
ASD (Acute Stress Disorder)

 Tab.Promitil 25mg
0+0+1- 3 days
Then, 1+0+1
 Tab. Indever
1+1+1
 Tab. Rivotril 0.5 mg
0+0+2- 10 days
Then, 0+0+1
Depressive illness
 Adnor 75mg
0+0+1
 Tab. Amit/tryptin 25mg
1+0+2
 Tab. Deprex
0+0+1
 F/U- after 21 days
Somatoform disorder/HCR/FD
 Diet . NG feeding
 Inj. Ranitidin
1 amp IM stat & TDS
 Inj. Dormicum
1/2 amp IM (if no H/O asthma/COPD)
On discharge
 Tab. Frenxit/Anfree
1+0+0- 2 month
OR
2+0+0- 1 month
 Cap. Omeprazol- 15 days
1+0+1 (b/m)
54 | P a g e
Dr. Md Anwarul Azim
Skin
Scabies
 Tab. Azithromycin /Flufloxacin
 Tab. Histacin
1+0+1
 Bactrocin ointment
চরাজ ২ োর আক্রান্ত স্থাবি লািাবেি
 Scaper/Scabex/scabicid Cream
চিাসবলর পর টিউবের সেেু কু অংশ ঔষধ িলা চথব পা প নন্ত লািাবেি। ২৪ ঘন্টা পর চিাসল রবেি। েযেহা ন াপর-
চ াপর নসদ্ধ বর চধাবেি। চলপ,চতাষ ইতযানদ চ গুবলা ধুয়া ায় িা চসগুবলা চরাবদ শুন বয় নিবেি।
 পনরোবরর স ল সদসয এই এ ই নিয়বি ন ন ৎসা রবেি
Acne Vulgaris
 Tab. azithromycin 500mg
0+0+1-৩ নদি
এরপর ৪ নদি নেরনত নদবয় আোর ৩ নদি, এভােএ চিাে ৮ সপ্তা খাবেি।
 Scbionex jell/ Acne bar -সাোি নদবয় নদবি ৫/৬ োর িুখ ধুবেি
 Isotrex/Nilac jell -চরাজ রাবত আক্রান্ত স্থাবি লািাবেি
Seborrhoeic Dermatitis/ Seborrhoeic Folicuitis

 Tab. Oflacin 200mg- 10 days
1+0+1
 Tab. Telfast/Fenadin 180mg- 15 days
0+0+1
 Bactrocin/bectroderm oint.
 Diprosal lotion
নদবি ২ োর িাথায় লািাবেি
 Nizoder/dancel Shampoo
সপ্তাবহ ২-৩ নদি িাথা সহ সিস্ত শরীবর ঐই শযাম্পু চিবখ ১০ নিনিে পর চিাসল রবেি
55 | P a g e
Dr. Md Anwarul Azim
Psoriasis
 Tab. Oflacin 200mg
1+0+1
 Tab.Telfast 180mg
0+0+1
 Olive Oil
 Xenovet Oint. + Eucera cream + 5% salicylic acid
নিনশবয় চরাজ ২ োর আক্রান্ত স্থাবি লািাবেি
 Sastid bar
রুিাবলর সাবথ লানিবয় পনরস্কার রবেি
 Xenovet Scalp / Dermovet cream
চরাজ ২ োর িাথায় লািাবেি
 Fungitar shampoo
সপ্তাবহ ২-৩ নদি িাথা ধুবেি
Tinea
 Cap. fungata- 1 month
0+0+1
 Xfin cream- 1 month
 Tab. Telfast 180mg- 1 month
0+0+1
 Tab. Multivit
Onychomycosis
 Cap. fungata
সপ্তাবহ ১ো বর ৬ িাস
 Afun/Clarizole lotion
চরাজ ২ োর িবখ লািাবেি
56 | P a g e
Dr. Md Anwarul Azim
Contact/Allergic Dermatitis
 Tab. Azithromycin 500mg
 Tab. Telfast
 Diprobet/Mexiderm oint. + Eucera cream
Urticaria/Drug reaction
 Tab. Azithromycin 500mg
 Tab. Momentor
1+0+0
 Tab. Cortan- 10 days
 Cap. Omeprazole
 Tab. Monas(Montelukast) 10mg
0+0+1
Eczema
 Tab. Terbucef 250mg-10 days
1+0+1
 Tab. Telfast
 Xenovet oint. + Eucera cream
Impetig Eczema
1+0+1
 Tab. Telfast
 Bactrocin oint.
57 | P a g e
Dr. Md Anwarul Azim
S.Blephritis
 Betnovate-CL oint.
 Nizoder/dancel Shampoo
সপ্তাবহ ২-৩ নদি িাথা সহ সিস্ত শরীবর এই শযাম্পু চিবখ ১০ নিনিে পর চিাসল রবেি
White Discharge from Breast

1+0+1
 Tab. Telfast- 10 days
0+0+1
 Tab. Multivit- 1 month
1+0+1
Insect Bite
 Antibiotic
 Anti-histamine
 Diprobet/Mexiderm oint.
Skin Wart/Hard skin

 Duofilm lotion (salisylic acid)
 Tab. Telfast- 10 days
0+0+1
Alopecia
 Dermas cream 1%
চরাজ ১ োর আক্রান্ত স্থাবি লািাবেি
 Xenovet cream
চরাজ ১ োর আক্রান্ত স্থাবি লািাবেি
 Tab. E-Cap 400mg
0+0+1
58 | P a g e
Dr. Md Anwarul Azim
Measles
 Tab. AZith 500mg- 5days
1+0+1
1+0+1
 Tab. Deslor
 Tab. P/C
 Tab. Emistat/Domin (If complain vomiting)
Gonococcal Urethritis
 Inj. Ceftriaxone 1gm- For 3 days
 1 vial IV stat & daily
1+0+1 (b/m)
 Cap. Doxicap- 7 days
1+0+1
 Tab. Loratin
0+0+1
Erectile dysfunction/ ↓libido/ Night Ejaculation

 Tab. Silagra/Vegorex 25mg/50mg/100mg (sildenafil citrate)-short acting
OR
Tadalis/Intimate 5mg/10mg/20mg (Tadalafil)- Long acting
One hr before sexul intercourse (Contraindicated in IHD)
 Cap. Pirulin ( spirolina)- 2 month
1+0+1
 Tab. Frenxit
0+0+1
Black Spot/wrinkle
 White Objective Pen
59 | P a g e
Dr. Md Anwarul Azim
Cardiology
AMI

 Diet. Liquid
 Nitrosol/Anril Spray
2 puff S/L stat & SOS
OR
Tab. Anril/Angicard 0.5 (If pt poor)
1 tab S/L stat & SOS
1+0+1 (B/M)
 Tab. Anclog plus/Lopirel plus
0+1+0 (A/M)
 Tab. Atova
0+0+1
 Tab.Monocard 20mg (mononitrate)
1+1+0
OR
Tab. Nidocard-RTD/Trocer 2.6 (GTN)
1+0+1
 Tab. Metacard MR ( Trimetazidim)
1+0+1
 Tab.Epam/sedil 5mg
0+0+1
 Inj. Morphin 1 amp + 14cc D/W then
5 ml IV stat slowly, if not relief then 3 ml IV slowly 10 min interval can be given
within 1/2 hrs at same time BP must check if fall must stop morphin
 Inj. Emistat
1 amp IM/IV 15 min before giving morphin
 Inj. cardinex/Claxane (60mg or 80mg)- if pt comes > 12 hrs
1 syringe S/C stat & BD
If pt comes within 12 hrs
 Inj. Cotson 1 amp IV stat Then

Inj. Straptase (streptokinase) 1 vial + Inf. 5% DA 100cc
IV @ 25 d/m stat (No IM inj. in next 24 hrs of streptokinase)
 Inj. Cardinex/Claxane (60mg or 80mg)- after 24 hrs of inj. streptokinase
1 syn S/C BD
60 | P a g e
Dr. Md Anwarul Azim
If BP fall <80/50 mm of Hg- Pt goes to shock
 Inj. Dopamin 2amp + 5% DA 500ml

IV stat @ 6-8 d/m
 Inj. cotson-2 vial IV stat
MI with Bradycardia
 HR >40 b/m- 1 amp atropin IV stat & SOS

 HR <40 b/m- 2 amp atropin IV stat & SOS
MI with LVF
 Inj. Fusid-2amp/4amp IV stat & SOS

 Cap. Cephradin 500mg (1+1+1+1)
OR
Tab. Ciprofloxacin (1+0+1)
IHD
 Diet. Normal
 Nitrosol/Anril Spray
2 puff S/L stat & SOS
OR
Tab. Anril/Angicard 0.5 (If pt poor)
1 tab S/L stat & SOS
1+0+1 (B/M)
 Tab. Anclog plus/Lopirel plus
0+1+0 (A/M)
 Tab. Atova
0+0+1
 Tab.Monocard 20mg (mononitrate)
1+1+0
OR
Tab. Nidocard-RTD/Trocer 2.6 (GTN)
1+0+1
 Tab. Metacard MR ( Trimetazidim)
1+0+1
 Tab.Epam/sedil 5mg
0+0+1
 If HTN
Tab. Remoril/Ripril 2.5 (ACEI)
0+0+1
61 | P a g e
Dr. Md Anwarul Azim
CCF
 Bed rest
 Diet. Liquid
 Inj. Cotson
2 vial IV stat
 Inj. Fusid
2 amp IV stat & BD
 Cap . omeprazole 20mg
1+0+1 (b/m)
 Tab. Nidocard 2.6
1+0+1
 Antibiotc-Amoxocillin/Ciprofloxacin/Cephradin
 Agoxin 0.25mg (Digoxin)-May use
0+0+1/2 ( Fri & sat day off)
 Anti-hypertensive- If HTN
AF (Atrial Fibrillation)
 Tab. Lanoxin 0.25mg (Digoxin) Digoxin contra-indicated in

3+0+0- for 5 days AMI
Then, 1+0+0- Friday & Saturday off Digoxin(Cardiac glycoside)
↓
↑ force of contraction
↓
↑O2 demand
↓
Ischemia
VF (Ventricular fibrillation)
 DC Shock 200 joules

 If not control another 300 joules
 If control- 2% Lignocaine 100cc + 5% DA 400cc
IV @ 5-8 d/m for 24 hrs
 After 24 hrs
Tab. Pacet 200mg
1+1+1
62 | P a g e
Dr. Md Anwarul Azim
SVT (Supra Ventricular tachycardia)

 Bed rest
 O2 inhalation Stat
 Inj. Osiden/Adicard (Adenosine)
2 amp IV rapidly stat ( within 2 second)
 Tab. Veracal 40mg ( verapamil)
1+1+1
 Inj. sedil
1 amp IM stat
 If not response
Inj. Veracal 10mg
IV slowly over 5-10min
 If not response- DC chock
VT (Ventricular Tachycardia)
 Bed rest
 O2 inhalation Stat
 Inj. 2% Lignocaine
3-5 cc bolus stat over 1 min
 If not control- repeat after 5-10 min
 If normal- Mantanance by
Inj. 2% Lignocaine 100cc + 5% DA 400cc
IV @ 5-10 d/m for 24 hrs
 Then, 2% lignocaine for next 24 hrs
 Tab. Amiodaronr
 Tab. Pacet 200mg
1+1+1-for 7 days
1+0+1-for 7 days
1+0+0- Maintenances dose
 If no Improvement- DC shock
63 | P a g e
Dr. Md Anwarul Azim
Ischemic Cardiomyopathy
 Tab. Anclog 75mg
0+1+0
 Tab. Monocard 20mg
1+1+0
1+0+1 (b/m)
 Tab. Fusid plus
1+0+0
 Tab. Cardopil 25mg
1/2 +0+1/2
 Tab. Lanoxin/Agoxin (0.25)
1/2 +0+ 1/2 ( Fri & sat day off)
 Tab. Angicard/Anril 0.5mg
1 tab S/L
64 | P a g e
Dr. Md Anwarul Azim
Hypertension (HTN)
Classification
BHS Classification:
Category Systolic BP (mmHg) Diastolic BP (mmHg)

BP
Optimal < 120 < 80
Normal < 130 85
High normal 130-139 85-89
Hypertension
Grade 1 (mild) 140-159 90-99
Grade 2 (moderate) 160-179 100-109
Grade 3 (severe) ≥ 180 ≥ 110
Isolated systolic
hypertension
Grade 1 140-159 < 90
Grade 2 ≥ 160 < 90
JNS Classification:
Category Systolic BP (mmHg) Diastolic BP (mmHg)

BP
Normal 90-119 60-79
Pre-hypertensive 120-139 80-89
Hypertensive
Stage-1 140-159 90-99
Stage-2 >160 >100
Isolated systolic >140 <90
hypertension
HTN
Primary/Essential HTN Secondary HTN

95% unknown cause Alcohol
Obesity
Renal
Endocrine
Drugs- OCP, Steroids, NSAID
65 | P a g e
Dr. Md Anwarul Azim
HTN খি েলে?
 At least 2 clinical visits

 At least 2 times BP measure (5 min interval)
Rx শুরু রার আবি
 Asses the pt life style/Risk factor

 To identify secondary cause
 To identify target organ
Management
Non Drug Therapy/ Life style Modification
 Wt reduction: Try to BMI <23

 Exercise: Daily minimum 30min/ িা ঘািা প নন্ত
 Reduce salt intake: up to 6 gm daily
 Reduce alcohol intake
 Intake K+, Ca++ containing food: Milk
Drug Therapy
Step-1: single drug
 Age <55 yrs: (ACE Inhibitor)

 Age>55 yrs: Thiazide(1st line), ACE inhibitor (2nd line), Ca++ Channel Blocker (3rd
line)
Step-2: Combination
 Age <55 yrs: ACE Inhibitor + Ca++ Channel Blocker

 Age>55 yrs: ACE Inhibitor + Thiazide
Step-3: ACE Inhibitor + Thiazide + + Ca++ Channel Blocker
Step-4: Previous 3 drug + additional 4th drug (β- Blocker)
66 | P a g e
Dr. Md Anwarul Azim
With Co-morbidity
 HTN with stable Angina

− β- Blocker
− Ca++ Channel Blocker
 HTN with ACS (Acute coronary syndrome)
− β- Blocker/ ACE Inhibitor (short acting Captopril)
 OMI
− β- Blocker + ACE Inhibitor
(β- Blocker is 1st choice in IHD)
 HTN with HF
− Loop diuretic
− ACE Inhibitor
(Don't use β- Blocker in HF, but carvedilol may use in stable HF)
 HTN with DM
If S.creatinine >3mg/dl- তাহবল 130/80 mmhg চত ই Rx শুরু রে
If S.creatinine normal- তাহবল 140/90 mmhg চত Rx শুরু রে
ACEI intolaret হবল ARB (Angiotensin receptor blocker) use রে
** ACEI use if S.creatinine <3mg/dl
 HTN with CVD
− ACE Inhibitor
− If one more then thiazide
Malignant HTN/Hypertensive emergency
When HTN associate with end organ damage
 Inj. Lebecard (Labetalol)- 2mg/min (1 amp = 10ml=50mg)

5% DA 90 ml + 1amp
IV @ 60 d/m
OR
 Inj. GTN (safer)- 100µ/min
5% DA 500ml + 1 amp
IV @ 15 d/min
Isolated HTN: >140/<190 (Usually in old age)
 Ca++ Channel Blocker
Resistance HTN
67 | P a g e
Dr. Md Anwarul Azim
 If BP not decrease in use of 3 drugs combination + Diuretic

 Re exclude secondary cause
 BP measurement right or wrong ?
 Pt salt intake বর ন িা
 Diuretc add বরনে ন িা, appropiate combinition হবলা ন িা
 Pt steroids/OCP/NSAID চিয় ন িা
F/U- Target goal এ চপৌোর পর ৩-৬ িাস পর পর F/U রে
NB.
 নদ target organ damage িা হয় তাহবল orally Rx রে এেং slowly (minimum 48-72hrs) BP

িাে। But Suddenly BP িাবিা াবে িা এবত brain এ Ischemia হবত পাবর
 তারাহুরা বর drug change রে িা, dose ও োড়ােএা িা। eg. Diuretc এ effect চপবত minimum
১িাস সিয় লাবি
 Target goal এ িা চপৌো প নন্ত single drug এর maximum dose নদবয় try রে। ন ন্তু target goal নদ
হয় 150 mmhg but BP not decrease or 150 mmhg তাহবল ২ো drug এর combination use
রবত পানর
Investigation:
 ECG
 RBS
 Lipid profile
 S.creatinine
 S.electrolytes
 S.urea
 Urine R/M/E
 Other disease related investigation if present
68 | P a g e
Dr. Md Anwarul Azim
Paediatrics
69 | P a g e
Dr. Md Anwarul Azim
Dosage of Drug
Inj. Ampicillin (IV 500mg/5ml) Inj.Gentamycin

Dose: 100mg/kg/day 5mg/kg/day (80mg/2ml, 20mg/1ml)
( ত kg তত ml) Neonate: < 3kg-Once daily
In Septicemia: 200mg/kg/day >3kg BD
In Meningitis: 400mg/kg/day Child: 8 hrly
Neonate: 12 hrly, Child: 6 hrly divided dose
Inj. Ceftazidim IV/IM Azithromycin
100mg/kg/day 10-20mg/kg/day
250,500,1gm vial 1 TSF = 200mg
Cefotaxim IM/IV Erythromycin
50-100mg/kg/day 50mg/kg/day 6 hrly)
In severe case: 200mg/kg/day 1 TSF = 125mg
250mg/5ml, 500mg/5ml, 1gm/10ml
Ceftriaxone IV/IM Ciprofloxacin
50-100mg/kg/day Neonate: 10mg/kg/day (BD)
Meningitis,Enteric fever- 100mg/kg/day Child: 30mg/kg/day (BD)
1 TSF = 250mg
Amoxycillin Metronidazole
50mg/kg/day (TDS) 30mg/kg/ (TDS), 10mg/kg/dose
1 TSF = 120mg 1 TSF = 200mg
Tab. 250mg, 500mg, 875mg Inj 1 bag= 500gm/100ml
day 6 ml/kg/day (TDS), 2ml/kg/dose
Tab. phenoxymethyl penicillin
50mg/kg/day (6 hrly). 1 Tab. 250,500mg
Cephradin Cloxacillin
30-50mg/kg/day ( 4 hrly) 50-100mg/kg/day ( 6 hrly)
1 TSF = 125mg Inj. 250, 500mg
Drop. 100mg/ml/15 drop Cap. 250, 500mg
1 drop = 7mg Drop. 20 drop = 125mg = 1.25 ml
Tab. 250, 500 mg
Cefixime Flucloxacillin
10mg/kg/day 50-100mg/kg/day (6 hrly)
1 TSF = 100mg 1 TSF = 125mg
In Enteric fever- 20mg/kg/day Cap. 250, 500mg
Cefuroxime Tetracycline
20mg/kg/day (BD) 50mg/kg/day (6 hrly)
1 TSF = 125mg Cap. 250, 500mg
Tab. 125, 250, 500mg
Cefpodoxime Co-trimoxazole
10mg/kg/day 10mg/kg/day
1 TSF = 40mg 1 TSF = 40mg
70 | P a g e
Dr. Md Anwarul Azim
Cefaclor Ofloxacin
20mg/kg/day 15mg/kg/day (12 hrly for 10 days)
Cap. 250mg, 500mg 1 tab. 200, 400mg
Co-Amoxiclave Aldendazole
25mg/kg/dose (8 hrly) <2y: 200mg single dose
1 TSF = 125mg >2y: 400mg single dose
Tab. 250, 500mg Tab. 200, 400mg
1 TSF = 200mg
Domperidone Mebendazole
0.4mg/kg/dose 100mg BD for 3 days
1 TSF = 5mg OR
1 tab = 10mg 500mg single dose
Supp. 15, 30mg 1 TSF = 100mg
Use: > 2 years of age
Odansetron Simethicon
0.2mg/kg/dose (8-12 hrly) 15mg/kg/dar (BD)
1 TSF = 4mg 1ml = 67mg
1 Tab = 4mg, 8mg 1ml/5kg = 3 drop/kg
Inj. 1 ml = 2mg
Electro-K Ranitidine
4 mmol/kg/day 10mg/kg/day
1 TSF = 10 mmol 1 TSF = 75mg
1 amp = 50mg/2ml
Inj. Konakion (2/10 mg mm) Zinc
Neonate: 2 mg mm <6 month: 3mg/kg/day
1amp P/O stat or 1/2 amp IV stat & 1,5,25 >6 month: 5mg/kg/day
day Tab. 10,20mg
Vit-A/Cap. retinol fort Folic acid/Folison
50 thou,1lac,2lac unit Upto 1 yrs: 0.5mg/kg/day
<5month: 50 thousand 1-5y- 5mg/kg/day
5mnt-1yrs: 1lac unit 6-12y- 10mg/kg/day
>1yrs: 2lac Unit 1 Tab = 5mg
Promethazine/Phenargan Pheniramine maleate/Avil
Tab: 10mg (BD) Tab. 22.7mg
Syp. 2-5y: 5-15mg 75mg at bed time
5-10y: 10-25mg Inj. 50mg/2ml
5mg/5ml 25-50mg IM/ slow IV (BD)
Inj. >5y: 6.25-12.5mg (IM) Syp. 1 TSF = 15mg
Adult: 25-50mg (IM/IV) 5-22.5mg (BD/TDS)
25mg/1ml
50mg/2ml
71 | P a g e
Dr. Md Anwarul Azim
Hydrocortisone (100mg/2ml) Frusemide

5mg/kg/dose (6 hrly) 2mg/kg/day
1 Tab = 40mg
Inj 1 amp = 20mg/2ml
Dexamethasone Spironolactone
0.4mg/kg/dose 3mg/kg/day
OR 1 Tab = 25mg
1 mg/kg/day
1 amp = 1ml = 5mg
Tab. 0.5mg
Prednisolone Frusemide + Spironolactone
1-2mg/kg/day Tab. 20mg + 50mg
1 1ab. 5, 20 mg Tab. 40mg + 50mg
Fusid plus, Edeloss plus
Aminophylline/Filin Nefedipine
LD: 0.2ml/kg/dose 0.5mg/kg/dose
(dilute with eaqal amount water) 1 Tab = 10mg
MD: 0.7ml/kg/day
1 amp = 5ml = 125mg
1ml = 25mg (Order- .....ml/100ml saline)
Tab. 100mg
Theophyllin Inj. Phenobarbitone (1ml + 9ml D/W)

10mg/kg/day (6 hrly) 1 amp = 1ml = 200mg
1 TSF = 120mg LD: ত kg তত ml stat
Tab. Asmanyl 300mg SR MD: 1/8th of loading dose 12 hrly
LD: 20mg/kg/dode
MD: 5mg/kg/day
Sulbutamol Diazepam
0.4mg/kg/day (TDS) P/O: 1mg/kg/day (BD/TDS)
1 TSF = 2mg P/R: 0.5mg/kg/dose
Nebulization dose: 0.2mg/kg/dose + Norsol Ongoing febrile convulsion:
Ventolin nebule 1ml = 1mg Inj. Sedil (0._ + .....ml D/W)
Ventolin solution = 5mg ত kg ওজি তার আবি দশনি
1 Tab = 2mg, 4mg If wt 2kg = 0.2ml, If 12kg = 1.2ml
then dilute বর চিাে 3ml োিাে
If necessary repeat the dose 2-3 times 10-15
Ketorolac min interval.
< 10 kg: Inj. 10mg 1 amp Inj. 10mg/2ml
10-20kg: Inj. 30mg 1/2 amp Supp. 10mg
>20kg: Inj. 30mg 1amp
72 | P a g e
Dr. Md Anwarul Azim
Paracetamol Beclofen (Skeletal muscle relaxant)

15/kg/dose (TDS) 0.7mg/kg/day (6 hrly)
Paedi drop = 1ml = 80mg 1 Tab = 10mg
1 drop = 5mg
Suppo. 60,125,250,500mg
Aspirin Chloroquine 250mg
50mg/kg/day 25mg/kg; 3 days
As antirheumatc Day dose: 1st = 10mg/kg
100mg/kg/day (6 hrly) 2nd = 10mg/kg
3rd = 5mg/kg
Avloquin, jsochlor
Diclofen:1-3mg/kg/day (BD) Quinine
Suppo.12.5mg, 50mg 10mg/kg/day (TDS)
Inj. 75mg/3ml Jasoquine)
Tab. 25, 50mg
Formula feeding (Biomeal, Lactogen)
Upto 6 month : I
Upto 1 yrs : II
>1 yrs : III
In case of acute watery diarrhoea give lactogen free milk
Gastro-fix
O-lac
Baby saline- 5% DA + 0.225% NaCl

Hartsol Plus : 5% DA + H/S
Libott-S junior: 5%DA + 0.45% NaCl
Libott-25: 25% DA
Fluid Mx
1st day- 60ml/kg/day
2nd day- 80ml/kg/day
3rd day- 100ml/kg/day If age 10yrs & wt 25(10+10+5) kg

Then,
4th day- 120ml/kg/day
1st 10kg = 10 × 100 = 1000ml
5th day- 140ml/kg/day 2nd 10kg = 10 × 50 = 500ml
3rd 5kg = 5 × 20 = 100ml
5th day-2nd month- 150ml/kg/day Total = 1000 + 500 + 100 = 1600ml/day
>2 month & 1st 10 kg of total wt 100ml/kg/day
For next 10 kg 50ml/kg/day
For next 10kg 20ml/kg/day
73 | P a g e
Dr. Md Anwarul Azim
Drop calculation:
24 hrs এ নদবল ত শ fluid পাবে তত d/m
If 1600ml, then 16 d/m or 16 × 4 = 64 µd/m
If 500ml, then 5 d/m or 5 × 4 = 20 µd/min
** drop চ 4 নদবয় গুি রবল µd পাওয়া াবে
**We use µd if baby wt < 10 kg
Formula:
Total Fluid in ml
4 × hrs
500ml fluid 6 hrs এ নদবত হবল :
500ml
4 × 6
= 20 d/m
1000ml fluid in Adult

 10 d/m takes 24 hrs
 60 d/m takes 4hrs
Fluid
1st day: 10% DA
2nd day: 3yrs: APN, electrodex, Baby saline
>3 yrs: Libott-s junior, H/S Plus
NB:
**In Head Injury
<25 kg-Baby saline
 20% of fluid shoule be reduced in >25 kg- N/S
 Birth asphyxia
 Any stressful condition
 20% fiuid should be added in
 Preterm
 LBW
 If preterm/LBW with Stress/ Birth asphyxia no add or reduction
74 | P a g e
Dr. Md Anwarul Azim
Birth asphyxia/Neonatal Sepsis/Neonatal Convulsion

 Fluid: EBF/NG/IV Inf. According to age
 O2 Inhalation stat & SOS ( suction if necessary)
 Inj.Ampicillin (500mg/5ml)
100mg/kg/day (200mg/kg/day in septicemia)
 Inj. Cefotaxim (500mg/5ml)
100mg/kg/day
OR
Inj. Genyamycin (1amp = 80mg/2ml)
1wks 5mg/kg/day, 2nd wks 7.5mg/kg/day (neonate single dose, Child TDS)
 Keep the baby warm
 Maintain PTR
If convulsion:
 Inj. Barbit (1ml + 9ml D/W)

LD: ত kg তত ml stat
MD: 1/8th of loading dose 12 hrly
Hypoglycemia:
 10% DA 5ml/kg IV slowly for 2-3min

Then, 10% DA for 2 days acc. to age
Hypocalcaemia: (1st day- baby of diabetic mother)
 IV or Oral 10% Ca-gluconate

5ml/kg/24hrs
OR
1ml/kg ( ত kg তত ml নদবয় Dilute রবত হবে)
Then, IV slowly Over 20min
 500 IU Vit-D P/O per day
Hypomagnesemia:
 Mag-sulph 50% solutionb (IM)

0.2ml/kg/dose
Metabolic acidosis:
 Sodibicarb (7.5%)
Mix 1ml of NHCO3 with 1ml of 10% DA
Then, give 1ml/kg IV slowly over 5min
75 | P a g e
Dr. Md Anwarul Azim
LBW/Preterm Baby
 Airway clearance with suction
 O2 Inhalation stat & SOS
 Fluid: EBF/NG/IV Inf. According to age
 Inj.Ampicillin (500mg/5ml)
Dose: 100mg/kg/day - Prophylactic
200mg/kg/day- septicemia
400mg/kg/day- meningitis
 Inj. Cefotaxim (500mg/5ml)
100mg/kg/day
OR
Inj. Genyamycin (1amp = 80mg/2ml)
1wks 5mg/kg/day, 2nd wks 7.5mg/kg/day (neonate single dose, Child TDS)
 Inj. konakion
2mg orally at birth
Then, 2mg orally 4-7days later
 Multivitamin & folic acid- from 2nd wks of life
10-15 drops once or twice daily
 Iron- After 6-7 wks
2-3 mg/kg/day
 Wt record on alternative day
Umbilical Sepsis
 Cleaning with sprit/genlion violet(1% viola)
 Inj. Ampicillin- 200mg/kglday
 Inj. Gentamycin- 5mg/kg/dose (single dose)
 Rx of fever by P/C
Clinical feature:
 Discharge
 Red & inflammed periumbilical area
 Foul smell
 Fever
 Delayed cord falling
76 | P a g e
Dr. Md Anwarul Azim
Neonate Of HBsAg +ve mother

 Hb Ig (Hepabig)- 100 IU in 0.5ml IM within 12hrs
+
 HB vaccine(Engerix B 10 µg in 0.5ml vial
3 dose 0,1,6 month IM in the anterolateral thigh
Rh Incompatibility
 Exchange transfusion
1st child Mother:
Rh (-ve) mother & Rh (+ve) child
Give Anti D to mother within 48 hrs
**This anti D reacted wtih Rh antigen, thereby prevent antibody formation, So 2nd baby is not
affected
Neonatal Jaundice
Physiological Jaundice:
 Develop after 2-3 days Conjugated(Direct):

 Unconjugated  Neonatal hepatitis
 Resolved before 10 days  Extrahepatic biliary atresia
 Inborn error of metabolism
Rx Unconjugated(Indirect):
 Physiological jaundice
Phototherapy  Breast milk jaundice
 Crigler-Najjar syndrom
Indication-  Ongoing haemolysis
 Hypothirodism
If S.bilirubun in-
Term baby: 10-12mg/dl or more
Preterm baby: 15mg/dl or more
Investigation:
S.bilirubin: Direct & Indirect
77 | P a g e
Dr. Md Anwarul Azim
Acute RTI
 O2 inhalation Danger sign:

 Inj. Ceftriaxone: 50-100mg/kg/day  Stop feeding well
 P/C: 15mg/kg/day  Convulsion
 Abnormally sleep
1ml = 15 drop = 80mg
 Stridoe,wheez
1 TSF syp = 5ml = 120mg  Fever or low body temp
 Nasal drop: 1 drop 8 hrly in both nostril
 Bronchodilator: Salbutamol
Oral-0.4mg/kg/dose (8 hrly)
1 TSF = 2mg = 5ml
1 Tab- 2mg, 4mg No Pneumonia:
 Nebulization: 0.15-0.3mg/kg/dose  No sign of pneumonia
1 nabule = 2.5mg  Cough & cold
Pneumonia:(Only for 2month-5yrs)
1ml solution = 5mg salbutamol
 Fast breathing >40 breathing
OR Severe pneumonia:
<5 yrs = 0.5ml/dose  Pneumonia + Chest Indrawing
>5 yrs = 1ml/dose  In case <2 month only fast
 Amynophyllin: LD- 5mg/kg over 20min breathing ,>60 breathing is called
Then 0.5mg/kg/hrs severe pneumonia
Very severe disease:
1ml = 25mg
 Severe pneumonia + Danger sign
 Hydrocortisone: 3-4mg/kg/dose (6 hrly)
1 vial = 100mg
 Prednisolone: 1-2mg/kg/day (TDS)
1 Tab. = 5mg
UTI
 Ciprofloxacin ( 10-20mg/kg/day )-BD
OR
Ofloxacin (15mg/kg/day)-BD
OR
Cefixime (10mg/kg/day)-BD
OR
Azithromycin (20mg/kg/day)-Once daily
 More intake of water
 Regular emptying of bladder
78 | P a g e
Dr. Md Anwarul Azim
Meningitis
Clinical feature:
 Onset is acute
Headache, nausea, vomiting, fever, restlessness, irritability, neck pain, poor
feeding, seizure, coma
 Fever, photophobia, neck rigidity, kernig's sign, brudzinki's sign, stupor,coma,
bulge frontanalles
Rx
 Inj. Ceftriaxone 100mg/kg/day- Casative Organism:

Once daily IV for 15 days 0-2month:
Or  E.coli
 S.Agalactic
Inj. Ampicillin 400mg/kg/day (6 hrly)
 Listeria monocytogen
 Inj. Cefotaxime 200mg/kg/day (6hrly)  S.pneumonia
 Inj. dexamethasone(oradexon)  H.influenza
0.4mg/kg/dose (BD)
 P/C: 15mg/kg/dose 2-6 yrs:
 Rx of complication:  S.pneumonia
 H.influenza
Increase intracranial pressure
 n.meningitidis
-IV mannitol 0.5-1g/kg infusion
+ 6 yrs:
-Inj. Lasix 1mg/kg/dose (BD)  S.pneumonia
1 amp = 40mg = 2ml)  N.meningitidis
All age:
 TB
Oral Thrush
Dx:
লালা পরবে
Vomiting
Rx:
Nystat Oral drop
15 drop orally apply twice daily
79 | P a g e
Dr. Md Anwarul Azim
Febrile Convulsion
 Per rectal Sedil
ত kg ওজি তার আবি দশনি
If wt 7kg = 0.7ml
then dilute বর চিাে 3ml োিাে (0.7ml + 2.3ml D/W)
 Tab. Sedil
1mg/kg/day (TDS)
 Syp. P/C: 15mg/kg/dose
 Napa suppo: 15/mg/kg/dose ( if temp >101o F)
 Syp. Amoxicillin
50mg/kg/dose (TDS)
1 TSF = 120mg Criteria:
 Age: 6 month to 6 years, peak 18 month
OR  Family history +ve
Syp. Cefotim- 8mg/kg/dose (BD)  Male>Female
 Reassurance  Infection: 90% cases
o Pharyngitis
 Advice
o Otitis Media
o UTI
o Pneumonia
o Roseola
 Seizure occur with a rapid rise of
temparature
 Onset within 24 hrs of illness
 Type- Generalized tonic clonic
 Duration 15 min
Tetanus
 NPO TFO
 IV infusion 5% or 10% DA
 Inj. TIG
1 amp in each buttock stat
 Inj. C-penicillin
1 lac unit/kg/day (6 hrly)
 Inj. Sedil- 3mg/kg/dose IV ( 6 hrly)
OR
Inj. midazolam-0.2mg/kg
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Dr. Md Anwarul Azim
AGN
 Bed rest
 Fluid restriction:
Body surface area × 400 ml + previous day output
 Antibiotic: Body surface area
Phenoxymethyl penicillin: 50mg/kg/day (6 hrly) Wt(kg) × 4 + 7
1 Tab = 125mg, penvik fort 1 tab = 250mg Wt(kg) + 90
 Control of Oedema: Salt restriction, no added salt
Tab. fusid- 2-4mg/kg/day (BD)
1 tab = 40mg
 Control of BP: Tab. Nifin 10mg (0.0.6mg/kg/day)
NS
 Bed rest
 Salt & water restriction if Oedema present
 Tab. Frusemide
1-2mg/kg/day (BD)
+
Tab. Spironolactone
2-3mg/kg/day (BD)
 Prednisolone
60mg/m2 body surface area/day in 3 divided dose until urine become protein free.
Then, 60mg/m2/day single dose every alternate day for 3-6 month
 If frequent relapse
-Prednisolone 2mg/kg/day until urine become protein free for consecutive 3 day
followed by alternate day 0.5-1mg/kg/day fro wks
-Cyclophosphamide
2mg/kg/day (8 hrly)
 Antibiotic
Phenoxymethyl penicillin
50mg/kg/day (6 hrly)
81 | P a g e
Dr. Md Anwarul Azim
Asthma
 Sulbutamol
 Oral: 0.2mg/kg/day (TDS)
 Syp. 1 TSF = 2mg, Tab. = 2mg, 4mg
 Inhaler: 2 puffs 12 hrly
 Nebulization: 0.15-0.3mg/kg/dose
 1 Nabule = 2.5 mg
1ml solution = 5mg
 Sulmeterol: 2 puff 12 hrly
 Hydrocortisone: 3-4mg/kg/dose (4-6 hrly)
1 vial = 100mg
 Prednisolone: 1-2 mg/kg/day (TDS)
1 Tab = 5mg
 Aminophylline: LD- 5mg/kg followed by 0.5mg/kg/hrs
1 ml = 25mg
 Beclomethasone: 1-2 puff 6 hrly
 Fluticasone: 50-100µgm (BD)
 MgSO4: 25-50mg/kg (Inj. 5ml = 2.5mg)
 Kititifen: 1mg BD with food (asthma with allergic reaction)
1 Tab = 1mg
Ascariasis
 Levamisole
3mg/kg/dose (single dose)
1 TSF = 40mg
1 Tab = 40mg
Adult dose- 3 tab stat
OR
Mebendazole
100mg 12 hrly for 3 days
1 TSF = 100mg
OR
Pyrantel pamoate
82 | P a g e
Dr. Md Anwarul Azim
Diarrhoea
 Acute- <14 days

 Persisten- >14 days
 Dysentry- Passes of bloob
Trait No dehydration Some Severe

Appearance Well,alert Restless,irritable Uncoscious,irritable
Thurst normal Drink eagerly Unable to drink
Skin pinch Goes quickly Slowly(2sec) Very slowly
Eye Not shunken shunken shunken
No sign of dehydration
Home Mx: 3 golden triad
1)More fluid:
<2 yrs:10-20 TSF (50-100ml) after each motion
>2-5 yrs: 20-40 TSF (100-200ml) after each motion
> 5 yrs: as much he drinks
2)More food
3)Referral knowledge
 Many watery stool

 Repeated vomiting
 Mark thrust
 Eating & drinking poorly
 Fever & loose stool
83 | P a g e
Dr. Md Anwarul Azim
Some sign dehydration

ORS: 75mg/kg over 4 hrs
OR
( ত kg তত ি প্রনত ১৫ নিনিে পরপর ৪ ঘন্টা প নন্ত)
IV correction if:
Some dehydration + 3 or more vomiting + high purging rate(15 purging/hrs)
+ Impending paralytic ilium(abdominal distension) + lactose Intolerance
Drop calculation:
75 × wt
4 × 4(hrs)
= .... d/m
Drug:
 <6 month: Syp. Erythromycin -40-50mg/kg/day (6 hrly)

Eromycin paedi drop 1 drop = 40mg (1 ml = 15 drop)
>6 month: Syp. Azithromycin- 10-20mg/kg/day Once daily (1 TSF = 200mg)
 Syp. Zinc: 2-3 mg/kg/day 8 hrly (1 TSF = 10mg)
 Syp. Electro-k: 3mmol/kg/day 8-12 hrly (1 TSF = 10mg)
 Syp. Odansetrone:0.2mg/kg/dose 8-12 hrly
(1 TSF = 4mg, 1 Tab = 4mg/8mg, Inj. 1ml = 2mg)
 Syp. Metronidazole: 30mg/kg/day 8 hrly (1 TSF = 200mg)
 Vit-A:
 < 6 month: 50 thousand
 6 month- 1 yrs: 1 lac unit
 >1 yrs: 2 lac unit
If desentry:
Syp. Cotrimoxazole/Ciprofloxacin/Azithromycin/Cephradin/Cefixim/Flucloxacillin
84 | P a g e
Dr. Md Anwarul Azim
Severe dehydration
 IV fluid 100ml/kg
**Under 1 yrs correction should be done within 6 hrs
Age First give 30ml/kg in Then 70ml/kg in

<1 yrs 1 hrs 5 hrs
>1 yrs/Older 0.5 hrs (30 min) 21/2 hrs
 <6 month: Syp. Erythromycin -40-50mg/kg/day (6 hrly)

Eromycin paedi drop 1 drop = 40mg (1 ml = 15 drop)
>6 month: Syp. Azithromycin- 10-20mg/kg/day Once daily (1 TSF = 200mg)
OR
 Syp. cefaclor/Loracef : 20mg/kg/day 12 hrly (1ml = 40mg)
OR
 Syp. Ofloxacin: 15mg/kg/day 12 hrly for 10 days
Near drowing
 CPR if necessary
 High flow O2 inhalation
 Left lateral position
 Keep the baby warm Pathophisiology:
 IV fluid- NS  Ischemic-anoxic
 If convulsion: Inj. Berbit injury
 Pulmonary
o LD: ত kg তত ml stat
aspiration
o MD: 1/8th of loading dose 12 hrly  Hypothermia
 Antibiotic: Inj. amoxicillin  Cardiac arrest
50mg/kg/day 3 divided dose  Cerebral oedema
Near drowning: If pt does not died within 24 hrs
Drowning: If pt must be died within 24 hrs
85 | P a g e
Dr. Md Anwarul Azim
Malaria
 Tab. Chloroquine(jasochlor): 25mg/kg/dose- 3 days schedule

 1st day- 10mg/kg/dose Single dose (A/M)
 2nd day- 7.5mg/kg/dose single dose (A/M)
 3rd day- 7.5mg/kg/dose single dose (A/M)
 4th day- Tab. Primaquine: 1mg/kg single dose
Treatment Failure malaria
 Day 1- Quinine (jasoquine)

10mg/kg/dose (TDS)
Jasoquine 1 tab = 300mg
 Day 2- Quinine
10mg/kg/dose (TDS)
 Day 3- Quinine
10mg/kg/dose (TDS)
+
Sulphadoxime & Pyramethamine
Sulphadoxime: 25mg/kg
Pyramethamine: 1.25mg/kg single dose
 Day 4- Primaquine
Enteric Fever
 Inj. Ceftriaxone: 100mg/kg/day- for 14 days

OR
 Inj. Ceftriaxone: 100mg/kg/day- for 7 days
+
Oral. Cefixim: 10mg/kg/day 12 hrly (1 TSF = 100mg)
 Syp. P/C
 Tepid sponging
86 | P a g e
Dr. Md Anwarul Azim
PEM (Protein Energy Malnutrition)

Diagnostic criteria for PEM
 Wt for age: Gomez Classification:
Wt for age Grade of malnutrition

76-90 G-1, mild
61-75 G-2, moderate
<60 G-3, severe
 Welcome trust classification:
Wt for age With oedema Without oedema

60-80 Kwashiorkor Undernutrition
<60 Marasmic Kwashiorkor Marasmur
 Classification based on MUAC
Circumference Level of nutrition

>13.5 cm (green) Normal
12.5-13.5 cm (yellow) Borderline
<12.5 cm (red) Malnourished
 Classification based on BMI
BMI = Wt in kg/m2 of height or length
BMI Level of Malnutrition

>20 Normal
18.5-20 Marginal
17-18.4 Mild
16-16.9 Moderate
<16 severe
87 | P a g e
Dr. Md Anwarul Azim
Management of PEM
1) Prevention of hypoglycemia
 If pt conscious: give 50ml of 10% glucose or F-75 Diet

2-3 hrly by mouth
 If pt unconscious: give 5ml/kg 10% glucose IV
Followed by 10% glucose by NG tube
2) Prevention of hypothermia
3) Correction of dehydration if present
Re-So-Mal (rehydration solution for malnourished)

70-100ml/kg over 12 hrly
Starting 5ml/kg every 30 min for 2 hrs
Then, 5-10 ml/kg/hrs orally or NG
Preparation of Re-So-Mal
ORS 1 pack in litre of water

+
25gm sucrose
+
20ml of mineral mix solution/ syp. electro-k (2 TSF)
4) Rx of septic shock
 Inj. Ampicillin (100mg/kg/day)

 Inj. gentamycin (7.5mg/kg/day)
5) Dietary Rx
 Total energy requirement is 100kcl/kg/day

 Fluid requirement is 100ml/kg/day
Feeding should be given 2 hrly ( 12 feeding)
Feeding should be F-75
F-75: 100 ml of fluid contain 75 kcl of energy
88 | P a g e
Dr. Md Anwarul Azim
Example
Suppose the wt of the baby is 5 kg
So, total fluid requirement is = 5 × 130 = 650 ml
In, F-75 diet
100 ml contain 75 kcl
So, 1 ml contain 75/100 kcl
So, 650 ml contain (75 × 650)/100 ml
= 487.5 kcl
In, 12 feeding,
Per feeding fluid require (650 ÷ 12) = 54.11 ml or 55ml
And energy require (487.5 ÷ 12) = 40.65 kcl
So the fluid should be made by 55ml of D/W containing 40.65 kcl energy
Energy available
1 TSF milk =20 kcl
1 TSF sugar =20 kcl
1 ml soyabin oil = 9 kcl
So, we should made the fluid with
(3/4 TSF of milk + 3/4 TSF of sugar + 1 ml of soyabin oil) = 40.65 kcl energy
6) Correction of Vitamin deficiency
 Vit-A supplementary is given (Day-1,Day-2,Day-3)

Dose: <6month: 50 thousand
6mnt-1yrs: 1lac unit
>1yrs: 2lac Unit
(Cap. retinol forte, 1 cap = 50,000 unit)
 Folic acid supplementation
Day 1 - 5mg orally, then 1mg daily
 Multivit drop- 10 drops/day
Kerosene Poisoning
 NPO TFO
 O2 inhalation
 IV infusion: Inf. baby saline
 Antibiotic: Inj/Oral amoxycillin
 Inj. Ranitidine- 5mg/kg/dose (8-12 hrly)
1 TSF = 75 mg
89 | P a g e
Dr. Md Anwarul Azim
Dose of dopamine
10 µg/kg/min
Example
If wt 20kg
Then, 20 × 10 = 200 µg/min
= 200 × 60 µg/hrs
= (200 × 60)/1000 mg/hrs
= 12 mg/hrs
We know
40 µg = 1 ml
So, 1 µg = 1/40 ml
So, 12 µ = (1 × 12)/40 = 0.3 ml
How to give?
20 ml/kg/hrs in NS
If wt is 20 kg, 20 × 20 = 400ml
0.3 ml (dopamine)
= 400.3 ml/hrs
Drop calculation
We know,
Total fluid/(4 × hrs)
So, 400.3ml/(4 × 1 hrs) = 100 d/m
90 | P a g e
Dr. Md Anwarul Azim
SURGERY
91 | P a g e
Dr. Md Anwarul Azim
Head Injury
 NPO TFO
 O2 inhalation if needed
 Inf. N/S 3000cc
IV stat @ 30 d/m
 Inj. Ceftriaxone 1 gm
1 vial IV stat & daily/BD
1 vial IV stat & BD
 Inj. Ketorolac 30 mg
1 amp IM stat & BD/TDS
 Inj. Oradexon
 Inj. Berbit
1 amp IM stat & 1/2(0.5) amp BD
 Catheterization if necessary
If cutting wound present then,
 Inj. TT
1 amp IM stat
Inj. TIG
 1 amp IM stat
**Investigation: CT scan of Brain
Physical assault (P/A) ( চাপা মাইর )

 Cap. cephradin 500mg/ flucloxacillin 500
1+1+1+1
1+0+1 (b/m)
 Tab. ketorolac 10mg/Diclofenac 50mg
92 | P a g e
Dr. Md Anwarul Azim
Massive cut Injury or P/A

 NPO TFO
 Inf. H/S 3000cc
IV stat @ 30 d/m
 Inj. Ceftriaxone
1 vial IV stat & daily/BD
 Inj. Omeprazole 40 mg
1 vial IV stat & BD
 Inj. Ketorolac 30mg
1 amp IM stat TDS
 Inj. TT
1 amp IM stat
 Inj. TIG
1 amp IM stat
 Then stich given on necessary site
Suture material: -prolin/Silk (cutting body)- for skin
-Vicryl (R/B)- for muscle
Small cut injury

 Cap. Cephradin 500mg/Flucloxacillin 500mg
1+1+1+1
1+0+1 (b/m)
 Tab. Ketorolac/ Diclofenac ( Inj. Ketorolac if complain more pain)
 Tab. Ceevit 250mg
1+1+1
 Inj. TT
1 amp IM stat
 Inj. TIG
1 amp IM stat
93 | P a g e
Dr. Md Anwarul Azim
Acute case of intestine/ Acute Emergency

(Intestinal perforation/ Intestinal obstruction/ Volvolus/ Strangulation/ Intussusception/
Acute appendicitis/ Obstructed hetnia)
 NPO TFO & NG suction (must) half hourly

 Inf. HS 2000cc + 5% DNS 1000cc
Iv stat 30 d/m
1 vial iv stat daily/BD
OR
Inj. Ciprofloxacin
1 bag IV stat & BD
 Inj. Metronidazole
1 Bottle IV stat & TDS
 Inj. Omeprazole
1 vial IV stat & BD
 Inj. Anadol
1 amp IM stat & BD
OR
Inj. Algin
1 amp IM stat & TDS
 In case of Intestinal obstruction H/O no defecation for prolong times then give
glycerine suppository 4 stick P/R stat
Investigation:
 Plane X ray of abdomen in erect posture including both dome of diaphragm
 USG of W/A
 Blood for Grouping & cross matching
94 | P a g e
Dr. Md Anwarul Azim
A case of Hepato-Biliary system

(Acute cholecystitis/ Acute cholelithiasis/ Acute choledocolithiasis/ Acute pancreatitis/
Biliary ascariasis/ Obstructive jaundice)
 NPO TFO
 NG suction half hourly
 Inf. HS 2000cc + 5% DNS 1000cc
Iv stat 30 d/m
 Inj. Cefuroxime
1 vial IV stat & BD/TDS
 Inj. Metronidazole
1 Bottle IV stat & TDS

Investigation:
 Inj. Omeprazole
 USG of HBS
1 vial IV stat & BD  S. amylase
 Inj. Algin
1 amp IM stat & TDS
OR
Inj. Butapan- 1 amp IM stst & TDS
+
Inj. Nospa- 1 amp IM stat & TDS
 In case of biliary ascariasis
3 levamisol tab stat
Acute Abdomen
 Acute Exacerbation of PUD
 Acute Cholecystitis
 Acute Cholelithiasis
 Acute cholidocolithiasis
 Acute Appendicitis
 Acute Pancreatitis
 Acute Intestinal Obstruction
 Acute Intestinal Perforation
 Volvolus, strangulation, Intussusception
 Obstructed hernia
 Obstructive jaundice
 Biliary Ascariasis
95 | P a g e
Dr. Md Anwarul Azim
Accidental fall from height

 Diet. If pt unconsciousness then NPO TFO with Inf. NS
If conscious then diet Normal
 Tab. Cefuroxime 500mg (1+0+1)/ Tab. Cephradin 500mg(1+1+1+1)
1+0+1 (b/m)
 Tab. Naprosyn/onap/Naprox
1+1+1 (a/m)
 Tab. Myotil (muscle relaxant)
1+0+1
Investigation:
 Plain X-ray of L/S spine both view

 Sometimes X-ray of T/L both view
Abscess
 Incision & drainage
 Cap. flucloxacillin 500mg
1+1+1+1
+
Cap. Cephradin 500mg
1+1+1+1
1+0+1 (b/m)
 Tab. Ketorolac 10mg/Diclofenac 50mg
1+1+1
 Regular dressing
96 | P a g e
Dr. Md Anwarul Azim
Ulcer
 Cap. flucloxacillin 500mg
1+1+1+1
OR
Cap. Cephradin 500mg
1+1+1+1
1+0+1 (b/m)
 Tab. Ketorolac 10mg/Diclofenac 50mg
1+1+1
Retention of Urine/ Structure urethra

Main Mx is:
 Try to catheterization- to try for 1 time

 Supra pubic puncture (bu saline set)
 Supra pubic cystostomy
Drug:
 Tab. ciprofloxacin 500mg

1+0+1
1+0+1 (b/m)
 If pain, Tab. Ketorolac/Diclofenac
97 | P a g e
Dr. Md Anwarul Azim
BEP (Benign Enlargement Of Prostate)

 Main Mx is operative
 Initial catheterization
 Tab. Uromax/Maxrin (0.4mg)
0+0+1
 Tab.Ciprofloxacin
 Tab. Omeprazole
 Sympypmatic
Hernia & Hydrocele

 Main Mx is Operative
But initial:
 Tab. Levamisol- 3 Tab stat

 Inj. Titavax- 1 amp IM stat
 Cap. Omeprazole- 1+0+1 (b/m)
 Symptomatic Rx
PVD(Peripheral vascular Disease)

 Diet. Normal
 Avoidance of smoking
 Cap. cephradin 500mg- 1=1+1+1
 Cap. Omeprazole 20mg- 1+0+1 (b/m)
 Tab. Oxifil CR 400mg- 1+0+1
 Tab. cinaron- 1+1+1
 Tab. diclofecac- if pain
 Tab. Sedil- 0+0+1
98 | P a g e
Dr. Md Anwarul Azim
Haemorrhoids /Anal fissure/rectal prolapse

 Tab. Metronidazole
1+1+1
 Cap. Omeprazole
1+0+1 (b/m)
 Tab. Algin/Clofenac- If pain
 Tab. F/S
1+0+1
 Tab. Levamisol- 3 tab stat
 Syp. Avolac
4 TSF BD
 Hip bath
3 times daily & after defeacation
 Anustat Ointment
Apply before & after defeacation
Peri-Anal Abscess
 Cap. Cephradin 500mg/Flucloxacillin 500 mg
1+1+1+1
 Tab. Metronidazole 400mg
1+1+1
 Cap. Omeprazole
1+0+1 (b/m)
 Tab. Ketorolac/Clofenac
1+0+1
 Hip bath
3 times daily & after defeacation
99 | P a g e
Dr. Md Anwarul Azim
100 | P a g e
Dr. Md Anwarul Azim
EYE
Age related Cataract (ARC)

In Ward
 Diet: Normal
 Cloramphenicol E/D: 1 drop 6 hrly
 Tab. Ranitidin 150mg: 1+0+1 (b/m)
 Tab. Sedil: 0+0+1
 Tab. Ibuprofen: 1+0+1 (a/m)
 Tab. B/C: 1+0+1
Specific Rx: Surgery
Phaco/SICS with PC IOL
Acute/Acute on Chronic Dacrocystitis

 Cap. Fluclox 500mg: 1+1+1+1
 Tab. Clofenac 50mg/ Rolac 10mg: BD or TDS (a/m)
 MoxiBac E/D: 1 times 4 hrly
 After 7-10 days DCR Sx when acute s/s subside
101 | P a g e
Dr. Md Anwarul Azim
Chronic Dacrocystitis (CDC)

In ward
 Diet. Normal
 Cloramphenicol E/D: 1 drop 6 hrly
 Cap. Amoxycillin 500mg: 1+1+1
 Tab. B/C: 1+0+1
Specific Rx: Surgery
 Dacryosystorhinostomy (DCR) If age <60 y

 Dacryosystotomy (DCT) if age >60 y
Ocular Injury
 Bed rest
 Haemostasis if needed
 Tab. Antibiotic
 Tab. Ranitidin
 Tab. Ketorolac
 Tab. Sedil
 Tab. Vit-C
 If penetrating ocular injury occur dont give any drop or oinment, Just pad &
bandage then refer the pt tertiary hospital.
102 | P a g e
Dr. Md Anwarul Azim
Fungal Corneal Ulcer

 Bed rest
 Use sun glass, Avoid water
 Diet. Normal
 Natamycin E/D: 1 drop 3 hrly
 Moxifloxacin E/D: 1 drop 2 hrly
 Atropin E/D: 1 drop 3 hrly
 Cotrimazole E/O: at bed time
 Tab. Levofloxacin 500mg: 0+1+1
 Tab. Fluconazole 50mg: 0+1+0
 Tab. Ranitidin: 1+0+1 (b/m)
 Tab. Ketorolac 10mg: 1+0+1 (a/m)
 Tab. Vit-C: 1+0+1
103 | P a g e
Dr. Md Anwarul Azim
Viral Keratitis
 Diet. Normal
 Acyvir/Xoviral E/O: 1 drop 5 hrly 21 days
 Cloramphenicol/Moxifloxacin E/D: 1 drop 4 hrly
 Artificial tear(protear/Autotear) E/D: 1 drop 6 hrly
 Atropin E/D: 1 drop8 hrly (in some case)
 Analgesics
 Tab. Ranitidin
 Tab. Ceevit
 F/U after 7 days if SPK subside then add Mild sierod E/D (AFM/Lotinol):
1 drop 6 hrly for 10-14 days
104 | P a g e
Dr. Md Anwarul Azim
ENT
Epistaxis
 Pressure over the Ala of the nose
 Ice over the nasal bridge (If H/O trauma)
 Inj. Traxyl-3 amp IV stat & SOS
 Antazol 0.1%/Rhinozol nasal drop
5 drop in each nostril 3 times daily
 IV nfusion- H/S 1000cc
 Antibiotc- Inj. Amoxycillin/Cloxacillin
 Tab. Lorfast- 0+0+1
 Tab. Sedil- 0+0+1
 BP measure if pt hypertensive
F.B Larynx/Trachea
 O2 inhalation
 Inj. Dexamet- (to prevent laryngeal Oedema)
 IV Infusion
 Antibiotic
 Analgesics
 H2 Blocker
Advice: X-ray soft tissue neck A/P & lateral view.
F.B Pharynx/Oesophagus
 NPO TFO
 IV infusion
 Omeprazole
 Analgesics
 H2 blocker
Advice: X-ray soft tissue neck A/P & lateral view.
105 | P a g e
Dr. Md Anwarul Azim
Acute Epiglottitis
 Inj. Amoxycillin/Flucoxacillin Clue to Dx:
 Inj. Ranitid/Omeprazole  Hoarsness of voice
 Tab. Histacin: 1+0+1  Dysphagia
 O/E- Epiglottis
 Thick
 Swollen
 Inflam
Hanging
1st to see stridor: If present- Tracheostomy
 NPO TFO
 O2 inhalation
 IV infusion
 Inj. dexamet- To prevent laryngeal oedema
 Inj. Ketorolac
 Inj. Berbit: 1 amp IM stat & 1/2 amp BD
DNS
 Cap. Omeprazole
 H2 blocker
 Analgesics
 Antazole Nasal drop( 0.1% )- 3 drops in each nostril BD
106 | P a g e
Dr. Md Anwarul Azim
CSOM
 Tab. Ciprofloxacin
 Tab. P/C
 Cap. Omeprazole
 H2 blocker
 Gentin HC ear drop- 3 drops in each ear 3 times daily
Traumatic Rupture Of TM
 Inj. cefradin
 Inj. Ranitidin
 Inj. Diclofenac
 Tab. Histacin: 1+0+1
 Tab. Omidon:1+0+1
 Gentin HC ear drop: 3 drop 3 times daily in effected ear
Sub-mandibular Growth
 Cap. Omeprazole
 Tab. F/S: 0+1+0
 Povisep mouth wash: 3 TSF in 1 glass of water then gargle 3 times daily
Nasal Mass With HIT

 Cap. Omeprazole
 Tab. P/C
 H2 blocker
 Antazole Nasal drop- 3 drops in each nostril BD
107 | P a g e
Dr. Md Anwarul Azim
Rhinosporidiosis
 Tab. Dapsone 100mg
1+0+0
 Cap. omeprazole
1+0+1(b/m)
 Tab. sedil
0+0+1
 Tab. B/C
1+0+1
 Antazole nasal drop 0.1% - 3 drops in each nostril 3 times daily
Nodular Goitre
Advice:
1+0+1
 USG of thyroid
 Cap. omeprazole  T3, T4, TSH
1+0+1 (b/m)  FNAC of thyroid
 Tab. sedil
0+0+1
 Tab. B/C
1+0+1
 Tab. F/S
1+0+1
Cervical Lymphadenopathy
1+0+1
 Cap. omeprazole
1+0+1 (b/m)
 Tab. sedil: 0+0+1
 Tab. F/S: 1+0+1
108 | P a g e
Dr. Md Anwarul Azim
Parotid Abscess
 Cap. Cephradin 500mg
1+1+1+1
 Inj. Genyamycin: 8 hrly
 Tab. Neotack
1+0+1 (b/m)
 Tab. diclofenac
1+0+1 (a/m)
 Tab. Sedil
0+0+1
Maxillary Sinusitis
 Cap. Cephradin- 7 days
1+1+1+1
 Tab. Alatrol- 7 days
0+0+1
 Tab. Pantid 20mg- 15days
1+0+1
 Antazole nasal drop 0.1%
drop in each nostril 3 times daily
 Tab. P/C
1+0+1
109 | P a g e
Dr. Md Anwarul Azim
Gynae & Obstetrics
110 | P a g e
Dr. Md Anwarul Azim
GYNAE & OBSTETRICS

Common pt in Obs
 FTP
 FTP with PET
 FTP with Eclampsia
 Post partum Eclampsia
 Obstructed Labour
 APH
 PPH
 Shock
 IUD
 Retained Placenta
Common Pt in Gynae
 PV bleeding
 Incomplete Abortion/ threaten Abortion
 DUB
 Genital Prolapse
 Perineal tear
 Ectopic Pregnancy
 VVF
Indication of C/S
 Previous H/O C/S

 Obstructed labour & failed medical Induction (FMI)
 Post dated pregnancy
 Eclampsia
 RM with Oligohydramnios if AFI <8 (on USG)
 Less foetal movement
 Presentation
 Breech
 transverse
111 | P a g e
Dr. Md Anwarul Azim
OBS
FTP with Normal Finding/Normal Labour
 Wait for NVD (Give NVD list to the pt)

 Cap. Cephradin 500mg: 1+1+1+1
 Tab. Pantoprazole 20mg
 Advice: Blood for grouping & cross matching
During active stage of labour
 Inf. H/S 1000 cc

 IV @ 20 d/min
 Inj. Algin
2 amp IM stat
 Emptying of bladder by catheter
After delivery & expulsion of placenta
 Inj. Piton 4 amp in drip

 Tab. Isovent/Cytomis
1 tab P/R stat
 If PPH- Inj. Urgot 1amp IM stat
FTP with PET

Finding:
 BP raised
 Oedema
Rx
 Diet. Normal
 Tab. Pantoprazole
 Tab. Sandopa (alfa-methyldopa): 1+1+1
If not controlled then given dose (2+2+2) even (2+2+2+2)
(Target BP- Systolic: 130-140 mmhg, Diastolic: 90-100 mmhg)
 Tab. Nidipin SR (Nifedipin): 1+0+1
 Tab. Sedil: (0+0+1) OR Tab. Berbit 30mg: (0+0+1)
112 | P a g e
Dr. Md Anwarul Azim
Eclampsia
Finding:
 BP raised
 Oedema
 Convulsion
 Unconscious
Rx
 NPO TFO
 O2 inhalation (if needed)
 Inf. H/S 1000ml
IV @ 20 d/m
 Inj. Sedil: 1-2 amp dilute with 5cc D/W
IV slowly over 5 min
 Inf. Nalepsin (mag sulph)
1st bag IV running
2nd bag half running & another half 12 d/m
3rd bag 6 d/m
(24 hrs from last convulsion)
 Inj. Cephradin 500mg
 Inj. pantoprazole 40mg
 1 vial IV stat & BD
 Maintain PTR chart
Advice:
 Arrange 3 or 3 bags blood

 Counseling to the pt party that pt & baby's condition are not good, anything can happen
 C/s list give & Pt ready to C/S
Post Partum Eclampsia

Almost same as Eclampsia treatment
113 | P a g e
Dr. Md Anwarul Azim
Retained Placenta
Not try to remove placenta without blood & senior.
General Mx
 Open IV channel
 Blood grouping & cross matching
 Ready match blood transfusion
 Catheterization
Specific Mx
 If bleeding- placenta should be delivered by 2 amp oxitocin IM stat & uterine

message
 If placenta Separated & retained- Control cord traction
 If placenta unseparated- Manual removal of placenta by G/A
 If placenta retained with sepsis- Intra uterine swab for C/S & board spectrum
antibiotic
 If only morbid adherent placenta- Only antibiotic
IUD
 Diet. Normal
 Cap. Cephradin 500mg: 1+1+1+1
 Tab. Pantoprazole 20mg: 1+0+1 (b/m)
 Tab. Cytomis: 1/2 +0+ 1/2
OR
Inj. Cytomis 4 amp in 1000cc H/S in drip
 Tab. F/S: 1+0+1
 Tab. B/C: 1+0+1
 Wait for expulsion of dead baby
Advice: Arrange blood if necessary
114 | P a g e
Dr. Md Anwarul Azim
Obstructed Labour
(Failed medical induction, Try to done delivery at home)
History:
Pt party চ নজবেস রবত হবে delivery চ স্টা রা হবয়নেল ন িা (ধাত্রী দ্বারা) ?
 চ াি saline or Vasofix পড়াবিা হবয়বেল ন িা ?

 তক্ষি ধবর labour pain লবে ?
 পানি ভাঙ্গবস তক্ষি আবি ?
নদ উপবরাক্ত history positive হয় তাহবল অবি সিয় pt party সঠি history নদবত াইবে িা, তাই ভলভাবে
নজবেস রবত হবে ৷
Findings:
− Vulvular swelling/Oedema
− Distended bladder
− P/V: Rupture membrane
− Head of the baby obstructed
Rx
 NPO TFO
 IV infusion 5% DA- 30 d/m
 Inj. Ceftriaxone 1gm/ Inj. Cefradin 500mg
 Inj. Ranitidine
 Urgent continuous catheterization
 Pls. maintain PTR chart
Advice:
 Counseling
 Blood grouping & cross matching
 Ready for Urgent C/S
115 | P a g e
Dr. Md Anwarul Azim
APH
 NPO TFO
 Inf. H/S 1000cc + 5% DA 1000cc
IV stat @ 30 d/m
 Inj. Cefradin 500mg: 6 hrly
 Inj. Ranitidin: IV 1 amp stat & BD
 If pain: Inj. Algin 1amp IM stat & TDS
 If bleeding present: Inj. Traxyl 1 amp IV 8 hrly
 Catheterization
 Blood transfusion if necessary
 If bleeding not control- Ready to pt for emergency C/S by taking written informed
concent
PPH
 NPO TFO
 Inf. H/S 1000cc + 5% DA 1000cc
IV stat @ 30 d/m
 Inj. Urgot
1-2 amp IM stat
 Inj. Cefradin 500mg: 6 hrly
 Inj. Ranitidin: IV 1 amp stat & BD
 If pain: Inj. Algin 1amp IM stat & TDS
 If bleeding present: Inj. Traxyl 1 amp IV 8 hrly
 Catheterization
 Blood transfusion if necessary
116 | P a g e
Dr. Md Anwarul Azim
Hyperemisis Gravidarum
 NPO TFP
 Inf. HS 2000cc + 5% DA 1000cc
(With 1 amp vit B-50 forte + 1 amp ascoson in each bag)- IV @ 30 d/m
 Inj. Pantoprazole 40mg
 Inj. Emistat
1 amp IV stat & 8 hrly & sos
Or
Inj. Paloxy- 1 amp stat
 Inj. Sedil. 1 amp IM stat
Shock
 If pulse not palpable & BP not recordable Then, Dopamine drip given
Inf. 5% DA 500cc + 2 amp dopamine
IV stat 6-8 d/m
 If hypovolumic shock due to loss of excessive blood
Then, blood transfusion done
also give Inf. H/S 2000ml
30 d/m IV stat
 If bleeding then, Inj. traxyl- 1 amp I/V 8 hrly
 Otherwise conservative Rx conyinue
Nice to know
 োচ্চা delivery হওয়ার পর ো হওয়ার আবি (চপবে)িারা চিবল িা চ breast milk suppressive drug নদবত
হবে
Tab. bromodil: 1+0+1
 After C/S if complain cough
Tab. Bexidal: 1+0+1
Syp. Ofcof/Ambrox : 2 TSF TDS
 After delivery Breast milk িা আসবল
Tab. Omidon: 2+2+2
Tab. Hollydeed/Lactogen: 1+0+1 (if pt rich)
117 | P a g e
Dr. Md Anwarul Azim
Gynae
PV Bleeding
 Diet. NPO TFO

 Inf. H/S 2000cc + 5% DA 1000cc
IV stat @ 30 d/m
 Inj. Cefradin: 6 hrly
 Inj. Ranitidin: 12 hrly
 Inj. Traxyl: 8 hrly
 Inj. algin: 8 hrly - (If pain)
 Blood transfusion immediately
Advice:
 USG of pregnancy profile (if pregnant)

OR
USG of lower abdomen
 Blood grouping & cross matching
Incomplete Abortion
If huge P/V bleeding present then Rx as above but antibiotic must be Ciprofloxacin &
Metronidazole Combination.
Otherwise Rx will be as below
 Diet. Normal
 Tab. ciprofloxacin 500mg: 1+0+1
 Tab. Metronidazole: 1+1+1
 Tab. Algin: 1+1+1
 Cap. Traxyl: 1+1+1
 Tab. F/S: 1+0+1
 Tab. B/C: 1+0+1
Advice:
 Blood for grouping & cross matching

 USG of lower abdomen
 Arrange blood
118 | P a g e
Dr. Md Anwarul Azim
Threatened Abortion
 Diet. Normal
 Cap. Cefradin 500mg: 1+1+1+1
 Tab. Algin: 1+1+1
 Tab. F/S: 1+0+1
 Tab. B/C: 1+0+1
 If bleeding-Cap. Traxyl: 1+1+1
Advice: USG of Pregnancy profile
DUB/Fibroid Uterus
 Diet. Normal
 Tab. Omeprazole 20mg: 1+0+1 (b/m)
 Tab. Algin: 1+1+1 (If pain)
 Tab. F/S: 1+0+1
 Tab. B/C: 1+0+1
Advice: USG of Lower abdomen
Genital Prolapse
 Diet. Normal
 Tab. Omeprazple 20mg: 1+0+1 (b/m)
 If constipation then, Syp. Avolac: 3 TSF TDS
 If pain-Tab. Algin: 1+1+1
 Cap. Traxyl: 1+1+1
 Tab. F/S: 1+0+1
119 | P a g e
Dr. Md Anwarul Azim
Ectopic Pregnancy
 Tab. Metronidazole 500mg: 1+1+1
 Tab. Ranitidin/Pantoprazole: 1+0+1 (b/m)
 Tab. Diclofenac
 Tab. F/S: 1+0+1
 Tab. B/C: 1+0+1
** In case of rupture ectopic pregnancy 1st asses the pt feature of shock & treat the pt acc.
to pt condition
Perineal Tear
Perineal tear should be repair within 24 hrs otherwise 3 months later.

 Tab. Ranitidin/Pantoprazole: 1+0+1 (b/m)
 Tab. Diclofenac
 Tab. F/S: 1+0+1
 Tab. B/C: 1+0+1
VVF
 Diet. Normal
 Tab. Ciprofloxacin 500mg: 1+0+1
 Cap. Omeprazole 20mg: 1+0+1 (b/m)
 Tab. F/S: 1+0+1
 Tab. B/C: 1+0+1
120 | P a g e
Dr. Md Anwarul Azim
PID
 Adequate rest
 Analgesic
 Antibiotic- Amoxicillin/Doxycycline/Tretracycline
If not response within 48 hrs then hospitalization
 NPO TFO
 IV channel open & all drug should be given parenterally
1 vial IV stat & daily
 Inj. Metronidazole 100ml
1 bottle IV stat & TDS Investigation:
 Inj. Omeprazole 40mg  High vaginal swab for gram stain
1 vial IV stat & BD & c/s
 Voltalin Suppository  Urine for R/M/E
 Blood for c/s (if fever present)
1 stick P/R stat & SOS
Post Conductive order(In Obs)/Post Expulsive Order(In Gynae)
 NPO For 6 hrs

 Inf. H/S 1000cc: IV stat @ 30 d/m + 4 amp piton
 Inj. cefradin: 1 vial IV stat
 Inj. Metronidazole: 1 bottle IV stat
 Inj. Ranitidin: 1 amp IV stat & slowly
 Inj. Diclofenac: 1 amp IM stat
After 6 hours
 Diet. Soft then normal

 Tab. Ranitidin/Omeprazole: 1+0+1 (b/m)
 Tab. Diclofenac: 1+1+1 or 1+0+1
 Tab. Ceevit 250mg: 1+0+1
 For Baby: Inj. Konakion(2mg mm) per orally stat
121 | P a g e
Dr. Md Anwarul Azim
Bowel Preparation On 1st day
Non residual diet (ORS/Coconut water/Glucose water)

Tab. Ciprofloxacin 500mg
1+0+1
Tab. Metronidazole
1+1+1
Tab. Ranitidine
1+0+1 (b/m)
Tab. Duralex
2+2+2
Tab. Laexena
0+0+2
Bowel Preparation On 2nd & 3rd day
NPO (except glucose water & medication)

Inf. Cholera saline 400mg
IV @ 40 d/m
Inf. Manitol 500ml
1 glass at morning & 1 glass at night (Oral)
Inj. Ciprofloxacin 100 ml
1 bag IV stat & BD
Inj. metronidazole
1 bottle IV stat & TDS
Inj. Omeprazole
1 vial IV stat & BD
Tab. Duralex
2+2+2
Tab. Laexena
0+0+2
122 | P a g e

RX Protocol Kakoli 2nd Edition

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Dr.

Dr. Md. Anwarul Azim (SM-2)

1st Edit: 2012

SL No. Topics Page No.

10 Snake bite (poisonous) 18

11 Snake bite (Non-poisonous) 19

19 Acute Gastritis (Food poisoning) 23

20 Chronic Gastritis/Gastric ulcer 23

24 Mallory weiss syndrome 25

34 Acute Viral hepatitis 27

38 Hepato Cellular Carcinoma 29

39 Fatty change of Liver 30

45 Hyperkalemia (K > 5.5 mmol/L) 33

48 Enteric Fever/ Typhoid 34

52 Cerebral Malaria/Severe Malaria 35

55 Fever Under Evaluation/UTI/RTI 36

58 Acute Migraine attack 38

60 Vertigo with Headache 39

66 Mumps & Orchitis 42

68 Steven Jonson Syndrome 42

71 Fe Chelating agent in Thalassaemic PT 43

81 Low Back Pain 48

2 GAD (Generalized Anxiety Disorder) 52

3 OCD (Obsessive Compulsive Disorder) 53

4 PPP (Post Partum Psychosis) 53

5 SRD (Substance related disorder)/Sleeping Pill 53

6 ASD (Acute Stress Disorder) 54

3 Seborrhoeic Dermatitis/ Seborrhoeic Folicuitis 55

12 White Discharge from Breast 58

14 Skin Wart/Hard skin 58

6 SVT (Supra Ventricular tachycardia) 63

3 Birth asphyxia/Neonatal Sepsis/Neonatal Convulsion 75

6 Neonate Of HBsAg +ve mother 77

23 PEM (Protein Energy Malnutrition) 87

2 Physical assault (P/A) 92

3 Massive cut Injury or P/A 93

4 Small cut injury 93

5 Acute case of intestine/ Acute Emergency 94

6 A case of Hepato-Biliary system 95

7 Accidental fall from height 96

10 Retention of Urine/ Structure urethra 97

11 BEP (Benign Enlargement Of Prostate) 98

12 Hernia & Hydrocele 98

13 PVD(Peripheral vascular Disease) 98

14 Haemorrhoids /Anal fissure/rectal prolapse 99

16 Gut Preparation for Surgery 100

17 Gut Preparation for IVU 100

1 Age related Cataract (ARC) 101

2 Acute/Acute on Chronic Daryosistitis 101

3 Chronic Dacryocystitis (CDC) 102

4 Ocular Injury 102

6 Fungal Corneal Ulcer 103

7 Viral Keratitis 104

2 F.B Larynx/Trachea 105

3 F.B Pharynx/Oesophagus 105

4 Acute Epiglottitis 106

8 Traumatic Rupture Of TM 107

9 Sub-mandibular Growth 107

10 Nasal Mass With HIT 107