OUTPATIENT DISEASES

VCTB, MD
Benign Paroxysmal Positional Vertigo (BPPV) Dyspepsia/ GERD/ Acid Peptic Disease (APD)
Betahistine 16 mg/tab BID x 7 days Domperidone 10 mg/tab TID
Cinnarizine 25 mg/tab PRN x dizziness HNBB 10 mg/tab (Buscopan) q8 PRN x abdominal
MIMS: TID discomfort
Migraine Metoclopramide 10 mg/tab q8 PRN x vomiting
Paracetamol + BID or TID PRN Omeprazole 40 mg/tab OD taken 30 mins before
Propyphenazone + (NOT taken for >1 breakfast x 14 days
caffeine (Saridon) week)
Pantoprazole 40 mg/tab + OD taken 30 mins before
Sumatriptan 50 mg/tab 1 tab once a day for Domperidone 30 mg/tab breakfast
severe headache
Sodium alginate sachet q8 PRN x heartburn
(Gaviscon)
Diarrhea
Oresol Dissolve 4 sachets in Constipation
1L. Consume 2-3L per
day Bisacodyl 5 mg/tab Take 2 tablets before bedtime

Loperamide 2 mg/cap Take 2 capsules initially Lactulose Consume 30cc before

then 1 capsule on each bedtime
episode of unformed
stool (max 16 mg)
Hypertension Post MI/ post stroke
Losartan 50/100 mg/tab OD (usually AM) Aspirin 80 mg/tab OD
(ODHS)
Clopidogrel 75 mg OD
Irbesartan 50/100 mg/tab
Angina/ chest pain
Telmisartan 40 mg/tab
ISDN 5 mg/tab PRN every 5 minutes
Any of the above + 12.5/25
mg HCTZ ISMN 30 mg/tab OD
Amlodipine 5/10 mg/tab OD (usually AM) Trimetazidine 35 BID
common SE: bipedal edema mg/tab
alternative: S-amlodipine Dyslipidemia
Enalapril 5/10/20 mg/tab OD Atorvastatin 10/20/40 OD HS
Ideal for CHF mg/tab
common SE: cough
Rosuvastatin 5/10/20 OD HS
Furosemide 20/40 mg/tab OD usually x 5 days mg/tab
Captopril 25 mg/tab For >BP 160/100 max 3 Simvastatin OD HS
tabs 10/20/40/80 mg/tab
Methyldopa 250 mg/tab BID/TID for pregnant Fenofibrate 160 mg/tab OD
patients
Asthma/ COPD Cough

Salbutamol 2/4 mg/tab TID/QID N-acetylcysteine 600 Dissolve 1 sachet in ½ cup

mg/sachet of water, take before
Salbutamol neb 1 mg/ml in 2.5 ml 2.5 to 5 ml QID bedtime for 5 days
nebule (productive cough)

Salbutamol + Ipratropium bromide 1 vial in acute attacks Butamirate citrate 50 mg/tab TID (dry cough - antitussive)
(2.5 mg + 500 mcg/ 2.5 mL) q6 for maintenance Chlorpheniramine maleate q8 x 2 weeks
Combivent 2mg, Dextromethorphan HBr
10mg, Guaifenesin 50mg,
Budesonide + Formoterol 2 puffs BID phenylpropanolamine HCl
fumarate max of 4 puffs 25mg/cap (Mucobron forte)
Symbicort
Allergic cough 1) Na Ascorbate + Zinc 1tab
Salmeterol + Fluticasone 2 puffs BID OD
Seretide 2) Loratadine OR Cetirizine
10mg/tab 1 tab ODHS
Levocetirizine + Montelukast 10 ODHS
Acute tonsillopharyngitis
mg + 5 mg/tab
Clindamycin 300 mg/tab QID x 7days
CAP-LR
Co-amoxiclav 625 mg/tab TID x 7 days
Co-amoxiclav 1 g/tab BID for 7 days
Chlorhexidine mouthwash TID
Mild Leptospirosis Benign Prostatic Hyperplasia

Doxycycline 100 mg/tab BID Tamsulosin 400 mcg OD (for symptomatic only, without
confirmation of enlarged prostate)
Azithromycin 500 mg/tab 1 g initially then 500
Tamsulosin + Finasteride OD (if confirmed BPH/ moderate-
mg OD for 2 more 400 mcg + 5 mg/tab severe prostatism)
days
CKD/ Urolithiasis/ Anemia
Ketoanalogue 600 mg/tab 2 tabs TID
Sambong 500 mg/tab 2 tabs TID
UTI (Cystitis)
Ferrous sulfate 325 mg/tab BID/TID x 30 days
Ciprofloxacin 500 mg/tab BID x 7 days
Ferrous fumarate + folic acid OD
Cefuroxime 500 mg/tab BID x 7 days
Ascorbic acid 500 mg/tab OD
Nitrofurantoin 100 mg QID x 7 days
Epoetin alfa 2,000/4,000 IU Initially 60 units/kg for 1-2 min 3 x
Fosfomycin 3g PO single dose weekly by IV or SC
Maintenance: 25-50 units/kg 2-3
Amoebiasis per week
Metronidazole 500 mg/tab q8 for 7 days Potassium citrate 1080 mg Severe hypocitraturia (urinary
citrate < 150 mg/day): initially 60
Numbness/Paresthesia mEq/day with meals or within 30
min after meals
Vitamin B complex OD to TID depends
Mild to moderate hypocitraturia (>
Muscle relaxants 150 mg/day): initially 30 mEq/day
(10 mEq TID) with meals
Eperisone 50 mg/tab TID x 5 days
Diabetes Mellitus type II Hemorrhoids
Metformin 500 mg/tab Depends Diosmin 450 mg + Hesperidin 50 1 tab TID x 4 days, then 1 tab BID
Linagliptin 5 mg/tab OD for px with CKD mg/tab x 3 days
Gliclazide 60 mg/tab OD Hemostatic
Dapagliflozin 10 mg/tab OD Tranexamic acid 500 mg/tab 1 tab BID
Insulin 70:30 STI
Hyperthyroidism Ceftriaxone 250 mg IM (or Cefixime 400 mg PO)
Propylthiouracil PTU 60 mg/tab q8
+Doxycycline 100 mg/tab PO 1 tab q12 x 7 days or
Methimazole 5/20 mg/tab 10-20 mg q8/ OD Azithromycin 1g
Propanolol 10/20 mg/tab q6/ PRN x palpitations Pain relievers
Hypothyroidism
Paracetamol 500 mg/tab q6 x pain
Levothyroxine 25/ 50/100 mcg Initially 25-50 mcg/day q4 x fever
Maintenance: 100-200
mcg/day Mefenamic acid 500 mg/tab TID PRN x pain
Fatty liver Naproxen 550 mg/tab BID PRN x pain
Silymarin capsule 2 tabs TID
Celecoxib 200 mg/tab BID PRN x pain
Gouty arthritis
Paracetamol 325 mg + Tramadol q8 PRN x pain
Colchicine 500 mcg TID for acute attacks, then 37.5 mg/tab
decreased to OD after acute
attack, maintained until uric Pregabalin 75 mg/tab 1 tab PRN pins and needles
acid < 6 mg/dl
Paracetamol + Orphenadrine 450 2 tabs TID for MPS
Allopurinol 100 mg/tab OD
mg + 35 mg/tab CI: bladder obstruction, glaucoma
Febuxostat 40 mg/tab 40-80 mg OD
GI
Functional constipation, T/C upper Increase oral fluid intake 2-3 L/day. Increase fiber intake.
gastrointestinal bleeding; Diagnostics: WAB ultrasound, transrectal ultrasound, fecalysis, FOBT
Benign prostate hypertrophy with mild Therapeutics: Lactulose 30 cc at bedtime
prostatism Avoid meat for 3 days prior to FOBT, avoid dark colored foods
Continue moderate exercise for 3-4x/week,
WOF: profuse bleeding, pallor. To come back with results or if with problems
T/C Acid Peptic Disease; Avoid caffeinated, carbonated drinks, spicy food, adequate oral fluid intake
Therapeutics:
1) Omeprazole tablet 40mg/tab 1 tab OD 30 minutes before breakfast x 14 days
2) Domperidone tablet 10mg/tab 1 tab TID 30 minutes before meals
Non-Alcoholic Fatty Liver Disease Decrease fat intake, increase fluid intake
Calculous of the Gallbladder Diagnostics: For HBT UTZ after 6 months
Therapeutics: Continue Rowachol capsule 1 capsule TID before meals
WOF: Abdominal pain, jaundice, acholic stools
Acute Gastroenteritis, no signs of Diet as tolerated, ↑OFI (2-3L/day)
dehydration; Obese I Dx: Fecalysis
Tx: 1) ORS sachet 4 sachets in 1L water, consume 2-3L/day, 2) Probiotics 1 tab OD x 14 days
Advised consumption of safe drinking water and practice of food safety.
WOF: intractable vomiting, bloody stool, pallor.
Intestinal Ascariasis; Acid Peptic Diet as tolerated, increase oral fluid intake
Disease Diagnostics: CXR PA/L; PFA upright
Therapeutics: Albendazole 400 mg/tab; Omeprazole 40 mg/tab OD 30 minutes before meal; Celecoxib
200 mg/tab q12 PRN for pain
Observe proper food preparation
Regular handwashing
Daily body hygiene
WOF: Difficulty of breathing, chest pain, severe abdominal pain
PULMO
Upper Respiratory Tract Infection; Diet as tolerated, consume fruits and vegetables, increase fluid intake
COVID suspect Diagnostics: for RT PCR for SARS-CoV-2
Therapeutics: N-acetylcysteine 600 mg twice daily for cough, Sodium ascorbate + Zinc tab once daily,
Paracetamol tab every 4 hours for fever, ORS sachet mix 4 sachets in 1L of water 2-3L/day
URTI prob. bacterial, COVID suspect, DASH, AOFI
Presumptive PTB Diagnostics: For SARS COV 2 RT PCR via NS/OP, CXR PA, Gene Xpert
Therapeutics:
1. Co-amoxiclav 625mg/tab 1 tab Q8 x 7 days
2. NAC 600mg/tab in 1/2 glass water ODHS
3. Paracetamol 500mg/tab 1 tab Q4 PRN for fever
4. ORS 1-2L/day
5. MV + Zinc tab 1 tab OD
Advise referral to BHERT Quarantine for 10 days or until with swab results
t/c Allergic cough; presumptive PTB; DASH, DM diet
Hypertension St. I; DM type II Dx: CXR PA, for GeneXpert, UA, 12L ECG, FBS, Lipid profile, Creatinine, AST, ALT, Serum K
Tx:
1. NAC 600 mg/tab, ODHS
2. Na Ascorbate + Zinc tab OD
3. Losartan 50 mg/tab OD
4. Levocetirizine 5mg/tab ODHS
5. Metformin 500 mg/tab OD
Proper cough etiquette and hand hygiene > Compliance to diet and medications > For BP monitoring and
record > Advised follow up once with laboratory results or anytime if with results
NEPHRO/ URO
Nephrolithiasis, right; benign prostatic Diet as tolerated, increase oral fluid intake about 3L per day
hypertrophy; mild prostatism; Diagnostics: for repeat KUB with prostate ultrasound after 3 months
complicated UTI Therapeutics:
1. Tamsulosin 400 mcg/tab ODHS
2. Finasteride 5 mg/tab 1 tab ODHS
3. Ciprofloxacin 500 mg/tab BID for 7 days
4. K citrate tab 2 tabs TID for 3 months
For referral to surgery for evaluation on nephrolithiasis
Urinary tract infection, r/o nephrolithiasis, Diet as tolerated, increased oral fluid intake
r/o sciatica Diagnostics: Lumbosacral xray, Urinalysis, KUB Ultrasound
Therapeutics: Ciprofloxacin 500 mg/tab BID x 7 days, Paracetamol 325 mg + Tramadol 37.5 mg / tab
Q8 PRN pain
Avoid eating salty food
Nephrolithiasis, Left; Hypertension, St. DASH diet, inc OFI (3-4 L/day)
2, controlled; NAFLD; Low back pain Dx: urinalysis, WAB ultrasound, FBS, lipid profile, creatinine, AST/ALT, Na, K, Cl, CXR PA
syndrome; Obese II Therapeutics:
1) Losartan + Hydrochlorothiazide 50 mg/12.5 mg/tab, 1 tab OD AM
2) Sambong 500 mg/cap, 1 cap TID
3) Vitamin B complex, 1 tab OD
4) 4) Sodium ascorbate + zinc, 1 tab OD
5) 5) Orphenadrine citrate + paracetamol 35 mg/450 mg/tab, 1 tab q8 PRN for pain
Advised proper body mechanics; warm compress on affected area as needed
Advised adherence to diet and moderate intensity exercise (150 min/wk)
WOF: hematuria, fever, chills Follow up once with lab results Well-advised.
MSK
T/C Osteoarthritis, knees, bilateral; lumbosacral DASH diet, with adequate oral fluid intake
vertebrae; shoulders, bilateral; ankle bilateral; Diagnostics: X-ray of: lumbosacral, knee bilateral, ankles bilateral, shoulders bilateral
Therapeutics:
Mefenamic acid 500mg/tab 1 tab q6 PRN 4-6/10 pain
Celecoxib 200mg/cap 1 cap q12 PRN pain >7/10 pain
Proper body alignment + mechanics. Refer to Rehab med for PT.
Myofascial Pain Syndrome Upper Back and Adequate oral fluid intake, 3L water/day
Shoulders, Bilateral; To consider Tension Headache Therapeutics: Vitamin B complex BID, Celecoxib 200 mg/cap, 1 cap q12 as needed for headache
t/c Sciatica, left Diagnostics: Lumbosacral x-ray AP/L
Therapeutics: Pregabalin 75mg/tab 1 tab OD, Vitamin B complex 1 tab OD
Plan to refer to Rehab Medicine once with work up
Warm compress at flank area, left
T/C Gouty Arthritis; Hypertensive suspect; Obese I Low salt, Low fat, Low purine diet. Increase oral fluid intake
Diagnostics: Urinalysis, FBS, Lipid profile, BUN, Crea, AST, ALT, BUA, Na, K, Hand APO right, Knee AP left, KUB ultrasound
Therapeutics: Colchicine 500 mcg/tab 1 tab BID
Advised weight reduction, Cold compress on affected area
Moderate intensity Exercise 30 mins/session 5-7x/week
Daily BP monitoring and record
T/C Tophaceous gout, ankle, right; Hypertension Diet: LSLF diet, low purine diet, increase oral fluid intake 3-4 L/day
Stage 1, controlled; Benign prostatic hyperplasia Diagnostics: PSA, repeat FBS, LP, Crea, AST, ALT, Serum Na & K, BUA, urinalysis, 12L-ECG, CXR (PA) on Jan 2022
with mild prostatism; T/C non alcoholic fatty liver Medications: 1) Febuxostat 40 mg/tab 1 tab OD 2) Losartan 50 mg/tab 1 tab OD 3) Amlodipine 5 mg/tab 1 tab OD D/C 1)
disease Simvastatin 20 mg/tab 1 tab ODHS, 4) Tamsulosin 400 mcg/tab 1 tab OD, 5) Paracetamol 500 mg/tab 1 tab q6 PRN pain
Warm compress on affected area 10-15 mins 4x a day Daliy BP monitoring and recording Moderate intensity exercises 30 mins 3-
4x/week
If PSA <4.0 ng/mL, plan to initiate 5-alphareductase inhibitor on next follow up
Gouty Arthritis in Flare Up; T/C Muscle Atrophy Diet: low purine diet, increase oral fluid intake
Secondary to Nerve Impingement Diagnostics: Still for EMG, NCS; for uric acid test
Therapeutics: (1) Etoricoxib 100 mg/tab OD (2) Febuxostat 40 mg/tab, 1 tab OD (3) Colchicine 5 mg/tab, 1 tab BID (4) Vitamin B
Complex OD (5) Tramadol 50 mg/tab q6 for knee pain
Advised adherence to diet changes. Advised COVID-19 vaccination. Advised adherence to COVID-19 protocols.
Plan to give Pregabalin 75 mg/tab BID, Gabapentin 30 mg/tab OD once muscle atrophy is confirmed.
Plan to refer to Rehab Med once with EMG.
NEURO
T/C Error of refraction vs BPPV Diet as tolerated with adequate oral fluid intake
Diagnostics: Serum creatinine, FBS, ALT/AST, lipid profile, Sodium, Potassium, Urinalysis, 12-L ECG
Treatment:
1) Paracetamol tablet 500 mg/tab, 1 tab Q6 for pain
2) Cinnarizine tablet 25 mg/tab, 1 tab Q8 PRN for dizziness
Advised ophthalmology consult for further evaluation
t/c Schizophreniform Disorder; r/o Limit coffee, softdrinks, and energy drinks. Adequate fluid intake
Hypothyroidism Diagnostics: 12L ECG, TSH, FT4, FT3, Crea, FBS, Lipid profile, AST, ALT, Na, K.
Therapeutics: Propranolol 10mg/tab TID as needed for palpitations
Advise to be accompanied for next consult. Advise to be accompanied at all times.
Safety precautions: remove any object that may cause harm. For referral to Psychiatry Department once with results.
To consider Transient Ischemic Stroke Low salt, low fat diet. Adequate fluid intake.
Dx: Plain cranial CT-scan, FBS, Lipid profile, Serum electrolytes
Watch-out for: Recurrence of numbness and weakness, slurred speech.
Advise to go to ER once with the symptoms.
T/C Migraine without Aura; Adequate oral fluid intake
Diagnostics: Plain cranial CT scan
Therapeutics:
1. Sumatriptan 50mg/tab 1 tab once a day for severe headache
2. Celecoxib 200mg/cap 1 cap every 12 hours as needed for pain

Watch out for: non-resolving headache, body weakness, facial asymmetry, slurring of speech
Come to ER if with symptoms
T/C Generalized Anxiety Disorder vs Major Diet: DAT, AOFI
Depressive Disorder; r/o thyroid dysfunction Dx: TSH, FT4, CBC
Tx: 1) Diphenhydramine 25 mg/tab 1 tab before bedtime 2) Multivitamins 1 tab OD
Advice: deep breathing exercise
Follow up if insomnia persists and if with results for possible referral to psych
CARDIO
t/c Deep Vein Thrombosis; r/o Heart Failure; DASH diet,
Hypertension stage 1, t/c Stasis Dermatitis Limit OFI <2L/day, decrease sodium intake.
Diagnostics:
Na+, K+, 12L ECG, UA, Lipid profile, Crea, CXR PA, FBS, BUN, TPAG, AV duplex scan bilateral lower extremities,
AST/ALT
Therapeutics:
1) Furosemide 40mg/tab 1 tab OD AM x 5 days
2) Losartan + Hydrochlorothiazide 50/12.5mg/tab 1 tab OD AM
Compression stockings on for 4 hours, off for 4 hours.
Leg elevation while at home. Adherence to MECQ protocols. Follow-up at Telehealth.
Hypertension Suspect DASH diet, AOFI
Dx: Urinalysis, FBS, Serum Na K, Creatinine, LP, Uric Acid, 12L ECG, AST/ALT
Tx: None for now Advised adherence to dash diet - low salt, low fat
Advised daily BP monitoring with recording
Advised daily moderate intensity exercise (150min/week)
WOF: chest pain, palpitations, slurring of speech, nape pain
Follow up at telehealth after 3 days
Hypertension Stage II, controlled; Bronchial DASH & DM diet, AOFI
asthma, partly controlled; Diabetes mellitus type Diagnostics: Follow up of previous labs (EBS, ECG, X-ray bilateral knee)
II; t/c osteoarthritis; t/c chronic heart failure, Therapeutics: 1) Atorvastatin 40 mg/tab OD at night 2) Telmisartan 40 mg 1 tab ODAM 3) Budesonide + Formoterol
NYHA II; t/c coronary artery disease 320/4.5 MDI 2 puffs BID PRN for DOB 4) Paracetamol + Tramadol 325/37.5 mg q8 PRN pain 5) Metoprolol 50 mg OD
at night 6) Aspirin 80 mg at lunch 7) Isosorbide dinitrate 5mg sublingual PRN for chest pain 8) Gliclazide 80 mg/tab BID
Moderate exercises (30 mins) 4x per week Deep breathing exercises Adequate sleep and rest
T/C Chronic Venous Insufficiency; DM Low salt, low fat diet; DM diet; AOFI
Nephropathy; Hypertensive Atherosclerotic Diagnostics: Still for venous duplex scan (bilateral lower extremities), repeat FBS, LP, Creatinine, Serum Na, K, HbA1c,
Cardiovascular Disease; Acute Coronary urinalysis, AST, ALT, 12L ECG, KUB-UTZ
Syndrome, CCS Class II; Type 2 Diabetes Therapeutics:
Mellitus; Nephrolithiasis, Right 1) Vitamin B complex tab, BID, 2) Losartan 100 mg/tab, 1 tab OD, 3) Amlodipine 10 mg/tab, 1 tab OD 4) Bisoprolol 5
mg/tab, 1 tab OD 5) Aspirin 80 mg/tab, 1 tab OD 6) Simvastatin 20 mg/tab, 1 tab ODHS 7) Metformin 500 mg/tab
BID 8) Isosorbide dinitrate 5 mg/tab SL PRN chest pain 9) Paracetamol 500 mg/tab q6 PRN chest pain
Compression stockings 2 hours on and 2 hours off on bilateral lower extremities
Mild intensity exercises 150 mins/week
Advised compliance to medications
IDS
Acute viral exanthem, resolved; Obese I Diet as tolerated, Adequate oral fluid intake
Diagnostics: FBS, Lipid profile, AST/ALT, creatinine
Therapeutics: 1) Vitamin C with Zinc tablet, 1 tab OD
Health Education and advice: Advised daily moderate intensity exercise (150min/wk), advised weight
reduction by 10% (1-2 lbs/week), advised adherence to COVID-19 health protocols
Osteoarthritis, lumbosacral; t/c Arthropod Diet as tolerated, adequate oral fluid intake
bite with secondary bacterial infection Diagnostics: Lumbosacral X-ray
Therapeutics: 1) Paracetamol 500mg/tab 1 tab q6 PRN for pain 2) Mupirocin ointment apply TID x 7
days 3) Cetirizine 10mg/tab 1 tab OD x 5 days
Stretching exercises (moderate to high intensity)
Continue ambulation Apply NJJ compress BID
T/C Sexually Transmitted Infection, Diet for age; adequate oral fluid intake
Probably Gonoccocal-Chlamydial Diagnostics: HIV screening test
Urethritis Therapeutics: 1) Ceftriaxone 1g TIM ANST now 2) Doxycycline 100 BID for 7 days
Health Education and Advice: Practice safe sex. Improve self hygiene. Advised treatment of sexual
partners for past 6 months. Encouraged proper nutrition. Update adult immunization. Avoid sexual
intercourse until completion of treatment.
S/P suturing and dirty wounds Cloxacillin 500 mg/tab q6 x 7 days
Dexketoprofen 25mg/cap 2 caps q8 prn x pain
ENDO

Clinically Euthyroid Hyperthyroidism; Diet as tolerated; Avoid fried fatty & oily food; Adequate oral fluid intake
Obese II Diagnostics: RPR, TFTs (FT3, FT4), Urinalysis, CBC, Blood typing, CXR, drug test - To
request FBS, lipid profile, AST/ALT
Therapeutics: none for now
Advised to have the vaccination for 2021 COVID-19 vaccine; HPV vaccine
Advised self breast examination
Advised cervical cancer screening (pap smear)
Advised adherence to COVID-19 health protocols
HEMA

T/C Anemia, unspecified Diet for age, adequate oral fluid intake (encouraged meat intake and green leafy
vegetables)
Dx: CBC with PC, FBS, ALT, AST, Lipid profile
Therapeutics: Multivitamins OD
Regular moderate to high intensity exercise; Advised proper sleep routine
INTERNAL MEDICINE

VCTB, MD
PULMONOLOGY: CAP

VCTB, MD
PULMONOLOGY

VCTB, MD
PULMONOLOGY

VCTB, MD
PULMONOLOGY

SAMPLE (CAP-MR) GENERAL NOTES

Pharmacologic management:
• Ampicillin-Sulbactam 3g IV every 6 hours
- Monitor response to therapy which is expected within 24-72 hours
- Once the patient is clinically improving, patient can start oral antibiotics
- May shift to Amoxicillin-Clavulanic acid 625 mg every 8 hours or 1g every 12 hours
- Treatment will last for 7-10 days
- Patients should be afebrile for 48 to 72 hours with no signs of clinical instability before discontinuation of treatment
• Azithromycin 500 mg/tab once a day for 3-5 days
• Paracetamol 500 mg/tab every 4 hours PRN for T> 37.8C
• NAC 600 mg/sachet + ½ glass of water once a day at bedtime
• Continue oxygen support via nasal cannula at 1-2 lpm

Non-pharmacologic management:
• Lifestyle modification
• Smoking cessation
• Hand washing/ hygiene
• Pneumococcal and influenza vaccination
After discharge, follow-up after 1 month or if with problems
VCTB, MD
PULMONOLOGY

SAMPLE (CAP-MR with COPD and DM) ACTUAL PATIENT

Admit to room _ under the service of Drs. _.
Secure consent for admission and management.
DAT with SAP.
IVF: 1L PNSS x 90 cc/hr.
Dx: CBC, UA, BUN, Crea, AST, ALT, Na, K, Cl, Ca, 12L-ECG, CBG, CXR PA, sputum CS/GS, FBS, Hba1c
Tx: May go home
1. Ceftriaxone 2g TIV q24
2. Azithromycin 500mg/tab 1 tab OD Dx: Spirometry
3. Salbutamol + Ipatropium q8 Tx:
4. NAC 600mg/sachet in ½ glass of water ODHS
1. Cefpodoxime 200 mg/tab, 1 tab BID for 5 days
5. Paracetamol 300mg TIV q4 for fever >=37.8
6. Hydrocortisone 100mg TIV q8 2. Azithromycin 500 mg/tab, 1 tab OD for 3 days
7. Regular insulin 5 units SC PRN for CBG >= 180mg/dL 3. NAC 600 mg/tab in ½ glass water ODHS
VSq4. I and O qshift. Refer.
4. Beclomethasone + Formoterol MDI, 2 puffs BID
Follow up on ____

VCTB, MD
PULMONOLOGY: BA

VCTB, MD
PULMONOLOGY

VCTB, MD
PULMONOLOGY

SAMPLE (BAIAE, AR)

VCTB, MD
PULMONOLOGY

SAMPLE (BAIAE, AR) ACTUAL PATIENT

VCTB, MD
PULMONOLOGY: COPD

VCTB, MD
PULMONOLOGY

VCTB, MD
PULMONOLOGY: PTB

SAMPLE (PTB, DM)

VCTB, MD
CARDIOLOGY: HPN CPG 2020

VCTB, MD
CARDIOLOGY

VCTB, MD
CARDIOLOGY

SAMPLE (HPN) ACTUAL PATIENT OPD

DASH, AOFI
Dx: 12L-ECG, FBS, LP, UA, Na, K, creatinine
Tx:
1. Losartan 50 mg/tab 1 tab OD or Telmisartan 40 mg/tab ODAM
2. Amlodipine 5 mg/tab 1 tab OD (if with edema may give S-Amlodipine 2.5 mg/tab 1 tab ODHS)
3. Atorvastatin 40 mg/tab 1 tab OD

Advice smoking cessation, moderate alcoholic beverage intake

Advice gradual weight loss
Daily BP monitoring
Moderate intensity exercises 3-4x/week

VCTB, MD
CARDIOLOGY: DYSLIPIDEMIA CPG 2020

Goal for patients with comorbid:

• LDL goal of less than 100 mg/dL for most persons with diabetes for
primary prevention
• Diabetes with >1 risk factor (male, smoker, hypertension ≥140/90
mmHg, BMI 25, family history of premature coronary heart disease,
proteinuria, left ventricular hypertrophy and postmenopausal women),
LDL-C goal of less than 70 mg/dL
• For individuals with ACS, early high-intensity statin that is maximally-
tolerated is RECOMMENDED and should not be discontinued (Adjunct:
Ezetimibe)
• Fibrates if TG >200 mg/dL

VCTB, MD
CARDIOLOGY: DYSLIPIDEMIA CPG 2020

VCTB, MD
CARDIOLOGY: HF

SAMPLE (HF)
Heart Failure with Reduced Ejection Fraction (EF = 38%), ACCF Stage C, NYHA IV
Coronary Artery Disease, Left Ventricular Hypertrophy
Valvular Heart Disease (Mitral and Aortic Regurgitation)
Atrial Fibrillation
Hypertensive Cardiovascular Disease
Metabolic Syndrome
Chronic liver congestion, T/C Alcoholic Liver Disease
T/C Acute Renal Failure on top of Chronic Kidney Disease G3A
S/P Myocardial Infarction (2010, 2016)

Address symptom: Give Furosemide 40mg IV Non-pharmacologic management:

- Give diuretic with blood pressure precaution • DASH and DM diet
- Monitor potassium levels • Limit fluid intake to less than 1.5L/day
- Monitor resolution of symptoms; may increase dose • Limit sodium intake
until congestion is resolved • Daily blood pressure monitoring
• Aerobic exercises 30 minutes per day, 3-5 times a week
• Losartan 50mg/tab 1 tab once a day • Smoking cessation
• Metoprolol succinate 25mg/tab 1 tab once a day • Abstain from or avoid excessive alcohol intake
• Spironolactone 25 mg/tab 1/2 tab once a day • Follow up after 1 week
• Empagliflozin 10 mg/tab 1 tab once a day
• Atorvastatin 80 mg/tab 1 tab once a day
• Rivaroxaban 15 mg/tab 1 tab once a day
• Aspirin 80 mg/tab 1 tab once a day
• Clopidogrel 75 mg/tab 1 tab once a day
VCTB, MD
CARDIOLOGY: HF

SAMPLE (HF) ACTUAL PATIENT

Heart Failure with reduced Ejection Fraction (EF: 28%)
Coronary Artery Disease, Lateral Wall Ischemia
Acute Kidney Injury, Resolving
To consider Chronic Kidney Disease secondary to Hypertensive Nephrosclerosis
Emphysematous gallbladder

Admit patient at ICU under the service of Drs._____

NPO temporarily. TPR qshift.
IVF: Heplock
Dx: CBC, BUN, Crea, AST, ALT, Na, K, Cl, UA, Serum Ca, Mg, Trop I then serial, ProBNP, 12LECG then serial, 2d echo with DS, CXR PA
Tx:
1. Aspirin 80 mg tab 1 tab ODPC
May go home
2. Clopidogrel 75 mg tab 1 tab OD
3. Atorvastatin 40 mg tab 1 tab ODHS Tx:
4. Enoxaparin 0.6 cc SC q24h 1. Enalapril 5 mg/tab 1 tab OD
5. Omeprazole 40 mg TIV OD 2. Carvedilol 6.25 mg/tab ½ tab BID
6. Furosemide 40 mg TIV q8h with BP precaution 3. ASA 80 mg/tab 1 tab ODPC
7. ISDN 5 mg tab 1 tab SL PRN for chest pain 4. Atorvastatin 40 mg/tab 1 tab ODHS
8. Captopril 25 mg tab ¼ tab q8h Follow up on ____
9. Metoprolol 50 mg tab ½ tab Q6
10. Diazepam 5 mg TIV PRN for agitation
11. Morphine sulfate 2 mg TIV PRN for sever chest pain
12. Dobutamine drip 250 mg + D5W 250 cc at 9 cc/hr to up/down titrate by 5 cc to maintain SBP >90/60 max 46 cc/hr

Moderate to high back rest, CBG AC/HS. Pls maintain cardiac monitor.VCTB,
Cardiac
MD rehab: complete bedrest without bathroom privileges.
CARDIOLOGY: MI

SAMPLE (ACS)
Admit patient at ICU under the service of Drs._____. Secure consent for admission and management.
NPO except for medications for first 12 hours, LSLF diet if tolerated thereafter.
IVF: 1L D5W to run for 24 hours KVO
Dx: 12L ECG STAT, Troponin I STAT, CBC, CRP, PT/PTT, Crea, Na, K, Ca, Cl, Mg, albumin, phosphorus, BUN, FBS, LP, CXR PA/L, 2D echo with DS
1. Aspirin 80 mg tab 4 tabs chewed and swallowed now, 1 tab PO OD thereafter
2. Clopidogrel 75 mg tab 4 tabs chewed and swallowed now, 1 tab PO OD thereafter
3. Enoxaparin 0.6 cc SC q24 for 5 days
4. Carvedilol 6.25mg/tab ½ tab PO q12
5. Atorvastatin 80 mg/tab 1 tab PO ODHS
6. ISDN 5 mg tab 1 tab SL PRN for chest pain
7. Enalapril 10 mg/tab 1 tab OD
8. Metoprolol 50 mg tab ½ tab Q6
9. Morphine sulfate 2 mg SIVP PRN for severe chest pain
10. Omeprazole 40 mg TIV OD pre-breakfast
11. Lactulose 30 cc PO ODHS, defer if BM >2x/day

VSq1, temperature q4
I and O qshift. Refer.

VCTB, MD
CARDIOLOGY: PAD

VCTB, MD
CARDIOLOGY: PAD

SAMPLE (PAD)
Acute Cellulitis, Moderate, foot, left
Chronic Limb-Threatening Ischemia, Rutherford Stage 5, Fontaine Stage IV,
WIfI Clinical Stage 2, foot, left
Coronary Artery Disease, Anterolateral wall ischemia
Left Ventricular Hypertrophy, Regular Sinus Rhythm
Hypertensive Cardiovascular Disease
Metabolic Syndrome
T/C Chronic Kidney Disease (G3bA1) probably secondary to
1) Diabetic Kidney Disease, 2) Hypertensive Nephrosclerosis

Non-pharmacologic management:
• DASH and DM diet
• Daily blood pressure monitoring
• Supervised exercise training programs for 30-45 minutes sessions, 3-5 times per week for at least 12 weeks
• Smoking cessation
• Abstain from or avoid excessive alcohol intake
• Feet should be kept clean and protected against excessive drying with moisturizing creams
VCTB, MD
• Wear well-fitting and protective shoes to avoid trauma
INFECTIOUS DISEASE: DENGUE

VCTB, MD
INFECTIOUS DISEASE: DENGUE

SAMPLE (DENGUE AND LEPTOSPIROSIS)

Dengue with Warning Signs
Moderate-Severe Leptospirosis

• DAT, IOFI
• Avoid strenuous physical
activities for 6 weeks
• Advise dengue preventive
measures such as proper
storage of water and self-
protection measures
• Advise leptospirosis
preventive measures such as
avoidance of wading in flood
• Educate patient regarding
pre- and post-exposure
prophylaxis for leptospirosis

VCTB, MD
INFECTIOUS DISEASE: DENGUE

SAMPLE (DENGUE WITH WARNING SIGNS) ACTUAL PATIENT

Dengue Fever with Warning Sign (Abdominal Pain)

Admit to room __ under the service of Drs. ___.

Secure consent for admission and management. TPR qshift.
DAT except dark colored food.
IVF: PNSS 1L 150 cc/hr
Dx: CBC q12, BUN, Crea, AST, ALT, Na, K, Cl, UA, CXR PA, 12-L ECG, Dengue IgG/IgM
Tx:
1. ORS sachet, 4 sachets in 1 L H2O, 2-3L/day
2. Paracetamol 300 mg TIV q4 PRN for fever
3. Omeprazole 40 mg IV OD

VSq4. Refer.

VCTB, MD
INFECTIOUS DISEASE: UTI

SAMPLE (ACUTE COMPLICATED PYELONEPHRITIS) ACTUAL PATIENT

Acute Complicated Pyelonephritis
Type II Diabetes Mellitus Uncontrolled
Acute Kidney Injury, Resolved

Please admit at room __ under the service of Drs. ____.

Secure consent for admission and management. TPR qshift.
DM diet, increase oral fluid intake.
IVF: PNSS 1 L x 80 cc/hr
Dx: UA, CBC, KUB UTZ, urine GS/CS (tailor fit diagnostics based on tests already done in the ER)
Tx:
1. Ceftriaxone 2 grams IV OD (THM Cefpodoxime 200 mg/tab 1 tab BID x 7 days)
2. Paracetamol 300 mg IV PRN x fever q4
3. Insulin glargine 10 units SC ODHS (THM Metformin 500 mg/tab 1 tab OD, insulin glargine 14 units SC ODHS)
4. Atorvastatin 40 mg/tab ODHS
5. Regular insulin 5 units SC PRN

CBG monitoring TID premeds. VSq4. I and O qshift. Refer.

VCTB, MD
INFECTIOUS DISEASE: SSTI

VCTB, MD
INFECTIOUS DISEASE: SSTI

SAMPLE (CELLULITIS) ACTUAL PATIENT

Cellulitis, moderate, left leg, resolving
T/C Chronic Venous Insufficiency

Admit to room __ under the service of Drs. ___.

Secure consent for admission and management. TPR qshift.
DAT
IVF: PNSS 1L x 80cc/hr
Diagnostics: CBC, BUN, Creatinine, Na, K, Cl, AST, ALT, Urinalysis, Chest x-ray, 12L ECG, Venous duplex scan, FBS, LP
Therapeutics:
1. Clindamycin 900mg/IV LD then 600mg/IV q8h (THM Clindamycin 300 mg/tab 1 tab q6 for 3 more days*)
2. Paracetamol 300mg/IV q4 PRN for fever (THM Paracetamol + Tramadol 325/37.5 mg tab 1 tab q8 PRN for
pain)
3. Diosmin + Hesperidin 450/50mg/tab BID (THM BID)

Refer to: IDS, Vascular Surgery, Dermatology. VS q4. I&O qshift. Refer.

VCTB, MD
NEURO: STROKE

SAMPLE (STROKE-INFARCT) INITIAL

NPO for now except meds
IVF: PNSS 1L x 16 hrs
Dx: plain cranial CT, CXR PA, 12L ECG, CBCPC, PT/PTT, RBS, Na, K, Crea, BUN, UA, LP
Tx:
1. Omeprazole 40mg TIV OD
2. Aspirin 80mg 4 tabs now then ODPC
3. Citicoline 1g TIV q12
4. Lactulose 30cc ODHS
5. BP control: long-acting oral maintenance meds + short-acting PRN oral meds OR Nicardipine drip 10mg in 90cc PNSS
10ugtt/min titrate by 5ugtt to maintain MAP 110-130
6. Blood sugar control: regular insulin 5u TIV PRN for CBG>200 and D5050 1 vial PRN for CBG<80
Insert NGT
Hook to O2 support via NC @ 2-3 lpm
Please maintain MAP 110-130, temp 34-37 deg Celsius, CBG 140-180, SpO2>94%
Seizure precaution
WOF: changes in sensorium, desaturation
VSQ4 w/NVS
I & O qshift. CBG AC/HS.
VCTB, MD
NEURO: STROKE

SAMPLE (LACUNAR STROKE) ACTUAL PATIENT

Cerebral Infarction, Lacunar, right middle cerebral artery in distribution, probably atherothrombic NIHSS = 3
Hypertensive cardiovascular disease, left ventricular hypertrophy, regular sinus rhythm I

Please admit under the service of Drs. __.

Secure consent for admission and management. TPR qshift.
DASH
IVF: PNSS 1L x 80cc/hr.
Dx: CBC, UA, Na, K , Cl, BUN, Crea, AST, ALT, 12L ECG, CXRPA, FBS, LP, AST, ALT, Hba1C
Tx:
1. ASA 80mg/tab 1 tab OD
2. Atorvastatin 80mg/tab 1 tab OD
3. T/S Losartan 50 mg/tab 1 tab OD
4. T/s Amlodipine 5 mg/tab 1 tab OD

VSq4. I and O qshift. Refer.

VCTB, MD
NEURO: ICH

SAMPLE (ICH)
Please admit at _ under the service of Drs._.
Secure consent for admission and management.
Diet: DASH with SAP.
IVF: PNSS 1L x 80 cc/hr.
Dx: CBC, UA, BUN, Crea, AST, ALT, Na, K, Cl, 12L ECG, CXR PA, Plain cranial CT, Cranial MRI with contrast, MRA, MRV, FBS, LP, 2D
echo with DS, Covid-19 NPS, OPS RT-PCR.

Tx:
1. Mannitol 20% 175 cc IV LD then 45cc IV q6.
2. Losartan 50 mg/tab 1 tab OD AM.
3. Amlodipine 10 mg/tab, 1 tab OD PM.
4. Captopril 25 mg/tab, 1 tab PO PRN for BP ≥ 160/100.
5. Paracetamol 600 mg IV q6 PRN for headache.
Referral: Neuro.
Moderate to high back rest.
CBG AC/HS.
VSQ4 with NVS.
Accurate I&O. Refer.
VCTB, MD
OB-GYNE

VCTB, MD
OPD
NEW OB PATIENT
Contact #

LMP, AOG, CC
Patient is GP (TPAL) who came in for her __ PNCU. Patient takes the following medications:___.
HPP:
1st trimester (cessation of menses, PT, NV/dizziness/dc, PNCU done?, meds, UTZ)
2nd trimester (quickening (16-20 wks), ab pain/dc/vomiting, PNCU, meds, UTZ)
3rd trimester (bleeding, labor pains, dc, fetal movement, PNCU, meds)
PMHx, FHx, PSHx
MIDAS, sexual history
OBGyn Hx (G, sex, outcome, mode, place, FMC)
General, VS, FHT *IE for term: the vagina is smooth, cervix is smooth, closed/dilated, non-tender
Assessment:
16 year old G2P1 (1-0-0-1) PU, 37 weeks AOG by LMP, CNIL
Plan:
MGH, DAT, AOFI
Dx: CBCPC, UA, BTRh, HBsAg, RPR/VDRL, HIV Screening, TVS/Pelvic/BPS with biometry, FBS, 75g OGTT
Meds: MV OD, FeSO4 OD, folic acid OD/ CaCO3 BID (1st tri/2nd-3rd tri)
Follow up (monthly for <28w, q2wks for 28-36 wks, q1wk >36 wks)
VCTB, MD
LTCS
DAY 1
Please admit under the service of Drs. ___.
Secure consent for this admission and management.
NPO temporarily.
IVF: D5LR 1L for 8 hours.
Diagnostics: CBC, UA, BTRh
Therapeutics:
1. Cefazolin 2g TIV
2. Metoclopramide 40mg TIV now
3. Ranitidine 50mg TIV now.
Book to anesthesia service for repeat Low Transverse Cesarean Section for scarred uterus.
VSQ1, FHTQ1. Refer.

POST OPERATIVE ORDERS:

S/P repeat low transverse caesarean section for scarred uterus under spinal anesthesia. To recovery room now
then to OB wards once stable. NPO for 6 hours. May have clear liquids after. Soft diet then diet as tolerated once
with BM. IVF: D5LR 1L with 40u oxytocin x 8hrs. Dx: Follow up pending labs. Tx: Tranexamic acid 1g q8 x 24hrs. Pain
medications c/o anesthesia service. Maintain tight abdominal binder. Daily body and perineal hygiene. Maintain
IFC for 6hrs. VSq15 at recovery room. Encourage breastfeeding.
VCTB, MD Refer.
LTCS
DAY 2
May have clear fluids.
Maintain heplock.
Diagnostics: None
Therapeutics:
1) Cefalexin 500 mg 1 tab q6 for 7 days
2) Multivitamins 1 tab once daily
3) Ferrous Sulfate 1 tab once daily
4) Malunggay capsule 1 cap TID
5) Mefenamic acid 500mg/tab q6 PRN
6) Tranexamic acid 2g TIV q8 for 24 hours

Daily body and perineal hygiene. Maintain tight abdominal binder. May remove indwelling foley catheter.
Continue breastfeeding.
VSQ4. Refer.

VCTB, MD
LTCS
DAY 3
May go home once with NBS.
Soft diet.
IVF: Remove heplock.
Diagnostics: None.
Therapeutics:
1) Cefalexin 500mg 1 tab q6 for 7 days
2) Multivitamins 1 tab once daily
3) Ferrous Sulfate 1 tab once daily
4) Malunggay capsule 1 cap TID
5) Mefenamic acid 500mg/tab q6 PRN
6) Iron Sucrose 2 amps now*

Daily body and perineal hygiene. Maintain tight abdominal binder. Daily wound care, care of ROD.
Continue breastfeeding.
VSQ4. Refer.

VCTB, MD
NSD
DAY 1
Please admit under the service of Drs. ___.
Secure consent for admission and management.
Diet as tolerated with strict aspiration precaution.
IVF: D5LR 1L + 10 units oxytocin for 8 hours.
Diagnostics: CBCPC, urinalysis, BTRH.
Medications: None.
Monitor progress of labor (plot partograph). Monitor vital signs every hour and fetal heart tones every hour. Refer.

POSTPARTUM ORDERS
S/P spontaneous vaginal delivery with right mediolateral episiotomy and repair.
To recovery room now then to OB wards once stable.
Diet as tolerated with strict aspiration precaution.
IVF: D5LR 1L + 10 units oxytocin for 8 hours.
Dx: Follow up pending labs.
Tx:
1. 10 units Oxytocin TIM now
2. Co-Amoxiclav 625 mg/tab every 8 hours for 7 days
3. Multivitamins 1 tablet once a day, Ferrous sulfate 1 tablet once a day, Malunggay capsule three times a day while breastfeeding
4. Mefenamic acid 500 mg every 6 hours as needed for pain

Keep uterus well contracted. Daily body and perineal hygiene. VS q15VCTB,
minutes
MD while at recovery room. Refer.
NSD
DAY 2
Diet as tolerated. Adequate oral fluid intake.
IVF: Maintain on heplock.
Dx: Follow up pending labs.
Tx:
1. Co-Amoxiclav 625 mg/tab every 8 hours for 7 days
2. Multivitamins 1 tablet OD
3. Mefenamic acid 500 mg/tab every 6 hours as needed for pain
4. Ferrous sulfate 1 tablet OD
5. Malunggay capsule TID while breastfeeding

Encourage breastfeeding. Daily body and perineal hygiene.

Monitor vital signs every 4 hours. Refer.

VCTB, MD
NSD
DAY 3
May go home once with newborn screening.
Diet as tolerated. Increase oral fluid intake.
Take home medications:
1. Co-amoxiclav 625 mg/tab every 8 hours for 7 days
2. Mefenamic acid 500 mg/tab every 6 hours as needed for pain
3. Multivitamins tablet OD
4. Ferrous sulfate tablet OD
5. Malunggay capsule TID

VSQ4.
Daily body and perineal hygiene. Continue breastfeeding.
Follow up at health center after 2 weeks. Refer.

VCTB, MD
THREATENED PRETERM LABOR

For workup of infection (CBC, UA, Urine GS/CS, Vaginal swab GS/CS)
For tocolysis of labor (Nifedipine 10 mg/tab every 8 hours; CI in HPN)
For Dexamethasone completion (Dexamethasone 6 mg IM every 12 hours x 4 doses)
Fetal surveillance (BPS with biometry and NST, with cervical length and funneling)
Fosfomycin 3g as single dose (if with asymptomatic bacteriuria)
Multivitamins tab OD, FeSO4 tab OD

Watch out for: signs of active labor, fetomaternal distress, watery discharge

OPTIONS FOR FETAL LUNG MATURATION

1. Dexamethasone 6 mg IM x q12h x 4 doses
2. Betamethasone 12mg IM x q24h x 2 doses

VCTB, MD
PROM

Diet: May have sips of water

IVF: D5LR 1 liter to run for 8 hours (mainline); D5LR 1 liter + 10 units oxytocin to run at 8-10 drops/minute
(sidedrip) – titrate to regular contractions
Dx: CBCPC, UA, BTRh
Tx:
1. Ampicillin 2g TIV q6 until delivery
2. Meperidine 25 mg/IM + Promethazine 25 mg/IM OR Nalbuphine 10 mg/IM

Monitor vital signs and uterine contractions.

Refer to Pedia and Anes

VCTB, MD
PRETERM LABOR

Monitor VS and uterine contractions

Hook to fetal monitor
Dx: CBC, UA
Tocolytic: Terbutaline ½ ampule SC (if not tachycardic); give remaining ½ ampule SC after 1 hour if there are still
contractions
Tx:
1. Dydrogesterone 10 mg/tab OD
2. Progesterone 200 mg/cap OD
3. Isoxuprine 10 mg/tab TID (defer if tachycardic)
4. Nifedipine 30 mg/tab loading dose then 10 mg/tab BID (defer if BP <90/60)

VCTB, MD
PRE-ECLAMPSIA

Secure consent for management and admission,

NPO or sips of water
IVF: D5LR 1 L to run for 8 hours (mainline); D5LR 1 L + 10 units oxytocin at 10-20 drops/minute (sidedrip)- titrate
accordingly
Dx: RT-PCR SARS-CoV2 SWAB or COVID-19 Antigen Rapid Test, CBCPC, UA, BTRh, UPCR, Crea, LDH, AST, ALT
Tx:
1. Hydralazine 5 mg/IV (total 20 mg)
2. MgSO4 4g IV in 100 mL NSS infused in 15-20 minutes; then side drip D5W 1 L + 20 g MgSO4 to run at 1 g/hr for
24 hours

Monitor vital signs and FHT.

Refer.

VCTB, MD
UNCOMPLICATED GC INFECTION

• Ceftriaxone 250 mg IM single dose OR

• Cefixime 400 mg/tab single dose OR
• Single dose injectible cephalosphorin + Azithromycin 1g PO single dose/ Spectinomycin 2g IM single dose if
allergic to penicillin
• PLUS treatment for chlamydial infection

VCTB, MD
OPHTHALMOLOGY

VCTB, MD
Corneal metallic foreign body, OD FB removal under topical anesthesia
Diquafosol E/S q8 to OD
Levofloxacin 0.5% E/S q6 to OD
Lid hygiene, avoid eye manipulation, avoid exposure to contaminated water, wear protective goggles
Contusion hematoma, OS secondary 4,000 U AT ()ANST; 0.5 ml TT
to trauma
Laceration upper lid, left Skull APL, Caldwell's, water's view; PNS CT and orbital CT 1-2mm cuts (coronal, axial, sagittal)
Subconjunctival hemorrhage, OS
Comotio retinae, OS Tobramycin E/O TID to affected area for 7 days
To rule out orbital fracture, left Cloxacillin 500 mg Q6 for 7 days (70 mg/kg/day)
Nepafenac E/S q6 OS
Atropine E/S q8, OS
Mefenamic acid 500 mg/cap q6 for pain

Suturing, wound cleaning, and dressing under local anesthesia

Proper wound care; cold compress 15 mins QID for the first 24 hrs, then warm compress 15 mins QID
thereafter
Laceration, left periorbital area 4,000 U AT ()ANST; 0.5 ml TT
Lid hygiene, avoid eye manipulation
Tobramycin E/O tid to affected area for 7 days
Cloxacillin 500 mg q6 for 7 days
Cold compress 15 min QID to OS for the first 24 hours then warm compress 15 min QID thereafter
Preseptal cellulitis secondary to acute Tobramycin E/S TID to affected eye
dacrocystitis Co-Amoxiclav 625 mg/cap BID
Paracetamol 500 mg/tab q6 PRN for pain
Warm compress, Criggler massage, lid hygiene
Avoid eye manipulation
Open globe injury, OS Admit under the service of Drs. __.
1) Corneoscleral perforating injury Secure consent for admission and management.
2) Traumatic hyphema OS NPO.
3) Iris prolapse OS Heplock.
4) T/c ruptured globe OS Dx: CBC with PC, UA, CXR PA/L, Skull AP/L, Caldwell’s view, Water’s View.
Medications:
1) Moxifloxacin E/S 1gtt to OS
2) Oxacillin 320mg TIV q6
3) Gentamicin 30mg TIV q8
4) Paracetamol 130mg TIV q6 PRN x pain
Maintain on eye shield. VSQ4. I&O Qshift. Refer.
Viral/bacterial conjunctivitis OR Tobramycin + Dexamethasone ointment TID
External hordeolum (new)
External hordeolum (recurring) Erythromycin E/O TID
Foreign body Levofloxacin 0.5% E/S q6 to OD
SURGERY

VCTB, MD
Pain medications • Dexketoprofen 25 mg/cap 2 caps q8 PRN OR
• Paracetamol + Tramadol 325/37.5 mg/tab q6 PRN OR
• HNBB 10 mg/tab q8 PRN

Abdominal pain at the ER 1. Omeprazole 40mg TIV

2. HNBB 10mg q8 TIV
3. Paracetamol 600mg TIV
4. Tramadol 50 mg TIV Q8

THM:
Omeprazole 20 mg 1 tab 30 min pre-breakfast for 14 days
HNBB 10 mg Q8 PRN pain
Para + Trama 325/37.5 Q6 PRN for pain

Muscle relaxant Eperisone 50 mg/tab q8 x 5 days

S/P suturing and dirty wounds Cloxacillin 500 mg/tab q6 x 7 days

Dexketoprofen 25mg/cap 2 caps q8 PRN x pain
Trauma ATS 4500 U adult 3000 U pedia
TT 0.5 mL IM adult
Abscess s/p ID Clindamycin 300 mg Q6 x 7 days
XRAY VIEWS

Ankle AP, lateral, Mortisse

Face Paranasal sinus series
Nasal bone STL
Foot AP/O/L
Hand PA/O/L
Wrist AP/L
Long bones AP/L
Clavicle AP/Velpeau (glenohumeral joint)
Shoulder AP/Scapular Y view
Hips AP/Frogleg
Spine AP/O/L
Knee AP/L/Skyline/Sunrise
Elbow AP/L/Greenspan
Orbits Waters view
Thoracic cage Left/Right VCTB, MD
ENT

VCTB, MD
Ear abrasion Cloxacillin 500 mg/tab q6 x 7 days (70 mg/kg/day for pediatrics; available at 125/5 or 250/5 mg/mL)
Foreign body impaction, (object), PND (polymyxin B + Neomycin + Dexamethasone) otic drops, 2-3gtts TID x 7 days
(laterality) Paracetamol 500mg tab q6 PRN for pain/ q4 for fever for adult, syrup for pedia (250/5 mg/mL)
Laceration ATS 4500 U adult 3000 U pedia
TT 0.5 mL IM adult
Paracetamol 500mg tab for adult, syrup for pedia (250mg/5ml) q6 PRN x pain
Cloxacillin 500 mg/tab q6 x 7 days (70 mg/kg/day for pediatrics; available at 125/5 or 250/5 mg/mL)
Ciprofloxacin 250 mg/ml q12 x 7 days
Mupirocin ointment apply TID to affected area

Daily wound care

Maintain compressive dressing
Epistaxis Sodium chloride nasal spray 2-3 times/day
Aphthous stomatitis Betadine throat spray, 2-3 sprays TID for 14 days
Aural Toilette 1:1 water: Hydrogen Peroxide, 2-3x/day
Soak for 10-15 minutes
Wipe excess solution
EAC Abrasions Ciprofloxacin + Dexamethasone otic drops 2-3 drops TID for 7 days
Acute otitis externa Ciprofloxacin + Dexamethasone otic drops, 2-3 drops TID for 7 days or PND otic drops
PE: Narrowed EAC Paracetamol 500 mg/tab for adult, syrup for pedia
Check for tragal tenderness Oral antibiotics if with internal involvement (fever, bilateral clogging, systemic symptoms)
Acute Otitis Media Most common etiology: Streptococcus pneumonia
Stage 1-2 DOC: Amoxicillin 80-90 mg/kg/day in 2-3 divided doses PO
Adult: Co-Amoxiclav 625mg/tab every 8 hours x 7days

Stage 2: add decongestant (Nafarin A) up to 5 days

Stage 3 Adult: Ciprofloxacin + Dexamethasone otic drops 2-3 drops TID x 7 days
Chronic: Ofloxacin otic drops 2-3 gtts TID x 7 days
Co-Amoxiclav 625 mg/tab q8 for 7 days
Pedia: Polymixin B + Neomycin + Dexa otic drops 2-3 drops, TID for 7 days
*do not use Ciprofloxacin - AE: tendon rupture
Keep ears dry. Avoid manipulation.
Impacted Cerumen Aural toilette, Cerumenolytics to soften, may follow-up for removal
PE: TM not visible Sodium docusate otic drops 2-3 drops, 3 times a day, for 7-14 days
Occasional hearing loss Pain meds
Occasional ear pain
Torus Palatinus Usually not treated
Surgical shaving if it affects patient’s life
Peritonsillar cellulitis Clindamycin 900 mg TIV as LD then 600mg q8
Factors: change of voice, uvula For THM: Clindamycin 300 mg/cap q6 x 7 days
deviation
Neck STL Xray to check for retropharyngeal abscess (serial, every 6 hours), CBC, CBG
Differentiate with peritonsillar abscess C2 = less than 7mm (adult) ; < 5mm (pedia)
thru aspiration (aspirate from soft C6 = adult: less than 21mm ; <14mm (pedia)
palate, using 10 cc syringe, 18G
needle, medially towards uvula to
avoid carotid artery)
Acute Tonsillopharyngitis, non Co-Amoxiclav 625 mg/tab 1 tab q8 x 7 days
exudative, bilateral Paracetamol 500 mg/tab for adult
Chlorhexidine gargle TID
TMJ Dislocation Eperisone 50mg/tab TID, 5 days
Paracetamol PRN q6
Barton’s Bandage
Foreign body impaction, nose Retract tip of nose
Cover mouth with gauze - to avoid aspiration upon removal
NaCl nasal spray TID
Co-amoxiclav 250mg/62.5mg 40mg/kg/day, TID (compute using Amoxicillin)
If battery: coordinate with Toxicology
PEDIATRICS

VCTB, MD
DENGUE
DENGUE
AGE

VCTB, MD
AGE

VCTB, MD
AGE

VCTB, MD
AGE

VCTB, MD
AGE

VCTB, MD
AGE

VCTB, MD
AGE

VCTB, MD
AGE

SAMPLE CASE
At the ER
Diet: Diet as tolerated
Fluids: IVF 171 cc PLR for the first hour then shift to 513 cc D5 0.3 NaCl to run for 102-103
cc/hour for 5 hours
MF: D5 IMB 1L 44-45 cc per hour to run for 24 hours
Labs: Fecalysis, Urinalysis, CBC, Na, K, Cl, chest x-ray
Medications:
1. Paracetamol 120 mg TIV q6 as needed for abdominal pain
2. ORS 2 liters per day
3. Probiotics once a day
4. Zinc sulfate 20 mg/ml 5 ml once a day

VCTB, MD
AGE

SAMPLE CASE
CWI: Ascariasis
Diet: Diet as tolerated
Fluids: None
Labs: None
Medications:
1. Mebendazole 100 mg/5 ml 5 ml q12 for 3 consecutive days
2. Paracetamol 120 mg TIV q6 as needed for abdominal pain
3. ORS 2 liters per day
4. Probiotics once a day
5. Zinc sulfate 20 mg/ml 5 ml once a day

VCTB, MD
PCAP

VCTB, MD
PCAP

Amoxicillin preparations: 250 mg/5 mL (60 mL) 125 mg/ 5 mL (60 mL)
Azithromycin: 200 mg/5 mL (15-20 mL per bottle)

VCTB, MD
Exudative Pharyngitis Amoxicillin 50 mg/kg/day PO q8h x 10 days (max 1g/day) (NOT CO-AMOXICLAV)
If allergic, Macrolides
Otitis media Amoxicillin 80-90 mg/kg/day PO q12h (<2y 10d, >=2 7d)
With anaphylaxis: Clarithromycin 15mkday PO q12h
Sinusitis Co-Amoxiclav 10-14 days
1-3 mos: 30 mkday q12
>=3 mos: 20-40 mkday q8h
Sepsis Ampicillin + Gentamicin/ Amikacin
Bacterial Meningitis <2 mos: Ampicillin/ Cefotaxime
>2mos-18yrs: Ceftriaxone
Prophylaxis: Rifampicin 10 mkday x 4 days for <3yo, 20 mkday for >3-10yo
UTI <2mos: Cefotaxime + Amikacin
2mos-18yrs: Cefuroxime 20-30 mkday PO q12h
Cefuroxime 250-500 mg PO q12h or Nitrofurantoin 5-7 mkday q6h max dose 400 mg/d
SSTI Cloxacillin 50-100 mkd in 4 doses