Medications in surgery
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- Blood trasfusion
P. 57
- shock
- Hyperklemia
Abs in common use
P. 124
- Hyponateremia
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IV fliuds
P. 55-56
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Prophylactic Abs
P.199
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- TTT against tetanus
(as soon as possible)
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- Prophylaxis against tetanus
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Early immunization during childhood + booster doses
On injury
Low risk : 0.5 ml toxoid initially then every 4 weeks
High risk: 0.5 ml IM toxoid + 250 units IM TIG + Abs
Neutralize toxin with TIG
(IM 3000-6000 units in vincinty of wound + repeated doses may be needed)
Excise and debride the suspected wound
Barbiturates
Diazepam reduce the needed dose of barbiturates
Ms relaxant e' mechanical ventilation is alternative
If respiratory problems
(30-6-% mortality)
Tracheostomy
or mechanical ventilation
Aqueous penicillin G 10-40 million units a day
to kill CL. & PREVENT FURTHER TOXINS
Nursing
Dark, quiet rrom, no sudden stimuli, no unnecessary movements
Nasogastric nutrition
Severe dilutational hyponatremia
No rapid correction of hyponatremia
Hypertonic 3% saline
Depletion hyponatremia
Enough amounts of normal saline ( sodiume chloride 9%) or Ringer latate
IV Ca gluconate
IV Na bicarbonate
Dextrose & insulin infusion
(10 units insulin + 20 gm glucose)
If fails ... Na polystyrene stilfonate , 50 gm in 70% sorbitol
( by mouth or enema)
If fails >>> dialysis
- Hypocalcemia
Acute >>> IV Ca gluconate
Chronic >>> Vit D, oral Ca, Al hydroxide
- Infections
Cellulitis
Penicillin group
Erysipelas
Penicillin group IV
Boils & carbuncle
Abs against staph.
Necrotizing fasciitis
Penicillin 20-40 million units/day IV + gentamycin 5mg/kg/day or amikacin 15mg/kg/day
Gas gangene (Cl.myositis)
Penicillin 20-40 million units/day IV
Penicillin allergy >>> clindamycin or metronidazole
Hyperbaric O2 may be used
TB
Chemothrapy : INH, rifampcin, pyrazinamide and ethambutul ( at least 2 drugs, at least 9 months)
Improve general condition
Local management
Fungal inf.
In oral inf. >> oral non-absorbable antifungula as nystatin
In severe infection >>> systemic antifungal therapy amphotericin B, 5 fluorocystosine & fluconazole