Medications in surgery

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  1. Blood trasfusion
    P. 57
  1. shock
  1. Hyperklemia

Abs in common use
P. 124

  1. Hyponateremia

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IV fliuds
P. 55-56

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Prophylactic Abs
P.199

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  1. TTT against tetanus
    (as soon as possible)

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  1. 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

  1. Hypocalcemia

Acute >>> IV Ca gluconate

Chronic >>> Vit D, oral Ca, Al hydroxide

  1. 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