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Steps for Patient Managementa comprehensive manual for medical studentsDr. Soran Mohammed Gharib2015Cover and interior design: Mardin UzeriAll rights are reserved.No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without prior permission of the author.In The Name of GodThe Hippocratic OathI swear to fulfill, to the best of my ability and judgment, this covenant:I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.I will apply, for the benefit of the sick, all measures which are required, avoiding those twin traps of overtreatment and therapeutic nihilism. I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug. I will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery. I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. I must tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this responsibility must be faced with great humbleness and awareness of my own frailty. I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick. I will prevent disease whenever I can, for prevention is preferable to cure. I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm. If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.About this bookletDear student, this booklet you are holding in your hands is the accumulative fruition of nearly a decade’s earnest endeavor. I have been in charge of serving medical students for quite a time now and never lost rejoices and enthusiasm hitherto. This booklet employs a bulletin based approach and attempts to funnel what I regard as practical and useful into your ever expanding realm of medical knowledge. I have prioritized quality over quantity. The content has been condensed as much as essentiality permits. As an experienced practitioner, I have filtered the boundless dimensions of clinical basics into a comprehensive guide that will provide you with the confidence you need towards a successful medical career.Dr. Soran M. GharibAbout The AuthorInternist-RheumatologistMedical Doctor ( MD, MBChB)Internist ( Member of American college of Physician)ACPMember of (American college of Rheumatology)ACRMember of BSR ( British Society for Rheumatology)Mini- MBA ( Cambridge international college )Member of Importer & Exporter Union Kurdistan Region of IraqCertificate In medical LASER therapy ( USA)Diploma In HR Management07702142283dr.soran_medicine@Fb : Soran Mohammed GharibTABLE OF CONTENTHistory Taking……………………….………..……….11General Physical Examination…….………..……..21Investigation………………………………………….…28Treatment……………………………………..…………31Common Diseases…………………………..………..39Injection …………………………………………..…….51Cannulation …………………………………………….52Stomach Tube (NG ) Tube………………….……….53Main Types of Infusion Fluids…………………..…54References…………………………………………….…55Other Products of the Author ………………….…56Patient management Steps In Medicine1. History taking2. Physical Examination.3. Investigation (according to differential diagnosis).4. Diagnosis.5. Treatment.History TakingIntroductionFrom the very moment you see the patient, it is crucial to show professionalism and establish a first impression that evokes a feeling of comfort and trust. From here onwards, the patient will be more inclined to corporate and provide you with precise responses.Keep the following tips in mind:Always greet the patientAlertness; from the moment you first see the patient you should employ your eye, ears, nose and hands in a systematic fashion to collect the information tell the patients your name and why you are talking to themAlways give the patient your whole attention and never take shortcutsTry to observe the patient’s walk (gait) in the room. Experienced practitioners can suspect and foresee certain conditions such as thyroid diseases, hemiplegia, cyanosis and other symptoms and signs by a mere look at how the patient walksYou may meet a patient who cannot talk your language. When conducting an interviewed through an interpreter, keep your questions short and simple and have them translated answered one at a time.All question should not be asked in the leading way, so patient is left with a free choice of answers, e.g. if you say, “the pain moves to the right hand sides, doesn’t it?” So the patient may answer you yes, just to please you, but the question should be, “does the pain ever move?” and “where does it go?”46482066675How to Take the History1- NASORThis acronym sums up the most basics information to be gathered from your patient.Name: should be triple name Age: in yearsSex: male or femaleOccupation: brief description of jobResidence (location): where (s)he livesYou may also ask about blood group, marital status and religion.2-Chief Complaint and DurationThe chief complaint is the driving factor that makes the patient visit the hospital. Use short accurate questions to acquire the singular main reason the patient decided to visit you. 3- History of Present Illness A-PainPain is the unpleasant sensation of varying intensity. Tenderness may be assign detected by doctors or may be a symptom detected by the patient when he feels painful area. Ask about the following to investigate pain:SiteThe site describes the location and depth of the painful area. This is the most important factor to indicate the source of the pain. The patient may not be able to point out the exact site of the pain. Also ask the patient about the depth of the pain, common responses are superficial or deep.SeverityThis is how strongly the patient perceives the pain. Does the pain stop the patient from going to work? Or keep him awake at night? Pain severity is frequently expressed in terms of mild, moderate, and severe.Aggravating FactorsAnything which make the pain worse (e.g. exercise)Relieving Factors Anything which make the pain better (e.g. rest, heat)Diurnal Variation How does the pain behave in a 24-hour time span? For instance, some pains worsen at night and alleviate during day time.Radiation Some types of pain move within a repeating pattern, with the origin of the pain prevailing. For example, Sciatica is lower back pain that radiates down the leg and into the foot.Shifting (Referred) Painorigin of pain is in one site later pain shifts to another site and pain at original site disappears.Associated Features Is the pain correlated with any other condition?For example, abdominal pain may be associated with vomiting.Onset TimeDescribes the elapsed time period before the pain causes discomfort; usually addressed in terms of sudden and gradual.Nature of the PainSpecifies how the pain is felt. (e.g. burning pain, throbbing pain, stabbing pain)B-VomitingThe following details must be deduced through methodical inquiry:Frequency(more than 5 times a day should be admitted)ColorContains blood or notDoes it contain blood?Associated with diarrhea or notC-DiarrheaAsk about how often the patient defecates. You should ask about frequency defecation, colors, consistency with clear concise questions. If it turns out that the patient has diarrhea, make sure you know the following details:1-Frequency2-Color3-Contain mucus or not4-Associated with vomiting or not5-Amount6-Contain blood or not (important!) If the feces contain blood, ask further questions about the characteristics of the blood. Fresh blood originates from the lower GIT, dark blood from the upper GIT.Investigations are done via a General Stool Examination (GSE).D- Fever and RigorIf the patient has a fever, it usually fits one of these categories: Continuous: always high.Remittent: sometime becomes low but never reaches baseline temperature. Intermittent: high temperature, then reaches baseline. E- Dehydration Dehydration is usually associated with the following signs and symptoms:Absence of tearsDry tongueLoss of skin elasticityIncreased pulse rate Decreased BPDecreased urine outputTarry (dark) stool4- Review of body systemsGIT, Respiratory, CVS, Urinary and Genital, CNSA-Gastrointestinal Tract (GIT, Elementary System)AppetiteIncreased, decreased or unchanged?DietWeightVomitingDiarrheaB-The Respiratory SystemCoughHow often does it come? Does it come in certain posture? Is it dry or wet? SputumIts quantity, color, smell, tasteHemoptysis Mean presence of blood in sputumDyspneaCyanosis C- The Cardiovascular SystemBreathlessness (dyspnea)(like in respiratory system)Orthopnea: is the dyspnea occurring when lying flat. While paroxysmal nocturnal dyspnea is a sudden attack of dyspnea in the middle of the night which awakens the patient. These forms of dyspnea are commonly seen in the heart disease. PainCardiac pain is retrosternal or sometimes epigastric which may radiate to the neck or left arm. Its natures usually constricting,, it’s usually related to exercise.PalpitationEpisodes of tachycardia experienced by the patient or fluttering of the heartCough Sputum (same as respiratory system)D- The Urogenital SystemThirstHow often does the patient become thirsty? Does (s)he drink excessive water?MicturitionHow often does the patients pass urine? Is it painful? Nature and site of the pain? UrineIs there any blood in the urine? Color? Smell? Quantity?E-The Nervous System( CNS )Any history of stroke? Changes in the sense of smell, vision, or hearing? Peripheral nerves; ask about paralysis or weakness, any loss of cutaneous sensation of the pain, touch, temperature, presence parathesisea (tingling) in the limbs.5-Past medical historyIn a medical encounter, a past medical history (abbreviated PMH), is the total sum of a patient's health status prior to the presenting problem. (e.g. hypertension, diabetic)6-Past surgical historyHave any operations been done previously? When? Which operation? Did it have complications?7-Drug historyHas the patient taken any drugs? How often? Any reported allergies towards specific drugs?8-Family historyAre any diseases running in his or her family? (e.g. hypertension)9-Socioeconomic historyAsk about marital status, smoking, drinking alcohol, about unusual eating habit? Also ask about their source of their water and whether they keep animals at homeGeneral Physical ExaminationYou should be on the right side of the patient.Is the patient conscious or not?Comfortable or not?Cooperative or not?Orientation of patient for time, place & person?Vital SignsVital signs are measurements of the body's most basic functions. The four main vital signs routinely monitored by medical professionals include the following:Pulse rate Normal range: 60-100 bpm2084070119380Blood Pressure Normal range: 120-80 mmHgRespiratory rate (RR) Normal range: 16±2 breaths per minuteTemperature Normal range: 37±0.4 °CThe temperature in the axilla= temp. + 0.5The temperature in the rectum= temp. - 0.5Examination of the mouth20872452870201- Cyanosis: a bluish discoloration of the skin resulting from poor circulation.There are 2 types of cyanosis:Central cyanosis (on the tip of tongue and lips) Peripheral cyanosis (on the tip of the fingers)2- Pallor: pale color of the skin.We carefully examine the color of the tongue.3- Jaundice: Is a yellowish discoloration of the skin or conjunctiva. In mouth We look at the frenulum.20885159207563592710Examination of the neckWe examine the thyroid gland and the following lymph node groups through gentle palpation:SubmentalSubmandibular PreiauricularPostauricular OccipitalSupraclavicular105410375920CervicalHand examination234759524130Pallor(by comparing it with your hand) Clubbing is a deformity of the fingers and fingernails associated with a number of diseases, mostly of the heart and lungs.We test the angle of the nail to determine the presence of clubbing.Peripheral cyanosisTremor (Fine, Resting, Flapping)464185618490Resting tremor mostly indicates Parkinson’s disease. However, a flapping tremor is usually found in heart, renal, and liver failure.514985-3175-3810769620Lower limb examinationClubbingCyanosisEdema (Unilateral or Bilateral)2402205104140Pitting edema is examined by the Rule of One; that is pressing the thumb for one minute against the area behind the medial malleolus and depressing the skin one centimeter. If the depression persists, the test is positive. If the swelling is present in both limbs, it is called bilateral edema. The main causes of bilateral edema are heart failure, liver failure and renal failure.Bilateral edema with swelling of the face is caused by renal failure. An increase in the pulsation of the jugular vein (jugular pulse) with bilateral edema is caused by heart failure. Lymph node obstruction causes unilateral edema.2019301079505245102124075Investigations 1976120127001-Blood investigations:-Hb%normal range: 11-18% P.C.V normal range: 42±5%WBC normal range: 4000-11000 cells/μLESR normal range: 0-15 mm/hrHigh levels of ESR means either malignancy or severe inflammationBlood group2-Random Blood Sugar (RBS)normal range: 60-180 mg/dL3-Fasting Blood Sugar (FBS)normal range: 60-150 mg/dL4- Renal function test (kidney function test) Urea normal range: 15-45 mg/dLSerum Creatinine normal range: 0.1-1.2 mg/dL5- T.S.B (Total Serum Bilirubin)normal range: 0.1-1.2 mg/dL6- S. Cholesterol normal range: 150-240 mg/dL7- S. Triglyceridenormal range: 60-190 mg/dL8- G.S.E (General Stool Examination)9-G.U.E (General Urine Examination)10- PT pregnancy test either positive or negative11- IGg & IGm (for salmonella) either positive or negative13- Rose Bengal test either positive or negativeRadiologyThe most common radiologic diagnostic tools include: X-RayC.T. scanMRI Others:Ultra Sound U/S-266700519430ECGTreatment :Drug FormsTabletCapsuleAmpuleVialSyrup SuppositoryOintmentDropsPain killers (Analgesics)1-Paracetamol (Panadol?)Found as ampule, tab, drop, syrup and suppositoryFunction of paracetamol (indication):- To relieve pain and decrease feverTab for mild pain.Ampoule for severe pain. Rx (Treatment):Paracetamol tab 1x3 (10)Paracetamol is safe in pregnancySyrup is used for children. Suppository also for childrenParacetamol suppository 1x3Paracetamol syrup 1X3; tablespoon for adultsCoffee spoon -1X3 for childSuppository is more effective than the syrup in decreasing fever, so it is used for children with tonsillitis2-Diclofenac Sodium (Cataflam?, Voltaren?)Its injection is by IM (never IV)Found as ampoule, tab, suppository and ointmentIndication: Pain and spasmVoltaren is contraindicated in:Hypertension Gastric ulcerDuodenal ulcerAsthmaPregnancyIts side effect is bleeding in the case of high doses3- Tramadol Used for severe painRoutes of administration are IM, IV, or subcutaneouslyWhen it is used by IV, it may lead to vomiting. Therefore before injection of Tramal. Intravenously, you should inject Plasil (Metoclopramide) which has anti-vomiting effects. Hoverer in the case of IM, it will not lead to vomiting. Tramal should be dispensed only on prescriptionTramal in high doses may lead to addictionIt is found as ampoule and tab4-PethidineFound only as ampouleIts use may lead to addictionUsed by IM and IVIn the case of IV, it’ll lead to vomiting, so it should be used with PlasilIt affects the brain so it may lead to slight anesthesia and the patient may fall asleep subsequentlyUsed for severe painOther drugs1- Metoclopramide (Plasil?)It’s used against vomiting and nauseaIt’s found as ampoule, tab (1*2 before meal), syrup and drop (for children)Used by IM or IV2-Furosamide(Lasix?)It is a diureticFound as ampoule (IM/IV), tabUsed in hypertension3-Hydrocortisone (H.C.)Found as veil.Used by IM and IVIndicationAllergy AsthmaAnaphylactic shock.Example:Rx of asthma:O2Vial of hydrocortisone Ventolin inhaler (leads to bronchodilation)Antibiotics Most of them are found as vial.1-CeftriaxoneIt has a very wide range of use; used for both G-ve and G+ve bacteriaUsed for infections such as typhoid fever, brucellosisAlso used in pneumonitisIt’s given as 1x22-Metronidazole(Flagyl?) AntiparasiticUsed for diarrheaFound as tab, and as bottle (500 mg), also found as syrupCommon DiseasesUrinary tract infection ( UTI )UTI In pregnancy (admission case)Treatment:CannulaFluidAntibiotics like claforan 1x3Analgesia like paracetamol ampule 1x2UTI (outpatient)Treatment:Suprax capsule (400 mg) 1x1Paracetamol tab 1x2 Influenza or flu-like illness:The patient is commonly presented with fever, sore throat, headache, generalized body ache, runny nose, cough, bone pain, and loss of appetite.Treatment:Decadrone ampule (8mg) 1x2Voltaren ampule if it’s not contraindicated 1x1 or paracetamol ampule Lortin tab or fexofenadine tab 1x1Paracetamol tab or dolocold tab 1x3Solvodin syrup if there is coughing with itAntibiotic like suprax capsule 1x1 or azithromycine capsule 1x1 if there is bacterial infection.Tonsillitis in children:The child is usually presented with fever, hedache, runny nose, and sometimes with bone pain and abdominal pain.Rx:Ampiclox syrup 1x4 by teaspoon or azithromycine syrup 5cc x1 for 3 daysParacetamol suppository or syrup 1x3Lortin syrup 1x1 by teaspoonCommon cold in adults:The patient comes with runny nose, sore throat, and loss of appetite.Rx:Tolux tab 1x3 or Tullin D tab 1x3Anti-flu tab or anti-cold tab 1x3Vicks inhaler (Eucaliptus)Paracetamol tab 1x3Decadrone ampule 1x1 Common cold in children:The patient come with runny nose , sore throat , loss of appetite.Rx?1-Tullin D syrup 1x3 or Rhinoraz Syrup 1x32-lortin syrup 1x1( if you give Rhinoraz so you don’t need to give lortin)3-Paracetamol syrup 1x3Urinary tract infection (UTI) The patient usually comes with dysuria and pain in loin region, either unilateral or bilateral, or pain in suprapubic region over bladder.And occasionally, the patient may have fever, rigor, vomiting or nausea.Send for GUE and you see pus cell in GUEIf there is blood in urine better to send for abdomibal us to exclude renal stone.You can use one or combination of the followings:?Uricole powder: Uricol effervescent granule :For UTI m stoneCiprodar tablet (500 mg) 1x2;it is contraindicated in pregnancy and it should not be given to patient under age of 18.(Instead, we can use suprax)Gentamicine ampule 1x2Urisept tab 1x3Rawatin X tabParacetamol tab 1x3 or voltaren tab or ampoule if there is no contraindicationTyphoid Fever:The patient may come with(fever, rigor and abdominal pain, generalized body ache, dizziness, muscle pain, bone pain, headache, loss of appetite, sweating) for more than one week?Send for :IGg and Igm for salmonella if both positive then u decide that this is typhoid fever or at least if IGm is positive means he has typhoid fever . Blood culture (more sensitive) ?Treatment:Paracetamol ampule or tab 1x3?Antibiotic such as ceftriaxone vial (1 gm) 1x2IV fluid (1000 cc GS)Antipyretic (Paracetamol ampule 1x3)Doxydar capsule 1x2 Multivitamine four 1x1Brucellosis:The patient may come with (fever, rigor and abdominal pain, generalized body ache, dizziness, muscle pain, bone pain, headache, loss of appetite, sweating joint pain) for more than one week send for Rose Bengal test, if it is positive so it is brucellosis.best investigation is sending for IGg and IGm for brucella by ELISA test if positive so its brucellosis.or you can send blood for CS.?Treatment:??Ceftriaxone vial 1x2 or gentamicine (80 mg for adult, 40 mg for children) 1x2Paracetamole ampule 1x2Capsule Rifampicine 1x2Capsule Doxydar 100 mg 1x2 Bactrim tab 1x2 Vila streptomycin 1gm 1x1 IMToothache:?Rx:Voltaren ampule if there is no contraindication 1x1 IMVoltaren or paracetamol tab 1x3Flagyl tab 1x3 Amoxicillin capsule 1x3Citrolin mouth wash 1x2 every time for 5 minutes for mouth wash and gargling. Citrolin is an antiseptic mouth wash and gargle with anesthetic properties used for gingivitis, oropharyngitis, throat infections, and tonsillitis. Lidocaine spray for severe toothache.Irritable bowel syndrome (IBS):The patient comes with abdominal distension, abdominal pain, flatulence, constipation and sometimes diarrhea, anxiety, and nervousness.?Buscopan tab 1x3 Librax (chlordizepoxide) (5 mg) clidinium bromide tab (2.5 mg) 1x3 before mealDuspatalin (mebeverine)tab 1x3 before mealStelabid (isopropamide+trifluperazine)1x3 before mealLactulose syrup 1x3 or bisacodyl tab 1x1 if there is constipation with itDiabetes Mellitus?Glucophage (metformin) tab (500 mg) 1x2 or (850 mg) 1x1Glibinclamide (daonil) tab (5 mg) 1x1other new oral hypoglycemic tabletsinsulin (soluble and lenti)Nausea and VomitingYou can use one of the following according to age and severity of vomiting:Plasil (metochlopromide) ampule (10 mg) 1x1 (IV/IM)Plasil tablet 1x3 before meal Motilium tablet (10 mg) 1x3 or syrup before meal Plasil drop for children; to prevent nausea and vomiting1-3 years old = 10 drops x 33-5 years old = 20 drops x 35 years old = 40 drops x 3Plasil syrup : 1x3 by teaspoon before meal for children and enterostop tab 1x3 for 5 days if there is diarrhea with it, rehydration, antibiotic on need.Gastric pain or epigastric painYou can give one or combination of 2 or more of the following according to the severity of gastric pain:Tagamet (cimitidine) ampule (200 mg) 1x2 (IV/IM)Losec (omeprazole) capsule (20 mg, 40 mg) 1x2 before mealLosec vial (20 mg, 40 mg) 1x2 or as infusionRanitidine (zantac) tablet (150 mg) 1x2 before meal or zantac ampule (50 mg) IM/IVMaalox plus tab; for epigastric painMalos syrup; for epigastric pain1x3 tablespoon for adult 1x3 teaspoon for child?7. Gaviscon syrup; for epigastric pain1x3 tablespoon for adult after meal 1x3 teaspoon for child after meal Cough SyrupsSyrup bromhexine (solvodine) syrup 1x3 by spoon for productive coughSyrup tussileit 1x3 by teaspoon for pediatric age group for productive coughSyrup exidil (theophylline) 1x3 by teaspoon for pediatric age group for productive coughSyrup samilin 1x3 for adult and pediatric for productive coughSyrup ventolin (salbutamol) (a bronchodilator) 1x3 by teaspoon for pediatric age group for dry coughSyrup ketotifin 1x1 for pediatric for allergy for dry cough.Syrup calmex 1x3 for adult and pediatric for productive cough.Diarrhea and VomitingInvestigation: send for General stool examination (GSE), S. Electrolytes , RFT, and monitor urine output.?Treatment of DVD:Cannula IV fluid either RL (Ringer lactate), NS (normal saline), or GS(glucose saline)Flagyl tab (or syrup for children) 1x3, or ciprodar tab 1x2 or 1x3, or doxydar capsule (100 mg) 1x2 or (200 mg) 1x1Plasil tab (or syrup for children) 1x3 before meal or plasil ampule 1x2 Buscopan ampule (or syrup for children) for abdominal pain 1x2 or buscopan tab 1x2 ?Note:If vomiting occurs less than 5 times per day, there is no need for admission and no need for IV fluids, treat him as an outpatient.Herpes Simplex (Herpes Labialis)Skin lesions are visible on the patients lips. HC Or allermine tab or syrup 1x2Acyclovir (zovirax) tab 1x5 or ointment 1x3Note: Zovirax eye ointment is better than skin ointment Eye problems:Patient may come with red, painful, and runny eyes. You can prescribe one, two, or more of the following according to the severity of the disease:Chloramphenicol eye drop, 2 drops x3Tetracycline eye ointment 1x1(at night)Gentamicin eye ointment 1 x1 (at night)AcneDoxydar capsule (100 mg) 1x2 after mealBen oxide Gel or Lotion 1x1;Applied at night and washed in the morning with soapRetane or isortin (isotretinoic acid) (10 mg , 20 mg, 40 mg) 1x1?lincin (clindamicin) lotion 1x1 : either 1% or 2%; squeeze few drops of that solution on a small piece of cotton or face pad and apply to affected area twice daily after cleaning skin with soap and rinsing well with waterClindamycine lotion Golmar no acne soap 1x1Loss of AppetiteUse one of the following:?Cyproheptadine (periactin) tablet (4 mg) 1x3 before meal for adultsCyproheptadine (periactin) syrup 1x3 before meal for childrenRouza (pizotifen) syrup 1x2 for adults and childrenEarache?Otocain ear drop: 3 drops x3; for pain in earAntibiotic such as ciprodar ear drop 1x2Paracetamol or NSAID may be needed?Constipation:You can use one of the following:Cascara tab (5 mg) 1x2 or you can use (senna or sennade) tab: 2 tabs at nightBisacodyl tab or suppository (10 mg, 5mg) 1x1 or (2.5 mg) 1x1 in childrenLaxidyl suppositpry (10 mg) 1x1 for adult and (5 mg) 1x1 for childLaxidyl tab 1x1 or laxidyl suppository 1x3 Lactulose syrup 1x2 by teaspoon in children or elderly Abdominal painOne of the following:Buscopan ampule 1x1Buscopan tab 1x2InjectionIntravenous (IV) injectionTo ensure that the needle is within a vein, draw the syringe’s plunger. If blood is drawn, then you are within a vein.Intramuscular (IM) injection A common site for this kind of injection is the upper lateral quadrant of the buttock. When you inject the syringe, draw a small amount. If this test yields blood, don’t inject in that place because the blood means you hit the vein.2269490400050-50165200660CannulationIntravenous (IV) cannulation is a technique in which a cannula is placed inside a vein to provide venous access. Venous access allows administration of fluids, medications, nutrition, and chemotherapy.Cannula types Yellow cannula is used for childrenGreen cannula is the largest one and it’s used for shock conditionsAfter the green, the brown and blue and then pink come in sizeStomach tube (Nasogastric tube, NG)A nasogastric tube is a special tube that carries food and medicine to the stomach through the nose. When we use the NG tube, to ensure that it reaches the stomach, inject some amount of air in the tube while simultaneously putting the stethoscope on the stomach. You should hear the sound of bubbling of air in the stomach.NG tube is frequently used for gastric lavage and for cerebrovascular accident CVA patients. (Those patients can’t eat by mouth so he receives food and drugs by the tube.)110680512700Main Types of Infusion Fluids2019935132715An infusion set is used to intravenously administer fluids into the patient’s body.Most bottles have 500 ml volumes. Ringer’s LactateThis fluid is frequently used in dehydration. It doesn’t have contraindications.Glucose Saline (GS)Contains dissolved glucose that provides energy.It has one main contraindication due to its glucose content; it may not be used for diabetic patients.Normal Saline (NS)Contains a solution of NaCl. This solution is contraindicated in hypertensive patients.201549015303513652562230 References:1-Hutchisons Clinical Method Michael Swash , 21st Editio 20022-Macleods Clinical ExaminationGraham Douglas ,11th Ediction,20053-Mannual of Practical MedicineR.Alagappan, 1st Edition, 19984-Davidsons Principles and Practice of MedicineHaslet , Chilvers , Boon, Colledge,Hunter 19th Edition ,20025-The ECG Made Easy John R. , Hampton , 5th Edition,19986-Essentials of Applied ElectrocardiographyAtul Luthra ,1st Edition ,19937- UC UC San Diego , Division Of Medical Education 8- 9-My daily practice10- Other Products of the Author: Preparing the following Medical books : 1-History taking and Physical examination in Medicine 2-Guide For Newly Graduated Doctors 3-Clinical Orthopedic.4- Clinical Gynecology .5- Clinical ENT .6- Clinical psychiatry .7- Clinical Neurology .25 Cases in Clinical pediatric .9- History taking and physical examination in surgery .10- The most important subject for 4,5, 6 th stages that you have to know before the exam .11- OSCE exam for 6th stage .12- ECG interpretation.13- Common abdominal signs and symptoms .14-Theory exam Of previous years for 6th stage15- Collection of physiology exam of previous years for second stage medical students.POther Products In Kurdish Lnaguage:1-Hypertension2- Diabetes Mellitus.3-First Aid4-Breast cancer5-Leukemia6-AIDS7-Acne8-LASIK9-Mobile hazardous10-Typhoid Fever11-Sleep Disorders12-Rheumatodi Arthritis13-Osteo Arthritis ................
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