internal-guide-book.pdf

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-13

(STABLE ANGINA) 1720 (ACUTE CORONARY SYNDROME) 2222

PCI/23

7 - 6 -

-13

(STABLE ANGINA) 1720 (ACUTE CORONARY SYNDROME) 2222

PCI/23

7- 7 -

13

17

22

23

20

22

CHF / 22

26 28

(APBS) 29(SVT) 29

29(CHRONIC ATRIAL FIBRILLATION) 33

(ATRIAL FLUTTER) 34(MAT) 34

WWW- 34(A-V BLOCKS) - 34

(VPBS) 35(VT) 35

TORSADE DE POINTES36WIDE COMPLEX TACHYCARDIA36

37 38

41

6

(PAF)

42COPD44

46

: 46495052

- 5355565758

58 60

61

DVT

:

63 / INR64

DIABETIC KETOACIDOSIS65 68

7 - 8 -

24

3031

31

3636

37

36

37

36

38

3938

40

43

31

35

28

42COPD44

46

: 46495052

- 5355565758

58 60

61

DVT

:

63 / INR64

DIABETIC KETOACIDOSIS65 68

7- 9 -

444648

485152545557585960

63

60

65

67

62

66

70

75 76

SYNCOPE77

TIA78CVA79

, 80( ) 81

82

8486

(UTI) 88/89

ERYSIPELAS91CELLULITIS92

,SEPTIC/DIABETIC FOOT93

/ 95

96IBD97

99SBP- ,TENSE ASCITES100

101

8

101 102

103

104

SHOCK106

107 109

112

113

G6PD 114 115 116

117 118

121 123

124 125

126

9 - 10 -

77

80

86

82

90

97

93

99

95

102

78

79

84

81

88

83

91

98

94

101

103

101 102

103

104

SHOCK106

107 109

112

113

G6PD 114 115 116

117 118

121 123

124 125

126

9- 11 -

103

105

111

106

108

114

116

120

118

125

127

104

109

115

117

123

119

126

128

- 127- 128 129

GLASGOW COMA SCALE130MINI MENTAL STATE TEST131

PEAK EXPIRATORY FLOW 132 133

CHADS2/CHA2DS2-VASC, HAS-BLED, ABCD2/ABCD3 SCORES

MODIFED WELLS CRITERIA

PAUDA PREDICTION SCORE

135136137138

10

NOACS (new oral anticoagulants)

-

.(gasping ) .( ) / /

.(21-600 ) .

. 10- - .( ) ,

. 5- , 100- 30 .

: .AIRWAY . -

2 , 30 1/3) 600-400 ,

5 .(.

.(QUICK LOOK)

:VT/VF

.14 , , ) , . CPR - (PEA

. pulse oxymeter - ( )

. .(16-14 , ) ,

. ,

. .

11 - 12 -

129

133

138

131

135

140

130

134

139

132

137

- .(gasping ) .( ) / /

.(21-600 ) .

. 10- - .( ) ,

. 5- , 100- 30 .

: .AIRWAY . -

2 , 30 1/3) 600-400 ,

5 .(.

.(QUICK LOOK)

:VT/VF

.14 , , ) , . CPR - (PEA

. pulse oxymeter - ( )

. .(16-14 , ) ,

. ,

. .

11- 13 -

. , . 2-

. . , :

.( 10-8) 8-6 . . , . . 100%-

: ,

.gain- , , . - VF , , . . ) TRANSCUTANEOUS PACING -

.(ICCU-. 3 5-3 I.V. ADRENALINE 1 mg . 10 2

:VF/VT . 360

: (30/2 / )

. 2 .

: . 360

: .30/2 /

: . .

:

12

. . . I.V. ADRENALINE 1 mg :

10 . 5-3 .NaCl 0.9%

. 360 , - VT/VF

300 I.V. AMIODARONE (PROCOR, AMIODACORE ) 360 .

GLUCOSE 20 150 I.V. AMIODARONE .

. 5% I.V. (POLYMORPHIC VT) TORSADES DE POINTES

NaCl 0.9% 100 - MAGNESIUM SULFATE 50% 4 cc = 2 gr. 15

- - - .

. , .(33 ) I.V. AMIODARONE . : :

, ICCU- . .

5-3 . I.V. ATROPINE 0.5 mg .( Mobitz II) . 3

. 0.5 -:

NaCl 0.9% 100 I.V. DOPAMINE (DOCARD) 200 mg.10 cc/h GLUCOSE 5%

) 3 Mobitz II A-V BLOCK. ICCU ,(

13 - 14 -

. . . I.V. ADRENALINE 1 mg :

10 . 5-3 .NaCl 0.9%

. 360 , - VT/VF

300 I.V. AMIODARONE (PROCOR, AMIODACORE ) 360 .

GLUCOSE 20 150 I.V. AMIODARONE .

. 5% I.V. (POLYMORPHIC VT) TORSADES DE POINTES

NaCl 0.9% 100 - MAGNESIUM SULFATE 50% 4 cc = 2 gr. 15

- - - .

. , .(33 ) I.V. AMIODARONE . : :

, ICCU- . .

5-3 . I.V. ATROPINE 0.5 mg .( Mobitz II) . 3

. 0.5 -:

NaCl 0.9% 100 I.V. DOPAMINE (DOCARD) 200 mg.10 cc/h GLUCOSE 5%

) 3 Mobitz II A-V BLOCK. ICCU ,(

13- 15 -

PULSELESS ELECTRICAL ACTIVITY (PEA):( , )

. / , , , : , - , , , ,

.M.I. , . 5-3 I.V. ADRENALINE 1 mg .Fluid Challenge

.31 :SVT .31 :

: - 10, I.V. CALCIUM GLUCONATE 10% :

. , , . 50 = 50, I.V. SODIUM BICARBONATE 8.4% :

, , - . PEA ,

. ,

. :

, , , , , .

. . . .

14

(STABLE ANGINA) :

: . . . . : ,( ) " , ,

.( ) :

, , : ) , , , ,

.(:

. . / .( 3-2 " " ) ISOSORBIDE DINITRATE (ISOKET SPRAY) - .

: ) ( " 4) 1 SYR. DIPYRONE (OPTALGIN)

.( :

: I.M./ I.V. MORPHINE 2.5-5 mg ) I.M./ I.V. METOCLOPRAMIDE (PRAMIN) 10 mg

.(COPD "

- ,. . .. .(20 ' ) ACS

: , ICCU - I.V. ISOSORBIDE DINITRATE (ISOKET) 20 cc = 20 mg

5 cc/h GLUCOSE 5% NaCl 0.9% 80 cc

15 - 16 -

(STABLE ANGINA) :

: . . . . : ,( ) " , ,

.( ) :

, , : ) , , , ,

.(:

. . / .( 3-2 " " ) ISOSORBIDE DINITRATE (ISOKET SPRAY) - .

: ) ( " 4) 1 SYR. DIPYRONE (OPTALGIN)

.( :

: I.M./ I.V. MORPHINE 2.5-5 mg ) I.M./ I.V. METOCLOPRAMIDE (PRAMIN) 10 mg

.(COPD "

- ,. . .. .(20 ' ) ACS

: , ICCU - I.V. ISOSORBIDE DINITRATE (ISOKET) 20 cc = 20 mg

5 cc/h GLUCOSE 5% NaCl 0.9% 80 cc

15- 17 -

. 100 cc/h ..

: :( )

.TAB. ASPIRIN (MICROPIRIN) 100 mg X1/d.

CAPS/TAB. OMEPRAZOLE (LOSEC, OMEPRADEX) 20 mg X1-2/d

: ) TAB. CLOPIDOGREL (PLAVIX) 75 mg X1/d

.( + ,CLOPIDOGREL (PLAVIX) -

- OMEPRAZOLE (LOSEC) - TAB. FAMOTIDINE (GASTRO) 20 mg X1/d

. ,PPI'S :( ) :

TAB. ISOSORBIDE MONONITRATE (MONONIT, MONOCORD)

: ( ) 20-40 mg X1/d: TAB. MONONIT RETARD 50 mg X1/d

: CAPS. MONOLONG 40-60 mg X1/dPATCH NITROGLYCERIN (NITRODERM TTS, DEPONIT) 5-10 mg/24 hrs

: : TAB. BISOPROLOL (CONCOR, CARDILOC, BISOLOL) 5 mg X1/d

: TAB. PROPRANOLOL (DERALIN, INDERAL, PROLOL) 10-40 mg X3-4/d: TAB. SLOW DERALIN 80-160 mg X1/d

: TAB. ATENOLOL (NORMITEN, NORMALOL) 25-100 mg X1/d.TAB. METOPROLOL (LOPRESSOR DIVITABS, NEOBLOC) 100-200 mg X1/d

. , , ,

16

.PRINZMETALS ANGINA , - :

: TAB. FELODIPINE (PENEDIL) 5-10 mg X1/d: TAB. AMLODIPINE (NORVASC, AMLOW) 5-10 mg X1/d

: TAB. LERCANIDIPINE (VASODIP) 10 mg X1/d: TAB. NIFEDIPINE (OSMO-ADALAT) 20-60 mg X1/d

: TAB. DILTIAZEM (DILATAM, LEVONEX) 30-60 mg X3-4/d: TAB. DILATAM CD 240 mg X1/d

: TAB. VERAPAMIL (IKACOR) 40-80 mg X3-4/d.TAB. VERAPAMIL SR (IKAPRESS, VERAPRESS) 120-240 mg X1/d

..

:

, , (27 ' ) ACE .( )

: . . . . , CPK MB )

.( , , , :( )

.HDL , .( ) . .

. ( ) / ,WPW , LBBB

, ST-T .( )

. ,. . . .

17

.(ATORVASTATIN, RESUVASTATIN) 75 .(SIMVASTATIN 75

- 18 -

.PRINZMETALS ANGINA , - :

: TAB. FELODIPINE (PENEDIL) 5-10 mg X1/d: TAB. AMLODIPINE (NORVASC, AMLOW) 5-10 mg X1/d

: TAB. LERCANIDIPINE (VASODIP) 10 mg X1/d: TAB. NIFEDIPINE (OSMO-ADALAT) 20-60 mg X1/d

: TAB. DILTIAZEM (DILATAM, LEVONEX) 30-60 mg X3-4/d: TAB. DILATAM CD 240 mg X1/d

: TAB. VERAPAMIL (IKACOR) 40-80 mg X3-4/d.TAB. VERAPAMIL SR (IKAPRESS, VERAPRESS) 120-240 mg X1/d

..

:

, , (27 ' ) ACE .( )

: . . . . , CPK MB )

.( , , , :( )

.HDL , .( ) . .

. ( ) / ,WPW , LBBB

, ST-T .( )

. ,. . . .

17


- 19 -

ACUTE CORONARY SYNDROME : ACUTE MI (CARDIAC ENZYMES/TROPONIN )

UNSTABLE ANGINA (NORMAL CARDIAC ENZYMES)

: . . . . . , , )

.( . .( ) PT/PTT .CRP :

: . . / .( 3-2 " " )

. 8-6 .( ) TAB. ASPIRIN (MICROPIRIN) 300 mg (ISOKET SPRAY ISOSORBIDE DINITRATE) -

: . " 5-2.5 I.V. MORPHINE

I.M./ I.V. METOCLOPRAMIDE (PRAMIN) 10 mg )

.(COPD - ,

: TAB. OXAZEPAM (VABEN) 10 mg.TAB. DIAZEPAM (ASSIVAL) 5-10 mg

. ,ICCU- I.V ISOSORBIDE DINITRATE (ISOKET) 20 cc = 20 mg : 10 cc/h GLUCOSE 5% NaCl 0.9% 80 cc . 100 cc/h .

. :

18

:( ) .TAB. ASPIRIN 100 mg X1/d

.

.CAPS/TAB. OMEPRAZOLE (LOSEC, OMEPRADEX) 20 mg X1-2/d

:( ) . 1mg/kg) S.C. ENOXAPARIN (CLEXANE) 60-80 mg X2/d

- . 4-2 . .(.I.V

.(23 ' - )

, T. CLOPIDOGREL (PLAVIX) 300 mg ( " 600 : 6- )

.T. CLOPIDOGREL (PLAVIX) 75 mg X1/d : ,CLOPIDOGREL (PLAVIX) -


. ,PPI'S : ,

.(18 ' ) - , , ,

75ACE INHIBITOR

: . . . . " . - - . .( CPK- CPK MB ) .PTT/PT . 24 )

.(

19

.(ATORVASTATIN, RESUVASTATIN) 75 .(SIMVASTATIN

.(27 ' ) ,

- 20 -

:( ) .TAB. ASPIRIN 100 mg X1/d

.

.CAPS/TAB. OMEPRAZOLE (LOSEC, OMEPRADEX) 20 mg X1-2/d

:( ) . 1mg/kg) S.C. ENOXAPARIN (CLEXANE) 60-80 mg X2/d

- . 4-2 . .(.I.V

.(23 ' - )

, T. CLOPIDOGREL (PLAVIX) 300 mg ( " 600 : 6- )

.T. CLOPIDOGREL (PLAVIX) 75 mg X1/d : ,CLOPIDOGREL (PLAVIX) -


. ,PPI'S : ,

.(18 ' ) - , , ,

75ACE INHIBITOR

: . . . . " . - - . .( CPK- CPK MB ) .PTT/PT . 24 )

.(

19

.(ATORVASTATIN, RESUVASTATIN) 75 .(SIMVASTATIN

.(27 ' ) ,

- 21 -

.( ) . . :

: . . . . .

: 4 . ( " 4) 1 SYR. DIPYRONE (OPTALGIN)

: / : / TAB. ORPHENADRINE-PARACETAMOLE (MUSCOL) 1 TAB. X3/d 500-250 TAB. NAPROXEN (NAXYN, NAPROXI) ,NSAID

. 3 400 TAB. IBUPROFEN (ARTOFEN, ADEX, NUROFEN) : ,:

. . , . , :

: :ANTACID-

SUSP. ALUM. HYDROX.-MAG. HYDROX. (MAALOX) 30 cc X4/d.

:H2 : TAB. FAMOTIDINE (GASTRO, FAMO, ROGASTI) 20-40 mg X2/d

: TAB. RANITIDINE (ZANTAB, ZANTAC, ZANIDEX) 150-300 mg X1-2/d: TAB. CIMETIDINE (TAGAMET, CEMIDIN) 400 mg X2/d

:PPI

20

TAB./CAPS. OMEPRAZOLE (LOSEC, OMEPRADEX)

. 20 .20 mg X1-2/d:

. .U.S .. "

PCI/ , ,( ) " :

. , 10.00 - ( ) 12.00 -

- .( ).

" 10 TAB. DIAZEPAM/OXAZEPAM (ASSIVAL/VABEN) : .

/ , : , )

.( . 5

. -'

. . T. CLOPIDOGREL (PLAVIX) 300 mg -

( 6- " 600) 6.PCI - " 75-

: : TAB. PREDNISONE .1 . 12 40 TAB. FAMOTIDINE (GASTRO) - 8 " 40

. 2 mg TAB. CHLORPHENIRAMINE (AHISTON) , I.V. METHYLPREDNISOLONE (SOLU-MEDROL) :

21 - 22 -

TAB./CAPS. OMEPRAZOLE (LOSEC, OMEPRADEX)

. 20 .20 mg X1-2/d:

. .U.S .. "

PCI/ , ,( ) " :

. , 10.00 - ( ) 12.00 -

- .( ).

" 10 TAB. DIAZEPAM/OXAZEPAM (ASSIVAL/VABEN) : .

/ , : , )

.( . 5

. -'

. . T. CLOPIDOGREL (PLAVIX) 300 mg -

( 6- " 600) 6.PCI - " 75-

: : TAB. PREDNISONE .1 . 12 40 TAB. FAMOTIDINE (GASTRO) - 8 " 40

. 2 mg TAB. CHLORPHENIRAMINE (AHISTON) , I.V. METHYLPREDNISOLONE (SOLU-MEDROL) :

21- 23 -

: 125 mgI.V. PROMETHAZINE (PROTHIAZINE) 12.5 mg

. 7 , 13 " 50 .2TAB. CHLORPHENIRAMINE (AHISTON) 2 mg

TAB. PROMETHAZINE (PROTHIAZINE) 12.5-25 mg. NaCl 0.9% :

12 ( 500 cc - ) 1000 cc TAB. N-ACETYL CYSTEINE ( - )

) 1200 mg X2/d (SIRAN).( ' 29

10-5- 500-1000 cc NaCl 0.9% :.( )

INR- : INR ' ) INR- FFP K ,1.5-

PT .1.5- INR- (66 .INR "

,:

: , , )

, , , , - , , , ,

.( , , . , ,CPK , , , , , " :

. . : . .

: . 15-10

22

.(90% 2 " " :COPD ) 95% . I.V. FUROSEMIDE (FUSID) 60-120 mg I.V./I.M. " 5-2.5 I.V. MORPHINE

METOCLOPRAMIDE (PRAMIN) 10 mg .

,CO2 , , /. -

: " 100 : , 2 ISOKET SPRAY

I.V. ISOSORBIDE DINITRATE (ISOKET) 2-4 mg.

I.V. ISOSORBIDE DINITRATE (ISOKET) 20 mg " 5 GLUCOSE 5% NaCl 0.9% 80 cc . " 30 .

. I.V , ,

: 6-8 I.V. DIGOXIN 0.25 mg : I.V. DIGOXIN 0.5 mg

) 1.5 mg ,.(

- , . ,HOCM, WPW ,

. . 0.5-0.8 ng/ml . :

. / - " 90- : ,

GLUCOSE 5% 100 cc I.V. DOPAMINE (DOCARD) 200 mg .20 cc/h NaCl 0.9%

I.V. DOBUTAMINE :( ) NaCl 0.9% 100 cc 250 mg (BUTAMINE, DOBUJECT)

23 - 24 -

.(90% 2 " " :COPD ) 95% . I.V. FUROSEMIDE (FUSID) 60-120 mg I.V./I.M. " 5-2.5 I.V. MORPHINE

METOCLOPRAMIDE (PRAMIN) 10 mg .

,CO2 , , /. -

: " 100 : , 2 ISOKET SPRAY

I.V. ISOSORBIDE DINITRATE (ISOKET) 2-4 mg.

I.V. ISOSORBIDE DINITRATE (ISOKET) 20 mg " 5 GLUCOSE 5% NaCl 0.9% 80 cc . " 30 .

. I.V , ,

: 6-8 I.V. DIGOXIN 0.25 mg : I.V. DIGOXIN 0.5 mg

) 1.5 mg ,.(

- , . ,HOCM, WPW ,

. . 0.5-0.8 ng/ml . :

. / - " 90- : ,

GLUCOSE 5% 100 cc I.V. DOPAMINE (DOCARD) 200 mg .20 cc/h NaCl 0.9%

I.V. DOBUTAMINE :( ) NaCl 0.9% 100 cc 250 mg (BUTAMINE, DOBUJECT)

23- 25 -

.10 cc/h GLUCOSE 5%.40 cc/h

,( , / ) , .( ) 350-400 cc -

. : - BIPAP " , 1- - ,4 - EPAP, 12 - IPAP : )

.(90% . :BIPAP

.10-5 PEEP ,40% .

: . . . . . - I.V. FUROSEMIDE (FUSID) 60-80 mg X2/d .TAB. FUROSEMIDE (FUSID) 40-80 mg X2-3/d -

TAB. HYDROCHLOROTHIAZIDE (DISOTHIAZIDE)

:( ) 12.5-25 mg X1/d ) TAB. METOLAZONE (ZAROXOLYN) 2.5-5 mg x1/d

.( . :

:( ) ,(35%>LVEF ) 3-4 NYHA CLASS - TAB. SPIRONOLACTONE (ALDACTONE, ALDOSPIRONE) 12.5 mg x1/d

: , , ,

:( ) , : TAB. KCl SR (SLOW K) 0.6-1.2 gr X2-3/d

24

POTASSIUM ORAL SOLUTION 1-3 gr X1-3/d

.SLOW K KCl

: ACE : TAB. RAMIPRIL (TRITACE) 1.25-2.5 mg X1/d: TAB. CILAZAPRIL (VASCACE) 2.5-5 mg X1/d: TAB. FOSINOPRIL (VASOPRIL) 10 mg X1/d

: TAB. ENALAPRIL (CONVERTIN, ENALADEX) 2.5-5 mg X1/d .TAB. CAPTOPRIL (ACERIL) 6.25-12.5 mg X3/d ACE

. ,ACE - ( )

: .TAB. CARVEDILOL (CARVEDEXXON) 3.125 mg X2/d

:( " / " 3 ) : ,ACE

) TAB. ISOSORBIDE MONONITRATE (MONONIT) 20-40 mg X2/d TAB. HYDRALAZINE (ALPHAPRESS) (

.( ) 10-25 mg X3-4/d. / " 150

. TAB. DIGOXIN 0.125-0.5 mg X1/d.

. :

. , . . . . , . .

25 - 26 -

POTASSIUM ORAL SOLUTION 1-3 gr X1-3/d

.SLOW K KCl

: ACE : TAB. RAMIPRIL (TRITACE) 1.25-2.5 mg X1/d: TAB. CILAZAPRIL (VASCACE) 2.5-5 mg X1/d: TAB. FOSINOPRIL (VASOPRIL) 10 mg X1/d

: TAB. ENALAPRIL (CONVERTIN, ENALADEX) 2.5-5 mg X1/d .TAB. CAPTOPRIL (ACERIL) 6.25-12.5 mg X3/d ACE

. ,ACE - ( )

: .TAB. CARVEDILOL (CARVEDEXXON) 3.125 mg X2/d

:( " / " 3 ) : ,ACE

) TAB. ISOSORBIDE MONONITRATE (MONONIT) 20-40 mg X2/d TAB. HYDRALAZINE (ALPHAPRESS) (

.( ) 10-25 mg X3-4/d. / " 150

. TAB. DIGOXIN 0.125-0.5 mg X1/d.

. :

. , . . . . , . .

25- 27 -

.ICCU- -

. ( ) . . . :

. 12 " . . STRIP . , , . . . , : ,

:

. ,. . . . -

-

: . , , . .

: .

: : P.O. (TAB.)/I.M./I.V. DIAZEPAM (ASSIVAL) 5-10 mg X1-3/d :

P.O. (TAB) OXAZEPAM (VABEN) 10 mg X1-3/d

: TAB./SUPP. PARACETAMOL (ACAMOL) 0.5-1 gr X3-4/d :: TAB./SYR. DIPYRONE (OPTALGIN) 0.5-1 gr X3-4/d

.TAB./SUPP. NAPROXEN (NAXYN) 250-500 mg X2/d

26

P.O. (TAB.)/I.V. FUROSEMIDE (FUSID) :(22 ' ) : 40-80 mg X1-3/d

: TAB. HYDROCHLOROTHIAZIDE (DISOTHIAZIDE) 12.5-25 mg X1/d-

8-6 ( ) TAB. DIGOXIN 0.25 mg: ( ) " 1.25

) TAB. DIGOXIN 0.125-0.25 mg X1/d

.( . : . : . : TAB. PROPRANOLOL :

20-80 mg X3-4/d (DERALIN, INDERAL, PROLOL)

.:

: TAB. PROPRANOLOL (DERALIN, INDERAL, PROLOL) 10-40 mg X3-4/d: TAB. ATENOLOL (NORMITEN) 25-100 mg X1/d

.TAB. METOPROLOL (LOPRESSOR, NEOBLOC) 50-100 mg X1/d

: TSH . -

27 - 28 -

P.O. (TAB.)/I.V. FUROSEMIDE (FUSID) :(22 ' ) : 40-80 mg X1-3/d

: TAB. HYDROCHLOROTHIAZIDE (DISOTHIAZIDE) 12.5-25 mg X1/d-

8-6 ( ) TAB. DIGOXIN 0.25 mg: ( ) " 1.25

) TAB. DIGOXIN 0.125-0.25 mg X1/d

.( . : . : . : TAB. PROPRANOLOL :

20-80 mg X3-4/d (DERALIN, INDERAL, PROLOL)

.:

: TAB. PROPRANOLOL (DERALIN, INDERAL, PROLOL) 10-40 mg X3-4/d: TAB. ATENOLOL (NORMITEN) 25-100 mg X1/d

.TAB. METOPROLOL (LOPRESSOR, NEOBLOC) 50-100 mg X1/d

: TSH . -

27

24

- 29 -

: . . . .

:.

: . " 10 I.V. CALCIUM GLUCONATE 10%

GLUCOSE 5% NaCl 0.9% " 100- " 200 I.V. DOPAMINE (DOCARD). " 15-5

.39 ' :.

. I.V. ATROPINE 0.5 mg : " 10 - I.V. GLUCAGON 5-10 mg :

NaCl " 100 " 10 : . NaCl 0.9%. ' 29 . 3 (5% ) 0.9%

:TAB. LEVOTHYROXINE (ELTROXIN) 25 mcg X1/d

.( 4-1 25- ) TSH , , :

. , :

. , .:

.TAB./CAPS. THEOPHYLLINE (THEOTRIM/THEOTARD) 100 mg X2/d- /

4 , I.V. ATROPINE 0.5 mg I.V. DOPAMINE (DOCARD) 200

.

ICCU -

28

5% 100-20

ATRIAL PREMATURE BEATS (APB'S)(. ) : .

.RHYTHMEX ,

PAROXYSMAL SUPRAVENTRICULAR TACHYCARDIA (SVT):

. . , . 20-10 .

. :

.10 cc NaCl 0.9% I.V. ADENOSINE (ADENOCOR) 6 mg .( ) 2 I.V. ADENOSINE (ADENOCOR) 12 mg :

: , 4 , 5-3 I.V. VERAPAMIL (IKACOR) 5 mg

: . .( , )

: ,( , ' 200-100)

. I.V. MIDAZOLAM (DORMICUM) 5 m:

: TAB. VERAPAMIL (IKACOR) 80 mg X3/d TAB. PROPRANOLOL (DERALIN, INDERAL, PROLOL) 10-40 mg X3-4/d .( ) ACUTE/PAROXYSMAL ATRIAL FIBRILLATION (PAF)

, -PAROXYSMAL : ) -PERMANENT , -PERSISTENT , ,60- -LONE .

.( :

:

29 - 30 -

ATRIAL PREMATURE BEATS (APB'S)(. ) : .

.RHYTHMEX ,

PAROXYSMAL SUPRAVENTRICULAR TACHYCARDIA (SVT):

. . , . 20-10 .

. :

.10 cc NaCl 0.9% I.V. ADENOSINE (ADENOCOR) 6 mg .( ) 2 I.V. ADENOSINE (ADENOCOR) 12 mg :

: , 4 , 5-3 I.V. VERAPAMIL (IKACOR) 5 mg

: . .( , )

: ,( , ' 200-100)

. I.V. MIDAZOLAM (DORMICUM) 5 m:

: TAB. VERAPAMIL (IKACOR) 80 mg X3/d TAB. PROPRANOLOL (DERALIN, INDERAL, PROLOL) 10-40 mg X3-4/d .( ) ACUTE/PAROXYSMAL ATRIAL FIBRILLATION (PAF)

, -PAROXYSMAL : ) -PERMANENT , -PERSISTENT , ,60- -LONE .

.( :

:

29- 31 -

,( , ' 200) . I.V. MIDAZOLAM (DORMICUM) 5 mg

.: ,

. 1. ) 2.

, .( -(rate control ) ,

, . ,.

: , 4 5-3 I.V. VERAPAMIL (IKACOR) 5 mg

) . , :(

: TAB. PROPRANOLOL (DERALIN, INDERAL, PROLOL) 10-20 mg X3/d TAB. ATENOLOL (NORMITEN, NORMALOL) 25-50 mg X1-2/d " 10 :

. I.V. CALCIUM GLUCONATE 10%

, , - :( )

6-4 I.V. DIGOXIN 0. 25 mg , I.V. DIGOXIN 0. 5 mg. " 1.5 ,

50% -.( NaCl 0.9% " 100- ' 2)

48- ,: ,

. ) S.C. ENOXAPARIN (CLEXANE) 60-80 mg X2/d - , -

2-3- " 10-5 TAB. WARFARIN (COUMADIN) .( ( , ) ,

, ) PT

30

.( PT

:( 48- ) + 200 cc I.V. AMIODARONE (PROCOR, AMIODACORE) 300 mg

( " 150 " 100 ) GLUCOSE 5% ,( 4 " ) 3 .

..

: 48 )

( ) (

,.

:-

: ( ) TAB. VERAPAMIL (IKACOR) 80 mg X3/d : TAB. PROPRANOLOL (DERALIN, INDERAL, PROLOL) 10-40 mg X3/d TAB. DIGOXIN 0.125-0.25 mg x1/d , , )

.( ,. :

: - ) - ,TEE

.( -

) 3 :(1.8 INR-

3- , .

,

) / 3

PT

31

NOAC (new oral anticoagulant)

NOAC

NOAC

.(140

,

.(32 ' -

- 32 -

.( PT

:( 48- ) + 200 cc I.V. AMIODARONE (PROCOR, AMIODACORE) 300 mg

( " 150 " 100 ) GLUCOSE 5% ,( 4 " ) 3 .

..

: 48 )

( ) (

,.

:-

: ( ) TAB. VERAPAMIL (IKACOR) 80 mg X3/d : TAB. PROPRANOLOL (DERALIN, INDERAL, PROLOL) 10-40 mg X3/d TAB. DIGOXIN 0.125-0.25 mg x1/d , , )

.( ,. :

: - ) - ,TEE

.( -

) 3 :(1.8 INR-

3- , .

,

) / 3

PT

31


NOAC

NOAC

.(140

,

.(32 ' -

- 33 -

. (TEE ) ( )

.:

:( ) ,-

: TAB. PROPAFENONE (RYTHMEX) 600 mg. 3-2 " 150-300

: , TAB. AMIODARONE (PROCOR, AMIODACORE) 400 mg X2-3/d

- TAB. AMIODARONE (PROCOR, AMIODACORE) 200 mg X1/d

) ,( ) (. ) ( ) ,(

: , : .TAB. FLECAINIDE (TAMBOCOR) 50 mg X2/d

. - TAB. SOTALOL 80 mg X2/d: ,

,( , ' 200). I.V. MIDAZOLAM (DORMICUM) 5 mg

. 7

.( ) :

- .

- , : . ,

. , ) TAB. SOTALOL 80 mg X2/d.(QT

32

:

, 48-

.(137 , ) CHA2DS2-VASc CHADS2

.

. ,

,2-

( 48- ) . :

,2-

,

)

3 HAS-BLED SCORE .(137

/ :LONE ATRIAL FIBRILLATION.

CHRONIC ATRIAL FIBRILLATION.( , 6- )

: : ( ) TAB. VERAPAMIL (IKACOR) 40-80 mg X3/d TAB. PROPRANOLOL (DERALIN, INDERAL, PROLOL) 10-40 mg X3-4/d

:TAB. DIGOXIN 0.125-0.25 mg X1/d

, , ).( ,

: .(115 ) PT ( ) TAB. COUMADIN

. ,2- CHADS2 )

(

33

NOAC

NOAC

NOAC

NOAC

NOAC

NOAC

NOAC


THS

.

(140

.(138 NOAC

CHA2DS2-VAScCHADS2

2

. 2

- 34 -

:

, 48-

.(137 , ) CHA2DS2-VASc CHADS2

.

. ,

,2-

( 48- ) . :

,2-

,

)

3 HAS-BLED SCORE .(137

/ :LONE ATRIAL FIBRILLATION.

CHRONIC ATRIAL FIBRILLATION.( , 6- )

: : ( ) TAB. VERAPAMIL (IKACOR) 40-80 mg X3/d TAB. PROPRANOLOL (DERALIN, INDERAL, PROLOL) 10-40 mg X3-4/d

:TAB. DIGOXIN 0.125-0.25 mg X1/d

, , ).( ,

: .(115 ) PT ( ) TAB. COUMADIN

. ,2- CHADS2 )

(

33

NOAC

NOAC

NOAC

NOAC

NOAC

NOAC

NOAC


THS

.

(140

.(138 NOAC

CHA2DS2-VAScCHADS2

2

. 2

117140

- 35 -

ATRIAL FLUTTER:( )

.PAROXYSMAL ATRIAL FIBRILLATION - ,( , ' 100-50)

. I.V. DORMICUM 5 mg.

MULTIFOCAL ATRIAL TACHYCARDIA (MAT) COPD ; P-R , P , )

( . .TAB. VERAPAMIL (IKACOR) 40-80 mg X3/d :

WPW - . . , :SVT

. , , : /

.Ia (PRONESTIL), Ic (RYTHMEX), III (PROCOR, SOTALOL)

- , , , , : 1st degree A-V block

.:2nd degree A-V block

. - MOBITZ 1= WENCKEBACH:

.ICCU - . I.V. ATROPINE 0.5 mg - MOBITZ 2

. ICCU - . . ICCU - :3rd degree A-V block

34

VENTRICULAR PREMATURE BEATS (VPB'S)

. (s/p MI ,LVH, CARDIOMYOPATHY)

.( ) : AMIODARONE- ,.(34 ' ) (PROCOR, AMIODACORE)

VENTRICULAR TACHYCARDIA (VT)

) monomorphic/polymorphic VT- .( QRS

: , VT- , ' 360-200)

. 5 mg I.V. DORMICUM ( VT-:

TORSADES DE - ) Q-T " . ,TORSADES DE POINTS- .(POINTS

I.V. AMIODARONE (PROCOR, AMIODACORE ) 150 mg - QT : . 10

. I.V. LIDOCAINE 100 mg . - VT- I.V. MAGNESIUM SULPHATE 50%

: TAB. AMIODARONE (PROCOR, AMIODACORE) 400 mg X3/d

- , TAB. AMIODARONE (PROCOR, AMIODACORE) 200 mg X1/d

) ,( ) ) ( ) ,(

.(. , , , :

35 - 36 -

VENTRICULAR PREMATURE BEATS (VPB'S)

. (s/p MI ,LVH, CARDIOMYOPATHY)

.( ) : AMIODARONE- ,.(34 ' ) (PROCOR, AMIODACORE)

VENTRICULAR TACHYCARDIA (VT)

) monomorphic/polymorphic VT- .( QRS

: , VT- , ' 360-200)

. 5 mg I.V. DORMICUM ( VT-:

TORSADES DE - ) Q-T " . ,TORSADES DE POINTS- .(POINTS

I.V. AMIODARONE (PROCOR, AMIODACORE ) 150 mg - QT : . 10

. I.V. LIDOCAINE 100 mg . - VT- I.V. MAGNESIUM SULPHATE 50%

: TAB. AMIODARONE (PROCOR, AMIODACORE) 400 mg X3/d

- , TAB. AMIODARONE (PROCOR, AMIODACORE) 200 mg X1/d

) ,( ) ) ( ) ,(

.(. , , , :

35- 37 -

TORSADES DE POINTES

) .(Ia, Ic, III

. , ' 360-200 I.V. MAGNESIUM SULPHATE 50% 2 gr = 4 cc ( 5 ) " 10

24 1000 cc I.V. MAGNESIUM SULPHATE 50%, 6 gr = 12 cc

.(42 cc/h )

WIDE COMPLEX TACHYCARDIA

VT.

.AV node- SVT VT: VT-

. ,M.I. A-V DISSOCIATION (atrial capture ,fusion beats) ,RBBB V1- 140 : QRS.LBBB V1- 160

. 180 90 :EXTREME AXIS DEVIATION :BBB QRS.V1- R :V1- RBBB

QRS :V1 - LBBB .V1- 100-60

. QRS:

. ' 100 , - I.V. AMIODARONE (PROCOR, AMIODACORE) - .(39 ) I.V. LIDOCAINE (33 ' )

.VT IKACOR

36

.13 , - VENTRICULAR FIBRILLATION (VF)

. -

. TAB. KCl SR (SLOW K) 0.6-1.2 gr. X2-3/d

. . -

. 10-5 I.V. ATROPINE O.5 mg ) Fab =

. (-

.( ) : . I.V. LIDOCAINE 100 mg.60 cc/h 1000 cc NaCl 0.9% I.V. LIDOCAINE 2 gr

100 cc " 250 I.V. PHENYTOIN , .( 50 mg/ min ) 10 NaCl 0.9% . " 1000 5 " 100 .GLUCOSE 5%-

,

NaCl 0.9%- .

/ , ,mEq/L 5.5< ,( ) , " 10- , " /' 10 30-15 NaCl 0.9%- .Fab I.V =

.:Fab-

- 0.8 " = Fab-

.0.5

- (ng/mL) = Fab-

.100 ( " )

37 - 38 -

. -

. TAB. KCl SR (SLOW K) 0.6-1.2 gr. X2-3/d

. . -

. 10-5 I.V. ATROPINE O.5 mg ) Fab =

. (-

.( ) : . I.V. LIDOCAINE 100 mg.60 cc/h 1000 cc NaCl 0.9% I.V. LIDOCAINE 2 gr

100 cc " 250 I.V. PHENYTOIN , .( 50 mg/ min ) 10 NaCl 0.9% . " 1000 5 " 100 .GLUCOSE 5%-

,

NaCl 0.9%- .

/ , ,mEq/L 5.5< ,( ) , " 10- , " /' 10 30-15 NaCl 0.9%- .Fab I.V =

.:Fab-

- 0.8 " = Fab-

.0.5

- (ng/mL) = Fab-

.100 ( " )

37- 39 -

Fab - , ,

. ". ,Fab

.

: . , , ,( ) , " . . . . . .

: :(EMERGENT HYERTENSION)

) .(

" 120 , , , ) ,(' , , , 100- )

: ( 3 " . 2 I.V. LABETALOL (TRANDATE) 20 mg

20 . LABETALOL . " 300

. " 100-

38

: URGENT HYPERTENSION

, 120 110- ,

: . 5-4 80 I.V. ISOSORBIDE DINITRATE (ISOKET) 20 cc = 20 mg

.5 cc/h GLUCOSE 5% NaCl 0.9% . 30 cc/h -

.( - ) TAB. FUROSEMIDE (FUSID) 20-40 mg . 4 .TAB. FELODIPINE (PENEDIL) 5 mg : ,

.TAB. CAPTOPRIL (ACERIL) 12.5-25 mg: , 120-

. :(ACE + ) 2 -

: TAB. LERCANIDIPINE (VASODIP) 10 mg X1/d : TAB. FELODIPINE (PENEDIL) 2.5-10 mg X1/d TAB. AMLODIPINE (NORVASC, AMLOW) 2.5-10 mg X1/d- ( ) ACE

: TAB. ENALAPRIL (ENALADEX) 10 mg X1-2/d 4-2 .TAB. CAPOTOPRIL (ACERIL) 12.5-25 mg X2/d: 50 mg X3/d

3-2 .TAB. RAMIPRIL (TRITACE) 1.25-2.5 mg X1/d.10 mg X1/d

. / - II

: 100 mg/d .TAB. LOSARTAN (OCSAAR) 25-50 mg X1/d .TAB. CANDESARTAN (ATACAND) 8-16 mg X1/d -

.TAB. HYDROCHLOROTHIAZIDE (DISOTHIAZIDE) 25 mg X1/d39 - 40 -

: URGENT HYPERTENSION

, 120 110- ,

: . 5-4 80 I.V. ISOSORBIDE DINITRATE (ISOKET) 20 cc = 20 mg

.5 cc/h GLUCOSE 5% NaCl 0.9% . 30 cc/h -

.( - ) TAB. FUROSEMIDE (FUSID) 20-40 mg . 4 .TAB. FELODIPINE (PENEDIL) 5 mg : ,

.TAB. CAPTOPRIL (ACERIL) 12.5-25 mg: , 120-

. :(ACE + ) 2 -

: TAB. LERCANIDIPINE (VASODIP) 10 mg X1/d : TAB. FELODIPINE (PENEDIL) 2.5-10 mg X1/d TAB. AMLODIPINE (NORVASC, AMLOW) 2.5-10 mg X1/d- ( ) ACE

: TAB. ENALAPRIL (ENALADEX) 10 mg X1-2/d 4-2 .TAB. CAPOTOPRIL (ACERIL) 12.5-25 mg X2/d: 50 mg X3/d

3-2 .TAB. RAMIPRIL (TRITACE) 1.25-2.5 mg X1/d.10 mg X1/d

. / - II

: 100 mg/d .TAB. LOSARTAN (OCSAAR) 25-50 mg X1/d .TAB. CANDESARTAN (ATACAND) 8-16 mg X1/d -

.TAB. HYDROCHLOROTHIAZIDE (DISOTHIAZIDE) 25 mg X1/d39- 41 -

-( ) : TAB. PROPRANOLOL (DERALIN, INDERAL, PROLOL) 20-40 mg X3/d : TAB. ATENOLOL (NORMITEN, NORMALOL) 25-100 mg X1/d .TAB. METOPROLOL (LOPRESSOR DIVITABS, NEOBLOC) 100-200 mg X1/d

, , .PRINZMETALS ANGINA , - ,

- ( , ) .TAB. DOXAZOCIN (CADEX, CARDORAL, DOXALOC) 1 mg X1/d

.16 mg X1/d 2-1 .

: 220 ( ) :

. 120 / 160 140 - :

. 120 100 - :

: . . . . . .

: .( ) VMA- .( ) . . +

40

:

: PT/PTT . . .

(.. ) - :

. " " ) S.C. ENOXAPARIN (CLEXANE) 1 mg/kg = 60-80 mg X2/d.(I.V. - .

./ 10-5 :( PT- )

.PT , , 2-3- .117 ,PT .3-2 INR-

. INR- -

.( ) INFERIOR VENA CAVA FILTER

.:

) 5-4 + .(

.PT ( ) 6-3 :

. . . .PT/PTT41

138 CTA CT

- 42 -

:

: PT/PTT . . .

(.. ) - :

. " " ) S.C. ENOXAPARIN (CLEXANE) 1 mg/kg = 60-80 mg X2/d.(I.V. - .

./ 10-5 :( PT- )

.PT , , 2-3- .117 ,PT .3-2 INR-

. INR- -

.( ) INFERIOR VENA CAVA FILTER

.:

) 5-4 + .(

.PT ( ) 6-3 :

. . . .PT/PTT41

138 CTA CT

- 43 -

) D Dimer

,.(

.( ) CT.

.

:.88 ' ,

::

- 110 , 25 :

50%- Peak expiratory flow (PEF) ,

: , 33%- PEF

, , , ,(silent lungs).COMA , ,

.peak flow meter peak expiratory flow .( ) .( ) :

3-2 " " - .

: ,2cc NaCl 0.9%- SOL. SALBUTAMOL (VENTOLIN) 2.5 mg = 0.5 cc

. 4-3 . 3 20

42

. anti B2 glycoprotein - antiphospholipid (APLA)/anti cardiolipin antibodies

138 CTA

.(134 ' )

:INH. IPRATROPIUM BROMIDE (AEROVENT)

. 6 2 cc NaCl 0.9%- :

I.V. METHYLPREDNISOLONE (SOLU-MEDROL) 125 mg

" 100 I.V. HYDROCORTISONE 100 mg X3/d -.5%

-TAB. PREDNISONE 40-60 mg X1/d

: , I.V. AMINOPHYLLINE 250-400 mg (5 mg/kg)

. 30 GLUCOSE 5% NaCl 0.9% 100 cc ,

:1000 cc I.V. AMINOPHYLLINE 1000 mg

.35-40 cc/h (0.5 mg/kg/h)

, ". S.C. ADRENALINE 0.3 mg :

. - )

,- :(

- TAB. DOXYLIN 100 mg X2

) 10 TAB. DOXYCYCLINE (DOXYLIN, DOXY) 100 mg X1/d

.( .PEF

: TAB. PREDNISONE 40 mg X1/d -

INHAL. FLUTICASONE PROPIONATE (FLIXOTIDE) 125-500 mcg = 1 puff X2/d

: . / 1000 .INHAL. BUDESONIDE (BUDICORT) 200 mcg = 1 puff X2/d

. / 1600

43

1 0.25

peak expiratory flow 10

- 44 -

:INH. IPRATROPIUM BROMIDE (AEROVENT)

. 6 2 cc NaCl 0.9%- :

I.V. METHYLPREDNISOLONE (SOLU-MEDROL) 125 mg

" 100 I.V. HYDROCORTISONE 100 mg X3/d -.5%

-TAB. PREDNISONE 40-60 mg X1/d

: , I.V. AMINOPHYLLINE 250-400 mg (5 mg/kg)

. 30 GLUCOSE 5% NaCl 0.9% 100 cc ,

:1000 cc I.V. AMINOPHYLLINE 1000 mg

.35-40 cc/h (0.5 mg/kg/h)

, ". S.C. ADRENALINE 0.3 mg :

. - )

,- :(

- TAB. DOXYLIN 100 mg X2

) 10 TAB. DOXYCYCLINE (DOXYLIN, DOXY) 100 mg X1/d

.( .PEF

: TAB. PREDNISONE 40 mg X1/d -

INHAL. FLUTICASONE PROPIONATE (FLIXOTIDE) 125-500 mcg = 1 puff X2/d

: . / 1000 .INHAL. BUDESONIDE (BUDICORT) 200 mcg = 1 puff X2/d

. / 1600

43

1 0.25

peak expiratory flow 10

- 45 -

: , : -

: INHAL. SALMETEROL (SEREVENT) 25 mcg = 2 puffS X2/d: DISC. SALMETEROL (SEREVENT) 50 mcg X2/d

.INHAL. CAP. FORMOTEROL (FORADIL) 1X2/d :( )

.TAB. MONTELEUKAST (SINGULAIR) 10 mg X1/d

: .( ) . . .

:

CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD):

. . - " . . :

.90% / 2-1 " " :( , ) . " 4 -EPAP , " 12 -IPAP : ) BIPAP / 1- - , , ) (90%

.(90% ,

- SOL. IPRATROPIUM BROMIDE (AEROVENT) 0.25 mg = 1 cc :

: / 4-2 2 cc NaCl 0.9% NaCl 0.9% - SOL. SALBUTAMOL (VENTOLIN) 0.5 cc

4-2 2.5 mg = 2cc

)

.(

44

.(45 ' ) -

TAB. THEOPHYLLINE (THEOTRIM) 100-300 mg X2/d

) 10-20 g/mL. .(10 g/mL-

CAPS. THEOPHYLLINE (THEOTARD)

. -

TAB. DOXYCYCLIN (DOXYLIN, DOXY) 100 mg X2

. 10 100 mg

.TAB. AMOXYCILLIN - CLAVULANIC ACID (AUGMENTIN) ,

. 10 - 875 mg X2/d - ,( )

- .TAB. ACETAZOLAMIDE (DIAMOX) 250 mg X1-2/d

. ( ) :

.90% . + - - .45 ' ," "

. COPD-

. -:

.( ) . . . .

45 - 46 -

.(45 ' ) -

TAB. THEOPHYLLINE (THEOTRIM) 100-300 mg X2/d

) 10-20 g/mL. .(10 g/mL-

CAPS. THEOPHYLLINE (THEOTARD)

. -

TAB. DOXYCYCLIN (DOXYLIN, DOXY) 100 mg X2

. 10 100 mg

.TAB. AMOXYCILLIN - CLAVULANIC ACID (AUGMENTIN) ,

. 10 - 875 mg X2/d - ,( )

- .TAB. ACETAZOLAMIDE (DIAMOX) 250 mg X1-2/d

. ( ) :

.90% . + - - .45 ' ," "

. COPD-

. -:

.( ) . . . .

45- 47 -

:

. . - PH . " . , ,

.

:

5-1 " " - ( )

.:

.( - ) LDH

LDH

, ,( ) PH , . + :

.( . ) )

,( ) , ZN ,.( ) , ,( ) +

: . .CRP , . CT . .RF, ANCA , ,TSH, ANA :

: .

- . 48- - : . 48

46

.90%

. . - , - , - :

, , , , : .

. . , , , , , , : .( )

.( ) :( " / " 400 )

/ 2.4 ) .( " / " 100 " / " 100

. - :

.SSRI's , , :

48- ) .NaCl 3% - / 110 - (

2 . / 12-10 ) / 1 ( ) / 4 ( / 110 8- / 0.5 18 . / 120

. 48 - /

, / / 0.5 : : / 110 . 24 / 10-8 - . 48 - / 18 -

( 48 ) .OSMOTIC DEMYELINATION -

47 - 48 -

. . - , - , - :

, , , , : .

. . , , , , , , : .( )

.( ) :( " / " 400 )

/ 2.4 ) .( " / " 100 " / " 100

. - :

.SSRI's , , :

48- ) .NaCl 3% - / 110 - (

2 . / 12-10 ) / 1 ( ) / 4 ( / 110 8- / 0.5 18 . / 120

. 48 - /

, / / 0.5 : : / 110 . 24 / 10-8 - . 48 - / 18 -

( 48 ) .OSMOTIC DEMYELINATION -

47- 49 -

" - ( ,Na

- ( , ) = - : , ) I.V. + -

.( - .

- - : .SIADH - . " 1000-500- - SIADH - : SIADH-

. I.V. NaCl 0.9% 1000 cc + I.V. FUROSEMIDE (FUSID) 40 mg:

, , , , , .

. TSH . . . . , +

: , , , , :

. . . ) , , , ,

.( :

. :

.I.V. Glucose 5% .

49- 51 -

: . .NaCl 0.9% ,

.(GLUCOSE 5% NaCl 0.45%)

: Water Deficit = [plasma Na - 140] x TBW

041 )sretiL(

( ) TBW.( ) 0.6- ( ) 0.5

.www.medcalc.com/sodium.html :

. 72-48 12 mEq/L : .0.5 mEq/hr . 0.5 mMole 12 mMole . 3 , .145 mEq -

. :

. , , . . .

: ) , , , ,

.( ) CPK , ,( . , . " .9-8 : TTKG= (Uk/Pk)/(Uosm/Posm)

50

4 3 7

: . - (U ,T ) " .( , ) : POTASSIUM ORAL SOLN. 1-3 gr = 13-40 mEq = 6.5-19.5 ml X2-3/d

TAB. KCl SR (SLOW K) 0.6-2.4 gr X2-3/d.(SLOW K KCl ) KCl ,( )

: / . - ) 1000 cc NaCl 0.9% KCl 1.5-3 gr = 20-40 mEq

. 20 mEq = 1.5 gr- (NaCl 0.9% " 100 - . 3-2

.( - ) 10

%9.0 lCaN cc0001 I.V. MAGNESIUM SULFATE 50%.250 cc/hr

: , TAB. SPIRONOLACTONE (ALDACTONE, ALDOSPIRONE) 25 mg X1/d

: . , . , , ) TSH

.( . . " . : .

51 - 52 -

: . - (U ,T ) " .( , ) : POTASSIUM ORAL SOLN. 1-3 gr = 13-40 mEq = 6.5-19.5 ml X2-3/d

TAB. KCl SR (SLOW K) 0.6-2.4 gr X2-3/d.(SLOW K KCl ) KCl ,( )

: / . - ) 1000 cc NaCl 0.9% KCl 1.5-3 gr = 20-40 mEq

. 20 mEq = 1.5 gr- (NaCl 0.9% " 100 - . 3-2

.( - ) 10

%9.0 lCaN cc0001 I.V. MAGNESIUM SULFATE 50%.250 cc/hr

: , TAB. SPIRONOLACTONE (ALDACTONE, ALDOSPIRONE) 25 mg X1/d

: . , . , , ) TSH

.( . . " . : .

51- 53 -

: ) "

.( - )

) , , ,( .(

. " . :7-

.9-8 : .

:

PR ,T ) " /7.5 mEq :(P , -

.

, ) I.V. CALCIUM GLUCONATE 10% 10 cc .( 5

. 50 mEq = " 50 I.V. SODIUM BICARBONATE 8.4%

.100 cc GLUCOSE 5%

- (K>6 mEq/l)

: 1000cc GLUCOSE 5% . 12 units REGULAR INSULIN +100 cc GLUCOSE 50%

. INHAL. SALBUTAMOL (VENTOLIN) 2-3 cc. 3

: . I.V. FUROSEMIDE (FUSID) 40-80 mg

: POWDER SOD. POLYSTYRENE SULPHONATE (KAYEXALATE) 15-30 gr x3/d

52

transtubular K gradient =TTKG= (Uk/Pk)/(Uosm/Posm)

QRS

- BISACODYL (LAXADIN) 2T X1/d : TAB. PHENOLPHTHALEIN (LAXATIVE)

.(LAEVOLAC, AVILAC) LACTULOSE " 30. , ' 30 KAYEXALATE

: . . . . . . . , .ACTH TEST .( 08.00- ) :

(130 ,129 ' )

::

.129 ' www.medcalc.com/acidbase.html

. , , , . :

. .(PH>7.45) (PH

- BISACODYL (LAXADIN) 2T X1/d : TAB. PHENOLPHTHALEIN (LAXATIVE)

.(LAEVOLAC, AVILAC) LACTULOSE " 30. , ' 30 KAYEXALATE

: . . . . . . . , .ACTH TEST .( 08.00- ) :

(130 ,129 ' )

::

.129 ' www.medcalc.com/acidbase.html

. , , , . :

. .(PH>7.45) (PH

. , , ,(. : ( )

. :(20- )

(

KCl

NaCl) .( , )

- . I.V. NaCl 0.9%

TAB. ACETAZOLAMIDE (URAMOX) 250-375 mg X2/d . PPI H2 .

, :20 . , .( , , )

. :

- 1.5X HCO3+821 PaCO2- .

. Anion Gap: AG=Na-(Cl+HCO3)- , ,DKA :(12 ) AG , , , , , - , ,

.HCO3+AG-12 .. AG - .( )(12-7) AG , . Na+K-Cl Urinary Anion Gap-

.(RTA) - . .

I.V. ,(HCO3

: .( , )

. .

: .( ) , , , , , ,

Corrected Ca = serum Ca + 0.8 X (normal albumin-patient albumin)

. . . . .:

.( ) ,( " 300-200) 6-4 I.V. NaCl 0.9%

. , ,.I.V. FUROSEMIDE (FUSID)

.( ) 20-40 mg X2-3/d .4 units/kg X2/d S.C./I.M. CALCITONIN (MIACALCIC)

8 units/kg X2/d .8 units/kg X4/d :

. . . - ( , , ) .TAB. PREDNISON 20-50 mg X2/d

: I.V. PAMIDRONATE (AREDIA) 60-90 mg , " 1000 , NaCl 0.9% " 500

55

(Ca> 12 QT

- 57 -

. 4

/ - .

: . , , .( ) . , .( , ) Parathyroid hormone (PTH) . . US

: , , ,( +) , , ,

. . . .

: , , , :

. . . - : ( - . . . , , ) . 10 I.V. CALCIUM GLUCONATE 10% 2 gr

500 cc GLUCOSE 5% I.V. CALCIUM GLUCONATE 10% 6 gr ,.8-9 mg % , 6-4

: . + 3 TAB. CALCIUM SANDOZ :

. 4-0.25 ,ALPHA D3

56

. -

: ,( ) , , , ,

. , . , .D ,PTH . ,

: , pH , , , , , , ,

. , )

.(:

, ,

: ,( ) , , , ,

. , . , .D ,PTH . ,

: , pH , , , , , , ,

. , )

.(:

, ,

. .D ,PTH

: . , pH , , , ,

: .( ) :

3 3-1 TAB. CALCIUM CARBONATE (CALTRATE) 600 mg- .55

, - . , 2-1

I.V. NaCl 0.9%

. :

. , pH , , , , .D , PTH

(ACUTE RENAL FAILURE, ACUTE KIDNEY INJURY=AKI ):

CPK

, , , , , , , "

. , + + .( )

. //

58

2.4-0.8

.( BUN ) urea/creatinine :

:20- . :40-.

:40- .urine Cr/plasma Cr :.

.[(urine Na/plasma Na)/(urine Cr/plasma Cr) X100 = FeNa] :2%- .. :1%-

FeUrea = : 35%- .[(urine urea/plasma urea)/(urine Cr/plasma Cr)] X100

.

.

. /mEq 20- 40-

/ 500- 350- .

: ,NSAID'S , )

.(' , , ACE,ARB .( )

:. - . 60-30 NaCl 0.9% 500-1000 cc :

.:

.I.V. FUROSEMIDE (FUSID) 100-400 mg. " :

. :

. .55-57 ' , ,

59 - 60 -

.( BUN ) urea/creatinine :

:20- . :40-.

:40- .urine Cr/plasma Cr :.

.[(urine Na/plasma Na)/(urine Cr/plasma Cr) X100 = FeNa] :2%- .. :1%-

FeUrea = : 35%- .[(urine urea/plasma urea)/(urine Cr/plasma Cr)] X100

.

.

. /mEq 20- 40-

/ 500- 350- .

: ,NSAID'S , )

.(' , , ACE,ARB .( )

:. - . 60-30 NaCl 0.9% 500-1000 cc :

.:

.I.V. FUROSEMIDE (FUSID) 100-400 mg. " :

. :

. .55-57 ' , ,

59- 61 -

.( / - ) . , :

, , : .

. :

. .( ) - , ( ) .

. . ANCA, VDRL, anti HCV, HBsAg, ANA, Complement - :

. ,ASLO, Anti GBM, PEP+IEP . :Acute Interstitial Nephritis - ( ) :papillary necrosis -

. . . .( ) .

(CHRONIC RENAL FAILURE, CHRONIC KIDNEY DISEASE=CKD)

: . , , , , , , " . + .

60

CPK

: NSAID'S , )

.(' ,ACE,ARB . .( / ) - . ,( 60-40)

-

. : " / " 7-

, TAB. CALCIUM CARBONATE (CALTRATE) 1.5-3 gram X3/d

POWDER SEVELAMER (RENVELA)

.55 - X : " / " 7 -

.CAPS. HYDROXY 1 VIT. D3 (ALPHA D3) 0.25-1 microgram X1/d : , - TAB. FOLIC ACID 5 mg X1/d, TAB. TRIBEMIN 1 T X1/d

.TAB. VITAMIN C 50 MG X1/d

: . . , , , , , - . . , )

: / + + + + "

.

61

B12 ,

2.4-0.8

- 62 -

: NSAID'S , )

.(' ,ACE,ARB . .( / ) - . ,( 60-40)

-

. : " / " 7-

, TAB. CALCIUM CARBONATE (CALTRATE) 1.5-3 gram X3/d

POWDER SEVELAMER (RENVELA)

.55 - X : " / " 7 -

.CAPS. HYDROXY 1 VIT. D3 (ALPHA D3) 0.25-1 microgram X1/d : , - TAB. FOLIC ACID 5 mg X1/d, TAB. TRIBEMIN 1 T X1/d

.TAB. VITAMIN C 50 MG X1/d

: . . , , , , , - . . , )

: / + + + + "

.

61

B12 ,

2.4-0.8

- 63 -

, : ) + : - , , + B12

.(soluble transferrin receptor, G6PD, Coombs, Hb electrophoresis

. .PT/PTT ,LDH,TSH, ( ) , .( ) . . .

: ) ,

- ) 2-1 - ( I.V. - .( B12 .FUROSEMIDE (FUSID) 20-40 mg

. - ,

8- ) .(

. :

. TAB. FERROUS SULPHATE (SLOW Fe) 1T X2/d - , I.M. VIT. B12 1000 mcg X1/d: B12 .

( ) EPOETIN BETA (RECORMON) 1500 IU X 3/week -

: . , ) S.C. DARBEPOETIN (ARANESP) 30 mcg X1/month

.( :

. - ( " ) .X 3

62

: . .( ) - ( )

. ( ) .( ) .RF, ANCA , ,ANA , - .( ) -

: . , " ,PT/PTT -

DVT - .. -

:-

) S.C. ENOXAPARIN (CLEXANE) 60-80 mg X2/d.(

.( )

- .IVC FILTER

: INR . 5-4 +

. ,(2 DVT . 6-3 :

,.(3-2 INR - ) PT

.

63

DEEP VEIN THROMBOSIS (DVT) :

( 139 DVT

.32 ' -

- 64 -

: . .( ) - ( )

. ( ) .( ) .RF, ANCA , ,ANA , - .( ) -

: . , " ,PT/PTT -

DVT - .. -

:-

) S.C. ENOXAPARIN (CLEXANE) 60-80 mg X2/d.(

.( )

- .IVC FILTER

: INR . 5-4 +

. ,(2 DVT . 6-3 :

,.(3-2 INR - ) PT

.

63

DEEP VEIN THROMBOSIS (DVT) :

( 139 DVT

.32 ' -

- 65 -

: .PT/PTT . . . + CT -

. - - DVT

) :(

LAC (LUPUS ANTICOAGULANT), ANTIPHOSPHOLIPID Ab (APLA),

, ,S ,C ANTI BETA-2 GLYCOPROTEIN,.PT20210 , ,3 ,APC RESISTANCE

. ( )

.

:

. " .PT/PTT:

.FFP 4-2 - . 2 - - . INR - INR 3-5

SOL. VITAMIN K . - INR 5-9.( ) 1-2.5 mg

SOL. VITAMIN K . - INR >9.( ) 2.5-5 mg

.(K , 10- INR- ) I.V. VITAMIN K 10 mg . - INR > 20

64

4-2 . 5% " 100 .FFP

: . " .PT/PTT

DIABETIC KETOACIDOSIS

: . . , , . . . " .( ) , , , , ,pH , , , , , , :

. , .

Na-(Cl+HCO3) = ANION GAP .( ) . . . . . :

. 2 :

: NaCl 0.9% . - NaCl 0.9% + 0.45% " / " 200 -

. 4 / ,GLUCOSE 5% NaCl ) ,

.( . - (CVP)

65 - 66 -

4-2 . 5% " 100 .FFP

: . " .PT/PTT

DIABETIC KETOACIDOSIS

: . . , , . . . " .( ) , , , , ,pH , , , , , , :

. , .

Na-(Cl+HCO3) = ANION GAP .( ) . . . . . :

. 2 :

: NaCl 0.9% . - NaCl 0.9% + 0.45% " / " 200 -

. 4 / ,GLUCOSE 5% NaCl ) ,

.( . - (CVP)

65- 67 -

: /mEq 5

.1-2 gr KCl " 1000 , ":

: . I.V. REGULAR INSULIN 10-20 UNITS

: .1000 cc NaCl 0.9% I.V. REGULAR INSULIN 100 UNITS

. 100 cc - .( 10-6 - ) 60-100 cc/h . " / " 200-150 , I.V. I.M. , .% " 400-

.( ) I.M. I.M. REGULAR INSULIN 20 UNITS -

. REGULAR INSULIN 6-10 UNITS:

pH

. : , - S.C. ENOXAPARIN (CLEXANE) 40 mg X1/d :. ,

. ::

, , . ( , , )

. ,15 , ANION GAP -

. 2-1 - - ,

S.C. .S.C.

I.V.

. I.V.:

: TAB. KCl SR (SLOW K) 0.6-1.2 gr X2-3/d

.POTASSIUM ORAL SOLN. 1-3 gr X2-3/d

: . , , , , . . , . , . . . .

67

30

- 69 -

6869

HbA1C

.(76 BASAL-BOLUS

76 BASAL-BOLUS METFORMIN

HbA1C 76 BASAL-BOLUS180 8%

76 BASAL-BOLUS180

6.5%

- 70 -

69

HbA1C

.(76 BASAL-BOLUS

76 BASAL-BOLUS METFORMIN

HbA1C 76 BASAL-BOLUS180 8%

76 BASAL-BOLUS180

6.5%

- 71 -

70

2 250 180 3 300 251 4 350 301

1 35050

71

0.8

:TPN 24total daily dose

.(74 BASAL-BOLUS

180

5%

- 72 -

71

0.8

:TPN 24total daily dose

.(74 BASAL-BOLUS

180

5%

- 73 -

7273

170

10

1570-

100

70-

70-% 70-

SC IV

(77

- 74 -

73

170

10

1570-

100

70-

70-% 70-

SC IV

(77

- 75 -

74

BASAL-BOLUS 2

250-180300-251

0.40.5

50%

3-

180

TDD180

-

24

SC

180-11070-

180-80

20%-

TDD

Total Daily Dose (TDD)

TDD 24

20%-

: :

. ) C-PEPTIDE - , , :

. .( : .2X . .

: -

.( ) .% 45-30 - 15-10 / )

.( 60 , 30

. 15

. -

: central line - I.V. GLUCOSE GLUCOSE 50%

. I.V. GLUCOSE 10%. 1 S.C. GLUCAGON - -

:.( 15- )

. .

: . - . C peptide , -

75

75

2 201:1

- 76 -

: :

. ) C-PEPTIDE - , , :

. .( : .2X . .

: -

.( ) .% 45-30 - 15-10 / )

.( 60 , 30

. 15

. -

: central line - I.V. GLUCOSE GLUCOSE 50%

. I.V. GLUCOSE 10%. 1 S.C. GLUCAGON - -

:.( 15- )

. .

: . - . C peptide , -

75

75

2 201:1

- 77 -

. , , .

:

.PTT ,PT , , , , , " " ) ACTH ( ) .( /

. . , , . . , . , : :

: ACTH- .I.V. HYDROCORTISONE 100 mg X3/d

- ,ACTH - ACTH I.V. DEXAMETHASONE 10 mg

.( " , , ) . I.V. NaCl 0.9% + GLUCOSE 5% .(M.I.)

:

.:

- . " 2.5 , " 5 TAB. PREDNISONE : " . 3 - I.V. HYDROCORTISONE 50 mg X3/d -

. , 4-3 -

.

76

- TAB. FLUDROCORTISONE (FLORINEF)

, . - .100 mg/day -

- 50 " .

: . , . , , ACTH TEST -

. . , ACTH

: .

,PTT ,PT, PPD, HIV, CMV, ,FT4 ,TSH , PROLACTIN, FSH/LH , IGF1 ACTH

.( ) .

. CT .

SYNCOPE:

.' , - . . . . . , , ":

. .SYNCOPE-

77 - 78 -

- TAB. FLUDROCORTISONE (FLORINEF)

, . - .100 mg/day -

- 50 " .

: . , . , , ACTH TEST -

. . , ACTH

: .

,PTT ,PT, PPD, HIV, CMV, ,FT4 ,TSH , PROLACTIN, FSH/LH , IGF1 ACTH

.( ) .

. CT .

SYNCOPE:

.' , - . . . . . , , ":

. .SYNCOPE-

77- 79 -

:

. . . .. . .

.EEG - ,( ) : TILT TABLE TEST ,( )

, .( - ). CT ANGIOGRAPHY -

CT- .(TIA/CVA- )

TRANSIENT ISCHEMIC ATTACK (TIA): .PT/PTT , , , " . . .:

TAB. ASPIRIN 300 mg X1/d .

CAPS/TAB. OMEPRAZOLE (LOSEC, OMEPRADEX) 20-40 mg x1-2/d

TAB. CLOPIDOGREL (PLAVIX) 75 mg ,.X1/d

: - TIA-: TAB. CLOPIDOGREL (PLAVIX) 75 mg X1/d

TAB. ASPIRIN + DIPYRIDAMOLE CF (AGGRENOX) 25+200 mg X2/d

: S.C. ENOXAPARIN (CLEXANE) + TAB. WARFARIN (COUMADIN) -

.(32-33 ' )

:

. . .78

300-75 24 TIA300 75

75


.(137 ) ABCD2 SCORE - CT ABCD2- 48 - -

CEREBROVASCULAR ACCIDENT (CVA): 4.5-3-

.: 4.5

: .PT/PTT , , , " . . . .( ) CT

:: CT-

.TAB. ASPIRIN 300 mg X1/d.

: CAPS/TAB. OMEPRAZOLE (LOSEC, OMEPRADEX) 20-40 mg x1-2/d

-.TAB. CLOPIDOGREL (PLAVIX) 75 mg X1/d

: - CVA - , TAB. CLOPIDOGREL (PLAVIX) 75 mg X1/d

: TAB. ASPIRIN + DIPYRIDAMOLE CF (AGGRENOX) 25+200 mg X2/d

: S.C. ENOXAPARIN (CLEXANE) + TAB. WARFARIN -

.(32-33 ' ) (COUMADIN)

: .( ) CT . . -

79

24 minor CVA300 75 300-75

75

3.3


- 80 -

.(137 ) ABCD2 SCORE - CT ABCD2- 48 - -

CEREBROVASCULAR ACCIDENT (CVA): 4.5-3-

.: 4.5

: .PT/PTT , , , " . . . .( ) CT

:: CT-

.TAB. ASPIRIN 300 mg X1/d.

: CAPS/TAB. OMEPRAZOLE (LOSEC, OMEPRADEX) 20-40 mg x1-2/d

-.TAB. CLOPIDOGREL (PLAVIX) 75 mg X1/d

: - CVA - , TAB. CLOPIDOGREL (PLAVIX) 75 mg X1/d

: TAB. ASPIRIN + DIPYRIDAMOLE CF (AGGRENOX) 25+200 mg X2/d

: S.C. ENOXAPARIN (CLEXANE) + TAB. WARFARIN -

.(32-33 ' ) (COUMADIN)

: .( ) CT . . -

79

24 minor CVA300 75 300-75

75

3.3


- 81 -

/ / :.

,:

.(133 ) MINI MENTAL STATE TEST . , , , , , , " .(' , , ) : . + .X 2 .( ) . , , ) , , : . (

CT -( ) .

. :

) I.M. HALOPERIDOL (HALDOL) 0.5-1 mg X1-2/d - .(

. :

.( ) .(86 ' ) : . .B12 .HIV .VDRL, TPHA .EEG .( ) CT . .( )

80

( ) :

. , , , , , .( CT ) . CT . :

. . . I.V. DIAZEPAM (ASSIVAL) 10 mg-

(! ) 100 cc NaCl 0.9% I.V. PHENYTOIN 1000 mg .( / " 200 = / " 50- )

. -

.

.

10 100 cc NaCl 0.9% I.V. PHENYTOIN 250 mg

. -

.PHENOBARBITAL PROPOFOL- MIDAZOLAM:( 24)

CAPS./SUSP. PHENYTOIN (EPANUTIN, DILANTIN) 300 mg x1/d I.V. PHENYTOIN 100 mg X3/d : 100 mg X3/d :

: . .EEG . , CT

. : 5-

81

I.V. SODIUM VALPROATE (ORFIRIL

- 82 -

( ) :

. , , , , , .( CT ) . CT . :

. . . I.V. DIAZEPAM (ASSIVAL) 10 mg-

(! ) 100 cc NaCl 0.9% I.V. PHENYTOIN 1000 mg .( / " 200 = / " 50- )

. -

.

.

10 100 cc NaCl 0.9% I.V. PHENYTOIN 250 mg

. -

.PHENOBARBITAL PROPOFOL- MIDAZOLAM:( 24)

CAPS./SUSP. PHENYTOIN (EPANUTIN, DILANTIN) 300 mg x1/d I.V. PHENYTOIN 100 mg X3/d : 100 mg X3/d :

: . .EEG . , CT

. : 5-

81

I.V. SODIUM VALPROATE (ORFIRIL

- 83 -

: . + .X3

PCR

. + .

: . . ZN . , , , . .

, ,.

: , , ,

- )

.( , -

. : ( )-

, 100 , 39- ) :/ , 10

, line sepsis - , , / , /

,( ,:

P.O. (TAB). AMOXYCILLIN-CLAVULANIC ACID (AUGMENTIN) 875 mg X2/d

: ,

82

: P.O. (TAB.) CIPROFLOXACIN (CIPROXIN, CIPROGIS, CIPRODEX) 75O mg X2/d

,( ) : :

) I.V. PIPERACILLIN-TAZOBACTAM (TAZOCIN) 4.5 gr X3/d.( ,

,

: , , ,

.- ( , + SIRS )

.I.V. CEFTRIAXONE (ROCEPHIN) 1-2 gr X1/d

, ) - ( ,

: I.V. CEFTAZIDIME (FORTUM) 1 gram X3/d

I.V. PIPERACILLIN-TAZOBACTAM (TAZOCIN) 4.5 gram X3/d

, ) I.V. GENTAMICIN 240 mg X1/d

:P.O.(TAB.)/I.V. AZITHROMYCIN (AZENIL, ZETO) 500 mg x1/d

: .CRP , :

83

.(123-124

- 84 -

: P.O. (TAB.) CIPROFLOXACIN (CIPROXIN, CIPROGIS, CIPRODEX) 75O mg X2/d

,( ) : :

) I.V. PIPERACILLIN-TAZOBACTAM (TAZOCIN) 4.5 gr X3/d.( ,

,

: , , ,

.- ( , + SIRS )

.I.V. CEFTRIAXONE (ROCEPHIN) 1-2 gr X1/d

, ) - ( ,

: I.V. CEFTAZIDIME (FORTUM) 1 gram X3/d

I.V. PIPERACILLIN-TAZOBACTAM (TAZOCIN) 4.5 gram X3/d

, ) I.V. GENTAMICIN 240 mg X1/d

:P.O.(TAB.)/I.V. AZITHROMYCIN (AZENIL, ZETO) 500 mg x1/d

: .CRP , :

83

.(123-124

- 85 -

- ,MYCOPLASMA, CHLAMYDIA

,Q FEVER, BRUCELLA, TOXOPLASMA

,MONO TEST, EBV, CMV, HIV

,( , ) WEST NILE FEVER.( , )

,.

,.

,( ) , - ZN -

- ,( ) ,

.( ) :

.( CT ) .(RHEUMATOID FACTOR, ANA)

TSH

. ,.

.. , , CT

:.

.PET CT

:SIRS + ) ; >90 : ; 38 :

.( >10% 12,000 : ; >24 ::

. + 84

PCR

. . , , , .X3 . + . , , , , : . . :

, - .119 , I.V. DOPAMINE (DOCARD) - .

- :

1 gr X1/d : I.V. CEFTRIAXONE (ROCEPHIN) 2 gr X1/d:

I.V. PIPERACILLIN-TAZOBACTAM (TAZOCIN) 4.5 gr X3-4/d

( . ) . ) I.V. GENTAMICIN 240 mg X1/d :

.( 123-124

- ( ) - ) I.V. GENTAMICIN 240 mg X1/d

- ) I.V. AMIKACIN 1000 mg X1/d : .(123-124

I.V. CEFTRIAXONE (ROCEPHIN) 2 gr X1/d :( ) .1 gr x1/d

- .(88 )

- :

(123-124 - ) I.V. GENTAMICIN 240 mg X1/d+ ( ) I.V. AMPICILLIN (PENIBRIN) 2 gr X4/d

: .P.O (TAB.)/I.V METRONIDAZOLE (FLAGYL) 500 mg X3/d

85

.(123-124 '

- 86 -

. . , , , .X3 . + . , , , , : . . :

, - .119 , I.V. DOPAMINE (DOCARD) - .

- :

1 gr X1/d : I.V. CEFTRIAXONE (ROCEPHIN) 2 gr X1/d:

I.V. PIPERACILLIN-TAZOBACTAM (TAZOCIN) 4.5 gr X3-4/d

( . ) . ) I.V. GENTAMICIN 240 mg X1/d :

.( 123-124

- ( ) - ) I.V. GENTAMICIN 240 mg X1/d

- ) I.V. AMIKACIN 1000 mg X1/d : .(123-124

I.V. CEFTRIAXONE (ROCEPHIN) 2 gr X1/d :( ) .1 gr x1/d

- .(88 )

- :

(123-124 - ) I.V. GENTAMICIN 240 mg X1/d+ ( ) I.V. AMPICILLIN (PENIBRIN) 2 gr X4/d

: .P.O (TAB.)/I.V METRONIDAZOLE (FLAGYL) 500 mg X3/d

85

.(123-124 '

- 87 -

- + I.V. CEFTRIAXONE (ROCEPHIN) 1-2 gr X1/d

P.O (TAB.)/I.V. METRONIDAZOLE (FLAGYL) 500 mg X3/d

PCR

: , P.O. (TAB.) CIPROFLOXACIN (CIPROXIN, CIPROGIS, CIPRODEX) 500 mg X2/d

. : 8 ,

.I.V. HYDROCORTISONE 100 mg X3/d

: , ,

. ) - , , ,

.( .( )

: . . , , , , . . CT/ U.S

: . + - .

. , , ,. / NaCl 0.9%

.X 2 . , - . . . - :

86

.(131 ) PNEUMONIA SEVERITY INDEX CURB -65 -:

. - ( ) :

: , : I.V. AMPICILLIN 1-2 gr X4/d

( 3 ) P.O. (TAB.) AZITHROMYCIN (AZENIL, ZETO) 500 mg X1/d:

P.O. (TAB.) DOXYCYCLINE (DOXYLIN) 100 mg X2/d

, , ) 80 , , , , ,

:( ,: I.V. CEFTRIAXONE (ROCEPHIN) 1-2 gr X1/d

P.O. (TAB.)/I.V. AZITHROMYCIN (AZENIL, ZETO) 500 mg X1/d

:(131-132 ) : I.V. CEFTRIAXONE (ROCEPHIN) 2 gr X1/d


:P.O. (TAB.) CIPROFLOXACIN (CIPROXIN, CIPROGIS, CIPRODEX) 500 mg X2/d

:P.O. (CAPS.) CLINDAMYCIN (DALACIN) 300 mg X4/d

:I.V. PIPERACILLIN 4 gr X4/d

, ) - ,( , ,COPD


:)

, ,- (

87 - 88 -

.(131 ) PNEUMONIA SEVERITY INDEX CURB -65 -:

. - ( ) :

: , : I.V. AMPICILLIN 1-2 gr X4/d

( 3 ) P.O. (TAB.) AZITHROMYCIN (AZENIL, ZETO) 500 mg X1/d:

P.O. (TAB.) DOXYCYCLINE (DOXYLIN) 100 mg X2/d

, , ) 80 , , , , ,

:( ,: I.V. CEFTRIAXONE (ROCEPHIN) 1-2 gr X1/d


:(131-132 ) : I.V. CEFTRIAXONE (ROCEPHIN) 2 gr X1/d


:P.O. (TAB.) CIPROFLOXACIN (CIPROXIN, CIPROGIS, CIPRODEX) 500 mg X2/d


:I.V. PIPERACILLIN 4 gr X4/d

, ) - ,( , ,COPD


:)

, ,- (

87- 89 -

.( ) I.V. CEFTRIAXONE (ROCEPHIN) 1-2 gr X1/d-

I.V. PIPERACILLIN-TAZOBACTAM (TAZOCIN) 4.5 gr X3/d

:.

: ,I.V. AMOXYCILLIN-CLAVULANIC ACID (AUGMENTIN) 1 gr X3/d

: - I.V. CEFTRIAXONE (ROCEPHIN) 1 gr X1/d

) I.V. METRONIDAZOLE (FLAGYL) 500 mg X3/d.( , ,

: ,

. / , :

.

. 7 ( ):

, :.Q FEVER ,

COPD : .46

(PYELONEPHRITIS) ::

. + .

88

.1 gr X3/d

. .X 2 . - , :

: TAB. OFLOXACIN (TARIVID, OFLODEX) 200-400 mg X2/dTAB. CIPROFLOXACIN (CIPROGIS ,CIPROXIN, CIPRODEX) 500 mg X2/d

: - - , (123-124 , ) I.V. GENTAMICIN 240 mg X1/d

: (123-124 , ) I.V. AMIKACIN 1000 mg X1/d

:( ) CEFTRIAXONE (ROCEPHIN) 1-2 gr X1/d I.V

. - -

.. -

, - .

: . ( ) - -

.(TRUS)

/ : :

.(132 ) GLASGOW COMA SCALE . . . . . CT .

89 - 90 -

. .X 2 . - , :

: TAB. OFLOXACIN (TARIVID, OFLODEX) 200-400 mg X2/dTAB. CIPROFLOXACIN (CIPROGIS ,CIPROXIN, CIPRODEX) 500 mg X2/d

: - - , (123-124 , ) I.V. GENTAMICIN 240 mg X1/d

: (123-124 , ) I.V. AMIKACIN 1000 mg X1/d

:( ) CEFTRIAXONE (ROCEPHIN) 1-2 gr X1/d I.V

. - -

.. -

, - .

: . ( ) - -

.(TRUS)

/ : :

.(132 ) GLASGOW COMA SCALE . . . . . CT .

89- 91 -

. + , , + : INDIA INK , + : WEST - , / PCR ,

.NILE FEVER:

: .I.V. CEFTRIAXONE (ROCEPHIN) 2 gr X2/d

- , ) - I.V. VANCOMYCIN 1 gr X2/d

.( - , 50

: . ) I.V. AMPICILLIN (PENIBRIN) 2 gr X6/d

.( - (CSF SHUNT )

: /- I.V. VANCOMYCIN 1 gr X2/d

.( ) I.V. CEFTAZIDIME (FORTUM) 2 gr X3/d :

.I.V. CHLORAMPHENICOL (SYNTHOMYCINE) 1 gr X4/d

: - . - I.V. DEXAMETHASONE 10 mg X4/d

, ( ) T. RIFAMPICIN (RIMACTAN) 600 mg X1/d

. ,

. : ,

I.V. ACYCLOVIR 700 mg (10 mg/kg) X3/d

: ,

. - ( )

90

. . 4-: -

: , ,( ) WEST NILE FEVER

( ) .EEG . CT

ERYSIPELAS :( )

: . .X2 -

.)

:(94 - , :

I.V. PENICILLIN G SODIUM 1-2 million units X4-6/d

: P.O. (CAPS.) AMOXYCILLIN (MOXYPEN) 500 mg X3/d

: : I.V. CLINDAMYCIN 600 mg X3/d

P.O. (CAPS.) CLINDAMYCIN (DALACIN) 300 mg X4/d

- NECROTIZING FASCIITIS/TOXIC SHOCK SYNDROME

, , ):( /

91 - 92 -

. . 4-: -

: , ,( ) WEST NILE FEVER

( ) .EEG . CT

ERYSIPELAS :( )

: . .X2 -

.)

:(94 - , :

I.V. PENICILLIN G SODIUM 1-2 million units X4-6/d

: P.O. (CAPS.) AMOXYCILLIN (MOXYPEN) 500 mg X3/d

: : I.V. CLINDAMYCIN 600 mg X3/d

P.O. (CAPS.) CLINDAMYCIN (DALACIN) 300 mg X4/d

- NECROTIZING FASCIITIS/TOXIC SHOCK SYNDROME

, , ):( /

91- 93 -

: I.V. PENICILLIN G SODIUM 4 million units X4-6/d.I.V. CLINDAMYCIN 900 mg X3/d

.( 29 ) IVIG / / .

-: CREAM CLOTRIMAZOLE (AGISTEN) X1-2/d

CREAM MICONAZOLE (DAKTARIN) X1-2/d

:-

P.O. (CAPS.) AMOXYCILLIN (MOXYPEN) 500 mg X3/d

- .P.O. (CAPS.) CLINDAMYCIN (DALACIN) 300 mg X4/d

.:

. .(BULLOUS ERYSIPELAS ) :

( ):

. .X2 . - :

- : P.O. (CAPS.) CEFALEXIN (CEFORAL, CEFOVIT) 500 mg X4/d

: I.V. CEFAZOLIN (CEFAMEZINE) 1 gr X3/dI.V. CLOXACILLIN (ORBENIL) 1 gr X4/d

: I.V. CLINDAMYCIN 600 mg X3/d

92

- I.V. AMOXYCILLIN-CLAVULANIC ACID (AUGMENTIN) 1 gr X3/d

:P.O. (TAB.) AMOXYCILLIN-CLAVULANIC ACID (AUGMENTIN) 875 mg X2/d

:d/2X gm 005 )XEDORPIC ,SIGORPIC ,NIXORPIC( NICAXOLFORPIC ).BAT( .O.P


: I.V. PIPERACILLIN-TAZOBACTAM (TAZOCIN) 4.5 gr X3/d

: P.O. (TAB.) CIPROFLOXACIN (CIPROXIN, CIPROGIS, CIPRODEX) 500 mg X2/d


: -

P.O. (TAB.) AMOXYCILLIN-CLAVULANIC ACID (AUGMENTIN) 875 mg X2/d

. - ,

P.O. (TAB.) CIPROFLOXACIN (CIPROXIN, CIPROGIS, CIPRODEX) 500 mg X2/d

: P.O. (CAPS.) CLINDAMYCIN (DALACIN) 300 mg X4/d

.:

. . . , SEPTIC/DIABETIC FOOT :

: . .X2

93 - 94 -

- I.V. AMOXYCILLIN-CLAVULANIC ACID (AUGMENTIN) 1 gr X3/d

:P.O. (TAB.) AMOXYCILLIN-CLAVULANIC ACID (AUGMENTIN) 875 mg X2/d

:d/2X gm 005 )XEDORPIC ,SIGORPIC ,NIXORPIC( NICAXOLFORPIC ).BAT( .O.P


: I.V. PIPERACILLIN-TAZOBACTAM (TAZOCIN) 4.5 gr X3/d

: P.O. (TAB.) CIPROFLOXACIN (CIPROXIN, CIPROGIS, CIPRODEX) 500 mg X2/d


: -

P.O. (TAB.) AMOXYCILLIN-CLAVULANIC ACID (AUGMENTIN) 875 mg X2/d

. - ,

P.O. (TAB.) CIPROFLOXACIN (CIPROXIN, CIPROGIS, CIPRODEX) 500 mg X2/d


.:

. . . , SEPTIC/DIABETIC FOOT :

: . .X2

93- 95 -

: , . -. : ,

. -:

: - P.O. (TAB.) AMOXYCILLIN-CLAVULANIC ACID (AUGMENTIN) 875 mg X2/d

:: P.O. (TAB.) CIPROFLOXACIN (CIPROXIN, CIPROGIS, CIPRODEX) 500 mg X2/d

P.O. (TAB.) OFLOXACIN (TARIVID, OFLODEX) 200-400 mg X2/d


- . ) I.V. PIPERACILLIN 4 gr X4/d

- ( . ) I.V. GENTAMYCIN 240 mg X1/d

.(122-121

: : P.O. (TAB.) OFLOXACIN (TARIVID, OFLODEX) 200 mg X2/d

P.O.(TAB.) CIPROFLOXACIN (CIPROXIN, CIPROGIS, CIPRODEX) 500 mg X2/d

: 10-7 P.O. (CAPS.) CLINDAMYCIN (DALACIN) 300 mg X4/d

.:

. , - .

. , -

94

: . , , , , . + +

. , ,

. - .X2 -

: , , , : ,

. , ) KCl

.( + . . -

.I.V. / P.O.(TAB.) METOCLOPRAMIDE (PRAMIN) 10 mg X1-3/d

- I.V/I.M./ P.O.(TAB.) PAPAVERINE 80 mg X3/d

. - P.O. (CAPS.) LOPERAMIDE (IMODIUM) 2-4 mg X3/d

. :( , ) : 5-3 P.O. (TAB.)/I.V. AZITHROMYCIN 500 mg X1/d

. 5 I.V. CEFTRIAXONE (ROCEPHIN) 1 gr X1/d :

.P.O. (TAB.) METRONIDAZOLE (FLAGYL) 500 mg X3/d

. : 95

CMV PCR

123-124

- 96 -

: . , , , , . + +

. , ,

. - .X2 -

: , , , : ,

. , ) KCl

.( + . . -

.I.V. / P.O.(TAB.) METOCLOPRAMIDE (PRAMIN) 10 mg X1-3/d

- I.V/I.M./ P.O.(TAB.) PAPAVERINE 80 mg X3/d

. - P.O. (CAPS.) LOPERAMIDE (IMODIUM) 2-4 mg X3/d

. :( , ) : 5-3 P.O. (TAB.)/I.V. AZITHROMYCIN 500 mg X1/d

. 5 I.V. CEFTRIAXONE (ROCEPHIN) 1 gr X1/d :

.P.O. (TAB.) METRONIDAZOLE (FLAGYL) 500 mg X3/d

. : 95

CMV PCR

- 97 -

: . , . 10 :

- . 10 ( ) SOL. VANCOMYCIN 125 mg X4/d

- .

. - :

.( ) + . .(MODIFIED ZN ) :HIV -

: . , , , ,PT/PTT , " . 4-2 .

: . .

. - COFFEE GROUND . NaCl 0.9% - FFP / 4-2 -(1.5 INR) 16-8

:

- ( 50,000- ) .

I.V. OMEPRAZOLE (LOSEC) 80 mg X1/d

. I.V. CONTROLOC (PANTROPRAZOLE)

96

8 20 100 40)

.

- . - " 2-1 " 2 TERLIPRESSIN = GLYPRESSIN

I.V. CEFTRIAXONE (ROCEPHIN) 1 gram X1/d

: . 48 : . 6-4 SOMATOSTATIN (OCTREOTIDE) : . 6-4 " 1 3

. 50-25 50-25.( 24 ) 5-2

. :

.PT/PTT , " . . I.V. ERYTHROMYCIN 250 mg .

. . / - .

INFLAMMATORY BOWEL DISEASE:

, , , , , " ,CRP , . ,

. , , ; : .

CT . ,

97

PPI I.V. RANITIDINE (ZANTAC) 50 mg X3/d

- 98 -

- . - " 2-1 " 2 TERLIPRESSIN = GLYPRESSIN

I.V. CEFTRIAXONE (ROCEPHIN) 1 gram X1/d

: . 48 : . 6-4 SOMATOSTATIN (OCTREOTIDE) : . 6-4 " 1 3

. 50-25 50-25.( 24 ) 5-2

. :

.PT/PTT , " . . I.V. ERYTHROMYCIN 250 mg .

. . / - .

INFLAMMATORY BOWEL DISEASE:

, , , , , " ,CRP , . ,

. , , ; : .

CT . ,

97

PPI I.V. RANITIDINE (ZANTAC) 50 mg X3/d

- 99 -

: .NSAIDS-

. 3-2- 4-2 5-ASA (PENTASA, RAFASSAL) retention- , ' 1)

.( ,enema

T. PREDNISONE 20-40 mg X1/d :. I.V. HYDROCORTISONE 100 mg X3/d

, , : . ,

.( ) , :

. , . I.V. .( ) .I.V. HYDROCORTISONE 100 mg X3/d . : Crohns disease - - .TAB. METRONIDAZOLE (FLAGYL) 250 mg X3/d

.TAB. CIPROFLOXACIN 500 mg X2/d

: . , , , , , , " . , ,B12 . . .

. CMV PCR

98

: , , , , ,

.PT/PTT , ,( ) . . : :

: , , : ,

. ,. . :

. I.V./TAB. METOCLOPRAMIDE (PRAMIN) 10 mg : .

4-2- .FFP - PT-.

: TOTAL PROTEIN , , , ,PT/PTT

.ALBUMIN , ,G6PD ,COOMBS , :

. :

,CMV, EBV ,HBcAb IgM ,( ) HAV Ab ,HCV Ab ,HBsAg.ANA, ANTI SMOOTH MUSCLE Ab (ASMA) ,ANTI MITOCHONDRIAL Ab (AMA), MONO TEST

. FETO PROTEIN : primary sclerosing ) CA 19-9, pANCA : .(cholangitis

, :( 40- ) . ,

.( ) : .( ) + 99

N-ACETYL CYSTEINE104-105

.(7 5

- 100 -

: , , , , ,

.PT/PTT , ,( ) . . : :

: , , : ,

. ,. . :

. I.V./TAB. METOCLOPRAMIDE (PRAMIN) 10 mg : .

4-2- .FFP - PT-.

: TOTAL PROTEIN , , , ,PT/PTT

.ALBUMIN , ,G6PD ,COOMBS , :

. :

,CMV, EBV ,HBcAb IgM ,( ) HAV Ab ,HCV Ab ,HBsAg.ANA, ANTI SMOOTH MUSCLE Ab (ASMA) ,ANTI MITOCHONDRIAL Ab (AMA), MONO TEST

. FETO PROTEIN : primary sclerosing ) CA 19-9, pANCA : .(cholangitis

, :( 40- ) . ,

.( ) : .( ) + 99

N-ACETYL CYSTEINE104-105

.(7 5

- 101 -

SBP - /TENSE ASCITES:

. , , , , , . , , , , + ( ) : . , :

. TAB. SPIRONOLACTONE (ALDACTONE, ALDOSPIRONE) 25-50 mg X1/d.( , , )

.TAB. FUROSEMIDE (FUSID) 40 mg X1/d . ,( ) - . .

, , , , + ZN , : ,pH ,

. , ,

: - (250 NEUTROPHILS/MCL ) SBP- .I.V. CEFTRIAXONE (ROCEPHIN) 1-2 gr X1/d I.V. 8 ,TENSE ASCITES- , 5

. / 1.2 10 BUN ,> 1 mg/dL : ) SBP-

) ,(>4 mg/dL 30 mg/dL:(

/ 1- / 1.5 I.V. ALBUMIN.

: , , , ,

, . . + ,

100

250

HEPATIC ENCEPHALOPATHY:

, . , , , . , + ( )

. , .(102 ) - . .(133 ) MINI MENTAL STATE TEST :

: , ,GI , , ,

. , : , .SYR. LACTULOSE (AVILAC, LEVOLAC) 30 cc X3/d

.( 2-3 ) 700 300 - ,

. 6-4 NaCl 0.9% :

:

I.V. CEFTRIAXONE (ROCEPHIN) 1 gr X1/d : : TAB. NEOMYCIN 500 mg X4/d

.TAB. METRONIDAZOLE (FLAGYL) 250-500 mg X3/dTAB. RIFAXIMIN (LORMYX)

: . , , . , . . . .

: . , , , . ,

101

400 600

- 102 -

HEPATIC ENCEPHALOPATHY:

, . , , , . , + ( )

. , .(102 ) - . .(133 ) MINI MENTAL STATE TEST :

: , ,GI , , ,

. , : , .SYR. LACTULOSE (AVILAC, LEVOLAC) 30 cc X3/d

.( 2-3 ) 700 300 - ,

. 6-4 NaCl 0.9% :

:

I.V. CEFTRIAXONE (ROCEPHIN) 1 gr X1/d : : TAB. NEOMYCIN 500 mg X4/d

.TAB. METRONIDAZOLE (FLAGYL) 250-500 mg X3/dTAB. RIFAXIMIN (LORMYX)

: . , , . , . . . .

: . , , , . ,

101

400 600

- 103 -

, .

. :

. I.V. ALBUMIN 1 gr/kg 6-4 1 I.V. TERLIPRESSIN (GLYPRESSIN) : , 29 .

: . , , , . + ( )

: . I.V. ALBUMIN 20-40 gr/d . 4 2- 3

/ 1.5- .( ) 15

:

. . .( ) . . . -

, , (PT , ) (AST, ALT) . pH , ,

: N )

.(

36- 7.5 8 / 100 , 4 / 200 ) N- ,( 12 / 50 ,

: 102

6-4 0.5

PVD

10

SOL. ACETYLCYSTEINE (MUCOMYST) : 70 mg/kg (11.5-8.5) 140 mg/kg

. 12 4 (' 5.5 - 4) (' 12-9) 150 mg/kg INJ. ACETYLCYSTEINE (PARVOLEX) :

50 mg/kg , 5% " 200 (' 8-6) 100 mg/kg 4 5% " 500 (' 4-3)

. 16 5% " 1000 :

. , . , .

: .PT , "

: : FFP-

1 . 1.5- INR / 80,000 .

2 . 1.8 - 1.5 INR / 80,000 - 60,000 . PLUGGED BIOPSY

3 . ) / 1.8 INR / 60,000-40,000 . ' ( "

4 . 40,000 40,000 - . '

5 .- 1.8 INR . GUIDED MICRO PUNCTURE OF JUGULAR VEIN

: .

103 - 104 -

SOL. ACETYLCYSTEINE (MUCOMYST) : 70 mg/kg (11.5-8.5) 140 mg/kg

. 12 4 (' 5.5 - 4) (' 12-9) 150 mg/kg INJ. ACETYLCYSTEINE (PARVOLEX) :

50 mg/kg , 5% " 200 (' 8-6) 100 mg/kg 4 5% " 500 (' 4-3)

. 16 5% " 1000 :

. , . , .

: .PT , "

: : FFP-

1 . 1.5- INR / 80,000 .

2 . 1.8 - 1.5 INR / 80,000 - 60,000 . PLUGGED BIOPSY

3 . ) / 1.8 INR / 60,000-40,000 . ' ( "

4 . 40,000 40,000 - . '

5 .- 1.8 INR . GUIDED MICRO PUNCTURE OF JUGULAR VEIN

: .

103- 105 -

:

.CRP , . , , , , , , " .X2 - , + : ) ( ) .

.( . - : - -NSAID

.TAB. NAPROXEN (NAXYN, NAPROXI) 500 mg X2/d

: T. INDOMETHACIN (INDOMED, INDOTARD, INDOVIS) 50 mg X4/d

25 mg X3/d 3 50 mg X3/d . 3

/ PPI .NSAID- .

, ,

,

) NSAIDS -

- ,

.

I.M. TETRACOSACTIDE (SYNACTHEN DEPO) 1 cc=1 mg: . 3-2

INJ. BETAMETHASONE (DIPROSPANE) - INJ. METHYLPREDNISOLONE (DEPO MEDROL) 40-80 mg : 2 cc

: . . 3-2 TAB. PREDNISONE 40 mg X1/d , ) : . - . - ( )

104

1 TAB. COLCHICINE NSAID0.5

0.5

. : ,

I.V. CEFAMEZIN (CEFAZOLIN) 2 gr X3/d

: ,( ) .I.V. CEFTRIAXONE (ROCEPHIN) 2 gr X1/d

:( ) : I.V. CEFTAZIDIME (FORTUM) 1 gr X3/d

.( ) I.V. CIPROFLOXACIN (CIPROXIN) 400 mg X2/d. -

: . .CRP , ,

) anti-CCP antibody, rheumatoid factor, ANA . (

: .( ) B19 , , ,HBsAg

.

105 - 106 -

. : ,

I.V. CEFAMEZIN (CEFAZOLIN) 2 gr X3/d

: ,( ) .I.V. CEFTRIAXONE (ROCEPHIN) 2 gr X1/d

:( ) : I.V. CEFTAZIDIME (FORTUM) 1 gr X3/d

.( ) I.V. CIPROFLOXACIN (CIPROXIN) 400 mg X2/d. -

: . .CRP , ,

) anti-CCP antibody, rheumatoid factor, ANA . (

: .( ) B19 , , ,HBsAg

.

105- 107 -

SHOCK

: . ,PT/PTT , , , , , " . .TROPONIN ,CPK - . - . , , , , -

: . . . .( / ) CVP . + SALINE -

. 100 cc NaCl I.V. DOPAMINE (DOCARD) 200 mg -

.15 cc/h 0.9%:( )

100 cc GLUCOSE 5% - " 8 I.V. NOREPINEPHRINE (LEVOPHED).( , ) 8 ml/hr

: .NaCl 0.9% 4-2 - I.V. HYDROCORTISONE 100 mg X3/d - I.V. CEFTRIAXONE (ROCEPHIN) 1-2 gr X1/d : I.V. PIPERACILLIN-TAZOBACTAM (TAZOCIN) 4.5 gr X 3/d

. ) I.V. VANCOMYCIN 1gr X 2/d.(

: - .NaCl 0.9% 4-2 - - ( PT) . 4-2

106

- .FFP 4-2 .( ) 16-8

. -:

. I.V. FUROSEMIDE (FUSID) 40-80 mg - .(32 ' ) - . - .ICCU - :

.NaCl 0.9% 4-2 - . 20 .S.C ADRENALINE 0.3-0.5 mg - . I.V. METHYLPREDNISOLONE (SOLU-MEDROL) 10-40 mg.I.V. HYDROCORTISONE 100 mg X3/d

. I.V./I.M. PROMETHAZINE (PROTHIAZINE) 25-50 mg: TAB. CHLORPHENIRAMINE (AHISTON) 2 mg X3/d -.TAB. LORATADINE (LORASTINE, LORATRIM) 10 mg X1/d

- SALBUTAMOL (VENTOLIN) - .

:ADRENAL (ADDISONIAN) CRISIS

-

:

. , , , " - - . :

. . . . , , - .

: . . . , , , "

107

.(45 ' ) I.V. AMINOPHYLLINE

.78 '

- 108 -

- .FFP 4-2 .( ) 16-8

. -:

. I.V. FUROSEMIDE (FUSID) 40-80 mg - .(32 ' ) - . - .ICCU - :

.NaCl 0.9% 4-2 - . 20 .S.C ADRENALINE 0.3-0.5 mg - . I.V. METHYLPREDNISOLONE (SOLU-MEDROL) 10-40 mg.I.V. HYDROCORTISONE 100 mg X3/d

. I.V./I.M. PROMETHAZINE (PROTHIAZINE) 25-50 mg: TAB. CHLORPHENIRAMINE (AHISTON) 2 mg X3/d -.TAB. LORATADINE (LORASTINE, LORATRIM) 10 mg X1/d

- SALBUTAMOL (VENTOLIN) - .

:ADRENAL (ADDISONIAN) CRISIS

-

:

. , , , " - - . :

. . . . , , - .

: . . . , , , "

107

.(45 ' ) I.V. AMINOPHYLLINE

.78 '

- 109 -

. . . :

. . :

. , ,PT/PTT , + " . - . .( ) .( ) . - , )

:( . , . ' .( ) CA 15-3 .( ) PSA .( ) CA 125 .( ) CA 19-9 .( ) CEA .( ) CYFRA 21-1 .( ) FETOPROTEIN .( ) HCG . ZN ,( ) , ,PPD - . , -

108

.(VAS ) 10- 1 :

:(VAS 1-3)

: , 4 TAB. PARACETAMOL (ACAMOL) 500-1000 mg : , 4 TAB. DIPYRONE (OPTALGIN) 500-1000 mg : , 4 SYR. DIPYRONE (OPTALGIN) 1 gram (4 cc) : , 4 I.V. DIPYRONE (OPTALGIN) 1000 mg .(22 ' ) NSAID :(VAS 4-6)

. 4 TAB. OXYCODONE-PARACETAMOL (PERCOCET-5):

4 ( " 25) 10 SOL. TRAMADOL (TRAMADEX, TRAMAL) ( " 50) 20 , 8 ( " 50) 20 ,

- 6: TAB. TRAMADOL (TRAMADEX ,TRAMAL) 100-200 mg X2/d

- .TAB. OXYCODONE (OXYCONTIN) 10 mg X2/d . 160 mg X2/d OXYCONTIN

SYR. OXYCODONE (OXYCOD) " 10-5= " 5-2.5 " ) 1/8-

, 2- .(.

: ,: TAB. BISACOGYL (LAXADIN) 10 mg X1/d

.SYR. LACTULOSE (AVILAC, LAEVOLAC) 30 cc X1-2/d

. TAB. TARGIN :: - ( )

109

.TAB. METOCLOPRAMIDE (PRAMIN) 10 mg

- 110 -

.(VAS ) 10- 1 :

:(VAS 1-3)

: , 4 TAB. PARACETAMOL (ACAMOL) 500-1000 mg : , 4 TAB. DIPYRONE (OPTALGIN) 500-1000 mg : , 4 SYR. DIPYRONE (OPTALGIN) 1 gram (4 cc) : , 4 I.V. DIPYRONE (OPTALGIN) 1000 mg .(22 ' ) NSAID :(VAS 4-6)

. 4 TAB. OXYCODONE-PARACETAMOL (PERCOCET-5):

4 ( " 25) 10 SOL. TRAMADOL (TRAMADEX, TRAMAL) ( " 50) 20 , 8 ( " 50) 20 ,

- 6: TAB. TRAMADOL (TRAMADEX ,TRAMAL) 100-200 mg X2/d

- .TAB. OXYCODONE (OXYCONTIN) 10 mg X2/d . 160 mg X2/d OXYCONTIN

SYR. OXYCODONE (OXYCOD) " 10-5= " 5-2.5 " ) 1/8-

, 2- .(.

: ,: TAB. BISACOGYL (LAXADIN) 10 mg X1/d

.SYR. LACTULOSE (AVILAC, LAEVOLAC) 30 cc X1-2/d

. TAB. TARGIN :: - ( )

109

.TAB. METOCLOPRAMIDE (PRAMIN) 10 mg

- 111 -

:(VAS 7-10) :

: . I.V./I.M. PETHIDINE 50-75 mg

: : , I.V./I.M. MORPHINE 2.5-10 mg : TAB. MORPHIN (MIR) 15-30 mg . SUPP. MORPHIN (MSP) 10-20 mg (2-3mg) I.V.

. . .COPD -

. :

: 72 - :PATCH FENTANYL (DUROGESIC, FENTA) - 12 : .( 48 ) , 18-12 . /

.SYR. OXYCOD 5 cc - MIR 15 mg - I.V./I.M PETHIDINE I.V./I.M. MORPHINE -

: 8 12 TAB. MCR MCR - ,3 - . MCR - 0.4-

. MCR . . TAB. MCR 30 mg X2/d -

.NSAID MCR .MCR

, . MCR . TAB. MIR 15-30 mg

:

110

: . 72 - :PATCH FENTANYL (DUROGESIC, FENTA) 18-12 . / 12

.MIR ,:

, . -

, , , - ( ) 25-10- ) : .( ) ,( ) , , ,( 4-3 " ) ( ) : .

.(

111 - 112 -

: . 72 - :PATCH FENTANYL (DUROGESIC, FENTA) 18-12 . / 12

.MIR ,:

, . -

, , , - ( ) 25-10- ) : .( ) ,( ) , , ,( 4-3 " ) ( ) : .

.(

111- 113 -

) , , (

:: 1.

.( + ) I.V. CEFTRIAXONE (ROCEPHIN) ' 2 . ,

, ) .(

I.V. CHLORAMPHENICOL (SYNTHOMYCIN)

: " 2. . 15 3-2 6- I.V CEFTRIAXONE (ROCEPHIN) ' 1

. ,( )

.TAB. AZITHROMYCIN (AZENIL, ZETO) 500 mg

:( ) 3. 15 2

.(' , ) I.V. CEFTRIAXONE

.(ROCEPHINE) 2 gr

. : 4.

. 15 3-2 I.V. CEFTRIAXONE (ROCEPHIN) ' 2

112

. ,

.: 5.

. 2 ( ) ' 4.5 PIPERACILLIN-TAZOBACTAM (TAZOCIN)

CEFTAZIDIME (FORTUM) ' 2 -.

- ,.(84-85 ' ) AUGMENTIN + CIPROFLOXACIN

1 .. - , , ,2 .

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