5/21/2018

1/12

bronchial asthma

patient said he is asthmaticcomplain of chest allergy

! "#$%dyspnea and chest &hee'e

/).- ,+*()e0amination

bilateral diff1se sibilant ronchi

2!bronchial asthma

3% "4

5% "6, 789:; 8>?@A82 -B

C$)4 ,

8D89D 82 E9; 789:; F

8D89D GHB

I

82, E9; GHB JK/

L#$% 2

:2

FM9% N

OP G#Q

9; "6, 3= 8

;785;$cardiac patient2#B 6Rentolin

JKO2, I2 2! S; T

;$. 5U "6, V,46I)6 785;V8.28

B 785;

5/21/2018

2/12

_$

,

+

785;

%SB4 #B 9C24I3I\;

PZ[:2WQ2" N

;785+48>89

82T==$:=; 2:2#

%P9% )6%, 4#2P9% 4#` 2# ,B T=$:=; 82/8\>4#2

; P9%, J5B

M

O

#!

,s1dden decomprition ofbladder &allN)*P26w) 3I\;haemat1ria

.

3; x*$

B 2

D V

%epista0isS9U, JKO2

P9% 2+ T=

$;

5U,zP2% WK/

5/21/2018

3/12

N)*$2

Nv8

nasal pac{ 3I\;haemostatic7

Hu;

hemostop,

#)4, #!

, 785;

N)*$2VI; P9% P9%, ^2O local.O~

),6

P9% P^\) 3I\;,1ta tablets

hemostop tablets x*$2

S$\=B, Z

^2

8=B

6,

6 48`, x*

,;\3I) $; 9W\>%

,[,epinefrineS WX 8L=$C%W7

x*$92

6w) -

2, x*$2

#)*) 5

P2

2

JKO2

V[ JKO2

J5)

[

5U,( M2 #X=;3 $9v, )8;#2Z / PN2 c]

z

D P9%

K

Nv8[, ;.G8M*(6 NY =:; T;, P9X #>

D= 5U],7, N)*$2QJC2],7

~

4

K2

; 3)#B, E9; 789:\B 28! P92 W$\2, C28D -)8> C2

?7

SO

,

8

! 6

O; FL

; N

O

3I\; dressing=

HB, G

,7]8

8$B Z# %\>! 45=X+ $! A=82 |8$3I;, ZBM=2[S$\) 8

! 6O;3I;, 8

! 6O; P9% j)\92 =IF2H2

z|8

=

=2

X) ,

C;

5/21/2018

4/12

2 , |8

=

=92 P%

6 H

.

$2

3>

;[

, +

I\2

, 7

$\2

P

,

C2

;

\> 8T; Z]#2B WK\2

ZHO:2 4#

; .,I\2V|$2F; #=)

zJ

Q)

D

89D F

@

9% x

O) ;285L 3;5;2853=,B>,

P 6

; =%=2 3 $!@S; 765=2BD 89

;I;?FC=>[ 7 3;8

#X+, j)\2 [ #5I2 +L #X48= B85Y 2! P G

$=;I B85Y T; M#>=+ V^9% P8^% I %$

gastritis

4#2

P9% 8\! "

;

52

Y, "#

\2

F

P

F2

heart painSD,

) 3I\;,na1sea

)

4

8W2

H%

U

?@AFM

9% 789:; F

=785;

VB8IB 785;

5/21/2018

5/12

SD

B 82 V

5;

B 785;

2:2! P9% -B =785;B P.=I3I\;,5U V5;52[E)=) ; V2; #:2 789:\24I3I\;,

_

P52 "#X

) H% P9% 95=>,

'antac @A or AA mg tab[

P28 ,!#"

hypertensionmore than AA

JKO2-

5/21/2018

6/12

8

L FM$

B ]

.2

,hypertension 1rgency3; 9%

V8I

B 78=)#2

A$L -

,(X\2(L,by oralj) 8$22 3I2,end organ damage2capotenV92_:+

7 5$2

B

;

hypertension emergency3; 9%

V8I

B 28=)#2

JKO2

AS;end organ damage

^;, Z

W

=![

3I2, #

,

B,

=

8)68B 9

) 8$2

L,

IL,3% 4

5% 8L 92

, 7#)

=2

8L B 2

) 2

,

2

! 68D8;

Y ;

#Q=

E5`

(hypertension emergency2;9D8$(# ($; (j7intraReno1s

2:\2>

2! ;S ,6% "6 C$)4P22I2Z[! P 8$\; 8D89D

P2

2

JKO2

Z[

! P

8$\; E9;

*2(#"#2,6( 2!2\3 5$D P F2

B PC

BS)j5$2, )8 3QV8

IB %63

\

2

$C92

4 "#> #

B, "482

P

#B F2[

,48=>6

) "6,#; P.q2X [ M T

,;.S

D

+ P

3I\; ,

P

92 5Y4 3I\;,

M

#>

+

V

^9% #!

, SB8B

D8

B 7

V

I\2

P9% 4,

2

[ q:.2

S;Pmacb1rny point

P5=BtenderP P5) 3I\;,rigidityV

\>cross tenerness

2\D8) 3 5$D 7\^2$C2P9% JK/rebo1nd tenderness also

co1gh tenderness,

:I2

5/21/2018

7/12

3I;

6

8$\;

5U,analgisicV

^9% q2

Xnot mas{ thediagnosic

;89> qK; T MP.V^9% 78B

5/21/2018

8/12

821rate#X

)1roslolRin eff

; 8> q

P9% 4

8

-

>#X) I2P SD, P 82,

'yloric AA mg 1p to AA mg tab

82o0alateepimag eff

; 8> q

P9% 4

8

-

>, C.2,, 2, FU\W28:26[

P2\ "68D8; H;[, H;3;

:),

52

,

^2

,,9U_9\

P=2:25; 3T9W58.24] %62:=2>

82phoshate#X)Ritacid c tab

82

+p1sD! G#Q

; \X 3;

82@A"#X

L V

2

8

:2

6

O\2

8

6#:+ V

^9% %4*;

5/21/2018

9/12

F=Q+,

4

8U $U

B|; #

B #X

)@P5)

; #:2

v6p1pil f1lly dilated or p1lse reaches ?A

=

785;

#X

)"#

; #

BAA+ B P2=>+ P9% =I" M P9% F2 78X6

$U

B 78X6 F+, )

K92

j)

\92 ;

2

2

:2

, ;89

;

Y "6

; 7,

$+

%6

#$% P

M$2

)

=2

,

5/21/2018

10/12

, #2

Z

Y 9

:+ _59U 82 ) 89DA(

v6G#X

=)

; 8

2

I2

V

G

$

;, 2

2

8

+852

+ 3; 92

\:

B 6,direct iR789:\2

W% #B 92"8WQ2AA8>89D F?@S; @,}AZ#!,

; 3

28

Z\IB 8

;3852+ ,P9% 8=:+ ZB2% 5 ;, +$)Y} 7,

2

8

F

;, -U

W52

, FU

\W2

,

8\2

5/21/2018

11/12

iagnosispassage of clots or heaRy dar{ colo1red 1rine

passage of smo{y colo1red 1rine cocacola colored isdiagnostic of

ac1te glomer1lonephritis not a 1rological case

mangementchec{ Rital signs esprate p1lse temp

hemostaticscyclo{apron amp

dicynone amp Rit { amp

is mandatory

bladder &ash@Ainsert nelaton ?A si'e is ?A ch and &ith the 1se of

cc syringe inect AA cc saline in the catheter thenaspirate 1 &ill aspirate clotted blood

repeat inection aspiration till the 1rine becomes clearclear means normal color of 1rine

if the bleeding not stopped 1 m1st referr the patientimmediatly for cystoscopy

for stones for renal mass

o1tpatient clinicmedications

diosed c tab tds

ase of &hee'y chest in a child

5/21/2018

12/12

ronchitis &ith spasmronchpne1monia &ith spasm

inal diagnosis can be setteled after management of spasm

management

line ~ neb1li'er settingA@ml salb1tamol sol1tion for inhalation A@ml atroRent

@ml normal salinecan be repeated 1pto times &ith ?A min interRal bet&een each

other

line ?~ hydrocortisone sol1cortef iRAmg{gdose or ?mlA{g body &eight

then &ait for A min

line ~ if &hee'es still present aminophylline inf1sionml dil1ted aminophylline@{g body &eight in Aml @ oRer

?A minin seRere cases fortecortine half amp can be added

if the case is Rery seRere ie no air entry proceed to aggressiReline directly eg neb1li'er setting sol1cortef

~ feRer sho1ld be treated before management of &hee'es

7,,,,,,,,,,,,,,,,,,,,,,,8$;%#2E2` 3; 8$+ 7 \D FI2 4B