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Drug therapy in observaton period.pptx

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Drug therapy in observaton period.pptx

  1. 1. Tips on using my ppt. 1. You can freely download, edit, modify and put your name etc. 2. Don’t be concerned about number of slides. Half the slides are blanks except for the title. 3. First show the blank slides (eg. Aetiology ) > Ask students what they already know about ethology of today's topic. > Then show next slide which enumerates aetiologies. 4. At the end rerun the show – show blank> ask questions > show next slide. 5. This will be an ACTIVE LEARNING SESSION x three revisions. 6. Good for self study also. 7. See notes for bibliography.
  2. 2. Introduction
  3. 3. Introduction Our cases fall in one of the three categories. Viz. • 1.Diagnosis is immediately obvious. • 2.Diagnosis is immediately excluded. • 3.Diagnosis is unclear.
  4. 4. • I want to discuss today this third category in which most of the patients we see fall.
  5. 5. • When diagnosis is not clear we order further investigations and keep the patient under observation. Repeat examinations over a period of time clarify the diagnosis. The question is what treatment should be given during observation
  6. 6. • The question is what treatment should be given during observation
  7. 7. • I want to discuss today this third category in wLet us look at some typical cases that we often see. • 1.Acute Abdominal Pain. • 2.Head Injury. • 3.Acute Testicular Pain. • 4.Blunt abdominal
  8. 8. • In all of the above the two extremes ie. Absence of a lesion requiring operative intervention and presence of a lesion requiring operative intervention present no particular difficulty in choosing line of management.
  9. 9. • How about a patient • Who may or may not have acute appendicitis. • May or may not have middle meningeal artery hemorrhage. • May or may not have testicular torsion. • May or may not have visceral injury.
  10. 10. • A typical protocol for ?Acute Appendicitis that we use is • Nill orally • Inj. Xone 1gm. Iv 12 hourly • Inj.Metrogyl 100ml. Iv.8 hourly • Inj. Gentamicin 80 mg.iv 8 hourly • Inj. Diclofenac 75mg.im stat & 12hourly • Inj.Tramazac 2ml.iv. sos. • Inj.Ringer’s Lactate 2000 ml.
  11. 11. • A typical prescription for suspected head injury is • No sedation • Nill orally • Inj.Xone 1gm. Iv.12hourly • Inj.Mannitol 300ml.iv. 12 hourly fast. • Inj.Decadron 8mg. Iv. 6hourly • Inj.Dextrose 50% 50 ml. Iv 6hourly • Inj. Dextrose 10% 1000ml. • Inj. Dextrose 5% 1000ml
  12. 12. • A typical prescription for Acute Testicular Pain is • Nill orally • Inj. Ciplox 100 ml.iv. 12 hourly • Inj.Diclofenac 75mg. Im. 12 hourly • Inj. Ringer’s Lactate 2000ml. • Scrotal Support.
  13. 13. • The rationale seems to be that mild degree of these diseases are to be treated conservatively and if conservative management fails then only patient should be operated.
  14. 14. • These protocols have served us well over the years and most of the patients who are treated in this way do well, recover fast and need no surgery. Only a small a percentage of cases requires surgical intervention.
  15. 15. • But I beg to differ. • The very purpose of observation is to identify that small minority of patients who will need surgery.
  16. 16. • Majority of patients who do well on the above regimen never needed surgery and their course would have been the same if they were not treated at all.
  17. 17. • Let us discuss effect of our regimen on those who need surgery. • Drug therapy masks their symptoms which leads to delay in surgery hence increasing the mortality and morbidity.
  18. 18. • 1.In case of head injury giving of mannitol or dextrose • I Serves to enhance intracranial hemorrhage. • II. Delays the development of alarming signs and symptoms thus delaying referral to neurosurgeon. • III.Had dehydration therapy not been given we could give it now to buy time for shifting the patient to neurosurgical centre.
  19. 19. • In case of Acute Appendicitis giving of antibiotics leads to masking of symptoms which delays operation increasing mortality and morbidity. We should not forget that pathology of acute appendicitis is obstruction and it is not helped by antibiotics .
  20. 20. • . In acute testicular pain we must exclude torsion which is not possible clinically. Giving of conservative treatment gives us a false sense of security while the testis is becoming gangrenous.
  21. 21. • Hence I suggest following regimen: • 1.Head injury • No Sedation. • Nil orally. • Inj. Ringer’s Lactate 1 litre/24hours. • Antibiotics and Tetanus Prophylaxis if external injury.
  22. 22. • .Abdominal Pain • NO ANTIBIOTICS NO ANALGESICS • Nil orally • Inj. Ringer’s Lactate 2 litre/24hours. • Inj. Ranitidine 1amp. iv. 8 hourly. • Inj. Buscopan 1amp. iv. on pain. •
  23. 23. Acute Testicular Pain. • Exploration.
  24. 24. • Blunt abdominal trauma. • Nil orally. • Inj Ringer’s Lactate 1 litre/24hours.
  25. 25. •Thanks
  26. 26. Get this ppt in mobile 1. Download Microsoft PowerPoint from play store. 2. Open Google assistant 3. Open Google lens. 4. Scan qr code from next slide.
  27. 27. Get this ppt in mobile
  28. 28. Get my ppt collection • https://www.slideshare.net/drpradeeppande/ edit_my_uploads • https://www.dropbox.com/sh/x600md3cvj8 5woy/AACVMHuQtvHvl_K8ehc3ltkEa?dl =0 • https://www.facebook.com/doctorpradeeppa nde/?ref=pages_you_manage

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