Note: this post is meant to give a brief quick review for when to use amiodrone, verapamil, lidocaine and adenosine.

Lidocaine: It’s drug of choice in post MI ventricular tachycardia.

Amiodrone: amiodrone can be given in both post myocardia infarction ventricular tachycardia, and vt without MI too.

In Supra ventricular tachycardia, drug of choice is adenosine and then verapil.

If you have any queries or want to discuss, please let me know through comments.

Tips to avoid pollen allergy outcomes for the patients with asthma specially:

avoid dust

avoid going into the hilly areas or lush green areas where pollen is in abundance

wear the protective mask to keep out any pollens from getting into your wind pipe.

avoid cold

Nebulize everyday for around 10 minutes

keep the inhaler with you at all times, specially when you go out

take mast cell stabalizer (monteka for example) and antihistamine (telfast-d for example) during this season to help avoind getting pollen allergy attacks.

If the patient gets serious shortness of breath (SOB) don’t wait for magic to happen at home, rush him or her to the hospital.

Eosinophils are usually indicative of any allergic reaction going on in the body.

Eosinophils are generally associated with antigen-antibody reactions taking place int he body. So any situation in which allergic reaction takes place in the body as a result of any allergic agent or a hypersensitivity reaction, eosinophils count will shoot up.

Examples of reactions in which eosinophils count will rise include:

• hay fever
• asthma
• drug hypersensitivity
• bee stings
• etc

Note: Decrease in eosinophils count can be seen in the patients receiving corticosteroids therapy.

The lab reports always go along with the history and physical examination of the patient and there is no alternate for professional medical consultation.

First of all we need to have a brief background. Less mature neutrophils are called bands or stabs (due to their appearance).

In acute bacterial infection, there will be increase in total number of mature neutrophils along with less mature bands or stabs in response to the infection.

In old days, when the laboratory reports were written by hand, less mature neutrophils were written first on the left side of the lab report. This term is holdover from that era and increase in less mature neutrophils is still called as “shift to left” in acute infections.

Less mature neutrophils are less than 10% of the total neutrophils in the blood stream. So if the complete blood picture says that there is a shift to left then it means that the less mature neutrophils are more than 10% in this patients blood.

There is a difference in neutrophils response to bacterial and viral infections.

Neutrophils count increases in cases of bacterial infection (exceptions are typhoid, brucelosis, etc).

However, viral infections tend to reduce the neutrophils count (e.g hepatitis, influenza, rubella, rubeola, and mumps).

So next time you face a patient with symptoms of an acute infection and a valid history, the neutrophils count would be helpful in determining which type of infection is going on in the patient, viral or bacterial.

Note: This post is not at all an alternate to professional medical consultation, consult a doctor if you’re having any symptoms of viral or bacterial infection and don’t take only neutrophil count as the indicator of bacterial or viral infection.

Emergency treatment for low blood pressure (hypotension)

First of all, make sure that the condition you’re feeling is “hypotension” / low blood pressure. Because if the blood pressure is already high, increasing it further may lead to complications. So make sure you check the blood pressure properly using bp apparatus (sphygmomanometer) and make sure its LOW (below 100/80 atleast)

Secondly, make sure that the person isn’t hypertensive, that is, he don’t have high blood pressure issues, as he may go into hypertension again once remedies for low blood pressure are being given, uncontrolled.

Now comes the main part, how to elevate the blood pressure of a person in hypotension.

Salt - Salt is the potent blood pressure elevator. Whenever you’re experiencing low blood pressure, take some salt with water and it will restore your blood pressure within seconds. Pour and stir some salt in water until it gets saturated and starts settling down in the glass and then drink it.

Let me know if you have any queries related to low blood pressure and its emergency management when you don’t have any hospital or medication near you.

Well there are several remedies to lower down your blood pressure at home in an emergency situation which we’ll be sharing in this post.

Please note, tips to lower down your blood pressure in this post aren’t meant to replace specialist consultation and hospital visit in any circumstances. Please visit your nearest hospital whenever possible in case of hypertension as it may have serious outcomes.

First of all, once you find out high blood pressure, note it down in a notebook with date and time with it.

Secondly, drink WATER. lots and lots of it.

Water is an emergency blood pressure lowering agent. It might not work to lower the blood pressure when it’s “too” high, but still lowers it to a certain degree.

When ever you have high blood pressure and don’t have any antihypertensive medication around you, start drinking water. Lots and lots of it, once glass after another. After 4-8 glass of water you will definitely feel an urge to urinate.

Recheck your blood pressure after urinating and keep on having water.

Intake of extra water causes kidneys to filter out the excess water from the body, which infact also takes out the salt from the body leading to lowering of blood pressure.

This tip is tried by me personally on my patients and it really works when we’re out of medications at home or at some place.

There are other tips around on the internet too but haven’t tested them or heard them from any reliable source so will prefer not sharing them.

Please note, don’t give water to a patient when he is unconscious or semi conscious as it may go in his respiratory tract and cause serious complications.

Herniorraphy = repairing the defect by stitching the healthy ends of tissue / muscle together

Hernioplasty = repairing the defect using mesh patches

How to remember it ? well if the original tissue is Repaired (R) then it’s hernioRraphy and if a mesh Patch is applied then its hernioPlasty.

This is what I’ve experienced myself during my housejob in General Medicine team- 2 of Dr Rauf Niazi in Pakistan Institute of Medical Sciences, Islamabad, the tertiary care hospital of the capital of the country.

The house job rotation period in the general medicine is 2 months. During this period, the house officer has to work at three places, ward, emergency and opd. Details of the work done at these places is as follows:

First I’ll outline whats “required” to be done by house officer during housejob in pims general medicine. Things which he CAN do if he’s interested and get a chance to do will be listed later.

SOP for house officers in ward

1. timing 8am to 2pm (however, he/she has to stay after 2 if their beds work isn’t complete)
2. sampling of beds (all sort of sampling, all blood drawing and stuff is done by the house officer, along with some other nursing staffs work too)
3. accompanying patient when he goes for ct scan, echo, taking time for their ultrasonography and ct scan, mri etc, (along with some other ward boy stuff too)
4. history taking & examination (pg trainee takes their own history, so ho’s history isn’t used in patients management)
5. progress notes (again, pg writes their own notes)
6. bsr and vitals monitoring, ecg (after bringing ecg machine from other wards) (again, along with other nurses work)
7. passing nasogastric tube, catheterization of the patient
8. tracing labs of the patient
9. etc (includes some other related stuff)

 SOP for house officers in ER

1. Presence in ER when they have duty there
2. bsr and vitals monitoring of patients who need it
3. injecting insulin, i/v fluids etc
4. sampling of blood
5. making investigation slips for the investigations ordered by the pg
6. informing pg to come to ER when a patient is referred to general medicine
7. passing nasogastric tube, catheterization of the patient
8. abg’s
9. tracing lab reports of the patient
10. taking patient to ultrasound, shifting to departments etc

SOP for house officers in OPD

1. after doing blood sampling and other nurse and ward boys stuff in ward they’ll goto opd on their opd day
2. making investigation slips ordered by seniors
3. taking patient to the senior / other department required

In the end, this prepares the house officer for managing patients in remote areas, as once his housejob is complete, he won’t be in hospital setup and will be working in some clinic or remote region until he gets admission or post graduate training.

This routine in 2 months is carefully designed by the head of departments (Dr Jamal Zafar and Dr Rauf Niazi) to make the house officer capable enough of managing all the acute emergencies, most opd cases and managing normal ward patients.

1. surgical blade
2. gloves
3. 0 silk suture
4. angiocath
5. swab, guaze
6. some money
7. pocket / hand book of your current department’s speciality