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Ped hiv
Ped hivAimmary
油
The Thai National HIV Guidelines Working Group updated treatment guidelines for pediatric HIV in March 2010. Key aspects include:
1) ART should be initiated in infants <12 months regardless of symptoms and all children with CDC stage B/C or WHO stage 3/4 disease. CD4-guided thresholds are provided for mildly symptomatic children.
2) The preferred first-line regimen for children <3 years is AZT+3TC+NVP. For children >3 years it is AZT+3TC+EFV. Consider TDF+3TC+EFV for adolescents weighing >40kg.
3) The preferred second-line regimen for first-line failure comprises 2NRTI+LPV/r.Narain c-spine injury 2
Narain c-spine injury 2Aimmary
油
This document discusses cervical spine injuries. It begins by providing epidemiological data on cervical spine injuries, including common causes, levels of injury, and classifications of complete vs incomplete spinal cord injuries. It then discusses neurological assessment techniques, airway management considerations, importance of breathing and circulation support, clinical criteria for clearing the cervical spine, and immobilization guidelines. Recommendations are provided for tracheal intubation methods, criteria for cervical spine imaging, and guidelines for cervical spine clearance. Early removal of cervical collars is also recommended to reduce complications.
Chitlada upper gi bleeding 2
Chitlada upper gi bleeding 2Aimmary
油
Initial resuscitation of patients with upper GI bleeding is critical and includes IV access, oxygen, fluid resuscitation, and blood product transfusion if needed. Early risk stratification evaluates factors like age, comorbidities, hemodynamic stability, and endoscopic findings to determine risk of rebleeding, need for intervention, and mortality. Source of bleeding is identified through endoscopy within 24 hours when possible. For low risk patients, medical therapy with PPIs is usually sufficient, while high risk patients may require endoscopic treatment or radiologic intervention. High dose PPIs, especially IV formulations, are effective in preventing rebleeding and shortening hospital stays when given before and after endoscopy. Surgery is reserved for
Hiv adult
Hiv adultAimmary
油
The document provides guidelines for antiretroviral therapy (ART) for HIV-1 infected adults and adolescents in Thailand. Key points include:
- ART is now recommended to start at a CD4+ T-cell count of <350 cells/mm3.
- The preferred first regimen is a non-nucleoside reverse transcriptase inhibitor (NNRTI) such as efavirenz or nevirapine combined with lamivudine and either zidovudine or tenofovir.
- Guidelines were updated based on recent evidence and considerations for the Thai setting and available drugs.
Update tox 2010 june 2010 summon chomchai
Update tox 2010 june 2010 summon chomchaiAimmary
油
A 55-year-old man was found unconscious at home after ingesting kratom and alcohol. At the emergency department, he was comatose with low vital signs. Treatment with naloxone had no effect. He was given supportive care and woke up 10 hours later, admitting to ingesting kratom and whiskey. Kratom contains compounds that are opioid receptor agonists and can cause respiratory depression, especially in combination with alcohol. Supportive care is the primary treatment for kratom toxicity.Status epilepticus kong kiat
Status epilepticus kong kiatAimmary
油
This document discusses status epilepticus (SE), including:
- Definitions and types of SE such as convulsive SE, nonconvulsive SE, and acute repetitive seizures.
- Characteristics of generalized convulsive SE.
- Incidence and mortality rates of SE which increase with age.
- Main causes of SE such as low antiepileptic drug levels, cerebrovascular accidents, anoxia/hypoxia, and metabolic disturbances.
- Guidelines for the management of SE including initiating treatment with benzodiazepines like lorazepam or diazepam, followed by antiepileptic drugs like fosphenytoin, phenytoin,
Prasit acute abdomen
Prasit acute abdomenAimmary
油
1) Acute abdomen is a common presentation accounting for 4-10% of emergency department visits. 50% have a clear diagnosis while 15-30% require surgical procedures, especially in the elderly.
2) Unique presentations can occur in pediatric and elderly patients, with the elderly having higher rates of misdiagnosis and mortality due to less prominent physical exam findings.
3) A thorough history and physical exam remain important for assessing abdominal pain, though imaging studies can help when the diagnosis is unclear. Close observation is often needed to determine if the condition is surgical or non-surgical.
Nath abdominal trauma
Nath abdominal traumaAimmary
油
This document discusses the evaluation and management of abdominal trauma. It provides an overview of abdominal anatomy, mechanisms of injury, investigations including FAST, CT scans and DPL, and treatment approaches for blunt, penetrating and blast injuries. Algorithms are presented for the clinical assessment and decision making process depending on the stability of the patient and findings on examination and investigations. Special considerations for combined injuries and pelvic fractures are also reviewed.
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Hiv adult
Hiv adultAimmary
油
The document provides guidelines for antiretroviral therapy (ART) for HIV-1 infected adults and adolescents in Thailand. Key points include:
- ART is now recommended to start at a CD4+ T-cell count of <350 cells/mm3.
- The preferred first regimen is a non-nucleoside reverse transcriptase inhibitor (NNRTI) such as efavirenz or nevirapine combined with lamivudine and either zidovudine or tenofovir.
- Guidelines were updated based on recent evidence and considerations for the Thai setting and available drugs.Update tox 2010 june 2010 summon chomchai
Update tox 2010 june 2010 summon chomchaiAimmary
油
A 55-year-old man was found unconscious at home after ingesting kratom and alcohol. At the emergency department, he was comatose with low vital signs. Treatment with naloxone had no effect. He was given supportive care and woke up 10 hours later, admitting to ingesting kratom and whiskey. Kratom contains compounds that are opioid receptor agonists and can cause respiratory depression, especially in combination with alcohol. Supportive care is the primary treatment for kratom toxicity.Status epilepticus kong kiat
Status epilepticus kong kiatAimmary
油
This document discusses status epilepticus (SE), including:
- Definitions and types of SE such as convulsive SE, nonconvulsive SE, and acute repetitive seizures.
- Characteristics of generalized convulsive SE.
- Incidence and mortality rates of SE which increase with age.
- Main causes of SE such as low antiepileptic drug levels, cerebrovascular accidents, anoxia/hypoxia, and metabolic disturbances.
- Guidelines for the management of SE including initiating treatment with benzodiazepines like lorazepam or diazepam, followed by antiepileptic drugs like fosphenytoin, phenytoin,Prasit acute abdomen
Prasit acute abdomenAimmary
油
1) Acute abdomen is a common presentation accounting for 4-10% of emergency department visits. 50% have a clear diagnosis while 15-30% require surgical procedures, especially in the elderly.
2) Unique presentations can occur in pediatric and elderly patients, with the elderly having higher rates of misdiagnosis and mortality due to less prominent physical exam findings.
3) A thorough history and physical exam remain important for assessing abdominal pain, though imaging studies can help when the diagnosis is unclear. Close observation is often needed to determine if the condition is surgical or non-surgical.Nath abdominal trauma
Nath abdominal traumaAimmary
油
This document discusses the evaluation and management of abdominal trauma. It provides an overview of abdominal anatomy, mechanisms of injury, investigations including FAST, CT scans and DPL, and treatment approaches for blunt, penetrating and blast injuries. Algorithms are presented for the clinical assessment and decision making process depending on the stability of the patient and findings on examination and investigations. Special considerations for combined injuries and pelvic fractures are also reviewed.