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1. Peritonitis
a. Reatain NG with suction/bag
b. Reatain foley catheter
i. Record urine/hr
c. Lab
i. CBC
ii. BUN,Cr,Elyte,BS/DTx
iii. H/C ABO sepsis/septic shock
iv. CXR (PA upright)
v. EKG > 45 cardiovascular
system
d. Isotonic solution (NSS,LRS ,Acetar)
i. IV 200-240 ml/hr
ii. Hypotension / sepsis / septic shock
IV loading 1000 ml
in 15-30 min ( CHF , pulmonary edema
,ESRD )
iii. IV rate urine output/hr
e. start empirical antibiotic septic work up
i. PUP
Ampicillin 1 gm / PGS 2 mil U/ Clinda 600 mg iv
+Gentamycin 240 mg iv drip / Cef-3 2 gm iv
ii.
ampicillin/PGS + Cef-3/Genta + Metro
f.
ICU , ventilator
2. Appendicitis
a. NPO time
b. Basic Lab
i. CBC,UA
ii. BUN,CR,Elyte,BS/DTx
iii. CXR,EKG > 45 ,

c. Alvarado score CBC

d. IV : condition ( DM,Elyte imbalance,CHF,ESRD)
e. ABO:

i. ruptured appendicitis /localize peritonitis : Cef3/Genta + Metro

3. UGIH
a.
48
b. Low risk group
.
(EGD) .
089-7554375
care map
c. High risk group : refer
i. Initial assessment and resuscitation
Maintain airway
Hx. and PE
NG irrigation
Fluid resuscitation
Basic Lab : CBC,BUN,Cr,Elyte
Cross-match,
ii. High risk group
Age>60
Unstable V/S
Co-morbidity (IHD,CHF,ESRD,Cirrhosis,COPD)
Coagulopathy
Active bleeding
a. Continuous Red Blood from NG
b. Red blood from rectum
Rebleeding
d. Suspected EV
i. Previous Dx. EV or GV
ii. Sign of Portal HT
Splenomegaly
Ascites
Hepatic encephalopathy
Superficial vein dilatation
iii. Clinical cirrhosis with

 Thrombocytopenia and/or splenomegaly

e. Medical treatment
i. Antisecretory therapy Ulcer bleeding
Omeprazole
80 mg iv bolus !then 40 mg iv q
12 hr.
Pantoprazole (controloc)80 mg iv bolus!then iv drip 8
mg/hr.
4. TRAUMA
a. ATLS guideline
b. Refer
5. Head injury
a. ATLS guideline
b. Refer
6. NF
a. Basic lab +/- H/C
b. line consult
c. start ABO
i. Clindamycin+Cef-3
ii. PGS+CEF-3
iii. Etc
d. Wound dressing
e. NPO
f. IV :
7. Surgical septic shock
a. Sepsis guideline (Work up +resuscitation +initial treatment)
i. CBC,BUN,Cr,ELyte,BS
ii. CXR,EKG
iii. H/C x II
iv. Start ABO source
v. IV resuscitation ( loading 1000 ml)
vi. Monitor V/S , urine , O2 sat
vii. ET
b. soft tissue lesion : line consult
c. Advise