Medical Protocols PDF

{"version":131106,"timestamp":1727417926120,"data":{"tasks":[{"task":{"title":"Z what must be present for dx of ID befor 18 yrs","priority":2,"creationDate":1678345720361,"modificationDate":1706523263474,"de letionDate":1706523263000,"notes":".\n\ncognitive and adaptive dysfunction must be present b...

{"version":131106,"timestamp":1727417926120,"data":{"tasks":[{"task":{"title":"Z what must be present for dx of ID befor 18 yrs","priority":2,"creationDate":1678345720361,"modificationDate":1706523263474,"de letionDate":1706523263000,"notes":".\n\ncognitive and adaptive dysfunction must be present before 18 yrs","remoteId":"606444573249400569"},"alarms":[],"geofences": [],"tags":[],"comments":[],"attachments":[],"caldavTasks":[]},{"task": {"title":"Staff policy","priority":2,"creationDate":1679199691713,"modificationDate":1706523263516, "deletionDate":1706523263000,"remoteId":"2135905247026277102"},"alarms": [],"geofences":[],"tags":[],"comments":[],"attachments":[],"caldavTasks":[]}, {"task":{"title":"Minimum payment that can be done","priority":2,"creationDate":1679199707547,"modificationDate":1706523263544,"d eletionDate":1706523263000,"remoteId":"1715944300280761889"},"alarms": [],"geofences":[],"tags":[],"comments":[],"attachments":[],"caldavTasks":[]}, {"task":{"title":"Social security","priority":2,"creationDate":1679199714396,"modificationDate":170652326355 9,"deletionDate":1706523263000,"remoteId":"4115995801859481997"},"alarms": [],"geofences":[],"tags":[],"comments":[],"attachments":[],"caldavTasks":[]}, {"task": {"title":"Contract","priority":2,"creationDate":1679199794668,"modificationDate":17 06523263578,"deletionDate":1706523263000,"remoteId":"1877919100050493301"},"alarms" :[],"geofences":[],"tags":[],"comments":[],"attachments":[],"caldavTasks":[]}, {"task":{"title":"CD markers in Lymphoma","priority":0,"creationDate":1727417711901,"modificationDate":172741771190 1,"notes":"Here’s a list of key markers, their significance, and their role in prognosis:\n\n1. CD20\npresent on most B-cell lymphomas, including diffuse large B- cell lymphoma (DLBCL) and follicular lymphoma.\n\n\nPrognosis: The presence of CD20 can make the lymphoma responsive to rituximab, improving overall outcomes.\n\n\n\ n\n\n2. CD30\nSignificance: Found on Reed-Sternberg cells in Hodgkin lymphoma and some anaplastic large cell lymphomas (ALCL).\n\nPrognosis: CD30 positivity is a hallmark of Hodgkin lymphoma and can be targeted by brentuximab vedotin, improving prognosis for certain cases.\n\n\n\n\n3. CD3\nSignificance: A marker of T-cell origin; found on most T-cell lymphomas.\nPrognosis: The presence of CD3 helps confirm T-cell lineage, which is crucial for diagnosing T-cell lymphomas and guiding treatment strategies.\n\n\n\n4. CD19\nSignificance: A pan-B-cell marker, found in most B-cell lymphomas.\nPrognosis: Like CD20, the presence of CD19 can aid in the use of targeted therapies like CAR-T cells.\n\n\n\n\n5. CD5\nSignificance: Expressed in chronic lymphocytic leukemia (CLL) and some T-cell lymphomas, such as mantle cell lymphoma.\nPrognosis: CD5 positivity is used to diagnose and classify specific types of lymphomas, impacting treatment decisions.\n\n\n\n6. CD10\ nSignificance: Associated with follicular lymphoma and some B-cell lymphomas, such as DLBCL.\nPrognosis: CD10-positive lymphomas, such as follicular lymphoma, often have a more indolent course compared to other types.\n\n\n\n\n7. BCL2\ nSignificance: An anti-apoptotic protein commonly overexpressed in follicular lymphoma and some other B-cell lymphomas.\nPrognosis: BCL2 overexpression often indicates a more indolent lymphoma, such as follicular lymphoma, but can also be seen in more aggressive forms.\n\n\n\n\n8. BCL6\nSignificance: A transcription factor associated with germinal center B-cell lymphomas, including DLBCL and follicular lymphoma.\nPrognosis: BCL6 positivity can indicate a germinal center origin and helps in subclassifying DLBCL, which can impact treatment strategies.\n\ n\n\n\n9. MYC\nSignificance: An oncogene often involved in aggressive lymphomas, such as Burkitt lymphoma and some DLBCL.\n\nPrognosis: MYC rearrangement is associated with a more aggressive disease course and can be a marker of poor prognosis.\n\n\n\n\n10. ALK (Anaplastic Lymphoma Kinase)\nSignificance: A receptor tyrosine kinase found in ALK-positive anaplastic large cell lymphoma (ALCL).\ nPrognosis: ALK positivity is associated with a generally favorable prognosis and is targeted by therapies like crizotinib.\n\n\n\n\n**11. EBV (Epstein-Barr Virus)\ nSignificance: Associated with Hodgkin lymphoma, some DLBCLs, and post-transplant lymphoproliferative disorders (PTLD).\nPrognosis: EBV-positive Hodgkin lymphoma can have variable prognosis, often influenced by the extent of disease and response to therapy.\n\n\n\n\n**12. Kappa and Lambda Light Chains\nSignificance: Used to identify clonality in B-cell lymphomas; either kappa or lambda light chain restriction indicates monoclonal proliferation.\nPrognosis: Light chain restriction helps confirm diagnosis but is less directly related to prognosis.\n\n\n\n\n**13. Ki-67\nSignificance: A proliferation marker indicating the growth fraction of the lymphoma.\nPrognosis: High Ki-67 levels are associated with more aggressive disease and poorer prognosis.\n\n\n\n\n**14. IgM/IgG\nSignificance: Immunoglobulin markers used to determine clonality and subtype in certain lymphomas.\nPrognosis: Specific isotypes can indicate particular types of lymphomas, such as IgM in Waldenström macroglobulinemia.","ringFlags":16,"remoteId":"3335218181810716249","order":87},"al arms":[{"time":3600000,"type":3}],"geofences":[],"tags":[],"comments": [],"attachments":[],"caldavTasks": [{"calendar":"MTI1NDExNjU0OTUyOTY3MDUzMTk6MDow","remoteId":"SGVIWXUyUkFnMmNxN3R4OQ" ,"object":null,"lastSync":1727417711901,"remoteOrder":87}]},{"task": {"title":"Amikacin sulfate","priority":0,"creationDate":1727417711918,"modificationDate":1727417711918 ,"notes":"15-20 mg/kg/day IV, IM q 8-12 hr. Intravenous infusion to be given over 1 hour\n\nAdult dose: 1.5 gm/day q 12 hr\n\n(Inj amicin, alfakim, amistar, biocin, ivimicin, amitax, mikacin, novacin vials 100 mg, 250 mg and 500 mg)","ringFlags":16,"remoteId":"1077490087642088438","order":62},"alarms": [{"time":3600000,"type":3}],"geofences":[],"tags":[],"comments":[],"attachments": [],"caldavTasks": [{"calendar":"MTI1NDExNjU0OTUyOTY3MDUzMTk6MDow","remoteId":"R3BtVXVWM0tEeWlfQUU4Ug" ,"object":null,"lastSync":1727417711918,"remoteOrder":62}]},{"task": {"title":"Clindamycin hydrochloride ","priority":0,"creationDate":1727417711928,"modificationDate":1727417711928,"notes ":"10mg/kg/dose tds\n Dilute for slow infusion over 30 min. \n\nUseful for MRSA, anerobic infections, P. carinii pneumonia and toxoplasma encephalitis.\n\nAdult dose: 150-450 mg q 6-8 hr.\nCaution: Pseudomembranous colitis. Avoid coadministration\n\nwith erythromycin.\n(Dalcinex, dalacin-c caps 150 mg, 300 mg; inj dalacin, climycin 150 mg per ml in 2 ml, 4 ml ampoules, erytop and clindapene gel for acne)","ringFlags":16,"remoteId":"3235173826899427952","order":51},"alarms": [{"time":3600000,"type":3}],"geofences":[],"tags":[],"comments":[],"attachments": [],"caldavTasks": [{"calendar":"MTI1NDExNjU0OTUyOTY3MDUzMTk6MDow","remoteId":"NmZIeS1mWXVUeUZmOEozbg" ,"object":null,"lastSync":1727417711928,"remoteOrder":51}]},{"task": {"title":"Iron","priority":0,"creationDate":1727417711935,"modificationDate":172741 7711935,"notes":"Xevita XT Syrup (5 ml) is typically:\n\nFerrous Ascorbate: 30 mg of elemental iron.\nFolic Acid: 550 mcg.\n\n5ml/30mg iron\n\nPreventative dose: 1-2 mg/kg/day of elemental iron1.\n\nTreatment dose: 3-6 mg/kg/day of elemental iron1","ringFlags":16,"remoteId":"3120796911657972565","order":76},"alarms": [{"time":3600000,"type":3}],"geofences":[],"tags":[],"comments":[],"attachments": [],"caldavTasks": [{"calendar":"MTI1NDExNjU0OTUyOTY3MDUzMTk6MDow","remoteId":"NGNtQ1BtcUxvMGhEbVItRA" ,"object":null,"lastSync":1727417711935,"remoteOrder":76}]},{"task":{"title":"worm in stool","priority":0,"creationDate":1727417711971,"modificationDate":1727417711971," notes":"Albendazole (400 mg single dose or for 3 days):\n\nCan be repeated in 2 weeks if necessary.\n\nMebendazole (100 mg twice a day for 3 days or 500 mg single dose):\n\n\n\nOften used for roundworms, whipworms, and hookworms.\n\n\n\n\n\n2nd line:\nPyrantel pamoate (for pinworms):\n\nSingle dose, repeated after 2 weeks.\ nPraziquantel (for tapeworms):\n\nDosage depends on the type of tapeworm.\n\ nPraziquantel Dosing:\nSchistosomiasis (Bilharzia):\n\nDose: 20 mg/kg body weight per dose, taken 3 times in a single day (total 60 mg/kg/day).\nTapeworm Infections (Taeniasis or Diphyllobothriasis):\n\nDose: 5-10 mg/kg as a single dose.\ nNeurocysticercosis (Larval form of Taenia solium):\n\nDose: 50 mg/kg/day, divided into 3 doses per day, for 7-14 days.\nLiver Flukes (Clonorchiasis, Opisthorchiasis):\n\nDose: 25 mg/kg body weight per dose, taken 3 times in a single day (total 75 mg/kg/day).\nParagonimiasis (Lung Flukes):\n\nDose: 25 mg/kg body weight per dose, taken 3 times daily for 2 consecutive days.\n\n\n\n\n\ nIvermectin:\nUsed for strongyloidiasis and onchocerciasis (less common intestinal parasites).\n\ n","ringFlags":16,"remoteId":"1175162285544740744","order":74},"alarms": [{"time":3600000,"type":3}],"geofences":[],"tags":[],"comments":[],"attachments": [],"caldavTasks": [{"calendar":"MTI1NDExNjU0OTUyOTY3MDUzMTk6MDow","remoteId":"YUxBNWN4T1c5bWxiY1IwTQ" ,"object":null,"lastSync":1727417711971,"remoteOrder":74}]},{"task":{"title":"Solid tumor Trement protocol","priority":0,"creationDate":1727417711991,"modificationDate":172741771199 1,"notes":"PNNET family tumor\n1. Ewwing Sarcoma NeoAdjuvant VDC/IE 21 days cycle then 1 week gap then new, for 3 cycles i.e 12 wks then at 12wk surgery then and ajuvant or RT for 8 to 10 cycles. 2nd line ICE\n\n2. PNNET\nsurgical resection whenever possible, adjuvant/neoadjuvant VDC/IE, and radiotherapy. \n\n\n\n\nGeerm cell tumor surgery then 4-6cycles of adjuvant BEP then RT. BEP 21 days cycle then gap 1 week then another cycle. Bleomycin, Etoposide, Cisplatin. 2nd line: ICE Surgery for resectable disease post-chemotherapy (typically after 4 cycles); radiotherapy for certain localized cases.\n\n\n\n\nHepatoblastoma: The SIOPEL regimen:\n5-Fluorouracil (5-FU), Doxorubicin, Cisplatin\nor Cisplatin, 5-FU, Vincristine (C5V) regimen 2nd line ICE. Surgical resection after 2-4 cycles if feasible; liver transplant if non-resectable. Radiotherapy rarely used.\n\nLCH First-Line:\nunifocal or multifocal: Vinblastine and Prednisone\nMultisystem: Vinblastine and Prednisone for 6-12 months, sometimes with Cyclophosphamide or Methotrexate for severe cases. Surgery for single lesions; low-dose radiotherapy (6-12 Gy) for specific bone lesions not amenable to surgery.\n\nLCH-III\" protocol. The typical chemotherapy regimen may include:\n6-MP: An antimetabolite that interferes with DNA synthesis.\nVinblastine, Cytarabine (Ara-C), Methotrexate\ n Second-Line: Etoposide and Ifosphamide, HDMX\n\n\n\n\nLymphomas:\n\nHoodgkin lymphoma ABVD reevaluate in 3rd(6) cycle then give total of 6-8 cycles. most patients with this diagnosis are cured or that or the disease can be be controlled for years. 2nd line ICE. Radiotherapy after chemotherapy (usually after 2-4 cycles) for bulky disease or residual disease, Unfavorable response after 2-4 cycles.\n\n\ n\nABVD: Nodular Sclerosis Hodgkin Lymphoma (NSHL): \nMixed Cellularity Hodgkin Lymphoma (MCHL)\nLymphocyte-Rich Hodgkin Lymphoma (LRHL)\n\nBEACOPP:\nLymphocyte- Depleted Hodgkin Lymphoma (LDHL)\n\nRCHOP\nNodular Lymphocyte-Predominant Hodgkin Lymphoma (NLPHL)\n\n\n\n\nNHL: Radiotherapy: May be considered for bulky disease, residual disease post-chemotherapy, or CNS involvement. surgery not indicated.\n\n\ n1. Burkitt Lymphoma (BL):\nSubtype Features: Highly aggressive B-cell NHL; associated with MYC gene rearrangements: CODOX-M/IVAC regimen or COPADM. 2nd line R-ICE. \n\n2. DLBCL: R-CHOP (Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, Prednisone) for 6-8 cycles. 2nd line ICE. \n2nd line: ICE\nThe most common types of CD20-positive lymphoma are B-cell lymphomas, including diffuse large B-cell lymphoma (DLBCL), follicular lymphoma, and certain other B-cell malignancies.\n\n\n\n3. ALCL: ALCL99 protocol (APO regimen: Doxorubicin, Prednisone, Vincristine).\n2nd line: ICE. often presents with CD30-positive cells. Present with ALK rearrangement\n\n4. 4. Lymphoblastic Lymphoma (LL): BfFM Protocol\ n\n5. Primary Mediastinal B-cell Lymphoma (PMBCL): RCHOP\n\n\n\n\n\n\n\n\ nOssteosarcoma/chondrosarcoma Neoadujvant AP or MAP 2 cycle of 35 days, then surgery at wk 11 then adjuvant till 29 weeks. total 10 cycles\nReassess in 4th cycle\nAfter 4th cycle no more cysplatin\n 2nd line ICE\n\n\nMeedulobalstoma:\ nFirst-Line: Post-Surgery: Vincristine, Cisplatin, Cyclophosphamide, and Actinomycin D. \n2nd line: ICE. radiotherapy After surgery and completion of initial chemotherapy (usually within 4-6 weeks post-surgery).\n\nNeeuroblastoma \ nstage 1/2 surgery alone\nhigh risk: surgery --> CCG regimen d1 to d5 (Cisplatin, Doxorubicin, Etoposide, cyclophoshamide) 4-6 cycles then surgery then radiation therapy and biologic/immunologic therapy, 2nd line ICE.\nReevaluation: Imaging (MRI/CT and MIBG scan) after 2-4 cycles and post-surgery\n\n\n\n\nEpendymoma: First-Line: Vincristine, Cyclophosphamide, and Actinomycin D\nSecond-Line: ICE \n\ nGliomas:\nFirst-Line: Temozolomide, Carboplatin, and Vincristine\nSecond-Line: High-Dose Chemotherapy with stem cell rescue, Carboplatin and Etoposide\n\n\n Pheochromocytoma:\n \tFirst-Line:\no\tRegimen: Often includes Carboplatin, Etoposide, Cyclophosphamide, or Ifosphamide-based regimens.\n \tSecond-Line:\no\ tSalvage Regimens: ICE (Ifosphamide**, Carboplatin, Etoposide), Topotecan and Ifosphamide\n\n\n\n\nRMMS/ synovial sarcoma: surgery if possible then VAC 14 cycles, 3 cycles then 2 cycle VC only + if RT needed started at 9-13 week, then continue VAC, upto 28 wks then reevaluate, for relapse VDC/IE. (viincristine, 1.4mg/m2, dooxorubicin 30mg/m2, Cyyclophosphamide 1200mg/m2/ Ifosfamide 3000mg/m2 + Etoposide 150mg/m2). 2nd line ICE\n\n\n\n\nRetinoblastoma: First-Line: VEC (Vincristine, Etoposide, Carboplatin) 2nd line ICE. Focal therapies (laser, cryotherapy) or enucleation if advanced; radiotherapy if extraocular extension. Reevaluation: Examination under anesthesia (EUA) and imaging after 2 cycles of chemotherapy. \n\n\nWiilms tumor:\nCOP regimen: Nephrectomy before chemotherapy if feasible; radiotherapy for Stage III/IV After nephrectomy and initial chemotherapy. TT done in daycare\n\nSIOP regimen \nNeoadjuvant DD4A CT for 12 wks i.e 3months\ nthen surgery\nthen 3 weekly chemotherapy for extra 8-12 cycles. 2nd line ICE\n\ n","ringFlags":16,"remoteId":"3806687567219714267","order":109},"alarms": [{"time":3600000,"type":3}],"geofences":[],"tags":[],"comments":[],"attachments": [],"caldavTasks": [{"calendar":"MTI1NDExNjU0OTUyOTY3MDUzMTk6MDow","remoteId":"dUR3SVpoS0ZsX2ZGYXBLUg" ,"object":null,"lastSync":1727417711991,"remoteOrder":109}]},{"task": {"title":"vomitting emetogenic potential","priority":0,"creationDate":1727417712004,"modificationDate":17274177120 04,"notes":"1. Aprepitant\nClass: Neurokinin-1 (NK1) receptor antagonist\nUse: Effective for preventing nausea and vomiting associated with chemotherapy and postoperative settings.\n\n2. Palonosetron\nClass: 5-HT3 receptor antagonist\nUse: Highly effective for preventing chemotherapy-induced nausea and vomiting (CINV), particularly in delayed onset.\n\n3. Ondansetron\nClass: 5-HT3 receptor antagonist\ nUse: Commonly used for CINV and postoperative nausea and vomiting (PONV). Less effective in delayed CINV compared to palonosetron.\n\n4. Granisetron\nClass: 5-HT3 receptor antagonist\nUse: Similar to ondansetron, it is used for CINV and PONV. It has a longer half-life, making it effective for prolonged symptoms.\n\n5. Dexamethasone\nClass: Corticosteroid\nUse: Used in combination with other antiemetics for CINV; has synergistic effects when combined with 5-HT3 antagonists.\n\n6. Metoclopramide\nClass: Dopamine receptor antagonist\nUse: Effective for nausea due to gastrointestinal causes and chemotherapy; also enhances gastric emptying.\n\n7. Prochlorperazine\nClass: Phenothiazine (dopamine antagonist)\nUse: Effective for nausea and vomiting; commonly used in emergency settings.\n\n8. Promethazine\nClass: Phenothiazine\nUse: Used for motion sickness and PONV, but less potent compared to the aforementioned agents.\n\n9. Dimenhydrinate (Dramamine)\nClass: Antihistamine\nUse: Effective for motion sickness; generally considered less potent for chemotherapy-induced nausea.\n\n10. Cyclizine\nClass: Antihistamine\nUse: Used for motion sickness and some cases of nausea; lower potency compared to stronger antiemetics.\n\n\nHighest Potency: Aprepitant and palonosetron are among the most potent antiemetics, particularly in preventing CINV.\n\n\nModerate Potency: Ondansetron, granisetron, and dexamethasone are effective for both acute and delayed nausea.\n\n\nLower Potency: Metoclopramide, prochlorperazine, promethazine, and antihistamines are useful for specific situations but are generally less potent than the first-line agents listed.","ringFlags":16,"remoteId":"85240703817758046","order":0},"alarms": [{"time":3600000,"type":3}],"geofences":[],"tags":[],"comments":[],"attachments": [],"caldavTasks": [{"calendar":"MTI1NDExNjU0OTUyOTY3MDUzMTk6MDow","remoteId":"RGc4UUFON0VVa2hjdG84YQ" ,"object":null,"lastSync":1727417712004}]},{"task":{"title":"PET scan","priority":0,"creationDate":1727417712014,"modificationDate":1727417712014,"n otes":"Positron Emission Tomography (PET):\n\nFunction: PET imaging provides information about the metabolic activity of tissues. It detects gamma rays emitted indirectly by a positron-emitting radiotracer, which is usually a form of glucose (e.g., F-18 fluorodeoxyglucose, or FDG).\n\nUse: PET is particularly useful in identifying areas of increased metabolic activity, which can indicate the presence of tumors, infections, or other conditions.","ringFlags":16,"remoteId":"4596132228792121570","order":1},"alarms": [{"time":3600000,"type":3}],"geofences":[],"tags":[],"comments":[],"attachments": [],"caldavTasks": [{"calendar":"MTI1NDExNjU0OTUyOTY3MDUzMTk6MDow","remoteId":"QjBKQ3RhdHl4dnJ0b2s3Zg" ,"object":null,"lastSync":1727417712014,"remoteOrder":1}]},{"task": {"title":"Magnesium sulfate mgso4","priority":0,"creationDate":1727417712025,"modificationDate":1727417712025," notes":"2-3 mEq/kg/day for PEM. Magnesium sulfate 50% solution provides 4 mEq/ml of elemental magnesium. Give 0.5-1.0 ml/kg/day q 6 hr IM. Magnesium sulfate 1% solution contains 10 mg magnesium/ml equivalent to 0.08 mEq magnesium/ml. It is given in a dose of 100 mg/kg IV. For use in asthma see section on Bronchodilators.\ n(Inj magnesium sulfate 1%, 10%, 25%, 50% 1 ml ampoules).","ringFlags":16,"remoteId":"1962966712360756669","order":6},"alarms": [{"time":3600000,"type":3}],"geofences":[],"tags":[],"comments":[],"attachments": [],"caldavTasks": [{"calendar":"MTI1NDExNjU0OTUyOTY3MDUzMTk6MDow","remoteId":"MGtwa05CcHQtR0s2dW9acg" ,"object":null,"lastSync":1727417712025,"remoteOrder":6}]},{"task": {"title":"Potassium chloride","priority":0,"creationDate":1727417712035,"modificationDate":172741771203 5,"notes":" 1-2 mEq/kg/day q 8 hr oral\nCaution: Administer only when urine flow is established. \n\n(Syrup potklor, K-sus, keylyte, potasol 15 ml / 20 mEq of K and potassium chloride \n\ninjection 15% 10 ml ampoules provide 2 mEq of K+ per ml)\n\ n","ringFlags":16,"remoteId":"3777678835561255530","order":2},"alarms": [{"time":3600000,"type":3}],"geofences":[],"tags":[],"comments":[],"attachments": [],"caldavTasks": [{"calendar":"MTI1NDExNjU0OTUyOTY3MDUzMTk6MDow","remoteId":"RVlIU0xfY1Q2bHRjdTUtNQ" ,"object":null,"lastSync":1727417712035,"remoteOrder":2}]},{"task":{"title":"Zinc ","priority":0,"creationDate":1727417712046,"modificationDate":1727417712046,"notes ":"For deficiency administer 0.5 mg/kg/day for infants; 10 mg/day in 6 months of age for treatment of acute and persistent diarrhea for 14 days and 6 mg/kg/d for treatment of acrodermatitis entero- pathica. Maximum adult dose is 220 mg/day.","ringFlags":16,"remoteId":"1240287156338755228","order":3},"alarms": [{"time":3600000,"type":3}],"geofences":[],"tags":[],"comments":[],"attachments": [],"caldavTasks": [{"calendar":"MTI1NDExNjU0OTUyOTY3MDUzMTk6MDow","remoteId":"YjBtOGs2TkJiRzF5TG5xLQ" ,"object":null,"lastSync":1727417712046,"remoteOrder":3}]},{"task":{"title":"Sodium bicarbonate ","priority":0,"creationDate":1727417712066,"modificationDate":1727417712066,"notes ":"1-2 mEq/kg per dose IV or calculate on the basis of base deficit as follows:\ nBase deficit x weight in kg x 0.6 = mEq or ml of 7.5% solution of sodium bicarbonate required for correction of acidosis.\nIndic: Correction of documented metabolic acidosis during prolonged resuscitation, bicarbonate deficit due to renal or GI losses.\nSE: Local tissue necrosis, hypernatremia, and hypocalcemia. Caution: Ensure adequate ventilation prior to infusion. Avoid\nbolus dose in newborn babies. Give after dilution with equal volume of distilled water or double volume of 5% dextrose. (Inj sodium bicarbonate 7.5% 10 ml ampoules providing 0.9 mEq bicarbonate per ml).","ringFlags":16,"remoteId":"2407720164789346946","order":4},"alarms": [{"time":3600000,"type":3}],"geofences":[],"tags":[],"comments":[],"attachments": [],"caldavTasks": [{"calendar":"MTI1NDExNjU0OTUyOTY3MDUzMTk6MDow","remoteId":"X3hBZC1ybG9GU0tyVUFYWg" ,"object":null,"lastSync":1727417712066,"remoteOrder":4}]},{"task": {"title":"Ranitidine hydrochloride ","priority":0,"creationDate":1727417712098,"modificationDate":1727417712098,"notes ":"It is non-imidazole H, blocker. 2-4 mg/kg per day q 12 hr oral for 4 to 6 weeks. In GERD, the dose is double. The IV dose is one-half of oral. The experience for its use in children is limited.\nAdult dose: 150 mg twice daily or 300 mg/day at bedtime for 4-6 weeks. IV dose is 50 mg q 6 hr.\nIndic: Gastroesophageal reflux disease (GERD), duodenal ulcer, gastric ulcer, and gastrinoma (Zollinger-Ellison syndrome).\n(Rantac, aciloc, ranitin, histac, lydin, ranial, rantid, advene tabs 150 mg, 300 mg; rantac syrup 75 mg/per 5 ml, inj ranitin,\naciloc 50 mg per 2 ml ampoule)\n","ringFlags":16,"remoteId":"3321125402444776183","order":5},"alarms": [{"time":3600000,"type":3}],"geofences":[],"tags":[],"comments":[],"attachments": [],"caldavTasks": [{"calendar":"MTI1NDExNjU0OTUyOTY3MDUzMTk6MDow","remoteId":"cDJ6MEVsWXFncUdNNUtpbA" ,"object":null,"lastSync":1727417712098,"remoteOrder":5}]},{"task": {"title":"Vitamin K","priority":0,"creationDate":1727417712126,"modificationDate":1727417712126,"note s":" Prophylaxis against hemorrhagic disease of the newborn: 1.0 mg for term, 0.5 mg for preterm neonates IM. Therapeutic dose: 5-10 mg/dose SC, IM or IV. Maximum single dose is 10 mg.\nIndic: Hemorrhagic disease of the newborn, bleeding tendency due to liver disorder, deficiency of vitamin In dependent clotting factors.\n(Inj menadione sodium bisulphite, phytomenadione, kapilin (acetmenaphthone) 10 mg per 1 ml ampoule, inj kenadion 1 mg and 10 mg/ml, kenadion tab 1 mg)","ringFlags":16,"remoteId":"1970953387667294088","order":7},"alarms": [{"time":3600000,"type":3}],"geofences":[],"tags":[],"comments":[],"attachments": [],"caldavTasks": [{"calendar":"MTI1NDExNjU0OTUyOTY3MDUzMTk6MDow","remoteId":"c3FHX0VXXzBHa3owRDIxMg" ,"object":null,"lastSync":1727417712126,"remoteOrder":7}]},{"task": {"title":"Prednisolone","priority":0,"creationDate":1727417712153,"modificationDate ":1727417712153,"notes":"1-2 mg/kg/day q 6 to 8 hr oral after meals. Predominantly anti-inflammatory effect with minimal sodium retaining activity.\nAdult dose: 60 mg/m2\nIndic: Nephrotic syndrome, rheumatic carditis, systemic- onset rheumatoid arthritis, bronchial asthma, and pemphigus.\nSE: Obesity, hypertension, osteoporosis, diabetes mellitus, hirsutism, and acne.\n(Wysolone, nucort tabs 5 mg, 10 mg, 20 mg, 30 mg, 40 mg; deltacortil, hostacortin 'H', solucort, predcip, predinga tab\nHormones and Drugs for Endocrinal Disorders\n5 mg; syr besone, kidpred, predone, nucort 5 mg/5 ml, predone forte 15 mg per 5 ml, omnacortil 5 mg/5 ml, omnacortil forte 15 mg/5 ml, kidpred forte 15 mg/5 ml)\ n","ringFlags":16,"remoteId":"4015381974568048501","order":8},"alarms": [{"time":3600000,"type":3}],"geofences":[],"tags":[],"comments":[],"attachments": [],"caldavTasks": [{"calendar":"MTI1NDExNjU0OTUyOTY3MDUzMTk6MDow","remoteId":"MjlpeGpFZGVoWmNxTWN3cg" ,"object":null,"lastSync":1727417712153,"remoteOrder":8}]},{"task":{"title":"Methyl prednisolone ","priority":0,"creationDate":1727417712179,"modificationDate":1727417712179,"notes ":"0.5-1.7 mg/kg/day IM, IV or oral. In emergency situations use higher doses of 30 mg/kg IV bolus over 10 to 20 minutes and repeat after 4 hours if necessary. For pulse therapy 30 mg/kg is given daily for 3-5 days. For shock 30 mg/kg/dose q 6 hr for 2-3 days.\nAdult dose: 24 mg/d q 6 hr, gradually tapered over 21 days, bronchial asthma 40-80 mg q 8-12 hr until PEF is 70% of predicted or personal best. Pulse therapy 1.0 g/d IV for 3-5 days.\nIndic: ITP, pulse therapy, used as anti- inflammatory and immunosuppressant glucocorticoid in allergic, neoplastic and inflammatory disorders.\nCaution: Administration of live virus vaccine, suspected tuberculosis or fungal infection.\n(Medrol tabs 4 mg, 8 mg, 16 mg; inj solu-medrol 140 mg, 500 mg, 1 g, 2 g; inj unidrol, depo-medrol 40 mg per ml as 1 ml and 2 ml vials)","ringFlags":16,"remoteId":"819894956926630462","order":9},"alarms": [{"time":3600000,"type":3}],"geofences":[],"tags":[],"comments":[],"attachments": [],"caldavTasks": [{"calendar":"MTI1NDExNjU0OTUyOTY3MDUzMTk6MDow","remoteId":"dzJSa2dNUHhFTWltclZTWQ" ,"object":null,"lastSync":1727417712179,"remoteOrder":9}]},{"task": {"title":"Hydrocortisone sodium ","priority":0,"creationDate":1727417712202,"modificationDate":1727417712202,"notes ":"succinate For anti-inflammatory action: 2.5-10 mg/kg/day divided 6 hourly. Status asthma- ticus: 10 mg/kg/dose stat followed by 5 mg/kg/dose 6 hourly IV. Endotoxic shock: 50 mg/kg initial dose followed by 50-150 mg/kg/day q 6 hr IV for 48-72 hours. Acute adrenal insufficiency: 50 mg/m2/day IV initially followed\n 138 Drug Dosages in Children\nby 100 mg/ m2/day and for long-term replacement give 10 mg/m2/day. In CAH the initial dose is 10-15 mg/m2/ day divided in 3 doses.\ nCaution: Abrupt withdrawal may cause adrenal insufficiency. (Hydrocortistab tab 20 mg; hydrocortone tabs 5 mg, 10 mg; inj efcorlin, lycortin 100 mg per vial)","ringFlags":16,"remoteId":"1505234457145418696","order":10},"alarms": [{"time":3600000,"type":3}],"geofences":[],"tags":[],"comments":[],"attachments": [],"caldavTasks": [{"calendar":"MTI1NDExNjU0OTUyOTY3MDUzMTk6MDow","remoteId":"cEoyVVRpdURIWlNuS2Jrcg" ,"object":null,"lastSync":1727417712202,"remoteOrder":10}]},{"task": {"title":"Dexamethasone ","priority":0,"creationDate":1727417712228,"modificationDate":1727417712228,"notes ":"0.05-0.5 mg/kg/day oral. For anti inflammatory action: 0.08-0.3 mg/kg/day divided 6 hourly. For congenital adrenal hyperplasia (CAH): 0.5 to 1.0 mg per day oral. For cerebral edema: 0.5 mg/kg/dose q 6 hr IM or IV. Hib meningitis: 0.6 mg/kg/day divided 6 hourly for 2 days, should be given prior to administration of antibiotics or along with first dose of antibiotics. For high dose pulse dexamethasone therapy for autoimmune disorders affecting skin, joints and kidneys, give 5 mg/kg as a slow infusion (maximum 100 mg).\nAdult dose: 10-50 mg stat then 4-8 mg q4 hr for shock. 0.375- 0.5 mg OD for congenital adrenal hyperplasia.\ n(Decadron, decdan, dexasone, wymesone, dexona tab 0.5 mg; inj 4 mg per ml; dexona- 20, 20 mg per ml)","ringFlags":16,"remoteId":"2958600898823145890","order":11},"alarms": [{"time":3600000,"type":3}],"geofences":[],"tags":[],"comments":[],"attachments": [],"caldavTasks": [{"calendar":"MTI1NDExNjU0OTUyOTY3MDUzMTk6MDow","remoteId":"QWhfRWU2dGJ1LV9xdER1cg" ,"object":null,"lastSync":1727417712228,"remoteOrder":11}]},{"task": {"title":"Spironolactone","priority":0,"creationDate":1727417712245,"modificationDa te":1727417712245,"notes":"2-3 mg/kg/day single dose oral. It is administered in combination with thiazides. It is also used as an antihypertensive (1.0-3.3 mg/kg/day q 6-12 hr) and\nfor primary hyperaldosteronism (100-400 mg/m2/dav q 12-24 hr).\n132\n Drug Dosages in Children\nAdult dose: 25-200 mg in 1-2 divided doses\ nSE: Hyperkalemia, drowsinss, confusion, and gynecomastia 22 C/I: Hyperkalemia, renal failure\n(Aldactone, lactone tabs 25 mg, 50 mg, 100 mg)","ringFlags":16,"remoteId":"3358341686803004693","order":12},"alarms": [{"time":3600000,"type":3}],"geofences":[],"tags":[],"comments":[],"attachments": [],"caldavTasks": [{"calendar":"MTI1NDExNjU0OTUyOTY3MDUzMTk6MDow","remoteId":"LW1BUXk3ZEtadWNzRmVuVA" ,"object":null,"lastSync":1727417712245,"remoteOrder":12}]},{"task": {"title":"Furosemide","priority":0,"creationDate":1727417712262,"modificationDate": 1727417712262,"notes":"2-6 mg/kg/day q 12 hr oral. In emergency situations 1-2 mg/kg/dose q 6-8 hr may be given. The IV dose is one-half of the oral dose. IV infusion rate 0.1-1.0 mg/ kg/hr.\nAdult dose: 40-80 mg per day. For oliguria 250 mg/dose\nincrease every 6 hr up to maximum of 2 gm/dose.\n(Lasix, salinex, frusenex, frusem tab 40 mg; lasix tab 500 mg;\ninj lasix, fru, frusim, frusix ampoule 10 mg per ml in 2 ml\nand 15 ml vials, inj lasix high dose ampoule 250 mg per 25 ml)","ringFlags":16,"remoteId":"2842085648540969367","order":13},"alarms": [{"time":3600000,"type":3}],"geofences":[],"tags":[],"comments":[],"attachments": [],"caldavTasks": [{"calendar":"MTI1NDExNjU0OTUyOTY3MDUzMTk6MDow","remoteId":"T1B2SjM1VFVQNVp6cGo4MQ" ,"object":null,"lastSync":1727417712262,"remoteOrder":13}]},{"task": {"title":"Acetazolamide ","priority":0,"creationDate":1727417712286,"modificationDate":1727417712286,"notes ":"5 mg/kg/day q 12 to 24 hr oral as diuretic and 20-100 mg/kg/day q 8 hr oral for hydrocephalus. Also useful in glaucoma and epilepsy (8-30 mg/kg/day).\nAdult dose: 250-500 mg per day q 12-24 hr for edema or glaucoma; 8-30 mg/kg/day q 8 hr (maximum 1 g/day) in epilepsy.\nC/L Sodium or potassium depletion, marked hepatic and renal dysfunction.\n(Diamox, zolamide, avva, actamide tab 250 mg, avva SR, iopar SR cap 250 mg)","ringFlags":16,"remoteId":"3392930380851017740","order":14},"alarms": [{"time":3600000,"type":3}],"geofences":[],"tags":[],"comments":[],"attachments": [],"caldavTasks": [{"calendar":"MTI1NDExNjU0OTUyOTY3MDUzMTk6MDow","remoteId":"aFRuaElUejZDckhNVnNOcg" ,"object":null,"lastSync":1727417712286,"remoteOrder":14}]},{"task": {"title":"Salbutamol","priority":0,"creationDate":1727417712309,"modificationDate": 1727417712309,"notes":" 0.1-0.4 mg/kg/dose every 8 hr oral. For acute exacerbation up to 3 treatments of 2-4 puffs (100 pg per puff) by MDI at 20 min intervals followed by 2 puffs every 4-6 hours. A spacer and mask is used in preschool children. For nebulization 0.15 mg/kg/dose is given every 20 min for 3 doses through a nebuliser using airflow of 6 L/min delivering 2-5 micron particle size. This can be continued till patient improves, thereafter nebulization is given every\n2-6 hours. Injection salbutamol 4-6 pg/kg/dose SC, IM or IV q 6-8 hr.\nAdult dose: 2-4 mg/dose 3-4 times/day up to maximum of 32 mg/day.\nSE: Irritability, tremors, tachycardia, nervousness, dizziness, and hypokalemia.\n(Asthalin, ventorlin, asmanil, bronkotab, salbetol tabs 2 mg, 4 mg; ventorlin CR 4 mg cap, bronkotus, mucolinc tabs contain salbutamol 2 mg and bromhexine 8 mg, forte tabs salbutamol 4 mg, bromhexine 8 mg, syrup salbutamol 2 mg, bromhexine 4 mg per 5 ml, syrup ventryl expectorant contains salbutamol 2 mg and bromhexine 8 mg per 5 ml, sal mucolite contains salbutamol 2 mg + ambroxol 30 mg per 5 ml, syrup asthalin, ventorlin, bronkosyrup 2 mg (with guaiphenesin 100 mg) per 10 ml; bronkoplus syrup contains salbutamol 2 mg and theophyllin 100 mg per 10 ml. Asthalin, derihaler,ventorlinMDI100pgpermetereddose;asthalin rotacaps contain 200 pg/cap; salsol nebuliser 3 ml solution contains 2.5 mg; asthalin repirator sol 1.0 ml contains 5 mg, respules 2.5 ml contains 2.5 mg, budesal respule contains salbutamol 2.5 mg + budesonide 5 mg in 2.5 ml)\ n","ringFlags":16,"remoteId":"550328607991944406","order":15},"alarms": [{"time":3600000,"type":3}],"geofences":[],"tags":[],"comments":[],"attachments": [],"caldavTasks": [{"calendar":"MTI1NDExNjU0OTUyOTY3MDUzMTk6MDow","remoteId":"RklKMWd1Y0FpOWJjQU1PTw" ,"object":null,"lastSync":1727417712309,"remoteOrder":15}]},{"task": {"title":"Ipratropium bromide","priority":0,"creationDate":1727417712330,"modificationDate":1727417712330 ,"notes":" For nebulization 250 pg is diluted in 2 ml of normal saline and given over 10 minutes, every 20 minutes for 3 doses followed by 250 pg every 2-4 hours. Ipratropium MDI 1-2 puffs thrice daily. (Ipraventrespiratorsolution250pgperml,ipraventrespule 500 pg/2.5 ml, ipravent MDI provides one metered dose of 20 pg. Duolin inhaler delivers levosalbutamol 50 pg and ipratropium bromide 20 pg per actuation, duolin rotacap provides levosalbutamol 100 pg and ipratropium bromide 40 pg, duolin respule contains levosalbutamol 1.25 mg, ipratropium bromide 500 pg per 2.5 ml)","ringFlags":16,"remoteId":"3431948259905776281","order":16},"alarms": [{"time":3600000,"type":3}],"geofences":[],"tags":[],"comments":[],"attachments": [],"caldavTasks": [{"calendar":"MTI1NDExNjU0OTUyOTY3MDUzMTk6MDow","remoteId":"Vm1vT3hSX2tnVEdPZ0FOWA" ,"object":null,"lastSync":1727417712330,"remoteOrder":16}]},{"task": {"title":"Aciclovir ","priority":0,"creationDate":1727417712345,"modificationDate":1727417712345,"notes ":"Neonatal HSV: 10 mg/kg q 8 hr IV for 14-21 days. HSV encephalitis >3 months: 20 mg/kg q 8 hr IV for 21 days. Varicella in immunocompetenthost: 80 mg/kg/d q 6 hr for 5 days (beneficial only when given within first 24 hours of onset of rash). Herpes zoster or chickenpox in adolescents and adults 800 mg q 6 hr for 5 days. Herpes simplex 200 mg q 4 hr for 5 days. Varicella-zoster in immunocompromised children: 80 mg/kg/d q 8 hr or 250-600 mg/m2/dose in 4-5 doses per day for 7-10 days.\nCaution: The recommended final concentration for IV administration is 7 mg/ml. Administer over at least one hour to prevent renal tubular damage. For varicella, aciclovir therapy is not indicated in infants below 2 years of age. (Zovirax, acivir, ocuvir, axovir, acyclor, herperax, herpikind, herpex tabs 200 mg, 400 mg, 800 mg; zovirax susp 400 mg/5 ml in 100 ml bottle, inj aclovir, zovirax 250 mg 1 ml ampoule; ophthalmic ointment 3% and herpex skin ointment 5%)","ringFlags":16,"remoteId":"4244993548550377760","order":17},"alarms": [{"time":3600000,"type":3}],"geofences":[],"tags":[],"comments":[],"attachments": [],"caldavTasks": [{"calendar":"MTI1NDExNjU0OTUyOTY3MDUzMTk6MDow","remoteId":"UW52NHd2S3RSWnJQWlVFOA" ,"object":null,"lastSync":1727417712345,"remoteOrder":17}]},{"task": {"title":"Metronidazole ","priority":0,"creationDate":1727417712371,"modificationDate":1727417712371,"notes ":"15-20mg/kg/dayq8hrorallyfor5-7days for giardiasis, 35-50 mg/kg/day q 8 hr orally for 10 days for amebiasis (intestinal and extra intestinal) and 20 mg/ kg/day q 6 hr orally or IV for anerobic infections, 20 mg/ kg/dose (maximum 400 mg/d) q 8 hr oral for 7-10 d for antibiotic associated diarrhea.\nAdult dose: 200-400 mg q 8 hr\ n(Flagyl, aristogyl, metrogyl, rogyl tabs 200 mg, 400 mg; susp 200 mg per 5 ml; aristogyl susp 100 mg per 5 ml; inj melron, metrogyl 500 mg/100 ml)","ringFlags":16,"remoteId":"2383055874746464596","order":18},"alarms": [{"time":3600000,"type":3}],"geofences":[],"tags":[],"comments":[],"attachments": [],"caldavTasks": [{"calendar":"MTI1NDExNjU0OTUyOTY3MDUzMTk6MDow","remoteId":"MnctMWtfTEw5SXJpUHlOaQ" ,"object":null,"lastSync":1727417712371,"remoteOrder":18}]},{"task": {"title":"Labetalol ","priority":0,"creationDate":1727417712383,"modificationDate":1727417712383,"notes ":"10-40 mg/kg/day q 12 hr oral after meals. For hypertensive crisis 0.25 to 1 mg/kg IV over 2 min, repeat after 5-10 min. May be administered by continuous infusion (0.4-3.0 mg/kg/hr).\nAdult dose: Start with 100 mg twice a day, increase gradually every 2 weeks up to 200-400 mg twice a day.\nCaution: Avoid in asthmatics, heart failure and hypoglycemic states\n(Normadate caps 50 mg, 100 mg, 200 mg; labeta cap 50 mg, trandate tabs 100 mg, 200 mg, 400 mg; lobet, labil, gravidol tab 100 mg; inj gravidol 5 mg per ml, inj lobet, labeta 20 mg per ml, inj lobesol 20 mg, 100 mg, 200 mg, inj labit 20 mg, 100 mg)","ringFlags":16,"remoteId":"2225964276407949124","order":19},"alarms": [{"time":3600000,"type":3}],"geofences":[],"tags":[],"comments":[],"attachments": [],"caldavTasks": [{"calendar":"MTI1NDExNjU0OTUyOTY3MDUzMTk6MDow","remoteId":"aDF0UnpOVVlUNDJWWXA1dg" ,"object":null,"lastSync":1727417712383,"remoteOrder":19}]},{"task": {"title":"Hydralazine hydrochloride ","priority":0,"creationDate":1727417712398,"modificationDate":1727417712398,"notes ":"It is a directly acting vasodilator and is useful when hypertension is associated with renal involvement. 0.5-7.0 mg/kg/day q 6 to 8 hr oral, increase gradually over 3-4 weeks. For hypertensive crisis 0.1-0.2 mg/kg/dose q 6 hr IV or IM (maximum 2 mg/kg/dose).\nAdult dose: Initial 10 mg q 6 hr up to maximum of 100 mg q 6 hr\nAntihypertensives\nC/I: Porphyria, SEE, and rheumatic mitral valve disease.\n(Nepresol, zinepress, apresoline tab 25 mg; inj apresoline\n20 mg per ml ampoule; Corbetasine: hydralazine 25 mg + 11 propranolol 40 mg)","ringFlags":16,"remoteId":"2041045716783811574","order":20},"alarms": [{"time":3600000,"type":3}],"geofences":[],"tags":[],"comments":[],"attachments": [],"caldavTasks": [{"calendar":"MTI1NDExNjU0OTUyOTY3MDUzMTk6MDow","remoteId":"R0dXVGd6TURyelpzak41eQ" ,"object":null,"lastSync":1727417712398,"remoteOrder":20}]},{"task": {"title":"Enalapril maleate ","priority":0,"creationDate":1727417712409,"modificationDate":1727417712409,"notes ":"is an orally active ACE inhibitor. 0.1-1.0 mg/kg/d q 12-24 hr oral.\nAdult dose: Initially 5 mg daily; usual dose 10-20 mg with a maximum dose of 40 mg daily.\nSE: Fatigue, hypotension, cough, hyperkalemia, and angio- edema\nC/I: Aortic stenosis, bilateral renal artery stenosis, outflow obstruction, glomerular filtration rate 12 yrs.\nAdult dose: 120 mg-180 mg daily q 12-24 hr.\nIndic: Allergic rhinitis, allergic skin conditions (chronic idiopathic urticaria)\nC/I: Flu-like symptoms, dizziness, drowsiness, dry mouth, and sleep disorder.\n(Allegra tabs 30 mg, 120 mg, 180 mg; fegra, histafree, fexofast, fexo, fexofen tabs 120 mg,180 mg, allegra, histafree susp 30 mg/5 ml)","ringFlags":16,"remoteId":"205301197730816307","order":26},"alarms": [{"time":3600000,"type":3}],"geofences":[],"tags":[],"comments":[],"attachments": [],"caldavTasks": [{"calendar":"MTI1NDExNjU0OTUyOTY3MDUzMTk6MDow","remoteId":"ajltVHFHV0NPdE1rRUJ0aw" ,"object":null,"lastSync":1727417712473,"remoteOrder":26}]},{"task": {"title":"Diphenhydramine hydrochloride ","priority":0,"creationDate":1727417712483,"modificationDate":1727417712483,"notes ":"5 mg/kg/day q 6 hr oral, maximum dose 300 mg/24 hr. For anaphylaxis or phenothiazine overdose 1-2 mg /kg IV slowly\nAdult dose: 10-50 mg per dose up to maximum of 400 mg/ day.\nC/I: With MAOIs; asthma, narrow angle glaucoma, urinary retention.\n(Dimiril tab 25 mg; benadryl caps 25 mg, 50 mg; syrup benadryl, dimiril 12.5 mg per 5 ml, inj benadryl 50 mg/ml ampoule and 10 mg/ml vial)","ringFlags":16,"remoteId":"3120735697630992783","order":27},"alarms": [{"time":3600000,"type":3}],"geofences":[],"tags":[],"comments":[],"attachments": [],"caldavTasks": [{"calendar":"MTI1NDExNjU0OTUyOTY3MDUzMTk6MDow","remoteId":"XzczRm5mVVVZb01LVm81Vw" ,"object":null,"lastSync":1727417712483,"remoteOrder":27}]},{"task": {"title":"Cetirizine dihydrochloride ","priority":0,"creationDate":1727417712493,"modificationDate":1727417712493,"notes ":"6 mo-2 yr: 2.5 mg OD; 2-6 yrs: 2.5 mgBDor5mgOD,>6yrs:5-10mgoralOD.\nAdult dose: 10-20 mg daily q 12-24 hr.\nCaution: Avoid in children below 6 months\n(Cetzine, alerid, allerzine, cetcip, cetrine, cetiriz, citrazan, CZ3, zyncef, zyncet, zyrtec tab 10 mg; cetrizet, sizon tab 5 mg; syrup 5 mg per 5 ml)","ringFlags":16,"remoteId":"2640123597488196922","order":28},"alarms": [{"time":3600000,"type":3}],"geofences":[],"tags":[],"comments":[],"attachments": [],"caldavTasks": [{"calendar":"MTI1NDExNjU0OTUyOTY3MDUzMTk6MDow","remoteId":"NXRuODh5QTR6ZklKb1E2Vg" ,"object":null,"lastSync":1727417712493,"remoteOrder":28}]},{"task": {"title":"Voriconazole ","priority":0,"creationDate":1727417712502,"modificationDate":1727417712502,"notes ":"Children above 2 years loading dose 6 mg/ kg q 12 hours followed by 4 mg/kg q 12 hours.\nAdult dose: 200 mg (maximum 600 mg/d) BD above 40 kg; 100 mg (maximum 300 mg/d) BD below 40 kg body weight PO. IV loading dose 6 mg/kg q 12 hr for first 24 hr followed by maintenance dose of 4 mg/kg q 12 hr.\nIndic: Invasive aspergillosis, candidemia in non-neutropenic patients, fluconazole resistant serious Candida infections.\nS/E: Skin rash, hepatotoxicity, and photosensitivity\n(Verz, fungivor, voritek, vorikab, voritrop, vorage tabs 50 mg, 200 mg; inj 200 mg ampoule)","ringFlags":16,"remoteId":"4264218439362141052","order":29},"alarms": [{"time":3600000,"type":3}],"geofences":[],"tags":[],"comments":[],"attachments": [],"caldavTasks": [{"calendar":"MTI1NDExNjU0OTUyOTY3MDUzMTk6MDow","remoteId":"Z2w2X09wTXNYRUI5WGI5aw" ,"object":null,"lastSync":1727417712502,"remoteOrder":29}]},{"task": {"title":"Fluconazole ","priority":0,"creationDate":1727417712513,"modificationDate":1727417712513,"notes ":"3-6 mg/kg/day once daily. Invasive systemic candidiasis 6-12 mg/kg/day for 28 days.\nAdult dose: Mucosal 50-100 mg daily for 14-30 days. Systemic infections: 400 mg on day 1 followed by 200-400 mg/day for a minimum of 28 days.\nSE: Dizziness, skin rash, abdominal pain, and hepatic dysfunction.\nIndic: Candidiasis, cryptococcal meningitis, and as a prophylactic agent for prevention of fungal infections in an immunocompromised host.\n(Flucos, zocon, syscan, flumed, fluzon, flucal, flubit, flucan, fluzole, zazole tabs 50 mg, 150 mg, 200 g; conflu, cancap, concize, fungicon tabs 50 mg, 150 mg; injection 2 mg per ml in a bottle of 100 ml physiological saline)","ringFlags":16,"remoteId":"1292605481053731724","order":30},"alarms": [{"time":3600000,"type":3}],"geofences":[],"tags":[],"comments":[],"attachments": [],"caldavTasks": [{"calendar":"MTI1NDExNjU0OTUyOTY3MDUzMTk6MDow","remoteId":"TlMwOWhQamhzTl92VXN3bA" ,"object":null,"lastSync":1727417712513,"remoteOrder":30}]},{"task": {"title":"Ondansetron hydrochloride dihydrate ","priority":0,"creationDate":1727417712536,"modificationDate":1727417712536,"notes ":"Oral dose 12yr:8mgq4hr.IVdose\nfor >3 yr old 0.15-0.45 mg/kg/dose at 30 min before and 4 and 8 hr after emetogenic drugs.\nAdult dose: 8 mg orally or slow IV q 4 hr. 8 Indic: Chemotherapy and radiotherapy induced emesis, post\noperative nausea and vomiting (prophylaxis)\nC/I: Children < 3 year age, liver dysfunction, suspected or proven prolonged QT syndrome, hypersensitivity. (Ondem, ondace emeset, periset, vomis, zofer tabs 4 mg, 8 mg; ondem, ondace syrup 2 mg/5 ml, inj 2 mg per ml in 2 ml and 4 ml ampoule)\ n","ringFlags":16,"remoteId":"4382646797899904213","order":31},"alarms": [{"time":3600000,"type":3}],"geofences":[],"tags":[],"comments":[],"attachments": [],"caldavTasks": [{"calendar":"MTI1NDExNjU0OTUyOTY3MDUzMTk6MDow","remoteId":"YmFfQm1xU1NGV25uTEpLSw" ,"object":null,"lastSync":1727417712536,"remoteOrder":31}]},{"task": {"title":"Valproate sodium ","priority":0,"creationDate":1727417712560,"modificationDate":1727417712560,"notes ":"Initial 10-15 mg/kg/day q 8-12 hr oral, 7 can increase up to maximum of 60 mg/kg/day (increments\nof 5-10 mg/kg/day at weekly intervals). Therapeutic level 50-100 mg/1. In status epilepticus 20 mg/kg loading dose followed by 5-10 mg/kg /dose q 8 hr. Infuse over one hour\nup to a maximum of 20 mg/min.\nAdult dose: 600 mg daily in 2 divided doses, increase by 200 mg at weekly intervals. The usual adult dose is 1-2 gm daily up to a maximum of 5 gm.\nIndic: Broad spectrum for majority of epilepsies, e.g. genera lized tonic-clonic partial seizures, absence attacks, myoclonic, atonic, frequent febrile seizures, Lennox-Gestaut syndrome. West syndrome and juvenile myoclonic epilepsy.\nC/I: Active liver disease, urea cycle disorders\nSE: Hepatic and renal dysfunction, \"Reye-like\" syndrome, bleeding, alopecia, excessive weight gain, aggravation of polycystic ovarian disease, and false positive urine sugar test. (Encorate chrono, epilex chrono, manoval, magprol CR, torvate chrono tab 200 mg; valparin chrono, cinaval chrono tabs 200 mg, 300 mg, 400 mg, 500 mg; valprol CR 200 mg, 300 mg, 500 mg; syrup valparin, epilex 200 mg per 5 ml; injection encorate 100 mg/ml for IV infusion as 5 ml vial)","ringFlags":16,"remoteId":"4254808534987705940","order":32},"alarms": [{"time":3600000,"type":3}],"geofences":[],"tags":[],"comments":[],"attachments": [],"caldavTasks": [{"calendar":"MTI1NDExNjU0OTUyOTY3MDUzMTk6MDow","remoteId":"Q25zLU9IekV6UGhVenJzZw" ,"object":null,"lastSync":1727417712560,"remoteOrder":32}]},{"task": {"title":"Prednisolone ","priority":0,"creationDate":1727417712569,"modificationDate":1727417712569,"notes ":"2 mg/kg/day q 12 hr for 2-6 weeks. Taper it over next 4—12 weeks.\nIndic: Infantile spasms, epilepsia partialis continua\n(Wysolone, nucort, omnacortil tabs 5 mg, 10 mg, 20 mg, predone, besone syrup 5 mg and 15 mg per 5 ml, kidpred 10 mg/5 ml)","ringFlags":16,"remoteId":"3377839772857475948","order":33},"alarms": [{"time":3600000,"type":3}],"geofences":[],"tags":[],"comments":[],"attachments": [],"caldavTasks": [{"calendar":"MTI1NDExNjU0OTUyOTY3MDUzMTk6MDow","remoteId":"RkhhRmNQd2JBT09LMkVqNg" ,"object":null,"lastSync":1727417712569,"remoteOrder":33}]},{"task": {"title":"Phenytoin sodium ","priority":0,"creationDate":1727417712578,"modificationDate":1727417712578,"notes ":"Loading dose 15-20 mg/kg slowly IV at a rate of lmg/kg/min. IV dose should be diluted in normal saline and not dextrose, given slowly under cardiac monitoring. Avoid IM as absorption is erratic. Maintenance dose 5-8 mg/kg/day q 8-12 hr or single dose oral. Therapeutic level 10-20 mg/1.\nAdult dose: 150-300 mg daily in a single or two divided doses, increased as required to 200-400 mg/day.\nIndic: Tonic-clonic seizures, partial epilepsy, cardiac arrhythmias, trigeminal neuralgia, migraine, and status epilepticus.\nC/I: Prophyria, heart block.\nSE: Gingival hypertrophy, hirsutism, and ataxia\n(Dilantin and epileptin cap 100 mg; epsolin tab 100 mg; eptoin tabs 50 mg, 100 mg; susp dilantin 125 mg per 5 ml; syrup eptoin 30 mg per 5 ml; inj epsolin 2 ml ampoule 50 mg per ml; injection dilantin 25 mg/ml in 2 ml ampoules)","ringFlags":16,"remoteId":"2030214374038502673","order":34},"alarms": [{"time":3600000,"type":3}],"geofences":[],"tags":[],"comments":[],"attachments": [],"caldavTasks": [{"calendar":"MTI1NDExNjU0OTUyOTY3MDUzMTk6MDow","remoteId":"OVRfMzFteEZ4cHQtdUxpbA" ,"object":null,"lastSync":1727417712578,"remoteOrder":34}]},{"task": {"title":"Midazolam Status epilepticus ","priority":0,"creationDate":1727417712591,"modificationDate":1727417712591,"notes ":"0.2 mg/kg IV or IM bolus followed by 0.1-0.2 mg/kg/hr. For sedation during mechanical ventilation 0.05-0.15 mg/kg/dose q 1-2 hr or continuous infusion at a rate of 0.2-1.0 pg/kg/min for neonates and 0.5-3 pg/kg/min for infants and children. For sedation 0.05-0.1 mg/kg over 2 min, may repeat 0.05 mg/ kg in 2-3 min intervals up to a total dose of 0.2 mg/kg. Onset of action 1-5 min. Intranasal 0.3 mg/kg (5 mg/ml IV preparation), buccal route 0.3 mg/kg may be used for acute seizure control till intravenous access is established. For other\ndetails refer to section on Tranquillisers, Hypnotics, Sedatives and Antidepressants.\nAdult dose: 0.07-0.08 mg/kg IM and 0.01-0.07 mg/kg IV\nC/I: Respiratory depression, shock, coma, and acute narrow\nangle glaucoma.\nCaution: Avoid co-administration with erythromycin which may increase the depth and duration of sedation.\n(Fulsed, mezolam, midosed, shortal 1 mg/ml in 5 ml and 10 ml vials and 5 mg/ml in 1 ml ampoule, zapiz 0.25 mg and 0.5 mg sublingual tabs, insed nasal spray or atomizer provides 0.5 mg midazolam per metered dose.","ringFlags":16,"remoteId":"4344965022311072191","order":35},"alarms": [{"time":3600000,"type":3}],"geofences":[],"tags":[],"comments":[],"attachments": [],"caldavTasks": [{"calendar":"MTI1NDExNjU0OTUyOTY3MDUzMTk6MDow","remoteId":"Y1NMckZpMHR1dXE1RnJrWQ" ,"object":null,"lastSync":1727417712591,"remoteOrder":35}]},{"task": {"title":"Diazepam","priority":0,"creationDate":1727417712614,"modificationDate":17 27417712614,"notes":"In status epilepticus above one month of age 0.2-0.5 mg/kg/dose IV, may be repeated at 3-5 minute intervals. May administer IM if IV administration not possible but efficacy is diminished and absorption is erratic. Maximum total dose 5 yr: 10 mg. per-rectal dose 0.3-0.5 mg/kg/dose. Rapid TV bolus may cause apnea.\n\n\nFor symptomatic relief of anxiety, sedation and muscle relaxation, oral dose 0.1-0.3 mg/kg/day q 4-8 hr adjusted to clinical response. For neonatal tetanus 0.5-5.0 mg/kg IV every 2 to 4 hours.\nAdult dose: 5- 50 mg/day in divided doses.\nCaution: Flumazenil, a benzodiazepine antagonist, can\ nreverse sedation but it may not reverse respiratory depression.\nIndic: Status epilepticus, muscle spasms due to tetanus, febrile seizures, and anxiety states.\ nC/I: Myasthenia gravis, acute narrow angle glaucoma, and paralytic ileus.\ n(Valium, placidox, anaxol tabs 2 mg, 5 mg, 10 mg; calmod, paxum tab 5 mg; calmpose tabs 5 mg, 10 mg; susp calmpose 2 mg per 5 ml; inj calmpose, paxum 10 mg per 2 ml ampoule; Direc 2 rectal diazepam 2 mg/ml; Rec-DZ rectal solution 2 mg/2.5 ml and 5 mg/5 ml)","ringFlags":16,"remoteId":"3142970803611121599","order":36},"alarms": [{"time":3600000,"type":3}],"geofences":[],"tags":[],"comments":[],"attachments": [],"caldavTasks": [{"calendar":"MTI1NDExNjU0OTUyOTY3MDUzMTk6MDow","remoteId":"NVhONDJoVjdCc05YQ2E4Mg" ,"object":null,"lastSync":1727417712614,"remoteOrder":36}]},{"task": {"title":"Clonazepam ","priority":0,"creationDate":1727417712634,"modificationDate":1727417712634,"notes ":"0.01-0.03 mg/kg/day q 8-12 hr oral. Increase every 3 days by 0.25-0.5 mg till a maximum dose of 0.2 mg/ kg/day is reached.\nAdult dose: Initially 0.5 mg q 12 hr, increase by 0.5 mg/day every 3-7 days till maintenance dose of 4-8 mg/day.\nC/I: Significant liver disease, acute narrow angle glaucoma Indic: Add-on therapy for atonic, akinetic epilepsy, resistant absence attacks, myoclonus, infantile spasms, and Lennox- Gestaut syndrome.\n(Clonotril, rivotril, lonazep, lonacen, zozep, sezolep, ozepam tabs 0.5 mg, 2 mg; melzap, zapiz tabs 0.25 mg, 0.5 mg, 1 mg, 2 mg)","ringFlags":16,"remoteId":"2698355302624993090","order":37},"alarms": [{"time":3600000,"type":3}],"geofences":[],"tags":[],"comments":[],"attachments": [],"caldavTasks": [{"calendar":"MTI1NDExNjU0OTUyOTY3MDUzMTk6MDow","remoteId":"LVE3Z24wVDZ4R0ZiNzR1RA" ,"object":null,"lastSync":1727417712634,"remoteOrder":37}]},{"task":{"title":"Low Molecular Weight Heparin (Enoxaparin)","priority":0,"creationDate":1727417712646,"modificationDate":17274177 12646,"notes":"\nRecommended for prophylaxis and treatment of thromboem bolicdisordersspecificallyprevent!onofDVTfollowingsurgery.\nAdministered with Warfarin for inpatient treatment of DVT with or without pulmonary embolism and outpatient acute DVT without pulmonary embolism.\nSubcutaneous: 2 months to 400 mg/day.\n(Tarivid, zanocin, oflox, ofla, zenflox, uneek, floxur tabs 200 mg, 400 mg; ofromax, zanocin, oflin tab 100 mg; zenflox, ofla, orivid, zo, oflomac, oflox, uneek, bioff, diof, oflotas, susp 50mg/5ml,zenfloxforte,oflomacforte,duflox,zanocin,ofla, susp 100 mg per 5 ml, inj oflox, tarivid 200 mg, 400 mg per 100 ml)","ringFlags":16,"remoteId":"248322686221620951","order":52},"alarms": [{"time":3600000,"type":3}],"geofences":[],"tags":[],"comments":[],"attachments": [],"caldavTasks": [{"calendar":"MTI1NDExNjU0OTUyOTY3MDUzMTk6MDow","remoteId":"c1JzZVRRY3k5YzZCOW8xRg" ,"object":null,"lastSync":1727417712814,"remoteOrder":52}]},{"task": {"title":"Levofloxacin Itislevo- isomerofofloxacin.","priority":0,"creationDate":1727417712831,"modificationDate":17 27417712831,"notes":"10mg/kgsingle dose daily oral or IV with max dose 500 mg.\ nAdult dose: 500 mg daily\nIndic: Effective against Gram-positive and Gram-negative infections and MDR TB. No coverage against Pseudomonas aeruginosa.\nCaution: Avoid concurrent use of antacids\n(Levoflox, lotor, levocide, levoday, fynal tabs 250 mg, 500 mg; levoflox, lotor, loxof, fynal 5 mg/ml for IV infusion)","ringFlags":16,"remoteId":"2969845259434000194","order":53},"alarms": [{"time":3600000,"type":3}],"geofences":[],"tags":[],"comments":[],"attachments": [],"caldavTasks": [{"calendar":"MTI1NDExNjU0OTUyOTY3MDUzMTk6MDow","remoteId":"SnFyclFjNXZJN1RWeFc2QQ" ,"object":null,"lastSync":1727417712831,"remoteOrder":53}]},{"task": {"title":"Ciprofloxacin ","priority":0,"creationDate":1727417712843,"modificationDate":1727417712843,"notes ":"20-40 mg/kg/day q 12 hr oral or 10-20 mg/ kg/day 12 hr IV (maximum 800 mg/day). 20 mg/kg single dose for contacts of N. meningitidis.\nAdult dose: 250-750 mg q 12 hr oral; 100-400 mg q 12 hr by intravenous infusion. 500 mg single oral dose for contacts of N. meningitidis.\nCaution: It should be reserved for children where anticipated or cultured pathogens are resistant to all other antibiotics. (Cifran, ciplox, ciprobid tabs 100 mg, 250 mg, 500 mg, 750 mg; ciproflox, ciprolet, ciprowin, quinobact, strox, supraflox tabs 250 mg, 500 mg; disquin DT 250 mg, susp ciprolar, avilox 125 mg and 250 mg per 5 ml, injection cifran 100 mg per 50 ml, injection ciplox 200 mg per 100 ml).","ringFlags":16,"remoteId":"4174234518017339906","order":54},"alarms": [{"time":3600000,"type":3}],"geofences":[],"tags":[],"comments":[],"attachments": [],"caldavTasks": [{"calendar":"MTI1NDExNjU0OTUyOTY3MDUzMTk6MDow","remoteId":"TTRHVU8yZ3cwdjhHamxFQw" ,"object":null,"lastSync":1727417712843,"remoteOrder":54}]},{"task": {"title":"Cefuroxime axetil ","priority":0,"creationDate":1727417712853,"modificationDate":1727417712853,"notes ":"100-150 mg/kg/day q 6-8 hr IV and IM. Oral dose 20-30 mg/kg/day q 12 hr. For enteric fever 40 mg/kg/day q 12 hr oral. Give with or after food.\nAdult dose: 750 mg 8 hr IM or IV; severe infections 1.5 gm 8 hr; oral dose 250-500 mg twice daily.\ n(Ceftum, forcef, cefexl, cefoxim, cetil, zocef, zefu, cefakind tabs 125, 250, 500 mg; ceftum, cefoxim, zocef, zefu, kefstar cefakind and fastclav syrup 125 mg per 5 ml. Inj cefogen, supacef, ceftum 250 mg, 750 mg, 1500 mg vials; inj furoxil 250 mg, 750 mg vials; inj altacef 250 mg, 750 mg, 1.5 gm)","ringFlags":16,"remoteId":"3912993664143151319","order":55},"alarms": [{"time":3600000,"type":3}],"geofences":[],"tags":[],"comments":[],"attachments": [],"caldavTasks": [{"calendar":"MTI1NDExNjU0OTUyOTY3MDUzMTk6MDow","remoteId":"TmxTSWZPdnhZal9wekkwag" ,"object":null,"lastSync":1727417712853,"remoteOrder":55}]},{"task": {"title":"Ceftriaxone sodium","priority":0,"creationDate":1727417712860,"modificationDate":1727417712860, "notes":" 50-75 mg/kg/day IV q 12-24 hr. For meningitis use 100 mg/kg/day q 12 hr (maximum dose 4 gm). 25-50 mg/kg (maximum 125 mg) IM or IV single dose can be given for treatment of gonococcal ophthalmia neonatorum. For prophylaxis against N. meningitidis 125 mg IM single dose can be given to all contacts.\nAdult dose: 1 gm daily by deep IM or slow IV; severe infections 2-4 gm daily.\nC/1: Pencillin or cephalosporin hypersensitivity.\n(Inj monocef, axone, cefaxone, torocef, oframax powercef, monotax 125 mg, 250 mg, 500 mg, 1 gm vials).","ringFlags":16,"remoteId":"284421968772526546","order":56},"alarms": [{"time":3600000,"type":3}],"geofences":[],"tags":[],"comments":[],"attachments": [],"caldavTasks": [{"calendar":"MTI1NDExNjU0OTUyOTY3MDUzMTk6MDow","remoteId":"NkEtbldiOGZOcmN6LXhZYw" ,"object":null,"lastSync":1727417712860,"remoteOrder":56}]},{"task": {"title":"Ceftazidime","priority":0,"creationDate":1727417712865,"modificationDate" :1727417712865,"notes":"100-150 mg/kg/day q 8 hr IV, IM. For meningitis 150 mg/kg/day q 8 hr.\nAdult dose: 2-6 gm daily in 2-3 divided doses, maximum 6 gm/day.\nIndic: Specific for Pseudomonas aeruginosa.\n(Inj fortum, ceftidin, cefzid, tizime, zytaz, zidime 250 mg, 500 mg, 1 gm vials)\ n","ringFlags":16,"remoteId":"1835581142330033977","order":57},"alarms": [{"time":3600000,"type":3}],"geofences":[],"tags":[],"comments":[],"attachments": [],"caldavTasks": [{"calendar":"MTI1NDExNjU0OTUyOTY3MDUzMTk6MDow","remoteId":"SXQxYWVQVGxINllGcUN1bA" ,"object":null,"lastSync":1727417712865,"remoteOrder":57}]},{"task": {"title":"Cefotaxime","priority":0,"creationDate":1727417712869,"modificationDate": 1727417712869,"notes":"100-150 mg/kg/day q 6-8 hr. For meningitis use 200 mg/kg/day q 6 hr.\nAdult dose: 1-2 gm IM or IV 12 hr; maximum 12 gm/day q 6-8 hr\nC/I: Cephalosporin hypersensitivity\n(Inj claforan, biotax, lyforan, omnatax, sifotaxim, taxim 250 mg, 500 mg, 1 gm per vial)","ringFlags":16,"remoteId":"706553882859619827","order":58},"alarms": [{"time":3600000,"type":3}],"geofences":[],"tags":[],"comments":[],"attachments": [],"caldavTasks": [{"calendar":"MTI1NDExNjU0OTUyOTY3MDUzMTk6MDow","remoteId":"LWhYV3ZIMTIxVGVqVVRPSg" ,"object":null,"lastSync":1727417712869,"remoteOrder":58}]},{"task": {"title":"Cefixime","priority":0,"creationDate":1727417712879,"modificationDate":17 27417712879,"notes":"8mg/kg/dayoralonceortwiceaday.Forenteric fever 20 mg/kg/day q 12 hr or 24 hr.\nAdult dose: 400 mg daily q 12-24 hr\n(Taxim-o, zifi, cefi, zofix, omnatax-o, ziprax, cefolac, biotax-o, fixx, extacef tabs, 50 mg DT, 100 mg DT; 200 mg DT, 400 mg; syrup taxim-o, zifi, zofix, ziprax, hifen, topcef, ceftas, biotax-o, brutacef, brutacef DS, 50 mg and 100 mg per 5 ml.)","ringFlags":16,"remoteId":"3573713905987530356","order":59},"alarms": [{"time":3600000,"type":3}],"geofences":[],"tags":[],"comments":[],"attachments": [],"caldavTasks": [{"calendar":"MTI1NDExNjU0OTUyOTY3MDUzMTk6MDow","remoteId":"S212NUZ5eENtNkxjblB2Tw" ,"object":null,"lastSync":1727417712879,"remoteOrder":59}]},{"task": {"title":"Cefepime","priority":0,"creationDate":1727417712895,"modificationDate":17 27417712895,"notes":"Children >2 mo: 100 mg/kg/day IV q 12 hr. Meningitis, febrile neutropenia, serious infections, cystic fibrosis: 150 mg/kg/day IV q 8 hr, 1.9 m2 : 2 tabs or 20 ml \n\ ntab TMP 80 mg, SMZ 400 mg or double strength tab; \n\nSyp TMP(cotrim) 40 mg/5ml and SMZ 200 mg/5 ml; \n\n\n C/I: Age 95% of children with\nMCD respond to corticosteroid therapy\n\n\n😀😀😀😀😃😃😃😃😃😀\nPathology:\n\ nIn MCD: the glomeruli appear normal or show a minimal\nincrease in mesangial cells and matrix\n\nMesangial proliferation is characterized by a diffuse increase in mesangial\ncells and matrix on light microscopy. Immunofluorescence microscopy might\nreveal trace to 1+ mesangial IgM and/or IgA staining. Only 50% respond to steroid.\n\n FSGS: glomeruli show lesions that\nare both focal (present only in a proportion of glomeruli) and segmental\n(localized to ≥ 1 intraglomerular tufts). The lesions consist of mesangial cell\nproliferation and segmental scarring on light microscopy (Fig. 545.3 and see\nTable 545.2 ). Immunofluorescence microscopy is positive for IgM and C3\nstaining in the areas of segmental sclerosis.\nOnly 20% fang respond to steroid.\n\n\n😀😀😀😀😀😀😀😀😃😃😃\n\nCm:\n\nAge mc 2 to 6 but can occur 6m to adulthood. Mc in Male, \n\nThe more common cause of idiopathic nephrotic\nsyndrome in this older age-group is FSGS. FSGS is the most common cause of\nend-stage renal disease in adolescent.\n\nChildren usually present with mild edema, which is initially noted around the\neyes and in the lower extremities. Nephrotic syndrome can initially be\nmisdiagnosed as an allergic disorder because of the periorbital swelling that\ndecreases throughout the day. With time, the edema becomes generalized, with\nthe development of ascites, pleural effusions, and genital edema. Anorexia,\nirritability, abdominal pain, and diarrhea are common. \ n\n\nImportant features of\nminimal change idiopathic nephrotic syndrome are the absence of hypertension\nand gross hematuria (the so-called nephritic features\n\ nurinalysis reveals 3+ or 4+ proteinuria, \n\nmicroscopic hematuria is\npresent in 20% of children.\n\n A spot urine protein:creatinine ratio should be > 2.0.\n\nThe serum creatinine value is \nusually normal, but it may be abnormally elevated\nif there is diminished renal perfusion from contraction of the intravascular\ nvolume. \n\nThe serum albumin level is < 2.5 g/dL, and serum cholesterol and\ ntriglyceride levels are elevated. \n\nSerum complement levels are normal. \n\nA renal\nbiopsy is not routinely performed if the patient fits the standard clinical picture\nof MCNS.\n\n\n\n😃😃😃😃😃😃😃😃😃😃😃\n\nDiagnosis \n\nConfirmed by first morning Upc ratio, rft, albumin, cholesterol. Nephrotic range proteinuria, hypoalbuminemia (≤2.5 g/dL), edema, and\nhyperlipidemia (cholesterol > 200 mg/dL)\ n\n\nTo r/o secondary: c3, ANA, dsDNA, aso, hepatitis B,C, biopsy.\n\n😃😃😃😃😃😃 😃😃😃😃😃\n\nTreatment: 1st episode with moderate to mild edema may be managed outpatient. \n\nUncomplicated NS can be mx with directly steroid without biopsy. Children with features that make\nMCNS less likely (gross hematuria, hypertension, renal insufficiency,\nhypocomplementemia, or age < 1 yr or > 12 yr) should be considered for renal\nbiopsy before treatment.\n\nTuuberculosis must be ruled out prior to starting immunosuppressive therapy.\n\nSteroid: 60 mg/m2 /day or 2 mg/kg/day to a\nmaximum of 60 mg daily for 4-6 wk followed by alternate-day prednisone\n(starting at 40 mg/m2 qod or 1.5 mg/kg qod) for a period ranging from 8 wk to 5\nmo, with tapering of the dose. The issue of the duration of steroid treatment has\nbeen controversial. \n\nResponse:\n remission within the initial 4 wk of corticosteroid\ntherapy. \n\nRemission consists of a urine protein:creatinine ratio of < 0.2 or < 1+\nprotein on urine dipstick testing for 3 consecutive days. \ n\nMost children with\nminimal change disease respond to daily prednisone therapy fairly quickly,\nwithin the first 2-3 wk of treatment. \n\n\nRelapse is an increase in the first morning urine protein:creatinine ratio > 2 or a reading of 2+ and higher for 3\nconsecutive days on Albustix testing.\n\n Frequently relapsing: is two or more relapses within 6 mo after the initial therapy or four relapses in a 12-mo period.\n\nSteroid dependent is a relapse during steroid tapering or a relapse within 2 wk\nof the discontinuation of therapy. \n\nSteroid resistance is the inability to induce\nremission within 8wk of daily steroid therapy. Steroid- resistant nephrotic syndrome, and specifically FSGS, is associated with a\n50% risk for end-stage kidney disease within 5 yr of diagnosis. \n\n🤑🤑🤑🤑🤑🤑🤑🤑🤑🤑🤑\n\nMx of edema:\nPleural effusion, ascites, scrotal swelling \n\nsodium\nrestriction ( 300,000/µL in ALL \nand even higher in CML. \n\nMC in myelomonocytic (FAB-M4/M5/M3) leukemia, \n\n\nClinically, respiratory or neurological distress due to viscosity & stasis And is a medical emergency. \n\n\n\n\n\nPathophysiology:\ n\n\nMay be asymptomatic, \n\nCNS vessel leukostasis: mental status changes, headaches, blurred vision, seizures, coma, stroke, papilledema.\n\nincreased risk for ICH that persists for at least a week after the reduction of WBC, perhaps due to reperfusion injury as previously ischemic areas of the brain regain blood flow.\ n\n\n\nRespiratory – Dyspnea, hypoxia, tachypnea diffuse interstitial or alveolar infiltrates on imaging studies.\n\n\n\n\n\nlaboratory abnormalities:\n\nArterial pO2 can be falsely decreased because of the enhanced metabolic activity of the malignant cells, Pulse oximetry provides a more accurate assessment of O2 saturation. \n\nPlatelet count – The platelet count may be overestimated by automated blood cell counters because fragments of blasts on blood smear can be mistakenly counted as platelets. A manual platelet count is needful.\n\n spurious hyperkalemia due to its release from leukemic blasts during the in vitro clotting process. Measurement from a heparinized plasma sample, rather than from serum, can minimize the effect.\n\nCoagulopathy – Disseminated intravascular coagulation (DIC) occurs in up to 40%\n\nTumor lysis syndrome\n\n\n\n\nManagement:\n\n\ nHydration with Normal Saline at 3L/m2/day\n\n Prednisolone 40mg/m2\n\ nCytoreduction : hydroxyurea or remission induction chemotherapy or leukapheresis. \nHydroxyurea takes time to reduce hyperleukocytosis. So are given to patient who are not able to promptly receive intensive induction chemotherapy.\ n\n\n\nIt is important to simultaneously provide intravenous hydration and prophylaxis for TLS because cytoreduction with hydroxyurea can precipitate TLS.\ n\nIV fluid rate 3,000 mL/m2/day = 125 mL/m2/hr (at least 2 times maintenance) \n\ n\nAlkalization: as Pt may go to toe, nahco3 added in the fluid.\n\n\n\nTransfuse pRBC with extreme caution (only indicated if cardiovascular compromise secondary to anaemia) as this may increase viscosity. Hgb should be kept below 8.5 g/dL o May transfuse platelets for active bleeding or platelets 1 g/m2, important to\nvigorously hydrate the patient with 2.5–3.5 liters/m2/day of IV 0.9% sodium\nchloride starting 12 hours before and for 24–48 hours after methotrexate\ninfusion. \n\nSodium bicarbonate should be included\nin the IV fluid to ensure that the urine pH is greater than 7.0 at the time of\ndrug infusion and ideally for up to 48–72 hours after drug is given.\n\n7. Methotrexate blood levels should be monitored in patients receiving\nhigh-dose therapy, patients with renal dysfunction (CrCl 13 yrs - 2 doses >1m apart) whereas \nsingle booster dose in previously completed\nimmunization. \ n\nVaccination is not needed in children with\nh/o chicken-pox prior to treatment. Children\nexposed to varicella infection during ongoing\nCT should be given prophylaxis with Varicella\nZoster Immunoglobulin (VZIg)/IVIg or oral acyclovir\n\ n(VZIg) should be\noffered (Dose 0-5 years 250 mg, 6-10 years 500 mg, 11-\n14 years 750 mg, ≥15 years 1000 mg given by slow\nintramuscular injection). Alternatively, human normal\nimmunoglobulin at 0.2g/kg can be given intravenously, in\ncase both the above are unaffordable high dose oral\nacyclovir prophylaxis (age 6 years 800 mg QID) has to be\nstarted from day 7 and continued till day 21 from the time\nof exposure.\n\n\nRotavirus\t\nupper age limit: 12 months of age\nAs child outgrows the maximum\npermissible age for vaccination by 6 months after end of chemotherapy therefore rotavirus vaccine is not indicated.\n\n\nDPT(age appropriate preparation-DwPT/DaPT/TdaP/TD w= whole, d=diptheria\n ≤7 yr: DTaP or DTwP at 0, 1 and 6 mo\n >7 yr: Tdap at O mo; Td at 1 and 6 mo\n2 Three doses at 0,1, and 6 months after 6m of chemotherapy\t\n3 Single booster dose 6 month after stopping CT\n\nHib\t\nUpper age limit is 5 years\ nunimmunized children the schedule is age dependent (age 6-12 months - two doses 8 week apart, followed by booster at 12 months; age 12-15 months - one dose and booster at 18 months; age 15-60 months - one dose).\n\n\nIPV\t\nupper age limit 5 years\nfor previously unimmunized children 2 doses of IPV 2m apart\nand 3rd dose after 6m after 2nd dose whereas in\npreviously immunised children a single booster dose of IPV is sufficient. \nIn children with previously completed\nimmunization with OPV, 2 doses of IPV 1m apart is recommended. \n\n\n HBV\t\nNo.age limit\ns 3 doses at 0, 1 and 6m in previously\nunimmunized children and a single booster dose in children with previously completed immunization.\n \n\n\nHAV\t\nupper age limit 5yrs\npreviously unimmunized children comprises\nof 2 doses 6 months apart. In children with previously completed immunization, single booster dose is adequate.\ n\n\nInactivated Infuenza vaccine:\t\nRecommendation during ongoing chemotherapy and up to 1 year after completion of treatment is age dependent\n(age 6 months to 9 years – two doses one month apart and\nthen single dose every year till indicated, age >9 years – single dose every year till indicated).\n\nAfter 1 year from the completion of chemotherapy,\ninfluenza vaccine is not recommended routinely unless the\nchild continues to have high-risk conditions necessitating\ninfluenza vaccination\n\n\nPneumococcal vaccine\t\nupper age limit 5 yrs\nfor previously unimmunized children (age 14 yr–3 doses at 0,1 and 6m\n(bivalent HPV), or 0, 2 and 6 months quadrivalent (HPV) in females]. HPV vaccines are not licensed for use in male\nchildren in India\n\n\nRabies :\ nlocal infiltration of immunoglobulin followed by anti-rabies vaccination.\nEven immunocompromised\npatients with category II exposures should receive rabies\ nimmunoglobulin in addition to a full post-exposure vaccination including the 6th dose on day 90 which is also mandatory\n\n\nTetanus: In a child with cancer who is on treatment and who then gets a wound, it can be assumed that the antibody\nlevels are inadequate. Therefore in a clean, minor wound – Td/TdaP booster regardless of immunization status is\nrecommended, for all other wounds – Td/TdaP + Tetanus\ nImmuno Globulin is advised.\n\n\nImmunization in asplenia/hyposplenia :\nThese children are at a high risk of serious\ninfection with encapsulated organisms. In addition to\nroutine vaccines, immunization with pneumococcal (both\nconjugate and polysaccharide), hemophilus influenzae\ntype B, meningococcal and typhoid vaccines are\nindicated.\nIf splenectomy is planned, immunization should be\ninitiated at least 2 weeks prior to splenectomy to achieve a\nsuperior immunologic response\n\n\ nImmunization of Contacts of Children with Cancer:\nSiblings: All non-live vaccines are allowed\nas per immunisation schedule. Additionally inactivated\ninfluenza vaccine is recommended for the siblings. Live\nvaccines like BCG, MMR, Varicella, Rotavirus and\nYellow fever vaccine are also allowed as scheduled. Oral\npolio virus vaccine is contraindicated including pulse\npolio immunization days. Sibling should receive IPV and\nif either is given by mistake or given because of lack of\ noption, then the sibling should remain away from index\nchild for at least 2 weeks.\nVaricella vaccine is encouraged in the unimmunized\nsibling who has not had chicken-pox before and if the\nsibling develops varicella vaccine induced rash, then the\nsibling should stay away from index child till all lesions\ncrust.\ nRotavirus vaccine is not discouraged but\nimmunocompromised contact (child with cancer) should\nrefrain from changing diapers of the vaccinated infant till 4\ nweeks from day of vaccination.\nParents : Inactivated Influenza vaccine is strongly\nrecommended varicella vaccine is also encouraged in the\nunimmunized parent who has not had chicken-pox before\nand if the parent develops varicella vaccine induced rash,\nthen the parent should stay away from index child\n\n\n\n\ n","ringFlags":16,"remoteId":"4014283027390183951","order":130},"alarms": [{"time":3600000,"type":3}],"geofences":[],"tags":[],"comments":[],"attachments": [],"caldavTasks": [{"calendar":"MTI1NDExNjU0OTUyOTY3MDUzMTk6MDow","remoteId":"amxSV3JhLW9VYi02M20xcA" ,"object":null,"lastSync":1727417713824,"remoteOrder":133}]},{"task": {"title":"Etoposide","priority":0,"creationDate":1727417713834,"modificationDate":1 727417713834,"notes":"MECHANISM OF ACTION\n Plant alkaloid extracted from the Podophyllum peltatum mandrake plant.\n Cell cycle–specific late S- and G2-phases.\ n Inhibits topoisomerase II by stabilizing the topoisomerase II-DNA complex\nand preventing the unwinding of DNA\n\nTOXICITY 1\nMyelosuppression. \nNadir usually occurs 10–14 days after therapy, with recovery by day 21\n\nTOXICITY 2: \nNausea and vomiting. \n\nTOXICITY 3\nhepatic enzyme elevations.\n\nTOXICITY 4\nAlopecia observed in nearly two-thirds of patients.\n\nTOXICITY 5\nMucositis and diarrhea are unusual with standard \n\n\n\n\nINDICATIONS\n. Germ cell tumors.\n. Non- Hodgkin’s lymphoma.\n. Hodgkin’s lymphoma.\n. Gastric cancer.\n\n\nDOSAGE RANGE\n1. IV: Testicular cancer—As part of the PEB regimen, 100 mg/m2 IV on days\n1–5 with cycles repeated every 3 weeks.\n2. IV: SCLC—As part of cisplatin/VP-16 regimen, 100–120 mg/m2 IV on days\n1–3 with cycles repeated every 3 weeks.\n3. SCLC—50 mg/m2/day PO for 21 days.\n\n\nDRUG INTERACTIONS\nWarfarin—Etoposide may alter the anticoagulant effect of warfarin by prolonging\nthe PT and INR. Coagulation parameters (PT and INR) need to be closely\nmonitored, and dose of warfarin may require adjustment\n\nSPECIAL CONSIDERATIONS\n1. Dose reduction\nis recommended in patients with renal dysfunction. \n\n2. Use with caution in patients with abnormal liver function. Dose reduction\nis recommended in this setting.\n\n3. Administer drug over a period of at least 30–60 minutes to avoid the risk\nof hypotension. Should the blood pressure drop, immediately discontinue\nthe drug and administer IV fluids. Rate of administration must be reduced\nupon restarting therapy.\n\n\ n","ringFlags":16,"remoteId":"3283731726368489878","order":852},"alarms": [{"time":3600000,"type":3}],"geofences":[],"tags":[],"comments":[],"attachments": [],"caldavTasks": [{"calendar":"MTI1NDExNjU0OTUyOTY3MDUzMTk6MDow","remoteId":"N2R5N0I0R3UzV1ByQkFlZQ" ,"object":null,"lastSync":1727417713834,"remoteOrder":858}]},{"task":{"title":"New case protocol solid tumors","priority":0,"creationDate":1727417713859,"modificationDate":1727417713859, "notes":"Summary: Previous Radiology/chemo\nPrimary site of tumor\n\nMetastasis sites: Bone marrow or Testis or Lungs or any\n\nStage:\n\nSurgery: ressetable/unressectable/ post surgery\n\nOn Chemo cycle and day of CT\n\nRT: \n\ nFluid given:\n\n\nVomitting/muvositis/ constipation/ fever\nNeutropenia/ antibiotics/ nukrine\nHepatosleenomegaly\nRelaspse features present or not. \nSize comparison \nLN \nTestis:\n\n\n\nPlan in this cycle\n\n\n\n\n\ n","ringFlags":16,"remoteId":"3966962959301979893","order":111},"alarms": [{"time":3600000,"type":3}],"geofences":[],"tags":[],"comments":[],"attachments": [],"caldavTasks": [{"calendar":"MTI1NDExNjU0OTUyOTY3MDUzMTk6MDow","remoteId":"SUx3MC1meFJ2anNNWm9qaA" ,"object":null,"lastSync":1727417713859,"remoteOrder":111}]},{"task": {"title":"BRAIN CANCER Protocol\t Neuroblastoma","priority":0,"creationDate":1727417713870,"modificationDate":1727417 713870,"notes":"It can be difficult to treat some brain tumors with chemo- therapy drugs because the blood-brain barrier only allows certain substances through from the blood to the brain tissues. \n\nAccording to Cancer Research UK, children less than 3 years old with primitive neuroectodermal tumours (PNETs), ependymomas, or gliomas may have chemotherapy instead of radiotherapy. They will have the same chemotherapy drugs repeated every week for up to 2 years, to reduce the long-term side effects that radiotherapy can have in very young children. \n\nOnce the child is over 3 years old, they can have radiotherapy. \n\nThe first treatment for PNETs is surgery, if possible.\n\nfollowed by radiation in patients age 3 years or older, sometimes to both the brain and the spine. \n\nClinical trials testing new chemotherapy, targeted therapy, or immunotherapy drugs may also be available.\n\n\ n\n\n surgical resection whenever possible, adjuvant/neoadjuvant VDC/IE, and radiotherapy. \n\n\n\ n","ringFlags":16,"remoteId":"3842337111477015914","order":180},"alarms": [{"time":3600000,"type":3}],"geofences":[],"tags":[],"comments":[],"attachments": [],"caldavTasks": [{"calendar":"MTI1NDExNjU0OTUyOTY3MDUzMTk6MDow","remoteId":"RjA2cmZsNXJnNGE5RjJtdw" ,"object":null,"lastSync":1727417713870,"remoteOrder":185}]},{"task": {"title":"Nukrine","priority":0,"creationDate":1727417713881,"modificationDate":172 7417713881,"notes":"The standard dosages is 5 µg/kg/day for G-CSF\n\n and 250 µg/m2/day for GM-CSF.\n\nMax dose 300µg od\n\nThese dosages of G-CSF have been associated with reduced durations of neutropenia and decreased frequency of infectious complications. 439 The use of higher doses has not been associated with improved clinical outcome. 4\n\n\n trials addressing administration of G-CSF or GM- CSF as adjunctive therapy to antibiotics, at beginning febrile Neutorpenia, has beneficial effects on patient outcome. \n\n However, none have found a discernible impact on infection-related mortality. Thus, the ASCO guidelines on the use of CSFs recommend that G-CSF and GM-CSF not routinely be initiated as adjunctive therapy for the patient presenting with FN.\n\nG-CSF and GM-CSF are also used in HSCT recipients as part of most immediate posttransplant regimens for their impact on shortening the duration of neutropenia.\n\nIn children, there are no published guidelines on the use of G-CSF for chemotherapy associated neutropenia.\n\nupdated guidelines recommend that G-CSF not be used in pediatric patients with relapsed ALL or newly diagnosed AML who do not have an infection \n\nIn summary, published literature do support the use of G-CSF as primary prophylaxis in children with solid tumors or lymphoma being treated with moderate-to-severe myelosuppressive chemotherapy.\n\nG-CSF is used in patients who have certain cancers and neutropenia caused by some types of chemotherapy and in patients who have severe chronic neutropenia that is not caused by cancer treatment.\n\n\nS/E \nBone pain \nFever\n\ nFilgrastim: colony-stimulating factors:to alleviate myelosuppression: Inj Nukrine\ n\nis a recombinant form of G-CSF made from inserting human GCSF gene into Escherichia coli bacteria.\n\nExample of rescuing patient from dose-limiting toxicities include the use of hematopoietic growth factors or CSF such as filgrastim or pegfilgrastim to limit the duration of granulocytopenia after myelosuppressive therapy, the administration of mesna to block the urotoxicity of the oxazaphosphorines, l eucovorin rescue from HDMTX, and the prevention of anthracycline\n\ncardiotoxicity with dexrazoxane.\n\nUses:\n\n(a) an attempt to ameliorate myelosuppression after chemotherapy (primary prophylaxis),\n\n(b) an attempt to prevent a recurrence of febrile neutropenia or a delay in subsequent chemotherapy administration(secondary prophylaxis),\n\n(c) treatment of established neutropenia to prevent an infection,\n\n(d) treatment of an established infection- associated episode of febrile neutropenia.\n\nMany RCTs have demonstrated that primary prophylaxis with recombinant CSFs can reduce the risk of febrile neutropenia and documented infection.\n\nPegfilgrastim, a pegylated form of filgrastim, has a longer half-life because of decreased renal clearance. Only a single injection is needed postchemotherapy cycle.","ringFlags":16,"remoteId":"1367894135122938551","order":134},"alarms": [{"time":3600000,"type":3}],"geofences":[],"tags":[],"comments":[],"attachments": [],"caldavTasks": [{"calendar":"MTI1NDExNjU0OTUyOTY3MDUzMTk6MDow","remoteId":"OG05aUxkZm0xUVpxYjhERg" ,"object":null,"lastSync":1727417713881,"remoteOrder":137}]},{"task": {"title":"VDC/IE chemotherapy D for doxo","priority":0,"creationDate":1727417713896,"modificationDate":1727417713896,"n otes":"IE chemoregimen \nAlternate with VDC EVERY 21 days cycle\n\nWeek 1 VDC\nWeek 3 IE\nWeek 6 VDC\nWeek 9 IE\nWeek 12 VDC\nWeek 15 IE\nWeek 18 VDC\nWeek 21 IE\nWeek 24 VDC\nWeek 27 IE\nWeek 30 VDC\nWeek 33 IE\nWeek 36 VDC\n\n\nVDC chemoregimen: cycle to be repeated every 21 days\nD1 to D3: Inj grandem od\nD1 to D3: Inj Dexona 4mg iv bd\nD1 to D3: Inj Aciloc 50mg iv bd\nD1 AND D8 : Inj vincristine 1.4mg/m2 IV PUSH max 2mg\nD1 INJ cyclophosphamide 1.2mg/m2 with 500ml 5% dextrose over 4 hrs with inj mesna at 0 4 and 8 hours push\nD1 and D3: Inj doxorubicin 30mg/m2 with 500ml ns over 4 hrs\nF/U after 7 days with cbc bio\n10% dose reduction if neutropenia\nReasses of 6 cycle\n\n\n\n\nIE regimen: 21 days cycle alternate with VDC\n\nD1- D3: inj ifosfamide 3000mg/m2 with 1 litre of NS over 22 hours\nD1-D3: Inj Mesna 3000mg/m2 in 1 litre of D5W + 20Meq kcl + 40mmol nahco3 over 22 hours\ nD1-D3: Inj etoposide 150mg/m2: in 500ml ns over 2 hours\nD1-D5: Inj grandem 1mg iv od\nD1-D5: Inj dexona 4mg iv bd\nD1-D5: In Aciloc 50mg iv bd\nDo daily urine reme\ nF/U after 7 days with cbc bio\n10% dose reduction if neutropenia\nReasses of 6 cycle\nEcho to be done\ n","ringFlags":16,"remoteId":"4427124240601544769","order":116},"alarms": [{"time":3600000,"type":3}],"geofences":[],"tags":[],"comments":[],"attachments": [],"caldavTasks": [{"calendar":"MTI1NDExNjU0OTUyOTY3MDUzMTk6MDow","remoteId":"TXFGeDlyLWZVVWl0SXdSMg" ,"object":null,"lastSync":1727417713896,"remoteOrder":117}]},{"task": {"title":"Abnormalitis of chromosomes","priority":0,"creationDate":1727417713907,"modificationDate":172741771 3907,"notes":".\n\n SIDDING\n\nTranslocation:\ninvolves transfer of material from one chromosome to other\n\nmay be Reciprocal translocation: reciprocal exchange of broken segment in noonhomologous chromosome\n\nRobersoninan translocation:\n2 acrocentric chromosome break at centromere and lonf arm fuse to form a single large chromosme with single centomere\n\nInversion\nDeletion\nDuplication\nInsertion\ nIsochromosome","ringFlags":16,"remoteId":"45112664393704594","order":478},"alarms" :[{"time":3600000,"type":3}],"geofences":[],"tags":[],"comments":[],"attachments": [],"caldavTasks": [{"calendar":"MTI1NDExNjU0OTUyOTY3MDUzMTk6MDow","remoteId":"elkyeHljdGljdzRwbmNyRA" ,"object":null,"lastSync":1727417713907,"remoteOrder":483}]},{"task":{"title":"08H IDA nelson 21 iron deficiency anemia","priority":0,"creationDate":1727417713917,"modificationDate":1727417713917, "notes":".\n\nBreastfed infants have an advantage, because they absorb iron 2-3 times more efficiently than infants fed cow's milk; \n\nnonetheless, breastfed infants are at risk of developing iron deficiency without regular intake of iron- fortified foods by 6 mo of age.\n\nhemoglobin concentration of the newborn infant falls during the first 2-3 mo of life, considerable iron is recycled. These iron stores are usually sufficient for blood formation in the 1st 6-9 mo of life in term infants. Stores are depleted sooner in premature infants, low-birthweight infants\ nbecause their iron stores are smaller. Delayed (1-3 min) clamping of the umbilical cord can improve iron status and reduce the risk of iron deficiency, whereas early clamping (2 cell components have been seriously compromised. ANC 65% or venous hb >22g/dl. As capillary hematocrit is 20% higher. \n\nHematocrit initially rises after birth due to placental transfer of RBCs, then decrease to baseline after 24 hrs. \n\n\nCauses: \ n\nDelayed cord clamping: 1min blood volumes 10ml/kg, 2mins volume is 90ml/kg \n\ nHolding the baby below the mother at delivery \n\nTwin to twin transfusion \n\ nSga/iugr/LGA\n\nMaternal hypertension \n\nPregnancy at high altitude \n\nMaternal smoking \n\nIDM \n\nMaternal propanolol \n\nDehydration in infants \n\nSepsis \n\n\ n\n\nC/M: \n\nCentral nervous system (CNS). Poor feeding, lethargy, hypotonia, apnea, tremors, jitteriness, seizures, \ncerebral venous thrombosis\n\nB. Cardiorespiratory. Cyanosis, tachypnea, heart murmur, congestive heart failure, cardiomegaly, elevated \npulmonary vascular resistance, prominent vascular markings on chest x-ray\n\nC. Renal. Decreased glomerular filtration, decreased sodium excretion, renal vein thrombosis, hematuria, proteinuria\n\nD. Other. Other thrombosis, thrombocytopenia, poor feeding, increased jaundice, persistent hypoglycemia, \nhypocalcemia, testicular infarcts, necrotizing enterocolitis (NEC), priapism, disseminated intravascular \ncoagulation\n\nThe timing and site of blood sampling alter the hematocrit value. We do not routinely screen well \nterm newborns for this syndrome because there are few data showing that treatment of asymptomatic patients \nwith partial exchange transfusion is beneficial in the long term.\n\nThe capillary blood or peripheral venous hematocrit level should be determined in any baby \nwho appears plethoric, who has any predisposing cause of polycythemia, who has any of the symptoms \nmentioned in section IV, or who is not well for any reason.\n\nIf the capillary blood hematocrit is above 65%, the peripheral \nvenous hematocrit should be determined.\n\n\n\n\n\nMx\n\n>65% \n\ nfirst exclude dehydration/sepsis and recheck\n\nIf >65 and symptomatic PET\n\ nAsymptomatic and >75 PET \n\nAsymptomatic 70 to 74 then consider hydration \n\ nAsymptomatic 65 to 69, monitor symptoms\n\nvolume of exhchage in ml= ((wt in kg * blood volume/kg) * (observed hematocrit - Desired Hematocrit))/ Observed Hematorcrit\n\n\nVolume to be exchanged in exchange Transfusion in polycythemia term 80-90ml/kg and 90-100ml/kg in preterm","ringFlags":16,"remoteId":"3724213910001341568","order":418},"alarms": [{"time":3600000,"type":3}],"geofences":[],"tags":[],"comments":[],"attachments": [],"caldavTasks": [{"calendar":"MTI1NDExNjU0OTUyOTY3MDUzMTk6MDow","remoteId":"b1l1dFBwNzhIYW0tX21mQQ" ,"object":null,"lastSync":1727417725909,"remoteOrder":423}]},{"task": {"title":"Fetal disease screening test vs Diagnostic","priority":0,"creationDate":1727417725943,"modificationDate":1727417725 943,"notes":".\n\nScreening test:\n1st trimester 3\nNt, for collecton of fluid in the nape of neck is sensitive marker for anuploidy. Nuchal fold>4mm thick is significant.\n\nPapp a and b hcg are altered in aneuploidy conception esp trisomy21, detects less than 1/2 of trisomy 21 \n\n\n2nd\nMsafp measured in 15 to 18 wks for NTDs\n\nTriple and quad test 70/80 \nusg\nusg following serum screening for aneuploidy\n\n😛😛😛😛😛\n\nDiagnostic test:\n\nCvs chronic villous sampling : \ n 10 to 12 wog\nif done before may be associated with increased risk of fetal limb reduction and oromandibular malformation, fetal loss more than aminocentesis\n\ naminocetesis: 15-16wog Nelson, about 20ml is removed\nearly aminocentesis i.e before 14 is associated with increased pregnancy loss and association with clubfoot\n\n\ncordocentesis: or percutaneous umbilical cord blood sampling: >18wog\ n\npreimplantation biopsy\n\nfree cell DNA","ringFlags":16,"remoteId":"3143556291169197061","order":417},"alarms": [{"time":3600000,"type":3}],"geofences":[],"tags":[],"comments":[],"attachments": [],"caldavTasks": [{"calendar":"MTI1NDExNjU0OTUyOTY3MDUzMTk6MDow","remoteId":"M1ZzeXRuUDhDQUtSNnkyTA" ,"object":null,"lastSync":1727417725943,"remoteOrder":422}]},{"task": {"title":"Vaginal bleeding","priority":0,"creationDate":1727417725981,"modificationDate":172741772598 1,"notes":".\n\nVaginal bleeding in newborn\n\nDevelopment of withdrawal like bleeding may occur in 1/4th of female at 3-5 days of birth.\n\nOccur due to fall in sex hormones after birth, bleeding is mild and last 2 to 4 days.\n\nLocal antiseptic cleaning if genitals is advised\n\nVit k unnecessary","ringFlags":16,"remoteId":"1068384639653110915","order":416},"alarms": [{"time":3600000,"type":3}],"geofences":[],"tags":[],"comments":[],"attachments": [],"caldavTasks": [{"calendar":"MTI1NDExNjU0OTUyOTY3MDUzMTk6MDow","remoteId":"QlhtR3c5NUp4RnIzb2hTdw" ,"object":null,"lastSync":1727417725981,"remoteOrder":421}]},{"task":{"title":". Mastitis neonatrum Enlargement of one or both the breast of both sexes mostly on 3rd to 4th day. Administration of meeetoclopromide may aggavate breast hypertrophy Tt: reassurance","priority":0,"creationDate":1727417726002,"modificationDate":172741772 6002,"ringFlags":16,"remoteId":"7063764751234076","order":415},"alarms": [{"time":3600000,"type":3}],"geofences":[],"tags":[],"comments":[],"attachments": [],"caldavTasks": [{"calendar":"MTI1NDExNjU0OTUyOTY3MDUzMTk6MDow","remoteId":"eTlrNWVsV2E3Y3IzV2VpLQ" ,"object":null,"lastSync":1727417726002,"remoteOrder":420}]},{"task": {"title":"Sodium bicarbonate. Bolus administration of iv sodium bicarbonate may lead to intraventricular or pulmonary hemorrhage.","priority":0,"creationDate":1727417726025,"modificationDate":172741772 6025,"ringFlags":16,"remoteId":"4272061999486112896","order":414},"alarms": [{"time":3600000,"type":3}],"geofences":[],"tags":[],"comments":[],"attachments": [],"caldavTasks": [{"calendar":"MTI1NDExNjU0OTUyOTY3MDUzMTk6MDow","remoteId":"V0tDSzNGSkt1a29SZFZnRw" ,"object":null,"lastSync":1727417726025,"remoteOrder":419}]},{"task": {"title":"ABG","priority":0,"creationDate":1727417726053,"modificationDate":1727417 726053,"notes":".\n\nABG Made Easy\n\nFio2: Fraction of inspired oxygen\n\nPo2: partial pressure of oxygen\n\nPao2: partial pressure of oxygen in arterial blood.\ n\nPA02: partial pressure of oxygen in alveoli\n\nPaCO2: partial pressure of co2 in arterial blood and is controlled by ventilation\n\nSo2: oxygen saturation in any blood.\n\nSao2: oxygen saturation is arterial blood.It can be measured using a probe (pulse oximeter) applied to the finger or earlobe.\n\n\nHypoxia refers to any state in which tissues receive an inadequate \nsupply of O2 to support normal aerobic metabolism'\n\nHypoxaemia refers to any state in which the O2 content of arterial blood is reduced. it is identified by a low Pao2 (48 hrs, Severe is requiring assited ventilation for >48hrs\n\nClassification of meconium \nMild is thin and watery, not opaque\n\ nModerate is opaque without particles\n\nthick is opaque with particle like pea soup\n\n\n\nMx\nfirst see vigorous or not\n\naVigorous Child\nHR>100, Spontaneous respiration, Good tone\n\nIf non vigorous\n\nOral cavity, oropharynx and glottis be promptly and effectively sucked under direct vision using laryngoscope. The et tube is gradually withdrawn while intermittent suction is applied \n\nThe infants maybe intubated 2-3 times till all the traces of meconium has been sucked out.\n\ nSuctioning of et tube itself is not recommended \n\nAfter\nTransfer to nicu, stomach wash with normal saline is recommended to reduce the risk of gastritis\n\ nInfants should be watched for mas and pphn.","ringFlags":16,"remoteId":"3889748450167623312","order":412},"alarms": [{"time":3600000,"type":3}],"geofences":[],"tags":[],"comments":[],"attachments": [],"caldavTasks": [{"calendar":"MTI1NDExNjU0OTUyOTY3MDUzMTk6MDow","remoteId":"LVE5aHF2bzVlYWZZSERkWg" ,"object":null,"lastSync":1727417726087,"remoteOrder":417}]},{"task": {"title":"Fetal wellbeing assessment Antepartum and intrapartum 5","priority":0,"creationDate":1727417726110,"modificationDate":1727417726110,"note s":".\n\n,,\nFetal Movement Monitoring:\nactive period averages from 30 to 40 mins\ nPeriod of inactivity >1hr should raise suspicious of fetal compromise\n\nLess than 10 movement per day is suspicious.\n\n\n\n\nNon stress test I.e\nFetal activity results in redflex acceleration in hr\n\n\nHR 110 to 160 bpm\nBeat to beat variability 5b/min\n\n2 acceleration over 20mins, \n\neach lasting 15 sec consisting 15b/min\n\n,\nCST: contraction stress test i.e uterine contractions\n\ nis a backup confirmatory test when nst is non reactive or inadequate \n\n\nbased on principle that \n\nuterine contraction can compromise an unhealthy fetus\n\nCST is positive if late deceleratin are seen in association with contractions\n\n\n,\ nBiophysical profile:\nCombines NST with other parameters by real time usg\n\n ( aminiotic fluid volume, HR, fetal activity etc)\n\n\nDopler USG\n\n\n\n😘😘😘😘\ nIntrapartum\nContineous eletronic fetal monitoring: Baseline HR, Beat to beat variability, acceleration and deaaceleration, fetal scalp abg","ringFlags":16,"remoteId":"462655161730343010","order":411},"alarms": [{"time":3600000,"type":3}],"geofences":[],"tags":[],"comments":[],"attachments": [],"caldavTasks": [{"calendar":"MTI1NDExNjU0OTUyOTY3MDUzMTk6MDow","remoteId":"NWZ5ZzU4bERSeVFFOXZjVw" ,"object":null,"lastSync":1727417726110,"remoteOrder":416}]},{"task":{"title":"BERA. 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