earth quick peshawer maps

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cell physiology type of cell

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interior and posterior human muscle diagram

RAO ANWER ARRESTED IN DUBI AIRPORT

HAEMATEMESIS CLINACLE FEATURE MANAGEMENT DIAGNOSIS INVESTIGATION

HAEMATEMESIS

   IT IS BLOOD IN VOMITING .IT MAY BE BRIGHT RED OR LIKE COFFEE GROUND .THERE MAY BE PRESENT MELAENA  FOR EXAMPLE  BLACK LIKE TAR COAL  SO CALLED TARRY BLACK COLORED STOOL WITH CHARACTERISTIC SMELL STOOL ARE SEMI SOLID FOLLOWING ARE THE CAUSES OF THE HAEMATEMESIS 

1 PEPTIC ULCER 

2 GASTRIC ERROSIONS 

3 INTAKE OF DRUG FOR EXAMPLE ASPRINE STEROIDS AND NASID

4 ESOPHAGEAL VAR ICES

5 CARCINOMA OF STOMACH 

6 MALLORY WEISS SYNDROME 

7 DOUYDINITIS AND ESOPHAGEAL 

8 BLEEDING DISORDER 

CLINICAL FEATURE      

1 PATIENT LOOK PALE 

2 HE MAY BE SWEATING PROFUSELY COOL AND CLAMMY SKIN 

3 PULSE IS FAST MORE THEN 100/MM AND THREADY 

4 BP MAY BE LOW LESSER THAN 100 MM HG

5 EXCESSIVE BLEEDING MAY LEAD TO SHOCK 

6 URINE OUT PUT IS DECREASES LESSER THAN 30ML/HR 

7 IF BLEEDING IS FROM OSEOPHAGEAL VARICES FEATURE OF LIVER CIRRHOSIS FOR EXAMPLE ASCITES AND SPLENOMEGALY ARE PRESENT 

8 PRESENCE OF MASS EPIGASTRIUM IS SUGGESTIVE  OF CARCINOMA OF STOMACH MAY BE WITH SECONDARY IN LIVER 

9 BOARD LIKE RIGIDITY OF ABDOMEN AND SHOCK LIKE CONDITION IS SUGGESTIVE OF PERITONITIS OR PERFORATED PIPTIC ULCER

MANAGEMENT    

IRRESPECTIVE OF THE  CAUSE FOLLOWING STEP ARE IMMEDIATELY TAKEN 

1 FOOT END OF THE BED IS ELEVATED 

2 IV LINE IS MAINTAINED 

3 BLOOD PLASMA PLASMA EX PANDER NORMAL SALINE OR 5% DEXTROSE DRIP IS IMMEDIATELY STARTED 

4 INJ TRANEXAMIC ACID IGM /6 HR IV FOR 48HR 

5 ANTIEMETIC INJECTION MAXALON OR PLASIL IS GIVEN 

6 ASPIRATION TO ASSESS WEATHER BLEEDING IS GOING ON OR NOT AND TO CLEAR THE STOMACH FROM BLOOD CLOTS 

7 NASOGASTRIC TUBE IS PASSED 

8 VITAL SIGN FOR EXAMPLE BP PULSE AND RESPIRATION IS CHEEKED HALF HR .INCREASED PULSE RATE . MORE THEN 100/MIN  INCREASED RESPIRATORY RATE AND FALLING OF SYSTOLIC B.P LESS THEN 100/MIN HG IS SUGGESTIVE OF CONTINUOUS BLEEDING .

9 OXYGEN MAY BE GIVEN TO CHECK CEREBRAL ANOXIA 

10 IF DESIRED PATIENT CAN BE GIVEN LIQUID OR SEMI SOLID DIET FOR EXAMPLE CHILLED MILK ICE CREAM PUDDING CUSTARD ETC 

11 DEHYDRATION IS AVOIDED BY GIVING IV FLUID .AFTER COMBATING WITH ACTIVE BLEEDING AND SHOCK FOLLOWING STEP ARE TAKEN TO ESTABLISHED THE DIAGNOSIS 

DIAGNOSTIC     POINTS 

1 H/O INTAKE OF ASPRIN NASID AND STEROID IS SUGGESTIVE OF PIPTIC ULCER 

2 H/O INTAKE OF ALCOHOL IS SUGGESTIVE OF GASTRIC LIVER CIRRHOSIS AND PANCREATITIS 

3 PAIN IN EPIGASTRIUM WITH DYSPEPSIA  HEART BURN AND RETROSTERNAL BURNING FOLLOWING INTAKE OF FOOD IS SUGGESTIVE OF PIPTIC ULCER 

INVESTIGATION 

FOLLOWING INVESTIGATION ARE DONE TO ESTABLISH THE DIAGNOSIS 

1 EMERGENCY ENDOSCOPY  IS DONE TO SEE THE SOURCES OF BLEEDING FOR EXAMPLE PEPTIC ULCER ESOPHAGEAL VARIES OR  MALIGNANCY BIOPSY IS TAKEN IF MALIGNANCY IS SUSPECTED 

2 X RAY BARIUM MEAL FOLLOW THROUGH 

3 LIVER FUNCTION TESTES  

naqeebullah case

naqeebullah case.rao anwer to be arrested if he doesnot cooperate says investigation officer

systemic examination

in general practice examination of all the system is not required A quick and in to the point examination of the disease  system is always rewarding Following scheme of system examination is not substitute for through and detailed clinical examination of patient. mentioned in standard clinical methods .....

           however this scheme well not only satisfy the doctor that he has examined the patient properly  but also the patient satisfaction  of the patient is of paramount importance in general practice 

MALARIA ,BLACK WATER MALARIA ALGID MALARIA CEREBRAL MALARIA DIAGNOSIS

MALARIA

            HIGH GRADE FEVER WITH SHIVERING SHOULD BE CONSIDERED AS MALARIA  UNTIL PROVIDE OTHERWISE

D/D

ACUTE PHARYNGITIS ACUTE TONSILS CHOLECYSTITIS CHOLANGITIS  GLOMERULLO-NEPRITIS   (UTI)  AND CERTAIN VIRAL FEVERS ARE ALSO ACCOMPANIED WITH RIGORS 

               PERIODIC FEVER  FOR EXAMPLE AFTER SECOND THIRD OR FORTH SHOULD BE CONSIDERED AS MALARIA 

            MALARIA MAY PRESENT OF THE ONE AS FOLLOWING FORMS SO IT IS THE AWARENESS OF SUCH CLINICAL PRESENTATION OF MALARIA WHICH IS VERY IMPORTANT

CEREBRAL MALARIA    

                                      HIGH GRADE FEVER ,SEVERE HEADACHE ,DROWSINESS CONVULSION OR COMA FOCAL NEUROLOGICAL SIGNS MAY BE PRESENT IN THE CERTAIN CASE 

BLACK WATER FEVER 

                                               DUE TO EXCESSIVE HEAMOLYSIS PATIENT PASSES BLACK URINE DUE TO PRESENCE OF HB IN URINE 

                                        RENAL FAILURE HEPATIC FAILURE OR PULMONARY OEDEMA MAY BE PRESENTING FEATURE IN RARE CASES 

ALGID MALARIA 

                           PATIENT MAY HAVE CHOLERA LIKE SYMPTOM SEVER VOMITING AND DIARRHOEA PATIENT GOSE INTO SHOCK DUE TO DEHYDRATION 

DIAGNOSIS 

      BLOOD EXAMINATION SHOW THE PRESENCE OF MALARIA PARASITES ANYHOW ITS ABSENCE DOSE NOT RULE OUT MALARIAL INFECTION .RAPID STICK TESTS ARE ALSO AVAILABLE

Diseases of CVS

1  Angina 

2 myocardial infraction 

3 acute heart failure
4 Atrial ectopics
5 atrial flutter
6 supraventricular tachycardia
7 Atrial fibirillation
8ventricular ectopics

9 ventricualr tachycardia

10 heart block
11 syncopial attack
12 torsada De pointee (TDP)
13cardiac Arrest
14 CPR
15 pericarditis
16 shock
17 septic shock
18 hypertensive Encephalopathy
19 pulmonary embolism
20 Deep veins Thrombosis 

headache due tension ,worries depression

after ruling out the other causes of headache . tension is the most probable cause of chronic headache . patient usually complain of persistent dull headache in hole of head in general and in the occipital region in particular
                      head remains heavy since morning and headache become worse in the evening due to constant built of tension 
           tension and worries can be due to anything financial , social official are family problem are the main cause of tension headache .
              patient suffering from any chronic illness may also suffer from headache ,quite independent of his disease .this is due to worries about the prognosis of the disease .
         highly sensitive personalities , who grumbles all the time about all the things related are unrelated to them . usually suffer from constant indigestion and headache . constant headache leads to mental tension and constant mental tension lead to headache this is vicious circle in which so many person are trapped 

      treatment 

                               tab diazepam 
                              tab analgesic 

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