DIAGNOSTIC & MANAGEMENT FLOWCHARTS
Neonatal Resuscitation Protocol (NRP)
- Initial Steps: Dry baby, maintain warmth, position airway, suction if needed.
- Assessment: Check Heart Rate (HR) and Breathing.
- Decision Node 1 (HR < 100 bpm or Apnea):
- Start Positive Pressure Ventilation (PPV).
- Monitor SpO2.
- Decision Node 2 (HR < 60 bpm after 30 sec PPV):
- Start Chest Compressions.
- Ratio: 3:1 (Compressions: Ventilation).
- Decision Node 3 (HR < 60 bpm after compressions):
- Administer Epinephrine.
Management of Post-Partum Hemorrhage (PPH)
- Step 1: Prevention/Initial:
- Active management of 3rd stage of labor (AMTSL) using Oxytocin.
- Uterine Massage.
- Step 2: Medical Management (if atonic):
- Oxytocin (IV infusion).
- Methylergometrine (Contraindicated in HTN).
- Carboprost (PGF2a).
- Misoprostol (Rectal).
- Step 3: Mechanical/Surgical:
- Intrauterine Balloon Tamponade (e.g., Bakri Balloon).
- Compression Sutures (B-Lynch).
- Hysterectomy (Last resort).
- Evaluation of Amenorrhea (Primary & Secondary)
- Scenario 1: Primary Amenorrhea + Sexual Characteristics:
- Check for Uterus (USG).
- If Uterus Absent: Mullerian Agenesis (Mayer-Rokitansky-Kuster-Hauser) vs. Androgen Insensitivity,.
- If Uterus Present + Cryptomenorrhea: Imperforate Hymen.
- Scenario 2: Secondary Amenorrhea:
- Step 1: Rule out Pregnancy (UPT).
- Step 2: History of D&C? Suspect Asherman’s Syndrome (Intrauterine Adhesions),.
- Step 3: Hormonal Profile (FSH/LH).
- High FSH: Ovarian Failure (Premature Menopause).
- Normal/Low FSH: Hypothalamic/Pituitary cause.
COMPARISON TABLES
Meningitis: CSF Analysis Findings
| Feature | Bacterial (Pyogenic) | Tubercular (TB) | Viral | Fungal (Cryptococcal) |
| Appearance | Turbid/Purulent | Cobweb Coagulum | Clear | Clear/Cloudy |
| Cells | Neutrophils, | Lymphocytes | Lymphocytes | Lymphocytes |
| Protein | High (>100 mg/dL) | High (raised) | Normal/Mild high | Elevated |
| Glucose | Very Low | Low | Normal | Low |
| Specific Test | Gram Stain | CBNAAT/AFB | PCR | India Ink Positive, |
Hepatitis B Serology Interpretation
| Serological Marker | Interpretation |
| HBsAg (+), IgM Anti-HBc (+) | Acute Hepatitis B Infection |
| HBsAg (-), Anti-HBs (+), IgG Anti-HBc (+) | Past/Resolved Infection (Immunity) |
| HBsAg (-), Anti-HBs (+), IgG Anti-HBc (-) | Vaccinated Immunity |
| HBsAg (+), IgG Anti-HBc (+) | Chronic Hepatitis B |
Peripheral Nerve Injuries (Upper & Lower Limb)
| Nerve Injured | Clinical Sign/Deformity | Sensory Loss Area |
| Radial Nerve | Wrist Drop | Anatomical Snuffbox / Dorsum of hand |
| Ulnar Nerve | Claw Hand (Medial fingers) | Medial 1.5 fingers |
| Median Nerve | Ape Thumb / Pointing Index | Lateral 3.5 fingers / Thenar eminence |
| Common Peroneal | Foot Drop / Loss of Eversion | Dorsum of Foot |
| Long Thoracic | Winging of Scapula | – |
Thyroid Carcinomas: Key Features
| Type | Histopathology Feature | Marker/Association |
| Papillary | Orphan Annie Eye Nuclei, Psammoma Bodies | Lymphatic Spread |
| Medullary | Amyloid Stroma | Calcitonin (C-cells), MEN Syndrome |
| Follicular | Capsular/Vascular Invasion | Hematogenous Spread |
CHECKLISTS & SCORING SYSTEMS
Biomedical Waste Management (Color Coding Checklist)
- Yellow Bag:
- Human Anatomical Waste (Placenta, Body parts).
- Soiled Waste (Cotton, dressings with blood),,.
- Expired Cytotoxic Drugs.
- PPE Kits.
- Red Bag:
- Recyclable Plastics (Tubing, Catheters, Urine bags).
- Gloves (if not blood-soaked).
- White Translucent Container:
- Sharps (Needles, Scalpels),.
- Blue Marking/Container:
- Glassware (Vials, Ampoules),.
- Metallic Implants.
Glasgow Coma Scale (GCS) Criteria
- Eye Opening (Max 4):
- Spontaneous (4)
- To Speech (3)
- To Pain (2)
- None (1)
- Verbal Response (Max 5):
- Oriented (5)
- Confused (4)
- Inappropriate Words (3)
- Incomprehensible Sounds (2)
- None (1)
- Motor Response (Max 6):
- Obeys Commands (6)
- Localizes Pain (5)
- Withdraws (4)
- Abnormal Flexion (Decorticate) (3)
- Extension (Decerebrate) (2)
- None (1)
Rule of Nines (Burn Surface Area Estimation – Adult)
- Head & Neck: 9%
- Upper Limbs: 9% each (Total 18%)
- Trunk (Anterior): 18%
- Trunk (Posterior): 18%
- Lower Limbs: 18% each (Total 36%)
- Genitalia/Perineum: 1%
- Calculation Example: Half chest + half abdomen + half upper arm + one leg = Calculation required based on segments involved.
APGAR Score Checklist (Newborn Assessment)
- Appearance: Blue/Pale (0) | Acrocyanosis (1) | Pink (2).
- Pulse: Absent (0) | <100 (1) | >100 (2).
- Grimace: No response (0) | Grimace (1) | Cry/Cough (2).
- Activity: Flaccid (0) | Some flexion (1) | Active motion (2).
- Respiration: Absent (0) | Slow/Irregular (1) | Good cry (2).
