Tetanus prophylaxis guideline nepal 2023

Please go through the pdf for tetanus prophylaxis guideline nepal 2023 below.

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Tetanus guideline

Appropriate tetanus prophylaxis should be administered as soon as possible following a wound but should be given even to patients who present late for medical attention. This is because the incubation period is quite variable; most cases occur within 8 days, but the incubation period can be as short as 3 days or as long as 21 days. For patients who have been vaccinated against tetanus previously but who are not up to date, there is likely to be little benefit in administering human tetanus immune globulin more than 1 week or so after the injury. However, for patients thought to be completely unvaccinated, human tetanus immune globulin should be given up to 21 days following the injury; Td or Tdap should be given concurrently to such patients

NHPC model exam 2080

NHPC

Package of Essential Non-communicable Diseases (PEN)

PEN module book

what is pen package who nepal

Package of Essential Non-communicable Diseases (PEN) was training developed for trainignn doctors and paramedics regardaing non communicalve diseasae.

Package of Essential Non-communicable Diseases (PEN) is a trainign program for health professionals to increase if NCD treatment in rural communities

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How to perform ABG and interpretation ABG analysis results

How to perform and interpret ABG analysis

Introduction to ABG:

ABG stands for arterial blood gas. ABG is a common test done in case of critical care and severely ill patient to know the arterial bloog gas status of the patient along with various other parameters.

Sample for ABG analysis

Normal ABG value ranges:

ABG practice questions:

Normal lab test ranges and values for common tests

Blood collection tubes: Normal lab test ranges and values for common tests

~~Table of Contents(toc)~~

Introduction

How to read and ECG: Mnemonic for ECG reading fast

Introduction

A structured approach makes ECG interpretation systematic and reliable. A commonly used mnemonic is:

RRAHI

R = Rhythm
R = Rate
A = Axis
H = Hypertrophy
I = Ischemia

How to Calculate Heart Rate in Regular Rhythm ECG

For a regular rhythm, use either of the following methods:

Method 1 (Big boxes)

Take any two R waves
Count the number of big boxes between them
Divide 300 by that number
The result is the heart rate

Method 2 (Small boxes)

Take any two R waves
Count the number of small boxes between them
Divide 1500 by that number
The result is the heart rate

How to Calculate Heart Rate in Irregular Rhythm ECG

For irregular rhythms, use a longer rhythm strip:

Take 10 big boxes in the rhythm strip
Count the number of QRS complexes (R waves) within those 10 big boxes
Multiply that number by 30

👉 This gives the heart rate in beats per minute (bpm)

Completed Formula

Heart rate = (Number of QRS complexes in 10 big boxes) × 30

Why this works:

1 big box = 0.2 seconds
10 big boxes = 2 seconds
60 seconds ÷ 2 seconds = 30

So you are converting a 2-second sample into a 1-minute rate.

How to Check Rhythm of an ECG

To determine the rhythm:

Check if R–R intervals are regular or irregular
Look for P waves before every QRS complex
Ensure P waves have a consistent shape
Confirm that each P wave is followed by a QRS

Normal (Sinus Rhythm) Features:

Regular rhythm
One P wave before each QRS
Normal PR interval
Heart rate between 60–100 bpm

How to Check Axis of an ECG

Axis refers to the overall direction of electrical activity in the heart.

Basic Method (using limb leads):

Look at Lead I and aVF

Lead I	aVF	Axis
+	+	Normal axis
+	–	Left axis deviation
–	+	Right axis deviation
–	–	Extreme axis deviation

Normal Axis:

Between -30° to +90°

The electrical impulse normally:

Starts from the right atrium
Travels toward the left ventricle
Occurs 60–100 times per minute

How to Identify Myocardial Ischemia on ECG

Look for these three key changes:

ST segment changes
- Elevation → possible acute injury
- Depression → ischemia
T wave changes
- Inversion
- Flattening
Q waves
- May indicate previous myocardial infarction

How to Identify Hypertrophy on ECG

Hypertrophy leads to increased voltage (amplitude) on ECG.

Left Ventricular Hypertrophy (LVH)

A commonly used method:

S wave in V1 + R wave in V5 or V6 ≥ 35 mm

Additional clues:

Deep S waves in V1
Tall R waves in V5/V6
Possible left axis deviation

This completes the full ECG reading framework using the RRAHI approach, covering all essential steps: rate, rhythm, axis, hypertrophy, and ischemia.

Thyroid function test: TFT how to interpret TFT and know these dangerous disease at home

Core Tests

TSH (Thyroid Stimulating Hormone) → most sensitive
Free T4 (FT4) → active hormone
Free T3 (FT3) → useful in hyperthyroidism
± Antibodies:
- Anti-TPO
- TRAb (TSH receptor antibody)

Step 1: Look at TSH first

          TSH
        /  |   \
     Low Normal High

IF TSH LOW → Think Hyperthyroid OR Central Hypothyroid

TSH ↓
  |
  ├── FT4 ↑ / FT3 ↑ → PRIMARY HYPERTHYROIDISM
  │        (e.g. Graves', toxic nodules)
  │
  ├── FT3 ↑ only → T3 TOXICOSIS
  │
  ├── FT4 normal, FT3 normal → SUBCLINICAL HYPERTHYROIDISM
  │
  └── FT4 ↓ → CENTRAL (SECONDARY) HYPOTHYROIDISM
           (pituitary/hypothalamic disease)

Diagnoses

Graves’ disease
Toxic multinodular goiter
T3 toxicosis
Central hypothyroidism

IF TSH HIGH → Think Hypothyroidism

TSH ↑
  |
  ├── FT4 ↓ → PRIMARY HYPOTHYROIDISM
  │        (thyroid gland failure)
  │
  ├── FT4 normal → SUBCLINICAL HYPOTHYROIDISM
  │
  └── FT4 ↑ → RARE:
           - TSH-secreting adenoma
           - Thyroid hormone resistance

Diagnoses

Hashimoto thyroiditis
Iodine deficiency
Post-thyroidectomy
TSH-secreting pituitary adenoma

IF TSH NORMAL → Check FT4/FT3 carefully

TSH normal
  |
  ├── FT4 ↓ → CENTRAL HYPOTHYROIDISM
  │
  ├── FT4 ↑ → TSHOMA / RESISTANCE
  │
  └── FT4 normal → EUTHYROID

SUMMARY FLOWCHART (HIGH-YIELD)

                TSH
         ┌──────┼──────┐
        ↓       N       ↑
        |       |       |
     Check     Check    Check
     FT4/FT3   FT4      FT4
        |       |        |
   ┌────┼───┐   |    ┌───┼────┐
  ↑     N   ↓   |   ↓    N     ↑
Hyper Subclin Central   Primary Subclin Rare
thyroid hyper  hypo     hypo    hypo   causes

SPECIAL PATTERNS (EXAM FAVORITES)

1. Euthyroid Sick Syndrome

TSH: normal/low
FT3: ↓ (early)
FT4: ↓ (late)

👉 Seen in severe illness (ICU patients)

2. Subclinical Disease

Condition	TSH	FT4
Subclinical hyperthyroidism	↓	Normal
Subclinical hypothyroidism	↑	Normal

3. Pregnancy Changes

TSH ↓ (1st trimester)
FT4 slightly ↑ early

4. Drug Effects

Amiodarone → hypo OR hyper
Steroids → ↓ TSH
Lithium → hypothyroidism

MEMORY TRICKS

“TSH runs opposite to thyroid hormones”

↑ TSH = ↓ thyroid function (usually)
↓ TSH = ↑ thyroid function

“Think CENTRAL if TSH doesn’t match FT4”

Low TSH + Low FT4 → pituitary problem
Normal TSH + Low FT4 → pituitary problem

“Subclinical = TSH abnormal, FT4 normal”

QUICK CLINICAL PROTOCOL

Suspected Hypothyroidism

Check TSH
If ↑ → check FT4
If FT4 ↓ → treat
If FT4 normal → monitor / anti-TPO

Suspected Hyperthyroidism

Check TSH
If ↓ → check FT4, FT3
If elevated → confirm cause:
- TRAb → Graves’ disease
- Scan → nodules

Suspected Pituitary Disease

Always check:
- FT4
- TSH (may be misleading)

COMMON PITFALLS

Relying only on TSH in pituitary disease
Ignoring FT3 in hyperthyroidism
Misinterpreting illness-related changes

ULTRA-SHORT REVISION

TSH ↑ + FT4 ↓ → Primary hypothyroid
TSH ↓ + FT4 ↑ → Hyperthyroid
TSH ↑ + FT4 normal → Subclinical hypo
TSH ↓ + FT4 normal → Subclinical hyper
TSH ↓ + FT4 ↓ → Central hypothyroid

RFT- Renal function test (notes summary)

RFT- Renal function test: Indication, Interpretatin, Normal Range

~~Table of Contents(toc)~~

Introduction of Renal Function Test (RFT)

Renal Function Tests (RFTs) are a group of blood and urine tests used to assess the health and efficiency of the kidneys. These tests help in evaluating how well the kidneys are filtering waste products, maintaining electrolyte balance, and regulating fluid levels in the body.

RFTs are essential tools in diagnosing and monitoring kidney diseases, as well as in managing systemic conditions like hypertension and diabetes that can impact kidney function.

By analyzing key parameters such as serum creatinine, blood urea nitrogen (BUN), estimated glomerular filtration rate (eGFR), and electrolytes, healthcare providers can detect early signs of renal impairment and initiate appropriate interventions.

Indications for RFT

Suspected kidney disease
Hypertension
Diabetes mellitus (routine monitoring)
Urinary tract infections (recurrent or severe)
Edema (swelling of legs/face)
Hematuria (blood in urine)
Proteinuria (protein in urine)
Monitoring patients on nephrotoxic drugs (e.g., aminoglycosides, NSAIDs)
Preoperative assessment
Chronic kidney disease (CKD) follow-up

Components of RFT

Serum Creatinine
Blood Urea Nitrogen (BUN) / Urea
Estimated Glomerular Filtration Rate (eGFR)
Serum Electrolytes (Na⁺, K⁺, Cl⁻, HCO₃⁻)
Urinalysis (protein, glucose, blood, specific gravity)
Creatinine Clearance (if needed)

Normal Ranges

(Note: may vary slightly by lab)

Serum Creatinine:

Males: 0.7 – 1.3 mg/dL
Females: 0.6 – 1.1 mg/dL

Blood Urea Nitrogen (BUN): 7 – 20 mg/dL
Urea (alternative to BUN): 20 – 40 mg/dL
eGFR:

Normal: >90 mL/min/1.73 m²
Mild decrease: 60–89
Moderate: 30–59
Severe: 15–29
Kidney failure: <15

Creatinine Clearance: 90 – 140 mL/min
Serum Sodium (Na⁺): 135 – 145 mEq/L
Serum Potassium (K⁺): 3.5 – 5.0 mEq/L
Serum Bicarbonate (HCO₃⁻): 22 – 29 mEq/L

Interpretation

↑ Creatinine & BUN: Indicates impaired renal function or acute/chronic kidney disease
↓ eGFR: Suggests declining kidney function
↑ Potassium (Hyperkalemia): Common in advanced renal failure
↓ Sodium (Hyponatremia): Seen in fluid overload or renal salt wasting
Urinalysis:

Proteinuria: Indicates glomerular damage
Hematuria: Suggests infection, stones, or glomerulonephritis
Low Specific Gravity: May suggest tubular dysfunction

Please learn to read a Lipid profile report

Lipid profile- Know the danger of cholesterol in a single test

~~Table of contents(toc)~~

Introduction Lipid panel

Lipid simply means fat or cholesterol in general.

But lipid profile contains multiple parameters viz. Total cholesterol, triglycerides, high density lipoprotein, low density lipoprotein and very low density lipoprotein.

These all parameters have their own reference range and own function in our body.

Now we will discuss each of the above aprameter individually.

Parameters that are measuted in lipid profile

Here are the parameters measured in Lipid profile

Total cholesterol
triglycerides
high density lipoprotein
low density lipoprotein
very low density lipoprotein

Total Cholesterol

Reference ranges:

< 200 mg/dL (Desirable)

• 200–239 mg/dL: Borderline high

• ≥ 240 mg/dL: High

Triglycerides

Reference ranges:

< 150 mg/dL (Normal)

• 150–199 mg/dL: Borderline high

• 200–499 mg/dL: High

• ≥ 500 mg/dL: Very high

High density lipoprotein

Reference ranges:

Men: > 40 mg/dL (Optimal)

• Women: > 50 mg/dL (Optimal)

• ≥ 60 mg/dL is considered protective against heart disease

Low density lipoprotein

Reference ranges:

Optimal: < 100 mg/dL

• 100–129 mg/dL: Near optimal

• 130–159 mg/dL: Borderline high

• 160–189 mg/dL: High

• ≥ 190 mg/dL: Very high

Very low density lipoprotein

Reference ranges: 5–30 mg/dL (Normal range)

Atherosclerosis risk of deranged lipid profile
Heart disease risk of deranged lipid profile
Arterial plaque buildup of deranged lipid profile
Coronary artery disease and deranged lipid profile
Cardiovascular health and deranged lipid profile
Cholesterol testing
Lipid profile interpretation
Cholesterol management
Dietary cholesterol impact
Lifestyle modifications
Statins and cholesterol control
Exercise and cholesterol levels
Genetic predisposition to high cholesterol
Importance of regular lipid screening

Tetanus prophylaxis guideline nepal 2023

Tetanus guideline

NHPC model exam 2080

Package of Essential Non-communicable Diseases (PEN)

what is pen package who nepal

How to perform and interpret ABG analysis

Introduction to ABG:

Normal ABG value ranges:

ABG practice questions:

Normal lab test ranges and values for common tests

Introduction

Introduction

RRAHI

How to Calculate Heart Rate in Regular Rhythm ECG

Method 1 (Big boxes)

Method 2 (Small boxes)

How to Calculate Heart Rate in Irregular Rhythm ECG

Completed Formula

Why this works:

How to Check Rhythm of an ECG

Normal (Sinus Rhythm) Features:

How to Check Axis of an ECG

Basic Method (using limb leads):

Normal Axis:

How to Identify Myocardial Ischemia on ECG

How to Identify Hypertrophy on ECG

Left Ventricular Hypertrophy (LVH)

Additional clues:

Table of Contents

Core Tests

Step 1: Look at TSH first

IF TSH LOW → Think Hyperthyroid OR Central Hypothyroid

Diagnoses

IF TSH HIGH → Think Hypothyroidism

Diagnoses

IF TSH NORMAL → Check FT4/FT3 carefully

SUMMARY FLOWCHART (HIGH-YIELD)

SPECIAL PATTERNS (EXAM FAVORITES)

1. Euthyroid Sick Syndrome

2. Subclinical Disease

3. Pregnancy Changes

4. Drug Effects

MEMORY TRICKS

“TSH runs opposite to thyroid hormones”

“Think CENTRAL if TSH doesn’t match FT4”

“Subclinical = TSH abnormal, FT4 normal”

QUICK CLINICAL PROTOCOL

Suspected Hypothyroidism

Suspected Hyperthyroidism

Suspected Pituitary Disease

COMMON PITFALLS

ULTRA-SHORT REVISION

RFT- Renal function test: Indication, Interpretatin, Normal Range

Introduction of Renal Function Test (RFT)

Indications for RFT

Components of RFT

Normal Ranges

Interpretation

Lipid profile- Know the danger of cholesterol in a single test

Introduction Lipid panel

Parameters that are measuted in lipid profile

Total Cholesterol

Triglycerides

High density lipoprotein

Low density lipoprotein

Very low density lipoprotein

What is Ultrasound – The Video Xray? is it harmful to our body?

Introduction

Use of video x ray

benefits of video x ray

Risks of video x ray

Side effects of video x ray

Conclusion