1. Anaphylaxis 

    - Adrenaline (epinephrine) injection 1:1000, 1 mg/ml
    - Intramuscular adrenaline (0.5 ml of 1 in 1000 solution) 
    - Repeat at 5 minutes if needed

2. Hypoglycaemia

    - Oral glucose solution/tablets/gel/powder 
    - Glucagon injection 1 mg  Intramuscular
    - Proprietary non-diet drink or 5 g glucose powder in water     

3. Acute exacerbation of asthma

    - (Beta-2 agonist) Salbutamol aerosol inhaler 100  mcg/activation
    - Salbutamol aerosol Activations directly or up to six into a spacer
    
4. Status epilepticus
    - Buccal or intranasal midazolam 10 mg/ml
       
5. Angina
    - Glyceryl trinitrate spray 400 mcg/metered activation   
    
6. Myocardial infarct

    - Dispersible aspirin 300 mg

Chickenpox

Chickenpox is caused by the varicella-zoster virus (VZV), also known as human herpes virus 3 (HHV-3)

Chickenpox is highly infectious and spreads from person to person by direct contact or through the air from an infected person’s coughing or sneezing
A persons with chickenpox is contagious 1-2 days before the rash appears and until all blisters have formed scabs It takes 5- 10 days

0-21 days after contact with an infected person for someone to develop chickenpox

start as a 2-4 mm red papule which develops an irregular outline (rose petal).

A thin-walled, clear vesicle (dew drop) develops on top of the area of redness. This "dew drop on a rose petal" lesion is very characteristic for chicken pox

After about 8-12 hours the fluid in the vesicle gets cloudy and the vesicle breaks leaving a crust.

The fluid is highly contagious, but once the lesion crusts over, it is not considered contagious. The crust usually falls off after 7 days sometimes leaving a craterlike scar

Vaccination

Routine vaccination against varicella zoster virus has dramatically reduced the incidence of disease

Herpes simplex virus

The herpes simplex virus (HSV) (also known as Cold Sore, Night Fever, or Fever Blister) is a virus that manifests itself in two common viral infections, each marked by painful, watery blisters in the skin or mucous membranes (such as the mouth or lips) or on the genitals

the two most common are type 1 (HSV-1) and type 2 (HSV-2). HSV-1 is more common and generally considered to be associated with orofacial infection, usually the lips

HSV-2 is associated with the infection of the genitals, although both types can affect either region. HSV-2 infection is of particular concern because of the largely asymptomatic nature of the infection, and the shedding of infective virions even in asymptomatic individuals.

Orofacial infection

Prodromal symptoms

Skin appears irritated

Sore or cluster of fluid-filled blisters appear

Lesion begins to heal, usually without scarring

These infections usually occur on lips especially near the vermilion border. Rarely will a cold sore appear inside the mouth. The sores may appear to be either weeping or dry, and may resemble a pimple, insect bite, or lesion. Vesicles may also appear on the fingers, an infection called whitlow.

Genital infection

Prodromal symptoms

Sore appears

Lesion begins to heal, usually without scarring

In men, the lesions may occur on the shaft of the penis, in the genital region, on the inner thigh, buttocks, or anus. In women, lesions may occur on or near the pubis, labia, clitoris, vulva, buttocks, or anus

Treatments

antiviral medications for controlling herpes outbreaks, including acyclovir (Zovirax), valacyclovir (Valtrex), famcyclovir (Famvir), and pencyclovir

All drugs in this class depend on the activity of the viral thymidine kinase to convert the drug to a monophosphate form and subsequently interfere with viral DNA replication.

Pencyclovir's primary advantage over acyclovir is that it has a far longer cellular half-life

Docosanol works by preventing the virus from fusing to cell membranes, thus barring entry into the cell for the virus

Tromantadine is another antiviral drug effective against herpes.

Herpes zoster

Herpes zoster, colloquially known as shingles, is the reactivation of varicella zoster virus, leading to a crop of painful blisters over the area of a dermatome

Signs and symptoms

pain is the first symptom. This pain can be characterized as stinging, tingling, numbing, or throbbing, and can be pronounced with quick stabs of intensity.

Then 2-3 crops of red lesions develop, which gradually turn into small blisters filled with serous fluid.

Shingles blisters are unusual in that they only appear on one side of the body . That is because the chickenpox virus can remain dormant for decades, and does so inside the spinal column or a nerve fiber.

If it reactivates as shingles, it affects only a single nerve fiber, or ganglion, which can radiate to only one side of the body.

The blisters therefore only affect one area of the body and do not cross the midline

The rash and pain usually subside within 3 to 5 weeks. The most common chronic complication of herpes zoster is postherpetic neuralgia.

serious effects including partial facial paralysis (usually temporary), ear damage, or encephalitis may occur.

Shingles on the upper half of the face (the first branch of the trigeminal nerve) may result in eye damage

Treatment

Aciclovir (an antiviral drug) inhibits replication of the viral DNA, and is used both as prophylaxis (e.g. in patients with AIDS) and as therapy for herpes zoster.

Steroids are often given in severe cases

A vaccine called live attenuated Oka/Merck VZV that has been proven successful in preventing it

Influenza

Influenza, commonly known as the flu or the grippe, is a contagious disease of the upper airways and the lungs, caused by an RNA virus

Symptoms

The virus attacks the respiratory tract, is transmitted from person to person by saliva droplets expelled by coughing, and causes the following symptoms:

Fever
Headache
Fatigue/Sore joints (can be extreme)
Dry cough
Sore throat
Nasal congestion
Sneezing
Irritated eyes
Body aches
Extreme coldness

Treatment

get plenty of rest, drink a lot of liquids

acetaminophen to relieve the fever and muscle aches

Children and teenagers with flu symptoms (particularly fever) should avoid taking aspirin as taking aspirin in the presence of influenza infection (especially influenza type B) can lead to Reye syndrome, a rare but potentially fatal disease of the liver

Mumps

Mumps or epidemic parotitis is a viral disease of humans.

Caused by a paramyxovirus, and is spread from person to person by saliva droplets or direct contact

Symptoms

The more common symptoms of mumps are:

Swelling of the parotid gland (or parotitis) in >90% of patients.

Fever
Headache
Sore throat
Orchitis

A physical examination confirms the presence of the swollen glands

If  there is uncertainty about the diagnosis, serology or a saliva test for the virus may be carried out.

Rubella

caused by the Rubella virus

Symptoms

swollen glands or lymph nodes (may persist for up to a week)

fever (rarely rises above 38 degrees Celsius [100.4 degrees Fahrenheit])

rash (Appears on the face and then spreads to the trunk and limbs. It appears as pink dots under the skin. It appears on the first or third day of the illness but it disappears after a few days with no staining or peeling of the skin)

Forchheimer's sign occurs in 20% of cases, and is characterized by small, red papules on the area of the soft palate flaking, dry skin

inflammation of the eyes

nasal congestion

joint pain and swelling

pain in the testicles

loss of appetite

headache

nerves become weak or numb (very rare)

rubella can cause congenital rubella syndrome in the fetus of an infected pregnant woman.

Treatment

No specific treatment

MMR Vaccine is effective prevention

Poliomyelitis

infantile paralysis, is a viral paralytic disease.

The causative agent, a virus called poliovirus (PV), enters the body orally, infecting the intestinal wall.

It may proceed to the blood stream and into the central nervous system causing muscle weakness and often paralysis

Meningitis

Meningitis is inflammation of the membranes (meninges) covering the brain and the spinal cord.

Symptms

The classical symptoms of meningitis are headache, neck stiffness and photophobia (intolerance of bright light); the trio is called meningism.

 Fever and chills are often present, along with myalgia.

An altered state of consciousness or other neurological deficits may be present depending on the severity of the disease.

In meningococcal meningitis or septicaemia, a petechial rash may appear.

 A lumbar puncture to obtain cerebrospinal fluid (CSF) is usually indicated to determine the cause and direct appropriate treatment.

Convulsions and hydrocephalus are known complications of meningitis.

Diagnosis

examination of the cerebrospinal fluid

In patients with focal neurological deficits or signs of increased intracranial pressure, a CT scan of the head

Treatment

a broad spectrum intravenous antibiotic should be started immediately , often a third generation cephalosporin

Corticosteroids to relieve brain pressure and swelling and to prevent hearing loss that is common in patients with Haemophilus influenza meningitis

anticonvulsants such as dilantin or phenytoin to prevent seizures and corticosteroids to reduce brain inflammation

Vaccinations against Haemophilus influenzae (Hib) have decreased early childhood meningitis.

Bacterial infectious diseases

Anthrax

- an acute infectious disease caused by the bacteria Bacillus anthracis
- Anthrax can enter the human body through the intestines (ingestion), lungs (inhalation), or skin (cutaneous).

1. Pulmonary (pneumonic, respiratory, or inhalation) anthrax

Respiratory infection initially presents with cold or flu-like symptoms for several days, followed by severe (and often fatal) respiratory collapse.

A lethal dose of anthrax is reported to result from inhalation of 10,000-20,000 spores. This form of the disease is also known as Woolsorters' disease or as Ragpickers' disease.

2. Gastrointestinal (gastroenteric) anthrax

Gastrointestinal infection often presents with serious gastrointestinal difficulty, vomiting of blood, and severe diarrhea. Untreated intestinal infections result in 25-65% mortality.

3. Cutaneous (skin) anthrax

Cutaneous infection often presents with large, painless necrotic ulcers (beginning as an irritating and itchy skin lesion or blister that is dark and usually concentrated as a black dot, somewhat resembling bread mold) at the site of infection.

Treatment

- large doses of intravenous and oral antibiotics, such as penicillin, ciprofloxacin, doxycycline, erythromycin, and vancomycin.
- Antibiotic prophylaxis is crucial in cases of pulmonary anthrax to prevent death.

Cholera

- a water-borne disease caused by the bacterium Vibrio cholerae, which are typically ingested by drinking contaminated water, or by eating improperly cooked fish, especially shellfish.

Symptoms

- general GI tract upset: profuse diarrhea (eg 1L/hour), abdominal cramping, fever, nausea and vomiting.

- Dehydration

- severe metabolic acidosis with potassium depletion, anuria, circulatory collapse and cyanosis

- Death is through circulatory volume shock (massive loss of fluid and electrolytes)

Treatment

- rehydration and replacement of electrolytes

- Tetracycline antibiotics may have a role in reducing the duration and severity of cholera

Diphtheria

- Diphtheria is an upper respiratory tract illness characterized by sore throat, low-grade fever, and an adherent membrane (a pseudomembrane) on the tonsil(s), pharynx, and/or nose

Signs and symptoms

- Incubation time of 1-4 days

- Symptoms include fatigue, fever, a mild sore throat and problems swallowing

- Children infected have symptoms that include nausea, vomiting, chills, and a high fever,

Treatment

- Antibiotics are used in patients or carriers to eradicate C. diphtheriae and prevent its transmission to others

- Erythromycin (orally or by injection) for 14 days (40 mg/kg per day with a maximum of 2 g/d), or

- Procaine penicillin G given intramuscularly for 14 days (300,000 U/d for patients weighing <10 kg and 600,000 U/d for those weighing >10 kg).

- Patients with allergies to penicillin G or erythromycin can use rifampin or clindamycin.

- In more severe cases lymph nodes in the neck may swell, and breathing and swallowing will be more difficult throat may require intubation or a tracheotomy

Pertussis

- Pertussis, also known as "whooping cough", is a highly contagious disease caused by certain species of the bacterium Bordetella—usually B. pertussis

- The disease is characterized initially by mild respiratory infections symptoms such as cough, sneezing, and runny nose (catarrhal stage).

- After one to two weeks the cough changes character, with paroxysms of coughing followed by an inspiratory "whooping" sound (paroxysmal stage)

- Other complications of the disease include pneumonia, encephalitis, pulmonary hypertension, and secondary bacterial superinfection.

- The disease is spread by contact with airborne discharges from the mucous membranes of infected people.

- Laboratory diagnosis include; Calcium alginate throat swab, culture on Bordet-Gengou medium, immunofluorescence and serological methods.

-Treatment of the disease with antibiotics (often erythromycin, azithromycin, clarithromycin or trimethoprim-sulfamethoxazole)

- Vaccination in children as preventive measure . The immunizations are often given in combination with tetanus and diphtheria immunizations, at ages 2, 4, and 6 months, and later at 15–18 months and 4–6 years

Tetanus

Tetanus is a serious and often fatal disease caused by the neurotoxin tetanospasmin which is produced by the Gram-positive, obligate anaerobic bacterium Clostridium tetani.

Symptoms

-The incubation period for tetanus is 3 days to as long as 15 weeks

- For neonates, the incubation period is 4 to 14 days, with 7 days being the average

- The first sign of tetanus is a mild jaw muscle spasm called lockjaw (trismus), followed by stiffness of the neck and back, risus sardonicus, difficulty swallowing, and muscle rigidity in the abdomen.

- Typical signs of tetanus include an increase in body temperature by 2 to 4°C, diaphoresis (excessive sweating), an elevated blood pressure, and an episodic rapid heart rate

Treatment

- Penicillin and metronidazole

- Human anti-tetanospasmin immunoglobulin should be given.

- Diazepam and DPT vaccine booster are also given

Syphilis

- a sexually transmitted disease (STD) that is caused by a spirochaete bacterium, Treponema pallidum

- The route of transmission for syphilis is almost invariably by sexual contact

Stages of syphilis

1.Primary syphilis

Chancres on penis due to primary syphilitic infection

Primary syphilis is manifested after an incubation period of 10-90 days (the average is 21 days) with a primary sore.

During the initial incubation period, individuals are asymptomatic.

The sore, called a chancre, is a firm, painless skin ulceration localized at the point of initial exposure to the bacterium, often on the penis, vagina or rectum.

 Local lymph node swelling can occur. The primary lesion may persist for 4 to 6 weeks and then heal spontaneously.

2. Secondary syphilis

characterized by a skin rash that appears 1-6 months (commonly 6 to 8 weeks) after the primary infection

This is a symmetrical reddish-pink non-itchy rash on the trunk and extremities , nvolves the palms of the hands and the soles of the feet

in moist areas of the body the rash becomes flat broad whitish lesions called condylomata lata. Mucous patches may also appear on the genitals or in the mouth

common other symptoms include fever, sore throat, malaise, weight loss, headache, meningismus, and enlarged lymph nodes

3. Tertiary syphilis

occurs from as early as one year after the initial infection but can take up to ten years to manifest

This stage is characterised by gummas, soft, tumor-like growths, readily seen in the skin and mucous membranes, but which can occur almost anywhere in the body, often in the skeleton

Other characteristics of untreated syphilis include Charcot's joints (joint deformity),

Clutton's joints (bilateral knee effusions).

The more severe manifestations include neurosyphilis and cardiovascular syphilis.

Cardiovascular complications include aortic aortitis, aortic aneurysm, aneurysm of sinus of Valsalva, and aortic regurgitation, and are a frequent cause of death

Syphilitic aortitis can cause de Musset's sign

4.Congenital syphilis

Congenital syphilis is syphilis present in utero and at birth, and occurs when a child is born to a mother with secondary or tertiary syphilis.

Manifestations of congenital syphilis include abnormal x-rays; Hutchinson's teeth (centrally notched, widely-spaced peg-shaped upper central incisors);

mulberry molars (sixth year molars with multiple poorly developed cusps);

frontal bossing; saddle nose; poorly developed maxillae; enlarged liver; enlarged spleen; petechiae;

other skin rash; anemia; lymph node enlargement; jaundice; pseudoparalysis; and snuffles, the name given to rhinitis in this situation.

Rhagades, linear scars at the angles of the mouth and nose result from bacterial infection of skin lesions.

Death from congenital syphilis is usually through pulmonary hemorrhage.

Diagnosis

First effective test for syphilis, the Wassermann test

Rapid Plasma Reagin (RPR) and Venereal Disease Research Laboratory (VDRL) test are not as effective

Newer tests based on monoclonal antibodies and immunofluorescence, including Treponema pallidum haemagglutination assay (TPHA) and Fluorescent Treponemal Antibody Absorption (FTA-ABS) are more specific, but are still unable to rule out non-syphillis Treponomal infections such as Yaws and Pinta.

Microscopy of chancre fluid using dark ground illumination can be extremely quick and effective.

Treatment

first choice treatment for syphilis remains penicillin, in the form of benzathine penicillin G or aqueous procaine penicillin G injections

oral tetracyclines. In patients allergic  to penicillins

Typhoid fever

- Typhoid fever (Enteric fever) is an illness caused by the bacterium Salmonella typhi

Symptoms

After infection, symptoms include:

a high fever from 39 °C to 40 °C (103 °F to 104 °F) that rises slowly

chills

bradycardia (slow heart rate)

weakness

diarrhea

headaches

myalgia (muscle pain)

lack of appetite

constipation

stomach pains

in some cases, a rash of flat, rose-colored spots called "rose spots"

extreme symptoms such as intestinal perforation or hemorrhage, delusions and confusion are also possible.

Diagnosis

Widal test (demonstration of salmonella antibodies against antigens O-somatic and H-flagellar)

Treatment

Antibiotics, such as ampicillin, chloramphenicol, trimethoprim-sulfamethoxazole, and ciprofloxacin, are commonly used to treat typhoid fever in developed countries

Usage of Ofloxacin along with Lactobacillus acidophilus is also recommended.