1. Patient who complain of pain in the chest or have painful and swollen joints should be advised rest.
2. If the pain is localized, giving the part rest will be helpful.
3. Local heat (hot water bag of hot water bottle) gives relief from pain due to local infection, such as boils or abscess. In order to prevent a burn while applying heat, place a piece of cloth between the bottle and the skin.
4. Acute abdominal pain accompanied by vomiting and stiffness (hardness) of the abdominal muscle must be referred to the doctor immediately.
5. In all other abdominal pains, advise the patient to avoid spices and chillies in the food.
   Sometimes patients suffering from pain neglect their diet, in such cases, ensure adequate food and water intake. Do not starve the patient

1. Acute chest pain, particularly in elderly people, should be referred immediately.
2. Acute abdominal pain, when accompanied by vomiting and stiffness (hardening) of abdominal wall should be referred immediately.
3. Pain due to severe injuries (fracture of open wounds).
4. Eye pain and ear pain.
5. Any severe pain.
6. Pain persisting for more than 3 days.
   Headache associated with vomiting, paralysis, mental change, high blood pressure of change in consciousness

1. Do not use aspirin to treat abdominal pain.
2. Do not use aspirin to treat pain associated with abdominal symptoms such as nausea, vomiting and pain.
3. Do not repeat codeine frequently as it may cause constipation.
4. Avoid atropine in patients older that 60 years of age as it may cause  eye or urinary problems, and aspirin in children below 12 years of age suffering from chickenpox or influenza.
5. Refer the patient with abscess for surgery.

Fever is often a symptom of infectious diseases and may be a valuable guide to know the severity of the disease. Mild cases need no immediate treatment with drugs.

ORS- bicarbonate
Sodium chloride         3.5 g
Sodium bicarbonate   2.5 g
Potassium chloride     1.5 g
Glucose                     20.0 g

1. If a patient gets sudden fever in a place where malaria is known to occur, take a blood smear for examination for malaria parasites.
2. Advice rest in bed as long as there is fever.
3. Give plenty of fluids, such as plain water (preferably boiled and then cooled), rice water, vegetable soup, buttermilk, milk, weak tea or coffee, coconut water or lime juice. Sugar and salt may be added to taste.
4. Meals should be light. Avoid food that is spicy, pungent or excessively oily. Do not starve the patient.
5. If the patient is uncomfortable because of fever, bodyache or headache, give aspirin or Paracetamol 3 times a day.
6. If the armpit temperature is more than 39.5°C or if the patient is delirious because of high fever, give sponge with tepid water. Remove all clothes except underwear. Sponge with a cloth the entire body, part by part, with water at room temperature (not very cold). Do not dry the skin. The water will evaporate and cool the body.
7. In case of fever associated with sore throat and pain, advice repeated gargling with warm water containing common salt; add one teaspoonful of salt to a glass of warm water.

Used properly, it is quite safe

1. Fever of acute onset which does not respond to treatment in 2-3 days.
2. If the patient is very ill, too weak even to eat and drink, or is dehydrated.
3. If the patient talks incoherently, does not recognize people, is drowsy or unconscious, or has convulsions.
4. If the patient complains of marked headache and has attacks of vomiting of signs of stiffness of neck.
5. All fevers with a duration of more than 7 days or occurring intermittently. Remember that tuberculosis commonly presents ass an irregular fever.
6. If a child has fever, cough, rapid breathing and chest indrawing give oral penicillin and refer to the doctor immediately. Similarly, children with difficulty in breathing and face discoloration should be referred immediately.

1. The solution should be prepared fresh every day using a clean utensil and spoons and after washing the hands thoroughly. It should be kept      covered in a cool place.
2. During ORS administration, measure the amount of urine passed. A patient who has received adequate amounts of ORS will pass the normal amount     of urine daily. Failure to increase urine output suggests a need for administering more ORS. Continue ORS therapy till the diarrhoea stops or the     patient is referred to the doctor.
3. If ORS packets are stored at high temperature (more than 30° C) and high humidity for a long time, the product is likely to cake. It can still be used     provided it dissolves completely in water. If the ORS has turned to a brown colour it should not be used.
4. All cases of moderate or severe dehydration should be started on ORS fluid as mentioned above and referred to the doctor.
5. Educate the families and encourage them to begin giving ORS – either complete formula or sugar and salt – on their own.

1. When aspirin is used, it must be given with plenty of water and after food.
2. Before giving sulphonamide, co-trimoxazole or penicillin, enquire whether the patient has ever had a reaction, such as skin rash, itching, or joint pain following such drugs. In such cases avoid the possibly offending drug.
3. Watch the patient for any reactions following sulphonamide, co-trimoxazole or penicillin. Stop the drug if signs such as rash, itching or urticaria occur.
   Do not give purgatives such as castor-oil. If the patient is constipated, advice glycerine suppository in children or simple enema in adults

Most types of cough do not require drug treatment. Basically, cough cleans the windpipe by throwing out the irritating material which may reach it from outside or is produced locally. This is necessary for preventing mechanical obstruction to breathing. Therefore, cough is a friend and not a foe. The common respiratory irritants are – fumes, cigarette or bidi smoke, dust particles, pollens from flowers, and germs. Some of these also give rise to allergy and cough. The commonest cause of transient cough is common cold or influenza.

1. Avoid respiratory tract irritants such as smoke, chemicals, dust and cigarettes.
2. Avoid cold and dry air. A warm room with a humid atmosphere is beneficial.
3. Simple steam inhalation and warm drinks bring relief.
4. Patients should take a good amount of fluids.
5. In case of cough with plenty of sputum, encourage the patient to cough voluntarily from time to time.
   Remember, saliva is the best natural soothing agent for an inflamed throat and it can easily be increased by keeping a sugar candy or lemondrop in the mouth

1. Any cough that does not respond to therapy within 4-5 days.
2. Cases of productive cough referred to above and children with whooping cough.
3. If the patient looks ill, has difficulty in breathing, or is blue (cyanosed).
4. Persistent cough in cigarette or bidi smokers.

1. Ephedrine may cause palpitation. Avoid it in patients with known heart disease or high blood pressure. It may also cause retention of urine in old people.
2.  Chlorpheniramine, if used excessively, causes drowsiness and drying of respiratory secretions.
3. Do not use antibiotics or sulphadimidine or co-trimoxazole in patients with cough due to common cold or influenza. In such cases cough is self-limiting and the drugs have no action against the organisms causing the disease.