7. 2 Iftl1ere was improvement and no other sign or symptom developed, advice the patient to continue the above management for at least five more days. 7. 3 If there were no improvement, ask the patient if any new symptom had developed since the last visit; if any red symptom has developed, do the following :. 7. 3. 1 examine the patient for any red signs which could have developed since the patient's last visit. 7. 3. 2 proceed with either Plan B or Plan C depending on the presence or absence· of red signs or symptoms. 7. 4 If there were no. improvement and no new sign or symptom had developed since the last visit, proceed with Plan B. PLAN B: 1,0 Refer the patient to a doctor within 24-48 hours. 2,0 Advice the patient to do the following supportive management: 2. 1 stop smoking or avoid exposure to smoke; 2. 2 avoid crowded places; 2. 3 drink plenty of water and juic. e but not caffeine or cola-containing drinks; 2-4 have steam inhalation for 10-15 minutes as often as the patie. nt likes; there is no need to add anything to the v,1ater; 2. 5 drain mucus from the lungs by postural drainage following the procedure described section 3. 5 in Plan A; 2. 6 continue taking the antihypertensive medicine until patient is seen by the doctor; 2. 7 continue taking the medicine for ulcer until patient is seen by the doctor; 3. 0 Provide the doctor with the necessary clinical record or referral note containing the brief history of the disease, pertinent physical examination findings result of laboratory examination (if available) and initial management started at the referring level. (see Figure 3. 2 for a sample referral fom1) Plan C: 1. 0 Refer the patient immediately to a hospital, preferably the nearest one. 2. 0 Make the patient as comfortable as possible. 3. 0 If the patient coughed out large amount of blood, do the flowing: 3. 1 give tranexamic acid by mouth if patient is no longer vomiting or vitamin K preparation by parenteral route if available and patient is not in a position to take anything per orem; 3. 2 place ice on the patient's chest. 4. 0 Provide the doctor with the necessary clinical record or referral note containing the brief history of the disease, pertinent physical examination findings result of laboratory examination (if available) and initial management started at the referring level. (see Figure 3. 2 for a sample referral form) 393 