Why patients in the ICU improve…

محاضرة بعنوان Capnography and its clinical uses

أنشروها للإستفادة

فيديو بعنوان Chest pain on night on call

شاركوا الفيديو..لما فيه من فائدة في التعامل مع حالات ألام الصدر في الطوارئ والمناوبات الليلية

On deeper reflection

Clinical pearl:-

👉Chest X-ray can be negative in 1/3 of patient with pneumonia>> CT- scan chest should be ordered if clinically justified.

👉Chest X-ray can be falsely positive in 1/3 of patient with sepsis>> leads to misleading source of sepsis and delays source control if indicated. Use clinical data to navigate through this.

👉Steroids can have positive outcome in patient with severe community acquired pneumonia who needs ICU admission.

👉Steroids carry a particular benefit in Streptococcal pneumonia if no contraindication.

👉prednisone 50mg daily or hydrocortisone 50mg every 6 hours

👉Steroids do not have mortality benefit but improves outcome and reduce ICU stay.

👉Radiological classification of pneumonia (lobar, bronchopneumonia,interstitial) might not be so accurate but should not be ignored.

👉Cover atypical with (azithromycin or doxycycline) and use beta-lactam antibiotics as:-
-Ceftriaxone if no concern for pseudomonas or MDR.
👉Cover for gram negative and pseudomonas if:-
-structural lung diseases
-previous positive culture for psudomonas or MDR
- immunocompromised or on steroids

-cover with Piperacillin-Tazobactam or Cefepime

👉Cover for MRSA if:-
-high shorr score
-skin infection
-IV drug use
- previous positive culture for MRSA

Cover with Vancomycin or linezolid


👉No Fluoroquinolones in ICU but can be used as outpatient especially if legionella pneumonia is questioned. (Use ciprofloxacin for 7-10 days)

Practical tips:-

👉 during morning round:-

-document everything as much and as accurate as you can..
-write a clear problem based plan for example:-

#acute hypoxemic respiratory failure:-

Assessment:- patient with history of T2 DM and Br asthma who presented with shortness of breath and cough. He found to have SPO2 87% on RA which was improved to 92 % on 6 L Nasal cannula. His initial ABG showed? And his CXR ?

He received back to back salbutamol nebulizer, steroid and magnesium and he was started on BIPAP? and transferred to the ICU for further evaluation and management.

Etiology:-
Most likely AHRF in the setting of acute exacerbation of bronchial asthma. Less likely PE and patient is clinically euvolemic with normal BNP and EF 65%.

Plan:- 1, 2, 3,etc

# Acute exacerbation of bronchial asthma:-
Assessment
Etiology:-

Plan:-1, 2, 3, 4 etc

# HFpEF:-

Assessment:- patient is known case of HFPEF with last echo on 11/2023 (EF 65%)…..
Plan: 1, 2, 3 etc

#T2 DM:-
Plan:-
Insulin sliding scale
Stop metformin etc

#Hypertension:
Plan:- continue/withhold losartan in the setting of AKI


👉these are just examples but the more you write about your thought process the more efficient communication through writing and the better delivery of info to the other teams on other shifts.

👉take this very seriously and spend sometime during notes writing will be translated into a positive patient outcome.



👉avoid writing CST and disappearing

ليس الهدف من التعليم الطبي انتقال المعرفة…بل الهدف إحداث التغيير الفكري والسلوكي للمُتلقي…

من المحتمل أن يكون المتلقي أكثر علما من المعلم ولكنه حتما يحتاج إلى الجودة ليتغير فكره وسلوكه فيُثمر علمه وترتفع جودته…

مرحبا بكم يا أحباب:-


مراحل التعلم أربعة:-

الإنتباه ومشاهدة السلوك⬅️التمثيل الداخلي(استحضار السلوك)⬅️إنتاج المعرفة(نقاشها العمل بها)⬅️التحسين للمعرفة في سياقات مختلفة..( استخدام ما تعلمت في سيناريوهات مختلفة)..

حفظكم الله..

وفي سياقٍ آخر..

العلم ميت…وحياته التعليم
‏فإذا حيي فهو خفي..وظهوره المذاكرة
‏فإذا ظهر فهو ضعيف…وقوته المناظرة
‏فإذا قوي فهو عقيم..وثمرته العمل

(ينادي العلم أين العمل فإن أجابه وإلا ارتحل)

‏*الرجراجي ٦٣٣هـ

السلام عليكم:-

أول خطوة في حل المشكلات هو:-

الشعور بالمشكلة…

حفظكم الله..

بدأت بتنزيل سلسلة الNeurology على قناة اليوتيوب من جديد بعد أن فقدناها من القناة السابقة لأسباب فنية..

👇

https://youtu.be/MBo5LiUsJUQ?si=-W3NkLQL7TSB6c6V

هناك شهادة للخبرة (يسهل الحصول عليها)..وهناك شواهد للخبرة (يصعب الوصول إليها)..

أرِنا شواهد خبرتك..لا شهادة خبرتك..

الفشل الإيجابي..Failing Forward..

الفشل الذي يبني نجاحا..

كيف؟
بتقبله والتأمل فيه وإصلاح الأخطاء والمحاولة من جديد..

Mesenteric ischemia:-👇

👉Four types:- embolic/thrombotic/venous/non-occlusive.

👉Context is a key

👉Acute onset abdominal pain out of proportion to clinical exam

👉usually misdiagnosed as gastroenteritis as patients usually have nausea, vomiting and diarrhea. Think 10 times before diagnosing patients especially elderly with gastroenteritis

👉Lactate persistently high despite IV fluid resuscitation🧐

👉order CTA abdomen (not CT abdomen with contrast)


👉6 As for management of mesenteric ischemia➡️

👉Aggressive fluid management➡️ these people have lost a lot of fluids because of third spacing and volume loss..(10 L in 24 hours is very common)..you should manage the hemodynamics with fluid as able because we want to avoid
vasopressors


👉Antibiotics➡️ enteric covering antibiotics Ceftriaxone plus Flagyl

👉Anticoagulation➡️ unfractionated Heparin
👉Analgesia➡️

👉Avoidance of vasopressors by all means and keep them last resort for resuscitation

👉All the help➡️ General surgery or Interventional radiology. (It is not unreasonable if you call them before the result of the imaging)

👉In addition➡️nasogastric tube for bowel decompression

Best of luck