السلام عليكم
منشور موقت
سوف أستقبل أي أستفسار طبي بشكل عام أو أي مساعده على حسابي هذا
@m_rassam

🛑protocol of fresh frozen plasma transfusion
✅reversal warfarin effect in present of major bleeding

✅ DIC with bleeding target platelets above 50000
above 100000 if there is central nervous system bleeding

✅periopertive transfusion in present of major bleeding

🛑prophylactic use pre procedur⬇️
✅ surgery involving crtical sites (brain ,eye) Transfusion trigger 100000

✅if platelets less than 10000
✅patients with platelet 10000_20000 with additional risk factors ex sepsis
#salah

#Remember
🛑about hypovolaemia with AkI
✅Fluid should be given in bolus 250_500ml over 20_ 30min
✅fluid should be given until hypovolaemia is corrected and Not until AKI is resolve
✅do not add maninntince fluids in patients with Oliguria except after increas in urine output

✅don't give fluids without looking to the status of the lung


✅لو حابين نشرح موضوع hemodynamic treatment in AkI مع حالات
✅Aki+ gastrointestiits
✅Aki + liver Cirrhosis
✅AkI CHf
✅Aki + urosepis

لبكره ان شاءالله
#Salah

🛑Which Vasopressor use?

✅–In patients with vasoplegic shock especially #septic shock, norepinephrine should be the first-line vasopres- sor of choice
✅–In children, however, epinephrine may be considered as the first-line agent because of issues related to vascular access (as extravasation of norepinephrine from periph- eral intravenous access can cause more tissue damage in children).
✅–Vasopressin or epinephrine can be added as the second- line agent in non-responsive patients
✅ Vasopressin infusion should perhaps be started early (within 6–12 h of septic shock onset) and at a lower norepinephrine dose (<15 mcg/min)

✅Dopamine should only be used in patients with brady- cardia and hypotension

🛑 In patients with cardiogenic shock, norepinephrine
should be the first-line vasopressor

🛑In patients with hypovolemic and haemorrhagic shock, focus should be on correction of volume deficit and haemostatic resuscitation respectively PLUS correction of underlying defect.

✅. Vasopressor infusion should be started only in life-threatening hypotension. Again, norepinephrine should possibly be the first-choice agent.

#salah

Handbook of Intravenous Fluids 2022

#Remember
In treatment hypokalemia with oral or Iv KCl hold treatments if SCr >= 2 mg/dL
#salah

حوالي 85% من مرضى CHF يخرجوا من المستشفى ومازال هناك congestion يعني فقط 15% يكونوا eupvolemic لذا قبل اعطاء recommendations بان loop diuretics لايستخدم ك chronic use تذكر القيمه ذي👀
#ESC
#salah

نذكر انه ما فيش mortality benefits ل الاستخدام الطويل ل ادويه loop diuretics ولكن قد نعطيها اذا مازال في congestion symptoms او ف حاله رجوع اعراض congestion بعد ايقاف الدواء 😁
#ACCp

✅في دراسه حديثه اسمها GRADE
✅كانت بعنوان After Metformin, Which Medication Should Be Next for Patients with Type 2 Diabetes? (يعني في مريض السكري النوع الثاني بعد استخدام metformin ماهو الدواء المناسب الذي نضيفه )

✅قارنت بين اربع عائلات مختلفه من ادويه السكر
✅insulin(glargine)
✅GLP-1 receptor agonists(liraglutide)
✅sulfonylureas(glimepiride)
✅ DPP-4 inhibitors(sitagliptin)

✅وتابع المرضى خلال خمس سنوات فكانت النتائج كالاتي

✅A minority of patients in all groups had HbA1c values consistently lower than 7.0%. More patients who took liraglutide (32%) or glargine (33%) maintained HbA1c <7.0%, compared with those who took glimepiride (28%) or sitagliptin (23%).
✅يعني المرضى الذين اخذوا glargine insulin و liraglutide كان السكري التراكمي وصل الى اقل من 7%

✅Severe hypoglycemia, although rare, occurred most frequently in patients taking glimepiride (i.e., in 2.2% of glimepiride users vs. ≈1% of other groups).
✅ انخفاض السكري Hypoglycemia نادر في جميع المجموعات لكن كان يحصل بشكل متكرر في المرضى الذين اخذوا glimepiride

I✅ncidences of major adverse cardiovascular events (MACE; i.e., nonfatal myocardial infarction, stroke, or death from cardiac cause), hypertension, dyslipidemia, albuminuria, or peripheral neuropathy were similar among groups.
✅اما حدوث major adverse cardiovascular events كانت متقاربه بين جميع المجموعات

✅Incidence of any adverse cardiovascular event (i.e., MACE, unstable angina or heart failure requiring hospitalization, and revascularization) was less common with liraglutide: 6.6% of liraglutide users, compared with 9% of patients in other groups (number needed to treat with liraglutide for 5 years to prevent 1 event, ≈40).
✅بينما حصول اي any adverse cardiovascular event كانت اقل في المرضى الذين اخذوا دواء liraglutide

✅مختصر الدراسه
✅Liraglutide produced modestly better cardiovascular outcomes and equivalent or better glycemic results, whereas glimepiride was slightly less safe than the other medications*

✅لكن بنفس الوقت يجب اخذ cost بعين الاعتبار عند اختيار دواء نضيفه الى metformin
خاصه في فرق كبير في السعر بين glimepiride و liraglutide
#salah

#تذكر
✅بنسبه لجرعه Amlodipine في معالجة ارتفاع ضغط الدم نبدا غالبا ب 5 ملجم وممكن نرفع الى 10 ملجم مره في اليوم
✅لكن لو كان مريض عنده تليف كبدي او عمره فوق 65 سنه نبدا ب 2.5 ملجم
#martindale
#Lexicomp
#Salah

✅هنا يوضح لنا بان piperacillin-tazobactam افضل من carbapenem اذا كانت العدوى المسببه هي Pseudomonas ,لكن في حالة وجود ESBLs ايضا هنا قد نفضل carbapenem

#IDSA