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مثال بسيط أخبرته بأن يعتبر نفسه كلينك فارمسي ويلخص لي الادوية التي تاخذ ع معده فارغه ثم طلبت منه وضعه ع شكل pdf

#remember
✅Arterial Blood Gas (ABG)

✅Arterial blood gases should be used for assessing respiratory failure in Critically ill Patients or those with Shock or Hypotension (Systolic blood pressure < 90mmHg)

(British Thoracic Society, 2017)

🛑 pulmonary embolism and Chest X-ray

✅usually normal in PE😁
✅Should be performed in all patients with symptoms or signs suggestive of PE➡️ to exclude other pathology

#Not and Note

🛑ABG Use in

1 🛑. Evaluation of Oxygenation:

✅Determine arterial oxygen (PaO₂) levels in conditions like hypoxemia or respiratory distress.

✅Assess response to oxygen therapy or mechanical ventilation.

2.🛑 Assessment of Ventilation:

✅Monitor arterial carbon dioxide (PaCO₂) levels in respiratory failure, COPD, or hyperventilation syndromes.

🛑3. Acid-Base Imbalance:

✅Diagnose and monitor metabolic or respiratory acidosis/alkalosis in conditions like diabetic ketoacidosis, renal failure, or sepsis.

🛑4. Monitoring Critically Ill Patients:

✅Track changes in pH, PaO₂, and PaCO₂ during severe illness, trauma, or after major surgery.

#remember

✅  improving glycemic  control reduce microvascular complications but this has no significant impact upon cardiovascular morbidity and mortality.

✅lowering blood pressure significantly reduced morbidity from both microvascular and macrovascular disease.

#Not and Note

🛑Heparin and thyroid function test

✅ Heparin is having an "in vitro" effect on thyroxine (T4) levels.

✅IV heparin interferes with the thyroid function tests assay on occasions displacing bound thyroid hormone.

✅ Normal TSH + high T3 and T4
#Not and Note

#remember

🛑Tricyclic overdose ➡️ give IV bicarbonate

#Not and Note

🛑Management

✅Check U&Es, looking specifically for hypokalaemia, and ABG looking for acidosis.

✅Hypokalaemia should be corrected. ECG should be done to assess the QRS interval.

✅Gastric lavage should only be considered if it is within one hour a potentially fatal overdose.

✅50 g of charcoal can be given if it is within one hour of ingestion.

✅50 ml of 8.4% sodium bicarbonate should be given if the pH is less than 7.1, QRS interval is more than 0.16 s, or there are cardiac arrhythmias or hypotension.

✅Indication for sodium bicarbonate in tricyclic poisoning includes wide QRS complex.

✅Intravenous sodium bicarbonate is the standard initial therapy for patients who develop cardiotoxicity (usually a QRS > 100ms or a ventricular arrhythmia) as a result of tricyclic antidepressant (TCA) overdose.

✅Mechanism of Sodium bicarbonate action:

✅alkalinisation of blood to a pH of 7.45-7.55 uncouples TCA from myocardial sodium channels;

✅also, additional sodium increases extracellular sodium concentration, thereby improving the gradient across the channel.

✅ Intravenous magnesium sulphate can be used as a second-line agent in refractory arrhythmias.

#Not and Note

#سؤال
تحبوا نرجع نشرح المواضيع على شكل فيديو مصور نفس ماكنا من قبل او كتابية فقط؟

نموذج اخر موضوع شرح على شكل فيديو

#remember
🛑Klebsiella pneumoniae

➡Classically occurs in alcoholics (Friedlander's pneumonia) and immunosuppressed individuals

➡can cause cavitating pneumonia

✅usually affects the upper lobes

✅Chest x-ray features may include abscess formation in the middle/upper lobes and empyema.

✅The mortality approaches 30-50%.
🛑Treatment

✅Community-acquired K. pneumoniae pneumonia quinolones third-generation cephalosporins or

✅Extended-spectrum beta-lactamase (ESBL) K. pneumoniae carbapenem therapy

#Not and Note

🛑رجاله ال ceftriaxone prophylaxis حصلنا لكم استخدام يبرر الاستخدام العشوائي لهذه الدواء ك وقاية 😂

#New ( August 2024)

Ceftriaxone for pneumonia prevention in ventilated patients with acute traumatic brain injury
●For patients with moderate-to-severe traumatic brain injury who require mechanical ventilation, we recommend a single dose of ceftriaxone (2 g intravenously) within 12 hours of intubation (Grade 1B).

#UPTODATE2024

#New ( September 2024)

🛑Treating Patients Who Have Helicobacter pylori Infections

✅Key Recommendations

✅Because of the association of chronic H. pylori infection with gastric malignancy, all patients who test positive should be treated.

✅For a patient with a first infection, the preferred regimen is a 14-day course of a bismuth salt, metronidazole or tinidazole, tetracycline, and a proton-pump inhibitor (PPI). A 10-day course is no longer considered to be adequate, and substitution of doxycycline for tetracycline weakens the regimen. Alternative regimens include a rifabutin-based combination or combinations using a novel potassium-competitive acid blocker (vonoprazan; NEJM JW Gen Med Jun 15 2024 and Clin Gastroenterol Hepatol 2024 May 13; [e-pub]) rather than a PPI.

✅A treated patient should undergo a test of cure at least 1 month after treatment with a breath test, fecal antigen test, or tissue-based test.

✅Salvage treatment options for patients with persistent infections include the four-drug preferred regimen above (for those who either did not receive it exactly according to recommendations or did not receive it at all) or clarithromycin- and rifabutin-based alternatives.

✅No good data yet quantitate the overall costs and benefits of routine susceptibility testing to tailor drug choices. However, clarithromycin and levofloxacin should not be used for either primary or salvage treatment without demonstrated susceptibility, and susceptibility testing also is advised when choice of salvage therapy is unclear.


#NEJM Journal Watch2024

#موضوع_مهم
🛑بخصوص معالجة ارتفاع ضغط الدم في المريض المقيم في المستشفى أو مايسمى (Asymptomatic elevated inpatient BP)
✅مش بمجرد تقيس ضغط دم المريض وتشوفهSBP/DBP ≥180/110 mm Hg)  بدون  دليل على وجود target-organ damage تروح تعطيه حقنه لازكس او اي parenteral antihypertensive  او انك تزيد من جرعه دواء الضغط الفموي الذي كان ماشي عليه المريض قبل دخوله المستشفى( يعني مشخص ان لدية ارتفاع ضغط الدم ) لانه ممكن يزيد من adverse outcomes

✅هناك توصيات قبل اتخذ قرار باعطاء دواء لمعالجة ارتفاع ضغط الدم (Asymptomatic elevated blood pressure
✅اولا  تأكد بأنه تم قياس ضغط الدم للمريض بشكل صحيح
Accurate BP assessment: Assure that the BP cuff is the a ppropriate size for the patient.

✅تأكد من عدم وجود اسباب reversible لارتفاع ضغط الدم مثل stress او pain او اضطراب في النوم ..الخ
Identify and manage reversible causes of inpatient elevated BP (e.g., stress, pain, sleep deprivation, withdrawal from alcohol or recreational drugs

✅ايقاف او إنقاص من جرعه الادوية التي قد تساهم في ارتفاع ضغط الدم مثل المحاليل الوريدية  او مسكنات NSAIDs  او corticosteroids


✅في حاله قررت أن تبدأ بمعالجه ارتفاع ضغط الدم (Asymptomatic elevated blood pressure فقوم بإعادة ادوية الضغط الفمويه التي كان ماشي عليها المريض قبل دخوله المستشفى وبدون رفع الجرعه ،في حاله كان المريض لم يشخص بارتفاع الضغط الدم المزمن من قبل قد ياجل ذلك حتى زياره المريض أخصائي القلب
 If the patient was not on prior BP medications, the decision whether to start oral BP medications during the hospitalization (vs. deferring this decision to outpatient follow-up) should be individualized.


#NEJM Journal Watch 2024

✅Recent evidence suggests that asymptomatic patients with elevated blood pressure (BP) in the hospital are at risk for adverse outcomes with use of parenteral antihypertensive agents or up-titration of oral agents during the inpatient stay. 


✅Key Recommendations


🛑Asymptomatic elevated inpatient BP

✅Accurate BP assessment: Assure that the BP cuff is the appropriate size for the patient.

✅Identify and manage reversible causes of inpatient elevated BP (e.g., stress, pain, sleep deprivation, withdrawal from alcohol or recreational drugs).

✅Stop, limit, or reconsider medications that might contribute to elevated BP (e.g., intravenous fluids, nonsteroidal anti-inflammatory drugs, corticosteroids, stimulant medications).

✅Avoid treatment of asymptomatic elevated inpatient BP (including asymptomatic markedly elevated BP, i.e., SBP/DBP ≥180/110 mm Hg) in most situations.

✅If choosing to treat markedly elevated inpatient BP without evidence of target-organ damage, start by resuming the patient's home oral BP medications. If the patient was not on prior BP medications, the decision whether to start oral BP medications during the hospitalization (vs. deferring this decision to outpatient follow-up) should be individualized


✅Hypertensive emergency

Defined as markedly elevated BP (systolic/diastolic, ≥180/110 mm Hg) with evidence of new or worsening target-organ damage. Target-organ systems include brain (e.g., stroke, cerebral hemorrhage, hypertensive encephalopathy or posterior reversible encephalopathy syndrome [PRES]), arteries (e.g., aortic dissection, preeclampsia, eclampsia, HELLP [hemolysis, elevated liver enzymes, low platelets] syndrome), retina (e.g., acute hypertensive retinopathy), kidneys (e.g., acute kidney injury, thrombotic microangiopathy), and heart (e.g., acute coronary syndrome, acute heart failure, pulmonary edema) — denoted by the mnemonic BARKH

#NEJM watch 2024

🛑Vitamin D  supplements

✅When supplementation is given, low daily doses are recommended (rather than high doses given at intervals such as weekly or monthly), because evidence suggests some adverse effects with intermittent high dosing.

#NEJM watch 2024

🛑Mycoplasma pneumonia

✅Indolent onset, concurrent
URI symptoms (eg, rhinorrhea, pharyngitis, ear ache), and the presence of non-respiratory tract manifestations (eg, hemolysis) are suggestive Mycoplasma pneumoniae

✅WBC can be normal

✅Mycoplasma pneumoniae ➡️Serology is diagnostic
#Not and Note