🛑OPIOID ANALGESICS in treatment pain in critically ill  adult patients

✅Patients with bronchospasm – For patients with known or active bronchospasm, fentanyl or hydromorphone is preferred rather than morphine because little histamine is released by these synthetic opioids


✅Patients requiring fluid restriction – Hydromorphone may be useful in fluid-restricted patients with high opioid requirements since it is available in a highly concentrated preparation (10 mg/mL)

✅Patients with hemodynamic instability – For patients with hemodynamic instability, we use shorter-acting agents such as fentanyl rather than morphine, which has a slightly longer duration of action. Morphine also causes more histamine release, which can exacerbate hypotension.

✅Patients with renal and/or hepatic insufficiency – For critically ill patients with renal and/or hepatic insufficiency, we typically select intravenous fentanyl or hydromorphone, with dose adjustments as needed.
Morphine should be avoided due to its renal clearance.

✅In patients with severe multiorgan failure, remifentanil is occasionally selected because its metabolism is not dependent on renal or hepatic function


#UPTODATE2025

🛑NSAIDs analgesics and AKI

✅NSAID use in at-risk patients – We avoid systemic NSAIDs for pain or inflammation in patients with the following:
•✅Volume depletion
•✅Nephrotic syndrome
•✅Heart failure
•✅Cirrhosis
•✅Hypercalcemia

#UPTODATE2025

🛑sulfamethoxazole/trimethoprim and hyperkalemia

✅Hyperkalemia may occur with sulfamethoxazole/trimethoprim and be life threatening  usually reversible following discontinuation

 ✅Hyperkalemia may occur with sulfamethoxazole/trimethoprim and be life threatening  usually reversible following discontinuation 

✅Onset: Varied; usually occurs within 5 to 10 days after sulfamethoxazole/trimethoprim is initiated

✅Risk factors:
• High doses (trimethoprim 20 mg/kg/day)
• Kidney impairment
• Older patients
• Hypoaldosteronism
• Concomitant use of medications causing or exacerbating hyperkalemia

#UPTODATE2025

🛑SGLT2I inhibitors drugs and surgery

✅Sodium-glucose cotransporter 2 (SGLT2) inhibitors – SGLT2 inhibitors (eg, empagliflozin, dapagliflozin, canagliflozin, ertugliflozin, bexagliflozin) should be stopped three to four days before surgery

✅ These agents increase the risk of urinary tract infections and hypovolemia

#New
🛑ATS/CDC/IDSA recommendations on management of drug-susceptible and drug-resistant tuberculosis (TB)

✅A 4-month regimen (2 months of isoniazid, rifapentine, pyrazinamide, and moxifloxacin ➡️followed by 2 months of isoniazid, rifapentine, and moxifloxacin [2HPZM/2HPM])
✅ is generally as safe and efficacious as a 6-month regimen (2 months of isoniazid, rifampin, pyrazinamide, and ethambutol followed by 4 months of isoniazid and rifampin [2HRZE/4HR]) for isoniazid- and rifampin-susceptible pulmonary TB in those aged ≥12 years.

#NEJM watch guidelines 2025

Diabetes and Ramadan: Practical guidelines 2021

1-s2.0-S0168822721005453-main1.pdf

critical care essential therapeutics للدكتور خالد محمد علي كتاب شامل ومفصل للأدوية الضرورية بالرعاية الحرجة ويعتبر هاذا الكتاب هو رفيق أساسي لجميع فرق العناية المركزة؛ الفرق الطبية وفرق الطوارئ والجراحة التي تتعامل مع الأمراض الحرجة والمنقذة للحياة وعلاجاتها الأساسية. الكتاب غني بجميع الأدوية الأساسية والتطبيقات السريرية المستخدمة في إدارة الأمراض الحرجة والطارئة المختلفة والإجراءات الحرجة الأساسية التي يتم شرحها في مناقشات بسيطة للغاية ورسوم توضيحية للملصقات

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#Clinical_Notes

🛑Managing Portal Vein Thrombosis in Patients with Cirrhosis

🛑Who should receive anticoagulation:

✅A patient with intestinal ischemia requires emergent anticoagulation and should be managed by a multidisciplinary team if available.

✅A patient with a recent PVT (<6 months) that is >50% occlusive or involves the main portal vein or mesenteric vessels (particularly if more than one vascular bed is involved), a patient who is a liver transplant candidate, or a patient in whom thrombus has progressed.

🛑Who should not receive anticoagulation:

✅A patient with recent thrombosis (<6 months) involving the intrahepatic portal vein branches or with <50% occlusion of the main portal vein, splenic vein, or mesenteric veins. (However, follow-up computed tomography or magnetic resonance imaging every 3 months is required, and anticoagulation should be started if symptoms develop, the patient becomes a liver transplant candidate, or clot progression occurs.)



✅Vitamin K antagonists, low-molecular-weight heparin (LMWH), and direct-acting oral anticoagulants all can be used in patients with Child-Pugh class A/B cirrhosis. Only LMWH should be used in patients with class C cirrhosis

✅Patients who are receiving anticoagulation should undergo CT or MRI every 3 months, and anticoagulation should be continued if partial improvement is seen.


#NEJM watch guidelines 2025

🛑Should not fast

✅Poorly controlled hypertension (as defined by your specialist)
✅ Recent acute coronary syndrome / myocardial infarction (<6 weeks)
✅ Hypertrophic Cardiomyopathy with obstruction
✅ Severe valvular disease 
✅ Severe heart failure without advanced features 
✅ Poorly controlled arrhythmias (as defined by your specialist)
✅   High risk of fatal arrhythmias (e.g. inherited arrhythmic syndromes, arrhythmogenic cardiomyopathy)
✅ Implantable cardioverter defibrillator +/- cardiac resynchronisation therapy

بالنسبه للاستاتين
اذا كان لم يستخدم او ماشي من قبل ب جرعه قليل او متوسط ف يجب إعطائه نعطيه جرعه عاليه
High intensity
وبتوصيه اقل ممكن نضيف دواء اخر
Non intensity
اعادة المتابعه بعد 6-8 اسابيع
اما اذا كان بالجرعه العاليه هنا فيه عدة خيارات
اذا اقل من 55 نستمر بنفس الجرعه اما اذا كان ما بين 56 -69 فهنا نضيف دواء اخر من غير العائله لكن التوصيه هنا اقل كانت class 2a
اما اذا كثر من 70 هنا نضيف دواء اخر ايضا لكن التوصيه هنا كانت
Class 1

سلسله تحديثات جديده في الجايدلاين الامريكي 2025
2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes:

Hs-cTn preferred cardiac biomarker;
هو مؤشر حيوي مفضل للقلب عند استخدامه يمكن تكراره بعد 1-2 ساعة مقارنة بـ 3-6 ساعات للتروبونين التقليدي