ندي للمريض ٤ حبات Aspirin أبو 75mg يعني 300mg نطحنهن لو ماقدر أو حتى بالـ NGT
و ٤ حبات Clopidogrel نفس الجرعة، لكن في الـ Guidelines ندي له ticagrelor 180mg PO أحسن.
ندي له Morphin 5- 10 mg IV
ندي له Metocloperamide
ندي له Sublingual nitrates أو IV nitrate لو مستمر الـ pain.
ندي لها Metoprolol أو bisoprolol،لكن لو ممنوع كما في الـ asthma ندي CCB مثل verapamil 80–120mg/8h PO.

وبعدا نشوف لو شي PCI متوفرة خلال ٩٠ "١٢٠" دقيقة كان بها. المهم خلال ١٢ ساعة ممكن.
لو مش متوفرة ندي  له tPA لو مابش ممنوعات له، وهذا مايفعلوه عندنا.

إذا يعني الـ PCI متوفرة وسويناها خلال الـ٩٠ أو ١٢٠ دقيقة، ندي له معها:
PCI + GP IIb/IIIa receptor antagonists IV,as Eptifibatide ,Abciximab.
وبعدا في المستشفى يستمر على:

Maintenance in-hospital medication:
-Aspirin
-Clopidogrel
-Statin
-BB
-ACEI.

#Medicine

Fractures names.

#Surgery

Ml (STEMI/NSTEMI) is defined by evidence of myocardial necrosis and is diagnosed by arise/fall of serum markers plus anyone of :

1-Symptoms of ischemia (chest/upper extremity /mandibular/ epigastric discomfort: dyspnea)
2-ECG changes (ST-T changes, newBBB, or pathological Q waves).

3-Imaging evidence (myocardial loss of viability, wall motion abnormality ,or intracoronary thrombus).

-If biomarker changes are unattainable, cardiac symptoms combined with new ECG changes is sufficient.

-STEMI meets criteria for Ml characterized by ST elevation or new BBB.

-NSTEMI meets criteria for Ml without ST elevation or BBB.

-Toronto notes
#Medicine

PCI " the stent of life".

- Major advantages over thrombolytics:
1-Higher reperfusion rates (greater han 90% success rate of opening the occluded artery)
2-Decreased incidence of stroke
3-More effective than thrombolytics in patients with acute decompensated heart failure, cardiogenic shock, and prior bypass surgery.

Terminology:
-Primary PCI:
Patient with STEMI is taken directly to the catheterization lab for PCI instead of receiving thrombolytics.
- Rescue PCI:
Urgent PCI after failure to reperfuse with thrombolytics.
- Pharmacoinvasive PCI:
PCI after reperfusion with thrombolytics.

#Medicine

Give low flow oxygen only if SaO2 <90% or the patient is breathless.

Plain X-ray in Acute appendicitis:

May show the following:
-Lumbar scoliosis towards right due to psoas spasm which is not uncommon
-Faecolith on the right side;
-Obliteration of preperitoneal fat line due to retrocaecal appendicitis;
-Segmental ileus in caecum and terminal ileum
-Speckled extraluminal gas in right iliac fossa, gas in appendix,
-Pneumoperitoneum (very rare);
-Intestinal obstruction (occasionally only);
-Soft tissue mass in mass or abscess of appendix.

all these features are very much nonspecific. X-ray is useful to rule out DU perforation, intestinal obstruction, ureteric stone.

Also Radio-opaque appendix in a plain X-ray. It could be calcified or have calcified content.

د. فواز عمران يحب يسأل فيهن.

#Surgery

Differences between mass and abscess of appendix.

#Surgery

Some fractures the may heal without immobilization:

-Rib
-Scapula
-Clavicle.

#Surgery

Umblical and Para-umblical hernia.

-Imp.
#Surgery

Remember:

-All causes of CKD cause anaemia Except polycystic kidney disease& Renal cell carcinoma which cause polycythemia due to excess erythropoietin secretion.

#Nephrology

Nerve supply of Appendix:

- T10 supplies the peritoneal coverings of the appendix, so reffered appendicular pain is felt at the umbilicus.

#Surgery

Descent of the Testes:

- At the 6th month of the intrauterine life, they lie at the internal inguinal rings(common site for undescended testis).

- At 7th month they go through the inguinal canal.

-At 8th month they lie at the external inguinal rings or at the neck of scrotum.

-They descend to scrotum just before birth.

#Surgery

Remember:


-Malignant transformation in undescended testis is 20 times more common than normally descended testis.
-It is higher in abdominal than in inguinally located testis.
-Seminoma is the most common malignancy in undescended testis.
-The testis which has normally descended on other side testis (in case of unilateral undescended testis), is also more prone for malignant transformation than normal individual.

#Surgery

What is the commonest plane of lipoma?

-Subcutaneous (between the deep fascia and skin).

#Surgery

What is slip sign?

-If the edge of the lump is pressed, the swelling slips from beneath the finger.
-This can be easily demonstrated in the case of a subcutaneous lipoma and it is said to be pathognomonic.

#Surgery

Associated Anomalies with undescended testis:

-Epididymal anomalies and patent processus vaginalis upto 90%.

-Renal Anomalies in10% cases (Renal hypoplasia, agenesis,horseshoe kidney, PUJ obstruction)

-Hypospadias.

#Surgery