Chronic subdural hematoma

◼️On CT scanning of the head, new blood appears bright (Hyperdense), this brightness remains for about 3 days, thereafter the collection assume a density similar to brain tissue (Isodense), after 2-3 weeks it becomes hypodense, therefore "new blood" looks bright, "intermediate age blood" looks just like the brain, and "old blood" looks some what like CSF.

◼️Chronic SDH is common in elderly and alcoholics due to brain atrophy and stretching of cortical dural bridging veins which are then prone to rupture and bleed, anticoagulants and antiplatelets also increases risk, in these groups even trivial trauma maybe enough.

◼️A chronic SDH is an old hematoma which has been presents for about 2 to 3 weeks, sometimes new bleeds may occur (acute on chronic) appearing heterogenous on CT scan (see fig, new blood bright and old blood dark).

◼️Unlike the thick acute SDH, the old clot is thinned out, it resembles motor oil in viscosity, and so it can be drained by simple burr holes.

#Medicine

Indications of CT scan of the head according to NICE guidelines

◼️CT scan must be done within 1 hour if:

1- GCS is less than 13 at any point.
2- GCS is less than 15 at 2 hours.
3- More than one episode of vomitting.
4- Post-traumatic seizure.
5- Focal neurological deficit.
6- Suspected open, depressed or basilar skull fracture.

◼️CT scan should be done within 8 hours if:

1- Age is more than 65 years.
2- Patient has a coagulopathy, taking anticoagulants or antiplatelets including aspirin.
3- Post-traumatic retrograde amnesia for more than 30 minutes.
4- Dangerous mechanism of injury such as RTA.

#Surgery

Williams Obstetrics 26th Edition.
It's considered as the Bible of Obstetrics.

Remember:

-Fibroids, Endometriosis, Breast cancer, Endometrial hyperplasia, Endometrial cancer, Vulval cancer, Ovarian cancer and PID are associated more with Nulliparity!

-Cervical cancer occurs with multiparity.

#Obs_Gyne

55 year old man, known case of CKD presented with sudden onset chest pain and palpitation.

This is “Acute myocardial infarction complicated by Ventricular tachycardia”

-The ECG shows a wide complex tachycardia at a rate of ~175 bpm.
-Although the rhythm is irregular, there are findings that suggest ventricular tachycardia (VT); Most notably AV dissociation (P waves are shown with arrows). As you see, there is no relationship between P waves and QRS complexes. Note that VT may be irregular in particular at the beginning.

-STT changes are common findings in any rhythm with wide QRS complexes including VT, However, despite secondary STT changes, there are concordant ST-elevations (ST-elevations in leads with positive QRS complexes) in leads 1, aVL and V6 which suggest acute myocardial infarction (MI). The next ECG is taken after the patient got cardioversion shock and confirms anterolateral MI.

#Medicine

Diseases associated with increased maternal or paternal age for their first child for the first time.

#Obs_Gyne
#Pediatrics

Common Indications of CS:

Primigravidae:
(1) Failed induction
(2) Fetal distress (nonreassuring fetal FHR)
(3) Cephalopelvic disproportion (CPD
(4) Dystocia, nonprogress of labor
(5) Malposition and malpresentation (occipitoposterior, breech).
(6) On maternal request

Mutigravidae:
(1) Previous cesarean delivery
(2) Antepartum hemorrhage (placenta previa, placental abruption)
(3) Malpresentation (breech, transverse lie).

#Obs_Gyne

TIME OF OPERATION:

-Elective
-Emergency.

Emergency:

-Category of CS (NICE): Emergency:
-When the operation is to be done due to an acute obstet ric emergency (fetal distress).A time interval of 30 minutes between the decision and delivery is taken as reasonable.

•Category 1:
-When there is immediate threat to the life of the woman or the fetus.
-Decision delivery interval should be 30 minutes.

•Category 2:
-When there is maternal or fetal compromise which is not immediately life-threatening.
-CS should be done within 75 minutes of making decision.

•Category 3:
-There is no maternal or fetal compromise but needs early delivery.

•Category 4:
-Delivery is planned to suit the woman, family members and the hospital staff.

#Obs_Gyne

1-Lower segment cesarean section (LSCS):

-In this operation, the extraction of the baby is done through an incision made in the lower segment through a transperitoneal approach.

-It is the only method practiced in present day obstetrics and unless specified, cesarean section means lower segment operation.

#Obs_Gyne

Classical:

-In this operation, the baby is extracted through an incision made in the upper segment of the uterus.
-Its indications in present day obstetrics are very much limited and the operation is only done under forced circumstances, such as:

•Lower segment approach is difficult:
1) Dense adhe sions due to previous abdominal operation;
2) Severe contracted pelvis (osteomalacic or rachitic) with pendulous abdomen.

•Lower segment approach is risky:
1) Big fibroid on the lower segment blood loss is more and contemplating myomectomy may end in hysterectomy.
2) Carcinoma of cervix
3) Repair of high VVF
4) Complete anterior placenta previa with engorged vessels in the lower segment—risk of hemorrhage.

•Perimortem cesarean section:
It is done to have a live baby (rare):
Perimortem section is an extreme emergency procedure.

#Obs_Gyne

Lower vs Upper CS.

#Obs_Gyne

Timing of Discharge from hospital and of starting coitus.

#Obs_Gyne

Tocolytic drugs.
MOA, Dosage, AE.