Quick Notes
Causes of carpal tunnel syndrome: (ARM PIT). 1- Amyloidosis, Acromegaly. 2- Rheumatoid arthritis and other wrist arthritis. 3- Myxedema (hypothyroidism), multiple myeloma. 4- Pregnancy. 5- Idiopathic ( most common ) . 6- Trauma ( fracture ) , DM .…
And from this post and downward is considered #Surgery.
Forwarded from Quick Notes
Post-operative return of GI function:
-Small bowel: 12-24h.
-Stomach: 24-48h.
-Large bowel: 48-72h.
#Surgery
-Small bowel: 12-24h.
-Stomach: 24-48h.
-Large bowel: 48-72h.
#Surgery
Forwarded from Quick Notes
Post-operative History:
History taking:
•Ask about the following points and repeat them every day starting from day 0 (day of operation):
-Fever
-Nausea and vomiting (causes: pain, opioids analgesics, paralytic ileus, and anesthesia).
-Oral intake: solid and liquid.
-Cough/sputum (causes: anesthesia, chest infection).
-Dyspnea.
-Chest pain.
-Pain at site of operation: excessive pain maybe caused by wound infection.
-Wound discharge or bleeding.
-Passage of flatus or stool (indicates the return of GIT function).
-Passage of urine.
-Mobility (i.e. does the patient get up and start walking? prolonged immobility is bad - DVT).
-Pain in the legs (may indicate DVT).
-Tubes & Drains: e.g. Foley catheter, nasogastric tube (NG tube), surgical drain.
-Treatment received: Drugs & IV fluids.
#Surgery
History taking:
•Ask about the following points and repeat them every day starting from day 0 (day of operation):
-Fever
-Nausea and vomiting (causes: pain, opioids analgesics, paralytic ileus, and anesthesia).
-Oral intake: solid and liquid.
-Cough/sputum (causes: anesthesia, chest infection).
-Dyspnea.
-Chest pain.
-Pain at site of operation: excessive pain maybe caused by wound infection.
-Wound discharge or bleeding.
-Passage of flatus or stool (indicates the return of GIT function).
-Passage of urine.
-Mobility (i.e. does the patient get up and start walking? prolonged immobility is bad - DVT).
-Pain in the legs (may indicate DVT).
-Tubes & Drains: e.g. Foley catheter, nasogastric tube (NG tube), surgical drain.
-Treatment received: Drugs & IV fluids.
#Surgery
Forwarded from Quick Notes
Cont...
Example of post-operative history:
Day 0:
-The patient had cough, sputum, mild pain at the the site of operation. But there was no fever, no nausea or vomiting, no oral intake, no chest pain, no shortness of breath. She passed urine but hasn't passed flatus or stool. No leg pain & hasn't started mobilizing yet. She received IV fluids & IV medications.
Day 1:
-No fever, no nausea or vomiting, no cough, no chest pain or dyspnea, she passed flatus and stool & oral intake was resumed in the form of liquid & soft food (e.g. orange juice & biscuit). The pain is decreased at the site of operation. The patient started walking in the ward and going to bathroom. She received IV fluids & IV medications.
Day 2:
-No fever, no nausea or vomiting, no cough, no chest pain or shortness of breath, mild pain at operation wound, normal oral intake, normal passage of stool and urine, no leg pain and normal mobility.
#Surgery
Example of post-operative history:
Day 0:
-The patient had cough, sputum, mild pain at the the site of operation. But there was no fever, no nausea or vomiting, no oral intake, no chest pain, no shortness of breath. She passed urine but hasn't passed flatus or stool. No leg pain & hasn't started mobilizing yet. She received IV fluids & IV medications.
Day 1:
-No fever, no nausea or vomiting, no cough, no chest pain or dyspnea, she passed flatus and stool & oral intake was resumed in the form of liquid & soft food (e.g. orange juice & biscuit). The pain is decreased at the site of operation. The patient started walking in the ward and going to bathroom. She received IV fluids & IV medications.
Day 2:
-No fever, no nausea or vomiting, no cough, no chest pain or shortness of breath, mild pain at operation wound, normal oral intake, normal passage of stool and urine, no leg pain and normal mobility.
#Surgery
Forwarded from Quick Notes
Day 0: It's the day of operation till 12 am.
E.g.,patient has undergone a surgery at 11:00 pm. on Friday, it's called zero day. But when it becomes 12:00 am. Saturday, it became Day 1.
#Surgery
E.g.,patient has undergone a surgery at 11:00 pm. on Friday, it's called zero day. But when it becomes 12:00 am. Saturday, it became Day 1.
#Surgery
Forwarded from Quick Notes
Forwarded from Quick Notes
Examination of an Incision
By inspection:
Site, side, length, direction, the healing by primary or secondary intention, relation to deep structures any signs of complication of incision as hematoma, discharge, swelling, redness..etc
-If there's dressing, comment on:
Site, side, dry or wet, clear in colour or red, yellow...
-Do not forget to say to the examiner:
"I shoud to expose the dressing".
#Surgery
By inspection:
Site, side, length, direction, the healing by primary or secondary intention, relation to deep structures any signs of complication of incision as hematoma, discharge, swelling, redness..etc
-If there's dressing, comment on:
Site, side, dry or wet, clear in colour or red, yellow...
-Do not forget to say to the examiner:
"I shoud to expose the dressing".
#Surgery
Forwarded from Quick Notes
Methods to elicit MURPHY’S SIGN:
1)Patient in upright/sitting position, the right hand of the examiner curls up under the right costal margin (or extended fingers with moderate pressure) of the patient at the tip of the ninth rib and patient is requested to take a deep breath. If the gallbladder is inflamed, the patient will experience pain (winces with pain and catch the breath) as the gallbladder descends and contacts the palpating hand.
2)The extended and abducted left thumb is placed in right subcostal region without pressing deep; the patient is requested to take a deep breath.This is elicited in lying down supine position. Called Moynihan’s modification of eliciting Murphy’s sign.
3)Identify the right Midclavicular line then descend to the right costal margin and put your one or two fingers there, as that site is the anatomical position of GB fundus.
4)From linea semilunaris and ascend to right costal margin. This isn't good in obese patients.
5)A line from left ASIS to the umblicus and other from the umblicus to the right costal margin tip of 9th costal cartilage. It's called Grey Turner line.
6)From the RIF and ascend upward, this facilitates the detection if there is also hydropes of GB. د. رمزي
7)Sonographic Murphy’s sign is eliciting same sign using sonographic transducer. It is more sensitive and more accurate.
1)Patient in upright/sitting position, the right hand of the examiner curls up under the right costal margin (or extended fingers with moderate pressure) of the patient at the tip of the ninth rib and patient is requested to take a deep breath. If the gallbladder is inflamed, the patient will experience pain (winces with pain and catch the breath) as the gallbladder descends and contacts the palpating hand.
2)The extended and abducted left thumb is placed in right subcostal region without pressing deep; the patient is requested to take a deep breath.This is elicited in lying down supine position. Called Moynihan’s modification of eliciting Murphy’s sign.
3)Identify the right Midclavicular line then descend to the right costal margin and put your one or two fingers there, as that site is the anatomical position of GB fundus.
4)From linea semilunaris and ascend to right costal margin. This isn't good in obese patients.
5)A line from left ASIS to the umblicus and other from the umblicus to the right costal margin tip of 9th costal cartilage. It's called Grey Turner line.
6)From the RIF and ascend upward, this facilitates the detection if there is also hydropes of GB. د. رمزي
7)Sonographic Murphy’s sign is eliciting same sign using sonographic transducer. It is more sensitive and more accurate.
Quick Notes
Post-gastroectomy complications. #رمزي
Like these posts, were questions from many writing exam.
WHO Informal Working Groups on Echinococcosis Classification of Hepatic Echinococcal Cysts" Hydatid cyst ".
#Surgery.
#Surgery.
Quick Notes
Photo
Hydralyzine (Apresoline):
الـ hydralyzine معروف تجارياً باسم Apresoline، يجي على شكل 20mg dry powder ampoule كما في الصورة.
بيستخدم كثير في النسائية، وكذلك في حالة عدم توفر الـ Labetalol.
1. Mechanism of action:
It prevent efflux of calcium from sarcoplasmic reticulum> arterioles relaxation > decrease peripheral vascular resistance > decrease diastolic BP .
-و لأنه يقلل الـ DBP، عيحفز الـ baro-receptors و بالتالي ترفع الـ HR, stroke volume, and cardiac output، فمعناها الـ hydralyzine يزيد الـ cardiac demand لذلك ممنوع نديه لشخص عندة IHD (إلا لو أدينا معه BBs)، و أيضاً ممنوع نديه لشخص عنده aortic dissection AD؛ لأنه عيزيد الـ HR و بالتالي يزيد الـ sheering force فاحتمال يسبب rupture dissected aorta.
2. Indications:
-Mainly in eclampsia and pre-eclampsia (Labetalol is the first line) and in case of acute HT nephropathy.
- يستعمل بشكل عام في حالات الـ hypertensive emergency، لكن أبداً ما يكون هو الـ first line، بسبب side effects، اللي هن tachycardia and increase COP و أيضا الـ BP lowering effect يكون unpredicatable و هذا شيء مزعج..!
و أيضاً ما نستعمله أذا كانت ال PE سببها SLE.
3. Preparation and dosage regimen:
مهم جداً تعرف لأنه تجي تقول لك الممرضة أو الممرض كيف أحله يادكتور و أنت مناوب، مصيبة ما تعرف..!!
-نضيف 1ml من الـ sterile water بيصير عندنا 20mg/1cc، بعدها نسحب الجرعة و نضيف عليها 9cc NS، فـصار عندنا 20mg/10cc، يعني 2mg = 1cc.
نقدر نديه injection و infusion:
• الـ IV injection:
نبدأ بـ5mg (2.5cc) نديه وريدي خلال 3 دقائق، و نراقب الضغط، إذا ما وصل للـ target بعد 20 دقيقة، نعيد الجرعة 5mg، و نفس الحالة الأولى. إذا المريض ما أستجاب بعد 20mg (أمبولة كاملة)، فهذا unlikely أن يستجيب بعد.
• الـ IV infusion:
تجيب 20mg/10cc و تضيفهن على 190cc NS، صار عندنا 20mg/200cc، يعني 1mg/10cc، و اللي تعني 100mcg/1cc.
نبدأ الـ infusion بـ:
200-300 mcg/min (يعني 2-3cc).
Note: hydralyzine is INCOMPATIBLE with glucose solutions, and it is compatible with ringer and normal saline.
4. Side effects:
Hypotension, reflex tachycardia, induce angina, and can give lupus-like picture .
5. Contraindications:
Recent MI, AD, myocardial insufficiency due to mechanical obstruction, Cor pulmonale, and SLE.
Caution: in liver and renal failure.. the half life maybe extended .
يعني عندها PE و بنفس الوقت معها renal impairment لكن الـ CrCl أكثر من 15، عادي نقدر نستعمل الـ hydralyzine، بس نراقب الضغط بشكل مستمر حتى بعد ٢٠ ساعة من توقف العلاج لأن الـhalf life بيزداد.
Apresoline in ICH:
Not recommended!!!
الـ hydralyzine معروف تجارياً باسم Apresoline، يجي على شكل 20mg dry powder ampoule كما في الصورة.
بيستخدم كثير في النسائية، وكذلك في حالة عدم توفر الـ Labetalol.
1. Mechanism of action:
It prevent efflux of calcium from sarcoplasmic reticulum> arterioles relaxation > decrease peripheral vascular resistance > decrease diastolic BP .
-و لأنه يقلل الـ DBP، عيحفز الـ baro-receptors و بالتالي ترفع الـ HR, stroke volume, and cardiac output، فمعناها الـ hydralyzine يزيد الـ cardiac demand لذلك ممنوع نديه لشخص عندة IHD (إلا لو أدينا معه BBs)، و أيضاً ممنوع نديه لشخص عنده aortic dissection AD؛ لأنه عيزيد الـ HR و بالتالي يزيد الـ sheering force فاحتمال يسبب rupture dissected aorta.
2. Indications:
-Mainly in eclampsia and pre-eclampsia (Labetalol is the first line) and in case of acute HT nephropathy.
- يستعمل بشكل عام في حالات الـ hypertensive emergency، لكن أبداً ما يكون هو الـ first line، بسبب side effects، اللي هن tachycardia and increase COP و أيضا الـ BP lowering effect يكون unpredicatable و هذا شيء مزعج..!
و أيضاً ما نستعمله أذا كانت ال PE سببها SLE.
3. Preparation and dosage regimen:
مهم جداً تعرف لأنه تجي تقول لك الممرضة أو الممرض كيف أحله يادكتور و أنت مناوب، مصيبة ما تعرف..!!
-نضيف 1ml من الـ sterile water بيصير عندنا 20mg/1cc، بعدها نسحب الجرعة و نضيف عليها 9cc NS، فـصار عندنا 20mg/10cc، يعني 2mg = 1cc.
نقدر نديه injection و infusion:
• الـ IV injection:
نبدأ بـ5mg (2.5cc) نديه وريدي خلال 3 دقائق، و نراقب الضغط، إذا ما وصل للـ target بعد 20 دقيقة، نعيد الجرعة 5mg، و نفس الحالة الأولى. إذا المريض ما أستجاب بعد 20mg (أمبولة كاملة)، فهذا unlikely أن يستجيب بعد.
• الـ IV infusion:
تجيب 20mg/10cc و تضيفهن على 190cc NS، صار عندنا 20mg/200cc، يعني 1mg/10cc، و اللي تعني 100mcg/1cc.
نبدأ الـ infusion بـ:
200-300 mcg/min (يعني 2-3cc).
Note: hydralyzine is INCOMPATIBLE with glucose solutions, and it is compatible with ringer and normal saline.
4. Side effects:
Hypotension, reflex tachycardia, induce angina, and can give lupus-like picture .
5. Contraindications:
Recent MI, AD, myocardial insufficiency due to mechanical obstruction, Cor pulmonale, and SLE.
Caution: in liver and renal failure.. the half life maybe extended .
يعني عندها PE و بنفس الوقت معها renal impairment لكن الـ CrCl أكثر من 15، عادي نقدر نستعمل الـ hydralyzine، بس نراقب الضغط بشكل مستمر حتى بعد ٢٠ ساعة من توقف العلاج لأن الـhalf life بيزداد.
Apresoline in ICH:
Not recommended!!!
Quick Notes
طريقة حساب الـ creatinine clearance (CrCl) من الـ Serum Creatinine. Note: -Creatinine clearance can be used to approximate the eGFR.
أو من Medscape ادخل للـ Calculators وابحث عن حسابة الـ Creatinine clearance باستخدام معادلة "Cockcroft Gault ".
وادخل البيانات المطلوبة مثل اللي بالصورة.
وادخل البيانات المطلوبة مثل اللي بالصورة.