•Causes of bradycardia in ER:

5H

Hypothermia
Hyperkalemia
H+ increase ( acidosis)
Hypoxia
Hypovolumia


5T

Tension pneumothorax
Tamponade ( cardiac)
Thrombosis pulmonary PE
Trombosis cardiac MI
Toxins.

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-Infection above diaphragm is usually of Gram positive bacteria while infection below diaphram is usually of gram negative .

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-In correction of hyperkalemia the first thing we give the patient is membrane stabilizers ( Ca gluconate to prevent caradic arrest ) which will not restore the potassium level but more importantly will counter the action of K on cardiac muscle cell membrane.

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-Severe thrombocytopenia (< 10 × 109/L) may result in retinal haemorrhage and potentially fatal intracranial bleeding, but this is rare.

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-In case of thrombocytopenia, Spontaneous bleeding does not usually occur until the platelet count falls below 20 × 109/L, unless their function is also compromised.

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-Apparent erythrocytosis with a raised Hct, normal red cell mass (RCM) and reduced plasma volume may be associated with hypertension, smoking, alcohol and diuretic use (Gaisböck’s syndrome).

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(Gaisböck’s syndrome):

-The presence of hypertension, smoking, excess alcohol consumption and/or diuretic use is consistent with low-volume polycythaemia.

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-In polycythaemia rubra vera (PRV), a mutation in a kinase, JAK-2 V617F, is found in over 90% of cases.

-Patients with PRV have an increased risk of arterial thromboses, particularly stroke, and venous thromboembolism.

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Symptoms/signs of possible acute transfusion reaction:

-Fever, chills, tachycardia, hyper- or hypotension, collapse, rigors, flushing, urticaria, bone, muscle, chest and/or abdominal pain, shortness of breath, nausea, generally feeling unwell, respiratory distress.


د. محمد قاسم في الراوند قال:
"Back pain is the first! ".

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-The most common reason for a raised platelet count is that it is reactive to another process, such as infection, inflammation, connective tissue disease, malignancy, iron deficiency, acute haemolysis or gastrointestinal bleeding.

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-Antiplatelet medications are of greater efficacy in the prevention of arterial thrombosis and of less value in the prevention of venous thromboembolism.

-Thus, antiplatelet agents, such as aspirin, clopidogrel and, increasingly, ticagrelor, are the drugs of choice in acute coronary events and in ischaemic cerebrovascular disease.


-While Warfarin and other anticoagulants are favoured in VTE " venous " and management of atrial fibrillation.

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-ESR: blood cells sediment in a period of one hour, Normally more in adult female.
-Increase in: - all collagen diseases (autoimmune), infection, malignancy.
-Decrease in: - polycythemia, congestive heart failure, sickle cell anemia, hereditary spherocytosis , Hyper viscosity.

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Anemia according to WHO:

• Hb <13 g/dL in adult male.
• Hb <12 g/dL in adult females.
• Hb <11 g/dl in pregnancy.

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-Iron is absorbed from the duodenum & upper jejunum.

-Serum ferritin is the best single test to confirm iron deficiency.

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•Anisocytosis: the RBCs are not of the same size.
•Poikilocytosis: the RBCs are not of the same shape.

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a)-Skin and mucous membranes pallor [hemoglobin level is 8-10 g/dL].

b)-Palmar creases pallor [hemoglobin level is <8 g/dL].

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Serum ferritin is the best single test to confirm iron deficiency

•Plummer-Vinson syndrome (PVS):

-Triad of iron deficiency anemia, postcricoid dysphagia, and upper esophageal webs.

-Associated with an increased risk of esophageal squamous cell carcinoma and glossitis.

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Pica: the craving to eat unusual substances such as dirt, clay, ice, or hair.

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In case of Iron deficiency anemia
Monitoring response to iron therapy:

1)-Reticulocytosis starts on 3rd day & peaks at 7th after starting treatment.
2)-Hemoglobin rises by rate of 1g/dl per week.
3)-Normalization of the hemoglobin level (1 month).
4)-Repletion of iron stores (2-4 months).

Note: - If the patient is not responding look for another cause of anemia.

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-Pernicious anemia is the most common cause of severe vitamin B12 deficiency worldwide and is due to autoimmune destruction of parietal cells and/or intrinsic factor. 

-Pernicious anemia is more in persons of blood group A.

-Diphyllobothrium latum (fish tapeworm) competes with the body for cobalamin.

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