Diuretics and electrolytes

#Renal

IgA nephropathy in adults - Treatment Standard.

#Renal

Heart failure

classes

HFrEF <40%
HFpEF >50%
HFiEF <40% then >40%
HFmREF between 40 and 50
HFhEF >60%

Treatment

4 pillars within 1 month

1-BB. First line  (Metoprolol 12.5-25-200mg once,
carvidolol 3.125_25mg twice ,
Bisoprolol (concor) 1.25_ 10mg once) up titrated every 2 weeks
>30% improvements in mortality

2- ACEI/ARBs
Ramipril 1.25- 10 mg once daily
begin with BB at same time

Novel drug...
ARNI (Sacopatril 49 + Valsartan51)
100-200mg twice
Expensive used mainly in HFrEF



3-MRA
Spironolactone 25-50mg once after 1-2 weeks
if the patient develop gynacomastia change to eplerenon with same dosage

4-Empa (empagliflozine , canagliflozine , dapagliflozine)with 10mg once. No titration needed
Na glucose cotransport inhibitor
Used for all stage
the only drugs that improve prognosis in HFmrEF

Dr / Salah Al-Shawki

#Cardiology

Berlin criteria for ARDS

•Acute onset: respiratory failure within one week of a known predisposing factor (e.g., sepsis, pneumonia) or worsening respiratory symptoms

Bilateral opacities (on chest x-ray or CT)

Hypoxemia: PaO2/FiO2 ≤ 300 mm Hg

Respiratory failure cannot be fully accounted for by heart failure or fluid overload.


#Respiratory

Remember:

-ARDS diagnostic criteria
include: 
Abnormal x-ray, Respiratory failure < 1 week after a known or suspected trigger,Decreased PaO2/FiO2, Should exclude CHF or fluid overload as a potential cause of respiratory distress.

#Respiratory

Management of ARDS

-ARDS is a life-threatening condition that usually requires early lung-protective ventilation (i.e., with low tidal volumes and low plateau pressures) to prevent further lung damage.
لأن الـ Alveoli السليمة تشل Oxygen أكثر من قدرتها بسبب اللي جنبها تكون ملان fluid، و حين تجي تسوي Ventilation ضروري تنقص TV لأنه لو عطيت مثل الطبيعي عينفجرين السليمات وبالتالي ينتهي المريض.

All patients with ARDS

Oxygenation: Hypoxemia is a hallmark feature of ARDS and should be addressed immediately

Lung-protective ventilation: All patients with ARDS should be treated with lung-protective ventilation to decrease the risk of VILI. 

General initial settings include:

Low tidal volume
Low plateau pressure
PEEP > 5 cm H2O

A low tidal volume and low plateau pressure are the principles of lung-protective ventilation!!!

#Respiratory

Remember:

-Polymyositis is the commonest cause of inflammatory muscle disease in people under 50-years-old.

-Inclusion body myositis is the commonest in those over 50- years-old.

#Rheumatology

Stages of Diabetic Nephropathy.

#Renal
#Endocrine

Polycythemia.

#Hematology

Remember:


-AMOIDRONE is contraindicated in individuals with polymorphic ventricular tachycardia as it is associated with a prolonged QT interval which will be made worse with anti-arrhythmic drugs.

#Cardiology

Common pathogens in pneumonia and lower respiratory tract infections:

-COPD exacerbations 👉🏼 H.influenza.

-Cystic fibrosis 👉🏼Pseudomonas ( foul smelling sputum ).

-Alcoholic and diabetic 👉🏼 klebsiella ( cavitation).

-HIV 👉🏼 PCP , Histoplasmosis ( insidous cavitation) , staph aureus( acute, cavitation) , and cryptococcus ( positive India ink).

-Hypogamaglobulinemia 👉🏼 streptococcus and hemoohilus influenza .

-Exposure to bats 👉🏼 Histoplasmosis .

#mrcp1
#Respiratory

Remember:

-Hyponatremia + abdominal pain + vomiting:


With hypotension 👉🏼 think in Addison

With hypertension ( and neuro psychatric symptoms )👉🏼Porphyria .

-Do not give metoclopramide in patients with suspected porphyria.

Best treatment for acute intermittent porphyria IV glucose infusion with mild cases and haem arginate IV with severe cases .


#mrcp1
#Endocrine

Exercise ECG is not useful in patients with:
1) Conduction abnormalities: e.g. LBBB.
2) Resting ECG abnormalities like ST segment depression of ˃ 1 mm.
3) WPWS
4) Those with ventricular pacing rhythm.
5) Those on digoxin.

#Cardiology

Sudden cardiac death (SCD):
-It is an unexpected death due to cardiac causes that occurs in a short time period (generally within 1 hour of symptom onset) in a person with known or unknown cardiac disease.

#Cardiology