هنا
Av block agent contraindications
مثل ال CCB و adenosine و digoxin ,لان بيها risk تتحول VF

Treatment choice:

Cardiovertion
Flecainid
Procainamide

( Interested case )
First case I have ever seen since
Starting my medical journey
Young age female with negative PMH presented with Dark color urine for 2 days duration described as coffee color
Associated with abdominal pain that preceding the change in urine color about 5 days
Abdominal pain at RUQ gradual in onset associated with nausea and vomiting
Patient complaining from fatigue in last 2 weeks associated with progressive proximal muscle weakness involving the upper and lower limbs
Till make patient unable to walk and doing the daily usual activities

Investigations are done
Extensively reviewed the drug history
Which revealed that patients started Simvastatin since 30 days
Also patient had skin lesion in last 1 month at buttock area in which attend dermatologist and diagnosed as Fungal infection and give her itraconazole and cyclosporine syrup

This is a case of statin induced rhabdomyolysis
And statin induced hepatitis

Why you think this patient developed this serious side effect ?
Hopefully stops all offending drugs and check Thyroid function status
Patient improved and complete recovery occur

د محمد منير

#renal_stone

خلي نحجي شوية عن ال renal stone
من اهم الاسباب الي تسوي renal stone ♦️هي dehydration
♦️قلة شرب الماء
♦️بالاضافة بالصيف over sweating ميتناسب وي كمية الماء الي نشربها يؤثر وتكون سبب رئيسي

♦️كثرة الكاربوهيدرات والبروتين مثل اللحم يعتبر risk factor مع قلة ca
♦️الجاي وما ادراك ما الجاي بيها oxalate و هاي risk خصوصا بقلة الكالسيوم
التدخين و UTI
♦️و hyperparathyroidism و غيرها من الاسباب ممكن تكون جينية وممكن مكتسبة

♦️غالبا الاعراض تجي :
Loin pain /dysurea/hematuria gross or microscopr/N/V

♦️Investigation :
US
CBC
RFT
GUE
CT

♦️بروتوكول العلاج بالنسبة للطوارئ
🔼analgesic/choice is NSAID
Voltarin/ketrolac
Add Paracetamol 1g
🔼Opioid analgesics/such tramadol
و ممكن morphine and pethidine منستخدمهم يمنا و ممتوفرة غالبا
🔼Acupan
🔼fluid such N/S
🔼Plasil
🔼و ننطي وياها Buscopan (مو علمي استخدامة )

♦️و ننصح المريض يكثر سوائل قدر الامكان
الكرفس والرشاد فد شي رهيب و مفيد ب renal stone لان تحتوي ع كمية كبيرة من الكالسيوم يشتري كم باكة كرفس جدا مفيدة

رياضة لان immobilize تكون risk
و اكيد يراجع اخصائي
خل نحجي شوية عن
♦️Protocol therapy of renal stone :
1)medical therapy
يتضمن موسعات الحالب مثل tamsulosin
فوار مثل k/citrate
و analgesic
و اكيد life style
2)extrocorporeal shock wave lithotripsy
موجات فوق الصوتيه تفتت ال Stone
Size 10-20mm

3)precutanous nephrolithotomy
Size more 20mm
نسوي شق بالجلد يكون بحدود 1cm ونفتت ال stone
4) retrograde intrarenal surgery
هنا ureterorenoscopy و بالليزر نفتت
5)open surgery

احد الكيسات الي اجانه البارحة بليل
#case

23 yrs old pt. Presented with loin pain ' nausea 'dysurea

IX: CBC /GUE

Tx: paracetamol vial
Ketorolac amp.
Buscopan amp.

المهم بالنسبة النا هو الطوارئ والباقي لفائدتكم 🤍🤍

📋 نموذج من طبلات الطوارئ.
ال differential diagnoses لهذا الكيس هي:
1- inferior myocardial infarction "inferior STEMI" (definitive diagnosis)
2- aortic dissection
3- pneumonia
4- pulmonary embolism
5- musculoskeletal strain
6- GERD
7- panic attack

*منقول من احد الدكاترة .

#ECG
#Notes_R

نماذج من طبلات الطوارئ وال DDX. مع العلاج
كلش مرتبات ومفيدات👆🔥

#طوارئيات

#DKA 🦜
Criteria

1-s.Glucose >250 mg /dl
2-ketonemia >3 mmol/l
3-ketonuria ++
4-ABG : ph <7.30
HCO3<18
Anion Gap>10

#Severe DKA
#IF one or more of the following is present #on_admission

GCS <12
SBP<90
Pulse <60 or >100
O2 saturation <92%

Ketones >6 mmol/l
ABG readings:
Anion gap >16
PH <7.1
Hco3<5 mmol/l
K<3.5mmol/l

Dka patient may present with any of the following s and s

📌Hyperventilation
📌nausea
📌vomiting
📌abdominal pain
📌coma
📌cns instability
📌lethargy

DKA one of the commonest cases in the emergency department , actually it is simple to diagnosid it with magical result , and it is easy to pass without diagnosis .

Diabetic Young age male presented with decrease level of concentration when he was driving his car , feeling of fatigue otherwise healthy, no chest pain , he is conscious , oriented , without significant pmh
This case from Baqubah teaching hospital

55 years old man presented to ED of Baqubah teaching hospital with One month of recurrent attack of fever , constant chest pain that is worsened by lying supine and is relieved by sitting forward.
Pmh / dm , ht
What is your suspicion about this ecg ?