Types of Surgery and infection rate .

#جراحة

Lidocaine toxicity.

Maximum dose > 4.5mg / kg

اذا استخدمنا epinephrine
Maximum dose > 7mg/ kg

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الجرعة المتوفرة عندنا
Lidocaine 2% = 20 mg / 1ml
= 100 mg / 5 ml

ناخذ مثال :
Pt 70kg
4.5 ×70 = 315 mg = ~ 15 ml
يعني ما نزيدش على ال 15 ml

واذا استخدمنا ال epinephrine
7×70 = 490 mg

يعني تقريبا 24.5 ml ...
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Antidote for toxicity:

Intravenous Lipid emulsion
لان ال lidocaine يذوب في الدهون
و بالتالي يذوب في الدهون هذي ويبتعد عن التأثير بالأعضاء المهمة .
Bolus dose :
1.5 mg /kg
تعطى خلال دقيقة
بعدين
Infusion :
0.25/ml/kg / minute.

Echinococcus genus of tapeworms has nine recognized species, but four are of primary public health concern in humans. These species cause three main forms of the disease, known collectively as echinococcosis or hydatid disease. 
The main species and the diseases they cause are:
Echinococcus granulosus sensu lato This species complex is the most common cause of human echinococcosis worldwide, causing cystic echinococcosis (CE), also known as hydatid disease or hydatidosis. The larval stage forms slow-growing, fluid-filled, unilocular (single-chambered) cysts, typically in the liver or lungs.
Echinococcus multilocularis This species is found in the northern hemisphere and causes alveolar echinococcosis (AE). This form is more aggressive, behaving like a malignant tumor by growing in an infiltrative, multilocular pattern (many small, interconnected vesicles) primarily in the liver, and can spread to other organs.
Echinococcus vogeli and Echinococcus oligarthrus These species are limited to Central and South America and are responsible for the rare polycystic echinococcosis (PE) or neotropical echinococcosis. E. vogeli typically causes large, polycystic growths in the liver and abdomen, while E. oligarthrus rarely infects humans and is found in the orbit or heart. 
Two other species, Echinococcus shiquicus (found in the Tibetan fox) and Echinococcus felidis (found in African lions), have been identified but their potential for human infection is currently unknown or not reported. 

Grades of Gastric injury

The ileoappendicular ligament (also known as the ileocecal fold, ileocaecal fold, or the bloodless fold of Treves)

The Tokyo Guidelines (TG18) for acute cholecystitis :

Incision at Mcburney point ?

Tokyo classification of Acute Cholecystitis.

#جراحة

Valentino's sign (or Syndrome) in peptic ulcer disease refers to the rare presentation of right lower quadrant abdominal pain due to a perforated ulcer, where gastric/duodenal contents leak down the right side, mimicking acute appendicitis.

Grades of liver injury ...

لدعم الطالبة نوران ياسر عبيديل
فضلاً اضغط الرابط واعمل like للفيديو

https://www.facebook.com/share/v/1Af6aNKqtM/

TNM staging for breast cancer

معادلات مهمة في الطوارىء و الرعاية :
1. Corrected Sodium (للـ Hyperglycemia)
Na_corrected = Na_measured + 1.6 × (Glucose - 100) / 100
(أو ≈ +2 لكل 100 مجم/ديسيلتر فوق 100)
مثال: Glucose 400 → +4.8–6 mEq/L للـ Na

2. Corrected Calcium (للـ Hypoalbuminemia)
Ca_corrected = Ca_measured + 0.8 × (4 - Albumin g/dL)
(أو +0.2 لكل 1 g/dL انخفاض الألبومين تحت 4)
مثال: Albumin 2 → +1.6 mg/dL للـ Ca

3. Serum Osmolality (Calculated)
Osm_calc = 2 × Na + Glucose/18 + BUN/2.8
(جميعها في mg/dL، Na في mEq/L)
Normal: 275–295 mOsm/kg
Osmolar gap = Measured Osm - Calculated Osm (>10 يشير لـ toxins زي methanol، ethylene glycol).
4. Anion Gap (AG)
AG = Na - (Cl + HCO₃)
Normal: 8–12 mEq/L (بدون K) أو 12–16 لو مع K.
Corrected AG لو albumin منخفض: AG + 2.5 × (4 - Albumin)

5. Delta Ratio (Δ/Δ or Delta-Delta) – لتقييم Mixed Metabolic Acidosis
Delta Ratio = (AG - 12) / (24 - HCO₃)
<0.4: Hyperchloremic normal AG acidosis
0.4–0.8: Mixed high AG + normal AG acidosis
1–2: Pure high AG metabolic acidosis (الأكثر شيوعًا)
2: Mixed high AG acidosis + metabolic alkalosis (أو chronic resp. acidosis)

6. ازاي تعرف الـ pH صح ولا غلط؟ (في ABG)
أول حاجة: قارن pH بالـ [H+] المتوقع (تقريبي):
pH 7.00 → [H+] ≈ 100 nmol/L
pH 7.40 → [H+] ≈ 40
pH 7.20 → [H+] ≈ 63
لو الـ [H+] مش مطابق للـ pH → الـ sample غلط (خطأ في القياس أو تأخير).
تاني حاجة: استخدم Henderson-Hasselbalch:
pH = 6.1 + log([HCO₃] / (0.03 × PaCO₂))
لو الـ pH محسوب مش مطابق للـ measured → خطأ في الـ ABG.
تالت حاجة: لو metabolic acidosis موجود (HCO₃ منخفض)، شوف الـ Delta Ratio:
لو قريب من 1–2 → الـ acidosis متسق (pure HAGMA).
لو خارج النطاق → mixed disorder (مش متسق مع pH لوحده).
7. Dehydration بالتحاليل (أهم علامات)
•BUN/Creatinine ratio >20:1 (prerenal azotemia).
•Sodium مرتفع (> 145) لو free water loss.
•Hematocrit مرتفع or HCT/albumin
•Uric acid مرتفع أحيانًا.
•Serum Osmolality مرتفع (>295).
•Urine specific gravity >1.020 أو Urine Osm >500–600.
•Fractional excretion of urea <35% (أحسن من FENa في dehydration) لأن الكلى بتعمله reabsorption في حالة الdehydration

TIRADs : and its recommendation

Appendicular mass (APP mass) is a complication of acute appendicitis caused by localization of infection by the omentum and bowel loops.
The patient usually presents with right iliac fossa pain, fever, vomiting, and a palpable tender mass after 3–5 days of symptoms.
Investigations include CBC showing leukocytosis and abdominal ultrasound or CT to confirm the diagnosis.
Management is usually conservative by the Ochsner-Sherren regimen: NPO, IV fluids, antibiotics, and close observation.
Interval appendicectomy is commonly done after 6–8 weeks to prevent recurrence.

ASA classification

The Forrest classification of bleeding peptic ulcer ...