وحدة من الكيسات الي بقت ببالي
Middle age male presented with typical hx of MI
ECG and troponin were positive
بعد ما اخذ الانتي اسكيميا تم اعطاءه اكتليز و حسب البروتوكول
بعد ٦ ساعات patient developed disturbed level of consciousness, mouth deviation and lt side weakness
CT shows ICH and IVH !!
صحيح هو واحد من السايد افكت للاكتليز ولكن هالشي كلشش رير ونسبته قليلة
هل السبب انو جان عنده كونترا اندكيشن ؟ او الهيمورج مو بسبب الاكتليز انما كوفد ملام ؟ لان السي تي بين اكو انفلتريشن باللنك ايضاً يمشي وي كوفد

طبعا خلال الفترة الفاتت لاحظنا ازدياد كيسات ischemic stroke عند اشخاص بالعشرينات و الثلاثينيات ماعدهم اي رسك فاكترز ، درك هستري او فاملي هستري
الشي الوحيد الي كدرت الكاه بواحد منهم انو جان عنده هستري مال اصابة كوفد قوية ٧-١٠ ايام قبل وكعته
Coronavirus disease 2019 (COVID-19) is associated with a hypercoagulable state, especially with viral strains that circulated early in the pandemic. The degree of hypercoagulability depends on the magnitude of the systemic inflammatory response.
لهذا ممكن نلكه ال d dimer - PT - Ptt مرتفعات …

Pre and post actylase
المفروض اكو اي سي جي بري اوضح
بس يبدو مضيعيه

27 years old male presented to ER an RTA case
After resuscitation and primary Ix The patient had both femoral and tibial fracture, otherwise he was normal
So Skin traction was placed until ORIF was possible 1 day after the RTA
On The second day post op the patient presented to ER again but with SOB and agitation
PR was 135bpm
Spo2 was 74% without O2 and 100% with O2
Bp= 11/70
Chest auscultation> clear chest with bilateral good air entry
ECG as shown below (sinus tachycardia)
D dimer 4300
Hb 7.3
Plt 101
Otherwise normal ix including RBS LFT and electrolytes
CT couldn’t be done as he’s not stable yet and ct with contrast wasn’t Available anyway
The most likely dx is PE and anticoagulants was started immediately as bolus and maintenance

Young age female (35 years old ) presented to ER with headache
She was vitally stable
No hx of trauma
No HTN, NO dm
No drug hx
Everything was normal
So she was treated with paracetamol vial only but without any benefits
After digging in hx she revealed several episodes of vomiting for the past 2 days and single episode of fainting attack!!
I immediately sent her for CT scan it showed the results in the pic. ,
Ddx either ischemic stroke / cavernous thrombosis
Or brain tumor
MRI is needed in such cases and in such age group
I lost follow up with her as my call has ended but before that we put her on keppra infusion as such lesions which effect the cortex has risk of Fit

Middle age female with sob and palpitation
ECG SHOWS SVT
حتى ناخذلنا رفيو سريع و مختصر ع اللاين اوف مانجمنت
اذا جان الضغط زين و الامور تمام نمشي باللاينات
First line is valsalva manuver بالتعليقات الطريقة
2nd is adenosine 6mg يعني امبولة وحدة
تنعطى دايركت بكانيولا تكون بروكزمال وراها نرفع الايد و فلش سريع نورمال سلاين ١٠ سي سي لان الهالف لايف مالته قصير حتى يوصل اسرع
اذا مفادني هنا ننطي بجرعة ١٢ ملغم يعني امبولتين و بنفس الطريقة
واذا مفاد هم نكدر نعيد ١٢ ملغم
3rd line is Beta blocker or CCB
الي هنه اما ايزوبتين ٥ ملغم سلو دايركت او
ميتابرلول ٥ ملغم سلو دايركت نكدر نعيدهم مرتين (((((بس مو سوية لو هذا لو هذا )))))
اما اذا لا والله مشوك و hemodynamically un stable the > DC shock


In this patient ecg of Pre and post single dose of isoptine 5 mg direct slow iv