AAS Medical Notes

Massive Transfusion Protocol (MTP): MTP is a systematic approach to the resuscitation of patients with massive hemorrhage, often defined as requiring the replacement of one blood volume within 24 hours, >10 units of packed red blood cells (PRBCs) within 24 hours, or >3 units in 1 hour with continued bleeding. Goals: Restore hemodynamic stability. Achieve and maintain hemostasis. Minimize complications such as coagulopathy, hypothermia, and acidosis (the "lethal triad"). Components of MTP: 1. Initial Activation Criteria Suspected massive hemorrhage (e.g., trauma, obstetric hemorrhage, GI bleed). Clinical signs: hypotension, tachycardia, or clinical shock with uncontrolled bleeding. Laboratory triggers: Base deficit >6 mmol/L. INR >1.5. Hemoglobin <7 g/dL. 2. Resuscitation Ratios Administer blood products in a balanced ratio to prevent coagulopathy: PRBCs : Fresh Frozen Plasma (FFP) : Platelets = 1:1:1 or 2:1:1. PRBCs: To restore oxygen-carrying capacity. FFP: To replenish coagulation factors (start with 4 units after 4 PRBCs). Platelets: Maintain platelet count >50,000/μL (>100,000/μL in neurosurgical or obstetric cases). 3. Adjunctive Therapies Tranexamic Acid (TXA): Dose: 1 g IV over 10 minutes, followed by 1 g over 8 hours. Administer within 3 hours of trauma if indicated. Cryoprecipitate: Administer if fibrinogen <100-150 mg/dL. Dose: 10 units or target fibrinogen >200 mg/dL. Calcium Replacement: Use calcium gluconate or calcium chloride to prevent hypocalcemia from citrate in blood products. Goal ionized calcium >1.1 mmol/L. Correct Hypothermia: Use warming devices to keep body temperature >36°C. Correct Acidosis: Target pH >7.2 using bicarbonate if necessary. 4. Laboratory Monitoring Perform serial labs every 30–60 minutes or after every major intervention: Complete blood count (CBC). Coagulation studies (PT/INR, aPTT). Fibrinogen levels. Electrolytes, calcium, and lactate. 5. Endpoints of Resuscitation Hemodynamic stability achieved. Control of bleeding (surgical or radiologic). Normalization of lab parameters: INR <1.5. Fibrinogen >200 mg/dL. Platelets >50,000/μL. Complications to Monitor For: Volume overload (e.g., pulmonary edema). Hyperkalemia or citrate toxicity. Disseminated Intravascular Coagulation (DIC). Cessation of MTP: Stop MTP when bleeding is controlled, or laboratory targets are met. Transition to standard care for anemia and ongoing management. This protocol is adapted and customizable to institutional policies and patient-specific factors.

Packed RBCs transfusion من كتاب Ahmed for pediatric emergency

Insulin in DKA: 1. the initial dose is 0.1 unit/kg, with target RBS refuction by 50-90 mg/dl per hr. No max dose. و يا ريت العالم تقتنع بهالشي. بيشنت الرندوم ماله ما ينزل عن 500، و مبقينه 7 وحدات بالساعة، من تحاجيهم يبقى يعترض بشي هو اصلا جاهل بيه. 2. Adminstration: IV route is preferred. SC or IM route can be used in mild to moderate DKA. IV: The preferred way is to add 50 units insulin in 50 cc NS (final conc is 1 unit/1 ml). الكثير يخلي 50 وحده ب 500 سيسي. يعني اذا تريد تنطي 14 وحده انسولين، لازم تنطي 140 سيسي و هذا يعتبر hidden not calculated fluid ممكن يدخل البيشنت بمضاعفات انت ما ماخذ بالك منها. فمن تنطي 140 سيسي، لازم الفلود الي حاسبه تقلل منه 140، و هذا الشي لم و لن يطبق. 3. contraindications: insulin should be #discontinued if serum K was <3.3 even if he has severe acidosis !!!!

old age F with -ve past hx, presented with dry cough for >2 mn, associated with fever, wt loss. Otherwise, no significant symptoms. no hx of TB contact. طبعا هذا واضح Cavitary lung lesion و ال ddx جدا هواي، منها lung CA (SCC) lung abscess TB fungal infection Granulomatosis with polyangitis شلون راح تسوون evaluation يعني شنو الـ next step حتى rule out or rule in CA lung?? و مثل مجاي تلحظون هذا peripheral cavitation يعني اكيد ال bronchoscope ما راح يوصله. #radiology

An interesting CXR: miliary TB + right side pleural effusion. can you notice one extra finding??? @AASmedicalbot #radiology

السلام عليكم كتابي الاطفال صار متواجد و راح يبدء توصيل الطلبات أن شاء الله.

although epigastric pain in old age >>> think about cardiac pain. But, please do not forget other serious causes of pain in this area: dissecting aorta perforated viscus acute pancreatitis pulmonary embolism pneumothorax ruptured hepatic cyst (e.g, hydatid cyst) this pt has perforated viscous (air under diaphragm).

لا المال يبقى ولا الأرواح خالدة لا شيء يبقى سوى ذكراك والأثر يفنى العباد و لا تفنى صنائعهم فاختر لنفسك ما يحلو به الأثر كلمات للأستاذ، الأب، المربي، الخلوق و المحترم، الأستاذ مجيد الحمامي الذي غادر عالمنا بعد صراعهِ مع المرض. أسمع كلماته الأبويه و راح تعرف شگد خسارتنا كبيرة بيه. (أنتم طلابي، و أني احبكم) الفاتحة أخوان، بارك الله فيكم.

Diabetic patient presented with high grade fever how to progress in his Rx. he has CKD on medical Rx.

Name this test??

improvement of weakness in a patient with acute ischemic stroke after alteplase (actilyse) adminstration. دكتور الجملة العصبية، علي عزيز

Encysted pleural effusion in a patient with previous hx of community acquired pneumonia who developed complicated parapnrumonic effusion CPPE, but refuse pleural aspiration. Now, this CPPE transformed into empyema (mostly), and it needs chest tube for drainage. 1) what is the difference between: simple parapneumonic effusion vs complicated parapneumonic effusion vs empyema 2) mention one additional chest X ray findings beside the encysted effusion

In addition to the commonly recognized risk factor of alcoholism, and the perhaps less commonly known but logically obvious risk factors such as bariatric surgery and chronic illness, another patient who is typically thiamine deficient is the patient in septic shock. Thiamine deficiency is extremely common in sepsis patients and is associated with an increased risk of death. Indeed, thiamine has been explored as part of sepsis resuscitation protocols, though its exact role has not been definitively determined.

الحمد لله نعلن انفتاح الحجز المسبق لكتاب Ahmed for neonatology and pediatric emergency اغلب الي موجودين عدهم فكرة عن الكتاب، فما راح اشرح عنه. الكتاب متوفر فقط في مكتبة جمان. سعر الكتاب 28 ألف دينار عراقي. للحجز، مراسلة المكتبة على أحد صفحاتها انستكرام juman_medical_library https://www.instagram.com/juman_medical_library/profilecard/?igsh=Mjl4dXFjdHdhcXJp فيسبوك جمان للكتب الطبية https://www.facebook.com/juman.library?mibextid=ZbWKwL حساب التلكرام T.me/Juman_library واتساب +9647759137993

Hypernatremia

رسالة أحد الأطباء المنضمين لكورس طوارىء الباطنية (اعتقد كان ناشرها ستوريات، لذلك دزهن الي على شكل صور). الشعور الي تولده هيج كلمات محفزة، صعب اوصفه الكم. و لله الحمد، من أقدم المحاضرة، ما ابقي معلومة عندي بخصوص الموضوع (حتى تميزني عن المشتركين) إلا و قدمتها، هذا سواء كان على مستوى الكورس او على مستوى البثوث الي نسويها بالقناة. و الي يحفزك حتى تقدم أكثر ما لديك هو دعوات الكثير من الإصدقاء لك في ظهر الغيب. بالنسبة للمهتمين بكورس الباطنية يكدرون يلكون تفاصيل عنه هنا، او يكدرون يراسلوني ع حسابي @AhmedAbdSam

من محاسن الصدف: البارحة أجونا للطوارىء كيسين the first case: hx of forgetfullness, disorientation, and repeated fit. serum Na was 105. weight 75 the second case: decrease oral intake, dyspnea, edema, and disorientation. serum Na 182 weight 80 شلون تتعاملون مع هيج كيسات بالطووووووارىء.

Wet purpura in a patient with ITP. Wet purpura herald high risk of ICH. PLT count was 5 !!!!!!

شويه و نسوي بث ع هاي المحاضرة pediatric Packed RBC transfusion

for Discussion???