IV Notes 💉

معلومة في الوريد 💉 عشان توفر على نفسك وقت ومجهود وتوفر على العيان وقت ومخاطر مهم جداً تعرف العيان بتاعك ده غالباً ايه ال complications اللي ممكن تحصله نتيجة الحالة المرضية اللي هو فيها , خلينا ناخد مثال وانت تفهم قصدي .. عيان لسة عامل Aortic valve replacement ايه اللي احط عيني عليه أخاف ليحصله ؟ 1- Aortic regurgitation : due to unfit size of valve or improper position 2- Ischemic stroke : due to embolization of calcified valve 3- Myocardial infarction : due to obstruction of coronary ostia ده منظر ال Valve في الصورة يا إما حجمه مش مظبوط وهيعمل ارتجاع يا إما هيحصل عليه ترسيبات وتفك وتعمل stroke يا إما هيسد فتحة ال coronary اللي هي قريبة من ال valve جدا وتعمل MI , أي شك ولو صغير في الأمور دي في عيان مغير صمام لازم تتاخد على محمل الخطورة والجد لأنه معرض ليهم أكتر من غيره فبدل ما تقعد تفكر في كتاب الباطنة كله لو جالك اشتكالك من أحد ال complications دي لأ وفر وقتك ووقته و focus على مشكلتك . 🧠🫀 #By_Dr_Mo #IV_Notes

This patient's clinical presentation—chest discomfort, ST elevation on ECG, elevated troponin I level—is consistent with acute myocardial infarction . Beta blockers are used in MI to reduce myocardial oxygen demand by lowering heart rate, cardiac contractility. Contraindications to beta blockers include bradycardia or heart block, hypotension, and overt heart failure (eg, pulmonary edema). Also, non-cardioselective beta blockers (eg, propranolol) can trigger bronchospasm in patients with underlying obstructive lung disease due to beta-2 receptor blockade and should be avoided Cardioselective beta blockers with predominant action on beta-1 receptors (eg, metoprolol, atenolol, bisoprolol, nebivolol) are safe in patients with stable obstructive lung disease and are the beta blocker of choice in these patients. Sotalol is a class III antiarrhythmic drug with beta blocker properties and is primarily used for the treatment of atrial and ventricular arrhythmias. It would not be indicated in a patient with a recent myocardial infarction who is in sinus rhythm.

60y COPD man presented with chest pain, it was intermittent over the last 3 days but now sustained. The patient has no associated palpitations, lightheadedness, or shortness of breath. Blood pressure is 145/90 mm Hg and pulse is 93/min. Oxygen saturation by pulse oximetry is 98% on room air. Physical examination shows no heart murmurs, and lungs are clear to auscultation. ECG shows sinus rhythm with 2-mm anterior ST segment elevation , troponin positive .

فاكرين الحالة دي قولت ساعتها ده أنا لو عندي خراج في صباعي مليان pus ميصحش اخد مضاد حيوي فقط ولازم افتحه ، ما بالك لو الخراج ده في ال chest طب ما بالك هنا بقى لو الخراج ده في القلب 😃 ميصحش ابدا اسيبه كدة ي irritate ال heart أكتر من كدة وميصحش مخدش ال fluid ده أزرعه وأشوف ال organism بالظبط والمضاد الحيوي المناسب ، دي حالة fatal اعمل كل حاجة وأي حاجة تأمنك وتأمن العيان

This patient has fever, chills, leukocytosis with left shift, new arrhythmia, and a pericardial effusion . This presentation is most concerning for purulent pericarditis. Purulent pericarditis is an acute febrile illness resulting from bacterial infection (or fungal infection) of the pericardium. Chronic hemodialysis places patients at increased risk. Other causes include direct spread from an intrathoracic infection (pneumonia) and inoculation of bacteria into the pericardium during cardiothoracic surgery. Purulent pericarditis is rapidly progressive and highly fatal; hence, prompt diagnosis and treatment are necessary . Affected patients typically have systemic symptoms (eg, fever, chills, fatigue) and chest pain and appear severely ill on examination. Tachycardia is typical, and sometimes, new arrhythmias (eg, atrial fibrillation) can occur due to epicardial inflammation and irritation. Pericardial effusion commonly develops due to exudative fluid buildup in the pericardial space and can lead to distant heart sounds and low-voltage QRS complexes on ECG. Chest x-ray may show an enlarged cardiac silhouette with clear lung fields. Cardiac tamponade can sometimes develop. Echocardiography confirms pericardial effusion but cannot distinguish whether it is purulent. Therefore, when purulent pericarditis is suspected, urgent pericardiocentesis is indicated for both confirmation of the diagnosis and treatment (removal of infectious fluid). Purulent fluid is usually turbid due to a high leukocyte count (neutrophil predominant), and Gram stain and culture often reveal the causative organism to guide antibiotic therapy.

حالة بتعبر عن فقة الأولوليات بشدة 🤌

64y diabetic hypertensive CKD man comes to ER due to 2 days of fevers, chills, and chest pain. The patient undergoes hemodialysis 3 times a week but missed his last session because he did not feel well. Temperature is 39.2 , blood pressure is 100/60 mm Hg, pulse is 130/min and irregular, and respirations are 20/min. The patient appears unwell. Examination shows clear lungs, distant heart sounds, no heart murmurs, and minimal lower extremity edema. The dialysis catheter site appears clean. The remainder of the examination shows no abnormalities. Blood leukocytes are 25,000 ,80% neutrophils. ECG shows atrial fibrillation with rapid ventricular response and low-amplitude QRS complexes. Chest x-ray reveals normal lung fields. Bedside echocardiography reveals normal left and right ventricular function, no significant valvular disease, and a moderate pericardial effusion with no evidence of tamponade. Blood cultures are obtained, and broad-spectrum antibiotics are administered.

معلومة في الوريد 💉 ال Progesterone كمثبت للحمل هو أكبر فقاعة في التاريخ طبعا زي ما إحنا عارفين 😃 بعض دكاترة النسا بتكتبهم كنوع من أنواع الروتين عشان تريح المدام نفسياً مش أكتر , أومال بقى لو اتكلمنا صح إمتى ال progesterone يستخدم كمثبت للحمل ؟ في حالة إن يكون عندي Progesterone dificency , طيب وده بيحصل إمتى ؟ هو مين اللي ماسك ال progesterone في الحمل ؟ ال corpus leteum في أول 3 شهور ثم ال placenta بعد كدة . وبالتالي ممكن يحصل في ال 1st trimester in case of corpus leuteum insufficincy وممكن يحصل في ال 2nd or 3rd في حالة placental insufficincy 👩‍⚕️👩‍⚕️ #By_Dr_Mo #iv_notes

معلومة في الوريد 💉 دور ال steroid في ال Bell's palsy مقتصر فقط على أول 3 أسابيع لأن كل وظيفته إنه يحسن ال Edema وال Edema بتنتهي بعد 3 أسابيع , فلو جالك بعد 3 أسابيع ووصفت steroid يبقى كدة عك . 💊💊 #By_Dr_Mo #iv_notes

مش هقول بعيداً عن محتوى القناة , لأني الحقيقة جاي أطلب إنه يكون صلب المحتوى جوة كل واحد .. اعقد نية في نفسك في كل لحظة تعب انت بتتعبها دلوقتي سواء في شغل أو مذاكرة أو سعى بتسعاه إنك من خلال ثغرك تكون في طلائع الدفاع عن أمتك كما إخوانك المخذولين هناك , يمكن متعرفش دلوقتي ازاي ممكن تكون في الطلائع من خلال اللي بتعمله حتى وانت تمارس أضعف الإيمان ( بقلبك ) ولكن عقد نواياك من الأن فيه الحسنيين يا إما هتقدر تقدملهم شئ حينما يفتح عليك الله بما تستطع أو أنك قد أُجرت عن نواياك الحسنة , فالنية هي مبدأ كل عمل وأصله .

معلومة في الوريد 💉 فرق بسيط بس مهم بين ال thrombocytopenia & Hemophilia إن ال thrombocytopenia بتعمل نزيف من غير trauma أما ال Hemophilia لازملها trauma عشان تنزف 🩸🩸 #IV_notes #By_Dr_Mo

معلومة في الوريد 💉 عيانين ال asthma ممنوع عنهم المكسنات لأنها بتزود ال attack عشان بتقفل طريق ال cox وبتوجه كل ال mediators ناحية طريق ال lox اللي بيعمل ال asthma طيب بعيدا عن ال paracetamol هل كل المسكنات ممنوعة ؟ لأ ال selective cox2 inhibitors زي ال celecoxib مفيش منهم مشكلة لأن ال asthma بتشتغل على cox 1 فقط 💊💊 #By_Dr_Mo #iv_notes

Severe epigastric pain radiating to the back accompanied by nausea/vomiting and elevated pancreatic enzymes (amylase, lipase) is highly suggestive of acute pancreatitis. Other common features include abdominal distention, decreased bowel sounds, and signs of shock. Alcohol use is a common cause of acute pancreatitis. MI would not explain this patient's elevated amylase and lipase or his abdominal distention and epigastric tenderness. PUD would also not explain the elevated lipase, and onset of symptoms would likely be less acute than in this patient aortic dissection would not explain this patient's largely epigastric pain and elevated amylase and lipase. In esophageal rapture patients classically present with mediastinal crepitus on exam, and a crunching heard over the precordium as the heart beats against air-filled tissues (Hamman's sign) also no reason for elevated serum amylase and lipase levels. Acute mesenteric ischemia abdominal pain is often out of proportion to examination findings rather than patients exhibiting guarding and tenderness. Furthermore, this patient has no additional risk factors for thromboembolism such as atrial fibrillation, and mesenteric ischemia would manifest with an elevated lactate and LDH rather than elevated lipase and amylase.

> Mohammed Hosni: A 50y smoker, alcoholic man comes to you because of severe lower chest pain for the past hour. The pain radiates to the back and is associated with nausea. He has had two episodes of non-bloody vomiting since the pain started. He has a history of hypertension and type 2 diabetes mellitus. His medications include enalapril and metformin. His temperature is 38.5 , pulse is 110, and blood pressure is 90/60. The lungs are clear to auscultation. Examination shows a distended abdomen with epigastric tenderness and guarding but no rebound; bowel sounds are decreased. Laboratory studies show: Hemoglobin 14.5 g/dL Leukocyte count 5,100/mm3 Platelet count 280,000/mm3 Serum Na+ 133 mEq/L K+ 3.5 mEq/L Cl- 98 mEq/L Total bilirubin 1.0 mg/dL Amylase 160 U/L Lipase 880 U/L ECG :