BATCH 23 MEDICAL UST #دفعة الدكتور حسن العريفي

طالما أنك ذكرت الحروق ، هذي معلومة عنها ، مهمة جدا في الجراحة لازم الكل يكون عارفها . 🔺Fluids resuscitation in burns:- 🔹 Parkland Formula: 4 mL x [Total Body Surface Area Burned (%)] x [body weight (kg)] given in 24 hours. ▫️ 50% given over 8 hours and 50% given over the next 16 hours. 🔹 Brooke Formula: 2 mL x [Total Body Surface Area Burned (%)] x [body weight (kg)] given in 24 hours . ▫️ 50% given over 8 hours and 50% given over the next 16 hours. ▫️ 2009 military study evaluated Parkland vs. Brooke formulas for severe burn patients and found the outcomes were the same . ▫️ Guidelines are in flux on which formula to use, but reducing the overall volume using the Brooke formula can be done without significant change in morbidity or mortality . ▫️ Using fluid responsiveness by measuring urine output and signs of fluid overload can help guide overall resuscitative approach in burn patients.

Treatment of Internal Hemorrhoids: Patients with mild to moderate internal hemorrhoids (grades I-II) and constipation are treated with fiber, fluids, and possibly laxatives to improve their bowel habits. For most of these patients this medical treatment to improve their bowel function will resolve their hemorrhoidal symptoms. For patients with “hemorrhoids” and hyperactive bowel function, treatment should be directed at the cause of the diarrhea/multiple bowel movements. #surgery

Causes of rectal bleeding: Hemorrhoids Anal fissure Proctitis Anal fistula Cancer Ulceration/infection Rectal prolapsed/solitary rectal ulcer

Causes of anorectal discharge: Prolapsing internal hemorrhoids Anal fistula Proctitis Rectal polyp (villous adenoma) Anal or rectal cancer Anal warts Mucosal/rectal prolapsed Fecal incontinence/leakage (multiple etiologies) Post-surgical: keyhole deformity

Causes of anorectal mass: Thrombosed external hemorrhoids Sentinel tag Anal skin tag Anal condyloma Anorectal abscess Hypertrophied anal papilla Internal hemorrhoids Rectal polyp Anal or rectal cancer Unusual tumors: GIST, lipoma, endometriosis

🌱 How to diff between hemothorax and pneumothorax clinical y ? By percussion : In hemothorax dull but in pneumothorax hyper.resonant . 🌱 Causes of decrease venus return in case of chest truma ? Due to moving mediastinum from side to side during breathing ( mediastinal flutter ) Or due to compression of mediastenum by tension pneumothorax .