SubGroup A

👥 أسعد الله مسائكم بِكل خير .. 🖋 دوام يوم غدٍ الأربعاء كما في الجدول كالتالي  : 🌟المكان : مستشفى الثورة - قسم الجراحة 🌟الوقت : 9:00 صباحًا إلى 11:00 ظهرًا 🌟الدكتور/ة : عبدالكريم العامري ⬅️ الموضوع : DVT ‼️الدكتور يبلغكم تأخذوا حالات. #SubGroup_A

و هذول الثنتين التقسيمات اللي قالهن لما حضر لنا مجموعات في صورة واحدة .

👥 أسعد الله مسائكم بِكل خير .. 🖋 دوام يوم غدٍ الثلاثاء كما في الجدول كالتالي  : 🌟المكان : مستشفى الثورة - قسم الجراحة 🌟الوقت : 9:30 صباحًا إلى 11:00 ظهرًا 🌟الدكتور/ة : نبيل المضواحي ⬅️ الموضوع : Congenital vascular disease ‼️الدكتور يبلغكم تأخذوا حالات . #SubGroup_A

⭐Part 2 *Atrial fibrillation ( most serious as complicated by mural thrombosis & emboli) . *pulmonary HTN ( backward consequence ) *cardiogenic shock ( forward consequence ) note : always consider preload, afterload , & contractlity when dealing with heart diseases . never do surgery for old age pt with pulmonary HTN especially females . if necessary ,anticogulate the pt untill ACT « activated clotting time » becomes 400 or more « normally it's up to 180 » . antidote of heparin is protamine. which may cause anaphylactic reactions in some female pt. ◼️ if a heumatic heart disease pt come to ER with AF first chech if AF is with : 1- high ventriclar rate ( serious ) 2- low ventriclar rate look for the ECG & BP : if there is drop of BP, so the pt needs DC shock. also ask about the duration of AF if it's 72 hrs or more : anticogulate the pt . ( it's estimated that it takes 72hrs ,since onset of AF, to develop thrombosis ) #SubGroup_A

الأسبوع الأول : ملخص محاضرة الدكتور / زيد شيبان ⭐Part 1 ▪️Psoas sign : right hip flextion for relief of pain of appendicitis , because an inflamed appendix lies on the psoas muscle. ▪️ pain of pancreatitis is relieved by leaning forwards. ▪️in case of pleural effusion in one side, the pt prefers to sleep on that side, so the other lung can fully expand during breathing . 💡the decubitus and gate of pt is very important as they change with many illnesses so you can search and read about them . 🔹as the pt lost consciousnesses you must check his state of hydration , nutrition : * dehydration : loss of total body water. ( lose of interacelluar water leads to hypertoncity ) there is loss of water more than Na loss. * volume depletion : loss of extracelluar volume only ( proportionate loss of water and Na) as in vomiting , diarrhoea , polyuria,) ▫️ dehydrated pt is assessed by : sunken eyes, dryness of tongue , loss of skin elasticity , low urine output , absence of axillary sweating . ▫️assessment of subcutaneous fat : over triceps, subscapular , thighs, buttocks . ▪️assessment of muscle mass: tricpes, biceps, muscles of legs .. ▪️BMI = less than 16 —› severe malnourished more than 25 —› overweight more than 30 —› obese 🔹Tilt test : read about pathophysiology ( important ) the pt is kept in a spuine position for 2 mins then he stands up then his B.P and heart rate are measured to evaluate the cause of repeated unexplained episodes of lightheadedness, dizziness or fainting. The test can help determine if the cause is related to your heart rate or blood pressure. ◼️ capillary refill time : normal if refilling is within 3 seconds . it's prolonged in pt with hypovolumic shock . *cardiogenic shock : persistent drop of cardiac output despite normal blood volume. 🔶 Vascular diseases : in atherosclerosis : the fat deposition is subintimal and my extend to the muscular layer. 🔹in peripheral vascular diseases if it's : *chronic : look for trophic changes like atrophic skin, loss of hair , color changes and ulcers. *acute ( which may be caused by embolism , thrombosis , or trauma.) : look for the six Ps : painful, pluseless, pale, paralysis , perishing cold, paraesthesia. * intermittent claudication: exertional pain of calf muscles ▪️you must assess the functional capacity of pt : how far he used to walk? and how illness restricted his activities? ans does pain comes at rest or with exertion . in low functional capacity you will notice the pt changes his posture to use muscles unaffected by the vascular disease. ◼️collaterals take time to develop so they're found in chronic vascular diseases but not in acute state. ▫️when there are collaterals › good prognosis. ◼️saphenous vein is rich site for collaterals while popliteal vein is poor site . 🔹 internal mammary aa are better for coronary bypass surgery than saphenous veins ( there is intimal hyperplasia of saphenous vein ) 🔹statins are the best antilipid drugs as they can regress the size of atherosclerosis. ▫️Arteriosclerosis : arterial wall thickening and loss of elasticity. Aneurysm : dilation of blood vessels or heart. it involves all the 3 layers of artery. especially the media where there is loss of elasticity of internal & external lamina . complications of aneurysm : obstruction , embolism , rupture , compression of adjacent structures « symptoms of mediastainal compression like dysphagia, dyspnea, cough, hoarseness of voice » ◼️ aortic dissection : A tear in the intima leads to blood surging into the aortic media separating the intima and adventitia. the pattern of pain of acute dissection : sudden onset of stabbing or tearing ( very severe, worse than that of MI) pain in ant. chest radiated to the back between scapulae . there is also loss of consciousnesses and multiorgan failure .( so do a review for all systems ) 🔹 a valvular disease that can cause mediastinal compression is Mitral stenosis ( left atrial enlargement ) consequences of Lt. atrial enlargement : #SubGroup_A

👥 أسعد الله مسائكم بِكل خير .. 🖋 دوام يوم غدٍ الاثنين كما في الجدول كالتالي  : 🌟المكان : مستشفى الثورة - قسم الجراحة 🌟الوقت : 8:00 صباحًا إلى 11:00 ظهرًا 🌟الدكتور/ة : زيد شيبان ⬅️ الموضوع : aneurysms ‼️الدكتور يبلغكم تأخذوا حالات . #SubGroup_A

👥 أسعد الله مسائكم بِكل خير .. 🖋 دوام يوم غدٍ الأحد كما في الجدول كالتالي  : 🌟المكان : مركز القلب - مستشفى العسكري 🌟الوقت : 9:00 صباحًا إلى 11:00 ظهرًا 🌟الدكتور/ة : عبدالعزيز الجعدي ⬅️ الموضوع : investigations of vascular injury #SubGroup_A

متى نطلب Brain CT  بعد head trauma خاصة ان الحالات شبه متكررة يوميا مع الأطفال في الاستقبال ‼️ 1️⃣  لو Glasgow Coma Scale اقل من 15  خلال ساعتين من ال trauma 2️⃣ لو فحصت الرأس ووجدت Open or Depressed Skull Fracture و هنا لازم نفحص الرأس جيدا خاصه لو الشعر كثيف لان الشعر احيانا بيحجب ال injury 3️⃣ لو الشخص رجع مرتين او أكثر لازم مقطعيه على الفور 4️⃣ لو حصل  inconvulsions  بعد ال  head trauma خاصه لو المريض ليس مريض Epilepsy 5️⃣ لو حصل اي neurological deficits  بعد ال head trauma زي ال weakness, numbness, tingling, or coordination difficulties in a specific limb or facial area 6️⃣ لو المريض 65 سنة او اكثر لان كبار السن هم أكثر عرضة ل intracranial haemorrhage بعد head trauma 7️⃣ لو ظهرت علامة من علامات Basal Skull Fracture Signs زي raccoon eyes, Battle’s sign 8️⃣ لو حدث CSF Leakage from Ear or Nose #SubGroup_A

▫️Head Trauma Map 🧠 #SubGroup_A

👥 أسعد الله مسائكم بِكل خير .. 🖋 دوام يوم غدٍ السبت كما في الجدول كالتالي  : 🌟المكان : المستشفى العسكري 🌟الوقت : 8:00 صباحًا إلى 11:00 ظهرًا 🌟الدكتور/ة : علي الحوثي ⬅️ الموضوع : Head Trauma ‼️الدكتور يبلغكم تحضروا الموضوع و تأخذوا حالات. #SubGroup_A

🔴الملفات مرسلة من الدكتور أحمد العنسي 🔼