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Channel Posts
| 2 | Share '🔸 Abdominal examination 🔸.pdf' | 1 168 |
| 3 | 🔴Foley catheter
IVU Intra venous contrast
Cystogram, retrograde urethrogram (contrast)
Vesicourethral reflex in children valve damage
Diagnostic of foley catheter
Collect urine, contrast study, cysyometry
Therapeutic
Drain the bladder, prevent obstruction, rest the bladder لان ال سترچ اابلدر ممكن يأثر عل ووند هيلنغ
# Indication of foley catheter :
Pelvic bone fracture (immobilization for healing)
adminstration of medications
#Types of urethral catheter
Simple and indwelling
Simple catheter --> for urine sample, contrast material, obstetrics (second stage of labor)
Indwelling catheter --> اوتكعد بل بلدر لوقت ساعات او ايام أسابيع حسب
Foley catheter اشهر وحده retention mechanism is ballon
# Types of foley catheter :
_ According to number of....
Two way catheter --> one for drianage and other for ballon
Three way catheter --> one single use for bladder irrigation
Bleeding (in hematuria) bec. Perforation or trauma for prevent clotting do continuos fluid runing and out
For input and output at same time
_ According to material
Latex : cause more reaction and more colonizable
Silicon : less reactive less allergy less risk of bacteria but is expensive
Silicon cot Latex :
Short term العاديه
Long term السليكون
# Contra Indication :
Allergy, partial urethral injury (drop of blood in external urethral meatus), acute Bacterial prostatitis (sepsis)
# Complication :
Infection, injury (acute at the time of insertion injury to prostate_false passage, chronic injury continuos irritation to the catheter "bulbar" cause fibrinous)
** Latex can remain up to 3 weeks
Silicon can remian upto 6 weeks
Size (diameter)
6 to 26
Indication of size
Underlying pathology (urethral stricture select narrow,
Age
Gender
16 french in adult
24 french catheter after prostactomy for 3 way catheter لان غالبا ذوله عدهم post.bleeding فعلمود تفوت الكلوت
2cc lidocaine
10 ml N/S | 1 198 |
| 4 | Ulcer+diabetic foot .pdf | 781 |
| 5 | Share 'post op (drainage types).pdf' | 776 |
| 6 | 🔴Abdominal pain
▪️History
➰Site, onset (sudden or gradual), radiation, associated symtoms, menstrual period
➰Epigastric oain in elderly --> ECG
➰Constant باقي --> indicate inflammation
or colicky لويات وراها يروح الالم وهكذا (occur in obstruction)
➰Biliary colic and renal colic اكو الم بس يزيد ويقل يعني هو مو كوليك الكوليك الحقيقي يروح وييجي
▪️Inspection
➰Shape
Flat --> normal
Scaphoid --> dehydrated esp. in child, malignancy
Distended abdomin (5F)
➰Symmetrical or asymmetrical
➰Umbilicus
inverted --> normal
everted -->
▪️Visible cough impulse
▪️Abdomin not move with respiration --> indicate peritonitis
▪️Palpation (superficial and deep)
Superficial --> tenderness, rebound tenderness, guarding (الايد من تنحط عل voluntary مكان بل بطن عضلات البطن تتقلص), rigidity (بدون منحط الايد هو متقلص involuntary)
🔸شون نفرق هاي سوبرفيشيل ماس لو ديب ماس نكول للمريض يرفع راسه وينزل نسوي تنسنگ لعضلات البطن اذا الماس اختفت معناها ديب واذا ظهرت اكثر فهي سوبرفيشيل
Deep --> deep tenderness (abscess may be), deep mass, hepatospleenomegaly
▪️Auscultation خاصه بعد العمليه --> at machburny point (ileocecal valve)
Absent bowel sound --> paralytic ileus
▪️Hernial oriffices, DRE, vaginal exam, cervical lymph node (virchow's lumph node) and femoral artery pulsation
▪️Peristalisis increase in intestinal obstruction --> so pain occur
▪️Infarction --> very severe pain
▪️Irregular irregular pulse (AF) --> cause emboli to sup. mesenteric artery --> infarction --> severe abd. pain
ex. elderly with very severe abd.pain with soft abdomin --> mesenteric ischemia
🔺Hemorrhage
*The onset is always rapid
*Signs of shock and collapse precede the pain
*Cullen's and Grey Turner's signs تطلع وره ٣-٤ ايام من الهيمورج
cullen (around umbilicus), grey turner بلصفحه
▪️Hx. of any abnormality in MC in female childbearing age + sudden onset of abdominal pain --> ectopic pregnancy
▪️Pelvic appendix --> diarrhea, dysuria
rupture of appendix --> generalized appendicitis
Psoas sign --> reproduction of pain right iliac fossa نسوي اكستنشن للهب جوينت
obturator sign --> flexion of hip نفره
🔸اذا التقيوء بده قبل الالم مال بطن الموضوع اكثر شي يخص الباطنيه
🔺Murphy's sign
راح نلگي تندرنس بright upper quadrant نحط الthumb على 9th costal margin ونگله ياخذ نفس من ياخذ نفس الgall bladder تجي عل بريتونيم يصير الم كلش قوي يكطع النفس مالته
**Whenever examine acute abdomin and can not found obvious cause --> think acute pancreatits or mesenteric vascular infarction or keaking abdominal aortic aneurysm
🔺Chronic cholecystitis --> dyspepsia | 783 |
| 7 | ## 60% water content
## D5% is isotonic initially & become hypotonic when dextrose is metabolized or become hypertonic in DM pt. --> so not used in resucitation
## Tonicity --> according to molecular wt
## Overuse of Nacl --> hyperchloremic metabolic acidosis
So prefer ringer (content similar to plasma & less risk of hyperchloremic MA)
🔺 Isotonic is CI in HF, edema, HTN, hyper Na, infant <2m (immature kidney), drugs (amiodarone, amphotericin B, adrenaline, valium)
🔺 Ringer Na 147 Cl 156 K4 Ca4.5
## Not give with cephalosporin (formation of white crystals in lung & kidney lead to death)
🔺 Ringer lactate (Hartman solution) Na 130 Cl 108 K4 Ca2.7 lactate 28
## tx mild acidosis
## CI in liver disease or DM pt ot lactic acidosis
## Burn parkland formula 4ml×wt× TBSA% (half given in 1st 8h & other half next 16h) | 628 |
| 8 | Fluid 💦 👇 | 598 |
| 9 |  No text... | 612 |
| 10 | 📍 Cushing triad (pressure on brain stem)--> HTN + bradycardia + disorderd breathing
## Urgent CT
📍 Acute cerebellar Hge with Hydrocephalus (hematoma) --> top emergency burr holes & evacuate (within minutes) & shunt
## correct coagulation by plasma
📍 Causes of increase ICP
1- CSF 10% --> overproduction by choroid plexus or obstruction by tumor or arachnoid villi
2- Blood 10% --> hematoma
3- Brain 80% --> tumor abscess
## Above 2y --> will see copper beating appearance (x-ray )
## Lateral ventricle (production of CSF) --> top 3rd ventricle --> floor of 4th ventricle
## 4th ventricle dilation --> communicating can do LP
📍 Hydrocephalus
## Collection of CSF within ventricular system either due to obstruction or over production
## Complications of shunt --> infection 40%, over drainage, malfunction
## External shunt --> for intrathecal ABs in resistant case or see the amount
📍 Neural tube defect
Occulta (without visible herniation)
Cystica (sac covering)
Aperta (neurological defect) = myelomeningocele --> failure of closure of post arch on neural tube+/- herniation of neural tissue
## Complications : Hydrocephalus, Meningitis, recurrent UTI, renal failure (most common cause of death)
## associated with --> Hydrocephalus, congenital defect
## surgery --> immediate closure within 48h if it is rupture
📍 6 power
5 --> normal
4 --> weakness
3 --> against gravity
2 --> with gravity
1 --> some contraction
0 --> no
📍 GCS < 8 --> mandatory need intubation (sedation then put it bc without sedation with cause shouting BP)
📍 Cold 🥶 --> for prevent epilepsy/ awake craniotomy
Warm 🥵 --> for homeostasis/ rapid aggregation of platelets
📍 Sensation area in brain --> dura & scalp
📍 Indications of hematoma surgery
1- Deterioration of GCS
2- Extension of mass
3- Progressive neurological defect
4- Focal neural signs
5_ Intractable raise ICP
📍 Dura --> bluish color
## Epidura --> hematoma (life threatening by pressure effect)
While Subdura --> bloody (serious)
📍 Herniation --> occur in pressure difference from site to other or supratentorial & infratentorial or ant fossa & post fossa or orbital cavity & ant cavity
📍 Romberg sign --> dorsal column like tabes dorsalis, vit B12 deficiency, peripheral neuropathy, cerebellar disorder
📍 Indications of admission to hospital
1- hx of LOC
2- hx of convulsion
3- on Anticoagulant
4- medical disease --> MI attack
5- persistent headache & vomiting
6- extreme age
7- multiple or associated injury
8- alcoholic
9- doubtful case
10- fracture
📍 Normal brain reflexes --> 6 (conscious,pupillary, corneal, gag, respiratory , cough)
## Abnormal reflexes --> grasp, glabeller, snout, gaw
📍 SAH
3H --> hyperventilation, hypervolemia, hypertension
📍 Basal skull fracture
Otorrhea --> come first
Rhinorrhea --> serious
📍 Head injury+ increase ICP
1- head elevation 45⁰ for decrease CSF
2- hyperventilation
3- drugs like acetazolamide or furosemide
4- mannitol
5- decompressive craniotomy
📍 Hyperdense --> acute Hge, meningoma, medulloblastoma, calcification
Hypodense --> chronic Hge, infarction, brain abscess, Brian edema, Glioma except medulloblastoma | 661 |
| 11 | 🧠 Neuro 👇 | 555 |
| 12 | No text... | 576 |
| 13 | 🔺Vanous cutdown then CV catheter the intraosseous
## Venous cutdown --> in burn
## CV catheter --> difficult peripheral, TPN, monitoring, K >60 mmol, amiodarone
## Intraosseous --> 2cm below tibial tuberosity
🔺 Canula
Yellow 🟡 --> blue 🔵 --> pink 🍒 --> green 🍏 --> white 🤍 --> grey --> brown 🟤 (orange)🍊
## Blood transfusion --> green
## hypotension --> white/grey/ brown
Children --> blue/pink
## more deep 45⁰/ superficial 10⁰
## 30⁰
## complications :
1- infection of skin/ vein (thrombophlebitis)
2- clot emboli/ air emboli
3- injury to near structures like ulnar n
4- irritation
🔺 Examination :
1- Site
2- Color
3- working or not
4- type of fluid or drug & dose
5- surrounding skin
6- complications | 593 |
| 14 | Canula 👇 | 539 |
| 15 | 🔺
1- Evaluation of symptoms --> tachycardia then hypotension
2- UOP --> minimal 0.5 cc/kg/h
3- Capillary refill --> should be immediately
4- Conscious
🔺 Crystalloid : <3000 Dalton, can cross capillaries & renal filteration
Cheap, available & safe
## Nacl --> main electrolytes of IVC is Na
## Ringer --> physiologic solution (Na, Cl, K, lactate)
## Hartman --> lactate by liver convert to HCO3 (so use in hypovolemia associated with acidosis)
## Glucose saline --> renal failure
## 1/3, 1/5 NS --> high therapeutic index (more flexible) | 595 |
| 16 | Assess severity of internal bleeding or hypovolemia 👇 | 578 |
| 17 | 🔺 Care
1- remove stitches 🪡
2- evacuate pus & sample for C&S
3- irrigation of wound
4- remove of necrotic tissue by currete
5- Debridement
6- parenteral ABs + local antiseptic
7- Daily dressing & cut the end
8- leave open but if large 2ry suture
🔺Causes :
Systemic : immunocompromised (DM, steroid, chemotherapy, chronic HTN, liver or renal failure)
Local : foreign body (mesh), tension (necrosis of skin)
🔺
Clean --> breast, thyroid, hernia/ incisional wound (6-8h)
Clean contaminated --> cholecystectomy in chronic inflammation, GIT
Contaminated --> appendectomy with no rupture
Dirty --> ruptured appendic, rupture bowel
## Clean = incisional wound 6-8h
Contaminated = presence of bacteria <10⁵ without multiplication
Colonize = presence of bacteria with multiplication without effect host defense
Infected = with effect host defense
🔺 Types of debridement :
Surgical/ mechanical/ enzymatic/ biological/ autolytic
🔺 Dressing :
1- provide moist & clean (enhance granulation tissue & healing)
2- stop bleeding
3- protect from infection
4- keep wound warm, decrease edema & filling the gab | 640 |
| 18 | Wound infection (abdominoplasty) 👇 | 574 |
| 19 | No text... | 636 |
| 20 | Share 'checklist-post-op.pdf' | 670 |
