MEDICAL COLLECTIONS
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01 The various positions of the appendix
, Note that the commonest position is retrocaecal (74%) this is because during childhood the continous growth of the caecum rotates the appendix behind it how ever it will always remain intraperitoneal .
#Vermiform_Appendix | 142 | 1 | Loading... |
02 With new updates in 2023 in American Heart Association "AHA"
Or either European society of cardiology "ESC"
BOTH DRUGS CAN be used in patients Class I heart failure either have diabetes type 2 or not | 168 | 1 | Loading... |
03 Be in medicine
The sodium-glucose cotransporter-2 (SGLT2) inhibitors empagliflozin and dapagliflozin reduce cardiovascular death and heart failure hospitalizations in patients with heart failure. However, cardiac medications within the same class may not all have the same benefit. For example, carvedilol reduces mortality by 16% relative to metoprolol in patients with heart failure, and chlorthalidone is more potent than hydrochlorothiazide in the treatment of essential hypertension. In patients with diabetes, empagliflozin may be associated with greater weight loss, reduction of blood pressure, and reduction of cholesterol compared with dapagliflozin.In patients with heart failure, a single center retrospective study suggested that empagliflozin may be associated with improvements in left ventricular ejection fraction and functional status compared with dapagliflozin.However, the outcomes of empagliflozin vs dapagliflozin on clinically important patient-centered outcomes for patients with heart failure is unclear. In this multicenter retrospective cohort study, we sought to compare the composite outcome of all-cause mortality and hospitalization between those initiated on empagliflozin vs dapagliflozin in patients with heart failure. | 162 | 1 | Loading... |
04 Most common causes of Atrial Fibrillation:
MATCH
M—-> mitral stenosis
A——> Acute myocardial infarction
T—-> thyrotoxicosis
C—> constrictive pericarditis
H—-> hypertensive heart disease | 176 | 3 | Loading... |
05 🔴🟢كتائب القسام تنشر:
"كمين جباليا.. ستبتلعكم رمال غزة يا حثالة الأمم". | 128 | 0 | Loading... |
06 Media files | 92 | 3 | Loading... |
07 افحص قبل الزواج قبل أن تتعب روحك ومرتك وجهالك.
الثلاسيميا مرض وراثي
افحص عشان ما تنجب أطفال فيهم هذا المرض وتجلس أنت وهم تعاني طول حياتهم. | 385 | 1 | Loading... |
08 السحب بعد يومين على ١٥ ألف فائز بالمميز المجاني لمدة عام ، انضم للقناة فقط وتدخل السحب ، بالتوفيق للجميع. | 61 | 0 | Loading... |
09 Media files | 57 | 1 | Loading... |
10 Media files | 1 | 0 | Loading... |
11 السحب بعد يومين على ١٥ ألف فائز بالمميز المجاني لمدة عام ، انضم للقناة فقط وتدخل السحب ، بالتوفيق للجميع. | 1 | 0 | Loading... |
12 #خطب_ومحاضرات_صوتية
🎤 خطبة بعنوان: (دروس من أحداث غزة).
📌 د. يوسف حسين الرخمي.
🗓 الجمعة 27/ 10/ 2023م، الموافق 12/ 4/ 1445هـ . | 152 | 1 | Loading... |
13 #خطب_ومحاضرات_صوتية
🎤 خطبة بعنوان: (معركة طوفان الأقصى).
📌 د. يوسف حسين الرخمي.
🗓 الجمعة 13/ 10/ 2023م، الموافق 28/ 3/ 1445هـ . | 199 | 2 | Loading... |
14 السلام عليكم ورحمة الله
بالنسبة لمستوى رابع
معك نظري من الساعة 8 إلى 10 ومن 12الى 2
تدرسوا الكل في القاعة تماما مثل ثالث
الراوند من 10الى12
با يقسموكم ثلاث مجاميع للثلاثة الاقسام: باطنة- جراحة- نسائية
بحيث كل مجموعة تبدأ راوند مختلف لمدة شهرين وبعدين تاخذ الذي بعد
يعني الذي با يبدأ باطنة لمدة شهرين ثم جراحة واخر شي النسائية
الباطنة
. بالنسبة للراوند با تكونوا تسيروا القسم وتاخذوا history وتفعلوا examination على الحالات وبا يشرحوا لكم المعيدين
بالنسبة للفيديوهات معك الدكتور محمود علام والدكتور سيف ضريف لكن انصحك ابدا بعلام
وزيد شوف فيديوهات amboss , Geeky medics, macleod
أما المراجع المعيدين الأغلب با يشرحوا لكم من سويلم
زيد اطلع على macleod ايضا في كتاب حق الدكتور محمود علام مرتب لسويلم
أنت شوف الذي يعجبك وثبت لك واحد
.النظري
د. محمد الحوثيcardio
د. ضيف الله جيد cardio
د. صلاح الشوكي cardio
د. علي الحنظي respiratory
د. محمد قاسم endocrine
د. حسام العزاني renal
د. عبدالسلام المقدادhepato
د. عبدالباسط الحاج GIT
د. محمد الذاهبي infectious
بالنسبة للمصادر ال, renal, cardio ,GIT من Davidson
الrenal آخر السنة قال نقريه من Mayo clinic
ال infectious من Kumar وركز على شرح الدكتور
ال hepato الدكتور عبدالسلام قال أشتي الحل من المحاضرات..اقرا من أي مكان وارجع شوف محاضراته
أيضا الدكتور علي الحنضي ما يشتي الا المحاضرات حقه
بالنسبة للدكتور محمد قاسم با يكون يشرح لكم ويلخص
وعد في معك كتاب danish او oxford hand book
واهم شي لازم تشوف لك ملخص أو شيتات او مرجع صغير
بحيث لما يجي الاختبار النهائي تقدر تراجع المنهج بحكم ان الاختبار أغلبه كتابي ..
معك شيتات د. سيف ضريف (وهي للامانة مفيدة وخاصة للذي با يقرا من Davidson)
ونصيحة مني شوف المرجع الذي يناسبك وضيف عليه المعلومات الزيادة وثبته افضل لك من الشتات وايضا تكون مراجعته اسهل ايام الاختبارات
ولا تنسى ما تكون تتطلع على amboss
.الفيديوهات معك د. سيف ضريف او محمود علام
__
الجراحة
الراوند معك الhistory وال examination مقارب للباطنة
وبا يكونوا يشرحوا لكم الدكاترة حسب الجدول الذي با ينزل لكم
الفيديوهات انا شفت د. محمد شلوف
وعد في معك د. وهدان
كتاب العملي مافي كتاب محدد بس شوف د متولي ولا الشيتات حق د. محمد شلوف وباقي ملفات شوفها في data
. النظري
د. سعيد البهلوليGIT
د. رمزي الكولي GIT and salivary glands
د. كمال باحكيم و د. الحضوري liver and biliary
د. خالد شنان renal
د. عبدالصمد السنباني renal
د. احمد الوشلي renal
د. عبدالاله الشجاع GIT
د. فواز عمران endocrine
د. انور عثمان breast-spleen-panceas
الجراحة أغلب الدكاترة يشتوا محاضراتهم
المراجع معك bailey and love وهو المعتمد حق القسم
ومعك مرجع SRB والمطري
وفي المصري الطبعة الاخيرة حالية وخاصة لل renal
د.انور يشتي مواضيعه من SRB
أيضا كون شوف amboss
وبالنسبة للجراحة من اين ما ذاكرت لازم في الاخير تقرأ محاضرات الدكاترة
الفيدوهات في د. محمد شلوف ومعه شيتات مرتبات وهو غالبا يشرح من bailey
وباقي معك الدكتور وهدان شفت له بعض المواضيع الذي ما شرحهن شلوف وشرحه قوي
__
النسائية
د. محمد عقبات
د. عبدالرحمن الحرازي
د. حكيمة فاضل
د. سميرة التعزي
د. حليمة الضبياني
هي قسمين obs &gyne
الفيديوهات معك د. خالد عبدالملك
وفي المندوه قالوا تمام
المرجع فاروق حسيب عدا د. عبدالرحمن الحرازي يشتي محاضراته
العملي مابش زيادة على ال history وال examination والباقي نفس النظري
هذا بالنسبة للذي اطلعت عليه وكان في ال data ملفات وفيديوهات ما فتحتهن
اقصد لما تنسخ الdata شوف الباقيات لو اعجبينك
أيضا ..
.الحضور مهم وخاصة العملي لأنه غياب يوم بنص درجة
.بالنسبة للدكاترة حق مستوى رابع متفاهمين وشرحهم مفيد تحس انك تستفيد من الحضور ولا تصدق الكلام على بعض الدكاترة
لأن الدكاترة الذي كانوا يفجعونا منهم طلعوا احسن من يشرح وحتى اختبارهم كان واضح أفضل من غيرهم
ربنا يوفقك ويعينك.. | 581 | 39 | Loading... |
15 Media files | 404 | 3 | Loading... |
16 Note the flushing and sweating following a gustatory stimulus in frey syndrome, for details refer to the previous post .
#Salivary_Glands | 505 | 0 | Loading... |
17 Minor test or starch iodine test, note the brown-black discoloration of starch indicating a positive test for Frey syndrome, for details refer to the previous post .
#Salivary_Glands | 398 | 0 | Loading... |
18 "Frey syndrome"
◼️ Also referred to as auriculotemporal syndrome or Baillarger syndrome, is a condition which stems from damage to the auriculotemporal nerve, most commonly in the course of parotid gland surgery .
◼️ The auriculotemporal nerve is a branch of the posterior trunk of mandibular division of trigeminal nerve, soon after the nerve enters the infratemporal fossa through foramen ovale the auriculotemporal nerve is given off as two roots which straddle the middle meningeal branch of maxillary artery, the roots join together and pass posterior to neck of mandible and appear between the tympanic part of temporal bone and temporomandibular joint, this nerve is carrying parasympathetic nerve fibres to the parotid gland as well as sympathetic fibres to sweat glands in the preauricular and temple area .
◼️ Parasympathetic fibres destinated for the parotid gland originate from the inferior salivary nucleus in the medulla, this is a nucleus of the glossopharyngeal nerve, soon after the nerve exist via the jugular foramen a small branch called Jacobson's nerve originates from the glossopharyngeal nerve and re-enters the skull to reach the middle ear cavity, from here it participate in the tympanic plexus of middle ear cavity, from the tympanic plexus parasympathetic fibres leave as the lesser petrosal nerve which enters the middle cranial fossa .
◼️ In the middle cranial fossa the lesser petrosal nerve course towards foramen ovale and exists the cavity to enter the infratemporal fossa, here preganglionic fibres relay in the otic ganglion .
◼️ From the otic ganglion post ganglionic fibres travel in the auriculotemporal nerve to reach the parotid gland .
◼️ In frey syndrome when the auriculotemporal nerve is damaged, parasympathetic nerves regenerate and re-grow in the sympathetic pathway and innervate the sweat glands, therefore when feeding is anticipated the parasympathetic fibres are activated leading to flushing and sweating in the pre-auricular area of the cheek .
◼️ So in short frey's syndrome result from mis-innervation of the sweat glands and cutaneous blood vessels from the parasympathetic fibres of the auriculotemporal nerve following nerve damage .
◼️ Diagnosis is suggested by history of previous parotid gland surgery, flushing, warmth and sweating of the cheek while eating or anticipating to eat, especially sour and spicy food (See image below) .
◼️ Diagnosis is confirmed by Minor test, also called starch iodine test, in which iodine is painted over the affected area and allowed to dry, and then starch is applied over the area and the patient is presented with a salivary stimulus, if sweating occurs the starch gets moist and turns brown in the presence of iodine (see image below) .
◼️ The most widely used treatment is botulinum toxin injection which will chemically denervate the sweat glands, surgical treatments can include auriculotemporal nerve section, or Jacobson's neurectomy .
#Salivary_Glands | 350 | 4 | Loading... |
19 Important note:
The most common hereditary colorectal cancer is Lynch syndrome (otherwise known as hereditary non-polyposis colorectal cancer) it is inherited as autosomal dominant disorder and stems from a mutation in one of DNA mismatch repair genes, the genetic hallmark of the disease is microsatellite instability, there is about 80% lifetime risk of having colorectal cancer which is usually right sided, mucinous, and aggressive, a histologic feature is lymphocytic infilteration, in addition to colorectal carcinoma there is a high risk of endometrial cancer and gastric cancer, a myriad of other malignancies can also occur for example pancreatic cancer, it is also noteworthy to note that despite the name, few colorectal polyps are often found at colonoscopy .
#Colorectal_Surgery | 285 | 2 | Loading... |
20 Note:
Beta 2 transferrin is a carbohydrate free form of transferrin found almost exclusively in CSF, making it the most accurate test for CSF leak, it is also found in perilymph of inner ear, therefore an otorrhea with a positive beta 2 transferrin will either represent a CSF leak or a perilymph leak .
#Neurosurgery | 293 | 1 | Loading... |
21 Malignant hyperthermia
◼️ It is a disorder charactarized by marked muscle rigidity, tachycardia, and fever, classically triggered by some anesthetic agents and muscle relaxants .
◼️ The disorder is most commonly inherited as autosomal dominant, with the commonest mutation involving Ryanodine receptor-1 carried on chromosome 19 .
◼️ Normally ryanodine receptor is found in the sarcoplasmic reticulum of myocytes and functions to release calcium into the cytoplasm upon muscle depolarization and influx of calcium across the cell membrane through L-type calcium channels, causing muscle contraction, in MH the mutant ryanodine receptor causes the release of calcium in response to a triggering factor leading to sustained muscle contraction which will cause excessive heat production, release of excessive potassium causing hyperkalemia, marked acid production leading to metabolic acidosis, and rhabdomyolysis with release of myoglobin with potential acute kidney injury .
◼️ The classical triggering factor is halothane and suxamethonium, but also desflurane, enflurane and sevoflurane can cause MH, rarely MH may be triggered due to exposure to hot environment or after vigorous physical exercise, also very rarely it is associated with central core myopathy an inherited autosomal dominant myopathy usually presenting at birth with hypotonia and muscle weakness .
◼️ The diagnosis is clinical, early signs include muscle rigidity, tachycardia and tachypnea, despite the name, hyperthermia is a late sign, laboratory studies are helpful but treatment should be initiated immediately before results are obtained, typical findings include hyperkalemia, lactic acidosis or mixed metabolic respiratory acidosis, high level of creatine kinase due to muscle breakdown, if acute kidney injury occur this can be a confounding factor for hyperkalemia, high levels of serum creatinine and urinary myoglobin is typical, ECG is vital and may show typical changes of hyperkalemia .
◼️ Treatment include supportive measures such as body cooling, adequate oxygenation, and addressing hyperkalemia, the only drug known to be effective in MH is Dantrolene which acts to block ryanodine receptor and thus reduce calcium release, mortality rate before this drug was introduced was 80%, this is now reduced to 5% only .
◼️ In those thought to be susceptible to MH on basis of family history, the classical screening test is Caffiene-Halothane contracture test which involve obtaining a muscle biopsy, the biopsy is then bathed in a solution containing caffiene and halothane, a positive test is noted with muscle contraction, a negative test does not exclude susceptibility to MH .
#Perioperative_Care | 350 | 2 | Loading... |
22 Drehmann sign
◼️ A sign elicited during physical examination which describes an unavoidable external rotation of hip when it is passively flexed (see fig above) .
◼️ It is classically described as being a sign of slipped upper femoral epiphysis .
◼️ For furthur details on Slipped upper femoral epiphysis use the search bar on the channel .
#Orthopedics | 241 | 2 | Loading... |
23 "Complications of blood transfusion"
◼️ Febrile reaction is the most common complication, it results from pre-formed cytokines in the donor blood product, risk is somewhat reduced in leukocyte-depleted products, if this reaction occurs the transfusion should stop because initial features are similar to acute hemolytic reactions, a hemolytic workup should follow and if hemolysis is excluded the reaction can be treated with paracetamol and transfusion resumed but at slower rate .
◼️ Transfusion associated circulatory overload (TACO) , this is considered to be the second most common complication and usually occur in those who already have fluid overload, such as patients with congestive heart failure and acute renal failure, the features are those of cardiogenic pulmonary edema with raised JVP and high pulmonary capillary wedge pressure which reflects left atrial pressure (normal value is 8-12 mmHg), brain natriuretic peptide can also be elevated (a usual feature in those with heart failure), this can be managed with reducing infusion rate to the lowest possible limit and using diuretics and oxygen supplements to counteract pulmonary edema .
◼️ Infections are now rare as all blood products are screened prior to transfusion, bacterial infection especially gram positive organisms is commonest with platelet transfusion as they are stored at room temperature, gram negative bacterial infection is found to be more with packed RBC transfusion .
◼️ Allergic reaction is an uncommon event which occur frequently in patients with IgA defeciency, the proposed mechanism is that individuals with IgA defeciency mount an immune response against IgA in donor blood product, this can range from urtecaria to anaphylactic shock .
◼️ Transfusion related acute lung injury , this is an uncommon complication but is the most common cause of death due to blood transfusion, it occurs due to donor antibodies directed against human leukocyte antigen and human neutrophil antigen of the recepient, for furthur details search TRALI in search bar of the channel .
◼️ Acute hemolytic reaction, it is now a very rare event, occuring in 1 per 2 million transfusions and result from ABO incompatibility, features include jaundice, fever, back and loin pain with eventual shock, the transfusion should be stopped immediately, isotonic saline should be administrated along with diuretics .
◼️ Delayed hemolytic transfusion reaction, it can occur in few days up to few months following a transfusion and result from an immune response against minor RBC donor antigens such as Rh, Duffy and Kell antigens .
◼️ Electrolyte abnormalities, including hypocalcemia which is caused by binding of citrate to calcium, Citrate is used as an anticoagulant in storage of blood products, hyperkalemia is another possible complication which occur due to release of potassium from stored cells in the blood product, conversely hypokalemia may occur due to conversion of citrate to bicarbonate in the liver causing alkalinisation which promote intracellular influx of potassium ions in exchange for hydrogen ions as a way of compensation .
#Perioperative_Care | 266 | 2 | Loading... |
24 العيد الرابع والثلاثون لليوم الوطني للجمهورية اليمنية✌️🏻
22 مايو - عيد وحدة مجيد🇾🇪
كل عام وبلد الإيمان والحكمة بألف خير 🫡 | 428 | 1 | Loading... |
25 -أهم تسعة مواقع في المصادر العلمية المختلفة:
*موقع pdfdrive..
أكبر وأفضل موقع لتحميل الكتب في جميع التخصّصات بصيغة PDF يحتوي أكثر من ٢٢٥ مليون كتاب جاهزة للتحميل المباشر و يمكن استخدامه للدراسة.
https://www.pdfdrive.com
*موقع kotobgy..
محرك بحث يحتوي على الملايين من الكتب العربية القابلة للتحميل.
https://www.kotobgy.com
*موقع refseek..
محرك بحث يوفر المصادر الأكاديمية بطريقة سهلة أكثر من مليار مصدر من الكتب والمجلات والأخبار والموسوعات.
https://www.refseek.com
*موقع WorldCat..
محرك بحث سهلُ الإستخدام يبحث في أكثر من ٢٠ ألف مكتبة ويحتوي على أكثر من ٢ مليار مصد ويُمكّنك من إيجاد أقرب مكتبة لك.
https://www.worldcat.org
* موقع Springer..
يحتوي على أكثر من ٣ مليون مصدر في مختلف المجالات العلمية من مقالات وأوراق ومؤتمرات وأجزاء من كتب.
https://link.springer.com
* موقع Microsoft_Academic..
يحمل نتائج بحث واسعة المحتوى للأكاديميين
ويتم تحديثها باستمرار يحتوي على أكثر من ١٢ مليون مطبوعة.
https://academic.microsoft.com
* موقع Bioline..
محرك بحث تطوعي يعمل على جمع المقالات المنشورة في المجلات العلمية بالدول النامية مثل مصر وتركيا والعراق والأردن وغيرها.
http://www.bioline.org.br
* موقع EThOS..
يحمل أكثر من 500 ألف رسالة ماجستير و دكتوراه في جميع المجالات.
https://ethos.bl.uk
* موقع base-search..
من أفضل و أقوى محركات البحوث الأكاديمية توجد أكثر من 100 مليون وثيقة علمية.. ٧٠٪ من المقالات التي يحتويها مجانية.
https://www.base-search.net | 559 | 11 | Loading... |
26 Concerning signs in soft tissue tumors:
◼️ Soft tissue tumors are common and vast majority are benign .
◼️ Soft tissue tumors such as a lipoma is usually considered benign in the first instance, but certain parameters suggests that malignancy is more likely and referral to a specialist centre is advised in the following :
1- Size of lesion is more than 5 cm.
2- Location of lesion is deep to fascia.
3- Lesion rapidly increases in size.
4- The lesion is painful.
5- Recurrence of the lesion after adequate excision . | 424 | 1 | Loading... |
27 Endothermal ablation for varicose veins:
◼️ This is now considered the gold standard treatment for superficial venous incompetence replacing ligation and stripping, as it offers more safety, a rapid recovery, and better short term improvement in quality of life with equivalent long term improvement .
◼️ The basic idea is to introduce a heat generating device percutaneously into the involved vein under local anesthesia which is infilerated in a perivenous site, the device maybe laser based or radiofrequency based, which ever technique is chosen, the thermal energy created will permenantly occlude the vein .
◼️ Local anesthetic solution helps to compress the vein against the device and empty the vein of blood, it also hydrodissect important structures away from the zone of damage especially the saphenous nerve in great saphenous vein ablation and sural nerve in small saphenous vein ablation, it also acts as a heat sink absorbing the generated heat and reducing collateral damage .
◼️ It is useful mainly for truncal or junctional incompetence, peripheral varicosities are treated with either phlebectomy or injection sclerotherapy with the former being more preferred by most vascular surgeons as it allows treatment in a single setting . | 403 | 1 | Loading... |
28 Media files | 373 | 1 | Loading... |
29 https://youtu.be/FPgBm5_59gA?si=HWPZEMXc93q1RfoR | 297 | 0 | Loading... |
30 Recommendations on perioperative management for patients on steroid therapy:
◼️ Increased steroid production is a physiological stress response to surgical intervention, and if patients are taking steroid therapy for enough dose and long enough time to cause adrenal suppression are at risk of acute adrenal insufficiency if not appropriately supplemented with steroids .
◼️ In general, patients taking 10 mg/day of prednisolone or equivalent dose of another steroid agent will require "steroid cover" perioperatively, additionally those which were taking steroid therapy but had stopped the therapy within a timeframe of less than 3 months prior to surgery will also need a steroid cover because duration of adrenal suppression can last up to 3 months .
◼️ For body surface and intermediate operations, give 100 mg of IV hydrocortisone at induction of anesthesia, followed by immediate institution of continuous infusion of 200 mg IV hydrocortisone over 24 hours, thereafter give the patient double the usual dose of steroids that they were on for 48 hours, and no additional cover will be needed after this time .
◼️ For major operations, the recommendation is similar, except that postoperatively the patient recieves a furthur 200 mg of IV hydrocortisone as a continuous infusion over 24 hours .
◼️ Steroid cover will generally not be needed for routine dental and minor surgical operations done on local anesthesia for those on long term steroid therapy, but if any sign of adrenal insufficiency develop additional steroid therapy should be started without delay .
N.B: These recommendations are of the Royal College of physicians and endocrinologists, sources may vary slightly regarding management guidelines . | 341 | 2 | Loading... |
31 Open fractures:
◼️ Defined as any fracture in which the fractured bone and/or the fracture hematoma is exposed to the external environment through a defect in the covering soft tissues and epithelial surface, which is usually the skin, but also a mucosal surface such as a pelvic fracture that has lacerated through the rectal mucosa .
◼️ Most open fractures are the result of high energy trauma which breaks the bone together with its overlying coverage, however it can also result from low energy trauma where the sharp end of a fractured bone lacerate the overlying tissue coverage .
◼️ When the overlying skin tears away, it creates vacuum effect, which sucks in all the surrounding debris, this explains why contaminants can be found in deep locations within the wound .
◼️ The external wound may not be always located on the fracture site, therefore any fracture associated with any nearby wound "generally within the same limb" should be regarding as open fracture until proven otherwise .
◼️ Most open fractures affecting males occur in the age group 15 to 19 years, and most open fractures affecting females occur in the age group 80-89 years .
◼️ The most common site of an open fracture is the phalanges of the hand, the most common long bone affected is the tibia .
◼️ Open fractures are classified according to Gustilo-Anderson classification into the following :
1) Type I: result from low energy trauma in which the wound is less than 1 cm with minimal soft tissue damage .
2) Type II: result from low to moderate energy trauma in which the wound is more than 1 cm with moderate soft tissue damage .
3) Type III: result from high energy trauma in which the wound is greater than 10 cm, it is furthur subdivided into type IIIa in which there is adequate soft tissue cover, type IIIb in which there is loss of soft tissue cover, and type IIIc in which there is vascular injury .
◼️ Because open fractures are usually associated with other life threatening injuries, management initially should follow the ATLS principles .
◼️ After dealing with immediately life threatening injuries, the open fracture should be managed urgently, in the emergency department it is acceptable to remove only the gross contaminants in the wound, but thorough washout and debridement should only be attempted in the operating theatre, the wound should be packed with sterile saline soaked gauze and covered with an impermeable film, it is important to take photographs of the wound site to avoid reopening of the dressings upon arrival of the orthopedic surgeon because this will increase infection risk .
◼️ If vascular injury is suspected, and if it is thought to result from compression of a vessel by the displaced fracture, this should be immediately reduced .
◼️ Antibiotic therapy is started immediately, preferrably in the prehospital setting, and should ideally start within 3 hours of injury, a retrospective study suggest that if adequate antibiotics are started within 1 hour of injury, infection risk is essentially 0%, but increase to 17% after this timeframe .
◼️ High dose penicillin (or clindamycin if allergic) should be specifically considered when clostridial infection is likely, such as trauma sustained in a farm yard .
◼️ If vascular injury is present, the first operative step is to establish a temporary vascular shunt, in which an artifical conduit is used to connect the two ends of an injured artery, the next step is handed to the orthopedic team which will stabilise the fracture usually with an external skeletal fixator "some exceptions are present, for example an open fracture of the patella which is usually managed with internal fixation even if opened" the third step is handed back to the vascular team which will fashion the definitive vascular repair .
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32 "Note"
All cases of breast cancer treated by breast conserving surgery (excision of the tumor with a 1cm margin) should recieve radiotherapy because local recurrence rates are unacceptably high without radiotherapy, breast conserving surgery is avoided in those with large tumor in relation to breast size, multicentric disease, and those with widespread DCIS, it is also avoided in patients with systemic lupus erythematosus or other collagen vascular diseases because they are at high risk of severe radiation reactions, in these scenarios mentioned above a mastectomy is more preferred .
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The various positions of the appendix
, Note that the commonest position is retrocaecal (74%) this is because during childhood the continous growth of the caecum rotates the appendix behind it how ever it will always remain intraperitoneal .
#Vermiform_Appendix
With new updates in 2023 in American Heart Association "AHA"
Or either European society of cardiology "ESC"
BOTH DRUGS CAN be used in patients Class I heart failure either have diabetes type 2 or not
Be in medicine
The sodium-glucose cotransporter-2 (SGLT2) inhibitors empagliflozin and dapagliflozin reduce cardiovascular death and heart failure hospitalizations in patients with heart failure. However, cardiac medications within the same class may not all have the same benefit. For example, carvedilol reduces mortality by 16% relative to metoprolol in patients with heart failure, and chlorthalidone is more potent than hydrochlorothiazide in the treatment of essential hypertension. In patients with diabetes, empagliflozin may be associated with greater weight loss, reduction of blood pressure, and reduction of cholesterol compared with dapagliflozin.In patients with heart failure, a single center retrospective study suggested that empagliflozin may be associated with improvements in left ventricular ejection fraction and functional status compared with dapagliflozin.However, the outcomes of empagliflozin vs dapagliflozin on clinically important patient-centered outcomes for patients with heart failure is unclear. In this multicenter retrospective cohort study, we sought to compare the composite outcome of all-cause mortality and hospitalization between those initiated on empagliflozin vs dapagliflozin in patients with heart failure.
Most common causes of Atrial Fibrillation:
MATCH
M—-> mitral stenosis
A——> Acute myocardial infarction
T—-> thyrotoxicosis
C—> constrictive pericarditis
H—-> hypertensive heart disease
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🔴🟢كتائب القسام تنشر:
"كمين جباليا.. ستبتلعكم رمال غزة يا حثالة الأمم".
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افحص قبل الزواج قبل أن تتعب روحك ومرتك وجهالك.
الثلاسيميا مرض وراثي
افحص عشان ما تنجب أطفال فيهم هذا المرض وتجلس أنت وهم تعاني طول حياتهم.
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السحب بعد يومين على ١٥ ألف فائز بالمميز المجاني لمدة عام ، انضم للقناة فقط وتدخل السحب ، بالتوفيق للجميع.
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Prizes of the draw15000 Telegram Premium subscriptions for 12 months
All channel subscribers:
4.26m
~2.36m
55.35%
Completion date
Repost from WeWantYou
Prizes of the draw15000 Telegram Premium subscriptions for 12 months
All channel subscribers:
4.26m
~2.36m
55.35%
Completion date