Emtyaze
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پست ها | ديناميک بازديد ها | |||||
معلومة على السريع اي ⬇️
Migratory abdominal pain associated with Anorexia and McBurney tenderness is
= APPENDICITIS UNTIL PROVEN OTHERWISE
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🩺 | Bell's Palsy ( Facial Nerve Palsy)
بيانات الحالة: مريضة في الثلاثينات من العمر، لا تعاني من أي أمراض مزمنة أو تاريخ مرضي يُذكر.
📍 الشكوى الرئيسية: عدم القدرة على إغلاق العين اليمنى مع انحراف في زاوية الفم إلى الجهة اليسرى منذ الصباح.
🩺 الفحص السريري:
- العلامات الحيوية مستقرة.
- الفحص العصبي سليم، ولا توجد أي علامات توحي بسكتة دماغية أو إصابة عصبية مركزية.
- لا توجد فقاعات أو طفح في الأذن.
❇️ التشخيص : Bell's Palsy
🚨 Red Flags
- Forehead sparing
- Limb weakness and aphasia
- Altered consciousness
- Cerebellar signs
- Recurrent facial palsy
- Bilateral facial weakness
- Progressive symptoms
- Additional cranial nerve involvement.
❇️ الخطة العلاجية:
Rx – Bell's Palsy (Facial palsy)
1. Prednisone 20 mg tab
Take 1 tablet PO TID after meals × 5 days.
Then:
Prednisone 10 mg tab
Take 1 tablet PO TID after meals × 5 days.
*Monitor blood pressure and blood glucose.*
2. Valacyclovir 1 g tab
Take 1 tablet PO TID × 7 days.
OR
Acyclovir 400 mg tab
Take 1 tablet PO five times daily × 10 days.
3. Artificial Tears
Instill 1–2 drops into the affected eye every 2–4 hours while awake.
+ Lubricating eye ointment at bedtime.
+ Eye patch/taping during sleep if unable to close the eye completely.
4. Pantoprazole 20–40 mg
Take 1 tablet PO once daily, 30 minutes before breakfast × 10 days.
📚 نقاط تعليمية مهمة:
🔹 Bell's palsy accounts for approximately 60–75% of all cases of unilateral facial paralysis
🔹 Forehead involved = Think LMNL (Bell's palsy).
🔹 Forehead spared = Think UMNL (Stroke) until proven otherwise.
🔹 Facial palsy present with any one of red flag should evaluate for stroke and warrants Brain CT to exclude a central lesion as Stroke.
🔹 Corticosteroids are the only treatment with strong evidence for improving complete recovery and should be started within 72 hours of symptom onset.
🔹 Antiviral therapy may provide additional benefit in severe paralysis, but should never replace corticosteroids.
🔹 Eye protection is mandatory in patients with incomplete eyelid closure to prevent exposure keratitis and corneal ulceration.
🔹 Baseline BP and RBS should be assessed whenever feasible before initiating corticosteroids therapy, particularly in patients with known hypertension, diabetes mellitus, or other risk factors. Both should be monitored during treatment.
#Case 5 #ED
#BellPalsy
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 +3تقييم و علاج التهاب الحلق ، العلاج مع الجرعات للاطفال و البالغين و بدائل البنسلين في حال وجود حساسية
♦️المصدر UpToDate
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 A 55-year-old male from Amran, with unknown case of any chronic medical illness, presented with chronic throbbing headache for 1.5 months, associated with bilateral tinnitus and palpitations.
He denied any bleeding tendency from any body orifice, including hematemesis, melena, hematochezia, hematuria, or epistaxis. There was no history of purpura, petechiae, or recurrent infections.
-Constitutional symptoms : There's decrease activity, No fever no wight Loos, no sweating,
-Review of Systems
Chronic watery diarrhea for the past 4 months.
The remainder of the systemic review was irrelevant
- Past and Family History irrelevant.
O/E
The patient looks ill, cachectic with Marked severe pallor was noted (as shown in the photo), and Bilateral painless pitting lower limb edema, extending up to the mid-leg.
No jaundice, No Cyanosis, No palpable lymphadenopathy.
- ماهي التشخيصات التفريقية ؟
- ماهي التدخلات الأولية المناسبة لهذا المريض؟ وما هي الفحوصات الأولية التي يجب طلبها في الطوارئ؟
#Case 4 #ED
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