Important Tips in Internal Medicine‼️👌

#تلخيصات

FRAX score for assessment of osteoporosis ABCD Age Alcohol intake BMI≤19 Previous hx of fragility fracture Previous hx of hip fracture Sex Current Smoking Current Steroids Disease or Drugs causes 2ry osteoporosis

Brain herniation

TIMI Risk Score mnemonic [AMERICA] #Cardiology

Hyperkalemia ttt (Critical) ‎ الأساس إننا نعمل Intracellular shifting & Removal from body either by K-binder (SZC) or cation exchange resin (Patiromer) or even dialysis if refractory دا طبعا بجانب ال general measures : ABCDE, cardiac monitoring (ECG), ABG, Serum K -أول حاجة لو مادخلش ف Arrest [1] Moderate (Serum K: 6-6.4 mmol/L): 10 units of Short-acting Insulin & 25g Glucose (250mL Glucose 10%) IV over 15-30 min. Follow-up by 10% glucose at 50mL/h for 5h in patients é pre-treatment glucose level <7mmol/L. [2] Severe (Serum K >= 6.5 mmol/L) & No ECG changes: ‎نفس الكلام ونضيف عليه Salbutamol 10-20mg nebulized. [3] Severe (Serum K >= 6.5 mmol/L) & toxic ECG changes: ‎نفس الكلام بالظبط لكن لا ننسى نحمي القلب بال 10 mL Calcium chloride 10% IV over 2-5 min. وتابع بال ECG ممكن تحتاج تكرر الجرعة -طيب لو الحالة Arrested يبقا الكلام دا بسرعة بمعنى Calcium chloride : IV rapid bolus injection. (if refractory=repeat) Insulin : IV rapid injection Sodium Bicarbonate 50 mmol (50 mL 8.4% solution): IV rapid injection. ‎يبقا كدا -Calcium chloride in case of severe hyperkalemia + ECG changes either arrested or not -Sodium Bicarbonate: Bi=👋=arrested وماننساش إن لو الحالة severe لازم يكون معانا حد أكبر مننا expert

«مَـا فاتَ ماتَ وَفِـي الآمالِ مُتسعٌ وفُسحةُ الوقتِ للسّاعِيْنَ لمْ تزَل»🖤

● Deformities in Rheumatoid Arthritis : 😁 BMW و SUZuki عربية Boutunniere MW : ms wasting --- Swan neck Ulnar deviation Z- shaped thumb + trigger finger .. tenosinvitis ملهاش تحشيشه بقا 😁

Tachyarrhythmia 👉 Unstable Synchronized cardioversion بعد التالته مفيش استجابه Amiodarone 300mg Or Procainamide 10_15 ml/kg 👉Stable لو هو regular بنبدا vegal stimulation بعدها adenosine ٣ جرعات 6 12 18 mg مستجابش اشوف QRS Wide .. Amiodarone Procainamide Narrow.. BB Ca channel blockers If no response..Mange as unstable 👉Irregular Mostly AF سواء wide or narrow بندى BB deltiazim Verapamil Anticoagulant» 48h 🔻torsade de point ... irregular wide QRS tacyarrythmia  manged by 2 g magnesium 👉 Amiodarone & digitals .. irregular tacyarrythmia with evidence of HF

👉Post cardiac arrest Start immediately after ROSC ABCD approach هشوف العيان محتاج يتيب ولا لأ O2 saturation 94-98% PaO2 75_100 Tv 6_8 ml/kg ideal body weight PaCo2 35_45 TTM 32_36 " prevent fever at least 72h" SBP more than 100 Avoid hypotension less than 65 Blood glucose 140_180 avoid HypOglycemia "less than 70" 👉Give levetiracetam and  sodium valproate .. seizures after ROSC 🔻 Routine Stress ulcer Prophylaxis DVT prophylaxis Feeding 👉 Not routine Prophylaxis anti seizures Giving Steroids Prophylactic AB not recommend 👉TTM only for comatose      👉 Prognostication 👈 * Clinical Examination *Electrophysiology *Biomarkers *Imaging 🔻 Poor out come * Absent pupillary and corneal reflex>72 * Status myoclonus >72h *Highly malignant EEG >24 *Bilateral absent N2o SSEP >24 *Increase NSE *Diffuse anoxic injury on Brain CT &MRI *Glasgow Motor score<= 3

★Drug induced myositis? -Nsaid -Quindine -Hmg co reductase I -Hydroxyurea -Penicillamine

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