Emergency notes🫀

The following was taken from a pt with progressive fever and lethargy and right shoulder pain. Also had abdominal pain, nausea, and vomitting with abdominal tenderness and rebound tenderness. What caused the finding?

بالguidelines القديم لل ESC

كان انه اذا ال AF صارلهة يومين او اقل نحولهة الى sinus rhythm سواء electrical or pharmacological cardioversion
هسة بالكايدلاين ال2024 صار يوم واحد فقط 😱..
يعني اقل من يوم نحاول نرجعة اكثر من يوم نبقي rate control

حامل وعدهه arrhythmia شنو نننطيهه🔥

Adenosine ➡️SVT
Digoxine ➡️SVT

🤔🤔هنا ال digoxine من يستخدم ويه الحامل راح تلاحظ ارتفاع بنسبة ال digoxine ب circulation 🤨🤨🤔.. ليش لان ال circulation of pregnancy تكون موجوده بيهه جزيئات تشبه ال. Digoxine لذلك راح تطلع النتيجه بيهه نسبة خطأ لذلك اتذكر هاي الملاحظه الي تكول 🗣️🗣️🗣️

assay for measuring digoxin levels during pregnancy can result in falsely elevated levels due to circulating digoxin-like fragments

Procainamide ➡️VT

Lidocain➡️VT

Torsade de pointes ➡️mg sulfate

Pateint presented with Wide QRS complex in ED ...
و متكدر تفرق هذا
لو VT🤔
لو AF + BBB 🤔
لو SVt + WPW 🤔
نعالجه ع الاخطر الي هي VT
نبلش ننطي amidarone❤️
Dont forget the C.I :
💫digoxin induced vt
💫arrhythmia due hyperkalimia

Toxicity: 💔
Loss of patellar reflux
respiratory arrest so contraindicated in MG

Antidot :🤔
Reversal of magnesium sulfate toxicity
Is ca gluconate 1g 10%

Dose of magnesium sulfate :

🔥Torsade de pointes:
Loading dose: 2 gram/15 min if the patient was pulsatile,
and over 2 min if the patient was pulseless

Maintenance dose: 1 g/hr for 24 hr

🔥Acute exacerbation of asthma
In Adult: 2 gram over 20 min, no Maintenance dose.

Clinical Uses of magnesium sulfate is ABCDE :

(A)cute severe asthma
(B)arium poisoning
(C)onstipation
(D)e pointes ( torsade de pointes ) /Digoxin intoxication
(E)clampsia

الجواب Air under diaphragm, perforated viscus

الair مأشر بالاخضر

مريض متوسط العمر اجة بacute abdomen .. شنو ممكن يكون التشخيص بالاعتماد على هاي الx ray

📍Isoniazid [ anti tb ]
Mech ; act on cell wall synthyesis
side effects : 📝

- hepatotoxicity ( GIT )
- lupus erythematous + Rash
- peripheral neuropathy (PNS)
- seziure + psycosis (CNS)

So advice pateint to don LFT as follow up + check if signs of hepatitis appeare

IMP INV:

wegener's🔥
Most specific diagnostic test of wegener's granulomatosis
C_ANCA.

Most definitive diagnosis of wegener's granulomatosis is lung biopsy.

scleroderma🔥
Most sensitive diagnostic test of scleroderma is ANA.

Most specific diagnostic test of limited form of scleroderma is anti_centromere.

Most specific diagnostic test of generalized form of scleroderma is
anti_opoisomerase antibody (anti_scleroderma antibody).

RA🔥
Most specific diagnostic test of reumatoid arthritis is anti_CCP antibody.

Sle🔥
Most sensitive diagnostic test of SLE is anti _nuclear antibody (ANA).

Most specific diagnostic test of SLE is anti_sm ab and anti_ double stranded DNA antibody (AdsDNA)

The right main bronchus is wider, shorter, and more vertical than the left main bronchus so aspiration of foreign bodies and aspiration pneumonia are more likely in the right lung.

no evidence of increased fetal risks or pregnancy loss with typical CXR doses.

دائما اتصير انه الواحد يفكر انه ممكن هذا الاشعاع يأثر على الطفل ، بس بالحقيقة ماكو اي تأثير

Hematuria + proteinuria + hypertension + periorbital edema
👉 Glomerulonephritis

Hematuria+ hemoptysis + Rapid deterioration of renal function
👉 Goodpasture syndrome
Or Granulomatosis with polyangiitis depend on age

Hematuria +Chronic sinusitis or nasal ulcer + Epistaxis
👉 Granulomatosis with polyangiitis

Hematuria + cramping abdominal pain + painful palpable purpura+ arthralgia
👉 Henoch Schonlein purpura

Hematuria+ resistant asthma + eosinophilia(>1,000)+neuropathy
👉 Churg Strauss

🤡Beta blockers, calcium channel blockers, and nitrates can cause false negative results on exercise and pharmacologic stress testing and should be held for 48 hours prior to testing. 

However, aspirin, statins, and lisinopril are not known to affect stress testing results.

A 64-year-old man is admitted to the hospital due to intermittent palpitations and lightheadedness for the past several days.  The patient has had no chest pain or shortness of breath.  He has a history of coronary artery disease with prior myocardial infarction and percutaneous coronary intervention.  Medications include metoprolol, lisinopril, aspirin, clopidogrel, and rosuvastatin.  Echocardiogram reveals mild left ventricular dilation, a left ventricular ejection fraction of 30%, and no major valvular abnormality.  Serum potassium is 4.2 mEq/L, and magnesium is 1.9 mg/dL.  On day 2 of hospitalization, the patient develops sudden-onset and sustained palpitations.  Blood pressure is 122/60 mm Hg and pulse is 120/min.  He is alert and does not appear to be in acute distress.  The lungs are clear bilaterally.  ECG rhythm strip is shown in the exhibit.  Which of the following is the best next step in management of this patient

Treatment of sustained monomorphic VT depends on the patient's clinical status. 

Patients with pulseless VT are treated with immediate defibrillation. 

Patients with a pulse but evidence of hemodynamic instability (eg, hypotension, angina, confusion) are treated with immediate synchronized electrical cardioversion (). 

In hemodynamically stable patients such as this one, pharmacologic cardioversion to sinus rhythm should be attempted.  Intravenous amiodarone is usually the preferred agent; other agents (eg, procainamide, sotalol, lidocaine) are also sometimes used