MRCP - محمد العقوري

https://apps.apple.com/app/id1259401721

السلام عليكم

اللي ماقدرش يفتح التسجيلات ينقلهن للبرنامج هذا وحيفتحن بإذن الله

بالتوفيق والسداد

غدا بإذن الله موعدنا مع محاضرة بعنوان:-
Atrial Fibrillation.. Diagnosis/Management in emergency setting.

It will be Case based simulation with take home messages.

المحاضرة ضمن كورس:-
Acute Cardiovascular Emergencies

التوقيت:-
الساعة الثامنة مساءً بتوقيت ليبيا

ربط الزوم:-

Mohammed Elagouri is inviting you to a scheduled Zoom meeting.

Topic: Acute Cardiovascular Emergencies
Time: Nov 12, 2022 01:00 PM Eastern Time (US and Canada)

Join Zoom Meeting
https://us06web.zoom.us/j/3189422384?pwd=bEt4RkJUQmkrK3J2cjVQNlF1SmlrQT09

Meeting ID: 318 942 2384
Passcode: 123456

غدا الإثنين ١٩/٩/٢٠٢٢.. ستكون محاضرة بعنوان:-
RV failure in the setting of Sub-massive/Massive Pulmonary Embolism.

من الساعة 7-10 بتوقيت ليبيا

نفس رابط الزوم السابق..

سنتحدث عمليا وبإختصار عن النقاط الكلنيكية والعملية في هذا الموضوع…

بالتوفيق للجميع..

من محاضرتنا اليوم ضمن كورس
Acute Cardiovascular Emergencies

(Right ventricular failure)

-Etiology:- one of three usually
1-RV infarction, 2- Massive/submassive PE
3- Acute decompensation of chronic (undiagnosed) pulmonary hypertension

Our discussion revolved around number 3 as follows:

We talked about pathophysiology:-
Low MAP, high CVP, High RV afterload, reduced RV perfusion. We also discussed double hit pathophysiology of systemic organs.

Goals of management:-
1- maintain MAP (Norepinephrine/vasopressin) and diurese to a target CVP 8-12 ( if PA catheter PCWP 15) the well know approach of Squeeze and diurese.

2- for high PVR: optimize the lung:-
Treat hypoxia, hypercapnia and acidosis ( all vasoconstric pulmonary arteriole). May be inhaled NO/ Epoprostenerol?!!

3-if still struggling to optimize the MAP (dobutamine for inotropy) careful about arrhythmogenic SE as Afib would lead to decompensation.

4- treat precipitating factors as above plus:
A fib: cardioversion
No B-blockers
No pure alpha agonists
Be careful about fluid ( patient might fall off frank starling curve)

5- POCUS is key..learn how to do it. It will make your assessment more effective.

6- we talked about ECHO findings for RVF and how to diagnose.

Attached, some short videos from the lecture.

Will discuss RV failure because of PE, RV infarct on future videos.

All the best,

السلام عليكم:
هذا رابط محاضرة اليوم..

نلتقي بإذن الله…

‏Mohammed Elagouri is inviting you to a scheduled Zoom meeting.

‏Topic: Acute Cardiovascular Emergencies


‏( Management of Right Ventricular Failure)

‏Time: Sep 17, 2022 07:00 PM Tripoli

‏Join Zoom Meeting
‏https://us06web.zoom.us/j/3189422384?pwd=bEt4RkJUQmkrK3J2cjVQNlF1SmlrQT09

‏Meeting ID: 318 942 2384
‏Passcode: 123456
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السلام عليكم..

سنعود لكورس
Acute Cardiovascular Emergencies

يوم السبت القادم الساعة 7-10بتوقيت ليبيا

عنوان المحاضرة؛-
Principles of management for Right ventricular failure (With P. HTN,RV infarction, PE)

سأقوم بنشر الرابط لاحقا..

بالتوفيق للجميع ..

من محاضرة اليوم في كورس ال

Acute Medical Emergencies

How management of Cardiogenic shock because of critical aortic stenosis differ from other causes of cardiogenic shock?

1- we need high normal preload(high filling pressure) AS pt are preload dependent.
(No nitrate and assess volume status carefully as they have narrow margin for deterioration with diuresis).

2-we need to maintain Diastolic BP (to maintain coronary perfusion)
Coronary perfusion pressure= diastolic BP-LVEDP. AS pt have high LVEDP and reduction in DBP will reduce CPP. (Be careful with arteriodilator and use vasopressors as Phenylephrine and in case of low flow,low gradient AS use norepinephrine as it combines vasopressor action with mild inotropic effect)

3- maintain MAP in the mid-range (some degree of afterload with vasopressors as mentioned above. ( to maintain COP)

4- no tachycardia allowed..(high heart rate will shorten diastole>> less filling>>less SV and COP. A fib won’t be tolerated by pt with critical AS and should be promptly treated by DCCV or digoxin) maintain heart rate on the slow side but not very slow.

5- hypovolumia ( bleed,vomiting, diuresis), A fib, sepsis very common causes for decompensation. However, AS might present because of worsening preexisting disease.

Treat them promptly.

6-Consult interventionist early as pt with AS might not be avle to stabilize medically. Might consider aortic balloon valvoplasty as a palliative and temporizing intervention. Also, patient might need Mechanical support.

7-try to avoid intubation as the effect of premedication with sedatives might be detrimental.
WATCH THE VIDEO BELOW FOR AORTIC STENOSIS PATIENT DURING INDUCTION OF GENERAL ANESTHESIA.LOOK AT THE DROP IN BP AND DISAPPEARANCE OF ETCO2 TRACE. at this point the best intervention would be pressors and fluid.

8-generally:
Avoid nitrates
Avoid arteriodilators e.g ACE inhibitors
Avoid excessive diuresis
Avoid tachycardia and profound bradycardia
Try to avoid intubation
Be vigilant for low flow,low fradient AS (common with poor prognosis)
No spinal anesthesia
Use CWD for high flow AS and pulse wave doppler for low flow AS.

Keep the patient Slightly wet, Slow with mid-range BP.

https://youtu.be/litb_efr9g0

السلام عليكم:-
غدا ستكون محاضرتنا الثالثة في سلسلة ال:-
Cardiovascular Emergencies..

سيتم الحديث غدا عن :-

Treating the Cold, wet patient (Cardiogenic Shock)

We will try to clarify concepts and simplify approach but also expecting bumps on the way and how to manage them.

الموعد:-

الخميس،الساعة 10:30-12:30 مساءً بتوقيت ليبيا..

رابط الزوم:-

https://us02web.zoom.us/j/85807466470?pwd=gLe_cv0kewrPF9qre_NDJXnrAjS5pt.1

نلتقي بإذن الله..