Residency 🧑🏻‍⚕👨🏼‍⚕إقامة دورية 2024 のテレグラム投稿

Statins indications:-
1- acute coronary syndrome
2- MI or stenting
3- any arterial disease( PAD ,carotid diease,stroke ,MI, )
4-10- year risk of CAD >7.5%
5-primary hyperlipidemia if LDL >190 even without CAD
6- pt >40 years with DM and LDL( 70-190)

Diuretic site action

Osteoarthritis (OA)

No drug causes OA.
No drug prevents OA.
No drug increases OA progression.
No drug stops OA progression.

Steroid-induced psychosis—

incidence is 5% to 28 %.
Among this, 3% attempt suicide.
Abrupt withdrawal of steroid is recommended here. (NO tapering)
After stop steroid-

one-half will reverse within 4 days and remaining one-half will reverse within 2 weeks.

Abdominal pain in DKA is mainly poorly understood , but could be explained by :-
- delayed gastric emptying
- distended hepatic capsule
- or as apart of underlying causative etiology

Severe Diarrhea

If hypokalemia + met-acidosis present
✅Treat BOTH simultaneously
In acidosis, K⁺ moves out of cell

Fixing only acidosis → K⁺ will move into cell → worsened hypokalemia

Fixing only hypokalemia →K⁺ stays outside cells due to acidosis→ risk of hyperkalemia

Organophosphorus poisoning

Ascites approach

Vasopressors and Inotropes - Summary Sheet

1️⃣ Norepinephrine (Levo)
💉 Action: α1 > β1 agonist → ↑↑ SVR, ↑ CO, reflex brady may negate ↑ HR
📌 Uses: Septic shock (1st), Cardiogenic shock (1st), Hypovolemic shock (1st)

2️⃣ Phenylephrine (Neo)
💉 Action: Pure α1 agonist → ↑↑ SVR
📌 Uses: Septic shock with ↑ HR or ↓ BP; AFRVR, HOCM, AS, RV failure

3️⃣ Vasopressin (Vaso)
💉 Action: V1 (↑ SVR), V2 (↑ renal H2O reabsorption)
📌 Uses: Septic shock (2nd line), Anaphylaxis (2nd line), RV failure

4️⃣ Epinephrine (Epi)
💉 Action:
•Low dose: β1 > β2 > α1 → ↑ CO, neutral SVR
•High dose: α1 > β1 > β2 → ↑ CO, ↑ SVR
📌 Uses: ACLS (1st), Anaphylaxis (1st), Symptomatic bradycardia (2nd), Septic shock, Bronchospasm

5️⃣ Dopamine (Dopa)
💉 Action:
•Low: D1 > β1 → ↑ CO, ↑ UOP
•Medium: β1 > D1 → ↑ CO, ↑ SVR
•High: α1 > β1 > D1 → ↑ SVR
📌 Uses: Symptomatic bradycardia, Septic shock with bradycardia (↑ mortality vs. Levo in septic and cardiogenic shock)

6️⃣ Methylene Blue
💉 Action: ↓ NO and cGMP → ↑ smooth muscle tone, ↑ SVR
📌 Uses: Refractory sepsis/anaphylaxis, post-cardiopulmonary bypass, amlodipine overdose, methemoglobinemia

7️⃣ Dobutamine (Dobuta)
💉 Action: β1 > β2 > α1 agonist → ↑ CO, ↓ SVR
📌 Uses: Cardiogenic shock, Add to Levo in septic shock with ↓ LVEF

8️⃣ Milrinone
💉 Action: PDE inhibitor → ↑ cAMP → ↑ inotropy, vasodilation → ↑ CO, ↓ PVR/SVR
📌 Uses: Cardiogenic shock, RV failure (↓ PVR, ↓ LVEDV)

9️⃣ Isoproterenol (Isuprel)
💉 Action: β1 = β2 agonist → ↑ HR, ↓ SVR
📌 Uses: Symptomatic bradycardia, Mg-refractory

MI types
Type 1 -plaque rupture
Type 2 -Mismatch
Type 3 -Sudden death
Type 4 -PCI related
Type 5 -CABG related