๐ุงูุฌูุงุจ
โ ุฌู ูุน ู ุฏุฑุงุช ุงูุจูู ุฃูู ูุนุงููุฉ ูู ุงูู ุฑุถู ุงูุฐูู ูุนุงููู ู ู ุงุฎุชูุงู ูุธุงุฆู ุงูููู. ูุฌุจ ุฃู ูุตู ูู ู ู ู ุฏุฑุงุช ุงูุจูู Thiazide ู ุซู Hydrochlorothiazide ูู ุฏุฑุงุช loop diuretics ู ุซู ูุงุฒูุณ ุฅูู ู ูุทูู lumen of renal tubule ุนุดุงู ุชุนู ู ุ ุจููุณ ุงูููุช ููุงู ูุงููุงุช ุงู organic acid ุชุชูุณุทูุง ูู ู ูุทูู proximal tubule ุ ูู ุฑูุถ ุงููุดู ุงููููู ููู ูุฏูู ู ุนุฏู ุงูุชุฑุดูุญ ุงููููู GFR โฌ ๏ธ ุจุชุงูู ูู ูู organic acid ูุฒูุฏ โฌ ๏ธุจุชุงูู ูุญุตู ู ูุงูุณู ู ุน ุงูู ุฏุฑุงุช ููุงูุชูุงู ุฅูู ู ููุทู tubule lumen ูุงูู ุฏุฑุงุช ุฎุงุตู Thiazide ุฃูู ูุนุงููู ูู ุงูู ูุงูุณู ู ุน ูู ูู organic acid
โ ููุฐู ูุญุจูุง ุจุงููุบู ุงูุงูุฌููุฒูู
๐All diuretics are less effective in patients with impaired kidney function. Both thiazide and loop diuretics must reach the lumen of the renal tubule to act, a process mediated by organic acid transporters in the proximal tubule
โ . As glomerular filtration rate (GFR) decreases, organic acid levels increase, and these acids compete with diuretics for transport into the tubular lumen. Thiazides are less effective in competing with accumulating organic acids than loop diuretics in this setting
#UpTodate2023
โ ุฌู ูุน ู ุฏุฑุงุช ุงูุจูู ุฃูู ูุนุงููุฉ ูู ุงูู ุฑุถู ุงูุฐูู ูุนุงููู ู ู ุงุฎุชูุงู ูุธุงุฆู ุงูููู. ูุฌุจ ุฃู ูุตู ูู ู ู ู ุฏุฑุงุช ุงูุจูู Thiazide ู ุซู Hydrochlorothiazide ูู ุฏุฑุงุช loop diuretics ู ุซู ูุงุฒูุณ ุฅูู ู ูุทูู lumen of renal tubule ุนุดุงู ุชุนู ู ุ ุจููุณ ุงูููุช ููุงู ูุงููุงุช ุงู organic acid ุชุชูุณุทูุง ูู ู ูุทูู proximal tubule ุ ูู ุฑูุถ ุงููุดู ุงููููู ููู ูุฏูู ู ุนุฏู ุงูุชุฑุดูุญ ุงููููู GFR โฌ ๏ธ ุจุชุงูู ูู ูู organic acid ูุฒูุฏ โฌ ๏ธุจุชุงูู ูุญุตู ู ูุงูุณู ู ุน ุงูู ุฏุฑุงุช ููุงูุชูุงู ุฅูู ู ููุทู tubule lumen ูุงูู ุฏุฑุงุช ุฎุงุตู Thiazide ุฃูู ูุนุงููู ูู ุงูู ูุงูุณู ู ุน ูู ูู organic acid
โ ููุฐู ูุญุจูุง ุจุงููุบู ุงูุงูุฌููุฒูู
๐All diuretics are less effective in patients with impaired kidney function. Both thiazide and loop diuretics must reach the lumen of the renal tubule to act, a process mediated by organic acid transporters in the proximal tubule
โ . As glomerular filtration rate (GFR) decreases, organic acid levels increase, and these acids compete with diuretics for transport into the tubular lumen. Thiazides are less effective in competing with accumulating organic acids than loop diuretics in this setting
#UpTodate2023
๐ hyperglycemia treatment in crtical care patients
โ There is no universally accepted insulin regimen for glycemic control in critically ill patients. However, in general, we use short-acting preparations as either an intermittent subcutaneous regimen (eg, four- to six-hour dosing) or continuous infusion to achieve the optimal target value (ie, 140 to 180 mg
โ Our concern regarding avoidance of using longer-acting insulin preparations during early phases of critical illness before patients have stabilized is that the insulin requirement may change acutely (eg, discontinuation of enteral or parenteral feeding or glucocorticoids), thereby placing the patient at risk of developing hypoglycemia.
๐Choosing between an intermittent regimen and an infusion depends upon factors including the level of blood glucose, the presence of diabetes, agents that induce hyperglycemia, and response to the insulin regimen used.
โ In patients whose blood glucose is consistently above 180 mg/dL for 12 hours or more, we generally initiate an intermittent sliding-scale subcutaneous regimen, provided the patient does not have diabetic ketoacidosis.
โ If blood glucose continues be uncontrolled during the ensuing 24 hours, we typically escalate to a more aggressive intermittent sliding-scale regimen (ie, increase the dose and/or frequency of insulin) before initiating an insulin infusion.
โ For some patients, the threshold to start an insulin infusion may be lower. This includes patients with diabetes, patients with labile values, and patients with severely elevated blood glucose levels (eg, >250 mg/dL
#UpTodate2023
โ There is no universally accepted insulin regimen for glycemic control in critically ill patients. However, in general, we use short-acting preparations as either an intermittent subcutaneous regimen (eg, four- to six-hour dosing) or continuous infusion to achieve the optimal target value (ie, 140 to 180 mg
โ Our concern regarding avoidance of using longer-acting insulin preparations during early phases of critical illness before patients have stabilized is that the insulin requirement may change acutely (eg, discontinuation of enteral or parenteral feeding or glucocorticoids), thereby placing the patient at risk of developing hypoglycemia.
๐Choosing between an intermittent regimen and an infusion depends upon factors including the level of blood glucose, the presence of diabetes, agents that induce hyperglycemia, and response to the insulin regimen used.
โ In patients whose blood glucose is consistently above 180 mg/dL for 12 hours or more, we generally initiate an intermittent sliding-scale subcutaneous regimen, provided the patient does not have diabetic ketoacidosis.
โ If blood glucose continues be uncontrolled during the ensuing 24 hours, we typically escalate to a more aggressive intermittent sliding-scale regimen (ie, increase the dose and/or frequency of insulin) before initiating an insulin infusion.
โ For some patients, the threshold to start an insulin infusion may be lower. This includes patients with diabetes, patients with labile values, and patients with severely elevated blood glucose levels (eg, >250 mg/dL
#UpTodate2023
๐ุจูุณุจู ู ุงูู
ุณููุงุช ู chronic pain ูู ู
ุฑูุถ ุงููุดู ุงููููู ุงูู
ุฒู
ู ุจุชุญุฏูุฏ Stage 4 ู 5 ู
ุงูู ุงูู
ุณููุงุช ุงูุฐู ู
ุณู
ูุญ ูุงุฎุฐูุง ูู
ุงูู ุงูุชู ูุณุชุฎุฏู
ูุง ุจุญุฐุฑ ูู
ุงูู ุงูุชู ูุชุฌูุจูุง ู
ูุถุญู ูู ุฌุฏููโค๏ธ
Preferred analgesic medications for chronic pain management in CKD stages 4 and 5
Preferred analgesic medications for chronic pain management in CKD stages 4 and 5
โุชุฎูู ุชููู ู
ูุฏููุงู ุฑูุจ ุงู ุตูุฏูุงูู ูุงุญุฏ ุฃุตูุงู ุงุฏููู PPI ู
ุซู pantoprazole ููุณุงูู ุงูุทุจูุจ ูู
ุงุฐุง ูุงุฎุฐ ูุฐู ุงูุงุฏููู ุบุงูุจุง ูู ุงูุตุจุงุญ ุงูุจุงูุฑ ู
ุด ูู ููุช ุซุงูู ุุ
โ ุงูุฌูุงุจ ุงูุนูู ู ูุงูู ูู ูู H-K-ATPase ุงูุฐู ุชุดุชุบู ุนููู ูุฐู ุงูุงุฏููุฉ ุชููู ู ุชูุงุฌุฏู ูู ุงูุฎููู ุงูุฌุฏุงุฑูู (parietal cell ) ุจุดูู ุงูุจุฑ ุจุนุฏ ูุชุฑู ุตูุงู ุทููู ุนู ุงูุทุนุงู
๐Because the amount of H-K-ATPase present in the parietal cell is greatest after a prolonged fast, PPIs should be administered before the first meal of the day
#Salah
#UpTodate2023
โ ุงูุฌูุงุจ ุงูุนูู ู ูุงูู ูู ูู H-K-ATPase ุงูุฐู ุชุดุชุบู ุนููู ูุฐู ุงูุงุฏููุฉ ุชููู ู ุชูุงุฌุฏู ูู ุงูุฎููู ุงูุฌุฏุงุฑูู (parietal cell ) ุจุดูู ุงูุจุฑ ุจุนุฏ ูุชุฑู ุตูุงู ุทููู ุนู ุงูุทุนุงู
๐Because the amount of H-K-ATPase present in the parietal cell is greatest after a prolonged fast, PPIs should be administered before the first meal of the day
#Salah
#UpTodate2023
๐ูู ู
ู
ูู ุงูู ู
ุนุงูุฌุฉ ุงูุงุฑุชุฌุงุน ุงูู
ุฑูุฆู ุงูู
ูุนุฏูู ูุชุฃุซุฑ ุจู
ุนุงูุฌุฉ ุฌุฑุซูู
ู ุงูู
ุนุฏู ุุ
โ ุงูุงุฌุงุจู ูุนู ุญุณุจ ุงู ููุน gastritis ุงูู ุฑุงูู ู H.pylori
โ ูู ูุงู ู ุฑูุถ ุงูุงุฑุชุฌุงุน ูุฏูู gastritis ููุนู corpus-dominant gastritis ูู ูุฐู ุงูุญุงูู ูู ุนุงูุฌุช ุฌุฑุซูู ู ุงูู ุนุฏู ูุนู ูุช ููุง eradication ู ู ูู ูุญุตู worsen ู GERD ููุนุงููุฉ ุงุฏููู PPI ุชูู
โ ุงู ุง ูู ูุงู ู ุฑูุถ ุงูุงุฑุชุฌุงุน ูุฏูู antral-dominant gastritis ู ู ูู ู ุนุงูุฌู ุฌุฑุซูู ู ุงูู ุนุฏู ุชุญุณู ู ู ู ุนุงูุฌุฉ ุงูุงุฑุชุฌุงุน
๐ Eradication of H. pylori is associated with mild worsening of gastroesophageal reflux disease (GERD) in patients with corpus-dominant or pangastritis and improvement in those with antral-dominant gastritis. These effects must be balanced against the risks of continued infection
#UpTodate2023
#Salah
โ ุงูุงุฌุงุจู ูุนู ุญุณุจ ุงู ููุน gastritis ุงูู ุฑุงูู ู H.pylori
โ ูู ูุงู ู ุฑูุถ ุงูุงุฑุชุฌุงุน ูุฏูู gastritis ููุนู corpus-dominant gastritis ูู ูุฐู ุงูุญุงูู ูู ุนุงูุฌุช ุฌุฑุซูู ู ุงูู ุนุฏู ูุนู ูุช ููุง eradication ู ู ูู ูุญุตู worsen ู GERD ููุนุงููุฉ ุงุฏููู PPI ุชูู
โ ุงู ุง ูู ูุงู ู ุฑูุถ ุงูุงุฑุชุฌุงุน ูุฏูู antral-dominant gastritis ู ู ูู ู ุนุงูุฌู ุฌุฑุซูู ู ุงูู ุนุฏู ุชุญุณู ู ู ู ุนุงูุฌุฉ ุงูุงุฑุชุฌุงุน
๐ Eradication of H. pylori is associated with mild worsening of gastroesophageal reflux disease (GERD) in patients with corpus-dominant or pangastritis and improvement in those with antral-dominant gastritis. These effects must be balanced against the risks of continued infection
#UpTodate2023
#Salah
#remember
โ In postmenopausal osteoporosis, 1200 mg of calcium daily (total diet plus supplement) and 800 international units of vitamin D daily are advised.
โ In premenopausal osteoporosis or in males with osteoporosis, 1000 mg of calcium (total of diet and supplement) and 600 international units of vitamin D daily are generally suggested.
#UpTodate2023
โ In postmenopausal osteoporosis, 1200 mg of calcium daily (total diet plus supplement) and 800 international units of vitamin D daily are advised.
โ In premenopausal osteoporosis or in males with osteoporosis, 1000 mg of calcium (total of diet and supplement) and 600 international units of vitamin D daily are generally suggested.
#UpTodate2023
๐ ูู ูู ู
ุฑูุถ ุฑุงุญ ูุงุฎุฐ ุงุฏููู PPI ุฑุงุญ ูุญุชุงุฌ ูุญุต ุงูู
ุบููุณููู
ุ
โ ุงูุงุฌุงุจู ูุง ู ุด ูู ุงูุญุงูุงุช ู ู ูู ูู ุงูุญุงูุงุช ุงูุงุชูู
โ ุงูู ุฑุถู ุงูุฐูู ู ู ุงูู ุชููุน ุฃู ูุชูููุง ุนูุงุฌูุง ู ู ุงุฏููู PPi ุทููู ุงูุฃู ุฏ (ุณูุฉ ูุงุญุฏุฉ ุฃู ุฃูุซุฑ)
โ ูู ุงูู ุฑุถู ุงูุฐูู ุฑุงุญ ูุงุฎุฐูุง PPi ุจุงูุชุฒุงู ู ู ุน ุฃุฏููุฉ ุฃุฎุฑู ู ุฑุชุจุทุฉ ุจููุต ุงูู ุบููุณููู ุงูุฏู ู ุซู ู ุฏุฑุงุช ุงูุจูู
โ ุงูู ุฑุถู ุงูุฐูู ูุฏููู history ู arrhythmias or QT interval prolongation ู ู ูู ูุฑุงูุจ ู ุณุชูู ุงูู ุบููุณููู ูู 6 ุงุดูุฑ
๐obtain serum magnesium levels prior to starting a PPI in patients who are expected to be on long-term (โฅ1 year) treatment or in patients who take PPIs in conjunction with other medications associated with hypomagnesemia (eg, diuretics). In addition, we obtain magnesium levels periodically in such patients while they are taking a PPI. The frequency of testing is based on the clinical history and the presence of symptoms of hypomagnesemia. As an example, in patients with a history of arrhythmias or QT interval prolongation, we monitor magnesium levels every six months.
#UpTodate2023
#Salah
โ ุงูุงุฌุงุจู ูุง ู ุด ูู ุงูุญุงูุงุช ู ู ูู ูู ุงูุญุงูุงุช ุงูุงุชูู
โ ุงูู ุฑุถู ุงูุฐูู ู ู ุงูู ุชููุน ุฃู ูุชูููุง ุนูุงุฌูุง ู ู ุงุฏููู PPi ุทููู ุงูุฃู ุฏ (ุณูุฉ ูุงุญุฏุฉ ุฃู ุฃูุซุฑ)
โ ูู ุงูู ุฑุถู ุงูุฐูู ุฑุงุญ ูุงุฎุฐูุง PPi ุจุงูุชุฒุงู ู ู ุน ุฃุฏููุฉ ุฃุฎุฑู ู ุฑุชุจุทุฉ ุจููุต ุงูู ุบููุณููู ุงูุฏู ู ุซู ู ุฏุฑุงุช ุงูุจูู
โ ุงูู ุฑุถู ุงูุฐูู ูุฏููู history ู arrhythmias or QT interval prolongation ู ู ูู ูุฑุงูุจ ู ุณุชูู ุงูู ุบููุณููู ูู 6 ุงุดูุฑ
๐obtain serum magnesium levels prior to starting a PPI in patients who are expected to be on long-term (โฅ1 year) treatment or in patients who take PPIs in conjunction with other medications associated with hypomagnesemia (eg, diuretics). In addition, we obtain magnesium levels periodically in such patients while they are taking a PPI. The frequency of testing is based on the clinical history and the presence of symptoms of hypomagnesemia. As an example, in patients with a history of arrhythmias or QT interval prolongation, we monitor magnesium levels every six months.
#UpTodate2023
#Salah
#remember
โ Patients taking biotin should hold the supplement for two days prior to assessing thyroid function and longer if they are taking more than 10 mg a day
โ ุทุจุนุง ุงู biotin ุงูุฐู ูุทูู ุนููู ููุชุงู ูู B7 ุงู vitamin H ู ูุฌูุฏ ูู multivitamin ุงู ู ูุฌูุฏ ููุญุฏู ุจุชุฑููุฒ 1000mcg
#UpTodate2023
โ Patients taking biotin should hold the supplement for two days prior to assessing thyroid function and longer if they are taking more than 10 mg a day
โ ุทุจุนุง ุงู biotin ุงูุฐู ูุทูู ุนููู ููุชุงู ูู B7 ุงู vitamin H ู ูุฌูุฏ ูู multivitamin ุงู ู ูุฌูุฏ ููุญุฏู ุจุชุฑููุฒ 1000mcg
#UpTodate2023
๐ ู
ู ุงูู
ุนุฑูู ุจุฃูู ูู ุงูุฌุฑุนุงุช ุงูุนูุงุฌูุฉ ู
ู ุงูููุจุงุฑูู ูุณุชุฎุฏู
aPTT ู monitoring therapy
โ ููู ูู ุญุงูู ุงุฎุฐ ุฌุฑุนุงุช ุนุงููู ู ู ุงูููุจุงุฑูู ูู ุญุงูุงุช ู ุซู cardiopulmonary bypass ุงู ECMO ุงู hemodialysis ูู ูุฐู ุงูุญุงูู ู ู ูู ู ุงูููุน ูุณุชุฎุฏู aPTT ูุงูู ุฌุฑุนุงุช ุงูููุจุงุฑูู ุชูุฏู ุฅูู ุฑูุน ุชุฑููุฒ ุงูููุจุงุฑูู ูู plasma ููู 1unit/mL ููุฐุง ูุนุฏู ูุทุงู aPTT test ู ู ูู ูุณุชุฎุฏู ACT test ุงูุฐู ูุฏ ูุนุทู ูุชูุฌู ุฏูููู ุญุชู ูู ุชุฑููุฒ ุงูููุจุงุฑูู ูู plasma ู ู 1 ุฅูู 5 unit/ml
๐ Patients receiving high-dose unfractionated heparin for cardiopulmonary bypass or other procedures such as extracorporeal membrane oxygenation (ECMO) or hemodialysis can be monitored using the activated clotting time (ACT)
โ In these settings, the aPTT may not be useful because the doses of heparin administered often result in a plasma heparin concentration >1 unit/mL, which prolongs the aPTT beyond the linear monitoring range.
โ In contrast, the ACT shows a dose-response to heparin concentrations in the range of 1 to 5 units/mL
#UpTodate2023
โ ููู ูู ุญุงูู ุงุฎุฐ ุฌุฑุนุงุช ุนุงููู ู ู ุงูููุจุงุฑูู ูู ุญุงูุงุช ู ุซู cardiopulmonary bypass ุงู ECMO ุงู hemodialysis ูู ูุฐู ุงูุญุงูู ู ู ูู ู ุงูููุน ูุณุชุฎุฏู aPTT ูุงูู ุฌุฑุนุงุช ุงูููุจุงุฑูู ุชูุฏู ุฅูู ุฑูุน ุชุฑููุฒ ุงูููุจุงุฑูู ูู plasma ููู 1unit/mL ููุฐุง ูุนุฏู ูุทุงู aPTT test ู ู ูู ูุณุชุฎุฏู ACT test ุงูุฐู ูุฏ ูุนุทู ูุชูุฌู ุฏูููู ุญุชู ูู ุชุฑููุฒ ุงูููุจุงุฑูู ูู plasma ู ู 1 ุฅูู 5 unit/ml
๐ Patients receiving high-dose unfractionated heparin for cardiopulmonary bypass or other procedures such as extracorporeal membrane oxygenation (ECMO) or hemodialysis can be monitored using the activated clotting time (ACT)
โ In these settings, the aPTT may not be useful because the doses of heparin administered often result in a plasma heparin concentration >1 unit/mL, which prolongs the aPTT beyond the linear monitoring range.
โ In contrast, the ACT shows a dose-response to heparin concentrations in the range of 1 to 5 units/mL
#UpTodate2023
#remember
โ ุดุฎุต ู ุงุดู ุนูู ุงุฏููู PPI ูุงุญุชุงุฌ ู ูู ูุงุช ูุงูุณููู ููุถู calcium citrate
๐Insoluble calcium, such as calcium carbonate, requires an acid environment for optimal absorption. As a result, drugs that reduce stomach acid secretion (PPIs and H2 blockers) may reduce calcium absorption. We usually recommend calcium citrate as a first-line calcium supplement in these patients.
#UpTodate2023
โ ุดุฎุต ู ุงุดู ุนูู ุงุฏููู PPI ูุงุญุชุงุฌ ู ูู ูุงุช ูุงูุณููู ููุถู calcium citrate
๐Insoluble calcium, such as calcium carbonate, requires an acid environment for optimal absorption. As a result, drugs that reduce stomach acid secretion (PPIs and H2 blockers) may reduce calcium absorption. We usually recommend calcium citrate as a first-line calcium supplement in these patients.
#UpTodate2023
Clinical Notes
#remember โ
In postmenopausal osteoporosis, 1200 mg of calcium daily (total diet plus supplement) and 800 international units of vitamin D daily are advised. โ
In premenopausal osteoporosis or in males with osteoporosis, 1000 mg of calcium (total of diet andโฆ
๐We suggest cholecalciferol (vitamin D3), when available, rather than ergocalciferol (vitamin D2) for vitamin D supplementation
โ Some , but not all , studies suggest that vitamin D3 increases serum 25(OH)D more efficiently than does vitamin D2 .
โ In addition, vitamin D2 is not accurately measured in all vitamin D assays. For these reasons, we suggest supplementation with vitamin D3, when possible, rather than vitamin D2.
โ Some , but not all , studies suggest that vitamin D3 increases serum 25(OH)D more efficiently than does vitamin D2 .
โ In addition, vitamin D2 is not accurately measured in all vitamin D assays. For these reasons, we suggest supplementation with vitamin D3, when possible, rather than vitamin D2.
"ูุฅูููู ุฃุฌูุงููุฏู ูุง ุงููู ูู ูุง ุฃุชููุซ ุ ุฃุญูุงููู ุฃู ุฃูููู ูู ุตููู ุงูุตุงูุญูู ุ ูุฃุนูููู "โค๏ธ
#ุฌู ุนุฉ_ู ุจุงุฑูุฉ
#ุฌู ุนุฉ_ู ุจุงุฑูุฉ
#remember
๐A plasma osmolal gap greater than 55 mosmol/kg and a mannitol dose exceeding 250 mg/kg every four hours increase the risk of reversible AKI.
โ Patients who develop kidney injury appear to recover kidney function rapidly if treated with hemodialysis to remove the excess mannitol
#UpTodate2023
#Salah
๐A plasma osmolal gap greater than 55 mosmol/kg and a mannitol dose exceeding 250 mg/kg every four hours increase the risk of reversible AKI.
โ Patients who develop kidney injury appear to recover kidney function rapidly if treated with hemodialysis to remove the excess mannitol
#UpTodate2023
#Salah
Clinical Notes
ุจุฑูุงู
ุฌ BMJ best practices ู
ู ุฃูุถู ุงูุจุฑุงู
ุฌ ุงูุทุจูู ูู ุงูู
ู
ุงุฑุณู ุงูุทุจูุฉ ูุทูุงุจ ุงูุทุจ ุจุบุถ ุงููุถุฑ ุทูุงุจ ุจููุฑุฏุ ุงู ุทูุงุจ ุงูุงู
ุชูุงุฒ ุงู ุงูุตูุฏูุฉ ุงูุณุฑูุฑูู ุงู ุงูุตูุฏูู ุงูุนุงู
ู ูุงูุฌู
ูู ููู ุฃูู ูุณุชุทูุน ุชุญู
ูู ุงูุจูุงูุงุช ูุงุณุชุฎุฏุงู
ู ุฏูู ุฅูุชุฑูุช ููู ูุณุจุจ ูุซุฑู ุงูุถุบุท ุน ุงูุญุณุงุจ ุงูุฐู ูุนูุชูโฆ
ุงูุณูุงู
ุนูููู
ูุฑุญู
ุฉ ุงููู ูุจุฑูุงุชู
ูุตุฑ ุงููู ุงูู ุฌุงูุฏูู ูู ุบุฒุฉ ูููุณุทูู ูุญู ู ุงููู ุงูููุง ูู ุบุฒุฉ
ุงูุญุณุงุจุงุช ุฐู ุชุณุชุฎุฏู ูู ุงูุจุฑูุงู ุฌ ููุณู ู ุด ู ุฑุงุณูู ุงูุจุฑูุฏ ุงูุฅููุชุฑููู
ูุฌุฏุช ุขูุงู ุงูุฑุณุงูู ูู ุงูุจุฑูุฏุงุช
ู ู ูู ูุณุชุทุน ุงุณุชุฎุฏุงู ู ุงู ูู ูููู ู ุงู ุทุฑููู ุชุณุฌูู ุงูุฏุฎูู ูุฑุงุณููู ุชูุฌุฑุงู ู ุด ูู ุงูุจุฑูุฏ ุงูุงูุชุฑููู
ุฐุง ุญุณุงุจู
@m_rassam
ูุณูู ุฃูุถุญ ูู ููุฏููุง ูุฑูุจุง ุงู ุดุงุก ุงููู
ูุตุฑ ุงููู ุงูู ุฌุงูุฏูู ูู ุบุฒุฉ ูููุณุทูู ูุญู ู ุงููู ุงูููุง ูู ุบุฒุฉ
ุงูุญุณุงุจุงุช ุฐู ุชุณุชุฎุฏู ูู ุงูุจุฑูุงู ุฌ ููุณู ู ุด ู ุฑุงุณูู ุงูุจุฑูุฏ ุงูุฅููุชุฑููู
ูุฌุฏุช ุขูุงู ุงูุฑุณุงูู ูู ุงูุจุฑูุฏุงุช
ู ู ูู ูุณุชุทุน ุงุณุชุฎุฏุงู ู ุงู ูู ูููู ู ุงู ุทุฑููู ุชุณุฌูู ุงูุฏุฎูู ูุฑุงุณููู ุชูุฌุฑุงู ู ุด ูู ุงูุจุฑูุฏ ุงูุงูุชุฑููู
ุฐุง ุญุณุงุจู
@m_rassam
ูุณูู ุฃูุถุญ ูู ููุฏููุง ูุฑูุจุง ุงู ุดุงุก ุงููู
๐Definition of high bleeding risk
is present if one major or two minor criteria (risk factors) for major bleeding are present
โ ู ุชู ูููู ุจุฃู ุงูู ุฑูุถ ุงูุฐู ุฑุงุญ ูุฎุถุน ู ูุณุทุฑุฉ ููุจูุฉ PCI ุจูููู ู ุนุฑุถ ูููุฒูู
โ ุงุฐุง ูุฌุฏ one major factor ุงู ุงุซููู ู ู minor factor
ู ูุถุญ ูู ุงูุตูุฑู ูุงูุฌุฏูู
is present if one major or two minor criteria (risk factors) for major bleeding are present
โ ู ุชู ูููู ุจุฃู ุงูู ุฑูุถ ุงูุฐู ุฑุงุญ ูุฎุถุน ู ูุณุทุฑุฉ ููุจูุฉ PCI ุจูููู ู ุนุฑุถ ูููุฒูู
โ ุงุฐุง ูุฌุฏ one major factor ุงู ุงุซููู ู ู minor factor
ู ูุถุญ ูู ุงูุตูุฑู ูุงูุฌุฏูู
Clinical Notes
๐Definition of high bleeding risk is present if one major or two minor criteria (risk factors) for major bleeding are present โ
ู
ุชู ูููู ุจุฃู ุงูู
ุฑูุถ ุงูุฐู ุฑุงุญ ูุฎุถุน ู ูุณุทุฑุฉ ููุจูุฉ PCI ุจูููู ู
ุนุฑุถ ูููุฒูู โ
ุงุฐุง ูุฌุฏ one major factor ุงู ุงุซููู ู
ู minor factor ู
ูุถุญโฆ
ุงูุฌุฏูู๐
๐ู
ุณุงุก ุงูุฎูุฑ
โ ูุญู ูุฏุฑู ุฃูู ูุฉ ุฏูุงุก ุงูุฃุณุจุฑูู ูู ู ุฑุถู ุงูููุจ ุจุชุญุฏูุฏ secondary prevention ููู ู ุฑุถู ischemic strokeุู ุงุฐุง ูู ูุงู ุงูู ุฑูุถ ูุฏูู ุชุญุณุณ ู ู ุงูุฃุณุจุฑูู ู ุงูู ุงูุญู ุ ุฑุงุญ ุงูุฑุงุก ุชุนูููุงุชูู ุงููุง ุซู ูุทุฑุญ ุงูุญููู ุงูุนูู ูุฉ ุงูู ู ููุฉ
#Salah
โ ูุญู ูุฏุฑู ุฃูู ูุฉ ุฏูุงุก ุงูุฃุณุจุฑูู ูู ู ุฑุถู ุงูููุจ ุจุชุญุฏูุฏ secondary prevention ููู ู ุฑุถู ischemic strokeุู ุงุฐุง ูู ูุงู ุงูู ุฑูุถ ูุฏูู ุชุญุณุณ ู ู ุงูุฃุณุจุฑูู ู ุงูู ุงูุญู ุ ุฑุงุญ ุงูุฑุงุก ุชุนูููุงุชูู ุงููุง ุซู ูุทุฑุญ ุงูุญููู ุงูุนูู ูุฉ ุงูู ู ููุฉ
#Salah