🛑 beta blockers in Acute MI

✅Heart rate goal — We suggest reducing the heart rate to between 55 and 70 beats per minute while maintaining a systolic pressure above 90 mmHg, based on a small amount of published evidence and our clinical experience.
#UpTodate2024

البورد الأمريكي ACCp 2023 قسم cardiology

🛑إعادة نشر
✅ممكن نستخدم CRP test عشان نشوف انه ممكن نصرف antibotic لمريض pneumonia خاصه اذا not clear whether antibiotics should be prescribed
✅فلو كانت CRP اقل من 20 هنا عاده مابنصرف
✅اما لو كانت بين 20 و 100 فممكن اصرف لو الاعراض زادات
✅فوق 100 هنا نعطي antibotic
#NICE_guideline

#salah

🛑 ماهو anticoagulant المستخدم لمريض STEMI ؟؟
✅الجواب حسب الطريقه المتبعه في عمل reperfusion (ثلاث طرق)
✅فإذا كنت راح اسوي قسطرة قلبية PCI راح استخدم هيبارين او bivalirudin
✅اما لو استخدمت  مذيبات الجلطة fibrinolysis فهنا ممكن استخدام الكليكسان enoxaparin او  fondaparinux ,طبعا بعض المرضى الذي نستخدم لهم مذيبات الجلطة قد تستمر لديهم الاعراض نلجأ إلى عمل قسطرة قلبية تسمى Rescue PCI ⬅️هنا نستخدم الهيبارين

✅اما اذا المريض مشى ع ischemia guided ( مافيش invasive يعني) ⬅️ هنا نستخدم كليسكان او هيبارين
#UpTodate2024

🛑Symptomatic hypoglycemia from intentional sulfonylurea overdose is treated with both dextrose and octreotide.

✅In adults, the dose of octreotide is 50 to 100 mcg administered by intramuscular, or subcutaneous, injection every six hours.

✅In children, the dose of octreotide is 1 to 1.5 mcg/kg (up to 50 mcg) every six hours.

✅the role of octreotide in hypoglycemia associated with therapeutic use of sulfonylureas is unclear.
#UpTodate2024

🛑Celecoxib

✅Less risk of GI toxicity relative to nonselective NSAIDs

✅No effect on platelet function

✅Cardiovascular and kidney risks are dose-related and may be similar to nonselective NSAIDs

✅May be tolerated by patients with AERD or pseudoallergic reactions (eg, asthma, rhinosinusitis) who cannot take other NSAIDs.
#UpTodate2024

#remember
✅⭕ In patients taking an ACE inhibitor, ARB, or MRA, trimethoprim-sulfamethoxazole (TMP-SMX) should be avoided or used with caution with careful monitoring.

✅ An elevated risk of hyperkalemia and acute kidney injury has been observed in patients treated with ACE inhibitor plus TMP-SMX
#UpTodate2024

*دكتور داخل يشرح أول مره*

🇺🇲 : Hello, I'm Dr. Mohamed

🇸🇦: مرحبا أنا دكتور محمد

🇪🇾🇪: لسه جاي من أمريكا وعديت علي ألمانيا في الطريق وجيت علي المدرج هنا بالغلط أصلا يا شويه فقراء
#ترفيهه😂

#remember
🛑Patients with hypertrophic cardiomyopathy and AF should be anticoagulated, regardless of CHA2 DS2-VASc score.
✅في الأغلب نستخدم Score معينه الذي هي CHA2 DS2-VASc score في مريض الرجفان الاذيني ( الرجفان الاذيني اللاصمامي) لتحديد اذا ماكان بحاجه الى مضادات التجلط او لا
✅لكن في حاله كان مريض اعتلال عضلة القلب الضخامي مع رجفان اذيني نعطي مضادات التجلط بغض النظر عن قيمه Score

#ACCP203

🛑متى نعطي دواء Spironolactone في مريض الفشل القلبي؟؟؟
✅ Recommended in patients with NYHA class II–IV HF with an LVEF of 35% or less to reduce morbidity and mortality unless a contraindication exists.
✅Patients with NYHA class II HF should have a history of CV hospitalization or elevated BNP concentrations. 
✅   Recommended in patients after an acute MI who have an LVEF of 35% or less with symptoms of HF or history of DM, unless contraindicated  
🛑ماهي الفائده من إعطاء دواء Spironolactone في مريض الفشل القلبي ؟؟
  
✅Decreased mortality (30% RRR compared with placebo)
✅ Decreased hospitalizations for HF (35% RRR compared with placebo)  

✅Improved symptoms

#ACCP203

أسوأ شعور هو أن يصيبك فقدان الشغف في حب القراءة والإطلاع 💔

لقد بدأت افقد الشغف يارفاق

#remember
🛑Labetalol has both alpha-blockade and beta-blockade activity. The ratio of alpha to beta blockade activity is:
✅ 1:3 when used orally
✅ 1:7 when used intravenously

#crtical_care_pearl2018

#remember
🛑Psychiatric symptoms may develop as soon as after 4 days of corticosteroid therapy, although they can occur anytime in therapy or even after the completion of treatment.
✅Administration of high dose corticosteroid is one of the key risk factor for psychosis.
✅ Primary treatment is tapering off steroid along with various antipsychotic drugs if needed.

#crtical_care_pearl2018

🛑Heparin Induced Hyperkalemia??

✅ Hyperkalemia from Heparin is a well know phenomenon and has been detected particularly on geriatric, renal insufficient and diabetic patients.
✅Hyperkalemia can be anywhere from .3 to 1.7 mEq/Liter.
✅ It usually occurs around day 3 with SQ heparin (as for DVT prophylaxis) but can occur early with IV heparin.

✅Mechanism of action
Heparin induces hypoaldosteronism and can subsequently lead to hyperkalemia.

✅Treatment
Best thing is to discontinue the culprit but if heparin is absolutely required, fludrocortisone (.1 mg/day) has been reported to be effective in heparininduced hyperkalemia

#crtical_care_pearl2018