#remember

✅Carbamazepine not only increases the clearance of cisatracurium, but also increases the resistance to the neuromuscular blocking effect of cisatracurium. Higher doses of cisatracurium may be required in patients on chronic carbamazepine therapy
#crtical_care_pearl2018

🛑What is the major clinical difference between Parkinson's disease and tardive dyskinesia patients on examination?

✅Answer: Patients with Parkinson’s disease have difficulty moving, whereas patients with tardive dyskinesia have no problem in moving and ambulation.
#crtical_care_pearl2018

🛑vancomycin. V linezolid

✅Penetration of linezolid into bronchial fluids is much higher than that of Vancomycin.
✅linezolid has high bioavailability and allows easy switching to oral therapy.
✅it does not require any adjustment in kidney dysfunction.


لكن cost يظل اقل ل vancomycin مقارنة ب linezolid لذا نفضله غالبا اول خيار😁

#crtical_care_pearl2018

🛑How to define submassive PE?

✅Answer: Submassive PE is an acute PE without systemic hypotension but patient having either right ventricular dysfunction or myocardial necrosis.

#crtical_care_pearl2018

#remember
🛑Intravenous Labetalol and hyperkalemia

✅Intravenous Labetalol, a nonselective α- and β-blocking drug, is commonly used to treat severe hypertension, but it can cause hyperkalemia ↗️↗️

✅In patients with renal failure, it can be life threatening, particularly in situations where emergent hemodialysis is not available.

#crtical_care_pearl2018

✅Steroid psychosis is very common in ICUs but unfortunately often go undiagnosed. It occurs in about 5% of patients receiving steroids for other medical reasons. Physicians usually have a window of 1-3 days to abort the full-blown picture of steroid psychosis.

✅ Discontinuation of steroids, supportive treatment and psychotropic medications are needed.

✅Treatment includes Thioridazine (Mellaril) 50 to 200mg q.d. Chlorpromazine (Thorazine) 50 to 200mg p.o., q.d. or haloperidol (Haldol) 2 to 10mg po. q.d

✅ Symptoms of steroid psychosis sits on a wide range of spectrum including: anxiety, disturbances of body image, profound distractibility, pressured speech, emotional labiality, severe insomnia, sensory flooding, apathy, perplexity, hallucinations, agitation, mutism, delusions, depression, hypomania, and intermittent memory impairment.
#crtical_care_pearl2018

🛑 ماهي الحاله التي نستخدم فيها ادوية benzodiazepines مثل lorazepam او diazepam في معالجة ارتفاع ضغط الدم ؟؟

✅الاجابه في حاله cocaine induced hypertension ( ارتفاع ضغط الدم الناتج عن التسمم بجرعه كوكايين )

✅في هذا الحاله يمنع استخدم ادويه beta blockers والسبب
✅because it may result in unopposed alpha effects of cocaine and may further increase the blood pressure. There are also some reports of seizures with Beta-blocker in such situations


✅ولايفضل ادويه Calcium channel blockers والسبب

✅can dilate splanchnic vessels, thereby increasing absorption of ingested cocaine from the gastrointestinal tract, which may create a challenging situation in body packers

✅نستخدم
✅Administer diazepam (5 mg IV) or lorazepam (1 mg IV); may repeat every 5 minutes until sedated

#crtical_care_pearl2018
#UpTodate2024

#remember

🛑 diabetic ketoacidosis and Upper GIT bleeding

✅9% of hospitalized diabetic
ketoacidosis patients have upper gastrointestinal complications.
✅The most common abnormality is erosive esophagitis. 
✅GI Bleeding correlates with glucose level, admission to the ICU, duration of diabetes and the presence of diabetic complications.
#crtical_care_pearl2018

#important_information
🛑 heparin  and rising AST and ALT

✅Elevation of serum aminotransferase levels is very common and reported in as many as 80% of patients receiving heparin.

✅values are usually less than 5 times the upper limit of normal and are rarely associated with symptoms or jaundice.
✅ Values above 5 times the upper limit of normal occur in ~2% of those receiving the high doses of heparin

✅To note, this abnormality is not associated with liver dysfunction, and it disappears after the drug is discontinued.
✅The serum enzyme elevations generally resolve fully within 4 to 10 days of stopping heparin. 

#crtical_care_pearl2018
#LiverTox
#Salah

بالعربي كذا
✅غالبا مايرافق استخدام الهيبارين ارتفاع في انزيمات الكبد
✅في العاده الارتفاع مايتجاوز خمسه اضعاف القيمة الطبيعي ونادرا مايصاحب الارتفاع وجود اعراض
✅هذا الارتفاع لايعني بأنه يوجد خلل وظيفي في الكبد
✅يختفي هذا الارتفاع بعد اربعه إلى عشره ايام من ايقاف دواء الهيبارين

حسب التحديثات الأخيره في ال
European Society of Cardiology (ESC) 2024
توصيات لمرضى ال
ACS
ضروري نبداء نستخدم او نستمر في high-dose statin therapy as early as possible
بغض النضر عن قيمة ال LDL cholesterol
ضروري يقل إلى
< 55 mg/dL (< 1.4 mmol/L) and to reduce LDL cholesterol by ≥ 50% from baseline

قد نضيف دواء
Ezetimibe
اذا لم يصل المريض إلى الهدف المطلوب في خلال
4-6 weeks

اذا لم يصل إلى الهدف المطلوب في
4-6 weeks
بعد إضافة الدواء الثاني أضيف PCSK9 ك دواء ثالث
#massoud

#remember
✅Each one unit of platelet transfusion is expected to increase platelet count by 5 - 10,000 / uL, and platelet transfusion is usually given as 6 or 10 units together.
#crtical_care_pearl2018

🛑What is the difference between Filgrastim (Neupogen) and pegfilgrastim (Neulasta)?

✅ Filgrastim (Neupogen): is a granulocyte colony-stimulating factor (G-CSF) analog used to stimulate the differentiation and proliferation of granulocytes in neutropenic patients, It can be given subcutaneously or intravenously.  Usual dose is 5 mcg/kg daily.

✅ Pegfilgrastim (Neulasta) Pegfilgrastim has an added polyethylene glycol molecule, which is absent in Filgrastim, thus reducing the renal clearance and prolonging persistence in vivo (half-life range: 46-62 hours). 
✅Pegfilgrastim can be given on the first day of chemotherapy.  The effect of single dose of pegfilgrastim lasts for fourteen days. It can only be given subcutaneously and not intravenously. 
✅The recommended dosage is a single subcutaneous injection of 6 mg administered once per chemotherapy cycle

#crtical_care_pearl2018

✅SADMANS
اختصار ل الادوية التي نلجأ إلى ايقافها لو حصل جفاف نتيجة اسهال حاد او ترجيع
#Rexfill

🛑Which corticosteroid has the highest Relative Sodium Retention (RSR)?
  ✅ Answe: Hydrocortisone :

✅ Hydrocortisone has Relative Sodium Retention of "20" in comparison to other steroids
✅ Prednisone's RSR is 1
✅Methylprednisone RSR is 0.5
✅Dexamethasone RSR is 0

#crtical_care_pearl2018

🛑 طيب ليش تستخدم metformin؟
✅ المريض عشان اخس(ينقص وزني)


✅طيب المرجع الكندي Rxfiles يقول بانة حسب الدراسات راح تنزل بمقدار 2.9 كيلو خلال اربع سنوات😜، ما تعمل رياضة كل يوم وتنزل اكثر من كذا بكثير خلال ست اشهر😂

#Rexfill

#remember

✅This is important to know that PO (by mouth) potassium replacement is as effective as IV replacement and should be used if enteral route is available.
✅ Actually, correction of K levels could be faster with oral supplementation due to limitation of slow rate needed for IV potassium.

✅40 meq of PO KCl increases serum K by 0.5 - 0.7 meq/L in 1 - 2 hours, means K level may rise from 3 to 3.5 meq/L with one PO dose of 40 meq KCl elixir.


✅Potassium IV solutions should be administered only in well-hydrated patients and with adequate urine flow (especially in post-surgical patients).

#crtical_care_pearl2018
#medscape
#NIH

🛑Should we be using Tranexamic acid (TXA)
for noncardiac surgery in patients at high risk of bleeding and cardiovascular complications?

✅Yes, when we consider all the evidence, TXA can prevent bleeding complications without increasing adverse cardiovascular events.

#Critical Care Reviews Book2023