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خلصت اجازة العيد والحمدلله اني اقدرت احضر وسجل موضوعين وهو Community-acquired pneumonia و Septic shock اخذت مني جهد ووقت واكتشفت انه الجانب الأكاديمي متعب😅 اتمنى بانة قد اوصلت الموضوعين بشكل جيد ، وغدا نعود لدوام العمل 😁 ونلتقي في الإجازات في مواضيع ثانية ان شاءالله،أسأل الله أن يكون هذا العمل خالص لوجهه الكريم 👏👏
Clinical Notes
🔹PCT appears to be a more specific marker for bacterial infections than either CRP or ESR, and it can be a valuable tool for the clinician to help assess mortality risks of patients with infections and also can help determine when to initiate antibacterial
🔺PCT levels may help determine whether to discontinue empiric antibiotics in possibly infected patients as well as to determine when antibiotics can be discontinued in patients recovering from infections.

🔹PCT levels below 0.25 ng/mL (mcg/L) are associated with low risk of infection and can help justify the discontinuation of antibiotics, while levels >0.5 ng/mL (mcg/L) may indicate that antibiotics should be continued
🛑Approach for shock management

Point of care ultrasound to differentiate cause of shock

Is there evidence of overt fluid/blood loss e.g. GIT bleeding ➡️blood and fluid resuscitation

In absence of evidence of overt blood loss➡️ Fluid responsiveness

Titrate norepinephrine to reach MAP ≥ 65 mmHg

After reaching the target of MAP ➡️assess tissue perfusion using lactate and/or capillary rfill time

If tissue perfusion is adequate→start weaning of vasopressor

If tissue perfusion is inadequate consider higher MAP (70-75 mmHg)

If tissue perfusion remains inadequate after achieving high MAP→ consider inotropic support in patients with poor contractility.

#Evidence-Based Critical Care Protocols 2022
🛑ادويه anticoagulants المستخدمه في معالجة مريض Acute coronary syndrome هي
heparin
enoxaparin
fondaparinux
bivalirudin
السؤال متى نستخدم كل واحد ؟؟
🔸In patients with pneumonia or sepsis, it may be valuable to recheck a PCT level every 1 to 2 days to monitor resolution.
🔹If the PCT reduces by 80% to 90% or falls below 0.25 ng/mL (mcg/L), then it may be reasonable to discontinue antibiotics, assuming they do not continue to show other signs of infection such as hemodynamic instability or respiratory distress.
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كيف نختار المحلول الوريدي المناسب حسب حاله المريض؟؟
العظمه ذي من مرجع Shock للبروف Ahmed Hasanin
مساء الخير راح اسجل اليوم موضوع
pulmonary embolism
او مايسمى باللغة العربية
الانصمامُ الرئوي وراح اتكلم على ثلاثة محاور
Diagnosis
Risk stratification
Treatment
حسب الجايدلاين الاوروبي ESC
انتظرونا عند الساعه العاشره مساء ان شاء الله ❤️
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Clinical Notes
Risk stratification of pulmonary embolism
🔻🔻
في حالة الانفكشن وقبل أن تضهر النتيجه فيه أشياء نركز عليه عند إختيار المضاد الحيوي
🔻
أولاً أسأله معينة يجيب معرفتة
(1) prior knowledge of colonization or infections,
(2) previous antimicrobial exposure,
(3) the site of infection and the most likely pathogens, and
(4) local antibiogram and resistance patterns for important pathogens

🔸ثانياً نركز ع عوامل معينه منها
🔸
Severity and acuity of the disease, local epidemiology and antibiogram,
patient history,
host factors,
factors related to the drugs used, and the necessity for using multiple agents.
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Which one of the following fluoroquinolones provides activity against MRSA?

Which one of the following fluoroquinolones provides activity against MRSA?
Anonymous Quiz
28%
Levofloxacin
36%
Moxifloxacin
20%
Delafloxacin
16%
Levofloxacin
✔️Which of the following statins is most affected by grapefruit juice?
Anonymous Quiz
43%
A. Simvastatin
10%
B.Pitavastatin
9%
C. Pravastatin
38%
D. Rosuvastatin
لإظهار التفسير ع الإجابة الصحيه الضغط على العلامة
🔻تذكر ادويه الاستاتين هناك نوعين
1️⃣ Hydrophilic statins, such as rosuvastatin and pravastatin,
وهذه تكون
water-soluble
وتملك ميزة أنها 🔺
less muscle penetration, which results in a lower risk of muscle-related side effects.
ف تعتبر اقل ادويه تعمل myopathy
بينما
2️⃣lipophilic statins, such as simvastatin, fluvastatin, pitavastatin, lovastatin, and atorvastatin,
تكون أكثر في 🔺
more lipid-soluble and can easily enter cells, including muscle cells, which increases the risk of muscle-related side effects.
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💠🔹A patient was recently discharged from the hospital following a myocardial infarction. One of the medications they were started on was rosuvastatin 20 mg once daily.

When should lipid levels be reassessed?
Anonymous Quiz
14%
A. 7-14 days
41%
B. 4-6 weeks
18%
C. 6 months
27%
D. Every 3-12 months
2024/06/30 05:20:55
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