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Hesham's Notes: post #502 — TG.ME

Hesham's Notes@HeshamNotes · 5.5K subscribers Open in TelegramOpen

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t.me/HeshamNotes/502

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May 21, 2024 6.7K

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---------------------------------------------------- 3.8K·Feb 18 [media post] 3.8K·Feb 18

[media post] 3.9K·Feb 18 📌 Random Medical Notes #10: "Management of an Anaphylactic reaction to a drug": - If an allergic reaction occurs: 📍ABCDE APPROACH for life-threatining problems, keep the patient supine or semi-sitting, not standing, discontinue the drug administeration .. 📍1st line of TTT: Give 0.5 mg Adrenaline I.M in the middle of the anterolateral part of the thigh .. So, with Adrenaline 0.25 mg/ ml ampoule for example.. we give 2 ml I.M .. to be repeated every 5 mins if symptoms didn't improve up to 2 doses .. If no improvement, refer to the Refractory Anaphylaxis algorithm shown below .. 📍 Monitoring: NIBP, Pulse oximeter, ECG 📍+ if Hypotension occurs: Administer IV Crystalloids (Normal Saline or Ringer lactate) via wide-bore cannula rapidly (Give 1 Liter bolus in adults, with additional fluid resuscitation as needed in severe anaphylactic shock up to 3-5 Liters in adults) 📍+ if Respiratory distress occurs: Administer High flow Oxygen (6-8L/ min) + Nebulized Atrovent or Salbutamol in case of Wheezy chest 📍 Additional lines of TTT: Give Dexa, Hydrocortisone, and Avil to relieve the allergic reaction symptoms .. Transport the patient to hospital The algorithm shown below may be of help.. 3.8K·Feb 18 📍 Random Medical Notes #9: "Local anesthesia in an abscess"👇 👈 ليه لما بندي local anesthesia في abscess مبيعملش effect و العيان بيحس؟ فكرة عمل الlocal anesthesia لما بحقنها، إن فيه منها جزء بيبقى non-ionized و ده بيبقى lipophilic و بيقدر يعدي الcell membrane بتاع الnerve و يخدره .. و العكس، فيه جزء بيبقى ionized مبيقدرش يعدي الcell membrane و مبيخدرش الnerve .. و بالتبعية، كل ما زاد الجزء الnon-ionized و قل الجزء الionized كل ما المُخدر اشتغل أحسن .. 👈 طب إيه اللي بيحصل في الabscess؟ الmetabolic byproducts اللي بتطلع نتيجة للبكتيريا و رد فعل الجسم تجاهها، بتخلي الmedia بتاعة الabscess تكون acidic .. و الacidic media، يعني H+ زيادة .. الH+ ده يروح يمسك في الlocal anesthetics و يخليها ionized .. و الionized anesthetics مبتشتغلش و مبتخدرش العصب زي ما قولنا فوق .. 👈 طب هل فيه حل للموضوع ده؟ أه، إننا نخلي الmedia دي less acidic .. و ده عن طريق إننا نحقن NaHco3 الأول في الabscess و بعد كده نحقن الlocal anesthesia .. أو نعمل buffering للlocal anesthesia عن طريق إننا نخلطها مع NaHco3 في الحقنة قبل ما نحقنها .. بس لازم اللي يعمل كده يكون حد متدرب، و بتبقى بconcentration معينة .. 7.2K·May 21

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