Saturday, May 25, 2013

Managment of Ascites

Ascites is our topic today so we will start by Ascites definition

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Ascites and paracentesis

Definition of Ascites:

Ascites is the collection of excess free fluid in the peritoneal cavity.

Causes of Ascites:

Hepatic :
  • Liver Cirrhosis.
  • Hepatic tumors (hepatocellular carcinoma)
Malignant Disease:
  • Hepatocellular carcinoma
  • Abdominal or pelvis tumors that may be primary or secondary tumors
  • Primary mesothelioma

  • Congestive Cardiac failure or right heart faliure
  • Constrictive pericarditits.
  • Tricuspid incompetence (regurge)
Venous obstruction:
  • Budd-Chiari syndrome.
  • Veno-occlusive disease.
  • Hepatic portal vein obstruction.
  • Inferior vena cave obstruction.
 Management of Ascites:
Watch this video (paracentesis):

General Investigations:
1. Urine Dipstick:  strongly positive for protein in nephrotic syndrome.
2. Complete Blood Count: Raised white cell count may indicate an infection
3. Urea and Electrolytes: Elevated urea and creatinine may indicate a renal etiology
4. LFT’s :in hepatic faliure.
5. Chest X-ray: Findings suggestive of cardiac failure are cardiomegaly.
6. Ultrasound Abdomen: detect any intra abdominal masses that are not palpable on clinical examination. OR fatty deposits in the liver in the presence of cirrhosis.
7. Abdominal Paracentesis: Aspiration of the ascitic fluid is very useful to help determine the underlying cause. A sample should be sent to microbiology  clinical chemistry and pathology.
8.Ascitic fluid Examinations.
A. Echocardiography
B. Liver biopsy
C. Renal Biopsy
D. Portal venography

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Thursday, May 23, 2013

Chest Tube Insertion

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Chest tube is a flexible plastic tube that is inserted through the chest wall and into the pleural Space or mediastinum.
Indication of chest tube insertion:
Contraindications of chest tube insertion:
1.                  Infection over insertion site
2.                  Uncontrolled bleeding diathesis

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1.                  Chest tube with or without trocar; OR Fuhrman catheter
2.                  Chest tube suction unit , tubing, wall suction hookup
3.                  Chest tube tray to include scalpel blade and handle, large Kelly clamps, needle driver, scissors
4.                  Packet of 0 or 1.0 silk suture on a curved needle
5.                  Tape, gauze.
6.                  2% lidocaine with epinephrine injection, 20 cc syringe, 23-gauge needle for infiltration
7.                  Sterile prep solution; mask, gown and gloves.

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 Location (Safety triangle):
1) lateral border of the pectoralis major muscle
2) anterior border of the latissimus dorsi
3) Imaginary horizontal level of the nipple

Area of insertion 4th to 6th intercostal space anterior to Mid-axillary line

Thursday, May 2, 2013

Endotracheal intubation from Advanced Trauma Life Support(ATLS)

How to Intubate a patient? is our topic Today to intubate or orotracheal intubation.

we will use youtube video to learn you How you can intubate a patient?

Indication for Orotracheal intubation(ETT): Respiratory arrestwhatever the cause. Respiratory failureas in multiple medical diseases. Airway obstruction commonly in Foreign body. Need for prolonged ventilatory supportin ICU. Class III or IV hemorrhage with poor perfusion Severe flail chest or pulmonary contusion Multiple trauma, head injury and abnormal mental statusas in Road trafic accident. Inhalation injury with erythema/edema of the vocal cords Protection from aspiration.

--> Endotracheal intubation Definition:  is the placement of a tube into the trachea.
Steps for intubation:
  • Open the airway to give oxygen before intubation(using Ambu bage connected with oxygen)
  • Remove blockages from the airway or secretion by suction machine.
  • Try to get a better view of the upper airway to put ETT.
  • Put the ETT in the trachea in clear vision.
  • Protect the lungs in certain patients.
  • careful from Bleedind or infection.
  • Be sure that ETT putted in correct position using stethoscope.
Now watch this youtube video:

Other videos about ATLS you can watch from our learnning youtube channel:

ATLS cricothyroidotomy

 ACLS Guidelines updated video

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Saturday, April 20, 2013

Drug allergy and Food Allergy

Drug allergy unwanted side effect to certain medication.Food allergy same like Drug Allergy in effect,commonly skin reaction (rash).nousea ,vomiting, Diarrhea and swelling In mouth and throat. Drug allergy commonly occured secand time use of the medicine not first use.
Drug allergy is ife-threatening conditin but rare to couse Death.
Skin reactions of Drug allergy is measles-like rash so we must take good history for prober diagnosis and wright managment.
we should know that skin allergy may be occured after days or weeks from the first dose of the drug.(NB: good history)
Systemic symptomes and signs such as Rapid or irregular heart beat,Fainting.low Blood pressure and Chest tightness, wheezing, throat tightness
Now You can watch This Video and we hope that is informative:

Advice you to Read This topic if you are interested by Drug allergy and Food Allergy

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# Commenest drugs couse allergy such as codeine, morphine, nonsteroidal antiinflammatory drugs (NSAIDs, such as ibuprofen or indomethacin), and aspirin.
# Antibiotics such as penicillin, sulfa drugs, and tetracycline.
# Antiseizure medications such as phenytoin (Dilantin) or carbamazepine (Tegretol).
# Certain food allergies such as to eggs, soybeans, or shellfish
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Friday, April 19, 2013

Bronchial Asthma video from A-Z

Bronchial Asthma video from A-Z

Bronchial Asthma  common in USA about 20 million Americans have asthma.So we here will discus How we can deal with Allergy and what we should know about Bronchial Asthma by reading this topics and watching video from youtube also within days we will discus all allergy diseases in details so you can add your E-mail below to follow our blog.
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Bronchial Asthma Triggers:

Bronchial asthma triggers may include:
  • Smoking and passive smoking.
  • Infections such as colds, flu, or pneumonia.
  • Allergens such as food, pollen, mold, dust mites, and pet dander and others.
  • Excessive Exercise.
  • Air pollution and toxins,dust.
  • Weather, especially extreme changes in temperature.
  • Drugs (such as aspirin, NSAID, and beta-blockers).
  • Food additives (such as MSG).
  • Emotional stress and anxiety.
  • Perfumes and fragrances.
  • Acid reflux.
  • Rare: Singing, laughing, or crying.
--> Watch This Video:


Signs and Symptoms of Bronchial Asthma

One or more of the following signs and symptoms:
  • Shortness of breathing.
  • Tightness of chest.
  • Wheezing (patient can hear that in sever asthma)
  •  cough or a cough that keeps you awake at night.
Specially in:
*At  night or early morning
*Exercise – cold air
*Genetic Atopy ( IgE)
*Respiratory infections
*After asprin or B-blockers

Diagnosing Bronchial Asthma

Asthma tests may include:

  • Spirometry: A lung function test to measure breathing capacity and how well you breathe. You will breath into a device called a spirometer.
  • Peak Expiratory Flow (PEF): Using a device called a peak flow meter, you forcefully exhale into the tube to measure the force of air you can expend out of your lungs. Peak flow monitoring can allow you to monitor how well your asthma is doing at home.
  • Chest X-ray: Your doctor may do a chest X-ray to rule out any other diseases that may be causing similar symptoms as pneumonia.

Treating Bronchial Asthma

Aim of Treatment

*Relievers (Quick)
*Controllers (long term)
*Patient education

-Short-acting inhaled β2-agonists
Salbutamol,   Terbutaline
-Long-acting oral β2-agonists
Ipatropium, Tiotropium give synergestic bronchodilatation BUT of more benefit in COPD
Inhaled corticosteroids
=Budesonide/ beclomethasone/ fluticasoneuse any
=Start (400-1000 mcg/day approx. in 2 divided doses)
=Maintain for 3 months
=Taper slowly and keep at 200 mcg
=Safe for long-term use (years)
Famous available drugs :

lClenil modulite = Beclomethasone
Symbicort = Budesonide  + Formoterol
Pulmicort = budesonide
Seretide  = Fluticasone + Salmeterol
Flixotide = fluticasone
Foradil = formoterol
Atrovent = ipratropium bromide
Spiriva = tiotropium
Leukotrine receptor antagonist 
Benefit in exercise induced asthma – ch  rhinitis
Can be used alone - Not as effective as inhaled steroid
May be first-line for 2 to 5 yr. olds.
Montelukast (singulair)  - Zafirlukast
4 mg, 5 mg, 8 mg tabs available & sachets
Can be add on to ICS, IBD inhalers
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Step Up and Down  
1- Inhaled SABA  prn
2- Add inhaled steroid at 200-800 mcg/d (400 appropriate)
3- Add LABA : A- Good Control àcontinue    
                          B- Inadequate àincrease C/S 
                          C- No response à stop LABA increase C/S  & if still less controlled à+ trial leuktrienes or SR theophylline
4- Trial :  - C/S 2000 mcg/d   - Leuk     - SR theoph.  . Oral SABA 
5- Daily Steroid tab at lowest dose OR anti IgE . Continue maximum dose inhaled steroids .

We hope that topic is helpfull
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