🟧Middle age female presented with chest pain and SOB

🟢PMH:-HTN,DM

📗O/E

👉Conscious
👉Oriented
👉Dyspnic
👉Tachypnic
👉Chest repitatians
👉BP=90/50

📚ECG interpretation📚

✅Bradycardia
✅AV dissociation
✅incomplete RBBB
✅LAD
✅Q wave most leads

📚CHB+ Incomplete RBBB + LAD(LAHB) =True trifasicular block 📚
طبعا الكيس أجتنا احاله من غير مستشفى جايه STEMI وماخذه Actylase واحنا يمنا خلينالها Temporary pacemaker

#dr_laith_alkhalidy
#ECG

#Keep_in_your_mind

🟢Whenever patients presented with red flag 🚩 of sepsis you should do “six spsis”

👉1-give O2 to keep saturation >94
👉2-take blood culture
👉3-give braod spectrum antibiotic
👉4-give bolus crystalloid fluid (500ml/15min)
👉5-measure accurately UOP hourly
👉6-measure serum lactate

#dr_laith_alkhalidy
#Sepsis

🟧Nice case

🟢Old age male a known case of CKD presented with confusion

🟢Vitally :- BP=undetected , PR=undetected , SPO2=undetected in oximetry

🟢O/ E

👉Confused
👉Decrease UOP
👉Cold extremities
👉Chest crackles
👉Dyspnic

🟢Investigations

👉S.cr =4
👉S.K=6.5

📚ECG

👉regular
👉bradycardia
👉absent P wave

📗Regularized AF (CHB+ AF)

📪It is a case of BRASH syndrome

B—>Bradycardia
R—>Renal failure
A—>AV block
S—>Shock
H—>hyperkalemia

#dr_laith_alkhalidy
#Emergency_case

#Keep_in_your_mind

🟧Indications of lung transplantation in COPD

✅MODE score >=7

✅FEV1<15_20%

✅Three or more sever Exacerbation in preceding year

✅one sever exacerbation with acute hypercapnic RF

✅Moderate to severe pulmonary hypertension

#dr_laith_alkhalidy
#harrison

🟧Nice case

📚45 yrs old man presented to me with sudden onset of peticheal rash all of body and oral mucous membranes (see picture above).on history taking he mentioned he had URTI before 1 month .then developed hematuria.

🟢Negative PMH
🟢Negative PSH(away from appendectomy) before 20 yrs
🟢No any hematological disease in family
🟢No neurological signs
🟢No organomegally or lymphadenopathy
🟢No jaundice

📗I sent him for investigations and result was

👉platelets = 1000 !!!(sever thrombocytopenia un correlated with his simple presentation )
👉Normal Hb and WBC
👉Normal RFT , LFT
👉PT,PTT (mild prolongation )
👉blood smear (normal away of dicyclopenia)
👉fibrinogen (normal)

📕After admission the patient developed malena and hemoptysis

📪We referred him to hematologist and my suspicions was ITP (but prolonged PT go against diagnosis)

✅Bone marrow biopsy done and was normal

📚So final diagnosis was ITP with or without von willbrand disease 📚

👉Von willibrand factor test sent and waiting for result

❤️It was amazing case

#dr_laith_alkhalidy
#hematology
#ITP

🟧اشوكت المريض من يجيني اخاف منه ولازم خلال اسبوعين ادزه screening for Colorectal cancer

📚Abdominal mass or rectal mass
📚Un explained Anal mass or ulceration
📚age <50 yrs with Rectal Bleeding with any one of the following
👉1-abdominal pain
👉2-wight loss
👉3-Iron deficiency anemia
👉4-change in bowel habits

اكو تصنيف ثاني على اساسه ندز المريض ايضا خلال اسبوعين for screening

📚patients >= 40 yrs with unexplained wight loss+ abdominal pain
📚patients >=50 yrs unexplained rectal bleeding 🩸
📚patients >=60 yrs with Iron deficiency anemia or change in bowel habits

#dr_laith_alkhalidy
#GIT
#Pass_medicine

Important note about ACEI,ARBs

#Resource_Laith_for_internal_medicine