Hossam Hassan

 32 years old lady known case of SLE presented with 3 days history of generalised malaise,nausea and repeated vomiting

,she was out of town and she did not use her medication for one week

 Vital signs are as follow  BP 80/45,pulse 110,RR20,temp. 36.9,,o2 sat. 97% R/A  Where you triage this patient

 Patient was shifted to resus. Now she is on bed  What do you want to do with her

 2 IV line gauge 18 canulas was inserted blood was drained for investigation ?  IV normal saline bolus was given no response

 Gl 3.5 mmol  Na 126  K 5.2 mmol  Urea 30 mmol  Crea. 178  CBC no abnormality

 What is your diagnosis ?  What is your immediat action?  What is the disposition of the Pt.

 52 years old male syrian known case of hypertension on medication 5 years post renal transplant presented with history of throat pain since last night

 V.S  BP 90/50  Pulse 52  RR 16  Temp  O2 Sat 93% R/A  What is your immediat action

 That is his ECG

 What is your immediat action

 You shifted the patient to resus room 2 IV cannulas G.18 iv fluid started  ASA  Plavix  Heparin  15 lead ECG

 BP Improved with IV Fluid trans cutaneous pacing patient was referred to cardiac cath

 16 years old boy known to have allergy to fish he went to a resturant with his friends and ate alone 1 Kg of shrimps 15 minutes after dinner he started to C/O SOB and generalised skin rash

 V.S  BP 70/40  Pulse 120  RR 40  Temp 36.8  O2 Sat 85% R/A

 On examination he is having rhonchi alleover his chest the soft palate and the tongue are swollen the skin is red with maculo papular rashes allover the body  What is your immediate action

 Call anaesthesia  Prepare fibro optic intubation set  Epinephreine Sc,IM,Or IV and why?  Antihistamin,steroids,H2 blockerand nebulized beta 2 agonest  During intubation what induction agent Are you going to use and why?

 91 years old lady bed riden since 4 years post CVA she is known hypertensive on medication she is in vegetative state since she got that CVA  Her daughter C/O that she is vomiting sputum since morning and refusing to eat

 VS  BP120/80, pulse 144, O2 Sat. 88% R/A temp. 38.2

 Where do you triage this patient ?

 Pt. is now in resuscitation 2 IV canulas are inserted 2 litter N.S was given  Iv Antibiotics was given?  O2 4 L by nasal canula was given  Paracetamol 1 Gm IV stat  Now V.S  Bp 125/85 pulse 105 O2 Sat. 95% temp. 37.2

 Investigation  CBC  WBC 25 with toxic granulation  S. createnine 130  Urea 40  S.Lactate 7  CXR

 34 years old male involved in MVA it was front collesion on presentation he is fully conscious oriented pupils equal and reactive  V S Bp 80/50 pulse 140 O2 Sat. 82% temp 37

 Examination Diminished air entry Rt side of the chest with raised JVP trachea shifted to the lt  What is your immediate action

 Female patient about 36 years old  No past medical history  Post partum Caesarian Section 2 weeks ago  Presented to ER with: ◦ SOB ◦ Pleuretic chest pain increased by inspiration ◦ Tachycardia and tachypnia ◦ Hypotension ◦ O2 sat at room air 88%

 V S BP 85/45, pulse 110,RR 24 O2 sat 88%  Where you triage the patient  what investigation you want to add

 ECG: ◦ Sinus tachycardia > 110/minute ◦ Right axis deviation & tall R in lead V1 ◦ S1 Q3 T3 ◦ Inverted T-wave in inferior and anteroseptal leads III, AVF, V1,V2, V3, V4  Diagnosis: Massive Pulmonary Embolism

 What is the managment

 Male patient about 46 years old  Heavy smoker  Presented to ER with typical chest pain radiating to left shoulder.

 ECG: ◦ Hyperacute T-wave in leads I, AVL, V2,V3,V4 ◦ T-wave wide and greater than R wave ◦ Reciprocal depression in inferior leads III, AVF  Diagnosis: Acute Anterolateral Myocardial Infarction