 📺 Teaching Video: https://youtu.be/Z-SdOaWs16o&list=PLOlpsJ0eDlASRw1LywI2iGfzDTqxlAYFJ Sigmoid Volvulus
- Sigmoid volvulus = twisting of sigmoid colon around its mesentery - Causes a closed-loop bowel obstruction, impairing blood flow - Risk of ischemia and perforation if untreated --- Risk Factors for Sigmoid Volvulus - Chronic constipation increases colonic redundancy - High-fiber diets lead to bulky stool and colon distension - Institutionalization (e.g., nursing homes) due to immobility and chronic constipation - Congenital conditions like Hirschsprung’s disease predispose to volvulus --- Clinical Presentation - Progressive abdominal distension and pain - Nausea, vomiting, and constipation or obstipation - Symptoms may develop gradually, especially in elderly patients - Cognitive impairment may delay symptom recognition --- Diagnostic Imaging - Abdominal X-ray: "Coffee bean sign" — massively dilated sigmoid loop - CT scan: "Whirl sign" — twisted mesentery visible - Imaging is critical for early diagnosis and management planning --- Management Approach - Initial step: Endoscopic decompression in stable patients - High recurrence rate after non-surgical decompression - Definitive treatment: Surgical resection (e.g., sigmoid colectomy) - Emergency surgery required if signs of peritonitis or decompression failure --- Prognosis and Key Points - Mortality increases significantly with bowel ischemia or perforation - Early diagnosis and timely intervention are critical to survival - Recurrence risk necessitates planning for definitive surgical management 📺 Teaching Video: https://youtu.be/Z-SdOaWs16o&list=PLOlpsJ0eDlASRw1LywI2iGfzDTqxlAYFJ
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 📺 Teaching Video: https://youtu.be/C33tUAYn_SM&list=PLOlpsJ0eDlASRw1LywI2iGfzDTqxlAYFJ Critical Initial Steps in Stroke Management
Importance of Glucose Check - Always check fingerstick blood glucose in patients with suspected stroke. - Hypoglycemia can mimic or worsen stroke symptoms. - Treat detected hypoglycemia promptly to avoid diagnostic errors. --- Brain Imaging in Acute Stroke - Perform non-contrast CT or MRI as soon as possible. - Aim for brain imaging within 20 minutes of hospital arrival. - Imaging helps rule out hemorrhage and guides treatment planning. --- Endovascular Thrombectomy (EVT) - For ischemic stroke patients ineligible for intravenous fibrinolysis, consider EVT. - EVT is especially beneficial for large vessel occlusions with favorable imaging profiles. --- Time Window for EVT - EVT is supported within 6 hours of symptom onset. - Selected patients with favorable imaging may be treated up to 24 hours after onset. --- Transfer to EVT-Capable Centers - Transfer eligible patients if EVT is not available onsite. - Expedite transfers to achieve EVT within 3 hours of initial hospital arrival. - Faster EVT correlates with better functional outcomes. 📺 Teaching Video: https://youtu.be/C33tUAYn_SM&list=PLOlpsJ0eDlASRw1LywI2iGfzDTqxlAYFJ  📺 Teaching Video: https://youtu.be/K95Mc3ePTqw&list=PLOlpsJ0eDlASRw1LywI2iGfzDTqxlAYFJ Ebola Virus Disease
- Rare but severe illness caused by Ebola virus species - Discovered in 1976; outbreaks mainly in sub-Saharan Africa - Critical for healthcare providers to ensure early diagnosis, management, and infection control --- Etiology - Ebola viruses: Filoviridae family, Orthoebolavirus genus - Six species identified; four cause human disease (Zaire, Sudan, Taï Forest, Bundibugyo) - Zaire ebolavirus most deadly with highest fatality rates - Fruit bats likely the natural reservoir - Transmission: Contact with infected animals or body fluids of infected humans --- Transmission Details - Human-to-human via blood, feces, saliva, urine, vomit, breast milk, semen, etc. - Entry through broken skin or mucous membranes (eyes, nose, mouth) - Only contagious after symptom onset - Surfaces and materials contaminated with fluids can spread infection --- Virus Behavior - Targets immune cells: dendritic cells, macrophages - Rapid spread via blood and lymphatic systems - Virus evades early immune detection using glycoproteins - Triggers "cytokine storm," leading to vascular leakage and organ failure --- Clinical Effects - Direct endothelial damage increases vascular permeability - Impaired coagulation leads to hemorrhagic symptoms - Liver dysfunction and adrenal insufficiency worsen shock - Fatal cases: High viral load, delayed immune response, DIC, shock --- Early Symptoms - Incubation: 2–21 days (average 8–10 days) - Early "dry" symptoms: - Fever, severe fatigue, muscle/joint pain, headache, sore throat --- Progressive Symptoms - "Wet" symptoms: - Severe diarrhea, vomiting, abdominal pain - Other signs: - Chest pain, shortness of breath, confusion, hiccups, rash - Bleeding manifestations in ~40% of patients - Rapid progression to multi-organ failure and death in severe cases --- Diagnosis - High suspicion needed with epidemiologic risk factors - Confirmatory tests: - RT-PCR for viral RNA (gold standard) - Antigen capture tests, antibody ELISA, virus culture, electron microscopy - Early RT-PCR negative? Repeat testing if suspicion remains --- Supportive Care - Aggressive fluid and electrolyte replacement critical - Symptomatic treatment for fever, nausea, diarrhea - Nutritional support essential for recovery - Monitor and manage complications: bleeding, shock, organ failure --- Therapeutics & Infection Control - Investigational treatments: - Monoclonal antibodies (Inmazeb, Ebanga) improve survival - Infection control: - Strict PPE use, safe injections, waste management, safe burials - Care in specialized Ebola Treatment Units (ETUs) --- Prognosis - Mortality varies: 25–90%, average ~50% - Zaire ebolavirus has highest fatality - Early diagnosis and intensive supportive care improve survival - Survivors often face long-term complications (Post-Ebola Syndrome) --- Prevention and Vaccination - rVSV-ZEBOV (Ervebo) vaccine effective against Zaire ebolavirus - Critical for outbreak control and protecting high-risk individuals - Ongoing research for broader vaccines --- Summary - EVD: High-mortality disease requiring urgent recognition and care - Healthcare providers key to early detection, isolation, treatment - Combined efforts in management, vaccination, and infection control essential to combat outbreaks 📺 Teaching Video: https://youtu.be/K95Mc3ePTqw&list=PLOlpsJ0eDlASRw1LywI2iGfzDTqxlAYFJ  📺 Teaching Video: https://youtu.be/NqM7IKz9-to&list=PLOlpsJ0eDlASRw1LywI2iGfzDTqxlAYFJ Damage Control Resuscitation (DCR)
- A strategy for managing severely injured trauma patients experiencing significant hemorrhage. Objective -To correct or prevent the lethal triad of hypothermia, acidosis, and coagulopathy. Approach - Prioritizes early hemorrhage control and hemostatic resuscitation, contrasting with traditional large-volume crystalloid resuscitation. Core Principles - Minimize crystalloid use to mitigate dilutional coagulopathy. - Utilize permissive hypotension (target systolic blood pressure of 80-100 mmHg) until hemorrhage is controlled (exception: patients with traumatic brain injury). - Administer prompt, balanced transfusion of blood products (commonly in a 1:1:1 ratio of packed red blood cells, fresh frozen plasma, and platelets) to address coagulopathy and emulate whole blood. - Initiate early administration of tranexamic acid (TXA). Integration - Performed in conjunction with damage control surgery, focusing initial surgical efforts on immediate life-saving hemorrhage and contamination control. Teaching Video: https://youtu.be/NqM7IKz9-to&list=PLOlpsJ0eDlASRw1LywI2iGfzDTqxlAYFJ   Why Azithromycin is a Better Choice Than Clarithromycin for Patients Taking Atorvastatin?
Drug Interactions - Atorvastatin is metabolized by the CYP3A4 enzyme. - Clarithromycin strongly inhibits CYP3A4, increasing atorvastatin levels in the blood. - Elevated statin levels raise the risk of muscle toxicity and kidney injury. - Azithromycin has minimal effect on CYP3A4 and is safer for concurrent use. Clinical Example - Case: 52-year-old male on atorvastatin prescribed clarithromycin for pneumonia. - Outcome: Developed severe muscle pain, dark urine, and kidney injury by Day 5. - Lab Results: Elevated creatinine and CPK levels, indicating rhabdomyolysis-induced kidney damage. - Resolution: Stopped clarithromycin and atorvastatin, switched to azithromycin, and patient recovered fully. Prevention Strategies - Avoid clarithromycin in patients taking atorvastatin unless no alternatives exist. - If clarithromycin is necessary, temporarily stop atorvastatin during treatment. - Consider switching to statins like rosuvastatin or pravastatin, which are less dependent on CYP3A4 metabolism. Key Takeaway - Clarithromycin + Atorvastatin = Higher risk of muscle toxicity and kidney injury. - Azithromycin = Safer choice with minimal interaction risk. - Prioritize patient safety by choosing antibiotics carefully. Final Recommendation - When treating infections in patients on atorvastatin: - Use azithromycin instead of clarithromycin. - Plan for drug interactions to prevent complications. - Always consider patient-specific factors when prescribing medications. Comparison of Zithromycin and Clarithromycin Key Differences Explained:
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