,

.
.
. ,
, . , ,,
.

,

.
.

 .
:


-

.
.
, -
.
- .
: .
,
.
. , 100%
.
,ABC
.
/ .
,
.
huassaf@lycos.com - first steps :

.
http://www.mdcalc.com

[]2


A
Acute Coronary Syndrome

- AF
- AF ( 48)
- Anemia
- ARF
- Asthma
- Arthritis
- Acid/base/
- AciDOSIS METABOLIC
- Alkalosis Metabolic
- Acid/Base/ 4 :
- Allergic Reaction
- Antiserum

7
8
9
10
12
13
14
14
14
15
15
16
17

B
- Blood Gas Analysis A-a gradient
- Bicarbonate
- Bleeding

17
18
18

C
- CRF
CCT - Creatinine Clearance Test
CHF - Congestive Heart Failure
- Cellulitis
- COPD
- Calcium

19
19
20
21
21
22

D
- Diabetes
- DKA
- Diabetes HHS

23
25
26

[]3

 - Dialysis
- DVT
- Delirium
- Delirium
- Delirium
- Diarrhea & Gastroenteritis

28
28
29
30
31
31

E
- Erysipelas
- ECG rules of thumb

32
32

F
- FUO

33

H
- Hypertension
- Hypertension
- Hypertensive Crisis
- Hypotension
- Hypernatremia
- Hyperkalemia
- Hyperkalemia
- Hyperkalemia
- Hypokalemia
- Hypercalcemia
- Hypoglycemia
- Hyponatremia

- Hypophosphatemia
- Hiccups
- Hepatic Encephalopathy

35
35
36
37
38
39
40
40
40
41
42
42
43
44
44
45

- IBW - Ideal Body Weight

- Intubation

46
46

[]4

J
- Jaundice
- Jaundice
- Jaundice
- Jaundice :?
- Jaundice

46
47
47
49
49

L
- Line Sepsis

50

M
- Melena
- MI ST
- Meningitis

51
51
52

N
- Neutropenic Fever
- Nausea

53
54

O
- Oliguria

54

P
55
- Pericarditis
56
- Pyelonephritis
56
- Pneumonia
57
- Pneumonia
) - Pneumonia (Hospital Acquired 58
58
- Pulmonary Edema
59
) - PE (Pulmonary Embolus
61
- Pleurocentesis
62
- Pleurocentesis, Empyema
62
- Proteinuria

[]5

S
- Spontaneous Bacterial Peritonitis
- Syncope ( )
- Seizures

- Seizures
Sinus Tachycardia

63
63
64
65
66
66

T
- TIA/CVA
- Thrombocytopenia
- Thrombocytopenia ITP : ?TTP
TTP

- Thrombophilia, Suspected
- Torsades De Pointes

67
68
68
69
70
70

U
- UTI
- UTI, male

71
71

V
( - Ventilation (Mechanical
- Ventilation anesthesia
Ventilation: BPAP
- Vitamin K K

72
73
73
73

- 1
2
- 3
- 4 ( )

RETICULOCYTE PRODUCTION INDEX -

[]6

74
75
75
76

 - 5 ()ACS
- 6

77
79
80
81

a
Acute Coronary Syndrome
()NSTEM I/ UNSTABLE ANGINA
:
.
CLEXANE 1\ (
).
300 ( )
( 75 )MICROPIRIN 100- .
( AHA UA/NESTEMI 300 .
75).
:
DERALIN 10 3 , 12.5 NORMITEN
.
*
40 SIMOVIL
OMEPRAZOLE 20
.GI
5 CORDIL ( SL ) (.)SOS
( ,)PR .
:
CPK ,Troponin

[]7

 :
2-3 MO IV 10 PRAMIN ( .(IV
:IV
50 ISOKET 100 ,0.9% NaCl 4
( 4 ( .
:
, ,Troponin ,CPK-MB ,CPK , , (
)
---------------*

TAB LIPITOR 80mg

AF
? Valsalva (
) - .
( CLEXANE 1 mg/kg X 2 ) -
( COUMADIN 7.5 - 10 mg )LONE ATRIAL FIBRILLATION-
:
)verapamil( IKACOR
2.5 ,100- - ( 80 ) .
, TAB IKACOR 40-80 mg X 3 :
TAB DERALIN 10 mg X 3
DIGOXIN
- :
) DIGOXIN 0.25-0.5mg (PO/IV 0.25 mg 6.
1-1.5 mg :
DIGOXIN 0.25 mg X 1 :
: ! ( 25%-
, )
: , ,PT(INR) ,T4 ,T3 ,TSH , ,
( ) , .

[]8

 AF ( 48)
* / !
:
IV PROCOR (amiodarone) 300 mg/100 cc 5% Glucose in 30 min
, *PO PROCOR 600mgX2/d IV
1050 24-.
TAB PROCOR 200 mg X 3- ,
.200 mg X 1
.
:
.SC CLEXANE 1 mg/kg X 2
:
.RYTHMEX (Propaphenone) 600 mg
.TAB RYTHMEX 150-300 mg X 3 :
:
IKACOR 2.5-5mg .
( , ,
).
:
, ,T4 ,T3 ,TSH , , .
:
PROCOR , .
50%- DIGOXIN,COUMADIN-
.
PROCOR .optic neuritis-
:
50-100J -
, )Midazolam( DORMICUM
**
,ASSIVAL ( . )188
---------------* , PROCOR-
- . : .

[]9

** :American Collage of cardiology/American heart association

.
!

Anemia
:
Cross (
).
/ Cross .
10- ,% .
PR !
( ).
.
INR/PT.
:
? , Coombs
,ESR , Haptoglobin- ( Coombs).
? , .
:
, ,
(.)Coombs, Fe, Transferrin, Ferritin, TSH, B12, Folate
: , !

[]10

 []11

 ARF
US : .
. -.
: NSAIDs ,ACEI ,ARBs ,
.ALDACTONE
.

:
,Na ,K .Specific gravity
: ( ,CPK ,)Na ,K.urea ,creatinin ,
- .Mg ,Ca
:
? .FUSID 20-160 mg
? ( )NaCl 0.9% .
:
( ,
).
VOLUME OVERLOAD .
.
- .
.
.
:
, , ,
( + UREA + CREATININE + CCT + )Ca , PH, Protein, K , Na.
: ? ?
.anti-streptolysin, ANA, ANCA , Anti Hep C ab, Hep B Ag, c3, c4
,40-60 gr/d : , .

[ ]12

 Asthma
.
, - (CO2

) ! -!
)Aspirin,Beta blockers (:
:
VENTOLIN 0.3 - 0.5ccX4/d .BRICALIN 0.5ccX4/d
.AEROVENT 0.5 - 1.5ccX4/d
: VENTOLIN BRICALIN- (
).
IV HYDROCORTISONE 200mg/100cc NaCl 0.9% :
.DEXACORT
:
.MgSO4 2gr/100cc NaCl 0.9% :
- AMINOPHYLLINE 250mg/100cc NaCl 0.9% - 20
.THEOTARD 100 - 300mgX2/d

? , : , ,
, ( Theophylline ).
, ,
.

[]13

 Arthritis
:septic arthritis
.
- , , ,.
? !
:
IV/IM CEFTRIAXONE 1gr/d
Doxycycline ( ,200mgx2/d
) 7.
:
.CEPAZOLIN 1-2G X3
.
( NSAIDS ).
.Septic arthritis
:.uric acid ,CRP ,ESR ,ASO ,
.RF ,ANA ,C4 ,C3 :

Acid/Base/
:

pH: 7.35-7.45

PO2: 92-104

PCO2: 32-40

HCO3: 21-27

- Metabolic Acidosis
(:)MUD PILERS

Paraldehyde

Methanol

Isoniazid

Uremia
Lactic acidosis

DKA

:

Ethylene glycol
Rhabdomyolysis
Salicylates

[]14

 - Metabolic Alkalosis
, - SALINE-:
.
().
(.)CO2
.Cystic fibrosis
.
, - SALINE-:
.
.
.
(.)Barter
.
( ).
.
.refeeding syndrome -

- Acid/Base/ 4 :
- 1:
PH - .
7.35- 7.45-.
PCO2 ( )HCO3 pH
. pH , PCO2 ()HCO3
.
- 2 :
( = )122

Anion gap (:)AG
AG > 20 AG .MUDPILERS
)OG( Osmolar gap
=

[]15

 .)ethylene glycol ,uremia ,methanol( MUE 15 meq/L > OG

AG- , ) (UAG
.
UAG () .
,(-10)-(10( : .-10 < UAG
- 3 :
PCO2 : 1.2- .1 meq/L HCO3
PCO2 : 6- .10 meq/L HCO3
HCO3 : 1 meq/L- 10 PCO2
4 meq/L .
HCO3 : 2 meq/L- 10 PCO2 .
- 4 :
PCO2 =
PCO2 > PCO2 .
PCO2 > PCO2 .
:Excess anion gap
30 > EAG .
23 < EAG (.)non-anion gap

Allergic Reaction
:
( SC ADRENALIN 0.1-0.4mg )0.3 1:1000
IV ADRENALIN 0.5-1mg 1:10000 5
( ).
( IM PHENERGAN 25-50mg 4) IV ZANTAC 50mg + 8
TAB CIDALIN 50mgX4/d .TAB OTAREX 25mgX2/d
IV HYDROCORTISONE 300mg , IV DEXACORT 12mg
.IV SALINE

[]16

 Antiserum
30-80 SALINE 500cc 15 ,4cc/h
.
:
.
.
.

b
- Blood Gas Analysis A-a gradient
A-a gradient = PAO2 - PaO2
O2 = PaO2 - .
O2 = PAO2 () - :
( PAO2 = 150 - PaO2X1.2 ).
= A-a 2 + 10 .

(.)PE

[]17

 - Bicarbonate
( ) .1mEq/kg -
1mL solution = 1meq :
( , , :)TCA
1mEq/kg.
( CO2 ).
pH- , ( )HCO3:
.(24-[HCO3]) x0.1xbody weight : ,
( )24 ( 20% ).
.)BE = base excess( BEx0.1xbody weight :
.
6.9 < pH
IV NaHCO3 100mmol/L in 400mL H20 :
( - .)48meq/L NaHCO3
!

pH = 6.9-7.0
-IV NaHCO3 150 meq in 200mL H20 ,
pH 7.0.
[ ]K!

- Bleeding
PT ( factor VII) , .K
PTT , .APLA ,factor VII, IX, XI
PPT PT- ,factor I, II, V, X
, , .DIC ,K

[]18

c
- CRF
? ( , ,
,).
:
.
, , ACEI .FUSID
:
: , , [.]K
.TAB CALTRATE + D 600mgX1
.
:
ERYTHROPOETIN ( ).
.

)Creatinine Clearance Test (CCT

( COCKROFT)GAULT-
CCT= (140-age)/(72 * [ser.Creatinine]( :
CCT= (140-age)/(72 * [ser.Creatinine]) * 0.85 :

[]19

) - Congestive Heart Failure (CHF

( )MI (,
Thyrotoxicosis) , , ( Troponin ,CPK
).
:

ASPIRIN
ACEI
TAB DIMITONE (Carvedilol) 3.125mgX2 ,
(mg25 X 2 )*.
.
4-5 .
Stage III- .TAB/IV FUSID 40-120mg -
,ALDACTONE (Spironolactone) - Stage III
.
.5.0
FUSID- ( THIAMINE 100mg/d
Vitamin B-Complex ).
: , ,CPK+MB ,TSH , , .
---------------* ,NORMITEN- .

[]20

 - Cellulitis

:
IV CEFAZOLIN 1-2gX3/d
( IV ORBENIN (Cloxacillin) 2gX4/d ).
-.
: ,.

- COPD
, 1-3 ( ).
.

? .
- ( CO2
).
.Beta blockers, Aspirin :
- :
:
VENTOLIN 0.3-0.5ccX4 or BRICALIN 0.5ccX4
.AEROVENT 1.5ccX4
HYDROCORITSONE 200mg/100cc NaCl 0.9%
.DEXACORT push 10mg
, , .
.
IV Aminophylin 250mg/100cc NaCl 0.9% 20.
.SYRAN 200mgX3

[]21

 :
: +
Doxicilin 200mg , .100mgX2
: , ( ) ,.
:COPD
5-10 , :
TAB STEROCORT 4mg-8mgX3/d TAB PREDNISONE 30-60mgX1/d
:
MgSO4 2-4gr/50cc NaCl 0.9% : ).(MgSO4 50% 4cc

- Calcium
:
)Corrected Ca = serum Ca + 0.8 * (4 - serum albumin

[]22

d
- Diabetes
:
-
.
) :Metformin (Glucophage\Glucomin ,
, ,CHF , .
( )Acidosis Lactic
( )Novonorm !
:
, .
, ACEI ,
.ENALAPRIL 2.5mgX1/d:
.TAB ASPIRIN 75mgX1/d
.TAB SIMVASTATIN 40mgX1/d
: .SC REG INSULIN 0.5 units/kg/d :
:
( ,)REGULAR INSULIN ()
.
:
4 100%
*
!
---------------* , ,
( ).
:
.1 MIX - ,HBA1C
,Lantus/Levemir MIX .
.2
(.)lantus/levemir

[]23

 :
):NPH (intermediate
1-2 :.
6-12 :.
18-24 :.
:Regular
1 :.
2-4 :.
6-8 :.
:)NPH 70%, Regular 30%( Insulin mix 30/70
( 30/70 .25/75 )50/50
30 : .
2-4 :.
18-24 :.
( Ultra-rapid acting insulin ):
15 :.
1 :.
3.5-4 :.
LEVEMIR, GLARGINE , 24-.
NPH ( ultra-rapid ).
:
.Metformin
( DAONIL, GLIBETIC, GLUBEN :Glibenclamide ).
.GLUCORITE :Glipizide
Novonorm( : Repaglanide
).

[]24

 - DKA
,pH < 7.3 > 250mg%
:
, , , ,Creatinine ,Urea ,
,.
- ! .IV NaCl 0.9%
:



( )NaHCO3 PH .6.9
, .

( , ).
.pH
:
IV NaCl 0.9% 1000mL : ,
. .
,
.
IV INSULIN 10 units : ( ,)0.15units/kg
.
, 0.1 units/kg/h . .
.50-70mg%/h
! .
0.45%-0.9% ( . :
1.6meq/L 100meq/L .)100
( )K (
)3.3- .
250 ,%
GLUCOSE 5%( . !).

[]25

 :
100 100 - 20
( ) . 7-10 -
( )0.1units/kg/h .
:
.
-.
( .)pH


( )K .
. 3.3<K
.(10cc 15%( KCL
,
250-.%
:
REGULAR INSULIN 0.5units/kg.
.0.1units/kg/h

(.)50-70mg%/h

- Diabetes HHS
:
, , ,Creatinine ,Urea , ,.
IV NaCl 1000cc/h : - 15-20ml/kg/h .
:

[]26

 :
Na + glucose/18 + urea/2.8

2905 :
- IV NaCl 0.45% 4-14 mL/kg/h
.
.IV NaCl 0.9% 4-14mL/kg/h
( 1.6meq/L : 100meq/L ,)100
\\.
:
( )DKA-
300 - GLUCOSE 5%
( !).
( .)Na, K -
:
- , IV NaCl 0.9% 1000cc
.
! .

(- ,NaCl 0.45% .)NaCl 0.9%
:
:
.IV REGULAR INSULIN 0.15units/kg
( IV REGULAR INSULIN 0.1 units/kg/h : .(DKA
.
50mg%- ,
.70-100mg%/h
, 4-.
:

< 3.3 SYRUP KCl 15%

10cc/ .3.3
> 5.5 .K 4.

[]27

 > 5.5 > 3.3 20-30meq .

( HHS-:)DKA-
.5% Dextrose + 0.45NaCl
.INSULIN 0.05-0.1units/kg/h
250-300
, .

- Dialysis

.
.

.
.
( , ,,
.wrist/foot drop
.

- DVT
?DVT
D-Dimer US- .
:
)low molecular weight heparin( SC CLEXANE 1mg/kgX2/d
.1.5mg/kgX1/d
( TAB COUMADIN 10mg 5).
.
: , .

[]28

 :
Lupus anti-coagulant
Anti-Phospholipid Ab
Protein C
Protein S

( Anti-Thrombin 3 ,APLA ,APCR : ).

- Delirium
.
().
:
, , , , ? !
.CT
. .
+.
.
,Na, K, Ca, Mg, Creatinine, BUN : .
:

( )IM HALIDOL 0.5mg\
(.)ASSIVAL 2.5-10mg
.

. (
).

[]29

 - Delirium

[]30

 - Delirium
: ( ) , ,PCP ,LSD ,
(.)Phencyclidine
: , .CNS
: , , .CO ,
.Na, Ca, Mg, P :

:\ - , , , ,.
, , \.
: ,B12 : ,.
.
.
: ,
,\

- Diarrhea & Gastroenteritis

!
?
.)CD( Clostridium Difficile
:
( +)0.9% ).(IV NaCl 0.9% + KCl 1-3gr
.IV PRAMIN 10mg :
Cramps .IV PAPAVERINE 80mg :
TAB CIPRO 500X2/d
, .TAB TARIVID 200mgX2/d
.TAB FLAGYL 500MGx3/d CD-
: , , , ,CD ,
( \ ).

[]31

e
- Erysipelas

:
IV PENICILLIN 4mil UnitsX4/d
.IV CEFAZOLIN 1-2gX3/d
, ,
.
: ,.
Cellulitis- .

- ECG rules of thumb

ST aVL ,I .
ST v4-6 ,aVL ,I .
ST v1-3 -.
ST v1-3 v7-9-
.

[]32

f
- Fuo
:
+ , ( 2 , 3
, ) , ,CRP ,
+ , , (.)MB+CPK
.RF ,ANA ,HCV ,EBV ,CMV ,HIV ,VDRL
.MANTOUX
.Q fever ,Brucella ,Toxoplasma ,Rickettsia
.TSH ,Ferritin ,Transferrin ,Fe
.
:
US , , , .
.

[]33

[]34

h
- Hypertension
?
?
- , -
:
TAB DISOTHIAZIDE 12.5mg - 25mg/d :
.
: ACEI .
.Bilateral renal artery stenosis
.Beta blocker :
: , ,.

160- /
100 -
.
( :)malignant hypertension .5
3 ,
( 25-50 ) .

- Hypertension
( Bilateral renal artery stenosis- ACEI
) :
:
-TAB CAPOTEN (Captopril) 12.5-25mg 4.
- SPRAY ISOKET 2.5mg .

[]35

 :
- IV ISOKET 50mg/100cc 0.9%NaCl 3-5 ml/hr 15 ,
3-5 . .
, .
: , , ,
(.)Catecholamines ,Metanephrines ,free Cortisole, VMA
:
.Dexamethasone suppression test
.Aldosterone/Renin

- Hypertension Crisis
!
:
.IV ISOKET 50mg/100cc NaCl 0.9% 5 mL/hr
160 . 15%
24.
CVA .

[]36

 - Hypotension
:
.
IV ( ).
:
?MI :? .
? ,.
? ?
.
?
?
:
IV DOPAMINE 200mg/100cc NaCl 0.9% 5-10-15-20 mL/hr
, 8- (.)8 cc/hr
+ .

.Noradrenaline -
( ()
.)IV DEXACORT 5 mg push
( ,
).
:
, ,.
.

[]37

 - Hypernatremia
,
.
:
, Na + K , .
: , .
:
.

,
(
).
=
( 0.5- .)0.6
48-72 , 12 .
- .4

[]38

 - Hyperkalemia
?
.
: + + () , .
:
, .SSRIs
(? ? ?)
.IV DEXACORT 10mg push
- ?
T PR , , ,P QRS.
:
- Ca GLUCONATE IV 10% ,10cc! (
).
INH. VENTOLIN 0.5cc
,IV FUSID 40-80mg .
+:
GLUCOSE 5% 500cc + INSULIN 5-6 units
GLUCOSE 5% 1000cc + INSULIN 10-12 units

( 4 100mg%).
- 100-mEq )NaHCO3( -
100 - ,
.
POWDER KAYEXALATE 30gX3/d :
, -.
.
: -!
:
, , , +.

[]39

 - Hyperkalemia
5 .
:
5 = GLUCOSE 5% 500 mL 100 25 ,
5 10 , ( 5%).

- Hyperkalemia
" : T PR , , ,P QRS.
Ca GLUCONATE 10mL 2-3 -
( .)Digoxin
REGULAR INSULIN 10 UNITS in NaCl 0.9% 50cc + GLUCOSE 50% 50cc
5 , .
.POWDER KAYEXALATE 30grX3/d

- Hypokalemia
" : T , .U
:
, , .
IV NaCl 1000cc + KCl 2-3gr :
SYR KCl 15% (10cc = 1.5gr) : .
: ( TAB SLOW-K 0.6-1.2gr - ,
.)1.2
: , :Mg
)4cc - 2gr( MgSO4 50% in 100cc NaCl .

[]40

 : ( ,)?
:
, ,Mg + ,
,.
.

- Hypercalcemia
:

. /
.
( ).
/:
, . -
.IV HYDROCORT 200mg/100cc NaCl 0.9%
:
,IV AREDIA 60-90mg/500cc NaCl 0.9% 3-4 .
.
().
:
, - 24.
( PTH !) ,TSH ,.
.protein electrophoresis

[]41

 - Hypoglycemia
? - !
? )Glibenclamide( DAONIL .
-
, .DEXACORT 5mg
, .
( )
.
:
!
2 ,IV GLUCOSE 50% 20cc - .
( ) .
.
FULL STANDARD - 1/3 STANDARD
:
,TSH , .HbA1c ,c-peptide ,
50 - c-peptide ,
.

- Hyponatremia
:
= ( - ) \ *0.6
:1 +
, ,0.6 .0.5- ,0.4-
.0.45

( ).

[]42

 , .4
, 12 mmol/L ,
1-2mmol/L -.
( ) : ( ) +,
() , .
: , , .TSH ,
: , 100 mg%
,100 1.6 ( . = ,400 300
, 3*1.6).
.4

0.9% NaCl - 154 mmol/L
Ringer Lactate NaCl - 130 mmol/L
0.45% NaCl - 77 mmol/L
0.2% Nacl in 5% dextrose - 34 mmol/L
5% Dextrose = 0 mmol/L
) Full Standard - 154 mmol/L + 5% Dextrose (560
) ( 1/3 Standard 3.3% dextrose + 0.3 NaCl - 52 meq
Ringer lactate - 130 meq Na + 0.3 g K + 20 mg Ca
Specially made 5% dextrose + 0.9% NaCl
Solution + K -5.0 glucose + 0.15%Kcl +0.33 NaCl - 56 meq Na
( , )
) - Dextrose 10% (505
) - or 20% (1010
!

[]43

 - Hypophosphatemia
:
1<Phosphate<2 PO FLEET ENEMA 5ccX3/d
.CALCILESS 1X3/d

:
+ 0.09-0.16 NaPO4 mmol/k = 2-3cc
6.

IV NaCl 0.45%100cc

- Hiccups
? ? ?
? -? MI ?
.
:
.
.
ETHER .
.TAB LARGACTIL
-.

[]44

 - Hepatic Encephalopathy
.
, /
.ACUTE LIVER FAILURE
:
, ( ).
.ALT, AP
PT/ PTT ,D-Dimer .
: , , (. , ) , ,
, , .
PR.
:


.
.
.
-!
INR - ,K !FFP -
- .10,000
- 10,000 8-12.
NEOMYCIN 500mgX4/d
SYR DUPHALAC (Lactulose) 30ccX2-3/d

:
( - NH3 !) , .PT/INR ,
\ -.

[]45

i
) - Ideal Body Weight (IBW
50 : 0.9 + 152.4.
45.5 : 0.9 + 152.4.

- Intubation
23 ( ).
IV DORMICUM 2.5-10mg , .
- Airway + Ambu
.

- Jaundice
:
, ( ).
.ALT, AP
PT/ PTT ,D-Dimer .
, ( ) .
SLE ! .

[]46

:
-\ .
-\.
-.
.

- Jaundice

2 - AST, ALT :!
.
- : ( ).
:
,
.HAV, HBV, HCV, EBV, CMV
( HCV RNA .)HCV-
( Ceruloplasmin , < )40
24 (.)Cu2+
,ANA .Liver Kidney Microsomal Ab ,Anti Smooth Muscle Ab
.
Iron, Ferritin, Transferrin .

- Jaundice
2 .GGT, Alk.Phos :
?
US .
US , ,
( US.)ERCP ,
!

[]47

.CA 19-9, CEA :

.Intrahepatic Cholestasis
:
,CMV ,EBV ,AMA ,CEA ,CA 19-9 .
:

[]48

 - Jaundice :?

, .
( Coombs ,Haptoglobin : ).
:
Cross (
, , :
-).
.

- Jaundice
! .Probenecid ,Rifampin
:
,G6PD -.
,Spherocytosis ,Rotor ,Dubin Johnson :
.
, ,.
.
( ,).
.
:
,ceruloplasmin ,haptoglobin ( ),
Coombs , , + , +
.

[]49

l
- Line Sepsis
\ :
IV vancomycin 1gX2/d + iV amikacin 1gX/d
.
.
- , .
.

[]50

m
- Melena
: , (
) , ,.
( IV ZANTAC 50mgX3/d .)IV Omeprazole
, .
.PO
:
INR K/ :
,IV VITAMIN K 0.5-2mg/100cc NaCl - INR 15,
( .FFP .)K
Cross + .
.
:
, , \ ( : ).

- MI ST


MONA
IV MORPHINE 2-3mg
O2
) - TAB CORDIL 5mg (SL MI-!!!
( TAB ASPIRIN 325mg).
. IV HEPARIN 5000 Units push
INR .

[]51

 Cross .
- ( 300-600 )clopidrogel.
:
, - .PE
!

- Meningitis
:
!
:
- Pneumococ, N meningitis .
Listeria .50
CT :


, .
- .
!!!LP - .
.1-4 -
: , ( ,) , ,
.
PCR-.
.
:
:
,LP .
.IV ROCEFIN (Ceftriaxone) 2gX2/d

[]52

 ( ) -
iv dexacort 10mg : 10 6
4.
:50 .IV PENBRITIN (Ampicillin) 2gX6/d
( )
IV zovirax (Acyclovir) 15-30mg/kg mgX3/d

:
, + PT , .

n
- Neutropenic Fever
+\ .
:
iv tazocin 4.5mgX3/d
AUGMENTIN + CIPRO - .
, (
- , ):
.tab Ciproxin 750mgX2/d +tab augmentin 875mgX2/d

[]53

 - Nausea
?MO
:
( IV Pramin 10mg push )
( IM/IV LARGACTYL 25mg )
.IM/IV Phenergan 25-50mg
?
:
IV ZOFRAN (Ondasterone) 8mg/100cc NaCl
DEXACORT 20mg .

o
- Oliguria
500- ( 200 ).

[]54

p
- Pericarditis
:
*:
TAB Ibuprofen 400-800mgX3/d
( TAB Aspirin 1 grX3-4/d )
TAB NAXYN 500mgX3/d
INDOMETHACINE 75-225mg/d
:NSAIDs
TAB COLCHICINE 0.5-1.0 mg/mg/d
:
TAB PREDNISONE 1-1.5mg/kg/d

:
TAB OMEPRAZOLE 20mgX2/d LANSOPRAZOLE 30mg X 2

:
, ,CPK+MB , ,.
----------* - ,
NSAIDs-.COLCHICIN-

[]55

 - Pyelonephritis
:


!
- .
.30 mL/hr
.IV
NSAIDs ( ).
IV ZINACEF (Cefuroxime) 750mgX3/d
-IV GARAMYCIN 4-7mg/kg .

:
+ +.
US .
:
, .GARAMYCIN

Pneumonia

:
.
.
.
:
.IV ZINACEF (Cefuroxime) 750mgX3/d
.TAB RULID (Roxithromycin) 150mgX2/d -
.MEGAXIN 400mgX1/d -

[]56

 :
.
DOXILIN 100mgX2/d- ( MEGAXIN 400mgX1/d \
).
:
,.
*

-----------

* - 16 CEFTRIAXONE )ROCEFIN( 1-2 - IV

azitromycin 500mg , )ampicillin/sulbactam (timtntin
1.5 mg -3mg every 6h plus azitromycin 500 mg p.o or i.v

- Pneumonia
:
.
.
.
.
.
:
( MEGAXIN 400mgX1/d \ ).
.IV ROCEFIN 2gX1/d
:
,.

[]57

)Pneumonia (Hospital Acquired

:

48 , .
:
.
( MEGAXIN 400mgX1/d \ ).
TAZOCIN (Piperacillin/Tazobactam) 4.5GRx3/d
( TIMENTIN (Ticarcillin/Clavulanate) 3gX4/d ).
:
,.

- Pulmonary Edema
:
.
.
.IV FUSID 60-120mg push
,100% .COPD
( CORDIL > )100 .IV ISOKET
5-2 .CO2
15-12.5-10-5 :CPAP ,O2H 10 .
:
.
.
, ,.
/.

[]58

 , .
: ? : ,
,MI ,.
"" , .
.
:
, ,CPK+MB ,Troponin , .

) - PE (Pulmonary Embolus
:
, .
, , INR ,. D-Dimer ,
( PR !).
.
, CT .
:
.
.SC CLEXANE 1.5mg/kgX1/d
SC CLEXANE 1mg/kgX2/d .
HEPARIN .
, .
{ TAB COUMADIN 10mg ( 80
5 )} . .CLEXANE
.
.

[]59

[]60

Wells Criteria
Number of
points

Variable
Risk factors
Clinical signs and symptoms of deep venous
thrombosis

3.0

An alternative diagnosis deemed less likely than

pulmonary embolism

3.0

Heart rate > 100 beats/min

1.5

Immobilization or surgery in the previous 4 weeks

1.5

Previous deep venous thrombosis or pulmonary

embolism

1.5

Hemoptysis

1.0

Cancer (receiving treatment, treated in the past 6 mo,

or palliative care)

1.0

Clinical probability
<2.0

Low
Intermediate

2.0-6.0
>6.0

High

- Pleurocentesis
.
:
.) (
.) , ,LDH , (
.pH
acid- , , (
.) fast
.

]61[

 :
,LDH>200

> .3
:
,RA- .
, .
, , .
, .TB ,PE

Pleurocentesis, Empyema

.
.
< .50
pH<7.0 pH- .0.15

, ! / .

- Proteinuria
< 150 .
150-300 .
> 300 .

[]62

s
Spontaneous Bacterial Peritonitis

:
( 1 ).
:
IV ROCEFIN 2gX1/D

- Syncope ( (
:
: , , , , ,
( .)post ictal state
:

( ).
( ).

?
.
.
.PE
Troponin .
EEG .
: , .

[]63

 - Seizures
!
: , , ,! !
.
:
, ,
? ? ?
? ! + +
( !LP ).
CT .
, ( 100).
CT : .
:
IV ASSIVAL 5mg + 5mg ! ( ).
Push IV PHENYTOIN 18-20mg/kg : 50mg/min
( . - ).
-
.
100mgX3/d .
:
.

[]64

[]65

 - Seizures



-



.
( ).
.malignant neuroleptic syndrome -

Sinus Tachycardia
: , ,.
: - , DERALIN
(propranolol) 10-20mgX3/d , .

,:
,MI ,PE , , , ...
:

.
.
( ).
( push IV ASSIVAL (diazepam) 10mg 5!).
. VABEN 10mgX3/d .
.
:
, ,.

[]66

t
- TIA/CVA
CVA , 3 -
.
:
CT CT , .
gag - .
:
.
- TAB ASPIRIN 325.
( IV ).
.
24.
- 24 ,
,CLEXANE 40 MG X1 ,DVT .
, 12.
:
, .
.180/110 15% 24 .
CVA : - !
.
: , , .
TAB PLAVIX 75mgX1/d .

[]67

 - Thrombocytopenia
.
)Thrombotic thrombocytopenic purpura( TTP/HUS
( ,
TTP
).
- )Paroxysmal Nocturnal Hemoglobinuria( PNH
.
)Idiopathic Thrombocytopenic Purpura( ITP .
:
, Cross ( 10!).
.
:
, ,LDH .COOMBS
TTP- . ( ,
) , .

- Thrombocytopenia ITP : TTP

:ITP
, .
- (
).
.
.
.
.
10%- .EVANs Syndrome -
.TAB LOSEC 20mgX1/d + TAB PREDNISONE 1-2mg/kg :ITP

[]68

 :
, + .Hep C ,APLA ,HIV ,C3 ,ANA ,
(,
NSAIDs ,).

TTP
- Medical Emergency !
.


: , .
PT/PTT

LDH

( )Schistiocytes !!!
:
.CROSS
!!!
:
FFP
PREDNISONE
ASPIRIN 325mg

[]69

 - Thrombophilia, Suspected
PE\DVT , .
:
5-10%( APCR .)DVT
APLA
Homocysteinemia
.Protein S, Protein C, Anti-Thrombin III

- Torsades De Pointes

( ).
IV MgSO4 2g 50% ,
. .3-20mg/min
IV ISOPROTERENOL 2mcg/min
100.
\ .
.LIDOCAINE :Class IIb
Torsades- ,QUININE ( )NaHCO3
( ).

[]70

u
- UTI
:
+ ( ),
,.
-HCG ().
:


( ) .
.
IV GARAMYCIN 4-7mg/kg .
.
.30 < CCT
IV ZINACEF (Cefuroxime) 750mgX3/d
.IV GARAMYCIN ,

- UTI, male
: ( )PR .
:
+.
.
.
: US - + .
:
.IV ZINACEF (Cefuroxime) 750mgX3/d
( IV GARAMYCIN 4-7mg/kgX1/d ,
).

[]71

 - .IV
NSAIDs .
:
,
.GARAMYCIN
() , TARAVID-
)(Ofloxacin
\ .

v
) - Ventilation (Mechanical
SIMV

10-20 :Pressure support

400-500 (6mL/kg) :TV
( 30-40 :Peak flow COPD .)100
14-18 :RR
:PEEP ( .5 , , .)15-20
30 :Peak pressure
2 :Assist sensitivity
( 1:2 :I:E ratio ,30% .)40%
0.5 :Inspiratory pause 2

[]72

 - Ventilation Anesthesia
:
IV DORMICUM (Midazolam) 30-300mcg/kg 5,
2.5-5 ( ).
!
:
5-8( IV DORMICUM 50mg/100cc NaCl - 5cc/h ) .35mcg/h
- .DORMICUM-
:
.IV MORPHINE 1-2mg/h .

Ventilation: BPAP
:IPAP ( cm H2O8-10 .)24
:EPAP ( 5 cm H2O .)6-7
:
, , , ,
, ( /
).

- Vitamin K K
, INR ,
!

- IV Vitamin K -
5-10 , .

[]73

 INR ( ):
6>INR>8 ,IV VITAMIN K 0.5mg/100cc NaCl INR
- INR .
.IV VITAMIN K 1mg/100cc NaCl 8>INR
:
Cross , FFP
.
, K .

:1
:
:
,LDH ,pH , ,
( ).
.
:
> 0.5
LDH LDH > 0.6
LDH , - .
:
: ,LDH , ( ),
.Alfa Feto Protein
:
< 500
250 < PMN

[]74

 \ = .
> 1.1 .
> 1.1 ( ,Budd-Chiari syndrome ,
,TB , ).

:
< 30 mg/d
30-300 mg/d

Reticylocyte Production Index :2

= Reticulocyte Production Index

- R%
- HCT
- MT ( MT .)maturation time ,
:
HTC=45 - MT=1.0
HTC=35 - MT=1.5
HTC=25 - MT=2.0
HTC=15 - MT=2.5

:3
, :
IV DEXTROSE 5% 2500-3000mL in NaCl 0.2% + 30meq KCl
.NaCl 0.33% + Glucose 5% + 1.5g KCl/L :

[]75

 :4 ( (
1 :

TBW=0.6*body weight
, .
:
X/total change
. - .

:
60 , .108
.NaCl 3% = 513mmol/L :

.10.9mmol/L - 3%
5mmol : 12-.
5/10.9 = 0.46L NaCl 0.3%

:
- 5mmol/L 460.
38 - .
, , NaCl 0.9%

3 :
.NaCl 23.4% 30mL
- .NaCl 0.3%

[]76

 :5 ()ACS
ST LBBB , :MI -



()TAB PLAVIX
IV HEPARIN 5000units

12 90 , .
, 30 .
:
( ACEI ).
24 .
ST T , , :


()TAB PLAVIX
( HEPARIN )
- IIb/IIIa .

T ST , :
.
.
.
- .

[]77

2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency
Cardiovascular Care: http://circ.ahajournals.org/content/vol112/24_suppl/

]78[

 :6

Actarapid

Novo
Nordisk

30

1-3

Insulitard

Novo
Nordisk

NPH

1.30

4-12

24

Mixtard

Novo
Nordisk

Mix 30/70

30

2-4

18-24

Humilin R

Lilli

Regular

30

2-4

6-8

Humolin
N

Lilli

NPH

1-2

6-12

18-24

Humolin
70/30

Lilli

Mix

30

2-4

18-24

Novorapid

Novo
Nordisk

Analog

10-20

1-3

3-5

NovoMix
30

Novo
Nordisk

Mix

10-20

1-4

24

Levemir

Novo
Nordisk

3-14

24

Humalog

Lilli

Lyspro

15

Humalog
mix 25

Lilli

Lyspro 25% +75%

lyspro protamin

15

Humalog
mix 50

Lilli

Lyspro 50 % +50%
lyspro protamin

15

Lantus

Sanofi
Aventis

Insulin glargin

Apidra

Sanofi
Aventis

Insulin
glulisine

30

Insulin Analogs

]79[


:


/ .
.
UP TO DATE

.HARRISONS INTERNAL MEDICINE

(/).
- NEJM .
CHEST .
).Pocket Medicine (Lippincott Williams & Willkins

[]80

[]81

[]82