Emergencies |PED2|

Added: 2026-05-18

[00:00:00]May the peace, blessings, and mercy of God be upon you. You know, two girls, doctors, it was a really nice cartoon, I love it, by the way. Two girls, I wear watches, I mean, where's my watch? I don't have a watch, I'm definitely waiting until the watch comes down suddenly and gets on my wrist, I can't take it off. Yes, it's refreshing, we've changed the subject.

[00:00:15]Look, we'll take it now, we're in the last, God willing, lesson in the Pediatrics 2 video series. What is this lesson called? Focus with me, please. Scroll down with me, where? Scroll down, where? Where? Here are the lessons that we have finished, thank God, starting from, for example, Neonatology, Nephrology, Hematology, Endocrinology, Neurology, Rheumatology.

[00:00:36]Now, we said the last lesson is called Emergencies, what does that mean? So, in pediatric emergency medicine, you mean the common cases you see in the emergency room. And you have to cover exactly eight topics in pediatric emergency medicine. These eight topics are divided as follows: The first topic is general, which is the survey you study in each module—how to deal with any emergency case in general. Next, we have two topics under the respiratory system: estriate respiratory failure. Then, two more topics with the cardiovascular system: circulatory failure (shocks) and sepsis. Then, we have two topics under the CNS ( sources nerve system): coma and static encephalopathy.

[00:01:21]We heard about these in the neurology lesson in pediatrics 2. And finally, we have one topic under endocrinology: diabetic ketoacidosis. We also heard about this in pediatric endocrinology. Okay, so look, I'll give you exactly what you need to know. You pause the video three times and write this down. You'll say... Why? What benefit do we get from this, sir?

[00:01:41]Please, Systematic, we're going to cover them all in one lesson? You'll get lost and it'll all slip away from me. Stop the video right now and write down the page in front of you, okay? Just so you understand, as we can see, four of the eight topics start with the letter S. Here are two, and this is one, and this is another one. Okay, Systematic as much as possible. Great, sir. We'll start right away, God willing, and we put our trust in God. They said, "Glory be to You, we have no knowledge except what You have taught us. Indeed, You are the All-Knowing, the All-Wise." In the name of God, the Most Gracious, the Most Merciful. The first topic we have out of the eight is the Five Sequential Steps. That means you have five steps that you will do with any emergency situation you see in your entire life. They are five, the same five, all repeated. Okay? What are these five? They are exactly: Assessment Management, then another Assessment Management, then Monitoring. You see, five very well-structured steps. First Something primary assessment and management, what does the word name mean? It means you will evaluate it, but you won't put your hand in anything, just an evaluation like that, marriage, home skills, I don't know, evaluation things, okay, management, what do you start with? You address these things, okay, then again Alexandria, again assessment and management, okay, and after that, what do you end with? Okay, with monitors, there are exactly 5 steps: 1, 2, 3, 4, 5.

[00:03:06]Let's start with the first step, which is the primary assessment.

[00:03:09]We know it. Our goal is to save his life. ABC stands for what? It's an abbreviation of five words. Okay, for each of these, you're in an assessment, an evaluation. You won't put your hand on him; you'll just evaluate whether this thing is there or not. It's very simple. For example, is the airway open or closed? Is his breathing passage open? Okay, is he breathing or not? Okay, is it regrowth or regrowth? Okay, yes. Okay, circulation: is there circulation? Is there a pulse? Can you feel a pulse or not? Okay, disability: is there an impairment? Is there disability or not?

[00:03:52]We assess him by consciousness level, by the glaucoma skill, and we'll take it as a beauty exposure. This is something we absolutely must do. We have to make an exposure for him, literally. We'll do it to check if he has injuries or bleeding, and so on. Okay, after we've assessed him, we'll start management. We'll manage the abnormal things, the things where one of these was not present. We'll manage it. If it was positive, if it was present, for example, then we'll do something for it. Okay, for example, the same letters ABC, DEF, the same letters again. Look, if he doesn't have airway, breathing, and circulation, then we do something called CPR, which is cardiostimulation. We explained this in detail in a separate video. Anyway, look, all of this is, of course, life support. Life support is what we do to help him live. Basic life support is ABC, and advanced life support is DEF, I-Remove Screams for Bleeding.

[00:04:50]So if there are any fluids inside his mouth, like bleeding, for example... Something starts by placing the suction device and withdrawing it, okay, fine. We'll make him breathe. This means mouth-to-mouth ventilation, or a bag and mask. So you'll sit next to him like a gentleman and start kissing him, and then what? You blow into his mouth. The carbon dioxide and oxygen you're introducing are meant to save him. The carbon dioxide stimulates the respirator center, and the oxygen helps with oxygenation and the oxygenation process. You know what that means? It's biomedicine. Anyway, if you don't want to, you're disgusted, or you don't have a tissue or anything, then this device, the bag and mask, is what they call the respirator. Okay, the child mask looks like this.

[00:05:34]You press on it like this so that air enters him. It has a valve, so it's a C- arm, chest compression, and IV fluid. So you'll start pressing on his chest with the CPR. We're used to it, but listen, it's different with children here. We know, let's write it down because this information is very valuable. We know that with adults, we used to do 3 compressions, meaning we'd give 30 compressions and then two breaths, or more precisely, we'd give 15 compressions and then one breath. It's different with newborns, like a month old, or even younger, up to 3:1. You'd give three compressions and then one breath with an ampoule bag. Often, their circulatory collapse is due to hypoxia, not something like a heart condition like with adults. We always follow the same steps, so please write this down. It's a good approach, so that's it. For LifeSports, the first thing is to keep the airway open. We can do something called a head lift to raise their head backward. The diaphragm or health head returns like this, but he didn't write it for you here because we're in pediatrics and stuff. Anyway, we already said the mouth, mouth, and blood pressure, and the C, compression, and IP, and so on.

[00:06:53]Okay, Advanced Life Support, the D, we said the D is specialized in disability. How are we going to treat this disability, or rather, how are we going to raise the level of consciousness? With adrenaline, half a milliliter per kilogram of body weight, and one in 10,000 dilution. And adrenaline, my friend, or epinephrine, this is truly a lifesaver. I mean, I don't know how someone can be standing in the ER and not have an ampoule of adrenaline or something in their pocket. Glory be to God! It saves the lives of many people, especially, for example, someone with influenza, or someone with a severe allergy, or something like that. So, you, if you're standing in the ER You put an adrenaline ampoule in your pocket and also a pulse oximeter. The important thing is that when we get to the next stage, God willing, we'll explain these things. Next, we mentioned the ECG exposure, but she'll perform the exposure herself, meaning she'll remove the shirt, for example, and start inserting the ECG electrodes and so on to detect heart rate, endocardium, and so on, until the assessment is complete. And the ECG machine—don't tell me it's not for you, no, that's for the nurses who will set it up. As a doctor, you need to teach the nurses how to set up the ECG, so you have some background knowledge. If it shows up in the rhythmia, if it shows up in the ventricular septum, if it shows up in a straight line, you'll perform defibrillation, you'll start pressing and electrocuting it, and so on. So, that was regarding the primary assessment.

[00:08:12]We said primary assessment is combined with primary management.

[00:08:14]Primary management is with us. The CPR is strong, so let's move on to the third and fourth steps, which are the Alexandria Assessment and its management. First, the Alexandria Assessment is what starts with the letter SDD, Systematic Review. This means you go through each system, one by one.

[00:08:29]Look, my friend, Systematic Review, Alexandria Assessment means you'll go through each system and see if it has developed a failure or not. With simple thinking, it's hit to miss. Look, for example, the respiratory system is one system because it dies in moments if it's not there. What is a respiratory failure?

[00:08:46]It's the failure of the respiratory system to perform its function of bringing in oxygen and expelling carbon dioxide. We'll take a look at that today. Okay, there are two types: Type 1 and Type 2. Sorry, we'll postpone that for now; we'll take a detailed look at that today. Okay, as for the cardiovascular failure, it's the failure of the heart and blood vessels to perform their function of moving the blood. So, it happened Heart failure, the heart can't pump properly, there's shock, which is hypotensive, hyporeflux. Okay, neurological failure, meaning it's not complete organ failure, general convulsions, seizures, fainting. Pitbull syndrome, is he/she hypothermia, low temperature, dehydration, acidosis, or bisclerotherapy? He/she will, of course, take an IPG and check this. Organ failure, does he/she have kidney failure, liver failure, acidosis, etc.? We check this too. Hematological failure, is he/she acute anemia, is his/her blood breaking down spontaneously, what about flux, or what? Is he/she bleeding internally or externally? Okay, this is just an example. We give him/her oxygen, but why? Because of respiratory failure or something. You're looking at pictures, doctors, for a change, for example, cardiovascular. Filler, and so on. This is a convalescent test, so it's a neurological filler. Okay, this is, for example, at the endocrine level in general, they call it a metabolic filler. Okay, and we'll start assessing the lion's baseline balance and start taking a sample and checking the electrolytes and normal malformations. This is very important. We also have to consider that he might have acute kidney injury or even liver filler, as we can see in his eye. He might have gout or diabetic ketoacidosis. We'll check his history. Is he sick? We'll take this today, God willing. Is he diabetic or not? Does he have hemolytic anemia? Is his blood breaking down? It's all an assessment like this. You take it from head to toe, from his head down. You're an examiner, you're a doctor, you have to have studied all of medicine, not just one system. Okay? Besides, this could even be a multidisciplinary approach if more than one doctor is involved.

[00:10:49]Management depends on the cement. I found a specific anabolic factor here, and you start treating it. Today, God willing, we'll start taking these anabolic factors. For example, we'll talk about the receptor filler, we'll talk about the shock, we'll talk about the acid-base anabolic factor (I don't know what it is), we'll talk about acidosis, we'll talk about... these things we'll cover today. We'll give a brief overview and discuss the management of each one. Okay, sir. The last thing we have is the monitors. You'll start by looking at the vital signs, the EPG, the pulse oximeter, and the electronic monitor. We literally need some equipment in a reputable hospital. We'll start monitoring different bodily functions, starting with the vital signs. I don't know how, but in some hospitals here in Egypt, unfortunately, a patient comes in after surgery. I swear to God, I saw it myself after surgery, and they didn't put it on.

[00:11:34]On the monitor, he's sitting there, safe and sound. I mean, he started crying, he fainted, something like that. Then someone came to him and nothing happened to him, so you're okay. I don't know how this happens. I don't know how it happens. God help us.

[00:11:43]This monitor is essential, sir.

[00:11:45]We monitor vital science. We'll take the EPG and start sending it to the lab, and so on. We might also get the ECG or something. We start collecting information from different angles. So, of course, in vital science, we said what we said: blood pressure, positive rate, temperature, receptor rate, plus oxygen saturation, and so on. Very nice. So, we've finished the first topic, which is primary assessment management.

[00:12:09]Then secondary assessment and management. And then what? Monitoring. Very nice, sir.

[00:12:14]So, we'll do a good check here, in the first topic, in a good way. Then, what is this topic?

[00:12:23]Okay, doctors, [clears throat] Okay, let's get down to business about the estridor. Look, what does the word "estridor" mean in Arabic? Look, " estridor" in Arabic means a loud whistle, like a whistle. You know what someone whistles? They put their hand like this. I don't know how to whistle, by the way. Okay, but what's the idea behind the whistling?

[00:12:40]The idea behind the whistling is that it moves in a narrow passage, so it starts to vibrate the tissue around it, producing a sound. Glory be to God! This sound is made up of vibrations. Okay, so this patient definitely has an off ventricular track, like, for example, the laryngospermia, and so on. Okay, logically speaking, it's loud, loud, it means harsh, it means strong. Okay, so will this be an inspirational issue when you inhale or when you exhale? It's definitely an inspirational issue when you inhale.

[00:13:06]Why? Because there's a negative pressure developing inside the airways, and when you inhale, there's... Negative pressure is based on the idea that the airflow is normal. A receiver tract or receiver air tract is narrower than an expert tract. An expert tract is one where the pressure enters and widens the airflow. So, the effect is with the narrowness already present, which is the pressure. It's not important. I don't understand. Remember this, because an anor is an anorectal pressure, which is due to an upper oroaction. An oscillator is an anorectal pressure, and the reason is normal. So, there's a difference. This is good, as you can see. I've crossed out the title because I don't like it. Why don't I like it? Because the term "oscillator" is written, and it will confuse people. So, here's another definition for you: high sound. Please stop and write for a second. 3. Now, look with me. What are the causes?

[00:14:02]What are the reasons? We don't even need to explain them because, logically, anything will illuminate the airflow for us.

[00:14:12]Wheezing means anything like that. I lit the airway and blew, and it produced wheezing. So, what does it do with breathing? Wheezing. We can divide this into two parts: infections or non-infections. Infections, my friend, mean contagion. So, any infection that enters and causes inflammation. And one of the characteristics of inflammation is that it's hypersensitive, meaning it's sensitive to what it does: construction, spasms.

[00:14:38]Okay, I wrote here about croup. What is croup? Look, inflammation.

[00:14:44]Anything we add to it, like inflammation of the laryngitis, it's called laryngitis. Inflammation of the trachea, it's called trachea. Inflammation of the bronchus, it's called bronchitis. Inflammation of all three together, we call laryngitis, trachea, and bronchitis, or croup. They called croup because it has a barking sound, like a dog barking. Okay, and what is it when it takes its breath? Okay, so there are three levels of croup. Please write this definition down. I wrote it brilliantly. Now, first, infections. We'll divide them internally into croup, which includes acute ringworm and ringworm bronchitis, and epiglottitis. These are structures, of course, in the septic tract.

[00:15:22]Look, the difference between them is that the former is usually caused by a virus, while the latter is usually caused by bacteria, and they lead to completely different symptoms. First, the virus, like parainfluenza, respiratory influenza, and so on. We won't argue about that; it's influenza or something with a virus.

[00:15:38]Clinically speaking, first, the laryngitis—we know it, and honestly, I don't even need to give you the laryngology; it's embarrassing, you're a doctor and you know what the laryngitis is and what it is—the important thing is that it's somewhat close to the nose, and it's also a virus. So, the nose causes ringworm, and then there's chorea, so what will he have?

[00:15:57]Chorea, which is what? It's ringworm, okay?

[00:15:59]And mild cough, which is a cough, but relatively mild. Okay, epiglottitis This is usually bacteria. Who is Haemophilus? Okay, bacteria. Okay, what's the difference? I mean, a virus and bacteria? This bacteria is stronger, Bas More Vegs Organism. Oh, so what will it do? I mean, it will start to come out, it will cause inflammation. Okay, inflammation. This will cause all the clinical signs in front of you, from, for example, high fever, okay, to, for example, toxic fever. You will look at your face and find a type of sick person. Okay, Severe Look, meaning very sick and tired. Severe Progressive Severe, normal Severe, okay, minimal cough. Okay, why minimal cough?

[00:16:40]Because the structure that is affected is the epiglottis, not the lanx. These two are the ones that have more CAF receptors. Okay, and through between, this is the key I taught you. I mean, his throat will hurt, so he swallows, not knowing that his throat hurts. Okay, okay, so if you try to open a page about it, it might, I mean, die. Okay, so why?

[00:17:17]Because That's good, boss. So, let's look at the pictures again. If it 's a viral infection, what does the virus like? It likes epiglottids. But if it's a bacterial infection, well, the virus likes laryngitis bronchitis. And what does the bacteria like? It likes epiglottids. Anyway, in both cases, they'll have stridor. So, when they breathe or speak, they'll have a whistling sound. We don't need to open YouTube videos; I explained this to you in detail in the LT, and we watched a lot of videos there, by the way. Now, non-infections, boss, any disease will also lead to a narrowing of the airway. It's the same thing, exactly. Like, for example, laryngitis spasm, which is like a cluster of things.

[00:18:02]Okay, laryngitis malaysia, mashedy, swelling, swallowing a pound or something, it's an abscess that forms behind the genitals, and so on and so forth. So, any disease that narrows the airway for us is good, good, boss. Come on. We go into the two degrees. The stridor is all stridor, not just one with all. What I told you, with viral infection it's stridor mild, with aphthous it's stridor sphere, and so on. So, it has degrees, right? There are exactly four degrees: one, two, three, and four. Okay, stridor and something else, stridor and extrinsic. So, with exertion, when the child cries, the airway demand increases, so the air moves more, causing stridor. Okay, stridor stress, meaning he's sitting like that, not making normal demands.

[00:19:01]Stridor is a number, two, no. What does ' S' mean? It means signs of difficulty breathing, like what? For example, you'll find the upper part of the body here, and the intestinal walls are going inside, and the extremities are bluish, and so on.

[00:19:23]Okay, because very sphere extrinsic... Blue, between you and me, isn't actually blue at all. It's... it's... it's... what?

[00:19:34]Light yellow, I mean light red, but on the skin from the outside because of the lipid layer, it appears blue. Anyway, these are the four grades, my friend.

[00:19:45]How do we memorize them? Personally, I honestly memorize them by letters: ARC, ARC, ARC, short for A, A-Excretion, R-Res, the second R-Res, Stress, and C- Cynos. Okay, everyone has their own way of memorizing them.

[00:19:57]Treatment, look, my friend, grade 1 and grade 2 you'll treat at home normally, but grade 4 and above you take him to the hospital. That's what the problem is. The problem is usually inflammation, so narrowing of the blood vessels or narrowing of the respiratory tract. So you'll give him an antibiotic, an anti- inflammatory, along with all of them. Okay, you can also give him a steam inhalation, like... what? Warm steam inhalation. Then he'll start... what? He'll... For the irrigation, it is fine to reduce the inflammation a little, so with both, I mean, but the idea is in the way of giving.

[00:20:30]Look with me who is in this house. It is a normal warm steam, not a condition. I mean, from a nebulizer or something with lime, three or four. No nebuliser.

[00:20:39]What device is it? It is the homeostatic device, and with it the medication is not only the homeostatic treatment. It is fine, and with both, we give it a steroid medication, such as dexamizon, which reduces the inflammation, as we agreed.

[00:20:48]But this will be Oral, and this will be Brental, which is something other than GIT, which is, for example, either in the muscle, or by God, in the blood, or so on. Only with this condition, observation, you will start monitoring it a little more carefully, because the tooth is quick and it enters the granules, which after that is quick. As for the granules, no and four, do not give him oxygen either, and give him antibiotics because if It was the bacteria infection that would give you a lah, four, and a mechanical Ventilation, what do you put in it? Ventilation, and so on. Okay, so that's it.

[00:21:17]We've finished another topic, which is the steroid. I just wanted to take a picture so we can wrap things up. This is the tumescent steam, sir, without a nebulizer. The tumescent steam goes in like this. This is helpful, keep that in mind. Look, you put it on your head like this, and put a bowl of boiling water and inhale the steam.

[00:21:32]Okay, it soothes the cold and calms things down. Here's another picture of the tumescent steam, and another one of the tumescent steam. It's a simple solution.

[00:21:38]As for the nebulizer, no, that's a device. This device has both ventilation and medication capabilities. Okay, you can even put the device on a teddy bear, it won't say no. And of course, we need to give the steroid, which is the prednisol we agreed on, an anti-inflammatory, to reduce inflammation. Anything else you want in the steroid? Okay, sir, you're all set.

[00:21:57]Everything's fine, boss. Let's move on to respiratory failure.

[00:22:00]We'll finish the two respiratory topics one after the other and then move on to respiratory failure.

[00:22:03]Look, my dear friend, first, what does respiratory failure mean? It means the respiratory system is failing to perform its function. What's its function, my friend? It's to expel oxygen and expel carbon dioxide. If it knows how to do that, it's a genius! We have two types, and I explained them to you in the respiratory video series. Type 1 is 1, 1, 1, 1, and it only has one thing: hypoxia. Okay? Type 2 has two things: hypoxia and hyperkalemia. Okay?

[00:22:27]We've memorized this, and it's the basis of the lesson. Good. So, what's the problem? The problem with Type 1 is that oxygen can't get in; it can't get in and perform gas exchange. So, look at this: the one in blue is the ophthalmoplegia, okay? And the one in red is the diaphragm, the air intake. Okay, it's called ventilation. And its exit means a complete change in the devices. Its name is gas exchange. The arrival of blood is called profusion. I'm sure you know these terms. The important thing is A1 and A1, and what's the problem? The problem is that the oxygen doesn't know how to diffuse; it doesn't know how to enter like that. This process is called fusion, which is what we call diffusion instead of gassing. Okay, okay. So, for example, if there's some liquid here, you, for example, if you put liquids here, for example, someone with hemophilia or something, will the oxygen know how to diffuse in this direction? No, it won't. Now, logically, don't tell me that it won't. Well, carbon dioxide also won't know how to get out. It's the same liquid. Cover it so I can tell you no, it will know how to get out.

[00:23:21]Why won't it know?

[00:23:23]Because carbon dioxide has more diffusion. It has a stronger diffusion, about 20 times stronger. Okay, and that's why hypoxia happened. But okay, and type 2, TT, bad carbon dioxide. Ventilation – we don't know how to expel carbon dioxide. We can't expel it anyway. How were we expelling it? For example, in the respiratory system and its components. The respiratory system works fine; we activate it, so we breathe, and the carbon dioxide is expelled. We don't know how to expel it. Well, if you disrupt the ventilation, you won't be able to expel the carbon dioxide, nor will you be able to bring in oxygen.

[00:23:55]So, it will have both hypoxia and hypercapnia. That's great. But with Type 1, there's an advantage with carbon dioxide: it can diffuse naturally. That's why hypercapnia isn't present here. You're a genius, my friend. Now, let's read everything in as much detail as possible. First, the ability of the respiratory system to keep you at a level of oxygen and carbon dioxide. Yes, that's the function of the respiratory system. I don't know anymore.

[00:24:18]Okay, let's make a table, broken up into two pages. I don't know why there's a difference between Type 1 and Type 2.

[00:24:23]We said Type 1 is because the lungs have a problem getting oxygen in, but Type 2 is n't. It's because, for example, the problem is usually with the CNS, for example, the respiratory center, which leads to carbon dioxide not being able to exit. Okay, what are the causes? The causes here for Type 1 are anything that blocks the airway and the capillary action, anything that blocks the airway, like spasms, like exudates. Okay, look, we'll read them together: Croup, bronchitis, spirosis, broncholithotripsy, bronchospasm, bronchomyelitis, dysplasia. All these diseases will lead to, for example, the presence of exudates here, so carbon dioxide or oxygen, I mean, it can't diffuse inside. Okay, okay. But these, no, these... Respiratory system components cause hypoventilation. We have this system made up of components, starting from the center in the brain, starting from the muscles, and so on. There are many components; he's written two here. Okay, if he messes them up, then hypoventilation occurs. His breathing becomes slow, and we can't get carbon dioxide out. We can't get carbon dioxide out. For example, what's Zecrine? This is a problem on top of a syndrome, a problem on top of a problem on the spinal cord, motor neurons, and we explained this in detail in neurology. Okay, the important thing is that the result is that Type 1 has hypoxemia. Okay, Type 2, however, has both hypoxemia and hyperemia due to hypoventilation. Okay, clinically, Type 1 has hypoxemia, so the body's natural reaction is to increase the respiratory negative pressure because We're drawing in air, so we'll do negative pressure here, drawing in air from outside. We'll increase it; the more we increase it, the closer we get to the receptor diastolic gradients.

[00:26:24]I explained them to you in Pediatrics 1, right?

[00:26:27]For example, retractions up to synovial, and so on. Okay, but hypoventilation here will appear on the patient as a case of pleurisy. My son can't breathe; his breathing is slow. Okay, sir. On the EPG with the 1, we said we'd find hypoxia, hy, and hypoxia, but here we'll find hypercapnia and hypoxia. Here, there will be both, sir; there will be acidosis. Why? Why? Why will there be acidosis? Because we're not in both; there's hypoxia.

[00:26:51]Okay, there's no oxygen, so we'll do aerobic respiration. We'll do anerobic respiration to release energy. Its negative aspect is that it releases lactic acid, which enters the Acidosis, but is this acidosis metabolic, meaning a problem at a level like the kidneys or blood in general? We're not concerned with the respiratory system, right? Yes, that's metabolic.

[00:27:12]But here it's respiratory because the problem is hypoventilation; the respiration system isn't functioning quickly enough. The treatment here is very important, focus on it, sir. Type 1 is oxygen; you'll give it oxygen because the problem is that oxygen can't enter the blood. So we'll increase the amount. Type 2, on the other hand, has hypoventilation, so you'll install mechanical ventilation, a device that makes it breathe automatically. And so on. This was an important table, sir.

[00:27:37]Type 1 is a problem with oxygen inflow (hypoxemia), while Type 2 is a problem with carbon dioxide expulsion. So, sir, Type 1 is a problem of infection or something like the picture in front of you; an infection has occurred. As for Type 2, it could be an infection, yes. And the problem is that the respiratory pump itself, the muscles of the cerebral duct, are damaged, for example, hypoventilation. Let's continue. Look at management, management, you already know, there's nothing new. We said that for type 1, you give oxygen, and for type T, you give ventilation. But before that, with both of them, you have to do cyclical monitoring. You'll start coming every now and then and start monitoring him, following him, generally speaking. So you've won, and so on and so forth. And also, sir, you'll check the oxygenation, which is oxygen, you do n't know the abbreviation, but we'll put a pulse oximeter on him and start seeing what percentage of oxygen he has. Okay? And the blood gas assessment, meaning you'll take an IPG and see if he has hypoxemia only, type 1, or hypoxemia with both, so type 2. Okay, now, regarding the treatment that is Hespair Support, we said oxygen with type 1 and ventilation with type T. As for type 1. The oxygen indicator, or any other type 1 device, like a Hyboxor, a receiver, a sensor, an ammeter ( which is the session), and so on. Okay, no problem. The mercury mask, the bronchoscope, the endotracheal mask, and so on. Look, this is the face mask, you probably know it, it's a shame you don't.

[00:29:07]This is the nose clip, it's placed near the nose, like this lovely girl, God bless her, they put a nose clip on her. This, honestly, I've never heard of it before, this is the headbox.

[00:29:19]Okay, this is the headbox, something nice too. And this, sir, is the ventricular mask. I'm showing you pictures, but I'm not going into detail because there's more to it than that. And this, my dear, is the endotracheal tube, you insert a tube so that something can be delivered from inside. This is a device we give... Hemolyzed oxygen, hemolyzed oxygen in general, there are many types, I explained them to you, I'm sure, in the skill lab and in detail. What I'm trying to tell you is that there are indications for oxygen therapy, and we said the type, very briefly, and there are methods for giving it oxygen, and we saw the pictures of them, okay? So what is the precursor? First, this oxygen is hemolyzed. Why? Because oxygen causes regeneration, as if it's dry, it enters and cuts through the mycoses. Use a list of oxygen concentrations, which is the list fraction of inserted oxygen.

[00:30:09]Why? Because excess oxygen is toxic, my friend, it's like sugar, too much of it is poisonous. Anything in excess of its limit becomes harmful. Okay, oxygen is free, it's not needed, okay?

[00:30:18]Because we agreed that oxygen is toxic. Okay, the complications, my friend, we gave it a lot of oxygen, a lot... Radicals increased, which is the O, but not O, no, it's O, but okay. So it will cause a combination of many things, like what, for example? It will cause retinitis pigmentosa, meaning if you do an eye exam, you'll find the retina is damaged, literally destroyed. Or it will cause lung injury, meaning it will damage the lungs. Because, sir, you've messed up the oxygen level. The first thing to be damaged is the lungs, or bronchospasm. Because, too, it 's lung injury. Okay, okay, oxygen defense with a defect from oxygen. So, unfortunately, the patient will be used to oxygen.

[00:31:02]She'll try to take it off her, saying, "No, I don't want it, I need oxygen. I can't breathe without it anymore," and the body has gotten used to it. Okay, that was for the treatment of type 1. What is the treatment for type T ventilation? Okay, positive pressure. Why is it called positive pressure? Because it's based on how you breathe. How do you breathe? In the negative pressure, in short, you produce the negative pressure here by the diaphragm contracting and the diaphragm expanding, thus creating a negative pressure that draws in air. Now, no, we'll call this positive pressure from the outside. Okay, positive pressure, I don't know how to explain this to you, positive pressure, not negative pressure, it's a wave, a push. Okay, CPR, what is it? It's the pump we saw in the picture, it was white and bag and mask, okay, or bag and tube, okay, I won't disagree. We saw the pictures. Mechanical positive pressure ventilation.

[00:31:55]Mechanical means automatic, it doesn't have to be manual, you just press automatically, like, for example, the C-door. You know the apartment door, that's the C-door.

[00:32:02]Okay, continuous. Look, everything I'm telling you is positive pressure ventilation, but the difference is in the rate and rhythm. Okay, this is continuous, this is intermittent. He gives him air, then after a while he stops breathing on his own, and then the person breathes, and so on, to complete the air supply. So, a little ventilation, yes, a little machine, a little patient, okay, controlled, meaning we control it on our hands, okay, or high frequency, which is tiny rapid breaths, we give him many small, frequent breaths, okay? This, sir, is the bag and mask, here's the bag and here's the mask. And this, sir, is the tube, it has a bag and tube or a mask and tube, sorry, here's the mask and here's the tube. And this, sir, is the CPAP machine, and I don't need to know the details, and this is the intermittent machine, and again, I don't need to know the details, and this is the continuous machine, and again, I don't need to know the details, and this is the high frequency machine, okay, and again, I don't need to know the details. What I'm trying to tell you is that we give him oxygen in two ways: either regular oxygen therapy or with a ventilation machine. This machine has a manual and it has Mechanically, all right, and that was for the respiratory function lesson. I expect it was also simple, God willing.

[00:33:12]Ready to move on to the next lesson? We have four more pages. I want to give you a break and make a separate video for you, no problem. If you want to continue straight ahead, that's fine too, whatever you like. I think it's not worth continuing straight ahead; you're a doctor, and this is simple, God willing. Look, what do we have left? We have shock. Here's one.

[00:33:30]Scroll down further. Here's sepsis, here's coma, here's statistical sepsis, and dabit. That's a lot of small topics in four pages, half the lesson, and we'll finish it quickly. Look, first, shock means the shock. You know the shock program?

[00:33:43]No, you don't, it's not important. Shock is hypotension, hypoperfusion. If you had to describe it in two words, hypoperfusion means the amount of blood going to a certain tissue is low. What does hypotension mean? The reason I have a low blood supply is because there's low blood pressure, which is hypotension. This is an acute circuit in an arc called the shock supply of oxygen, meaning low oxygen.

[00:34:13]Metabolism—we don't know whether to send it to the heart or not—is hypotension. So, hypotension, more precisely, means low oxygen.

[00:34:18]We needed oxygen to perform ATP ( Autotrophic Phosphorylation). Okay, two degrees of shock.

[00:34:24]We'll give it four degrees: early, stable, advanced, and reversed. First, the early shock is compensatory, meaning the body was able to compensate. It has n't yet entered hypotension or stable shock. The body was able to compensate as soon as it noticed hypoporosis, which is low oxygen reaching the cells. It used two compensatory mechanisms. What are they? First, a booster, meaning it raises the heart rate. And we know, of course, hypotension means low blood pressure, so this reduces Stroke volume, which is the amount of blood pumped from the heart, means there's no pressure to get like that.

[00:35:03]You understand? Now we'll increase the heart rate, so the cardiac output is two times the blood pressure line. Okay, fine. And what about peripheral hypothermia?

[00:35:11]What else will it do? It will cause bump construction in the extremities, which will increase the blood pressure. Increased blood flow to the extremities will raise the blood pressure until peripheral hypothermia occurs. We'll reduce the amount of blood going to the extremities and leave it for the terminal organs, but only for cold extremes. The blood was hot, so we reduced it from the extremities, so it became cold. Okay, skin irritation, meaning the skin will have skin pigmentation. Write it down as skin pigmentation because you distributed the blood unevenly, so some areas will be pigmented. And peripheral sinusitis, it will turn blue. It's like when you press on your finger like this, as we can see. Notice. Notice, notice, notice, notice, or not? I removed my hand and it went back to being red again, again, as we see, with pressure, there it is. Okay, I removed my hand and it went back to red quickly, white, then back to red. I don't know, even the white doesn't complete its observations. Thank God, why? Because I don't have a circulatory filler. This will happen and it will be more than two seconds for it to go back to red again, or more than five seconds with the shock. So, stabilized shock, meaning the compensator mechanism, that's it, no need for any 30. And indeed, the patient's blood pressure decreased and hypotension occurred. So, advanced shock, meaning hypotension or hyporefaction, this is when the oxygen is low. It slows down because the organ can no longer tolerate it, so it has a filler. Okay, multiple organ fillers, more than one organ, like, for example, put all the organs of the body, sir, remove the ATP from them, sir, like, for example, brain, hypoxic-ischemic encephalopathy occurs. Hart followed by Myocardia, followed by Accutrum, followed by Al-Kadni, Acute Renal, followed by Metabolic, Metabolic Asdos, followed with GIT Stress, Seresh, all the way. Some of these things have their own separate chapters.

[00:36:47]The idea is that we talked about oxygen in all of them, okay? Then we got organoids, which are great, then we got visibly shocked, which is a shock that was treated. What happened was a collapse of the blood vessels, you can't widen them, okay? Then there was a smegma, the cell died, it was gone, okay? We can treat it, which is what? It's non-refractory. What's the word refractory? It's heat-resistant. Let's look at another translation. Look, I want to tell you something. I used to use Google Translate, now I use DPL. DPL is honestly better, but it means betlaurelium outside, okay?

[00:37:30]It says it's treatment-resistant, meaning it's transformed into a disease that can't be treated, it's betacorporeal, okay? So why did it happen in the first place? Because of the lack of oxygen. So, we're done with the degrees, the shock, and now let's go. Let's take a look at his love, first pictures, what will Grade 1 have with him? He 'll have tachycardia, okay, because we increased the hard rate. He'll also have peripheral sinusitis because we performed vasoconstriction on the limbs. He'll have a delaminated capillary refill act of five seconds, not five minutes as he wrote. That's five minutes, meaning he's dead. So, Grade 2? No, Grade 2 means he has hypotension, meaning his pressure is low. Grade 4? No, now there's a problem at the brain level, for example, encephalopathy. Okay, a problem could occur anywhere, like myocardial ischemia, and so on, or even renal filler, or even the cervix. The cervix is ​​at the GIT level.

[00:38:19]Okay, Grade 4? No, this is a refractor beta-acidosis, meaning no matter how much you treat it, it won't be treated. Now, there are types of shock, I explained them to you once. There are four types, but there isn't a fifth, not five as he wrote here. Look, first, hypo Volumia means low blood volume, for example, due to severe dehydration, excessive burning, a burn, resulting in plasma leakage, or a mass leak, causing blood loss. Anything can be said to lower blood volume, thus lowering blood pressure and putting it into action.

[00:38:49]Okay, and there's also a mechanism I'm not sure you'll understand now, but I explained it to you in the CV, so here's a few points: When the volume is low, there's a reduced blood flow return.

[00:38:56]The amount of blood returning to the heart is low, so the preload (the ventricular return) decreases, and the cardiac output decreases. So what's this called?

[00:39:03]Distributive shock, that's a type of 3-in-1. You know Nescafé 3-in-1? Yes, that's the 3-in-1, which is sugar, sugar, milk, and coffee.

[00:39:17]Nescafé is coffee from Nestlé. The important thing I'm trying to say is, what are the three types? I'm talking about neurogenic allergies, which are caused by a problem with the nerves, and septic allergies, which are caused by a bacterial infection.

[00:39:28]Distributive means a problem with blood distribution. What happened in the distribution? There was a loss of motor tone and wide-ranging blood flow. What happened? The blood vessel dilated, so the pressure inside decreased. What caused this dilation?

[00:39:40]Allergies, my friend? Histamine was released and dilated it. No, my friend, the sympathetic nervous system was damaged. Okay, what was doing the vasoconstriction was damaged, so now there's vasoconstriction. Okay, fine. Or, for example, in septic allergies, an infection entered and released inflammatory cytokines, causing vasoconstriction. Okay, that's the idea in its simplest form.

[00:39:57]Good, my friend. Obstructive means what? Or cardiogenic? Cardiogenic means a problem with the heart muscle. The muscle is damaged and can't pump blood, so it weakens. Imagine that: the motor is damaged, so the blood will flow with low pressure. Okay.

[00:40:13]Obstructive edema means that blood enters everything, but there's obstruction in the middle, in the middle, for example, in the venstrombosis, and so on.

[00:40:21]Or for example, thrombosis, which is fluid around the heart that compresses it, or pneumothorax, which is air in the pleura that also compresses the medullary glands, and so on. Okay, a few pictures, my friend.

[00:40:30]For example, this case has severe dehydration, so what are we talking about? We're talking about hypovolemic shock. But this case, of course, has, for example, basophilic dehydration, so we're talking about distributive shock. What does that mean? For example, endoflavancy occurred, for example, there was bacteria present that led to endoflavancy, and so on. But this case in front of you has cardiac shock, and that's why we're going to treat the heart. We give a defibrillator and compress the heart, we do whatever is necessary. The next part is n't easy, so you need to focus on it. Look, Okay, first of all, the types of shocks we've been talking about, we want to discuss two things: CVS ( Cyst- Score Resistance), which is related to vasoconstriction. So, if vasoconstriction occurs in the extremities, the systemic vasoconstriction will increase, the resistance will increase. Imagine the brain's awareness narrowing, so the resistance will definitely increase.

[00:41:24]That's number one. Number two is central vasopressor. This is the pressure in the right atrium.

[00:41:29]This is vasore return.

[00:41:31]We explained this in a Sculpture Lab video, I'm sure of that. Anyway, let's look at hypopophilia.

[00:41:39]Systemic vasopressor increases. Why does it increase?

[00:41:42]Because the volume is low, so the body's natural reaction is disrupted. The vasoconstriction in the extremities, and even the cardioverter deflects, is disrupted. The body's reaction to any shock disrupts the vasoconstriction in the extremities, so it will increase, increase, increase. As for dystonia, Actually, the problem is basilation, and that's why the blood pressure will decrease. We did a basilation, okay? Now, regarding the central ventricle, we have hypotension, meaning the pressure is low. So the natural reaction is that the ventricle return will be low, because there is no blood to send you back to the heart, right? So with hypoflammatory or distributive, the blood is low in the right atrium.

[00:42:21]But with cardiogenic, no, the heart muscle is weak, so it does n't know how to pump at all. It is dilated and full of blood, so its center of ventricle will increase. Okay, and based on this, the cardiac output with hypoflammatory is very low, which is the amount of cardiac blood that is pumped out. Why?

[00:42:39]Because the volume is low, here in cardiogenic shock, the amount of blood is also low because the muscle is weak and can't pump blood.

[00:42:47]But in distributive cardiac shock, the amount is high.

[00:42:50]Why is it high? It's a reaction to pump more blood because there's little blood in the extremities. Look, if you want an explanation, it's written right in front of you. I'll give you three seconds. You'll see in hypoflammic shock. Okay, we'll talk about the change and what causes it.

[00:43:05]I'm not going to read it. I'll give you three seconds to stop and read as you like. I've explained it to you now.

[00:43:10]You have three seconds. 3, 3, 1. This is with hypoflammic shock, with cardiogenic shock, and with distributive shock.

[00:43:14]You have three seconds. 3, 3, 1. And if you're not someone who wants to memorize every word and just wants to understand it, then this is enough. So, what's written is enough. Okay, boss.

[00:43:25]Management of the shock: first, monitor, and then... You'll be monitoring the cardiocardiogram logically, meaning what exactly will you be monitoring? First, clinically, and then in the lab and imaging. Logically, clinically, you'll look at the heart rate, blood pressure, and reflux (for example, the blood pressure reading, which is the capillary respiration), and urine output.

[00:43:42]If the amount of blood coming out is low, then it's a good indicator.

[00:43:50]Similarly, if the amount of urine coming out is low, it means the amount of blood being expelled is low, indicating a possible shock. In the lab, you'll look at blood pressure, serum electrolytes, blood sugar, kidney function, and muscle tone. This is to identify the type of shock. Clinically, this identifies if there's a shock. Identifying if all these things are very, very, very low, very low, or if the heart rate is high, the reflex rate is high, and the rest are low. In the lab, we want to identify the type of shock.

[00:44:13]For example, if we find cultures are positive, it indicates a positive septic shock. For example, in destructive shock, for instance, septic shock, okay, you'll do an X-ray and an echocardiogram, also an echocardiogram, for example, to see if there's a problem at the cardiac level, cardiogenic, or something like that. So you're looking for the cause. What else? You'll check the central ventricle pressure and the systemic vasoresistance, as we agreed, because they change depending on the type. Okay, then you start doing the support. The support is also logical; we'll decrease it, we'll increase it. I mean the preload. The preload is the pre- load before the heart pumps. Let's remember that the load is the heart pumping. Simply put, the preload is before the heart pumps. Okay, the heart fills up before it pumps, so the vasore return. So the preload is the vasore return; we want to increase it. The afterload is after the heart pumps; the blood that comes out encounters the resistance. That's what the afterload is, which is the resistance.

[00:45:04]Pre-operative resistance is fine. We want to increase the pre-load, the amount of blood going to the heart, and decrease the afterload resistance. This will help with blood flow and other issues. We'll do a few things, like oxygen, then oxygen again. We'll increase the pre-load as we agreed, giving it any solution that increases blood flow. We'll give cardiac neurotropics, which strengthen the heart muscle, like dopamine and dopamine, and so on. These are things that specifically treat, for example, cardiac shock. We'll decrease the acetaminophen, as we agreed. We might give sodium nitroprusside, for example, to induce vasospasm, and a treatment for irritability, a specific treatment to address aseptic shock, antibiotics, and multisystem support, and so on. This is because more than one system has an effect in the end. That's a quick overview.

[00:45:49]What will we do for a patient with shock? First, we'll monitor them. We'll start tracking all their vital signs, such as blood pressure, electrolytes, and renal function, etc. We might do a chest X-ray. We might also measure central venous pressure and catheterization. Then we start treating them. How will we treat them? We'll give them oxygen first, and then we'll start administering Ringer's lactate or something to increase their blood volume. If they need a blood transfusion, we might give them blood transfusions themselves. We might also give them dopamine, something to strengthen their heart muscle. So, we'll use a multisystemic approach. A doctor will then begin treating them.

[00:46:35]It depends on the specific problem he has, but that was regarding the shock. Now let's move on, God willing, to sepsis and coma, and so on. Look, first, what is sepsis?

[00:46:45]Septicemia is always described, always. I remember that it's emia, you know blood emia, and sepsis, meaning blood poisoning. Okay, it equals these two words, and I memorized them for you from surgery, and it's a shame not to know them. It equals multiple lines, bacteremia, and toxemia.

[00:47:00]Okay, that means bacteria, meaning there are bacteria in the blood, meaning they start to multiply, and bacterial toxemia, meaning the bacteria also produce toxins. Okay, if this happens, there's a spread of inflammation throughout the whole body. Now, at what level? The system? We're talking about the blood. Okay, okay, let's read the definition.

[00:47:19]Yes, toxemia and bacteremia. Okay, logically speaking, bacteria, so it's bacteremia, my friend. So, what type of bacteria is this?

[00:47:31]Gram-negative. Negative bacteria, why? Because these specifically produce a lot of endotoxins. Okay, it causes toxemia, just like the flu-like symptoms of co-occurring bacteria, or even Gram-positive co-occurring bacteria. The important thing is that it's bacteria, that's all.

[00:47:45]But more often, Gram-negative is good. The two functions were in one area and then spread to the blood, and so on. Okay, that's the shock, which is... I didn't tell you the vital science of shock, my friend. Let me explain it again. Look, usually I tell you the vital science. We have BPTR, right? The baroreceptor will be low (hypotension), the basal cell count will be high (tachycardia), the permeation will be low (hypotension), and the receptor will be high (tactile pneumonia).

[00:48:12]Right, right. But that's the general presentation of shock. There's an exception: neurogenic shock. The positive rate is low because we've already activated the Vagas, so it creates a bradycardia. And an exception with temperature, it's high because septic shock is the body's reaction. It increases the temperature, so it inhibits For bacteria growth, that's the difference in vital science. Generally, this will be the first clinical presentation for any patient with septic shock. So, this is the summary of septic shock. The second thing is hygienic locus, I don't know what this is about. In the investigation, you'll find locus and pandemic. What is pandemic? It means increased blood cell count. Yes, which is what? It's hematophile. Why? Because the demand for trophophile has increased. Why? So, to attack the bacteria. Okay, for example, hygienic BSR will increase. I don't see what the organism is. Will it be infected or not? And so on.

[00:49:12]Or what do you give? Both are small things, sir.

[00:49:14]As we see, this is bacteria. Where is it found? It's found in the blood, and not just any bacteria, but bacteria with toxins. What do we say? Multiple lines of bacteremia with toxemia. Okay, this will lead to the inflammatory mediators multiplying, multiplying, multiplying, and causing inflammation. The important thing is that we'll do his blood test. We'll find the blood cells are high, very high. Why?

[00:49:34]Because it's a natural reaction of the body attacking the bacteria. We'll also find the CR is positive and high, indicating inflammation. We'll do a blood culture, boss, to see exactly which bacteria are present so we can give them an antibiotic. We'll give a specific antibiotic based on the blood culture we'll do. We'll see if it's positive.

[00:49:54]This is microbiology, my friend, not like here in Egypt. They just give antibiotics like, "You have a bacterial infection, yes, we diagnosed it as a bacterial infection, give him a broad-spectrum antibiotic and that's it." No, man, it's not like that. We do n't want a generic antibiotic. We want a specific one. Yes, a specific one, because everything has its risks. So, what we're going to kill is the bacteria in the fluorescent tuberculosis. Anyway, we'll take CSF now, study it, and so on. So, what's the point? We'll start gathering some information about the whole body. That was regarding sepsis. Let's go straight to the topic. Okay, first, do I have a cold or what, doctors? Why am I blowing my nose? Excuse me, I need to blow my nose. Where are the tissues, doctors?

[00:50:33]Can someone tell me where the tissues are? Oh, I'm back, boss. I went and got my tissues to blow my nose. I got a bacterial infection, I don't know why, and I thought I'd tease you a little. I found a samosa. Okay, or what do they call it? Is it a samosa or what? Just a second, if you don't mind, I'll blow my nose. Okay, okay, come on, close the recording now so you don't smell the nose. Do you know how to smell it? I blew my nose, thank God, doctors. And here's my nose. Anyone want it? This is my nose. Anyone want it? My nose, analyze it, aren't you all going to become pathologists? You won't become pathologists, here's my nose, there you go. There is no power nor strength except with God. There is no power nor strength. You know from the beginning, you know. I seek forgiveness from God Almighty. Look at the group, meaning one person and he fainted. We know, meaning state of loss of consciousness, meaning he has no consciousness, he has no awareness.

[00:51:16]Okay, hey, wake up, wake up, wake up, wake up, wake up, wake up. I'm pressing on places, by the way, studied places, not random places. The important thing is, the one above the eye, like this, okay, and the one near the sternal canal like this, or near the ears, studied places. The important thing is, wake up, man. He doesn't want to wake up, okay. If it's a nose, we call it a nose, similar to a cloud, yes, okay, a nose, okay. The nose continues like this, it doesn't differ, so it wakes you up.

[00:51:54]The nose is good, we We said that a coma has content and also a rash. This is the rash.

[00:52:00]As for content, the topic is more detailed than that, but I don't want to comment further. The types and causes of coma are either primary or secondary, meaning it happened to the brain.

[00:52:15]As for secondary, no, it's more serious. Okay, let's look at this.

[00:52:22]Someone hit their head. It could be an infection. It's probably focal. First, imagine someone gets hit with a stick. It's one-way. So, it will show on their eyes: internal, people, and so on. Okay, regardless of the action, it's a C-infection. Why? Because a C-infection usually affects the blood. Okay, so it will affect the CN cells. And if it's in the brain, no, it will spread. It's in the blood. Okay, but this is usually diffuse on both sides. It's not a problem. As long as it's blood, it will affect both sides. Okay, this is blood, and this is blood. Okay, metabolic blood and sensitivity blood.

[00:53:01]Okay, the co-administration, anything that leads to this, well, here you have a problem, meaning any drugs that will play on his blood metabolism up to the brain.

[00:53:29]This needs specific metabolisms. If we mess it up, he'll faint.

[00:53:45]Okay, the diagnostics do a CT MRI with structural damage to see if the neuron is damaged or not. You'll see if there are blind spots, edema, infarction, etc. Now, here's the lab. You see here the blood sugar level, the level of... I don't know what lab, okay, of course, this is a response to blood pressure, meaning not strongly, why? Because he has high blood pressure, okay, okay.

[00:53:55]But here, it's good, why? Because the patient has diabetes. What do you give him? The sugar will rise. What does he have? He has high toxins. Give him the antibiotic, okay?

[00:54:03]Look at this patient in front of you. He's in a coma, meaning he's in a coma. As soon as you give him a stimulant, so that he wakes up, okay?

[00:54:14]There's no way he doesn't wake up. What happened was a problem in the reticuloactivity system in the head, the system that tries to wake him up. Like, for example, intracranial hemorrhage. You know hemorrhage appears white on a CT scan. We know how to do a DCT because the bone is white. Or inversion. Inversion shows up in color, depending on what, but it could be pan hypodensity, meaning a diagnostic scan.

[00:54:39]We'll do a CT scan and MRI with primary coma patients. Here, sir, is a decent MRI image. But with Alexandrian coma, this is metabolic, so what will you do? You'll do a lab investigation. Okay, the clinical approach to coma, like any approach, you'll take the history. Okay, we'll take the history to see why these [cases/cases] are good. We'll listen, God willing.

[00:55:04]The history will be beautiful science. You'll see, of course, the pressure and the respiratory rate. And also, you'll see the disc scale, which we've explained 1000 times. It's the AVM, which is what the A-response is. The highest you give it is four if its eyes are open. The Verb response is the highest you give it if it responds, meaning it's speaking normally. The motor response is the highest you give it if it's moving normally. If it's not moving normally, you'll put it in between during stimulation and start reducing it. That's how I explained the AVM to you in detail. I could give you a quick explanation once to remind you, but I wo n't explain it. We've explained it 1000 times in several neurological lessons. For example, open spontaneity is four, voice is three, which means normal. This is the flexion, this is the extension, this is one. Okay, if it's less than nine, you take it to the hospital and insert an intubation. Okay, the investigation in Urgent things you need to do, like CPG, CBC, blood glucose, serum electrolytes, urea, serum creatine, and so on. There are also optional things depending on your partner's situation, like serotonin, toxicity, metabolic syndrome, and so on. For management, there's nothing new: ABC as usual.

[00:56:23]After that, you'll control the complexes he had, for example, with Baldazam (Bendazine Depressant). Okay, you'll give him, sir, hypoglycemia (sugar), calcium for hypocalcemia (calcium glucose), and so on. Okay, he has increased intracranial pressure. You'll give him a foot raise, raise his head about 30 degrees, and give him fluid restriction. I won't give him fluids because his blood pressure is high, so we don't want to administer Cyperedema. Okay, you'll give him mannitol (Diuretic) and Lasix to reduce the blood pressure. From the load and such, and the dioxin, which is the anti-inflammatory, which is what's corti, and hyperintensity, and so on. Okay, the line, which is what's against, against the lion, which is BPI, which is okay, which is proton, which is something for the sake of the heart, and so on. It's simple talk, and we explained it in detail in other models. Okay, the same thing I told you, but in pictures. First, we'll look at the glaucoma scale, meaning you'll look at the eye opening and start from the eye. As for the feral response, you'll start by examining the feral response, and then the motor response.

[00:57:36]Okay, we'll take a sample of the APG, take a CBC, check the glucose level, check the electrolytes, check the renal function, do a cesarean section ( this is optional), do a toxicology section (this is also optional). The important thing is how you'll treat it. You'll put it on its left side, as you see in this lateral position. This is very, very important, and don't forget, by God, Don't forget him, I swear to God, don't forget him, okay? Because you could save his life. If he vomits, he might aspiration and die, but if you put him in this position, he won't die, okay? You'll give him oxygen.

[00:58:06]We'd put him on intravenous fluid. We'll give him diazepam if he has congestion, and then you'll start raising his head like this. If he has elevated intracranial pressure, raise his head 30 degrees, and then we'll start giving him mannitol. Mannitol will also reduce the pressure. If he has high blood sugar, we'll give him Lasix. Why not? Lasix will also reduce the pressure. We can give him dexamethasone. We'll do a ventilator section if there's airway obstruction, and you'll start turning him over frequently because of the heart rate. Because of the heart rate, you have to turn him over frequently. Glory be to God!

[00:58:36]They turned him to the right and left, as if they were asleep for a very long time, like 300 years or so. Something like that, okay, sir. State epilepsy and diabetic acidosis, we've already explained them in other contexts, so I can read them with you, but only briefly, just to broaden your understanding.

[00:58:55]Look, sir, what does "state epilepsy" mean? From the name, it's the state where the patient has entered a state of epilepsy.

[00:59:00]Okay, so what does "epilepsy" mean? It means recurrent convulsions. If you're going to explain it in two words, okay, convulsion, sorry, recurrent seizures, recurrent seizures. There's a difference. A seizure is a convulsion, and a convulsion is the motor type of seizure.

[00:59:17]We explained this in detail in the section on epilepsy, so I'm going to summarize it for you quickly. Okay, so it says "convulsions," meaning a seizure. We said a seizure means an epileptic seizure. Convulsions mean a convulsion. Okay, that's the old definition. Plus Moran 30.

[00:59:31]New, more than five minutes, walking or short-circuiting, meaning between attacks he doesn't regain consciousness, then we'll consider it one period. We'll consider it a dangerous state of speed, in short, a convulsion.

[00:59:46]Okay, the normal state is a condition or combination.

[00:59:56]From this excessive speed, what will happen will happen on all levels of the body. It will start to be damaged by respiratory distress.

[01:00:03]That is, he regurgitated, and this thing entered the respiratory tract. Okay, cardiovascular shock, heart failure, cardiostimulation, metabolic, hypoglycemia, acidosis, hypoglycemia, urological, encephalomyelitis, hemologic, and so on.

[01:00:16]We explained this before. Management, my friend, is ABC. And then if he has convulsions, give him diazepam, and so on. If diazepam doesn't work for him, give him phenobarbital. If it doesn't work for him, give him phenytoin, which is antidepressant, anticonvulsant, or angiotensin. Okay, that's it, one picture, one picture. Look at what's in front of you. This is what he doesn't know, he's calling it an IgG, I think. Yes, the electroencephalogram (EEG). Okay, this is what actually diagnoses the type of epilepsy. So we've diagnosed it as epilepsy. We can give him phenobarbital as a treatment for epilepsy, or you can calm him down at that moment so that complications don't get involved. I mean, the stage of complications is less important, so let's continue.

[01:00:56]I also talked to you about it in detail. Well, someone has type 1 and type 1 diabetes. There's a problem.

[01:01:03]Where is the problem?

[01:01:05]We'll describe it. Yes, autoimmune and autoimmune.

[01:01:08]As for insulin resistance, autoimmune means the insulin can't come out because the immune system has attacked the beta cells of the pancreas, so the insulin can't come out.

[01:01:17]Okay, what's the reason? Well, the idea is that this patient experienced something that increased The body's needs increased, like infection, and the body's insulin levels decreased. So, the cells couldn't use glucose, so they started using lipids. The lipids then produced ketone bodies as a primary product, leading to a significant increase in blood sugar. This resulted in ketoacidosis. Why? Because ketone bodies are acidic. This leads to ketoacidosis because it's accompanied by hyperglycemia. The presentation of abdominal pain and cerebral palsy are the two most important factors in ketoacidosis.

[01:01:51]Besides that, there are the three basic metabolic disorders: polyuria, polydypia, and polypia. This means acetone, a smell of the mouth, a strong odor like acid, and so on. Complications arise because this acidity will damage the entire body, leading to hypophimbic shock, brain edema, cerebral edema, and cardiac edema. Of course, the sugar will be extremely high. It's called diabetic, more than 300. And as we said, ketoacidosis, meaning he'll have ketoacidosis and metabolic acidosis. There's the name, right? And ketoneuria and glucose. This will also show up in the urine, right? And a drop in hyponitrate, right? So, management will involve giving him fluvoxamine or something to do, giving him insulin, and giving him creatinine therapy to treat the metabolic acidosis, and so on.

[01:02:37]Look, my friend, here are some pictures of the type. This person was taking insulin, for example, like this, right? Suddenly, he didn't take his insulin, and he also got an infection, for example. He got an infection that increased the likelihood that his body needed more sugar, so the demand increased, in addition to the fact that he forgot to take his insulin dose, right? So, on top of all this, he'll go into diabetic acidosis. First, there's severe abdominal pain. Where in the abdomen? Secondly, polyuria. The sugar is very high, so he'll go to the bathroom a lot, and there's severe dehydration, meaning he'll get very dehydrated. We'll smell acetone breath.

[01:03:12]How do you start treating it, sir? You'll give him sodium bicarbonate for acidosis and start intravenous fluids. And of course, we'll give him his insulin dose, whatever he needs. That's it, sir. Today's lesson, I know it's simple, and it is simple, God willing, but the idea is the number of topics. There are eight topics: diabetic ketoacidosis, acidosis, and before that we covered statins and appletixes.

[01:03:34]We went through them quickly because we explained them before. Before that, we also covered coma, which we also went through before and explained quickly. Then there's hypotonia, and before that, stomatitis, and before that, sir, we have respiratory failure, and before that, sir, estradiol, and before that, sir, 5-in-1.

[01:03:48]The squiz steps for Oil Primary and Alexandria Service, all of these, sir, are about emergencies.

[01:03:52]These are emergency cases you might encounter. I want to tell you something: God willing, after you graduate, there will be lectures during your internship at some universities.

[01:04:01]These lectures will cover emergencies, which are the topics you see in every module. You know the modules you took when you first entered college, especially the clinical ones. You'll take topics called emergencies, which are the common things you might see in an emergency room. This will be useful for you in emergencies later on, during your two years of internship. During your internship, you might want to get an MRSP equivalency, or maybe the British Fellowship, the American Fellowship, or the Egyptian Fellowship— whatever you like. But ask God for His mercy and guidance, for God is merciful to His servants. So, we're done, thank God. We've finished the theory.

[01:04:34]We've finished the theory, thank God.

[01:04:39]Now, let's move on. You have many files, like 3, 6, 7, 8, 9, 10, and 11—about 12 files or something for the OSB.

[01:04:47]You've heard half of these files from me in the lecture, so you'll understand them on your own. You've already attended your section, so you're fine.

[01:04:55]Try to figure out the other half yourself. If I make a Q&A video, I might give you hints, but from your perspective, there's something called " SAP." We haven't explained it yet. I'm telling you the bottom line so you don't forget before your exam and blame me. We ask God for His mercy. Doctors, please subscribe and share the channel for the sake of God Almighty. I really want to reach over 10,000 subscribers, but no one is responding. I don't know why. It's for the sake of God Almighty. And God provides for whomever He wills without measure. If God were to extend His provision to His servants, they would surely transgress in the land. But He sends it down in due measure as He wills, by His permission. And their final supplication will be, "Praise be to God, Lord of the Worlds."

[01:05:28]Amen