acute calculus cholecystitis

new guidelines link (emergency surgery )

2016 WSES guidelines on acute calculous cholecystitis

https://wjes.biomedcentral.com/articles/10.1186/s13017-016-0082-5

adopted algorithm from the new guidelines

ACC: acute calculous cholecystitis; CBD: common bile duct; DLC: delayed laparoscopic cholecystectomy; ELC: early laparoscopic cholecystectomy; ERCP endoscopic retrograde cholangiopancreateography; EUS: endoscopic ultrasound; IOC: intraoperative cholangiography; LUS: laparoscopic ultrasound; MRCP magnetic resonance cholangiopancreatography

calculation of sulfamethoxazole -trimethoprim dose in PCP (simple way)

Recommended dose based on trimethoprim 15-20 mg/kg

1. 20mg (trimethoprim)X body weight = dose / day
2. 20Xwt/80 = bottles /day
3. 20X wt/80/4 = bottle/day
4. bottle/day / 480 = dose/6hrs

off course not the above one but see next,

Simply , mathematically

Wt X 30 = dose/6hrs 

then round to nearest figure to avoid wasting bottles = 1440 mg, 1920 mg, 2300 mg /6 hrs

Indication for surgical intervention in head truama

Epidural hematoma :

1. hematoma larger than 30 ml
2. midline shift >= 5 mm  

Subdural hematoma (serious and worse)

i-regardless GCS

1. hematoma larger than 1 cm
2. midline shift >=5 mm 

ii-all patients with GCS less than 9 , hematoma should be evacuated and ICP monitor be instituted.

iii- if GCS > 9 and SDH < 10mm and midline shift < 5mm , surgery is indicated if 

• GCS drops by 2 points
• new development of assymetric or dilated fixed pupils
• ICP> 20

ICH

• more than 50 ml volume and less than 85 ml
• Patients with GCS 6-8, with frontal or temporal lesion volume > 20cc with midline shift >5mm or cisternal compression.

Non Ischemic High Troponin associated conditions

Notes about troponin in ICU

Heart related

1. Arryhythmia.
2. aortic dissiction
3. coronary vasospasm
4. cardiomyopathy
5. contusion
6. chemotherapy
7. takotsubo cardiomypathy
8. myocaditis
9. pericarditis

Plumonary related

1. PE
2. pulmonary hypertension

Others

Neurological catastrophe , chronic renal failure.

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Troponin has poor prognostic potential except in critically ill patients where the mortality is 2.5 higher with longer ICU length of stay.

Chronic renal failure patients with higher troponin (TnT>> TnI) have poorer outcome.