د.شاهر 🇸🇦

MD 👨🏻‍⚕️ | Madrid 🇪🇸 | Ittihad 🐯 | ABHA 🗻

[د.شاهر 🇸🇦 @IshaherI]

لما تولى الله أمر يوسف؛ أحوَج القافلة في الصحراء للماء ليصل يوسف عليه السلام إلى الخلاص، ثم أحوَج عزيز مصر للأولاد ليتبناه، ثم أحوَج الملك لتفسير رؤياه ليخرجه من السجن، ثم أحوَج مصر كلها للطعام، ليصبح عزيز مصر!

اللهمّ تولّنا بولايتك ..

[د.شاهر 🇸🇦 @IshaherI]

@md1talk 🔺Tumor Lysis Syndrome = ↑ K⁺, ↑ Phosphate, ↑ Uric acid
⬇️ Calcium (secondary to phosphate rise)

[د.شاهر 🇸🇦 @IshaherI]

Do you remember when you joined X? I do! #MyXAnniversary

[د.شاهر 🇸🇦 @IshaherI]

#Ittihad 🐅

[د.شاهر 🇸🇦 @IshaherI]

@InsiderMix1

[Ross Prager @ross_prager]

(1/x) The term 'pre-renal' acute kidney injury is dated and should stop being taught in medical schools.

Why? The term pre-renal is inextricably linked to the idea that the treatment of pre-renal AKI is IV fluids.

Here's the paradigm of hemodynamic AKI and why it is helpful.

A 🧵

#foamed #medtwitter #meded #hemodynamics

[Qasem Ahmed @QAlmulihi]

Vasopressors and Inotropes - Summary Sheet

1️⃣ Norepinephrine (Levo)
💉 Action: α1 > β1 agonist → ↑↑ SVR, ↑ CO, reflex brady may negate ↑ HR
📌 Uses: Septic shock (1st), Cardiogenic shock (1st), Hypovolemic shock (1st)

2️⃣ Phenylephrine (Neo)
💉 Action: Pure α1 agonist → ↑↑ SVR
📌 Uses: Septic shock with ↑ HR or ↓ BP; AFRVR, HOCM, AS, RV failure

3️⃣ Vasopressin (Vaso)
💉 Action: V1 (↑ SVR), V2 (↑ renal H2O reabsorption)
📌 Uses: Septic shock (2nd line), Anaphylaxis (2nd line), RV failure

4️⃣ Epinephrine (Epi)
💉 Action:
•Low dose: β1 > β2 > α1 → ↑ CO, neutral SVR
•High dose: α1 > β1 > β2 → ↑ CO, ↑ SVR
📌 Uses: ACLS (1st), Anaphylaxis (1st), Symptomatic bradycardia (2nd), Septic shock, Bronchospasm

5️⃣ Dopamine (Dopa)
💉 Action:
•Low: D1 > β1 → ↑ CO, ↑ UOP
•Medium: β1 > D1 → ↑ CO, ↑ SVR
•High: α1 > β1 > D1 → ↑ SVR
📌 Uses: Symptomatic bradycardia, Septic shock with bradycardia (↑ mortality vs. Levo in septic and cardiogenic shock)

6️⃣ Methylene Blue
💉 Action: ↓ NO and cGMP → ↑ smooth muscle tone, ↑ SVR
📌 Uses: Refractory sepsis/anaphylaxis, post-cardiopulmonary bypass, amlodipine overdose, methemoglobinemia

7️⃣ Dobutamine (Dobuta)
💉 Action: β1 > β2 > α1 agonist → ↑ CO, ↓ SVR
📌 Uses: Cardiogenic shock, Add to Levo in septic shock with ↓ LVEF

8️⃣ Milrinone
💉 Action: PDE inhibitor → ↑ cAMP → ↑ inotropy, vasodilation → ↑ CO, ↓ PVR/SVR
📌 Uses: Cardiogenic shock, RV failure (↓ PVR, ↓ LVEDV)

9️⃣ Isoproterenol (Isuprel)
💉 Action: β1 = β2 agonist → ↑ HR, ↓ SVR
📌 Uses: Symptomatic bradycardia, Mg-refractory Torsades

[د.علي القحطاني @dr_3li]

الإنشغال نعمة.

[Ross Prager @ross_prager]

(1/x) A cardiac arrest patient is the most unstable patient in your hospital - they just died (temporarily)!

They are at very high risk of dying (again) until you know what exactly is going on.

Here are my 10 top tips to preventing your temporarily deceased patient from becoming permanently deceased.

A 🧵

#medtwitter #foamed #foamcc #echofirst #CPR

[badER ¯\_(ツ)_/¯ @badrowes]

Night shifts and ICU oncalls 🤣

[د.شاهر 🇸🇦 @IshaherI]

#Palestine #FreePalestine #غزة_تنتصر #فلسطين_قضيتي

[د.شاهر 🇸🇦 @IshaherI]

@IAseeer عريكه

[د.شاهر 🇸🇦 @IshaherI]

لا اله الا الله وحده لا شريك له له الملك وله الحمد وهو على كل شيئ قدير..

[د.شاهر 🇸🇦 @IshaherI]

@Ahmedmalfifi 😂😂😂😂😂😂😂

[د.شاهر 🇸🇦 @IshaherI]

#الاتحاد_بطل_الدوري_2023

[د.شاهر 🇸🇦 @IshaherI]

الله يغفر له و يرحمه و يسكنه الفردوس الاعلى من الجنه
#فهد_الحيان

[علاء سعيد @alaa_saeed88]

😅 على طريقة جماهير #الاتحاد بعد الانتصارات :

🏃🏾‍♂️ يــمــشـي كـدا كــدا 🏃🏾‍♂️

#الاتحاد_ابها

[Doc Kamal 🫁 @doc_kamal99]

الدراما بتعلمنا كيفية تركيب ال oropharyngeal tube😐

[فهد ديباجي @fahddeepaji1]

🛑الخلاصة.
واحد هارب الفساد ..
واحد هارب بسبب التطرف ..
واحد هارب بسبب المخدرات ..

[رَوائِعُ القَصِيدْ @raway_alqasid]

"يَا خيرَ رُسل اللّٰهِ قدرُك قد سمَا
فاشفع لمَن صلّى عليكَ وسلّما" ﷺ