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1.what is the most appropriate step after stabilization in a pt with GI bleed n suspected: a.Peptic ulcer(iv PPIs Vs Endoscopy) b.Variceal bleed(iv Octreotide vs Endoscopy)
2.In Arrhythmias do we always use DC current or do we use AC too......also when to do synchronous cardioversion n when to do asynchronous cardioversion?
3.In a child with Night terrors do we just reassure parents or r/o temporal lobe epilepsy with a EEG 1st(Step 1 Kap notes insists on latter n step 2 on former)
khalid22 Forum Newbie
Topics: 3 Posts: 7
12/26/04 - 05:17 AM
#2
in varecial bleeding 2nd step is endoscopy with injecting a sclerosing agent :idea:
usmleasr Forum Guru
Topics: 105 Posts: 970
12/26/04 - 08:18 AM
#3
1. After stabilising , endoscopy in both cases I guess...becos U need to know the source and if it is actively bleeding....
2. AC instruments were used before and are bulky...at present we use DC instuments mostly....these have transformers that convert AC to DC of various energy levels.. synchronized means...u r giving electical energy at the time of R wave in EKG...it is used in treatment of all arrhythmias except when there is no time for synchronization ...i mean in ventricular fibrillation.... in other words...asynchronized cardioversion = defibrillation
3. in step 2 , if clinical scenerio is typical of night terror...ans is reassurance 8)
miky Forum Senior
Topics: 16 Posts: 99
01/08/05 - 10:37 AM
#4
Dear Anil Kumar,
1.what is the most appropriate step after stabilization in a pt with GI bleed n suspected: a.Peptic ulcer(iv PPIs Vs Endoscopy) b.Variceal bleed(iv Octreotide vs Endoscopy)
Here's a nice management plan:
Pt. with GI Bleeding:
1st: stabilize pt. give iv fluid / blood / blood products and O2 supplement.
2nd: insert a NT tube into pt's stomach: if blood present - that's an upper GI Bleed; if blood absent: that's probably a lower GI bleed
if upper GI Bleed: next: Endoscopy
if eso varices: next: attempt sclerotherapy; if that fails - Angiography & chemical embolization; if severe bleeding - send the pt. directly to OP room - needs surgery to stop bleeding
if gastric ulcer / duodenal ulcer - look for perforation S/S - if perforation- next: immediate laparoscopy / laparotomy; if no perforation - give PPI - if fails - surgery & resection of bleeding segment
if gastritis - give PPI; rarely life-threatening
if lower GI Bleed: Next: Rectosigmoidoscopy - if negative: Full colonoscopy; if negative - Angiography to detect the source of bleeding - if no source identified - Abdominal scan (RBCs labeled with a subst - you know - to detect low flow bleeding - if however no source found after all the above procedures - you may chose to treat pt. symptomatically and observe for another bleeding episode taking place)
My opinion. ___________________ always happy and ready to serve and help my friends and patients as well.
...i mean in ventricular fibrillation.... 
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