Transannular Patch: A Surgical Solution for TOF and RVOT Obstruction

💉 Streptokinase Infusion in Acute Cardiac Care 🚑 Streptokinase remains a crucial thrombolytic agent in the management of acute myocardial infarction (AMI), pulmonary embolism, and DVT. By dissolving intravascular clots, it restores circulation and improves survival — especially when given early. 🔹 Preparation & Dosage Supplied as a powder vial (usually 1.5 million IU). Reconstitute with 5 mL sterile water (do NOT shake, swirl gently). Further dilute in 100 mL Normal Saline or 5% Dextrose. Dosage for AMI: ➡️ 1.5 million IU IV infusion over 60 minutes (single dose). Avoid mixing with heparin or other drugs in the same line. 🔹 Nursing Responsibilities During Infusion ✅ Continuous ECG & vital signs monitoring ✅ Watch for hypotension, arrhythmias, bleeding ✅ Maintain IV access & strict infusion protocol ✅ Provide patient reassurance & education ✅ Document response and adverse reactions accurately ⚠️ Contraindications: Recent surgery, hemorrhagic stroke, active bleeding, severe hypertension. ⏱️ Early administration = better outcomes. Nurses play a vital role in ensuring safe administration, early complication detection, and quality patient care. #CardiacNursing #CriticalCare #Streptokinase #AMIManagement #Thrombolysis #EmergencyNursing #NursingEducation #NursingLeadership #PatientSafety #AcuteCare #NursingSkills #CoronaryCare #CriticalCareNursing #CardiologyCare #NurseLife #EvidenceBasedPractice #ClinicalExcellence #HealthcareProfessionals #NursingUpdates #MedicationSafety

🫁 Recognizing and Managing Tension Pneumothorax in the Field Tension pneumothorax is one of the most life-threatening emergencies paramedics face in the field. It can develop rapidly, and without quick recognition and intervention, it can lead to cardiac arrest within minutes. 1. What it is A tension pneumothorax occurs when air enters the pleural space and cannot escape. Pressure builds inside the chest, collapsing the lung and shifting the mediastinum, which compresses the heart and great vessels. 2. Early recognition is critical The challenge for EMS providers is that the signs can be subtle at first. Key findings to watch for: • Severe shortness of breath and respiratory distress • Decreased or absent breath sounds on one side • Hypotension with rapid heart rate • Jugular vein distension (when visible) • Tracheal deviation (a late sign) 3. On-scene management The priority is rapid recognition and immediate action: • Administer high-flow oxygen • Prepare for needle decompression at the second intercostal space, mid-clavicular line (or fifth intercostal, anterior axillary line depending on protocol) • Provide supportive care and transport urgently to a facility with chest tube capability 4. Why speed matters Delays can be fatal. Studies have shown that prehospital needle decompression performed by trained paramedics can dramatically improve survival in trauma patients with suspected tension pneumothorax (Journal of Trauma and Acute Care Surgery, 2017). ⸻ ✨ Takeaway Tension pneumothorax is rare but deadly. For paramedics, the ability to recognize it early and act decisively can mean the difference between life and death in the field. #EMS #Paramedics #AirwayManagement #PrehospitalCare #EmergencyMedicine

📚 DVT vs PE 🔹 Deep Vein Thrombosis (DVT) :- A blood clot forms in a deep vein (commonly in the leg) and can break off, traveling to the lungs causing a Pulmonary Embolism (PE). 🔍 Diagnosis:- • Doppler Ultrasound • Venography • D-Dimer ⚠️ Signs/Symptoms:- • Unilateral leg swelling • Pain, warmth, redness • One leg appears different than the other 📌 Risk Factors:- • Prolonged immobility (e.g., post-op, flights) • Varicose veins • Contraceptive use • Obesity, smoking • Age >60 💊 Nursing Interventions:- • DO NOT* massage or apply heat (may dislodge clot) • Elevate leg above heart level • Administer anticoagulants (e.g., warfarin, heparin) ------------------------ 🔹 Pulmonary Embolism (PE):- A life-threatening blockage in the pulmonary arteries due to a clot (often from DVT). 🔍 Diagnosis :- • Chest X-ray • CT scan • D-Dimer • MRI ⚠️ Signs/Symptoms:- • Sudden SOB • Chest pain, tachycardia • Cough, possible hemoptysis 📌 Risk Factors:- • History of DVT • A-fib (untreated) • Immobility, surgery, trauma • Smoking, poor diet 💊 Nursing Interventions :- • High Fowler’s position • Administer O₂ • Administer anticoagulants & thrombolytics • Prepare for possible embolectomy • Monitor ABGs & vital signs 🧠 NCLEX TIP :- ✔️ Always assess for signs of PE in patients with DVT. Sudden SOB = medical emergency! 🩺 Save it. Know it. Share it. This knowledge saves lives! Keep following along with @nurse_ahmed_here for more amazing #nursingtips, guides and related content👋

✅ INCENTIVE SPIROMETRY ✅ What It Is: Incentive spirometry is a respiratory therapy technique that uses a handheld device to help patients breathe deeply. It is mainly used to prevent or treat lung complications, especially after surgery or during long bed rest. The goal is to: • Re-expand the lungs • Improve oxygenation • Prevent infections like pneumonia or atelectasis (collapsed lung) ✅ When It’s Used: Incentive spirometry is commonly recommended for patients who: • Have undergone abdominal or chest surgery • Are on prolonged bed rest • Have lung diseases (e.g., COPD, pneumonia) • Are recovering from rib fractures • Have weak respiratory muscles ✅ How to Use It (Step-by-Step): 1. Sit upright (in bed or a chair). 2. Hold the spirometer upright. 3. Exhale normally. 4. Place the mouthpiece in your mouth and seal your lips around it. 5. Inhale slowly and deeply through the mouthpiece. 6. Watch the indicator rise to the target level. 7. Hold your breath for about 3–5 seconds. 8. Remove the mouthpiece and exhale slowly. 9. Rest a few seconds. 10. Repeat 10 times every 1–2 hours, or as instructed. Many devices include: • A piston/chamber to show inhalation volume • An adjustable marker to set a target • A ball/indicator to show correct speed of inhalation ✅ Benefits: ✔ Prevents lung collapse (atelectasis) ✔ Improves lung expansion ✔ Reduces risk of pneumonia ✔ Clears secretions ✔ Improves breathing post-surgery ✔ Strengthens respiratory muscles ✅ Precautions: • Avoid rapid inhalation (can cause dizziness) • Clean the device daily • Stop if chest pain or severe discomfort occurs • Follow healthcare provider instructions ✅ Who Should Not Use It? Caution in patients with: • Severe respiratory distress • Uncontrolled pain • Facial or oral trauma • Very young children (unless assisted)

❓Why In-Depth Knowledge of Cardiac Medications Is Crucial in Cardiac Rehabilitation In cardiac rehab, we support patients recovering from myocardial infarction, CABG, PCI, valve surgery, or managing heart failure. A surface level understanding of their medications is not enough. Detailed pharmacological knowledge directly impacts patient safety, clinical decision-making, and outcomes. Here are specific examples where this matters: 1. Beta-blockers and exercise prescription Medications like bisoprolol or metoprolol reduce the heart rate response. Using standard HR formulas (such as 220 - age) can lead to overprescribing exercise intensity. Clinicians need to adjust using perceived exertion scales and understand the blunted HR profile in these patients. 2. ACE inhibitors or ARBs and blood pressure response Drugs such as ramipril or candesartan can cause postural hypotension, especially when combined with diuretics. This affects how patients tolerate upright exercise, especially during initial ambulation, cooldowns, or resistance sessions. 3. Antiplatelets and anticoagulants and fall risk Aspirin, clopidogrel, or apixaban increase bleeding risk. A minor fall in a rehab gym can result in major complications. Fall prevention protocols should account for medication risks, not just physical mobility. 4. Statins and muscle pain differentiation Statin-associated muscle symptoms can mimic exercise-related soreness or even angina. Clinicians need to distinguish delayed-onset muscle soreness (DOMS) from adverse effects or cardiac symptoms through careful questioning and timing. 5. Diuretics and electrolyte imbalance Loop diuretics like furosemide can lead to hypokalemia, fatigue, or arrhythmias. If a patient complains of cramping, lightheadedness, or unusual fatigue, this may not be due to exertion alone. Knowing when the patient last took the medication is essential. Summary Cardiac medications are not a side note in rehab. They affect exercise tolerance, safety, monitoring, patient education, and progression planning. Every cardiac rehab clinician, whether a nurse, physiotherapist, or exercise physiologist, should treat pharmacology as core knowledge, not background detail. #cardiacrehab #cardiology #cardiacrehabilitation #pharmacology #exercisephysiology #heartfailure #patienteducation #clinicalexcellence #medicationsafety #rehabprofessionals #healthcarequality

THESE ARE THE REASONS YOU SHOULD VISIT AN OPTOMETRIST FOR ANY EYE COMPLAINT. Visiting an optometrist for every eye complaint is important because your eyes are delicate, complex organs, and many conditions that seem minor can actually be early signs of something more serious. Here are some key reasons why: 1. Accurate Diagnosis Not all eye discomfort is due to simple issues like tiredness or allergies. An optometrist can differentiate between harmless irritations and conditions like infections, glaucoma, retinal problems, or corneal injuries. 2. Preventing Vision Loss Some eye diseases (e.g., glaucoma, diabetic retinopathy, macular degeneration) may not show noticeable symptoms until significant damage has occurred. Early detection by an optometrist can prevent permanent vision loss. 3. Specialised Equipment & Expertise Optometrists use tools that can’t be replaced by self-checks or over-the-counter solutions (e.g., slit lamp, tonometer, retinal imaging). They can pick up subtle changes invisible to the naked eye. 4. Tailored Treatment Instead of self-medicating with eye drops, which may worsen the condition, an optometrist prescribes safe, effective, and targeted treatment. 5. Link Between Eyes and General Health The eyes often reflect systemic conditions like diabetes, hypertension, thyroid disease, or autoimmune disorders. Optometrists can identify these and refer you to the right specialists early. 6. Children and Aging Eyes Need Extra Care Kids may not recognise or report vision problems, which can affect learning. In older adults, age-related issues like cataracts or macular degeneration are better managed if detected early.

Ankaferd Blood Stopper (ABS) and Epistaxis Can a topical agent stop a nosebleed in just 30 seconds? Epistaxis management just got a radical upgrade. Epistaxis is a common emergency, often distressing and potentially severe in clinical settings. The need for rapid, local, and efficient hemostasis is critical for patient comfort and time management. Traditionally, we've relied on agents like gelatin foam (GF) or combinations such as adrenaline plus lidocaine (AL) to control bleeding. But how fast is fast? A comparative study in an experimental epistaxis model evaluated the efficacy of Ankaferd Blood Stopper (ABS) against these agents. The results for the mean time to bleeding cessation were impressive and statistically significant: Ankaferd Blood Stopper (ABS): 30 seconds Adrenaline + Lidocaine (AL): 90 seconds Gelatin Foam (GF): 90 seconds Control (Saline Solution): 210 seconds Hemostasis time with ABS was significantly shorter than with AL and GF (P=0.002). Unlike agents that promote traditional fibrin formation, histopathological analysis suggests ABS acts through a unique mechanism: it induces the formation of a protein network and the aggregation of vital red blood cells that rapidly cover the bleeding area. This unique network formation is what allows it to act so quickly. For otolaryngologists and emergency teams: this means a topical agent that can control nosebleeds three times faster than common options. Otolaryngologists and Emergency Physicians: Nasal bleeding management is a fundamental skill. How would having a solution that reduces hemostasis time to 30 seconds change your epistaxis protocol? Share your experience or the most challenging hemostatic control application in your practice below! #AnkaferdBloodStopper #Epistaxis #Otolaryngology #EmergencyMedicine #ENT #Hemostasis #UrgentCare #SurgicalInnovation.

🚨 Rib Fractures: When to Stabilize Surgically? New CWIS Guidelines Just Dropped! 🚨 As trauma surgeons, we all know rib fractures can turn a "simple" blunt chest injury into a nightmare of pain, prolonged ventilation, and complications. But when does surgical stabilization of rib fractures (SSRF) cross from "maybe" to "must-do"? The latest Chest Wall Injury Society (CWIS) guidelines (J Trauma Acute Care Surg, 2025) synthesize RCTs, meta-analyses, and expert consensus to guide us. Here's the TL;DR for busy clinicians: Indications (Ventilated Patients): 1. Chest wall instability: ≥3 bicortical fractures >50% displaced, paradoxical motion, ≥20% volume loss, or clicking/popping. 2. Failure to wean from MV due to rib fractures. Indications (Non-Ventilated Patients): 1. Same instability signs. 2. Progressive respiratory failure despite optimal analgesia. 3. ≥3 displaced fractures + ≥2 pulmonary derangements (RR ≥20, IS <50% predicted/declining, pain >5/10, poor cough). Worsening scores (e.g., SCARF, STUMBL, RibScore). Timing: As early as possible—ideally <72 hours. Benefits like shorter LOS, fewer pneumonias, and better pain control hold even if delayed, but don't wait if feasible. Combine with other procedures to minimize OR trips. Contraindications: Absolute: Ongoing resuscitation or nonsurvivable TBI. Relative: Pediatrics, frailty/comorbidities, post-CPR fractures, severe TBI/spinal injuries, empyema, contusions, acute cardiac events, uncorrected coagulopathy—assess case-by-case with multidisciplinary input. Pulmonary contusions? No longer a hard no—evidence shows SSRF is safe across severities. And for flail chest? Still the gold standard indication, backed by 6 RCTs. These guidelines aren't rigid; they're a framework to optimize outcomes while weighing risks. In polytrauma, prioritize life/limb first, then stabilize the chest wall. What’s your take? Have SSRF protocols changed your practice? Drop experiences in the comments—let's discuss! #TraumaSurgery #RibFractures #SSRF #ChestWallInjury #SurgicalInnovation #MedTwitter #TraumaCare

Day 118 🤩 🫁 Tracheostomy 🔬 Definition ➡️ Tracheostomy is a surgical procedure where a permanent or temporary opening (called stoma) is created in the trachea (windpipe) through the neck. ➡️ A tracheostomy tube is inserted for breathing. Trachea = windpipe 🚇 → carries oxygen from nose/mouth to lungs. When this “road” is blocked 🚧, tracheostomy gives a new entry gate 🚪 directly into lungs. ⸻ 📍 Anatomy Involved • 👃 Nose → 🗣️ Pharynx → 🧵 Larynx (voice box) → 🛣️ Trachea → 🫁 Lungs • Tracheostomy tube is usually inserted below the cricoid cartilage (2nd–4th tracheal ring). 📌 Why here? ✔️ Safe zone (less vascular) ✔️ Away from vocal cords ✔️ Easy access ⸻ 🧑⚕️ Indications (When it’s Needed) 1. 🚫 Upper airway obstruction • Tumor, trauma, swelling, foreign body 2. ⏳ Prolonged ventilation (>7–10 days in ICU) 3. 💉 Major head/neck surgeries 4. 🤕 Neurological patients (stroke, spinal cord injury – poor airway protection) 5. 😷 Excess secretions → easier suctioning 6. 🫀 Post cardiac/thoracic surgeries with delayed extubation ⸻ ⚙️ Procedure – Step by Step 1. 💉 Local / general anesthesia given 2. ✂️ Horizontal / vertical incision on neck 3. 🧵 Soft tissue + strap muscles separated 4. ⛏️ Trachea identified → small window made 5. 🧪 Tube inserted + secured with tapes 6. 💨 Patient now breathes through tracheostomy ⸻ 🛠️ Types of Tracheostomy ⏳ By Duration • Temporary (ICU, post-op cases) • Permanent (laryngeal cancer, irreversible airway damage) 🧪 By Technique • Surgical tracheostomy (open, in OT) • Percutaneous tracheostomy (bedside in ICU using dilators) ⸻ 🌬️ Advantages • 🚪 Direct airway access • 💨 Easier ventilation for long term • 🧹 Suctioning secretions simple • 🔇 Can allow speech (with speaking valve) • 😌 More comfortable than prolonged ET tube ⸻ ⚠️ Complications 🩸 Early (hours–days) • Bleeding 🩸 • Pneumothorax 🫁💥 (air leak into chest) • Subcutaneous emphysema 💨 under skin • Tube displacement ❌ 🦠 Late (days–weeks) • Infection 🤒 • Tube blockage 🧱 by secretions • Tracheal stenosis (narrowing 🚧) • Tracheoesophageal fistula (abnormal opening 🔗) ⸻ 🏥 Nursing Care 1. 🧴 Suctioning secretions regularly 2. 💧 Humidified oxygen to prevent dryness 3. 🔄 Tube care & changing ties 4. 🧼 Stoma site cleaning (prevent infection) 5. 🛑 Emergency readiness → spare tube at bedside 6. 🗣️ Communication support → writing board, speaking valve ⸻ 📊 Comparison: Normal Breathing vs Tracheostomy 👃 Nose/Mouth → 🗣️ Larynx → 🛣️ Trachea → 🫁 Lungs ➡️ Normal route 🫁 Tracheostomy Neck stoma ➡️ Tube ➡️ Trachea ➡️ Lungs ➡️ Shortcut route 🚪

*Popliteal Sciatic Nerve Block* 🟢Indication: Surgical Analgesia for time sensitive Below Knee Amputation in a patient with compromised cardiac function. Adductor canal block also administered separately 🟡Probe position: 8-10 cm above the Popliteal fossa parallel to popliteal crease with the patient in lateral position with the target leg up (included at the end of the video) 🟢Volume: 25-30 ml of 0.375% Bupivacaine along with 4 mg of dexamethasone 🔵Procedural sedation: not required and consented against by the patient ▶️Procedure: 🔸Aseptic measures ensured 🔸Needle inserted 3-4 cm before the probe in the "in-plane orientation" making sure the needle direction was as parallel to probe surface as possible 🔸Common peroneal nerve (lateral) was lifted up with the help of the needle and the perineurium was targeted at 6 o clock 🔸Local anaesthetic was injected in the perineurium sleeve of tibial nerve, at a point the needle was flush against the tibial nerve at which point it was slightly retracted 🔸On withdrawal local anaesthetic was injected in the perineurium sheath of the tibial nerve as well. ✅Result: A dense, reliable sciatic block achieved, with extended analgesia thanks to dexamethasone. Safe, effective, and avoided the hemodynamic stress of general and spinal anesthesia. Constructive criticism is appreciated