#nurses shouldn't take photos inside the theater /يجب أن لا يأخذ الممرضين صور فوتوغرافية داخل صالة العمليات

Nurses shouldn't do photos for the patients :

The chief of neurosurgery at Karolinska University Hospital, Mikael Svensson, said the incident was "deeply unfortunate".

"It violates basic ethical codes," he said.

Cameras are banned from operating theatres unless they are intended as teaching aids for students. It appears that the nurse, who is unnamed for legal reasons, used her mobile phone.

The patients could not be identified from the photos, which have now been deleted from her internet page, but staff at the hospital have had an emergency meeting to remind them about patient privacy.

The woman, who has been suspended, is said to be "devastated" by her actions. It seems she wanted to impress her friends with her high powered job.

In the daily telegraph :

http://www.telegraph.co.uk/news/uknews/2583411/Nurses-posts-brain-surgery-pictures-on-Facebook.html

#Gantacurium

من صفحة/ عالم التخدير
The content in
English /Arabic :
#ادوية_التخدير
في الحالات الطارئة نحتاج #مرخي_عضلي سريع التأثير وبأقل اضرار على المريض 🎗 لذلك نستعمل دواء #سكولين Scoline ولكن #حديثا تم صناعة مرخي عضلي من نوع NDMRs سريع التأثير اسمه #Gantacurium فتابعوا ....
****************************************
#المقدمة
********
👨‍🏫 يوجد لدينا دوائين نستعملها في الطوارىء لسرعتهما وهما :
🔹️ دواء #سكولين ولقد تحدثنا عنه سابقاً ...
🔹️ دواء Rocuronium او يسمى #ازميرون بجرعة 0.6-1.2 ملغم/كغم 🤔 ولكن هذه تعتبر جرعة عالية خاصة بعد الافاقة والخوف من رجوع تأثير المرخي كمضاعفات للدواء ....

لذلك جاءت #الفكرة بصناعة دواء له سرعة #السكولين و له صفات #الازميرون وهو دواء Gantacurium ...
****************************************
🥥 ينتمي دواء ال Gantacurium الى المرخيات العضلية نوع nondepolarizing neuromuscular blockers وله اسم ثاني هو #chlorofumarates .....

طيب 🧚‍♂️ ماهو مميزات هذا الدواء ؟؟؟

🥑 يبدا عمله بسرعة عالية Ultra-Short acting يعني خلال اقل من 60 ثانية وبعض المصادر تقول خلال 45 ثانية .

🥑 ينتهي عمله بعد 5-10 دقائق .

****************************************
#الجرعة_والتآثيرات
*****************
🍉 يعطى بجرعة مقدارها 0.2 ملغم/كغم لعمل الانبوب الرغامي intubation dose .

🍉 التأثيرات الجانية :
******************
المصادر تقول بأنه امن لمرضى القلب والربو كونه لا يسبب تأثيرات جانية لكن هناك بحث نشر حديثا كالأتي :
● تم اعطاء ال Gantacurium لأربعة متطوعين بجرعة 0.5 ملغم/كغم فلاحظوا بأن شخص واحد فقط حدث له هبوط طفيف بضغط الدم مع زيادة طفيفة بدقات القلب ....

● تم اعطاء ال Gantacurium بجرعة 0.7 ملغم/كغم فلاحظوا اصابة ثلاث اشخاص بهبوط الضغط وارتفاع دقات القلب قليلا مع احمرار بسيط ....

#الاستنتاج
*********
🌽 يسبب هبوط ضغط الدم .
🌽 يسبب زيادة بسيطة بدقات القلب
🌽 احمرار بسيط cutaneous flushing

#ملاحظة
تظهر التأثيرات اعلاه فقط بجرعات عالية وللعلم تزول بعد مدة اقل من 2 دقيقة لذلك لا تحتاج اي تدخل علاجي .
****************************************
- المصدر :

صفحة عالم التخدير - امجد عدنان .

- رابط قناة عالم التخدير على التلغرام :
t.me/anaesthesia1994

From the page / The World of Anesthesia
·

# Anesthetics
In case of emergency, we need a quick-impact muscle relaxant and minimal damage to the patient. Therefore, we use Scoline, but # newly developed a fast-acting NDMRs muscle strain called #Gantacurium.
**************************************
#Introduction
********
👨🏫 We have two drugs we use in the emergency of their speed:
🔹️ # Sculin medicine We have talked about before ...
R Rocuronium is called اZimonon with a dose of 0.6-1.2 mg / kg 🤔 but this is considered a high dose, especially after recovery and fear of the return of the effect of the relaxant as complications of the drug.

So # the idea came with the manufacture of a drug with a speed of # sugars and has the characteristics of # Azimiron, a medicine Gantacurium ...
**************************************
🥥 Gantacurium belongs to the nondepolarizing neuromuscular blockers and its second name is #chlorofumarates .....

Ok 🧚️️ What are the advantages of this drug ???

🥑 It starts at ultra-short operating time in less than 60 seconds and some sources say within 45 seconds.

🥑 ends up after 5-10 minutes.

**************************************
#Dose and Effects
*****************
🍉 A dose of 0.2 mg / kg is given to the intubation dose.

🍉 Adverse effects:
******************
Sources say it is safe for heart patients and asthma because it does not cause harmful effects, but there is research published recently as follows:
Gantacurium was given to four volunteers with a dose of 0.5 mg / kg. They observed that only one person had a slight drop in blood pressure with a slight increase in heart rate.

Gantacurium was given at a dose of 0.7 mg / kg. They noticed three people with decreased pressure and a slightly higher heart rate with a slight redness.

# Conclusion
*********
🌽 causes hypotension.
🌽 causes a slight increase in heart rate
C Cutaneous flushing

#Note
The above effects appear only at high doses and the flag disappears after less than 2 minutes so no therapeutic intervention is required.
**************************************
- Source :

Anesthesia World - Amjad Adnan.

- Link to the world of anesthesia on the Tigram:
t.me/anaesthesia1994

#Typhoid and Para Typhoid ((A)) Diagnosis and Comparison

Paratyphoid fever   diagnosis

Pathogen review :

salmonella enterica serotypes Typhi and Paratyphi A,

 Paratyphi B (tartrate negative), and Paratyphi C cause a potentially severe and occasionally life-threatening bacteremic illness referred to respectively as typhoid and paratyphoid fever, and collectively as ((enteric fever))

DIAGNOSIS:

First is to review in mind the Clinical presentation

The incubation period of typhoid and paratyphoid infections is 6–30 days.The onset of illness is insidious with gradually increasing fatigue and a fever that increases daily from low-grade to as high as 102°F–104°F (38°C–40°C) by the third to fourth day of illness. Headache, malaise, and anorexia are nearly universal, and abdominal pain, diarrhea, or constipation are common. Hepatosplenomegaly can often be detected. A transient, macular rash of ((rose-colored spots can occasionally be seen on the trunk.))*Fever is commonly lowest in the ((morning)), reaching a peak in late ((afternoon or evening.))this clinical presentation is often confused with: malaria, and typhoid fever should be suspected in a person with a history of travel to an endemic area who is not responding to antimalarial medication. Untreated, the disease can last for a month. The serious complications of typhoid fever generally occur after 2–3 weeks of illness and may include life-threatening intestinal hemorrhage or perforation.

Laboratory tests:

Infection with typhoid or paratyphoid fever results in a low-grade septicemia. thus blood culture is the mainstay of diagnosis in typhoid and paratyphoid fever, a single culture is positive in only approximately 50% of cases. Multiple cultures increase the sensitivity and may be required to make the diagnosis. Bone marrow culture increases the diagnostic yield to approximately 80% of cases and is relatively unaffected by prior or concurrent antibiotic use. Stool culture is not usually positive during the first week of illness, so blood culture is preferred. &  Urine culture has(( no higher diagnostic yield)) than stool culture for acute cases.

*The Widal test is unreliable but is widely used in developing countries because of its low cost. It is a serologic assay that may react in patients with typhoid or paratyphoid fever, but is not specific and false positives may occur. Serologic assays are not an adequate substitute

 for   ((blood, stool, or bone marrow culture.))

((Because there is no definitive serologic test for typhoid or paratyphoid fever, the initial diagnosis often has to be made clinically.)) The combination of a history of risk for infection and a gradual onset of fever that increases in severity over several days should raise suspicion of typhoid or paratyphoid fever. Typhoid fever is a nationally notifiable disease

Note :

the ((US National Library of MedicineNational Institutes of Health)) puplished comparism done in Egypt 1996  between paratyphoid(( A ))sever infection and typhoid fever infection which was :

Twenty eight positive blood culture paratyphoid A fever cases which may mimic the typhoid fever infection and  were studied. Forty two positive blood culture typhoid cases were taken as controls.

 Cases and controls were subjected to:

 1) careful history,(( especially young arrival from developing countries and from same country into urban areas

 2) thorough clinical examination,

 3) two blood cultures for salmonella,

 4) Widal agglutination test,

5) total and differential white blood count,

 6) urine and stool cultures following therapy.

*There was no significant difference in the clinical picture between acute paratyphoid(( A)) fever and  / acute typhoid fever except the:

 significant decrease of anorexia (57%), toxic look (54%), coated tongue (64%) in acute paratyphoid A cases when compared to acute typhoid cases.

Important note :The prevalence of extraintestinal symptoms in paratyphoid A cases may mimic viral infections. Three of the 4 classical signs namely; toxic look (54%), bronchitic chest (50%), splenomegaly (72%) and tympanitis (64%) were good bed side suggestive clinical diagnostic aids in paratyphoid A cases.

THUS: Blood culture  IS the CORNERSTONE of diagnosis of paratyphoid microbs cases. In 6 (21%), only the second blood sample was positive stressing the value of multiple cultures. Significant Widal antibody titre was elicited in only about half (57%) of paratyphoid A cases which was significantly lower than typhoid cases (83%). Leucopenia was found in only 25% of paratyphoid A cases. Eosinopenia was constant and is considered as a diagnostic and prognostic aid.

SO,

 No correlation was elicited between either the height of antibody titre or the height of leucocytic count and the severity of illness. There was no significant difference in the response to therapy or the occurrence of complications between paratyphoid(( A)) cases and typhoid cases. Up to the current knowledge, this is the first report on comparative study between acute paratyphoid A fever and acute typhoid fever in Egypt from clinical, diagnostic, therapeutic and prognostic points of view.

 Egypt Public Health Assoc.  at 1996.

Content source: 

1^st  Centers for Disease Control and Prevention
National Center for Emerging and Zoonotic Infectious Diseases (NCEZID)
Division of Global Migration and Quarantine (DGMQ)

   2^nd  Chapter 3: Infectious Diseases Related to Travel

CDC website: www.cdc.gov/typhoid-fever

Site :https://wwwnc.cdc.gov/travel/yellowbook/2018/infectious-diseases-related-to-travel/typhoid-paratyphoid-fever

3d    MEDSCPAE-Salmonella typhi and para typhiUpdated: Mar 01, 2018

Author: John L Brusch, MD, FACP; Chief Editor: Michael Stuart Bronze

4^th US National Library of MedicineNational Institutes of Health -database

Written by :saif alaa alqaisy

30-11-018

اسعافات النمل----#ANTS ambulance and first aid

رعاية اليرقات :
تهتم بعض العاملات برعاية اليرقات بعد فقسها من البيوض لتكون مربيتها و تطعمها من مواد تخرج من فمها.
مخازن الطعام :
يحتفظ النمل ببقايا النباتات و الحشرات المقتولة كطعام لفصل الشتاء القادم اثناء السبات
مقبرة النمل :
يحتفظ النمل بجثث موتاهم بحجرة خاصة تحت الارض حيث يتم تغليفهم بمادة خاصة و يدفنون بالمقبرة المخصصة لهم وسبب التغليف حتى لا تنتشر رائحة كريهة في المقبرة
النمل الاحمر :
اشرس انواع النمل حتى ان لسعته حارقة للانسان ليست مميته لكنها تسبب الالام مبرحة و الاغرب من هذا انهم يهاجمون بعض انواع النمل و بعضهم يجعلونهم عبيد لهم و احياناً يكون الغلبة للنمل الاسود في المعارك و الحروب فحرب النمل معروفة في عالم الحشرات
حشرة المن :
مثل ما يرعى الانسان قطعان الماشية و الاغنام و الماعز فيرعى النمل حشرة المن و يستخدمها للرعي و استخراج مادة عسلية ذات طعم مثل السكر يتم وضعها في الاوراق للاستفادة
منها كغذاء في فصل الشتاء
المصدر :
Encyclopedia of Nature
Leonard Moore
موسوعة الطبيعة
ليونارد مور

اليكسثيميا اللامفرداتية او التلعثم العاطفي Alexithymia

Alexithymia
Classification and external resources
Specialty	Psychiatry
[edit on Wikidata]

A

lexithymia

 is a personality construct characterized by the subclinical inability to identify and describe emotions in the self.^[1] The core characteristics of alexithymia are marked dysfunction in emotional awareness, social attachment, and interpersonal relating.

 Furthermore, people with alexithymia have difficulty in distinguishing and appreciating the emotions of others, which is thought to lead to unempathic and ineffective emotional responding.

 Alexithymia occurs in approximately 10% of the population and can occur with a number of psychiatric conditions

اللامفرداتية أو نقص الانسجام النفسي أو اليكسيثيميا(بالإنجليزية: (Alexithymia) أو ما يعرف ب(فقد العواطف) ،

حالة ضعف في الشخصية للتعبير عن العواطف والمشاعر والتعلق الاجتماعي، والعلاقات الشخصية. وعلاوة على ذلك، الأشخاص الذين يعانون من االيكسيثيميا يجدون أيضا صعوبة في التمييز بين مشاعر الاخرين و وتقدير ها،.
وذلك ليس لانهم قساة القلوب والعكس صحيح فالمصابون بهذه الحالات معروفين بانهم اناس حساسين جداً ولكن يوجد لديهم كبت يجعلهم في حالة
unempathic

غير عاطفيين خارجيا اي بمعنى لا يعبرون عن مشاعرهم .نسبة الاشخاص المصابين بهذه الحالة قد تصل إلى حوالي 10% من الب

مررت بلحظات عجزت فيها عن التعبير عن مشاعرك بصورة لفظية؟

هذه الحالة تسمى #اليكسيثيميا وهي حالة يفشل فيها الشخص في التعبير عن مشاعره وأحيانًا الفشل في إدراكها أو فهمها.
العديد من الأشخاص تتحول لديهم حالة (أليكسيثيميا) إلى حالة نفسية مستمرة ودائمة ويجدون صعوبة في فهم أو التعبير عن مشاعرهم طوال الوقت.
بعض التقديرات تقول أن 10 بالمائة فقط مروا بهذه الحاله

(( اعتقد الحبچية واليصارحون متجاوزين هذي الحالة بس محبين الالوان الخضراء يترددون ))

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https://ar.m.wikipedia.org/…/%D9%84%D8%A7%D9%85%D9%81%D8%B1…

https://en.m.wikipedia.org/wiki/Alexithymia

baculum is against evolution theory ? what is your comment on my opinion please readers

Baculum... we are monkies primates and penis bone is supporting that fact  ??

Dose evolution theory goes to this or due to short time sexual meeting in humans ?Or because the  polygamous mating that  take place among humans &  it’s not common enough to necessitate the retention of the penis bone.”
they think that  reasons for the lack of baculum in humans is that the human mating system takes place throughout the year and is less competitive than that of other animals?! 
& shirt bones in our relatives ((as evolution theory analysis which are :
Chimpanzees,  they only have sex for around seven seconds at a time, thus , they have a very small baculum, suggesting that there might be evolutionary pressure among apes to lose the penis bone depending on sexual meeting time , and by time humans evolution theory explain their lost of penile bone ????

Why evolution dose not continue in the monkies ((as they call them our primates )) why the shirt bone penis primates motoring the bone by years and why long bones primates not getting shorter bones for their penis by years 
Getting time sex human males as in porn stars not showing genetics to start growing a penile bone according to their need 
& the monkeys have a polygamous mating system also  in which a female will mate with several males a day when she’s in heat, 
So is it a controversy for the theory of evolution 
??

Primate
A primate is any member of the biological order Primates, the group that contains all the species commonly related to the lemurs, monkeys, and apes, with the latter category including humans.

Let's talk about primates first before going into the articles and what international sites wrote about  BUCULUM EVOLUTIONS ,

PRIMATES :

Primates are found all over the world.

Non-human primates occur mostly in Central and South America, Africa, and southern Asia.

A few species exist as far north in the Americas as southern Mexico, and as far north in Asia as northern Japan.

The Primates order is divided informally into three main groupings: 

prosimians,
monkeys of the New World, 
and
monkeys
 and 
apes of the Old World.

All primates have five fingers (pentadactyly), a generalized dental pattern, and a primitive (unspecialized) body plan.

Another distinguishing feature of primates is fingernails.

Opposing thumbs are also a characteristic primate feature, but are not limited to this order; opossums, for example, also have opposing thumbs.

Now let's see what they write about BUCULUM ,

The guardian published :

It can be as long as a finger in a monkey. In the walrus, it can be two feet long. But the human male has lost it completely. And researchers are a little stumped.

Known as the baculum to scientists with an interest, the penis bone is a marvel of evolution. It pops up in mammals and primates around the world, but varies so much in terms of length and whether it is present at all, that it is described as the most diverse bone ever to exist.

Prompted by the extraordinary differences in penis bone length found in the animal kingdom, scientists set out to reconstruct the evolutionary story of the baculum, by tracing its appearance in mammals and primates throughout history.

They found that the penis bone evolved in mammals more than 95 million years ago and was present in the first primates that emerged about 50 million years ago. From that moment on, the baculum became larger in some animals and smaller in others. The stump-tailed macaque, an animal that weighs only 10kg, has an extremely long baculum for its size, with the bone extending for 5cm. The bone is five times the size of the baculum in the collared mangabey, which is a slightly larger monkey.))

https://www.theguardian.com/science/2016/dec/14/why-dont-humans-have-a-penis-bone-scientists-may-now-know-baculum

Independent published also :

Humans have no penis bone because sex doesn't last long enough, scientists discover
Most primates and 

Scientists have discovered why humans do not have a penis bone, unlike chimpanzees, bears and most other mammals.

The penis bone, or baculum, first evolved in mammals between 145 and 95 million years ago, according to new research from University College London.

The study’s lead author Matilda Brindle told The Independent one of the reasons humans had lost their penis bone was because we do not have sex for long enough to need one.

The common ancestors of both primates and carnivores had a baculum,” she said. “Humans are quite weird as we’re one of the few primates that doesn’t have one”

Primates who mate for three minutes or more tend to have far longer penis bones than those whose intromission, or vaginal penetration, is below three minutes, she said.

“The human intromission duration tends to be below two minutes, which most people wouldn’t expect.”

While polygamous mating does take place among humans, it’s not common enough to necessitate the retention of the penis bone.”

Other reasons for the lack of baculum in humans is that the human mating system takes place throughout the year and is less competitive than that of other animals.

Chimpanzees, who only have sex for around seven seconds at a time, have a very small baculum, suggesting that there might be evolutionary pressure among apes to lose the penis bone.

However, the monkeys have a polygamous mating system in which a female will mate with several males a day when she’s in heat.

MY OWN OPINION IS :

ITS SCIENCE WHO SHOULD ADMIT THAT HUMANS STARTED AS HUMANS AND APES STARTED AS APES , EVOLUTION THEORY COULD BE APPLIED ON MANY CREATURES , AND ON CERTAIN DEVELOPMENTS ON HUMANS BODY , BUT NOT TO LOOK TO HUMANS AS AN OLD MONKEY GENERATIONS OR RELATIVES , SCIENCE IS FREE TO BE LIBERATED FROM MYTHS AND UNREALISTIC STORIES IN RELIGIONS DOCTRINES AND FAITHS ALLOVER THE GLOBE 
, BUT , PLEASE Science KEEP US AWAY FROM MONKEY, AND BOTH 

GENDERS ARE CONTENT WITHOUT BUCULUM I GUESS .
why the apes still apes and why the monkey   still monk and why the bones still exist in those species and absent in our bodies now and before 
actually its not relevant to connect us to monkey due to the baculum 

http://www.independent.co.uk/life-style/health-and-families/health-news/penis-bone-humans-baculum-sex-doesnt-last-long-enough-ucl-why-a7473401.html

The brain can assign the value to an object in less than a tenth of a second- البحوث أثبتت قدرة دماغ الإنسان بتمييز الثمين من الأشياء من بين أشياء مماثلة بالشكل خلال عشر الثانية

خر
المصدر :

البحوث أثبتت قدرة دماغ الإنسان بتمييز الثمين من الأشياء من بين أشياء مماثلة بالشكل خلال عشر الثانية

http://neurosciencenews.com/object-value-8469/

Separating Trash From Treasure: How the Brain Assigns Value to Objects -
The brain can assign the value to an object in less than a tenth of a second; about the same amount of time it takes to recognize an object.

Summary: A new study from JHU researchers finds the brain can assign the value to an object in less than a tenth of a second; roughly the same amount of time as it takes to recognize an object.

Source: Johns Hopkins University.

Johns Hopkins neuroscientists have discovered how the brain can determine an object’s value almost as soon as we see it.

The team found the brain can begin processing value just 80 milliseconds after seeing something. That’s less than a tenth of a second—and means the brain is basically figuring out if something is quality or junk at the same time it recognizes what it is.

Having watched his wife shop, Ed Connor, the senior author of the research and director of the university’s Zanvyl Krieger Mind/Brain Institute, can appreciate the speed of value judgments.

“She’s flipping through the racks at Anthropologie at like two items per second and there’s an instant no, no, no, maybe, yes—try this on,” he says. “It’s an example of how all through life, we see things and attach value to them very quickly. With this study, we’ve answered how at the brain level this can be so fast and even automatic.”

The findings are published online today in Current Biology.

“At the same time we know it’s a car, we know it’s a cheap car, or a sports car, or an old car,” Connor said. “That has to rely on automatic and immediate value processing by the visual system.”

Past research has shown that value representation is strongly associated with later responses in the prefrontal cortex. The new findings show that value processing can begin in the visual cortex, before any value signals appear in the prefrontal cortex. The visual cortex is well equipped to discriminate the fine details in appearance that underlie value judgments about natural objects, Connor said.

The researchers trained monkeys to recognize four different letters. Each letter varied, as if seen in slightly different fonts. The exact shape indicated how much of a liquid treat the monkey would get. The monkeys became experts at choosing the more valuable of two letters in order to get a larger reward. Neural response measurements during this task revealed the rapid emergence of value-related signals in the visual cortex.

Brain surgery anasthesia

#Information

When the nervous processes are concerned with the # pressure of the brain and maintain it so it will be our subject is to deal with the high pressure of the brain Intracranial pressure ... ...

# Introduction_

The ICP represents pressure within the cranial cranium and is determined by three factors:
Blood in the brain
Brain Block
- The size of CSF
According to Monroe-Kellie's theory, the volume group represents 80% of the brain, 10% of the blood in the brain. CSF is 10%. These volumes remain constant to maintain ICP. Above, one of the factors decreases to stay close to normal)
☆☆ ■ ■■■ ☆☆ ■ ■■■ ☆☆ ■ ■■ ☆☆.
#Natural ratio
- The normal proportions of the ICP brain pressure for adults and adult children is less than 10-15 mmHg.
- Children 3-7 mm Hg
* When the brain pressure of 20-25 mm Hg is considered high and needs a therapeutic overlap ... while when 40 mmHg is considered emergency, which requires immediate emergency treatment.
☆☆ ■ ■■■ ☆☆ ■ ■■■ ☆☆ ■ ■■ ☆☆.
#Signs and symptoms
At high ICP we observe the following:
- Dizziness
- vomiting
- Low heart rate Bradycardia and high blood pressure
- Slow breathing
- may reach a loss of consciousness
In anesthesia the patient is unconscious
☆☆ ■ ■■■ ☆☆ ■ ■■■ ☆☆ ■ ■■ ☆☆.
#the reasons
There are many reasons for high brain pressure:
Brain tumors
Brain abscess
3 - brain swelling of the brain Intracranial hematoma
Cerebral edema cerebral edema
5. Encephalitis
Meningitis
7 - a blow to the brain Traumatic brain injury
8. Hepatic encephalopathy
9. Stroke
10. Increase the volume of CSF
☆☆ ■ ■■■ ☆☆ ■ ■■■ ☆☆ ■ ■■ ☆☆.
# Procedures _ during anesthesia_and treatment
In neurosurgery, the surgeon asks us to lower the pressure of the brain so it is a therapeutic and anesthetic procedure so we use a number of these methods:
1. Preserving (airway, breathing, circulatory system) ie ABC system.
2. Giving oxygen to 100% and maintaining PaCO2 30-35 mmHg (use of high ventilation).
3 - raising the head of the patient 15-30 degrees.
Give Mannitol Mannol at a dose of 0.5-1 g / kg and then 0.25-0.5 g / kg every 6 hours as needed.
5 - giving the beakers Bexamethasone dose of 8 mg.
6. Prevent Seizure Seizure by giving # Midazolam 2-5 mg or # Valiaz Diazepam of 5-10 mg or both.
7. Preserving the temperature.
8. Use of pentothal to reduce Cerebral metabolic rate.
9 - Preserving fluids by giving Normal Slane or Renker Lacetit ..
10 - can be used as managers such as LASIK 20-40 mg.
11. Use of opioid such as # fentanyl 50 micrograms or Remifentanil use of 1-2 mg diluted with 500 ml normal seline.
12 - In case of non-response to treatment is the process of opening the skull.
#Note
● Do not use premedication in these processes.
Inhalation gases increase brain pressure so when we want to use them, they should be used with a little MAC (eg, halothin use 0.6% or isoflavin less than 1%).
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#معلومة
عند عمليات الجملة العصبية نهتم ب #ضغط_الدماغ والمحافظة عليه لذلك سيكون موضوعنا هو التعامل مع ارتفاع  #ضغط_الدماغ Intracranial pressure ......

#مقدمة_فسلجية
ضغط الدماغ ICP يمثل الضغط داخل قحف الجمجمة ويتحدد بثلاث عوامل :
- الدم في الدماغ blood
- كتلة الدماغ
- حجم السائل الشوكي CSF
و حسب نظرية Monroe- Kellie  تنص على ان مجموعة الحجوم تمثل ( الدماغ يعادل 80 %) ، ( الدم في الدماغ يمثل 10 % ) ، ( السائل الشوكي CSF يمثل 10 % ) وان هذه الحجوم تبقى ثابتة للمحافظة على ICP ( اي عند ارتفاع احد الحجوم اعلاه ينخفض احد العوامل ليبقى مقارب للطبيعي )
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#النسبة_الطبيعية
- النسب الطبيعية لضغط الدماغ ICP للبالغ والاطفال الكبار هو اقل من 10-15 ملم زئبق .
- الاطفال 3-7 ملم زئبق
* عندما يكون ضغط الدماغ من 20-25 ملم زئبق يعتبر مرتفع ويحتاج الى تداخل علاجي ... بينما عندما يكون 40 ملم زئبق يعتبر emergency اي تحتاج علاج فوري طارىء .
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#العلامات_والاعراض
عند ارتفاع ضغط الدماغ ICP نلاحظ الأتي :
- دوخة
- تقيء
- انخفاض دقات القلب Bradycardia وارتفاع ضغط الدم
- بطيء التنفس
- قد يصل الى فقدان الوعي
¤ في التخدير المريض يكون فاقد للوعي LOC
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#الاسباب
هنالك العديد من الاسباب تسبب ارتفاع ضغط الدماغ هي :
1- ورم بالدماغ Brain tumors
2- حدوث خراج بالدماغ Brain abscess
3- تورم دومي بالدماغ Intracranial hematoma
4- وذمة دماغية Cerebral edema
5- التهاب الدماغ Encephalitis
6- التهاب السحايا Meningitis
7- ضربة على الدماغ Traumatic brain injury
8- حالة Hepatic encephalopathy
9- الجلطة Stroke
10- زيادة حجم السائل الشوكي CSF
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#الاجراءات_خلال_التخدير_والعلاج
في عمليات الجملة العصبية يطلب منا الجراح ان نخفض ضغط الدماغ لذلك يعتبر اجراء علاجي وتخديري لذلك نستعمل عدد من هذه الطرق  :
1- المحافظة على ( المجرى الهوائي ، التنفس ، الدورة الدموية ) اي نظام ABC .
2- اعطاء الاوكسجين 100% والمحافظة على PaCO2 30-35 ملم زئبق ( استعمال تهوية عالية Hyperventilation ) .
3- رفع رأس المريض 15-30 درجة .
4- اعطاء #مانيتول Mannitol بجرعة 0.5-1 غم/كغم وبعد ذلك 0.25-0.5 غم/كغم كل 6 ساعات حسب الحاجة .
5- اعطاء الديكادرون Bexamethasone بجرعة 8 ملغم .
6-  منع حدوث النوبات Seizure بأعطاء #ميدازولام 2-5 ملغم او #الفاليوم Diazepam من 5-10 ملغم او كلاهما .
7- المحافظة على درجة الحرارة .
8- استعمال البنتوثال لتقليل Cerebral metabolic rate .
9- المحافظة على السوائل بأعطاء (نورمال سلاين او رنكر لاكتيت ) ..
10- يمكن استعمال المدررات مثل #لازكس 20-40 ملغم .
11- استعمال ال Opioid مثل #فنتانيل 50 مايكروغرام او استعمال Remifentanil بمقدار 1-2 ملغم تخفف ب 500 مل نورمال سلاين .
12- في حالة عدم الاستجابة للعلاج يتم اجراء عملية فتح الجمجمة .
#ملاحظة
● لا نستعمل premedication في هذه العمليات .
● الغازات الاستنشاقية #ترفع ضغط الدماغ لذلك عندما نريد استعمالها يجب  استعمالها ب MAC قليل مثلا ( الهالوثين نستعمله ب 0.6% او ايزوفلورين اقل من 1% ) .
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