ΘΕΡΑΠΕΥΤΙΚΗ - ΔΗΜΗΤΣΑΝΑ 1-5-15.pdf

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.: 22 007

: 27950 - 31.401 27950 - 31.402

: 27950 - 29.206

/ : [email protected]

ISBN 978-960-6827-14-3

MEDICAL GRAPHICS 10-12, ..:185 36 . .:210 4510874, fax:210 4528025

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.

Amlodipine: Norvasc/Amlopen caps 5, 10 mg Diltiazem: Tildiem/Dipen tabl 60 mg, inj. 100 mg/vial Verapamil: Isoptin, amp 5 mg/2 ml, tbs: 40, 80, 120, 240 mg. Nifedipine: Adalat, caps 5 mg l0 mg. Nisolpidine: Syscor tabl. 10 mg.

.

Adrenaline: inj. sol. amp l mg/ml. Ethylphenylephrine: Effortil amp l0 mg /ml. Dopamine: Giludop, amp 50 mg / 5 ml. Dobutamine: Inotrex inj. sol. 250 mg /20 ml. Isoproterenol: Isuprel amp 0,2 mg/ml. Clonidine: Catapresan tbs 0,150 mg, amp 0,150 mg.

.

Amiodarone: Angoron amp 150 mg / 3ml, Adenosine: Adenocor amp 6 mg / 2ml. Disopyramide: Rythmodan caps 100 mg, Xylocaine (Lidocaine): 1 FL = 50cc. : 2% (20 mg/ml), Mexiletine: Mexitil amp 254 mg / l0cc, Verapamil: Isoptin amp. 5 mg / 2 ml

.

Aspirine tabl 500mg, Salospir tabl 100mg, tabl 325 mg. Ticlopidine: Ticlid tabl 250mg, Dipyradamole: Persantin drag 75mg, amp l0mg / 2ml. Clopidogrel: Plavix/Iscover tbs. 75 mg, tabl 150 mg. Ticagrelor: Brilique tbs. 90 mg.

():

Atropine: amp l mg / ml.

(-).

Enalapril: Renitec tbs. 5 mg, 20 mg. Captopril: Capoten tabl. 25mg & tabl. 50mg, Benazepril: Cibacen tabl. 20mg.

().

Valsartan: Diovan, tbs. 80 mg, 160 mg. Irbesartan: Aprovel, tbs. 75, 150, 300 mg. Telmisartan: Micardis, tbs. 40, 80 mg.

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7

.

Streptokinase: Streptase inj. lyoph. 750.000 IU, 1.500.000 IU Alteplase ( ): Actilyse: l amp = 50 mg. Reteplase: Rapilysin inj.pd.ly. 0,56 gr (10 iu) / vial.

.

Heparine (UFH) 5000 IU/ml (l amp = 5 ml = 25000 IU). Enoxaparine (Clexane) 2000 iu/0,2 ml 10000 iu/1 ml Tinzaparine (Innohep) 3500 iu/0,35 ml 20000 iu/2 ml Fondaparinux (Arixtra) inj. sol. 2,5mg/0,5ml, 7,5mg/0,6ml, 10mg/0,8ml.

:

: Digoxine tabl. 0,25 mg, amp 0,5 mg.,

: Lanitop tabl. 0,1 mg,

.

Furosemide: Lasix amp 20 mg / 2ml, tabl 30, 40, 500 mg. Furosemide + Amiloride: Frumil tabl (40+5) mg. Bumetanide: Burinex tabl 1 mg, amp. 0,5 mg/ml

(b-blockers).

Metoprolol: Lopressor tabl. 100 mg, Atenolol: Tenormin tabl. 100 mg, amp 5mg/ l0cc, Propranolol: Inderal tabl. 40 mg, amp 5mg/ l0cc. Labetalol: Trandate tabl. 100, 200, 300 mg, amp 5 mg.

:

Nitroglycerine: Nitrolingual amp 25mg / 25ml, Nitrolingual spray. Isosorbide Mononitrate: Monosordil tab. 20 mg, 40 mg. Imdur tab. 60 mg Isosorbide Dinitrate: Pensordil subl. tab. 5mg, tab. 10 mg.

:

Nimodipine: Nimotop inj. sol. 10mg/50cc.

:

Piracetam: Nootrop/Oxynium amp 3gr / l5ml, Bulfomedil: Loftyl inj. 50 mg /5ml. : Daflon tbs. 500 mg. Pycnogenol tbs. 20 mg & 50 mg.

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8

.

2 ( & ):

Salboutamol: Aerolin resp.sol. 5mg/cc. Terbutaline: Dracanyl 0,5 mg /dose Salmeterol: Serevent 25 mcg/dose, 50 mcg/dose Formoterol: Foradil/Oxez 9 mcg/dose, 12 mcg/dose.

().

Ipratropium: Atrovent resp. solution, spray.

2 .

Ipratropium + Phenoterol: Berodual inhaler, respirator solution. Ipratropium + Salboutamol: Berovent inh. sol. neb. sol.

.

Budesonide: Pulmicort 0,25 mg/ml/amp.

Beclometazone: Becotide 50 mcg/dose, 250 mcg/dose.

Fluticasone: Flixotide (neb) 0,5 mg/dose, 2 mg/dose.

():

Aminophylline: Euphyllin amp 240mg, Aminophylline amp 250mg,

Theophylline: Uniphyllin amp 240mg/4cc.

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9

. &

, .

Klysmol Fluid Ounces 133 ml, : Duphalac Sir 3,3 gr/cc (300cc), : Parafin oil, Nujol oil, : Milk of Magnesia 8,5% (340cc), Mannitol: Sol 20% (500cc), Glycerine: Supp Bebe (0,6 gr), enf (l,2 gr), adult (2,4 gr).

/ ( ):

Loperamide: Imodium caps 2 mg & Sir l mg / 5cc, Octamylamin: Octinum-D drops, Diphenoxylate + Atropine: Reasec tabl (2,5 mg + 0,025 mg).

.

Metoclopramide: Primperan amp l0 mg / 2ml. Betahistine: Antivom tbs. 8, 16 mg. Ribrain tbs. 6 mg. Promethazine: Titanox amp. 50 mg / 2ml. Chlorpromazine: Zuledine amp. 25 mg / 5ml. Ondansentron: Zofron amp. 4 mg / 2ml.

:

: Simeco tabl., susp. aalx tabl, susp. Milk of Magnesia oral susp. 425 mg/ 5ml.

& : Hyoscine--butylbromide: Buscopan amp 20 mg/ lcc. Trimebutine: Ibutin tbs. 300 mg.

2 :

Ranitidine: Zantac/Lumaren tabl. 75, 150, 300 mg, amp 50 mg / 2ml.

(PPI) Omeprazol: Losec/Lordin/Penrazol inj. sol. 40 mg/amp. Pantoprazole: Zurcazol/Controloc inj. sol. 40 mg/vial

: + : Carbosylane caps, : Ceolat tabl. 80 mg.

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10

.

.

Phenytoin: Epanutin amp 250 mg, Midazolam: Dormicum amp 5 mg / 5cc, l5 mg / cc. Diazepam: Stedon amp l0mg/2cc, tabl. 5mg, l0mg. Levetiracetam: Keppra amp 100 mg/ml x 5ml. Sodium Valproate: Depakine inj. sol. 400 mg/vial

.

Dimenhydrinate: Vertigo-Vomex Caps, Supp., amp. Vomex- 100 mg/ 2cc, Betahistine: Ribrain tabl. 6 mg. Antivom tbs. 8 mg, 16 mg. Ondansentron: Zofron amp. 4mg / 2ml.

.

Sumatriptan: Imigran amp 6 mg Rizatriptan : Maxalt Rapid sol. tab tbs. ling. 10 mg Ergotamine + Caffeine : Cafergot supp. (2+100) mg.

& .

Carbamazepine: Tegretol tbs. 200mg, 400mg, syr. 100mg/5ml.

Clonazepam: Rivotril tbs. 0,5mg, 2mg, syr. 2,5 mg/ml

Pregabalin: Lyrica 25, 75, 150, 300 mg.

:

Biperiden: Akineton amp 5 mg/ml Benzhexol: Artane tbs 2mg, 5mg.

:

Nimodipine: Nimotop inj. sol. 10mg/50cc.

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11

.

( ):

:

Aloperidol: Aloperidin amp. 5 mg / lcc, drops l0 mg / cc. Chlorpromazine: Zuledin amp. 25 mg / 5cc. Olanzapine: Zyprexa amp. 10 mg/vial Promazine: Sparine fl. 50 mg / cc.

():

Diazepam: Stedon amp. l0 mg / 2cc, tabl. 5 mg, l0 mg Clorazepate: Tranxene caps 5, l0, 20 mg. Lorazepam: Tavor amp. 4 mg/ml

. , &

& .

Diclofenac sodium: Amp. Voltaren 75 mg / 3 cc, Indomethacin: Indocid amp 50 mg, Paracetamol: Amp. Apotel 600 mg, Lysine acetyl-salicylate: Egicalm l,8 gr, Lornoxicam: amp. Xefo 4 mg/ml, Tenoxicam: Tilcitin inj. 20 mg Parecoxib: amp. Dynastat 40 mg/vial.

.

Baclofen: Miorel / Vioridon tabl. 10 mg, Orphenadrine: Norflex amp. 60 mg /2 ml Thiocolchicoside: Musco-Ril amp. 4mg / 2cc, Tizanidine: Sirdalud tabl. 2 mg & 4 mg.

.

: Glucagon inj. sol. 1 mg/amp.

:

Insuline Actrapid 100 iu/ml,

Insuline Humulin Regular 100 iu/ml.

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12

. &

Morphine amp. l5 mg, tbs. 10, 15 mg.

Pethidine amp. 0,l gr.

Tramadol: Tramal amp. 100 mg / 2ml, tbs. 50, 100 mg.

Dextroproxyphen: Romidon/Zideron amp. 75 mg / 2cc.

.

:

Proparacaine: Coll. Alcaine 0,5%, Tetracaine: Coll. Tetracaine 0,5%

:

Dexamethazone: Coll. (ea/ey sol.) Decadron 0,1%, fl. 5 ml, Prednizolone: coll. Adelone 1%, fl. 5 ml, Fthoriometholone: Coll. FML 0,1 %.

:

+ : Coll. Sulfachloramfenicol, Sulfanicole. Neomycine + Vacitracine: Coll. Nebacetin. : Coll. Thilocof Tobramycine: Coll. Tobrex Gentamicin: ea/ey sol. Garamycin 0,3%

.

:

Diydralazine: Nepresol, amp 25mg / 2cc.

( ):

Isoxuprine: Duvadilan tabl 20mg amp l0mg/2cc, Ritodrine: Yutopar tab l0mg, amp 50mg/5cc.

: :

Melhylergonovine: Methergin drag 0,125mg, Demergin: inj. 0,2mg/ lcc, tabl 0,2mg.

: : Oxytocin amp 5 IU/ lcc. Betamethazone: Celestone chronodose amp 6mg/ 1 cc.

.. ...

13

.

Atropine: amp. 1 mg/ml

Pralidoxime: Contrathion amp. 200 mg

Naloxone: Narcan amp. 0,4 mg/lcc

Flumazeline: Anexate amp. 0,5mg/5cc

Bentonide: Bentonite pd.oral.susp. 70 gr/vial.

Vitamine 1: Konakion amp. l0 mg/lcc

Ipecacuanha liguid extract 7%: Ipecavom syr. 1000 mg/15ml (fl. l5cc)

: Ultracarbon tabl. 250 mg

Methylene blue: amp. 1% (100mg/10ml)

Physostigmine: Neostigmine amp. 2,5mg / lcc, Prostigmine amp.

Acetylocysteine: Parvolex / Flumil, amp. 2 gr/10 ml.

Penicillamine: caps 250 mg.

Glucagon: inj. sol. 1 mg/amp.

Calcium Gluconate: amp. 10%

Silibinin: Legalon inj. 350 mg/vial

Dimercaprol: BAL inj. sol. 100 mg/2ml

. &

& , .

Almora n.

Dextrose Water - 35% [amp. l0cc = 3,5 gr.]

Glucose (Dextrose Water) inj. sol. 5%, 10%

Potasium chloride (KCl) 10% [amp. l0cc = lgr.]

: Sir. Sopa ,

Water for injection [amp. l0 cc].

Gluconate calcium - 10% [amp. l0 cc = lgr].

Sodium chloride - 15% (NaCl 15%) [amp. l0 cc = l,5gr].

Sodium chloride - 0,9% (NaCl 0,9%) [amp. l0 cc]

Sodium chloride 0,9% (100, 500, 1000 ml)

Sodium Bicarbonate = 4 [amp. l0 cc = 0,4 gr.]

Ringers Lactate

Ringers Solution

Mannitol sol 20% ( ).

.. ...

14

. & :

: Dexamethasone: Decadron / Dexaton inj. 8 mg / 2cc, Methylprednizolone: Solu-Medrol inj. sol. 125 mg, 500 mg, l gr Prednizolone: Prezolon inj. 25 mg / lcc Betamethazone: Celestone chronodose amp. 6 mg / l cc. Hydrocortisone: Solu-Cortef inj. sol. 250 mg, 500 mg.

:

Betamethazone: Betnovate cream 0,1%, Mometazone: Elocon cream 0,1%.

.

Dimetindene maleate: Fenistil, amp 4 mg / 4 cc. Promethazine: Titanox, amp 50 mg / 2ml. Hydroxyzine: Atarax inj. sol. 100 mg/2ml.

. &

:

Cefotaxime: inj. Claforan amp l gr. Ceftriaxone: inj. Rochephin 2 gr Penicillin G inj. 1000000 IU.

( ).

Amoxicilline: inj. Amoxil vial l gr. Cefoxitine: inj. Mefoxil vial l gr. Ceftazidime: inj. Solvetan vial 500 mg, l gr., 2 gr. Cefouroxime: Inj. Zinacef vial 750 mg.

: Amikacine: inj. Briklin amp 500mg, Netilmicin: inj. Netromycin amp 300 mg / l,5cc.

: : Betadine sol 240cc 10%, surgical scrub 1000cc. ("").

.. ...

15

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(Levin) .

60 cc .

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14G (2,1 mm) (45 mm) 1,47 mm 300 ml /

16G (1,8 mm) (45 mm) 1,25 mm 200 ml /

18G (1,3 mm) (33 mm) 0,85 mm 90 ml /

20G (0,65 mm) (33 mm) 0,70 mm 61 ml /

22G (0,9 mm) (25 mm) 0,55 mm 36 ml /

24G (0,6 mm) (19 mm) 0,45 mm 15 ml /

24G , 22G 20G . 14G 20G .

(, , ) .. .

.. ...

22

4. (Intraosseous, io)

, , 6 , .

(2010) (ERC), (, , ) . ( , shock ...).

K - (.: BIG Bone Injection Gun) Jamshidi .

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(35 cm) .

10 ml NaCl 0,9% 3-5 .

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30 - 60

30 - 60

2-3

2-3

3-5

10-20

15-30

5-30

30-90

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25

&&

, ( 285-295 mOsm/lt) (, , ) .

:

Na+: 141 mEq/L,

Cl - : 103 mEq/L,

K+: 4 mEq/L,

Ca++

: 5 mEq/L,

Mg++

: 2 mEq/L,

HCO3-: 26 mEq/L.

, . , , . , , (, , ..). , , ( -).

H , .

240 340 mOsmol/L . 340 mOsmol/L 240 mOsmol/L .

, 1000 ml D5W 80 ml. 1000 ml N/S 275-300 ml 1 lit 600 ml.

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26

, , , .

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, 4 ml / kg , .

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(HES) , , . (Voluven, Tetraspan 6%) . (~5 ) , .

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23/10/2013, , , (PRAC) , , . .

.. ...

27

:

NaCl 0,9% - (: 308 mOsmol/L - pH: 5,1) Na+: 154 mEq/L Cl-: 154 mEq/L.

NaCl . 1000 ml N/S 275 ml 875 ml.

. .

NaCl 7,5% - (: 2567 mOsmol/L - pH: 5,7) ,

( ) Na+ / Cl-.

Na+ . 2 . , . 250 ml NaCl 7,5% 4 ml/kg 1000 ml . , , .

- ( ) . .

Ringers Solution - (: 309 msmol/L) K+, Na+, Cl- Ca++,

. : Na+:147 mEq/L, Cl-: 155 mEq/L, K

+: 4 mEq/L, Ca

++: 4,4 mEq/L.

R/S , . .

Lactate Ringers - (: 273 mOsmol/L - pH: 6,5) .

: Na+: 130 mEq/l, Cl-: 109 mEq/l, K+: 4 mEq/l, Ca++: 3 mEq/l, : 28 mEq/l. ,

, . H .

, , . R/L Ca

++ . R/L

.

.. ...

28

(5%, 20%) , 80%

. 65-69 kD .

Human Albumin 5% (, , , ) ... .

N/S R/S (Ringer Solution) Human Albumin 20% 4 . , , .

.

35 [Haemaccel (: 274 mOsmol/L, pH:7,3)] [Gelofusine (: 274 mOsmol/L, pH:7,4) (, , shock).

( 20-25 kD) (2-3 ). 80% , . 1,5 lt , .

. .

(HES) ( --

.:130-200 kD), 6% 10%, NaCl 0,9%. (. > 450 kD) . . 6% 100%, 10% 130% .

6% [Voluven

6% Tetraspan 6%, (:308 mOsmol/L, pH:5,0)] . , , , .

, 2 lt , 30-40 ml/kg/24 4-6 . , .

.. ...

29

()

D/W 5% - (252 mOsmol/L - pH: 4,5)

. 2 . , 170 kcal/L.

. 1000 ml D5W 80 ml.

D/W 10% - (505 mOsmol/L)

, 2 340 kcal/L. , . , . .

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SHOCK

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: 25% 5% 5%. 5%.

. shock .

SHOCK

.

. ' , 2 , . ( Tetraspan 6%) shock shock.

( , , , ) .

( Ringers Lactate) ( 24).

( ) :

1. 50% (BSA). 2. 24 . 3. .

.. ...

31

( ) . .. 1000 ml 4 , 250 ml/.

( ) . 2-3 , . .

ml. 50-60 ml, 8-20 ml.

:

/min = [ (ml/h) x / ml] / 60 (min )..

.. 1000 ml 8 30 = 1 ml, : /min = [1000/8 x 30] / 60 = 62,5 /min.

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32

. , pH . .

14 - 18/ 40/. (2) 21% (CO2). 2 CO2 .

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SaO2 > 90%, Hb . 2 , .

() , . . 2 .

: 1. (.. ,

, , .) 2. (.. , shock, ) 3. (.. , ) 4. 5. 6. (.. , , -) 7. , 8.

2 2 (FiO2). :

I. 2

()

i.

ii. a) b)

II. 2

O2 Venturi

.. ...

33

1 . , .

FiO2 = 0,24 - 0,40 1 6 L/min.

FiO2 :

FiO2 = 20% + [4% x [ 2]...

: 1 L/min 24% 2 2 L/min 28% 2 3 L/min 32% 2

4 L/min 36% 2 5 L/min 40% 2 6 L/min 44% 2.

4 L/min , . 2 2 . .

2

, , . (-) . .

2 35-60% ( FiO2 0,6) 6-10 L/min. . (, , ). .

FiO2 , FiO2 60%. .

2

FiO2 > 0,6. 2 80-90% 6-10 L/min. 750-1200 ml . . -.

FiO2 2 CO2.

2. , . .

.. ...

34

2

, , 2 ( ) FiO2 > 0,5. 8-12 L/min.

FiO2 = 1,0 2 (10 L/min) . FiO2.

, 2 2 . FiO2.

, - .

FiO2 0,9. .

2 VENTURI

2 15 . Venturi . 2 FiO2 0,24-0,5 . .

2

. 2 FiO2.

.. ...

35

FiO2 .

: 2 FiO2,

.

( ) FiO2. 2 . .

2 (> 0,5) , .

2 (AMBU)

, . ().

1300-1500 ml, < 5 300-500 ml.

.. ...

36

, , .

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, .

, . . 2 15 L/min FiO2 = 1,0. 2 ambu 2,5 L. ambu FiO2 < 0,5.

ambu 2. .

, , , SpO2 > 90%.

ambu OBESE:

Obese...

Beard

Edentulous

Snoring/oSa...

Elderly > 55y. > 55 .

.. ...

37

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40

, .

, .. Ceclor.

: caps. Ceclor 500 mg bt No II ()

bt boite = , bt No II () . caps .

Ceclor :

Sirop Ceclor 375 mg bt No I ()

( ) Ceclor :

Caps 500mg, tabl. retard 750mg, sirop 125mg, sirop 250mg, sirop 375mg

Tabl retard .

, Voltaren, :

Tabl 25mg, tabl 50mg, tabl disp. 50mg, tabl. retard 75mg, tabl. retard 100mg, amp. 75 mg, supp. 50mg, gel 1%

Amp = , supp = .

.. supp. Voltaren 50 mg, bt No I ()

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2001, , () .

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.. ...

41

;

0% 10% ;

((00%%))

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(0%) :

1. , .

2. .

3. .

4. , & - , .

5. .

6. .

7. ( ).

8. ( ).

9. ( , ).

10. C.

11. Wilson ( ).

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15. , 3 4.

16. ,

17. Niemann Pick C

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((1100%%))

10% :

1. Parkinson

2.

3. (, , ...),

4.

5.

6.

7.

8. Wilson ( )

9. Burger

10.

11.

12. , Alzheimer

13. Charcot.

10% .

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, . .. 30 tabl. tabl. tabl. , 60 , 2 . 10 tabl. 1 tabl. , 3 .

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. . :

Xanax, Tavor, Lexotanil, Hipnosedon, Stedon, Gardenal, Diphenal, Halcion, Librax, Loramet, Sival-b, Stilnox, Tramal, ...

(Lonalgal, Lonarid-N), tabl. Lonarid-N . , .

;

.. , . , , . , 36 . 12 , 3 . 36 36 ... , .

.. ...

44

30 ;

30 . 5 . 25 .

. . .. , 10 , . . ( ). , .

;

, , . .. , , - - .. , !

, , .

:

1. 25 30 ( 5 ) 2. ( ,

). 3. .. 20 .

. 25-30 .

4. ...

, ;

. 2-5 ( ) 10% ( 25%).

.

!!! . .. , .. Lasix 10%, . , ( ) . ( ).

.. ...

45

;

:

1. , , .

2. , . ' , . .. " " .

3. , .

4. ( ).

;

, ( ).

, , . , .

...

( ). . o , . , ( ) , . , .

" ;"

! . , , .

, .

.. ...

46

' .

, , , .

, .

. .. (3 ). .

:

:

tab. Glucophage 1x2 tab. Diamicron 1x2, 3 .

1. 3 3 3 .

2. 2 glucophage (x 30) 1 diamicron (x 60). .

3. - , . .

4. (. ).

5. : " - . 1 2 3" ( 1, 2 3 ). ( ).

23 , 23 , 23 23 ( 5 ;).

. , . ( 6). 3 . .

.. ...

47

;

, / / . (.. . , 3002).

.

.

() . .

/ . . , , - , .

.

, . , .

, .

. , . . .

, , ( ), , !!!

.. ...

48

( 3 ) .

.. " , " ( ).

,

&

/ : .

:

/ : .

: .

: ...

: .

Rp.

1. ... ( )

2. .

3. .

(. )

-

: . / / .

.. ...

49

.

( ) . :

1. .

2. Gram (-) .

3. .

4. , (3 ).

5. , HIV , .

6. ( ).

7. .

8. ( ).

9. [ (.. , , Sjogren)].

. , . , .

, . . , , (.. ..).

, , .

.

.. ...

50

. O .

O .

H ( ) . (, , ) ' ( ).

. 6-12 pH 2 . (1-3 ) .. , .

:

1. , , . E .

2. . .

3. .

4. . .

5. G-6-PD.

6. .

.. ...

51

7. .

8. .

9. K (210-77.93.777).

Y

O .

T mg/kg. . .

. H 70 kg 1,8 m2. :

.. = [ (m2) / 1,8] x ..

. .

.. ...

52

1. , .. , , . : A.

, B. ,

, .

2. : , . , , , .

3. : . (1) (2) . (3) - .

4. ) , ) ) : A.

.

B. .

5. T : (10%). . .

6. 25% : 25%, .

7. M : , .

.. ...

53

8. : (. INNOHEP syr 2 X 0.45 X 4500 IU INNOHEP syr. 10 X 0.45 X 4500 IU) . ( 2 INNOHEP syr. 10 X 0.45 X 4500 IU: P 10amp/0.45 X 4500 IU BT () 20 2).

9. .. .. : . .. .. .. .. .

10. .. .. : .. .. , . .

11. : .

12. : [ (3) ] (. 2) .

13. : - 2 3 . . .

14. : . , 0% 10% .

.. ...

54

&&

(..) (..), , . , , .

( ), :

, , .. , ( /

5749/56).

. .. ,

. [ 3/. 11681 / 28-8-1984 ( 602)]

, , (N. 2071/92).

, , , (3/ 11681/84).

. 5 2 . 121/2008 ( 83A) , .

.., , .. , ( 1397/83, 18).

, , .

.. .. . , , ( 3487/55).

.. ...

55

. , 3487/55 / 5749/56 , . , , .

( ) , ( ) .

. 27 66 . 3984/2011 ( 150) [: 4-5] , (7) . . (4, 8, 12, 14, 15, 16, 17, 18 ) () .

, , 7 (5 , 1 , 1 - ). , , , , . . [ 1.v 1. 4 . 3868/2010 ( 129)]

24 . 3599/2007 ( 176) . ..... (3) , , . 21 8 . 3868/2010 ( 129) . . 11 . 8 7 . 3329/2005 ( 81) .

.. 24 .

.. ...

56

.. .. ..

, .

, , . / , , , , , .

, : , / , . , . , , , , , .

, - - A, B, C, D, E (. . ). .

, , , . , .

.. / ..

: : , ;

:

1. .

2. ( ) ( ).

3. .

4. .

, , ( ) .

... : , , ECG . ,

.. ...

57

, / .

, .

, : ( < 90 mmHg), (/ >180/110 mmHg), ( > 150 /min), ( > 30 /min), ( < 10 /min), (SpO2 < 90%)

, :

, /

, , (shock)

.

.

:

1. (). 2. () 3.

(C). 4. (D).

--C-D-E .

( , , ) A-B-C-D-E.

, ( , , , ).

. , . .

.. ...

58

[, , , , (, )]. : 25% , 10% !

... ( , ). ST (STEMI) ST (non-STEMI).

, .

O STEMI

, , .

: , , , , , , , , .

1. 1 tab 500 mg () . 2. per os 300-600 mg (4-8 tbs. Plavix 75 mg),

. , . (Brilique, tbs. 90 mg) ASA NSTEMI ( -ST) 90 mg x 2, per os.

3. 2 2-4 lt/min , SpO2 > 90-92%.

4. 250 ml N/S. , ( 2 s) 1-2 amp Zantac 1 amp Controloc .

.. ...

59

5. , . 250 ml N/S 250 ml D5W 1 amp. Nitrolingual 25 mg, 5-30 .. >100 mmHg. ( ).

6. , 4-5 iu Actrapid 250 ml D5W. 7. (UFH), : 60-80 iu/kgr iv bolus ( 1 ml =

5000 i.u). : 12 iu/kg/h, . max 1000 iu = 0,2 ml UFH 500 cc N/S 1 . ( UFH D5W). (Clexane) 1 mg/kgr .. (sc). - - 1 amp Fondaparinux (Arixtra) 2,5 mg.

8. , (1 amp 14 ml N/S 3 ml ). .

9. , 5 mg 2-3 (. 1 amp 5 mg 10 cc N/S). (max:15 mg), 5-15 .

10. , .

11. . monitoring .

12. , , .

6 12 .

, ACC/AHA t ( 90 min), 15 mg iv-bolus, 50 mg 30 min 35 mg 60 min.

.

:

(SK) (

APSAC)

1,5 106 IU

D5W N/S 30-60 min

(iv) SK

24-48

(tPA) (Actilyse)

a) 15 mg iv bolus b) 0,75 mg/kg 30 min, iv c) 0,5 mg/kg 60 min, iv

( 100 mg)

(iv) 24-48

(r-PA) 10 IU + 10 IU (iv)

30 min (iv) 24-48

( - tPA) 0,5 mg/kg iv bolus (iv) 24-48

.. ...

60

: >180 mmHg >100 mmHg, . .

: >220 mmHg >120 mmHg, (, , ). .

, , , , , ..

. .

. : ( ../...,

, / , .., .), .

1. ..., .. . .

2. 1 tabl Lexotanil 1,5 - 3 mg p.o., . 3. : 1 tbl Capoten 25 mg, p.o/sl 30-45 .

4. , : amp. 1 amp. Catapresan (im). 5. 15-25% 1-2 .

...

1. 2 4-6 lt/min. 2. ... . (

... ). [ : ..., ].

3. 3way 1000 cc N/S R/L 3 amp Nootrop. 4. ( >220 mmHg >120 mmHg)

, : 1 amp. Catapresan 100 cc N/S 15-30 , : 10-20 mg (2-4 amp) Trandate 100 cc N/S 5-10 . 250 ml N/S D5W, 1 amp. Nitrolingual 25 mg 5-20 ~170-180 mmHg.

5. .. 180/110 mmHg, : fl. Nimotop 10 mg (iv) , .

6. Foley . 7. -

.. - 20% 60 .

.. ...

61

1. ... . .

2. 2 4-8 lt/min. 3. 3way 250 ml D/W 5% 250 ml N/S,

1 amp. Nitrolingual 25 mg 5-20 , .. 4. . iv bolus 13 amp Lasix . 5. Foley . 6. , , 1 amp. Aerolin 1 amp. Atrovent,

3 ml N/S 2 6 lt/min. 7. , .

1. ..., . . , .

2. . . 3. : 1 amp 5 mg iv bolus 10-20 mg (2-4

amp Trandate) 250 cc N/S, 5-20 . 4. 250 ml D/W 5% 1 amp. Nitrolingual 25 mg 10-40 . 5. , - ( )

(Brevibloc) 500 g/kg (. Brevibloc 100mg/10ml 3,5-5 ml 35-50 mg) 1 .

6. 4-30 mg/min. 7. 100140 mmHg

. 8. .

1. (/ >150/100 mmHg), 2 4-6 lt/min .

2. ... .

3. 3way : - 1 amp Nepresol 25 mg, 100 cc N/S 10-20 , 30 . .

4. : 10-20 mg (2-4 amp) Trandate 100 250 cc N/S 5-10 , .

5. , 2-4 gr MgSO4 5-10 ( 2-4 gr MgSO4 100 ml N/S, iv ). 1 gr MgSO4 . MgSO4 . 1 amp. 10 ml .

6. 15-30

.

.

.. ...

62

( , , , ) ( , 3 , , , ) .

, (...) shock.

, , , , , .

, . . (, , ...)

1. 2 100%, 4 - 8 lt, . 2. 1-3 amp Lasix 250 ml D/W 5% (

iv bolus ).

3. 30-60 , .

:

A. B. C. D. E. B Blockers F. G.

(-)..

, . :

a) b) c) d)

< 40%, . 2 . .

1. (Renitec), tabs. 5, 20 mg : 10 20 mg /24h. 2. (Capoten), tabs. 25, 50, 100 mg : 50 450 mg /24h. 3. (Accupron), tabs. 5, 20, 40 mg : 20 40 mg/24h. 4. (Coversyl), tabs. 4 mg. : 4 8 mg. 5. (Triatec), tabs. 1,25, 2,5 mg : 5 10 mg.

.. ...

63

-V NYHA. () ( ) . . ( ) . 0,5 kgr /24h. :

1. + (Moduretic). : 1 2 tab. / 24h.

2. + (Frumil). : 1 2 tab. / 24h.

3. (Lasix), tabs. 40, 500 mg & amp. 20 mg. : 1 - 2 tabs. 40 mg /24h, 7 - 15 .

(, ) ( ) 6 , . . . 10 .

+

- . - , .

1. Cibadrex ( + )

2. Co-Renitec ( + )

3. Superace, Uresan ( + )

4. Accuretic ( + )

5. Zestoretic ( + )

6. Preterax ( + )

() . .

a) tabs. Aldactone 25 mg, 100 mg 50 100 mg / 24h, max: 200 mg/24h

b) tabs. Inspra 25 mg, 50 mg 25 mg /24h.

< 2,5 mg/dl < 5,0 mmol/l. 12,5 mg 25 mg < 5,0 mmol/l . . .

.. ...

64

..

-. - -. - . . , -, .

[h] [mg]

Losartan Cozaar 2 h 50 100 mg

Candesartan Atacand 9 h 4 32 mg

Valsartan Diovan / Dalzad 6 h 80 320 mg

Irbesartan Aprovel / Karvea 1115 h 150 300 mg

Telmisartan Micardis / Pritor 24 h 40 80 mg

Eprosartan Teveten 5 h 400 800 mg

Olmesartan Olartan / Olmetec 1416 h 10 40 mg

B Blockers.

, 30% 25% . II-IV NYHA , -. :

a) b) c) d) e) .

2 (start low - go slow).

(Lobivon): 1,25 mg x1 10 mg x1

(Dilatrend): 6,25 mg x1 25-50 mg x2

(Lopresor): 12,5 mg x2 100 mg x2

(Pactens): 1,5 mg x1 10 mg x1

.

. V , . 3 > 75 .

.. ...

65

.

: (.: ), , , , , , , .

, ( ), , . , . , . , . (, , SpO2, , , GCS, Glustick).

1. A-B-C-D .

2. 2 100% 4-8 lt/min 12 lt/min, . , 1 amp. Aerolin 1 amp. Atrovent, 3 ml N/S .

3. , . 4. 3way (18 G). 5. , ( ) 2-4 amp Lasix (iv

bolus) 1-2 amp 15 .. 6. , (1 amp Nitrolingual 25 mg

250 ml D/W 5% N/S, 5-30 ), , (.. ... .).

7. Foley, . 8.

. 1 amp. (15 mg) 9 cc Cl 0,9%. 1,5 mg/ml. Xo 1 ml iv 5 10-20 mg. (! PCO2 50 mmHg).

9. - 1 amp Digoxin, . 10.

.. ...

66

60 /min.

P PR 1/1 (-) .

:

1. ( , , ). 2. ( Ca++, b-blockers, ,

, , , ). 3. ( , ,

, , , , , , Ebstein, , .).

, , , , , .

.. ...

67

1. . , 24 48 .

2. , 250-500 cc N/S .

3. monitoring SpO2. 4. , Ventouri.

5. 0,5 mg iv-bolus,

3-5 3 mg ( max : 3 amp ).

6. , . [ 0 mA, . 50-80 mA. (1-2 mg Tavor iv) 2-4 mg iv].

7. * : iv (5 amp Isuprel 0,2 mg/ml 250 cc D5W, 10-30

).

2-10 g iv (2 amp Adrenaline 500 cc N/S 5-10 ).

3-10 g/kg/min iv (4 amp Giludop 50 mg/5ml 250 cc D5W 10-20 ).

, ( ) .

8. -, 0,05-0,15 mg/kg (1-3 amp. Glucagen 100 cc N/S). .

9. , (SSS).

0,5 mg !

* .

.. ...

68

.. ...

69

1

PR (> 0,20 sec).

( 10-30%) .

P-R , .

( - ), , , , , - ...

1. . , PR QRS , . 300 ms QRS , .

2. 1 - . .

3. 0,5 mg iv-bolus, 3-5 3 mg .

.. ...

70

2

Mobitz I ( Luciani-Wenckebach AV block)

PR QRS . .

- - , .

His-Purkinje, QRS .

.

, , , .

1. , .

2. 0,5 mg iv bolus, 3-5 3 mg .

3. , . 500 cc N/S. ( ).

4. , .

.. ...

71

2

Mobitz I

PR . ( ) ( ).

- , His , - .

QRS .

Mobitz II - ( , ). ( Adams-Stokes).

Mobitz II - 2:1 Mobitz I - , 0,5 mg Atropine iv bolus, Mobitz I 1 .

1. (, , SpO2).

2. 2-6 lt, Ventouri.

3. 250-500 ml N/S.

4. 0,5-1 mg iv bolus, 3-5 3 mg (. max = 3 amp).

5. , (5 amp Isuprel /.Isoprenaline 0,2 mg/ml 250 ml D5W, 10-30 ) .

6. monitoring , - .

7. , .

.. ...

72

3

()

. .

- ( 45-60 /) ( 30-40 /) .

- QRS .

( ) QRS .

- , , , , , , , . 15-30% Adams-Stokes. , , 15 sec, , .

1. . 2. 0,5 mg iv bolus,

3-5 3 mg . 3. 4-8 lt, Ventouri. 4. ,

(5 amp Isuprel / Isoprenaline 0,2 mg/ml 250 cc D5W, 10-30 ).

5. ( QRS), . . [ 0 mA, . 50-80 mA. (1-2 mg Tavor iv) 2-4 mg iv].

.. ...

73

(AV Junctional Escape Rhythm)

, - - , 35-60 /, . .

, QRS-T , , aVF aVR. , QRS. QRS PR 0,12 sec.

( ), , (), , , . .

, .

.. ...

74

, 60-100 / .

1. .

2. , .

3. 0,5-1 mg (iv-bolus), 3-5 3 mg ( 0,04 mg/kg). , .

4. - . [ 0 mA, . 50-80 mA. (1-2 mg Tavor iv) 2-4 mg iv].

.. ...

75

> 100-180 /. PR . aVF.

. : 1. (, , stress, ) 2. (, , ). 3. (, , , ,

[ ], , ).

1. . 2.

. , , , , ...

3. , (.. ), . b-blocker (tab. Inderal 40 mg, 1x1 1x2, ).

4. (Procoralan, If) 5 mg 7,5 mg , -, .

5. , .

.. ...

76

(90% ) His. 100-250 / , , , .

( , , ) , , , , .

, , .

1. , .

: , 10 . .

Valsalva: 10 . .

: 5-10 . .

2. . (1 amp. Adenocor 6 mg, iv-bolus) 20 ml . , . 1-2 .

.. ...

77

3. 2 12 mg (2 amp. Adenocor 6 mg, iv-bolus). 12 mg 2 . 50% (Isoptin), (Tildiem), - .

4. QRS , 5-10 mg ( 2 amp. Isoptin 5 mg 10-15 cc N/S 15-60 sec). , 3-5 ml 10% 5 . 15 30 mg.

5. ( 2 amp. Angoron 250 ml N/S 10 ).

6. ( , ) 25-50 Joule. .

- (ablation) - . 90%, . , .. .

.. ...

78

100-160 / ( 100 bpm , ).

1. , , 3 . . , , , aVF aVR.

2. , PR RR.

.

(60-85% ), , , , , , , , .

, , , (> 45%) . , , , .

1. / (.. , , ).

2. 2 gr (MgSO4) 2-5 ( 2 gr MgSO4 50 ml N/S, bolus iv ).

.. ...

79

3. . 500 ml N/S 6 gr MgSO4 6 (. 1g/h).

4. . , (2 amp. KCl 250 cc N/S D5W 1 ).

+ 4 mEq/L .

5. g++ K+ , - 2-5 mg bolus iv 2 . 15 .

6. ( ) 5-10 mg ( 1-2 amp. Isoptin 5 mg 10-15 cc N/S 1-2 ). ( ) 0,15 mg/kg (3 amp Isoptin 250 cc N/S, 15 ).

7. .

.. ...

80

. 250-350 /. , .

, aVF ( ) V1 ( ).

2:1 , .

. , , , , , , (), , , ...

Valsalva - , .

1. , / . , .

2. ( ) 48 , ~50 J 50 J, . (1-2 mg Tavor iv) (2-4 mg, iv).

.. ...

81

3. ( 48 ) ( 2 amp. Angoron 150 mg 250 ml N/S 10 ).

4. 0,01mg/kg ( 1 amp. Corvert 10ml 100 cc N/S) 10 ( 60-70%). .

5. 48 (UFH: 80 iu/kg iv-bolus 18 iu/kg/h). 3-4 .

6. ( ) 5-10 mg ( 1-2 amp. Isoptin 5 mg 10-15 cc N/S 1-2 ).

7. ( ) 0,5 mg (. 1 amp. Digoxin 0,5 mg 100 cc N/S). (150 mg 100 ml N/S 10 ).

, .

( Ia, c, ) , .

.. ...

82

(AF) 300-600 /. (. QRS) 160-180 /, - .

V1, V2, V3 aVF.

1-2% , 12% . ( , ). (lone) .

H , , , , , , .

( : PIRATES)

P.E., Pneumonia, Pericarditis

I Ischemia (CAD and MI)

R Rheumatic heart disease, Respiratory failure

A Alcohol, Amyloidosis

T Thyrotoxicosis

E Endocrine (Ca), Enlarged atria (mitral valve disease, cardiomyopathy)

S Sepsis, Stress (fever), SSS.

5% , 30% 80 .

.. ...

83

.

. . 1 , . 1 ,

.

1. , (, , SpO2), .

2. 48 .

3. ( 48 ) ( 2 amp. Angoron 150 mg 250 ml N/S 10 ).

4. (100-200 J) 48 . (1-2 mg Tavor iv) (2-4 mg, iv).

5. 48 (UFH: 80 iu/kg iv-bolus 18 iu/kg/h) . U/S . 3 .

6. , . 5-10 mg ( 1-2 amp. Isoptin 5 mg 10-15 cc N/S 1-2 ). , 10 ml 10% (1 amp) 5 .

7. ( ) 0,5 mg (. 1 amp. Digoxin 0,5 mg 100 cc N/S).

8. (150 mg 100 ml N/S 10 ).

~~~~~~~~~~~~~~~~~~~~~~~~ (ablation)

. , .

.. ...

84

:

, CHADS2 (Cardiac failure, Hypertension, Age, Diabetes, Stroke 2).

, , >75 (1) . (2) .

CHADS score > 2 ( ) R 2-3, 2,5.

CHADS score 0-1 CHADS2-VASc: (CHADS2-VASc score: 0) 75 325mg .

(CHADS2-VASc score: 1) , .

CHADS2-VASc score: 2 .

INR 15 30 ...

Dabigatran (Pradaxa) , , . 150 mg , , . Dabigatran 110 mg , , .

H Rivaroxaban (Xarelto) Xa . Xa , . H Rivaroxaban 20 mg , , , , .

, (monitoring) . , IR. , .

, 100-325 mg 75 mg . .

.. ...

85

(Wolff - Parkinson - White)

( - ).

, .: 1. PQ 2. () 3. QRS ( PQ) 4. ( ST ,

R).

WPW, . , R , , Kent .

QS . Kent .

.. ...

86

WPW : I. (5%) II. (10-20%) III. (40-80%).

WPW , 80-90% QRS, 10-20% QRS.

1. , . :

, 10 . .

Valsalva: 10 . .

2. WPW QRS () . (1 amp. Adenocor 6 mg, iv-bolus) 20 ml . 2 12 mg (2 amp. Adenocor 6 mg, iv-bolus). 12 mg 2 .

3. QRS , 5-10 mg ( 2 amp. Isoptin 5 mg 10-15 cc N/S 15-60 sec). , 3-5 ml 10% 10 ml 10%, 5 . 15 30 mg.

4. WPW QRS () . 50-100 J.

5. - . 100 mg 5 (. 1 amp. 10 ml Pronestyl 100mg/ml, 1 ml 10 ml N/S 1 . 5 1 gr Pronestyl 1 amp).

, (ablation) , , Kent .

.. ...

87

() 3 >100 /.

. , (, ), - , .

: 1. QRS 2. QRS 3. 140-200 bpm. 4. , 5. QRS. 6. .

. shock (, , , , , , ).

VT , . .

(< 7 ) 4% > 65 . , , , .

.. ...

88

1. , / (.. , , ..).

2. 200 Joule.

3. , (200-360 J). (1-2 mg Tavor, iv) (2-4 mg, iv).

4. . 100 mg 5 ( amp. Pronestyl 100 mg/ml 10 ml, 1 ml 10 ml N/S 1 ). 5 1 gr Pronestyl 1 amp).

5. ( 2 amp. Angoron 150 mg, 250 ml N/S 7-10 ).

6. (60-100 mg Xylocaine, 3-5 ml Xylocaine 10 cc N/S 60-100 sec). 2 iv-bolus 5-10 . 3 mg/kg. (

).

(, ), . , ( ), 1 35% .

() (90%) (98%).

: . . . , (.. ) . , 95% .

.. ...

89

(Torsade de Pointes)

() QRS .

QT.

. (, , ), (, ) (, , , ), , , . , .

1. QT. QT , . .

2. QT.

3. , (4-8 lt) / (.: ).

4. 1-2 gr (MgSO4) 2-5 ( 1-2 gr MgSO4 50 ml N/S, bolus iv ).

5. 500 ml N/S 6 gr MgSO4 6 (: 1gr/h).

6. 1 (MgSO4), (1-2 amp. KCl 250 cc N/S D5W 1 ). + , 4 mEq/L, .

7. . 200 Joule.

.. ...

90

. QRS, R. 300-4000 , . .

. , , , - , .

, . , .

1. 200 J. 300 J 360 J.

2. 3 , ALS/ACLS. ( , . ).

3. . .

4. 1000 cc N/S. 5. 1 mg iv-bolus 20 ml

N/S, . 6. 360 J, 30-60 sec. 7. - 2-5 .

. 8. 3 300 mg (2 amp.

Angoron 150 ml 20 cc N/S D5W) iv-bolus .

.. ...

91

&&

- .

, ( ). , .

- .

, - , , .

, , .

, .

.

, placebo , VF.

, !

(MgSO4) torsades de pointes.

(NaHCO3) , . .

, , , , .

.. ...

92

.. ...

93

. . . , . , .

/ (85%) :

, , , , , .

, , , , . , .

:

, , , , / , ,

, (, ) .

, , .

. .

, , , .

.

.. ...

94

. . , , .

, , , , . . . , .

, , . [ > 25 / . > 120 / ]. , ,

, (85% ), .

1. 1 amp. Berovent (Aerolin + Atrovent) 1 amp. Pulmicort 2 5-8 lt/min.

2. .. SpO2 . , 10 .

3.

-1 amp. .

4. , 20 1 amp. Aerolin Berovent 1 amp. Pulmicort 2 () 5-8 lt/min. Ventouri.

5. 15-20 , 250-500 ml NaCl 0,9% , 1 amp. Solu-Cortef () 250 500 mg, .

6. , MgSO4 1-2 gr 250 ml N/S (iv), 20-30 , 30-60 .

7. ( PEFR, , ) .

:

.

, 5-7 : tabs. Medrol 16 mg, 1x2 .

, 2 , , , .

.

.. ...

95

, . 30 . 20 . >75% .

, , , , .

85% . 15% . .

:

.

( 1).

1/3 .

, , , , , . . .

SpO2 < 90%, , , . [ >25 / . >120 / ]. .

Sp2 PaO2

100 % 90 mm Hg

90 % 60 mm Hg

60 % 30 mm Hg

50 % 27 mm Hg

.

1. .

2. (, , , SpO2, , ) GCS.

3. 2 2-5 lit, Venturi 28%. SpO2 88-94%.

4. 1 amp Berovent (Aerolin/Atrovent) 1amp Pulmicort 2 3-6 lt, .

5. Venturi 24% 4 L 1-3 L. SpO2 = 90-94% / PO2 > 60 mmHg, PCO2 > 10mmHg p

.. ...

96

7. SABA (Aerolin) SAMA (Atrovent) ICS (Pulmicort) , 10-15 .

8. 500 ml NaCl 0,9% , 1 amp Solu-Cortef () 250 500 mg, .

9. , , Aminophylline (1 amp. 250 ml N/S) 30-40 . > 120 / / .

10. (UFH) 60-80 iu/kgr iv bolus ( 1 ml = 5000 i.u) LMWH [ (Clexane) 1 mg/kgr .. (sc)].

11. .

:

1. . 5 .

2. 2- (LABA SABA ) [SAMA () LAMA ()] 5-10 .

3. . , ( ), , . Inmunoferon , , NK , , .

4. () p.o. 7-14 , (tbs. Prezolon 5 mg, 2x4 x3d 2x3 x3d 1x4 x2d 1x3 x2d)

5. , 3 Anthonisen, , , 2 , . 7-10 . / () (, ).

6. / . : (, ) / .

.. ...

97

: , () . , , . ! , .. , , . , , , , .

. , (DVT), , , , ..

, , , , , , , , , , , ...

Wells. Well' s , .

&

DVT (, , ) +3

.. +3

.. DVT +1,5

> 100 bpm +1,5

( 30 ) +1,5

+1

6 +1

, Wells 7 , 2-6 0-1 .

. , , , , , , . , > 38,9 C ..

... 70% .. , . ST . (V1-V3) .. ( strain). , S , Q (. SI, QIII, TIII - McGinn-White).

.. ...

98

, , , d-dimers, .. .. , .. .. (10% ), (30-40%) (67-87%).

.

1. 2, 100% .

2. ., , , SpO2 .

3. 500-1000 ml NaCl 0,9% . ( shock ).

4. ( ) (UFH), 80 iu/kg iv-bolus ( 1 ml = 5000 i.u). , 3 12-20 . UFH bolus, . , , .

UFH , , 18 iu/kg 6 aPTT. 10000 iu UFH (iv) 1000 ml N/S ( D/W 5%).

5. (Clexane) 1 mg/kgr .. (sc) Fondaparinux (Arixtra) 7,5 mg (sc) ( 60 100 kg).

6. -1 amp iv 100 ml N/S

7. . < 90 mmHg 4 8 amp 50 mg (Giludop) 250 500 ml , .

8. ( monitoring .//SpO2), /.

. . , , , . , , .

.. ...

99

, , / . , .

; , , ( ), , !

; , . .

, , .

, , , .

, : tab. Clarityne 10 mg, 1x1 : tab. Xozal 5 mg, 1x1 . : tab. Rupafin 10 mg, 1x1 .

, , .

(Ronal) 1-2 8-12 . , (Otrivin) 8-12 . 3-4 , , , . .

(Nasonex) 2 8 . + :

Nasal spray Dexarhina, 2 6-8 , 4 .

, .. , .

5 . , : / . ( ). . IgE .

.. ...

100

()

() . 10 50 . .

. Kiesselbach 90% ( ), 10%.

. , , , , , , .. :

1. , . 2.

. 3. . 4. 5. ( , , ) 6. .

1. . 5-10 . . .

2. . 3.

. 4. , spray

(1:1000) . 5.

10% . (: , , ).

6. , Jellonet 24-36 . (Merocel, Rapid-Rhino, Nasapore).

7. (Augmentin, Ceclor) . 8. ,

Bellocq -.

Foley 10-14 fr, , () . . , .

( !) ( Brighton).

.. ...

101

H - , A - (GABHS). . . 24 72 . .

, , , , , .

, , , , , - (GABHS).

, , , , , >10% .

1. , .

2. Centor Strep test ( 85-91%, 90-96%). O ASTO .

3. Centor, : ) , ) ,

) , ) ,

:

- (GABHS) ,

GABHS.

Strept test.

4. , : V (Ospen), 1.500.000 i.u. / 8, , [ 20 ml oral susp x 3,

p.o], 1 , 10 , (Amoxil) 500 mg x 3 10 , p.o. (Klaricid) 250 mg x 2 10 , p.o. (Zithromax) 500 mg / 24 3 , p.o. 2 gr .

5. + (Augmentin) 625 mg 1x3 p.o. + (Begalin) 375 mg, 1x3 p.o. .

6. ( Strep-test) , , (Dalacin) 300 mg 1x4 p.o. 7-10 , Ultralevure 250 mg 2x3 .

7. : .. 500-650 mg x 4 , , 6 Octonion 10 ml x3.

.. ...

102

, , , , , .

. . 7 3- 4 .

Streptococcus pneumoniae, Haemophilus influenzae Moraxella catarrhalis.

.

, 10 , 6-10 , .

1. : :

Augmentin 1 gr 1x2 p.o., 7-10

Procef 500 mg 1x2 p.o., 10

Zinadol 500 mg 1x2 p.o., 10

Lorbef 500 mg 1x2 p.o., 10

Spectracef 400 mg 1x2 p.o., 10 .

2. , ( -), :

Klaricid 500 mg, 1x2 p.o., 10-14

Zithromax 250 mg, 2x1 p.o., 3

Vibramycin 100 mg, 1x2 p.o., 10 .

3. ( 3), :

Avelox 400 mg 1x1, (p.o), 10

Tavanic 500 mg 1x3 (p.o), 10

Rocephin 1 gr 1x1 (im), 5

Flagyl 500 mg 1x3 (p.o), - 10

Dalacin 300 mg 1x4 (p.o), - , 10 . Sccharomyces bulardii (p.o) (Ultralevure 250 mg x 2 p.o) 30-60 .

4. , .

5. .

6. . , , , 7 , .

.. ...

103

: - . H 3 Anthonisen, , , . E , ,

. ,

. . , , .

: Haemophilus influenzae, Haemophilus parainfluenzae, Streptococcus pneumoniae Moraxella catarhallis, (Chlamydia pneumoniae) .

. .

1. .. SpO2 . 2. 1 amp Berovent 1 amp Pulmicort 2 4-6 lt. 3.

3 , , . , , 1 , :

Klaricid 500 mg 1x2 (p.o.) 10 ,

Zithromax 250 mg 2x1 (p.o.) 3 .

4. : Augmentin 625 mg, 1x3 (p.o.) 7-10

Begalin 375 mg, 1x3 (p.o.) 7

Ceclor 1 gr, 1x3 (p.o.) 7-10

Zinadol 500 mg, 1x2 (p.o.) 7-10

Vibramycin 100 mg, 1x2 (p.o.) 7-10 .

5. .

6. 7-10 . Sachs. Trebon- 600 mg, 1x1 (p.o) Syr. Mucosolvan, 30 mg/5ml, 1x2 1x3.

.

.

.. ...

104

() . : Streptococcus pneumoniae, Haemophilus influenzae,

Moraxella catarrhalis.

(). ; .

. Pseudomonas aeruginosa. ( )

. .

. Staphylococcus aureus, Pseudomonas aeruginosa .

.

10 ( 6).

1. / (tabs. Augmentin 625 mg, 1x3, p.o. 10 ), [ : 30 mg/kg/8 p.o.], :

2. (tabs. Procef 500 mg, 1x2 p.o. 10 ) (tabs. Ceclor MR 750 mg, 1x2 p.o. 10 ) (caps. Cetrizin 500 mg, 1x2 p.o. 10 ), [ 10-20 mg/kg/12 p.o.]

3. (tabs. Klaricid 500 mg, 1x2, p.o. 10 ), (tabs. Zithromax 500 mg / 24h, p.o. 6 ). (>30%) .

4. 3-5 , . Nasal spray Dexarhina, 2 6-8 , 3-4 .

5. per os ( ) ' ( / Ceftoral 400 mg), in vitro.

6. 21 .

.. ...

105

, , . , .

6 . . 60-85% . , . , 30% .

. : > 60 , (, , , , , ).

< 60 :

Streptococcus pneumoniae (20-60%)

Haemophilus influenzae (3-10%)

Chlamydia pneumoniae (4-6%)

Legionella pneumophila (2-8%)

Mycoplasma pneumoniae (1-6%)

Staphylococcus aureus (3-5%)

(Moraxella, Gram (-) , (7-18%)

: , , , , , , , , (, , ).

: - (, ) ( ) (300-500 ml ) (

)

: ( ) / ( Legionella) ( Legionella) ... , . , , ( Legionella) ( Legionella).

.. ...

106

CURB-65. .

Confusion ( GCS < 8) Urea 40 mg/dl Respiratory rate 30/min Blood pressure ( < 90 mmHg < 60 mmHg) 65 .

0-1: 1,5%. .

2: 9,2%. .

3: 22%. .

4 . . .

1. (, , SpO2, , GCS). 2. , score CURB-65 2,

6-8 lt/min SpO2 > 90% 1000 cc NaCl 0,9% .

3. (1g /6) (.: ):

Tab. Amoxil 1 gr, 1x4 10 ,

Tab. Klaricid 500 mg, 1x2 10 . , - (.: ):

Tab. Augmentin 1 gr, 1x2 10 ,

Tab. Zithromax 250 mg, 2x1 3 .

4. , :

(Tavanic) tab. 500 mg, 1x2 10 ,

(Avelox/Octegra) tab. 400 mg, 1x1 10 . , , 10 .

5. (, -, , , , , ) .

6. ( , iv , , ...) < 60 , . .

(Zinadol) tab. 500 mg 1x2 10 ,

(Dalacin) tab. 300 mg 1x3 10 .

.. ...

107

, , .

. .

5 2 1 3 3 12 . ,

(80-90%),

(60-80%),

/ (40-60%),

(20-70%),

(20-25%),

,

,

, ,

, ,

.

( ), 40 C, . . (10-20%), (20-30%), (20-60%) (20-60%).

5% (, /, ). : ( ), , , , , , , . ... , , , , .

H , . H ( , ), (99mTc

67Ga citrate) MRI.

12 . ) , ) , . ) , , .

, - , - , , , .

Wright. Wright 7

-10

.

. B. melitensis 70-80% , B. abortus B. suis,

.. ...

108

(30-50%). Wright, 1/160 . 1/40-1/80 . 1/160 , (, , ), .

, , , .

, :

1. 1 :

: tbs. Vibramycin 100 mg, 1x2 (p.o), 6 ,

: amp. inj. Streptomycin 1 gr, 1x1 (im) 3 .

:


: amp. inj. Garamycin 80 mg, 1x3 (im), 2-3 .

8 ( ).

( 3 ).

2. 2 :


: tbs. Rifadin 900 mg, 1x1 (p.o), 6 .

:

3 . .

, , .

: tbs. Vibramycin 100 mg, 1x2 (p.o), 3-4 , : tbs. Rifadin 900 mg, 1x1 (p.o), 3-4 .

( ) 2-3 . : amp. inj. Streptomycin 1 gr, 1x1 (im) 3 : amp. inj. Garamycin 80 mg, 1x3 (im), 2-3 .

: (Tabrin) 400 mg /12 p.o, (Cirpoxin) 750 mg 1g /12 p.o.

Jarisch-Herxheimer, . ():

tab. Prezolon 5 mg, 4x3 (p.o), 7-10 ( ).

.. ...

109

(AEE) , , 24 , .

; , (Transient Ischaemic Attack); . ( ). : / , / , / , . : , , , .

( - Transient Ischaemic Attack) , < 60 ,

. 60% .

(80%), . , , , , , , . , , status epilepticus.

(20%) 40-60 . , , , . ( ).

..; ;

. . ; . , .

(/, , Babinski, , ). (G.C.S.).

Cincinnati. (3) . 1. (

). 2. (

). 3. (

, ).

.. ...

110

1. A, B, C, D, . . . .

2. 2 4-8 l/min SpO2 > 90%.

3. 3way 500-1000 ml N/S R/L, .

D/W 5% ( ). / 220/110 mmHg, 3way 250 ml D5W 1 amp. Nitrolingual 25 mg, 170-180 mmHg.

4. 24, (, , ) . 90 mmHg, . , ( b-blocker) : 1-3 amp Catapresan, 250 cc N/S 20-60 , . 10-20 mg (2-4 amp) Trandate 100 cc N/S 2-5 .

5. 3-4 amp. Nootrop 1 amp Nootrop iv bolus. , 1 fl Nootrop (iv) 20 ( ).

6. , 1 amp Dexamethasone 8 mg (Decadron) iv im ( ).

7. 2 amp (Zantac - iv bolus) .

8. 1 amp (Primperan iv bolus) ( ) .

9. Levin .

10. Foley ( ) .

11. 1 amp (Stedon) 10 mg iv 100 cc N/S 1 amp Aloperidin 1 amp Zuledin (im).

12. 1 amp (Stedon) 10 mg iv 100 cc N/S. 3 amp Epanutin 500 ml NaCl 0,9%, 10-20 mg/min (. 40-60 ).

13. , .. 180/110 mmHg, , . 1 fl. Nomotop 10 mg /50 ml (iv), .

14. 30. (Stroke Units).

.. ...

111

(?) , , .

(?)

:

(, , ).

.

(.. Meniere, , ). , . . . , . , .

. , . /, Romberg. ( . )

, . , .

Triplex CT / MRI . , .

.. ...

112

. :

1. 500 ml N/S 3 amp (Nootrop/Oxynium) , 60 , 1 amp Nootrop, bolus.

2. , 1 amp Vomex-A (im). 3. 1-2 amp Zantac 1 amp Primperan (iv im). 4. , .

. :

1. -1 amp Stedon 10 mg (im) 250 ml N/S (iv) 30 . 2. , 3 amp Nootrop

30-60 . 3. 15-20 oral-drops (Stugeron) p.o.

. :

, .

Caps. Vertigo-Vomex 1x2, 5-7 , Supp. Vomex-A 100 mg 1x2 1x4, 5 Tabs. Antivom 8 mg 1x2, 7-12

(, , ). Syr. Nootrop tabs. Nootrop 1200 mg 1x3 1x4. Stugeron tbs. 25 mg 1x3 caps. 75 mg 1x1, 5-7 .

, . 80% . , . Hamid 10 .

.. ...

113

.

() .

.

.

Status Epilepticus: , , , / 30 .

, , 20 , 10 5 . .

- - ( , , ).

. , ; ( , , , , , , ..). .

(.. , ). ;

: (, , ), , , (), , ( , ).

5-10 .

() ( 80%) 30 .

. , .

.. ...

114

1. , Status Epilepticus.

2. , . . .

3. 2 4-8 lt/min SpO2 > 90% SpO2 ( ).

4. Dextro-stick , . (, , , ).

5. 3way 500 ml D/W 5%.

6. 1-2 amp (Stedon 10 mg/amp) (iv) 100 ml NaCl 0,9%, . 1-2 amp. Tavor 4 mg/amp 100 ml N/S (iv) . . ( [Anexate/Flumil])

7. , 2-4 amp Epanutin 500 ml NaCl 0,9%, 20-30 mg/min (. 40-60 ), ( N/S, ).

8. Status Epilepticus, , 1-2 tab. Gardenal 100 mg 15-20 Lumidrops . ( ).

.. ...

115

. : , / , , , , -- , / . ! :

,

. . 30% , .

. . . .. -, , , , , .

: , , ..., , , , , , .

: : . . : , ,

. : , . : 4-24 . 48-72 . : . : , , ,

, , , .

: . 40 . . . . . , . . .

. (

).

.. ...

116

. :

1. 250 ml N/S 1 amp Egicalm. 2. ,

1-2 amp. (Zantac) PPI (Nexium, Zurcazol) . 3. , 1 amp Primperan. 4. 500 ml N/S 3 amp (Nootrop/Oxynium)

, 45-60 , 1 amp Nootrop, iv-bolus.

5. , 1 amp Vomex-A (-im).

6. A , 1 amp Apotel-plus im, 1 amp. Musco-Ril.

7. , 1 amp Xefo (im) (iv) 100 ml N/S.

. :

1. 1 amp Imigran 6 mg (sc). , 1 , 2 24 . 1 tb. Imigran 50 mg p.o. , 1 , 300 mg / 24h.

2. , DHE, . 1 amp Dihydergot ( iv), 1 amp. Primperan (iv) .

3. ( + ) supp. Cafergot 102 mg. , Cafergot 2-3 , 2 / 24.

4. , - 1 amp. Romidon (im).

. :

1. , tab. Maxalt 10 mg , .

2. , . 1 amp Imigran 6 mg, . ( , ..- .., , >65 , ).

3. - (tbs. Inderal 80 mg, 1x2 1x3). 4. (Topamac) tb. 25 mg 100 mg /. 5. S.S.R.I. (, ). 6. ,

. . , , , , ...

, ( ) .. . .

.. ...

117

. Bell. Bell . " ". , :

-/

(Ramsay-Hunt), Guillian Barre /

:

1. . 2. . 3. . 4. . 5. . 6. . 7. .

, , , , , . , C/T .

1-2 .

1. (), , : tabs. Prezolon 5 mg, 10 (2x4 x5d - 2x3 x2d - 1x4 x2d - 1x3 x1d).

(): tabs. Medrol 4 mg, 10 (2x4 x5d - 2x3 x2d - 1x4 x2d - 1x3 x1d).

2. , : tabs. Zovirax 400 mg 1x5, 7 tabs. Famvir 500 mg 1x3, 7 .

3. , . syr. Nootrop 1-2 .

4. , , : gel. Dacrio Gel 2 x 3 coll. Celluvisc 2 drops x3 coll. Vidilac 2 drops x3.

, .

5. , 8-12 .

6. . , . 15 , .

7. ... .

.. ...

118

, 50 , 3/2 .

60% 2 / 3 ( ). 30 , .

!!

, , , , , , , (tic doloureux) .. .

. , , . .

, MRI , , . (MRA) .

1. 1-2 amp (Rivotril) 1 mg, 250 ml NaCl 0,9% 30 - 45 .

:

2. , tabs. 200 mg (Tegretol) 3-4 , . (Trileptal 300 mg, 1x3 2x4) .

3. , (Neurontin) caps. 300 mg 1x3 1x5, .

4. tabs. Baclofen 10 mg, 1x4 2x4, 10-20 , .

5. . / . :

,

,

.

,

Gamma Knife.

.. ...

119

,

( )

(.. , , , , , , ..) . 10-15 .

( ) , , , . , , , !

. . . stress, .

. : , - ,

, /, .

: , () . , , . , .

1. , , A-B-C-D-E. .

2. . 3.

, . .

4. :

1-2 tab. Alprazolam (Xanax) 0,25 mg (per os),

1 tab. Bromazepam (Lexotanil) 1,5 mg 3 mg (p.o).

5. :

1 amp. Stedon 10 mg (im iv 100 ml N/S).

:

, :

tab. Lorazepam (Tavor) 1 mg, 1x3 10-15 ( ).

Tab. Buspirone (Bespar) 10 mg. 5 mg x3 , 45 mg .

.. ...

120

( 15 ), .

( ) , , , , ( ). , , , , ( ).

, , , , , .

. ( ). , ; .

, .

:

a. (F23.0)

b. (F23.1)

c. (F23.2)

d. , (F23.3)

e. (F23.8).

1. stress , . .

1 - 2 amp. Aloperidin

1 amp. Akineton (im), . 1 amp. Zuledin

2. , - 1 amp Stedon (im), . 3.

, .

1 amp. Zyprexa 10 mg (im). 2-3 .

4. . , .

.. ...

121

-

. , .

, . . . , , , , .

. , , , , , , . . ( Holiday Heart Syndrome).

, . , . .

1. , (), () (C), (D) ().

2. . - - (.. ). < 70 mg/dl 1000 cc D/W 5%, ( - ).

3. (100 mg - iv) 1-2 amp MVI, , Wernicke.

4. Foley, , [ !] , .

.. ...

122

5. , (Anexate) 2 ml = 0,2 mg bolus 15 sec 60 sec 1mg = 10 ml.

6. 1-2 amp Anexate 1000cc D/W 5% 10%, 0,3-0,4 mg/h, .

7. , 1-2 amp. Naloxone (iv). , , / , .

8. 1-2 amp (Zantac) 1 amp , .

9. , , 34 C. .

10. ( ) , 12 .

- : - , , , , , , . , . , , , .

ΘΕΡΑΠΕΥΤΙΚΗ - ΔΗΜΗΤΣΑΝΑ 1-5-15.pdf

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