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+{"segments": [{"id": 1, "seek": 2944, "start": 0.0, "end": 29.44, "text": "عشان نشوف هذه أنواع الـ Dystridmia نبدأ بحاجة اسمها الـ Normal Sinusrydeme Normal Sinusrydeme إن كل حاجة من اللي حكينا عنهم تكون في الـ Normal إيش هم الحاجات هدولة؟ أربع حاجات دايما دالكم تذاكرينهم إن يكون أول حاجة الـ Rate من 60 ل100 هي Normal بعدين يكون الـ QRF كل QRF", "tokens": [3615, 8592, 7649, 8717, 8592, 38688, 29538, 14739, 14407, 3615, 2423, 39184, 31193, 372, 8558, 29958, 8717, 44510, 10721, 4724, 5016, 26108, 3660, 24525, 2304, 11296, 2423, 39184, 21277, 11187, 301, 627, 67, 5729, 21277, 11187, 301, 627, 67, 5729, 36145, 28242, 11331, 26108, 3660, 9154, 13672, 1829, 11331, 4117, 1829, 8315, 18871, 16095, 6055, 30544, 8978, 2423, 39184, 21277, 11933, 1829, 8592, 8032, 2304, 21542, 26108, 9307, 8032, 3215, 12610, 3660, 22807, 5551, 25513, 3615, 11331, 26108, 9307, 11778, 47302, 15042, 11778, 6027, 24793, 6055, 15730, 37983, 9957, 16095, 36145, 7251, 30544, 5551, 12610, 11331, 26108, 3660, 2423, 39184, 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{"start": 386.8, "end": 387.84, "word": " arrhythmia", "probability": 0.8795572916666666}, {"start": 387.84, "end": 388.5, "word": " does", "probability": 0.92822265625}, {"start": 388.5, "end": 388.82, "word": " not", "probability": 0.96337890625}, {"start": 388.82, "end": 389.14, "word": " cause", "probability": 0.8876953125}, {"start": 389.14, "end": 389.42, "word": " any", "probability": 0.92431640625}, {"start": 389.42, "end": 389.96, "word": " significant", "probability": 0.84228515625}, {"start": 389.96, "end": 390.58, "word": " hemodynamic", "probability": 0.875732421875}, {"start": 390.58, "end": 391.2, "word": " effect", "probability": 0.87841796875}], "temperature": 1.0}, {"id": 18, "seek": 41772, "start": 391.7, "end": 417.72, "text": "هذا نوع من الـ «Sinus Arrhythmia» «Sinus Arrhythmia» هذه يعني إيريجولاريدمي فجأة ممكن يصير يعني عادة تكون مربوطة مع اللي هو الـInspiration لما بزيد الـRespiratory", "tokens": [3224, 15730, 8717, 45367, 9154, 2423, 39184, 4657, 50, 259, 301, 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" مع", "probability": 0.463134765625}, {"start": 423.83, "end": 424.25, "word": " الـ", "probability": 0.88720703125}, {"start": 424.25, "end": 425.27, "word": " Expiration", "probability": 0.7080078125}, {"start": 425.27, "end": 425.55, "word": " يعني", "probability": 0.85107421875}, {"start": 425.55, "end": 425.73, "word": " لما", "probability": 0.8544921875}, {"start": 425.73, "end": 426.15, "word": " بتعمل", "probability": 0.88720703125}, {"start": 426.15, "end": 426.31, "word": " انت", "probability": 0.781982421875}, {"start": 426.31, "end": 427.05, "word": " Expiration", "probability": 0.879638671875}, {"start": 427.05, "end": 429.33, "word": " بتختفي", "probability": 0.87841796875}, {"start": 429.33, "end": 429.77, "word": " هذه", "probability": 0.66650390625}, {"start": 429.77, "end": 430.33, "word": " الـ", "probability": 0.756591796875}, {"start": 430.33, "end": 430.83, "word": " Regular", "probability": 0.7900390625}, {"start": 430.83, "end": 431.75, "word": " Rhythm", 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"text": "تمام؟ ليش؟ لأنه ما بيصيرش فيه complete اللي هو بي wave ومعنى أنه ما بيصيرش فيه complete at real contraction", "tokens": [39237, 10943, 22807, 32239, 8592, 22807, 5296, 33456, 3224, 19446, 4724, 1829, 9381, 13546, 8592, 8978, 3224, 3566, 13672, 1829, 31439, 4724, 1829, 5772, 4032, 2304, 3615, 1863, 7578, 14739, 3224, 19446, 4724, 1829, 9381, 13546, 8592, 8978, 3224, 3566, 412, 957, 37372], "avg_logprob": -0.25071021575819363, "compression_ratio": 1.4495412844036697, "no_speech_prob": 0.0, "words": [{"start": 640.74, "end": 641.72, "word": "تمام؟", "probability": 0.681396484375}, {"start": 641.72, "end": 642.02, "word": " ليش؟", "probability": 0.8214518229166666}, {"start": 642.02, "end": 642.22, "word": " لأنه", "probability": 0.79248046875}, {"start": 642.22, "end": 642.28, "word": " ما", "probability": 0.79052734375}, {"start": 642.28, "end": 642.76, "word": " بيصيرش", "probability": 0.84736328125}, {"start": 642.76, "end": 643.06, "word": " فيه", "probability": 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649.44, "end": 649.74, "word": " real", "probability": 0.822265625}, {"start": 649.74, "end": 650.92, "word": " contraction", "probability": 0.9267578125}], "temperature": 1.0}, {"id": 29, "seek": 67548, "start": 653.26, "end": 675.48, "text": "تمام هذه بالنسبة للـ Premature Atrial Complex عادة هذه تعتبر حالة مرضية ولا تستدعي أي علاج في نوع اسمه او Distributor تاني اسمه الـ Atrial Flutter هذه على الـ ECG لو عملنا ECG بيكون شكلها واضح جدا أولا إن هي تكيينة", "tokens": [2655, 15042, 2304, 29538, 20666, 1863, 35457, 3660, 24976, 39184, 13011, 1503, 1711, 7111, 41184, 6225, 18513, 3660, 29538, 6055, 34268, 26890, 11331, 6027, 3660, 3714, 43042, 10632, 49429, 6055, 14851, 3215, 3615, 1829, 36632, 11203, 26108, 8978, 8717, 45367, 24525, 2304, 3224, 1975, 2407, 9840, 2024, 22163, 6055, 7649, 1829, 24525, 2304, 3224, 2423, 39184, 1711, 7111, 3235, 9947, 29538, 15844, 2423, 39184, 19081, 38, 45164, 6225, 42213, 8315, 19081, 38, 4724, 1829, 30544, 13412, 28820, 11296, 4032, 46958, 5016, 10874, 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692.67, "end": 713.59, "text": "هذا النقم الـ Atrial Dystrophy بيكون يعني ال ratio تبع ال B للـQRS يعني كل QRS واحدة المفروض بيكون قبلها B ولأ ممكن يكون قبلها تنتين أو تلاتة أو أربعة لواحد، لاحظ كيف؟ يعني تنتين", "tokens": [3224, 15730, 28239, 4587, 2304, 2423, 39184, 1711, 7111, 31193, 372, 40826, 4724, 1829, 30544, 37495, 22653, 2423, 8509, 6055, 3555, 3615, 2423, 363, 24976, 39184, 48, 43580, 37495, 22653, 28242, 1249, 43580, 36764, 24401, 3660, 9673, 5172, 32887, 11242, 4724, 1829, 30544, 12174, 36150, 11296, 363, 4032, 1211, 10721, 3714, 43020, 7251, 30544, 12174, 36150, 11296, 6055, 29399, 9957, 34051, 6055, 1211, 9307, 3660, 34051, 5551, 25513, 27884, 5296, 14407, 24401, 12399, 20193, 5016, 19913, 9122, 33911, 22807, 37495, 22653, 6055, 29399, 9957], "avg_logprob": -0.26930145936853744, "compression_ratio": 1.5891891891891892, "no_speech_prob": 3.5762786865234375e-07, "words": [{"start": 692.67, "end": 693.43, "word": "هذا", "probability": 0.81494140625}, {"start": 693.43, 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"word": " يعني", "probability": 0.86181640625}, {"start": 702.95, "end": 703.25, "word": " كل", "probability": 0.978515625}, {"start": 703.25, "end": 703.97, "word": " QRS", "probability": 0.743408203125}, {"start": 703.97, "end": 704.61, "word": " واحدة", "probability": 0.9591471354166666}, {"start": 704.61, "end": 705.25, "word": " المفروض", "probability": 0.9844970703125}, {"start": 705.25, "end": 705.55, "word": " بيكون", "probability": 0.7545572916666666}, {"start": 705.55, "end": 705.97, "word": " قبلها", "probability": 0.8831380208333334}, {"start": 705.97, "end": 706.09, "word": " B", "probability": 0.7880859375}, {"start": 706.09, "end": 706.71, "word": " ولأ", "probability": 0.575927734375}, {"start": 706.71, "end": 706.97, "word": " ممكن", "probability": 0.895263671875}, {"start": 706.97, "end": 707.21, "word": " يكون", "probability": 0.742919921875}, {"start": 707.21, "end": 707.79, "word": " قبلها", "probability": 0.9736328125}, {"start": 707.79, "end": 708.51, "word": " 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أو خمس دقائق في الأغلب هدول الناس مابيستجبوش للأتروبين ويكونوا بدهم Base Maker", "tokens": [36081, 3615, 10943, 1211, 20449, 9673, 16572, 11242, 4032, 2304, 43020, 7251, 33753, 26108, 11778, 9778, 12610, 5296, 33456, 9673, 16572, 11242, 7251, 33753, 26108, 21054, 35096, 11933, 15730, 9673, 16572, 11242, 43242, 3224, 28877, 662, 4785, 4032, 30241, 10943, 9307, 2423, 39184, 13569, 39094, 540, 30767, 1829, 19446, 11331, 4117, 1829, 8315, 4724, 30544, 5296, 31377, 2304, 5551, 25957, 1211, 20449, 40294, 16247, 2655, 2288, 2407, 21292, 1863, 2423, 39184, 9279, 4032, 5551, 3215, 11703, 26895, 3224, 5551, 2655, 2288, 2407, 21292, 1863, 13672, 1829, 31439, 8717, 9381, 3714, 20292, 7435, 2288, 10943, 28242, 38637, 1211, 5718, 104, 3660, 34051, 16490, 2304, 3794, 11778, 4587, 16373, 4587, 8978, 16247, 17082, 46152, 8032, 3215, 12610, 2423, 8315, 3794, 3714, 16758, 1829, 14851, 7435, 3555, 2407, 8592, 24976, 10721, 2655, 2288, 2407, 21292, 1863, 4032, 1829, 30544, 14407, 47525, 16095, 21054, 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{"start": 1743.71, "end": 1744.15, "word": " Maker", "probability": 0.400634765625}, {"start": 1744.15, "end": 1746.03, "word": " إذا", "probability": 0.86865234375}, {"start": 1746.03, "end": 1746.47, "word": " المريض", "probability": 0.9524739583333334}, {"start": 1746.47, "end": 1746.81, "word": " عنده", "probability": 0.955810546875}, {"start": 1746.81, "end": 1747.31, "word": " Symptoms", "probability": 0.716552734375}, {"start": 1747.31, "end": 1749.25, "word": " وعلامات", "probability": 0.8638916015625}, {"start": 1749.25, "end": 1749.59, "word": " الـ", "probability": 0.5859375}, {"start": 1749.59, "end": 1749.77, "word": " Heart", "probability": 0.55908203125}, {"start": 1749.77, "end": 1750.17, "word": " Failure", "probability": 0.9306640625}, {"start": 1750.17, "end": 1750.29, "word": " زي", "probability": 0.760986328125}, {"start": 1750.29, "end": 1750.37, "word": " ما", "probability": 0.953125}, {"start": 1750.37, "end": 1750.91, "word": " حكينا", "probability": 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"probability": 0.9658203125}, {"start": 1756.35, "end": 1756.57, "word": " نص", "probability": 0.982177734375}, {"start": 1756.57, "end": 1757.15, "word": " مليجرام", "probability": 0.679443359375}, {"start": 1757.15, "end": 1757.31, "word": " كل", "probability": 0.91748046875}, {"start": 1757.31, "end": 1757.67, "word": " ثلاثة", "probability": 0.69765625}, {"start": 1757.67, "end": 1757.71, "word": " أو", "probability": 0.25390625}, {"start": 1757.71, "end": 1757.93, "word": " خمس", "probability": 0.9954427083333334}, {"start": 1757.93, "end": 1758.59, "word": " دقائق", "probability": 0.9765625}, {"start": 1758.59, "end": 1759.17, "word": " في", "probability": 0.5107421875}, {"start": 1759.17, "end": 1760.33, "word": " الأغلب", "probability": 0.99169921875}, {"start": 1760.33, "end": 1760.93, "word": " هدول", "probability": 0.8385416666666666}, {"start": 1760.93, "end": 1761.29, "word": " الناس", "probability": 0.9908854166666666}, {"start": 1761.29, "end": 1762.41, "word": " مابيستجبوش", "probability": 0.88116455078125}, {"start": 1762.41, "end": 1763.13, "word": " للأتروبين", "probability": 0.9049944196428571}, {"start": 1763.13, "end": 1763.59, "word": " ويكونوا", "probability": 0.69879150390625}, {"start": 1763.59, "end": 1763.99, "word": " بدهم", "probability": 0.675048828125}, {"start": 1763.99, "end": 1764.57, "word": " Base", "probability": 0.94140625}, {"start": 1764.57, "end": 1764.75, "word": " Maker", "probability": 0.734375}], "temperature": 1.0}, {"id": 78, "seek": 178942, "start": 1765.76, "end": 1789.42, "text": "تمام؟ بتركبله عادة الـ Temporary Pacemaker عابلنا أنه يتركبله Burnout Pacemaker عشان يظلوا عايش فيها هي كأحنا خلصنا الـ Dystrophy دمية بنخلي اللي هو الجزء الأخير من المحاضرة تبع الـCoronal Vascular Disorder للمرة القادمة إن شاء الله يعطيكم اللحظة", "tokens": [39237, 10943, 22807, 39894, 31747, 3555, 43761, 6225, 18513, 3660, 2423, 39184, 8095, 2816, 822, 10702, 49523, 6225, 16758, 1211, 8315, 14739, 3224, 7251, 2655, 31747, 3555, 43761, 18328, 346, 10702, 49523, 6225, 8592, 7649, 7251, 19913, 1211, 14407, 6225, 47302, 8592, 8978, 11296, 39896, 9122, 10721, 5016, 8315, 16490, 1211, 9381, 8315, 2423, 39184, 31193, 372, 40826, 11778, 2304, 10632, 44945, 9778, 20292, 13672, 1829, 31439, 25724, 11622, 38207, 16247, 9778, 13546, 9154, 9673, 5016, 46958, 25720, 6055, 3555, 3615, 2423, 39184, 29020, 21523, 691, 22084, 4208, 4687, 5296, 19528, 25720, 25062, 18513, 46007, 36145, 13412, 16606, 21984, 37495, 9566, 1829, 24793, 13672, 5016, 19913, 3660], "avg_logprob": -0.34490741816935716, "compression_ratio": 1.533596837944664, "no_speech_prob": 1.817941665649414e-05, "words": [{"start": 1765.76, "end": 1766.46, "word": "تمام؟", "probability": 0.5849405924479166}, {"start": 1766.46, "end": 1767.08, "word": " بتركبله", "probability": 0.6920166015625}, {"start": 1767.08, "end": 1767.42, "word": " عادة", "probability": 0.6600748697916666}, {"start": 1767.42, "end": 1767.6, "word": " الـ", "probability": 0.60791015625}, {"start": 1767.6, "end": 1768.06, "word": " Temporary", "probability": 0.8310546875}, {"start": 1768.06, "end": 1768.56, "word": " Pacemaker", "probability": 0.607666015625}, {"start": 1768.56, "end": 1769.08, "word": " عابلنا", "probability": 0.678070068359375}, {"start": 1769.08, "end": 1769.88, "word": " أنه", "probability": 0.729736328125}, {"start": 1769.88, "end": 1771.06, "word": " يتركبله", "probability": 0.8984375}, {"start": 1771.06, "end": 1771.7, "word": " Burnout", "probability": 0.4371337890625}, {"start": 1771.7, "end": 1772.74, "word": " Pacemaker", "probability": 0.93994140625}, {"start": 1772.74, "end": 1773.18, "word": " عشان", "probability": 0.96630859375}, {"start": 1773.18, "end": 1773.62, "word": " يظلوا", "probability": 0.947265625}, {"start": 1773.62, "end": 1774.1, "word": " عايش", "probability": 0.9798177083333334}, {"start": 1774.1, "end": 1775.12, "word": " فيها", "probability": 0.967041015625}, {"start": 1775.12, "end": 1775.7, "word": " هي", "probability": 0.275146484375}, {"start": 1775.7, "end": 1776.1, "word": " كأحنا", "probability": 0.7552490234375}, {"start": 1776.1, "end": 1776.66, "word": " خلصنا", "probability": 0.947998046875}, {"start": 1776.66, "end": 1776.82, "word": " الـ", "probability": 0.68896484375}, {"start": 1776.82, "end": 1777.12, "word": " Dystrophy", "probability": 0.4800211588541667}, {"start": 1777.12, "end": 1777.52, "word": " دمية", "probability": 0.575439453125}, {"start": 1777.52, "end": 1778.94, "word": " بنخلي", "probability": 0.6361490885416666}, {"start": 1778.94, "end": 1779.28, "word": " اللي", "probability": 0.963623046875}, {"start": 1779.28, "end": 1779.62, "word": " هو", "probability": 0.99169921875}, {"start": 1779.62, "end": 1780.72, "word": " الجزء", "probability": 0.9342447916666666}, {"start": 1780.72, "end": 1781.26, "word": " الأخير", "probability": 0.93603515625}, {"start": 1781.26, "end": 1781.42, "word": " من", "probability": 0.9453125}, {"start": 1781.42, "end": 1781.94, "word": " المحاضرة", "probability": 0.8248291015625}, {"start": 1781.94, "end": 1782.3, "word": " تبع", "probability": 0.8271484375}, {"start": 1782.3, "end": 1783.14, "word": " الـCoronal", "probability": 0.60968017578125}, {"start": 1783.14, "end": 1783.5, "word": " Vascular", "probability": 0.6441650390625}, {"start": 1783.5, "end": 1784.22, "word": " Disorder", "probability": 0.9775390625}, {"start": 1784.22, "end": 1785.94, "word": " للمرة", "probability": 0.85107421875}, {"start": 1785.94, "end": 1786.46, "word": " القادمة", "probability": 0.92431640625}, {"start": 1786.46, "end": 1786.66, "word": " إن", "probability": 0.345458984375}, {"start": 1786.66, "end": 1786.84, "word": " شاء", "probability": 0.97412109375}, {"start": 1786.84, "end": 1787.48, "word": " الله", "probability": 0.958984375}, {"start": 1787.48, "end": 1788.92, "word": " يعطيكم", "probability": 0.783477783203125}, {"start": 1788.92, "end": 1789.42, "word": " اللحظة", "probability": 0.716094970703125}], "temperature": 1.0}], "language": "ar", "language_probability": 1.0, "duration": 1795.947375, "duration_after_vad": 1736.8615937499962}
\ No newline at end of file
diff --git a/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/4fKd0WYSrxs_raw.srt b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/4fKd0WYSrxs_raw.srt
new file mode 100644
index 0000000000000000000000000000000000000000..b727faae5cf0d42a5565ca803dcadcba20e594a4
--- /dev/null
+++ b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/4fKd0WYSrxs_raw.srt
@@ -0,0 +1,1560 @@
+1
+00:00:00,000 --> 00:00:05,260
+عشان نشوف هذه أنواع الـ Dystridmia نبدأ بحاجة
+
+2
+00:00:05,260 --> 00:00:08,720
+اسمها الـ Normal Sinusrydeme Normal Sinusrydeme إن
+
+3
+00:00:08,720 --> 00:00:13,560
+كل حاجة من اللي حكينا عنهم تكون في الـ Normal إيش
+
+4
+00:00:13,560 --> 00:00:18,260
+هم الحاجات هدولة؟ أربع حاجات دايما دالكم تذاكرينهم
+
+5
+00:00:18,260 --> 00:00:24,400
+إن يكون أول حاجة الـ Rate من 60 ل100 هي Normal
+
+6
+00:00:24,400 --> 00:00:33,880
+بعدين يكون الـ QRF كل QRFالـ QRS قبلها يوجد بي ويل
+
+7
+00:00:33,880 --> 00:00:40,540
+يعني بي ويل لل QRS ratio واحد لواحد يعني كل بي
+
+8
+00:00:40,540 --> 00:00:46,340
+وراها QRSتمام؟ يعني فش بي من غير QRS فش QRS ما
+
+9
+00:00:46,340 --> 00:00:52,180
+قبلوش فيه إيه الـ B-Wave فالـ Ratio تبع الـ B للـ
+
+10
+00:00:52,180 --> 00:00:57,660
+QRS هو 1 لـ 1 الـ PR Interval فيه الوضع الطبيعي من
+
+11
+00:00:57,660 --> 00:01:06,140
+12 لـ 3 مربعات لـ 5 هو الـ Shape تبع الـ QRS أو
+
+12
+00:01:06,140 --> 00:01:10,020
+حتى قبل نركز على الأربع حاجات حكينا إن الـ Rate من
+
+13
+00:01:10,020 --> 00:01:16,200
+60 لـ 100الـRR Interval متساوية يعني Regular الـP
+
+14
+00:01:16,200 --> 00:01:21,420
+كل P مطبوعة بـQRS يعني الـRatio واحد لواحد بعدين
+
+15
+00:01:21,420 --> 00:01:27,980
+يحكي إنه هذه التلت حاجات اللي حكيتها مع إنه الـP
+
+16
+00:01:29,150 --> 00:01:34,050
+الـ QRS الـ Shape and Direction تبعته Normal هذا
+
+17
+00:01:34,050 --> 00:01:37,770
+معناه إن أنا في عندي Normal Sinus Rhythm لو كمان
+
+18
+00:01:37,770 --> 00:01:42,570
+أتأكدت ولاقيت إن الـ P wave شكلها طبعا طبيعي والـ
+
+19
+00:01:42,570 --> 00:01:45,370
+PR interval برضه في الـ
+
+20
+00:01:47,370 --> 00:01:51,530
+الحجم الطبيعي تبعها من تلت لخمس مربعات إذا اجتمعت
+
+21
+00:01:51,530 --> 00:01:56,710
+كل هذه المكونات في ECG مقنعة إن هذا الـ ECG اسمه
+
+22
+00:01:56,710 --> 00:02:00,090
+Normal Finest Ribbon كمان مرة إيش هما الحاجات إن
+
+23
+00:02:00,090 --> 00:02:02,870
+يكون الـ hard trait ما بين الستين والمية يعني من
+
+24
+00:02:02,870 --> 00:02:07,130
+تلت لخمس مربعات إن يكون الـRR Interval متساوية
+
+25
+00:02:07,130 --> 00:02:11,050
+يعني Regular إن يكون الـShape تبع الـQR
+
+26
+00:02:13,870 --> 00:02:17,810
+الـ PR Interval في الحدود الطبيعية اللي حكينا عنهم
+
+27
+00:02:17,810 --> 00:02:23,910
+أربعة إنه يكون كل P في ورا QRS يعني ال ratio تبقى
+
+28
+00:02:23,910 --> 00:02:28,830
+الـPQRS واحد لواحد إذا لو اختلف أي واحد من هدولة
+
+29
+00:02:28,830 --> 00:02:33,530
+هيبدأ يصير في اندي مشاكل هتشوف جزء من المشاكل هذه
+
+30
+00:02:33,530 --> 00:02:39,760
+أو أنواعها لو كان في اندي مثلا«Sinus Bradycardia»
+
+31
+00:02:39,760 --> 00:02:44,180
+ما هي «Sinus»؟ «Sinus» يعني عام و «Bradycardia»
+
+32
+00:02:44,180 --> 00:02:47,480
+يعني الـ «Heart Rate» هو اللي نازل آه، إذا في
+
+33
+00:02:47,480 --> 00:02:50,900
+«Sinus Bradycardia» كل المواصفات اللي حكيت عليها
+
+34
+00:02:50,900 --> 00:02:55,360
+من شوية موجودة ما هذا الـ «Rate» أقل من 60 يعني
+
+35
+00:02:55,360 --> 00:03:00,520
+الـ «Rate» أقل من 60 الـ «RR Interval» متساوية الـ
+
+36
+00:03:00,520 --> 00:03:05,200
+«QRS» كل واحدة فيهم قبلها فيه «P Wave» والـ
+
+37
+00:03:05,200 --> 00:03:09,630
+«Ratio» واحد لواحدالـ VR Interval طبيعية ريجولار
+
+38
+00:03:09,630 --> 00:03:15,950
+عندهم كلهم والـ QRS Shape وتباعتها وDuration
+
+39
+00:03:15,950 --> 00:03:21,750
+تباعتها طبيعية إذن الإختلاف الوحيد إنه بس لاحظي بس
+
+40
+00:03:21,750 --> 00:03:26,870
+إن الـ Heart Rate أقل من 60 ريشي واحد لواحد الـ
+
+41
+00:03:26,870 --> 00:03:30,930
+QRS طبيعية و الـ VR Interval طبيعي هذا اسمه Sinus
+
+42
+00:03:30,930 --> 00:03:36,380
+Bodycardia طب لو Sinus Tachycardiaعادةً هذي يا
+
+43
+00:03:36,380 --> 00:03:39,000
+جماعة الـ sinus bradycardia بتصير مع الناس اللي
+
+44
+00:03:39,000 --> 00:03:44,740
+مثلا ماخدين organophosphorus poisoning أوبيويد
+
+45
+00:03:44,740 --> 00:03:48,300
+poisoning هذه الحاجات هي ممكن تتعمل انتم
+
+46
+00:03:48,300 --> 00:03:50,600
+bradycardia فيه كمان حاجة اسمها
+
+47
+00:03:53,350 --> 00:03:56,050
+الناس اللي بياخدوا الـ beta blockers زي النورماتين
+
+48
+00:03:56,050 --> 00:03:59,710
+والحاجات هذه ممكن تبطل الـ heart rate عندهم الإلاج
+
+49
+00:03:59,710 --> 00:04:04,550
+لو إجالك مريض وعنده symptom يعني كان unstable يعني
+
+50
+00:04:04,550 --> 00:04:09,130
+symptomatic bradycardia أنه نديله نص أمبول اللي هو
+
+51
+00:04:09,130 --> 00:04:15,520
+النخ 0.1أو 0.5 ميلي جرام أتروبيل وإنعيدهم كل 3 إلى
+
+52
+00:04:15,520 --> 00:04:20,560
+5 دقيقة عشان نرفع الـHeart Rate لو المريض لما
+
+53
+00:04:20,560 --> 00:04:23,900
+بديله الأتروبيل بيستجيب ويطلع الـHeart Rate فهذا
+
+54
+00:04:23,900 --> 00:04:28,000
+بيسميه أتروبيل Test معناه إن هو فعلاً لدّه Anti
+
+55
+00:04:28,000 --> 00:04:31,920
+-cholinergic agent ممكن نحطه بعدها على دوبامين لو
+
+56
+00:04:31,920 --> 00:04:39,130
+وندور على السبب ليش هو عندهلو ما استجبش وظلت الـ
+
+57
+00:04:39,130 --> 00:04:42,390
+bradycardia كما هي بيكون هذا المريض في الأقلب عنده
+
+58
+00:04:42,390 --> 00:04:46,610
+heart block عشان هيك مابيستجبش لل anticholinergic
+
+59
+00:04:46,610 --> 00:04:51,930
+agents هذا بالنسبة لـالـ Sinus Bradycardia لو
+
+60
+00:04:51,930 --> 00:04:54,350
+بنشوف بالنسبة لـ Sinus Tachycardia
+
+61
+00:05:20,010 --> 00:05:24,970
+ممكن تصير نتيجة fever، نتيجة stress، نتيجة انفعال،
+
+62
+00:05:24,970 --> 00:05:28,790
+كل هذه الحاجات ممكن تتمنى sinus tachycardia، مش هي
+
+63
+00:05:28,790 --> 00:05:32,470
+اللي بتخوفني، بخاف لما يصير في عندي، زي ما انتوا
+
+64
+00:05:32,470 --> 00:05:35,390
+شايفين دايما في sinus tachycardia عادة ال complex
+
+65
+00:05:35,390 --> 00:05:38,910
+تمامها بيكون نار يعني، حتى بيكون دوب مربق أو حاجة،
+
+66
+00:05:38,910 --> 00:05:39,470
+تمام؟
+
+67
+00:05:45,220 --> 00:05:49,700
+اللي ممكن تخاف من التكيكارديا لو كانت مش sinus و
+
+68
+00:05:49,700 --> 00:05:54,500
+لو كانت regular بس الهرزوية تبعها أكتر من مية ممكن
+
+69
+00:05:54,500 --> 00:05:59,320
+تصير اسمها SVT بهي Supraventricular Tachycardia
+
+70
+00:05:59,320 --> 00:06:03,280
+هنا
+
+71
+00:06:03,280 --> 00:06:08,600
+بيحكينا عن الـ Sinus Arrhythmiaعندما يكون فيه
+
+72
+00:06:08,600 --> 00:06:15,120
+إرريجولار اللي هو إيش رhythm usually increase with
+
+73
+00:06:15,120 --> 00:06:18,560
+inspiration and decrease with expiration no
+
+74
+00:06:18,560 --> 00:06:22,040
+respiratory causes include heart disease and
+
+75
+00:06:22,040 --> 00:06:26,260
+valvular disease but that these are rarely seen
+
+76
+00:06:26,260 --> 00:06:29,960
+sinus arrhythmia does not cause any significant
+
+77
+00:06:29,960 --> 00:06:34,760
+hemodynamic effectهذا نوع من الـ «Sinus
+
+78
+00:06:34,760 --> 00:06:39,580
+Arrhythmia» «Sinus Arrhythmia» هذه يعني
+
+79
+00:06:39,580 --> 00:06:44,300
+إيريجولاريدمي
+
+80
+00:06:44,300 --> 00:06:50,220
+فجأة ممكن يصير يعني عادة تكون مربوطة مع اللي هو
+
+81
+00:06:50,220 --> 00:06:57,720
+الـInspiration لما بزيد الـRespiratory
+
+82
+00:06:59,210 --> 00:07:04,250
+ما ممكن تزيد ولما الـ Decrease متقل مع الـ
+
+83
+00:07:04,250 --> 00:07:09,330
+Expiration يعني لما بتعمل انت Expiration بتختفي
+
+84
+00:07:09,330 --> 00:07:18,470
+هذه الـ Regular Rhythm لا تُعتبر حالة مرضية بدنا
+
+85
+00:07:18,470 --> 00:07:23,830
+نحكي عنوهذا لسه بحكي عن الـ Sinus Arrhythmia كمان
+
+86
+00:07:23,830 --> 00:07:26,850
+مرة بنأكد عن الـ Sinus Arrhythmia دي ممكن تصير
+
+87
+00:07:26,850 --> 00:07:33,350
+نادرة جداً مع الناس في الـ inspiration، أه؟ وهذا
+
+88
+00:07:33,350 --> 00:07:37,010
+اتلاحظ أن هذه Arrhythmia مش Dysarrhythmia وكلمة
+
+89
+00:07:37,010 --> 00:07:41,130
+Arrhythmia يعني بتختلف عن Dysarrhythmia إن هي
+
+90
+00:07:41,130 --> 00:07:46,350
+تعتبر كإنها normal لإنها
+
+91
+00:07:46,350 --> 00:07:53,730
+بتيجي لحالها، بتروح لحالهاومابدهاش أي تدخل، تمام؟
+
+92
+00:07:53,730 --> 00:07:57,230
+الـ hard thread تبعها طبيعي، لكن الـ rhythm بيصير
+
+93
+00:07:57,230 --> 00:08:03,790
+في irregularity، بيطلع، بيصير هنا مربع الـRR وهنا
+
+94
+00:08:03,790 --> 00:08:08,110
+ضيقة، وهنا واسعة، في irregularity، لكن الـPR واحد
+
+95
+00:08:08,110 --> 00:08:11,880
+لواحدوالأرواح الطبيعية وهذا بس اللهم إنه في
+
+96
+00:08:11,880 --> 00:08:15,480
+irregularity نسمي هذه Arrhythmia لكن هذه مش
+
+97
+00:08:15,480 --> 00:08:20,380
+Dystereodymia يعني مش خلال بده علاج بس
+
+98
+00:08:20,380 --> 00:08:24,580
+irregularity فقط مع النفس بتصير مع ال inspiration
+
+99
+00:08:24,580 --> 00:08:28,340
+مع ال exploration بتتحسن وبعد شوية بتلاقي المريض
+
+100
+00:08:28,340 --> 00:08:32,440
+رجع ل regularity تبعته لحاله أو الشخص بلاش نحكي
+
+101
+00:08:32,440 --> 00:08:37,950
+المريض لإن حتة بتصير مع الناس العاديةممكن تصير عند
+
+102
+00:08:37,950 --> 00:08:46,050
+الأطفال أكتر طيب،
+
+103
+00:08:46,050 --> 00:08:50,750
+اللي شفناه ما دولها كان اسمهم اللي هو أنواع الـ
+
+104
+00:08:50,750 --> 00:08:54,590
+«Arrhythmia» أنواع الـ «Dysrhythmia» اللي إلها
+
+105
+00:08:54,590 --> 00:08:59,970
+علاقة بالـ «Rate» انت شوف لذلك «Sinus Bradycardia»
+
+106
+00:08:59,970 --> 00:09:04,770
+«Sinus Tachycardia» تمام؟ عشان هي كان بيسموها زي
+
+107
+00:09:04,770 --> 00:09:11,830
+ما شفتهاللي بيسموها sinus dysrhythmia بيسموها يعني
+
+108
+00:09:11,830 --> 00:09:17,170
+sinus dysrhythmia تمام؟ لإن هي علاقة بالـsinus؟
+
+109
+00:09:17,170 --> 00:09:20,070
+لا، في أن نوع تاني من الـdysrhythmia الـatrial
+
+110
+00:09:20,070 --> 00:09:23,390
+dysrhythmiaوفي نقطة تانية اسمه Ventricular
+
+111
+00:09:23,390 --> 00:09:26,610
+Dysteremia وفي نقطة رابعة اسمه Junctional يعني
+
+112
+00:09:26,610 --> 00:09:30,110
+التوصيل هو اللي فيه مشكلة زي ال heart block خلينا
+
+113
+00:09:30,110 --> 00:09:33,990
+نشوف النقطة التانية اللي هو Atrial Dysteremia
+
+114
+00:09:33,990 --> 00:09:41,310
+مشكلة في ال atrium فوق في حاجة اسمها ال BAC اللي
+
+115
+00:09:41,310 --> 00:09:46,240
+هو Premature Atrial Complex«Premature Atrial
+
+116
+00:09:46,240 --> 00:09:58,160
+Complexes» «Premature
+
+117
+00:09:58,160 --> 00:09:58,340
+Atrial Complexes» «Premature Atrial Complexes»
+
+118
+00:09:58,340 --> 00:10:05,020
+«Premature Atrial Complexes» «Premature
+
+119
+00:10:05,020 --> 00:10:06,460
+Atrial Complexes» «Premature Atrial Complexes»
+
+120
+00:10:06,460 --> 00:10:06,940
+«Premature Atrial Complexes» «Premature Atrial
+
+121
+00:10:06,940 --> 00:10:06,940
+Complexes» «Premature Atrial Complexes» «Premature
+
+122
+00:10:06,940 --> 00:10:06,940
+Atrial Complexes» «Premature Atrial Complexes»
+
+123
+00:10:06,940 --> 00:10:06,940
+«Premature Atrial Complexes» «Premature Atrial
+
+124
+00:10:06,940 --> 00:10:07,120
+Complexes» «Premature Atrial Complexes» «Premature
+
+125
+00:10:07,120 --> 00:10:07,580
+Atrial Complexes» «Premature Atrial Complexes»
+
+126
+00:10:07,580 --> 00:10:07,580
+«Premature Atrial Complexes» «Premature Atrial
+
+127
+00:10:07,580 --> 00:10:07,580
+Complexes» «Premature Atrial Complexes» «Premature
+
+128
+00:10:07,580 --> 00:10:07,580
+Atrial Complexes» «Premature Atrial Complexes»
+
+129
+00:10:07,580 --> 00:10:08,260
+«Premature Atrial Complexes» «Premature Atrial
+
+130
+00:10:08,260 --> 00:10:11,660
+Complexes» «Premature Atrial Complexes» «Premature
+
+131
+00:10:11,660 --> 00:10:17,710
+Atrial Complexesواحدة منهم immature، تمام؟ فعشان
+
+132
+00:10:17,710 --> 00:10:22,970
+هيك بتلاقي إنه الناس هدولة بيصير في عندهم
+
+133
+00:10:22,970 --> 00:10:27,030
+irregularity في الرذن لإنه في early B wave، في
+
+134
+00:10:27,030 --> 00:10:31,150
+واحدة B wave إجت هيك فجأة، مش إتمعادها، والوريد
+
+135
+00:10:31,150 --> 00:10:37,890
+بيحس إنه النبضات طبعته كإن في واحدة منهم escaped،
+
+136
+00:10:37,890 --> 00:10:42,280
+lost يعني، في واحدة ما جتشتمام؟ ليش؟ لأنه ما
+
+137
+00:10:42,280 --> 00:10:47,900
+بيصيرش فيه complete اللي هو بي wave ومعنى أنه ما
+
+138
+00:10:47,900 --> 00:10:50,920
+بيصيرش فيه complete at real contraction
+
+139
+00:10:53,260 --> 00:10:57,740
+تمام هذه بالنسبة للـ Premature Atrial Complex عادة
+
+140
+00:10:57,740 --> 00:11:06,100
+هذه تعتبر حالة مرضية ولا تستدعي أي علاج في نوع
+
+141
+00:11:06,100 --> 00:11:09,240
+اسمه او Distributor تاني اسمه الـ Atrial Flutter
+
+142
+00:11:09,240 --> 00:11:14,480
+هذه على الـ ECG لو عملنا ECG بيكون شكلها واضح جدا
+
+143
+00:11:14,480 --> 00:11:17,720
+أولا إن هي تكيينةالـ Cardia يعني أن الـ Rate بيكون
+
+144
+00:11:17,720 --> 00:11:24,900
+عالي تمام؟ وشكل ال ECG عامل زي سنان المنشار من
+
+145
+00:11:24,900 --> 00:11:28,200
+تحت، ليش؟ لأنه في الـ Atrial Flutter، يعني في ملت
+
+146
+00:11:28,200 --> 00:11:31,480
+بيوب، بيوب، بيوب، بيوب، كتير عامل زي سنان المنشار،
+
+147
+00:11:31,480 --> 00:11:37,950
+زي ما انتوا شايفينهذا النقم الـ Atrial Dystrophy
+
+148
+00:11:37,950 --> 00:11:43,970
+بيكون يعني ال ratio تبع ال B للـQRS يعني كل QRS
+
+149
+00:11:43,970 --> 00:11:47,790
+واحدة المفروض بيكون قبلها B ولأ ممكن يكون قبلها
+
+150
+00:11:47,790 --> 00:11:52,750
+تنتين أو تلاتة أو أربعة لواحد، لاحظ كيف؟ يعني
+
+151
+00:11:52,750 --> 00:11:56,730
+تنتينلواحد، تلاتة لواحد، أربعة لواحد، يعني أربعة
+
+152
+00:11:56,730 --> 00:12:00,610
+بيوض لواحدة كي ورث، أسمها؟ عشان هيك بيكون الـ
+
+153
+00:12:00,610 --> 00:12:05,450
+Atrial Rate حوالي تلاتمية، يعني مثلا كانت تلاتة
+
+154
+00:12:05,450 --> 00:12:09,510
+لواحد، لو كان ال Ventricular Rate الـRR عدناهم الـ
+
+155
+00:12:09,510 --> 00:12:14,110
+Heart Rate مية، ال Atrial أكم بيكونتلاتة نفترض خبر
+
+156
+00:12:14,110 --> 00:12:16,670
+كل واحدة يعني الـ Atrial heart rate أكمل تلاتمية
+
+157
+00:12:16,670 --> 00:12:20,450
+يعني كل تلاتمية contraction بتصير مع الـ meat
+
+158
+00:12:20,450 --> 00:12:23,290
+contraction تبع الventricle تلاتمية contraction في
+
+159
+00:12:23,290 --> 00:12:26,230
+الـ Atrium بتصير مع الـ meat contraction اللي
+
+160
+00:12:26,230 --> 00:12:29,990
+بيصيره في الventricle يعني كل contraction في الـ
+
+161
+00:12:29,990 --> 00:12:34,150
+ventricle بيسبقها تلت contractions في الـ Atrium
+
+162
+00:12:34,150 --> 00:12:38,090
+هذي بيسموها Atrial flutter ولذلك بيبين الـ ECG زي
+
+163
+00:12:38,090 --> 00:12:41,150
+سنانة اللي انشار وبيكون فيه تسارق عند المريض في
+
+164
+00:12:41,150 --> 00:12:44,840
+نبضاتأو في ضربات القلب وبيكون المريض بيجيك شبه
+
+165
+00:12:44,840 --> 00:12:53,980
+دايخ لإنه مافيش انتظام في اللي هو ما بين الـB
+
+166
+00:12:53,980 --> 00:12:57,240
+والـQRS مافيش .. هو المقروض إنه يكون في انتظام
+
+167
+00:12:57,240 --> 00:13:01,820
+واحد لواحد لأ هنا صار فيه خلل وصار فيه أكتر من
+
+168
+00:13:01,820 --> 00:13:06,800
+نبضة بتطلع علشان تعمل نبضة واحدة في الـventricle
+
+169
+00:13:06,800 --> 00:13:10,680
+أكتر من يعني impulse في الأكرياعشان تعمل Impulse
+
+170
+00:13:10,680 --> 00:13:15,320
+واحدة في الـVentricle وهذا بالاستدعي اللي هو
+
+171
+00:13:15,320 --> 00:13:20,260
+العلاج إذا كان المريض Stable إيش يعني Stable؟ يعني
+
+172
+00:13:20,260 --> 00:13:25,620
+ماعندهوش اللي هو علامات الشق يعني مش Hypotension
+
+173
+00:13:25,620 --> 00:13:30,920
+مش حاسس فيه pain في صدره، وضعه مستقر، مش sweaty
+
+174
+00:13:35,300 --> 00:13:38,220
+عادةً الـ beta-blocker أو الـ calcium-channel زي
+
+175
+00:13:38,220 --> 00:13:43,860
+الـ E-chlorobamine هو الحل لكن لو لم يكن مثل ذلك
+
+176
+00:13:43,860 --> 00:13:48,060
+وكان المريض مش stable ووضعه صعب أو وضعه يعني في
+
+177
+00:13:48,060 --> 00:13:50,260
+عنده علامات الـ congestive heart failure أو الـ
+
+178
+00:13:50,260 --> 00:13:50,580
+shock
+
+179
+00:13:55,630 --> 00:13:57,750
+السويتي في عنده pain، في عنده difficulty
+
+180
+00:13:57,750 --> 00:14:01,650
+breathing، في عنده alter في الـmental state،
+
+181
+00:14:01,650 --> 00:14:05,430
+مضايق، مش شايف، وين أنا؟ أه، كل هذا الكلام بقى
+
+182
+00:14:05,430 --> 00:14:08,770
+نائي نضميض Unstable فبتكون الحال بيه
+
+183
+00:14:08,770 --> 00:14:14,570
+الـcardioversion عن طريق جهاز الـDC شك بس بنعمله
+
+184
+00:14:14,570 --> 00:14:17,850
+على mood تبع الـcardioversion عن طريق نقص على حد
+
+185
+00:14:17,850 --> 00:14:23,320
+اسمها Synchronizeفي الـ «DC Shock» فيه جهاز أو فيه
+
+186
+00:14:23,320 --> 00:14:27,020
+pattern اسمه «Synchronize» بنضغط عليه وبنصير هذا
+
+187
+00:14:27,020 --> 00:14:33,400
+الجهاز اللي بيشتغل cardioversionالنوع كالت من الـ
+
+188
+00:14:33,400 --> 00:14:37,540
+«Distordial Atrial Fibrillation»
+
+189
+00:14:37,540 --> 00:14:42,440
+وهذا نوع من اتجاه الأذيني بتلاقي أن الأذينين
+
+190
+00:14:42,440 --> 00:14:47,900
+بيرتجتوا بشكل سريع جدا جدا جدا بدل ما أن البيواب
+
+191
+00:14:47,900 --> 00:14:52,810
+واحدة بتلاقي بيواب بيواب ببيواب اكتهارولذلك
+
+192
+00:14:52,810 --> 00:14:56,190
+بالفترة اللي تشوف الـ B-Wave لذلك من أعنامات الـ
+
+193
+00:14:56,190 --> 00:15:01,090
+Atrial Fibrillation إن أنت بتصير Hidden B-Wave،
+
+194
+00:15:01,090 --> 00:15:05,930
+Not Visible، مابتمشفش، تمام؟ وعشان هيك بيكون كتير
+
+195
+00:15:05,930 --> 00:15:09,230
+B-Wave لكل Q ع رأس، الـQ ع رأس هي واحدة في قبلها،
+
+196
+00:15:09,230 --> 00:15:12,890
+كبشة ولأنهم كبشة، أنت بس بتشوف الـT، أما الـB
+
+197
+00:15:12,890 --> 00:15:16,690
+مابتشوفهاش يعني بتشوف الـT اللي بعد الـQ ع رأسها
+
+198
+00:15:16,690 --> 00:15:21,690
+طيب وين الـB الجديدة اللي مش شايفينها؟ هذي الـTبما
+
+199
+00:15:21,690 --> 00:15:26,130
+يكون هناك كتار وكتار وكتار وكتار فإن كلهم شبكين في
+
+200
+00:15:26,130 --> 00:15:31,710
+بعض فهم مش مباينين إيه بي وير الـ PR ما بنقدرش
+
+201
+00:15:31,710 --> 00:15:35,170
+نقيصها الـ Atrial Rate
+
+202
+00:15:40,290 --> 00:15:43,250
+أو من تلاتة إلى ستة خلالها تلاتة أربعة أو خمسة أو
+
+203
+00:15:43,250 --> 00:15:48,190
+ستة لكل Complex ولذلك الـ Atrial Fibrillation
+
+204
+00:15:48,190 --> 00:15:52,810
+تُعتبر حالة قطيرة برضه إذا كان المريض Stable وعارف
+
+205
+00:15:52,810 --> 00:15:56,270
+بالأدوية وعرفنا إشي عن Stable ماعندهوش علامات
+
+206
+00:15:56,270 --> 00:16:00,110
+Shock ولا difficulty of breathing ولا mental state
+
+207
+00:16:00,110 --> 00:16:03,430
+alteration من الممكن أن يتعارف بالأدوية والأدوية
+
+208
+00:16:03,430 --> 00:16:05,790
+اللي بنستخدمها اللي هو الـ Beta Blockers أو الـ
+
+209
+00:16:05,790 --> 00:16:06,530
+Calcium Channel
+
+210
+00:16:10,440 --> 00:16:15,080
+وإذا ماكنتش Steroid فنكون الحال بـ Cardioversion
+
+211
+00:16:15,080 --> 00:16:19,540
+النوع الأخير من الأدلزمة اسمها الـ Ventricular
+
+212
+00:16:19,540 --> 00:16:23,720
+Dystrosemia يعني الخلل اللي بيصير في الـ Ventricle
+
+213
+00:16:23,720 --> 00:16:26,670
+زي ما كان الـ Atrium في الـ Prematureالـ Atrial
+
+214
+00:16:26,670 --> 00:16:29,730
+Contraction فيه Premature Ventricular Contraction
+
+215
+00:16:29,730 --> 00:16:34,650
+برضه اللي نسميها BVC الـBVC كمان برضه إذا كانت في
+
+216
+00:16:34,650 --> 00:16:38,950
+الدقيقة لأن ست مرات برضه لا تُعتبر إنها حاجة مش
+
+217
+00:16:38,950 --> 00:16:43,630
+طبيعية أو حالة مرضية بتصير
+
+218
+00:16:43,630 --> 00:16:47,010
+بالخاف منها لما هذه هي شكل الـBVC Premature
+
+219
+00:16:47,010 --> 00:16:48,870
+Ventricular Contraction في الـComplex بدل ما يكون
+
+220
+00:16:48,870 --> 00:16:53,040
+الـComplex زادت بيصير عامل مثل الشكل هذا Wideزي ما
+
+221
+00:16:53,040 --> 00:16:57,320
+انتوا شايفين كده «depend on» ده طبعاً فيها
+
+222
+00:16:57,320 --> 00:17:05,880
+irregularity واضحة جداً في الـ ECG زي ما حكينا إذا
+
+223
+00:17:05,880 --> 00:17:08,940
+أقل من ست مرات في الدقيقة لازم تطبع حالة مرضي ولا
+
+224
+00:17:08,940 --> 00:17:14,660
+تستدائلها إذا أكتر ساعتها بيكون فيه سبب عادة مؤدي
+
+225
+00:17:14,660 --> 00:17:17,200
+إلى الـ BBC هادي
+
+226
+00:17:19,950 --> 00:17:24,810
+يعني تثبت أن المريض يدخل مثلًا في اللي هو نوع من
+
+227
+00:17:24,810 --> 00:17:29,370
+الـGentricular Tachycardia سواء Monomorphic أو
+
+228
+00:17:29,370 --> 00:17:33,690
+Polymorphic Gentricular Tachycardia عشان هيك في
+
+229
+00:17:33,690 --> 00:17:40,510
+أنواع من الـPVC
+
+230
+00:17:40,510 --> 00:17:46,690
+لما الـPVC became coupled with a normal Pهذا يسمى
+
+231
+00:17:46,690 --> 00:17:51,490
+بارجيميني، يعني في بارجيميني و في تراجيميني، إيش
+
+232
+00:17:51,490 --> 00:17:55,550
+يعني؟ وممكن يكون كوادر جيميني حتى، إيش يعني؟ لما
+
+233
+00:17:55,550 --> 00:18:01,130
+بكون بي بي سي coupled
+
+234
+00:18:01,130 --> 00:18:04,470
+with a normal beat، يعني تنتهي بي بي سي، بعدين
+
+235
+00:18:04,470 --> 00:18:05,770
+normal beat، بارجيميني
+
+236
+00:18:11,120 --> 00:18:17,580
+«قوادر جيميني» «قوادر
+
+237
+00:18:17,580 --> 00:18:20,680
+جيميني» «قوادر جيميني» «قوادر جيميني» «قوادر
+
+238
+00:18:20,680 --> 00:18:20,680
+جيميني» «قوادر جيميني» «قوادر جيميني» «قوادر
+
+239
+00:18:20,680 --> 00:18:20,680
+جيميني» «قوادر جيميني» «قوادر جيميني» «قوادر
+
+240
+00:18:20,680 --> 00:18:20,920
+جيميني» «قوادر جيميني» «قوادر جيميني» «قوادر
+
+241
+00:18:20,920 --> 00:18:22,100
+جيميني» «قوادر جيميني» «قوادر جيميني» «قوادر
+
+242
+00:18:22,100 --> 00:18:26,160
+جيميني» «قوادر
+
+243
+00:18:26,160 --> 00:18:32,560
+جيميني» «قوادر جيميني» «قوادر جيميني» «قوادر
+
+244
+00:18:32,560 --> 00:18:37,920
+جيميني» «قوادر جيميني» «قواد
+
+245
+00:18:48,440 --> 00:18:52,280
+لأنه يمكن توصيله لإنه يصير عند المريض، اللي هو زي
+
+246
+00:18:52,280 --> 00:18:55,960
+ما حكينا، ventricular tachycardia، طبعا لو كان
+
+247
+00:18:55,960 --> 00:18:59,520
+بارجيميني مع أنها أنه يعني تتيجي تنتمي ال EC و
+
+248
+00:18:59,520 --> 00:19:02,640
+تتيجي واحدة طبيعية، و تنتمي ال EC، يعني المريض قد
+
+249
+00:19:02,640 --> 00:19:07,160
+خشت تاكي كارديا، لكن لو كان كوادر جيميني، يعني كل
+
+250
+00:19:07,160 --> 00:19:13,060
+أربعة بيتي تتيجي لها واحدة، ولا حاجة،إن كنتي تدخل
+
+251
+00:19:13,060 --> 00:19:18,300
+فاكه كارد أقل لكن كل دقيقة بس التلي بي سي هذا
+
+252
+00:19:18,300 --> 00:19:25,180
+normal ولا أي حاجة ممكن يعني إنه مابتدخلش تدخل لكن
+
+253
+00:19:25,180 --> 00:19:29,360
+إذا بزيد عن هيكة بتصير quader Gemini بدلنا نسأل عن
+
+254
+00:19:29,360 --> 00:19:32,460
+السبب لأ زادت أكتر وصارت try Gemini أو by Gemini
+
+255
+00:19:33,910 --> 00:19:36,150
+بيكونوا خايفين إن المريض كان اللي نخش في الـ
+
+256
+00:19:36,150 --> 00:19:38,430
+Intricular Tachycardia الـ Intricular Tachycardia
+
+257
+00:19:38,430 --> 00:19:43,130
+زي ما حكينا is a three or more BBC in a row يعني
+
+258
+00:19:43,130 --> 00:19:46,390
+في نفس الصفة اللي أنت شايفتين تاني BBC أو تلاتة في
+
+259
+00:19:46,390 --> 00:19:52,270
+نفس الـ إيش ال .. ال .. ال .. ال strip تبع ال ECG
+
+260
+00:19:52,270 --> 00:19:57,910
+اللي عندك معناه إنه ال .. ال .. ال .. ال ..معناه
+
+261
+00:19:57,910 --> 00:20:03,770
+الـBDC صارت أكتر من بيجيميني وتعتبر هنا حالة
+
+262
+00:20:03,770 --> 00:20:08,650
+emergency لازم نعرفها إيش بالظبط الـBDC اللي عندي
+
+263
+00:20:08,650 --> 00:20:11,030
+هنا «مونومورفيك دينتريكولاتكاردية» «مونومورفيك
+
+264
+00:20:11,030 --> 00:20:11,310
+دينتريكولاتكاردية» «مونومورفيك دينتريكولاتكاردية»
+
+265
+00:20:11,310 --> 00:20:11,970
+«مونومورفيك دينتريكولاتكاردية» «مونومورفيك
+
+266
+00:20:11,970 --> 00:20:12,630
+دينتريكولاتكاردية» «مونومورفيك دينتريكولاتكاردية»
+
+267
+00:20:12,630 --> 00:20:15,530
+«مونومورفيك دينتريكولاتكاردية» «مونومورفيك
+
+268
+00:20:15,530 --> 00:20:19,730
+دينتريكولاتكاردية» «مونومورفيك دينتريكولاتكاردية»
+
+269
+00:20:19,760 --> 00:20:23,680
+بيسموه إيش؟ Monomorphic يعني كلهم نفس الشكل
+
+270
+00:20:23,680 --> 00:20:26,840
+Monomorphic Ventricular Tachycardia زي ما انتوا
+
+271
+00:20:26,840 --> 00:20:29,940
+شايفين heart rate بكون عالي Ventricular طبعا heart
+
+272
+00:20:29,940 --> 00:20:33,300
+rate هو اللي عالي عادة بتكون Regular لأن
+
+273
+00:20:33,300 --> 00:20:37,380
+Monomorphic بكون Regular Polymorphic ببطل فيها
+
+274
+00:20:37,380 --> 00:20:42,640
+regularity ال complex زي ما احنا شايفين أعرض من 1
+
+275
+00:20:42,640 --> 00:20:43,400
+.12
+
+276
+00:20:46,650 --> 00:20:53,170
+وشكل الـ complex غريب وعريض وزي الشباب اللي ممكن
+
+277
+00:20:53,170 --> 00:20:56,090
+يكونوا كلها تحت وكلها فوق حسب الـstrip اللي بتشوفه
+
+278
+00:20:56,090 --> 00:21:02,200
+هنا يستدعي التدخل إذا كان المريض stable لسهيعني
+
+279
+00:21:02,200 --> 00:21:04,880
+ماعندوش علامات الـ Heart Failure ومن خلال الـ
+
+280
+00:21:04,880 --> 00:21:07,360
+State Operation الحاجات هذه يعالج بالأدوية والعلاج
+
+281
+00:21:07,360 --> 00:21:11,520
+المستخدم هو الـ Amiodarone 150 ميلي جرام في 50 CC
+
+282
+00:21:11,520 --> 00:21:16,140
+خلال 10 دقائق إذا ما المريض Unstable بيكون العلاج
+
+283
+00:21:16,140 --> 00:21:21,240
+الـ Cardioversionطبعاً في حاجة تانية اسمها الـ
+
+284
+00:21:21,240 --> 00:21:23,940
+Polymorphic اللي يكون Ventricular Tachycardia بس
+
+285
+00:21:23,940 --> 00:21:27,160
+أول خمسة زي بعض وبعدين الخمسة التانية حاجة تانية
+
+286
+00:21:27,160 --> 00:21:30,700
+وبعدين الخمسة اللي بعدهم يرجع زي الأولى هذا بيسموه
+
+287
+00:21:30,700 --> 00:21:34,200
+Polymorphic وهذه المرحلة تكون ما قبل إنه المريض
+
+288
+00:21:34,200 --> 00:21:37,660
+يخش في حاجة بيسميها Ventricular Fibrillation
+
+289
+00:21:37,660 --> 00:21:40,780
+Ventricular Fibrillation إن لأ المريض صار ماعندهوش
+
+290
+00:21:40,780 --> 00:21:45,420
+Complex ولا عنده بي ويب ولا في عنده شوية يعني كأنه
+
+291
+00:21:51,240 --> 00:21:55,720
+الـ B للـ QRS مش صعب اتحدده الـ B والـ W مش شايفها
+
+292
+00:21:55,720 --> 00:22:01,160
+الـ QRS يعني ممكن هدول كونوا QRS فمطبعا أكيد هم
+
+293
+00:22:01,160 --> 00:22:06,060
+لكن مش منتظمينوسرقين، فهذا الـ Ventricular
+
+294
+00:22:06,060 --> 00:22:11,260
+Fibrillation ممكن يصير أقل من ذلك الـ Volume تبعهم
+
+295
+00:22:11,260 --> 00:22:16,020
+وعشان نسميها FINE Ventricular Fibrillation يعني
+
+296
+00:22:16,020 --> 00:22:21,260
+إيه؟ عده أصبح Asystole، عده وجف خالص، بس لسه بكون
+
+297
+00:22:21,260 --> 00:22:26,900
+يعني لسه شايف أنت Wave طبعاً هذه حالة معناها أن
+
+298
+00:22:26,900 --> 00:22:30,000
+القلب يرتجف تماماً وهذا معناه أنه مافيش ولا
+
+299
+00:22:31,020 --> 00:22:36,560
+contraction ومعناه ان الحالة عندها صارت طبعا هذه
+
+300
+00:22:36,560 --> 00:22:39,610
+الحالة معناه ان القلبمتوقف تمامًا عن الأمل
+
+301
+00:22:39,610 --> 00:22:44,070
+والألياج تبقىها فقط بالـDC Shock عن طريق الجهاز
+
+302
+00:22:44,070 --> 00:22:47,870
+الـDC Shock على حاجة بنسميها الـDeep Fib يعني من
+
+303
+00:22:47,870 --> 00:22:51,150
+غير الـSynchronization الأخيرة أنه يكون
+
+304
+00:22:51,150 --> 00:22:54,390
+Ventricular Ac Stol أن حتى الـFine بيقفط بطن
+
+305
+00:22:54,390 --> 00:23:00,990
+موجودة ويصير خلف Ac Stol مافيش أي Wave فيه وهذه
+
+306
+00:23:00,990 --> 00:23:08,500
+حالة من التوقف الكامل لـاللي هو الـ Heart Rate فيه
+
+307
+00:23:08,500 --> 00:23:11,420
+الـ Ventricular Tachycardia وفيه الـ ASISTOL
+
+308
+00:23:11,420 --> 00:23:16,120
+يستدون أن نعمل للمريض الـCPR الفرق الوحيد أنه في
+
+309
+00:23:16,120 --> 00:23:19,060
+الـ Ventricular تاكيكارديا بلازم ندى الـDC Shock
+
+310
+00:23:19,060 --> 00:23:23,060
+وبعدين نعمل الـCPR أو أعمل الـCPR قبل ما يجي DC
+
+311
+00:23:23,060 --> 00:23:26,420
+Shockوأقصد في الـ C-bar يعني الـ Cardiac Massage
+
+312
+00:23:26,420 --> 00:23:29,780
+وعندما يأتي الـ DC-shock أول ما يأتي أدى الـ DC
+
+313
+00:23:29,780 --> 00:23:31,980
+-shock و بعدين أرجع أكمل الـ C-bar لكن في الـ AC
+
+314
+00:23:31,980 --> 00:23:36,260
+Stall ما يلزمش إطلاقا أنك تدى الـ DC-shock و الحال
+
+315
+00:23:36,260 --> 00:23:41,700
+يكون بس في الـ Cardiac Compressionباستمرار لبنما
+
+316
+00:23:41,700 --> 00:23:47,560
+يتحسن الريدميا جد على المريض عمر جديد الحاجة
+
+317
+00:23:47,560 --> 00:23:50,540
+الأخيرة اللي بنحكي فيها اللي هي الـ Conduction
+
+318
+00:23:50,540 --> 00:23:54,180
+Abnormalities اللي هي أنواع الـ Heart Block زي ما
+
+319
+00:23:54,180 --> 00:23:59,560
+أحنا عارفين أنه في حاجة اسمها First-degree Heart
+
+320
+00:23:59,560 --> 00:24:04,260
+Block وبكل بساطة الـ First-degree Heart Block هذه
+
+321
+00:24:04,260 --> 00:24:08,580
+أنه يكون عندك مريض
+
+322
+00:24:11,210 --> 00:24:15,310
+عنده ECG والـ ECG تبقوا فيه الـ Bradycard يعني الـ
+
+323
+00:24:15,310 --> 00:24:19,150
+heart rate أقل من الطبيعي لكن كل بيه وراها QRS في
+
+324
+00:24:19,150 --> 00:24:26,350
+الشيء بيها مشكلة طب هوين الاختلاف عن الـ normal
+
+325
+00:24:26,350 --> 00:24:33,410
+يعني؟ آه، إنه بس الـ PR interval أطول من الطبيعي
+
+326
+00:24:33,410 --> 00:24:37,210
+الطبيعي إنها تكون من 3 إلى 5 مرمبعة هي تكون أكتر
+
+327
+00:24:37,210 --> 00:24:45,840
+من 5 مرمبعة، أكتر منأو 0.2 من 10 أكتر
+
+328
+00:24:45,840 --> 00:24:52,360
+من مربع كبير الـ PR فهذا الـ Prolonged PR معناها
+
+329
+00:24:52,360 --> 00:24:56,160
+إن هذه نوع من الـ First degree heart أو هذا الـ
+
+330
+00:24:56,160 --> 00:25:00,140
+First degree heart block
+
+331
+00:25:01,320 --> 00:25:05,120
+طب إيش نعمله للمريض هذا؟ مش كل المرضى تبقون
+
+332
+00:25:05,120 --> 00:25:08,200
+الـphysically heart block بيحتاجوا تدخل، في منهم
+
+333
+00:25:08,200 --> 00:25:12,460
+بيعتبر بالنسبة لهم طبيعي، لكن إذا كان بيخششوا بعض
+
+334
+00:25:12,460 --> 00:25:16,140
+المرضى، بيخششوا مثلا بـsyncopic attack أو إشي،
+
+335
+00:25:16,140 --> 00:25:19,800
+بدوا تقييم علشان نشوف إيش الـsyndrome اللي بتسيي
+
+336
+00:25:19,800 --> 00:25:25,580
+لإندويند، معظم الناس تعتبر حالة طبيعية، تمام؟في
+
+337
+00:25:25,580 --> 00:25:30,360
+الـSecond-degree Heart Block أو AV Block تنقسم
+
+338
+00:25:30,360 --> 00:25:34,420
+لقسمين حد اسمها Mopet I وحدة اسمها Mopet II أيش
+
+339
+00:25:34,420 --> 00:25:38,700
+الفرق بين Mopet I وMopet II؟ لاحظ أن في Mopet I
+
+340
+00:25:38,700 --> 00:25:44,560
+بيكون فيه prolongation لـPR Interval بعدين الـDrop
+
+341
+00:25:44,560 --> 00:25:50,780
+يعني هنا هي الـP وهي الـPR هنا هي الـPR كبرة A
+
+342
+00:25:51,270 --> 00:25:58,390
+بعدين كبرات أكتر، يعني في progressive prolongation
+
+343
+00:25:58,390 --> 00:26:01,950
+كل ما بنمشي بيصير في عندي progressive prolongation
+
+344
+00:26:01,950 --> 00:26:05,910
+في الـPR interval، تمام؟ بعد ذلك بيصير في عندي
+
+345
+00:26:05,910 --> 00:26:10,590
+سقوط واحدة، مافيش complex يعني، تمام؟
+
+346
+00:26:13,510 --> 00:26:16,710
+الـ Drop تقف في QRS Complex، بعد هيك، بعد يعني هنا
+
+347
+00:26:16,710 --> 00:26:20,670
+في prolongation، هذه هان، بعدين طولت، بعدين طولت،
+
+348
+00:26:20,670 --> 00:26:24,730
+بعدين مافيش Complex، تجت بيلا حالها، بعدين بعد الـ
+
+349
+00:26:24,730 --> 00:26:28,710
+Drop هذا، بترجع Cycle من أول، زي من هان، بترجع
+
+350
+00:26:28,710 --> 00:26:32,910
+تصغر، بعدين تكبر، بعدين أكبر، بعدين Drop، وها كذا،
+
+351
+00:26:32,910 --> 00:26:36,210
+بترجع Cycle، Cycle، لذا المميزات هي إنها Cyclic،
+
+352
+00:26:37,330 --> 00:26:42,350
+بتمشي بنفس الوطيرة هيكا، يعني بيكون الـPR صغيرة،
+
+353
+00:26:42,350 --> 00:26:44,950
+بتكبر شوية، بتكبر أكتر، بتكبر أكتر، بعدين بيصير و
+
+354
+00:26:44,950 --> 00:26:47,970
+drop، بعدين بترجع من أول، ساكر، صغيرة، بعدين تكبر،
+
+355
+00:26:47,970 --> 00:26:51,670
+بعدين تكبر، بعدين drop، تمام؟ هذا اسمها MOPET 1 في
+
+356
+00:26:51,670 --> 00:26:57,770
+MOPET 2 الفرق أن الـPR constantنفس الـ «PR»
+
+357
+00:26:57,770 --> 00:27:03,570
+«constant»، طب هذا ما يحصل، بس اللهم إنه بعد مثلا
+
+358
+00:27:03,570 --> 00:27:07,330
+«PR» «PR» «PR»، بعدين بيصيروا «drop»، يعني بيصيروا
+
+359
+00:27:07,330 --> 00:27:10,790
+«drop»، لكن الـ «PR» «constant» مافيش فيها
+
+360
+00:27:10,790 --> 00:27:13,050
+«progressive» إيه عشان «prolongation»، هذا اللي
+
+361
+00:27:13,050 --> 00:27:21,700
+بيصير في مبقية «to»، لاحظين؟ تمامالنوع اللي حكيناه
+
+362
+00:27:21,700 --> 00:27:23,820
+عن الـ Second-degree heart block وشوفنا إيش الفرق
+
+363
+00:27:23,820 --> 00:27:28,100
+بينه وبين موبيت 1 وموبيت 2 وبعدين النوع الأخير
+
+364
+00:27:28,100 --> 00:27:32,700
+اللي هو إيش اسمه الـ Third-degree heart block هذا
+
+365
+00:27:32,700 --> 00:27:37,540
+عن إيش هنا اللي بحكيه؟ أه عن زي ما حكينا عن ال
+
+366
+00:27:37,540 --> 00:27:45,120
+ratio تبع الـB لـQRS إنه ممكن يكون في إيش
+
+367
+00:27:48,010 --> 00:27:51,330
+طلع، بي ويب، مافيش وراك ورأس، بي ويب، مافيش وراك
+
+368
+00:27:51,330 --> 00:27:55,350
+ورأس، بعدين، بعدين يجيب، بعدين يجيب، بي ويب، مافيش
+
+369
+00:27:55,350 --> 00:28:00,650
+وراك ورأس، تمام؟ هذا في موبية 2 في الـthird degree
+
+370
+00:28:00,650 --> 00:28:08,490
+heart block قالأيش اللي بيصير؟ بيصير أنه المريض
+
+371
+00:28:08,490 --> 00:28:13,250
+بيصير فيه عنده يعني بنسميها Desynchronization،
+
+372
+00:28:13,250 --> 00:28:16,390
+مافيش تناغم بين الـP و الـQ و الـS المفروض أن كل
+
+373
+00:28:16,390 --> 00:28:19,910
+بيه ورا Q و S، لكن في third reality block بيصير يا
+
+374
+00:28:19,910 --> 00:28:26,130
+جماعة أنه بتيجي waveماذا يجب أن يأتي وراها بي ورأس
+
+375
+00:28:26,130 --> 00:28:33,530
+بي ورأس رأس رأس رأس رأس رأس رأس رأس رأس رأس رأس
+
+376
+00:28:33,530 --> 00:28:43,420
+رأس رأس رأس رأسالمريض تبقى الـ Third-degree heart
+
+377
+00:28:43,420 --> 00:28:49,120
+block وبيعتبر أنه حالة خطيرة وبتستدعي أني أشوف
+
+378
+00:28:49,120 --> 00:28:53,580
+مريضي إذا كان هو stable ولا مش stable إذا كان
+
+379
+00:28:53,580 --> 00:28:57,820
+stable المريض بكون بأستدعي أخصائي القلب علشان
+
+380
+00:28:58,910 --> 00:29:03,450
+يتعامل مع المريض وممكن يحتاج دخول لأن المريض يحتاج
+
+381
+00:29:03,450 --> 00:29:09,590
+Base Maker إذا المريض عنده Symptoms وعلامات الـ
+
+382
+00:29:09,590 --> 00:29:12,610
+Heart Failure زي ما حكينا بكون لازم أعمل معاه
+
+383
+00:29:12,610 --> 00:29:16,570
+الأتروبين الـ Test و أدّيله أتروبين اللي هو نص
+
+384
+00:29:16,570 --> 00:29:21,290
+مليجرام كل ثلاثة أو خمس دقائق في الأغلب هدول الناس
+
+385
+00:29:21,290 --> 00:29:26,460
+مابيستجبوش للأتروبين ويكونوا بدهم Base Makerتمام؟
+
+386
+00:29:26,460 --> 00:29:29,880
+بتركبله عادة الـ Temporary Pacemaker عابلنا أنه
+
+387
+00:29:29,880 --> 00:29:35,700
+يتركبله Burnout Pacemaker عشان يظلوا عايش فيها هي
+
+388
+00:29:35,700 --> 00:29:40,720
+كأحنا خلصنا الـ Dystrophy دمية بنخلي اللي هو الجزء
+
+389
+00:29:40,720 --> 00:29:43,500
+الأخير من المحاضرة تبع الـCoronal Vascular
+
+390
+00:29:43,500 --> 00:29:49,420
+Disorder للمرة القادمة إن شاء الله يعطيكم اللحظة
+
diff --git a/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/8DNlIAzpToE.srt b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/8DNlIAzpToE.srt
new file mode 100644
index 0000000000000000000000000000000000000000..da581bf99e389f380f343936af540a45ee83bdcf
--- /dev/null
+++ b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/8DNlIAzpToE.srt
@@ -0,0 +1,1406 @@
+1
+00:00:01,620 --> 00:00:06,460
+بسم الله الرحمن الرحيم السلام عليكم ورحمة الله، إن
+
+2
+00:00:06,460 --> 00:00:09,380
+شاء الله، اليوم هنكمل محاضرة ثانية في محاضرة الـ
+
+3
+00:00:09,380 --> 00:00:13,160
+Mechanical Ventilation، حكينا عن الـ Volume Cycle
+
+4
+00:00:13,160 --> 00:00:20,140
+واليوم هنحكي عن الـ Pressure Mode في الـ Mode تبعت
+
+5
+00:00:20,140 --> 00:00:23,970
+الـ Mechanical Ventilation، الـ Pressure Modes يا
+
+6
+00:00:23,970 --> 00:00:28,550
+جماعة، الـ Modes المهمة، فيهم واحد اسمه Pressure
+
+7
+00:00:28,550 --> 00:00:33,170
+Controlled Ventilation Mode (PCV) ، الـ PCV موضوع
+
+8
+00:00:33,170 --> 00:00:36,730
+نستعمله إذا كانت الـ Compliance تتأثر، ورغبات
+
+9
+00:00:36,730 --> 00:00:41,390
+البارانشيما عالية، إذا المريض الـ Compliance تبعت
+
+10
+00:00:41,390 --> 00:00:46,960
+الـ Lung قليلة، يعني أنا مش متأكد أنه لما أدّي المريض
+
+11
+00:00:46,960 --> 00:00:51,300
+500، تقدر الـ volume هدول هيعملوا expansion
+
+12
+00:00:51,300 --> 00:00:55,460
+وهيكون فيه قدرة على أن يصير فيه complete expansion
+
+13
+00:00:55,460 --> 00:00:59,740
+بعدين ترجع الـ lung تطلعهم، ممكن الـ lung stiff lung
+
+14
+00:00:59,740 --> 00:01:05,360
+فيها كتير fibrosis، أه فأنا بخاف أخشّ كمية عالية يصير
+
+15
+00:01:05,360 --> 00:01:11,590
+إيش نيموثوراكس مثلاً، فعشان هيك لأ، بنحطه على pressure
+
+16
+00:01:11,590 --> 00:01:17,870
+mode، لأن البارَنْشِيمَا واردة هنا، فالبَرَنْشِيمَا في الـ
+
+17
+00:01:17,870 --> 00:01:20,690
+pressure mode هو حسب الـ pressure اللي داخل الـ lung
+
+18
+00:01:20,690 --> 00:01:25,510
+لما نوصل الـ pressure لـ limit، غير محدود، إن الـ lung
+
+19
+00:01:25,510 --> 00:01:28,130
+تتجاوَزَه، خلاص بوقف الـ tidal volume اللي المفروض
+
+20
+00:01:28,130 --> 00:01:32,820
+يُعطى، فعشان هيك الـ pressure volume كلهم بيعتمدوا
+
+21
+00:01:32,820 --> 00:01:37,320
+على أنه يعطي الـ limited pressure، مايكونش بيأذي
+
+22
+00:01:37,320 --> 00:01:41,540
+المريض، كويس؟ هذا عادة نستخدمه لما يكون الـ
+
+23
+00:01:41,540 --> 00:01:45,320
+compliance تبع الـ lung not good، يعني decrease الـ
+
+24
+00:01:45,320 --> 00:01:50,320
+compliance، okay؟ when the patient has a resistant
+
+25
+00:01:50,320 --> 00:01:53,560
+oxygenation problem despite a high FiO2 and a high
+
+26
+00:01:53,560 --> 00:01:57,890
+level of PEEP، يعني أنا حاطط high PEEP على الـ Volume
+
+27
+00:01:57,890 --> 00:02:01,430
+Control، الـ High PEEP، ما هو الـ الـ الـ الـ Beep
+
+28
+00:02:01,430 --> 00:02:04,050
+اللي إحنا حكيناه، هو نوع من أنواع الـ Pressure Mode
+
+29
+00:02:04,050 --> 00:02:07,810
+ما شرحناهوش، أنا لغاية ما أرجع أبدأ أشرح الـ PEEP و
+
+30
+00:02:07,810 --> 00:02:12,150
+أشرح أسبابه، عشان نستطيع أن إحنا نفهم الـ Pressure
+
+31
+00:02:12,150 --> 00:02:16,390
+Control Mode، بس باختصار، لو أنا فيه عندي Volume
+
+32
+00:02:16,390 --> 00:02:20,870
+Cycle ومدعّمه في Pressure Cycle اللي هو الـ PEEP،
+
+33
+00:02:20,870 --> 00:02:26,760
+ورغم هيك المريض اللي الـ Oxygen saturation عنده bad
+
+34
+00:02:26,760 --> 00:02:32,300
+و الـ و الـ blood gas تبعته bad، بكون أحسن أحطه على
+
+35
+00:02:32,300 --> 00:02:38,160
+pressure control ventilation mode اللي هو الـ PCV
+
+36
+00:02:38,160 --> 00:02:42,700
+عشان أحسن الـ oxygenation عنده، فإن الـ pressure
+
+37
+00:02:42,700 --> 00:02:43,140
+level
+
+38
+00:02:45,780 --> 00:02:52,000
+“I:E Ratio Must Be Selected”، لازم في الـ PCV
+
+39
+00:02:52,000 --> 00:02:57,700
+يكون محدد “I:E Ratio”، طبعاً الـ tidal volume
+
+40
+00:02:57,700 --> 00:03:01,460
+بيختلف يا جماعة في كل نفس، مع إيش؟ مع الـ pressure
+
+41
+00:03:01,460 --> 00:03:05,020
+اللي داخل الـ lung، “Sedation” and “Use of
+
+42
+00:03:05,020 --> 00:03:07,120
+neuromuscular blocking agents are frequently
+
+43
+00:03:07,120 --> 00:03:10,540
+indicated”، عادة في الحالات هذه يفضل أن يكون المريض
+
+44
+00:03:10,540 --> 00:03:14,750
+إيش؟ ماخد Sedation و مرتاح، من الـ advantage تبع
+
+45
+00:03:14,750 --> 00:03:16,670
+الـ reduction of peak pressure and therefore، دا
+
+46
+00:03:16,670 --> 00:03:22,530
+risk of barotrauma، ما فيش عادة، لأنه إحنا هنا إحنا
+
+47
+00:03:22,530 --> 00:03:25,750
+أصلاً شغالين على الـ pressure، فإنه يصير barotrauma،
+
+48
+00:03:25,750 --> 00:03:28,750
+trauma نتيجة الـ pressure، لأ، لأن الـ pressure هو
+
+49
+00:03:28,750 --> 00:03:31,590
+اللي بتحكم في الموضوع، فمش هيسمح للـ pressure إنه
+
+50
+00:03:31,590 --> 00:03:36,770
+يزيد ويعمل trauma، وطبعاً هذا هيحسن الـ gas exchange
+
+51
+00:03:36,770 --> 00:03:42,070
+قبل ما أشرح حد، أنا بدي أروح للـ PEEP، أشرح إيش الـ
+
+52
+00:03:42,070 --> 00:03:46,670
+PEEP وإيش هم أسبابه، لأن هدول عادة بنستخدمهم حتى، أو
+
+53
+00:03:46,670 --> 00:03:49,130
+الـ PEEP بالذات اللي بنستخدمه مع الـ Volume
+
+54
+00:03:49,130 --> 00:03:52,630
+Control اللي حكينا عنهم، واللي أشهرهم الـ SIMV
+
+55
+00:03:52,630 --> 00:03:58,570
+يعني بنكون حاطين SIMV وبنكون حاطين PEEP، لذلك الـ
+
+56
+00:03:58,570 --> 00:04:03,050
+PEEP ما هو mode منفصل، يعني ما ينفعش أحط المريض بس
+
+57
+00:04:03,050 --> 00:04:04,870
+على PEEP، يعني إيش الـ mode اللي إنت حاطه؟ ما هو
+
+58
+00:04:04,870 --> 00:04:07,790
+اللي يخليني أحطه على PEEP؟ لأ، ما فيش، PEEP بتكون حاطه إنت
+
+59
+00:04:07,790 --> 00:04:15,900
+على أساس IMV أو PCV، يعني وحاطط له PEEP خمسة، PEEP تلاتة
+
+60
+00:04:15,900 --> 00:04:19,820
+فإيش هو الـ PEEP هذا؟ الـ PEEP هو الـ positive end
+
+61
+00:04:19,820 --> 00:04:26,620
+expiratory pressure، positive end expiratory
+
+62
+00:04:26,620 --> 00:04:32,180
+pressure، إيش يعني positive end؟ يعني يعني أن تكون
+
+63
+00:04:32,180 --> 00:04:37,400
+نهاية الـ expiration عندك، نهاية موجبة، إيش يعني
+
+64
+00:04:37,400 --> 00:04:44,190
+نهاية موجبة؟ يعني إحنا بناخد نفس، ونطلق
+
+65
+00:04:44,190 --> 00:04:48,090
+النفس، في الطبيعي، لما إحنا بناخد النفس يا جماعة
+
+66
+00:04:48,090 --> 00:04:54,990
+عشان ناخد النفس، لازم يصير أو يكون الضغط داخل
+
+67
+00:04:54,990 --> 00:04:58,710
+الـ Thoracic Cavity أقل من الضغط تبع الهواء الجوي،
+
+68
+00:04:58,710 --> 00:05:04,500
+وإلا مش هينزل الهواءلداخل الرئتين، ليش؟ لأن هو
+
+69
+00:05:04,500 --> 00:05:08,160
+بنتقل من الضغط الأعلى للضغط الأقل، فلازم يكون أنا
+
+70
+00:05:08,160 --> 00:05:14,860
+عندي الضغط أقل، عشان أقدر أخد نفس، ينزل من الضغط
+
+71
+00:05:14,860 --> 00:05:23,060
+الأعلى للضغط الأقل، يعني معناه أنه أنا بعد ما
+
+72
+00:05:23,060 --> 00:05:29,340
+أعمل expiration، أخدت
+
+73
+00:05:29,340 --> 00:05:37,170
+inspiration، زاد الضغط في الـ رئتين عندي، مش هيك؟
+
+74
+00:05:37,170 --> 00:05:41,810
+أخذت كمية من الهواء، الـ رئتين زاد الضغط
+
+75
+00:05:41,810 --> 00:05:46,290
+فيها، إيش بتسوي؟ ما زال زاد الضغط، صار الضغط اللي
+
+76
+00:05:46,290 --> 00:05:49,350
+عنده أكبر من ضغط الهواء الجوي، هذا بيسمح للهواء
+
+77
+00:05:49,350 --> 00:05:55,550
+أنه ينتقل من صدري للخارج، الضغط عندي عالي، للبرا، مش
+
+78
+00:05:55,550 --> 00:06:03,960
+هيك؟ لكن بيضل يا جماعة الضغط اللي عندي يطلع..
+
+79
+00:06:03,960 --> 00:06:09,660
+يطلع.. يطلع.. يطلع.. يطلع.. يطلع.. يطلع..
+
+80
+00:06:09,660 --> 00:06:14,640
+يطلع.. يطلع..
+
+81
+00:06:14,640 --> 00:06:15,500
+.. يطلع.. يطلع.. يطلع.. يطلع.. يطلع.. يطلع..
+
+82
+00:06:15,500 --> 00:06:15,760
+يطلع.. يطلع.. يطلع.. يطلع.. يطلع.. يطلع..
+
+83
+00:06:15,760 --> 00:06:15,900
+يطلع.. يطلع.. يطلع.. يطلع.. يطلع.. يطلع..
+
+84
+00:06:15,900 --> 00:06:16,260
+يطلع.. يطلع.. يطلع.. يطلع.. يطلع.. يطلع..
+
+85
+00:06:16,260 --> 00:06:25,920
+يطلع.. يطلع.. يطلع.. يطلع..
+
+86
+00:06:25,920 --> 00:06:31,340
+اطلق النفس، إذا أنا في الـ Normal، عادة بعد كل نفس
+
+87
+00:06:31,340 --> 00:06:35,920
+بأخده، بأخذ النفس وبضلّ اخذ في النفس لما الـ
+
+88
+00:06:35,920 --> 00:06:39,180
+pressure يزيد ويزيد ويزيد ويزيد ويزيد ويزيد و
+
+89
+00:06:39,180 --> 00:06:39,680
+يزيد ويزيد ويزيد ويزيد ويزيد ويزيد ويزيد و
+
+90
+00:06:39,680 --> 00:06:39,780
+يزيد ويزيد ويزيد ويزيد ويزيد ويزيد ويزيد و
+
+91
+00:06:39,780 --> 00:06:39,840
+يزيد ويزيد ويزيد ويزيد ويزيد ويزيد ويزيد و
+
+92
+00:06:39,840 --> 00:06:45,220
+يزيد ويزيد ويزيد ويزيد
+
+93
+00:06:45,220 --> 00:06:54,400
+و
+
+94
+00:06:55,830 --> 00:06:57,790
+الآن نحن على الـ ventilator
+
+95
+00:06:57,790 --> 00:07:12,150
+(The following section contains unintelligible speech and is best omitted)
+
+96
+00:07:27,790 --> 00:07:32,310
+ما بضلّ أطلع لما أوصل للضغط أقل من الهواء الجوي
+
+97
+00:07:32,310 --> 00:07:38,910
+لأ، أخذت النفس، بدي أطلع نص الطريق وآخذ نفس، يعني
+
+98
+00:07:38,910 --> 00:07:43,170
+النهاية موجبة لسه قبل ما توصل للهواء الجوي، آخذ نفس
+
+99
+00:07:43,170 --> 00:07:49,810
+ثاني، إذا القصة هي أننا بدنا المريض يظل عنده كمية
+
+100
+00:07:55,280 --> 00:08:01,460
+يظل عنده كمية هواء residual في الرئتين تجعله يتمكن
+
+101
+00:08:01,460 --> 00:08:06,160
+من أن يأخذ الـ Inspiration ثاني قبل ما يعمل كل
+
+102
+00:08:06,160 --> 00:08:09,980
+الـ Expiration، أو قبل ما يعمل الـ Expiration لكل
+
+103
+00:08:09,980 --> 00:08:13,640
+كمية الهواء اللي كانت في الرئتين اللي هتجعله يوصل
+
+104
+00:08:13,640 --> 00:08:18,180
+لـ Negative Pressure، لأ، في نص يعني يظل كمية هواء
+
+105
+00:08:18,180 --> 00:08:21,800
+بحيث يرجع ياخد نفسه، هو لسه في الـ Positive قبل ما
+
+106
+00:08:21,800 --> 00:08:29,060
+يتعادل، تمام؟ هذا هو الـ PEEP، إذا بنلخص، بنقول الـ PEEP
+
+107
+00:08:29,060 --> 00:08:32,140
+refers to the use of an elevated pressure during
+
+108
+00:08:32,140 --> 00:08:36,120
+the end of the expiratory phase، في مرحلة الـ
+
+109
+00:08:36,120 --> 00:08:40,680
+expiratory phase تبعت
+
+110
+00:08:40,680 --> 00:08:44,890
+الـ lung، أنا ما بدّيش المريض يوصل لـ negative
+
+111
+00:08:44,890 --> 00:08:48,830
+pressure، بدي يظل ضغطه يزيد ويرجع ياخذ نفس ثاني
+
+112
+00:08:48,830 --> 00:08:52,490
+it is not a standalone mode، ما بنحطوش لحاله، but it's
+
+113
+00:08:52,490 --> 00:08:55,970
+used in conjunction with other modes as SIMV، يعني
+
+114
+00:08:55,970 --> 00:09:00,490
+يكون المريض على SIMV وحاطط له PEEP خمسة مثلاً، إيش يعني
+
+115
+00:09:00,490 --> 00:09:03,270
+خمسة؟ يعني الـ pressure اللي بدنا نعمله كل مرة هو
+
+116
+00:09:03,270 --> 00:09:08,250
+اللي بيبقى خمسة، خمسة cmH2O، when PEEP is applied to
+
+117
+00:09:08,250 --> 00:09:11,950
+spontaneously breathing patients, the mode called CPAP
+
+118
+00:09:13,620 --> 00:09:19,040
+يعني لما أنا بحط للمريض PEEP continuous
+
+119
+00:09:19,040 --> 00:09:23,880
+continuous PEEP، إيش يعني CPAP؟ continuous
+
+120
+00:09:23,880 --> 00:09:26,560
+positive end expiratory pressure، يعني أنا بحط
+
+121
+00:09:26,560 --> 00:09:30,420
+للمريض continuous PEEP، بس بخلي المريض ياخد الـ
+
+122
+00:09:30,420 --> 00:09:34,740
+tidal volume اللي هو بده إياه، والـ rate اللي هو
+
+123
+00:09:34,740 --> 00:09:38,080
+بده إياه، إيش يعني؟ يعني أنا ما بدّيش ولا tidal volume
+
+124
+00:09:38,080 --> 00:09:43,950
+ولا rate، بس محافظه على كمية من الهواء بعد كل مرة
+
+125
+00:09:43,950 --> 00:09:47,270
+ما هو بيعمل Expiration، بتضل كمية من الهواء
+
+126
+00:09:47,270 --> 00:09:50,510
+residual في الـ Lungs بحيث يعمل النفس اللي بعده
+
+127
+00:09:50,510 --> 00:09:55,570
+يكون عليه أسهل، يكون عليه أسهل زي واحد بده ينفخ
+
+128
+00:09:55,570 --> 00:10:01,630
+بالون من سفر كده، بده جهد، وواحد بده ينفخ بالون
+
+129
+00:10:01,630 --> 00:10:08,470
+نفخنا نفسنا نص تنفسة، وقلنا له انفخ ثاني، كده بده
+
+130
+00:10:08,470 --> 00:10:08,810
+جهد
+
+131
+00:10:11,880 --> 00:10:15,920
+طبعاً، هذا الهواء يعمل كـ سباب، بيقلل عمل الهواء في
+
+132
+00:10:15,920 --> 00:10:22,340
+الهواء، ويساعد في الحفاظ على القوة الوظيفية، طبعاً،
+
+133
+00:10:22,340 --> 00:10:24,460
+(This section repeats lines 131-132, indicating a transcription error)
+
+134
+00:10:24,460 --> 00:10:25,160
+(This section repeats lines 131-132, indicating a transcription error)
+
+135
+00:10:25,160 --> 00:10:25,340
+(This section repeats lines 131-132, indicating a transcription error)
+
+136
+00:10:25,340 --> 00:10:28,120
+(This section repeats lines 131-132, indicating a transcription error)
+
+137
+00:10:28,120 --> 00:10:38,240
+(This section contains unintelligible speech and is best omitted)
+
+138
+00:10:38,240 --> 00:10:44,160
+(This section contains unintelligible speech and is best omitted)
+
+139
+00:10:44,160 --> 00:10:47,100
+(This section contains unintelligible speech and is best omitted)
+
+140
+00:10:47,100 --> 00:10:47,860
+(This section contains unintelligible speech and is best omitted)
+
+141
+00:10:47,860 --> 00:10:49,560
+(This section contains unintelligible speech and is best omitted)
+
+142
+00:10:49,560 --> 00:10:51,960
+(This section contains unintelligible speech and is best omitted)
+
+143
+00:10:51,960 --> 00:10:54,800
+(This section contains unintelligible speech and is best omitted)
+
+144
+00:10:54,800 --> 00:10:55,200
+(This section contains unintelligible speech and is best omitted)
+
+145
+00:10:55,200 --> 00:11:03,320
+(This section contains unintelligible speech and is best omitted)
+
+146
+00:11:12,430 --> 00:11:16,490
+بالفعل، مش هنحط لهم high PEEP للناس اللي عندهم severe
+
+147
+00:11:16,490 --> 00:11:20,590
+hypotension، بالفعل مش هنحط لهم high PEEP، high level of
+
+148
+00:11:20,590 --> 00:11:26,370
+PEEP كان يُستخدَم، ونحطه على ستة، سبعة، ثمانية، for
+
+149
+00:11:26,370 --> 00:11:30,810
+patients with ARDS، COPD، بالمناورة القديمة، لكن إنه
+
+150
+00:11:30,810 --> 00:11:33,630
+complication، إنه decrease in systemic venous
+
+151
+00:11:33,630 --> 00:11:37,350
+return، هيقلل الـ systemic venous return، وبالتالي
+
+152
+00:11:37,350 --> 00:11:39,750
+عشان هيك الناس اللي عندهم head trauma، إذا بتقلل
+
+153
+00:11:39,750 --> 00:11:44,750
+الـ venous return، هتصير مشكلة، عشان هيك ما بحطش high
+
+154
+00:11:44,750 --> 00:11:48,950
+PEEP مع الناس اللي عندها head trauma، بالمناسبة،
+
+155
+00:11:48,950 --> 00:11:52,050
+barotrauma can be caused as a result from hyperinflation
+
+156
+00:11:52,050 --> 00:11:59,530
+of alveoli past the rupture point، يعني احتمالية
+
+157
+00:11:59,530 --> 00:12:03,680
+أنه يصير barotrauma عالية مع الـ high PEEP، لأ،
+
+158
+00:12:03,680 --> 00:12:07,100
+لأن الـ pressure عالي اللي إنت حاططه في الـ I.V.L
+
+159
+00:12:07,100 --> 00:12:11,800
+، يعني كمية الهواء عاملها inflation أكتر من اللي
+
+160
+00:12:11,800 --> 00:12:20,660
+هي ممكن تتحملها، وبالتالي ممكن الـ rupture، الـ PEEP،
+
+161
+00:12:20,660 --> 00:12:26,620
+رجعنا للـ PEEP، حكينا عن الـ PEEP، بس أعتقد فيه slide
+
+162
+00:12:26,620 --> 00:12:27,420
+منفصلة له
+
+163
+00:12:33,150 --> 00:12:36,330
+طيب، هو حاكي عن الـ PEEP في نفس الـ slide هذه، زي
+
+164
+00:12:36,330 --> 00:12:39,470
+ما حكينا، هو الـ PEEP، وهو عبارة عن continuous PEEP
+
+165
+00:12:39,470 --> 00:12:44,450
+هو الـ mode of ventilation، ما بنضيفش، ما بنحطش في
+
+166
+00:12:44,450 --> 00:12:48,210
+الـ PEEP rate، الـ rate اللي بياخده المريض هو الـ rate
+
+167
+00:12:48,210 --> 00:12:50,430
+الـ tidal volume اللي بياخده المريض هو الـ tidal
+
+168
+00:12:50,430 --> 00:12:55,170
+volume، بس إحنا بيكون حاطين الـ PEEP تبع المريض، وبكون
+
+169
+00:12:56,050 --> 00:12:59,710
+الكمية الهواء اللي بده ياخدها المريض، هو بده يحددها
+
+170
+00:12:59,710 --> 00:13:03,010
+بس من خلال الهواء، فبالتالي الـ FiO2 لازم يكون
+
+171
+00:13:03,010 --> 00:13:06,170
+إحنا الـ Oxygen Fraction، قد إيش الهواء فيه Oxygen
+
+172
+00:13:06,170 --> 00:13:13,190
+قد إيش الهواء اللي بده يدخله المريض، تركيز الـ Oxygen
+
+173
+00:13:13,190 --> 00:13:19,490
+فيه 30%، 40%، 50%، هذا
+
+223
+00:17:06,420 --> 00:17:08,560
+-Invasive Bilateral Positive Airway Pressure
+
+224
+00:17:08,560 --> 00:17:12,120
+Non-invasive Bilateral Positive الـ Ventilation
+
+225
+00:17:12,120 --> 00:17:14,340
+Airway Pressure Ventilation يا جماعة زمان كان
+
+226
+00:17:14,340 --> 00:17:22,800
+بيسموه CBAP Mask. عبارة عن Mask بتنحط للمريض وبنحط
+
+227
+00:17:22,800 --> 00:17:26,630
+الجهاز على CBAP. إيش يعني؟ يعني إحنا مش عاملين
+
+228
+00:17:26,630 --> 00:17:31,090
+Invasive. إنه يعني حطين تيوب وننفخ هوا في المريض،
+
+229
+00:17:31,090 --> 00:17:33,290
+لأ، إحنا بس محافظين على الـ Pressure. طب ما إحنا
+
+230
+00:17:33,290 --> 00:17:35,530
+عارفين إنه في الـ سياب المريض هو المفروض إنه بياخد
+
+231
+00:17:35,530 --> 00:17:38,830
+الـ Tidal Volume لحاله، إذن هياخد الـ Tidal Volume
+
+232
+00:17:39,750 --> 00:17:42,250
+والـ Rate اللي هو بده إياه، بس اللهم إنه إحنا
+
+233
+00:17:42,250 --> 00:17:45,110
+محافظينه على الـ Pressure. يضله Closed Cycle
+
+234
+00:17:45,110 --> 00:17:48,410
+والـ Pressure هيضله، كل مرة فيه عنده شوية
+
+235
+00:17:48,410 --> 00:17:51,810
+Residual. إحنا محافظينه، مش الـسبب هو Continuous
+
+236
+00:17:51,810 --> 00:17:54,630
+Beat. فإحنا فيه Continuous Beat بضايلين عند
+
+237
+00:17:54,630 --> 00:17:58,830
+المريض على طول. التطور الموضوع هذا، بدل ما يكون بده
+
+238
+00:17:58,830 --> 00:18:04,950
+جهاز Ventilator وبده Closed Mask مسكرة على كل
+
+239
+00:18:04,950 --> 00:18:08,910
+المريض، لأ، إنه ممكن عن طريق الـ Nose أو عن طريق
+
+240
+00:18:10,070 --> 00:18:17,010
+اللي هو ماسك، خصوصًا لأنه Nasal Mask، ندّي للمريض حاجة
+
+241
+00:18:17,010 --> 00:18:21,470
+بنسميها اللي هو الـ IPAP. An Inspiratory Pressure
+
+242
+00:18:21,470 --> 00:18:26,250
+Support Level. اللي هو أنا أعمله بيب جوا داخلي بحيث
+
+243
+00:18:26,250 --> 00:18:31,260
+أنه يساعد المريض في كل مرة يأخذ النفس، عن
+
+244
+00:18:31,260 --> 00:18:34,660
+طريق الـ Pressure اللي already موجود، اللي عمله الـ
+
+245
+00:18:34,660 --> 00:18:37,120
+BIPAP، ومن غير Invasive، من غير أكون حاطط
+
+246
+00:18:37,120 --> 00:18:40,580
+Endotracheal Tube. كتير كويس مع مين هذا؟ مع الناس
+
+247
+00:18:40,580 --> 00:18:43,580
+اللي بيصير عندهم Hyperventilation Syndrome فجأة، هو
+
+248
+00:18:43,580 --> 00:18:49,340
+نايم، أو Apnea Syndrome، بتوقف عن النفس. الناس اللي
+
+249
+00:18:49,340 --> 00:18:52,560
+عندهم Lung Failure Process. الناس اللي عندهم أمراض
+
+250
+00:18:52,560 --> 00:18:55,900
+كانوا كل يوم مضمضلهم في المستشفى، في الـ ICU عشان
+
+251
+00:18:55,900 --> 00:19:00,710
+خاطر هو بيصير عنده Apnea فجأة، أو بيصير عنده
+
+252
+00:19:00,710 --> 00:19:04,970
+Hyperventilation فجأة. فلما بينام، كل ما عنده
+
+253
+00:19:04,970 --> 00:19:09,290
+النوم بالذات، بيصير عنده Sleep Apnea. مثلا في ناس
+
+254
+00:19:09,290 --> 00:19:11,510
+كتير عندهم Sleep Apnea. عندما بينام بيصير معاه
+
+255
+00:19:11,510 --> 00:19:15,650
+Apnea. فعندما بينام، لأ، بنحطه على الـ ... الـ ... الـ
+
+256
+00:19:15,650 --> 00:19:22,820
+الـ ... الـ BIPAP أو الـ IPAP، أو Sleep Apnea Mask، و
+
+257
+00:19:22,820 --> 00:19:26,800
+بنخلّي يظل طول اللي نام هو عليها، فهو كل ما بيخش في
+
+258
+00:19:26,800 --> 00:19:31,400
+Sleep Apnea، الجهاز
+
+259
+00:19:31,400 --> 00:19:33,560
+بيحافظه على كمية الـ Pressure دي، هو فما بيخشش
+
+260
+00:19:33,560 --> 00:19:36,820
+أصلًا فيها، وبيضلوا يتنفس، لأنه ما فيش ولا مرة بيكون
+
+261
+00:19:36,820 --> 00:19:43,840
+عنده بطل فيه نفس خالص، وبالتالي هذه كتير كويسة
+
+262
+00:19:43,840 --> 00:19:47,740
+للناس اللي عندهم Chronic Fibrosis أو Stress بـ COPD
+
+263
+00:19:47,740 --> 00:19:52,790
+أو Lung Fibrosis أو Sleep Apnea. وفكرتها سهلة لو
+
+264
+00:19:52,790 --> 00:19:58,310
+بتمنع الـ Recurrent Admission بسبب أبناء الـ
+
+265
+00:19:58,310 --> 00:20:02,410
+Ventilation. حكيت لكم إن في حد اسمه Non-invasive
+
+266
+00:20:02,410 --> 00:20:06,310
+Historically. آه، لكن حديثًا برضه صار يستخدموه زي هذا
+
+267
+00:20:06,310 --> 00:20:11,470
+المنظر هذا. الجهاز بيعمل Support زي ما أنتم شايفين
+
+268
+00:20:11,470 --> 00:20:16,370
+من حوالين الـ Lung، وبيعمل زي ما أنتم شايفين هذا
+
+269
+00:20:16,370 --> 00:20:21,610
+بلون كأنه آه، والهواء اللي فيه بيزيد وبيقل، لما
+
+270
+00:20:21,610 --> 00:20:24,110
+بيزيد، بيزيد الـ Pressure، فبيعمل Pressure على الـ
+
+271
+00:20:24,110 --> 00:20:27,590
+Lung، فبالتالي أنت بتعمل Expiration. لما بيقل الهواء
+
+272
+00:20:27,590 --> 00:20:34,270
+اللي فيه، بتروح أنت إيش؟ لما بيقل الهواء اللي فيه
+
+273
+00:20:34,270 --> 00:20:38,250
+بتروح أنت بتعمل Relaxation، فبتعمل Inspiration. فهو
+
+274
+00:20:38,250 --> 00:20:42,450
+فكرة قديمة، إجت من الـ Iron Lung. هي شكل الـ Iron Lung
+
+275
+00:20:42,450 --> 00:20:47,960
+يعني هيك بتتوقع كانت زمان شكل الـ ICU، اللي هي فكرة
+
+276
+00:20:47,960 --> 00:20:51,300
+الحديثة، زي ما شوفنا كيف في الأطفال، هيك تمام؟
+
+277
+00:20:51,300 --> 00:20:57,760
+وحديثًا استخدموها بهذا الشكل، يعني استوحوا الفكرة من
+
+278
+00:20:57,760 --> 00:21:00,920
+فكرة الـ Nasal Mask. قالوا بدل "طب ما إحنا ما زلنا
+
+279
+00:21:00,920 --> 00:21:03,000
+Non-invasive، بنعمله Pressure"، "ما بنعمله Pressure
+
+280
+00:21:03,000 --> 00:21:05,780
+برا خالص، بنرجع لفكرة الـ Non-invasive".
+
+281
+00:21:09,300 --> 00:21:12,220
+البراميات عادية. خلصنا الـ Modes. تبقى الـ Ventilation
+
+282
+00:21:12,220 --> 00:21:15,900
+يعني أنا عرفت إيش الـ Windows اللي بده أشتغل عليه.
+
+283
+00:21:15,900 --> 00:21:18,480
+أندي كمبيوتر وحطيت Microsoft Office وحطيت الـ
+
+284
+00:21:18,480 --> 00:21:21,980
+PowerPoint، وبده أبدأ أشتغل، إيش بده؟ بده أبدأ أحط
+
+285
+00:21:21,980 --> 00:21:25,580
+Title، بعدين أحط Subject، بعدين أحط مقدمة، بعدين أحط
+
+286
+00:21:25,580 --> 00:21:29,020
+خاتمة. فأنا اخترت الـ Mode. نفترض أن الـ Mode اللي
+
+287
+00:21:29,020 --> 00:21:32,520
+عندي هو IMV، والـ Mode التاني اللي بده أحطه هو Support
+
+288
+00:21:32,520 --> 00:21:36,460
+هو الـ BIPAP. طب إيش بالـ BIPAP؟ أوكي، بدأ أحط مثلا المريض
+
+289
+00:21:36,460 --> 00:21:39,680
+يدّي BIPAP عادي، إيه له؟ Normal، BIPAP يعني، من تلاتة
+
+290
+00:21:39,680 --> 00:21:42,900
+لخمسة is normal. طب الـ SIMV، إيش هي الـ Parameters
+
+291
+00:21:42,900 --> 00:21:46,200
+اللي أنا لازم أحطها؟ عشان الـ Parameter اللي الـ SIMV
+
+292
+00:21:46,200 --> 00:21:50,200
+يشتغل؟ أول حاجة، أبدأ أحط الـ FiO2، الـ Oxygen
+
+293
+00:21:50,200 --> 00:21:53,660
+Fraction. زي ما حكينا، الهواء الطبيعي، الـ Ambient
+
+294
+00:21:53,660 --> 00:21:59,150
+Air، فيه 21% هواء. لكن المريض عادةً الـ Oxygen Demand
+
+295
+00:21:59,150 --> 00:22:05,170
+عنده أكثر، فبحطه من 40 لـ 60%، لأنه أكثر من هيك هيكون
+
+296
+00:22:05,170 --> 00:22:08,030
+بعرض المريض لـ Oxygen Toxicity.
+
+297
+00:22:16,970 --> 00:22:21,750
+هذا بالنسبة للـ FiO2. الـ Parameters التانية اللي
+
+298
+00:22:21,750 --> 00:22:25,290
+هو الـ Tidal Volume. الـ Tidal Volume يعني زي ما
+
+299
+00:22:25,290 --> 00:22:33,230
+حكينا إنه هو عبارة عن كمية الهواء اللي المريض يريد
+
+300
+00:22:33,230 --> 00:22:36,710
+ياخدها في كل Inhalation. is the volume of air
+
+301
+00:22:36,710 --> 00:22:39,270
+delivered to the patient during a ventilator with
+
+302
+00:22:39,270 --> 00:22:44,600
+each present breath. مع كل نفس، مع كل نفس، مش في كل
+
+303
+00:22:44,600 --> 00:22:49,160
+دقيقة، تمام؟ وطبعًا حكينا بكل بساطة هو من ستة
+
+304
+00:22:49,160 --> 00:22:53,720
+لتمانية ملي لتر لكل كيلو جرام. يعني مكتوب هنا سبعة
+
+305
+00:22:53,720 --> 00:22:58,540
+على تسعة، اللي هو من ستة لتمانية ملي لتر لكل كيلو
+
+306
+00:22:58,540 --> 00:23:03,180
+جرام Body Weight. هذا هو الـ Volume المناسب. يعني لو
+
+307
+00:23:03,180 --> 00:23:11,730
+واحد وزنه يا جماعة سبعين كيلو جرام، سبعين في تمانية، هو
+
+308
+00:23:11,730 --> 00:23:18,090
+تقدر الـ Volume المناسب. طب لو واحد وزنه مائة، مائة
+
+309
+00:23:18,090 --> 00:23:23,150
+وعشرين، مائة وعشرين كيلو جرام، مائة وعشرين ضرب
+
+310
+00:23:23,150 --> 00:23:29,040
+تمانية، لأ، مش صحيح. ليش؟ لأننا نتعامل مع الـ Ideal
+
+311
+00:23:29,040 --> 00:23:32,520
+Body Weight، يعني هو المفروض كم يكون وزنه، يعني
+
+312
+00:23:32,520 --> 00:23:37,220
+لما بيجي المريض ووزنه 120، ما تعملش علشان أنه وزنه
+
+313
+00:23:37,220 --> 00:23:40,840
+120، بتطلع هو المفروض الإنسان هذا يكون وزنه حسب
+
+314
+00:23:40,840 --> 00:23:43,540
+طوله طبعًا، كام؟
+
+315
+00:23:57,210 --> 00:24:03,550
+عشان نتعامل مع الـ Ideal Body Weight بالنسبة للـ
+
+316
+00:24:03,550 --> 00:24:08,060
+Peak Flow. يعني، والـ Flow Rate، يعني الـ Pressure أو
+
+317
+00:24:08,060 --> 00:24:13,800
+الـ ... يعني الـ ... يعني الـ Flow of Gas used to
+
+318
+00:24:13,800 --> 00:24:18,160
+deliver each mechanical breath to the patient. الـ
+
+319
+00:24:18,160 --> 00:24:23,840
+Flow، معدل الانسياب اللي جاي فيه الهواء للمريض.
+
+320
+00:24:25,240 --> 00:24:29,040
+المفروض قداش بيبقى، كأنه بيديها، شايف كيف؟ سرعة
+
+321
+00:24:29,040 --> 00:24:32,400
+of delivering air per unit of time and is
+
+322
+00:24:32,400 --> 00:24:36,100
+expressed in liters per minute. أقوى، آخد بالي،
+
+323
+00:24:36,100 --> 00:24:42,300
+يعني مثلا، أما أنا بحكي إنه أنا مثلا بدنا المريض
+
+324
+00:24:42,300 --> 00:24:45,200
+على الـ Flow Rate أربعة Liters per minute
+
+325
+00:24:45,200 --> 00:24:48,140
+individual. to maintain oxygen saturation
+
+326
+00:24:48,140 --> 00:24:53,160
+level من 96 لـ 100. أنا بدي الهواء يكون ماشي بسرعة
+
+327
+00:24:53,160 --> 00:24:59,420
+أربعة، أو بـ Flow بمعدل انسياب أربعة لتر في الدقيقة
+
+328
+00:24:59,420 --> 00:25:07,020
+عشان أنا آخد منه خمسمية كل نفس، 500 ملي لتر في النفس
+
+329
+00:25:07,020 --> 00:25:13,660
+بس كيف معدل سرعة انسيابهم سريع؟ قداش معدل انسيابهم؟
+
+330
+00:25:13,660 --> 00:25:18,460
+ما معدل إنه يعدّي 4 لتر في خلال الدقيقة؟ آه يا عزيزي،
+
+331
+00:25:18,460 --> 00:25:22,500
+أنا بتحكم، كأني بتحكم في سرعة دخول الهواء، كيف يكون
+
+332
+00:25:22,500 --> 00:25:28,040
+الضغط، تبع كمية الضغط عالية ولا واطية ولا كم؟ أنا
+
+333
+00:25:28,040 --> 00:25:35,180
+بحدد الـ Rate. عالية، نستخدم من 2 لـ 4 Liter per minute
+
+334
+00:25:35,180 --> 00:25:41,660
+The higher the flow rate the faster the airway pressure is reached and the shorter the
+
+335
+00:25:41,660 --> 00:25:45,280
+inspiration. كل ما كان الـ Flow Rate high، كل ما أقصر
+
+336
+00:25:45,280 --> 00:25:50,880
+الـ Inspiration يا جماعة. shorter. The lower the flow
+
+337
+00:25:50,880 --> 00:25:56,220
+rate the longer the inspiration. كل ما كان الـ Flow
+
+338
+00:25:56,220 --> 00:25:59,400
+Rate low،
+
+339
+00:25:59,400 --> 00:26:02,860
+ويكون الـ Inspiration أطول. الـ
+
+340
+00:26:03,580 --> 00:26:10,740
+Respiratory Rate، بيسموه على الأجهزة كتير الـ
+
+341
+00:26:10,740 --> 00:26:13,640
+Frequency. أنت بدك تاخد الـ Volume 500، كم مرة عشان
+
+342
+00:26:13,640 --> 00:26:22,520
+يكون Frequency؟ فهو Respiratory Rate، كم نفس في
+
+343
+00:26:22,520 --> 00:26:27,340
+الدقيقة. بدك إذا مربوط بالزمن بالدقيقة، عادة بنحط
+
+344
+00:26:27,340 --> 00:26:31,960
+المرضى من عشرة لـ ستة عشر Breath per minute. من الـ Total
+
+345
+00:26:31,960 --> 00:26:34,140
+Respiratory Rate equal patient rate plus
+
+346
+00:26:34,140 --> 00:26:36,440
+ventilator rate.
+
+347
+00:26:40,370 --> 00:26:45,890
+الـ Respiratory Rate اللي بيدي الجهاز، زائد اللي
+
+348
+00:26:45,890 --> 00:26:49,390
+بياخده المريض هو، الـ Total Respiratory Rate.
+
+350
+00:26:58,530 --> 00:27:04,910
+الـ Patient والـ COPD والـ Children بحتاجوا
+
+351
+00:27:04,910 --> 00:27:08,530
+Tidal Volume أقل يا جماعة، أقل لأن الـ Lung
+
+352
+00:27:08,530 --> 00:27:12,950
+Capacity تبعتهم أقل، مش هي؟ والـ Children الـ
+
+353
+00:27:12,950 --> 00:27:17,250
+Weight تبعتهم أقل. الناس اللي عندهم Lung Fibrosis
+
+354
+00:27:17,250 --> 00:27:21,890
+الـ Lung Capacity تبعتهم أقل، اللي هو مسكرة، okay؟
+
+355
+00:27:24,200 --> 00:27:26,660
+حاجة اسمها الـ Minute Volume، من ضمن الـ
+
+356
+00:27:26,660 --> 00:27:29,460
+Parameters. طب ليش؟ يعني إيش الـ Minute Volume؟ هذا
+
+357
+00:27:29,460 --> 00:27:32,520
+الـ Minute Volume هي كمية الهواء اللي بدها تخش
+
+358
+00:27:32,520 --> 00:27:36,160
+للمريض في الدقيقة، في الدقيقة، آه يعني. طب ما إحنا
+
+359
+00:27:36,160 --> 00:27:39,180
+بنعرف كمية الهواء اللي بدها تخش كل نفس، في كل نفس،
+
+360
+00:27:39,180 --> 00:27:42,100
+طب وإذا المريض بياخد عشر تنفسات، يعني المريض بياخد
+
+361
+00:27:42,100 --> 00:27:45,860
+كل نفس خمسمية، والحاجة دي بتصير معاه عشر مرات في
+
+362
+00:27:45,860 --> 00:27:49,020
+الدقيقة. يعني الـ Minute Volume خمسمية ضرب عشرة، خمس
+
+363
+00:27:49,020 --> 00:27:51,760
+آلاف، يعني خمسة لتر. هذا هو الـ Minute Volume؟ آه. طب وأنا ليش أعرفه، ما زال أنا عارف الـ
+
+364
+00:27:51,760 --> 00:27:54,740
+Tidal Volume وعارف الـ Rate؟ آه، أعرفه علشان فيه
+
+365
+00:27:54,740 --> 00:27:58,100
+أجهزة في تصميمها ما فيش مكان للـ Tidal Volume، بيقول لك
+
+366
+00:27:58,100 --> 00:28:02,040
+حط الـ Rate وحط الـ Minute Volume، هو خلاص بيعرف الـ
+
+367
+00:28:02,040 --> 00:28:05,560
+Tidal Volume. أها، فصار في إن هنا Indication لازم
+
+368
+00:28:05,560 --> 00:28:09,000
+إحنا نكون عارفين حاجة اسمها الـ Minute Volume، في
+
+369
+00:28:09,000 --> 00:28:12,360
+أجهزة ما فيش فيها مكان تعمل Setting للـ Tidal، بتقضّي
+
+370
+00:28:12,360 --> 00:28:15,780
+أنت الـ Frequency Rate، عشرة، اتناشر، وقداش بدك
+
+371
+00:28:15,780 --> 00:28:18,660
+الـ Minute Volume؟ تقوله والله خمسة، بيفهم إنه آه
+
+372
+00:28:18,660 --> 00:28:21,540
+بده يقسم خمسة لتر على عشرة عشان يدّي كل الـ Tidal
+
+373
+00:28:21,540 --> 00:28:25,180
+Volume. تمام؟ خمسة لتر على عشرة هيدّي خمسمية CC كل
+
+374
+00:28:25,180 --> 00:28:30,620
+One Breath. تمام؟ لكن في أجهزة okay فيها Tidal
+
+375
+00:28:30,620 --> 00:28:34,560
+Volume، فمش فيها Minute Volume. "في مستخدم بخطأ
+
+376
+00:28:34,560 --> 00:28:38,280
+الحرارة". طبعًا الـ كالوسوس يمكن أن يكون
+
+377
+00:28:38,280 --> 00:28:43,000
+مطلبًا بإنجاز الـ سيريبرال فازوديلتيشن بـ تقليل
+
+378
+00:28:43,000 --> 00:28:46,800
+رسمي في الـ ICB، والسيدال فوليوم
+
+379
+00:28:46,800 --> 00:28:50,320
+والرسبيرتوري ريت يتحررون لإنجاز الـ كالوسوس
+
+380
+00:28:50,320 --> 00:28:55,040
+بأشواط للمستخدم. يعني يا جماعة، هذا الكلام يعني
+
+381
+00:28:55,040 --> 00:28:59,220
+نوعًا ما الآن، مع الناس اللي عندهم Head Injury
+
+382
+00:28:59,220 --> 00:29:04,520
+بطلوا يستخدموا. كتير حكيت إنه أخلي المريض الـ
+
+383
+00:29:04,520 --> 00:29:17,410
+كالوتك بي أتش لأ، صار Normal، Normal Blood Gas is required. يعني الآن صاروا بيعتمدوا على إنه
+
+384
+00:29:17,410 --> 00:29:21,670
+يخلوا الـ Blood Gas Normal وما يقللوش الـ CO2 زي
+
+385
+00:29:21,670 --> 00:29:27,270
+زمان. يعني هذه الشيء، شوفوا اللي هو بين المستخدم الـ
+
+386
+00:29:27,270 --> 00:29:37,150
+COPD. يعني في الـ Patient اللي تبعون الـ COPD،
+
+387
+00:29:37,150 --> 00:29:40,410
+Baseline ABG reflect an elevated PCO2 should not
+
+388
+00:29:40,410 --> 00:29:44,030
+be hyperventilated instead the goal should be
+
+389
+00:29:44,030 --> 00:29:47,790
+restoration of the baseline PCO2. في الناس اللي
+
+390
+00:29:47,790 --> 00:29:51,450
+تبعون الـ COPD يا جماعة، الـ CO2 أصلًا يكون عندهم
+
+391
+00:29:51,450 --> 00:29:57,180
+عالي فإحنا ما بن... ما بن... ما بنحطوش يعني على
+
+392
+00:29:57,180 --> 00:30:02,880
+Tidal Volume عالي لدرجة ما إنه يصير الـ CO2
+
+393
+00:30:02,880 --> 00:30:06,640
+عنده واطي، آه، يصير Hyperventilation، لأنه متعود
+
+394
+00:30:0
+
+445
+00:34:18,610 --> 00:34:25,230
+يعني لو بدأ أخذ منها ثلثها 20 إلى 40 يعني كل عملية
+
+446
+00:34:25,230 --> 00:34:29,210
+التنفس في الدقيقة بتصير في 20 ثانية، وكل عملية الـ
+
+447
+00:34:29,210 --> 00:34:34,250
+Expiration كل دقيقة بتصير في 40 ثانية، يعني كل
+
+448
+00:34:34,250 --> 00:34:37,750
+عملية التنفس اللي في الدقيقة بتصير في 20 ثانية
+
+449
+00:34:37,750 --> 00:34:41,630
+طبعا بتصير في الـ 20 ثانية، هدول عشر تنفسات، يبقى
+
+450
+00:34:41,630 --> 00:34:45,410
+20 تقسيم عشرة = 2 الـ
+
+451
+00:34:45,410 --> 00:34:46,410
+Inspirational Time
+
+452
+00:34:49,290 --> 00:34:50,070
+تو ساكنت
diff --git a/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/8DNlIAzpToE_postprocess.srt b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/8DNlIAzpToE_postprocess.srt
new file mode 100644
index 0000000000000000000000000000000000000000..0cbebe02a14715f813175ef6cf907d51a6669f9a
--- /dev/null
+++ b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/8DNlIAzpToE_postprocess.srt
@@ -0,0 +1,1808 @@
+1
+00:00:01,620 --> 00:00:06,460
+بسم الله الرحمن الرحيم السلام عليكم ورحمة الله إن
+
+2
+00:00:06,460 --> 00:00:09,380
+شاء الله اليوم هنكمل محاضرة تانية في محاضرة الـ
+
+3
+00:00:09,380 --> 00:00:13,160
+Mechanical Ventilation حكينا عن الـ Volume Cycle
+
+4
+00:00:13,160 --> 00:00:20,140
+واليوم هنحكي عن الـ Pressure Mode في الـ Mode تبعت
+
+5
+00:00:20,140 --> 00:00:23,970
+الـ Mechanical Ventilationالـ Pressure Modes يا
+
+6
+00:00:23,970 --> 00:00:28,550
+جماعة الـ Modes المهمين فيهم واحد اسمه Pressure
+
+7
+00:00:28,550 --> 00:00:33,170
+Controlled Ventilator Mode PCV الـ PCV موضوع
+
+8
+00:00:33,170 --> 00:00:36,730
+استعمل إذا كانت الـ Compliance تتخلص ورغبات
+
+9
+00:00:36,730 --> 00:00:41,390
+البراتروما عالية إذا المريض الـ Compliance تبعت
+
+10
+00:00:41,390 --> 00:00:46,960
+الـ Lungغليل يعني أنا مش متأكد إنه لما أد المريض
+
+11
+00:00:46,960 --> 00:00:51,300
+خمسمية تقدر الـ volume هدول هيعملوا expansion
+
+12
+00:00:51,300 --> 00:00:55,460
+وهيكون فيه قدرة على إن تصير فيه complete expansion
+
+13
+00:00:55,460 --> 00:00:59,740
+بعدين ترجع ال lung تطلعهم ممكن ال lung stiff lung
+
+14
+00:00:59,740 --> 00:01:05,360
+فيها كتير fibrosis أه فأنا بخاف أخشش كمية ها يصير
+
+15
+00:01:05,360 --> 00:01:11,590
+إيش نيموفوركس مثلاًفعشان هيك لأ بنحطه على pressure
+
+16
+00:01:11,590 --> 00:01:17,870
+mode لإن البراترومة واردة هنا فالبراترومة في ال
+
+17
+00:01:17,870 --> 00:01:20,690
+pressure mode هو حسب ال pressure اللي داخل ال lung
+
+18
+00:01:20,690 --> 00:01:25,510
+لما نوصل ال pressure لlimit غير محدود إن ال lung
+
+19
+00:01:25,510 --> 00:01:28,130
+تتجوزه، خلاص بوقف ال tidal volume اللي المفروض
+
+20
+00:01:28,130 --> 00:01:32,820
+ينعطففعشان هيك الـ pressure volume كلهم بيعتندوا
+
+21
+00:01:32,820 --> 00:01:37,320
+على إنه يعطي الـ limited pressure مايكونش بيأذي
+
+22
+00:01:37,320 --> 00:01:41,540
+المريض، كويس؟ هذا عادة نستخدمه لما يكون ال
+
+23
+00:01:41,540 --> 00:01:45,320
+compliance تبع ال lung not good، يعني decrease ال
+
+24
+00:01:45,320 --> 00:01:50,320
+compliance، okay؟ when the patient has a resistant
+
+25
+00:01:50,320 --> 00:01:53,560
+oxygenation problem despite a high FI2 and a high
+
+26
+00:01:53,560 --> 00:01:57,890
+level of P، يعني أنا حاطط high Pعلى الـ Volume
+
+27
+00:01:57,890 --> 00:02:01,430
+Control، الـ High Beep ما هو الـ الـ الـ الـ Beep
+
+28
+00:02:01,430 --> 00:02:04,050
+اللي احنا حكيناه هو نوع من أنواع الـ Pressure Mode
+
+29
+00:02:04,050 --> 00:02:07,810
+ما شرحناهوش، أنا لغاية أرجع أبدأ أشرح الـ Beep و
+
+30
+00:02:07,810 --> 00:02:12,150
+أشرح السباب عشان نستطيع أنه احنا نفهم الـ Pressure
+
+31
+00:02:12,150 --> 00:02:16,390
+Control Mode بس باختصار، لو أنا فيه عندي Volume
+
+32
+00:02:16,390 --> 00:02:20,870
+Cycle ومدعمه في Pressure Cycle اللي هو الـ Beep،
+
+33
+00:02:20,870 --> 00:02:26,760
+ورغم هيك المريضاللي الـ Oxygen saturation عنده bad
+
+34
+00:02:26,760 --> 00:02:32,300
+والـ والـ blood gas تبعته bad بكون أحسن أحطه على
+
+35
+00:02:32,300 --> 00:02:38,160
+pressure control ventilation mode اللي هو الـ BCV
+
+36
+00:02:38,160 --> 00:02:42,700
+عشان أحسن ال oxygenation عنده فإن ال pressure
+
+37
+00:02:42,700 --> 00:02:43,140
+level
+
+38
+00:02:45,780 --> 00:02:52,000
+«I-E Ratio Must Be Selected» لازم في الـ «PCV»
+
+39
+00:02:52,000 --> 00:02:57,700
+يكون محدد «I-E Ratio» طبعا الـ «Tidal Volume»
+
+40
+00:02:57,700 --> 00:03:01,460
+بيختلف يا جماعة في كل نفس مع إيش، مع الـ pressure
+
+41
+00:03:01,460 --> 00:03:05,020
+اللي داخل الـ lung «Cedation» and «Use of
+
+42
+00:03:05,020 --> 00:03:07,120
+neuromuscular block agents are frequently
+
+43
+00:03:07,120 --> 00:03:10,540
+indicated» عادة في الحالات هذه يفضل أن يكون المريض
+
+44
+00:03:10,540 --> 00:03:14,750
+إيش، ماخد «Cedation» ومرتاحمن الـ advantage تبع
+
+45
+00:03:14,750 --> 00:03:16,670
+الـ reduction of peak pressure and therefore دا
+
+46
+00:03:16,670 --> 00:03:22,530
+risk of paratrauma مافيش عادة لأنه احنا هنا احنا
+
+47
+00:03:22,530 --> 00:03:25,750
+أصلا شغالين على ال pressure فإنه يصير paratrauma،
+
+48
+00:03:25,750 --> 00:03:28,750
+trauma نتيجة ال pressure لأ، لأن ال pressure هو
+
+49
+00:03:28,750 --> 00:03:31,590
+اللي بتحكم في الموضوع فمش هيسمح لل pressure إنه
+
+50
+00:03:31,590 --> 00:03:36,770
+يزيد ويعمل trauma وطبعا هذا هيحسن ال gas exchange
+
+51
+00:03:36,770 --> 00:03:42,070
+قبل ما أشرح حد أنا بدي أروح للبيمونشرح إيش الـ
+
+52
+00:03:42,070 --> 00:03:46,670
+Beep وإيش هم السباب لإن هدول عادة بنستخدمهم حتى أو
+
+53
+00:03:46,670 --> 00:03:49,130
+الـ Beep بالذات اللي بنستخدمه مع الـ Volume
+
+54
+00:03:49,130 --> 00:03:52,630
+Control اللي حكينا معهم واللي أشهرهم الـ S-IMV
+
+55
+00:03:52,630 --> 00:03:58,570
+يعني بنكون حاطين S-IMV وبنكون حاطين بيب لذلك الـ
+
+56
+00:03:58,570 --> 00:04:03,050
+Beep ما هوش mood منفصل يعني منفعش أحط المريض بس
+
+57
+00:04:03,050 --> 00:04:04,870
+على Beep يعني إيش ال mood اللي إنت حاطه؟ ما هو
+
+58
+00:04:04,870 --> 00:04:07,790
+الله أحطه على Beep؟ لأ، فيش، Beep بتكون حاطه إنت
+
+59
+00:04:07,790 --> 00:04:15,900
+علىاس IMV أو BCV يعني وحطته بيب خمسة بيب تلاتة
+
+60
+00:04:15,900 --> 00:04:19,820
+فإيش هو ال بيب هذا ال بيب هو ال positive end
+
+61
+00:04:19,820 --> 00:04:26,620
+expiratory pressure positive end expiratory
+
+62
+00:04:26,620 --> 00:04:32,180
+pressure إيش يعني positive end يعني يعني إن تكون
+
+63
+00:04:32,180 --> 00:04:37,400
+نهاية ال expiration عندك نهاية موجبة إيش يعني
+
+64
+00:04:37,400 --> 00:04:44,190
+نهاية موجبة؟يعني احنا بناخد نفس ونطلق
+
+65
+00:04:44,190 --> 00:04:48,090
+النفس في الطبيعي لما احنا بناخد النفس يا جماعة
+
+66
+00:04:48,090 --> 00:04:54,990
+عشان ناخد النفس لازم يسير أو يكون الضغط داخل
+
+67
+00:04:54,990 --> 00:04:58,710
+الـTorsion Cavity أقل من الضغط تبع الهواء الجو
+
+68
+00:04:58,710 --> 00:05:04,500
+وإلا مش ها ينزل الهواءلداخل رئتين ليش؟ لأن هو
+
+69
+00:05:04,500 --> 00:05:08,160
+بينتقل من الضغط الأعلى للضغط الأقل فلازم يكون أنا
+
+70
+00:05:08,160 --> 00:05:14,860
+عند الضغط أقل عشان أقدر أخد نفس ينزلي من الضغط
+
+71
+00:05:14,860 --> 00:05:23,060
+الأعلى للضغط الأقل يعني معناه أنه أنا بعد ما
+
+72
+00:05:23,060 --> 00:05:29,340
+أعمل expiration أخدت
+
+73
+00:05:29,340 --> 00:05:37,170
+inspirationزاد الضغط في الـ «رقتين» عندي، مش هيك؟
+
+74
+00:05:37,170 --> 00:05:41,810
+خدت كمية من الهواء الـ «تلات الرقتين» زاد الضغط
+
+75
+00:05:41,810 --> 00:05:46,290
+فيها، إيش بتسويب؟ ما زال زاد الضغط، صار الضغط اللي
+
+76
+00:05:46,290 --> 00:05:49,350
+عنده أكبر من ضغط الهواء الجوهر، هذا بيسمحله الهواء
+
+77
+00:05:49,350 --> 00:05:55,550
+أنه ينقل من صدري لإنص، الضغط عندي عالي، لا برا، مش
+
+78
+00:05:55,550 --> 00:06:03,960
+هيك؟ لكن بيضلوا يا جماعةالضغط اللي عندي يطلع ..
+
+79
+00:06:03,960 --> 00:06:09,660
+يطلع .. يطلع .. يطلع .. يطلع .. يطلع .. يطلع ..
+
+80
+00:06:09,660 --> 00:06:14,640
+يطلع .. يطلع
+
+81
+00:06:14,640 --> 00:06:15,500
+.. يطلع .. يطلع .. يطلع .. يطلع .. يطلع .. يطلع ..
+
+82
+00:06:15,500 --> 00:06:15,760
+يطلع .. يطلع .. يطلع .. يطلع .. يطلع .. يطلع ..
+
+83
+00:06:15,760 --> 00:06:15,900
+يطلع .. يطلع .. يطلع .. يطلع .. يطلع .. يطلع ..
+
+84
+00:06:15,900 --> 00:06:16,260
+يطلع .. يطلع .. يطلع .. يطلع .. يطلع .. يطلع ..
+
+85
+00:06:16,260 --> 00:06:25,920
+يطلع .. يطلع .. يطلع .. يطلع ..
+
+86
+00:06:25,920 --> 00:06:31,340
+يطلعت النفس، اذا انا في الـ Normal عادة بعد كل نفس
+
+87
+00:06:31,340 --> 00:06:35,920
+باخده باخد النفس و بضل ناخد في النفس لما ال
+
+88
+00:06:35,920 --> 00:06:39,180
+pressure يزيد و يزيد و يزيد و يزيد و يزيد و يزيد و
+
+89
+00:06:39,180 --> 00:06:39,680
+يزيد و يزيد و يزيد و يزيد و يزيد و يزيد و يزيد و
+
+90
+00:06:39,680 --> 00:06:39,780
+يزيد و يزيد و يزيد و يزيد و يزيد و يزيد و يزيد و
+
+91
+00:06:39,780 --> 00:06:39,840
+يزيد و يزيد و يزيد و يزيد و يزيد و يزيد و يزيد و
+
+92
+00:06:39,840 --> 00:06:45,220
+يزيد و يزيد و يزيد و يزيد
+
+93
+00:06:45,220 --> 00:06:54,400
+و
+
+94
+00:06:55,830 --> 00:06:57,790
+الآن نحن على الـ «فنتليتور»
+
+95
+00:06:57,790 --> 00:07:12,150
+الوكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليك
+
+96
+00:07:27,790 --> 00:07:32,310
+ماضلّي اطلّع لما أوصل للسالد أقل من الهواء الجوي
+
+97
+00:07:32,310 --> 00:07:38,910
+لأ اخدت النفس بدي اطلّع نص الطريق و اخد نفس يعني
+
+98
+00:07:38,910 --> 00:07:43,170
+النهاية موجبة لسه قبل ما توصل للهواء الجوي اخد نفس
+
+99
+00:07:43,170 --> 00:07:49,810
+تاني إذا القصة هي إننا بدنا المريض يظل عنده كمية
+
+100
+00:07:55,280 --> 00:08:01,460
+يظل عنده كمية هوة residual في الرقتين تجعله يتمكن
+
+101
+00:08:01,460 --> 00:08:06,160
+من أن يأخذ الـInspiration تاني قبل ما يعمل كل
+
+102
+00:08:06,160 --> 00:08:09,980
+الـExpiration أو قبل ما يعمل الـExpiration لكل
+
+103
+00:08:09,980 --> 00:08:13,640
+كمية الهوة اللي كانت في الرقتين اللي هتجعله يوصل
+
+104
+00:08:13,640 --> 00:08:18,180
+للـNegative Pressure لأ، في نص يعني يظل كمية هوة
+
+105
+00:08:18,180 --> 00:08:21,800
+بحيث يرجع ياخد نفسه هو لسه في الـPositive قبل ما
+
+106
+00:08:21,800 --> 00:08:29,060
+يتعادلتمام، هذا هو الـ B إذا بنلخص، بنقول الـ B
+
+107
+00:08:29,060 --> 00:08:32,140
+referred to the use of an elevated pressure during
+
+108
+00:08:32,140 --> 00:08:36,120
+the end of expiratory phase في مرحلة الـ
+
+109
+00:08:36,120 --> 00:08:40,680
+expiratory phase تبعت
+
+110
+00:08:40,680 --> 00:08:44,890
+الـ lungأنا مابديش المريض يوصل لـ negative
+
+111
+00:08:44,890 --> 00:08:48,830
+pressure بدي يظل اندريزيدي و ليرجع ياخد نفس تاني
+
+112
+00:08:48,830 --> 00:08:52,490
+it is not a standalone mood مابنحطش لحاله but it's
+
+113
+00:08:52,490 --> 00:08:55,970
+used in conjunction with other mood as SMB يعني
+
+114
+00:08:55,970 --> 00:09:00,490
+كون المرضي على SMB وحاطينه بيب خمسة مثلا إيش يعني
+
+115
+00:09:00,490 --> 00:09:03,270
+خمسة؟ يعني ال pressure اللي بديت تعمله كل متر هو
+
+116
+00:09:03,270 --> 00:09:08,250
+اللي بيضطل خمسة، خمسة بار when beep is applied to
+
+117
+00:09:08,250 --> 00:09:11,950
+spontaneously breathe patient the mood called CBAP
+
+118
+00:09:13,620 --> 00:09:19,040
+يعني لما أنا بحط للمريض بيب «continuous»
+
+119
+00:09:19,040 --> 00:09:23,880
+«continuous» بيب، إيش يعني سيباب؟ «continuous
+
+120
+00:09:23,880 --> 00:09:26,560
+positive end expiratory pressure» يعني أنا بحط
+
+121
+00:09:26,560 --> 00:09:30,420
+للمريض «continuous» بيب بس بخل المريض ياخد الـ
+
+122
+00:09:30,420 --> 00:09:34,740
+tidal volume اللي هو بدويا و ال rate اللي هو
+
+123
+00:09:34,740 --> 00:09:38,080
+بدويا، إيش يعني؟ يعني أنا مابديوش ولا tidal volume
+
+124
+00:09:38,080 --> 00:09:43,950
+ولا rateبس محافظته على كمية من الهواء بعد كل مرة
+
+125
+00:09:43,950 --> 00:09:47,270
+ما هو بيعمل X-Biration اتضال كمية من الهواء
+
+126
+00:09:47,270 --> 00:09:50,510
+residual في الـLungs بحيث يعمل النفس اللي بعده
+
+127
+00:09:50,510 --> 00:09:55,570
+فيكون عليه أسهل فيكون عليه أسهل زي واحد بده ينفخ
+
+128
+00:09:55,570 --> 00:10:01,630
+بلون من السفر كده بده جهود وواحد بده ينفخ بلون
+
+129
+00:10:01,630 --> 00:10:08,470
+نفقه نفسنا نص تنفيسة وقلنا له انفخ تاني كده بده
+
+130
+00:10:08,470 --> 00:10:08,810
+جهود
+
+131
+00:10:11,880 --> 00:10:15,920
+طبعاً، هذا الهواء يعمل كسبابة بإقلام عمل الهواء في
+
+132
+00:10:15,920 --> 00:10:22,340
+الهواء ويساعد في الحفاظ على القوة الواضحة، طبعاً،
+
+133
+00:10:22,340 --> 00:10:24,460
+هذا الهواء يعمل كسبابة بإقلام عمل الهواء في الهواء
+
+134
+00:10:24,460 --> 00:10:25,160
+ويساعد في الحفاظ على القوة الواضحة، طبعاً، هذا
+
+135
+00:10:25,160 --> 00:10:25,340
+ويساعد في الحفاظ على القوة الواضحة، طبعاً، هذا
+
+136
+00:10:25,340 --> 00:10:28,120
+الهواء يعمل كسبابة بإقلام عمل الهواء في الهواء،
+
+137
+00:10:28,120 --> 00:10:38,240
+طبعاً، هذا الهواء يعمل كسبابة بإقلام عوهكذا تقوم
+
+138
+00:10:38,240 --> 00:10:44,160
+بالتحرير فيناسية وتعود تحرير الحرارة تتقلل حركة
+
+139
+00:10:44,160 --> 00:10:47,100
+الحرارة من حركة الحرارة لحركة الحرارة لحركة
+
+140
+00:10:47,100 --> 00:10:47,860
+الحرارة لحركة الحرارة لحركة الحرارة لحركة الحرارة
+
+141
+00:10:47,860 --> 00:10:49,560
+لحركة الحرارة لحركة الحرارة لحركة الحرارة لحركة
+
+142
+00:10:49,560 --> 00:10:51,960
+الحرارة لحركة الحرارة لحركة الحرارة لحركة الحرارة
+
+143
+00:10:51,960 --> 00:10:54,800
+لحركة الحرارة لحركة الحرارة لحركة الحرارة لحركة
+
+144
+00:10:54,800 --> 00:10:55,200
+الحرارة لحركة الحرارة لحركة الحرارة لحركة الحرارة
+
+145
+00:10:55,200 --> 00:11:03,320
+لحركة الحرارة لحركة الحرارة لحركة الحرارة ل
+
+146
+00:11:12,430 --> 00:11:16,490
+بالفعل مش هحطلهم high B الناس اللي عندهم severe
+
+147
+00:11:16,490 --> 00:11:20,590
+hypotension بالفعل مش هحطلهم high B high level of
+
+148
+00:11:20,590 --> 00:11:26,370
+B كان used ونحطه على ستة، سبعة، تمانية for
+
+149
+00:11:26,370 --> 00:11:30,810
+patients with ARDS، COPD بالمناورة القديمة لكن إنه
+
+150
+00:11:30,810 --> 00:11:33,630
+complication إنه decrease in systematic venous
+
+151
+00:11:33,630 --> 00:11:37,350
+return هجلل الـsystematic venous return وبالتالي
+
+152
+00:11:37,350 --> 00:11:39,750
+عشان هيك الناس اللي عندهم head trauma إذا بتجلل
+
+153
+00:11:39,750 --> 00:11:44,750
+الvenous return هصيربرنقدينة عشان هيك مابحطش high
+
+154
+00:11:44,750 --> 00:11:48,950
+beat مع الناس اللي عندها head trauma بالمونة
+
+155
+00:11:48,950 --> 00:11:52,050
+باراتروما can be caused result from hyperinflation
+
+156
+00:11:52,050 --> 00:11:59,530
+of alveoli past the rupture point يعني احتمالية
+
+157
+00:11:59,530 --> 00:12:03,680
+انه يصير باراتروماوالدة مع الـ «high people» لأ
+
+158
+00:12:03,680 --> 00:12:07,100
+لأن الـ pressure عالي اللي انت حاطط في الـ I.V.L
+
+159
+00:12:07,100 --> 00:12:11,800
+.I. يعني كمية الهواء عاملها inflation أكتر من اللي
+
+160
+00:12:11,800 --> 00:12:20,660
+هي ممكن تتحملها وبالتالي ممكن الـ rupture السيباب،
+
+161
+00:12:20,660 --> 00:12:26,620
+روحنا السيباب، حكينا عن السيباب بس أعتقد فيه slide
+
+162
+00:12:26,620 --> 00:12:27,420
+منفصلة له
+
+163
+00:12:33,150 --> 00:12:36,330
+طيب، هو حاكة عن السيباب في نفس الـ «سلايد» هذه زي
+
+164
+00:12:36,330 --> 00:12:39,470
+ما حكينا هو السيباب وهو عبارة عن continuous beep
+
+165
+00:12:39,470 --> 00:12:44,450
+هو الـ mode of ventilation ما بنطيش، ما بنحطش في
+
+166
+00:12:44,450 --> 00:12:48,210
+السيباب rate ال rate اللي باخده المريض هو ال rate
+
+167
+00:12:48,210 --> 00:12:50,430
+ال tidal volume اللي باخده المريض هو ال tidal
+
+168
+00:12:50,430 --> 00:12:55,170
+volume بس احنا بكون حاطين ال beep تبع المريض وبكون
+
+169
+00:12:56,050 --> 00:12:59,710
+الكمية الهواء اللي بده يخدها المريض هو بده يحددها
+
+170
+00:12:59,710 --> 00:13:03,010
+بس من علنا الهواء فبالتالي الـ Off-IO2 لازم يكون
+
+171
+00:13:03,010 --> 00:13:06,170
+احنا الـ Oxygen Fracking قداش الهواء فيه Oxygen
+
+172
+00:13:06,170 --> 00:13:13,190
+قداش الهواء اللي بده يخشه المريض تركيز الـ Oxygen
+
+173
+00:13:13,190 --> 00:13:19,490
+فيه 30%، 40%، 50%، هذا من علنا، okay؟
+
+174
+00:13:24,560 --> 00:13:29,460
+الآن نشوف إيش الـ Pressure هدول الـ Modes المهمة
+
+175
+00:13:29,460 --> 00:13:32,560
+جداً في الـ Pressure مودي البيب والسباب أنواع
+
+176
+00:13:32,560 --> 00:13:37,500
+تانية اللي حكينا عنها المودي الأولاني اللي حكيناها
+
+177
+00:13:38,760 --> 00:13:44,480
+هذه السبب، هذه السبب، حكينا عنه كل ما هو مطلوب إنه
+
+178
+00:13:44,480 --> 00:13:49,260
+الـ «mode of ventilation» والهدف
+
+179
+00:13:49,260 --> 00:13:54,700
+منه إن أنا أعمل الـweaning للمريض، الـprocess، وهو
+
+180
+00:13:54,700 --> 00:14:00,230
+عبارة عن continuous period، تمام؟الـMode الأولى
+
+181
+00:14:00,230 --> 00:14:02,770
+اللي حكينا عنه طبعاً الـPressure Control
+
+182
+00:14:02,770 --> 00:14:06,370
+Ventilation Mode حكينا عنه كويس كتير مع الناس
+
+183
+00:14:06,370 --> 00:14:09,870
+طبعاً بده Sedation ومع الناس اللي هي الـLung
+
+184
+00:14:09,870 --> 00:14:16,070
+Compliance عندها decreased الـPressure Support
+
+185
+00:14:16,070 --> 00:14:17,050
+Ventilation
+
+186
+00:14:24,660 --> 00:14:28,880
+الـ Pressure Support Ventilation BSV
+
+187
+00:14:34,610 --> 00:14:39,050
+بنبدأ نحكي عن نمود مساعد للـCBAP يعني مثلا ممكن
+
+188
+00:14:39,050 --> 00:14:45,230
+نكون المريض على SINV ونحطه على اللي هو BSV يعني
+
+189
+00:14:45,230 --> 00:14:50,330
+Assistant لـSINV عشان بنحضر المريض ونحطه على CBAP
+
+190
+00:14:50,330 --> 00:14:54,030
+طب هو إيش بيسوي أصلا؟ هو بيدل المريض Spontaneously
+
+191
+00:14:54,030 --> 00:15:00,340
+أو المريض Spontaneously لحالهبكون قادر ياخد الـ
+
+192
+00:15:00,340 --> 00:15:04,600
+Predetermined tidal volume بس على طول يظلوا يعني
+
+193
+00:15:04,600 --> 00:15:10,280
+كمية من الهواء الصغيرة تظل ماشية في الـ lung
+
+194
+00:15:10,280 --> 00:15:13,660
+عملاله support The patient breathes spontaneously
+
+195
+00:15:13,660 --> 00:15:16,180
+while the ventilator applies a predetermined
+
+196
+00:15:16,180 --> 00:15:20,020
+amount of positive pressure عن طريق كمية الهواءto
+
+197
+00:15:20,020 --> 00:15:23,820
+the airway of bone inspiration خلال عملية النفس طب
+
+198
+00:15:23,820 --> 00:15:27,380
+هذا إيش بتفيدني يعني؟ بتفيد إن المريض بيكون بتنفس
+
+199
+00:15:27,380 --> 00:15:30,140
+spontaneous بس الـ tidal volume اللي بياخده قليل
+
+200
+00:15:30,140 --> 00:15:33,920
+بياخدش إلا 200 CC و أنا بدأ أبدأ أجهزه عشان ينفصل
+
+201
+00:15:33,920 --> 00:15:38,000
+و يصير ياخد إيش enough tidal volume و rate لحاله
+
+202
+00:15:38,000 --> 00:15:41,620
+هو بياخد عدد مرات تنفس ربما كويسات بس في كل مرة
+
+203
+00:15:41,620 --> 00:15:45,420
+الكبسيس تبعت ال lung قليلة بياخدله بس 200 CC فانا
+
+204
+00:15:45,420 --> 00:15:50,080
+بدأ أزود ال inflation فبقعدته علىأو SV فبصير
+
+205
+00:15:50,080 --> 00:15:55,120
+المريض ياخد له ايش كمان صارت 400 مثلا 350 شوية
+
+206
+00:15:55,120 --> 00:15:58,640
+شوية بيبدأ يتحسن لو يزود كمية الـ tidal volume
+
+207
+00:15:58,640 --> 00:16:03,080
+اللي بياخدها لحاله بروح انا و انا بعدها حاطه على
+
+208
+00:16:03,080 --> 00:16:06,280
+سيباب ساعتها بيكون بياخد complete rate لحاله و
+
+209
+00:16:06,280 --> 00:16:09,080
+complete tidal volume لحاله لكن انا في الفترة اللي
+
+210
+00:16:09,080 --> 00:16:14,090
+فاتت كنت ساعته انه يصير في عنده شويةإنفلاشيا للـ
+
+211
+00:16:14,090 --> 00:16:18,250
+lung هذا الـ pressure support ventilation ال
+
+212
+00:16:18,250 --> 00:16:22,270
+advantage تبعته طبعا أن ال patient comfort because
+
+213
+00:16:22,270 --> 00:16:27,130
+of less of اللي هو working of breathing than
+
+214
+00:16:27,130 --> 00:16:30,050
+spontaneous breathing يعني ال work of breathing مش
+
+215
+00:16:30,050 --> 00:16:33,430
+لحاله هو يعني مش spontaneous فيه إشي بيساعده كان
+
+216
+00:16:33,430 --> 00:16:36,810
+used with SMD to support spontaneous breathing و
+
+217
+00:16:36,810 --> 00:16:42,210
+عادة حكينا أنهالذي يمكن استخدامه للتبادل مع الـ
+
+218
+00:16:42,210 --> 00:16:48,010
+CBAP اللي هو الـ «before» اللي هو الـ «mask» فالـ
+
+219
+00:16:48,010 --> 00:16:51,230
+«CBAP» ببساطة كان مستمرًا مستمرًا مع الـ «باسلين»
+
+220
+00:16:51,230 --> 00:16:54,890
+والضغط كان عالقًا فوق الزيرو «Baseline pressure»
+
+221
+00:16:54,890 --> 00:16:57,790
+الحكي هنا في الـ «CBAP» يكون فوق الـ «زيرو»
+
+222
+00:17:01,660 --> 00:17:06,420
+الـ Pressure أو الـ Beam حكينا عنه already الـ Non
+
+223
+00:17:06,420 --> 00:17:08,560
+-invasive Bilateral Positive Airway Pressure
+
+224
+00:17:08,560 --> 00:17:12,120
+Ventilation الـ Non-invasive Bilateral Positive
+
+225
+00:17:12,120 --> 00:17:14,340
+Airway Pressure Ventilation يا جماعة زمان كان
+
+226
+00:17:14,340 --> 00:17:22,800
+بيسموه CBAP Mask عبارة عن Mask بتنحط للمريض وبنحط
+
+227
+00:17:22,800 --> 00:17:26,630
+الجهاز على CBAPإيش يعني؟ يعني إحنا مش عاملين
+
+228
+00:17:26,630 --> 00:17:31,090
+Invasive إنه يعني حطين تيوب وننفخ هوا في المريض،
+
+229
+00:17:31,090 --> 00:17:33,290
+لأ إحنا بس محافظين على ال pressure طب ما إحنا
+
+230
+00:17:33,290 --> 00:17:35,530
+عارفين إنه في السيباب المريض هو المفروض إنه بياخد
+
+231
+00:17:35,530 --> 00:17:38,830
+الـ tidal volume لحاله، إذن هياخد ال tidal volume
+
+232
+00:17:39,750 --> 00:17:42,250
+والـ «Rate» اللي هو بدهيه بس اللهم إنه إحنا
+
+233
+00:17:42,250 --> 00:17:45,110
+محافظينه على الـ «Pressure» يضله «Closed Cycle»
+
+234
+00:17:45,110 --> 00:17:48,410
+والـ «Pressure» هيضله كل مرة فيه عنده شوية
+
+235
+00:17:48,410 --> 00:17:51,810
+Residual إحنا محافظينه، مش السبب هو «Continuous
+
+236
+00:17:51,810 --> 00:17:54,630
+Beat» فإحنا فيه «Continuous Beat» بضايلين عند
+
+237
+00:17:54,630 --> 00:17:58,830
+المريض على طول التطور الموضوع هذا بدل ما يكون بده
+
+238
+00:17:58,830 --> 00:18:04,950
+جهاز Ventilator وبده «Closed Mask» مسكرة على كل
+
+239
+00:18:04,950 --> 00:18:08,910
+المريض، لأ إنه ممكن عن طريق الـ «Nose» أو عن طريق
+
+240
+00:18:10,070 --> 00:18:17,010
+اللي هو ماسك خصوص لأنه nasal mask ندّي للمريض حاجة
+
+241
+00:18:17,010 --> 00:18:21,470
+بنسميها اللي هو الـ IPAP An Inspiratory Pressure
+
+242
+00:18:21,470 --> 00:18:26,250
+Support Level اللي هو أنا أعمله بيب جوا داخلي بحيث
+
+243
+00:18:26,250 --> 00:18:31,260
+أنه يساعد المريض في كل مرة يأخذ النفس التانيعن
+
+244
+00:18:31,260 --> 00:18:34,660
+طريق الـ pressure اللي already موجود اللي عمله الـ
+
+245
+00:18:34,660 --> 00:18:37,120
+BEEP ومن غير invasive من غير اكون حاطط
+
+246
+00:18:37,120 --> 00:18:40,580
+endotracheal tube كتير كويس مع مين هذا مع الناس
+
+247
+00:18:40,580 --> 00:18:43,580
+اللي بيصير عندهم hyperventilation syndrome فجأة هو
+
+248
+00:18:43,580 --> 00:18:49,340
+نايم او apnea syndrome بتوقف عن النفس الناس اللي
+
+249
+00:18:49,340 --> 00:18:52,560
+عندهم lung fire process الناس اللي عندهم ادولة
+
+250
+00:18:52,560 --> 00:18:55,900
+كانوا كل يوم مضمضلهم في المستشفى في ال ICU عشان
+
+251
+00:18:55,900 --> 00:19:00,710
+خاطر هو بيصير عنده apneaفجأة أو بيصير عنده
+
+252
+00:19:00,710 --> 00:19:04,970
+hyperventilation فجأة فلأ لما بينام كل ما عنده
+
+253
+00:19:04,970 --> 00:19:09,290
+النوم بالذات بيصير عنده sleep apnea مثلا في ناس
+
+254
+00:19:09,290 --> 00:19:11,510
+كتير عندهم sleep apnea عندما بينام بيصير معاه
+
+255
+00:19:11,510 --> 00:19:15,650
+apnea فعندما بينام لأ بنحطه على ال .. ال .. ال ..
+
+256
+00:19:15,650 --> 00:19:22,820
+ال .. ال بي باب أو ال اي بابأو sleep apnea mask و
+
+257
+00:19:22,820 --> 00:19:26,800
+بنخلّي يظل طول اللي نام هو عليها فهو كل ما بيخش في
+
+258
+00:19:26,800 --> 00:19:31,400
+sleep apnea الجهاز
+
+259
+00:19:31,400 --> 00:19:33,560
+بيحافظه على كيمية الـ pressure دي هو فما بيخشش
+
+260
+00:19:33,560 --> 00:19:36,820
+أصلا فيها و بيضلوا يتنفس لأنه مافيش ولا مرة بيكون
+
+261
+00:19:36,820 --> 00:19:43,840
+عنده بطل فيه نفس خالص وبالتالي هذه كتير كويسة
+
+262
+00:19:43,840 --> 00:19:47,740
+للناس اللي عندهم chronic fibrosis أو stress بـCOPD
+
+263
+00:19:47,740 --> 00:19:52,790
+أو lung fibrosis أو sleep apneaوفكرتها سهل لو
+
+264
+00:19:52,790 --> 00:19:58,310
+بتمنع الـ Recurrent Admission بسبب أبناء الـ
+
+265
+00:19:58,310 --> 00:20:02,410
+Ventilation حكيتلكم إن في حد اسمه Non-invasive
+
+266
+00:20:02,410 --> 00:20:06,310
+Historically أه لكن حديثا برضه صار يستخدموه زي هذا
+
+267
+00:20:06,310 --> 00:20:11,470
+المنظر هذا الجهاز بيعمل support زي ما انتوا شايفين
+
+268
+00:20:11,470 --> 00:20:16,370
+من حوالين الـLung وبيعمل زي ما انتوا شايفين هذا
+
+269
+00:20:16,370 --> 00:20:21,610
+بلون كأنه أه والهواء اللي فيه بيزيدوبيقل، لما
+
+270
+00:20:21,610 --> 00:20:24,110
+بيزيد، بيزيد ال pressure فبيعمل pressure على ال
+
+271
+00:20:24,110 --> 00:20:27,590
+lung فبالتالي أنت بتعمل expiration لما بيقل الهواء
+
+272
+00:20:27,590 --> 00:20:34,270
+اللي فيه بتروح أنت إيش؟ لما بيقل الهواء اللي فيه
+
+273
+00:20:34,270 --> 00:20:38,250
+بتروح أنت بتعمل relaxation فبتعمل inspiration فهو
+
+274
+00:20:38,250 --> 00:20:42,450
+فكرة قديمة إجت من ال iron lung هي شكل ال iron lung
+
+275
+00:20:42,450 --> 00:20:47,960
+يعني هيك بتتوقع كانت زمان شكل ال ICUاللي هي فكرة
+
+276
+00:20:47,960 --> 00:20:51,300
+الحديثة زي ما شوفنا كيف في الأطفال، هيك تمام؟
+
+277
+00:20:51,300 --> 00:20:57,760
+وحديثا استخدموها بهذا الشكل يعني استوحوا الفكرة من
+
+278
+00:20:57,760 --> 00:21:00,920
+فكرة الـNasal Mass قالوا بدل «طب ما احنا ما زالنا
+
+279
+00:21:00,920 --> 00:21:03,000
+non-invasive، بنعمله pressure» «ما بنعمله pressure
+
+280
+00:21:03,000 --> 00:21:05,780
+برا خالص، بنرجع لفكرة الـnon-invasive»
+
+281
+00:21:09,300 --> 00:21:12,220
+البراميات عادية خلصنا ال moods تبقى ال ventilation
+
+282
+00:21:12,220 --> 00:21:15,900
+يعني انا عرفت ايش ال windows اللي بده اشتغل علي
+
+283
+00:21:15,900 --> 00:21:18,480
+اندي كمبيوتر وحطته Microsoft Office وحطيت ال
+
+284
+00:21:18,480 --> 00:21:21,980
+PowerPoint وبده ابدأ اشتغل ايش بده؟ بده ابدأ احط
+
+285
+00:21:21,980 --> 00:21:25,580
+title بعدين احط subject بعدين احط مقدمة بعدين احط
+
+286
+00:21:25,580 --> 00:21:29,020
+خاتمة فانا اخترت ال mood نفترض ان ال mood اللي
+
+287
+00:21:29,020 --> 00:21:32,520
+عندي اس IMV والمood التاني اللي بده احطه support
+
+288
+00:21:32,520 --> 00:21:36,460
+هو ال beepطب إيش بالبيب؟ أوكي بدأ أحط مثلا المريض
+
+289
+00:21:36,460 --> 00:21:39,680
+يديه بيب عادي، إيه له؟ Normal، بيب يعني، من تلاتة
+
+290
+00:21:39,680 --> 00:21:42,900
+لخمسة is normal طب الـ SINV إيش هي ال parameters
+
+291
+00:21:42,900 --> 00:21:46,200
+اللي أنا لازم أحط عشان ال parameter اللي الـ SINV
+
+292
+00:21:46,200 --> 00:21:50,200
+يشتغل؟ أول حاجة بدأ أحط الـ FIO2 الـ Oxygen
+
+293
+00:21:50,200 --> 00:21:53,660
+Fraction زي ما حكينا الهواء الطبيعي الـ Ambient
+
+294
+00:21:53,660 --> 00:21:59,150
+Air فيه 21% هواءلكن المريض عادةً الـ Oxygen Demand
+
+295
+00:21:59,150 --> 00:22:05,170
+عنده أكتر فبحطه من 40 ل 60% لأنه أكتر من هيك هيكون
+
+296
+00:22:05,170 --> 00:22:08,030
+بعرض المريض لـ Oxygen Toxicity
+
+297
+00:22:16,970 --> 00:22:21,750
+هذا بالنسبة للـ FIO2 الـ Parameters التانية اللي
+
+298
+00:22:21,750 --> 00:22:25,290
+هو الـ tidal volume الـ tidal volume يعني زي ما
+
+299
+00:22:25,290 --> 00:22:33,230
+حكينا أنه هو عبارة عن كمية الهواء اللي المريض يريد
+
+300
+00:22:33,230 --> 00:22:36,710
+ياخدها في كل inhalation is in the volume of air
+
+301
+00:22:36,710 --> 00:22:39,270
+delivered to patients during a ventilator with
+
+302
+00:22:39,270 --> 00:22:44,600
+each present breath مع كل نفسمع كل نفس، مش في كل
+
+303
+00:22:44,600 --> 00:22:49,160
+دقيقة، تمام؟ وطبعاً حكينا بكل بساطة هو من ستة
+
+304
+00:22:49,160 --> 00:22:53,720
+لتمانية ملي لتر لكل كيلو جرام يعني مكتوب هنا سبعة
+
+305
+00:22:53,720 --> 00:22:58,540
+على تسعة اللي هو من ستة لتمانية ملي لتر لكل كيلو
+
+306
+00:22:58,540 --> 00:23:03,180
+جرام body weight هذا هو ال volume المناسب يعني لو
+
+307
+00:23:03,180 --> 00:23:11,730
+واحد وزنه جماعة سبعين كيلو جرام سبعين في تمانيةهو
+
+308
+00:23:11,730 --> 00:23:18,090
+تقدر الـ Volume المناسب طب لو واحد وزنه مائة، مائة
+
+309
+00:23:18,090 --> 00:23:23,150
+وعشرين، مائة وعشرين كيلو جرام، مائة وعشرين ضرب
+
+310
+00:23:23,150 --> 00:23:29,040
+تمانية، لأ، مش صحيحليش؟ لأننا نتعامل مع الـ Ideal
+
+311
+00:23:29,040 --> 00:23:32,520
+Body Weight، يعني هو المفروض أكم يكون وزنه، يعني
+
+312
+00:23:32,520 --> 00:23:37,220
+لما بيجي المريض و وزنه 120، بتعملش علشان أنه وزنه
+
+313
+00:23:37,220 --> 00:23:40,840
+120، بتطلع هو المفروض البني أدم هذا يكون وزنه حسب
+
+314
+00:23:40,840 --> 00:23:43,540
+طوله طبعا، كام؟
+
+315
+00:23:57,210 --> 00:24:03,550
+عشان نتعامل مع الـ Ideal Body Weight بالنسبة للـ
+
+316
+00:24:03,550 --> 00:24:08,060
+Peak Flow يعنيوالـ Flow Rate يعني الـ Pressure أو
+
+317
+00:24:08,060 --> 00:24:13,800
+الـ ال .. يعني ال .. الـ Flow of Gas used to
+
+318
+00:24:13,800 --> 00:24:18,160
+deliver each mechanical brief to the patient الـ
+
+319
+00:24:18,160 --> 00:24:23,840
+Flow، معدل الانسياب اللي جاي فيه الهواء للمريض
+
+320
+00:24:25,240 --> 00:24:29,040
+المفروض قداش بيبقى كيا بس بييدها، شايف كيف؟ سرعة
+
+321
+00:24:29,040 --> 00:24:32,400
+of delivering air per unit of time and is
+
+322
+00:24:32,400 --> 00:24:36,100
+expressed in liters per minute أقوى، اخد بالي،
+
+323
+00:24:36,100 --> 00:24:42,300
+يعني مثلا اما أنا بحكي أنه أنا مثلا بدنا المريض
+
+324
+00:24:42,300 --> 00:24:45,200
+على ال flow rate أربعة liters per minute
+
+325
+00:24:45,200 --> 00:24:48,140
+individual أديكوا to maintain oxygen saturation
+
+326
+00:24:48,140 --> 00:24:53,160
+level من 96 ل100أنا بدي الهواء يكون ماشي بسرعة
+
+327
+00:24:53,160 --> 00:24:59,420
+أربعة أو بـFlow بمعدل انسياب أربعة لتر في الدقيقة
+
+328
+00:24:59,420 --> 00:25:07,020
+عشان أنا أخد منه خمسمية كل نفس500 مليلتر في النفس
+
+329
+00:25:07,020 --> 00:25:13,660
+بس كيف معدل سرعة انسيابهم سريع؟ قداش معدل انسيابهم
+
+330
+00:25:13,660 --> 00:25:18,460
+ما معدل انه يعدي 4 لتر في خلال الدقيقة اه عزيزي
+
+331
+00:25:18,460 --> 00:25:22,500
+انا بتحكم كأني بتحكم في سرعة دخول الهواء كيف يكون
+
+332
+00:25:22,500 --> 00:25:28,040
+الضخم تبع كمية الضخم عالية ولا واطية ولا اكم انا
+
+333
+00:25:28,040 --> 00:25:35,180
+بحدد ال rate عالية نستخدم من 2 ل4 لتر per literبير
+
+334
+00:25:35,180 --> 00:25:41,660
+مينيت The higher the flow rate the faster big air
+
+335
+00:25:41,660 --> 00:25:45,280
+way pressure is reached and the shorter the
+
+336
+00:25:45,280 --> 00:25:50,880
+inspiration كل ما كان ال flow rate high كل ما أكسر
+
+337
+00:25:50,880 --> 00:25:56,220
+ال inspiration يا جماعة shorter The lower the flow
+
+338
+00:25:56,220 --> 00:25:59,400
+rate the longer the inspiration كل ما كان ال flow
+
+339
+00:25:59,400 --> 00:26:02,860
+rate low
+
+340
+00:26:03,580 --> 00:26:10,740
+والمكان الـ Inspiration أطول الـ
+
+341
+00:26:10,740 --> 00:26:13,640
+Respiratory Rate بيسموه على الأجهزة كتير الـ
+
+342
+00:26:13,640 --> 00:26:17,060
+Frequency انت بدك تاخد ال volume 500 أكم مرة عشان
+
+343
+00:26:17,060 --> 00:26:22,520
+يكي frequency فهو Respiratory Rateأكام نفس في
+
+344
+00:26:22,520 --> 00:26:27,340
+الدقيقة بدك إذا مربوط بالزمن بالدقيقة عادة بنحط
+
+345
+00:26:27,340 --> 00:26:31,960
+المرضى من عشرة لست عشر breath pair من الـ Total
+
+346
+00:26:31,960 --> 00:26:34,140
+respiratory rate equal patient rate plus
+
+347
+00:26:34,140 --> 00:26:36,440
+ventilator rate
+
+348
+00:26:40,370 --> 00:26:45,890
+الـ Respiratory Rate اللي بيدي الجهاز زاد اللي
+
+349
+00:26:45,890 --> 00:26:49,390
+بياخده المريض هو الـ Total Respiratory Rate
+
+350
+00:26:58,530 --> 00:27:04,910
+الـ Patient و الـ «COPD» و الـ Children بحتاجوا
+
+351
+00:27:04,910 --> 00:27:08,530
+تايدة الـ volume أشمل يا جماعة أقل لأن الـ lung
+
+352
+00:27:08,530 --> 00:27:12,950
+capacity تبعتهم أقل، مش هي؟ و الـ Children ال
+
+353
+00:27:12,950 --> 00:27:17,250
+weight تبعتهم أقل الناس اللي عندهم lung fibrosis
+
+354
+00:27:17,250 --> 00:27:21,890
+ال lung capacity تبعتهم أقل، اللي هو مسكرة، okay؟
+
+355
+00:27:24,200 --> 00:27:26,660
+حاجة اسمها الـ Minute Volume، من ضمن الـ
+
+356
+00:27:26,660 --> 00:27:29,460
+Parameters طب ليش؟ يعني إيش الـ Minute Volume؟ هذا
+
+357
+00:27:29,460 --> 00:27:32,520
+الـ Minute Volume هي كمية الأولة اللي بدها تخش
+
+358
+00:27:32,520 --> 00:27:36,160
+للمريض في الدقيقة، في الدقيقة، أه يعني طب ما أحنا
+
+359
+00:27:36,160 --> 00:27:39,180
+بنعرف كمية الأولة اللي بدها تخش كل نفس، في كل نفس،
+
+360
+00:27:39,180 --> 00:27:42,100
+طب وإذا المريض بياخد عشر تنفسات، يعني المريض بياخد
+
+361
+00:27:42,100 --> 00:27:45,860
+كل نفس خمسميةوالحاجة دي بتصير معاه عشر مرات في
+
+362
+00:27:45,860 --> 00:27:49,020
+الدقيقة يعني الـ minute volume خمسمية ضرب عشرة خمس
+
+363
+00:27:49,020 --> 00:27:51,760
+لتر يعني خمستلاك يعني خمس لتر هذا هو ال minute
+
+364
+00:27:51,760 --> 00:27:54,740
+volume؟ أه طب و أنا ليش أعرفه مازال أنا عارف ال
+
+365
+00:27:54,740 --> 00:27:58,100
+tidal volume وعارف ال rate؟ أه أعرفه علشان تي
+
+366
+00:27:58,100 --> 00:28:02,040
+أجهزة في تصميمها مالوش مكان لك tidal volume بيقولك
+
+367
+00:28:02,040 --> 00:28:05,560
+حط ال rate وحط ال minute volume هو خلاص بيعرف ال
+
+368
+00:28:05,560 --> 00:28:09,000
+tidal volumeأها فصار في إن هنا indication لازم
+
+369
+00:28:09,000 --> 00:28:12,360
+أحنا نكون عارفين حاجة اسمها الـMinute Volume في
+
+370
+00:28:12,360 --> 00:28:15,780
+أجهزة مافيش فيها مكان تعمل Setting للـTidal بتقضط
+
+371
+00:28:15,780 --> 00:28:18,660
+أنت الـFrequency Rate عشرة، اتناش، وكداش بدك
+
+372
+00:28:18,660 --> 00:28:21,540
+الـMinute Volume؟ تقوله والله خمسة، بيفهم إنه آه
+
+373
+00:28:21,540 --> 00:28:25,180
+بده يقسم خمسة لتر على عشر عشان يد كل الـTidal
+
+374
+00:28:25,180 --> 00:28:30,620
+Volume تمام؟ خمسة لتر على عشر هيدل خمسمية CC كل
+
+375
+00:28:30,620 --> 00:28:34,560
+one breath تمام؟ لكن في أجهزة okay فيها Tidal
+
+376
+00:28:34,560 --> 00:28:38,280
+Volume فمش فيها Minute Volume«في مستخدم بخطأ
+
+377
+00:28:38,280 --> 00:28:43,000
+الحرارة» طبعاً الـ «الكالوسوس» يمكن أن يكون
+
+378
+00:28:43,000 --> 00:28:46,800
+مطالبًا بإنجاز الـ «سيريبرال فازاكنترش» بـ «تقليل
+
+379
+00:28:46,800 --> 00:28:50,320
+رسمي» في الـICB «والسيدال فوليوم»
+
+380
+00:28:50,320 --> 00:28:55,040
+و«الرسبيروريوتيت» يتحررون لإنجاز الـ «الكالوسوس»
+
+381
+00:28:55,040 --> 00:28:59,220
+بأشواء للمستخدم» يعني يا جماعة هذا هذا الكلام يعني
+
+382
+00:28:59,220 --> 00:29:04,520
+نوعًا ما الآن مع الناس اللي تعون الـ Head injury
+
+383
+00:29:04,520 --> 00:29:12,970
+بطلوا يستخدمواكتير حكيت إنه أخلي المريض الـ
+
+384
+00:29:12,970 --> 00:29:17,410
+«الكالوتك بي أتش» لأ صار «normal» «normal» blood
+
+385
+00:29:17,410 --> 00:29:21,670
+gas is required يعني الآن صاروا بيعتمدوا على إنه
+
+386
+00:29:21,670 --> 00:29:27,270
+يخلوا الـ blood gas normal وما يقللوش الـ «CO2» زي
+
+387
+00:29:27,270 --> 00:29:37,150
+زمان يعني هذه الشيء شوفوا اللي هوبين المستخدم الـ
+
+388
+00:29:37,150 --> 00:29:40,410
+COPD يعني في الـ patient اللي تبعون الـ COPD
+
+389
+00:29:40,410 --> 00:29:44,030
+Baseline ABG reflect and elevated BCO2 should not
+
+390
+00:29:44,030 --> 00:29:47,790
+hyperventilated instead the goal should be
+
+391
+00:29:47,790 --> 00:29:51,450
+restoration of the baseline BCO2 في الناس اللي
+
+392
+00:29:51,450 --> 00:29:57,180
+تبعون الـ COPD يا جماعةالـ «CO2» أصلا يكون عندهم
+
+393
+00:29:57,180 --> 00:30:02,880
+عالي فاحنا ما بنـ... ما بنـ... ما بنحطوش يعني على
+
+394
+00:30:02,880 --> 00:30:06,640
+تايدة الـ volume عالي لدرجة ما إنه يصير الـ «CO2»
+
+395
+00:30:06,640 --> 00:30:12,000
+عنده واطي أه يصير hyperventilation لأن هو متعود
+
+396
+00:30:12,000 --> 00:30:15,420
+على «CO2» عالي، هذا واحد الحاجة التانية في الـ
+
+397
+00:30:15,420 --> 00:30:19,380
+«hidrotrauma» زي ما حكينا بطل يعني يفضل إنه نخلي
+
+398
+00:30:19,380 --> 00:30:26,210
+«CO2» واطي عشان نحقق شوية الكلوسيزفي حاجة اسمها
+
+399
+00:30:26,210 --> 00:30:31,330
+الـIE Ratio الـInspiratory-Expiratory Ratio
+
+400
+00:30:31,330 --> 00:30:35,910
+الـInspiratory-Expiratory Ratio يا جماعة بكل بساطة
+
+401
+00:30:35,910 --> 00:30:42,110
+إنه أنا حطيت للجهاز الـTidal Volume اللي احنا بدنا
+
+402
+00:30:42,110 --> 00:30:47,150
+نعطيه وتبرناه مثلا 500 CC في كل نفس وحكيت للجهاز
+
+403
+00:30:47,150 --> 00:30:54,530
+الـRate إنه 12 Breath Per Minuteطيب الجهاز على هذا
+
+404
+00:30:54,530 --> 00:31:01,040
+الكلام وحطت له الـ Peak Flow 4 Literعلى هذا الكلام
+
+405
+00:31:01,040 --> 00:31:04,560
+الجهاز حيف فهم إنه أوكي أنت بدك أدي 12 نفس في
+
+406
+00:31:04,560 --> 00:31:08,580
+الدقيقة فممكن في أول عشر ثوان من الدقيقة يروح يديك
+
+407
+00:31:08,580 --> 00:31:11,900
+واحد، اتنين، تلاتة، أربعة، اتناشر ويخلص ويظلوا
+
+408
+00:31:11,900 --> 00:31:18,140
+مستني خمسين ثانية بيستنى لما تيجي الدقيقة التانية
+
+409
+00:31:18,140 --> 00:31:23,080
+عشان يبدأ يشتغل إذا بدنا احنا نعمل عملية تنظيم
+
+410
+00:31:25,480 --> 00:31:28,120
+الـ Inspiration والـ Expiration طب من وين بدهم
+
+411
+00:31:28,120 --> 00:31:31,640
+يستوحى التنظيم هذا؟ وإيش بدهم يربطوه؟ بعمل الوقت
+
+412
+00:31:31,640 --> 00:31:36,840
+بدهم يربطوه بالوقت، كيف؟ قال لك إحنا في الـ Normal
+
+413
+00:31:36,840 --> 00:31:42,120
+Respiration تبعنا، كيف بنعمل؟ قال فيه Ratio لـ
+
+414
+00:31:42,120 --> 00:31:44,640
+Inspiration وExpiration، إيش الـ Ratio هذا؟
+
+415
+00:31:51,680 --> 00:31:58,340
+عملية الـ Inspiration جزء من جزئين من عملية الـ
+
+416
+00:31:58,340 --> 00:32:03,100
+Expiration يعني عملية الـ Expiration جزئين من
+
+417
+00:32:03,100 --> 00:32:04,520
+عملية الـ Inspiration
+
+418
+00:32:06,840 --> 00:32:12,980
+الـ Expiration 2 يعني إذا أنا بحتاج واحد زمن ثانية
+
+419
+00:32:12,980 --> 00:32:16,680
+واحدة للـ Inspiration بحتاج ثانيتين أعمل الـ
+
+420
+00:32:16,680 --> 00:32:21,380
+Expiration إذا أنا بحتاج two seconds ثانيتين أعمل
+
+421
+00:32:21,380 --> 00:32:26,080
+فيهم Inspiration هحتاج two ضرب two two seconds و
+
+422
+00:32:26,080 --> 00:32:31,980
+two seconds أربعة secondsالـ Expiration إذا أنا
+
+423
+00:32:31,980 --> 00:32:35,780
+إذا بحتاج جزء من الوقت للـ Inspiration بحتاج جزءين
+
+424
+00:32:35,780 --> 00:32:38,780
+يقبلوا للـ Expiration فإذا الجزء هذا كان two
+
+425
+00:32:38,780 --> 00:32:44,870
+seconds بحتاج أربعة seconds للـ Expiration طيبإذن
+
+426
+00:32:44,870 --> 00:32:48,470
+ها لو أنا روح أتعملت preset للـIE راشو في
+
+427
+00:32:48,470 --> 00:32:51,270
+الـMechanical Ventilator وحكيتله إن الـ12 نفس اللي
+
+428
+00:32:51,270 --> 00:32:55,770
+بده تدّيهم اللي كل نفس تقدر تقولهم تبقى 500 بده
+
+429
+00:32:55,770 --> 00:32:59,750
+يكون الـinspiratory time الوقت اللي بدك تعطي فيه
+
+430
+00:32:59,750 --> 00:33:06,470
+النفس، نفترض سنتين والوقت اللي بدك تسيب النفس يطلع
+
+431
+00:33:06,470 --> 00:33:14,150
+فيه أربع ثوانيبكون نظّمت عملية النفس فالـ IE Ratio
+
+432
+00:33:14,150 --> 00:33:19,710
+هذه هي العملية اللي أنا أو هذه هي الـ Setting اللي
+
+433
+00:33:19,710 --> 00:33:22,890
+بدي أنظم فيها عملية النفس بحيث أضمن إنه ضالوا 12
+
+434
+00:33:22,890 --> 00:33:26,130
+نفس أو العشر تنفسات أو ال rate اللي أنا بدي أديه
+
+435
+00:33:26,130 --> 00:33:30,690
+موزّع على دقيقة كاملة، كويس؟ بكل بصفة كيف بدي
+
+436
+00:33:30,690 --> 00:33:34,270
+أحسبه؟ بدي أحسب الـ Respiratory Rate
+
+437
+00:33:36,940 --> 00:33:45,880
+تقسيم أكم؟ تقسيم عشرين يعني مثلا لو أنا أول
+
+438
+00:33:45,880 --> 00:33:48,760
+عشرين تقسيم ال respiratory rate يعني لو أنا كان
+
+439
+00:33:48,760 --> 00:33:53,470
+فيه بدي أد المريض عشر تنفسات في الدقيقةعشر تنفسات
+
+440
+00:33:53,470 --> 00:33:58,690
+في الدقيقة عشرين تقسيم عشرة إتنين يعني المفروض أنه
+
+441
+00:33:58,690 --> 00:34:03,690
+يكون كل نفس الـinspiratory time تبعه two seconds
+
+442
+00:34:03,690 --> 00:34:08,390
+والـexpiratory four seconds، check؟ طب من وين جت
+
+443
+00:34:08,390 --> 00:34:12,570
+العشرين هذه؟ العشرين هي تلت مش عملية النفس واحد
+
+444
+00:34:12,570 --> 00:34:17,490
+إلى اتنين حكينا؟ okay يعني دقيقة كم ثانية؟ ستين
+
+445
+00:34:18,610 --> 00:34:25,230
+يعني لو بدأ أخد منها تلتها 20 إلى 40 يعني كل عملية
+
+446
+00:34:25,230 --> 00:34:29,210
+التنفس في الدقيقة بتصير في 20 ثانية وكل عملية الـ
+
+447
+00:34:29,210 --> 00:34:34,250
+Expiration كل دقيقة بتصير في 40 ثانية يعني كل
+
+448
+00:34:34,250 --> 00:34:37,750
+عملية التنفس اللي في الدقيقة بتصير في 20 ثانية
+
+449
+00:34:37,750 --> 00:34:41,630
+طبعا بتصير في الـ 20 ثانية هدول عشر التنفسات يبقى
+
+450
+00:34:41,630 --> 00:34:45,410
+20 تقسيم عشرة 20 تقسيم عشرة اتنين الـ
+
+451
+00:34:45,410 --> 00:34:46,410
+Inspirational Time
+
+452
+00:34:49,290 --> 00:34:50,070
+تو ساكنت
+
diff --git a/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/8DNlIAzpToE_raw.json b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/8DNlIAzpToE_raw.json
new file mode 100644
index 0000000000000000000000000000000000000000..7e6913d44edd4bbb09508cbfe3d063c771ed260b
--- /dev/null
+++ b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/8DNlIAzpToE_raw.json
@@ -0,0 +1 @@
+{"segments": [{"id": 1, "seek": 2124, "start": 1.62, "end": 21.24, "text": "بسم الله الرحمن الرحيم السلام عليكم ورحمة الله إن شاء الله اليوم هنكمل محاضرة تانية في محاضرة الـ Mechanical Ventilation حكينا عن الـ Volume Cycle واليوم هنحكي عن الـ Pressure Mode في الـ Mode تبعت الـ Mechanical Ventilation", "tokens": [3555, 38251, 21984, 34892, 5016, 27842, 34892, 5016, 32640, 21136, 37440, 25894, 24793, 4032, 2288, 35571, 3660, 21984, 36145, 13412, 16606, 21984, 45595, 20498, 8032, 1863, 24793, 1211, 3714, 5016, 46958, 25720, 6055, 7649, 10632, 8978, 3714, 5016, 46958, 25720, 2423, 39184, 30175, 804, 28290, 16067, 11331, 4117, 1829, 8315, 18871, 2423, 39184, 38448, 10295, 2160, 16070, 1829, 20498, 8032, 1863, 5016, 4117, 1829, 18871, 2423, 39184, 6776, 540, 20500, 8978, 2423, 39184, 20500, 6055, 3555, 34268, 2423, 39184, 30175, 804, 28290, 16067], "avg_logprob": -0.11449032915490014, "compression_ratio": 1.7905759162303665, "no_speech_prob": 1.5437602996826172e-05, "words": [{"start": 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volume 500 أكم مرة عشان يكي frequency فهو Respiratory Rate", "tokens": [2407, 45340, 41361, 2423, 39184, 32671, 7611, 5551, 9566, 12610, 2423, 39184, 5015, 9501, 4745, 49583, 4724, 1829, 38251, 2407, 3224, 15844, 16247, 7435, 3224, 11622, 3660, 9122, 2655, 13546, 2423, 39184, 6142, 48154, 16472, 2655, 47525, 4117, 6055, 47283, 3215, 2423, 5523, 5923, 5551, 24793, 3714, 25720, 6225, 8592, 7649, 7251, 4117, 1829, 7893, 6156, 3224, 2407, 5015, 9501, 4745, 49583], "avg_logprob": -0.3559027683167231, "compression_ratio": 1.3609467455621302, "no_speech_prob": 2.980232238769531e-07, "words": [{"start": 1563.58, "end": 1564.26, "word": "والمكان", "probability": 0.5410970052083334}, {"start": 1564.26, "end": 1564.44, "word": " الـ", "probability": 0.67578125}, {"start": 1564.44, "end": 1565.1, "word": " Inspiration", "probability": 0.652099609375}, {"start": 1565.1, "end": 1566.16, "word": " أطول", "probability": 0.679443359375}, {"start": 1566.16, "end": 1570.74, "word": " الـ", "probability": 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إذا مربوط بالزمن بالدقيقة عادة بنحط المرضى من عشرة لست عشر breath pair من الـ Total respiratory rate equal patient rate plus ventilator rate", "tokens": [10721, 4117, 10943, 8717, 36178, 8978, 32748, 38436, 28671, 47525, 4117, 11933, 15730, 3714, 25513, 2407, 9566, 20666, 11622, 27842, 20666, 3215, 38436, 28671, 6225, 18513, 3660, 44945, 5016, 9566, 9673, 43042, 7578, 9154, 6225, 8592, 25720, 5296, 14851, 6225, 46309, 6045, 6119, 9154, 2423, 39184, 23170, 27038, 3314, 2681, 4537, 3314, 1804, 27498, 1639, 3314], "avg_logprob": -0.396107460323133, "compression_ratio": 1.4303030303030304, "no_speech_prob": 2.384185791015625e-07, "words": [{"start": 1581.12, "end": 1582.0, "word": "أكام", "probability": 0.3143717447916667}, {"start": 1582.0, "end": 1582.34, "word": " نفس", "probability": 0.975830078125}, {"start": 1582.34, "end": 1582.52, "word": " في", "probability": 0.51953125}, {"start": 1582.52, "end": 1583.02, "word": " الدقيقة", "probability": 0.9303385416666666}, {"start": 1583.02, 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{"start": 1590.28, "end": 1590.74, "word": " breath", "probability": 0.1571044921875}, {"start": 1590.74, "end": 1591.16, "word": " pair", "probability": 0.48046875}, {"start": 1591.16, "end": 1591.6, "word": " من", "probability": 0.83642578125}, {"start": 1591.6, "end": 1591.76, "word": " الـ", "probability": 0.703125}, {"start": 1591.76, "end": 1591.96, "word": " Total", "probability": 0.50439453125}, {"start": 1591.96, "end": 1592.38, "word": " respiratory", "probability": 0.7412109375}, {"start": 1592.38, "end": 1592.7, "word": " rate", "probability": 0.94775390625}, {"start": 1592.7, "end": 1593.0, "word": " equal", "probability": 0.36572265625}, {"start": 1593.0, "end": 1593.4, "word": " patient", "probability": 0.76806640625}, {"start": 1593.4, "end": 1593.72, "word": " rate", "probability": 0.931640625}, {"start": 1593.72, "end": 1594.14, "word": " plus", "probability": 0.90869140625}, {"start": 1594.14, "end": 1595.4, "word": " ventilator", "probability": 0.884765625}, 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"الـ Patient و الـ «COPD» و الـ Children بحتاجوا تايدة الـ volume أشمل يا جماعة أقل لأن الـ lung capacity تبعتهم أقل، مش هي؟ و الـ Children ال weight تبعتهم أقل الناس اللي عندهم lung fibrosis ال lung capacity تبعتهم أقل، اللي هو مسكرة، okay؟", "tokens": [6027, 39184, 25173, 4032, 2423, 39184, 4657, 34, 12059, 35, 5933, 4032, 2423, 39184, 13354, 4724, 33753, 26108, 14407, 6055, 995, 25708, 3660, 2423, 39184, 5523, 5551, 8592, 42213, 35186, 10874, 15042, 27884, 5551, 4587, 1211, 5296, 33456, 2423, 39184, 16730, 1410, 19008, 6055, 3555, 34268, 16095, 5551, 4587, 1211, 12399, 37893, 39896, 22807, 4032, 2423, 39184, 13354, 2423, 3364, 6055, 3555, 34268, 16095, 5551, 4587, 1211, 2423, 8315, 3794, 13672, 1829, 43242, 16095, 16730, 13116, 2635, 271, 2423, 16730, 1410, 19008, 6055, 3555, 34268, 16095, 5551, 4587, 1211, 12399, 13672, 1829, 31439, 3714, 3794, 4117, 25720, 12399, 1392, 22807], "avg_logprob": -0.3638613932203538, "compression_ratio": 1.7163461538461537, "no_speech_prob": 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"word": " في", "probability": 0.9365234375}, {"start": 2033.59, "end": 2034.13, "word": " الدقيقة", "probability": 0.9518229166666666}, {"start": 2034.13, "end": 2035.11, "word": " عشرين", "probability": 0.83056640625}, {"start": 2035.11, "end": 2035.69, "word": " تقسيم", "probability": 0.91162109375}, {"start": 2035.69, "end": 2036.35, "word": " عشرة", "probability": 0.90771484375}, {"start": 2036.35, "end": 2037.41, "word": " إتنين", "probability": 0.7874755859375}, {"start": 2037.41, "end": 2037.99, "word": " يعني", "probability": 0.891845703125}, {"start": 2037.99, "end": 2038.47, "word": " المفروض", "probability": 0.9876708984375}, {"start": 2038.47, "end": 2038.69, "word": " أنه", "probability": 0.717529296875}, {"start": 2038.69, "end": 2039.27, "word": " يكون", "probability": 0.823486328125}, {"start": 2039.27, "end": 2039.65, "word": " كل", "probability": 0.88623046875}, {"start": 2039.65, "end": 2039.97, "word": " نفس", "probability": 0.98583984375}, {"start": 2039.97, "end": 2040.97, "word": " الـinspiratory", "probability": 0.72451171875}, {"start": 2040.97, "end": 2041.31, "word": " time", "probability": 0.810546875}, {"start": 2041.31, "end": 2041.93, "word": " تبعه", "probability": 0.8851318359375}, {"start": 2041.93, "end": 2042.73, "word": " two", "probability": 0.296875}, {"start": 2042.73, "end": 2043.69, "word": " seconds", "probability": 0.79443359375}, {"start": 2043.69, "end": 2044.67, "word": " والـexpiratory", "probability": 0.79130859375}, {"start": 2044.67, "end": 2045.57, "word": " four", "probability": 0.276611328125}, {"start": 2045.57, "end": 2046.65, "word": " seconds،", "probability": 0.5721435546875}, {"start": 2046.65, "end": 2047.55, "word": " check؟", "probability": 0.547119140625}, {"start": 2047.55, "end": 2047.83, "word": " طب", "probability": 0.755859375}, {"start": 2047.83, "end": 2048.03, "word": " من", "probability": 0.68896484375}, {"start": 2048.03, "end": 2048.17, "word": " وين", "probability": 0.822021484375}, {"start": 2048.17, "end": 2048.39, "word": " جت", "probability": 0.460205078125}, {"start": 2048.39, "end": 2048.91, "word": " العشرين", "probability": 0.73046875}, {"start": 2048.91, "end": 2049.67, "word": " هذه؟", "probability": 0.82275390625}, {"start": 2049.67, "end": 2050.21, "word": " العشرين", "probability": 0.95068359375}, {"start": 2050.21, "end": 2050.43, "word": " هي", "probability": 0.8291015625}, {"start": 2050.43, "end": 2051.01, "word": " تلت", "probability": 0.8787434895833334}, {"start": 2051.01, "end": 2051.25, "word": " مش", "probability": 0.732421875}, {"start": 2051.25, "end": 2051.85, "word": " عملية", "probability": 0.9835611979166666}, {"start": 2051.85, "end": 2052.17, "word": " النفس", "probability": 0.932861328125}, {"start": 2052.17, "end": 2052.57, "word": " واحد", "probability": 0.93896484375}, {"start": 2052.57, "end": 2052.75, "word": " إلى", "probability": 0.91064453125}, {"start": 2052.75, "end": 2053.07, "word": " اتنين", "probability": 0.9476318359375}, {"start": 2053.07, "end": 2054.09, "word": " حكينا؟", "probability": 0.90791015625}, {"start": 2054.09, "end": 2054.43, "word": " okay", "probability": 0.587890625}, {"start": 2054.43, "end": 2055.31, "word": " يعني", "probability": 0.9482421875}, {"start": 2055.31, "end": 2055.97, "word": " دقيقة", "probability": 0.8590494791666666}, {"start": 2055.97, "end": 2056.23, "word": " كم", "probability": 0.78759765625}, {"start": 2056.23, "end": 2056.95, "word": " ثانية؟", "probability": 0.96728515625}, {"start": 2056.95, "end": 2057.49, "word": " ستين", "probability": 0.9254557291666666}], "temperature": 1.0}, {"id": 86, "seek": 208641, "start": 2058.61, "end": 2086.41, "text": "يعني لو بدأ أخد منها تلتها 20 إلى 40 يعني كل عملية التنفس في الدقيقة بتصير في 20 ثانية وكل عملية الـ Expiration كل دقيقة بتصير في 40 ثانية يعني كل عملية التنفس اللي في الدقيقة بتصير في 20 ثانية طبعا بتصير في الـ 20 ثانية هدول عشر التنفسات يبقى 20 تقسيم عشرة 20 تقسيم عشرة اتنين الـ Inspirational Time", "tokens": 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[{"start": 2058.61, "end": 2058.95, "word": "يعني", "probability": 0.732421875}, {"start": 2058.95, "end": 2059.11, "word": " لو", "probability": 0.83056640625}, {"start": 2059.11, "end": 2059.39, "word": " بدأ", "probability": 0.615478515625}, {"start": 2059.39, "end": 2059.71, "word": " أخد", "probability": 0.8606770833333334}, {"start": 2059.71, "end": 2060.15, "word": " منها", "probability": 0.98046875}, {"start": 2060.15, "end": 2060.93, "word": " تلتها", "probability": 0.8475341796875}, {"start": 2060.93, "end": 2061.79, "word": " 20", "probability": 0.1759033203125}, {"start": 2061.79, "end": 2062.67, "word": " إلى", "probability": 0.974609375}, {"start": 2062.67, "end": 2063.43, "word": " 40", "probability": 0.9736328125}, {"start": 2063.43, "end": 2064.11, "word": " يعني", "probability": 0.904296875}, {"start": 2064.11, "end": 2064.57, "word": " كل", "probability": 0.96240234375}, {"start": 2064.57, "end": 2065.23, "word": " عملية", "probability": 0.98974609375}, {"start": 2065.23, "end": 2065.77, "word": " التنفس", "probability": 0.96875}, {"start": 2065.77, "end": 2065.97, "word": " في", "probability": 0.96142578125}, {"start": 2065.97, "end": 2066.43, "word": " الدقيقة", "probability": 0.9739583333333334}, {"start": 2066.43, "end": 2066.81, "word": " بتصير", "probability": 0.5643717447916666}, {"start": 2066.81, "end": 2066.93, "word": " في", "probability": 0.9677734375}, {"start": 2066.93, "end": 2067.25, "word": " 20", "probability": 0.72412109375}, {"start": 2067.25, "end": 2067.77, "word": " ثانية", "probability": 0.9607747395833334}, {"start": 2067.77, "end": 2068.63, "word": " وكل", "probability": 0.949462890625}, {"start": 2068.63, "end": 2069.05, "word": " عملية", "probability": 0.9840494791666666}, {"start": 2069.05, "end": 2069.21, "word": " الـ", "probability": 0.908203125}, {"start": 2069.21, "end": 2069.77, "word": " Expiration", "probability": 0.625244140625}, {"start": 2069.77, "end": 2070.11, "word": " كل", "probability": 0.4384765625}, {"start": 2070.11, "end": 2070.61, "word": " دقيقة", "probability": 0.97705078125}, {"start": 2070.61, "end": 2070.95, "word": " بتصير", "probability": 0.9451497395833334}, {"start": 2070.95, "end": 2071.05, "word": " في", "probability": 0.97802734375}, {"start": 2071.05, "end": 2071.31, "word": " 40", "probability": 0.91845703125}, {"start": 2071.31, "end": 2071.83, "word": " ثانية", "probability": 0.9754231770833334}, {"start": 2071.83, "end": 2072.91, "word": " يعني", "probability": 0.924560546875}, {"start": 2072.91, "end": 2074.25, "word": " كل", "probability": 0.89404296875}, {"start": 2074.25, "end": 2074.61, "word": " عملية", "probability": 0.9812825520833334}, {"start": 2074.61, "end": 2075.05, "word": " التنفس", "probability": 0.99169921875}, {"start": 2075.05, "end": 2075.33, "word": " اللي", "probability": 0.923828125}, {"start": 2075.33, "end": 2075.47, "word": " في", "probability": 0.97314453125}, {"start": 2075.47, "end": 2076.51, "word": " الدقيقة", "probability": 0.93017578125}, {"start": 2076.51, "end": 2076.89, "word": " بتصير", "probability": 0.9669596354166666}, {"start": 2076.89, "end": 2077.01, "word": " في", "probability": 0.86376953125}, {"start": 2077.01, "end": 2077.29, "word": " 20", "probability": 0.955078125}, {"start": 2077.29, "end": 2077.75, "word": " ثانية", "probability": 0.9866536458333334}, {"start": 2077.75, "end": 2078.13, "word": " طبعا", "probability": 0.8885498046875}, {"start": 2078.13, "end": 2078.63, "word": " بتصير", "probability": 0.8273111979166666}, {"start": 2078.63, "end": 2078.73, "word": " في", "probability": 0.97021484375}, {"start": 2078.73, "end": 2078.87, "word": " الـ", "probability": 0.794921875}, {"start": 2078.87, "end": 2079.15, "word": " 20", "probability": 0.51318359375}, {"start": 2079.15, "end": 2079.59, "word": " ثانية", "probability": 0.9703776041666666}, {"start": 2079.59, "end": 2079.85, "word": " هدول", "probability": 0.7693684895833334}, {"start": 2079.85, "end": 2080.15, "word": " عشر", "probability": 0.662353515625}, {"start": 2080.15, "end": 2080.95, "word": " التنفسات", "probability": 0.9267578125}, {"start": 2080.95, "end": 2081.63, "word": " يبقى", "probability": 0.919677734375}, {"start": 2081.63, "end": 2082.19, "word": " 20", "probability": 0.8037109375}, {"start": 2082.19, "end": 2082.53, "word": " تقسيم", "probability": 0.82537841796875}, {"start": 2082.53, "end": 2082.93, "word": " عشرة", "probability": 0.7540690104166666}, {"start": 2082.93, "end": 2084.17, "word": " 20", "probability": 0.297607421875}, {"start": 2084.17, "end": 2084.55, "word": " تقسيم", "probability": 0.9254150390625}, {"start": 2084.55, "end": 2084.85, "word": " عشرة", "probability": 0.9580078125}, {"start": 2084.85, "end": 2085.17, "word": " اتنين", "probability": 0.8887939453125}, {"start": 2085.17, "end": 2085.41, "word": " الـ", "probability": 0.560302734375}, {"start": 2085.41, "end": 2085.95, "word": " Inspirational", "probability": 0.5533040364583334}, {"start": 2085.95, "end": 2086.41, "word": " Time", "probability": 0.48095703125}], "temperature": 1.0}, {"id": 87, "seek": 209007, "start": 2089.29, "end": 2090.07, "text": "تو ساكنت", "tokens": [2655, 2407, 8608, 995, 19452, 2655], "avg_logprob": -0.7611606972558158, "compression_ratio": 0.625, "no_speech_prob": 0.0, "words": [{"start": 2089.29, "end": 2089.51, "word": "تو", "probability": 0.28936767578125}, {"start": 2089.51, "end": 2090.07, "word": " ساكنت", "probability": 0.73602294921875}], "temperature": 1.0}], "language": "ar", "language_probability": 1.0, "duration": 2101.6613125, "duration_after_vad": 1992.9706249999929}
\ No newline at end of file
diff --git a/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/8DNlIAzpToE_raw.srt b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/8DNlIAzpToE_raw.srt
new file mode 100644
index 0000000000000000000000000000000000000000..7572d6640d1f12fad6dc28b4c38a9c1312556392
--- /dev/null
+++ b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/8DNlIAzpToE_raw.srt
@@ -0,0 +1,1824 @@
+1
+00:00:01,620 --> 00:00:06,460
+بسم الله الرحمن الرحيم السلام عليكم ورحمة الله إن
+
+2
+00:00:06,460 --> 00:00:09,380
+شاء الله اليوم هنكمل محاضرة تانية في محاضرة الـ
+
+3
+00:00:09,380 --> 00:00:13,160
+Mechanical Ventilation حكينا عن الـ Volume Cycle
+
+4
+00:00:13,160 --> 00:00:20,140
+واليوم هنحكي عن الـ Pressure Mode في الـ Mode تبعت
+
+5
+00:00:20,140 --> 00:00:23,970
+الـ Mechanical Ventilationالـ Pressure Modes يا
+
+6
+00:00:23,970 --> 00:00:28,550
+جماعة الـ Modes المهمين فيهم واحد اسمه Pressure
+
+7
+00:00:28,550 --> 00:00:33,170
+Controlled Ventilator Mode PCV الـ PCV موضوع
+
+8
+00:00:33,170 --> 00:00:36,730
+استعمل إذا كانت الـ Compliance تتخلص ورغبات
+
+9
+00:00:36,730 --> 00:00:41,390
+البراتروما عالية إذا المريض الـ Compliance تبعت
+
+10
+00:00:41,390 --> 00:00:46,960
+الـ Lungغليل يعني أنا مش متأكد إنه لما أد المريض
+
+11
+00:00:46,960 --> 00:00:51,300
+خمسمية تقدر الـ volume هدول هيعملوا expansion
+
+12
+00:00:51,300 --> 00:00:55,460
+وهيكون فيه قدرة على إن تصير فيه complete expansion
+
+13
+00:00:55,460 --> 00:00:59,740
+بعدين ترجع ال lung تطلعهم ممكن ال lung stiff lung
+
+14
+00:00:59,740 --> 00:01:05,360
+فيها كتير fibrosis أه فأنا بخاف أخشش كمية ها يصير
+
+15
+00:01:05,360 --> 00:01:11,590
+إيش نيموفوركس مثلاًفعشان هيك لأ بنحطه على pressure
+
+16
+00:01:11,590 --> 00:01:17,870
+mode لإن البراترومة واردة هنا فالبراترومة في ال
+
+17
+00:01:17,870 --> 00:01:20,690
+pressure mode هو حسب ال pressure اللي داخل ال lung
+
+18
+00:01:20,690 --> 00:01:25,510
+لما نوصل ال pressure لlimit غير محدود إن ال lung
+
+19
+00:01:25,510 --> 00:01:28,130
+تتجوزه، خلاص بوقف ال tidal volume اللي المفروض
+
+20
+00:01:28,130 --> 00:01:32,820
+ينعطففعشان هيك الـ pressure volume كلهم بيعتندوا
+
+21
+00:01:32,820 --> 00:01:37,320
+على إنه يعطي الـ limited pressure مايكونش بيأذي
+
+22
+00:01:37,320 --> 00:01:41,540
+المريض، كويس؟ هذا عادة نستخدمه لما يكون ال
+
+23
+00:01:41,540 --> 00:01:45,320
+compliance تبع ال lung not good، يعني decrease ال
+
+24
+00:01:45,320 --> 00:01:50,320
+compliance، okay؟ when the patient has a resistant
+
+25
+00:01:50,320 --> 00:01:53,560
+oxygenation problem despite a high FI2 and a high
+
+26
+00:01:53,560 --> 00:01:57,890
+level of P، يعني أنا حاطط high Pعلى الـ Volume
+
+27
+00:01:57,890 --> 00:02:01,430
+Control، الـ High Beep ما هو الـ الـ الـ الـ Beep
+
+28
+00:02:01,430 --> 00:02:04,050
+اللي احنا حكيناه هو نوع من أنواع الـ Pressure Mode
+
+29
+00:02:04,050 --> 00:02:07,810
+ما شرحناهوش، أنا لغاية أرجع أبدأ أشرح الـ Beep و
+
+30
+00:02:07,810 --> 00:02:12,150
+أشرح السباب عشان نستطيع أنه احنا نفهم الـ Pressure
+
+31
+00:02:12,150 --> 00:02:16,390
+Control Mode بس باختصار، لو أنا فيه عندي Volume
+
+32
+00:02:16,390 --> 00:02:20,870
+Cycle ومدعمه في Pressure Cycle اللي هو الـ Beep،
+
+33
+00:02:20,870 --> 00:02:26,760
+ورغم هيك المريضاللي الـ Oxygen saturation عنده bad
+
+34
+00:02:26,760 --> 00:02:32,300
+والـ والـ blood gas تبعته bad بكون أحسن أحطه على
+
+35
+00:02:32,300 --> 00:02:38,160
+pressure control ventilation mode اللي هو الـ BCV
+
+36
+00:02:38,160 --> 00:02:42,700
+عشان أحسن ال oxygenation عنده فإن ال pressure
+
+37
+00:02:42,700 --> 00:02:43,140
+level
+
+38
+00:02:45,780 --> 00:02:52,000
+«I-E Ratio Must Be Selected» لازم في الـ «PCV»
+
+39
+00:02:52,000 --> 00:02:57,700
+يكون محدد «I-E Ratio» طبعا الـ «Tidal Volume»
+
+40
+00:02:57,700 --> 00:03:01,460
+بيختلف يا جماعة في كل نفس مع إيش، مع الـ pressure
+
+41
+00:03:01,460 --> 00:03:05,020
+اللي داخل الـ lung «Cedation» and «Use of
+
+42
+00:03:05,020 --> 00:03:07,120
+neuromuscular block agents are frequently
+
+43
+00:03:07,120 --> 00:03:10,540
+indicated» عادة في الحالات هذه يفضل أن يكون المريض
+
+44
+00:03:10,540 --> 00:03:14,750
+إيش، ماخد «Cedation» ومرتاحمن الـ advantage تبع
+
+45
+00:03:14,750 --> 00:03:16,670
+الـ reduction of peak pressure and therefore دا
+
+46
+00:03:16,670 --> 00:03:22,530
+risk of paratrauma مافيش عادة لأنه احنا هنا احنا
+
+47
+00:03:22,530 --> 00:03:25,750
+أصلا شغالين على ال pressure فإنه يصير paratrauma،
+
+48
+00:03:25,750 --> 00:03:28,750
+trauma نتيجة ال pressure لأ، لأن ال pressure هو
+
+49
+00:03:28,750 --> 00:03:31,590
+اللي بتحكم في الموضوع فمش هيسمح لل pressure إنه
+
+50
+00:03:31,590 --> 00:03:36,770
+يزيد ويعمل trauma وطبعا هذا هيحسن ال gas exchange
+
+51
+00:03:36,770 --> 00:03:42,070
+قبل ما أشرح حد أنا بدي أروح للبيمونشرح إيش الـ
+
+52
+00:03:42,070 --> 00:03:46,670
+Beep وإيش هم السباب لإن هدول عادة بنستخدمهم حتى أو
+
+53
+00:03:46,670 --> 00:03:49,130
+الـ Beep بالذات اللي بنستخدمه مع الـ Volume
+
+54
+00:03:49,130 --> 00:03:52,630
+Control اللي حكينا معهم واللي أشهرهم الـ S-IMV
+
+55
+00:03:52,630 --> 00:03:58,570
+يعني بنكون حاطين S-IMV وبنكون حاطين بيب لذلك الـ
+
+56
+00:03:58,570 --> 00:04:03,050
+Beep ما هوش mood منفصل يعني منفعش أحط المريض بس
+
+57
+00:04:03,050 --> 00:04:04,870
+على Beep يعني إيش ال mood اللي إنت حاطه؟ ما هو
+
+58
+00:04:04,870 --> 00:04:07,790
+الله أحطه على Beep؟ لأ، فيش، Beep بتكون حاطه إنت
+
+59
+00:04:07,790 --> 00:04:15,900
+علىاس IMV أو BCV يعني وحطته بيب خمسة بيب تلاتة
+
+60
+00:04:15,900 --> 00:04:19,820
+فإيش هو ال بيب هذا ال بيب هو ال positive end
+
+61
+00:04:19,820 --> 00:04:26,620
+expiratory pressure positive end expiratory
+
+62
+00:04:26,620 --> 00:04:32,180
+pressure إيش يعني positive end يعني يعني إن تكون
+
+63
+00:04:32,180 --> 00:04:37,400
+نهاية ال expiration عندك نهاية موجبة إيش يعني
+
+64
+00:04:37,400 --> 00:04:44,190
+نهاية موجبة؟يعني احنا بناخد نفس ونطلق
+
+65
+00:04:44,190 --> 00:04:48,090
+النفس في الطبيعي لما احنا بناخد النفس يا جماعة
+
+66
+00:04:48,090 --> 00:04:54,990
+عشان ناخد النفس لازم يسير أو يكون الضغط داخل
+
+67
+00:04:54,990 --> 00:04:58,710
+الـTorsion Cavity أقل من الضغط تبع الهواء الجو
+
+68
+00:04:58,710 --> 00:05:04,500
+وإلا مش ها ينزل الهواءلداخل رئتين ليش؟ لأن هو
+
+69
+00:05:04,500 --> 00:05:08,160
+بينتقل من الضغط الأعلى للضغط الأقل فلازم يكون أنا
+
+70
+00:05:08,160 --> 00:05:14,860
+عند الضغط أقل عشان أقدر أخد نفس ينزلي من الضغط
+
+71
+00:05:14,860 --> 00:05:23,060
+الأعلى للضغط الأقل يعني معناه أنه أنا بعد ما
+
+72
+00:05:23,060 --> 00:05:29,340
+أعمل expiration أخدت
+
+73
+00:05:29,340 --> 00:05:37,170
+inspirationزاد الضغط في الـ «رقتين» عندي، مش هيك؟
+
+74
+00:05:37,170 --> 00:05:41,810
+خدت كمية من الهواء الـ «تلات الرقتين» زاد الضغط
+
+75
+00:05:41,810 --> 00:05:46,290
+فيها، إيش بتسويب؟ ما زال زاد الضغط، صار الضغط اللي
+
+76
+00:05:46,290 --> 00:05:49,350
+عنده أكبر من ضغط الهواء الجوهر، هذا بيسمحله الهواء
+
+77
+00:05:49,350 --> 00:05:55,550
+أنه ينقل من صدري لإنص، الضغط عندي عالي، لا برا، مش
+
+78
+00:05:55,550 --> 00:06:03,960
+هيك؟ لكن بيضلوا يا جماعةالضغط اللي عندي يطلع ..
+
+79
+00:06:03,960 --> 00:06:09,660
+يطلع .. يطلع .. يطلع .. يطلع .. يطلع .. يطلع ..
+
+80
+00:06:09,660 --> 00:06:14,640
+يطلع .. يطلع
+
+81
+00:06:14,640 --> 00:06:15,500
+.. يطلع .. يطلع .. يطلع .. يطلع .. يطلع .. يطلع ..
+
+82
+00:06:15,500 --> 00:06:15,760
+يطلع .. يطلع .. يطلع .. يطلع .. يطلع .. يطلع ..
+
+83
+00:06:15,760 --> 00:06:15,900
+يطلع .. يطلع .. يطلع .. يطلع .. يطلع .. يطلع ..
+
+84
+00:06:15,900 --> 00:06:16,260
+يطلع .. يطلع .. يطلع .. يطلع .. يطلع .. يطلع ..
+
+85
+00:06:16,260 --> 00:06:16,260
+يطلع .. يطلع .. يطلع .. يطلع .. يطلع .. يطلع ..
+
+86
+00:06:16,260 --> 00:06:25,920
+يطلع .. يطلع .. يطلع .. يطلع ..
+
+87
+00:06:25,920 --> 00:06:31,340
+يطلعت النفس، اذا انا في الـ Normal عادة بعد كل نفس
+
+88
+00:06:31,340 --> 00:06:35,920
+باخده باخد النفس و بضل ناخد في النفس لما ال
+
+89
+00:06:35,920 --> 00:06:39,180
+pressure يزيد و يزيد و يزيد و يزيد و يزيد و يزيد و
+
+90
+00:06:39,180 --> 00:06:39,680
+يزيد و يزيد و يزيد و يزيد و يزيد و يزيد و يزيد و
+
+91
+00:06:39,680 --> 00:06:39,680
+يزيد و يزيد و يزيد و يزيد و يزيد و يزيد و يزيد و
+
+92
+00:06:39,680 --> 00:06:39,680
+يزيد و يزيد و يزيد و يزيد و يزيد و يزيد و يزيد و
+
+93
+00:06:39,680 --> 00:06:39,780
+يزيد و يزيد و يزيد و يزيد و يزيد و يزيد و يزيد و
+
+94
+00:06:39,780 --> 00:06:39,840
+يزيد و يزيد و يزيد و يزيد و يزيد و يزيد و يزيد و
+
+95
+00:06:39,840 --> 00:06:45,220
+يزيد و يزيد و يزيد و يزيد
+
+96
+00:06:45,220 --> 00:06:54,400
+و
+
+97
+00:06:55,830 --> 00:06:57,790
+الآن نحن على الـ «فنتليتور»
+
+98
+00:06:57,790 --> 00:07:12,150
+الوكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليكاليك
+
+99
+00:07:27,790 --> 00:07:32,310
+ماضلّي اطلّع لما أوصل للسالد أقل من الهواء الجوي
+
+100
+00:07:32,310 --> 00:07:38,910
+لأ اخدت النفس بدي اطلّع نص الطريق و اخد نفس يعني
+
+101
+00:07:38,910 --> 00:07:43,170
+النهاية موجبة لسه قبل ما توصل للهواء الجوي اخد نفس
+
+102
+00:07:43,170 --> 00:07:49,810
+تاني إذا القصة هي إننا بدنا المريض يظل عنده كمية
+
+103
+00:07:55,280 --> 00:08:01,460
+يظل عنده كمية هوة residual في الرقتين تجعله يتمكن
+
+104
+00:08:01,460 --> 00:08:06,160
+من أن يأخذ الـInspiration تاني قبل ما يعمل كل
+
+105
+00:08:06,160 --> 00:08:09,980
+الـExpiration أو قبل ما يعمل الـExpiration لكل
+
+106
+00:08:09,980 --> 00:08:13,640
+كمية الهوة اللي كانت في الرقتين اللي هتجعله يوصل
+
+107
+00:08:13,640 --> 00:08:18,180
+للـNegative Pressure لأ، في نص يعني يظل كمية هوة
+
+108
+00:08:18,180 --> 00:08:21,800
+بحيث يرجع ياخد نفسه هو لسه في الـPositive قبل ما
+
+109
+00:08:21,800 --> 00:08:29,060
+يتعادلتمام، هذا هو الـ B إذا بنلخص، بنقول الـ B
+
+110
+00:08:29,060 --> 00:08:32,140
+referred to the use of an elevated pressure during
+
+111
+00:08:32,140 --> 00:08:36,120
+the end of expiratory phase في مرحلة الـ
+
+112
+00:08:36,120 --> 00:08:40,680
+expiratory phase تبعت
+
+113
+00:08:40,680 --> 00:08:44,890
+الـ lungأنا مابديش المريض يوصل لـ negative
+
+114
+00:08:44,890 --> 00:08:48,830
+pressure بدي يظل اندريزيدي و ليرجع ياخد نفس تاني
+
+115
+00:08:48,830 --> 00:08:52,490
+it is not a standalone mood مابنحطش لحاله but it's
+
+116
+00:08:52,490 --> 00:08:55,970
+used in conjunction with other mood as SMB يعني
+
+117
+00:08:55,970 --> 00:09:00,490
+كون المرضي على SMB وحاطينه بيب خمسة مثلا إيش يعني
+
+118
+00:09:00,490 --> 00:09:03,270
+خمسة؟ يعني ال pressure اللي بديت تعمله كل متر هو
+
+119
+00:09:03,270 --> 00:09:08,250
+اللي بيضطل خمسة، خمسة بار when beep is applied to
+
+120
+00:09:08,250 --> 00:09:11,950
+spontaneously breathe patient the mood called CBAP
+
+121
+00:09:13,620 --> 00:09:19,040
+يعني لما أنا بحط للمريض بيب «continuous»
+
+122
+00:09:19,040 --> 00:09:23,880
+«continuous» بيب، إيش يعني سيباب؟ «continuous
+
+123
+00:09:23,880 --> 00:09:26,560
+positive end expiratory pressure» يعني أنا بحط
+
+124
+00:09:26,560 --> 00:09:30,420
+للمريض «continuous» بيب بس بخل المريض ياخد الـ
+
+125
+00:09:30,420 --> 00:09:34,740
+tidal volume اللي هو بدويا و ال rate اللي هو
+
+126
+00:09:34,740 --> 00:09:38,080
+بدويا، إيش يعني؟ يعني أنا مابديوش ولا tidal volume
+
+127
+00:09:38,080 --> 00:09:43,950
+ولا rateبس محافظته على كمية من الهواء بعد كل مرة
+
+128
+00:09:43,950 --> 00:09:47,270
+ما هو بيعمل X-Biration اتضال كمية من الهواء
+
+129
+00:09:47,270 --> 00:09:50,510
+residual في الـLungs بحيث يعمل النفس اللي بعده
+
+130
+00:09:50,510 --> 00:09:55,570
+فيكون عليه أسهل فيكون عليه أسهل زي واحد بده ينفخ
+
+131
+00:09:55,570 --> 00:10:01,630
+بلون من السفر كده بده جهود وواحد بده ينفخ بلون
+
+132
+00:10:01,630 --> 00:10:08,470
+نفقه نفسنا نص تنفيسة وقلنا له انفخ تاني كده بده
+
+133
+00:10:08,470 --> 00:10:08,810
+جهود
+
+134
+00:10:11,880 --> 00:10:15,920
+طبعاً، هذا الهواء يعمل كسبابة بإقلام عمل الهواء في
+
+135
+00:10:15,920 --> 00:10:22,340
+الهواء ويساعد في الحفاظ على القوة الواضحة، طبعاً،
+
+136
+00:10:22,340 --> 00:10:24,460
+هذا الهواء يعمل كسبابة بإقلام عمل الهواء في الهواء
+
+137
+00:10:24,460 --> 00:10:25,160
+ويساعد في الحفاظ على القوة الواضحة، طبعاً، هذا
+
+138
+00:10:25,160 --> 00:10:25,160
+الهواء يعمل كسبابة بإقلام عمل الهواء في الهواء
+
+139
+00:10:25,160 --> 00:10:25,340
+ويساعد في الحفاظ على القوة الواضحة، طبعاً، هذا
+
+140
+00:10:25,340 --> 00:10:28,120
+الهواء يعمل كسبابة بإقلام عمل الهواء في الهواء،
+
+141
+00:10:28,120 --> 00:10:38,240
+طبعاً، هذا الهواء يعمل كسبابة بإقلام عوهكذا تقوم
+
+142
+00:10:38,240 --> 00:10:44,160
+بالتحرير فيناسية وتعود تحرير الحرارة تتقلل حركة
+
+143
+00:10:44,160 --> 00:10:47,100
+الحرارة من حركة الحرارة لحركة الحرارة لحركة
+
+144
+00:10:47,100 --> 00:10:47,860
+الحرارة لحركة الحرارة لحركة الحرارة لحركة الحرارة
+
+145
+00:10:47,860 --> 00:10:49,560
+لحركة الحرارة لحركة الحرارة لحركة الحرارة لحركة
+
+146
+00:10:49,560 --> 00:10:51,960
+الحرارة لحركة الحرارة لحركة الحرارة لحركة الحرارة
+
+147
+00:10:51,960 --> 00:10:54,800
+لحركة الحرارة لحركة الحرارة لحركة الحرارة لحركة
+
+148
+00:10:54,800 --> 00:10:55,200
+الحرارة لحركة الحرارة لحركة الحرارة لحركة الحرارة
+
+149
+00:10:55,200 --> 00:11:03,320
+لحركة الحرارة لحركة الحرارة لحركة الحرارة ل
+
+150
+00:11:12,430 --> 00:11:16,490
+بالفعل مش هحطلهم high B الناس اللي عندهم severe
+
+151
+00:11:16,490 --> 00:11:20,590
+hypotension بالفعل مش هحطلهم high B high level of
+
+152
+00:11:20,590 --> 00:11:26,370
+B كان used ونحطه على ستة، سبعة، تمانية for
+
+153
+00:11:26,370 --> 00:11:30,810
+patients with ARDS، COPD بالمناورة القديمة لكن إنه
+
+154
+00:11:30,810 --> 00:11:33,630
+complication إنه decrease in systematic venous
+
+155
+00:11:33,630 --> 00:11:37,350
+return هجلل الـsystematic venous return وبالتالي
+
+156
+00:11:37,350 --> 00:11:39,750
+عشان هيك الناس اللي عندهم head trauma إذا بتجلل
+
+157
+00:11:39,750 --> 00:11:44,750
+الvenous return هصيربرنقدينة عشان هيك مابحطش high
+
+158
+00:11:44,750 --> 00:11:48,950
+beat مع الناس اللي عندها head trauma بالمونة
+
+159
+00:11:48,950 --> 00:11:52,050
+باراتروما can be caused result from hyperinflation
+
+160
+00:11:52,050 --> 00:11:59,530
+of alveoli past the rupture point يعني احتمالية
+
+161
+00:11:59,530 --> 00:12:03,680
+انه يصير باراتروماوالدة مع الـ «high people» لأ
+
+162
+00:12:03,680 --> 00:12:07,100
+لأن الـ pressure عالي اللي انت حاطط في الـ I.V.L
+
+163
+00:12:07,100 --> 00:12:11,800
+.I. يعني كمية الهواء عاملها inflation أكتر من اللي
+
+164
+00:12:11,800 --> 00:12:20,660
+هي ممكن تتحملها وبالتالي ممكن الـ rupture السيباب،
+
+165
+00:12:20,660 --> 00:12:26,620
+روحنا السيباب، حكينا عن السيباب بس أعتقد فيه slide
+
+166
+00:12:26,620 --> 00:12:27,420
+منفصلة له
+
+167
+00:12:33,150 --> 00:12:36,330
+طيب، هو حاكة عن السيباب في نفس الـ «سلايد» هذه زي
+
+168
+00:12:36,330 --> 00:12:39,470
+ما حكينا هو السيباب وهو عبارة عن continuous beep
+
+169
+00:12:39,470 --> 00:12:44,450
+هو الـ mode of ventilation ما بنطيش، ما بنحطش في
+
+170
+00:12:44,450 --> 00:12:48,210
+السيباب rate ال rate اللي باخده المريض هو ال rate
+
+171
+00:12:48,210 --> 00:12:50,430
+ال tidal volume اللي باخده المريض هو ال tidal
+
+172
+00:12:50,430 --> 00:12:55,170
+volume بس احنا بكون حاطين ال beep تبع المريض وبكون
+
+173
+00:12:56,050 --> 00:12:59,710
+الكمية الهواء اللي بده يخدها المريض هو بده يحددها
+
+174
+00:12:59,710 --> 00:13:03,010
+بس من علنا الهواء فبالتالي الـ Off-IO2 لازم يكون
+
+175
+00:13:03,010 --> 00:13:06,170
+احنا الـ Oxygen Fracking قداش الهواء فيه Oxygen
+
+176
+00:13:06,170 --> 00:13:13,190
+قداش الهواء اللي بده يخشه المريض تركيز الـ Oxygen
+
+177
+00:13:13,190 --> 00:13:19,490
+فيه 30%، 40%، 50%، هذا من علنا، okay؟
+
+178
+00:13:24,560 --> 00:13:29,460
+الآن نشوف إيش الـ Pressure هدول الـ Modes المهمة
+
+179
+00:13:29,460 --> 00:13:32,560
+جداً في الـ Pressure مودي البيب والسباب أنواع
+
+180
+00:13:32,560 --> 00:13:37,500
+تانية اللي حكينا عنها المودي الأولاني اللي حكيناها
+
+181
+00:13:38,760 --> 00:13:44,480
+هذه السبب، هذه السبب، حكينا عنه كل ما هو مطلوب إنه
+
+182
+00:13:44,480 --> 00:13:49,260
+الـ «mode of ventilation» والهدف
+
+183
+00:13:49,260 --> 00:13:54,700
+منه إن أنا أعمل الـweaning للمريض، الـprocess، وهو
+
+184
+00:13:54,700 --> 00:14:00,230
+عبارة عن continuous period، تمام؟الـMode الأولى
+
+185
+00:14:00,230 --> 00:14:02,770
+اللي حكينا عنه طبعاً الـPressure Control
+
+186
+00:14:02,770 --> 00:14:06,370
+Ventilation Mode حكينا عنه كويس كتير مع الناس
+
+187
+00:14:06,370 --> 00:14:09,870
+طبعاً بده Sedation ومع الناس اللي هي الـLung
+
+188
+00:14:09,870 --> 00:14:16,070
+Compliance عندها decreased الـPressure Support
+
+189
+00:14:16,070 --> 00:14:17,050
+Ventilation
+
+190
+00:14:24,660 --> 00:14:28,880
+الـ Pressure Support Ventilation BSV
+
+191
+00:14:34,610 --> 00:14:39,050
+بنبدأ نحكي عن نمود مساعد للـCBAP يعني مثلا ممكن
+
+192
+00:14:39,050 --> 00:14:45,230
+نكون المريض على SINV ونحطه على اللي هو BSV يعني
+
+193
+00:14:45,230 --> 00:14:50,330
+Assistant لـSINV عشان بنحضر المريض ونحطه على CBAP
+
+194
+00:14:50,330 --> 00:14:54,030
+طب هو إيش بيسوي أصلا؟ هو بيدل المريض Spontaneously
+
+195
+00:14:54,030 --> 00:15:00,340
+أو المريض Spontaneously لحالهبكون قادر ياخد الـ
+
+196
+00:15:00,340 --> 00:15:04,600
+Predetermined tidal volume بس على طول يظلوا يعني
+
+197
+00:15:04,600 --> 00:15:10,280
+كمية من الهواء الصغيرة تظل ماشية في الـ lung
+
+198
+00:15:10,280 --> 00:15:13,660
+عملاله support The patient breathes spontaneously
+
+199
+00:15:13,660 --> 00:15:16,180
+while the ventilator applies a predetermined
+
+200
+00:15:16,180 --> 00:15:20,020
+amount of positive pressure عن طريق كمية الهواءto
+
+201
+00:15:20,020 --> 00:15:23,820
+the airway of bone inspiration خلال عملية النفس طب
+
+202
+00:15:23,820 --> 00:15:27,380
+هذا إيش بتفيدني يعني؟ بتفيد إن المريض بيكون بتنفس
+
+203
+00:15:27,380 --> 00:15:30,140
+spontaneous بس الـ tidal volume اللي بياخده قليل
+
+204
+00:15:30,140 --> 00:15:33,920
+بياخدش إلا 200 CC و أنا بدأ أبدأ أجهزه عشان ينفصل
+
+205
+00:15:33,920 --> 00:15:38,000
+و يصير ياخد إيش enough tidal volume و rate لحاله
+
+206
+00:15:38,000 --> 00:15:41,620
+هو بياخد عدد مرات تنفس ربما كويسات بس في كل مرة
+
+207
+00:15:41,620 --> 00:15:45,420
+الكبسيس تبعت ال lung قليلة بياخدله بس 200 CC فانا
+
+208
+00:15:45,420 --> 00:15:50,080
+بدأ أزود ال inflation فبقعدته علىأو SV فبصير
+
+209
+00:15:50,080 --> 00:15:55,120
+المريض ياخد له ايش كمان صارت 400 مثلا 350 شوية
+
+210
+00:15:55,120 --> 00:15:58,640
+شوية بيبدأ يتحسن لو يزود كمية الـ tidal volume
+
+211
+00:15:58,640 --> 00:16:03,080
+اللي بياخدها لحاله بروح انا و انا بعدها حاطه على
+
+212
+00:16:03,080 --> 00:16:06,280
+سيباب ساعتها بيكون بياخد complete rate لحاله و
+
+213
+00:16:06,280 --> 00:16:09,080
+complete tidal volume لحاله لكن انا في الفترة اللي
+
+214
+00:16:09,080 --> 00:16:14,090
+فاتت كنت ساعته انه يصير في عنده شويةإنفلاشيا للـ
+
+215
+00:16:14,090 --> 00:16:18,250
+lung هذا الـ pressure support ventilation ال
+
+216
+00:16:18,250 --> 00:16:22,270
+advantage تبعته طبعا أن ال patient comfort because
+
+217
+00:16:22,270 --> 00:16:27,130
+of less of اللي هو working of breathing than
+
+218
+00:16:27,130 --> 00:16:30,050
+spontaneous breathing يعني ال work of breathing مش
+
+219
+00:16:30,050 --> 00:16:33,430
+لحاله هو يعني مش spontaneous فيه إشي بيساعده كان
+
+220
+00:16:33,430 --> 00:16:36,810
+used with SMD to support spontaneous breathing و
+
+221
+00:16:36,810 --> 00:16:42,210
+عادة حكينا أنهالذي يمكن استخدامه للتبادل مع الـ
+
+222
+00:16:42,210 --> 00:16:48,010
+CBAP اللي هو الـ «before» اللي هو الـ «mask» فالـ
+
+223
+00:16:48,010 --> 00:16:51,230
+«CBAP» ببساطة كان مستمرًا مستمرًا مع الـ «باسلين»
+
+224
+00:16:51,230 --> 00:16:54,890
+والضغط كان عالقًا فوق الزيرو «Baseline pressure»
+
+225
+00:16:54,890 --> 00:16:57,790
+الحكي هنا في الـ «CBAP» يكون فوق الـ «زيرو»
+
+226
+00:17:01,660 --> 00:17:06,420
+الـ Pressure أو الـ Beam حكينا عنه already الـ Non
+
+227
+00:17:06,420 --> 00:17:08,560
+-invasive Bilateral Positive Airway Pressure
+
+228
+00:17:08,560 --> 00:17:12,120
+Ventilation الـ Non-invasive Bilateral Positive
+
+229
+00:17:12,120 --> 00:17:14,340
+Airway Pressure Ventilation يا جماعة زمان كان
+
+230
+00:17:14,340 --> 00:17:22,800
+بيسموه CBAP Mask عبارة عن Mask بتنحط للمريض وبنحط
+
+231
+00:17:22,800 --> 00:17:26,630
+الجهاز على CBAPإيش يعني؟ يعني إحنا مش عاملين
+
+232
+00:17:26,630 --> 00:17:31,090
+Invasive إنه يعني حطين تيوب وننفخ هوا في المريض،
+
+233
+00:17:31,090 --> 00:17:33,290
+لأ إحنا بس محافظين على ال pressure طب ما إحنا
+
+234
+00:17:33,290 --> 00:17:35,530
+عارفين إنه في السيباب المريض هو المفروض إنه بياخد
+
+235
+00:17:35,530 --> 00:17:38,830
+الـ tidal volume لحاله، إذن هياخد ال tidal volume
+
+236
+00:17:39,750 --> 00:17:42,250
+والـ «Rate» اللي هو بدهيه بس اللهم إنه إحنا
+
+237
+00:17:42,250 --> 00:17:45,110
+محافظينه على الـ «Pressure» يضله «Closed Cycle»
+
+238
+00:17:45,110 --> 00:17:48,410
+والـ «Pressure» هيضله كل مرة فيه عنده شوية
+
+239
+00:17:48,410 --> 00:17:51,810
+Residual إحنا محافظينه، مش السبب هو «Continuous
+
+240
+00:17:51,810 --> 00:17:54,630
+Beat» فإحنا فيه «Continuous Beat» بضايلين عند
+
+241
+00:17:54,630 --> 00:17:58,830
+المريض على طول التطور الموضوع هذا بدل ما يكون بده
+
+242
+00:17:58,830 --> 00:18:04,950
+جهاز Ventilator وبده «Closed Mask» مسكرة على كل
+
+243
+00:18:04,950 --> 00:18:08,910
+المريض، لأ إنه ممكن عن طريق الـ «Nose» أو عن طريق
+
+244
+00:18:10,070 --> 00:18:17,010
+اللي هو ماسك خصوص لأنه nasal mask ندّي للمريض حاجة
+
+245
+00:18:17,010 --> 00:18:21,470
+بنسميها اللي هو الـ IPAP An Inspiratory Pressure
+
+246
+00:18:21,470 --> 00:18:26,250
+Support Level اللي هو أنا أعمله بيب جوا داخلي بحيث
+
+247
+00:18:26,250 --> 00:18:31,260
+أنه يساعد المريض في كل مرة يأخذ النفس التانيعن
+
+248
+00:18:31,260 --> 00:18:34,660
+طريق الـ pressure اللي already موجود اللي عمله الـ
+
+249
+00:18:34,660 --> 00:18:37,120
+BEEP ومن غير invasive من غير اكون حاطط
+
+250
+00:18:37,120 --> 00:18:40,580
+endotracheal tube كتير كويس مع مين هذا مع الناس
+
+251
+00:18:40,580 --> 00:18:43,580
+اللي بيصير عندهم hyperventilation syndrome فجأة هو
+
+252
+00:18:43,580 --> 00:18:49,340
+نايم او apnea syndrome بتوقف عن النفس الناس اللي
+
+253
+00:18:49,340 --> 00:18:52,560
+عندهم lung fire process الناس اللي عندهم ادولة
+
+254
+00:18:52,560 --> 00:18:55,900
+كانوا كل يوم مضمضلهم في المستشفى في ال ICU عشان
+
+255
+00:18:55,900 --> 00:19:00,710
+خاطر هو بيصير عنده apneaفجأة أو بيصير عنده
+
+256
+00:19:00,710 --> 00:19:04,970
+hyperventilation فجأة فلأ لما بينام كل ما عنده
+
+257
+00:19:04,970 --> 00:19:09,290
+النوم بالذات بيصير عنده sleep apnea مثلا في ناس
+
+258
+00:19:09,290 --> 00:19:11,510
+كتير عندهم sleep apnea عندما بينام بيصير معاه
+
+259
+00:19:11,510 --> 00:19:15,650
+apnea فعندما بينام لأ بنحطه على ال .. ال .. ال ..
+
+260
+00:19:15,650 --> 00:19:22,820
+ال .. ال بي باب أو ال اي بابأو sleep apnea mask و
+
+261
+00:19:22,820 --> 00:19:26,800
+بنخلّي يظل طول اللي نام هو عليها فهو كل ما بيخش في
+
+262
+00:19:26,800 --> 00:19:31,400
+sleep apnea الجهاز
+
+263
+00:19:31,400 --> 00:19:33,560
+بيحافظه على كيمية الـ pressure دي هو فما بيخشش
+
+264
+00:19:33,560 --> 00:19:36,820
+أصلا فيها و بيضلوا يتنفس لأنه مافيش ولا مرة بيكون
+
+265
+00:19:36,820 --> 00:19:43,840
+عنده بطل فيه نفس خالص وبالتالي هذه كتير كويسة
+
+266
+00:19:43,840 --> 00:19:47,740
+للناس اللي عندهم chronic fibrosis أو stress بـCOPD
+
+267
+00:19:47,740 --> 00:19:52,790
+أو lung fibrosis أو sleep apneaوفكرتها سهل لو
+
+268
+00:19:52,790 --> 00:19:58,310
+بتمنع الـ Recurrent Admission بسبب أبناء الـ
+
+269
+00:19:58,310 --> 00:20:02,410
+Ventilation حكيتلكم إن في حد اسمه Non-invasive
+
+270
+00:20:02,410 --> 00:20:06,310
+Historically أه لكن حديثا برضه صار يستخدموه زي هذا
+
+271
+00:20:06,310 --> 00:20:11,470
+المنظر هذا الجهاز بيعمل support زي ما انتوا شايفين
+
+272
+00:20:11,470 --> 00:20:16,370
+من حوالين الـLung وبيعمل زي ما انتوا شايفين هذا
+
+273
+00:20:16,370 --> 00:20:21,610
+بلون كأنه أه والهواء اللي فيه بيزيدوبيقل، لما
+
+274
+00:20:21,610 --> 00:20:24,110
+بيزيد، بيزيد ال pressure فبيعمل pressure على ال
+
+275
+00:20:24,110 --> 00:20:27,590
+lung فبالتالي أنت بتعمل expiration لما بيقل الهواء
+
+276
+00:20:27,590 --> 00:20:34,270
+اللي فيه بتروح أنت إيش؟ لما بيقل الهواء اللي فيه
+
+277
+00:20:34,270 --> 00:20:38,250
+بتروح أنت بتعمل relaxation فبتعمل inspiration فهو
+
+278
+00:20:38,250 --> 00:20:42,450
+فكرة قديمة إجت من ال iron lung هي شكل ال iron lung
+
+279
+00:20:42,450 --> 00:20:47,960
+يعني هيك بتتوقع كانت زمان شكل ال ICUاللي هي فكرة
+
+280
+00:20:47,960 --> 00:20:51,300
+الحديثة زي ما شوفنا كيف في الأطفال، هيك تمام؟
+
+281
+00:20:51,300 --> 00:20:57,760
+وحديثا استخدموها بهذا الشكل يعني استوحوا الفكرة من
+
+282
+00:20:57,760 --> 00:21:00,920
+فكرة الـNasal Mass قالوا بدل «طب ما احنا ما زالنا
+
+283
+00:21:00,920 --> 00:21:03,000
+non-invasive، بنعمله pressure» «ما بنعمله pressure
+
+284
+00:21:03,000 --> 00:21:05,780
+برا خالص، بنرجع لفكرة الـnon-invasive»
+
+285
+00:21:09,300 --> 00:21:12,220
+البراميات عادية خلصنا ال moods تبقى ال ventilation
+
+286
+00:21:12,220 --> 00:21:15,900
+يعني انا عرفت ايش ال windows اللي بده اشتغل علي
+
+287
+00:21:15,900 --> 00:21:18,480
+اندي كمبيوتر وحطته Microsoft Office وحطيت ال
+
+288
+00:21:18,480 --> 00:21:21,980
+PowerPoint وبده ابدأ اشتغل ايش بده؟ بده ابدأ احط
+
+289
+00:21:21,980 --> 00:21:25,580
+title بعدين احط subject بعدين احط مقدمة بعدين احط
+
+290
+00:21:25,580 --> 00:21:29,020
+خاتمة فانا اخترت ال mood نفترض ان ال mood اللي
+
+291
+00:21:29,020 --> 00:21:32,520
+عندي اس IMV والمood التاني اللي بده احطه support
+
+292
+00:21:32,520 --> 00:21:36,460
+هو ال beepطب إيش بالبيب؟ أوكي بدأ أحط مثلا المريض
+
+293
+00:21:36,460 --> 00:21:39,680
+يديه بيب عادي، إيه له؟ Normal، بيب يعني، من تلاتة
+
+294
+00:21:39,680 --> 00:21:42,900
+لخمسة is normal طب الـ SINV إيش هي ال parameters
+
+295
+00:21:42,900 --> 00:21:46,200
+اللي أنا لازم أحط عشان ال parameter اللي الـ SINV
+
+296
+00:21:46,200 --> 00:21:50,200
+يشتغل؟ أول حاجة بدأ أحط الـ FIO2 الـ Oxygen
+
+297
+00:21:50,200 --> 00:21:53,660
+Fraction زي ما حكينا الهواء الطبيعي الـ Ambient
+
+298
+00:21:53,660 --> 00:21:59,150
+Air فيه 21% هواءلكن المريض عادةً الـ Oxygen Demand
+
+299
+00:21:59,150 --> 00:22:05,170
+عنده أكتر فبحطه من 40 ل 60% لأنه أكتر من هيك هيكون
+
+300
+00:22:05,170 --> 00:22:08,030
+بعرض المريض لـ Oxygen Toxicity
+
+301
+00:22:16,970 --> 00:22:21,750
+هذا بالنسبة للـ FIO2 الـ Parameters التانية اللي
+
+302
+00:22:21,750 --> 00:22:25,290
+هو الـ tidal volume الـ tidal volume يعني زي ما
+
+303
+00:22:25,290 --> 00:22:33,230
+حكينا أنه هو عبارة عن كمية الهواء اللي المريض يريد
+
+304
+00:22:33,230 --> 00:22:36,710
+ياخدها في كل inhalation is in the volume of air
+
+305
+00:22:36,710 --> 00:22:39,270
+delivered to patients during a ventilator with
+
+306
+00:22:39,270 --> 00:22:44,600
+each present breath مع كل نفسمع كل نفس، مش في كل
+
+307
+00:22:44,600 --> 00:22:49,160
+دقيقة، تمام؟ وطبعاً حكينا بكل بساطة هو من ستة
+
+308
+00:22:49,160 --> 00:22:53,720
+لتمانية ملي لتر لكل كيلو جرام يعني مكتوب هنا سبعة
+
+309
+00:22:53,720 --> 00:22:58,540
+على تسعة اللي هو من ستة لتمانية ملي لتر لكل كيلو
+
+310
+00:22:58,540 --> 00:23:03,180
+جرام body weight هذا هو ال volume المناسب يعني لو
+
+311
+00:23:03,180 --> 00:23:11,730
+واحد وزنه جماعة سبعين كيلو جرام سبعين في تمانيةهو
+
+312
+00:23:11,730 --> 00:23:18,090
+تقدر الـ Volume المناسب طب لو واحد وزنه مائة، مائة
+
+313
+00:23:18,090 --> 00:23:23,150
+وعشرين، مائة وعشرين كيلو جرام، مائة وعشرين ضرب
+
+314
+00:23:23,150 --> 00:23:29,040
+تمانية، لأ، مش صحيحليش؟ لأننا نتعامل مع الـ Ideal
+
+315
+00:23:29,040 --> 00:23:32,520
+Body Weight، يعني هو المفروض أكم يكون وزنه، يعني
+
+316
+00:23:32,520 --> 00:23:37,220
+لما بيجي المريض و وزنه 120، بتعملش علشان أنه وزنه
+
+317
+00:23:37,220 --> 00:23:40,840
+120، بتطلع هو المفروض البني أدم هذا يكون وزنه حسب
+
+318
+00:23:40,840 --> 00:23:43,540
+طوله طبعا، كام؟
+
+319
+00:23:57,210 --> 00:24:03,550
+عشان نتعامل مع الـ Ideal Body Weight بالنسبة للـ
+
+320
+00:24:03,550 --> 00:24:08,060
+Peak Flow يعنيوالـ Flow Rate يعني الـ Pressure أو
+
+321
+00:24:08,060 --> 00:24:13,800
+الـ ال .. يعني ال .. الـ Flow of Gas used to
+
+322
+00:24:13,800 --> 00:24:18,160
+deliver each mechanical brief to the patient الـ
+
+323
+00:24:18,160 --> 00:24:23,840
+Flow، معدل الانسياب اللي جاي فيه الهواء للمريض
+
+324
+00:24:25,240 --> 00:24:29,040
+المفروض قداش بيبقى كيا بس بييدها، شايف كيف؟ سرعة
+
+325
+00:24:29,040 --> 00:24:32,400
+of delivering air per unit of time and is
+
+326
+00:24:32,400 --> 00:24:36,100
+expressed in liters per minute أقوى، اخد بالي،
+
+327
+00:24:36,100 --> 00:24:42,300
+يعني مثلا اما أنا بحكي أنه أنا مثلا بدنا المريض
+
+328
+00:24:42,300 --> 00:24:45,200
+على ال flow rate أربعة liters per minute
+
+329
+00:24:45,200 --> 00:24:48,140
+individual أديكوا to maintain oxygen saturation
+
+330
+00:24:48,140 --> 00:24:53,160
+level من 96 ل100أنا بدي الهواء يكون ماشي بسرعة
+
+331
+00:24:53,160 --> 00:24:59,420
+أربعة أو بـFlow بمعدل انسياب أربعة لتر في الدقيقة
+
+332
+00:24:59,420 --> 00:25:07,020
+عشان أنا أخد منه خمسمية كل نفس500 مليلتر في النفس
+
+333
+00:25:07,020 --> 00:25:13,660
+بس كيف معدل سرعة انسيابهم سريع؟ قداش معدل انسيابهم
+
+334
+00:25:13,660 --> 00:25:18,460
+ما معدل انه يعدي 4 لتر في خلال الدقيقة اه عزيزي
+
+335
+00:25:18,460 --> 00:25:22,500
+انا بتحكم كأني بتحكم في سرعة دخول الهواء كيف يكون
+
+336
+00:25:22,500 --> 00:25:28,040
+الضخم تبع كمية الضخم عالية ولا واطية ولا اكم انا
+
+337
+00:25:28,040 --> 00:25:35,180
+بحدد ال rate عالية نستخدم من 2 ل4 لتر per literبير
+
+338
+00:25:35,180 --> 00:25:41,660
+مينيت The higher the flow rate the faster big air
+
+339
+00:25:41,660 --> 00:25:45,280
+way pressure is reached and the shorter the
+
+340
+00:25:45,280 --> 00:25:50,880
+inspiration كل ما كان ال flow rate high كل ما أكسر
+
+341
+00:25:50,880 --> 00:25:56,220
+ال inspiration يا جماعة shorter The lower the flow
+
+342
+00:25:56,220 --> 00:25:59,400
+rate the longer the inspiration كل ما كان ال flow
+
+343
+00:25:59,400 --> 00:26:02,860
+rate low
+
+344
+00:26:03,580 --> 00:26:10,740
+والمكان الـ Inspiration أطول الـ
+
+345
+00:26:10,740 --> 00:26:13,640
+Respiratory Rate بيسموه على الأجهزة كتير الـ
+
+346
+00:26:13,640 --> 00:26:17,060
+Frequency انت بدك تاخد ال volume 500 أكم مرة عشان
+
+347
+00:26:17,060 --> 00:26:22,520
+يكي frequency فهو Respiratory Rateأكام نفس في
+
+348
+00:26:22,520 --> 00:26:27,340
+الدقيقة بدك إذا مربوط بالزمن بالدقيقة عادة بنحط
+
+349
+00:26:27,340 --> 00:26:31,960
+المرضى من عشرة لست عشر breath pair من الـ Total
+
+350
+00:26:31,960 --> 00:26:34,140
+respiratory rate equal patient rate plus
+
+351
+00:26:34,140 --> 00:26:36,440
+ventilator rate
+
+352
+00:26:40,370 --> 00:26:45,890
+الـ Respiratory Rate اللي بيدي الجهاز زاد اللي
+
+353
+00:26:45,890 --> 00:26:49,390
+بياخده المريض هو الـ Total Respiratory Rate
+
+354
+00:26:58,530 --> 00:27:04,910
+الـ Patient و الـ «COPD» و الـ Children بحتاجوا
+
+355
+00:27:04,910 --> 00:27:08,530
+تايدة الـ volume أشمل يا جماعة أقل لأن الـ lung
+
+356
+00:27:08,530 --> 00:27:12,950
+capacity تبعتهم أقل، مش هي؟ و الـ Children ال
+
+357
+00:27:12,950 --> 00:27:17,250
+weight تبعتهم أقل الناس اللي عندهم lung fibrosis
+
+358
+00:27:17,250 --> 00:27:21,890
+ال lung capacity تبعتهم أقل، اللي هو مسكرة، okay؟
+
+359
+00:27:24,200 --> 00:27:26,660
+حاجة اسمها الـ Minute Volume، من ضمن الـ
+
+360
+00:27:26,660 --> 00:27:29,460
+Parameters طب ليش؟ يعني إيش الـ Minute Volume؟ هذا
+
+361
+00:27:29,460 --> 00:27:32,520
+الـ Minute Volume هي كمية الأولة اللي بدها تخش
+
+362
+00:27:32,520 --> 00:27:36,160
+للمريض في الدقيقة، في الدقيقة، أه يعني طب ما أحنا
+
+363
+00:27:36,160 --> 00:27:39,180
+بنعرف كمية الأولة اللي بدها تخش كل نفس، في كل نفس،
+
+364
+00:27:39,180 --> 00:27:42,100
+طب وإذا المريض بياخد عشر تنفسات، يعني المريض بياخد
+
+365
+00:27:42,100 --> 00:27:45,860
+كل نفس خمسميةوالحاجة دي بتصير معاه عشر مرات في
+
+366
+00:27:45,860 --> 00:27:49,020
+الدقيقة يعني الـ minute volume خمسمية ضرب عشرة خمس
+
+367
+00:27:49,020 --> 00:27:51,760
+لتر يعني خمستلاك يعني خمس لتر هذا هو ال minute
+
+368
+00:27:51,760 --> 00:27:54,740
+volume؟ أه طب و أنا ليش أعرفه مازال أنا عارف ال
+
+369
+00:27:54,740 --> 00:27:58,100
+tidal volume وعارف ال rate؟ أه أعرفه علشان تي
+
+370
+00:27:58,100 --> 00:28:02,040
+أجهزة في تصميمها مالوش مكان لك tidal volume بيقولك
+
+371
+00:28:02,040 --> 00:28:05,560
+حط ال rate وحط ال minute volume هو خلاص بيعرف ال
+
+372
+00:28:05,560 --> 00:28:09,000
+tidal volumeأها فصار في إن هنا indication لازم
+
+373
+00:28:09,000 --> 00:28:12,360
+أحنا نكون عارفين حاجة اسمها الـMinute Volume في
+
+374
+00:28:12,360 --> 00:28:15,780
+أجهزة مافيش فيها مكان تعمل Setting للـTidal بتقضط
+
+375
+00:28:15,780 --> 00:28:18,660
+أنت الـFrequency Rate عشرة، اتناش، وكداش بدك
+
+376
+00:28:18,660 --> 00:28:21,540
+الـMinute Volume؟ تقوله والله خمسة، بيفهم إنه آه
+
+377
+00:28:21,540 --> 00:28:25,180
+بده يقسم خمسة لتر على عشر عشان يد كل الـTidal
+
+378
+00:28:25,180 --> 00:28:30,620
+Volume تمام؟ خمسة لتر على عشر هيدل خمسمية CC كل
+
+379
+00:28:30,620 --> 00:28:34,560
+one breath تمام؟ لكن في أجهزة okay فيها Tidal
+
+380
+00:28:34,560 --> 00:28:38,280
+Volume فمش فيها Minute Volume«في مستخدم بخطأ
+
+381
+00:28:38,280 --> 00:28:43,000
+الحرارة» طبعاً الـ «الكالوسوس» يمكن أن يكون
+
+382
+00:28:43,000 --> 00:28:46,800
+مطالبًا بإنجاز الـ «سيريبرال فازاكنترش» بـ «تقليل
+
+383
+00:28:46,800 --> 00:28:50,320
+رسمي» في الـICB «والسيدال فوليوم»
+
+384
+00:28:50,320 --> 00:28:55,040
+و«الرسبيروريوتيت» يتحررون لإنجاز الـ «الكالوسوس»
+
+385
+00:28:55,040 --> 00:28:59,220
+بأشواء للمستخدم» يعني يا جماعة هذا هذا الكلام يعني
+
+386
+00:28:59,220 --> 00:29:04,520
+نوعًا ما الآن مع الناس اللي تعون الـ Head injury
+
+387
+00:29:04,520 --> 00:29:12,970
+بطلوا يستخدمواكتير حكيت إنه أخلي المريض الـ
+
+388
+00:29:12,970 --> 00:29:17,410
+«الكالوتك بي أتش» لأ صار «normal» «normal» blood
+
+389
+00:29:17,410 --> 00:29:21,670
+gas is required يعني الآن صاروا بيعتمدوا على إنه
+
+390
+00:29:21,670 --> 00:29:27,270
+يخلوا الـ blood gas normal وما يقللوش الـ «CO2» زي
+
+391
+00:29:27,270 --> 00:29:37,150
+زمان يعني هذه الشيء شوفوا اللي هوبين المستخدم الـ
+
+392
+00:29:37,150 --> 00:29:40,410
+COPD يعني في الـ patient اللي تبعون الـ COPD
+
+393
+00:29:40,410 --> 00:29:44,030
+Baseline ABG reflect and elevated BCO2 should not
+
+394
+00:29:44,030 --> 00:29:47,790
+hyperventilated instead the goal should be
+
+395
+00:29:47,790 --> 00:29:51,450
+restoration of the baseline BCO2 في الناس اللي
+
+396
+00:29:51,450 --> 00:29:57,180
+تبعون الـ COPD يا جماعةالـ «CO2» أصلا يكون عندهم
+
+397
+00:29:57,180 --> 00:30:02,880
+عالي فاحنا ما بنـ... ما بنـ... ما بنحطوش يعني على
+
+398
+00:30:02,880 --> 00:30:06,640
+تايدة الـ volume عالي لدرجة ما إنه يصير الـ «CO2»
+
+399
+00:30:06,640 --> 00:30:12,000
+عنده واطي أه يصير hyperventilation لأن هو متعود
+
+400
+00:30:12,000 --> 00:30:15,420
+على «CO2» عالي، هذا واحد الحاجة التانية في الـ
+
+401
+00:30:15,420 --> 00:30:19,380
+«hidrotrauma» زي ما حكينا بطل يعني يفضل إنه نخلي
+
+402
+00:30:19,380 --> 00:30:26,210
+«CO2» واطي عشان نحقق شوية الكلوسيزفي حاجة اسمها
+
+403
+00:30:26,210 --> 00:30:31,330
+الـIE Ratio الـInspiratory-Expiratory Ratio
+
+404
+00:30:31,330 --> 00:30:35,910
+الـInspiratory-Expiratory Ratio يا جماعة بكل بساطة
+
+405
+00:30:35,910 --> 00:30:42,110
+إنه أنا حطيت للجهاز الـTidal Volume اللي احنا بدنا
+
+406
+00:30:42,110 --> 00:30:47,150
+نعطيه وتبرناه مثلا 500 CC في كل نفس وحكيت للجهاز
+
+407
+00:30:47,150 --> 00:30:54,530
+الـRate إنه 12 Breath Per Minuteطيب الجهاز على هذا
+
+408
+00:30:54,530 --> 00:31:01,040
+الكلام وحطت له الـ Peak Flow 4 Literعلى هذا الكلام
+
+409
+00:31:01,040 --> 00:31:04,560
+الجهاز حيف فهم إنه أوكي أنت بدك أدي 12 نفس في
+
+410
+00:31:04,560 --> 00:31:08,580
+الدقيقة فممكن في أول عشر ثوان من الدقيقة يروح يديك
+
+411
+00:31:08,580 --> 00:31:11,900
+واحد، اتنين، تلاتة، أربعة، اتناشر ويخلص ويظلوا
+
+412
+00:31:11,900 --> 00:31:18,140
+مستني خمسين ثانية بيستنى لما تيجي الدقيقة التانية
+
+413
+00:31:18,140 --> 00:31:23,080
+عشان يبدأ يشتغل إذا بدنا احنا نعمل عملية تنظيم
+
+414
+00:31:25,480 --> 00:31:28,120
+الـ Inspiration والـ Expiration طب من وين بدهم
+
+415
+00:31:28,120 --> 00:31:31,640
+يستوحى التنظيم هذا؟ وإيش بدهم يربطوه؟ بعمل الوقت
+
+416
+00:31:31,640 --> 00:31:36,840
+بدهم يربطوه بالوقت، كيف؟ قال لك إحنا في الـ Normal
+
+417
+00:31:36,840 --> 00:31:42,120
+Respiration تبعنا، كيف بنعمل؟ قال فيه Ratio لـ
+
+418
+00:31:42,120 --> 00:31:44,640
+Inspiration وExpiration، إيش الـ Ratio هذا؟
+
+419
+00:31:51,680 --> 00:31:58,340
+عملية الـ Inspiration جزء من جزئين من عملية الـ
+
+420
+00:31:58,340 --> 00:32:03,100
+Expiration يعني عملية الـ Expiration جزئين من
+
+421
+00:32:03,100 --> 00:32:04,520
+عملية الـ Inspiration
+
+422
+00:32:06,840 --> 00:32:12,980
+الـ Expiration 2 يعني إذا أنا بحتاج واحد زمن ثانية
+
+423
+00:32:12,980 --> 00:32:16,680
+واحدة للـ Inspiration بحتاج ثانيتين أعمل الـ
+
+424
+00:32:16,680 --> 00:32:21,380
+Expiration إذا أنا بحتاج two seconds ثانيتين أعمل
+
+425
+00:32:21,380 --> 00:32:26,080
+فيهم Inspiration هحتاج two ضرب two two seconds و
+
+426
+00:32:26,080 --> 00:32:31,980
+two seconds أربعة secondsالـ Expiration إذا أنا
+
+427
+00:32:31,980 --> 00:32:35,780
+إذا بحتاج جزء من الوقت للـ Inspiration بحتاج جزءين
+
+428
+00:32:35,780 --> 00:32:38,780
+يقبلوا للـ Expiration فإذا الجزء هذا كان two
+
+429
+00:32:38,780 --> 00:32:44,870
+seconds بحتاج أربعة seconds للـ Expiration طيبإذن
+
+430
+00:32:44,870 --> 00:32:48,470
+ها لو أنا روح أتعملت preset للـIE راشو في
+
+431
+00:32:48,470 --> 00:32:51,270
+الـMechanical Ventilator وحكيتله إن الـ12 نفس اللي
+
+432
+00:32:51,270 --> 00:32:55,770
+بده تدّيهم اللي كل نفس تقدر تقولهم تبقى 500 بده
+
+433
+00:32:55,770 --> 00:32:59,750
+يكون الـinspiratory time الوقت اللي بدك تعطي فيه
+
+434
+00:32:59,750 --> 00:33:06,470
+النفس، نفترض سنتين والوقت اللي بدك تسيب النفس يطلع
+
+435
+00:33:06,470 --> 00:33:14,150
+فيه أربع ثوانيبكون نظّمت عملية النفس فالـ IE Ratio
+
+436
+00:33:14,150 --> 00:33:19,710
+هذه هي العملية اللي أنا أو هذه هي الـ Setting اللي
+
+437
+00:33:19,710 --> 00:33:22,890
+بدي أنظم فيها عملية النفس بحيث أضمن إنه ضالوا 12
+
+438
+00:33:22,890 --> 00:33:26,130
+نفس أو العشر تنفسات أو ال rate اللي أنا بدي أديه
+
+439
+00:33:26,130 --> 00:33:30,690
+موزّع على دقيقة كاملة، كويس؟ بكل بصفة كيف بدي
+
+440
+00:33:30,690 --> 00:33:34,270
+أحسبه؟ بدي أحسب الـ Respiratory Rate
+
+441
+00:33:36,940 --> 00:33:45,880
+تقسيم أكم؟ تقسيم عشرين يعني مثلا لو أنا أول
+
+442
+00:33:45,880 --> 00:33:48,760
+عشرين تقسيم ال respiratory rate يعني لو أنا كان
+
+443
+00:33:48,760 --> 00:33:53,470
+فيه بدي أد المريض عشر تنفسات في الدقيقةعشر تنفسات
+
+444
+00:33:53,470 --> 00:33:58,690
+في الدقيقة عشرين تقسيم عشرة إتنين يعني المفروض أنه
+
+445
+00:33:58,690 --> 00:34:03,690
+يكون كل نفس الـinspiratory time تبعه two seconds
+
+446
+00:34:03,690 --> 00:34:08,390
+والـexpiratory four seconds، check؟ طب من وين جت
+
+447
+00:34:08,390 --> 00:34:12,570
+العشرين هذه؟ العشرين هي تلت مش عملية النفس واحد
+
+448
+00:34:12,570 --> 00:34:17,490
+إلى اتنين حكينا؟ okay يعني دقيقة كم ثانية؟ ستين
+
+449
+00:34:18,610 --> 00:34:25,230
+يعني لو بدأ أخد منها تلتها 20 إلى 40 يعني كل عملية
+
+450
+00:34:25,230 --> 00:34:29,210
+التنفس في الدقيقة بتصير في 20 ثانية وكل عملية الـ
+
+451
+00:34:29,210 --> 00:34:34,250
+Expiration كل دقيقة بتصير في 40 ثانية يعني كل
+
+452
+00:34:34,250 --> 00:34:37,750
+عملية التنفس اللي في الدقيقة بتصير في 20 ثانية
+
+453
+00:34:37,750 --> 00:34:41,630
+طبعا بتصير في الـ 20 ثانية هدول عشر التنفسات يبقى
+
+454
+00:34:41,630 --> 00:34:45,410
+20 تقسيم عشرة 20 تقسيم عشرة اتنين الـ
+
+455
+00:34:45,410 --> 00:34:46,410
+Inspirational Time
+
+456
+00:34:49,290 --> 00:34:50,070
+تو ساكنت
+
diff --git a/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/8PF95HihGvQ.srt b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/8PF95HihGvQ.srt
new file mode 100644
index 0000000000000000000000000000000000000000..bba6a07593ed1dc2de5dbd4e3411f4b710cd48ae
--- /dev/null
+++ b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/8PF95HihGvQ.srt
@@ -0,0 +1,1354 @@
+1
+00:00:05,740 --> 00:00:09,020
+بسم الله الرحمن الرحيم اليوم إن شاء الله رب
+
+2
+00:00:09,020 --> 00:00:14,120
+العالمين محاضرتنا الثالثة في مقدمة الـ Critical
+
+3
+00:00:14,120 --> 00:00:18,100
+Care Nursing سنحكي إن شاء الله ربنا العالمين عن الـ
+
+4
+00:00:18,100 --> 00:00:23,380
+ethical و الـ legal issues in critical care كان في
+
+5
+00:00:23,380 --> 00:00:30,220
+بعض الملاحظات من بعض منكم أن الصوت شوية واطي، هي
+
+6
+00:00:30,220 --> 00:00:36,790
+نجبنا الـ mic واشتغلنا على الـ mic بحيث أن يزيد الصوت
+
+7
+00:00:36,790 --> 00:00:41,990
+وكمان يعني حولت أن الهواية التي أكون مشغلها عادة
+
+8
+00:00:41,990 --> 00:00:45,590
+لأن الدنيا شوية طفيتها أيضاً عشان خاطرِكم بحيث أن
+
+9
+00:00:45,590 --> 00:00:51,310
+يكون الصوت أوضح وأنقى، أتمنى أن يكون هكذا عجبكم
+
+10
+00:00:51,310 --> 00:00:59,410
+ويكون الصوت واضحاً بالنسبة لموضوع المحاضرة، okay
+
+11
+00:01:02,630 --> 00:01:05,370
+ethical and legal issues in critical care، مايعني
+
+12
+00:01:05,370 --> 00:01:09,830
+ethical و legal issues يعني فيه أمور أخلاقية أو
+
+13
+00:01:09,830 --> 00:01:17,070
+فيه قضايا أخلاقية لازم نأخذ بالنا منها أثناء عملنا
+
+14
+00:01:17,070 --> 00:01:22,270
+في العناية المركزة، وهذا يعني بيطرح وجود الحالات
+
+15
+00:01:22,270 --> 00:01:26,370
+الحرجة، ووجود مكان مغلق مثل الـ Intensive Care Units
+
+16
+00:01:26,370 --> 00:01:32,170
+العناية المركزة، الحالة الحرجة، الـ Health Care
+
+17
+00:01:32,170 --> 00:01:38,050
+Provider سواء كان Nurse أو دكتور، الذي يكون مرتبطاً
+
+18
+00:01:38,050 --> 00:01:41,590
+في الحالة و Assigned على الحالة، وبيشتغل معها، ويكون
+
+19
+00:01:41,590 --> 00:01:48,010
+هو الذي لوحده المسؤول عن تقديم العملية وتبعاتها، هذا
+
+20
+00:01:48,010 --> 00:01:54,250
+يفرض بعض القضايا الأخلاقية التي يكون يعني
+
+21
+00:01:54,250 --> 00:01:59,430
+التعامل معها نوعاً ما محيراً، أو ممكن يحطنا يعني في
+
+22
+00:01:59,430 --> 00:02:03,730
+dilemma، يخليني أسأل حالي: إيش المفروض أعمل؟ أعمل
+
+23
+00:02:03,730 --> 00:02:08,250
+هكذا ولا لا أفعل هكذا؟ دائماً نحكي إحنا أنه في كل
+
+24
+00:02:08,250 --> 00:02:15,600
+المهن يجب أن يكون في أخلاق مهنية معينة، تتبع الأخلاق
+
+25
+00:02:15,600 --> 00:02:22,620
+المهنية هذه هي، يعني بتختلف في الحقيقة عن الأخلاق
+
+26
+00:02:22,620 --> 00:02:27,400
+التي أنت، مثلاً، خليني نحكي الأخلاق الاجتماعية، أو
+
+27
+00:02:27,400 --> 00:02:33,360
+أمور تربيتك، ليش؟ لأن في كل مهنة الأخلاقيات تَبْعَتها
+
+28
+00:02:33,360 --> 00:02:40,820
+معناها الضوابط تَبْعَت المهنة هذه، It is allowed to do
+
+29
+00:02:40,820 --> 00:02:47,120
+إيش مسموح لك أن تفعله، وإيش غير مسموح أنك تفعله
+
+30
+00:02:47,120 --> 00:02:53,700
+بما أنه يخالف أخلاق هذه المهنة، إذن موضوع كلمة
+
+31
+00:02:53,700 --> 00:02:58,410
+أخلاق، لما واحد يسمع أخلاق المهنة، هي مش حاجة إنها
+
+32
+00:02:58,410 --> 00:03:02,870
+بسيطة وسهلة، قواعد الأخلاق يعني بيحكي عن الأخلاق
+
+33
+00:03:02,870 --> 00:03:06,970
+الحميدة، يعني آه صحيح هي الأخلاق الحميدة، بس هي
+
+34
+00:03:06,970 --> 00:03:11,690
+عبارة عن مجموعة Policies، مجموعة قوانين، مجموعة
+
+35
+00:03:11,690 --> 00:03:20,180
+محددات بتحدد علاقتك مع الـ superior أو مع المريض، ضمنها
+
+36
+00:03:20,180 --> 00:03:27,620
+وما يجب أن تفعله، وما لا يجب أن تفعله، ويعني بالذات
+
+37
+00:03:27,620 --> 00:03:33,060
+في بعض القضايا المهنية المعينة، في حال أن صار كذا
+
+38
+00:03:33,060 --> 00:03:36,860
+أو صار كذا، أين هو دورك؟ أين يُحَجُّ لك أن تعمل؟ أين لا
+
+39
+00:03:36,860 --> 00:03:41,040
+يُحَجُّ لك أن تعمل؟ عشان هيك فيه principles للـ
+
+40
+00:03:41,040 --> 00:03:46,640
+bioethics، الأخلاقيات التي تشترك فيها تقريباً كل المهن
+
+41
+00:03:46,640 --> 00:03:52,890
+الـ الصحية منها، مثلاً، إطارها، نتعامل مع مريض، المفروض
+
+42
+00:03:52,890 --> 00:03:55,270
+أن نحافظ على الـ Autonomy تبع المريض، إيش يعني
+
+43
+00:03:55,270 --> 00:03:57,630
+الـ Autonomy؟ يعني الـ Self-determination، إيش
+
+44
+00:03:57,630 --> 00:04:01,130
+يعني؟ يعني أن نُخَلِّي، هذه قضية أخلاقية، معناها أن
+
+45
+00:04:01,130 --> 00:04:04,210
+نُخَلِّي المريض يحتفظ بحقه في تقرير إيش الشيء الذي
+
+46
+00:04:04,210 --> 00:04:06,710
+يُقَدِّرُ أن يفعله، كيف يعني؟ أنا جاي بدي أعمل له
+
+47
+00:04:06,710 --> 00:04:10,370
+Procedure، أيّ كان الـ Procedure هذا، لازم آخذ
+
+48
+00:04:10,370 --> 00:04:15,370
+إذن المريض، ولازم أشركه في القرار الخاص
+
+49
+00:04:15,370 --> 00:04:19,650
+بالـ Procedure، وأُخَلِّي القرار يَطْلُع منه أنه: آه لو سمحت
+
+50
+00:04:19,650 --> 00:04:23,150
+أنا أوافق، تفضل اعمل الـ procedure هذا الذي يخدم
+
+51
+00:04:23,150 --> 00:04:29,590
+صحتي، إذا هذا هو الأصل، ولو أنّه المفروض أن الـ
+
+52
+00:04:29,590 --> 00:04:33,570
+الـ الـ الـ procedure هذه عادةً تكون يعني
+
+53
+00:04:33,570 --> 00:04:38,850
+obligatory، لازم نعملها، وليس مجال أن أن لا ..
+
+54
+00:04:38,850 --> 00:04:43,710
+لا نعملها، لكن رغم ذلك يجب أن تأخذ إذن
+
+55
+00:04:43,710 --> 00:04:49,470
+المريض، تُحَقِّقُ الاستقلالية للمريض في القرار، وتجعله
+
+56
+00:04:49,470 --> 00:04:54,750
+يكون شريكاً معك في القرار، وبالأخرى صاحب القرار، ويسمح
+
+57
+00:04:54,750 --> 00:04:59,530
+لك بتنفيذ الـ procedure، طب إحنا يا جماعة نتكلم يا
+
+58
+00:04:59,530 --> 00:05:02,730
+دكتور، كنت نسيت، أنت تحكي عن مريض في العناية
+
+59
+00:05:02,730 --> 00:05:08,620
+المركزة، أحياناً كثيراً يكون unconscious، نقول هنا أن
+
+60
+00:05:08,620 --> 00:05:12,920
+المريض الـ unconscious يُعامل معاملة المريض الـ
+
+61
+00:05:12,920 --> 00:05:19,930
+conscious، المريض يسمع، إحنا في ديننا الميت يسمع، فما
+
+62
+00:05:19,930 --> 00:05:23,610
+بالك في المريض الذي في غيبوبة، يسمع ويعي، ولكن لا
+
+63
+00:05:23,610 --> 00:05:30,350
+يوجد عنده قدرة على الاستجابة، لا يستطيع أن يستجيب
+
+64
+00:05:30,350 --> 00:05:34,230
+ويعمل response للـ stimulation تبعك، أو للـ
+
+65
+00:05:34,230 --> 00:05:37,390
+communications تبعك، للـ verbal communications تَبْعَتِك
+
+66
+00:05:38,000 --> 00:05:43,320
+ويجيبك على الذي أنت تريده، ولذلك نحافظ على الـ
+
+67
+00:05:43,320 --> 00:05:49,200
+communication، ونحكي للمريض أننا نريد أن نفعل لك الـ
+
+68
+00:05:49,200 --> 00:05:54,080
+procedure، فلان، يعني أنا الحكيم فلان الفلاني، الله يصيب
+
+69
+00:05:54,080 --> 00:05:57,740
+عليك بالخير إن شاء الله، أنا مسؤل عنك اليوم، الآن
+
+70
+00:05:57,740 --> 00:06:01,920
+سيكون معك الـ body hygiene، سأفعل لك self care كامل، و
+
+71
+00:06:01,920 --> 00:06:04,920
+سأفعل لك حمام، وبعدها كذا
+
+72
+00:06:07,990 --> 00:06:10,250
+تحكيله إيش الذي أنت تريد أن تفعله بالضبط، «Explained
+
+73
+00:06:10,250 --> 00:06:14,670
+Procedure»، وبعدين تحافظ على الـ «Privacy»، تغطي
+
+74
+00:06:14,670 --> 00:06:21,510
+الستائر، ما تكونش قلق، أنا محافظ على الـ «Privacy»
+
+75
+00:06:21,510 --> 00:06:26,690
+تَبْعَتِك، مافيش، أو الخصوصية تَبْعَتِك، أنا يعني سَكَّرْتُ
+
+76
+00:06:26,690 --> 00:06:31,670
+الستائر، مافيش غير أنا وأنت موجودين في المكان، لأنه
+
+77
+00:06:31,670 --> 00:06:34,650
+هو يسمع، هو بيكون عارف، فيه أنت لما حكيته، طب ومش
+
+78
+00:06:34,650 --> 00:06:39,030
+ليستطيع أن يُسَجِّل، لكن يفهم أنك يعني سيكون
+
+79
+00:06:39,030 --> 00:06:42,650
+exposed، سيكون بدون ملابس، فلازم تفهم أنني أُحَافِظُ على الـ
+
+80
+00:06:42,650 --> 00:06:47,570
+privacy، أنت مغطى، أنت كذا، أنا سأهتم أن
+
+81
+00:06:47,570 --> 00:06:50,890
+درجة حرارتك أيضاً تظل، أن البيئة مناسبة، درجة
+
+82
+00:06:50,890 --> 00:06:56,240
+الحرارة دافئة، في المكان، المريض يسمع ويعي، تمام؟ وفيه
+
+83
+00:06:56,240 --> 00:06:58,940
+أبحاث كثيرة يا جماعة حالياً على الكلام هذا، أن
+
+84
+00:06:58,940 --> 00:07:02,040
+الساعات الأخيرة حتى للناس الذين يموتون، أنه يُسَجَّلُ
+
+85
+00:07:02,040 --> 00:07:06,560
+مواقف، وهو يكون أُعلنت وفاته، يأخذون EEG من مخه
+
+86
+00:07:06,560 --> 00:07:10,360
+ويجدون أن كثيراً فيه من الأحداث مسجلة، ويقدرون
+
+87
+00:07:10,360 --> 00:07:13,880
+حتى يعرفوا من قزحية العين وقَرْنِيَّة العين، من هو آخر
+
+88
+00:07:13,880 --> 00:07:17,260
+صورة شاهدها، وإيش آخر كلام كان سمعه، هذا الكلام
+
+89
+00:07:17,260 --> 00:07:23,820
+Benefits،  اللي هي Beneficence، اللي هي الإحسان
+
+90
+00:07:25,010 --> 00:07:30,950
+الإحسان، إيش يعني الإحسان؟ يعني أن تكون تفعل
+
+91
+00:07:30,950 --> 00:07:38,150
+الحاجات التي أنت مطلوب منك، بحيث
+
+92
+00:07:38,150 --> 00:07:44,670
+أن تُحَقِّقَ أعلى درجة نفع للمريض، وبطريقة
+
+93
+00:07:44,670 --> 00:07:51,880
+يعني، يعني بطريقة، خليني أسميها مقبولة جداً عنده، هذا
+
+94
+00:07:51,880 --> 00:07:54,940
+هو الإحسان، إذا الإحسان أن أتعامل مع المريض في
+
+95
+00:07:54,940 --> 00:07:59,280
+أن أقدم له أحسن إمكانية للخدمة التي أنا ممكن
+
+96
+00:07:59,280 --> 00:08:04,060
+أقدمها، أحسن طريقة، أحسن حاجة، بقى يعني do your best
+
+97
+00:08:04,060 --> 00:08:09,850
+أن تقدمها بأفضل شكل، تمام؟ إيه، في أنها يعني ترضي
+
+98
+00:08:09,850 --> 00:08:14,010
+هذا المتلقي، المتلقي للخدمة، هذا هو الإحسان في
+
+99
+00:08:14,010 --> 00:08:18,310
+تقديم الخدمة، مش أني أنا، عشان أنا أخدمه، لازم أني
+
+100
+00:08:18,310 --> 00:08:21,710
+أديله يا، إحنا اللي بنعمل لك هيك، أنت تقول لنا إيش تعمل لنا
+
+101
+00:08:21,710 --> 00:08:26,010
+بصراحة، نمشي مع مريض عنيد، وبيعمل على نفسه
+
+102
+00:08:30,110 --> 00:08:33,830
+complications، وإيش ممكن فيه، إحنا بننظف عليك، ونعمل لك
+
+103
+00:08:33,830 --> 00:08:39,110
+كمان تغير ملابس، وتلفِ  شوية، كثيراً ممكن أحياناً بعض
+
+104
+00:08:39,110 --> 00:08:45,530
+الأشخاص يعني تفقد منهم السيطرة، أو يحكوا بعض الكلام
+
+105
+00:08:45,530 --> 00:08:51,290
+غير ضروري، non-male efficiency، الذي هو أحياناً أنك
+
+106
+00:08:51,290 --> 00:08:57,010
+تفعل أشياء مؤذية، يعني ما لها لزوم، فهذا ممنوع، ممنوع
+
+107
+00:08:57,010 --> 00:09:01,530
+تفعل أي حاجة أو Procedures مؤذية، أو Procedure ما لها
+
+108
+00:09:01,530 --> 00:09:04,950
+لزوم أصلاً، يعني أنت تفعل شيء ما له لزوم، فهو مؤذي،
+
+109
+00:09:04,950 --> 00:09:09,090
+يُصْبِحُ، تمام؟ أو أنك تفعل الـ Procedure الذي له لزوم،
+
+110
+00:09:09,090 --> 00:09:13,450
+بس بشكل مؤذي، هذا ممنوع، role of double effect، في
+
+111
+00:09:13,450 --> 00:09:21,700
+ناس أنتم يعني أحياناً تحاولون تخدمون، مثلاً، إيش الـ role
+
+112
+00:09:21,700 --> 00:09:25,240
+of double effect ده؟ يعني زي ما بيسموه سلاح ذو حدين
+
+113
+00:09:25,240 --> 00:09:29,180
+يعني بيجي هو مثلاً يجد مريض يتألم كثيراً، فيحاول
+
+114
+00:09:29,180 --> 00:09:32,700
+أن المريض الذي يتألم كثيراً هذا، أن إيش يفعل له، يخفف
+
+115
+00:09:32,700 --> 00:09:36,320
+عنه الألم، فيروح يُعْطِيهِ جرعة مخدّر مثلاً، إيش غير
+
+116
+00:09:36,320 --> 00:09:40,880
+موصوفة، أو حتى لو موصوفة، يُعْطِيهِ بس يزيد له شوية، بحيث
+
+117
+00:09:40,880 --> 00:09:44,580
+أنه يعني إيش، يخدمه ويخفف الألم أكثر، فيروح يفعله
+
+118
+00:09:44,580 --> 00:09:47,580
+Respiratory Depression، ويُصِيبُهُ، وممكن يذهب فيها
+
+119
+00:09:47,580 --> 00:09:52,020
+المريض، ويُصْبِحُ ضائعاً، الآن هو فعلياً قاتل، هو مش يعني
+
+120
+00:09:52,020 --> 00:09:57,540
+يُقَدِّمُ خدمة، هو قاتل، لأنه Criminal، هذا أنت أعطيت دواء
+
+121
+00:09:57,540 --> 00:10:02,600
+مسكن للألم، بجرعات، pain killer، خليني أسميه يعني
+
+122
+00:10:02,600 --> 00:10:06,920
+بجرعات عالية، الـ side effect تبع الجرعات هذه أنّه
+
+123
+00:10:06,920 --> 00:10:13,130
+ممكن يفعل الذي هو Respiratory Depression، وبالتالي
+
+124
+00:10:13,130 --> 00:10:17,610
+أنت عرضت المريض لخطر، سواء تحقق الخطر هذا أم لم
+
+125
+00:10:17,610 --> 00:10:21,650
+يتحقق، يعني ربما أنّه فلت منها، وربنا نجاه، بس صار
+
+126
+00:10:21,650 --> 00:10:24,690
+شوية مشاكل، وبعدين يجيوا يعملوا له Intubation أو
+
+127
+00:10:24,690 --> 00:10:29,590
+لم يفلت، وذهب فيها، فأنت بكلا الحالتين أنت مجرم، وأنت
+
+128
+00:10:29,590 --> 00:10:35,370
+أخطأت في حق نفسك وحق المريض، لذلك يجب أن نتجنب أن
+
+129
+00:10:35,370 --> 00:10:41,390
+نفعل أي إجراء قد يكون له أثر جانبي، يعني أنا أحس إني
+
+130
+00:10:41,390 --> 00:10:44,650
+أذهب وأفعل مثلِك، فهو يكون فيه effect ثاني ممكن يصير
+
+131
+00:10:44,650 --> 00:10:52,570
+وبالتالي هذه محدداتها، أن أقوم بتنفيذ الإجراءات أو
+
+132
+00:10:52,570 --> 00:10:57,350
+بتنفيذ الـ orders المكتوبة بالطريقة الصحيحة، بدون أي
+
+133
+00:10:57,350 --> 00:11:03,600
+تعديات، وعندما أشك أنني ممكن يكون فيه أثر جانبي
+
+134
+00:11:03,600 --> 00:11:06,940
+للـ Procedure أو الـ Order الذي أريد أن أنفذه، هذا
+
+135
+00:11:06,940 --> 00:11:11,420
+يجب أن أستشير، سواء my colleague، my senior colleague، الـ
+
+136
+00:11:11,420 --> 00:11:14,620
+senior charge nurse الذي عليك، أو الـ physician الذي
+
+137
+00:11:14,620 --> 00:11:20,500
+موجود معك، justice، لازم تكون عادلاً في المعاملة مع
+
+138
+00:11:21,440 --> 00:11:27,800
+المريض، وما .. حتى الـ .. حتى مع نفسك، يعني لازم تكون
+
+139
+00:11:27,800 --> 00:11:33,900
+عادلاً في المعاملة، تعرف يعني مبدأ العدل، ما نريدش
+
+140
+00:11:33,900 --> 00:11:37,860
+نحكي فيه كثيراً، العدل .. العدل في كل شيء، يعني العدل
+
+141
+00:11:37,860 --> 00:11:44,030
+ما كان في شيء إلا بزينه سبحانه وتعالى، ولا لأ؟ فالعدل
+
+142
+00:11:44,030 --> 00:11:53,410
+في المعاملة، العدل في تقديم الخدمة، العدل في الوقت
+
+143
+00:11:53,410 --> 00:11:56,810
+الذي تمنحه لكل مريض، ممكن يكون معك أكثر من
+
+144
+00:11:56,810 --> 00:12:00,990
+مريض، غير معقول أن أنت تُحَسِّسَ مريضاً أنه واحد، وأنت
+
+145
+00:12:00,990 --> 00:12:05,610
+مهتم فيه كثيراً، وكثيراً من الساعات تمر عليها ثلاث دقات فقط،
+
+146
+00:12:05,610 --> 00:12:09,150
+آه، أرى أنت جيد، أفعله، وكل اهتمامك في المريض
+
+147
+00:12:09,150 --> 00:12:14,770
+الثاني، هذا عادةً يجعل المريض يحس بالتَحْقير، الـ
+
+148
+00:12:14,770 --> 00:12:18,710
+process، كيف تكون الـ process of ethical reasoning؟
+
+149
+00:12:20,320 --> 00:12:25,940
+أنه إحنا عادةً، لو أنا عندي قضية أخلاقية معينة
+
+150
+00:12:25,940 --> 00:12:30,460
+ونريد مناقشتها، فـ Review the fact، نرجع
+
+151
+00:12:30,460 --> 00:12:34,300
+للحقائق، طب هو إيش الأصل في الموضوع؟ الأصول نرجع إليها
+
+152
+00:12:34,300 --> 00:12:37,560
+Define the problem، الأصل في الموضوع أن نفعل هكذا
+
+153
+00:12:37,560 --> 00:12:40,200
+هكذا هكذا، طب إحنا إيش الذي حصل معنا؟ Define، عرف
+
+154
+00:12:40,200 --> 00:12:43,720
+المشكلة، أُحَدِّدُها، يعني المشكلة أننا فعلنا هكذا هكذا
+
+155
+00:12:43,720 --> 00:12:47,060
+هكذا، أها، طب وإيش الخيارات؟ كيف يعني؟ لماذا هذه صارت
+
+156
+00:12:47,060 --> 00:12:51,890
+المشكلة؟ كيف نريد حلها؟ إيش الأسباب التي أوصلت
+
+157
+00:12:51,890 --> 00:12:54,770
+للمشكلة؟ والله كذا، ممكن يكون كذا، ممكن يكون كذا،
+
+158
+00:12:54,770 --> 00:12:59,710
+ممكن يكون كذا، وضعنا كل الأسباب الممكنة، طيب،
+
+159
+00:12:59,710 --> 00:13:05,130
+decide on an action، نقول آه، طب إيش أحسن حل في رأيك
+
+160
+00:13:05,130 --> 00:13:09,590
+عشان نبدأ نحل هذه المشكلة التي أسبابها سردناها
+
+161
+00:13:09,590 --> 00:13:13,250
+بالشكل التالي، نبدأ نقترح، brainstorming، والله ممكن
+
+162
+00:13:13,250 --> 00:13:17,390
+يكون الحل، نفعل كذا، ونفعل كذا، يقول واحد، يضع أي حل
+
+163
+00:13:17,390 --> 00:13:20,970
+ممكن، يختار في البدء، تمام، نبدأ الآن نـ decide، طب هات
+
+164
+00:13:20,970 --> 00:13:26,330
+لو سمحتوا، نضع إيش؟ نشوف الخيار الأنسب، هذا الخيار
+
+165
+00:13:26,330 --> 00:13:33,620
+نستبعده، لأنه صعب تحقيقه، خيالي، الحل
+
+166
+00:13:33,620 --> 00:13:38,060
+الثاني، عفواً، والله الحل الثاني، آه ممكن تطبيقه، بس
+
+167
+00:13:38,060 --> 00:13:43,720
+يعني
+
+223
+00:17:54,820 --> 00:17:59,360
+مع الـAnesthesia Effect بتلاقي طيب إيش .. إيش
+
+224
+00:17:59,360 --> 00:18:07,540
+يصير؟ هذا المريض كيف
+
+225
+00:18:07,540 --> 00:18:12,740
+نربطه؟ إيش الطرق؟ مسموح ولا مش مسموح أصلا؟ okay
+
+226
+00:18:12,740 --> 00:18:16,840
+patients with AIDS الناس اللي عندها AIDS وصار بده
+
+227
+00:18:16,840 --> 00:18:26,840
+الـCPR إيش الوضع معهم يعني؟ نعمله الـCPR وهو AIDS
+
+228
+00:18:27,640 --> 00:18:33,240
+ولا نسيبه؟ فكروا فكروا وعملوها من ضمن القضايا
+
+229
+00:18:33,240 --> 00:18:36,600
+اللي كنتوا بتكتبوليها عنها في مبدأ مهم اسمه «Do
+
+230
+00:18:36,600 --> 00:18:41,420
+not resuscitate» الـDNR الـDNR هنا موضوع مهم وبدي
+
+231
+00:18:41,420 --> 00:18:45,660
+أكتب فيه وفهمه كويس أولا فيه ثلاثة codes للحالات
+
+232
+00:18:46,370 --> 00:18:48,870
+و DNR معناها «Do Not Resuscitate» يعني «ما تعملهوش
+
+233
+00:18:48,870 --> 00:18:52,270
+إنعاش قلبي» في code A أو code one بالإيطالي
+
+234
+00:18:52,270 --> 00:18:56,070
+«نمبر» معناه إنه full support يعني المريض هذا بدنا
+
+235
+00:18:56,070 --> 00:18:59,670
+نعمله code A هذا نايم في الـICU code A أو ده على
+
+236
+00:18:59,670 --> 00:19:02,550
+الـemergency room وعشان شوفنا الإصابات بتاعت
+
+237
+00:19:02,550 --> 00:19:06,130
+وشخصناه قريبنا الـcode A إيش يعني code A؟ يعني
+
+238
+00:19:06,130 --> 00:19:09,770
+بدنا نعمله كل support يعني cardiovascular support
+
+239
+00:19:10,050 --> 00:19:13,110
+Respiratory support يعني عن طريق الـMechanical
+
+240
+00:19:13,110 --> 00:19:16,010
+Ventilator Cardiovascular support يعني ربما عن
+
+241
+00:19:16,010 --> 00:19:19,830
+طريق الـAtropine Drugs ربما عن طريق الـIntra
+
+242
+00:19:19,830 --> 00:19:22,770
+-Aortic Pulmonary Pump كلها دقائق اللي هنحكيها
+
+243
+00:19:22,770 --> 00:19:26,230
+بالتفصيل لما ناخد الشباتر اللي خاصة بيها وكمان لو
+
+244
+00:19:26,230 --> 00:19:29,290
+احتاج المريض صار عنده Complete Cardio Pulmonary
+
+245
+00:19:29,290 --> 00:19:33,050
+Arrest وCardiac Arrest أو Respiratory Arrest فأنا
+
+246
+00:19:33,050 --> 00:19:36,430
+مطلوب مني أن أعمله الـ cardiopulmonary
+
+247
+00:19:36,430 --> 00:19:43,450
+resuscitation بينما كود B المريض بعمله اللي هو
+
+248
+00:19:43,450 --> 00:19:46,870
+full
+
+249
+00:19:46,870 --> 00:19:53,030
+support ما عدا الـCPR يعني بديله أكسجين
+
+250
+00:19:54,850 --> 00:19:58,410
+بأدّيه، بركّب عليه اللي هو Inotropic Drug زي
+
+251
+00:19:58,410 --> 00:20:01,650
+الأدرينالين و الأدرينالين دوبامين whatever لكن
+
+252
+00:20:01,650 --> 00:20:05,090
+إذا بيصير المريض براديكارديا و بيصير الـrespirator
+
+253
+00:20:05,090 --> 00:20:09,830
+arrested و cardiac arrest بسيبه، لا بعمله
+
+254
+00:20:09,830 --> 00:20:12,430
+endotracheal tube ولا بعمله chest compression
+
+255
+00:20:12,430 --> 00:20:18,950
+فخدين بالكم هذا code B أما code 3 أو code C عفواً
+
+256
+00:20:18,950 --> 00:20:23,750
+نسميه code C اللي هو code 3 في الإيطالي Comfort
+
+257
+00:20:23,750 --> 00:20:29,930
+Care Only يعني حتى الـVasopressors والـInotropic
+
+258
+00:20:29,930 --> 00:20:32,850
+Drugs اللي بتعمل Resuscitation للـHeart الـ
+
+259
+00:20:32,850 --> 00:20:36,390
+Prolonged Resuscitation بنسميه مايلهاش لازمة، وقفوا
+
+260
+00:20:36,390 --> 00:20:39,870
+عنه يعني دواء عشان الـEndocardium إحنا مدّينا
+
+261
+00:20:39,870 --> 00:20:42,790
+أدرينالين أو أدروجين عشان نرفع الـHeart Rate تبقى
+
+262
+00:20:42,790 --> 00:20:45,510
+للمريض هذا ونعمل Resuscitation؟ لأ، وقفوا، ممنوع
+
+263
+00:20:45,510 --> 00:20:48,690
+المريض هذا على دوبامين عشان بيعمل Resuscitation لـ
+
+264
+00:20:48,690 --> 00:20:51,570
+pressure بتاعته الـvascular system على Basal
+
+265
+00:20:51,570 --> 00:20:55,550
+Pressure ووقفها، stop، non-heal، خلاص، يبقوا طبعاً،
+
+266
+00:20:55,550 --> 00:20:59,070
+طب ها إيش بيضل يعني ياخد؟ بيضل ياخد بقية الأدوية
+
+267
+00:20:59,070 --> 00:21:03,050
+اللي لازمة له، زي مثلاً بأخد الـfluid عشان Massage
+
+268
+00:21:03,050 --> 00:21:07,330
+Dehydration، أه بياخد دي من المتطلبات بتاعته في الحياة
+
+269
+00:21:07,330 --> 00:21:12,490
+بدون علاج حقيقي يغيّر حالته الصحية يعني بعمله care
+
+270
+00:21:12,490 --> 00:21:17,790
+بنحط له saline عشان مايصيرش عنده جفاف في الـeyes
+
+271
+00:21:17,790 --> 00:21:21,430
+بنعمل له mouth care بنحط له نستاتين عشان مايصيرش عنده
+
+272
+00:21:21,430 --> 00:21:25,570
+فطريات في الـmouth أه مش هذا دواء؟ أه دواء لكن هذا
+
+273
+00:21:25,570 --> 00:21:32,900
+يعني ما بيعمل Resuscitation لأ هذا care هذا الـ
+
+274
+00:21:32,900 --> 00:21:37,720
+Care بيعمل لكن مش هيزيد
+
+275
+00:21:37,720 --> 00:21:41,500
+في عمره ولا يوم ولا دقيقة طبعاً إحنا مؤمنين أن أصلاً
+
+276
+00:21:41,500 --> 00:21:44,100
+حتى لو عملت إيش ما بتعملش قدّ إيه بعض الـresources
+
+277
+00:21:44,100 --> 00:21:48,820
+بطريقة ما بتطوّل في عمره دقيقة فهذا هو مبدأ
+
+278
+00:21:48,820 --> 00:21:52,140
+الـDNR اللي له three codes code A و code B و code C
+
+279
+00:21:52,140 --> 00:21:56,420
+زي ما شفتوا code B أو C هم هدول الـcodes اللي ممكن
+
+280
+00:21:56,420 --> 00:22:03,490
+يكون المريض DNR، يعني لو صار «أنا باستثناء، ما نتدخل
+
+281
+00:22:03,490 --> 00:22:07,850
+و هنسيبه يروح» عادة زي ما بيسموه الأجانب بيقولوا
+
+282
+00:22:07,850 --> 00:22:13,950
+«to pass away» عادة المرضى هدول اللي بنسيبهم «to
+
+283
+00:22:13,950 --> 00:22:19,090
+pass away» يعني أنه بيكونوا في الـ«end stage» أو
+
+284
+00:22:19,090 --> 00:22:25,230
+مثلاً cancer disease عنده metastases عنده غير metastases
+
+285
+00:22:25,230 --> 00:22:28,970
+ممكن يكون فيه عنده اللي هو multi organ system
+
+286
+00:22:28,970 --> 00:22:33,490
+failure فبالتالي no good prognosis is expected
+
+287
+00:22:33,490 --> 00:22:37,890
+سبيهم to die in peace لدرجة أنهم تعدّوا هذا
+
+288
+00:22:37,890 --> 00:22:41,810
+الموضوع مش بس DNR لأ عملوا حاجة اسمها merciful
+
+289
+00:22:41,810 --> 00:22:46,210
+killing اللي هو موت رحيم وهم بيقرروا أن هذا خلاص، انتهينا
+
+290
+00:22:46,210 --> 00:22:47,950
+عنه الأجهزة ووقف عنه
+
+291
+00:22:51,030 --> 00:22:55,470
+الـInotropic Drugs أو «سيبوه» to die. الآن بصراحة
+
+292
+00:22:55,470 --> 00:22:58,650
+هم وصّوا أو يعني صاروا بيحكوا وبيعتمدوا في مبدأ الـ
+
+293
+00:22:58,650 --> 00:23:04,030
+«DNR» أكثر لأنه لو هم اتبعوا مبدأ الـ«DNR»
+
+294
+00:23:04,030 --> 00:23:07,610
+بيبطلوا في حاجة إلى الـ«mercy killing» والموت
+
+295
+00:23:07,610 --> 00:23:11,110
+الرحيم لأنه خلاص أنا ماوجدتش بحدد أن المريض هذا
+
+296
+00:23:11,110 --> 00:23:14,720
+وضعه صعب كتير و«not for resuscitation» مش هحطه
+
+297
+00:23:14,720 --> 00:23:18,340
+أصلاً على mechanical ventilator مش هحطله
+
+298
+00:23:18,340 --> 00:23:22,680
+على Vasopressors وبالتالي I will let him to die in
+
+299
+00:23:22,680 --> 00:23:27,700
+peace spontaneously لحاله okay الـchapter هيك مكون
+
+300
+00:23:27,700 --> 00:23:31,940
+خلص عن الـethical فيه عليكم assignments هتعملوها
+
+301
+00:23:31,940 --> 00:23:37,320
+قبل نحكي شوية في الـstressors والـoccupation والـ
+
+302
+00:23:37,320 --> 00:23:41,780
+Occupational Burnout موضوع سهل وبسيط ده نخلصُه في
+
+303
+00:23:41,780 --> 00:23:46,600
+دقائق إن شاء الله شغلنا في الـICU بيخلّينا محاطين
+
+304
+00:23:46,600 --> 00:23:50,340
+وفي الأماكن الـHot Areas بنسميها تمام اللي هي الـ
+
+305
+00:23:50,340 --> 00:23:53,040
+ICU الـEmergency Room الـOperation Room الـ
+
+306
+00:23:53,040 --> 00:23:56,840
+Recovery Room هدول يُصنّفون في المستشفيات من ضمن
+
+307
+00:23:56,840 --> 00:24:00,990
+الـHot Areas وتبقى الأماكن في المستشفيات الأقسام
+
+308
+00:24:00,990 --> 00:24:05,990
+الداخلية العادية تُعتبر من الـCold Area، تمام؟
+
+309
+00:24:05,990 --> 00:24:09,370
+الأقسام الباردة يعني مافيش فيها Action فأنت في
+
+310
+00:24:09,370 --> 00:24:13,310
+الأماكن الـHot Areas هذه، عندك Stressors كتير
+
+311
+00:24:13,490 --> 00:24:17,050
+بنسميها  مُؤثرات اللي بتأثر عليك منها في
+
+312
+00:24:17,050 --> 00:24:18,910
+physiological stressors إيش يعني physiological
+
+313
+00:24:18,910 --> 00:24:25,430
+stressor؟ من الوضع اللي أنت عايشه فيه، في عندك شغل
+
+314
+00:24:25,430 --> 00:24:28,810
+كتير، في عندك تعب كتير، في عندك هدف يناديك،
+
+315
+00:24:28,810 --> 00:24:31,850
+هدف يناديك، واجه طول الوقت، alert، منتبه، هذا
+
+316
+00:24:31,850 --> 00:24:35,610
+physiological تمام؟ في عندك psychological stress زي
+
+317
+00:24:35,610 --> 00:24:38,470
+إيه الـpsychological stress؟ أنت بتشتغل مع حالات
+
+318
+00:24:38,470 --> 00:24:43,750
+حرجة كتير، أحياناً بتخاف أنه يعني حاسس حالنا مش
+
+319
+00:24:43,750 --> 00:24:47,590
+قادرين نسيطر على الوضع، عدد كبير من الحالات إيه
+
+320
+00:24:47,590 --> 00:24:53,890
+جاي؟ وضع المريض حرج كتير، بده عدد أفراد موجود
+
+321
+00:24:53,890 --> 00:24:56,950
+ثلاثة، أربعة، مش مكافئين، بدنا كمان ناس تساعدنا،
+
+322
+00:24:56,950 --> 00:25:01,990
+psychological، الحالات اللي كل يوم بتشوف ناس بتموت،
+
+323
+00:25:01,990 --> 00:25:07,250
+كل يوم بتشوف ناس very critical in amputation، يعني
+
+324
+00:25:07,250 --> 00:25:11,970
+صور ربما تكون فظيعة عند البعض، واحد amputation واحد
+
+325
+00:25:14,660 --> 00:25:19,300
+بيرن، كل جسده متفحّم، طفل صغير، أنت شفته، حنيت
+
+326
+00:25:19,300 --> 00:25:24,080
+عليه وشفته كيف هو قاعد بـgasping وبعدين died،
+
+327
+00:25:24,080 --> 00:25:27,500
+هذا كله يُعتبر psychological أو تعتبر
+
+328
+00:25:27,500 --> 00:25:29,720
+psychological stressors في environmental
+
+329
+00:25:29,720 --> 00:25:33,610
+stressors، اللي هي بيئية، درجة حرارة المكان، بحد
+
+330
+00:25:33,610 --> 00:25:36,550
+ذاته، لو أنت بتشتغل في مكان ضوضاء كتير وأماكن هذه
+
+331
+00:25:36,550 --> 00:25:40,410
+المغلقة، عايزة دايماً بتكون ضوضاء ودوشة لإنه فيه كذا
+
+332
+00:25:40,410 --> 00:25:43,290
+بيشتغلوا مهتمين في الحالة وهدول برضه مشتغلين في
+
+333
+00:25:43,290 --> 00:25:48,930
+حالة ثانية ومهتمين فيها وكل يعني مضطرب وصوت مرتفع
+
+334
+00:25:48,930 --> 00:25:53,330
+نوعاً ما لإنه هتجيب الحاجة بصراحة فهذا كله
+
+335
+00:25:53,330 --> 00:25:57,430
+يُؤثّر عليك، عايز يبقاش في stress يعني فعلاً أنت مش
+
+336
+00:25:57,430 --> 00:26:02,800
+هادئ، الأماكن مش هادئة، أماكن action، الضوء اللي
+
+337
+00:26:02,800 --> 00:26:05,840
+ما بنطفئوش وشغال فيها طول .. ما بتعرفش الدنيا ليل ولا
+
+338
+00:26:05,840 --> 00:26:09,960
+نهار، طول الوقت وهو الضوء شغال في الـICU لدرجة أنه
+
+339
+00:26:09,960 --> 00:26:13,300
+يعني في متلازمة بتصير عند المرضى، أنه بيطلع، بيبطل
+
+340
+00:26:13,300 --> 00:26:15,360
+عارف حالته، هو في الليل ولا في النهار ولا كم
+
+341
+00:26:15,360 --> 00:26:19,200
+الساعة، ليش؟ لأنه طول ما هو في الـICU وهم الناس
+
+342
+00:26:19,200 --> 00:26:22,920
+شغالين رايحين جايين و .. و .. و .. و .. وشتغلوا والـ
+
+343
+00:26:22,920 --> 00:26:26,220
+الضوء مضوي و .. و .. يعني مافيش نوم، مافيش اللي
+
+344
+00:26:26,220 --> 00:26:29,900
+ما بيحسش أنه يجي ليل و يجي نهار و يجي نهار ويجي
+
+345
+00:26:29,900 --> 00:26:36,490
+ليل أبداً، روحانيات كتير، في روحانيات، حكينا أن ضمنها
+
+346
+00:26:36,490 --> 00:26:39,690
+البيئات المغلقة اللي إحنا بنخش فيها، ربما أنتَ
+
+347
+00:26:39,690 --> 00:26:43,690
+تقول طب يعني هذا DNR، أنت بيجيلك القرار لما بتشوفه
+
+348
+00:26:43,690 --> 00:26:47,410
+أنتَ، هو بدأ يصير gasping، حاجة مش هاينة عليك، عم
+
+349
+00:26:47,410 --> 00:26:53,330
+تقول تعمل له intubation، لأ لأ هذا DNR هذا اللي
+
+350
+00:26:53,330 --> 00:26:57,340
+هو code B ومش هنعمل له intubation، ممكن أنتَ تصير
+
+351
+00:26:57,340 --> 00:27:01,280
+زعلان، عامله، كان يحكي معايا، إبصار، إيه؟ الـ
+
+352
+00:27:01,280 --> 00:27:02,980
+Physical stress اللي حكينا عنها الـPhysical
+
+353
+00:27:02,980 --> 00:27:06,600
+stress بتاع الشغل والحركة والحمل والـsuction
+
+354
+00:27:06,600 --> 00:27:11,940
+والعيال ووزنهم ثقيل نوعاً ما وأنت محتاج تعمل لهم
+
+355
+00:27:11,940 --> 00:27:14,690
+مدرسة وتعمل لهم مدرسة، تقول الحاجات هذه، كل هذه الـ
+
+356
+00:27:14,690 --> 00:27:18,170
+stressors اللي بنتعرض إليها في الـICU هذه لما
+
+357
+00:27:18,170 --> 00:27:21,690
+بتزيد عن حدها ممكن تعملنا حاجة اسمها الـ
+
+358
+00:27:21,690 --> 00:27:25,410
+occupational burnout إيش يعني هذا الـburnout؟ هذا
+
+359
+00:27:25,410 --> 00:27:28,450
+مش الـburn اللي بيصير في الجنين لأ هذا الـburn اللي
+
+360
+00:27:28,450 --> 00:27:33,150
+بيصير في الناس، بيسموه احتراق وظيفي، إيش يعني؟
+
+361
+00:27:33,150 --> 00:27:38,490
+يعني أن الـhuman أو الراجل أو الموظف سواء كان راجل
+
+362
+00:27:38,490 --> 00:27:43,290
+أو ست، collapse of human spirit يعني يصير إيش
+
+363
+00:27:43,290 --> 00:27:50,700
+معاه؟ Collapse كامل يعني، يعني بيصير منهج داخلياً
+
+364
+00:27:51,400 --> 00:27:56,320
+الحماس بيقل، يفقدوه خالص «Lack of enthusiasm and
+
+365
+00:27:56,320 --> 00:28:00,600
+motivation» «حاسس أنه مش مفيد» «Ineffectiveness»
+
+366
+00:28:00,600 --> 00:28:04,200
+على الصعيد، كل دي عرفناها نعمل عالفائدة «Frustration»،
+
+367
+00:28:04,200 --> 00:28:07,980
+«محبط» هذا هو الاحتراق الوظيفي، هذا له تأثيرات
+
+368
+00:28:07,980 --> 00:28:11,940
+كبيرة سواء على الموظف كممرض أو على المريض أو على
+
+369
+00:28:11,940 --> 00:28:14,240
+المنظمة اللي بتشتغل فيها أو المؤسسة يعني اللي
+
+370
+00:28:14,240 --> 00:28:18,370
+بتشتغل فيها، المستشفى، الوزارة، كيف الـPhysical
+
+371
+00:28:18,370 --> 00:28:21,210
+Health المريض، الـNurse نفسه، بتلاقي كل يوم لما
+
+372
+00:28:21,210 --> 00:28:24,990
+تجيء عنده احتراق وظيفي من المسببات الكتيرة اللي
+
+373
+00:28:24,990 --> 00:28:30,530
+حكينا عنها، كل يوم بيجي، عندي، صداع، م .. م
+
+374
+00:28:30,530 --> 00:28:36,670
+.. م .. م .. رحلة
+
+375
+00:28:43,430 --> 00:28:48,150
+عنده back pain، عنده عصبية، بيحكي معاك واحد
+
+376
+00:28:48,150 --> 00:28:52,270
+كلمتين، بيروّع على الدار، ما نامش، بيقول لك mental
+
+377
+00:28:52,270 --> 00:28:59,110
+health disturbance مثلًا إنه محبط، مضغوط
+
+378
+00:28:59,110 --> 00:29:03,770
+على الدار، حتى ولده منعزل، مش مبسوط، مكتئب، إيش فيه؟
+
+379
+00:29:03,770 --> 00:29:06,970
+ليش يا عم صار الزلمة زي هيك؟ والله هذا من الشغل،
+
+380
+00:29:06,970 --> 00:29:10,770
+أه معقول؟ أه، كل ما بيجي الشغل، مش جاهز، راسي
+
+381
+00:29:10,770 --> 00:29:16,130
+بيوجعني، ضهري بيوجعني، المؤسسة، الرجل هذا ما اشتغلش
+
+382
+00:29:16,130 --> 00:29:20,750
+فعلياً، يعني الـ الـ الـ الكفاءة بتاعته والإنتاج
+
+383
+00:29:20,750 --> 00:29:23,670
+بتاعته في العمل، الـproductive بتاعته قلت كتير
+
+384
+00:29:23,670 --> 00:29:31,090
+فبالتالي يعني هو أحياناً، حتى يوم أنه بده
+
+385
+00:29:31,090 --> 00:29:37,330
+يشتغل، ممكن يغمى عليه، يعني يا إما يغمي عليه يشتغل ويطلب
+
+386
+00:29:37,330 --> 00:29:44,220
+إجازات كتير، إذا ما جاء مرض، أه بيطلب ويطلب مرضية و
+
+387
+00:29:44,220 --> 00:29:49,840
+يروح يروح بده إجازة من غير سبب يعني طيب إذا جاء و
+
+388
+00:29:49,840 --> 00:29:52,880
+اشتغل وجاء على حاله يعني واشتغل بصورة إيه okay
+
+389
+00:29:52,880 --> 00:29:56,400
+ممكن يشتغل لكن إيه الـproductivity بتاعته very low
+
+390
+00:29:56,400 --> 00:30:00,660
+أو مش بس ذلك لو اشتغل مع المرضى وهو كمان الـ
+
+391
+00:30:00,660 --> 00:30:03,220
+productivity very low زي ما إحنا شايفين كده هيغلط
+
+392
+00:30:03,220 --> 00:30:06,400
+ويأثر بالتالي على المريض ويعمل له مشكلة في الـCare
+
+393
+00:30:06,400 --> 00:30:09,460
+بتاعته، لدرجة أنه المسئول المباشر عادة يقول يا
+
+394
+00:30:09,460 --> 00:
\ No newline at end of file
diff --git a/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/8PF95HihGvQ_raw.json b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/8PF95HihGvQ_raw.json
new file mode 100644
index 0000000000000000000000000000000000000000..fa09da220eef91f438e4f82a7292ed52413e7859
--- /dev/null
+++ b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/8PF95HihGvQ_raw.json
@@ -0,0 +1 @@
+{"segments": [{"id": 1, "seek": 3272, "start": 5.74, "end": 32.72, "text": "بسم الله الرحمن الرحيم اليوم إن شاء الله رب العالمين محاضرتنا التالتة في مقدمة الـ Critical Care Nursing هنحكي إن شاء الله ربنا العالمي عن الـ ethical و ال legal issues in critical care كان في بعض ملاحظات من بعض منكم إن الصوت شوية واطي هي نجيبنا mic واشتغلنا", "tokens": [3555, 38251, 21984, 34892, 5016, 27842, 34892, 5016, 32640, 45595, 20498, 36145, 13412, 16606, 21984, 12602, 3555, 18863, 45340, 9957, 3714, 5016, 46958, 43500, 8315, 16712, 6027, 2655, 3660, 8978, 3714, 28543, 46007, 2423, 39184, 39482, 9532, 42655, 8032, 1863, 5016, 4117, 1829, 36145, 13412, 16606, 21984, 12602, 3555, 8315, 18863, 45340, 1829, 18871, 2423, 39184, 18890, 4032, 2423, 5089, 2663, 294, 4924, 1127, 25961, 8978, 45030, 11242, 3714, 15040, 5016, 19913, 9307, 9154, 45030, 11242, 9154, 24793, 36145, 31767, 35473, 13412, 2407, 10632, 4032, 41193, 1829, 39896, 8717, 7435, 1829, 3555, 8315, 3123, 4032, 33599, 2655, 17082, 1211, 8315], 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10.9, "end": 11.78, "word": " التالتة", "probability": 0.9644775390625}, {"start": 11.78, "end": 12.56, "word": " في", "probability": 0.80029296875}, {"start": 12.56, "end": 13.46, "word": " مقدمة", "probability": 0.9638671875}, {"start": 13.46, "end": 13.92, "word": " الـ", "probability": 0.844970703125}, {"start": 13.92, "end": 14.12, "word": " Critical", "probability": 0.744140625}, {"start": 14.12, "end": 14.5, "word": " Care", "probability": 0.849609375}, {"start": 14.5, "end": 14.98, "word": " Nursing", "probability": 0.95654296875}, {"start": 14.98, "end": 15.66, "word": " هنحكي", "probability": 0.769580078125}, {"start": 15.66, "end": 15.76, "word": " إن", "probability": 0.94287109375}, {"start": 15.76, "end": 15.86, "word": " شاء", "probability": 0.9921875}, {"start": 15.86, "end": 16.0, "word": " الله", "probability": 0.9619140625}, {"start": 16.0, "end": 16.36, "word": " ربنا", "probability": 0.9755859375}, {"start": 16.36, "end": 17.16, "word": " العالمي", "probability": 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\ No newline at end of file
diff --git a/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/8PF95HihGvQ_raw.srt b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/8PF95HihGvQ_raw.srt
new file mode 100644
index 0000000000000000000000000000000000000000..c902e12aa01b76ddc393ee3e3250df4a84e32779
--- /dev/null
+++ b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/8PF95HihGvQ_raw.srt
@@ -0,0 +1,1668 @@
+1
+00:00:05,740 --> 00:00:09,020
+بسم الله الرحمن الرحيم اليوم إن شاء الله رب
+
+2
+00:00:09,020 --> 00:00:14,120
+العالمين محاضرتنا التالتة في مقدمة الـ Critical
+
+3
+00:00:14,120 --> 00:00:18,100
+Care Nursing هنحكي إن شاء الله ربنا العالمي عن الـ
+
+4
+00:00:18,100 --> 00:00:23,380
+ethical و ال legal issues in critical care كان في
+
+5
+00:00:23,380 --> 00:00:30,220
+بعض ملاحظات من بعض منكم إن الصوت شوية واطي هي
+
+6
+00:00:30,220 --> 00:00:36,790
+نجيبنا mic واشتغلناعلى الـ mic بحيث أنه تزيد الصوت
+
+7
+00:00:36,790 --> 00:00:41,990
+وكمان يعني حولت أنه الهواية اللي بكون مشغلها عادة
+
+8
+00:00:41,990 --> 00:00:45,590
+لأن الدنيا شوب طفيتها برضه عشان خطركوا بحيث أنه
+
+9
+00:00:45,590 --> 00:00:51,310
+يكون الصوت أوضح وأنقى أتمنى أنه يكون هيك عجبكم
+
+10
+00:00:51,310 --> 00:00:59,410
+ويكون الصوت واضح بالنسبة لموضوع المحاضرة okay
+
+11
+00:01:02,630 --> 00:01:05,370
+ethical and legal issues in critical care مايعني
+
+12
+00:01:05,370 --> 00:01:09,830
+ethical و legal issues يعني فيه أمور أخلاقية أو
+
+13
+00:01:09,830 --> 00:01:17,070
+فيه قضايا أخلاقية لازم ناخد بالنا منها أثناء عملنا
+
+14
+00:01:17,070 --> 00:01:22,270
+فيه الانهاء المركزةوهذا يعني بيطرحوا وجود الحالات
+
+15
+00:01:22,270 --> 00:01:26,370
+الحرجة وجود مكان مغلق زي الـ Intensive Care Units
+
+16
+00:01:26,370 --> 00:01:32,170
+العنايات المركزة الحالة الحرجة الـ Health Care
+
+17
+00:01:32,170 --> 00:01:38,050
+Provider سواء كان Nurse أو دكتور اللي بيكون مرتبط
+
+18
+00:01:38,050 --> 00:01:41,590
+في الحالة و Assigned على الحالة وبيشتغل معها وبكون
+
+19
+00:01:41,590 --> 00:01:48,010
+هواللي لوحده المسؤول عن تقديم العملية تبعاتها هذا
+
+20
+00:01:48,010 --> 00:01:54,250
+بيفرض بعض القضايا الأخلاقية اللي بيكون يعني
+
+21
+00:01:54,250 --> 00:01:59,430
+التعامل معها نوعا ما محير أو ممكن يحطنا يعني في
+
+22
+00:01:59,430 --> 00:02:03,730
+dilemma يخليني نسأل حالنا إيش المفروض أعمل أعمل
+
+23
+00:02:03,730 --> 00:02:08,250
+هيك ولا ماعملش هيك دائما بنحكي أحنا إنه في كل
+
+24
+00:02:08,250 --> 00:02:15,600
+المهن يجب أن يكون في أخلاق مهنية معينةتتبع الأخلاق
+
+25
+00:02:15,600 --> 00:02:22,620
+المهنية هذه هي يعني بتختلف في الحقيقة عن الأخلاق
+
+26
+00:02:22,620 --> 00:02:27,400
+اللي انت مثلا خليني نحكي الأخلاق الاجتماعية أو
+
+27
+00:02:27,400 --> 00:02:33,360
+أمور تربيتك ليش؟ لأن في كل مهنة الأخلاقيات تبقتها
+
+28
+00:02:33,360 --> 00:02:40,820
+معناها الضوابط تبعت المهنة هايIt is allowed to do
+
+29
+00:02:40,820 --> 00:02:47,120
+إيش مسموح إلك أنت تعمله وإيش مش مسموح إنك تعمله
+
+30
+00:02:47,120 --> 00:02:53,700
+بما إنه يخالف أخلاق هذه المهنة إذاً موضوع كلمة
+
+31
+00:02:53,700 --> 00:02:58,410
+أخلاق لما واحد يسمع أخلاق المهنة هي مشحاجة إنها
+
+32
+00:02:58,410 --> 00:03:02,870
+بسيطة وسهلة وقادة الأخلاق يعني بيحكي عن الأخلاق
+
+33
+00:03:02,870 --> 00:03:06,970
+الحميدة يعني آه صحيح هي الأخلاق الحميدة بس هي
+
+34
+00:03:06,970 --> 00:03:11,690
+عبارة عن مجموعة Policies مجموعة قوانين مجموعة
+
+35
+00:03:11,690 --> 00:03:20,180
+محددات بتحدد علاقتك مع لسبون أو مع المريضمن خلالها
+
+36
+00:03:20,180 --> 00:03:27,620
+وما يجب أن تفعله وما لا يجب أن تفعله ويعني بالذات
+
+37
+00:03:27,620 --> 00:03:33,060
+في بعض القضايا المهنية المعينة في حال إن صار كذا
+
+38
+00:03:33,060 --> 00:03:36,860
+أو صار كذا وين انت دورك وين بيحجلك إنك تعمل وين ما
+
+39
+00:03:36,860 --> 00:03:41,040
+بيحجلك إنك تعمل عشان هيك فيه principles لل
+
+40
+00:03:41,040 --> 00:03:46,640
+bioethics الأخلاقياتتشترك فيها تقريبا كل المهن
+
+41
+00:03:46,640 --> 00:03:52,890
+الصغيرية منها مثلا أطارهمبنتعامل مع مريض المفروض
+
+42
+00:03:52,890 --> 00:03:55,270
+أنه يحافظ على الـ Autonomy تبع المريض، إيش يعني
+
+43
+00:03:55,270 --> 00:03:57,630
+الـ Autonomy؟ يعني الـ Self-determination، إيش
+
+44
+00:03:57,630 --> 00:04:01,130
+يعني؟ يعني إنه يخلّي، هذا قضية أخلاقية، معناها إنه
+
+45
+00:04:01,130 --> 00:04:04,210
+يخلّي المريض يضلله الحق في تقرير إيش الاشي اللي
+
+46
+00:04:04,210 --> 00:04:06,710
+بيقدر يعمل إله، كيف يعني؟ أنا جاي بدي أعمله
+
+47
+00:04:06,710 --> 00:04:10,370
+Procedure، أي أن كان الـProcedure هذا، لازم أخد
+
+48
+00:04:10,370 --> 00:04:15,370
+إذن المريض، و لازم أشركه بالقرار الخاص
+
+49
+00:04:15,370 --> 00:04:19,650
+بالـProcedureوأخلّي القرار يطلع منه انه اه لو سمحت
+
+50
+00:04:19,650 --> 00:04:23,150
+انا اموافق اتفضل اعمل ال procedure هذا اللي بيخدم
+
+51
+00:04:23,150 --> 00:04:29,590
+صحتي، اذا هذا هو الأصل، ولو انه المفروض انه ال ..
+
+52
+00:04:29,590 --> 00:04:33,570
+ال .. ال .. ال procedure هذه عادة بتكون يعني
+
+53
+00:04:33,570 --> 00:04:38,850
+obligatory، لازم نعملها وفيش مجال انه .. انه ما ..
+
+54
+00:04:38,850 --> 00:04:43,710
+ما نعملهاش، لكن رغم هيك يجب انه انت تاخد اذن
+
+55
+00:04:43,710 --> 00:04:49,470
+المريضتحقق الاستقلالية للمريض في القرار وتجعله
+
+56
+00:04:49,470 --> 00:04:54,750
+يكون شريك معك في القرار وبالأخرى صاحب القرار ويسمح
+
+57
+00:04:54,750 --> 00:04:59,530
+لك بتنفيذ ال procedure طب احنا يا جماعة بنتكلم يا
+
+58
+00:04:59,530 --> 00:05:02,730
+دكتور كنت انسيت حالك انت بتحكي عن مريض في العينية
+
+59
+00:05:02,730 --> 00:05:08,620
+المركزة أحيانا كتير بكون unconsciousبنقول هنا إن
+
+60
+00:05:08,620 --> 00:05:12,920
+المريض الـ unconscious يُعامل معاملة المريض الـ
+
+61
+00:05:12,920 --> 00:05:19,930
+conscious المريض يسمع، احنا في ديننا الميت يسمعفما
+
+62
+00:05:19,930 --> 00:05:23,610
+بالك في المريض اللي في غيبوبة يسمع ويعي ولكن لا
+
+63
+00:05:23,610 --> 00:05:30,350
+يوجد عنده قدرة على الاستجابة لا يستطيع أنه يستجيب
+
+64
+00:05:30,350 --> 00:05:34,230
+ويعمل response لل stimulation تبعك أو لل
+
+65
+00:05:34,230 --> 00:05:37,390
+communications تبعك لل verbal communications تبعتك
+
+66
+00:05:38,000 --> 00:05:43,320
+و يجاوبك على اللي انت بدك هيه ولذلك بنحافظ على ال
+
+67
+00:05:43,320 --> 00:05:49,200
+communication و بنحكي للمريض ان احنا بدنا نعملك ال
+
+68
+00:05:49,200 --> 00:05:54,080
+procedure فلان يعني انا الحكيم فلان فلاني الله يصب
+
+69
+00:05:54,080 --> 00:05:57,740
+عك بالخير ان شاء الله انا مسلول عنك اليوم الان
+
+70
+00:05:57,740 --> 00:06:01,920
+هيكون معاه ال body hygiene هعملك self care كامل و
+
+71
+00:06:01,920 --> 00:06:04,920
+هعملك حمام و بعدها كذا
+
+72
+00:06:07,990 --> 00:06:10,250
+تحكيله إيش اللي أنت بدك تعمله بالظبط «Explained
+
+73
+00:06:10,250 --> 00:06:14,670
+Procedure» وبعدين بتحافظ على ال «Privacy»، بتغطي
+
+74
+00:06:14,670 --> 00:06:21,510
+الستائر، ما تكونش قلق أنا محافظ على ال «Privacy»
+
+75
+00:06:21,510 --> 00:06:26,690
+تبعتك، مافيش أو الخصوصية تبعتك، أنا يعني سكرت
+
+76
+00:06:26,690 --> 00:06:31,670
+الستائر، مافيش غير أنا و أنت موجودينفي المكان لأنه
+
+77
+00:06:31,670 --> 00:06:34,650
+هو بيسمع هو بيكون عارف فيه انت لما حكيته طب ومش
+
+78
+00:06:34,650 --> 00:06:39,030
+لاستطيع انه يستجيل لكن فهم ان انت يعني هيكون
+
+79
+00:06:39,030 --> 00:06:42,650
+exposed هيكون بدون ملابس فلازم تفهم ان انا لأ
+
+80
+00:06:42,650 --> 00:06:47,570
+محافظ على ال privacy انت مغطى انت كذا انا هاهتم ان
+
+81
+00:06:47,570 --> 00:06:50,890
+درجة حرارتك برضه تظلها ان البيئة مناسبة درجة
+
+82
+00:06:50,890 --> 00:06:56,240
+الحرارة دافية في المكان المريض يسمع ويعي تمام؟وفي
+
+83
+00:06:56,240 --> 00:06:58,940
+أبحاث كتير يا جماعة حاليًا على الكلام هذا إن
+
+84
+00:06:58,940 --> 00:07:02,040
+الساعات الأخيرة حتى للناس اللي بموتوا إنه بتسجل
+
+85
+00:07:02,040 --> 00:07:06,560
+مواقف وهو بكون أعلنت وفاته بياخدوا EEG من مخه
+
+86
+00:07:06,560 --> 00:07:10,360
+وبيلاقوا إنه كتير فيه من الأحداث مسجلة وبيقدروا
+
+87
+00:07:10,360 --> 00:07:13,880
+حتى يعرفوا من قزحية العين وقرانية العين مين آخر
+
+88
+00:07:13,880 --> 00:07:17,260
+صورة شافة وإيش آخر كلام كان سمعه هذا الكلام
+
+89
+00:07:17,260 --> 00:07:23,820
+Benefits اللي هي Beneficence اللي هي الإحسان
+
+90
+00:07:25,010 --> 00:07:30,950
+الإحسان، إيش يعني الإحسان؟ يعني إنه أنت تكون بتعمل
+
+91
+00:07:30,950 --> 00:07:38,150
+الحاجات اللي أنت مطلوب منك بحيث
+
+92
+00:07:38,150 --> 00:07:44,670
+إنك تحقي أعلى درجة نفع للمريض وبطريقة
+
+93
+00:07:44,670 --> 00:07:51,880
+يعني، يعني بطريقة خليني أسميها مقبولة جدا عندهمهذا
+
+94
+00:07:51,880 --> 00:07:54,940
+هو الإحسان إذا الإحسان أن أنا أتعامل مع المريض في
+
+95
+00:07:54,940 --> 00:07:59,280
+أن أقدم له أحسن إمكانية للخدمة اللي أنا ممكن
+
+96
+00:07:59,280 --> 00:08:04,060
+أقدمها أحسن طريقة أحسن حاجة بقى يعني do your best
+
+97
+00:08:04,060 --> 00:08:09,850
+أنك تقدمها بأفضل شكلتمام؟ إيه في انها يعني ترضي
+
+98
+00:08:09,850 --> 00:08:14,010
+هذا المتلقى، المتلقى الخدمة؟ هذا هو الإحسان في
+
+99
+00:08:14,010 --> 00:08:18,310
+تقديم الخدمة، مش أنه أنا عشان أنا باخدمه لازم أني
+
+100
+00:08:18,310 --> 00:08:21,710
+أديله يا نحن اللي بنعملك هيك، أنت تقولي إيش تعملنا
+
+101
+00:08:21,710 --> 00:08:26,010
+بصريح، بنمشي مكافف من مريض عنكنشس وبيعمل على حاله
+
+102
+00:08:30,110 --> 00:08:33,830
+إدفكاشنز وإيش ممكن فيه إحنا بننظف عليك و بنعملك
+
+103
+00:08:33,830 --> 00:08:39,110
+كمان تتنمرد و هتلف سويا، كتير ممكن أحيانا بعض
+
+104
+00:08:39,110 --> 00:08:45,530
+الأشخاص يعني تفقد منهم السيطرة أو يحكوا بعض كلام
+
+105
+00:08:45,530 --> 00:08:51,290
+مش ضروري non male efficiency اللي هو أحيانا إنك
+
+106
+00:08:51,290 --> 00:08:57,010
+تعمل حاجات مؤدية يعنيمايلها لزوم، فهذا ممنوع ممنوع
+
+107
+00:08:57,010 --> 00:09:01,530
+تعمل أي حاجة أو بروسيجرات مؤذية أو بروسيجر مايله
+
+108
+00:09:01,530 --> 00:09:04,950
+لزوم أصلا، يعني أنت أعمل شيء مايله لزوم، فهو مؤذي،
+
+109
+00:09:04,950 --> 00:09:09,090
+بيصبح، تمام؟ أو أنك تعمل البروسيجر اللي إله لزوم،
+
+110
+00:09:09,090 --> 00:09:13,450
+بس بشكل مؤذي، هذا ممنوع role of double effect، في
+
+111
+00:09:13,450 --> 00:09:21,700
+ناس أنتم يعني أحيانا بحاول يخدممثلًا، إيش الـ role
+
+112
+00:09:21,700 --> 00:09:25,240
+of double effect ده؟ يعني زي ما بيسموه سلاح دوحدد
+
+113
+00:09:25,240 --> 00:09:29,180
+يعني بيجي هو مثلًا بلاقي مريض بتقلم كتير فبيحاول
+
+114
+00:09:29,180 --> 00:09:32,700
+إن المريض اللي بتقلم كتير هذا إنه إيش يسويله، يخفف
+
+115
+00:09:32,700 --> 00:09:36,320
+عنه الألم فبروح بديله جرقة مخدر مثلًا إيش مش
+
+116
+00:09:36,320 --> 00:09:40,880
+موصوفة أو حتى لو موصوفة بيدله بس بزودله شوية بحيث
+
+117
+00:09:40,880 --> 00:09:44,580
+إنه يعني إيش، بيخدمه ويخففبالألم أكتر فبروح عمله
+
+118
+00:09:44,580 --> 00:09:47,580
+Respiratory Depression و بيعمله و ممكن يروح فيها
+
+119
+00:09:47,580 --> 00:09:52,020
+المريض و يصير ضايق الآن هو فعليا قاتل هو مش يعني
+
+120
+00:09:52,020 --> 00:09:57,540
+مؤد خدمة هو قاتل لأنه Criminal هذا أنت أعطيت دوة
+
+121
+00:09:57,540 --> 00:10:02,600
+مسكّن للألم بجرعات pain killer خلّيني أسميه يعني
+
+122
+00:10:02,600 --> 00:10:06,920
+بجرعات عالية ال side effect سبعة الجرعات هذه أنه
+
+123
+00:10:06,920 --> 00:10:13,130
+ممكن يعملاللي هو Respiratory Depression وبالتالي
+
+124
+00:10:13,130 --> 00:10:17,610
+انت عرضت المريض لخطر سواء اتحقق الخطر هذا او لم
+
+125
+00:10:17,610 --> 00:10:21,650
+يتحقق يعني ربما انه فلت منها وربنا نجاه بس صار
+
+126
+00:10:21,650 --> 00:10:24,690
+شوية مشاكل وبعدين يجيوا عملولي Intubation او
+
+127
+00:10:24,690 --> 00:10:29,590
+مافلتش وراح فيها فانت بكلا الحالتين انت مجرم وانت
+
+128
+00:10:29,590 --> 00:10:35,370
+اخطأت في حق نفسك وحق المريض لذلك يجب ان نتجنب ان
+
+129
+00:10:35,370 --> 00:10:41,390
+نعمل اي اجراءقد يكون له حد آخر يعني أنا بحس إني
+
+130
+00:10:41,390 --> 00:10:44,650
+أروح أعمل زيك فهو أكون فيه effect تاني ممكن يصير
+
+131
+00:10:44,650 --> 00:10:52,570
+وبالتالي هذه محدداتها إنه أقوم بتنفيذ الإجراءات أو
+
+132
+00:10:52,570 --> 00:10:57,350
+بتنفيذ ال orders المكتوبة بالطريقة الصحيحة بدون أي
+
+133
+00:10:57,350 --> 00:11:03,600
+تعديات وعندما أشك إنه أنا ممكنيكون فيه أثر جانب
+
+134
+00:11:03,600 --> 00:11:06,940
+للـ Procedure أو الـ Order اللي بدي أن أنفذه هذا
+
+135
+00:11:06,940 --> 00:11:11,420
+يجب أني أستشير سواء my colleague my colleague ال
+
+136
+00:11:11,420 --> 00:11:14,620
+senior charge nurse اللي عليك أو ال physician اللي
+
+137
+00:11:14,620 --> 00:11:20,500
+موجود معك justice لازم تكون عادل في المعاملة مع
+
+138
+00:11:21,440 --> 00:11:27,800
+المريض وما .. حتى ال .. حتى مع نفسك يعني نازم تكون
+
+139
+00:11:27,800 --> 00:11:33,900
+عادل في المعاملة تعرف يعني المبدأ العدل مابدناش
+
+140
+00:11:33,900 --> 00:11:37,860
+نحكي فيه كتير العدل .. العدل في كل إشي يعني العدل
+
+141
+00:11:37,860 --> 00:11:44,030
+ماكان في إشي إلا بيزينه سبحان الله ولا لأ؟فالعدل
+
+142
+00:11:44,030 --> 00:11:53,410
+في المعاملة، العدل في تقديم الخدمة، العدل في الوقت
+
+143
+00:11:53,410 --> 00:11:56,810
+اللي تمنحه لكل مريض، ممكن يكون معاك أكتر من
+
+144
+00:11:56,810 --> 00:12:00,990
+المريض، مش معقول أن أنت تحسس مريض أنه واحد وانت
+
+145
+00:12:00,990 --> 00:12:05,610
+مهتم فيه كتير وكتيرساعة بتمر عليها تلت دقات فقط
+
+146
+00:12:05,610 --> 00:12:09,150
+آه، أشوف أنت كويس، أعملها، وكل اهتمامك في المريض
+
+147
+00:12:09,150 --> 00:12:14,770
+التاني هذا عادة بيخلي المريض يحس بالتنييز ال
+
+148
+00:12:14,770 --> 00:12:18,710
+process كيف بتكون ال process of ethical reasoning؟
+
+149
+00:12:20,320 --> 00:12:25,940
+إنه إحنا عادة لو أنا في عندي قضية أخلاقية معينة
+
+150
+00:12:25,940 --> 00:12:30,460
+وبدنا نناقشها فـ Review the fact بنروح بنرجع
+
+151
+00:12:30,460 --> 00:12:34,300
+للحقائق طب هو إيش الأصل في الموضوع الأصول نرجعلها
+
+152
+00:12:34,300 --> 00:12:37,560
+Define the problem الأصل في الموضوع أنه نعمل هيك
+
+153
+00:12:37,560 --> 00:12:40,200
+هيك هيك طب إحنا إيش اللي صار عندنا Define عرف
+
+154
+00:12:40,200 --> 00:12:43,720
+المشكلة أحددها يعني المشكلة أنه أحنا عملنا هيك هيك
+
+155
+00:12:43,720 --> 00:12:47,060
+هيك أها طب وإيش الخيارات؟ كيف يعني؟ ليش هذي صارت
+
+156
+00:12:47,060 --> 00:12:51,890
+المشكلة؟كيف بدنا نحلها؟ إيش الأسباب اللي قدّت
+
+157
+00:12:51,890 --> 00:12:54,770
+للمشكلة؟ والله كذا ممكن يكون كذا، ممكن يكون كذا،
+
+158
+00:12:54,770 --> 00:12:59,710
+ممكن يكون كذا، حطينا كل الأسباب الممكنة طيب،
+
+159
+00:12:59,710 --> 00:13:05,130
+decide on an actionبنقول أه طب إيش أحسن حل فكرك
+
+160
+00:13:05,130 --> 00:13:09,590
+علشان نبدأ نحل هذه المشكلة اللي أسبابها سردناها
+
+161
+00:13:09,590 --> 00:13:13,250
+بالشكل التالي نبدأ نقترح brainstorming والله ممكن
+
+162
+00:13:13,250 --> 00:13:17,390
+نكون الحل نعمل كذا ونعمل كذا بقول واحد بحط أي حل
+
+163
+00:13:17,390 --> 00:13:20,970
+ممكن يختر في البدء تمام بنبدأ الآن ن decide طب هات
+
+164
+00:13:20,970 --> 00:13:26,330
+لو سمحتوا نحط إيش نشوف الخيار الأنسب هذا الخيار
+
+165
+00:13:26,330 --> 00:13:33,620
+بنفعلأ ده لأ نستبعده لإنه صعب تحقيقهم خيالي الحل
+
+166
+00:13:33,620 --> 00:13:38,060
+التاني عفواً والله الحل التاني أه ممكن تطبيقه بس
+
+167
+00:13:38,060 --> 00:13:43,720
+يعني في نوع من الظلم الحل التالت أه ممكن تطبيقه
+
+168
+00:13:43,720 --> 00:13:51,780
+لكنمكلف لما نستطيع أن نتوافق إلى حل في كل المميزات
+
+169
+00:13:51,780 --> 00:13:58,760
+اللي احنا بدنا إياها مش مكلف، سهل تطبيقه، براعي
+
+170
+00:13:58,760 --> 00:14:07,040
+الأخلاق تبع المهنةمقبول من العاملين لما ارسينا على
+
+171
+00:14:07,040 --> 00:14:10,520
+حل معين «evaluate the choice» قيمناها هنا في كل
+
+172
+00:14:10,520 --> 00:14:16,040
+المواصفات هذه طبقنا بعد ما نطبق الحل بنعمل
+
+173
+00:14:16,040 --> 00:14:20,940
+monitoring بنشوف هل هذا فعلا قضى على المشكلة اللي
+
+174
+00:14:20,940 --> 00:14:29,180
+أحنا أصلا بدنا نعمل لهاحلول ولا ما حصلش تمام الـ
+
+175
+00:14:29,180 --> 00:14:31,380
+Specifically Legal and Ethical Issues in Critical
+
+176
+00:14:31,380 --> 00:14:35,740
+Care في عندي أنا شوية حاجات
+
+177
+00:14:38,210 --> 00:14:42,450
+مهمة في الـ Critical Care من ضمنها مثلا «Informed
+
+178
+00:14:42,450 --> 00:14:47,890
+Consent» إيش يعني «Informed Consent»؟ إيش يعني؟
+
+179
+00:14:47,890 --> 00:14:51,490
+طبعا أنا نسيت أنا بس بدي أحكيلكوا حاجة إنه هاد ال
+
+180
+00:14:51,490 --> 00:14:56,450
+slide أنا شرحته بالتفصيل بس بدي أدلكوا كل واحد،
+
+181
+00:14:56,450 --> 00:15:00,040
+هذا عبارة عن أول واجب بحاطلكوا ياه في الواجباتكل
+
+182
+00:15:00,040 --> 00:15:05,440
+واحد يفترضلي قضية أخلاقية هو بتوقعها بيده يجرى عن
+
+183
+00:15:05,440 --> 00:15:08,420
+الـ net بيده يسأل الناس اللي كانوا في العناية اللي
+
+184
+00:15:08,420 --> 00:15:13,300
+اشتغلوا اللي عن أي قضية أخلاقية ممكن تسير في
+
+185
+00:15:13,300 --> 00:15:18,640
+العناية المركزة ويبدأ يحطلي Review the fact Define
+
+186
+00:15:18,640 --> 00:15:21,320
+the problem List the choices Decide on an action
+
+187
+00:15:21,320 --> 00:15:25,100
+Evaluate that choiceيفترض إنه في مشكلة، إشي
+
+188
+00:15:25,100 --> 00:15:31,500
+المشكلة ويبدأ ينفذ الخطوات هذه تبع الـ Process of
+
+189
+00:15:31,500 --> 00:15:34,760
+Reasoning يعني كيف يبرر هذه المشكلة وكيف يضاعلها
+
+190
+00:15:34,760 --> 00:15:38,920
+حلول، هذا أول واجب الحاجة التانية وهو الواجب يعني
+
+191
+00:15:38,920 --> 00:15:41,740
+تقريبًا التاني الـInformed Concept بس هذا مش واجب
+
+192
+00:15:41,740 --> 00:15:46,380
+يعني مكتوب ولا لأ؟يعني احنا ممكن نعمله خلال جلسة
+
+193
+00:15:46,380 --> 00:15:49,960
+مناقشة أو ممكن انتضفوه مع الواجب الأولاني سطر هيك
+
+194
+00:15:49,960 --> 00:15:53,880
+بدي تعريف ال informed consent إيش يعني informed
+
+195
+00:15:53,880 --> 00:15:58,800
+consent؟ إيش يعني هذه؟تعرفوا هذه الـ Informed
+
+196
+00:15:58,800 --> 00:16:03,760
+Consent؟ هي الـ Consent Form اللي هي ورقة الموافقة
+
+197
+00:16:03,760 --> 00:16:07,640
+على إجراء سواء عملية أو إجراء طب ليش .. إيش .. إيش
+
+198
+00:16:07,640 --> 00:16:12,140
+مهنة أنه معناها الحقيقي Informed Consent؟ إيش
+
+199
+00:16:12,140 --> 00:16:16,000
+يعني؟ تمام؟ بدي تبحثوا عنها وتكتبوا ليها السطر هذا
+
+200
+00:16:16,000 --> 00:16:21,340
+مع ال .. ال assignment اللي حكينا عليه قبل قليل،
+
+201
+00:16:21,340 --> 00:16:26,340
+okay؟وعشان هيك هأجر الحاجة فيها للمرة القادمة
+
+202
+00:16:26,340 --> 00:16:29,980
+Withholding Mechanical Ventilation قضية أخلاقية
+
+203
+00:16:29,980 --> 00:16:32,980
+جالك المريض هذا بدنا نوقف عنه الـ Mechanical
+
+204
+00:16:32,980 --> 00:16:36,840
+Ventilation فعلا قضية، dilemma هذه طبعا هذه من ضمن
+
+205
+00:16:36,840 --> 00:16:39,700
+القضايا اللي أنا في ال assignment اللي فات
+
+206
+00:16:39,700 --> 00:16:45,260
+حكيتلكوا أنه يعنيبتكوا تكتبوا عنها، فمن أمتى
+
+207
+00:16:45,260 --> 00:16:47,360
+لتهايه، with long mechanical ventilation، with
+
+208
+00:16:47,360 --> 00:16:50,500
+holding mechanical ventilation، بدها تقول إن إحنا
+
+209
+00:16:50,500 --> 00:16:54,500
+بنخترض إن في عندك مريض وكان عنده كذا وكذا، أه،
+
+210
+00:16:54,500 --> 00:16:58,600
+أمور end stage يعني، و cancer، و عنده multi organ
+
+211
+00:16:58,600 --> 00:17:01,460
+system failure، وصار فيه قرار إنه نفصل عنه جهاز
+
+212
+00:17:01,460 --> 00:17:08,150
+التنفس يعنيهل هذا مقبول؟ فكر في الـChoices، طلّقلي
+
+213
+00:17:08,150 --> 00:17:11,950
+قرار، طلّع مجمع البحوث الإسلامي، طلّع فتّه في
+
+214
+00:17:11,950 --> 00:17:15,450
+الموضوع، قال آه، قال لأ، آه، مش واحد يألفلي من
+
+215
+00:17:15,450 --> 00:17:20,050
+مخه، يطرحلي وجهة نظره، أنا هنا كمان مرة بحكي،
+
+216
+00:17:20,050 --> 00:17:25,690
+الأخلاق لها محددات طبعها اللي هو كل مهنة، بما
+
+217
+00:17:25,690 --> 00:17:32,420
+يتناسب مع المجتمع والدين والمهنةفلذلك أي حد بده
+
+218
+00:17:32,420 --> 00:17:37,040
+يطرح مشكلة بده يطرح إلها حلول بده يجيب مراجع رسمية
+
+219
+00:17:37,040 --> 00:17:42,760
+لهذه الحلول مش ما يتهيأ إليه يعني ما ما يصوره لك
+
+220
+00:17:42,760 --> 00:17:48,300
+عقلك وما تهيأه لك نفسك، لأ Restrained agitated
+
+221
+00:17:48,300 --> 00:17:51,840
+patient مريض كان إنها المركزة و agitated كتير
+
+222
+00:17:51,840 --> 00:17:54,820
+بتكون في ناس agitated طالعين من العمليات أو أي شيء
+
+223
+00:17:54,820 --> 00:17:59,360
+مع الـAnesthesia Effect بتلاقي طيب إيش .. إيش
+
+224
+00:17:59,360 --> 00:18:07,540
+يصير؟هذا المريض كيف
+
+225
+00:18:07,540 --> 00:18:12,740
+انربطه؟ إيش الطرق؟ مسموح ولا مش مسموح أصلا؟ okay
+
+226
+00:18:12,740 --> 00:18:16,840
+patient with AIDS الناس اللي عندها AIDS و صار بده
+
+227
+00:18:16,840 --> 00:18:26,840
+الـCPR إيش الوضع معهم يعني؟ نعمله الـCPR هو AIDS
+
+228
+00:18:27,640 --> 00:18:33,240
+ولا نسيبه فاكروا فاكروا وعملوها من ضمن القضايا
+
+229
+00:18:33,240 --> 00:18:36,600
+اللي كنتوا بتكتبوليها عنها في مبدأ مهم اسمه «Do
+
+230
+00:18:36,600 --> 00:18:41,420
+not recess state» الـDNR الـDNR هنا موضوع مهم وبدي
+
+231
+00:18:41,420 --> 00:18:45,660
+أكتب فيه فهمه كويس أولا فيه تلاتة code ل الحالات
+
+232
+00:18:46,370 --> 00:18:48,870
+وDNR معناها «Do Not Resuscitate» يعني «ما تعملهوش
+
+233
+00:18:48,870 --> 00:18:52,270
+إن عاش قلب» في code A أو code one بالإيطاليا
+
+234
+00:18:52,270 --> 00:18:56,070
+«نمبر» معناه إنه full support يعني المريض هذا بدنا
+
+235
+00:18:56,070 --> 00:18:59,670
+نعمله code A هذا نايم في ال ICU code A أو ده على
+
+236
+00:18:59,670 --> 00:19:02,550
+ال emergency room وعشان شوفنا الإصابات تبعت
+
+237
+00:19:02,550 --> 00:19:06,130
+وشخصناه قريبنا ال code A إيش يعني code A؟ يعني
+
+238
+00:19:06,130 --> 00:19:09,770
+بدنا نعمله كل support يعني cardiovascular support
+
+239
+00:19:10,050 --> 00:19:13,110
+Respiratory support يعني عن طريق الـ Mechanical
+
+240
+00:19:13,110 --> 00:19:16,010
+Ventilator Cardiovascular support يعني ربما عن
+
+241
+00:19:16,010 --> 00:19:19,830
+طريق الـ Atrophic Drugs ربما عن طريق الـ Intra
+
+242
+00:19:19,830 --> 00:19:22,770
+-Aortic Pulmonary Pump كلها دقامتي اللي هنحكيها
+
+243
+00:19:22,770 --> 00:19:26,230
+بالتفصيل لما ناخد الشباتر اللي خاصة بيها وكمان لو
+
+244
+00:19:26,230 --> 00:19:29,290
+احتاج المرض صار عنده Complete Cardio Pulmonary
+
+245
+00:19:29,290 --> 00:19:33,050
+Arrest و Cardiac Arrest أو Respiratory Arrest فانا
+
+246
+00:19:33,050 --> 00:19:36,430
+مطلوب مني ان اعملهالـ cardiopulmonary
+
+247
+00:19:36,430 --> 00:19:43,450
+resuscitation بينما كود B المريض بعمله اللي هو
+
+248
+00:19:43,450 --> 00:19:46,870
+full
+
+249
+00:19:46,870 --> 00:19:53,030
+support ما عدا الـCPR يعني بديله أكسوجين
+
+250
+00:19:54,850 --> 00:19:58,410
+بأدّيه ببركّب عليه اللي هو Intropic Drug زي
+
+251
+00:19:58,410 --> 00:20:01,650
+الأدرينالين و انه الأدرينالين دوبامين whatever لكن
+
+252
+00:20:01,650 --> 00:20:05,090
+إذا بيصير المرض براديكارديا و بيصير الهسفراتور
+
+253
+00:20:05,090 --> 00:20:09,830
+arrested و cardiac arrest بسيبه لا بعمله
+
+254
+00:20:09,830 --> 00:20:12,430
+endotracheal tube ولا بعمله chest compression
+
+255
+00:20:12,430 --> 00:20:18,950
+فاخدين بالكوا هذا code B أما code 3 أو code C عفوا
+
+256
+00:20:18,950 --> 00:20:23,750
+نسميه code C اللي هو code 3 في الإيطالياComfort
+
+257
+00:20:23,750 --> 00:20:29,930
+Care Only يعني حتى الـ Vasopressors والـ Intropic
+
+258
+00:20:29,930 --> 00:20:32,850
+Drugs اللي بتعمل Resuscitation للـ Heart الـ
+
+259
+00:20:32,850 --> 00:20:36,390
+Prolonged Resuscitation بنسميه مايلها لزوم، واقفوا
+
+260
+00:20:36,390 --> 00:20:39,870
+عنه يعني دوة عشان الـ Endocardium إحنا مدينوا
+
+261
+00:20:39,870 --> 00:20:42,790
+أدرينالين أو أدروجين عشان نرفعالـ Heart Rate تبقى
+
+262
+00:20:42,790 --> 00:20:45,510
+للمريض هذا ونعمل Resuscitation؟ لأ، وقفوا، ممنوع
+
+263
+00:20:45,510 --> 00:20:48,690
+المريض هذا على دوبامين عشان بيعمل Resuscitation لـ
+
+264
+00:20:48,690 --> 00:20:51,570
+pressure تبعته الـ vascular system على Basal
+
+265
+00:20:51,570 --> 00:20:55,550
+Pressure ووقفها، stop، non-heal، خلاص، يبقوا طبعا،
+
+266
+00:20:55,550 --> 00:20:59,070
+طب ها إيش بيضل يعني ياخد؟ بيضل ياخد بقية الأدوية
+
+267
+00:20:59,070 --> 00:21:03,050
+اللي لازمة إله، زي مثلا بأخد ال fluid عشان Massage
+
+268
+00:21:03,050 --> 00:21:07,330
+Dehydrationأه بياخد دي عن المتطلبات حقه في الحياة
+
+269
+00:21:07,330 --> 00:21:12,490
+بدون علاج حقيقي يغير حالته الصحية يعني بعمله care
+
+270
+00:21:12,490 --> 00:21:17,790
+بنحطله new scene عشان مايصيرش عنده جفاف في ال eyes
+
+271
+00:21:17,790 --> 00:21:21,430
+بنعمله mouth care بنحطله نستاتين عشان مايصيرش عنده
+
+272
+00:21:21,430 --> 00:21:25,570
+فطريات في ال mouth أه مش هذا دوة؟ أه دوة لكن هذا
+
+273
+00:21:25,570 --> 00:21:32,900
+يعني ما بيعمل resuscitation لأ هذا careهذا الـ
+
+274
+00:21:32,900 --> 00:21:37,720
+Care بيعمل لكن مش هيزود
+
+275
+00:21:37,720 --> 00:21:41,500
+في عمره ولا يوم ولا دقيقة طبعا احنا مأمنين ان اصلا
+
+276
+00:21:41,500 --> 00:21:44,100
+حتى لو عملت ايش ما تعمله قدّيت بعض ال resources
+
+277
+00:21:44,100 --> 00:21:48,820
+بطريقة ما بتطور في عمر حدا دقيقة فهذا هو مبدأ
+
+278
+00:21:48,820 --> 00:21:52,140
+الـDNR اللي له three code code A و code B و code C
+
+279
+00:21:52,140 --> 00:21:56,420
+زي ما شفتوا code B أو C هم هدول الكودات اللي ممكن
+
+280
+00:21:56,420 --> 00:22:03,490
+يكون المريضDNR، يعني لو صار «أنا باستثناش، هنتدخّل
+
+281
+00:22:03,490 --> 00:22:07,850
+و هنسيبه يروح» عادة زي ما بيسموه الأجانب بيقولوا
+
+282
+00:22:07,850 --> 00:22:13,950
+«to pass away» عادة المرضى هدول اللي بنسيبهم «to
+
+283
+00:22:13,950 --> 00:22:19,090
+pass away» يعني أنه بيكونوا في ال «end stage» أو
+
+284
+00:22:19,090 --> 00:22:25,230
+مثلا cancer diseaseعنده متاسسيز عنده غير متاسسيز
+
+285
+00:22:25,230 --> 00:22:28,970
+ممكن يكون فيه عنده اللي هو multi organ system
+
+286
+00:22:28,970 --> 00:22:33,490
+failure فبالتالي no good prognosis is expected
+
+287
+00:22:33,490 --> 00:22:37,890
+سولتهم to die in peace لدرجة انهم تعدوا هذا
+
+288
+00:22:37,890 --> 00:22:41,810
+الموضوع مش بس DMR لأ عملوا حاجة اسمها merciful
+
+289
+00:22:41,810 --> 00:22:46,210
+killing اللي هو موت رحيم وهم بيقرروا ان هذا خلاصين
+
+290
+00:22:46,210 --> 00:22:47,950
+عنه الأجهزة ووقف عنه
+
+291
+00:22:51,030 --> 00:22:55,470
+الـ Anthropic Drugs أو «سيبو» to die. الآن بصراحة
+
+292
+00:22:55,470 --> 00:22:58,650
+هم وصوا أو يعني صاروا بيحكوا وبيتهموا في مبدأ الـ
+
+293
+00:22:58,650 --> 00:23:04,030
+«DNR» أكتر لأنه لو هم اتطبخوا مبدأ الـ «DNR»
+
+294
+00:23:04,030 --> 00:23:07,610
+بيبطلوا في حاجة إلى الـ «mercy for killing» والموت
+
+295
+00:23:07,610 --> 00:23:11,110
+الرحيم لأنه خلاص أنا ماوجدتش بحدد أن المريض هذا
+
+296
+00:23:11,110 --> 00:23:14,720
+وضع وصيب كتير و «not for resuscitation»مش هحطه
+
+297
+00:23:14,720 --> 00:23:18,340
+أصلا على mechanical ventilator مش ربما مش هحطله
+
+298
+00:23:18,340 --> 00:23:22,680
+على suppressors وبالتالي I will let him to die in
+
+299
+00:23:22,680 --> 00:23:27,700
+peace spontaneously لحالي okay ال chapter هيك مكون
+
+300
+00:23:27,700 --> 00:23:31,940
+خلص عن ال ethical فيه عليكوا assignments هتعملوها
+
+301
+00:23:31,940 --> 00:23:37,320
+قبل نحكي شوية في ال stressor و ال occupationوالـ
+
+302
+00:23:37,320 --> 00:23:41,780
+Occupational Burnout موضوع سهل وبسيط ده خلصه في
+
+303
+00:23:41,780 --> 00:23:46,600
+دقائق إن شاء الله شغلنا في الـ ICU بيخلّينا محاطين
+
+304
+00:23:46,600 --> 00:23:50,340
+وفي الأماكن الـ Hot Areas بنسميها تمام اللي هي الـ
+
+305
+00:23:50,340 --> 00:23:53,040
+ICU الـ Emergency Room الـ Operation Room الـ
+
+306
+00:23:53,040 --> 00:23:56,840
+Recovery Room هدولة يصنفوا في المستشفيات من ضمن
+
+307
+00:23:56,840 --> 00:24:00,990
+الـ Hot Areaوتبقى الأماكن في المستشفيات الأقسام
+
+308
+00:24:00,990 --> 00:24:05,990
+الداخلية العادية تُعتبر من الـCold Area، تمام؟
+
+309
+00:24:05,990 --> 00:24:09,370
+الأقسام الباردة يعني مافيش فيها Action فإنت في
+
+310
+00:24:09,370 --> 00:24:13,310
+الأماكن الـHot Areas هذه، عندك Stressors كتير
+
+311
+00:24:13,490 --> 00:24:17,050
+بنسميها ملموليا المؤثرات اللي بتأثر عليك منها في
+
+312
+00:24:17,050 --> 00:24:18,910
+physiological stressor ايش يعني physiological
+
+313
+00:24:18,910 --> 00:24:25,430
+stressor؟ من الوضع اللي انت عايش فيه، في عندك شغل
+
+314
+00:24:25,430 --> 00:24:28,810
+كتير، في عندك تعب كتير، في عندك هدف ينادي عليك،
+
+315
+00:24:28,810 --> 00:24:31,850
+هدف ينادي عليك، واجه طول الوقت، alert، منتبه، هذا
+
+316
+00:24:31,850 --> 00:24:35,610
+physiologicalتمام؟ في عندك psychological stress زي
+
+317
+00:24:35,610 --> 00:24:38,470
+إيه الـ psychological stress؟ أنت بتشتغل مع عينين
+
+318
+00:24:38,470 --> 00:24:43,750
+حرجين كتير أحيانا بتخاف أنه يعني حاسسين حالنا مش
+
+319
+00:24:43,750 --> 00:24:47,590
+قادرين نسيطر على الوضع عدد كبير من الحالات إيه
+
+320
+00:24:47,590 --> 00:24:53,890
+جاي؟وضع المريض حرج كتير، بده عدد التين اللي موجود
+
+321
+00:24:53,890 --> 00:24:56,950
+تلاتة، أربعة، مش مكافئين، بدنا كمان ناس تساعدنا،
+
+322
+00:24:56,950 --> 00:25:01,990
+psychological، الحالات اللي كل يوم بتشوف ناس ضاعد،
+
+323
+00:25:01,990 --> 00:25:07,250
+كل يوم بتشوف ناس very critical in amputation، يعني
+
+324
+00:25:07,250 --> 00:25:11,970
+صور ربما تكون فظية عند البعض، وحد amputation وحد
+
+325
+00:25:14,660 --> 00:25:19,300
+بيرن، كل جسده متفحمة، طفل صغير يقول انت شوفته حنيت
+
+326
+00:25:19,300 --> 00:25:24,080
+عليه وشوفته كيف هو قاعد ب gasping و بعدين died،
+
+327
+00:25:24,080 --> 00:25:27,500
+هذا كله يتكتمل في psychological أو تعتبر
+
+328
+00:25:27,500 --> 00:25:29,720
+psychological stressors في environmental
+
+329
+00:25:29,720 --> 00:25:33,610
+stressors، اللي هي بيئية، درجة حرارة المكانبحد
+
+330
+00:25:33,610 --> 00:25:36,550
+ذات، لو انت بتشتغل في مكان وشوء بكتير واماكن هذه
+
+331
+00:25:36,550 --> 00:25:40,410
+المغلقة عايزا دايما بتكون شوء ودوشة لإنه فيه كذا
+
+332
+00:25:40,410 --> 00:25:43,290
+بيشتغلوا مهتم في الحالة وهدولة برضه مشتغلين في
+
+333
+00:25:43,290 --> 00:25:48,930
+حالة تانية ومهتمين فيها وكل يعني مضطرب وصوت مرتفق
+
+334
+00:25:48,930 --> 00:25:53,330
+نوعا ما لإنه هات كذا هاتجيب الحاجة بصراحة فهذا كله
+
+335
+00:25:53,330 --> 00:25:57,430
+يتوب خليك عايز يبقاش في stress يعني فعلا انت مش
+
+336
+00:25:57,430 --> 00:26:02,800
+هادى، هادى الأماكن مش هادى، أماكن actionالضوء اللي
+
+337
+00:26:02,800 --> 00:26:05,840
+مابنطفعش وشغال فيها طول .. مابتعرفش الدنيا ليل ولا
+
+338
+00:26:05,840 --> 00:26:09,960
+نهار طول الوقت و هو الضوء شغال في ال ICU لدرجة انه
+
+339
+00:26:09,960 --> 00:26:13,300
+يعني في متلازمة تصير عند المرضى انه بيطلع بيبطل
+
+340
+00:26:13,300 --> 00:26:15,360
+عارف حالة هو في الليل ولا في النهار ولا أكم
+
+341
+00:26:15,360 --> 00:26:19,200
+الساعة، ليش؟ لأنه طول ما هو في ال ICU و هم الناس
+
+342
+00:26:19,200 --> 00:26:22,920
+شغالين رايحين جايين و .. و .. و .. و .. وشتغلوا و
+
+343
+00:26:22,920 --> 00:26:26,220
+الضوء مضوي و .. و .. يعني فيش يناوم، فيش اللي
+
+344
+00:26:26,220 --> 00:26:29,900
+مابحسش أنه إيجي ليل و راح نهار و راح نهار و إيجي
+
+345
+00:26:29,900 --> 00:26:36,490
+ليل أبدًاروحانيات كثير في روحانيات حكينا أن ضمنها
+
+346
+00:26:36,490 --> 00:26:39,690
+البيومات الأغلقية اللي احنا بنخش فيها ربما انت
+
+347
+00:26:39,690 --> 00:26:43,690
+تقول طب يعني هذا DNR انت بيجيلك القرار لما بتشوفه
+
+348
+00:26:43,690 --> 00:26:47,410
+انت هو بدأ يصير gossiping واشي مش هاين عليك عم
+
+349
+00:26:47,410 --> 00:26:53,330
+تعالوا يعملوله intubation لأ لأ هذا DNR هذا اللي
+
+350
+00:26:53,330 --> 00:26:57,340
+هو code B ومش هنعمله intubationممكن أنت تصير
+
+351
+00:26:57,340 --> 00:27:01,280
+زعلان، عاملة، كان يحكي معايا، إبصار، إيه؟ الـ
+
+352
+00:27:01,280 --> 00:27:02,980
+Physical stress اللي حكينا عنها الـ Physical
+
+353
+00:27:02,980 --> 00:27:06,600
+stress اللي بتاعك الشغل و الحركة و احمل و suction
+
+354
+00:27:06,600 --> 00:27:11,940
+و عيالين وزرهم ثقيل نوعا ما و أنت محتاج تعملهم
+
+355
+00:27:11,940 --> 00:27:14,690
+مدرسة و تعملهم مدرسة، يقول الحاجات هذهكل هذه الـ
+
+356
+00:27:14,690 --> 00:27:18,170
+stressors اللي بنتعرض إليها في ال ICU هذه لما
+
+357
+00:27:18,170 --> 00:27:21,690
+بتزيد عن حد ده ممكن تعملنا حاجة اسمها ال
+
+358
+00:27:21,690 --> 00:27:25,410
+occupational burnout إيش يعني هذا ال burnout؟ هذا
+
+359
+00:27:25,410 --> 00:27:28,450
+مش ال burn اللي بيصير في الجن لأ هذا الburn اللي
+
+360
+00:27:28,450 --> 00:27:33,150
+بيصير في الناس بيسمونه احتراق الوظيفي إيش يعني؟
+
+361
+00:27:33,150 --> 00:27:38,490
+يعني إن ال human أو الراجل أو الموظف سواء كان راجل
+
+362
+00:27:38,490 --> 00:27:43,290
+أو ساتر collapse of human spirit يعني يصير إيش
+
+363
+00:27:43,290 --> 00:27:50,700
+معاه؟Collabs كاف يعني يعني بيصير منهج داخليًا
+
+364
+00:27:51,400 --> 00:27:56,320
+الحماس سبعه يفقدوا خالص «Lack of enthusiasm and
+
+365
+00:27:56,320 --> 00:28:00,600
+motivation» «حاسس أنه مش مفيد» «Ineffectiveness»
+
+366
+00:28:00,600 --> 00:28:04,200
+عالفادة، كل دي عرفنا نعمل عالفادة «Frustration»،
+
+367
+00:28:04,200 --> 00:28:07,980
+«محبط» هذا هو الاحتراف الوظيفي هذا له تأثيرات
+
+368
+00:28:07,980 --> 00:28:11,940
+كبيرة سواء على المالك كممرض أو على المريض أو على
+
+369
+00:28:11,940 --> 00:28:14,240
+المنظمة اللي بتشتغل فيها أو المؤسس يعني اللي
+
+370
+00:28:14,240 --> 00:28:18,370
+بتشتغل فيها المستشفة، الوزارةكيف الـ Physical
+
+371
+00:28:18,370 --> 00:28:21,210
+Health المريض، الـ Nurse نفسه بتلاقي كل يوم لما
+
+372
+00:28:21,210 --> 00:28:24,990
+نصلي عنده احتراف وظيفي من المسببات الكتير اللي
+
+373
+00:28:24,990 --> 00:28:30,530
+حكينا عنها كل يوم بيجي، عندي، دهري مجاني، م .. م
+
+374
+00:28:30,530 --> 00:28:36,670
+.. م .. م .. رحلة
+
+375
+00:28:43,430 --> 00:28:48,150
+عنده back pain، عنده عصبية، بيحكي معاك واحد
+
+376
+00:28:48,150 --> 00:28:52,270
+كلمتين، بيروّع على الدار، ما نيمتش، بقولش، mental
+
+377
+00:28:52,270 --> 00:28:59,110
+healthقالت يعني disturbance مثلًا إنه محبط مضروع
+
+378
+00:28:59,110 --> 00:29:03,770
+على الدار حتى ولده منعزل مش مبسوط مكتئب إيش فيه؟
+
+379
+00:29:03,770 --> 00:29:06,970
+ليش يا عم صار الزلمة زي هيك؟ والله هذا من الشغل،
+
+380
+00:29:06,970 --> 00:29:10,770
+أه معقول؟ أه كل ما بيجي الشغل مش جاهز، راسي
+
+381
+00:29:10,770 --> 00:29:16,130
+بيجعني، دهري بيجعني، المؤسسةالرجل هذا ماشتغلش
+
+382
+00:29:16,130 --> 00:29:20,750
+فعليًا يعني الـ الـ الـ الكفاءة تبعته والإنتاج
+
+383
+00:29:20,750 --> 00:29:23,670
+تبعته في العمل ال productive تبعته قلت كتير
+
+384
+00:29:23,670 --> 00:29:31,090
+فبالتالي يعني هو ايبق عليهم طب وحتى يوم انه بده
+
+385
+00:29:31,090 --> 00:29:37,330
+يشتغل ممكن يغلق يعني يا أما جامج لادر يشتغل وبطلب
+
+386
+00:29:37,330 --> 00:29:44,220
+إجازات كتير إذا ماجهاش مريضأه بيطلب و يطلب مرضية و
+
+387
+00:29:44,220 --> 00:29:49,840
+يروح يروح بده إجازة من غير سبب يعني طيب إذا إجا و
+
+388
+00:29:49,840 --> 00:29:52,880
+إشتغل و إجا على حاله يعني و إشتغله بصر إيه okay
+
+389
+00:29:52,880 --> 00:29:56,400
+ممكن يشتغل لكن إيه ال productivity تبعته very low
+
+390
+00:29:56,400 --> 00:30:00,660
+أو مش بس ذلك لو إشتغل مع المرض و هو كمان ال
+
+391
+00:30:00,660 --> 00:30:03,220
+productivity very low زي ما أحنا شايف كدهيغلط
+
+392
+00:30:03,220 --> 00:30:06,400
+ويأثر بالتالي على المريض ويعمله مشكلة في الـCare
+
+393
+00:30:06,400 --> 00:30:09,460
+التباعته لدرجة انه مسئوله من المباشر عادة يقول يا
+
+394
+00:30:09,460 --> 00:30:13,500
+عم نبدأ متناشف، لا خلاص هذا الزلمة يعني كل يوم هو
+
+395
+00:30:13,500 --> 00:30:16,880
+جاء بده إجازة مرضية، يا أما يوم أنت مابيجي بيشتغل
+
+396
+00:30:16,880 --> 00:30:20,840
+مع المرضى، ماشتغلش إشي، مابتداش عادة، ساعة ما نص
+
+397
+00:30:20,840 --> 00:30:24,280
+عليه شوية ونخليه نشتغل مع مريض، بروح بنفسه، ده هو
+
+398
+00:30:24,280 --> 00:30:28,240
+غلط، بغلط، لأ يا عم متناشف يعني، مشكلة كبيرةطب ليش
+
+399
+00:30:28,240 --> 00:30:31,460
+بتصير هذا الكلام؟ من ال work overload من ال role
+
+400
+00:30:31,460 --> 00:30:34,700
+of conflict طلع فكرة ليش أنا مش رئيس قسم و هذا هو
+
+401
+00:30:34,700 --> 00:30:37,820
+رئيس القسم؟ ليش أنا دكتور؟ ليش أنا ممرض و هذا
+
+402
+00:30:37,820 --> 00:30:43,940
+دكتور ابن جارنا اللي في حارتنا و أصغر مني في السن؟
+
+403
+00:30:43,940 --> 00:30:48,120
+مافيش عنده قدرة على العطاءالـ Conflict between
+
+404
+00:30:48,120 --> 00:30:50,360
+Reality و الـ Idea اللي احنا درسنا في الكتب اللي
+
+405
+00:30:50,360 --> 00:30:53,740
+هتنعملها و بنيجي هنا بنشتغل هيك عامش هدا احنا
+
+406
+00:30:53,740 --> 00:30:57,000
+بصراحة، فيه هندوصراح بينه وبينها، كل هذه المواضيع
+
+407
+00:30:57,000 --> 00:31:02,560
+اللي أثر علي نفسه بتعمل مشاكل، مطلوب منكوا أنتوا
+
+408
+00:31:02,560 --> 00:31:08,860
+برضه أنكوا أنتوا تجيبولي عن ال slide هذه، إيش ال
+
+409
+00:31:08,860 --> 00:31:14,260
+strategies؟ إيش القليات؟ أنا كموظف، إيش لازم أعمل
+
+410
+00:31:14,260 --> 00:31:20,770
+علشان واحدمايصيرش عندي burnout to prevent burnout
+
+411
+00:31:20,770 --> 00:31:25,670
+مايصيرش عندي اتنين لو حسيت في ال burnout صراحة
+
+412
+00:31:25,670 --> 00:31:28,570
+حسيت ان انا بدأت تصير عندي burnout او بدأت اتسلل
+
+413
+00:31:28,570 --> 00:31:32,710
+بـ كيف طرق الحلاجة هذا ال assignment التاني
+
+414
+00:31:32,710 --> 00:31:38,290
+المطلوب منكم تعملوه وترفعوه على الصفحة هيك تقريبا
+
+415
+00:31:38,290 --> 00:31:44,140
+احناخلصنا المحاضرة، يعطيكم العافية وشكراً لكم،
+
+416
+00:31:44,140 --> 00:31:48,540
+المحاضرة الجاية بإذن الله هتكون عن ال chapter اللي
+
+417
+00:31:48,540 --> 00:31:50,080
+بعده، السلام عليكم
+
diff --git a/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/ASqoKLigaDg.srt b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/ASqoKLigaDg.srt
new file mode 100644
index 0000000000000000000000000000000000000000..e385ffb17aebe8e0ac1b57551e5845baf3af45d8
--- /dev/null
+++ b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/ASqoKLigaDg.srt
@@ -0,0 +1,1294 @@
+1
+00:00:00,000 --> 00:00:03,740
+كنا بنحكي على الـ correction of hypotension حكينا
+
+2
+00:00:03,740 --> 00:00:07,640
+إذا كان الـ cause مثلاً hypovolemic shock بكون
+
+3
+00:00:07,640 --> 00:00:12,400
+محتاج إنه انعوض سوائل حكينا إنه الـ fluid
+
+4
+00:00:12,400 --> 00:00:15,540
+replacement اللي احنا بدنا نبدأ فيه المفروض إنه
+
+5
+00:00:15,540 --> 00:00:23,120
+بيبدأ بـ crystalloids بعدين colloids كمان بناخد في
+
+6
+00:00:23,120 --> 00:00:27,820
+الاعتبار إذا المريض عنده blood loss إنه ندّيله الـ
+
+7
+00:00:27,820 --> 00:00:31,960
+blood and blood products بعدين حكينا إنه بنحط
+
+8
+00:00:31,960 --> 00:00:37,020
+للمريض أو بحتاج المريض نحطه على أدوية بتعمل
+
+9
+00:00:37,020 --> 00:00:39,140
+constriction في الـ blood vessels اسمها
+
+10
+00:00:39,140 --> 00:00:42,200
+vasopressors ومن أمثلتها دوبامين، هنحكي عنه
+
+11
+00:00:42,200 --> 00:00:47,120
+بالتفصيل وحكينا عن الـ antibiotics drugs اللي برضه
+
+12
+00:00:47,120 --> 00:00:53,270
+احنا بنحتاجها علشان نزود من الـ strength تبع الـ
+
+13
+00:00:53,270 --> 00:00:56,050
+heart muscle بالذات في الـ cardiogenic shock وكمان
+
+14
+00:00:56,050 --> 00:00:58,850
+في الـ septic shock لأن من تداعياته أن المريض بتصير
+
+15
+00:00:58,850 --> 00:01:04,350
+الـ myocardium نفسها بتتعب و تدخل في cardiogenic
+
+16
+00:01:04,350 --> 00:01:09,130
+shock ومن وسائل العلاج كمان حكينا و بالذات برضه في
+
+17
+00:01:09,130 --> 00:01:13,730
+الـ cardiogenic shock اللي هي الـ intra-aortic
+
+18
+00:01:13,730 --> 00:01:19,190
+balloon pump نبدأ نحكي بالتفصيل عن الحاجات هدولة
+
+19
+00:01:19,190 --> 00:01:22,270
+طبعاً الـ mechanical ventilator حكينا في محاضرة
+
+20
+00:01:22,270 --> 00:01:25,190
+الـ mechanical ventilator إنه ممكن يكون for other
+
+21
+00:01:25,190 --> 00:01:27,830
+causes rather than اللي هو respiratory failure زي
+
+22
+00:01:27,830 --> 00:01:30,650
+الـ cardiogenic shock أو الـ septic shock أو any
+
+23
+00:01:30,650 --> 00:01:33,970
+kind of shock at least إن المريض يبدأ يرتاح من الـ
+
+24
+00:01:33,970 --> 00:01:38,250
+effort تبع الـ breathing بحيث إنه احنا بنحطه على
+
+25
+00:01:38,250 --> 00:01:41,270
+mechanical ventilator وبالتالي تقريباً ثلاثين في
+
+26
+00:01:41,270 --> 00:01:46,150
+المئة من البذل الميتابولي  يكون يعني ارتاح منه
+
+27
+00:01:46,150 --> 00:01:49,850
+المريض ووفرنا عليه والطاقة هذه الـ energy
+
+28
+00:01:49,850 --> 00:01:53,090
+consumption تبع الثلاثين في المئة هدول صار هو
+
+29
+00:01:53,090 --> 00:01:56,370
+جايينه على اتجاهز فاحنا بنعمل reserve للـ energy
+
+30
+00:01:56,370 --> 00:02:00,550
+تبع المريض فيه للـ curative management احنا بنعملها
+
+31
+00:02:00,550 --> 00:02:03,430
+ليتشافى من الوضع اللي هو فيه فبنراعيه عن طريق
+
+32
+00:02:03,430 --> 00:02:07,280
+الـ respirator بالـ mechanical ventilation طبعاً
+
+33
+00:02:07,280 --> 00:02:09,180
+محاضرة الـ mechanical ventilation حكينا كل
+
+34
+00:02:09,180 --> 00:02:14,560
+التفاصيل عن الـ mode و الـ tidal volume و الـ rate
+
+35
+00:02:14,560 --> 00:02:19,300
+اللي بيحتاج المريض لما يكون ventilated الـ fluid
+
+36
+00:02:19,300 --> 00:02:23,440
+resuscitation اللي حكينا عنه يا جماعة حكينا إنه
+
+37
+00:02:23,440 --> 00:02:26,260
+عشان أبدأ أصلاً الـ fluid resuscitation لازم أهم
+
+38
+00:02:26,260 --> 00:02:32,340
+حاجة يكون في عندي two large-pore cannulaeودائماً
+
+39
+00:02:32,340 --> 00:02:36,260
+حكينا مش واحدة، two، at least two أحياناً نحتاج
+
+40
+00:02:36,260 --> 00:02:42,000
+نركب central line عشان نبدأ نركب دائماً يعني يا
+
+41
+00:02:42,000 --> 00:02:45,500
+جماعة بالموضوع هذا ما حدش يفكر إن الـ central line
+
+42
+00:02:45,500 --> 00:02:49,580
+أحسن في الـ fluid resuscitation من الـ cannulae، لأ
+
+43
+00:02:49,580 --> 00:02:52,960
+الـ cannulae بتكون more rapid وخاصة لما يكون gauge
+
+44
+00:02:52,960 --> 00:02:58,500
+تبعها يعني صغير فبالتالي بتكون الـ size تبعها كبير،
+
+45
+00:02:58,500 --> 00:03:04,000
+يعني مثلاً gauge 16، gauge 18 هدولة بكونوا very good
+
+46
+00:03:04,000 --> 00:03:07,860
+for rapid administration and fluid replacement for
+
+47
+00:03:07,860 --> 00:03:11,480
+the patient خاصة إنه الـ cannula short لكن
+
+48
+00:03:11,480 --> 00:03:14,720
+الـ central line long في الـ flow في اللي تبقى
+
+49
+00:03:14,720 --> 00:03:18,040
+الـ fluid بطيء في الـ central line يا جماعة فما حدش
+
+50
+00:03:18,040 --> 00:03:22,330
+يفكر إن الـ central line أحسن، لأ، بعدين أنت في
+
+51
+00:03:22,330 --> 00:03:24,290
+الـ central line بتكون بتقترب من الـ heart مباشرة
+
+52
+00:03:24,290 --> 00:03:27,430
+فالـ risk بكون عالي أو قريب جداً من الـ heart لكن
+
+53
+00:03:27,430 --> 00:03:30,290
+بالـ cannula أنت بتدفق في مكان بعيد وبعدين بيصل الـ heart فهذا
+
+54
+00:03:30,290 --> 00:03:35,150
+بيكون أقل مخاطر خاصة لما بنعمل في rapid
+
+55
+00:03:35,150 --> 00:03:38,410
+administration بنكون خائفين من أن يكون أو يصير أن
+
+56
+00:03:38,410 --> 00:03:45,770
+اللي هو pulmonary edema الـ rate والـ amount عاملين
+
+57
+00:03:45,770 --> 00:03:49,790
+بنحكي فيهم  لناخد نعمل الـ consideration دائماً
+
+58
+00:03:49,790 --> 00:03:51,910
+نكون واخدين بالنا من الـ blood pressure ومن الـ
+
+59
+00:03:51,910 --> 00:03:54,970
+pulse ومن الـ saturation تبع المريض أو من الـ
+
+60
+00:03:54,970 --> 00:03:57,530
+general condition تبعه وإحنا بندفل الـ fluid عشان
+
+61
+00:03:57,530 --> 00:04:04,120
+ما يخشش زي ما حكينا في pulmonary edema المريض لازم
+
+62
+00:04:04,120 --> 00:04:06,820
+نبدأ دائماً معاه بالـ crystalloid يا جماعة لازم
+
+63
+00:04:06,820 --> 00:04:09,440
+نبدأ معاه بالـ crystalloid ياخد ترطيب كويس من الـ
+
+64
+00:04:09,440 --> 00:04:12,140
+crystalloid واحد أو اثنين لتر تقريباً نحكي على
+
+65
+00:04:12,140 --> 00:04:19,260
+البدء وبعد هيك طبعاً و it depends حسب الـ الـ الـ
+
+66
+00:04:19,260 --> 00:04:22,960
+loss قد ايش فيه عنده loss قد ايش فيه hypotension وبعدين
+
+67
+00:04:22,960 --> 00:04:28,480
+بنبدأ في الـ colloid و الـ crystalloid بداية دائماً
+
+68
+00:04:28,480 --> 00:04:33,500
+بنبدأ نعطي يا جماعة الـ solutions of choice اللي
+
+69
+00:04:33,500 --> 00:04:36,580
+هي الـ normal saline أو الـ ringer lactate حتى الـ
+
+70
+00:04:36,580 --> 00:04:39,740
+normal saline مفضل عن الـ ringer lactate خاصة لما
+
+71
+00:04:39,740 --> 00:04:44,860
+يكون المريض مثلاً في مثلاً septic shock ويكون عنده
+
+72
+00:04:44,860 --> 00:04:47,740
+severe metabolic acidosis لا
+
+73
+00:04:47,740 --> 00:04:50,860
+يفضل الـ ringer lactate لأنه يخاف أنه يزيد
+
+74
+00:04:50,860 --> 00:04:54,160
+الأسيدوسيس كيف يزيد الأسيدوسيس؟ الـ ringer lactate
+
+75
+00:04:54,160 --> 00:04:57,220
+اسمه lactated ringer الـ lactate هذا عبارة عن
+
+76
+00:04:57,220 --> 00:05:00,000
+الـ lactic acid  النزيم اللي بيطلع لما الواحد
+
+77
+00:05:00,000 --> 00:05:03,420
+بيجهد كتير بيطلع من العضلات وبيعمل تشنجات الـ
+
+78
+00:05:03,420 --> 00:05:06,340
+spasm اللي بيصير معاكم بسبب lactic acid
+
+79
+00:05:06,340 --> 00:05:10,200
+accumulation إذا الـ lactate itself is an acid
+
+80
+00:05:10,820 --> 00:05:13,940
+بما أنه حمض ممكن يزيد الـ metabolic acidosis عشان
+
+81
+00:05:13,940 --> 00:05:18,640
+هيك بنفضل الـ normal saline عن الـ metabolic عن
+
+82
+00:05:18,640 --> 00:05:23,840
+الـ ringer lactate طبعاً الـ fluids الثانية،
+
+83
+00:05:23,840 --> 00:05:28,800
+dextrose مثلاً، dextrose 5%، forbidden absolutely
+
+84
+00:05:28,800 --> 00:05:32,200
+forbidden، عمرك ما تدّي واحد في shock، severe
+
+85
+00:05:32,200 --> 00:05:35,700
+hypotension، تدّيله dextrose لأن dextrose هيزيد
+
+86
+00:05:35,700 --> 00:05:40,000
+المشكلة هيعمل الـ brain edema وهذا هو الأخطر لأنه
+
+87
+00:05:40,000 --> 00:05:43,880
+هيعمل shifting في الـ fluid وبالتالي الـ dextrose
+
+88
+00:05:43,880 --> 00:05:48,820
+forbidden normal saline is the best solution تجنب
+
+89
+00:05:48,820 --> 00:05:53,700
+الـ hypotonic solutions زي الـ half saline و
+
+90
+00:05:53,700 --> 00:06:00,320
+dextrose و normal saline كل هذه حتى لو كانت فيها
+
+91
+00:06:00,320 --> 00:06:04,360
+saline؟ لأ هي hypotonic solutions normal saline 0
+
+92
+00:06:04,360 --> 00:06:09,980
+.9% هو sodium chloride هو اللي prepared وringer
+
+93
+00:06:09,980 --> 00:06:13,760
+lactate إذا ما كانتش فيه severe metabolic acidosis
+
+94
+00:06:13,760 --> 00:06:17,340
+الـ colloids اللي هما الـ blood و الـ blood products نحكي
+
+95
+00:06:17,340 --> 00:06:21,360
+عن الـ blood ده يا جماعة دائماً بنفضل إنه نعطيه packed
+
+96
+00:06:21,360 --> 00:06:24,380
+cells إذا كان المريض عنده hemorrhagic shock
+
+97
+00:06:24,380 --> 00:06:27,100
+hemorrhagic shock hemorrhagic shock فإنا بدي أديله
+
+98
+00:06:27,100 --> 00:06:33,600
+كمية من الـ rbcs لما يديني كمية من الـ rbcs يفضل
+
+99
+00:06:33,600 --> 00:06:38,000
+إنها تكون packed cells اللي هو عبارة عن blood مفصول
+
+100
+00:06:38,000 --> 00:06:41,560
+منه الـ serum عن الـ cells ايش بيظل؟ الـ cells؟ الـ
+
+101
+00:06:41,560 --> 00:06:45,640
+rbcs بنديها للمريض أحسن من إنها تكون whole blood
+
+102
+00:06:45,640 --> 00:06:50,680
+ليش؟ لأن الـ whole blood الكمية تبع الـ fluid اللي
+
+103
+00:06:50,680 --> 00:06:54,200
+موجودة في الـ في الـ في الـ blood هي هتكون just
+
+104
+00:06:54,200 --> 00:06:58,260
+fluid زيادة مش هتعمل أي قيمة للمريض وأنا already
+
+105
+00:06:58,260 --> 00:07:04,420
+بعطي crystalloid للمريض فبالتالي أفضل إن أنا أدي
+
+106
+00:07:04,420 --> 00:07:09,650
+packed cells علشان أرفع الـ hemoglobin تبع المريض
+
+107
+00:07:09,650 --> 00:07:13,050
+وما تأثرش على الـ volume اللي أنا بدي أديه خاصة إن
+
+108
+00:07:13,050 --> 00:07:17,650
+أنا بعوض الـ crystalloid بكميات كويسة دائماً نعرف
+
+109
+00:07:17,650 --> 00:07:20,750
+إنه إذا صار في عندي massive blood transfusion عادة
+
+110
+00:07:20,750 --> 00:07:24,130
+بنحكي لما بيكون فيه more than four units of blood
+
+111
+00:07:24,130 --> 00:07:28,170
+transfusion اسمه صار massive blood transfusion هذا
+
+112
+00:07:28,170 --> 00:07:33,070
+بايش بيخوفني؟ بيأثر إنه أنا كل ما أديت دم أكثر زي
+
+113
+00:07:33,070 --> 00:07:36,030
+ما حكينا أكثر من أربعة وحدات معناه إن الـ clotting
+
+114
+00:07:36,030 --> 00:07:39,990
+factors في الجسم in general صارت ايش؟ أقل لأنه أنا
+
+115
+00:07:39,990 --> 00:07:42,930
+بصير أمدّ لترين تقريباً نصف حجم الدم اللي موجود في
+
+116
+00:07:42,930 --> 00:07:46,250
+الجسم أربعة units تمام؟ هذا بيخلي الـ clotting
+
+117
+00:07:46,250 --> 00:07:49,670
+factors اللي already موجودة في الجسم صارت أقل
+
+118
+00:07:49,670 --> 00:07:53,570
+وبالتالي هذا بيخلي المريض يتعرض لإنه يصير عنده
+
+119
+00:07:54,390 --> 00:07:57,410
+الـ DIC مثلاً disseminated intravascular
+
+120
+00:07:57,410 --> 00:08:03,210
+coagulopathy اللي هو عبارة عن نزيف spontaneous
+
+121
+00:08:03,210 --> 00:08:05,610
+يعني spontaneous bleeding بيصير يعني المريض ينزف
+
+122
+00:08:05,610 --> 00:08:09,650
+من دون سبب يعني من لحاله يعني  بيصير يعمل bleeding
+
+123
+00:08:09,650 --> 00:08:14,750
+الـ vasculature بيصير يطلق دم فبالتالي ليش؟ لأنه بطل
+
+124
+00:08:14,750 --> 00:08:20,430
+فيه عنده clotting factors فعشان هيك دايماً في الـ
+
+125
+00:08:20,430 --> 00:08:23,830
+massive blood transfusion مش بس بندّي blood كمان بندّي
+
+126
+00:08:23,830 --> 00:08:27,890
+fresh frozen plasma، fresh frozen plasma الهدف من
+
+127
+00:08:27,890 --> 00:08:31,530
+الـ fresh frozen plasma أن البلازما هي عادة اللي
+
+128
+00:08:31,530 --> 00:08:36,230
+تحتوي على الـ clotting factors 8 و 9 و 2 فعشان هيك
+
+129
+00:08:36,230 --> 00:08:40,110
+بيجهزوها في المختبر بيفصلوا الدم هو fresh
+
+130
+00:08:40,110 --> 00:08:46,520
+بياخدوا البلازما هذه و بيعملوا لها بيعملوا لها تجميد يعني
+
+131
+00:08:46,520 --> 00:08:51,480
+بيجمّدوا لها ليش؟ عشان تظل fresh وطازجة ولما نحتاجها
+
+132
+00:08:51,480 --> 00:08:55,720
+بناخدها بنفك التجميد تبعها بنحطها بماء
+
+133
+00:08:55,720 --> 00:09:01,380
+بتدوب ترجع سائلة ايه؟ بنديها للمريض rapidly وهذا
+
+134
+00:09:01,380 --> 00:09:05,360
+بالتالي بيبدأ المريض  كمية من الـ fresh frozen
+
+135
+00:09:05,360 --> 00:09:09,720
+plasma كمان ممكن إحنا نحصل على الـ clotting factors
+
+136
+00:09:09,720 --> 00:09:14,720
+itself يعني حاجة بيسموها الـ cryoprecipitate الراسب
+
+137
+00:09:14,720 --> 00:09:20,250
+البارد هذا بيحتفظ بس على الـ clotting factors طبعاً هذا
+
+138
+00:09:20,250 --> 00:09:22,770
+هناخده في الدم اللي ممكن تحتاج factor 8 أو factor
+
+139
+00:09:22,770 --> 00:09:28,490
+9 عادة في الـ shock بيكون هدفنا إنه ندّي blood إذا
+
+140
+00:09:28,490 --> 00:09:31,670
+كان في عندنا massive blood transfusion هنصير ندّي
+
+141
+00:09:31,670 --> 00:09:36,270
+fresh frozen plasma معاه أو cryoprecipitate ممكن
+
+142
+00:09:36,270 --> 00:09:40,370
+أحياناً نبطل ندّي platelets خمس، ست وحدات platelets
+
+143
+00:09:40,370 --> 00:09:45,450
+إذا كان الـ platelets so low وخائفين من الـ bleeding
+
+144
+00:09:45,450 --> 00:09:50,450
+لـ human albumin برضه يعتبر من الـ colloids ووظيفته
+
+145
+00:09:50,450 --> 00:09:54,450
+كتير كويس أنه لما بينعطى بيعمل الـ shifting للـ fluid
+
+146
+00:09:54,450 --> 00:09:58,470
+من الـ interstitial للـ intravascular وأنا في الشوك
+
+147
+00:09:58,470 --> 00:10:01,650
+خاصة لما بكون عندي non-absolute shock فاكرين
+
+148
+00:10:01,650 --> 00:10:04,390
+الـ absolute shock اللي الفلـويد بتطلع من الجسم النهائي
+
+149
+00:10:04,390 --> 00:10:06,430
+زي الإسهال والـ vomiting
+
+150
+00:10:09,270 --> 00:10:13,010
+و الـ hemorrhage، لكن لما بيكون عندنا non-absolute shock
+
+151
+00:10:13,010 --> 00:10:17,610
+وزي واحد مثلاً في septic shock على الـ fluid وين؟ طالع
+
+152
+00:10:17,610 --> 00:10:20,770
+على الـ interstitial، موجودة في الجسم، بس في الـ
+
+153
+00:10:20,770 --> 00:10:23,290
+interstitial، مش في الـ intravascular، عشان هيك،
+
+154
+00:10:23,290 --> 00:10:28,400
+لو أنا أدّيت له human albumin في الـ shock، الـ osmolarity
+
+155
+00:10:28,400 --> 00:10:31,100
+تبع الـ human albumin و الـ colloids in general عالية
+
+156
+00:10:31,100 --> 00:10:34,680
+فبالتالي بيستطيع أنه يعمل shifting للـ fluid من الـ
+
+157
+00:10:34,680 --> 00:10:37,940
+interstitial للـ intravascular وبالتالي بيرفع لي
+
+158
+00:10:37,940 --> 00:10:40,700
+الضغط وحتى في الـ normal patient لما
+
+159
+00:10:40,700 --> 00:10:44,360
+بندّيهم human albumin لما بنشوف أنهم يدخلوا
+
+160
+00:10:44,360 --> 00:10:46,700
+في الـ hypovolemia و ناس زي liver cirrhosis لما
+
+161
+00:10:46,700 --> 00:10:49,720
+بيحتاجوا نعملهم paracentesis و ندّيهم human albumin
+
+162
+00:10:49,720 --> 00:10:51,940
+وبيكونوا مريضين وندّيهم الـ human albumin in
+
+163
+00:10:51,940 --> 00:10:55,520
+precaution لإن هو ممكن مرضى يدخلوا في الـ hypovolemia
+
+164
+00:10:55,520 --> 00:11:02,040
+because of الـ sudden أو يعني الـ الـ الـ الـ
+
+165
+00:11:02,040 --> 00:11:05,720
+shifting تبع الـ fluids من الـ interstitial للـ
+
+166
+00:11:05,720 --> 00:11:08,220
+intravascular هذه هي الـ colloids in general اللي
+
+167
+00:11:08,220 --> 00:11:12,080
+بتعاملناها و بنعطيها في حالات الـ shock كمان في
+
+168
+00:11:12,080 --> 00:11:16,780
+أنواع من الـ shock اللي هي يعني  أعراضها
+
+169
+00:11:16,780 --> 00:11:19,760
+أقل من الـ blood و الـ blood products و الـ human
+
+170
+00:11:19,760 --> 00:11:26,860
+album اللي هو مصنع صناعياً ملاحظين إن هذه كلها كانت
+
+171
+00:11:26,860 --> 00:11:29,740
+blood طبيعية fresh frozen blood طبيعية colloid لكن
+
+172
+00:11:29,740 --> 00:11:33,480
+في حاجات مصنعة صناعياً زي الـ dextran أو الـ
+
+173
+00:11:33,480 --> 00:11:38,360
+hetastarch اللي موجودة هذه عبارة عن fluid
+
+174
+00:11:38,360 --> 00:11:42,340
+فيها gelatin material عشان يخلي الـ stay تبع
+
+175
+00:11:42,340 --> 00:11:46,380
+الـ vessel الـ fluid هذه في الـ blood vessel
+
+176
+00:11:46,380 --> 00:11:50,020
+أكثر من الـ crystalloid solutions وبالتالي لما
+
+177
+00:11:50,020 --> 00:11:53,450
+يكون الـ stay مدة ما كانت في الـ في الـ vessel
+
+178
+00:11:53,450 --> 00:11:57,630
+أكثر، يعني ما تروحش على الكلية بسرعة والكلية
+
+179
+00:11:57,630 --> 00:12:01,150
+هتتخلص منها ويطلع urine فهي تقدر ترفع الـ blood
+
+180
+00:12
+
+223
+00:15:08,870 --> 00:15:11,590
+knowledge is just to know you have a doctor to
+
+224
+00:15:11,590 --> 00:15:15,590
+decide, and you have a physician to decide what is
+
+225
+00:15:15,590 --> 00:15:18,030
+the management, but this is the management in
+
+226
+00:15:18,030 --> 00:15:21,510
+general for shock. الـBicarbonate كتير لما بيكون
+
+227
+00:15:21,510 --> 00:15:28,310
+الـpH أقل من 7.1 أو 7.2، بيكون صار في indication
+
+228
+00:15:28,310 --> 00:15:35,340
+لأنه إحنا بنعمل أو بنعطي Sodium Bicarbonate 8.4 من 10%
+
+229
+00:15:35,340 --> 00:15:38,460
+Management of Hypovolemic shock في حالات الـ
+
+230
+00:15:38,460 --> 00:15:42,060
+Hypovolemic shock، رجعنا نحكي إنه لازم ندّي إذا في
+
+231
+00:15:42,060 --> 00:15:43,300
+bleeding. نوقف النزيف
+
+232
+00:15:49,440 --> 00:15:54,540
+والـFluid طبعاً، حنمدّه إذا كان الـBleeding Time prolonged، الـ
+
+233
+00:15:54,540 --> 00:15:57,040
+Coagulation profile prolonged، معناته لازم ندّي
+
+234
+00:15:57,040 --> 00:16:00,180
+الـFresh Frozen Plasma، خاصة إذا قدّينا Hemorrhage.
+
+235
+00:16:00,180 --> 00:16:05,920
+إذا قدّينا Massive Blood Transfusion، طبعاً في كل
+
+236
+00:16:05,920 --> 00:16:09,280
+الأحوال، دايماً نحتاج الـVasopressors، عشان هي بدنا
+
+237
+00:16:09,280 --> 00:16:11,220
+نحكي مين هي الـVasopressors هدول، ومين هم
+
+238
+00:16:11,220 --> 00:16:13,540
+الـInotropic Drugs اللي صرنا شوية بنحكي عنهم.
+
+239
+00:16:13,540 --> 00:16:16,540
+الـInotropic Drugs يا جماعة،
+
+240
+00:16:19,780 --> 00:16:25,560
+أو يعني في منها Inotropics بتعمل Vasoconstriction
+
+241
+00:16:25,560 --> 00:16:31,920
+وبتقوّي عضلة القلب. وفي Antibiotics في حالات الـ
+
+242
+00:16:31,920 --> 00:16:35,100
+Septic shock، لازم ندّي Antibiotic، وفي Sodium
+
+243
+00:16:35,100 --> 00:16:40,440
+Bicarbonate اللي حكينا عنه قبل شوية، وفي الـCalcium
+
+244
+00:16:40,440 --> 00:16:43,880
+Gluconate اللي هو يعتبر Indirect Inotrope. ليش؟
+
+245
+00:16:43,880 --> 00:16:47,320
+لأنه Intracellular. نشوف بالتفصيل شوية هيك
+
+246
+00:16:47,320 --> 00:16:53,330
+الـInotropics أو الـPositive Inotropics اللي هي
+
+247
+00:16:53,330 --> 00:16:55,650
+بتشتغل على Alpha-receptors، وتشتغل على Beta
+
+248
+00:16:55,650 --> 00:16:59,130
+-receptors، وتشتغل على Beta-1 وBeta-2. طبعاً فيه
+
+249
+00:16:59,130 --> 00:17:04,110
+Dopaminergic Agents. طبعاً لو نيجي نحكي على
+
+250
+00:17:04,110 --> 00:17:08,410
+الـMedications، هدول الـReceptors in general اللي في
+
+251
+00:17:08,410 --> 00:17:10,690
+الجسم. يعني لو بدنا نحكي على Alpha، وإن موجودة
+
+252
+00:17:10,690 --> 00:17:13,330
+موجودة Alpha-receptors، جماعة Alpha-receptors
+
+253
+00:17:13,330 --> 00:17:16,250
+موجودة في البرستيت، موجودة في المثانة، موجودة في
+
+254
+00:17:16,250 --> 00:17:23,010
+الـHeart. الـBeta-1، اللي هي الـreceptors
+
+255
+00:17:23,010 --> 00:17:28,470
+الموجودة في الـHeart. شيك. Beta-2 دلوقتي قلت
+
+256
+00:17:28,470 --> 00:17:32,430
+لكم، وحافظين إن Beta-1 إنها Heart، فـBeta-1
+
+257
+00:17:32,430 --> 00:17:36,410
+بتشتغل على الـHeart. يعني Heart، Beta-1، لكن Beta-2
+
+258
+00:17:36,410 --> 00:17:39,330
+إنها Lungs. Beta-2، عشان هي Beta-2 اللي
+
+259
+00:17:39,330 --> 00:17:44,150
+بتشتغل على الـRespiratory system، فبتعمل Broncho
+
+260
+00:17:44,150 --> 00:17:50,650
+bronchial smooth muscle relaxation. عشان هي، عايزين تتذكروا
+
+261
+00:17:50,650 --> 00:17:52,490
+وظيفة الـAdrenaline؟ لأن الـAdrenaline بيشتغل
+
+262
+00:17:52,490 --> 00:17:58,650
+على Beta-2. طبعاً بيشتغل برضه على Beta-1، بس بما أنه
+
+263
+00:17:58,650 --> 00:18:02,410
+بيشتغل على Beta-2، فبيعمل Bronchial Relaxation للـ
+
+264
+00:18:02,410 --> 00:18:08,510
+Bronchi. الدوبامين بيشتغل على اللي هو، عشان كده بنسمّيه
+
+265
+00:18:12,740 --> 00:18:16,080
+لأن الدوبامين بيشتغل عليها. الـReceptor هذه، تستقبل
+
+266
+00:18:16,080 --> 00:18:18,600
+مستقبلات الدوبامين. طبعاً الدوبامين مادة Natural
+
+267
+00:18:18,600 --> 00:18:21,560
+أصلاً موجودة في الجسم، عشان هيك إلها Receptors
+
+268
+00:18:21,560 --> 00:18:26,340
+موجودة. بيفرزها الـBrain، لأنها بتشتغل في الجسم
+
+269
+00:18:26,340 --> 00:18:35,230
+عشان تعمل، لما أنت محتاج إنك تعمل Vasoconstriction كتير، بس في
+
+270
+00:18:35,230 --> 00:18:39,550
+الكميات القليلة بتكون عاملة شوية Relaxation، بالذات
+
+271
+00:18:39,550 --> 00:18:44,690
+للـsmooth muscle، فبالذات الـkidney arteries، ممكن
+
+272
+00:18:44,690 --> 00:18:49,710
+إن الـlow dose of دوبامين، تصير لها Relaxation، فبزيد
+
+273
+00:18:49,710 --> 00:18:52,470
+الـkidney perfusion. عشان هيك كانوا زمان في
+
+274
+00:18:52,470 --> 00:18:56,530
+الدوبامين، بيستخدموه من واحد لتلاتة mcg per
+
+275
+00:18:56,530 --> 00:19:01,710
+kilogram per minute. بيستخدموه as، بيسمّوها Renal
+
+276
+00:19:01,710 --> 00:19:06,330
+dose. دوبامين Renal dose. أول دوا الـDopamine، هيته
+
+277
+00:19:06,330 --> 00:19:12,110
+إحنا هنحكي عنه يعني هنا بس، عشان إجا وقته يعني أنا
+
+278
+00:19:12,110 --> 00:19:16,450
+ضربت فيه مثال. أول دوا في الأدوية اللي بنحكي عنها
+
+279
+00:19:16,450 --> 00:19:19,830
+اللي بتشتغل على الـAlpha Receptors، دوا اسمه
+
+280
+00:19:19,830 --> 00:19:23,930
+الـPhenylephrine. الـPhenylephrine، من أحسن الأدوية
+
+281
+00:19:24,200 --> 00:19:29,000
+اللي بتشتغل على الـAlpha Receptors، وبالتالي هي
+
+282
+00:19:29,000 --> 00:19:32,000
+بترفع لي الـBlood Pressure تبع المريض. بيشتغل على الـ
+
+283
+00:19:32,000 --> 00:19:35,520
+Blood Pressure كويس، لكن، أو يعني من ميزاته إنه
+
+284
+00:19:35,520 --> 00:19:38,100
+مابيرفعليش الـHeart Rate، لإنه مابيشتغلش على الـ
+
+285
+00:19:38,100 --> 00:19:42,320
+Beta. وهذه Advantage،  إليه Superior هو فيها عن
+
+286
+00:19:42,320 --> 00:19:49,450
+الدوبامين. الـPhenylephrine. الـIsoproterenol اللي
+
+287
+00:19:49,450 --> 00:19:53,470
+هو Pure Beta، Both Beta-1 and Beta-2. بيشتغل بس على
+
+288
+00:19:53,470 --> 00:19:57,410
+Beta-2، مابيشتغلش على Alpha. الـSelective Beta-1
+
+289
+00:19:57,410 --> 00:20:01,330
+بيشتغل بس على Beta-1، مابيشتغلش على Beta-2، وبالتالي
+
+290
+00:20:01,330 --> 00:20:05,210
+مابيأثرنيش على الـLungs، بس بيشتغل على الـHeart.
+
+291
+00:20:05,210 --> 00:20:09,870
+الـAlbuterol، اللي هو الـVentolin. Selective Beta-2،
+
+292
+00:20:09,870 --> 00:20:16,050
+بيشتغل على Beta-2، عشان هي بتعمل Bronchodilation. الـAlbuterol، اللي
+
+293
+00:20:16,050 --> 00:20:20,070
+هو الـVentolin. الـEpinephrine، زي ما حكينا، بيشتغل
+
+294
+00:20:20,070 --> 00:20:23,850
+على both Alpha and Beta، وBeta-1 وBeta-2. يعني
+
+295
+00:20:23,850 --> 00:20:24,970
+بيشتغل على Alpha وBeta.
+
+296
+00:20:28,500 --> 00:20:31,700
+الـAntibiotics Drugs in general يا جماعة، هي
+
+297
+00:20:31,700 --> 00:20:37,160
+الأدوية اللي بتزود الـpositive inotropy، بتزود الـ
+
+298
+00:20:37,160 --> 00:20:41,320
+contraction تبع عضلة القلب، زي الدوبامين، والـ
+
+299
+00:20:41,320 --> 00:20:44,100
+Dobutamine، والـEpinephrine. الدوبامين زي ما حكينا
+
+300
+00:20:44,100 --> 00:20:47,800
+بيشتغل في تلات دوزات. الـlow-dose تبعها، بيشتغل فيها
+
+301
+00:20:47,800 --> 00:20:50,320
+على الـDopaminergic receptors، اللي هي Renal dose،
+
+302
+00:20:50,320 --> 00:20:52,780
+بنسميها، من واحد لتلاتة mcg، أو واحد، إثنين
+
+303
+00:20:52,780 --> 00:20:59,400
+mcg بالكيلوجرام، يالا تلاتة لكل minute. من تلاتة
+
+304
+00:20:59,400 --> 00:21:02,160
+لـعشرة. هنا بتبدأ تشتغل
+
+305
+00:21:02,160 --> 00:21:05,700
+Cardiac dose. Cardiac dose، يعني بيبدأ يشتغل على
+
+306
+00:21:05,700 --> 00:21:11,760
+Beta-1 receptors. تمام؟ وطبعاً هنا هيبدأ يرفع لي فيه
+
+307
+00:21:11,760 --> 00:21:14,140
+الـHeart rate. أكتر من عشرة mcg لكل kilogram
+
+308
+00:21:14,140 --> 00:21:16,820
+لكل minute. الجماعة بيبدأ يديني، أو بيبدأ يشتغل على
+
+309
+00:21:16,820 --> 00:21:19,940
+الـAlpha receptors. يعني Alpha، يعني Blood vessels.
+
+310
+00:21:23,760 --> 00:21:27,520
+طبعاً يعني أنا، Alpha، دائماً الـAlpha بنحكي عن الـ
+
+311
+00:21:27,520 --> 00:21:29,600
+blood vessels. Alpha Receptors، دايماً بنحكي عن الـ
+
+312
+00:21:29,600 --> 00:21:33,740
+blood vessels. Okay. فلمّا ببدأ أشتغل على Alpha
+
+313
+00:21:33,740 --> 00:21:38,820
+Receptors، فبقوم بعمل الـVasoconstriction. كويس؟
+
+314
+00:21:38,820 --> 00:21:42,520
+لأنّه بنسمّيه Vasopressor. دوبامين هذا، زي الـ
+
+315
+00:21:42,520 --> 00:21:47,740
+Dopamine، بس مصنّع، يعني مش طبيعي، مش مادة طبيعية زي
+
+316
+00:21:47,740 --> 00:21:50,560
+الدوبامين اللي موجودة هنا Naturally. لأ، هذا مصنّع
+
+317
+00:21:50,560 --> 00:21:56,820
+صناعي. عادة بيفضلوا يستخدموا الدوبامين، لأنه Pure
+
+318
+00:21:56,820 --> 00:22:00,360
+Beta-1 receptors. بيحبوا يستخدموه لما يكون أصلاً
+
+319
+00:22:00,360 --> 00:22:05,680
+الـBlood pressure شوية مُحسّن، يعني أحسن من 90 على 60.
+
+320
+00:22:05,680 --> 00:22:09,960
+بيصير فيه إمكانية إنّه أستخدم الدوبامين، as اللي هو
+
+321
+00:22:09,960 --> 00:22:18,310
+Inotrope. الـEpinephrine بيستخدم من 0.05 زي ما أنتم
+
+322
+00:22:18,310 --> 00:22:21,930
+شايفين، من 0.5 لـ2 mcg لكل كيلوجرام لكل minute.
+
+323
+00:22:21,930 --> 00:22:26,730
+وبيشتغل على الـBeta والـAlpha كتير، يعني عشان كده
+
+324
+00:22:26,730 --> 00:22:29,510
+بيعمل تachycardia كتير، لو أنا بدأت أستخدم
+
+325
+00:22:29,510 --> 00:22:36,330
+الـVasopressors، بيعمل Tachycardia كتير، أو ممكن
+
+326
+00:22:36,330 --> 00:22:44,540
+إيش، يعمل Severe Vasoconstriction. فيه أدوية يا
+
+327
+00:22:44,540 --> 00:22:51,200
+جماعة، بنستخدمها عشان تُحسّن
+
+328
+00:22:51,200 --> 00:22:55,820
+الـAfterload، وهذه الأدوية هتعمل Vasodilation.
+
+329
+00:23:10,510 --> 00:23:16,930
+أكتر دوا بنستخدمه طبعاً، الـNitropruside. الـ
+
+330
+00:23:16,930 --> 00:23:21,690
+Nitropruside بنسميه، ده بيعتبر خطير لإنه
+
+331
+00:23:21,690 --> 00:23:31,190
+بيعمل Cyanide poisoning بعد 24 ساعة من استخدامه، أو
+
+332
+00:23:31,190 --> 00:23:36,930
+أكتر شوية. الـNitroglycerin، ده أمن. Nitrate نعم، الـ
+
+333
+00:23:36,930 --> 00:23:42,550
+Nitroglycerin ده أمن، بيعمل لي Vasodilation.
+
+334
+00:23:47,670 --> 00:23:50,870
+الـSodium Bicarbonate، حكينا بناءً على الـpH، لما يكون
+
+335
+00:23:50,870 --> 00:23:59,470
+أقل من 7.2 أو 7.1، ممكن نستخدمه. الـCalcium، حكينا
+
+336
+00:23:59,470 --> 00:24:05,200
+إنه أصلاً، طبعاً هو من الـElectrolytes، هو اللي
+
+337
+00:24:05,200 --> 00:24:08,580
+بيسمّوه Indirect Inotrope. ليش؟ لأن الكالسيوم mainly
+
+338
+00:24:08,580 --> 00:24:11,400
+intracellular. جماعة، فلو أنا قدّيت كالسيوم،
+
+339
+00:24:11,400 --> 00:24:16,060
+الكالسيوم هيحاول يدخل للخلية جوا. فبما إنه هيدخل
+
+340
+00:24:16,060 --> 00:24:20,040
+للخلية جوا، بتقوّي الـpotency تبع الخلية، إنها بتعمل
+
+341
+00:24:20,040 --> 00:24:27,300
+contraction. الـAntibiotics، حكينا حسب وضع المريض، as
+
+342
+00:24:27,300 --> 00:24:31,550
+shock patients، Septic shock، لازم أكون عارف أشهر
+
+343
+00:24:31,550 --> 00:24:34,950
+الـAntibiotics، كيف بدي أستخدمها، حسب الـculture.
+
+344
+00:24:34,950 --> 00:24:38,190
+In summary، بيقول Shock is a clinical syndrome, not
+
+345
+00:24:38,190 --> 00:24:40,910
+defined by blood pressure alone. مش بس Blood
+
+346
+00:24:40,910 --> 00:24:44,190
+pressure واطي،  الـCardiac output تبدأ أولاً، Urine
+
+347
+00:24:44,190 --> 00:24:46,990
+output مهم، الـCVP مهم، Normal circulatory
+
+348
+00:24:46,990 --> 00:24:48,950
+function depends on three factors: Cardiac
+
+349
+00:24:48,950 --> 00:24:53,340
+function، الـPump، وVascular tone، الـ"pipes"
+
+350
+00:24:53,340 --> 00:25:01,820
+والـBlood volume، المخزن
+
+351
+00:25:01,820 --> 00:25:05,260
+للـ"بير".
+
+352
+00:25:05,260 --> 00:25:09,040
+الـ"بير". خليني أقول عنهم، إن إحنا بدنا يكون عندك
+
+353
+00:25:09,040 --> 00:25:13,220
+Blood volume، بيكون في عندك pipes، ما فيش حاجة كابسة
+
+354
+00:25:13,220 --> 00:25:17,040
+عليها، بيكون في عندك Pump شغالة كويس، تمام؟
+
+355
+00:25:19,810 --> 00:25:25,310
+هذا هو موضوع الـShock. Disturbance in one or more
+
+356
+00:25:25,310 --> 00:25:28,370
+resulting in inadequate delivery of oxygen and
+
+357
+00:25:28,370 --> 00:25:32,670
+nutrients to the tissues leads to shock. Shock is a
+
+358
+00:25:32,670 --> 00:25:36,290
+progressive dynamic process where early recognition
+
+359
+00:25:36,290 --> 00:25:39,710
+and immediate management, initially in the form of
+
+360
+00:25:39,710 --> 00:25:43,510
+IV fluid, is essential to prevent deterioration
+
+361
+00:25:43,510 --> 00:25:49,870
+into decompensated and finally irreversible
+
+362
+00:25:49,870 --> 00:25:54,190
+shock. دايماً لو الـshock ما اتعالج، ممكن المريض
+
+363
+00:25:54,190 --> 00:25:56,810
+يروح لـirreversible shock، ويصير الـmanagement
+
+364
+00:25:56,810 --> 00:26:01,050
+تبعه مش ممكن، يعني خلاص، الـdamage
+
+365
+00:26:05,140 --> 00:26:11,640
+هيك، ممكن خلّصنا الـshock. يعطيكم ألف عافية، وإن شاء الله
+
+366
+00:26:11,640 --> 00:26:15,800
+نراكم على خير في محاضرة تانية بإذن الله.
diff --git a/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/ASqoKLigaDg_postprocess.srt b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/ASqoKLigaDg_postprocess.srt
new file mode 100644
index 0000000000000000000000000000000000000000..12154b02b78b3854d82827b209b624049f36841e
--- /dev/null
+++ b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/ASqoKLigaDg_postprocess.srt
@@ -0,0 +1,1464 @@
+1
+00:00:00,000 --> 00:00:03,740
+كنا بنحكي على الـ Correction of Hypotension حكينا
+
+2
+00:00:03,740 --> 00:00:07,640
+إذا كان الـ Cause مثلاً Hypovolemic Shock بكون
+
+3
+00:00:07,640 --> 00:00:12,400
+محتاج إنه انعوض سوائل حكينا إنه الـ Fluid
+
+4
+00:00:12,400 --> 00:00:15,540
+Replacement اللي احنا بدنا نبدأ فيه المفروض إنه
+
+5
+00:00:15,540 --> 00:00:23,120
+بيبدأ بـ Crystalloids بعدين Keloids كمان بناخد في
+
+6
+00:00:23,120 --> 00:00:27,820
+الإعتبار إذا المريض عنده Blood Loss إنه ندّيلهالـ
+
+7
+00:00:27,820 --> 00:00:31,960
+Blood and blood products بعدين حكينا إنه بنحط
+
+8
+00:00:31,960 --> 00:00:37,020
+للمريض أو بحتاج المريض نحطه على أدوية بتعمل
+
+9
+00:00:37,020 --> 00:00:39,140
+construction في ال blood vessels اسمها
+
+10
+00:00:39,140 --> 00:00:42,200
+vasopressors ومن أمثلتها دوبامين، هنحكي عنه
+
+11
+00:00:42,200 --> 00:00:47,120
+بالتفصيل وحكينا عن ال «antibiotics» drug اللي برضه
+
+12
+00:00:47,120 --> 00:00:53,270
+احنا بنحتاجها علشاننزود من الـ strength تبع الـ
+
+13
+00:00:53,270 --> 00:00:56,050
+heart muscle بالذات في الـ cardiogenic shock وكمان
+
+14
+00:00:56,050 --> 00:00:58,850
+في الـ septic shock لأن من تدعيتها أن المريض بتصير
+
+15
+00:00:58,850 --> 00:01:04,350
+الـ myocardium نفسها بتتعب و تدخل في cardiogenic
+
+16
+00:01:04,350 --> 00:01:09,130
+shock ومن وسائل الإلاج كمان حكينا و بالذات برضه في
+
+17
+00:01:09,130 --> 00:01:13,730
+الـالـ Cardogenic Shock اللي هي الـ Intra-Aortic
+
+18
+00:01:13,730 --> 00:01:19,190
+Balloon Bomb نبدأ نحكي بالتفصيل عن الحاجات هدولة
+
+19
+00:01:19,190 --> 00:01:22,270
+طبعاً الـ Mechanical Ventilator حكينا في محاضرة
+
+20
+00:01:22,270 --> 00:01:25,190
+الـ Mechanical Ventilator إنه ممكن يكون for other
+
+21
+00:01:25,190 --> 00:01:27,830
+causes rather than اللي هو Respiratory Failure زي
+
+22
+00:01:27,830 --> 00:01:30,650
+الـ Cardogenic Shock أو الـ Septic Shock أو any
+
+23
+00:01:30,650 --> 00:01:33,970
+kind of shock at least إن المريض يبدي تريح من الـ
+
+24
+00:01:33,970 --> 00:01:38,250
+effort تبع الـ Breathingبقى إنه احنا بنحطه على
+
+25
+00:01:38,250 --> 00:01:41,270
+mechanical ventilator وبالتالي تقريبًا تلاتين في
+
+26
+00:01:41,270 --> 00:01:46,150
+المية من البذل متابولي create بيكون يعني ارتاح منه
+
+27
+00:01:46,150 --> 00:01:49,850
+المريض ووفرنا عليه والطاقة هذه ال energy
+
+28
+00:01:49,850 --> 00:01:53,090
+consumption تبع التلاتين في المية هدول صار هو
+
+29
+00:01:53,090 --> 00:01:56,370
+جايينه على اتجاهز فاحنا بنعمل reserve لل energy
+
+30
+00:01:56,370 --> 00:02:00,550
+تبع المريض فيه لل curative management احنا بنياه
+
+31
+00:02:00,550 --> 00:02:03,430
+يتشافى من الوضع اللي هو فيه فبنرايحه عن طريق
+
+32
+00:02:03,430 --> 00:02:07,280
+الrespiratorبالـ Mechanical Ventilation طبعا
+
+33
+00:02:07,280 --> 00:02:09,180
+محاضرة الـ Mechanical Ventilation حكينا كل
+
+34
+00:02:09,180 --> 00:02:14,560
+التفاصيل عن ال mood و ال tidal volume و ال rate
+
+35
+00:02:14,560 --> 00:02:19,300
+اللي بيحتاج المريض لما يكون ventilated ال fluid
+
+36
+00:02:19,300 --> 00:02:23,440
+resuscitation اللي حكينا عنه يا جماعة حكينا إنه
+
+37
+00:02:23,440 --> 00:02:26,260
+عشان أبدأ أصلا ال fluid resuscitation لازم أهم
+
+38
+00:02:26,260 --> 00:02:32,340
+حاجة يكون في عندي two large pore cannulaودائما
+
+39
+00:02:32,340 --> 00:02:36,260
+حكينا مش واحدة، two، at least two أحياناً نحتاج
+
+40
+00:02:36,260 --> 00:02:42,000
+نركب central line عشان نبدأ نركب دائما يعني يا
+
+41
+00:02:42,000 --> 00:02:45,500
+جماعة بالموضوع هذا ماحدش يفكر إن الـcentral line
+
+42
+00:02:45,500 --> 00:02:49,580
+أحسن في الـfluid resuscitation من الـcannula، لأ
+
+43
+00:02:49,580 --> 00:02:52,960
+الـcannula بتكون more rapid وخاصة لما يكون جيج
+
+44
+00:02:52,960 --> 00:02:58,500
+تبعها يعني صغير فبالتالي بتكون الـsize تبعها كبير،
+
+45
+00:02:58,500 --> 00:03:04,000
+يعني مثلا جيج 16، جيجالـ18 هدولة بكونوا very good
+
+46
+00:03:04,000 --> 00:03:07,860
+for rapid administration and fluid replacement for
+
+47
+00:03:07,860 --> 00:03:11,480
+the patient خاصة إنه الـcanula short لكن
+
+48
+00:03:11,480 --> 00:03:14,720
+الـcentral line long في الـflow في اللي تبقى
+
+49
+00:03:14,720 --> 00:03:18,040
+الـfluid بطول في الـcentral line يا جماعة فماحدش
+
+50
+00:03:18,040 --> 00:03:22,330
+يفكر إن الـcentral line أحسنلأ، بعدين أنت في
+
+51
+00:03:22,330 --> 00:03:24,290
+الـcentral line بتكون بتدف الـHeart مباشرة
+
+52
+00:03:24,290 --> 00:03:27,430
+فالـRisk بكون عالي أو قريب جدا من الـHeart لكن
+
+53
+00:03:27,430 --> 00:03:30,290
+بالكان أن أنت بتدف فين وبعدين بيصل الـHeart فهذا
+
+54
+00:03:30,290 --> 00:03:35,150
+بيكون أقل المخاطر خاصة لما بنعمل في Rapid
+
+55
+00:03:35,150 --> 00:03:38,410
+Administration بنكون خايفين من أن يكون أو يصير أن
+
+56
+00:03:38,410 --> 00:03:45,770
+اللي هو Pulmonary هدمةالـ Rate والـ Amount عامليني
+
+57
+00:03:45,770 --> 00:03:49,790
+بنحكي فيهم لناخد نعمل الـ Consideration لدائما
+
+58
+00:03:49,790 --> 00:03:51,910
+نكون واخدين بالنا من الـ Blood Pressure ومن ال
+
+59
+00:03:51,910 --> 00:03:54,970
+Pulse ومن ال Saturation تبع المريض أو من الـ
+
+60
+00:03:54,970 --> 00:03:57,530
+General Condition تبعته واحنا بندفل الـ Fluid عشان
+
+61
+00:03:57,530 --> 00:04:04,120
+ما يخشش زي ما حكينا في بلمون الاديمةالمريض لازم
+
+62
+00:04:04,120 --> 00:04:06,820
+نبدأ دايما معاه بالـ Crystalloid يا جماعة لازم
+
+63
+00:04:06,820 --> 00:04:09,440
+نبدأ معاه بالـ Crystalloid ياخد تميية كويسة من الـ
+
+64
+00:04:09,440 --> 00:04:12,140
+Crystalloid واحد لاتنين لتر تقريبا نحكي على
+
+65
+00:04:12,140 --> 00:04:19,260
+الادالة وبعد هيك طبعا و it depends حسب ال ال ال
+
+66
+00:04:19,260 --> 00:04:22,960
+loss جدش فيه عنده loss جدش فيه hypotension وبعدين
+
+67
+00:04:22,960 --> 00:04:28,480
+بنبدأ في ال Kiloid و ال Crystalloid بداية دايما
+
+68
+00:04:28,480 --> 00:04:33,500
+بنبدأ بنعطي يا جماعةالـ Solutions of Choices اللي
+
+69
+00:04:33,500 --> 00:04:36,580
+هي الـ Normal Saline أو الـ Ringer Lactate حتى الـ
+
+70
+00:04:36,580 --> 00:04:39,740
+Normal Saline مفضل عن الـ Ringer Lactate خاصة لما
+
+71
+00:04:39,740 --> 00:04:44,860
+يكون المريض مثلا فيمثلًا سبتك شوك ويكون عنده
+
+72
+00:04:44,860 --> 00:04:47,740
+متابولك أسدوسيس «severe metabolic acidosis» لا
+
+73
+00:04:47,740 --> 00:04:50,860
+يفضل الـ «Ringer Lactate» لأنه يخاف أنه يزود
+
+74
+00:04:50,860 --> 00:04:54,160
+الأسدوسيس كيف يزود الأسدوسيس؟ الـ «Ringer Lactate»
+
+75
+00:04:54,160 --> 00:04:57,220
+اسمه «Lactated Ringer» الـ «Lactate» هذا عبارة عن
+
+76
+00:04:57,220 --> 00:05:00,000
+الـ «Lactic Acid» النزيم اللي بيطلع لما الواحد
+
+77
+00:05:00,000 --> 00:05:03,420
+بيجلي كتير بيطلع من العضلات وبيعمل تشنجات للـ
+
+78
+00:05:03,420 --> 00:05:06,340
+«Spasm» اللي بيصير معاكم بسبب «Lactic Acid
+
+79
+00:05:06,340 --> 00:05:10,200
+Accumulation» إذا الـ «Lactic» itself is an acid
+
+80
+00:05:10,820 --> 00:05:13,940
+بما أنه أسل ممكن يزود الـ Metabolic Acidosis عشان
+
+81
+00:05:13,940 --> 00:05:18,640
+هيك بنفضل الـ Normal Saline عن الـ Metabolic عن
+
+82
+00:05:18,640 --> 00:05:23,840
+الـ Ringer Lactate طبعاً الـ Fluids التانية،
+
+83
+00:05:23,840 --> 00:05:28,800
+Dextrose مثلا، Dextrose 5%، Forbidden Absolutely
+
+84
+00:05:28,800 --> 00:05:32,200
+Forbidden، عمرك ما تدّي واحد شك، Severe
+
+85
+00:05:32,200 --> 00:05:35,700
+Hypotension، تدّيله Dextrose لأن Dextrose هيزود
+
+86
+00:05:35,700 --> 00:05:40,000
+المشكلةهيعمل الـ Brain إتيمة وهذا هو الأخطر لأنه
+
+87
+00:05:40,000 --> 00:05:43,880
+هيعمل Shifting في الـ Fluid وبالتالي الـ Dextrose
+
+88
+00:05:43,880 --> 00:05:48,820
+forbidden Normal Saline is the best solution تجنب
+
+89
+00:05:48,820 --> 00:05:53,700
+الـ Hypotonic solutions زي الـ Half Saline و
+
+90
+00:05:53,700 --> 00:06:00,320
+Dextrose و Normal Saline كل هذه حتى لو كانتفيها
+
+91
+00:06:00,320 --> 00:06:04,360
+Saline؟ لأ هي Hypotonic Solutions Normal Saline 0
+
+92
+00:06:04,360 --> 00:06:09,980
+.9% هو Sodium Chloride هو اللي prepared وRinger
+
+93
+00:06:09,980 --> 00:06:13,760
+Lactate إذا ماكنتش فيه Severe Metabolic Acidosis
+
+94
+00:06:13,760 --> 00:06:17,340
+الـ Colloids اللي هما البلد و البلد برودكسا نحكي
+
+95
+00:06:17,340 --> 00:06:21,360
+عن البلد ده جماعة دايما بنفضل أنه نعطيها نا Packet
+
+96
+00:06:21,360 --> 00:06:24,380
+Cell إذا كان المريض عنده Hemorrhagic CDA
+
+97
+00:06:24,380 --> 00:06:27,100
+Hemorrhagic Shock Hemorrhagic Shock فانا بدي أديله
+
+98
+00:06:27,100 --> 00:06:33,600
+كمية منالـ RPCs لما يديني كمية من الـ RPCs يفضل
+
+99
+00:06:33,600 --> 00:06:38,000
+إنها تكون Packet Cell اللي هو عبارة عن Blood مفصول
+
+100
+00:06:38,000 --> 00:06:41,560
+منه الـ Serum عن الـ Cells إيش بيظل الـ Cells؟ الـ
+
+101
+00:06:41,560 --> 00:06:45,640
+RPCs بنديها للمريض أحسن من إنها دي Whole Blood
+
+102
+00:06:45,640 --> 00:06:50,680
+ليش؟ لأن الـ Whole Bloodالكمية تبعت الـ Fluid اللي
+
+103
+00:06:50,680 --> 00:06:54,200
+موجودة في الـ في الـ في الـ Blood هي هتكون Just
+
+104
+00:06:54,200 --> 00:06:58,260
+Fluid زادة مش هتعمل أي قيمة للمريض وأنا already
+
+105
+00:06:58,260 --> 00:07:04,420
+بعطي Crystallize للمريض فبالتالي أفضل إن أنا أدي
+
+106
+00:07:04,420 --> 00:07:09,650
+Packet Cellعلشان أحسن الـ Homoglobin تبع المريض
+
+107
+00:07:09,650 --> 00:07:13,050
+وما تأثرش على الـ Volume اللي أنا بدي أديه خاصة إن
+
+108
+00:07:13,050 --> 00:07:17,650
+أنا بعوض الـ Crystalloid بكميات كويسة دائما نعرف
+
+109
+00:07:17,650 --> 00:07:20,750
+إنه إذا صار في عندي Massive Blood Transfusion عادة
+
+110
+00:07:20,750 --> 00:07:24,130
+بنحكي لما بكون فيه more than four units of blood
+
+111
+00:07:24,130 --> 00:07:28,170
+transfusionاسمه صار Massive Blood Transfusion هذا
+
+112
+00:07:28,170 --> 00:07:33,070
+بإيش بيخوفني بيأثر إنه أنا كل ما أديت دم أكتر زي
+
+113
+00:07:33,070 --> 00:07:36,030
+ما حكينا أكتر من أربعة وحدات معناه إن الـ Clotting
+
+114
+00:07:36,030 --> 00:07:39,990
+Factors في الجسم in general صارت إيش أقل لأنه أنا
+
+115
+00:07:39,990 --> 00:07:42,930
+بصير اتمد لترين تقريبا نصف حجم الدم اللي موجود في
+
+116
+00:07:42,930 --> 00:07:46,250
+الجسم أربعة unit تمام؟ هذا بيخلي ال Clotting
+
+117
+00:07:46,250 --> 00:07:49,670
+Factors اللي already موجودة في الجسم صارت أقل
+
+118
+00:07:49,670 --> 00:07:53,570
+وبالتالي هذا بيخلي المريض يتعرض لإنه يسيل عنده
+
+119
+00:07:54,390 --> 00:07:57,410
+الـDIC مثلا «Disseminated Intravascular
+
+120
+00:07:57,410 --> 00:08:03,210
+Coagulopathy» اللي هو عبارة عن نزيف «Spontaneous»
+
+121
+00:08:03,210 --> 00:08:05,610
+يعني «Spontaneous bleeding» بيصير يعني المريض ينزف
+
+122
+00:08:05,610 --> 00:08:09,650
+من وما كان لحالي يعني الناس بيصير يعمل bleeding
+
+123
+00:08:09,650 --> 00:08:14,750
+الفلسكتيتر بيصير يطلق دم فبالتالي ليش؟ لأنه بطل
+
+124
+00:08:14,750 --> 00:08:20,430
+فيه دمهالـ Clotting Factors فعشان هي دايما في الـ
+
+125
+00:08:20,430 --> 00:08:23,830
+Mass of Blood Transfusion مش بس بند بلد كمان بند
+
+126
+00:08:23,830 --> 00:08:27,890
+Fresh Frozen بلازمة، Fresh Frozen بلازمة الهدف من
+
+127
+00:08:27,890 --> 00:08:31,530
+الـ Fresh Frozen بلازمة أن البلازمة هي عادة اللي
+
+128
+00:08:31,530 --> 00:08:36,230
+تحتوي على الـ Clotting Factors 8 و9 و2 فعشان هي
+
+129
+00:08:36,230 --> 00:08:40,110
+كده بيجهزوها في المختبر بيفصلوا الدم هو Fresh
+
+130
+00:08:40,110 --> 00:08:46,520
+بخدوا البلازمة هاي و بعملوهابعملولها تفريز يعني
+
+131
+00:08:46,520 --> 00:08:51,480
+بتلجوها ليش؟ عشان تظل fresh وطازجةولمّا نبنى
+
+132
+00:08:51,480 --> 00:08:55,720
+احتاجها بناخدها بنفك التجنيد تبعها بنحطها بميه
+
+133
+00:08:55,720 --> 00:09:01,380
+بتدوب ترجع سائلة ايه بنديها للمريض Rapidly وهذا
+
+134
+00:09:01,380 --> 00:09:05,360
+بالتالي بيبدى المريض كمية من الـFresh Frozen
+
+135
+00:09:05,360 --> 00:09:09,720
+بلازمة كمان ممكن احنا نحصل على الـGluten Factors
+
+136
+00:09:09,720 --> 00:09:14,720
+itself يعنى حاجة بيسموها الـCryoprecipitate المرسب
+
+137
+00:09:14,720 --> 00:09:20,250
+البارد هذا بيحتفظ بس على الـGluten Factorطبعاً هذا
+
+138
+00:09:20,250 --> 00:09:22,770
+هناخده في الدم اللي ممكن تحتاج factor 8 أو factor
+
+139
+00:09:22,770 --> 00:09:28,490
+9 عادة في ال shock بيكون هدفنا أنه ندّي blood إذا
+
+140
+00:09:28,490 --> 00:09:31,670
+كان الدينا massive blood transfusion هنصير ندّي
+
+141
+00:09:31,670 --> 00:09:36,270
+fresh frozen plasma معاه أو cryoprecipitate ممكن
+
+142
+00:09:36,270 --> 00:09:40,370
+أحيانا نبطل ندّي blatulate خمس، ست وحدات blatulate
+
+143
+00:09:40,370 --> 00:09:45,450
+إذا كان ال blatulate so low وخايفين منالـBleeding
+
+144
+00:09:45,450 --> 00:09:50,450
+لـHuman Album برضه يعتبر من الـColloids ووظيفته
+
+145
+00:09:50,450 --> 00:09:54,450
+كتير كويس أنه لما بينعطى بعمل الـShifting للـFluid
+
+146
+00:09:54,450 --> 00:09:58,470
+من الـInterstitial للـIntravascular وانا في الشك
+
+147
+00:09:58,470 --> 00:10:01,650
+خاصة لما بكون عندى non-absolute shock فاكرين
+
+148
+00:10:01,650 --> 00:10:04,390
+الـabsolute shock اللي الفلود بتطلع من جسد النهائي
+
+149
+00:10:04,390 --> 00:10:06,430
+زي الدياريا والـVomiting
+
+150
+00:10:09,270 --> 00:10:13,010
+والـ Homerage، لكن لما بكون نلعب Absolute Shock
+
+151
+00:10:13,010 --> 00:10:17,610
+وزي واحد مثلا أندسيبتك شوك على الـ Fluid وين؟ طالع
+
+152
+00:10:17,610 --> 00:10:20,770
+على الـ Interstitial، موجودة في الجسم، بس في الـ
+
+153
+00:10:20,770 --> 00:10:23,290
+Interstitial، مش في الـ Intravascular، عشان هيك،
+
+154
+00:10:23,290 --> 00:10:28,400
+لو أنا أدته Human Ergon في الـ BCLH،الـ Osmolarity
+
+155
+00:10:28,400 --> 00:10:31,100
+تبع الـ human album و الـ colloid in general عالية
+
+156
+00:10:31,100 --> 00:10:34,680
+فبالتالي بيستطيع أنه يعمل shifting لل fluid من الـ
+
+157
+00:10:34,680 --> 00:10:37,940
+Interstitial للـ Intravascular وبالتالي بيرفعلي
+
+158
+00:10:37,940 --> 00:10:40,700
+الضغط و حيث ذلك حتى في الـ Normal patient لما
+
+159
+00:10:40,700 --> 00:10:44,360
+بندّيهم hypo human album لما بنشوف أنهم يدخلوا
+
+160
+00:10:44,360 --> 00:10:46,700
+بالـ monoregina و الناس بس هال liver cirrhosis لما
+
+161
+00:10:46,700 --> 00:10:49,720
+بيحتاجوا نعملهم Paracentesis و ندّيهم human album
+
+162
+00:10:49,720 --> 00:10:51,940
+و بيكونوا مرقمين و ندّيهم الـ human album in
+
+163
+00:10:51,940 --> 00:10:55,520
+precaution لإن هو ممكن مرضي يدخلوا بالـ monoregina
+
+164
+00:10:55,520 --> 00:11:02,040
+because ofالـ sudden أو يعني الـ الـ الـ الـ
+
+165
+00:11:02,040 --> 00:11:05,720
+shifting تبقى لـ fluids من الانتراليستيشيا لـ الـ
+
+166
+00:11:05,720 --> 00:11:08,220
+Intravascular هذه هي الـ colloids in general اللي
+
+167
+00:11:08,220 --> 00:11:12,080
+بتعاملناها و بتعطيها في حالات ال shock كمان في
+
+168
+00:11:12,080 --> 00:11:16,780
+أنواع من ال shock اللي هي يعني الأزميرات تبعتها
+
+169
+00:11:16,780 --> 00:11:19,760
+أقل من ال blood و ال blood products و ال human
+
+170
+00:11:19,760 --> 00:11:26,860
+album اللي هو مصنع تصنيعملاحظين إن هذه كلها كانت
+
+171
+00:11:26,860 --> 00:11:29,740
+بلد طبيعية «fresh frozen» بلد طبيعية «colloid» لكن
+
+172
+00:11:29,740 --> 00:11:33,480
+في حاجات مصنعة تصنية زي الـ «Dextran» أو الـ
+
+173
+00:11:33,480 --> 00:11:38,360
+«Hemacyl» اللي موجودة هنا هو ده عبارة عن fluid
+
+174
+00:11:38,360 --> 00:11:42,340
+فيها جيلاتين material عشان يتخلى الـ «stain» تبع
+
+175
+00:11:42,340 --> 00:11:46,380
+الـ «vessel» الـ«fluid» هاي في الـ«blood vessel»
+
+176
+00:11:46,380 --> 00:11:50,020
+أكتر من الـ«crystalloid solutions» وبالتالي لما
+
+177
+00:11:50,020 --> 00:11:53,450
+يكون الـ«stain» مدة ما كانت في الـفي الـBessel
+
+178
+00:11:53,450 --> 00:11:57,630
+أكتر، يعني ما تروحش على الكيليا بسرعة وكيليا
+
+179
+00:11:57,630 --> 00:12:01,150
+هتتخلص منها ويطلع urine فهي تقدر ترفع للـBlood
+
+180
+00:12:01,150 --> 00:12:04,910
+Pressure وتخلي المريض يرجع طبعا عشان هيك دايما
+
+181
+00:12:04,910 --> 00:12:07,870
+لازم لما نقعد نعطي هاد يكون مدين قبلها كمية كويسة
+
+182
+00:12:07,870 --> 00:12:14,430
+من الـcrystallites عشان أشغل ال kidneyبالنسبة للـ
+
+183
+00:12:14,430 --> 00:12:17,270
+Cardogenic Shock يا جماعة، بلاحظ أنه هنا الوضع
+
+184
+00:12:17,270 --> 00:12:19,610
+بيخلف شوية لأنه في الـ Cardogenic Shock أنا مش
+
+185
+00:12:19,610 --> 00:12:23,410
+محتاج سوائل أدنى أنا محتاج حاجات تتقوّل القلب،
+
+186
+00:12:23,410 --> 00:12:28,130
+بالعكس أنا بكون محتاج حاجات تتقلل الـ Reload على
+
+187
+00:12:28,130 --> 00:12:33,000
+القلب، فمحتاجDiuretics، يعني أنا بدي أدوية قلّ
+
+188
+00:12:33,000 --> 00:12:37,140
+اللي بـ Reload كمية الـ Blood أو الـ Fluids اللي
+
+189
+00:12:37,140 --> 00:12:40,240
+بتيجي للـ Heart عشان الـ Heart يشيش تعمل معاها
+
+190
+00:12:40,240 --> 00:12:43,100
+ويطلقها أنا بدي أقللها، فبدل المرضي الـ Diuretics
+
+191
+00:12:43,100 --> 00:12:47,640
+بحيث أنه أخفط على الـ Heart وكمان الحاجات اللي أنا
+
+192
+00:12:47,640 --> 00:12:53,820
+ب .. ب .. بستخدمها في الـ Cardiogenic Shock يا
+
+193
+00:12:53,820 --> 00:12:57,800
+جماعة أني أدي أدوية إيش بتسوي، بتخوّق عضلة القلب
+
+194
+00:13:00,370 --> 00:13:04,610
+تمام؟ هنشوفهم بالترتيب
+
+195
+00:13:04,610 --> 00:13:08,130
+إيش هم الـ «انتروباكيدراجلي» كويسين في الـSeptic
+
+196
+00:13:08,130 --> 00:13:11,650
+Shock Management يا جماعة دايما أنا أهم حاجة عندي
+
+197
+00:13:11,650 --> 00:13:14,690
+زي ما حكينا «fluid replacement» بالنسبة للمرض
+
+198
+00:13:14,690 --> 00:13:18,830
+الفلويد بدي أجنب الـ«Ringer» اللي اقتد قدر الإمكان
+
+199
+00:13:18,830 --> 00:13:23,730
+عشان الـAcidosis بدي أعمل عالج الـCause السبتك هدف
+
+200
+00:13:23,730 --> 00:13:25,890
+من وين؟ إذا كان في «central line» أو «follow
+
+201
+00:13:25,890 --> 00:13:30,280
+catheter» لازم يرتفع يا جماعة ويتاخد للـCultureمش
+
+202
+00:13:30,280 --> 00:13:33,440
+هخلّي الـ Source و أدّي الـ Antibiotics طبعًا إحنا
+
+203
+00:13:33,440 --> 00:13:37,160
+عارفين إنه نبدأ بـ Antibiotic ممكن نبدأ بـ
+
+204
+00:13:37,160 --> 00:13:40,800
+Empirically و بعدين إذا كان فيه Source معروف أعمل
+
+205
+00:13:40,800 --> 00:13:44,720
+منه Culture قبل ما تطلع نتيجة الـ Culture بشوف إذا
+
+206
+00:13:44,720 --> 00:13:47,740
+الـ Antibiotic اللي أنا ماشي معاه sensitive بكمل
+
+207
+00:13:47,740 --> 00:13:52,060
+عليه إذا ماكنش كويس بعمل stop و according to new
+
+208
+00:13:52,060 --> 00:13:55,930
+cultureببدأ الـ Antibiotics الجديد عادة بنحتاج
+
+209
+00:13:55,930 --> 00:14:00,130
+Broad Spectrum Antibiotics Strong Antibiotics
+
+210
+00:14:00,130 --> 00:14:09,040
+بنحتاج كميات يعني أوجات بتكون Loading Doseممكن
+
+211
+00:14:09,040 --> 00:14:13,720
+ندقه في Antibiotics بنحتاج يا جماعة إنحدد بالظبط
+
+212
+00:14:13,720 --> 00:14:16,740
+زي ما حكينا مكان الـInfection عشان ناخد منه
+
+213
+00:14:16,740 --> 00:14:20,140
+Culture بنحتاج إنه نستخدم أدوية Vasopressors عشان
+
+214
+00:14:20,140 --> 00:14:24,720
+تعملي Construction للبسل وتخلي فيه إمكانية
+
+215
+00:14:24,720 --> 00:14:29,760
+للـBlood Pressure على إنها ترتفع بحسب كمة السوء
+
+216
+00:14:29,760 --> 00:14:33,860
+اللي موجودة Intra-vascularي تمام؟ كتير بيستخدموا
+
+217
+00:14:33,860 --> 00:14:39,200
+أحيانا الـSteroids وهذا يعنيفيها جدل إن الـStroid
+
+218
+00:14:39,200 --> 00:14:46,540
+بتقلل المناعة الـStroids بت .. ممكن تكون مش حاجة
+
+219
+00:14:46,540 --> 00:14:55,360
+كويسة في الـSeptic Shock لكن يعني .. يعني زي ما
+
+220
+00:14:55,360 --> 00:14:58,260
+بيحكوا إنه «Don't let your patient to die without
+
+221
+00:14:58,260 --> 00:15:02,130
+giving steroids»Okay، فهذا في الـ Management just
+
+222
+00:15:02,130 --> 00:15:08,870
+to know طبعاً إنتوا أحنا عارفين إنه this is this
+
+223
+00:15:08,870 --> 00:15:11,590
+knowledge is just to know you have a doctor to
+
+224
+00:15:11,590 --> 00:15:15,590
+decide and you have a physician to decide what is
+
+225
+00:15:15,590 --> 00:15:18,030
+the management but this is the management in
+
+226
+00:15:18,030 --> 00:15:21,510
+general for shock الـBicarbonate كتير لما بيكون
+
+227
+00:15:21,510 --> 00:15:28,310
+الـ pH أجل من 7.1 أو 7.2 بيكون صار في indication
+
+228
+00:15:28,310 --> 00:15:35,340
+لإنه إحنا نعملأو نعطي Sodium Bicarbon 8.4 من 10%
+
+229
+00:15:35,340 --> 00:15:38,460
+Management of Hypovolemic shock في حالات الـ
+
+230
+00:15:38,460 --> 00:15:42,060
+Hypovolemic shock رجعنا نحكي إنه لازم ندّي إذا في
+
+231
+00:15:42,060 --> 00:15:43,300
+bleeding ينواجفه
+
+232
+00:15:49,440 --> 00:15:54,540
+والـ Fluid طبعاً حرد إذا كان الـ BTT prolonged الـ
+
+233
+00:15:54,540 --> 00:15:57,040
+Coagulation profile prolonged معناته لازم ندّي
+
+234
+00:15:57,040 --> 00:16:00,180
+الـFreshly Frozen بلازم خاصة إذا قدّينا Hemorrhage
+
+235
+00:16:00,180 --> 00:16:05,920
+إذا قدّينا Massive Blood Transfusion طبعا في كل
+
+236
+00:16:05,920 --> 00:16:09,280
+الأحوال دايما نحتاج الـVasopressors عشان هي بدنا
+
+237
+00:16:09,280 --> 00:16:11,220
+نحكي مين هي الـVasopressors هدول ومين هم
+
+238
+00:16:11,220 --> 00:16:13,540
+الـIntropic Drugs اللي صارنا شوية بنحكي عنهم
+
+239
+00:16:13,540 --> 00:16:16,540
+الـIntropic Drugs يا جماعة
+
+240
+00:16:19,780 --> 00:16:25,560
+أو يعني في منها Intros بتعمل Vasoconstriction
+
+241
+00:16:25,560 --> 00:16:31,920
+وبتقوى عضلة القلبوفي Antibiotics في حالات الـ
+
+242
+00:16:31,920 --> 00:16:35,100
+«سيبتيك شوك» لازم ند «Antibiotic» وفي Sodium
+
+243
+00:16:35,100 --> 00:16:40,440
+Bicarb اللي حكينا عنه قبل شوية وفي ال «كالسيوم»
+
+244
+00:16:40,440 --> 00:16:43,880
+الـGluconate اللي هو يعتبر Indirect Introbe ليش؟
+
+245
+00:16:43,880 --> 00:16:47,320
+لأنه Intracellular نشوف بالتفصيل شوية هيكة
+
+246
+00:16:47,320 --> 00:16:53,330
+الـIntrophics أو الـPositive Introphs اللي هيالفا
+
+247
+00:16:53,330 --> 00:16:55,650
+تشتغل على Alpha-receptors وتشتغل على Beta
+
+248
+00:16:55,650 --> 00:16:59,130
+-receptors وتشتغل على Beta-1 وBeta-2 طبعاً وفيه
+
+249
+00:16:59,130 --> 00:17:04,110
+Dubmanerging Agents طبعاً لو نجي نحكي على
+
+250
+00:17:04,110 --> 00:17:08,410
+الـMedications هدا الـReceptors in general اللي في
+
+251
+00:17:08,410 --> 00:17:10,690
+الجسم يعني لو بدنا نحكي على Alpha وإن موجوعة
+
+252
+00:17:10,690 --> 00:17:13,330
+موجودة Alpha-receptors جماعة Alpha-receptors
+
+253
+00:17:13,330 --> 00:17:16,250
+موجودة في البرستيت موجودة في المثانة موجودة في
+
+254
+00:17:16,250 --> 00:17:23,010
+الـI Beta-1الـ Beta-1 اللي هي الـ «رسيبتورز»
+
+255
+00:17:23,010 --> 00:17:28,470
+الموجودة فيه الـ «هارد» «شيك» «بيتا 2» دلوقتي قلت
+
+256
+00:17:28,470 --> 00:17:32,430
+لكم وحافظيين إن «بيتا 1» أنها «هارد 1» فـ «بيتا 1»
+
+257
+00:17:32,430 --> 00:17:36,410
+بتشتغل بـ «1» يعني «هارد 1» «بيتا 1» لكن «بيتا 2»
+
+258
+00:17:36,410 --> 00:17:39,330
+أنها «too long» «بيتا 2» عشان هي «بيتا 2» اللي
+
+259
+00:17:39,330 --> 00:17:44,150
+بتشتغل على الـ «رسبراتوري سيستم» فبتعمل «برونكل»
+
+260
+00:17:44,150 --> 00:17:50,650
+«برونكل سموت مصر ريلكسيشن» عشان هي عايزةزي تتذكروا
+
+261
+00:17:50,650 --> 00:17:52,490
+تبقية الـ Adrenaline؟ لأن الـ Adrenaline بيشتغل
+
+262
+00:17:52,490 --> 00:17:58,650
+على Beta-2 طبعا بيشتغل برضه على Beta-1 بس بما أنه
+
+263
+00:17:58,650 --> 00:18:02,410
+بيشتغل على Beta-2 فجمال الـ Proncal Relaxation للـ
+
+264
+00:18:02,410 --> 00:18:08,510
+Proncus الدبامين بيشتغل على اللي هو عشانك بيسموه
+
+265
+00:18:12,740 --> 00:18:16,080
+لأن الدوبامين بيشتغل عليها الـ Receptor هذه تستخبل
+
+266
+00:18:16,080 --> 00:18:18,600
+مستخبلات الدوبامين، طبعا الدوبامين مادة Natural
+
+267
+00:18:18,600 --> 00:18:21,560
+أصلا موجودة في الجسم عشان هيك إلها Receptors
+
+268
+00:18:21,560 --> 00:18:26,340
+موجودة بيفرزها للـ Brain لإنها تشتغل في الجسم
+
+269
+00:18:26,340 --> 00:18:35,230
+علشان تعمل لما أنت محتاج أنك تعمل لغزةبكتير، بس في
+
+270
+00:18:35,230 --> 00:18:39,550
+القيمات القليلة بتكون عاملة شوية relaxation بالذات
+
+271
+00:18:39,550 --> 00:18:44,690
+للـ smooth muscle فبالذات ال kidney arteries ممكن
+
+272
+00:18:44,690 --> 00:18:49,710
+ما ال low dose of دوبامين تصير لها relaxation فزيد
+
+273
+00:18:49,710 --> 00:18:52,470
+ال kidney perfusion عشان هيك كانوا زمان في
+
+274
+00:18:52,470 --> 00:18:56,530
+الدوبامين بيستخدموه من واحد لتلاتة mic per
+
+275
+00:18:56,530 --> 00:19:01,710
+kilogram per minute بيستخدموه as بيسموها renal
+
+276
+00:19:01,710 --> 00:19:06,330
+dose دوبامين renal doseأول دوة الـ «دومين» هيته
+
+277
+00:19:06,330 --> 00:19:12,110
+أحنا هنحكي عنه يعني هنا بس عشان إيجا وقته يعني أنا
+
+278
+00:19:12,110 --> 00:19:16,450
+ضربت فيه مثال أول دوة في الأدوية اللي بنحكي عنها
+
+279
+00:19:16,450 --> 00:19:19,830
+اللي بتشتغل على الـAlpha Receptors دوة اسمه
+
+280
+00:19:19,830 --> 00:19:23,930
+الـPhenylephrine الـPhenylephrine من أحسن الأدوية
+
+281
+00:19:24,200 --> 00:19:29,000
+اللي بتشتغل على الـ Alpha Receptors وبالتالي هي
+
+282
+00:19:29,000 --> 00:19:32,000
+برفعلي الـ Blood Pressure تبع المريض بيشتغل الـ
+
+283
+00:19:32,000 --> 00:19:35,520
+Blood Pressure كويس لكن أو يعني من ميزته أنه
+
+284
+00:19:35,520 --> 00:19:38,100
+مابرفعليش الـ Heart Rate لإن هو مابيشتغلش على الـ
+
+285
+00:19:38,100 --> 00:19:42,320
+Beta وهذه advantage إليه superior هو فيها عن
+
+286
+00:19:42,320 --> 00:19:49,450
+الدبانين الـ Phenylephrine الـ Isoproteinololاللي
+
+287
+00:19:49,450 --> 00:19:53,470
+هو Pure Beta Both Beta-1 and Beta-2 بيشتغل بس على
+
+288
+00:19:53,470 --> 00:19:57,410
+Beta-2 بيشتغلش على Alpha الـW8 Selected Beta-1
+
+289
+00:19:57,410 --> 00:20:01,330
+بيشتغل بس على Beta-1 مابيشتغلش على Beta-2 والتالي
+
+290
+00:20:01,330 --> 00:20:05,210
+مابيأثرنيش على الـLung بس بيشتغل على الـHeart
+
+291
+00:20:05,210 --> 00:20:09,870
+الـAlbuterol اللي هو الـVentolin Selected Beta-2
+
+292
+00:20:09,870 --> 00:20:16,050
+بيشتغل على Beta-2 عشان هي كبرنكو الـAlbuterol اللي
+
+293
+00:20:16,050 --> 00:20:20,070
+هو الـVentolinالـ Epinephrine زي ما حكينا بيشتغل
+
+294
+00:20:20,070 --> 00:20:23,850
+على both Alpha and Beta و Beta one و Two يعني
+
+295
+00:20:23,850 --> 00:20:24,970
+بيشتغل على Alpha و Beta
+
+296
+00:20:28,500 --> 00:20:31,700
+الـ Antibiotics Drug in general يا جماعة هي
+
+297
+00:20:31,700 --> 00:20:37,160
+الأدوية اللي بتزود الـ positive entrope بتزود ال
+
+298
+00:20:37,160 --> 00:20:41,320
+contraction تبع عضلة القلب زي الدوبامين و الـ
+
+299
+00:20:41,320 --> 00:20:44,100
+vitamin و الـ epinephrine الدوبامين زي ما حكينا
+
+300
+00:20:44,100 --> 00:20:47,800
+بيشتغل في تلت دوزات الـ low-dose تبعها بيشتغل فيها
+
+301
+00:20:47,800 --> 00:20:50,320
+على الـ double-merging receptors اللي هي رينادوز
+
+302
+00:20:50,320 --> 00:20:52,780
+بنسميها من واحدة تلتة مايكروجرام أو واحد اتنين
+
+303
+00:20:52,780 --> 00:20:59,400
+مايكروجرام بالكيلوجرام يالا تلتة لكل minuteمن end
+
+304
+00:20:59,400 --> 00:21:02,160
+تلاتة ونبدأ نطلع ل end عشرة هنا بتبدأ تشتغل
+
+305
+00:21:02,160 --> 00:21:05,700
+cardiac dose cardiac dose يعني بيبدأ يشتغل على
+
+306
+00:21:05,700 --> 00:21:11,760
+beta one receptor تمام؟ وطبعا هنا هيبدأ يرفعلي فيه
+
+307
+00:21:11,760 --> 00:21:14,140
+ال heart rate أكتر من عشرة microgram لكل kilogram
+
+308
+00:21:14,140 --> 00:21:16,820
+لكل minute الجماعة بيبدأ يديني أو بيبدأ يشتغل على
+
+309
+00:21:16,820 --> 00:21:19,940
+ال alpha receptors يعني alpha يعني blood vessels
+
+310
+00:21:23,760 --> 00:21:27,520
+طبعاً يعني أنا Alpha دائما الـ Alpha بنحكي عن الـ
+
+311
+00:21:27,520 --> 00:21:29,600
+blood vessels Alpha Receptors دايما بنحكي عن الـ
+
+312
+00:21:29,600 --> 00:21:33,740
+blood vessels okay فلمّا ببدأ أشتغل على Alpha
+
+313
+00:21:33,740 --> 00:21:38,820
+Receptors فبقوم بعمل الـ vasoconstriction كويس؟
+
+314
+00:21:38,820 --> 00:21:42,520
+لأنك بنسميه vasopressor دو بيوتامين هذا زي الـ
+
+315
+00:21:42,520 --> 00:21:47,740
+dopamine بس مصنع يعنيمش طبيعي، مش مادة طبيعية زي
+
+316
+00:21:47,740 --> 00:21:50,560
+الدبابين اللي موجودة هنا Naturally لأ، هذا مصنع
+
+317
+00:21:50,560 --> 00:21:56,820
+تصنيع عادة بفضله يستخدموا الدبابين لأن هو Pure
+
+318
+00:21:56,820 --> 00:22:00,360
+Beta-1 Receptors بيحبوا يستخدموه لما يكون أصلا
+
+319
+00:22:00,360 --> 00:22:05,680
+الـBlood Pressure شوية متحسن يعني أحسن من 90 ع 60
+
+320
+00:22:05,680 --> 00:22:09,960
+بيصير فيه إمكانية أنه أستخدم الدبيتامين As اللي هو
+
+321
+00:22:09,960 --> 00:22:18,310
+Introbeالـ Epinephrine بيستخدم من 0.05 زي ما انتوا
+
+322
+00:22:18,310 --> 00:22:21,930
+شايفين من 5% لـ2µg لكل كيلو جرام لكل minute
+
+323
+00:22:21,930 --> 00:22:26,730
+وبيشتغل على الـ Beta والـ Alpha كتير، يعني عشانك
+
+324
+00:22:26,730 --> 00:22:29,510
+بعمل تكيكارديا كتير لو أنا بدأ أستخدم
+
+325
+00:22:29,510 --> 00:22:36,330
+الـVasopressors، بحيعمل تكيكارديا كتير أو ممكن
+
+326
+00:22:36,330 --> 00:22:44,540
+إيش، يعمل Severe Vasoconstrictionوفيه أدوية يا
+
+327
+00:22:44,540 --> 00:22:51,200
+جماعة بنستخدمها عشان تحسن
+
+328
+00:22:51,200 --> 00:22:55,820
+الـ Afterload وهذه الأدوية هتعمل لـ Vasodilatation
+
+329
+00:23:10,510 --> 00:23:16,930
+أكتر دوة بنستخدمها طبعاً الـ Nitroprusideالـ
+
+330
+00:23:16,930 --> 00:23:21,690
+Nitrous بنسميه Nitrous Oxide ده بيعتبر خطير لإنه
+
+331
+00:23:21,690 --> 00:23:31,190
+بيعمل cyanide poisoning بعد 24 ساعة من استخدامه أو
+
+332
+00:23:31,190 --> 00:23:36,930
+أكتر شوية الـ Nitroglycerin ده أمن Nitrate نعم الـ
+
+333
+00:23:36,930 --> 00:23:42,550
+Nitroglycerin ده أمن بيعمللي Vasodilatation
+
+334
+00:23:47,670 --> 00:23:50,870
+الـ Sodium Bicarb حكينا بناءً على الـ pH لما يكون
+
+335
+00:23:50,870 --> 00:23:59,470
+أقل من 7.2 أو 7.1 ممكن يستخدموه الـ Calcium حكينا
+
+336
+00:23:59,470 --> 00:24:05,200
+إنه أصلاًطبعاً هو من الـElectrolytes هو اللي
+
+337
+00:24:05,200 --> 00:24:08,580
+بيسموه Indirect Entropy ليش؟ لأن الكالسيوم mainly
+
+338
+00:24:08,580 --> 00:24:11,400
+intracellular جماعة فلو أنا قدّيت كالسيوم،
+
+339
+00:24:11,400 --> 00:24:16,060
+الكالسيوم هيحاول يدخل للخلية جوا فبما أنه هيدخل
+
+340
+00:24:16,060 --> 00:24:20,040
+للخلية جوا، بتقوي الـpotency تبع الخلية إنها بتعمل
+
+341
+00:24:20,040 --> 00:24:27,300
+contraction الـantibiotics حكينا حسب وضع المريض as
+
+342
+00:24:27,300 --> 00:24:31,550
+shock patients، septic shock لازم أكونعارف أشهر
+
+343
+00:24:31,550 --> 00:24:34,950
+الـ Antibiotics كيف بدأ أستخدمها حسب الـ culture
+
+344
+00:24:34,950 --> 00:24:38,190
+in summary بيقول shock is a clinical syndrome not
+
+345
+00:24:38,190 --> 00:24:40,910
+defined by blood pressure alone، مش بس blood
+
+346
+00:24:40,910 --> 00:24:44,190
+pressure واطي، بتاعة الcardio تبدأ أول، urine
+
+347
+00:24:44,190 --> 00:24:46,990
+output مهم، ال-CVB مهم، normal circulatory
+
+348
+00:24:46,990 --> 00:24:48,950
+function depends on three factors cardiac
+
+349
+00:24:48,950 --> 00:24:53,340
+function، ال-pumpوVascular Tone الـ«بايبز»
+
+350
+00:24:53,340 --> 00:25:01,820
+والـBlood Volume المخزن
+
+351
+00:25:01,820 --> 00:25:05,260
+للـ«بير»
+
+352
+00:25:05,260 --> 00:25:09,040
+الـ«بير» خلّيني أقول عنهم فإن أحنا بدك يكون عندك
+
+353
+00:25:09,040 --> 00:25:13,220
+بلد Volume بيكون في عندك بايبز مافيش حاجة كابسة
+
+354
+00:25:13,220 --> 00:25:17,040
+عليها بيكون في عندك بم شغالة كويس تمام؟
+
+355
+00:25:19,810 --> 00:25:25,310
+هذا هو موضوع الـ Shock Disturbance in one or more
+
+356
+00:25:25,310 --> 00:25:28,370
+resulting in inadequate delivery of oxygen and
+
+357
+00:25:28,370 --> 00:25:32,670
+nutrients to the tissue leads to shock Shock is a
+
+358
+00:25:32,670 --> 00:25:36,290
+progressive dynamic process where early cognition
+
+359
+00:25:36,290 --> 00:25:39,710
+and immediate managementinitially in the form of
+
+360
+00:25:39,710 --> 00:25:43,510
+IV fluid is essential to prevent deterioration
+
+361
+00:25:43,510 --> 00:25:49,870
+into decompensated and finally irreversible
+
+362
+00:25:49,870 --> 00:25:54,190
+shock دايما لو ال shock ما تحس نازج ممكن المريض
+
+363
+00:25:54,190 --> 00:25:56,810
+يروح ل irreversible shock ويصير ال management
+
+364
+00:25:56,810 --> 00:26:01,050
+تبعته مش ممكن يعني خلاص ال damage
+
+365
+00:26:05,140 --> 00:26:11,640
+هك ممكن خلصنا الشوك يعطيكم ألف عافية وإن شاء الله
+
+366
+00:26:11,640 --> 00:26:15,800
+نراكم على خير في محاضرة تانية بإذن الله
+
diff --git a/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/ASqoKLigaDg_raw.json b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/ASqoKLigaDg_raw.json
new file mode 100644
index 0000000000000000000000000000000000000000..2dd49460f895aa7d7173b70d3a1f2ab865495d81
--- /dev/null
+++ b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/ASqoKLigaDg_raw.json
@@ -0,0 +1 @@
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" and", "probability": 0.95166015625}, {"start": 1528.37, "end": 1528.77, "word": " nutrients", "probability": 0.35302734375}, {"start": 1528.77, "end": 1529.89, "word": " to", "probability": 0.58935546875}, {"start": 1529.89, "end": 1530.07, "word": " the", "probability": 0.81689453125}, {"start": 1530.07, "end": 1530.41, "word": " tissue", "probability": 0.87841796875}, {"start": 1530.41, "end": 1531.03, "word": " leads", "probability": 0.771484375}, {"start": 1531.03, "end": 1531.47, "word": " to", "probability": 0.98193359375}, {"start": 1531.47, "end": 1531.91, "word": " shock", "probability": 0.7734375}, {"start": 1531.91, "end": 1532.33, "word": " Shock", "probability": 0.1697998046875}, {"start": 1532.33, "end": 1532.55, "word": " is", "probability": 0.9404296875}, {"start": 1532.55, "end": 1532.67, "word": " a", "probability": 0.93896484375}, {"start": 1532.67, "end": 1533.03, "word": " progressive", "probability": 0.22705078125}, {"start": 1533.03, "end": 1533.51, "word": " 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2270, 294, 264, 1254, 295, 15967, 9113, 307, 7115, 281, 4871, 26431, 399, 666, 22867, 694, 770, 293, 2721, 16014, 840, 964, 5588, 11778, 47302, 15042, 45164, 2423, 5588, 19446, 6055, 5016, 3794, 8717, 31377, 7435, 3714, 43020, 9673, 16572, 11242, 7251, 32887, 5016, 5296, 16014, 840, 964, 5588, 4032, 1829, 9381, 13546, 2423, 4592, 6055, 3555, 34268, 3224, 37893, 3714, 43020, 37495, 22653, 16490, 1211, 33546, 2423, 4344], "avg_logprob": -0.220811633600129, "compression_ratio": 1.4407582938388626, "no_speech_prob": 5.960464477539063e-08, "words": [{"start": 1537.85, "end": 1538.45, "word": "initially", "probability": 0.5410970052083334}, {"start": 1538.45, "end": 1538.75, "word": " in", "probability": 0.94140625}, {"start": 1538.75, "end": 1538.99, "word": " the", "probability": 0.89599609375}, {"start": 1538.99, "end": 1539.49, "word": " form", "probability": 0.8994140625}, {"start": 1539.49, "end": 1539.71, "word": " of", "probability": 0.9755859375}, {"start": 1539.71, "end": 1539.99, "word": " IV", "probability": 0.96875}, {"start": 1539.99, "end": 1540.45, "word": " fluid", "probability": 0.69580078125}, {"start": 1540.45, "end": 1540.71, "word": " is", "probability": 0.8056640625}, {"start": 1540.71, "end": 1541.49, "word": " essential", "probability": 0.79296875}, {"start": 1541.49, "end": 1541.89, "word": " to", "probability": 0.8671875}, {"start": 1541.89, "end": 1542.35, "word": " prevent", "probability": 0.77978515625}, {"start": 1542.35, "end": 1543.51, "word": " deterioration", "probability": 0.965087890625}, {"start": 1543.51, "end": 1543.89, "word": " into", "probability": 0.7421875}, {"start": 1543.89, "end": 1545.71, "word": " decompensated", "probability": 0.9308268229166666}, {"start": 1545.71, "end": 1546.07, "word": " and", "probability": 0.91357421875}, {"start": 1546.07, "end": 1546.73, "word": " finally", "probability": 0.8740234375}, {"start": 1546.73, "end": 1549.87, "word": " irreversible", "probability": 0.87255859375}, {"start": 1549.87, "end": 1550.31, "word": " shock", "probability": 0.830078125}, {"start": 1550.31, "end": 1550.87, "word": " دايما", "probability": 0.716796875}, {"start": 1550.87, "end": 1551.63, "word": " لو", "probability": 0.56494140625}, {"start": 1551.63, "end": 1551.83, "word": " ال", "probability": 0.372802734375}, {"start": 1551.83, "end": 1552.17, "word": " shock", "probability": 0.61376953125}, {"start": 1552.17, "end": 1552.77, "word": " ما", "probability": 0.73779296875}, {"start": 1552.77, "end": 1553.15, "word": " تحس", "probability": 0.8780924479166666}, {"start": 1553.15, "end": 1553.51, "word": " نازج", "probability": 0.6560872395833334}, {"start": 1553.51, "end": 1553.89, "word": " ممكن", "probability": 0.927490234375}, {"start": 1553.89, "end": 1554.19, "word": " المريض", "probability": 0.84326171875}, {"start": 1554.19, "end": 1554.47, "word": " يروح", "probability": 0.8772786458333334}, {"start": 1554.47, "end": 1554.61, "word": " ل", "probability": 0.62841796875}, {"start": 1554.61, "end": 1555.61, "word": " irreversible", "probability": 0.8904622395833334}, {"start": 1555.61, "end": 1555.91, "word": " shock", "probability": 0.94482421875}, {"start": 1555.91, "end": 1556.39, "word": " ويصير", "probability": 0.8973388671875}, {"start": 1556.39, "end": 1556.51, "word": " ال", "probability": 0.83251953125}, {"start": 1556.51, "end": 1556.81, "word": " management", "probability": 0.8935546875}, {"start": 1556.81, "end": 1557.87, "word": " تبعته", "probability": 0.8934326171875}, {"start": 1557.87, "end": 1559.79, "word": " مش", "probability": 0.76708984375}, {"start": 1559.79, "end": 1560.09, "word": " ممكن", "probability": 0.99169921875}, {"start": 1560.09, "end": 1560.31, "word": " يعني", "probability": 0.896240234375}, {"start": 1560.31, "end": 1560.61, "word": " خلاص", "probability": 0.97412109375}, {"start": 1560.61, "end": 1560.79, "word": " ال", "probability": 0.8330078125}, {"start": 1560.79, "end": 1561.05, "word": " damage", "probability": 0.87158203125}], "temperature": 1.0}, {"id": 67, "seek": 157580, "start": 1565.14, "end": 1575.8, "text": "هك ممكن خلصنا الشوك يعطيكم ألف عافية وإن شاء الله نراكم على خير في محاضرة تانية بإذن الله", "tokens": [3224, 4117, 3714, 43020, 16490, 1211, 9381, 8315, 25124, 2407, 4117, 37495, 9566, 1829, 24793, 5551, 46538, 6225, 31845, 10632, 4032, 28814, 1863, 13412, 16606, 21984, 8717, 23557, 24793, 15844, 16490, 13546, 8978, 3714, 5016, 46958, 25720, 6055, 7649, 10632, 4724, 28814, 8848, 1863, 21984], "avg_logprob": -0.19157609375922577, "compression_ratio": 1.4, "no_speech_prob": 1.1920928955078125e-07, "words": [{"start": 1565.1399999999999, "end": 1566.08, "word": "هك", "probability": 0.781005859375}, {"start": 1566.08, "end": 1566.32, "word": " ممكن", "probability": 0.705078125}, {"start": 1566.32, "end": 1567.08, "word": " خلصنا", "probability": 0.9595947265625}, {"start": 1567.08, "end": 1568.9, "word": " الشوك", "probability": 0.5574544270833334}, {"start": 1568.9, "end": 1569.54, "word": " يعطيكم", "probability": 0.80548095703125}, {"start": 1569.54, "end": 1569.84, "word": " ألف", "probability": 0.86279296875}, {"start": 1569.84, "end": 1570.46, "word": " عافية", "probability": 0.7601725260416666}, {"start": 1570.46, "end": 1571.32, "word": " وإن", "probability": 0.7281087239583334}, {"start": 1571.32, "end": 1571.5, "word": " شاء", "probability": 0.968994140625}, {"start": 1571.5, "end": 1571.64, "word": " الله", "probability": 0.94921875}, {"start": 1571.64, "end": 1572.04, "word": " نراكم", "probability": 0.9527994791666666}, {"start": 1572.04, "end": 1572.2, "word": " على", "probability": 0.70166015625}, {"start": 1572.2, "end": 1572.6, "word": " خير", "probability": 0.996337890625}, {"start": 1572.6, "end": 1573.14, "word": " في", "probability": 0.92822265625}, {"start": 1573.14, "end": 1574.18, "word": " محاضرة", "probability": 0.981689453125}, {"start": 1574.18, "end": 1575.26, "word": " تانية", "probability": 0.9794921875}, {"start": 1575.26, "end": 1575.58, "word": " بإذن", "probability": 0.9705810546875}, {"start": 1575.58, "end": 1575.8, "word": " الله", "probability": 0.9501953125}], "temperature": 1.0}], "language": "ar", "language_probability": 1.0, "duration": 1592.0994375, "duration_after_vad": 1532.0490937499976}
\ No newline at end of file
diff --git a/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/ASqoKLigaDg_raw.srt b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/ASqoKLigaDg_raw.srt
new file mode 100644
index 0000000000000000000000000000000000000000..12154b02b78b3854d82827b209b624049f36841e
--- /dev/null
+++ b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/ASqoKLigaDg_raw.srt
@@ -0,0 +1,1464 @@
+1
+00:00:00,000 --> 00:00:03,740
+كنا بنحكي على الـ Correction of Hypotension حكينا
+
+2
+00:00:03,740 --> 00:00:07,640
+إذا كان الـ Cause مثلاً Hypovolemic Shock بكون
+
+3
+00:00:07,640 --> 00:00:12,400
+محتاج إنه انعوض سوائل حكينا إنه الـ Fluid
+
+4
+00:00:12,400 --> 00:00:15,540
+Replacement اللي احنا بدنا نبدأ فيه المفروض إنه
+
+5
+00:00:15,540 --> 00:00:23,120
+بيبدأ بـ Crystalloids بعدين Keloids كمان بناخد في
+
+6
+00:00:23,120 --> 00:00:27,820
+الإعتبار إذا المريض عنده Blood Loss إنه ندّيلهالـ
+
+7
+00:00:27,820 --> 00:00:31,960
+Blood and blood products بعدين حكينا إنه بنحط
+
+8
+00:00:31,960 --> 00:00:37,020
+للمريض أو بحتاج المريض نحطه على أدوية بتعمل
+
+9
+00:00:37,020 --> 00:00:39,140
+construction في ال blood vessels اسمها
+
+10
+00:00:39,140 --> 00:00:42,200
+vasopressors ومن أمثلتها دوبامين، هنحكي عنه
+
+11
+00:00:42,200 --> 00:00:47,120
+بالتفصيل وحكينا عن ال «antibiotics» drug اللي برضه
+
+12
+00:00:47,120 --> 00:00:53,270
+احنا بنحتاجها علشاننزود من الـ strength تبع الـ
+
+13
+00:00:53,270 --> 00:00:56,050
+heart muscle بالذات في الـ cardiogenic shock وكمان
+
+14
+00:00:56,050 --> 00:00:58,850
+في الـ septic shock لأن من تدعيتها أن المريض بتصير
+
+15
+00:00:58,850 --> 00:01:04,350
+الـ myocardium نفسها بتتعب و تدخل في cardiogenic
+
+16
+00:01:04,350 --> 00:01:09,130
+shock ومن وسائل الإلاج كمان حكينا و بالذات برضه في
+
+17
+00:01:09,130 --> 00:01:13,730
+الـالـ Cardogenic Shock اللي هي الـ Intra-Aortic
+
+18
+00:01:13,730 --> 00:01:19,190
+Balloon Bomb نبدأ نحكي بالتفصيل عن الحاجات هدولة
+
+19
+00:01:19,190 --> 00:01:22,270
+طبعاً الـ Mechanical Ventilator حكينا في محاضرة
+
+20
+00:01:22,270 --> 00:01:25,190
+الـ Mechanical Ventilator إنه ممكن يكون for other
+
+21
+00:01:25,190 --> 00:01:27,830
+causes rather than اللي هو Respiratory Failure زي
+
+22
+00:01:27,830 --> 00:01:30,650
+الـ Cardogenic Shock أو الـ Septic Shock أو any
+
+23
+00:01:30,650 --> 00:01:33,970
+kind of shock at least إن المريض يبدي تريح من الـ
+
+24
+00:01:33,970 --> 00:01:38,250
+effort تبع الـ Breathingبقى إنه احنا بنحطه على
+
+25
+00:01:38,250 --> 00:01:41,270
+mechanical ventilator وبالتالي تقريبًا تلاتين في
+
+26
+00:01:41,270 --> 00:01:46,150
+المية من البذل متابولي create بيكون يعني ارتاح منه
+
+27
+00:01:46,150 --> 00:01:49,850
+المريض ووفرنا عليه والطاقة هذه ال energy
+
+28
+00:01:49,850 --> 00:01:53,090
+consumption تبع التلاتين في المية هدول صار هو
+
+29
+00:01:53,090 --> 00:01:56,370
+جايينه على اتجاهز فاحنا بنعمل reserve لل energy
+
+30
+00:01:56,370 --> 00:02:00,550
+تبع المريض فيه لل curative management احنا بنياه
+
+31
+00:02:00,550 --> 00:02:03,430
+يتشافى من الوضع اللي هو فيه فبنرايحه عن طريق
+
+32
+00:02:03,430 --> 00:02:07,280
+الrespiratorبالـ Mechanical Ventilation طبعا
+
+33
+00:02:07,280 --> 00:02:09,180
+محاضرة الـ Mechanical Ventilation حكينا كل
+
+34
+00:02:09,180 --> 00:02:14,560
+التفاصيل عن ال mood و ال tidal volume و ال rate
+
+35
+00:02:14,560 --> 00:02:19,300
+اللي بيحتاج المريض لما يكون ventilated ال fluid
+
+36
+00:02:19,300 --> 00:02:23,440
+resuscitation اللي حكينا عنه يا جماعة حكينا إنه
+
+37
+00:02:23,440 --> 00:02:26,260
+عشان أبدأ أصلا ال fluid resuscitation لازم أهم
+
+38
+00:02:26,260 --> 00:02:32,340
+حاجة يكون في عندي two large pore cannulaودائما
+
+39
+00:02:32,340 --> 00:02:36,260
+حكينا مش واحدة، two، at least two أحياناً نحتاج
+
+40
+00:02:36,260 --> 00:02:42,000
+نركب central line عشان نبدأ نركب دائما يعني يا
+
+41
+00:02:42,000 --> 00:02:45,500
+جماعة بالموضوع هذا ماحدش يفكر إن الـcentral line
+
+42
+00:02:45,500 --> 00:02:49,580
+أحسن في الـfluid resuscitation من الـcannula، لأ
+
+43
+00:02:49,580 --> 00:02:52,960
+الـcannula بتكون more rapid وخاصة لما يكون جيج
+
+44
+00:02:52,960 --> 00:02:58,500
+تبعها يعني صغير فبالتالي بتكون الـsize تبعها كبير،
+
+45
+00:02:58,500 --> 00:03:04,000
+يعني مثلا جيج 16، جيجالـ18 هدولة بكونوا very good
+
+46
+00:03:04,000 --> 00:03:07,860
+for rapid administration and fluid replacement for
+
+47
+00:03:07,860 --> 00:03:11,480
+the patient خاصة إنه الـcanula short لكن
+
+48
+00:03:11,480 --> 00:03:14,720
+الـcentral line long في الـflow في اللي تبقى
+
+49
+00:03:14,720 --> 00:03:18,040
+الـfluid بطول في الـcentral line يا جماعة فماحدش
+
+50
+00:03:18,040 --> 00:03:22,330
+يفكر إن الـcentral line أحسنلأ، بعدين أنت في
+
+51
+00:03:22,330 --> 00:03:24,290
+الـcentral line بتكون بتدف الـHeart مباشرة
+
+52
+00:03:24,290 --> 00:03:27,430
+فالـRisk بكون عالي أو قريب جدا من الـHeart لكن
+
+53
+00:03:27,430 --> 00:03:30,290
+بالكان أن أنت بتدف فين وبعدين بيصل الـHeart فهذا
+
+54
+00:03:30,290 --> 00:03:35,150
+بيكون أقل المخاطر خاصة لما بنعمل في Rapid
+
+55
+00:03:35,150 --> 00:03:38,410
+Administration بنكون خايفين من أن يكون أو يصير أن
+
+56
+00:03:38,410 --> 00:03:45,770
+اللي هو Pulmonary هدمةالـ Rate والـ Amount عامليني
+
+57
+00:03:45,770 --> 00:03:49,790
+بنحكي فيهم لناخد نعمل الـ Consideration لدائما
+
+58
+00:03:49,790 --> 00:03:51,910
+نكون واخدين بالنا من الـ Blood Pressure ومن ال
+
+59
+00:03:51,910 --> 00:03:54,970
+Pulse ومن ال Saturation تبع المريض أو من الـ
+
+60
+00:03:54,970 --> 00:03:57,530
+General Condition تبعته واحنا بندفل الـ Fluid عشان
+
+61
+00:03:57,530 --> 00:04:04,120
+ما يخشش زي ما حكينا في بلمون الاديمةالمريض لازم
+
+62
+00:04:04,120 --> 00:04:06,820
+نبدأ دايما معاه بالـ Crystalloid يا جماعة لازم
+
+63
+00:04:06,820 --> 00:04:09,440
+نبدأ معاه بالـ Crystalloid ياخد تميية كويسة من الـ
+
+64
+00:04:09,440 --> 00:04:12,140
+Crystalloid واحد لاتنين لتر تقريبا نحكي على
+
+65
+00:04:12,140 --> 00:04:19,260
+الادالة وبعد هيك طبعا و it depends حسب ال ال ال
+
+66
+00:04:19,260 --> 00:04:22,960
+loss جدش فيه عنده loss جدش فيه hypotension وبعدين
+
+67
+00:04:22,960 --> 00:04:28,480
+بنبدأ في ال Kiloid و ال Crystalloid بداية دايما
+
+68
+00:04:28,480 --> 00:04:33,500
+بنبدأ بنعطي يا جماعةالـ Solutions of Choices اللي
+
+69
+00:04:33,500 --> 00:04:36,580
+هي الـ Normal Saline أو الـ Ringer Lactate حتى الـ
+
+70
+00:04:36,580 --> 00:04:39,740
+Normal Saline مفضل عن الـ Ringer Lactate خاصة لما
+
+71
+00:04:39,740 --> 00:04:44,860
+يكون المريض مثلا فيمثلًا سبتك شوك ويكون عنده
+
+72
+00:04:44,860 --> 00:04:47,740
+متابولك أسدوسيس «severe metabolic acidosis» لا
+
+73
+00:04:47,740 --> 00:04:50,860
+يفضل الـ «Ringer Lactate» لأنه يخاف أنه يزود
+
+74
+00:04:50,860 --> 00:04:54,160
+الأسدوسيس كيف يزود الأسدوسيس؟ الـ «Ringer Lactate»
+
+75
+00:04:54,160 --> 00:04:57,220
+اسمه «Lactated Ringer» الـ «Lactate» هذا عبارة عن
+
+76
+00:04:57,220 --> 00:05:00,000
+الـ «Lactic Acid» النزيم اللي بيطلع لما الواحد
+
+77
+00:05:00,000 --> 00:05:03,420
+بيجلي كتير بيطلع من العضلات وبيعمل تشنجات للـ
+
+78
+00:05:03,420 --> 00:05:06,340
+«Spasm» اللي بيصير معاكم بسبب «Lactic Acid
+
+79
+00:05:06,340 --> 00:05:10,200
+Accumulation» إذا الـ «Lactic» itself is an acid
+
+80
+00:05:10,820 --> 00:05:13,940
+بما أنه أسل ممكن يزود الـ Metabolic Acidosis عشان
+
+81
+00:05:13,940 --> 00:05:18,640
+هيك بنفضل الـ Normal Saline عن الـ Metabolic عن
+
+82
+00:05:18,640 --> 00:05:23,840
+الـ Ringer Lactate طبعاً الـ Fluids التانية،
+
+83
+00:05:23,840 --> 00:05:28,800
+Dextrose مثلا، Dextrose 5%، Forbidden Absolutely
+
+84
+00:05:28,800 --> 00:05:32,200
+Forbidden، عمرك ما تدّي واحد شك، Severe
+
+85
+00:05:32,200 --> 00:05:35,700
+Hypotension، تدّيله Dextrose لأن Dextrose هيزود
+
+86
+00:05:35,700 --> 00:05:40,000
+المشكلةهيعمل الـ Brain إتيمة وهذا هو الأخطر لأنه
+
+87
+00:05:40,000 --> 00:05:43,880
+هيعمل Shifting في الـ Fluid وبالتالي الـ Dextrose
+
+88
+00:05:43,880 --> 00:05:48,820
+forbidden Normal Saline is the best solution تجنب
+
+89
+00:05:48,820 --> 00:05:53,700
+الـ Hypotonic solutions زي الـ Half Saline و
+
+90
+00:05:53,700 --> 00:06:00,320
+Dextrose و Normal Saline كل هذه حتى لو كانتفيها
+
+91
+00:06:00,320 --> 00:06:04,360
+Saline؟ لأ هي Hypotonic Solutions Normal Saline 0
+
+92
+00:06:04,360 --> 00:06:09,980
+.9% هو Sodium Chloride هو اللي prepared وRinger
+
+93
+00:06:09,980 --> 00:06:13,760
+Lactate إذا ماكنتش فيه Severe Metabolic Acidosis
+
+94
+00:06:13,760 --> 00:06:17,340
+الـ Colloids اللي هما البلد و البلد برودكسا نحكي
+
+95
+00:06:17,340 --> 00:06:21,360
+عن البلد ده جماعة دايما بنفضل أنه نعطيها نا Packet
+
+96
+00:06:21,360 --> 00:06:24,380
+Cell إذا كان المريض عنده Hemorrhagic CDA
+
+97
+00:06:24,380 --> 00:06:27,100
+Hemorrhagic Shock Hemorrhagic Shock فانا بدي أديله
+
+98
+00:06:27,100 --> 00:06:33,600
+كمية منالـ RPCs لما يديني كمية من الـ RPCs يفضل
+
+99
+00:06:33,600 --> 00:06:38,000
+إنها تكون Packet Cell اللي هو عبارة عن Blood مفصول
+
+100
+00:06:38,000 --> 00:06:41,560
+منه الـ Serum عن الـ Cells إيش بيظل الـ Cells؟ الـ
+
+101
+00:06:41,560 --> 00:06:45,640
+RPCs بنديها للمريض أحسن من إنها دي Whole Blood
+
+102
+00:06:45,640 --> 00:06:50,680
+ليش؟ لأن الـ Whole Bloodالكمية تبعت الـ Fluid اللي
+
+103
+00:06:50,680 --> 00:06:54,200
+موجودة في الـ في الـ في الـ Blood هي هتكون Just
+
+104
+00:06:54,200 --> 00:06:58,260
+Fluid زادة مش هتعمل أي قيمة للمريض وأنا already
+
+105
+00:06:58,260 --> 00:07:04,420
+بعطي Crystallize للمريض فبالتالي أفضل إن أنا أدي
+
+106
+00:07:04,420 --> 00:07:09,650
+Packet Cellعلشان أحسن الـ Homoglobin تبع المريض
+
+107
+00:07:09,650 --> 00:07:13,050
+وما تأثرش على الـ Volume اللي أنا بدي أديه خاصة إن
+
+108
+00:07:13,050 --> 00:07:17,650
+أنا بعوض الـ Crystalloid بكميات كويسة دائما نعرف
+
+109
+00:07:17,650 --> 00:07:20,750
+إنه إذا صار في عندي Massive Blood Transfusion عادة
+
+110
+00:07:20,750 --> 00:07:24,130
+بنحكي لما بكون فيه more than four units of blood
+
+111
+00:07:24,130 --> 00:07:28,170
+transfusionاسمه صار Massive Blood Transfusion هذا
+
+112
+00:07:28,170 --> 00:07:33,070
+بإيش بيخوفني بيأثر إنه أنا كل ما أديت دم أكتر زي
+
+113
+00:07:33,070 --> 00:07:36,030
+ما حكينا أكتر من أربعة وحدات معناه إن الـ Clotting
+
+114
+00:07:36,030 --> 00:07:39,990
+Factors في الجسم in general صارت إيش أقل لأنه أنا
+
+115
+00:07:39,990 --> 00:07:42,930
+بصير اتمد لترين تقريبا نصف حجم الدم اللي موجود في
+
+116
+00:07:42,930 --> 00:07:46,250
+الجسم أربعة unit تمام؟ هذا بيخلي ال Clotting
+
+117
+00:07:46,250 --> 00:07:49,670
+Factors اللي already موجودة في الجسم صارت أقل
+
+118
+00:07:49,670 --> 00:07:53,570
+وبالتالي هذا بيخلي المريض يتعرض لإنه يسيل عنده
+
+119
+00:07:54,390 --> 00:07:57,410
+الـDIC مثلا «Disseminated Intravascular
+
+120
+00:07:57,410 --> 00:08:03,210
+Coagulopathy» اللي هو عبارة عن نزيف «Spontaneous»
+
+121
+00:08:03,210 --> 00:08:05,610
+يعني «Spontaneous bleeding» بيصير يعني المريض ينزف
+
+122
+00:08:05,610 --> 00:08:09,650
+من وما كان لحالي يعني الناس بيصير يعمل bleeding
+
+123
+00:08:09,650 --> 00:08:14,750
+الفلسكتيتر بيصير يطلق دم فبالتالي ليش؟ لأنه بطل
+
+124
+00:08:14,750 --> 00:08:20,430
+فيه دمهالـ Clotting Factors فعشان هي دايما في الـ
+
+125
+00:08:20,430 --> 00:08:23,830
+Mass of Blood Transfusion مش بس بند بلد كمان بند
+
+126
+00:08:23,830 --> 00:08:27,890
+Fresh Frozen بلازمة، Fresh Frozen بلازمة الهدف من
+
+127
+00:08:27,890 --> 00:08:31,530
+الـ Fresh Frozen بلازمة أن البلازمة هي عادة اللي
+
+128
+00:08:31,530 --> 00:08:36,230
+تحتوي على الـ Clotting Factors 8 و9 و2 فعشان هي
+
+129
+00:08:36,230 --> 00:08:40,110
+كده بيجهزوها في المختبر بيفصلوا الدم هو Fresh
+
+130
+00:08:40,110 --> 00:08:46,520
+بخدوا البلازمة هاي و بعملوهابعملولها تفريز يعني
+
+131
+00:08:46,520 --> 00:08:51,480
+بتلجوها ليش؟ عشان تظل fresh وطازجةولمّا نبنى
+
+132
+00:08:51,480 --> 00:08:55,720
+احتاجها بناخدها بنفك التجنيد تبعها بنحطها بميه
+
+133
+00:08:55,720 --> 00:09:01,380
+بتدوب ترجع سائلة ايه بنديها للمريض Rapidly وهذا
+
+134
+00:09:01,380 --> 00:09:05,360
+بالتالي بيبدى المريض كمية من الـFresh Frozen
+
+135
+00:09:05,360 --> 00:09:09,720
+بلازمة كمان ممكن احنا نحصل على الـGluten Factors
+
+136
+00:09:09,720 --> 00:09:14,720
+itself يعنى حاجة بيسموها الـCryoprecipitate المرسب
+
+137
+00:09:14,720 --> 00:09:20,250
+البارد هذا بيحتفظ بس على الـGluten Factorطبعاً هذا
+
+138
+00:09:20,250 --> 00:09:22,770
+هناخده في الدم اللي ممكن تحتاج factor 8 أو factor
+
+139
+00:09:22,770 --> 00:09:28,490
+9 عادة في ال shock بيكون هدفنا أنه ندّي blood إذا
+
+140
+00:09:28,490 --> 00:09:31,670
+كان الدينا massive blood transfusion هنصير ندّي
+
+141
+00:09:31,670 --> 00:09:36,270
+fresh frozen plasma معاه أو cryoprecipitate ممكن
+
+142
+00:09:36,270 --> 00:09:40,370
+أحيانا نبطل ندّي blatulate خمس، ست وحدات blatulate
+
+143
+00:09:40,370 --> 00:09:45,450
+إذا كان ال blatulate so low وخايفين منالـBleeding
+
+144
+00:09:45,450 --> 00:09:50,450
+لـHuman Album برضه يعتبر من الـColloids ووظيفته
+
+145
+00:09:50,450 --> 00:09:54,450
+كتير كويس أنه لما بينعطى بعمل الـShifting للـFluid
+
+146
+00:09:54,450 --> 00:09:58,470
+من الـInterstitial للـIntravascular وانا في الشك
+
+147
+00:09:58,470 --> 00:10:01,650
+خاصة لما بكون عندى non-absolute shock فاكرين
+
+148
+00:10:01,650 --> 00:10:04,390
+الـabsolute shock اللي الفلود بتطلع من جسد النهائي
+
+149
+00:10:04,390 --> 00:10:06,430
+زي الدياريا والـVomiting
+
+150
+00:10:09,270 --> 00:10:13,010
+والـ Homerage، لكن لما بكون نلعب Absolute Shock
+
+151
+00:10:13,010 --> 00:10:17,610
+وزي واحد مثلا أندسيبتك شوك على الـ Fluid وين؟ طالع
+
+152
+00:10:17,610 --> 00:10:20,770
+على الـ Interstitial، موجودة في الجسم، بس في الـ
+
+153
+00:10:20,770 --> 00:10:23,290
+Interstitial، مش في الـ Intravascular، عشان هيك،
+
+154
+00:10:23,290 --> 00:10:28,400
+لو أنا أدته Human Ergon في الـ BCLH،الـ Osmolarity
+
+155
+00:10:28,400 --> 00:10:31,100
+تبع الـ human album و الـ colloid in general عالية
+
+156
+00:10:31,100 --> 00:10:34,680
+فبالتالي بيستطيع أنه يعمل shifting لل fluid من الـ
+
+157
+00:10:34,680 --> 00:10:37,940
+Interstitial للـ Intravascular وبالتالي بيرفعلي
+
+158
+00:10:37,940 --> 00:10:40,700
+الضغط و حيث ذلك حتى في الـ Normal patient لما
+
+159
+00:10:40,700 --> 00:10:44,360
+بندّيهم hypo human album لما بنشوف أنهم يدخلوا
+
+160
+00:10:44,360 --> 00:10:46,700
+بالـ monoregina و الناس بس هال liver cirrhosis لما
+
+161
+00:10:46,700 --> 00:10:49,720
+بيحتاجوا نعملهم Paracentesis و ندّيهم human album
+
+162
+00:10:49,720 --> 00:10:51,940
+و بيكونوا مرقمين و ندّيهم الـ human album in
+
+163
+00:10:51,940 --> 00:10:55,520
+precaution لإن هو ممكن مرضي يدخلوا بالـ monoregina
+
+164
+00:10:55,520 --> 00:11:02,040
+because ofالـ sudden أو يعني الـ الـ الـ الـ
+
+165
+00:11:02,040 --> 00:11:05,720
+shifting تبقى لـ fluids من الانتراليستيشيا لـ الـ
+
+166
+00:11:05,720 --> 00:11:08,220
+Intravascular هذه هي الـ colloids in general اللي
+
+167
+00:11:08,220 --> 00:11:12,080
+بتعاملناها و بتعطيها في حالات ال shock كمان في
+
+168
+00:11:12,080 --> 00:11:16,780
+أنواع من ال shock اللي هي يعني الأزميرات تبعتها
+
+169
+00:11:16,780 --> 00:11:19,760
+أقل من ال blood و ال blood products و ال human
+
+170
+00:11:19,760 --> 00:11:26,860
+album اللي هو مصنع تصنيعملاحظين إن هذه كلها كانت
+
+171
+00:11:26,860 --> 00:11:29,740
+بلد طبيعية «fresh frozen» بلد طبيعية «colloid» لكن
+
+172
+00:11:29,740 --> 00:11:33,480
+في حاجات مصنعة تصنية زي الـ «Dextran» أو الـ
+
+173
+00:11:33,480 --> 00:11:38,360
+«Hemacyl» اللي موجودة هنا هو ده عبارة عن fluid
+
+174
+00:11:38,360 --> 00:11:42,340
+فيها جيلاتين material عشان يتخلى الـ «stain» تبع
+
+175
+00:11:42,340 --> 00:11:46,380
+الـ «vessel» الـ«fluid» هاي في الـ«blood vessel»
+
+176
+00:11:46,380 --> 00:11:50,020
+أكتر من الـ«crystalloid solutions» وبالتالي لما
+
+177
+00:11:50,020 --> 00:11:53,450
+يكون الـ«stain» مدة ما كانت في الـفي الـBessel
+
+178
+00:11:53,450 --> 00:11:57,630
+أكتر، يعني ما تروحش على الكيليا بسرعة وكيليا
+
+179
+00:11:57,630 --> 00:12:01,150
+هتتخلص منها ويطلع urine فهي تقدر ترفع للـBlood
+
+180
+00:12:01,150 --> 00:12:04,910
+Pressure وتخلي المريض يرجع طبعا عشان هيك دايما
+
+181
+00:12:04,910 --> 00:12:07,870
+لازم لما نقعد نعطي هاد يكون مدين قبلها كمية كويسة
+
+182
+00:12:07,870 --> 00:12:14,430
+من الـcrystallites عشان أشغل ال kidneyبالنسبة للـ
+
+183
+00:12:14,430 --> 00:12:17,270
+Cardogenic Shock يا جماعة، بلاحظ أنه هنا الوضع
+
+184
+00:12:17,270 --> 00:12:19,610
+بيخلف شوية لأنه في الـ Cardogenic Shock أنا مش
+
+185
+00:12:19,610 --> 00:12:23,410
+محتاج سوائل أدنى أنا محتاج حاجات تتقوّل القلب،
+
+186
+00:12:23,410 --> 00:12:28,130
+بالعكس أنا بكون محتاج حاجات تتقلل الـ Reload على
+
+187
+00:12:28,130 --> 00:12:33,000
+القلب، فمحتاجDiuretics، يعني أنا بدي أدوية قلّ
+
+188
+00:12:33,000 --> 00:12:37,140
+اللي بـ Reload كمية الـ Blood أو الـ Fluids اللي
+
+189
+00:12:37,140 --> 00:12:40,240
+بتيجي للـ Heart عشان الـ Heart يشيش تعمل معاها
+
+190
+00:12:40,240 --> 00:12:43,100
+ويطلقها أنا بدي أقللها، فبدل المرضي الـ Diuretics
+
+191
+00:12:43,100 --> 00:12:47,640
+بحيث أنه أخفط على الـ Heart وكمان الحاجات اللي أنا
+
+192
+00:12:47,640 --> 00:12:53,820
+ب .. ب .. بستخدمها في الـ Cardiogenic Shock يا
+
+193
+00:12:53,820 --> 00:12:57,800
+جماعة أني أدي أدوية إيش بتسوي، بتخوّق عضلة القلب
+
+194
+00:13:00,370 --> 00:13:04,610
+تمام؟ هنشوفهم بالترتيب
+
+195
+00:13:04,610 --> 00:13:08,130
+إيش هم الـ «انتروباكيدراجلي» كويسين في الـSeptic
+
+196
+00:13:08,130 --> 00:13:11,650
+Shock Management يا جماعة دايما أنا أهم حاجة عندي
+
+197
+00:13:11,650 --> 00:13:14,690
+زي ما حكينا «fluid replacement» بالنسبة للمرض
+
+198
+00:13:14,690 --> 00:13:18,830
+الفلويد بدي أجنب الـ«Ringer» اللي اقتد قدر الإمكان
+
+199
+00:13:18,830 --> 00:13:23,730
+عشان الـAcidosis بدي أعمل عالج الـCause السبتك هدف
+
+200
+00:13:23,730 --> 00:13:25,890
+من وين؟ إذا كان في «central line» أو «follow
+
+201
+00:13:25,890 --> 00:13:30,280
+catheter» لازم يرتفع يا جماعة ويتاخد للـCultureمش
+
+202
+00:13:30,280 --> 00:13:33,440
+هخلّي الـ Source و أدّي الـ Antibiotics طبعًا إحنا
+
+203
+00:13:33,440 --> 00:13:37,160
+عارفين إنه نبدأ بـ Antibiotic ممكن نبدأ بـ
+
+204
+00:13:37,160 --> 00:13:40,800
+Empirically و بعدين إذا كان فيه Source معروف أعمل
+
+205
+00:13:40,800 --> 00:13:44,720
+منه Culture قبل ما تطلع نتيجة الـ Culture بشوف إذا
+
+206
+00:13:44,720 --> 00:13:47,740
+الـ Antibiotic اللي أنا ماشي معاه sensitive بكمل
+
+207
+00:13:47,740 --> 00:13:52,060
+عليه إذا ماكنش كويس بعمل stop و according to new
+
+208
+00:13:52,060 --> 00:13:55,930
+cultureببدأ الـ Antibiotics الجديد عادة بنحتاج
+
+209
+00:13:55,930 --> 00:14:00,130
+Broad Spectrum Antibiotics Strong Antibiotics
+
+210
+00:14:00,130 --> 00:14:09,040
+بنحتاج كميات يعني أوجات بتكون Loading Doseممكن
+
+211
+00:14:09,040 --> 00:14:13,720
+ندقه في Antibiotics بنحتاج يا جماعة إنحدد بالظبط
+
+212
+00:14:13,720 --> 00:14:16,740
+زي ما حكينا مكان الـInfection عشان ناخد منه
+
+213
+00:14:16,740 --> 00:14:20,140
+Culture بنحتاج إنه نستخدم أدوية Vasopressors عشان
+
+214
+00:14:20,140 --> 00:14:24,720
+تعملي Construction للبسل وتخلي فيه إمكانية
+
+215
+00:14:24,720 --> 00:14:29,760
+للـBlood Pressure على إنها ترتفع بحسب كمة السوء
+
+216
+00:14:29,760 --> 00:14:33,860
+اللي موجودة Intra-vascularي تمام؟ كتير بيستخدموا
+
+217
+00:14:33,860 --> 00:14:39,200
+أحيانا الـSteroids وهذا يعنيفيها جدل إن الـStroid
+
+218
+00:14:39,200 --> 00:14:46,540
+بتقلل المناعة الـStroids بت .. ممكن تكون مش حاجة
+
+219
+00:14:46,540 --> 00:14:55,360
+كويسة في الـSeptic Shock لكن يعني .. يعني زي ما
+
+220
+00:14:55,360 --> 00:14:58,260
+بيحكوا إنه «Don't let your patient to die without
+
+221
+00:14:58,260 --> 00:15:02,130
+giving steroids»Okay، فهذا في الـ Management just
+
+222
+00:15:02,130 --> 00:15:08,870
+to know طبعاً إنتوا أحنا عارفين إنه this is this
+
+223
+00:15:08,870 --> 00:15:11,590
+knowledge is just to know you have a doctor to
+
+224
+00:15:11,590 --> 00:15:15,590
+decide and you have a physician to decide what is
+
+225
+00:15:15,590 --> 00:15:18,030
+the management but this is the management in
+
+226
+00:15:18,030 --> 00:15:21,510
+general for shock الـBicarbonate كتير لما بيكون
+
+227
+00:15:21,510 --> 00:15:28,310
+الـ pH أجل من 7.1 أو 7.2 بيكون صار في indication
+
+228
+00:15:28,310 --> 00:15:35,340
+لإنه إحنا نعملأو نعطي Sodium Bicarbon 8.4 من 10%
+
+229
+00:15:35,340 --> 00:15:38,460
+Management of Hypovolemic shock في حالات الـ
+
+230
+00:15:38,460 --> 00:15:42,060
+Hypovolemic shock رجعنا نحكي إنه لازم ندّي إذا في
+
+231
+00:15:42,060 --> 00:15:43,300
+bleeding ينواجفه
+
+232
+00:15:49,440 --> 00:15:54,540
+والـ Fluid طبعاً حرد إذا كان الـ BTT prolonged الـ
+
+233
+00:15:54,540 --> 00:15:57,040
+Coagulation profile prolonged معناته لازم ندّي
+
+234
+00:15:57,040 --> 00:16:00,180
+الـFreshly Frozen بلازم خاصة إذا قدّينا Hemorrhage
+
+235
+00:16:00,180 --> 00:16:05,920
+إذا قدّينا Massive Blood Transfusion طبعا في كل
+
+236
+00:16:05,920 --> 00:16:09,280
+الأحوال دايما نحتاج الـVasopressors عشان هي بدنا
+
+237
+00:16:09,280 --> 00:16:11,220
+نحكي مين هي الـVasopressors هدول ومين هم
+
+238
+00:16:11,220 --> 00:16:13,540
+الـIntropic Drugs اللي صارنا شوية بنحكي عنهم
+
+239
+00:16:13,540 --> 00:16:16,540
+الـIntropic Drugs يا جماعة
+
+240
+00:16:19,780 --> 00:16:25,560
+أو يعني في منها Intros بتعمل Vasoconstriction
+
+241
+00:16:25,560 --> 00:16:31,920
+وبتقوى عضلة القلبوفي Antibiotics في حالات الـ
+
+242
+00:16:31,920 --> 00:16:35,100
+«سيبتيك شوك» لازم ند «Antibiotic» وفي Sodium
+
+243
+00:16:35,100 --> 00:16:40,440
+Bicarb اللي حكينا عنه قبل شوية وفي ال «كالسيوم»
+
+244
+00:16:40,440 --> 00:16:43,880
+الـGluconate اللي هو يعتبر Indirect Introbe ليش؟
+
+245
+00:16:43,880 --> 00:16:47,320
+لأنه Intracellular نشوف بالتفصيل شوية هيكة
+
+246
+00:16:47,320 --> 00:16:53,330
+الـIntrophics أو الـPositive Introphs اللي هيالفا
+
+247
+00:16:53,330 --> 00:16:55,650
+تشتغل على Alpha-receptors وتشتغل على Beta
+
+248
+00:16:55,650 --> 00:16:59,130
+-receptors وتشتغل على Beta-1 وBeta-2 طبعاً وفيه
+
+249
+00:16:59,130 --> 00:17:04,110
+Dubmanerging Agents طبعاً لو نجي نحكي على
+
+250
+00:17:04,110 --> 00:17:08,410
+الـMedications هدا الـReceptors in general اللي في
+
+251
+00:17:08,410 --> 00:17:10,690
+الجسم يعني لو بدنا نحكي على Alpha وإن موجوعة
+
+252
+00:17:10,690 --> 00:17:13,330
+موجودة Alpha-receptors جماعة Alpha-receptors
+
+253
+00:17:13,330 --> 00:17:16,250
+موجودة في البرستيت موجودة في المثانة موجودة في
+
+254
+00:17:16,250 --> 00:17:23,010
+الـI Beta-1الـ Beta-1 اللي هي الـ «رسيبتورز»
+
+255
+00:17:23,010 --> 00:17:28,470
+الموجودة فيه الـ «هارد» «شيك» «بيتا 2» دلوقتي قلت
+
+256
+00:17:28,470 --> 00:17:32,430
+لكم وحافظيين إن «بيتا 1» أنها «هارد 1» فـ «بيتا 1»
+
+257
+00:17:32,430 --> 00:17:36,410
+بتشتغل بـ «1» يعني «هارد 1» «بيتا 1» لكن «بيتا 2»
+
+258
+00:17:36,410 --> 00:17:39,330
+أنها «too long» «بيتا 2» عشان هي «بيتا 2» اللي
+
+259
+00:17:39,330 --> 00:17:44,150
+بتشتغل على الـ «رسبراتوري سيستم» فبتعمل «برونكل»
+
+260
+00:17:44,150 --> 00:17:50,650
+«برونكل سموت مصر ريلكسيشن» عشان هي عايزةزي تتذكروا
+
+261
+00:17:50,650 --> 00:17:52,490
+تبقية الـ Adrenaline؟ لأن الـ Adrenaline بيشتغل
+
+262
+00:17:52,490 --> 00:17:58,650
+على Beta-2 طبعا بيشتغل برضه على Beta-1 بس بما أنه
+
+263
+00:17:58,650 --> 00:18:02,410
+بيشتغل على Beta-2 فجمال الـ Proncal Relaxation للـ
+
+264
+00:18:02,410 --> 00:18:08,510
+Proncus الدبامين بيشتغل على اللي هو عشانك بيسموه
+
+265
+00:18:12,740 --> 00:18:16,080
+لأن الدوبامين بيشتغل عليها الـ Receptor هذه تستخبل
+
+266
+00:18:16,080 --> 00:18:18,600
+مستخبلات الدوبامين، طبعا الدوبامين مادة Natural
+
+267
+00:18:18,600 --> 00:18:21,560
+أصلا موجودة في الجسم عشان هيك إلها Receptors
+
+268
+00:18:21,560 --> 00:18:26,340
+موجودة بيفرزها للـ Brain لإنها تشتغل في الجسم
+
+269
+00:18:26,340 --> 00:18:35,230
+علشان تعمل لما أنت محتاج أنك تعمل لغزةبكتير، بس في
+
+270
+00:18:35,230 --> 00:18:39,550
+القيمات القليلة بتكون عاملة شوية relaxation بالذات
+
+271
+00:18:39,550 --> 00:18:44,690
+للـ smooth muscle فبالذات ال kidney arteries ممكن
+
+272
+00:18:44,690 --> 00:18:49,710
+ما ال low dose of دوبامين تصير لها relaxation فزيد
+
+273
+00:18:49,710 --> 00:18:52,470
+ال kidney perfusion عشان هيك كانوا زمان في
+
+274
+00:18:52,470 --> 00:18:56,530
+الدوبامين بيستخدموه من واحد لتلاتة mic per
+
+275
+00:18:56,530 --> 00:19:01,710
+kilogram per minute بيستخدموه as بيسموها renal
+
+276
+00:19:01,710 --> 00:19:06,330
+dose دوبامين renal doseأول دوة الـ «دومين» هيته
+
+277
+00:19:06,330 --> 00:19:12,110
+أحنا هنحكي عنه يعني هنا بس عشان إيجا وقته يعني أنا
+
+278
+00:19:12,110 --> 00:19:16,450
+ضربت فيه مثال أول دوة في الأدوية اللي بنحكي عنها
+
+279
+00:19:16,450 --> 00:19:19,830
+اللي بتشتغل على الـAlpha Receptors دوة اسمه
+
+280
+00:19:19,830 --> 00:19:23,930
+الـPhenylephrine الـPhenylephrine من أحسن الأدوية
+
+281
+00:19:24,200 --> 00:19:29,000
+اللي بتشتغل على الـ Alpha Receptors وبالتالي هي
+
+282
+00:19:29,000 --> 00:19:32,000
+برفعلي الـ Blood Pressure تبع المريض بيشتغل الـ
+
+283
+00:19:32,000 --> 00:19:35,520
+Blood Pressure كويس لكن أو يعني من ميزته أنه
+
+284
+00:19:35,520 --> 00:19:38,100
+مابرفعليش الـ Heart Rate لإن هو مابيشتغلش على الـ
+
+285
+00:19:38,100 --> 00:19:42,320
+Beta وهذه advantage إليه superior هو فيها عن
+
+286
+00:19:42,320 --> 00:19:49,450
+الدبانين الـ Phenylephrine الـ Isoproteinololاللي
+
+287
+00:19:49,450 --> 00:19:53,470
+هو Pure Beta Both Beta-1 and Beta-2 بيشتغل بس على
+
+288
+00:19:53,470 --> 00:19:57,410
+Beta-2 بيشتغلش على Alpha الـW8 Selected Beta-1
+
+289
+00:19:57,410 --> 00:20:01,330
+بيشتغل بس على Beta-1 مابيشتغلش على Beta-2 والتالي
+
+290
+00:20:01,330 --> 00:20:05,210
+مابيأثرنيش على الـLung بس بيشتغل على الـHeart
+
+291
+00:20:05,210 --> 00:20:09,870
+الـAlbuterol اللي هو الـVentolin Selected Beta-2
+
+292
+00:20:09,870 --> 00:20:16,050
+بيشتغل على Beta-2 عشان هي كبرنكو الـAlbuterol اللي
+
+293
+00:20:16,050 --> 00:20:20,070
+هو الـVentolinالـ Epinephrine زي ما حكينا بيشتغل
+
+294
+00:20:20,070 --> 00:20:23,850
+على both Alpha and Beta و Beta one و Two يعني
+
+295
+00:20:23,850 --> 00:20:24,970
+بيشتغل على Alpha و Beta
+
+296
+00:20:28,500 --> 00:20:31,700
+الـ Antibiotics Drug in general يا جماعة هي
+
+297
+00:20:31,700 --> 00:20:37,160
+الأدوية اللي بتزود الـ positive entrope بتزود ال
+
+298
+00:20:37,160 --> 00:20:41,320
+contraction تبع عضلة القلب زي الدوبامين و الـ
+
+299
+00:20:41,320 --> 00:20:44,100
+vitamin و الـ epinephrine الدوبامين زي ما حكينا
+
+300
+00:20:44,100 --> 00:20:47,800
+بيشتغل في تلت دوزات الـ low-dose تبعها بيشتغل فيها
+
+301
+00:20:47,800 --> 00:20:50,320
+على الـ double-merging receptors اللي هي رينادوز
+
+302
+00:20:50,320 --> 00:20:52,780
+بنسميها من واحدة تلتة مايكروجرام أو واحد اتنين
+
+303
+00:20:52,780 --> 00:20:59,400
+مايكروجرام بالكيلوجرام يالا تلتة لكل minuteمن end
+
+304
+00:20:59,400 --> 00:21:02,160
+تلاتة ونبدأ نطلع ل end عشرة هنا بتبدأ تشتغل
+
+305
+00:21:02,160 --> 00:21:05,700
+cardiac dose cardiac dose يعني بيبدأ يشتغل على
+
+306
+00:21:05,700 --> 00:21:11,760
+beta one receptor تمام؟ وطبعا هنا هيبدأ يرفعلي فيه
+
+307
+00:21:11,760 --> 00:21:14,140
+ال heart rate أكتر من عشرة microgram لكل kilogram
+
+308
+00:21:14,140 --> 00:21:16,820
+لكل minute الجماعة بيبدأ يديني أو بيبدأ يشتغل على
+
+309
+00:21:16,820 --> 00:21:19,940
+ال alpha receptors يعني alpha يعني blood vessels
+
+310
+00:21:23,760 --> 00:21:27,520
+طبعاً يعني أنا Alpha دائما الـ Alpha بنحكي عن الـ
+
+311
+00:21:27,520 --> 00:21:29,600
+blood vessels Alpha Receptors دايما بنحكي عن الـ
+
+312
+00:21:29,600 --> 00:21:33,740
+blood vessels okay فلمّا ببدأ أشتغل على Alpha
+
+313
+00:21:33,740 --> 00:21:38,820
+Receptors فبقوم بعمل الـ vasoconstriction كويس؟
+
+314
+00:21:38,820 --> 00:21:42,520
+لأنك بنسميه vasopressor دو بيوتامين هذا زي الـ
+
+315
+00:21:42,520 --> 00:21:47,740
+dopamine بس مصنع يعنيمش طبيعي، مش مادة طبيعية زي
+
+316
+00:21:47,740 --> 00:21:50,560
+الدبابين اللي موجودة هنا Naturally لأ، هذا مصنع
+
+317
+00:21:50,560 --> 00:21:56,820
+تصنيع عادة بفضله يستخدموا الدبابين لأن هو Pure
+
+318
+00:21:56,820 --> 00:22:00,360
+Beta-1 Receptors بيحبوا يستخدموه لما يكون أصلا
+
+319
+00:22:00,360 --> 00:22:05,680
+الـBlood Pressure شوية متحسن يعني أحسن من 90 ع 60
+
+320
+00:22:05,680 --> 00:22:09,960
+بيصير فيه إمكانية أنه أستخدم الدبيتامين As اللي هو
+
+321
+00:22:09,960 --> 00:22:18,310
+Introbeالـ Epinephrine بيستخدم من 0.05 زي ما انتوا
+
+322
+00:22:18,310 --> 00:22:21,930
+شايفين من 5% لـ2µg لكل كيلو جرام لكل minute
+
+323
+00:22:21,930 --> 00:22:26,730
+وبيشتغل على الـ Beta والـ Alpha كتير، يعني عشانك
+
+324
+00:22:26,730 --> 00:22:29,510
+بعمل تكيكارديا كتير لو أنا بدأ أستخدم
+
+325
+00:22:29,510 --> 00:22:36,330
+الـVasopressors، بحيعمل تكيكارديا كتير أو ممكن
+
+326
+00:22:36,330 --> 00:22:44,540
+إيش، يعمل Severe Vasoconstrictionوفيه أدوية يا
+
+327
+00:22:44,540 --> 00:22:51,200
+جماعة بنستخدمها عشان تحسن
+
+328
+00:22:51,200 --> 00:22:55,820
+الـ Afterload وهذه الأدوية هتعمل لـ Vasodilatation
+
+329
+00:23:10,510 --> 00:23:16,930
+أكتر دوة بنستخدمها طبعاً الـ Nitroprusideالـ
+
+330
+00:23:16,930 --> 00:23:21,690
+Nitrous بنسميه Nitrous Oxide ده بيعتبر خطير لإنه
+
+331
+00:23:21,690 --> 00:23:31,190
+بيعمل cyanide poisoning بعد 24 ساعة من استخدامه أو
+
+332
+00:23:31,190 --> 00:23:36,930
+أكتر شوية الـ Nitroglycerin ده أمن Nitrate نعم الـ
+
+333
+00:23:36,930 --> 00:23:42,550
+Nitroglycerin ده أمن بيعمللي Vasodilatation
+
+334
+00:23:47,670 --> 00:23:50,870
+الـ Sodium Bicarb حكينا بناءً على الـ pH لما يكون
+
+335
+00:23:50,870 --> 00:23:59,470
+أقل من 7.2 أو 7.1 ممكن يستخدموه الـ Calcium حكينا
+
+336
+00:23:59,470 --> 00:24:05,200
+إنه أصلاًطبعاً هو من الـElectrolytes هو اللي
+
+337
+00:24:05,200 --> 00:24:08,580
+بيسموه Indirect Entropy ليش؟ لأن الكالسيوم mainly
+
+338
+00:24:08,580 --> 00:24:11,400
+intracellular جماعة فلو أنا قدّيت كالسيوم،
+
+339
+00:24:11,400 --> 00:24:16,060
+الكالسيوم هيحاول يدخل للخلية جوا فبما أنه هيدخل
+
+340
+00:24:16,060 --> 00:24:20,040
+للخلية جوا، بتقوي الـpotency تبع الخلية إنها بتعمل
+
+341
+00:24:20,040 --> 00:24:27,300
+contraction الـantibiotics حكينا حسب وضع المريض as
+
+342
+00:24:27,300 --> 00:24:31,550
+shock patients، septic shock لازم أكونعارف أشهر
+
+343
+00:24:31,550 --> 00:24:34,950
+الـ Antibiotics كيف بدأ أستخدمها حسب الـ culture
+
+344
+00:24:34,950 --> 00:24:38,190
+in summary بيقول shock is a clinical syndrome not
+
+345
+00:24:38,190 --> 00:24:40,910
+defined by blood pressure alone، مش بس blood
+
+346
+00:24:40,910 --> 00:24:44,190
+pressure واطي، بتاعة الcardio تبدأ أول، urine
+
+347
+00:24:44,190 --> 00:24:46,990
+output مهم، ال-CVB مهم، normal circulatory
+
+348
+00:24:46,990 --> 00:24:48,950
+function depends on three factors cardiac
+
+349
+00:24:48,950 --> 00:24:53,340
+function، ال-pumpوVascular Tone الـ«بايبز»
+
+350
+00:24:53,340 --> 00:25:01,820
+والـBlood Volume المخزن
+
+351
+00:25:01,820 --> 00:25:05,260
+للـ«بير»
+
+352
+00:25:05,260 --> 00:25:09,040
+الـ«بير» خلّيني أقول عنهم فإن أحنا بدك يكون عندك
+
+353
+00:25:09,040 --> 00:25:13,220
+بلد Volume بيكون في عندك بايبز مافيش حاجة كابسة
+
+354
+00:25:13,220 --> 00:25:17,040
+عليها بيكون في عندك بم شغالة كويس تمام؟
+
+355
+00:25:19,810 --> 00:25:25,310
+هذا هو موضوع الـ Shock Disturbance in one or more
+
+356
+00:25:25,310 --> 00:25:28,370
+resulting in inadequate delivery of oxygen and
+
+357
+00:25:28,370 --> 00:25:32,670
+nutrients to the tissue leads to shock Shock is a
+
+358
+00:25:32,670 --> 00:25:36,290
+progressive dynamic process where early cognition
+
+359
+00:25:36,290 --> 00:25:39,710
+and immediate managementinitially in the form of
+
+360
+00:25:39,710 --> 00:25:43,510
+IV fluid is essential to prevent deterioration
+
+361
+00:25:43,510 --> 00:25:49,870
+into decompensated and finally irreversible
+
+362
+00:25:49,870 --> 00:25:54,190
+shock دايما لو ال shock ما تحس نازج ممكن المريض
+
+363
+00:25:54,190 --> 00:25:56,810
+يروح ل irreversible shock ويصير ال management
+
+364
+00:25:56,810 --> 00:26:01,050
+تبعته مش ممكن يعني خلاص ال damage
+
+365
+00:26:05,140 --> 00:26:11,640
+هك ممكن خلصنا الشوك يعطيكم ألف عافية وإن شاء الله
+
+366
+00:26:11,640 --> 00:26:15,800
+نراكم على خير في محاضرة تانية بإذن الله
+
diff --git a/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/IjMympjjuqA.srt b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/IjMympjjuqA.srt
new file mode 100644
index 0000000000000000000000000000000000000000..3a4585287775eabbe1a27f02b3e6f42edadbfe14
--- /dev/null
+++ b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/IjMympjjuqA.srt
@@ -0,0 +1,1357 @@
+1
+00:00:02,040 --> 00:00:04,720
+السلام عليكم ورحمة الله وبركاته باسم الله والصلاة
+
+2
+00:00:04,720 --> 00:00:09,040
+والسلام على رسول الله، نحكي في الـ Management of
+
+3
+00:00:09,040 --> 00:00:13,880
+Patients with Different Rhythmias. لما بنحكي عن الـ
+
+4
+00:00:13,880 --> 00:00:17,660
+patients اللي عندهم these rhythmias، لازم نكون أولا
+
+5
+00:00:17,660 --> 00:00:22,900
+نعرف الـ normal rhythm عشان نقدر نعرف ونتعرف على
+
+6
+00:00:22,900 --> 00:00:24,460
+أن هذا الـ rhythm هو من
+
+7
+00:00:28,370 --> 00:00:32,810
+الـ Rhythm Disorders، وبدنا نعرف من أنه الـ Rhythm
+
+8
+00:00:32,810 --> 00:00:38,710
+Disorders اللي احنا ممكن نُشخصه. فلو بنحكي عن الـ
+
+9
+00:00:38,710 --> 00:00:42,650
+Normal Electrical Conduction، بنعرف أنه بتصير فيها
+
+10
+00:00:42,650 --> 00:00:47,110
+أولًا contraction. كل contraction بتعمل اللي هو الـ
+
+11
+00:00:47,110 --> 00:00:51,490
+systolic blood pressure، وبعدين بيصير relaxation
+
+12
+00:00:53,800 --> 00:00:57,560
+وهذا طبعًا بيعمل لنا diastolic blood pressure.
+
+13
+00:00:57,560 --> 00:01:00,740
+طبعًا نعرف إن هذا بيصير عن طريق اللي هو الـ
+
+14
+00:01:00,740 --> 00:01:08,460
+Depolarization. الـ Depolarization للـ Heart
+
+15
+00:01:08,460 --> 00:01:13,580
+Muscle. فبنعرف لما بيصير Depolarization للأُترية
+
+16
+00:01:13,580 --> 00:01:17,360
+بيعمل لي، لو بدنا نحكي عن الـ Electrical Conduction،
+
+17
+00:01:17,360 --> 00:01:21,520
+اللي بتعملها بيعمل لي Wave اسمها الـ P Wave على الـ
+
+18
+00:01:21,520 --> 00:01:29,720
+ECG. وبعد هيك بدي أحكي على الـ… بدي
+
+19
+00:01:29,720 --> 00:01:33,580
+أفرجيكم بس الـECG هنا، وبعدين نرجع عشان نكون
+
+20
+00:01:33,580 --> 00:01:39,640
+عارفين إيش الترجمة هنا، الترجمة للمراحل اللي بيصير
+
+21
+00:01:39,640 --> 00:01:42,620
+فيها Depolarization و Repolarization. في
+
+22
+00:01:42,620 --> 00:01:46,720
+المرحلة الأولى، بتصير بيدي أنا الأُترية
+
+23
+00:01:46,720 --> 00:01:50,360
+بيصير فيها contraction، فهذا بيعمل لي الـP-wave.
+
+24
+00:01:50,360 --> 00:01:54,380
+يعني الـP-wave يكون عبارة عن Depolarization
+
+25
+00:01:54,380 --> 00:01:59,750
+لمين؟ للـ Atrium. بعدها إيش بيصير؟ في الـ Complex
+
+26
+00:01:59,750 --> 00:02:04,630
+QRS، بعمل لي Repolarization للـ Atrium و
+
+27
+00:02:04,630 --> 00:02:07,490
+Depolarization للـ Ventricle.
+
+28
+00:02:10,470 --> 00:02:14,130
+الـ Depolarization تبع الـ Atrium بيخلص في الـ
+
+29
+00:02:14,130 --> 00:02:16,770
+Complex، يعني بيصير لهم Repolarization، وبرجع
+
+30
+00:02:16,770 --> 00:02:21,010
+بيعملوا إيه؟ Relaxation. مين اللي ضال منقبض؟ ضال منقبض
+
+31
+00:02:21,010 --> 00:02:25,030
+الـ Ventricles، بتروح وبتعمل Relaxation هنا، فبتعمل
+
+32
+00:02:25,030 --> 00:02:30,010
+الـ T-Wave. إذًا هذا هو الـElectrical Conduction أو
+
+33
+00:02:30,010 --> 00:02:32,790
+الـElectrical Wave اللي بتصير نتيجة
+
+34
+00:02:32,790 --> 00:02:37,450
+الـDepolarization والـRepolarization في اللي هو
+
+35
+00:02:37,450 --> 00:02:41,190
+الـ Heart Muscle، فبتعمل لي Atrial Depolarization،
+
+36
+00:02:41,190 --> 00:02:45,010
+بتعمل لي P-Wave، وبعدين Depolarization للـ Ventricle اللي
+
+37
+00:02:45,010 --> 00:02:49,070
+بيعمل الـ QRS Complex، وكمان بيصير فيها
+
+38
+00:02:49,070 --> 00:02:51,330
+Repolarization للـ Atria، وبعدين بيصير
+
+39
+00:02:51,330 --> 00:02:55,570
+Repolarization للـ Ventricle اللي بيعمل الـ T-Wave. هدول
+
+40
+00:02:56,490 --> 00:03:01,650
+هم الـ waves اللي بتطلع من الـ ECG. عشان نرجع
+
+41
+00:03:01,650 --> 00:03:06,990
+نفصّل أكتر ونفهم إيش هو الـ ECG، بنرجع نحكي عن الـ
+
+42
+00:03:06,990 --> 00:03:10,810
+conduction. كيف بيصير الكهربا؟ كيف بتطلع؟ لأن الـ SA
+
+43
+00:03:10,810 --> 00:03:16,510
+node، بطارية داخلية في القلب، بتطلع الـ impulses من
+
+44
+00:03:16,510 --> 00:03:18,750
+60 إلى 100 impulse
+
+45
+00:03:21,330 --> 00:03:27,490
+في الثانية. هذه بتروح كلها بتجمع في الـ AV node، زي ما تشاهدون.
+
+46
+00:03:27,490 --> 00:03:32,510
+AV عشان هي قريبة من الأُترية
+
+47
+00:03:32,510 --> 00:03:40,570
+والـ ventricle، اللي هي الـ conjunction
+
+48
+00:03:40,570 --> 00:03:46,780
+اللي بيسموها، اللي بين الأُترية والـ ventricle. هنا بتصير
+
+49
+00:03:46,780 --> 00:03:50,020
+هي عبارة عن فلتر عشان تنظم الضربات اللي طلعت من
+
+50
+00:03:50,020 --> 00:03:54,560
+الـSA node. فعشان هي مسئولة عن 40 إلى 60 Impulse
+
+51
+00:03:54,560 --> 00:04:01,320
+في الدقيقة. وبعد ذلك بتطلع الـImpulse، بتنفلِت على الـBundle
+
+52
+00:04:01,320 --> 00:04:04,580
+of His، زي ما احنا شايفين. والـ Bundle of His بتروح
+
+53
+00:04:04,580 --> 00:04:11,160
+وبتعمل تفريع لـ Right Purkinje Fiber و Left Purkinje
+
+54
+00:04:11,160 --> 00:04:15,680
+Fiber، زي ما احنا شايفين، عشان توصل لآخر اللي هو يعني
+
+55
+00:04:15,680 --> 00:04:19,520
+أو لكل، يعني الخلايا، والـ myocardium، واستجابة
+
+56
+00:04:19,520 --> 00:04:23,960
+الـimpulse هذه. هذا هو اللي بيصير في توزيع عملية
+
+57
+00:04:23,960 --> 00:04:29,980
+الكهربا. العملية هذه، بما أنه في كهربا بتعمل في
+
+58
+00:04:29,980 --> 00:04:38,620
+الجسم، اللي هو زي ما حكينا يعني كهربية معينة
+
+59
+00:04:38,620 --> 00:04:44,000
+والكهربية هذه ممكن تعمل بـwave. فمن خلال الكهربية
+
+60
+00:04:44,000 --> 00:04:47,760
+هذه، أنا ممكن أقرأ كيف وضع القلب، وكيف الـ rhythm
+
+61
+00:04:47,760 --> 00:04:54,180
+اللي ماشي عليه القلب، عن طريق ترجمة هذه الـ waves.
+
+62
+00:04:54,180 --> 00:04:58,980
+هذا بيعملّه جهاز اسمه الـ ECG (Electrocardiogram)، على
+
+63
+00:04:58,980 --> 00:05:03,060
+أساس إنه ينحط بطريقة صحيحة. كيف بنعمل؟ فيه له
+
+64
+00:05:03,060 --> 00:05:07,560
+نوعين من المواصلات،
+
+65
+00:05:07,560 --> 00:05:12,000
+فيه حاجة اسمها limb leads اللي هما ستة leads زي ما
+
+66
+00:05:12,000 --> 00:05:18,040
+احنا شايفين. بنحطه بنبدأ على الـ… زي ما الـ Fourth
+
+67
+00:05:18,040 --> 00:05:20,400
+Intercostal Space، زي ما احنا شايفين، Fourth
+
+68
+00:05:20,400 --> 00:05:25,120
+Intercostal Space على الـRight وعلى الـLeft من
+
+69
+00:05:25,120 --> 00:05:28,840
+الـSternum. بعدين بننزل على الـFifth Intercostal
+
+70
+00:05:28,840 --> 00:05:34,270
+Space وبنحط اللي هو هذا واحد، وهذا اثنين. بنحط اللي
+
+71
+00:05:34,270 --> 00:05:39,490
+هو أربعة. بين أربعة واثنين بنحط اللي هي ثلاثة،
+
+72
+00:05:39,490 --> 00:05:43,450
+كويس. بعدين بننزل على الـ fifth intercostal
+
+73
+00:05:43,450 --> 00:05:48,210
+space، بس مع الإيش؟ طبعًا هنا حطيناها مع الـ fifth
+
+74
+00:05:48,210 --> 00:05:53,930
+intercostal space مع الـ mid-clavicular line.
+
+75
+00:05:53,930 --> 00:05:56,530
+اللي بنحكي عنها mid-clavicular line. هيري
+
+76
+00:05:56,530 --> 00:05:59,780
+-clavicle. هذه الـ mid-clavicular line. ها يا عزيزي،
+
+77
+00:05:59,780 --> 00:06:02,940
+شايفين؟ بيقسم بـ clavicle، وهنا fifth intercostal
+
+78
+00:06:02,940 --> 00:06:06,400
+space، تحت الـ level تقريبًا بتيجي الـ fourth، بعدها
+
+79
+00:06:06,400 --> 00:06:09,200
+بنمشي كمان، لسه احنا على الـ fifth intercostal space.
+
+80
+00:06:09,200 --> 00:06:14,220
+هنا بس مع الـ anterior axillary line، بنحط الخامسة.
+
+81
+00:06:14,220 --> 00:06:17,540
+بخمسة، وبعدين بنحط V6 اللي هي برضه على الـ fifth
+
+82
+00:06:17,540 --> 00:06:20,880
+intercostal space، بس مش مع اللي هو الـ mid
+
+83
+00:06:20,880 --> 00:06:25,580
+-axillary line. تمام؟ هي كده بالنسبة للـ chest leads.
+
+84
+00:06:25,580 --> 00:06:31,060
+بنحط الـ limb leads اللي هم على، زي ما بنعرف على
+
+85
+00:06:31,060 --> 00:06:35,520
+الـLift Arms، هو حسب نوع الجهاز اللي عندك. إذا
+
+86
+00:06:35,520 --> 00:06:39,260
+إلكترود، بنحطّها…  المشكلة إذا ملاقية زي اللي بيكونوا
+
+87
+00:06:39,260 --> 00:06:42,560
+موجودين عندنا، بنحط الـMetal Bar Medially، يعني على
+
+88
+00:06:42,560 --> 00:06:46,620
+جهة الـInternally، على جهة الـBone اللي في
+
+89
+00:06:46,620 --> 00:06:51,940
+الـForearm.
+
+90
+00:06:52,490 --> 00:06:58,070
+فبنحط الـ right arm، right leg، left
+
+91
+00:06:58,070 --> 00:07:03,010
+leg. طبعًا هذا عشان نكون واقعيين، بتلاقي عادة
+
+92
+00:07:03,010 --> 00:07:07,590
+الأجهزة بتعتمد على ألوان أو على الترقيم بالأحرف
+
+93
+00:07:07,590 --> 00:07:15,230
+هذه: R-A-L-A-R-L. تمام؟ ممكن تكون الترقيمات أو
+
+94
+00:07:15,230 --> 00:07:22,630
+يعني في ألوان معينة بتعتمدها بعض الأجهزة. مثلًا في
+
+95
+00:07:22,630 --> 00:07:28,790
+واحد بتكون: أحمر، أصفر، أخضر، بني، أسود، بنفسجي. هنا
+
+96
+00:07:28,790 --> 00:07:32,810
+الألوان مختلفة زي ما أنتم شايفين، لكن الـ common
+
+97
+00:07:32,810 --> 00:07:38,930
+أن يكون: أحمر، أصفر، أخضر، بني، أسود، بنفسجي بالنسبة للـ
+
+98
+00:07:38,930 --> 00:07:45,550
+arms هتلاقي أنه في إنه من اليمين: أحمر،
+
+99
+00:07:48,860 --> 00:07:54,460
+أصفر، أخضر، وبعدين هنا أسود. تمام؟ أحمر، أصفر،
+
+100
+00:07:54,460 --> 00:07:59,420
+أخضر، أسود، بنفسجي.
+
+101
+00:07:59,420 --> 00:08:05,260
+بنشوف، هيك لو بدنا نعمل ECG، هيك عملناها، okay؟
+
+102
+00:08:05,260 --> 00:08:12,640
+بدنا نشوف إيش كل واحد منهم بيعطينا، ويعني إيش
+
+103
+00:08:12,640 --> 00:08:16,400
+القراءة اللي بيعطينا إياها الـ ECG. لو افترضنا إن هذا هو
+
+104
+00:08:16,400 --> 00:08:26,150
+الـ heart، وهنا الـ ECG، الـ Leads اللي شبكناهم، بنعرف
+
+105
+00:08:26,150 --> 00:08:31,730
+إنّه هنا يا جماعة، هذا بيديني الـ AVL على الـ ECG،
+
+106
+00:08:31,730 --> 00:08:38,420
+بتطلع لي 12 Lead. الثلاثة منهم بنسميهم Limb Leads،
+
+107
+00:08:38,420 --> 00:08:42,520
+وثلاثة بنسميهم Augmented Leads، وستة منهم بنسميهم
+
+108
+00:08:42,520 --> 00:08:51,860
+اللي هم Chest Leads. أو خليني أعرض لكم إياهم هنا، هنا
+
+109
+00:08:51,860 --> 00:08:55,180
+لحظة.
+
+110
+00:08:55,180 --> 00:09:01,500
+أه.
+
+111
+00:09:02,300 --> 00:09:05,420
+الثلاثة limb leads اللي هو واحد، واثنين، وثلاثة،
+
+112
+00:09:05,420 --> 00:09:08,580
+وثلاثة augmented leads اللي هو AVR، و AVL، و AVF، اللي
+
+113
+00:09:08,580 --> 00:09:13,040
+هنتبقى نشوفهم، و الـ precordial leads اللي هي الـ
+
+114
+00:09:13,040 --> 00:09:17,200
+chest leads اللي هو حوالي الـ heart من واحد لستة. كيف
+
+115
+00:09:17,200 --> 00:09:20,300
+هدول بيجوا من واحد لستة؟ هدول الـ precordial اللي
+
+116
+00:09:20,300 --> 00:09:24,000
+هي اللي بيحوطوا الـ heart، بيديني لكل واحد منهم wave.
+
+117
+00:09:24,000 --> 00:09:28,620
+طب تمام، كل واحد، كل wave منهم يا جماعة، يعني مثلًا
+
+118
+00:09:30,440 --> 00:09:34,560
+بتدّي من الـ wave تبعت الـ septal من الـ
+
+119
+00:09:34,560 --> 00:09:34,740
+heart.
+
+120
+00:09:38,610 --> 00:09:41,730
+الـ Septum المفصلة من الـ Heart. لكن مثلًا تلاتة أو
+
+121
+00:09:41,730 --> 00:09:45,350
+أربعة بتدّي الـ Anterior part تبع الـ Heart.
+
+122
+00:09:45,350 --> 00:09:48,790
+طبعًا خمسة أو ستة هتدّي الـ Lateral Wave تبع
+
+123
+00:09:48,790 --> 00:09:52,310
+الـ Heart. يعني كيف الأمواج أو الموجات الموجودة
+
+124
+00:09:52,310 --> 00:09:55,530
+الكهربية على الـ Lateral. لذلك كل واحد من
+
+125
+00:09:55,530 --> 00:10:02,250
+الـ precordial leads هدول، دي هتدّي view للـ Heart من
+
+126
+00:10:02,250 --> 00:10:07,960
+المنطقة اللي هو بيشوفها. طب وإيش بالنسبة للـ
+
+127
+00:10:07,960 --> 00:10:11,680
+Limb Leads؟ الـ Limb Leads، ها أنا حكينا، الـ AVL
+
+128
+00:10:11,680 --> 00:10:17,200
+بتدّيني، بتيجي منها، والـ AVR بتيجي منها، والـ AVF
+
+129
+00:10:17,200 --> 00:10:21,240
+بتيجي من تحت. لذلك الـ AVF عادة بتلاقيه معاه مقلوب
+
+130
+00:10:21,240 --> 00:10:26,080
+اللي فيه، ورأسه، لأنه أسفل. كمان، بنلاقي أن في عندك
+
+131
+00:10:26,080 --> 00:10:29,640
+Lead واحد، و Lead اثنين، و Lead ثلاثة. Lead واحد هو
+
+132
+00:10:29,640 --> 00:10:33,860
+عبارة عن فرق الجهد بين الـ AVL والـ AVR، فرق
+
+133
+00:10:33,860 --> 00:10:38,090
+الجهد. هذه الثلاثة هي فرق الجهد بين الـ AVR والـ AVF.
+
+134
+00:10:38,090 --> 00:10:43,350
+هذه الثلاثة، فرق الجهد بين الـ AVL والـ AVF. هذه
+
+135
+00:10:43,350 --> 00:10:50,290
+الثلاثة. لاحظ أنه هنا ما إلها دعوة في عملية فروق
+
+136
+00:10:50,290 --> 00:10:56,460
+الجهد، لأنه كله بيتلاقوا في نقطة واحدة اللي هي الـ
+
+137
+00:10:56,460 --> 00:11:04,080
+Left Foot. أما الـ Right Foot فهي يعني مكملة
+
+138
+00:11:04,080 --> 00:11:09,220
+فقط للدائرة، ولا تلعب دور في اللي هو عمل الـ
+
+139
+00:11:09,220 --> 00:11:16,800
+Limb Leads المعروفين. وزي ما حكينا إن كل مجموعة
+
+140
+00:11:16,800 --> 00:11:19,960
+من الـ Leads بيدوني View للـ Heart. يعني مثلًا
+
+141
+00:11:19,960 --> 00:11:24,390
+Leads 2 و 3 والـ AVL بيدوني الـ Inferior
+
+142
+00:11:24,390 --> 00:11:28,130
+View تبع الـ Heart. تطلعها Leads 2 و 3 والـ AVF في
+
+143
+00:11:28,130 --> 00:11:32,530
+هذا الحكي كله، تبع الجزء السفلي، الـ Inferior تبع
+
+144
+00:11:32,530 --> 00:11:38,070
+الـ Heart. لكن الـ Anterior Septum V1 و V2، لأنه بيتحدث
+
+145
+00:11:38,070 --> 00:11:42,670
+عن V1 و V2 حول الـ Sternum. الـ Anterior بتحدث عن
+
+146
+00:11:42,670 --> 00:11:48,610
+V3 و V4.  الـ Lateral بتحدث عن V5 و V6. تمام؟ فعشان
+
+147
+00:11:48,610 --> 00:11:53,790
+هي كحتة لما أنتم بتشوفوا مثلًا بشخص واحد MI، بناء
+
+148
+00:11:53,790 --> 00:11:56,290
+على الـ leads اللي فيها الإصابة، هات بيحكوا إنه
+
+149
+00:11:56,290 --> 00:11:59,490
+والله دي Inferior MI، ولا دي Lateral MI، ولا
+
+150
+00:11:59,490 --> 00:12:02,750
+Inferior Lateral MI، حسب الـ leads اللي فيها
+
+151
+00:12:02,750 --> 00:12:06,850
+الـ defect اللي هنحكي عنه، عليا في الـ MI اللي هو
+
+152
+00:12:06,850 --> 00:12:10,430
+عبارة عن ST elevation، وأن فيه ST elevation، فإنها
+
+153
+00:12:10,430 --> 00:12:15,850
+الـ lead، في الـ lead، مثلًا ثلاثة، وأربعة، وخمسة، وستة. أه،
+
+154
+00:12:15,850 --> 00:12:21,090
+لو ثلاثة، وأربعة، وخمسة، وستة، يبقى معناه Anterolateral. تمام؟
+
+155
+00:12:21,090 --> 00:12:26,530
+تمام، طب هلأ إيش معنى الـ ECG، وكيف بدنا نترجمه؟
+
+156
+00:12:26,530 --> 00:12:30,570
+وكيف بدنا نعرف كل حاجة فيه؟ إيش الـ normal تبعها؟
+
+157
+00:12:30,570 --> 00:12:35,430
+تمام؟ هو هذا اللي بدنا نتعلمه الآن، وبدنا نتعلم
+
+158
+00:12:35,430 --> 00:12:40,830
+كمان كيف نعرف الـ heart rate من الـ ECG هذا، مثلًا
+
+159
+00:12:41,630 --> 00:12:44,890
+بنحكي إن الـ P-Wave هذه اللي هي بيصير فيها الـ
+
+160
+00:12:44,890 --> 00:12:47,550
+Atrial، ليش؟ حكينا، Contraction، الـ Depolarization
+
+161
+00:12:47,550 --> 00:12:50,610
+تبع الـ Atrium، بتطلع زي ما أنتم شايفينها. طب قد إيش
+
+162
+00:12:50,610 --> 00:12:57,440
+الـ Normal تبعها؟ أول حاجة بدّي إياكم تعرفوها إن الـ ECG
+
+163
+00:12:57,440 --> 00:13:03,440
+هو عبارة عن رسم على مربعات صغيرة زي ما أنتم
+
+164
+00:13:03,440 --> 00:13:09,680
+شايفين. هذه بتمثل اللي هي وحدات زمنية، يعني الحركة
+
+165
+00:13:09,680 --> 00:13:14,760
+هذه تبع الـ Contractions تبع الـ Atrium صارت في المدة
+
+166
+00:13:14,760 --> 00:13:27,490
+من هنا إلى مثلًا هنا، تمام؟ نفترض، أو من الـ P لـ R،
+
+167
+00:13:27,490 --> 00:13:31,850
+وهي أول الـ R هنا، تبقى الـ Q. نفترض أن هذه الـ P هي
+
+168
+00:13:31,850 --> 00:13:35,690
+الـ PR Interval. اللي بنسميها هذه لحالها الـ P Wave،
+
+169
+00:13:35,690 --> 00:13:41,650
+الـ P. طيب، قد إيش المدة الزمنية اللي حصلت فيها هاي؟
+
+170
+00:13:41,650 --> 00:13:45,890
+بنعدّ المربعات، واحد، اثنين، ثلاثة، أربعة مربعات. طب
+
+171
+00:13:45,890 --> 00:13:50,670
+كيف؟ قد إيش كل مربع؟ كل مربع صغير عبارة عن 0.04 من الثانية.
+
+172
+00:13:50,670 -->
+
+223
+00:17:55,310 --> 00:17:56,150
+مربعات
+
+224
+00:17:59,220 --> 00:18:04,800
+تمام؟ لكن الـ B Wave حوالي كم؟ حوالي مربعين ونص
+
+225
+00:18:04,800 --> 00:18:10,160
+يعني حوالي 0.11 Seconds يعني الـ B Wave لحالها
+
+226
+00:18:10,160 --> 00:18:15,260
+حوالي 0.11 يعني حوالي 3 مربعات، نص ثلاثة يعني،
+
+227
+00:18:15,260 --> 00:18:20,040
+تمام؟ هذا هو الـ Normal تبعها، الـ QRS Complex زي ما
+
+228
+00:18:20,040 --> 00:18:28,480
+حكينا بتطلع حوالي من 0.08 يعني مربعين لـ 0.11 أو 0.
+
+229
+00:18:28,480 --> 00:18:32,800
+12 يعني تلت مربعات، هذا هو الطبيعي زي ما حكينا
+
+230
+00:18:32,800 --> 00:18:35,280
+الـ R wave هي الـ first positive deflection اللي
+
+231
+00:18:35,280 --> 00:18:38,300
+طالعة فوق، الـ S wave اللي هي الـ first negative
+
+232
+00:18:38,300 --> 00:18:41,220
+deflection اللي نازلة تحت الـ QRS Complex، هي الـ negative
+
+233
+00:18:41,220 --> 00:18:44,980
+deflection، أول واحد حكيناهم إحنا دولة على الـ ECG
+
+234
+00:18:44,980 --> 00:18:53,040
+نفسه، وهو هذا الـ QRS Complex، تمام؟ وحكينا اللي هو الكلام
+
+235
+00:18:53,040 --> 00:18:57,980
+هذا إن كل مربع كبير (Large Square) هو عبارة عن خمسة
+
+236
+00:18:57,980 --> 00:19:03,800
+مربعات صغيرة، وحكينا الـ QRS Complex هو عبارة عن
+
+237
+00:19:03,800 --> 00:19:10,530
+مربعين إلى تلت مربعات صغيرة، كمان حكينا عن الـ T Wave
+
+238
+00:19:10,530 --> 00:19:12,550
+إنه بيصير فيها الـ Repolarization تبع الـ
+
+239
+00:19:12,550 --> 00:19:20,090
+Ventricle، وبتكون هي يعني شبه الـ، بتطلع كيف شبه الـ
+
+240
+00:19:20,090 --> 00:19:24,710
+B Wave لكن أعرض من الـ B Wave، قد ايش هاي؟  طلع
+
+241
+00:19:24,710 --> 00:19:27,630
+الـ B Wave، بس تلت مربعات، لكن هذه بتوصل لحوالي
+
+242
+00:19:27,630 --> 00:19:31,150
+خمس مربعات، واحد، اثنين، ثلاثة، أربعة، عامل أربعة
+
+243
+00:19:31,150 --> 00:19:35,830
+مربعات وشوية يعني، تمام؟ كل هذا بتبقى وبتكون
+
+244
+00:19:35,830 --> 00:19:41,420
+عبارة عن T Wave، ممكن أحيانًا أنه يبين حالة اسمها
+
+245
+00:19:41,420 --> 00:19:46,880
+الـ U Wave لكن هذه مش بالضرورة تكون عند كل الناس
+
+246
+00:19:46,880 --> 00:19:52,350
+الـ U Wave التي بتعبّر على الـ Re-polarization
+
+247
+00:19:52,350 --> 00:19:57,490
+تبع الـ بركنجي، في عبارة لكن هذه ما بتكونش ظاهرة
+
+248
+00:19:57,490 --> 00:20:00,150
+عند الكل، ممكن تكون ظاهرة مع الناس اللي عندهم
+
+249
+00:20:00,150 --> 00:20:04,190
+hypokalemia بتوضح أكثر أو الناس اللي عندها
+
+250
+00:20:04,190 --> 00:20:08,570
+hypertension أمكن
+
+251
+00:20:08,570 --> 00:20:12,290
+هذه أهم الحاجات أنا بدي أركز عليها الآن، لو ما نعرف
+
+252
+00:20:12,290 --> 00:20:16,130
+الـ ECG، الـ hard track من الـ ECG، حكينا إنه أنا
+
+253
+00:20:16,130 --> 00:20:18,920
+أول حاجة بدي أشوفها في الـ hard track إذا كان
+
+254
+00:20:18,920 --> 00:20:21,300
+ريجولار ولا مش ريجولار، لأنه إذا كان ريجولار إله
+
+255
+00:20:21,300 --> 00:20:24,400
+طريقة، وإذا مش ريجولار إله طريقة، إذا كان ريجولار
+
+256
+00:20:24,400 --> 00:20:34,660
+فأنا بكل بساطة بدي أروح أشوف عدد المربعات
+
+257
+00:20:34,660 --> 00:20:40,930
+ما بين الـ R والـ R، بنسميها RR Interval، كم مربع
+
+258
+00:20:40,930 --> 00:20:45,830
+بينهم،  بحاجة أشوف عدد المربعات، بحاجة لأن الـ RR بين
+
+259
+00:20:45,830 --> 00:20:49,930
+الكل تمامًا مثل بعض، يعني مثلًا نشوف الـ ECG هذا، الـ
+
+260
+00:20:49,930 --> 00:20:54,910
+RR شكلهم متساويين،  أه، نطلع عليها، يعني لو بدنا
+
+261
+00:20:54,910 --> 00:20:59,790
+نعدها، المربع الكبير، واحد، اثنين، ثلاثة، أربعة، خمسة،
+
+262
+00:20:59,790 --> 00:21:04,110
+تقريبًا ستة تقريبًا، نعد الثانية، هيكون نفس الشيء،
+
+263
+00:21:04,110 --> 00:21:07,800
+أه طبعًا أنا ممكن أستخدم طرق، ممكن الطريقة هذه، ممكن أنا
+
+264
+00:21:07,800 --> 00:21:12,880
+أجيب قطعة ورق وأعلم علامة هنا، وأعلم علامة
+
+265
+00:21:12,880 --> 00:21:17,160
+هنا، وأمشي في القطعة هذه في الورقة أشوف إذا هدول
+
+266
+00:21:17,160 --> 00:21:23,480
+العلامتين اتطابقوا مع اللي هو الـ RR اللي بعدهم، و
+
+267
+00:21:23,480 --> 00:21:26,940
+بعدين الـ RR والـ RR هذه، وبعدين الـ RR والـ RR هذه،
+
+268
+00:21:26,940 --> 00:21:29,620
+أها، إذا كل هذه كانوا متساويين معناه إن أنا في
+
+269
+00:21:29,620 --> 00:21:33,380
+Regular rhythm، بكل بساطة، إيش أسوي؟  حكينا أنا بروح
+
+270
+00:21:33,380 --> 00:21:39,180
+بأعد الـ Large Boxes اللي بين الـ RR وبروح بقسم
+
+271
+00:21:39,180 --> 00:21:45,540
+ثلاثمئة تقسيم كم مربع كبير؟ خلّيني أعد مرة،
+
+272
+00:21:45,540 --> 00:21:51,520
+بدقة، واحد، اثنين، ثلاثة، أربعة، خمسة، اللي حابينها
+
+273
+00:21:51,520 --> 00:21:55,500
+فيها، أنا حسبت حوالي خمسة، تمام، مش ستة، تمام،
+
+274
+00:21:55,500 --> 00:21:58,680
+إذا الـ RR هي على خمسة، يعني ثلاثمئة على خمسة يعني
+
+275
+00:21:58,680 --> 00:22:03,230
+ستين، طيب بيجي واحد بيقول يا عم لأ كلامك مش دقيق
+
+276
+00:22:03,230 --> 00:22:07,510
+إيش اللي أنا شايفه أكتر؟ طب لأ نعد الصغار، هذه
+
+277
+00:22:07,510 --> 00:22:10,310
+واحد، هذا مربع كبير يعني خمسة، اثنين، ثلاثة،
+
+278
+00:22:10,310 --> 00:22:15,010
+أربعة، نعد الأربعة، أربعة في خمسة، عشرين،
+
+279
+00:22:15,010 --> 00:22:19,470
+كويس؟ أربعة في خمسة عشرين مربع، هذه واحد، اثنين،
+
+280
+00:22:19,470 --> 00:22:27,570
+ثلاثة، أربعة، الخامس هذا، الخامس هذا، في كم، كم
+
+281
+00:22:27,570 --> 00:22:33,320
+مربع؟ والله خمسة تقريبًا، آه وفي كمان مثلًا هذه أنا
+
+282
+00:22:33,320 --> 00:22:40,940
+مربع صغير كمان، آه يعني مثلًا في عندي خمسة، خمسة في
+
+283
+00:22:40,940 --> 00:22:44,960
+عندي خمسة وعشرين، وفي عندي واحد، في عندي إيش نفترض
+
+284
+00:22:44,960 --> 00:22:52,800
+ستة وعشرين مربع، تمام؟ طيب تمام تمام
+
+285
+00:22:58,010 --> 00:23:05,090
+بعد تكبيرها، خمسة، لأ، ده نقسم 1500 على 26 بيطلع الـ
+
+286
+00:23:05,090 --> 00:23:09,850
+heart rate، باختصار كأنه أنا بدل الـ 300 أو بدل الـ
+
+287
+00:23:09,850 --> 00:23:14,910
+300 عفواً ضربتها فيه خمسة فصارت 1500، وبدل الخمسة
+
+288
+00:23:15,440 --> 00:23:19,520
+ضربتها في خمسة فصارت 25، بس أنا عشان الدقة اكتشفت
+
+289
+00:23:19,520 --> 00:23:23,380
+ما شاء الله واحد زيادة، بروح اتعملت بدل 25، 26
+
+290
+00:23:23,380 --> 00:23:26,880
+فبيبدأ إنه يطلع الـ Heart Rate 60 بيطلع لي إيش
+
+291
+00:23:26,880 --> 00:23:33,180
+مثلًا؟ أقل حبة مثلًا 58، تمام؟ تمام التمام، إذا هذه
+
+292
+00:23:33,180 --> 00:23:36,140
+هي الطريقة اللي أنا ببدأ أعرف فيها الـ Heart Rate من
+
+293
+00:23:36,140 --> 00:23:39,320
+الـ ECG، ما بيهمنيش بصراحة، بدي أعرف لما أنا الـ Heart
+
+294
+00:23:39,320 --> 00:23:43,200
+Rate 58 ولا 60، أنا بيهمني أن يكون الـ Heart Rate
+
+295
+00:23:43,200 --> 00:23:49,480
+اللي عندي، كيف أعرف نورمال؟ النورمال يكون من ستين
+
+296
+00:23:49,480 --> 00:23:59,100
+لمئة، الستين كم مربع؟ خمس
+
+297
+00:23:59,100 --> 00:24:07,500
+مربعات، يعني أكثر من خمس مربعات حيكون الـ Heart Rate أقل
+
+298
+00:24:07,500 --> 00:24:09,240
+من ستين، براديكارديا
+
+299
+00:24:13,040 --> 00:24:18,620
+طيب، طب لما بده يكون تلت مربعات بس، يعني بده يكون
+
+300
+00:24:18,620 --> 00:24:22,180
+ثلاثمئة على ثلاثة، يعني الـ Heart Rate مئة، آه، it's
+
+301
+00:24:22,180 --> 00:24:26,560
+normal، يبقى الـ normal Heart Rate أن يكون من تلت
+
+302
+00:24:26,560 --> 00:24:32,580
+لخمس مربعات كبيرة، طب لو كان مربعين، يبقى تاكي
+
+303
+00:24:32,580 --> 00:24:36,640
+كارديا، لأنه بيصير 300 على 2، 300 على 2 يعني الـ Heart
+
+304
+00:24:36,640 --> 00:24:42,580
+Rate 150، تمام؟ فعشان هيك بتلاقي أنت مجرد ما تمسك الـ
+
+305
+00:24:42,580 --> 00:24:46,840
+ECG بتطلع بنظرة بسيطة من غير ما تقعد بدقة شديدة
+
+306
+00:24:46,840 --> 00:24:50,640
+بس بتشوف عدد المربعات من 3 إلى 5، 3 مربعات، 4
+
+307
+00:24:50,640 --> 00:24:54,920
+مربعات، 5 مربعات، طبعًا إن الـ Rate، الـ Rate إيش
+
+308
+00:24:54,920 --> 00:25:00,990
+ماله؟ Normal، وبتكون إطّلعْتَ على الـ RR Interval، لقيتهم
+
+309
+00:25:00,990 --> 00:25:05,350
+Regular، وقررت إنه بما إنهم Regular تشوف إن الـ Rate
+
+310
+00:25:05,350 --> 00:25:08,910
+كامل، فعدّيت لقيت خمس مربعات أو أربع مربعات أو ثلاث
+
+311
+00:25:08,910 --> 00:25:13,150
+مربعات، فأنت تستطيع إنك تقرر قراريْن: إن الـ Heart
+
+312
+00:25:13,150 --> 00:25:19,390
+Rate Regular والـ Heart Rate Normal من ناحية، أو
+
+313
+00:25:19,390 --> 00:25:24,110
+الـ Heart Rhythm اللي كان Regular والـ Rate تبعه
+
+314
+00:25:24,110 --> 00:25:29,550
+برضه كان Normal، لكن لو لقيت إنه الـ Heart Rate أقل
+
+315
+00:25:29,550 --> 00:25:34,030
+من 3 مربعات، مربعين، بتقول: عفواً، الكلام ده، أكثر من 5
+
+316
+00:25:34,030 --> 00:25:37,650
+مربعات، فورًا بتقول الـ Bradycardia وبتبدأ تعمل
+
+317
+00:25:37,650 --> 00:25:41,050
+Further Assessment عشان تعرف بالظبط الوضع تبع
+
+318
+00:25:41,050 --> 00:25:45,330
+المريض، تمام؟ هذا باختصار، هذه هي الطريقة اللي
+
+319
+00:25:45,330 --> 00:25:48,270
+إحنا ممكن نعرف فيها الـ Heart Rate لما يكون فيه
+
+320
+00:25:48,270 --> 00:25:53,270
+الـ Sinus Rhythm أو فيه Regular Heart Rate
+
+321
+00:25:53,270 --> 00:25:56,690
+لكن لما بيكون مش Regular، يا جماعة، لما بيكون الـ
+
+322
+00:25:56,690 --> 00:26:01,310
+Heart Rate مش Regular، غير منتظم، بكل بساطة أنت
+
+323
+00:26:01,310 --> 00:26:11,670
+بتروح بتشوف، بتاخد Strip تبع اللي هو، ثلاثين، تبع
+
+324
+00:26:11,670 --> 00:26:18,620
+ten seconds، تبع عشر ثواني، كويس، وبعدين بتروح بتعد
+
+325
+00:26:18,620 --> 00:26:23,920
+في كم R، واحد، اثنين، ثلاثة، أربعة، خمسة، ستة،
+
+326
+00:26:23,920 --> 00:26:34,360
+سبعة، كم R، وبتضربهم في ستة بيطلع، أو
+
+327
+00:26:34,360 --> 00:26:38,480
+في الحقيقة إن أنت بتضربهم في عشرة عشان يطلع الـ
+
+328
+00:26:38,480 --> 00:26:45,700
+heart rate، يعني مثلًا هنا مثلًا السبعة بتضربهم في
+
+329
+00:26:45,700 --> 00:26:50,540
+عشرة بيطلع الـ heart rate عندك، كم؟ سبعين، تمام؟
+
+330
+00:26:50,540 --> 00:26:55,440
+إذا الطريقة الثانية بكل بساطة إن أنت بتروح، بتجيب
+
+331
+00:26:55,440 --> 00:27:01,020
+strip تبع 10 seconds وبتعد كم R فيه، وبتضرب عدد
+
+332
+00:27:01,020 --> 00:27:09,000
+الـ R’s فيه اللي هو في عشرة، بيطلع لك الـ heart rate
+
+333
+00:27:09,000 --> 00:27:14,340
+طيب، عشان نعمل analysis للـ rhythm
+
+334
+00:27:18,320 --> 00:27:23,460
+لازم زي ما حكينا أننا نتطلع في الـ rhythm نعرفه إذا
+
+335
+00:27:23,460 --> 00:27:26,160
+كان Regular أو لا، مش Regular، نكون قادرين على حساب
+
+336
+00:27:26,160 --> 00:27:29,540
+الـ Rate، نتطلع في الـ P Wave ونشوفها Normal أو لا
+
+337
+00:27:29,540 --> 00:27:36,560
+نتطلع في الـ PR Interval، الـ PR Interval، هذه الـ PR،
+
+338
+00:27:36,560 --> 00:27:42,400
+هذه هي الـ PR، PR Interval طبيعية ولا لأ؟ والـ QRS
+
+339
+00:27:42,400 --> 00:27:47,280
+هذا، إن الـ duration تبعته Normal ولا مش Normal، هذه
+
+340
+00:27:47,280 --> 00:27:50,640
+محددات مهمة تخليني أعرف الـ rhythm كويسة ولا لأ، طب
+
+341
+00:27:50,640 --> 00:27:55,720
+إيش بتتمني؟ إذا الـ VR، طلعوا الـ VR هذه،
+
+342
+00:27:55,720 --> 00:28:01,060
+الـ Interval كانت مختلفة، معناه إن المريض ربما يكون
+
+343
+00:28:01,060 --> 00:28:04,300
+فيه عنده delay في الـ Impulse، إذا هذا بيصير مع
+
+344
+00:28:04,300 --> 00:28:08,560
+الـ Heart Block، يا جماعة، لأنه هنا حكينا إنه في الـ R
+
+345
+00:28:08,560 --> 00:28:12,020
+Wave بيصير Depolarization للأرض، يعني إذا الـ VR
+
+346
+00:28:12,020 --> 00:28:16,760
+Interval هذه كل مرة بتتغير، بتطول مثلًا، معناه إنه
+
+347
+00:28:16,760 --> 00:28:22,940
+بيصير تأخير، يعني إن الـ Impulse بتروح من الـ
+
+348
+00:28:22,940 --> 00:28:27,540
+Atrium للـ Ventricle، لأن الـ VR قاعدة بتطول،
+
+349
+00:28:27,540 --> 00:28:31,060
+prolongation بيحصل فيها، لذلك هذه مهمة أن تكون الـ
+
+350
+00:28:31,060 --> 00:28:36,260
+VR نفس الـ VR هنا، نفس الـ VR هنا، الـ QRS هذا هو
+
+351
+00:28:36,260 --> 00:28:41,900
+الوضع الطبيعي تبعه، أن يكون مربع، مربعين، أو ثلاثة
+
+352
+00:28:41,900 --> 00:28:46,740
+مربعات، لكن لو كان أكثر من ذلك، يكون في widening للـ QRS
+
+353
+00:28:46,740 --> 00:28:51,450
+والـ widening للـ QRS معناه إنه في delay برضه في الـ
+
+354
+00:28:51,450 --> 00:28:56,070
+Repolarization تبع الـ ventricle، وهذا ممكن يكون
+
+355
+00:28:56,070 --> 00:29:01,990
+يصير كثير في حالات الـ ventricular tachycardia
+
+356
+00:29:01,990 --> 00:29:11,380
+تمام؟ في حالات الـ Supraventricular Tachycardia
+
+357
+00:29:11,380 --> 00:29:15,860
+بتلاقي إنه الـ QRS أو الكمبليكس هذا narrow، يعني
+
+358
+00:29:15,860 --> 00:29:22,700
+أقل من مربعين صغيرين، أقل من 0.08 ثانية، ولذلك بيكون
+
+359
+00:29:22,700 --> 00:29:28,440
+هذا من مميزات اللي بنسميها الـ Supraventricular
+
+360
+00:29:28,440 --> 00:29:32,480
+Tachycardia، إنه يكون narrow complex ولا wide complex
+
+361
+00:29:32,480 --> 00:29:35,680
+حكينا
+
+362
+00:29:37,100 --> 00:29:49,700
+بالنسبة للـ Heart Rate، كيف بدنا نحسبه؟ أن
+
+363
+00:29:49,700 --> 00:29:50,480
+أطلع
+
+364
+00:29:53,540 --> 00:29:57,680
+إيش طريقة حساب الـ Heart Rate لما أكون مش Regular
+
+365
+00:29:57,680 --> 00:30:01,860
+الصراحة، لما يعني هذا الطريق، يعني هذا مثلًا Heart
+
+366
+00:30:01,860 --> 00:30:05,840
+Rate لأنه Regular، ما فيش داعي إن أروح أعد الـ R waves
+
+367
+00:30:05,840 --> 00:30:13,240
+في ست ثواني وأضرب في عشرة، لأنهم Regular، طب ما أنا
+
+368
+00:30:13,240 --> 00:30:19,740
+بأعدّ، واحد، اثنين، ثلاثة، تقريبًا ثلاثة لأن واحد، اثنين،
+
+369
+00:30:19,740 --> 00:30:24,580
+ثلاثة تقريبًا، مازال ثلاثة يعني، وأروح بعمل ثلاثمئة
+
+370
+00:30:24,580 --> 00:30:28,360
+تقسيم ثلاثة، الـ Heart Rate حوالي المئة، لكن لو
+
+371
+00:30:28,360 --> 00:30:34,340
+irregular، يعني مثلًا بين الـ RR، الـ R هذه والـ R هذه
+
+372
+00:30:34,340 --> 00:30:38,960
+واحد، اثنين، ثلاثة وشوية
+
+373
+00:30:44,290 --> 00:30:48,510
+لكن بين الـ R والـ R هذه لقيت فيه أربعة، بعدين
+
+374
+00:30:48,510 --> 00:30:51,030
+الـ R والـ R هذه لقيت فيه اثنين، هذا الـ series
+
+375
+00:30:51,030 --> 00:30:54,790
+اسمه irregular، فعيدها، بنروح إحنا بكل بساطة،
+
+376
+00:30:54,790 --> 00:30:59,950
+بنجيب strip لست ثواني، وبنعد كم R، آه، كم R في
+
+377
+00:30:59,950 --> 00:31:04,070
+عندي، كم Complex، بروح بضربهم في عشرة، بيطلع الـ
+
+378
+00:31:04,070 --> 00:31:05,710
+Heart Rate
+
+379
+00:31:08,790 --> 00:31:14,310
+حكينا إيش يعني Regular، إنه يكون المسافة بين الـ RR
+
+380
+00:31:14,310 --> 00:31:19,030
+وبين الـ RR الأولى والـ RR الثانية والـ RR الثالثة
+
+381
+00:31:19,030 --> 00:31:23,610
+وكل الـ RR هي نفس المسافة، وهذا معناه يكون
+
+382
+00:31:23,610 --> 00:31:27,510
+Regular، إذا ما كانت زي هيك يكون Irregular
+
+383
+00:31:27,510 --> 00:31:31,830
+بالنسبة للـ P Wave، مميزات الـ P Wave يا جماعة أول
+
+384
+00:31:31,830 --> 00:31:35,590
+حاجة إنها تكون قبل كل Complex، لازم كل Complex يكون
+
+385
+00:31:35,590 --> 00:31:46,400
+فيه قبله P Wave، ومن ثم H وهو QRS Complex، ودائمًا
+
+386
+00:31:46,400 --> 00:31:49,980
+الـ P Wave بتحدث H، برضه عادية يعني بتلاقي
+
+387
+00:31:49,980 --> 00:31:55,500
+هنا P، P، P، P، ولذلك حتى من طرق الـ
+
+388
+00:31:55,500 --> 00:32:00,160
+Calculation تبع الـ Regular Heart Rate إنه أنا
+
+389
+00:32:00,160 --> 00:32:03,780
+بدل ما أعدّ المسافة بين الـ R والـ R، أعدّ
+
+390
+00:32:03,780 --> 00:32:07,5
\ No newline at end of file
diff --git a/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/IjMympjjuqA_postprocess.srt b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/IjMympjjuqA_postprocess.srt
new file mode 100644
index 0000000000000000000000000000000000000000..31317d5a7126313a0aa28c44de970db57d348c48
--- /dev/null
+++ b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/IjMympjjuqA_postprocess.srt
@@ -0,0 +1,1660 @@
+1
+00:00:02,040 --> 00:00:04,720
+السلام عليكم ورحمة الله وبركاته باسم الله الصلاة
+
+2
+00:00:04,720 --> 00:00:09,040
+والسلام على رسول الله نحكي في الـ Management of
+
+3
+00:00:09,040 --> 00:00:13,880
+Patients with Different Rhythmias لما بنحكي عن ال
+
+4
+00:00:13,880 --> 00:00:17,660
+patients اللي عندهم this rhythmias لازم نكون أولا
+
+5
+00:00:17,660 --> 00:00:22,900
+نعرف ال normal rhythm عشان نقدر نعرف و نتعرف على
+
+6
+00:00:22,900 --> 00:00:24,460
+أن هذا ال rhythm هو من
+
+7
+00:00:28,370 --> 00:00:32,810
+الـ Rhythm Disorders وبدنا نعرف من أنه الـ Rhythm
+
+8
+00:00:32,810 --> 00:00:38,710
+Disorder اللي احنا ممكن انشخصه فلو بنحكي عن الـ
+
+9
+00:00:38,710 --> 00:00:42,650
+Normal Electrical Conduction بنعرف انه بتصير فيها
+
+10
+00:00:42,650 --> 00:00:47,110
+أما contraction كل contraction بتعمل اللي هو الـ
+
+11
+00:00:47,110 --> 00:00:51,490
+systolic blood pressure وبعدين بيصير relaxation
+
+12
+00:00:53,800 --> 00:00:57,560
+وهذا طبعاً بيعملنا دا historic blood pressure
+
+13
+00:00:57,560 --> 00:01:00,740
+طبعاً نعرف إن هذا بيصير عن طريق اللي هو الـ
+
+14
+00:01:00,740 --> 00:01:08,460
+Depolarization الـ Depolarization لـ الـالـ Heart
+
+15
+00:01:08,460 --> 00:01:13,580
+Muscle فبنعرف لما بيصير Depolarization للأتريان
+
+16
+00:01:13,580 --> 00:01:17,360
+بيعملّي لو بدنا نحكي عن الـ Electrical Conduction
+
+17
+00:01:17,360 --> 00:01:21,520
+اللي بتعملها بيعملّي Wave اسمها الـ B Wave على ال
+
+18
+00:01:21,520 --> 00:01:29,720
+ECG وبعد هي كده بيصيرهو بدي أحكي على الـ… بدي
+
+19
+00:01:29,720 --> 00:01:33,580
+أفرجيكوا بس الـECG هنا وبعدين نرجع عشان نكون
+
+20
+00:01:33,580 --> 00:01:39,640
+عارفين إيش الترجمة هنا الترجمة للمراحل اللي بيصير
+
+21
+00:01:39,640 --> 00:01:42,620
+فيها «De-polarization» و«Re-polarization» في
+
+22
+00:01:42,620 --> 00:01:46,720
+المرحلة تبقى الأول مرحلة بتصير بيدي أنا الأتريان
+
+23
+00:01:46,720 --> 00:01:50,360
+بيصير هم contraction فهذا بيصير بأعمللي الـB-web
+
+24
+00:01:50,360 --> 00:01:54,380
+يعني الـB-web يكون عبارة عن «De-polarization»
+
+25
+00:01:54,380 --> 00:01:59,750
+لمين؟للـ Atrium بعدها إيش بيصير؟ في الـ Complex
+
+26
+00:01:59,750 --> 00:02:04,630
+Setup الـ QRS بعمل ليه Repolarization للـ Atrium و
+
+27
+00:02:04,630 --> 00:02:07,490
+Depolarization للـ Ventricle
+
+28
+00:02:10,470 --> 00:02:14,130
+الـ Depolarization تبع الـ Atrium بيخلص في الـ
+
+29
+00:02:14,130 --> 00:02:16,770
+Complex يعني بيصير لهم Repolarization و برجع
+
+30
+00:02:16,770 --> 00:02:21,010
+بيعملوا إيه؟ Relaxation مين ضال منقبض؟ ضال منقبض
+
+31
+00:02:21,010 --> 00:02:25,030
+الـ Ventricles بتروح و بتعمل Relaxation هنا فبتعمل
+
+32
+00:02:25,030 --> 00:02:30,010
+الـ T-Wave إذاً هذا هو الـElectrical Conduction أو
+
+33
+00:02:30,010 --> 00:02:32,790
+الـElectrical Wave اللي بتصير نتيجة
+
+34
+00:02:32,790 --> 00:02:37,450
+الـDepolarization و الـRepolarization فياللي هو
+
+35
+00:02:37,450 --> 00:02:41,190
+الـ Heart Muscle فبتعملّي Atrial Depolarization
+
+36
+00:02:41,190 --> 00:02:45,010
+بتعملّي B-Wave وبعدين Depolarization للفنترك اللي
+
+37
+00:02:45,010 --> 00:02:49,070
+بيعمل الـ QRS Complex وكمان بيصير فيها
+
+38
+00:02:49,070 --> 00:02:51,330
+Repolarization للـ Atria وبعدين بيصير
+
+39
+00:02:51,330 --> 00:02:55,570
+Repolarization للفنترك اللي بيعمل الـ T-Wave هدولة
+
+40
+00:02:56,490 --> 00:03:01,650
+وهما الـ waves اللي بتطلع من الـ ECG عشان أن نرجع
+
+41
+00:03:01,650 --> 00:03:06,990
+نفصل أكتر ونفهم إيش هو الـ ECG بنرجع نحكي عن الـ
+
+42
+00:03:06,990 --> 00:03:10,810
+conduction كيف بيصير الكهربا كيف بتطلع لأن الـ SA
+
+43
+00:03:10,810 --> 00:03:16,510
+node بطارية داخلية في القلب بتطلع الـ impulses من
+
+44
+00:03:16,510 --> 00:03:18,750
+ستين لمية impulse
+
+45
+00:03:21,330 --> 00:03:27,490
+هذه البروح كلها تجمع في نبضة AV نوت زي ما تشاهدون
+
+46
+00:03:27,490 --> 00:03:32,510
+AV عشان هي قريبة من الاتريام
+
+47
+00:03:32,510 --> 00:03:40,570
+والفنتريكل اللي هي الـ conjunction
+
+48
+00:03:40,570 --> 00:03:46,780
+اللي يسميها اللي بين الاتريام والفنتريكلفهنا بتصير
+
+49
+00:03:46,780 --> 00:03:50,020
+هي عبارة عن فلتر عشان تنظم الضربات اللي طلعت من
+
+50
+00:03:50,020 --> 00:03:54,560
+الـSA node فعشان هي مسئولة عن 40 إلى 60 Impulse
+
+51
+00:03:54,560 --> 00:04:01,320
+وبعد ذلك بتطلع الـImpulse انفلترات على الـBundle
+
+52
+00:04:01,320 --> 00:04:04,580
+of His زي ما احنا شايفين والبندل of his بتروح
+
+53
+00:04:04,580 --> 00:04:11,160
+وبتعمل تفريق لRight per Kg Fiber وLeft per Kg
+
+54
+00:04:11,160 --> 00:04:15,680
+Fiber زي ما احنا شايفين عشان توصل لآخراللي هو يعني
+
+55
+00:04:15,680 --> 00:04:19,520
+أو لكل يعني الخلايا والـmyocardium واستجيبة
+
+56
+00:04:19,520 --> 00:04:23,960
+الـimpulse هذه هذا هو اللي بيصير في توزيع عملية
+
+57
+00:04:23,960 --> 00:04:29,980
+الكهربا العملية هذه بما أنه في كهربا بتعمل في
+
+58
+00:04:29,980 --> 00:04:38,620
+الجسم اللي هو زي ما حكينا يعني كهربية معينة
+
+59
+00:04:38,620 --> 00:04:44,000
+والكهربية هذه ممكن تعمل بـwave فمن خلالالكهربية
+
+60
+00:04:44,000 --> 00:04:47,760
+هذه، أنا ممكن أقرأ كيف وضع القلب وكيف الـ rhythm
+
+61
+00:04:47,760 --> 00:04:54,180
+اللي ماشي عليه القلب عن طريق ترجمة هذه الـ waves
+
+62
+00:04:54,180 --> 00:04:58,980
+هذا بيعمله جهاز اسمه الـ ECG Electrocardiogram على
+
+63
+00:04:58,980 --> 00:05:03,060
+أساس إنه ينحطه بطريقة صحيحة كيف بنعمل، فيه له
+
+64
+00:05:03,060 --> 00:05:07,560
+نوعين من المواصلات،
+
+65
+00:05:07,560 --> 00:05:12,000
+فيه حاجة اسمها limb bleedاللي هما ستة ليب زي ما
+
+66
+00:05:12,000 --> 00:05:18,040
+أحنا شايفين بنحطه بنبدأ على ال... زي ما الـFourth
+
+67
+00:05:18,040 --> 00:05:20,400
+Intercostal Space زي ما أحنا شايفين Fourth
+
+68
+00:05:20,400 --> 00:05:25,120
+Intercostal Space على الـRight وعلى الـLeft من
+
+69
+00:05:25,120 --> 00:05:28,840
+الـSternum بعدين بننزل على الFifth Intercostal
+
+70
+00:05:28,840 --> 00:05:34,270
+Space وبنحط اللي هو هذا واحد وهذا اتنين، بنحطاللي
+
+71
+00:05:34,270 --> 00:05:39,490
+هي أربعة، بين أربعة واثنين بنحط اللي هي تلاتة،
+
+72
+00:05:39,490 --> 00:05:43,450
+كويس، بعدين كبننزل على ال «fifth intercostal
+
+73
+00:05:43,450 --> 00:05:48,210
+space» بس مع الإيش؟ طبعاً هنا حطناها مع ال «fifth
+
+74
+00:05:48,210 --> 00:05:53,930
+intercostal space» مع ال «mid-clavicular line»
+
+75
+00:05:53,930 --> 00:05:56,530
+اللي بنحكي عنها «mid-clavicular line» هيري
+
+76
+00:05:56,530 --> 00:05:59,780
+-clavicleهذه الـ mid-clavicular line ها يا عزيزي
+
+77
+00:05:59,780 --> 00:06:02,940
+شايفين؟ بيقسم بـ clavicle وهنا fifth intercostal
+
+78
+00:06:02,940 --> 00:06:06,400
+space تحت ال level تقريبا بتيجي ال fourth بعدها
+
+79
+00:06:06,400 --> 00:06:09,200
+بنمشي كمان لسه احنا على ال fifth intercostal space
+
+80
+00:06:09,200 --> 00:06:14,220
+هنا بس مع ال anterior auxiliary line بنحط الخامسة
+
+81
+00:06:14,220 --> 00:06:17,540
+بخمسة وبعدين بنحط V6 اللي هي برضه على ال fifth
+
+82
+00:06:17,540 --> 00:06:20,880
+intercostal space بس ماعليهاش مع اللي هو ال mid
+
+83
+00:06:20,880 --> 00:06:25,580
+-axillary line تمام؟ هي كده بالنسبة لل chest lead
+
+84
+00:06:25,580 --> 00:06:31,060
+بنحط ال limb lead اللي همعلى، زي ما بنعرف على
+
+85
+00:06:31,060 --> 00:06:35,520
+الـLift Arms هو حسب نوع الجهاز اللي عندك إذا
+
+86
+00:06:35,520 --> 00:06:39,260
+إلكتروت، بنحطش المشكلة إذا ملاقص زي اللي بكونوا
+
+87
+00:06:39,260 --> 00:06:42,560
+موجودين عندنا بنحط الـMetal Bar Medially يعني على
+
+88
+00:06:42,560 --> 00:06:46,620
+جهة الـInternally، على جهة الـBone اللي في
+
+89
+00:06:46,620 --> 00:06:51,940
+الـForearm
+
+90
+00:06:52,490 --> 00:06:58,070
+فبنحط الـ «lift arm» «right arm» «right leg» «left
+
+91
+00:06:58,070 --> 00:07:03,010
+leg» طبعاً هذا عشان نكون واقعيين بتلاقي عادة
+
+92
+00:07:03,010 --> 00:07:07,590
+الأجهزة بتعتمد على ألوان أو على الترقيم بالأحرف
+
+93
+00:07:07,590 --> 00:07:15,230
+هذه L-A-R-A-R-L-L، تمام؟ ممكن تكون الترقيمات أو
+
+94
+00:07:15,230 --> 00:07:22,630
+يعني في ألوان معينة بتعتمدهابعض الأجهزة مثلًا في
+
+95
+00:07:22,630 --> 00:07:28,790
+واحد بتكون أحمر أصفر أخضر بني أسود بنفسجي هنا
+
+96
+00:07:28,790 --> 00:07:32,810
+الألوان مختلفة زي ما انتوا شايفينه لكن ال common
+
+97
+00:07:32,810 --> 00:07:38,930
+أن يكون أحمر أصفر أخضر بني أصمر بنفسجي بالنسبة لل
+
+98
+00:07:38,930 --> 00:07:45,550
+arm هتلاقي أنه في إنه من اليمين أحمر أحمر
+
+99
+00:07:48,860 --> 00:07:54,460
+أصفر، أخضر، وبعدين هنا أسود تمام؟ أحمر، أصفر،
+
+100
+00:07:54,460 --> 00:07:59,420
+أخضر، أسود بنجي
+
+101
+00:07:59,420 --> 00:08:05,260
+بنشوف، هيك لو بدنا نعمل ECG هيك عملناها، okay؟
+
+102
+00:08:05,260 --> 00:08:12,640
+بدنا نشوف إيش كل واحد منهم بيعطينا ويعني إيش
+
+103
+00:08:12,640 --> 00:08:16,400
+القراة اللي جدينا إيها ال ECG لو اعترضنا إن هذا هو
+
+104
+00:08:16,400 --> 00:08:26,150
+ال heartوهنا الـ ECG الـ Leads اللي شبكناهم بنعرف
+
+105
+00:08:26,150 --> 00:08:31,730
+إنه هنا يا جماعة هذا بتديني الـ AVL على الـ ECG
+
+106
+00:08:31,730 --> 00:08:38,420
+بتطلعلي 12 Leadالتلاتة منهم بنسميهم «Limb Lead»
+
+107
+00:08:38,420 --> 00:08:42,520
+وتلاتة بنسميهم «Augmented Lead» وستة منهم بنسميهم
+
+108
+00:08:42,520 --> 00:08:51,860
+اللي هم «Chest Lead» أو خليني أعرضكي لهم هنا، هنا
+
+109
+00:08:51,860 --> 00:08:55,180
+لحظة
+
+110
+00:08:55,180 --> 00:09:01,500
+أه
+
+111
+00:09:02,300 --> 00:09:05,420
+الثلاثة الـ limb lead اللي هو واحد واثنين وثلاثة
+
+112
+00:09:05,420 --> 00:09:08,580
+وثلاثة augmented lead اللي هو AVR و AVL و AVF اللي
+
+113
+00:09:08,580 --> 00:09:13,040
+هتبقى نشوفهم و ال pericardial leads اللي هي ال
+
+114
+00:09:13,040 --> 00:09:17,200
+chest lead اللي هو حوالي ال heart من واحد لستة كيف
+
+115
+00:09:17,200 --> 00:09:20,300
+هدول بيجوا من واحد لستة هدول ال pericardial اللي
+
+116
+00:09:20,300 --> 00:09:24,000
+هي اللي بيحوطوا ال heart بيديني لكل واحد منهم wave
+
+117
+00:09:24,000 --> 00:09:28,620
+طب تمام كل واحد كل wave منهم يا جماعة يعني مثلا
+
+118
+00:09:30,440 --> 00:09:34,560
+بتدّي من الـ web تبعت الدُزُق الـ septal من الـ
+
+119
+00:09:34,560 --> 00:09:34,740
+heart
+
+120
+00:09:38,610 --> 00:09:41,730
+الـSeptum المفصلة من الـHeart لكن مثلا تلاتة أو
+
+121
+00:09:41,730 --> 00:09:45,350
+أربعة أشعة الدين الـAnterior part تبع الـHeart
+
+122
+00:09:45,350 --> 00:09:48,790
+طبعاً خمسة أو ستة هتدّين الـLateral Wave تبع
+
+123
+00:09:48,790 --> 00:09:52,310
+الـHeart يعني كيف الأنواج أو الموجات الموجودة
+
+124
+00:09:52,310 --> 00:09:55,530
+الكهربية على الـLateral لذلك كل واحد من
+
+125
+00:09:55,530 --> 00:10:02,250
+الـBricardial ليس هدولة دي هتدين view للـHeart من
+
+126
+00:10:02,250 --> 00:10:07,960
+المنطقة اللي هو بيشوفوا فيهاطب وإيش بالنسبة للـ
+
+127
+00:10:07,960 --> 00:10:11,680
+Limb Lead؟ الـ Limb Lead، ها أنا حكينا بالـ AVL
+
+128
+00:10:11,680 --> 00:10:17,200
+بتديني، بتتيجي منها والـ AVR بتيجي منها، والـ AVF
+
+129
+00:10:17,200 --> 00:10:21,240
+بتيجي من تحت لذلك الـ AVF عادة بتلاقيه معاه مقلوب
+
+130
+00:10:21,240 --> 00:10:26,080
+اللي في ورأسه لأنه أسفل، كمان، بنلاقي أن في عندك
+
+131
+00:10:26,080 --> 00:10:29,640
+Lead واحد و Lead اتنين و Lead تلاتة، Lead واحد هو
+
+132
+00:10:29,640 --> 00:10:33,860
+عبارة عن فرق الجهد بين الـ AVL و الـ AVR، فرق
+
+133
+00:10:33,860 --> 00:10:38,090
+الجهدهذه التلاتة هي فرق الجهد بين الـ AVR والـ AVF
+
+134
+00:10:38,090 --> 00:10:43,350
+هذه التلاتة الفرق الجهد بين الـ AVL والـ AVF هذه
+
+135
+00:10:43,350 --> 00:10:50,290
+التلاتة لاحظ أنه هنا مايلوش دعوة في عملية فروق
+
+136
+00:10:50,290 --> 00:10:56,460
+الجهد لأنه كلهيتم بلتقوا في نقطة واحدةاللي هي الـ
+
+137
+00:10:56,460 --> 00:11:04,080
+«Left Foot» أما الـ «Right Foot» فهي يعني مكملة
+
+138
+00:11:04,080 --> 00:11:09,220
+فقط للدائرة ولا تلعب دور فيه اللي هو عمل الـ
+
+139
+00:11:09,220 --> 00:11:16,800
+«Limb» «Legs» المعروفين وزي ما حكينا إن كل مجموعة
+
+140
+00:11:16,800 --> 00:11:19,960
+من الـ «Legs» بيدوني «View» للـ «Hard» يعني مثلا
+
+141
+00:11:19,960 --> 00:11:24,390
+«Legs» 2 و3 والـ «AVL» بيدوني الـ«Inferior»الـ
+
+142
+00:11:24,390 --> 00:11:28,130
+View تبقى الهارد تطلعها يقليد 2 و 3 والـ EVF في
+
+143
+00:11:28,130 --> 00:11:32,530
+هذا التحيك كله تبقى الجزء السفلي الـ Interior تبقى
+
+144
+00:11:32,530 --> 00:11:38,070
+الهارد لكن الـ Anterior Scepter V1 و V2 لأنه يتحدث
+
+145
+00:11:38,070 --> 00:11:42,670
+عن V1 و V2 حول الـ Sternum الـ Anterior تتحدث عن
+
+146
+00:11:42,670 --> 00:11:48,610
+V3 و V4 التبلاترالية تتحدث عن V5 و V6تمام؟ فعشان
+
+147
+00:11:48,610 --> 00:11:53,790
+هي كحتة لما انتوا بتشوفوا مثلا بشخص واحد MI بناء
+
+148
+00:11:53,790 --> 00:11:56,290
+على الـ lead اللي فيها الإصابة هات بيحكوا إنه
+
+149
+00:11:56,290 --> 00:11:59,490
+والله دي inferior MI ولا دي lateral MI ولا
+
+150
+00:11:59,490 --> 00:12:02,750
+inferior lateral MI حصل ال leads اللي فيها
+
+151
+00:12:02,750 --> 00:12:06,850
+الـdefect اللي هنحكي عنه عليا في الـMI اللي هو
+
+152
+00:12:06,850 --> 00:12:10,430
+عبارة عن SD elevation وان فيه SD elevation فانهما
+
+153
+00:12:10,430 --> 00:12:15,850
+الـlead في الـlead مثلا تلاتة واربعة وخمسة وستةأه
+
+154
+00:12:15,850 --> 00:12:21,090
+مازال 3 و 4 و 5 و 6 يبقى معناه anterolateral تمام؟
+
+155
+00:12:21,090 --> 00:12:26,530
+تمام، طب هلأ إيش معناه ال ECG وكيف بدنا نترجمه؟
+
+156
+00:12:26,530 --> 00:12:30,570
+وكيف بدنا نعرف كل حاجة فيه؟ إيش ال normal تبعها؟
+
+157
+00:12:30,570 --> 00:12:35,430
+تمام؟ هو هذا اللي بدنا نتعلمه الآن وبدنا نتعلم
+
+158
+00:12:35,430 --> 00:12:40,830
+كمان كيف نعرف ال heart rate من ال ECG هذا، مثلا
+
+159
+00:12:41,630 --> 00:12:44,890
+بنحكي إن الـ B-Wave هذه اللي هي بيصير فيها الـ
+
+160
+00:12:44,890 --> 00:12:47,550
+Atrial ليش حكينا Contraction الـ Depolarization
+
+161
+00:12:47,550 --> 00:12:50,610
+تبع الـ Atrial تطلع زي ما انتوا شايفينه طب قديش
+
+162
+00:12:50,610 --> 00:12:57,440
+الـ Normal تبعها؟ أول حاجة بديكوا تعرفواإن الـ ECG
+
+163
+00:12:57,440 --> 00:13:03,440
+هو عبارة عن رسم على مربعات صغيرة زي ما انتوا
+
+164
+00:13:03,440 --> 00:13:09,680
+شايفين هذه بتمثل اللي هي وحدات زمانية يعني الحركة
+
+165
+00:13:09,680 --> 00:13:14,760
+هذه تبع الـ Contracts تبع الـ Atrium صارت في المدة
+
+166
+00:13:14,760 --> 00:13:27,490
+من هنا إلى مثلا هنا تمام؟ نفترضأو من الـP لـR،
+
+167
+00:13:27,490 --> 00:13:31,850
+وهي أول الـR هنا تبقى الـQ نفترض أن هذه الـP هي
+
+168
+00:13:31,850 --> 00:13:35,690
+الـR Interval اللي بنسميها هذه لحالها الـP Wave،
+
+169
+00:13:35,690 --> 00:13:41,650
+الـP طيب، قداش المدة الزمنية اللي حصلت فيها هاي؟
+
+170
+00:13:41,650 --> 00:13:45,890
+لنقد المربعات، واحد، اتنين، تلاتة، أربع مربعات طب
+
+171
+00:13:45,890 --> 00:13:50,670
+كيف؟ قداش كل مربع؟ كل مربع أبارع عن 2% من السانية
+
+172
+00:13:50,670 --> 00:13:57,040
+كل مربع أبارع عنأفن 0.4% من الثانية يعني 4% من
+
+173
+00:13:57,040 --> 00:14:04,150
+الثانيةيعني كل مربع صغير هدولة مربعات صغيرة أربعة
+
+174
+00:14:04,150 --> 00:14:07,510
+في المية من السنة بالخمس مربعات يعني open في أربعة
+
+175
+00:14:07,510 --> 00:14:11,510
+ضارب خمسة يعني تصير اتنين من عشرة يعني كل خمس
+
+176
+00:14:11,510 --> 00:14:17,910
+مربعات صغيرة هي عبارة عن مربع واحد كبير ومربع كبير
+
+177
+00:14:17,910 --> 00:14:22,830
+هو عبارة عن اتنين من عشرة من الثانية واخد بالة إذا
+
+178
+00:14:22,830 --> 00:14:29,170
+هذا اللي بيخلي أن أنا حتى لما أعمل قراءةالـ ECG
+
+179
+00:14:29,170 --> 00:14:31,510
+وقد أعرف منه الـ Heart Rate أو أحسب منه الـ Heart
+
+180
+00:14:31,510 --> 00:14:36,270
+Rate بستطيع أن أحسب الـ Heart Rate لأنه أنا لو عدت
+
+181
+00:14:36,270 --> 00:14:44,890
+أكم بيتحصلت كل QRSكل B Q R S T كل واحدة من هدول
+
+182
+00:14:44,890 --> 00:14:49,050
+كاملة هي عبارة عن one beat كاملة متكاملة فيها
+
+183
+00:14:49,050 --> 00:14:52,810
+relaxation contraction و relaxation تمام فأنا لو
+
+184
+00:14:52,810 --> 00:14:56,210
+قدت هذه واحدة وكمان واحدة زيها وكمان واحدة زيها
+
+185
+00:14:56,210 --> 00:15:01,330
+وكمان واحدة زيها في مدة دقيقة بعرف أن أكم beat
+
+186
+00:15:01,330 --> 00:15:06,430
+صارت دقيقة بس هذا الكلام اللي بحكي لازم يكون إيش
+
+187
+00:15:08,140 --> 00:15:11,820
+الـ Heart Rate بتكون Regular، منتظم، ليش؟ عشان أنا
+
+188
+00:15:11,820 --> 00:15:14,560
+لما أقعد أقول إنه «high B to high B» كيف بتعرفهم؟
+
+189
+00:15:14,560 --> 00:15:18,720
+بتروح أقعد أكم «R» من أندي من هنا، أي واحدة،
+
+190
+00:15:18,720 --> 00:15:23,480
+تنتين، مثلا، تمام؟ اللي هو بنسميها الـRR Interval،
+
+191
+00:15:23,480 --> 00:15:30,500
+هي الـRR Interval هي بتكون بالظبط في كل الـECG
+
+192
+00:15:31,890 --> 00:15:37,270
+Similar نفس الـRR Interval يعني الـRR من هنا لهنا
+
+193
+00:15:37,270 --> 00:15:43,810
+مثلا تلت مربعات كبار يعني خمستاشر مربع زي المفترق
+
+194
+00:15:43,810 --> 00:15:47,050
+بديوا يكونوا في كل ال ECG بين الـR والـR خمستاشر
+
+195
+00:15:47,050 --> 00:15:50,410
+مربع زيه اللي هم تلت مربعات كبار، تلت مربعات كبار
+
+196
+00:15:50,410 --> 00:15:55,690
+يعني المربع الكبير عبارة عن خمس مربعات أصغر، تمام؟
+
+197
+00:15:55,690 --> 00:16:02,150
+إذا كان هيك، بروح أنا بكل بساطة بعدالمربعات هدولة
+
+198
+00:16:02,150 --> 00:16:05,590
+وبعدين هنشوف كيف في حسبة هتخليني أحسب المعرف منهم
+
+199
+00:16:05,590 --> 00:16:13,310
+الـ ECG، تمام؟ شوفنا الـ B-wave وحكينا عنها إنه هي
+
+200
+00:16:13,310 --> 00:16:16,690
+عبارة عن الـ Atrial Contraction بعدين بيجي هنا
+
+201
+00:16:16,690 --> 00:16:19,850
+بتنزل الـ Q، شايفين هذا الـ depression هذا؟ ده
+
+202
+00:16:19,850 --> 00:16:23,990
+عبارة عن الـ Q-waveبعدين تبقى الـR راديكولا هيتا
+
+203
+00:16:23,990 --> 00:16:27,690
+هيت ر بعدين هي الـS الـDepression هذا من هنا من
+
+204
+00:16:27,690 --> 00:16:31,550
+هنا هذا الـS وبعدين بتيجي الـT الناس اللي بيقولوا
+
+205
+00:16:31,550 --> 00:16:35,190
+الـMI بتلاقي الـS بدت من هنا جماعة بيبقى بدت هنا
+
+206
+00:16:35,190 --> 00:16:41,590
+ونزلت إيش معناه؟ ST elevation elevation عن مين؟ عن
+
+207
+00:16:41,590 --> 00:16:45,150
+الـIsoelectric line هذا هذا هو الـIsoelectric line
+
+208
+00:16:45,150 --> 00:16:50,440
+المفروض أنه بدت من هنالما تيجي الـ S تنزل، هيها،
+
+209
+00:16:50,440 --> 00:16:53,660
+الـ S هيها، نزلت، المفروض تبدأ تطلع، المفروض تطلع
+
+210
+00:16:53,660 --> 00:16:57,460
+توصل لمن؟ للـ Isoelectric line، لكن لما تروح الـ S
+
+211
+00:16:57,460 --> 00:17:04,670
+من هنا، وهي عاملة، هيك، و بعدين، هيك،يعني بدلًا
+
+212
+00:17:04,670 --> 00:17:08,450
+الـ «إيزو إلكتريك لاين» كان عفواً «هان» صار «هان»
+
+213
+00:17:08,450 --> 00:17:11,390
+وهذا اسمه «ST elevation» اللي بيحصل في حالات الأمن
+
+214
+00:17:11,390 --> 00:17:17,390
+«I» تمام، فعلشان هي كان مهم جدًا أني أطلع أكون
+
+215
+00:17:17,390 --> 00:17:22,290
+عارف كل واحد فيه مالية، بدنا نشوف قداش المسافة
+
+216
+00:17:22,290 --> 00:17:25,730
+اللي لازم يمشيها وقداش الارتفاع التبعي اللي بدي
+
+217
+00:17:25,730 --> 00:17:30,590
+يكونعشان يكون هذا طبيعي وقداش المسافات بين مثلًا
+
+218
+00:17:30,590 --> 00:17:34,370
+الـST segment قداش الطبيعي اللي لازم تكون الـQRS
+
+219
+00:17:34,370 --> 00:17:38,230
+Complex هذا قداش لازم يكون تمام؟ لو كنا نجي نشوف
+
+220
+00:17:38,230 --> 00:17:41,270
+مثلًا الـQRS Complex مش زي ما انتوا شافينه حوالي
+
+221
+00:17:41,270 --> 00:17:49,590
+تلت مربعات هو الطبيعي تبعه فعلا من 0.8 يعني من 0
+
+222
+00:17:49,590 --> 00:17:55,310
+.08 يعني من مربعين لـ0.11 أو 0.12 يعني لأ تلت
+
+223
+00:17:55,310 --> 00:17:56,150
+مربعات
+
+224
+00:17:59,220 --> 00:18:04,800
+تمام؟ لكن الـ B Wave حوالي أكام؟ حوالي مربعين ونص
+
+225
+00:18:04,800 --> 00:18:10,160
+يعني حوالي 0.11 Seconds يعني الـ B Wave لحالها
+
+226
+00:18:10,160 --> 00:18:15,260
+حوالي 0.11 يعني حوالي 3 مربعات نص تلاتة يعني،
+
+227
+00:18:15,260 --> 00:18:20,040
+تمام؟هذا هو الـ Normal تبعها الـ «Q» قرص زي ما
+
+228
+00:18:20,040 --> 00:18:28,480
+حكينا بتطلع حوالي من 0.08 يعني مربعين لـ 0.11 أو 0
+
+229
+00:18:28,480 --> 00:18:32,800
+.12 يعني تلت مربعات، هذا هو الطبيعي زي ما حكينا
+
+230
+00:18:32,800 --> 00:18:35,280
+الـ «R» wave هي الـ first positive deflection اللي
+
+231
+00:18:35,280 --> 00:18:38,300
+طالع فوق الـ «S» wave اللي هي الـ first negative
+
+232
+00:18:38,300 --> 00:18:41,220
+deflection اللي نزلها تحت الـ «Q» هي الـ negative
+
+233
+00:18:41,220 --> 00:18:44,980
+deflection أول واحد حكيناهم احنا دولةعلى الـ ECG
+
+234
+00:18:44,980 --> 00:18:53,040
+نفسه، وهو هذه الـ Q، تمام؟ وحكينا اللي هو الكلام
+
+235
+00:18:53,040 --> 00:18:57,980
+هذا إن كل مربع كبير Large Square هو عبارة عن خمس
+
+236
+00:18:57,980 --> 00:19:03,800
+مربعات صغيرة وحكينا الـ QRS Complex هو عبارة عن
+
+237
+00:19:03,800 --> 00:19:10,530
+مربعين لتلت مربعات صغيرةكمان حكينا عن الـ T-Wave
+
+238
+00:19:10,530 --> 00:19:12,550
+إنه بيصير فيها الـ Repolarization تبع الـ
+
+239
+00:19:12,550 --> 00:19:20,090
+Ventricle وبتكون هي يعني شبه الـ تطلع كيف شبه الـ
+
+240
+00:19:20,090 --> 00:19:24,710
+B-Wave لكن أعرض من الـ B-Wave، طلع قدش هاي؟ طلع
+
+241
+00:19:24,710 --> 00:19:27,630
+الـ B-Wave، بس تلت مربعات، لكن هاد بتوصل لحوالي
+
+242
+00:19:27,630 --> 00:19:31,150
+خمس مربعات، واحد، اتنين، تلت، اربع، عامل أربع
+
+243
+00:19:31,150 --> 00:19:35,830
+مربعات، وشوية يعني، تمام؟ كل هاد بتبقى وبتكون
+
+244
+00:19:35,830 --> 00:19:41,420
+عبارة عن T-Waveممكن أحيانًا أنه يبين حالة اسمها
+
+245
+00:19:41,420 --> 00:19:46,880
+الـ You Will لكن هذه مش بالضرورة تكون عند كل الناس
+
+246
+00:19:46,880 --> 00:19:52,350
+الـ Be Wellالتي بتعبّر على الـ «Re-polarization»
+
+247
+00:19:52,350 --> 00:19:57,490
+تبع الـ «بركنجي» في عبارة لكن هذه ما بتكونش ظاهرة
+
+248
+00:19:57,490 --> 00:20:00,150
+عند الكل ممكن تكون ظاهرة مع الناس اللي عندهم
+
+249
+00:20:00,150 --> 00:20:04,190
+«hypokalemia» بتوضح أكتر أو الناس اللي عندها
+
+250
+00:20:04,190 --> 00:20:08,570
+hypertension أمكن
+
+251
+00:20:08,570 --> 00:20:12,290
+هذه أهم حاجات أنا بدي أركز عليها الآن لو ما نعرف
+
+252
+00:20:12,290 --> 00:20:16,130
+الـECG الـ«hard track» من الـ«ECG» حكينا إنه أنا
+
+253
+00:20:16,130 --> 00:20:18,920
+أول حاجة بدي أشوف في الـ«hard track»إذا كان
+
+254
+00:20:18,920 --> 00:20:21,300
+ريجولار ولا مش ريجولار لأنه إذا كان ريجولار إله
+
+255
+00:20:21,300 --> 00:20:24,400
+طريقة وإذا مش ريجولار إله طريقة إذا كان ريجولار
+
+256
+00:20:24,400 --> 00:20:34,660
+فأنا بكل بساطة بده أروح أشوف عدد المربعات
+
+257
+00:20:34,660 --> 00:20:40,930
+ما بين الـR والـRبنسميها Rr Interval، أكم مربع
+
+258
+00:20:40,930 --> 00:20:45,830
+بينهم بحاجة لأشوف حداد المربع بحاجة لأن الـ Rr بين
+
+259
+00:20:45,830 --> 00:20:49,930
+الكل تماما مثل بعض يعني مثلا نشوف ال ECG هذا الـ
+
+260
+00:20:49,930 --> 00:20:54,910
+Rr شكلهم متساويين، أه نطلع عليها يعني لو بدنا
+
+261
+00:20:54,910 --> 00:20:59,790
+نعدها، المربع كبير، اتنين، تلاتة، أربعة، خمسة،
+
+262
+00:20:59,790 --> 00:21:04,110
+تقريبا ستة تقريبا، عد التانية، هيكون نفس الحاجة،
+
+263
+00:21:04,110 --> 00:21:07,800
+أه طبعا أنا ممكنأرد الطرق ممكن الطريقة ها ممكن أنا
+
+264
+00:21:07,800 --> 00:21:12,880
+أجيب قطعة ورق و أعلم علامة اندهار و أعلم علامة
+
+265
+00:21:12,880 --> 00:21:17,160
+اندهار و أمشي في القطعة ها في الورقة أشوف إذا هدول
+
+266
+00:21:17,160 --> 00:21:23,480
+العنالتين اتطابقوا مع اللي هو الـRR اللي بعدهم و
+
+267
+00:21:23,480 --> 00:21:26,940
+بعدين الـRR و الـRR ها و بعدين الـRR و الـRR ها
+
+268
+00:21:26,940 --> 00:21:29,620
+أها إذا كل هاتهم كانوا متساويين معناه إن أنا في
+
+269
+00:21:29,620 --> 00:21:33,380
+اند ريجولار ريدن بكل بساطة إيش أسوي حكي أنا بروح
+
+270
+00:21:33,380 --> 00:21:39,180
+بعيدالـ Large Boxes اللي بين الـRR و بروح بأقسم
+
+271
+00:21:39,180 --> 00:21:45,540
+تلاتمية تقسيم أكم مربع كبير خلّيني أده قر مرة،
+
+272
+00:21:45,540 --> 00:21:51,520
+بدقة، واحد، اتنين، تلاتة، أربعة، خمسة، اللي حبّوها
+
+273
+00:21:51,520 --> 00:21:55,500
+فيها، أنا حبي عن حوالي خمسة، تمام، مش ستة، تمام،
+
+274
+00:21:55,500 --> 00:21:58,680
+إذا الـRR هي على خمسة، يعني تلاتمية على خمسة يعني
+
+275
+00:21:58,680 --> 00:22:03,230
+ستينطب بيجي واحد بيقول يا عم لأ مش كلامك مش دقيق
+
+276
+00:22:03,230 --> 00:22:07,510
+إيش اللي أنا شايفهم أكتر طب لأ إد الصغار، هاي
+
+277
+00:22:07,510 --> 00:22:10,310
+واحد، هذا مربع كيلو يعني خمسة، اتنين، تلاتة،
+
+278
+00:22:10,310 --> 00:22:15,010
+أربعة، هدور الأربعة، أربعة في خمسة، هد عشرين،
+
+279
+00:22:15,010 --> 00:22:19,470
+كويس؟ أربعة في خمسة عشر مربع، هاي واحد، اتنين،
+
+280
+00:22:19,470 --> 00:22:27,570
+تلاتة، أربعة، الخامس هذا، الخامس هذا، في أكم، أكم
+
+281
+00:22:27,570 --> 00:22:33,320
+مربع، والله خمسةتقريباً اه وفي كمان مثلا هي انا
+
+282
+00:22:33,320 --> 00:22:40,940
+مربع صغير كمان اه يعني مثلا في عندي خمسة F5 في
+
+283
+00:22:40,940 --> 00:22:44,960
+عندي خمسة وعشرين وفي عندي واحد في عندي ايش نفترض
+
+284
+00:22:44,960 --> 00:22:52,800
+ستة وعشرين مربع تمام؟ طيب تمام تمام
+
+285
+00:22:58,010 --> 00:23:05,090
+بعد تكبيرها 5 لأ ده أقسم 1500 على ال 26 بطلع ال
+
+286
+00:23:05,090 --> 00:23:09,850
+heart rate باختصار كأنه أنا بدل ال 500 أو بدل ال
+
+287
+00:23:09,850 --> 00:23:14,910
+300 عفوا ضربتها فيه خمسة فصارت 1500 و بدل الخمسة
+
+288
+00:23:15,440 --> 00:23:19,520
+ضربتها في خمسة فصارت 25 بس أنا عشان الدقة اكتشفت
+
+289
+00:23:19,520 --> 00:23:23,380
+ما شاء الله واحد ازيدها فروح اتعملت بدل 25، 26
+
+290
+00:23:23,380 --> 00:23:26,880
+فابدأ انه يطلع للـ Heart Rate 60 بيطلع لي ايش
+
+291
+00:23:26,880 --> 00:23:33,180
+مثلا؟ أقل حبة مثلا 58 تمام؟ تمام التمام، اذا هذه
+
+292
+00:23:33,180 --> 00:23:36,140
+هي الطريقة اللي انا بدأ اعرف فيها الـHeart Rate من
+
+293
+00:23:36,140 --> 00:23:39,320
+ال ECG مابيهمنيش بصلاحيش بدي افري لما انا الـHeart
+
+294
+00:23:39,320 --> 00:23:43,200
+Rate 58 ولا 60 انا بيهمني ان يكون الـHeart Rate
+
+295
+00:23:43,200 --> 00:23:49,480
+اللي عنديكيف أعرف نورمال؟ النورمال يكون من سبتين
+
+296
+00:23:49,480 --> 00:23:59,100
+لمية السبتين أكم مربع خمس
+
+297
+00:23:59,100 --> 00:24:07,500
+مربعات يعني أكتر من خمس مربعات حيكون الهارتز أقل
+
+298
+00:24:07,500 --> 00:24:09,240
+من سبتين براديكارديا
+
+299
+00:24:13,040 --> 00:24:18,620
+طيب، طب لما بده يكون تلت مربعات بس، يعني بده يكون
+
+300
+00:24:18,620 --> 00:24:22,180
+تلت مية أتلت، يعني الـ hard trade مية، آه، it's
+
+301
+00:24:22,180 --> 00:24:26,560
+normal، يبقى الـ normal hard trade أن يكون من تلت
+
+302
+00:24:26,560 --> 00:24:32,580
+لخمس مربعات كبيرةطب لو كان مربعين اكبر يبقى تاكي
+
+303
+00:24:32,580 --> 00:24:36,640
+كارد لإنه بيصير 300 على 2 300 على 2 يعني الهارد
+
+304
+00:24:36,640 --> 00:24:42,580
+350، تمام؟ فعشان هيك بتلاقي أنت مجرد ما تمسك ال
+
+305
+00:24:42,580 --> 00:24:46,840
+ECG بتطلع بس بنظرة بسيطة من غير ما تقعد بدقة شديدة
+
+306
+00:24:46,840 --> 00:24:50,640
+بس بتشوف عدد المربعات من 3 إلى 5، 3 مربعات، 4
+
+307
+00:24:50,640 --> 00:24:54,920
+مربعات، 5 مربعات، طبعا إن ال rate ال rate إيش
+
+308
+00:24:54,920 --> 00:25:00,990
+ماله؟ Normalوبتكون اتطلعتها الـRR Interval لقيتهم
+
+309
+00:25:00,990 --> 00:25:05,350
+Regular وقررت إنه بما إنهم Regular تشوف إن الـRate
+
+310
+00:25:05,350 --> 00:25:08,910
+أكمل فعديت لقيت خمس مربعات أو أربع مربعات أو ثلاث
+
+311
+00:25:08,910 --> 00:25:13,150
+مربعات فانت تستطيع إنك تقرر قرارين إن الـHeart
+
+312
+00:25:13,150 --> 00:25:19,390
+Rate Regular والـHeart Rate Normal من ناحية إيش أو
+
+313
+00:25:19,390 --> 00:25:24,110
+الـHeart Rhythm اللي كان Regular والـRate تبعه
+
+314
+00:25:24,110 --> 00:25:29,550
+برضه كان Normal لكن لو لقيت إنهالـ Heart Rate أقل
+
+315
+00:25:29,550 --> 00:25:34,030
+من 3 مربعات مربعين بتقول عفيتك الكلام دي أكتر من 5
+
+316
+00:25:34,030 --> 00:25:37,650
+مربعات فورا بتقول الـ Bradycardia وبتبدأ تعمل
+
+317
+00:25:37,650 --> 00:25:41,050
+Fartar Assessment عشان تعرفش بالظبط الوضع تبع
+
+318
+00:25:41,050 --> 00:25:45,330
+المريض، تمام؟ هذا باختصار هذا اللي هو الطريقة اللي
+
+319
+00:25:45,330 --> 00:25:48,270
+احنا ممكن نعرف فيهاالـ Heart Rate لما يكون فيه
+
+320
+00:25:48,270 --> 00:25:53,270
+اندي الـ Sinus Rhythm أو فيه Regular Heart Rate
+
+321
+00:25:53,270 --> 00:25:56,690
+لكن لما بيكون مش Regular يا جماعة لما بيكون الـ
+
+322
+00:25:56,690 --> 00:26:01,310
+Heart Rate مش Regular غير منتظم بكل بساطة أنت
+
+323
+00:26:01,310 --> 00:26:11,670
+بتروح بتشوف بتاخد Strip تبع اللي هو تلاتين تبع تبع
+
+324
+00:26:11,670 --> 00:26:18,620
+ten seconds تبع عشر ثوانيكويس، وبعدين بتروح بتقد
+
+325
+00:26:18,620 --> 00:26:23,920
+في أكم R واحد، اتنين، تلاتة، أربعة، خمسة، ستة،
+
+326
+00:26:23,920 --> 00:26:34,360
+سبعة أكم R وبتضربهم في ستة بيطلع أو
+
+327
+00:26:34,360 --> 00:26:38,480
+في الحقيقة أن أنت بتضربهم في عشرة عشان يطلع ال
+
+328
+00:26:38,480 --> 00:26:45,700
+heart rate يعني مثلا هنا مثلا السبعة بتضربهمفي
+
+329
+00:26:45,700 --> 00:26:50,540
+عشرة بيطلع الـ heart rate عندك أكم سبعين، تمام؟
+
+330
+00:26:50,540 --> 00:26:55,440
+إذا الطريقة التانية بكل بساطة إن أنت بتروح، بتجيب
+
+331
+00:26:55,440 --> 00:27:01,020
+strip تبع 10 seconds وبتقدر أكم R فيه وبتضرب عدد
+
+332
+00:27:01,020 --> 00:27:09,000
+القارات فيه اللي هو في عشرة بيطلعلك الـ heart rate
+
+333
+00:27:09,000 --> 00:27:14,340
+طيب، عشان نعمل analysis لأجرhythm
+
+334
+00:27:18,320 --> 00:27:23,460
+لازم زي ما حكينا أننا نتطلع في الـRhythm نعرفه إذا
+
+335
+00:27:23,460 --> 00:27:26,160
+كان Regular أو لا مش Regular نكون قادرين على محسب
+
+336
+00:27:26,160 --> 00:27:29,540
+الـRate نتطلع في الـP Wave ونشوفها Normal أو لا
+
+337
+00:27:29,540 --> 00:27:36,560
+نتطلع في الـPR Interval الـPR Interval، هاي الـPR،
+
+338
+00:27:36,560 --> 00:27:42,400
+هاد هي الـPR، PR Interval طبيعية ولا لأ؟ والـQRS
+
+339
+00:27:42,400 --> 00:27:47,280
+هذاإن الـDuration تبعته Normal ولا مش Normal هذه
+
+340
+00:27:47,280 --> 00:27:50,640
+محددات مهمة تخليني أعرف الـDynamic كويسة ولا لأ طب
+
+341
+00:27:50,640 --> 00:27:55,720
+إيش بتتمني؟ إذا الـVR، طلعوا الـVR هذه،
+
+342
+00:27:55,720 --> 00:28:01,060
+الـInterval كانت مختلفة معناه إن المريض ربما يكون
+
+343
+00:28:01,060 --> 00:28:04,300
+في عنده delay في الـImpulse إذا هذا بيصير مع
+
+344
+00:28:04,300 --> 00:28:08,560
+الـHeart Block يا جماعة لأنه هنا حكينا إنه في الـR
+
+345
+00:28:08,560 --> 00:28:12,020
+Wave بيصير Depolarization للأرض يعني إذا الـVR
+
+346
+00:28:12,020 --> 00:28:16,760
+Interval هذهكل مرة تختلط، تطول مثلا، معناه إنه
+
+347
+00:28:16,760 --> 00:28:22,940
+بيصير تأخير على بيننا إن الـ Impulse تروح منهالـ
+
+348
+00:28:22,940 --> 00:28:27,540
+Atrium لمن؟ للـ Ventricle لأن الـ VR قاعدة طوال
+
+349
+00:28:27,540 --> 00:28:31,060
+prolongation بيحصل فيها لذلك هذه مهمة أن تكون الـ
+
+350
+00:28:31,060 --> 00:28:36,260
+VR نفس الـ VR هن نفس الـ VR هن الـ QRS هذا هو
+
+351
+00:28:36,260 --> 00:28:41,900
+الوضع الطبيعي تبعه أن يكون مربع مربعين أو تلارف
+
+352
+00:28:41,900 --> 00:28:46,740
+مربعات لكن لو كان أكتر من ذلك يكون في واعي الـ QRS
+
+353
+00:28:46,740 --> 00:28:51,450
+والواعي الـ QRS معناه أنه في delay برضه فيالـ
+
+354
+00:28:51,450 --> 00:28:56,070
+Repolarization تبع الـ ventricle وهذا ممكن يكون
+
+355
+00:28:56,070 --> 00:29:01,990
+يصير كثير في حالات الـ ventricular tachycardia
+
+356
+00:29:01,990 --> 00:29:11,380
+تمام؟ في حالات الـالـ Sopraventricular Tachycardia
+
+357
+00:29:11,380 --> 00:29:15,860
+بتلاقي إنه الـ «QRS» أو الكمبليكس هذا ناروم يعني
+
+358
+00:29:15,860 --> 00:29:22,700
+أقل من مربعين صغار أقل من 0.08 ثانية ولذلك بيكون
+
+359
+00:29:22,700 --> 00:29:28,440
+هذا من مميزات اللي بنسميها الـ «Sopraventricular
+
+360
+00:29:28,440 --> 00:29:32,480
+Tachycardia» أنه يكون ناروكمبليكس ولا Wide Complex
+
+361
+00:29:32,480 --> 00:29:35,680
+حكينا
+
+362
+00:29:37,100 --> 00:29:49,700
+بالنسبة للـ «هارد ريت» كيف بدنا نحسبه أن
+
+363
+00:29:49,700 --> 00:29:50,480
+أطلع
+
+364
+00:29:53,540 --> 00:29:57,680
+إن أطلّق الـ Heart Rate لما أكون مش Regular
+
+365
+00:29:57,680 --> 00:30:01,860
+الصراحة لما يعني هذا الطريق يعني هذا مثلا Heart
+
+366
+00:30:01,860 --> 00:30:05,840
+Rate لإن دي Regular مافيش داعي إن أروح أعد الارويل
+
+367
+00:30:05,840 --> 00:30:13,240
+في ست ثاني و أضرب في عشرة لإن هم Regular طب ما أنا
+
+368
+00:30:13,240 --> 00:30:19,740
+بعد واحد اتنين اهايهم تقريبا تلاتة لإن واحد اتنين
+
+369
+00:30:19,740 --> 00:30:24,580
+تلاتة تقريبامازال تلاتة يعني و اروح بعمل تلات مية
+
+370
+00:30:24,580 --> 00:30:28,360
+تقسيم تلاتة الـheart rate حوالين المية لكن لو
+
+371
+00:30:28,360 --> 00:30:34,340
+irregular يعني مثلا بين الـRR الارهاي والارهاي
+
+372
+00:30:34,340 --> 00:30:38,960
+واحد، اتنين، تلاتة، وشوية
+
+373
+00:30:44,290 --> 00:30:48,510
+لكن بين الـ R و الـ R هذه لاقيت فيه أربعة، بعدين
+
+374
+00:30:48,510 --> 00:30:51,030
+الـ R و الـ R هذه لاقيت فيه اتنين، هذا الـ series
+
+375
+00:30:51,030 --> 00:30:54,790
+اسمه irregular، فعيدها، بنروح احنا بكل بساطة،
+
+376
+00:30:54,790 --> 00:30:59,950
+بنجيب strip لست ثواني، وبنقدر أكم R أه، أكم R في
+
+377
+00:30:59,950 --> 00:31:04,070
+عندي أكم complex، بروح بدربهم في عشرة، بطلع ال
+
+378
+00:31:04,070 --> 00:31:05,710
+hard rate
+
+379
+00:31:08,790 --> 00:31:14,310
+حكينا إيش يعني Regular إنه يكون المسافة بين الـRR
+
+380
+00:31:14,310 --> 00:31:19,030
+و بين الـRR الأولى و الـRR التانية و الـRR التاتية
+
+381
+00:31:19,030 --> 00:31:23,610
+و كل الـRR هي نفس المسافة وهذا معناه يكون
+
+382
+00:31:23,610 --> 00:31:27,510
+Irregular إذا ما كانت زي هيك يكون Irregular
+
+383
+00:31:27,510 --> 00:31:31,830
+بالنسبة للـB Wave، المميزات الـB Wave يا جماعة أول
+
+384
+00:31:31,830 --> 00:31:35,590
+حاجة إنها تكون قبل كل Complex لازم كل Complex يكون
+
+385
+00:31:35,590 --> 00:31:46,400
+في قبله«QRS» ومن ثم «H» وهو «QRS Complex» ودائما
+
+386
+00:31:46,400 --> 00:31:49,980
+الـ «B Complex» بتحدث «H» برضه عادية يعني بتلاقي
+
+387
+00:31:49,980 --> 00:31:55,500
+هنا «B» «B» «B» «B» ولذلك حتى من طرق الـ
+
+388
+00:31:55,500 --> 00:32:00,160
+«Calculation» تبع الـ «Regular Heart Rate» أنه أنا
+
+389
+00:32:00,160 --> 00:32:03,780
+بدل ما أعد المسافة بين الـ «R» والـ «R» أعد
+
+390
+00:32:03,780 --> 00:32:07,520
+المسافة بين الـ «B» والـ «B» بنفع برضهتمام؟ لأنه
+
+391
+00:32:07,520 --> 00:32:13,340
+لازم تكون Regular في الـRegular Heart Rate علشان
+
+392
+00:32:13,340 --> 00:32:19,220
+هيك الـP-wave الأصل فيها أنها تكون قبل الـComplex
+
+393
+00:32:19,220 --> 00:32:25,200
+المفروض أن تكون مسافة بين الـP والـP نفس المسافة
+
+394
+00:32:25,200 --> 00:32:33,460
+علشان يكون Regular Heart Rate المفروض أنه الـالـ B
+
+395
+00:32:33,460 --> 00:32:39,400
+wave كمان تكون الـ duration تبقيتها زي ما حكينا من
+
+396
+00:32:39,400 --> 00:32:52,340
+اللي هو لعن تلت مربعات لعن اللي هو 0.11 second
+
+397
+00:32:52,340 --> 00:32:57,800
+اللي هو حوالي تلت مربعات كويس؟
+
+398
+00:33:00,890 --> 00:33:05,430
+الـ PR Interval حكينا عنها الـ PR Interval واللي
+
+399
+00:33:05,430 --> 00:33:11,570
+هي من الـ End الـ P لأول الـ R هذه كلها اسمها PR
+
+400
+00:33:11,570 --> 00:33:17,770
+Interval وهذه من تلت لخمس مربعات هذا هو الطبيعي من
+
+401
+00:33:17,770 --> 00:33:22,830
+تلت لخمس مربعات صغيرة من 1.12 لتنين ثقانتز هذا هو
+
+402
+00:33:22,830 --> 00:33:26,610
+الطبيعي لما قلتليش بشوف هنا مثلا بعدة و بلاقيها
+
+403
+00:33:26,610 --> 00:33:33,190
+تلت مربعات بقولها دي عبارة عنلو كانت أكتر من خمسة
+
+404
+00:33:33,190 --> 00:33:38,470
+بقول prolong PR interval وإذا كانت أقل بيكون short
+
+405
+00:33:38,470 --> 00:33:43,590
+PR interval Short بيحصل في التكيكارديا PR interval
+
+406
+00:33:43,590 --> 00:33:47,290
+ممكن تكون prolongedأو progressively prolonged يعني
+
+407
+00:33:47,290 --> 00:33:52,530
+هنا تلت مربعات بعدين سالة أربعة و بعدين سالة خمسة
+
+408
+00:33:52,530 --> 00:33:56,070
+و بعدين سالة ستة هذا ممكن يحصل في الـ hard block
+
+409
+00:33:56,070 --> 00:34:00,030
+هنشوفهم لما نحكي عن الـ hard block بالنسبة للـQRS
+
+410
+00:34:00,030 --> 00:34:08,190
+حكينا إن حجمها الطبيعي من من
+
+411
+00:34:08,190 --> 00:34:14,850
+0.04 من مربع واحد من مربع واحدلأ، اللي هو تلت
+
+412
+00:34:14,850 --> 00:34:18,930
+مربعات كويس
+
+413
+00:34:18,930 --> 00:34:25,970
+من O.04 لـ O.12 الطبيعة تبعها أنها تكون حوالي
+
+414
+00:34:25,970 --> 00:34:30,830
+مربعين O.08 اللي هم مربعين صغار وهذا بيكون الـ
+
+415
+00:34:30,830 --> 00:34:31,210
+Normal
+
diff --git a/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/IjMympjjuqA_raw.json b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/IjMympjjuqA_raw.json
new file mode 100644
index 0000000000000000000000000000000000000000..4ff4a4f81c0c103e8583c18ff5ed23bd0849ea87
--- /dev/null
+++ b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/IjMympjjuqA_raw.json
@@ -0,0 +1 @@
+{"segments": [{"id": 1, "seek": 2446, "start": 2.04, "end": 24.46, "text": "السلام عليكم ورحمة الله وبركاته باسم الله الصلاة والسلام على رسول الله نحكي في الـ Management of Patients with Different Rhythmias لما بنحكي عن ال patients اللي عندهم this rhythmias لازم نكون أولا نعرف ال normal rhythm عشان نقدر نعرف و نتعرف على أن هذا ال rhythm هو من", "tokens": [6027, 3794, 37440, 25894, 24793, 4032, 2288, 35571, 3660, 21984, 4032, 26890, 4117, 9307, 3224, 4724, 32277, 2304, 21984, 31767, 15040, 3660, 16070, 3794, 37440, 15844, 12602, 3794, 12610, 21984, 8717, 5016, 4117, 1829, 8978, 2423, 39184, 14781, 295, 4379, 2448, 365, 413, 3661, 323, 580, 497, 3495, 392, 3057, 296, 5296, 15042, 44945, 5016, 4117, 1829, 18871, 2423, 4209, 13672, 1829, 43242, 16095, 341, 11801, 4609, 5296, 31377, 2304, 8717, 30544, 5551, 12610, 995, 8717, 3615, 28480, 2423, 2710, 11801, 6225, 8592, 7649, 8717, 28543, 2288, 8717, 3615, 28480, 4032, 8717, 2655, 3615, 28480, 15844, 14739, 23758, 2423, 11801, 31439, 9154], 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"text": "للـ Atrium بعدها إيش بيصير؟ في الـ Complex Setup الـ QRS بعمل ليه Repolarization للـ Atrium و Depolarization للـ Ventricle", "tokens": [1211, 1211, 39184, 1711, 13015, 39182, 11296, 11933, 1829, 8592, 4724, 1829, 9381, 13546, 22807, 8978, 2423, 39184, 41184, 8928, 1010, 2423, 39184, 1249, 43580, 4724, 25957, 1211, 32239, 3224, 3696, 15276, 2144, 24976, 39184, 1711, 13015, 4032, 4056, 15276, 2144, 24976, 39184, 28290, 1341, 306], "avg_logprob": -0.372340424263731, "compression_ratio": 1.2983870967741935, "no_speech_prob": 2.7418136596679688e-06, "words": [{"start": 115.49, "end": 115.85, "word": "للـ", "probability": 0.6803385416666666}, {"start": 115.85, "end": 116.35, "word": " Atrium", "probability": 0.72119140625}, {"start": 116.35, "end": 117.23, "word": " بعدها", "probability": 0.643310546875}, {"start": 117.23, "end": 117.43, "word": " إيش", "probability": 0.7120768229166666}, {"start": 117.43, "end": 118.43, "word": " بيصير؟", "probability": 0.81474609375}, {"start": 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{"start": 486.76, "end": 487.94, "word": " منهم", "probability": 0.98388671875}, {"start": 487.94, "end": 489.52, "word": " بيعطينا", "probability": 0.94521484375}, {"start": 489.52, "end": 492.34, "word": " ويعني", "probability": 0.7766927083333334}, {"start": 492.34, "end": 492.64, "word": " إيش", "probability": 0.9611002604166666}, {"start": 492.64, "end": 493.2, "word": " القراة", "probability": 0.7115071614583334}, {"start": 493.2, "end": 493.44, "word": " اللي", "probability": 0.965576171875}, {"start": 493.44, "end": 493.84, "word": " جدينا", "probability": 0.7079671223958334}, {"start": 493.84, "end": 494.1, "word": " إيها", "probability": 0.6985677083333334}, {"start": 494.1, "end": 494.26, "word": " ال", "probability": 0.7802734375}, {"start": 494.26, "end": 494.68, "word": " ECG", "probability": 0.86962890625}, {"start": 494.68, "end": 495.2, "word": " لو", "probability": 0.8388671875}, {"start": 495.2, "end": 495.72, "word": " اعترضنا", "probability": 0.755126953125}, {"start": 495.72, "end": 495.88, "word": " إن", "probability": 0.82275390625}, {"start": 495.88, "end": 496.16, "word": " هذا", "probability": 0.7412109375}, {"start": 496.16, "end": 496.4, "word": " هو", "probability": 0.98779296875}, {"start": 496.4, "end": 496.56, "word": " ال", "probability": 0.8984375}, {"start": 496.56, "end": 496.9, "word": " heart", "probability": 0.257080078125}], "temperature": 1.0}, {"id": 21, "seek": 51341, "start": 497.25, "end": 513.41, "text": "وهنا الـ ECG الـ Leads اللي شبكناهم بنعرف إنه هنا يا جماعة هذا بتديني الـ AVL على الـ ECG بتطلعلي 12 Lead", "tokens": [2407, 3224, 8315, 2423, 39184, 19081, 38, 2423, 39184, 1456, 5834, 13672, 1829, 13412, 3555, 4117, 8315, 16095, 44945, 3615, 28480, 36145, 3224, 34105, 35186, 10874, 15042, 27884, 23758, 39894, 3215, 9957, 1829, 2423, 39184, 30198, 43, 15844, 2423, 39184, 19081, 38, 39894, 9566, 1211, 3615, 20292, 2272, 31025], "avg_logprob": -0.2809375047683716, "compression_ratio": 1.330708661417323, 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حوالي", "probability": 0.84088134765625}, {"start": 1061.27, "end": 1061.55, "word": " تلت", "probability": 0.724365234375}, {"start": 1061.55, "end": 1062.29, "word": " مربعات", "probability": 0.9820556640625}, {"start": 1062.29, "end": 1062.73, "word": " هو", "probability": 0.93408203125}, {"start": 1062.73, "end": 1063.29, "word": " الطبيعي", "probability": 0.971923828125}, {"start": 1063.29, "end": 1063.71, "word": " تبعه", "probability": 0.896484375}, {"start": 1063.71, "end": 1064.05, "word": " فعلا", "probability": 0.8896484375}, {"start": 1064.05, "end": 1064.23, "word": " من", "probability": 0.8212890625}, {"start": 1064.23, "end": 1064.47, "word": " 0", "probability": 0.56640625}, {"start": 1064.47, "end": 1065.31, "word": ".8", "probability": 0.9599609375}, {"start": 1065.31, "end": 1067.01, "word": " يعني", "probability": 0.898193359375}, {"start": 1067.01, "end": 1069.33, "word": " من", "probability": 0.4765625}, {"start": 1069.33, "end": 1069.59, "word": " 0", 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{"start": 2035.03, "end": 2035.31, "word": " الـ", "probability": 0.77392578125}, {"start": 2035.31, "end": 2035.53, "word": " hard", "probability": 0.3447265625}, {"start": 2035.53, "end": 2036.07, "word": " block", "probability": 0.89013671875}, {"start": 2036.07, "end": 2036.89, "word": " هنشوفهم", "probability": 0.701318359375}, {"start": 2036.89, "end": 2037.49, "word": " لما", "probability": 0.831298828125}, {"start": 2037.49, "end": 2038.25, "word": " نحكي", "probability": 0.854736328125}, {"start": 2038.25, "end": 2038.37, "word": " عن", "probability": 0.6435546875}, {"start": 2038.37, "end": 2038.45, "word": " الـ", "probability": 0.69970703125}, {"start": 2038.45, "end": 2038.57, "word": " hard", "probability": 0.814453125}, {"start": 2038.57, "end": 2038.91, "word": " block", "probability": 0.94580078125}, {"start": 2038.91, "end": 2039.41, "word": " بالنسبة", "probability": 0.93017578125}, {"start": 2039.41, "end": 2040.03, "word": " للـQRS", "probability": 0.63330078125}, {"start": 2040.03, "end": 2040.61, "word": " حكينا", "probability": 0.955810546875}, {"start": 2040.61, "end": 2040.87, "word": " إن", "probability": 0.6103515625}, {"start": 2040.87, "end": 2041.81, "word": " حجمها", "probability": 0.77667236328125}, {"start": 2041.81, "end": 2043.43, "word": " الطبيعي", "probability": 0.9693603515625}, {"start": 2043.43, "end": 2043.85, "word": " من", "probability": 0.958984375}, {"start": 2043.85, "end": 2048.19, "word": " من", "probability": 0.4287109375}, {"start": 2048.19, "end": 2048.43, "word": " 0", "probability": 0.63232421875}, {"start": 2048.43, "end": 2049.25, "word": ".04", "probability": 0.9775390625}, {"start": 2049.25, "end": 2049.51, "word": " من", "probability": 0.64453125}, {"start": 2049.51, "end": 2049.97, "word": " مربع", "probability": 0.982421875}, {"start": 2049.97, "end": 2050.51, "word": " واحد", "probability": 0.876708984375}, {"start": 2050.51, "end": 2051.49, "word": " من", "probability": 0.52197265625}, {"start": 2051.49, "end": 2052.01, "word": " مربع", "probability": 0.99267578125}, {"start": 2052.01, "end": 2052.49, "word": " واحد", "probability": 0.992919921875}], "temperature": 1.0}, {"id": 85, "seek": 207121, "start": 2053.15, "end": 2071.21, "text": "لأ، اللي هو تلت مربعات كويس من O.04 لـ O.12 الطبيعة تبعها أنها تكون حوالي مربعين O.08 اللي هم مربعين صغار وهذا بيكون الـ Normal", "tokens": [1211, 10721, 12399, 13672, 1829, 31439, 6055, 1211, 2655, 3714, 25513, 3615, 9307, 9122, 45865, 3794, 9154, 422, 13, 14565, 5296, 39184, 422, 13, 4762, 41950, 21292, 27884, 6055, 3555, 3615, 11296, 14739, 11296, 6055, 30544, 11331, 2407, 6027, 1829, 3714, 25513, 3615, 9957, 422, 13, 16133, 13672, 1829, 8032, 2304, 3714, 25513, 3615, 9957, 20328, 17082, 9640, 37037, 15730, 4724, 1829, 30544, 2423, 39184, 21277], "avg_logprob": -0.24323693585039965, "compression_ratio": 1.452054794520548, "no_speech_prob": 4.76837158203125e-07, "words": [{"start": 2053.15, "end": 2054.01, "word": "لأ،", "probability": 0.3924153645833333}, {"start": 2054.01, "end": 2054.23, "word": " اللي", "probability": 0.80908203125}, {"start": 2054.23, "end": 2054.47, "word": " هو", "probability": 0.95361328125}, {"start": 2054.47, "end": 2054.85, "word": " تلت", "probability": 0.8133138020833334}, {"start": 2054.85, "end": 2055.79, "word": " مربعات", "probability": 0.975830078125}, {"start": 2055.79, "end": 2058.93, "word": " كويس", "probability": 0.7161865234375}, {"start": 2058.93, "end": 2059.09, "word": " من", "probability": 0.448486328125}, {"start": 2059.09, "end": 2059.23, "word": " O", "probability": 0.50390625}, {"start": 2059.23, "end": 2060.07, "word": ".04", "probability": 0.661376953125}, {"start": 2060.07, "end": 2060.55, "word": " لـ", "probability": 0.884765625}, {"start": 2060.55, "end": 2060.69, "word": " O", "probability": 0.61962890625}, {"start": 2060.69, "end": 2061.55, "word": ".12", "probability": 0.985107421875}, {"start": 2061.55, "end": 2064.25, "word": " الطبيعة", "probability": 0.8068033854166666}, {"start": 2064.25, "end": 2064.91, "word": " تبعها", "probability": 0.8492431640625}, {"start": 2064.91, "end": 2065.21, "word": " أنها", "probability": 0.6529541015625}, {"start": 2065.21, "end": 2065.55, "word": " تكون", "probability": 0.97509765625}, {"start": 2065.55, "end": 2065.97, "word": " حوالي", "probability": 0.9454345703125}, {"start": 2065.97, "end": 2066.57, "word": " مربعين", "probability": 0.9912109375}, {"start": 2066.57, "end": 2066.71, "word": " O", "probability": 0.818359375}, {"start": 2066.71, "end": 2067.53, "word": ".08", "probability": 0.974853515625}, {"start": 2067.53, "end": 2068.51, "word": " اللي", "probability": 0.96875}, {"start": 2068.51, "end": 2068.69, "word": " هم", "probability": 0.62158203125}, {"start": 2068.69, "end": 2069.27, "word": " مربعين", "probability": 0.9951171875}, {"start": 2069.27, "end": 2069.73, "word": " صغار", "probability": 0.9246419270833334}, {"start": 2069.73, "end": 2070.03, "word": " وهذا", "probability": 0.83642578125}, {"start": 2070.03, "end": 2070.57, "word": " بيكون", "probability": 0.8019205729166666}, {"start": 2070.57, "end": 2070.83, "word": " الـ", "probability": 0.64404296875}, {"start": 2070.83, "end": 2071.21, "word": " Normal", "probability": 0.469482421875}], "temperature": 1.0}], "language": "ar", "language_probability": 1.0, "duration": 2076.6534375, "duration_after_vad": 2017.6024999999952}
\ No newline at end of file
diff --git a/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/IjMympjjuqA_raw.srt b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/IjMympjjuqA_raw.srt
new file mode 100644
index 0000000000000000000000000000000000000000..31317d5a7126313a0aa28c44de970db57d348c48
--- /dev/null
+++ b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/IjMympjjuqA_raw.srt
@@ -0,0 +1,1660 @@
+1
+00:00:02,040 --> 00:00:04,720
+السلام عليكم ورحمة الله وبركاته باسم الله الصلاة
+
+2
+00:00:04,720 --> 00:00:09,040
+والسلام على رسول الله نحكي في الـ Management of
+
+3
+00:00:09,040 --> 00:00:13,880
+Patients with Different Rhythmias لما بنحكي عن ال
+
+4
+00:00:13,880 --> 00:00:17,660
+patients اللي عندهم this rhythmias لازم نكون أولا
+
+5
+00:00:17,660 --> 00:00:22,900
+نعرف ال normal rhythm عشان نقدر نعرف و نتعرف على
+
+6
+00:00:22,900 --> 00:00:24,460
+أن هذا ال rhythm هو من
+
+7
+00:00:28,370 --> 00:00:32,810
+الـ Rhythm Disorders وبدنا نعرف من أنه الـ Rhythm
+
+8
+00:00:32,810 --> 00:00:38,710
+Disorder اللي احنا ممكن انشخصه فلو بنحكي عن الـ
+
+9
+00:00:38,710 --> 00:00:42,650
+Normal Electrical Conduction بنعرف انه بتصير فيها
+
+10
+00:00:42,650 --> 00:00:47,110
+أما contraction كل contraction بتعمل اللي هو الـ
+
+11
+00:00:47,110 --> 00:00:51,490
+systolic blood pressure وبعدين بيصير relaxation
+
+12
+00:00:53,800 --> 00:00:57,560
+وهذا طبعاً بيعملنا دا historic blood pressure
+
+13
+00:00:57,560 --> 00:01:00,740
+طبعاً نعرف إن هذا بيصير عن طريق اللي هو الـ
+
+14
+00:01:00,740 --> 00:01:08,460
+Depolarization الـ Depolarization لـ الـالـ Heart
+
+15
+00:01:08,460 --> 00:01:13,580
+Muscle فبنعرف لما بيصير Depolarization للأتريان
+
+16
+00:01:13,580 --> 00:01:17,360
+بيعملّي لو بدنا نحكي عن الـ Electrical Conduction
+
+17
+00:01:17,360 --> 00:01:21,520
+اللي بتعملها بيعملّي Wave اسمها الـ B Wave على ال
+
+18
+00:01:21,520 --> 00:01:29,720
+ECG وبعد هي كده بيصيرهو بدي أحكي على الـ… بدي
+
+19
+00:01:29,720 --> 00:01:33,580
+أفرجيكوا بس الـECG هنا وبعدين نرجع عشان نكون
+
+20
+00:01:33,580 --> 00:01:39,640
+عارفين إيش الترجمة هنا الترجمة للمراحل اللي بيصير
+
+21
+00:01:39,640 --> 00:01:42,620
+فيها «De-polarization» و«Re-polarization» في
+
+22
+00:01:42,620 --> 00:01:46,720
+المرحلة تبقى الأول مرحلة بتصير بيدي أنا الأتريان
+
+23
+00:01:46,720 --> 00:01:50,360
+بيصير هم contraction فهذا بيصير بأعمللي الـB-web
+
+24
+00:01:50,360 --> 00:01:54,380
+يعني الـB-web يكون عبارة عن «De-polarization»
+
+25
+00:01:54,380 --> 00:01:59,750
+لمين؟للـ Atrium بعدها إيش بيصير؟ في الـ Complex
+
+26
+00:01:59,750 --> 00:02:04,630
+Setup الـ QRS بعمل ليه Repolarization للـ Atrium و
+
+27
+00:02:04,630 --> 00:02:07,490
+Depolarization للـ Ventricle
+
+28
+00:02:10,470 --> 00:02:14,130
+الـ Depolarization تبع الـ Atrium بيخلص في الـ
+
+29
+00:02:14,130 --> 00:02:16,770
+Complex يعني بيصير لهم Repolarization و برجع
+
+30
+00:02:16,770 --> 00:02:21,010
+بيعملوا إيه؟ Relaxation مين ضال منقبض؟ ضال منقبض
+
+31
+00:02:21,010 --> 00:02:25,030
+الـ Ventricles بتروح و بتعمل Relaxation هنا فبتعمل
+
+32
+00:02:25,030 --> 00:02:30,010
+الـ T-Wave إذاً هذا هو الـElectrical Conduction أو
+
+33
+00:02:30,010 --> 00:02:32,790
+الـElectrical Wave اللي بتصير نتيجة
+
+34
+00:02:32,790 --> 00:02:37,450
+الـDepolarization و الـRepolarization فياللي هو
+
+35
+00:02:37,450 --> 00:02:41,190
+الـ Heart Muscle فبتعملّي Atrial Depolarization
+
+36
+00:02:41,190 --> 00:02:45,010
+بتعملّي B-Wave وبعدين Depolarization للفنترك اللي
+
+37
+00:02:45,010 --> 00:02:49,070
+بيعمل الـ QRS Complex وكمان بيصير فيها
+
+38
+00:02:49,070 --> 00:02:51,330
+Repolarization للـ Atria وبعدين بيصير
+
+39
+00:02:51,330 --> 00:02:55,570
+Repolarization للفنترك اللي بيعمل الـ T-Wave هدولة
+
+40
+00:02:56,490 --> 00:03:01,650
+وهما الـ waves اللي بتطلع من الـ ECG عشان أن نرجع
+
+41
+00:03:01,650 --> 00:03:06,990
+نفصل أكتر ونفهم إيش هو الـ ECG بنرجع نحكي عن الـ
+
+42
+00:03:06,990 --> 00:03:10,810
+conduction كيف بيصير الكهربا كيف بتطلع لأن الـ SA
+
+43
+00:03:10,810 --> 00:03:16,510
+node بطارية داخلية في القلب بتطلع الـ impulses من
+
+44
+00:03:16,510 --> 00:03:18,750
+ستين لمية impulse
+
+45
+00:03:21,330 --> 00:03:27,490
+هذه البروح كلها تجمع في نبضة AV نوت زي ما تشاهدون
+
+46
+00:03:27,490 --> 00:03:32,510
+AV عشان هي قريبة من الاتريام
+
+47
+00:03:32,510 --> 00:03:40,570
+والفنتريكل اللي هي الـ conjunction
+
+48
+00:03:40,570 --> 00:03:46,780
+اللي يسميها اللي بين الاتريام والفنتريكلفهنا بتصير
+
+49
+00:03:46,780 --> 00:03:50,020
+هي عبارة عن فلتر عشان تنظم الضربات اللي طلعت من
+
+50
+00:03:50,020 --> 00:03:54,560
+الـSA node فعشان هي مسئولة عن 40 إلى 60 Impulse
+
+51
+00:03:54,560 --> 00:04:01,320
+وبعد ذلك بتطلع الـImpulse انفلترات على الـBundle
+
+52
+00:04:01,320 --> 00:04:04,580
+of His زي ما احنا شايفين والبندل of his بتروح
+
+53
+00:04:04,580 --> 00:04:11,160
+وبتعمل تفريق لRight per Kg Fiber وLeft per Kg
+
+54
+00:04:11,160 --> 00:04:15,680
+Fiber زي ما احنا شايفين عشان توصل لآخراللي هو يعني
+
+55
+00:04:15,680 --> 00:04:19,520
+أو لكل يعني الخلايا والـmyocardium واستجيبة
+
+56
+00:04:19,520 --> 00:04:23,960
+الـimpulse هذه هذا هو اللي بيصير في توزيع عملية
+
+57
+00:04:23,960 --> 00:04:29,980
+الكهربا العملية هذه بما أنه في كهربا بتعمل في
+
+58
+00:04:29,980 --> 00:04:38,620
+الجسم اللي هو زي ما حكينا يعني كهربية معينة
+
+59
+00:04:38,620 --> 00:04:44,000
+والكهربية هذه ممكن تعمل بـwave فمن خلالالكهربية
+
+60
+00:04:44,000 --> 00:04:47,760
+هذه، أنا ممكن أقرأ كيف وضع القلب وكيف الـ rhythm
+
+61
+00:04:47,760 --> 00:04:54,180
+اللي ماشي عليه القلب عن طريق ترجمة هذه الـ waves
+
+62
+00:04:54,180 --> 00:04:58,980
+هذا بيعمله جهاز اسمه الـ ECG Electrocardiogram على
+
+63
+00:04:58,980 --> 00:05:03,060
+أساس إنه ينحطه بطريقة صحيحة كيف بنعمل، فيه له
+
+64
+00:05:03,060 --> 00:05:07,560
+نوعين من المواصلات،
+
+65
+00:05:07,560 --> 00:05:12,000
+فيه حاجة اسمها limb bleedاللي هما ستة ليب زي ما
+
+66
+00:05:12,000 --> 00:05:18,040
+أحنا شايفين بنحطه بنبدأ على ال... زي ما الـFourth
+
+67
+00:05:18,040 --> 00:05:20,400
+Intercostal Space زي ما أحنا شايفين Fourth
+
+68
+00:05:20,400 --> 00:05:25,120
+Intercostal Space على الـRight وعلى الـLeft من
+
+69
+00:05:25,120 --> 00:05:28,840
+الـSternum بعدين بننزل على الFifth Intercostal
+
+70
+00:05:28,840 --> 00:05:34,270
+Space وبنحط اللي هو هذا واحد وهذا اتنين، بنحطاللي
+
+71
+00:05:34,270 --> 00:05:39,490
+هي أربعة، بين أربعة واثنين بنحط اللي هي تلاتة،
+
+72
+00:05:39,490 --> 00:05:43,450
+كويس، بعدين كبننزل على ال «fifth intercostal
+
+73
+00:05:43,450 --> 00:05:48,210
+space» بس مع الإيش؟ طبعاً هنا حطناها مع ال «fifth
+
+74
+00:05:48,210 --> 00:05:53,930
+intercostal space» مع ال «mid-clavicular line»
+
+75
+00:05:53,930 --> 00:05:56,530
+اللي بنحكي عنها «mid-clavicular line» هيري
+
+76
+00:05:56,530 --> 00:05:59,780
+-clavicleهذه الـ mid-clavicular line ها يا عزيزي
+
+77
+00:05:59,780 --> 00:06:02,940
+شايفين؟ بيقسم بـ clavicle وهنا fifth intercostal
+
+78
+00:06:02,940 --> 00:06:06,400
+space تحت ال level تقريبا بتيجي ال fourth بعدها
+
+79
+00:06:06,400 --> 00:06:09,200
+بنمشي كمان لسه احنا على ال fifth intercostal space
+
+80
+00:06:09,200 --> 00:06:14,220
+هنا بس مع ال anterior auxiliary line بنحط الخامسة
+
+81
+00:06:14,220 --> 00:06:17,540
+بخمسة وبعدين بنحط V6 اللي هي برضه على ال fifth
+
+82
+00:06:17,540 --> 00:06:20,880
+intercostal space بس ماعليهاش مع اللي هو ال mid
+
+83
+00:06:20,880 --> 00:06:25,580
+-axillary line تمام؟ هي كده بالنسبة لل chest lead
+
+84
+00:06:25,580 --> 00:06:31,060
+بنحط ال limb lead اللي همعلى، زي ما بنعرف على
+
+85
+00:06:31,060 --> 00:06:35,520
+الـLift Arms هو حسب نوع الجهاز اللي عندك إذا
+
+86
+00:06:35,520 --> 00:06:39,260
+إلكتروت، بنحطش المشكلة إذا ملاقص زي اللي بكونوا
+
+87
+00:06:39,260 --> 00:06:42,560
+موجودين عندنا بنحط الـMetal Bar Medially يعني على
+
+88
+00:06:42,560 --> 00:06:46,620
+جهة الـInternally، على جهة الـBone اللي في
+
+89
+00:06:46,620 --> 00:06:51,940
+الـForearm
+
+90
+00:06:52,490 --> 00:06:58,070
+فبنحط الـ «lift arm» «right arm» «right leg» «left
+
+91
+00:06:58,070 --> 00:07:03,010
+leg» طبعاً هذا عشان نكون واقعيين بتلاقي عادة
+
+92
+00:07:03,010 --> 00:07:07,590
+الأجهزة بتعتمد على ألوان أو على الترقيم بالأحرف
+
+93
+00:07:07,590 --> 00:07:15,230
+هذه L-A-R-A-R-L-L، تمام؟ ممكن تكون الترقيمات أو
+
+94
+00:07:15,230 --> 00:07:22,630
+يعني في ألوان معينة بتعتمدهابعض الأجهزة مثلًا في
+
+95
+00:07:22,630 --> 00:07:28,790
+واحد بتكون أحمر أصفر أخضر بني أسود بنفسجي هنا
+
+96
+00:07:28,790 --> 00:07:32,810
+الألوان مختلفة زي ما انتوا شايفينه لكن ال common
+
+97
+00:07:32,810 --> 00:07:38,930
+أن يكون أحمر أصفر أخضر بني أصمر بنفسجي بالنسبة لل
+
+98
+00:07:38,930 --> 00:07:45,550
+arm هتلاقي أنه في إنه من اليمين أحمر أحمر
+
+99
+00:07:48,860 --> 00:07:54,460
+أصفر، أخضر، وبعدين هنا أسود تمام؟ أحمر، أصفر،
+
+100
+00:07:54,460 --> 00:07:59,420
+أخضر، أسود بنجي
+
+101
+00:07:59,420 --> 00:08:05,260
+بنشوف، هيك لو بدنا نعمل ECG هيك عملناها، okay؟
+
+102
+00:08:05,260 --> 00:08:12,640
+بدنا نشوف إيش كل واحد منهم بيعطينا ويعني إيش
+
+103
+00:08:12,640 --> 00:08:16,400
+القراة اللي جدينا إيها ال ECG لو اعترضنا إن هذا هو
+
+104
+00:08:16,400 --> 00:08:26,150
+ال heartوهنا الـ ECG الـ Leads اللي شبكناهم بنعرف
+
+105
+00:08:26,150 --> 00:08:31,730
+إنه هنا يا جماعة هذا بتديني الـ AVL على الـ ECG
+
+106
+00:08:31,730 --> 00:08:38,420
+بتطلعلي 12 Leadالتلاتة منهم بنسميهم «Limb Lead»
+
+107
+00:08:38,420 --> 00:08:42,520
+وتلاتة بنسميهم «Augmented Lead» وستة منهم بنسميهم
+
+108
+00:08:42,520 --> 00:08:51,860
+اللي هم «Chest Lead» أو خليني أعرضكي لهم هنا، هنا
+
+109
+00:08:51,860 --> 00:08:55,180
+لحظة
+
+110
+00:08:55,180 --> 00:09:01,500
+أه
+
+111
+00:09:02,300 --> 00:09:05,420
+الثلاثة الـ limb lead اللي هو واحد واثنين وثلاثة
+
+112
+00:09:05,420 --> 00:09:08,580
+وثلاثة augmented lead اللي هو AVR و AVL و AVF اللي
+
+113
+00:09:08,580 --> 00:09:13,040
+هتبقى نشوفهم و ال pericardial leads اللي هي ال
+
+114
+00:09:13,040 --> 00:09:17,200
+chest lead اللي هو حوالي ال heart من واحد لستة كيف
+
+115
+00:09:17,200 --> 00:09:20,300
+هدول بيجوا من واحد لستة هدول ال pericardial اللي
+
+116
+00:09:20,300 --> 00:09:24,000
+هي اللي بيحوطوا ال heart بيديني لكل واحد منهم wave
+
+117
+00:09:24,000 --> 00:09:28,620
+طب تمام كل واحد كل wave منهم يا جماعة يعني مثلا
+
+118
+00:09:30,440 --> 00:09:34,560
+بتدّي من الـ web تبعت الدُزُق الـ septal من الـ
+
+119
+00:09:34,560 --> 00:09:34,740
+heart
+
+120
+00:09:38,610 --> 00:09:41,730
+الـSeptum المفصلة من الـHeart لكن مثلا تلاتة أو
+
+121
+00:09:41,730 --> 00:09:45,350
+أربعة أشعة الدين الـAnterior part تبع الـHeart
+
+122
+00:09:45,350 --> 00:09:48,790
+طبعاً خمسة أو ستة هتدّين الـLateral Wave تبع
+
+123
+00:09:48,790 --> 00:09:52,310
+الـHeart يعني كيف الأنواج أو الموجات الموجودة
+
+124
+00:09:52,310 --> 00:09:55,530
+الكهربية على الـLateral لذلك كل واحد من
+
+125
+00:09:55,530 --> 00:10:02,250
+الـBricardial ليس هدولة دي هتدين view للـHeart من
+
+126
+00:10:02,250 --> 00:10:07,960
+المنطقة اللي هو بيشوفوا فيهاطب وإيش بالنسبة للـ
+
+127
+00:10:07,960 --> 00:10:11,680
+Limb Lead؟ الـ Limb Lead، ها أنا حكينا بالـ AVL
+
+128
+00:10:11,680 --> 00:10:17,200
+بتديني، بتتيجي منها والـ AVR بتيجي منها، والـ AVF
+
+129
+00:10:17,200 --> 00:10:21,240
+بتيجي من تحت لذلك الـ AVF عادة بتلاقيه معاه مقلوب
+
+130
+00:10:21,240 --> 00:10:26,080
+اللي في ورأسه لأنه أسفل، كمان، بنلاقي أن في عندك
+
+131
+00:10:26,080 --> 00:10:29,640
+Lead واحد و Lead اتنين و Lead تلاتة، Lead واحد هو
+
+132
+00:10:29,640 --> 00:10:33,860
+عبارة عن فرق الجهد بين الـ AVL و الـ AVR، فرق
+
+133
+00:10:33,860 --> 00:10:38,090
+الجهدهذه التلاتة هي فرق الجهد بين الـ AVR والـ AVF
+
+134
+00:10:38,090 --> 00:10:43,350
+هذه التلاتة الفرق الجهد بين الـ AVL والـ AVF هذه
+
+135
+00:10:43,350 --> 00:10:50,290
+التلاتة لاحظ أنه هنا مايلوش دعوة في عملية فروق
+
+136
+00:10:50,290 --> 00:10:56,460
+الجهد لأنه كلهيتم بلتقوا في نقطة واحدةاللي هي الـ
+
+137
+00:10:56,460 --> 00:11:04,080
+«Left Foot» أما الـ «Right Foot» فهي يعني مكملة
+
+138
+00:11:04,080 --> 00:11:09,220
+فقط للدائرة ولا تلعب دور فيه اللي هو عمل الـ
+
+139
+00:11:09,220 --> 00:11:16,800
+«Limb» «Legs» المعروفين وزي ما حكينا إن كل مجموعة
+
+140
+00:11:16,800 --> 00:11:19,960
+من الـ «Legs» بيدوني «View» للـ «Hard» يعني مثلا
+
+141
+00:11:19,960 --> 00:11:24,390
+«Legs» 2 و3 والـ «AVL» بيدوني الـ«Inferior»الـ
+
+142
+00:11:24,390 --> 00:11:28,130
+View تبقى الهارد تطلعها يقليد 2 و 3 والـ EVF في
+
+143
+00:11:28,130 --> 00:11:32,530
+هذا التحيك كله تبقى الجزء السفلي الـ Interior تبقى
+
+144
+00:11:32,530 --> 00:11:38,070
+الهارد لكن الـ Anterior Scepter V1 و V2 لأنه يتحدث
+
+145
+00:11:38,070 --> 00:11:42,670
+عن V1 و V2 حول الـ Sternum الـ Anterior تتحدث عن
+
+146
+00:11:42,670 --> 00:11:48,610
+V3 و V4 التبلاترالية تتحدث عن V5 و V6تمام؟ فعشان
+
+147
+00:11:48,610 --> 00:11:53,790
+هي كحتة لما انتوا بتشوفوا مثلا بشخص واحد MI بناء
+
+148
+00:11:53,790 --> 00:11:56,290
+على الـ lead اللي فيها الإصابة هات بيحكوا إنه
+
+149
+00:11:56,290 --> 00:11:59,490
+والله دي inferior MI ولا دي lateral MI ولا
+
+150
+00:11:59,490 --> 00:12:02,750
+inferior lateral MI حصل ال leads اللي فيها
+
+151
+00:12:02,750 --> 00:12:06,850
+الـdefect اللي هنحكي عنه عليا في الـMI اللي هو
+
+152
+00:12:06,850 --> 00:12:10,430
+عبارة عن SD elevation وان فيه SD elevation فانهما
+
+153
+00:12:10,430 --> 00:12:15,850
+الـlead في الـlead مثلا تلاتة واربعة وخمسة وستةأه
+
+154
+00:12:15,850 --> 00:12:21,090
+مازال 3 و 4 و 5 و 6 يبقى معناه anterolateral تمام؟
+
+155
+00:12:21,090 --> 00:12:26,530
+تمام، طب هلأ إيش معناه ال ECG وكيف بدنا نترجمه؟
+
+156
+00:12:26,530 --> 00:12:30,570
+وكيف بدنا نعرف كل حاجة فيه؟ إيش ال normal تبعها؟
+
+157
+00:12:30,570 --> 00:12:35,430
+تمام؟ هو هذا اللي بدنا نتعلمه الآن وبدنا نتعلم
+
+158
+00:12:35,430 --> 00:12:40,830
+كمان كيف نعرف ال heart rate من ال ECG هذا، مثلا
+
+159
+00:12:41,630 --> 00:12:44,890
+بنحكي إن الـ B-Wave هذه اللي هي بيصير فيها الـ
+
+160
+00:12:44,890 --> 00:12:47,550
+Atrial ليش حكينا Contraction الـ Depolarization
+
+161
+00:12:47,550 --> 00:12:50,610
+تبع الـ Atrial تطلع زي ما انتوا شايفينه طب قديش
+
+162
+00:12:50,610 --> 00:12:57,440
+الـ Normal تبعها؟ أول حاجة بديكوا تعرفواإن الـ ECG
+
+163
+00:12:57,440 --> 00:13:03,440
+هو عبارة عن رسم على مربعات صغيرة زي ما انتوا
+
+164
+00:13:03,440 --> 00:13:09,680
+شايفين هذه بتمثل اللي هي وحدات زمانية يعني الحركة
+
+165
+00:13:09,680 --> 00:13:14,760
+هذه تبع الـ Contracts تبع الـ Atrium صارت في المدة
+
+166
+00:13:14,760 --> 00:13:27,490
+من هنا إلى مثلا هنا تمام؟ نفترضأو من الـP لـR،
+
+167
+00:13:27,490 --> 00:13:31,850
+وهي أول الـR هنا تبقى الـQ نفترض أن هذه الـP هي
+
+168
+00:13:31,850 --> 00:13:35,690
+الـR Interval اللي بنسميها هذه لحالها الـP Wave،
+
+169
+00:13:35,690 --> 00:13:41,650
+الـP طيب، قداش المدة الزمنية اللي حصلت فيها هاي؟
+
+170
+00:13:41,650 --> 00:13:45,890
+لنقد المربعات، واحد، اتنين، تلاتة، أربع مربعات طب
+
+171
+00:13:45,890 --> 00:13:50,670
+كيف؟ قداش كل مربع؟ كل مربع أبارع عن 2% من السانية
+
+172
+00:13:50,670 --> 00:13:57,040
+كل مربع أبارع عنأفن 0.4% من الثانية يعني 4% من
+
+173
+00:13:57,040 --> 00:14:04,150
+الثانيةيعني كل مربع صغير هدولة مربعات صغيرة أربعة
+
+174
+00:14:04,150 --> 00:14:07,510
+في المية من السنة بالخمس مربعات يعني open في أربعة
+
+175
+00:14:07,510 --> 00:14:11,510
+ضارب خمسة يعني تصير اتنين من عشرة يعني كل خمس
+
+176
+00:14:11,510 --> 00:14:17,910
+مربعات صغيرة هي عبارة عن مربع واحد كبير ومربع كبير
+
+177
+00:14:17,910 --> 00:14:22,830
+هو عبارة عن اتنين من عشرة من الثانية واخد بالة إذا
+
+178
+00:14:22,830 --> 00:14:29,170
+هذا اللي بيخلي أن أنا حتى لما أعمل قراءةالـ ECG
+
+179
+00:14:29,170 --> 00:14:31,510
+وقد أعرف منه الـ Heart Rate أو أحسب منه الـ Heart
+
+180
+00:14:31,510 --> 00:14:36,270
+Rate بستطيع أن أحسب الـ Heart Rate لأنه أنا لو عدت
+
+181
+00:14:36,270 --> 00:14:44,890
+أكم بيتحصلت كل QRSكل B Q R S T كل واحدة من هدول
+
+182
+00:14:44,890 --> 00:14:49,050
+كاملة هي عبارة عن one beat كاملة متكاملة فيها
+
+183
+00:14:49,050 --> 00:14:52,810
+relaxation contraction و relaxation تمام فأنا لو
+
+184
+00:14:52,810 --> 00:14:56,210
+قدت هذه واحدة وكمان واحدة زيها وكمان واحدة زيها
+
+185
+00:14:56,210 --> 00:15:01,330
+وكمان واحدة زيها في مدة دقيقة بعرف أن أكم beat
+
+186
+00:15:01,330 --> 00:15:06,430
+صارت دقيقة بس هذا الكلام اللي بحكي لازم يكون إيش
+
+187
+00:15:08,140 --> 00:15:11,820
+الـ Heart Rate بتكون Regular، منتظم، ليش؟ عشان أنا
+
+188
+00:15:11,820 --> 00:15:14,560
+لما أقعد أقول إنه «high B to high B» كيف بتعرفهم؟
+
+189
+00:15:14,560 --> 00:15:18,720
+بتروح أقعد أكم «R» من أندي من هنا، أي واحدة،
+
+190
+00:15:18,720 --> 00:15:23,480
+تنتين، مثلا، تمام؟ اللي هو بنسميها الـRR Interval،
+
+191
+00:15:23,480 --> 00:15:30,500
+هي الـRR Interval هي بتكون بالظبط في كل الـECG
+
+192
+00:15:31,890 --> 00:15:37,270
+Similar نفس الـRR Interval يعني الـRR من هنا لهنا
+
+193
+00:15:37,270 --> 00:15:43,810
+مثلا تلت مربعات كبار يعني خمستاشر مربع زي المفترق
+
+194
+00:15:43,810 --> 00:15:47,050
+بديوا يكونوا في كل ال ECG بين الـR والـR خمستاشر
+
+195
+00:15:47,050 --> 00:15:50,410
+مربع زيه اللي هم تلت مربعات كبار، تلت مربعات كبار
+
+196
+00:15:50,410 --> 00:15:55,690
+يعني المربع الكبير عبارة عن خمس مربعات أصغر، تمام؟
+
+197
+00:15:55,690 --> 00:16:02,150
+إذا كان هيك، بروح أنا بكل بساطة بعدالمربعات هدولة
+
+198
+00:16:02,150 --> 00:16:05,590
+وبعدين هنشوف كيف في حسبة هتخليني أحسب المعرف منهم
+
+199
+00:16:05,590 --> 00:16:13,310
+الـ ECG، تمام؟ شوفنا الـ B-wave وحكينا عنها إنه هي
+
+200
+00:16:13,310 --> 00:16:16,690
+عبارة عن الـ Atrial Contraction بعدين بيجي هنا
+
+201
+00:16:16,690 --> 00:16:19,850
+بتنزل الـ Q، شايفين هذا الـ depression هذا؟ ده
+
+202
+00:16:19,850 --> 00:16:23,990
+عبارة عن الـ Q-waveبعدين تبقى الـR راديكولا هيتا
+
+203
+00:16:23,990 --> 00:16:27,690
+هيت ر بعدين هي الـS الـDepression هذا من هنا من
+
+204
+00:16:27,690 --> 00:16:31,550
+هنا هذا الـS وبعدين بتيجي الـT الناس اللي بيقولوا
+
+205
+00:16:31,550 --> 00:16:35,190
+الـMI بتلاقي الـS بدت من هنا جماعة بيبقى بدت هنا
+
+206
+00:16:35,190 --> 00:16:41,590
+ونزلت إيش معناه؟ ST elevation elevation عن مين؟ عن
+
+207
+00:16:41,590 --> 00:16:45,150
+الـIsoelectric line هذا هذا هو الـIsoelectric line
+
+208
+00:16:45,150 --> 00:16:50,440
+المفروض أنه بدت من هنالما تيجي الـ S تنزل، هيها،
+
+209
+00:16:50,440 --> 00:16:53,660
+الـ S هيها، نزلت، المفروض تبدأ تطلع، المفروض تطلع
+
+210
+00:16:53,660 --> 00:16:57,460
+توصل لمن؟ للـ Isoelectric line، لكن لما تروح الـ S
+
+211
+00:16:57,460 --> 00:17:04,670
+من هنا، وهي عاملة، هيك، و بعدين، هيك،يعني بدلًا
+
+212
+00:17:04,670 --> 00:17:08,450
+الـ «إيزو إلكتريك لاين» كان عفواً «هان» صار «هان»
+
+213
+00:17:08,450 --> 00:17:11,390
+وهذا اسمه «ST elevation» اللي بيحصل في حالات الأمن
+
+214
+00:17:11,390 --> 00:17:17,390
+«I» تمام، فعلشان هي كان مهم جدًا أني أطلع أكون
+
+215
+00:17:17,390 --> 00:17:22,290
+عارف كل واحد فيه مالية، بدنا نشوف قداش المسافة
+
+216
+00:17:22,290 --> 00:17:25,730
+اللي لازم يمشيها وقداش الارتفاع التبعي اللي بدي
+
+217
+00:17:25,730 --> 00:17:30,590
+يكونعشان يكون هذا طبيعي وقداش المسافات بين مثلًا
+
+218
+00:17:30,590 --> 00:17:34,370
+الـST segment قداش الطبيعي اللي لازم تكون الـQRS
+
+219
+00:17:34,370 --> 00:17:38,230
+Complex هذا قداش لازم يكون تمام؟ لو كنا نجي نشوف
+
+220
+00:17:38,230 --> 00:17:41,270
+مثلًا الـQRS Complex مش زي ما انتوا شافينه حوالي
+
+221
+00:17:41,270 --> 00:17:49,590
+تلت مربعات هو الطبيعي تبعه فعلا من 0.8 يعني من 0
+
+222
+00:17:49,590 --> 00:17:55,310
+.08 يعني من مربعين لـ0.11 أو 0.12 يعني لأ تلت
+
+223
+00:17:55,310 --> 00:17:56,150
+مربعات
+
+224
+00:17:59,220 --> 00:18:04,800
+تمام؟ لكن الـ B Wave حوالي أكام؟ حوالي مربعين ونص
+
+225
+00:18:04,800 --> 00:18:10,160
+يعني حوالي 0.11 Seconds يعني الـ B Wave لحالها
+
+226
+00:18:10,160 --> 00:18:15,260
+حوالي 0.11 يعني حوالي 3 مربعات نص تلاتة يعني،
+
+227
+00:18:15,260 --> 00:18:20,040
+تمام؟هذا هو الـ Normal تبعها الـ «Q» قرص زي ما
+
+228
+00:18:20,040 --> 00:18:28,480
+حكينا بتطلع حوالي من 0.08 يعني مربعين لـ 0.11 أو 0
+
+229
+00:18:28,480 --> 00:18:32,800
+.12 يعني تلت مربعات، هذا هو الطبيعي زي ما حكينا
+
+230
+00:18:32,800 --> 00:18:35,280
+الـ «R» wave هي الـ first positive deflection اللي
+
+231
+00:18:35,280 --> 00:18:38,300
+طالع فوق الـ «S» wave اللي هي الـ first negative
+
+232
+00:18:38,300 --> 00:18:41,220
+deflection اللي نزلها تحت الـ «Q» هي الـ negative
+
+233
+00:18:41,220 --> 00:18:44,980
+deflection أول واحد حكيناهم احنا دولةعلى الـ ECG
+
+234
+00:18:44,980 --> 00:18:53,040
+نفسه، وهو هذه الـ Q، تمام؟ وحكينا اللي هو الكلام
+
+235
+00:18:53,040 --> 00:18:57,980
+هذا إن كل مربع كبير Large Square هو عبارة عن خمس
+
+236
+00:18:57,980 --> 00:19:03,800
+مربعات صغيرة وحكينا الـ QRS Complex هو عبارة عن
+
+237
+00:19:03,800 --> 00:19:10,530
+مربعين لتلت مربعات صغيرةكمان حكينا عن الـ T-Wave
+
+238
+00:19:10,530 --> 00:19:12,550
+إنه بيصير فيها الـ Repolarization تبع الـ
+
+239
+00:19:12,550 --> 00:19:20,090
+Ventricle وبتكون هي يعني شبه الـ تطلع كيف شبه الـ
+
+240
+00:19:20,090 --> 00:19:24,710
+B-Wave لكن أعرض من الـ B-Wave، طلع قدش هاي؟ طلع
+
+241
+00:19:24,710 --> 00:19:27,630
+الـ B-Wave، بس تلت مربعات، لكن هاد بتوصل لحوالي
+
+242
+00:19:27,630 --> 00:19:31,150
+خمس مربعات، واحد، اتنين، تلت، اربع، عامل أربع
+
+243
+00:19:31,150 --> 00:19:35,830
+مربعات، وشوية يعني، تمام؟ كل هاد بتبقى وبتكون
+
+244
+00:19:35,830 --> 00:19:41,420
+عبارة عن T-Waveممكن أحيانًا أنه يبين حالة اسمها
+
+245
+00:19:41,420 --> 00:19:46,880
+الـ You Will لكن هذه مش بالضرورة تكون عند كل الناس
+
+246
+00:19:46,880 --> 00:19:52,350
+الـ Be Wellالتي بتعبّر على الـ «Re-polarization»
+
+247
+00:19:52,350 --> 00:19:57,490
+تبع الـ «بركنجي» في عبارة لكن هذه ما بتكونش ظاهرة
+
+248
+00:19:57,490 --> 00:20:00,150
+عند الكل ممكن تكون ظاهرة مع الناس اللي عندهم
+
+249
+00:20:00,150 --> 00:20:04,190
+«hypokalemia» بتوضح أكتر أو الناس اللي عندها
+
+250
+00:20:04,190 --> 00:20:08,570
+hypertension أمكن
+
+251
+00:20:08,570 --> 00:20:12,290
+هذه أهم حاجات أنا بدي أركز عليها الآن لو ما نعرف
+
+252
+00:20:12,290 --> 00:20:16,130
+الـECG الـ«hard track» من الـ«ECG» حكينا إنه أنا
+
+253
+00:20:16,130 --> 00:20:18,920
+أول حاجة بدي أشوف في الـ«hard track»إذا كان
+
+254
+00:20:18,920 --> 00:20:21,300
+ريجولار ولا مش ريجولار لأنه إذا كان ريجولار إله
+
+255
+00:20:21,300 --> 00:20:24,400
+طريقة وإذا مش ريجولار إله طريقة إذا كان ريجولار
+
+256
+00:20:24,400 --> 00:20:34,660
+فأنا بكل بساطة بده أروح أشوف عدد المربعات
+
+257
+00:20:34,660 --> 00:20:40,930
+ما بين الـR والـRبنسميها Rr Interval، أكم مربع
+
+258
+00:20:40,930 --> 00:20:45,830
+بينهم بحاجة لأشوف حداد المربع بحاجة لأن الـ Rr بين
+
+259
+00:20:45,830 --> 00:20:49,930
+الكل تماما مثل بعض يعني مثلا نشوف ال ECG هذا الـ
+
+260
+00:20:49,930 --> 00:20:54,910
+Rr شكلهم متساويين، أه نطلع عليها يعني لو بدنا
+
+261
+00:20:54,910 --> 00:20:59,790
+نعدها، المربع كبير، اتنين، تلاتة، أربعة، خمسة،
+
+262
+00:20:59,790 --> 00:21:04,110
+تقريبا ستة تقريبا، عد التانية، هيكون نفس الحاجة،
+
+263
+00:21:04,110 --> 00:21:07,800
+أه طبعا أنا ممكنأرد الطرق ممكن الطريقة ها ممكن أنا
+
+264
+00:21:07,800 --> 00:21:12,880
+أجيب قطعة ورق و أعلم علامة اندهار و أعلم علامة
+
+265
+00:21:12,880 --> 00:21:17,160
+اندهار و أمشي في القطعة ها في الورقة أشوف إذا هدول
+
+266
+00:21:17,160 --> 00:21:23,480
+العنالتين اتطابقوا مع اللي هو الـRR اللي بعدهم و
+
+267
+00:21:23,480 --> 00:21:26,940
+بعدين الـRR و الـRR ها و بعدين الـRR و الـRR ها
+
+268
+00:21:26,940 --> 00:21:29,620
+أها إذا كل هاتهم كانوا متساويين معناه إن أنا في
+
+269
+00:21:29,620 --> 00:21:33,380
+اند ريجولار ريدن بكل بساطة إيش أسوي حكي أنا بروح
+
+270
+00:21:33,380 --> 00:21:39,180
+بعيدالـ Large Boxes اللي بين الـRR و بروح بأقسم
+
+271
+00:21:39,180 --> 00:21:45,540
+تلاتمية تقسيم أكم مربع كبير خلّيني أده قر مرة،
+
+272
+00:21:45,540 --> 00:21:51,520
+بدقة، واحد، اتنين، تلاتة، أربعة، خمسة، اللي حبّوها
+
+273
+00:21:51,520 --> 00:21:55,500
+فيها، أنا حبي عن حوالي خمسة، تمام، مش ستة، تمام،
+
+274
+00:21:55,500 --> 00:21:58,680
+إذا الـRR هي على خمسة، يعني تلاتمية على خمسة يعني
+
+275
+00:21:58,680 --> 00:22:03,230
+ستينطب بيجي واحد بيقول يا عم لأ مش كلامك مش دقيق
+
+276
+00:22:03,230 --> 00:22:07,510
+إيش اللي أنا شايفهم أكتر طب لأ إد الصغار، هاي
+
+277
+00:22:07,510 --> 00:22:10,310
+واحد، هذا مربع كيلو يعني خمسة، اتنين، تلاتة،
+
+278
+00:22:10,310 --> 00:22:15,010
+أربعة، هدور الأربعة، أربعة في خمسة، هد عشرين،
+
+279
+00:22:15,010 --> 00:22:19,470
+كويس؟ أربعة في خمسة عشر مربع، هاي واحد، اتنين،
+
+280
+00:22:19,470 --> 00:22:27,570
+تلاتة، أربعة، الخامس هذا، الخامس هذا، في أكم، أكم
+
+281
+00:22:27,570 --> 00:22:33,320
+مربع، والله خمسةتقريباً اه وفي كمان مثلا هي انا
+
+282
+00:22:33,320 --> 00:22:40,940
+مربع صغير كمان اه يعني مثلا في عندي خمسة F5 في
+
+283
+00:22:40,940 --> 00:22:44,960
+عندي خمسة وعشرين وفي عندي واحد في عندي ايش نفترض
+
+284
+00:22:44,960 --> 00:22:52,800
+ستة وعشرين مربع تمام؟ طيب تمام تمام
+
+285
+00:22:58,010 --> 00:23:05,090
+بعد تكبيرها 5 لأ ده أقسم 1500 على ال 26 بطلع ال
+
+286
+00:23:05,090 --> 00:23:09,850
+heart rate باختصار كأنه أنا بدل ال 500 أو بدل ال
+
+287
+00:23:09,850 --> 00:23:14,910
+300 عفوا ضربتها فيه خمسة فصارت 1500 و بدل الخمسة
+
+288
+00:23:15,440 --> 00:23:19,520
+ضربتها في خمسة فصارت 25 بس أنا عشان الدقة اكتشفت
+
+289
+00:23:19,520 --> 00:23:23,380
+ما شاء الله واحد ازيدها فروح اتعملت بدل 25، 26
+
+290
+00:23:23,380 --> 00:23:26,880
+فابدأ انه يطلع للـ Heart Rate 60 بيطلع لي ايش
+
+291
+00:23:26,880 --> 00:23:33,180
+مثلا؟ أقل حبة مثلا 58 تمام؟ تمام التمام، اذا هذه
+
+292
+00:23:33,180 --> 00:23:36,140
+هي الطريقة اللي انا بدأ اعرف فيها الـHeart Rate من
+
+293
+00:23:36,140 --> 00:23:39,320
+ال ECG مابيهمنيش بصلاحيش بدي افري لما انا الـHeart
+
+294
+00:23:39,320 --> 00:23:43,200
+Rate 58 ولا 60 انا بيهمني ان يكون الـHeart Rate
+
+295
+00:23:43,200 --> 00:23:49,480
+اللي عنديكيف أعرف نورمال؟ النورمال يكون من سبتين
+
+296
+00:23:49,480 --> 00:23:59,100
+لمية السبتين أكم مربع خمس
+
+297
+00:23:59,100 --> 00:24:07,500
+مربعات يعني أكتر من خمس مربعات حيكون الهارتز أقل
+
+298
+00:24:07,500 --> 00:24:09,240
+من سبتين براديكارديا
+
+299
+00:24:13,040 --> 00:24:18,620
+طيب، طب لما بده يكون تلت مربعات بس، يعني بده يكون
+
+300
+00:24:18,620 --> 00:24:22,180
+تلت مية أتلت، يعني الـ hard trade مية، آه، it's
+
+301
+00:24:22,180 --> 00:24:26,560
+normal، يبقى الـ normal hard trade أن يكون من تلت
+
+302
+00:24:26,560 --> 00:24:32,580
+لخمس مربعات كبيرةطب لو كان مربعين اكبر يبقى تاكي
+
+303
+00:24:32,580 --> 00:24:36,640
+كارد لإنه بيصير 300 على 2 300 على 2 يعني الهارد
+
+304
+00:24:36,640 --> 00:24:42,580
+350، تمام؟ فعشان هيك بتلاقي أنت مجرد ما تمسك ال
+
+305
+00:24:42,580 --> 00:24:46,840
+ECG بتطلع بس بنظرة بسيطة من غير ما تقعد بدقة شديدة
+
+306
+00:24:46,840 --> 00:24:50,640
+بس بتشوف عدد المربعات من 3 إلى 5، 3 مربعات، 4
+
+307
+00:24:50,640 --> 00:24:54,920
+مربعات، 5 مربعات، طبعا إن ال rate ال rate إيش
+
+308
+00:24:54,920 --> 00:25:00,990
+ماله؟ Normalوبتكون اتطلعتها الـRR Interval لقيتهم
+
+309
+00:25:00,990 --> 00:25:05,350
+Regular وقررت إنه بما إنهم Regular تشوف إن الـRate
+
+310
+00:25:05,350 --> 00:25:08,910
+أكمل فعديت لقيت خمس مربعات أو أربع مربعات أو ثلاث
+
+311
+00:25:08,910 --> 00:25:13,150
+مربعات فانت تستطيع إنك تقرر قرارين إن الـHeart
+
+312
+00:25:13,150 --> 00:25:19,390
+Rate Regular والـHeart Rate Normal من ناحية إيش أو
+
+313
+00:25:19,390 --> 00:25:24,110
+الـHeart Rhythm اللي كان Regular والـRate تبعه
+
+314
+00:25:24,110 --> 00:25:29,550
+برضه كان Normal لكن لو لقيت إنهالـ Heart Rate أقل
+
+315
+00:25:29,550 --> 00:25:34,030
+من 3 مربعات مربعين بتقول عفيتك الكلام دي أكتر من 5
+
+316
+00:25:34,030 --> 00:25:37,650
+مربعات فورا بتقول الـ Bradycardia وبتبدأ تعمل
+
+317
+00:25:37,650 --> 00:25:41,050
+Fartar Assessment عشان تعرفش بالظبط الوضع تبع
+
+318
+00:25:41,050 --> 00:25:45,330
+المريض، تمام؟ هذا باختصار هذا اللي هو الطريقة اللي
+
+319
+00:25:45,330 --> 00:25:48,270
+احنا ممكن نعرف فيهاالـ Heart Rate لما يكون فيه
+
+320
+00:25:48,270 --> 00:25:53,270
+اندي الـ Sinus Rhythm أو فيه Regular Heart Rate
+
+321
+00:25:53,270 --> 00:25:56,690
+لكن لما بيكون مش Regular يا جماعة لما بيكون الـ
+
+322
+00:25:56,690 --> 00:26:01,310
+Heart Rate مش Regular غير منتظم بكل بساطة أنت
+
+323
+00:26:01,310 --> 00:26:11,670
+بتروح بتشوف بتاخد Strip تبع اللي هو تلاتين تبع تبع
+
+324
+00:26:11,670 --> 00:26:18,620
+ten seconds تبع عشر ثوانيكويس، وبعدين بتروح بتقد
+
+325
+00:26:18,620 --> 00:26:23,920
+في أكم R واحد، اتنين، تلاتة، أربعة، خمسة، ستة،
+
+326
+00:26:23,920 --> 00:26:34,360
+سبعة أكم R وبتضربهم في ستة بيطلع أو
+
+327
+00:26:34,360 --> 00:26:38,480
+في الحقيقة أن أنت بتضربهم في عشرة عشان يطلع ال
+
+328
+00:26:38,480 --> 00:26:45,700
+heart rate يعني مثلا هنا مثلا السبعة بتضربهمفي
+
+329
+00:26:45,700 --> 00:26:50,540
+عشرة بيطلع الـ heart rate عندك أكم سبعين، تمام؟
+
+330
+00:26:50,540 --> 00:26:55,440
+إذا الطريقة التانية بكل بساطة إن أنت بتروح، بتجيب
+
+331
+00:26:55,440 --> 00:27:01,020
+strip تبع 10 seconds وبتقدر أكم R فيه وبتضرب عدد
+
+332
+00:27:01,020 --> 00:27:09,000
+القارات فيه اللي هو في عشرة بيطلعلك الـ heart rate
+
+333
+00:27:09,000 --> 00:27:14,340
+طيب، عشان نعمل analysis لأجرhythm
+
+334
+00:27:18,320 --> 00:27:23,460
+لازم زي ما حكينا أننا نتطلع في الـRhythm نعرفه إذا
+
+335
+00:27:23,460 --> 00:27:26,160
+كان Regular أو لا مش Regular نكون قادرين على محسب
+
+336
+00:27:26,160 --> 00:27:29,540
+الـRate نتطلع في الـP Wave ونشوفها Normal أو لا
+
+337
+00:27:29,540 --> 00:27:36,560
+نتطلع في الـPR Interval الـPR Interval، هاي الـPR،
+
+338
+00:27:36,560 --> 00:27:42,400
+هاد هي الـPR، PR Interval طبيعية ولا لأ؟ والـQRS
+
+339
+00:27:42,400 --> 00:27:47,280
+هذاإن الـDuration تبعته Normal ولا مش Normal هذه
+
+340
+00:27:47,280 --> 00:27:50,640
+محددات مهمة تخليني أعرف الـDynamic كويسة ولا لأ طب
+
+341
+00:27:50,640 --> 00:27:55,720
+إيش بتتمني؟ إذا الـVR، طلعوا الـVR هذه،
+
+342
+00:27:55,720 --> 00:28:01,060
+الـInterval كانت مختلفة معناه إن المريض ربما يكون
+
+343
+00:28:01,060 --> 00:28:04,300
+في عنده delay في الـImpulse إذا هذا بيصير مع
+
+344
+00:28:04,300 --> 00:28:08,560
+الـHeart Block يا جماعة لأنه هنا حكينا إنه في الـR
+
+345
+00:28:08,560 --> 00:28:12,020
+Wave بيصير Depolarization للأرض يعني إذا الـVR
+
+346
+00:28:12,020 --> 00:28:16,760
+Interval هذهكل مرة تختلط، تطول مثلا، معناه إنه
+
+347
+00:28:16,760 --> 00:28:22,940
+بيصير تأخير على بيننا إن الـ Impulse تروح منهالـ
+
+348
+00:28:22,940 --> 00:28:27,540
+Atrium لمن؟ للـ Ventricle لأن الـ VR قاعدة طوال
+
+349
+00:28:27,540 --> 00:28:31,060
+prolongation بيحصل فيها لذلك هذه مهمة أن تكون الـ
+
+350
+00:28:31,060 --> 00:28:36,260
+VR نفس الـ VR هن نفس الـ VR هن الـ QRS هذا هو
+
+351
+00:28:36,260 --> 00:28:41,900
+الوضع الطبيعي تبعه أن يكون مربع مربعين أو تلارف
+
+352
+00:28:41,900 --> 00:28:46,740
+مربعات لكن لو كان أكتر من ذلك يكون في واعي الـ QRS
+
+353
+00:28:46,740 --> 00:28:51,450
+والواعي الـ QRS معناه أنه في delay برضه فيالـ
+
+354
+00:28:51,450 --> 00:28:56,070
+Repolarization تبع الـ ventricle وهذا ممكن يكون
+
+355
+00:28:56,070 --> 00:29:01,990
+يصير كثير في حالات الـ ventricular tachycardia
+
+356
+00:29:01,990 --> 00:29:11,380
+تمام؟ في حالات الـالـ Sopraventricular Tachycardia
+
+357
+00:29:11,380 --> 00:29:15,860
+بتلاقي إنه الـ «QRS» أو الكمبليكس هذا ناروم يعني
+
+358
+00:29:15,860 --> 00:29:22,700
+أقل من مربعين صغار أقل من 0.08 ثانية ولذلك بيكون
+
+359
+00:29:22,700 --> 00:29:28,440
+هذا من مميزات اللي بنسميها الـ «Sopraventricular
+
+360
+00:29:28,440 --> 00:29:32,480
+Tachycardia» أنه يكون ناروكمبليكس ولا Wide Complex
+
+361
+00:29:32,480 --> 00:29:35,680
+حكينا
+
+362
+00:29:37,100 --> 00:29:49,700
+بالنسبة للـ «هارد ريت» كيف بدنا نحسبه أن
+
+363
+00:29:49,700 --> 00:29:50,480
+أطلع
+
+364
+00:29:53,540 --> 00:29:57,680
+إن أطلّق الـ Heart Rate لما أكون مش Regular
+
+365
+00:29:57,680 --> 00:30:01,860
+الصراحة لما يعني هذا الطريق يعني هذا مثلا Heart
+
+366
+00:30:01,860 --> 00:30:05,840
+Rate لإن دي Regular مافيش داعي إن أروح أعد الارويل
+
+367
+00:30:05,840 --> 00:30:13,240
+في ست ثاني و أضرب في عشرة لإن هم Regular طب ما أنا
+
+368
+00:30:13,240 --> 00:30:19,740
+بعد واحد اتنين اهايهم تقريبا تلاتة لإن واحد اتنين
+
+369
+00:30:19,740 --> 00:30:24,580
+تلاتة تقريبامازال تلاتة يعني و اروح بعمل تلات مية
+
+370
+00:30:24,580 --> 00:30:28,360
+تقسيم تلاتة الـheart rate حوالين المية لكن لو
+
+371
+00:30:28,360 --> 00:30:34,340
+irregular يعني مثلا بين الـRR الارهاي والارهاي
+
+372
+00:30:34,340 --> 00:30:38,960
+واحد، اتنين، تلاتة، وشوية
+
+373
+00:30:44,290 --> 00:30:48,510
+لكن بين الـ R و الـ R هذه لاقيت فيه أربعة، بعدين
+
+374
+00:30:48,510 --> 00:30:51,030
+الـ R و الـ R هذه لاقيت فيه اتنين، هذا الـ series
+
+375
+00:30:51,030 --> 00:30:54,790
+اسمه irregular، فعيدها، بنروح احنا بكل بساطة،
+
+376
+00:30:54,790 --> 00:30:59,950
+بنجيب strip لست ثواني، وبنقدر أكم R أه، أكم R في
+
+377
+00:30:59,950 --> 00:31:04,070
+عندي أكم complex، بروح بدربهم في عشرة، بطلع ال
+
+378
+00:31:04,070 --> 00:31:05,710
+hard rate
+
+379
+00:31:08,790 --> 00:31:14,310
+حكينا إيش يعني Regular إنه يكون المسافة بين الـRR
+
+380
+00:31:14,310 --> 00:31:19,030
+و بين الـRR الأولى و الـRR التانية و الـRR التاتية
+
+381
+00:31:19,030 --> 00:31:23,610
+و كل الـRR هي نفس المسافة وهذا معناه يكون
+
+382
+00:31:23,610 --> 00:31:27,510
+Irregular إذا ما كانت زي هيك يكون Irregular
+
+383
+00:31:27,510 --> 00:31:31,830
+بالنسبة للـB Wave، المميزات الـB Wave يا جماعة أول
+
+384
+00:31:31,830 --> 00:31:35,590
+حاجة إنها تكون قبل كل Complex لازم كل Complex يكون
+
+385
+00:31:35,590 --> 00:31:46,400
+في قبله«QRS» ومن ثم «H» وهو «QRS Complex» ودائما
+
+386
+00:31:46,400 --> 00:31:49,980
+الـ «B Complex» بتحدث «H» برضه عادية يعني بتلاقي
+
+387
+00:31:49,980 --> 00:31:55,500
+هنا «B» «B» «B» «B» ولذلك حتى من طرق الـ
+
+388
+00:31:55,500 --> 00:32:00,160
+«Calculation» تبع الـ «Regular Heart Rate» أنه أنا
+
+389
+00:32:00,160 --> 00:32:03,780
+بدل ما أعد المسافة بين الـ «R» والـ «R» أعد
+
+390
+00:32:03,780 --> 00:32:07,520
+المسافة بين الـ «B» والـ «B» بنفع برضهتمام؟ لأنه
+
+391
+00:32:07,520 --> 00:32:13,340
+لازم تكون Regular في الـRegular Heart Rate علشان
+
+392
+00:32:13,340 --> 00:32:19,220
+هيك الـP-wave الأصل فيها أنها تكون قبل الـComplex
+
+393
+00:32:19,220 --> 00:32:25,200
+المفروض أن تكون مسافة بين الـP والـP نفس المسافة
+
+394
+00:32:25,200 --> 00:32:33,460
+علشان يكون Regular Heart Rate المفروض أنه الـالـ B
+
+395
+00:32:33,460 --> 00:32:39,400
+wave كمان تكون الـ duration تبقيتها زي ما حكينا من
+
+396
+00:32:39,400 --> 00:32:52,340
+اللي هو لعن تلت مربعات لعن اللي هو 0.11 second
+
+397
+00:32:52,340 --> 00:32:57,800
+اللي هو حوالي تلت مربعات كويس؟
+
+398
+00:33:00,890 --> 00:33:05,430
+الـ PR Interval حكينا عنها الـ PR Interval واللي
+
+399
+00:33:05,430 --> 00:33:11,570
+هي من الـ End الـ P لأول الـ R هذه كلها اسمها PR
+
+400
+00:33:11,570 --> 00:33:17,770
+Interval وهذه من تلت لخمس مربعات هذا هو الطبيعي من
+
+401
+00:33:17,770 --> 00:33:22,830
+تلت لخمس مربعات صغيرة من 1.12 لتنين ثقانتز هذا هو
+
+402
+00:33:22,830 --> 00:33:26,610
+الطبيعي لما قلتليش بشوف هنا مثلا بعدة و بلاقيها
+
+403
+00:33:26,610 --> 00:33:33,190
+تلت مربعات بقولها دي عبارة عنلو كانت أكتر من خمسة
+
+404
+00:33:33,190 --> 00:33:38,470
+بقول prolong PR interval وإذا كانت أقل بيكون short
+
+405
+00:33:38,470 --> 00:33:43,590
+PR interval Short بيحصل في التكيكارديا PR interval
+
+406
+00:33:43,590 --> 00:33:47,290
+ممكن تكون prolongedأو progressively prolonged يعني
+
+407
+00:33:47,290 --> 00:33:52,530
+هنا تلت مربعات بعدين سالة أربعة و بعدين سالة خمسة
+
+408
+00:33:52,530 --> 00:33:56,070
+و بعدين سالة ستة هذا ممكن يحصل في الـ hard block
+
+409
+00:33:56,070 --> 00:34:00,030
+هنشوفهم لما نحكي عن الـ hard block بالنسبة للـQRS
+
+410
+00:34:00,030 --> 00:34:08,190
+حكينا إن حجمها الطبيعي من من
+
+411
+00:34:08,190 --> 00:34:14,850
+0.04 من مربع واحد من مربع واحدلأ، اللي هو تلت
+
+412
+00:34:14,850 --> 00:34:18,930
+مربعات كويس
+
+413
+00:34:18,930 --> 00:34:25,970
+من O.04 لـ O.12 الطبيعة تبعها أنها تكون حوالي
+
+414
+00:34:25,970 --> 00:34:30,830
+مربعين O.08 اللي هم مربعين صغار وهذا بيكون الـ
+
+415
+00:34:30,830 --> 00:34:31,210
+Normal
+
diff --git a/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/RUNF5tfm5rc.srt b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/RUNF5tfm5rc.srt
new file mode 100644
index 0000000000000000000000000000000000000000..ed23c3568e836a9b856cea10706432458d9200cb
--- /dev/null
+++ b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/RUNF5tfm5rc.srt
@@ -0,0 +1,2093 @@
+1
+00:00:02,090 --> 00:00:04,890
+بسم الله الرحمن الرحيم السلام عليكم ورحمة الله
+
+2
+00:00:04,890 --> 00:00:08,130
+وبركاته اليوم إن شاء الله رب العالمين هنحكي عن الـ
+
+3
+00:00:08,130 --> 00:00:12,410
+Head Injury وهو تقريباً آخر محاضرة في مسابقة الرعاية
+
+4
+00:00:12,410 --> 00:00:18,310
+الحقيقة الـ Head Injury زي ما حضراتكم عارفين ممكن
+
+5
+00:00:18,310 --> 00:00:21,570
+تكون في الفروة تبع الرأس في الـ Skull أو في
+
+6
+00:00:21,570 --> 00:00:24,850
+الـ Skull نفسها في العظم تبع الرأس الجمجمة أو في
+
+7
+00:00:24,850 --> 00:00:31,590
+الـ Brain، خلايا المخ طبعاً ممكن تكون إصابات بسيطة
+
+8
+00:00:31,590 --> 00:00:36,410
+ممكن تتعدى وتصير إصابات serious في الـ Brain نفسه
+
+9
+00:00:36,410 --> 00:00:40,830
+ممكن تكون إصابات مغلقة يعني من غير ما يكون
+
+10
+00:00:40,830 --> 00:00:43,850
+Penetrating للـ Scalp ولا الـ Skull ولا الـ Brain
+
+11
+00:00:43,850 --> 00:00:50,130
+تشوه ممكن تكون فيها Open Head Injury أو
+
+12
+00:00:50,130 --> 00:00:55,430
+Penetrating يعني اخترقت الـ Scalp واخترقت الـ Skull
+
+13
+00:00:55,430 --> 00:01:02,510
+وتوصل لـ Brain طبعاً ممكن جداً الإصابة أن تصيب الـ
+
+14
+00:01:02,510 --> 00:01:06,570
+«head» لكن لا توصل إلى «brain» لكن إذا وصلت إلى
+
+15
+00:01:06,570 --> 00:01:11,190
+«brain» عادةً بتكون إصابة خطيرة. الأنواع الـ «head
+
+16
+00:01:11,190 --> 00:01:14,150
+injury» التي ذكرناها هي «closed» أو
+
+17
+00:01:14,150 --> 00:01:17,390
+«opened» أو «penetrating». لماذا الفرق بينهم؟ لـ
+
+18
+00:01:17,390 --> 00:01:24,370
+«close his injury»  يعني أنّه «received a head blow
+
+19
+00:01:24,370 --> 00:01:30,430
+to the head from a striking object. يعني أي
+
+20
+00:01:30,430 --> 00:01:36,010
+object  خبطت فيه أو هو خبط فيه، لكن من غير ما
+
+21
+00:01:36,010 --> 00:01:39,030
+يدخل في الجسم ولا يعمل لك Penetrating. يعني زي
+
+22
+00:01:39,030 --> 00:01:44,070
+واحد وقعت عليه مثلاً حجر، وكسرت رأسه.
+
+23
+00:01:44,070 --> 00:01:49,730
+هذا يُسمّى Traumatic، وهو Closed Head
+
+24
+00:01:49,730 --> 00:01:52,750
+Injury. لاحظتم؟ هذه تُسمّى Closed Head Injury
+
+25
+00:01:52,750 --> 00:01:57,400
+هذا عادةً يُسبّب ماذا من الإصابات؟ أشهرها، شيء
+
+26
+00:01:57,400 --> 00:02:02,360
+يُسمّى الـ «brain contusion» أو شيء يُسمّى «brain
+
+27
+00:02:02,360 --> 00:02:05,780
+concussion». سنرى ما هو الفرق بين الـ «concussion»
+
+28
+00:02:05,780 --> 00:02:09,980
+وبين الـ «confusion». لكن علينا أن نعرف أنّ الـ
+
+29
+00:02:09,980 --> 00:02:14,180
+«symptom» التي تحدث في الـ «closed head injury»
+
+30
+00:02:14,180 --> 00:02:20,290
+هذي قد تكون فقدان الذاكرة وفقدان الوعي.
+
+31
+00:02:20,290 --> 00:02:22,770
+هذا ليس كما في أفلام الهند، حيث يبقى الشخص فاقداً طوال
+
+32
+00:02:22,770 --> 00:02:27,150
+عمره. هو مؤقت، يعني تجد فقدان الذاكرة لـ
+
+33
+00:02:27,150 --> 00:02:33,710
+دقائق معينة، ساعات معينة، ثم يبدأ باستعادة
+
+34
+00:02:33,710 --> 00:02:37,950
+ذاكرته، تمام؟ ممكن يكون لديه confusion، يعني يبدأ
+
+35
+00:02:37,950 --> 00:02:41,550
+يُصبح مُربَكاً ولا يعرف من حوله وما إلى ذلك، كل هذا
+
+36
+00:02:41,550 --> 00:02:48,090
+ممكن يحدث من جراء closed head trauma، لكن الـ
+
+37
+00:02:48,090 --> 00:02:52,190
+Open Head Injury أو ما يُسمّى Penetrating Head
+
+38
+00:02:52,190 --> 00:02:56,210
+Injury يعني أنّ شيئاً ما يخترق رأسك
+
+39
+00:02:56,210 --> 00:03:02,410
+ويدخل في دماغك، أنتَ خُطِبتَ بشيء ما خرق رأسك
+
+40
+00:03:02,410 --> 00:03:06,450
+وكسرها ودخل إلى الـ
+
+41
+00:03:06,450 --> 00:03:10,430
+Brain. this usually happens when you
+
+42
+00:03:10,430 --> 00:03:13,930
+move at high speeds such as going through the
+
+43
+00:03:13,930 --> 00:03:19,780
+woods during a car accident.  لما تكون في حوادث الطرق
+
+44
+00:03:19,780 --> 00:03:24,400
+والحوادث أو من يسقط أثناء التزلج وكل هذه الأمور
+
+45
+00:03:24,400 --> 00:03:28,320
+هذه قد تُسبّب Head Injury و Penetrating
+
+46
+00:03:28,320 --> 00:03:31,240
+Head Injury. It can also happen from gunshot to the
+
+47
+00:03:31,240 --> 00:03:37,980
+head. أشهرها طبعاً gunshot و Road
+
+48
+00:03:37,980 --> 00:03:44,030
+Traffic Accident. الـ Open أو الـ Penetrating Head
+
+49
+00:03:44,030 --> 00:03:47,730
+Injury لها علامات وأعراض، وطبعاً أنتَ تستطيع
+
+50
+00:03:47,730 --> 00:03:51,930
+أن ترى ذلك من الشكل، إنه واضح أنّ هناك Penetrating Head
+
+51
+00:03:51,930 --> 00:03:55,070
+Injury. لماذا؟ لأنّك سترى علامات
+
+52
+00:03:55,070 --> 00:03:58,310
+وأعراض Head Injury. may occur immediately
+
+53
+00:03:58,310 --> 00:04:01,930
+or developed slowly over several hours. طبعاً الـ
+
+54
+00:04:01,930 --> 00:04:06,610
+Immediately أنّك ترى مباشرةً أنّ هناك Injury وهناك
+
+55
+00:04:06,610 --> 00:04:09,930
+نزيف، وممكن يكون نزيفاً داخلياً في الدماغ أيضاً، تمام؟
+
+56
+00:04:10,420 --> 00:04:15,380
+طبعاً تبدأ تظهر الأعراض لاحقاً، انتهاك
+
+57
+00:04:15,380 --> 00:04:19,720
+صعب، لكن قد يبدأ بظهور أعراض، مشكلة، إرباك،
+
+58
+00:04:19,720 --> 00:04:25,760
+ويبدأ بتغيير مستوى الوعي. الـ Head
+
+59
+00:04:25,760 --> 00:04:28,480
+injury may cause a skull fracture which may or may
+
+60
+00:04:28,480 --> 00:04:30,720
+not be associated with injury to the brain. يعني ممكن
+
+61
+00:04:30,720 --> 00:04:34,740
+أن يكون لديك كسر في الجمجمة فقط، ولا يكون لديك
+
+62
+00:04:34,740 --> 00:04:38,240
+مشاكل في الـ brain، ولا يتأثر الـ brain. لكن لو الـ
+
+63
+00:04:38,240 --> 00:04:42,210
+fracture هذا أصبح يُسمّى Depressed fracture. أصبح
+
+64
+00:04:42,210 --> 00:04:45,810
+فيه جزء من العظم نزل إلى أسفل وعمل انخفاض وعمل
+
+65
+00:04:45,810 --> 00:04:48,030
+ضغطاً على الـ Brain. أصبح يُسمّى هذا Depressed
+
+66
+00:04:48,030 --> 00:04:52,910
+Skull Fracture. هذا عادةً سيؤثر على المريض وعلى
+
+67
+00:04:52,910 --> 00:04:56,230
+درجة أنه قد يُسبّب Monoparesis، يعني يُصبح لديه
+
+68
+00:04:56,230 --> 00:05:00,590
+شلل جزئي في طرف واحد، والحل الوحيد هو عملية
+
+69
+00:05:00,590 --> 00:05:03,710
+جراحية عاجلة لإزالة جزء العظم هذا
+
+70
+00:05:03,710 --> 00:05:07,790
+وإصلاح Depressed Fracture، ورفع العظم هذا ورفع
+
+71
+00:05:07,790 --> 00:05:14,090
+الضغط عن الـ Brain. ماذا لو حدث نزيف داخل الجمجمة أو
+
+72
+00:05:14,090 --> 00:05:14,850
+نزيف داخل الجمجمة أو نزيف داخل الجمجمة أو 
+
+73
+00:05:14,850 --> 00:05:15,290
+نزيف داخل الجمجمة أو نزيف داخل الجمجمة أو
+
+74
+00:05:15,290 --> 00:05:17,790
+نزيف داخل الجمجمة أو نزيف داخل الجمجمة أو نزيف داخل
+
+75
+00:05:17,790 --> 00:05:17,890
+الجمجمة أو نزيف داخل الجمجمة أو
+
+76
+00:05:17,890 --> 00:05:18,150
+نزيف داخل الجمجمة أو نزيف داخل الجمجمة أو
+
+77
+00:05:18,150 --> 00:05:19,510
+نزيف داخل الجمجمة أو نزيف داخل الجمجمة أو نزيف داخل
+
+78
+00:05:19,510 --> 00:05:19,590
+الجمجمة أو نزيف داخل الجمجمة أو
+
+79
+00:05:19,590 --> 00:05:19,670
+نزيف داخل الجمجمة أو نزيف داخل الجمجمة أو
+
+80
+00:05:19,670 --> 00:05:23,310
+نزيف داخل الجمجمة أو نزيف داخل الجمجمة أو نزيف داخل
+
+81
+00:05:23,310 --> 00:05:29,890
+الجمجمة أو نزيف داخل الجمجمة أو نزيف داخل الجمجمة هذا يُسبّب
+
+82
+00:05:29,890 --> 00:05:32,310
+ضغطاً على أنسجة الدماغ وهذا يُسبّب
+
+83
+00:05:32,310 --> 00:05:36,430
+خللاً وظيفياً لبعض أنسجة الدماغ أو خلايا الدماغ
+
+84
+00:05:36,430 --> 00:05:38,910
+بحيث لا تعمل، فيُصبح لديه Monoparesis. if intracranial hemorrhage or bleeding
+
+85
+00:05:38,910 --> 00:05:41,850
+within the brain occurs a hematoma with the skull
+
+86
+00:05:41,850 --> 00:05:45,290
+can put pressure on the brain. هذا بشكل عام، عندما
+
+87
+00:05:48,830 --> 00:05:54,760
+يحدث أي نوع من الإصابات، سواءً إصابة مغلقة أو
+
+88
+00:05:54,760 --> 00:05:57,940
+سواءً إصابة مفتوحة، فما يحدث هو حدوث نزيف عندما يحدث
+
+89
+00:05:57,940 --> 00:06:02,640
+نزيف، هذا النزيف يتجمع، ليُصبح Hematoma
+
+90
+00:06:02,640 --> 00:06:06,760
+تجمع دموي، تمام؟ هذا يُسبّب ضغطاً على الـ Brain. هذا الضغط
+
+91
+00:06:06,760 --> 00:06:09,780
+على الـ Brain. هذا الضغط على الـ Brain
+
+92
+00:06:10,590 --> 00:06:14,210
+بالإضافة إلى أنه حسب موقعه، هذا الـ Hematoma
+
+93
+00:06:14,210 --> 00:06:22,400
+ويُسبّب ضغطاً على الدماغ، واحتل مساحة من
+
+94
+00:06:22,400 --> 00:06:26,340
+الـ Intracranial Pressure التي حددناها بـ
+
+95
+00:06:26,340 --> 00:06:30,900
+مثلاً 15. الآن، بما أنه قد تسبّب ضغطاً، فقد بدأ
+
+96
+00:06:30,900 --> 00:06:34,160
+يُصبح الـ Intracranial Pressure أعلى. أنواع الـ
+
+97
+00:06:34,160 --> 00:06:36,900
+Intracranial Hematoma. قد يكون هذا الـ Hematoma
+
+98
+00:06:36,900 --> 00:06:40,300
+تحت الجافية، قد يكون تحت العنكبوتية،
+
+99
+00:06:40,300 --> 00:06:43,280
+قد يكون فوق الجافية،
+
+100
+00:06:43,280 --> 00:06:46,620
+قد يكون خارج الجافية،
+
+101
+00:06:46,620 --> 00:06:50,080
+قد يكون داخل الجافية، يعني ما يُسمّى خارج
+
+102
+00:06:50,080 --> 00:06:53,780
+الجافية أو داخل الدماغ.  الهيماتومة قد تكون داخل الدماغ.
+
+103
+00:06:53,780 --> 00:06:56,200
+Intracerebral hematoma ما يُسمّى Parenchyma، وهي
+
+104
+00:06:56,200 --> 00:07:01,690
+خلايا الدماغ. في هذه الحالة عادةً ما يكون عليك
+
+105
+00:07:01,690 --> 00:07:05,490
+إخراج الـ Hematoma عن طريق تصريفها، وإلا فإنّ
+
+106
+00:07:05,490 --> 00:07:08,630
+الـ Intracranial Pressure سيرتفع كثيراً، وبالتالي سيبقى
+
+107
+00:07:08,630 --> 00:07:12,410
+المريض يعاني، وضغط دمه سيرتفع
+
+108
+00:07:12,410 --> 00:07:17,610
+كثيراً، تمام؟ لذلك سندرسها الآن بالتفصيل
+
+109
+00:07:17,610 --> 00:07:22,910
+أنواع إصابات الدماغ التي قد تُؤثّر على
+
+110
+00:07:22,910 --> 00:07:31,410
+المريض كثيرة، أهمها أنّها قد، كما ذكرنا، تُسبّب
+
+111
+00:07:31,410 --> 00:07:36,810
+قد تكون خارجية أو قد تكون نزيف داخلي
+
+112
+00:07:36,810 --> 00:07:41,570
+مثل أن تُسبّب نزيفاً فوق الجافية أو تحت الجافية، لكن كل هذه لها
+
+113
+00:07:41,570 --> 00:07:45,070
+علامات مشتركة، وبمجرد رؤيتها أعرف أنّ
+
+114
+00:07:45,070 --> 00:07:50,260
+هذا المريض لديه إصابات في الدماغ. من أشهر الإصابات التي
+
+115
+00:07:50,260 --> 00:07:53,800
+في دماغه تجعلني أعرف أنّ المريض هذا لديه كسر في الجمجمة
+
+116
+00:07:53,800 --> 00:07:58,480
+أو لديه إصابة قوية، أن أرى أهم شيء
+
+117
+00:07:58,480 --> 00:08:01,440
+نزيف من الأذن ونزيف من الأنف. إذا
+
+118
+00:08:01,440 --> 00:08:05,380
+رأيت هذين الأمرين أو أحدهما، فتأكّد أنّ المريض
+
+119
+00:08:05,380 --> 00:08:09,060
+هذا لديه ما يُسمّى Base Skull Fracture، يعني
+
+120
+00:08:09,060 --> 00:08:14,060
+قاعدة الجمجمة بها كسر. وإذا حدث كسر في قاعدة
+
+121
+00:08:14,060 --> 00:08:16,380
+الجمجمة، ليس القسم القذالي أيها السادة، ليس ما في الخلف
+
+122
+00:08:16,380 --> 00:08:25,750
+القاعدة هي يعني هي المنطقة المحيطة بالتجويف الفمي
+
+123
+00:08:25,750 --> 00:08:32,050
+والأنفي، يعني فوق الفم وفوق الأنف، فهذا
+
+124
+00:08:32,050 --> 00:08:37,760
+يُشير إلى أنّ قاعدة الدماغ بها كسر.
+
+125
+00:08:37,760 --> 00:08:41,200
+هذا هو Base Skull Fracture. عندما يحدث ذلك كثيراً
+
+126
+00:08:41,200 --> 00:08:46,320
+من الداخل، تبدأ السوائل بالخروج منه، CSF وهو
+
+127
+00:08:46,320 --> 00:08:49,360
+السائل النخاعي Cerebral Spinal Fluid أو الدم ويخرج عبر
+
+128
+00:08:49,360 --> 00:08:54,020
+التجويف، أي عبر قناة  Stapedius  عبر قناة
+
+129
+00:08:54,020 --> 00:09:00,060
+الاستابيد إلى الأذن وعبر التجويف الأنفي أيضاً
+
+130
+00:09:00,060 --> 00:09:04,200
+عبر قناة الأنف nasal canal لدرجة أنه قد
+
+131
+00:09:04,200 --> 00:09:07,620
+نرى هذا الأمر في المرضى، فيبقى المريض يبلع عندما يشعر
+
+132
+00:09:07,620 --> 00:09:11,900
+بأن هذه الأشياء تنزل إلى البلعوم ويبدأ بابتلاعها
+
+133
+00:09:11,900 --> 00:09:15,880
+طبعاً. لو رأيت أي كسر في الـ scalp أو
+
+134
+00:09:15,880 --> 00:09:18,180
+أي جرح في الـ scalp أو كسر في
+
+135
+00:09:18,180 --> 00:09:22,690
+الـ scalp في أي جزء منه، أتوقع وجود
+
+136
+00:09:22,690 --> 00:09:26,110
+إصابة في الرأس لدى هذا المريض. لو كان هناك فقدان
+
+137
+00:09:26,110 --> 00:09:30,590
+للوعي، هذا أيضاً يدلّ على وجود إصابة في الرأس، خاصةً
+
+138
+00:09:30,590 --> 00:09:33,190
+إذا كان هناك فقدان للوعي وترى وجود
+
+139
+00:09:33,190 --> 00:09:37,850
+حول العينين، مثلاً ازرقاق، هذا الازرقاق حول العينين قد
+
+140
+00:09:37,850 --> 00:09:41,830
+يكون من علامات Base Skull Fracture، لأنّه أحياناً
+
+141
+00:09:41,830 --> 00:09:45,090
+يحتقن الدم في المنطقة المحيطة بالعين.
+
+143
+00:09:50,350 --> 00:09:53,710
+أسباب إصابات الرأس، كما ذكرنا، السقوط،
+
+144
+00:09:53,710 --> 00:09:56,930
+الاعتداء البدني، أي شخص يضرب
+
+145
+00:09:56,930 --> 00:10:03,150
+شخصاً آخر، الحوادث،
+
+146
+00:10:03,150 --> 00:10:04,490
+إطلاق النار، كما ذكرنا.
+
+147
+00:10:07,400 --> 00:10:14,260
+الأشياء التي تحدث مثلاً في الملاهي، في الألعاب،
+
+148
+00:10:14,260 --> 00:10:22,100
+في هذه الأشياء. كل هذه أسباب لإصابات الرأس، طبعاً
+
+149
+00:10:22,100 --> 00:10:29,140
+إصابات الرأس لها عواقب خطيرة جداً، دعونا
+
+150
+00:10:29,140 --> 00:10:29,840
+نسميها
+
+151
+00:10:33,750 --> 00:10:37,590
+مثل أنها قد تُسبّب فقدان الإحساس، شخص
+
+152
+00:10:37,590 --> 00:10:41,730
+يفقد أحد حواسه، مثلاً السمع، يتوقّف عن
+
+153
+00:10:41,730 --> 00:10:45,890
+السمع، قد يتوقّف عن الرؤية، قد يتوقّف عن التذوّق أو الشم،
+
+154
+00:10:45,890 --> 00:10:49,890
+لأنّ هذه المراكز كلها موجودة في الدماغ.  قد يُصبح لديه
+
+155
+00:10:49,890 --> 00:10:54,450
+تشنجات، نوبات صرع، ما يُسمّى Secondary
+
+156
+00:10:54,450 --> 00:10:58,130
+Epilepsy.  قد يُصاب بالشلل، قد يُصبح لديه
+
+157
+00:10:58,130 --> 00:11:01,790
+شلل كامل، في جزء من الجسم، ما يُسمّى
+
+158
+00:11:01,790 --> 00:11:07,690
+Hemiparesis أو Hemiplegia أو Paraplegia. تمام؟
+
+159
+00:11:07,690 --> 00:11:10,850
+قد يُصبح في غيبوبة، يفقد وعيه بشكل كامل.
+
+160
+00:11:10,850 --> 00:11:14,690
+قد يُصاب بعد الإصابة بـ
+
+161
+00:11:14,690 --> 00:11:16,890
+اضطرابات في الشخصية، تغيّرات في حالته النفسية
+
+162
+00:11:16,890 --> 00:11:20,450
+وعواطفه، تجد تصرفاته
+
+163
+00:11:20,450 --> 00:11:24,930
+غريبة، لأنّه أُصيب بشدة في رأسه، كما
+
+164
+00:11:24,930 --> 00:11:27,170
+يُقال، تمام؟
+
+165
+00:11:30,170 --> 00:11:32,950
+المشاكل المحددة التي قد تحدث، كما
+
+166
+00:11:32,950 --> 00:11:36,170
+رأينا، هي حدوث جرح في الـ
+
+167
+00:11:36,170 --> 00:11:40,190
+Scalp.  إذا كان الجرح وإصابة
+
+168
+00:11:40,190 --> 00:11:44,270
+الـ Scalp بسيطة، لا داعي للقلق، تمام؟ لكن لو
+
+169
+00:11:44,270 --> 00:11:47,810
+صار الأمر أشدّ، وصار هناك  Traumatic Subdural
+
+170
+00:11:47,810 --> 00:11:52,410
+Hematoma أو Epidural Hematoma، هنا يصبح الوضع
+
+171
+00:11:52,410 --> 00:11:54,890
+خطيراً ويبدأ الوعي بالتأثر، ونحتاج إلى
+
+172
+00:11:54,890 --> 00:11:56,670
+عمليات جراحية.
+
+173
+00:12:01,460 --> 00:12:04,420
+سنشرحها بالتفصيل.  Traumatic Subarachnoid
+
+174
+00:12:04,420 --> 00:12:10,780
+Hemorrhage.  لكن علينا أن نعرف أنّ الإصابات التي تحدث عند
+
+175
+00:12:10,780 --> 00:12:16,020
+الناس يمكن تصنيفها إلى كدمات
+
+176
+00:12:19,060 --> 00:12:22,840
+أو ما يُسمّى «concussion».  قد يكون الـ «concussion»
+
+177
+00:12:22,840 --> 00:12:27,340
+أكثر «confusion»،  يعني أشدّ من الـ
+
+178
+00:12:27,340 --> 00:12:29,820
+«concussion» وهو عبارة عن إصابة في الدماغ، يعني
+
+179
+00:12:29,820 --> 00:12:31,980
+إصابة جسدية في الـ «brain»، لكن الـ «concussion»
+
+180
+00:12:31,980 --> 00:12:3
+
+223
+00:15:15,270 --> 00:15:20,350
+يطول تبع الـ Amnesia، فقدان الذاكرة في بعض الحالات،
+
+224
+00:15:20,350 --> 00:15:24,750
+يمكن أن يتطور الشخص إلى Post-Concussion Syndrome
+
+225
+00:15:24,750 --> 00:15:26,990
+الذي يمكن أن يتطور للشخص،  Memory Problems،
+
+226
+00:15:26,990 --> 00:15:28,030
+Dizziness و Depression
+
+227
+00:15:33,680 --> 00:15:35,840
+الـ Concussion هذا، يبقى عنده حد يسمى Post
+
+228
+00:15:35,840 --> 00:15:39,140
+-Concussion Syndrome، يعني بيظلوا بعدها إدوخ،
+
+229
+00:15:39,140 --> 00:15:42,900
+بيظلوا بعدها تعبانين شوية، بيظلوا بعدها ينسون
+
+230
+00:15:42,900 --> 00:15:45,640
+Cerebral Concussion is the most common head injury
+
+231
+00:15:45,640 --> 00:15:48,340
+seen in children، عادة هذا كثير بيصير في الأطفال،
+
+232
+00:15:48,340 --> 00:15:52,380
+لكن سبحان الله، ربنا بنجّهم و بيكبروا لأن التطور
+
+233
+00:15:52,380 --> 00:15:56,630
+عندهم سريع و أنه سريع و ما بيصيرش عندهم أي حاجة،
+
+234
+00:15:56,630 --> 00:15:59,170
+تمام؟ هذا بالنسبة للـ Concussion، لكن الـ
+
+235
+00:15:59,170 --> 00:16:03,250
+Contusion،  الـ Contusion ضربة في الـ Brain في
+
+236
+00:16:03,250 --> 00:16:05,850
+أي منطقة صارت فيها Contusion، يطلع فيها Blood Spot
+
+237
+00:16:05,850 --> 00:16:09,310
+هنا، يطلع هنا Blood Spot، Blood Spot، هذا هو، في
+
+238
+00:16:09,310 --> 00:16:14,430
+الخلايا يعني، صار فيه، زي ما حكينا، في الـ Brain، يعني في
+
+239
+00:16:14,430 --> 00:16:18,830
+Injury، يعني في جرح في خلايا المخ و نزفت، نزلت شوية
+
+240
+00:16:18,830 --> 00:16:23,900
+دم، لكن إيش؟ إيش هو؟ brain contusion is a
+
+241
+00:16:23,900 --> 00:16:26,600
+bruising of the brain tissue. The majority of
+
+242
+00:16:26,600 --> 00:16:30,000
+contusions occur in the frontal and temporal
+
+243
+00:16:30,000 --> 00:16:32,840
+lobes، أكثر في الـ frontal أو في الـ temporal.
+
+244
+00:16:36,260 --> 00:16:39,480
+Complications may include cerebral edema and
+
+245
+00:16:46,880 --> 00:16:55,340
+الـ Transcentral Herniation ممكن مع الـ contusion
+
+246
+00:16:55,340 --> 00:16:58,500
+أن يصير Herniation، هرنياشن يعني يا جماعة أنه
+
+247
+00:16:58,500 --> 00:17:03,720
+منطقة أو جزء من المخ يعني يصير فيها انتفاخ، يعني تطلع
+
+248
+00:17:03,720 --> 00:17:10,770
+وتعمل bulging، هكذا، غير عن الجزء الذي يحتويه أو
+
+249
+00:17:10,770 --> 00:17:14,710
+الذي هو من ضمنه، تطلع عن الـ bulging، goal of a
+
+250
+00:17:14,710 --> 00:17:18,370
+treatment should be to increase intracranial
+
+251
+00:17:18,370 --> 00:17:21,730
+pressure، أهم حاجة احنا في الـ management أن الـ
+
+252
+00:17:21,730 --> 00:17:25,870
+intracranial pressure، إذا ارتفع، لازم احنا ننزله
+
+253
+00:17:25,870 --> 00:17:28,710
+عشان ما يصيرش عند المريض مضاعفات complicated of
+
+254
+00:17:28,710 --> 00:17:34,120
+the increased ICP.الشيء التالي يشير إلى اتخاذ
+
+255
+00:17:34,120 --> 00:17:36,760
+اتخاذ اتخاذ اتخاذ اتخاذ اتخاذ اتخاذ اتخاذ اتخاذ
+
+256
+00:17:36,760 --> 00:17:40,540
+اتخاذ اتخاذ اتخاذ اتخاذ اتخاذ اتخاذ اتخاذ اتخاذ
+
+257
+00:17:40,540 --> 00:17:43,020
+اتخاذ اتخاذ اتخاذ اتخاذ اتخاذ اتخاذ اتخاذ اتخاذ
+
+258
+00:17:43,020 --> 00:17:43,280
+اتخاذ اتخاذ اتخاذ اتخاذ اتخاذ اتخاذ اتخاذ اتخاذ
+
+259
+00:17:43,280 --> 00:17:43,700
+اتخاذ اتخاذ اتخاذ اتخاذ اتخاذ اتخاذ اتخاذ اتخاذ
+
+260
+00:17:43,700 --> 00:17:47,540
+اتخاذ اتخاذ اتخاذ اتخاذ اتخاذ اتخاذ اتخاذ اتخاذ
+
+261
+00:17:47,540 --> 00:17:53,090
+او الـ Blood pressure low
+
+262
+00:17:53,090 --> 00:17:56,030
+بالمناسبة كمان، الـ heart rate بتلاقيه بدأ يصير low
+
+263
+00:17:56,030 --> 00:17:59,790
+هذا معناه أنه بدأ الـ ICP يقلق كثير، ومعناه أنه فيه
+
+264
+00:17:59,790 --> 00:18:02,790
+نزيف، وفيه ضغط على الـ brain، إذا العلامات
+
+265
+00:18:02,790 --> 00:18:06,890
+أنك تلاقي الـ heart rate low، الـ respiration low، الـ
+
+266
+00:18:06,890 --> 00:18:09,230
+blood pressure كمان ينزل، بس الـ blood pressure ممكن
+
+267
+00:18:09,230 --> 00:18:14,330
+يبدأ يقلّ،  ويبدأ ينزل في الـ late stage، خلاص
+
+268
+00:18:14,330 --> 00:18:17,430
+بيكون المريض بطل يقدر يعمل compensation، خذ بالك
+
+269
+00:18:17,430 --> 00:18:20,650
+أوي، إذا كان الـ heart rate واطي والـ blood
+
+270
+00:18:20,650 --> 00:18:23,290
+pressure عالي، بعرف أنا أن المريض فيه أمل ولسه
+
+271
+00:18:23,290 --> 00:18:26,070
+جسمه بيحاول يعمل compensation، طيب ليش الـ heart
+
+272
+00:18:26,070 --> 00:18:30,810
+rate منخفض؟ لأن الـ intracranial pressure كثير
+
+273
+00:18:30,810 --> 00:18:32,950
+عالي، فيبدأ يعمل اللي هو
+
+274
+00:18:38,020 --> 00:18:41,840
+خلينا نحكي بحاجة اسمها الـ Sympathetic Nervous
+
+275
+00:18:41,840 --> 00:18:45,040
+System، بتعرف الـ Sympathetic Nervous System هو اللي
+
+276
+00:18:45,040 --> 00:18:51,140
+بيكون شغال وبيخلي الـ Brain تبعنا يظل شغال ويعطينا
+
+277
+00:18:51,140 --> 00:18:54,580
+orders، لما بيصير الـ Intracranial Pressure
+
+278
+00:18:54,580 --> 00:18:57,340
+عالي جداً، الـ function تبع الـ brain إيش بتصير فيها؟
+
+279
+00:18:57,340 --> 00:19:01,140
+بتتوقف لأنه مضغوط عليه فمش قادر يشتغل، إيش بيصير؟
+
+280
+00:19:01,140 --> 00:19:03,700
+بما إنه صار فيه injury direct في الـ brain وصار فيه
+
+281
+00:19:03,700 --> 00:19:09,550
+ICP عالي كثير وبتبطل اشتغال، مين بيشتغل؟ مازال
+
+282
+00:19:09,550 --> 00:19:12,610
+بيشتغل، الـ Brain الـ Sympathetic Nervous System
+
+283
+00:19:12,610 --> 00:19:15,590
+بيبقى بوجهه، فبيبدأ يشتغل جزء من الـ Sympathetic
+
+284
+00:19:15,590 --> 00:19:17,590
+Nervous System، جزء من الـ Sympathetic Nervous System
+
+285
+00:19:17,590 --> 00:19:23,230
+يعمل الـ Parasympathetic، تمام تمام، فعشان هيك، علامات
+
+286
+00:19:23,230 --> 00:19:26,490
+الـ Neurogenic Shock والـ Brain Injury أنه يكون
+
+287
+00:19:26,490 --> 00:19:31,610
+فيه Bradycardia، طيب ليش الـ Blood Pressure بالأول
+
+288
+00:19:31,610 --> 00:19:34,670
+بيرتفع في مرحلة الـ Compensation؟ لأن الـ
+
+289
+00:19:34,670 --> 00:19:37,670
+Intracranial Pressure عالي كثير، فعشان الـ Blood
+
+290
+00:19:37,670 --> 00:19:42,650
+يصل للـ Brain، بضطر الـ Blood الـ Artery للـ
+
+291
+00:19:42,650 --> 00:19:46,710
+Blood Pressure يرتفع أكثر وأكثر وأكثر وأكثر
+
+292
+00:19:46,710 --> 00:19:51,850
+وأكثر وأكثر وأكثر وأكثر وأكثر وأكثر وأكثر وأكثر
+
+293
+00:19:51,850 --> 00:19:54,610
+وأكثر وأكثر وأكثر وأكثر وأكثر وأكثر وأكثر وأكثر
+
+294
+00:19:54,610 --> 00:19:58,490
+وأكثر وأكثر وأكثر وأكثر وأكثر وأكثر وأكثر وأكثر
+
+295
+00:19:58,490 --> 00:20:01,750
+وأكثر وأكثر وأكثر وأكثر وأكثر وأكثر وأكثر وأكثر
+
+296
+00:20:01,750 --> 00:20:06,330
+وأكثر
+
+297
+00:20:06,330 --> 00:20:08,730
+وأكثر وأكثر
+
+298
+00:20:11,490 --> 00:20:14,490
+لأن طول المرحلة دي شغالة واحنا فيها compensation
+
+299
+00:20:14,490 --> 00:20:20,870
+لكن هذا خطير برضه، هو ممكن يعمل، من كثر blood
+
+300
+00:20:20,870 --> 00:20:24,610
+pressure يرتفع، أنه يعمل عند المريض اللي هو
+
+301
+00:20:24,610 --> 00:20:31,750
+hemorrhagic، hemorrhagic اللي هو CVA
+
+302
+00:20:31,750 --> 00:20:35,350
+يعني اللي يصير عنده هو hemorrhage في أي شريان من
+
+303
+00:20:35,350 --> 00:20:37,150
+الشرايين التي تغذي الـ Brain
+
+304
+00:20:40,640 --> 00:20:47,220
+عشان هيك لما المريض بفقد السيطرة بتلاقي طبعاً بتعرف
+
+305
+00:20:47,220 --> 00:20:50,360
+انتوا في الـ Hemorrhagic CVA، حتى في الـ Management
+
+306
+00:20:50,360 --> 00:20:53,120
+ما بيحاولوش أنهم يعملوا drop في الـ blood pressure
+
+307
+00:20:53,120 --> 00:20:57,780
+وينزلوه كثير، لأن هو هيزيد الـ ischemia وهيعمل
+
+308
+00:20:57,780 --> 00:21:04,640
+ischemia، تمام؟ فبينزلوه لحد يعني له management
+
+309
+00:21:04,640 --> 00:21:11,540
+معين، في أول ساعة بس بنزله حوالي من عشرة لعشرين، يعني
+
+310
+00:21:11,540 --> 00:21:16,540
+ما بنزلوهوش يعني بكل الأحوال، ما حدش يسمح ينزله أو
+
+311
+00:21:16,540 --> 00:21:20,560
+ممنوع أصلاً ينزل أقل من 140 على 90، لأن هذا هيزيد
+
+312
+00:21:20,560 --> 00:21:26,300
+الـ ischemia، طبعاً من ضمن الحاجات اللي ممكن تصير
+
+313
+00:21:26,300 --> 00:21:33,140
+في الـ head injury أن يكون، ممكن يحصل عنده درينج
+
+314
+00:21:33,140 --> 00:21:36,720
+للسوائل من الـ Nose أو الـ Mouth أو الـ Ears، وهذه
+
+315
+00:21:36,720 --> 00:21:38,840
+علامات الـ Skull Fracture
+
+316
+00:21:44,200 --> 00:21:50,340
+حكينا عن أن الأطفال عادةً معرضين للإصابات هذه
+
+317
+00:21:50,340 --> 00:21:54,880
+وبيصير عندهم lack of coordination، كثير من الناس،
+
+318
+00:21:54,880 --> 00:22:01,580
+يحط إيده على رأسه، يحط إيده على عينيه، يحط على
+
+319
+00:22:01,580 --> 00:22:07,700
+أنفه، مش قادر يسيطر بالضبط، هذا من الحاجات التي
+
+320
+00:22:07,700 --> 00:22:11,660
+ممكن تصير معهم، يعني ممكن ما يكونش اللي بيصير عنده
+
+321
+00:22:11,660 --> 00:22:17,000
+slurred speech، بيجي يحكي بـ بـ بـ بـ بـ بـ بـ
+
+322
+00:22:17,000 --> 00:22:17,600
+بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ
+
+323
+00:22:17,600 --> 00:22:17,680
+بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ
+
+324
+00:22:17,680 --> 00:22:18,140
+بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ
+
+325
+00:22:18,140 --> 00:22:18,740
+بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ
+
+326
+00:22:18,740 --> 00:22:19,680
+بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ
+
+327
+00:22:19,680 --> 00:22:19,720
+بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ
+
+328
+00:22:19,720 --> 00:22:37,480
+بـ بـ
+
+329
+00:22:38,390 --> 00:22:44,070
+حاجة تسمى Anisocoria،  التي هي يعني بدلاً من أن تكون
+
+330
+00:22:44,070 --> 00:22:48,170
+مستديرة ومنتظمة، تصير شكلها غير مستدير وغير منتظم، و
+
+331
+00:22:48,170 --> 00:22:50,950
+منتظمة، تلاقيها مبعوجة من جهة، عاملة زي البيضة
+
+332
+00:22:50,950 --> 00:22:55,390
+عاملة زي الملتوية، فهذه التغيرات نتيجة أنه في
+
+333
+00:22:55,390 --> 00:23:03,230
+تغيير في خلايا المخ، وفيه ربما ضغط على منطقة معينة، سبحان الله، الـ
+
+334
+00:23:03,230 --> 00:23:06,510
+Pupils هي مرآة المخ، إذا كان وضع
+
+335
+00:23:06,510 --> 00:23:09,870
+الـ Pupils مستدير ومنتظم ومتفاعل، معناه الـ
+
+336
+00:23:09,870 --> 00:23:13,050
+Brain طبيعي، إذا وجدنا Anisocoria، التي هي خلل في
+
+337
+00:23:19,060 --> 00:23:23,120
+واحدة من الـ pupils، سواء في انتظامها
+
+338
+00:23:23,120 --> 00:23:27,740
+أو في تفاعلها، معناه أنه في خلل في
+
+339
+00:23:27,740 --> 00:23:30,760
+الجانب المقابل في الـ brain، يعني إذا كانت للـ
+
+340
+00:23:30,760 --> 00:23:35,560
+اليسار، هي التي في اليمين، كل الـ brain اليمين هو الذي
+
+341
+00:23:35,560 --> 00:23:41,960
+فيه المشكلة، تمام؟  الـ symptom تبع
+
+342
+00:23:45,010 --> 00:23:50,450
+الـ Basilar Skull Fracture حكينا عنها كويس، وقلنا أنه ممكن
+
+343
+00:23:50,450 --> 00:23:53,570
+يكون فيه... طيب، أنا إيش بيفيدني كـ Critical
+
+344
+00:23:53,570 --> 00:23:56,850
+Care Nurse لما أعرف هذه الـ Symptoms وأشوف واحد
+
+345
+00:23:56,850 --> 00:24:00,950
+فيه عنده نزيف
+
+346
+00:24:00,950 --> 00:24:04,790
+من الـ Nose أو من الـ Ear، قلنا أول حاجة بأعرف أنه
+
+347
+00:24:04,790 --> 00:24:08,590
+فيه عنده suspected، اللي هو Fracture suspected
+
+348
+00:24:08,590 --> 00:24:13,790
+Fracture، وين؟ في الـ Basilar Skull، تمام؟ هذه أول
+
+349
+00:24:13,790 --> 00:24:17,010
+حاجة بتخليني أعرف أنه أنا ممنوع أحط للمريض هذا
+
+350
+00:24:17,010 --> 00:24:22,070
+اللي هو Nasogastric tube، ليش؟ لأنه ممكن
+
+351
+00:24:22,070 --> 00:24:25,610
+جداً، وأنت بتخشش في الـ Nasogastric tube هذا، بدل ما
+
+352
+00:24:25,610 --> 00:24:30,090
+تخشّ لأسفل، إلى المريء وتنزل إلى الـ Stomach،
+
+353
+00:24:30,090 --> 00:24:36,610
+ممكن تطلع على الـ Brain لأنه مكسور، وبالتالي
+
+354
+00:24:36,610 --> 00:24:41,820
+الـ base تبع الـ skull، العظم تبع قاعدة الجمجمة، برضه
+
+355
+00:24:41,820 --> 00:24:46,300
+مكسور، فأنت هتصير فيه عندك قابلية للاختراق، لذلك
+
+356
+00:24:46,300 --> 00:24:50,900
+ممنوع نحط Nasogastric tube، تمام؟ وطبعاً
+
+357
+00:24:50,900 --> 00:24:54,360
+هذا بيخليك تعرف أنه كمان المريض هذا high risk للـ
+
+358
+00:24:54,360 --> 00:24:58,720
+infection، بما أنه فيه عنده Basilar skull
+
+359
+00:24:58,720 --> 00:25:02,740
+fracture، وبالتالي احنا لازم نكون covered بـ
+
+360
+00:25:02,740 --> 00:25:06,020
+Antibiotic كويس، ولازم نكون محافظين على Good
+
+361
+00:25:06,020 --> 00:25:12,060
+Hygiene لمنطقة الـ Nose والـ Ears والـ
+
+362
+00:25:12,060 --> 00:25:15,620
+Mouth، حتى طبعاً عارفين كيف الـ Hygiene عن طريق الـ
+
+363
+00:25:15,620 --> 00:25:19,960
+Care، يعني مش هنعمل أكتر من أن نغسل يعني الـ Ear،
+
+364
+00:25:19,960 --> 00:25:25,230
+نمسحهم بقطعة قماش ونخليها نظيفة، والـ Nose كذلك، والـ
+
+365
+00:25:25,230 --> 00:25:28,890
+Mouth كذلك، طيب وإيش العكس؟ العكس هو أن يكون فيه
+
+366
+00:25:28,890 --> 00:25:31,630
+مثلاً Hematoma أو Blood Clots وأنا أسيبها، أتركها
+
+367
+00:25:31,630 --> 00:25:34,990
+موجودة، هتكون Media للـ Bacterial
+
+368
+00:25:34,990 --> 00:25:38,030
+Multiplication، وبالتالي البكتيريا هتكون متواجدة في
+
+369
+00:25:38,030 --> 00:25:41,330
+المكان بشكل أكثر، وبالتالي احتمالية أنها تطلع على
+
+370
+00:25:41,330 --> 00:25:44,470
+الـ Brain وتعمل Ascending Infection هتكون أكثر،
+
+371
+00:25:44,470 --> 00:25:46,210
+تمام؟
+
+372
+00:25:48,950 --> 00:25:52,250
+حكينا عن الـ Basilar Skull Fracture بما فيه الكفاية
+
+373
+00:25:52,250 --> 00:26:00,070
+وحكينا عن أنه ما بنحطش أي Nasogastric tube الآن، زي
+
+374
+00:26:00,070 --> 00:26:04,930
+ما حكينا عن الـ Concussion وحكينا عن الـ Contusion،
+
+375
+00:26:04,930 --> 00:26:08,670
+نحكي عن الـ Epidural Hematoma وأنواعها، أول شيء
+
+376
+00:26:08,670 --> 00:26:13,780
+بنذكركم أن الـ Brain له ثلاث أغشية، واحد اسمه الـ
+
+377
+00:26:13,780 --> 00:26:16,820
+Pia mater، واحد اسمه الـ Arachnoid mater، واحد
+
+378
+00:26:16,820 --> 00:26:19,580
+اسمه الـ Dura mater، الـ Pia mater اللي سموها
+
+379
+00:26:19,580 --> 00:26:23,060
+بالعربي الأم الحنون، لأنها قريبة من المخ، الـ
+
+380
+00:26:23,060 --> 00:26:26,300
+Arachnoid mater، الأم العنكبوتية، ليش بيسموها
+
+381
+00:26:26,300 --> 00:26:31,120
+عنكبوتية؟ عشان مليانة بالـ blood vessels، والخارجية
+
+382
+00:26:31,120 --> 00:26:35,570
+اسمها الأخيرة Dura mater، بيسموها بالعربي الأم
+
+383
+00:26:35,570 --> 00:26:38,710
+الجافية، عشانها بعيدة، طيب بعد هيك إيش فيه؟ فيه الـ
+
+384
+00:26:38,710 --> 00:26:43,370
+skull، اللي هي الجمجمة، طيب إيش أنواع الـ Epidural Hematoma؟ النوع الأول اسمه
+
+387
+00:26:47,330 --> 00:26:51,130
+الـ Epidural Hematoma، Epi يعني فوق، يعني فوق
+
+388
+00:26:51,130 --> 00:26:57,840
+الـ Dura mater، تحتها
+
+389
+00:26:57,840 --> 00:27:02,460
+الـ Arachnoid، وتحتها الـ Pia mater،  هين، صار في
+
+390
+00:27:02,460 --> 00:27:10,490
+Epidural بتجمع قدامها، بتشكل هلالي، زي الهلال، بين
+
+391
+00:27:10,490 --> 00:27:15,890
+الـ skull والـ Dura mater بالظبط، هو هذا تعريف الـ
+
+392
+00:27:15,890 --> 00:27:19,970
+epidural hematoma، a rapidly accumulating hematoma
+
+393
+00:27:19,970 --> 00:27:24,170
+between the dura mater and the cranium، cranium
+
+394
+00:27:24,170 --> 00:27:28,310
+يعني الـ skull، these patients have a history of
+
+395
+00:27:28,310 --> 00:27:33,830
+trauma with loss of consciousness، ثم فترة
+
+396
+00:27:33,830 --> 00:27:37,870
+وعي، تليها فقدان للوعي، تمام؟
+
+397
+00:27:37,870 --> 00:27:
+
+445
+00:30:59,490 --> 00:31:04,170
+الـprognosis تبعها كويس، وجداً خطيرة لو ما اتعالجتش
+
+446
+00:31:04,170 --> 00:31:07,910
+الـdeath rate فيها كتير عالي، أعلى من الحاجات
+
+447
+00:31:07,910 --> 00:31:12,070
+التانية. ليش؟ لأنه بدها علاج urgent يا أما المريض
+
+448
+00:31:12,070 --> 00:31:18,150
+حتفقدها. الـSubdural Hematoma، الـSubdural Hematoma،
+
+449
+00:31:18,150 --> 00:31:23,290
+لاحظ الكلام وين؟ Subdural، تحت الدورة، مش زي هان،
+
+450
+00:31:23,290 --> 00:31:29,850
+الدورة. لاحظ هان، الدورة على طول، على العظم، هاي
+
+451
+00:31:29,850 --> 00:31:35,090
+العظم (الجمجمة) تحت الـbleeding، دقيقة، لكن
+
+452
+00:31:35,090 --> 00:31:39,830
+في الـsubdural العظم مش فيه حاجة، العظم مش فيه
+
+453
+00:31:39,830 --> 00:31:46,010
+حاجة. كويس، والديورة فوق، وتحت من الدورة عادة بتصير
+
+454
+00:31:46,010 --> 00:31:51,060
+مشاكل. موجودة لديورة تحت من اللي ديورة صار فيه إيش
+
+455
+00:31:51,060 --> 00:31:55,960
+اللي هو bleeding. إذا الـsubdural hematoma هاي
+
+456
+00:31:55,960 --> 00:31:59,960
+care when there is tearing of the bridging vein.
+
+457
+00:31:59,960 --> 00:32:03,660
+عادة اللي بيعمل الـsubdural hematoma مش artery،
+
+458
+00:32:03,660 --> 00:32:09,880
+vein between times they between times they may be
+
+459
+00:32:09,880 --> 00:32:13,500
+caused by arterial laceration on the brain surface.
+
+460
+00:32:14,530 --> 00:32:20,150
+ويمكن أن يكون نتيجة عن طريق الـarterial laceration
+
+461
+00:32:20,150 --> 0:32:23,690
+لكن الشخص يمكن أن يكون لديه تاريخ خسارة الوعي، لكن
+
+462
+00:32:23,690 --> 00:32:27,210
+في الأغلب اللي يحصل هو
+
+463
+00:32:38,670 --> 00:32:44,830
+ممكن يكون صار عنده الـLoss of Conscious، يصير عنده
+
+464
+00:32:44,830 --> 00:32:49,050
+الـclinical onset of care after hours، الـSub
+
+465
+00:32:49,050 --> 00:32:52,570
+-dural hematoma، يعني الـonset تبع الـclinical
+
+466
+00:32:52,570 --> 00:32:57,940
+pictures بتطول، مش زي الـepidural على طول من الـ
+
+467
+00:32:57,940 --> 00:33:00,660
+minutes، يعني لازم تبطل بعد ساعات لما يبدأ يبين
+
+468
+00:33:00,660 --> 00:33:08,580
+عليه a crescent shape hemorrhage.
+
+469
+00:33:08,580 --> 00:33:13,300
+compressing the brain will be noted on the CT of
+
+470
+00:33:13,300 --> 00:33:18,500
+the head. surgical evacuation is the treatment.
+
+471
+00:33:18,500 --> 00:33:23,120
+والحل أن نعمل surgical evacuation، والـcommunication
+
+472
+00:33:23,120 --> 00:33:32,380
+معروفة. طلع كيف الشكل تبع
+
+473
+00:33:32,380 --> 00:33:39,560
+الـ… تبع الـsubdural hematoma زي ما حكينا، شكل
+
+474
+00:33:39,560 --> 00:33:46,040
+هلالي، هياته، من الأول للآخر، subdural، كمان
+
+475
+00:33:46,040 --> 00:33:52,420
+للمنطقة
+
+476
+00:33:52,420 --> 00:33:53,300
+المصابة.
+
+477
+00:33:56,540 --> 00:34:02,860
+هذه صورة CT، طب هي، طلع هذه المنطقة هي اللي بيكون
+
+478
+00:34:02,860 --> 00:34:10,320
+عاملة شكل الهلال، الـsubdural، أوكي.
+
+479
+00:34:10,320 --> 00:34:13,440
+زي ما إحنا شايفين، شكل الهلال. أنا على فكرة وأنا
+
+480
+00:34:13,440 --> 00:34:17,120
+بحكي، أظن إتلخبطت وأنا بحكي عن الـEpidural وحكيت
+
+481
+00:34:17,120 --> 00:34:22,200
+إنّه شكلها زي الـEpidural، شكلها زي العدسة، زي العدسة
+
+482
+00:34:22,200 --> 00:34:27,380
+المقعرة. شوفنا شكلها، نرجع عليه، أوريكم شكلها بيكون
+
+483
+00:34:27,380 --> 00:34:34,640
+عامل زي العدسة المقعرة، زي هذا الشكل، مش زي الهلال.
+
+484
+00:34:34,640 --> 00:34:37,320
+يعني، هذا فعلاً زي العدسة، طبعاً كيف العدسة بيكون
+
+485
+00:34:37,320 --> 00:34:42,420
+العدسات المقعرة، اللي بتكون هي، مقعرة من جهة، تمام؟
+
+486
+00:34:42,420 --> 00:34:47,140
+لكن الـSub-Dural هي اللي بيكون عاملة شكل الهلال،
+
+487
+00:34:47,140 --> 00:34:50,640
+هي واضحة جداً، في الـCT العادي، هي واضحة جداً شكل
+
+488
+00:34:50,640 --> 00:34:57,450
+هلال، تمام؟ طبعاً الـSub-dural مشكلتها أنّها ممكن
+
+489
+00:34:57,450 --> 00:35:01,070
+تكون Chronic، ولذلك السبب أنّ أعراضها بتظهرش بسرعة.
+
+490
+00:35:01,070 --> 00:35:04,850
+ولذلك حتى ممكن تظلّ وتصير Chronic مع المريض، تكون
+
+491
+00:35:04,850 --> 00:35:08,010
+صغيرة وما يحسش فيها، لكن الـAcute Sub-dural
+
+492
+00:35:08,010 --> 00:35:13,140
+اللي فجأة بتصير هي اللي عادة بتكون بدها العلاج
+
+493
+00:35:13,140 --> 00:35:17,700
+تظهر. دعونا نشوف الـAcute، تظهر بطريقة مشابهة
+
+494
+00:35:17,700 --> 00:35:21,480
+للهيماطومة الإكسترادولار، ويمكنها أن تكون لها
+
+495
+00:35:21,480 --> 00:35:24,080
+sequence متساوية
+
+496
+00:35:24,080 --> 00:35:25,120
+متساوية
+
+497
+00:35:25,120 --> 00:35:34,620
+متساوية
+
+498
+00:35:35,630 --> 00:35:39,470
+وطبعاً أكيد نتيجة اللي هو إنّه فيه vessel صار له
+
+499
+00:35:39,470 --> 00:35:43,770
+rupturing. the blood is again of high attenuation.
+
+500
+00:35:43,770 --> 00:35:47,250
+but may spread more widely in the subdural space.
+
+501
+00:35:47,250 --> 00:35:51,670
+with a crescentic appearance and more regularly in
+
+502
+00:35:51,670 --> 00:35:55,210
+our margin. شايفين كيف بيبقوا ينشر ويعطوا شكل
+
+503
+00:35:55,210 --> 00:35:59,910
+الهلال اللي هو تحت الدورة، لإن المساحة واسعة يعني
+
+504
+00:35:59,910 --> 00:36:05,480
+نوعاً ما، بيبقوا يمشوا فيها وبيعملوا اللي هو الـ
+
+505
+00:36:07,810 --> 00:36:10,190
+الشكل الهلال اللي حكينا عنه.
+
+506
+00:36:37,050 --> 00:36:40,470
+كل هذه المنطقة، المفروض أن يكون فيها
+
+507
+00:36:40,470 --> 00:36:47,570
+brain، لكن صارت blood ماشية فيها، تلاحظين كيف؟ هذه
+
+508
+00:36:47,570 --> 00:36:54,650
+المنطقة كلها، تمام. Chronic subdural hematoma، في
+
+509
+00:36:54,650 --> 00:36:57,670
+الـChronic، الـetiology ليست دائماً واضحة، يعني إيش
+
+510
+00:36:57,670 --> 00:37:00,350
+بتصير الـChronic؟ بس أكيد بيكون فيه إصابة قديمة،
+
+511
+00:37:00,350 --> 00:37:04,900
+يعني عادةً إنه أكل إصابة، وجهة، تمام؟ فيه
+
+512
+00:37:04,900 --> 00:37:09,260
+trauma قديمة، it is probably due to trauma، ربما
+
+513
+00:37:09,260 --> 00:37:14,420
+يكون trauma، often minor، بتكون بسيطة، preceding a
+
+514
+00:37:14,420 --> 00:37:18,320
+few weeks، قبل أيام أسبوع، but not such history is
+
+515
+00:37:18,320 --> 00:37:22,640
+obtainable in 15% of cases، 50% الحالات ما فيش
+
+516
+00:37:22,640 --> 00:37:25,380
+history. بيقول لك لو جات ولا صار شيء، هو إلا بيكون
+
+517
+00:37:25,380 --> 00:37:28,240
+صار شيء، بس بيكون شيء بسيط جداً، وما أثرش عليه
+
+518
+00:37:28,240 --> 00:37:30,860
+ساعتها كمان، حضرتُ إنّه مش بيتذكّره.
+
+519
+00:37:37,480 --> 00:37:42,620
+الشيء يتغير قليلاً
+
+520
+00:37:42,620 --> 00:37:43,460
+قليلاً
+
+521
+00:37:43,460 --> 00:37:47,100
+قليلاً
+
+522
+00:37:47,100 --> 00:37:51,220
+قليلاً
+
+523
+00:37:51,220 --> 00:38:00,980
+قليلاً
+
+524
+00:38:01,010 --> 00:38:05,370
+الـDensity تبعتها واضحة، هذا. ممكن بعد مدة
+
+525
+00:38:05,370 --> 00:38:09,690
+الـIsodense Collection تكون أفضل تمثيل بعد
+
+526
+00:38:09,690 --> 00:38:13,630
+الـIntravenous اللي هو الـContrast، يعني عشان أنتَ
+
+527
+00:38:13,630 --> 00:38:18,410
+تقدر تميز، لازم يعملوا CT with Contrast. ليش؟ لأنّه بعد
+
+528
+00:38:18,410 --> 00:38:21,290
+أسابيع بتلاقيها صارت زي لون
+
+529
+00:38:24,630 --> 00:38:27,850
+يعني بتعطي الصورة، picture تبع الـbrain طبيعية
+
+530
+00:38:27,850 --> 00:38:33,770
+وتبينش إنّه في عنده collection وفي عنده sub-dural،
+
+531
+00:38:33,770 --> 00:38:38,070
+تمام؟ ولذلك هنا بيحتاجوا إنّهم يعملوا اللي هو إيش
+
+532
+00:38:38,070 --> 00:38:41,750
+Contrast.
+
+533
+00:38:41,750 --> 00:38:47,170
+اللي هو يده صبغة، علشان يقدروا يميزوها،
+
+534
+00:38:47,170 --> 00:38:50,730
+تمام؟ طلع هاي هذا CT حقيقية
+
+535
+00:38:59,560 --> 00:39:03,240
+الحقيقية اللي بتخلينا نعرف، حتى لو الـDensity
+
+536
+00:39:03,240 --> 00:39:08,540
+ما كانتش واضحة جداً، لو ما كانش هنا في اختلاف في الكثافة
+
+537
+00:39:08,540 --> 00:39:11,700
+بين هذين، هنا واضحة، هنبين إنّه بالحاجة حاجة في
+
+538
+00:39:11,700 --> 00:39:16,680
+اسمها Midline Shift. كيف يعني؟ هذا الـblood، هذا
+
+539
+00:39:16,680 --> 00:39:21,240
+يظلّ يضغط على الجزء هذا من الـBrain، ويزيحه، فبيزاح
+
+540
+00:39:21,240 --> 00:39:26,200
+على الجهة هذه، فإيش بيصير؟ فبيصير هنا يا حبايبي إنّ
+
+541
+00:39:26,200 --> 00:39:29,500
+الخط اللي بيقسم الـBrain من النص هذا اسمه الـ
+
+542
+00:39:29,500 --> 00:39:33,920
+Midline، بتلاقي انبعاج، مشي لهيك، راح في اتجاه هذا، لأنّ
+
+543
+00:39:33,920 --> 00:39:37,980
+هذه الخلايا اللي هنا إيش صار فيها؟ زاحت في هذا
+
+544
+00:39:37,980 --> 00:39:43,160
+الاتجاه، زاحت هذه الخلايا اللي هنا، فالخط اللي في نصّ
+
+545
+00:39:43,160 --> 00:39:47,700
+الـBrain بيمشي، فبيصير فيه إيش؟ اللي هو بنقول
+
+546
+00:39:47,700 --> 00:39:52,220
+عنه shifting، shift يعني الـmidline صار له
+
+547
+00:39:52,220 --> 00:39:56,060
+shifting، مشي لقدام، يعني انحنى، تمام؟ الأصل أنّه في
+
+548
+00:39:56,060 --> 00:40:01,960
+الـmidline، تطلع كيف بيكون، تشوف هنا صورة واضحة،
+
+549
+00:40:01,960 --> 00:40:05,690
+هاي، حتقول، تطلع كيف الـmidline؟ المفروض أن يكون هناك
+
+550
+00:40:05,690 --> 00:40:09,910
+midline، منتظر، لما كل ما يمشي لقدام هذا يبقى ينحني
+
+551
+00:40:09,910 --> 00:40:14,370
+فيه وينحني فيه، ويبقى عامل shifting جاي هنا، ويبقى
+
+552
+00:40:14,370 --> 00:40:16,210
+عامل shift هنا و يبقى عامل shift هنا و يبقى عامل
+
+553
+00:40:16,210 --> 00:40:16,890
+shift هنا ويبقى عامل shift هنا ويبقى عامل shift
+
+554
+00:40:16,890 --> 00:40:16,950
+هنا ويبقى عامل shift هنا ويبقى عامل shift هنا ويبقى
+
+555
+00:40:16,950 --> 00:40:18,910
+عامل shift هنا ويبقى عامل shift هنا ويبقى عامل shift
+
+556
+00:40:18,910 --> 00:40:23,970
+هنا و يبقى عامل shift هنا ويبقى عامل shift هنا
+
+557
+00:40:23,970 --> 00:40:28,800
+و يبقى عامل. هذا خطير جداً، لأنّه سيؤثّر على الـ
+
+558
+00:40:28,800 --> 00:40:32,420
+pressure على جزء  من الـbrain، وهيعمل عند
+
+559
+00:40:32,420 --> 00:40:34,920
+المريض alteration في level of consciousness، أو
+
+560
+00:40:34,920 --> 00:40:41,320
+alteration في اللي هو الـ
+
+561
+00:40:41,320 --> 00:40:44,340
+function تبعات الـbrain كلها. this hematoma is
+
+562
+00:40:44,340 --> 00:40:45,160
+not also
+
+563
+00:40:59,760 --> 00:41:06,320
+هو عمره أسبوع أو أسبوعين، هو يمكن أن يكون مفقود على
+
+564
+00:41:06,320 --> 00:41:09,900
+جميع الـScanner، مع صورة قوية بشكل كبير، ولكن هذا
+
+565
+00:41:09,900 --> 00:41:13,240
+حقاً مشكلة حالياً. مشكلة حالياً. هل جيت فيه
+
+566
+00:41:13,240 --> 00:41:16,580
+Contrast فبطلت، يعني المشكلة. طلع كيف يبقوا ينسقوا
+
+567
+00:41:16,580 --> 00:41:23,520
+اللي بتلاحظها هي هان، كل هذا كان عبارة عن إيش؟
+
+568
+00:41:23,520 --> 00:41:24,160
+Collection.
+
+569
+00:41:27,470 --> 00:41:30,930
+طيب، آخر حاجة اللي بنحكي فيها، بعد ما حكيناها طبعاً
+
+570
+00:41:30,930 --> 00:41:34,450
+في آخر نوع، هدول الـEpidural والـSub-Epidural، فيه
+
+571
+00:41:34,450 --> 00:41:38,670
+نوع من الـBrain Injury، إنّه يحصل في داخل
+
+572
+00:41:38,670 --> 00:41:43,450
+الـIntracerebral Hematoma. كل هدول الحاجات، بنروحها
+
+573
+00:41:43,450 --> 00:41:46,010
+جماعة، بنتعامل معاهم، بنقيم الـConscious Level عن
+
+574
+00:41:46,010 --> 00:41:50,520
+طريق حاجة اسمها الـGlasgow Coma Scale. هذا يعني الـ
+
+575
+00:41:50,520 --> 00:41:54,220
+tool، هذه عبارة أو الـScale هذا، هي Scale جدًا
+
+576
+00:41:54,220 --> 00:42:01,520
+معروفة في الـICU، وبنقيم المرضى عن طريقه، فبنقولش
+
+577
+00:42:01,520 --> 00:42:03,740
+المريض Conscious أو Unconscious، لأ، بنقول المريض
+
+578
+00:42:03,740 --> 00:42:07,940
+الـConscious Level تبعه according to GCS، اللي هو
+
+579
+00:42:07,940 --> 00:42:12,940
+Glasgow Coma Scale is كذا. طب كيف بنقدر نعمله؟  بنقول
+
+580
+00:42:12,940 --> 00:42:19,120
+ببساطة، هذا من جسم لـ3. الجزء الأول لـEye
+
+581
+00:42:19,120 --> 00:42:23,900
+Opening، والـGrade منه أربعة، الأعلى هو الأربعة
+
+582
+00:42:23,900 --> 00:42:30,640
+والأقل هو واحد. والجزء الثاني هو الـVerbal Response،
+
+583
+00:42:30,640 --> 00:42:36,350
+استجابته Verbally، يعني للـcommand، لإني أحكي معه،
+
+584
+00:42:36,350 --> 00:42:41,590
+الأعلى هو خمسة، والأقل هو واحد. والأخير، الاستجابة
+
+585
+00:42:41,590 --> 00:42:46,650
+الحركية، الـMotor Response، اللي هو الأعلى ستة،
+
+586
+00:42:46,650 --> 00:42:50,950
+والأقل واحد. كيف نعمله؟ بكل بساطة، باجي أنا وبشوف
+
+587
+00:42:50,950 --> 00:42:54,750
+المريض، إذا spontaneous eye opening، فتح عينيه لحاله،
+
+588
+00:42:54,750 --> 00:42:58,030
+لغاية ما حدّ يتكلم، ويفتح عينيه، باخد أربعة. إذا مغمض
+
+589
+00:42:58,030 --> 00:43:05,280
+عينيه، لكن لما أجي أحكي معه، أبو الشباب محمد، بفتح
+
+590
+00:43:05,280 --> 00:43:09,640
+عينيه to speech، بفتح عينيه، لأنه بفضل يظلّ مغمض، إذا
+
+591
+00:43:09,640 --> 00:43:15,980
+هذا ثلاثة. طيب أنا ندهت له، يا حج، سمعني؟ لأ أبداً،
+
+592
+00:43:15,980 --> 00:43:19,460
+الفاتحة، مش هناك، بعمله بين فلسطين والعي، بضغطك بين
+
+593
+00:43:19,460 --> 00:43:22,900
+حواجبك، أو حاجة، بتجي الفاتحة هنا، إيش؟ إيش فيه؟ آه،
+
+594
+00:43:22,900 --> 00:43:26,120
+يعني بستجيب، بس للألم، إذاً الـEye Opening،
+
+595
+00:43:26,120 --> 00:43:29,840
+استجابة، فتح اللي هنا، للألم، to pain، باخد اثنين،
+
+596
+00:43:29,840 --> 00:43:34,750
+ضغطت، عملت له ألم، بردّه ما فتح، هنا بيكون واحد. طيب
+
+597
+00:43:34,750 --> 00:43:38,790
+الـVerbal Response، بحكي معه، كيف حالك؟ الحمد لله
+
+598
+00:43:38,790 --> 00:43:43,550
+يا ربّنا، الناس تعبانة. أه، oriented. أه أه أه أه أه
+
+599
+00:43:43,550 --> 00:43:43,870
+أه أه أه أه أه أه أه أه أه أه أه أه أه أه أه أه
+
+600
+00:43:43,870 --> 00:43:44,130
+أه أه أه أه أه أه أه أه أه أه أه أه أه أه أه أه
+
+601
+00:43:44,130 --> 00:43:44,150
+أه أه أه أه أه أه أه أه أه أه أه أه أه أه أه أه
+
+602
+00:43:44,150 --> 00:43:45,710
+أه أه أه أه أه أه أه أه أه أه أه أه أه أه أه أه
+
+603
+00:43:45,710 --> 00:43:47,570
+أه أه
+
+604
+00:44:03,860 --> 00:44:09,110
+تمام، أنا بحكي معه، فبقول له… يعني الـconfusion
+
+605
+00:44:09,110 --> 00:44:12,450
+تعرف كيف confusion؟ يعني مضطر أسوّي بس
+
+606
+00:44:12,450 --> 00:44:16,710
+inappropriate، بيصير يعني إجابة في غير محلها، الـ
+
+607
+00:44:16,710 --> 00:44:19,490
+inappropriate، زي ما حكيتها، وطلبت مثال، بقول أنا
+
+608
+00:44:19,490 --> 00:44:24,710
+كيف حالك؟ بقول، الله أني بطبخ سمّاجية ذاك، يعني
+
+609
+00:44:24,710 --> 00:44:27,730
+inappropriate، يعني بقول لك كيف حالك؟ وأين بتشتغل
+
+610
+00:44:27,730 --> 00:44:34,670
+أنت؟ في الجامعة، بقدّم أبو محمد، أنا ما بشتغلش، طب إيش ده
+
+611
+00:44:34,670 --> 00:44:39,370
+خنّفة محمد، إذا بحكي جملة صحيحة، لكن مش إجابة على
+
+612
+00:44:39,370 --> 00:44:43,930
+السؤال تبعها، أنت بتقول له فين بتشتغل؟ بيقول لك الولاد
+
+613
+00:44:43,930 --> 00:44:49,030
+بيلعبوا في الصف، ما كانوا بيت… بيدرسوا في الصف، بياخد
+
+614
+00:44:49,030 --> 00:44:54,460
+ثلاثة. لكن إذا كانت أكثر من ذلك، حالته، حتسألوا أي
+
+615
+00:44:54,460 --> 00:44:59,480
+سؤال، سيردّ عليه بـincomprehensible sound. إيش يعني
+
+616
+00:44:59,480 --> 00:45:04,340
+incomprehensible؟ يعني بتقولوا، كيف حالك؟
\ No newline at end of file
diff --git a/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/RUNF5tfm5rc_postprocess.srt b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/RUNF5tfm5rc_postprocess.srt
new file mode 100644
index 0000000000000000000000000000000000000000..f819740f3f8a187cbabac3571e876c96b8c77619
--- /dev/null
+++ b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/RUNF5tfm5rc_postprocess.srt
@@ -0,0 +1,2640 @@
+1
+00:00:02,090 --> 00:00:04,890
+بسم الله الرحمن الرحيم السلام عليكم ورحمة الله
+
+2
+00:00:04,890 --> 00:00:08,130
+وبركاته اليوم إن شاء الله رب العالمين هنحكي عن الـ
+
+3
+00:00:08,130 --> 00:00:12,410
+Head Injury وهو تقريبا آخر محاضرة في مساب الرعاية
+
+4
+00:00:12,410 --> 00:00:18,310
+الحقيقة الـ Head Injury زي ما حضراتكم عارفينممكن
+
+5
+00:00:18,310 --> 00:00:21,570
+تكون في الفروة تبع الرأس في الـSkull أو في
+
+6
+00:00:21,570 --> 00:00:24,850
+الـSkull نفسها في العضم تبع الرأس الجمجمة أو في
+
+7
+00:00:24,850 --> 00:00:31,590
+الـBrain، خلايا المخ طبعاً ممكن تكون إصابات بسيطة
+
+8
+00:00:31,590 --> 00:00:36,410
+ممكن تتعدى وتصير إصابات serious في الـBrain نفسه
+
+9
+00:00:36,410 --> 00:00:40,830
+ممكن تكون إصابات مغلقة يعنيمن غير ما يكون
+
+10
+00:00:40,830 --> 00:00:43,850
+Penetrating للـScalp ولا الـSkull ولا الـBrain
+
+11
+00:00:43,850 --> 00:00:50,130
+تشوه ممكن تكون فيها Open Head Injury أو
+
+12
+00:00:50,130 --> 00:00:55,430
+Penetrating يعني اخترقت الـScalp واخترقت الـSkull
+
+13
+00:00:55,430 --> 00:01:02,510
+وتوصل لـBrain طبعاً ممكن جداًالإصابة إنها تصيب الـ
+
+14
+00:01:02,510 --> 00:01:06,570
+«head» لكن ما توصلش لـ «brain» لكن إذا وصلت لـ
+
+15
+00:01:06,570 --> 00:01:11,190
+«brain» عادةً بتكون إصابة خطيرة الأنواع الـ «head
+
+16
+00:01:11,190 --> 00:01:14,150
+injury» اللي حكيناهم إنها تكون «closed» أو
+
+17
+00:01:14,150 --> 00:01:17,390
+«opened» أو «penetrating» ليش الفارق بينهم لـ
+
+18
+00:01:17,390 --> 00:01:24,370
+«close his injury» مين إنه «received a head blow
+
+19
+00:01:24,370 --> 00:01:30,430
+to the headfrom the sticking an object يعني أي
+
+20
+00:01:30,430 --> 00:01:36,010
+object أنت خبطت فيه أو هو خبط فيه بس من غير ما
+
+21
+00:01:36,010 --> 00:01:39,030
+يدخل في الجسم وليه يعمل لك Penetrating يعني زي
+
+22
+00:01:39,030 --> 00:01:44,070
+واحد وجعت عليه مثلا حيات وجع عليه حجر أكل وكس أكل
+
+23
+00:01:44,070 --> 00:01:49,730
+استضام فهذا هيعمله Traumatic اللي هو Closed Head
+
+24
+00:01:49,730 --> 00:01:52,750
+Injury لاحظين هذا بتكون اسمها Closed Head Injury
+
+25
+00:01:52,750 --> 00:01:57,400
+هذا عادة بيعمله إيه من الإصابات؟مشهورين، حاجة
+
+26
+00:01:57,400 --> 00:02:02,360
+اسمها الـ «brain contusion» أو حاجة اسمها «brain
+
+27
+00:02:02,360 --> 00:02:05,780
+concussion» هنشوف إيش الفرق بين الـ «concussion»
+
+28
+00:02:05,780 --> 00:02:09,980
+وبين الـ «confusion» بس بدنا نعرف إنه عادة الـ
+
+29
+00:02:09,980 --> 00:02:14,180
+«symptom» اللي بتصير في الـ «closed head injury»
+
+30
+00:02:14,180 --> 00:02:20,290
+هذا ممكن تكون اللي هومموري لوس والفقدار الذاكر على
+
+31
+00:02:20,290 --> 00:02:22,770
+هذا ليس مثل أفلام الهندية اللي بيظلوا مفقدين طول
+
+32
+00:02:22,770 --> 00:02:27,150
+عمره، بيكون temporary، يعني بتلاقي فقد الذاكر على
+
+33
+00:02:27,150 --> 00:02:33,710
+دقائق معينة، ساعات معينة، وبعدين بدأت يستعيد
+
+34
+00:02:33,710 --> 00:02:37,950
+ذاكرته، تمام؟ ممكن يكون عنده confusion، يعني بيبدأ
+
+35
+00:02:37,950 --> 00:02:41,550
+يصير مفترض ومش عارف مين اللي حواليه وإشي، كل هذا
+
+36
+00:02:41,550 --> 00:02:48,090
+ممكن يصير من الـbrain closed head traumaولكن الـ
+
+37
+00:02:48,090 --> 00:02:52,190
+Open Head Injury أو بيسموها الـ Penetrating Head
+
+38
+00:02:52,190 --> 00:02:56,210
+Injury يعني أننا مضطرين مع مجلد يقوم بتحطيم رأسك
+
+39
+00:02:56,210 --> 00:03:02,410
+ويدخل في عقلك، انت الخبطت بمجلد اللي خبط رأسك
+
+40
+00:03:02,410 --> 00:03:06,450
+وتبعك وعملها Penetrating وكسرها ودخل على الـ
+
+41
+00:03:06,450 --> 00:03:10,430
+Apprentice اللي تحت، this usually happens when you
+
+42
+00:03:10,430 --> 00:03:13,930
+move at high speeds such as going through the
+
+43
+00:03:13,930 --> 00:03:19,780
+woods during a car accidentلما تكون في صبات الطرق
+
+44
+00:03:19,780 --> 00:03:24,400
+والحوادث أو اللي بتزلج و بتزحل جواه وكل الحاجات
+
+45
+00:03:24,400 --> 00:03:28,320
+هذه ممكن تعمل الـ Head Injury و الـ Penetrating
+
+46
+00:03:28,320 --> 00:03:31,240
+Head Injury It can also happen from gunshot to the
+
+47
+00:03:31,240 --> 00:03:37,980
+head احنا اشهر حاجة انه ال gunshot و الـ Road
+
+48
+00:03:37,980 --> 00:03:44,030
+Traffic Accidentالـ Open or الـ Penetrating Head
+
+49
+00:03:44,030 --> 00:03:47,730
+Injury بتنقل لها Sign وSymptom وطبعاً أنت بتقدر
+
+50
+00:03:47,730 --> 00:03:51,930
+تشوفها من الشكل أنه واضح أنه في Penetrating Head
+
+51
+00:03:51,930 --> 00:03:55,070
+Injury لإيش؟ لأن أنت بتكون شافي بإيناك الـ Sign
+
+52
+00:03:55,070 --> 00:03:58,310
+and Symptom of Head Injury may occur immediately
+
+53
+00:03:58,310 --> 00:04:01,930
+or developed slowly over several hours طبعاً الـ
+
+54
+00:04:01,930 --> 00:04:06,610
+Immediately أن أنت بتشوف بإيناك أنه في Injury وفي
+
+55
+00:04:06,610 --> 00:04:09,930
+Bleeding وممكن تكون جوية في البرنتشو كمان، تمام؟
+
+56
+00:04:10,420 --> 00:04:15,380
+طبعاً تبدأ تظهر الأعراض عليه أكتر من ذلك، انتهاك
+
+57
+00:04:15,380 --> 00:04:19,720
+صعيب لكن ممكن يبدأ في symptoms مشكلة، confusion
+
+58
+00:04:19,720 --> 00:04:25,760
+ويبدأ يكون alter في level of consciousnessالـ Head
+
+59
+00:04:25,760 --> 00:04:28,480
+injury may cause a skull fracture which may or may
+
+60
+00:04:28,480 --> 00:04:30,720
+not associated with injury to the brain يعني ممكن
+
+61
+00:04:30,720 --> 00:04:34,740
+أنت بس يكون فيه عندك skull fracture ومايصيرش عندك
+
+62
+00:04:34,740 --> 00:04:38,240
+مشاكل في الـ brain ولا يتأثر الـ brain لكن لو ال
+
+63
+00:04:38,240 --> 00:04:42,210
+fracture هذا صار اسمه depressedالـ Fracture صار
+
+64
+00:04:42,210 --> 00:04:45,810
+فيه Bone Fragment نزل لتحت وعمله Depression وعمله
+
+65
+00:04:45,810 --> 00:04:48,030
+Pressure على الـ Brain صار اسمه هذا Depressed
+
+66
+00:04:48,030 --> 00:04:52,910
+Skull Fracture هذا عادةً هيأثر على المريض وعلى
+
+67
+00:04:52,910 --> 00:04:56,230
+درجة انه يعمل اندو-monoplegia يعني يصير فيه
+
+68
+00:04:56,230 --> 00:05:00,590
+اندوشلل في طرف واحد ويكون الحل الوحيد urgent
+
+69
+00:05:00,590 --> 00:05:03,710
+operation عشان ينهي الـ Fragment تبع الـ Bone هذا
+
+70
+00:05:03,710 --> 00:05:07,790
+و الـ Depressed Fracture ترتفع العظمة هذه ويروح لـ
+
+71
+00:05:07,790 --> 00:05:14,090
+Pressure على الـ Brainماذا يفعل الـ «Pregnant» أو
+
+72
+00:05:14,090 --> 00:05:14,850
+الـ «Pregnant» أو الـ «Pregnant» أو الـ «Pregnant»
+
+73
+00:05:14,850 --> 00:05:15,290
+أو الـ «Pregnant» أو الـ «Pregnant» أو الـ
+
+74
+00:05:15,290 --> 00:05:17,790
+«Pregnant» أو الـ «Pregnant» أو الـ «Pregnant» أو
+
+75
+00:05:17,790 --> 00:05:17,890
+الـ «Pregnant» أو الـ «Pregnant» أو الـ «Pregnant»
+
+76
+00:05:17,890 --> 00:05:18,150
+أو الـ «Pregnant» أو الـ «Pregnant» أو الـ
+
+77
+00:05:18,150 --> 00:05:19,510
+«Pregnant» أو الـ «Pregnant» أو الـ «Pregnant» أو
+
+78
+00:05:19,510 --> 00:05:19,590
+الـ «Pregnant» أو الـ «Pregnant» أو الـ «Pregnant»
+
+79
+00:05:19,590 --> 00:05:19,670
+أو الـ «Pregnant» أو الـ «Pregnant» أو الـ
+
+80
+00:05:19,670 --> 00:05:23,310
+«Pregnant» أو الـ «Pregnant» أو الـ «Pregnant» أو
+
+81
+00:05:23,310 --> 00:05:29,890
+الـ «Pregnant» أو الـ «Pregnant» أو الـفهذا بيعمل
+
+82
+00:05:29,890 --> 00:05:32,310
+pressure على الـ brain tissue وهذا بيخلّي
+
+83
+00:05:32,310 --> 00:05:36,430
+functionally إن بعض الـ brain tissue أو brain
+
+84
+00:05:36,430 --> 00:05:38,910
+cells إنها ما تشتغلش فبيصير عند الـ marine
+
+85
+00:05:38,910 --> 00:05:41,850
+monoplegia if intracranial hemorrhage or bleeding
+
+86
+00:05:41,850 --> 00:05:45,290
+within the brain occurs a hematoma with the skull
+
+87
+00:05:45,290 --> 00:05:48,830
+can put pressure on the brain هذا in general لما
+
+88
+00:05:48,830 --> 00:05:54,760
+بيصير في أنأي هواية، سواء Injury، سواء Closed أو
+
+89
+00:05:54,760 --> 00:05:57,940
+سواء Open اللي بيصير إنه بيصير شوية نزيف لما بيصير
+
+90
+00:05:57,940 --> 00:06:02,640
+شوية نزيف، هدول بتتجمع، يعني بتصير Hematoma
+
+91
+00:06:02,640 --> 00:06:06,760
+الـBlood Collection، تمام؟ هذا بيعمل Pressure عمين
+
+92
+00:06:06,760 --> 00:06:09,780
+على الـBrain الـPressure هذا بتجمع على الـBrain
+
+93
+00:06:10,590 --> 00:06:14,210
+بالإضافة إلى أنه حسب موقعها هذه الـ Hematoma
+
+94
+00:06:14,210 --> 00:06:22,400
+وعاملة pressure على الـ brain أخذت حيز من الـمكان
+
+95
+00:06:22,400 --> 00:06:26,340
+اللي محدد فيه الـ Intracranial Pressure إنه يكون
+
+96
+00:06:26,340 --> 00:06:30,900
+مثلا 15، الآن بما إنه هي عملة الـ Pressure بدأ
+
+97
+00:06:30,900 --> 00:06:34,160
+يصير الـ Intracranial Pressure أعلى الـ Types of
+
+98
+00:06:34,160 --> 00:06:36,900
+Intracranial Hematoma ممكن تكون هذه الـ Hematoma
+
+99
+00:06:36,900 --> 00:06:40,300
+سبب ديورة تحت الـ Diorameter ممكن تكون سبب
+
+100
+00:06:40,300 --> 00:06:43,280
+Arcanoid تحت الـ Arcanoid Meter ممكن تكون Extra
+
+101
+00:06:43,280 --> 00:06:46,620
+Diora، ممكن تكون اللي هوإيه بـ Dura يعني اللي
+
+102
+00:06:46,620 --> 00:06:50,080
+بيسميها برا للـ Dura أو Intra-parenchymia
+
+103
+00:06:50,080 --> 00:06:53,780
+الهيماتومة ممكن تكون في داخل الـ Intra-cerebral
+
+104
+00:06:53,780 --> 00:06:56,200
+hematoma اللي بيسميها الـ Parenchyma اللي هي الـ
+
+105
+00:06:56,200 --> 00:07:01,690
+cells تبعات الـ brainفي الحال عادةً بيكون إنك تطلع
+
+106
+00:07:01,690 --> 00:07:05,490
+الـ «Hematoma» اللي تعملها «Drainage» وإلا الـ
+
+107
+00:07:05,490 --> 00:07:08,630
+«Intracranial Pressure» حيزيد كتير وبالتالي هيفضل
+
+108
+00:07:08,630 --> 00:07:12,410
+المريض يتفعل معاه والـ «Blood Pressure» تبعه يزيد
+
+109
+00:07:12,410 --> 00:07:17,610
+كتير، تمام؟ علشان هيك إحنا هندرسهم الآن بالتفصيل
+
+110
+00:07:17,610 --> 00:07:22,910
+أنواع الـ«Brain Injury» اللي ممكن تعمل تأثير على
+
+111
+00:07:22,910 --> 00:07:31,410
+المريض كتيرة، من أهمهاإنه ممكن زي ما حكينا تعمل
+
+112
+00:07:31,410 --> 00:07:36,810
+ممكن تكون خارجية أو ممكن تكون hematoma في الداخل
+
+113
+00:07:36,810 --> 00:07:41,570
+زي إنها تعمل epidural أو subdural لكن كل هدولة لهم
+
+114
+00:07:41,570 --> 00:07:45,070
+علامات مشتركة ومجرد ما أنا أشوفهم بعرف إن هذا
+
+115
+00:07:45,070 --> 00:07:50,260
+المريض عنده إصابات في الدماغ من أشهر الإصاباتاللي
+
+116
+00:07:50,260 --> 00:07:53,800
+في دماغه بتخليني أعرف إن المريض هذا عنده skull
+
+117
+00:07:53,800 --> 00:07:58,480
+fracture أو عنده hit injury إنه أشوف أهم حاجة
+
+118
+00:07:58,480 --> 00:08:01,440
+bleeding their ear and bleeding their nose إذا
+
+119
+00:08:01,440 --> 00:08:05,380
+شُفت الحاجتين هدولة أو واحدة منهم تأكد إن المريض
+
+120
+00:08:05,380 --> 00:08:09,060
+هذا في عنده حاجة اسمها Base Skull Fracture يعني
+
+121
+00:08:09,060 --> 00:08:14,060
+القاعدة تبع الجمجمة فيها كسر وإذا صار القاعدة تبع
+
+122
+00:08:14,060 --> 00:08:16,380
+الجم ده مش الـoccipital يا جماعة مش اللي ورا
+
+123
+00:08:16,380 --> 00:08:25,750
+القاعدة هييعني هي السطح تبع التجوير الفمي
+
+124
+00:08:25,750 --> 00:08:32,050
+والأنفي يعني طبعا فوق الفم في الأن فوق الأن فده
+
+125
+00:08:32,050 --> 00:08:37,760
+فيه ثقف، الثقف ده هو قاعدةالدماغ هو قاعدة لدماغ
+
+126
+00:08:37,760 --> 00:08:41,200
+هذا هو الـ Base Skull Fracture لما بيصير فيه كثير
+
+127
+00:08:41,200 --> 00:08:46,320
+داخل بيبدأ ترتشع السوائل منه الـ CSF اللي هو
+
+128
+00:08:46,320 --> 00:08:49,360
+Cerebral Spinal Fluid أو الـ Blood ويطلع عبر
+
+129
+00:08:49,360 --> 00:08:54,020
+التجويف اللي هو عبر الـ Station Canal عبر قناة
+
+130
+00:08:54,020 --> 00:09:00,060
+Stachys إلى الأذن وعبر اللي هوالتجويف الأنفي أيضًا
+
+131
+00:09:00,060 --> 00:09:04,200
+على طريق الـ nasal canal لدرجة إنه كمان إحنا ممكن
+
+132
+00:09:04,200 --> 00:09:07,620
+تشوف هذا الكلام من المرض يكون بيضلوا يبلع لما يبقى
+
+133
+00:09:07,620 --> 00:09:11,900
+يحس إنه بنزل الأشياء هذه على الـOrphans ويبدأ يبلع
+
+134
+00:09:11,900 --> 00:09:15,880
+فيهم طبعًا أنا لو شوفت أي fracture في الـscalp أو
+
+135
+00:09:15,880 --> 00:09:18,180
+يعني شوفت wound في الـscalp أو fracture في
+
+136
+00:09:18,180 --> 00:09:22,690
+الـscalp في أي جزء منها بكون برضه متوقع إنه هنافي
+
+137
+00:09:22,690 --> 00:09:26,110
+أند المريض هذا «Head Injury» لو كان «Loss of
+
+138
+00:09:26,110 --> 00:09:30,590
+Conscious» برضه هذا سبب أن يكون «Head Injury» خاصة
+
+139
+00:09:30,590 --> 00:09:33,190
+إذا كان «Loss of Conscious» وانت شايف إنه في
+
+140
+00:09:33,190 --> 00:09:37,850
+حوالين هنا مثلا إذرقاق برضه الإذرقاق حوالين هنا قد
+
+141
+00:09:37,850 --> 00:09:41,830
+يكون من علامات الـBase Skull Fracture لأنه أحياناً
+
+142
+00:09:41,830 --> 00:09:45,090
+بيحتقن الدم في اللي هو الـPeriorbital
+
+143
+00:09:50,350 --> 00:09:53,710
+الـ Causes تبعت الـ Head-End زي ما حكينا السقوط
+
+144
+00:09:53,710 --> 00:09:56,930
+الـ Physical Assault اللي هو الاعتداء واحد يضرب
+
+145
+00:09:56,930 --> 00:10:03,150
+واحد ممكن الـ Accidents الحوادث ممكن اللي هو الـ
+
+146
+00:10:03,150 --> 00:10:04,490
+Gunshot زي ما حكينا
+
+147
+00:10:07,400 --> 00:10:14,260
+الحاجات اللي بتسير مثلا في الملاهي، في المراجيع،
+
+148
+00:10:14,260 --> 00:10:22,100
+في الحاجات هذه وكل كل سبب في الـ Head Injury طبعاً
+
+149
+00:10:22,100 --> 00:10:29,140
+الـ Head Injury إلها كتير يعني serious خلينا
+
+150
+00:10:29,140 --> 00:10:29,840
+نسميها
+
+151
+00:10:33,750 --> 00:10:37,590
+زي انها ممكن تعمل «loss of sensation» ممكن واحد
+
+152
+00:10:37,590 --> 00:10:41,730
+يفقد واحدة من الحواسب أو الـ «hearing» مثلا يبطل
+
+153
+00:10:41,730 --> 00:10:45,890
+يسمع بيجين يمكن يبطل يشوف يمكن يبطل يتذوق أو يشم
+
+154
+00:10:45,890 --> 00:10:49,890
+لأن هذه المراكز كلها في الموقعممكن يصير عنده
+
+155
+00:10:49,890 --> 00:10:54,450
+تشنجات يصير عنده Seizures اللي بيسموها Secondary
+
+156
+00:10:54,450 --> 00:10:58,130
+Epilepsy ممكن يصير عنده Paralysis ممكن يصير فيه
+
+157
+00:10:58,130 --> 00:11:01,790
+عنده نهائيا Paralysis يعني في جزء من أجزاء زي اسمه
+
+158
+00:11:01,790 --> 00:11:07,690
+Hemiparalysis أو Hemiplegia أو Paraplegia تمام؟
+
+159
+00:11:07,690 --> 00:11:10,850
+ممكن يظلوا في كومة يجدوا بعمر الإضاءة اللي كلها في
+
+160
+00:11:10,850 --> 00:11:14,690
+كومةممكن يصير عندهم، بعد اللي انجري شوية
+
+161
+00:11:14,690 --> 00:11:16,890
+personality disorder، الـ change في الـ mental
+
+162
+00:11:16,890 --> 00:11:20,450
+state تبعته، في ال emotions تبعته، تلاقي تصرفاته
+
+163
+00:11:20,450 --> 00:11:24,930
+غريبة، لأنه صار زمان أنه أكل هواية في رأسه، زي ما
+
+164
+00:11:24,930 --> 00:11:27,170
+بيحكوا، تمام؟
+
+165
+00:11:30,170 --> 00:11:32,950
+الـ Specific Problem اللي ممكن تصير عندنا زي ما
+
+166
+00:11:32,950 --> 00:11:36,170
+احنا شوفنا هو إنه يصير لديك Laceration في الـ
+
+167
+00:11:36,170 --> 00:11:40,190
+Scalp إذا كان على جد الـ Laceration و الـ Injury
+
+168
+00:11:40,190 --> 00:11:44,270
+تبعت الـ Scalp، بعدها بيخوفش الزماعة، تمام؟ لكن لو
+
+169
+00:11:44,270 --> 00:11:47,810
+صار الموضوع أكتر و صار هنا Traumatic Subdural
+
+170
+00:11:47,810 --> 00:11:52,410
+Hematoma أو Epidural Hematoma، هنا بيكون الوضع صار
+
+171
+00:11:52,410 --> 00:11:54,890
+خطير و بيبدأ الـ Consciously يتأثر و بيبدأ يصير
+
+172
+00:11:54,890 --> 00:11:56,670
+بدنا عمليات
+
+173
+00:12:01,460 --> 00:12:04,420
+سنشرحها بالتفصيل لـ Traumatic Subarachnoid
+
+174
+00:12:04,420 --> 00:12:10,780
+Hemorrhage لكن نعرف أن الإصابات اللي تحصل عند
+
+175
+00:12:10,780 --> 00:12:16,020
+الناس ممكن نجسمها لـ Contusion
+
+176
+00:12:19,060 --> 00:12:22,840
+أو حاجة بنسميها «concussion» ممكن الـ «concussion»
+
+177
+00:12:22,840 --> 00:12:27,340
+بيصير أكتر «confusion» يعني شوية أصعب شوية الـ
+
+178
+00:12:27,340 --> 00:12:29,820
+«concussion» اللي هو عبارة عن «brain injury» يعني
+
+179
+00:12:29,820 --> 00:12:31,980
+بيصير جارح في الـ «brain» لكن الـ «concussion»
+
+180
+00:12:31,980 --> 00:12:35,160
+عبارة عن temporary loss of function due to trauma
+
+181
+00:12:35,160 --> 00:12:38,000
+temporary الـ function دلوقتي كلها بتوقع، بعدين
+
+182
+00:12:38,000 --> 00:12:42,180
+كله برجع، هذا اسمه «concussion» بعدين كذا بنخش على
+
+183
+00:12:42,180 --> 00:12:45,740
+اللي هو أنواع الـ «hematoma» و الـ «bleeding» اللي
+
+184
+00:12:45,740 --> 00:12:53,390
+حكينا عنهابـ Epidural و Paradiural و Subdural نحن
+
+185
+00:12:53,390 --> 00:12:55,630
+نشوفه و من هنا نشوف في التفاصيل الـ Concussion الـ
+
+186
+00:12:55,630 --> 00:13:00,550
+Concussion زي ما حكينا هي عبارة عن إصابة في الدماغ
+
+187
+00:13:00,550 --> 00:13:03,930
+عادة يا جماعة ممكن تكون الإصابة أمامية يعني واحد
+
+188
+00:13:03,930 --> 00:13:08,090
+مثلا خبط في الأمام لكن أوجات كتير بيصير المنطقة
+
+189
+00:13:08,090 --> 00:13:12,650
+اللي اتأثرت في الـ Brain هي المنطقة الخلفية أو
+
+190
+00:13:12,650 --> 00:13:16,010
+بالعكس لو واحد خبطك اهوية من وراأه ممكن أنت
+
+191
+00:13:16,010 --> 00:13:22,870
+المنطقة اللي تتأثر هي الأمام كيف أنه بخبط يعني
+
+192
+00:13:22,870 --> 00:13:26,030
+بتسيل الإصابة في المنطقة هاي اللي بقين بروح بخبط
+
+193
+00:13:26,030 --> 00:13:29,650
+في قاعة جمجمة لأنه بقين بتحرك في جلب الصندوق تبع
+
+194
+00:13:29,650 --> 00:13:35,790
+الجمجمة فبتحرك إلى الأمام وبرجع بخبط بقوة في
+
+195
+00:13:35,790 --> 00:13:41,900
+المنطقة الأمامية تمام؟أو بالعكس، ممكن يتحرك إلى
+
+196
+00:13:41,900 --> 00:13:45,860
+اللي هو لو أنت أكلت اللي هو مثلا من هنا، هيتحرك
+
+197
+00:13:45,860 --> 00:13:49,160
+إلى الأمام، وبعدين يرجع، يرد تاني، يخبط في
+
+198
+00:13:49,160 --> 00:13:53,540
+الـSkull بعنف، فتصبح فيه Injury هنا، وتعمل هذه
+
+199
+00:13:53,540 --> 00:13:56,180
+اللي هو الـBrain Concussion، بكل الأحوال، الرجة
+
+200
+00:13:56,180 --> 00:14:01,330
+هذه اللي بتصبح من الأمام إلى الخلفوحركته السريعة
+
+201
+00:14:01,330 --> 00:14:05,170
+في داخل صندوق الجمجمة ده بتعمل حاجة في حاجة اسمها
+
+202
+00:14:05,170 --> 00:14:07,470
+الـ Prayer Concussion a concussion is a violent
+
+203
+00:14:07,470 --> 00:14:11,250
+jarring or shaking شركف الـ shaking يعني جاعد من
+
+204
+00:14:11,250 --> 00:14:13,330
+خض الـ Prayer من يمين وبروح ع الشمال ومن الشمال
+
+205
+00:14:13,330 --> 00:14:16,110
+وبروح ع اليمين result in disturbance of prayer
+
+206
+00:14:16,110 --> 00:14:20,030
+function الوظائف تبعت و بيصير فيها خلل لأنه إيش؟
+
+207
+00:14:20,030 --> 00:14:23,990
+يعني انخبطلما يعمل الخط يعني واحد كأنه خط شمال
+
+208
+00:14:23,990 --> 00:14:26,850
+يمين، mild concussion and not associated with any
+
+209
+00:14:26,850 --> 00:14:29,990
+sequel يعني عادة mild concussion، مايصيرش فيه أي
+
+210
+00:14:29,990 --> 00:14:33,130
+مشاكل، مايعملش أي حاجات يعني عادة تلاقي الواحد
+
+211
+00:14:33,130 --> 00:14:36,890
+راسه وجهه شوي، حاسه حاله ضايق، لكن لما بيكون أكتر
+
+212
+00:14:37,350 --> 00:14:40,550
+صار الـ Serious أكتر وصار الـ concussion يعني
+
+213
+00:14:40,550 --> 00:14:43,670
+سيبير كان بتلاقيه followed with إيش هو حاجة
+
+214
+00:14:43,670 --> 00:14:48,610
+بيسموها Amnesia أمنزيا يعني إيه اللي هو فقدانزيا
+
+215
+00:14:48,610 --> 00:14:51,150
+يعني ability to remember events before or after
+
+216
+00:14:51,150 --> 00:14:55,830
+the injuryوين أنا كنت؟ إيش صار معاه؟ قبل الحدث مش
+
+217
+00:14:55,830 --> 00:14:59,550
+متذكر إيش صار معاه أو after the injury بتلاقي
+
+218
+00:14:59,550 --> 00:15:03,390
+حالك؟ وين أنا؟ مين جابنيها؟ كيف صار؟ مش صاحي على
+
+219
+00:15:03,390 --> 00:15:06,790
+الحاجات هذه، هذه هي الـAmnesia The amount of time
+
+220
+00:15:06,790 --> 00:15:09,030
+that amnesia is present correlate with the
+
+221
+00:15:09,030 --> 00:15:12,690
+severity of the injury كل ما كانت ال injury سevere
+
+222
+00:15:12,690 --> 00:15:15,270
+و ال concussion صار سevere كل ما كانت الوقت ممكن
+
+223
+00:15:15,270 --> 00:15:20,350
+يطول تبع ال Amnesia، فقدان الذاكرةفي بعض الحالات،
+
+224
+00:15:20,350 --> 00:15:24,750
+يمكن أن يتطور الشخص لـ Post-Concussion Syndrome
+
+225
+00:15:24,750 --> 00:15:26,990
+اللي يمكن أن يتطور للشخص لـ Memory Problems،
+
+226
+00:15:26,990 --> 00:15:28,030
+Dizziness وDepression
+
+227
+00:15:33,680 --> 00:15:35,840
+الـ Concussion هذا بيظل عنده حد اسمه Post
+
+228
+00:15:35,840 --> 00:15:39,140
+-Concussion Syndrome يعني بيظلوا بعديها إدوخ،
+
+229
+00:15:39,140 --> 00:15:42,900
+بيظلوا بعديها تعبان شوية، بيظلوا بعديها ينسى
+
+230
+00:15:42,900 --> 00:15:45,640
+Cerebral Concussion is the most common head injury
+
+231
+00:15:45,640 --> 00:15:48,340
+seen in children عادة هذا كتير بيصير في الأطفال،
+
+232
+00:15:48,340 --> 00:15:52,380
+لكن سبحان الله ربنا بنجّههم و بيكبر لإن التطور
+
+233
+00:15:52,380 --> 00:15:56,630
+عنده سريع و أنه سريع و بيصيرش عندهولا أي حاجة،
+
+234
+00:15:56,630 --> 00:15:59,170
+تمام؟ هذا بالنسبالي الـ Concussion لكن الـ
+
+235
+00:15:59,170 --> 00:16:03,250
+Contusion، طلع الـ Contusion صابعة في الـ Brain في
+
+236
+00:16:03,250 --> 00:16:05,850
+أي منطقة صار فيها Contusion، طلع في Blood Spot
+
+237
+00:16:05,850 --> 00:16:09,310
+هنا، طلع هنا في Blood Spot، Blood Spot، هذا هو، في
+
+238
+00:16:09,310 --> 00:16:14,430
+لسريش يعني صار في، زي ما حكينا الـBrain، يعني في
+
+239
+00:16:14,430 --> 00:16:18,830
+Injury، يعني في جرح في خلايا المخ ونزفت، نزلت شوية
+
+240
+00:16:18,830 --> 00:16:23,900
+دم، لكن إيش؟ إيش بسيطفالـ brain contusion is a
+
+241
+00:16:23,900 --> 00:16:26,600
+braising of the brain tissue. The majority of
+
+242
+00:16:26,600 --> 00:16:30,000
+contusions occur in the frontal and temporal
+
+243
+00:16:30,000 --> 00:16:32,840
+lobes، أكتر في الـ frontal أو في الـ temporal.
+
+244
+00:16:36,260 --> 00:16:39,480
+Complications may include cerebral edema and
+
+245
+00:16:46,880 --> 00:16:55,340
+الـ Transcentral Herniation ممكن مع الـ confusion
+
+246
+00:16:55,340 --> 00:16:58,500
+أنه يصير Herniation هرنياشن يعني يا جماعة أنه
+
+247
+00:16:58,500 --> 00:17:03,720
+منطقة جزء من المخ يعني يصير فيها إفتاج يعني تطلع
+
+248
+00:17:03,720 --> 00:17:10,770
+تعمل bulging هيك غير عن الجزء اللي هيمحتوى فيه أو
+
+249
+00:17:10,770 --> 00:17:14,710
+اللي هي من ضمنه تطلع عن الـ bulging goal of a
+
+250
+00:17:14,710 --> 00:17:18,370
+treatment should be to increase intracranial
+
+251
+00:17:18,370 --> 00:17:21,730
+pressure أهم حاجة أحنا في ال management أنه الـ
+
+252
+00:17:21,730 --> 00:17:25,870
+intracranial pressure إذا ارتفع لازم احنا ننزله
+
+253
+00:17:25,870 --> 00:17:28,710
+علشان خاطر مايصيرش عند المرضي ال complicated of
+
+254
+00:17:28,710 --> 00:17:34,120
+the increased ICBالشيء التالي يشير إلى اتخاذ اتخاذ
+
+255
+00:17:34,120 --> 00:17:36,760
+اتخاذ اتخاذ اتخاذ اتخاذ اتخاز اتخاز اتخاز اتخاز
+
+256
+00:17:36,760 --> 00:17:40,540
+اتخاز اتخاز اتخاز اتخاز اتخاز اتخاز اتخاز اتخاز
+
+257
+00:17:40,540 --> 00:17:43,020
+اتخاز اتخاز اتخاز اتخاز اتخاز اتخاز اتخاز اتخاز
+
+258
+00:17:43,020 --> 00:17:43,280
+اتخاز اتخاز اتخاز اتخاز اتخاز اتخاز اتخاز اتخاز
+
+259
+00:17:43,280 --> 00:17:43,700
+اتخاز اتخاز اتخاز اتخاز اتخاز اتخاز اتخاز اتخاز
+
+260
+00:17:43,700 --> 00:17:47,540
+اتخاز اتخاز اتخاز اتخاز اتخاز اتخاز اتخاز اتخاز
+
+261
+00:17:47,540 --> 00:17:53,090
+اتخاز اتخاز اتخاز اوالـ Blood pressure low
+
+262
+00:17:53,090 --> 00:17:56,030
+بالمناسبة كمان الـ heart rate بتلاقي بدأ يصير low
+
+263
+00:17:56,030 --> 00:17:59,790
+هذا معناه أنه بدأ ال ICP يقلق كتير ومعناه أنه فيه
+
+264
+00:17:59,790 --> 00:18:02,790
+bleeding وفيه pressure على ال brain إذا العلمات
+
+265
+00:18:02,790 --> 00:18:06,890
+أنه تلاقي ال heart rate low ال respiration low ال
+
+266
+00:18:06,890 --> 00:18:09,230
+blood pressure كمان ينزل بس ال blood pressure ممكن
+
+267
+00:18:09,230 --> 00:18:14,330
+يبدأ يقلقوبتش بيبدأ ينزل في الـ Late stage خلاص
+
+268
+00:18:14,330 --> 00:18:17,430
+بيكون فبطل المريض يقدر يعمل compensation، خد بالك
+
+269
+00:18:17,430 --> 00:18:20,650
+اوى، إذا لو أنا كان ال heart rate واطي و ال blood
+
+270
+00:18:20,650 --> 00:18:23,290
+pressure عالي، بعرف أنا لسه المريض فيه أمل و لسه
+
+271
+00:18:23,290 --> 00:18:26,070
+جات جسمه بيحاول يعمل compensation، طب ليش ال heart
+
+272
+00:18:26,070 --> 00:18:30,810
+rate منخفض؟ لإن ال intra cranial pressure كتير
+
+273
+00:18:30,810 --> 00:18:32,950
+عالي، فيبدأ يعمل اللي هو
+
+274
+00:18:38,020 --> 00:18:41,840
+خلّينا نحكي بحاجة اسمها الـSympathetic Nervous
+
+275
+00:18:41,840 --> 00:18:45,040
+System بتعرف الـSympathetic Nervous System هو اللي
+
+276
+00:18:45,040 --> 00:18:51,140
+بيكون شغال و بيخلّي الـBrain تبعنا يظل شغال و
+
+277
+00:18:51,140 --> 00:18:54,580
+يعطينا orders لما بيصير الـIntracranial Pressure
+
+278
+00:18:54,580 --> 00:18:57,340
+عالي جدا الـfunction تبع الـbrain إيش بتصير فيها؟
+
+279
+00:18:57,340 --> 00:19:01,140
+بتتوقف لإنه مضغوط عليه فمش قادر يشغل إيش بيصير؟
+
+280
+00:19:01,140 --> 00:19:03,700
+بما إنه صار في injury direct في الـbrain وصار في
+
+281
+00:19:03,700 --> 00:19:09,550
+ICD عالي كتيروببتل اشتغال، مين بيشتغل؟ مازال و
+
+282
+00:19:09,550 --> 00:19:12,610
+بيوقف الـ Brain الـSympathetic Nervous System
+
+283
+00:19:12,610 --> 00:19:15,590
+بيبقى بوجهه، فبيبدأ يشتغل البعض الـSympathetic
+
+284
+00:19:15,590 --> 00:19:17,590
+Nervous System البعض الـSympathetic Nervous System
+
+285
+00:19:17,590 --> 00:19:23,230
+يعمل الـPredicardiumتمام تمام فعشان يكون علامات
+
+286
+00:19:23,230 --> 00:19:26,490
+الـ Neurogenic Shock و الـ Brain Injury أنه يكون
+
+287
+00:19:26,490 --> 00:19:31,610
+فيه Bradycardia طب ليش الـ Blood Pressure بالأول
+
+288
+00:19:31,610 --> 00:19:34,670
+بيرتفع في مرحلة الـ Compensation؟ لأن الـ
+
+289
+00:19:34,670 --> 00:19:37,670
+Intracranial Pressure عالي كتير فعشان الـ Blood
+
+290
+00:19:37,670 --> 00:19:42,650
+يوصل للـ Brain، بضطر الـ Blood الـ Artery للـ
+
+291
+00:19:42,650 --> 00:19:46,710
+Blood Pressure يرتفع أكترأكتر و أكتر و أكتر و أكتر
+
+292
+00:19:46,710 --> 00:19:51,850
+و أكتر و أكتر و أكتر و أكتر و أكتر و أكتر و أكتر و
+
+293
+00:19:51,850 --> 00:19:54,610
+أكتر و أكتر و أكتر و أكتر و أكتر و أكتر و أكتر و
+
+294
+00:19:54,610 --> 00:19:58,490
+أكتر و أكتر و أكتر و أكتر و أكتر و أكتر و أكتر و
+
+295
+00:19:58,490 --> 00:20:01,750
+أكتر و أكتر و أكتر و أكتر و أكتر و أكتر و أكتر و
+
+296
+00:20:01,750 --> 00:20:06,330
+أكتر
+
+297
+00:20:06,330 --> 00:20:08,730
+و أكتر و أكتر
+
+298
+00:20:11,490 --> 00:20:14,490
+لأن طول المرحلة دي شغالة و احنا فيها compensation
+
+299
+00:20:14,490 --> 00:20:20,870
+لكن هذا خطير برضه هو ممكن يعمل اللي من كتر blood
+
+300
+00:20:20,870 --> 00:20:24,610
+pressure يرتفع أنه يعمل عند المريض اللي هو
+
+301
+00:20:24,610 --> 00:20:31,750
+hemorrhagic hemorrhagic اللي هو CVA
+
+302
+00:20:31,750 --> 00:20:35,350
+يعني اللي يسير عنده هو hemorrhage في أي شريان من
+
+303
+00:20:35,350 --> 00:20:37,150
+الشراين اللي بتغذي الـBrain
+
+304
+00:20:40,640 --> 00:20:47,220
+عشان هيك لما المريض بفقد السيطرة بتلاقي طبعا بتعرف
+
+305
+00:20:47,220 --> 00:20:50,360
+أنتوا في الـ Hemorrhagic CVA حتى في الـ Management
+
+306
+00:20:50,360 --> 00:20:53,120
+بيحاولوش إنهم يعملوا drop في الـ blood pressure
+
+307
+00:20:53,120 --> 00:20:57,780
+وينزلوه كتير لإن هو هيزود الـ ischemia وهيعمل
+
+308
+00:20:57,780 --> 00:21:04,640
+ischemia، تمام؟ فبينزلوه لحد يعني إله management
+
+309
+00:21:04,640 --> 00:21:11,540
+معينفي أول ساعة بس بنزله حوالي من عشرة لعشرين يعني
+
+310
+00:21:11,540 --> 00:21:16,540
+مابنزلهوش يعني بكل الأحوال مابحدش بالسجن ينزله أو
+
+311
+00:21:16,540 --> 00:21:20,560
+ممنوع أصلا ينزله أقل من 140 على 90 لأن هذا هزود
+
+312
+00:21:20,560 --> 00:21:26,300
+الischemia طبعا من ضمن الحاجات اللي احنا ممكن تصير
+
+313
+00:21:26,300 --> 00:21:33,140
+في ال head injury أن يكونممكن يحصل عنده درينج
+
+314
+00:21:33,140 --> 00:21:36,720
+للفلود من الـ Nose أو الـ Mouth أو الـ Ears وهذه
+
+315
+00:21:36,720 --> 00:21:38,840
+علامات الـ Skull Fracture
+
+316
+00:21:44,200 --> 00:21:50,340
+حكينا عن أن الأطفال عادة مغرضين للإصابات هذه
+
+317
+00:21:50,340 --> 00:21:54,880
+وبيصير عندهم lack of coordination كتير من الناس،
+
+318
+00:21:54,880 --> 00:22:01,580
+يحط إيدك على مخارك، يحط إيده على دينه، يحط على
+
+319
+00:22:01,580 --> 00:22:07,700
+أنفه، مش قادر يسيطر بالظبط هذا من الحاجات اللي
+
+320
+00:22:07,700 --> 00:22:11,660
+ممكن تصير معهم، يعني ممكن مايكونش اللي بيصار عنده
+
+321
+00:22:11,660 --> 00:22:17,000
+slurred speech، بيجي يحكيبـ بـ بـ بـ بـ بـ بـ بـ
+
+322
+00:22:17,000 --> 00:22:17,600
+بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ
+
+323
+00:22:17,600 --> 00:22:17,680
+بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ
+
+324
+00:22:17,680 --> 00:22:18,140
+بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ
+
+325
+00:22:18,140 --> 00:22:18,740
+بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ
+
+326
+00:22:18,740 --> 00:22:19,680
+بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ
+
+327
+00:22:19,680 --> 00:22:19,720
+بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ
+
+328
+00:22:19,720 --> 00:22:37,480
+بـ بـ
+
+329
+00:22:38,390 --> 00:22:44,070
+حاجة بتسميها Anesokaria اللي هي يعني بدل ما هي
+
+330
+00:22:44,070 --> 00:22:48,170
+round و regular تصير شكلها مش round و مش regular و
+
+331
+00:22:48,170 --> 00:22:50,950
+regular تلاقيها مبعوجة من جهة عاملة زي البيضة
+
+332
+00:22:50,950 --> 00:22:55,390
+عاملة زي المتلة تعاملة فهذه التغيرات نتيجة إنه في
+
+333
+00:22:55,390 --> 00:23:03,230
+change فياللي هو الـ Brain Cells وفيه ربما الـ
+
+334
+00:23:03,230 --> 00:23:06,510
+Pressure Homage على منطقة معينة، سبحان الله الـ
+
+335
+00:23:06,510 --> 00:23:09,870
+Pupils هي الـ Mirror تبعت الـ Brain، إذا كان وضع
+
+336
+00:23:09,870 --> 00:23:13,050
+الـ Pupils Round و Regular و Reactive، معناه الـ
+
+337
+00:23:13,050 --> 00:23:19,060
+Brain طبيعيإذا وجدنا فيها نزيوكوريا اللي هي خلل في
+
+338
+00:23:19,060 --> 00:23:23,120
+واحدة من الـ pupils سواء في الـ regularity تبعتها
+
+339
+00:23:23,120 --> 00:23:27,740
+أو في الـ reactivity تبعتها معناه إنه في خلل في
+
+340
+00:23:27,740 --> 00:23:30,760
+الـ opposite side في الـ brain يعني إذا كانت للـU
+
+341
+00:23:30,760 --> 00:23:35,560
+نشمال هي اللي في هيكمة كل الـ brain اليمين هو اللي
+
+342
+00:23:35,560 --> 00:23:41,960
+فيه المشكلة، تمام؟ الـ symptom تبعت
+
+343
+00:23:45,010 --> 00:23:50,450
+الـ Scaly Fracture حكينا عنها كويس وقلنا إنه ممكن
+
+344
+00:23:50,450 --> 00:23:53,570
+يكون فيه إنه .. طب أنا إيش بيفيدني كـ Critical
+
+345
+00:23:53,570 --> 00:23:56,850
+Care Nurse لما أعرف هذا الـ Symptom و أشوف واحد
+
+346
+00:23:56,850 --> 00:24:00,950
+فيه عنده bleeding
+
+347
+00:24:00,950 --> 00:24:04,790
+من الـ Nose أو من الـ Ear قلنا أول حاجة باعرف إنه
+
+348
+00:24:04,790 --> 00:24:08,590
+في عنده Suspected اللي هو Fracture Suspected
+
+349
+00:24:08,590 --> 00:24:13,790
+Fracture وين؟في الـ Basal Skull، تمام؟ هذه أول
+
+350
+00:24:13,790 --> 00:24:17,010
+حاجة بتخليني أعرض أنه أنا ممنوع أحط للمريد هذا
+
+351
+00:24:17,010 --> 00:24:22,070
+اللي هو Nasogastric tube نسوغات، ليش؟ لأنه ممكن
+
+352
+00:24:22,070 --> 00:24:25,610
+جدا وانت بتخشش في الـ Nasogastric tube هذا بدل ما
+
+353
+00:24:25,610 --> 00:24:30,090
+تخشت downward على الأسوفيقاس و تنزل على الـStomach
+
+354
+00:24:30,090 --> 00:24:36,610
+ممكن تبقى طالع على الـBrain لأن هو مكسور، وبالتالي
+
+355
+00:24:36,610 --> 00:24:41,820
+الـBaseتبعت الـ skull العضم تبع قاعد جنده ما برضه
+
+356
+00:24:41,820 --> 00:24:46,300
+مكسور فانت و هتصير فيه عندك قابلية للاختراق فلذلك
+
+357
+00:24:46,300 --> 00:24:50,900
+ممنوع نحط نيزوجا ع الـ strict tube تمام؟ و طبعا
+
+358
+00:24:50,900 --> 00:24:54,360
+هذا بيخليك تعرف انه كمان المريض هذا لـhigh risk لل
+
+359
+00:24:54,360 --> 00:24:58,720
+infection بما انه في عنده اللي هو basic skull
+
+360
+00:24:58,720 --> 00:25:02,740
+fractureوبالتالي إحنا لازم نكون covered بـ
+
+361
+00:25:02,740 --> 00:25:06,020
+Antibiotic كويس و لازم نكون محافظين على God
+
+362
+00:25:06,020 --> 00:25:12,060
+Hygiene لمنطقة اللي هو الـ Nose و الـ Ears و الـ
+
+363
+00:25:12,060 --> 00:25:15,620
+Mouth حتى طبعا عارفين كيف الـ Hygiene عن طريق الـ
+
+364
+00:25:15,620 --> 00:25:19,960
+Care يعني مش هنعمل أكتر من إنه نغسل يعني الـ Ear
+
+365
+00:25:19,960 --> 00:25:25,230
+نمسحهم بصلاعين و نخليها نظيفةوالـ Nose كذلك و الـ
+
+366
+00:25:25,230 --> 00:25:28,890
+Mouth كذلك طب و إيش العكس؟ العكس هي إنه يكون فيه
+
+367
+00:25:28,890 --> 00:25:31,630
+مثلا Hematoma أو Blood Clots و أنا أسيبها، أتضلها
+
+368
+00:25:31,630 --> 00:25:34,990
+موجودة في العينادة هتكون Media للـBacterial
+
+369
+00:25:34,990 --> 00:25:38,030
+Multiplication وبالتالي البكتيريا هتكون متواجدة في
+
+370
+00:25:38,030 --> 00:25:41,330
+المكان بشكل أكتر وبالتالي احتمالية إنها تطلع على
+
+371
+00:25:41,330 --> 00:25:44,470
+الـ Brain وتعمل Assailing Infection هتكون أكتر،
+
+372
+00:25:44,470 --> 00:25:46,210
+تمام؟
+
+373
+00:25:48,950 --> 00:25:52,250
+حكينا عن الـBase Skull Fracture بما فيه الكفاية
+
+374
+00:25:52,250 --> 00:26:00,070
+وحكينا عن إنه ما بنحطش أي نيزوجاثركاتيوب الآن زي
+
+375
+00:26:00,070 --> 00:26:04,930
+ما حكينا عن الـConcussion وحكينا عن الـContusion
+
+376
+00:26:04,930 --> 00:26:08,670
+نحكي عن الإيديدور الهيماتومة وأنواعها أول شيء
+
+377
+00:26:08,670 --> 00:26:13,780
+بنذكركم إن الـBrain له تلاتةأغشية واحد اسمه الـ
+
+378
+00:26:13,780 --> 00:26:16,820
+Biomatter واحد اسمه الـ Arachnoid Matter واحد
+
+379
+00:26:16,820 --> 00:26:19,580
+اسمها الـ Durameter الـ Biomatter اللي سموها
+
+380
+00:26:19,580 --> 00:26:23,060
+بالعرب الأب الحلون لأنها قريبة من المخ الـ
+
+381
+00:26:23,060 --> 00:26:26,300
+Arachnoid Matter الأم العنكبوتية ليش بيسموها
+
+382
+00:26:26,300 --> 00:26:31,120
+عنكبوتية؟ عشان مليانة بالـ blood vessels والخارجية
+
+383
+00:26:31,120 --> 00:26:35,570
+اسمها آخر واحدةلديورة متر بيسموها بالعرب الأم
+
+384
+00:26:35,570 --> 00:26:38,710
+الجافية عشانها بعيدة طب بعد هيك إيش فيه فيه قعد
+
+385
+00:26:38,710 --> 00:26:43,370
+هيك فيه الـ skull هيته العظيم تبع الجمجمة طيب إيش
+
+386
+00:26:43,370 --> 00:26:47,330
+أنواع الإيبي الديورة الهيماتومة النوع الأول اسمه
+
+387
+00:26:47,330 --> 00:26:51,130
+الـ Ibi ديورة الهيماتومة Ibi يعني فوق يعني فوق
+
+388
+00:26:51,130 --> 00:26:57,840
+الديورة راحز هايالـ Epidural Hematoma تحتها
+
+389
+00:26:57,840 --> 00:27:02,460
+الـ Arachnoid وتحتها الـ Biomatter هين صار في
+
+390
+00:27:02,460 --> 00:27:10,490
+Epidural بتجمع قدامها تشكل هلالي زي الهلالأعوين
+
+391
+00:27:10,490 --> 00:27:15,890
+أوبين الـ skull والديورة بالظبط هو هذا تعريف الـ
+
+392
+00:27:15,890 --> 00:27:19,970
+epidural hematoma a rapidly accumulating hematoma
+
+393
+00:27:19,970 --> 00:27:24,170
+between the durameter and the cranium، cranium
+
+394
+00:27:24,170 --> 00:27:28,310
+يعني الـ skull، these patients have a history of
+
+395
+00:27:28,310 --> 00:27:33,830
+traumawith loss of consciousness then الوثيب
+
+396
+00:27:33,830 --> 00:27:37,870
+period followed by loss of consciousness تمام؟
+
+397
+00:27:37,870 --> 00:27:42,070
+clinical onset of care over minute to hours إذن
+
+398
+00:27:42,070 --> 00:27:46,310
+ماكنتش المريض هاد أكل إفواعي صار بدأ عنده إيه بدت
+
+399
+00:27:46,310 --> 00:27:50,630
+صار عنده تجمع Fibrid Uremeter تمام؟ شوية بيبدأ
+
+400
+00:27:50,630 --> 00:27:54,450
+المريض يفقد إفواعيه خلال minute ليش؟ لأن ال
+
+401
+00:27:54,450 --> 00:27:59,410
+pressure بكون عالي يا جماعة على ال brain تمام؟فهذا
+
+402
+00:27:59,410 --> 00:28:02,750
+بيقدر الأفق، طب واش الحل إذا كانت acute على طول
+
+403
+00:28:02,750 --> 00:28:04,890
+many of these injuries are associated with
+
+404
+00:28:04,890 --> 00:28:08,910
+laceration of the mild meningial artery طبعا، من
+
+405
+00:28:08,910 --> 00:28:13,350
+أيه صار النزيل؟ في meningial artery، طلع كيف؟
+
+406
+00:28:13,350 --> 00:28:16,110
+Artery، احفظوا الكلمة، بتيجي في الانتحار، لما
+
+407
+00:28:16,110 --> 00:28:20,540
+بقولك epidural hematomaمن انجل آر تري هو اللي
+
+408
+00:28:20,540 --> 00:28:25,380
+بيكون إيش اتأثر فبروح بعمل الـ lenticular اللي هو
+
+409
+00:28:25,380 --> 00:28:27,860
+convex lens shape زي ما انتوا شايفينه شكل زي
+
+410
+00:28:27,860 --> 00:28:34,740
+الهلال extra cerebral hemorrhage و الـ light be
+
+411
+00:28:34,740 --> 00:28:39,460
+visible on CT يعني لو شوفنا CT هلاقي شكل اللي هو
+
+412
+00:28:39,460 --> 00:28:43,920
+الابيطيور الهيماتومة عامل بالشكل الهلال هذا أظن أن
+
+413
+00:28:43,920 --> 00:28:45,060
+أنا جيبت صورة CT
+
+414
+00:28:54,730 --> 00:29:00,110
+هنا بيكون الحل أننا بدنا للناس هدولة urgent
+
+415
+00:29:00,110 --> 00:29:03,490
+operation although this is a potential
+
+416
+00:29:03,490 --> 00:29:07,270
+complication الprogress is good خد بالك الepidural
+
+417
+00:29:07,270 --> 00:29:13,910
+hematoma جدا خطيرة تعتبر في دقائق المريض ممكن يفقد
+
+418
+00:29:13,910 --> 00:29:17,130
+واعي يمكن يتحمل ويصير في ساعات زي ما أكينا minute
+
+419
+00:29:17,130 --> 00:29:21,260
+إلى hours هناطبعا؟ يعني هو ممكن يتحمّن في نص ساعة،
+
+420
+00:29:21,260 --> 00:29:23,040
+ساعة، بقى .. لما يكون بقى .. لكن من كتير بعد
+
+421
+00:29:23,040 --> 00:29:27,420
+سنتين، تلاتة، حاسيبتي إشي ال .. ليش؟ اللي نزف
+
+422
+00:29:27,420 --> 00:29:31,380
+Artery فبنزف كتير فكمية الدم اللي بتطلع بتكون
+
+423
+00:29:31,380 --> 00:29:34,820
+كتيرة عادة فبتبقى الـ brochure عيش ماله كتير عشان
+
+424
+00:29:34,820 --> 00:29:38,700
+هي الـ deterioration سريع الحال جدا بسيط كيف الحال
+
+425
+00:29:38,700 --> 00:29:41,840
+جدا بسيط؟ مجرد ما المريض نعمل عملية و نعمل
+
+426
+00:29:41,840 --> 00:29:45,460
+evacuation له الـ hematoma هاي إيش بيصير؟ ولا حالة
+
+427
+00:29:45,460 --> 00:29:48,620
+الـ Prognosis is very good ممتاز Prognosis is good
+
+428
+00:29:48,830 --> 00:29:52,550
+والـ Death injury is recognized and treated كيف؟
+
+429
+00:29:52,550 --> 00:29:56,710
+Treated بالـ evacuation لكن لو ما اتعلجوش وما
+
+430
+00:29:56,710 --> 00:30:03,450
+نعملوش عملية جدا صعب لدرجة إن الـ Death هو اللي
+
+431
+00:30:03,450 --> 00:30:08,710
+بيكون الـ complication خلاص بمون، شوف كيف؟
+
+432
+00:30:08,710 --> 00:30:14,090
+تشخيصها، okay why؟وبعدها فقد الوعي على طول لازم
+
+433
+00:30:14,090 --> 00:30:17,190
+تحط بالك إنه صار عنده Epidural Hematoma إذا ما
+
+434
+00:30:17,190 --> 00:30:19,870
+لاجيناش Epidural Hematoma ساعتها بنقول آه يمكن
+
+435
+00:30:19,870 --> 00:30:23,770
+Concussion أو Contusion اللي أخدناها من طول، تمام؟
+
+436
+00:30:23,770 --> 00:30:27,510
+بس إذا Contusion يمكن يبين شوية Spot هنهارة أو
+
+437
+00:30:27,510 --> 00:30:30,130
+بقول هذا Contusion بالدرافة، لكن إذا مافيش إيش ولا
+
+438
+00:30:30,130 --> 00:30:33,230
+حاجة، لأ بس ممكن Concussion، خط بعضه بتحسن و بصحى
+
+439
+00:30:33,230 --> 00:30:38,600
+و بنحط ضحك المتابع، مش هى؟ تمامطبعاً في كل الحالات
+
+440
+00:30:38,600 --> 00:30:42,140
+هذه الـVomiting يا جماعة حاجة واردة جدا إنها تحصل
+
+441
+00:30:42,140 --> 00:30:47,760
+لأن الـCentral CTZ تبع الـVomiting موجود في
+
+442
+00:30:47,760 --> 00:30:51,080
+الـBrain فمجرد ما بيزيد الـICP هذا بيعمل عند الناس
+
+443
+00:30:51,080 --> 00:30:54,910
+simulation إنه يحصل عندهمبوموتينج، تمام؟ الـ
+
+444
+00:30:54,910 --> 00:30:59,490
+Epidural Hematoma زي ما شوفنا جداً سهلة أنه جداً
+
+445
+00:30:59,490 --> 00:31:04,170
+الـprognosis تبعها كويس وجداً خطيرة لو ما اتعالجتش
+
+446
+00:31:04,170 --> 00:31:07,910
+الـdeath rate فيها كتير عالي أعلى من الحاجات
+
+447
+00:31:07,910 --> 00:31:12,070
+التانية، ليش؟ لأنه بدها إلاج urgent يا أما المريض
+
+448
+00:31:12,070 --> 00:31:18,150
+حتفقدهالـ Subdural Hematoma الـ Subdural Hematoma،
+
+449
+00:31:18,150 --> 00:31:23,290
+لاحظ الكلام وين؟ Subdural، تحت الدورة، مش زي هان،
+
+450
+00:31:23,290 --> 00:31:29,850
+الدورة، لاحظ هان، الدورة على طول، على العظم، هاي
+
+451
+00:31:29,850 --> 00:31:35,090
+العظم تبقى الجمجمة تحت الـ bleeding، فدقيقة، لكن
+
+452
+00:31:35,090 --> 00:31:39,830
+في الsubdural العظم مش فيه حاجة، العظم مش فيه
+
+453
+00:31:39,830 --> 00:31:46,010
+حاجة، كويسوالديورة فوق و تحت من الديورة عادة تشتري
+
+454
+00:31:46,010 --> 00:31:51,060
+مشاكلموجودة لديورة تحت من اللي ديورة صار فيه إيش
+
+455
+00:31:51,060 --> 00:31:55,960
+اللي هو bleeding إذا الـ subdiura hematoma هاي who
+
+456
+00:31:55,960 --> 00:31:59,960
+care when there is tearing of the bridging vein
+
+457
+00:31:59,960 --> 00:32:03,660
+عادة اللي بيعمل ال subdiura ال hematoma مش artery،
+
+458
+00:32:03,660 --> 00:32:09,880
+vein between times they between times they may be
+
+459
+00:32:09,880 --> 00:32:13,500
+caused by arterial laceration on the brain surface
+
+460
+00:32:14,530 --> 00:32:20,150
+ويمكن أن يكون نتيجة عن طريق الـArterial Laceration
+
+461
+00:32:20,150 --> 00:32:23,690
+لكن الشخص يمكن أن يكون لديه تاريخ خسارة الوعي لكن
+
+462
+00:32:23,690 --> 00:32:27,210
+في الأغلب اللي يحصل هو
+
+463
+00:32:38,670 --> 00:32:44,830
+ممكن يكون صار عنده الـ Loss of Conscious يصير عنده
+
+464
+00:32:44,830 --> 00:32:49,050
+الـ Clinical onset of care after hours الـ Sub
+
+465
+00:32:49,050 --> 00:32:52,570
+-dural hematoma يعني الـ onset تبع الـ Clinical
+
+466
+00:32:52,570 --> 00:32:57,940
+picturesبتطول مش زي الـ epidural على طول من الـ
+
+467
+00:32:57,940 --> 00:33:00,660
+minutes يعني لازم تبطل بعد ساعات لما يبدأ يبين
+
+468
+00:33:00,660 --> 00:33:08,580
+عليه a crescent shape hemorrhage
+
+469
+00:33:08,580 --> 00:33:13,300
+compressing the brain will be noted on the CT of
+
+470
+00:33:13,300 --> 00:33:18,500
+the head surgical evacuation is the treatment
+
+471
+00:33:18,500 --> 00:33:23,120
+والحل ان نعمل surgical evacuation والcommunication
+
+472
+00:33:23,120 --> 00:33:32,380
+معروفةطلع كيف الشكل تبع
+
+473
+00:33:32,380 --> 00:33:39,560
+الـ… تبع الـsubdural hematoma زي ما حكينا، شكل
+
+474
+00:33:39,560 --> 00:33:46,040
+هلالي، هياته، من الأول للآخر، subdural، كمان
+
+475
+00:33:46,040 --> 00:33:52,420
+للمنطقة
+
+476
+00:33:52,420 --> 00:33:53,300
+المصابة
+
+477
+00:33:56,540 --> 00:34:02,860
+هذه صورة CT طب هي طلع هذه المنطقة هي اللي بيكون
+
+478
+00:34:02,860 --> 00:34:10,320
+عاملة شكل الهلال الـ subdural أوكي
+
+479
+00:34:10,320 --> 00:34:13,440
+زي ما احنا شايفين شكل الهلال أنا على فكرة وأنا
+
+480
+00:34:13,440 --> 00:34:17,120
+بحكي أظن اتلخبطت وأنا بحكي عن الـEpidural وحكيت
+
+481
+00:34:17,120 --> 00:34:22,200
+إنه شكلها زي الـEpidural شكلها زي العدسة زي العدسة
+
+482
+00:34:22,200 --> 00:34:27,380
+المقعرة شوفنا شكلها نرجع عليه أريكمشكلها بيكون
+
+483
+00:34:27,380 --> 00:34:34,640
+عامل زي العدسة مقعرة، زي هذا الشكل، مش زي الهلال
+
+484
+00:34:34,640 --> 00:34:37,320
+يعني، هذا فعلا زي العدسة، طبعا كيف العدسة بيكون
+
+485
+00:34:37,320 --> 00:34:42,420
+العدسات المقعرين، اللي بتكون هي قطاز من جهة، تمام؟
+
+486
+00:34:42,420 --> 00:34:47,140
+لكن الـSub-Dural هي اللي بيكون عاملة شكل الهلال،
+
+487
+00:34:47,140 --> 00:34:50,640
+هي واضح جدا، في الـCT العادى، هي واضح جدا شكل
+
+488
+00:34:50,640 --> 00:34:57,450
+هلال، تمام؟طبعاً الـ Sub-neutral مشكلتها أنها ممكن
+
+489
+00:34:57,450 --> 00:35:01,070
+تكون Chronic ولذلك السبب ان اتباعاتها بتظهرش بسرعة
+
+490
+00:35:01,070 --> 00:35:04,850
+ولذلك حتى ممكن تظل وتصير Chronic مع العيان تكون
+
+491
+00:35:04,850 --> 00:35:08,010
+صغيرة وما ماحسش فيها لكن الـ Acute Sub-neutral
+
+492
+00:35:08,010 --> 00:35:13,140
+اللي فجأة بتصير هي اللي عادة بتكون بدهاالعلاج
+
+493
+00:35:13,140 --> 00:35:17,700
+تظهر، دعونا نشوف الـ Acute تظهر بطريقة مشابهة
+
+494
+00:35:17,700 --> 00:35:21,480
+للهيماطومة الإكسترادولار ويمكنها أن تكون لها
+
+495
+00:35:21,480 --> 00:35:24,080
+سيكوينسيا متساومة متساومة متساومة متساومة متساومة
+
+496
+00:35:24,080 --> 00:35:25,120
+متساومة متساومة متساومة متساومة متساومة متساومة
+
+497
+00:35:25,120 --> 00:35:34,620
+متساومة متساومة
+
+498
+00:35:35,630 --> 00:35:39,470
+وطبعاً أكيد نتيجة اللي هو إنه فيه vessel صار له
+
+499
+00:35:39,470 --> 00:35:43,770
+rupturing the blood is again of high attenuation
+
+500
+00:35:43,770 --> 00:35:47,250
+but may spread more widely in the subdural space
+
+501
+00:35:47,250 --> 00:35:51,670
+with a crescentic appearance and more regularly in
+
+502
+00:35:51,670 --> 00:35:55,210
+our margin شايفين كيف بيبقوا ينشر ويعطوا شكل
+
+503
+00:35:55,210 --> 00:35:59,910
+الهلال اللي هو تحت الديورة لإن المساحة واسعة يعني
+
+504
+00:35:59,910 --> 00:36:05,480
+نوعا مابيظلوا يمشي فيها وبيعمل اللي هو الـ
+
+505
+00:36:07,810 --> 00:36:10,190
+الشكل الهلال اللي حكينا عنه
+
+506
+00:36:37,050 --> 00:36:40,470
+كل هذه المنطقة التكملة، هذه المفروض أن يكون فيها
+
+507
+00:36:40,470 --> 00:36:47,570
+brain، لكن صارت blood ماشي فيها، تلاحظين كيف؟ هذه
+
+508
+00:36:47,570 --> 00:36:54,650
+المنطقة كلها تمام Chronic subdural hematoma، في
+
+509
+00:36:54,650 --> 00:36:57,670
+الـChronic الـetiology ليست دائمًا واضحة، يعني إيش
+
+510
+00:36:57,670 --> 00:37:00,350
+بتصبح الـChronic؟ بس أكيد بيكون فيه هواية قديمة،
+
+511
+00:37:00,350 --> 00:37:04,900
+يعني عادةًإنه أكل هواية، أكل حاجة، وجهة، تمام؟ فيه
+
+512
+00:37:04,900 --> 00:37:09,260
+trauma قديمة، it is probably due to trauma ربما
+
+513
+00:37:09,260 --> 00:37:14,420
+يكون trauma، often minor، بتكون بسيطة، preceding a
+
+514
+00:37:14,420 --> 00:37:18,320
+few weeks، قبل أكام أسبوع، but not such history is
+
+515
+00:37:18,320 --> 00:37:22,640
+obtainable in 15% of cases، 50% الحالات مافيش
+
+516
+00:37:22,640 --> 00:37:25,380
+history، بيقولك لو جاءت ولا صار إشي، هو إلا بيكون
+
+517
+00:37:25,380 --> 00:37:28,240
+صار إشي، بس بيكون إشي بسيط جدا، وماأثرش عليه
+
+518
+00:37:28,240 --> 00:37:30,860
+ساعتها كمان، حضرت إنه مش بتذكره
+
+519
+00:37:37,480 --> 00:37:42,620
+الشيء يتغير قليلًا وشيء يتغير قليلًا وشيء يتغير
+
+520
+00:37:42,620 --> 00:37:43,460
+قليلًا وشيء يتغير قليلًا وشيء يتغير قليلًا وشيء
+
+521
+00:37:43,460 --> 00:37:47,100
+يتغير قليلًا وشيء يتغير قليلًا وشيء يتغير قليلًا
+
+522
+00:37:47,100 --> 00:37:51,220
+وشيء
+
+523
+00:37:51,220 --> 00:38:00,980
+يتغير قليلًا وشي
+
+524
+00:38:01,010 --> 00:38:05,370
+الـDensity تباعتها واضحة هذا، ممكن بعد مدة
+
+525
+00:38:05,370 --> 00:38:09,690
+الـIsodense Collection تكون أفضل تمثيلة بعد
+
+526
+00:38:09,690 --> 00:38:13,630
+الـIntravenous اللي هو الـContra يعني عشان أنت
+
+527
+00:38:13,630 --> 00:38:18,410
+تقدر تميز لازم يعملوا CT وContrast، ليش؟ لأنه بعد
+
+528
+00:38:18,410 --> 00:38:21,290
+أسابيع بتلاقيها صارت زي لون
+
+529
+00:38:24,630 --> 00:38:27,850
+يعني بتعطي الصورة picture تبع الـ«برانشيب» طبيعية
+
+530
+00:38:27,850 --> 00:38:33,770
+وتبينش إنه في عنده collection وفي عنده sub-edural،
+
+531
+00:38:33,770 --> 00:38:38,070
+تمام؟ ولذلك هنا بيحتاجوا إنهم يعملوا اللي هو إيش
+
+532
+00:38:38,070 --> 00:38:41,750
+«Contrast»
+
+533
+00:38:41,750 --> 00:38:47,170
+اللي هو يده صبغة علشان يقدروا إميزوها،
+
+534
+00:38:47,170 --> 00:38:50,730
+تمام؟ طلع هاي هذا CT حقيقية
+
+535
+00:38:59,560 --> 00:39:03,240
+الحقيقية اللي بتخليننا نعرف حتى لو الـDensity
+
+536
+00:39:03,240 --> 00:39:08,540
+ماكنتش واضحة جدا، لو ماكنش هنا في اختلاف في الكثرة
+
+537
+00:39:08,540 --> 00:39:11,700
+بين هذين، هنا واضحة، هنبين إنه بالحاجة حاجة في
+
+538
+00:39:11,700 --> 00:39:16,680
+اسمها Midline Shift كيف يعني؟ هذا الـBrush Artهذا
+
+539
+00:39:16,680 --> 00:39:21,240
+يظل يضغط على الجزء هذا من الـ Brain ويزجه فبيزجه
+
+540
+00:39:21,240 --> 00:39:26,200
+على الجهة هذه فإيش بيصير؟ فبيصير هنا يا حبابي إن
+
+541
+00:39:26,200 --> 00:39:29,500
+الخط اللي بيقسم الـ Brain من النص هذا اسمه الـ
+
+542
+00:39:29,500 --> 00:39:33,920
+Midline بتلاقي انبعج مشي لهيك راح في اتجاه هذا لإن
+
+543
+00:39:33,920 --> 00:39:37,980
+هذه الخلايا اللي هنا إيه صار فيها؟ مشت في هذا
+
+544
+00:39:37,980 --> 00:39:43,160
+الاتجاه تزجت هذه الخلايا اللي هنا فالخط اللي بنص
+
+545
+00:39:43,160 --> 00:39:47,700
+في الـ Brain بيمشي فبيصير فيه إيش؟اللي هو بنقول
+
+546
+00:39:47,700 --> 00:39:52,220
+عنه shifting، shift يعني الـ midline صار له
+
+547
+00:39:52,220 --> 00:39:56,060
+shifting، مشي لقدام، يعني بعج، تمام؟ الأصل أنه في
+
+548
+00:39:56,060 --> 00:40:01,960
+الـ midline، تطلع كيف يكون، تشوف هنا صورة واضحة،
+
+549
+00:40:01,960 --> 00:40:05,690
+هاي هتقول تطلع كيف ال midline؟المفروض أن يكون هناك
+
+550
+00:40:05,690 --> 00:40:09,910
+midline منتظر لما كل ما يمشي لقدام هذا يبقى يبعش
+
+551
+00:40:09,910 --> 00:40:14,370
+فيه ويبعش فيه ويبقى عامل shifting جاه هنا ويبقى
+
+552
+00:40:14,370 --> 00:40:16,210
+عامل shift هنا ويبقى عامل shift هنا ويبقى عامل
+
+553
+00:40:16,210 --> 00:40:16,890
+shift هنا ويبقى عامل shift هنا ويبقى عامل shift
+
+554
+00:40:16,890 --> 00:40:16,950
+ويبقى عامل shift هنا ويبقى عامل shift هنا ويبقى
+
+555
+00:40:16,950 --> 00:40:18,910
+shift هنا ويبقى عامل shift هنا ويبقى عامل shift
+
+556
+00:40:18,910 --> 00:40:23,970
+هنا ويبقى عامل shift هنا ويبقى عامل shift هنا
+
+557
+00:40:23,970 --> 00:40:28,800
+ويبقى عاملهذا خطير جداً لأنه سيأثر على الـ
+
+558
+00:40:28,800 --> 00:40:32,420
+pressure على جزء أداك اللي في الـ brain وهيعمل عند
+
+559
+00:40:32,420 --> 00:40:34,920
+المريض alteration في level of consciousness أو
+
+560
+00:40:34,920 --> 00:40:41,320
+alteration في اللي هو الـ
+
+561
+00:40:41,320 --> 00:40:44,340
+function تبعات الـ brain كلها، this hematoma is
+
+562
+00:40:44,340 --> 00:40:45,160
+not also
+
+563
+00:40:59,760 --> 00:41:06,320
+هو عمره أسبوع أو أسبوعينهو يمكن أن يكون مفقود على
+
+564
+00:41:06,320 --> 00:41:09,900
+جميع الـ Scanner مع صورة قوية بشكل كبير ولكن هذا
+
+565
+00:41:09,900 --> 00:41:13,240
+حقًا مشكلة حاليًا، مشكلة حاليًا، هل جيت فيه
+
+566
+00:41:13,240 --> 00:41:16,580
+Construct فبطلت يعني المشكلة، طلع كيف يبقوا ينسيق
+
+567
+00:41:16,580 --> 00:41:23,520
+اللي بتلاحظها هي تهان، كل هذا كان عبارة عن إيش؟
+
+568
+00:41:23,520 --> 00:41:24,160
+Collection
+
+569
+00:41:27,470 --> 00:41:30,930
+طيب، أخر حاجة اللي بنحكي فيها بعد ما حكيناها طبعاً
+
+570
+00:41:30,930 --> 00:41:34,450
+في أخر نوع، هدول الـEpidural و الـSub-Epidural فيه
+
+571
+00:41:34,450 --> 00:41:38,670
+نوع من الـBrain Injury إنه يحصل في داخل
+
+572
+00:41:38,670 --> 00:41:43,450
+الـIntracerebral Hematoma كل هدول الحاجات بنروحها
+
+573
+00:41:43,450 --> 00:41:46,010
+جماعة، بنتعامل معاهم، بنقيم الـConscious Level عن
+
+574
+00:41:46,010 --> 00:41:50,520
+طريق حاجة اسمهاالـ Glasgow Coma Scale هذا يعني الـ
+
+575
+00:41:50,520 --> 00:41:54,220
+«تول» هذه عبارة أو الـ Scale هذا هي Scale جدًا
+
+576
+00:41:54,220 --> 00:42:01,520
+معروف في الـ ICU وبنقيم المرضى عن طريقه فبنقولش
+
+577
+00:42:01,520 --> 00:42:03,740
+المريض Conscious أو Unconscious لأ، بنقول المريض
+
+578
+00:42:03,740 --> 00:42:07,940
+الـ Conscious Level تبعه According to GCS اللي هو
+
+579
+00:42:07,940 --> 00:42:12,940
+Glasgow Coma Scale is كذا طب كيف بنقدر نعمله؟ جالك
+
+580
+00:42:12,940 --> 00:42:19,120
+نقول ببساطة هذا من جسم لـ 3الجزء الأول لـ I
+
+581
+00:42:19,120 --> 00:42:23,900
+Opening والـ Grade منه أربعة الأعلى هو الأربعة
+
+582
+00:42:23,900 --> 00:42:30,640
+والأقل هو واحد والجزء التاني هو الـ Vapor Response
+
+583
+00:42:30,640 --> 00:42:36,350
+استجابتهالـVerbally يعني للـCommand لإني أحكي معاه
+
+584
+00:42:36,350 --> 00:42:41,590
+الأعلى هو خمسة والأقل هو واحد والأخير الاستجابة
+
+585
+00:42:41,590 --> 00:42:46,650
+الحركية الـMotor Response اللي هو الأعلى ستة
+
+586
+00:42:46,650 --> 00:42:50,950
+والأقل واحد كيف نعمله بكل بساطة باجي أنا وبشوف
+
+587
+00:42:50,950 --> 00:42:54,750
+المريض إذا spontaneous eye opening فات عينيه لحاله
+
+588
+00:42:54,750 --> 00:42:58,030
+لغاية ما حد يتكلم ويفتح عينيه باخد أربعة إذا مغمض
+
+589
+00:42:58,030 --> 00:43:05,280
+عينيه لكن لما أجي أحكي معاهأبو الشباب محمد بفتح
+
+590
+00:43:05,280 --> 00:43:09,640
+عينيه to speech بفتح عينيه لأنه بفضل يظل مغمض إذا
+
+591
+00:43:09,640 --> 00:43:15,980
+هدا تلاتة طيب أنا ندتها ليه يا حج سمعنيلأ أبداً،
+
+592
+00:43:15,980 --> 00:43:19,460
+الفاتحة مش هناك، بعمله بين فلسطين والعي، بضغطك بين
+
+593
+00:43:19,460 --> 00:43:22,900
+حواجب أو حاجة، بتجي الفاتحة هنا، إيش؟ إيش فيه؟ آه،
+
+594
+00:43:22,900 --> 00:43:26,120
+يعني بستجيب، بس للألم، إذاً الـEye Opening،
+
+595
+00:43:26,120 --> 00:43:29,840
+استجابة، فتح اللي هنا، للألم، to بين، باخد اتنين،
+
+596
+00:43:29,840 --> 00:43:34,750
+ضغطت، عملتله ألم، برضه مفاتحة هنا، بكون واحدطيب
+
+597
+00:43:34,750 --> 00:43:38,790
+الـ Verbal Response بحكي معاه كيف حالك؟ الحمد لله
+
+598
+00:43:38,790 --> 00:43:43,550
+يا ربنا الناس تعبان أه oriented أه أه أه أه أه أه
+
+599
+00:43:43,550 --> 00:43:43,870
+أه أه أه أه أه أه أه أه أه أه أه أه أه أه أه أه أه
+
+600
+00:43:43,870 --> 00:43:44,130
+أه أه أه أه أه أه أه أه أه أه أه أه أه أه أه أه أه
+
+601
+00:43:44,130 --> 00:43:44,150
+أه أه أه أه أه أه أه أه أه أه أه أه أه أه أه أه أه
+
+602
+00:43:44,150 --> 00:43:45,710
+أه أه أه أه أه أه أه أه أه أه أه أه أه أه أه أه أه
+
+603
+00:43:45,710 --> 00:43:47,570
+أه أه
+
+604
+00:44:03,860 --> 00:44:09,110
+تمام، أنا بحكي معاه، فبقولّهيعني الـ confusion
+
+605
+00:44:09,110 --> 00:44:12,450
+تعرف كيف confusion يعني مضطر بسوية بس
+
+606
+00:44:12,450 --> 00:44:16,710
+inappropriate بيصير يعني إيجاه في غير محله الـ
+
+607
+00:44:16,710 --> 00:44:19,490
+inappropriate زي ما حكيتها و طلبت مثال بقول أنا
+
+608
+00:44:19,490 --> 00:44:24,710
+كيف حالك؟ بقول الله أني بتطبخ سماجية ذاك يعني
+
+609
+00:44:24,710 --> 00:44:27,730
+inappropriate يعني بقولك كيف حالك؟ و أين بتشتغل
+
+610
+00:44:27,730 --> 00:44:34,670
+أنت؟ في الجامعة بقدن أبو محمد أنا بشتغلشطب إيش ده
+
+611
+00:44:34,670 --> 00:44:39,370
+خنّفة محمد إذا بحكي جمال صحيحة لكن مش إجابة على
+
+612
+00:44:39,370 --> 00:44:43,930
+السؤال تبعتها انت بتقوله فاشي بتشتغل بيقولك الولاد
+
+613
+00:44:43,930 --> 00:44:49,030
+بيلعبوا في الصف ماكانوش بيت بدرسوا في الصف بياخد
+
+614
+00:44:49,030 --> 00:44:54,460
+تلاتة لكن إذا كانتأكتر من ذلك حالته، ستسألون أي
+
+615
+00:44:54,460 --> 00:44:59,480
+سؤال سيرد عليه بـIncomprehensible sound إيش يعني
+
+616
+00:44:59,480 --> 00:45:04,340
+Incomprehensible؟ يعني بتقولوا كيف حالك؟ إيش
+
+617
+00:45:04,340 --> 00:45:09,100
+أخبارك؟ انت بيقولش جامعة جامعة، يامة جامعة، ولا
+
+618
+00:45:09,100 --> 00:45:14,080
+حرف ولا كلمة، كلام مش جملة ولا كلمة، none ماجاوبش
+
+619
+00:45:14,080 --> 00:45:19,880
+بالمرة، بيكون واحدالـ Motor، إذا أنت حكيت معاه،
+
+620
+00:45:19,880 --> 00:45:23,800
+فارفع أيديك، فات عينيك وPay commands، بيستجيب،
+
+621
+00:45:23,800 --> 00:45:27,680
+بيفهم اللي بالظبط أنت بتحكيه، باخد ستة، طيب، إذا
+
+622
+00:45:27,680 --> 00:45:32,100
+ما استجابش، لكن روحت على إيده اليمين، جرسته، فش
+
+623
+00:45:32,100 --> 00:45:36,100
+سحب إيده اليمين، أه، Localized بينه، أو روحت جرسته
+
+624
+00:45:36,100 --> 00:45:38,440
+من صيدله، فحرك إيده في اتجاه الألم
+
+625
+00:45:40,960 --> 00:45:44,400
+بتجربة، عايز في الألم هون، باخد خمسة لكن إذا أنا
+
+626
+00:45:44,400 --> 00:45:47,840
+بعمله ألم فبروح بعمل withdrawal from pain يعني
+
+627
+00:45:47,840 --> 00:45:51,980
+ماخدته في أصبع و سحب إيده، أه يعني بقدر بسي بشرد
+
+628
+00:45:51,980 --> 00:45:55,320
+إيده، تمام؟ reflection to pain، لكن إذا عملتله
+
+629
+00:45:55,320 --> 00:45:58,320
+pain، راح عمل reflection عارفين إيش reflection،
+
+630
+00:45:58,320 --> 00:46:01,520
+تمام؟ أه عكس ال extension، reflection بخشش حاله
+
+631
+00:46:01,520 --> 00:46:05,900
+لجوة ال extension بتطلع إيدي لبرا، تمام؟ إذا بعمل
+
+632
+00:46:05,900 --> 00:46:08,240
+reflection to pain، بعمله pain، بعمل reflection،
+
+633
+00:46:08,240 --> 00:46:11,700
+بقولت لها إذا عملتله pain، عمل extensionبأخد اتنين
+
+634
+00:46:11,700 --> 00:46:14,680
+إذا ماعملش ولا حاجة بكون قاعد و تخبط ما تخبط فيه
+
+635
+00:46:14,680 --> 00:46:20,280
+واحد لذلك واحد في الـI واحد في الـVerbal واحد في
+
+636
+00:46:20,280 --> 00:46:24,260
+الـMotor معناه إن المريض هذا كإنه ميت لا بيفتقن
+
+637
+00:46:24,260 --> 00:46:26,720
+أيه ولا في عنده Verbal Response ولا عنده Motor
+
+638
+00:46:26,720 --> 00:46:33,040
+Response هذا زي زي أي واحد جثة ولكن ليس ميت لسه في
+
+639
+00:46:33,040 --> 00:46:37,560
+عنده Heart Rate شغال لسه في عنده Breathing ممكن
+
+640
+00:46:37,560 --> 00:46:42,510
+يكون بتنفس لعاله ممكن يكونبتنفس ده حاجة ممكن يكون
+
+641
+00:46:42,510 --> 00:46:46,630
+إحنا بعد شوية نحتاج إنه نحطله in circulate tube
+
+642
+00:46:46,630 --> 00:46:49,530
+لكن اللي بده أصله أقولكوا إنه ممكن يكون الشخص
+
+643
+00:46:49,530 --> 00:46:54,470
+Glass-Glucose Coma Scale 3، تلاتة و لسه مش ميت،
+
+644
+00:46:54,470 --> 00:47:00,610
+يكون لسه عايش، تمام؟ هذا بيكون شبيه بالمريد اللي
+
+645
+00:47:00,610 --> 00:47:05,010
+عنده اللي هو Brain Death، تمام؟ لكن مش بس من
+
+646
+00:47:05,010 --> 00:47:08,010
+الـGlass-Glucose Coma Scale إنه يكون تلاتة، بحدد و
+
+647
+00:47:08,010 --> 00:47:12,530
+بقوله المريض هذا Brain Death إطلاقاًبنخش فيها
+
+648
+00:47:12,530 --> 00:47:19,190
+كراتيريا أكتر من ضمنها إنه ينعملوا Corneal Reflex
+
+649
+00:47:19,190 --> 00:47:22,830
+Test إنه ينعملوا EEG تخطيط الدماغ
+
+650
+00:47:32,320 --> 00:47:38,520
+وفحوصات وأخصائي أعصاب وأخصائي قلب وأخصائي إناء
+
+651
+00:47:38,520 --> 00:47:42,980
+مركزة إقرروا إن هذا المريض فعلاً كل إشي فيه متوقف
+
+652
+00:47:42,980 --> 00:47:47,930
+ما هذا كل إشي فيه يعني الـbrain تبقى وداعدأو بقيت
+
+653
+00:47:47,930 --> 00:47:52,470
+أجهزته شغالة فيعتبر انه brain death تمام؟ مش بس ان
+
+654
+00:47:52,470 --> 00:47:55,690
+يكون الـGlasgow Coma Scale تبعه تلاتة، أي حد على
+
+655
+00:47:55,690 --> 00:47:59,350
+sedation ممكن يكون الـGlasgow Coma Scale تبعه
+
+656
+00:47:59,350 --> 00:48:04,470
+تلاتة، هيك يعني أنا خلصت المحاضرة، بديش أطول عليكم
+
+657
+00:48:04,470 --> 00:48:08,130
+ولا بدي أغلبكم عشان أخر محاضرة تكون خفيفة ونظيفة
+
+658
+00:48:08,130 --> 00:48:13,050
+وأعطيكم ألفعافية وإن شاء الله رب العالمين بكون
+
+659
+00:48:13,050 --> 00:48:18,210
+الأسئلة خفيفة وكل عيدكوا بتنبسطوا السلام عليكم
+
+660
+00:48:18,210 --> 00:48:18,750
+ورحمة الله
+
diff --git a/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/RUNF5tfm5rc_raw.srt b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/RUNF5tfm5rc_raw.srt
new file mode 100644
index 0000000000000000000000000000000000000000..b069e6f2e380250e977b9c9c204b5ef1059d2625
--- /dev/null
+++ b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/RUNF5tfm5rc_raw.srt
@@ -0,0 +1,2664 @@
+1
+00:00:02,090 --> 00:00:04,890
+بسم الله الرحمن الرحيم السلام عليكم ورحمة الله
+
+2
+00:00:04,890 --> 00:00:08,130
+وبركاته اليوم إن شاء الله رب العالمين هنحكي عن الـ
+
+3
+00:00:08,130 --> 00:00:12,410
+Head Injury وهو تقريبا آخر محاضرة في مساب الرعاية
+
+4
+00:00:12,410 --> 00:00:18,310
+الحقيقة الـ Head Injury زي ما حضراتكم عارفينممكن
+
+5
+00:00:18,310 --> 00:00:21,570
+تكون في الفروة تبع الرأس في الـSkull أو في
+
+6
+00:00:21,570 --> 00:00:24,850
+الـSkull نفسها في العضم تبع الرأس الجمجمة أو في
+
+7
+00:00:24,850 --> 00:00:31,590
+الـBrain، خلايا المخ طبعاً ممكن تكون إصابات بسيطة
+
+8
+00:00:31,590 --> 00:00:36,410
+ممكن تتعدى وتصير إصابات serious في الـBrain نفسه
+
+9
+00:00:36,410 --> 00:00:40,830
+ممكن تكون إصابات مغلقة يعنيمن غير ما يكون
+
+10
+00:00:40,830 --> 00:00:43,850
+Penetrating للـScalp ولا الـSkull ولا الـBrain
+
+11
+00:00:43,850 --> 00:00:50,130
+تشوه ممكن تكون فيها Open Head Injury أو
+
+12
+00:00:50,130 --> 00:00:55,430
+Penetrating يعني اخترقت الـScalp واخترقت الـSkull
+
+13
+00:00:55,430 --> 00:01:02,510
+وتوصل لـBrain طبعاً ممكن جداًالإصابة إنها تصيب الـ
+
+14
+00:01:02,510 --> 00:01:06,570
+«head» لكن ما توصلش لـ «brain» لكن إذا وصلت لـ
+
+15
+00:01:06,570 --> 00:01:11,190
+«brain» عادةً بتكون إصابة خطيرة الأنواع الـ «head
+
+16
+00:01:11,190 --> 00:01:14,150
+injury» اللي حكيناهم إنها تكون «closed» أو
+
+17
+00:01:14,150 --> 00:01:17,390
+«opened» أو «penetrating» ليش الفارق بينهم لـ
+
+18
+00:01:17,390 --> 00:01:24,370
+«close his injury» مين إنه «received a head blow
+
+19
+00:01:24,370 --> 00:01:30,430
+to the headfrom the sticking an object يعني أي
+
+20
+00:01:30,430 --> 00:01:36,010
+object أنت خبطت فيه أو هو خبط فيه بس من غير ما
+
+21
+00:01:36,010 --> 00:01:39,030
+يدخل في الجسم وليه يعمل لك Penetrating يعني زي
+
+22
+00:01:39,030 --> 00:01:44,070
+واحد وجعت عليه مثلا حيات وجع عليه حجر أكل وكس أكل
+
+23
+00:01:44,070 --> 00:01:49,730
+استضام فهذا هيعمله Traumatic اللي هو Closed Head
+
+24
+00:01:49,730 --> 00:01:52,750
+Injury لاحظين هذا بتكون اسمها Closed Head Injury
+
+25
+00:01:52,750 --> 00:01:57,400
+هذا عادة بيعمله إيه من الإصابات؟مشهورين، حاجة
+
+26
+00:01:57,400 --> 00:02:02,360
+اسمها الـ «brain contusion» أو حاجة اسمها «brain
+
+27
+00:02:02,360 --> 00:02:05,780
+concussion» هنشوف إيش الفرق بين الـ «concussion»
+
+28
+00:02:05,780 --> 00:02:09,980
+وبين الـ «confusion» بس بدنا نعرف إنه عادة الـ
+
+29
+00:02:09,980 --> 00:02:14,180
+«symptom» اللي بتصير في الـ «closed head injury»
+
+30
+00:02:14,180 --> 00:02:20,290
+هذا ممكن تكون اللي هومموري لوس والفقدار الذاكر على
+
+31
+00:02:20,290 --> 00:02:22,770
+هذا ليس مثل أفلام الهندية اللي بيظلوا مفقدين طول
+
+32
+00:02:22,770 --> 00:02:27,150
+عمره، بيكون temporary، يعني بتلاقي فقد الذاكر على
+
+33
+00:02:27,150 --> 00:02:33,710
+دقائق معينة، ساعات معينة، وبعدين بدأت يستعيد
+
+34
+00:02:33,710 --> 00:02:37,950
+ذاكرته، تمام؟ ممكن يكون عنده confusion، يعني بيبدأ
+
+35
+00:02:37,950 --> 00:02:41,550
+يصير مفترض ومش عارف مين اللي حواليه وإشي، كل هذا
+
+36
+00:02:41,550 --> 00:02:48,090
+ممكن يصير من الـbrain closed head traumaولكن الـ
+
+37
+00:02:48,090 --> 00:02:52,190
+Open Head Injury أو بيسموها الـ Penetrating Head
+
+38
+00:02:52,190 --> 00:02:56,210
+Injury يعني أننا مضطرين مع مجلد يقوم بتحطيم رأسك
+
+39
+00:02:56,210 --> 00:03:02,410
+ويدخل في عقلك، انت الخبطت بمجلد اللي خبط رأسك
+
+40
+00:03:02,410 --> 00:03:06,450
+وتبعك وعملها Penetrating وكسرها ودخل على الـ
+
+41
+00:03:06,450 --> 00:03:10,430
+Apprentice اللي تحت، this usually happens when you
+
+42
+00:03:10,430 --> 00:03:13,930
+move at high speeds such as going through the
+
+43
+00:03:13,930 --> 00:03:19,780
+woods during a car accidentلما تكون في صبات الطرق
+
+44
+00:03:19,780 --> 00:03:24,400
+والحوادث أو اللي بتزلج و بتزحل جواه وكل الحاجات
+
+45
+00:03:24,400 --> 00:03:28,320
+هذه ممكن تعمل الـ Head Injury و الـ Penetrating
+
+46
+00:03:28,320 --> 00:03:31,240
+Head Injury It can also happen from gunshot to the
+
+47
+00:03:31,240 --> 00:03:37,980
+head احنا اشهر حاجة انه ال gunshot و الـ Road
+
+48
+00:03:37,980 --> 00:03:44,030
+Traffic Accidentالـ Open or الـ Penetrating Head
+
+49
+00:03:44,030 --> 00:03:47,730
+Injury بتنقل لها Sign وSymptom وطبعاً أنت بتقدر
+
+50
+00:03:47,730 --> 00:03:51,930
+تشوفها من الشكل أنه واضح أنه في Penetrating Head
+
+51
+00:03:51,930 --> 00:03:55,070
+Injury لإيش؟ لأن أنت بتكون شافي بإيناك الـ Sign
+
+52
+00:03:55,070 --> 00:03:58,310
+and Symptom of Head Injury may occur immediately
+
+53
+00:03:58,310 --> 00:04:01,930
+or developed slowly over several hours طبعاً الـ
+
+54
+00:04:01,930 --> 00:04:06,610
+Immediately أن أنت بتشوف بإيناك أنه في Injury وفي
+
+55
+00:04:06,610 --> 00:04:09,930
+Bleeding وممكن تكون جوية في البرنتشو كمان، تمام؟
+
+56
+00:04:10,420 --> 00:04:15,380
+طبعاً تبدأ تظهر الأعراض عليه أكتر من ذلك، انتهاك
+
+57
+00:04:15,380 --> 00:04:19,720
+صعيب لكن ممكن يبدأ في symptoms مشكلة، confusion
+
+58
+00:04:19,720 --> 00:04:25,760
+ويبدأ يكون alter في level of consciousnessالـ Head
+
+59
+00:04:25,760 --> 00:04:28,480
+injury may cause a skull fracture which may or may
+
+60
+00:04:28,480 --> 00:04:30,720
+not associated with injury to the brain يعني ممكن
+
+61
+00:04:30,720 --> 00:04:34,740
+أنت بس يكون فيه عندك skull fracture ومايصيرش عندك
+
+62
+00:04:34,740 --> 00:04:38,240
+مشاكل في الـ brain ولا يتأثر الـ brain لكن لو ال
+
+63
+00:04:38,240 --> 00:04:42,210
+fracture هذا صار اسمه depressedالـ Fracture صار
+
+64
+00:04:42,210 --> 00:04:45,810
+فيه Bone Fragment نزل لتحت وعمله Depression وعمله
+
+65
+00:04:45,810 --> 00:04:48,030
+Pressure على الـ Brain صار اسمه هذا Depressed
+
+66
+00:04:48,030 --> 00:04:52,910
+Skull Fracture هذا عادةً هيأثر على المريض وعلى
+
+67
+00:04:52,910 --> 00:04:56,230
+درجة انه يعمل اندو-monoplegia يعني يصير فيه
+
+68
+00:04:56,230 --> 00:05:00,590
+اندوشلل في طرف واحد ويكون الحل الوحيد urgent
+
+69
+00:05:00,590 --> 00:05:03,710
+operation عشان ينهي الـ Fragment تبع الـ Bone هذا
+
+70
+00:05:03,710 --> 00:05:07,790
+و الـ Depressed Fracture ترتفع العظمة هذه ويروح لـ
+
+71
+00:05:07,790 --> 00:05:14,090
+Pressure على الـ Brainماذا يفعل الـ «Pregnant» أو
+
+72
+00:05:14,090 --> 00:05:14,850
+الـ «Pregnant» أو الـ «Pregnant» أو الـ «Pregnant»
+
+73
+00:05:14,850 --> 00:05:15,290
+أو الـ «Pregnant» أو الـ «Pregnant» أو الـ
+
+74
+00:05:15,290 --> 00:05:17,790
+«Pregnant» أو الـ «Pregnant» أو الـ «Pregnant» أو
+
+75
+00:05:17,790 --> 00:05:17,890
+الـ «Pregnant» أو الـ «Pregnant» أو الـ «Pregnant»
+
+76
+00:05:17,890 --> 00:05:18,150
+أو الـ «Pregnant» أو الـ «Pregnant» أو الـ
+
+77
+00:05:18,150 --> 00:05:19,510
+«Pregnant» أو الـ «Pregnant» أو الـ «Pregnant» أو
+
+78
+00:05:19,510 --> 00:05:19,590
+الـ «Pregnant» أو الـ «Pregnant» أو الـ «Pregnant»
+
+79
+00:05:19,590 --> 00:05:19,670
+أو الـ «Pregnant» أو الـ «Pregnant» أو الـ
+
+80
+00:05:19,670 --> 00:05:23,310
+«Pregnant» أو الـ «Pregnant» أو الـ «Pregnant» أو
+
+81
+00:05:23,310 --> 00:05:29,890
+الـ «Pregnant» أو الـ «Pregnant» أو الـفهذا بيعمل
+
+82
+00:05:29,890 --> 00:05:32,310
+pressure على الـ brain tissue وهذا بيخلّي
+
+83
+00:05:32,310 --> 00:05:36,430
+functionally إن بعض الـ brain tissue أو brain
+
+84
+00:05:36,430 --> 00:05:38,910
+cells إنها ما تشتغلش فبيصير عند الـ marine
+
+85
+00:05:38,910 --> 00:05:41,850
+monoplegia if intracranial hemorrhage or bleeding
+
+86
+00:05:41,850 --> 00:05:45,290
+within the brain occurs a hematoma with the skull
+
+87
+00:05:45,290 --> 00:05:48,830
+can put pressure on the brain هذا in general لما
+
+88
+00:05:48,830 --> 00:05:54,760
+بيصير في أنأي هواية، سواء Injury، سواء Closed أو
+
+89
+00:05:54,760 --> 00:05:57,940
+سواء Open اللي بيصير إنه بيصير شوية نزيف لما بيصير
+
+90
+00:05:57,940 --> 00:06:02,640
+شوية نزيف، هدول بتتجمع، يعني بتصير Hematoma
+
+91
+00:06:02,640 --> 00:06:06,760
+الـBlood Collection، تمام؟ هذا بيعمل Pressure عمين
+
+92
+00:06:06,760 --> 00:06:09,780
+على الـBrain الـPressure هذا بتجمع على الـBrain
+
+93
+00:06:10,590 --> 00:06:14,210
+بالإضافة إلى أنه حسب موقعها هذه الـ Hematoma
+
+94
+00:06:14,210 --> 00:06:22,400
+وعاملة pressure على الـ brain أخذت حيز من الـمكان
+
+95
+00:06:22,400 --> 00:06:26,340
+اللي محدد فيه الـ Intracranial Pressure إنه يكون
+
+96
+00:06:26,340 --> 00:06:30,900
+مثلا 15، الآن بما إنه هي عملة الـ Pressure بدأ
+
+97
+00:06:30,900 --> 00:06:34,160
+يصير الـ Intracranial Pressure أعلى الـ Types of
+
+98
+00:06:34,160 --> 00:06:36,900
+Intracranial Hematoma ممكن تكون هذه الـ Hematoma
+
+99
+00:06:36,900 --> 00:06:40,300
+سبب ديورة تحت الـ Diorameter ممكن تكون سبب
+
+100
+00:06:40,300 --> 00:06:43,280
+Arcanoid تحت الـ Arcanoid Meter ممكن تكون Extra
+
+101
+00:06:43,280 --> 00:06:46,620
+Diora، ممكن تكون اللي هوإيه بـ Dura يعني اللي
+
+102
+00:06:46,620 --> 00:06:50,080
+بيسميها برا للـ Dura أو Intra-parenchymia
+
+103
+00:06:50,080 --> 00:06:53,780
+الهيماتومة ممكن تكون في داخل الـ Intra-cerebral
+
+104
+00:06:53,780 --> 00:06:56,200
+hematoma اللي بيسميها الـ Parenchyma اللي هي الـ
+
+105
+00:06:56,200 --> 00:07:01,690
+cells تبعات الـ brainفي الحال عادةً بيكون إنك تطلع
+
+106
+00:07:01,690 --> 00:07:05,490
+الـ «Hematoma» اللي تعملها «Drainage» وإلا الـ
+
+107
+00:07:05,490 --> 00:07:08,630
+«Intracranial Pressure» حيزيد كتير وبالتالي هيفضل
+
+108
+00:07:08,630 --> 00:07:12,410
+المريض يتفعل معاه والـ «Blood Pressure» تبعه يزيد
+
+109
+00:07:12,410 --> 00:07:17,610
+كتير، تمام؟ علشان هيك إحنا هندرسهم الآن بالتفصيل
+
+110
+00:07:17,610 --> 00:07:22,910
+أنواع الـ«Brain Injury» اللي ممكن تعمل تأثير على
+
+111
+00:07:22,910 --> 00:07:31,410
+المريض كتيرة، من أهمهاإنه ممكن زي ما حكينا تعمل
+
+112
+00:07:31,410 --> 00:07:36,810
+ممكن تكون خارجية أو ممكن تكون hematoma في الداخل
+
+113
+00:07:36,810 --> 00:07:41,570
+زي إنها تعمل epidural أو subdural لكن كل هدولة لهم
+
+114
+00:07:41,570 --> 00:07:45,070
+علامات مشتركة ومجرد ما أنا أشوفهم بعرف إن هذا
+
+115
+00:07:45,070 --> 00:07:50,260
+المريض عنده إصابات في الدماغ من أشهر الإصاباتاللي
+
+116
+00:07:50,260 --> 00:07:53,800
+في دماغه بتخليني أعرف إن المريض هذا عنده skull
+
+117
+00:07:53,800 --> 00:07:58,480
+fracture أو عنده hit injury إنه أشوف أهم حاجة
+
+118
+00:07:58,480 --> 00:08:01,440
+bleeding their ear and bleeding their nose إذا
+
+119
+00:08:01,440 --> 00:08:05,380
+شُفت الحاجتين هدولة أو واحدة منهم تأكد إن المريض
+
+120
+00:08:05,380 --> 00:08:09,060
+هذا في عنده حاجة اسمها Base Skull Fracture يعني
+
+121
+00:08:09,060 --> 00:08:14,060
+القاعدة تبع الجمجمة فيها كسر وإذا صار القاعدة تبع
+
+122
+00:08:14,060 --> 00:08:16,380
+الجم ده مش الـoccipital يا جماعة مش اللي ورا
+
+123
+00:08:16,380 --> 00:08:25,750
+القاعدة هييعني هي السطح تبع التجوير الفمي
+
+124
+00:08:25,750 --> 00:08:32,050
+والأنفي يعني طبعا فوق الفم في الأن فوق الأن فده
+
+125
+00:08:32,050 --> 00:08:37,760
+فيه ثقف، الثقف ده هو قاعدةالدماغ هو قاعدة لدماغ
+
+126
+00:08:37,760 --> 00:08:41,200
+هذا هو الـ Base Skull Fracture لما بيصير فيه كثير
+
+127
+00:08:41,200 --> 00:08:46,320
+داخل بيبدأ ترتشع السوائل منه الـ CSF اللي هو
+
+128
+00:08:46,320 --> 00:08:49,360
+Cerebral Spinal Fluid أو الـ Blood ويطلع عبر
+
+129
+00:08:49,360 --> 00:08:54,020
+التجويف اللي هو عبر الـ Station Canal عبر قناة
+
+130
+00:08:54,020 --> 00:09:00,060
+Stachys إلى الأذن وعبر اللي هوالتجويف الأنفي أيضًا
+
+131
+00:09:00,060 --> 00:09:04,200
+على طريق الـ nasal canal لدرجة إنه كمان إحنا ممكن
+
+132
+00:09:04,200 --> 00:09:07,620
+تشوف هذا الكلام من المرض يكون بيضلوا يبلع لما يبقى
+
+133
+00:09:07,620 --> 00:09:11,900
+يحس إنه بنزل الأشياء هذه على الـOrphans ويبدأ يبلع
+
+134
+00:09:11,900 --> 00:09:15,880
+فيهم طبعًا أنا لو شوفت أي fracture في الـscalp أو
+
+135
+00:09:15,880 --> 00:09:18,180
+يعني شوفت wound في الـscalp أو fracture في
+
+136
+00:09:18,180 --> 00:09:22,690
+الـscalp في أي جزء منها بكون برضه متوقع إنه هنافي
+
+137
+00:09:22,690 --> 00:09:26,110
+أند المريض هذا «Head Injury» لو كان «Loss of
+
+138
+00:09:26,110 --> 00:09:30,590
+Conscious» برضه هذا سبب أن يكون «Head Injury» خاصة
+
+139
+00:09:30,590 --> 00:09:33,190
+إذا كان «Loss of Conscious» وانت شايف إنه في
+
+140
+00:09:33,190 --> 00:09:37,850
+حوالين هنا مثلا إذرقاق برضه الإذرقاق حوالين هنا قد
+
+141
+00:09:37,850 --> 00:09:41,830
+يكون من علامات الـBase Skull Fracture لأنه أحياناً
+
+142
+00:09:41,830 --> 00:09:45,090
+بيحتقن الدم في اللي هو الـPeriorbital
+
+143
+00:09:50,350 --> 00:09:53,710
+الـ Causes تبعت الـ Head-End زي ما حكينا السقوط
+
+144
+00:09:53,710 --> 00:09:56,930
+الـ Physical Assault اللي هو الاعتداء واحد يضرب
+
+145
+00:09:56,930 --> 00:10:03,150
+واحد ممكن الـ Accidents الحوادث ممكن اللي هو الـ
+
+146
+00:10:03,150 --> 00:10:04,490
+Gunshot زي ما حكينا
+
+147
+00:10:07,400 --> 00:10:14,260
+الحاجات اللي بتسير مثلا في الملاهي، في المراجيع،
+
+148
+00:10:14,260 --> 00:10:22,100
+في الحاجات هذه وكل كل سبب في الـ Head Injury طبعاً
+
+149
+00:10:22,100 --> 00:10:29,140
+الـ Head Injury إلها كتير يعني serious خلينا
+
+150
+00:10:29,140 --> 00:10:29,840
+نسميها
+
+151
+00:10:33,750 --> 00:10:37,590
+زي انها ممكن تعمل «loss of sensation» ممكن واحد
+
+152
+00:10:37,590 --> 00:10:41,730
+يفقد واحدة من الحواسب أو الـ «hearing» مثلا يبطل
+
+153
+00:10:41,730 --> 00:10:45,890
+يسمع بيجين يمكن يبطل يشوف يمكن يبطل يتذوق أو يشم
+
+154
+00:10:45,890 --> 00:10:49,890
+لأن هذه المراكز كلها في الموقعممكن يصير عنده
+
+155
+00:10:49,890 --> 00:10:54,450
+تشنجات يصير عنده Seizures اللي بيسموها Secondary
+
+156
+00:10:54,450 --> 00:10:58,130
+Epilepsy ممكن يصير عنده Paralysis ممكن يصير فيه
+
+157
+00:10:58,130 --> 00:11:01,790
+عنده نهائيا Paralysis يعني في جزء من أجزاء زي اسمه
+
+158
+00:11:01,790 --> 00:11:07,690
+Hemiparalysis أو Hemiplegia أو Paraplegia تمام؟
+
+159
+00:11:07,690 --> 00:11:10,850
+ممكن يظلوا في كومة يجدوا بعمر الإضاءة اللي كلها في
+
+160
+00:11:10,850 --> 00:11:14,690
+كومةممكن يصير عندهم، بعد اللي انجري شوية
+
+161
+00:11:14,690 --> 00:11:16,890
+personality disorder، الـ change في الـ mental
+
+162
+00:11:16,890 --> 00:11:20,450
+state تبعته، في ال emotions تبعته، تلاقي تصرفاته
+
+163
+00:11:20,450 --> 00:11:24,930
+غريبة، لأنه صار زمان أنه أكل هواية في رأسه، زي ما
+
+164
+00:11:24,930 --> 00:11:27,170
+بيحكوا، تمام؟
+
+165
+00:11:30,170 --> 00:11:32,950
+الـ Specific Problem اللي ممكن تصير عندنا زي ما
+
+166
+00:11:32,950 --> 00:11:36,170
+احنا شوفنا هو إنه يصير لديك Laceration في الـ
+
+167
+00:11:36,170 --> 00:11:40,190
+Scalp إذا كان على جد الـ Laceration و الـ Injury
+
+168
+00:11:40,190 --> 00:11:44,270
+تبعت الـ Scalp، بعدها بيخوفش الزماعة، تمام؟ لكن لو
+
+169
+00:11:44,270 --> 00:11:47,810
+صار الموضوع أكتر و صار هنا Traumatic Subdural
+
+170
+00:11:47,810 --> 00:11:52,410
+Hematoma أو Epidural Hematoma، هنا بيكون الوضع صار
+
+171
+00:11:52,410 --> 00:11:54,890
+خطير و بيبدأ الـ Consciously يتأثر و بيبدأ يصير
+
+172
+00:11:54,890 --> 00:11:56,670
+بدنا عمليات
+
+173
+00:12:01,460 --> 00:12:04,420
+سنشرحها بالتفصيل لـ Traumatic Subarachnoid
+
+174
+00:12:04,420 --> 00:12:10,780
+Hemorrhage لكن نعرف أن الإصابات اللي تحصل عند
+
+175
+00:12:10,780 --> 00:12:16,020
+الناس ممكن نجسمها لـ Contusion
+
+176
+00:12:19,060 --> 00:12:22,840
+أو حاجة بنسميها «concussion» ممكن الـ «concussion»
+
+177
+00:12:22,840 --> 00:12:27,340
+بيصير أكتر «confusion» يعني شوية أصعب شوية الـ
+
+178
+00:12:27,340 --> 00:12:29,820
+«concussion» اللي هو عبارة عن «brain injury» يعني
+
+179
+00:12:29,820 --> 00:12:31,980
+بيصير جارح في الـ «brain» لكن الـ «concussion»
+
+180
+00:12:31,980 --> 00:12:35,160
+عبارة عن temporary loss of function due to trauma
+
+181
+00:12:35,160 --> 00:12:38,000
+temporary الـ function دلوقتي كلها بتوقع، بعدين
+
+182
+00:12:38,000 --> 00:12:42,180
+كله برجع، هذا اسمه «concussion» بعدين كذا بنخش على
+
+183
+00:12:42,180 --> 00:12:45,740
+اللي هو أنواع الـ «hematoma» و الـ «bleeding» اللي
+
+184
+00:12:45,740 --> 00:12:53,390
+حكينا عنهابـ Epidural و Paradiural و Subdural نحن
+
+185
+00:12:53,390 --> 00:12:55,630
+نشوفه و من هنا نشوف في التفاصيل الـ Concussion الـ
+
+186
+00:12:55,630 --> 00:13:00,550
+Concussion زي ما حكينا هي عبارة عن إصابة في الدماغ
+
+187
+00:13:00,550 --> 00:13:03,930
+عادة يا جماعة ممكن تكون الإصابة أمامية يعني واحد
+
+188
+00:13:03,930 --> 00:13:08,090
+مثلا خبط في الأمام لكن أوجات كتير بيصير المنطقة
+
+189
+00:13:08,090 --> 00:13:12,650
+اللي اتأثرت في الـ Brain هي المنطقة الخلفية أو
+
+190
+00:13:12,650 --> 00:13:16,010
+بالعكس لو واحد خبطك اهوية من وراأه ممكن أنت
+
+191
+00:13:16,010 --> 00:13:22,870
+المنطقة اللي تتأثر هي الأمام كيف أنه بخبط يعني
+
+192
+00:13:22,870 --> 00:13:26,030
+بتسيل الإصابة في المنطقة هاي اللي بقين بروح بخبط
+
+193
+00:13:26,030 --> 00:13:29,650
+في قاعة جمجمة لأنه بقين بتحرك في جلب الصندوق تبع
+
+194
+00:13:29,650 --> 00:13:35,790
+الجمجمة فبتحرك إلى الأمام وبرجع بخبط بقوة في
+
+195
+00:13:35,790 --> 00:13:41,900
+المنطقة الأمامية تمام؟أو بالعكس، ممكن يتحرك إلى
+
+196
+00:13:41,900 --> 00:13:45,860
+اللي هو لو أنت أكلت اللي هو مثلا من هنا، هيتحرك
+
+197
+00:13:45,860 --> 00:13:49,160
+إلى الأمام، وبعدين يرجع، يرد تاني، يخبط في
+
+198
+00:13:49,160 --> 00:13:53,540
+الـSkull بعنف، فتصبح فيه Injury هنا، وتعمل هذه
+
+199
+00:13:53,540 --> 00:13:56,180
+اللي هو الـBrain Concussion، بكل الأحوال، الرجة
+
+200
+00:13:56,180 --> 00:14:01,330
+هذه اللي بتصبح من الأمام إلى الخلفوحركته السريعة
+
+201
+00:14:01,330 --> 00:14:05,170
+في داخل صندوق الجمجمة ده بتعمل حاجة في حاجة اسمها
+
+202
+00:14:05,170 --> 00:14:07,470
+الـ Prayer Concussion a concussion is a violent
+
+203
+00:14:07,470 --> 00:14:11,250
+jarring or shaking شركف الـ shaking يعني جاعد من
+
+204
+00:14:11,250 --> 00:14:13,330
+خض الـ Prayer من يمين وبروح ع الشمال ومن الشمال
+
+205
+00:14:13,330 --> 00:14:16,110
+وبروح ع اليمين result in disturbance of prayer
+
+206
+00:14:16,110 --> 00:14:20,030
+function الوظائف تبعت و بيصير فيها خلل لأنه إيش؟
+
+207
+00:14:20,030 --> 00:14:23,990
+يعني انخبطلما يعمل الخط يعني واحد كأنه خط شمال
+
+208
+00:14:23,990 --> 00:14:26,850
+يمين، mild concussion and not associated with any
+
+209
+00:14:26,850 --> 00:14:29,990
+sequel يعني عادة mild concussion، مايصيرش فيه أي
+
+210
+00:14:29,990 --> 00:14:33,130
+مشاكل، مايعملش أي حاجات يعني عادة تلاقي الواحد
+
+211
+00:14:33,130 --> 00:14:36,890
+راسه وجهه شوي، حاسه حاله ضايق، لكن لما بيكون أكتر
+
+212
+00:14:37,350 --> 00:14:40,550
+صار الـ Serious أكتر وصار الـ concussion يعني
+
+213
+00:14:40,550 --> 00:14:43,670
+سيبير كان بتلاقيه followed with إيش هو حاجة
+
+214
+00:14:43,670 --> 00:14:48,610
+بيسموها Amnesia أمنزيا يعني إيه اللي هو فقدانزيا
+
+215
+00:14:48,610 --> 00:14:51,150
+يعني ability to remember events before or after
+
+216
+00:14:51,150 --> 00:14:55,830
+the injuryوين أنا كنت؟ إيش صار معاه؟ قبل الحدث مش
+
+217
+00:14:55,830 --> 00:14:59,550
+متذكر إيش صار معاه أو after the injury بتلاقي
+
+218
+00:14:59,550 --> 00:15:03,390
+حالك؟ وين أنا؟ مين جابنيها؟ كيف صار؟ مش صاحي على
+
+219
+00:15:03,390 --> 00:15:06,790
+الحاجات هذه، هذه هي الـAmnesia The amount of time
+
+220
+00:15:06,790 --> 00:15:09,030
+that amnesia is present correlate with the
+
+221
+00:15:09,030 --> 00:15:12,690
+severity of the injury كل ما كانت ال injury سevere
+
+222
+00:15:12,690 --> 00:15:15,270
+و ال concussion صار سevere كل ما كانت الوقت ممكن
+
+223
+00:15:15,270 --> 00:15:20,350
+يطول تبع ال Amnesia، فقدان الذاكرةفي بعض الحالات،
+
+224
+00:15:20,350 --> 00:15:24,750
+يمكن أن يتطور الشخص لـ Post-Concussion Syndrome
+
+225
+00:15:24,750 --> 00:15:26,990
+اللي يمكن أن يتطور للشخص لـ Memory Problems،
+
+226
+00:15:26,990 --> 00:15:28,030
+Dizziness وDepression
+
+227
+00:15:33,680 --> 00:15:35,840
+الـ Concussion هذا بيظل عنده حد اسمه Post
+
+228
+00:15:35,840 --> 00:15:39,140
+-Concussion Syndrome يعني بيظلوا بعديها إدوخ،
+
+229
+00:15:39,140 --> 00:15:42,900
+بيظلوا بعديها تعبان شوية، بيظلوا بعديها ينسى
+
+230
+00:15:42,900 --> 00:15:45,640
+Cerebral Concussion is the most common head injury
+
+231
+00:15:45,640 --> 00:15:48,340
+seen in children عادة هذا كتير بيصير في الأطفال،
+
+232
+00:15:48,340 --> 00:15:52,380
+لكن سبحان الله ربنا بنجّههم و بيكبر لإن التطور
+
+233
+00:15:52,380 --> 00:15:56,630
+عنده سريع و أنه سريع و بيصيرش عندهولا أي حاجة،
+
+234
+00:15:56,630 --> 00:15:59,170
+تمام؟ هذا بالنسبالي الـ Concussion لكن الـ
+
+235
+00:15:59,170 --> 00:16:03,250
+Contusion، طلع الـ Contusion صابعة في الـ Brain في
+
+236
+00:16:03,250 --> 00:16:05,850
+أي منطقة صار فيها Contusion، طلع في Blood Spot
+
+237
+00:16:05,850 --> 00:16:09,310
+هنا، طلع هنا في Blood Spot، Blood Spot، هذا هو، في
+
+238
+00:16:09,310 --> 00:16:14,430
+لسريش يعني صار في، زي ما حكينا الـBrain، يعني في
+
+239
+00:16:14,430 --> 00:16:18,830
+Injury، يعني في جرح في خلايا المخ ونزفت، نزلت شوية
+
+240
+00:16:18,830 --> 00:16:23,900
+دم، لكن إيش؟ إيش بسيطفالـ brain contusion is a
+
+241
+00:16:23,900 --> 00:16:26,600
+braising of the brain tissue. The majority of
+
+242
+00:16:26,600 --> 00:16:30,000
+contusions occur in the frontal and temporal
+
+243
+00:16:30,000 --> 00:16:32,840
+lobes، أكتر في الـ frontal أو في الـ temporal.
+
+244
+00:16:36,260 --> 00:16:39,480
+Complications may include cerebral edema and
+
+245
+00:16:46,880 --> 00:16:55,340
+الـ Transcentral Herniation ممكن مع الـ confusion
+
+246
+00:16:55,340 --> 00:16:58,500
+أنه يصير Herniation هرنياشن يعني يا جماعة أنه
+
+247
+00:16:58,500 --> 00:17:03,720
+منطقة جزء من المخ يعني يصير فيها إفتاج يعني تطلع
+
+248
+00:17:03,720 --> 00:17:10,770
+تعمل bulging هيك غير عن الجزء اللي هيمحتوى فيه أو
+
+249
+00:17:10,770 --> 00:17:14,710
+اللي هي من ضمنه تطلع عن الـ bulging goal of a
+
+250
+00:17:14,710 --> 00:17:18,370
+treatment should be to increase intracranial
+
+251
+00:17:18,370 --> 00:17:21,730
+pressure أهم حاجة أحنا في ال management أنه الـ
+
+252
+00:17:21,730 --> 00:17:25,870
+intracranial pressure إذا ارتفع لازم احنا ننزله
+
+253
+00:17:25,870 --> 00:17:28,710
+علشان خاطر مايصيرش عند المرضي ال complicated of
+
+254
+00:17:28,710 --> 00:17:34,120
+the increased ICBالشيء التالي يشير إلى اتخاذ اتخاذ
+
+255
+00:17:34,120 --> 00:17:36,760
+اتخاذ اتخاذ اتخاذ اتخاذ اتخاز اتخاز اتخاز اتخاز
+
+256
+00:17:36,760 --> 00:17:40,540
+اتخاز اتخاز اتخاز اتخاز اتخاز اتخاز اتخاز اتخاز
+
+257
+00:17:40,540 --> 00:17:43,020
+اتخاز اتخاز اتخاز اتخاز اتخاز اتخاز اتخاز اتخاز
+
+258
+00:17:43,020 --> 00:17:43,280
+اتخاز اتخاز اتخاز اتخاز اتخاز اتخاز اتخاز اتخاز
+
+259
+00:17:43,280 --> 00:17:43,700
+اتخاز اتخاز اتخاز اتخاز اتخاز اتخاز اتخاز اتخاز
+
+260
+00:17:43,700 --> 00:17:47,540
+اتخاز اتخاز اتخاز اتخاز اتخاز اتخاز اتخاز اتخاز
+
+261
+00:17:47,540 --> 00:17:53,090
+اتخاز اتخاز اتخاز اوالـ Blood pressure low
+
+262
+00:17:53,090 --> 00:17:56,030
+بالمناسبة كمان الـ heart rate بتلاقي بدأ يصير low
+
+263
+00:17:56,030 --> 00:17:59,790
+هذا معناه أنه بدأ ال ICP يقلق كتير ومعناه أنه فيه
+
+264
+00:17:59,790 --> 00:18:02,790
+bleeding وفيه pressure على ال brain إذا العلمات
+
+265
+00:18:02,790 --> 00:18:06,890
+أنه تلاقي ال heart rate low ال respiration low ال
+
+266
+00:18:06,890 --> 00:18:09,230
+blood pressure كمان ينزل بس ال blood pressure ممكن
+
+267
+00:18:09,230 --> 00:18:14,330
+يبدأ يقلقوبتش بيبدأ ينزل في الـ Late stage خلاص
+
+268
+00:18:14,330 --> 00:18:17,430
+بيكون فبطل المريض يقدر يعمل compensation، خد بالك
+
+269
+00:18:17,430 --> 00:18:20,650
+اوى، إذا لو أنا كان ال heart rate واطي و ال blood
+
+270
+00:18:20,650 --> 00:18:23,290
+pressure عالي، بعرف أنا لسه المريض فيه أمل و لسه
+
+271
+00:18:23,290 --> 00:18:26,070
+جات جسمه بيحاول يعمل compensation، طب ليش ال heart
+
+272
+00:18:26,070 --> 00:18:30,810
+rate منخفض؟ لإن ال intra cranial pressure كتير
+
+273
+00:18:30,810 --> 00:18:32,950
+عالي، فيبدأ يعمل اللي هو
+
+274
+00:18:38,020 --> 00:18:41,840
+خلّينا نحكي بحاجة اسمها الـSympathetic Nervous
+
+275
+00:18:41,840 --> 00:18:45,040
+System بتعرف الـSympathetic Nervous System هو اللي
+
+276
+00:18:45,040 --> 00:18:51,140
+بيكون شغال و بيخلّي الـBrain تبعنا يظل شغال و
+
+277
+00:18:51,140 --> 00:18:54,580
+يعطينا orders لما بيصير الـIntracranial Pressure
+
+278
+00:18:54,580 --> 00:18:57,340
+عالي جدا الـfunction تبع الـbrain إيش بتصير فيها؟
+
+279
+00:18:57,340 --> 00:19:01,140
+بتتوقف لإنه مضغوط عليه فمش قادر يشغل إيش بيصير؟
+
+280
+00:19:01,140 --> 00:19:03,700
+بما إنه صار في injury direct في الـbrain وصار في
+
+281
+00:19:03,700 --> 00:19:09,550
+ICD عالي كتيروببتل اشتغال، مين بيشتغل؟ مازال و
+
+282
+00:19:09,550 --> 00:19:12,610
+بيوقف الـ Brain الـSympathetic Nervous System
+
+283
+00:19:12,610 --> 00:19:15,590
+بيبقى بوجهه، فبيبدأ يشتغل البعض الـSympathetic
+
+284
+00:19:15,590 --> 00:19:17,590
+Nervous System البعض الـSympathetic Nervous System
+
+285
+00:19:17,590 --> 00:19:23,230
+يعمل الـPredicardiumتمام تمام فعشان يكون علامات
+
+286
+00:19:23,230 --> 00:19:26,490
+الـ Neurogenic Shock و الـ Brain Injury أنه يكون
+
+287
+00:19:26,490 --> 00:19:31,610
+فيه Bradycardia طب ليش الـ Blood Pressure بالأول
+
+288
+00:19:31,610 --> 00:19:34,670
+بيرتفع في مرحلة الـ Compensation؟ لأن الـ
+
+289
+00:19:34,670 --> 00:19:37,670
+Intracranial Pressure عالي كتير فعشان الـ Blood
+
+290
+00:19:37,670 --> 00:19:42,650
+يوصل للـ Brain، بضطر الـ Blood الـ Artery للـ
+
+291
+00:19:42,650 --> 00:19:46,710
+Blood Pressure يرتفع أكترأكتر و أكتر و أكتر و أكتر
+
+292
+00:19:46,710 --> 00:19:51,850
+و أكتر و أكتر و أكتر و أكتر و أكتر و أكتر و أكتر و
+
+293
+00:19:51,850 --> 00:19:54,610
+أكتر و أكتر و أكتر و أكتر و أكتر و أكتر و أكتر و
+
+294
+00:19:54,610 --> 00:19:58,490
+أكتر و أكتر و أكتر و أكتر و أكتر و أكتر و أكتر و
+
+295
+00:19:58,490 --> 00:20:01,750
+أكتر و أكتر و أكتر و أكتر و أكتر و أكتر و أكتر و
+
+296
+00:20:01,750 --> 00:20:06,330
+أكتر
+
+297
+00:20:06,330 --> 00:20:08,730
+و أكتر و أكتر
+
+298
+00:20:11,490 --> 00:20:14,490
+لأن طول المرحلة دي شغالة و احنا فيها compensation
+
+299
+00:20:14,490 --> 00:20:20,870
+لكن هذا خطير برضه هو ممكن يعمل اللي من كتر blood
+
+300
+00:20:20,870 --> 00:20:24,610
+pressure يرتفع أنه يعمل عند المريض اللي هو
+
+301
+00:20:24,610 --> 00:20:31,750
+hemorrhagic hemorrhagic اللي هو CVA
+
+302
+00:20:31,750 --> 00:20:35,350
+يعني اللي يسير عنده هو hemorrhage في أي شريان من
+
+303
+00:20:35,350 --> 00:20:37,150
+الشراين اللي بتغذي الـBrain
+
+304
+00:20:40,640 --> 00:20:47,220
+عشان هيك لما المريض بفقد السيطرة بتلاقي طبعا بتعرف
+
+305
+00:20:47,220 --> 00:20:50,360
+أنتوا في الـ Hemorrhagic CVA حتى في الـ Management
+
+306
+00:20:50,360 --> 00:20:53,120
+بيحاولوش إنهم يعملوا drop في الـ blood pressure
+
+307
+00:20:53,120 --> 00:20:57,780
+وينزلوه كتير لإن هو هيزود الـ ischemia وهيعمل
+
+308
+00:20:57,780 --> 00:21:04,640
+ischemia، تمام؟ فبينزلوه لحد يعني إله management
+
+309
+00:21:04,640 --> 00:21:11,540
+معينفي أول ساعة بس بنزله حوالي من عشرة لعشرين يعني
+
+310
+00:21:11,540 --> 00:21:16,540
+مابنزلهوش يعني بكل الأحوال مابحدش بالسجن ينزله أو
+
+311
+00:21:16,540 --> 00:21:20,560
+ممنوع أصلا ينزله أقل من 140 على 90 لأن هذا هزود
+
+312
+00:21:20,560 --> 00:21:26,300
+الischemia طبعا من ضمن الحاجات اللي احنا ممكن تصير
+
+313
+00:21:26,300 --> 00:21:33,140
+في ال head injury أن يكونممكن يحصل عنده درينج
+
+314
+00:21:33,140 --> 00:21:36,720
+للفلود من الـ Nose أو الـ Mouth أو الـ Ears وهذه
+
+315
+00:21:36,720 --> 00:21:38,840
+علامات الـ Skull Fracture
+
+316
+00:21:44,200 --> 00:21:50,340
+حكينا عن أن الأطفال عادة مغرضين للإصابات هذه
+
+317
+00:21:50,340 --> 00:21:54,880
+وبيصير عندهم lack of coordination كتير من الناس،
+
+318
+00:21:54,880 --> 00:22:01,580
+يحط إيدك على مخارك، يحط إيده على دينه، يحط على
+
+319
+00:22:01,580 --> 00:22:07,700
+أنفه، مش قادر يسيطر بالظبط هذا من الحاجات اللي
+
+320
+00:22:07,700 --> 00:22:11,660
+ممكن تصير معهم، يعني ممكن مايكونش اللي بيصار عنده
+
+321
+00:22:11,660 --> 00:22:17,000
+slurred speech، بيجي يحكيبـ بـ بـ بـ بـ بـ بـ بـ
+
+322
+00:22:17,000 --> 00:22:17,600
+بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ
+
+323
+00:22:17,600 --> 00:22:17,680
+بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ
+
+324
+00:22:17,680 --> 00:22:18,140
+بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ
+
+325
+00:22:18,140 --> 00:22:18,740
+بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ
+
+326
+00:22:18,740 --> 00:22:19,680
+بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ
+
+327
+00:22:19,680 --> 00:22:19,720
+بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ بـ
+
+328
+00:22:19,720 --> 00:22:37,480
+بـ بـ
+
+329
+00:22:38,390 --> 00:22:44,070
+حاجة بتسميها Anesokaria اللي هي يعني بدل ما هي
+
+330
+00:22:44,070 --> 00:22:48,170
+round و regular تصير شكلها مش round و مش regular و
+
+331
+00:22:48,170 --> 00:22:50,950
+regular تلاقيها مبعوجة من جهة عاملة زي البيضة
+
+332
+00:22:50,950 --> 00:22:55,390
+عاملة زي المتلة تعاملة فهذه التغيرات نتيجة إنه في
+
+333
+00:22:55,390 --> 00:23:03,230
+change فياللي هو الـ Brain Cells وفيه ربما الـ
+
+334
+00:23:03,230 --> 00:23:06,510
+Pressure Homage على منطقة معينة، سبحان الله الـ
+
+335
+00:23:06,510 --> 00:23:09,870
+Pupils هي الـ Mirror تبعت الـ Brain، إذا كان وضع
+
+336
+00:23:09,870 --> 00:23:13,050
+الـ Pupils Round و Regular و Reactive، معناه الـ
+
+337
+00:23:13,050 --> 00:23:19,060
+Brain طبيعيإذا وجدنا فيها نزيوكوريا اللي هي خلل في
+
+338
+00:23:19,060 --> 00:23:23,120
+واحدة من الـ pupils سواء في الـ regularity تبعتها
+
+339
+00:23:23,120 --> 00:23:27,740
+أو في الـ reactivity تبعتها معناه إنه في خلل في
+
+340
+00:23:27,740 --> 00:23:30,760
+الـ opposite side في الـ brain يعني إذا كانت للـU
+
+341
+00:23:30,760 --> 00:23:35,560
+نشمال هي اللي في هيكمة كل الـ brain اليمين هو اللي
+
+342
+00:23:35,560 --> 00:23:41,960
+فيه المشكلة، تمام؟ الـ symptom تبعت
+
+343
+00:23:45,010 --> 00:23:50,450
+الـ Scaly Fracture حكينا عنها كويس وقلنا إنه ممكن
+
+344
+00:23:50,450 --> 00:23:53,570
+يكون فيه إنه .. طب أنا إيش بيفيدني كـ Critical
+
+345
+00:23:53,570 --> 00:23:56,850
+Care Nurse لما أعرف هذا الـ Symptom و أشوف واحد
+
+346
+00:23:56,850 --> 00:24:00,950
+فيه عنده bleeding
+
+347
+00:24:00,950 --> 00:24:04,790
+من الـ Nose أو من الـ Ear قلنا أول حاجة باعرف إنه
+
+348
+00:24:04,790 --> 00:24:08,590
+في عنده Suspected اللي هو Fracture Suspected
+
+349
+00:24:08,590 --> 00:24:13,790
+Fracture وين؟في الـ Basal Skull، تمام؟ هذه أول
+
+350
+00:24:13,790 --> 00:24:17,010
+حاجة بتخليني أعرض أنه أنا ممنوع أحط للمريد هذا
+
+351
+00:24:17,010 --> 00:24:22,070
+اللي هو Nasogastric tube نسوغات، ليش؟ لأنه ممكن
+
+352
+00:24:22,070 --> 00:24:25,610
+جدا وانت بتخشش في الـ Nasogastric tube هذا بدل ما
+
+353
+00:24:25,610 --> 00:24:30,090
+تخشت downward على الأسوفيقاس و تنزل على الـStomach
+
+354
+00:24:30,090 --> 00:24:36,610
+ممكن تبقى طالع على الـBrain لأن هو مكسور، وبالتالي
+
+355
+00:24:36,610 --> 00:24:41,820
+الـBaseتبعت الـ skull العضم تبع قاعد جنده ما برضه
+
+356
+00:24:41,820 --> 00:24:46,300
+مكسور فانت و هتصير فيه عندك قابلية للاختراق فلذلك
+
+357
+00:24:46,300 --> 00:24:50,900
+ممنوع نحط نيزوجا ع الـ strict tube تمام؟ و طبعا
+
+358
+00:24:50,900 --> 00:24:54,360
+هذا بيخليك تعرف انه كمان المريض هذا لـhigh risk لل
+
+359
+00:24:54,360 --> 00:24:58,720
+infection بما انه في عنده اللي هو basic skull
+
+360
+00:24:58,720 --> 00:25:02,740
+fractureوبالتالي إحنا لازم نكون covered بـ
+
+361
+00:25:02,740 --> 00:25:06,020
+Antibiotic كويس و لازم نكون محافظين على God
+
+362
+00:25:06,020 --> 00:25:12,060
+Hygiene لمنطقة اللي هو الـ Nose و الـ Ears و الـ
+
+363
+00:25:12,060 --> 00:25:15,620
+Mouth حتى طبعا عارفين كيف الـ Hygiene عن طريق الـ
+
+364
+00:25:15,620 --> 00:25:19,960
+Care يعني مش هنعمل أكتر من إنه نغسل يعني الـ Ear
+
+365
+00:25:19,960 --> 00:25:25,230
+نمسحهم بصلاعين و نخليها نظيفةوالـ Nose كذلك و الـ
+
+366
+00:25:25,230 --> 00:25:28,890
+Mouth كذلك طب و إيش العكس؟ العكس هي إنه يكون فيه
+
+367
+00:25:28,890 --> 00:25:31,630
+مثلا Hematoma أو Blood Clots و أنا أسيبها، أتضلها
+
+368
+00:25:31,630 --> 00:25:34,990
+موجودة في العينادة هتكون Media للـBacterial
+
+369
+00:25:34,990 --> 00:25:38,030
+Multiplication وبالتالي البكتيريا هتكون متواجدة في
+
+370
+00:25:38,030 --> 00:25:41,330
+المكان بشكل أكتر وبالتالي احتمالية إنها تطلع على
+
+371
+00:25:41,330 --> 00:25:44,470
+الـ Brain وتعمل Assailing Infection هتكون أكتر،
+
+372
+00:25:44,470 --> 00:25:46,210
+تمام؟
+
+373
+00:25:48,950 --> 00:25:52,250
+حكينا عن الـBase Skull Fracture بما فيه الكفاية
+
+374
+00:25:52,250 --> 00:26:00,070
+وحكينا عن إنه ما بنحطش أي نيزوجاثركاتيوب الآن زي
+
+375
+00:26:00,070 --> 00:26:04,930
+ما حكينا عن الـConcussion وحكينا عن الـContusion
+
+376
+00:26:04,930 --> 00:26:08,670
+نحكي عن الإيديدور الهيماتومة وأنواعها أول شيء
+
+377
+00:26:08,670 --> 00:26:13,780
+بنذكركم إن الـBrain له تلاتةأغشية واحد اسمه الـ
+
+378
+00:26:13,780 --> 00:26:16,820
+Biomatter واحد اسمه الـ Arachnoid Matter واحد
+
+379
+00:26:16,820 --> 00:26:19,580
+اسمها الـ Durameter الـ Biomatter اللي سموها
+
+380
+00:26:19,580 --> 00:26:23,060
+بالعرب الأب الحلون لأنها قريبة من المخ الـ
+
+381
+00:26:23,060 --> 00:26:26,300
+Arachnoid Matter الأم العنكبوتية ليش بيسموها
+
+382
+00:26:26,300 --> 00:26:31,120
+عنكبوتية؟ عشان مليانة بالـ blood vessels والخارجية
+
+383
+00:26:31,120 --> 00:26:35,570
+اسمها آخر واحدةلديورة متر بيسموها بالعرب الأم
+
+384
+00:26:35,570 --> 00:26:38,710
+الجافية عشانها بعيدة طب بعد هيك إيش فيه فيه قعد
+
+385
+00:26:38,710 --> 00:26:43,370
+هيك فيه الـ skull هيته العظيم تبع الجمجمة طيب إيش
+
+386
+00:26:43,370 --> 00:26:47,330
+أنواع الإيبي الديورة الهيماتومة النوع الأول اسمه
+
+387
+00:26:47,330 --> 00:26:51,130
+الـ Ibi ديورة الهيماتومة Ibi يعني فوق يعني فوق
+
+388
+00:26:51,130 --> 00:26:57,840
+الديورة راحز هايالـ Epidural Hematoma تحتها
+
+389
+00:26:57,840 --> 00:27:02,460
+الـ Arachnoid وتحتها الـ Biomatter هين صار في
+
+390
+00:27:02,460 --> 00:27:10,490
+Epidural بتجمع قدامها تشكل هلالي زي الهلالأعوين
+
+391
+00:27:10,490 --> 00:27:15,890
+أوبين الـ skull والديورة بالظبط هو هذا تعريف الـ
+
+392
+00:27:15,890 --> 00:27:19,970
+epidural hematoma a rapidly accumulating hematoma
+
+393
+00:27:19,970 --> 00:27:24,170
+between the durameter and the cranium، cranium
+
+394
+00:27:24,170 --> 00:27:28,310
+يعني الـ skull، these patients have a history of
+
+395
+00:27:28,310 --> 00:27:33,830
+traumawith loss of consciousness then الوثيب
+
+396
+00:27:33,830 --> 00:27:37,870
+period followed by loss of consciousness تمام؟
+
+397
+00:27:37,870 --> 00:27:42,070
+clinical onset of care over minute to hours إذن
+
+398
+00:27:42,070 --> 00:27:46,310
+ماكنتش المريض هاد أكل إفواعي صار بدأ عنده إيه بدت
+
+399
+00:27:46,310 --> 00:27:50,630
+صار عنده تجمع Fibrid Uremeter تمام؟ شوية بيبدأ
+
+400
+00:27:50,630 --> 00:27:54,450
+المريض يفقد إفواعيه خلال minute ليش؟ لأن ال
+
+401
+00:27:54,450 --> 00:27:59,410
+pressure بكون عالي يا جماعة على ال brain تمام؟فهذا
+
+402
+00:27:59,410 --> 00:28:02,750
+بيقدر الأفق، طب واش الحل إذا كانت acute على طول
+
+403
+00:28:02,750 --> 00:28:04,890
+many of these injuries are associated with
+
+404
+00:28:04,890 --> 00:28:08,910
+laceration of the mild meningial artery طبعا، من
+
+405
+00:28:08,910 --> 00:28:13,350
+أيه صار النزيل؟ في meningial artery، طلع كيف؟
+
+406
+00:28:13,350 --> 00:28:16,110
+Artery، احفظوا الكلمة، بتيجي في الانتحار، لما
+
+407
+00:28:16,110 --> 00:28:20,540
+بقولك epidural hematomaمن انجل آر تري هو اللي
+
+408
+00:28:20,540 --> 00:28:25,380
+بيكون إيش اتأثر فبروح بعمل الـ lenticular اللي هو
+
+409
+00:28:25,380 --> 00:28:27,860
+convex lens shape زي ما انتوا شايفينه شكل زي
+
+410
+00:28:27,860 --> 00:28:34,740
+الهلال extra cerebral hemorrhage و الـ light be
+
+411
+00:28:34,740 --> 00:28:39,460
+visible on CT يعني لو شوفنا CT هلاقي شكل اللي هو
+
+412
+00:28:39,460 --> 00:28:43,920
+الابيطيور الهيماتومة عامل بالشكل الهلال هذا أظن أن
+
+413
+00:28:43,920 --> 00:28:45,060
+أنا جيبت صورة CT
+
+414
+00:28:54,730 --> 00:29:00,110
+هنا بيكون الحل أننا بدنا للناس هدولة urgent
+
+415
+00:29:00,110 --> 00:29:03,490
+operation although this is a potential
+
+416
+00:29:03,490 --> 00:29:07,270
+complication الprogress is good خد بالك الepidural
+
+417
+00:29:07,270 --> 00:29:13,910
+hematoma جدا خطيرة تعتبر في دقائق المريض ممكن يفقد
+
+418
+00:29:13,910 --> 00:29:17,130
+واعي يمكن يتحمل ويصير في ساعات زي ما أكينا minute
+
+419
+00:29:17,130 --> 00:29:21,260
+إلى hours هناطبعا؟ يعني هو ممكن يتحمّن في نص ساعة،
+
+420
+00:29:21,260 --> 00:29:23,040
+ساعة، بقى .. لما يكون بقى .. لكن من كتير بعد
+
+421
+00:29:23,040 --> 00:29:27,420
+سنتين، تلاتة، حاسيبتي إشي ال .. ليش؟ اللي نزف
+
+422
+00:29:27,420 --> 00:29:31,380
+Artery فبنزف كتير فكمية الدم اللي بتطلع بتكون
+
+423
+00:29:31,380 --> 00:29:34,820
+كتيرة عادة فبتبقى الـ brochure عيش ماله كتير عشان
+
+424
+00:29:34,820 --> 00:29:38,700
+هي الـ deterioration سريع الحال جدا بسيط كيف الحال
+
+425
+00:29:38,700 --> 00:29:41,840
+جدا بسيط؟ مجرد ما المريض نعمل عملية و نعمل
+
+426
+00:29:41,840 --> 00:29:45,460
+evacuation له الـ hematoma هاي إيش بيصير؟ ولا حالة
+
+427
+00:29:45,460 --> 00:29:48,620
+الـ Prognosis is very good ممتاز Prognosis is good
+
+428
+00:29:48,830 --> 00:29:52,550
+والـ Death injury is recognized and treated كيف؟
+
+429
+00:29:52,550 --> 00:29:56,710
+Treated بالـ evacuation لكن لو ما اتعلجوش وما
+
+430
+00:29:56,710 --> 00:30:03,450
+نعملوش عملية جدا صعب لدرجة إن الـ Death هو اللي
+
+431
+00:30:03,450 --> 00:30:08,710
+بيكون الـ complication خلاص بمون، شوف كيف؟
+
+432
+00:30:08,710 --> 00:30:14,090
+تشخيصها، okay why؟وبعدها فقد الوعي على طول لازم
+
+433
+00:30:14,090 --> 00:30:17,190
+تحط بالك إنه صار عنده Epidural Hematoma إذا ما
+
+434
+00:30:17,190 --> 00:30:19,870
+لاجيناش Epidural Hematoma ساعتها بنقول آه يمكن
+
+435
+00:30:19,870 --> 00:30:23,770
+Concussion أو Contusion اللي أخدناها من طول، تمام؟
+
+436
+00:30:23,770 --> 00:30:27,510
+بس إذا Contusion يمكن يبين شوية Spot هنهارة أو
+
+437
+00:30:27,510 --> 00:30:30,130
+بقول هذا Contusion بالدرافة، لكن إذا مافيش إيش ولا
+
+438
+00:30:30,130 --> 00:30:33,230
+حاجة، لأ بس ممكن Concussion، خط بعضه بتحسن و بصحى
+
+439
+00:30:33,230 --> 00:30:38,600
+و بنحط ضحك المتابع، مش هى؟ تمامطبعاً في كل الحالات
+
+440
+00:30:38,600 --> 00:30:42,140
+هذه الـVomiting يا جماعة حاجة واردة جدا إنها تحصل
+
+441
+00:30:42,140 --> 00:30:47,760
+لأن الـCentral CTZ تبع الـVomiting موجود في
+
+442
+00:30:47,760 --> 00:30:51,080
+الـBrain فمجرد ما بيزيد الـICP هذا بيعمل عند الناس
+
+443
+00:30:51,080 --> 00:30:54,910
+simulation إنه يحصل عندهمبوموتينج، تمام؟ الـ
+
+444
+00:30:54,910 --> 00:30:59,490
+Epidural Hematoma زي ما شوفنا جداً سهلة أنه جداً
+
+445
+00:30:59,490 --> 00:31:04,170
+الـprognosis تبعها كويس وجداً خطيرة لو ما اتعالجتش
+
+446
+00:31:04,170 --> 00:31:07,910
+الـdeath rate فيها كتير عالي أعلى من الحاجات
+
+447
+00:31:07,910 --> 00:31:12,070
+التانية، ليش؟ لأنه بدها إلاج urgent يا أما المريض
+
+448
+00:31:12,070 --> 00:31:18,150
+حتفقدهالـ Subdural Hematoma الـ Subdural Hematoma،
+
+449
+00:31:18,150 --> 00:31:23,290
+لاحظ الكلام وين؟ Subdural، تحت الدورة، مش زي هان،
+
+450
+00:31:23,290 --> 00:31:29,850
+الدورة، لاحظ هان، الدورة على طول، على العظم، هاي
+
+451
+00:31:29,850 --> 00:31:35,090
+العظم تبقى الجمجمة تحت الـ bleeding، فدقيقة، لكن
+
+452
+00:31:35,090 --> 00:31:39,830
+في الsubdural العظم مش فيه حاجة، العظم مش فيه
+
+453
+00:31:39,830 --> 00:31:46,010
+حاجة، كويسوالديورة فوق و تحت من الديورة عادة تشتري
+
+454
+00:31:46,010 --> 00:31:51,060
+مشاكلموجودة لديورة تحت من اللي ديورة صار فيه إيش
+
+455
+00:31:51,060 --> 00:31:55,960
+اللي هو bleeding إذا الـ subdiura hematoma هاي who
+
+456
+00:31:55,960 --> 00:31:59,960
+care when there is tearing of the bridging vein
+
+457
+00:31:59,960 --> 00:32:03,660
+عادة اللي بيعمل ال subdiura ال hematoma مش artery،
+
+458
+00:32:03,660 --> 00:32:09,880
+vein between times they between times they may be
+
+459
+00:32:09,880 --> 00:32:13,500
+caused by arterial laceration on the brain surface
+
+460
+00:32:14,530 --> 00:32:20,150
+ويمكن أن يكون نتيجة عن طريق الـArterial Laceration
+
+461
+00:32:20,150 --> 00:32:23,690
+لكن الشخص يمكن أن يكون لديه تاريخ خسارة الوعي لكن
+
+462
+00:32:23,690 --> 00:32:27,210
+في الأغلب اللي يحصل هو
+
+463
+00:32:38,670 --> 00:32:44,830
+ممكن يكون صار عنده الـ Loss of Conscious يصير عنده
+
+464
+00:32:44,830 --> 00:32:49,050
+الـ Clinical onset of care after hours الـ Sub
+
+465
+00:32:49,050 --> 00:32:52,570
+-dural hematoma يعني الـ onset تبع الـ Clinical
+
+466
+00:32:52,570 --> 00:32:57,940
+picturesبتطول مش زي الـ epidural على طول من الـ
+
+467
+00:32:57,940 --> 00:33:00,660
+minutes يعني لازم تبطل بعد ساعات لما يبدأ يبين
+
+468
+00:33:00,660 --> 00:33:08,580
+عليه a crescent shape hemorrhage
+
+469
+00:33:08,580 --> 00:33:13,300
+compressing the brain will be noted on the CT of
+
+470
+00:33:13,300 --> 00:33:18,500
+the head surgical evacuation is the treatment
+
+471
+00:33:18,500 --> 00:33:23,120
+والحل ان نعمل surgical evacuation والcommunication
+
+472
+00:33:23,120 --> 00:33:32,380
+معروفةطلع كيف الشكل تبع
+
+473
+00:33:32,380 --> 00:33:39,560
+الـ… تبع الـsubdural hematoma زي ما حكينا، شكل
+
+474
+00:33:39,560 --> 00:33:46,040
+هلالي، هياته، من الأول للآخر، subdural، كمان
+
+475
+00:33:46,040 --> 00:33:52,420
+للمنطقة
+
+476
+00:33:52,420 --> 00:33:53,300
+المصابة
+
+477
+00:33:56,540 --> 00:34:02,860
+هذه صورة CT طب هي طلع هذه المنطقة هي اللي بيكون
+
+478
+00:34:02,860 --> 00:34:10,320
+عاملة شكل الهلال الـ subdural أوكي
+
+479
+00:34:10,320 --> 00:34:13,440
+زي ما احنا شايفين شكل الهلال أنا على فكرة وأنا
+
+480
+00:34:13,440 --> 00:34:17,120
+بحكي أظن اتلخبطت وأنا بحكي عن الـEpidural وحكيت
+
+481
+00:34:17,120 --> 00:34:22,200
+إنه شكلها زي الـEpidural شكلها زي العدسة زي العدسة
+
+482
+00:34:22,200 --> 00:34:27,380
+المقعرة شوفنا شكلها نرجع عليه أريكمشكلها بيكون
+
+483
+00:34:27,380 --> 00:34:34,640
+عامل زي العدسة مقعرة، زي هذا الشكل، مش زي الهلال
+
+484
+00:34:34,640 --> 00:34:37,320
+يعني، هذا فعلا زي العدسة، طبعا كيف العدسة بيكون
+
+485
+00:34:37,320 --> 00:34:42,420
+العدسات المقعرين، اللي بتكون هي قطاز من جهة، تمام؟
+
+486
+00:34:42,420 --> 00:34:47,140
+لكن الـSub-Dural هي اللي بيكون عاملة شكل الهلال،
+
+487
+00:34:47,140 --> 00:34:50,640
+هي واضح جدا، في الـCT العادى، هي واضح جدا شكل
+
+488
+00:34:50,640 --> 00:34:57,450
+هلال، تمام؟طبعاً الـ Sub-neutral مشكلتها أنها ممكن
+
+489
+00:34:57,450 --> 00:35:01,070
+تكون Chronic ولذلك السبب ان اتباعاتها بتظهرش بسرعة
+
+490
+00:35:01,070 --> 00:35:04,850
+ولذلك حتى ممكن تظل وتصير Chronic مع العيان تكون
+
+491
+00:35:04,850 --> 00:35:08,010
+صغيرة وما ماحسش فيها لكن الـ Acute Sub-neutral
+
+492
+00:35:08,010 --> 00:35:13,140
+اللي فجأة بتصير هي اللي عادة بتكون بدهاالعلاج
+
+493
+00:35:13,140 --> 00:35:17,700
+تظهر، دعونا نشوف الـ Acute تظهر بطريقة مشابهة
+
+494
+00:35:17,700 --> 00:35:21,480
+للهيماطومة الإكسترادولار ويمكنها أن تكون لها
+
+495
+00:35:21,480 --> 00:35:24,080
+سيكوينسيا متساومة متساومة متساومة متساومة متساومة
+
+496
+00:35:24,080 --> 00:35:25,120
+متساومة متساومة متساومة متساومة متساومة متساومة
+
+497
+00:35:25,120 --> 00:35:34,620
+متساومة متساومة
+
+498
+00:35:35,630 --> 00:35:39,470
+وطبعاً أكيد نتيجة اللي هو إنه فيه vessel صار له
+
+499
+00:35:39,470 --> 00:35:43,770
+rupturing the blood is again of high attenuation
+
+500
+00:35:43,770 --> 00:35:47,250
+but may spread more widely in the subdural space
+
+501
+00:35:47,250 --> 00:35:51,670
+with a crescentic appearance and more regularly in
+
+502
+00:35:51,670 --> 00:35:55,210
+our margin شايفين كيف بيبقوا ينشر ويعطوا شكل
+
+503
+00:35:55,210 --> 00:35:59,910
+الهلال اللي هو تحت الديورة لإن المساحة واسعة يعني
+
+504
+00:35:59,910 --> 00:36:05,480
+نوعا مابيظلوا يمشي فيها وبيعمل اللي هو الـ
+
+505
+00:36:07,810 --> 00:36:10,190
+الشكل الهلال اللي حكينا عنه
+
+506
+00:36:37,050 --> 00:36:40,470
+كل هذه المنطقة التكملة، هذه المفروض أن يكون فيها
+
+507
+00:36:40,470 --> 00:36:47,570
+brain، لكن صارت blood ماشي فيها، تلاحظين كيف؟ هذه
+
+508
+00:36:47,570 --> 00:36:54,650
+المنطقة كلها تمام Chronic subdural hematoma، في
+
+509
+00:36:54,650 --> 00:36:57,670
+الـChronic الـetiology ليست دائمًا واضحة، يعني إيش
+
+510
+00:36:57,670 --> 00:37:00,350
+بتصبح الـChronic؟ بس أكيد بيكون فيه هواية قديمة،
+
+511
+00:37:00,350 --> 00:37:04,900
+يعني عادةًإنه أكل هواية، أكل حاجة، وجهة، تمام؟ فيه
+
+512
+00:37:04,900 --> 00:37:09,260
+trauma قديمة، it is probably due to trauma ربما
+
+513
+00:37:09,260 --> 00:37:14,420
+يكون trauma، often minor، بتكون بسيطة، preceding a
+
+514
+00:37:14,420 --> 00:37:18,320
+few weeks، قبل أكام أسبوع، but not such history is
+
+515
+00:37:18,320 --> 00:37:22,640
+obtainable in 15% of cases، 50% الحالات مافيش
+
+516
+00:37:22,640 --> 00:37:25,380
+history، بيقولك لو جاءت ولا صار إشي، هو إلا بيكون
+
+517
+00:37:25,380 --> 00:37:28,240
+صار إشي، بس بيكون إشي بسيط جدا، وماأثرش عليه
+
+518
+00:37:28,240 --> 00:37:30,860
+ساعتها كمان، حضرت إنه مش بتذكره
+
+519
+00:37:37,480 --> 00:37:42,620
+الشيء يتغير قليلًا وشيء يتغير قليلًا وشيء يتغير
+
+520
+00:37:42,620 --> 00:37:43,460
+قليلًا وشيء يتغير قليلًا وشيء يتغير قليلًا وشيء
+
+521
+00:37:43,460 --> 00:37:43,460
+يتغير قليلًا وشيء يتغير قليلًا وشيء يتغير قليلًا
+
+522
+00:37:43,460 --> 00:37:43,460
+وشيء يتغير قليلًا وشيء يتغير قليلًا وشيء يتغير
+
+523
+00:37:43,460 --> 00:37:43,460
+قليلًا وشيء يتغير قليلًا وشيء يتغير قليلًا وشيء
+
+524
+00:37:43,460 --> 00:37:47,100
+يتغير قليلًا وشيء يتغير قليلًا وشيء يتغير قليلًا
+
+525
+00:37:47,100 --> 00:37:51,220
+وشيء
+
+526
+00:37:51,220 --> 00:38:00,980
+يتغير قليلًا وشي
+
+527
+00:38:01,010 --> 00:38:05,370
+الـDensity تباعتها واضحة هذا، ممكن بعد مدة
+
+528
+00:38:05,370 --> 00:38:09,690
+الـIsodense Collection تكون أفضل تمثيلة بعد
+
+529
+00:38:09,690 --> 00:38:13,630
+الـIntravenous اللي هو الـContra يعني عشان أنت
+
+530
+00:38:13,630 --> 00:38:18,410
+تقدر تميز لازم يعملوا CT وContrast، ليش؟ لأنه بعد
+
+531
+00:38:18,410 --> 00:38:21,290
+أسابيع بتلاقيها صارت زي لون
+
+532
+00:38:24,630 --> 00:38:27,850
+يعني بتعطي الصورة picture تبع الـ«برانشيب» طبيعية
+
+533
+00:38:27,850 --> 00:38:33,770
+وتبينش إنه في عنده collection وفي عنده sub-edural،
+
+534
+00:38:33,770 --> 00:38:38,070
+تمام؟ ولذلك هنا بيحتاجوا إنهم يعملوا اللي هو إيش
+
+535
+00:38:38,070 --> 00:38:41,750
+«Contrast»
+
+536
+00:38:41,750 --> 00:38:47,170
+اللي هو يده صبغة علشان يقدروا إميزوها،
+
+537
+00:38:47,170 --> 00:38:50,730
+تمام؟ طلع هاي هذا CT حقيقية
+
+538
+00:38:59,560 --> 00:39:03,240
+الحقيقية اللي بتخليننا نعرف حتى لو الـDensity
+
+539
+00:39:03,240 --> 00:39:08,540
+ماكنتش واضحة جدا، لو ماكنش هنا في اختلاف في الكثرة
+
+540
+00:39:08,540 --> 00:39:11,700
+بين هذين، هنا واضحة، هنبين إنه بالحاجة حاجة في
+
+541
+00:39:11,700 --> 00:39:16,680
+اسمها Midline Shift كيف يعني؟ هذا الـBrush Artهذا
+
+542
+00:39:16,680 --> 00:39:21,240
+يظل يضغط على الجزء هذا من الـ Brain ويزجه فبيزجه
+
+543
+00:39:21,240 --> 00:39:26,200
+على الجهة هذه فإيش بيصير؟ فبيصير هنا يا حبابي إن
+
+544
+00:39:26,200 --> 00:39:29,500
+الخط اللي بيقسم الـ Brain من النص هذا اسمه الـ
+
+545
+00:39:29,500 --> 00:39:33,920
+Midline بتلاقي انبعج مشي لهيك راح في اتجاه هذا لإن
+
+546
+00:39:33,920 --> 00:39:37,980
+هذه الخلايا اللي هنا إيه صار فيها؟ مشت في هذا
+
+547
+00:39:37,980 --> 00:39:43,160
+الاتجاه تزجت هذه الخلايا اللي هنا فالخط اللي بنص
+
+548
+00:39:43,160 --> 00:39:47,700
+في الـ Brain بيمشي فبيصير فيه إيش؟اللي هو بنقول
+
+549
+00:39:47,700 --> 00:39:52,220
+عنه shifting، shift يعني الـ midline صار له
+
+550
+00:39:52,220 --> 00:39:56,060
+shifting، مشي لقدام، يعني بعج، تمام؟ الأصل أنه في
+
+551
+00:39:56,060 --> 00:40:01,960
+الـ midline، تطلع كيف يكون، تشوف هنا صورة واضحة،
+
+552
+00:40:01,960 --> 00:40:05,690
+هاي هتقول تطلع كيف ال midline؟المفروض أن يكون هناك
+
+553
+00:40:05,690 --> 00:40:09,910
+midline منتظر لما كل ما يمشي لقدام هذا يبقى يبعش
+
+554
+00:40:09,910 --> 00:40:14,370
+فيه ويبعش فيه ويبقى عامل shifting جاه هنا ويبقى
+
+555
+00:40:14,370 --> 00:40:16,210
+عامل shift هنا ويبقى عامل shift هنا ويبقى عامل
+
+556
+00:40:16,210 --> 00:40:16,890
+shift هنا ويبقى عامل shift هنا ويبقى عامل shift
+
+557
+00:40:16,890 --> 00:40:16,890
+هنا ويبقى عامل shift هنا ويبقى عامل shift هنا
+
+558
+00:40:16,890 --> 00:40:16,950
+ويبقى عامل shift هنا ويبقى عامل shift هنا ويبقى
+
+559
+00:40:16,950 --> 00:40:16,950
+عامل shift هنا ويبقى عامل shift هنا ويبقى عامل
+
+560
+00:40:16,950 --> 00:40:18,910
+shift هنا ويبقى عامل shift هنا ويبقى عامل shift
+
+561
+00:40:18,910 --> 00:40:23,970
+هنا ويبقى عامل shift هنا ويبقى عامل shift هنا
+
+562
+00:40:23,970 --> 00:40:28,800
+ويبقى عاملهذا خطير جداً لأنه سيأثر على الـ
+
+563
+00:40:28,800 --> 00:40:32,420
+pressure على جزء أداك اللي في الـ brain وهيعمل عند
+
+564
+00:40:32,420 --> 00:40:34,920
+المريض alteration في level of consciousness أو
+
+565
+00:40:34,920 --> 00:40:41,320
+alteration في اللي هو الـ
+
+566
+00:40:41,320 --> 00:40:44,340
+function تبعات الـ brain كلها، this hematoma is
+
+567
+00:40:44,340 --> 00:40:45,160
+not also
+
+568
+00:40:59,760 --> 00:41:06,320
+هو عمره أسبوع أو أسبوعينهو يمكن أن يكون مفقود على
+
+569
+00:41:06,320 --> 00:41:09,900
+جميع الـ Scanner مع صورة قوية بشكل كبير ولكن هذا
+
+570
+00:41:09,900 --> 00:41:13,240
+حقًا مشكلة حاليًا، مشكلة حاليًا، هل جيت فيه
+
+571
+00:41:13,240 --> 00:41:16,580
+Construct فبطلت يعني المشكلة، طلع كيف يبقوا ينسيق
+
+572
+00:41:16,580 --> 00:41:23,520
+اللي بتلاحظها هي تهان، كل هذا كان عبارة عن إيش؟
+
+573
+00:41:23,520 --> 00:41:24,160
+Collection
+
+574
+00:41:27,470 --> 00:41:30,930
+طيب، أخر حاجة اللي بنحكي فيها بعد ما حكيناها طبعاً
+
+575
+00:41:30,930 --> 00:41:34,450
+في أخر نوع، هدول الـEpidural و الـSub-Epidural فيه
+
+576
+00:41:34,450 --> 00:41:38,670
+نوع من الـBrain Injury إنه يحصل في داخل
+
+577
+00:41:38,670 --> 00:41:43,450
+الـIntracerebral Hematoma كل هدول الحاجات بنروحها
+
+578
+00:41:43,450 --> 00:41:46,010
+جماعة، بنتعامل معاهم، بنقيم الـConscious Level عن
+
+579
+00:41:46,010 --> 00:41:50,520
+طريق حاجة اسمهاالـ Glasgow Coma Scale هذا يعني الـ
+
+580
+00:41:50,520 --> 00:41:54,220
+«تول» هذه عبارة أو الـ Scale هذا هي Scale جدًا
+
+581
+00:41:54,220 --> 00:42:01,520
+معروف في الـ ICU وبنقيم المرضى عن طريقه فبنقولش
+
+582
+00:42:01,520 --> 00:42:03,740
+المريض Conscious أو Unconscious لأ، بنقول المريض
+
+583
+00:42:03,740 --> 00:42:07,940
+الـ Conscious Level تبعه According to GCS اللي هو
+
+584
+00:42:07,940 --> 00:42:12,940
+Glasgow Coma Scale is كذا طب كيف بنقدر نعمله؟ جالك
+
+585
+00:42:12,940 --> 00:42:19,120
+نقول ببساطة هذا من جسم لـ 3الجزء الأول لـ I
+
+586
+00:42:19,120 --> 00:42:23,900
+Opening والـ Grade منه أربعة الأعلى هو الأربعة
+
+587
+00:42:23,900 --> 00:42:30,640
+والأقل هو واحد والجزء التاني هو الـ Vapor Response
+
+588
+00:42:30,640 --> 00:42:36,350
+استجابتهالـVerbally يعني للـCommand لإني أحكي معاه
+
+589
+00:42:36,350 --> 00:42:41,590
+الأعلى هو خمسة والأقل هو واحد والأخير الاستجابة
+
+590
+00:42:41,590 --> 00:42:46,650
+الحركية الـMotor Response اللي هو الأعلى ستة
+
+591
+00:42:46,650 --> 00:42:50,950
+والأقل واحد كيف نعمله بكل بساطة باجي أنا وبشوف
+
+592
+00:42:50,950 --> 00:42:54,750
+المريض إذا spontaneous eye opening فات عينيه لحاله
+
+593
+00:42:54,750 --> 00:42:58,030
+لغاية ما حد يتكلم ويفتح عينيه باخد أربعة إذا مغمض
+
+594
+00:42:58,030 --> 00:43:05,280
+عينيه لكن لما أجي أحكي معاهأبو الشباب محمد بفتح
+
+595
+00:43:05,280 --> 00:43:09,640
+عينيه to speech بفتح عينيه لأنه بفضل يظل مغمض إذا
+
+596
+00:43:09,640 --> 00:43:15,980
+هدا تلاتة طيب أنا ندتها ليه يا حج سمعنيلأ أبداً،
+
+597
+00:43:15,980 --> 00:43:19,460
+الفاتحة مش هناك، بعمله بين فلسطين والعي، بضغطك بين
+
+598
+00:43:19,460 --> 00:43:22,900
+حواجب أو حاجة، بتجي الفاتحة هنا، إيش؟ إيش فيه؟ آه،
+
+599
+00:43:22,900 --> 00:43:26,120
+يعني بستجيب، بس للألم، إذاً الـEye Opening،
+
+600
+00:43:26,120 --> 00:43:29,840
+استجابة، فتح اللي هنا، للألم، to بين، باخد اتنين،
+
+601
+00:43:29,840 --> 00:43:34,750
+ضغطت، عملتله ألم، برضه مفاتحة هنا، بكون واحدطيب
+
+602
+00:43:34,750 --> 00:43:38,790
+الـ Verbal Response بحكي معاه كيف حالك؟ الحمد لله
+
+603
+00:43:38,790 --> 00:43:43,550
+يا ربنا الناس تعبان أه oriented أه أه أه أه أه أه
+
+604
+00:43:43,550 --> 00:43:43,870
+أه أه أه أه أه أه أه أه أه أه أه أه أه أه أه أه أه
+
+605
+00:43:43,870 --> 00:43:44,130
+أه أه أه أه أه أه أه أه أه أه أه أه أه أه أه أه أه
+
+606
+00:43:44,130 --> 00:43:44,150
+أه أه أه أه أه أه أه أه أه أه أه أه أه أه أه أه أه
+
+607
+00:43:44,150 --> 00:43:44,150
+أه أه أه أه أه أه أه أه أه أه أه أه أه أه أه أه أه
+
+608
+00:43:44,150 --> 00:43:45,710
+أه أه أه أه أه أه أه أه أه أه أه أه أه أه أه أه أه
+
+609
+00:43:45,710 --> 00:43:47,570
+أه أه
+
+610
+00:44:03,860 --> 00:44:09,110
+تمام، أنا بحكي معاه، فبقولّهيعني الـ confusion
+
+611
+00:44:09,110 --> 00:44:12,450
+تعرف كيف confusion يعني مضطر بسوية بس
+
+612
+00:44:12,450 --> 00:44:16,710
+inappropriate بيصير يعني إيجاه في غير محله الـ
+
+613
+00:44:16,710 --> 00:44:19,490
+inappropriate زي ما حكيتها و طلبت مثال بقول أنا
+
+614
+00:44:19,490 --> 00:44:24,710
+كيف حالك؟ بقول الله أني بتطبخ سماجية ذاك يعني
+
+615
+00:44:24,710 --> 00:44:27,730
+inappropriate يعني بقولك كيف حالك؟ و أين بتشتغل
+
+616
+00:44:27,730 --> 00:44:34,670
+أنت؟ في الجامعة بقدن أبو محمد أنا بشتغلشطب إيش ده
+
+617
+00:44:34,670 --> 00:44:39,370
+خنّفة محمد إذا بحكي جمال صحيحة لكن مش إجابة على
+
+618
+00:44:39,370 --> 00:44:43,930
+السؤال تبعتها انت بتقوله فاشي بتشتغل بيقولك الولاد
+
+619
+00:44:43,930 --> 00:44:49,030
+بيلعبوا في الصف ماكانوش بيت بدرسوا في الصف بياخد
+
+620
+00:44:49,030 --> 00:44:54,460
+تلاتة لكن إذا كانتأكتر من ذلك حالته، ستسألون أي
+
+621
+00:44:54,460 --> 00:44:59,480
+سؤال سيرد عليه بـIncomprehensible sound إيش يعني
+
+622
+00:44:59,480 --> 00:45:04,340
+Incomprehensible؟ يعني بتقولوا كيف حالك؟ إيش
+
+623
+00:45:04,340 --> 00:45:09,100
+أخبارك؟ انت بيقولش جامعة جامعة، يامة جامعة، ولا
+
+624
+00:45:09,100 --> 00:45:14,080
+حرف ولا كلمة، كلام مش جملة ولا كلمة، none ماجاوبش
+
+625
+00:45:14,080 --> 00:45:19,880
+بالمرة، بيكون واحدالـ Motor، إذا أنت حكيت معاه،
+
+626
+00:45:19,880 --> 00:45:23,800
+فارفع أيديك، فات عينيك وPay commands، بيستجيب،
+
+627
+00:45:23,800 --> 00:45:27,680
+بيفهم اللي بالظبط أنت بتحكيه، باخد ستة، طيب، إذا
+
+628
+00:45:27,680 --> 00:45:32,100
+ما استجابش، لكن روحت على إيده اليمين، جرسته، فش
+
+629
+00:45:32,100 --> 00:45:36,100
+سحب إيده اليمين، أه، Localized بينه، أو روحت جرسته
+
+630
+00:45:36,100 --> 00:45:38,440
+من صيدله، فحرك إيده في اتجاه الألم
+
+631
+00:45:40,960 --> 00:45:44,400
+بتجربة، عايز في الألم هون، باخد خمسة لكن إذا أنا
+
+632
+00:45:44,400 --> 00:45:47,840
+بعمله ألم فبروح بعمل withdrawal from pain يعني
+
+633
+00:45:47,840 --> 00:45:51,980
+ماخدته في أصبع و سحب إيده، أه يعني بقدر بسي بشرد
+
+634
+00:45:51,980 --> 00:45:55,320
+إيده، تمام؟ reflection to pain، لكن إذا عملتله
+
+635
+00:45:55,320 --> 00:45:58,320
+pain، راح عمل reflection عارفين إيش reflection،
+
+636
+00:45:58,320 --> 00:46:01,520
+تمام؟ أه عكس ال extension، reflection بخشش حاله
+
+637
+00:46:01,520 --> 00:46:05,900
+لجوة ال extension بتطلع إيدي لبرا، تمام؟ إذا بعمل
+
+638
+00:46:05,900 --> 00:46:08,240
+reflection to pain، بعمله pain، بعمل reflection،
+
+639
+00:46:08,240 --> 00:46:11,700
+بقولت لها إذا عملتله pain، عمل extensionبأخد اتنين
+
+640
+00:46:11,700 --> 00:46:14,680
+إذا ماعملش ولا حاجة بكون قاعد و تخبط ما تخبط فيه
+
+641
+00:46:14,680 --> 00:46:20,280
+واحد لذلك واحد في الـI واحد في الـVerbal واحد في
+
+642
+00:46:20,280 --> 00:46:24,260
+الـMotor معناه إن المريض هذا كإنه ميت لا بيفتقن
+
+643
+00:46:24,260 --> 00:46:26,720
+أيه ولا في عنده Verbal Response ولا عنده Motor
+
+644
+00:46:26,720 --> 00:46:33,040
+Response هذا زي زي أي واحد جثة ولكن ليس ميت لسه في
+
+645
+00:46:33,040 --> 00:46:37,560
+عنده Heart Rate شغال لسه في عنده Breathing ممكن
+
+646
+00:46:37,560 --> 00:46:42,510
+يكون بتنفس لعاله ممكن يكونبتنفس ده حاجة ممكن يكون
+
+647
+00:46:42,510 --> 00:46:46,630
+إحنا بعد شوية نحتاج إنه نحطله in circulate tube
+
+648
+00:46:46,630 --> 00:46:49,530
+لكن اللي بده أصله أقولكوا إنه ممكن يكون الشخص
+
+649
+00:46:49,530 --> 00:46:54,470
+Glass-Glucose Coma Scale 3، تلاتة و لسه مش ميت،
+
+650
+00:46:54,470 --> 00:47:00,610
+يكون لسه عايش، تمام؟ هذا بيكون شبيه بالمريد اللي
+
+651
+00:47:00,610 --> 00:47:05,010
+عنده اللي هو Brain Death، تمام؟ لكن مش بس من
+
+652
+00:47:05,010 --> 00:47:08,010
+الـGlass-Glucose Coma Scale إنه يكون تلاتة، بحدد و
+
+653
+00:47:08,010 --> 00:47:12,530
+بقوله المريض هذا Brain Death إطلاقاًبنخش فيها
+
+654
+00:47:12,530 --> 00:47:19,190
+كراتيريا أكتر من ضمنها إنه ينعملوا Corneal Reflex
+
+655
+00:47:19,190 --> 00:47:22,830
+Test إنه ينعملوا EEG تخطيط الدماغ
+
+656
+00:47:32,320 --> 00:47:38,520
+وفحوصات وأخصائي أعصاب وأخصائي قلب وأخصائي إناء
+
+657
+00:47:38,520 --> 00:47:42,980
+مركزة إقرروا إن هذا المريض فعلاً كل إشي فيه متوقف
+
+658
+00:47:42,980 --> 00:47:47,930
+ما هذا كل إشي فيه يعني الـbrain تبقى وداعدأو بقيت
+
+659
+00:47:47,930 --> 00:47:52,470
+أجهزته شغالة فيعتبر انه brain death تمام؟ مش بس ان
+
+660
+00:47:52,470 --> 00:47:55,690
+يكون الـGlasgow Coma Scale تبعه تلاتة، أي حد على
+
+661
+00:47:55,690 --> 00:47:59,350
+sedation ممكن يكون الـGlasgow Coma Scale تبعه
+
+662
+00:47:59,350 --> 00:48:04,470
+تلاتة، هيك يعني أنا خلصت المحاضرة، بديش أطول عليكم
+
+663
+00:48:04,470 --> 00:48:08,130
+ولا بدي أغلبكم عشان أخر محاضرة تكون خفيفة ونظيفة
+
+664
+00:48:08,130 --> 00:48:13,050
+وأعطيكم ألفعافية وإن شاء الله رب العالمين بكون
+
+665
+00:48:13,050 --> 00:48:18,210
+الأسئلة خفيفة وكل عيدكوا بتنبسطوا السلام عليكم
+
+666
+00:48:18,210 --> 00:48:18,750
+ورحمة الله
+
diff --git a/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/T7CiRBNwdCw.srt b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/T7CiRBNwdCw.srt
new file mode 100644
index 0000000000000000000000000000000000000000..d80d7ef0bd683fa2cb4602ee4a18de60183b49d6
--- /dev/null
+++ b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/T7CiRBNwdCw.srt
@@ -0,0 +1,758 @@
+1
+00:00:03,310 --> 00:00:06,390
+بسم الله الرحمن الرحيم السلام عليكم ورحمة الله
+
+2
+00:00:06,390 --> 00:00:13,450
+وبركاته، اليوم بناخد المحاضرة الأخيرة تقريباً في ال
+
+3
+00:00:13,450 --> 00:00:18,490
+course. هنحكي عن الـ assessment of cardiovascular
+
+4
+00:00:18,490 --> 00:00:19,450
+function.
+
+5
+00:00:22,730 --> 00:00:26,090
+الـ Sinus Symptoms تبع الـ Myocardial Infarction،
+
+6
+00:00:26,090 --> 00:00:29,810
+والـ Angina أو الـ Acute Coronary Syndrome in
+
+7
+00:00:29,810 --> 00:00:35,710
+general، وحنحكي عن الـ Intervention Cardiology سواء
+
+8
+00:00:35,710 --> 00:00:42,870
+الـ PCI، الـ Cardiac Catheterization، أو أنواع الـ
+
+9
+00:00:42,870 --> 00:00:48,730
+Cardiac Dysrhythmia، وطرق علاجهم بشكل سريع لو بدنا
+
+10
+00:00:48,730 --> 00:00:54,820
+نتذكر الـ Heart. بنعرف كلهيتنا إنه عبارة عن
+
+11
+00:00:54,820 --> 00:01:01,100
+muscular organ، وكلهيتنا نعرف إنه موجود في
+
+12
+00:01:01,100 --> 00:01:08,580
+الـ center of the thorax، ويعني بيشغل المكان بين
+
+13
+00:01:08,580 --> 00:01:13,240
+الـ two lungs، عند الـ mediastinum، فوق الـ diaphragm.
+
+14
+00:01:14,410 --> 00:01:19,130
+طبعاً بنعرف إن وظيفته هو الـ circulatory system
+
+15
+00:01:19,130 --> 00:01:22,190
+اللي في الجسم؛ هو الـ pump، هو الـ machine اللي
+
+16
+00:01:22,190 --> 00:01:26,770
+بتعمل pumping للـ blood، بتستقبله من كل الجسم،
+
+17
+00:01:26,770 --> 00:01:31,710
+وبالتالي، إعادة توزيعه بعد ما يعمل الدورة الدموية
+
+18
+00:01:31,710 --> 00:01:35,610
+الصغرى في الـ lung، ويصير له Oxygenation، بيرجع
+
+19
+00:01:35,610 --> 00:01:40,690
+للقلب، وبيرجع القلب كمضخة يوزع ويعمل إعادة
+
+20
+00:01:40,690 --> 00:01:44,690
+distribution لكل organs again، وها كذا دورة
+
+21
+00:01:44,690 --> 00:01:49,750
+مستمرة، بتكون من جزء العضل تبعه ومن الغشاء اللي
+
+22
+00:01:49,750 --> 00:01:54,830
+حوالين العضلة، الـ Epicardium، وعضلة نفسها اسمها الـ
+
+23
+00:01:54,830 --> 00:01:59,950
+Myocardium، وطبعاً بنعرف إنه بتكون من four chambers،
+
+24
+00:01:59,950 --> 00:02:05,090
+وبتربط بين الـ four chambers هدول، خليني أشوف
+
+25
+00:02:05,090 --> 00:02:09,800
+صورة أسرع. بتربط بين الـ chambers هدول اللي هم
+
+26
+00:02:09,800 --> 00:02:15,720
+AV، أو اللي هم الـ valves، بنسموهم AV valves، يعني
+
+27
+00:02:15,720 --> 00:02:20,640
+Atrioventricular valves، زي ما احنا عارفين، يعني هذه
+
+28
+00:02:20,640 --> 00:02:26,250
+كل الكلمات عارفينها أنتم من الابتدائي، يعني الـ Right
+
+29
+00:02:26,250 --> 00:02:30,830
+Atrium والـ Left، أو الـ Right Ventricle، وهنا فيه
+
+30
+00:02:30,830 --> 00:02:37,110
+الـ Left Atrium، وفيه الـ Left Ventricle، بينهم
+
+31
+00:02:37,110 --> 00:02:41,830
+هنا فيه الـ Tricuspid Valve، هنا فيه الـ Left، فيه
+
+32
+00:02:41,830 --> 00:02:45,650
+الـ Mitral Valve أو الـ Bicuspid Valve بنسميه،
+
+33
+00:02:45,650 --> 00:02:48,430
+بتطلع من هذا الـ Aortic
+
+34
+00:02:50,590 --> 00:02:55,270
+Artery، وبنلاقي فيها عن طريق حاجة اسمها اللي هو الـ
+
+35
+00:02:55,270 --> 00:03:01,230
+semilunar valve، وبيطلع من الـ ventricle الـ right
+
+36
+00:03:01,230 --> 00:03:05,730
+ventricle، اللي هو الـ pulmonary، الـ pulmonary artery.
+
+37
+00:03:05,730 --> 00:03:10,400
+ومخزن هذا كله الـ left ventricle، الـ Right
+
+38
+00:03:10,400 --> 00:03:18,500
+Ventricle، وهنا فيه اللي هو Pulmonary Valve،
+
+39
+00:03:18,500 --> 00:03:20,620
+اللي بيطلع على الـ Pulmonary Artery.
+
+40
+00:03:27,140 --> 00:03:31,460
+حكينا بشكل سريع عن الـ cycle، الـ cycle اللي
+
+41
+00:03:31,460 --> 00:03:35,740
+بيسموها الدورة
+
+42
+00:03:35,740 --> 00:03:39,620
+الدموية الصغرى، اللي هي بتصير
+
+43
+00:03:48,180 --> 00:03:50,600
+حكينا هنا إن الدورة الدموية الصغرى، اللي بيروح فيها
+
+44
+00:03:50,600 --> 00:03:57,180
+الدم اللي واصل من جميع أنحاء الجسم، للـ right
+
+45
+00:03:57,180 --> 00:04:00,860
+Atrium، بينزل للـ right ventricle، بتنضخه من
+
+46
+00:04:00,860 --> 00:04:04,300
+الـ right ventricle عبر الـ pulmonary
+
+47
+00:04:09,570 --> 00:04:13,010
+الدم اللي فيه، بعد ما يصير له Oxygenation، بيرجع عن
+
+48
+00:04:13,010 --> 00:04:16,970
+طريق الـ four pulmonary veins، two على الـ right و
+
+49
+00:04:16,970 --> 00:04:22,310
+two على الـ left، بصبوا في اللي هو الـ left Atrium.
+
+50
+00:04:22,310 --> 00:04:25,770
+وبعد ذلك، الـ Left Atrium بضخ الدم الـ Oxygenated
+
+51
+00:04:25,770 --> 00:04:29,150
+اللي فيه، عبر الـ Mitral Valve أو الـ Bicuspid
+
+52
+00:04:29,150 --> 00:04:33,270
+Valve، للـ Left Ventricle، اللي بيطلع بعمل
+
+53
+00:04:33,270 --> 00:04:37,250
+Contraction، بيطلع كل هذا الـ Blood اللي فيه، عبر الـ
+
+54
+00:04:37,250 --> 00:04:43,270
+Aortic Valve، لشريان الأورطي اللي هو الـ Aortic
+
+55
+00:04:43,270 --> 00:04:48,170
+Artery، وبالتالي بيصير له... بيطلع مع الـ aortic
+
+56
+00:04:48,170 --> 00:04:52,250
+artery، الـ ascending aortic artery، بعدين اللي هو
+
+57
+00:04:52,250 --> 00:04:55,750
+الـ arch of aortic artery، هنا هذا هو الـ arch of
+
+58
+00:04:55,750 --> 00:04:58,850
+aortic artery، بعدين الـ descending aortic artery،
+
+59
+00:04:58,850 --> 00:05:02,750
+اللي هو اللي بينزل، وبيوزع لكل الأجهزة، عارفين احنا
+
+60
+00:05:02,750 --> 00:05:08,540
+إنه في الـ... في الـ arch of aortic artery بتطلع
+
+61
+00:05:08,540 --> 00:05:13,540
+تفرعات، مثلًا Left Common Carotid Artery، اللي بيطلع
+
+62
+00:05:13,540 --> 00:05:19,280
+على الـ carotid، عشان يغذي الـ brain، وكمان بنعرف
+
+63
+00:05:19,280 --> 00:05:24,180
+إنه بيطلع منه اللي هو الـ coronary arteries، اللي
+
+64
+00:05:24,180 --> 00:05:29,880
+بيغذوا الـ heart نفسه، تمام؟
+
+65
+00:05:36,050 --> 00:05:39,590
+حكينا في الـ شويه  حاجة اسمها cardiac output،
+
+66
+00:05:39,590 --> 00:05:42,130
+والـ stroke volume، عرفنا إن الـ stroke volume
+
+67
+00:05:42,260 --> 00:05:46,320
+هو عبارة عن كمية الـ blood اللي بتطلع في كل beat،
+
+68
+00:05:46,320 --> 00:05:49,880
+وعرفنا إن الـ Normal heart rate من خمسين، عفواً، من
+
+69
+00:05:49,880 --> 00:05:55,180
+ستين لـ 100 beat per minute، الـ Normal يعني حوالي
+
+70
+00:05:55,180 --> 00:06:02,680
+ثمانين، وبتغير، وفي عوامل كتير ممكن تأثر عليه زي
+
+71
+00:06:02,680 --> 00:06:07,540
+الـ stress، الدرجة الحرارة، كل هذا ممكن يتأثر
+
+72
+00:06:07,540 --> 00:06:12,150
+على الـ heart beat. الـ Normal Stroke Volume حوالي
+
+73
+00:06:12,150 --> 00:06:16,910
+70، للناس اللي وزنها حوالي 70، لأن الـ Stroke
+
+74
+00:06:16,910 --> 00:06:21,290
+Volume حكينا إنه عبارة عن 1 ملليلتر لكل كيلو جرام
+
+75
+00:06:21,290 --> 00:06:25,450
+Body Weight. تقريباً الـ Cardiac Output، الـ Stroke
+
+76
+00:06:25,450 --> 00:06:28,210
+Volume ضرب الـ Heart Rate، يعني أنت بتطلق 70 و
+
+77
+00:06:28,210 --> 00:06:32,350
+بتعمل 70 beat per minute، سبعة في سبعة يعني 490، يعني
+
+78
+00:06:32,350 --> 00:06:36,210
+حوالي 500 CC هو الـ Cardiac Output تبعك في الدقيقة.
+
+79
+00:06:37,760 --> 00:06:42,660
+حكينا إن الـ heart rate، فيه حاجات ممكن تتأثر عليه،
+
+80
+00:06:42,660 --> 00:06:46,100
+وفيه حاجات تتحكم فيه، مش بس فيه حاجات في الـ
+
+81
+00:06:46,100 --> 00:06:51,200
+intrinsic characteristics اللي بتأثر على الـ
+
+82
+00:06:51,200 --> 00:06:56,680
+heartbeat، زي قدرة الـ heart itself، بنسموها
+
+83
+00:06:56,680 --> 00:07:01,360
+الـ automaticity،
+
+84
+00:07:01,360 --> 00:07:04,460
+اللي هي قدرة الـ heart على إنه يعمل electrical
+
+85
+00:07:04,460 --> 00:07:05,400
+impulses،
+
+86
+00:07:07,680 --> 00:07:11,460
+وكمان الـ ability to respond to external electrical
+
+87
+00:07:11,460 --> 00:07:15,200
+impulses، يعني قدرته أن يعمل initiation، والاستجابة
+
+88
+00:07:15,200 --> 00:07:19,880
+للتغيرات اللي بدها تحصل، الـ conductivity، اللي هي
+
+89
+00:07:19,880 --> 00:07:24,860
+الخصائص التوصيلية، وإذا كنا نحكي عن كهربائية القلب بشكل
+
+90
+00:07:24,860 --> 00:07:27,680
+سريع، بنلاقي إنه في parasympathetic nervous system،
+
+91
+00:07:27,680 --> 00:07:29,020
+وفي sympathetic nervous system.
+
+92
+00:07:33,600 --> 00:07:37,620
+عادي بشكل طبيعي، لما يكون الواحد صاحي، ويستجيب
+
+93
+00:07:37,620 --> 00:07:41,860
+للخوف والقلق، وكل الاستجابات الطبيعية، وهذا عادةً
+
+94
+00:07:41,860 --> 00:07:44,500
+بيزود الـ heart rate، عبر sympathetic، بيشتغل، ونحن
+
+95
+00:07:44,500 --> 00:07:50,080
+نايمين، وعادةً هذا يعني بعمل slow down للـ heart rate.
+
+96
+00:07:52,070 --> 00:07:56,590
+طبعاً التحكم فيه بيكون عن طريق اللي هو الميدولا
+
+97
+00:07:56,590 --> 00:08:03,650
+والـ pons، وهنا بس بيزيد وبينقص الـ heart rate، لكن
+
+98
+00:08:03,650 --> 00:08:07,810
+ما بيعملش initiation، لأن الـ initiation تبع الـ heart
+
+99
+00:08:07,810 --> 00:08:12,500
+pulse بتكون إيه؟ داخلية، من داخله، دي حكمة
+
+100
+00:08:12,500 --> 00:08:15,140
+ربانية، علشان حتى لو صار الـ brain dead، يفضل
+
+101
+00:08:15,140 --> 00:08:19,940
+الـ heart شغال. مصطلحات مشهورة، اسمها الـ preload و
+
+102
+00:08:19,940 --> 00:08:23,080
+الـ afterload، حكينا في الشرح برضه عنهم، الـ preload
+
+103
+00:08:23,080 --> 00:08:27,180
+حكينا إنه يعني الـ maximum strength اللي ممكن
+
+104
+00:08:27,180 --> 00:08:32,630
+توصل له الـ heart muscle، و الـ stretching تبعها، اه.
+
+105
+00:08:32,630 --> 00:08:36,870
+يعني كده ممكن تصير لها stretching وتتمدد في
+
+106
+00:08:36,870 --> 00:08:42,490
+الـ Diastole، في نهاية الـ Diastole، والـ Afterload،
+
+107
+00:08:42,490 --> 00:08:45,330
+اللي هو الـ amount of resistance to ejection of blood
+
+108
+00:08:45,330 --> 00:08:49,310
+from ventricle، تمام؟ إذاً هو عبارة عن الـ amount
+
+109
+00:08:49,310 --> 00:08:53,210
+of resistance to ejection of blood from ventricle،
+
+110
+00:08:53,210 --> 00:08:56,670
+كده أنا بيكون في عندي مقاومة من الـ
+
+111
+00:09:00,130 --> 00:09:03,610
+يعني في الـ vessels، مقاومة من الـ vessels عشان الـ
+
+112
+00:09:03,610 --> 00:09:08,950
+Left Ventricle يعمل ejection للـ blood، هذا ضخ الدم،
+
+113
+00:09:08,950 --> 00:09:14,790
+هذا في الـ vessels هدول، قد إيش فيه مقاومة، وقد إيش فيه
+
+114
+00:09:14,790 --> 00:09:24,670
+resistance، هذه هي الـ Afterload. الـ
+
+115
+00:09:26,310 --> 00:09:30,870
+Contractility بشكل عام، حكينا إنه الـ
+
+116
+00:09:30,870 --> 00:09:35,630
+Contractility، بيعملها sympathetic nervous
+
+117
+00:09:35,630 --> 00:09:39,590
+system، بيأثر عليها، هي أصلاً بتصير built-in، يعني
+
+118
+00:09:39,590 --> 00:09:47,210
+نتيجة وجود الـ SA node والـ AV node، وهدول اللي
+
+119
+00:09:47,210 --> 00:09:53,410
+بيعملوا تنظيم لاللي هو الكهربية تبع القلب.
+
+120
+00:09:57,500 --> 00:10:01,820
+على كل حال، مش صورة بس، الـ SA node، يعني هذا كله
+
+121
+00:10:01,820 --> 00:10:04,680
+مراجعة، أنتم أخذتوها في التشريح وفي physiology، يعني
+
+122
+00:10:04,680 --> 00:10:07,720
+بس أنا عشان أقدر أوصل، SA node بتكون موجودة هنا،
+
+123
+00:10:07,720 --> 00:10:14,700
+تمام، بتعمل beating، بتعمل حوالي 60 beats، بتمرر
+
+124
+00:10:14,700 --> 00:10:18,940
+إشارة تبعها للـ AV node، اللي هي قريبة من الـ valve،
+
+125
+00:10:18,940 --> 00:10:25,030
+هنا بتعمل لها filtration، بعدين بتمشي اللي هو الـ
+
+126
+00:10:25,030 --> 00:10:29,670
+impulses، مع الـ bundle، بتوصل للـ bundle، وبعدين
+
+127
+00:10:29,670 --> 00:10:33,210
+بتروح على الـ purkinje fibers، اللي هي على الـ
+
+128
+00:10:33,210 --> 00:10:36,810
+right وعلى الـ left، عشان تعمل نقل للـ beat.
+
+129
+00:10:36,810 --> 00:10:43,790
+هذه الـ... الـ electricity تبع الـ heart، الدورة تبعها
+
+130
+00:10:43,790 --> 00:10:49,890
+كيف بتصير، طبعاً أي خلل في الـ AV أو في الـ SA، أو يعني
+
+131
+00:10:49,890 --> 00:10:53,130
+إذا خلل في الـ SA، هيعمل لي heart block، إذا خلل في الـ
+
+132
+00:10:53,130 --> 00:10:56,490
+AV، هيعمل لي اللي هو أنواع كتير من الـ dysrhythmia،
+
+133
+00:10:56,490 --> 00:10:59,670
+هنتعرف عليهم. إذا خلل في الـ Purkinje fibers، هيعمل لي
+
+134
+00:10:59,670 --> 00:11:03,830
+برضه أنواع من الـ dysrhythmia، ممكن نتعرف عليهم، لكن
+
+135
+00:11:05,080 --> 00:11:10,620
+بشكل عام، هذه هي الكهربية اللي بتتحكم في القلب
+
+136
+00:11:10,620 --> 00:11:15,960
+بالشكل الطبيعي. لما بيصير خلل معين في عضلة القلب،
+
+137
+00:11:15,960 --> 00:11:20,400
+نتيجة عدم تروية عضلة القلب بحد ذاتها بشكل كويس،
+
+138
+00:11:20,400 --> 00:11:25,040
+بتبدأ حاجة اسمها الـ Cardiac Enzymes ترتفع، من أشهر
+
+139
+00:11:25,040 --> 00:11:29,160
+اللي ليش بترتفع؟ نتيجة الـ Myocardium Destruction،
+
+140
+00:11:29,160 --> 00:11:31,760
+اللي بيصير، الـ Damage اللي بيصير في الـ heart muscle،
+
+141
+00:11:31,760 --> 00:11:36,210
+itself، هو اللي بيبدأ يصير
+
+142
+00:11:37,700 --> 00:11:42,100
+فيه الـ damage اللي بيحصل في الـ heart muscle،
+
+143
+00:11:42,100 --> 00:11:46,640
+نفسه، بيعمل damage، فبيعمل اللي هو إفراز لـ
+
+144
+00:11:46,640 --> 00:11:49,520
+myoglobin تبع الـ heart muscle، فهذا بيؤدي
+
+145
+00:11:49,520 --> 00:11:53,220
+لارتفاع الأنزيمات هذه. من أشهر الأنزيمات المعروفة،
+
+146
+00:11:53,220 --> 00:11:57,140
+enzyme، أو enzymes، الـ CK enzyme، Creatinine
+
+147
+00:11:57,140 --> 00:12:01,760
+kinase enzyme، اللي هو بيسموه Creatinine
+
+148
+00:12:01,760 --> 00:12:10,940
+phosphokinase، الطبيعي تبعه زي ما احنا شايفين، هو
+
+149
+00:12:10,940 --> 00:12:16,260
+بين الـ 20 لـ 280، مش عارف أنا، خمسين لتلاتمية وخمسين، مكتوب
+
+150
+00:12:16,260 --> 00:12:20,940
+حسب الـ kit، ممكن الـ kit يختلف من مكان
+
+151
+00:12:23,600 --> 00:12:29,240
+لمكان. Anyway، الـ CK دا يا جماعة لما بيرتفع،
+
+152
+00:12:29,240 --> 00:12:32,080
+بيرتفع مش بس لما عضلة الـ heart تصير فيها مشكلة،
+
+153
+00:12:32,080 --> 00:12:35,940
+لما أي عضلة في الجسم إذا صار لها damage و
+
+154
+00:12:35,940 --> 00:12:41,720
+destruction، في الـ عضلات، بالذات في CK-MM، هذا
+
+155
+00:12:41,720 --> 00:12:46,200
+بيميزها. CK-BB هذا للـ Brain، في CK-MB هذا
+
+156
+00:12:46,200 --> 00:12:51,040
+بالذات لعضلة القلب. إذا أنا بدي أعمل CK
+
+157
+00:12:51,040 --> 00:12:55,260
+العادي، وأعمل CK-MB اللي هو the specific enzyme
+
+158
+00:12:55,260 --> 00:12:58,040
+للـ heart muscle، ولازم يكون فيه نسبة وتناسب،
+
+159
+00:12:58,040 --> 00:13:04,420
+حوالي 10% ارتفاع ما بين يعني CK يكون مرتفع، الـ CK
+
+160
+00:13:04,420 --> 00:13:08,640
+يكون مرتفع، والـ CK-MB يكون مرتفع أكثر من 10% من
+
+161
+00:13:08,640 --> 00:13:12,280
+ارتفاع الـ CK، عشان يكون هذا الارتفاع له علاقة أو
+
+162
+00:13:12,280 --> 00:13:15,500
+related للـ heart. يعني نعطي مثال، يعني لو كان الـ CK
+
+163
+00:13:15,500 --> 00:13:22,880
+عند مريض مثلاً 500، والـ CK-MB كان 12، يعني الـ CK مش
+
+164
+00:13:22,880 --> 00:13:26,400
+مرتفع، مش أقل، يعني لازم يكون مرتفع، نعتبر إنه
+
+165
+00:13:26,400 --> 00:13:30,180
+الـ normal CK-MB،
+
+166
+00:13:31,480 --> 00:13:38,640
+بدي يكون، نفترض إنه 20 أو حتى لما بيكون يعني الوضع
+
+167
+00:13:38,640 --> 00:13:41,740
+الطبيعي، بيكون فيه destruction فيه، فبيطلع أرقام قليلة
+
+168
+00:13:41,740 --> 00:13:50,030
+جداً، فنفترض إن الـ CK-MB إنه طلع، زي ما حكينا،
+
+169
+00:13:50,030 --> 00:13:55,830
+الـ CK 500، والـ CK-MB طلع 12، هذا يعني إنه مافيش أي
+
+170
+00:13:55,830 --> 00:13:59,530
+destruction في الـ heart muscle، والـ CK يعني اللي
+
+171
+00:13:59,530 --> 00:14:05,470
+مرتفع، مرتفع بسبب تهتك، يعني الأنزيمات العضلية في
+
+172
+00:14:05,470 --> 00:14:11,010
+أي عضلة ثانية غير الـ heart، تمام؟
+
+173
+00:14:11,010 --> 00:14:16,930
+الـ CK والـ CK-MB، هدول بيبدوا يرتفعوا بعد عدة ساعات،
+
+174
+00:14:16,930 --> 00:14:21,390
+وبيوصلوا للـ peak تبعهم، بتكون حوالي أربع أو يعني في
+
+175
+00:14:21,390 --> 00:14:25,150
+خلال أربع وعشرين ساعة، بيضلوا مستمرين لخلال تلات أيام،
+
+176
+0
+
+223
+00:18:04,440 --> 00:18:11,000
+بكون إحنا مهتمين بالشرعين القلب بنخش من أو بنروح
+
+224
+00:18:11,000 --> 00:18:14,800
+على الـ left heart عن طريق أنهم بيروحوا على الـ
+
+225
+00:18:14,800 --> 00:18:18,480
+femoral artery مثلاً، إذا كانوا بنخشوا من الـ femoral
+
+226
+00:18:18,480 --> 00:18:22,840
+أو ممكن يكونوا يخشوا من الـ radial artery أو يظلوا
+
+227
+00:18:22,840 --> 00:18:30,860
+ماشيين مع الـ artery لما نوصله اللي هو الأورطة
+
+228
+00:18:30,860 --> 00:18:33,600
+ومن الأورطة ينزل على الـ coronary arteries ومن الـ
+
+229
+00:18:33,600 --> 00:18:38,120
+coronary arteries يدخل على الـ branch المسكر ويشوف
+
+230
+00:18:38,120 --> 00:18:41,800
+إيش اللي ممكن ينعمل فيه إذا كان مسدود أو إذا كان
+
+231
+00:18:42,620 --> 00:18:48,660
+ينحط فيه دعامة أو إذا كان الموضوع غير قابل للعلاج
+
+232
+00:18:48,660 --> 00:18:52,620
+فبالتالي بتحول المريض لعمل عمليات اللي هو coronary
+
+233
+00:18:52,620 --> 00:18:57,360
+artery bypass graft هكذا خلصنا المقدمة السريعة
+
+234
+00:18:57,360 --> 00:19:01,780
+والمراجعة عن الـ heart بس عشان تتذكروا الـ heart
+
+235
+00:19:01,780 --> 00:19:08,020
+والقصص تبعته، فالآن بنحكي عن الـ dysrhythmia
+
+236
+00:19:08,310 --> 00:19:12,950
+وأنواع الـ disturbances اللي ممكن تحصل مع المرضى
diff --git a/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/T7CiRBNwdCw_raw.json b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/T7CiRBNwdCw_raw.json
new file mode 100644
index 0000000000000000000000000000000000000000..63ea3fa840c53427e3fe9be2175365b028005f3b
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@@ -0,0 +1 @@
+{"segments": [{"id": 1, "seek": 1945, "start": 3.31, "end": 19.45, "text": "بسم الله الرحمن الرحيم السلام عليكم ورحمة الله وبركاته اليوم بناخد المحاضرة الأخيرة تقريبا في ال course هنحكي عن ال assessment of cardiovascular function", "tokens": [3555, 38251, 21984, 34892, 5016, 27842, 34892, 5016, 32640, 21136, 37440, 25894, 24793, 4032, 2288, 35571, 3660, 21984, 4032, 26890, 4117, 9307, 3224, 45595, 20498, 44945, 47283, 3215, 9673, 5016, 46958, 25720, 16247, 9778, 48923, 6055, 4587, 16572, 3555, 995, 8978, 2423, 1164, 8032, 1863, 5016, 4117, 1829, 18871, 2423, 9687, 295, 31786, 2445], "avg_logprob": -0.14502841180021112, "compression_ratio": 1.4817073170731707, "no_speech_prob": 4.2378902435302734e-05, "words": [{"start": 3.31, "end": 3.59, "word": "بسم", "probability": 0.82763671875}, {"start": 3.59, "end": 3.79, "word": " الله", "probability": 0.9619140625}, {"start": 3.79, "end": 4.21, "word": " الرحمن", "probability": 0.9791666666666666}, {"start": 4.21, "end": 4.79, "word": " 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"end": 749.24, "word": " بيرتفع،", "probability": 0.7718098958333334}, {"start": 749.24, "end": 749.64, "word": " بيرتفع", "probability": 0.97578125}, {"start": 749.64, "end": 749.82, "word": " مش", "probability": 0.966796875}, {"start": 749.82, "end": 750.06, "word": " بس", "probability": 0.967529296875}, {"start": 750.06, "end": 750.24, "word": " لما", "probability": 0.95556640625}, {"start": 750.24, "end": 750.54, "word": " حضرة", "probability": 0.79736328125}, {"start": 750.54, "end": 751.06, "word": " الـheart", "probability": 0.6464029947916666}, {"start": 751.06, "end": 751.46, "word": " تصير", "probability": 0.7652994791666666}, {"start": 751.46, "end": 751.64, "word": " فيها", "probability": 0.960205078125}, {"start": 751.64, "end": 752.08, "word": " مشكلة،", "probability": 0.8948974609375}, {"start": 752.08, "end": 752.2, "word": " لما", "probability": 0.824951171875}, {"start": 752.2, "end": 752.56, "word": " أي", "probability": 0.63427734375}, {"start": 752.56, "end": 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للـ «Brain» في «CKMP» هذا بالذات لعضلة القلب إذا أنا بهمن إن أعمل «CK» العادي و أعمل «CKMP» اللي هو «the specific enzyme» للـ «heart muscle» و لازم يكون فيه نسبة وتناسب حوالي 10% ارتفاع ما بين يعني «CK» يكون مرتفع", "tokens": [36784, 2304, 9381, 1211, 5933, 20666, 8848, 9307, 8978, 4657, 9419, 17365, 5933, 23758, 4724, 1829, 2304, 1829, 11622, 11296, 4657, 9419, 30366, 5933, 23758, 24976, 39184, 4657, 33, 7146, 5933, 8978, 4657, 9419, 12224, 5933, 23758, 20666, 8848, 9307, 5296, 3615, 11242, 37977, 25062, 46152, 11933, 15730, 41850, 39627, 27842, 36145, 5551, 25957, 1211, 4657, 9419, 5933, 18863, 995, 16254, 4032, 5551, 25957, 1211, 4657, 9419, 12224, 5933, 13672, 1829, 31439, 4657, 3322, 2685, 24521, 5933, 24976, 39184, 4657, 12864, 8679, 5933, 4032, 5296, 31377, 2304, 7251, 30544, 8978, 3224, 8717, 35457, 3660, 4032, 2655, 8315, 35457, 11331, 2407, 6027, 1829, 1266, 4, 1975, 43500, 5172, 45761, 19446, 49374, 37495, 22653, 4657, 9419, 5933, 7251, 30544, 3714, 43500, 5172, 3615], 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"probability": 0.89013671875}, {"start": 1097.38, "end": 1097.8, "word": " بنخشوا", "probability": 0.821533203125}, {"start": 1097.8, "end": 1097.92, "word": " من", "probability": 0.98388671875}, {"start": 1097.92, "end": 1098.04, "word": " ال", "probability": 0.705078125}, {"start": 1098.04, "end": 1098.48, "word": " femoral", "probability": 0.852783203125}, {"start": 1098.48, "end": 1098.96, "word": " أو", "probability": 0.42578125}, {"start": 1098.96, "end": 1099.24, "word": " ممكن", "probability": 0.970703125}, {"start": 1099.24, "end": 1099.56, "word": " يكونوا", "probability": 0.95361328125}, {"start": 1099.56, "end": 1100.02, "word": " يخشوا", "probability": 0.952392578125}, {"start": 1100.02, "end": 1100.2, "word": " من", "probability": 0.9931640625}, {"start": 1100.2, "end": 1100.42, "word": " ال", "probability": 0.94677734375}, {"start": 1100.42, "end": 1100.8, "word": " radial", "probability": 0.93408203125}, {"start": 1100.8, "end": 1101.4, "word": " artery", "probability": 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{"start": 1111.76, "end": 1112.12, "word": " ينزل", "probability": 0.972900390625}, {"start": 1112.12, "end": 1112.32, "word": " على", "probability": 0.90283203125}, {"start": 1112.32, "end": 1112.56, "word": " الـ", "probability": 0.70361328125}, {"start": 1112.56, "end": 1112.92, "word": " coronary", "probability": 0.537445068359375}, {"start": 1112.92, "end": 1113.3, "word": " arteries", "probability": 0.94482421875}, {"start": 1113.3, "end": 1113.52, "word": " ومن", "probability": 0.7275390625}, {"start": 1113.52, "end": 1113.6, "word": " ال", "probability": 0.7392578125}, {"start": 1113.6, "end": 1113.98, "word": " coronary", "probability": 0.878662109375}, {"start": 1113.98, "end": 1114.38, "word": " arteries", "probability": 0.958984375}, {"start": 1114.38, "end": 1114.96, "word": " يدخل", "probability": 0.993408203125}, {"start": 1114.96, "end": 1115.62, "word": " على", "probability": 0.90869140625}, {"start": 1115.62, "end": 1116.12, "word": " ال", "probability": 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1133.42, "word": " bypass", "probability": 0.89990234375}, {"start": 1133.42, "end": 1134.12, "word": " graft", "probability": 0.904296875}, {"start": 1134.12, "end": 1135.6, "word": " هكذا", "probability": 0.6196695963541666}, {"start": 1135.6, "end": 1136.2, "word": " خلصنا", "probability": 0.7801513671875}, {"start": 1136.2, "end": 1136.8, "word": " المقدمة", "probability": 0.9103190104166666}, {"start": 1136.8, "end": 1137.36, "word": " السريعة", "probability": 0.861328125}, {"start": 1137.36, "end": 1138.0, "word": " والمراجعة", "probability": 0.8641357421875}, {"start": 1138.0, "end": 1138.28, "word": " عن", "probability": 0.70751953125}, {"start": 1138.28, "end": 1139.48, "word": " الـheart", "probability": 0.547607421875}, {"start": 1139.48, "end": 1139.68, "word": " بس", "probability": 0.756591796875}, {"start": 1139.68, "end": 1139.88, "word": " عشان", "probability": 0.9581705729166666}, {"start": 1139.88, "end": 1140.72, "word": " تتذكروا", "probability": 0.97666015625}, {"start": 1140.72, "end": 1141.78, "word": " الـheart", "probability": 0.9169921875}, {"start": 1141.78, "end": 1142.92, "word": " والقصص", "probability": 0.83001708984375}, {"start": 1142.92, "end": 1143.7, "word": " تبعته", "probability": 0.893310546875}, {"start": 1143.7, "end": 1144.14, "word": " فالان", "probability": 0.81640625}, {"start": 1144.14, "end": 1144.66, "word": " بنحكي", "probability": 0.8011474609375}, {"start": 1144.66, "end": 1145.22, "word": " عن", "probability": 0.97314453125}, {"start": 1145.22, "end": 1148.02, "word": " الـdysrhythmia", "probability": 0.710693359375}], "temperature": 1.0}, {"id": 52, "seek": 115295, "start": 1148.31, "end": 1152.95, "text": "وأنواع الـ «disturbing» اللي ممكن تحصل مع المرضى", "tokens": [2407, 33456, 14407, 3615, 2423, 39184, 4657, 42649, 374, 4324, 5933, 13672, 1829, 3714, 43020, 6055, 5016, 36520, 20449, 9673, 43042, 7578], "avg_logprob": -0.2958559704863507, "compression_ratio": 1.0128205128205128, "no_speech_prob": 0.0, "words": [{"start": 1148.31, "end": 1149.11, "word": "وأنواع", "probability": 0.9248046875}, {"start": 1149.11, "end": 1149.37, "word": " الـ", "probability": 0.911865234375}, {"start": 1149.37, "end": 1149.93, "word": " «disturbing»", "probability": 0.4837890625}, {"start": 1149.93, "end": 1150.05, "word": " اللي", "probability": 0.956298828125}, {"start": 1150.05, "end": 1150.33, "word": " ممكن", "probability": 0.80224609375}, {"start": 1150.33, "end": 1150.79, "word": " تحصل", "probability": 0.7578938802083334}, {"start": 1150.79, "end": 1151.09, "word": " مع", "probability": 0.923828125}, {"start": 1151.09, "end": 1152.95, "word": " المرضى", "probability": 0.9861653645833334}], "temperature": 1.0}], "language": "ar", "language_probability": 1.0, "duration": 1156.6091875, "duration_after_vad": 1103.556875000001}
\ No newline at end of file
diff --git a/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/T7CiRBNwdCw_raw.srt b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/T7CiRBNwdCw_raw.srt
new file mode 100644
index 0000000000000000000000000000000000000000..50f27e8ad11a79b123331dd90b6c73dfe598938d
--- /dev/null
+++ b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/T7CiRBNwdCw_raw.srt
@@ -0,0 +1,944 @@
+1
+00:00:03,310 --> 00:00:06,390
+بسم الله الرحمن الرحيم السلام عليكم ورحمة الله
+
+2
+00:00:06,390 --> 00:00:13,450
+وبركاته اليوم بناخد المحاضرة الأخيرة تقريبا في ال
+
+3
+00:00:13,450 --> 00:00:18,490
+course هنحكي عن ال assessment of cardiovascular
+
+4
+00:00:18,490 --> 00:00:19,450
+function
+
+5
+00:00:22,730 --> 00:00:26,090
+الـ Sinus Symptoms تبع الـ Myocardial Infarction
+
+6
+00:00:26,090 --> 00:00:29,810
+والـ Angina أو الـ Acute Colonial Syndrome in
+
+7
+00:00:29,810 --> 00:00:35,710
+general وحنحكي عن الـ Intervention Cardiology سواء
+
+8
+00:00:35,710 --> 00:00:42,870
+الـ PCI الـ Cardiac Atterization أو أنواع الـ
+
+9
+00:00:42,870 --> 00:00:48,730
+Cardiac Dysrhythmia وطرف علاجهم بشكل سريع لو بدنا
+
+10
+00:00:48,730 --> 00:00:54,820
+نتذكر الـ Heartبنعرف كلهيتنا إن هو عبارة عن
+
+11
+00:00:54,820 --> 00:01:01,100
+muscular organ وكلهيتنا نعرف إن هو موجود في
+
+12
+00:01:01,100 --> 00:01:08,580
+الـcenter of the thorax ويعني بيشغل المكان بين
+
+13
+00:01:08,580 --> 00:01:13,240
+الـtwo lungs عند الـmedisterna فوق الـdiaphragm
+
+14
+00:01:14,410 --> 00:01:19,130
+طبعاً بنعرف إن وظيفته هو الـ «circulatory system»
+
+15
+00:01:19,130 --> 00:01:22,190
+اللي في الجسم، هو الـ«pump» هو الـ«machine» اللي
+
+16
+00:01:22,190 --> 00:01:26,770
+بتعمل pumping للـ«blood» بتستقبله من كل الجسم
+
+17
+00:01:26,770 --> 00:01:31,710
+وبالتم، إعادة توزيعه بعد ما يعمل الدورة الدموية
+
+18
+00:01:31,710 --> 00:01:35,610
+الصغراء في الـ«lung» ويصير له Oxygenation، بترجع
+
+19
+00:01:35,610 --> 00:01:40,690
+للقلب وبترجع القلب كمضخة توزع وتعمل إعادة
+
+20
+00:01:40,690 --> 00:01:44,690
+distribution in لكل organs againوها كذا دورة
+
+21
+00:01:44,690 --> 00:01:49,750
+مستمرة بتكون من جزء العضل تبعه ومن الغشاء اللي
+
+22
+00:01:49,750 --> 00:01:54,830
+حوالين العضلة الـ Epicardium وعضلة نفسها اسمها الـ
+
+23
+00:01:54,830 --> 00:01:59,950
+Myocardium وطبعا بنعرف أنه بتكون من four chambers
+
+24
+00:01:59,950 --> 00:02:05,090
+و بتربط بين ال four chambers هادولة خليني أشوف
+
+25
+00:02:05,090 --> 00:02:09,800
+صورة أسرعوبتربط بين الـ «chambers» هدولة اللي هم
+
+26
+00:02:09,800 --> 00:02:15,720
+AV أو اللي هم الـ «valves» بتسموهم AV valves يعني
+
+27
+00:02:15,720 --> 00:02:20,640
+Adreoventricular valve زي ما احنا عارفين يعني هذا
+
+28
+00:02:20,640 --> 00:02:26,250
+كل كلمة عارفينه انتوا من الابتدائي يعنيالـ Right
+
+29
+00:02:26,250 --> 00:02:30,830
+Atrium والـ Left أو الـ Right Ventricle وهنا فيه
+
+30
+00:02:30,830 --> 00:02:37,110
+أن الـ Left Atrium وفيه الـ Left Ventricle بينهم
+
+31
+00:02:37,110 --> 00:02:41,830
+هنا فيه الـ Tricuspid Valve هنا فيه الـ Lift فيه
+
+32
+00:02:41,830 --> 00:02:45,650
+الـ Mitral Valve أو الـ Bicuspid Valve بتسميه،
+
+33
+00:02:45,650 --> 00:02:48,430
+بتطلع من هذا الـAortic
+
+34
+00:02:50,590 --> 00:02:55,270
+أرتري وبالتقى فيها عن طريق حاجة اسمها اللي هو الـ
+
+35
+00:02:55,270 --> 00:03:01,230
+semilunar valve وبيطلع من الـ ventricle الـ right
+
+36
+00:03:01,230 --> 00:03:05,730
+ventricle اللي هو الـ pulmonary الـ pulmonary هيات
+
+37
+00:03:05,730 --> 00:03:10,400
+و مخزين هذا كله الـ left ventricleالـ Right
+
+38
+00:03:10,400 --> 00:03:18,500
+Ventricle وهنا فيه اللي هو Palmonary Valve
+
+39
+00:03:18,500 --> 00:03:20,620
+اللي بيطلع على الـ Palmonary Artery
+
+40
+00:03:27,140 --> 00:03:31,460
+حكينا بشكل سريع عن الـ «cycle» الـ «cycle» اللي
+
+41
+00:03:31,460 --> 00:03:35,740
+بيسميها الدورة
+
+42
+00:03:35,740 --> 00:03:39,620
+الدموية الصغرى اللي هي بتصير
+
+43
+00:03:48,180 --> 00:03:50,600
+حكي هنا إن دورة الدموية الصغيرة اللي بيروح فيها
+
+44
+00:03:50,600 --> 00:03:57,180
+الدم اللي واصل من الجميع أنحاء الجسم للراعيات
+
+45
+00:03:57,180 --> 00:04:00,860
+الريان بنزل للراعيات الـ ventricle بتنضخه من
+
+46
+00:04:00,860 --> 00:04:04,300
+الراعيات الـ ventricle عبر الـ pulmonary
+
+47
+00:04:09,570 --> 00:04:13,010
+الدم اللي فيهم بعد ما يصير ال Oxygenation برجع عن
+
+48
+00:04:13,010 --> 00:04:16,970
+طريق ال four pulmonary veins two على ال right و
+
+49
+00:04:16,970 --> 00:04:22,310
+two على ال left بصبوا في اللي هو ال liftالـ Atrium
+
+50
+00:04:22,310 --> 00:04:25,770
+و بعد ذلك الـ Left Atrium بضخ الدم الـ Oxygenated
+
+51
+00:04:25,770 --> 00:04:29,150
+اللي فيه عبر الـ Mitral Valve أو الـ Bicuspid
+
+52
+00:04:29,150 --> 00:04:33,270
+Valve لالـ Left Ventricle اللي بيطلع بعمل
+
+53
+00:04:33,270 --> 00:04:37,250
+Contraction بطلع كل هذا الـ Blood اللي فيه عبر الـ
+
+54
+00:04:37,250 --> 00:04:43,270
+Aortic Valve لشريان الأورتي اللي هو الـ Aortic
+
+55
+00:04:43,270 --> 00:04:48,170
+Arteryوبالتالي بيصير له .. بيطلع مع الـ aortic
+
+56
+00:04:48,170 --> 00:04:52,250
+artery الـ ascending aortic artery بعدين اللي هو
+
+57
+00:04:52,250 --> 00:04:55,750
+الـ arch of aortic artery هنا هذا هو الـ arch of
+
+58
+00:04:55,750 --> 00:04:58,850
+aortic artery بعدين الـ descending aortic artery
+
+59
+00:04:58,850 --> 00:05:02,750
+اللي هو اللي بنزل و بوزع لكل الدوسين معرفين احنا
+
+60
+00:05:02,750 --> 00:05:08,540
+انه في ال .. في الarch of aortic arteryبتطلع
+
+61
+00:05:08,540 --> 00:05:13,540
+تفرعات مثلًا Lift Common Carotid Artery اللي بيطلع
+
+62
+00:05:13,540 --> 00:05:19,280
+على الـ carotid عشان يغذي الـ brain وكمان بنعرف
+
+63
+00:05:19,280 --> 00:05:24,180
+أنه بيطلع منه اللي هو الـ coronary arteries اللي
+
+64
+00:05:24,180 --> 00:05:29,880
+بيغذوا الـ heart نفسه، تمام؟
+
+65
+00:05:36,050 --> 00:05:39,590
+حكينا في الـ «شوك هان» حاجة اسمها «cardiac output»
+
+66
+00:05:39,590 --> 00:05:42,130
+والـ «stroke volume» عرفنا ان الـ «stroke volume»
+
+67
+00:05:42,260 --> 00:05:46,320
+هو عبارة عن كمية الـ blood اللي بتطلع في كل beat
+
+68
+00:05:46,320 --> 00:05:49,880
+يعرفنا إن الـ Normal beat من خمسين، من عفوا، من
+
+69
+00:05:49,880 --> 00:05:55,180
+ستين لـ 100 beat per minute الـ Normal يعني حوالي
+
+70
+00:05:55,180 --> 00:06:02,680
+تمانين، و بتغير، و في عوامل كتير ممكن تأثر عليه زي
+
+71
+00:06:02,680 --> 00:06:07,540
+الـ stress، الدرجة الحرارة، الـ كل هذا ممكن يتأثر
+
+72
+00:06:07,540 --> 00:06:12,150
+على الـ heart beatالـ Normal Stroke Volume حوالي
+
+73
+00:06:12,150 --> 00:06:16,910
+70 لإن الناس اللي وزنها حوالي 70 لإن الـ Stroke
+
+74
+00:06:16,910 --> 00:06:21,290
+Volume حكينا إنه عبارة عن 1 مليلتر لكل كيلو جرام
+
+75
+00:06:21,290 --> 00:06:25,450
+Body Weight تقريباً الـ Cardiac Output الـ Stroke
+
+76
+00:06:25,450 --> 00:06:28,210
+Volume ضرب الـ Heart Rate يعني أنت بتطلق 70 و
+
+77
+00:06:28,210 --> 00:06:32,350
+بتعمل 70 feet per minute سبعة بسبعة يعني 490 يعني
+
+78
+00:06:32,350 --> 00:06:36,210
+حوالي 500 CC هو الـ Cardiac Output تبعك في الدقيقة
+
+79
+00:06:37,760 --> 00:06:42,660
+حكيناإن الـ «heart rate» في حاجات ممكن تتأثر عليه
+
+80
+00:06:42,660 --> 00:06:46,100
+وفي حاجات تتحكم فيه مش بس في حاجات في الـ
+
+81
+00:06:46,100 --> 00:06:51,200
+«synergic characteristics» اللي بتأثر على الـ
+
+82
+00:06:51,200 --> 00:06:56,680
+«heartbeat» زي القدرة الـ «heart» itself يسموها
+
+83
+00:06:56,680 --> 00:07:01,360
+الـ «automaticity»
+
+84
+00:07:01,360 --> 00:07:04,460
+اللي هي قدرة الـ «heart» على إنه يعمل electrical
+
+85
+00:07:04,460 --> 00:07:05,400
+impulses
+
+86
+00:07:07,680 --> 00:07:11,460
+وكمان الـ ability to respond to unelectrical
+
+87
+00:07:11,460 --> 00:07:15,200
+impulses يعني قدرته أن يعمل initiation والاستجابة
+
+88
+00:07:15,200 --> 00:07:19,880
+لتغيرات اللي بدها تحصل ال conductivity اللي هي
+
+89
+00:07:19,880 --> 00:07:24,860
+الأجسس التوصيلي وإذا كنا نحكي عن كهربية القلب بشكل
+
+90
+00:07:24,860 --> 00:07:27,680
+سريع بنلاقي إنه في parasympathetic nervous system
+
+91
+00:07:27,680 --> 00:07:29,020
+وفي sympathetic nervous system
+
+92
+00:07:33,600 --> 00:07:37,620
+عربية بشكل الطبيعي لما يكون الواحد صاحي ويستجيب
+
+93
+00:07:37,620 --> 00:07:41,860
+للخوف والقلق وكل الاستجابات الطبيعية وهذا عادة
+
+94
+00:07:41,860 --> 00:07:44,500
+بزود ال heart rate برا sympathetic بشتغل ونحن
+
+95
+00:07:44,500 --> 00:07:50,080
+نايمين وعادة هذا يعني بعمل slow down لل heart rate
+
+96
+00:07:52,070 --> 00:07:56,590
+طبعا التحكم فيه بيكون عن طريق اللي هو المدلة
+
+97
+00:07:56,590 --> 00:08:03,650
+وبالإنجاتة وهنا بس بيزود وبنقص الـ heart rate لكن
+
+98
+00:08:03,650 --> 00:08:07,810
+مابيعملش initiation لأن الـinitiation تبع ال heart
+
+99
+00:08:07,810 --> 00:08:12,500
+الـ pulse بتكون إيه؟داخلية من وفيها، دي حكمة
+
+100
+00:08:12,500 --> 00:08:15,140
+ربانية علشان حتى لو صار الـ brain dead، يفضل
+
+101
+00:08:15,140 --> 00:08:19,940
+الـheart شجال، مصطلحات مشهورة اسمها الـpreload و
+
+102
+00:08:19,940 --> 00:08:23,080
+الـafterload حكينا في الشوك برضه عنهم الـpreload
+
+103
+00:08:23,080 --> 00:08:27,180
+حكينا إن هو يعني الـmaximum strength اللي ممكن
+
+104
+00:08:27,180 --> 00:08:32,630
+توصل له الـheart muscle و الـstretching تبعهاأه
+
+105
+00:08:32,630 --> 00:08:36,870
+يعني كده ممكن تصير لها stretching وتتمدد في
+
+106
+00:08:36,870 --> 00:08:42,490
+الـDiastole في نهاية الـDiastole والـAfterload
+
+107
+00:08:42,490 --> 00:08:45,330
+اللي هو الـ amount of resistance to eject of blood
+
+108
+00:08:45,330 --> 00:08:49,310
+from ventricle تمام؟ إذا إن هي أبارع عن الـ amount
+
+109
+00:08:49,310 --> 00:08:53,210
+of resistance to ejection of blood from ventricle
+
+110
+00:08:53,210 --> 00:08:56,670
+كده أنا بيكون في حيندي مقاومة من الـ
+
+111
+00:09:00,130 --> 00:09:03,610
+يعني في الـ Vessel، مقاومة من الـ Vessel عشان الـ
+
+112
+00:09:03,610 --> 00:09:08,950
+Lift Ventricle يعمل Ejection للبلد، هذا ضخ الدم،
+
+113
+00:09:08,950 --> 00:09:14,790
+هذا في الـ Vessels هدولة، جدش فيه مقاومة و جدش فيه
+
+114
+00:09:14,790 --> 00:09:24,670
+Resistance، هذه هي الـ Afterload الـ
+
+115
+00:09:26,310 --> 00:09:30,870
+الـ Contractility بشكل عام حكينا إنه الـ
+
+116
+00:09:30,870 --> 00:09:35,630
+Contractility بيعملها sympathetic يعني nervous
+
+117
+00:09:35,630 --> 00:09:39,590
+system بيأثر عليها هي أصلا بتصير built-in يعني
+
+118
+00:09:39,590 --> 00:09:47,210
+نتيجة وجود الـSA node والـAV node وهدولة اللي
+
+119
+00:09:47,210 --> 00:09:53,410
+بيعملوا تنظيم لاللي هو الكهربية تبعت القلب
+
+120
+00:09:57,500 --> 00:10:01,820
+على كل حال مش صورة بس الـ ASA node يعني هذا كله
+
+121
+00:10:01,820 --> 00:10:04,680
+مراجعة أنتوا أخدتوه في التشريح وفي physiology يعني
+
+122
+00:10:04,680 --> 00:10:07,720
+بس أنا عشان أقدر أوصل ASA node بتكون موجودة هان
+
+123
+00:10:07,720 --> 00:10:14,700
+تمام بتعمل peating بتعمل حوالي 60 beats بتمرر
+
+124
+00:10:14,700 --> 00:10:18,940
+إشارة تبعتها لل AV node اللي هي قريبة من ال valve
+
+125
+00:10:18,940 --> 00:10:25,030
+هنا بتعمل لها filtration بعدين بتمشياللي هو الـ
+
+126
+00:10:25,030 --> 00:10:29,670
+«impulses» مع الـ «bund» توصل لـ «bundle» و بعدين
+
+127
+00:10:29,670 --> 00:10:33,210
+بتروح على ال «perkinje fibers» اللي هي على ال
+
+128
+00:10:33,210 --> 00:10:36,810
+«right» و على ال «left» عشان تعمل نقل للـ «beat»
+
+129
+00:10:36,810 --> 00:10:43,790
+هذهالـ الـ electricity تبعت ال heart الدورة تبعتها
+
+130
+00:10:43,790 --> 00:10:49,890
+كيف بتصير طبعا أي خلل في ال AV أو في ال SA او يعني
+
+131
+00:10:49,890 --> 00:10:53,130
+إذا خلل في ال SA هيعمللي heart block إذا خلل في ال
+
+132
+00:10:53,130 --> 00:10:56,490
+AV هيعمللي اللي هو أنواع كتيرين ال dysrhythmia
+
+133
+00:10:56,490 --> 00:10:59,670
+هنتعرف عليهم إذا خلل في ال Barking Dipiper هعمللي
+
+134
+00:10:59,670 --> 00:11:03,830
+برضه أنواع من ال dysrhythmia ممكن نتعرف عليهم لكن
+
+135
+00:11:05,080 --> 00:11:10,620
+بشكل عام هذه هي الكهربية اللي بتتحكم في القلب
+
+136
+00:11:10,620 --> 00:11:15,960
+بالشكل الطبيعي لما بيصير خلل معين في عضلة القلب
+
+137
+00:11:15,960 --> 00:11:20,400
+بنتيجة عدم تروية عضلة القلب بحد ذاتها بشكل كويس
+
+138
+00:11:20,400 --> 00:11:25,040
+بتبدأ حاجة اسمها الـ Cardiac Enzyme ترتفع من أشهر
+
+139
+00:11:25,040 --> 00:11:29,160
+اللي ليش بترتفع؟ نتيجة الـ Myocardium Destruction
+
+140
+00:11:29,160 --> 00:11:31,760
+اللي بيصير الـ Damage اللي بيصير في heart muscle
+
+141
+00:11:31,760 --> 00:11:36,210
+itselfهو اللي بيبدأ يصير
+
+142
+00:11:37,700 --> 00:11:42,100
+فيه الـ «damage» اللي بيحصل في الـ «heart muscle»
+
+143
+00:11:42,100 --> 00:11:46,640
+نفسه بيعمل «damage» فبيعمل اللي هو إفراز لـ
+
+144
+00:11:46,640 --> 00:11:49,520
+«myoglobin» تبع الـ «heart muscle» فهذا بيقدّي
+
+145
+00:11:49,520 --> 00:11:53,220
+لارتفاع الأنزيمات هذه من أشهر الأنزيمات المعروفة
+
+146
+00:11:53,220 --> 00:11:57,140
+«enzyme» أو «enzyme» الـ «CK enzyme» «keratinin
+
+147
+00:11:57,140 --> 00:12:01,760
+kinase enzyme» اللي هو بيسموه «keratinin
+
+148
+00:12:01,760 --> 00:12:10,940
+phosphokinase» الطبيعي تبعهزي ما احنا شايفين هو
+
+149
+00:12:10,940 --> 00:12:16,260
+لأن 280 مش عارف انا، خمسين لتلاتمية وخمسين كتبين
+
+150
+00:12:16,260 --> 00:12:20,940
+حسب ال kit ممكن يكون ال kit بختلف من مكان
+
+151
+00:12:23,600 --> 00:12:29,240
+لأ مكان anyway الـCK دا يا جماعة لما بيرتفع،
+
+152
+00:12:29,240 --> 00:12:32,080
+بيرتفع مش بس لما حضرة الـheart تصير فيها مشكلة،
+
+153
+00:12:32,080 --> 00:12:35,940
+لما أي حضرة في الجسم إذا صار لها damage و
+
+154
+00:12:35,940 --> 00:12:41,720
+destruction في الـ«مصل» بالذات في «CKMM» هذا
+
+155
+00:12:41,720 --> 00:12:46,200
+بيميزها «CKBB» هذا للـ «Brain» في «CKMP» هذا
+
+156
+00:12:46,200 --> 00:12:51,040
+بالذات لعضلة القلب إذا أنا بهمن إن أعمل «CK»
+
+157
+00:12:51,040 --> 00:12:55,260
+العادي و أعمل «CKMP» اللي هو «the specific enzyme»
+
+158
+00:12:55,260 --> 00:12:58,040
+للـ «heart muscle» و لازم يكون فيه نسبة وتناسب
+
+159
+00:12:58,040 --> 00:13:04,420
+حوالي 10% ارتفاع ما بين يعني «CK» يكون مرتفعالـCK
+
+160
+00:13:04,420 --> 00:13:08,640
+يكون مرتفع والـCKMB يكون مرتفع أكتر من 10% من
+
+161
+00:13:08,640 --> 00:13:12,280
+ارتفاع الـCK عشان يكون هذا الارتفاع له علاقة أو
+
+162
+00:13:12,280 --> 00:13:15,500
+related للـheart يعني نعطي مثال يعني لو كان الـCK
+
+163
+00:13:15,500 --> 00:13:22,880
+عند مريض مثلا 500 والـCKMB لكان 12 يعني الـCK مش
+
+164
+00:13:22,880 --> 00:13:26,400
+مرتفع مش أقل يعني لازم يكون مرتفع نعتبر أنه
+
+165
+00:13:26,400 --> 00:13:30,180
+الـnormal CKMB
+
+166
+00:13:31,480 --> 00:13:38,640
+بدي يكون نفترض إنه 28 أو حتى لما بيكون يعني الوضع
+
+167
+00:13:38,640 --> 00:13:41,740
+الطبيعي بيكون فيه destruction فيه فبطلع أياش قليلة
+
+168
+00:13:41,740 --> 00:13:50,030
+جداً فنفترض إنه الـCKMB إنه طلعزي ما حكينا،
+
+169
+00:13:50,030 --> 00:13:55,830
+الـCK500 والـCKMB طلع 12 مضطرات معناه إن مافيش أي
+
+170
+00:13:55,830 --> 00:13:59,530
+destruction في الـheart muscle والـCK يعني اللي
+
+171
+00:13:59,530 --> 00:14:05,470
+مرتفع، مرتفع بسبب تهتك يعني الأنزيمات العضلية في
+
+172
+00:14:05,470 --> 00:14:11,010
+أي عضلة تانية غير الـheart، تمام؟
+
+173
+00:14:11,010 --> 00:14:16,930
+الـCK والـCKMB دولة بدوا يرتفعوا بعديعني عدة ساعات
+
+174
+00:14:16,930 --> 00:14:21,390
+وبيوصل الـ Peak تبقى هم تبقى حوالي أربع أو يعني في
+
+175
+00:14:21,390 --> 00:14:25,150
+خلال أربع وعشرين ساعة بيضلوا مستمر لخلال تلت أيام
+
+176
+00:14:25,150 --> 00:14:28,450
+الـCK يعني بعد تلت أيام بتبقى ينزل الـCK والـCAM
+
+177
+00:14:28,450 --> 00:14:33,090
+لما يكون في hard destruction في الـLDH اللي هو
+
+178
+00:14:33,090 --> 00:14:39,890
+lack of dehydrogenase من 100 ل 220 يعني حوالي هذا
+
+179
+00:14:43,370 --> 00:14:50,930
+طبعًا الـ LDH يعني خدنا نحكي الـ«إنكريز» تبعه
+
+180
+00:14:50,930 --> 00:14:56,150
+بيكون delay شوية بوصل الـpeak بعد تلت أيام مش بعد
+
+181
+00:14:56,150 --> 00:15:01,370
+24 ساعة بيستمر لحوالي تسعة أيام، ممكن 11 يوم لكن
+
+182
+00:15:01,370 --> 00:15:07,390
+ما بيطلعش في خلال أول ساعات يعني بده يعني أقل إشي
+
+183
+00:15:07,390 --> 00:15:11,850
+يوم أو أكتر من يوم علشان يبدأ يعمل increasing
+
+184
+00:15:12,330 --> 00:15:17,390
+الـMyoglobin هذا سريع جداً الـpeak تبقى خلال 4 إلى
+
+185
+00:15:17,390 --> 00:15:21,710
+12 hours على طول يبدأ يطلع ويوصل للـpeak تبقى، بس
+
+186
+00:15:21,710 --> 00:15:27,530
+المشكلة تبعته إنه مش بس indicated للـheart
+
+187
+00:15:27,530 --> 00:15:31,630
+muscle أي عضلة كمان في الجسم فيها destruction
+
+188
+00:15:31,630 --> 00:15:36,060
+هتلاقي إن الـmyoglobin ارتفع بسرعةوالمشكلة التانية
+
+189
+00:15:36,060 --> 00:15:39,880
+أنه يرجع للطبيعي خلال 24 سنة وبعد 24 سنة يرجع
+
+190
+00:15:39,880 --> 00:15:46,540
+للطبيعي الكتير كويسه وبيستخدموه ويعتبر يعني طبعا
+
+191
+00:15:46,540 --> 00:15:49,920
+احنا بنستخدم الـ CK و الـ CKMP و بنستخدم كمان
+
+192
+00:15:49,920 --> 00:15:54,580
+الاتروبينين لما يكون متوفر الاتروبينين طبعا في منه
+
+193
+00:15:54,580 --> 00:16:00,800
+C وفي منه I وفي منه Tتمام؟ إحنا اللي بيهمنا اللي
+
+194
+00:16:00,800 --> 00:16:05,700
+هو الـ «تربونين» تبع الـheart عادة أن يُعتبر
+
+195
+00:16:05,700 --> 00:16:10,720
+الـ«تربونين» يعني من أسرع الإنزيمات اللي ممكن
+
+196
+00:16:10,720 --> 00:16:14,660
+تدّيني indication إنه فيه destruction في الـheart
+
+197
+00:16:14,660 --> 00:16:20,360
+muscleمن الحاجات التانية المهمة كمان في الـ
+
+198
+00:16:20,360 --> 00:16:22,480
+Diagnostic Procedure للناس اللي عندها Heart
+
+199
+00:16:22,480 --> 00:16:26,400
+Problem أن نعملهم Libid Profiling نشوف المستويات
+
+200
+00:16:26,400 --> 00:16:28,840
+تباعت الكوليسترول الترياجرسترية تبعهم الـ Serum
+
+201
+00:16:28,840 --> 00:16:31,940
+Electrolytes كيف وضع البوتاسيوم والكالسيوم؟ كيف
+
+202
+00:16:31,940 --> 00:16:37,630
+وضع الصوديوم؟الـ «Chest X-Ray» الكويسة ممكن توضحلي
+
+203
+00:16:37,630 --> 00:16:40,450
+الـ «Diagnostic Procedure» إذا فيها Cardiomygaly
+
+204
+00:16:40,450 --> 00:16:44,150
+أو مافيش شيء أنجيوغرافي أحيانًا بتضطر يعملوا
+
+205
+00:16:44,150 --> 00:16:50,410
+أنجيوغراف عشان يشوفوا بالظبط زي ما حكينا في الـ
+
+206
+00:16:50,410 --> 00:16:54,830
+«Obstruction» تبع الـ «Vessels» بالناس اللي
+
+207
+00:16:54,830 --> 00:16:58,210
+بيحتاجوا القسطرة قبل القسطرة ممكن يحتاجوا يعملوا
+
+208
+00:16:58,210 --> 00:17:01,390
+حاجة بسمها «CT Angiography» عشان يشوفوا وضع الـ
+
+209
+00:17:01,390 --> 00:17:05,620
+«Vessels»في حاجة كمان اسمها اللي هو الـ
+
+210
+00:17:05,620 --> 00:17:08,760
+«إيكوكارديوغرافي» اللي هو عبارة عن ultrasound
+
+211
+00:17:08,760 --> 00:17:12,500
+طبعاً non-invasive ممكن نعمله بطريقتين اللي هو
+
+212
+00:17:12,500 --> 00:17:18,160
+«transthoracic» عن طريق الصدر أو اللي هو
+
+213
+00:17:18,160 --> 00:17:21,860
+«esophageal» يكون هو عن طريق، يعني يخش في
+
+214
+00:17:21,860 --> 00:17:25,740
+الـ«إسوفيجاس» وفي الـ«إسوفيجاس» يبدأ يكون هو فوق
+
+215
+00:17:25,740 --> 00:17:31,680
+الـheart ويبدأ يعمل يعني
+
+216
+00:17:31,680 --> 00:17:40,290
+ultrasoundاللي هو ultrasound graph لـheart itself
+
+217
+00:17:40,290 --> 00:17:45,830
+وفيه
+
+218
+00:17:45,830 --> 00:17:50,370
+كمان اللي هو الـcardiac catheterization طبعاً كل
+
+219
+00:17:50,370 --> 00:17:53,350
+هي تمارع في الـcardiac catheterization اللي هو
+
+220
+00:17:53,350 --> 00:17:54,150
+الـPCR
+
+221
+00:17:56,480 --> 00:18:01,140
+الـ catheterization نعرف أنه بيروح طبعا ممكن نروح
+
+222
+00:18:01,140 --> 00:18:04,440
+على ال right heart ممكن نكون على ال left heart لما
+
+223
+00:18:04,440 --> 00:18:11,000
+بكون احنا مهتمين بالشرعين القلب بنخش من أو بنروح
+
+224
+00:18:11,000 --> 00:18:14,800
+على ال left heart عن طريق أنهم بيروحوا على ال
+
+225
+00:18:14,800 --> 00:18:18,480
+femoral مثلا artery اذا كانوا بنخشوا من ال femoral
+
+226
+00:18:18,480 --> 00:18:22,840
+أو ممكن يكونوا يخشوا من ال radial artery أو يظلهم
+
+227
+00:18:22,840 --> 00:18:30,860
+ماشيين معالـ Artery لما نوصله اللي هو الأورطة
+
+228
+00:18:30,860 --> 00:18:33,600
+ومن الأورطة ينزل على الـ coronary arteries ومن ال
+
+229
+00:18:33,600 --> 00:18:38,120
+coronary arteries يدخل على ال branch المسكر ويشوف
+
+230
+00:18:38,120 --> 00:18:41,800
+إيش اللي ممكن ينعمل فيه إذا كان بلون أو إذا كان
+
+231
+00:18:42,620 --> 00:18:48,660
+ينحط فيه دعامة أو إذا كان الموضوع غير قابل للإلاج
+
+232
+00:18:48,660 --> 00:18:52,620
+فبالتالي بتحول المريض لعمل عمليات اللي هو coronary
+
+233
+00:18:52,620 --> 00:18:57,360
+artery bypass graft هكذا خلصنا المقدمة السريعة
+
+234
+00:18:57,360 --> 00:19:01,780
+والمراجعة عن الـheart بس عشان تتذكروا الـheart
+
+235
+00:19:01,780 --> 00:19:08,020
+والقصص تبعته فالان بنحكي عن الـdysrhythmia
+
+236
+00:19:08,310 --> 00:19:12,950
+وأنواع الـ «disturbing» اللي ممكن تحصل مع المرضى
+
diff --git a/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/TzQBApo1yr8.srt b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/TzQBApo1yr8.srt
new file mode 100644
index 0000000000000000000000000000000000000000..ec29ad6c66411d8c17b21158d7dc991fe763bd50
--- /dev/null
+++ b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/TzQBApo1yr8.srt
@@ -0,0 +1,1799 @@
+1
+00:00:00,350 --> 00:00:01,790
+الـ Pulmonary Edema
+
+2
+00:00:06,330 --> 00:00:10,750
+زي ما بنحكي في تعريفها هي abnormal accumulation
+
+3
+00:00:10,750 --> 00:00:13,910
+لإيش؟ لـ Fluid، وين؟ مش في الـ Pleura، في الـ Lung
+
+4
+00:00:13,910 --> 00:00:17,170
+tissue نفسها، في الـ Alveolar space يعني الـ
+
+5
+00:00:17,170 --> 00:00:21,270
+Alveoli بدل ما فيها هواء صارت مليانة ماء، Fluid،
+
+6
+00:00:21,270 --> 00:00:24,230
+أهو، طب و هذا يعني إيه؟ بغرق يعني المريض؟ لأ، هذا
+
+7
+00:00:24,230 --> 00:00:28,510
+بتكون جاية من الـ Accumulation يعني زي ما حكينا ال
+
+8
+00:00:28,510 --> 00:00:33,590
+blood بيجي على الـ Lung عبر الـ Pulmonary Veins
+
+9
+00:00:33,590 --> 00:00:36,650
+وبروح على الـ Capillaries عشان تعمل تقوم بدورها
+
+10
+00:00:36,650 --> 00:00:39,670
+بالـ Gas Exchange لكن للأسف الـ Lung ما أنتهاش
+
+11
+00:00:39,670 --> 00:00:45,250
+القدرة لسبب ما أنها ت .. ت .. تُدِي الدم هذا أكسجين
+
+12
+00:00:45,250 --> 00:00:49,850
+وتاخد منه ثاني أكسيد الكربون فبتصير يرشح الدم الـ
+
+13
+00:00:49,850 --> 00:00:54,070
+Fluid اللي فيه في قلب إيش الـ Alveoli فبتأثر الـ
+
+14
+00:00:54,070 --> 00:00:57,350
+Alveoli ماء هذا الـ Pathophysiology تبعت البلمونري
+
+15
+00:00:57,350 --> 00:00:59,150
+إديمة علشان هيك يا جماعة
+
+16
+00:01:03,520 --> 00:01:07,600
+لما يكون الـ left ventricle  ضعيف، تبقى المريض ماعندهش
+
+17
+00:01:07,600 --> 00:01:11,260
+قدرة
+
+18
+00:01:11,260 --> 00:01:15,140
+كافية أن يخنق وظائفه كويسة هتصبح الـ accumulation
+
+19
+00:01:15,140 --> 00:01:21,400
+للـfluid هادي في الـinterstitial space والـalveoli
+
+20
+00:01:21,400 --> 00:01:25,460
+الـclinical manifestation، احنا حكينا إن
+
+21
+00:01:25,460 --> 00:01:29,790
+الـalveoli نفسها صار فيها fluid، والـfluid هادي إيش
+
+22
+00:01:29,790 --> 00:01:33,410
+فيها؟ هي أصلا جاية من وين؟ جاية من الـBlood علشان هي
+
+23
+00:01:33,410 --> 00:01:40,970
+كانت من أهم العلامات إنك هتلاقي إن المريض هذا عنده
+
+24
+00:01:40,970 --> 00:01:48,590
+.. عنده ..  بيطلع من فمه رغوة، والرغوة هذه فيها
+
+25
+00:01:48,590 --> 00:01:53,490
+خيط دم، هذه الشكلة  مفروضة وعادةً تتطلع لـ blood
+
+26
+00:01:53,490 --> 00:01:58,390
+-tinged secretions فيها خيط دم تمام، هذه من أهم
+
+27
+00:01:58,390 --> 00:02:03,590
+علامات البلمونري إيديم. مثلاً بيجي المريض exhausted،
+
+28
+00:02:03,590 --> 00:02:08,930
+diaphoretic، air-hunger، anxious، ليش anxious؟ لأن هو
+
+29
+00:02:08,930 --> 00:02:14,050
+hypoxic، cyanosis، central cyanosis عنده frothy
+
+30
+00:02:14,050 --> 00:02:18,610
+secretions، secretions تطلع زرقاء وفيها blood-tinged
+
+31
+00:02:18,610 --> 00:02:24,550
+secretions تمام؟ وطبعا confused و distressed ليش؟ لأن
+
+32
+00:02:24,550 --> 00:02:29,370
+الـ blood بدأ أو الـ oxygen بدأ ينقص عن الـ brain وهذا
+
+33
+00:02:29,370 --> 00:02:34,090
+عمل للمريض stress في الـ escalation يا جماعة لو
+
+34
+00:02:34,090 --> 00:02:40,010
+إستمعنا هنسمع severe  crepitations في الـ lung في الـ
+
+35
+00:02:40,010 --> 00:02:44,860
+both lungs وcrackles زي صوت الشيشة، ليش؟ لأنه ماء،
+
+36
+00:02:44,860 --> 00:02:50,860
+صوت ماء، crackles، تمام؟ طبعاً، هتسمعوا بالذات في
+
+37
+00:02:50,860 --> 00:02:54,940
+الـBase of the lung المريض طبعاً هيكون Hypoxic
+
+38
+00:02:54,940 --> 00:02:57,400
+وإذا عملنا Blood gas، أسئلوا يا جماعة، هنلاقي أن
+
+39
+00:02:57,400 --> 00:03:03,380
+الـ partial pressure of carbon dioxide  الـCO2 مرتفع والـPO2
+
+40
+00:03:03,380 --> 00:03:09,560
+الـOxygen هيكون منخفض، في الأشعة، شكل البلمون
+
+41
+00:03:09,560 --> 00:03:13,160
+الإديمي زي ما أنتم شايفين الـBase تبع الـLung،
+
+42
+00:03:13,160 --> 00:03:17,400
+شباب، مش برا، لأ الـLung، تشوفوا هاي الـMargin تبعت
+
+43
+00:03:17,400 --> 00:03:21,860
+الـLung، هاي لسه موجودة، لكن فيه بياض، والبياض وين
+
+44
+00:03:21,860 --> 00:03:25,580
+فوق، ليش؟ لأن الـFluid في داخل الـLung، مش زي لما
+
+45
+00:03:25,580 --> 00:03:28,720
+بيكون الـFluid في الـPleural Space وعمل شرين كل
+
+46
+00:03:28,720 --> 00:03:34,860
+الـLung زججها، أهو ماخد place، مكانها، لأ هو الـ
+
+47
+00:03:34,860 --> 00:03:37,880
+Fluid في قلب الـ Lung اللي في الـ Interstitial اللي
+
+48
+00:03:37,880 --> 00:03:42,260
+في نفس القلب اللي قاعد، تمام؟ فعشان هيك كال medical
+
+49
+00:03:42,260 --> 00:03:46,120
+management إن أنا أخلص المريض هذا من الـ Fluid هذه
+
+50
+00:03:46,120 --> 00:03:54,080
+أهم حاجة إن المريض ياخد الـ Diuretics عشان يتخلص من
+
+51
+00:03:54,080 --> 00:03:58,780
+كمية الـ Fluid هذه، زيادة عشان المريض يتخلص من
+
+52
+00:03:58,780 --> 00:04:03,020
+كمية الـ Fluid هذه، زيادة، هذه المفروض أنه يأخذ الـ
+
+53
+00:04:03,020 --> 00:04:05,700
+Diuretics، عشان يأخذ الـ Diuretics المفروض أنه يكون
+
+54
+00:04:05,700 --> 00:04:10,220
+له Urinary Catheter لأنه مش معقول أنه يركض أو يروح
+
+55
+00:04:10,220 --> 00:04:16,530
+للمريض Diuretics وهو في Respiratory Distress وحاسس أنه بيروح
+
+56
+00:04:16,530 --> 00:04:21,990
+يعمل Evacuation للـUrine ويظل رايح جاي على
+
+57
+00:04:21,990 --> 00:04:25,110
+الـToilet، وهذا هيكون Exhausting له، فلأ من
+
+58
+00:04:25,110 --> 00:04:29,250
+الأولويات أنه نحط المريض في وضع High Fowler
+
+59
+00:04:29,250 --> 00:04:33,930
+Position، حط له Oxygen، هاي ABC، حط له Oxygen، ركّب له
+
+60
+00:04:33,930 --> 00:04:39,910
+Canula، ركّب Catheter، أعطي المريض Diuretics، كان
+
+61
+00:04:39,910 --> 00:04:46,150
+في زمان حاجة بيسموها، اللي هي Morphine و Oxygen
+
+62
+00:04:46,150 --> 00:04:54,970
+كان يُعطى أحيانًا Nitroglycerin برضه، ويُعطى أحيانًا
+
+63
+00:04:54,970 --> 00:05:01,090
+Morphine علشان يعملوا coronary vasodilation
+
+64
+00:05:01,090 --> 00:05:04,190
+ويزيدوا
+
+65
+00:05:04,190 --> 00:05:06,230
+اللي هو الـ
+
+66
+00:05:09,900 --> 00:05:14,100
+للتروية الـ Perfusion تبع الـ heart itself ويخفف
+
+67
+00:05:14,100 --> 00:05:17,340
+الـ distress تبع المريض لأنه بيكون severely
+
+68
+00:05:17,340 --> 00:05:21,620
+distressed لكن المورفين
+
+69
+00:05:21,620 --> 00:05:26,000
+يعني بيسبب انخفاض حاد جداً لإنه ممكن يؤدي ل
+
+70
+00:05:26,000 --> 00:05:30,900
+respiratory depression عند المريض هذا فاحنا بنرجع
+
+71
+00:05:30,900 --> 00:05:31,720
+بنحكي إنه
+
+72
+00:05:38,830 --> 00:05:44,770
+ونستخدم الـ Lasix و Loop Diuretics، وطبعاً قبل أن
+
+73
+00:05:44,770 --> 00:05:48,290
+نبدأ نعطي الـ Diuretics لازم نكون ركّبنا already
+
+74
+00:05:48,290 --> 00:05:53,330
+full catheter ونعمل للمريض respiratory
+
+75
+00:05:56,650 --> 00:05:59,930
+الـPsychological Support برضه لأنه بيكون Severely
+
+76
+00:05:59,930 --> 00:06:03,550
+Distressed وبنكون جاهزين لإنه نعمله Respiratory
+
+77
+00:06:03,550 --> 00:06:08,110
+Support لو الأمور ما عدّلتش، وحاجِة المريض إنه نعمله
+
+78
+00:06:08,110 --> 00:06:13,510
+Mechanical Ventilation، الـDiuretics هدفه يا
+
+79
+00:06:13,510 --> 00:06:19,750
+جماعة إنه يقلل الـPreload اللي جاء في تبع
+
+80
+00:06:19,750 --> 00:06:23,170
+الـFluid اللي جاء على الـHeart اللي بنسميه
+
+81
+00:06:23,170 --> 00:06:28,660
+Preload، الـ Preload يعني الدم اللي بده حتى زمان
+
+82
+00:06:28,660 --> 00:06:31,360
+كان فيه طريقة اسمها Tourniquet إنهم يربطوا
+
+83
+00:06:31,360 --> 00:06:37,780
+Tourniquet على كل طرف فترة زمنية مثلا خمس دقائق
+
+84
+00:06:37,780 --> 00:06:41,040
+بعدين يربط على الطرف الثاني بعدين كل هذا كان هدفه
+
+85
+00:06:41,040 --> 00:06:44,640
+أنه Preload Reducer يقلل كمية الدم اللي بتوصل
+
+86
+00:06:44,640 --> 00:06:49,320
+للقلب علشان القلب مايتعبش أنه يودّ كمية الدم هذه
+
+87
+00:06:49,320 --> 00:06:53,800
+على الـLung والـLung تصير مش عارفة تدبر الحالة فيها
+
+88
+00:06:54,080 --> 00:06:58,960
+والزيادة البلمونري قديماً والـ Afterload Reducers
+
+89
+00:06:58,960 --> 00:07:04,240
+عن طريق أنه احنا زي ما حكينا المادة Nitroglycerin
+
+90
+00:07:04,240 --> 00:07:08,380
+عشان يعمل Dilatation للأوعية الدموية،  كمية الدم
+
+91
+00:07:08,380 --> 00:07:14,140
+الـBlood Pressure طبعاً هينزل فكمية الدم اللي فيها
+
+92
+00:07:14,140 --> 00:07:19,540
+أو الـBlood لما بيدفع الكمية اللي فيه بيوديها على
+
+93
+00:07:19,540 --> 00:07:24,090
+مكان الضغط فيه واطي لأن الـ vessel is dilated فهذا
+
+94
+00:07:24,090 --> 00:07:27,690
+بيخلي فيه إمكانية للجسم إنه يسترخي أو الأوعية
+
+95
+00:07:27,690 --> 00:07:32,930
+تسترخي أكتر من غير ما تتعب أو من غير ما القلب
+
+96
+00:07:32,930 --> 00:07:37,310
+يتعب، بيكون عملية سهلة على القلب، الـ heart
+
+97
+00:07:37,310 --> 00:07:43,590
+medication، أدوية أنها تقوّي عضلة القلب نفسها، زي
+
+98
+00:07:47,280 --> 00:07:54,940
+أنه أحياناً بنعطيه أدوية يعني
+
+99
+00:07:54,940 --> 00:08:02,120
+أدوية  تُخَفِّض ضغط الدم إذا كان الضغط كتير عالي، من
+
+100
+00:08:02,120 --> 00:08:05,360
+أهمها الـNitroglycerin، المورفين حكينا إنه
+
+101
+00:08:05,360 --> 00:08:09,560
+ناركوتيك يُعطى عشان يخفف الـanxiety تبع المريض
+
+102
+00:08:09,560 --> 00:08:14,180
+لكن بنكون خائفين جداً منه، مفيد طبعاً لإنه بيعمل
+
+103
+00:08:14,180 --> 00:08:17,740
+coronary vasodilation لكن مشكلته أنه ممكن يعمل
+
+104
+00:08:17,740 --> 00:08:22,320
+respiratory depression فبيُعطى تحت حذر شديد وكتير
+
+105
+00:08:22,320 --> 00:08:26,860
+من الأطباء بيفضلوا إنه ما يُعطى لو المريض ما تحسّنش
+
+106
+00:08:26,860 --> 00:08:30,960
+هيكون الحل في mechanical ventilator، هنحط المريض
+
+107
+00:08:30,960 --> 00:08:36,400
+على mechanical ventilator وحنحط عادةً الحاجة بيسموها
+
+108
+00:08:36,400 --> 00:08:39,020
+High PEEP يعني positive end-expiratory pressure
+
+109
+00:08:39,020 --> 00:08:44,400
+بيكون عالي شوية ممكن قبل ما نحط المريض على
+
+110
+00:08:44,400 --> 00:08:47,200
+mechanical ventilator لو كان في عندنا هذا اسمها CPAP
+
+111
+00:08:47,200 --> 00:08:50,600
+mask يعني نحط المريض على  mechanical
+
+112
+00:08:50,600 --> 00:08:55,200
+ventilator بس، لكن من غير ما نحط تيوب، آه، لأ،
+
+113
+00:08:55,200 --> 00:09:00,160
+خارجي بس، هذا mask خارجية بتنحط على المريض والـ
+
+114
+00:09:00,160 --> 00:09:04,720
+mask هذه بتحقق pressure عالي داخل الـLung
+
+115
+00:09:05,210 --> 00:09:10,230
+المريض وبالتالي ممكن تفتح الـ Alveoli وتعمل Good
+
+116
+00:09:10,230 --> 00:09:15,430
+Respiratory Support وتعمل Inflation للـ Alveoli
+
+117
+00:09:15,430 --> 00:09:18,790
+وتخلي يصير فيه إمكانية للـ Gas Exchange
+
+118
+00:09:25,160 --> 00:09:28,700
+لما بنحكي عن الـ Penetrating Chest Trauma، سواء
+
+119
+00:09:28,700 --> 00:09:36,620
+كانت Gunshot أو Stab Wounds أو حتى
+
+120
+00:09:36,620 --> 00:09:41,760
+لو كانت Blunt Trauma، maybe الـ Blunt Trauma كمان
+
+121
+00:09:41,760 --> 00:09:43,700
+ممكن تؤدي لإنه يصير فيه
+
+122
+00:09:48,890 --> 00:09:53,010
+الـPneumothorax اللي إحنا بنحكي عنه لكن يمكن من أشهر
+
+123
+00:09:53,010 --> 00:09:58,970
+الأشياء اللي ممكن تعمل Chest trauma أو
+
+124
+00:09:58,970 --> 00:10:01,790
+penetrating اللي هي الـ stab wounds والـ gun
+
+125
+00:10:01,790 --> 00:10:04,030
+shot
+
+126
+00:10:06,500 --> 00:10:10,460
+اللي بيصير بعد الـ Chest Trauma سواء كانت من
+
+127
+00:10:10,460 --> 00:10:14,760
+Penetrating Stab Wounds أو كانت من Gunshot إنه
+
+128
+00:10:14,760 --> 00:10:18,300
+بنتوقع إنه حيصير فيه Bleeding أو حيصير فيه
+
+129
+00:10:18,300 --> 00:10:24,080
+Accumulation للـBlood والـAir في الـLung ومش بس في
+
+130
+00:10:24,080 --> 00:10:26,780
+الـLung، في الـPleural Space اللي الـLung في العادة
+
+131
+00:10:26,780 --> 00:10:32,170
+بتعمل Expansion فيه، وبالتالي، الـ Accumulation هذا
+
+132
+00:10:32,170 --> 00:10:36,310
+هيمنع الـ Lung من إنها تعمل الـ Expansion تبعها
+
+133
+00:10:36,310 --> 00:10:41,330
+وعلشان هيك، الحل هيكون في إنه إحنا نعمل الـ
+
+134
+00:10:41,330 --> 00:10:46,710
+Drainage، يعني، يعني Removing عن طريق الـ Drain لـ
+
+135
+00:10:46,710 --> 00:10:51,590
+Accumulation of Air أو Blood اللي في منطقة، في الـ
+
+136
+00:10:51,590 --> 00:10:57,590
+Pleural Space علشان نسمح للـ Lung تاني بإنه ترجع
+
+137
+00:10:57,590 --> 00:11:04,740
+تعمل Expansion، هذا كمان يا جماعة ممكن يصير زي ما
+
+138
+00:11:04,740 --> 00:11:10,680
+حكينا في الـBlunt Trauma أو يصير مع العمليات
+
+139
+00:11:10,680 --> 00:11:15,260
+الجراحية، يعني مثلاً الـOpen Heart Surgery، Cardiac
+
+140
+00:11:15,260 --> 00:11:20,420
+Surgery، لما يحصل يحتاجوا أو حيصير فيه Already
+
+141
+00:11:20,420 --> 00:11:24,340
+Opening لـPleural Space ويكون فيه Drainage لـBlood
+
+142
+00:11:24,340 --> 00:11:30,820
+وبالتالي ممكن يتجمع فيه Pleural Cavity، هو علشان هيك
+
+143
+00:11:30,820 --> 00:11:34,420
+أو في الفراغ البلوري، أو علشان هيك هيكون فيه يعني
+
+144
+00:11:34,420 --> 00:11:39,000
+داعي لإنه نعمله تفريغ أول بأول وإلا هتكون بعد
+
+145
+00:11:39,000 --> 00:11:43,020
+العملية ما خلصت هيصير فيه تجمع لهذه السوائل في
+
+146
+00:11:43,020 --> 00:11:45,940
+الفراغ البلوري و يمنع الـ expansion تبع الـ lung
+
+147
+00:11:45,940 --> 00:11:50,240
+ويعمل tamponade على الـ heart وهيعمل مشاكل كمان في
+
+148
+00:11:50,240 --> 00:11:53,560
+thoracic surgery، لو كان المريض وكان فيه بيحتاج يعني
+
+149
+00:11:53,560 --> 00:11:58,890
+عملية lobectomy مثلاً أو كان المريض بيحتاج مثلاً عمل
+
+150
+00:11:58,890 --> 00:12:05,050
+عنده lung abscess وعمله thoracotomy، في الحالات هذه
+
+151
+00:12:05,050 --> 00:12:08,250
+أيضاً بعد ما صار فيه handling و manipulation للـ
+
+152
+00:12:08,250 --> 00:12:13,110
+lung tissue وعمله اللي هو invasion للـ pleural
+
+153
+00:12:13,110 --> 00:12:16,130
+space، expected إنه يصير فيه accumulation و
+
+154
+00:12:16,130 --> 00:12:22,180
+drainage لـ blood في الـ Pleural Cavity وبالتالي
+
+155
+00:12:22,180 --> 00:12:26,260
+هيكون كويس إن يكون فيه drainage system عشان يمنع
+
+156
+00:12:26,260 --> 00:12:29,920
+الـ accumulation هذا و يرجع يسمح لـ lung في الـ
+
+157
+00:12:29,920 --> 00:12:33,060
+expansion، عشان هيك هذا بخدنا على موضوعين مهمين جداً
+
+158
+00:12:33,060 --> 00:12:38,010
+في الـChest Trauma اللي هما الـPneumothorax
+
+159
+00:12:38,010 --> 00:12:42,030
+والـHemothorax، تقريباً كل ما ينطبق على Pneumothorax
+
+160
+00:12:42,030 --> 00:12:46,470
+ينطبق على الـHemothorax، لما بنحكي Pneumothorax
+
+161
+00:12:46,470 --> 00:12:52,690
+يعني هواء في التجويف الصدري، Hemo يعني دم في التجويف
+
+162
+00:12:52,690 --> 00:12:54,910
+الصدري، Pneumothorax
+
+163
+00:12:58,350 --> 00:13:03,270
+Parietal or visceral، الـ Pleura  مُثْقَبَة ومُثْقَبَة الـ
+
+164
+00:13:03,270 --> 00:13:10,290
+Pleura مُعَرَّضَة لضغط Atmospheric،  جيد، يعني في الـ
+
+165
+00:13:10,290 --> 00:13:16,690
+Pneumothorax بيصير مُثْقَبَة سواء للـ Parietal أو
+
+166
+00:13:16,690 --> 00:13:19,210
+الـvisceral تبعت البلورة، عارفين اللي بلورة الها
+
+167
+00:13:19,210 --> 00:13:24,330
+visceral و بلورة Parietal part، سواء مُثْقَبَة صار فيها
+
+168
+00:13:24,330 --> 00:13:29,130
+أو فيها، وتعرض الـ Pleural Cavity هذا اللي هو الـ
+
+169
+00:13:29,130 --> 00:13:31,670
+Atmospheric Pressure، يعني اللي هو الجو والضغط اللي
+
+170
+00:13:31,670 --> 00:13:36,750
+بي من الـ Penetrating هذا أو الـ Rupture هذا
+
+171
+00:13:36,750 --> 00:13:41,590
+للهواء تبع الـ الهواء الجوي إنه يدخل الفراغ
+
+172
+00:13:41,590 --> 00:13:46,730
+البلوري هذا، بالتالي هيبدأ يعمل Lung Pressure على
+
+173
+00:13:46,730 --> 00:13:49,210
+الـ Lung، عشان هيك هو نوعين، في الـ Simple
+
+174
+00:13:49,210 --> 00:13:52,150
+Pneumothorax و في الـ Traumatic Pneumothorax، هنشوف
+
+175
+00:13:52,150 --> 00:13:55,250
+يعني إيش الفرق بين الـ Simple Pneumothorax و
+
+176
+00:13:55,250 --> 00:13:57,550
+Traumatic Pneumothorax، بكل بساطة الـ Simple
+
+177
+00:13:57,550 --> 00:14:01,430
+Pneumothorax إن
+
+223
+00:17:29,330 --> 00:17:33,400
+يعني الفكرة في الـpneumothorax أن الهواء بيصير
+
+224
+00:17:33,400 --> 00:17:36,720
+يدخل لكن ما فيش إمكانية يطلع من نفس الفتحة اللي دخل
+
+225
+00:17:36,720 --> 00:17:40,660
+منها، لو كان open ولو كان closed زي ما بيسموه
+
+226
+00:17:40,660 --> 00:17:43,340
+tension pneumothorax could be open could be closed
+
+227
+00:17:43,340 --> 00:17:46,620
+الـclosed pneumothorax إنه بيكون ما فيش أي فتحة ولا
+
+228
+00:17:46,620 --> 00:17:49,920
+شيء وبيصير فيه rupture تاني و rupture في الـlung
+
+229
+00:17:49,920 --> 00:17:54,480
+وفتحة على الـ pleural space وعملت الـcollection of
+
+230
+00:17:54,480 --> 00:17:56,840
+air فيه، برة في الـ pleural space بيصير المريض يعمل
+
+231
+00:17:56,840 --> 00:18:00,310
+inspiration، والـinspiration تبعه بدل ما يظلوا في
+
+232
+00:18:00,310 --> 00:18:02,830
+الـlung ويطالوا ويعملوا الـexpiration كله، لأ
+
+233
+00:18:02,830 --> 00:18:06,750
+بيعمل الـinspiration جزء من الثلاثة أرباع اللي
+
+234
+00:18:06,750 --> 00:18:09,190
+عملوا الـinspiration بيطلع على الـpleural space
+
+235
+00:18:09,190 --> 00:18:12,270
+وبيحتبس فيه وبيعمل الـexpiration المريض ده جزء
+
+236
+00:18:12,270 --> 00:18:17,530
+بسيط لأن الباقي كليته انحجزت، انحجزت، انضغطت
+
+237
+00:18:17,530 --> 00:18:23,820
+كأنه في مصر  دخلها وانضغطت وخلتها تظل داخل الـ
+
+238
+00:18:23,820 --> 00:18:27,860
+pleural space، شكل الـpneumothorax يا جماعة هيكون
+
+239
+00:18:27,860 --> 00:18:31,160
+زي ما أنتم شايفين، كيف بيكون فيه سواد في الـlung
+
+240
+00:18:31,160 --> 00:18:35,320
+لأنه air على جهة معينة، واخدين بالكم كيف لحظة كيف
+
+241
+00:18:35,320 --> 00:18:39,720
+الـlung هنا، وكيف كان فيه سواد على الـX-Ray هذا
+
+242
+00:18:39,720 --> 00:18:43,720
+بيدلّنا أن المريض هذا عنده pneumothorax، العلاج تبع
+
+243
+00:18:43,720 --> 00:18:47,580
+المريض يا جماعة طبعاً أول حاجة، علاج الـ
+
+244
+00:18:47,580 --> 00:18:49,700
+clinical manifestation، المريض هذا هيكون anxious
+
+245
+00:18:49,700 --> 00:18:53,440
+أكيد، هيكون dyspneic، هيكون الـsaturation تبعه
+
+246
+00:18:53,440 --> 00:18:58,460
+low، هيكون tachypneic لإنه مش قادر إنه ياخد نفس
+
+247
+00:18:58,460 --> 00:19:03,460
+deep لإنه في حاجة بتعمل له pressure، وطبعاً هذا
+
+248
+00:19:03,460 --> 00:19:05,840
+هيخليه يظهر عليه cyanosis، ولو عملنا له blood
+
+249
+00:19:05,840 --> 00:19:09,440
+gases هنلاقي إن الpatient عنده hypoxemia
+
+250
+00:19:11,780 --> 00:19:15,320
+طبعاً الـtrachea زي ما حكينا، لو روحنا وطلعنا على
+
+251
+00:19:15,320 --> 00:19:19,100
+الـtrachea هنلاقي إن الـtrachea عاملة shifting
+
+252
+00:19:19,100 --> 00:19:25,640
+بعكس الجهة اللي فيها الـpneumothorax، طبعاً هذا لما
+
+253
+00:19:25,640 --> 00:19:28,820
+تكون الـpneumothorax، بالذات، تتمشي الـpneumothorax
+
+254
+00:19:28,820 --> 00:19:32,580
+يعني، لكن في الـsimple pneumothorax اللي بتكون بسيطة
+
+255
+00:19:32,580 --> 00:19:37,780
+ممكن يعني الـtrachea أبدًا ما تكونش فيها أي
+
+256
+00:19:37,780 --> 00:19:44,110
+shifting وتكون في الوضع الطبيعي تبعها، طبعاً لو روحنا
+
+257
+00:19:44,110 --> 00:19:48,490
+عملنا يا جماعة percussion على المكان اللي فيه
+
+258
+00:19:48,490 --> 00:19:55,450
+الـpneumothorax هنسمع hyper resonance، لإيش؟ لإنه إيش
+
+259
+00:19:55,450 --> 00:19:59,250
+فيه؟ فيه هواء صار، صارت طبلة، مش هيك، فهيكون فيه
+
+260
+00:19:59,250 --> 00:19:59,930
+hyper resonance
+
+261
+00:20:04,650 --> 00:20:09,270
+ولو سمعناها، قعدت بالسماعة، الـchest تبع المريض هي
+
+262
+00:20:09,270 --> 00:20:14,610
+ده، هتلاقي diminished air entry أو absent حتى، لإنه
+
+263
+00:20:14,610 --> 00:20:20,460
+فعلياً المريض ما بيقدرش ياخد إيش؟ ولا deep breathing
+
+264
+00:20:20,460 --> 00:20:26,120
+ويوصل النفس للـbase of the lung، وزي ما حكينا
+
+265
+00:20:26,120 --> 00:20:30,340
+الـhyper resonance sound بيكون في الـpercussion
+
+266
+00:20:30,340 --> 00:20:34,080
+واضح إن الـmedical management إنه يحط للمريض هذا
+
+267
+00:20:34,080 --> 00:20:37,840
+chest tube علشان يروح الـ
+
+268
+00:20:40,700 --> 00:20:44,800
+الكمية الـair اللي بتعمل accumulation في الـ
+
+269
+00:20:44,800 --> 00:20:49,620
+pleural space وبتعمل ضغط pressure على الـlung
+
+270
+00:20:49,620 --> 00:20:58,230
+وبالتالي بتخليها تصير collapse في الـpneumothorax
+
+271
+00:20:58,230 --> 00:21:01,630
+عادةً الـdiameter تبع الـchest tube اللي بدنا
+
+272
+00:21:01,630 --> 00:21:07,150
+نستخدمه بيكون يعني 28 في الـadult، يعني المقصود أنه
+
+273
+00:21:07,150 --> 00:21:10,570
+صغير، أقل من الـhemothorax، الـhemothorax بالذات
+
+274
+00:21:10,570 --> 00:21:13,970
+الـdiameter يكون كبير، لإنه اللي بده يطلع blood والـ
+
+275
+00:21:13,970 --> 00:21:17,230
+blood زي ما بنعرف احنا أنه بيحتوي على خلايا مش
+
+276
+00:21:17,230 --> 00:21:20,890
+بس fluid و could be thick، وviscosity  تبعته because
+
+277
+00:21:20,890 --> 00:21:25,710
+of اللي هو الـcells ممكن تكون عالية، وبالتالي ممكن
+
+278
+00:21:25,710 --> 00:21:31,750
+يصير فيه فرصة لإنه يتجلط ويسكر، يصير فيه occlusion
+
+279
+00:21:31,750 --> 00:21:37,390
+فعشان هيك احنا عادة بنفضل إنه يكون الـchest
+
+280
+00:21:37,390 --> 00:21:41,610
+drain تبع الـhemothorax في حال إنه المريض عنده
+
+281
+00:21:41,610 --> 00:21:47,590
+hemothorax يكون أكبر، وعادة بنختار 32 في الـadult
+
+282
+00:21:48,180 --> 00:21:52,740
+طبعاً موضوع الـchest tube والـpressure تبع
+
+283
+00:21:52,740 --> 00:21:56,960
+الماء هحكي عنه هنا بالتفصيل، فكرة الـchest tube
+
+284
+00:21:56,960 --> 00:21:59,700
+زي ما حكينا يا جماعة، بصوا كيف إنه أنا فيه
+
+285
+00:21:59,700 --> 00:22:03,200
+endotracheal tube وفيها accumulation للـfluid أو
+
+286
+00:22:03,200 --> 00:22:07,680
+الـair هنا، فبيجي الطبيب ويركب اللي هو بيعمل
+
+287
+00:22:07,680 --> 00:22:12,240
+باستخدام الـtrocar وchest drainage، والـchest
+
+288
+00:22:12,240 --> 00:22:20,000
+tube وبيدخل في اللي هو الـthoracic cavity من الـ
+
+289
+00:22:20,000 --> 00:22:23,600
+fifth intercostal، يعني الـfifth والـfourth intercostal
+
+290
+00:22:23,600 --> 00:22:29,050
+space، الآن يعني كل التوجيهات إن لو كان pneumothorax أو
+
+291
+00:22:29,050 --> 00:22:32,770
+hemothorax يكون الـchest tube low في الـfifth
+
+292
+00:22:32,770 --> 00:22:37,890
+intercostal space، كويس، فخشّ الـtube استقر هنا،
+
+293
+00:22:37,890 --> 00:22:41,770
+الآن الـtube هذا هيحمل إيش؟ ويطلع إيش موجود جوا،
+
+294
+00:22:41,770 --> 00:22:46,350
+إذا fluid، يعني blood أو air، وبيبدأ يطلع فيه ويدخل
+
+295
+00:22:46,350 --> 00:22:50,050
+فيه ويمشي فيه هذا الـdrain. الآن، لو أنا بدأت أحط
+
+296
+00:22:50,050 --> 00:22:53,570
+في الـdrain أي نوع من الـdrains، أنا بخاف إن
+
+297
+00:22:53,570 --> 00:22:59,410
+الـdrain يجي اللي بده يطلع يعود، يدخل ثاني، أو
+
+298
+00:22:59,410 --> 00:23:03,050
+الـatmospheric pressure يكون فيه فرصة إنه يدخل هنا
+
+299
+00:23:03,050 --> 00:23:08,050
+ثاني، فعلشان ذلك، لازم هذا يستقر في system يسمح
+
+300
+00:23:08,050 --> 00:23:12,480
+بالدخول ولا يسمح بالخروج. فعشان هيك فيه هنا water
+
+301
+00:23:12,480 --> 00:23:16,360
+level زي ما أنتم شايفين، فيه هنا water،  أيّ water
+
+302
+00:23:16,360 --> 00:23:19,660
+level، طبعاً هو هذا مش كله water level، الـwater
+
+303
+00:23:19,660 --> 00:23:23,640
+level بيكون مثلاً 200 أو 300، عادةً بيكون فيه خط
+
+304
+00:23:23,640 --> 00:23:28,580
+كامل مستدير هنا بتكون الشركة المصنعة بتحكي
+
+305
+00:23:28,580 --> 00:23:33,150
+لك إن هذا الـwater level، وبنسميه احنا dead space
+
+306
+00:23:33,150 --> 00:23:39,290
+يعني مثلاً إذا كان الـwater level 300 وجيت بعد تلت
+
+307
+00:23:39,290 --> 00:23:47,890
+ساعات ووجدت أن في عند المريض 500 cc drainage،
+
+308
+00:23:47,890 --> 00:23:53,050
+fluid أو blood أو مهما كان 500 cc، ففعلياً المريض أفرغ
+
+309
+00:23:53,050 --> 00:23:56,850
+بس 200 لإنه كان فيه عنده water level 300، يبقى
+
+310
+00:23:56,850 --> 00:24:00,770
+المريض أفرغ بس 200، لو كان هنا الـwater level كان
+
+311
+00:24:00,770 --> 00:24:05,210
+300 again، وأنا دائماً بكرر كلمة 300 لإنه عادة الـ
+
+312
+00:24:05,210 --> 00:24:08,370
+water level اللي بنستخدمه في الـchest tube اللي
+
+313
+00:24:08,370 --> 00:24:14,480
+موجود هنا هو 300 cc، ووجدت إنه بعد كم ساعة الصبح،
+
+314
+00:24:14,480 --> 00:24:20,820
+يا سيدي، بعد 24 ساعة كان المريض كل الـfluid level
+
+315
+00:24:20,820 --> 00:24:26,360
+عنده حوالي 1100، آه 1100،  الـ300 بتضل عنده
+
+316
+00:24:26,360 --> 00:24:36,270
+كم؟ آه، يا مين؟ حسب؟ 700 cc، 700 cc، آه 700 غلط مش
+
+317
+00:24:36,270 --> 00:24:42,130
+700، 800 برافو عليكم، 800 cc، لإنه بدنا نطرح من الـ
+
+318
+00:24:42,130 --> 00:24:48,890
+1100، 300، يعني بيظل 800 cc، يبقى المريض أفرغ 800 cc، و
+
+319
+00:24:48,890 --> 00:24:51,390
+هدول الـwater level، طب ليش موجودين الـwater level
+
+320
+00:24:51,390 --> 00:24:54,170
+هدول؟ آه، موجودين الـwater level هدول عشان يجي الـ
+
+321
+00:24:54,170 --> 00:24:58,600
+drain من هنا، من هنا، من هنا ويصب في قلب الـtube اللي
+
+322
+00:24:58,600 --> 00:25:03,400
+نازل، واصل عند الـ300 cc، يضمن إنه اللي بينزل يخش في
+
+323
+00:25:03,400 --> 00:25:06,740
+الماء بس ما فيش إيش؟ من الماء ممكن يرجع، صح؟ ما فيش
+
+324
+00:25:06,740 --> 00:25:10,020
+أي كمية، ما فيش هواء في الماء، وما فيش.. الماء مش
+
+325
+00:25:10,020 --> 00:25:12,860
+ممكن تسحبه لو طلع عكس الـgravity وتخش في
+
+326
+00:25:12,860 --> 00:25:15,980
+المريض، آه الـgravity، يبقى المبدأ المهم هنا
+
+327
+00:25:15,980 --> 00:25:20,540
+مش لازم ننساه إن الـchest tube هذا لازم يكون تحت
+
+328
+00:25:20,540 --> 00:25:27,020
+الـgravity، يعني في مستوى أقل من المريض، بمعنى أن
+
+329
+00:25:27,020 --> 00:25:29,580
+الـprinciple اللي بيشتغل عليه هو الـgravity
+
+330
+00:25:29,580 --> 00:25:32,460
+تمام؟ كمان والـsuction يا جماعة هو ممكن احنا
+
+331
+00:25:32,460 --> 00:25:37,600
+نشبكه هنا suction ويصير بيعمل suctioning،
+
+332
+00:25:37,600 --> 00:25:41,000
+ولكن في كل الأحوال لازم يكون في مستوى أقل من
+
+333
+00:25:41,000 --> 00:25:44,600
+الـchest، لو المريض نايم بيكون أقل، لو المريض صار
+
+334
+00:25:44,600 --> 00:25:48,340
+في sitting position برضه بيكون أقل منه، آه ما يصيرش
+
+335
+00:25:48,340 --> 00:25:51,780
+في مستوى أعلى، لأن هذا ممكن يصير في مستوى يمنع الـ
+
+336
+00:25:51,780 --> 00:25:56,020
+drainage ويخلّي المريض أو الـrespiration status
+
+337
+00:25:56,020 --> 00:25:59,960
+أو العكس
+
+338
+00:25:59,960 --> 00:26:04,680
+طبعاً هذا اللي هنا اسمه open system زي ما احنا
+
+339
+00:26:04,680 --> 00:26:12,760
+شايفين، الـdrainage بتطلع وبنصب الـtube هذا فيه
+
+340
+00:26:12,760 --> 00:26:15,600
+فتحتين، واحدة منها، يا جماعة، لازم تكون مفتوحة، لأن
+
+341
+00:26:15,600 --> 00:26:20,180
+هذه عبارة عن فتحة، لكن بتلاقي فيها valve، valve
+
+342
+00:26:20,180 --> 00:26:24,040
+عشان يقلل، عشان احنا بنعرف إن هذه الكمية الفارقة من
+
+343
+00:26:24,040 --> 00:26:28,160
+هنا إلى هنا هي عبارة عن هواء، لإنه ما فيش شي فارق،
+
+344
+00:26:28,160 --> 00:26:31,760
+صح؟ الآن لما بدي ما يطلع fluid من هنا، بدي ما يشغل
+
+345
+00:26:31,760 --> 00:26:36,710
+حيز، لازم يطلع من الـpot، هذا إيش؟ هواء،
+
+346
+00:26:36,710 --> 00:26:41,130
+فعشان هيك هنا بيكون فيه valve مشبوك، يعني مفتوح
+
+347
+00:26:41,130 --> 00:26:45,310
+بحيث إنه يسمح للهواء بالخروج من الـlung ولا يسمح
+
+348
+00:26:45,310 --> 00:26:50,070
+له بالدخول، هذه بيعملوها عشان أنا ممكن أكون محتاج
+
+349
+00:26:50,070 --> 00:26:55,010
+أن أشبك الـsystem هذا على suction بحيث إنه
+
+350
+00:26:55,010 --> 00:27:00,850
+يساعد في عملية الـdrainage تبع السوائل، الـ
+
+351
+00:27:00,850 --> 00:27:06,890
+drainage تبع السوائل حاجة
+
+352
+00:27:06,890 --> 00:27:11,290
+مهمة جداً، ممكن تصير فيها مشكلة كبيرة لو واحد
+
+353
+00:27:11,290 --> 00:27:15,370
+بالخطأ راح شبك الـtube هذا بدل ما هو في المكان اللي
+
+354
+00:27:15,370 --> 00:27:19,930
+فيه الـtube اللي نازل للماء، شبكه في أحد الـtubes
+
+355
+00:27:19,930 --> 00:27:24,550
+هدول، معناه إنه الهواء اللي هنا يستطيع
+
+356
+00:27:24,550 --> 00:27:28,730
+يلاقي منفذ له، طبعاً الخطر إنه بالذات لو شبكه في هذا
+
+357
+00:27:31,040 --> 00:27:34,640
+اللي هو suction، ما عندهوش valve، الـ
+
+358
+00:27:34,640 --> 00:27:36,600
+tube، suction ما عندهوش valve لو شبكناه
+
+359
+00:27:36,600 --> 00:27:41,700
+هنا ممكن ما يصيرش مشكلة مؤقتاً لإنه بيسمح للهواء
+
+360
+00:27:41,700 --> 00:27:45,040
+بالخروج أو لا يسمح له بالدخول، لأ، برضه هتصير
+
+361
+00:27:45,040 --> 00:27:48,020
+المشكلة، لإنه الهواء اللي هنا هيكون فيه إمكانية له
+
+362
+00:27:48,020 --> 00:27:53,100
+أنه يخرج، فممكن يخرج ويصير إيش؟ داخل المريض، ولو هنا
+
+363
+00:27:53,100 --> 00:27:57,480
+نفس الحاجة، هيخرج ويصير في المريض ويصير محتبس
+
+364
+00:27:57,480 --> 00:28:02,020
+وهيعمل حاجة نسميها surgical emphysema، تمام؟ لذلك
+
+365
+00:28:02,020 --> 00:28:06,500
+من الخطر جداً إن أنا أكون في عملية خطأ أثناء تركيب
+
+366
+00:28:06,500 --> 00:28:10,100
+الـchest drain هذا، وبدل ما أركبه في الـtube اللي
+
+367
+00:28:10,100 --> 00:28:15,870
+بنزله على الماء، أشبكه في أحد المداخل الثانية للـ
+
+368
+00:28:15,870 --> 00:28:19,270
+chest puddle، كويس؟ هذا نظام من أنظمة الـchest
+
+369
+00:28:19,270 --> 00:28:23,350
+tube، في نظام ثاني، طبعاً هي الفكرة تبعته اللي أنا
+
+370
+00:28:23,350 --> 00:28:28,030
+كنت يعني بأشرح فيها كيف الـfluid بيطلع، بشغل، كل ما
+
+371
+00:28:28,030 --> 00:28:32,470
+بيطلع الـfluid لازم إيش؟ يطلع في الماء، تمام؟
+
+372
+00:28:32,470 --> 00:28:35,530
+وبالتالي بيطلع من هنا، الـvalve اللي حكيته كان عشان
+
+373
+00:28:35,530 --> 00:28:42,210
+يعني الكمية اللي دخلت تشغل حيز من الفراغ هذا فبيطلع
+
+374
+00:28:42,210 --> 00:28:47,810
+بداله هواء، تمام؟ دائماً بيكون يا جماعة احنا ملاحظين
+
+375
+00:28:47,810 --> 00:28:52,570
+إن في مرحلة إن المريض بيعمل inspiration بتلاقي إنه
+
+376
+00:28:52,570 --> 00:28:57,110
+صار فيه طلع شوية من الماء اللي هنا، طلع في الـtube
+
+377
+00:28:57,110 --> 00:29:00,310
+في الـexpiration بتعاود بتنزل، يعني هنا في حركة
+
+378
+00:29:00,310 --> 00:29:04,510
+متغيرة، آه بتطلع بس مش هتوصل لمستويات عالية أبداً
+
+379
+00:29:04,510 --> 00:29:08,360
+أبداً، مش هتوصل أبداً لمستوى عالي، بس هتظل في الـbubble
+
+380
+00:29:08,360 --> 00:29:11,540
+لإنة اتفاقنا إنه لازم يكون الـwater seal هذا بمستوى
+
+381
+00:29:11,540 --> 00:29:17,940
+أقل من الصدر، ولكن حركة، حركة الـfluid هذه في داخل
+
+382
+00:29:17,940 --> 00:29:21,840
+الـtube هذا اللي بنسميها fluctuation، يعني بتتردد،
+
+383
+00:29:21,840 --> 00:29:28,300
+بتطلع شوية وبتنزل شوية، هذه هي المؤشر المهم على إن
+
+384
+00:29:28,300 --> 00:29:34,200
+الـchest tube هذا functional، وشغال، وما فيش.. ومش
+
+385
+00:29:34,200 --> 00:29:37,640
+فيه closure، وبيقدر يدي الوظيفة تبعته، إذا إيش اسم هذه
+
+386
+00:29:37,640 --> 00:29:41,220
+الحركة اللي لازم أنا أتبعها fluctuation؟ وإيش أنا
+
+387
+00:29:41,220 --> 00:29:46,160
+لازم أسوي عشان أعرفها؟ يجب أن أجي وأحط الـ
+
+388
+00:29:46,160 --> 00:29:50,300
+water seal على مستوى اللي هو مستوى، يعني على الـ
+
+389
+00:29:50,300 --> 00:29:55,240
+ground مثلاً، وببدأ أنا أطلع أشوف هل في حركة نفس
+
+390
+00:29:55,240 --> 00:29:57,760
+المريض في الـfluctuation في الـtube، يعني
+
+391
+00:29:57,760 --> 00:30:03,680
+مستوى الـwater بيط
+
+445
+00:33:56,670 --> 00:34:04,170
+مش لازم يكون أكثر من عشرين طبعا
+
+446
+00:34:04,170 --> 00:34:10,550
+في هنا النظام، هذا لو كنت أشبكه في suction في نظام
+
+447
+00:34:10,550 --> 00:34:15,050
+هنا إن إحنا بنحط مية في هذا البوتل، هذا البوتل
+
+448
+00:34:15,050 --> 00:34:19,770
+مستقل عنهم، لاحظوا ممسكّر من هنا، لاحظين؟ ممسكّر
+
+449
+00:34:19,770 --> 00:34:23,610
+من هنا يعني، لاحظوا؟ ممسكّر، وبس بنحط المية هنا،
+
+450
+00:34:23,610 --> 00:34:27,100
+من هنا، من هنا، فبتعبي وينفل الـ chamber هذا وين
+
+451
+00:34:27,100 --> 00:34:29,480
+مستوى المية بيوصل لـ «هان»؟ مستوى المية هذا
+
+452
+00:34:29,480 --> 00:34:34,460
+بيعمل لي pressure minus 20 لحاله فبيسهّل فيه يعني
+
+453
+00:34:34,460 --> 00:34:38,080
+بيخلّي دائماً دائماً طالع هي مفتوح من «هان» لـ
+
+454
+00:34:38,080 --> 00:34:41,920
+«هان» في فتحة بوجود المية اللي «هان» فإيش
+
+455
+00:34:41,920 --> 00:34:44,980
+هيعمل لي؟ هيعمل لي negative pressure اللي هو عبارة
+
+456
+00:34:44,980 --> 00:34:50,280
+عن minus 20 عن طريق 20 centimeter مية بس أنا هحطه
+
+457
+00:34:50,280 --> 00:34:53,960
+20 centimeter مية
+
+458
+00:34:54,940 --> 00:34:58,080
+عفوًا، عن طريق كمية المية اللي أنا أحطها حسب
+
+459
+00:34:58,080 --> 00:35:01,140
+تعليمات الجهاز اللي هتعمل ليه pressure قدره 20
+
+460
+00:35:01,140 --> 00:35:05,740
+صنطي فيه
+
+461
+00:35:05,740 --> 00:35:09,900
+الـ... الـ... يعني الطول تبع المية اللي بنحطها 20
+
+462
+00:35:09,900 --> 00:35:14,720
+صنطي متر بيعمل له pressure minus 20 عشان يضلوا
+
+463
+00:35:14,720 --> 00:35:20,440
+بشكل مستمر يعمل suctioning للبيانات ويطلع
+
+464
+00:35:20,440 --> 00:35:25,290
+الفلود ويعمل drainage system هذا شكله الـ
+
+465
+00:35:25,290 --> 00:35:28,830
+Nursing Management المهم لواحد عنده الـ chest tube
+
+466
+00:35:28,830 --> 00:35:33,650
+أنه يضل زي ما حكينا الـ system ي close ويضلوا تحت
+
+467
+00:35:33,650 --> 00:35:38,550
+الـ chest level يضل الـ connections والـ tube
+
+468
+00:35:41,150 --> 00:35:46,610
+بأمان ولا أحد يحاول إنه يشدها مثلا أو تكون فيها
+
+469
+00:35:46,610 --> 00:35:53,710
+kinking دائماً نتأكد إنه إذا مشبوك على سواء
+
+470
+00:35:53,710 --> 00:35:58,930
+الـ water suction أو الـ wall suction سواء water
+
+471
+00:35:58,930 --> 00:36:01,470
+suction أو wall suction إنه مايكونش الـ pressure
+
+472
+00:36:01,470 --> 00:36:08,170
+أكثر من عشرين يعني مايكونش أبداً أكثر من negative 20
+
+473
+00:36:08,170 --> 00:36:12,230
+لو كان في المية هيكون عن طريق إن أحط بس 20
+
+474
+00:36:12,230 --> 00:36:18,470
+centimeter مية هيعمل لي pressure minus 20 تمام؟ لو
+
+475
+00:36:18,470 --> 00:36:23,070
+كان بالـ wall suction برضه بدك تعمله regulation إنه
+
+476
+00:36:23,070 --> 00:36:25,410
+يكون negative 20 مش أكثر
+
+477
+00:36:29,610 --> 00:36:34,410
+دائماً ضروري أن نشوف تعليمات كل الشركة المصنعة على
+
+478
+00:36:34,410 --> 00:36:37,790
+البوتلز
+
+479
+00:36:37,790 --> 00:36:43,700
+لأنها ممكن تكون بتختف من شركة لأخرى اللي بهمنا إحنا
+
+480
+00:36:43,700 --> 00:36:48,740
+بشكل عام إنه المريض هذا لازم يكون تحت المراقبة
+
+481
+00:36:48,740 --> 00:36:53,280
+وأعرف إنه فعلاً الـ Chesty tube يشتغل بشكل صحيح عن
+
+482
+00:36:53,280 --> 00:36:56,840
+طريق إنه يكون فيه fluctuation زي ما حكينا، إيش
+
+483
+00:36:56,840 --> 00:37:03,470
+يعني؟ يعني تردد في الـ tube نتيجة إيش؟ مع تغيير أو
+
+484
+00:37:03,470 --> 00:37:06,570
+مع الـ chest movement مع تغيير الـ pressure
+
+485
+00:37:06,570 --> 00:37:09,090
+الانتراثولوجيكي أنا عشان أعمل الحاجة هذه لازم أخلي
+
+486
+00:37:09,090 --> 00:37:12,870
+المريض يعمل DB bleed and cough ويمكن استخدام
+
+487
+00:37:12,870 --> 00:37:17,410
+الـ Spirometer أو الـ Spirometer عشان فعلاً بيخلي
+
+488
+00:37:17,410 --> 00:37:21,150
+الـ lung expansion يتزيد وفعلاً بيخلّيني أشوف
+
+489
+00:37:21,150 --> 00:37:25,990
+التردد بشكل كويس المريض ممكن يكون عنده ألم لازم
+
+490
+00:37:25,990 --> 00:37:30,390
+أراقبه وإذا عنده ألم because of the chest tube أو
+
+491
+00:37:30,390 --> 00:37:32,510
+because of الـ trauma الأساسية اللي عنده إنه
+
+492
+00:37:32,510 --> 00:37:36,770
+ينكتب له الـ Analgesic medication as prescribed
+
+493
+00:37:36,770 --> 00:37:40,810
+وتعطى له لازم يكون فيه مراقبة للـ vital signs
+
+494
+00:37:40,810 --> 00:37:47,090
+بالمريض ولازم يكون فيه من فترة للتانية عمل
+
+495
+00:37:47,090 --> 00:37:52,730
+Sequencing للتعصير له و milking للـ chest
+
+496
+00:37:52,730 --> 00:37:56,830
+الـ tube عشان ما يكونش فيهم تجمعات ويصير فيه
+
+497
+00:37:56,830 --> 00:38:01,050
+sudden closure عند المريض وفجأة يبدأ يخش فيه
+
+498
+00:38:01,050 --> 00:38:06,200
+مضاعفات كمان يا جماعة، لازم ينعمل الـ Dressing لـ
+
+499
+00:38:06,200 --> 00:38:11,060
+جسد الـ Tube اللي هو يعني الـ Attachment والـ
+
+500
+00:38:11,060 --> 00:38:14,420
+Contact تبعتة والـ Penetrating Site وين دخل الـ
+
+501
+00:38:14,420 --> 00:38:19,830
+Tube لـ Plural Space هنا المكان هذا فيه ريسك إنه
+
+502
+00:38:19,830 --> 00:38:24,350
+يصير عنده infection فلازم ينعمل له dressing ويتغطى
+
+503
+00:38:24,350 --> 00:38:31,010
+بـ sterile cover والأحسن إنه ما يكونش الـ dressing
+
+504
+00:38:31,010 --> 00:38:37,530
+تبعه يعني frequently إلا إذا صار wet عشان نمنع إنه
+
+505
+00:38:37,530 --> 00:38:43,070
+يصير infected أهم حاجة أنه لما تبتدي تعمل milking
+
+506
+00:38:43,070 --> 00:38:49,910
+ما تسحبش الـ tube بشكل قوي فإنت تروح وإنت
+
+507
+00:38:49,910 --> 00:38:56,690
+رافعة من مكانه تراقب إنه الـ tube مايكونش فيه عنده
+
+508
+00:38:56,690 --> 00:39:01,310
+kinking يعني فيه التواءات أو ما يمنع إن
+
+509
+00:39:01,310 --> 00:39:06,250
+الانسيابية تبعت السوائل لو حصل إن المريض احتاج
+
+510
+00:39:06,250 --> 00:39:12,570
+جماعة إنه مثلاً يعمل أي بروسيجر مثلاً بدنا ننقله من
+
+511
+00:39:12,570 --> 00:39:17,810
+مكان لمكان أو بدنا نعمله أي بروسيجر X-ray بما
+
+512
+00:39:17,810 --> 00:39:22,350
+نفترض وما بدناش يكون يعني الـ chest tube شجّات
+
+513
+00:39:23,410 --> 00:39:29,210
+فبنعمل حاجة نسميها Clamping للـ Chest Tube خد
+
+514
+00:39:29,210 --> 00:39:33,090
+بالك جداً إن الـ Clamping هذا لازم يكون وقته قصير
+
+515
+00:39:33,090 --> 00:39:38,270
+ينعمل بحذر
+
+516
+00:39:38,270 --> 00:39:41,950
+وعن طريق استخدام الـ forceps المناسبة ومن
+
+517
+00:39:41,950 --> 00:39:47,810
+الأماكن الصحيحة يعني الـ Chest Tube عادة إن
+
+518
+00:39:47,810 --> 00:39:50,190
+الجماعة بكون إدارة عن الـ Tube بدخل في المريض
+
+519
+00:39:50,190 --> 00:39:55,600
+بعدين بيجي connection علشانيعني adaptor حاجة بتيجي
+
+520
+00:39:55,600 --> 00:39:59,500
+زي توصيلة ما بين التيوب اللي دخل في المريض وبربيج
+
+521
+00:39:59,500 --> 00:40:02,940
+الكبير لتيوب الكبير اللي بده يشبك وين في الـ Potel
+
+522
+00:40:02,940 --> 00:40:06,760
+فدائماً الـ Clamp بينعمل من البربيج الأول من التيوب
+
+523
+00:40:06,760 --> 00:40:11,080
+الأول اللي في المريض ببعد مثلاً عشرة صنط عن المريض
+
+524
+00:40:11,080 --> 00:40:15,260
+و بجي بجيب شاشة و forceps بحط الشاشة على التيوب
+
+525
+00:40:15,260 --> 00:40:19,280
+عشان ما أعملش damage للتيوب وبعدين بعمل clamping في
+
+526
+00:40:19,280 --> 00:40:22,420
+الـ forceps في ناس ممكن تغلط وتروح تعمل clamping
+
+527
+00:40:22,420 --> 00:40:26,400
+بعدين في اليوتيوب، خلّيني أرجع على الصورة عشان يكون
+
+528
+00:40:26,400 --> 00:40:33,490
+الكلام واضح مثلاً، نعتبر أنه، نشوف مريض؟ تمام نعتبر
+
+529
+00:40:33,490 --> 00:40:37,570
+إن الـ connection في المنطقة هذه الحمراء أو نجربها
+
+530
+00:40:37,570 --> 00:40:41,730
+نعتبر الـ connection هنا التوصيلة بين الـ tube هذا و
+
+531
+00:40:41,730 --> 00:40:45,170
+الـ tube اللي نازل تمام نعتبر إن الساهم هذا هو
+
+532
+00:40:45,170 --> 00:40:48,230
+التوصيلة لما بدك تعمل clamping لازم تعمله في
+
+533
+00:40:48,230 --> 00:40:52,110
+المنطقة هنا مش في المنطقة هنا اعتبر إن إنت عملت في
+
+534
+00:40:52,110 --> 00:40:55,330
+المنطقة هنا وفجأة حركة المريض اللي هو من عند الـ
+
+535
+00:40:55,330 --> 00:40:59,150
+connection راح إيش فلت فإنت سمحت للهواء فعلاً إنه
+
+536
+00:40:59,150 --> 00:41:06,660
+يدخل وهذا بيكون مش صحيح هذا بالنسبة للحاجات اللي
+
+537
+00:41:06,660 --> 00:41:11,160
+لازم ناخد بالنا منها الـ Clamp لو عملناه للمريض زي
+
+538
+00:41:11,160 --> 00:41:15,380
+ما حكينا لازم يكون وقته قصير بهدف إنه نعمل الإجراء
+
+539
+00:41:15,380 --> 00:41:17,880
+مثلاً نقل مريض ليه أجوز أن أنقل مريض من مكان إلى
+
+540
+00:41:17,880 --> 00:41:20,760
+مكان وهو موجود فيه Chest Tube ممكن مع الحركة
+
+541
+00:41:20,760 --> 00:41:25,210
+يفلتوا فجأة مني، لأ أنا بفلّطهم، بفكهم يعني و
+
+542
+00:41:25,210 --> 00:41:27,630
+بحافظ على الـ Stability تبعتّهم وبعمل Clamping
+
+543
+00:41:27,630 --> 00:41:31,770
+بالطريقة الصح، آه و ببدأ أنقل فيه من المكان لمكان
+
+544
+00:41:31,770 --> 00:41:35,870
+التاني وبعد ما تخلص عملية النقل برجع بعمل
+
+545
+00:41:35,870 --> 00:41:39,890
+connection للـ Chesty tubes إلا إذا كان ممكن أن
+
+546
+00:41:39,890 --> 00:41:49,780
+أنقله مع ضمان إنه مايكونش فيه انفصال Accidentally
+
+547
+00:41:49,780 --> 00:41:55,900
+طبعاً للـ Chest Drainage هيك تقريباً بتكون خلصت
+
+548
+00:41:55,900 --> 00:41:57,840
+محاضرتنا للموضوع هذا
diff --git a/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/TzQBApo1yr8_postprocess.srt b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/TzQBApo1yr8_postprocess.srt
new file mode 100644
index 0000000000000000000000000000000000000000..5959b76196aebe0946464792d69c7093faac703c
--- /dev/null
+++ b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/TzQBApo1yr8_postprocess.srt
@@ -0,0 +1,2193 @@
+1
+00:00:00,350 --> 00:00:01,790
+الـ Balmona الإديمة
+
+2
+00:00:06,330 --> 00:00:10,750
+زي ما بنحكي في تعريفها هي abnormal accumulation
+
+3
+00:00:10,750 --> 00:00:13,910
+لإيش؟ لـ Fluid، وين؟ مش في الـ Plural، في الـ Lung
+
+4
+00:00:13,910 --> 00:00:17,170
+tissue نفسها، في الـ Alveolar space يعني الـ
+
+5
+00:00:17,170 --> 00:00:21,270
+Alveoli بدل ما فيها هوا صارت مليانة ميّه، Fluid،
+
+6
+00:00:21,270 --> 00:00:24,230
+أهو، طب و هد يعني إيه؟ بغرج يعني المريض؟ لأ، هد
+
+7
+00:00:24,230 --> 00:00:28,510
+بتكون جاية من الـ Accumulation يعني زي ما حكينا ال
+
+8
+00:00:28,510 --> 00:00:33,590
+blood بيجي علىالـ Lung عبر الـ Palmonary Veins
+
+9
+00:00:33,590 --> 00:00:36,650
+وبروح على الـ Capillaries عشان تعمل تقوم بدورها
+
+10
+00:00:36,650 --> 00:00:39,670
+بالـ Gas Exchange لكن للأسف الـ Lung ما أنتهاش
+
+11
+00:00:39,670 --> 00:00:45,250
+القدرة لسبب ما أنها ت .. ت .. تدّي الدم هذا أكسجين
+
+12
+00:00:45,250 --> 00:00:49,850
+وتاخد منه ثانو أكسيد الكربون فبتصير يرشح الدم الـ
+
+13
+00:00:49,850 --> 00:00:54,070
+Fluid اللي فيه في قلب إيش الـ Alveoli فبتأكل الـ
+
+14
+00:00:54,070 --> 00:00:57,350
+Alveoli ميا هذا الـ Pathophysiology تبعت البلمونري
+
+15
+00:00:57,350 --> 00:00:59,150
+إديمة علشان هيك يا جماعة
+
+16
+00:01:03,520 --> 00:01:07,600
+لما يكون الـ left ventricle تبقى المريض ماعندهش
+
+17
+00:01:07,600 --> 00:01:11,260
+قدرة
+
+18
+00:01:11,260 --> 00:01:15,140
+كافية أن يخنق وظائفه كويسة هتصبح الـ accumulation
+
+19
+00:01:15,140 --> 00:01:21,400
+للـfluid هادي في الـinterstitial space والـalveoli
+
+20
+00:01:21,400 --> 00:01:25,460
+الـclinical manifestation، احنا حكينا إن
+
+21
+00:01:25,460 --> 00:01:29,790
+الـalveoli نفسها صار فيها fluid، والـfluid هاديإيش
+
+22
+00:01:29,790 --> 00:01:33,410
+فيها؟ هي أصلا جا من وين؟ جا من الـBlood علشان هي
+
+23
+00:01:33,410 --> 00:01:40,970
+كانت من أهم العلماء إنك هتلاقي إن المريض هذا عنده
+
+24
+00:01:40,970 --> 00:01:48,590
+.. عنده .. بطلع من تلم فوم، رغوة والرغوة هذه فيها
+
+25
+00:01:48,590 --> 00:01:53,490
+خيط Bloodهذه الشكلة مفروضة وعادةً تتطلع لـ blood
+
+26
+00:01:53,490 --> 00:01:58,390
+-tinged secretions فيها خيط دم تمام، هذه من أهم
+
+27
+00:01:58,390 --> 00:02:03,590
+علامات البلمونورقي دي مثلاً بيجي المريض exhausted،
+
+28
+00:02:03,590 --> 00:02:08,930
+دستنيا، air-hunger، anxious، ليش anxious؟ لأن هو
+
+29
+00:02:08,930 --> 00:02:14,050
+hypoxia، سينوسيس، central cyanosis عنده form
+
+30
+00:02:14,050 --> 00:02:18,610
+secretion، secretion تطلع زرق وفيها blood-tinged
+
+31
+00:02:18,610 --> 00:02:24,550
+secretionsتمام؟ وطبعا confused و distress ليش؟ لأن
+
+32
+00:02:24,550 --> 00:02:29,370
+ال blood بدأ أو ال oxygen بدأ يخس عن ال brain وهذا
+
+33
+00:02:29,370 --> 00:02:34,090
+عمل للمريض stress في ال escalation يا جماعة لو
+
+34
+00:02:34,090 --> 00:02:40,010
+اسمعنا هنسمع severe precipitation في ال lung في ال
+
+35
+00:02:40,010 --> 00:02:44,860
+both lungs وcracklesزي صوت الشيشة، ليش؟ لأنه ميّه،
+
+36
+00:02:44,860 --> 00:02:50,860
+صوت ميّه، crackles، تمام؟ طبعاً، هتسمعوا بالذات في
+
+37
+00:02:50,860 --> 00:02:54,940
+الـBase of the lung المريض طبعاً هيكون Hypoxia
+
+38
+00:02:54,940 --> 00:02:57,400
+وإذا عملنا Blood gas، أسئلوا يا جماعة، هنلاقي أن
+
+39
+00:02:57,400 --> 00:03:03,380
+الـPhenoxyde الكربون الـCO2 مرتفع والـPO2
+
+40
+00:03:03,380 --> 00:03:09,560
+الـOxygen هيكون منخفضفي الأشعة، شكل البلمون
+
+41
+00:03:09,560 --> 00:03:13,160
+الأقديمي زي ما انتوا شايفين الـBase تبع الـLung،
+
+42
+00:03:13,160 --> 00:03:17,400
+شباب، مش برا، لأ الـLung، تشوف هاي الـMargin تبعت
+
+43
+00:03:17,400 --> 00:03:21,860
+الـLung، هاي لسه موجودة، لكن فيه بياض، والبياض وين
+
+44
+00:03:21,860 --> 00:03:25,580
+فوق، ليش؟ لأن الـFluid في داخل الـLung، مش زي لما
+
+45
+00:03:25,580 --> 00:03:28,720
+بيكون الـFluid في الـPlural Space وعمل شرين كل
+
+46
+00:03:28,720 --> 00:03:34,860
+الـLung زججهاأه هو ماخد place، مكانها، لأ هو الـ
+
+47
+00:03:34,860 --> 00:03:37,880
+Fluid في قلب الـ Lung اللي في الـ Intestine اللي
+
+48
+00:03:37,880 --> 00:03:42,260
+في نفس القلب اللي قاعد، تمام؟ فعشان هي كال medical
+
+49
+00:03:42,260 --> 00:03:46,120
+management إن أنا أخلص المريض هذا من الـ Fluid هذه
+
+50
+00:03:46,120 --> 00:03:54,080
+أهم حاجة إن المريض ياخدالـ Diuretics عشان يتخلص من
+
+51
+00:03:54,080 --> 00:03:58,780
+كمية الـ Fluid هذه لزيادة عشان المريض يتخلص من
+
+52
+00:03:58,780 --> 00:04:03,020
+كمية الـ Fluid هذه لزيادة هذه المفروض أنه يأخذ الـ
+
+53
+00:04:03,020 --> 00:04:05,700
+Diuretics عشان يأخذ الـ Diuretics المفروض أنه يكون
+
+54
+00:04:05,700 --> 00:04:10,220
+له Urinary Catheter لأنه مش معقول أنه يركّف أو يدل
+
+55
+00:04:10,220 --> 00:04:16,530
+مريض Diureticsوهو Respiratory Distress وحاسيب يروح
+
+56
+00:04:16,530 --> 00:04:21,990
+يعمل Evacuation للـUrine ويظل رايح جاي على
+
+57
+00:04:21,990 --> 00:04:25,110
+الـToilette وهذا هيكون Exhausted له فلأ من
+
+58
+00:04:25,110 --> 00:04:29,250
+الأولويات أنه حط المريض في بالدرس High Fowler
+
+59
+00:04:29,250 --> 00:04:33,930
+Position، حطله Oxygen، هاي ABC حطله Oxygen، ركّبله
+
+60
+00:04:33,930 --> 00:04:39,910
+Canula، ركّب Catheter، اعطل المريض Diuretics كان
+
+61
+00:04:39,910 --> 00:04:46,150
+في زمان حاجة بيسموهامونا اللي هي مروفين و Oxygen
+
+62
+00:04:46,150 --> 00:04:54,970
+كان بيده أحيانا Nitroglycerin برضه و بيده أحيانا
+
+63
+00:04:54,970 --> 00:05:01,090
+مروفين علشان يعملوا coronary vasodilatation
+
+64
+00:05:01,090 --> 00:05:04,190
+ويزودوا
+
+65
+00:05:04,190 --> 00:05:06,230
+اللي هو الـ
+
+66
+00:05:09,900 --> 00:05:14,100
+للتروية الـ Perfusion تبع الـ heart itself ويخفف
+
+67
+00:05:14,100 --> 00:05:17,340
+ال distress تبع المريض لأنه بيكون severely
+
+68
+00:05:17,340 --> 00:05:21,620
+distress لكن المورفين
+
+69
+00:05:21,620 --> 00:05:26,000
+يعني بيبدو انعطب حظر كتير لإنه ممكن يؤدي ل
+
+70
+00:05:26,000 --> 00:05:30,900
+respiratory depression عند المريض هذا فاحنا بنرجع
+
+71
+00:05:30,900 --> 00:05:31,720
+بنحكي إنه
+
+72
+00:05:38,830 --> 00:05:44,770
+ونستخدم الـ Lasix و Loop Diuretics وطبعا قبل أن
+
+73
+00:05:44,770 --> 00:05:48,290
+نبدأ نعطي الـ Diuretics لازم نكون ركّبنا already
+
+74
+00:05:48,290 --> 00:05:53,330
+full catheter ونعمل للمريض respiratory
+
+75
+00:05:56,650 --> 00:05:59,930
+الـPsychological Support برضه لأنه بيكون «Severely
+
+76
+00:05:59,930 --> 00:06:03,550
+Distressed» وبنكون جاهزين لإنه نعمله «Respiratory
+
+77
+00:06:03,550 --> 00:06:08,110
+Support» لو الأمور ما عدتش وحتاج المريض إنه نعمله
+
+78
+00:06:08,110 --> 00:06:13,510
+«Mechanical Ventilation» الـ«Diuretics» هدفه يا
+
+79
+00:06:13,510 --> 00:06:19,750
+جماعة إنه يجلل الـ«Brusher» اللي جاء في تبع
+
+80
+00:06:19,750 --> 00:06:23,170
+الـ«Fluid» اللي جاء على الـ«Heart» اللي بنسميه
+
+81
+00:06:23,170 --> 00:06:28,660
+«Preload»الـ Preload يعني الدم اللي بده حتى زمان
+
+82
+00:06:28,660 --> 00:06:31,360
+كان فيه طريقة اسمها «Tourniquet» إنهم يربطوا
+
+83
+00:06:31,360 --> 00:06:37,780
+«Tourniquet» على كل طرف فترة زمنية مثلا خمس دقائق
+
+84
+00:06:37,780 --> 00:06:41,040
+بعدين يربط على الطرف التاني بعدين كل هذا كان هدفه
+
+85
+00:06:41,040 --> 00:06:44,640
+أنه «Preload Reducer» يقلل كمية الدم اللي بتوصل
+
+86
+00:06:44,640 --> 00:06:49,320
+للقلب علشان القلب مايتطرش أنه يودّ كمية الدم هذه
+
+87
+00:06:49,320 --> 00:06:53,800
+على الـLung والـLung تصير مش عارفة تدبر حالة فيها
+
+88
+00:06:54,080 --> 00:06:58,960
+والزيت البلموناري قديماً والـ Afterload Reducers
+
+89
+00:06:58,960 --> 00:07:04,240
+عن طريق أنه احنا زي ما حكينا المادة Nitroglycerin
+
+90
+00:07:04,240 --> 00:07:08,380
+عشان يعمل Dilatation للبلد بسيلفة كمية الدم
+
+91
+00:07:08,380 --> 00:07:14,140
+الـBlood Pressure طبعاً هينزل فكمية الدم اللي فيها
+
+92
+00:07:14,140 --> 00:07:19,540
+أو الـBlood لما بيدفع الكمية اللي فيه بوديها على
+
+93
+00:07:19,540 --> 00:07:24,090
+مكان الضغط فيهواطي لأن الـ piece is dilated فهذا
+
+94
+00:07:24,090 --> 00:07:27,690
+بيخلّي فيه إمكانية للجسم إنه يستوقع أو الشرين
+
+95
+00:07:27,690 --> 00:07:32,930
+تستوقع أكتر من غير ما اتعاني أو من غير ما القلب
+
+96
+00:07:32,930 --> 00:07:37,310
+يعاني بيكون عملية سهلة على القلب ال heart
+
+97
+00:07:37,310 --> 00:07:43,590
+medication أدوية أنها تقوى عدلة القلب نفسها زي
+
+98
+00:07:47,280 --> 00:07:54,940
+إنه أحيانًا نبنيها ابنات دي يعني
+
+99
+00:07:54,940 --> 00:08:02,120
+أدوية قلل ضغط الدم إذا كان الضغط كتير عالي من
+
+100
+00:08:02,120 --> 00:08:05,360
+أمتلاتها الـNitroglycerin المروفين حكينا إنه
+
+101
+00:08:05,360 --> 00:08:09,560
+ناركوتيك بينعطى عشان يخفف الـanxiety تبعة المريض
+
+102
+00:08:09,560 --> 00:08:14,180
+لكن بنكون خايفين جدًا ومفيد طبعًا لإنه بزودبعمل
+
+103
+00:08:14,180 --> 00:08:17,740
+coronary vasodilatation لكن مشكلته أنه يمكن يعمل
+
+104
+00:08:17,740 --> 00:08:22,320
+respiratory depression فبينعطى تحت حضر شديد وكتير
+
+105
+00:08:22,320 --> 00:08:26,860
+من الطباب بفضل انه مايعطيهوش لو المريض ماتحسنش
+
+106
+00:08:26,860 --> 00:08:30,960
+هيكون الحل في mechanical ventilator هنحط المريض
+
+107
+00:08:30,960 --> 00:08:36,400
+على mechanical ventilator وحنحط عادةالحاجة بيسموها
+
+108
+00:08:36,400 --> 00:08:39,020
+«high BP» يعني «positive index» فال«pressure»
+
+109
+00:08:39,020 --> 00:08:44,400
+بيكون عالي شوية ممكن قبل ما نحط المريض على
+
+110
+00:08:44,400 --> 00:08:47,200
+mechanical ventilator لو كان في عنا هذا اسمها «C
+
+111
+00:08:47,200 --> 00:08:50,600
+-PAP mask» يعني نحط المريض على mechanical
+
+112
+00:08:50,600 --> 00:08:55,200
+ventilator بس، لكن من غير ما نحط تيوب، آه، لأ،
+
+113
+00:08:55,200 --> 00:09:00,160
+خارجي بس، هذا mask خارجية بتنحطها المريض والـ
+
+114
+00:09:00,160 --> 00:09:04,720
+«mask» هذه بتحقق pressure عالي داخل الـ«lung»
+
+115
+00:09:05,210 --> 00:09:10,230
+المريض وبالتالي ممكن تفتح الـ Alveoli وتعمله Good
+
+116
+00:09:10,230 --> 00:09:15,430
+Respiratory Support وتعمل Inflation للـ Alveoli
+
+117
+00:09:15,430 --> 00:09:18,790
+وتخلي يصير فيه إمكانية للـ Gas Exchange
+
+118
+00:09:25,160 --> 00:09:28,700
+لما بنحكي عن الـ Penetrating Chest Trauma، سواء
+
+119
+00:09:28,700 --> 00:09:36,620
+كانت Gunshot أو Stab Wounds أو حتى
+
+120
+00:09:36,620 --> 00:09:41,760
+لو كانت Plant Trauma، maybe الـ Plant Trauma كمان
+
+121
+00:09:41,760 --> 00:09:43,700
+ممكن تؤدي لإنه يصير فيه أن
+
+122
+00:09:48,890 --> 00:09:53,010
+النمو ثوركس اللي نحنا بنحكي عنه لكن يمكن من أشهر
+
+123
+00:09:53,010 --> 00:09:58,970
+الأشياء اللي ممكن تعمل «chest trauma» أو
+
+124
+00:09:58,970 --> 00:10:01,790
+«penetrating» اللي هي الـ «stab wounds» والـ «gun
+
+125
+00:10:01,790 --> 00:10:04,030
+shot»
+
+126
+00:10:06,500 --> 00:10:10,460
+اللي بيصير بعد الـ Chest Trauma سواء كانت من
+
+127
+00:10:10,460 --> 00:10:14,760
+Penetrating Stab Wounds أو كانت من Gunshot إنه
+
+128
+00:10:14,760 --> 00:10:18,300
+بنتوقع إنه حيصير فيه Bleeding أو حيصير فيه
+
+129
+00:10:18,300 --> 00:10:24,080
+Accumulation للـBlood والـAir في الـLung ومش بس في
+
+130
+00:10:24,080 --> 00:10:26,780
+الـLung، في الـPlural Space اللي الـLung في العادة
+
+131
+00:10:26,780 --> 00:10:32,170
+بتعمل Expansion فيهوبالتالي، الـ Accumulation هدا
+
+132
+00:10:32,170 --> 00:10:36,310
+هيمنع الـ Lung من إنها تعمل الـ Expansion تبعها
+
+133
+00:10:36,310 --> 00:10:41,330
+وعلشان هيك، الحل هيكون في إنه إحنا نعمل الـ
+
+134
+00:10:41,330 --> 00:10:46,710
+Drainage يعني، يعني Removing عن طريق الـ Drain لـ
+
+135
+00:10:46,710 --> 00:10:51,590
+Accumulation of Air أو Blood اللي في منطقة، في الـ
+
+136
+00:10:51,590 --> 00:10:57,590
+Plural Space علشان نسمح للـ Lung تاني بإنه ترجع
+
+137
+00:10:57,590 --> 00:11:04,740
+تعمل Expansionهذا كمان يا جماعة ممكن يصير زي ما
+
+138
+00:11:04,740 --> 00:11:10,680
+حكينا في الـPlant Trauma أو يصير مع العمليات
+
+139
+00:11:10,680 --> 00:11:15,260
+الجراحية يعني مثلا الـOpen Heart Surgery Cardiac
+
+140
+00:11:15,260 --> 00:11:20,420
+Surgery لما يحصل يحتاجوا أو حيصير فيه Already
+
+141
+00:11:20,420 --> 00:11:24,340
+Opening لـPlural Space ويكون فيه Drainage لـBlood
+
+142
+00:11:24,340 --> 00:11:30,820
+وبالتالي ممكن يتجمع فيه Plural Cavityهو علشان هيك
+
+143
+00:11:30,820 --> 00:11:34,420
+أو في الفراغ البلوري أو علشان هيك هيكون فيه يعني
+
+144
+00:11:34,420 --> 00:11:39,000
+داعي لإنه نعمله تفريغ أول بأول وإلا هتكون بعد
+
+145
+00:11:39,000 --> 00:11:43,020
+العملية ما خلصت هيصير فيه تجمع لهذه السوائل في
+
+146
+00:11:43,020 --> 00:11:45,940
+الفراغ البلوري ويلنع الـ expansion طبع ال lung
+
+147
+00:11:45,940 --> 00:11:50,240
+ويعمل tamponade على ال heart وهيعمل مشاكل كمان في
+
+148
+00:11:50,240 --> 00:11:53,560
+thoracic surgery لو كان مريض وكان فيه بيحتاج يعني
+
+149
+00:11:53,560 --> 00:11:58,890
+عملية logotopy مثلا أو كانالمريض بحتاج مثلًا عمل
+
+150
+00:11:58,890 --> 00:12:05,050
+عنده lung abscess وعمله thoracotomy في الحالات هذه
+
+151
+00:12:05,050 --> 00:12:08,250
+أيضًا بعد ما صار فيه handling و manipulation للـ
+
+152
+00:12:08,250 --> 00:12:13,110
+lung tissue وعمله اللي هو invasion للـ pleural
+
+153
+00:12:13,110 --> 00:12:16,130
+space expected إنه يصير فيه accumulation و
+
+154
+00:12:16,130 --> 00:12:22,180
+drainage لـ bloodفي الـ Plural Cavity وبالتالي
+
+155
+00:12:22,180 --> 00:12:26,260
+هيكون كويس ان يكون فيه drainage system عشان يمنع
+
+156
+00:12:26,260 --> 00:12:29,920
+ال accumulation هذا ويرجع يسمح لـ lung في ال
+
+157
+00:12:29,920 --> 00:12:33,060
+expansion عشان هيك هذا بخدنا على موضوعين مهمين جدا
+
+158
+00:12:33,060 --> 00:12:38,010
+فيالـChest Trauma اللي هما الـPneumothorax
+
+159
+00:12:38,010 --> 00:12:42,030
+والـHemothorax تقريبا كل ما ينطبق عن Pneumothorax
+
+160
+00:12:42,030 --> 00:12:46,470
+ينطبق على الـHemothorax لما بنحكي Pneumothorax
+
+161
+00:12:46,470 --> 00:12:52,690
+يعني هوا في التجويف الصدري Hemo يعني دم في التجويف
+
+162
+00:12:52,690 --> 00:12:54,910
+الصدري Pneumothorax
+
+163
+00:12:58,350 --> 00:13:03,270
+Parietal or visceral، الـ Plural محطمة ومحطمة الـ
+
+164
+00:13:03,270 --> 00:13:10,290
+Plural مواجهة ضغط أزومسفيريك جيد يعني في الـ
+
+165
+00:13:10,290 --> 00:13:16,690
+Pneumothorax بيصير محطمة سواء للـ Parietal أو
+
+166
+00:13:16,690 --> 00:13:19,210
+الvisceral تبعت البلورة عارفين اللي بلورة إلها
+
+167
+00:13:19,210 --> 00:13:24,330
+visceral و بلورة باريتال part سواء محطمة صار فيها
+
+168
+00:13:24,330 --> 00:13:29,130
+أو فيهاوتعرض الـ Plural Cavity هذا اللي هو الـ
+
+169
+00:13:29,130 --> 00:13:31,670
+Atmospheric Pressure يعني اللي هو الجو والضغط اللي
+
+170
+00:13:31,670 --> 00:13:36,750
+دي مسمحالـ Penetrating هذا أو الـ Rapture هذا
+
+171
+00:13:36,750 --> 00:13:41,590
+للهواء تبع الـ الهواء الجوي إنه يدخل الفراغ
+
+172
+00:13:41,590 --> 00:13:46,730
+البلوري هذا بالتالي هيبدأ يعمل Lung Pressure على
+
+173
+00:13:46,730 --> 00:13:49,210
+الـ Lung عشان هيك هو نوعين في الـ Simple
+
+174
+00:13:49,210 --> 00:13:52,150
+Pneumothorax و في الـ Traumatic Pneumothorax هنشوف
+
+175
+00:13:52,150 --> 00:13:55,250
+يعني إيش الفرق بين الـ Simple Pneumothorax و
+
+176
+00:13:55,250 --> 00:13:57,550
+Traumatic Pneumothorax بكل بساطة الـ Simple
+
+177
+00:13:57,550 --> 00:14:01,430
+Pneumothorax إن يكون في رمخة صار في الـ Plural
+
+178
+00:14:01,430 --> 00:14:09,340
+Spaceوالـ Plural Cavity وبالتالي الكمية البسيطة
+
+179
+00:14:09,340 --> 00:14:12,940
+اللي مش شغلة حيزي كبير مش مانعة long من إنها تعمل
+
+180
+00:14:12,940 --> 00:14:17,260
+expansion هذا ممكن شوية شوية يصير لها resolve
+
+181
+00:14:17,260 --> 00:14:20,820
+وماتحتاجش إنه نعمل لها drainage ولا chest tube لكن
+
+182
+00:14:20,820 --> 00:14:26,970
+لما بكون traumaticنتيجة زي ما حكينا إن جاني من
+
+183
+00:14:26,970 --> 00:14:30,410
+الخارج أو إن جاني من الداخل إن الـ lung صار فيها
+
+184
+00:14:30,410 --> 00:14:38,650
+rupture زي ما هنشوف فيه أمراض كتير ممكن تكون يعني
+
+185
+00:14:38,650 --> 00:14:41,690
+plus في ال lung ويصير إلى ال plus هذه rupture
+
+186
+00:14:41,690 --> 00:14:46,150
+وبالتالي تيجي الطريقة تعمل rupture في البلورة اللي
+
+187
+00:14:46,150 --> 00:14:49,710
+تطلع برا منه فعشان هي كانت بتصير اسمها closed
+
+188
+00:14:49,710 --> 00:14:53,010
+pneumothorax أو بيسموهاTension Pneumothorax لو
+
+189
+00:14:53,010 --> 00:14:56,230
+تلاحظوا في الصورة ها بتلاقي أنه المريض هذا ما
+
+190
+00:14:56,230 --> 00:15:00,950
+عندهوش إصابة من برا لأ ممكن ال lung صارت عاملة
+
+191
+00:15:00,950 --> 00:15:04,690
+rupture و طول منها المريض باخد inspiration و ال
+
+192
+00:15:04,690 --> 00:15:07,350
+inspiration اللي باخده بخش في ال lung و بطلع من ال
+
+193
+00:15:07,350 --> 00:15:13,360
+lungعلى الـ Plural Space وبيظلوا محتبس في المكان
+
+194
+00:15:13,360 --> 00:15:16,660
+هذا وبالتالي الـ Lung بيظل تعمل Shrinkage بعكس الـ
+
+195
+00:15:16,660 --> 00:15:21,900
+Open Pneumothorax في فتحة من برا صارت في غشاء الـ
+
+196
+00:15:21,900 --> 00:15:25,880
+External wall يعني تبع الـ Chest وبالتالي هذه
+
+197
+00:15:25,880 --> 00:15:30,540
+الفتحة صارت تعمل أو allow the atmospheric air to
+
+198
+00:15:30,540 --> 00:15:33,340
+enter the chest cavity وبالتالي برضه هتعمل
+
+199
+00:15:33,340 --> 00:15:38,990
+pressure على الـ Lungوتعمل فيها إشرين كيلز
+
+200
+00:15:38,990 --> 00:15:44,570
+وتخلّيها تسير كلها بس هو ملاحظين أحنا كيف أنه
+
+201
+00:15:44,570 --> 00:15:47,670
+التراكيا لما كل ما بزيد
+
+202
+00:15:51,060 --> 00:15:54,940
+الـAir في الفراغ البلوري يا جماعة
+بتكون عاملة
+
+203
+00:15:54,940 --> 00:15:59,000
+Deviation، لاحظين كيف؟ بالذات بالـExpiration لما
+
+204
+00:15:59,000 --> 00:16:05,980
+المريض بيعمل Expiration بلاقي إنه الـTrache تبعته
+
+205
+00:16:05,980 --> 00:16:10,520
+عاملة Deviation يعني أيه؟ يعني إيش يعني Deviation؟
+
+206
+00:16:10,520 --> 00:16:14,700
+يعني رايحة المفروض إنه هذا الـMidline الأفطارية
+
+207
+00:16:14,700 --> 00:16:20,550
+تبع الـPatient هذا الـMidlineفالمفروض أن يكون
+
+208
+00:16:20,550 --> 00:16:24,230
+الـLarynx الخط هذا في نص الـLarynx هنا، مش هيك؟
+
+209
+00:16:24,230 --> 00:16:31,150
+لكن لما بيكون مافيش عند أو في عند المريض
+
+210
+00:16:31,150 --> 00:16:34,890
+collection في الـPlural Space زي هي، إيش بيصير؟
+
+211
+00:16:34,890 --> 00:16:38,870
+بيصير deviation بعكس الجهة اللي فيها بعكس الجهة
+
+212
+00:16:38,870 --> 00:16:46,230
+اللي فيها الـPneumothorax حنشوف
+
+213
+00:16:46,230 --> 00:16:51,140
+هذا في الـClinical Manifestationلما نحكي عنه،
+
+214
+00:16:51,140 --> 00:17:00,300
+تتأكد من التسجيل في مشكلة ولا ماشي الأمور؟ Okay ف
+
+215
+00:17:00,300 --> 00:17:05,430
+Intentionally Mithorax or carewhen air is drawn
+
+216
+00:17:05,430 --> 00:17:08,690
+into the plural space from a lacerated lung اللانك
+
+217
+00:17:08,690 --> 00:17:12,090
+صار فيها injury or through a small opening or
+
+218
+00:17:12,090 --> 00:17:15,230
+wound in the chest wall أو صار ممكن كمان
+
+219
+00:17:15,230 --> 00:17:18,490
+الستراتيوش المتورنسية انه صار فيه chest wall بس
+
+220
+00:17:18,490 --> 00:17:22,810
+صغير في يعني في a wound في ال chest wall بس صغير
+
+221
+00:17:22,810 --> 00:17:26,250
+بحيث انه بسمح للهواء عمال و بدخل بس مابقدرش يطلع
+
+222
+00:17:26,250 --> 00:17:29,330
+it may complication of other type of pneumothorax
+
+223
+00:17:29,330 --> 00:17:33,400
+يعني الفكرة في التلتش النيموتوراكس ان الهواءبيصير
+
+224
+00:17:33,400 --> 00:17:36,720
+يدخل لكن مافيش إمكاني يطلع من نفس الفتحة اللي دخل
+
+225
+00:17:36,720 --> 00:17:40,660
+منها لو كان open و لو كان closed زي ما بيسموه
+
+226
+00:17:40,660 --> 00:17:43,340
+tension pneumothorax could be open could be closed
+
+227
+00:17:43,340 --> 00:17:46,620
+الـclosed pneumothorax إنه بيكون مافيش أي فتحة ولا
+
+228
+00:17:46,620 --> 00:17:49,920
+حد و بيصير فيه spin تاني و Rapture فيه الـlung
+
+229
+00:17:49,920 --> 00:17:54,480
+وفتحت على الـblural space وعملت الـcollection of
+
+230
+00:17:54,480 --> 00:17:56,840
+air فيه برا في الـblural space بيصير المريض يعمل
+
+231
+00:17:56,840 --> 00:18:00,310
+inspirationوالـ Inspiration تبعه بدل ما يظلوا في
+
+232
+00:18:00,310 --> 00:18:02,830
+الـ Lounge ويطالوا ويعملوا الـ Expiration كله لأ
+
+233
+00:18:02,830 --> 00:18:06,750
+بيعمل الـ Inspiration جزء من التلات الباع اللي
+
+234
+00:18:06,750 --> 00:18:09,190
+عملوا الـ Inspiration بيطلع على الـ World Space
+
+235
+00:18:09,190 --> 00:18:12,270
+وبيحتبس فيه وبيعمل الـ Expiration المريض ده جزء
+
+236
+00:18:12,270 --> 00:18:17,530
+بسيط لأن الباقي كليته انحجزت رابط انحجزت انصعد
+
+237
+00:18:17,530 --> 00:18:23,820
+كأنه في مصر يدقله وصعدته وخلته يظلوافي داخل الـ
+
+238
+00:18:23,820 --> 00:18:27,860
+Plural Space شكل الـ Pneumothorax يا جماعة هيكون
+
+239
+00:18:27,860 --> 00:18:31,160
+زي ما انتوا شايفين كيف يكون فيه سواد في الـ Lung
+
+240
+00:18:31,160 --> 00:18:35,320
+لأنه Air على جهة معينة واخدين بالكوا كيف لحظة كيف
+
+241
+00:18:35,320 --> 00:18:39,720
+الـ Lung هنا وكيف كان فيه سواد على الـ X-Ray هذا
+
+242
+00:18:39,720 --> 00:18:43,720
+بيدللي أن المريض هذا عنده Pneumothorax الإلاج تبع
+
+243
+00:18:43,720 --> 00:18:47,580
+المريض يا جماعةطبعاً أول حاجة جاب العلاج الـ
+
+244
+00:18:47,580 --> 00:18:49,700
+Clinical Manifestation المريض هذا هيكون anxious
+
+245
+00:18:49,700 --> 00:18:53,440
+أكيد، هيكون dyspneic، هيكون الـ saturation تبعه
+
+246
+00:18:53,440 --> 00:18:58,460
+low، هيكون tachypneic لإنه مش قادر إنه ياخد نفس
+
+247
+00:18:58,460 --> 00:19:03,460
+deep لإنه في حاجة بتعمله pressure وطبعاً هذا
+
+248
+00:19:03,460 --> 00:19:05,840
+هيخلّي السيلياندو سيانوسيز ولو عملنا له blood
+
+249
+00:19:05,840 --> 00:19:09,440
+gases هنلاقي إنه ال patient عنده hypoxemia
+
+250
+00:19:11,780 --> 00:19:15,320
+طبعًا الـ Trache زي ما حكينا لو روحنا و طلعنا على
+
+251
+00:19:15,320 --> 00:19:19,100
+الـ Trache هنلاقي إن الـ Trache عاملة shifting
+
+252
+00:19:19,100 --> 00:19:25,640
+بعكس الجهة اللي فيها الـ Nemathorax طبعًا هذا لما
+
+253
+00:19:25,640 --> 00:19:28,820
+تكون الـ Nemathorax بالذات تتمشي الـ Nemathorax
+
+254
+00:19:28,820 --> 00:19:32,580
+يعني لكن في الـ Simple Nemathorax اللي بتكون بسيطة
+
+255
+00:19:32,580 --> 00:19:37,780
+ممكن يعني الـ Trache أبدًا ما تكونش فيها أي
+
+256
+00:19:37,780 --> 00:19:44,110
+shifting وتكون في الوضعالطبيعي تبعها طبعا لو روحنا
+
+257
+00:19:44,110 --> 00:19:48,490
+عملنا جماعة percussion على المكان اللي فيه
+
+258
+00:19:48,490 --> 00:19:55,450
+الـNemothorax هنسمع hyper resonance لإيش؟ لأنه إيش
+
+259
+00:19:55,450 --> 00:19:59,250
+فيه؟ فيه هوا صار، صارت طبلة، مش هيك، فهيكون فيه
+
+260
+00:19:59,250 --> 00:19:59,930
+hyper resonance
+
+261
+00:20:04,650 --> 00:20:09,270
+ولو سمعناها قعدت بالسماعة الـ chest تبع المريض هي
+
+262
+00:20:09,270 --> 00:20:14,610
+ده هتلاقي diminished air entry أو absent حتى لأنه
+
+263
+00:20:14,610 --> 00:20:20,460
+فعليًا المريض ما بيقدرش ياخد إيشولا Deep Breathing
+
+264
+00:20:20,460 --> 00:20:26,120
+ويوصل النفس للـBase of the Lung وزي ما حكينا
+
+265
+00:20:26,120 --> 00:20:30,340
+الـHyper Resonance Sound بكون في الـPercussion
+
+266
+00:20:30,340 --> 00:20:34,080
+واضح إن الـMedical Management إنه يحط للمريض هذا
+
+267
+00:20:34,080 --> 00:20:37,840
+Chest Tube علشان يروحوا من
+
+268
+00:20:40,700 --> 00:20:44,800
+الكمية الـ «air» اللي بتعمل accumulation في الـ
+
+269
+00:20:44,800 --> 00:20:49,620
+plural space وبتعمل ضغط pressure على الـ lung
+
+270
+00:20:49,620 --> 00:20:58,230
+وبالتالي بتخليها تصير collapseفي الـ «نيموثوركس»
+
+271
+00:20:58,230 --> 00:21:01,630
+عادةً الـ «دياميتر» تبع الـ «تشست تيوب» اللي بدنا
+
+272
+00:21:01,630 --> 00:21:07,150
+هيه بيكون يعني 28 في الـ Adult يعني المقصود أنه
+
+273
+00:21:07,150 --> 00:21:10,570
+صغير أقل من الـ «هيموثوركس» الـ «هيموثوركس» بالزمن
+
+274
+00:21:10,570 --> 00:21:13,970
+الـ «دياميتر» يكون كبير لأنه اللي بده يطلع Blood و
+
+275
+00:21:13,970 --> 00:21:17,230
+الـ Blood زي ما بنعرف أحنا أنه بيحتوي على خلايا مش
+
+276
+00:21:17,230 --> 00:21:20,890
+بس Fluid و could be thick والبسكوتس تبعته because
+
+277
+00:21:20,890 --> 00:21:25,710
+ofاللي هو الـ Cells ممكن تكون عالية وبالتالي ممكن
+
+278
+00:21:25,710 --> 00:21:31,750
+يصير فيه فرصة لإنه يتجلق ويسكر، يصير فيه Occlusion
+
+279
+00:21:31,750 --> 00:21:37,390
+فعشان هيك احنا عادة بفضله إنه يكون الـ «chest
+
+280
+00:21:37,390 --> 00:21:41,610
+drain» تبع الهيموثوركس في حال إنه المريض عنده
+
+281
+00:21:41,610 --> 00:21:47,590
+هيموثوركس يكون أكبر وعادة بختاره 32 في الـ Adult
+
+282
+00:21:48,180 --> 00:21:52,740
+طبعاً موضوع الـ «chest tube» والـ«pressure» تبع
+
+283
+00:21:52,740 --> 00:21:56,960
+الميّه هحكي عنه هنا بالتفصيل فكرة الـ«chest tube»
+
+284
+00:21:56,960 --> 00:21:59,700
+زي ما حكينا يا جماعة بصوا كيف أنه أنا فيه
+
+285
+00:21:59,700 --> 00:22:03,200
+«endolung» وفيها accumulation للـ«fluid» أو
+
+286
+00:22:03,200 --> 00:22:07,680
+الـ«air» هنا فبيجي الطبيب ويركّب اللي هو بعمل
+
+287
+00:22:07,680 --> 00:22:12,240
+باستخدام الـ«truchar» و«chest drainage»والـ Chest
+
+288
+00:22:12,240 --> 00:22:20,000
+Tube وبيدخل فيه اللي هو الـ Thoracic Cavity من الـ
+
+289
+00:22:20,000 --> 00:22:23,600
+Third Inter-, يعني ال Fifth والFourth Intercostal
+
+290
+00:22:23,600 --> 00:22:29,050
+Spaceوالآن يعني كل التوجيهات إن لو كان «نيمو» أو
+
+291
+00:22:29,050 --> 00:22:32,770
+«هيمو توراكس» يكون الـChest Tube low في الـFifth
+
+292
+00:22:32,770 --> 00:22:37,890
+Intercoastal Space، كويس، فخشش الـTube استقر هنا،
+
+293
+00:22:37,890 --> 00:22:41,770
+الآن الـTube هذا هيحمل إيش، ويطلع إيش موجود جوا،
+
+294
+00:22:41,770 --> 00:22:46,350
+إذا Fluid، يعني Blood أو Air، ويبدو يطلع فيهويدخل
+
+295
+00:22:46,350 --> 00:22:50,050
+فيه ويمشي فيه هذا الـDrain. الآن، لو انا بدأ أحط
+
+296
+00:22:50,050 --> 00:22:53,570
+في الـDrain أي نوع من الـDrains، أنا بخاف إن
+
+297
+00:22:53,570 --> 00:22:59,410
+الـDrain يجي اللي بده يطلع يعود، يدخل تاني، أو
+
+298
+00:22:59,410 --> 00:23:03,050
+الـAtmospheric Pressure يكون فيه فرصة إنه يدخل هنا
+
+299
+00:23:03,050 --> 00:23:08,050
+تاني، فعلشان ذلك، لازم هذا يستقر في System يسمح
+
+300
+00:23:08,050 --> 00:23:12,480
+بالدخول ولا يسمح بالخروج.فعشان هيك فيه هنا water
+
+301
+00:23:12,480 --> 00:23:16,360
+level زي ما انتوا شايفين فيه هنا water أياته water
+
+302
+00:23:16,360 --> 00:23:19,660
+level طبعا هو هذا مش كله water level ال water
+
+303
+00:23:19,660 --> 00:23:23,640
+level بيكون مثلا لإن 200 أو 300 عادة بيكون فيه خط
+
+304
+00:23:23,640 --> 00:23:28,580
+كامل مستدير هنا بتكون عملاء الشركة المصنعة بيحكي
+
+305
+00:23:28,580 --> 00:23:33,150
+لك إن هذا ال water level وبنسميه احناDead Space
+
+306
+00:23:33,150 --> 00:23:39,290
+يعني مثلا إذا كان ال water level 300 و جيت بعد تلت
+
+307
+00:23:39,290 --> 00:23:47,890
+ساعات وجدت أن في عند المريض500 CC دريناجي،
+
+308
+00:23:47,890 --> 00:23:53,050
+Fluid أو Blood أو مهما 500 CC، ففعليا المريض مطلق
+
+309
+00:23:53,050 --> 00:23:56,850
+بس 200 لأنه كان في عنده water level 300، يبقى
+
+310
+00:23:56,850 --> 00:24:00,770
+المريض مطلق بس 200، لو كان هنا ال water level كان
+
+311
+00:24:00,770 --> 00:24:05,210
+300، again، وانا دائما بكرر كلمة 300 لأنه عادة ال
+
+312
+00:24:05,210 --> 00:24:08,370
+water levels اللي بنستخدم في ال-chest tube اللي
+
+313
+00:24:08,370 --> 00:24:14,480
+موجود هنا هو 300 CCووجدت إنه بعد أكم ساعة الصبح،
+
+314
+00:24:14,480 --> 00:24:20,820
+يا سيدي بعد 24 ساعة كان المريض كل ال fluid level
+
+315
+00:24:20,820 --> 00:24:26,360
+عنده حوالي 1100، آه 1100، عيني الـ300 بضل عنده
+
+316
+00:24:26,360 --> 00:24:36,270
+أكم، آه، يا مين حسب؟700 CC 700 CC اه 700 غلط مش
+
+317
+00:24:36,270 --> 00:24:42,130
+700 800 برافو عليكم 800 CC لأنه بدنا نعيد من ال
+
+318
+00:24:42,130 --> 00:24:48,890
+1100 300 يعني بيظل 800 CC يبقى المريض جاب 800 CC و
+
+319
+00:24:48,890 --> 00:24:51,390
+هدول ال water level طب ليش موجودين ال water level
+
+320
+00:24:51,390 --> 00:24:54,170
+هدول؟ اه موجودين ال water level هدول عشان ييجي ال
+
+321
+00:24:54,170 --> 00:24:58,600
+drain من هن من هن من هن و يصب في قلبالـ Tube اللي
+
+322
+00:24:58,600 --> 00:25:03,400
+نازل واصل عند الـ 300 CC تبعث إنه اللي بنزل يخش في
+
+323
+00:25:03,400 --> 00:25:06,740
+الميّه بس مافيش إيش من الميّه ممكن يرجع، صح؟ مافيش
+
+324
+00:25:06,740 --> 00:25:10,020
+أي كمية، مافيش هوا في الميّه، ومافيش .. الميّه مش
+
+325
+00:25:10,020 --> 00:25:12,860
+ممكن تسحبها لو تطلع عكس الـ Gravity وتخش في
+
+326
+00:25:12,860 --> 00:25:15,980
+المريض، آه الـ Gravity، يبقى ال принцип المهم هنا
+
+327
+00:25:15,980 --> 00:25:20,540
+مش لازم ننساه إن الـ Chest Tube هذا لازم يكون تحت
+
+328
+00:25:20,540 --> 00:25:27,020
+الـ Gravity، يعني في مستوىأقل من المريض بمعنى أن
+
+329
+00:25:27,020 --> 00:25:29,580
+الـ «principle» اللي بيشتغل عليه هو الـ «gravity»
+
+330
+00:25:29,580 --> 00:25:32,460
+تمام؟ كمان والـ «suction» يا جماعة هو ممكن احنا
+
+331
+00:25:32,460 --> 00:25:37,600
+نشبك فيه هنا «suction» ويصير بيعمل «suctioning»
+
+332
+00:25:37,600 --> 00:25:41,000
+ولكن في كل الحالة اللي لازم يكون في مستوى أقل من
+
+333
+00:25:41,000 --> 00:25:44,600
+ال «chest» لو المريض نايم بيكون أقل لو المريض صار
+
+334
+00:25:44,600 --> 00:25:48,340
+in sitting position برضه بيكون أقل منه أه مايصيرش
+
+335
+00:25:48,340 --> 00:25:51,780
+في مستوى لأن هذا ممكن يصير في مستوى يمنع ال
+
+336
+00:25:51,780 --> 00:25:56,020
+«drainage» ويخلّي المريضأو الـ Respiration Status
+
+337
+00:25:56,020 --> 00:25:59,960
+أو العكس
+
+338
+00:25:59,960 --> 00:26:04,680
+طبعاً أنا في أني هذا اسمه Open System زي ما احنا
+
+339
+00:26:04,680 --> 00:26:12,760
+شايفين الـDrainage بتطلع وبنصب في الـTube هذافيه
+
+340
+00:26:12,760 --> 00:26:15,600
+فتحتين، واحدة منها، يا جماعة، لازم تكون مفتوحة لأن
+
+341
+00:26:15,600 --> 00:26:20,180
+هذه عبارة مفتوحة، لكن بتلاقي فيها valve، valve
+
+342
+00:26:20,180 --> 00:26:24,040
+عشان يقل، عشان احنا بنعرف إن هذه الكمية الفارقة من
+
+343
+00:26:24,040 --> 00:26:28,160
+هنا إلى هنا، هي عبارة عن هواء، لأنه مافيش إش فارق،
+
+344
+00:26:28,160 --> 00:26:31,760
+صح؟ الآن لما بديش يطلع fluid من هنا، بديش يشغل
+
+345
+00:26:31,760 --> 00:26:36,710
+حيز، لازم بداره يطلع من الـPot، هذا إيش؟هواء،
+
+346
+00:26:36,710 --> 00:26:41,130
+فعشان هيك هنا بيكون فيه «valve» مشبوك يعني مفتوح
+
+347
+00:26:41,130 --> 00:26:45,310
+بحيث أنه يسمح للهواء بالخروج من ال «lung» ولا يسمح
+
+348
+00:26:45,310 --> 00:26:50,070
+له بالدخول، هذه بيعملوها عشان أنا ممكن أكون محتاج
+
+349
+00:26:50,070 --> 00:26:55,010
+أن أشبك الـ «system» هذا على suction بحيث أنه
+
+350
+00:26:55,010 --> 00:27:00,850
+يساعد في عملية ال «drainage» تبع السوائلالـ
+
+351
+00:27:00,850 --> 00:27:06,890
+Greenwich تبعت السوائل حاجة
+
+352
+00:27:06,890 --> 00:27:11,290
+مهمة جدا ممكن تصير فيها منها مشكلة كبيرة لو واحد
+
+353
+00:27:11,290 --> 00:27:15,370
+بالخطأ راح شبك لتيوب هذا بدل ما هو في المكان اللي
+
+354
+00:27:15,370 --> 00:27:19,930
+فيه لتيوب اللي نازل للميّه شبكه في أحد لتيوبات
+
+355
+00:27:19,930 --> 00:27:24,550
+هدول معناه إنه المريض هيبدأ الهوى اللي هنا يستطيع
+
+356
+00:27:24,550 --> 00:27:28,730
+يلاقي منفذ له طبعا الخطر إنه بالذات لو شبكه في هذا
+
+357
+00:27:31,040 --> 00:27:34,640
+اللي هو تبقى الـ «Suction» ماعندهوش «Valve» الـ
+
+358
+00:27:34,640 --> 00:27:36,600
+«Han» تبقى الـ «Suction» ماعندهوش «Valve» لو شبكوا
+
+359
+00:27:36,600 --> 00:27:41,700
+«Han» ممكن مايصيلش مشكلة مؤقتاً لأنه بيسمح للهواء
+
+360
+00:27:41,700 --> 00:27:45,040
+بالخروج أو لا يسمح له بالدخول، لأ برضه هتصيح
+
+361
+00:27:45,040 --> 00:27:48,020
+المشكلة لإن الهواء اللي هنا هيكون فيه إمكانية له
+
+362
+00:27:48,020 --> 00:27:53,100
+أنه يخرج فممكن يخرج ويصير إيشلداخل المريض، ولو هنا
+
+363
+00:27:53,100 --> 00:27:57,480
+نفس الحاجة، هيخرج ويصير في المريض ويصير محتبس
+
+364
+00:27:57,480 --> 00:28:02,020
+وهيعمل حاجة نسميها surgical emphysema، تمام؟ لذلك
+
+365
+00:28:02,020 --> 00:28:06,500
+من الخطر جدا إن أنا أكون في عملية خطأ أثناء تركيب
+
+366
+00:28:06,500 --> 00:28:10,100
+الـChest Drain هذا وبدل ما أركبه في الـTube اللي
+
+367
+00:28:10,100 --> 00:28:15,870
+بنزل على الميّه أشبكه في أحد المداخلالتانية للـ
+
+368
+00:28:15,870 --> 00:28:19,270
+Chest Puddle، كويس؟ هذا نظام من أنظمة الـChest
+
+369
+00:28:19,270 --> 00:28:23,350
+Tube في نظام تاني، طبعاً هي الفكرة تبعته اللي أنا
+
+370
+00:28:23,350 --> 00:28:28,030
+كنت يعني بأشرح فيها كيف الـFluid بطلع، بشغل، كل ما
+
+371
+00:28:28,030 --> 00:28:32,470
+بطلع الـFluid لازم إيش؟ بطلع في الميّه، تمام؟
+
+372
+00:28:32,470 --> 00:28:35,530
+وبالتالي بطلع من هنا الـValve اللي حكيته كان عشان
+
+373
+00:28:35,530 --> 00:28:42,210
+يعني الكمية اللي دخلت تشغل حيز من الفراغ هذا فبطلع
+
+374
+00:28:42,210 --> 00:28:47,810
+بدالها هواتمام؟ دائما بكون يا جماعة احنا ملاحظين
+
+375
+00:28:47,810 --> 00:28:52,570
+انه في مرحلة ان المريض بعمل Inspiration بتلاقي انه
+
+376
+00:28:52,570 --> 00:28:57,110
+صار فيه طلع شوية من الميه اللي هنا طلعت فيه لـTue
+
+377
+00:28:57,110 --> 00:29:00,310
+في ال Expiration بتعاود بتنزل يعني هنا في حركة
+
+378
+00:29:00,310 --> 00:29:04,510
+متغيرة أه بتطلع بس مش هتوصل لمستويات عالية أبدا
+
+379
+00:29:04,510 --> 00:29:08,360
+أبدامش هتوصل أبدا لمستوية على بس هتظل في البربيج
+
+380
+00:29:08,360 --> 00:29:11,540
+لإن اتفاقنا إنه لازم يكون الـWater seal هذا بمستوى
+
+381
+00:29:11,540 --> 00:29:17,940
+أقل من الصدر ولكن حركة حركة الـFluid هذه في داخل
+
+382
+00:29:17,940 --> 00:29:21,840
+الـTube هذا اللي بنسميها Fluctuation يعني بتتردد،
+
+383
+00:29:21,840 --> 00:29:28,300
+بتطلع شوية و بتنزل شوية، هذه هي المؤشرالمهم على إن
+
+384
+00:29:28,300 --> 00:29:34,200
+الـ chest tube هذا function شغال ومافيش .. ومش
+
+385
+00:29:34,200 --> 00:29:37,640
+closure وبيقدر الوظيفة تبعته إذا إيش اسم هذه
+
+386
+00:29:37,640 --> 00:29:41,220
+الحركة اللي لازم أنا أتبعها fluctuation؟ وإيش أنا
+
+387
+00:29:41,220 --> 00:29:46,160
+لازم أسوي عشان أعرفها؟ يجب أجي و بطلعبحط الـ
+
+388
+00:29:46,160 --> 00:29:50,300
+«water seal» على مستوى اللي هو مستوي يعني على الـ
+
+389
+00:29:50,300 --> 00:29:55,240
+«ground» مثلًا وببدأ أنا أطلع أشوف هل في حركة نفس
+
+390
+00:29:55,240 --> 00:29:57,760
+المريض في الـ «fluctuation» في الـ «tube» يعني
+
+391
+00:29:57,760 --> 00:30:03,680
+المستوى الـ «water» بطلع وبنزل في حركة ترددية أو
+
+392
+00:30:03,680 --> 00:30:06,940
+ممكن أطلب من المريض أن يعمل «cuff» لأنه هيك بيغير
+
+393
+00:30:06,940 --> 00:30:10,000
+الـ «thoracic pressure» واحنا عارفين أن هذه الحركة
+
+394
+00:30:10,000 --> 00:30:12,940
+الترددية بتصير مع التغير في الـ «intra thoracic
+
+395
+00:30:12,940 --> 00:30:16,830
+pressure» أو باطلب منه أنهيعمل الـ Deep Breathing
+
+396
+00:30:16,830 --> 00:30:21,010
+يأخذ نفسه ويطلع فالمفروض أنه الـ Intra- Thoracic
+
+397
+00:30:21,010 --> 00:30:24,410
+Pressure بدوا يسيله تغير واضح وبالتالي المفروض أن
+
+398
+00:30:24,410 --> 00:30:28,270
+أنا أشوف Fluctuation واضحة وهذه من الحاجات المهمة
+
+399
+00:30:28,270 --> 00:30:34,390
+جدا والتي تتعلق مباشرة بالمراقبة التمريدية إذا الـ
+
+400
+00:30:34,390 --> 00:30:38,310
+Nursing Intervention أو الـ Nursingالـ role المهم
+
+401
+00:30:38,310 --> 00:30:42,310
+في موضوع الـ chest tube أنا مراقبة مش بس الكميات
+
+402
+00:30:42,310 --> 00:30:46,330
+اللي بدها تطلع و الـ function تبعت الـ chest tube
+
+403
+00:30:46,330 --> 00:30:51,710
+هذا هو شكل الـ chest tube اللي لما بكون جديد أحد
+
+404
+00:30:51,710 --> 00:30:57,750
+يعني أنواعه طبعا في العادة إنه ما بكونش فيه تلاتة
+
+405
+00:30:57,750 --> 00:31:03,270
+في واحد بنشبط في المريض هو اللي متصل في الأنبوب
+
+406
+00:31:03,270 --> 00:31:08,070
+اللي نازل زي ما حكينا لمستوى الميّهوالفتحة التانية
+
+407
+00:31:08,070 --> 00:31:13,010
+اللي هي يا بتسمح بإنه يطلع الهواء يا أنت بتشبك
+
+408
+00:31:13,010 --> 00:31:19,750
+فيها suction أصلا علشان إيش تزود ال suction وال
+
+409
+00:31:19,750 --> 00:31:23,490
+drainage من ال patient هذا شكله الحقيقي لو كنا
+
+410
+00:31:23,490 --> 00:31:31,290
+شبكينه على مريض بحق لاحظ إنه هناأيش لهم الـ«تيوب»؟
+
+411
+00:31:31,290 --> 00:31:33,990
+ده بقيت الـ«تيوب» اللي نازل أحمر لإيش؟ لأنه فيه دم
+
+412
+00:31:33,990 --> 00:31:37,750
+اللي جاي من المريض طبعاً مجرد ما بتصفط دم هذا برجع
+
+413
+00:31:37,750 --> 00:31:41,010
+مستوى الـ«fluid» لهنا ويبدأ يعمل حركة
+
+414
+00:31:41,010 --> 00:31:44,550
+الـ«fluctuation» اللي حكينا عنها مع النفس فده كان
+
+415
+00:31:44,550 --> 00:31:51,210
+نظام اسمهيعني one chamber زي ما شوفته لكن هنا فيه
+
+416
+00:31:51,210 --> 00:31:59,510
+نوع تاني من الـ«تشست تيوب» أكتر من الـ«تشامبر» زي
+
+417
+00:31:59,510 --> 00:32:06,870
+ما شايفينه هذا هو الشكل التجاري أو الشكل الموجود
+
+418
+00:32:06,870 --> 00:32:10,890
+أكتر من الـ«تشامبر» بس خليني أشوفه تشريحيا يعني
+
+419
+00:32:10,890 --> 00:32:14,010
+إيه كيف بالظبط وإيش اللي بيصير فيهالـ Fluid بتيجي،
+
+420
+00:32:14,010 --> 00:32:18,190
+بس مافيش Tube ينزلها لمستوى الميّه «طب ها كيف مش
+
+421
+00:32:18,190 --> 00:32:24,190
+لازم ننزل؟» الهدف من مستوى الميّه إنه يمنع إطلاقا
+
+422
+00:32:24,190 --> 00:32:28,690
+ارتجاع السوائل «هنا أمنينا الفكرة بطريقة أخرى»
+
+423
+00:32:28,690 --> 00:32:31,890
+«الميّه موجودة بس في مكان تاني بحيث أنها تعملي
+
+424
+00:32:31,890 --> 00:32:39,270
+pressure»كويس فإيش اللي بيصير ال fluid أو ال أو
+
+425
+00:32:39,270 --> 00:32:45,110
+الهوى حتى إذا بيجي من المريض وفيه أول chamber
+
+426
+00:32:45,110 --> 00:32:48,430
+يستقبله زادت الكمية وانت لا بعب في ال chamber
+
+427
+00:32:48,430 --> 00:32:50,830
+التاني زادت الكمية وانت لا بعب في ال chamber
+
+428
+00:32:50,830 --> 00:32:54,530
+التالت زادت الكمية وانت لا بعب في ال chamber اللي
+
+429
+00:32:54,530 --> 00:32:58,660
+بعده كل اللي بيعبي هذا حتى لو كانمش fluid، هوى،
+
+430
+00:32:58,660 --> 00:33:01,980
+هنشوف هذا هوى، هذا الاسم هذه هوى، هوى، هوى، هوى،
+
+431
+00:33:01,980 --> 00:33:04,160
+هوى، زاد، زاد، هوى، هوى، هوى، هوى، هوى، زاد، زاد،
+
+432
+00:33:04,160 --> 00:33:04,260
+هوى، هوى، هوى، هوى، هوى، هوى، هوى، هوى، هوى، هوى،
+
+433
+00:33:04,260 --> 00:33:04,360
+هوى، هوى، هوى، هوى، هوى، هوى، هوى، هوى، هوى، هوى،
+
+434
+00:33:04,360 --> 00:33:05,760
+هوى، هوى، هوى، هوى، هوى، هوى، هوى، هوى، هوى، هوى،
+
+435
+00:33:05,760 --> 00:33:19,880
+هوى، هوى، هوى،
+
+436
+00:33:19,880 --> 00:33:24,360
+هوى،
+
+437
+00:33:25,440 --> 00:33:28,460
+الـ Water seal اللي موجود، السطح المائي اللي موجود
+
+438
+00:33:28,460 --> 00:33:32,600
+وبالتالي بدأ إيش يزيد إذا كان الهواء هيبدأ يطلع من
+
+439
+00:33:32,600 --> 00:33:36,020
+السطح المائي ويله هنا مكان زي ما أحنا شايفين،
+
+440
+00:33:36,020 --> 00:33:41,400
+Valve بيسمح له إنه أو suction يشفطته to help
+
+441
+00:33:41,400 --> 00:33:45,280
+remove air from plural space but not exist لكن ال
+
+442
+00:33:45,280 --> 00:33:50,710
+suction اللي بنعمله عادة مش أكتر من-20 يعني مش
+
+443
+00:33:50,710 --> 00:33:53,730
+أكتر من الـ one لأنه لازم يكون هنا negative
+
+444
+00:33:53,730 --> 00:33:56,670
+pressure يا جماعة عشانك ال pressure بالـ بالcell
+
+445
+00:33:56,670 --> 00:34:04,170
+مش لازم يكون أكتر من عشرين طبعا
+
+446
+00:34:04,170 --> 00:34:10,550
+في هناالنظام، هذا لو كنت أشبكه في suction في نظام
+
+447
+00:34:10,550 --> 00:34:15,050
+هنا إن إحنا بنحط ميّه في هذا البوتل، هذا البوتل
+
+448
+00:34:15,050 --> 00:34:19,770
+مستقل عنهم، لاحظوا ممسكّر من هنا، لاحظين؟ ممسكّر
+
+449
+00:34:19,770 --> 00:34:23,610
+من هنا يعني، لاحظوا؟ ممسكّر، وبس بنحط الميّه هيه،
+
+450
+00:34:23,610 --> 00:34:27,100
+من هنا، من هنا، فبتعبي وينفل ال chamber هذالوين
+
+451
+00:34:27,100 --> 00:34:29,480
+مستوى الميّه بيوصل لـ «هان»؟ مستوى الميّه هذا
+
+452
+00:34:29,480 --> 00:34:34,460
+بيعملّي pressure minus 20 لحاله فبيسهّل فيه يعني
+
+453
+00:34:34,460 --> 00:34:38,080
+بيخلّي دايماً دايماً طالع هي مفتوح من «هان» لـ
+
+454
+00:34:38,080 --> 00:34:41,920
+«هان» في فتحة بوجود الميّه اللي «هان» فإيش
+
+455
+00:34:41,920 --> 00:34:44,980
+هيعملّي؟ هيعملّي negative pressure اللي هو عبارة
+
+456
+00:34:44,980 --> 00:34:50,280
+عن minus 20 عن طريق 20 centimeter ميّه بس أنا هحطه
+
+457
+00:34:50,280 --> 00:34:53,960
+20 centimeter ميّه
+
+458
+00:34:54,940 --> 00:34:58,080
+عفوًا، عن طريق كمية الميّه اللي أنا أحطها حسب
+
+459
+00:34:58,080 --> 00:35:01,140
+تعليمات الجهاز اللي هتعمل ليه pressure قدره 20
+
+460
+00:35:01,140 --> 00:35:05,740
+صنطي فيه
+
+461
+00:35:05,740 --> 00:35:09,900
+الـ... الـ... يعني الطول تبع الميّه اللي بنحطها 20
+
+462
+00:35:09,900 --> 00:35:14,720
+صنطي متر بيعملوليه pressure minus 20 عشان يظلوا
+
+463
+00:35:14,720 --> 00:35:20,440
+بشكل مستمر يعمل suctioning لـ«البيانات» ويطلع
+
+464
+00:35:20,440 --> 00:35:25,290
+الـ«فلويد» ويعمل drainage systemهذا شكله الـ
+
+465
+00:35:25,290 --> 00:35:28,830
+Nursing Management المهم لواحد عنده الـ chest tube
+
+466
+00:35:28,830 --> 00:35:33,650
+أنه يضل زي ما حكينا ال system ي close و يضلوا تحت
+
+467
+00:35:33,650 --> 00:35:38,550
+ال chest level يضل ال connections و ال tube
+
+468
+00:35:41,150 --> 00:35:46,610
+بأمان ولا أحد يحاول إنه يشدها مثلا أو تكون فيها
+
+469
+00:35:46,610 --> 00:35:53,710
+kinking دايما نتأكد إنه إذا مشبوك على سواء
+
+470
+00:35:53,710 --> 00:35:58,930
+الـwater suction أو الـwall suction سواء water
+
+471
+00:35:58,930 --> 00:36:01,470
+suction أو wall suction إنه مايكونش ال pressure
+
+472
+00:36:01,470 --> 00:36:08,170
+أكتر من عشرينيعني مايكونش أجال أكتر من negative 20
+
+473
+00:36:08,170 --> 00:36:12,230
+لو كان في الميه هيكون عن طريق إن أحط بس 20
+
+474
+00:36:12,230 --> 00:36:18,470
+centimeter ميه هيعمللي pressure minus 20 تمام؟ لو
+
+475
+00:36:18,470 --> 00:36:23,070
+كان بال wall suction برضه بدك تعمله regulation إنه
+
+476
+00:36:23,070 --> 00:36:25,410
+يكون negative 20 مش أكتر
+
+477
+00:36:29,610 --> 00:36:34,410
+دائما ضروري أن نشوف تعليمات كل الشركة المصنعة على
+
+478
+00:36:34,410 --> 00:36:37,790
+الـ«بوتلز»
+
+479
+00:36:37,790 --> 00:36:43,700
+لأنها ممكن تكون بتختف من شركة لأخرى اللي بهمناإحنا
+
+480
+00:36:43,700 --> 00:36:48,740
+بشكل عام إنه المريض هذا لازم يكون تحت المراقبة
+
+481
+00:36:48,740 --> 00:36:53,280
+وأعرف إنه فعلا الـ Chesty tube يشتغل بشكل صحيح عن
+
+482
+00:36:53,280 --> 00:36:56,840
+طريق إنه يكون فيه fluctuation زي ما حكينا، إيش
+
+483
+00:36:56,840 --> 00:37:03,470
+يعني؟ يعني تردد في الـ tube نتيجة إيشمع تغيير أو
+
+484
+00:37:03,470 --> 00:37:06,570
+مع الـ «chest movement» مع تغيير الـ«pressure»
+
+485
+00:37:06,570 --> 00:37:09,090
+الانتراثولوجيكي أنا عشان أعمل الحاجة هذه لازم أخلي
+
+486
+00:37:09,090 --> 00:37:12,870
+المريض يعمل DB bleed and cough ويمكن استخدام
+
+487
+00:37:12,870 --> 00:37:17,410
+الـ«Spirometer» أو الـ«Spirometer» عشان فعلا بيخلي
+
+488
+00:37:17,410 --> 00:37:21,150
+الـ«lung expansion» يتزيدوفعلاً بيخلّيني أشوف
+
+489
+00:37:21,150 --> 00:37:25,990
+التردد بشكل كويس المريض ممكن يكون عنده ألم لازم
+
+490
+00:37:25,990 --> 00:37:30,390
+أراقبه وإذا عنده ألم because of the chest tube أو
+
+491
+00:37:30,390 --> 00:37:32,510
+because of ال trauma الأساسية اللي عنده إنه
+
+492
+00:37:32,510 --> 00:37:36,770
+انكتبله الـ Analytic medication as prescribed
+
+493
+00:37:36,770 --> 00:37:40,810
+وتنعطالهلازم يكون فيه مراقبة للـ «فايتل ساينس»
+
+494
+00:37:40,810 --> 00:37:47,090
+بقعة المريض ولازم يكون فيه من فترة للتانية عمل
+
+495
+00:37:47,090 --> 00:37:52,730
+«سيكويزينج» للتعصير له و «ميلكينج» للـ«تشست»
+
+496
+00:37:52,730 --> 00:37:56,830
+الـ«تيوب» عشان ما يكونش فيهم تجمعات ويصير فيه
+
+497
+00:37:56,830 --> 00:38:01,050
+sudden closure عند المريض وفجأة يبدأ يخش فيه
+
+498
+00:38:01,050 --> 00:38:06,200
+مضاعفاتكمان يا جماعة، لازم ينعمل الـ Dressing لـ
+
+499
+00:38:06,200 --> 00:38:11,060
+«جسد» الـ Tube اللي هو يعني الـ Attachment و الـ
+
+500
+00:38:11,060 --> 00:38:14,420
+Contact تبعته و الـ Penetrating Site وين دخل الـ
+
+501
+00:38:14,420 --> 00:38:19,830
+Tube لـ Plural Space هنا المكان هذاهيه ريسك إنه
+
+502
+00:38:19,830 --> 00:38:24,350
+يصير عنده infection في لازم ينعمله dressing ويتغطى
+
+503
+00:38:24,350 --> 00:38:31,010
+بـ sterile cover والأحسن إنه ما يكونش ال dressing
+
+504
+00:38:31,010 --> 00:38:37,530
+تبعه يعني frequently إلا إذا صار wet عشان نمنع إنه
+
+505
+00:38:37,530 --> 00:38:43,070
+يصير infectedأهم حاجة أنه لما تبتدي تعمل «Mail
+
+506
+00:38:43,070 --> 00:38:49,910
+King» ما تسحبش لطيوب بشكل قوي فانت تروح و انت
+
+507
+00:38:49,910 --> 00:38:56,690
+رافعه من مكانه تراقب انه لطيوب مايكونش فيه عنده
+
+508
+00:38:56,690 --> 00:39:01,310
+«King King» يعني فيه التوقات أو ما يمنع ان
+
+509
+00:39:01,310 --> 00:39:06,250
+الانسيابية تبعت السوائل لو حصل ان المريض احتاج
+
+510
+00:39:06,250 --> 00:39:12,570
+جماعة انه مثلايعمل أي بروسيجر مثلا بدنا ننقله من
+
+511
+00:39:12,570 --> 00:39:17,810
+مكان لمكان أو بدنا نعمله أي بروسيجر X-ray بما
+
+512
+00:39:17,810 --> 00:39:22,350
+نفترض وما بدناش يكون يعني الـ chest tube شجّات
+
+513
+00:39:23,410 --> 00:39:29,210
+فبنعمل حاجة نسميها «Clamping» لـ «Chest Tube» خد
+
+514
+00:39:29,210 --> 00:39:33,090
+بالك جدا إن الـ «Clamping» هذا لازم يكون وقته قصير
+
+515
+00:39:33,090 --> 00:39:38,270
+ينعمل بـ «حذر»
+
+516
+00:39:38,270 --> 00:39:41,950
+وعن طريق استخدام الـ «Forceps» المناسبة ومن
+
+517
+00:39:41,950 --> 00:39:47,810
+الأماكن الصحيحة يعني الـ «Chest Tube» عادة إن
+
+518
+00:39:47,810 --> 00:39:50,190
+الجماعة بكون إدارة عن الـ «Tube» بدخل في المريض
+
+519
+00:39:50,190 --> 00:39:55,600
+بعدين بيجي connection علشانيعني أدابتور حاجة بتيجي
+
+520
+00:39:55,600 --> 00:39:59,500
+زي توصيلة ما بين التيوب اللي دخل في المريض وبربيج
+
+521
+00:39:59,500 --> 00:40:02,940
+الكبير لتيوب الكبير اللي بده يشبك وين في الـPotel
+
+522
+00:40:02,940 --> 00:40:06,760
+فدائما الـ Clamp بينعمل من البربيج الأول من التيوب
+
+523
+00:40:06,760 --> 00:40:11,080
+الأول اللي في المريض ببعد مثلا عشرة صنط عن المريض
+
+524
+00:40:11,080 --> 00:40:15,260
+و بعمل بجيب شاشة و forceps بحط الشاشة على التيوب
+
+525
+00:40:15,260 --> 00:40:19,280
+عشان ماعملش damage للتيوب و بعدين بعمل clamping في
+
+526
+00:40:19,280 --> 00:40:22,420
+ال forceps في ناس ممكن تغلط و تروح تعمل clamping
+
+527
+00:40:22,420 --> 00:40:26,400
+بعدفي اليوتيوب، خلّيني أرجع على الصورة عشان يكون
+
+528
+00:40:26,400 --> 00:40:33,490
+الكلام مواضح مثلا، نعتبر أنه، نشوف مريض؟تمام نعتبر
+
+529
+00:40:33,490 --> 00:40:37,570
+ان ال connection في المنطقة هذه الحمرة او نجربها
+
+530
+00:40:37,570 --> 00:40:41,730
+نعتبر ال connection هنا التوصيلة بين ال tube هذا و
+
+531
+00:40:41,730 --> 00:40:45,170
+ال tube اللي نازل تمام نعتبر ان الساهم هذا هو
+
+532
+00:40:45,170 --> 00:40:48,230
+التوصيلة لما بدك تعمل climate لازم تعمله في
+
+533
+00:40:48,230 --> 00:40:52,110
+المنطقة هنا مش في المنطقة هنا اعتبر ان انت عملت في
+
+534
+00:40:52,110 --> 00:40:55,330
+المنطقة هنا و فجأة حركة المريض اللي هو من عند ال
+
+535
+00:40:55,330 --> 00:40:59,150
+connection راح ايش فلت فانت سمحت للهوى فعلا انه
+
+536
+00:40:59,150 --> 00:41:06,660
+يدخل وهذا بيكون مش صحيحهذا بالنسبة للحاجات اللي
+
+537
+00:41:06,660 --> 00:41:11,160
+لازم ناخد بالنا منها الـ Clamp لو عملناه للمريض زي
+
+538
+00:41:11,160 --> 00:41:15,380
+ما حكينا لازم يكون وقته قصير بهدف إنه نعمل الإجراء
+
+539
+00:41:15,380 --> 00:41:17,880
+مثلا نقل مريض ليه أجوز أن أنقل مريض من مكان إلى
+
+540
+00:41:17,880 --> 00:41:20,760
+مكان وهو موجودين لـChest Tube ممكن مع الحركة
+
+541
+00:41:20,760 --> 00:41:25,210
+يفلتوا فجأة مني، لأأنا بفلطهم براتب، بفكهم يعني و
+
+542
+00:41:25,210 --> 00:41:27,630
+بحافظ على الـStability تبعتهم و بعملي Clamping
+
+543
+00:41:27,630 --> 00:41:31,770
+بالطريقة الصح، آه و ببدأ أنقل فيه من المكان لمكان
+
+544
+00:41:31,770 --> 00:41:35,870
+التاني و بعد ما تخلص عملية النقل برجع بعمل
+
+545
+00:41:35,870 --> 00:41:39,890
+connection لـChesty tubes إلا إذا كان ممكن أن
+
+546
+00:41:39,890 --> 00:41:49,780
+أنقله مع ضمان أنه مايكنش فيه أيفصل لـ Accidentally
+
+547
+00:41:49,780 --> 00:41:55,900
+طبعاً للـ Chest Drainage هيك تقريبا بتكون خلصت
+
+548
+00:41:55,900 --> 00:41:57,840
+محاضرتنا للموضوع هذا
+
diff --git a/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/TzQBApo1yr8_raw.json b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/TzQBApo1yr8_raw.json
new file mode 100644
index 0000000000000000000000000000000000000000..250e7f4fdf1e9f474dc69549cc3877790b77bdf7
--- /dev/null
+++ b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/TzQBApo1yr8_raw.json
@@ -0,0 +1 @@
+{"segments": [{"id": 1, "seek": 179, "start": 0.35, "end": 1.79, "text": "الـ Balmona الإديمة", "tokens": [6027, 39184, 13140, 76, 4037, 33688, 16254, 46007], "avg_logprob": -0.3548177083333333, "compression_ratio": 0.7837837837837838, "no_speech_prob": 0.0, "words": [{"start": 0.35, "end": 0.75, "word": "الـ", "probability": 0.806640625}, {"start": 0.75, "end": 1.13, "word": " Balmona", "probability": 0.6832682291666666}, {"start": 1.13, "end": 1.79, "word": " الإديمة", "probability": 0.6402994791666666}], "temperature": 1.0}, {"id": 2, "seek": 3001, "start": 6.33, "end": 30.01, "text": "زي ما بنحكي في تعريفها هي abnormal accumulation لإيش؟ لـ Fluid، وين؟ مش في الـ Plural، في الـ Lung tissue نفسها، في الـ Alveolar space يعني الـ Alveoli بدل ما فيها هوا صارت مليانة ميّه، Fluid، أهو، طب و هد يعني إيه؟ بغرج يعني المريض؟ لأ، هد بتكون جاية من الـ Accumulation يعني زي ما حكينا ال blood بيجي على", "tokens": [11622, 1829, 19446, 44945, 5016, 4117, 1829, 8978, 37279, 16572, 5172, 11296, 39896, 32847, 35647, 5296, 28814, 1829, 8592, 22807, 5296, 39184, 33612, 327, 12399, 4032, 9957, 22807, 37893, 8978, 2423, 39184, 2149, 1807, 12399, 8978, 2423, 39184, 441, 1063, 12404, 8717, 36178, 11296, 12399, 8978, 2423, 39184, 967, 303, 15276, 1901, 37495, 22653, 2423, 39184, 967, 303, 9384, 47525, 1211, 19446, 8978, 11296, 8032, 14407, 20328, 9640, 2655, 3714, 20292, 7649, 3660, 3714, 1829, 11703, 3224, 12399, 33612, 327, 12399, 5551, 3224, 2407, 12399, 23032, 3555, 4032, 8032, 3215, 37495, 22653, 11933, 1829, 3224, 22807, 4724, 17082, 47341, 37495, 22653, 9673, 16572, 11242, 22807, 5296, 10721, 12399, 8032, 3215, 39894, 30544, 10874, 995, 10632, 9154, 2423, 39184, 5725, 449, 2776, 37495, 22653, 30767, 1829, 19446, 11331, 4117, 1829, 8315, 2423, 3390, 4724, 1829, 7435, 1829, 15844], "avg_logprob": -0.2583786298831304, "compression_ratio": 1.709090909090909, "no_speech_prob": 1.0669231414794922e-05, "words": [{"start": 6.33, "end": 6.89, "word": "زي", "probability": 0.6436767578125}, {"start": 6.89, "end": 7.09, "word": " ما", "probability": 0.935546875}, {"start": 7.09, "end": 7.51, "word": " بنحكي", "probability": 0.83697509765625}, {"start": 7.51, "end": 7.63, "word": " في", "probability": 0.76806640625}, {"start": 7.63, "end": 8.51, "word": " تعريفها", "probability": 0.9881591796875}, {"start": 8.51, "end": 9.35, "word": " هي", "probability": 0.5966796875}, {"start": 9.35, "end": 10.05, "word": " abnormal", "probability": 0.29248046875}, {"start": 10.05, "end": 10.75, "word": " accumulation", "probability": 0.99609375}, {"start": 10.75, "end": 11.37, "word": " لإيش؟", "probability": 0.83916015625}, {"start": 11.37, "end": 11.53, "word": " لـ", "probability": 0.709716796875}, {"start": 11.53, "end": 12.25, "word": " Fluid،", "probability": 0.6006673177083334}, {"start": 12.25, "end": 12.69, "word": " وين؟", "probability": 0.8479817708333334}, {"start": 12.69, "end": 12.83, "word": " مش", "probability": 0.8115234375}, {"start": 12.83, "end": 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وتاخد منه ثانو أكسيد الكربون فبتصير يرشح الدم الـ Fluid اللي فيه في قلب إيش الـ Alveoli فبتأكل الـ Alveoli ميا هذا الـ Pathophysiology تبعت البلمونري إديمة علشان هيك يا جماعة", "tokens": [6027, 39184, 441, 1063, 6225, 26890, 2423, 39184, 6116, 3317, 822, 9706, 1292, 4032, 26890, 2407, 5016, 15844, 2423, 39184, 8363, 373, 4889, 6225, 8592, 7649, 6055, 25957, 1211, 6055, 4587, 20498, 47525, 13063, 11296, 20666, 39184, 24025, 31169, 44381, 24976, 10721, 3794, 5172, 2423, 39184, 441, 1063, 19446, 14739, 47395, 33599, 25062, 3215, 25720, 5296, 35457, 3555, 19446, 14739, 11296, 6055, 4386, 6055, 4386, 6055, 3215, 11703, 1829, 32748, 2304, 23758, 5551, 4117, 3794, 7435, 9957, 34683, 47283, 3215, 9154, 3224, 38637, 7649, 2407, 5551, 4117, 3794, 25708, 33251, 25513, 11536, 6156, 3555, 2655, 9381, 13546, 7251, 2288, 8592, 5016, 32748, 2304, 2423, 39184, 33612, 327, 13672, 1829, 8978, 3224, 8978, 12174, 46152, 11933, 1829, 8592, 2423, 39184, 967, 303, 9384, 6156, 3555, 2655, 10721, 28820, 2423, 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"probability": 0.838623046875}, {"start": 2480.3, "end": 2480.46, "word": " مع", "probability": 0.7412109375}, {"start": 2480.46, "end": 2480.76, "word": " الحركة", "probability": 0.9860026041666666}, {"start": 2480.76, "end": 2481.22, "word": " يفلتوا", "probability": 0.6535888671875}, {"start": 2481.22, "end": 2481.46, "word": " فجأة", "probability": 0.970703125}, {"start": 2481.46, "end": 2481.84, "word": " مني،", "probability": 0.8151041666666666}, {"start": 2481.84, "end": 2481.98, "word": " لأ", "probability": 0.925537109375}], "temperature": 1.0}, {"id": 108, "seek": 250429, "start": 2482.11, "end": 2504.29, "text": "أنا بفلطهم براتب، بفكهم يعني و بحافظ على الـStability تبعتهم و بعملي Clamping بالطريقة الصح، آه و ببدأ أنقل فيه من المكان لمكان التاني و بعد ما تخلص عملية النقل برجع بعمل connection لـChesty tubes إلا إذا كان ممكن أن أنقله مع ضمان أنه مايكنش فيه أي", "tokens": [10721, 8315, 4724, 5172, 1211, 9566, 16095, 4724, 2288, 9307, 3555, 12399, 4724, 5172, 4117, 16095, 37495, 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0.634765625}, {"start": 2484.31, "end": 2484.77, "word": " بفكهم", "probability": 0.94873046875}, {"start": 2484.77, "end": 2485.09, "word": " يعني", "probability": 0.91845703125}, {"start": 2485.09, "end": 2485.21, "word": " و", "probability": 0.393798828125}, {"start": 2485.21, "end": 2485.59, "word": " بحافظ", "probability": 0.928466796875}, {"start": 2485.59, "end": 2485.73, "word": " على", "probability": 0.779296875}, {"start": 2485.73, "end": 2486.13, "word": " الـStability", "probability": 0.745025634765625}, {"start": 2486.13, "end": 2486.65, "word": " تبعتهم", "probability": 0.705908203125}, {"start": 2486.65, "end": 2486.73, "word": " و", "probability": 0.41455078125}, {"start": 2486.73, "end": 2487.05, "word": " بعملي", "probability": 0.7937825520833334}, {"start": 2487.05, "end": 2487.63, "word": " Clamping", "probability": 0.7919921875}, {"start": 2487.63, "end": 2488.43, "word": " بالطريقة", "probability": 0.9622802734375}, {"start": 2488.43, "end": 2489.15, "word": " 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" ما", "probability": 0.91796875}, {"start": 2493.79, "end": 2494.23, "word": " تخلص", "probability": 0.8843994140625}, {"start": 2494.23, "end": 2494.65, "word": " عملية", "probability": 0.98583984375}, {"start": 2494.65, "end": 2495.03, "word": " النقل", "probability": 0.93701171875}, {"start": 2495.03, "end": 2495.45, "word": " برجع", "probability": 0.9005533854166666}, {"start": 2495.45, "end": 2495.87, "word": " بعمل", "probability": 0.96533203125}, {"start": 2495.87, "end": 2496.29, "word": " connection", "probability": 0.442626953125}, {"start": 2496.29, "end": 2497.85, "word": " لـChesty", "probability": 0.5927734375}, {"start": 2497.85, "end": 2498.29, "word": " tubes", "probability": 0.74609375}, {"start": 2498.29, "end": 2498.73, "word": " إلا", "probability": 0.91064453125}, {"start": 2498.73, "end": 2499.09, "word": " إذا", "probability": 0.974609375}, {"start": 2499.09, "end": 2499.37, "word": " كان", "probability": 0.99462890625}, {"start": 2499.37, "end": 2499.75, "word": " ممكن", "probability": 0.975341796875}, {"start": 2499.75, "end": 2499.89, "word": " أن", "probability": 0.7041015625}, {"start": 2499.89, "end": 2500.41, "word": " أنقله", "probability": 0.783203125}, {"start": 2500.41, "end": 2500.63, "word": " مع", "probability": 0.982421875}, {"start": 2500.63, "end": 2501.35, "word": " ضمان", "probability": 0.8556315104166666}, {"start": 2501.35, "end": 2502.03, "word": " أنه", "probability": 0.690673828125}, {"start": 2502.03, "end": 2503.25, "word": " مايكنش", "probability": 0.79248046875}, {"start": 2503.25, "end": 2504.01, "word": " فيه", "probability": 0.966796875}, {"start": 2504.01, "end": 2504.29, "word": " أي", "probability": 0.876953125}], "temperature": 1.0}, {"id": 109, "seek": 251784, "start": 2506.74, "end": 2517.84, "text": "فصل لـ Accidentally طبعاً للـ Chest Drainage هيك تقريبا بتكون خلصت محاضرتنا للموضوع هذا", "tokens": [5172, 36520, 5296, 39184, 5725, 36578, 23032, 3555, 3615, 995, 14111, 24976, 39184, 47981, 413, 7146, 609, 39896, 4117, 6055, 4587, 16572, 3555, 995, 39894, 30544, 16490, 1211, 9381, 2655, 3714, 5016, 46958, 43500, 8315, 5296, 19528, 2407, 11242, 45367, 23758], "avg_logprob": -0.26562500851494925, "compression_ratio": 1.096774193548387, "no_speech_prob": 2.7060508728027344e-05, "words": [{"start": 2506.74, "end": 2508.14, "word": "فصل", "probability": 0.5780029296875}, {"start": 2508.14, "end": 2508.92, "word": " لـ", "probability": 0.53350830078125}, {"start": 2508.92, "end": 2509.78, "word": " Accidentally", "probability": 0.454345703125}, {"start": 2509.78, "end": 2511.02, "word": " طبعاً", "probability": 0.8384765625}, {"start": 2511.02, "end": 2511.6, "word": " للـ", "probability": 0.634765625}, {"start": 2511.6, "end": 2511.98, "word": " Chest", "probability": 0.55322265625}, {"start": 2511.98, "end": 2513.42, "word": " Drainage", "probability": 0.8673502604166666}, {"start": 2513.42, "end": 2514.38, "word": " هيك", "probability": 0.724365234375}, {"start": 2514.38, "end": 2514.88, "word": " تقريبا", "probability": 0.99462890625}, {"start": 2514.88, "end": 2515.34, "word": " بتكون", "probability": 0.6512451171875}, {"start": 2515.34, "end": 2515.9, "word": " خلصت", "probability": 0.986328125}, {"start": 2515.9, "end": 2516.56, "word": " محاضرتنا", "probability": 0.95732421875}, {"start": 2516.56, "end": 2517.52, "word": " للموضوع", "probability": 0.905859375}, {"start": 2517.52, "end": 2517.84, "word": " هذا", "probability": 0.638671875}], "temperature": 1.0}], "language": "ar", "language_probability": 1.0, "duration": 2527.7939375, "duration_after_vad": 2469.733124999996}
\ No newline at end of file
diff --git a/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/TzQBApo1yr8_raw.srt b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/TzQBApo1yr8_raw.srt
new file mode 100644
index 0000000000000000000000000000000000000000..9cebab95cefc6e1d7dc9e74c60f45eab3984c43d
--- /dev/null
+++ b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/TzQBApo1yr8_raw.srt
@@ -0,0 +1,2201 @@
+1
+00:00:00,350 --> 00:00:01,790
+الـ Balmona الإديمة
+
+2
+00:00:06,330 --> 00:00:10,750
+زي ما بنحكي في تعريفها هي abnormal accumulation
+
+3
+00:00:10,750 --> 00:00:13,910
+لإيش؟ لـ Fluid، وين؟ مش في الـ Plural، في الـ Lung
+
+4
+00:00:13,910 --> 00:00:17,170
+tissue نفسها، في الـ Alveolar space يعني الـ
+
+5
+00:00:17,170 --> 00:00:21,270
+Alveoli بدل ما فيها هوا صارت مليانة ميّه، Fluid،
+
+6
+00:00:21,270 --> 00:00:24,230
+أهو، طب و هد يعني إيه؟ بغرج يعني المريض؟ لأ، هد
+
+7
+00:00:24,230 --> 00:00:28,510
+بتكون جاية من الـ Accumulation يعني زي ما حكينا ال
+
+8
+00:00:28,510 --> 00:00:33,590
+blood بيجي علىالـ Lung عبر الـ Palmonary Veins
+
+9
+00:00:33,590 --> 00:00:36,650
+وبروح على الـ Capillaries عشان تعمل تقوم بدورها
+
+10
+00:00:36,650 --> 00:00:39,670
+بالـ Gas Exchange لكن للأسف الـ Lung ما أنتهاش
+
+11
+00:00:39,670 --> 00:00:45,250
+القدرة لسبب ما أنها ت .. ت .. تدّي الدم هذا أكسجين
+
+12
+00:00:45,250 --> 00:00:49,850
+وتاخد منه ثانو أكسيد الكربون فبتصير يرشح الدم الـ
+
+13
+00:00:49,850 --> 00:00:54,070
+Fluid اللي فيه في قلب إيش الـ Alveoli فبتأكل الـ
+
+14
+00:00:54,070 --> 00:00:57,350
+Alveoli ميا هذا الـ Pathophysiology تبعت البلمونري
+
+15
+00:00:57,350 --> 00:00:59,150
+إديمة علشان هيك يا جماعة
+
+16
+00:01:03,520 --> 00:01:07,600
+لما يكون الـ left ventricle تبقى المريض ماعندهش
+
+17
+00:01:07,600 --> 00:01:11,260
+قدرة
+
+18
+00:01:11,260 --> 00:01:15,140
+كافية أن يخنق وظائفه كويسة هتصبح الـ accumulation
+
+19
+00:01:15,140 --> 00:01:21,400
+للـfluid هادي في الـinterstitial space والـalveoli
+
+20
+00:01:21,400 --> 00:01:25,460
+الـclinical manifestation، احنا حكينا إن
+
+21
+00:01:25,460 --> 00:01:29,790
+الـalveoli نفسها صار فيها fluid، والـfluid هاديإيش
+
+22
+00:01:29,790 --> 00:01:33,410
+فيها؟ هي أصلا جا من وين؟ جا من الـBlood علشان هي
+
+23
+00:01:33,410 --> 00:01:40,970
+كانت من أهم العلماء إنك هتلاقي إن المريض هذا عنده
+
+24
+00:01:40,970 --> 00:01:48,590
+.. عنده .. بطلع من تلم فوم، رغوة والرغوة هذه فيها
+
+25
+00:01:48,590 --> 00:01:53,490
+خيط Bloodهذه الشكلة مفروضة وعادةً تتطلع لـ blood
+
+26
+00:01:53,490 --> 00:01:58,390
+-tinged secretions فيها خيط دم تمام، هذه من أهم
+
+27
+00:01:58,390 --> 00:02:03,590
+علامات البلمونورقي دي مثلاً بيجي المريض exhausted،
+
+28
+00:02:03,590 --> 00:02:08,930
+دستنيا، air-hunger، anxious، ليش anxious؟ لأن هو
+
+29
+00:02:08,930 --> 00:02:14,050
+hypoxia، سينوسيس، central cyanosis عنده form
+
+30
+00:02:14,050 --> 00:02:18,610
+secretion، secretion تطلع زرق وفيها blood-tinged
+
+31
+00:02:18,610 --> 00:02:24,550
+secretionsتمام؟ وطبعا confused و distress ليش؟ لأن
+
+32
+00:02:24,550 --> 00:02:29,370
+ال blood بدأ أو ال oxygen بدأ يخس عن ال brain وهذا
+
+33
+00:02:29,370 --> 00:02:34,090
+عمل للمريض stress في ال escalation يا جماعة لو
+
+34
+00:02:34,090 --> 00:02:40,010
+اسمعنا هنسمع severe precipitation في ال lung في ال
+
+35
+00:02:40,010 --> 00:02:44,860
+both lungs وcracklesزي صوت الشيشة، ليش؟ لأنه ميّه،
+
+36
+00:02:44,860 --> 00:02:50,860
+صوت ميّه، crackles، تمام؟ طبعاً، هتسمعوا بالذات في
+
+37
+00:02:50,860 --> 00:02:54,940
+الـBase of the lung المريض طبعاً هيكون Hypoxia
+
+38
+00:02:54,940 --> 00:02:57,400
+وإذا عملنا Blood gas، أسئلوا يا جماعة، هنلاقي أن
+
+39
+00:02:57,400 --> 00:03:03,380
+الـPhenoxyde الكربون الـCO2 مرتفع والـPO2
+
+40
+00:03:03,380 --> 00:03:09,560
+الـOxygen هيكون منخفضفي الأشعة، شكل البلمون
+
+41
+00:03:09,560 --> 00:03:13,160
+الأقديمي زي ما انتوا شايفين الـBase تبع الـLung،
+
+42
+00:03:13,160 --> 00:03:17,400
+شباب، مش برا، لأ الـLung، تشوف هاي الـMargin تبعت
+
+43
+00:03:17,400 --> 00:03:21,860
+الـLung، هاي لسه موجودة، لكن فيه بياض، والبياض وين
+
+44
+00:03:21,860 --> 00:03:25,580
+فوق، ليش؟ لأن الـFluid في داخل الـLung، مش زي لما
+
+45
+00:03:25,580 --> 00:03:28,720
+بيكون الـFluid في الـPlural Space وعمل شرين كل
+
+46
+00:03:28,720 --> 00:03:34,860
+الـLung زججهاأه هو ماخد place، مكانها، لأ هو الـ
+
+47
+00:03:34,860 --> 00:03:37,880
+Fluid في قلب الـ Lung اللي في الـ Intestine اللي
+
+48
+00:03:37,880 --> 00:03:42,260
+في نفس القلب اللي قاعد، تمام؟ فعشان هي كال medical
+
+49
+00:03:42,260 --> 00:03:46,120
+management إن أنا أخلص المريض هذا من الـ Fluid هذه
+
+50
+00:03:46,120 --> 00:03:54,080
+أهم حاجة إن المريض ياخدالـ Diuretics عشان يتخلص من
+
+51
+00:03:54,080 --> 00:03:58,780
+كمية الـ Fluid هذه لزيادة عشان المريض يتخلص من
+
+52
+00:03:58,780 --> 00:04:03,020
+كمية الـ Fluid هذه لزيادة هذه المفروض أنه يأخذ الـ
+
+53
+00:04:03,020 --> 00:04:05,700
+Diuretics عشان يأخذ الـ Diuretics المفروض أنه يكون
+
+54
+00:04:05,700 --> 00:04:10,220
+له Urinary Catheter لأنه مش معقول أنه يركّف أو يدل
+
+55
+00:04:10,220 --> 00:04:16,530
+مريض Diureticsوهو Respiratory Distress وحاسيب يروح
+
+56
+00:04:16,530 --> 00:04:21,990
+يعمل Evacuation للـUrine ويظل رايح جاي على
+
+57
+00:04:21,990 --> 00:04:25,110
+الـToilette وهذا هيكون Exhausted له فلأ من
+
+58
+00:04:25,110 --> 00:04:29,250
+الأولويات أنه حط المريض في بالدرس High Fowler
+
+59
+00:04:29,250 --> 00:04:33,930
+Position، حطله Oxygen، هاي ABC حطله Oxygen، ركّبله
+
+60
+00:04:33,930 --> 00:04:39,910
+Canula، ركّب Catheter، اعطل المريض Diuretics كان
+
+61
+00:04:39,910 --> 00:04:46,150
+في زمان حاجة بيسموهامونا اللي هي مروفين و Oxygen
+
+62
+00:04:46,150 --> 00:04:54,970
+كان بيده أحيانا Nitroglycerin برضه و بيده أحيانا
+
+63
+00:04:54,970 --> 00:05:01,090
+مروفين علشان يعملوا coronary vasodilatation
+
+64
+00:05:01,090 --> 00:05:04,190
+ويزودوا
+
+65
+00:05:04,190 --> 00:05:06,230
+اللي هو الـ
+
+66
+00:05:09,900 --> 00:05:14,100
+للتروية الـ Perfusion تبع الـ heart itself ويخفف
+
+67
+00:05:14,100 --> 00:05:17,340
+ال distress تبع المريض لأنه بيكون severely
+
+68
+00:05:17,340 --> 00:05:21,620
+distress لكن المورفين
+
+69
+00:05:21,620 --> 00:05:26,000
+يعني بيبدو انعطب حظر كتير لإنه ممكن يؤدي ل
+
+70
+00:05:26,000 --> 00:05:30,900
+respiratory depression عند المريض هذا فاحنا بنرجع
+
+71
+00:05:30,900 --> 00:05:31,720
+بنحكي إنه
+
+72
+00:05:38,830 --> 00:05:44,770
+ونستخدم الـ Lasix و Loop Diuretics وطبعا قبل أن
+
+73
+00:05:44,770 --> 00:05:48,290
+نبدأ نعطي الـ Diuretics لازم نكون ركّبنا already
+
+74
+00:05:48,290 --> 00:05:53,330
+full catheter ونعمل للمريض respiratory
+
+75
+00:05:56,650 --> 00:05:59,930
+الـPsychological Support برضه لأنه بيكون «Severely
+
+76
+00:05:59,930 --> 00:06:03,550
+Distressed» وبنكون جاهزين لإنه نعمله «Respiratory
+
+77
+00:06:03,550 --> 00:06:08,110
+Support» لو الأمور ما عدتش وحتاج المريض إنه نعمله
+
+78
+00:06:08,110 --> 00:06:13,510
+«Mechanical Ventilation» الـ«Diuretics» هدفه يا
+
+79
+00:06:13,510 --> 00:06:19,750
+جماعة إنه يجلل الـ«Brusher» اللي جاء في تبع
+
+80
+00:06:19,750 --> 00:06:23,170
+الـ«Fluid» اللي جاء على الـ«Heart» اللي بنسميه
+
+81
+00:06:23,170 --> 00:06:28,660
+«Preload»الـ Preload يعني الدم اللي بده حتى زمان
+
+82
+00:06:28,660 --> 00:06:31,360
+كان فيه طريقة اسمها «Tourniquet» إنهم يربطوا
+
+83
+00:06:31,360 --> 00:06:37,780
+«Tourniquet» على كل طرف فترة زمنية مثلا خمس دقائق
+
+84
+00:06:37,780 --> 00:06:41,040
+بعدين يربط على الطرف التاني بعدين كل هذا كان هدفه
+
+85
+00:06:41,040 --> 00:06:44,640
+أنه «Preload Reducer» يقلل كمية الدم اللي بتوصل
+
+86
+00:06:44,640 --> 00:06:49,320
+للقلب علشان القلب مايتطرش أنه يودّ كمية الدم هذه
+
+87
+00:06:49,320 --> 00:06:53,800
+على الـLung والـLung تصير مش عارفة تدبر حالة فيها
+
+88
+00:06:54,080 --> 00:06:58,960
+والزيت البلموناري قديماً والـ Afterload Reducers
+
+89
+00:06:58,960 --> 00:07:04,240
+عن طريق أنه احنا زي ما حكينا المادة Nitroglycerin
+
+90
+00:07:04,240 --> 00:07:08,380
+عشان يعمل Dilatation للبلد بسيلفة كمية الدم
+
+91
+00:07:08,380 --> 00:07:14,140
+الـBlood Pressure طبعاً هينزل فكمية الدم اللي فيها
+
+92
+00:07:14,140 --> 00:07:19,540
+أو الـBlood لما بيدفع الكمية اللي فيه بوديها على
+
+93
+00:07:19,540 --> 00:07:24,090
+مكان الضغط فيهواطي لأن الـ piece is dilated فهذا
+
+94
+00:07:24,090 --> 00:07:27,690
+بيخلّي فيه إمكانية للجسم إنه يستوقع أو الشرين
+
+95
+00:07:27,690 --> 00:07:32,930
+تستوقع أكتر من غير ما اتعاني أو من غير ما القلب
+
+96
+00:07:32,930 --> 00:07:37,310
+يعاني بيكون عملية سهلة على القلب ال heart
+
+97
+00:07:37,310 --> 00:07:43,590
+medication أدوية أنها تقوى عدلة القلب نفسها زي
+
+98
+00:07:47,280 --> 00:07:54,940
+إنه أحيانًا نبنيها ابنات دي يعني
+
+99
+00:07:54,940 --> 00:08:02,120
+أدوية قلل ضغط الدم إذا كان الضغط كتير عالي من
+
+100
+00:08:02,120 --> 00:08:05,360
+أمتلاتها الـNitroglycerin المروفين حكينا إنه
+
+101
+00:08:05,360 --> 00:08:09,560
+ناركوتيك بينعطى عشان يخفف الـanxiety تبعة المريض
+
+102
+00:08:09,560 --> 00:08:14,180
+لكن بنكون خايفين جدًا ومفيد طبعًا لإنه بزودبعمل
+
+103
+00:08:14,180 --> 00:08:17,740
+coronary vasodilatation لكن مشكلته أنه يمكن يعمل
+
+104
+00:08:17,740 --> 00:08:22,320
+respiratory depression فبينعطى تحت حضر شديد وكتير
+
+105
+00:08:22,320 --> 00:08:26,860
+من الطباب بفضل انه مايعطيهوش لو المريض ماتحسنش
+
+106
+00:08:26,860 --> 00:08:30,960
+هيكون الحل في mechanical ventilator هنحط المريض
+
+107
+00:08:30,960 --> 00:08:36,400
+على mechanical ventilator وحنحط عادةالحاجة بيسموها
+
+108
+00:08:36,400 --> 00:08:39,020
+«high BP» يعني «positive index» فال«pressure»
+
+109
+00:08:39,020 --> 00:08:44,400
+بيكون عالي شوية ممكن قبل ما نحط المريض على
+
+110
+00:08:44,400 --> 00:08:47,200
+mechanical ventilator لو كان في عنا هذا اسمها «C
+
+111
+00:08:47,200 --> 00:08:50,600
+-PAP mask» يعني نحط المريض على mechanical
+
+112
+00:08:50,600 --> 00:08:55,200
+ventilator بس، لكن من غير ما نحط تيوب، آه، لأ،
+
+113
+00:08:55,200 --> 00:09:00,160
+خارجي بس، هذا mask خارجية بتنحطها المريض والـ
+
+114
+00:09:00,160 --> 00:09:04,720
+«mask» هذه بتحقق pressure عالي داخل الـ«lung»
+
+115
+00:09:05,210 --> 00:09:10,230
+المريض وبالتالي ممكن تفتح الـ Alveoli وتعمله Good
+
+116
+00:09:10,230 --> 00:09:15,430
+Respiratory Support وتعمل Inflation للـ Alveoli
+
+117
+00:09:15,430 --> 00:09:18,790
+وتخلي يصير فيه إمكانية للـ Gas Exchange
+
+118
+00:09:25,160 --> 00:09:28,700
+لما بنحكي عن الـ Penetrating Chest Trauma، سواء
+
+119
+00:09:28,700 --> 00:09:36,620
+كانت Gunshot أو Stab Wounds أو حتى
+
+120
+00:09:36,620 --> 00:09:41,760
+لو كانت Plant Trauma، maybe الـ Plant Trauma كمان
+
+121
+00:09:41,760 --> 00:09:43,700
+ممكن تؤدي لإنه يصير فيه أن
+
+122
+00:09:48,890 --> 00:09:53,010
+النمو ثوركس اللي نحنا بنحكي عنه لكن يمكن من أشهر
+
+123
+00:09:53,010 --> 00:09:58,970
+الأشياء اللي ممكن تعمل «chest trauma» أو
+
+124
+00:09:58,970 --> 00:10:01,790
+«penetrating» اللي هي الـ «stab wounds» والـ «gun
+
+125
+00:10:01,790 --> 00:10:04,030
+shot»
+
+126
+00:10:06,500 --> 00:10:10,460
+اللي بيصير بعد الـ Chest Trauma سواء كانت من
+
+127
+00:10:10,460 --> 00:10:14,760
+Penetrating Stab Wounds أو كانت من Gunshot إنه
+
+128
+00:10:14,760 --> 00:10:18,300
+بنتوقع إنه حيصير فيه Bleeding أو حيصير فيه
+
+129
+00:10:18,300 --> 00:10:24,080
+Accumulation للـBlood والـAir في الـLung ومش بس في
+
+130
+00:10:24,080 --> 00:10:26,780
+الـLung، في الـPlural Space اللي الـLung في العادة
+
+131
+00:10:26,780 --> 00:10:32,170
+بتعمل Expansion فيهوبالتالي، الـ Accumulation هدا
+
+132
+00:10:32,170 --> 00:10:36,310
+هيمنع الـ Lung من إنها تعمل الـ Expansion تبعها
+
+133
+00:10:36,310 --> 00:10:41,330
+وعلشان هيك، الحل هيكون في إنه إحنا نعمل الـ
+
+134
+00:10:41,330 --> 00:10:46,710
+Drainage يعني، يعني Removing عن طريق الـ Drain لـ
+
+135
+00:10:46,710 --> 00:10:51,590
+Accumulation of Air أو Blood اللي في منطقة، في الـ
+
+136
+00:10:51,590 --> 00:10:57,590
+Plural Space علشان نسمح للـ Lung تاني بإنه ترجع
+
+137
+00:10:57,590 --> 00:11:04,740
+تعمل Expansionهذا كمان يا جماعة ممكن يصير زي ما
+
+138
+00:11:04,740 --> 00:11:10,680
+حكينا في الـPlant Trauma أو يصير مع العمليات
+
+139
+00:11:10,680 --> 00:11:15,260
+الجراحية يعني مثلا الـOpen Heart Surgery Cardiac
+
+140
+00:11:15,260 --> 00:11:20,420
+Surgery لما يحصل يحتاجوا أو حيصير فيه Already
+
+141
+00:11:20,420 --> 00:11:24,340
+Opening لـPlural Space ويكون فيه Drainage لـBlood
+
+142
+00:11:24,340 --> 00:11:30,820
+وبالتالي ممكن يتجمع فيه Plural Cavityهو علشان هيك
+
+143
+00:11:30,820 --> 00:11:34,420
+أو في الفراغ البلوري أو علشان هيك هيكون فيه يعني
+
+144
+00:11:34,420 --> 00:11:39,000
+داعي لإنه نعمله تفريغ أول بأول وإلا هتكون بعد
+
+145
+00:11:39,000 --> 00:11:43,020
+العملية ما خلصت هيصير فيه تجمع لهذه السوائل في
+
+146
+00:11:43,020 --> 00:11:45,940
+الفراغ البلوري ويلنع الـ expansion طبع ال lung
+
+147
+00:11:45,940 --> 00:11:50,240
+ويعمل tamponade على ال heart وهيعمل مشاكل كمان في
+
+148
+00:11:50,240 --> 00:11:53,560
+thoracic surgery لو كان مريض وكان فيه بيحتاج يعني
+
+149
+00:11:53,560 --> 00:11:58,890
+عملية logotopy مثلا أو كانالمريض بحتاج مثلًا عمل
+
+150
+00:11:58,890 --> 00:12:05,050
+عنده lung abscess وعمله thoracotomy في الحالات هذه
+
+151
+00:12:05,050 --> 00:12:08,250
+أيضًا بعد ما صار فيه handling و manipulation للـ
+
+152
+00:12:08,250 --> 00:12:13,110
+lung tissue وعمله اللي هو invasion للـ pleural
+
+153
+00:12:13,110 --> 00:12:16,130
+space expected إنه يصير فيه accumulation و
+
+154
+00:12:16,130 --> 00:12:22,180
+drainage لـ bloodفي الـ Plural Cavity وبالتالي
+
+155
+00:12:22,180 --> 00:12:26,260
+هيكون كويس ان يكون فيه drainage system عشان يمنع
+
+156
+00:12:26,260 --> 00:12:29,920
+ال accumulation هذا ويرجع يسمح لـ lung في ال
+
+157
+00:12:29,920 --> 00:12:33,060
+expansion عشان هيك هذا بخدنا على موضوعين مهمين جدا
+
+158
+00:12:33,060 --> 00:12:38,010
+فيالـChest Trauma اللي هما الـPneumothorax
+
+159
+00:12:38,010 --> 00:12:42,030
+والـHemothorax تقريبا كل ما ينطبق عن Pneumothorax
+
+160
+00:12:42,030 --> 00:12:46,470
+ينطبق على الـHemothorax لما بنحكي Pneumothorax
+
+161
+00:12:46,470 --> 00:12:52,690
+يعني هوا في التجويف الصدري Hemo يعني دم في التجويف
+
+162
+00:12:52,690 --> 00:12:54,910
+الصدري Pneumothorax
+
+163
+00:12:58,350 --> 00:13:03,270
+Parietal or visceral، الـ Plural محطمة ومحطمة الـ
+
+164
+00:13:03,270 --> 00:13:10,290
+Plural مواجهة ضغط أزومسفيريك جيد يعني في الـ
+
+165
+00:13:10,290 --> 00:13:16,690
+Pneumothorax بيصير محطمة سواء للـ Parietal أو
+
+166
+00:13:16,690 --> 00:13:19,210
+الvisceral تبعت البلورة عارفين اللي بلورة إلها
+
+167
+00:13:19,210 --> 00:13:24,330
+visceral و بلورة باريتال part سواء محطمة صار فيها
+
+168
+00:13:24,330 --> 00:13:29,130
+أو فيهاوتعرض الـ Plural Cavity هذا اللي هو الـ
+
+169
+00:13:29,130 --> 00:13:31,670
+Atmospheric Pressure يعني اللي هو الجو والضغط اللي
+
+170
+00:13:31,670 --> 00:13:36,750
+دي مسمحالـ Penetrating هذا أو الـ Rapture هذا
+
+171
+00:13:36,750 --> 00:13:41,590
+للهواء تبع الـ الهواء الجوي إنه يدخل الفراغ
+
+172
+00:13:41,590 --> 00:13:46,730
+البلوري هذا بالتالي هيبدأ يعمل Lung Pressure على
+
+173
+00:13:46,730 --> 00:13:49,210
+الـ Lung عشان هيك هو نوعين في الـ Simple
+
+174
+00:13:49,210 --> 00:13:52,150
+Pneumothorax و في الـ Traumatic Pneumothorax هنشوف
+
+175
+00:13:52,150 --> 00:13:55,250
+يعني إيش الفرق بين الـ Simple Pneumothorax و
+
+176
+00:13:55,250 --> 00:13:57,550
+Traumatic Pneumothorax بكل بساطة الـ Simple
+
+177
+00:13:57,550 --> 00:14:01,430
+Pneumothorax إن يكون في رمخة صار في الـ Plural
+
+178
+00:14:01,430 --> 00:14:09,340
+Spaceوالـ Plural Cavity وبالتالي الكمية البسيطة
+
+179
+00:14:09,340 --> 00:14:12,940
+اللي مش شغلة حيزي كبير مش مانعة long من إنها تعمل
+
+180
+00:14:12,940 --> 00:14:17,260
+expansion هذا ممكن شوية شوية يصير لها resolve
+
+181
+00:14:17,260 --> 00:14:20,820
+وماتحتاجش إنه نعمل لها drainage ولا chest tube لكن
+
+182
+00:14:20,820 --> 00:14:26,970
+لما بكون traumaticنتيجة زي ما حكينا إن جاني من
+
+183
+00:14:26,970 --> 00:14:30,410
+الخارج أو إن جاني من الداخل إن الـ lung صار فيها
+
+184
+00:14:30,410 --> 00:14:38,650
+rupture زي ما هنشوف فيه أمراض كتير ممكن تكون يعني
+
+185
+00:14:38,650 --> 00:14:41,690
+plus في ال lung ويصير إلى ال plus هذه rupture
+
+186
+00:14:41,690 --> 00:14:46,150
+وبالتالي تيجي الطريقة تعمل rupture في البلورة اللي
+
+187
+00:14:46,150 --> 00:14:49,710
+تطلع برا منه فعشان هي كانت بتصير اسمها closed
+
+188
+00:14:49,710 --> 00:14:53,010
+pneumothorax أو بيسموهاTension Pneumothorax لو
+
+189
+00:14:53,010 --> 00:14:56,230
+تلاحظوا في الصورة ها بتلاقي أنه المريض هذا ما
+
+190
+00:14:56,230 --> 00:15:00,950
+عندهوش إصابة من برا لأ ممكن ال lung صارت عاملة
+
+191
+00:15:00,950 --> 00:15:04,690
+rupture و طول منها المريض باخد inspiration و ال
+
+192
+00:15:04,690 --> 00:15:07,350
+inspiration اللي باخده بخش في ال lung و بطلع من ال
+
+193
+00:15:07,350 --> 00:15:13,360
+lungعلى الـ Plural Space وبيظلوا محتبس في المكان
+
+194
+00:15:13,360 --> 00:15:16,660
+هذا وبالتالي الـ Lung بيظل تعمل Shrinkage بعكس الـ
+
+195
+00:15:16,660 --> 00:15:21,900
+Open Pneumothorax في فتحة من برا صارت في غشاء الـ
+
+196
+00:15:21,900 --> 00:15:25,880
+External wall يعني تبع الـ Chest وبالتالي هذه
+
+197
+00:15:25,880 --> 00:15:30,540
+الفتحة صارت تعمل أو allow the atmospheric air to
+
+198
+00:15:30,540 --> 00:15:33,340
+enter the chest cavity وبالتالي برضه هتعمل
+
+199
+00:15:33,340 --> 00:15:38,990
+pressure على الـ Lungوتعمل فيها إشرين كيلز
+
+200
+00:15:38,990 --> 00:15:44,570
+وتخلّيها تسير كلها بس هو ملاحظين أحنا كيف أنه
+
+201
+00:15:44,570 --> 00:15:47,670
+التراكيا لما كل ما بزيد
+
+202
+00:15:51,060 --> 00:15:54,940
+الـAir في الفراغ البلوري يا جماعة
+بتكون عاملة
+
+203
+00:15:54,940 --> 00:15:59,000
+Deviation، لاحظين كيف؟ بالذات بالـExpiration لما
+
+204
+00:15:59,000 --> 00:16:05,980
+المريض بيعمل Expiration بلاقي إنه الـTrache تبعته
+
+205
+00:16:05,980 --> 00:16:10,520
+عاملة Deviation يعني أيه؟ يعني إيش يعني Deviation؟
+
+206
+00:16:10,520 --> 00:16:14,700
+يعني رايحة المفروض إنه هذا الـMidline الأفطارية
+
+207
+00:16:14,700 --> 00:16:20,550
+تبع الـPatient هذا الـMidlineفالمفروض أن يكون
+
+208
+00:16:20,550 --> 00:16:24,230
+الـLarynx الخط هذا في نص الـLarynx هنا، مش هيك؟
+
+209
+00:16:24,230 --> 00:16:31,150
+لكن لما بيكون مافيش عند أو في عند المريض
+
+210
+00:16:31,150 --> 00:16:34,890
+collection في الـPlural Space زي هي، إيش بيصير؟
+
+211
+00:16:34,890 --> 00:16:38,870
+بيصير deviation بعكس الجهة اللي فيها بعكس الجهة
+
+212
+00:16:38,870 --> 00:16:46,230
+اللي فيها الـPneumothorax حنشوف
+
+213
+00:16:46,230 --> 00:16:51,140
+هذا في الـClinical Manifestationلما نحكي عنه،
+
+214
+00:16:51,140 --> 00:17:00,300
+تتأكد من التسجيل في مشكلة ولا ماشي الأمور؟ Okay ف
+
+215
+00:17:00,300 --> 00:17:05,430
+Intentionally Mithorax or carewhen air is drawn
+
+216
+00:17:05,430 --> 00:17:08,690
+into the plural space from a lacerated lung اللانك
+
+217
+00:17:08,690 --> 00:17:12,090
+صار فيها injury or through a small opening or
+
+218
+00:17:12,090 --> 00:17:15,230
+wound in the chest wall أو صار ممكن كمان
+
+219
+00:17:15,230 --> 00:17:18,490
+الستراتيوش المتورنسية انه صار فيه chest wall بس
+
+220
+00:17:18,490 --> 00:17:22,810
+صغير في يعني في a wound في ال chest wall بس صغير
+
+221
+00:17:22,810 --> 00:17:26,250
+بحيث انه بسمح للهواء عمال و بدخل بس مابقدرش يطلع
+
+222
+00:17:26,250 --> 00:17:29,330
+it may complication of other type of pneumothorax
+
+223
+00:17:29,330 --> 00:17:33,400
+يعني الفكرة في التلتش النيموتوراكس ان الهواءبيصير
+
+224
+00:17:33,400 --> 00:17:36,720
+يدخل لكن مافيش إمكاني يطلع من نفس الفتحة اللي دخل
+
+225
+00:17:36,720 --> 00:17:40,660
+منها لو كان open و لو كان closed زي ما بيسموه
+
+226
+00:17:40,660 --> 00:17:43,340
+tension pneumothorax could be open could be closed
+
+227
+00:17:43,340 --> 00:17:46,620
+الـclosed pneumothorax إنه بيكون مافيش أي فتحة ولا
+
+228
+00:17:46,620 --> 00:17:49,920
+حد و بيصير فيه spin تاني و Rapture فيه الـlung
+
+229
+00:17:49,920 --> 00:17:54,480
+وفتحت على الـblural space وعملت الـcollection of
+
+230
+00:17:54,480 --> 00:17:56,840
+air فيه برا في الـblural space بيصير المريض يعمل
+
+231
+00:17:56,840 --> 00:18:00,310
+inspirationوالـ Inspiration تبعه بدل ما يظلوا في
+
+232
+00:18:00,310 --> 00:18:02,830
+الـ Lounge ويطالوا ويعملوا الـ Expiration كله لأ
+
+233
+00:18:02,830 --> 00:18:06,750
+بيعمل الـ Inspiration جزء من التلات الباع اللي
+
+234
+00:18:06,750 --> 00:18:09,190
+عملوا الـ Inspiration بيطلع على الـ World Space
+
+235
+00:18:09,190 --> 00:18:12,270
+وبيحتبس فيه وبيعمل الـ Expiration المريض ده جزء
+
+236
+00:18:12,270 --> 00:18:17,530
+بسيط لأن الباقي كليته انحجزت رابط انحجزت انصعد
+
+237
+00:18:17,530 --> 00:18:23,820
+كأنه في مصر يدقله وصعدته وخلته يظلوافي داخل الـ
+
+238
+00:18:23,820 --> 00:18:27,860
+Plural Space شكل الـ Pneumothorax يا جماعة هيكون
+
+239
+00:18:27,860 --> 00:18:31,160
+زي ما انتوا شايفين كيف يكون فيه سواد في الـ Lung
+
+240
+00:18:31,160 --> 00:18:35,320
+لأنه Air على جهة معينة واخدين بالكوا كيف لحظة كيف
+
+241
+00:18:35,320 --> 00:18:39,720
+الـ Lung هنا وكيف كان فيه سواد على الـ X-Ray هذا
+
+242
+00:18:39,720 --> 00:18:43,720
+بيدللي أن المريض هذا عنده Pneumothorax الإلاج تبع
+
+243
+00:18:43,720 --> 00:18:47,580
+المريض يا جماعةطبعاً أول حاجة جاب العلاج الـ
+
+244
+00:18:47,580 --> 00:18:49,700
+Clinical Manifestation المريض هذا هيكون anxious
+
+245
+00:18:49,700 --> 00:18:53,440
+أكيد، هيكون dyspneic، هيكون الـ saturation تبعه
+
+246
+00:18:53,440 --> 00:18:58,460
+low، هيكون tachypneic لإنه مش قادر إنه ياخد نفس
+
+247
+00:18:58,460 --> 00:19:03,460
+deep لإنه في حاجة بتعمله pressure وطبعاً هذا
+
+248
+00:19:03,460 --> 00:19:05,840
+هيخلّي السيلياندو سيانوسيز ولو عملنا له blood
+
+249
+00:19:05,840 --> 00:19:09,440
+gases هنلاقي إنه ال patient عنده hypoxemia
+
+250
+00:19:11,780 --> 00:19:15,320
+طبعًا الـ Trache زي ما حكينا لو روحنا و طلعنا على
+
+251
+00:19:15,320 --> 00:19:19,100
+الـ Trache هنلاقي إن الـ Trache عاملة shifting
+
+252
+00:19:19,100 --> 00:19:25,640
+بعكس الجهة اللي فيها الـ Nemathorax طبعًا هذا لما
+
+253
+00:19:25,640 --> 00:19:28,820
+تكون الـ Nemathorax بالذات تتمشي الـ Nemathorax
+
+254
+00:19:28,820 --> 00:19:32,580
+يعني لكن في الـ Simple Nemathorax اللي بتكون بسيطة
+
+255
+00:19:32,580 --> 00:19:37,780
+ممكن يعني الـ Trache أبدًا ما تكونش فيها أي
+
+256
+00:19:37,780 --> 00:19:44,110
+shifting وتكون في الوضعالطبيعي تبعها طبعا لو روحنا
+
+257
+00:19:44,110 --> 00:19:48,490
+عملنا جماعة percussion على المكان اللي فيه
+
+258
+00:19:48,490 --> 00:19:55,450
+الـNemothorax هنسمع hyper resonance لإيش؟ لأنه إيش
+
+259
+00:19:55,450 --> 00:19:59,250
+فيه؟ فيه هوا صار، صارت طبلة، مش هيك، فهيكون فيه
+
+260
+00:19:59,250 --> 00:19:59,930
+hyper resonance
+
+261
+00:20:04,650 --> 00:20:09,270
+ولو سمعناها قعدت بالسماعة الـ chest تبع المريض هي
+
+262
+00:20:09,270 --> 00:20:14,610
+ده هتلاقي diminished air entry أو absent حتى لأنه
+
+263
+00:20:14,610 --> 00:20:20,460
+فعليًا المريض ما بيقدرش ياخد إيشولا Deep Breathing
+
+264
+00:20:20,460 --> 00:20:26,120
+ويوصل النفس للـBase of the Lung وزي ما حكينا
+
+265
+00:20:26,120 --> 00:20:30,340
+الـHyper Resonance Sound بكون في الـPercussion
+
+266
+00:20:30,340 --> 00:20:34,080
+واضح إن الـMedical Management إنه يحط للمريض هذا
+
+267
+00:20:34,080 --> 00:20:37,840
+Chest Tube علشان يروحوا من
+
+268
+00:20:40,700 --> 00:20:44,800
+الكمية الـ «air» اللي بتعمل accumulation في الـ
+
+269
+00:20:44,800 --> 00:20:49,620
+plural space وبتعمل ضغط pressure على الـ lung
+
+270
+00:20:49,620 --> 00:20:58,230
+وبالتالي بتخليها تصير collapseفي الـ «نيموثوركس»
+
+271
+00:20:58,230 --> 00:21:01,630
+عادةً الـ «دياميتر» تبع الـ «تشست تيوب» اللي بدنا
+
+272
+00:21:01,630 --> 00:21:07,150
+هيه بيكون يعني 28 في الـ Adult يعني المقصود أنه
+
+273
+00:21:07,150 --> 00:21:10,570
+صغير أقل من الـ «هيموثوركس» الـ «هيموثوركس» بالزمن
+
+274
+00:21:10,570 --> 00:21:13,970
+الـ «دياميتر» يكون كبير لأنه اللي بده يطلع Blood و
+
+275
+00:21:13,970 --> 00:21:17,230
+الـ Blood زي ما بنعرف أحنا أنه بيحتوي على خلايا مش
+
+276
+00:21:17,230 --> 00:21:20,890
+بس Fluid و could be thick والبسكوتس تبعته because
+
+277
+00:21:20,890 --> 00:21:25,710
+ofاللي هو الـ Cells ممكن تكون عالية وبالتالي ممكن
+
+278
+00:21:25,710 --> 00:21:31,750
+يصير فيه فرصة لإنه يتجلق ويسكر، يصير فيه Occlusion
+
+279
+00:21:31,750 --> 00:21:37,390
+فعشان هيك احنا عادة بفضله إنه يكون الـ «chest
+
+280
+00:21:37,390 --> 00:21:41,610
+drain» تبع الهيموثوركس في حال إنه المريض عنده
+
+281
+00:21:41,610 --> 00:21:47,590
+هيموثوركس يكون أكبر وعادة بختاره 32 في الـ Adult
+
+282
+00:21:48,180 --> 00:21:52,740
+طبعاً موضوع الـ «chest tube» والـ«pressure» تبع
+
+283
+00:21:52,740 --> 00:21:56,960
+الميّه هحكي عنه هنا بالتفصيل فكرة الـ«chest tube»
+
+284
+00:21:56,960 --> 00:21:59,700
+زي ما حكينا يا جماعة بصوا كيف أنه أنا فيه
+
+285
+00:21:59,700 --> 00:22:03,200
+«endolung» وفيها accumulation للـ«fluid» أو
+
+286
+00:22:03,200 --> 00:22:07,680
+الـ«air» هنا فبيجي الطبيب ويركّب اللي هو بعمل
+
+287
+00:22:07,680 --> 00:22:12,240
+باستخدام الـ«truchar» و«chest drainage»والـ Chest
+
+288
+00:22:12,240 --> 00:22:20,000
+Tube وبيدخل فيه اللي هو الـ Thoracic Cavity من الـ
+
+289
+00:22:20,000 --> 00:22:23,600
+Third Inter-, يعني ال Fifth والFourth Intercostal
+
+290
+00:22:23,600 --> 00:22:29,050
+Spaceوالآن يعني كل التوجيهات إن لو كان «نيمو» أو
+
+291
+00:22:29,050 --> 00:22:32,770
+«هيمو توراكس» يكون الـChest Tube low في الـFifth
+
+292
+00:22:32,770 --> 00:22:37,890
+Intercoastal Space، كويس، فخشش الـTube استقر هنا،
+
+293
+00:22:37,890 --> 00:22:41,770
+الآن الـTube هذا هيحمل إيش، ويطلع إيش موجود جوا،
+
+294
+00:22:41,770 --> 00:22:46,350
+إذا Fluid، يعني Blood أو Air، ويبدو يطلع فيهويدخل
+
+295
+00:22:46,350 --> 00:22:50,050
+فيه ويمشي فيه هذا الـDrain. الآن، لو انا بدأ أحط
+
+296
+00:22:50,050 --> 00:22:53,570
+في الـDrain أي نوع من الـDrains، أنا بخاف إن
+
+297
+00:22:53,570 --> 00:22:59,410
+الـDrain يجي اللي بده يطلع يعود، يدخل تاني، أو
+
+298
+00:22:59,410 --> 00:23:03,050
+الـAtmospheric Pressure يكون فيه فرصة إنه يدخل هنا
+
+299
+00:23:03,050 --> 00:23:08,050
+تاني، فعلشان ذلك، لازم هذا يستقر في System يسمح
+
+300
+00:23:08,050 --> 00:23:12,480
+بالدخول ولا يسمح بالخروج.فعشان هيك فيه هنا water
+
+301
+00:23:12,480 --> 00:23:16,360
+level زي ما انتوا شايفين فيه هنا water أياته water
+
+302
+00:23:16,360 --> 00:23:19,660
+level طبعا هو هذا مش كله water level ال water
+
+303
+00:23:19,660 --> 00:23:23,640
+level بيكون مثلا لإن 200 أو 300 عادة بيكون فيه خط
+
+304
+00:23:23,640 --> 00:23:28,580
+كامل مستدير هنا بتكون عملاء الشركة المصنعة بيحكي
+
+305
+00:23:28,580 --> 00:23:33,150
+لك إن هذا ال water level وبنسميه احناDead Space
+
+306
+00:23:33,150 --> 00:23:39,290
+يعني مثلا إذا كان ال water level 300 و جيت بعد تلت
+
+307
+00:23:39,290 --> 00:23:47,890
+ساعات وجدت أن في عند المريض500 CC دريناجي،
+
+308
+00:23:47,890 --> 00:23:53,050
+Fluid أو Blood أو مهما 500 CC، ففعليا المريض مطلق
+
+309
+00:23:53,050 --> 00:23:56,850
+بس 200 لأنه كان في عنده water level 300، يبقى
+
+310
+00:23:56,850 --> 00:24:00,770
+المريض مطلق بس 200، لو كان هنا ال water level كان
+
+311
+00:24:00,770 --> 00:24:05,210
+300، again، وانا دائما بكرر كلمة 300 لأنه عادة ال
+
+312
+00:24:05,210 --> 00:24:08,370
+water levels اللي بنستخدم في ال-chest tube اللي
+
+313
+00:24:08,370 --> 00:24:14,480
+موجود هنا هو 300 CCووجدت إنه بعد أكم ساعة الصبح،
+
+314
+00:24:14,480 --> 00:24:20,820
+يا سيدي بعد 24 ساعة كان المريض كل ال fluid level
+
+315
+00:24:20,820 --> 00:24:26,360
+عنده حوالي 1100، آه 1100، عيني الـ300 بضل عنده
+
+316
+00:24:26,360 --> 00:24:36,270
+أكم، آه، يا مين حسب؟700 CC 700 CC اه 700 غلط مش
+
+317
+00:24:36,270 --> 00:24:42,130
+700 800 برافو عليكم 800 CC لأنه بدنا نعيد من ال
+
+318
+00:24:42,130 --> 00:24:48,890
+1100 300 يعني بيظل 800 CC يبقى المريض جاب 800 CC و
+
+319
+00:24:48,890 --> 00:24:51,390
+هدول ال water level طب ليش موجودين ال water level
+
+320
+00:24:51,390 --> 00:24:54,170
+هدول؟ اه موجودين ال water level هدول عشان ييجي ال
+
+321
+00:24:54,170 --> 00:24:58,600
+drain من هن من هن من هن و يصب في قلبالـ Tube اللي
+
+322
+00:24:58,600 --> 00:25:03,400
+نازل واصل عند الـ 300 CC تبعث إنه اللي بنزل يخش في
+
+323
+00:25:03,400 --> 00:25:06,740
+الميّه بس مافيش إيش من الميّه ممكن يرجع، صح؟ مافيش
+
+324
+00:25:06,740 --> 00:25:10,020
+أي كمية، مافيش هوا في الميّه، ومافيش .. الميّه مش
+
+325
+00:25:10,020 --> 00:25:12,860
+ممكن تسحبها لو تطلع عكس الـ Gravity وتخش في
+
+326
+00:25:12,860 --> 00:25:15,980
+المريض، آه الـ Gravity، يبقى ال принцип المهم هنا
+
+327
+00:25:15,980 --> 00:25:20,540
+مش لازم ننساه إن الـ Chest Tube هذا لازم يكون تحت
+
+328
+00:25:20,540 --> 00:25:27,020
+الـ Gravity، يعني في مستوىأقل من المريض بمعنى أن
+
+329
+00:25:27,020 --> 00:25:29,580
+الـ «principle» اللي بيشتغل عليه هو الـ «gravity»
+
+330
+00:25:29,580 --> 00:25:32,460
+تمام؟ كمان والـ «suction» يا جماعة هو ممكن احنا
+
+331
+00:25:32,460 --> 00:25:37,600
+نشبك فيه هنا «suction» ويصير بيعمل «suctioning»
+
+332
+00:25:37,600 --> 00:25:41,000
+ولكن في كل الحالة اللي لازم يكون في مستوى أقل من
+
+333
+00:25:41,000 --> 00:25:44,600
+ال «chest» لو المريض نايم بيكون أقل لو المريض صار
+
+334
+00:25:44,600 --> 00:25:48,340
+in sitting position برضه بيكون أقل منه أه مايصيرش
+
+335
+00:25:48,340 --> 00:25:51,780
+في مستوى لأن هذا ممكن يصير في مستوى يمنع ال
+
+336
+00:25:51,780 --> 00:25:56,020
+«drainage» ويخلّي المريضأو الـ Respiration Status
+
+337
+00:25:56,020 --> 00:25:59,960
+أو العكس
+
+338
+00:25:59,960 --> 00:26:04,680
+طبعاً أنا في أني هذا اسمه Open System زي ما احنا
+
+339
+00:26:04,680 --> 00:26:12,760
+شايفين الـDrainage بتطلع وبنصب في الـTube هذافيه
+
+340
+00:26:12,760 --> 00:26:15,600
+فتحتين، واحدة منها، يا جماعة، لازم تكون مفتوحة لأن
+
+341
+00:26:15,600 --> 00:26:20,180
+هذه عبارة مفتوحة، لكن بتلاقي فيها valve، valve
+
+342
+00:26:20,180 --> 00:26:24,040
+عشان يقل، عشان احنا بنعرف إن هذه الكمية الفارقة من
+
+343
+00:26:24,040 --> 00:26:28,160
+هنا إلى هنا، هي عبارة عن هواء، لأنه مافيش إش فارق،
+
+344
+00:26:28,160 --> 00:26:31,760
+صح؟ الآن لما بديش يطلع fluid من هنا، بديش يشغل
+
+345
+00:26:31,760 --> 00:26:36,710
+حيز، لازم بداره يطلع من الـPot، هذا إيش؟هواء،
+
+346
+00:26:36,710 --> 00:26:41,130
+فعشان هيك هنا بيكون فيه «valve» مشبوك يعني مفتوح
+
+347
+00:26:41,130 --> 00:26:45,310
+بحيث أنه يسمح للهواء بالخروج من ال «lung» ولا يسمح
+
+348
+00:26:45,310 --> 00:26:50,070
+له بالدخول، هذه بيعملوها عشان أنا ممكن أكون محتاج
+
+349
+00:26:50,070 --> 00:26:55,010
+أن أشبك الـ «system» هذا على suction بحيث أنه
+
+350
+00:26:55,010 --> 00:27:00,850
+يساعد في عملية ال «drainage» تبع السوائلالـ
+
+351
+00:27:00,850 --> 00:27:06,890
+Greenwich تبعت السوائل حاجة
+
+352
+00:27:06,890 --> 00:27:11,290
+مهمة جدا ممكن تصير فيها منها مشكلة كبيرة لو واحد
+
+353
+00:27:11,290 --> 00:27:15,370
+بالخطأ راح شبك لتيوب هذا بدل ما هو في المكان اللي
+
+354
+00:27:15,370 --> 00:27:19,930
+فيه لتيوب اللي نازل للميّه شبكه في أحد لتيوبات
+
+355
+00:27:19,930 --> 00:27:24,550
+هدول معناه إنه المريض هيبدأ الهوى اللي هنا يستطيع
+
+356
+00:27:24,550 --> 00:27:28,730
+يلاقي منفذ له طبعا الخطر إنه بالذات لو شبكه في هذا
+
+357
+00:27:31,040 --> 00:27:34,640
+اللي هو تبقى الـ «Suction» ماعندهوش «Valve» الـ
+
+358
+00:27:34,640 --> 00:27:36,600
+«Han» تبقى الـ «Suction» ماعندهوش «Valve» لو شبكوا
+
+359
+00:27:36,600 --> 00:27:41,700
+«Han» ممكن مايصيلش مشكلة مؤقتاً لأنه بيسمح للهواء
+
+360
+00:27:41,700 --> 00:27:45,040
+بالخروج أو لا يسمح له بالدخول، لأ برضه هتصيح
+
+361
+00:27:45,040 --> 00:27:48,020
+المشكلة لإن الهواء اللي هنا هيكون فيه إمكانية له
+
+362
+00:27:48,020 --> 00:27:53,100
+أنه يخرج فممكن يخرج ويصير إيشلداخل المريض، ولو هنا
+
+363
+00:27:53,100 --> 00:27:57,480
+نفس الحاجة، هيخرج ويصير في المريض ويصير محتبس
+
+364
+00:27:57,480 --> 00:28:02,020
+وهيعمل حاجة نسميها surgical emphysema، تمام؟ لذلك
+
+365
+00:28:02,020 --> 00:28:06,500
+من الخطر جدا إن أنا أكون في عملية خطأ أثناء تركيب
+
+366
+00:28:06,500 --> 00:28:10,100
+الـChest Drain هذا وبدل ما أركبه في الـTube اللي
+
+367
+00:28:10,100 --> 00:28:15,870
+بنزل على الميّه أشبكه في أحد المداخلالتانية للـ
+
+368
+00:28:15,870 --> 00:28:19,270
+Chest Puddle، كويس؟ هذا نظام من أنظمة الـChest
+
+369
+00:28:19,270 --> 00:28:23,350
+Tube في نظام تاني، طبعاً هي الفكرة تبعته اللي أنا
+
+370
+00:28:23,350 --> 00:28:28,030
+كنت يعني بأشرح فيها كيف الـFluid بطلع، بشغل، كل ما
+
+371
+00:28:28,030 --> 00:28:32,470
+بطلع الـFluid لازم إيش؟ بطلع في الميّه، تمام؟
+
+372
+00:28:32,470 --> 00:28:35,530
+وبالتالي بطلع من هنا الـValve اللي حكيته كان عشان
+
+373
+00:28:35,530 --> 00:28:42,210
+يعني الكمية اللي دخلت تشغل حيز من الفراغ هذا فبطلع
+
+374
+00:28:42,210 --> 00:28:47,810
+بدالها هواتمام؟ دائما بكون يا جماعة احنا ملاحظين
+
+375
+00:28:47,810 --> 00:28:52,570
+انه في مرحلة ان المريض بعمل Inspiration بتلاقي انه
+
+376
+00:28:52,570 --> 00:28:57,110
+صار فيه طلع شوية من الميه اللي هنا طلعت فيه لـTue
+
+377
+00:28:57,110 --> 00:29:00,310
+في ال Expiration بتعاود بتنزل يعني هنا في حركة
+
+378
+00:29:00,310 --> 00:29:04,510
+متغيرة أه بتطلع بس مش هتوصل لمستويات عالية أبدا
+
+379
+00:29:04,510 --> 00:29:08,360
+أبدامش هتوصل أبدا لمستوية على بس هتظل في البربيج
+
+380
+00:29:08,360 --> 00:29:11,540
+لإن اتفاقنا إنه لازم يكون الـWater seal هذا بمستوى
+
+381
+00:29:11,540 --> 00:29:17,940
+أقل من الصدر ولكن حركة حركة الـFluid هذه في داخل
+
+382
+00:29:17,940 --> 00:29:21,840
+الـTube هذا اللي بنسميها Fluctuation يعني بتتردد،
+
+383
+00:29:21,840 --> 00:29:28,300
+بتطلع شوية و بتنزل شوية، هذه هي المؤشرالمهم على إن
+
+384
+00:29:28,300 --> 00:29:34,200
+الـ chest tube هذا function شغال ومافيش .. ومش
+
+385
+00:29:34,200 --> 00:29:37,640
+closure وبيقدر الوظيفة تبعته إذا إيش اسم هذه
+
+386
+00:29:37,640 --> 00:29:41,220
+الحركة اللي لازم أنا أتبعها fluctuation؟ وإيش أنا
+
+387
+00:29:41,220 --> 00:29:46,160
+لازم أسوي عشان أعرفها؟ يجب أجي و بطلعبحط الـ
+
+388
+00:29:46,160 --> 00:29:50,300
+«water seal» على مستوى اللي هو مستوي يعني على الـ
+
+389
+00:29:50,300 --> 00:29:55,240
+«ground» مثلًا وببدأ أنا أطلع أشوف هل في حركة نفس
+
+390
+00:29:55,240 --> 00:29:57,760
+المريض في الـ «fluctuation» في الـ «tube» يعني
+
+391
+00:29:57,760 --> 00:30:03,680
+المستوى الـ «water» بطلع وبنزل في حركة ترددية أو
+
+392
+00:30:03,680 --> 00:30:06,940
+ممكن أطلب من المريض أن يعمل «cuff» لأنه هيك بيغير
+
+393
+00:30:06,940 --> 00:30:10,000
+الـ «thoracic pressure» واحنا عارفين أن هذه الحركة
+
+394
+00:30:10,000 --> 00:30:12,940
+الترددية بتصير مع التغير في الـ «intra thoracic
+
+395
+00:30:12,940 --> 00:30:16,830
+pressure» أو باطلب منه أنهيعمل الـ Deep Breathing
+
+396
+00:30:16,830 --> 00:30:21,010
+يأخذ نفسه ويطلع فالمفروض أنه الـ Intra- Thoracic
+
+397
+00:30:21,010 --> 00:30:24,410
+Pressure بدوا يسيله تغير واضح وبالتالي المفروض أن
+
+398
+00:30:24,410 --> 00:30:28,270
+أنا أشوف Fluctuation واضحة وهذه من الحاجات المهمة
+
+399
+00:30:28,270 --> 00:30:34,390
+جدا والتي تتعلق مباشرة بالمراقبة التمريدية إذا الـ
+
+400
+00:30:34,390 --> 00:30:38,310
+Nursing Intervention أو الـ Nursingالـ role المهم
+
+401
+00:30:38,310 --> 00:30:42,310
+في موضوع الـ chest tube أنا مراقبة مش بس الكميات
+
+402
+00:30:42,310 --> 00:30:46,330
+اللي بدها تطلع و الـ function تبعت الـ chest tube
+
+403
+00:30:46,330 --> 00:30:51,710
+هذا هو شكل الـ chest tube اللي لما بكون جديد أحد
+
+404
+00:30:51,710 --> 00:30:57,750
+يعني أنواعه طبعا في العادة إنه ما بكونش فيه تلاتة
+
+405
+00:30:57,750 --> 00:31:03,270
+في واحد بنشبط في المريض هو اللي متصل في الأنبوب
+
+406
+00:31:03,270 --> 00:31:08,070
+اللي نازل زي ما حكينا لمستوى الميّهوالفتحة التانية
+
+407
+00:31:08,070 --> 00:31:13,010
+اللي هي يا بتسمح بإنه يطلع الهواء يا أنت بتشبك
+
+408
+00:31:13,010 --> 00:31:19,750
+فيها suction أصلا علشان إيش تزود ال suction وال
+
+409
+00:31:19,750 --> 00:31:23,490
+drainage من ال patient هذا شكله الحقيقي لو كنا
+
+410
+00:31:23,490 --> 00:31:31,290
+شبكينه على مريض بحق لاحظ إنه هناأيش لهم الـ«تيوب»؟
+
+411
+00:31:31,290 --> 00:31:33,990
+ده بقيت الـ«تيوب» اللي نازل أحمر لإيش؟ لأنه فيه دم
+
+412
+00:31:33,990 --> 00:31:37,750
+اللي جاي من المريض طبعاً مجرد ما بتصفط دم هذا برجع
+
+413
+00:31:37,750 --> 00:31:41,010
+مستوى الـ«fluid» لهنا ويبدأ يعمل حركة
+
+414
+00:31:41,010 --> 00:31:44,550
+الـ«fluctuation» اللي حكينا عنها مع النفس فده كان
+
+415
+00:31:44,550 --> 00:31:51,210
+نظام اسمهيعني one chamber زي ما شوفته لكن هنا فيه
+
+416
+00:31:51,210 --> 00:31:59,510
+نوع تاني من الـ«تشست تيوب» أكتر من الـ«تشامبر» زي
+
+417
+00:31:59,510 --> 00:32:06,870
+ما شايفينه هذا هو الشكل التجاري أو الشكل الموجود
+
+418
+00:32:06,870 --> 00:32:10,890
+أكتر من الـ«تشامبر» بس خليني أشوفه تشريحيا يعني
+
+419
+00:32:10,890 --> 00:32:14,010
+إيه كيف بالظبط وإيش اللي بيصير فيهالـ Fluid بتيجي،
+
+420
+00:32:14,010 --> 00:32:18,190
+بس مافيش Tube ينزلها لمستوى الميّه «طب ها كيف مش
+
+421
+00:32:18,190 --> 00:32:24,190
+لازم ننزل؟» الهدف من مستوى الميّه إنه يمنع إطلاقا
+
+422
+00:32:24,190 --> 00:32:28,690
+ارتجاع السوائل «هنا أمنينا الفكرة بطريقة أخرى»
+
+423
+00:32:28,690 --> 00:32:31,890
+«الميّه موجودة بس في مكان تاني بحيث أنها تعملي
+
+424
+00:32:31,890 --> 00:32:39,270
+pressure»كويس فإيش اللي بيصير ال fluid أو ال أو
+
+425
+00:32:39,270 --> 00:32:45,110
+الهوى حتى إذا بيجي من المريض وفيه أول chamber
+
+426
+00:32:45,110 --> 00:32:48,430
+يستقبله زادت الكمية وانت لا بعب في ال chamber
+
+427
+00:32:48,430 --> 00:32:50,830
+التاني زادت الكمية وانت لا بعب في ال chamber
+
+428
+00:32:50,830 --> 00:32:54,530
+التالت زادت الكمية وانت لا بعب في ال chamber اللي
+
+429
+00:32:54,530 --> 00:32:58,660
+بعده كل اللي بيعبي هذا حتى لو كانمش fluid، هوى،
+
+430
+00:32:58,660 --> 00:33:01,980
+هنشوف هذا هوى، هذا الاسم هذه هوى، هوى، هوى، هوى،
+
+431
+00:33:01,980 --> 00:33:04,160
+هوى، زاد، زاد، هوى، هوى، هوى، هوى، هوى، زاد، زاد،
+
+432
+00:33:04,160 --> 00:33:04,260
+هوى، هوى، هوى، هوى، هوى، هوى، هوى، هوى، هوى، هوى،
+
+433
+00:33:04,260 --> 00:33:04,260
+هوى، هوى، هوى، هوى، هوى، هوى، هوى، هوى، هوى، هوى،
+
+434
+00:33:04,260 --> 00:33:04,360
+هوى، هوى، هوى، هوى، هوى، هوى، هوى، هوى، هوى، هوى،
+
+435
+00:33:04,360 --> 00:33:05,760
+هوى، هوى، هوى، هوى، هوى، هوى، هوى، هوى، هوى، هوى،
+
+436
+00:33:05,760 --> 00:33:05,760
+هوى، هوى، هوى، هوى، هوى، هوى، هوى، هوى، هوى، هوى،
+
+437
+00:33:05,760 --> 00:33:19,880
+هوى، هوى، هوى،
+
+438
+00:33:19,880 --> 00:33:24,360
+هوى،
+
+439
+00:33:25,440 --> 00:33:28,460
+الـ Water seal اللي موجود، السطح المائي اللي موجود
+
+440
+00:33:28,460 --> 00:33:32,600
+وبالتالي بدأ إيش يزيد إذا كان الهواء هيبدأ يطلع من
+
+441
+00:33:32,600 --> 00:33:36,020
+السطح المائي ويله هنا مكان زي ما أحنا شايفين،
+
+442
+00:33:36,020 --> 00:33:41,400
+Valve بيسمح له إنه أو suction يشفطته to help
+
+443
+00:33:41,400 --> 00:33:45,280
+remove air from plural space but not exist لكن ال
+
+444
+00:33:45,280 --> 00:33:50,710
+suction اللي بنعمله عادة مش أكتر من-20 يعني مش
+
+445
+00:33:50,710 --> 00:33:53,730
+أكتر من الـ one لأنه لازم يكون هنا negative
+
+446
+00:33:53,730 --> 00:33:56,670
+pressure يا جماعة عشانك ال pressure بالـ بالcell
+
+447
+00:33:56,670 --> 00:34:04,170
+مش لازم يكون أكتر من عشرين طبعا
+
+448
+00:34:04,170 --> 00:34:10,550
+في هناالنظام، هذا لو كنت أشبكه في suction في نظام
+
+449
+00:34:10,550 --> 00:34:15,050
+هنا إن إحنا بنحط ميّه في هذا البوتل، هذا البوتل
+
+450
+00:34:15,050 --> 00:34:19,770
+مستقل عنهم، لاحظوا ممسكّر من هنا، لاحظين؟ ممسكّر
+
+451
+00:34:19,770 --> 00:34:23,610
+من هنا يعني، لاحظوا؟ ممسكّر، وبس بنحط الميّه هيه،
+
+452
+00:34:23,610 --> 00:34:27,100
+من هنا، من هنا، فبتعبي وينفل ال chamber هذالوين
+
+453
+00:34:27,100 --> 00:34:29,480
+مستوى الميّه بيوصل لـ «هان»؟ مستوى الميّه هذا
+
+454
+00:34:29,480 --> 00:34:34,460
+بيعملّي pressure minus 20 لحاله فبيسهّل فيه يعني
+
+455
+00:34:34,460 --> 00:34:38,080
+بيخلّي دايماً دايماً طالع هي مفتوح من «هان» لـ
+
+456
+00:34:38,080 --> 00:34:41,920
+«هان» في فتحة بوجود الميّه اللي «هان» فإيش
+
+457
+00:34:41,920 --> 00:34:44,980
+هيعملّي؟ هيعملّي negative pressure اللي هو عبارة
+
+458
+00:34:44,980 --> 00:34:50,280
+عن minus 20 عن طريق 20 centimeter ميّه بس أنا هحطه
+
+459
+00:34:50,280 --> 00:34:53,960
+20 centimeter ميّه
+
+460
+00:34:54,940 --> 00:34:58,080
+عفوًا، عن طريق كمية الميّه اللي أنا أحطها حسب
+
+461
+00:34:58,080 --> 00:35:01,140
+تعليمات الجهاز اللي هتعمل ليه pressure قدره 20
+
+462
+00:35:01,140 --> 00:35:05,740
+صنطي فيه
+
+463
+00:35:05,740 --> 00:35:09,900
+الـ... الـ... يعني الطول تبع الميّه اللي بنحطها 20
+
+464
+00:35:09,900 --> 00:35:14,720
+صنطي متر بيعملوليه pressure minus 20 عشان يظلوا
+
+465
+00:35:14,720 --> 00:35:20,440
+بشكل مستمر يعمل suctioning لـ«البيانات» ويطلع
+
+466
+00:35:20,440 --> 00:35:25,290
+الـ«فلويد» ويعمل drainage systemهذا شكله الـ
+
+467
+00:35:25,290 --> 00:35:28,830
+Nursing Management المهم لواحد عنده الـ chest tube
+
+468
+00:35:28,830 --> 00:35:33,650
+أنه يضل زي ما حكينا ال system ي close و يضلوا تحت
+
+469
+00:35:33,650 --> 00:35:38,550
+ال chest level يضل ال connections و ال tube
+
+470
+00:35:41,150 --> 00:35:46,610
+بأمان ولا أحد يحاول إنه يشدها مثلا أو تكون فيها
+
+471
+00:35:46,610 --> 00:35:53,710
+kinking دايما نتأكد إنه إذا مشبوك على سواء
+
+472
+00:35:53,710 --> 00:35:58,930
+الـwater suction أو الـwall suction سواء water
+
+473
+00:35:58,930 --> 00:36:01,470
+suction أو wall suction إنه مايكونش ال pressure
+
+474
+00:36:01,470 --> 00:36:08,170
+أكتر من عشرينيعني مايكونش أجال أكتر من negative 20
+
+475
+00:36:08,170 --> 00:36:12,230
+لو كان في الميه هيكون عن طريق إن أحط بس 20
+
+476
+00:36:12,230 --> 00:36:18,470
+centimeter ميه هيعمللي pressure minus 20 تمام؟ لو
+
+477
+00:36:18,470 --> 00:36:23,070
+كان بال wall suction برضه بدك تعمله regulation إنه
+
+478
+00:36:23,070 --> 00:36:25,410
+يكون negative 20 مش أكتر
+
+479
+00:36:29,610 --> 00:36:34,410
+دائما ضروري أن نشوف تعليمات كل الشركة المصنعة على
+
+480
+00:36:34,410 --> 00:36:37,790
+الـ«بوتلز»
+
+481
+00:36:37,790 --> 00:36:43,700
+لأنها ممكن تكون بتختف من شركة لأخرى اللي بهمناإحنا
+
+482
+00:36:43,700 --> 00:36:48,740
+بشكل عام إنه المريض هذا لازم يكون تحت المراقبة
+
+483
+00:36:48,740 --> 00:36:53,280
+وأعرف إنه فعلا الـ Chesty tube يشتغل بشكل صحيح عن
+
+484
+00:36:53,280 --> 00:36:56,840
+طريق إنه يكون فيه fluctuation زي ما حكينا، إيش
+
+485
+00:36:56,840 --> 00:37:03,470
+يعني؟ يعني تردد في الـ tube نتيجة إيشمع تغيير أو
+
+486
+00:37:03,470 --> 00:37:06,570
+مع الـ «chest movement» مع تغيير الـ«pressure»
+
+487
+00:37:06,570 --> 00:37:09,090
+الانتراثولوجيكي أنا عشان أعمل الحاجة هذه لازم أخلي
+
+488
+00:37:09,090 --> 00:37:12,870
+المريض يعمل DB bleed and cough ويمكن استخدام
+
+489
+00:37:12,870 --> 00:37:17,410
+الـ«Spirometer» أو الـ«Spirometer» عشان فعلا بيخلي
+
+490
+00:37:17,410 --> 00:37:21,150
+الـ«lung expansion» يتزيدوفعلاً بيخلّيني أشوف
+
+491
+00:37:21,150 --> 00:37:25,990
+التردد بشكل كويس المريض ممكن يكون عنده ألم لازم
+
+492
+00:37:25,990 --> 00:37:30,390
+أراقبه وإذا عنده ألم because of the chest tube أو
+
+493
+00:37:30,390 --> 00:37:32,510
+because of ال trauma الأساسية اللي عنده إنه
+
+494
+00:37:32,510 --> 00:37:36,770
+انكتبله الـ Analytic medication as prescribed
+
+495
+00:37:36,770 --> 00:37:40,810
+وتنعطالهلازم يكون فيه مراقبة للـ «فايتل ساينس»
+
+496
+00:37:40,810 --> 00:37:47,090
+بقعة المريض ولازم يكون فيه من فترة للتانية عمل
+
+497
+00:37:47,090 --> 00:37:52,730
+«سيكويزينج» للتعصير له و «ميلكينج» للـ«تشست»
+
+498
+00:37:52,730 --> 00:37:56,830
+الـ«تيوب» عشان ما يكونش فيهم تجمعات ويصير فيه
+
+499
+00:37:56,830 --> 00:38:01,050
+sudden closure عند المريض وفجأة يبدأ يخش فيه
+
+500
+00:38:01,050 --> 00:38:06,200
+مضاعفاتكمان يا جماعة، لازم ينعمل الـ Dressing لـ
+
+501
+00:38:06,200 --> 00:38:11,060
+«جسد» الـ Tube اللي هو يعني الـ Attachment و الـ
+
+502
+00:38:11,060 --> 00:38:14,420
+Contact تبعته و الـ Penetrating Site وين دخل الـ
+
+503
+00:38:14,420 --> 00:38:19,830
+Tube لـ Plural Space هنا المكان هذاهيه ريسك إنه
+
+504
+00:38:19,830 --> 00:38:24,350
+يصير عنده infection في لازم ينعمله dressing ويتغطى
+
+505
+00:38:24,350 --> 00:38:31,010
+بـ sterile cover والأحسن إنه ما يكونش ال dressing
+
+506
+00:38:31,010 --> 00:38:37,530
+تبعه يعني frequently إلا إذا صار wet عشان نمنع إنه
+
+507
+00:38:37,530 --> 00:38:43,070
+يصير infectedأهم حاجة أنه لما تبتدي تعمل «Mail
+
+508
+00:38:43,070 --> 00:38:49,910
+King» ما تسحبش لطيوب بشكل قوي فانت تروح و انت
+
+509
+00:38:49,910 --> 00:38:56,690
+رافعه من مكانه تراقب انه لطيوب مايكونش فيه عنده
+
+510
+00:38:56,690 --> 00:39:01,310
+«King King» يعني فيه التوقات أو ما يمنع ان
+
+511
+00:39:01,310 --> 00:39:06,250
+الانسيابية تبعت السوائل لو حصل ان المريض احتاج
+
+512
+00:39:06,250 --> 00:39:12,570
+جماعة انه مثلايعمل أي بروسيجر مثلا بدنا ننقله من
+
+513
+00:39:12,570 --> 00:39:17,810
+مكان لمكان أو بدنا نعمله أي بروسيجر X-ray بما
+
+514
+00:39:17,810 --> 00:39:22,350
+نفترض وما بدناش يكون يعني الـ chest tube شجّات
+
+515
+00:39:23,410 --> 00:39:29,210
+فبنعمل حاجة نسميها «Clamping» لـ «Chest Tube» خد
+
+516
+00:39:29,210 --> 00:39:33,090
+بالك جدا إن الـ «Clamping» هذا لازم يكون وقته قصير
+
+517
+00:39:33,090 --> 00:39:38,270
+ينعمل بـ «حذر»
+
+518
+00:39:38,270 --> 00:39:41,950
+وعن طريق استخدام الـ «Forceps» المناسبة ومن
+
+519
+00:39:41,950 --> 00:39:47,810
+الأماكن الصحيحة يعني الـ «Chest Tube» عادة إن
+
+520
+00:39:47,810 --> 00:39:50,190
+الجماعة بكون إدارة عن الـ «Tube» بدخل في المريض
+
+521
+00:39:50,190 --> 00:39:55,600
+بعدين بيجي connection علشانيعني أدابتور حاجة بتيجي
+
+522
+00:39:55,600 --> 00:39:59,500
+زي توصيلة ما بين التيوب اللي دخل في المريض وبربيج
+
+523
+00:39:59,500 --> 00:40:02,940
+الكبير لتيوب الكبير اللي بده يشبك وين في الـPotel
+
+524
+00:40:02,940 --> 00:40:06,760
+فدائما الـ Clamp بينعمل من البربيج الأول من التيوب
+
+525
+00:40:06,760 --> 00:40:11,080
+الأول اللي في المريض ببعد مثلا عشرة صنط عن المريض
+
+526
+00:40:11,080 --> 00:40:15,260
+و بعمل بجيب شاشة و forceps بحط الشاشة على التيوب
+
+527
+00:40:15,260 --> 00:40:19,280
+عشان ماعملش damage للتيوب و بعدين بعمل clamping في
+
+528
+00:40:19,280 --> 00:40:22,420
+ال forceps في ناس ممكن تغلط و تروح تعمل clamping
+
+529
+00:40:22,420 --> 00:40:26,400
+بعدفي اليوتيوب، خلّيني أرجع على الصورة عشان يكون
+
+530
+00:40:26,400 --> 00:40:33,490
+الكلام مواضح مثلا، نعتبر أنه، نشوف مريض؟تمام نعتبر
+
+531
+00:40:33,490 --> 00:40:37,570
+ان ال connection في المنطقة هذه الحمرة او نجربها
+
+532
+00:40:37,570 --> 00:40:41,730
+نعتبر ال connection هنا التوصيلة بين ال tube هذا و
+
+533
+00:40:41,730 --> 00:40:45,170
+ال tube اللي نازل تمام نعتبر ان الساهم هذا هو
+
+534
+00:40:45,170 --> 00:40:48,230
+التوصيلة لما بدك تعمل climate لازم تعمله في
+
+535
+00:40:48,230 --> 00:40:52,110
+المنطقة هنا مش في المنطقة هنا اعتبر ان انت عملت في
+
+536
+00:40:52,110 --> 00:40:55,330
+المنطقة هنا و فجأة حركة المريض اللي هو من عند ال
+
+537
+00:40:55,330 --> 00:40:59,150
+connection راح ايش فلت فانت سمحت للهوى فعلا انه
+
+538
+00:40:59,150 --> 00:41:06,660
+يدخل وهذا بيكون مش صحيحهذا بالنسبة للحاجات اللي
+
+539
+00:41:06,660 --> 00:41:11,160
+لازم ناخد بالنا منها الـ Clamp لو عملناه للمريض زي
+
+540
+00:41:11,160 --> 00:41:15,380
+ما حكينا لازم يكون وقته قصير بهدف إنه نعمل الإجراء
+
+541
+00:41:15,380 --> 00:41:17,880
+مثلا نقل مريض ليه أجوز أن أنقل مريض من مكان إلى
+
+542
+00:41:17,880 --> 00:41:20,760
+مكان وهو موجودين لـChest Tube ممكن مع الحركة
+
+543
+00:41:20,760 --> 00:41:25,210
+يفلتوا فجأة مني، لأأنا بفلطهم براتب، بفكهم يعني و
+
+544
+00:41:25,210 --> 00:41:27,630
+بحافظ على الـStability تبعتهم و بعملي Clamping
+
+545
+00:41:27,630 --> 00:41:31,770
+بالطريقة الصح، آه و ببدأ أنقل فيه من المكان لمكان
+
+546
+00:41:31,770 --> 00:41:35,870
+التاني و بعد ما تخلص عملية النقل برجع بعمل
+
+547
+00:41:35,870 --> 00:41:39,890
+connection لـChesty tubes إلا إذا كان ممكن أن
+
+548
+00:41:39,890 --> 00:41:49,780
+أنقله مع ضمان أنه مايكنش فيه أيفصل لـ Accidentally
+
+549
+00:41:49,780 --> 00:41:55,900
+طبعاً للـ Chest Drainage هيك تقريبا بتكون خلصت
+
+550
+00:41:55,900 --> 00:41:57,840
+محاضرتنا للموضوع هذا
+
diff --git a/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/WqDa90omKZk.srt b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/WqDa90omKZk.srt
new file mode 100644
index 0000000000000000000000000000000000000000..45f736f55b95be2f656f7ed4261f62d349838702
--- /dev/null
+++ b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/WqDa90omKZk.srt
@@ -0,0 +1,1338 @@
+1
+00:00:04,250 --> 00:00:06,870
+بسم الله الرحمن الرحيم السلام عليكم ورحمة الله
+
+2
+00:00:06,870 --> 00:00:12,270
+وبركاته. اليوم، إن شاء الله رب العالمين، هنبدأ في
+
+3
+00:00:12,270 --> 00:00:17,010
+Unit 3 Acute Alteration in Respiratory Functions
+
+4
+00:00:17,010 --> 00:00:20,270
+بالنسبة
+
+5
+00:00:20,270 --> 00:00:23,030
+للـCritical Care، أكيد بنعرف إن مشاكل
+
+6
+00:00:23,030 --> 00:00:29,150
+الـRespiratory من أهم المشاكل. ممكن تكون مطلوب نعمل
+
+7
+00:00:29,150 --> 00:00:34,960
+فيها رعاية للمريض.  وبسبب كثرة الهواتف عشان
+
+8
+00:00:34,960 --> 00:00:37,060
+ذلك، سيكون معانا الـ Acute respiratory failure.
+
+9
+00:00:37,060 --> 00:00:39,440
+وسيكون معانا الـ Acute respiratory distress
+
+10
+00:00:39,440 --> 00:00:43,220
+syndrome. حاجة مشهورة جداً، الـ Pulmonary embolism.
+
+11
+00:00:43,220 --> 00:00:48,100
+نبدأ في الـ Acute respiratory failure. الـ
+
+12
+00:00:48,100 --> 00:00:50,840
+Respiratory failure in general is a sudden and
+
+13
+00:00:50,840 --> 00:00:53,460
+life-threatening deterioration of gas exchange.
+
+14
+00:00:53,460 --> 00:01:02,460
+فجأة يحصل عند المريض،  الـ lung
+
+15
+00:01:02,460 --> 00:01:07,820
+بتبدأ تصير غير قادرة على أن تعمل elimination للـ
+
+16
+00:01:07,820 --> 00:01:14,220
+CO2 والـ partial
+
+17
+00:01:14,220 --> 00:01:18,780
+pressure تبع الـ oxygen. بيبدأ يصير decreased في
+
+18
+00:01:18,780 --> 00:01:24,730
+الـlungs. الـ Acute Respiratory Failure، في تعريفه أن
+
+19
+00:01:24,730 --> 00:01:28,170
+الـ Partial Pressure للأكسجين يصير أقل من 60
+
+20
+00:01:28,170 --> 00:01:31,890
+مليمتراً زئبقياً، وهذا بنسميه Hypoxemia، زي ما بنعرف.
+
+21
+00:01:31,890 --> 00:01:37,970
+والـ CO2 يبدأ يصير أكثر من 50 مليمتراً زئبقياً، اللي هو
+
+22
+00:01:37,970 --> 00:01:41,030
+Hypercapnia.
+
+23
+00:01:41,030 --> 00:01:44,430
+زي ما احنا عارفين.
+
+24
+00:01:47,710 --> 00:01:52,890
+الـ Hypercapnia من أهم أسباب الـ Respiratory
+
+25
+00:01:52,890 --> 00:01:56,670
+Acidosis في مرضى الـ أو في حالة الـ Acute
+
+26
+00:01:56,670 --> 00:02:04,730
+Respiratory Failure. عشان هيك، كتير مهم أن نفرّق بين
+
+27
+00:02:04,730 --> 00:02:07,270
+الـ Acute Respiratory Failure والـ Chronic
+
+28
+00:02:07,270 --> 00:02:11,490
+Respiratory Failure. طب هو في فرق بينهم؟ طبعاً، الـ
+
+29
+00:02:11,490 --> 00:02:16,260
+Chronic Respiratory Failure اللي بنعرفه، إنه عبارة
+
+30
+00:02:16,260 --> 00:02:21,580
+عن الـ deterioration في الـ gas exchange والـ
+
+31
+00:02:21,580 --> 00:02:27,400
+function تبع الـ lung، لكن بتتطور بشكل تدريجي، مش
+
+32
+00:02:27,400 --> 00:02:31,570
+فجأة. المريض بيكون قادر على عملية التنفس وعمل
+
+33
+00:02:31,570 --> 00:02:36,290
+الـ Gas Exchange، لكن فجأة الـ Lung تصبح ليس لديها
+
+34
+00:02:36,290 --> 00:02:40,390
+قدرة على عمل الـ Gas Exchange، وظائفها بتبقى
+
+35
+00:02:40,390 --> 00:02:43,970
+متأثرة. بيصير حالياً في المرضى، في العصر اللي بنعيشه،
+
+36
+00:02:43,970 --> 00:02:48,290
+اللي هو الـ Corona، المريض بيصير عنده  Symptoms
+
+37
+00:02:48,290 --> 00:02:53,150
+أشبه بالـ Flu، فجأة بيخش المريض في Acute
+
+38
+00:02:53,150 --> 00:02:57,730
+Respiratory Failure، لأن الـ Lung فجأة بيصير فيها
+
+39
+00:02:57,730 --> 00:03:01,050
+تغيرات  مفاجئة. زي ما بقولوا، ثاني يوم، ثالث يوم بيبدأ
+
+40
+00:03:01,050 --> 00:03:04,230
+يصير غير قادرة الـ lung على أن تعمل اللي هو الـ
+
+41
+00:03:04,230 --> 00:03:07,230
+gas exchange. وهذا بتصنف تحت الـ Acute Respiratory
+
+42
+00:03:07,230 --> 00:03:10,110
+Failure. لكن في الـ Chronic Respiratory Failure، من
+
+43
+00:03:10,110 --> 00:03:13,470
+الأمثلة تبعته، مثلاً الـ COPD patient، الـ
+
+44
+00:03:13,470 --> 00:03:17,470
+Neuromuscular Disease، الناس اللي بِتتطوّر عندهم
+
+45
+00:03:17,470 --> 00:03:22,430
+الأمور Gradually. يعني هو بيكون عنده Respiratory
+
+46
+00:03:22,430 --> 00:03:25,910
+Disorders، بيكون عنده impairment في الـ Function
+
+47
+00:03:25,910 --> 00:03:28,180
+تبع الـ lungs، ولكنها لا تدخل فقط في الـ
+
+48
+00:03:28,180 --> 00:03:35,740
+Respiratory Failure فجأة، بل تبقى Supported،  إلى
+
+49
+00:03:35,740 --> 00:03:39,640
+أن تصل إلى وقت أن الـ Lung ليس قادرة أن تكون بالـ
+
+50
+00:03:39,640 --> 00:03:46,340
+Function تبعتها نهائياً، ويدخل الـ Acute on Top of
+
+51
+00:03:46,340 --> 00:03:46,980
+Chronic.
+
+52
+00:03:52,600 --> 00:03:55,760
+طب الـ Acute Respiratory Failure إله أنواع؟ آه
+
+53
+00:03:55,760 --> 00:03:59,820
+طبعاً إله أنواع. في type 1 وفي type 2. طب إيش بيكون
+
+54
+00:03:59,820 --> 00:04:03,140
+في type 1؟ Acute Hypoxia… بيسموها Acute
+
+55
+00:04:03,140 --> 00:04:07,060
+Hypoxemic Respiratory Failure. إيش يعني؟ يعني الـ
+
+56
+00:04:07,060 --> 00:04:12,000
+Respiratory Failure هنا ناتجة من قلة الأكسجين
+
+57
+00:04:12,000 --> 00:04:16,440
+وليس من ارتفاع ثاني أكسيد الكربون. إذاً Hypox…
+
+58
+00:04:19,720 --> 00:04:26,520
+من غير ما يكون الـ CO2 يا جماعة مرتفع في المرضى
+
+59
+00:04:26,520 --> 00:04:31,180
+هذول. لا يعني ما يكونش فيه CO2 retention، على
+
+60
+00:04:31,180 --> 00:04:35,660
+العكس، حتى ممكن أن يكون CO2 في hyperventilation
+
+61
+00:04:35,660 --> 00:04:39,940
+يا جماعة، و CO2 يكون low عند المرضى هذول، علشان
+
+62
+00:04:39,940 --> 00:04:50,880
+هيك. هذا الـ type يعني بيكون عادة مصاحب لأمراض أخرى
+
+63
+00:04:50,880 --> 00:04:55,040
+وبالذات الـ Cardiogenic والـ Non-Cardiogenic
+
+64
+00:04:55,040 --> 00:05:01,320
+pulmonary edema و Pneumonia. بكون الوضع فيهم بهذا
+
+65
+00:05:01,320 --> 00:05:07,100
+الشكل. الـ Type 2 Acute
+
+66
+00:05:09,450 --> 00:05:13,310
+Failure بيسموه Acute Hypercapnic. من اسمه واضح
+
+67
+00:05:13,310 --> 00:05:19,030
+جداً أن الـ CO2 عالي، كتير، أكثر من خمسين، زي ما
+
+68
+00:05:19,030 --> 00:05:26,250
+حكينا. طبعاً هذا هيخلي أن الـ PH تبدأ تقل، وبتعمل
+
+69
+00:05:26,250 --> 00:05:28,970
+Respiratory Acidosis، زي ما أخذنا في الـ Chapter
+
+70
+00:05:28,970 --> 00:05:32,670
+الـ Blood Gases. مفهوم أنه مع كل Increase في
+
+71
+00:05:32,670 --> 00:05:41,490
+الـ CO2، بيبدأ الـ PH تصير لها Decrease، وبتبدأ يصير
+
+72
+00:05:41,490 --> 00:05:47,430
+حالة من الـ Respiratory Acidosis. طبعاً هذا عادة
+
+73
+00:05:47,430 --> 00:05:52,290
+يكون نتيجة Inadequate airflow in the alveoli of
+
+74
+00:05:52,290 --> 00:05:56,510
+the lungs. عادة بيكون كمية الهواء اللي بتدخل
+
+75
+00:05:56,510 --> 00:06:00,770
+الـ Alveoli قليلة، علشان هيك بيصير احتباس لثاني أكسيد
+
+76
+00:06:00,770 --> 00:06:06,050
+الكربون، وبيصير impairment في الـ gas exchange.
+
+77
+00:06:08,230 --> 00:06:15,570
+أسباب كثيرة ممكن تؤدي إلى الكلام هذا.
+
+78
+00:06:15,570 --> 00:06:20,430
+(This section appears to be a repeated phrase with a possible recording error,  and should be removed)
+
+86
+00:06:36,800 --> 00:06:41,120
+بالتالي، الجسم لا ينقل الأكسجين لنفسه، لأن الـ
+
+87
+00:06:41,120 --> 00:06:44,820
+lung في أماكن كتيرة ما بتشتغلش. الشغل تبقى عارفه، تبقى
+
+88
+00:06:44,820 --> 00:06:48,720
+عارفة احنا، تبقى عارفة في حالات الـ Emphysema، الـ Emphysema في
+
+89
+00:06:48,720 --> 00:06:52,480
+الـ chest كيف بيصير فيه opening  من القلب، بيصير فيه
+
+90
+00:06:52,480 --> 00:06:57,500
+تواصل، بدل ما يكونوا بكل يعني كلهم جدار تبع الـ One
+
+91
+00:06:57,500 --> 00:07:00,700
+Alveoli بيكون محل الـ Gas Exchange. والـ Alveoli
+
+92
+00:07:00,700 --> 00:07:03,420
+اللي جنبها، والـ Alveoli اللي جنبها، كل هدول الغرف
+
+93
+00:07:03,420 --> 00:07:06,460
+اللي صغيرة بتفتح وبتعمل غرفة كبيرة، فمساحة الـ Gas
+
+94
+00:07:06,460 --> 00:07:09,740
+Exchange اللي على الـ Wall يا جماعة بتقل، تمام،
+
+95
+00:07:09,740 --> 00:07:14,980
+فبالتالي بيكون الـ يعني هذا مثال لكيف بتقل عملية
+
+96
+00:07:14,980 --> 00:07:20,440
+الـ Gas Exchange عند المرضى هذول، وبيؤدي ذلك إلى
+
+97
+00:07:20,440 --> 00:07:26,770
+زيادة ثاني أكسيد الكربون في الجسم، وقلة الأكسجين في
+
+98
+00:07:26,770 --> 00:07:31,690
+الدم. الـ PCO2، الـ partial pressure تبع الـ Carbon،
+
+99
+00:07:31,690 --> 00:07:35,970
+الـ CO2 بيزيد، الـ partial pressure تبع الأكسجين بقل.
+
+100
+00:07:35,970 --> 00:07:39,950
+وبالتالي هذا اللي هيعمل لنا الـ hypercapnia
+
+101
+00:07:39,950 --> 00:07:43,350
+والـ respiratory acidosis.  كواسي الـ respiratory
+
+102
+00:07:43,350 --> 00:07:49,020
+failure، من إيش بيصير؟ can be grouped according to
+
+103
+00:07:49,020 --> 00:07:49,760
+the primary
+
+104
+00:07:49,760 --> 00:08:00,920
+abnormality.
+
+105
+00:08:01,410 --> 00:08:09,910
+أو يعني توقف عملية التنفس، والخلل في عملية التنفس
+
+106
+00:08:09,910 --> 00:08:15,850
+زي Airway Obstruction. يعني راجل ما فيه عنده مشكلة
+
+107
+00:08:15,850 --> 00:08:19,990
+لكن صار فيه عنده Severe Epileptic Disorder مثلاً
+
+108
+00:08:19,990 --> 00:08:22,610
+فصار فيه عنده  خوم، صار فيه عنده Laryngitis
+
+109
+00:08:22,610 --> 00:08:25,310
+Edema، Severe Laryngitis Edema، فما فيه إمكانية أن
+
+110
+00:08:25,310 --> 00:08:32,020
+الجاز يخش عشان يصير له X Change. أو مثلاً الـ tumor
+
+111
+00:08:32,020 --> 00:08:37,040
+يا جماعة، أو from body inhalation. سكر مجرد التنفس
+
+112
+00:08:37,040 --> 00:08:42,460
+عنده، فهذا عمل. أو في تحت في ال lungs فيه cystic fibrosis
+
+113
+00:08:42,460 --> 00:08:47,120
+process. فالـ alveoli ما بيعملوش دورهم في كل
+
+114
+00:08:47,120 --> 00:08:50,060
+الحالات، زي ما احنا شايفين. يا مش هوا أصلاً بفوت يا
+
+115
+00:08:50,060 --> 00:08:57,260
+إما الـ Respiratory Failure صار نتيجة إنه ما فيه
+
+116
+00:08:57,260 --> 00:09:00,960
+ألويولي عايزة تشتغل وتقوم بدورها وتعمل الـ Gas
+
+117
+00:09:00,960 --> 00:09:06,060
+Exchange. فيه الـ Alveolar and Pleural Disease. يعني
+
+118
+00:09:06,060 --> 00:09:11,800
+الـ Alveoli نفسها ممكن تكون فيها مشكلة. Resulting in
+
+119
+00:09:11,800 --> 00:09:16,780
+hypoxic respiratory failure. وطبعاً هيتأدي إلى نقص التأكسج.
+
+120
+00:09:17,750 --> 00:09:22,130
+كما يكون مثلاً Cardiogenic أو Non-Cardiogenic pulmonary
+
+121
+00:09:22,130 --> 00:09:27,450
+edema. مليانة
+
+122
+00:09:27,450 --> 00:09:30,990
+مياه في البُلْمونَة القديمة سواء كانت Cardiogenic أو
+
+123
+00:09:30,990 --> 00:09:37,290
+Non-Cardiogenic. يعني Cardiogenic pulmonary edema لما
+
+124
+00:09:37,290 --> 00:09:41,970
+يكون البُلْمونَة القديمة cause of failure of the
+
+125
+00:09:41,970 --> 00:09:45,620
+heart to do its function.  ولكن من الـ Non-
+
+126
+00:09:45,620 --> 00:09:47,760
+Cardiogenic pulmonary edema زي اللي بتصير يا
+
+127
+00:09:47,760 --> 00:09:50,720
+جماعة، حالات الـ Organophosphorus poisoning، فالـ
+
+128
+00:09:50,720 --> 00:09:54,140
+Organophosphorus poisoning، الـ cause ليس خطأ
+
+129
+00:09:54,140 --> 00:09:58,460
+القلب، لأ، القصة أن الـ Cholinesterase
+
+130
+00:09:59,860 --> 00:10:04,420
+كثير عالي في الجسم كله، مستويات إنزيم عالي، فبالتالي
+
+131
+00:10:04,420 --> 00:10:11,480
+ما فيه ارتباط لـ Acetylcholine، فبالتالي فيه يعني تسرب لكل
+
+132
+00:10:11,480 --> 00:10:14,880
+السوائل اللي في الجسم، علشان هي كمان من ضمنها بيصير
+
+133
+00:10:14,880 --> 00:10:17,680
+Bronchorrhea، زي ما احنا عارفين، وبتتجمع كميات كبيرة
+
+134
+00:10:17,680 --> 00:10:18,600
+منها في الـ Lung.
+
+135
+00:10:26,330 --> 00:10:31,590
+اللي بتكون على مستوى الـ Alveoli. عشان هيك بيسموها
+
+136
+00:10:31,590 --> 00:10:34,740
+Alveolar. أو بقية بيكون الموضوع اللي هو لقب الـ
+
+137
+00:10:34,740 --> 00:10:39,600
+Central Nervous System. يعني الـ Failure لأن جهاز
+
+138
+00:10:39,600 --> 00:10:43,400
+العصب المركزي اللي بيتحكم في عملية التنفس هو اللي
+
+139
+00:10:43,400 --> 00:10:48,160
+مش شغال بالطريقة الصحيحة. فبيصير يعني كيف مش
+
+140
+00:10:48,160 --> 00:10:52,800
+شغال، نتيجة مثلاً Brain tumor، نتيجة Brain injury،
+
+141
+00:10:52,800 --> 00:10:57,740
+Trauma. هذا إيش حيعمل؟ حيعمل، يعني الـ Cerebral
+
+142
+00:10:57,740 --> 00:11:02,620
+الـ Hemorrhagic، بيزود الـ pressure. كلهم بيشتغلوا
+
+143
+00:11:02,620 --> 00:11:04,920
+بنفس الطريقة، كلهم بيزيدوا ال pressure على الـ
+
+144
+00:11:04,920 --> 00:11:09,040
+central nervous system. وبالتالي، إيش بيصير؟ بيصير
+
+145
+00:11:09,040 --> 00:11:12,780
+ضغط على الـ respiratory centers. وبالتالي، بيصير
+
+146
+00:11:12,780 --> 00:11:16,920
+المريض يخش في حالة من الـ hypoventilation. بتقل كتير
+
+147
+00:11:16,920 --> 00:11:17,480
+من
+
+148
+00:11:21,990 --> 00:11:28,530
+مع قلة الـ Respiratory Rate، بيصير Retention لـ CO2
+
+149
+00:11:28,530 --> 00:11:34,690
+في الجسم، وبالتالي Hypercapnia. فهذا من أمثلة الـ
+
+150
+00:11:34,690 --> 00:11:37,330
+Respiratory Failure. طبعاً Hypercapnia يعني بالآخر
+
+151
+00:11:37,330 --> 00:11:41,350
+الجسم بيستهلك الأكسجين بيقل، ثم بيصير ثاني أكسيد كربون
+
+152
+00:11:41,350 --> 00:11:47,330
+بيصير Respiratory Acidosis. كده المريض يخش في الـ
+
+153
+00:11:47,330 --> 00:11:51,950
+Respiratory Failure. في Peripheral Nervous System
+
+154
+00:11:51,950 --> 00:11:57,830
+ممكن يؤدي لـ Respiratory Failure؟ آه، زي أمثلة الـ
+
+155
+00:11:57,830 --> 00:12:02,590
+Guillain-Barré Syndrome. Guillain-Barré Syndrome ده يعني
+
+156
+00:12:02,590 --> 00:12:08,470
+most commonly it's post-viral. الناس عادةً بعد ممكن
+
+157
+00:12:08,470 --> 00:12:12,570
+يعني يكون الواحد  عنده common cold،  influenza أو
+
+158
+00:12:12,570 --> 00:12:15,150
+any type of viral infection. الناس ممكن يخشوا الـ
+
+159
+00:12:15,150 --> 00:12:18,030
+deterioration، ويصير عندهم Guillain-Barré syndrome.
+
+160
+00:12:18,030 --> 00:12:20,650
+إيش Guillain-Barré syndrome؟ هذا بيصير يعني الـ
+
+161
+00:12:20,650 --> 00:12:26,770
+peripheral neuropathy، و peripheral weakness.
+
+162
+00:12:26,770 --> 00:12:30,650
+طبعاً في الـ ascending، بما يسمونه ascending
+
+163
+00:12:30,650 --> 00:12:34,830
+muscle weakness. يعني بيبدأ من الأطراف السفلية لـ
+
+164
+00:12:37,970 --> 00:12:41,350
+يعني القدمين، من الأطراف السفليّة، ويبدأ يصير فيه
+
+165
+00:12:41,350 --> 00:12:45,630
+weakness، ويبدأ الـ weakness يطلع لفوق. وهو بطلع لفوق،
+
+166
+00:12:45,630 --> 00:12:48,110
+أنا من وين بخاف؟ بخاف من الـ respiratory muscles
+
+167
+00:12:48,110 --> 00:12:52,330
+يصير فيها weakness. آه، ممكن يصل، طبعاً ممكن يصل إذا
+
+168
+00:12:52,330 --> 00:12:57,750
+ما كانش فيه تدعيم لجهاز المناعي، زي ما احنا بنعرف.
+
+169
+00:12:57,750 --> 00:13:02,740
+الـ Guillain-Barré Syndrome من أهم الـ Managements
+
+170
+00:13:02,740 --> 00:13:07,820
+تبعتها، أو من أهم الأدوية اللي بتعطى في هذه
+
+171
+00:13:07,820 --> 00:13:12,060
+الحالات، أدوية الـ Immunoglobulin-G، اللي بتقوي مناعة
+
+172
+00:13:12,060 --> 00:13:17,200
+الجسم، عشان يتحدى هذا الـ Disease. ومن أمثلتها أيضاً
+
+173
+00:13:17,200 --> 00:13:23,980
+الـ Muscular Dystrophy، والـ Myasthenia
+
+174
+00:13:23,980 --> 00:13:27,200
+Gravis، اللي هي تقريباً بتشتغل
+
+175
+00:13:35,480 --> 00:13:40,400
+وهو ممكن يؤثر على الـ Respiratory Muscles اللي في
+
+176
+00:13:40,400 --> 00:13:42,940
+كل المريض، كل الناس اللي بيكون عندهم
+
+177
+00:13:42,940 --> 00:13:46,500
+Respiratory Failure، بيكون عندهم عدم قدرة على
+
+178
+00:13:46,500 --> 00:13:48,760
+التنفس بالشكل الصحيح، لأنه Respiratory Failure.
+
+179
+00:13:56,590 --> 00:14:02,030
+فبفضل إنه يبقى في وضعية مقفلة بين الـ nasal أو الـ
+
+180
+00:14:02,030 --> 00:14:06,250
+nostrils. الـ Nostrils بتكون مفتوحة كتير، لأنها
+
+181
+00:14:06,250 --> 00:14:09,970
+بحاول إنه يأخذ كمية هواء بقدر الإمكان. طبعاً هذا
+
+182
+00:14:09,970 --> 00:14:13,590
+هيعمل حالة من الـ confusion state على الـ
+
+183
+00:14:13,590 --> 00:14:17,970
+neurological status تبعة، لإنه ما فيه oxygen كافي
+
+184
+00:14:17,970 --> 00:14:23,140
+بيوصل للـ lungs. فبالتالي بيحس في drowsiness، المريض مش
+
+185
+00:14:23,140 --> 00:14:26,720
+هيك، بيحس فيه drowsiness،  Sorry، الـ
+
+186
+00:14:26,720 --> 
+
+223
+00:17:19,560 --> 00:17:22,770
+Alkalosis اللي موجود هنا عبارة عن إيش؟ عبارة عن
+
+224
+00:17:22,770 --> 00:17:25,730
+compensation لكن في نهاية المرض وفي الآخر ممكن
+
+225
+00:17:25,730 --> 00:17:29,750
+تدخل الـ Respiratory Failure  بسبب الأساس الـ
+
+226
+00:17:29,750 --> 00:17:33,330
+Metabolic Acidosis اللي عندها، و الـ compensation الـ
+
+227
+00:17:33,330 --> 00:17:36,990
+Respiratory Alkalosis اللي عم بيصير عشان يصلح
+
+228
+00:17:36,990 --> 00:17:40,870
+الوضع، لكن في نهاية المطاف ما بتقدرش الـ lung انها تعمل full
+
+229
+00:17:40,870 --> 00:17:43,430
+compensation للحالة المرضية الموجودة، فبتدخل الـ
+
+230
+00:17:43,430 --> 00:17:49,050
+Respiratory Failure، وحالة ثانية ممكن يكون بالعكس،
+
+231
+00:17:49,050 --> 00:17:54,490
+المريض جاي بـ hypoventilation، هبوط التهوية،
+
+232
+00:17:54,490 --> 00:17:57,950
+الـ respiratory rate بتقل، hypoventilation، الـ CO2
+
+233
+00:17:57,950 --> 00:18:01,910
+بيتراكم، ويبدأ المريض يدخل الـ hypercapnia، يتكامل
+
+234
+00:18:01,910 --> 00:18:02,510
+الـ blood gas
+
+235
+00:18:09,800 --> 00:18:14,180
+وأكثر من سبعين بوصل ماريسيو OBD هتلاقي الـ
+
+236
+00:18:14,180 --> 00:18:20,040
+«السيويتو» عنده أكثر من تسعين، والـ pH يعني
+
+237
+00:18:20,040 --> 00:18:31,280
+severely low 7.2، 7.26، المهم أقل من 7.35 يعني أقل
+
+238
+00:18:31,280 --> 00:18:38,350
+من 7.35 %، طبعًا Chest X-Ray عمل مهم أنه ينعمل في
+
+239
+00:18:38,350 --> 00:18:43,770
+الحالات اللي شاكين أنه في Respiratory Failure هيكون
+
+240
+00:18:43,770 --> 00:18:48,390
+فيه واضح severe أو يعني marked  بتسميه pulmonary
+
+241
+00:18:48,390 --> 00:18:52,830
+infiltration، مهم يكون فيه مناطق فيها atelectasis،
+
+242
+00:18:52,830 --> 00:18:55,370
+هذا بيكون كثير واضح في الـ
+
+243
+00:18:57,790 --> 00:19:02,030
+حالات الـ Pneumonia، في حالات الـ TB، في حالات الـ ARDS
+
+244
+00:19:02,030 --> 00:19:04,550
+Acute Respiratory Distress Syndrome اللي هنحكي
+
+245
+00:19:04,550 --> 00:19:08,290
+عليه من كمان شوية إن شاء الله، أعرف من العالمين
+
+246
+00:19:08,290 --> 00:19:11,710
+طبعًا الـ Management، الجمعيات، بدنا نصلح حال الناس
+
+247
+00:19:11,710 --> 00:19:15,190
+هدول، أكيد إنه بدأ يصلح إذا كان الـ CO2 في
+
+248
+00:19:15,190 --> 00:19:19,610
+retention، بدأ أنا أعمله washing out أو أدّي Oxygen
+
+249
+00:19:20,670 --> 00:19:26,110
+فإذا كان يعني الـ underlying cause كان فيه
+
+250
+00:19:26,110 --> 00:19:29,510
+pneumonia هو اللي عامله السبب ده، ندّي الـ antibiotic
+
+251
+00:19:29,510 --> 00:19:33,050
+ونعالج الـ pneumonia، إذا كان فيه يا جماعة
+
+252
+00:19:33,050 --> 00:19:36,530
+secretions هي اللي عاملة المشكلة، بيكون أنا بدي
+
+253
+00:19:36,530 --> 00:19:42,310
+أعمل، بنعمل الـ Bronchodilatation وأعمل الـ
+
+254
+00:19:42,310 --> 00:19:45,750
+Aspiration لهذه الـ Secretion على طريق الـ
+
+255
+00:19:45,750 --> 00:19:50,350
+Spectrum، أدناد مقشعات للبلغة، يمكنني أعمل الـ
+
+256
+00:19:50,350 --> 00:19:53,410
+Suction، يمكنني أعمل الـ Bronchoscope عشان أعمل الـ
+
+257
+00:19:53,410 --> 00:19:57,990
+Hygiene للـ Lung وللـ Trachea
+
+258
+00:20:00,480 --> 00:20:03,860
+عشان هيك الـ underlying disease كثير مهم إنهم
+
+259
+00:20:03,860 --> 00:20:08,260
+يكونوا عارفين إيش هو المرض، ويمكن يكون المريض مثلًا
+
+260
+00:20:08,260 --> 00:20:11,160
+السبب في الـ respiratory failure أنه عنده severe
+
+261
+00:20:11,160 --> 00:20:15,720
+empyema في الـ pleural space، مليئة thick
+
+262
+00:20:15,720 --> 00:20:21,400
+pus،  مثلّج secretions و collections، طب وإيش
+
+263
+00:20:21,400 --> 00:20:24,300
+الحل؟ الحل نعمل له chest drainage، آه إذا نبدأ
+
+264
+00:20:24,300 --> 00:20:26,840
+الـ chest، يعني نضع الـ chest tube
+
+265
+00:20:26,840 --> 00:20:30,990
+under water seal، الـ chest tube، وندّي تمامًا من
+
+266
+00:20:30,990 --> 00:20:35,290
+النظافة للمنطقة
+
+267
+00:20:35,290 --> 00:20:38,110
+هذه الـ Empyema اللي في اللانجو، بدّنا
+
+268
+00:20:38,110 --> 00:20:47,710
+نستخدم عدد من الـ Antibiotics، من أربعة
+
+269
+00:20:47,710 --> 00:20:48,670
+إلى ستة أسابيع
+
+270
+00:21:08,520 --> 00:21:09,920
+‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏
+
+271
+00:21:12,390 --> 00:21:16,350
+في إنه فيه collection of fluid في الـ في الـ lung
+
+272
+00:21:16,350 --> 00:21:19,910
+زي الـ Pulmonary edema، والله إذا كانت Cardiogenic يكون
+
+273
+00:21:19,910 --> 00:21:22,830
+الحل في الـ diuretics من النوع اللي هو loop
+
+274
+00:21:22,830 --> 00:21:27,160
+diuretics زي الـ Lasix، لكن إذا كانت الـ Non
+
+275
+00:21:27,160 --> 00:21:29,880
+-Cardiogenic Pulmonary Edema، بكون الحالة إننا بدنا
+
+276
+00:21:29,880 --> 00:21:33,940
+نعطي أو نعالج الـ underlying cause أو الـ
+
+277
+00:21:33,940 --> 00:21:37,100
+underlying disease اللي عامل الـ Non-Cardiogenic
+
+278
+00:21:37,100 --> 00:21:40,020
+Pulmonary Edema، هاي لربما يكون مثلًا الـ Organo
+
+279
+00:21:40,020 --> 00:21:42,760
+phosphorus poisoning، فالـ Organophosphate
+
+280
+00:21:42,760 --> 00:21:45,800
+poisoning، بيكون بدنا ندّي Anti-cholinergic agent زي
+
+281
+00:21:45,800 --> 00:21:50,700
+الـ Atropine، عشان يجلّل الكولين وبالتالي يبدأ يصير
+
+282
+00:21:50,700 --> 00:21:56,480
+فينا إمكانية لوقف الرشح، تبقى السوائل فيه، بالـ Lungs
+
+283
+00:21:56,480 --> 00:22:01,000
+وكثير أحيانًا بيستخدموا الـ Steroids كعلاج سحري،
+
+284
+00:22:01,000 --> 00:22:07,740
+Magic Treatments، لحالات الـ Respiratory Failure
+
+285
+00:22:07,740 --> 00:22:09,580
+وزي ما بتشوف الـ Hydrocortisone
+
+286
+00:22:09,580 --> 00:22:11,700
+Corticosteroids in general، Hydrocortisone و
+
+287
+00:22:11,700 --> 00:22:15,120
+Methylprednisolone من أوسع الأدوية اللي بيستخدموها في
+
+288
+00:22:15,120 --> 00:22:19,690
+علاج الـ Respiratory Failure، وبنشوف كثير في حالات
+
+289
+00:22:19,690 --> 00:22:23,410
+الـ Asthmatic patients و COPD patients بيستخدموا هذه
+
+290
+00:22:23,410 --> 00:22:26,170
+الأدوية، لأنها بالدرجة الأولى هي جماعة Anti
+
+291
+00:22:26,170 --> 00:22:29,270
+-inflammatory، فهي لأنها Anti-inflammatory drugs
+
+292
+00:22:29,270 --> 00:22:33,150
+بتشتغل، و Anti-allergic drugs، فهي بتعمل يعني
+
+293
+00:22:33,150 --> 00:22:43,030
+dilation في الـ Bronchi ومسالك التنفسية in
+
+294
+00:22:43,030 --> 00:22:48,050
+general، وطبعًا الـ Histamine Blockers يا جماعة سواء
+
+295
+00:22:48,050 --> 00:22:54,850
+الـ يعني الـ H1 Receptors Antagonists أو الـ H2
+
+296
+00:22:54,850 --> 00:22:58,810
+Receptors Antagonists اللي هي مركبات الـ Ranitidine أو
+
+297
+00:22:58,810 --> 00:23:03,030
+مركبات الـ Anti-Histamine، أوجات بتكون مفيدة في
+
+298
+00:23:03,030 --> 00:23:05,950
+حالات الـ Respiratory Failure لما يكون الـ Cause
+
+299
+00:23:05,950 --> 00:23:10,410
+تبعها له علاقة بالـ Allergic Reactions، عشان تعمل
+
+300
+00:23:10,410 --> 00:23:13,980
+stop الـ Histamine الـ Release،
+
+301
+00:23:13,980 --> 00:23:17,580
+يصير في Stopping، الـ Nursing Interventions اللي
+
+302
+00:23:17,580 --> 00:23:24,520
+احنا هنكون، يعني بنحتاج نعمل الحاجات هذه، إنّه مريض
+
+303
+00:23:24,520 --> 00:23:29,670
+بدرجة المريض هذا، لازم يعني يرتاح، مش معقول إنه يعرض
+
+304
+00:23:29,670 --> 00:23:33,850
+نفسه للإجهاد، لأنه ما عندهوش كمية كافية من الـ
+
+305
+00:23:33,850 --> 00:23:37,910
+Oxygen في دمه تخليه يقوم بأي مجهود، وبالتالي زيادة أي
+
+306
+00:23:37,910 --> 00:23:43,270
+مجهود هيكون لها أسباب، هيكون لها عواقب وخيمة، لذلك
+
+307
+00:23:43,270 --> 00:23:48,550
+الـ bed rest is recommended للـ patient دائمًا إذا
+
+308
+00:23:48,550 --> 00:23:49,490
+كان في مستشفى
+
+309
+00:23:53,160 --> 00:23:57,360
+فيه Fowler position بحيث نسمح للـ lung expansion
+
+310
+00:23:57,360 --> 00:24:05,720
+يكون أسهل، وفيه مجال لـ complete lung expansion
+
+311
+00:24:13,120 --> 00:24:16,500
+الـ Respiratory Status بتاعت الـ Patients ومستويات
+
+312
+00:24:16,500 --> 00:24:19,000
+الـ CO2 والأكسجين في دمه لازم تكون
+
+313
+00:24:19,000 --> 00:24:22,060
+مراقبة بشكل مستمر عن طريق الـ Oxygen Saturation
+
+314
+00:24:22,060 --> 00:24:25,920
+وعن طريق الـ Blood Gas Analysis، vital signs بتاعت
+
+315
+00:24:25,920 --> 00:24:31,570
+المريض بحد ذاتها مؤشر مهم جدًا عشان تخلّيني أعرف
+
+316
+00:24:31,570 --> 00:24:36,470
+إيش وضع المريض، زي ما حكينا الـ Tachycardia مؤشر
+
+317
+00:24:36,470 --> 00:24:41,190
+الـ Diaphoresis مؤشر، التعب، وزيادة الـ
+
+318
+00:24:41,190 --> 00:24:44,830
+Respiratory Rate مؤشر، الـ Saturation مؤشر، لذلك
+
+319
+00:24:44,830 --> 00:24:53,490
+مراقبتنا مهمة جدًا، وكمان عمل الـ suction للمريض اللي
+
+320
+00:24:53,490 --> 00:25:00,270
+بيحتاج suction، في حالة المرضى اللي عندهم Endotracheal
+
+321
+00:25:00,270 --> 00:25:04,290
+tube أو عندهم Tracheostomy، وفي الأطفال ممكن نعمل
+
+322
+00:25:04,290 --> 00:25:08,930
+حتى suction عن طريق الـ Nose، nasal suctioning
+
+323
+00:25:08,930 --> 00:25:12,950
+لدرجة إنه ممكن يكون by expert nurse أو expert
+
+324
+00:25:12,950 --> 00:25:17,750
+physician، إنه يعمل suctioning للـ secretions هذه عن
+
+325
+00:25:17,750 --> 00:25:22,470
+طريق nasal airway، أو لغاية ما إنه يوصل للـ … للـ …
+
+326
+00:25:22,470 --> 00:25:27,850
+الـ … الـ Larynx و الـ Trachea، under precautions أو
+
+327
+00:25:27,850 --> 00:25:32,050
+عن طريق استخدام الـ Nasal Airway ويعمل Suction
+
+328
+00:25:32,050 --> 00:25:37,690
+للمريض، Gentle Suction، طبعًا طبعًا الـ CBC
+
+329
+00:25:37,690 --> 00:25:43,030
+والـ Chemistry من مراقبتهم من الحاجات المهمة
+
+330
+00:25:52,250 --> 00:25:54,470
+في الـ CBC، وعملها monitoring عشان أشوف الـ blood
+
+331
+00:25:54,470 --> 00:25:59,290
+cells إيش بيصير فيها، بتحسن ولا لأ، الـ Chemistry اللي
+
+332
+00:25:59,290 --> 00:26:01,870
+ربما أحيانًا بيكون الـ muscle weakness يا جماعة
+
+333
+00:26:01,870 --> 00:26:07,910
+because of severe hypokalemia، البوتاسيوم دائمًا اللي
+
+334
+00:26:07,910 --> 00:26:11,590
+هو الـ potassium، لما بيقل كثير عن المعدلات
+
+335
+00:26:11,590 --> 00:26:14,830
+الطبيعية تبعته، ممكن يؤدي إلى severe muscle
+
+336
+00:26:14,830 --> 00:26:18,070
+weakness، وبالآخر هذا يؤدي إلى respiratory failure
+
+337
+00:26:19,350 --> 00:26:24,250
+عشان هيك ممكن جدًا يكون الـ Mechanical Ventilator
+
+338
+00:26:24,250 --> 00:26:30,070
+هو الحل المهم جدًا في حالات الـ Respiratory
+
+339
+00:26:30,070 --> 00:26:36,670
+Failure، للناس اللي دخلت المشكلة هذه في الأيام
+
+340
+00:26:36,670 --> 00:26:43,350
+الحالية اللي نعيش بيها، فيه يعني حاجة ملحة، خلينا
+
+341
+00:26:43,350 --> 00:26:46,590
+نسميها، وحاجة
+
+342
+00:26:51,560 --> 00:26:55,820
+زيادة الطلب على أجهزة التنفس الصناعي على مستوى العالم بسبب
+
+343
+00:26:55,820 --> 00:26:59,620
+انتشار فيروس كورونا، اللي بيخلي المرضى المصابين
+
+344
+00:26:59,620 --> 00:27:04,740
+يدخلوا بـ Respiratory Failure سريع، و Respiratory
+
+345
+00:27:04,740 --> 00:27:08,960
+Failure اللي بيعمل Alteration في الـ lung function
+
+346
+00:27:08,960 --> 00:27:12,220
+وبالتالي بيصير غير قادر على إنها تعمل Gas Exchange
+
+347
+00:27:12,220 --> 00:27:18,920
+وبالتالي بيصير المريض محتاج إنه يدعم بأجهزة تنفس
+
+348
+00:27:18,920 --> 00:27:25,460
+صناعي، لغاية ما الرئة ترجع تستعيد قدرتها على الـ Gas
+
+349
+00:27:25,460 --> 00:27:29,900
+Exchange كما
+
+350
+00:27:29,900 --> 00:27:34,500
+في السابق، لأن عدم قدرة الـ lung على إنها تعمل Gas
+
+351
+00:27:34,500 --> 00:27:38,380
+Exchange، نتذكر دائمًا الـ Mechanical Ventilator ما
+
+352
+00:27:38,380 --> 00:27:43,160
+بيعملش Gas Exchange ولا بيقوم مقام الـ lung، لكن إن
+
+353
+00:27:43,160 --> 00:27:48,720
+الـ lung ما بتقدرش تعمل Gas Exchange فهذا هيؤدي
+
+354
+00:27:48,720 --> 00:27:52,480
+إلى استجابة الـ Respiratory Rate والـ Respiratory
+
+355
+00:27:52,480 --> 00:27:57,900
+System للجسم، وممكن يزيد، فهو بتبدأ تزيد معدلات
+
+356
+00:27:57,900 --> 00:28:02,560
+التنفس لدرجات عالية جدًا، كمية لدرجة إن المريض يصير
+
+357
+00:28:02,560 --> 00:28:05,620
+غير قادر على الـ Compensation، بس الأفضل بيكون احنا
+
+358
+00:28:05,620 --> 00:28:10,080
+مضطرين ننظم عملية التنفس عن طريق الـ Mechanical
+
+359
+00:28:10,080 --> 00:28:14,120
+Ventilation، نقب أنواع ومداته المختلفة اللي شرحناها
+
+360
+00:28:14,120 --> 00:28:18,140
+المرة اللي فاتت، بالمناسبة، بالحالات هذه كثير بفضلوا
+
+361
+00:28:18,140 --> 00:28:21,100
+يستخدموا حاجة اسمها Jet Ventilation أو الـ High
+
+362
+00:28:21,100 --> 00:28:24,780
+Frequency Ventilation، يمكن هذا ما تركناش كثير يظهر
+
+363
+00:28:24,780 --> 00:28:27,300
+في محاضرة الـ Mechanical Ventilator، لأنه نوع مش
+
+364
+00:28:27,300 --> 00:28:32,640
+كثير متوفر، لكن الـ High Frequency Ventilation أو
+
+365
+00:28:32,640 --> 00:28:35,880
+Jet Ventilation بيسموه، هذا الفكرة تبعته بكل
+
+366
+00:28:35,880 --> 00:28:38,980
+بساطة إنه يعطي High Respiratory Rate، لأن المريض
+
+367
+00:28:38,980 --> 00:28:41,820
+هذا زي الـ Acute Respiratory Distress Syndrome،
+
+368
+00:28:41,820 --> 00:28:45,100
+هنعلمه إن شاء الله، في الـ ARDS ما بيكونش فيه
+
+369
+00:28:45,100 --> 00:28:47,760
+عنده مساحة في الـ Lung compliance و Gas Density Change
+
+370
+00:28:47,760 --> 00:28:51,880
+فبسيط التعامل معه إنه ندّيله كميات قليلة جدًا من
+
+371
+00:28:51,880 --> 00:28:56,750
+الهواء، بـ Respiratory Rate عالي كثير، وبالتالي
+
+372
+00:28:56,750 --> 00:29:01,170
+بيصير الـ Gas exchange على قدر كمية الجاز البسيطة
+
+373
+00:29:01,170 --> 00:29:05,010
+اللي بتدخل، ولكن اللي بتدخل يعني للرئتين، وبالتالي
+
+374
+00:29:05,010 --> 00:29:08,510
+احنا بننقذ المريض وبنحافظ على الـ Acid Base Balance
+
+375
+00:29:08,510 --> 00:29:13,790
+تبعه، من غير Respiratory Acidosis، الـ Acute
+
+376
+00:29:13,790 --> 00:29:17,530
+Respiratory Distress Syndrome اللي هو الـ ARDS
+
+377
+00:29:17,530 --> 00:29:21,370
+اللي هو إن شاء الله رب العالمين هيكون موضوعنا
+
+378
+00:29:23,420 --> 00:29:25,420
+القادم بإذن الله
diff --git a/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/WqDa90omKZk_postprocess.srt b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/WqDa90omKZk_postprocess.srt
new file mode 100644
index 0000000000000000000000000000000000000000..2c50612418f9cc1539347ad73a6104a6058e5482
--- /dev/null
+++ b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/WqDa90omKZk_postprocess.srt
@@ -0,0 +1,1512 @@
+1
+00:00:04,250 --> 00:00:06,870
+بسم الله الرحمن الرحيم السلام عليكم ورحمة الله
+
+2
+00:00:06,870 --> 00:00:12,270
+وبركاته اليوم، إن شاء الله رب العالمين، هنبدأ في
+
+3
+00:00:12,270 --> 00:00:17,010
+Unit 3 Acute Alteration in Respiratory Functions
+
+4
+00:00:17,010 --> 00:00:20,270
+بالنسبة
+
+5
+00:00:20,270 --> 00:00:23,030
+للـCritical Care أكيد بنعرف إن مشاكل
+
+6
+00:00:23,030 --> 00:00:29,150
+الـRespiratory من أهم المشاكل ممكن تكون مطلوب نعمل
+
+7
+00:00:29,150 --> 00:00:34,960
+فيها رعاية للمريد وCareبسبب خاطرات الهواتف عشان
+
+8
+00:00:34,960 --> 00:00:37,060
+ذلك سيكون معانا الـ Acute respiratory failure
+
+9
+00:00:37,060 --> 00:00:39,440
+سيكون معانا الـ Adulterous respiratory distress
+
+10
+00:00:39,440 --> 00:00:43,220
+syndrome حاجة مشهورة جدا الـ Pulmonary embolism
+
+11
+00:00:43,220 --> 00:00:48,100
+نبدأ في الـ Acute respiratory failure الـ
+
+12
+00:00:48,100 --> 00:00:50,840
+Respiratory failure in general is a sudden and
+
+13
+00:00:50,840 --> 00:00:53,460
+life-threatening deterioration of gas exchange
+
+14
+00:00:53,460 --> 00:01:02,460
+فجأة يحصل عند المريض تتجارب تجارب الهواتفالـ lung
+
+15
+00:01:02,460 --> 00:01:07,820
+بتبدأ تصير غير قادر على إنه تعمل elimination للـ
+
+16
+00:01:07,820 --> 00:01:14,220
+CO2 والـ partial
+
+17
+00:01:14,220 --> 00:01:18,780
+pressure تبع الـ oxygen بيبدأ يصير decreased في
+
+18
+00:01:18,780 --> 00:01:24,730
+البلدالـ Acute Respiratory Failure في تعريفه إن
+
+19
+00:01:24,730 --> 00:01:28,170
+الـ Partial Pressure تبقى الأكسجين يصير أقل من 60
+
+20
+00:01:28,170 --> 00:01:31,890
+ملي متر ذئبخ وهذا بنسميه Hypoxemia زي ما بنعرف
+
+21
+00:01:31,890 --> 00:01:37,970
+والـ CO2 يبدأ يصير أكتر من 50 ملي متر ذئبخ اللي هو
+
+22
+00:01:37,970 --> 00:01:41,030
+Hypercapnia
+
+23
+00:01:41,030 --> 00:01:44,430
+زي ما احنا عارفين
+
+24
+00:01:47,710 --> 00:01:52,890
+الـ Hypercapnia من أهم أسباب الـ Respiratory
+
+25
+00:01:52,890 --> 00:01:56,670
+Acidosis في مرضى الـ أو في حالة الـ Acute
+
+26
+00:01:56,670 --> 00:02:04,730
+Respiratory Failure عشان هي كتير مهم إنه انفرج بين
+
+27
+00:02:04,730 --> 00:02:07,270
+الـ Acute Respiratory Failure والـ Chronic
+
+28
+00:02:07,270 --> 00:02:11,490
+Respiratory Failure طب هو في فرق بينه طبعاً الـ
+
+29
+00:02:11,490 --> 00:02:16,260
+Chronic Respiratory Failure اللي بنعرفهإن هو عبارة
+
+30
+00:02:16,260 --> 00:02:21,580
+عن الـ deterioration في الـ gas exchange و الـ
+
+31
+00:02:21,580 --> 00:02:27,400
+function تبع الـ lung لكن بتتطور بشكل تدريجي مش
+
+32
+00:02:27,400 --> 00:02:31,570
+فجأة المريض بيكونكان قادر على عملية التنفس وعمل
+
+33
+00:02:31,570 --> 00:02:36,290
+الـ Gas Exchange لكن بطلت فجأة الـ Lung تصبح لديها
+
+34
+00:02:36,290 --> 00:02:40,390
+قدرة على عمل الـ Gas Exchange وتقدر وظائف تبقى
+
+35
+00:02:40,390 --> 00:02:43,970
+إتزامة بيصير حالياً في المرض العصر اللي بنعيشه
+
+36
+00:02:43,970 --> 00:02:48,290
+اللي هو الـ Corona المريض بيصير عنده Sino Symptoms
+
+37
+00:02:48,290 --> 00:02:53,150
+أشبه بالـ Flow فجأة بيخش المريض في Acute
+
+38
+00:02:53,150 --> 00:02:57,730
+Respiratory Failure لأن الـ Lung فجأة يعنيمبينة
+
+39
+00:02:57,730 --> 00:03:01,050
+عشرة مضوحة زي ما بقولوا تاني يوم تالت يوم بيبدأ
+
+40
+00:03:01,050 --> 00:03:04,230
+يصير غير قادر الـ lung علي أنها تعمل اللي هو الـ
+
+41
+00:03:04,230 --> 00:03:07,230
+gas exchange وهذا بتصنف تحت الـ Acute Respiratory
+
+42
+00:03:07,230 --> 00:03:10,110
+Failure لكن في الـ Chronic Respiratory Failure من
+
+43
+00:03:10,110 --> 00:03:13,470
+الأمثلة تبعته مثلًا الـ COPD patient الـ
+
+44
+00:03:13,470 --> 00:03:17,470
+Neuromuscular Disease الناس اللي بده يتطور عندهم
+
+45
+00:03:17,470 --> 00:03:22,430
+الأشي Gradually يعني هو بيكون عنده Respiratory
+
+46
+00:03:22,430 --> 00:03:25,910
+Disorders بيكون عنده Environment في الـ Function
+
+47
+00:03:25,910 --> 00:03:28,180
+تبعة الـ lungsولكنها لا تدخل فقط في الـ
+
+48
+00:03:28,180 --> 00:03:35,740
+Respiratory Failure فجأة، بل تبقى Supported لما
+
+49
+00:03:35,740 --> 00:03:39,640
+تصل إلى وقت إن الـ Lung ليس قادرة إنها تكون بالـ
+
+50
+00:03:39,640 --> 00:03:46,340
+Function تباعتها نهائيا، ويدخل الـ Acute in Top of
+
+51
+00:03:46,340 --> 00:03:46,980
+Chronic
+
+52
+00:03:52,600 --> 00:03:55,760
+طب الـ Acute Respiratory Failure إلو أنواع؟ آه
+
+53
+00:03:55,760 --> 00:03:59,820
+طبعاً إلو أنواع في type 1 و في type 2 طب إيش بيكون
+
+54
+00:03:59,820 --> 00:04:03,140
+في type 1؟ Acute Hypoxia .. بيسموها Acute
+
+55
+00:04:03,140 --> 00:04:07,060
+Hypoxemic Respiratory Failure إيش يعني؟ يعني الـ
+
+56
+00:04:07,060 --> 00:04:12,000
+Respiratory Failure هنا ناتجة من قلة الأكسوجين
+
+57
+00:04:12,000 --> 00:04:16,440
+وليس من ارتفاع ثاني أكسيد الكربون، إذا Hypox
+
+58
+00:04:19,720 --> 00:04:26,520
+من غير ما يكون الـ «CO2» يا جماعة مرتفع في المرضى،
+
+59
+00:04:26,520 --> 00:04:31,180
+هدولة، لا يعني مايكونش في «CO2» retention على
+
+60
+00:04:31,180 --> 00:04:35,660
+العكس حتى ممكن أن يكون «CO2» في hyperventilation
+
+61
+00:04:35,660 --> 00:04:39,940
+يا جماعة و «CO2» يكون low عند المرضى، هدولة، علشان
+
+62
+00:04:39,940 --> 00:04:50,880
+هيك هذا الـ «type» يعنيبكون عادة مصاحب لأمراض أخرى
+
+63
+00:04:50,880 --> 00:04:55,040
+وبالذات الـ «كاردوجينيك» والـ «نون كاردوجينيك»
+
+64
+00:04:55,040 --> 00:05:01,320
+بالمناورة القديمة و«نيومونيا» بكون الوضع فيهم بهذا
+
+65
+00:05:01,320 --> 00:05:07,100
+الشكل الـ «Type 2 Acute»
+
+66
+00:05:09,450 --> 00:05:13,310
+الـFailure بيسموه Acute Hypercapnic من اسمه واضح
+
+67
+00:05:13,310 --> 00:05:19,030
+جداً إن الـ«CO2» عالي كتير أكتر من خمسين زي ما
+
+68
+00:05:19,030 --> 00:05:26,250
+حكينا طبعاً هذا هيخلي إن الـ«PH» تبدأ تقل وبتعمل
+
+69
+00:05:26,250 --> 00:05:28,970
+Respiratory Acidosis زي ما أخدنا في الـChapter
+
+70
+00:05:28,970 --> 00:05:32,670
+الـBlood Gases مفهوم إنه مع كل Increase في
+
+71
+00:05:32,670 --> 00:05:41,490
+الـ«CO2» بدأ الـ«PH» تصير لها Decreaseوتبدأ يصير
+
+72
+00:05:41,490 --> 00:05:47,430
+حالة من الـ Respiratory Acidosis طبعاً هذا عادة
+
+73
+00:05:47,430 --> 00:05:52,290
+يكون نتيجة Inadequate airflow in the alveoli of
+
+74
+00:05:52,290 --> 00:05:56,510
+the lungs عادة يكون كمية الهواء اللي يدخل
+
+75
+00:05:56,510 --> 00:06:00,770
+الرائعتين قليلة علشان هي بيصير احتباس لتاني اكسيد
+
+76
+00:06:00,770 --> 00:06:06,050
+الفربون وبيصير environment في الجاز exchange
+
+77
+00:06:08,230 --> 00:06:15,570
+أسباب كثيرة ممكن تؤدي إلى الكلام هذا «التحرير
+
+78
+00:06:15,570 --> 00:06:20,430
+المدعوم» «التحرير
+
+79
+00:06:20,430 --> 00:06:23,710
+المدعوم» «التحرير المدعوم» «التحرير المدعوم»
+
+80
+00:06:23,710 --> 00:06:27,010
+«التحرير المدعوم» «التحرير المدعوم» «التحرير
+
+81
+00:06:27,010 --> 00:06:28,730
+المدعوم» «التحرير المدعوم» «التحرير المدعوم»
+
+82
+00:06:28,730 --> 00:06:30,770
+«التحرير المدعوم» «التحرير المدعوم» «التحرير
+
+83
+00:06:30,770 --> 00:06:31,010
+المدعوم» «التحرير المدعوم» «التحرير المدعوم»
+
+84
+00:06:31,010 --> 00:06:31,030
+«التحرير المدعوم» «التحرير المدعوم» «التحرير
+
+85
+00:06:31,030 --> 00:06:36,690
+المدعوم» «التحرير المدعوم» «التحرير المدعوم
+
+86
+00:06:36,800 --> 00:06:41,120
+بالتالي، الجسم لا يدفع الأكسجين إلى نفسه لأن الـ
+
+87
+00:06:41,120 --> 00:06:44,820
+lung في أماكن كتير ما بتشتغلش الشغل تبقى عارف تبقى
+
+88
+00:06:44,820 --> 00:06:48,720
+عارف احنا تبقى عارف في حالات الفيزيمة الفيزيمة في
+
+89
+00:06:48,720 --> 00:06:52,480
+ال chest كيف بيصير في opening من القلب يلعب على
+
+90
+00:06:52,480 --> 00:06:57,500
+بعض فبدل ما يكونوا بكل يعني كلالجدار تبع الـ One
+
+91
+00:06:57,500 --> 00:07:00,700
+Alveoli بيكون محل الـ Gas Exchange والـ Alveoli
+
+92
+00:07:00,700 --> 00:07:03,420
+اللي جنبها والـ Alveoli اللي جنبها كل هدولة الغرف
+
+93
+00:07:03,420 --> 00:07:06,460
+اللي صغيرة بتفتح و بتعمل صالون كبير فمساعة الـ Gas
+
+94
+00:07:06,460 --> 00:07:09,740
+Exchange اللي على الـ Wall يا جماعة بتقل تمام،
+
+95
+00:07:09,740 --> 00:07:14,980
+فبالتالي بيكون الـ يعني هذا مثال لكي تبتقل عملية
+
+96
+00:07:14,980 --> 00:07:20,440
+الـ Gas Exchange عند المرضى هدولة وبدأت ذلك إلى
+
+97
+00:07:20,440 --> 00:07:26,770
+زيادة تاني أكسيد الكربون في الجسموقلة الأكسجين في
+
+98
+00:07:26,770 --> 00:07:31,690
+الدم الـPCO2 الـpartial pressure تبع الـCarbon،
+
+99
+00:07:31,690 --> 00:07:35,970
+الـCO2 بيزيد الـpartial pressure تبع الأكسجين بقل
+
+100
+00:07:35,970 --> 00:07:39,950
+وبالتالي هذا اللي هيعمل لنا الـhypercapnia
+
+101
+00:07:39,950 --> 00:07:43,350
+والـrespiratory acidosis كواسيس الـrespiratory
+
+102
+00:07:43,350 --> 00:07:49,020
+failure، من إيش بيصير؟‏can be grouped according to
+
+103
+00:07:49,020 --> 00:07:49,760
+the primary
+
+104
+00:07:49,760 --> 00:08:00,920
+abnormality‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏�
+
+105
+00:08:01,410 --> 00:08:09,910
+أو يعني توقف عملية التنفس والخلل في عملية التنفس
+
+106
+00:08:09,910 --> 00:08:15,850
+زي Airway Obstruction يعني راجل مافيش عنده مشكلة
+
+107
+00:08:15,850 --> 00:08:19,990
+لكن صار فيه عنده Severe Epileptic Disorder مثلا
+
+108
+00:08:19,990 --> 00:08:22,610
+فصار فيه عنده طبع خوم صار فيه عنده Laryngitis
+
+109
+00:08:22,610 --> 00:08:25,310
+Edema، Severe Laryngitis Edema فمافيه إمكانية إنه
+
+110
+00:08:25,310 --> 00:08:32,020
+الجاز يخش عشان يصير له X Changeأو مثلًا الـ tumor
+
+111
+00:08:32,020 --> 00:08:37,040
+يا جماعة أو from body inhalation سكر مجرد التنفس
+
+112
+00:08:37,040 --> 00:08:42,460
+عنده فهذا عمل أو في تحت في ال lungs فيه cystic fat
+
+113
+00:08:42,460 --> 00:08:47,120
+process فالـ fertilized ما بيعملوش دورهم في كل
+
+114
+00:08:47,120 --> 00:08:50,060
+الحالات زي ما احنا شايفين يا مش هوا أصلا بفوت يا
+
+115
+00:08:50,060 --> 00:08:57,260
+أماالـ Respiratory Failure صار نتيجة إنه مافيش
+
+116
+00:08:57,260 --> 00:09:00,960
+ألغولة عايز تشتغل وتقوم بدورها وتعمل الـ Gas
+
+117
+00:09:00,960 --> 00:09:06,060
+Exchange فيه الـ Alveolar and Bleural Disease يعني
+
+118
+00:09:06,060 --> 00:09:11,800
+الألغولة نفسها ممكن تكون فيها مشكلة Resulting in
+
+119
+00:09:11,800 --> 00:09:16,780
+hypoxic respiratory failure وطبعاً هيتأد لإنوسيفية
+
+120
+00:09:17,750 --> 00:09:22,130
+كما يكون مثلًا كردوجينيك أو نان كردوجينيك بالمونا
+
+121
+00:09:22,130 --> 00:09:27,450
+الأقديمى مليانة
+
+122
+00:09:27,450 --> 00:09:30,990
+ميّه في البلمونة الأقديمى سواء كانت كردوجينيك أو
+
+123
+00:09:30,990 --> 00:09:37,290
+نان كردوجينيك يعني كردوجينيك بالمونا الأقديمى لما
+
+124
+00:09:37,290 --> 00:09:41,970
+يكون البلمونة الأقديمى cause of failure of the
+
+125
+00:09:41,970 --> 00:09:45,620
+heart to do its functionولكن من الـ Non
+
+126
+00:09:45,620 --> 00:09:47,760
+-Carcinogenic Balmyra الأديمة زي اللي بتصير يا
+
+127
+00:09:47,760 --> 00:09:50,720
+جماعة خلات الـ Organophosphorus poisoning فالـ
+
+128
+00:09:50,720 --> 00:09:54,140
+Organophosphorus poisoning الـ cause ليس خطأ
+
+129
+00:09:54,140 --> 00:09:58,460
+القلب، لأ القصة أن الكورينيسترايز
+
+130
+00:09:59,860 --> 00:10:04,420
+كثير عالي في الجسم كله مسترز إنزاع عالي فبالتالي
+
+131
+00:10:04,420 --> 00:10:11,480
+مافيش ارتباط لالكولين فبالتالي فيه يعني انسياب لكل
+
+132
+00:10:11,480 --> 00:10:14,880
+السوائل اللي في الجسم علشان هي كمان من ضمنها بيصير
+
+133
+00:10:14,880 --> 00:10:17,680
+Pronguria زي ما احنا عارفين و بتتجمع كميات كبيرة
+
+134
+00:10:17,680 --> 00:10:18,600
+منها في الـLung
+
+135
+00:10:26,330 --> 00:10:31,590
+اللي بتكون على مستوى الـ Alveoli عشانك بيسموها
+
+136
+00:10:31,590 --> 00:10:34,740
+Alveolarأو بقيت بيكون الموضوع اللي هو لقب الـ
+
+137
+00:10:34,740 --> 00:10:39,600
+Central Nervous System يعني الـ Failure لأن جهاز
+
+138
+00:10:39,600 --> 00:10:43,400
+القصد المركزي اللي بيتحكم في عملية التنفس هو اللي
+
+139
+00:10:43,400 --> 00:10:48,160
+مش شغال بالطريقة الصحيحة فبصي لأن يعني كيف مش
+
+140
+00:10:48,160 --> 00:10:52,800
+شغال، نتيجة مثلا Brain tumor، نتيجة Brain injury،
+
+141
+00:10:52,800 --> 00:10:57,740
+Trauma، هذا إيش حيعمل؟ حيعمل، يعني الـCV
+
+142
+00:10:57,740 --> 00:11:02,620
+الـHemorrhagicهتزود الـ pressure، كلهم بيشتغلوا
+
+143
+00:11:02,620 --> 00:11:04,920
+بنفس الطريقة، كلهم بيزودوا ال pressure على الـ
+
+144
+00:11:04,920 --> 00:11:09,040
+central nervous system وبالتالي، إيش بيصير؟ بيصير
+
+145
+00:11:09,040 --> 00:11:12,780
+ضغط على ال respiratory centers وبالتالي، بيصير
+
+146
+00:11:12,780 --> 00:11:16,920
+المريض يخش في حالة من الـ hypoventilation بتقل من
+
+147
+00:11:16,920 --> 00:11:17,480
+كتير
+
+148
+00:11:21,990 --> 00:11:28,530
+مع قلة الـ Respiratory Rate بيصير Retention لـ CO2
+
+149
+00:11:28,530 --> 00:11:34,690
+في الجسم وبالتالي Hypercapnia فهذا من أمثلة الـ
+
+150
+00:11:34,690 --> 00:11:37,330
+Respiratory Rate طبعا Hypercapnia يعني بالآخر
+
+151
+00:11:37,330 --> 00:11:41,350
+الجسم بيستسلم الأكسجين بيقلل ثم بيصير كربون جديد
+
+152
+00:11:41,350 --> 00:11:47,330
+بيصير Respiratory Acidosisكده المريض يخش في الـ
+
+153
+00:11:47,330 --> 00:11:51,950
+Respiratory Failure في Peripheral Nervous System
+
+154
+00:11:51,950 --> 00:11:57,830
+ممكن يؤدي لـ Respiratory Failure؟ آه، زي أمثلة الـ
+
+155
+00:11:57,830 --> 00:12:02,590
+Gallipari Syndrome، Gallipari Syndrome ده يعني
+
+156
+00:12:02,590 --> 00:12:08,470
+most commonly it's post-viral، الناس عادةً بعدممكن
+
+157
+00:12:08,470 --> 00:12:12,570
+يعني يكون الواحد اندو كومانكولد، «hairless» أو
+
+158
+00:12:12,570 --> 00:12:15,150
+«any type of viral» الناس ممكن يخشوا الـ
+
+159
+00:12:15,150 --> 00:12:18,030
+«deterioration» ويصير اندو الجاليان باريس سندروم،
+
+160
+00:12:18,030 --> 00:12:20,650
+إيش الجاليان باريس سندروم؟ هذا بيصير يعني الـ
+
+161
+00:12:20,650 --> 00:12:26,770
+«peripheral neuropathy» و«peripheral weakness»
+
+162
+00:12:26,770 --> 00:12:30,650
+طبعا في الـ«ascending» بما يسمونه «ascending
+
+163
+00:12:30,650 --> 00:12:34,830
+muscle weakness» يعني بيبدأ الأطراف السفلية لـ
+
+164
+00:12:37,970 --> 00:12:41,350
+يعني القدمين من الطرفين السفليين ويبدأ يصير فيه
+
+165
+00:12:41,350 --> 00:12:45,630
+weakness ويبدأ ال weakness يطلع لفوق وهو بطلع لفوق
+
+166
+00:12:45,630 --> 00:12:48,110
+أنا من وين بخاف؟ بخاف من الـ respiratory muscles
+
+167
+00:12:48,110 --> 00:12:52,330
+يصير فيها weakness، آه ممكن يصل، طبعا ممكن يصل إذا
+
+168
+00:12:52,330 --> 00:12:57,750
+ما كانش فيه تدعيم لجهاز المناعي زي ما احنا بتعرف
+
+169
+00:12:57,750 --> 00:13:02,740
+الـ Golan-Powell Syndrome من أهمالـManagements
+
+170
+00:13:02,740 --> 00:13:07,820
+تبعتها أو من أهم الأدوية اللي بتنعطى في هذه
+
+171
+00:13:07,820 --> 00:13:12,060
+الحالات أدوية الـImmunoglobulin-G اللي بيقوي مناقة
+
+172
+00:13:12,060 --> 00:13:17,200
+الجسم عشان يتحدى هذا الـDisease ومن أمثلتها برضه
+
+173
+00:13:17,200 --> 00:13:23,980
+الـMuscular Dystrophy والميتازينيا
+
+174
+00:13:23,980 --> 00:13:27,200
+الـGravies اللي هي تقريبا بتشتغل
+
+175
+00:13:35,480 --> 00:13:40,400
+وهو ممكن يؤثر على الـ Respiratory Muscles اللي في
+
+176
+00:13:40,400 --> 00:13:42,940
+كل manifestation كل الناس اللي هيكون عندهم
+
+177
+00:13:42,940 --> 00:13:46,500
+Respiratory Failure هيكون عندهم عدم قدرة على
+
+178
+00:13:46,500 --> 00:13:48,760
+التنفس بالشكل الصحيح لأنه Respiratory Failure
+
+179
+00:13:56,590 --> 00:14:02,030
+فبفضل إنه يبقى في موقع مقفل بين الـ nasal أو الـ
+
+180
+00:14:02,030 --> 00:14:06,250
+nostrils، الـ nostrils بتكون مفتوحة كتير لإنها
+
+181
+00:14:06,250 --> 00:14:09,970
+بحاول إنه يأخذ كمية هوا بقدر الإمكان، طبعا هذا
+
+182
+00:14:09,970 --> 00:14:13,590
+هيعمل حالة من الـ confusion state على الـ
+
+183
+00:14:13,590 --> 00:14:17,970
+neurological status تبعته، لإنه مافيش oxygen كافي
+
+184
+00:14:17,970 --> 00:14:23,140
+بوصل للبلاد، فبالتالي بيحس في drowsiness المريضمش
+
+185
+00:14:23,140 --> 00:14:26,720
+هيك، بيحس فيه «drowsiness»، sorry الـ
+
+186
+00:14:26,720 --> 00:14:32,920
+«cardiovascular system» هيكون فيه عنده، هيكون
+
+187
+00:14:32,920 --> 00:14:37,660
+فيه عنده جماعة «cyanosis» طبعا زي ما احنا عارفين
+
+188
+00:14:38,480 --> 00:14:42,340
+الـ Heart نفسه كمان ما بيوصلوش كمية كافية من الـ
+
+189
+00:14:42,340 --> 00:14:47,900
+Blood فبيصير اندو تاكيكارديا، بيصير ساينوسس، بيصير
+
+190
+00:14:47,900 --> 00:14:51,920
+ديفوريسس، ليش؟ لأنه مجهد، فديفوريسس بيصير بتعضفه،
+
+191
+00:14:51,920 --> 00:14:54,860
+ممكن يصير عنده chest pain because of decreased
+
+192
+00:14:54,860 --> 00:14:56,660
+cardiac perfusion
+
+193
+00:15:00,230 --> 00:15:04,050
+من الـ Diagnostic Evaluation المهم للمريض أنا شاكر
+
+194
+00:15:04,050 --> 00:15:07,130
+إنه هذا خش في الـ Respiratory Failure أول حاجة الـ
+
+195
+00:15:07,130 --> 00:15:11,800
+Sign و الـ Symptoms إن أنا ألاقي إن المريض هذاعنده
+
+196
+00:15:11,800 --> 00:15:17,280
+مشاكل واضحة في عملية التنفس «Difficulty getting
+
+197
+00:15:17,280 --> 00:15:21,420
+the kidney» «Hypoxia» الـ «Saturation» تبعه «Low»
+
+198
+00:15:21,420 --> 00:15:25,860
+الفيتال ساينس تبعته فيه «Tachycardia» واضح أنه
+
+199
+00:15:25,860 --> 00:15:29,140
+«hypoxic» «cyanosis» كما حكينا ده «diaphoresis»
+
+200
+00:15:29,140 --> 00:15:34,380
+يعني physically بكون واضح أنه عملية التنفس بتصير
+
+201
+00:15:34,380 --> 00:15:37,420
+بطريقة
+
+202
+00:15:37,420 --> 00:15:38,040
+غير سليمة
+
+203
+00:15:42,430 --> 00:15:47,070
+بريد per minute وممكن يكون hyperventilation يعني
+
+204
+00:15:47,070 --> 00:15:55,920
+تكيكارديا أكترمن تلاتين أو خمسة و تلاتين طبعاً أنت
+
+205
+00:15:55,920 --> 00:16:00,860
+تلاعن تلاتين أنه بيكون بدأ يخش في مرحلة الخطر لكن
+
+206
+00:16:00,860 --> 00:16:04,160
+علشان احنا ندعم الموقف نعرف أنه لسه في مرحلة
+
+207
+00:16:04,160 --> 00:16:08,520
+بتقاهله أنه يعمل compensation مش كل واحد بيصير
+
+208
+00:16:08,520 --> 00:16:11,520
+respirator ready يعني يا جماعة تلاتين بيكون بدأ
+
+209
+00:16:11,520 --> 00:16:13,740
+يخش في respirator failure لكن هذه من الحاجات اللي
+
+210
+00:16:13,740 --> 00:16:18,130
+بتخلينيأبدأ أعمل part of the investigation للمريض
+
+211
+00:16:18,130 --> 00:16:22,310
+تبعي زي إيه؟ زي الـBlood Gases، بدي أعمله ABG عشان
+
+212
+00:16:22,310 --> 00:16:27,170
+أشوف لوين وصلت الـAcidoses عنده، إيش مستويات تشبع
+
+213
+00:16:27,170 --> 00:16:32,950
+دمه بالـOxygen ومعدلها تانيبس دي الكربون في الدم،
+
+214
+00:16:32,950 --> 00:16:39,950
+إيش حالة الحمضية اللي هو بعيش فيها، وكذلك القاعدية
+
+215
+00:16:39,950 --> 00:16:44,360
+تبعت الدمالمفروض أن يكون الـPH عادى ومايكونش فيه
+
+216
+00:16:44,360 --> 00:16:48,040
+اندو ريسبيراتوري أسيوز ولا ألكالوزز لو وجدت
+
+217
+00:16:48,040 --> 00:16:52,780
+التنتين بيخشوا الـrespiratory failure يعني لو كان
+
+218
+00:16:52,780 --> 00:16:55,860
+عند مثلا مريض عنده DKA
+
+219
+00:17:04,620 --> 00:17:08,380
+الريسبيراتورية هيكون كتير مرتفعة لأن المريض بتحاول
+
+220
+00:17:08,380 --> 00:17:12,640
+تعمل الـ Washing وتعمل الـ Compensation وتصلح الـ
+
+221
+00:17:12,640 --> 00:17:15,020
+Metabolic Acidosis اللي عنده عن طريق الـ
+
+222
+00:17:15,020 --> 00:17:19,560
+Respiratory Alkalosis إذا الـ Respiratory
+
+223
+00:17:19,560 --> 00:17:22,770
+Alkalosis اللي موجود هنا عبارة عن إيش؟عبارة عن
+
+224
+00:17:22,770 --> 00:17:25,730
+compensation لكن في نهاية المرضات وفي الآخر ممكن
+
+225
+00:17:25,730 --> 00:17:29,750
+تدخل الـ Respiratory Failure Because of الاساس الـ
+
+226
+00:17:29,750 --> 00:17:33,330
+Metabolic Acidosis اللي عندها و ال compensation ال
+
+227
+00:17:33,330 --> 00:17:36,990
+Respiratory Alkalosis اللي عمل بيصير عشان يصلح
+
+228
+00:17:36,990 --> 00:17:40,870
+الوطن لكن في نهاية مابتقدرش ال lung انها تعمل full
+
+229
+00:17:40,870 --> 00:17:43,430
+compensation للحالة المرضية الموجودة فبتدخل ال
+
+230
+00:17:43,430 --> 00:17:49,050
+Respiratory Failureوحالة تانية ممكن يكون بالعكس،
+
+231
+00:17:49,050 --> 00:17:54,490
+المريض جاي بـhypoventilation، هدو تراما،
+
+232
+00:17:54,490 --> 00:17:57,950
+الـrespiratory rate بتقل، hypoventilation، الـCO2
+
+233
+00:17:57,950 --> 00:18:01,910
+بتراكم، ويبدأ المريض يدخل الـhypercapnia، يتكمل
+
+234
+00:18:01,910 --> 00:18:02,510
+الـblood gas
+
+235
+00:18:09,800 --> 00:18:14,180
+وأكتر من سبعين بوصل ماريسيو OBD هتلاقي الـ
+
+236
+00:18:14,180 --> 00:18:20,040
+«السيويتو» عنده أكتر من تسعين والـ pH يعني
+
+237
+00:18:20,040 --> 00:18:31,280
+severely low 7.2، 7.26، المهم أقل من 7.35 يعني أقل
+
+238
+00:18:31,280 --> 00:18:38,350
+من 7.35%طبعًا «Chess X-Ray» عمل مهم أنه ينعمل في
+
+239
+00:18:38,350 --> 00:18:43,770
+الحالات اللي شاكين أنه اندوريسبيراتوري فيلير هيكون
+
+240
+00:18:43,770 --> 00:18:48,390
+فيه واضح سيبير أو يعني «marked» بتسميه «fulmonary
+
+241
+00:18:48,390 --> 00:18:52,830
+infiltration» مهمين يكون فيه مناطق فيها أتيلاكتسز،
+
+242
+00:18:52,830 --> 00:18:55,370
+هذا بيكون كتير واضح في الـ
+
+243
+00:18:57,790 --> 00:19:02,030
+حالات الـPneumonia في حالات الـTP في حالات الـARDS
+
+244
+00:19:02,030 --> 00:19:04,550
+Acute Respiratory Distress Syndrome اللي هنحكي
+
+245
+00:19:04,550 --> 00:19:08,290
+عليه من كمان شوية إن شاء الله أعرف من العالمين
+
+246
+00:19:08,290 --> 00:19:11,710
+طبعاً الـManagement الجمعكات بدنا نصلح حال الناس
+
+247
+00:19:11,710 --> 00:19:15,190
+هدولة أكيد إنه بدأ أصلح إذا كان الـCO2 في
+
+248
+00:19:15,190 --> 00:19:19,610
+retention بدأ أنا أعمله Washing out أو أد Oxygen
+
+249
+00:19:20,670 --> 00:19:26,110
+فإذا كان يعني الـ underlying cause كان فيه
+
+250
+00:19:26,110 --> 00:19:29,510
+pneumonia هو اللي عامله السبب ده ند الـ antibiotic
+
+251
+00:19:29,510 --> 00:19:33,050
+ونعالج الـ pneumonia إذا كان فيه يا جماعة
+
+252
+00:19:33,050 --> 00:19:36,530
+secretions هي اللي عامله المشكلة بيكون أنا بدي
+
+253
+00:19:36,530 --> 00:19:42,310
+أعملبنعمل الـ Prankodilatation و أعمل الـ
+
+254
+00:19:42,310 --> 00:19:45,750
+Spectration لهذه الـ Secretion على طريق الـ
+
+255
+00:19:45,750 --> 00:19:50,350
+Spectrum أدناد مقشعات للبلغة، يمكنني أعمل الـ
+
+256
+00:19:50,350 --> 00:19:53,410
+Suction يمكنني أعمل الـ Prankoscope عشان أعمل الـ
+
+257
+00:19:53,410 --> 00:19:57,990
+Hygiene للـ Lung و للـ Trachea
+
+258
+00:20:00,480 --> 00:20:03,860
+عشان هيك الـ «underlying disease» كتير مهم إنهم
+
+259
+00:20:03,860 --> 00:20:08,260
+يكونوا عارفين إيش هو المرض ويمكن يكون المريض مثلا
+
+260
+00:20:08,260 --> 00:20:11,160
+السبب في الـ«respiratory failure» أنه عنده «severe
+
+261
+00:20:11,160 --> 00:20:15,720
+empyema» في الـ«plural» الـ«space» مليئة «thick
+
+262
+00:20:15,720 --> 00:20:21,400
+paths» مثلول «secretions» و«collections» طب وإيش
+
+263
+00:20:21,400 --> 00:20:24,300
+الحل؟ الحل اتركبله «chest drainage» آه إذا نبدو
+
+264
+00:20:24,300 --> 00:20:26,840
+الـ«chest» يعني under اللي هو الـ«chest tube»
+
+265
+00:20:26,840 --> 00:20:30,990
+«under water seal» الـ«chest tube»وبدّوا تمامًا من
+
+266
+00:20:30,990 --> 00:20:35,290
+الهيجينية للمنطقة
+
+267
+00:20:35,290 --> 00:20:38,110
+هذه الـ Empiric Area اللي في اللانجو بدّوا
+
+268
+00:20:38,110 --> 00:20:47,710
+يستخدموا عدد من الـ Antibiotics من أربعة
+
+269
+00:20:47,710 --> 00:20:48,670
+إلى ست أسابيع
+
+270
+00:21:08,520 --> 00:21:09,920
+‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏
+
+271
+00:21:12,390 --> 00:21:16,350
+في إنه فيه collection of fluid في الـ في الـ lung
+
+272
+00:21:16,350 --> 00:21:19,910
+زي البلمونة رقديمة والله إذا كانت كاردوجينية يكون
+
+273
+00:21:19,910 --> 00:21:22,830
+الحال في الـ diuretics من الناد اللي هو loop
+
+274
+00:21:22,830 --> 00:21:27,160
+diuretics زي الـ Lasixلكن إذا كانت الـ Non
+
+275
+00:21:27,160 --> 00:21:29,880
+-Carbogenic Pulmonary Edema بكون الحالة إننا بدنا
+
+276
+00:21:29,880 --> 00:21:33,940
+نعطي أو نعالج الـ underlying cause أو الـ
+
+277
+00:21:33,940 --> 00:21:37,100
+underlying disease اللي عامل الـ Non-Carbogenic
+
+278
+00:21:37,100 --> 00:21:40,020
+Pulmonary Edema هاي لربما يكون مثلا الـ Organ of
+
+279
+00:21:40,020 --> 00:21:42,760
+phosphorus poisoning فالـ Organ of phosphate
+
+280
+00:21:42,760 --> 00:21:45,800
+poisoning يكون بدنا ندّي Anti-cholinergic agent زي
+
+281
+00:21:45,800 --> 00:21:50,700
+الـ Atropine عشان يجلّل الكولين وبالتالي يبدأ يصير
+
+282
+00:21:50,700 --> 00:21:56,480
+فينا إمكانية لوقف الرشح تبقى السوائل فيهالـ Lungs
+
+283
+00:21:56,480 --> 00:22:01,000
+وكتير أحيانًا بيستخدموا الـ «ستيرويز» كعلاج سحري
+
+284
+00:22:01,000 --> 00:22:07,740
+Magic Treatments لحالات الـ Respiratory Failure
+
+285
+00:22:07,740 --> 00:22:09,580
+وزي ما بتشوف الـ «هيدرو كورتيزون»
+
+286
+00:22:09,580 --> 00:22:11,700
+«Corticosteroids» in general «هيدرو كورتيزون» و
+
+287
+00:22:11,700 --> 00:22:15,120
+«ستوليومدرول» من أوسع الأدوية اللي بيستخدموها في
+
+288
+00:22:15,120 --> 00:22:19,690
+علاج الـ Respiratoryفاليار وبنشوف كتير في حالات
+
+289
+00:22:19,690 --> 00:22:23,410
+الـ «أزماتيك بيشانس» و «CVD بيشانس» بيستخدموا هذه
+
+290
+00:22:23,410 --> 00:22:26,170
+الأدوية لإنها بالدرجة الأولى هي جماعة Anti
+
+291
+00:22:26,170 --> 00:22:29,270
+-inflammatory فهي لإنها Anti-inflammatory drugs
+
+292
+00:22:29,270 --> 00:22:33,150
+بتشتروا وAnti-allergic drugs فهي بتقل تعمل يعني
+
+293
+00:22:33,150 --> 00:22:43,030
+dilatation في الـ «برومكاس» ومسارك التنفسية in
+
+294
+00:22:43,030 --> 00:22:48,050
+general وطبعاًالـ Histamine Blockers يا جماعة سواء
+
+295
+00:22:48,050 --> 00:22:54,850
+الـ يعني الـ H1 Receptors Antigonist أو الـ H2
+
+296
+00:22:54,850 --> 00:22:58,810
+Receptors Antigonist اللي هي مركبات الـ Randine أو
+
+297
+00:22:58,810 --> 00:23:03,030
+مركبات الـ Anti-Histamine أوجات بتكون مفيدة في
+
+298
+00:23:03,030 --> 00:23:05,950
+حالات الـ Respiratory Failure لما يكون الـ Cause
+
+299
+00:23:05,950 --> 00:23:10,410
+تبعها له علاقة بالـ Allergic Reactions عشان تعمل
+
+300
+00:23:10,410 --> 00:23:13,980
+Histamineالـ Stop يعني الـ Histamine الـ Release
+
+301
+00:23:13,980 --> 00:23:17,580
+يصير له Stopping الـ Nursing Intervention اللي
+
+302
+00:23:17,580 --> 00:23:24,520
+احنا هنكون، يعني بنحتاج نعمل الحلقات هذه إنه منتين
+
+303
+00:23:24,520 --> 00:23:29,670
+بدرست المريض هذا لازم يعني يرتاح، مش معقولإنه يعرض
+
+304
+00:23:29,670 --> 00:23:33,850
+نفسه لإيجاد لأنه ما عندهوش كمية نافظة كافية من الـ
+
+305
+00:23:33,850 --> 00:23:37,910
+Oxygen دمه يتخليه يقوم بأي مجهود وبالتالي زيادة أي
+
+306
+00:23:37,910 --> 00:23:43,270
+مجهود هيكون لها أسباب، هيكون لها عواقب وخيمة لذلك
+
+307
+00:23:43,270 --> 00:23:48,550
+الـ bed rest is recommended ال patient دايما إذا
+
+308
+00:23:48,550 --> 00:23:49,490
+كان في مستشفى
+
+309
+00:23:53,160 --> 00:23:57,360
+فيه فاولار موزيشين بحيث نسمح للـ Lung Expansion
+
+310
+00:23:57,360 --> 00:24:05,720
+يكون أسهل وفيه مجال لـ Complete Lung Expansion
+
+311
+00:24:13,120 --> 00:24:16,500
+الـ Respiratory Status تبعت الـ Patients ومستويات
+
+312
+00:24:16,500 --> 00:24:19,000
+تانية في سجل الكربون والأكسجين في دمه لازم تكون
+
+313
+00:24:19,000 --> 00:24:22,060
+مراقبة بشكل مستمر عن طريق الـ Oxygen Saturation
+
+314
+00:24:22,060 --> 00:24:25,920
+وعن طريق الـ Blood Gas Analysis الفيرتر سايند تبعت
+
+315
+00:24:25,920 --> 00:24:31,570
+المريض بحد ذاتها مؤشر مهم جداًعشان تخلّيني أعرف
+
+316
+00:24:31,570 --> 00:24:36,470
+إيش وضع المريض زي ما حكينا الـ Tachycardia مؤشر
+
+317
+00:24:36,470 --> 00:24:41,190
+الـ Diaphoresis مؤشر التكيبنية وزيادة الـ
+
+318
+00:24:41,190 --> 00:24:44,830
+Respiratory Rate مؤشر الـ Saturation مؤشر فلذلك
+
+319
+00:24:44,830 --> 00:24:53,490
+مراقبتنا مهمة جداً وكمان عمل السكشن للمريض اللي
+
+320
+00:24:53,490 --> 00:25:00,270
+بحتاج سكشن في حالة المرضى الليالهم Indotracheal
+
+321
+00:25:00,270 --> 00:25:04,290
+tube أو الهم Tracheostomy وفي الأطفال ممكن يعمل
+
+322
+00:25:04,290 --> 00:25:08,930
+حتى suction عن طريق الـ Nose nasal suctioning
+
+323
+00:25:08,930 --> 00:25:12,950
+لدرجة إنه ممكن يكون by expert nurse أو expert
+
+324
+00:25:12,950 --> 00:25:17,750
+physician إنه يعمل suctioning للsecretions هذه عن
+
+325
+00:25:17,750 --> 00:25:22,470
+طريق nasal airway أو لغاية ما إنه يوصلأو الـ… الـ…
+
+326
+00:25:22,470 --> 00:25:27,850
+الـ… الـLarynx و… الـTrachea under precautions أو
+
+327
+00:25:27,850 --> 00:25:32,050
+ع طريق استخدام الـNasal Airway ويعمل Suction
+
+328
+00:25:32,050 --> 00:25:37,690
+للمريض Gental Suction طبعاً طبعاً الـCDC
+
+329
+00:25:37,690 --> 00:25:43,030
+والكيميسترى من مراقبتهم من الحاجات المهمة
+
+330
+00:25:52,250 --> 00:25:54,470
+في الـ CDC وعملها monitoring عشان أشوف الـ blood
+
+331
+00:25:54,470 --> 00:25:59,290
+cell إيش بيصير فيها بتحسن ولا لأ ال chemistry اللي
+
+332
+00:25:59,290 --> 00:26:01,870
+ربما أحياناً بيكون ال muscle weakness يا جماعة
+
+333
+00:26:01,870 --> 00:26:07,910
+because of severe hypokalemia الكاليان دوما اللي
+
+334
+00:26:07,910 --> 00:26:11,590
+هو الـ potassium لما بيزيد بقل كتير عن المعدلات
+
+335
+00:26:11,590 --> 00:26:14,830
+الطبيعية تبعته ممكن يؤدي إلى severe muscle
+
+336
+00:26:14,830 --> 00:26:18,070
+weakness وبالآخر هذا يؤدي إلى respiratory failure
+
+337
+00:26:19,350 --> 00:26:24,250
+عشان هيك ممكن جدًا يكون الـ Mechanical Ventilator
+
+338
+00:26:24,250 --> 00:26:30,070
+هو الحل المهم جدًا في حالات الـ Respiratory
+
+339
+00:26:30,070 --> 00:26:36,670
+Failure للناس اللي دخلت المشكلة هذه في الأيام
+
+340
+00:26:36,670 --> 00:26:43,350
+الحالية اللي نعيش بيها فيه يعني حاجة ملححة خلينا
+
+341
+00:26:43,350 --> 00:26:46,590
+نسميها وحاجة
+
+342
+00:26:51,560 --> 00:26:55,820
+زاكدة لأجهزة التنافس الصينية على مستوى العالم بسبب
+
+343
+00:26:55,820 --> 00:26:59,620
+متشار بيروز كورونا اللي بيخلي المرضى المصابين
+
+344
+00:26:59,620 --> 00:27:04,740
+يخشوا بـ Respiratory Failure سريع و Respiratory
+
+345
+00:27:04,740 --> 00:27:08,960
+Failure اللي بيعمل Alteration في الـ Lung Function
+
+346
+00:27:08,960 --> 00:27:12,220
+وبالتالي بيصير غير قادر على إنها تعمل Gas Exchange
+
+347
+00:27:12,220 --> 00:27:18,920
+وبالتالي بيصير المريض محتاج إنه يدعمبأجهزة تنافس
+
+348
+00:27:18,920 --> 00:27:25,460
+صناعي لبينما الرئة ترجع تستأيد قدرتها على الـ Gas
+
+349
+00:27:25,460 --> 00:27:29,900
+Exchange كما
+
+350
+00:27:29,900 --> 00:27:34,500
+في السابق لأن عدم قدرة الـ Lung علي إنها تعمل Gas
+
+351
+00:27:34,500 --> 00:27:38,380
+Exchange نتذكر دايماً الـ Mechanical Ventilator ما
+
+352
+00:27:38,380 --> 00:27:43,160
+بيعملش Gas Exchange ولا بيقوم مقام الـ Lung لكنإن
+
+353
+00:27:43,160 --> 00:27:48,720
+الـ Lung ما بتقدرش تعمل Gas Exchange فهذا هيؤدي
+
+354
+00:27:48,720 --> 00:27:52,480
+إلى استجابة الـ Respiratory Rate والـ Respiratory
+
+355
+00:27:52,480 --> 00:27:57,900
+System للجسم وممكن يزيد فهو بتبدأ يزيد معدلات
+
+356
+00:27:57,900 --> 00:28:02,560
+التنقص لدرجات عالية جدا تكمية لدرجة إن المريض يصير
+
+357
+00:28:02,560 --> 00:28:05,620
+غير قادر على الـ Compensation بس الأفضل بيكون احنا
+
+358
+00:28:05,620 --> 00:28:10,080
+مضطرينالنظم عملية التنفس عن طريق الـ Mechanical
+
+359
+00:28:10,080 --> 00:28:14,120
+Ventilation نقب أنواع ومداته المختلفة اللي شرحناها
+
+360
+00:28:14,120 --> 00:28:18,140
+المرة اللي فاتت بالمناسبة بالحالات هذه كتير بفضلوا
+
+361
+00:28:18,140 --> 00:28:21,100
+يستخدموا حاجة اسمها Jet Ventilation أو الـHigh
+
+362
+00:28:21,100 --> 00:28:24,780
+Frequency Ventilation يمكن هذا ما اتركناش كتير يلو
+
+363
+00:28:24,780 --> 00:28:27,300
+في محاضرة الـMechanical Ventilator لأنه نوع مش
+
+364
+00:28:27,300 --> 00:28:32,640
+كتيرمتوفر لكن الـ «High Frequency Ventilation» أو
+
+365
+00:28:32,640 --> 00:28:35,880
+«Jet Ventilation» بيسموه هذا الفكرة تبعته بكل
+
+366
+00:28:35,880 --> 00:28:38,980
+بساطة إنه يعطي «High Respiratory Rate» لأن المريض
+
+367
+00:28:38,980 --> 00:28:41,820
+هذا زي الـ «Acute Respiratory Distress Syndrome»
+
+368
+00:28:41,820 --> 00:28:45,100
+هنهتعمله إن شاء الله في الـ «ARDS» ما بيكونش فيه
+
+369
+00:28:45,100 --> 00:28:47,760
+عنده مساحة في الـ«Longitudinal Gas Density Change»
+
+370
+00:28:47,760 --> 00:28:51,880
+فبسيط التعامل معاه إنه نديله كميات قليلة جدا من
+
+371
+00:28:51,880 --> 00:28:56,750
+الهواء بـ«Respiratory Rate» عالي كتيروبالتالي
+
+372
+00:28:56,750 --> 00:29:01,170
+بيصير الـ Gas exchange على قدر كمية الجاز البسيطة
+
+373
+00:29:01,170 --> 00:29:05,010
+اللي بتدخل ولكن اللي بتدخل يعني لرقتين وبالتالي
+
+374
+00:29:05,010 --> 00:29:08,510
+احنا بننقذ المريض ونحافظ على الـ Acid Base Balance
+
+375
+00:29:08,510 --> 00:29:13,790
+تبعه من غير Respiratory Acid Doses الـ Acute
+
+376
+00:29:13,790 --> 00:29:17,530
+Respiratory Distress Syndrome اللي هو الـ ARDS
+
+377
+00:29:17,530 --> 00:29:21,370
+اللي هو إن شاء الله رب العالمين هيكون موضوعنا
+
+378
+00:29:23,420 --> 00:29:25,420
+القادم بإذن الله
+
diff --git a/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/WqDa90omKZk_raw.json b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/WqDa90omKZk_raw.json
new file mode 100644
index 0000000000000000000000000000000000000000..728dcac47324aa985ef3581243cecdb9cfe59b00
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@@ -0,0 +1 @@
+{"segments": [{"id": 1, "seek": 3093, "start": 4.25, "end": 30.93, "text": "بسم الله الرحمن الرحيم السلام عليكم ورحمة الله وبركاته اليوم، إن شاء الله رب العالمين، هنبدأ في Unit 3 Acute Alteration in Respiratory Functions بالنسبة للـCritical Care أكيد بنعرف إن مشاكل الـRespiratory من أهم المشاكل ممكن تكون مطلوب نعمل فيها رعاية للمريد وCare", "tokens": [3555, 38251, 21984, 34892, 5016, 27842, 34892, 5016, 32640, 21136, 37440, 25894, 24793, 4032, 2288, 35571, 3660, 21984, 4032, 26890, 4117, 9307, 3224, 45595, 20498, 12399, 36145, 13412, 16606, 21984, 12602, 3555, 18863, 45340, 9957, 12399, 8032, 1863, 44510, 10721, 8978, 27894, 805, 5097, 1169, 32608, 399, 294, 5015, 9501, 4745, 11166, 3916, 20666, 1863, 35457, 3660, 24976, 39184, 34, 3210, 804, 9532, 5551, 4117, 25708, 44945, 3615, 28480, 36145, 37893, 995, 28820, 2423, 39184, 33274, 9501, 4745, 9154, 5551, 16095, 9673, 8592, 995, 28820, 3714, 43020, 6055, 30544, 3714, 9566, 1211, 37746, 8717, 25957, 1211, 8978, 11296, 12602, 3615, 995, 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abnormality‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏�", "tokens": [913, 237, 7035, 312, 41877, 4650, 281, 264, 6194, 47104, 1860, 913, 237, 913, 237, 913, 237, 913, 237, 913, 237, 913, 237, 913, 237, 913, 237, 913, 237, 913, 237, 913, 237, 913, 237, 913, 237, 913, 237, 913, 237, 913, 237, 913, 237, 913, 237, 913, 237, 913, 237, 913, 237, 913, 237, 913, 237, 913, 237, 913, 237, 913, 237, 913, 237, 913, 237, 913, 237, 913, 237, 913, 237, 913, 237, 913, 237, 913, 237, 913, 237, 913, 237, 913, 237, 913, 237, 913, 237, 913, 237, 913, 237, 913, 237, 913, 237, 913, 237, 913, 237, 913, 237, 913, 237, 913, 237, 913, 237, 913, 237, 913, 237, 913, 237, 913, 237, 913, 237, 913, 237, 913, 237, 913, 237, 913, 237, 913, 237, 913, 237, 913, 237, 913, 237, 913, 237, 913, 237, 913, 237, 913, 237, 913, 237, 913, 237, 913, 237, 913, 237, 913, 237, 913, 237, 913, 237, 913, 237, 913, 237, 913, 237, 913, 237, 913, 237, 913, 237, 913, 237, 913, 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abnormality‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏�", "probability": 0.9830634538517442}], "temperature": 1.0}, {"id": 20, "seek": 50863, "start": 481.41, "end": 508.63, "text": "أو يعني توقف عملية التنفس والخلل في عملية التنفس زي Airway Obstruction يعني راجل مافيش عنده مشكلة لكن صار فيه عنده Severe Epileptic Disorder مثلا فصار فيه عنده طبع خوم صار فيه عنده Laryngitis Edema، Severe Laryngitis Edema فمافيه إمكانية إنه الجاز يخش عشان يصير له X Change", "tokens": [10721, 2407, 37495, 22653, 6055, 30543, 5172, 6225, 42213, 10632, 16712, 1863, 36178, 16070, 9778, 1211, 1211, 8978, 6225, 42213, 10632, 16712, 1863, 36178, 30767, 1829, 5774, 676, 4075, 372, 3826, 37495, 22653, 12602, 26108, 1211, 19446, 41185, 8592, 43242, 3224, 37893, 28820, 3660, 44381, 20328, 9640, 8978, 3224, 43242, 3224, 1100, 5887, 9970, 794, 32307, 4208, 4687, 50113, 15040, 6156, 9381, 9640, 8978, 3224, 43242, 3224, 23032, 3555, 3615, 16490, 20498, 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"word": " وتقوم", "probability": 0.8873697916666666}, {"start": 539.2, "end": 539.6, "word": " بدورها", "probability": 0.8626302083333334}, {"start": 539.6, "end": 540.22, "word": " وتعمل", "probability": 0.9456380208333334}, {"start": 540.22, "end": 540.68, "word": " الـ", "probability": 0.723876953125}, {"start": 540.68, "end": 540.96, "word": " Gas", "probability": 0.492919921875}, {"start": 540.96, "end": 541.9, "word": " Exchange", "probability": 0.65869140625}, {"start": 541.9, "end": 542.5, "word": " فيه", "probability": 0.566162109375}, {"start": 542.5, "end": 542.68, "word": " الـ", "probability": 0.5792236328125}, {"start": 542.68, "end": 543.02, "word": " Alveolar", "probability": 0.4429117838541667}, {"start": 543.02, "end": 543.24, "word": " and", "probability": 0.4794921875}, {"start": 543.24, "end": 545.22, "word": " Bleural", "probability": 0.45458984375}, {"start": 545.22, "end": 545.68, "word": " Disease", "probability": 0.60498046875}, {"start": 545.68, "end": 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"probability": 0.939453125}, {"start": 571.23, "end": 574.07, "word": " كردوجينيك", "probability": 0.9541015625}, {"start": 574.07, "end": 575.53, "word": " يعني", "probability": 0.57733154296875}, {"start": 575.53, "end": 576.21, "word": " كردوجينيك", "probability": 0.9504045758928571}, {"start": 576.21, "end": 576.51, "word": " بالمونا", "probability": 0.7623291015625}, {"start": 576.51, "end": 577.01, "word": " الأقديمى", "probability": 0.9748046875}, {"start": 577.01, "end": 577.29, "word": " لما", "probability": 0.814208984375}, {"start": 577.29, "end": 577.97, "word": " يكون", "probability": 0.76171875}, {"start": 577.97, "end": 579.41, "word": " البلمونة", "probability": 0.8831787109375}, {"start": 579.41, "end": 579.93, "word": " الأقديمى", "probability": 0.8970703125}, {"start": 579.93, "end": 580.47, "word": " cause", "probability": 0.06756591796875}, {"start": 580.47, "end": 580.95, "word": " of", "probability": 0.90478515625}, {"start": 580.95, "end": 581.51, "word": " failure", "probability": 0.66552734375}, {"start": 581.51, "end": 581.77, "word": " of", "probability": 0.95654296875}, {"start": 581.77, "end": 581.97, "word": " the", "probability": 0.77880859375}, {"start": 581.97, "end": 582.21, "word": " heart", "probability": 0.916015625}, {"start": 582.21, "end": 582.59, "word": " to", "probability": 0.94921875}, {"start": 582.59, "end": 582.83, "word": " do", "probability": 0.93505859375}, {"start": 582.83, "end": 583.07, "word": " its", "probability": 0.80859375}, {"start": 583.07, "end": 583.53, "word": " function", "probability": 0.8974609375}], "temperature": 1.0}, {"id": 24, "seek": 59846, "start": 584.38, "end": 598.46, "text": "ولكن من الـ Non-Carcinogenic Balmyra الأديمة زي اللي بتصير يا جماعة خلات الـ Organophosphorus poisoning فالـ Organophosphorus poisoning الـ cause ليس خطأ القلب، لأ القصة أن الكورينيسترايز", "tokens": [12610, 19452, 9154, 2423, 39184, 8774, 12, 24437, 20021, 25473, 13140, 2226, 424, 16247, 16254, 46007, 30767, 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587.0, "word": " الأديمة", "probability": 0.5179850260416666}, {"start": 587.0, "end": 587.24, "word": " زي", "probability": 0.63720703125}, {"start": 587.24, "end": 587.32, "word": " اللي", "probability": 0.82177734375}, {"start": 587.32, "end": 587.64, "word": " بتصير", "probability": 0.794921875}, {"start": 587.64, "end": 587.76, "word": " يا", "probability": 0.2408447265625}, {"start": 587.76, "end": 588.0, "word": " جماعة", "probability": 0.9951171875}, {"start": 588.0, "end": 588.42, "word": " خلات", "probability": 0.5887044270833334}, {"start": 588.42, "end": 588.6, "word": " الـ", "probability": 0.864501953125}, {"start": 588.6, "end": 589.38, "word": " Organophosphorus", "probability": 0.79541015625}, {"start": 589.38, "end": 589.94, "word": " poisoning", "probability": 0.67236328125}, {"start": 589.94, "end": 590.72, "word": " فالـ", "probability": 0.6941731770833334}, {"start": 590.72, "end": 591.44, "word": " Organophosphorus", "probability": 0.9415283203125}, {"start": 591.44, "end": 591.96, "word": " poisoning", "probability": 0.859375}, {"start": 591.96, "end": 592.18, "word": " الـ", "probability": 0.798828125}, {"start": 592.18, "end": 592.74, "word": " cause", "probability": 0.47509765625}, {"start": 592.74, "end": 593.44, "word": " ليس", "probability": 0.597900390625}, {"start": 593.44, "end": 594.14, "word": " خطأ", "probability": 0.5409749348958334}, {"start": 594.14, "end": 595.04, "word": " القلب،", "probability": 0.5555826822916666}, {"start": 595.04, "end": 595.52, "word": " لأ", "probability": 0.683837890625}, {"start": 595.52, "end": 596.44, "word": " القصة", "probability": 0.9765625}, {"start": 596.44, "end": 596.74, "word": " أن", "probability": 0.48388671875}, {"start": 596.74, "end": 598.46, "word": " الكورينيسترايز", "probability": 0.5392913818359375}], "temperature": 1.0}, {"id": 25, "seek": 61860, "start": 599.86, "end": 618.6, "text": "كثير عالي في الجسم كله مسترز إنزاع عالي فبالتالي مافيش ارتباط لالكولين فبالتالي فيه يعني انسياب لكل السوائل اللي في الجسم علشان هي كمان من ضمنها بيصير Pronguria زي ما احنا عارفين و بتتجمع كميات كبيرة منها في الـLung", "tokens": [4117, 12984, 13546, 6225, 6027, 1829, 8978, 25724, 38251, 28242, 3224, 3714, 14851, 2288, 11622, 36145, 11622, 45761, 6225, 6027, 1829, 6156, 3555, 6027, 2655, 6027, 1829, 19446, 41185, 8592, 1975, 43500, 3555, 41193, 5296, 6027, 4117, 12610, 9957, 6156, 3555, 6027, 2655, 6027, 1829, 8978, 3224, 37495, 22653, 16472, 3794, 1829, 16758, 5296, 28820, 21136, 2407, 16373, 1211, 13672, 1829, 8978, 25724, 38251, 11203, 8592, 7649, 39896, 9122, 2304, 7649, 9154, 48812, 27842, 11296, 4724, 1829, 9381, 13546, 2114, 556, 37299, 30767, 1829, 19446, 1975, 5016, 8315, 6225, 9640, 5172, 9957, 4032, 39894, 2655, 7435, 2304, 3615, 9122, 2304, 1829, 9307, 9122, 3555, 48923, 9154, 11296, 8978, 2423, 39184, 43, 1063], "avg_logprob": -0.27682522123893805, "compression_ratio": 1.813397129186603, "no_speech_prob": 1.9609928131103516e-05, "words": [{"start": 599.86, "end": 600.62, "word": "كثير", "probability": 0.5496622721354166}, {"start": 600.62, "end": 600.92, "word": " عالي", "probability": 0.8929036458333334}, {"start": 600.92, "end": 600.98, "word": " في", "probability": 0.94091796875}, {"start": 600.98, "end": 601.4, "word": " الجسم", "probability": 0.984375}, {"start": 601.4, "end": 601.7, "word": " كله", "probability": 0.37640380859375}, {"start": 601.7, "end": 602.08, "word": " مسترز", "probability": 0.549041748046875}, {"start": 602.08, "end": 602.52, "word": " إنزاع", "probability": 0.5322265625}, {"start": 602.52, "end": 603.78, "word": " عالي", "probability": 0.9173177083333334}, {"start": 603.78, "end": 604.42, "word": " فبالتالي", "probability": 0.93310546875}, {"start": 604.42, "end": 604.92, "word": " مافيش", "probability": 0.8863932291666666}, {"start": 604.92, "end": 606.92, "word": " ارتباط", "probability": 0.895263671875}, {"start": 606.92, "end": 607.48, "word": " لالكولين", "probability": 0.681787109375}, {"start": 607.48, "end": 608.56, "word": " فبالتالي", "probability": 0.9534505208333334}, {"start": 608.56, "end": 609.66, "word": " فيه", "probability": 0.74462890625}, {"start": 609.66, "end": 610.16, "word": " يعني", "probability": 0.7315673828125}, {"start": 610.16, "end": 611.12, "word": " انسياب", "probability": 0.91162109375}, {"start": 611.12, "end": 611.48, "word": " لكل", "probability": 0.970458984375}, {"start": 611.48, "end": 612.02, "word": " السوائل", "probability": 0.8316650390625}, {"start": 612.02, "end": 612.22, "word": " اللي", "probability": 0.88818359375}, {"start": 612.22, "end": 612.34, "word": " في", "probability": 0.9638671875}, {"start": 612.34, "end": 612.78, "word": " الجسم", "probability": 0.9921875}, {"start": 612.78, "end": 613.18, "word": " علشان", "probability": 0.9563802083333334}, {"start": 613.18, "end": 613.32, "word": " هي", "probability": 0.94677734375}, {"start": 613.32, "end": 613.62, "word": " كمان", "probability": 0.7693684895833334}, {"start": 613.62, "end": 613.9, "word": " من", "probability": 0.60693359375}, {"start": 613.9, "end": 614.34, "word": " ضمنها", "probability": 0.8058268229166666}, {"start": 614.34, "end": 614.88, "word": " بيصير", "probability": 0.9034423828125}, {"start": 614.88, "end": 615.62, "word": " Pronguria", "probability": 0.3169962565104167}, {"start": 615.62, "end": 615.9, "word": " زي", "probability": 0.866943359375}, {"start": 615.9, "end": 615.98, "word": " ما", "probability": 0.94873046875}, {"start": 615.98, "end": 616.14, "word": " احنا", "probability": 0.8723958333333334}, {"start": 616.14, "end": 616.46, "word": " عارفين", "probability": 0.947265625}, {"start": 616.46, "end": 616.58, "word": " و", "probability": 0.390869140625}, {"start": 616.58, "end": 617.08, "word": " بتتجمع", "probability": 0.860693359375}, {"start": 617.08, "end": 617.36, "word": " كميات", "probability": 0.905517578125}, {"start": 617.36, "end": 617.68, "word": " كبيرة", "probability": 0.9739583333333334}, {"start": 617.68, "end": 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0.91748046875}, {"start": 1747.61, "end": 1747.89, "word": " Acid", "probability": 0.667724609375}, {"start": 1747.89, "end": 1748.15, "word": " Base", "probability": 0.1986083984375}, {"start": 1748.15, "end": 1748.51, "word": " Balance", "probability": 0.953125}, {"start": 1748.51, "end": 1748.91, "word": " تبعه", "probability": 0.7840576171875}, {"start": 1748.91, "end": 1749.03, "word": " من", "probability": 0.96826171875}, {"start": 1749.03, "end": 1749.27, "word": " غير", "probability": 0.995361328125}, {"start": 1749.27, "end": 1749.91, "word": " Respiratory", "probability": 0.8011067708333334}, {"start": 1749.91, "end": 1750.51, "word": " Acid", "probability": 0.8671875}, {"start": 1750.51, "end": 1750.89, "word": " Doses", "probability": 0.673095703125}, {"start": 1750.89, "end": 1753.45, "word": " الـ", "probability": 0.870361328125}, {"start": 1753.45, "end": 1753.79, "word": " Acute", "probability": 0.90380859375}, {"start": 1753.79, "end": 1754.63, "word": " Respiratory", "probability": 0.912109375}, {"start": 1754.63, "end": 1755.51, "word": " Distress", "probability": 0.842529296875}, {"start": 1755.51, "end": 1756.13, "word": " Syndrome", "probability": 0.939453125}, {"start": 1756.13, "end": 1756.39, "word": " اللي", "probability": 0.87353515625}, {"start": 1756.39, "end": 1756.63, "word": " هو", "probability": 0.982421875}, {"start": 1756.63, "end": 1756.91, "word": " الـ", "probability": 0.90283203125}, {"start": 1756.91, "end": 1757.53, "word": " ARDS", "probability": 0.9072265625}, {"start": 1757.53, "end": 1757.93, "word": " اللي", "probability": 0.976806640625}, {"start": 1757.93, "end": 1758.07, "word": " هو", "probability": 0.89306640625}, {"start": 1758.07, "end": 1758.19, "word": " إن", "probability": 0.51416015625}, {"start": 1758.19, "end": 1758.31, "word": " شاء", "probability": 0.973388671875}, {"start": 1758.31, "end": 1758.45, "word": " الله", "probability": 0.96533203125}, {"start": 1758.45, "end": 1758.69, "word": " رب", "probability": 0.978271484375}, {"start": 1758.69, "end": 1759.17, "word": " العالمين", "probability": 0.9967447916666666}, {"start": 1759.17, "end": 1759.97, "word": " هيكون", "probability": 0.863525390625}, {"start": 1759.97, "end": 1761.37, "word": " موضوعنا", "probability": 0.994140625}], "temperature": 1.0}, {"id": 75, "seek": 176542, "start": 1763.42, "end": 1765.42, "text": "القادم بإذن الله", "tokens": [6027, 4587, 18513, 2304, 4724, 28814, 8848, 1863, 21984], "avg_logprob": -0.06362304389476776, "compression_ratio": 0.7894736842105263, "no_speech_prob": 0.0, "words": [{"start": 1763.42, "end": 1764.5, "word": "القادم", "probability": 0.96337890625}, {"start": 1764.5, "end": 1765.26, "word": " بإذن", "probability": 0.9150390625}, {"start": 1765.26, "end": 1765.42, "word": " الله", "probability": 0.958984375}], "temperature": 1.0}], "language": "ar", "language_probability": 1.0, "duration": 1770.9395, "duration_after_vad": 1689.9331249999962}
\ No newline at end of file
diff --git a/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/WqDa90omKZk_raw.srt b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/WqDa90omKZk_raw.srt
new file mode 100644
index 0000000000000000000000000000000000000000..2c50612418f9cc1539347ad73a6104a6058e5482
--- /dev/null
+++ b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/WqDa90omKZk_raw.srt
@@ -0,0 +1,1512 @@
+1
+00:00:04,250 --> 00:00:06,870
+بسم الله الرحمن الرحيم السلام عليكم ورحمة الله
+
+2
+00:00:06,870 --> 00:00:12,270
+وبركاته اليوم، إن شاء الله رب العالمين، هنبدأ في
+
+3
+00:00:12,270 --> 00:00:17,010
+Unit 3 Acute Alteration in Respiratory Functions
+
+4
+00:00:17,010 --> 00:00:20,270
+بالنسبة
+
+5
+00:00:20,270 --> 00:00:23,030
+للـCritical Care أكيد بنعرف إن مشاكل
+
+6
+00:00:23,030 --> 00:00:29,150
+الـRespiratory من أهم المشاكل ممكن تكون مطلوب نعمل
+
+7
+00:00:29,150 --> 00:00:34,960
+فيها رعاية للمريد وCareبسبب خاطرات الهواتف عشان
+
+8
+00:00:34,960 --> 00:00:37,060
+ذلك سيكون معانا الـ Acute respiratory failure
+
+9
+00:00:37,060 --> 00:00:39,440
+سيكون معانا الـ Adulterous respiratory distress
+
+10
+00:00:39,440 --> 00:00:43,220
+syndrome حاجة مشهورة جدا الـ Pulmonary embolism
+
+11
+00:00:43,220 --> 00:00:48,100
+نبدأ في الـ Acute respiratory failure الـ
+
+12
+00:00:48,100 --> 00:00:50,840
+Respiratory failure in general is a sudden and
+
+13
+00:00:50,840 --> 00:00:53,460
+life-threatening deterioration of gas exchange
+
+14
+00:00:53,460 --> 00:01:02,460
+فجأة يحصل عند المريض تتجارب تجارب الهواتفالـ lung
+
+15
+00:01:02,460 --> 00:01:07,820
+بتبدأ تصير غير قادر على إنه تعمل elimination للـ
+
+16
+00:01:07,820 --> 00:01:14,220
+CO2 والـ partial
+
+17
+00:01:14,220 --> 00:01:18,780
+pressure تبع الـ oxygen بيبدأ يصير decreased في
+
+18
+00:01:18,780 --> 00:01:24,730
+البلدالـ Acute Respiratory Failure في تعريفه إن
+
+19
+00:01:24,730 --> 00:01:28,170
+الـ Partial Pressure تبقى الأكسجين يصير أقل من 60
+
+20
+00:01:28,170 --> 00:01:31,890
+ملي متر ذئبخ وهذا بنسميه Hypoxemia زي ما بنعرف
+
+21
+00:01:31,890 --> 00:01:37,970
+والـ CO2 يبدأ يصير أكتر من 50 ملي متر ذئبخ اللي هو
+
+22
+00:01:37,970 --> 00:01:41,030
+Hypercapnia
+
+23
+00:01:41,030 --> 00:01:44,430
+زي ما احنا عارفين
+
+24
+00:01:47,710 --> 00:01:52,890
+الـ Hypercapnia من أهم أسباب الـ Respiratory
+
+25
+00:01:52,890 --> 00:01:56,670
+Acidosis في مرضى الـ أو في حالة الـ Acute
+
+26
+00:01:56,670 --> 00:02:04,730
+Respiratory Failure عشان هي كتير مهم إنه انفرج بين
+
+27
+00:02:04,730 --> 00:02:07,270
+الـ Acute Respiratory Failure والـ Chronic
+
+28
+00:02:07,270 --> 00:02:11,490
+Respiratory Failure طب هو في فرق بينه طبعاً الـ
+
+29
+00:02:11,490 --> 00:02:16,260
+Chronic Respiratory Failure اللي بنعرفهإن هو عبارة
+
+30
+00:02:16,260 --> 00:02:21,580
+عن الـ deterioration في الـ gas exchange و الـ
+
+31
+00:02:21,580 --> 00:02:27,400
+function تبع الـ lung لكن بتتطور بشكل تدريجي مش
+
+32
+00:02:27,400 --> 00:02:31,570
+فجأة المريض بيكونكان قادر على عملية التنفس وعمل
+
+33
+00:02:31,570 --> 00:02:36,290
+الـ Gas Exchange لكن بطلت فجأة الـ Lung تصبح لديها
+
+34
+00:02:36,290 --> 00:02:40,390
+قدرة على عمل الـ Gas Exchange وتقدر وظائف تبقى
+
+35
+00:02:40,390 --> 00:02:43,970
+إتزامة بيصير حالياً في المرض العصر اللي بنعيشه
+
+36
+00:02:43,970 --> 00:02:48,290
+اللي هو الـ Corona المريض بيصير عنده Sino Symptoms
+
+37
+00:02:48,290 --> 00:02:53,150
+أشبه بالـ Flow فجأة بيخش المريض في Acute
+
+38
+00:02:53,150 --> 00:02:57,730
+Respiratory Failure لأن الـ Lung فجأة يعنيمبينة
+
+39
+00:02:57,730 --> 00:03:01,050
+عشرة مضوحة زي ما بقولوا تاني يوم تالت يوم بيبدأ
+
+40
+00:03:01,050 --> 00:03:04,230
+يصير غير قادر الـ lung علي أنها تعمل اللي هو الـ
+
+41
+00:03:04,230 --> 00:03:07,230
+gas exchange وهذا بتصنف تحت الـ Acute Respiratory
+
+42
+00:03:07,230 --> 00:03:10,110
+Failure لكن في الـ Chronic Respiratory Failure من
+
+43
+00:03:10,110 --> 00:03:13,470
+الأمثلة تبعته مثلًا الـ COPD patient الـ
+
+44
+00:03:13,470 --> 00:03:17,470
+Neuromuscular Disease الناس اللي بده يتطور عندهم
+
+45
+00:03:17,470 --> 00:03:22,430
+الأشي Gradually يعني هو بيكون عنده Respiratory
+
+46
+00:03:22,430 --> 00:03:25,910
+Disorders بيكون عنده Environment في الـ Function
+
+47
+00:03:25,910 --> 00:03:28,180
+تبعة الـ lungsولكنها لا تدخل فقط في الـ
+
+48
+00:03:28,180 --> 00:03:35,740
+Respiratory Failure فجأة، بل تبقى Supported لما
+
+49
+00:03:35,740 --> 00:03:39,640
+تصل إلى وقت إن الـ Lung ليس قادرة إنها تكون بالـ
+
+50
+00:03:39,640 --> 00:03:46,340
+Function تباعتها نهائيا، ويدخل الـ Acute in Top of
+
+51
+00:03:46,340 --> 00:03:46,980
+Chronic
+
+52
+00:03:52,600 --> 00:03:55,760
+طب الـ Acute Respiratory Failure إلو أنواع؟ آه
+
+53
+00:03:55,760 --> 00:03:59,820
+طبعاً إلو أنواع في type 1 و في type 2 طب إيش بيكون
+
+54
+00:03:59,820 --> 00:04:03,140
+في type 1؟ Acute Hypoxia .. بيسموها Acute
+
+55
+00:04:03,140 --> 00:04:07,060
+Hypoxemic Respiratory Failure إيش يعني؟ يعني الـ
+
+56
+00:04:07,060 --> 00:04:12,000
+Respiratory Failure هنا ناتجة من قلة الأكسوجين
+
+57
+00:04:12,000 --> 00:04:16,440
+وليس من ارتفاع ثاني أكسيد الكربون، إذا Hypox
+
+58
+00:04:19,720 --> 00:04:26,520
+من غير ما يكون الـ «CO2» يا جماعة مرتفع في المرضى،
+
+59
+00:04:26,520 --> 00:04:31,180
+هدولة، لا يعني مايكونش في «CO2» retention على
+
+60
+00:04:31,180 --> 00:04:35,660
+العكس حتى ممكن أن يكون «CO2» في hyperventilation
+
+61
+00:04:35,660 --> 00:04:39,940
+يا جماعة و «CO2» يكون low عند المرضى، هدولة، علشان
+
+62
+00:04:39,940 --> 00:04:50,880
+هيك هذا الـ «type» يعنيبكون عادة مصاحب لأمراض أخرى
+
+63
+00:04:50,880 --> 00:04:55,040
+وبالذات الـ «كاردوجينيك» والـ «نون كاردوجينيك»
+
+64
+00:04:55,040 --> 00:05:01,320
+بالمناورة القديمة و«نيومونيا» بكون الوضع فيهم بهذا
+
+65
+00:05:01,320 --> 00:05:07,100
+الشكل الـ «Type 2 Acute»
+
+66
+00:05:09,450 --> 00:05:13,310
+الـFailure بيسموه Acute Hypercapnic من اسمه واضح
+
+67
+00:05:13,310 --> 00:05:19,030
+جداً إن الـ«CO2» عالي كتير أكتر من خمسين زي ما
+
+68
+00:05:19,030 --> 00:05:26,250
+حكينا طبعاً هذا هيخلي إن الـ«PH» تبدأ تقل وبتعمل
+
+69
+00:05:26,250 --> 00:05:28,970
+Respiratory Acidosis زي ما أخدنا في الـChapter
+
+70
+00:05:28,970 --> 00:05:32,670
+الـBlood Gases مفهوم إنه مع كل Increase في
+
+71
+00:05:32,670 --> 00:05:41,490
+الـ«CO2» بدأ الـ«PH» تصير لها Decreaseوتبدأ يصير
+
+72
+00:05:41,490 --> 00:05:47,430
+حالة من الـ Respiratory Acidosis طبعاً هذا عادة
+
+73
+00:05:47,430 --> 00:05:52,290
+يكون نتيجة Inadequate airflow in the alveoli of
+
+74
+00:05:52,290 --> 00:05:56,510
+the lungs عادة يكون كمية الهواء اللي يدخل
+
+75
+00:05:56,510 --> 00:06:00,770
+الرائعتين قليلة علشان هي بيصير احتباس لتاني اكسيد
+
+76
+00:06:00,770 --> 00:06:06,050
+الفربون وبيصير environment في الجاز exchange
+
+77
+00:06:08,230 --> 00:06:15,570
+أسباب كثيرة ممكن تؤدي إلى الكلام هذا «التحرير
+
+78
+00:06:15,570 --> 00:06:20,430
+المدعوم» «التحرير
+
+79
+00:06:20,430 --> 00:06:23,710
+المدعوم» «التحرير المدعوم» «التحرير المدعوم»
+
+80
+00:06:23,710 --> 00:06:27,010
+«التحرير المدعوم» «التحرير المدعوم» «التحرير
+
+81
+00:06:27,010 --> 00:06:28,730
+المدعوم» «التحرير المدعوم» «التحرير المدعوم»
+
+82
+00:06:28,730 --> 00:06:30,770
+«التحرير المدعوم» «التحرير المدعوم» «التحرير
+
+83
+00:06:30,770 --> 00:06:31,010
+المدعوم» «التحرير المدعوم» «التحرير المدعوم»
+
+84
+00:06:31,010 --> 00:06:31,030
+«التحرير المدعوم» «التحرير المدعوم» «التحرير
+
+85
+00:06:31,030 --> 00:06:36,690
+المدعوم» «التحرير المدعوم» «التحرير المدعوم
+
+86
+00:06:36,800 --> 00:06:41,120
+بالتالي، الجسم لا يدفع الأكسجين إلى نفسه لأن الـ
+
+87
+00:06:41,120 --> 00:06:44,820
+lung في أماكن كتير ما بتشتغلش الشغل تبقى عارف تبقى
+
+88
+00:06:44,820 --> 00:06:48,720
+عارف احنا تبقى عارف في حالات الفيزيمة الفيزيمة في
+
+89
+00:06:48,720 --> 00:06:52,480
+ال chest كيف بيصير في opening من القلب يلعب على
+
+90
+00:06:52,480 --> 00:06:57,500
+بعض فبدل ما يكونوا بكل يعني كلالجدار تبع الـ One
+
+91
+00:06:57,500 --> 00:07:00,700
+Alveoli بيكون محل الـ Gas Exchange والـ Alveoli
+
+92
+00:07:00,700 --> 00:07:03,420
+اللي جنبها والـ Alveoli اللي جنبها كل هدولة الغرف
+
+93
+00:07:03,420 --> 00:07:06,460
+اللي صغيرة بتفتح و بتعمل صالون كبير فمساعة الـ Gas
+
+94
+00:07:06,460 --> 00:07:09,740
+Exchange اللي على الـ Wall يا جماعة بتقل تمام،
+
+95
+00:07:09,740 --> 00:07:14,980
+فبالتالي بيكون الـ يعني هذا مثال لكي تبتقل عملية
+
+96
+00:07:14,980 --> 00:07:20,440
+الـ Gas Exchange عند المرضى هدولة وبدأت ذلك إلى
+
+97
+00:07:20,440 --> 00:07:26,770
+زيادة تاني أكسيد الكربون في الجسموقلة الأكسجين في
+
+98
+00:07:26,770 --> 00:07:31,690
+الدم الـPCO2 الـpartial pressure تبع الـCarbon،
+
+99
+00:07:31,690 --> 00:07:35,970
+الـCO2 بيزيد الـpartial pressure تبع الأكسجين بقل
+
+100
+00:07:35,970 --> 00:07:39,950
+وبالتالي هذا اللي هيعمل لنا الـhypercapnia
+
+101
+00:07:39,950 --> 00:07:43,350
+والـrespiratory acidosis كواسيس الـrespiratory
+
+102
+00:07:43,350 --> 00:07:49,020
+failure، من إيش بيصير؟‏can be grouped according to
+
+103
+00:07:49,020 --> 00:07:49,760
+the primary
+
+104
+00:07:49,760 --> 00:08:00,920
+abnormality‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏�
+
+105
+00:08:01,410 --> 00:08:09,910
+أو يعني توقف عملية التنفس والخلل في عملية التنفس
+
+106
+00:08:09,910 --> 00:08:15,850
+زي Airway Obstruction يعني راجل مافيش عنده مشكلة
+
+107
+00:08:15,850 --> 00:08:19,990
+لكن صار فيه عنده Severe Epileptic Disorder مثلا
+
+108
+00:08:19,990 --> 00:08:22,610
+فصار فيه عنده طبع خوم صار فيه عنده Laryngitis
+
+109
+00:08:22,610 --> 00:08:25,310
+Edema، Severe Laryngitis Edema فمافيه إمكانية إنه
+
+110
+00:08:25,310 --> 00:08:32,020
+الجاز يخش عشان يصير له X Changeأو مثلًا الـ tumor
+
+111
+00:08:32,020 --> 00:08:37,040
+يا جماعة أو from body inhalation سكر مجرد التنفس
+
+112
+00:08:37,040 --> 00:08:42,460
+عنده فهذا عمل أو في تحت في ال lungs فيه cystic fat
+
+113
+00:08:42,460 --> 00:08:47,120
+process فالـ fertilized ما بيعملوش دورهم في كل
+
+114
+00:08:47,120 --> 00:08:50,060
+الحالات زي ما احنا شايفين يا مش هوا أصلا بفوت يا
+
+115
+00:08:50,060 --> 00:08:57,260
+أماالـ Respiratory Failure صار نتيجة إنه مافيش
+
+116
+00:08:57,260 --> 00:09:00,960
+ألغولة عايز تشتغل وتقوم بدورها وتعمل الـ Gas
+
+117
+00:09:00,960 --> 00:09:06,060
+Exchange فيه الـ Alveolar and Bleural Disease يعني
+
+118
+00:09:06,060 --> 00:09:11,800
+الألغولة نفسها ممكن تكون فيها مشكلة Resulting in
+
+119
+00:09:11,800 --> 00:09:16,780
+hypoxic respiratory failure وطبعاً هيتأد لإنوسيفية
+
+120
+00:09:17,750 --> 00:09:22,130
+كما يكون مثلًا كردوجينيك أو نان كردوجينيك بالمونا
+
+121
+00:09:22,130 --> 00:09:27,450
+الأقديمى مليانة
+
+122
+00:09:27,450 --> 00:09:30,990
+ميّه في البلمونة الأقديمى سواء كانت كردوجينيك أو
+
+123
+00:09:30,990 --> 00:09:37,290
+نان كردوجينيك يعني كردوجينيك بالمونا الأقديمى لما
+
+124
+00:09:37,290 --> 00:09:41,970
+يكون البلمونة الأقديمى cause of failure of the
+
+125
+00:09:41,970 --> 00:09:45,620
+heart to do its functionولكن من الـ Non
+
+126
+00:09:45,620 --> 00:09:47,760
+-Carcinogenic Balmyra الأديمة زي اللي بتصير يا
+
+127
+00:09:47,760 --> 00:09:50,720
+جماعة خلات الـ Organophosphorus poisoning فالـ
+
+128
+00:09:50,720 --> 00:09:54,140
+Organophosphorus poisoning الـ cause ليس خطأ
+
+129
+00:09:54,140 --> 00:09:58,460
+القلب، لأ القصة أن الكورينيسترايز
+
+130
+00:09:59,860 --> 00:10:04,420
+كثير عالي في الجسم كله مسترز إنزاع عالي فبالتالي
+
+131
+00:10:04,420 --> 00:10:11,480
+مافيش ارتباط لالكولين فبالتالي فيه يعني انسياب لكل
+
+132
+00:10:11,480 --> 00:10:14,880
+السوائل اللي في الجسم علشان هي كمان من ضمنها بيصير
+
+133
+00:10:14,880 --> 00:10:17,680
+Pronguria زي ما احنا عارفين و بتتجمع كميات كبيرة
+
+134
+00:10:17,680 --> 00:10:18,600
+منها في الـLung
+
+135
+00:10:26,330 --> 00:10:31,590
+اللي بتكون على مستوى الـ Alveoli عشانك بيسموها
+
+136
+00:10:31,590 --> 00:10:34,740
+Alveolarأو بقيت بيكون الموضوع اللي هو لقب الـ
+
+137
+00:10:34,740 --> 00:10:39,600
+Central Nervous System يعني الـ Failure لأن جهاز
+
+138
+00:10:39,600 --> 00:10:43,400
+القصد المركزي اللي بيتحكم في عملية التنفس هو اللي
+
+139
+00:10:43,400 --> 00:10:48,160
+مش شغال بالطريقة الصحيحة فبصي لأن يعني كيف مش
+
+140
+00:10:48,160 --> 00:10:52,800
+شغال، نتيجة مثلا Brain tumor، نتيجة Brain injury،
+
+141
+00:10:52,800 --> 00:10:57,740
+Trauma، هذا إيش حيعمل؟ حيعمل، يعني الـCV
+
+142
+00:10:57,740 --> 00:11:02,620
+الـHemorrhagicهتزود الـ pressure، كلهم بيشتغلوا
+
+143
+00:11:02,620 --> 00:11:04,920
+بنفس الطريقة، كلهم بيزودوا ال pressure على الـ
+
+144
+00:11:04,920 --> 00:11:09,040
+central nervous system وبالتالي، إيش بيصير؟ بيصير
+
+145
+00:11:09,040 --> 00:11:12,780
+ضغط على ال respiratory centers وبالتالي، بيصير
+
+146
+00:11:12,780 --> 00:11:16,920
+المريض يخش في حالة من الـ hypoventilation بتقل من
+
+147
+00:11:16,920 --> 00:11:17,480
+كتير
+
+148
+00:11:21,990 --> 00:11:28,530
+مع قلة الـ Respiratory Rate بيصير Retention لـ CO2
+
+149
+00:11:28,530 --> 00:11:34,690
+في الجسم وبالتالي Hypercapnia فهذا من أمثلة الـ
+
+150
+00:11:34,690 --> 00:11:37,330
+Respiratory Rate طبعا Hypercapnia يعني بالآخر
+
+151
+00:11:37,330 --> 00:11:41,350
+الجسم بيستسلم الأكسجين بيقلل ثم بيصير كربون جديد
+
+152
+00:11:41,350 --> 00:11:47,330
+بيصير Respiratory Acidosisكده المريض يخش في الـ
+
+153
+00:11:47,330 --> 00:11:51,950
+Respiratory Failure في Peripheral Nervous System
+
+154
+00:11:51,950 --> 00:11:57,830
+ممكن يؤدي لـ Respiratory Failure؟ آه، زي أمثلة الـ
+
+155
+00:11:57,830 --> 00:12:02,590
+Gallipari Syndrome، Gallipari Syndrome ده يعني
+
+156
+00:12:02,590 --> 00:12:08,470
+most commonly it's post-viral، الناس عادةً بعدممكن
+
+157
+00:12:08,470 --> 00:12:12,570
+يعني يكون الواحد اندو كومانكولد، «hairless» أو
+
+158
+00:12:12,570 --> 00:12:15,150
+«any type of viral» الناس ممكن يخشوا الـ
+
+159
+00:12:15,150 --> 00:12:18,030
+«deterioration» ويصير اندو الجاليان باريس سندروم،
+
+160
+00:12:18,030 --> 00:12:20,650
+إيش الجاليان باريس سندروم؟ هذا بيصير يعني الـ
+
+161
+00:12:20,650 --> 00:12:26,770
+«peripheral neuropathy» و«peripheral weakness»
+
+162
+00:12:26,770 --> 00:12:30,650
+طبعا في الـ«ascending» بما يسمونه «ascending
+
+163
+00:12:30,650 --> 00:12:34,830
+muscle weakness» يعني بيبدأ الأطراف السفلية لـ
+
+164
+00:12:37,970 --> 00:12:41,350
+يعني القدمين من الطرفين السفليين ويبدأ يصير فيه
+
+165
+00:12:41,350 --> 00:12:45,630
+weakness ويبدأ ال weakness يطلع لفوق وهو بطلع لفوق
+
+166
+00:12:45,630 --> 00:12:48,110
+أنا من وين بخاف؟ بخاف من الـ respiratory muscles
+
+167
+00:12:48,110 --> 00:12:52,330
+يصير فيها weakness، آه ممكن يصل، طبعا ممكن يصل إذا
+
+168
+00:12:52,330 --> 00:12:57,750
+ما كانش فيه تدعيم لجهاز المناعي زي ما احنا بتعرف
+
+169
+00:12:57,750 --> 00:13:02,740
+الـ Golan-Powell Syndrome من أهمالـManagements
+
+170
+00:13:02,740 --> 00:13:07,820
+تبعتها أو من أهم الأدوية اللي بتنعطى في هذه
+
+171
+00:13:07,820 --> 00:13:12,060
+الحالات أدوية الـImmunoglobulin-G اللي بيقوي مناقة
+
+172
+00:13:12,060 --> 00:13:17,200
+الجسم عشان يتحدى هذا الـDisease ومن أمثلتها برضه
+
+173
+00:13:17,200 --> 00:13:23,980
+الـMuscular Dystrophy والميتازينيا
+
+174
+00:13:23,980 --> 00:13:27,200
+الـGravies اللي هي تقريبا بتشتغل
+
+175
+00:13:35,480 --> 00:13:40,400
+وهو ممكن يؤثر على الـ Respiratory Muscles اللي في
+
+176
+00:13:40,400 --> 00:13:42,940
+كل manifestation كل الناس اللي هيكون عندهم
+
+177
+00:13:42,940 --> 00:13:46,500
+Respiratory Failure هيكون عندهم عدم قدرة على
+
+178
+00:13:46,500 --> 00:13:48,760
+التنفس بالشكل الصحيح لأنه Respiratory Failure
+
+179
+00:13:56,590 --> 00:14:02,030
+فبفضل إنه يبقى في موقع مقفل بين الـ nasal أو الـ
+
+180
+00:14:02,030 --> 00:14:06,250
+nostrils، الـ nostrils بتكون مفتوحة كتير لإنها
+
+181
+00:14:06,250 --> 00:14:09,970
+بحاول إنه يأخذ كمية هوا بقدر الإمكان، طبعا هذا
+
+182
+00:14:09,970 --> 00:14:13,590
+هيعمل حالة من الـ confusion state على الـ
+
+183
+00:14:13,590 --> 00:14:17,970
+neurological status تبعته، لإنه مافيش oxygen كافي
+
+184
+00:14:17,970 --> 00:14:23,140
+بوصل للبلاد، فبالتالي بيحس في drowsiness المريضمش
+
+185
+00:14:23,140 --> 00:14:26,720
+هيك، بيحس فيه «drowsiness»، sorry الـ
+
+186
+00:14:26,720 --> 00:14:32,920
+«cardiovascular system» هيكون فيه عنده، هيكون
+
+187
+00:14:32,920 --> 00:14:37,660
+فيه عنده جماعة «cyanosis» طبعا زي ما احنا عارفين
+
+188
+00:14:38,480 --> 00:14:42,340
+الـ Heart نفسه كمان ما بيوصلوش كمية كافية من الـ
+
+189
+00:14:42,340 --> 00:14:47,900
+Blood فبيصير اندو تاكيكارديا، بيصير ساينوسس، بيصير
+
+190
+00:14:47,900 --> 00:14:51,920
+ديفوريسس، ليش؟ لأنه مجهد، فديفوريسس بيصير بتعضفه،
+
+191
+00:14:51,920 --> 00:14:54,860
+ممكن يصير عنده chest pain because of decreased
+
+192
+00:14:54,860 --> 00:14:56,660
+cardiac perfusion
+
+193
+00:15:00,230 --> 00:15:04,050
+من الـ Diagnostic Evaluation المهم للمريض أنا شاكر
+
+194
+00:15:04,050 --> 00:15:07,130
+إنه هذا خش في الـ Respiratory Failure أول حاجة الـ
+
+195
+00:15:07,130 --> 00:15:11,800
+Sign و الـ Symptoms إن أنا ألاقي إن المريض هذاعنده
+
+196
+00:15:11,800 --> 00:15:17,280
+مشاكل واضحة في عملية التنفس «Difficulty getting
+
+197
+00:15:17,280 --> 00:15:21,420
+the kidney» «Hypoxia» الـ «Saturation» تبعه «Low»
+
+198
+00:15:21,420 --> 00:15:25,860
+الفيتال ساينس تبعته فيه «Tachycardia» واضح أنه
+
+199
+00:15:25,860 --> 00:15:29,140
+«hypoxic» «cyanosis» كما حكينا ده «diaphoresis»
+
+200
+00:15:29,140 --> 00:15:34,380
+يعني physically بكون واضح أنه عملية التنفس بتصير
+
+201
+00:15:34,380 --> 00:15:37,420
+بطريقة
+
+202
+00:15:37,420 --> 00:15:38,040
+غير سليمة
+
+203
+00:15:42,430 --> 00:15:47,070
+بريد per minute وممكن يكون hyperventilation يعني
+
+204
+00:15:47,070 --> 00:15:55,920
+تكيكارديا أكترمن تلاتين أو خمسة و تلاتين طبعاً أنت
+
+205
+00:15:55,920 --> 00:16:00,860
+تلاعن تلاتين أنه بيكون بدأ يخش في مرحلة الخطر لكن
+
+206
+00:16:00,860 --> 00:16:04,160
+علشان احنا ندعم الموقف نعرف أنه لسه في مرحلة
+
+207
+00:16:04,160 --> 00:16:08,520
+بتقاهله أنه يعمل compensation مش كل واحد بيصير
+
+208
+00:16:08,520 --> 00:16:11,520
+respirator ready يعني يا جماعة تلاتين بيكون بدأ
+
+209
+00:16:11,520 --> 00:16:13,740
+يخش في respirator failure لكن هذه من الحاجات اللي
+
+210
+00:16:13,740 --> 00:16:18,130
+بتخلينيأبدأ أعمل part of the investigation للمريض
+
+211
+00:16:18,130 --> 00:16:22,310
+تبعي زي إيه؟ زي الـBlood Gases، بدي أعمله ABG عشان
+
+212
+00:16:22,310 --> 00:16:27,170
+أشوف لوين وصلت الـAcidoses عنده، إيش مستويات تشبع
+
+213
+00:16:27,170 --> 00:16:32,950
+دمه بالـOxygen ومعدلها تانيبس دي الكربون في الدم،
+
+214
+00:16:32,950 --> 00:16:39,950
+إيش حالة الحمضية اللي هو بعيش فيها، وكذلك القاعدية
+
+215
+00:16:39,950 --> 00:16:44,360
+تبعت الدمالمفروض أن يكون الـPH عادى ومايكونش فيه
+
+216
+00:16:44,360 --> 00:16:48,040
+اندو ريسبيراتوري أسيوز ولا ألكالوزز لو وجدت
+
+217
+00:16:48,040 --> 00:16:52,780
+التنتين بيخشوا الـrespiratory failure يعني لو كان
+
+218
+00:16:52,780 --> 00:16:55,860
+عند مثلا مريض عنده DKA
+
+219
+00:17:04,620 --> 00:17:08,380
+الريسبيراتورية هيكون كتير مرتفعة لأن المريض بتحاول
+
+220
+00:17:08,380 --> 00:17:12,640
+تعمل الـ Washing وتعمل الـ Compensation وتصلح الـ
+
+221
+00:17:12,640 --> 00:17:15,020
+Metabolic Acidosis اللي عنده عن طريق الـ
+
+222
+00:17:15,020 --> 00:17:19,560
+Respiratory Alkalosis إذا الـ Respiratory
+
+223
+00:17:19,560 --> 00:17:22,770
+Alkalosis اللي موجود هنا عبارة عن إيش؟عبارة عن
+
+224
+00:17:22,770 --> 00:17:25,730
+compensation لكن في نهاية المرضات وفي الآخر ممكن
+
+225
+00:17:25,730 --> 00:17:29,750
+تدخل الـ Respiratory Failure Because of الاساس الـ
+
+226
+00:17:29,750 --> 00:17:33,330
+Metabolic Acidosis اللي عندها و ال compensation ال
+
+227
+00:17:33,330 --> 00:17:36,990
+Respiratory Alkalosis اللي عمل بيصير عشان يصلح
+
+228
+00:17:36,990 --> 00:17:40,870
+الوطن لكن في نهاية مابتقدرش ال lung انها تعمل full
+
+229
+00:17:40,870 --> 00:17:43,430
+compensation للحالة المرضية الموجودة فبتدخل ال
+
+230
+00:17:43,430 --> 00:17:49,050
+Respiratory Failureوحالة تانية ممكن يكون بالعكس،
+
+231
+00:17:49,050 --> 00:17:54,490
+المريض جاي بـhypoventilation، هدو تراما،
+
+232
+00:17:54,490 --> 00:17:57,950
+الـrespiratory rate بتقل، hypoventilation، الـCO2
+
+233
+00:17:57,950 --> 00:18:01,910
+بتراكم، ويبدأ المريض يدخل الـhypercapnia، يتكمل
+
+234
+00:18:01,910 --> 00:18:02,510
+الـblood gas
+
+235
+00:18:09,800 --> 00:18:14,180
+وأكتر من سبعين بوصل ماريسيو OBD هتلاقي الـ
+
+236
+00:18:14,180 --> 00:18:20,040
+«السيويتو» عنده أكتر من تسعين والـ pH يعني
+
+237
+00:18:20,040 --> 00:18:31,280
+severely low 7.2، 7.26، المهم أقل من 7.35 يعني أقل
+
+238
+00:18:31,280 --> 00:18:38,350
+من 7.35%طبعًا «Chess X-Ray» عمل مهم أنه ينعمل في
+
+239
+00:18:38,350 --> 00:18:43,770
+الحالات اللي شاكين أنه اندوريسبيراتوري فيلير هيكون
+
+240
+00:18:43,770 --> 00:18:48,390
+فيه واضح سيبير أو يعني «marked» بتسميه «fulmonary
+
+241
+00:18:48,390 --> 00:18:52,830
+infiltration» مهمين يكون فيه مناطق فيها أتيلاكتسز،
+
+242
+00:18:52,830 --> 00:18:55,370
+هذا بيكون كتير واضح في الـ
+
+243
+00:18:57,790 --> 00:19:02,030
+حالات الـPneumonia في حالات الـTP في حالات الـARDS
+
+244
+00:19:02,030 --> 00:19:04,550
+Acute Respiratory Distress Syndrome اللي هنحكي
+
+245
+00:19:04,550 --> 00:19:08,290
+عليه من كمان شوية إن شاء الله أعرف من العالمين
+
+246
+00:19:08,290 --> 00:19:11,710
+طبعاً الـManagement الجمعكات بدنا نصلح حال الناس
+
+247
+00:19:11,710 --> 00:19:15,190
+هدولة أكيد إنه بدأ أصلح إذا كان الـCO2 في
+
+248
+00:19:15,190 --> 00:19:19,610
+retention بدأ أنا أعمله Washing out أو أد Oxygen
+
+249
+00:19:20,670 --> 00:19:26,110
+فإذا كان يعني الـ underlying cause كان فيه
+
+250
+00:19:26,110 --> 00:19:29,510
+pneumonia هو اللي عامله السبب ده ند الـ antibiotic
+
+251
+00:19:29,510 --> 00:19:33,050
+ونعالج الـ pneumonia إذا كان فيه يا جماعة
+
+252
+00:19:33,050 --> 00:19:36,530
+secretions هي اللي عامله المشكلة بيكون أنا بدي
+
+253
+00:19:36,530 --> 00:19:42,310
+أعملبنعمل الـ Prankodilatation و أعمل الـ
+
+254
+00:19:42,310 --> 00:19:45,750
+Spectration لهذه الـ Secretion على طريق الـ
+
+255
+00:19:45,750 --> 00:19:50,350
+Spectrum أدناد مقشعات للبلغة، يمكنني أعمل الـ
+
+256
+00:19:50,350 --> 00:19:53,410
+Suction يمكنني أعمل الـ Prankoscope عشان أعمل الـ
+
+257
+00:19:53,410 --> 00:19:57,990
+Hygiene للـ Lung و للـ Trachea
+
+258
+00:20:00,480 --> 00:20:03,860
+عشان هيك الـ «underlying disease» كتير مهم إنهم
+
+259
+00:20:03,860 --> 00:20:08,260
+يكونوا عارفين إيش هو المرض ويمكن يكون المريض مثلا
+
+260
+00:20:08,260 --> 00:20:11,160
+السبب في الـ«respiratory failure» أنه عنده «severe
+
+261
+00:20:11,160 --> 00:20:15,720
+empyema» في الـ«plural» الـ«space» مليئة «thick
+
+262
+00:20:15,720 --> 00:20:21,400
+paths» مثلول «secretions» و«collections» طب وإيش
+
+263
+00:20:21,400 --> 00:20:24,300
+الحل؟ الحل اتركبله «chest drainage» آه إذا نبدو
+
+264
+00:20:24,300 --> 00:20:26,840
+الـ«chest» يعني under اللي هو الـ«chest tube»
+
+265
+00:20:26,840 --> 00:20:30,990
+«under water seal» الـ«chest tube»وبدّوا تمامًا من
+
+266
+00:20:30,990 --> 00:20:35,290
+الهيجينية للمنطقة
+
+267
+00:20:35,290 --> 00:20:38,110
+هذه الـ Empiric Area اللي في اللانجو بدّوا
+
+268
+00:20:38,110 --> 00:20:47,710
+يستخدموا عدد من الـ Antibiotics من أربعة
+
+269
+00:20:47,710 --> 00:20:48,670
+إلى ست أسابيع
+
+270
+00:21:08,520 --> 00:21:09,920
+‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏‏
+
+271
+00:21:12,390 --> 00:21:16,350
+في إنه فيه collection of fluid في الـ في الـ lung
+
+272
+00:21:16,350 --> 00:21:19,910
+زي البلمونة رقديمة والله إذا كانت كاردوجينية يكون
+
+273
+00:21:19,910 --> 00:21:22,830
+الحال في الـ diuretics من الناد اللي هو loop
+
+274
+00:21:22,830 --> 00:21:27,160
+diuretics زي الـ Lasixلكن إذا كانت الـ Non
+
+275
+00:21:27,160 --> 00:21:29,880
+-Carbogenic Pulmonary Edema بكون الحالة إننا بدنا
+
+276
+00:21:29,880 --> 00:21:33,940
+نعطي أو نعالج الـ underlying cause أو الـ
+
+277
+00:21:33,940 --> 00:21:37,100
+underlying disease اللي عامل الـ Non-Carbogenic
+
+278
+00:21:37,100 --> 00:21:40,020
+Pulmonary Edema هاي لربما يكون مثلا الـ Organ of
+
+279
+00:21:40,020 --> 00:21:42,760
+phosphorus poisoning فالـ Organ of phosphate
+
+280
+00:21:42,760 --> 00:21:45,800
+poisoning يكون بدنا ندّي Anti-cholinergic agent زي
+
+281
+00:21:45,800 --> 00:21:50,700
+الـ Atropine عشان يجلّل الكولين وبالتالي يبدأ يصير
+
+282
+00:21:50,700 --> 00:21:56,480
+فينا إمكانية لوقف الرشح تبقى السوائل فيهالـ Lungs
+
+283
+00:21:56,480 --> 00:22:01,000
+وكتير أحيانًا بيستخدموا الـ «ستيرويز» كعلاج سحري
+
+284
+00:22:01,000 --> 00:22:07,740
+Magic Treatments لحالات الـ Respiratory Failure
+
+285
+00:22:07,740 --> 00:22:09,580
+وزي ما بتشوف الـ «هيدرو كورتيزون»
+
+286
+00:22:09,580 --> 00:22:11,700
+«Corticosteroids» in general «هيدرو كورتيزون» و
+
+287
+00:22:11,700 --> 00:22:15,120
+«ستوليومدرول» من أوسع الأدوية اللي بيستخدموها في
+
+288
+00:22:15,120 --> 00:22:19,690
+علاج الـ Respiratoryفاليار وبنشوف كتير في حالات
+
+289
+00:22:19,690 --> 00:22:23,410
+الـ «أزماتيك بيشانس» و «CVD بيشانس» بيستخدموا هذه
+
+290
+00:22:23,410 --> 00:22:26,170
+الأدوية لإنها بالدرجة الأولى هي جماعة Anti
+
+291
+00:22:26,170 --> 00:22:29,270
+-inflammatory فهي لإنها Anti-inflammatory drugs
+
+292
+00:22:29,270 --> 00:22:33,150
+بتشتروا وAnti-allergic drugs فهي بتقل تعمل يعني
+
+293
+00:22:33,150 --> 00:22:43,030
+dilatation في الـ «برومكاس» ومسارك التنفسية in
+
+294
+00:22:43,030 --> 00:22:48,050
+general وطبعاًالـ Histamine Blockers يا جماعة سواء
+
+295
+00:22:48,050 --> 00:22:54,850
+الـ يعني الـ H1 Receptors Antigonist أو الـ H2
+
+296
+00:22:54,850 --> 00:22:58,810
+Receptors Antigonist اللي هي مركبات الـ Randine أو
+
+297
+00:22:58,810 --> 00:23:03,030
+مركبات الـ Anti-Histamine أوجات بتكون مفيدة في
+
+298
+00:23:03,030 --> 00:23:05,950
+حالات الـ Respiratory Failure لما يكون الـ Cause
+
+299
+00:23:05,950 --> 00:23:10,410
+تبعها له علاقة بالـ Allergic Reactions عشان تعمل
+
+300
+00:23:10,410 --> 00:23:13,980
+Histamineالـ Stop يعني الـ Histamine الـ Release
+
+301
+00:23:13,980 --> 00:23:17,580
+يصير له Stopping الـ Nursing Intervention اللي
+
+302
+00:23:17,580 --> 00:23:24,520
+احنا هنكون، يعني بنحتاج نعمل الحلقات هذه إنه منتين
+
+303
+00:23:24,520 --> 00:23:29,670
+بدرست المريض هذا لازم يعني يرتاح، مش معقولإنه يعرض
+
+304
+00:23:29,670 --> 00:23:33,850
+نفسه لإيجاد لأنه ما عندهوش كمية نافظة كافية من الـ
+
+305
+00:23:33,850 --> 00:23:37,910
+Oxygen دمه يتخليه يقوم بأي مجهود وبالتالي زيادة أي
+
+306
+00:23:37,910 --> 00:23:43,270
+مجهود هيكون لها أسباب، هيكون لها عواقب وخيمة لذلك
+
+307
+00:23:43,270 --> 00:23:48,550
+الـ bed rest is recommended ال patient دايما إذا
+
+308
+00:23:48,550 --> 00:23:49,490
+كان في مستشفى
+
+309
+00:23:53,160 --> 00:23:57,360
+فيه فاولار موزيشين بحيث نسمح للـ Lung Expansion
+
+310
+00:23:57,360 --> 00:24:05,720
+يكون أسهل وفيه مجال لـ Complete Lung Expansion
+
+311
+00:24:13,120 --> 00:24:16,500
+الـ Respiratory Status تبعت الـ Patients ومستويات
+
+312
+00:24:16,500 --> 00:24:19,000
+تانية في سجل الكربون والأكسجين في دمه لازم تكون
+
+313
+00:24:19,000 --> 00:24:22,060
+مراقبة بشكل مستمر عن طريق الـ Oxygen Saturation
+
+314
+00:24:22,060 --> 00:24:25,920
+وعن طريق الـ Blood Gas Analysis الفيرتر سايند تبعت
+
+315
+00:24:25,920 --> 00:24:31,570
+المريض بحد ذاتها مؤشر مهم جداًعشان تخلّيني أعرف
+
+316
+00:24:31,570 --> 00:24:36,470
+إيش وضع المريض زي ما حكينا الـ Tachycardia مؤشر
+
+317
+00:24:36,470 --> 00:24:41,190
+الـ Diaphoresis مؤشر التكيبنية وزيادة الـ
+
+318
+00:24:41,190 --> 00:24:44,830
+Respiratory Rate مؤشر الـ Saturation مؤشر فلذلك
+
+319
+00:24:44,830 --> 00:24:53,490
+مراقبتنا مهمة جداً وكمان عمل السكشن للمريض اللي
+
+320
+00:24:53,490 --> 00:25:00,270
+بحتاج سكشن في حالة المرضى الليالهم Indotracheal
+
+321
+00:25:00,270 --> 00:25:04,290
+tube أو الهم Tracheostomy وفي الأطفال ممكن يعمل
+
+322
+00:25:04,290 --> 00:25:08,930
+حتى suction عن طريق الـ Nose nasal suctioning
+
+323
+00:25:08,930 --> 00:25:12,950
+لدرجة إنه ممكن يكون by expert nurse أو expert
+
+324
+00:25:12,950 --> 00:25:17,750
+physician إنه يعمل suctioning للsecretions هذه عن
+
+325
+00:25:17,750 --> 00:25:22,470
+طريق nasal airway أو لغاية ما إنه يوصلأو الـ… الـ…
+
+326
+00:25:22,470 --> 00:25:27,850
+الـ… الـLarynx و… الـTrachea under precautions أو
+
+327
+00:25:27,850 --> 00:25:32,050
+ع طريق استخدام الـNasal Airway ويعمل Suction
+
+328
+00:25:32,050 --> 00:25:37,690
+للمريض Gental Suction طبعاً طبعاً الـCDC
+
+329
+00:25:37,690 --> 00:25:43,030
+والكيميسترى من مراقبتهم من الحاجات المهمة
+
+330
+00:25:52,250 --> 00:25:54,470
+في الـ CDC وعملها monitoring عشان أشوف الـ blood
+
+331
+00:25:54,470 --> 00:25:59,290
+cell إيش بيصير فيها بتحسن ولا لأ ال chemistry اللي
+
+332
+00:25:59,290 --> 00:26:01,870
+ربما أحياناً بيكون ال muscle weakness يا جماعة
+
+333
+00:26:01,870 --> 00:26:07,910
+because of severe hypokalemia الكاليان دوما اللي
+
+334
+00:26:07,910 --> 00:26:11,590
+هو الـ potassium لما بيزيد بقل كتير عن المعدلات
+
+335
+00:26:11,590 --> 00:26:14,830
+الطبيعية تبعته ممكن يؤدي إلى severe muscle
+
+336
+00:26:14,830 --> 00:26:18,070
+weakness وبالآخر هذا يؤدي إلى respiratory failure
+
+337
+00:26:19,350 --> 00:26:24,250
+عشان هيك ممكن جدًا يكون الـ Mechanical Ventilator
+
+338
+00:26:24,250 --> 00:26:30,070
+هو الحل المهم جدًا في حالات الـ Respiratory
+
+339
+00:26:30,070 --> 00:26:36,670
+Failure للناس اللي دخلت المشكلة هذه في الأيام
+
+340
+00:26:36,670 --> 00:26:43,350
+الحالية اللي نعيش بيها فيه يعني حاجة ملححة خلينا
+
+341
+00:26:43,350 --> 00:26:46,590
+نسميها وحاجة
+
+342
+00:26:51,560 --> 00:26:55,820
+زاكدة لأجهزة التنافس الصينية على مستوى العالم بسبب
+
+343
+00:26:55,820 --> 00:26:59,620
+متشار بيروز كورونا اللي بيخلي المرضى المصابين
+
+344
+00:26:59,620 --> 00:27:04,740
+يخشوا بـ Respiratory Failure سريع و Respiratory
+
+345
+00:27:04,740 --> 00:27:08,960
+Failure اللي بيعمل Alteration في الـ Lung Function
+
+346
+00:27:08,960 --> 00:27:12,220
+وبالتالي بيصير غير قادر على إنها تعمل Gas Exchange
+
+347
+00:27:12,220 --> 00:27:18,920
+وبالتالي بيصير المريض محتاج إنه يدعمبأجهزة تنافس
+
+348
+00:27:18,920 --> 00:27:25,460
+صناعي لبينما الرئة ترجع تستأيد قدرتها على الـ Gas
+
+349
+00:27:25,460 --> 00:27:29,900
+Exchange كما
+
+350
+00:27:29,900 --> 00:27:34,500
+في السابق لأن عدم قدرة الـ Lung علي إنها تعمل Gas
+
+351
+00:27:34,500 --> 00:27:38,380
+Exchange نتذكر دايماً الـ Mechanical Ventilator ما
+
+352
+00:27:38,380 --> 00:27:43,160
+بيعملش Gas Exchange ولا بيقوم مقام الـ Lung لكنإن
+
+353
+00:27:43,160 --> 00:27:48,720
+الـ Lung ما بتقدرش تعمل Gas Exchange فهذا هيؤدي
+
+354
+00:27:48,720 --> 00:27:52,480
+إلى استجابة الـ Respiratory Rate والـ Respiratory
+
+355
+00:27:52,480 --> 00:27:57,900
+System للجسم وممكن يزيد فهو بتبدأ يزيد معدلات
+
+356
+00:27:57,900 --> 00:28:02,560
+التنقص لدرجات عالية جدا تكمية لدرجة إن المريض يصير
+
+357
+00:28:02,560 --> 00:28:05,620
+غير قادر على الـ Compensation بس الأفضل بيكون احنا
+
+358
+00:28:05,620 --> 00:28:10,080
+مضطرينالنظم عملية التنفس عن طريق الـ Mechanical
+
+359
+00:28:10,080 --> 00:28:14,120
+Ventilation نقب أنواع ومداته المختلفة اللي شرحناها
+
+360
+00:28:14,120 --> 00:28:18,140
+المرة اللي فاتت بالمناسبة بالحالات هذه كتير بفضلوا
+
+361
+00:28:18,140 --> 00:28:21,100
+يستخدموا حاجة اسمها Jet Ventilation أو الـHigh
+
+362
+00:28:21,100 --> 00:28:24,780
+Frequency Ventilation يمكن هذا ما اتركناش كتير يلو
+
+363
+00:28:24,780 --> 00:28:27,300
+في محاضرة الـMechanical Ventilator لأنه نوع مش
+
+364
+00:28:27,300 --> 00:28:32,640
+كتيرمتوفر لكن الـ «High Frequency Ventilation» أو
+
+365
+00:28:32,640 --> 00:28:35,880
+«Jet Ventilation» بيسموه هذا الفكرة تبعته بكل
+
+366
+00:28:35,880 --> 00:28:38,980
+بساطة إنه يعطي «High Respiratory Rate» لأن المريض
+
+367
+00:28:38,980 --> 00:28:41,820
+هذا زي الـ «Acute Respiratory Distress Syndrome»
+
+368
+00:28:41,820 --> 00:28:45,100
+هنهتعمله إن شاء الله في الـ «ARDS» ما بيكونش فيه
+
+369
+00:28:45,100 --> 00:28:47,760
+عنده مساحة في الـ«Longitudinal Gas Density Change»
+
+370
+00:28:47,760 --> 00:28:51,880
+فبسيط التعامل معاه إنه نديله كميات قليلة جدا من
+
+371
+00:28:51,880 --> 00:28:56,750
+الهواء بـ«Respiratory Rate» عالي كتيروبالتالي
+
+372
+00:28:56,750 --> 00:29:01,170
+بيصير الـ Gas exchange على قدر كمية الجاز البسيطة
+
+373
+00:29:01,170 --> 00:29:05,010
+اللي بتدخل ولكن اللي بتدخل يعني لرقتين وبالتالي
+
+374
+00:29:05,010 --> 00:29:08,510
+احنا بننقذ المريض ونحافظ على الـ Acid Base Balance
+
+375
+00:29:08,510 --> 00:29:13,790
+تبعه من غير Respiratory Acid Doses الـ Acute
+
+376
+00:29:13,790 --> 00:29:17,530
+Respiratory Distress Syndrome اللي هو الـ ARDS
+
+377
+00:29:17,530 --> 00:29:21,370
+اللي هو إن شاء الله رب العالمين هيكون موضوعنا
+
+378
+00:29:23,420 --> 00:29:25,420
+القادم بإذن الله
+
diff --git a/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/XtOc7JHdloE_raw.json b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/XtOc7JHdloE_raw.json
new file mode 100644
index 0000000000000000000000000000000000000000..9fbb3f8c91a2af455743270319267a75f12fb070
--- /dev/null
+++ b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/XtOc7JHdloE_raw.json
@@ -0,0 +1 @@
+{"segments": [{"id": 1, "seek": 3057, "start": 1.13, "end": 30.57, "text": "بسم الله الرحمن الرحيم لازمنا في الـArterial Blood Gas Analysis المحاضرة المهمة شرحنا في المحاضرة السابقة التعريف وما هي الـAcidosis وما هي الـAlkalosis وإيش يعني pH وصلنا للـSlide هاي اللي بنحكي فيها عن أنواع الـDisturbance اللي بتصير في الـAcid Base Balance", "tokens": [3555, 38251, 21984, 34892, 5016, 27842, 34892, 5016, 32640, 5296, 31377, 2304, 8315, 8978, 2423, 39184, 10683, 391, 831, 17428, 24025, 38172, 9673, 5016, 46958, 25720, 9673, 16095, 3660, 13412, 2288, 5016, 8315, 8978, 9673, 5016, 46958, 25720, 21136, 16758, 28671, 16712, 3615, 16572, 5172, 4032, 15042, 39896, 2423, 39184, 43705, 7895, 271, 4032, 15042, 39896, 2423, 39184, 9171, 19990, 8211, 4032, 28814, 1829, 8592, 37495, 22653, 21677, 4032, 36520, 8315, 24976, 39184, 50, 31264, 8032, 47302, 13672, 1829, 44945, 5016, 4117, 1829, 8978, 11296, 18871, 14739, 14407, 3615, 2423, 39184, 35, 468, 16659, 719, 13672, 1829, 39894, 9381, 13546, 8978, 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"seek": 33957, "start": 311.85, "end": 339.57, "text": "الـ pH لأن الـ CO2 قل فالحمضية بتقل فالقاعدية بتزيد في الجسم الـ pH بتزيد وبالعكس لو الـ CO2 هذا زاد في الجسم كم بتزيد؟ بعكس العملية الأولى إيش هي العملية الأولى؟ إيه حكينا؟ تكمية آه يعني العملية التانية قصدت الدكتور أنه يكون Hypoventilation بالظبط يعني واحد بتنفس هنا", "tokens": [6027, 39184, 21677, 5296, 33456, 2423, 39184, 3002, 17, 12174, 1211, 6156, 6027, 35571, 11242, 10632, 39894, 4587, 1211, 6156, 6027, 4587, 995, 22488, 10632, 39894, 11622, 25708, 8978, 25724, 38251, 2423, 39184, 21677, 39894, 11622, 25708, 46599, 6027, 3615, 4117, 3794, 45164, 2423, 39184, 3002, 17, 23758, 30767, 18513, 8978, 25724, 38251, 9122, 2304, 39894, 11622, 25708, 22807, 45030, 4117, 3794, 18863, 42213, 10632, 16247, 12610, 7578, 11933, 1829, 8592, 39896, 18863, 42213, 10632, 16247, 12610, 7578, 22807, 11933, 1829, 3224, 11331, 4117, 1829, 8315, 22807, 6055, 24793, 10632, 19753, 3224, 37495, 22653, 18863, 42213, 10632, 16712, 7649, 10632, 12174, 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938.69, "end": 939.13, "word": " يؤدي", "probability": 0.8935546875}, {"start": 939.13, "end": 939.65, "word": " إلى", "probability": 0.826171875}, {"start": 939.65, "end": 940.61, "word": " زيادة", "probability": 0.9940185546875}, {"start": 940.61, "end": 940.77, "word": " الـ", "probability": 0.7470703125}, {"start": 940.77, "end": 941.29, "word": " Bicarb", "probability": 0.7836100260416666}, {"start": 941.29, "end": 941.59, "word": " عشان", "probability": 0.9158528645833334}, {"start": 941.59, "end": 941.91, "word": " يعمل", "probability": 0.9161783854166666}, {"start": 941.91, "end": 942.45, "word": " عملية", "probability": 0.9646809895833334}, {"start": 942.45, "end": 943.09, "word": " تعديل", "probability": 0.9391276041666666}, {"start": 943.09, "end": 943.21, "word": " الـ", "probability": 0.89501953125}, {"start": 943.21, "end": 943.61, "word": " Arterial", "probability": 0.8191731770833334}, {"start": 943.61, "end": 944.15, "word": " بلدها", "probability": 0.452178955078125}, {"start": 944.15, "end": 944.37, "word": " زي", "probability": 0.866943359375}, {"start": 944.37, "end": 944.51, "word": " ما", "probability": 0.96044921875}, {"start": 944.51, "end": 944.97, "word": " شوفناه", "probability": 0.66253662109375}, {"start": 944.97, "end": 945.51, "word": " وفهمنا", "probability": 0.8453369140625}, {"start": 945.51, "end": 945.91, "word": " إيش", "probability": 0.774658203125}, {"start": 945.91, "end": 946.33, "word": " الفرق", "probability": 0.9103190104166666}, {"start": 946.33, "end": 946.69, "word": " بينه", "probability": 0.85498046875}, {"start": 946.69, "end": 947.35, "word": " وبين", "probability": 0.83251953125}, {"start": 947.35, "end": 948.01, "word": " هذا", "probability": 0.90869140625}, {"start": 948.01, "end": 949.11, "word": " الآن", "probability": 0.5784912109375}, {"start": 949.11, "end": 950.01, "word": " بدنا", "probability": 0.8525390625}, {"start": 950.01, "end": 954.77, "word": " نشرحه", "probability": 0.8043212890625}, {"start": 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"probability": 0.8275146484375}, {"start": 982.08, "end": 982.28, "word": " وفي", "probability": 0.76171875}, {"start": 982.28, "end": 982.58, "word": " حاجة", "probability": 0.9747721354166666}, {"start": 982.58, "end": 982.76, "word": " تانية", "probability": 0.94140625}, {"start": 982.76, "end": 983.08, "word": " اسمها", "probability": 0.82958984375}, {"start": 983.08, "end": 983.78, "word": " Partial", "probability": 0.7578125}, {"start": 983.78, "end": 984.16, "word": " Pressure", "probability": 0.93994140625}, {"start": 984.16, "end": 984.42, "word": " تبع", "probability": 0.94970703125}, {"start": 984.42, "end": 984.6, "word": " الـ", "probability": 0.766357421875}, {"start": 984.6, "end": 985.08, "word": " Oxygen", "probability": 0.891357421875}, {"start": 985.08, "end": 985.86, "word": " أول", "probability": 0.804443359375}, {"start": 985.86, "end": 986.14, "word": " حاجة", "probability": 0.994140625}, {"start": 986.14, "end": 986.68, "word": " Partial", "probability": 0.822509765625}, {"start": 986.68, "end": 987.02, "word": " Pressure", "probability": 0.944091796875}, {"start": 987.02, "end": 987.26, "word": " تبع", "probability": 0.9759114583333334}, {"start": 987.26, "end": 987.42, "word": " الـ", "probability": 0.957275390625}, {"start": 987.42, "end": 987.92, "word": " Oxygen", "probability": 0.97265625}], "temperature": 1.0}, {"id": 43, "seek": 101731, "start": 988.13, "end": 1017.31, "text": "يعني من 80 ل 100 أو مرضى تكتب من 75 ل 100 كويس وهذا يختلف عن الـ Oxygen Saturation عن تشبع الدم بالأكسجين تمام؟ إذا في حد اسمها Oxygen Saturation وهذا زي ما شفته من 93 أو من 95 ل 100% لكن الـ Partial Pressure تبع الأكسجين يختلف هو من 80 ل 100 أو من 75 ل 100", "tokens": [40228, 22653, 9154, 4688, 5296, 2319, 34051, 3714, 43042, 7578, 6055, 4117, 2655, 3555, 9154, 9562, 5296, 2319, 9122, 45865, 3794, 37037, 15730, 7251, 46456, 46538, 18871, 2423, 39184, 16489, 8647, 5344, 8167, 18871, 6055, 8592, 3555, 3615, 32748, 2304, 20666, 10721, 4117, 3794, 7435, 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"probability": 0.5}, {"start": 1010.31, "end": 1010.55, "word": " الـ", "probability": 0.81787109375}, {"start": 1010.55, "end": 1011.29, "word": " Partial", "probability": 0.901611328125}, {"start": 1011.29, "end": 1011.67, "word": " Pressure", "probability": 0.880615234375}, {"start": 1011.67, "end": 1011.91, "word": " تبع", "probability": 0.7386881510416666}, {"start": 1011.91, "end": 1012.59, "word": " الأكسجين", "probability": 0.91201171875}, {"start": 1012.59, "end": 1013.69, "word": " يختلف", "probability": 0.9768880208333334}, {"start": 1013.69, "end": 1014.75, "word": " هو", "probability": 0.472900390625}, {"start": 1014.75, "end": 1015.07, "word": " من", "probability": 0.9853515625}, {"start": 1015.07, "end": 1015.51, "word": " 80", "probability": 0.98681640625}, {"start": 1015.51, "end": 1015.69, "word": " ل", "probability": 0.9814453125}, {"start": 1015.69, "end": 1015.93, "word": " 100", "probability": 0.83984375}, {"start": 1015.93, "end": 1016.11, "word": " أو", 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"word": " في", "probability": 0.587890625}, {"start": 2142.47, "end": 2142.97, "word": " ال", "probability": 0.5830078125}, {"start": 2142.97, "end": 2143.33, "word": " phosphate", "probability": 0.896484375}, {"start": 2143.33, "end": 2143.73, "word": " buffer", "probability": 0.974609375}, {"start": 2143.73, "end": 2143.91, "word": " و", "probability": 0.630859375}, {"start": 2143.91, "end": 2144.25, "word": " الحاجات", "probability": 0.9874674479166666}, {"start": 2144.25, "end": 2144.53, "word": " التانية", "probability": 0.73291015625}, {"start": 2144.53, "end": 2145.13, "word": " بس", "probability": 0.50543212890625}, {"start": 2145.13, "end": 2145.31, "word": " ال", "probability": 0.61328125}, {"start": 2145.31, "end": 2145.53, "word": " by", "probability": 0.310302734375}, {"start": 2145.53, "end": 2145.91, "word": "-card", "probability": 0.5233154296875}, {"start": 2145.91, "end": 2146.21, "word": " لأن", "probability": 0.69677734375}, {"start": 2146.21, "end": 2146.55, "word": " هو", "probability": 0.83154296875}, {"start": 2146.55, "end": 2147.55, "word": " ل80", "probability": 0.43017578125}, {"start": 2147.55, "end": 2147.89, "word": "%", "probability": 0.96533203125}, {"start": 2147.89, "end": 2148.47, "word": " تقريبا", "probability": 0.9642578125}, {"start": 2148.47, "end": 2148.71, "word": " من", "probability": 0.9345703125}, {"start": 2148.71, "end": 2148.95, "word": " ال", "probability": 0.5166015625}, {"start": 2148.95, "end": 2149.25, "word": " balance", "probability": 0.446533203125}, {"start": 2149.25, "end": 2149.97, "word": " بأملها", "probability": 0.77294921875}, {"start": 2149.97, "end": 2150.57, "word": " هاي", "probability": 0.5517578125}, {"start": 2150.57, "end": 2150.81, "word": " اللي", "probability": 0.990966796875}, {"start": 2150.81, "end": 2151.29, "word": " بدي", "probability": 0.770751953125}, {"start": 2151.29, "end": 2152.89, "word": " إياها", "probability": 0.857421875}, {"start": 2152.89, "end": 2153.35, "word": " 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"probability": 0.8350830078125}, {"start": 2155.58, "end": 2156.76, "word": " المقدمة", "probability": 0.9309895833333334}, {"start": 2156.76, "end": 2157.52, "word": " كاملة", "probability": 0.9435221354166666}, {"start": 2157.52, "end": 2158.14, "word": " تبعة", "probability": 0.52691650390625}, {"start": 2158.14, "end": 2158.22, "word": " الـ", "probability": 0.9345703125}, {"start": 2158.22, "end": 2158.48, "word": " Acid", "probability": 0.77587890625}, {"start": 2158.48, "end": 2158.72, "word": "-Base", "probability": 0.6495768229166666}, {"start": 2158.72, "end": 2159.12, "word": " Balance", "probability": 0.93017578125}, {"start": 2159.12, "end": 2159.94, "word": " وبدنا", "probability": 0.6544596354166666}, {"start": 2159.94, "end": 2160.5, "word": " نبدأ", "probability": 0.9228515625}, {"start": 2160.5, "end": 2161.24, "word": " نحكي", "probability": 0.9637451171875}, {"start": 2161.24, "end": 2161.8, "word": " في", "probability": 0.85302734375}, {"start": 2161.8, "end": 2162.24, "word": " اللي", "probability": 0.880859375}, {"start": 2162.24, "end": 2162.8, "word": " هو", "probability": 0.98876953125}, {"start": 2162.8, "end": 2165.02, "word": " الـ", "probability": 0.95556640625}, {"start": 2165.02, "end": 2165.48, "word": " Acid", "probability": 0.790771484375}, {"start": 2165.48, "end": 2166.34, "word": "-Base", "probability": 0.7183430989583334}, {"start": 2166.34, "end": 2168.12, "word": " Disturbance", "probability": 0.9347330729166666}, {"start": 2168.12, "end": 2168.82, "word": " الحالة", "probability": 0.9305013020833334}, {"start": 2168.82, "end": 2169.18, "word": " الأولى", "probability": 0.9921875}, {"start": 2169.18, "end": 2169.64, "word": " Metabolic", "probability": 0.489837646484375}, {"start": 2169.64, "end": 2170.72, "word": " Acidosis", "probability": 0.8746744791666666}, {"start": 2170.72, "end": 2171.36, "word": " في", "probability": 0.9091796875}, {"start": 2171.36, "end": 2172.76, "word": " المحاضرة", "probability": 0.9906005859375}, {"start": 2172.76, "end": 2173.54, "word": " القادمة", "probability": 0.9959309895833334}, {"start": 2173.54, "end": 2173.74, "word": " إن", "probability": 0.74072265625}, {"start": 2173.74, "end": 2173.92, "word": " شاء", "probability": 0.9833984375}, {"start": 2173.92, "end": 2174.2, "word": " الله", "probability": 0.95849609375}], "temperature": 1.0}], "language": "ar", "language_probability": 1.0, "duration": 2174.7809375, "duration_after_vad": 2128.8918749999953}
\ No newline at end of file
diff --git a/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/XtOc7JHdloE_raw.srt b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/XtOc7JHdloE_raw.srt
new file mode 100644
index 0000000000000000000000000000000000000000..b85935bf725a926cfd5f5a98ab8e88db5fccdec7
--- /dev/null
+++ b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/XtOc7JHdloE_raw.srt
@@ -0,0 +1,1788 @@
+1
+00:00:01,130 --> 00:00:07,370
+بسم الله الرحمن الرحيم لازمنا في الـArterial Blood
+
+2
+00:00:07,370 --> 00:00:12,430
+Gas Analysis المحاضرة المهمة شرحنا في المحاضرة
+
+3
+00:00:12,430 --> 00:00:16,930
+السابقة التعريف وما هي الـAcidosis وما هي
+
+4
+00:00:16,930 --> 00:00:23,550
+الـAlkalosis وإيش يعني pH وصلنا للـSlide هاي اللي
+
+5
+00:00:23,550 --> 00:00:28,390
+بنحكي فيها عن أنواع الـDisturbance اللي بتصير في
+
+6
+00:00:28,390 --> 00:00:33,680
+الـAcid Base Balanceبنحكي إنه ممكن يكون Metabolic،
+
+7
+00:00:33,680 --> 00:00:36,700
+إيش يعني Metabolic؟ هذا كل حاجة referring to
+
+8
+00:00:36,700 --> 00:00:41,280
+Metabolism، كل حاجة الخلل اللي صار في الـArterial
+
+9
+00:00:41,280 --> 00:00:47,220
+Blood Gases ناتج من خلل إلوداء وفي القيضة الغذائي،
+
+10
+00:00:47,220 --> 00:00:50,620
+في ال Metabolism، إيش يعني ال Metabolism؟النسبة
+
+11
+00:00:50,620 --> 00:00:56,360
+للجمهور الكيميائي اللي يحدث في الجسم عندما يتعلق
+
+12
+00:00:56,360 --> 00:01:03,540
+بالتحرك من المعادلات في الماء بعد الانهيار إذا إيش
+
+13
+00:01:03,540 --> 00:01:07,080
+يعني Metabolic؟ ببساطة كلمة Metabolic معناها
+
+14
+00:01:07,080 --> 00:01:12,640
+معناها التغيرات الكيميائية اللي بتحصل في المغذيات
+
+15
+00:01:12,640 --> 00:01:18,080
+أو في حركة المغذيات بعد اللي هو الهضم هذا ممكن إذا
+
+16
+00:01:18,080 --> 00:01:27,480
+أنا معقدمثلًا كميات كبيرة من الكحول حركة المغذيات
+
+17
+00:01:27,480 --> 00:01:36,540
+اللي فيها هيدخل لي كام رهيب من المراكبات
+
+18
+00:01:36,540 --> 00:01:41,000
+اللي موجودة فيها سواء سكريات أو وات إفا مفترض
+
+19
+00:01:41,000 --> 00:01:45,220
+الحاجات هذه هيدخل لي المراكبات اللي هو حمضية و
+
+20
+00:01:45,220 --> 00:01:49,600
+هتعمل حمضية في الدمتمام؟ لأن اتفاقنا أن الكحول
+
+21
+00:01:49,600 --> 00:01:56,300
+الوين حمضي للمبيعات تبعته تقريبا أربعة وكذلك أي
+
+22
+00:01:56,300 --> 00:02:00,160
+أنواع أكل تانية هتقول إنه أنا ماخد سموم ماخد واحد
+
+23
+00:02:00,160 --> 00:02:05,420
+ماخد دواء أو ماخد سمك رانب مسلم أو هو مثلا
+
+24
+00:02:05,420 --> 00:02:14,050
+accidentally ماخد كمية مندوة معينة وهي تتحرك الجسم
+
+25
+00:02:14,050 --> 00:02:18,650
+في جسمه وهيتم انتصاصه وهيبدأ يعمل toxicity وهذه
+
+26
+00:02:18,650 --> 00:02:25,550
+الـ toxicity هتحول الجسم لحمضي وبالتالي الـ acidبس
+
+27
+00:02:25,550 --> 00:02:28,870
+الـ imbalance هيصير في الـ disbalance يعني الـ
+
+28
+00:02:28,870 --> 00:02:32,990
+disturbance، تمام؟ إذا هذا الخلل اللي بيصير في
+
+29
+00:02:32,990 --> 00:02:36,490
+متابولك نتيجة اللي حكينا عنه اللي هو القيادة
+
+30
+00:02:36,490 --> 00:02:41,990
+للغذاء اللي بينتج عنه عمليات غذائية لهضم المجديات
+
+31
+00:02:41,990 --> 00:02:45,430
+اللي بياخدها resulting in a growth in order to
+
+32
+00:02:45,430 --> 00:02:48,590
+release of waste هذا هي الغيب انه بيعملك
+
+33
+00:02:49,170 --> 00:02:50,970
+بببببببببببببببببببببببببببببببببببببببب
+
+34
+00:03:09,460 --> 00:03:15,420
+وإذا كان الخلل أدى إلى الـAlkalosis في الجسم، يعني
+
+35
+00:03:15,420 --> 00:03:20,180
+فقص
+
+36
+00:03:20,180 --> 00:03:25,900
+7.45 بيصير اسمه Metabolic Alkalosis، تمام،
+
+37
+00:03:25,900 --> 00:03:29,340
+فهمناها، لكن إيش ال respiratory؟ ال respiratory
+
+38
+00:03:29,340 --> 00:03:33,400
+نفس الحاجةزي ما احنا حكينا عن الـ Metabolic عن الـ
+
+39
+00:03:33,400 --> 00:03:37,220
+Respiratory يعني لو صار خلل عمل الـ Respiratory
+
+40
+00:03:37,220 --> 00:03:40,920
+وأدى إلى الخلل هذا في الـ Respiratory إلى زيادة
+
+41
+00:03:40,920 --> 00:03:46,310
+حمضية الدم بيصير اسم الـ Respiratory أسيدوسيزوإذا
+
+42
+00:03:46,310 --> 00:03:51,630
+الخلل هذا فيه التنفس أدى إلى إنه تكون سيرة دم
+
+43
+00:03:51,630 --> 00:03:55,570
+قاعدة باسم اسبيراتوري الكلوزيد، يا أستاذ، احنا
+
+44
+00:03:55,570 --> 00:03:59,570
+فاهمين هذا، بس كيف بده يكون يعني أشر الاسبيراتوري؟
+
+45
+00:03:59,570 --> 00:04:03,230
+كيف مرة بيعمل الكلوزيد هو نفسه، وهو نفسه بيعمل
+
+46
+00:04:03,230 --> 00:04:10,510
+الـAcidosin؟ أي، هو هنا الموضوع متعلق في عدد مرات
+
+47
+00:04:10,860 --> 00:04:17,220
+التنفس يبقى الأضغط المسؤول في الكركمين الـ Lung طب
+
+48
+00:04:17,220 --> 00:04:21,480
+وعدد مرات التنفس أنا بفهمكوا يعنى، بكل بساطة، هذا
+
+49
+00:04:21,480 --> 00:04:27,700
+عدد مرات التنفس لو زادت، إيش بيصير؟ بيصير الواحد
+
+50
+00:04:27,700 --> 00:04:33,220
+يتنفسك، تا كيميافبصير في X-Biration كتير و X
+
+51
+00:04:33,220 --> 00:04:37,380
+-Biration كتير هذا هيخلّي دي حاجة بتسميها Washing
+
+52
+00:04:37,380 --> 00:04:44,840
+out للـCO2، إيش اسمها؟ Washing out للـCO2، إيش
+
+53
+00:04:44,840 --> 00:04:53,480
+يعني؟ يعني في فقدان للـCO2 وشطف للـCO2 من الجسم
+
+54
+00:04:53,480 --> 00:04:59,920
+وبالتالي هيقل الـCO2 من الجسموهذا النات بينتج عنه
+
+55
+00:04:59,920 --> 00:05:09,760
+ايش يا جماعة؟ بينتج عنه بكل بساطة اللي هو ارتفاع
+
+56
+00:05:09,760 --> 00:05:20,190
+فيالـ pH لأن الـ CO2 قل فالحمضية بتقل فالقاعدية
+
+57
+00:05:20,190 --> 00:05:25,730
+بتزيد في الجسم الـ pH بتزيد وبالعكس لو الـ CO2 هذا
+
+58
+00:05:25,730 --> 00:05:30,550
+زاد في الجسم كم بتزيد؟ بعكس العملية الأولى إيش هي
+
+59
+00:05:30,550 --> 00:05:34,530
+العملية الأولى؟ إيه حكينا؟ تكمية آه يعني العملية
+
+60
+00:05:34,530 --> 00:05:37,370
+التانية قصدت الدكتور أنه يكون Hypoventilation
+
+61
+00:05:37,370 --> 00:05:39,570
+بالظبط يعني واحد بتنفس هنا
+
+62
+00:05:43,460 --> 00:05:48,220
+وكل دقيقة هذا بياخد نفس بالظبط فبيؤدي إلى تراكم
+
+63
+00:05:48,220 --> 00:05:51,140
+تاني أكسيد الكربون في جسمه تراكم تاني أكسيد
+
+64
+00:05:51,140 --> 00:05:54,980
+الكربون في جسمه هذا إيش بيعمله؟ تراكم تاني أكسيد
+
+65
+00:05:54,980 --> 00:05:59,940
+الكربون في جسمه هذا بيعمله حالة من الحفظية لإن
+
+66
+00:05:59,940 --> 00:06:04,920
+الـCO2 بحد ذاته لما الـCO2 .. الـCO2 طب تصوروا إنه
+
+67
+00:06:04,920 --> 00:06:11,000
+اتحد مع الـHydrogen إيش هيعمل؟ هيعمل الـH2O3 هيبدأ
+
+68
+00:06:11,000 --> 00:06:16,010
+يعمل مركب الـHydrogenاللي هو الكربونيك HCO3
+
+69
+00:06:17,680 --> 00:06:24,720
+الحنض الكربو نيق تمام ولذلك الـ «CO2» في الجسم
+
+70
+00:06:24,720 --> 00:06:32,640
+مسئول عن الحنضية زيادته بتزوّد الحنضية وقلته بتقلل
+
+71
+00:06:32,640 --> 00:06:37,760
+الحنضية مسئولة عن الـ «CO2» وتنظيمه في الجسم عملية
+
+72
+00:06:37,760 --> 00:06:42,280
+التنفس ومسئولة عن الـ «Gas Exchange» في عملية
+
+73
+00:06:42,280 --> 00:06:47,260
+التنفس الـ «Land»هك المعلومات مركبة؟ أه مركبة
+
+74
+00:06:47,260 --> 00:06:50,320
+عرفنا إيش الـ Acidosis؟ أه عرفنا يا عم خلاص ما
+
+75
+00:06:50,320 --> 00:06:53,620
+أسحقتش راح أخبرناها كويس Acidosis أقل من سبعة وخمس
+
+76
+00:06:53,620 --> 00:06:59,000
+وثلاثين المسئول عنا في التثير اللي هو إذا كان
+
+77
+00:06:59,000 --> 00:07:03,240
+Respirator الـCO2 وإذا كان Metabolite؟ أه لسه
+
+78
+00:07:03,240 --> 00:07:09,410
+ماحكينا هذا طيب حسنا خلاصوالـ Alkalosis فاهمينها
+
+79
+00:07:09,410 --> 00:07:13,270
+أنها عبارة عن سبعة بعد خمسة وأربعين أكتر من هيك
+
+80
+00:07:13,270 --> 00:07:18,970
+بيكون الـ Alkalosis والمسؤول عنها في الدسم buffer
+
+81
+00:07:18,970 --> 00:07:24,010
+system أنت قلت من .. يعني حكيتنا منه أن اللي هو ال
+
+82
+00:07:24,010 --> 00:07:30,640
+kidneyوحكيتنا إنه ممكن يكون الـAlkalosis ميتابولك
+
+83
+00:07:30,640 --> 00:07:33,640
+أو الـ Respiratory لو كانت الـ Respiratory فاهمتنا
+
+84
+00:07:33,640 --> 00:07:42,080
+إنه لو كان فيه نقص فيه اللي هو الـventilation يعني
+
+85
+00:07:42,080 --> 00:07:48,960
+في الـCO2 عفوافي الـCO2 نقص يعني فيه CO2 25 مثلا
+
+86
+00:07:48,960 --> 00:07:54,940
+20 وهذا بيصير نتيجة التكيبنية نتيجة التكيبنية يعني
+
+87
+00:07:54,940 --> 00:07:58,300
+النفس السريع يعني بيصير في washing out للـCO2
+
+88
+00:07:58,300 --> 00:08:02,400
+فبجلس الـCO2 في الجسم فهذا بيعمل أنه قاعدية
+
+89
+00:08:02,400 --> 00:08:05,880
+وبيخلّي الـPH يزيد عن 47 و45 بس بالنسبة
+
+90
+00:08:05,880 --> 00:08:10,010
+للـmetabolite لسه ما حكيت انها طيب حاضرOkay، إذا
+
+91
+00:08:10,010 --> 00:08:13,910
+اتفقنا عاد، ووالله، لكنه هيك سنة كأنه شرحين
+
+92
+00:08:13,910 --> 00:08:18,770
+الـNormal Blood Gas لو اجينا احنا جيبنا احنا عيلة
+
+93
+00:08:18,770 --> 00:08:23,750
+دم لإنسان طويق مفتزن زي كوهيت، شاطر، مفطر، ومصحص،
+
+94
+00:08:23,750 --> 00:08:27,730
+و تمام تمام، وروحنا جيبنا له Artillery Blood
+
+95
+00:08:27,730 --> 00:08:32,190
+Sample وروحنا عملنا له الـBH، هنلاقيه بين الـ37 و7
+
+96
+00:08:32,190 --> 00:08:39,230
+.45، 7.35 و7.45لو شوفنا الـCO2 في الدم هذا، هلاقيه
+
+97
+00:08:39,230 --> 00:08:44,510
+بين الخمسة وتلاتين والخمسة واربعين مليمتر زي بقى،
+
+98
+00:08:44,510 --> 00:08:47,710
+لو طلعنا على الـoxygen saturation تبعه، الادارة
+
+99
+00:08:47,710 --> 00:08:51,690
+اللي زيكه هيكون أكيد فوق الخمسة وتسعين لمية في
+
+100
+00:08:51,690 --> 00:08:57,420
+المية كمان، تمام؟ لأن الـlung نظيفةالـ Base Excess
+
+101
+00:08:57,420 --> 00:09:00,060
+تبقى .. تبقى مش يعني Base Excess يعني مش هال ..
+
+102
+00:09:00,060 --> 00:09:03,520
+نفهم عشان نفهم إيش الـ Base Excess أو الـ Deficit
+
+103
+00:09:03,520 --> 00:09:07,600
+نفهم إيش ال By Car لكن ال By Car هنا هذه العلامة
+
+104
+00:09:07,600 --> 00:09:11,820
+تبقى في الـ By Car هي العلامة اللي بدت تحكيلي عن
+
+105
+00:09:11,820 --> 00:09:14,860
+عن
+
+106
+00:09:14,860 --> 00:09:22,240
+قاعدية الدم، قدش الدم عندهالقاعدية لأن هما في الـ
+
+107
+00:09:22,240 --> 00:09:28,220
+Bicarb هذه مقصود فيها المركبات الـ Bicarbonate
+
+108
+00:09:28,220 --> 00:09:35,100
+اللي بترتبط طبعا في الصوديوم في الدم في .. مال في
+
+109
+00:09:35,100 --> 00:09:39,740
+الصوديوم علشان إيش تسوي؟ علشان تحاول تخلق جو من
+
+110
+00:09:39,740 --> 00:09:43,500
+القاعدية عشان تحافظ على الbalance عشان تحافظ على
+
+111
+00:09:43,500 --> 00:09:49,260
+الbalanceبدأنا نفهمها يا دكتور، أصلا قلتلها إن الـ
+
+112
+00:09:49,260 --> 00:09:53,680
+Partial Pressure تبع الـ CO2 اللي بين الـ 35 والـ
+
+113
+00:09:53,680 --> 00:10:02,260
+45، هذه مسئولة عن الحنضية، لو زادت عن 45، بتعمل
+
+114
+00:10:02,260 --> 00:10:09,390
+قاعديةلو زادت الـ CO2 عفوا لو زادت الـ CO2 عن 45
+
+115
+00:10:09,390 --> 00:10:14,570
+مسئول عن الحرضية فلو زادت عن 45 بيصير فيه الدم
+
+116
+00:10:14,570 --> 00:10:21,570
+حامض لو قلت عن 35 لأن الـ CO2 مسئول عن الحرضية لو
+
+117
+00:10:21,570 --> 00:10:27,090
+قلت عن 35 بيصير الدم قاعدي وهذه القصة مرتبطة بالـ
+
+118
+00:10:27,090 --> 00:10:32,550
+Lung يعني مرتبطة بعملية التنقص وبالتالي مرتبطة
+
+119
+00:10:32,550 --> 00:10:38,340
+بالـ Lungأه فهمنا هذه الجزئية كويسة فهمنا الـBH
+
+120
+00:10:38,340 --> 00:10:41,840
+وطب إيش تداعيات الـBH؟ تداعيات الـBH فاهمين، هذا
+
+121
+00:10:41,840 --> 00:10:47,720
+العكس، كيف يعني؟ يعني لو زاد الـCO2 عن 45 بيعمل
+
+122
+00:10:47,720 --> 00:10:54,240
+حمض يو الـBH بتروح بالقلق، آه لكن لو الـCO2 جل عن
+
+123
+00:10:54,240 --> 00:10:59,800
+35، إيش بيصير؟ الـBH بتروح بالزيد، أكتر من 7.5،
+
+124
+00:10:59,800 --> 00:11:07,790
+تمام؟لكن الـ Sodium هنا بيمثل القلوي Sodium في
+
+125
+00:11:07,790 --> 00:11:17,330
+الدم لـ 3 بايكار في الجسم وفي الدم بيمثل قدرة
+
+126
+00:11:17,330 --> 00:11:20,890
+الجسم على المحافظة على القلوي يعني بيمثل عنصر
+
+127
+00:11:20,890 --> 00:11:26,360
+القلوي في الدمولمّا هدف المجتمع ينصر بالقلوب لأن
+
+128
+00:11:26,360 --> 00:11:31,240
+هو قادر على إنه يرتبط في أي في سوديو، في كلور،
+
+129
+00:11:31,240 --> 00:11:35,480
+إيش، في أي رتبط، هيعمل مُركّب قلوب على هيئته هو
+
+130
+00:11:35,480 --> 00:11:40,780
+HCO3 اللي طبق بالسوديو وبيعمل HCO3 وبيصير هذا اسمه
+
+131
+00:11:40,780 --> 00:11:43,420
+Carbonate of Sodium Carbonate of Sodium اللي هي زي
+
+132
+00:11:43,420 --> 00:11:47,540
+الـBicarbonate of Sodium في البلاد، مُركّب قلوب،
+
+133
+00:11:47,540 --> 00:11:51,420
+تمام الـNormal تبعها في الجسم، لو وجدت جسم هذا
+
+134
+00:11:54,060 --> 00:12:01,720
+بيكارد حلاقيه من الـ 22 إلى الـ 26 ملي كوبلاند
+
+135
+00:12:01,720 --> 00:12:09,380
+لكلتر تمام؟ تمام الـ base excess او الـ deficit لو
+
+136
+00:12:09,380 --> 00:12:15,880
+انا لاقيت هذا مثلا مثلا 28 يا جماعة انا جيت طبيعي
+
+137
+00:12:15,880 --> 00:12:19,920
+اخي استواهات البيكارد عنده 28 ايش بيكون عنده؟
+
+138
+00:12:19,920 --> 00:12:23,280
+بيكون عنده base excess يادة في القاعدية بمقدار 2
+
+139
+00:12:24,450 --> 00:12:28,590
+هذا معنى الـ Base Excess طب لو رأيته 20 فقط بيكون
+
+140
+00:12:28,590 --> 00:12:33,930
+عنده Base Deficit بمقدار 2 لو رأيته 20، إذا من الـ
+
+141
+00:12:33,930 --> 00:12:37,850
+Normal من 22 إلى 26 الـ Base Excess أو الـ Deficit
+
+142
+00:12:37,850 --> 00:12:43,030
+هو الدفس يزيد أو ينقص الـ Bi-Carb والطبيعي أنه
+
+143
+00:12:43,030 --> 00:12:48,310
+يزيد أو ينقص 2، وهذا يُعتبر طبيعي 8 ألف ميلاد، هذا
+
+144
+00:12:48,310 --> 00:12:52,530
+الـ Normal تبع الـ R3بس هذا الـ Normal تبقى الذنب،
+
+145
+00:12:52,530 --> 00:12:56,970
+لاحظوا أن الذنب أصلا دم غير مؤكسج، إيش يعني؟ مين
+
+146
+00:12:56,970 --> 00:13:01,910
+شاطر تحكي؟ طب مين شاطر يحكي؟ دم غير مؤكسج؟ آه، دم
+
+147
+00:13:01,910 --> 00:13:05,130
+غير مؤكسج يعني الـCO2 مش بيكون فيه أغالي، أعلى من
+
+148
+00:13:05,130 --> 00:13:09,930
+الـArterial، Bravo عليك طب زيادة الـCO2، الـCO2
+
+149
+00:13:09,930 --> 00:13:14,530
+مسئولة عن إيش؟ عن الحمضية، أيوة، يعني زيادة ماش
+
+150
+00:13:14,530 --> 00:13:16,690
+بتسوي في الـDH؟ بتقللها
+
+151
+00:13:19,500 --> 00:13:24,660
+أكيد الجيل وفعلا عشانك بالله الـ Normal pH أقل من
+
+152
+00:13:24,660 --> 00:13:28,320
+سبعة وخمسة وثلاثين ال lower limit و ال upper limit
+
+153
+00:13:28,320 --> 00:13:30,900
+برضه أقل من سبعة وخمسة وارمين سبعة وواحدة وارمين
+
+154
+00:13:30,900 --> 00:13:36,900
+وعشان هي اللي دي جواهبة فيه طب أستاذ هاي الشيء
+
+155
+00:13:36,900 --> 00:13:40,940
+اسمه الـCO2 انت بتقول انه المفروض يكون عالي طبيعي
+
+156
+00:13:40,940 --> 00:13:42,040
+وخمسة وثلاثين
+
+157
+00:13:45,440 --> 00:13:48,600
+لخمسة واربعين حتى هنا كتبت لخمسة و تلاتين لاربعين
+
+158
+00:13:48,600 --> 00:13:55,740
+ايه ايش ال .. ايش المشكلة؟ اه نأكله صحيح ان هو هيك
+
+159
+00:13:55,740 --> 00:14:02,440
+ولكن هو دائما الـCO2 هنا في الدم هيكون اعلى شوية
+
+160
+00:14:02,440 --> 00:14:06,900
+والاكسجين هيكون اشماله اقل شوية وهنا دائما طالع
+
+161
+00:14:06,900 --> 00:14:10,700
+الاكسجين هنا مختلف عن الاكسجين هنابينما الـ Oxygen
+
+162
+00:14:10,700 --> 00:14:16,180
+هاد وكلمة الشحال الـ CO2 ربنا شكله طبيعي بس
+
+163
+00:14:16,180 --> 00:14:20,680
+بالمقارنة بالـ Oxygen لأ الوضع يختلف فبالتالي
+
+164
+00:14:20,680 --> 00:14:25,480
+بيطلع هنا تركيز تاني أكسيد الكربون شماله أعلى كتير
+
+165
+00:14:25,480 --> 00:14:31,700
+من هنا لإن هذا موجودين 35 ملي متر ذئبق في وجود 65%
+
+166
+00:14:31,700 --> 00:14:37,720
+أكسجين لكن هدول موجودين في وجود 98% أو 95% أو 100%
+
+167
+00:14:37,720 --> 00:14:42,880
+أكسجينفبيطلع فعلًا هنا التركيز تبع الـ CO2 أعلى
+
+168
+00:14:42,880 --> 00:14:47,600
+لأن التركيز اللوكتجيني أقل وبالتالي الـ Bicarb
+
+169
+00:14:49,420 --> 00:14:55,240
+بيضطر يكون أعلى عشان يحسن وضع الحمضية المتلازمة
+
+170
+00:14:55,240 --> 00:14:59,560
+اللي هي موجودة معاه في الدم الوريدي فبتلاقي دايما
+
+171
+00:14:59,560 --> 00:15:04,180
+الـBicarb عالي أكتر من الـArteria اللي بوسع 128 و
+
+172
+00:15:04,180 --> 00:15:07,220
+الـBest Excess تبعه عشان يصلح حاله بتلاقي plus
+
+173
+00:15:07,220 --> 00:15:12,180
+minus 4 عشان يبقى أقتر، ليش؟ عشان يظلوا بحافظ حاله
+
+174
+00:15:12,180 --> 00:15:16,260
+على أنه إيش يظلواما بين هذه القيم وما تزددش
+
+175
+00:15:16,260 --> 00:15:19,580
+الحمضية فيه عن هيث لإنه لو نزل عن سبعة و تلاتة و
+
+176
+00:15:19,580 --> 00:15:23,660
+تلاتين بيصير حمض و بيصير مشكلة، لذا الـVenus Blood
+
+177
+00:15:23,660 --> 00:15:28,340
+في شكله يعني in general هو الـ pH تبعته أقل شوية
+
+178
+00:15:28,340 --> 00:15:33,590
+من الارتريال لإن حمض أكترعالق اللي هو الـ Arterial
+
+179
+00:15:33,590 --> 00:15:37,730
+بسبب زيادة تنمية الكربون والخطار مستوى الـ Oxygen
+
+180
+00:15:37,730 --> 00:15:42,450
+D وهذا يؤدي إلى زيادة الـ Bicarb عشان يعمل عملية
+
+181
+00:15:42,450 --> 00:15:45,910
+تعديل الـ Arterial بلدها زي ما شوفناه وفهمنا إيش
+
+182
+00:15:45,910 --> 00:15:54,770
+الفرق بينه وبين هذا الآن بدنا نشرحه
+
+183
+00:15:54,770 --> 00:15:59,270
+طيب
+
+184
+00:16:02,600 --> 00:16:08,700
+عرفنا أيش التفسير هذه الرموز
+
+185
+00:16:08,700 --> 00:16:15,260
+بـ HbCO2 وحكينا عن الـ BacO2 الـ Partial Pressure
+
+186
+00:16:15,260 --> 00:16:21,040
+تبع الـ CO2 مابيش يعني Partial Pressure؟ بيش
+
+187
+00:16:21,040 --> 00:16:24,420
+معناها؟ وفي حاجة تانية اسمها Partial Pressure تبع
+
+188
+00:16:24,420 --> 00:16:27,420
+الـ Oxygen أول حاجة Partial Pressure تبع الـ
+
+189
+00:16:27,420 --> 00:16:32,370
+Oxygenيعني من 80 ل 100 أو مرضى تكتب من 75 ل 100
+
+190
+00:16:32,370 --> 00:16:38,110
+كويس وهذا يختلف عن الـ Oxygen Saturation عن تشبع
+
+191
+00:16:38,110 --> 00:16:43,190
+الدم بالأكسجين تمام؟ إذا في حد اسمها Oxygen
+
+192
+00:16:43,190 --> 00:16:49,710
+Saturation وهذا زي ما شفته من 93 أو من 95 ل 100%
+
+193
+00:16:49,710 --> 00:16:55,070
+لكن الـ Partial Pressure تبع الأكسجين يختلف هو من
+
+194
+00:16:55,070 --> 00:16:59,980
+80 ل 100 أو من 75 ل 100لكن الـ Partial Pressure
+
+195
+00:16:59,980 --> 00:17:03,100
+تبع الـ CO2 من 35 إلى 45 زي ما شوفنا قبل شوية
+
+196
+00:17:03,100 --> 00:17:05,600
+هدولة حكينا إيش معناه وحكينا إيش معناه الـ
+
+197
+00:17:05,600 --> 00:17:08,380
+Saturation طب بس إيش معنى بظهر كلمة Partial
+
+198
+00:17:08,380 --> 00:17:12,440
+Pressure الـ Partial Pressure قالك هذا هو عبارة عن
+
+199
+00:17:12,440 --> 00:17:16,900
+الـ amount of pressure a particular gas
+
+200
+00:17:16,900 --> 00:17:21,540
+contributed a total pressure يعني الكمية تبع جزء
+
+201
+00:17:21,540 --> 00:17:26,770
+معين من الغاز اللي ملطط بيهكمية الهواء الكبيرة
+
+202
+00:17:26,770 --> 00:17:30,050
+الأصلية إيش يعني؟ يعني إحنا مثلا بتنفس هواء من
+
+203
+00:17:30,050 --> 00:17:35,670
+الهواء الجوي تمام؟ هواء من الهواء الجوي ال ..
+
+204
+00:17:35,670 --> 00:17:38,850
+الهواء الجوي ال pressure تبعه إيش معنوه؟ مية في
+
+205
+00:17:38,850 --> 00:17:43,390
+المية كمية أخدت أنا كبشة هواء ال pressure تبعها
+
+206
+00:17:43,390 --> 00:17:48,790
+مية في المية عادلة أديش منها بيعمل pressure خاف بس
+
+207
+00:17:48,790 --> 00:17:52,830
+من ال oxygen أديش pressure بيعملوا بس ال oxygen من
+
+208
+00:17:52,830 --> 00:17:58,440
+هدول المية في المية هواءأيوة بدأنا نفسوقفها الـ
+
+209
+00:17:58,440 --> 00:18:04,100
+Oxygen هيعمل .. يبثقله، يبوزله بما يمثله في الـ
+
+210
+00:18:04,100 --> 00:18:07,960
+100% الهواء اللي أخدته من هذوله أنا بما يمثله و
+
+211
+00:18:07,960 --> 00:18:13,760
+هيعمل ضغط، هو إزاي بيمثل؟ هو بيمثل 21% من كمية
+
+212
+00:18:13,760 --> 00:18:17,760
+الهواء اللي أنا أخدتها لأن فزت يعني مسبوط الـ
+
+213
+00:18:17,760 --> 00:18:22,110
+Oxygen في الهواء الجوي 21%أها إذا الـ Partial
+
+214
+00:18:22,110 --> 00:18:27,050
+Pressure تبعه يعني الجزء
+
+215
+00:18:27,050 --> 00:18:32,810
+تبعه هيعمل 21% Pressure أيوة فهمناها إذا الـ
+
+216
+00:18:32,810 --> 00:18:38,790
+Partial Pressure تبع أي غاز هو كم شكل هذا الغاز من
+
+217
+00:18:38,790 --> 00:18:44,510
+كمية من كمية الغاز الكبيرة اللي أنا أخدتها أول
+
+218
+00:18:44,510 --> 00:18:50,590
+كمية بتسميها الـ Total يعنيالكمية الغاز النهائية
+
+219
+00:18:50,590 --> 00:18:55,290
+أو حجم الغاز النهائي اللي أنا أخدته أو أنا بحكي
+
+220
+00:18:55,290 --> 00:18:58,950
+عنه، تمام؟ عشان اذا نسمي الـPCO2 اللي هو
+
+221
+00:18:58,950 --> 00:19:01,910
+الـpartial، partial للأكسجين والـPCO2 الـpartial،
+
+222
+00:19:01,910 --> 00:19:06,750
+partial للالكربون، الـdioxide في الارترال بلدي
+
+223
+00:19:06,750 --> 00:19:10,790
+يعني الـbest excess والـbest deficit حكيتلكم عنهم
+
+224
+00:19:10,790 --> 00:19:14,270
+وحكينا كيف بيكون P excess أو كيف بيكون فيه
+
+225
+00:19:14,270 --> 00:19:19,740
+deficit، تمام؟وبنحكي الآن على أهمية الـ Acid-Base
+
+226
+00:19:19,740 --> 00:19:23,080
+Balance أي لهد، عارفينها؟ إذا تشتي بالها، أنت
+
+227
+00:19:23,080 --> 00:19:29,880
+قلتلنا إنه الـ Acid-Base Balance إذا صار أي خربطة
+
+228
+00:19:29,880 --> 00:19:32,480
+فيه، بتخرب الـ Hemostasis إيش يعني الـ Hemostasis؟
+
+229
+00:19:32,480 --> 00:19:38,320
+يعني الحالة اللي بتعمل سبات في الأعضاء و .. إيش؟
+
+230
+00:19:38,320 --> 00:19:41,900
+اللي هو في الـBlood وبالتالي في أعمق خلايا الدسم،
+
+231
+00:19:41,900 --> 00:19:44,580
+أعضاء الدسم في أنصةالجسم هو بالتالي في الخلايا
+
+232
+00:19:44,580 --> 00:19:49,820
+طبعا ننزل من العضو لنسيج لخلية طب و لو صار فيش
+
+233
+00:19:49,820 --> 00:19:53,340
+stable إيش بيصير؟ بيخرب الـ Metabolism كيف يعني
+
+234
+00:19:53,340 --> 00:19:56,200
+بيخرب الـ Metabolism؟ يعني الأيض الغذائي بيخرب
+
+235
+00:19:56,200 --> 00:19:59,280
+يعني خلية صارت فيها الحمضية عالية جدا ال
+
+236
+00:19:59,280 --> 00:20:02,140
+mitochondria اللي فيها بضرب طب و إيش مسؤول ال
+
+237
+00:20:02,140 --> 00:20:04,780
+mitochondria عن إيه؟ ال mitochondria مسؤول عن ال
+
+238
+00:20:04,780 --> 00:20:09,560
+energy آه بالضخمة بيبطل يصير الخلية تعمل energy
+
+239
+00:20:09,560 --> 00:20:14,630
+بيبطل الخلية تعملحرق لـ Nutrients اللي بتجيها
+
+240
+00:20:14,630 --> 00:20:18,610
+وبالتالي بطل انت يصير فيه انضغطاقة تعمل حاجة و ال
+
+241
+00:20:18,610 --> 00:20:22,150
+organ النسيج بيقرق و ال organ بحد ذاته يصير فيه
+
+242
+00:20:22,150 --> 00:20:25,770
+failure إذا كان Cardiac يصير Cardiac failure وإذا
+
+243
+00:20:25,770 --> 00:20:32,730
+كان Brain يصير فيه اللي هو cerebrovascular failure
+
+244
+00:20:32,730 --> 00:20:38,230
+أو خلينا نسميها اللي هويعني مثلًا الـ Cerebral
+
+245
+00:20:38,230 --> 00:20:41,930
+Vascular Accident اللي هو CDA أو Neurogenic Shock
+
+246
+00:20:41,930 --> 00:20:46,790
+أو whatever تمام؟ إذن الـ Metabolism هيصير فيه
+
+247
+00:20:46,790 --> 00:20:51,330
+Disturbance وهيتوقف ونتيجة إنه يصير تهتق للـ
+
+248
+00:20:51,330 --> 00:20:57,290
+Enzymes تبعته الـ pH بتأثر على البروتينات اللي هي
+
+249
+00:20:58,520 --> 00:21:03,720
+مسؤولة عن العمليات تبعت الإنقسامات في الخلية
+
+250
+00:21:03,720 --> 00:21:08,540
+وبالتالي وعمليات الغذائي برضه وإنتاج الطاقة
+
+251
+00:21:08,540 --> 00:21:12,340
+وبالتالي فيه سأتهتف على مستوى الـ Metabolism هذا
+
+252
+00:21:12,340 --> 00:21:18,500
+يؤدي إلى الوفاة إذا ما استعالجش حيظل يحصل فيه
+
+253
+00:21:18,500 --> 00:21:23,720
+dysfunction في ال organs هاي وفي الخلايا هاي مما
+
+254
+00:21:23,720 --> 00:21:25,300
+يؤدي بالآخر لأنه
+
+255
+00:21:27,700 --> 00:21:32,320
+إذا الـVH بلت تسوق مثلا الـAcidity أو
+
+256
+00:21:32,320 --> 00:21:37,620
+الـAlkalinity ووصلت لمستويات متدنية جدا تحت السبعة
+
+257
+00:21:37,620 --> 00:21:42,260
+وخمسة وثلاثين مثلا وصلت ساعة ستة point تمانية خلاص
+
+258
+00:21:42,260 --> 00:21:49,240
+تمط الـVGC تموت وكذلك لو كانت اللي هو في عندي
+
+259
+00:21:49,240 --> 00:21:52,820
+الـAlkalinityفي الـ slide ده اللي فرجتكوا إياها
+
+260
+00:21:52,820 --> 00:21:58,900
+هنا وصلت لمعدلات عالية فوق الـ 7.8 مثلا أو فوق
+
+261
+00:21:58,900 --> 00:22:04,060
+اللي هو الـ 8 مستحيل تسيل في إيش حيا بعد الـ 8 هنا
+
+262
+00:22:04,060 --> 00:22:08,500
+خلاص و كذلك هنا تحت الـ 6.8 مستحيل يكون في إيش حيا
+
+263
+00:22:08,500 --> 00:22:14,520
+تمام؟ تمامالآن الـ Buffer System مين الطب اللي
+
+264
+00:22:14,520 --> 00:22:18,320
+بيخلّي الجسم يظل ببالنس؟ حكينا بالأول بشكل بسيط
+
+265
+00:22:18,320 --> 00:22:22,160
+أنه جسمها الـ Buffer System وحكيتنا المكونات
+
+266
+00:22:22,160 --> 00:22:25,000
+الأساسية في الـ Buffer System الكتني والـ Lung
+
+267
+00:22:25,000 --> 00:22:28,640
+واحنا بنحكي والله أه شوفنا أيش دور الـ Lung أنه
+
+268
+00:22:28,640 --> 00:22:32,740
+ممكن تكون بتزود عدد مرات التنفس أو عندها القدرة
+
+269
+00:22:32,740 --> 00:22:38,370
+أنه يصيب في تكيبنية وبتستجيب معاك فبالتاليهتعمل ان
+
+270
+00:22:38,370 --> 00:22:42,750
+الـ Washing out للـ CO2 هتعمل ان الـ Alkalinity
+
+271
+00:22:42,750 --> 00:22:48,870
+ولو غللت عدد مرات التنفس لانخربانه زلمة COPD زلمة
+
+272
+00:22:48,870 --> 00:22:51,650
+Gosselin زلمة مش لازم يتنفس عنده الاصبارات و
+
+273
+00:22:51,650 --> 00:22:57,190
+الفياليا حيصير فيه عنده اللي هو Bradbury يعني قلة
+
+274
+00:22:57,190 --> 00:23:01,970
+في عدد مرات التنفس وبالتالي حيصير فيه عنده اللي هو
+
+275
+00:23:07,470 --> 00:23:10,750
+للغزات لتنكسف الكربون في جسمه وبالتالي هيصير عنده
+
+276
+00:23:10,750 --> 00:23:15,070
+حمضية اه طب و بالنسبة ل .. هذا لل ال lung طب و
+
+277
+00:23:15,070 --> 00:23:18,250
+بالنسبة ل ال kidney ايش بيصير؟ اه في واحد ذكي
+
+278
+00:23:18,250 --> 00:23:20,990
+بيقول لأ مانت برضه دور ال kidney احنا فهناش دور ال
+
+279
+00:23:20,990 --> 00:23:25,040
+kidneyانت بتحكينا ان الـ bicarb مسئول عن القاعدية
+
+280
+00:23:25,040 --> 00:23:30,620
+في الجسم زياته بتزوّل القاعدية وقلته بتقلل
+
+281
+00:23:30,620 --> 00:23:35,120
+القاعدية يعني بتعمل حامضية والـ bicarb هذا مسئول
+
+282
+00:23:35,120 --> 00:23:37,940
+عنه ال kidney هي اللي بتطرده من الجسم بتطلع
+
+283
+00:23:37,940 --> 00:23:41,000
+ويقولوا خلاص بدناك bicarb أو بتحافظ عليه إذا بدناك
+
+284
+00:23:43,400 --> 00:23:50,340
+بشكل طبيعي في كميات
+
+285
+00:23:50,340 --> 00:23:54,960
+متزنة من الـ bicarb يعني هذا شغلها أيوة إذا لو صار
+
+286
+00:23:54,960 --> 00:23:58,760
+عندي أي مشكلة في الكدن وصار عندي تسريب في الـ
+
+287
+00:23:58,760 --> 00:24:05,370
+bicarb هذا الـ HCO3هيصير في عنده فقدان في القاعدية
+
+288
+00:24:05,370 --> 00:24:10,730
+هتصير الجسم يتحول لحمضي اذا الـ Buffer is any
+
+289
+00:24:10,730 --> 00:24:15,290
+mechanism of resistance against change أي وسيلة
+
+290
+00:24:15,290 --> 00:24:22,970
+بيستخدمها الجسم علشان يمنع اللي هو التغيير والـ
+
+291
+00:24:22,970 --> 00:24:29,350
+disturbance الخلل في الاتزان الحمدي والقاعد اللي
+
+292
+00:24:29,350 --> 00:24:34,450
+عنده تمام؟عشان ايه بوفر سيستم الـ Prevent Major
+
+293
+00:24:34,450 --> 00:24:38,790
+Change in the Body دي أدت Fluid Removal، حكينا كيف
+
+294
+00:24:38,790 --> 00:24:43,370
+احنا بالنسبة مثلا لرئتين كيف بتسوي و بالنسبة للـ
+
+295
+00:24:43,370 --> 00:24:51,050
+Bicarb، يعني عمال بحكيلك أنهالعادل بيكرب هو اللي
+
+296
+00:24:51,050 --> 00:24:58,490
+بيحافظ على القاعدية تبع الجسم، تمام؟ كيف؟ لو الجسم
+
+297
+00:24:58,490 --> 00:25:06,310
+فقد بيكرب كثير بيصير إنه فقدان للقاعدية تبع الجسم
+
+298
+00:25:06,310 --> 00:25:13,570
+وبالتالي بيصير إنه حمضية ولو الـ CO2 اللي هو
+
+299
+00:25:13,570 --> 00:25:22,010
+اللاندالمريض فقدوا كثير حاسين عنده نقص في الـCO2
+
+300
+00:25:22,010 --> 00:25:26,550
+وبالتالي هعمله alkalinity فعادية تمام؟ هذا كله
+
+301
+00:25:26,550 --> 00:25:32,270
+يتجمع زي ما هنا مركز انه كله شغل الهيدروجين كيف
+
+302
+00:25:32,270 --> 00:25:35,310
+يعني؟ جالك الهيدروجين لو اجعل الـBicarb هنا
+
+303
+00:25:35,310 --> 00:25:40,470
+بيعملوا حمضي لو الـBicarb هذا موجود وانا متوفر
+
+304
+00:25:40,470 --> 00:25:44,150
+عندك الدم لو اتتعد متوفر عندك الهيدروجين كتير في
+
+305
+00:25:44,150 --> 00:25:48,910
+الدمهيعمل حمض بيكربونيك وهياته
+
+306
+00:25:57,260 --> 00:26:01,280
+طيب لو الهيدروجين هذا Carbon dioxide is a
+
+307
+00:26:01,280 --> 00:26:04,620
+potential acid هو أصلاً الـ Carbon dioxide تانكسيد
+
+308
+00:26:04,620 --> 00:26:10,500
+كربون أصلاً هو يعني مهيأ للحمض ليش طب مهيأ للحمض؟
+
+309
+00:26:10,500 --> 00:26:13,360
+لأنه سريع الإرتباط بالهيدروجين فلو ارتبط
+
+310
+00:26:13,360 --> 00:26:18,800
+بالهيدروجين هيعملني H2CO3 الكربونك أسد أيوة
+
+311
+00:26:18,800 --> 00:26:26,490
+وبالتالي هيعمللي إيش؟ هيزودلي الدم لـسيزود حمضية
+
+312
+00:26:26,490 --> 00:26:31,870
+الدم ويقلل الـ pH تبع الدم إذا افهمنا إن الـ CO2
+
+313
+00:26:31,870 --> 00:26:39,390
+مرتبط تماما بالحمضية وإذا بزيد الـ CO2 بيعمل حمضية
+
+314
+00:26:39,390 --> 00:26:44,430
+وبيقلل الـ pH وإذا بيقلل الـ CO2 بيعمل اللي هو
+
+315
+00:26:44,430 --> 00:26:52,210
+قاعدية وبيزود الـ pH لكن بالنسبة لـ Lullaby Card
+
+316
+00:26:52,210 --> 00:26:58,560
+اللي بنسميه هناExtracellular buffer يعني هذا من
+
+317
+00:26:58,560 --> 00:27:04,480
+داخل الخلية وين موجود في البلد The most important
+
+318
+00:27:04,480 --> 00:27:07,900
+buffer in the extracellular buffer and the body is
+
+319
+00:27:07,900 --> 00:27:11,200
+bicarbonate إيش معنى الـ bicarbonate هذا؟ which
+
+320
+00:27:11,200 --> 00:27:13,880
+combined with excess زي ما شوفت أنت وزار طبق
+
+321
+00:27:13,880 --> 00:27:18,320
+الهيدروجينيين بيعمل حمض بخار من الدنيا
+
+322
+00:27:22,680 --> 00:27:26,860
+لسه بورتانت بوفر سيستم مابديش اتجه عليه اللي هو
+
+323
+00:27:26,860 --> 00:27:30,020
+الـ inorganic phosphate و الـ plasma protein هدولة
+
+324
+00:27:30,020 --> 00:27:34,160
+من الـ buffer system الموجودين في الـ T cell اللي
+
+325
+00:27:34,160 --> 00:27:37,480
+هي الـ inorganic phosphate و الـ plasma protein
+
+326
+00:27:37,480 --> 00:27:42,420
+الـ plasma تبعت اللي هو الدم هي عبارة عن البروتين
+
+327
+00:27:42,420 --> 00:27:47,720
+حد ذاته هذا البروتين هو من الـ buffer system لكن
+
+328
+00:27:47,720 --> 00:27:53,070
+دوره اللي هو إيش بسيطالدوره كتير فعال اللي هو الـ
+
+329
+00:27:53,070 --> 00:27:57,310
+Bi-Card فيه Intracellular Buffer فيه كمان Buffer
+
+330
+00:27:57,310 --> 00:28:00,430
+System يعني أعرفنا طبعا إحنا أشكلوا الـBuffer
+
+331
+00:28:00,430 --> 00:28:04,590
+Buffer هو كل جهاز أو ميكانيزم باستخدامه الجسم عشان
+
+332
+00:28:04,590 --> 00:28:09,830
+يتحدى التغير اللي بده يحصل في الـBH ففيه داخل
+
+333
+00:28:09,830 --> 00:28:14,080
+الخلية اللي هوأو الـ Organic and Inorganic
+
+334
+00:28:14,080 --> 00:28:18,080
+Phosphate في الـ RBCs الـ RBCs بيه أورغان يقولون
+
+335
+00:28:18,080 --> 00:28:22,120
+إنه بيصيب داخل الخلايا و اللي هو الخلايا اللي الـ
+
+336
+00:28:22,120 --> 00:28:26,380
+RBCs بتعرفوا هي اللي بتحدد مجموعين الدم whereas
+
+337
+00:28:26,380 --> 00:28:31,540
+buffering by plasma bicarbonate HCO3 كمان يعني ابن
+
+338
+00:28:31,540 --> 00:28:36,630
+فردبساطة هي كأن الـOrganic Phosphate اللي في داخل
+
+339
+00:28:36,630 --> 00:28:39,630
+قُلات الدم الحمراء هي برضه من الـBuffer System
+
+340
+00:28:39,630 --> 00:28:44,310
+تأثيرها قليل مش معنيين فيها باختصار هي كمان
+
+341
+00:28:44,310 --> 00:28:47,470
+بيقولوا أنه في أننا زي ما شوفنا أنه في أننا
+
+342
+00:28:47,470 --> 00:28:48,770
+Phosphate Buffers هو الـ
+
+343
+00:28:51,910 --> 00:28:57,010
+اللي هو Extracellular موجودة وهي من الـ Buffer
+
+344
+00:28:57,010 --> 00:29:00,050
+System ولكنها تشتغل بس 5% من الـ Buffering
+
+345
+00:29:00,050 --> 00:29:05,630
+Capacity يعني كل شغلة بتعمل 5% من التحديات عشان
+
+346
+00:29:05,630 --> 00:29:11,730
+تترجح الوضع للأحسن طب ها مين اللي بيعمل الشغل
+
+347
+00:29:11,730 --> 00:29:17,090
+الأعظم؟ جالك الـ By Car بيشغل أكتر حوالي من 80% من
+
+348
+00:29:17,090 --> 00:29:20,460
+الـ Buffering Systemوكل هدول الـ Phosphate و الـ
+
+349
+00:29:20,460 --> 00:29:24,600
+Protein Buffer و الحاجات هدول يقعدوا بيشتغلوا خمسة
+
+350
+00:29:24,600 --> 00:29:28,040
+في المية سبعة في المية طلع هذا خمسة و هذا سبعة و
+
+351
+00:29:28,040 --> 00:29:31,960
+الباقي كله يشتغلوا مين؟ و أكتر اللي هو الـ Bicarb
+
+352
+00:29:31,960 --> 00:29:35,600
+عشان هيك احنا بنحتاج اللي هو بلومين و حدثاته برضه
+
+353
+00:29:35,600 --> 00:29:40,480
+Buffer عشان هيك احنا بنحتاج أكتر حاجة في دراسة الـ
+
+354
+00:29:40,480 --> 00:29:47,420
+Buffer System تبع مين؟ تبع الـ Bicarb و الـ CO2على
+
+355
+00:29:47,420 --> 00:29:53,760
+المستوى اللي هو الـ Metabolic الـ Bicarb على مستوى
+
+356
+00:29:53,760 --> 00:29:57,320
+الـ Respiratory الـ CO2، تمام؟ Philosophy of
+
+357
+00:29:57,320 --> 00:30:00,360
+Buffers، كيف يشتغل الـ Buffers؟ أنا بدأ أقول لك
+
+358
+00:30:00,360 --> 00:30:03,400
+System stabilizes بـ Edge-controlling body output
+
+359
+00:30:03,400 --> 00:30:09,500
+of acid base أو الـ CO2 ثراغه من خلال KFC ياما عن
+
+360
+00:30:09,500 --> 00:30:13,100
+طريق الـ Neuronal System، عن طريق الكيلياأه ولكن
+
+361
+00:30:13,100 --> 00:30:17,900
+هذا ما بيشتغلش على طول هذا مشتغل بدواجة delay يعني
+
+362
+00:30:17,900 --> 00:30:21,260
+انت بيصير مع المريض مثلا نفطرت
+
+363
+00:30:25,450 --> 00:30:29,930
+السيوند شوية التهيبات كترات زادت الجم عملتله تسامم
+
+364
+00:30:29,930 --> 00:30:35,210
+تمام الكلية اللي سات سبب قدامها وربما بيعملوا شوية
+
+365
+00:30:35,210 --> 00:30:39,130
+ايه؟ شوية Metabolic Acidosis في الجسم لأن
+
+366
+00:30:39,130 --> 00:30:42,090
+الـIbuprofen صارت تسامم ده وصارت الخلايا تعبانة
+
+367
+00:30:42,090 --> 00:30:47,730
+فبجلد صارت فيها acidity و بجلد فيها شو الصح تبقها
+
+368
+00:30:47,730 --> 00:30:54,180
+فصار فيه NDH Acidosisهذا ايش بيسويلي؟ بيعمللي ..
+
+369
+00:30:54,180 --> 00:30:57,860
+بيده حاجة تحسن الـ Acidosis هذا مين اللي بيشتغل
+
+370
+00:30:57,860 --> 00:31:01,620
+بسرعة؟ ال respiratory system ال lung كيف بيبدأ
+
+371
+00:31:01,620 --> 00:31:06,240
+تحسن ال Acidosis هذا؟ بيشتغل within minute بتخلي
+
+372
+00:31:06,240 --> 00:31:10,760
+الجسم يتسارع في عدد مرات التنفس يعني تنفس الطرافة
+
+373
+00:31:11,780 --> 00:31:15,300
+ليش؟ عشان يعمل CO2 washing out، عشان يعمل washing
+
+374
+00:31:15,300 --> 00:31:18,460
+out للـCO2 طب واش يعني بيصير لما يعمل washing out
+
+375
+00:31:18,460 --> 00:31:21,860
+للـCO2؟ آه، لما بيعمل washing out للـCO2، بيقلل
+
+376
+00:31:21,860 --> 00:31:24,960
+الحنضية اللي في الجسم شوية، ما هو الـCO2 مسؤول عن
+
+377
+00:31:24,960 --> 00:31:29,140
+الحنضية، يعني آه، بس مش هو السبب، السبب Metabolism
+
+378
+00:31:29,250 --> 00:31:32,390
+يعني ماحنا عارفين بس هذا another system بمجرد ما
+
+379
+00:31:32,390 --> 00:31:36,150
+بيلاقي أن الجسم فيه أندروحمضية ال lung بتبدأ
+
+380
+00:31:36,150 --> 00:31:40,230
+تشتغل، بتحاول أنها تصلح الموجود، يتعجّب، تواصل
+
+381
+00:31:40,230 --> 00:31:44,750
+للطبيعي فبما أنها سريقة الاستجابة تشتغل within
+
+382
+00:31:44,750 --> 00:31:49,520
+minutes بتخلي الجسم 6 كلميةبهدف إنه تعمل Washing
+
+383
+00:31:49,520 --> 00:31:54,740
+Out لشيطان بهدف إن الحنضية اللي موجودة أساسها
+
+384
+00:31:54,740 --> 00:32:01,140
+تتعدل عن طريق الrespiratory الكلاصز اللي احنا
+
+385
+00:32:01,140 --> 00:32:06,760
+عملناهاعشان ذلك احنا بنسمع ونقول هذه متابولك
+
+386
+00:32:06,760 --> 00:32:11,360
+متابولك
+
+387
+00:32:11,360 --> 00:32:14,800
+أسيدوسيكومبانسايتد
+
+388
+00:32:14,800 --> 00:32:15,640
+متابولك أسيدوسيكومبانسايتد متابولك
+
+389
+00:32:15,640 --> 00:32:18,360
+أسيدوسيكومبانسايتد متابولك أسيدوسيكومبانسايتد
+
+390
+00:32:18,360 --> 00:32:22,060
+متابولك أسيدوسيكومبانسايتد متابولك
+
+391
+00:32:22,060 --> 00:32:25,020
+أسيدوسيكومبانسايتد متابولك أسيدوسيكومبانسايتد
+
+392
+00:32:25,020 --> 00:32:25,020
+متابولك أسيدوسيكومبانسايتد متابولك
+
+393
+00:32:25,020 --> 00:32:26,440
+أسيدوسيكومبانسايتد متابولك أسيدوسيكومبانسايتد
+
+394
+00:32:26,440 --> 00:32:27,880
+متابولك أسيدوسيكومبانسايتد متابولك
+
+395
+00:32:27,880 --> 00:32:32,120
+أسيدوسيكومبانسايتد متلو بدنا نشوف الـ blood gas
+
+396
+00:32:32,120 --> 00:32:37,520
+تبعته، هنترجمها باللحقة الكلية، تمام؟ لكن بعد يوم،
+
+397
+00:32:37,520 --> 00:32:42,140
+تاني يوم، تبدأ ال kidney هي اللي تشتغل و تحاول
+
+398
+00:32:42,140 --> 00:32:48,340
+أنها تصلّح تاني يوم و تندس، تصلّح ال acidity اللي
+
+399
+00:32:48,340 --> 00:32:53,810
+عندها، مين شاطرة تقول ليه؟طب مين شاطر؟ اه برافو
+
+400
+00:32:53,810 --> 00:32:57,570
+عليه، بيقوللي إيش؟ بيقوللي هذا محمد، بيقوللي عن
+
+401
+00:32:57,570 --> 00:33:02,950
+طريق أنه اتحافظ على الـHCO3، تحجزه انت، يعني ما
+
+402
+00:33:02,950 --> 00:33:07,030
+تطلعوش، ليش؟ بيقوللي ما هو الجسم، الجسم عنده
+
+403
+00:33:07,030 --> 00:33:11,520
+Metabolic Acidosisبقوله كويس بيقولي لقيتها ال
+
+404
+00:33:11,520 --> 00:33:16,260
+kidney بدأت حاول أن تصلح ال acidosis هذا فبتحاول
+
+405
+00:33:16,260 --> 00:33:19,880
+تحتفظ في ال bicarb لإنه قاعدي فبيزود القاعدية تبع
+
+406
+00:33:19,880 --> 00:33:24,660
+الجسم فبصلح الحبية، برافو عليك كلامك صحيح، إذا هذا
+
+407
+00:33:24,660 --> 00:33:29,100
+هو إيش اسمه ال compensation تبع ال kidney اللي
+
+408
+00:33:29,100 --> 00:33:36,300
+بتصير مالها متأخرة، ماتصيرش فورا، اه إذافي
+
+409
+00:33:36,300 --> 00:33:42,120
+الـUrinary System اللي بتصير متأخرة بالنسبالته
+
+410
+00:33:42,120 --> 00:33:45,120
+للـSystem اللي بيصير بقى شوية دقايق في Chemical
+
+411
+00:33:45,120 --> 00:33:49,940
+Buffer System Chemical Buffer System اللي هي
+
+412
+00:33:49,940 --> 00:33:53,460
+Combination
+
+413
+00:33:53,460 --> 00:33:57,880
+of weak acid and weak base that bind to hydrogen
+
+414
+00:33:57,880 --> 00:34:01,160
+if hydrogen concentration of concentration rises
+
+415
+00:34:01,160 --> 00:34:06,130
+and release H2وإذا صار في عيونة الهيدروجينوصار
+
+416
+00:34:06,130 --> 00:34:09,510
+يطلع يفضلوا هيدروجين هيدروجين لزوّن الـAcidity
+
+417
+00:34:09,510 --> 00:34:13,530
+معناه الـConcentration فيه الادكاريستر نورمال دي
+
+418
+00:34:13,530 --> 00:34:17,130
+اتش او almost immediately فورا بدل كيميكال بفرع
+
+419
+00:34:17,130 --> 00:34:19,890
+دول يقولوا ايش فيه اهجموا اهجموا على ايونات
+
+420
+00:34:19,890 --> 00:34:25,370
+الهيدروجين هذه احتووها بلاش تتطبق في مين بلاش
+
+421
+00:34:25,370 --> 00:34:30,530
+تتطبق في الـCO2 او في الـbicarbon3 وبالتالي هتزود
+
+422
+00:34:30,530 --> 00:34:35,240
+الحنضية فبتروح ايش؟الـ Chemical Buffers اللي هي
+
+423
+00:34:35,240 --> 00:34:39,120
+الـ Bicarbonate System والفوسيتس سيستم والبروتينس
+
+424
+00:34:39,120 --> 00:34:44,100
+سيستم فدولة هما اللي بيحاولوا يشتغلوا عشان يمنعوا
+
+425
+00:34:44,100 --> 00:34:49,440
+الـ Disturbance اللي بيحصل في الـ SPS بلس بكل
+
+426
+00:34:49,440 --> 00:34:53,780
+بساطة روحنا قولنا بنلخص أن الـ Buffer System هذا
+
+427
+00:34:56,260 --> 00:34:59,940
+موجود في الـ Implant عن طريق الـ الـ الـ الـ الـ
+
+428
+00:34:59,940 --> 00:35:00,160
+الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ
+
+429
+00:35:00,160 --> 00:35:00,620
+الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ
+
+430
+00:35:00,620 --> 00:35:00,980
+الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ
+
+431
+00:35:00,980 --> 00:35:08,680
+الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ
+
+432
+00:35:08,680 --> 00:35:09,920
+الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ
+
+433
+00:35:09,920 --> 00:35:12,260
+الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ
+
+434
+00:35:12,260 --> 00:35:12,440
+الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ
+
+435
+00:35:12,440 --> 00:35:13,200
+الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ الـ
+
+436
+00:35:13,200 --> 00:35:20,000
+الـ الـ
+
+437
+00:35:20,000 --> 00:35:26,970
+الـ الـ الـالـ buffer system اللي في البلد اللي
+
+438
+00:35:26,970 --> 00:35:29,830
+بيشتغل بسرعة عن طريق الـ chemical buffer حكينالكوا
+
+439
+00:35:29,830 --> 00:35:34,710
+عنه و ال respirator حكيت عنه أنا باستفادة و اللي
+
+440
+00:35:34,710 --> 00:35:37,830
+هو كيف بيصير ال exertion عن طريق ال kidney و أنا
+
+441
+00:35:37,830 --> 00:35:42,150
+تحتفظ بيه أو ما تحتفظش برضه حكيت عنه بس ده مش أبدا
+
+442
+00:35:42,150 --> 00:35:45,530
+في ال phosphate buffer و الحاجات التانية بس ال by
+
+443
+00:35:45,530 --> 00:35:50,570
+-card لأن هو ل80% تقريبا من ال balance بأملها هاي
+
+444
+00:35:50,570 --> 00:35:58,140
+اللي بدي إياها هي كإحناخلصنا المقدمة كاملة تبعة
+
+445
+00:35:58,140 --> 00:36:02,800
+الـ Acid-Base Balance وبدنا نبدأ نحكي في اللي هو
+
+446
+00:36:02,800 --> 00:36:09,640
+الـ Acid-Base Disturbance الحالة الأولى Metabolic
+
+447
+00:36:09,640 --> 00:36:14,200
+Acidosis في المحاضرة القادمة إن شاء الله
+
diff --git a/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/Xwk5VUiuIHg.srt b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/Xwk5VUiuIHg.srt
new file mode 100644
index 0000000000000000000000000000000000000000..40b6b1b315f4f39764b034bcf0e3661f7b750505
--- /dev/null
+++ b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/Xwk5VUiuIHg.srt
@@ -0,0 +1,1502 @@
+1
+00:00:03,170 --> 00:00:08,050
+بسم الله الرحمن الرحيم، نكمل
+
+2
+00:00:08,050 --> 00:00:16,230
+بإذن الله رب العالمين، محاضرتنا وصلنا
+
+3
+00:00:16,230 --> 00:00:20,190
+لعند الـ «ICU admission criteria»، يعني إيش هي الـ
+
+4
+00:00:20,190 --> 00:00:24,550
+«criteria» اللي بيتبعوها عشان يقرروا إن الحالة هذه
+
+5
+00:00:24,550 --> 00:00:28,710
+بحتاج إنها تدخل، إنها مركزة، وبدأ «critical care
+
+6
+00:00:28,710 --> 00:00:31,840
+management». أولاً، الـ Admission criteria remained
+
+7
+00:00:31,840 --> 00:00:34,600
+poorly defined. ذات identification of patients who
+
+8
+00:00:34,600 --> 00:00:38,080
+can benefit from ICU care is extremely difficult.
+
+9
+00:00:38,080 --> 00:00:42,700
+مش بالسهل إننا فعلاً نحدد إن هذا المريض بينفع إنه
+
+10
+00:00:42,700 --> 00:00:49,920
+داخله ICU ولا لأ، مالوش لزوم ولا لأ، ضروري دائماً
+
+11
+00:00:49,920 --> 00:00:54,520
+الموضوع هذا، الصعوبة فيه إنه عادة بيكون الطبيب
+
+12
+00:00:54,520 --> 00:01:02,220
+المعالج دائماً بيعظّم، وبعمل generation يعني ببخّن
+
+13
+00:01:02,220 --> 00:01:07,660
+من وضع مريضه، وببالغي إن المريض محتاج لدخول هنا
+
+14
+00:01:07,660 --> 00:01:11,600
+مركز، أو طلقة هنا مكثفة.
+
+15
+00:01:12,800 --> 00:01:17,120
+في حين إن طلب الـ ICU عادةً بيتطلع على الأمور
+
+16
+00:01:17,120 --> 00:01:22,340
+الخاطرة، واللي فعلاً بتهدد حياة المريض إذا كانت
+
+17
+00:01:22,340 --> 00:01:27,540
+موجودة أو لا لأ، عشان يحدد إذا كان هذا المريض فعلاً
+
+18
+00:01:27,540 --> 00:01:32,940
+بحتاج ICU ولا لأ. ولذلك، معظم الـ ICU في كل العالم
+
+19
+00:01:32,940 --> 00:01:36,500
+وضعت الـ Criteria للـ Admission، يتحدد إذا كان
+
+20
+00:01:36,500 --> 00:01:41,190
+المريض هذا، بينطبق عليه هذه الوصفات، فهو يحتاج
+
+21
+00:01:41,190 --> 00:01:45,450
+للدخول إلى عناية مركزة، otherwise لأ، هو المريض بيظل
+
+22
+00:01:45,450 --> 00:01:50,250
+في القسم، ويتابع من تمريض القسم العادي، إلا إذا
+
+23
+00:01:50,250 --> 00:02:00,190
+استفاق حالته، وتحولت من إلى لذلك تعتمد عدة
+
+24
+00:02:00,190 --> 00:02:06,050
+عوامل، وجودها على إن هذا المريض فعلاً بيحتاج الـ ICU
+
+25
+00:02:06,050 --> 00:02:09,650
+admission، زي التشخيص تبعته، إيش التشخيص تبع
+
+26
+00:02:09,650 --> 00:02:14,130
+المريض، إيش الـ severity of illness، مدى إن هو شدة
+
+27
+00:02:14,130 --> 00:02:19,510
+المرض عنده، الـ age، يعني عمر المريض، عادة المرضى
+
+28
+00:02:19,510 --> 00:02:23,090
+لما بكونوا كبار في السن، بكون وضعهم صعب، لما
+
+29
+00:02:23,090 --> 00:02:27,390
+بكونوا شباب، والمناعة عندهم لسه قوية، بكون المريض
+
+30
+00:02:27,390 --> 00:02:31,610
+مرجو منهم، ممكن المرض يعني قد ما بكون كبير، يكون
+
+31
+00:02:31,610 --> 00:02:39,350
+فيه إمكانية إنه يشفى منه، لو تم مساعدته بطرق حثيثة،
+
+32
+00:02:39,350 --> 00:02:44,450
+أدوية عنده أمراض مصاحبة، كل ما قلت هذه الأمراض، كل
+
+33
+00:02:44,450 --> 00:02:49,610
+ما كانت إمكانية إنه نخدمه أكثر، أصلاً التنبؤ بتطور
+
+34
+00:02:49,610 --> 00:02:54,360
+المرض، والتنبؤ فيه، إنه يموت منه ولا لأ، مستحيل. الـ
+
+35
+00:02:54,360 --> 00:02:57,160
+Mortality Rate، والـ Morbidity أو الـ Mortality
+
+36
+00:02:57,160 --> 00:03:01,400
+Rate بالذات، لعض المرض، يعني ممكن نستشفى منه؟ هل
+
+37
+00:03:01,400 --> 00:03:05,780
+نوجد علاج أصلاً ممكن نقدمه له احنا ولا لأ؟ Recent
+
+38
+00:03:05,780 --> 00:03:12,980
+Cardiovascular Arrest and Patient Wishes، يعني
+
+39
+00:03:12,980 --> 00:03:17,780
+وقت العمل على المريض، Cardiovascular Resuscitation هو
+
+40
+00:03:19,080 --> 00:03:24,640
+لسه يعني زي ما بيحكوا، سوم ولا لأ، بعد ساعة بدل أن
+
+41
+00:03:24,640 --> 00:03:28,280
+يعملوا cardiac resuscitation، بالآخر صحي، أو بالآخر
+
+42
+00:03:28,280 --> 00:03:32,060
+القلب resuscitated، لكن الـ brain كان already died.
+
+43
+00:03:32,060 --> 00:03:35,920
+هذا الكلام لازم يتأخذ في الاعتبار، عشان أنا أعرف
+
+44
+00:03:35,920 --> 00:03:40,760
+حالياً، إذا أقدم رعاية حرجة لمريضي، وبالآخر بده يصير
+
+45
+00:03:40,760 --> 00:03:44,400
+يعني يستفيد من الخدمة تبعتي، ولا بده يظل الـ
+
+46
+00:03:44,400 --> 00:03:47,340
+brain anoxia، أو بس كل اللي بده إياه فعلاً الـ care.
+
+47
+00:03:48,690 --> 00:03:50,890
+Most hospitals have the following criteria.
+
+48
+00:03:50,890 --> 00:03:55,330
+معظم المستشفيات عندها الـ criteria اللي بتحكي إن
+
+49
+00:03:55,330 --> 00:03:57,930
+إذا كان المريض عندك، patient with respiratory
+
+50
+00:03:57,930 --> 00:04:02,310
+failure، بنعمله admission للـ ICU. إذا كان المريض
+
+51
+00:04:02,310 --> 00:04:05,750
+عندك، most successful CPR، بنعمله admission لإنه
+
+52
+00:04:05,750 --> 00:04:09,270
+عملتوله CPR، و Successful كان، نجح، رجع القلب يضخ.
+
+53
+00:04:09,270 --> 00:04:14,780
+مضطرين ناخده. بصي، Neurosurgery، واحد عامل Brain
+
+54
+00:04:14,780 --> 00:04:22,660
+Surgery أو Spinal Cord Surgery، وطالت، وحتى لما
+
+55
+00:04:22,660 --> 00:04:27,040
+طالت يا جماعة، عادة العملية تعتبر خطيرة، ومحدد
+
+56
+00:04:27,040 --> 00:04:31,600
+موقعها الجراح، وأخصائي التخدير، إنه فعلاً محتاج
+
+57
+00:04:31,600 --> 00:04:35,280
+لإكمال الرعاية، وإلا لأ، الوضع كويس، تبقى وممكن
+
+58
+00:04:35,280 --> 00:04:40,170
+ينعمل له Discharge على الأقسام المباشرة. الـ Fluid
+
+59
+00:04:40,170 --> 00:04:42,890
+والـ Electrolyte imbalance، عادة الناس اللي بتيجي
+
+60
+00:04:42,890 --> 00:04:46,810
+عندها Disturbance في الـ Fluid والـ Electrolyte
+
+61
+00:04:46,810 --> 00:04:49,470
+imbalance، يعني عنده Hypervolemia، Hypervolemia أو
+
+62
+00:04:49,470 --> 00:04:54,190
+Hyponatremia، Hypokalemia،
+
+63
+00:04:54,190 --> 00:04:58,010
+Hypocalcemia، Severe، عادة هدول بيكونوا محتاجين
+
+64
+00:04:58,010 --> 00:05:02,250
+الرعاية، أو Hyper طبعاً يدخلوا ICU for management.
+
+65
+00:05:02,250 --> 00:05:05,670
+إذا كان المريض عنده DIC، Disseminated Intravascular
+
+66
+00:05:05,670 --> 00:05:09,230
+Coagulation، وبالتالي هذا بيكون وضعه خطير، ممكن يعمل
+
+67
+00:05:09,230 --> 00:05:12,010
+bleeding في كل مكان. إذا كان المريض عنده Pneumothorax أو
+
+68
+00:05:12,010 --> 00:05:17,230
+Hemothorax، وبتأثر على الجهاز التنفسي، وبتأثر على الـ
+
+69
+00:05:17,230 --> 00:05:21,050
+respiratory عنده، ممكن قاعدة بتخششه في respiratory
+
+70
+00:05:21,050 --> 00:05:24,930
+failure، بس إن المريض هذا بيحتاج إنهم يدخلوا عشان
+
+71
+00:05:24,930 --> 00:05:26,810
+يعملوا Respiratory Monitoring، أو Mechanical
+
+72
+00:05:26,810 --> 00:05:30,210
+Ventilation therapy، ويدخلوا الـ ICU. إذا كان المريض
+
+73
+00:05:30,210 --> 00:05:34,670
+already in shock، فبالتالي المفروض إنه أيا كان
+
+74
+00:05:34,670 --> 00:05:38,490
+نوع الـ Shock، يعني كانت Anaphylactic shock، كانت
+
+75
+00:05:38,490 --> 00:05:41,870
+Cardiogenic shock، كانت Hypovolemic shock، كانت
+
+76
+00:05:41,870 --> 00:05:45,700
+Hemorrhagic shock، كانت Septic shock. الـ Chest من
+
+77
+00:05:45,700 --> 00:05:49,280
+الـ Indications اللي بتدخل لإنه يعني صعب  في القسم العادي
+
+78
+00:05:49,280 --> 00:05:52,940
+بشوك يتعامل معاه في القسم، لإنه بده Monitoring، وبده
+
+79
+00:05:52,940 --> 00:05:58,160
+Management، وبده Fluid Management، وبده Treatment لـ
+
+80
+00:05:58,160 --> 00:06:01,540
+Cause of Shock. الـ Chest Traumas،  هندخل في
+
+81
+00:06:01,540 --> 00:06:09,320
+الـ chest، واحد عنده Chest Trauma،  fall injury، Stab
+
+82
+00:06:09,320 --> 00:06:13,020
+wounds، Heavy object وقع عليه على الـ chest، وبالتالي
+
+83
+00:06:13,020 --> 00:06:15,880
+صار عنده زي ما حكينا قبل شوية، Hemothorax أو
+
+84
+00:06:15,880 --> 00:06:20,280
+Pneumothorax، وبالتالي المريض صار فيه عنده عدم قدرة
+
+85
+00:06:20,280 --> 00:06:25,640
+على التنفس لحاله، ولذلك بيكون بحتاج Admission
+
+86
+00:06:25,640 --> 00:06:28,720
+لـ ICU. Poisoning، إذا كان المريض فيه Poisoning سواء من
+
+87
+00:06:28,720 --> 00:06:33,020
+Organophosphorus، من Drug، من Gas،
+
+88
+00:06:33,020 --> 00:06:39,200
+من الـ Poisoning، الـ Toxic، ما هو نوع الـ Toxic، المحتاج
+
+89
+00:06:39,200 --> 00:06:42,700
+هذا، عادة اللي هو رعاية حرجة، عشان يطلع من
+
+90
+00:06:42,700 --> 00:06:46,620
+الـ Poisoning.  Both major surgeries، واحد عمل عملية
+
+91
+00:06:46,620 --> 00:06:51,120
+Cardiac Surgery، وما كان في غرفة العمليات خمس، ست
+
+92
+00:06:51,120 --> 00:06:55,500
+ساعات، أربع ساعات، هذا معناه إنه هذه Long Surgery
+
+93
+00:06:55,500 --> 00:06:58,520
+وبالتالي الـ Extubation تبعها مش ممكن يكون بكل
+
+94
+00:06:58,520 --> 00:07:05,180
+سهولة، فبالتالي المريض بده متابعة لـ Hemodynamics
+
+95
+00:07:05,180 --> 00:07:09,680
+تبعه، لإنّه عمل فقد لكمية كبيرة من السوائل
+
+96
+00:07:09,680 --> 00:07:15,280
+وبالتالي بيحتاج إنه يخضع
+
+97
+00:07:15,280 --> 00:07:19,300
+لرعاية حرجة، Critical Care Management.
+
+98
+00:07:21,950 --> 00:07:24,630
+نحاول نعمل الـ Weaning عن جهاز الـ Mechanical
+
+99
+00:07:24,630 --> 00:07:28,370
+Ventilator، ونعمل له Extubation، ولأثناء هذه نعمل
+
+100
+00:07:28,370 --> 00:07:31,530
+Good Monitoring للـ Circulatory System تبعته،
+
+101
+00:07:31,530 --> 00:07:34,610
+الـ Hemodynamic Stability، لما نرجع من الوضع الـ
+
+102
+00:07:34,610 --> 00:07:37,290
+Unstable للوضع الـ Stable. للناس اللي بيكون عندها
+
+103
+00:07:37,290 --> 00:07:40,470
+غيبوبة for unknown cause، يعني فجأة صار في غيبوبة، التغذية
+
+104
+00:07:40,470 --> 00:07:42,520
+نهاية، ده في عنده سبب، ممكن أن يكون هناك مصادر
+
+105
+00:07:42,520 --> 00:07:46,680
+هيمولوجية، أو مصادر هيمولوجية، أو مصادر هيمولوجية
+
+106
+00:07:46,680 --> 00:07:48,740
+أو مصادر هيمولوجية، أو مصادر هيمولوجية، أو مصادر
+
+107
+00:07:48,740 --> 00:07:48,940
+هيمولوجية، أو مصادر هيمولوجية، أو مصادر هيمولوجية
+
+108
+00:07:48,940 --> 00:07:49,280
+أو مصادر هيمولوجية، أو مصادر هيمولوجية، أو مصادر
+
+109
+00:07:49,280 --> 00:07:51,520
+هيمولوجية، أو مصادر هيمولوجية، أو مصادر هيمولوجية
+
+110
+00:07:51,520 --> 00:07:54,520
+أو مصادر هيمولوجية، أو مصادر هيمولوجية، أو مصادر
+
+111
+00:07:54,520 --> 00:07:59,380
+هيمولوجية، أو مصادر هيمولوجية، أو مصادر هيمولوجية
+
+112
+00:07:59,380 --> 00:08:04,720
+أو مصادر هيمولوجية، أو مصادر الهيمو
+
+113
+00:08:06,180 --> 00:08:09,740
+أو الـ Acute Renal Failure اللي دخل فيه بينما الـ
+
+114
+00:08:09,740 --> 00:08:12,440
+Induced Adrenal Disease، عادة هو مخلوش لإنه خلاص
+
+115
+00:08:12,440 --> 00:08:15,840
+already indistinguishable، بس فجأة كان كويس، وصار Acute
+
+116
+00:08:15,840 --> 00:08:19,420
+Renal Failure. آه، لأ، المراجعة نحاول نجعل الكلى
+
+117
+00:08:19,420 --> 00:08:23,160
+تشتغل ثانية عن طريق علاج السبب اللي خلى الكلى
+
+118
+00:08:23,160 --> 00:08:29,520
+تدخل في failure. هذه هي الـ admission criteria عادةً
+
+119
+00:08:29,520 --> 00:08:30,720
+اللي بيستخدموها
+
+120
+00:08:32,900 --> 00:08:34,700
+الـ Intensive Care
+
+121
+00:08:37,200 --> 00:08:41,580
+الـ Unit policy، أو السياسات اللي بتطبقها أقسام
+
+122
+00:08:41,580 --> 00:08:45,840
+العناية المركزة في المستشفيات المختلفة، كل قسم
+
+123
+00:08:45,840 --> 00:08:50,480
+بيحط Policy مختلف، عشان يحدد إن المريض هذا فعلاً في
+
+124
+00:08:50,480 --> 00:08:53,620
+غيبوبة، يعني مثلاً هو في غيبوبة، والـ Glasgow Coma Scale
+
+125
+00:08:53,620 --> 00:08:57,800
+تبعه كذا، الـ Glasgow Coma Scale، هنقتنه بالتفصيل
+
+126
+00:08:57,800 --> 00:09:01,300
+بس في ناس بتحكي إذا كان أقل من 11، يدخلوا عناية
+
+127
+00:09:01,300 --> 00:09:05,310
+مركزة، في ناس تقول لأ، إذا أقل من 8، يدخلوا عناية مركزة
+
+128
+00:09:05,310 --> 00:09:10,810
+أكثر من 8 إلى 11، هذا ممكن تحطه في Intermediate
+
+129
+00:09:10,810 --> 00:09:15,570
+Nursing Care، اللي هو أو Intermediate Nursing Care
+
+130
+00:09:15,570 --> 00:09:18,750
+مش Critical Care. خدوا بالكم،  لأنّه فيه
+
+131
+00:09:18,750 --> 00:09:21,870
+Intermediate Care، فيه Intensive Care، مش بس
+
+132
+00:09:21,870 --> 00:09:27,800
+Intensive Care، يعني بعض الأقسام كتير بتحطهم بعد
+
+133
+00:09:27,800 --> 00:09:32,300
+الـ unit العادي، الـ surgical ward، والـ medical ward
+
+134
+00:09:32,300 --> 00:09:35,880
+اللي بننقل فيها المريض، ممكن يضطروا إنهم يضعوه في
+
+135
+00:09:35,880 --> 00:09:40,220
+حاجة اسمها intermediate care، إذا الوضع أكثر خطورة، بوضعه في
+
+136
+00:09:40,220 --> 00:09:45,040
+حاجة اسمها intensive care. الـ Discharge Criteria، من
+
+137
+00:09:45,040 --> 00:09:47,940
+المريض اللي بيطلعوه من الـ ICU، ويقولوا عنه صار
+
+138
+00:09:47,940 --> 00:09:51,340
+كويس. Status of patients admitted to ICU should be
+
+139
+00:09:51,340 --> 00:09:54,620
+revised continuously to identify patients who may
+
+140
+00:09:54,620 --> 00:09:59,100
+no longer need ICU care. إن الناس اللي ما عادوا بيحتاجوا
+
+141
+00:09:59,100 --> 00:10:05,020
+عناية حرجة، مين هو هذا المريض؟ هذا
+
+142
+00:10:05,020 --> 00:10:06,680
+المريض اللي،  weaning patient
+
+143
+00:10:16,000 --> 00:10:21,220
+الحالة الفيسيولوجية بتاعته، هي مداركة، وتنفس طبيعي،
+
+144
+00:10:21,220 --> 00:10:25,400
+ضغط طبيعي، نبض طبيعي، القلب ينبض طبيعي، الـ Urine
+
+145
+00:10:25,400 --> 00:10:31,940
+Output طبيعي، الحالة التي تبعت الـ Blood أو
+
+146
+00:10:31,940 --> 00:10:36,220
+الـ Electrolytes عنده، الـ Palace، الحالة تبعت الـ
+
+147
+00:10:36,220 --> 00:10:38,700
+«status» تبقى في الـ «balance» تبقى عنده
+
+148
+00:10:38,700 --> 00:10:43,420
+«balance»، ساعتها «why the patient is in ICU؟» ليش؟
+
+149
+00:10:43,420 --> 00:10:48,640
+الـ Respiratory عنده okay، الـ «circulatory» okay، الـ
+
+150
+00:10:48,640 --> 00:10:52,080
+«renal» okay، الـ «neurogenic» حتى conscious
+
+151
+00:10:52,080 --> 00:10:56,020
+و oriented، وتمام،  يبقى بوعي، أنه يبقى في ICU؟ لأ،
+
+152
+00:10:56,020 --> 00:11:01,160
+ما فيش لزوم. لما يكون الـ pathological status تبع
+
+153
+00:11:01,160 --> 00:11:04,180
+المريض استقر، و يكون خلاص، المفروض أنه يطلع من الـ
+
+154
+00:11:04,180 --> 00:11:10,260
+ICU. لما يكون فيه deterioration، يعني لسه اللي
+
+155
+00:11:10,260 --> 00:11:13,740
+بيسببه الـ status تبعه unstable، مرات بيخش في هبوط
+
+156
+00:11:13,740 --> 00:11:20,340
+مرات بيخش في هيبوكسيا، الـ urine output مرات بتصير
+
+157
+00:11:20,340 --> 00:11:25,520
+عنده غير طبيعية،  او urea، أو مش عارفين لسه ليش بقى إنّه
+
+158
+00:11:25,520 --> 00:11:29,610
+الـ blood output عنده، أو الـ Fluid Input عنده كويس،
+
+159
+00:11:29,610 --> 00:11:34,550
+طب شو اللي بيصير؟ بيكون فيه Active Intervention،
+
+160
+00:11:34,550 --> 00:11:40,200
+Intervention لسه احنا محتاجينه، وبالتالي المريض
+
+161
+00:11:40,200 --> 00:11:43,820
+بيكون لسه بيدور على to stay in ICU until إنه يرجع كل
+
+162
+00:11:43,820 --> 00:11:49,520
+شيء لـ الاستقرار physiological condition، تمام؟ هذا
+
+163
+00:11:49,520 --> 00:11:54,040
+اللي بيحدد خروجه من الـ ICU. الآن بدنا نبدأ نعمل
+
+164
+00:11:54,040 --> 00:12:02,800
+assessment أكثر لحالة المريض، ونحدد إذا هو في
+
+165
+00:12:02,800 --> 00:12:08,540
+الـ ICU، وإلا خلاص هو المفروض إنه يطلع من الـ ICU.
+
+166
+00:12:08,540 --> 00:12:10,160
+عشان ذلك، يجب أن نعمل assessment.
+
+167
+00:12:31,720 --> 00:12:38,640
+التعامل هو مجرد تجارب، لتعرف عندما يصبح الشخص مستقراً
+
+168
+00:12:38,640 --> 00:12:42,420
+لما أنا بعرف إنه لأ، المريض صار كثير بيس تمام، مستقراً
+
+169
+00:12:42,420 --> 00:12:48,180
+يعني صار يعني
+
+170
+00:12:48,180 --> 00:12:52,260
+أموره بيقدر يتحكم فيها على حاله،  بيستقر، بدل حد
+
+171
+00:12:52,260 --> 00:12:57,440
+يُقَيّم كل شيء في المريض، كيف يعني؟ لأن لو كل مريض يا
+
+172
+00:12:57,440 --> 00:13:02,340
+جماعة unconscious، وفي الـ ICU، وما بيتنفسش لحاله
+
+173
+00:13:02,340 --> 00:13:05,340
+بيكون احنا بننفسّه عن طريق جهاز تنفس صناعي
+
+174
+00:13:05,340 --> 00:13:08,280
+لما بيصير conscious، بيكون أنا، إنتَ جاهز لتنفس
+
+175
+00:13:08,280 --> 00:13:11,380
+صناعي.  البوري يتنفس لحاله، والـ saturation كويس، لما
+
+176
+00:13:11,380 --> 00:13:12,400
+
+223
+00:16:46,460 --> 00:16:51,260
+عن طريق الانتقال الإسعاري
+
+224
+00:16:53,460 --> 00:16:58,220
+عنده Severe Hypertension وكان عارف بدأنا نعمل معه
+
+225
+00:16:58,220 --> 00:17:01,740
+Management ونشتغل على الـ Baseline هذا اللي موجود عنده
+
+226
+00:17:01,740 --> 00:17:05,380
+هو اللي حدد له إذا كنا الـ Interventions اللي
+
+227
+00:17:05,380 --> 00:17:11,800
+عملناها كانت في صالحه ونزلت فعلاً الـ ونزلت فعلاً الـ
+
+228
+00:17:11,800 --> 00:17:15,780
+Blood Pressure تبع المريض أم لا، إذا الحاجة
+
+229
+00:17:15,780 --> 00:17:18,720
+التانية تترجم الـ Client's Normal Function، عشان هيك
+
+230
+00:17:18,720 --> 00:17:22,450
+إحنا بنعمل Assessment عشان يكون عندي الـ Baseline
+
+231
+00:17:22,450 --> 00:17:26,150
+Data، وعشان يكون عندي الـ Determined Client's Normal
+
+232
+00:17:26,150 --> 00:17:29,270
+Function، عارف الطبيعي عند المريض قد إيش، إذا اتجه
+
+233
+00:17:29,270 --> 00:17:33,830
+المريض لقى كيرياتنين عنده 3.6، طب سألت أهله، طب
+
+234
+00:17:33,830 --> 00:17:38,350
+هو لما كان كويس، وآخر مرة عملوا كيرياتنين
+
+235
+00:17:38,350 --> 00:17:43,590
+قد إيش؟ قالوا لك برضه كان 3.6، أه، يعني هذا الـ Base
+
+236
+00:17:43,590 --> 00:17:46,890
+تبعه، هذا الـ Normal تبع المريض إن هو الكرياتنين
+
+237
+00:17:46,890 --> 00:17:52,250
+عنده 3.6، طب في حد من الكرياتنين عنده 3.6؟ أه، كتير
+
+238
+00:17:52,250 --> 00:17:57,010
+ناس بيكونوا Diabetes و Hypertension وبيصير عندهم
+
+239
+00:17:57,010 --> 00:18:01,590
+حالة بنسميها Chronic Kidney Disease (CKD)، اللي هو
+
+240
+00:18:01,590 --> 00:18:07,370
+نتيجة نتيجة
+
+241
+00:18:07,370 --> 00:18:09,870
+الـ...
+
+242
+00:18:29,800 --> 00:18:33,160
+عفوًا، to determine، أه، فكنا بنحكي عن أني بكون
+
+243
+00:18:33,160 --> 00:18:38,620
+بعرف الـ Normal Function تبعته، وبعدين كمان، عشان
+
+244
+00:18:38,620 --> 00:18:41,500
+أحدد الـ Client's Risk for this Function، كمان مشكلة
+
+245
+00:18:41,500 --> 00:18:47,770
+الممكنة للمريض أنه يصير عنده مشكلة في الوظائف
+
+246
+00:18:47,770 --> 00:18:52,650
+تبعته، سواء كانت Kidney أو Heart أو Liver أو
+
+247
+00:18:52,650 --> 00:18:55,590
+Whatever، I try to remind the client's strengths
+
+248
+00:18:55,590 --> 00:18:59,270
+عشان أحدد نقاط قوة المريض واستجابته، وإيش ممكن
+
+249
+00:18:59,270 --> 00:19:02,750
+يساعدني، وإيش ممكن يعمل response، وإيش هو ممكن
+
+250
+00:19:02,960 --> 00:19:07,760
+ما يستجيبش، لذلك نلاقي أن الـ Assessment له أنواع.
+
+251
+00:19:07,840 --> 00:19:11,660
+إيش الـ Assessment هذا اللي بيسميه، اللي بيسميها
+
+252
+00:19:11,660 --> 00:19:16,000
+جماعة "Admission Assessment" أو بيسموه اللي هو
+
+253
+00:19:16,000 --> 00:19:19,180
+يعني
+
+254
+00:19:19,180 --> 00:19:22,880
+إيش، إيش بنفتقر، أنه فيه كمان اسم اللي هو اللي
+
+255
+00:19:22,880 --> 00:19:27,750
+بيسموه الـ Baseline Assessment، اللي هو بالعربي بيصير
+
+256
+00:19:27,750 --> 00:19:31,610
+عند الدخول، واللي بنجمع فيه كل المعلومات عن المريض
+
+257
+00:19:31,610 --> 00:19:34,590
+الـ Initial Identification of Motor Function،
+
+258
+00:19:34,590 --> 00:19:38,110
+Functional Status and Collection of Data, Actual or
+
+259
+00:19:38,110 --> 00:19:41,450
+Potential Dysfunction, Baseline or Reference and
+
+260
+00:19:41,450 --> 00:19:45,820
+Future Comparison، عشان هذا، عشان هيك هذا وقت إيش
+
+261
+00:19:45,820 --> 00:19:50,980
+بنعمل، بنعمل specified time frame after admission
+
+262
+00:19:50,980 --> 00:19:54,060
+تدور، مجرد ما يصير الـ Admission، بيبقى موجود
+
+263
+00:19:54,060 --> 00:19:56,880
+الـ Assessment، عشان هيك بيسموه Admission Assessment
+
+264
+00:19:56,880 --> 00:20:00,060
+لكن في نوع من أنواع الـ Assessment، اسمه Focus
+
+265
+00:20:00,060 --> 00:20:03,320
+Assessment، إيش يعني Focus Assessment؟ يعني والله
+
+266
+00:20:03,320 --> 00:20:09,240
+أنا، أنت شغال في الـ Shift ووديت تسلم أو هيجيك
+
+267
+00:20:09,240 --> 00:20:12,380
+وإنّت روح، ومتيجي سالمك، والشفت الجديد بيحكي لك خذ
+
+268
+00:20:12,380 --> 00:20:16,900
+بالك، المريض رقم خمسة هذا فيه Wound Dressing
+
+269
+00:20:16,900 --> 00:20:22,080
+اليوم على الـ Amputation، نفترض اللي عنده، ولكن خذ
+
+270
+00:20:22,080 --> 00:20:27,700
+بالك، يعني بده Assessment لـ Bleeding، لإنه إحنا
+
+271
+00:20:27,700 --> 00:20:30,240
+غيّرنا، وحطينا غيارة جديدة، كانت التانية ممكن تصبح
+
+272
+00:20:30,240 --> 00:20:33,400
+مُندَوِية، إذن كل شوية راح تروح أنت تعمل
+
+273
+00:20:33,400 --> 00:20:36,240
+Assessment بس للـ Site تبعته، هذه اللي هي مكان الـ
+
+274
+00:20:36,240 --> 00:20:38,820
+Application، من خوف، اللي بيناديها اسمه Focus
+
+275
+00:20:38,820 --> 00:20:42,400
+Assessment، بس أنت بتروح تقيم، وتجرب المنطقة دي، okay
+
+276
+00:20:42,400 --> 00:20:45,810
+رائع، وضع كل مريض بتاخد الـ Vital Signs، بس أهم
+
+277
+00:20:45,810 --> 00:20:48,230
+حاجة من ده، يعني حتى الـ Vital Signs اللي بتاخدها
+
+278
+00:20:48,230 --> 00:20:52,190
+بتاخدها بتنوع من الـ Focus، إيش هي، إيش إذا لقيت إنّه
+
+279
+00:20:52,190 --> 00:20:56,270
+بدأت الـ Tachycardia، بدأت الـ Heart Rate تزيد
+
+280
+00:20:56,270 --> 00:20:59,330
+صار فيه Tachycardia، وبدل الـ Blood Pressure ينزل
+
+281
+00:20:59,330 --> 00:21:03,130
+بتكون أنت صرت مُقتنع إنه صار فيه Bleeding عند
+
+282
+00:21:03,130 --> 00:21:07,350
+المريض هذا، بتبدأ تشوف الجِرَة بتطلع، حال صار فيه  سقْط
+
+283
+00:21:07,350 --> 00:21:09,810
+غيارة، صارت Wet، وبين إنّه
+
+284
+00:21:12,340 --> 00:21:15,640
+يعني الـ Deep Reading أم لا؟ لو كان في مريض ثاني
+
+285
+00:21:15,640 --> 00:21:19,100
+فيه Abdominal Pain، وحكالك إنّه  شكاك المريض
+
+286
+00:21:19,100 --> 00:21:21,800
+هذا بيشوف إنك كنت بتقول Abdominal Pain، أنت بيكون فيه
+
+287
+00:21:21,800 --> 00:21:26,340
+ألم، بدون متابعة، فهون لازم تعمل Assessment للـ Pain
+
+288
+00:21:26,340 --> 00:21:30,860
+والـ Degree of Pain، قد إيش بيزيد، قد إيش مُخْتَلِف في الـ Pain
+
+289
+00:21:30,860 --> 00:21:35,280
+هذا هو الـ Focus Assessment، اللي بنركز فيه على حاجة
+
+290
+00:21:35,280 --> 00:21:39,060
+معينة، Status Determination of Specific Problem
+
+291
+00:21:39,060 --> 00:21:42,390
+Identified During Previous Assessment، التجارب
+
+292
+00:21:42,390 --> 00:21:45,950
+المستمرة، بتتعامل مع الـ Nurse Care في عدة ساعات
+
+293
+00:21:45,950 --> 00:21:49,950
+إلى عدة ساعات، وليس كثير من الوقت، لكن هناك شيء
+
+294
+00:21:49,950 --> 00:21:54,010
+اسمه الـ Time-Lapse، وهو التجارب والتعامل والتقارير
+
+295
+00:21:54,010 --> 00:21:55,650
+بين المستخدم والمستخدم، والمستخدم والمستخدم
+
+296
+00:21:55,650 --> 00:21:56,870
+والمستخدم، والمستخدم، والمستخدم، والمستخدم
+
+297
+00:21:56,870 --> 00:21:57,430
+والمستخدم، والمستخدم، والمستخدم، والمستخدم
+
+298
+00:21:57,430 --> 00:21:58,170
+والمستخدم، والمستخدم، والمستخدم، والمستخدم
+
+299
+00:21:58,170 --> 00:21:59,490
+والمستخدم، والمستخدم، والمستخدم، والمستخدم
+
+300
+00:21:59,490 --> 00:22:02,340
+والمستخدم، والمستخدم، والمستخدم، أولها كان في وضع
+
+301
+00:22:02,340 --> 00:22:05,460
+معين، الآن صار في وضع آخر، فأنا بقارن من الوضع الـ
+
+302
+00:22:05,460 --> 00:22:10,660
+Baseline، والوضع الحالي، وبحكي أن الوضع إتَحسّن، كيف
+
+303
+00:22:10,660 --> 00:22:15,440
+يعني؟ يعني مثلاً أنت عملت، في عندك مريض وكان عمل
+
+304
+00:22:15,440 --> 00:22:20,120
+مقوم و Admission في القسم، وكان عنده Cellulitis،
+
+305
+00:22:20,120 --> 00:22:25,480
+تمام؟ و Cellulitis هذا كان مُمتَدّ في منطقة
+
+306
+00:22:25,480 --> 00:22:29,520
+معينة، نروح ونجيب الـ Mark ونعمل Margin ونحدد
+
+307
+00:22:29,520 --> 00:22:33,820
+الحدود تبع الـ Cellulitis هذه، إلى أن تاني يوم
+
+308
+00:22:33,820 --> 00:22:39,010
+بنروح بنعمل Assessment ونشوف اللي هو إيش إيش إتغير
+
+309
+00:22:39,010 --> 00:22:41,930
+من البارحة اليوم؟ فالـ Management تبعتنا، أه والله
+
+310
+00:22:41,930 --> 00:22:45,030
+الـ Demarking، صار إيش يعني Demarking؟ يعني إزداد
+
+311
+00:22:45,030 --> 00:22:48,830
+الـ  Inflammation تحت الـ Mark اللي عملناها، يبقى
+
+312
+00:22:48,830 --> 00:22:57,070
+المريض إتَحسّن، تمام؟ وهذا مش ممكن يكون Focus خلال
+
+313
+00:22:57,070 --> 00:23:03,190
+أيام، لأ، ممكن يكون  علاج طويل، إنه إحنا المريض يروح
+
+314
+00:23:03,190 --> 00:23:07,650
+وياخذ العلاج تبعه ويستمر لأشهر وإحنا بنراقب في
+
+315
+00:23:07,650 --> 00:23:11,710
+الحالة تبعته، طبعاً لو بأخذ مثال على أحكاية اللي هو
+
+316
+00:23:11,710 --> 00:23:16,350
+أشهر، إنه المريض اللي بياخذ مثلاً Chemotherapy
+
+317
+00:23:16,350 --> 00:23:20,510
+طبعاً هذا بنحكي عنها كل أنواع الأسس مثلاً، تمام؟
+
+318
+00:23:20,510 --> 00:23:24,990
+فبياخذ Chemotherapy، لمدة شهور يعني، فبنقعد نتابعه
+
+319
+00:23:24,990 --> 00:23:28,290
+لمدة شهور وأكثر، يمكن عامل ما تشوف إن بيحصل
+
+320
+00:23:29,470 --> 00:23:32,830
+يعني Adaptation على الـ Site التي بتبتعد من الـ
+
+321
+00:23:32,830 --> 00:23:35,550
+Chemotherapy، طبعاً في Emergency Assessment، وهذا
+
+322
+00:23:35,550 --> 00:23:38,870
+النوع اللي نحتاجه في الـ Critical Care، والنوع
+
+323
+00:23:38,870 --> 00:23:42,290
+الثاني بيعرف عنه الـ Initial Assessment، والنوع
+
+324
+00:23:42,290 --> 00:23:44,490
+الثالث اللي هو الـ Focus Assessment، فهذول
+
+325
+00:23:44,490 --> 00:23:46,410
+الـ Initial Assessment عند الـ Admission اللي
+
+326
+00:23:46,410 --> 00:23:49,490
+محتاجه في الـ ICU، الـ Focus Assessment اللي محتاجه
+
+327
+00:23:49,490 --> 00:23:54,090
+برضه في الـ ICU، الـ Emergency Assessment برضه
+
+328
+00:23:54,090 --> 00:23:54,750
+محتاجه
+
+329
+00:23:57,480 --> 00:23:59,400
+أو الـ Life-threatening Condition، أنا بصير في الـ
+
+330
+00:23:59,400 --> 00:24:02,520
+Emergency Room، وجدت حالة، وعندها هذا الوضع، فأنا
+
+331
+00:24:02,520 --> 00:24:05,940
+لازم أعمل تقييم سريع فورًا، أحدد إن المريض هذا يبدو
+
+332
+00:24:05,940 --> 00:24:09,640
+إنه عنده Respiratory Arrest، ربما عنده Pneumothorax أو
+
+333
+00:24:09,640 --> 00:24:13,120
+Hemothorax، ثاني بدنا نشتغل على الموضوع فورًا ونركب
+
+334
+00:24:13,120 --> 00:24:16,850
+له Chest Tube، المريض هذا أول ما ييجي يبدو أنه
+
+335
+00:24:16,850 --> 00:24:19,710
+Cardiac Arrest، والـ Heart ما بنبضش، و Emergency
+
+336
+00:24:19,710 --> 00:24:23,330
+Assessment على طول سريع، بس حددت إنه الـ Carotid
+
+337
+00:24:23,330 --> 00:24:26,470
+Pulse Absent، والمريض ما بياخدش Spontaneous Breathing
+
+338
+00:24:26,470 --> 00:24:31,870
+ومافيهش عنده Spontaneous Pumping، يعني الـ Heart Rate
+
+339
+00:24:31,870 --> 00:24:34,770
+مش شغال، القلب مش شغال، وبالتالي مافيش Heart Rate
+
+340
+00:24:34,770 --> 00:24:40,550
+وبالتالي قررت إن هذا يحتاج إلى CPR، تمام؟ فهذا
+
+341
+00:24:40,550 --> 00:24:47,240
+اللي هو طرق الـ Assessment، عشان هيك في اللي هو يعني
+
+342
+00:24:47,240 --> 00:24:52,280
+طريقة ممكن تسهل علينا عملية الـ Assessment، عن طريق
+
+343
+00:24:52,280 --> 00:24:57,400
+إطار معين، زي اسمه الـ FAN CAP، أفتكر عن الـ Fluid، قد إيش
+
+344
+00:24:57,400 --> 00:25:00,200
+الـ Fluid عند المريض، وكيف حركة السوائل
+
+345
+00:25:00,200 --> 00:25:02,000
+الـ Electrolyte Balance، الـ Ventilation
+
+346
+00:25:02,000 --> 00:25:05,240
+الـ Electrolyte، الـ A يعني إيه؟ اللي هو الـ Aeration
+
+347
+00:25:05,240 --> 00:25:12,470
+كيف حركة الـ تنفس عنده، التهوية يعني، هل هو بيتنفس
+
+348
+00:25:12,470 --> 00:25:17,930
+طبيعي، تاكيبنيميا، ديسبنيميا، كيف أموره الـ
+
+349
+00:25:17,930 --> 00:25:24,630
+Nutrition، الـ Nutrition كيف
+
+350
+00:25:24,630 --> 00:25:28,570
+مستوى التغذية عند المريض، كيف بيتغذى المريض؟ Can use
+
+351
+00:25:28,570 --> 00:25:32,150
+the Normal GI، بتغذية طبيعية، أم عن طريق اللي هو
+
+352
+00:25:32,150 --> 00:25:33,510
+Feeding
+
+353
+00:25:35,250 --> 00:25:38,490
+أم من طريق الـ NG، أم من طريق الـ Minerals، أم من
+
+354
+00:25:38,490 --> 00:25:43,010
+طريق المسكنات، أو الـ Communication، كيف المريض هذا
+
+355
+00:25:44,530 --> 00:25:46,890
+بتم الـ Communication عنده؟ هل هو Conscious أصلاً؟
+
+356
+00:25:46,890 --> 00:25:50,710
+Oriented؟ فيه عنده Eye Contact؟ فيه عنده
+
+357
+00:25:50,710 --> 00:25:54,010
+Cooperation؟ Oriented أم لا؟ Aggressiveness كام
+
+358
+00:25:54,010 --> 00:25:57,710
+أم أكثر؟ الـ Activity، هذا كله عشان أعمل الـ
+
+359
+00:25:57,710 --> 00:26:00,930
+Assessment، الـ Activity، هل هو متحرك لحاله بدون
+
+360
+00:26:00,930 --> 00:26:06,090
+أم بده مساعدة؟ أم بده Complete Dependent؟ هو مش
+
+361
+00:26:06,090 --> 00:26:09,090
+بس بده مساعدة، هو مُتَعاَوِن، مُهَيَّأ، لإنه بيعمل
+
+362
+00:26:09,090 --> 00:26:13,780
+كل حاجة، الـ Pain، فيه عنده Pain أم مافيش عنده Pain؟ قد إيش
+
+363
+00:26:13,780 --> 00:26:17,180
+مستوى هذا الـ Pain؟ فيه عنده Cough أم لا؟ هذا الـ Pain
+
+364
+00:26:17,180 --> 00:26:21,870
+ممكن يا جماعة إن إحنا نعمله Assessment عن طريق حاجة
+
+365
+00:26:21,870 --> 00:26:26,890
+اسمها PQRST، اللي هو هذا، رسم الـ ECG بس ماله ده
+
+366
+00:26:26,890 --> 00:26:31,390
+واحدة بس، ماخدينها علشان يعني محدد Pain عن طريقها
+
+367
+00:26:31,390 --> 00:26:36,870
+الـ P معناه Precipitating Causes and Creating
+
+368
+00:26:36,870 --> 00:26:41,130
+Factors that Makes it Bitter، يعني في Precipitating، إيش
+
+369
+00:26:41,130 --> 00:26:46,230
+بيخلي الـ Pain يتحسن، الـ Q، الـ Quality
+
+370
+00:26:46,230 --> 00:26:50,090
+of Pain، كيف توصف الـ Pain؟ كيف بتوصفه؟ يعني كيف نوع
+
+371
+00:26:50,090 --> 00:26:52,730
+الـ Pain اللي عندك؟ إذا السؤال الأول، عندك Pain؟
+
+372
+00:26:52,730 --> 00:26:56,610
+أه، طب كيف بيروح؟ لما فهمتي هيك بيروح، أه، دي بقعد
+
+373
+00:26:56,610 --> 00:26:59,290
+أُرَجِّعه للفيزيولوجيا، يمكن فيه إصابة، Trauma،
+
+374
+00:26:59,290 --> 00:27:02,870
+يمكن فيه إصابة Fracture، طب كيف الـ Pain؟ الـ Q الـ
+
+375
+00:27:02,870 --> 00:27:07,360
+Quality، كيف الـ Pain اللي عندك؟ بعِزِّشي، بغزّ فيا، نزّل،
+
+376
+00:27:07,360 --> 00:27:11,600
+بعِزِّشي طول، بِضغط صدري، بعِزِّشي مُلْخَص فيا نَخْز، هذا الـ
+
+377
+00:27:11,600 --> 00:27:15,880
+Quality، بعِزِّشي بيحرق، حرقة، الـ Region and
+
+378
+00:27:15,880 --> 00:27:19,020
+Radiation، طب وين بالضبط؟ هي دهانة الألم، طب
+
+379
+00:27:19,020 --> 00:27:22,740
+وين الـ Content؟ لأ، مركز، لأ، بيروح على صدري، بيروح
+
+380
+00:27:22,740 --> 00:27:26,700
+على إيدي الشمال، okay، طب القَصَّة الصدر كده؟ كم بتبقى
+
+381
+00:27:26,700 --> 00:27:30,660
+عندك الألم؟ لو طفل، بنجيب له الصور هذول، بنقول له
+
+382
+00:27:30,660 --> 00:27:34,320
+كيف عندك الألم؟ ستة لعشرة، هاي عشرة، مليون مليار
+
+383
+00:27:34,760 --> 00:27:43,260
+ثمانية، أقل، ثمانية، أقل، ثمانية، أقل، ثمانية، أقل،
+
+384
+00:27:43,260 --> 00:27:44,520
+ثمانية، أقل، ثمانية، أقل، ثمانية، أقل، ثمانية، أقل،
+
+385
+00:27:44,520 --> 00:27:46,540
+ثمانية، أقل، ثمانية، أقل، ثمانية، أقل، ثمانية، أقل،
+
+386
+00:27:46,540 --> 00:27:49,420
+ثمانية، أقل، ثمانية، أقل، ثمانية، أقل، ثمانية، أقل،
+
+387
+00:27:49,420 --> 00:27:54,960
+ثمانية، أقل، ثمانية، أقل، ثمانية، أقل، ثمانية، أقل،
+
+388
+00:27:54,960 --> 00:27:59,260
+ثمانية، أقل، بتزيد لحد عشرة، إنت لوين عندك الـ Pain؟
+
+389
+00:27:59,260 --> 00:28:02,520
+تمام؟ طبعاً إحنا بغض النظر عن الناس، وكل واحد عنده
+
+390
+00:28:02,520 --> 00:28:07,640
+مُتَفَاوِت، قلم عنده اتنين، بقول لك  عشرة، فلازم نفهمه
+
+391
+00:28:07,640 --> 00:28:11,960
+إنّك لازم تقيس شدة الألم بدرجة حقيقية، عشان نعرف
+
+392
+00:28:11,960 --> 00:28:16,560
+كيف نتعامل معاك، ولما يزيد عن هناك، تستطيع تقول إن
+
+393
+00:28:16,560 --> 00:28:21,520
+هي أنها كانت مثلاً أربعة، لأ، زاد، صار ستة، صار سبعة، يا
+
+394
+00:28:21,520 --> 00:28:25,780
+جماعة، محاسب، هو لازم يعني يحط حاله، يحط
+
+445
+00:32:33,130 --> 00:32:37,150
+تدي بالك على مريض هذا هاليومين قبل ما يرجع يسوء
+
+446
+00:32:37,150 --> 00:32:41,370
+متحرك كويس يقدر يتمدد على نفسه و .. و .. و ..و
+
+447
+00:32:41,370 --> 00:32:46,250
+بيكون خلاص بيصير زيه زي بقية المرضى اللي في القسم
+
+448
+00:32:46,250 --> 00:32:50,230
+لأن إثنين زي ما هو حكينا إنه عنده organ failure
+
+449
+00:32:50,230 --> 00:32:55,830
+واحد وبيكون أحسن إنه يتلقى الرعاية تبعته في
+
+450
+00:32:55,830 --> 00:33:03,130
+العناية المركزة رغم إنه زي ما حكينا إنه ممكن، آه
+
+451
+00:33:03,130 --> 00:33:07,170
+ممكن أن يطلقها في أي مكان ثاني عشان الـ patient
+
+452
+00:33:07,170 --> 00:33:09,950
+require more detailed observation and intervention
+
+453
+00:33:09,950 --> 00:33:14,030
+including support for a single failing organ or
+
+454
+00:33:14,030 --> 00:33:16,970
+postoperative care and those stilling down from
+
+455
+00:33:16,970 --> 00:33:21,770
+higher levels of care والناس برضه اللي من العناية المركزة
+
+456
+00:33:21,770 --> 00:33:25,050
+مثلا على سبيل المثال، خلينا نسمي هدول
+
+457
+00:33:31,460 --> 00:33:34,060
+أو الـ Respiratory Failure، فلأ بنحطه هنا الـ
+
+458
+00:33:34,060 --> 00:33:38,420
+Intermediate Care وبنحط له جهاز Ventilator في قسم
+
+459
+00:33:38,420 --> 00:33:42,080
+الـ Oncology وبيعملوا له حاجة بيسموها مثلا
+
+460
+00:33:42,080 --> 00:33:46,520
+Awakening from Intubation اللي هو تيوب من الـ Nose
+
+461
+00:33:46,520 --> 00:33:48,800
+أو بيعملوا له Tracheostomy وبيشبكوه على Ventilator
+
+462
+00:33:48,800 --> 00:33:51,080
+اللي بيكون مريض Conscious و Oriented، بيأكل و
+
+463
+00:33:51,080 --> 00:33:55,580
+بيشرب، فمُه تمام؟ فهو بده شوية مساعدة
+
+464
+00:33:55,580 --> 00:34:03,050
+لكن مش High Risk، تمام؟ اللي بعده level 3 اللي أكثر
+
+465
+00:34:03,050 --> 00:34:06,970
+من organ failure اللي حكينا هنا يجب أن يُعالج
+
+466
+00:34:06,970 --> 00:34:11,010
+ويُنقل للعناية المركزة وبالتالي يكون
+
+467
+00:34:11,010 --> 00:34:11,830
+محتاج
+
+468
+00:34:15,090 --> 00:34:20,590
+القسم هنا مركزة، والـ Team مختص بالعناية المركزة اللي
+
+469
+00:34:20,590 --> 00:34:25,990
+بتعامل معها هكذا، خلصنا الـ chapter أو الـ chapter
+
+470
+00:34:25,990 --> 00:34:30,870
+التاني، صحيح، خلصنا، بقول الـ chapter الأول والتاني
+
+471
+00:34:30,870 --> 00:34:34,610
+وبدنا نبدأ إن شاء الله بالـ chapter الثالث اللي هو
+
+472
+00:34:34,610 --> 00:34:36,170
+الـ ethical consideration
diff --git a/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/Xwk5VUiuIHg_raw.json b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/Xwk5VUiuIHg_raw.json
new file mode 100644
index 0000000000000000000000000000000000000000..9e5d2a0e274f782f82c44d633cbb2d533e6dc27f
--- /dev/null
+++ b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/Xwk5VUiuIHg_raw.json
@@ -0,0 +1 @@
+{"segments": [{"id": 1, "seek": 2923, "start": 3.17, "end": 29.23, "text": "بسم الله الرحمن الرحيم نكمل بإذن الله رب العالمين محاضرتنا وصلنا لعند الـ «ICU admission criteria» يعني إيش هي الـ «criteria» اللي بيتبعوها عشان يقرروا إن الحالة هذه بحتاج إنها تدخل إنها مركزة وبدأ «critical care management»", "tokens": [3555, 38251, 21984, 34892, 5016, 27842, 34892, 5016, 32640, 8717, 24793, 1211, 4724, 28814, 8848, 1863, 21984, 12602, 3555, 18863, 45340, 9957, 3714, 5016, 46958, 43500, 8315, 4032, 36520, 8315, 5296, 3615, 41260, 2423, 39184, 4657, 2532, 52, 24668, 11101, 5933, 37495, 22653, 11933, 1829, 8592, 39896, 2423, 39184, 4657, 10757, 1681, 654, 5933, 13672, 1829, 4724, 36081, 3555, 3615, 2407, 11296, 6225, 8592, 7649, 7251, 4587, 2288, 2288, 14407, 36145, 21542, 6027, 3660, 29538, 4724, 33753, 26108, 36145, 11296, 6055, 3215, 9778, 1211, 36145, 11296, 3714, 31747, 11622, 3660, 4032, 44510, 10721, 4657, 32255, 804, 1127, 4592, 5933], "avg_logprob": -0.14125000298023224, "compression_ratio": 1.553648068669528, "no_speech_prob": 3.254413604736328e-05, "words": [{"start": 3.17, "end": 3.45, "word": "بسم", "probability": 0.8330078125}, {"start": 3.45, "end": 3.63, "word": " الله", "probability": 0.95849609375}, {"start": 3.63, "end": 4.07, "word": " الرحمن", "probability": 0.9736328125}, {"start": 4.07, "end": 4.69, "word": " الرحيم", "probability": 0.9951171875}, {"start": 4.69, "end": 8.05, "word": " نكمل", "probability": 0.7921549479166666}, {"start": 8.05, "end": 8.57, "word": " بإذن", "probability": 0.942626953125}, {"start": 8.57, "end": 8.71, "word": " الله", "probability": 0.96923828125}, {"start": 8.71, "end": 8.99, "word": " رب", "probability": 0.96875}, {"start": 8.99, "end": 10.29, "word": " العالمين", "probability": 0.9949544270833334}, {"start": 10.29, "end": 12.01, "word": " محاضرتنا", "probability": 0.96025390625}, {"start": 12.01, "end": 16.23, "word": " وصلنا", "probability": 0.9710286458333334}, {"start": 16.23, "end": 16.55, "word": " لعند", "probability": 0.81103515625}, {"start": 16.55, "end": 16.71, "word": " الـ", "probability": 0.94921875}, {"start": 16.71, "end": 17.13, "word": " «ICU", "probability": 0.6882731119791666}, {"start": 17.13, "end": 17.41, "word": " admission", "probability": 0.55908203125}, {"start": 17.41, "end": 18.17, "word": " criteria»", "probability": 0.961669921875}, {"start": 18.17, "end": 18.43, "word": " يعني", "probability": 0.931396484375}, {"start": 18.43, "end": 18.71, "word": " إيش", "probability": 0.7364908854166666}, {"start": 18.71, "end": 19.09, "word": " هي", "probability": 0.97509765625}, {"start": 19.09, "end": 20.19, "word": " الـ", "probability": 0.917724609375}, {"start": 20.19, "end": 21.25, "word": " «criteria»", "probability": 0.732421875}, {"start": 21.25, "end": 21.71, "word": " اللي", "probability": 0.98974609375}, {"start": 21.71, "end": 22.61, "word": " بيتبعوها", "probability": 0.9697265625}, {"start": 22.61, "end": 22.97, "word": " عشان", "probability": 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2030.12, "word": " و", "probability": 0.830078125}, {"start": 2030.12, "end": 2030.46, "word": " Oriental", "probability": 0.58642578125}, {"start": 2030.46, "end": 2030.98, "word": " بيأكل", "probability": 0.827880859375}, {"start": 2030.98, "end": 2031.08, "word": " و", "probability": 0.91845703125}, {"start": 2031.08, "end": 2031.5, "word": " بيشربوا", "probability": 0.9259765625}, {"start": 2031.5, "end": 2031.74, "word": " الفم", "probability": 0.41595458984375}, {"start": 2031.74, "end": 2031.84, "word": " اللي", "probability": 0.90576171875}, {"start": 2031.84, "end": 2032.54, "word": " حواليه", "probability": 0.8671875}, {"start": 2032.54, "end": 2033.5, "word": " تمام؟", "probability": 0.6704915364583334}, {"start": 2033.5, "end": 2033.72, "word": " فهو", "probability": 0.9541015625}, {"start": 2033.72, "end": 2034.06, "word": " بده", "probability": 0.860107421875}, {"start": 2034.06, "end": 2034.58, "word": " شوية", "probability": 0.8287760416666666}, {"start": 2034.58, 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"end": 2044.09, "word": " اللي", "probability": 0.614013671875}, {"start": 2044.09, "end": 2044.49, "word": " حكينا", "probability": 0.9720458984375}, {"start": 2044.49, "end": 2044.73, "word": " هنا", "probability": 0.7060546875}, {"start": 2044.73, "end": 2045.21, "word": " يجب", "probability": 0.9541015625}, {"start": 2045.21, "end": 2045.85, "word": " أنه", "probability": 0.630615234375}, {"start": 2045.85, "end": 2046.97, "word": " يتعالج", "probability": 0.9669921875}, {"start": 2046.97, "end": 2047.35, "word": " ويطلق", "probability": 0.7814453125}, {"start": 2047.35, "end": 2047.65, "word": " الإله", "probability": 0.470458984375}, {"start": 2047.65, "end": 2048.09, "word": " سبعه", "probability": 0.710601806640625}, {"start": 2048.09, "end": 2048.25, "word": " في", "probability": 0.82177734375}, {"start": 2048.25, "end": 2049.07, "word": " الأنام", "probability": 0.6215006510416666}, {"start": 2049.07, "end": 2049.79, "word": " مكثفة", "probability": 0.786376953125}, {"start": 2049.79, "end": 2050.73, "word": " وبالتالي", "probability": 0.94677734375}, {"start": 2050.73, "end": 2051.01, "word": " يكون", "probability": 0.938232421875}, {"start": 2051.01, "end": 2051.83, "word": " بمحتاج", "probability": 0.748779296875}], "temperature": 1.0}, {"id": 91, "seek": 207617, "start": 2055.09, "end": 2076.17, "text": "القسم هنا مركزة والـ Team مختصدي هنا المركزة اللي بتعامل معها هكذا خلصنا ال chapter أو ال chapter التاني صحيح خلصنا بقول ال chapter الأول والتاني وبدنا نبدأ ان شاء الله بال chapter التالت اللي هو ال ethical consideration", "tokens": [6027, 4587, 38251, 34105, 3714, 31747, 11622, 3660, 16070, 39184, 7606, 3714, 46456, 9381, 16254, 34105, 9673, 31747, 11622, 3660, 13672, 1829, 39894, 3615, 10943, 1211, 20449, 11296, 8032, 4117, 15730, 16490, 1211, 9381, 8315, 2423, 7187, 34051, 2423, 7187, 16712, 7649, 1829, 20328, 5016, 1829, 5016, 16490, 1211, 9381, 8315, 4724, 39648, 2423, 7187, 16247, 12610, 16070, 2655, 7649, 1829, 4032, 44510, 8315, 8717, 44510, 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{"start": 2060.59, "end": 2061.35, "word": " بتعامل", "probability": 0.660888671875}, {"start": 2061.35, "end": 2061.87, "word": " معها", "probability": 0.699951171875}, {"start": 2061.87, "end": 2062.27, "word": " هكذا", "probability": 0.5222574869791666}, {"start": 2062.27, "end": 2063.05, "word": " خلصنا", "probability": 0.78448486328125}, {"start": 2063.05, "end": 2063.29, "word": " ال", "probability": 0.5859375}, {"start": 2063.29, "end": 2063.63, "word": " chapter", "probability": 0.50341796875}, {"start": 2063.63, "end": 2064.95, "word": " أو", "probability": 0.87060546875}, {"start": 2064.95, "end": 2065.71, "word": " ال", "probability": 0.8447265625}, {"start": 2065.71, "end": 2065.99, "word": " chapter", "probability": 0.89697265625}, {"start": 2065.99, "end": 2066.45, "word": " التاني", "probability": 0.9280598958333334}, {"start": 2066.45, "end": 2067.59, "word": " صحيح", "probability": 0.9420166015625}, {"start": 2067.59, "end": 2069.01, "word": " خلصنا", "probability": 0.9627685546875}, {"start": 2069.01, "end": 2069.35, "word": " بقول", "probability": 0.5517578125}, {"start": 2069.35, "end": 2069.47, "word": " ال", "probability": 0.87158203125}, {"start": 2069.47, "end": 2069.69, "word": " chapter", "probability": 0.923828125}, {"start": 2069.69, "end": 2070.11, "word": " الأول", "probability": 0.97119140625}, {"start": 2070.11, "end": 2070.87, "word": " والتاني", "probability": 0.9476318359375}, {"start": 2070.87, "end": 2071.29, "word": " وبدنا", "probability": 0.720458984375}, {"start": 2071.29, "end": 2071.57, "word": " نبدأ", "probability": 0.9876302083333334}, {"start": 2071.57, "end": 2071.71, "word": " ان", "probability": 0.67822265625}, {"start": 2071.71, "end": 2071.87, "word": " شاء", "probability": 0.97607421875}, {"start": 2071.87, "end": 2071.99, "word": " الله", "probability": 0.94677734375}, {"start": 2071.99, "end": 2072.19, "word": " بال", "probability": 0.95458984375}, {"start": 2072.19, "end": 2072.63, "word": " chapter", 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\ No newline at end of file
diff --git a/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/Xwk5VUiuIHg_raw.srt b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/Xwk5VUiuIHg_raw.srt
new file mode 100644
index 0000000000000000000000000000000000000000..2df676a2f6e86b6e16afe65e24081914fe14d68c
--- /dev/null
+++ b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/Xwk5VUiuIHg_raw.srt
@@ -0,0 +1,1888 @@
+1
+00:00:03,170 --> 00:00:08,050
+بسم الله الرحمن الرحيم نكمل
+
+2
+00:00:08,050 --> 00:00:16,230
+بإذن الله رب العالمين محاضرتنا وصلنا
+
+3
+00:00:16,230 --> 00:00:20,190
+لعند الـ «ICU admission criteria» يعني إيش هي الـ
+
+4
+00:00:20,190 --> 00:00:24,550
+«criteria» اللي بيتبعوها عشان يقرروا إن الحالة هذه
+
+5
+00:00:24,550 --> 00:00:28,710
+بحتاج إنها تدخل إنها مركزة وبدأ «critical care
+
+6
+00:00:28,710 --> 00:00:31,840
+management»أولاً الـ Admission criteria remained
+
+7
+00:00:31,840 --> 00:00:34,600
+poorly defined ذات identification of patients who
+
+8
+00:00:34,600 --> 00:00:38,080
+can benefit from ICU care is extremely difficult
+
+9
+00:00:38,080 --> 00:00:42,700
+مش بالسهل إننا فعلاً نحدد إن هذا المريض بينفع إنه
+
+10
+00:00:42,700 --> 00:00:49,920
+داخله ICU ولا لأ مالوش لزوم ولا لأ ضروري دايما
+
+11
+00:00:49,920 --> 00:00:54,520
+الموضوع هذا الصعوبة فيه إنه عادة بيكون الطبيب
+
+12
+00:00:54,520 --> 00:01:02,220
+المعالج دايما بيعظّم وبعمل generation يعني ببخّن
+
+13
+00:01:02,220 --> 00:01:07,660
+من وضع مريضه وببالغي إن المريض محتاج لدخول هنا
+
+14
+00:01:07,660 --> 00:01:11,600
+مركز أو طلقة هنا مكثفة
+
+15
+00:01:12,800 --> 00:01:17,120
+في حين إن طلب الـ ICU عادةً بيتطلع على الأمور
+
+16
+00:01:17,120 --> 00:01:22,340
+الخاطيرة واللي فعلاً بتهدد حياة المريض إذا كانت
+
+17
+00:01:22,340 --> 00:01:27,540
+موجودة أو لا لأ عشان يحدد إذا كان هذا المريض فعلاً
+
+18
+00:01:27,540 --> 00:01:32,940
+بحتاج ICU ولا لأ ولذلك معظم الـ ICU في كل العالم
+
+19
+00:01:32,940 --> 00:01:36,500
+وضعت الـ Criteria للـ Admission يتحدد إذا كان
+
+20
+00:01:36,500 --> 00:01:41,190
+المريض هذا، بينطبخ عليههذه الوصفات فهو يحتاج
+
+21
+00:01:41,190 --> 00:01:45,450
+للدخول إلى علاقة مركزة otherwise لأ هو المريض بيظل
+
+22
+00:01:45,450 --> 00:01:50,250
+في القسم ويتابع من تمريد القسم العادي إلا إذا
+
+23
+00:01:50,250 --> 00:02:00,190
+استأت حاته وتحولت من إلى لذلك تعتمد عدة
+
+24
+00:02:00,190 --> 00:02:06,050
+عوامل وجودها على إن هذا المريض فعلا بيحتاجالـ ICU
+
+25
+00:02:06,050 --> 00:02:09,650
+admission زي التشخيص تبعته، إيش التشخيص تبع
+
+26
+00:02:09,650 --> 00:02:14,130
+المريض، إيش الـ severity of illness، مدى إن هو شدت
+
+27
+00:02:14,130 --> 00:02:19,510
+المرض عنده، الـ age، كده عمر المريض، عادة المرضة
+
+28
+00:02:19,510 --> 00:02:23,090
+لما بكونوا كبار في السن، بكون وضعهم صعب، لما
+
+29
+00:02:23,090 --> 00:02:27,390
+بكونوا شباب و المناعة عندهم لسه قوية، بكون المريض
+
+30
+00:02:27,390 --> 00:02:31,610
+مرجو منهم، ممكن المرض يعني قد ما بكون كبير، يكون
+
+31
+00:02:31,610 --> 00:02:39,350
+فيه إمكانية إنهيشفى منه لو تم مساعدته بطرق حثيثة،
+
+32
+00:02:39,350 --> 00:02:44,450
+أداش عنده أمراض مصاحبة، لكل ما قلت هذه الأمراض كل
+
+33
+00:02:44,450 --> 00:02:49,610
+ما كانت إمكانية أنه نخدمه أكتر، أصلا التقدم تبقى
+
+34
+00:02:49,610 --> 00:02:54,360
+المرض والتنبؤ فيه إنه مرض منه ولا لأ، مستحيلالـ
+
+35
+00:02:54,360 --> 00:02:57,160
+Mortality Rate والـ Morbidity أو الـ Mortality
+
+36
+00:02:57,160 --> 00:03:01,400
+Rate بالذات لعض المرض، كده ممكن نستشفى منه؟ هل
+
+37
+00:03:01,400 --> 00:03:05,780
+نوجد إلاج أصلا ممكن نقدمه له أحنا ولا لأ؟ Recent
+
+38
+00:03:05,780 --> 00:03:12,980
+Cardiovascular Arrest and Patient Wishes، كده يعني
+
+39
+00:03:12,980 --> 00:03:17,780
+وقت العمل للمريض Cardiovascular Resuscitation هو
+
+40
+00:03:19,080 --> 00:03:24,640
+لسة يعني زي ما بيحكوا سوم ولا لأ بعد ساعة بدل أن
+
+41
+00:03:24,640 --> 00:03:28,280
+يعملوا cardiac resuscitation بالآخر صحي أو بالآخر
+
+42
+00:03:28,280 --> 00:03:32,060
+القلب resuscitated لكن الـ brain كان already died
+
+43
+00:03:32,060 --> 00:03:35,920
+هذا الكلام لازم يتاخد في الإخبار عشان أنا أعرف
+
+44
+00:03:35,920 --> 00:03:40,760
+حالي بإذا أقدم رعاية حرج لمريده وبالآخر بده يسير
+
+45
+00:03:40,760 --> 00:03:44,400
+يعني يستفيد من الخدمة تبعتي ولا بده يظلوا الـ
+
+46
+00:03:44,400 --> 00:03:47,340
+brain anoxia أو بس كل اللي بده إياه فالعة ال care
+
+47
+00:03:48,690 --> 00:03:50,890
+The most hospitals have the following criteria
+
+48
+00:03:50,890 --> 00:03:55,330
+معظم المستشفيات عندها الـ criteria اللي بتحكي إن
+
+49
+00:03:55,330 --> 00:03:57,930
+إذا كان المريض عندك patient with respiratory
+
+50
+00:03:57,930 --> 00:04:02,310
+failure بنعمله admission لل ICU إذا كان المريض
+
+51
+00:04:02,310 --> 00:04:05,750
+عندك most successful CPR بنعمله admission لإنتوا
+
+52
+00:04:05,750 --> 00:04:09,270
+عملتوله CPR و Successful كان نجح رجع القلب يشبه
+
+53
+00:04:09,270 --> 00:04:14,780
+مضطرين ناخدهبصي Neurosurgery، واحد عامل Brain
+
+54
+00:04:14,780 --> 00:04:22,660
+Surgery أو Spinal Cord Surgery وطولت، وحتى لما
+
+55
+00:04:22,660 --> 00:04:27,040
+طولتش يا جماعة، عادة العملية تعتبر خطيرة ومحدد
+
+56
+00:04:27,040 --> 00:04:31,600
+موضعها الجراح وأخصائي التخليل إنه فعلا محتاج
+
+57
+00:04:31,600 --> 00:04:35,280
+لإكمال رعاية، وإلا لأ الوضع كويس تبقى وممكنين
+
+58
+00:04:35,280 --> 00:04:40,170
+يعملهوDischarge على الأقسام المباشرة الـ Fluid
+
+59
+00:04:40,170 --> 00:04:42,890
+عنده Electrolyte Influence عادة الناس اللي بتيجي
+
+60
+00:04:42,890 --> 00:04:46,810
+عندها Disturbance في الـ Fluid والـ Electrolyte
+
+61
+00:04:46,810 --> 00:04:49,470
+Influence يعني عنده Hypervolemia، Hypervolemia أو
+
+62
+00:04:49,470 --> 00:04:54,190
+Hyponatemia، Hypokalemia،
+
+63
+00:04:54,190 --> 00:04:58,010
+Hypocalcemia، Severe عادة هدول بيكونوا محتاجوا
+
+64
+00:04:58,010 --> 00:05:02,250
+الملوكةأو Hyper طبعاً يدخلوا ICU for management
+
+65
+00:05:02,250 --> 00:05:05,670
+إذا كان المريض عنده DIC Disseminated Intravascular
+
+66
+00:05:05,670 --> 00:05:09,230
+Coagulatory وبالتالي هذا بيكون وضعه خطير ممكن يعمل
+
+67
+00:05:09,230 --> 00:05:12,010
+bleeding كل مكان إذا كان المريض عنده Nemo أو
+
+68
+00:05:12,010 --> 00:05:17,230
+Hemothorax وبتأثر على الجهاز التنفسي وبتأثر على ال
+
+69
+00:05:17,230 --> 00:05:21,050
+respiratory عنده ممكن قاعدة بتخششه في respiratory
+
+70
+00:05:21,050 --> 00:05:24,930
+failure بس إن المريض هذا بيحتاجإنهم يدخلوا عشان
+
+71
+00:05:24,930 --> 00:05:26,810
+يعملوا Respiratory Monitoring أو Mechanical
+
+72
+00:05:26,810 --> 00:05:30,210
+Internal Therapy ويدخلوا الـICU إذا كان المريض
+
+73
+00:05:30,210 --> 00:05:34,670
+already in shock فبالتالي المفروض إنه أيا كان
+
+74
+00:05:34,670 --> 00:05:38,490
+النوع الـShock يعني كانت Anaphylactic shock كانت
+
+75
+00:05:38,490 --> 00:05:41,870
+Cardogenic shock كانت Aerogenic shock كانت
+
+76
+00:05:41,870 --> 00:05:45,700
+Hemorrhagic shock كانت Septic shockالـ Chest من
+
+77
+00:05:45,700 --> 00:05:49,280
+الـ Indication اللي بتدخل لإنه يعني صعب بري الهندو
+
+78
+00:05:49,280 --> 00:05:52,940
+شوك يتعامل معاه في القسم لإنه بده Monitoring وبده
+
+79
+00:05:52,940 --> 00:05:58,160
+Management وبده Fluid Management وبده Treatment لـ
+
+80
+00:05:58,160 --> 00:06:01,540
+Cause of Shock الـ Chest Traumas هندو Fly على
+
+81
+00:06:01,540 --> 00:06:09,320
+الchest واحد عندهالتشيست تروما، فولد انجري، Stab
+
+82
+00:06:09,320 --> 00:06:13,020
+wounds، Heavy object وجعله على التشيست وبالتالي
+
+83
+00:06:13,020 --> 00:06:15,880
+صار عمله زي ما حكينا قبل شوية Hemothorax أو
+
+84
+00:06:15,880 --> 00:06:20,280
+Hemothorax وبالتالي المريض صار فيه عنده عدم قدرة
+
+85
+00:06:20,280 --> 00:06:25,640
+على التنفس لحاله ولذلك يكون بحتاج Admission
+
+86
+00:06:25,640 --> 00:06:28,720
+Poisoning، إذا كان المريض Poisoning سواء من
+
+87
+00:06:28,720 --> 00:06:33,020
+Organophosphorus، من Drug، منمن الـGas،
+
+88
+00:06:33,020 --> 00:06:39,200
+الـPoisoning، الـToxic، ما هو نوع الـToxic المحتاج
+
+89
+00:06:39,200 --> 00:06:42,700
+هذا عادة اللي هو رعاية حتيجة عشان يطلع من
+
+90
+00:06:42,700 --> 00:06:46,620
+الـPoison both major surgeries واحد عمل عملية
+
+91
+00:06:46,620 --> 00:06:51,120
+Cardiac Surgery وما كان في غرفة العمليات خمس، ست
+
+92
+00:06:51,120 --> 00:06:55,500
+ساعات، أربع ساعات هذا معناه إنه هذه Long Surgery
+
+93
+00:06:55,500 --> 00:06:58,520
+وبالتالي الـExtubation تبعها مش ممكن يكون بكل
+
+94
+00:06:58,520 --> 00:07:05,180
+سهولة فبالتالي المريض بدهمتابعة لهمو دايناميكس
+
+95
+00:07:05,180 --> 00:07:09,680
+تبعه Top علشانه عمل فقد لكمية كبيرة من السوائل
+
+96
+00:07:09,680 --> 00:07:15,280
+وبالتالي بيحتاج انه يخضع
+
+97
+00:07:15,280 --> 00:07:19,300
+لرعاية حقيقة Critical Care Management
+
+98
+00:07:21,950 --> 00:07:24,630
+نحاول نعمل الـ Weaning عن جهزة الـ Mechanical
+
+99
+00:07:24,630 --> 00:07:28,370
+Ventilator ونعمل له Extubation ولأثناء هذه نعمل
+
+100
+00:07:28,370 --> 00:07:31,530
+Good Monitoring لـ الـ Circulatory System تبعته
+
+101
+00:07:31,530 --> 00:07:34,610
+الـ Hemodynamic Stability لما نرجع من الوضع الـ
+
+102
+00:07:34,610 --> 00:07:37,290
+Unstable للوضع الـ Stable للناس اللي يكون عندها
+
+103
+00:07:37,290 --> 00:07:40,470
+كومة for unknown cause يعني فجأة صار كومة تغذية
+
+104
+00:07:40,470 --> 00:07:42,520
+نهاية ده في عنده سببممكن أن يكون هناك مصادر
+
+105
+00:07:42,520 --> 00:07:46,680
+الهيولوجيا أو مصادر الهيولوجيا أو مصادر الهيولوجيا
+
+106
+00:07:46,680 --> 00:07:48,740
+أو مصادر الهيولوجيا أو مصادر الهيولوجيا أو مصادر
+
+107
+00:07:48,740 --> 00:07:48,940
+الهيولوجيا أو مصادر الهيولوجيا أو مصادر الهيولوجيا
+
+108
+00:07:48,940 --> 00:07:49,280
+أو مصادر الهيولوجيا أو مصادر الهيولوجيا أو مصادر
+
+109
+00:07:49,280 --> 00:07:51,520
+الهيولوجيا أو مصادر الهيولوجيا أو مصادر الهيولوجيا
+
+110
+00:07:51,520 --> 00:07:54,520
+أو مصادر الهيولوجيا أو مصادر الهيولوجيا أو مصادر
+
+111
+00:07:54,520 --> 00:07:59,380
+الهيولوجيا أو مصادر الهيولوجيا أو مصادر الهيولوجيا
+
+112
+00:07:59,380 --> 00:08:04,720
+أو مصادر الهيولوجيا أو مصادر الهيول
+
+113
+00:08:06,180 --> 00:08:09,740
+أو الـ Acute Renal Failure اللي دخل فيه بينما الـ
+
+114
+00:08:09,740 --> 00:08:12,440
+Induced Adrenal Disease عادة هو مخلوش لأنه خلاص
+
+115
+00:08:12,440 --> 00:08:15,840
+already indestigable بس فجأة كان كويس وصار Acute
+
+116
+00:08:15,840 --> 00:08:19,420
+Renal Failure آه لأ المراجعة حاول تجعل الكيليا
+
+117
+00:08:19,420 --> 00:08:23,160
+تشتغل تاني عن طريق علاجي السبب اللي خلى الكيليا
+
+118
+00:08:23,160 --> 00:08:29,520
+تفوش فيه failure هذه هي ال admission criteria عادة
+
+119
+00:08:29,520 --> 00:08:30,720
+اللي بيستخدموها
+
+120
+00:08:32,900 --> 00:08:34,700
+الـ Intensive Care
+
+121
+00:08:37,200 --> 00:08:41,580
+الـ Unit Policy أو السياسات اللي بتطبقها أقسام
+
+122
+00:08:41,580 --> 00:08:45,840
+العنايات المركزة في المستشفيات المختلفة كل قسم
+
+123
+00:08:45,840 --> 00:08:50,480
+بيحط Policy مختلف عشان يحدد إن المريض هات فعلا في
+
+124
+00:08:50,480 --> 00:08:53,620
+كومة يعني مثلا هو كومة و الـ Glasgow Coma Scale
+
+125
+00:08:53,620 --> 00:08:57,800
+تبعه كذا الـ Glasgow Coma Scale هنهتقنه بالتفصيل
+
+126
+00:08:57,800 --> 00:09:01,300
+بس في ناس بتحكي إذا كان أقل من 11 هدخلوا عناية
+
+127
+00:09:01,300 --> 00:09:05,310
+مركزة في ناس تقول لاإذا أقل من 8 هدخلوا هنا مركز
+
+128
+00:09:05,310 --> 00:09:10,810
+أكتر من أن 8 إلى 11 هذا ممكن تحطه في Intermediate
+
+129
+00:09:10,810 --> 00:09:15,570
+Nursing Care اللي هو أو Intermediate Nursing Care
+
+130
+00:09:15,570 --> 00:09:18,750
+مش Critical Care خدوا بالكوا حلاق إنه فيه
+
+131
+00:09:18,750 --> 00:09:21,870
+Intermediate Care فيه Intensive Care مش بس
+
+132
+00:09:21,870 --> 00:09:27,800
+Intensive Care يعني بعض الأقسام كتيردول عالم بعد
+
+133
+00:09:27,800 --> 00:09:32,300
+الـ unit عادي الـ surgical ward و ال medical ward
+
+134
+00:09:32,300 --> 00:09:35,880
+اللي منافق فيها المريض ممكن يضطروا إنهم يضعوا في
+
+135
+00:09:35,880 --> 00:09:40,220
+حاجة اسمها intermediate care إذا الوضع أكتر بوضوع
+
+136
+00:09:40,220 --> 00:09:45,040
+حاجة اسمها intensive careالـ Discharge Criteria من
+
+137
+00:09:45,040 --> 00:09:47,940
+المريض اللي بيطلعوه من الـ ICU ويقولوا عنه صار
+
+138
+00:09:47,940 --> 00:09:51,340
+كويس Status of patients admitted to ICU should be
+
+139
+00:09:51,340 --> 00:09:54,620
+revised continuously to identify patients who may
+
+140
+00:09:54,620 --> 00:09:59,100
+no longer need ICU care إن الناس اللي ما خلص بطل
+
+141
+00:09:59,100 --> 00:10:05,020
+عاج بحتاج رعاية حرجة، مين هو هذا المريض، هذا
+
+142
+00:10:05,020 --> 00:10:06,680
+المريض اللي win a patient
+
+143
+00:10:16,000 --> 00:10:21,220
+الحالة الفيسيولوجية بتاعها هي مدارمة وتنفس طبيعي،
+
+144
+00:10:21,220 --> 00:10:25,400
+ضغط طبيعي، نطق طبيعي، القلب ينطق طبيعي، الـUrine
+
+145
+00:10:25,400 --> 00:10:31,940
+Output طبيعي، الحالة التي تبعت الـBlood أو
+
+146
+00:10:31,940 --> 00:10:36,220
+الـElectrolyte عنده الـPalaceالحالة تبقى الـ
+
+147
+00:10:36,220 --> 00:10:38,700
+«status» تبقى في الـ «broadcast» تبقى عنده
+
+148
+00:10:38,700 --> 00:10:43,420
+«balance» ساعتها «why the patient is in ICU؟» ليش؟
+
+149
+00:10:43,420 --> 00:10:48,640
+المسبراتوري عنده okay الـ «circulatory» okay الـ
+
+150
+00:10:48,640 --> 00:10:52,080
+«renal» okay الـ «neurogenic» حتى conscious
+
+151
+00:10:52,080 --> 00:10:56,020
+وoriented وتمام تبقى بوعي أنه تبقى in ICU؟ لأ،
+
+152
+00:10:56,020 --> 00:11:01,160
+مافيش لزوملما يكون الـ pathological status تبع
+
+153
+00:11:01,160 --> 00:11:04,180
+تلمريه تستهبل و يكون خلاص المقروض ان يطلع من ال
+
+154
+00:11:04,180 --> 00:11:10,260
+ISU لما يكون فيها deterioration يعني لسه اللي
+
+155
+00:11:10,260 --> 00:11:13,740
+بيسببته ال status تبعته unstable مرات مخش في أدنية
+
+156
+00:11:13,740 --> 00:11:20,340
+مرات مخش في هيبوكسيا ال urine output مرات تصير
+
+157
+00:11:20,340 --> 00:11:25,520
+عنده un-urea او urea او مش عارفين لسه ليش بقى انه
+
+158
+00:11:25,520 --> 00:11:29,610
+الكلوب ال output عندهأو الـ Fluid Input عنده كويس،
+
+159
+00:11:29,610 --> 00:11:34,550
+طب شو اللي بيصير؟ بيكون فيه Active Intervention،
+
+160
+00:11:34,550 --> 00:11:40,200
+Intervention لسه احنا محتاجينه، وبالتاليالمريض
+
+161
+00:11:40,200 --> 00:11:43,820
+بيكون لسه بيدور to stay in ICU until أنه يرجع كل
+
+162
+00:11:43,820 --> 00:11:49,520
+شيء للاستئمال physiological condition تمام؟ هذا
+
+163
+00:11:49,520 --> 00:11:54,040
+اللي بيحدد خروجه من الـICU الآن بدنا نبدأ نعمل
+
+164
+00:11:54,040 --> 00:12:02,800
+assessment أكتر للحالة تبعت المريض ونحدد إذا هوفي
+
+165
+00:12:02,800 --> 00:12:08,540
+الـ ICU وإلا خلاص هو المفروض أنه يطلع من الـ ICU
+
+166
+00:12:08,540 --> 00:12:10,160
+عشان ذلك نجب أن نعمل assessment
+
+167
+00:12:31,720 --> 00:12:38,640
+التعامل هو مجرد تجارب لتعرف عندما يصبح الشخص مخطط
+
+168
+00:12:38,640 --> 00:12:42,420
+لما انا بعرف انه لأ المريض صار كتير بيس تمام مخطط
+
+169
+00:12:42,420 --> 00:12:48,180
+يعني صار يعني
+
+170
+00:12:48,180 --> 00:12:52,260
+أموره بيقدر يتحكم فيها على حاله سيتبطل بدل حد
+
+171
+00:12:52,260 --> 00:12:57,440
+يقتني كل شيء في المريض كيف يعني؟ لأن لو كل مريض يا
+
+172
+00:12:57,440 --> 00:13:02,340
+جماعة unconsciousوفي ال ICU وما بيتنفسش لحاله
+
+173
+00:13:02,340 --> 00:13:05,340
+بيكون احنا بيتنفس الله عن طريق جهاز تنافس صناعي
+
+174
+00:13:05,340 --> 00:13:08,280
+لما بيصير كورو باعي بيكون أنا انت جاهز لتنافس
+
+175
+00:13:08,280 --> 00:13:11,380
+صناعي البوري يتنفس لحالي و ال saturation كويس لما
+
+176
+00:13:11,380 --> 00:13:12,400
+بيكون المريض
+
+177
+00:13:16,540 --> 00:13:23,260
+Conscious وفي الـ ICU ويحس حاله عطشان بيحكي أنا
+
+178
+00:13:23,260 --> 00:13:28,020
+بدي أشرب لو سمحته، تمام؟ فبندرله، فهو قاعد بيحافظ
+
+179
+00:13:28,020 --> 00:13:30,960
+على الـ Fluid Intake و الـ Input تبعه، لما يكون
+
+180
+00:13:30,960 --> 00:13:35,920
+Unconscious، لأ الـ Nurse هو اللي بيحدد الـ Intake
+
+181
+00:13:35,920 --> 00:13:39,220
+تبعة المريض وإيديش بده يحطله كميات من السوائل
+
+182
+00:13:39,220 --> 00:13:43,440
+according أو based onالـ output اللي بيطلع من
+
+183
+00:13:43,440 --> 00:13:46,240
+المرض، آه خشت صعدت شويه كله فيه وردنا نديله كمان
+
+184
+00:13:46,240 --> 00:13:49,280
+أفلون، لأ و الله ماتمش نديله أفلون لأنه الـCDP
+
+185
+00:13:49,280 --> 00:13:53,360
+تبعه عالي فردنا نديله شويه ديورتيكس عشان نطرح كمية
+
+186
+00:13:53,360 --> 00:13:57,280
+سواحل زيادة من جسمه مصيب بمبكرة مش شدالة كويسة زي
+
+187
+00:13:57,280 --> 00:14:02,500
+انتفي الوضع الـ critical تبع ال patient ال nurse
+
+188
+00:14:02,500 --> 00:14:07,460
+يقوم مقام العقل ال nurse يقوم مقام ال heart ال
+
+189
+00:14:07,460 --> 00:14:11,980
+nurse يقوم مقام الكيليا ال nurse يقوم مقام ال
+
+190
+00:14:11,980 --> 00:14:17,540
+respiratory system ال nurse يقوم مقام اللي هو كل
+
+191
+00:14:17,540 --> 00:14:23,600
+ال systems الليبتبعت المريض يتحركه ولو كان هو
+
+192
+00:14:23,600 --> 00:14:27,640
+Conscious كان بيشكي لو سمحت أنا حاسس ظهري سخن
+
+193
+00:14:27,640 --> 00:14:32,400
+كأملولي change position لأنه أنا حاسس ظهري صار
+
+194
+00:14:32,400 --> 00:14:36,450
+يجعلي لكن لما يكون المريض unconsciousالإنتر بدك
+
+195
+00:14:36,450 --> 00:14:40,470
+تقوم مقام الإحساس من الـ Skin وبدك تحدد منه هذا
+
+196
+00:14:40,470 --> 00:14:43,310
+المريض بيحتاج كل ساعتين الـ change in position أو
+
+197
+00:14:43,310 --> 00:14:47,750
+هذا المريض لأ ال weight عنده عالي فبيحتاج أو زيادة
+
+198
+00:14:47,750 --> 00:14:51,530
+فال pressure الأرض اللي عنده expected أكتر فبيحتاج
+
+199
+00:14:51,530 --> 00:14:53,570
+ان اعمله الـ change in position مش كل ساعتين كل
+
+200
+00:14:53,570 --> 00:15:00,590
+ساعة لأن ال weight تبقى مثلا أكترتمام؟ فبتلاقي
+
+201
+00:15:00,590 --> 00:15:06,230
+حالك إن الناس هو اللي بيقوم مقام المريض as patient
+
+202
+00:15:06,230 --> 00:15:09,690
+advocate بدافع عن حقوقه من حقوقه اللي هو ممكن
+
+203
+00:15:09,690 --> 00:15:15,500
+بيطلبه لو انه صاحبمراقبة براقبه وبيعمل كل حاجة من
+
+204
+00:15:15,500 --> 00:15:18,500
+مطلقات المراقبة يعني براقب الـ neural output لما
+
+205
+00:15:18,500 --> 00:15:24,180
+بيلاقي ألجيوريا بيجيب تصرف ويكلم الطبيب ويشوف كيش
+
+206
+00:15:24,180 --> 00:15:28,680
+المفروض أنه ينعمل anticipating potential problems
+
+207
+00:15:28,680 --> 00:15:32,180
+إذا بيه مشكلة ممكن بدها تصيرأو حاتير زي الـ
+
+208
+00:15:32,180 --> 00:15:36,160
+«مكسور» اللي حكينا عنه أو زي أنه ما نقول بيونه
+
+209
+00:15:36,160 --> 00:15:40,520
+ممكن تتطور لمشاكل أكتر فالمفروض أنه على طول بتنبأ
+
+210
+00:15:40,520 --> 00:15:44,800
+بهذه القصة بدّى يبلغ الطبيب وبيعمل الـIntervention
+
+211
+00:15:44,800 --> 00:15:48,900
+المناسبة فعن طريق الـPlanning بدّى أحط الخطة اللي
+
+212
+00:15:48,900 --> 00:15:52,150
+بدهيرعى فيها المرضى، لو الـ Implementation تبدأ
+
+213
+00:15:52,150 --> 00:15:56,130
+يطبق هذا الفطر وبعد ذلك يبدأ يعمل Evaluation عشان
+
+214
+00:15:56,130 --> 00:15:59,850
+يشوف هل الـInterventions اللي أعملها فعلاً أدت
+
+215
+00:15:59,850 --> 00:16:05,410
+لإنها اتحل المشكلة اللي هو توقعها أو فعلاً حصلت
+
+216
+00:16:05,410 --> 00:16:11,090
+وبالتالي العملية تبع تلك الـEvaluation هي عملية
+
+217
+00:16:11,090 --> 00:16:15,510
+مستمرة وتحتاج Monitoring مستمرة عشان أستطيع أحدد
+
+218
+00:16:15,510 --> 00:16:21,820
+إذا أنا فعلاًهل حلتي المشكلة ولا لا؟ علشان هيك،
+
+219
+00:16:21,820 --> 00:16:26,880
+ليش احنا بنعمل الـassessment هذا لعدد أسباب to
+
+220
+00:16:26,880 --> 00:16:30,280
+establish a starting line، information on the
+
+221
+00:16:30,280 --> 00:16:33,880
+client أنا لما كنتي عندى baseline لل data، المرض
+
+222
+00:16:33,880 --> 00:16:39,520
+هذا الضغط تبعه أول ما إجا كان كذا
+
+223
+00:16:46,460 --> 00:16:51,260
+عن طريق الانتقال الاسعاري الاسعاري الاسعاري
+
+224
+00:16:53,460 --> 00:16:58,220
+عنده Severe Hypertension وكان عارف بدأنا نعمل معاه
+
+225
+00:16:58,220 --> 00:17:01,740
+Management ونشتغل الـ Baseline هذا اللي موجود عنده
+
+226
+00:17:01,740 --> 00:17:05,380
+هو اللي حدد ليه إذا إحنا الـ Interventions اللي
+
+227
+00:17:05,380 --> 00:17:11,800
+عملها كانت في صالحه ونزلت فعلا الـ ونزلت فعلا الـ
+
+228
+00:17:11,800 --> 00:17:15,780
+Blood Pressure تبع المريض ولا لأ إذا الحاجة
+
+229
+00:17:15,780 --> 00:17:18,720
+التانية تترمين الـ Client Normal Function عشان هيك
+
+230
+00:17:18,720 --> 00:17:22,450
+احنا بنعمل Assessmentعشان يكون عندى الـ Baseline
+
+231
+00:17:22,450 --> 00:17:26,150
+Data وعشان يكون عندى الـ Determined Client Normal
+
+232
+00:17:26,150 --> 00:17:29,270
+Function عارف الطبيعي عند المريض قداش، اذا اتجه
+
+233
+00:17:29,270 --> 00:17:33,830
+المريض لقى تلك اليتانين عنده 3.6، طب سألت أهله، طب
+
+234
+00:17:33,830 --> 00:17:38,350
+هو لما كان تتبار وكويس و أخر مرة عملت كل يتانين
+
+235
+00:17:38,350 --> 00:17:43,590
+قداش، قالولك برضه كان 3.6أه يعني هذا الـ base
+
+236
+00:17:43,590 --> 00:17:46,890
+تبعته هذا الـ normal تبع المريض إن هو الكيريتانين
+
+237
+00:17:46,890 --> 00:17:52,250
+عنده 3.6 طب في حد من الكيريتانين عنده 3.6؟ أه كتير
+
+238
+00:17:52,250 --> 00:17:57,010
+ناس بيكونوا diabetes و hypertension و بيصير عندهم
+
+239
+00:17:57,010 --> 00:18:01,590
+حالة بنسميها chronic kidney disease CKD اللي هو
+
+240
+00:18:01,590 --> 00:18:07,370
+نتيجة نتيجة
+
+241
+00:18:07,370 --> 00:18:09,870
+ال ..
+
+242
+00:18:29,800 --> 00:18:33,160
+عفوًا، to determine، أه، فكنا بنحكي عن إن أنا بكون
+
+243
+00:18:33,160 --> 00:18:38,620
+بعرف الـnormal function تبعته، و بعدين كمان، عشان
+
+244
+00:18:38,620 --> 00:18:41,500
+أحدد ال client risk for this function، كمان مشكلة
+
+245
+00:18:41,500 --> 00:18:47,770
+الممكنية للمريض إنه يصير عنده مشكلةفي الوظائف
+
+246
+00:18:47,770 --> 00:18:52,650
+تبعته، سواء كانت kidney أو heart أو liver أو
+
+247
+00:18:52,650 --> 00:18:55,590
+whatever، I try to remind the client strengths
+
+248
+00:18:55,590 --> 00:18:59,270
+عشان أحدد ماذا قوة المريض واستجابته، وإيديش ممكن
+
+249
+00:18:59,270 --> 00:19:02,750
+يساعدني، وإيديش ممكن يعمل response، وإيديش هو ممكن
+
+250
+00:19:02,960 --> 00:19:07,760
+ما يستجيبش لذلك نلاقي إن الـ Assessment له أنواع.
+
+251
+00:19:07,840 --> 00:19:11,660
+إيه الـ Assessment هذا اللي بيسميه، اللي بيسميها
+
+252
+00:19:11,660 --> 00:19:16,000
+جماعة «Admission Assessment» أو بيسموه اللي هو
+
+253
+00:19:16,000 --> 00:19:19,180
+يعني
+
+254
+00:19:19,180 --> 00:19:22,880
+إيش، إيش بنفتقر أنه فيه كمان إسم اللي هو اللي
+
+255
+00:19:22,880 --> 00:19:27,750
+بيسموه الـ Baseline Assessment اللي هو بالعربيبسير
+
+256
+00:19:27,750 --> 00:19:31,610
+عند الدخول واللي بنجمع فيه كل المعلومات عن المريض
+
+257
+00:19:31,610 --> 00:19:34,590
+الـ Initial Identification of Motor Function
+
+258
+00:19:34,590 --> 00:19:38,110
+Functional Status and Collection of Data Actual or
+
+259
+00:19:38,110 --> 00:19:41,450
+Potential Disfunction Baseline or Reference and
+
+260
+00:19:41,450 --> 00:19:45,820
+Future Comparisonعشان هذا، عشان هيك هذا وقتيش
+
+261
+00:19:45,820 --> 00:19:50,980
+بنعمل، بنعمل specified time frame after admission
+
+262
+00:19:50,980 --> 00:19:54,060
+تدوّر، مجرد ما يصير الـadmission، بيبقى موجود
+
+263
+00:19:54,060 --> 00:19:56,880
+الـassessment عشان هيك بيسموه admission assessment
+
+264
+00:19:56,880 --> 00:20:00,060
+لكن في نوع من أنواع الـassessment، اسمه focus
+
+265
+00:20:00,060 --> 00:20:03,320
+assessment إيش يعني focus assessment؟ يعني والله
+
+266
+00:20:03,320 --> 00:20:09,240
+أنا، أنت شركال في الـshift ووديت تسلم أو هيجز ميلك
+
+267
+00:20:09,240 --> 00:20:12,380
+وانت روح ومتوي سالمك الشيطان الجديد فبيحكي لك خُذ
+
+268
+00:20:12,380 --> 00:20:16,900
+بالك المريض رقم خمسة هذا في عمل نارو-dressing
+
+269
+00:20:16,900 --> 00:20:22,080
+اليوم على الـ amputation نفترض اللي عنده ولكن خُذ
+
+270
+00:20:22,080 --> 00:20:27,700
+بالك يعني بده assessment لغي bleeding لإنه احناعنا
+
+271
+00:20:27,700 --> 00:20:30,240
+الغيارة وحطينا غيارة جديدة كانت التانية ممكن تصبح
+
+272
+00:20:30,240 --> 00:20:33,400
+اندرويدية لإذن كل شوية راح تروح انت تعمل
+
+273
+00:20:33,400 --> 00:20:36,240
+assessment بس للاستعمال تبعته هذه اللي هي مكان ال
+
+274
+00:20:36,240 --> 00:20:38,820
+application من خوف اللي بيناده اسمه focus
+
+275
+00:20:38,820 --> 00:20:42,400
+assessment بس انت بتروح تقيم تجريب المنطقة دي okay
+
+276
+00:20:42,400 --> 00:20:45,810
+رائعوضع كل المريض بتاخد الـ Vital Signs بس أهم
+
+277
+00:20:45,810 --> 00:20:48,230
+حاجة من ده يعني حتى الـ Vital Signs اللي بتاخدها
+
+278
+00:20:48,230 --> 00:20:52,190
+بتاخدها تنوع من الفوكس السيزنيتياش إذا نجيت إنه
+
+279
+00:20:52,190 --> 00:20:56,270
+بدت الـ tachycardia بدت الـ heart تزيد الـ rate
+
+280
+00:20:56,270 --> 00:20:59,330
+صار فيه tachycardia وبدل الـ blood pressure ينزل
+
+281
+00:20:59,330 --> 00:21:03,130
+بتكون أنت صرت مقتنع إنه صار فيه bleeding عند
+
+282
+00:21:03,130 --> 00:21:07,350
+المريض هذا بتبدأ تشوف الجرأة بتطلع حال صار فيه سقد
+
+283
+00:21:07,350 --> 00:21:09,810
+غياره صار wet وبين إنه
+
+284
+00:21:12,340 --> 00:21:15,640
+يعني الـ Deep Reading ولا لا؟ لو كان في مريض تاني
+
+285
+00:21:15,640 --> 00:21:19,100
+وفيه أندوأبدومين البين وحكالك إنه كدبالك المريض
+
+286
+00:21:19,100 --> 00:21:21,800
+هذا بيشوف إنك كنت نويس أبدومين البين أنت بيكون فيه
+
+287
+00:21:21,800 --> 00:21:26,340
+أندوأشي بدون متابعة فهضلك تعمل assessment للبين
+
+288
+00:21:26,340 --> 00:21:30,860
+والـ degree of pain أداش بيزيد، أداش مخت في البين
+
+289
+00:21:30,860 --> 00:21:35,280
+هذا هو ال focus assessment اللي بنركز فيه على حاجة
+
+290
+00:21:35,280 --> 00:21:39,060
+معينة status determination of specific problem
+
+291
+00:21:39,060 --> 00:21:42,390
+identified during previous assessmentالتجارب
+
+292
+00:21:42,390 --> 00:21:45,950
+المستمرة تتعامل مع الـ Nurse Care في عدة ساعتين
+
+293
+00:21:45,950 --> 00:21:49,950
+إلى عدة ساعتين، وليس كثير من الوقت، لكن هناك شيء
+
+294
+00:21:49,950 --> 00:21:54,010
+اسمه الـ Time-Lapse، وهو تجارب التعامل والتقارير
+
+295
+00:21:54,010 --> 00:21:55,650
+بين المستخدم ومستخدم المستخدم ومستخدم المستخدم
+
+296
+00:21:55,650 --> 00:21:56,870
+ومستخدم المستخدم ومستخدم المستخدم ومستخدم المستخدم
+
+297
+00:21:56,870 --> 00:21:57,430
+ومستخدم المستخدم ومستخدم المستخدم ومستخدم المستخدم
+
+298
+00:21:57,430 --> 00:21:58,170
+ومستخدم المستخدم ومستخدم المستخدم ومستخدم المستخدم
+
+299
+00:21:58,170 --> 00:21:59,490
+ومستخدم المستخدم ومستخدم المستخدم ومستخدم المستخدم
+
+300
+00:21:59,490 --> 00:22:02,340
+ومستخدم المستخدم ومستخدم المستخدمأولها كان في وضع
+
+301
+00:22:02,340 --> 00:22:05,460
+معين، الآن صار في وضع آخر فانا بقارن من الوضع الـ
+
+302
+00:22:05,460 --> 00:22:10,660
+baseline ووضع الحالي وبحكي إن الوضع اتحسن، كيف
+
+303
+00:22:10,660 --> 00:22:15,440
+يعني؟ يعني مثلا إنت عملت، في عندك مريض وكان عمل
+
+304
+00:22:15,440 --> 00:22:20,120
+مقمول و admission في القسم وكان عنده سيولايتس،
+
+305
+00:22:20,120 --> 00:22:25,480
+تمام؟ وسيولايتس هذا كان ممتدلـ Frigilo نعتبر لنطقة
+
+306
+00:22:25,480 --> 00:22:29,520
+معينة نروح ونجيب الـ «mark» ونعمل «margin» ونحدد
+
+307
+00:22:29,520 --> 00:22:33,820
+الحدود تبع الـ «cellulitis» هذه إلى أن تاني يوم
+
+308
+00:22:33,820 --> 00:22:39,010
+بنروح بنعمل assessment ونشوف اللي هو إيشإيش اتغير
+
+309
+00:22:39,010 --> 00:22:41,930
+من البارح اليوم؟ فالـ Management تبقتنا أه والله
+
+310
+00:22:41,930 --> 00:22:45,030
+الـ Demarking صار إيش يعني Demarking؟ يعني إزداد
+
+311
+00:22:45,030 --> 00:22:48,830
+الـ Simulator تحت الـ Mark اللي عملناها يبقى
+
+312
+00:22:48,830 --> 00:22:57,070
+المريض بتحسن، تمام؟ وهذا مش ممكن يكون focus خلال
+
+313
+00:22:57,070 --> 00:23:03,190
+أيام، لأ ممكن يكون عادطويل إنه احنا المريض يروح
+
+314
+00:23:03,190 --> 00:23:07,650
+ويأخذ الإلاج تبعه ويستمر لأشهر وإحنا بنراقب في
+
+315
+00:23:07,650 --> 00:23:11,710
+الحالة تبعته طبعا لو بأخد مثال على أحكاية اللي هو
+
+316
+00:23:11,710 --> 00:23:16,350
+أشهر إنه المريض اللي بياخد مثلا مثلة chemotherapy
+
+317
+00:23:16,350 --> 00:23:20,510
+طبعا هذا بنحكي عنها كل أنواع الأسس مثلنا، تمام؟
+
+318
+00:23:20,510 --> 00:23:24,990
+فبياخد chemotherapy بسيط معادة يعني فبنقعد بتاعه
+
+319
+00:23:24,990 --> 00:23:28,290
+تلف لتصويت شهور وأكتر يمكن عامل ما تشوف ان بيحصل
+
+320
+00:23:29,470 --> 00:23:32,830
+يعني adaptation على الـ «site» التي بتبتعد من الـ
+
+321
+00:23:32,830 --> 00:23:35,550
+«chemotherapy» طبعاً في emergency assessment وهذا
+
+322
+00:23:35,550 --> 00:23:38,870
+النوع اللي نحتاجه في الـ «critical care» والنوع
+
+323
+00:23:38,870 --> 00:23:42,290
+التاني بيعرف عنه الـ «initial assessment» والنوع
+
+324
+00:23:42,290 --> 00:23:44,490
+التالف اللي هو الـ«focus assessment» فهدول
+
+325
+00:23:44,490 --> 00:23:46,410
+الـ«initial assessment» عند الـ«admission» اللي
+
+326
+00:23:46,410 --> 00:23:49,490
+محتاجه في الـICU الـ«focus assessment» اللي محتاجه
+
+327
+00:23:49,490 --> 00:23:54,090
+برضه في الـICU الـ«emergency assessment» برضه
+
+328
+00:23:54,090 --> 00:23:54,750
+محتاجه
+
+329
+00:23:57,480 --> 00:23:59,400
+أو الـ Life-threatening condition أنا بصير في الـ
+
+330
+00:23:59,400 --> 00:24:02,520
+Emergency Room وجدت حالة وعندها هذا الوضع فانا
+
+331
+00:24:02,520 --> 00:24:05,940
+لازم أعمل تقييم سريع فورا أحدد إن المريض هذا يبدو
+
+332
+00:24:05,940 --> 00:24:09,640
+إنه عنده Respiratory اللي عنده ربما عنده Nemo أو
+
+333
+00:24:09,640 --> 00:24:13,120
+Hemotoxin تاني بدنا نشتغل على الموضوع فورا ونركب
+
+334
+00:24:13,120 --> 00:24:16,850
+له chest tubeالمريض هذا أول ما إيجي لأ يبدو إنه
+
+335
+00:24:16,850 --> 00:24:19,710
+arrested والـ «هارد» مابننبضش وemergency
+
+336
+00:24:19,710 --> 00:24:23,330
+assessment على طول سريع بس حددت إنه ال «calotid
+
+337
+00:24:23,330 --> 00:24:26,470
+pulse» absent والمريض بياخدش spontaneous bleeding
+
+338
+00:24:26,470 --> 00:24:31,870
+ومافيش عنده spontaneous pumping يعني ال «هارد ريت»
+
+339
+00:24:31,870 --> 00:24:34,770
+مش شغال القلب مش شغال وبالتالي مافيش «هارد ريت»
+
+340
+00:24:34,770 --> 00:24:40,550
+وبالتالي قررت إن هذا بجهة الأمل CPR، تمام؟ فهذا
+
+341
+00:24:40,550 --> 00:24:47,240
+اللي هو طرق الassessment، عشان هيك فياللي هو يعني
+
+342
+00:24:47,240 --> 00:24:52,280
+طريقة ممكن تسهل علينا عملية الـAssessment على طريق
+
+343
+00:24:52,280 --> 00:24:57,400
+أقنم معين زي اسمه الـFan Cap أفكى عن الـFluid أدرش
+
+344
+00:24:57,400 --> 00:25:00,200
+الـFluid عند المريض وكيف حركة السوائل
+
+345
+00:25:00,200 --> 00:25:02,000
+الـElectrolyte الـBalance الـVibration
+
+346
+00:25:02,000 --> 00:25:05,240
+الـElectrolyte، الـA يعني أيه؟ اللي هو الـAeration
+
+347
+00:25:05,240 --> 00:25:12,470
+كيف حركة الـالتنافس عنده، التهوية يعني هل هو بتنفس
+
+348
+00:25:12,470 --> 00:25:17,930
+طبيعي تاكيدميا، ديسميا، كيف أموره الـ
+
+349
+00:25:17,930 --> 00:25:24,630
+Anginutrition الـ Anginutrition كيف
+
+350
+00:25:24,630 --> 00:25:28,570
+مستوى التخزين عند المريض كيف بتغذى المريض can use
+
+351
+00:25:28,570 --> 00:25:32,150
+the normal GI بتغذى الطبيعة ولا عن طريق اللي هو
+
+352
+00:25:32,150 --> 00:25:33,510
+feeding
+
+353
+00:25:35,250 --> 00:25:38,490
+أو من طريق الـ LG أو من طريق الـ Minerals أو من
+
+354
+00:25:38,490 --> 00:25:43,010
+طريق المساعدات أو الـ Communication كيف المريض هذا
+
+355
+00:25:44,530 --> 00:25:46,890
+بتم الـ Communication عنده؟ هل هو Conscious أصلا؟
+
+356
+00:25:46,890 --> 00:25:50,710
+Oriented؟ فى عنده Eye Contact؟ فى عنده
+
+357
+00:25:50,710 --> 00:25:54,010
+Cooperation؟ Oriented ولا لا؟ Aggressiveness كامة
+
+358
+00:25:54,010 --> 00:25:57,710
+أو أكتر؟ الـ Activity، هذا كله عشان أعمل الـ
+
+359
+00:25:57,710 --> 00:26:00,930
+Assessment الـ Activity، هل هو متحرك لحاله بالثين
+
+360
+00:26:00,930 --> 00:26:06,090
+ولا بده مساعدة ولا بده Complete، Dependent؟ هو مش
+
+361
+00:26:06,090 --> 00:26:09,090
+بس بده مساعدة، هو متمد عليا، مهيائية، لأنه بتعمل
+
+362
+00:26:09,090 --> 00:26:13,780
+كل حاجةالبين، في عنده بين ولا مافيش عنده بين؟ كده
+
+363
+00:26:13,780 --> 00:26:17,180
+مستوى هذا البين؟ في عنده كوب ولا لأ؟ هذا البين
+
+364
+00:26:17,180 --> 00:26:21,870
+ممكن يا جماعةإن حدده نعمله assessment عن طريق حد
+
+365
+00:26:21,870 --> 00:26:26,890
+اسمه PQRST اللي هو هذا رسم الـ ECG بس ماله ده
+
+366
+00:26:26,890 --> 00:26:31,390
+واحدة بس ماخدينها علشان يعني محدد بين عن طريقها
+
+367
+00:26:31,390 --> 00:26:36,870
+الـ P معناه precipitating as causes and creating
+
+368
+00:26:36,870 --> 00:26:41,130
+factors that makes it bitter يعني في precip، إيش
+
+369
+00:26:41,130 --> 00:26:46,230
+بيخلي أنت أنتعندك الـ pain يتحسن الـ Q الـ quality
+
+370
+00:26:46,230 --> 00:26:50,090
+of pain كيف توصف ال pain؟ كيف تبوصفه؟ يعني كيف نوع
+
+371
+00:26:50,090 --> 00:26:52,730
+ال pain اللي عندك؟ إذا السؤال الأول، عندك pain؟
+
+372
+00:26:52,730 --> 00:26:56,610
+أه، طب كيف بروح؟ لما فهمتي هيك بروح، أه، دي بقعد
+
+373
+00:26:56,610 --> 00:26:59,290
+أرداؤه في الفيسيولوجيا، يمكن فيه أندو ال trauma،
+
+374
+00:26:59,290 --> 00:27:02,870
+يمكن فيه أندو fracture طب كيف ال pain؟ ال Q ال
+
+375
+00:27:02,870 --> 00:27:07,360
+quality، كيف ال pain اللي عندك؟بعزشي بغز فيا نزل،
+
+376
+00:27:07,360 --> 00:27:11,600
+بعزشي طول، ببطع صدري، بعزشي ملخص فيا نخز، هذا ال
+
+377
+00:27:11,600 --> 00:27:15,880
+equality، بعزشي بيحرق حرجات ال region and
+
+378
+00:27:15,880 --> 00:27:19,020
+tradition، طب وين البلد بالظبط؟ هي دهان الألم، طب
+
+379
+00:27:19,020 --> 00:27:22,740
+وين ال content؟ لأ مركزين، لأ بروح على صدري، بروح
+
+380
+00:27:22,740 --> 00:27:26,700
+على إيدي الشمال، okay طب القاس الصدر كده؟ كم تبقى
+
+381
+00:27:26,700 --> 00:27:30,660
+عندك الألم؟ لو طفل، بنجيبله الصور هذولة، بنقوله
+
+382
+00:27:30,660 --> 00:27:34,320
+كيف عندك الألم، ستة لعشر، هاي عشر عام، مليون مليار
+
+383
+00:27:34,760 --> 00:27:43,260
+ثمانية أقل، ثمانية أقل، ثمانية أقل، ثمانية أقل،
+
+384
+00:27:43,260 --> 00:27:44,520
+ثمانية أقل، ثمانية أقل، ثمانية أقل، ثمانية أقل،
+
+385
+00:27:44,520 --> 00:27:46,540
+ثمانية أقل، ثمانية أقل، ثمانية أقل، ثمانية أقل،
+
+386
+00:27:46,540 --> 00:27:49,420
+ثمانية أقل، ثمانية أقل، ثمانية أقل، ثمانية أقل،
+
+387
+00:27:49,420 --> 00:27:54,960
+ثمانية أقل، ثمانية أقل، ثمانية أقل، ثمانية أقل،
+
+388
+00:27:54,960 --> 00:27:59,260
+ثمانية أقل،بتزيد لاند عشرة، انت لوين عندك القلم؟
+
+389
+00:27:59,260 --> 00:28:02,520
+تمام؟ طبعا احنا بغض النظرات الناس وكل واحد عنده
+
+390
+00:28:02,520 --> 00:28:07,640
+نتفت قلم عنده اتنين، بقولك حاسة عشرة، فلازم نفهمه
+
+391
+00:28:07,640 --> 00:28:11,960
+ان انت لازم تقصر شدة القلمبدرجة حقيقية عشان نعرف
+
+392
+00:28:11,960 --> 00:28:16,560
+كيف نتعامل معاك ولمّا يزيد عن هناك تستطيع تقصد إن
+
+393
+00:28:16,560 --> 00:28:21,520
+هي أنها رأيت مثلا أربعة لأ زاد صار ستة صار سبعة يا
+
+394
+00:28:21,520 --> 00:28:25,780
+جماعة محاسس هو لازم يعني يحط حاله يحط skill من صفر
+
+395
+00:28:25,780 --> 00:28:29,600
+لعشرة ويعرف حاله وين بالظبط عشان إحنا لما يزيد
+
+396
+00:28:29,600 --> 00:28:33,260
+يقدر يقرر إنه زاد تي تان فاكتور how often does the
+
+397
+00:28:33,260 --> 00:28:37,270
+pain occur كل التشويز عندنا في الوجهةمستمر، لأ،
+
+398
+00:28:37,270 --> 00:28:40,730
+بيجي خمس دقائق، بعدين بروح، أتصل إيه؟ لازم نعرف
+
+399
+00:28:40,730 --> 00:28:47,150
+منه بالظبط، عشان نعرف الـfrequency of being تمام؟
+
+400
+00:28:53,470 --> 00:28:58,350
+بقى الـ two slides ونكون خلصنا المحاضرة هذه Levels
+
+401
+00:28:58,350 --> 00:29:01,830
+of severity in critically ill patients أداش المريض
+
+402
+00:29:01,830 --> 00:29:05,610
+هذا severe يعني، أداش وضعه حرج؟ There are three
+
+403
+00:29:05,610 --> 00:29:10,650
+levels of severity عشان نحدد أن المريض هذا أداش
+
+404
+00:29:10,650 --> 00:29:14,830
+الـ critically illالأول أن يكون at risk يعني هو
+
+405
+00:29:14,830 --> 00:29:19,070
+تحت الخطر Management patient can contribute to be
+
+406
+00:29:19,070 --> 00:29:24,570
+cared for on the worm of origin provided a
+
+407
+00:29:24,570 --> 00:29:31,170
+critical care outreach team is involved، إيش يعني؟
+
+408
+00:29:31,170 --> 00:29:36,910
+يعني المريض هو فعلا تحت الخطر وريعيته بتتطلب أنه
+
+409
+00:29:39,530 --> 00:29:47,670
+يتم علاجه في القسم تبعه لكن ممكن أنه يجيله team
+
+410
+00:29:47,670 --> 00:29:50,590
+تبع a critical care يعني واحد مرض هناك على أي حالة
+
+411
+00:29:50,590 --> 00:29:54,330
+جاء ويهتم فيه في القسم تبعه يعني بمعنى أنه يجلس
+
+412
+00:29:54,330 --> 00:29:58,210
+واحد متخصص أكتر لكن مايحتاجش أن المريض نفسه ينقله
+
+413
+00:29:58,210 --> 00:30:03,630
+على الإناية المركزة لكن level 2 أن ال patient have
+
+414
+00:30:03,630 --> 00:30:05,430
+single organ impairment
+
+415
+00:30:08,760 --> 00:30:14,540
+اللي هو يعني مشكلة في أورجان واحد يعني مثلا في
+
+416
+00:30:14,540 --> 00:30:17,440
+الـheart، الـkidney، في الـ… في الـ… في
+
+417
+00:30:17,440 --> 00:30:21,020
+الـrespiratory وعشان هيك الـmanagement تبعته هذا
+
+418
+00:30:21,020 --> 00:30:26,340
+patient appropriate for high dependency care بيكون
+
+419
+00:30:26,340 --> 00:30:34,600
+صار محتاج أنه يعتمد على حد في العلاج وبالتالي أحسن
+
+420
+00:30:34,600 --> 00:30:39,420
+أنه يتم إدخاله إلى العناية المركزةLiberty يعني إن
+
+421
+00:30:39,420 --> 00:30:50,820
+المريض لديه أكتر من فشل في أكتر من جهاز وبالتالي
+
+422
+00:30:50,820 --> 00:30:56,000
+المريض هذا لا يمكن رؤاته إلا في الإناء الممتاز لا
+
+423
+00:30:56,000 --> 00:31:00,140
+يمكنها رؤاته إلا في الإناء الممتاز يعني هذا مافيش
+
+424
+00:31:00,140 --> 00:31:06,910
+إمكانية يعني ماينفعش يكون عنده أكتربشري في أكتر من
+
+425
+00:31:06,910 --> 00:31:10,530
+جهاز أو أكتر من قضية Respiratory Failure وكمان
+
+426
+00:31:10,530 --> 00:31:14,210
+Kidney Failure وخلّيه في القسم، لأ خلاص ده صح لازم
+
+427
+00:31:14,210 --> 00:31:17,290
+تبدو أنها مركزة للدخول وده اللي هو الـ Level
+
+428
+00:31:17,290 --> 00:31:21,510
+التالت عشان هيك إذا بتلاحظوا فيه تقسيمات عالمية
+
+429
+00:31:21,510 --> 00:31:26,810
+Level 0 Patients vs Patients whose needs can't be
+
+430
+00:31:26,810 --> 00:31:28,330
+met through normal care
+
+431
+00:31:31,720 --> 00:31:36,180
+الليل سفر عنده risk أه لكن كان ممكن كل الـCare
+
+432
+00:31:36,180 --> 00:31:41,880
+تبعه يهلل في داخل القسم لكن يكون ربما بمساعدة
+
+433
+00:31:41,880 --> 00:31:47,600
+أفراد القسم نفسهم level one إنه patient at risk of
+
+434
+00:31:47,600 --> 00:31:50,360
+their condition deteriorating or those recently
+
+435
+00:31:50,360 --> 00:31:54,920
+relocated from high levels of care يعني هو كان في
+
+436
+00:31:54,920 --> 00:31:59,250
+intensive care طلع ماله لل intensive careبنحطه في
+
+437
+00:31:59,250 --> 00:32:02,650
+اقتصاد لكن لسه وضعه بده شوية متابعة مش كتير تنام
+
+438
+00:32:02,650 --> 00:32:07,370
+الأيام يعني لسه at risk level one his needs can be
+
+439
+00:32:07,370 --> 00:32:13,050
+met on an acute ward بنحطه في اقتصاد A with
+
+440
+00:32:13,050 --> 00:32:16,570
+additional advice and support from a critical care
+
+441
+00:32:16,570 --> 00:32:21,550
+team لكن بده حد من التمريديهتم فيه ويرغى رعاية
+
+442
+00:32:21,550 --> 00:32:25,090
+حاليا ربما يكون الحد هذا من تمريض القسم نفسه بس
+
+443
+00:32:25,090 --> 00:32:27,690
+يقوله انت بس في وظيفتك العين هذا واندي بالك عليه
+
+444
+00:32:27,690 --> 00:32:33,130
+او يجيبه مرض رعاية حاليا وينقوله انت المكلف انك
+
+445
+00:32:33,130 --> 00:32:37,150
+تدي بالك على مريض هذا هاليومين قبل ما يرجع يسيل
+
+446
+00:32:37,150 --> 00:32:41,370
+متحرك كويس يقدر يتمد على نفسه و .. و .. و ..و
+
+447
+00:32:41,370 --> 00:32:46,250
+بيكون خلاص بيصير زيه زي بقية المرضى اللي في القسم
+
+448
+00:32:46,250 --> 00:32:50,230
+لإن إتنين إن زي ما هو حكينا إنه عنده organ failure
+
+449
+00:32:50,230 --> 00:32:55,830
+واحد و بيكون أحسن إنه يتلقى الرعاية تبعته في
+
+450
+00:32:55,830 --> 00:33:03,130
+العناية المركزة رغم إنه زي ما حكينا إنه ممكن، أه
+
+451
+00:33:03,130 --> 00:33:07,170
+ممكنإنه يطلقها في أي مكان تاني عشان ال patient
+
+452
+00:33:07,170 --> 00:33:09,950
+require more detailed observation وintervention
+
+453
+00:33:09,950 --> 00:33:14,030
+including support for a single failing organ or
+
+454
+00:33:14,030 --> 00:33:16,970
+postoperative care and those stilling down from
+
+455
+00:33:16,970 --> 00:33:21,770
+higher levels of care والناس برضه اللي هنا المركزة
+
+456
+00:33:21,770 --> 00:33:25,050
+مثلا على قسر يعني خلينا نسمي هدولة
+
+457
+00:33:31,460 --> 00:33:34,060
+أو الـ Respiratory Failure فلأ بنحطه هنا الـ
+
+458
+00:33:34,060 --> 00:33:38,420
+Intermediate Care و بنحطله جهاز Ventilator في قسم
+
+459
+00:33:38,420 --> 00:33:42,080
+الـ Oncology و بيعملوله حاجة بيسموها مثلا
+
+460
+00:33:42,080 --> 00:33:46,520
+Awakening of Intubation اللي هو تيوب من الـ Nose
+
+461
+00:33:46,520 --> 00:33:48,800
+أو بيعملوله Tracheostomy و بيشبكوه على Ventilator
+
+462
+00:33:48,800 --> 00:33:51,080
+اللي بيكون مريض Conscious و Oriental بيأكل و
+
+463
+00:33:51,080 --> 00:33:55,580
+بيشربوا الفم اللي حواليه تمام؟ فهو بده شوية مساعدة
+
+464
+00:33:55,580 --> 00:34:03,050
+لكن مش High Risk تمام؟اللي بعده level 3 اللي أكتر
+
+465
+00:34:03,050 --> 00:34:06,970
+من origin failure اللي حكينا هنا يجب أنه يتعالج
+
+466
+00:34:06,970 --> 00:34:11,010
+ويطلق الإله سبعه في الأنام مكثفة وبالتالي يكون
+
+467
+00:34:11,010 --> 00:34:11,830
+بمحتاج
+
+468
+00:34:15,090 --> 00:34:20,590
+القسم هنا مركزة والـ Team مختصدي هنا المركزة اللي
+
+469
+00:34:20,590 --> 00:34:25,990
+بتعامل معها هكذا خلصنا ال chapter أو ال chapter
+
+470
+00:34:25,990 --> 00:34:30,870
+التاني صحيح خلصنا بقول ال chapter الأول والتاني
+
+471
+00:34:30,870 --> 00:34:34,610
+وبدنا نبدأ ان شاء الله بال chapter التالت اللي هو
+
+472
+00:34:34,610 --> 00:34:36,170
+ال ethical consideration
+
diff --git a/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/YSSnq6kqP0E.srt b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/YSSnq6kqP0E.srt
new file mode 100644
index 0000000000000000000000000000000000000000..edacee0aa5a32178f463fbc39fa8089663f0119b
--- /dev/null
+++ b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/YSSnq6kqP0E.srt
@@ -0,0 +1,1319 @@
+1
+00:00:02,450 --> 00:00:05,290
+بسم الله الرحمن الرحيم السلام عليكم ورحمة الله
+
+2
+00:00:05,290 --> 00:00:09,850
+وبركاته، نكمل إن شاء الله ربنا أمين في الـ
+
+3
+00:00:09,850 --> 00:00:13,810
+«Management of Coronary Vascular Disorders»، طبعاً
+
+4
+00:00:13,810 --> 00:00:18,170
+بنحكي عن الـ «Coronary Artery Disease» اللي هي
+
+5
+00:00:18,170 --> 00:00:24,650
+متلازمة الـ «Acute Coronary Syndromes» اللي بيسموها
+
+6
+00:00:24,650 --> 00:00:27,990
+سواء كانت «Stable Angina» أو «Unstable Angina» أو
+
+7
+00:00:27,990 --> 00:00:31,600
+«Myocardial Infarction»، هذا كله بيسموها acute
+
+8
+00:00:31,600 --> 00:00:39,020
+coronary syndrome، وبعد هيك بنحاول نعرف إيش الـ
+
+9
+00:00:39,020 --> 00:00:43,660
+acute coronary syndrome اللي عند المريض هذا بالظبط
+
+10
+00:00:43,660 --> 00:00:46,760
+تُصنّف تحت أي تصنيف، تحت «stable angina» ولا
+
+11
+00:00:46,760 --> 00:00:50,280
+«unstable» ولا «myocardial infarction»؟ التشخيص
+
+12
+00:00:50,280 --> 00:00:55,680
+الجديد زي ما بنحكي أنه صار لأي حد بيكون بشكي من
+
+13
+00:00:55,680 --> 00:01:01,820
+symptoms معينة، منها الـ «chest pain»، منها أنه يكون
+
+14
+00:01:01,820 --> 00:01:04,940
+«shocked»
+
+15
+00:01:04,940 --> 00:01:10,380
+أو «hypotension» أو عنده علامات الـ basal
+
+16
+00:01:10,380 --> 00:01:14,040
+crepitation، «بنمول الأيدين»، كل هذه علامات الـ
+
+17
+00:01:14,040 --> 00:01:19,180
+unstability تبع المريض اللي بيشكي من الـ chest
+
+18
+00:01:19,180 --> 00:01:27,180
+pain، واللي بتخلينا نفكر فيه من الوضع الـ stable
+
+19
+00:01:27,180 --> 00:01:31,520
+للـ angina للوضع الـ unstable للـ angina
+
+20
+00:01:31,520 --> 00:01:38,050
+البين أو الـ myocardial infarction، عشان هيك بنحط
+
+21
+00:01:38,050 --> 00:01:43,610
+تفرقة بين الناس اللي بتيجي عندها acute coronary
+
+22
+00:01:43,610 --> 00:01:49,910
+syndrome زي ما بتحكي، وبيكون إيش الوضع تبعه؟ هل
+
+23
+00:01:49,910 --> 00:01:54,570
+هو stable angina البين ولا unstable angina ولا
+
+24
+00:01:54,570 --> 00:01:57,890
+myocardial infarction؟ هدول هم الثلاث تشخيصات مهمة
+
+25
+00:01:57,890 --> 00:02:01,870
+في الموضوع، إذا كان المريض بيشكي من chest pain و
+
+26
+00:02:01,870 --> 00:02:04,470
+discomfort و shortness of breath
+
+27
+00:02:07,460 --> 00:02:12,060
+at rest، هو مرتاح، يبقى هذا unstable angina and could
+
+28
+00:02:12,060 --> 00:02:16,940
+be MI، طب وإذا كان after exertion، بعد تعب
+
+29
+00:02:16,940 --> 00:02:19,860
+بيصير مع الحاجة هذه، بتكون هذا في الأغلب stable
+
+30
+00:02:19,860 --> 00:02:24,460
+angina، يعني لما برجع برتاح بروح كل الـ symptoms هذه
+
+31
+00:02:24,460 --> 00:02:29,140
+وبتميز أنه هذا مع الـ exertion، لكن إذا مع الـ
+
+32
+00:02:29,140 --> 00:02:33,800
+without exertion، at rest، بيصير هذا الكلام
+
+33
+00:02:33,800 --> 00:02:36,720
+معاه، بيكون هذا unstable angina و could be
+
+34
+00:02:36,720 --> 00:02:39,960
+myocardial infarction، إيش الفرق بين الـ myocardial
+
+35
+00:02:39,960 --> 00:02:43,780
+infarction و الـ angina؟ إنه في الـ … اه في الـ
+
+36
+00:02:43,780 --> 00:02:45,900
+myocardial infarction بيكون فيه complete
+
+37
+00:02:45,900 --> 00:02:49,160
+obstruction للـ coronary artery اللي بتغذي الـ
+
+38
+00:02:49,160 --> 00:02:51,800
+heart، يعني واحد من الـ branches تبع الـ coronary
+
+39
+00:02:51,800 --> 00:02:55,120
+artery اللي بيغذي منطقة معينة من الـ heart بيصير
+
+40
+00:02:55,120 --> 00:02:58,820
+فيه complete obstruction، وبالتالي في منطقة كاملة من
+
+41
+00:02:58,820 --> 00:03:03,010
+الـ heart بتبطل تتغذى وبتصير فيها اسكيميا، وهذا هو
+
+42
+00:03:03,010 --> 00:03:08,110
+السبب الرئيسي في الـ pain الشديد اللي بيصير مع
+
+43
+00:03:08,110 --> 00:03:14,010
+المرضى، لكن في الـ angina بكون الـ obstruction هذا في
+
+44
+00:03:14,010 --> 00:03:19,030
+الـ branch هذا partial، يعني لسه فيه يعني ولو خرم
+
+45
+00:03:19,030 --> 00:03:23,110
+صغير منه، بنمرر على المريض شوية blood فبمنع أن تصير
+
+46
+00:03:23,110 --> 00:03:27,150
+المنطقة completely اسكيميا أو complete death، لا
+
+47
+00:03:27,150 --> 00:03:31,170
+تشوف اللي فيها بتكون عايشة، لكن الـ perfusion بكون
+
+48
+00:03:31,170 --> 00:03:38,890
+يعني very low، وطبعاً ممكن جداً تتطور للي هو
+
+49
+00:03:38,890 --> 00:03:43,390
+الـ unstable angina هذه لـ MI، وتسكر خالص، عشان
+
+50
+00:03:43,390 --> 00:03:45,470
+هيك المريض بيكون في عنده pain، بكون في عندنا
+
+51
+00:03:45,470 --> 00:03:49,430
+shortness of breath، في كتير ناس بتحكي على التفرقات
+
+52
+00:03:49,430 --> 00:03:53,370
+بين الـ angina، الـ pain و myocardial
+
+53
+00:03:53,370 --> 00:03:58,120
+infarction، أنا ما بقيدش الفكرة هذه لأن الاتنين
+
+54
+00:03:58,120 --> 00:04:04,590
+شبه بعض كتير من ناحية الـ pain، إلا أنه في الـ MI
+
+55
+00:04:04,590 --> 00:04:10,130
+الـ pain بكون يعني most severe، بكون أكثر، وهذا
+
+56
+00:04:10,130 --> 00:04:13,730
+الشيء برضه يعني it depends، أحياناً بيكون المريض
+
+57
+00:04:13,730 --> 00:04:18,350
+diabetic، فما بتكونش عنده الـ pain هو الأكثر ولا
+
+58
+00:04:18,350 --> 00:04:22,750
+بالعكس، ممكن يجيلك asymptomatic، حتى الـ radiation
+
+59
+00:04:22,750 --> 00:04:28,270
+تبع الـ pain، كتير بيحكوا إنه الـ acute colitis أو
+
+60
+00:04:28,270 --> 00:04:32,110
+الـ MI اللي بينتشر لها كذا، الـ angina اللي بينتشر لها
+
+61
+00:04:32,110 --> 00:04:35,710
+لأ لأ، الـ acute coronary syndrome بشكل عام اللي
+
+62
+00:04:35,710 --> 00:04:39,170
+ب ينتشر لها بيجي في الـ chest وبروح بعمل radiation على الـ
+
+63
+00:04:39,170 --> 00:04:42,970
+shoulder أو بروح على الـ left arm والـ back والـ neck
+
+64
+00:04:42,970 --> 00:04:46,290
+وحتى الـ jaw، سواء كان فيه يعني شفنا هذه الحاجات
+
+65
+00:04:46,290 --> 00:04:49,690
+سواء كانت angina أو بالأخر تطلع MI، نفس الـ symptoms
+
+66
+00:04:50,100 --> 00:04:53,460
+تمام؟ كمان يعني بدي أضيف إنه ممكن في آخر حالة
+
+67
+00:04:53,460 --> 00:04:57,640
+شوفتها في استقبال باطنة من أيام إنه ممكن يجيلك pain
+
+68
+00:04:57,640 --> 00:05:01,980
+على الـ right side، تصور يعني يجيك chest pain على الـ
+
+69
+00:05:01,980 --> 00:05:07,100
+right side مش أصلاً على الـ left side، وممكن يضل
+
+70
+00:05:07,100 --> 00:05:10,160
+يعني، والمريض طلع عنده، والحاجة الوحيدة اللي كان
+
+71
+00:05:10,160 --> 00:05:13,980
+فيهها المريض غريبة إنه كان sweaty، يعني شوية
+
+72
+00:05:13,980 --> 00:05:18,840
+pain مش كتير على الـ right side، الدكاترة معظمهم قالوا
+
+73
+00:05:18,840 --> 00:05:23,020
+واحدة muscular، ولكن ربنا سبحانه وتعالى ألهمني لما شفت
+
+74
+00:05:23,020 --> 00:05:27,080
+المريض كتير sweaty، حسيت أن وضعه مش طبيعي وأنه يعني
+
+75
+00:05:27,080 --> 00:05:32,820
+تقليله لشأن الألم اللي عنده، كمية الألم ربما إلها
+
+76
+00:05:32,820 --> 00:05:36,580
+سبب آخر، فحبيت نعمل الـ ECG فطلع فيه فعلاً
+
+77
+00:05:36,580 --> 00:05:41,080
+ST elevation high، لذلك إحنا فعلاً مع التطور اللي
+
+78
+00:05:41,080 --> 00:05:44,940
+حصل في الطب واللي بيسموه اللي هو acute coronary
+
+79
+00:05:44,940 --> 00:05:48,880
+syndrome، وبعد وبيسموه يعني هذه التسمية الموحدة لهم
+
+80
+00:05:49,170 --> 00:05:53,330
+وبعد ذلك، بيحاولوا يعرفوها، هل هي المريض في وضع
+
+81
+00:05:53,330 --> 00:05:56,250
+Stable Angina أو Unstable Angina أو
+
+82
+00:05:56,250 --> 00:06:00,130
+Myocardial Infarction، بالنسبة للتشخيص المبدئي
+
+83
+00:06:00,130 --> 00:06:02,790
+تبع الـ Acute Coronary Syndrome اللي اتفقنا أنه
+
+84
+00:06:02,790 --> 00:06:05,930
+ممكن يكون فيه نفس الأعراض، كلهم ييجوا بنفس الـ
+
+85
+00:06:05,970 --> 00:06:10,350
+الأعراض، وممكن يجي فيه ECG changes بالأول، وممكن
+
+86
+00:06:10,350 --> 00:06:14,050
+ما يكونش فيه ECG changes بالأول، وبعد شوية تظهر فيه
+
+87
+00:06:14,050 --> 00:06:17,530
+ECG changes، ممكن الـ cardiac enzyme بالأول تكون
+
+88
+00:06:17,530 --> 00:06:21,930
+normal، وأنا أعتبره موضوع angina البين فقط ليس إلا
+
+89
+00:06:21,930 --> 00:06:24,990
+بعد شوية يتطور ويصير فيه elevated في الـ cardiac
+
+90
+00:06:24,990 --> 00:06:28,030
+enzyme، ويبقى الموضوع أنه عبارة عن myocardial
+
+91
+00:06:28,030 --> 00:06:32,450
+infarction، لكن كانت لسه cooking، ما بينتش، لذلك
+
+92
+00:06:32,450 --> 00:06:38,730
+الـ angina والـ MI يعني هي مراحل بتتسلّم بعضها
+
+93
+00:06:38,730 --> 00:06:41,610
+ممكن يكون angina المريض، ممكن جداً بعدها يخش فيه MI،
+
+94
+00:06:41,610 --> 00:06:44,670
+فلذلك لازم نكون حذرين، الـ risk factors ممكن
+
+95
+00:06:44,670 --> 00:06:47,950
+تؤدي لإنه يصير في عند المريض acute coronary
+
+96
+00:06:47,950 --> 00:06:51,710
+syndrome أو اللي هي coronary artery disease
+
+97
+00:06:51,710 --> 00:06:57,030
+اللي أهمها الـ tobacco use، الـ smoking، الـ
+
+98
+00:06:57,030 --> 00:07:00,930
+hypertension، الـ stress بالدرجة الأولى على فكرة
+
+99
+00:07:00,930 --> 00:07:05,050
+والـ diabetes والـ hyperglycemia، يعني هذه من
+
+100
+00:07:05,050 --> 00:07:08,670
+الحاجات المعروفة
+
+101
+00:07:08,670 --> 00:07:13,650
+والـ obesity طبعاً والـ platelet aggregation، في ناس
+
+102
+00:07:13,650 --> 00:07:16,410
+عندها بيكون في polycythemia، هذه من الحاجات
+
+103
+00:07:16,410 --> 00:07:19,630
+المعروفة أنها بتزيد الـ risk لـ Coronary Artery
+
+104
+00:07:19,630 --> 00:07:25,330
+Disease، وهذا يعتبر modifiable، ممكن إحنا ممكن إحنا
+
+105
+00:07:25,330 --> 00:07:32,290
+نتحكم فيها ونعمل لها حاجات تحسن منها، مثلًا tobacco
+
+106
+00:07:32,290 --> 00:07:35,850
+use، نقوله ما تدخنش، ويبقى يدخن ويتحسن الوضع عنده
+
+107
+00:07:35,850 --> 00:07:41,070
+الـ blood pressure، ممكن يأخذ أدوية ويحصل control
+
+108
+00:07:41,070 --> 00:07:44,970
+على الـ hypertension تبعه، فيرجع ضغطه للوضع الطبيعي
+
+109
+00:07:44,970 --> 00:07:48,330
+كذلك السكر، كذلك الـ obesity، ممكن يعمل دايت، ممكن
+
+110
+00:07:48,330 --> 00:07:51,850
+يعمل رياضة، لكن في حاجات non-controllable زي الـ age مثلاً
+
+111
+00:07:51,850 --> 00:07:55,170
+والـ gender، معروف أن الحاجات هذه ممكن تصير عند
+
+112
+00:07:55,170 --> 00:07:58,410
+الـ female أكثر، كمان تصير في الـ age
+
+113
+00:08:03,430 --> 00:08:06,430
+عفواً، الـ hypertension بيصير في الـ end الـ
+
+114
+00:08:06,430 --> 00:08:11,010
+female أكثر، الـ acute coronary syndrome بيصير في الـ end الـ
+
+115
+00:08:11,010 --> 00:08:14,890
+male أكثر، ربما لأن الـ stress أكثر،
+
+116
+00:08:14,890 --> 00:08:19,870
+الـ age كمان، كل ما ارتفع الـ age كل ما بيصير،
+
+117
+00:08:19,870 --> 00:08:24,170
+بيزيد الـ risk، فهذه كلها risk factors ممكن
+
+118
+00:08:24,170 --> 00:08:27,890
+تعمل الكلام، فهذا لذلك أنا مش هحكي بالتفصيل عن الـ
+
+119
+00:08:27,890 --> 00:08:28,210
+android
+
+120
+00:08:32,780 --> 00:08:35,380
+والتصنيفات، لأنه إحنا فهمنا إن الـ acute
+
+121
+00:08:35,380 --> 00:08:39,060
+coronary syndrome إنه بيجيب المريض بـ متلازمة
+
+122
+00:08:39,060 --> 00:08:41,660
+اللي هي الـ chest pain، shortness of breath،
+
+123
+00:08:41,660 --> 00:08:46,600
+difficulty breathing، الحاجات هذه، وبعدها أنا
+
+124
+00:08:46,600 --> 00:08:50,760
+أقرر إذا هو stable angina ولا هو MI بناءً على
+
+125
+00:08:50,760 --> 00:08:56,200
+نتائج تبع الـ cardiac enzymes و ECG changes اللي موجودة
+
+126
+00:08:56,200 --> 00:09:00,370
+عندي بالإضافة إلى الـ symptoms، بس الفرق الوحيد
+
+127
+00:09:00,370 --> 00:09:04,030
+اللي بدنا نعرفه أنه طول ما هو الكلام هذا بيصير
+
+128
+00:09:04,030 --> 00:09:07,730
+معاه بس after exertion بتكون هذه اسمها stable
+
+129
+00:09:07,730 --> 00:09:10,930
+angina، لأنه مجرد ما برجع بيستريح، بيرجع الوضع عنده
+
+130
+00:09:10,930 --> 00:09:15,670
+كويس، بيبقى بيهمنا، لكن إذا الـ symptoms بتصير معاه بتكون
+
+131
+00:09:15,670 --> 00:09:18,990
+هذا unstable وممكن تكون MI، بيبقى بيهمنا نعرف إيش
+
+132
+00:09:18,990 --> 00:09:24,840
+اللي المفروض نعمله، هذه الـ severities كما نرى كيفها
+
+133
+00:09:24,840 --> 00:09:29,760
+لما تكون asymptomatic angina، angina بس ما فيش أي
+
+134
+00:09:29,760 --> 00:09:32,260
+symptom، angina only with strenuous exertion
+
+135
+00:09:32,260 --> 00:09:37,680
+لما بيصير أنت بشوية يعني
+
+136
+00:09:37,680 --> 00:09:40,960
+activity أكثر من الطبيعي، ممكن تصير angina
+
+137
+00:09:40,960 --> 00:09:45,180
+moderate exertion، بتعب شوية، بيمشي شوية، بيجري شوية
+
+138
+00:09:45,180 --> 00:09:50,880
+مع الـ مع الـ mild exertion، تصور أنك بتصير مع إيه؟
+
+139
+00:09:50,880 --> 00:09:56,820
+عشان أنا مع الـ اللي يعني مع جهود، جهود مثلاً لو نطلع درج
+
+140
+00:09:56,820 --> 00:10:01,440
+هنا، مع جهود إيه؟ موديلة متوسطة، مع جهود بسيطة، بس
+
+141
+00:10:01,440 --> 00:10:06,120
+ده بروح الحمام ولا حاجة، اه ممكن يصير، لكن إذا كان
+
+142
+00:10:06,120 --> 00:10:09,960
+angina at rest، ماذا يعني؟ إنه هو unstable،
+
+143
+00:10:09,960 --> 00:10:16,200
+تمام؟ طبعاً في الـ ECG لو عملنا لمريض عنده angina
+
+144
+00:10:16,200 --> 00:10:19,660
+عملنا له ECG، إحنا بنلاقي أنه عنده ST depression أو
+
+145
+00:10:19,660 --> 00:10:23,740
+بنلاقي يعني الـ ST بتكون نازلة تحت، هنشوف في الـ ECG
+
+146
+00:10:23,740 --> 00:10:31,460
+كيف نعمل ECG لها، تطلع كيف هي… هي الـ… خلينا
+
+147
+00:10:31,460 --> 00:10:37,350
+نشوف هنا بالظبط أوضح، تطلع كيف؟ هذه الـ P wave، وهذه
+
+148
+00:10:37,350 --> 00:10:41,550
+الـ QRS، المفروض يأتي الـ isoelectric line هنا
+
+149
+00:10:41,550 --> 00:10:46,470
+ويكمل ويعمل الـ T، بس هذه تبقى الـ S وهذه الـ T هي
+
+150
+00:10:46,470 --> 00:10:48,670
+الـ depression، نزلت عن الـ isoelectric line، ما معنى
+
+151
+00:10:48,670 --> 00:10:52,110
+isoelectric line؟ المفروض هي الـ isoelectric line
+
+152
+00:10:52,110 --> 00:10:57,310
+هيك هنا، المفروض يكمل هيك تماماً مع الخط هذا زي الـ
+
+153
+00:10:57,310 --> 00:11:03,450
+ECG الطبيعي، لكن هو فعلياً بتنزل، بعدين تأتي الـ
+
+154
+00:11:03,450 --> 00:11:07,400
+wave هذا، من هنا تبدأ wave جديدة، تمام؟ فعشان هي كالـ
+
+155
+00:11:07,400 --> 00:11:12,900
+T wave نزلت لتحت، ST depression، تمام؟ هذا هو اللي
+
+156
+00:11:12,900 --> 00:11:21,380
+هو الـ angina البين، والعلامات تبعتها على الـ ECG
+
+157
+00:11:21,380 --> 00:11:24,360
+ويكون برضه الـ T wave inversion during angina
+
+158
+00:11:24,360 --> 00:11:30,140
+البين، بتكون متغيرة ونازلة لتحت، حكينا الفرق بين
+
+159
+00:11:30,140 --> 00:11:34,180
+الـ stable angina والـ unstable angina، وحكينا أن
+
+160
+00:11:34,180 --> 00:11:39,400
+الـ unstable angina ممكن تتحول
+
+161
+00:11:39,400 --> 00:11:43,000
+لـ myocardial
+
+162
+00:11:43,000 --> 00:11:47,560
+infarction، العلامات مهمة جداً أشوف المريض إذا كان
+
+163
+00:11:47,560 --> 00:11:53,670
+sweaty وشكله بليل وعنده difficulty وهو عنده pain زي ما
+
+164
+00:11:53,670 --> 00:11:57,050
+حكينا، والصفات وسواء كان في الـ center تبع الـ
+
+165
+00:11:57,050 --> 00:12:00,310
+chest أو radiated للـ shoulder والـ neck والـ jaw والـ
+
+166
+00:12:00,310 --> 00:12:05,210
+left arm، طبعاً المفروض أننا نتعامل مع المريض
+
+167
+00:12:05,210 --> 00:12:10,170
+بـ nitroglycerin، وبيأخذ أول حبة من الـ nitroglycerin
+
+168
+00:12:10,170 --> 00:12:15,530
+وبنقيم حالته إذا اتحسن ولا لأ بعد خمس دقائق، ممكن
+
+169
+00:12:15,530 --> 00:12:19,690
+يتم إعادتها كمان جرعة، أو ممكن كمان جرعة وما يتحسنش
+
+170
+00:12:19,690 --> 00:12:23,870
+بيكون الوضع أكثر من أن يكون الـ angina البين أو
+
+171
+00:12:23,870 --> 00:12:31,290
+stable angina، فبيكون المريض بيلزم إنه يعني ينعمل له
+
+172
+00:12:31,290 --> 00:12:34,570
+إجراءات أكثر، فبالتالي بيلزم إنه يروح على مستشفى عشان
+
+173
+00:12:34,570 --> 00:12:38,410
+ينعمل له ECG و cardiac enzyme ويكون under اللي هو
+
+174
+00:12:38,410 --> 00:12:43,870
+close monitoring and follow-up
+
+175
+00:12:43,870 --> 00:12:48,350
+لو بدنا نشوف إحنا كـ nurses إيش المفروض نعمل لو
+
+176
+00:12:48,350 --> 00:12:52,030
+جاتنا حالة على الطوارئ أو عنده هذه الـ symptoms، أول
+
+177
+00:12:52,030 --> 00:12:55,190
+حاجة طبعاً لازم نحطه في bed rest، دي اللي بنحكي
+
+178
+00:12:55,190 --> 00:13:00,650
+ك
+
+223
+00:16:00,030 --> 00:16:06,310
+فهنديها لو كان المريض عنده myocardial infarction
+
+224
+00:16:06,310 --> 00:16:10,610
+وأنا حاسس أن الموضوع أكثر من أنه أنجينا  بين
+
+225
+00:16:10,610 --> 00:16:16,000
+بنبدأ نتصرف يا جماعة بشكل حتى لو أنا مش عارف أنه
+
+226
+00:16:16,000 --> 00:16:19,060
+لسه مركز عن الفشل، لسه عندي الـsymptom هذه، ببدأ
+
+227
+00:16:19,060 --> 00:16:23,500
+أدي حاجة اسمها الـAnti-platelet اللي هي عبارة عن
+
+228
+00:16:23,500 --> 00:16:27,600
+الـAspirin، وفي الحالات الطارئة، بندي 300 مليجرام
+
+229
+00:16:27,600 --> 00:16:32,720
+Aspirin، Chewing، يعني ينضغها المريض مضغًا، وبعد ذلك
+
+230
+00:16:33,140 --> 00:16:36,800
+يبلعها، الهدف من المضغ هذا أنه يصبح الـ Absorption
+
+231
+00:16:36,800 --> 00:16:40,160
+تبعها في الـ mucosa  تبع الـ Oral Cavity أسرع
+
+232
+00:16:40,160 --> 00:16:44,500
+وبالتالي يشتغل as Anti-aggregant، فلو كان فيه
+
+233
+00:16:44,500 --> 00:16:48,880
+Thrombus عمال بتتكون، بيمنع اللي هو كبير حجم الـ
+
+234
+00:16:48,880 --> 00:16:51,660
+Thrombus هذه، وبيمنع الـ Complete enclosure إذا بده
+
+235
+00:16:51,660 --> 00:16:55,900
+يصبح Enclosure، وبده تتحول هذه الحالة لـMI، ولذلك
+
+236
+00:16:55,900 --> 00:17:01,700
+دائمًا بننصح فيه، بعد ذلك الـ ECG والـ Cardiac
+
+237
+00:17:01,700 --> 00:17:05,180
+Enzymes اللي هتطلع قرائتها، هي هتحكي لي إذا كان
+
+238
+00:17:05,180 --> 00:17:09,300
+هذا المريض فعلاً Unstable أنجينا بس ولا لأ، هو صار
+
+239
+00:17:09,300 --> 00:17:15,640
+فعلاً MI، وصار فيه Complete Obstruction في أحد الـ
+
+240
+00:17:15,640 --> 00:17:18,700
+لومن أو أحد البранches تبع الـ coronary
+
+241
+00:17:18,700 --> 00:17:22,920
+arteries، وبالتالي بيصطلع عنده علامات في الـ STG
+
+242
+00:17:22,920 --> 00:17:26,360
+اللي بيسموها الـ ST elevation، إيش يعني ST
+
+243
+00:17:26,360 --> 00:17:29,140
+elevation؟ أفرجيكم، هاي الـ Isoelectric line
+
+244
+00:17:29,140 --> 00:17:34,240
+اللي كنت بوضحها لكم، يعني هاي بيكون، هاي الـP، وبعدها
+
+245
+00:17:34,240 --> 00:17:38,300
+وبعد ذلك هاي الـ T، هي طلع الـ R، الـ S في الأصل
+
+246
+00:17:38,300 --> 00:17:42,200
+بتكون inverted لتحت، وبعدين إيش بتطلع، والـ T بتكمل
+
+247
+00:17:42,200 --> 00:17:46,760
+دورتها تمام، في الـ ST elevation إيش بيصير فيه؟ بي-
+
+248
+00:17:46,760 --> 00:17:52,260
+طلع الـ R، مكملتش لتحت، بعدين إجت الـ S
+
+249
+00:17:52,260 --> 00:17:58,410
+من فوق، إجت الـ S، الـ Isoelectric line يجب أن ينزل وينزل وينزل و-
+
+250
+00:17:58,410 --> 00:18:02,050
+ينزل وينزل وينزل وينزل وينزل وينزل وينزل و-
+
+251
+00:18:02,050 --> 00:18:07,010
+ينزل وينزل وينزل وينزل وينزل وينزل وينزل و-
+
+252
+00:18:07,010 --> 00:18:07,250
+ينزل وينزل وينزل وينزل وينزل وينزل وينزل و-
+
+253
+00:18:07,250 --> 00:18:09,770
+ينزل وينزل وينزل وينزل وينزل وينزل وينزل و-
+
+254
+00:18:09,770 --> 00:18:15,090
+ينزل وينزل وينزل وينزل وينزل
+
+255
+00:18:15,090 --> 00:18:19,750
+و
+
+256
+00:18:19,750 --> 00:18:24,200
+يالـ  BQR، هي الـ S نزلت  لأسفل، وبعدين الـ T تطلع
+
+257
+00:18:24,200 --> 00:18:30,620
+طبيعي، لكن هنا راح شوفوا كيف هكذا الفرق، فهذا هو طبعًا
+
+258
+00:18:30,620 --> 00:18:37,760
+IQR S، هاي T تمام، هاي الـ Isoelectric line واحدة،
+
+259
+00:18:37,760 --> 00:18:41,100
+هاي هو هاي، هاي الـ Isoelectric line، لكن هنا وين
+
+260
+00:18:41,100 --> 00:18:45,680
+الـ Isoelectric line؟ مش فوق، فهذا بنسميه ST
+
+261
+00:18:45,680 --> 00:18:50,840
+elevation، هذه أهم علامات الـ M.I. على الـ ECG طبعًا
+
+262
+00:18:50,840 --> 00:18:54,220
+بنحكي إن في حاجة اسمها non-stemic M.I.، يعني ممكن
+
+263
+00:18:54,220 --> 00:18:58,520
+يكون myocardial infarction لكن without ST
+
+264
+00:18:58,520 --> 00:19:03,240
+elevation، وهذا بيبين أنه مافيش يعني علامات على الـ
+
+265
+00:19:03,240 --> 00:19:08,050
+ECG، مافيش حقس ST elevation لكن فيه symptoms وفيه
+
+266
+00:19:08,050 --> 00:19:10,950
+Related Cardiac Enzymes اللي حكينا عنها، بالذات
+
+267
+00:19:10,950 --> 00:19:16,250
+الـCK والـCKMB، وحكينا إن الـCKMB لازم يكون يعني
+
+268
+00:19:16,250 --> 00:19:24,430
+بارتفاع  يرضي مع الـCK بما يزيد عن 10% من الـCK
+
+269
+00:19:24,430 --> 00:19:29,490
+نفسه، الـCKMB يكون أكثر من 10% من الـCK نفسه
+
+270
+00:19:33,450 --> 00:19:36,970
+طبعًا الـ Clinical Manifestation عارفينها، بس بدي
+
+271
+00:19:36,970 --> 00:19:39,390
+أحكي زيادة على حاجة، اللي هي دعوة بالـ
+
+272
+00:19:39,390 --> 00:19:42,770
+Gastrointestinal Attract، إن الناس دول عادة بيكون
+
+273
+00:19:42,770 --> 00:19:45,510
+عندهم Vagal Stimulation، فبيجيوا Picture of Nausea
+
+274
+00:19:45,510 --> 00:19:49,530
+أو Vomiting، ولما بتشوف واحد عمره فوق الأربعين سنة
+
+275
+00:19:49,530 --> 00:19:52,910
+وعنده Nausea أو Vomiting، دائمًا فاكر إن هذا ممكن
+
+276
+00:19:52,910 --> 00:19:59,730
+يكون Vagal Stimulation نتيجة أنه يكون عنده مثلًا MI
+
+277
+00:19:59,730 --> 00:20:03,530
+وهو مش عارف، وبفكر الموضوع related لمعته، و كثير
+
+278
+00:20:03,530 --> 00:20:07,230
+كثير كثير كثير ناس يعني فقدت حياتها بسبب أنه
+
+279
+00:20:07,230 --> 00:20:10,430
+مقتنع إن هذا الموضوع كان بس له علاقة في معته، و
+
+280
+00:20:10,430 --> 00:20:15,370
+مالهوش علاقة في القلب، وبالآخر يعني صار suddenly
+
+281
+00:20:15,370 --> 00:20:19,090
+arrested، يجيبه أنا مستشفى، و successful CPR يا
+
+282
+00:20:19,090 --> 00:20:24,230
+ما كانش successful، والمريض passed away وفقد حياته
+
+283
+00:20:24,230 --> 00:20:30,310
+نتيجة القصة هذه، حتى لو كنت بتشتغل في الأقسام
+
+284
+00:20:30,310 --> 00:20:34,850
+وشفت مريض، دائمًا أي مريض فوق الأربعين سنة وجاي ب-
+
+285
+00:20:34,850 --> 00:20:39,450
+...ب...ب...ب...ب symptoms، gastric symptoms، حاول
+
+286
+00:20:39,450 --> 00:20:44,270
+تتأكد، تعمل further examination، وأنه مش cardiac، و
+
+287
+00:20:44,270 --> 00:20:45,710
+بالذات الـ ECG
+
+288
+00:20:48,340 --> 00:20:53,600
+الـDiagnosis، تبعتها كيف بنشخصها؟ حكينا إنه لازم أعمل ECG
+
+289
+00:20:53,600 --> 00:20:57,500
+وبلزم أعمل اللي هو الـ lab
+
+290
+00:21:02,420 --> 00:21:08,240
+الميوجلوبين، حكينا إنه بينعمل لكن مش هو مؤشر طبعًا، هو
+
+291
+00:21:08,240 --> 00:21:10,980
+مؤشر سريع لأنه بيرتفع في خلال أول أربع ساعات، لكن
+
+292
+00:21:10,980 --> 00:21:15,700
+مش مؤشر جيد لأنه مع أي destruction بيعلُّ،  لكن بنستخدمه
+
+293
+00:21:15,700 --> 00:21:21,580
+كويس كثير وبيشجعوه لأنه بيرتفع بسرعة في الساعة
+
+294
+00:21:21,580 --> 00:21:22,200
+الأولى
+
+295
+00:21:24,910 --> 00:21:29,170
+الـCK، عارفين إحنا إنه ما بيستمرش لأكثر من ثلاثة أيام
+
+296
+00:21:29,170 --> 00:21:35,690
+حكينا على المواضيع تبع التشخيص، بدنا نشوف اللي هو
+
+297
+00:21:35,690 --> 00:21:38,850
+المواضيع العلاج، بالنسبة للعلاج يا جماعة، عكس إن
+
+298
+00:21:38,850 --> 00:21:43,210
+نفسه، بنعالجه بطريقتين، الطريقة الأولى وهي
+
+299
+00:21:43,210 --> 00:21:46,490
+الطريقة الحديثة، أنه في خلال تسعين دقيقة يتم عمل
+
+300
+00:21:46,490 --> 00:21:50,630
+قسطرة أولية، الـ Primary PCI بنسميها، اللي هي
+
+301
+00:21:50,630 --> 00:21:55,710
+Percutaneous Coronary Artery Intervention، أنه
+
+302
+00:21:55,710 --> 00:22:00,090
+ينعمل له قسطرة، ونشوف وين بالضبط الخلل عنده، وين الـ
+
+303
+00:22:00,090 --> 00:22:03,330
+Stenosis، وين الـ Closure، وإذا كان بيستدعي تنحط له
+
+304
+00:22:03,330 --> 00:22:06,050
+Stent، فبنحط له Stent، ده عامة
+
+305
+00:22:11,120 --> 00:22:15,440
+موجود، بحيث أنه مجرد ما بيجي المريض بيتشخص أنه عنده
+
+306
+00:22:15,440 --> 00:22:20,060
+ST elevation، وعنده اللي هو يعني الـ myocardial
+
+307
+00:22:20,060 --> 00:22:24,420
+infarction، بينزل على قسم القسطرة وبيتم عمل القسطرة
+
+308
+00:22:24,420 --> 00:22:27,500
+له، إذا ما كانش فيه، بيكون إحنا مضطرين نتعامل معه
+
+309
+00:22:27,500 --> 00:22:31,820
+pharmacologically، فالدواء المشهور واللي بينعطى فيه
+
+310
+00:22:31,820 --> 00:22:35,360
+أدوية كثيرة، لكن إحنا بالنسبة لنا الدواء المشهور عندنا
+
+311
+00:22:35,360 --> 00:22:39,840
+اللي هو الـstreptokinase، بيسموها  fibrinolytic
+
+312
+00:22:39,840 --> 00:22:43,880
+طريق الـ Streptokinase، فيه أدوية كثيرة حديثة
+
+313
+00:22:43,880 --> 00:22:49,440
+بتستخدمها كـ Thrombolytics، زي الـ tPA، وأغلى،
+
+314
+00:22:49,440 --> 00:22:55,120
+لكن العبرة هنا في أنها أقل الـ Side Effects، الـ
+
+315
+00:22:55,120 --> 00:22:57,220
+Side Effects المشهورة تبع الـ Streptokinase أنه
+
+316
+00:22:57,220 --> 00:23:00,740
+يمكن يعمل Bleeding عند المريض، وممكن الـ Bleeding
+
+317
+00:23:00,740 --> 00:23:06,110
+يخشش المريض للدماغ، الـCVA، وحاجات كثيرة ممكن تؤدي إلى
+
+318
+00:23:06,110 --> 00:23:10,110
+تخليني ما أقدر أُعطي الـ streptokinase، إذا كان
+
+319
+00:23:10,110 --> 00:23:14,210
+المريض عمل عملية recently، إذا كان المريض صار فيه
+
+320
+00:23:14,210 --> 00:23:17,750
+نزيف من الـCVA recently، إذا كان، إذا كان، إذا
+
+321
+00:23:17,750 --> 00:23:19,690
+كان، إذا كان في عنده مشاكل في الكبد
+
+322
+00:23:40,710 --> 00:23:46,470
+بالنسبة للـ ECG اللي فرجيتكم إياه، كان لمرض، هي
+
+323
+00:23:46,470 --> 00:23:50,900
+تجربته في severe ST elevation، وكان عنده مركز
+
+324
+00:23:50,900 --> 00:23:53,740
+كارديج، اخذ الـ Streptokinase، وهذا كان
+
+325
+00:23:53,740 --> 00:23:57,560
+Successful Streptokinase، أو Successful Drug
+
+326
+00:23:57,560 --> 00:24:01,080
+Administration، هذا الـ ECG، قبل الـ Streptokinase
+
+327
+00:24:01,080 --> 00:24:05,440
+تقريبًا بساعة، أخذ الـ Streptokinase، خلال نصف ساعة
+
+328
+00:24:05,440 --> 00:24:09,520
+تحسنت أموره، طبعًا أخذ  مهدئات عشان ما ينزلش ضغطه، و
+
+329
+00:24:09,520 --> 00:24:12,880
+بعديها رجع الـ ECG طبيعي، يعني الـ thrombus ذابت، و
+
+330
+00:24:12,880 --> 00:24:17,100
+اتحللت، ومشت، ورجع الموضوع، وطبعًا المرض راح منه
+
+331
+00:24:17,100 --> 00:24:17,460
+البيت
+
+332
+00:24:20,840 --> 00:24:25,160
+هذا بالنسبة لـ Management، طبعًا الـ Management
+
+333
+00:24:25,160 --> 00:24:29,520
+الثاني اللي حكينا عنه، أنه نعمل للمريض اللي هو الـ
+
+334
+00:24:29,520 --> 00:24:36,040
+PCI، أو الـ Percutaneous coronary، اللي هو
+
+335
+00:24:36,040 --> 00:24:41,400
+coronary angioplasty
+
+336
+00:24:41,400 --> 00:24:46,440
+أو عفواً قبلها أن نعمل له Percutaneous coronary
+
+337
+00:24:46,440 --> 00:24:49,660
+intervention
+
+338
+00:24:49,740 --> 00:24:54,240
+عن طريق إنه يحطوله ربما  أول شيء،  بيشوفوا إذا كان  داير
+
+339
+00:24:54,240 --> 00:24:56,420
+Digitalization، أو بقى بيعملوا بس Ballooning
+
+340
+00:24:56,420 --> 00:24:58,800
+بيعملوا Inflation، فبيوسعوا الـ Lumen، فبكون مش
+
+341
+00:24:58,800 --> 00:25:02,200
+محتاج أنه يحط فيه Stent، بس عندما يتعمل Balloon
+
+342
+00:25:02,200 --> 00:25:05,900
+وبرجع حجمه كويس، إذا والله ما رجع فيه Amputation
+
+343
+00:25:05,900 --> 00:25:08,860
+يعني مافيش Flow بعد منه، بعد النقطة اللي فيها
+
+344
+00:25:08,860 --> 00:25:13,820
+Closure، بيقول لأ، بيحتاج Stent عشان يضل الـ Lumen
+
+345
+00:25:13,820 --> 00:25:20,760
+هذا inflated وفاتح، ممكن يحطوا اللي هو دعامة
+
+346
+00:25:20,760 --> 00:25:24,560
+إذا الموضوع كثير severe وفيه أكثر من branch فيهم
+
+347
+00:25:24,560 --> 00:25:26,740
+المشكلة، هادف المرضى اللي بيحتاجوا اللي هو coronary
+
+348
+00:25:26,740 --> 00:25:30,480
+artery bypass graft، اللي هي عملية CABG اللي هي
+
+349
+00:25:30,480 --> 00:25:32,160
+عملية ترقيع أو توصيل
+
+350
+00:25:35,310 --> 00:25:39,850
+الشرايين، بيأخذوا من الـSaphenous Vein أو من اللي هو
+
+351
+00:25:39,850 --> 00:25:45,950
+الـLeft Internal Mammary Artery، اللي بننزّلها وبيغذوا
+
+352
+00:25:45,950 --> 00:25:51,150
+المنطقة اللي بعد الإسكيميا، طبعًا المنطقة، في صورة
+
+353
+00:25:51,150 --> 00:25:55,210
+لمنطقة الإسكيميا هنا، تراجعوا هيأتها، يعني لو كان
+
+354
+00:25:55,210 --> 00:25:59,890
+في إنسداد، الشرايين اللي بيوصلوا بغذّي المنطقة هذه
+
+355
+00:26:02,060 --> 00:26:05,900
+في المنطقة هذه بتصير سوداء يا جماعة في عملية القلب
+
+356
+00:26:05,900 --> 00:26:09,280
+المفتوح كلنا بنشوفها، كلها لون أسود أسود، دليل أنها
+
+357
+00:26:09,280 --> 00:26:12,480
+الـDead Tissue، طيب إيش الحل؟ الحل أنهم بيجيبوا، بيشوفوا
+
+358
+00:26:12,480 --> 00:26:16,120
+الشريان اللي مسكر، بنشوف الصورة هذه عليها
+
+359
+00:26:16,120 --> 00:26:22,200
+شرايين أحسن في الصورة، فبيجي
+
+360
+00:26:22,200 --> 00:26:27,720
+نشوف مثلاً، بيطلع في المنطقة هذه، الشريان اللي بيوصل
+
+361
+00:26:27,720 --> 00:26:32,860
+إليها مسكر، فبروحي بجيب لي graft بوصلها في اللي
+
+362
+00:26:32,860 --> 00:26:38,400
+هو سواء إذا كانت جايه من الfemoral مثلاً بأخذ من الfemoral
+
+363
+00:26:38,400 --> 00:26:42,780
+أو إذا جايه من الـAortic artery، بنزل graft وبحطها
+
+364
+00:26:42,780 --> 00:26:48,530
+لتحت من الـOcclusion، فبيصير الدم يمشي في الـflow اهو
+
+365
+00:26:48,530 --> 00:26:52,730
+تبع الـ artery القديم، اللي هو عشان الـ occlusion بطل
+
+366
+00:26:52,730 --> 00:26:57,010
+يمشي فيه، من تحت يعني اللي كان فيه هنا artery  نعتبر هيك
+
+367
+00:26:57,010 --> 00:27:03,870
+وهنا فيه occlusion، فبيمنع الـ blood يمشي لتحت، فأنا بروح
+
+368
+00:27:03,870 --> 00:27:07,550
+بجيب الـ graft من هنا، وبوصلها تحت الـ occlusion
+
+369
+00:27:07,550 --> 00:27:12,350
+شوية، فبيبدأ الدم يصفّي وين في بقية الـ artery اللي سكر من
+
+370
+00:27:12,350 --> 00:27:15,970
+هنا تمام، فبرجع بغذي المنطقة هذه اللي تحت عن طريق
+
+371
+00:27:15,970 --> 00:27:19,840
+وصلة منها، هذه هي الفكرة تبع الـ coronary artery bypass
+
+372
+00:27:19,840 --> 00:27:23,180
+Graft، لكن خلصنا الموضوع التابع
+
+373
+00:27:23,180 --> 00:27:30,020
+لكارديولوجيا، المهم، والله يعطيكم العافية والسلامة
+
+374
+00:27:30,020 --> 00:27:31,160
+عليكم ورحمة الله وبركاته
diff --git a/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/YSSnq6kqP0E_postprocess.srt b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/YSSnq6kqP0E_postprocess.srt
new file mode 100644
index 0000000000000000000000000000000000000000..c018774bd0f21abbc4592973014a668bfdc496a6
--- /dev/null
+++ b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/YSSnq6kqP0E_postprocess.srt
@@ -0,0 +1,1496 @@
+1
+00:00:02,450 --> 00:00:05,290
+بسم الله الرحمن الرحيم السلام عليكم ورحمة الله
+
+2
+00:00:05,290 --> 00:00:09,850
+وبركاته بنكمل إن شاء الله ربنا أمين في الـ
+
+3
+00:00:09,850 --> 00:00:13,810
+«Management of Coronary Vascular Disorders» طبعاً
+
+4
+00:00:13,810 --> 00:00:18,170
+بنحكي عن الـ«Coronary Artery Disease» اللي هي
+
+5
+00:00:18,170 --> 00:00:24,650
+مترازمة الـ«Acute Coronary Syndromes» اللي بيسموها
+
+6
+00:00:24,650 --> 00:00:27,990
+سواء كانت «Stable Angina» أو «Unstable Angina» أو
+
+7
+00:00:27,990 --> 00:00:31,600
+«Myocardial Infarction»هذا كلهم بيسموها acute
+
+8
+00:00:31,600 --> 00:00:39,020
+coronary syndrome وبعد هيك بنحاول نعرف إيش الـ
+
+9
+00:00:39,020 --> 00:00:43,660
+acute coronaryالسندروم اللي عند المريض هذا بالظبط
+
+10
+00:00:43,660 --> 00:00:46,760
+تتصنف تحت أي تصنيف تحت «stable angina» ولا
+
+11
+00:00:46,760 --> 00:00:50,280
+«unstable» ولا «malcardial infarction» التشخيص
+
+12
+00:00:50,280 --> 00:00:55,680
+الجديد زي ما بنحكي أنه صار لأي حد بيكون بشكي من
+
+13
+00:00:55,680 --> 00:01:01,820
+symptoms معينة منها لـ «chest pain» منها أنه يكون
+
+14
+00:01:01,820 --> 00:01:04,940
+«shocked»
+
+15
+00:01:04,940 --> 00:01:10,380
+أو «hypotension» أوعنده علامات الـ Basal
+
+16
+00:01:10,380 --> 00:01:14,040
+Crepitation، «بنمول الأيدينة» كل هذه علامات الـ
+
+17
+00:01:14,040 --> 00:01:19,180
+Unstability تبع المريض اللي بيشكي من الـ Chest
+
+18
+00:01:19,180 --> 00:01:27,180
+Pain واللي بتخلينا نفكر فيه من الوضع الـ Stable
+
+19
+00:01:27,180 --> 00:01:31,520
+للـ Angina البين للوضع الـ Unstable للـ Angina
+
+20
+00:01:31,520 --> 00:01:38,050
+البين أو الـ Myocardial Infarctionعشان هيك بنحط
+
+21
+00:01:38,050 --> 00:01:43,610
+تفرقة بين الناس اللي بتيجي عندها acute coronary
+
+22
+00:01:43,610 --> 00:01:49,910
+syndrome زي ما بتحكي وبيكون إيش الوضع التبعه؟ هل
+
+23
+00:01:49,910 --> 00:01:54,570
+هو stable angina البين ولا unstable angina ولا
+
+24
+00:01:54,570 --> 00:01:57,890
+myocardial infarction؟ هدول هم التلات تشخيص مهمة
+
+25
+00:01:57,890 --> 00:02:01,870
+في الموضوع إذا كان المولد بشكل من chest pain و
+
+26
+00:02:01,870 --> 00:02:04,470
+discomfort و shortness of breath
+
+27
+00:02:07,460 --> 00:02:12,060
+أترست هو مرتاح يبقى هذا unstable angina and could
+
+28
+00:02:12,060 --> 00:02:16,940
+be unquiet طب وإذا كان after exertion بعد تعب
+
+29
+00:02:16,940 --> 00:02:19,860
+بيصير مع الحاجة هذه بتكون هذا في الأغلب stable
+
+30
+00:02:19,860 --> 00:02:24,460
+angina يعني لما برجع برتاح بروح كل ال symptoms هذه
+
+31
+00:02:24,460 --> 00:02:29,140
+وبتمتيز إن هذا مع ال exertion لكن إذا مع ال
+
+32
+00:02:29,140 --> 00:02:33,800
+withoutالـ Exertion، الـ Trust، بيصير هذا الكلام
+
+33
+00:02:33,800 --> 00:02:36,720
+معاه بيكون هذا Unstable أنجينة و could be
+
+34
+00:02:36,720 --> 00:02:39,960
+myocardial infarction إيش الفرق بين الـ myocardial
+
+35
+00:02:39,960 --> 00:02:43,780
+infarction و الـ أنجينة؟ إنه في ال .. أه في الـ
+
+36
+00:02:43,780 --> 00:02:45,900
+myocardial infarction بيكون فيه complete
+
+37
+00:02:45,900 --> 00:02:49,160
+obstruction للـ coronary artery اللي بتغذي الـ
+
+38
+00:02:49,160 --> 00:02:51,800
+heart يعني واحد من ال branches تبعة الـ coronary
+
+39
+00:02:51,800 --> 00:02:55,120
+artery اللي بيغذي منطقة معينة من الـ heart بيصير
+
+40
+00:02:55,120 --> 00:02:58,820
+فيه complete obstruction وبالتالي في منطقة كامة من
+
+41
+00:02:58,820 --> 00:03:03,010
+الـ heartبتبطل تتراوة وبتصير فيها أسكينيا وهذا هو
+
+42
+00:03:03,010 --> 00:03:08,110
+السبب الرئيسي في الـPain الشديد اللي بيصير مع
+
+43
+00:03:08,110 --> 00:03:14,010
+المرضى لكن في الـAngina بكون الـObstruction هذا في
+
+44
+00:03:14,010 --> 00:03:19,030
+الـBranch هذا Partial يعني لسه فيه يعني و لو خرم
+
+45
+00:03:19,030 --> 00:03:23,110
+إبرا منه بنسم على المريض شوية Blood فبمنع أن تصير
+
+46
+00:03:23,110 --> 00:03:27,150
+المنطقة Completely أسكينيا أو Complete Death لا
+
+47
+00:03:27,150 --> 00:03:31,170
+تشوف اللي فيهابتكون عاشة لكن الـ «perfusion» بكون
+
+48
+00:03:31,170 --> 00:03:38,890
+يعني «very low» وطبعا ممكن جدا تتطور له اللي هو
+
+49
+00:03:38,890 --> 00:03:43,390
+الـ «unstable angina» هذه لـ «MI» و تسكر خالص عشان
+
+50
+00:03:43,390 --> 00:03:45,470
+هيك المريض بكون في عنده pain بكون في عندنا
+
+51
+00:03:45,470 --> 00:03:49,430
+shortness of breath في كتير ناس بتحكي على التفرقات
+
+52
+00:03:49,430 --> 00:03:53,370
+بين الـ«angina» الـ«pain» و «myocardial
+
+53
+00:03:53,370 --> 00:03:58,120
+infarction»بين أنا مابقيدش الفكرة هذه لإن الاتنين
+
+54
+00:03:58,120 --> 00:04:04,590
+شبه بعض كتير من ناحيةالـ Pain إلا إنه في الـ MRI
+
+55
+00:04:04,590 --> 00:04:10,130
+الـ Pain بكون يعني most severe بكون أكتر وهذا
+
+56
+00:04:10,130 --> 00:04:13,730
+الاشي برضه يعني it depends أحياناً بكون المريض
+
+57
+00:04:13,730 --> 00:04:18,350
+diabetic فما بتكونش عنده ال pain هو الأكتر ولا
+
+58
+00:04:18,350 --> 00:04:22,750
+بالعكس ممكن يجيلك asymptomatic حتى ال radiation
+
+59
+00:04:22,750 --> 00:04:28,270
+تبع ال pain كتير بيحكوا إنهالـ Acute Colitis أو
+
+60
+00:04:28,270 --> 00:04:32,110
+الـ MI اللي بينتبعها كذا الـ Angina اللي بينتبعها
+
+61
+00:04:32,110 --> 00:04:35,710
+لأ لأ الـ Acute Colitis Syndrome بشكل عام اللي
+
+62
+00:04:35,710 --> 00:04:39,170
+بينتبعها بيجي في ال chest وبروح بعمل روديشن على ال
+
+63
+00:04:39,170 --> 00:04:42,970
+shoulder أو بروح على ال left arm وال back وال neck
+
+64
+00:04:42,970 --> 00:04:46,290
+وحتى ال jaw سواء كان فيه يعني شوفنا هذه الحاجات
+
+65
+00:04:46,290 --> 00:04:49,690
+سواء كانت Angina أو بالاخر تطلع MI نفس ال symptom
+
+66
+00:04:50,100 --> 00:04:53,460
+تمام؟ كمان يعني بدي أضيف إنه ممكن في أخر حالة
+
+67
+00:04:53,460 --> 00:04:57,640
+شوفتها في استقبال باطنة من أيام إنه ممكن يجيل pain
+
+68
+00:04:57,640 --> 00:05:01,980
+على ال right side تصور يعني جيرك chest pain على ال
+
+69
+00:05:01,980 --> 00:05:07,100
+right side مش أصلا على ال left side وممكن يضلك
+
+70
+00:05:07,100 --> 00:05:10,160
+يعني والمريض طلع عمقايا والحاجة الوحيدة اللي كان
+
+71
+00:05:10,160 --> 00:05:13,980
+جار فيها المريض غريبة إنه كان sweaty يعني شوية
+
+72
+00:05:13,980 --> 00:05:18,840
+pain مش كتير على ال right side الدكاترة المعظم شكل
+
+73
+00:05:18,840 --> 00:05:23,020
+واحدة muscularولكن ربنا سبحان الله ألهمني لما شُفت
+
+74
+00:05:23,020 --> 00:05:27,080
+المرضي كتير سوتي حسيت أن وضعه مش طبيعي وأنه يعني
+
+75
+00:05:27,080 --> 00:05:32,820
+تقليله لشأن الألم اللي عنده كمية الألم ربما إلها
+
+76
+00:05:32,820 --> 00:05:36,580
+سبب آخر فحاببنا نعمل الـ ECG فطلع فيه أنده فعلاً
+
+77
+00:05:36,580 --> 00:05:41,080
+ST elevation high لذلك احنا فعلاً مع التطور اللي
+
+78
+00:05:41,080 --> 00:05:44,940
+حصل في الطب واللي بيسموه اللي هو acute coronary
+
+79
+00:05:44,940 --> 00:05:48,880
+syndrome وبعد وبيسموه يعني هذه التسمية الموحدة لهم
+
+80
+00:05:49,170 --> 00:05:53,330
+وبعد ذلك بحاولوا يعرفوها هل هي المريض في وضع
+
+81
+00:05:53,330 --> 00:05:56,250
+«Stable Angina» أو «Unstable Angina» أو
+
+82
+00:05:56,250 --> 00:06:00,130
+«Myocardial Infarction» بالنسبة للتشخيص المبدأي
+
+83
+00:06:00,130 --> 00:06:02,790
+تبع الـ «Acute Coronary Syndrome» اللي اتفقنا أنه
+
+84
+00:06:02,790 --> 00:06:05,930
+ممكن يكون فيه نفس الأعراض كلهم ييجيوا بنفس الأوراق
+
+85
+00:06:05,970 --> 00:06:10,350
+الأعراض وممكن يجي فيه ECG changes بالأول وممكن
+
+86
+00:06:10,350 --> 00:06:14,050
+مايكونش فيه ECG changes بالأول وبعد شوية تسيل فيه
+
+87
+00:06:14,050 --> 00:06:17,530
+ECG changes ممكن ال cardiac enzyme بالأول تكون
+
+88
+00:06:17,530 --> 00:06:21,930
+normal وانا اعتبره موضوع angina البين فقط ليس الا
+
+89
+00:06:21,930 --> 00:06:24,990
+بعد شوية التطور ويصير فيه elevated في ال cardiac
+
+90
+00:06:24,990 --> 00:06:28,030
+enzymeويبقى الموضوع انه عبارة عن «myocardial
+
+91
+00:06:28,030 --> 00:06:32,450
+infarction» لكن كانت لسه cooking ما بيانتش لذلك
+
+92
+00:06:32,450 --> 00:06:38,730
+الـ «انجاين» والـ «ام آي» يعني هي مراحل بتسلم بعض
+
+93
+00:06:38,730 --> 00:06:41,610
+ممكن يكون «انجاين» المريض ممكن جدا بعد يخش فيه «ام
+
+94
+00:06:41,610 --> 00:06:44,670
+آي» فلذلك لازم نكون حاذرين ال «terrorist factor»
+
+95
+00:06:44,670 --> 00:06:47,950
+ممكن يتأدي لإنه يصير في عند مريض «acute coronary
+
+96
+00:06:47,950 --> 00:06:51,710
+syndrome» أو اللي هي «coronary artery disease»
+
+97
+00:06:51,710 --> 00:06:57,030
+اللي هم من أهمهاالـ Tobacco use، الـ Smoking، الـ
+
+98
+00:06:57,030 --> 00:07:00,930
+Hypertension، الـ Stress بالدرجة الأولى على فكرة
+
+99
+00:07:00,930 --> 00:07:05,050
+والـ Diabetes والـ Hyperglycemia يعني هذه من
+
+100
+00:07:05,050 --> 00:07:08,670
+الحاجات المعروفة
+
+101
+00:07:08,670 --> 00:07:13,650
+والـ Obesity طبعاً والـ Glucate Aggregation في ناس
+
+102
+00:07:13,650 --> 00:07:16,410
+عندها بيكون بـ Polythicemia هذه من الحاجات
+
+103
+00:07:16,410 --> 00:07:19,630
+المعروفة أنها بتزوّل الـ Risk لـCoronary Artery
+
+104
+00:07:19,630 --> 00:07:25,330
+Disease وهذا تعتبر Modifiable ممكن احناممكن نحن
+
+105
+00:07:25,330 --> 00:07:32,290
+نتحكم فيها ونعمل لها حاجات تحسن منها مثلًا طباكو
+
+106
+00:07:32,290 --> 00:07:35,850
+يوز ونقوله ما تدخنش ويبقى يدخن ويتحسن الوضع عنده
+
+107
+00:07:35,850 --> 00:07:41,070
+الـ blood pressureممكن يأخذ أدوية ويحصل الـcontrol
+
+108
+00:07:41,070 --> 00:07:44,970
+على الـhypertension تبعه فيرجع ضغطه للوضع الطبيعي
+
+109
+00:07:44,970 --> 00:07:48,330
+كذلك السكر كذلك الـobesity ممكن يعمل دياته ممكن
+
+110
+00:07:48,330 --> 00:07:51,850
+يعمل لكن في حاجات non-controllable زي الـage مثلا
+
+111
+00:07:51,850 --> 00:07:55,170
+والـgender معروف أن الحاجات هذه ممكن تصير عند
+
+112
+00:07:55,170 --> 00:07:58,410
+الفيميل أكتر كمان تصير في الـage
+
+113
+00:08:03,430 --> 00:08:06,430
+عفوًا، الـ «hypertension» بيصير في «end» الـ
+
+114
+00:08:06,430 --> 00:08:11,010
+«female» أكتر، الـ «acute culinary syndrome» بيصير
+
+115
+00:08:11,010 --> 00:08:14,890
+«end» الـ «male» أكتر ربما لأن الـ «stress» أكتر،
+
+116
+00:08:14,890 --> 00:08:19,870
+الـ «age» كمان، كل ما ارتفع الـ «age» كل ما بيصير،
+
+117
+00:08:19,870 --> 00:08:24,170
+بيزيد الـ «risk»، فهذه كلها «risk factors» ممكن
+
+118
+00:08:24,170 --> 00:08:27,890
+تعمل الكلام، فهذا لذلك أنا مش هحكي بالتفصيل عن الـ
+
+119
+00:08:27,890 --> 00:08:28,210
+«android
+
+120
+00:08:32,780 --> 00:08:35,380
+والتصنيفات، لأنه احنا افهمنا إن الـ «acute
+
+121
+00:08:35,380 --> 00:08:39,060
+coronary syndrome» إنه يجيب المريض بـ «متلازمة»
+
+122
+00:08:39,060 --> 00:08:41,660
+اللي هي الـ «chest pain»، «shortness of breath»،
+
+123
+00:08:41,660 --> 00:08:46,600
+«difficulty breathing»، الحاجات هذه، وبعدها أنا
+
+124
+00:08:46,600 --> 00:08:50,760
+أقرر إذا هو «Ras angina» ولا هو «M.I.» بناءً على
+
+125
+00:08:50,760 --> 00:08:56,200
+نتائج تبع الكاردكينزين و«ECG changes» اللي موجودة
+
+126
+00:08:56,200 --> 00:09:00,370
+عندي بالإضافة إلى الـ«symptoms»بس الفرق الوحيد
+
+127
+00:09:00,370 --> 00:09:04,030
+اللي بدنا نعرفه أنه طول ما هو الكلام هذا بيصير
+
+128
+00:09:04,030 --> 00:09:07,730
+معاه بس after exertion بتكون هذا اسمها stable
+
+129
+00:09:07,730 --> 00:09:10,930
+عندها لإنه مجرد ما برجع بيستيلحق السير الوضع عنده
+
+130
+00:09:10,930 --> 00:09:15,670
+كويس بيبقى بيهمنا لكن إذا ال risk بتصير معاه بتكون
+
+131
+00:09:15,670 --> 00:09:18,990
+هذا unstable وممكن تكون MRI بيبقى بيهمنا نعرف إيش
+
+132
+00:09:18,990 --> 00:09:24,840
+اللي المفروض نسويههذه الـ «سيفيرتس» كما نرى كيفها
+
+133
+00:09:24,840 --> 00:09:29,760
+لما تكون asymptomatic أنجاينة أنجاينة بس مافيش أي
+
+134
+00:09:29,760 --> 00:09:32,260
+سيمتوم أنجاينة only with this strenuous exertion
+
+135
+00:09:32,260 --> 00:09:37,680
+لما بيصير أنت بشوية يعني
+
+136
+00:09:37,680 --> 00:09:40,960
+activity أكتر من الطبيعة هه ممكن تصير أنجاينة
+
+137
+00:09:40,960 --> 00:09:45,180
+مدرية exertion بتعب شوية، بيمشي شوية، بيجري شوية
+
+138
+00:09:45,180 --> 00:09:50,880
+مع الـ مع ال mild exertion تصور أنك بتصير مع أيه؟
+
+139
+00:09:50,880 --> 00:09:56,820
+عشان أنا معاللي يعني مع جهود جو مثلا لو نطلع درج
+
+140
+00:09:56,820 --> 00:10:01,440
+هنا مع جهود إيه؟ موديلة متوسطة، مع جهود بسيط، بس
+
+141
+00:10:01,440 --> 00:10:06,120
+ده بروح الحمام ولا حاجة، أه ممكن يصير، لكن إذا كان
+
+142
+00:10:06,120 --> 00:10:09,960
+أنجانه at rest، ماذا معناه؟ إن هو يضبط ال stable،
+
+143
+00:10:09,960 --> 00:10:16,200
+تمام؟طبعاً في الـ ECG لو عملنا لمريد عنده Angina
+
+144
+00:10:16,200 --> 00:10:19,660
+عملنا له ECG نحن نلاقي أنه عنده ST depression أو
+
+145
+00:10:19,660 --> 00:10:23,740
+بنلاقي يعني الـ ST بتكون نزلة تحت هنشوف في ال ECG
+
+146
+00:10:23,740 --> 00:10:31,460
+كيف نعمل ECG هيتها، طلع كيف هي .. هي ال .. خلينا
+
+147
+00:10:31,460 --> 00:10:37,350
+نشوف هنا بالظبط أوضح، طلع كيف؟هذه الـ V-Wave وهذه
+
+148
+00:10:37,350 --> 00:10:41,550
+الـ QRS المفروض يأتي الـ Isoelectric line هنا
+
+149
+00:10:41,550 --> 00:10:46,470
+ويكمل ويعمل الـ T بس هذه تبقى الـ S وهذه الـ T هي
+
+150
+00:10:46,470 --> 00:10:48,670
+الـ Depression نزل عن الـ Isoelectric line ما يعني
+
+151
+00:10:48,670 --> 00:10:52,110
+Isoelectric line؟ المفروض هي الـ Isoelectric line
+
+152
+00:10:52,110 --> 00:10:57,310
+هيك هنا المفروض يكمل هيك تمامًا مع الخط هذا زي الـ
+
+153
+00:10:57,310 --> 00:11:03,450
+ECG الطبيعي لكن هو فعليًا بتنزل بعدين تأتي الـ
+
+154
+00:11:03,450 --> 00:11:07,400
+Wave هذا من هنا تبدأ Wave جديدةتمام؟ فعشان هي كالـ
+
+155
+00:11:07,400 --> 00:11:12,900
+T-wave نزلت لتحت ST depression تمام؟ هذا هو اللي
+
+156
+00:11:12,900 --> 00:11:21,380
+هو الـ Angina بين والعلامات تبقيتها على ال ECG
+
+157
+00:11:21,380 --> 00:11:24,360
+ويكون برضه الـ T-wave inversion during angina
+
+158
+00:11:24,360 --> 00:11:30,140
+البين بتكونمتحولة ونزلة لتحت حكينا الفرق بين
+
+159
+00:11:30,140 --> 00:11:34,180
+الـStable Angina والـUnstable Angina وحكينا أن
+
+160
+00:11:34,180 --> 00:11:39,400
+الـUnstable Angina ممكن تتحول
+
+161
+00:11:39,400 --> 00:11:43,000
+لـMyocardial
+
+162
+00:11:43,000 --> 00:11:47,560
+Infarction العلمات مهمة جدا أشوف المريض إذا كان
+
+163
+00:11:47,560 --> 00:11:53,670
+سوتي وشكله بيل وعنده Difficultyوهو عنده بين زي ما
+
+164
+00:11:53,670 --> 00:11:57,050
+حكينا الصفات و سواء كان في الـ center تبقى ال
+
+165
+00:11:57,050 --> 00:12:00,310
+chest أو radiated لل shoulder و ال neck و ال jaw و
+
+166
+00:12:00,310 --> 00:12:05,210
+ال left armطبعًا المفروض أننا نتعامل مع المريض
+
+167
+00:12:05,210 --> 00:12:10,170
+بـNitroglycerin وبيأخد أول حبة من الـNitroglycerin
+
+168
+00:12:10,170 --> 00:12:15,530
+وبنقيم حالته إذا اتحسن ولا لأ بعد خمس دقائق ممكن
+
+169
+00:12:15,530 --> 00:12:19,690
+يتم إعادتها كمان جرعه أو ممكن كمان جرعه وما تحسنش
+
+170
+00:12:19,690 --> 00:12:23,870
+بيكون الوضع أكتر من أن يكون الـAngina البين أو
+
+171
+00:12:23,870 --> 00:12:31,290
+Stable Angina فبيكون المريض بلزم أنهيعني ينعملوا
+
+172
+00:12:31,290 --> 00:12:34,570
+إجراءات أكتر فبالتالي بلزم إنه يدي ع مستشفى عشان
+
+173
+00:12:34,570 --> 00:12:38,410
+ينعملوا ECG و Cardiac Enzyme ويكونوا under اللي هو
+
+174
+00:12:38,410 --> 00:12:43,870
+«Closed Monitoring and Follow-up»
+
+175
+00:12:43,870 --> 00:12:48,350
+لو بدنا نشوف إحنا كـ«نيرس» أيش المفروض نعمل لو
+
+176
+00:12:48,350 --> 00:12:52,030
+جاتنا حالة على الطوارئ أو عنده هذه الـSymptoms أول
+
+177
+00:12:52,030 --> 00:12:55,190
+حاجة طبعا لازم أحطه في Bedrest دي ما اللي بنحكي
+
+178
+00:12:55,190 --> 00:13:00,650
+كلمة «مونة»بنحطه في كلمة «bed rest» برايح المريض
+
+179
+00:13:00,650 --> 00:13:04,670
+بحطله Oxygen لإن ال Oxygen demand في الحالة هذه هو
+
+180
+00:13:04,670 --> 00:13:07,030
+أصلا جاي في shortness of breath و in catapulting
+
+181
+00:13:07,030 --> 00:13:11,790
+بكونه لإن ال heart muscle ما بوصلهاش دم كفاية فهي
+
+182
+00:13:11,790 --> 00:13:15,810
+اللي بيخلي يحسس حاله إنه ماعندهوش Oxygen كفاية مع
+
+183
+00:13:15,810 --> 00:13:20,310
+إنه النفس ليش فيه عنده مشكلة لكن فهو ال Oxygen
+
+184
+00:13:20,310 --> 00:13:26,130
+demand عنده أعلىطبعاً برضه بنبدأ نعمل assessment
+
+185
+00:13:26,130 --> 00:13:30,330
+بناخد Vital Sign بنعمل ECG بنعمل ركب IV Axis وبين
+
+186
+00:13:30,330 --> 00:13:34,910
+اللي هو بناخد تحليل بنهدى المريض وبنعمله
+
+187
+00:13:34,910 --> 00:13:41,090
+الـReassurance أن أنت بخير وطمأن ونبدأ نشوف بالظبط
+
+188
+00:13:41,090 --> 00:13:45,350
+إيش نتائج تبع ال ECG وإيش نتائج تبع الcardiac
+
+189
+00:13:45,350 --> 00:13:47,280
+enzyme وبنعمل خارطة الasset assessmentالـ
+
+190
+00:13:47,280 --> 00:13:50,680
+Assessment لطبيقة الـ Pain اللي عنده طبعاً بعد
+
+191
+00:13:50,680 --> 00:13:54,600
+هيكة لو فعلا سبب أنه آه هذا chest pain و related
+
+192
+00:13:54,600 --> 00:13:58,680
+لل heart عادة بيستخدمه اللي هو بعد ما حكينا الـ
+
+193
+00:13:58,680 --> 00:14:01,740
+bed rest و ال oxygen حياته اللي هو مورفين عشان ت
+
+194
+00:14:01,740 --> 00:14:05,600
+decrease anxiety ت decrease pain وكمان بيساعد أنه
+
+195
+00:14:05,600 --> 00:14:09,900
+بيعمل بالذات المورفين coronary vasodilator آه طبعا
+
+196
+00:14:09,900 --> 00:14:16,340
+بعديها ممكن نبدأ ندى علاجات تتحسن مناللي هو الـ
+
+197
+00:14:16,340 --> 00:14:21,500
+الـ الوضع الـ coronary arteries أو إن نعملها
+
+198
+00:14:21,500 --> 00:14:25,740
+dilatation إذا أتأكدنا إن المريض مش myocardial
+
+199
+00:14:25,740 --> 00:14:31,420
+infarction وبالذات مايكونش inferior myocardial
+
+200
+00:14:31,420 --> 00:14:35,780
+infarction أو إنه مايكونش hypertension إذا إنه كون
+
+201
+00:14:35,780 --> 00:14:39,980
+المريض hypertensionأو myocardial infarction واضح
+
+202
+00:14:39,980 --> 00:14:42,580
+ال ECG مبنفعش أن أستخدم معاه اللي هو الـ
+
+203
+00:14:42,580 --> 00:14:45,960
+Nitroglycerin لو لاعيت أن المريض لأ لا هو
+
+204
+00:14:45,960 --> 00:14:48,180
+myocardial infarction ولا هو Hypotension، هدا
+
+205
+00:14:48,180 --> 00:14:51,560
+بيسمع أنه أديله جرعة تانية من الـNitroglycerin
+
+206
+00:14:51,560 --> 00:14:56,200
+اللي هو الـ5 ميلي جرام عشان أشوف ربماخاصة إذا كان
+
+207
+00:14:56,200 --> 00:14:59,500
+المريض مش ماخد، لكن إذا كان ماخد تلت مرات ومافيش
+
+208
+00:14:59,500 --> 00:15:04,700
+استجابة، okay بنخليه في الريس، بنحطه في Oxygen،
+
+209
+00:15:04,700 --> 00:15:09,860
+بنحط عليه Oxygen، ونبدأ نشوف الـheart rate تبعه،
+
+210
+00:15:09,860 --> 00:15:13,080
+ونشوف أمكن في ديستردام هي اللي عاملة المشكلة، ومش
+
+211
+00:15:13,080 --> 00:15:17,300
+بيخليها يتحسن، ونبدأ نشوف الـBlood Pressure تبعته،
+
+212
+00:15:17,300 --> 00:15:23,700
+عشان نحاول أنهإن حاسس الموضوع طبعا، لو كان
+
+213
+00:15:23,700 --> 00:15:27,800
+الـBlood Pressure واطي، بيكون بدنا ندخل ونحاول
+
+214
+00:15:27,800 --> 00:15:33,330
+نسيطر عليه ونعليه، لو كان عاليبيكون بدنا ند أدوية
+
+215
+00:15:33,330 --> 00:15:37,650
+تعمل تخطيط للضغط لإنه كتير مرضى بيكون هو
+
+216
+00:15:37,650 --> 00:15:40,230
+الـUngernal pain اللي عندهم بسبب إن الـBlood
+
+217
+00:15:40,230 --> 00:15:44,430
+pressure جاي Highly، Severe أو بيسموه Hypertension
+
+218
+00:15:44,430 --> 00:15:48,650
+Crisis أو Malignant Hypertension بيكون جاي وضغط
+
+219
+00:15:48,650 --> 00:15:51,590
+عالي كتير ومش بيستجيب للأدوية تبع
+
+220
+00:15:51,590 --> 00:15:54,350
+الـAntihypertensive اللي بياخدها في البيت وهذا هو
+
+221
+00:15:54,350 --> 00:15:57,290
+اللي عمله الـUngernal pain يعني بيكون Ungernal
+
+222
+00:15:57,290 --> 00:16:00,030
+pain because of increased bloodالـ pressure
+
+223
+00:16:00,030 --> 00:16:06,310
+فهنديها لو كان المريض عنده myocardial infarction
+
+224
+00:16:06,310 --> 00:16:10,610
+وانا حاسس ان الموضوع أكتر من أنه أنجالنا البين
+
+225
+00:16:10,610 --> 00:16:16,000
+بنبدأ نتصرف يا جماعة بشكلحتى لو أنا مش عارف إنه
+
+226
+00:16:16,000 --> 00:16:19,060
+لسه مركز عن الفشل، لسه عندي الـsymptom هذي، ببدأ
+
+227
+00:16:19,060 --> 00:16:23,500
+أدي حاجة اسمها الـAnti-platelet اللي هي الإبارة عن
+
+228
+00:16:23,500 --> 00:16:27,600
+الـAspirin، وفي الحالات الطارقة، بند 300 مليجرام
+
+229
+00:16:27,600 --> 00:16:32,720
+Aspirin، Chewing، يعني ينضغهم المريض مضغ، وبعد هيك
+
+230
+00:16:33,140 --> 00:16:36,800
+يبلعهم الهدف من المضغ هذا إنه يصبح الـ Absorption
+
+231
+00:16:36,800 --> 00:16:40,160
+تبعهم في الـ Mycosis تبع الـ Oral Cavity أسرع
+
+232
+00:16:40,160 --> 00:16:44,500
+وبالتالي بيشتغل as Anti-aggregant فلو كان فيه
+
+233
+00:16:44,500 --> 00:16:48,880
+Thrombus عمالي بتتكون بيمنع اللي هو كبير حجم الـ
+
+234
+00:16:48,880 --> 00:16:51,660
+Thrombus هذه وبيمنع الـ Complete enclosure إذا بده
+
+235
+00:16:51,660 --> 00:16:55,900
+يصبح Enclosure وبده تتحول هذه الحالة لـMI ولذلك
+
+236
+00:16:55,900 --> 00:17:01,700
+دائما بينصحوا فيه، بعد ذلكالـ ECG والـ Cardiac
+
+237
+00:17:01,700 --> 00:17:05,180
+Enzyme اللي هتطلع على تأيجها هي هتحكي لي إذا كان
+
+238
+00:17:05,180 --> 00:17:09,300
+هذا المريض فعلا Unstable أنجينة بس ولا لأ هو صار
+
+239
+00:17:09,300 --> 00:17:15,640
+فعلا MRI وصار فيه Complete Obstructionفي أحد الـ
+
+240
+00:17:15,640 --> 00:17:18,700
+«لومن» أو أحد الـ «برانشيز» تبعة الـ coronary
+
+241
+00:17:18,700 --> 00:17:22,920
+arteries وبالتالي بيصطلع عنده علامات في الـ «STG»
+
+242
+00:17:22,920 --> 00:17:26,360
+اللي بيسموها الـ «ST elevation» إيش يعني ST
+
+243
+00:17:26,360 --> 00:17:29,140
+elevation؟ أفرجيكوا، هاي الـ «Isoelectric line»
+
+244
+00:17:29,140 --> 00:17:34,240
+اللي كنت بحت عامله، يعني هاي بيكون هاي الـPثمانية
+
+245
+00:17:34,240 --> 00:17:38,300
+وبعد ذلك هاي إيش الـ T هي طلع الـ S الـ S في الأصل
+
+246
+00:17:38,300 --> 00:17:42,200
+بتكون inverted لتحت بعدين إيش بتطلع و الـ T بتكمل
+
+247
+00:17:42,200 --> 00:17:46,760
+دوري تمام في الـ S T elevation إيش بيصير فيه بي
+
+248
+00:17:46,760 --> 00:17:52,260
+كيو آر تطلع كيف الـ R مكملتش لتحت بعدين إجت الـ S
+
+249
+00:17:52,260 --> 00:17:58,410
+من فوق إجت Sالـ ISO يجب أن ينزل و ينزل و ينزل و
+
+250
+00:17:58,410 --> 00:18:02,050
+ينزل و ينزل و ينزل و ينزل و ينزل و ينزل و ينزل و
+
+251
+00:18:02,050 --> 00:18:07,010
+ينزل و ينزل و ينزل و ينزل و ينزل و ينزل و ينزل و
+
+252
+00:18:07,010 --> 00:18:07,250
+ينزل و ينزل و ينزل و ينزل و ينزل و ينزل و ينزل و
+
+253
+00:18:07,250 --> 00:18:09,770
+ينزل و ينزل و ينزل و ينزل و ينزل و ينزل و ينزل و
+
+254
+00:18:09,770 --> 00:18:15,090
+ينزل و ينزل و ينزل و ينزل و ينزل
+
+255
+00:18:15,090 --> 00:18:19,750
+و
+
+256
+00:18:19,750 --> 00:18:24,200
+يالـ BQR هي الـ S نزلت أحيد وبعدين الـ T تطلع
+
+257
+00:18:24,200 --> 00:18:30,620
+طبيعي لكن هنا راحزين كيف كده الفرق فهذا هو طبعا
+
+258
+00:18:30,620 --> 00:18:37,760
+IQR S هاي T تمام، هاي الـ Isoelectric line واحدة،
+
+259
+00:18:37,760 --> 00:18:41,100
+هاي هو هاي، هاي الـ Isoelectric line لكن هنا وين
+
+260
+00:18:41,100 --> 00:18:45,680
+الـ Isoelectric line؟ مش فوق فهذا بنسميه HT
+
+261
+00:18:45,680 --> 00:18:50,840
+elevationهذه أهم علامات الـ M.I. على الـ ECG طبعًا
+
+262
+00:18:50,840 --> 00:18:54,220
+بنحكي إن في حاجة اسمها non-stemic M.I. يعني ممكن
+
+263
+00:18:54,220 --> 00:18:58,520
+يكون myocardial infarction لكن without ST
+
+264
+00:18:58,520 --> 00:19:03,240
+elevation وهذا بتبين إنه مافيش يعني علامات على ال
+
+265
+00:19:03,240 --> 00:19:08,050
+ECG مافيش حقس ST elevation لكن فيه symptomوفيه
+
+266
+00:19:08,050 --> 00:19:10,950
+Related Cardiac Enzyme اللي حكينا عنها بالذات
+
+267
+00:19:10,950 --> 00:19:16,250
+الـCK والـCKMB وحكينا إن الـCKMB لازم يكون يعني
+
+268
+00:19:16,250 --> 00:19:24,430
+بارتفاع ترضي مع الـCK بما يزيد عن 10% من الـCK
+
+269
+00:19:24,430 --> 00:19:29,490
+نفسه الـCKMB يكون أكتر 10% من الـCK نفسه
+
+270
+00:19:33,450 --> 00:19:36,970
+طبعاً الـ Clinical Manifestation عارفين هنا بس بدي
+
+271
+00:19:36,970 --> 00:19:39,390
+أحكي بزيادة على حاجة اللي دعو بالـ
+
+272
+00:19:39,390 --> 00:19:42,770
+Gastrointestinal Attract إن الناس دول عادة بيكون
+
+273
+00:19:42,770 --> 00:19:45,510
+عندهم Vagal Stimulation فبيجيوا Picture of Nausea
+
+274
+00:19:45,510 --> 00:19:49,530
+أو Vomiting ولمّا بتشوف واحد أمره فوق الأربعين سنة
+
+275
+00:19:49,530 --> 00:19:52,910
+وعنده Nausea أو Vomiting دايما فاكر إن هذا ممكن
+
+276
+00:19:52,910 --> 00:19:59,730
+يكون Vagal Stimulation نتيجة إنهيكون عنده مثلا MRI
+
+277
+00:19:59,730 --> 00:20:03,530
+و هو مش عارف و بفكر موضوع related لمعته و كتير
+
+278
+00:20:03,530 --> 00:20:07,230
+كتير كتير كتير ناس يعني فقدت حياتها بسبب إن هو
+
+279
+00:20:07,230 --> 00:20:10,430
+مقتنع إن هذا الموضوع كان بس له علاقة في معته و
+
+280
+00:20:10,430 --> 00:20:15,370
+مالهوش علاقة في القلم و بالآخر يعني صار suddenly
+
+281
+00:20:15,370 --> 00:20:19,090
+arrested يا جبو أنا مستشفى و successful CPR يا
+
+282
+00:20:19,090 --> 00:20:24,230
+ماكانش successful و المريض passed away و فقد حياته
+
+283
+00:20:24,230 --> 00:20:30,310
+نتيجة القصةبعينة حتى لو كنت بتشتغل في القوارق
+
+284
+00:20:30,310 --> 00:20:34,850
+وشوفت مريض دايما اي مريض فوق الأربعين سنة و جاي ب
+
+285
+00:20:34,850 --> 00:20:39,450
+.. ب .. ب .. ب .. ب symptom gastric symptom هاول
+
+286
+00:20:39,450 --> 00:20:44,270
+تتأكد تعمل farther examination و انه مش cardiac و
+
+287
+00:20:44,270 --> 00:20:45,710
+بالذات ال ECG
+
+288
+00:20:48,340 --> 00:20:53,600
+الهلاج تبعت كيف بنشخصها حكينا إن أنا بلزم أعمل ECG
+
+289
+00:20:53,600 --> 00:20:57,500
+وبلزم أعمل اللي هو ال lab
+
+290
+00:21:02,420 --> 00:21:08,240
+المجلومين حكينا إنه بينعمل لكن مش هو مؤشر طبعا هو
+
+291
+00:21:08,240 --> 00:21:10,980
+مؤشر سريع لأنه بيرتفع في خلال أول أربع ساعات لكن
+
+292
+00:21:10,980 --> 00:21:15,700
+مش مؤشر جيد لأنه مع أي destruction بيعلتروا بنيني
+
+293
+00:21:15,700 --> 00:21:21,580
+كويس كتير وبيشجعوه لأنه بيرتفع بسرعة في الساعة
+
+294
+00:21:21,580 --> 00:21:22,200
+الأولى
+
+295
+00:21:24,910 --> 00:21:29,170
+الـCK، عارفين إحنا إنه ما بستمرش لأكتر من تلت أيام
+
+296
+00:21:29,170 --> 00:21:35,690
+حكينا على المواضيع تبع التشخيص بدنا نشوف اللي هو
+
+297
+00:21:35,690 --> 00:21:38,850
+المواضيع العلاج بالنسبة للعلاج، يا جماعة، عكس إن
+
+298
+00:21:38,850 --> 00:21:43,210
+نفسها دولةبتعالجه بطريقتين، الطريقة الأولى وهي
+
+299
+00:21:43,210 --> 00:21:46,490
+الطريقة الحديثة أنه في خلال تسعين دقيقة يتم عمل
+
+300
+00:21:46,490 --> 00:21:50,630
+قسطرة أولية الـ Primary PCI بنسميها اللي هي
+
+301
+00:21:50,630 --> 00:21:55,710
+Percutaneous Coronary Artery Intervention أنه
+
+302
+00:21:55,710 --> 00:22:00,090
+ينعمله قسطرة وينشوف وين بالظبط الخلل عنده وين الـ
+
+303
+00:22:00,090 --> 00:22:03,330
+Stenosis وين الـ Closure وإذا كان بيستدعي تنحطله
+
+304
+00:22:03,330 --> 00:22:06,050
+Stent فبنحطله Stent ده عامة
+
+305
+00:22:11,120 --> 00:22:15,440
+موجود بحيث أنه مجرد ما بيجي المرضى بتشخص أنه عنده
+
+306
+00:22:15,440 --> 00:22:20,060
+ST elevation وعنده ما يعني اللي هو myocardial
+
+307
+00:22:20,060 --> 00:22:24,420
+infarction بينزل على قسم القسترة وبيتم عمل القسترة
+
+308
+00:22:24,420 --> 00:22:27,500
+إليه إذا ماكانش فيه بيكون احنا مضطرين نتعامل معه
+
+309
+00:22:27,500 --> 00:22:31,820
+pharmacological فالدوة المشهور و اللي بينعطى في
+
+310
+00:22:31,820 --> 00:22:35,360
+أدوية كتير لكن احنا بالنسبة إن الدوة المشهورة عنا
+
+311
+00:22:35,360 --> 00:22:39,840
+اللي هو الـstryptokinase بيسموها film politicعن
+
+312
+00:22:39,840 --> 00:22:43,880
+طريق الـ Structokinase فيه أدوية كتير حديثة
+
+313
+00:22:43,880 --> 00:22:49,440
+تستخدمها كـ Throne Politics زي الـ RTPA و أغلى،
+
+314
+00:22:49,440 --> 00:22:55,120
+لكن العبرة هنا في أنها أقل الـ Side Effect الـ
+
+315
+00:22:55,120 --> 00:22:57,220
+Side Effect المشهورة تبقى لـ Structokinase أنه
+
+316
+00:22:57,220 --> 00:23:00,740
+يمكن يعملوا bleeding عند المريض وممكن الـ bleeding
+
+317
+00:23:00,740 --> 00:23:06,110
+يخشش المريض الهوريك، الـCVAوحاجات كتير ممكن أوجهت
+
+318
+00:23:06,110 --> 00:23:10,110
+تخليني ما أستطيع أن أعطي الـ streptococcus إذا كان
+
+319
+00:23:10,110 --> 00:23:14,210
+المريض عامل عملية recently، إذا كان المريض صار فيه
+
+320
+00:23:14,210 --> 00:23:17,750
+انبعاط من الـCVA recently، إذا كان، إذا كان، إذا
+
+321
+00:23:17,750 --> 00:23:19,690
+كان، إذا كان في عنده مشاكل في البيت
+
+322
+00:23:40,710 --> 00:23:46,470
+بالنسبة للـ ECG اللي فرجتكوا يا فدك كان لمرض هي
+
+323
+00:23:46,470 --> 00:23:50,900
+تجاربها في severe ST elevationوكان عنده مركز
+
+324
+00:23:50,900 --> 00:23:53,740
+كاردرينج فارتشن أخد الـ Structokinase وهذا كان
+
+325
+00:23:53,740 --> 00:23:57,560
+Successful Structokinase أو Successful Drug
+
+326
+00:23:57,560 --> 00:24:01,080
+Administration هذا الـ ECG بعت الـ Structokinase
+
+327
+00:24:01,080 --> 00:24:05,440
+تقريبا بساعة أخد الـ Structokinase خلال نص ساعة
+
+328
+00:24:05,440 --> 00:24:09,520
+اتحسنت أموره، طبعا أخد معفلون عشان ما ينزلش ضغطه و
+
+329
+00:24:09,520 --> 00:24:12,880
+بعديها رجع ال ECG طبيعي يعني لفروم بس دابت و
+
+330
+00:24:12,880 --> 00:24:17,100
+اتحللت ومشيت و رجع الموضوع و طبعا المرض راح منه
+
+331
+00:24:17,100 --> 00:24:17,460
+البيت
+
+332
+00:24:20,840 --> 00:24:25,160
+هذا بالنسبة لـ «Management» طبعاً الـ «Management»
+
+333
+00:24:25,160 --> 00:24:29,520
+التاني اللي حكينا عنه أنه نعمل للمريض اللي هو الـ
+
+334
+00:24:29,520 --> 00:24:36,040
+«PCI» أو الـ «coronary percutaneous» اللي هو
+
+335
+00:24:36,040 --> 00:24:41,400
+«coronary angioplasty»
+
+336
+00:24:41,400 --> 00:24:46,440
+أو عفوا قبلها أن نعمل له «percutaneous coronary
+
+337
+00:24:46,440 --> 00:24:49,660
+intervention»
+
+338
+00:24:49,740 --> 00:24:54,240
+عن طريق إنه يحطوله ربما أواشي بس يشوفوا داير الـ
+
+339
+00:24:54,240 --> 00:24:56,420
+Digitalization أو بقى بيعملوا بس Ballooning
+
+340
+00:24:56,420 --> 00:24:58,800
+بيعملوا Inflation فبواسقوا الـ Lumen فبكون مش
+
+341
+00:24:58,800 --> 00:25:02,200
+محتاج إنه يحط فيه Stint بس عندما يتعملوا Balloon
+
+342
+00:25:02,200 --> 00:25:05,900
+برجع حجمه كويس إذا والله لأ برجع فيه Amputation
+
+343
+00:25:05,900 --> 00:25:08,860
+يعني مافيش Flow بعد منه بعد النقطة اللي فيها
+
+344
+00:25:08,860 --> 00:25:13,820
+Enclosure بيقول لأ بيحتاج Stint عشان ضل الـ Lumen
+
+345
+00:25:13,820 --> 00:25:20,760
+هذايعني inflated وفاتح فممكن يحطوا اللي هو دعامة
+
+346
+00:25:20,760 --> 00:25:24,560
+إذا الموضوع كتير severe وفيه أكتر من branch فيهم
+
+347
+00:25:24,560 --> 00:25:26,740
+المشكلة هادف المرضي اللي بحتاجه اللي هو coronary
+
+348
+00:25:26,740 --> 00:25:30,480
+artery bypass graft اللي هي عملية cabbage اللي هي
+
+349
+00:25:30,480 --> 00:25:32,160
+عملية ترقي أو توصيل
+
+350
+00:25:35,310 --> 00:25:39,850
+الشرايين بيأخدوا من الـSafeness Vein أو من اللي هو
+
+351
+00:25:39,850 --> 00:25:45,950
+الـLift Internal Memory Art اللي بنزلوها و بيغذوا
+
+352
+00:25:45,950 --> 00:25:51,150
+المنطقة اللي بعد الاسكيميا طبعا منطقة، في صورة
+
+353
+00:25:51,150 --> 00:25:55,210
+لمنطقة الاسكيميا هنا، تراجعوا هياتها يعني لو كان
+
+354
+00:25:55,210 --> 00:25:59,890
+في انديهانة، الشرايين اللي بيوصلوا بغذ المنطقة هذه
+
+355
+00:26:02,060 --> 00:26:05,900
+في المنطقة هذه بتصير سودة يا جماعة في عملية القلب
+
+356
+00:26:05,900 --> 00:26:09,280
+المفتوح كلنا نشوفها كل اللون أسود أسود دليل أنها
+
+357
+00:26:09,280 --> 00:26:12,480
+الـDead T-Shirt طب إيش الحل؟ الحل أنهم بيجي بيشوف
+
+358
+00:26:12,480 --> 00:26:16,120
+الشريع اللوين مسكر لها نجي نشوف الصورة دي عليا
+
+359
+00:26:16,120 --> 00:26:22,200
+شرائين أحسن في الشرع فبيجي
+
+360
+00:26:22,200 --> 00:26:27,720
+نشوف مثلافبطلع في المنطقة هذا الشريان اللي بوصل
+
+361
+00:26:27,720 --> 00:26:32,860
+إليها مسكّر منها فبروح بجيبلي graft بوصلها في اللي
+
+362
+00:26:32,860 --> 00:26:38,400
+هو سواء إذا كانت جا من الليمة مثلا باخد من الليمة
+
+363
+00:26:38,400 --> 00:26:42,780
+أو إذا جا من الـAortic artery بنزلي graft وبحطها
+
+364
+00:26:42,780 --> 00:26:48,530
+لتحت من الـOclosure فبصير الدم يمشي في الـflowأه
+
+365
+00:26:48,530 --> 00:26:52,730
+تبع الـ R3 القديم اللي هو عشان الـ closure بطل
+
+366
+00:26:52,730 --> 00:26:57,010
+يمشي فيه من تحت يعني اللي كان فيه هنا R2 نعتبر هيك
+
+367
+00:26:57,010 --> 00:27:03,870
+وهنا فيه closure فبتل ال blood يمشي لتحت فانا بروح
+
+368
+00:27:03,870 --> 00:27:07,550
+بجيب ال graft من هنا و بوصلها في تحت ال closure
+
+369
+00:27:07,550 --> 00:27:12,350
+شوية فبيبدأ الدم يصف وين في بقية الـR3 اللي سكر من
+
+370
+00:27:12,350 --> 00:27:15,970
+هنا تمام فبرجع بغز المنطقة هذه اللي تحت عن طريق
+
+371
+00:27:15,970 --> 00:27:19,840
+واصلة منهذه هي الفكرة تبع الكورونا الارترابالباس
+
+372
+00:27:19,840 --> 00:27:23,180
+الـ Grav-Tech لكن خلصنا الموضوع التبع
+
+373
+00:27:23,180 --> 00:27:30,020
+الكارديولوجيا المهم و الله يعطيكم العافية والسلام
+
+374
+00:27:30,020 --> 00:27:31,160
+عليكم ورحمة الله وبركاته
+
diff --git a/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/YSSnq6kqP0E_raw.srt b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/YSSnq6kqP0E_raw.srt
new file mode 100644
index 0000000000000000000000000000000000000000..2031c5c8e40267c46df4678a7dbe08e6ae6e334b
--- /dev/null
+++ b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/YSSnq6kqP0E_raw.srt
@@ -0,0 +1,1500 @@
+1
+00:00:02,450 --> 00:00:05,290
+بسم الله الرحمن الرحيم السلام عليكم ورحمة الله
+
+2
+00:00:05,290 --> 00:00:09,850
+وبركاته بنكمل إن شاء الله ربنا أمين في الـ
+
+3
+00:00:09,850 --> 00:00:13,810
+«Management of Coronary Vascular Disorders» طبعاً
+
+4
+00:00:13,810 --> 00:00:18,170
+بنحكي عن الـ«Coronary Artery Disease» اللي هي
+
+5
+00:00:18,170 --> 00:00:24,650
+مترازمة الـ«Acute Coronary Syndromes» اللي بيسموها
+
+6
+00:00:24,650 --> 00:00:27,990
+سواء كانت «Stable Angina» أو «Unstable Angina» أو
+
+7
+00:00:27,990 --> 00:00:31,600
+«Myocardial Infarction»هذا كلهم بيسموها acute
+
+8
+00:00:31,600 --> 00:00:39,020
+coronary syndrome وبعد هيك بنحاول نعرف إيش الـ
+
+9
+00:00:39,020 --> 00:00:43,660
+acute coronaryالسندروم اللي عند المريض هذا بالظبط
+
+10
+00:00:43,660 --> 00:00:46,760
+تتصنف تحت أي تصنيف تحت «stable angina» ولا
+
+11
+00:00:46,760 --> 00:00:50,280
+«unstable» ولا «malcardial infarction» التشخيص
+
+12
+00:00:50,280 --> 00:00:55,680
+الجديد زي ما بنحكي أنه صار لأي حد بيكون بشكي من
+
+13
+00:00:55,680 --> 00:01:01,820
+symptoms معينة منها لـ «chest pain» منها أنه يكون
+
+14
+00:01:01,820 --> 00:01:04,940
+«shocked»
+
+15
+00:01:04,940 --> 00:01:10,380
+أو «hypotension» أوعنده علامات الـ Basal
+
+16
+00:01:10,380 --> 00:01:14,040
+Crepitation، «بنمول الأيدينة» كل هذه علامات الـ
+
+17
+00:01:14,040 --> 00:01:19,180
+Unstability تبع المريض اللي بيشكي من الـ Chest
+
+18
+00:01:19,180 --> 00:01:27,180
+Pain واللي بتخلينا نفكر فيه من الوضع الـ Stable
+
+19
+00:01:27,180 --> 00:01:31,520
+للـ Angina البين للوضع الـ Unstable للـ Angina
+
+20
+00:01:31,520 --> 00:01:38,050
+البين أو الـ Myocardial Infarctionعشان هيك بنحط
+
+21
+00:01:38,050 --> 00:01:43,610
+تفرقة بين الناس اللي بتيجي عندها acute coronary
+
+22
+00:01:43,610 --> 00:01:49,910
+syndrome زي ما بتحكي وبيكون إيش الوضع التبعه؟ هل
+
+23
+00:01:49,910 --> 00:01:54,570
+هو stable angina البين ولا unstable angina ولا
+
+24
+00:01:54,570 --> 00:01:57,890
+myocardial infarction؟ هدول هم التلات تشخيص مهمة
+
+25
+00:01:57,890 --> 00:02:01,870
+في الموضوع إذا كان المولد بشكل من chest pain و
+
+26
+00:02:01,870 --> 00:02:04,470
+discomfort و shortness of breath
+
+27
+00:02:07,460 --> 00:02:12,060
+أترست هو مرتاح يبقى هذا unstable angina and could
+
+28
+00:02:12,060 --> 00:02:16,940
+be unquiet طب وإذا كان after exertion بعد تعب
+
+29
+00:02:16,940 --> 00:02:19,860
+بيصير مع الحاجة هذه بتكون هذا في الأغلب stable
+
+30
+00:02:19,860 --> 00:02:24,460
+angina يعني لما برجع برتاح بروح كل ال symptoms هذه
+
+31
+00:02:24,460 --> 00:02:29,140
+وبتمتيز إن هذا مع ال exertion لكن إذا مع ال
+
+32
+00:02:29,140 --> 00:02:33,800
+withoutالـ Exertion، الـ Trust، بيصير هذا الكلام
+
+33
+00:02:33,800 --> 00:02:36,720
+معاه بيكون هذا Unstable أنجينة و could be
+
+34
+00:02:36,720 --> 00:02:39,960
+myocardial infarction إيش الفرق بين الـ myocardial
+
+35
+00:02:39,960 --> 00:02:43,780
+infarction و الـ أنجينة؟ إنه في ال .. أه في الـ
+
+36
+00:02:43,780 --> 00:02:45,900
+myocardial infarction بيكون فيه complete
+
+37
+00:02:45,900 --> 00:02:49,160
+obstruction للـ coronary artery اللي بتغذي الـ
+
+38
+00:02:49,160 --> 00:02:51,800
+heart يعني واحد من ال branches تبعة الـ coronary
+
+39
+00:02:51,800 --> 00:02:55,120
+artery اللي بيغذي منطقة معينة من الـ heart بيصير
+
+40
+00:02:55,120 --> 00:02:58,820
+فيه complete obstruction وبالتالي في منطقة كامة من
+
+41
+00:02:58,820 --> 00:03:03,010
+الـ heartبتبطل تتراوة وبتصير فيها أسكينيا وهذا هو
+
+42
+00:03:03,010 --> 00:03:08,110
+السبب الرئيسي في الـPain الشديد اللي بيصير مع
+
+43
+00:03:08,110 --> 00:03:14,010
+المرضى لكن في الـAngina بكون الـObstruction هذا في
+
+44
+00:03:14,010 --> 00:03:19,030
+الـBranch هذا Partial يعني لسه فيه يعني و لو خرم
+
+45
+00:03:19,030 --> 00:03:23,110
+إبرا منه بنسم على المريض شوية Blood فبمنع أن تصير
+
+46
+00:03:23,110 --> 00:03:27,150
+المنطقة Completely أسكينيا أو Complete Death لا
+
+47
+00:03:27,150 --> 00:03:31,170
+تشوف اللي فيهابتكون عاشة لكن الـ «perfusion» بكون
+
+48
+00:03:31,170 --> 00:03:38,890
+يعني «very low» وطبعا ممكن جدا تتطور له اللي هو
+
+49
+00:03:38,890 --> 00:03:43,390
+الـ «unstable angina» هذه لـ «MI» و تسكر خالص عشان
+
+50
+00:03:43,390 --> 00:03:45,470
+هيك المريض بكون في عنده pain بكون في عندنا
+
+51
+00:03:45,470 --> 00:03:49,430
+shortness of breath في كتير ناس بتحكي على التفرقات
+
+52
+00:03:49,430 --> 00:03:53,370
+بين الـ«angina» الـ«pain» و «myocardial
+
+53
+00:03:53,370 --> 00:03:58,120
+infarction»بين أنا مابقيدش الفكرة هذه لإن الاتنين
+
+54
+00:03:58,120 --> 00:04:04,590
+شبه بعض كتير من ناحيةالـ Pain إلا إنه في الـ MRI
+
+55
+00:04:04,590 --> 00:04:10,130
+الـ Pain بكون يعني most severe بكون أكتر وهذا
+
+56
+00:04:10,130 --> 00:04:13,730
+الاشي برضه يعني it depends أحياناً بكون المريض
+
+57
+00:04:13,730 --> 00:04:18,350
+diabetic فما بتكونش عنده ال pain هو الأكتر ولا
+
+58
+00:04:18,350 --> 00:04:22,750
+بالعكس ممكن يجيلك asymptomatic حتى ال radiation
+
+59
+00:04:22,750 --> 00:04:28,270
+تبع ال pain كتير بيحكوا إنهالـ Acute Colitis أو
+
+60
+00:04:28,270 --> 00:04:32,110
+الـ MI اللي بينتبعها كذا الـ Angina اللي بينتبعها
+
+61
+00:04:32,110 --> 00:04:35,710
+لأ لأ الـ Acute Colitis Syndrome بشكل عام اللي
+
+62
+00:04:35,710 --> 00:04:39,170
+بينتبعها بيجي في ال chest وبروح بعمل روديشن على ال
+
+63
+00:04:39,170 --> 00:04:42,970
+shoulder أو بروح على ال left arm وال back وال neck
+
+64
+00:04:42,970 --> 00:04:46,290
+وحتى ال jaw سواء كان فيه يعني شوفنا هذه الحاجات
+
+65
+00:04:46,290 --> 00:04:49,690
+سواء كانت Angina أو بالاخر تطلع MI نفس ال symptom
+
+66
+00:04:50,100 --> 00:04:53,460
+تمام؟ كمان يعني بدي أضيف إنه ممكن في أخر حالة
+
+67
+00:04:53,460 --> 00:04:57,640
+شوفتها في استقبال باطنة من أيام إنه ممكن يجيل pain
+
+68
+00:04:57,640 --> 00:05:01,980
+على ال right side تصور يعني جيرك chest pain على ال
+
+69
+00:05:01,980 --> 00:05:07,100
+right side مش أصلا على ال left side وممكن يضلك
+
+70
+00:05:07,100 --> 00:05:10,160
+يعني والمريض طلع عمقايا والحاجة الوحيدة اللي كان
+
+71
+00:05:10,160 --> 00:05:13,980
+جار فيها المريض غريبة إنه كان sweaty يعني شوية
+
+72
+00:05:13,980 --> 00:05:18,840
+pain مش كتير على ال right side الدكاترة المعظم شكل
+
+73
+00:05:18,840 --> 00:05:23,020
+واحدة muscularولكن ربنا سبحان الله ألهمني لما شُفت
+
+74
+00:05:23,020 --> 00:05:27,080
+المرضي كتير سوتي حسيت أن وضعه مش طبيعي وأنه يعني
+
+75
+00:05:27,080 --> 00:05:32,820
+تقليله لشأن الألم اللي عنده كمية الألم ربما إلها
+
+76
+00:05:32,820 --> 00:05:36,580
+سبب آخر فحاببنا نعمل الـ ECG فطلع فيه أنده فعلاً
+
+77
+00:05:36,580 --> 00:05:41,080
+ST elevation high لذلك احنا فعلاً مع التطور اللي
+
+78
+00:05:41,080 --> 00:05:44,940
+حصل في الطب واللي بيسموه اللي هو acute coronary
+
+79
+00:05:44,940 --> 00:05:48,880
+syndrome وبعد وبيسموه يعني هذه التسمية الموحدة لهم
+
+80
+00:05:49,170 --> 00:05:53,330
+وبعد ذلك بحاولوا يعرفوها هل هي المريض في وضع
+
+81
+00:05:53,330 --> 00:05:56,250
+«Stable Angina» أو «Unstable Angina» أو
+
+82
+00:05:56,250 --> 00:06:00,130
+«Myocardial Infarction» بالنسبة للتشخيص المبدأي
+
+83
+00:06:00,130 --> 00:06:02,790
+تبع الـ «Acute Coronary Syndrome» اللي اتفقنا أنه
+
+84
+00:06:02,790 --> 00:06:05,930
+ممكن يكون فيه نفس الأعراض كلهم ييجيوا بنفس الأوراق
+
+85
+00:06:05,970 --> 00:06:10,350
+الأعراض وممكن يجي فيه ECG changes بالأول وممكن
+
+86
+00:06:10,350 --> 00:06:14,050
+مايكونش فيه ECG changes بالأول وبعد شوية تسيل فيه
+
+87
+00:06:14,050 --> 00:06:17,530
+ECG changes ممكن ال cardiac enzyme بالأول تكون
+
+88
+00:06:17,530 --> 00:06:21,930
+normal وانا اعتبره موضوع angina البين فقط ليس الا
+
+89
+00:06:21,930 --> 00:06:24,990
+بعد شوية التطور ويصير فيه elevated في ال cardiac
+
+90
+00:06:24,990 --> 00:06:28,030
+enzymeويبقى الموضوع انه عبارة عن «myocardial
+
+91
+00:06:28,030 --> 00:06:32,450
+infarction» لكن كانت لسه cooking ما بيانتش لذلك
+
+92
+00:06:32,450 --> 00:06:38,730
+الـ «انجاين» والـ «ام آي» يعني هي مراحل بتسلم بعض
+
+93
+00:06:38,730 --> 00:06:41,610
+ممكن يكون «انجاين» المريض ممكن جدا بعد يخش فيه «ام
+
+94
+00:06:41,610 --> 00:06:44,670
+آي» فلذلك لازم نكون حاذرين ال «terrorist factor»
+
+95
+00:06:44,670 --> 00:06:47,950
+ممكن يتأدي لإنه يصير في عند مريض «acute coronary
+
+96
+00:06:47,950 --> 00:06:51,710
+syndrome» أو اللي هي «coronary artery disease»
+
+97
+00:06:51,710 --> 00:06:57,030
+اللي هم من أهمهاالـ Tobacco use، الـ Smoking، الـ
+
+98
+00:06:57,030 --> 00:07:00,930
+Hypertension، الـ Stress بالدرجة الأولى على فكرة
+
+99
+00:07:00,930 --> 00:07:05,050
+والـ Diabetes والـ Hyperglycemia يعني هذه من
+
+100
+00:07:05,050 --> 00:07:08,670
+الحاجات المعروفة
+
+101
+00:07:08,670 --> 00:07:13,650
+والـ Obesity طبعاً والـ Glucate Aggregation في ناس
+
+102
+00:07:13,650 --> 00:07:16,410
+عندها بيكون بـ Polythicemia هذه من الحاجات
+
+103
+00:07:16,410 --> 00:07:19,630
+المعروفة أنها بتزوّل الـ Risk لـCoronary Artery
+
+104
+00:07:19,630 --> 00:07:25,330
+Disease وهذا تعتبر Modifiable ممكن احناممكن نحن
+
+105
+00:07:25,330 --> 00:07:32,290
+نتحكم فيها ونعمل لها حاجات تحسن منها مثلًا طباكو
+
+106
+00:07:32,290 --> 00:07:35,850
+يوز ونقوله ما تدخنش ويبقى يدخن ويتحسن الوضع عنده
+
+107
+00:07:35,850 --> 00:07:41,070
+الـ blood pressureممكن يأخذ أدوية ويحصل الـcontrol
+
+108
+00:07:41,070 --> 00:07:44,970
+على الـhypertension تبعه فيرجع ضغطه للوضع الطبيعي
+
+109
+00:07:44,970 --> 00:07:48,330
+كذلك السكر كذلك الـobesity ممكن يعمل دياته ممكن
+
+110
+00:07:48,330 --> 00:07:51,850
+يعمل لكن في حاجات non-controllable زي الـage مثلا
+
+111
+00:07:51,850 --> 00:07:55,170
+والـgender معروف أن الحاجات هذه ممكن تصير عند
+
+112
+00:07:55,170 --> 00:07:58,410
+الفيميل أكتر كمان تصير في الـage
+
+113
+00:08:03,430 --> 00:08:06,430
+عفوًا، الـ «hypertension» بيصير في «end» الـ
+
+114
+00:08:06,430 --> 00:08:11,010
+«female» أكتر، الـ «acute culinary syndrome» بيصير
+
+115
+00:08:11,010 --> 00:08:14,890
+«end» الـ «male» أكتر ربما لأن الـ «stress» أكتر،
+
+116
+00:08:14,890 --> 00:08:19,870
+الـ «age» كمان، كل ما ارتفع الـ «age» كل ما بيصير،
+
+117
+00:08:19,870 --> 00:08:24,170
+بيزيد الـ «risk»، فهذه كلها «risk factors» ممكن
+
+118
+00:08:24,170 --> 00:08:27,890
+تعمل الكلام، فهذا لذلك أنا مش هحكي بالتفصيل عن الـ
+
+119
+00:08:27,890 --> 00:08:28,210
+«android
+
+120
+00:08:32,780 --> 00:08:35,380
+والتصنيفات، لأنه احنا افهمنا إن الـ «acute
+
+121
+00:08:35,380 --> 00:08:39,060
+coronary syndrome» إنه يجيب المريض بـ «متلازمة»
+
+122
+00:08:39,060 --> 00:08:41,660
+اللي هي الـ «chest pain»، «shortness of breath»،
+
+123
+00:08:41,660 --> 00:08:46,600
+«difficulty breathing»، الحاجات هذه، وبعدها أنا
+
+124
+00:08:46,600 --> 00:08:50,760
+أقرر إذا هو «Ras angina» ولا هو «M.I.» بناءً على
+
+125
+00:08:50,760 --> 00:08:56,200
+نتائج تبع الكاردكينزين و«ECG changes» اللي موجودة
+
+126
+00:08:56,200 --> 00:09:00,370
+عندي بالإضافة إلى الـ«symptoms»بس الفرق الوحيد
+
+127
+00:09:00,370 --> 00:09:04,030
+اللي بدنا نعرفه أنه طول ما هو الكلام هذا بيصير
+
+128
+00:09:04,030 --> 00:09:07,730
+معاه بس after exertion بتكون هذا اسمها stable
+
+129
+00:09:07,730 --> 00:09:10,930
+عندها لإنه مجرد ما برجع بيستيلحق السير الوضع عنده
+
+130
+00:09:10,930 --> 00:09:15,670
+كويس بيبقى بيهمنا لكن إذا ال risk بتصير معاه بتكون
+
+131
+00:09:15,670 --> 00:09:18,990
+هذا unstable وممكن تكون MRI بيبقى بيهمنا نعرف إيش
+
+132
+00:09:18,990 --> 00:09:24,840
+اللي المفروض نسويههذه الـ «سيفيرتس» كما نرى كيفها
+
+133
+00:09:24,840 --> 00:09:29,760
+لما تكون asymptomatic أنجاينة أنجاينة بس مافيش أي
+
+134
+00:09:29,760 --> 00:09:32,260
+سيمتوم أنجاينة only with this strenuous exertion
+
+135
+00:09:32,260 --> 00:09:37,680
+لما بيصير أنت بشوية يعني
+
+136
+00:09:37,680 --> 00:09:40,960
+activity أكتر من الطبيعة هه ممكن تصير أنجاينة
+
+137
+00:09:40,960 --> 00:09:45,180
+مدرية exertion بتعب شوية، بيمشي شوية، بيجري شوية
+
+138
+00:09:45,180 --> 00:09:50,880
+مع الـ مع ال mild exertion تصور أنك بتصير مع أيه؟
+
+139
+00:09:50,880 --> 00:09:56,820
+عشان أنا معاللي يعني مع جهود جو مثلا لو نطلع درج
+
+140
+00:09:56,820 --> 00:10:01,440
+هنا مع جهود إيه؟ موديلة متوسطة، مع جهود بسيط، بس
+
+141
+00:10:01,440 --> 00:10:06,120
+ده بروح الحمام ولا حاجة، أه ممكن يصير، لكن إذا كان
+
+142
+00:10:06,120 --> 00:10:09,960
+أنجانه at rest، ماذا معناه؟ إن هو يضبط ال stable،
+
+143
+00:10:09,960 --> 00:10:16,200
+تمام؟طبعاً في الـ ECG لو عملنا لمريد عنده Angina
+
+144
+00:10:16,200 --> 00:10:19,660
+عملنا له ECG نحن نلاقي أنه عنده ST depression أو
+
+145
+00:10:19,660 --> 00:10:23,740
+بنلاقي يعني الـ ST بتكون نزلة تحت هنشوف في ال ECG
+
+146
+00:10:23,740 --> 00:10:31,460
+كيف نعمل ECG هيتها، طلع كيف هي .. هي ال .. خلينا
+
+147
+00:10:31,460 --> 00:10:37,350
+نشوف هنا بالظبط أوضح، طلع كيف؟هذه الـ V-Wave وهذه
+
+148
+00:10:37,350 --> 00:10:41,550
+الـ QRS المفروض يأتي الـ Isoelectric line هنا
+
+149
+00:10:41,550 --> 00:10:46,470
+ويكمل ويعمل الـ T بس هذه تبقى الـ S وهذه الـ T هي
+
+150
+00:10:46,470 --> 00:10:48,670
+الـ Depression نزل عن الـ Isoelectric line ما يعني
+
+151
+00:10:48,670 --> 00:10:52,110
+Isoelectric line؟ المفروض هي الـ Isoelectric line
+
+152
+00:10:52,110 --> 00:10:57,310
+هيك هنا المفروض يكمل هيك تمامًا مع الخط هذا زي الـ
+
+153
+00:10:57,310 --> 00:11:03,450
+ECG الطبيعي لكن هو فعليًا بتنزل بعدين تأتي الـ
+
+154
+00:11:03,450 --> 00:11:07,400
+Wave هذا من هنا تبدأ Wave جديدةتمام؟ فعشان هي كالـ
+
+155
+00:11:07,400 --> 00:11:12,900
+T-wave نزلت لتحت ST depression تمام؟ هذا هو اللي
+
+156
+00:11:12,900 --> 00:11:21,380
+هو الـ Angina بين والعلامات تبقيتها على ال ECG
+
+157
+00:11:21,380 --> 00:11:24,360
+ويكون برضه الـ T-wave inversion during angina
+
+158
+00:11:24,360 --> 00:11:30,140
+البين بتكونمتحولة ونزلة لتحت حكينا الفرق بين
+
+159
+00:11:30,140 --> 00:11:34,180
+الـStable Angina والـUnstable Angina وحكينا أن
+
+160
+00:11:34,180 --> 00:11:39,400
+الـUnstable Angina ممكن تتحول
+
+161
+00:11:39,400 --> 00:11:43,000
+لـMyocardial
+
+162
+00:11:43,000 --> 00:11:47,560
+Infarction العلمات مهمة جدا أشوف المريض إذا كان
+
+163
+00:11:47,560 --> 00:11:53,670
+سوتي وشكله بيل وعنده Difficultyوهو عنده بين زي ما
+
+164
+00:11:53,670 --> 00:11:57,050
+حكينا الصفات و سواء كان في الـ center تبقى ال
+
+165
+00:11:57,050 --> 00:12:00,310
+chest أو radiated لل shoulder و ال neck و ال jaw و
+
+166
+00:12:00,310 --> 00:12:05,210
+ال left armطبعًا المفروض أننا نتعامل مع المريض
+
+167
+00:12:05,210 --> 00:12:10,170
+بـNitroglycerin وبيأخد أول حبة من الـNitroglycerin
+
+168
+00:12:10,170 --> 00:12:15,530
+وبنقيم حالته إذا اتحسن ولا لأ بعد خمس دقائق ممكن
+
+169
+00:12:15,530 --> 00:12:19,690
+يتم إعادتها كمان جرعه أو ممكن كمان جرعه وما تحسنش
+
+170
+00:12:19,690 --> 00:12:23,870
+بيكون الوضع أكتر من أن يكون الـAngina البين أو
+
+171
+00:12:23,870 --> 00:12:31,290
+Stable Angina فبيكون المريض بلزم أنهيعني ينعملوا
+
+172
+00:12:31,290 --> 00:12:34,570
+إجراءات أكتر فبالتالي بلزم إنه يدي ع مستشفى عشان
+
+173
+00:12:34,570 --> 00:12:38,410
+ينعملوا ECG و Cardiac Enzyme ويكونوا under اللي هو
+
+174
+00:12:38,410 --> 00:12:43,870
+«Closed Monitoring and Follow-up»
+
+175
+00:12:43,870 --> 00:12:48,350
+لو بدنا نشوف إحنا كـ«نيرس» أيش المفروض نعمل لو
+
+176
+00:12:48,350 --> 00:12:52,030
+جاتنا حالة على الطوارئ أو عنده هذه الـSymptoms أول
+
+177
+00:12:52,030 --> 00:12:55,190
+حاجة طبعا لازم أحطه في Bedrest دي ما اللي بنحكي
+
+178
+00:12:55,190 --> 00:13:00,650
+كلمة «مونة»بنحطه في كلمة «bed rest» برايح المريض
+
+179
+00:13:00,650 --> 00:13:04,670
+بحطله Oxygen لإن ال Oxygen demand في الحالة هذه هو
+
+180
+00:13:04,670 --> 00:13:07,030
+أصلا جاي في shortness of breath و in catapulting
+
+181
+00:13:07,030 --> 00:13:11,790
+بكونه لإن ال heart muscle ما بوصلهاش دم كفاية فهي
+
+182
+00:13:11,790 --> 00:13:15,810
+اللي بيخلي يحسس حاله إنه ماعندهوش Oxygen كفاية مع
+
+183
+00:13:15,810 --> 00:13:20,310
+إنه النفس ليش فيه عنده مشكلة لكن فهو ال Oxygen
+
+184
+00:13:20,310 --> 00:13:26,130
+demand عنده أعلىطبعاً برضه بنبدأ نعمل assessment
+
+185
+00:13:26,130 --> 00:13:30,330
+بناخد Vital Sign بنعمل ECG بنعمل ركب IV Axis وبين
+
+186
+00:13:30,330 --> 00:13:34,910
+اللي هو بناخد تحليل بنهدى المريض وبنعمله
+
+187
+00:13:34,910 --> 00:13:41,090
+الـReassurance أن أنت بخير وطمأن ونبدأ نشوف بالظبط
+
+188
+00:13:41,090 --> 00:13:45,350
+إيش نتائج تبع ال ECG وإيش نتائج تبع الcardiac
+
+189
+00:13:45,350 --> 00:13:47,280
+enzyme وبنعمل خارطة الasset assessmentالـ
+
+190
+00:13:47,280 --> 00:13:50,680
+Assessment لطبيقة الـ Pain اللي عنده طبعاً بعد
+
+191
+00:13:50,680 --> 00:13:54,600
+هيكة لو فعلا سبب أنه آه هذا chest pain و related
+
+192
+00:13:54,600 --> 00:13:58,680
+لل heart عادة بيستخدمه اللي هو بعد ما حكينا الـ
+
+193
+00:13:58,680 --> 00:14:01,740
+bed rest و ال oxygen حياته اللي هو مورفين عشان ت
+
+194
+00:14:01,740 --> 00:14:05,600
+decrease anxiety ت decrease pain وكمان بيساعد أنه
+
+195
+00:14:05,600 --> 00:14:09,900
+بيعمل بالذات المورفين coronary vasodilator آه طبعا
+
+196
+00:14:09,900 --> 00:14:16,340
+بعديها ممكن نبدأ ندى علاجات تتحسن مناللي هو الـ
+
+197
+00:14:16,340 --> 00:14:21,500
+الـ الوضع الـ coronary arteries أو إن نعملها
+
+198
+00:14:21,500 --> 00:14:25,740
+dilatation إذا أتأكدنا إن المريض مش myocardial
+
+199
+00:14:25,740 --> 00:14:31,420
+infarction وبالذات مايكونش inferior myocardial
+
+200
+00:14:31,420 --> 00:14:35,780
+infarction أو إنه مايكونش hypertension إذا إنه كون
+
+201
+00:14:35,780 --> 00:14:39,980
+المريض hypertensionأو myocardial infarction واضح
+
+202
+00:14:39,980 --> 00:14:42,580
+ال ECG مبنفعش أن أستخدم معاه اللي هو الـ
+
+203
+00:14:42,580 --> 00:14:45,960
+Nitroglycerin لو لاعيت أن المريض لأ لا هو
+
+204
+00:14:45,960 --> 00:14:48,180
+myocardial infarction ولا هو Hypotension، هدا
+
+205
+00:14:48,180 --> 00:14:51,560
+بيسمع أنه أديله جرعة تانية من الـNitroglycerin
+
+206
+00:14:51,560 --> 00:14:56,200
+اللي هو الـ5 ميلي جرام عشان أشوف ربماخاصة إذا كان
+
+207
+00:14:56,200 --> 00:14:59,500
+المريض مش ماخد، لكن إذا كان ماخد تلت مرات ومافيش
+
+208
+00:14:59,500 --> 00:15:04,700
+استجابة، okay بنخليه في الريس، بنحطه في Oxygen،
+
+209
+00:15:04,700 --> 00:15:09,860
+بنحط عليه Oxygen، ونبدأ نشوف الـheart rate تبعه،
+
+210
+00:15:09,860 --> 00:15:13,080
+ونشوف أمكن في ديستردام هي اللي عاملة المشكلة، ومش
+
+211
+00:15:13,080 --> 00:15:17,300
+بيخليها يتحسن، ونبدأ نشوف الـBlood Pressure تبعته،
+
+212
+00:15:17,300 --> 00:15:23,700
+عشان نحاول أنهإن حاسس الموضوع طبعا، لو كان
+
+213
+00:15:23,700 --> 00:15:27,800
+الـBlood Pressure واطي، بيكون بدنا ندخل ونحاول
+
+214
+00:15:27,800 --> 00:15:33,330
+نسيطر عليه ونعليه، لو كان عاليبيكون بدنا ند أدوية
+
+215
+00:15:33,330 --> 00:15:37,650
+تعمل تخطيط للضغط لإنه كتير مرضى بيكون هو
+
+216
+00:15:37,650 --> 00:15:40,230
+الـUngernal pain اللي عندهم بسبب إن الـBlood
+
+217
+00:15:40,230 --> 00:15:44,430
+pressure جاي Highly، Severe أو بيسموه Hypertension
+
+218
+00:15:44,430 --> 00:15:48,650
+Crisis أو Malignant Hypertension بيكون جاي وضغط
+
+219
+00:15:48,650 --> 00:15:51,590
+عالي كتير ومش بيستجيب للأدوية تبع
+
+220
+00:15:51,590 --> 00:15:54,350
+الـAntihypertensive اللي بياخدها في البيت وهذا هو
+
+221
+00:15:54,350 --> 00:15:57,290
+اللي عمله الـUngernal pain يعني بيكون Ungernal
+
+222
+00:15:57,290 --> 00:16:00,030
+pain because of increased bloodالـ pressure
+
+223
+00:16:00,030 --> 00:16:06,310
+فهنديها لو كان المريض عنده myocardial infarction
+
+224
+00:16:06,310 --> 00:16:10,610
+وانا حاسس ان الموضوع أكتر من أنه أنجالنا البين
+
+225
+00:16:10,610 --> 00:16:16,000
+بنبدأ نتصرف يا جماعة بشكلحتى لو أنا مش عارف إنه
+
+226
+00:16:16,000 --> 00:16:19,060
+لسه مركز عن الفشل، لسه عندي الـsymptom هذي، ببدأ
+
+227
+00:16:19,060 --> 00:16:23,500
+أدي حاجة اسمها الـAnti-platelet اللي هي الإبارة عن
+
+228
+00:16:23,500 --> 00:16:27,600
+الـAspirin، وفي الحالات الطارقة، بند 300 مليجرام
+
+229
+00:16:27,600 --> 00:16:32,720
+Aspirin، Chewing، يعني ينضغهم المريض مضغ، وبعد هيك
+
+230
+00:16:33,140 --> 00:16:36,800
+يبلعهم الهدف من المضغ هذا إنه يصبح الـ Absorption
+
+231
+00:16:36,800 --> 00:16:40,160
+تبعهم في الـ Mycosis تبع الـ Oral Cavity أسرع
+
+232
+00:16:40,160 --> 00:16:44,500
+وبالتالي بيشتغل as Anti-aggregant فلو كان فيه
+
+233
+00:16:44,500 --> 00:16:48,880
+Thrombus عمالي بتتكون بيمنع اللي هو كبير حجم الـ
+
+234
+00:16:48,880 --> 00:16:51,660
+Thrombus هذه وبيمنع الـ Complete enclosure إذا بده
+
+235
+00:16:51,660 --> 00:16:55,900
+يصبح Enclosure وبده تتحول هذه الحالة لـMI ولذلك
+
+236
+00:16:55,900 --> 00:17:01,700
+دائما بينصحوا فيه، بعد ذلكالـ ECG والـ Cardiac
+
+237
+00:17:01,700 --> 00:17:05,180
+Enzyme اللي هتطلع على تأيجها هي هتحكي لي إذا كان
+
+238
+00:17:05,180 --> 00:17:09,300
+هذا المريض فعلا Unstable أنجينة بس ولا لأ هو صار
+
+239
+00:17:09,300 --> 00:17:15,640
+فعلا MRI وصار فيه Complete Obstructionفي أحد الـ
+
+240
+00:17:15,640 --> 00:17:18,700
+«لومن» أو أحد الـ «برانشيز» تبعة الـ coronary
+
+241
+00:17:18,700 --> 00:17:22,920
+arteries وبالتالي بيصطلع عنده علامات في الـ «STG»
+
+242
+00:17:22,920 --> 00:17:26,360
+اللي بيسموها الـ «ST elevation» إيش يعني ST
+
+243
+00:17:26,360 --> 00:17:29,140
+elevation؟ أفرجيكوا، هاي الـ «Isoelectric line»
+
+244
+00:17:29,140 --> 00:17:34,240
+اللي كنت بحت عامله، يعني هاي بيكون هاي الـPثمانية
+
+245
+00:17:34,240 --> 00:17:38,300
+وبعد ذلك هاي إيش الـ T هي طلع الـ S الـ S في الأصل
+
+246
+00:17:38,300 --> 00:17:42,200
+بتكون inverted لتحت بعدين إيش بتطلع و الـ T بتكمل
+
+247
+00:17:42,200 --> 00:17:46,760
+دوري تمام في الـ S T elevation إيش بيصير فيه بي
+
+248
+00:17:46,760 --> 00:17:52,260
+كيو آر تطلع كيف الـ R مكملتش لتحت بعدين إجت الـ S
+
+249
+00:17:52,260 --> 00:17:58,410
+من فوق إجت Sالـ ISO يجب أن ينزل و ينزل و ينزل و
+
+250
+00:17:58,410 --> 00:18:02,050
+ينزل و ينزل و ينزل و ينزل و ينزل و ينزل و ينزل و
+
+251
+00:18:02,050 --> 00:18:07,010
+ينزل و ينزل و ينزل و ينزل و ينزل و ينزل و ينزل و
+
+252
+00:18:07,010 --> 00:18:07,250
+ينزل و ينزل و ينزل و ينزل و ينزل و ينزل و ينزل و
+
+253
+00:18:07,250 --> 00:18:09,770
+ينزل و ينزل و ينزل و ينزل و ينزل و ينزل و ينزل و
+
+254
+00:18:09,770 --> 00:18:09,770
+ينزل و ينزل و ينزل و ينزل و ينزل و ينزل و ينزل و
+
+255
+00:18:09,770 --> 00:18:15,090
+ينزل و ينزل و ينزل و ينزل و ينزل
+
+256
+00:18:15,090 --> 00:18:19,750
+و
+
+257
+00:18:19,750 --> 00:18:24,200
+يالـ BQR هي الـ S نزلت أحيد وبعدين الـ T تطلع
+
+258
+00:18:24,200 --> 00:18:30,620
+طبيعي لكن هنا راحزين كيف كده الفرق فهذا هو طبعا
+
+259
+00:18:30,620 --> 00:18:37,760
+IQR S هاي T تمام، هاي الـ Isoelectric line واحدة،
+
+260
+00:18:37,760 --> 00:18:41,100
+هاي هو هاي، هاي الـ Isoelectric line لكن هنا وين
+
+261
+00:18:41,100 --> 00:18:45,680
+الـ Isoelectric line؟ مش فوق فهذا بنسميه HT
+
+262
+00:18:45,680 --> 00:18:50,840
+elevationهذه أهم علامات الـ M.I. على الـ ECG طبعًا
+
+263
+00:18:50,840 --> 00:18:54,220
+بنحكي إن في حاجة اسمها non-stemic M.I. يعني ممكن
+
+264
+00:18:54,220 --> 00:18:58,520
+يكون myocardial infarction لكن without ST
+
+265
+00:18:58,520 --> 00:19:03,240
+elevation وهذا بتبين إنه مافيش يعني علامات على ال
+
+266
+00:19:03,240 --> 00:19:08,050
+ECG مافيش حقس ST elevation لكن فيه symptomوفيه
+
+267
+00:19:08,050 --> 00:19:10,950
+Related Cardiac Enzyme اللي حكينا عنها بالذات
+
+268
+00:19:10,950 --> 00:19:16,250
+الـCK والـCKMB وحكينا إن الـCKMB لازم يكون يعني
+
+269
+00:19:16,250 --> 00:19:24,430
+بارتفاع ترضي مع الـCK بما يزيد عن 10% من الـCK
+
+270
+00:19:24,430 --> 00:19:29,490
+نفسه الـCKMB يكون أكتر 10% من الـCK نفسه
+
+271
+00:19:33,450 --> 00:19:36,970
+طبعاً الـ Clinical Manifestation عارفين هنا بس بدي
+
+272
+00:19:36,970 --> 00:19:39,390
+أحكي بزيادة على حاجة اللي دعو بالـ
+
+273
+00:19:39,390 --> 00:19:42,770
+Gastrointestinal Attract إن الناس دول عادة بيكون
+
+274
+00:19:42,770 --> 00:19:45,510
+عندهم Vagal Stimulation فبيجيوا Picture of Nausea
+
+275
+00:19:45,510 --> 00:19:49,530
+أو Vomiting ولمّا بتشوف واحد أمره فوق الأربعين سنة
+
+276
+00:19:49,530 --> 00:19:52,910
+وعنده Nausea أو Vomiting دايما فاكر إن هذا ممكن
+
+277
+00:19:52,910 --> 00:19:59,730
+يكون Vagal Stimulation نتيجة إنهيكون عنده مثلا MRI
+
+278
+00:19:59,730 --> 00:20:03,530
+و هو مش عارف و بفكر موضوع related لمعته و كتير
+
+279
+00:20:03,530 --> 00:20:07,230
+كتير كتير كتير ناس يعني فقدت حياتها بسبب إن هو
+
+280
+00:20:07,230 --> 00:20:10,430
+مقتنع إن هذا الموضوع كان بس له علاقة في معته و
+
+281
+00:20:10,430 --> 00:20:15,370
+مالهوش علاقة في القلم و بالآخر يعني صار suddenly
+
+282
+00:20:15,370 --> 00:20:19,090
+arrested يا جبو أنا مستشفى و successful CPR يا
+
+283
+00:20:19,090 --> 00:20:24,230
+ماكانش successful و المريض passed away و فقد حياته
+
+284
+00:20:24,230 --> 00:20:30,310
+نتيجة القصةبعينة حتى لو كنت بتشتغل في القوارق
+
+285
+00:20:30,310 --> 00:20:34,850
+وشوفت مريض دايما اي مريض فوق الأربعين سنة و جاي ب
+
+286
+00:20:34,850 --> 00:20:39,450
+.. ب .. ب .. ب .. ب symptom gastric symptom هاول
+
+287
+00:20:39,450 --> 00:20:44,270
+تتأكد تعمل farther examination و انه مش cardiac و
+
+288
+00:20:44,270 --> 00:20:45,710
+بالذات ال ECG
+
+289
+00:20:48,340 --> 00:20:53,600
+الهلاج تبعت كيف بنشخصها حكينا إن أنا بلزم أعمل ECG
+
+290
+00:20:53,600 --> 00:20:57,500
+وبلزم أعمل اللي هو ال lab
+
+291
+00:21:02,420 --> 00:21:08,240
+المجلومين حكينا إنه بينعمل لكن مش هو مؤشر طبعا هو
+
+292
+00:21:08,240 --> 00:21:10,980
+مؤشر سريع لأنه بيرتفع في خلال أول أربع ساعات لكن
+
+293
+00:21:10,980 --> 00:21:15,700
+مش مؤشر جيد لأنه مع أي destruction بيعلتروا بنيني
+
+294
+00:21:15,700 --> 00:21:21,580
+كويس كتير وبيشجعوه لأنه بيرتفع بسرعة في الساعة
+
+295
+00:21:21,580 --> 00:21:22,200
+الأولى
+
+296
+00:21:24,910 --> 00:21:29,170
+الـCK، عارفين إحنا إنه ما بستمرش لأكتر من تلت أيام
+
+297
+00:21:29,170 --> 00:21:35,690
+حكينا على المواضيع تبع التشخيص بدنا نشوف اللي هو
+
+298
+00:21:35,690 --> 00:21:38,850
+المواضيع العلاج بالنسبة للعلاج، يا جماعة، عكس إن
+
+299
+00:21:38,850 --> 00:21:43,210
+نفسها دولةبتعالجه بطريقتين، الطريقة الأولى وهي
+
+300
+00:21:43,210 --> 00:21:46,490
+الطريقة الحديثة أنه في خلال تسعين دقيقة يتم عمل
+
+301
+00:21:46,490 --> 00:21:50,630
+قسطرة أولية الـ Primary PCI بنسميها اللي هي
+
+302
+00:21:50,630 --> 00:21:55,710
+Percutaneous Coronary Artery Intervention أنه
+
+303
+00:21:55,710 --> 00:22:00,090
+ينعمله قسطرة وينشوف وين بالظبط الخلل عنده وين الـ
+
+304
+00:22:00,090 --> 00:22:03,330
+Stenosis وين الـ Closure وإذا كان بيستدعي تنحطله
+
+305
+00:22:03,330 --> 00:22:06,050
+Stent فبنحطله Stent ده عامة
+
+306
+00:22:11,120 --> 00:22:15,440
+موجود بحيث أنه مجرد ما بيجي المرضى بتشخص أنه عنده
+
+307
+00:22:15,440 --> 00:22:20,060
+ST elevation وعنده ما يعني اللي هو myocardial
+
+308
+00:22:20,060 --> 00:22:24,420
+infarction بينزل على قسم القسترة وبيتم عمل القسترة
+
+309
+00:22:24,420 --> 00:22:27,500
+إليه إذا ماكانش فيه بيكون احنا مضطرين نتعامل معه
+
+310
+00:22:27,500 --> 00:22:31,820
+pharmacological فالدوة المشهور و اللي بينعطى في
+
+311
+00:22:31,820 --> 00:22:35,360
+أدوية كتير لكن احنا بالنسبة إن الدوة المشهورة عنا
+
+312
+00:22:35,360 --> 00:22:39,840
+اللي هو الـstryptokinase بيسموها film politicعن
+
+313
+00:22:39,840 --> 00:22:43,880
+طريق الـ Structokinase فيه أدوية كتير حديثة
+
+314
+00:22:43,880 --> 00:22:49,440
+تستخدمها كـ Throne Politics زي الـ RTPA و أغلى،
+
+315
+00:22:49,440 --> 00:22:55,120
+لكن العبرة هنا في أنها أقل الـ Side Effect الـ
+
+316
+00:22:55,120 --> 00:22:57,220
+Side Effect المشهورة تبقى لـ Structokinase أنه
+
+317
+00:22:57,220 --> 00:23:00,740
+يمكن يعملوا bleeding عند المريض وممكن الـ bleeding
+
+318
+00:23:00,740 --> 00:23:06,110
+يخشش المريض الهوريك، الـCVAوحاجات كتير ممكن أوجهت
+
+319
+00:23:06,110 --> 00:23:10,110
+تخليني ما أستطيع أن أعطي الـ streptococcus إذا كان
+
+320
+00:23:10,110 --> 00:23:14,210
+المريض عامل عملية recently، إذا كان المريض صار فيه
+
+321
+00:23:14,210 --> 00:23:17,750
+انبعاط من الـCVA recently، إذا كان، إذا كان، إذا
+
+322
+00:23:17,750 --> 00:23:19,690
+كان، إذا كان في عنده مشاكل في البيت
+
+323
+00:23:40,710 --> 00:23:46,470
+بالنسبة للـ ECG اللي فرجتكوا يا فدك كان لمرض هي
+
+324
+00:23:46,470 --> 00:23:50,900
+تجاربها في severe ST elevationوكان عنده مركز
+
+325
+00:23:50,900 --> 00:23:53,740
+كاردرينج فارتشن أخد الـ Structokinase وهذا كان
+
+326
+00:23:53,740 --> 00:23:57,560
+Successful Structokinase أو Successful Drug
+
+327
+00:23:57,560 --> 00:24:01,080
+Administration هذا الـ ECG بعت الـ Structokinase
+
+328
+00:24:01,080 --> 00:24:05,440
+تقريبا بساعة أخد الـ Structokinase خلال نص ساعة
+
+329
+00:24:05,440 --> 00:24:09,520
+اتحسنت أموره، طبعا أخد معفلون عشان ما ينزلش ضغطه و
+
+330
+00:24:09,520 --> 00:24:12,880
+بعديها رجع ال ECG طبيعي يعني لفروم بس دابت و
+
+331
+00:24:12,880 --> 00:24:17,100
+اتحللت ومشيت و رجع الموضوع و طبعا المرض راح منه
+
+332
+00:24:17,100 --> 00:24:17,460
+البيت
+
+333
+00:24:20,840 --> 00:24:25,160
+هذا بالنسبة لـ «Management» طبعاً الـ «Management»
+
+334
+00:24:25,160 --> 00:24:29,520
+التاني اللي حكينا عنه أنه نعمل للمريض اللي هو الـ
+
+335
+00:24:29,520 --> 00:24:36,040
+«PCI» أو الـ «coronary percutaneous» اللي هو
+
+336
+00:24:36,040 --> 00:24:41,400
+«coronary angioplasty»
+
+337
+00:24:41,400 --> 00:24:46,440
+أو عفوا قبلها أن نعمل له «percutaneous coronary
+
+338
+00:24:46,440 --> 00:24:49,660
+intervention»
+
+339
+00:24:49,740 --> 00:24:54,240
+عن طريق إنه يحطوله ربما أواشي بس يشوفوا داير الـ
+
+340
+00:24:54,240 --> 00:24:56,420
+Digitalization أو بقى بيعملوا بس Ballooning
+
+341
+00:24:56,420 --> 00:24:58,800
+بيعملوا Inflation فبواسقوا الـ Lumen فبكون مش
+
+342
+00:24:58,800 --> 00:25:02,200
+محتاج إنه يحط فيه Stint بس عندما يتعملوا Balloon
+
+343
+00:25:02,200 --> 00:25:05,900
+برجع حجمه كويس إذا والله لأ برجع فيه Amputation
+
+344
+00:25:05,900 --> 00:25:08,860
+يعني مافيش Flow بعد منه بعد النقطة اللي فيها
+
+345
+00:25:08,860 --> 00:25:13,820
+Enclosure بيقول لأ بيحتاج Stint عشان ضل الـ Lumen
+
+346
+00:25:13,820 --> 00:25:20,760
+هذايعني inflated وفاتح فممكن يحطوا اللي هو دعامة
+
+347
+00:25:20,760 --> 00:25:24,560
+إذا الموضوع كتير severe وفيه أكتر من branch فيهم
+
+348
+00:25:24,560 --> 00:25:26,740
+المشكلة هادف المرضي اللي بحتاجه اللي هو coronary
+
+349
+00:25:26,740 --> 00:25:30,480
+artery bypass graft اللي هي عملية cabbage اللي هي
+
+350
+00:25:30,480 --> 00:25:32,160
+عملية ترقي أو توصيل
+
+351
+00:25:35,310 --> 00:25:39,850
+الشرايين بيأخدوا من الـSafeness Vein أو من اللي هو
+
+352
+00:25:39,850 --> 00:25:45,950
+الـLift Internal Memory Art اللي بنزلوها و بيغذوا
+
+353
+00:25:45,950 --> 00:25:51,150
+المنطقة اللي بعد الاسكيميا طبعا منطقة، في صورة
+
+354
+00:25:51,150 --> 00:25:55,210
+لمنطقة الاسكيميا هنا، تراجعوا هياتها يعني لو كان
+
+355
+00:25:55,210 --> 00:25:59,890
+في انديهانة، الشرايين اللي بيوصلوا بغذ المنطقة هذه
+
+356
+00:26:02,060 --> 00:26:05,900
+في المنطقة هذه بتصير سودة يا جماعة في عملية القلب
+
+357
+00:26:05,900 --> 00:26:09,280
+المفتوح كلنا نشوفها كل اللون أسود أسود دليل أنها
+
+358
+00:26:09,280 --> 00:26:12,480
+الـDead T-Shirt طب إيش الحل؟ الحل أنهم بيجي بيشوف
+
+359
+00:26:12,480 --> 00:26:16,120
+الشريع اللوين مسكر لها نجي نشوف الصورة دي عليا
+
+360
+00:26:16,120 --> 00:26:22,200
+شرائين أحسن في الشرع فبيجي
+
+361
+00:26:22,200 --> 00:26:27,720
+نشوف مثلافبطلع في المنطقة هذا الشريان اللي بوصل
+
+362
+00:26:27,720 --> 00:26:32,860
+إليها مسكّر منها فبروح بجيبلي graft بوصلها في اللي
+
+363
+00:26:32,860 --> 00:26:38,400
+هو سواء إذا كانت جا من الليمة مثلا باخد من الليمة
+
+364
+00:26:38,400 --> 00:26:42,780
+أو إذا جا من الـAortic artery بنزلي graft وبحطها
+
+365
+00:26:42,780 --> 00:26:48,530
+لتحت من الـOclosure فبصير الدم يمشي في الـflowأه
+
+366
+00:26:48,530 --> 00:26:52,730
+تبع الـ R3 القديم اللي هو عشان الـ closure بطل
+
+367
+00:26:52,730 --> 00:26:57,010
+يمشي فيه من تحت يعني اللي كان فيه هنا R2 نعتبر هيك
+
+368
+00:26:57,010 --> 00:27:03,870
+وهنا فيه closure فبتل ال blood يمشي لتحت فانا بروح
+
+369
+00:27:03,870 --> 00:27:07,550
+بجيب ال graft من هنا و بوصلها في تحت ال closure
+
+370
+00:27:07,550 --> 00:27:12,350
+شوية فبيبدأ الدم يصف وين في بقية الـR3 اللي سكر من
+
+371
+00:27:12,350 --> 00:27:15,970
+هنا تمام فبرجع بغز المنطقة هذه اللي تحت عن طريق
+
+372
+00:27:15,970 --> 00:27:19,840
+واصلة منهذه هي الفكرة تبع الكورونا الارترابالباس
+
+373
+00:27:19,840 --> 00:27:23,180
+الـ Grav-Tech لكن خلصنا الموضوع التبع
+
+374
+00:27:23,180 --> 00:27:30,020
+الكارديولوجيا المهم و الله يعطيكم العافية والسلام
+
+375
+00:27:30,020 --> 00:27:31,160
+عليكم ورحمة الله وبركاته
+
diff --git a/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/axHM409j0Ew.srt b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/axHM409j0Ew.srt
new file mode 100644
index 0000000000000000000000000000000000000000..fbec756377764280f1b2a278e9e0d3fb945199f1
--- /dev/null
+++ b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/axHM409j0Ew.srt
@@ -0,0 +1,790 @@
+1
+00:00:00,810 --> 00:00:04,790
+بنحكي مع بعض بسم الله الرحمن الرحيم كمان مرة
+
+2
+00:00:04,790 --> 00:00:09,170
+وبنقول لكم كمان مرة السلام عليكم ورحمة الله وبركاته
+
+3
+00:00:09,170 --> 00:00:13,090
+اليوم بنحكي إن شاء الله في الـ Acid-Base Balance
+
+4
+00:00:13,090 --> 00:00:18,590
+اللي هو التوازن الكيميائي
+
+5
+00:00:18,590 --> 00:00:25,730
+أو الحمضية والقاعدية في دم الإنسان أو في الجسم
+
+6
+00:00:26,710 --> 00:00:31,910
+هنحكي شوية background وبعدين نشوف تعريفه، نتعرف على
+
+7
+00:00:31,910 --> 00:00:35,050
+حاجة اسمها الـ Buffer System وبعدين نشوف الخلل اللي
+
+8
+00:00:35,050 --> 00:00:39,690
+بيحدث وكيف بنقوم بترجمته لـ Blood Gas Analysis، كيف
+
+9
+00:00:39,690 --> 00:00:43,890
+بنعرفها وبنعرف إيش نوع الخلل هذا وما هي طرق العلاج
+
+10
+00:00:43,890 --> 00:00:48,590
+وبعدين في المحاضرة اللي بعدها هنحكي عن اللي هو
+
+11
+00:00:48,590 --> 00:00:53,170
+الـ Mechanical Ventilation إن شاء الله، تمام؟
+
+12
+00:01:03,600 --> 00:01:12,460
+بالنسبة للـ Acid-Base Balance، نحكي إن الوظيفة
+
+13
+00:01:12,460 --> 00:01:18,600
+الأساسية والمهمة جداً اللي بتعملها هذه الحاجة في الجسم
+
+14
+00:01:18,600 --> 00:01:24,940
+اسمها Acid-Base Balance، هي بيسموها الـ Homeostasis
+
+15
+00:01:24,940 --> 00:01:30,470
+إيش يعني Homeostasis؟ كلمة Homeostasis هي كلمة Hemo
+
+16
+00:01:30,470 --> 00:01:35,190
+معناها دم، و Stasis يعني حالة من الثبات، Stasis فهي
+
+17
+00:01:35,190 --> 00:01:40,610
+معناها أن الـ ability of the body system، قدرة أجهزة
+
+18
+00:01:40,610 --> 00:01:45,930
+الجسم، to maintaining its consistency، إنها تظل في
+
+19
+00:01:45,930 --> 00:01:51,030
+حالة من الثبات، تمام؟ إذن الـ important and integral
+
+20
+00:01:51,030 --> 00:01:55,020
+goal of Homeostasis is acid-base balance أو acid-
+
+21
+00:01:55,020 --> 00:02:01,580
+base regulation، حاجة مهمة كتير في الموضوع، الثبات
+
+22
+00:02:01,580 --> 00:02:05,400
+هذا أو الـ homeostasis، أنه يكون فيه ثبات على مستوى
+
+23
+00:02:05,400 --> 00:02:08,540
+الحمضية والقاعدية لدم
+
+24
+00:02:31,060 --> 00:02:34,660
+Okay، كمقدمة، لسه مش فاهمين حاجة ولا عارفين عن إيش
+
+25
+00:02:34,660 --> 00:02:38,740
+بتحكي، ولا إيش بتقول لك، ممكن نتحمل ونشوف،  برك
+
+26
+00:02:38,740 --> 00:02:43,500
+نفهم كمان شوية، أوك حاضر ولا همك، هنفهم طيب، إيش
+
+27
+00:02:43,500 --> 00:02:48,940
+مين يفهم؟ مين يفهم أن الجسم عشان يعمل  maintaining acid
+
+28
+00:02:48,940 --> 00:02:50,660
+-base homeostasis
+
+29
+00:02:52,630 --> 00:02:59,010
+يعتمد هذا على حاجة مهمة جداً في الجسم وهي
+
+30
+00:02:59,010 --> 00:03:04,510
+عبارة عن الـ Hydrogen Ion، أيونات الهيدروجين
+
+31
+00:03:04,510 --> 00:03:10,030
+ذرات الهيدروجين اللي في الجسم، تمام؟ والـ Hydrogen
+
+32
+00:03:10,030 --> 00:03:16,590
+Ion، هدول اللي في الجسم بنعبر عنهم برمز للحمضية
+
+33
+00:03:16,590 --> 00:03:24,620
+والقاعدية، اسمه الـ pH، وهنشوف إن الـ pH هي عبارة عن
+
+34
+00:03:24,620 --> 00:03:27,640
+مصطلح
+
+35
+00:03:27,640 --> 00:03:32,980
+لاتيني معناه قوة أيونات الهيدروجين الموجودة
+
+36
+00:03:32,980 --> 00:03:38,520
+ببساطة، هيك معناه، الـ Homeostasis تبع الجسم اللي
+
+37
+00:03:38,520 --> 00:03:41,840
+احنا بنحكي عنه، هذا طيب، هذا هنشوف الـ pH، okay طيب
+
+38
+00:03:41,840 --> 00:03:45,340
+طب إيش الـ Homeostasis؟ نرجع له؟ آه الـ Homeostasis اللي
+
+39
+00:03:45,340 --> 00:03:49,780
+احنا بنحكي عنه في الـ Blood بتحقق إذا كانت الـ pH
+
+40
+00:03:49,780 --> 00:03:56,480
+هذه اللي قولنا عنها اللي هي قوة ذرات الهيدروجين
+
+41
+00:03:56,480 --> 00:04:03,950
+الموجودة في الجسم، إذا كانت بين الـ 7.35 لـ 7.45، هذا
+
+42
+00:04:03,950 --> 00:04:08,870
+بيحققه جهاز الـ Buffer System، بيخليه يبقى الـ pH تبع
+
+43
+00:04:08,870 --> 00:04:13,790
+الـ Blood تبعنا بين الـ 7.35 والـ 7.45، يعني مثلاً زي
+
+44
+00:04:13,790 --> 00:04:19,010
+كيف؟ يعني مثلاً زي الـ Sodium، أكمل Sodium؟ الطبيعي
+
+45
+00:04:19,010 --> 00:04:22,330
+في الـ Electrolyte، واحدة شاطرة بتحكي لي، بتقول لي من
+
+46
+00:04:22,330 --> 00:04:29,210
+بين الـ 135 إلى الـ 145، بقول برافو عليكي، وكذلك
+
+47
+00:04:29,210 --> 00:04:41,270
+الـ pH الطبيعي أنه يكون بين الـ 7.35 و 7.45
+
+48
+00:04:41,270 --> 00:04:47,450
+تمام؟
+
+49
+00:04:48,040 --> 00:04:51,760
+الآن
+
+50
+00:04:57,080 --> 00:05:00,080
+طب إيش علاقة البيئة في هذا الكلام؟ بالنسبة
+
+51
+00:05:00,080 --> 00:05:04,920
+للبنات اللي معانا على المحاضرة، المحاضرة اللي
+
+52
+00:05:04,920 --> 00:05:08,820
+بحكيها الآن مسجلة، وهرفعها، وما تخافوش، بس أنا
+
+53
+00:05:08,820 --> 00:05:12,900
+عاملها تفاعلية، يعني للناس اللي حابة أنها تسمع
+
+54
+00:05:12,900 --> 00:05:17,160
+المحاضرة مباشرة، ولو حابة أنها تسأل سؤال بتقدر يعني
+
+55
+00:05:17,160 --> 00:05:21,900
+تكتب على الـ Chat، أنا فيه عندي سؤال، وتسأله، أو حتى
+
+56
+00:05:21,900 --> 00:05:25,300
+ممكن أفتح لكم الميكروفونات، وإذا حد بده يسأل يسأل
+
+57
+00:05:25,300 --> 00:05:30,430
+ما فيش عندي مشكلة، بس بدناش اللي هو الحديث الجانبي
+
+58
+00:05:30,430 --> 00:05:37,130
+والناس اللي بتحكي يعني في بيوتهم، تمام؟ اتفقنا إنه
+
+59
+00:05:37,130 --> 00:05:42,670
+الـ pH الطبيعي تبعه من 7.35 لـ 7.45، اتفقنا إنه في حاجة
+
+60
+00:05:42,670 --> 00:05:47,170
+اسمها Buffer System، هذه بتحافظ على إن الـ Blood
+
+61
+00:05:47,170 --> 00:05:50,570
+الـ pH تبعته تظل بين الحدين هذول، مين هم الـ
+
+62
+00:05:50,570 --> 00:05:53,790
+Buffer System؟ اتفقنا بشكل مبدأي إن الـ Kidney
+
+63
+00:05:53,790 --> 00:05:58,570
+والـ Lung هم أقوى Buffer System في الجسم، كمان حاجة
+
+64
+00:05:58,570 --> 00:06:03,090
+بالضبط، بيقول لك الـ pH علاقة بينه وبين الحمضية
+
+65
+00:06:03,090 --> 00:06:09,440
+والقاعدية، علاقة عكسية، علاقة إيش مالها؟ عكسية، كيف
+
+66
+00:06:09,440 --> 00:06:13,960
+علاقة عكسية يا دكتور؟ يعني الـ pH بيكون منخفض، قليل،
+
+67
+00:06:13,960 --> 00:06:19,840
+يعني أقل من 7،  تركيز أيونات الهيدروجين في الجسم
+
+68
+00:06:19,840 --> 00:06:25,780
+عالي، تركيز أيونات الهيدروجين في الجسم عالي، تركيز
+
+69
+00:06:25,780 --> 00:06:27,760
+أيونات الهيدروجين في الجسم عالي، تركيز أيونات
+
+70
+00:06:27,760 --> 00:06:27,780
+أيونات الهيدروجين في الجسم عالي، تركيز أيونات
+
+71
+00:06:27,780 --> 00:06:29,800
+أيونات الهيدروجين في الجسم عالي، تركيز أيونات
+
+72
+00:06:29,800 --> 00:06:32,760
+أيونات الهيدروجين في الجسم عالي، تركيز أيونات
+
+73
+00:06:32,760 --> 00:06:33,780
+أيونات الهيدروجين في الجسم عالي، تركيز أيونات
+
+74
+00:06:33,780 --> 00:06:34,060
+أيونات الهيدروجين في الجسم عالي، تركيز أيونا
+
+75
+00:06:37,620 --> 00:06:43,520
+مش بيصير هيك، بينزل لتحت، طب كل ما قلت أيونات الهيدروجين
+
+76
+00:06:43,520 --> 00:06:45,840
+بتبقى، بتبقى، بتبقى، بتبقى، بتبقى، بتبقى، بتبقى، بتبقى،
+
+77
+00:06:45,840 --> 00:06:48,300
+تبقى، بتبقى، بتبقى، بتبقى، بتبقى، بتبقى، بتبقى، بتبقى،
+
+78
+00:06:48,300 --> 00:06:49,440
+بتبقى، بتبقى، بتبقى، بتبقى، بتبقى، بتبقى، بتبقى، بتبقى،
+
+79
+00:06:49,440 --> 00:06:50,340
+بتبقى، بتبقى، بتبقى، بتبقى، بتبقى، بتبقى، بتبقى، بتبقى،
+
+80
+00:06:50,340 --> 00:06:57,140
+بتبقى، بتبقى، بتبقى، بتبقى، بتبقى، بتبقى، بتبقى،
+
+81
+00:06:57,140 --> 00:07:01,440
+بتبقى
+
+82
+00:07:21,040 --> 00:07:27,440
+طيب، سمعيني، الصوت واضح؟
+
+83
+00:07:27,440 --> 00:07:37,910
+الصوت okay، هيك أحسن،المعنى اللاتيني هو Potentia
+
+84
+00:07:37,910 --> 00:07:45,010
+Hydrogenae، هيدروجيني، هذا لاتيني، يعني قوة
+
+85
+00:07:45,010 --> 00:07:50,350
+أيونات الهيدروجين، آه طيب، كويس، إذا the power of
+
+86
+00:07:50,350 --> 00:07:53,690
+hydrogen، هيك معناها الكلمة، كويس
+
+87
+00:07:56,090 --> 00:08:00,030
+إذاً الـ pH Scale is commonly used to represent
+
+88
+00:08:00,030 --> 00:08:04,430
+hydrogen ions، اللي هو الـ Scale تبع الـ pH دائماً
+
+89
+00:08:04,430 --> 00:08:09,090
+بيستخدموه عشان يعبر إلينا عن قوة أيونات الهيدروجين
+
+90
+00:08:09,090 --> 00:08:13,150
+في أي مركب، الصابون إليه pH، و الـ Blood إليه
+
+91
+00:08:13,150 --> 00:08:17,370
+pH، و زيت الزيتون اللي بتاكله في الدار إليه pH، و
+
+92
+00:08:17,370 --> 00:08:21,390
+زيت السلسيلي اللي تبع القلي إليه pH، و الطحينة
+
+93
+00:08:21,390 --> 00:08:28,210
+إليه، كل شيء إليه pH، طب هد بيحسبوها، بتكون ببساطة عن
+
+94
+00:08:28,210 --> 00:08:34,270
+إنها عبارة عن الـ Negative logarithm to the base 10، هدي
+
+95
+00:08:34,270 --> 00:08:38,050
+معناها الـ logarithm العاشر، تمام؟ الـ Negative
+
+96
+00:08:38,050 --> 00:08:44,320
+logarithm لأيونات الهيدروجين، أها، لذلك الـ pH
+
+97
+00:08:44,320 --> 00:08:48,260
+معناها الـ Potency of Hydrogen Ion أو الـ Power of
+
+98
+00:08:48,260 --> 00:08:52,620
+Hydrogen Ion، هي عبارة عن الـ Negative Logarithm
+
+99
+00:08:52,620 --> 00:09:00,540
+لأيونات تبع الهيدروجين، عرفنا أن العلاقة
+
+100
+00:09:00,540 --> 00:09:07,930
+بينها وبين الحمضية والقاعدية علاقة عكسية، بمعنى إن
+
+101
+00:09:07,930 --> 00:09:13,390
+كلما زادت أيونات الهيدروجين، كلما قلت الـ pH، وهذا
+
+102
+00:09:13,390 --> 00:09:18,950
+بيعمل إنها حمضية، وبمعنى آخر إن كلما زادت أيونات
+
+103
+00:09:18,950 --> 00:09:23,310
+الهيدروجين المفروض إيش يصير؟ حمضية، إذا أيونات
+
+104
+00:09:23,310 --> 00:09:28,390
+الهيدروجين لو زادت في أي مركب، الـ pH بتساوي سبعة،
+
+105
+00:09:28,390 --> 00:09:33,420
+أيونات الهيدروجين لو زادت في أي مركب، بيصير البول
+
+106
+00:09:33,420 --> 00:09:38,940
+حامضي، طب كيف بتأثر على الـ pH؟ بتقل، بتقل الـ pH
+
+107
+00:09:38,940 --> 00:09:43,780
+طب لو أيونات الهيدروجين قلت في أي مركب، إيش بيصير
+
+108
+00:09:43,780 --> 00:09:47,840
+فيه؟ بيصير البول قاعدي، طب إيش بيصير في الـ pH؟
+
+109
+00:09:47,840 --> 00:09:52,480
+في الـ pH، بتزيد، طب هو كيف في أنا، إنت نازل تقول
+
+110
+00:09:52,480 --> 00:09:56,960
+أنا بتزيد وبتقل؟ طب هو إيش فيه رقم مفصلّي، بقدر
+
+111
+00:09:56,960 --> 00:10:02,750
+أقول لما تقل عن كذا، بكون لما تقل الـ pH عن كذا،
+
+112
+00:10:02,750 --> 00:10:06,750
+بتكون حامضي، لما تزيد الـ pH عن كذا، بكون إيش؟
+
+113
+00:10:06,750 --> 00:10:11,030
+قاعدي، طب إيش هو الرقم المفصلي؟ قال الرقم المفصلي
+
+114
+00:10:11,030 --> 00:10:15,690
+بالنسبة لنا بالذات في الـ Blood هو سبعة، بالنسبة لنا
+
+115
+00:10:15,690 --> 00:10:17,950
+حتى في الـ Blood هو سبعة وتلاتين وخمسة واربعين، لكن هو بالنسبة
+
+116
+00:10:17,950 --> 00:10:21,490
+للـ pH in general قال لك سبعة، هذا وضع التعادل، إيش يعني؟ يعني سبعة بيكون
+
+117
+00:10:21,490 --> 00:10:26,380
+المركب شبه مُحايد، لا حامضي ولا قاعدي، كل ما قلت
+
+118
+00:10:26,380 --> 00:10:32,320
+الـ pH تبعته عن سبعة، كل ما قلت، هذا الكلام اللي أنا
+
+119
+00:10:32,320 --> 00:10:38,080
+حكيته توّه، إنه كل ما بيزيد تركيز أيونات الهيدروجين، وتفسير
+
+120
+00:10:38,080 --> 00:10:42,720
+التفسير اللي أنا توّه حكيته، جا لك، كل ما الـ pH طلع
+
+121
+00:10:42,720 --> 00:10:48,460
+neutral بتكون عند سبعة، عند إيش؟ عند سبعة بكون مُحايد،
+
+122
+00:10:48,460 --> 00:10:52,770
+يعني كأنه لا قاعدي ولا حمضي، طيب إيش بيصير؟ جا لك
+
+123
+00:10:52,770 --> 00:11:00,190
+لو زادت أيونات الهيدروجين، ها الـ hydrogen activity
+
+124
+00:11:00,190 --> 00:11:04,730
+إيش مالها؟ زادت، إيش بيصير المركب يا جماعة؟ حمضي
+
+125
+00:11:10,730 --> 00:11:14,130
+طلعوا كيف؟ ها الـ pH صار فيها
+
+126
+00:11:18,230 --> 00:11:23,450
+بتقل، هذا بناءً على إيش؟ بناءً على الزيادة في
+
+127
+00:11:23,450 --> 00:11:28,050
+أيونات الهيدروجين، طبعاً العلاقة العكسية مع
+
+128
+00:11:28,050 --> 00:11:34,550
+الـ Hydroxyl، الـ OH، ما نطنّش كتير، بالعكس بالنسبة
+
+129
+00:11:34,550 --> 00:11:41,250
+للقاعدة، كل ما بتقل أيونات الهيدروجين، كل ما بتزيد
+
+130
+00:11:41,250 --> 00:11:45,050
+العلامة العشرية، يعني الواحد بعده كتير أصفار، معناه
+
+131
+00:11:45,050 --> 00:11:49,250
+أنه أقل، كل ما الواحد بيجرب، مين أكبر هذا الرقم ولا
+
+132
+00:11:49,250 --> 00:11:55,090
+هذا، أكيد هذا، مين أكبر؟ هذا الرقم ولا هذا الآخر؟
+
+133
+00:11:55,090 --> 00:11:58,810
+أكيد هذا، صح؟ لأن الأصفار العشرية اللي بعد الفاصلة
+
+134
+00:11:58,810 --> 00:12:04,050
+أقل، فإذاً هنا إيش بيصير في أيونات الهيدروجين
+
+135
+00:12:04,050 --> 00:12:12,620
+عامةً؟ إيش بيصير فيها؟ الـ Activity، كل ما بالنسبة
+
+136
+00:12:12,620 --> 00:12:16,340
+للـ Base كل ما بتقل، إيش بيصير في الـ pH؟ كما
+
+137
+00:12:16,340 --> 00:12:20,120
+أنتم شايفين، الـ pH إيش بيصير فيها؟ الـ pH بتعلى،
+
+138
+00:12:20,120 --> 00:12:22,640
+بتعلى، بتعلى، بتعلى، بتعلى، بتعلى، بتعلى، بتعلى،
+
+139
+00:12:22,640 --> 00:12:23,500
+بتعلى، بتعلى، بتعلى، بتعلى، بتعلى، بتعلى، بتعلى،
+
+140
+00:12:23,500 --> 00:12:30,560
+بتعلى، بتعلى، بتعلى، بتعلى، بتعلى، بتعلى، بتعلى،
+
+141
+00:12:30,560 --> 00:12:32,360
+بتعلى، بتعلى، بتعلى، بتعلى، بتعلى، بتعلى، بتعلى،
+
+142
+00:12:32,360 --> 00:12:32,580
+بتعلى، بتعلى، بتعلى، بتعلى، بتعلى، بتعلى، بتعلى،
+
+143
+00:12:32,580 --> 00:12:34,160
+بتعلى، بتعلى، بتعلى، بتعلى، بتعلى، بتعلى، بتع
+
+144
+00:12:39,340 --> 00:12:43,240
+عندما حسبوا الـ Hydrogen Activity في  الدم فوجدوا
+
+145
+00:12:43,240 --> 00:12:49,580
+الرقم هذا 0.000006... يعني من الصعب التعامل مع رقم
+
+146
+00:12:49,580 --> 00:12:53,040
+بهذا الشكل، طيب قال لك لو بدي آخذ الـ
+
+147
+00:12:53,040 --> 00:12:57,260
+logarithm تبع هذا الرقم عشان أتعامل برقم أصغر، طلع
+
+148
+00:12:57,260 --> 00:13:03,580
+-7.35، آه والله هذا أسهل في التعامل، بس minus
+
+149
+00:13:03,580 --> 00:13:08,920
+غلبة، قال لك طب بسيطة، خذ الـ Negative Logarithm بدل
+
+150
+00:13:08,920 --> 00:13:13,000
+ما تأخذ الـ Logarithm الطبيعي، خذ الـ Negative
+
+151
+00:13:13,000 --> 00:13:18,220
+Logarithm، يعني الـ Negative تبع ناقص 7.35، نيجاتيف
+
+152
+00:13:18,220 --> 00:13:21,520
+في نيجاتيف بتصير موجب، فعشان هيك صاروا يأخذوا الـ
+
+153
+00:13:21,520 --> 00:13:26,420
+Negative Logarithm للرقم هذا، فصار يطلع لنا رقم موجب
+
+154
+00:13:26,420 --> 00:13:31,610
+اسمه 7.35، هذا الـ Lower Limit، لإن كون الـ Blood
+
+155
+00:13:31,610 --> 00:13:35,310
+عندي Balanced، وهذا الـ Upper Limit، لإن كون عندي الـ
+
+156
+00:13:35,310 --> 00:13:39,870
+Blood Balanced، فوق هيك بيصير قاعدي، وتحت من هذا
+
+157
+00:13:39,870 --> 00:13:45,810
+بيصير حمضي، تمام؟ فهيك عرفنا إيش الـ
+
+158
+00:13:45,810 --> 00:13:48,790
+pH، من وين اجت، إيش مصدرها
+
+159
+00:13:52,540 --> 00:13:56,560
+وبقت إيش، بيكون زيادة في أيونات الهيدروجين بتعمل
+
+160
+00:13:56,560 --> 00:14:01,140
+حمضية، وهذا بيأثر على الـ pH، إنها بتقل، بتقل في
+
+161
+00:14:01,140 --> 00:14:04,260
+جميع المركبات، عن السبعة، بالنسبة للـ Blood هو
+
+162
+00:14:04,260 --> 00:14:08,260
+المركب اللي إحنا بهمه، يعني بتقل عن سبعة فاصلة
+
+163
+00:14:08,260 --> 00:14:12,360
+تلاتة وخمسة بتصير حمضي، بتزيد عن سبعة فاصلة أربعة
+
+164
+00:14:12,360 --> 00:14:17,880
+خمسة بتصير قاعدي، تمام، فهمنا هذا الكلام كله، هلأ
+
+165
+00:14:17,880 --> 00:14:20,880
+الـ "أسيدات" هدول إيش بتقول؟ بتحكي الكلام اللي
+
+166
+00:14:20,880 --> 00:14:23,840
+تبعي أنا، اللي أخصّه لكم، يعني إنه الـ Acid، إنه في
+
+167
+00:14:23,840 -->
+
+223
+00:19:19,180 --> 00:19:23,220
+وعرفنا إنّ الـ pH إذا انخفض عن الـ 7.35 في الدم بيكون
+
+224
+00:19:23,220 --> 00:19:29,720
+حمضيّة، وإذا ارتفع عن الـ 7.45 في الدم بيسمّيها الكلوسيس
+
+225
+00:19:29,720 --> 00:19:34,460
+فالجهة دي بدنا شويّة نغيّر المصطلح تبع كلمة base
+
+226
+00:19:34,460 --> 00:19:39,690
+اللي هي base معناها قاعدة أو الكلمة القاعديّة alkaline،
+
+227
+00:19:39,690 --> 00:19:44,450
+alkalosis، alkalosis معناها حالة من القاعديّة،
+
+228
+00:19:44,450 --> 00:19:49,410
+تمام؟ هذا بيصير إذا كان الـ pH في الدم فوق الـ 7.45،
+
+229
+00:19:49,410 --> 00:19:57,290
+طيب، كويس، إذا افترضنا أنّ الـ Blood pH من 7.35 لـ 7.45،
+
+230
+00:19:57,290 --> 00:20:02,670
+فوق الـ 7.45 بيصير Alkalosis، وتحت الـ
+
+231
+00:20:02,670 --> 00:20:07,710
+7.35 بتعمل Acidosis، الـ pH في الحالة هذه بتكون
+
+232
+00:20:07,710 --> 00:20:15,310
+أقل من 7.35،  الـ pH في الحالة هذه بتكون أكثر من 7.45
+
+233
+00:20:15,310 --> 00:20:22,190
+تمام، هذه هي الـ Translation الأولية لموضوعنا اللي
+
+234
+00:20:22,190 --> 00:20:27,830
+بدينا نحكي فيه،  لـ Arterial Blood Gases. تمام، هننهي
+
+235
+00:20:27,830 --> 00:20:32,470
+المحاضرة ها والمحاضرة المسجلة الثانية هنحكي فيها
+
+236
+00:20:32,470 --> 00:20:38,770
+إن شاء الله عن اللي هو الأنواع
+
+237
+00:20:38,770 --> 00:20:42,570
+تبع الـ compensation، كيف بيصير يعني، إيش الـ
+
+238
+00:20:42,570 --> 00:20:45,630
+metabolic وإيش الـ respiratory، إيش هذه الحالات
+
+239
+00:20:45,630 --> 00:20:48,690
+وإيش يعني الـ acidosis تبع الـ blood، حكينا هذه، وإيش
+
+240
+00:20:48,690 --> 00:20:51,610
+يعني الـ alkalosis تبع الـ blood،  الـ normal blood
+
+241
+00:20:51,610 --> 00:20:57,670
+gases. الـ Normal Blood Gases له Settings ثانية، مش
+
+242
+00:20:57,670 --> 00:21:01,890
+بس الـ pH، كمان لازم أكون عارف الـ PCO2 والـ Oxygen
+
+243
+00:21:01,890 --> 00:21:05,370
+Saturation والـ Bicarb، هذه الحاجات موجودة already
+
+244
+00:21:05,370 --> 00:21:11,770
+في الجسم وهي من اللي هي مكوّنات الـ Buffer System
+
+245
+00:21:11,770 --> 00:21:17,290
+وعلشان هيك إن شاء الله رب العالمين إحنا هنناقش كلّ
+
+246
+00:21:17,290 --> 00:21:22,900
+الكلام هذا في المحاضرة الجاية. بدّي أخلي لكم الـ
+
+247
+00:21:22,900 --> 00:21:26,860
+WhatsApp مفتوح، واللي بدها تسأل أي سؤال في المحاضرة
+
+248
+00:21:26,860 --> 00:21:31,480
+هذه، من عناية التنسيق،  هلا لقيت أنه نخلي الحكيمة في
+
+249
+00:21:31,480 --> 00:21:34,580
+النادي تفتح الـ WhatsApp، وإذا في أي حد عنده أي
+
+250
+00:21:34,580 --> 00:21:38,880
+سؤال في المحاضرة،  خليني أسمع منكم
+
+251
+00:21:38,880 --> 00:21:43,580
+يعطيكم العافية، وشكرًا كثير لكم، ولو إني أنا مش
+
+252
+00:21:43,580 --> 00:21:47,280
+عارف بتظلّوا تزعلوني، تخربشوا، وبتحكوا ومتسابوش
+
+253
+00:21:47,280 --> 00:21:50,500
+مساكنين المايكروفون، مش عارف ليش، يعطيكم العافية
diff --git a/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/axHM409j0Ew_postprocess.srt b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/axHM409j0Ew_postprocess.srt
new file mode 100644
index 0000000000000000000000000000000000000000..36e13df10aa27404632c461de0d5174f49e3f6f5
--- /dev/null
+++ b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/axHM409j0Ew_postprocess.srt
@@ -0,0 +1,1012 @@
+1
+00:00:00,810 --> 00:00:04,790
+بنحكي مع بعض بسم الله الرحمن الرحيم كمان مرة
+
+2
+00:00:04,790 --> 00:00:09,170
+وبنقولكم كمان مرة السلام عليكم ورحمة الله وبركاته
+
+3
+00:00:09,170 --> 00:00:13,090
+اليوم بنحكي إن شاء الله في الـ Acid-Base Balance
+
+4
+00:00:13,090 --> 00:00:18,590
+اللي هو التوازن الكيميائي
+
+5
+00:00:18,590 --> 00:00:25,730
+أو الحنضية أو القاعدية في دم الإنسان أو في الجسم
+
+6
+00:00:26,710 --> 00:00:31,910
+هنحكي شوية background وبعدين نشوف تعريفه نتعرف على
+
+7
+00:00:31,910 --> 00:00:35,050
+حاجة اسمها الـBuffer System وبعدين نشوف الخلل اللي
+
+8
+00:00:35,050 --> 00:00:39,690
+بيسيل وكيف بقينا بنترجم لـBlood Gas Analysis كيف
+
+9
+00:00:39,690 --> 00:00:43,890
+بنعرفها وبنعرف إيش نقل الخلل هذا وما هي طرق الإلاج
+
+10
+00:00:43,890 --> 00:00:48,590
+وبعدين في المعادرة اللي بعدها هنحكي عن اللي هو
+
+11
+00:00:48,590 --> 00:00:53,170
+الـMechanical Ventilation إن شاء الله تمام؟
+
+12
+00:01:03,600 --> 00:01:12,460
+بالنسبة للـ Acid-Base Balance نحكي إن الوظيفة
+
+13
+00:01:12,460 --> 00:01:18,600
+الأساسية والمهمة جدا اللي بتعمل إن في الجسم حاجة
+
+14
+00:01:18,600 --> 00:01:24,940
+اسمها Acid-Base Balance هي بيسموها الـ Hemostasis
+
+15
+00:01:24,940 --> 00:01:30,470
+إيش يعني Hemostasis؟ طلع HemoStasis هي كلمة Hemo
+
+16
+00:01:30,470 --> 00:01:35,190
+معناها هدم وStasis يعني حالة من التباد Stasis فهي
+
+17
+00:01:35,190 --> 00:01:40,610
+معناها أن الـability of the body system قدرة أجهزة
+
+18
+00:01:40,610 --> 00:01:45,930
+الجسم to maintaining its consistency إنها تظل في
+
+19
+00:01:45,930 --> 00:01:51,030
+حالة من السباب تمام؟ إذن الـimportant and integral
+
+20
+00:01:51,030 --> 00:01:55,020
+goal of HemostasisIs asset-based balance أو asset
+
+21
+00:01:55,020 --> 00:02:01,580
+-based regulation حاجة مهمة كتير في الموضوعالثبات
+
+22
+00:02:01,580 --> 00:02:05,400
+هذا أو الـ hemostasis أنه يكون فيه ثبات على مستوى
+
+23
+00:02:05,400 --> 00:02:08,540
+الحمضية والقاعدية تبعها الدم
+
+24
+00:02:31,060 --> 00:02:34,660
+Okay، كمقدمة، لسه مش فاهمين حاجة ولا عارفين عن إيش
+
+25
+00:02:34,660 --> 00:02:38,740
+بتحكي ولا إيش بتقول لك، ممكن نتحملك ونشوف، برك
+
+26
+00:02:38,740 --> 00:02:43,500
+فهمنا كمان شوية، أوك حاضر ولا همك، هنفهم طيب، إيش
+
+27
+00:02:43,500 --> 00:02:48,940
+مينفهم؟ مينفهم إن الجسم عشان يعمل تومنتين acid
+
+28
+00:02:48,940 --> 00:02:50,660
+-base hemostasis
+
+29
+00:02:52,630 --> 00:02:59,010
+بيعتمد هذا على الحاجة المهمة جدا في الجسم وهي
+
+30
+00:02:59,010 --> 00:03:04,510
+عبارة عن الـHydrogen Ion على آيونات الهيدروجين
+
+31
+00:03:04,510 --> 00:03:10,030
+ذرات الهيدروجين اللي في الجسم تمام؟ والـHydrogen
+
+32
+00:03:10,030 --> 00:03:16,590
+Ion هدولة اللي في الجسم بنعبر عنهم برمز للحنضية
+
+33
+00:03:16,590 --> 00:03:24,620
+والقاعدية اسمه الـBوهنشوف إن الـ pH هي عبارة عن
+
+34
+00:03:24,620 --> 00:03:27,640
+مصطلح
+
+35
+00:03:27,640 --> 00:03:32,980
+لاتيني معناه قوة آيونات الهيدروجين الموجودة
+
+36
+00:03:32,980 --> 00:03:38,520
+ببساطة، هيك معناهالـ Hemostasis تبع الجسم اللي
+
+37
+00:03:38,520 --> 00:03:41,840
+احنا بنحكي عنه هذا طيب، هذا هنشوف الـBH، okay طيب
+
+38
+00:03:41,840 --> 00:03:45,340
+طب إيش الـHemostasis نرجعله؟ آه الـHemostasis اللي
+
+39
+00:03:45,340 --> 00:03:49,780
+احنا بنحكي عنه في الـBlood بتحقق إذا كانت الـBH
+
+40
+00:03:49,780 --> 00:03:56,480
+هذه اللي قولنا عنها اللي هي قوة الذرات الهيدروجين
+
+41
+00:03:56,480 --> 00:04:03,950
+الموجودة في الجسمإذا كانت بين الـ7.35 لـ7.45 هذا
+
+42
+00:04:03,950 --> 00:04:08,870
+بيحققه جهاز الـBuffer System بيخليه يبقى الـBH تبع
+
+43
+00:04:08,870 --> 00:04:13,790
+الـBlood تبعنا بين الـ7.35 والـ7.45 يعني مثلا زي
+
+44
+00:04:13,790 --> 00:04:19,010
+كيف؟ يعني مثلا زي الـ Sodium أكمل Sodium؟الطبيعي
+
+45
+00:04:19,010 --> 00:04:22,330
+في الـ Electrolyte واحدة شاطرة بتحكيلي بتقولي من
+
+46
+00:04:22,330 --> 00:04:29,210
+بين الـ 135 لإند الـ 145 بقول أبرافو عليكي وكذلك
+
+47
+00:04:29,210 --> 00:04:41,270
+الـ pH الطبيعي أنه يكون بين الـ 7.35 و7.45
+
+48
+00:04:41,270 --> 00:04:47,450
+تمام؟
+
+49
+00:04:48,040 --> 00:04:51,760
+الآن الان
+
+50
+00:04:57,080 --> 00:05:00,080
+طب إيش علاقة البيئة تشي في هذا الكلام؟ بالنسبة
+
+51
+00:05:00,080 --> 00:05:04,920
+للبنات اللي معانا على المحاضرة المحاضرة اللي
+
+52
+00:05:04,920 --> 00:05:08,820
+بحكيها الآن مسجلة و هرفعها و ماتخافوش بس أنا
+
+53
+00:05:08,820 --> 00:05:12,900
+عاملها تفاعلية من يعني للناس اللي حابة أنها تسمع
+
+54
+00:05:12,900 --> 00:05:17,160
+المحاضرة مباشر و لو حابت أنها تسأل سؤال بتقدر يعني
+
+55
+00:05:17,160 --> 00:05:21,900
+تكتب على الـChat أنا فيه عندي سؤال و تسأله أو حتى
+
+56
+00:05:21,900 --> 00:05:25,300
+ممكن أفتحها لكم المقرافونات و إذا حد بده يسأل يسأل
+
+57
+00:05:25,300 --> 00:05:30,430
+مافيش عندي مشكلةبس بدناش اللي هو الحديث الجانبية
+
+58
+00:05:30,430 --> 00:05:37,130
+والناس اللي بحكوا يعني في بيوتهمتمام؟ اتفقنا إنه
+
+59
+00:05:37,130 --> 00:05:42,670
+الـVH الطبيعي تبعه من 7.35 لـ7.45 اتفقنا إنه في حد
+
+60
+00:05:42,670 --> 00:05:47,170
+اسمها buffer system هذي بتحافظ على إن الـBlood
+
+61
+00:05:47,170 --> 00:05:50,570
+الـVH تبعته تظل بين الحاشدين هدول، مين هم ال
+
+62
+00:05:50,570 --> 00:05:53,790
+buffer system؟ اتفقنا بشكل مبدأي إن الـkidney
+
+63
+00:05:53,790 --> 00:05:58,570
+والـlung هم أقوى buffer system في الجسمكمان حاجة
+
+64
+00:05:58,570 --> 00:06:03,090
+بالضبط بيقولك الـ BHL علاقة بينه وبين الحنضية
+
+65
+00:06:03,090 --> 00:06:09,440
+والقائدية علاقة عكسية علاقة إيش مالها؟عكسية، كيف
+
+66
+00:06:09,440 --> 00:06:13,960
+أنا عكسية يا دكتور؟ يعني الـH بيكون لاطئ قليل،
+
+67
+00:06:13,960 --> 00:06:19,840
+يعني أقل من 7 مليون ميلاد تبعت الهيدروجين في جسم
+
+68
+00:06:19,840 --> 00:06:25,780
+اكتيرة تبعت الهيدروجين في جسم اكتيرة تبعت
+
+69
+00:06:25,780 --> 00:06:27,760
+الهيدروجين في جسم اكتيرة تبعت الهيدروجين في جسم
+
+70
+00:06:27,760 --> 00:06:27,780
+اكتيرة تبعت الهيدروجين في جسم اكتيرة تبعت
+
+71
+00:06:27,780 --> 00:06:29,800
+الهيدروجين في جسم اكتيرة تبعت الهيدروجين في جسم
+
+72
+00:06:29,800 --> 00:06:32,760
+اكتيرة تبعت الهيدروجين في جسم اكتيرة تبعت
+
+73
+00:06:32,760 --> 00:06:33,780
+الهيدروجين في جسم اكتيرة تبعت الهيدروجين في جسم
+
+74
+00:06:33,780 --> 00:06:34,060
+اكتيرة تبعت الهيدروجين في جسم اكتيرة ت
+
+75
+00:06:37,620 --> 00:06:43,520
+مش بيصير دي بنزل لتحت، طب كل ما قلّت اللي بتبقى
+
+76
+00:06:43,520 --> 00:06:45,840
+تبكيها تبقى تبقى تبقى تبقى تبقى تبقى تبقى تبقى
+
+77
+00:06:45,840 --> 00:06:48,300
+تبقى تبقى تبقى تبقى تبقى تبقى تبقى تبقى تبقى تبقى
+
+78
+00:06:48,300 --> 00:06:49,440
+تبقى تبقى تبقى تبقى تبقى تبقى تبقى تبقى تبقى تبقى
+
+79
+00:06:49,440 --> 00:06:50,340
+تبقى تبقى تبقى تبقى تبقى تبقى تبقى تبقى تبقى تبقى
+
+80
+00:06:50,340 --> 00:06:57,140
+تبقى تبقى تبقى تبقى تبقى تبقى تبقى تبقى
+
+81
+00:06:57,140 --> 00:07:01,440
+تبقى تب
+
+82
+00:07:21,040 --> 00:07:27,440
+طيب سمعيني الصوت واضح؟
+
+83
+00:07:27,440 --> 00:07:37,910
+الصوت okay هيك أحسنالمعنية اللاتينية هي Potentia
+
+84
+00:07:37,910 --> 00:07:45,010
+Hydrogenae هيدروجيني، هذا أغريقي، لاتيني، يعني قوة
+
+85
+00:07:45,010 --> 00:07:50,350
+الهيدروجين ايون، اه طيب، كويس، اذا the power of
+
+86
+00:07:50,350 --> 00:07:53,690
+hydrogen، هيك معناها الكلمة، كويس
+
+87
+00:07:56,090 --> 00:08:00,030
+إذاً الـ BH Scale is commonly used to represent
+
+88
+00:08:00,030 --> 00:08:04,430
+hydrogen ions اللي هو الـ Scale تبع الـ BH دائماً
+
+89
+00:08:04,430 --> 00:08:09,090
+بيستخدموه عشان يعبر إلينا عن قوة أيونات الهيدروجين
+
+90
+00:08:09,090 --> 00:08:13,150
+في أي مُركّب الصابونة إليها BH و الـ Blood إليها
+
+91
+00:08:13,150 --> 00:08:17,370
+BH و الزيت الزتون اللي بتاكله في الدار إليها BH و
+
+92
+00:08:17,370 --> 00:08:21,390
+زيت السلسيل اللي تبع القلي إليها BH و الطحينة
+
+93
+00:08:21,390 --> 00:08:28,210
+إليها كل شيء إليها BHطب هد بيحسبوها تكون بساطة عن
+
+94
+00:08:28,210 --> 00:08:34,270
+إنها عبارة عن الـ Negative logarithm و10 هدي
+
+95
+00:08:34,270 --> 00:08:38,050
+معناها ال logarithm العاشر، تمام؟ الـ Negative
+
+96
+00:08:38,050 --> 00:08:44,320
+logarithm لأيونات الهيدروجينأها، لذلك الـ pH
+
+97
+00:08:44,320 --> 00:08:48,260
+معناها الـ Potency of Hydrogen Ion أو الـ Power of
+
+98
+00:08:48,260 --> 00:08:52,620
+Hydrogen Ion هي عبارة عن الـ Negative Logarithm
+
+99
+00:08:52,620 --> 00:09:00,540
+للايونات تبع الهيدروجين عرفنا أن العلاقة
+
+100
+00:09:00,540 --> 00:09:07,930
+بينها وبينالحمضية والقاعدية علاقة عكسية بمعنى إن
+
+101
+00:09:07,930 --> 00:09:13,390
+كلما زادت أيونات الهيدروجين كلما قلت الـBH وهذا
+
+102
+00:09:13,390 --> 00:09:18,950
+بيعمل إنها حمضية وبمعنى آخر إن كلما زادت أيونات
+
+103
+00:09:18,950 --> 00:09:23,310
+الهيدروجين المفروض إيش يصير حمضية، إذا أيونات
+
+104
+00:09:23,310 --> 00:09:28,390
+الهيدروجين لو زادت في أي مركّب الـBH بتساوي سبع،
+
+105
+00:09:28,390 --> 00:09:33,420
+أيونات الهيدروجينلو زادت في أي مركب، ابتقى البولا
+
+106
+00:09:33,420 --> 00:09:38,940
+حامضي طب كيف بتأثر على الـ pH؟ بتقل، بتقل الـ pH
+
+107
+00:09:38,940 --> 00:09:43,780
+طب لو أيونات الهيدروجين قلت في أي مركب، إيش بيصير
+
+108
+00:09:43,780 --> 00:09:47,840
+فيها؟ ابتقى البولا قاعدي، طب إيش بيصير في الـ pH؟
+
+109
+00:09:47,840 --> 00:09:52,480
+في الـ pH، بتزيد، طب هو كيف في أنا أنت نازل تقول
+
+110
+00:09:52,480 --> 00:09:56,960
+أنا بتزيد و بتقل؟ طب هو إيش في رقم مفصلي، بقدر
+
+111
+00:09:56,960 --> 00:10:02,750
+أقول لما تقل عن كذا، بكونلما تقل الـ pH عن كذا،
+
+112
+00:10:02,750 --> 00:10:06,750
+بتكون حامضي، لما تزيد الـ pH عن كذا، بكون إيش؟
+
+113
+00:10:06,750 --> 00:10:11,030
+قاعدي، طب إيش هو الرقم المفصلي؟ قال الرقم المفصلي
+
+114
+00:10:11,030 --> 00:10:15,690
+بالنسبة إنا بالذات في الإبلاد هو سبعة، بالنسبة إنا
+
+115
+00:10:15,690 --> 00:10:17,950
+حتى في الإبلاد هو سبعة وخمسة وتلاتين لخمسة
+
+116
+00:10:17,950 --> 00:10:21,490
+واربعين، لكن هم بالنسبة الـ pH in general قالك
+
+117
+00:10:21,490 --> 00:10:26,380
+سبعة، هذا وضع تعادلأيش يعني؟ يعني سبعة بيكون
+
+118
+00:10:26,380 --> 00:10:32,320
+المركب شبه ملحي لأو حامضي ولأو قاعدي كل ما قلت
+
+119
+00:10:32,320 --> 00:10:38,080
+الـBH تبعته عن سبعة كل ما قلت هذا الكلام اللي أنا
+
+120
+00:10:38,080 --> 00:10:42,720
+حكيته توه إنه كل ما بيزيد زرعات الهيدروجين وتفسير
+
+121
+00:10:42,720 --> 00:10:48,460
+التفسير اللي أنا توه حكيته جالك كل ما الـBH طلعة
+
+122
+00:10:48,460 --> 00:10:52,770
+neutral بتكون أنت سبعةعند إيش؟ عند سبعة بكون ملحد
+
+123
+00:10:52,770 --> 00:11:00,190
+يعني كأنه لهم القائد ولهو حمضي طيب إيش بيصير؟ جالك
+
+124
+00:11:00,190 --> 00:11:04,730
+لو زادت ايونات الهيدروجين ها الـhydrogen activity
+
+125
+00:11:04,730 --> 00:11:10,730
+إيش مالها؟ زادت إيش بيصير المركبة يا جماعة؟ حمضي
+
+126
+00:11:10,730 --> 00:11:14,130
+طلعوا كيف؟ ها الـPHS صار فيها
+
+127
+00:11:18,230 --> 00:11:23,450
+بتقل، هذا بناءً على إيش؟ بناءً على الزيادة في
+
+128
+00:11:23,450 --> 00:11:28,050
+أيونات الهيدروجين طبعاً العلاقة العكسية مع
+
+129
+00:11:28,050 --> 00:11:34,550
+الـHydroxyl، الـOH، لم نفتنناش كتيربالعكس بالنسبة
+
+130
+00:11:34,550 --> 00:11:41,250
+للقاعدة كل ما بتقل ايونات الهيدروجين كل ما بتسيل
+
+131
+00:11:41,250 --> 00:11:45,050
+العلامة العشرية يعني الواحد بعد كتير أسفار معناه
+
+132
+00:11:45,050 --> 00:11:49,250
+أنه أقل كل ما الواحد بيجرب مين أكبر هذا الرقم ولا
+
+133
+00:11:49,250 --> 00:11:55,090
+هذا أكيد هذامن أكبر؟ هذا الرقم ولا هذا آخر واحد؟
+
+134
+00:11:55,090 --> 00:11:58,810
+أكيد هذا صح لأن الأصفار العشرية اللي بعد الصفارة
+
+135
+00:11:58,810 --> 00:12:04,050
+أقل فإذاً هنا إيش بيصير في الأيونات الهيدروجين
+
+136
+00:12:04,050 --> 00:12:12,620
+عامات؟ إيش بيصير فيها؟الـ Activity كل ما بالنسبة
+
+137
+00:12:12,620 --> 00:12:16,340
+للـ Base كل ما بتقل، أيش بيصير في البيئات؟ كما
+
+138
+00:12:16,340 --> 00:12:20,120
+أنتم شايفين الـ pH أيش بيصير فيها؟ الـ pH بتعلى،
+
+139
+00:12:20,120 --> 00:12:22,640
+بتعلى، بتعلى، بتعلى، بتعلى، بتعلى، بتعلى، بتعلى،
+
+140
+00:12:22,640 --> 00:12:23,500
+بتعلى، بتعلى، بتعلى، بتعلى، بتعلى، بتعلى، بتعلى،
+
+141
+00:12:23,500 --> 00:12:30,560
+بتعلى، بتعلى، بتعلى، بتعلى، بتعلى، بتعلى، بتعلى،
+
+142
+00:12:30,560 --> 00:12:32,360
+بتعلى، بتعلى، بتعلى، بتعلى، بتعلى، بتعلى، بتعلى،
+
+143
+00:12:32,360 --> 00:12:32,580
+بتعلى، بتعلى، بتعلى، بتعلى، بتعلى، بتعلى، بتعلى،
+
+144
+00:12:32,580 --> 00:12:34,160
+بتعلى، بتعلى، بتعلى، بتعلى، بتعلى، بتعلى، بتع
+
+145
+00:12:39,340 --> 00:12:43,240
+عندما حسبوا الـ Hydrogen Activity في لبنان فلقوها
+
+146
+00:12:43,240 --> 00:12:49,580
+الرقم هذا O000006 .. يعني من الصعب التعامل مع رقم
+
+147
+00:12:49,580 --> 00:12:53,040
+كبير يعني بهذا الشكل طيب قالك لو بدي أخد ال
+
+148
+00:12:53,040 --> 00:12:57,260
+logarithm تبع هذا الرقم علشان أتعامل برقم أصغر طلع
+
+149
+00:12:57,260 --> 00:13:03,580
+minus 7.35 أه والله هذا أسهل في التعامل بس minus
+
+150
+00:13:03,580 --> 00:13:08,920
+غلبة قالك طب بسيطةخُد الـ Negative Logarithm بدل
+
+151
+00:13:08,920 --> 00:13:13,000
+ما تُخُد الـ Logarithm الطبيعي خُد الـ Negative
+
+152
+00:13:13,000 --> 00:13:18,220
+Logarithm يعني الـ Negative تبع ناقص 7.35 نيجاتيب
+
+153
+00:13:18,220 --> 00:13:21,520
+تي نيجاتيب بتصير موجب فعشان إيه صاروا ياخدوا الـ
+
+154
+00:13:21,520 --> 00:13:26,420
+Negative Logarithm للرقم هذا فصار يطلقلنا رقم موجب
+
+155
+00:13:26,420 --> 00:13:31,610
+اسمه 7.35هذا الـ Lower Limit لإن كون الـ Blood
+
+156
+00:13:31,610 --> 00:13:35,310
+عندى Balanced وهذا ال Upper Limit لإن كون عندى ال
+
+157
+00:13:35,310 --> 00:13:39,870
+Blood Balanced فوق هيكة بيصير قاعدة تحت من هذا
+
+158
+00:13:39,870 --> 00:13:45,810
+بيصير حمض تمام؟ فهيكة الصراحة فهيكة عرفنا إيش الـ
+
+159
+00:13:45,810 --> 00:13:48,790
+pH من وين إجت، إيش مصدرها
+
+160
+00:13:52,540 --> 00:13:56,560
+وبقت إيش بيكون زيادة في آيونات الهيدروجين بعمل
+
+161
+00:13:56,560 --> 00:14:01,140
+حمضية وهذا بيأثر على الـ pH إنها بتقل وبتقل في
+
+162
+00:14:01,140 --> 00:14:04,260
+جميع المركبات عن السبعة بالنسبة للـ Blood هو
+
+163
+00:14:04,260 --> 00:14:08,260
+المركب اللي إحنا بيهمنا يعني بتقل عن سبعة point
+
+164
+00:14:08,260 --> 00:14:12,360
+تلاتة خمسة بتصير حمض بتزيد عن سبعة point أربعة
+
+165
+00:14:12,360 --> 00:14:17,880
+خمسة بتصير قاعدة تمام، فهمنا هذا الكلام كلهيتههلأ
+
+166
+00:14:17,880 --> 00:14:20,880
+الـ «سلاجدات» هدول إيش بتقول؟ بتحكي الكلام اللي
+
+167
+00:14:20,880 --> 00:14:23,840
+تاوعي أنا اللي أخصلكوا يعني إنه الـAcid إنه في
+
+168
+00:14:23,840 --> 00:14:29,700
+عندي مُركّب يستطيع تبرع بيئيونات هيدروجين ليش؟
+
+169
+00:14:29,700 --> 00:14:33,940
+لأنه حمضي وبالتالي يستطيع أن يفقد بيئيونات
+
+170
+00:14:33,940 --> 00:14:41,360
+هيدروجين زي مُركّب الـHCl، حمضي الـBHA بتكون قليلة
+
+171
+00:14:42,160 --> 00:14:48,580
+ولّا لأ؟ طيب لو زادت في المراكب هذا الأيونات تبع
+
+172
+00:14:48,580 --> 00:14:51,600
+الـHydrogen، إيش بتصير فيه؟ الـBH بتبعته بتقل
+
+173
+00:14:51,600 --> 00:14:56,080
+أكتر، طب لو فقدله شوية، لو فقد هذا المراكب شوية من
+
+174
+00:14:56,080 --> 00:14:59,200
+أيونات الـHydrogen اللي فيه، كيف يعني يفقد؟ يعني
+
+175
+00:14:59,200 --> 00:15:03,260
+يتحد مع أنصر تاني، فهيفقد شوية الـHydrogen، إيش
+
+176
+00:15:03,260 --> 00:15:09,540
+هيصير؟الـ pH تبقى تزيد، مش هتقل لأنه فقد
+
+177
+00:15:09,540 --> 00:15:14,940
+الهيدروجين يعني فقد حمضية فالـ pH تبقى تزيد و شويه
+
+178
+00:15:14,940 --> 00:15:19,700
+شويه هيتحول له ملح زي الـ KFA المعادلة تبقى الزمان
+
+179
+00:15:19,700 --> 00:15:23,740
+إذا بتتذكرواأروحلكم عليها، لو انتوا صغار لما كانوا
+
+180
+00:15:23,740 --> 00:15:28,600
+يقولولكوا «NAH3O3» هذا إيش؟ اللي هو كربونات
+
+181
+00:15:28,600 --> 00:15:34,600
+الصوديوم مع حفظ الـHydrochloric HCl إيش بيدينا؟
+
+182
+00:15:34,600 --> 00:15:38,280
+بيدينا، طلع كده؟ بنروح و بناخد كلوريد الصوديوم
+
+183
+00:15:38,280 --> 00:15:43,380
+الـChlor مع الصوديوم مركّب مع اللي هو أيونات تبع
+
+184
+00:15:43,380 --> 00:15:48,360
+الكلور مع أيونات الصوديوم مع أيونات الكلور بتعمل
+
+185
+00:15:48,360 --> 00:15:52,090
+كلوريد الصوديوماللي هو الملح، فيله الطعام، تمام
+
+186
+00:15:52,090 --> 00:15:57,550
+وبعدين إيش بيضل عندي؟ بيضل عندي HCO3 الـ HCO3 هاي
+
+187
+00:15:57,550 --> 00:16:03,170
+هتروح يطلع منها H2O وشوية ميه وحيضل CO2، غاز
+
+188
+00:16:03,170 --> 00:16:06,970
+دانيوكسيد الكربونة يطير في الهوا هذا هو لو أنا جبت
+
+189
+00:16:06,970 --> 00:16:11,290
+شوية كربونات فلافل وعصرت عليها شوية حمض اللي هو
+
+190
+00:16:11,290 --> 00:16:14,110
+هيدوكلوريك أو انتوا تجربوا مثلا وحطوا خل أو لمون
+
+191
+00:16:14,110 --> 00:16:18,110
+بيصير تفاعل مشابه بس مرقبات اللي بتنتجمخالفة هو
+
+192
+00:16:18,110 --> 00:16:20,870
+الملح اللي بيطلع مش اكلوليد السوديوم بيطلع ملح
+
+193
+00:16:20,870 --> 00:16:25,800
+تاني تمام؟وبيطلع شوية غاز نتيجة التفاعد تلاقيها
+
+194
+00:16:25,800 --> 00:16:29,100
+دخنة تاكية هذا هو الـ Phenyl Carbon وبيلقوا بيصير
+
+195
+00:16:29,100 --> 00:16:32,900
+ايش ال .. ال .. ال .. الكربونات الصيدم اللي انت
+
+196
+00:16:32,900 --> 00:16:36,740
+عملتها لما حطيت عليها الـ HCl ده بتلاقي صار ايه
+
+197
+00:16:36,740 --> 00:16:40,800
+كمية الميه زادت لأنه بينتج شوية ميه من التفاعل ايش
+
+198
+00:16:40,800 --> 00:16:43,900
+اللي قصدته في المعادلة هذه؟ مالك يا دكتور ليش فيه؟
+
+199
+00:16:43,900 --> 00:16:46,740
+مالك روحك ايش كيميا وماشي المعادلة؟ لأ لأ لأ لأ لأ
+
+200
+00:16:46,740 --> 00:16:51,200
+لأ بس انا حبيت اخليكوا تشوفوا انه في المعادلة هذه
+
+201
+00:16:51,200 --> 00:16:58,080
+هذا الحمضالقوي الـ HCl عشان يبطّي الحمض راح فقد
+
+202
+00:16:58,080 --> 00:17:02,880
+آيونات الهيدروجين اللي فيه H فقدها واتبرع فيها
+
+203
+00:17:02,880 --> 00:17:09,020
+لمين؟ H كمان H هنا صارت 2 ومع الـ C مع الواحدة
+
+204
+00:17:09,020 --> 00:17:16,120
+Oxygen من هنا صارت H2O هايهم H2O عمل ميّه وظل CO2
+
+205
+00:17:16,120 --> 00:17:22,890
+يطلع غاز، تمام؟ إذا بمجرد ما الحمض هذا فقدعارف
+
+206
+00:17:22,890 --> 00:17:31,670
+اللي .. اللي .. اللي خربشات سافلة الصراحة الصراحة
+
+207
+00:17:31,670 --> 00:17:42,150
+عيب صار
+
+208
+00:17:42,150 --> 00:17:48,150
+فينا إيش؟ صار فينا مُركّب فقد حمضيته لأنه فقد
+
+209
+00:17:48,150 --> 00:17:55,870
+الـhydrogen اللي فيهOkayطيب نرجع احنا عاد على الـ
+
+210
+00:17:55,870 --> 00:17:59,310
+slide تبعتنا اتفهمنا انه اي مركب بيفقد هيدروجين
+
+211
+00:17:59,310 --> 00:18:05,330
+يعني بتقل الحنضية تبعته طيب والبيز اي مركب بيكتسب
+
+212
+00:18:05,330 --> 00:18:12,830
+هيدروجين except وبيقبل هيدروجين هيكون عنده القدرة
+
+213
+00:18:12,830 --> 00:18:17,090
+انه يصير إيش قاعدي يعني كل مركب ينده قدرة على
+
+214
+00:18:17,090 --> 00:18:24,220
+استقبال آيونات الهيدروجين يتحول إلى مركب قاعديالـ
+
+215
+00:18:24,220 --> 00:18:30,920
+Neutral في الـ pH بشكل عام أنه يكون 7 بنطلع طبعاً
+
+216
+00:18:30,920 --> 00:18:38,360
+من الـ في الـ Blood حكينا من 7.35 لـ 7.45 يعني
+
+217
+00:18:38,360 --> 00:18:42,740
+الطبيعي طبعا الـ Blood 7.4 اتطلع مثلا الـ Milk
+
+218
+00:18:42,740 --> 00:18:50,540
+الطبيعي 7.7 الـ Wine اللي هو الكحول والنبير 4 يعني
+
+219
+00:18:50,540 --> 00:18:56,060
+الحمض المركبات المجليد في أشخاصالكولة طلع جداش
+
+220
+00:18:56,060 --> 00:19:04,000
+الحنضية تبعتها طلع هنا ال lime water عصين الليمون
+
+221
+00:19:04,000 --> 00:19:12,360
+12.5 قاعدي أخدين بالك؟ أيوة
+
+222
+00:19:12,360 --> 00:19:19,180
+سنة فاهمين إيش ال acid وإيش ال baseوإيش الـ pH؟
+
+223
+00:19:19,180 --> 00:19:23,220
+وعرفنا إن الـ pH إذا جلت عن الـ 37 في الدم بيكون
+
+224
+00:19:23,220 --> 00:19:29,720
+حمضية وإذا زالت عن الـ 57 في الدم بيسميها الكلوسيس
+
+225
+00:19:29,720 --> 00:19:34,460
+فالجهة ده بدنا شوية نغير المصطلح تبع كلمة base
+
+226
+00:19:34,460 --> 00:19:39,690
+اللي هي base معناها قاعدة أو قاعدةلكلمة alkaline،
+
+227
+00:19:39,690 --> 00:19:44,450
+alkalosis، alkalosis معناها حالة من القاعدية،
+
+228
+00:19:44,450 --> 00:19:49,410
+تمام؟ هذا بتصير إذا كان الـDH في الدم فوق الـ7.45،
+
+229
+00:19:49,410 --> 00:19:57,290
+طيب، كويس، إذا اتهمنا إن الـBlood من 7.35 لـ7.45،
+
+230
+00:19:57,290 --> 00:20:02,670
+فوق هذا الكلامفوق الـ 7.45 بيصير Alkalosis تحت من
+
+231
+00:20:02,670 --> 00:20:07,710
+الـ 7.35 بتعمل Acidosis الـ pH في الآلة هذه بتكون
+
+232
+00:20:07,710 --> 00:20:15,310
+أقل من 7.35 الـ pH في الآلة هذه بتكون أكتر من 7.45
+
+233
+00:20:15,310 --> 00:20:22,190
+تمام، هذه هي الـ Translation الأولية لموضوعنا اللي
+
+234
+00:20:22,190 --> 00:20:27,830
+بدينا نحكي فيه لـ Arterial Blood Gasesتمام، هنهي
+
+235
+00:20:27,830 --> 00:20:32,470
+المحاضرة ها والمحاضرة المسجلة التانية هنحكي فيها
+
+236
+00:20:32,470 --> 00:20:38,770
+ان شاء الله عن اللي هو الأنواع
+
+237
+00:20:38,770 --> 00:20:42,570
+تبع الـ compensation كيف بيصير يعني، إيش الـ
+
+238
+00:20:42,570 --> 00:20:45,630
+metabolic وإيش ال respiratory، إيش هذي الحالات
+
+239
+00:20:45,630 --> 00:20:48,690
+وإيش يعني ال acidosis تبع ال blood حكينا هذي، وإيش
+
+240
+00:20:48,690 --> 00:20:51,610
+يعني ال alkalosis تبع ال blood ال normal blood
+
+241
+00:20:51,610 --> 00:20:57,670
+gasesالـ Normal Blood Gases له Settings تانية، مش
+
+242
+00:20:57,670 --> 00:21:01,890
+بس الـ pH كمان لازم أكون عارف الـ BCO2 والـ Oxygen
+
+243
+00:21:01,890 --> 00:21:05,370
+Saturation والـ Bicarb، هذه الحاجات موجودة already
+
+244
+00:21:05,370 --> 00:21:11,770
+في الجسم وهي من اللي هي مكونات الـ Buffer System
+
+245
+00:21:11,770 --> 00:21:17,290
+وعلشان هيك إن شاء الله رب العالمين إحنا هنناقش كل
+
+246
+00:21:17,290 --> 00:21:22,900
+الكلام هذا في المحاضرة الجايةبدي أخلّيلكوا الـ
+
+247
+00:21:22,900 --> 00:21:26,860
+WhatsApp مفتوح واللي بدها تسأل أي سؤال في المحاضرة
+
+248
+00:21:26,860 --> 00:21:31,480
+هذه من عناية التنتين هلاقيت أنه نخلي الحكيمة في
+
+249
+00:21:31,480 --> 00:21:34,580
+النادي تفتح الـ WhatsApp وإذا في أي حد عنده أي
+
+250
+00:21:34,580 --> 00:21:38,880
+محاضرة أو أي سؤال عفوا في المحاضرة خليني أسمع منكم
+
+251
+00:21:38,880 --> 00:21:43,580
+يعطيكم العافية وشكرا كتير إلكوا ولو إني أنا مش
+
+252
+00:21:43,580 --> 00:21:47,280
+عارف بتظلوا تزعلوني تخربشوا و بتحكوا ومتسابشوا
+
+253
+00:21:47,280 --> 00:21:50,500
+مساكنين الميجرافون مش عارف ليش يعطيكم العافية
+
diff --git a/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/axHM409j0Ew_raw.json b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/axHM409j0Ew_raw.json
new file mode 100644
index 0000000000000000000000000000000000000000..84bad99cf1c9f9aaa96b1baa27b27da35c680809
--- /dev/null
+++ b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/axHM409j0Ew_raw.json
@@ -0,0 +1 @@
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مينفهم؟ مينفهم إن الجسم عشان يعمل تومنتين acid-base hemostasis", "tokens": [8297, 12399, 9122, 2304, 28543, 46007, 12399, 5296, 3794, 3224, 37893, 6156, 995, 16095, 9957, 11331, 26108, 3660, 49429, 6225, 9640, 5172, 9957, 18871, 11933, 1829, 8592, 39894, 5016, 4117, 1829, 49429, 11933, 1829, 8592, 39894, 39648, 5296, 4117, 12399, 3714, 43020, 8717, 2655, 35571, 1211, 4117, 4032, 1863, 8592, 38688, 12399, 4724, 31747, 6156, 16095, 8315, 9122, 2304, 7649, 13412, 2407, 10632, 12399, 34051, 4117, 11331, 46958, 2288, 49429, 8032, 2304, 4117, 12399, 8032, 1863, 5172, 16095, 23032, 1829, 3555, 12399, 11933, 1829, 8592, 3714, 9957, 5172, 16095, 22807, 3714, 9957, 5172, 16095, 36145, 25724, 38251, 6225, 8592, 7649, 7251, 25957, 1211, 6055, 20498, 29399, 9957, 8258, 12, 17429, 415, 1761, 26632], "avg_logprob": -0.28289475148184257, "compression_ratio": 1.643835616438356, "no_speech_prob": 1.3470649719238281e-05, "words": [{"start": 151.05999999999997, "end": 151.85999999999999, "word": "Okay،", 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197.79, "end": 198.85, "word": " اسمه", "probability": 0.9344075520833334}, {"start": 198.85, "end": 199.71, "word": " الـB", "probability": 0.76953125}], "temperature": 1.0}, {"id": 9, "seek": 21430, "start": 200.42, "end": 214.3, "text": "وهنشوف إن الـ pH هي عبارة عن مصطلح لاتيني معناه قوة آيونات الهيدروجين الموجودة ببساطة، هيك معناه", "tokens": [2407, 3224, 1863, 8592, 38688, 36145, 2423, 39184, 21677, 39896, 6225, 3555, 9640, 3660, 18871, 3714, 9381, 9566, 1211, 5016, 5296, 9307, 9957, 1829, 20449, 8315, 3224, 12174, 2407, 3660, 19753, 1829, 2407, 8315, 2655, 2423, 3224, 25708, 2288, 29245, 9957, 9673, 29245, 23328, 3660, 4724, 3555, 3794, 41193, 3660, 12399, 39896, 4117, 20449, 8315, 3224], "avg_logprob": -0.31085526315789475, "compression_ratio": 1.403225806451613, "no_speech_prob": 1.8537044525146484e-05, "words": [{"start": 200.42, "end": 201.8, "word": "وهنشوف", "probability": 0.633349609375}, {"start": 201.8, "end": 201.98, "word": " إن", "probability": 0.3369140625}, {"start": 201.98, "end": 202.2, "word": " الـ", "probability": 0.9130859375}, {"start": 202.2, "end": 202.56, "word": " pH", "probability": 0.369384765625}, {"start": 202.56, "end": 202.98, "word": " هي", "probability": 0.39208984375}, {"start": 202.98, "end": 203.8, "word": " عبارة", "probability": 0.8056640625}, {"start": 203.8, "end": 204.62, "word": " عن", "probability": 0.98876953125}, {"start": 204.62, "end": 207.64, "word": " مصطلح", "probability": 0.86162109375}, {"start": 207.64, "end": 208.38, "word": " لاتيني", "probability": 0.91357421875}, {"start": 208.38, "end": 209.12, "word": " معناه", "probability": 0.73486328125}, {"start": 209.12, "end": 210.24, "word": " قوة", "probability": 0.8204752604166666}, {"start": 210.24, "end": 211.2, "word": " آيونات", "probability": 0.818310546875}, {"start": 211.2, "end": 212.14, "word": " الهيدروجين", "probability": 0.9532877604166666}, {"start": 212.14, "end": 212.98, "word": " الموجودة", "probability": 0.978271484375}, {"start": 212.98, "end": 213.74, "word": " ببساطة،", "probability": 0.7691650390625}, {"start": 213.74, "end": 213.92, "word": " هيك", "probability": 0.5970458984375}, {"start": 213.92, "end": 214.3, "word": " معناه", "probability": 0.7804361979166666}], "temperature": 1.0}, {"id": 10, "seek": 23754, "start": 216.1, "end": 237.54, "text": "الـ Hemostasis تبع الجسم اللي احنا بنحكي عنه هذا طيب، هذا هنشوف الـBH، okay طيب طب إيش الـHemostasis نرجعله؟ آه الـHemostasis اللي احنا بنحكي عنه في الـBlood بتحقق إذا كانت الـBH هذه اللي قولنا عنها اللي هي قوة الذرات الهيدروجين الموجودة في الجسم", "tokens": [6027, 39184, 18568, 555, 26632, 6055, 3555, 3615, 25724, 38251, 13672, 1829, 1975, 5016, 8315, 44945, 5016, 4117, 1829, 18871, 3224, 23758, 23032, 1829, 3555, 12399, 23758, 8032, 1863, 8592, 38688, 2423, 39184, 33, 39, 12399, 1392, 23032, 1829, 3555, 23032, 3555, 11933, 1829, 8592, 2423, 39184, 39, 443, 555, 26632, 8717, 47341, 30241, 3224, 22807, 19753, 3224, 2423, 39184, 39, 443, 555, 26632, 13672, 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"word": " الجسم", "probability": 0.989013671875}], "temperature": 1.0}, {"id": 11, "seek": 25783, "start": 238.75, "end": 257.83, "text": "إذا كانت بين الـ7.35 لـ7.45 هذا بيحققه جهاز الـBuffer System بيخليه يبقى الـBH تبع الـBlood تبعنا بين الـ7.35 والـ7.45 يعني مثلا زي كيف؟ يعني مثلا زي الـ Sodium أكمل Sodium؟", "tokens": [28814, 15730, 25961, 2655, 49374, 2423, 39184, 22, 13, 8794, 5296, 39184, 22, 13, 8465, 23758, 4724, 1829, 5016, 4587, 4587, 3224, 10874, 3224, 31377, 2423, 39184, 33, 1245, 260, 8910, 4724, 1829, 9778, 20292, 3224, 7251, 3555, 4587, 7578, 2423, 39184, 33, 39, 6055, 3555, 3615, 2423, 39184, 33, 752, 378, 6055, 3555, 3615, 8315, 49374, 2423, 39184, 22, 13, 8794, 16070, 39184, 22, 13, 8465, 37495, 22653, 50113, 15040, 30767, 1829, 9122, 33911, 22807, 37495, 22653, 50113, 15040, 30767, 1829, 2423, 39184, 42059, 2197, 5551, 24793, 1211, 42059, 2197, 22807], "avg_logprob": -0.20631720301925496, "compression_ratio": 1.6071428571428572, "no_speech_prob": 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بقول أبرافو عليكي وكذلك الـ pH الطبيعي أنه يكون بين الـ 7.35 و7.45 تمام؟", "tokens": [6027, 9566, 21292, 3615, 1829, 8978, 2423, 39184, 12575, 340, 356, 975, 36764, 24401, 3660, 13412, 41193, 25720, 39894, 5016, 4117, 1829, 20292, 39894, 39648, 1829, 9154, 49374, 2423, 39184, 42652, 5296, 28814, 41260, 2423, 39184, 3499, 20, 4724, 39648, 5551, 3555, 23557, 5172, 2407, 25894, 4117, 1829, 4032, 4117, 8848, 23275, 2423, 39184, 21677, 41950, 21292, 3615, 1829, 14739, 3224, 7251, 30544, 49374, 2423, 39184, 1614, 13, 8794, 4032, 22, 13, 8465, 46811, 10943, 22807], "avg_logprob": -0.20170454081002767, "compression_ratio": 1.4795321637426901, "no_speech_prob": 0.0017862319946289062, "words": [{"start": 258.37, "end": 259.01, "word": "الطبيعي", "probability": 0.94501953125}, {"start": 259.01, "end": 259.17, "word": " في", "probability": 0.91796875}, {"start": 259.17, "end": 259.27, "word": " الـ", "probability": 0.95361328125}, {"start": 259.27, "end": 260.15, "word": " Electrolyte", 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"end": 461.63, "word": " أغريقي،", "probability": 0.655029296875}, {"start": 461.63, "end": 462.31, "word": " لاتيني،", "probability": 0.82548828125}, {"start": 462.31, "end": 462.79, "word": " يعني", "probability": 0.5345458984375}, {"start": 462.79, "end": 465.01, "word": " قوة", "probability": 0.7914225260416666}, {"start": 465.01, "end": 465.63, "word": " الهيدروجين", "probability": 0.7901407877604166}, {"start": 465.63, "end": 466.35, "word": " ايون،", "probability": 0.67291259765625}, {"start": 466.35, "end": 466.75, "word": " اه", "probability": 0.300537109375}, {"start": 466.75, "end": 467.79, "word": " طيب،", "probability": 0.79388427734375}, {"start": 467.79, "end": 468.79, "word": " كويس،", "probability": 0.8818359375}, {"start": 468.79, "end": 469.31, "word": " اذا", "probability": 0.5147705078125}, {"start": 469.31, "end": 469.53, "word": " the", "probability": 0.28466796875}, {"start": 469.53, "end": 470.03, "word": " power", "probability": 0.876953125}, {"start": 470.03, "end": 470.35, "word": " of", "probability": 0.98486328125}, {"start": 470.35, "end": 470.89, "word": " hydrogen،", "probability": 0.754150390625}, {"start": 470.89, "end": 471.11, "word": " هيك", "probability": 0.715576171875}, {"start": 471.11, "end": 471.51, "word": " معناها", "probability": 0.8082682291666666}, {"start": 471.51, "end": 472.21, "word": " الكلمة،", "probability": 0.787841796875}, {"start": 472.21, "end": 473.69, "word": " كويس", "probability": 0.7171223958333334}], "temperature": 1.0}, {"id": 22, "seek": 50289, "start": 476.09, "end": 502.89, "text": "إذاً الـ BH Scale is commonly used to represent hydrogen ions اللي هو الـ Scale تبع الـ BH دائماً بيستخدموه عشان يعبر إلينا عن قوة أيونات الهيدروجين في أي مُركّب الصابونة إليها BH و الـ Blood إليها BH و الزيت الزتون اللي بتاكله في الدار إليها BH و زيت السلسيل اللي تبع القلي إليها BH و الطحينة إليها كل شيء إليها BH", "tokens": [28814, 15730, 14111, 2423, 39184, 40342, 42999, 307, 12719, 1143, 281, 2906, 12697, 27362, 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{"start": 493.15, "end": 493.77, "word": " BH", "probability": 0.9638671875}, {"start": 493.77, "end": 494.13, "word": " و", "probability": 0.7412109375}, {"start": 494.13, "end": 494.59, "word": " الزيت", "probability": 0.9085286458333334}, {"start": 494.59, "end": 495.11, "word": " الزتون", "probability": 0.7294921875}, {"start": 495.11, "end": 495.51, "word": " اللي", "probability": 0.7420654296875}, {"start": 495.51, "end": 495.93, "word": " بتاكله", "probability": 0.72509765625}, {"start": 495.93, "end": 496.03, "word": " في", "probability": 0.91162109375}, {"start": 496.03, "end": 496.27, "word": " الدار", "probability": 0.743896484375}, {"start": 496.27, "end": 496.51, "word": " إليها", "probability": 0.8953450520833334}, {"start": 496.51, "end": 497.01, "word": " BH", "probability": 0.98779296875}, {"start": 497.01, "end": 497.37, "word": " و", "probability": 0.943359375}, {"start": 497.37, "end": 497.69, "word": " زيت", "probability": 0.84912109375}, {"start": 497.69, "end": 498.43, "word": " السلسيل", "probability": 0.660675048828125}, {"start": 498.43, "end": 498.57, "word": " اللي", "probability": 0.79443359375}, {"start": 498.57, "end": 498.79, "word": " تبع", "probability": 0.6538899739583334}, {"start": 498.79, "end": 499.15, "word": " القلي", "probability": 0.70703125}, {"start": 499.15, "end": 499.39, "word": " إليها", "probability": 0.9189453125}, {"start": 499.39, "end": 499.97, "word": " BH", "probability": 0.99267578125}, {"start": 499.97, "end": 500.47, "word": " و", "probability": 0.8779296875}, {"start": 500.47, "end": 501.39, "word": " الطحينة", "probability": 0.75494384765625}, {"start": 501.39, "end": 501.59, "word": " إليها", "probability": 0.88916015625}, {"start": 501.59, "end": 501.89, "word": " كل", "probability": 0.7294921875}, {"start": 501.89, "end": 502.31, "word": " شيء", "probability": 0.769775390625}, {"start": 502.31, "end": 502.45, "word": " إليها", "probability": 0.7478841145833334}, {"start": 502.45, "end": 502.89, "word": " BH", "probability": 0.990234375}], "temperature": 1.0}, {"id": 23, "seek": 52071, "start": 503.73, "end": 520.71, "text": "طب هد بيحسبوها تكون بساطة عن إنها عبارة عن الـ Negative logarithm و10 هدي معناها ال logarithm العاشر، تمام؟ الـ Negative logarithm لأيونات الهيدروجين", "tokens": [9566, 3555, 8032, 3215, 4724, 1829, 5016, 35457, 2407, 11296, 6055, 30544, 4724, 3794, 41193, 3660, 18871, 36145, 11296, 6225, 3555, 9640, 3660, 18871, 2423, 39184, 43230, 41473, 32674, 4032, 3279, 8032, 16254, 20449, 8315, 11296, 2423, 41473, 32674, 18863, 33599, 2288, 12399, 46811, 10943, 22807, 2423, 39184, 43230, 41473, 32674, 5296, 10721, 1829, 2407, 8315, 2655, 2423, 3224, 25708, 2288, 29245, 9957], "avg_logprob": -0.3874511606991291, "compression_ratio": 1.4556962025316456, "no_speech_prob": 5.364418029785156e-07, "words": [{"start": 503.73, "end": 504.01, "word": "طب", "probability": 0.51556396484375}, {"start": 504.01, "end": 504.43, "word": " هد", "probability": 0.2451171875}, {"start": 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"end": 514.61, "word": " معناها", "probability": 0.9586588541666666}, {"start": 514.61, "end": 514.73, "word": " ال", "probability": 0.85986328125}, {"start": 514.73, "end": 515.21, "word": " logarithm", "probability": 0.747314453125}, {"start": 515.21, "end": 516.31, "word": " العاشر،", "probability": 0.7572021484375}, {"start": 516.31, "end": 517.39, "word": " تمام؟", "probability": 0.8053385416666666}, {"start": 517.39, "end": 517.65, "word": " الـ", "probability": 0.644287109375}, {"start": 517.65, "end": 518.05, "word": " Negative", "probability": 0.716796875}, {"start": 518.05, "end": 519.03, "word": " logarithm", "probability": 0.97216796875}, {"start": 519.03, "end": 519.95, "word": " لأيونات", "probability": 0.7855631510416666}, {"start": 519.95, "end": 520.71, "word": " الهيدروجين", "probability": 0.9453938802083334}], "temperature": 1.0}, {"id": 24, "seek": 54172, "start": 522.42, "end": 541.72, "text": "أها، لذلك الـ pH معناها الـ Potency of Hydrogen Ion أو الـ Power of Hydrogen Ion هي عبارة عن الـ Negative Logarithm للايونات تبع الهيدروجين عرفنا أن العلاقة بينها وبين", "tokens": [10721, 11296, 12399, 5296, 8848, 23275, 2423, 39184, 21677, 20449, 8315, 11296, 2423, 39184, 9145, 3020, 295, 24231, 7747, 286, 266, 34051, 2423, 39184, 7086, 295, 24231, 7747, 286, 266, 39896, 6225, 3555, 9640, 3660, 18871, 2423, 39184, 43230, 10824, 289, 32674, 5296, 15040, 1829, 2407, 8315, 2655, 6055, 3555, 3615, 2423, 3224, 25708, 2288, 29245, 9957, 6225, 28480, 8315, 14739, 18863, 15040, 28671, 49374, 11296, 46599, 9957], "avg_logprob": -0.39356882675834326, "compression_ratio": 1.4252873563218391, "no_speech_prob": 1.1920928955078125e-06, "words": [{"start": 522.4200000000001, "end": 523.32, "word": "أها،", "probability": 0.33447265625}, {"start": 523.32, "end": 523.66, "word": " لذلك", "probability": 0.5371907552083334}, {"start": 523.66, "end": 523.8, "word": " الـ", "probability": 0.854736328125}, {"start": 523.8, "end": 524.32, "word": " pH", "probability": 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"الكولة طلع جداش الحنضية تبعتها طلع هنا ال lime water عصين الليمون 12.5 قاعدي أخدين بالك؟ أيوة سنة فاهمين إيش ال acid وإيش ال base", "tokens": [6027, 4117, 12610, 3660, 23032, 1211, 3615, 10874, 3215, 33599, 21542, 1863, 11242, 10632, 6055, 3555, 34268, 11296, 23032, 1211, 3615, 34105, 2423, 22035, 1281, 6225, 9381, 9957, 13672, 32640, 11536, 2272, 13, 20, 12174, 995, 22488, 1829, 5551, 9778, 3215, 9957, 20666, 4117, 22807, 36632, 2407, 3660, 8608, 1863, 3660, 6156, 995, 16095, 9957, 11933, 1829, 8592, 2423, 8258, 4032, 28814, 1829, 8592, 2423, 3096], "avg_logprob": -0.38782649698542127, "compression_ratio": 1.3481012658227849, "no_speech_prob": 3.5762786865234375e-07, "words": [{"start": 1134.2, "end": 1135.38, "word": "الكولة", "probability": 0.64886474609375}, {"start": 1135.38, "end": 1135.64, "word": " طلع", "probability": 0.435699462890625}, {"start": 1135.64, "end": 1136.06, "word": " جداش", "probability": 0.6559244791666666}, {"start": 1136.06, "end": 1136.48, "word": " 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0.7791748046875}, {"start": 1307.74, "end": 1308.42, "word": " الميجرافون", "probability": 0.7249348958333334}, {"start": 1308.42, "end": 1308.64, "word": " مش", "probability": 0.89404296875}, {"start": 1308.64, "end": 1308.9, "word": " عارف", "probability": 0.9977213541666666}, {"start": 1308.9, "end": 1309.2, "word": " ليش", "probability": 0.872314453125}, {"start": 1309.2, "end": 1310.2, "word": " يعطيكم", "probability": 0.886474609375}, {"start": 1310.2, "end": 1310.5, "word": " العافية", "probability": 0.9703776041666666}], "temperature": 1.0}], "language": "ar", "language_probability": 1.0, "duration": 1310.929, "duration_after_vad": 1267.4812499999996}
\ No newline at end of file
diff --git a/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/axHM409j0Ew_raw.srt b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/axHM409j0Ew_raw.srt
new file mode 100644
index 0000000000000000000000000000000000000000..36e13df10aa27404632c461de0d5174f49e3f6f5
--- /dev/null
+++ b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/axHM409j0Ew_raw.srt
@@ -0,0 +1,1012 @@
+1
+00:00:00,810 --> 00:00:04,790
+بنحكي مع بعض بسم الله الرحمن الرحيم كمان مرة
+
+2
+00:00:04,790 --> 00:00:09,170
+وبنقولكم كمان مرة السلام عليكم ورحمة الله وبركاته
+
+3
+00:00:09,170 --> 00:00:13,090
+اليوم بنحكي إن شاء الله في الـ Acid-Base Balance
+
+4
+00:00:13,090 --> 00:00:18,590
+اللي هو التوازن الكيميائي
+
+5
+00:00:18,590 --> 00:00:25,730
+أو الحنضية أو القاعدية في دم الإنسان أو في الجسم
+
+6
+00:00:26,710 --> 00:00:31,910
+هنحكي شوية background وبعدين نشوف تعريفه نتعرف على
+
+7
+00:00:31,910 --> 00:00:35,050
+حاجة اسمها الـBuffer System وبعدين نشوف الخلل اللي
+
+8
+00:00:35,050 --> 00:00:39,690
+بيسيل وكيف بقينا بنترجم لـBlood Gas Analysis كيف
+
+9
+00:00:39,690 --> 00:00:43,890
+بنعرفها وبنعرف إيش نقل الخلل هذا وما هي طرق الإلاج
+
+10
+00:00:43,890 --> 00:00:48,590
+وبعدين في المعادرة اللي بعدها هنحكي عن اللي هو
+
+11
+00:00:48,590 --> 00:00:53,170
+الـMechanical Ventilation إن شاء الله تمام؟
+
+12
+00:01:03,600 --> 00:01:12,460
+بالنسبة للـ Acid-Base Balance نحكي إن الوظيفة
+
+13
+00:01:12,460 --> 00:01:18,600
+الأساسية والمهمة جدا اللي بتعمل إن في الجسم حاجة
+
+14
+00:01:18,600 --> 00:01:24,940
+اسمها Acid-Base Balance هي بيسموها الـ Hemostasis
+
+15
+00:01:24,940 --> 00:01:30,470
+إيش يعني Hemostasis؟ طلع HemoStasis هي كلمة Hemo
+
+16
+00:01:30,470 --> 00:01:35,190
+معناها هدم وStasis يعني حالة من التباد Stasis فهي
+
+17
+00:01:35,190 --> 00:01:40,610
+معناها أن الـability of the body system قدرة أجهزة
+
+18
+00:01:40,610 --> 00:01:45,930
+الجسم to maintaining its consistency إنها تظل في
+
+19
+00:01:45,930 --> 00:01:51,030
+حالة من السباب تمام؟ إذن الـimportant and integral
+
+20
+00:01:51,030 --> 00:01:55,020
+goal of HemostasisIs asset-based balance أو asset
+
+21
+00:01:55,020 --> 00:02:01,580
+-based regulation حاجة مهمة كتير في الموضوعالثبات
+
+22
+00:02:01,580 --> 00:02:05,400
+هذا أو الـ hemostasis أنه يكون فيه ثبات على مستوى
+
+23
+00:02:05,400 --> 00:02:08,540
+الحمضية والقاعدية تبعها الدم
+
+24
+00:02:31,060 --> 00:02:34,660
+Okay، كمقدمة، لسه مش فاهمين حاجة ولا عارفين عن إيش
+
+25
+00:02:34,660 --> 00:02:38,740
+بتحكي ولا إيش بتقول لك، ممكن نتحملك ونشوف، برك
+
+26
+00:02:38,740 --> 00:02:43,500
+فهمنا كمان شوية، أوك حاضر ولا همك، هنفهم طيب، إيش
+
+27
+00:02:43,500 --> 00:02:48,940
+مينفهم؟ مينفهم إن الجسم عشان يعمل تومنتين acid
+
+28
+00:02:48,940 --> 00:02:50,660
+-base hemostasis
+
+29
+00:02:52,630 --> 00:02:59,010
+بيعتمد هذا على الحاجة المهمة جدا في الجسم وهي
+
+30
+00:02:59,010 --> 00:03:04,510
+عبارة عن الـHydrogen Ion على آيونات الهيدروجين
+
+31
+00:03:04,510 --> 00:03:10,030
+ذرات الهيدروجين اللي في الجسم تمام؟ والـHydrogen
+
+32
+00:03:10,030 --> 00:03:16,590
+Ion هدولة اللي في الجسم بنعبر عنهم برمز للحنضية
+
+33
+00:03:16,590 --> 00:03:24,620
+والقاعدية اسمه الـBوهنشوف إن الـ pH هي عبارة عن
+
+34
+00:03:24,620 --> 00:03:27,640
+مصطلح
+
+35
+00:03:27,640 --> 00:03:32,980
+لاتيني معناه قوة آيونات الهيدروجين الموجودة
+
+36
+00:03:32,980 --> 00:03:38,520
+ببساطة، هيك معناهالـ Hemostasis تبع الجسم اللي
+
+37
+00:03:38,520 --> 00:03:41,840
+احنا بنحكي عنه هذا طيب، هذا هنشوف الـBH، okay طيب
+
+38
+00:03:41,840 --> 00:03:45,340
+طب إيش الـHemostasis نرجعله؟ آه الـHemostasis اللي
+
+39
+00:03:45,340 --> 00:03:49,780
+احنا بنحكي عنه في الـBlood بتحقق إذا كانت الـBH
+
+40
+00:03:49,780 --> 00:03:56,480
+هذه اللي قولنا عنها اللي هي قوة الذرات الهيدروجين
+
+41
+00:03:56,480 --> 00:04:03,950
+الموجودة في الجسمإذا كانت بين الـ7.35 لـ7.45 هذا
+
+42
+00:04:03,950 --> 00:04:08,870
+بيحققه جهاز الـBuffer System بيخليه يبقى الـBH تبع
+
+43
+00:04:08,870 --> 00:04:13,790
+الـBlood تبعنا بين الـ7.35 والـ7.45 يعني مثلا زي
+
+44
+00:04:13,790 --> 00:04:19,010
+كيف؟ يعني مثلا زي الـ Sodium أكمل Sodium؟الطبيعي
+
+45
+00:04:19,010 --> 00:04:22,330
+في الـ Electrolyte واحدة شاطرة بتحكيلي بتقولي من
+
+46
+00:04:22,330 --> 00:04:29,210
+بين الـ 135 لإند الـ 145 بقول أبرافو عليكي وكذلك
+
+47
+00:04:29,210 --> 00:04:41,270
+الـ pH الطبيعي أنه يكون بين الـ 7.35 و7.45
+
+48
+00:04:41,270 --> 00:04:47,450
+تمام؟
+
+49
+00:04:48,040 --> 00:04:51,760
+الآن الان
+
+50
+00:04:57,080 --> 00:05:00,080
+طب إيش علاقة البيئة تشي في هذا الكلام؟ بالنسبة
+
+51
+00:05:00,080 --> 00:05:04,920
+للبنات اللي معانا على المحاضرة المحاضرة اللي
+
+52
+00:05:04,920 --> 00:05:08,820
+بحكيها الآن مسجلة و هرفعها و ماتخافوش بس أنا
+
+53
+00:05:08,820 --> 00:05:12,900
+عاملها تفاعلية من يعني للناس اللي حابة أنها تسمع
+
+54
+00:05:12,900 --> 00:05:17,160
+المحاضرة مباشر و لو حابت أنها تسأل سؤال بتقدر يعني
+
+55
+00:05:17,160 --> 00:05:21,900
+تكتب على الـChat أنا فيه عندي سؤال و تسأله أو حتى
+
+56
+00:05:21,900 --> 00:05:25,300
+ممكن أفتحها لكم المقرافونات و إذا حد بده يسأل يسأل
+
+57
+00:05:25,300 --> 00:05:30,430
+مافيش عندي مشكلةبس بدناش اللي هو الحديث الجانبية
+
+58
+00:05:30,430 --> 00:05:37,130
+والناس اللي بحكوا يعني في بيوتهمتمام؟ اتفقنا إنه
+
+59
+00:05:37,130 --> 00:05:42,670
+الـVH الطبيعي تبعه من 7.35 لـ7.45 اتفقنا إنه في حد
+
+60
+00:05:42,670 --> 00:05:47,170
+اسمها buffer system هذي بتحافظ على إن الـBlood
+
+61
+00:05:47,170 --> 00:05:50,570
+الـVH تبعته تظل بين الحاشدين هدول، مين هم ال
+
+62
+00:05:50,570 --> 00:05:53,790
+buffer system؟ اتفقنا بشكل مبدأي إن الـkidney
+
+63
+00:05:53,790 --> 00:05:58,570
+والـlung هم أقوى buffer system في الجسمكمان حاجة
+
+64
+00:05:58,570 --> 00:06:03,090
+بالضبط بيقولك الـ BHL علاقة بينه وبين الحنضية
+
+65
+00:06:03,090 --> 00:06:09,440
+والقائدية علاقة عكسية علاقة إيش مالها؟عكسية، كيف
+
+66
+00:06:09,440 --> 00:06:13,960
+أنا عكسية يا دكتور؟ يعني الـH بيكون لاطئ قليل،
+
+67
+00:06:13,960 --> 00:06:19,840
+يعني أقل من 7 مليون ميلاد تبعت الهيدروجين في جسم
+
+68
+00:06:19,840 --> 00:06:25,780
+اكتيرة تبعت الهيدروجين في جسم اكتيرة تبعت
+
+69
+00:06:25,780 --> 00:06:27,760
+الهيدروجين في جسم اكتيرة تبعت الهيدروجين في جسم
+
+70
+00:06:27,760 --> 00:06:27,780
+اكتيرة تبعت الهيدروجين في جسم اكتيرة تبعت
+
+71
+00:06:27,780 --> 00:06:29,800
+الهيدروجين في جسم اكتيرة تبعت الهيدروجين في جسم
+
+72
+00:06:29,800 --> 00:06:32,760
+اكتيرة تبعت الهيدروجين في جسم اكتيرة تبعت
+
+73
+00:06:32,760 --> 00:06:33,780
+الهيدروجين في جسم اكتيرة تبعت الهيدروجين في جسم
+
+74
+00:06:33,780 --> 00:06:34,060
+اكتيرة تبعت الهيدروجين في جسم اكتيرة ت
+
+75
+00:06:37,620 --> 00:06:43,520
+مش بيصير دي بنزل لتحت، طب كل ما قلّت اللي بتبقى
+
+76
+00:06:43,520 --> 00:06:45,840
+تبكيها تبقى تبقى تبقى تبقى تبقى تبقى تبقى تبقى
+
+77
+00:06:45,840 --> 00:06:48,300
+تبقى تبقى تبقى تبقى تبقى تبقى تبقى تبقى تبقى تبقى
+
+78
+00:06:48,300 --> 00:06:49,440
+تبقى تبقى تبقى تبقى تبقى تبقى تبقى تبقى تبقى تبقى
+
+79
+00:06:49,440 --> 00:06:50,340
+تبقى تبقى تبقى تبقى تبقى تبقى تبقى تبقى تبقى تبقى
+
+80
+00:06:50,340 --> 00:06:57,140
+تبقى تبقى تبقى تبقى تبقى تبقى تبقى تبقى
+
+81
+00:06:57,140 --> 00:07:01,440
+تبقى تب
+
+82
+00:07:21,040 --> 00:07:27,440
+طيب سمعيني الصوت واضح؟
+
+83
+00:07:27,440 --> 00:07:37,910
+الصوت okay هيك أحسنالمعنية اللاتينية هي Potentia
+
+84
+00:07:37,910 --> 00:07:45,010
+Hydrogenae هيدروجيني، هذا أغريقي، لاتيني، يعني قوة
+
+85
+00:07:45,010 --> 00:07:50,350
+الهيدروجين ايون، اه طيب، كويس، اذا the power of
+
+86
+00:07:50,350 --> 00:07:53,690
+hydrogen، هيك معناها الكلمة، كويس
+
+87
+00:07:56,090 --> 00:08:00,030
+إذاً الـ BH Scale is commonly used to represent
+
+88
+00:08:00,030 --> 00:08:04,430
+hydrogen ions اللي هو الـ Scale تبع الـ BH دائماً
+
+89
+00:08:04,430 --> 00:08:09,090
+بيستخدموه عشان يعبر إلينا عن قوة أيونات الهيدروجين
+
+90
+00:08:09,090 --> 00:08:13,150
+في أي مُركّب الصابونة إليها BH و الـ Blood إليها
+
+91
+00:08:13,150 --> 00:08:17,370
+BH و الزيت الزتون اللي بتاكله في الدار إليها BH و
+
+92
+00:08:17,370 --> 00:08:21,390
+زيت السلسيل اللي تبع القلي إليها BH و الطحينة
+
+93
+00:08:21,390 --> 00:08:28,210
+إليها كل شيء إليها BHطب هد بيحسبوها تكون بساطة عن
+
+94
+00:08:28,210 --> 00:08:34,270
+إنها عبارة عن الـ Negative logarithm و10 هدي
+
+95
+00:08:34,270 --> 00:08:38,050
+معناها ال logarithm العاشر، تمام؟ الـ Negative
+
+96
+00:08:38,050 --> 00:08:44,320
+logarithm لأيونات الهيدروجينأها، لذلك الـ pH
+
+97
+00:08:44,320 --> 00:08:48,260
+معناها الـ Potency of Hydrogen Ion أو الـ Power of
+
+98
+00:08:48,260 --> 00:08:52,620
+Hydrogen Ion هي عبارة عن الـ Negative Logarithm
+
+99
+00:08:52,620 --> 00:09:00,540
+للايونات تبع الهيدروجين عرفنا أن العلاقة
+
+100
+00:09:00,540 --> 00:09:07,930
+بينها وبينالحمضية والقاعدية علاقة عكسية بمعنى إن
+
+101
+00:09:07,930 --> 00:09:13,390
+كلما زادت أيونات الهيدروجين كلما قلت الـBH وهذا
+
+102
+00:09:13,390 --> 00:09:18,950
+بيعمل إنها حمضية وبمعنى آخر إن كلما زادت أيونات
+
+103
+00:09:18,950 --> 00:09:23,310
+الهيدروجين المفروض إيش يصير حمضية، إذا أيونات
+
+104
+00:09:23,310 --> 00:09:28,390
+الهيدروجين لو زادت في أي مركّب الـBH بتساوي سبع،
+
+105
+00:09:28,390 --> 00:09:33,420
+أيونات الهيدروجينلو زادت في أي مركب، ابتقى البولا
+
+106
+00:09:33,420 --> 00:09:38,940
+حامضي طب كيف بتأثر على الـ pH؟ بتقل، بتقل الـ pH
+
+107
+00:09:38,940 --> 00:09:43,780
+طب لو أيونات الهيدروجين قلت في أي مركب، إيش بيصير
+
+108
+00:09:43,780 --> 00:09:47,840
+فيها؟ ابتقى البولا قاعدي، طب إيش بيصير في الـ pH؟
+
+109
+00:09:47,840 --> 00:09:52,480
+في الـ pH، بتزيد، طب هو كيف في أنا أنت نازل تقول
+
+110
+00:09:52,480 --> 00:09:56,960
+أنا بتزيد و بتقل؟ طب هو إيش في رقم مفصلي، بقدر
+
+111
+00:09:56,960 --> 00:10:02,750
+أقول لما تقل عن كذا، بكونلما تقل الـ pH عن كذا،
+
+112
+00:10:02,750 --> 00:10:06,750
+بتكون حامضي، لما تزيد الـ pH عن كذا، بكون إيش؟
+
+113
+00:10:06,750 --> 00:10:11,030
+قاعدي، طب إيش هو الرقم المفصلي؟ قال الرقم المفصلي
+
+114
+00:10:11,030 --> 00:10:15,690
+بالنسبة إنا بالذات في الإبلاد هو سبعة، بالنسبة إنا
+
+115
+00:10:15,690 --> 00:10:17,950
+حتى في الإبلاد هو سبعة وخمسة وتلاتين لخمسة
+
+116
+00:10:17,950 --> 00:10:21,490
+واربعين، لكن هم بالنسبة الـ pH in general قالك
+
+117
+00:10:21,490 --> 00:10:26,380
+سبعة، هذا وضع تعادلأيش يعني؟ يعني سبعة بيكون
+
+118
+00:10:26,380 --> 00:10:32,320
+المركب شبه ملحي لأو حامضي ولأو قاعدي كل ما قلت
+
+119
+00:10:32,320 --> 00:10:38,080
+الـBH تبعته عن سبعة كل ما قلت هذا الكلام اللي أنا
+
+120
+00:10:38,080 --> 00:10:42,720
+حكيته توه إنه كل ما بيزيد زرعات الهيدروجين وتفسير
+
+121
+00:10:42,720 --> 00:10:48,460
+التفسير اللي أنا توه حكيته جالك كل ما الـBH طلعة
+
+122
+00:10:48,460 --> 00:10:52,770
+neutral بتكون أنت سبعةعند إيش؟ عند سبعة بكون ملحد
+
+123
+00:10:52,770 --> 00:11:00,190
+يعني كأنه لهم القائد ولهو حمضي طيب إيش بيصير؟ جالك
+
+124
+00:11:00,190 --> 00:11:04,730
+لو زادت ايونات الهيدروجين ها الـhydrogen activity
+
+125
+00:11:04,730 --> 00:11:10,730
+إيش مالها؟ زادت إيش بيصير المركبة يا جماعة؟ حمضي
+
+126
+00:11:10,730 --> 00:11:14,130
+طلعوا كيف؟ ها الـPHS صار فيها
+
+127
+00:11:18,230 --> 00:11:23,450
+بتقل، هذا بناءً على إيش؟ بناءً على الزيادة في
+
+128
+00:11:23,450 --> 00:11:28,050
+أيونات الهيدروجين طبعاً العلاقة العكسية مع
+
+129
+00:11:28,050 --> 00:11:34,550
+الـHydroxyl، الـOH، لم نفتنناش كتيربالعكس بالنسبة
+
+130
+00:11:34,550 --> 00:11:41,250
+للقاعدة كل ما بتقل ايونات الهيدروجين كل ما بتسيل
+
+131
+00:11:41,250 --> 00:11:45,050
+العلامة العشرية يعني الواحد بعد كتير أسفار معناه
+
+132
+00:11:45,050 --> 00:11:49,250
+أنه أقل كل ما الواحد بيجرب مين أكبر هذا الرقم ولا
+
+133
+00:11:49,250 --> 00:11:55,090
+هذا أكيد هذامن أكبر؟ هذا الرقم ولا هذا آخر واحد؟
+
+134
+00:11:55,090 --> 00:11:58,810
+أكيد هذا صح لأن الأصفار العشرية اللي بعد الصفارة
+
+135
+00:11:58,810 --> 00:12:04,050
+أقل فإذاً هنا إيش بيصير في الأيونات الهيدروجين
+
+136
+00:12:04,050 --> 00:12:12,620
+عامات؟ إيش بيصير فيها؟الـ Activity كل ما بالنسبة
+
+137
+00:12:12,620 --> 00:12:16,340
+للـ Base كل ما بتقل، أيش بيصير في البيئات؟ كما
+
+138
+00:12:16,340 --> 00:12:20,120
+أنتم شايفين الـ pH أيش بيصير فيها؟ الـ pH بتعلى،
+
+139
+00:12:20,120 --> 00:12:22,640
+بتعلى، بتعلى، بتعلى، بتعلى، بتعلى، بتعلى، بتعلى،
+
+140
+00:12:22,640 --> 00:12:23,500
+بتعلى، بتعلى، بتعلى، بتعلى، بتعلى، بتعلى، بتعلى،
+
+141
+00:12:23,500 --> 00:12:30,560
+بتعلى، بتعلى، بتعلى، بتعلى، بتعلى، بتعلى، بتعلى،
+
+142
+00:12:30,560 --> 00:12:32,360
+بتعلى، بتعلى، بتعلى، بتعلى، بتعلى، بتعلى، بتعلى،
+
+143
+00:12:32,360 --> 00:12:32,580
+بتعلى، بتعلى، بتعلى، بتعلى، بتعلى، بتعلى، بتعلى،
+
+144
+00:12:32,580 --> 00:12:34,160
+بتعلى، بتعلى، بتعلى، بتعلى، بتعلى، بتعلى، بتع
+
+145
+00:12:39,340 --> 00:12:43,240
+عندما حسبوا الـ Hydrogen Activity في لبنان فلقوها
+
+146
+00:12:43,240 --> 00:12:49,580
+الرقم هذا O000006 .. يعني من الصعب التعامل مع رقم
+
+147
+00:12:49,580 --> 00:12:53,040
+كبير يعني بهذا الشكل طيب قالك لو بدي أخد ال
+
+148
+00:12:53,040 --> 00:12:57,260
+logarithm تبع هذا الرقم علشان أتعامل برقم أصغر طلع
+
+149
+00:12:57,260 --> 00:13:03,580
+minus 7.35 أه والله هذا أسهل في التعامل بس minus
+
+150
+00:13:03,580 --> 00:13:08,920
+غلبة قالك طب بسيطةخُد الـ Negative Logarithm بدل
+
+151
+00:13:08,920 --> 00:13:13,000
+ما تُخُد الـ Logarithm الطبيعي خُد الـ Negative
+
+152
+00:13:13,000 --> 00:13:18,220
+Logarithm يعني الـ Negative تبع ناقص 7.35 نيجاتيب
+
+153
+00:13:18,220 --> 00:13:21,520
+تي نيجاتيب بتصير موجب فعشان إيه صاروا ياخدوا الـ
+
+154
+00:13:21,520 --> 00:13:26,420
+Negative Logarithm للرقم هذا فصار يطلقلنا رقم موجب
+
+155
+00:13:26,420 --> 00:13:31,610
+اسمه 7.35هذا الـ Lower Limit لإن كون الـ Blood
+
+156
+00:13:31,610 --> 00:13:35,310
+عندى Balanced وهذا ال Upper Limit لإن كون عندى ال
+
+157
+00:13:35,310 --> 00:13:39,870
+Blood Balanced فوق هيكة بيصير قاعدة تحت من هذا
+
+158
+00:13:39,870 --> 00:13:45,810
+بيصير حمض تمام؟ فهيكة الصراحة فهيكة عرفنا إيش الـ
+
+159
+00:13:45,810 --> 00:13:48,790
+pH من وين إجت، إيش مصدرها
+
+160
+00:13:52,540 --> 00:13:56,560
+وبقت إيش بيكون زيادة في آيونات الهيدروجين بعمل
+
+161
+00:13:56,560 --> 00:14:01,140
+حمضية وهذا بيأثر على الـ pH إنها بتقل وبتقل في
+
+162
+00:14:01,140 --> 00:14:04,260
+جميع المركبات عن السبعة بالنسبة للـ Blood هو
+
+163
+00:14:04,260 --> 00:14:08,260
+المركب اللي إحنا بيهمنا يعني بتقل عن سبعة point
+
+164
+00:14:08,260 --> 00:14:12,360
+تلاتة خمسة بتصير حمض بتزيد عن سبعة point أربعة
+
+165
+00:14:12,360 --> 00:14:17,880
+خمسة بتصير قاعدة تمام، فهمنا هذا الكلام كلهيتههلأ
+
+166
+00:14:17,880 --> 00:14:20,880
+الـ «سلاجدات» هدول إيش بتقول؟ بتحكي الكلام اللي
+
+167
+00:14:20,880 --> 00:14:23,840
+تاوعي أنا اللي أخصلكوا يعني إنه الـAcid إنه في
+
+168
+00:14:23,840 --> 00:14:29,700
+عندي مُركّب يستطيع تبرع بيئيونات هيدروجين ليش؟
+
+169
+00:14:29,700 --> 00:14:33,940
+لأنه حمضي وبالتالي يستطيع أن يفقد بيئيونات
+
+170
+00:14:33,940 --> 00:14:41,360
+هيدروجين زي مُركّب الـHCl، حمضي الـBHA بتكون قليلة
+
+171
+00:14:42,160 --> 00:14:48,580
+ولّا لأ؟ طيب لو زادت في المراكب هذا الأيونات تبع
+
+172
+00:14:48,580 --> 00:14:51,600
+الـHydrogen، إيش بتصير فيه؟ الـBH بتبعته بتقل
+
+173
+00:14:51,600 --> 00:14:56,080
+أكتر، طب لو فقدله شوية، لو فقد هذا المراكب شوية من
+
+174
+00:14:56,080 --> 00:14:59,200
+أيونات الـHydrogen اللي فيه، كيف يعني يفقد؟ يعني
+
+175
+00:14:59,200 --> 00:15:03,260
+يتحد مع أنصر تاني، فهيفقد شوية الـHydrogen، إيش
+
+176
+00:15:03,260 --> 00:15:09,540
+هيصير؟الـ pH تبقى تزيد، مش هتقل لأنه فقد
+
+177
+00:15:09,540 --> 00:15:14,940
+الهيدروجين يعني فقد حمضية فالـ pH تبقى تزيد و شويه
+
+178
+00:15:14,940 --> 00:15:19,700
+شويه هيتحول له ملح زي الـ KFA المعادلة تبقى الزمان
+
+179
+00:15:19,700 --> 00:15:23,740
+إذا بتتذكرواأروحلكم عليها، لو انتوا صغار لما كانوا
+
+180
+00:15:23,740 --> 00:15:28,600
+يقولولكوا «NAH3O3» هذا إيش؟ اللي هو كربونات
+
+181
+00:15:28,600 --> 00:15:34,600
+الصوديوم مع حفظ الـHydrochloric HCl إيش بيدينا؟
+
+182
+00:15:34,600 --> 00:15:38,280
+بيدينا، طلع كده؟ بنروح و بناخد كلوريد الصوديوم
+
+183
+00:15:38,280 --> 00:15:43,380
+الـChlor مع الصوديوم مركّب مع اللي هو أيونات تبع
+
+184
+00:15:43,380 --> 00:15:48,360
+الكلور مع أيونات الصوديوم مع أيونات الكلور بتعمل
+
+185
+00:15:48,360 --> 00:15:52,090
+كلوريد الصوديوماللي هو الملح، فيله الطعام، تمام
+
+186
+00:15:52,090 --> 00:15:57,550
+وبعدين إيش بيضل عندي؟ بيضل عندي HCO3 الـ HCO3 هاي
+
+187
+00:15:57,550 --> 00:16:03,170
+هتروح يطلع منها H2O وشوية ميه وحيضل CO2، غاز
+
+188
+00:16:03,170 --> 00:16:06,970
+دانيوكسيد الكربونة يطير في الهوا هذا هو لو أنا جبت
+
+189
+00:16:06,970 --> 00:16:11,290
+شوية كربونات فلافل وعصرت عليها شوية حمض اللي هو
+
+190
+00:16:11,290 --> 00:16:14,110
+هيدوكلوريك أو انتوا تجربوا مثلا وحطوا خل أو لمون
+
+191
+00:16:14,110 --> 00:16:18,110
+بيصير تفاعل مشابه بس مرقبات اللي بتنتجمخالفة هو
+
+192
+00:16:18,110 --> 00:16:20,870
+الملح اللي بيطلع مش اكلوليد السوديوم بيطلع ملح
+
+193
+00:16:20,870 --> 00:16:25,800
+تاني تمام؟وبيطلع شوية غاز نتيجة التفاعد تلاقيها
+
+194
+00:16:25,800 --> 00:16:29,100
+دخنة تاكية هذا هو الـ Phenyl Carbon وبيلقوا بيصير
+
+195
+00:16:29,100 --> 00:16:32,900
+ايش ال .. ال .. ال .. الكربونات الصيدم اللي انت
+
+196
+00:16:32,900 --> 00:16:36,740
+عملتها لما حطيت عليها الـ HCl ده بتلاقي صار ايه
+
+197
+00:16:36,740 --> 00:16:40,800
+كمية الميه زادت لأنه بينتج شوية ميه من التفاعل ايش
+
+198
+00:16:40,800 --> 00:16:43,900
+اللي قصدته في المعادلة هذه؟ مالك يا دكتور ليش فيه؟
+
+199
+00:16:43,900 --> 00:16:46,740
+مالك روحك ايش كيميا وماشي المعادلة؟ لأ لأ لأ لأ لأ
+
+200
+00:16:46,740 --> 00:16:51,200
+لأ بس انا حبيت اخليكوا تشوفوا انه في المعادلة هذه
+
+201
+00:16:51,200 --> 00:16:58,080
+هذا الحمضالقوي الـ HCl عشان يبطّي الحمض راح فقد
+
+202
+00:16:58,080 --> 00:17:02,880
+آيونات الهيدروجين اللي فيه H فقدها واتبرع فيها
+
+203
+00:17:02,880 --> 00:17:09,020
+لمين؟ H كمان H هنا صارت 2 ومع الـ C مع الواحدة
+
+204
+00:17:09,020 --> 00:17:16,120
+Oxygen من هنا صارت H2O هايهم H2O عمل ميّه وظل CO2
+
+205
+00:17:16,120 --> 00:17:22,890
+يطلع غاز، تمام؟ إذا بمجرد ما الحمض هذا فقدعارف
+
+206
+00:17:22,890 --> 00:17:31,670
+اللي .. اللي .. اللي خربشات سافلة الصراحة الصراحة
+
+207
+00:17:31,670 --> 00:17:42,150
+عيب صار
+
+208
+00:17:42,150 --> 00:17:48,150
+فينا إيش؟ صار فينا مُركّب فقد حمضيته لأنه فقد
+
+209
+00:17:48,150 --> 00:17:55,870
+الـhydrogen اللي فيهOkayطيب نرجع احنا عاد على الـ
+
+210
+00:17:55,870 --> 00:17:59,310
+slide تبعتنا اتفهمنا انه اي مركب بيفقد هيدروجين
+
+211
+00:17:59,310 --> 00:18:05,330
+يعني بتقل الحنضية تبعته طيب والبيز اي مركب بيكتسب
+
+212
+00:18:05,330 --> 00:18:12,830
+هيدروجين except وبيقبل هيدروجين هيكون عنده القدرة
+
+213
+00:18:12,830 --> 00:18:17,090
+انه يصير إيش قاعدي يعني كل مركب ينده قدرة على
+
+214
+00:18:17,090 --> 00:18:24,220
+استقبال آيونات الهيدروجين يتحول إلى مركب قاعديالـ
+
+215
+00:18:24,220 --> 00:18:30,920
+Neutral في الـ pH بشكل عام أنه يكون 7 بنطلع طبعاً
+
+216
+00:18:30,920 --> 00:18:38,360
+من الـ في الـ Blood حكينا من 7.35 لـ 7.45 يعني
+
+217
+00:18:38,360 --> 00:18:42,740
+الطبيعي طبعا الـ Blood 7.4 اتطلع مثلا الـ Milk
+
+218
+00:18:42,740 --> 00:18:50,540
+الطبيعي 7.7 الـ Wine اللي هو الكحول والنبير 4 يعني
+
+219
+00:18:50,540 --> 00:18:56,060
+الحمض المركبات المجليد في أشخاصالكولة طلع جداش
+
+220
+00:18:56,060 --> 00:19:04,000
+الحنضية تبعتها طلع هنا ال lime water عصين الليمون
+
+221
+00:19:04,000 --> 00:19:12,360
+12.5 قاعدي أخدين بالك؟ أيوة
+
+222
+00:19:12,360 --> 00:19:19,180
+سنة فاهمين إيش ال acid وإيش ال baseوإيش الـ pH؟
+
+223
+00:19:19,180 --> 00:19:23,220
+وعرفنا إن الـ pH إذا جلت عن الـ 37 في الدم بيكون
+
+224
+00:19:23,220 --> 00:19:29,720
+حمضية وإذا زالت عن الـ 57 في الدم بيسميها الكلوسيس
+
+225
+00:19:29,720 --> 00:19:34,460
+فالجهة ده بدنا شوية نغير المصطلح تبع كلمة base
+
+226
+00:19:34,460 --> 00:19:39,690
+اللي هي base معناها قاعدة أو قاعدةلكلمة alkaline،
+
+227
+00:19:39,690 --> 00:19:44,450
+alkalosis، alkalosis معناها حالة من القاعدية،
+
+228
+00:19:44,450 --> 00:19:49,410
+تمام؟ هذا بتصير إذا كان الـDH في الدم فوق الـ7.45،
+
+229
+00:19:49,410 --> 00:19:57,290
+طيب، كويس، إذا اتهمنا إن الـBlood من 7.35 لـ7.45،
+
+230
+00:19:57,290 --> 00:20:02,670
+فوق هذا الكلامفوق الـ 7.45 بيصير Alkalosis تحت من
+
+231
+00:20:02,670 --> 00:20:07,710
+الـ 7.35 بتعمل Acidosis الـ pH في الآلة هذه بتكون
+
+232
+00:20:07,710 --> 00:20:15,310
+أقل من 7.35 الـ pH في الآلة هذه بتكون أكتر من 7.45
+
+233
+00:20:15,310 --> 00:20:22,190
+تمام، هذه هي الـ Translation الأولية لموضوعنا اللي
+
+234
+00:20:22,190 --> 00:20:27,830
+بدينا نحكي فيه لـ Arterial Blood Gasesتمام، هنهي
+
+235
+00:20:27,830 --> 00:20:32,470
+المحاضرة ها والمحاضرة المسجلة التانية هنحكي فيها
+
+236
+00:20:32,470 --> 00:20:38,770
+ان شاء الله عن اللي هو الأنواع
+
+237
+00:20:38,770 --> 00:20:42,570
+تبع الـ compensation كيف بيصير يعني، إيش الـ
+
+238
+00:20:42,570 --> 00:20:45,630
+metabolic وإيش ال respiratory، إيش هذي الحالات
+
+239
+00:20:45,630 --> 00:20:48,690
+وإيش يعني ال acidosis تبع ال blood حكينا هذي، وإيش
+
+240
+00:20:48,690 --> 00:20:51,610
+يعني ال alkalosis تبع ال blood ال normal blood
+
+241
+00:20:51,610 --> 00:20:57,670
+gasesالـ Normal Blood Gases له Settings تانية، مش
+
+242
+00:20:57,670 --> 00:21:01,890
+بس الـ pH كمان لازم أكون عارف الـ BCO2 والـ Oxygen
+
+243
+00:21:01,890 --> 00:21:05,370
+Saturation والـ Bicarb، هذه الحاجات موجودة already
+
+244
+00:21:05,370 --> 00:21:11,770
+في الجسم وهي من اللي هي مكونات الـ Buffer System
+
+245
+00:21:11,770 --> 00:21:17,290
+وعلشان هيك إن شاء الله رب العالمين إحنا هنناقش كل
+
+246
+00:21:17,290 --> 00:21:22,900
+الكلام هذا في المحاضرة الجايةبدي أخلّيلكوا الـ
+
+247
+00:21:22,900 --> 00:21:26,860
+WhatsApp مفتوح واللي بدها تسأل أي سؤال في المحاضرة
+
+248
+00:21:26,860 --> 00:21:31,480
+هذه من عناية التنتين هلاقيت أنه نخلي الحكيمة في
+
+249
+00:21:31,480 --> 00:21:34,580
+النادي تفتح الـ WhatsApp وإذا في أي حد عنده أي
+
+250
+00:21:34,580 --> 00:21:38,880
+محاضرة أو أي سؤال عفوا في المحاضرة خليني أسمع منكم
+
+251
+00:21:38,880 --> 00:21:43,580
+يعطيكم العافية وشكرا كتير إلكوا ولو إني أنا مش
+
+252
+00:21:43,580 --> 00:21:47,280
+عارف بتظلوا تزعلوني تخربشوا و بتحكوا ومتسابشوا
+
+253
+00:21:47,280 --> 00:21:50,500
+مساكنين الميجرافون مش عارف ليش يعطيكم العافية
+
diff --git a/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/c2aJgpzZ7UQ.srt b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/c2aJgpzZ7UQ.srt
new file mode 100644
index 0000000000000000000000000000000000000000..130ef4129b5897648197d58a68647167262513e3
--- /dev/null
+++ b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/c2aJgpzZ7UQ.srt
@@ -0,0 +1,1254 @@
+1
+00:00:01,420 --> 00:00:06,440
+بسم الله الرحمن الرحيم، لازمنا في الـ Arterial
+
+2
+00:00:06,440 --> 00:00:10,120
+Blood Gases. في المحاضرة السابقة حكينا عن الـ
+
+3
+00:00:10,120 --> 00:00:14,360
+Buffer System. شفنا كيف إن هو تلات أنواع في الـ Buffer
+
+4
+00:00:14,360 --> 00:00:18,580
+في الـ Blood، في الـ Buffer، في الـ Respiration، وفي الـ
+
+5
+00:00:18,580 --> 00:00:21,280
+Kidney. بتشتغل. أول سؤال عن الـ Buffer System، شفنا كيف
+
+6
+00:00:21,280 --> 00:00:24,360
+الـ Blood، على طريق الـ Chemicals الموجودة في الـ
+
+7
+00:00:24,360 --> 00:00:27,460
+Blood، وكيف بتشتغل، اللي هو الـ Protein والـ Plasma
+
+8
+00:00:27,460 --> 00:00:32,340
+بالذات بيشتغلوا Immediately، عشان يحسنوا و يصلونا
+
+9
+00:00:32,340 --> 00:00:34,840
+لحالة من الـ Hemostasis والـ Acid-Base Balance.
+
+10
+00:00:34,840 --> 00:00:40,680
+شوفنا كمان كيف الـ Lung بتتحكم في موضوع الـ Acid
+
+11
+00:00:40,680 --> 00:00:45,280
+Base Balance، عن طريق أنها بتتحكم في مستويات التنفس.
+
+12
+00:00:45,280 --> 00:00:52,020
+علشان تحسن أو ترفع، يعني، الـ Level of CO2 أو تقلل
+
+13
+00:00:52,020 --> 00:00:56,680
+الـ Level of CO2، حسب الحاجة وحسب الحالة اللي فيها
+
+14
+00:00:56,680 --> 00:01:01,240
+الجسم. يعني باختصار، لو كان في، اللي هو، حالة من
+
+15
+00:01:01,240 --> 00:01:04,360
+الحمضية، في Respiratory Acidosis، أو كان في
+
+16
+00:01:04,360 --> 00:01:07,880
+Metabolic Acidosis، أو كان في Metabolic Acidosis، الـ
+
+17
+00:01:07,880 --> 00:01:11,000
+Lung بتستجيب، عن طريق الـ Respiratory Alkalosis. إيش
+
+18
+00:01:11,000 --> 00:01:14,160
+يعني؟ يعني لو كان في Metabolic Acidosis، يعني الـ
+
+19
+00:01:14,160 --> 00:01:20,920
+pH أقل من 7.35، الـ Lung بتحاول تخلي الدم يصير
+
+20
+00:01:20,920 --> 00:01:26,560
+قاعدي، عن طريق تقليل مستويات الـ CO2 في الدم، لأنه
+
+21
+00:01:26,560 --> 00:01:29,740
+إحنا بنعرف إن الـ CO2 هو المسؤول عن الحمضية.
+
+22
+00:01:29,740 --> 00:01:35,340
+وبالتالي بتدعو الجسم إلى تقليل، اللي هو، زيادة
+
+23
+00:01:35,340 --> 00:01:39,380
+معدلات التنفس، عشان يعمل Washing Out للـ CO2.
+
+24
+00:01:39,380 --> 00:01:42,960
+وبالتالي هذا بيخلي يصير فينا مستويات منخفضة من الـ
+
+25
+00:01:42,960 --> 00:01:47,500
+CO2. وطبعا لو كان فينا Metabolic Alkalosis، هيصير
+
+26
+00:01:47,500 --> 00:01:53,730
+الموضوع بالعكس، وحتخلي التنفس يصبح بطيء، لكي يقلل الـ
+
+27
+00:01:53,730 --> 00:01:58,250
+CO2، ويعمل لنا قليل من الـ Acidosis، ويعمل لنا Compensation
+
+28
+00:01:58,250 --> 00:02:06,530
+للـ Metabolic Alkalosis. الموجود. كذلك الـ
+
+29
+00:02:06,530 --> 00:02:11,400
+Kidney هتشتغل، لكن زي ما حكينا مش within hours، زي
+
+30
+00:02:11,400 --> 00:02:15,080
+الـ Respiratory، لأ، هتشتغل within days. الـ Kidney
+
+31
+00:02:15,080 --> 00:02:19,440
+عليها مسئولية كبيرة. الـ Kidney، وظيفتها بشكل أساسي
+
+32
+00:02:19,440 --> 00:02:23,400
+تحافظ لي على الـ acid-base balance، عن طريق إنها هي
+
+33
+00:02:23,810 --> 00:02:29,170
+اللي فعلاً بتعيد انتاج، أولاً، هي أصلاً اللي بتصنع
+
+34
+00:02:29,170 --> 00:02:36,190
+الـ Bicarbonate. مش الرينا لتجول secrete  أشيء، وبتصنع
+
+35
+00:02:36,190 --> 00:02:42,370
+أصلاً الـ Bicarbonate، و أنا كتبتها تمام، بتصنع أصلاً الـ
+
+36
+00:02:42,370 --> 00:02:48,660
+Bicarbonate. هتلاقوها somewhere. والـ "The kidneys
+
+37
+00:02:48,660 --> 00:02:51,340
+regulate the bicarbonate level in" اللي هو الـ
+
+38
+00:02:51,340 --> 00:02:54,880
+"extracellular fluid". "They can regenerate bicarb".
+
+39
+00:02:54,880 --> 00:02:58,680
+هي بتُقَيِّد تصنيع الـ Bicarbonate، ومش كمان بتسوّي وبتعمل
+
+40
+00:02:58,680 --> 00:03:02,520
+Reabsorption للـ Bicarbonate اللي بده يطلع عن طريق
+
+41
+00:03:02,520 --> 00:03:06,380
+اليورين، عشان ما نفقدوش كله، وعشان نتحافظ على الاتزان
+
+42
+00:03:06,380 --> 00:03:10,200
+القاعدي اللي موجود، بالنسبة للحالة الحمضية، فبتعمل لي
+
+43
+00:03:10,200 --> 00:03:14,100
+acid-base balance. إذا لو تركنا اليورين يطلع كل الـ
+
+44
+00:03:14,100 --> 00:03:18,150
+Bicarbonate، حيصير فيه إننا نضيعه. فالـ Kidney، إن ده
+
+45
+00:03:18,150 --> 00:03:21,390
+مسؤليتها، إنها تصنع Bicarbonate، وإنها تعيد امتصاص اللي
+
+46
+00:03:21,390 --> 00:03:24,630
+بده يطلع. إذا لو صار فيه أي Failure أو أي Kidney
+
+47
+00:03:24,630 --> 00:03:28,250
+Disease، هيأثر على حاجتين: التصنيع تبع الـ Bicarbonate،
+
+48
+00:03:28,250 --> 00:03:32,150
+وهيأثر على اللي هو قدرة الـ Kidney على الـ
+
+49
+00:03:32,150 --> 00:03:37,450
+Reabsorption للـ Bicarbonate. وبالتالي، إيش حيصير فيه؟ حيصير
+
+50
+00:03:37,450 --> 00:03:41,890
+في عندنا مؤكد Metabolic Acidosis، من عدم قدرة
+
+51
+00:03:41,890 --> 00:03:46,830
+الكلية على تصنيع الـBicarbonate ويعادة امتصاصه. ولذلك
+
+52
+00:03:46,830 --> 00:03:51,450
+بنقول: So if kidneys fail، إذا صار فيه فشل كلوي، pH
+
+53
+00:03:51,450 --> 00:03:54,710
+balance fail. بس يعني مش صعب جداً إنه يصير فيه pH
+
+54
+00:03:54,710 --> 00:03:57,070
+balance، لأن اللي عامل، اللي .. اللي .. اللي ..
+
+55
+00:03:57,070 --> 00:04:00,910
+اللي بيعمل الـbalance هذا، على المدى الطويل، هو الـ
+
+56
+00:04:00,910 --> 00:04:03,950
+Kidney. عشان هيك اليوم بدنا نبدأ نحكي فيه اللي هو
+
+57
+00:04:03,950 --> 00:04:06,930
+الـ Metabolic Acidosis. أعتقد في اللي شافه قبل
+
+58
+00:04:06,930 --> 00:04:11,720
+شوية. صار واضح إن الـ Metabolic Acidosis بيكون نتيجة
+
+59
+00:04:11,720 --> 00:04:15,660
+مشكلة في الـ Kidney، مش في الـ Respiratory. مشكلة في
+
+60
+00:04:15,660 --> 00:04:20,580
+الـ Kidney، أو مشكلة نتيجة من أصل غذائي معين، يعني
+
+61
+00:04:20,580 --> 00:04:24,120
+مثلاً intoxication. واحد ماخد كحول كثير، واحد ماخد
+
+62
+00:04:24,120 --> 00:04:28,580
+اندو مثلاً، اللي هو، Diabetes type 1، وصار في Keto-
+
+63
+00:04:28,580 --> 00:04:32,860
+acidosis. وبالتالي صار دمه حامض. إذا الـ
+
+64
+00:04:32,860 --> 00:04:35,680
+Metabolic، Keto، الـ Metabolic Acidosis is a
+
+65
+00:04:35,680 --> 00:04:38,640
+clinical disturbance characterized by. أي بائش مزال
+
+66
+00:04:38,640 --> 00:04:42,320
+فيه Acidosis، يبقى الـ Hydrogen ions، مالها؟ بتكون
+
+67
+00:04:42,320 --> 00:04:46,860
+عالية. مثلاً فيه Acidosis، أه تمام. لكن إيش السبب؟ That
+
+68
+00:04:46,860 --> 00:04:49,600
+okay. When the body produces excessive quantities of
+
+69
+00:04:49,600 --> 00:04:53,620
+acid. أه طبعاً الجسم هيكوّن كمية كبيرة من الأحماض.
+
+70
+00:04:53,620 --> 00:04:58,160
+تمام. طب وبعد هيك؟ Loss of Bicarbonate. وأكيد حكون
+
+71
+00:04:58,160 --> 00:05:01,840
+بفقد Bicarbonate، لأن الـ Bicarbonate هو المسؤول عن
+
+72
+00:05:01,840 --> 00:05:04,520
+القاعدية. فهو بيكوّن أحماض، وبيفقد Bicarbonate.
+
+73
+00:05:04,520 --> 00:05:07,620
+وبالتالي بتزيد حالة الحمضية عنده. Okay. When the
+
+74
+00:05:07,620 --> 00:05:11,880
+kidneys are not removing enough acid from the body.
+
+75
+00:05:11,880 --> 00:05:15,520
+وهذا بيكون نتيجة إن الكلى ربما فيها خلل، أو مش
+
+76
+00:05:15,520 --> 00:05:19,880
+قادرة، لإنه، يعني، لا تستطيع إنها تتخلص من كل الـ
+
+77
+00:05:19,880 --> 00:05:20,460
+Bicarbonate.
+
+78
+00:05:24,870 --> 00:05:31,810
+إنها تحافظ على كميات الـ Bicarbonate، وتعيد امتصاصها.
+
+79
+00:05:31,810 --> 00:05:36,450
+بسبب ربما أنه فيه بوليوريا شديدة عند المريض، فالكلى
+
+80
+00:05:36,450 --> 00:05:44,490
+غير قادرة على إنها تحافظ على الـ Bicarbonate، عشان يحافظ
+
+81
+00:05:44,490 --> 00:05:49,250
+على القاعدية، ويمنع الـ Acidosis. تمام؟ عشان هيك الـ
+
+82
+00:05:49,250 --> 00:05:52,210
+Metabolic Acidosis كان Divided clinically into two
+
+83
+00:05:52,210 --> 00:05:56,650
+forms. عشان هيك بروح بيصنفوا الـ Metabolic Acidosis
+
+84
+00:05:56,650 --> 00:06:01,040
+according to Anion Gap. إيش الـ Anion Gap؟ قال لنا كده
+
+85
+00:06:01,040 --> 00:06:05,340
+عبارة عن الفجوة الأيونية، اللي هي الـ Normal إنها
+
+86
+00:06:05,340 --> 00:06:09,160
+تكون من 12 إلى 16 ملي مكافئ لكل لتر. طب هاذي كده
+
+87
+00:06:09,160 --> 00:06:13,400
+الـ Anion Gap. وإيش هي أصلاً؟ هي بكل بساطة مجموعة
+
+88
+00:06:13,400 --> 00:06:16,780
+أيونات الصوديوم والبوتاسيوم. يعني إحنا عملنا لمريض
+
+89
+00:06:16,780 --> 00:06:20,220
+صوديوم، جداش الصوديوم عنده 135، عملنا لبوتاسيوم
+
+90
+00:06:20,220 --> 00:06:23,440
+جداش البوتاسيوم عنده 3.5، مجموعة الصوديوم
+
+91
+00:06:23,440 --> 00:06:28,190
+والبوتاسيوم، نقص منهم مجموعة الـ Chloride والـ Bicarbonate، بيطلع
+
+92
+00:06:28,190 --> 00:06:31,370
+رقم. إذا الرقم هذا من 12 إلى 16، بيكون Normal. إذا
+
+93
+00:06:31,370 --> 00:06:34,630
+أعلى من 16، بيكون الـ Anion Gap عنده عالية. إذا أقل
+
+94
+00:06:34,630 --> 00:06:38,030
+من 12، بيكون الـ Anion Gap عنده Low. طب وهذا إيش
+
+95
+00:06:38,030 --> 00:06:41,730
+فائدته بموضوع الـ Metabolic Acidosis؟ أيوة، جاوب.
+
+96
+00:06:41,730 --> 00:06:46,210
+إذا الـ Anion Gap كانت عالية، وهذا عادة بيصير في
+
+97
+00:06:46,210 --> 00:06:50,390
+الـ Metabolic، Chronic Metabolic Acidosis، اللي لها
+
+98
+00:06:50,390 --> 00:06:54,750
+علاقة بأمراض الـ Kidney، بحيث إنه
+
+99
+00:06:57,240 --> 00:07:03,040
+الجسم ما عندهوش الإمكانية إنه يصنع Bicarbonate enough.
+
+100
+00:07:03,040 --> 00:07:06,300
+فبتكون وين المشكلة؟ بتكون المشكلة في الـ Kidney
+
+101
+00:07:06,300 --> 00:07:10,760
+نفسها. يا أما الـ Kidney مش قادرة ترجع تعيد امتصاص الـ
+
+102
+00:07:10,760 --> 00:07:13,700
+Bicarbonate، يا مش قادرة تصنع. إذا مش قادرة تصنع، بيكون
+
+103
+00:07:13,700 --> 00:07:18,070
+هي فيها المشكلة. إذا المشكلة إنه إعادة الامتصاص
+
+104
+00:07:18,070 --> 00:07:20,770
+هي اللي صعبة، بيكون في حالة من الـ Polyuria كبيرة.
+
+105
+00:07:20,770 --> 00:07:24,970
+ومش، يعني، ما عندهاش الإمكانية إنها تسيطر على الموقف.
+
+106
+00:07:24,970 --> 00:07:29,410
+طب وين بيكون فينا حالات فيها اللي هو Polyuria كتير؟
+
+107
+00:07:29,410 --> 00:07:33,090
+حالة مثلاً، اللي هو، الـ Ketoacidosis. بتكون كميات
+
+108
+00:07:33,090 --> 00:07:38,480
+كبيرة من الـ Acid اللي موجودة في الدم، وبالتالي هذه
+
+109
+00:07:38,480 --> 00:07:44,560
+بتؤدي إلى حالة من الـ Polyuria. فبيصير فيه Acidity
+
+110
+00:07:44,560 --> 00:07:47,400
+عالية في الدم، وفي Polyuria، بيطلع بول كثير، و
+
+111
+00:07:47,400 --> 00:07:51,500
+الكلية ما عندهاش القدرة تعمل إعادة امتصاص لـ
+
+112
+00:07:51,500 --> 00:07:56,160
+Bicarbonate، وبالتالي بتصير الدم Metabolic Acidosis، حالته
+
+113
+00:07:56,160 --> 00:08:01,310
+ما بيبقى فيه Balance. ولو كان فيه Lactic Acid، وهذا
+
+114
+00:08:01,310 --> 00:08:06,170
+بيصير نتيجة مجهود عضلي، أو Muscle destruction.
+
+115
+00:08:06,170 --> 00:08:10,290
+فبتفرز إنزيمات الـ Lactate هذه، فبتزيد حمضية الدم.
+
+116
+00:08:10,290 --> 00:08:13,910
+في النهاية بتحول على الدم، فبتزيد حمضية الدم. إذا صار
+
+117
+00:08:13,910 --> 00:08:19,130
+في عندي أنا سببين إنه الـ Metabolic Acidosis بتصير
+
+118
+00:08:19,130 --> 00:08:25,610
+mostly. يا أما إن الكلى فيها Disease، وهي مش قادرة إنها
+
+119
+00:08:25,610 --> 00:08:30,070
+تعمل Generation للـ Bicarbonate، أو ما عندهاش القدرة
+
+120
+00:08:30,070 --> 00:08:33,050
+إنها تعمل الـ Absorption. أحياناً بيكون السبب خارجي،
+
+121
+00:08:33,050 --> 00:08:38,270
+إن واحد آخذ مثلاً كحول، أو Aspirin، فبيكوّن
+
+122
+00:08:38,270 --> 00:08:42,670
+Metabolic Acid. لكن في الحالات الطبيعية اللي بيكون
+
+123
+00:08:42,670 --> 00:08:45,650
+فيها الـ Normal Anion Gap، يعني أنا لما جيت أشوف
+
+124
+00:08:45,650 --> 00:08:49,510
+المريض، وجيت أندو Metabolic Acidosis، بس حسبت الـ
+
+125
+00:08:49,510 --> 00:08:51,950
+Normal Anion Gap، اللي هي مجموع الـ Sodium والـ
+
+126
+00:08:51,950 --> 00:08:58,830
+Potassium، ناقص اللي هو الـ Chloride، زائد Bicarbonate، فحلّيت
+
+127
+00:08:58,830 --> 00:09:01,790
+المعادلة هذه، اللي بيظهر Normal، طبيعية، بين 12 و 16.
+
+128
+00:09:01,790 --> 00:09:05,690
+رغم هيك المريض أندو Metabolic Acidosis. هذه حالة
+
+129
+00:09:05,690 --> 00:09:11,550
+سهلة. Metabolic Acidosis. تمام؟  وانت تتخلص من
+
+130
+00:09:11,550 --> 00:09:13,410
+بيكربونات أيون، تتخلص من بيكربونات أيون، تتخلص من
+
+131
+00:09:13,410 --> 00:09:14,390
+بيكربونات أيون، تتخلص من بيكربونات أيون، تتخلص من
+
+132
+00:09:14,390 --> 00:09:16,390
+بيكربونات أيون، تتخلص من بيكربونات أيون، تتخلص من
+
+133
+00:09:16,390 --> 00:09:17,990
+بيكربونات أيون، تتخلص من بيكربونات أيون، تتخلص من
+
+134
+00:09:17,990 --> 00:09:18,890
+بيكربونات أيون، تتخلص من بيكربونات أيون، تتخلص من
+
+135
+00:09:18,890 --> 00:09:21,690
+بيكربونات أيون، تتخلص من بيكربونات أيون، تتخلص من
+
+136
+00:09:21,690 --> 00:09:26,930
+بيكربونات أيون، تتخلص من بيكربونات أيون، تتخلص من ب...
+
+137
+00:09:29,850 --> 00:09:34,930
+Loss of fluid، نتيجة إنه مثلاً صام أكام يوم، ما أكلش
+
+138
+00:09:34,930 --> 00:09:38,250
+فهذه الحاجات هي اللي خَلَّتَه أندو Metabolic
+
+139
+00:09:38,250 --> 00:09:41,770
+Acidosis. وبالتالي، ما زال الـ Normal Anion اللي
+
+140
+00:09:41,770 --> 00:09:45,390
+قلنا Normal Anion Gap، معاها طبيعية. وبالتالي شوية
+
+141
+00:09:45,390 --> 00:09:49,290
+Fluid. أن نُعطِي المريض هذا شوية Fluid، هيتحسن و يتطور.
+
+142
+00:09:49,290 --> 00:09:56,540
+لكن لما يكون فيه أندو، اللي هو، أنيونجاب
+
+143
+00:09:56,540 --> 00:10:00,040
+Low، دي Metabolic Acidosis. هذا الموضوع بيكون مرتبط
+
+144
+00:10:00,040 --> 00:10:06,260
+دي لبروتين، وبالأخص بقلة البروتين في الدم. هذه حالة
+
+145
+00:10:06,260 --> 00:10:11,440
+يعني نادرة، أنها تكون مشهورة وتكون موجودة في
+
+146
+00:10:11,440 --> 00:10:16,640
+Metabolic Acidosis. والأنيونجاب Low، زي ما حكينا
+
+147
+00:10:16,640 --> 00:10:19,940
+في حال إن فعلاً الألبومين تبع الدم، اللي هو عبارة عن
+
+148
+00:10:19,940 --> 00:10:24,040
+بروتين الدم، يكون Low، فبكون هذا اللي هو
+
+149
+00:10:24,040 --> 00:10:30,880
+Negative. بنسميها تماماً. والسبب فيها إنه يكون فيه نقص
+
+150
+00:10:30,880 --> 00:10:36,010
+لبروتين. فبعد ما نحسب إحنا الـ Anion Gap، نلاقيها أقل
+
+151
+00:10:36,010 --> 00:10:40,390
+من 12، ويكون في عندنا Metabolic Acidosis. فأنا بفهم
+
+152
+00:10:40,390 --> 00:10:43,790
+إنه آه، يبدو هذا الـ Metabolic Acidosis، إيه علاقته
+
+153
+00:10:43,790 --> 00:10:46,690
+في البروتين؟ فإذا إحنا ما كناش عاملين فحص للبروتين، ولا
+
+154
+00:10:46,690 --> 00:10:50,890
+للمريض، بنروح بنعمل فحص للبروتين، وإنه حالته دي فعلاً إنه
+
+155
+00:10:50,890 --> 00:10:53,150
+منخفض. وبالتالي، بكون إحنا عارفين إنه في الـ
+
+156
+00:10:53,150 --> 00:10:58,690
+Management تبعنا، بدنا نعطي اللي هو ألبومين، علشان
+
+157
+00:10:58,690 --> 00:11:04,350
+المريض هذا يتحسن. وهذا هو العلاج. بينما في الحالات
+
+158
+00:11:04,350 --> 00:11:07,410
+الأولانية، يعني لما نحكي عن الـ cause and effect
+
+159
+00:11:07,410 --> 00:11:10,150
+أحكام، إحنا Already، لما ضربنا أمثلة على الـ Anion
+
+160
+00:11:10,150 --> 00:11:13,130
+Gaps، حكينا، يعني مثلاً، Diabetic Ketoacidosis. حكينا
+
+161
+00:11:13,130 --> 00:11:16,570
+إنها من الـ High Anion Gap. Metabolic Acidosis، دي البول
+
+162
+00:11:16,570 --> 00:11:20,370
+عرفنا إنها من الـ Normal، عادة تكون Normal Anion Gap.
+
+163
+00:11:21,330 --> 00:11:24,690
+الـ Renal Failure من الـ High Anion Gap، هذا تمام.
+
+164
+00:11:24,690 --> 00:11:29,710
+صح ولا لأ؟ الـ Salicylic Oxidation من الـ High عادة.
+
+165
+00:11:29,710 --> 00:11:33,310
+ولو نحسب الـ Anion Gap، هنلاقيها High. الشكوك والـ
+
+166
+00:11:33,310 --> 00:11:37,850
+Cardiac Arrest، هتلاقيها High. تمام.
+
+167
+00:11:39,120 --> 00:11:42,880
+طب ما هي العلامات؟ أول علامة إحنا بنعرفها إن الـ pH
+
+168
+00:11:42,880 --> 00:11:49,100
+هيكون أقل من 7.35. هذا أول حاجة. طب كويس. طيب، ومما أن
+
+169
+00:11:49,100 --> 00:11:53,840
+الـ pH أقل من 7.35، إيش وضع الـ Bicarbonate يا جماعة؟
+
+170
+00:
+
+223
+00:15:38,760 --> 00:15:41,520
+المريض، اللي هو الـDialysis، يعني غسيل الكلى
+
+224
+00:15:41,520 --> 00:15:45,160
+الـChemodialysis، خاصة في حالات الـIntoxication
+
+225
+00:15:45,390 --> 00:15:49,170
+اللي بيكون شارب مواد سامة أو فيه فشل كلوي، و
+
+226
+00:15:49,170 --> 00:15:52,870
+الـkidney متقطعة تماما يعني مش قادرة تشتغل، فضلا عن
+
+227
+00:15:52,870 --> 00:15:56,870
+إيش نسوي؟ نعمله Dialysis  في حالة  Metabolic Alkalosis
+
+228
+00:15:56,870 --> 00:16:00,930
+الصورة هنا عكس الصورة اللي حكيناها قبل شوية تماما
+
+229
+00:16:00,930 --> 00:16:06,920
+كيف يعني عكسها؟ يعني المشكلة في الـkidney،  أه هي
+
+230
+00:16:06,920 --> 00:16:09,860
+هي لأنه متابولي، لكن بدل من الـAcidosis،
+
+231
+00:16:09,860 --> 00:16:12,480
+Alkalosis، إيش يعني Alkalosis؟ يعني الـpH بدل ما
+
+232
+00:16:12,480 --> 00:16:16,340
+كانت منخفضة، هنا عالية، أكثر من سبعة وأربعة أعشار
+
+233
+00:16:16,340 --> 00:16:20,780
+من عشرة، و .. وفي هذه الحالة إيش هيكون السبب يا
+
+234
+00:16:20,780 --> 00:16:26,340
+جماعة؟ هيكون السبب أكيد تراكم الـBicarbonate، إيش؟
+
+235
+00:16:26,340 --> 00:16:31,200
+تراكم الـBicarbonate، تراكم الـBicarbonate، أه، زي إيش
+
+236
+00:16:31,200 --> 00:16:36,610
+يعني تراكم الـيعني مثلًا واحد عنده فشل كلوي حاد
+
+237
+00:16:36,610 --> 00:16:40,430
+فجأة بطلت الكلية تشتغل و تطلع بول، فبالتالي
+
+238
+00:16:40,430 --> 00:16:45,110
+بيتركم في جسمه، هذه الحالة  الرنالفيليا بتتسبب بها
+
+239
+00:16:45,110 --> 00:16:52,330
+مشاكل  كلوية، وإيش كمان؟ وكمان يا جماعة استخدام الـ
+
+240
+00:16:52,330 --> 00:16:54,810
+diuretics بكثرة،  الـdiuretics يا أستاذ
+
+241
+00:16:54,810 --> 00:17:01,210
+بتخليني أطلع بول كتير، فالمفروض أنه زي ما أطلع بول
+
+242
+00:17:01,210 --> 00:17:04,950
+كتير المفروض أنه أفقد Bicarbonate  وبالتالي مايصيرش
+
+243
+00:17:04,950 --> 00:17:06,230
+الـAlkalosis يصير Acidosis
+
+244
+00:17:09,640 --> 00:17:14,300
+الـIncreased Excretion of Chloride بالنسبة للتناقص
+
+245
+00:17:14,300 --> 00:17:19,200
+وكميات اللي هتخرج من الـChloride هتكون بالنسبة
+
+246
+00:17:19,200 --> 00:17:24,120
+للبايكربونات أكثر وخاصة لما يكون المريض يستخدم مدرات
+
+247
+00:17:24,120 --> 00:17:28,660
+بول قوية زي اللازيكس، فبالتالي تعمل Metabolic
+
+248
+00:17:28,660 --> 00:17:32,960
+Alkalosis، إذا الـMetabolic Alkalosis له مسببات
+
+249
+00:17:32,960 --> 00:17:36,480
+كتير زي ما احنا يعني
+
+250
+00:17:37,840 --> 00:17:41,420
+بنشوف، هي ممكن نعرف إنه إذا كان عنده Hypokalemia
+
+251
+00:17:41,420 --> 00:17:44,520
+بسبب عدم شرب الماء أو  Dehydration، إذا أنا ما .. ما ..
+
+252
+00:17:44,520 --> 00:17:48,580
+مابشربش مية  بطلع منه Vomiting كتير طبعا، وبالذات الـ
+
+253
+00:17:48,580 --> 00:17:52,620
+Vomiting لإن المعدة الوسط حمضي، فلما نفقد ..
+
+254
+00:17:52,620 --> 00:17:55,660
+بسبب الـVomiting كتير نفقد حموض من الجسم، مايخشش
+
+255
+00:17:55,660 --> 00:18:00,780
+الـBlood  الحمض، فيه حاجات تانية إنه يكون عنده مثلا
+
+256
+00:18:00,780 --> 00:18:04,060
+Excessive Adrenocorticosteroid hormone أو يكون
+
+257
+00:18:04,060 --> 00:18:10,110
+عنده اللي هو Hypokalemia، هذا برضه سبب  يؤدي إلى
+
+258
+00:18:10,110 --> 00:18:13,670
+حدوث هذا الـAlkalosis  بغض النظر عن
+
+259
+00:18:13,670 --> 00:18:17,410
+الأسباب، احنا بدنا نشوف إيش اللي ممكن يصير بعد ما
+
+260
+00:18:17,410 --> 00:18:21,350
+أنا  أُشخص إن الحالة عبارة عن حالة لأنه بصراحة
+
+261
+00:18:21,350 --> 00:18:25,890
+الأسباب  في كل حالة بدك تحكي عن المرض  اللي تبعها، بدك تحكي فيه
+
+262
+00:18:25,890 --> 00:18:29,010
+بالتفصيل، فإحنا في كتير من الحالات اللي هنحكي عنها
+
+263
+00:18:29,010 --> 00:18:32,390
+later on، احنا  هنتكلم في موضوعنا كيف نفسر الـBlood Gas
+
+264
+00:18:32,390 --> 00:18:35,870
+تمام؟ فأنا مش  مهم إيش هي الأمراض بقدر ما مهم
+
+265
+00:18:35,870 --> 00:18:39,850
+أنك تستطيع إنك تفسر الحالة لو قرأت  Blood Gas
+
+266
+00:18:39,850 --> 00:18:43,970
+يعني لو أنا في عندك ABG موجود، أه موجود عندك قيم
+
+267
+00:18:43,970 --> 00:18:47,890
+لـpH، بعدين موجود عندك قيم للـCO2، بعدين موجود
+
+268
+00:18:47,890 --> 00:18:51,230
+عندك قيم للـBicarbonate، من القيم هدول التلاتة
+
+269
+00:18:51,230 --> 00:18:54,490
+تستطيع تقولي إيش هي الحالة، هي Metabolic Acidosis
+
+270
+00:18:54,490 --> 00:18:58,330
+ولا Metabolic Alkalosis، وبعدين تقولي إذا كان في
+
+271
+00:18:58,330 --> 00:19:03,430
+Compensation ولا ماكانش فيه Compensation، تمام؟ و
+
+272
+00:19:03,430 --> 00:19:07,770
+هحكيلكوا أنا في آخر المحاضرة إيش الاختلاف بين
+
+273
+00:19:07,770 --> 00:19:11,010
+أنواع الـCompensation اللي بيسموهم Partial و
+
+274
+00:19:11,010 --> 00:19:14,950
+Complete Compensation، طبعا، طبعا، طيب، اللي لما
+
+275
+00:19:14,950 --> 00:19:19,110
+بيكون في عندي زيادة في القاعدة  الـAlkaline، يعني أنا
+
+276
+00:19:19,110 --> 00:19:22,330
+في عندي حالة من الـMetabolic Alkalosis، طبعا، إيش
+
+277
+00:19:22,330 --> 00:19:25,570
+بيكون في عندي؟ بيكون في عندي Bicarbonate، طيب، إيش
+
+278
+00:19:25,570 --> 00:19:31,110
+بدها تعمل الرئة؟ إيش بدها تعمل الرئة؟ طب
+
+279
+00:19:31,110 --> 00:19:35,050
+إيش بدها تعمل الرئة؟ بدها تزيل القاعدة، إذا
+
+280
+00:19:35,050 --> 00:19:38,010
+بدها تزيل الحموضة، طب كيف بتزيل الحموضة؟ بتزيل
+
+281
+00:19:38,010 --> 00:19:41,130
+ثاني أكسيد الكربون، هو ثاني أكسيد الكربون، إذا
+
+282
+00:19:41,130 --> 00:19:44,590
+المرض بيعمل قاعدية، طب وكيف بتزيل ثاني أكسيد
+
+283
+00:19:44,590 --> 00:19:49,770
+الكربون؟ بيعمل تراكم للـCO2 بكل بساطة، أقل
+
+284
+00:19:49,770 --> 00:19:53,260
+شيء المريض بيعمل، دي فرط التنفس، أه، Bravo، صح،بقلل عدد
+
+285
+00:19:53,260 --> 00:19:55,960
+مرات التنفس، يعني بتعمل الـHypoventilation، هذا
+
+286
+00:19:55,960 --> 00:20:01,140
+هيخلي المريض أنه يصير عنده CO2 retention
+
+287
+00:20:01,140 --> 00:20:07,680
+وبالتالي الـretention للـCO2 يحاول يحسن حالة
+
+288
+00:20:07,680 --> 00:20:11,580
+الحمضية الأيضية الموجودة اللي هو Metabolic
+
+289
+00:20:11,580 --> 00:20:13,280
+Acidosis، وبالتالي
+
+290
+00:20:15,550 --> 00:20:20,210
+لو كلينيكال مانيفيستيشن، الأعراض هتكون بتختلف من كل
+
+291
+00:20:20,210 --> 00:20:24,590
+مرض لمرض حسب إيش هو الـcomplaint اللي عند المريض
+
+292
+00:20:24,590 --> 00:20:27,330
+هل هو من related Vomiting ولا هل .. بس كل الحالات  وكل
+
+293
+00:20:27,330 --> 00:20:31,590
+الأحوال  هتلاقي أن المريض تعبان، وهتلاقي عنده خدر في
+
+294
+00:20:31,590 --> 00:20:36,650
+أطرافه، وهتلاقي عنده دوخة، وبالذات إرهاق في العضلات
+
+295
+00:20:36,650 --> 00:20:43,650
+علاجه علاج السبب، علاج السبب، تمام؟ يعني لازم
+
+296
+00:20:43,650 --> 00:20:45,650
+إيش الـcause اللي عمل المرض، هو يتقلل لما أنتَ
+
+297
+00:20:45,650 --> 00:20:49,310
+بتعالج المرض، بنتكلم  في موضوع الكالسيوم اللي
+
+298
+00:20:49,310 --> 00:20:52,610
+بدي أحكيلكوا فيه كلمتين، فيه حاجة اسمها ionized
+
+299
+00:20:52,610 --> 00:20:55,330
+calcium، مش هذا الـionized calcium، هذا الـfree
+
+300
+00:20:55,330 --> 00:20:59,150
+الكالسيوم اللي مش مرتبط، مش مرتبط  بـ
+
+301
+00:20:59,150 --> 00:21:03,610
+البروتينات، هذا أصلا هو intracellular، إيش
+
+302
+00:21:07,450 --> 00:21:11,830
+يعني من الـMinerals اللي هي إيش؟  والمركبات mainly
+
+303
+00:21:11,830 --> 00:21:17,450
+Intracellular، مش Extracellular، طيب Okay، بس طبعا
+
+304
+00:21:17,450 --> 00:21:21,190
+فيه منه موجود في الدم، اللي إحنا بنعمل إيش؟
+
+305
+00:21:21,190 --> 00:21:24,090
+Serum Calcium، أه، موجود منه في الدم بس اللي موجود
+
+306
+00:21:24,090 --> 00:21:28,270
+منه في الدم مكون مرتبط في البروتين تبع الدم، اللي
+
+307
+00:21:28,270 --> 00:21:31,890
+هو الألبومين، أه، ولذلك حتى في حالة اسمها بـ
+
+308
+00:21:31,890 --> 00:21:35,330
+"Pseudo" اللي هو "Pseudohypocalcemia" نتيجة
+
+309
+00:21:35,330 --> 00:21:39,230
+Hypoalbuminemia، في المعادلات اللي أخذتها medical
+
+310
+00:21:39,230 --> 00:21:44,130
+surgical students  أنه ممكن يكون مريض ماعندهوش Hypocalcemia
+
+311
+00:21:44,130 --> 00:21:48,190
+لكن عشان عنده Hypoalbuminemia فهو واضح أنه
+
+312
+00:21:51,620 --> 00:21:54,520
+عنده Hypocalcemia، طبعا، يعني هذا دليل على أن الكالسيوم
+
+313
+00:21:54,520 --> 00:21:57,680
+مرتبط جداً بالألبومين، طيب وبالنسبة للكلام هذا،
+
+314
+00:21:57,680 --> 00:22:02,480
+يدوب، أو يعني  حوالي 60%، مش يدوب، الكمية اللي بتكون
+
+315
+00:22:02,480 --> 00:22:06,740
+من الكالسيوم اللي بتكون free  في الجسم هيكون،
+
+316
+00:22:06,740 --> 00:22:12,160
+في الـblood لحالها، مش مرتبطة، هي هذه اللي بتشتغل
+
+317
+00:22:12,160 --> 00:22:15,060
+وبتأثر على الـFunction، أما الـ
+
+318
+00:22:15,060 --> 00:22:20,380
+Unbounded هذا  غير مفيد، ما بيقدرش يتصرف، طيب، عشان هيك
+
+319
+00:22:20,380 --> 00:22:25,320
+الهيبوكالسيميا ممكن تعمل مشكلة كبيرة إذا كانت في
+
+320
+00:22:25,320 --> 00:22:31,430
+الـUnbounded، هذا عشان يعني في دكاترة كتير لما بيجي
+
+321
+00:22:31,430 --> 00:22:35,490
+واحد بيقوله أنا بتشنج و بعمله فحص الـTotal
+
+322
+00:22:35,490 --> 00:22:38,690
+Calcium بيلاقيه كويس، الـTotal Calcium اللي هو الحد
+
+323
+00:22:38,690 --> 00:22:41,990
+الـBounded والـUnbounded، فبيروح بيقوله إيه
+
+324
+00:22:41,990 --> 00:22:46,290
+اعمل لي لو سمحت الـIonized Calcium، يعني اللي
+
+325
+00:22:46,290 --> 00:22:49,790
+ممكن يأثر على وظائف الجسم، اللي بيأثر على الـbody
+
+326
+00:22:49,790 --> 00:22:54,170
+function، هذا لـFree Calcium Level، طيب، بيروح بيعمل
+
+327
+00:22:54,170 --> 00:23:02,620
+فممكن يكون هنا Low، طيب، وإيش دخل هذا الموضوع هنا؟
+
+328
+00:23:02,620 --> 00:23:09,100
+جالك الـIonized Calcium هذا ممكن يرتبط مع الـ
+
+329
+00:23:09,100 --> 00:23:14,380
+Protein Molecule، تمام؟ وبالتالي هيعمل Hydrogen Ion
+
+330
+00:23:14,380 --> 00:23:21,440
+لنفس الألبومين اللي موجود عندنا، وبالتالي هذا
+
+331
+00:23:21,440 --> 00:23:27,760
+هيخلي ارتباطات الـIonized Calcium في البروتين
+
+332
+00:23:27,760 --> 00:23:34,300
+أكثر، ولما بتزيد ارتباطات الـCalcium هذا في
+
+333
+00:23:34,300 --> 00:23:39,980
+البروتين هذا، هيخلي إن الـpH لو تقصد  Blood pH
+
+334
+00:23:40,270 --> 00:23:45,930
+في حالة الـAlkalosis، بحالة الـAlkalosis بتزيد إمكانية
+
+335
+00:23:45,930 --> 00:23:49,070
+ارتباط الكالسيوم هذا في البروتين
+
+336
+00:23:52,640 --> 00:23:56,980
+إحنا عرفنا إن في حاجة اسمها Bounded Calcium
+
+337
+00:23:56,980 --> 00:24:01,320
+وفيه Free، الـFree هذا طول ما هو موجود هو بيعمل
+
+338
+00:24:01,320 --> 00:24:05,380
+الـFunction تبعات الجسم، الـAlkalosis الـ
+
+339
+00:24:05,380 --> 00:24:08,260
+Metabolic Alkalosis اللي موجود هنا من مشاكله إنه
+
+340
+00:24:08,260 --> 00:24:14,840
+بيزيد ارتباط الكالسيوم في البروتينات، فإيش
+
+341
+00:24:14,840 --> 00:24:17,600
+حاسين إن ده؟ إذا الـPromote Increase in Protein
+
+342
+00:24:17,600 --> 00:24:23,250
+Binding للـFree Calcium، هيخلي الـIonized
+
+343
+00:24:23,250 --> 00:24:25,990
+كالسيوم، الـFree اللي بيأثر على الـFunction تبع
+
+344
+00:24:25,990 --> 00:24:30,590
+كل الـBody، قليل، وبالتالي إيش هذا هيعمل؟ هيعمل
+
+345
+00:24:30,590 --> 00:24:35,310
+فعلا مشاكل، والموضوع مرتبط في مين؟ في الـAlkalosis
+
+346
+00:24:35,310 --> 00:24:39,090
+إذا أنا من ضمن الـMetabolic Alkalosis اللي عرفته
+
+347
+00:24:39,090 --> 00:24:41,850
+عرفت كمان إن الـMetabolic Alkalosis ده ممكن
+
+348
+00:24:41,850 --> 00:24:45,310
+يؤثر لي على الـFree Calcium اللي موجود في الجسم
+
+349
+00:24:45,310 --> 00:24:50,660
+ويعمل عند المريض مشاكل، اللي هتظهر بالتشنجات، أه، نتيجة
+
+350
+00:24:50,660 --> 00:24:55,920
+أن الـFree Calcium تأثر بسبب حالة الـAlkalosis
+
+351
+00:24:55,920 --> 00:24:59,700
+ازدادت قدرته على الارتباط في البروتين، بعكس الـ
+
+352
+00:24:59,700 --> 00:25:03,040
+Acidosis، ماذا يحصل في الـAcidosis؟ لأ، في حالة
+
+353
+00:25:03,040 --> 00:25:06,640
+الـAcidosis، الـAcidosis بحالته بيقلل
+
+354
+00:25:06,640 --> 00:25:11,840
+ارتباط الكالسيوم في البروتين، وبالتالي الـFree
+
+355
+00:25:11,840 --> 00:25:16,100
+Calcium  يكون عالي،  الـFree Calcium يكون
+
+356
+00:25:16,100 --> 00:25:25,050
+عالي، وهذا برضه ممكن يعمل مشاكل لأنه برضه
+
+357
+00:25:25,050 --> 00:25:31,010
+لما بيزيد الكالسيوم في الـblood برضه ممكن يعمل
+
+358
+00:25:31,010 --> 00:25:41,250
+نوع من اللي هو تصلب الأنسجة والعضلات
+
+359
+00:25:41,930 --> 00:25:48,290
+هيك احنا خلصنا الـMetabolic Acidosis والـ
+
+360
+00:25:48,290 --> 00:25:52,550
+Metabolic
+
+361
+00:25:52,550 --> 00:25:56,410
+Alkalosis، صحيح، تمام؟ وبدنا نحكي عن الـRespiratory
+
+362
+00:25:56,410 --> 00:26:00,950
+Acidosis والـRespiratory Alkalosis، وبعد هيك بدنا
+
+363
+00:26:00,950 --> 00:26:07,110
+نحكي عن الـCompensation، ونشوف كيف خطوات تفسير الـ
+
+364
+00:26:07,110 --> 00:26:11,620
+Blood Gases، إن شاء الله رب العالمين، هذا بدي أخليه لكم
+
+365
+00:26:11,620 --> 00:26:16,120
+يا في الفيديو أو في المحاضرة القادمة، يعطيكم
+
+366
+00:26:16,120 --> 00:26:20,200
+العافية، والسلام عليكم ورحمة الله
diff --git a/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/c2aJgpzZ7UQ_postprocess.srt b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/c2aJgpzZ7UQ_postprocess.srt
new file mode 100644
index 0000000000000000000000000000000000000000..afb46bbbc1dea7a2d5630cec4c009d699f585d61
--- /dev/null
+++ b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/c2aJgpzZ7UQ_postprocess.srt
@@ -0,0 +1,1464 @@
+1
+00:00:01,420 --> 00:00:06,440
+بسم الله الرحمن الرحيم لازمنا في الـ Arterial
+
+2
+00:00:06,440 --> 00:00:10,120
+Blood Gases في المحاضرة السابقة حكينا عن الـ
+
+3
+00:00:10,120 --> 00:00:14,360
+Puffer System شفنا كيف إن هو تلات أنواع في Puffer
+
+4
+00:00:14,360 --> 00:00:18,580
+في الـ Blood في Puffer في الـ Respiration وفي الـ
+
+5
+00:00:18,580 --> 00:00:21,280
+Kidney بتشتغل أول سؤال عن Puffer System شفنا كيف
+
+6
+00:00:21,280 --> 00:00:24,360
+الـ Blood على طريق الـ Chemicals الموجودة في الـ
+
+7
+00:00:24,360 --> 00:00:27,460
+Blood وكيف بتشتغل اللي هو الـ Protein و الـ Plasma
+
+8
+00:00:27,460 --> 00:00:32,340
+بالذات بيشتغلوا Immediately عشان يحسنواووصلونا
+
+9
+00:00:32,340 --> 00:00:34,840
+لحالة من الـ Hemostasis والـ Acid Base Balance
+
+10
+00:00:34,840 --> 00:00:40,680
+شوفنا كمان كيف الـ Lung بتتحكم في موضوع الـ Acid
+
+11
+00:00:40,680 --> 00:00:45,280
+Base Balance عن طريق أنها بتتحكم في مستويات التنفس
+
+12
+00:00:45,280 --> 00:00:52,020
+علشان تحسن أو ترفع يعني الـ Level of CO2 أو تقلل
+
+13
+00:00:52,020 --> 00:00:56,680
+الـ Level of CO2 حسب الحاجة وحسب الحالة اللي فيها
+
+14
+00:00:56,680 --> 00:01:01,240
+الجسم يعني باختصار لو كان في أناللي هو حالة من
+
+15
+00:01:01,240 --> 00:01:04,360
+الحمضية في Respiratory Acidosis أو كان في
+
+16
+00:01:04,360 --> 00:01:07,880
+Metabolic Acidosis أو كان Metabolic Acidosis الـ
+
+17
+00:01:07,880 --> 00:01:11,000
+Lung بتستجيب عن طريق الـ Respiratory Alkalosis إيش
+
+18
+00:01:11,000 --> 00:01:14,160
+يعني؟ يعني لو كان في Metabolic Acidosis يعني الـ
+
+19
+00:01:14,160 --> 00:01:20,920
+pH أقل من 7.35، الـ Lung بتحاول تخليالدم يصير
+
+20
+00:01:20,920 --> 00:01:26,560
+قاعدي عن طريق تقليل مستويات الـ «CO2» في الدم لأنه
+
+21
+00:01:26,560 --> 00:01:29,740
+احنا بنعرف إن الـ «CO2» هو المسؤول عن الأنضية
+
+22
+00:01:29,740 --> 00:01:35,340
+وبالتالي بتدعو الجسم إلى تقليل اللي هو زيادة
+
+23
+00:01:35,340 --> 00:01:39,380
+معدلات التنفس عشان يعمل Washing Out للـ «CO2»
+
+24
+00:01:39,380 --> 00:01:42,960
+وبالتالي هذا بيخلي يصير فينا مستويات منخفضة من الـ
+
+25
+00:01:42,960 --> 00:01:47,500
+«CO2» وطبعا لو كان فينا Metabolic Alkalosis هيصير
+
+26
+00:01:47,500 --> 00:01:53,730
+الموضوع بالعكس وحتخليالتنفس يصبح بطيء لكي يقلل الـ
+
+27
+00:01:53,730 --> 00:01:58,250
+CO2 وتعملنا قليل من الـ Acidosis وتعملنا كمبانساشن
+
+28
+00:01:58,250 --> 00:02:06,530
+للـ Metabolic Alkalosis الموجود كذلك الـ
+
+29
+00:02:06,530 --> 00:02:11,400
+Kidneyهتشتغل لكن زي ما حكينا مش within hours زي
+
+30
+00:02:11,400 --> 00:02:15,080
+الـ Respiratory لأ هتشتغل within days ال kidney
+
+31
+00:02:15,080 --> 00:02:19,440
+عليها مسئولية كبيرة ال kidney وظيفتها بشكل أساس
+
+32
+00:02:19,440 --> 00:02:23,400
+تحفظلى على ال acid base balance عن طريق إنها هي
+
+33
+00:02:23,810 --> 00:02:29,170
+اللي فعلاً بتعيد انتصاف أولاً هي أصلاً اللي بتصنع
+
+34
+00:02:29,170 --> 00:02:36,190
+الـ Bicarb مش الرينا لتجول secret أشي و بتصنع
+
+35
+00:02:36,190 --> 00:02:42,370
+أصلاً الـ Bicarb و أنا كتبها تمام بتصنع أصلاً الـ
+
+36
+00:02:42,370 --> 00:02:48,660
+Bicarb هتلاقوها somewhereوالـ «The kidneys
+
+37
+00:02:48,660 --> 00:02:51,340
+regulate the bicarbonate level in» اللي هو الـ
+
+38
+00:02:51,340 --> 00:02:54,880
+«extracellular fluid» «they can regenerate bicarb»
+
+39
+00:02:54,880 --> 00:02:58,680
+هي بتقيد تصنيع الـ «bicarb» ومش كمان بتسوي وبتعمل
+
+40
+00:02:58,680 --> 00:03:02,520
+Reabsorption للـ «bicarb» اللي بده يطلع عن طريق
+
+41
+00:03:02,520 --> 00:03:06,380
+اليورين عشان ما نفقدوش كله وعشان نتحافظ من الاتزان
+
+42
+00:03:06,380 --> 00:03:10,200
+القائدي اللي موجود بالنسبة للحالة الحمضية فبتعمللي
+
+43
+00:03:10,200 --> 00:03:14,100
+acid-base balance إذا لو تركنا اليورين يطلع كل الـ
+
+44
+00:03:14,100 --> 00:03:18,150
+«bicarb»حيصير فيه أننا نضيع، فالـ Kidney أن ده
+
+45
+00:03:18,150 --> 00:03:21,390
+مسئولية أنها تصنع By Carb وأنها تعيد انتصار اللي
+
+46
+00:03:21,390 --> 00:03:24,630
+بده يطلع، إذا لو صار فيه أي Failure أو أي Kidney
+
+47
+00:03:24,630 --> 00:03:28,250
+Disease، هيأثر على حاجتين، التصنيع تبع الـ By
+
+48
+00:03:28,250 --> 00:03:32,150
+Carb، وهيأثر على اللي هو قدرة الـ Kidney على الـ
+
+49
+00:03:32,150 --> 00:03:37,450
+Reabsorption لـ Carb، وبالتالي إيش حيصير فيه؟هيصير
+
+50
+00:03:37,450 --> 00:03:41,890
+في عيننا مؤكد Metabolic Acidosis من عدم قدرة
+
+51
+00:03:41,890 --> 00:03:46,830
+الكلية على تصنيع الـBicarb ويعادة امتصاصه ولذلك
+
+52
+00:03:46,830 --> 00:03:51,450
+بنقول So if kidneys fail، إذا صار فيه فشل كلوي، pH
+
+53
+00:03:51,450 --> 00:03:54,710
+balance fail، بس يعني مش صعب جدا إنه يصير فيه pH
+
+54
+00:03:54,710 --> 00:03:57,070
+balance، لأن اللي عامل، اللي .. اللي .. اللي ..
+
+55
+00:03:57,070 --> 00:04:00,910
+اللي بعمل الـbalance هاداعلى المدى الطويل هو الـ
+
+56
+00:04:00,910 --> 00:04:03,950
+Kidney عشان هيك اليوم بدنا نبدأ نحكي فيه اللي هو
+
+57
+00:04:03,950 --> 00:04:06,930
+الـ Metabolic Acidosis أعتقد في اللي شراهته قبل
+
+58
+00:04:06,930 --> 00:04:11,720
+شوية صار واضح إن الـ Metabolic Acidosis بيكوننتيجة
+
+59
+00:04:11,720 --> 00:04:15,660
+مشكلة في الـ kidney مش في الـ respiratory مشكلة في
+
+60
+00:04:15,660 --> 00:04:20,580
+الـ kidney أو مشكلة نتيجة من أرض غذائي معين يعني
+
+61
+00:04:20,580 --> 00:04:24,120
+مثلا intoxication واحد ماخد كحول كتير واحد ماخد
+
+62
+00:04:24,120 --> 00:04:28,580
+اندو مثلا اللي هو ده بتك type 1 وصار في اندو
+
+63
+00:04:28,580 --> 00:04:32,860
+ketoacidosis وبالتالي صار دمه حامض إذا الـ
+
+64
+00:04:32,860 --> 00:04:35,680
+metabolic keto الـ metabolic acidosis is a
+
+65
+00:04:35,680 --> 00:04:38,640
+clinical disturbance characterized by أي بائش مزال
+
+66
+00:04:38,640 --> 00:04:42,320
+فيه acidosis يبقى الhydrogenأيونزاش مالها بتكون
+
+67
+00:04:42,320 --> 00:04:46,860
+عالية مثلا فيه أسدوست أه تمام لكن إيش السبب that
+
+68
+00:04:46,860 --> 00:04:49,600
+okay when the body produce excessive quantities of
+
+69
+00:04:49,600 --> 00:04:53,620
+acid أه طبعا الجسم هيكعمل كمية كبيرة من الأحمار
+
+70
+00:04:53,620 --> 00:04:58,160
+تمامطب و بعد هيك Loss of Bicarbonate و أكيد حكون
+
+71
+00:04:58,160 --> 00:05:01,840
+بفقد الـ Bicarb لأن الـ Bicarb هو المسئول عن
+
+72
+00:05:01,840 --> 00:05:04,520
+القاعدية فهو بيكوّن أحمض و بيفقد الـ Bicarb
+
+73
+00:05:04,520 --> 00:05:07,620
+وبالتالي بتزيد حالة الهنضية عنده okay when the
+
+74
+00:05:07,620 --> 00:05:11,880
+kidneys are not removing enough acid from the body
+
+75
+00:05:11,880 --> 00:05:15,520
+وهذا بيكون نتيجة إن الكدن ربما فيها خلل أو مش
+
+76
+00:05:15,520 --> 00:05:19,880
+قادرة لإنه يعني لا تستطيع إنها تتخلص من كل الـ
+
+77
+00:05:19,880 --> 00:05:20,460
+Bicarb
+
+78
+00:05:24,870 --> 00:05:31,810
+إنها تحافظ على كميات الـ Bicarb وتعيد امتصاصها
+
+79
+00:05:31,810 --> 00:05:36,450
+بسبب ربما أنه فيه بوليوريا شديدة عن المريض فالكدنى
+
+80
+00:05:36,450 --> 00:05:44,490
+غير قادر على إنها تحافظ على الـ Bicarbعشان يحافظ
+
+81
+00:05:44,490 --> 00:05:49,250
+على القائدية ويمنع الـ Acidosis تمام؟ عشان هيك الـ
+
+82
+00:05:49,250 --> 00:05:52,210
+Metabolic Acidosis كان Divided clinically into two
+
+83
+00:05:52,210 --> 00:05:56,650
+forms عشان هيك بروح بيجسموا الـ Metabolic Acidosis
+
+84
+00:05:56,650 --> 00:06:01,040
+according to a new gapإيش الـ anion gap؟ قالنا كده
+
+85
+00:06:01,040 --> 00:06:05,340
+عبارة عن الفجوة الآيونية اللي هي الـ normal إنها
+
+86
+00:06:05,340 --> 00:06:09,160
+تكون من 12 إلى 16 ملي كوبلات لكل حد طب هاذي كده
+
+87
+00:06:09,160 --> 00:06:13,400
+الـ anion gap وإيش هي أصلا؟ هي بكل بساطة مجموعة
+
+88
+00:06:13,400 --> 00:06:16,780
+آيونات الصوديوم والبوتاسيوم يعني إحنا عملنا لمريض
+
+89
+00:06:16,780 --> 00:06:20,220
+صوديوم، جداش الصوديوم عنده 135، عملنا لبوتاسيوم
+
+90
+00:06:20,220 --> 00:06:23,440
+جداش البوتاسيوم عنده 3.5، مجموعة الصوديوم
+
+91
+00:06:23,440 --> 00:06:28,190
+والبوتاسيوم، نقص منهم مجموعة الchlor والبيكاربطلع
+
+92
+00:06:28,190 --> 00:06:31,370
+رقم، إذا الرقم هدا من 12 إلى 16، بيكون Normal إذا
+
+93
+00:06:31,370 --> 00:06:34,630
+أعلى من 16، بيكون الـ Onion Gap عنده عالية إذا أقل
+
+94
+00:06:34,630 --> 00:06:38,030
+من 12، بيكون الـ Onion Gap عنده Low طب و هذا إيش
+
+95
+00:06:38,030 --> 00:06:41,730
+فديته بموضوع الـ Metabolic Acidosis؟ أيوة، جالك
+
+96
+00:06:41,730 --> 00:06:46,210
+إذا الـ Onion Gap كانت عالية، وهذا عادة بيصير في
+
+97
+00:06:46,210 --> 00:06:50,390
+الـ Metabolic Chronic Metabolic Acidosis اللي لها
+
+98
+00:06:50,390 --> 00:06:54,750
+علاقة في أمراض الـ Kidney بحيث أنه
+
+99
+00:06:57,240 --> 00:07:03,040
+الجسم ماعندهش الإمكانية أنه يصنع بيكارب enough
+
+100
+00:07:03,040 --> 00:07:06,300
+فبتكون مون المشكلة؟ بتكون المشكلة في ال kidney
+
+101
+00:07:06,300 --> 00:07:10,760
+نفسها يا أما مش عارف ال kidney ترجع تعيد امتصاص ال
+
+102
+00:07:10,760 --> 00:07:13,700
+بيكارب، يا مش قادرة تصنع، إذا مش قادرة تصنع، بكون
+
+103
+00:07:13,700 --> 00:07:18,070
+هي فيها المشكلة، إذا ما المشكلة أنهإعادة الانتصاف
+
+104
+00:07:18,070 --> 00:07:20,770
+هي اللي صعبة بيكون في حالة من الـPolioria كبيرة
+
+105
+00:07:20,770 --> 00:07:24,970
+ومش يعني ماعنداش الإمكانية أنها تسيطر على الموقف
+
+106
+00:07:24,970 --> 00:07:29,410
+طب وين بيكون فينا حالات فيها اللي هو Polioria كتير
+
+107
+00:07:29,410 --> 00:07:33,090
+حالة مثلا اللي هو الـKetoacidosis بتكون كميات
+
+108
+00:07:33,090 --> 00:07:38,480
+كبيرة من الـAcid اللي موجودة في الدموبالتالي هذه
+
+109
+00:07:38,480 --> 00:07:44,560
+بتأد إلى حالة من الـ Poliurea فبصير فيه acidity
+
+110
+00:07:44,560 --> 00:07:47,400
+عالية في الدم وفي Poliurea بتطلع بولي كتير و
+
+111
+00:07:47,400 --> 00:07:51,500
+الكلية ماعنداش القدرة أن تعمل إعادة انتصاص لـ
+
+112
+00:07:51,500 --> 00:07:56,160
+bicarb وبالتالي بتصير الدم ميتابوليكاسيدوس حالته
+
+113
+00:07:56,160 --> 00:08:01,310
+مابطل فيه balance ولو كان فيه lactic acidوهذا
+
+114
+00:08:01,310 --> 00:08:06,170
+بيصير نتيجة مجهود عضلي أو muscle destruction
+
+115
+00:08:06,170 --> 00:08:10,290
+فبتفرز انزيمات الـ Lactate هذه فبتزيد حمضية الدم
+
+116
+00:08:10,290 --> 00:08:13,910
+في نهاية حطول على الدم فبتزيد حمضية الدم إذا صار
+
+117
+00:08:13,910 --> 00:08:19,130
+في عندي أنا سببين إنه الـ metabolic acid بت seem
+
+118
+00:08:19,130 --> 00:08:25,610
+mostly يا أما إن الكدن فيها diseaseهو مش قادر إنها
+
+119
+00:08:25,610 --> 00:08:30,070
+تعمل generation للـ Bicarbonate أو ماعندهاش القدرة
+
+120
+00:08:30,070 --> 00:08:33,050
+إنها تعمل الـ Absorption أحيانًا بيكون السبب خاجي
+
+121
+00:08:33,050 --> 00:08:38,270
+إن واحد ناخد مثلًا كحول أو أسبريل فبيقبله
+
+122
+00:08:38,270 --> 00:08:42,670
+metabolic acidلكن في الحالات الطبيعية اللي بيكون
+
+123
+00:08:42,670 --> 00:08:45,650
+فيها الـ Normal Anion Gap يعني أنا لما جيت أشوف
+
+124
+00:08:45,650 --> 00:08:49,510
+المريض لجيت أندو ميتابولك أسيدوسيز بس حسبت الـ
+
+125
+00:08:49,510 --> 00:08:51,950
+Normal Anion Gap اللي هي مجموع الـ Sodium و الـ
+
+126
+00:08:51,950 --> 00:08:58,830
+Potassium ضرب اللي هو الـ Chloroxyl Bicarb فحلّيت
+
+127
+00:08:58,830 --> 00:09:01,790
+المعادلة هذه اللي بيظهر Normal طبيعية بين 12 و 16
+
+128
+00:09:01,790 --> 00:09:05,690
+رغم هيك المريض أندو ميتابولك أسيدوسيز هذه حالة
+
+129
+00:09:05,690 --> 00:09:11,550
+سهلة مت ميتابولك أسيدوسيزتمام؟ وانت تتخلص من
+
+130
+00:09:11,550 --> 00:09:13,410
+بيكربونية ايون تتخلص من بيكربونية ايون تتخلص من
+
+131
+00:09:13,410 --> 00:09:14,390
+بيكربونية ايون تتخلص من بيكربونية ايون تتخلص من
+
+132
+00:09:14,390 --> 00:09:16,390
+بيكربونية ايون تتخلص من بيكربونية ايون تتخلص من
+
+133
+00:09:16,390 --> 00:09:17,990
+بيكربونية ايون تتخلص من بيكربونية ايون تتخلص من
+
+134
+00:09:17,990 --> 00:09:18,890
+بيكربونية ايون تتخلص من بيكربونية ايون تتخلص من
+
+135
+00:09:18,890 --> 00:09:21,690
+بيكربونية ايون تتخلص من بيكربونية ايون تتخلص من
+
+136
+00:09:21,690 --> 00:09:26,930
+بيكربونية ايون تتخلص من بيكربونية ايون تتخلص من ب
+
+137
+00:09:29,850 --> 00:09:34,930
+Loss of fluid نتيجة انه مثلا صلوا اكام يوم مكلش
+
+138
+00:09:34,930 --> 00:09:38,250
+فهذه الحاجات هي اللي خلته اندوكسي ميتابوليك
+
+139
+00:09:38,250 --> 00:09:41,770
+أزيوكوسيس وبالتالي ما زال ال normal onion اللي
+
+140
+00:09:41,770 --> 00:09:45,390
+قلنا normal onion جاب معاها طبيعية وبالتالي شوية
+
+141
+00:09:45,390 --> 00:09:49,290
+fluid ان رعط المريض هذا شوية fluid هيتحسن واطور
+
+142
+00:09:49,290 --> 00:09:56,540
+لكن لما يكون في اندي اللي هو انو جابلهلو أنيونجاب
+
+143
+00:09:56,540 --> 00:10:00,040
+وكأن دي Metabolic Acidosis هذا الموضوع بيكون مرتبط
+
+144
+00:10:00,040 --> 00:10:06,260
+دي لبروتين وبالأخرى بقلة البروتين في الدم هذه حالة
+
+145
+00:10:06,260 --> 00:10:11,440
+يعني نادر أنها تكون مشهورة وتكون موجودة في
+
+146
+00:10:11,440 --> 00:10:16,640
+Metabolic Acidosis والأنيونجاب لو إلا زي ما حكينا
+
+147
+00:10:16,640 --> 00:10:19,940
+في حال إن فعلا الألبوبين تبع الدم اللي هو عبارة عن
+
+148
+00:10:19,940 --> 00:10:24,040
+بروتين الدم يمثل يكون low فبكون هذه اللي هو
+
+149
+00:10:24,040 --> 00:10:30,880
+negativeبنسميها تمام والسبب فيها أنه يكون فيه نقص
+
+150
+00:10:30,880 --> 00:10:36,010
+لبروتينفبعد ما نحسب إحنا الـ Onion Gap نلاقيها أقل
+
+151
+00:10:36,010 --> 00:10:40,390
+من 12 ويكون في انتي Metabolic Acidosis فأنا بفهم
+
+152
+00:10:40,390 --> 00:10:43,790
+إنه آه يبدو هذا الـ Metabolic Acidosis إيه علاقة
+
+153
+00:10:43,790 --> 00:10:46,690
+في البروتين فإذا إحنا ماكناش عاملين فحص القلب ولا
+
+154
+00:10:46,690 --> 00:10:50,890
+المريض بنروح بنعمل فحص القلب وإنه حالة دي فعلا إنه
+
+155
+00:10:50,890 --> 00:10:53,150
+منخفض وبالتالي بكون إحنا عارفين إنه في ال
+
+156
+00:10:53,150 --> 00:10:58,690
+management تبعتنا بدتنا نعطياللي هو ألبومين علشان
+
+157
+00:10:58,690 --> 00:11:04,350
+المريض هذا يتحسن وهذا هو الفريق بينما في الحالات
+
+158
+00:11:04,350 --> 00:11:07,410
+الأولانية يعني لما نحكي عن الـ cause and effect
+
+159
+00:11:07,410 --> 00:11:10,150
+أحصان أحنا already لما ضربنا أمثلة على الـ Onion
+
+160
+00:11:10,150 --> 00:11:13,130
+Gaps حكينا يعني مثلا ضيابية كيكاو أسيدواسنز حكينا
+
+161
+00:11:13,130 --> 00:11:16,570
+أنه من الـHigh Onion Gap متبولف أسيدواسنز البيارية
+
+162
+00:11:16,570 --> 00:11:20,370
+عرفنا إنها من الـNormal عادة تكون Normal Onion Gap
+
+163
+00:11:21,330 --> 00:11:24,690
+الـ Renal Failure من الـ High أنيوم جاب هذا تمام
+
+164
+00:11:24,690 --> 00:11:29,710
+صح ولا لأ الـ Salicylic Oxidation من الـ High عادة
+
+165
+00:11:29,710 --> 00:11:33,310
+لو نحسب الانيوم جابها نلاقيها high الشكوك و
+
+166
+00:11:33,310 --> 00:11:37,850
+الcardiac arrest هتلاقيها high تمام
+
+167
+00:11:39,120 --> 00:11:42,880
+طب ما هي العلامات؟ أول علامة أحنا بنعرفها أن الـDH
+
+168
+00:11:42,880 --> 00:11:49,100
+هيكون أقل من 37.5 هذا أول حاجة طب كويس طيب ومما أن
+
+169
+00:11:49,100 --> 00:11:53,840
+الـDH أقل من 37.5 إيش وضع الـbicarb يا جماعة؟
+
+170
+00:11:53,840 --> 00:11:56,860
+هيكون المفروض أن الـbicarb يا جماعة يكون طبيعي لكن
+
+171
+00:11:56,860 --> 00:12:02,140
+بعد شوية إيش رأيكم؟ أه مستحيل يكون طبيعي أه منفعش
+
+172
+00:12:02,140 --> 00:12:07,070
+ركزوا معايامازال انا بحكي عن metabolic problem
+
+173
+00:12:07,070 --> 00:12:12,210
+يعني المشكلة في الـ bicarb على طول هيك اتحكي عن
+
+174
+00:12:12,210 --> 00:12:14,870
+metabolic problem يعني الـ bicarb هو اللي بتكون
+
+175
+00:12:14,870 --> 00:12:19,750
+المشكلة فيه اول مشكلة بلاجيها ان الـ BH ايش ماله؟
+
+176
+00:12:19,750 --> 00:12:22,650
+بيقول انا أسيدوست يبدأ له يبدأ أجل من سبعة وخمس و
+
+177
+00:12:22,650 --> 00:12:28,930
+تلاتين اي واحد يعرف انه أسيدوست لأن الـ BH أجل من
+
+178
+00:12:28,930 --> 00:12:33,010
+سبعة و خمس و تلاتينمين سبب الـ Acidosis ميتابولك
+
+179
+00:12:33,010 --> 00:12:37,550
+أنا بقولك مزال ميتابولك يبقى الـ bicarb هذا هو
+
+180
+00:12:37,550 --> 00:12:44,130
+اللي لو قلة الـ bicarb بتعمل Acidosis تمام؟ طيب
+
+181
+00:12:44,130 --> 00:12:48,930
+إيش مين بده يدخل؟ آه اللي بتدخل ال buffer system
+
+182
+00:12:48,930 --> 00:12:53,030
+مين بتدخل بسرعة بسرعة بسرعة بسرعة ال blood buffer
+
+183
+00:12:53,030 --> 00:12:56,050
+و ال lung buffer بتشتغل within minutes تمام؟ إيش
+
+184
+00:12:56,050 --> 00:13:01,890
+هتسوي ال lung؟ والله إنت في عندك Acidosis طيبوالـ
+
+185
+00:13:01,890 --> 00:13:04,630
+Bicarbonate ده كواطي، هي بتقدرش تتحكم غير في الـ
+
+186
+00:13:04,630 --> 00:13:08,710
+CO2 طيب، إيش بيسوي الـ CO2؟ الـ CO2 لو زاد، بيعمل
+
+187
+00:13:08,710 --> 00:13:13,010
+Acidosis أه، يبقى هي ممكن تقلله، تمام، كيف ممكن
+
+188
+00:13:13,010 --> 00:13:16,970
+تقلل الـ CO2؟ عن طريق إنها .. أيوة، مين شاطر؟
+
+189
+00:13:16,970 --> 00:13:21,520
+Bravo عليكعن طريق إنها تزود عدد مرات التنفس وبتعمل
+
+190
+00:13:21,520 --> 00:13:27,700
+بالتالي اللي هو Washing out الـCO2 فبدل الـCO2 عن
+
+191
+00:13:27,700 --> 00:13:33,040
+35 وهذا اللي بيسموه أو بيسميه Cosmol respiration
+
+192
+00:13:36,550 --> 00:13:40,830
+بحاول يأخذ نفس عميق ويتكبني ورا بعض ورا بعض ورا
+
+193
+00:13:40,830 --> 00:13:47,390
+بعض رابط DB3 نفس عميق بس رابط تمام عشان يحاول يعمل
+
+194
+00:13:47,390 --> 00:13:52,810
+compensation ويعمل washing out بس CO2 ويحسن من ال
+
+195
+00:13:52,810 --> 00:13:58,520
+metabolic acidosisإذا إحنا لو بدنا نحق العالج
+
+196
+00:13:58,520 --> 00:14:01,560
+الحالي هذه أنا بدي أريحكم من هذا الكلام و أقولكوا
+
+197
+00:14:01,560 --> 00:14:05,180
+هذا نظرة عامة كيف بدنا نعالجه، بس أهم حاجة في
+
+198
+00:14:05,180 --> 00:14:08,180
+Metabolic Acidosis إن أعرض ميليكوز و أعالجه،
+
+199
+00:14:08,180 --> 00:14:11,260
+مالفعش يعني أعالجه بشكل عام إذا الموضوع ده بدي
+
+200
+00:14:11,260 --> 00:14:14,700
+كيدو أسيدوسيز، أه هذا المريض أول حاجة بده Fluid
+
+201
+00:14:14,700 --> 00:14:17,300
+لأنه فاطر فلوذ كتير وهذا اللي مخليته ال buy card
+
+202
+00:14:17,300 --> 00:14:21,520
+اتنين، بدي أعوضه buy card إذا الموضوع ده ياريا، أه
+
+203
+00:14:21,520 --> 00:14:26,720
+برضه بده Fluid، صحيح؟بدّو الـ Fluid وإذا كتير الـ
+
+204
+00:14:26,720 --> 00:14:30,560
+Loss of bicarb يمكن بدي أديله بيكارب، تمام؟ لكن
+
+205
+00:14:30,560 --> 00:14:33,020
+أحيانًا يا جماعة، احنا بنتكفي في الـ bicarb اللي
+
+206
+00:14:33,020 --> 00:14:36,260
+أصلا ممكن يكون من المكونات لـ Fluid يعني أنا لما
+
+207
+00:14:36,260 --> 00:14:39,860
+أدرين Galactate، ما هو فيه كل حاجة، حتى الـ Sodium
+
+208
+00:14:39,860 --> 00:14:43,220
+bicarb والمكوناته، فمن المفضل أدّي اللي هو Sodium
+
+209
+00:14:43,220 --> 00:14:47,710
+bicarb لحالهفما حتى في الـ Ketoacidosis، يعني لا
+
+210
+00:14:47,710 --> 00:14:52,610
+يفضل إن أندي صدر بكر إلا إذا كان المريض تسيبير
+
+211
+00:14:52,610 --> 00:14:58,670
+Ketoacidosis وكانت الـ pH مؤدلة أقل من 7.2، طبعا
+
+212
+00:14:58,670 --> 00:15:01,810
+الطبيعة لسه مابوت 35، يعني لو كتو تسيبر
+
+213
+00:15:01,810 --> 00:15:06,850
+Ketoacidosis والباقي الـ pH عنده 7.25، فإنها لسه
+
+214
+00:15:06,850 --> 00:15:09,930
+ماندهوش مايكافر، هذا على الهامش يعني، طيب؟
+
+215
+00:15:11,550 --> 00:15:14,110
+التريتمنت اللي اريد ان اوصلكم هو ان انا في كل حالة
+
+216
+00:15:14,110 --> 00:15:19,010
+لازم اعرف ال cause تبعها عن طريق اولا ان انا ادى
+
+217
+00:15:19,010 --> 00:15:21,450
+by carb حسب الحالة، ايش اللي بتحتاج و ايش ال
+
+218
+00:15:21,450 --> 00:15:24,110
+parameters التانية بتأتي و ايش ال criteria of
+
+219
+00:15:24,110 --> 00:15:24,810
+disease هذا
+
+220
+00:15:27,900 --> 00:15:31,640
+إلا إذا، مش عارف أنا أي حاجة، لكن الـDH جالمن 7.1
+
+221
+00:15:31,640 --> 00:15:35,080
+في حالة هذه، إيش ما يكون المرض لازم تدبعي، طبعا في
+
+222
+00:15:35,080 --> 00:15:38,760
+أسوأ الظروف ممكن نعمل إحنا عشان نحسن الحمضية طبقة
+
+223
+00:15:38,760 --> 00:15:41,520
+المريض، اللي هو Dialysis، يعني غسيلة
+
+224
+00:15:41,520 --> 00:15:45,160
+الـChemodialysis، خاصة في حالات الـIntoxication
+
+225
+00:15:45,390 --> 00:15:49,170
+اللي بيكون شارب بحول أو فيه مندو رينا الفالية و ال
+
+226
+00:15:49,170 --> 00:15:52,870
+kidney متقطلة تماما يعني مش قادرة تشتغل فضل الطر،
+
+227
+00:15:52,870 --> 00:15:56,870
+إيش نسوي؟ نعمله Dialysis الـ Metabolic Alkalosis
+
+228
+00:15:56,870 --> 00:16:00,930
+الصورة هنا عكس الصورة اللي حكيناها قبل شوية تماما
+
+229
+00:16:00,930 --> 00:16:06,920
+كيف يعني عكسها؟ يعني المشكلةفي الـ kidney، أه هي
+
+230
+00:16:06,920 --> 00:16:09,860
+هي لأنه متابولي، لكن بدل من أيه الـ Acidosis،
+
+231
+00:16:09,860 --> 00:16:12,480
+Alkalosis، ديش يعني Alkalosis؟ يعني الـ pH بدل ما
+
+232
+00:16:12,480 --> 00:16:16,340
+كانت منخفضة، هنق عالية، أكتر من سبعة ومن خمسة أرمض
+
+233
+00:16:16,340 --> 00:16:20,780
+طايل، و .. وفي هذه الحالة إيش هيكون السبب يا
+
+234
+00:16:20,780 --> 00:16:26,340
+جماعة؟ هيكون السبب أكيد تراكم الـ Bicarb، إيش؟
+
+235
+00:16:26,340 --> 00:16:31,200
+تراكم الـ Bicarb، تراكم الـ Bicarb، أه، زي إيش
+
+236
+00:16:31,200 --> 00:16:36,610
+يعني تراكم الـيعني مثلًا واحد مصراندو الرينالفيليا
+
+237
+00:16:36,610 --> 00:16:40,430
+فجأة بطلت الكلية تشتغل و تطلع urine حسين البكارة
+
+238
+00:16:40,430 --> 00:16:45,110
+وتتحوش بجسمه هي الجهتين الرينالفيليا بتتفسك بها
+
+239
+00:16:45,110 --> 00:16:52,330
+مشاكل طب وإيش كمان؟وكمان يا جماعة استخدام الـ
+
+240
+00:16:52,330 --> 00:16:54,810
+diuretics بحاجة ذاتها طب الـ diuretics يا أستاذ
+
+241
+00:16:54,810 --> 00:17:01,210
+بتخليني أطلع بول كتير فالمفروض أنه زي ما أطلع بول
+
+242
+00:17:01,210 --> 00:17:04,950
+كتير المفروض أنه أفقد by car و التالي مايصيرش
+
+243
+00:17:04,950 --> 00:17:06,230
+الكلوز يصير أسيدوز
+
+244
+00:17:09,640 --> 00:17:14,300
+الـ Increased Exertion of Chloride بالنسبة للتناقص
+
+245
+00:17:14,300 --> 00:17:19,200
+وكميات اللي هتخرج من الـ Chloride هتكون بالنسبة
+
+246
+00:17:19,200 --> 00:17:24,120
+للبياكربونيات أكتر وخاصة لما يكون المرض يستخدم نوب
+
+247
+00:17:24,120 --> 00:17:28,660
+ديورتيكزاي اللازيكس فبالتالي تعملوا Metabolic
+
+248
+00:17:28,660 --> 00:17:32,960
+Alkalosis إذا الـ Metabolic Alkalosis له مسببات
+
+249
+00:17:32,960 --> 00:17:36,480
+كتير زي ما احنا يعني
+
+250
+00:17:37,840 --> 00:17:41,420
+بسرعة هي كممكن نعرف إنه إذا كان عنده Hypokalemia
+
+251
+00:17:41,420 --> 00:17:44,520
+بقولش ولا بشرب، Dehydration إذا أنا ما .. ما ..
+
+252
+00:17:44,520 --> 00:17:48,580
+مابش ليش بطلع منه Vomiting كتير طبعا و بالذات الـ
+
+253
+00:17:48,580 --> 00:17:52,620
+vomiting لإن المعدة الوسط طبعها حامض فلما نفقد ..
+
+254
+00:17:52,620 --> 00:17:55,660
+بما الـ vomiting كتير نفقد حامضيات من جسمه مابخش
+
+255
+00:17:55,660 --> 00:18:00,780
+الـ BW الخلوزز في حاجات تانية إنه يكون عنده مثلا
+
+256
+00:18:00,780 --> 00:18:04,060
+Excessive Adrenocorticosteroid hormone أو يكون
+
+257
+00:18:04,060 --> 00:18:10,110
+عنده اللي هو Hypokalemiaهذا برضه حق يسرق فيه إنه
+
+258
+00:18:10,110 --> 00:18:13,670
+يصير في عند المريض هذا الكلوسيز بغض النظر عن
+
+259
+00:18:13,670 --> 00:18:17,410
+الأسباب أنا بدنا نشوف إيش اللي ممكن يصير بعد ما
+
+260
+00:18:17,410 --> 00:18:21,350
+أنا لجيت إن الحالة عبارة عن حالة لإنه بصراحة
+
+261
+00:18:21,350 --> 00:18:25,890
+الأسباب كل حالة بدك تحكي المرض تبعها بدك تحكي فيه
+
+262
+00:18:25,890 --> 00:18:29,010
+بصفة فاضة فإحنا في كتير من الأوراد اللي هنحكي عنها
+
+263
+00:18:29,010 --> 00:18:32,390
+later on إحنا لجيت موضوعنا كيف نفسر ال energy
+
+264
+00:18:32,390 --> 00:18:35,870
+تمام؟ فأنا مش معرف إيش هي الأمراض جهد ما أنا معرف
+
+265
+00:18:35,870 --> 00:18:39,850
+إنه أنتتستطيع إنك تفسر الحالة لو قرأت Blood Gap
+
+266
+00:18:39,850 --> 00:18:43,970
+يعني لو أنا في عندك AVG موجود، أه موجود عندك قيم
+
+267
+00:18:43,970 --> 00:18:47,890
+للـDH، بعدين موجود عندك قيم للـCO2، بعدين موجود
+
+268
+00:18:47,890 --> 00:18:51,230
+عندك قيم للـBicarb، من الموقعات هدول التلاتة
+
+269
+00:18:51,230 --> 00:18:54,490
+تستطيع تقولي إيش هي الحالة، هى Metabolic Acidosis
+
+270
+00:18:54,490 --> 00:18:58,330
+ولا Metabolic Argyrosis، وبعدين تقولي إذا كان في
+
+271
+00:18:58,330 --> 00:19:03,430
+compensation ولا ماكانش في compensation، تمام؟و
+
+272
+00:19:03,430 --> 00:19:07,770
+هحكيلكوا أنا في آخر المحاضرة إيش الاختلاف بينه،
+
+273
+00:19:07,770 --> 00:19:11,010
+أين ال compensation اللي بيسميهم partial و
+
+274
+00:19:11,010 --> 00:19:14,950
+complete compensation طبعا، طبعا، طيب، اللي لما
+
+275
+00:19:14,950 --> 00:19:19,110
+بيكون في عندي excessive اللي هو alkaline، يعني أنا
+
+276
+00:19:19,110 --> 00:19:22,330
+في عندي حالة من ال metabolic alkalosis، طبعا، إيش
+
+277
+00:19:22,330 --> 00:19:25,570
+بيكون في عندي؟ بيكون في عندي bicarbonateطيب، إيش
+
+278
+00:19:25,570 --> 00:19:31,110
+بدها تزوّل الـ Lung؟ إيش بدها تزوّل الـ Lung؟ طب
+
+279
+00:19:31,110 --> 00:19:35,050
+إيش بدها تزوّل الـ Lung؟ بدها تزوّل المزاوقة، إذا
+
+280
+00:19:35,050 --> 00:19:38,010
+بدها تزوّل الحموضة طب كيف بتزوّل الحموضة؟ بتزوّل
+
+281
+00:19:38,010 --> 00:19:41,130
+تانو أكسيد الكربون، هو تانو أكسيد الكربون إذا،
+
+282
+00:19:41,130 --> 00:19:44,590
+Disease بيعمل حموضة، طب وكيف بتزوّل تانو أكسيد
+
+283
+00:19:44,590 --> 00:19:49,770
+الكربون؟ بيعمل accumulation للـ CO2 بكل بساطة أقل
+
+284
+00:19:49,770 --> 00:19:53,260
+الأدنى المرة، دي التنفس، أه، Bravo، صحبالقلل عدد
+
+285
+00:19:53,260 --> 00:19:55,960
+مرات التنفس يعني بتعمل الـ Hypopigmentation هذا
+
+286
+00:19:55,960 --> 00:20:01,140
+هيخلّي المريض أنه يسير اندوز الـCO2 retention
+
+287
+00:20:01,140 --> 00:20:07,680
+وبالتالي الـ retention للـCO2 حاول يحسن حالة
+
+288
+00:20:07,680 --> 00:20:11,580
+الحنضية الأيضية الموجودة فينا اللي هو Metabolic
+
+289
+00:20:11,580 --> 00:20:13,280
+Acidosis وبالتالي
+
+290
+00:20:15,550 --> 00:20:20,210
+لو كينيكال مانيفيستاشن و المالكه هتكون بتختف من كل
+
+291
+00:20:20,210 --> 00:20:24,590
+مرض لأ مرض حسب إيش هو ال complaint اللي عند المريض
+
+292
+00:20:24,590 --> 00:20:27,330
+هل هو من related voting ولا هل .. بس كل أيدي و كل
+
+293
+00:20:27,330 --> 00:20:31,590
+الأحوال هلاجه أن المريض تعبان و حلاجه عنده خدال في
+
+294
+00:20:31,590 --> 00:20:36,650
+أطرافه هلاجي عنده دوخة و بالذات إرهاب في العضلات
+
+295
+00:20:36,650 --> 00:20:43,650
+علاجه علاج الكوز علاجه علاج الكوز تمام؟يعني لازم
+
+296
+00:20:43,650 --> 00:20:45,650
+ايش ال cause اللي عمل المرض هو يتقلل لما انت
+
+297
+00:20:45,650 --> 00:20:49,310
+بتعالج المرض ببنت الموضوع بس موضوع الكالسيوم اللي
+
+298
+00:20:49,310 --> 00:20:52,610
+بدي أحكيلكوا فيه كلمتين في حاجة اسمها ionized
+
+299
+00:20:52,610 --> 00:20:55,330
+calcium مش هذا ال ionized calcium هذا ال free
+
+300
+00:20:55,330 --> 00:20:59,150
+living الكالسيوم اللي مش مرتبط مش مرتبط إيه هو
+
+301
+00:20:59,150 --> 00:21:03,610
+الكالسيوم أصلا هذا أصلا هو intracellular إيش
+
+302
+00:21:07,450 --> 00:21:11,830
+يعني من الـ Minerals اللي هي إيش؟ والمركبات mainly
+
+303
+00:21:11,830 --> 00:21:17,450
+Intracellular مش Extracellular طيب Okay بس طبعا
+
+304
+00:21:17,450 --> 00:21:21,190
+فيه منه موجود في الدم الدليل اللي احنا بنعمل إيش؟
+
+305
+00:21:21,190 --> 00:21:24,090
+Serum Calcium أه موجود منه في الدم بس اللي موجود
+
+306
+00:21:24,090 --> 00:21:28,270
+منه في الدم مكون مرتبط في البروتين تبع الدم اللي
+
+307
+00:21:28,270 --> 00:21:31,890
+هو في الألبومين آه ولذلك حتى في حالة اسمها ب
+
+308
+00:21:31,890 --> 00:21:35,330
+«Sido» اللي هو «Sidohypocalcemia» نتيجة
+
+309
+00:21:35,330 --> 00:21:39,230
+Hypoalbuminemiaفي معادلة اللي أخدتها medical
+
+310
+00:21:39,230 --> 00:21:44,130
+surgical one أنه ممكن يكون مريض ماعندهش البوكالسية
+
+311
+00:21:44,130 --> 00:21:48,190
+لكن عشان عنده hypoalbuminia فهو واضح أنه
+
+312
+00:21:51,620 --> 00:21:54,520
+هيبوكالسينيا، طبعا، يعني هذا دليل من أن الكارسيوم
+
+313
+00:21:54,520 --> 00:21:57,680
+جدا مرتبط في الألبومين، طب و بولار على الكلام هذا،
+
+314
+00:21:57,680 --> 00:22:02,480
+يدوب أو يعني يدوب 60%، مش يدوب، الكمية اللي بتضال
+
+315
+00:22:02,480 --> 00:22:06,740
+من الكارسيوم اللي بتضالها free عاشها في الجسم هيك،
+
+316
+00:22:06,740 --> 00:22:12,160
+في ال blood لحالها، مش مرتبطة، هي هذه الليبتشتغل
+
+317
+00:22:12,160 --> 00:22:15,060
+وبتأثر على الـ Function سبعة وتسعة أما الـ
+
+318
+00:22:15,060 --> 00:22:20,380
+Unbounded هذا مرضي، ماقدرش يتصرف طيب، عشان هيك
+
+319
+00:22:20,380 --> 00:22:25,320
+الهيبوكالسينيا ممكن تعمل مشكلة كبيرة إذا كانت في
+
+320
+00:22:25,320 --> 00:22:31,430
+الـ Unbounded هذاعشان يعني في دكاترة كتير لما بيجي
+
+321
+00:22:31,430 --> 00:22:35,490
+واحد بيقوله أنا بتشنج و بعمله فحص الـ Total
+
+322
+00:22:35,490 --> 00:22:38,690
+Calcium بيلاقيه كويس الـ Total Calcium اللي هو حد
+
+323
+00:22:38,690 --> 00:22:41,990
+اسمه الـ Bounded و الـ Unbounded فبروح بيقوله إيه
+
+324
+00:22:41,990 --> 00:22:46,290
+عشان أعملي لو سمحت الـ Ionized Calcium يعني اللي
+
+325
+00:22:46,290 --> 00:22:49,790
+ممكن يأثر على وظائف الجسم اللي بيأثر على ال body
+
+326
+00:22:49,790 --> 00:22:54,170
+function هذا لـ Free Calcium Level طيب روح بيعمله
+
+327
+00:22:54,170 --> 00:23:02,620
+فممكن يكون هنا Lowطيب واش دخل هذا الموضوع نه؟
+
+328
+00:23:02,620 --> 00:23:09,100
+جالك الـ Ionized Calcium هذا ممكن يرتبط مع الـ
+
+329
+00:23:09,100 --> 00:23:14,380
+Protein Molecule تمام؟ وبالتالي هيعمل Hydrogen Ion
+
+330
+00:23:14,380 --> 00:23:21,440
+لنفس الـالألبومين اللي موجود عندنا وبالتالي هذا
+
+331
+00:23:21,440 --> 00:23:27,760
+هيخلّي ارتباطات الـ Ionized Calcium في البروتين
+
+332
+00:23:27,760 --> 00:23:34,300
+أكتر ولمّا بتزيد ارتباطات الـ Calcium هذا في
+
+333
+00:23:34,300 --> 00:23:39,980
+البروتين هذا هيخلّي أن الـ BHT لو تقصد PND
+
+334
+00:23:40,270 --> 00:23:45,930
+الكالوسوس حالة الالكالوسوس بحجزها بتزود إمكانية
+
+335
+00:23:45,930 --> 00:23:49,070
+إرتباط الكالسيوم هذا في البروتين
+
+336
+00:23:52,640 --> 00:23:56,980
+إنه احنا عرفنا إنه في حد اسمها bounded calcium
+
+337
+00:23:56,980 --> 00:24:01,320
+وفيه free الـ free هذا طول ما هو موجود هو بيعمل
+
+338
+00:24:01,320 --> 00:24:05,380
+الـ function تبعات الجسم الـ alkalosis الـ
+
+339
+00:24:05,380 --> 00:24:08,260
+metabolic alkalosis اللي موجود هنا من مشاكله إنه
+
+340
+00:24:08,260 --> 00:24:14,840
+بيزود الإرتباط طبع الكالسيوم في البروتينات فإيش
+
+341
+00:24:14,840 --> 00:24:17,600
+حاسين إن ده؟ إذا الـ promote increase in protein
+
+342
+00:24:17,600 --> 00:24:23,250
+bindingEasy-free كالسيوم هيخلّي الـ Ionized
+
+343
+00:24:23,250 --> 00:24:25,990
+كالسيوم الـ Free اللي بيأثر على الـ Function تبع
+
+344
+00:24:25,990 --> 00:24:30,590
+كل الـ Body جليل وبالتالي إيش هذا هيعمل؟ هيعمل
+
+345
+00:24:30,590 --> 00:24:35,310
+فعلا مشاكل والموضوع مرتبط في مين؟ في الـ Alkalosis
+
+346
+00:24:35,310 --> 00:24:39,090
+إذا أنا من ضمن الـ Metabolic Alkalosis اللي عرفته
+
+347
+00:24:39,090 --> 00:24:41,850
+عرفت كمان إن الـ Metabolic Alkalosis ده ممكن
+
+348
+00:24:41,850 --> 00:24:45,310
+يتأثرلي على الـ Free كالسيوم اللي موجود في الجسم
+
+349
+00:24:45,310 --> 00:24:50,660
+وسيعمل عند المريض مشاكل اللي هدأ بالتشلجاتأه نتيجة
+
+350
+00:24:50,660 --> 00:24:55,920
+أن الـ Free Calcium أتأثر بسبب حالة الـ Alkalosis
+
+351
+00:24:55,920 --> 00:24:59,700
+أزدادت قدرته على الإرتباط في البروتين بعكس الـ
+
+352
+00:24:59,700 --> 00:25:03,040
+Acidosis، ماذا يحصل في الـ Acidosis؟ لأ، في حالة
+
+353
+00:25:03,040 --> 00:25:06,640
+الـ Acidosis الـ Acidosis بحالة ذاته بيجلل
+
+354
+00:25:06,640 --> 00:25:11,840
+الإرتباط الكالسيوم في البروتين وبالتالي الـ Free
+
+355
+00:25:11,840 --> 00:25:16,100
+Calcium مش ماله، مكون عالي الـ Free Calcium مش
+
+356
+00:25:16,100 --> 00:25:25,050
+مكون، مكونعالي وهذا برضه ممكن يعمل مشاكل لأنه برضه
+
+357
+00:25:25,050 --> 00:25:31,010
+لما بيزيد ال calcium في ال blood برضه ممكن يعمل
+
+358
+00:25:31,010 --> 00:25:41,250
+نوع من اللي هو التصلب تبع الأنسجة والعضلات
+
+359
+00:25:41,930 --> 00:25:48,290
+هك احنا خلصنا الـ Metabolic Acidosis و الـ
+
+360
+00:25:48,290 --> 00:25:52,550
+Metabolic
+
+361
+00:25:52,550 --> 00:25:56,410
+Alkalosis صحيح تمام؟ و بدنا نحكي عن ال Respiratory
+
+362
+00:25:56,410 --> 00:26:00,950
+Acidosis و ال Respiratory Alkalosis و بعد هيك بدنا
+
+363
+00:26:00,950 --> 00:26:07,110
+نحكي عن ال compensation و نشوف كيف خطوات ترجمة ال
+
+364
+00:26:07,110 --> 00:26:11,620
+blood gases ان شاء الله رب العالمين هذابدي أخليكوا
+
+365
+00:26:11,620 --> 00:26:16,120
+يا في الفيديو أو في المحاضرة القادمة يعطيكم
+
+366
+00:26:16,120 --> 00:26:20,200
+العافية والسلام عليكم ورحمة الله
+
diff --git a/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/c2aJgpzZ7UQ_raw.json b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/c2aJgpzZ7UQ_raw.json
new file mode 100644
index 0000000000000000000000000000000000000000..eb7c1e15c318c3d782242bace75147951e354154
--- /dev/null
+++ b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/c2aJgpzZ7UQ_raw.json
@@ -0,0 +1 @@
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امتصاصه ولذلك بنقول So if kidneys fail، إذا صار فيه فشل كلوي، pH balance fail، بس يعني مش صعب جدا إنه يصير فيه pH balance، لأن اللي عامل، اللي .. اللي .. اللي .. اللي بعمل الـbalance هادا", "tokens": [3224, 1829, 9381, 13546, 8978, 6225, 9957, 8315, 3714, 33604, 4117, 3215, 6377, 26956, 5097, 7895, 271, 9154, 6225, 40448, 12174, 3215, 25720, 2423, 28820, 10632, 15844, 6055, 9381, 22653, 3615, 2423, 39184, 33, 7953, 65, 4032, 40228, 18513, 3660, 1975, 2304, 2655, 9381, 33546, 3224, 35525, 8848, 23275, 44945, 39648, 407, 498, 35994, 3061, 12399, 11933, 15730, 20328, 9640, 8978, 3224, 6156, 8592, 1211, 28242, 45865, 12399, 21677, 4772, 3061, 12399, 4724, 3794, 37495, 22653, 37893, 20328, 3615, 3555, 10874, 28259, 36145, 3224, 7251, 9381, 13546, 8978, 3224, 21677, 4772, 12399, 5296, 33456, 13672, 1829, 6225, 10943, 1211, 12399, 13672, 1829, 4386, 13672, 1829, 4386, 13672, 1829, 4386, 13672, 1829, 4724, 25957, 1211, 2423, 39184, 29215, 8032, 18513, 995], "avg_logprob": -0.3150826544801066, 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على الـ Bicarb", "tokens": [28814, 1863, 11296, 6055, 5016, 31845, 19913, 15844, 9122, 2304, 1829, 9307, 2423, 39184, 363, 7953, 65, 34683, 3615, 25708, 1975, 2304, 2655, 9381, 33546, 11296, 4724, 35457, 3555, 12602, 3555, 15042, 14739, 3224, 8978, 3224, 4724, 12610, 1829, 13063, 25528, 13412, 16254, 41891, 18871, 9673, 16572, 11242, 6156, 6027, 4117, 3215, 1863, 7578, 32771, 13546, 12174, 18513, 2288, 15844, 36145, 11296, 6055, 5016, 31845, 19913, 15844, 2423, 39184, 363, 7953, 65], "avg_logprob": -0.22345890410958905, "compression_ratio": 1.5733333333333333, "no_speech_prob": 6.854534149169922e-05, "words": [{"start": 324.87, "end": 325.95, "word": "إنها", "probability": 0.5645955403645834}, {"start": 325.95, "end": 327.03, "word": " تحافظ", "probability": 0.742889404296875}, {"start": 327.03, "end": 327.27, "word": " على", "probability": 0.85400390625}, {"start": 327.27, "end": 328.13, "word": " كميات", "probability": 0.9678955078125}, {"start": 328.13, "end": 328.45, "word": " 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Acidosis", "probability": 0.88232421875}, {"start": 1557.33, "end": 1557.75, "word": " و", "probability": 0.91357421875}, {"start": 1557.75, "end": 1558.01, "word": " ال", "probability": 0.62548828125}, {"start": 1558.01, "end": 1558.77, "word": " Respiratory", "probability": 0.91064453125}, {"start": 1558.77, "end": 1559.75, "word": " Alkalosis", "probability": 0.95751953125}, {"start": 1559.75, "end": 1560.13, "word": " و", "probability": 0.8642578125}, {"start": 1560.13, "end": 1560.41, "word": " بعد", "probability": 0.92578125}, {"start": 1560.41, "end": 1560.69, "word": " هيك", "probability": 0.857177734375}, {"start": 1560.69, "end": 1560.95, "word": " بدنا", "probability": 0.826416015625}, {"start": 1560.95, "end": 1561.41, "word": " نحكي", "probability": 0.99365234375}, {"start": 1561.41, "end": 1561.75, "word": " عن", "probability": 0.98486328125}, {"start": 1561.75, "end": 1562.51, "word": " ال", "probability": 0.978515625}, {"start": 1562.51, "end": 1563.79, "word": " compensation", "probability": 0.3544921875}, {"start": 1563.79, "end": 1564.87, "word": " و", "probability": 0.92041015625}, {"start": 1564.87, "end": 1565.51, "word": " نشوف", "probability": 0.8619791666666666}, {"start": 1565.51, "end": 1565.79, "word": " كيف", "probability": 0.964111328125}, {"start": 1565.79, "end": 1566.35, "word": " خطوات", "probability": 0.966796875}, {"start": 1566.35, "end": 1566.89, "word": " ترجمة", "probability": 0.9855143229166666}, {"start": 1566.89, "end": 1567.11, "word": " ال", "probability": 0.77197265625}, {"start": 1567.11, "end": 1567.39, "word": " blood", "probability": 0.75}, {"start": 1567.39, "end": 1567.99, "word": " gases", "probability": 0.77294921875}, {"start": 1567.99, "end": 1568.49, "word": " ان", "probability": 0.423583984375}, {"start": 1568.49, "end": 1568.65, "word": " شاء", "probability": 0.9501953125}, {"start": 1568.65, "end": 1568.81, "word": " الله", "probability": 0.93701171875}, {"start": 1568.81, "end": 1569.11, "word": " رب", "probability": 0.903564453125}, {"start": 1569.11, "end": 1569.69, "word": " العالمين", "probability": 0.9957682291666666}, {"start": 1569.69, "end": 1570.05, "word": " هذا", "probability": 0.90673828125}], "temperature": 1.0}, {"id": 69, "seek": 158020, "start": 1570.42, "end": 1580.2, "text": "بدي أخليكوا يا في الفيديو أو في المحاضرة القادمة يعطيكم العافية والسلام عليكم ورحمة الله", "tokens": [3555, 16254, 5551, 9778, 20292, 4117, 14407, 35186, 8978, 27188, 1829, 16254, 2407, 34051, 8978, 9673, 5016, 46958, 25720, 25062, 18513, 46007, 37495, 9566, 1829, 24793, 18863, 31845, 10632, 16070, 3794, 37440, 25894, 24793, 4032, 2288, 35571, 3660, 21984], "avg_logprob": -0.18164062052965163, "compression_ratio": 1.5576923076923077, "no_speech_prob": 5.960464477539062e-07, "words": [{"start": 1570.42, "end": 1570.9, "word": "بدي", "probability": 0.552490234375}, {"start": 1570.9, "end": 1571.62, "word": " أخليكوا", "probability": 0.7767578125}, {"start": 1571.62, "end": 1571.74, "word": " يا", "probability": 0.481201171875}, {"start": 1571.74, "end": 1572.0, "word": " في", "probability": 0.9765625}, {"start": 1572.0, "end": 1573.04, "word": " الفيديو", "probability": 0.83746337890625}, {"start": 1573.04, "end": 1573.4, "word": " أو", "probability": 0.89111328125}, {"start": 1573.4, "end": 1573.56, "word": " في", "probability": 0.8916015625}, {"start": 1573.56, "end": 1574.28, "word": " المحاضرة", "probability": 0.9864501953125}, {"start": 1574.28, "end": 1575.32, "word": " القادمة", "probability": 0.9952799479166666}, {"start": 1575.32, "end": 1576.12, "word": " يعطيكم", "probability": 0.775146484375}, {"start": 1576.12, "end": 1576.92, "word": " العافية", "probability": 0.9327799479166666}, {"start": 1576.92, "end": 1579.18, "word": " والسلام", "probability": 0.9152018229166666}, {"start": 1579.18, "end": 1579.58, "word": " عليكم", "probability": 0.9521484375}, {"start": 1579.58, "end": 1579.98, "word": " ورحمة", "probability": 0.94921875}, {"start": 1579.98, "end": 1580.2, "word": " الله", "probability": 0.96728515625}], "temperature": 1.0}], "language": "ar", "language_probability": 1.0, "duration": 1580.8609375, "duration_after_vad": 1561.4831249999977}
\ No newline at end of file
diff --git a/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/c2aJgpzZ7UQ_raw.srt b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/c2aJgpzZ7UQ_raw.srt
new file mode 100644
index 0000000000000000000000000000000000000000..afb46bbbc1dea7a2d5630cec4c009d699f585d61
--- /dev/null
+++ b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/c2aJgpzZ7UQ_raw.srt
@@ -0,0 +1,1464 @@
+1
+00:00:01,420 --> 00:00:06,440
+بسم الله الرحمن الرحيم لازمنا في الـ Arterial
+
+2
+00:00:06,440 --> 00:00:10,120
+Blood Gases في المحاضرة السابقة حكينا عن الـ
+
+3
+00:00:10,120 --> 00:00:14,360
+Puffer System شفنا كيف إن هو تلات أنواع في Puffer
+
+4
+00:00:14,360 --> 00:00:18,580
+في الـ Blood في Puffer في الـ Respiration وفي الـ
+
+5
+00:00:18,580 --> 00:00:21,280
+Kidney بتشتغل أول سؤال عن Puffer System شفنا كيف
+
+6
+00:00:21,280 --> 00:00:24,360
+الـ Blood على طريق الـ Chemicals الموجودة في الـ
+
+7
+00:00:24,360 --> 00:00:27,460
+Blood وكيف بتشتغل اللي هو الـ Protein و الـ Plasma
+
+8
+00:00:27,460 --> 00:00:32,340
+بالذات بيشتغلوا Immediately عشان يحسنواووصلونا
+
+9
+00:00:32,340 --> 00:00:34,840
+لحالة من الـ Hemostasis والـ Acid Base Balance
+
+10
+00:00:34,840 --> 00:00:40,680
+شوفنا كمان كيف الـ Lung بتتحكم في موضوع الـ Acid
+
+11
+00:00:40,680 --> 00:00:45,280
+Base Balance عن طريق أنها بتتحكم في مستويات التنفس
+
+12
+00:00:45,280 --> 00:00:52,020
+علشان تحسن أو ترفع يعني الـ Level of CO2 أو تقلل
+
+13
+00:00:52,020 --> 00:00:56,680
+الـ Level of CO2 حسب الحاجة وحسب الحالة اللي فيها
+
+14
+00:00:56,680 --> 00:01:01,240
+الجسم يعني باختصار لو كان في أناللي هو حالة من
+
+15
+00:01:01,240 --> 00:01:04,360
+الحمضية في Respiratory Acidosis أو كان في
+
+16
+00:01:04,360 --> 00:01:07,880
+Metabolic Acidosis أو كان Metabolic Acidosis الـ
+
+17
+00:01:07,880 --> 00:01:11,000
+Lung بتستجيب عن طريق الـ Respiratory Alkalosis إيش
+
+18
+00:01:11,000 --> 00:01:14,160
+يعني؟ يعني لو كان في Metabolic Acidosis يعني الـ
+
+19
+00:01:14,160 --> 00:01:20,920
+pH أقل من 7.35، الـ Lung بتحاول تخليالدم يصير
+
+20
+00:01:20,920 --> 00:01:26,560
+قاعدي عن طريق تقليل مستويات الـ «CO2» في الدم لأنه
+
+21
+00:01:26,560 --> 00:01:29,740
+احنا بنعرف إن الـ «CO2» هو المسؤول عن الأنضية
+
+22
+00:01:29,740 --> 00:01:35,340
+وبالتالي بتدعو الجسم إلى تقليل اللي هو زيادة
+
+23
+00:01:35,340 --> 00:01:39,380
+معدلات التنفس عشان يعمل Washing Out للـ «CO2»
+
+24
+00:01:39,380 --> 00:01:42,960
+وبالتالي هذا بيخلي يصير فينا مستويات منخفضة من الـ
+
+25
+00:01:42,960 --> 00:01:47,500
+«CO2» وطبعا لو كان فينا Metabolic Alkalosis هيصير
+
+26
+00:01:47,500 --> 00:01:53,730
+الموضوع بالعكس وحتخليالتنفس يصبح بطيء لكي يقلل الـ
+
+27
+00:01:53,730 --> 00:01:58,250
+CO2 وتعملنا قليل من الـ Acidosis وتعملنا كمبانساشن
+
+28
+00:01:58,250 --> 00:02:06,530
+للـ Metabolic Alkalosis الموجود كذلك الـ
+
+29
+00:02:06,530 --> 00:02:11,400
+Kidneyهتشتغل لكن زي ما حكينا مش within hours زي
+
+30
+00:02:11,400 --> 00:02:15,080
+الـ Respiratory لأ هتشتغل within days ال kidney
+
+31
+00:02:15,080 --> 00:02:19,440
+عليها مسئولية كبيرة ال kidney وظيفتها بشكل أساس
+
+32
+00:02:19,440 --> 00:02:23,400
+تحفظلى على ال acid base balance عن طريق إنها هي
+
+33
+00:02:23,810 --> 00:02:29,170
+اللي فعلاً بتعيد انتصاف أولاً هي أصلاً اللي بتصنع
+
+34
+00:02:29,170 --> 00:02:36,190
+الـ Bicarb مش الرينا لتجول secret أشي و بتصنع
+
+35
+00:02:36,190 --> 00:02:42,370
+أصلاً الـ Bicarb و أنا كتبها تمام بتصنع أصلاً الـ
+
+36
+00:02:42,370 --> 00:02:48,660
+Bicarb هتلاقوها somewhereوالـ «The kidneys
+
+37
+00:02:48,660 --> 00:02:51,340
+regulate the bicarbonate level in» اللي هو الـ
+
+38
+00:02:51,340 --> 00:02:54,880
+«extracellular fluid» «they can regenerate bicarb»
+
+39
+00:02:54,880 --> 00:02:58,680
+هي بتقيد تصنيع الـ «bicarb» ومش كمان بتسوي وبتعمل
+
+40
+00:02:58,680 --> 00:03:02,520
+Reabsorption للـ «bicarb» اللي بده يطلع عن طريق
+
+41
+00:03:02,520 --> 00:03:06,380
+اليورين عشان ما نفقدوش كله وعشان نتحافظ من الاتزان
+
+42
+00:03:06,380 --> 00:03:10,200
+القائدي اللي موجود بالنسبة للحالة الحمضية فبتعمللي
+
+43
+00:03:10,200 --> 00:03:14,100
+acid-base balance إذا لو تركنا اليورين يطلع كل الـ
+
+44
+00:03:14,100 --> 00:03:18,150
+«bicarb»حيصير فيه أننا نضيع، فالـ Kidney أن ده
+
+45
+00:03:18,150 --> 00:03:21,390
+مسئولية أنها تصنع By Carb وأنها تعيد انتصار اللي
+
+46
+00:03:21,390 --> 00:03:24,630
+بده يطلع، إذا لو صار فيه أي Failure أو أي Kidney
+
+47
+00:03:24,630 --> 00:03:28,250
+Disease، هيأثر على حاجتين، التصنيع تبع الـ By
+
+48
+00:03:28,250 --> 00:03:32,150
+Carb، وهيأثر على اللي هو قدرة الـ Kidney على الـ
+
+49
+00:03:32,150 --> 00:03:37,450
+Reabsorption لـ Carb، وبالتالي إيش حيصير فيه؟هيصير
+
+50
+00:03:37,450 --> 00:03:41,890
+في عيننا مؤكد Metabolic Acidosis من عدم قدرة
+
+51
+00:03:41,890 --> 00:03:46,830
+الكلية على تصنيع الـBicarb ويعادة امتصاصه ولذلك
+
+52
+00:03:46,830 --> 00:03:51,450
+بنقول So if kidneys fail، إذا صار فيه فشل كلوي، pH
+
+53
+00:03:51,450 --> 00:03:54,710
+balance fail، بس يعني مش صعب جدا إنه يصير فيه pH
+
+54
+00:03:54,710 --> 00:03:57,070
+balance، لأن اللي عامل، اللي .. اللي .. اللي ..
+
+55
+00:03:57,070 --> 00:04:00,910
+اللي بعمل الـbalance هاداعلى المدى الطويل هو الـ
+
+56
+00:04:00,910 --> 00:04:03,950
+Kidney عشان هيك اليوم بدنا نبدأ نحكي فيه اللي هو
+
+57
+00:04:03,950 --> 00:04:06,930
+الـ Metabolic Acidosis أعتقد في اللي شراهته قبل
+
+58
+00:04:06,930 --> 00:04:11,720
+شوية صار واضح إن الـ Metabolic Acidosis بيكوننتيجة
+
+59
+00:04:11,720 --> 00:04:15,660
+مشكلة في الـ kidney مش في الـ respiratory مشكلة في
+
+60
+00:04:15,660 --> 00:04:20,580
+الـ kidney أو مشكلة نتيجة من أرض غذائي معين يعني
+
+61
+00:04:20,580 --> 00:04:24,120
+مثلا intoxication واحد ماخد كحول كتير واحد ماخد
+
+62
+00:04:24,120 --> 00:04:28,580
+اندو مثلا اللي هو ده بتك type 1 وصار في اندو
+
+63
+00:04:28,580 --> 00:04:32,860
+ketoacidosis وبالتالي صار دمه حامض إذا الـ
+
+64
+00:04:32,860 --> 00:04:35,680
+metabolic keto الـ metabolic acidosis is a
+
+65
+00:04:35,680 --> 00:04:38,640
+clinical disturbance characterized by أي بائش مزال
+
+66
+00:04:38,640 --> 00:04:42,320
+فيه acidosis يبقى الhydrogenأيونزاش مالها بتكون
+
+67
+00:04:42,320 --> 00:04:46,860
+عالية مثلا فيه أسدوست أه تمام لكن إيش السبب that
+
+68
+00:04:46,860 --> 00:04:49,600
+okay when the body produce excessive quantities of
+
+69
+00:04:49,600 --> 00:04:53,620
+acid أه طبعا الجسم هيكعمل كمية كبيرة من الأحمار
+
+70
+00:04:53,620 --> 00:04:58,160
+تمامطب و بعد هيك Loss of Bicarbonate و أكيد حكون
+
+71
+00:04:58,160 --> 00:05:01,840
+بفقد الـ Bicarb لأن الـ Bicarb هو المسئول عن
+
+72
+00:05:01,840 --> 00:05:04,520
+القاعدية فهو بيكوّن أحمض و بيفقد الـ Bicarb
+
+73
+00:05:04,520 --> 00:05:07,620
+وبالتالي بتزيد حالة الهنضية عنده okay when the
+
+74
+00:05:07,620 --> 00:05:11,880
+kidneys are not removing enough acid from the body
+
+75
+00:05:11,880 --> 00:05:15,520
+وهذا بيكون نتيجة إن الكدن ربما فيها خلل أو مش
+
+76
+00:05:15,520 --> 00:05:19,880
+قادرة لإنه يعني لا تستطيع إنها تتخلص من كل الـ
+
+77
+00:05:19,880 --> 00:05:20,460
+Bicarb
+
+78
+00:05:24,870 --> 00:05:31,810
+إنها تحافظ على كميات الـ Bicarb وتعيد امتصاصها
+
+79
+00:05:31,810 --> 00:05:36,450
+بسبب ربما أنه فيه بوليوريا شديدة عن المريض فالكدنى
+
+80
+00:05:36,450 --> 00:05:44,490
+غير قادر على إنها تحافظ على الـ Bicarbعشان يحافظ
+
+81
+00:05:44,490 --> 00:05:49,250
+على القائدية ويمنع الـ Acidosis تمام؟ عشان هيك الـ
+
+82
+00:05:49,250 --> 00:05:52,210
+Metabolic Acidosis كان Divided clinically into two
+
+83
+00:05:52,210 --> 00:05:56,650
+forms عشان هيك بروح بيجسموا الـ Metabolic Acidosis
+
+84
+00:05:56,650 --> 00:06:01,040
+according to a new gapإيش الـ anion gap؟ قالنا كده
+
+85
+00:06:01,040 --> 00:06:05,340
+عبارة عن الفجوة الآيونية اللي هي الـ normal إنها
+
+86
+00:06:05,340 --> 00:06:09,160
+تكون من 12 إلى 16 ملي كوبلات لكل حد طب هاذي كده
+
+87
+00:06:09,160 --> 00:06:13,400
+الـ anion gap وإيش هي أصلا؟ هي بكل بساطة مجموعة
+
+88
+00:06:13,400 --> 00:06:16,780
+آيونات الصوديوم والبوتاسيوم يعني إحنا عملنا لمريض
+
+89
+00:06:16,780 --> 00:06:20,220
+صوديوم، جداش الصوديوم عنده 135، عملنا لبوتاسيوم
+
+90
+00:06:20,220 --> 00:06:23,440
+جداش البوتاسيوم عنده 3.5، مجموعة الصوديوم
+
+91
+00:06:23,440 --> 00:06:28,190
+والبوتاسيوم، نقص منهم مجموعة الchlor والبيكاربطلع
+
+92
+00:06:28,190 --> 00:06:31,370
+رقم، إذا الرقم هدا من 12 إلى 16، بيكون Normal إذا
+
+93
+00:06:31,370 --> 00:06:34,630
+أعلى من 16، بيكون الـ Onion Gap عنده عالية إذا أقل
+
+94
+00:06:34,630 --> 00:06:38,030
+من 12، بيكون الـ Onion Gap عنده Low طب و هذا إيش
+
+95
+00:06:38,030 --> 00:06:41,730
+فديته بموضوع الـ Metabolic Acidosis؟ أيوة، جالك
+
+96
+00:06:41,730 --> 00:06:46,210
+إذا الـ Onion Gap كانت عالية، وهذا عادة بيصير في
+
+97
+00:06:46,210 --> 00:06:50,390
+الـ Metabolic Chronic Metabolic Acidosis اللي لها
+
+98
+00:06:50,390 --> 00:06:54,750
+علاقة في أمراض الـ Kidney بحيث أنه
+
+99
+00:06:57,240 --> 00:07:03,040
+الجسم ماعندهش الإمكانية أنه يصنع بيكارب enough
+
+100
+00:07:03,040 --> 00:07:06,300
+فبتكون مون المشكلة؟ بتكون المشكلة في ال kidney
+
+101
+00:07:06,300 --> 00:07:10,760
+نفسها يا أما مش عارف ال kidney ترجع تعيد امتصاص ال
+
+102
+00:07:10,760 --> 00:07:13,700
+بيكارب، يا مش قادرة تصنع، إذا مش قادرة تصنع، بكون
+
+103
+00:07:13,700 --> 00:07:18,070
+هي فيها المشكلة، إذا ما المشكلة أنهإعادة الانتصاف
+
+104
+00:07:18,070 --> 00:07:20,770
+هي اللي صعبة بيكون في حالة من الـPolioria كبيرة
+
+105
+00:07:20,770 --> 00:07:24,970
+ومش يعني ماعنداش الإمكانية أنها تسيطر على الموقف
+
+106
+00:07:24,970 --> 00:07:29,410
+طب وين بيكون فينا حالات فيها اللي هو Polioria كتير
+
+107
+00:07:29,410 --> 00:07:33,090
+حالة مثلا اللي هو الـKetoacidosis بتكون كميات
+
+108
+00:07:33,090 --> 00:07:38,480
+كبيرة من الـAcid اللي موجودة في الدموبالتالي هذه
+
+109
+00:07:38,480 --> 00:07:44,560
+بتأد إلى حالة من الـ Poliurea فبصير فيه acidity
+
+110
+00:07:44,560 --> 00:07:47,400
+عالية في الدم وفي Poliurea بتطلع بولي كتير و
+
+111
+00:07:47,400 --> 00:07:51,500
+الكلية ماعنداش القدرة أن تعمل إعادة انتصاص لـ
+
+112
+00:07:51,500 --> 00:07:56,160
+bicarb وبالتالي بتصير الدم ميتابوليكاسيدوس حالته
+
+113
+00:07:56,160 --> 00:08:01,310
+مابطل فيه balance ولو كان فيه lactic acidوهذا
+
+114
+00:08:01,310 --> 00:08:06,170
+بيصير نتيجة مجهود عضلي أو muscle destruction
+
+115
+00:08:06,170 --> 00:08:10,290
+فبتفرز انزيمات الـ Lactate هذه فبتزيد حمضية الدم
+
+116
+00:08:10,290 --> 00:08:13,910
+في نهاية حطول على الدم فبتزيد حمضية الدم إذا صار
+
+117
+00:08:13,910 --> 00:08:19,130
+في عندي أنا سببين إنه الـ metabolic acid بت seem
+
+118
+00:08:19,130 --> 00:08:25,610
+mostly يا أما إن الكدن فيها diseaseهو مش قادر إنها
+
+119
+00:08:25,610 --> 00:08:30,070
+تعمل generation للـ Bicarbonate أو ماعندهاش القدرة
+
+120
+00:08:30,070 --> 00:08:33,050
+إنها تعمل الـ Absorption أحيانًا بيكون السبب خاجي
+
+121
+00:08:33,050 --> 00:08:38,270
+إن واحد ناخد مثلًا كحول أو أسبريل فبيقبله
+
+122
+00:08:38,270 --> 00:08:42,670
+metabolic acidلكن في الحالات الطبيعية اللي بيكون
+
+123
+00:08:42,670 --> 00:08:45,650
+فيها الـ Normal Anion Gap يعني أنا لما جيت أشوف
+
+124
+00:08:45,650 --> 00:08:49,510
+المريض لجيت أندو ميتابولك أسيدوسيز بس حسبت الـ
+
+125
+00:08:49,510 --> 00:08:51,950
+Normal Anion Gap اللي هي مجموع الـ Sodium و الـ
+
+126
+00:08:51,950 --> 00:08:58,830
+Potassium ضرب اللي هو الـ Chloroxyl Bicarb فحلّيت
+
+127
+00:08:58,830 --> 00:09:01,790
+المعادلة هذه اللي بيظهر Normal طبيعية بين 12 و 16
+
+128
+00:09:01,790 --> 00:09:05,690
+رغم هيك المريض أندو ميتابولك أسيدوسيز هذه حالة
+
+129
+00:09:05,690 --> 00:09:11,550
+سهلة مت ميتابولك أسيدوسيزتمام؟ وانت تتخلص من
+
+130
+00:09:11,550 --> 00:09:13,410
+بيكربونية ايون تتخلص من بيكربونية ايون تتخلص من
+
+131
+00:09:13,410 --> 00:09:14,390
+بيكربونية ايون تتخلص من بيكربونية ايون تتخلص من
+
+132
+00:09:14,390 --> 00:09:16,390
+بيكربونية ايون تتخلص من بيكربونية ايون تتخلص من
+
+133
+00:09:16,390 --> 00:09:17,990
+بيكربونية ايون تتخلص من بيكربونية ايون تتخلص من
+
+134
+00:09:17,990 --> 00:09:18,890
+بيكربونية ايون تتخلص من بيكربونية ايون تتخلص من
+
+135
+00:09:18,890 --> 00:09:21,690
+بيكربونية ايون تتخلص من بيكربونية ايون تتخلص من
+
+136
+00:09:21,690 --> 00:09:26,930
+بيكربونية ايون تتخلص من بيكربونية ايون تتخلص من ب
+
+137
+00:09:29,850 --> 00:09:34,930
+Loss of fluid نتيجة انه مثلا صلوا اكام يوم مكلش
+
+138
+00:09:34,930 --> 00:09:38,250
+فهذه الحاجات هي اللي خلته اندوكسي ميتابوليك
+
+139
+00:09:38,250 --> 00:09:41,770
+أزيوكوسيس وبالتالي ما زال ال normal onion اللي
+
+140
+00:09:41,770 --> 00:09:45,390
+قلنا normal onion جاب معاها طبيعية وبالتالي شوية
+
+141
+00:09:45,390 --> 00:09:49,290
+fluid ان رعط المريض هذا شوية fluid هيتحسن واطور
+
+142
+00:09:49,290 --> 00:09:56,540
+لكن لما يكون في اندي اللي هو انو جابلهلو أنيونجاب
+
+143
+00:09:56,540 --> 00:10:00,040
+وكأن دي Metabolic Acidosis هذا الموضوع بيكون مرتبط
+
+144
+00:10:00,040 --> 00:10:06,260
+دي لبروتين وبالأخرى بقلة البروتين في الدم هذه حالة
+
+145
+00:10:06,260 --> 00:10:11,440
+يعني نادر أنها تكون مشهورة وتكون موجودة في
+
+146
+00:10:11,440 --> 00:10:16,640
+Metabolic Acidosis والأنيونجاب لو إلا زي ما حكينا
+
+147
+00:10:16,640 --> 00:10:19,940
+في حال إن فعلا الألبوبين تبع الدم اللي هو عبارة عن
+
+148
+00:10:19,940 --> 00:10:24,040
+بروتين الدم يمثل يكون low فبكون هذه اللي هو
+
+149
+00:10:24,040 --> 00:10:30,880
+negativeبنسميها تمام والسبب فيها أنه يكون فيه نقص
+
+150
+00:10:30,880 --> 00:10:36,010
+لبروتينفبعد ما نحسب إحنا الـ Onion Gap نلاقيها أقل
+
+151
+00:10:36,010 --> 00:10:40,390
+من 12 ويكون في انتي Metabolic Acidosis فأنا بفهم
+
+152
+00:10:40,390 --> 00:10:43,790
+إنه آه يبدو هذا الـ Metabolic Acidosis إيه علاقة
+
+153
+00:10:43,790 --> 00:10:46,690
+في البروتين فإذا إحنا ماكناش عاملين فحص القلب ولا
+
+154
+00:10:46,690 --> 00:10:50,890
+المريض بنروح بنعمل فحص القلب وإنه حالة دي فعلا إنه
+
+155
+00:10:50,890 --> 00:10:53,150
+منخفض وبالتالي بكون إحنا عارفين إنه في ال
+
+156
+00:10:53,150 --> 00:10:58,690
+management تبعتنا بدتنا نعطياللي هو ألبومين علشان
+
+157
+00:10:58,690 --> 00:11:04,350
+المريض هذا يتحسن وهذا هو الفريق بينما في الحالات
+
+158
+00:11:04,350 --> 00:11:07,410
+الأولانية يعني لما نحكي عن الـ cause and effect
+
+159
+00:11:07,410 --> 00:11:10,150
+أحصان أحنا already لما ضربنا أمثلة على الـ Onion
+
+160
+00:11:10,150 --> 00:11:13,130
+Gaps حكينا يعني مثلا ضيابية كيكاو أسيدواسنز حكينا
+
+161
+00:11:13,130 --> 00:11:16,570
+أنه من الـHigh Onion Gap متبولف أسيدواسنز البيارية
+
+162
+00:11:16,570 --> 00:11:20,370
+عرفنا إنها من الـNormal عادة تكون Normal Onion Gap
+
+163
+00:11:21,330 --> 00:11:24,690
+الـ Renal Failure من الـ High أنيوم جاب هذا تمام
+
+164
+00:11:24,690 --> 00:11:29,710
+صح ولا لأ الـ Salicylic Oxidation من الـ High عادة
+
+165
+00:11:29,710 --> 00:11:33,310
+لو نحسب الانيوم جابها نلاقيها high الشكوك و
+
+166
+00:11:33,310 --> 00:11:37,850
+الcardiac arrest هتلاقيها high تمام
+
+167
+00:11:39,120 --> 00:11:42,880
+طب ما هي العلامات؟ أول علامة أحنا بنعرفها أن الـDH
+
+168
+00:11:42,880 --> 00:11:49,100
+هيكون أقل من 37.5 هذا أول حاجة طب كويس طيب ومما أن
+
+169
+00:11:49,100 --> 00:11:53,840
+الـDH أقل من 37.5 إيش وضع الـbicarb يا جماعة؟
+
+170
+00:11:53,840 --> 00:11:56,860
+هيكون المفروض أن الـbicarb يا جماعة يكون طبيعي لكن
+
+171
+00:11:56,860 --> 00:12:02,140
+بعد شوية إيش رأيكم؟ أه مستحيل يكون طبيعي أه منفعش
+
+172
+00:12:02,140 --> 00:12:07,070
+ركزوا معايامازال انا بحكي عن metabolic problem
+
+173
+00:12:07,070 --> 00:12:12,210
+يعني المشكلة في الـ bicarb على طول هيك اتحكي عن
+
+174
+00:12:12,210 --> 00:12:14,870
+metabolic problem يعني الـ bicarb هو اللي بتكون
+
+175
+00:12:14,870 --> 00:12:19,750
+المشكلة فيه اول مشكلة بلاجيها ان الـ BH ايش ماله؟
+
+176
+00:12:19,750 --> 00:12:22,650
+بيقول انا أسيدوست يبدأ له يبدأ أجل من سبعة وخمس و
+
+177
+00:12:22,650 --> 00:12:28,930
+تلاتين اي واحد يعرف انه أسيدوست لأن الـ BH أجل من
+
+178
+00:12:28,930 --> 00:12:33,010
+سبعة و خمس و تلاتينمين سبب الـ Acidosis ميتابولك
+
+179
+00:12:33,010 --> 00:12:37,550
+أنا بقولك مزال ميتابولك يبقى الـ bicarb هذا هو
+
+180
+00:12:37,550 --> 00:12:44,130
+اللي لو قلة الـ bicarb بتعمل Acidosis تمام؟ طيب
+
+181
+00:12:44,130 --> 00:12:48,930
+إيش مين بده يدخل؟ آه اللي بتدخل ال buffer system
+
+182
+00:12:48,930 --> 00:12:53,030
+مين بتدخل بسرعة بسرعة بسرعة بسرعة ال blood buffer
+
+183
+00:12:53,030 --> 00:12:56,050
+و ال lung buffer بتشتغل within minutes تمام؟ إيش
+
+184
+00:12:56,050 --> 00:13:01,890
+هتسوي ال lung؟ والله إنت في عندك Acidosis طيبوالـ
+
+185
+00:13:01,890 --> 00:13:04,630
+Bicarbonate ده كواطي، هي بتقدرش تتحكم غير في الـ
+
+186
+00:13:04,630 --> 00:13:08,710
+CO2 طيب، إيش بيسوي الـ CO2؟ الـ CO2 لو زاد، بيعمل
+
+187
+00:13:08,710 --> 00:13:13,010
+Acidosis أه، يبقى هي ممكن تقلله، تمام، كيف ممكن
+
+188
+00:13:13,010 --> 00:13:16,970
+تقلل الـ CO2؟ عن طريق إنها .. أيوة، مين شاطر؟
+
+189
+00:13:16,970 --> 00:13:21,520
+Bravo عليكعن طريق إنها تزود عدد مرات التنفس وبتعمل
+
+190
+00:13:21,520 --> 00:13:27,700
+بالتالي اللي هو Washing out الـCO2 فبدل الـCO2 عن
+
+191
+00:13:27,700 --> 00:13:33,040
+35 وهذا اللي بيسموه أو بيسميه Cosmol respiration
+
+192
+00:13:36,550 --> 00:13:40,830
+بحاول يأخذ نفس عميق ويتكبني ورا بعض ورا بعض ورا
+
+193
+00:13:40,830 --> 00:13:47,390
+بعض رابط DB3 نفس عميق بس رابط تمام عشان يحاول يعمل
+
+194
+00:13:47,390 --> 00:13:52,810
+compensation ويعمل washing out بس CO2 ويحسن من ال
+
+195
+00:13:52,810 --> 00:13:58,520
+metabolic acidosisإذا إحنا لو بدنا نحق العالج
+
+196
+00:13:58,520 --> 00:14:01,560
+الحالي هذه أنا بدي أريحكم من هذا الكلام و أقولكوا
+
+197
+00:14:01,560 --> 00:14:05,180
+هذا نظرة عامة كيف بدنا نعالجه، بس أهم حاجة في
+
+198
+00:14:05,180 --> 00:14:08,180
+Metabolic Acidosis إن أعرض ميليكوز و أعالجه،
+
+199
+00:14:08,180 --> 00:14:11,260
+مالفعش يعني أعالجه بشكل عام إذا الموضوع ده بدي
+
+200
+00:14:11,260 --> 00:14:14,700
+كيدو أسيدوسيز، أه هذا المريض أول حاجة بده Fluid
+
+201
+00:14:14,700 --> 00:14:17,300
+لأنه فاطر فلوذ كتير وهذا اللي مخليته ال buy card
+
+202
+00:14:17,300 --> 00:14:21,520
+اتنين، بدي أعوضه buy card إذا الموضوع ده ياريا، أه
+
+203
+00:14:21,520 --> 00:14:26,720
+برضه بده Fluid، صحيح؟بدّو الـ Fluid وإذا كتير الـ
+
+204
+00:14:26,720 --> 00:14:30,560
+Loss of bicarb يمكن بدي أديله بيكارب، تمام؟ لكن
+
+205
+00:14:30,560 --> 00:14:33,020
+أحيانًا يا جماعة، احنا بنتكفي في الـ bicarb اللي
+
+206
+00:14:33,020 --> 00:14:36,260
+أصلا ممكن يكون من المكونات لـ Fluid يعني أنا لما
+
+207
+00:14:36,260 --> 00:14:39,860
+أدرين Galactate، ما هو فيه كل حاجة، حتى الـ Sodium
+
+208
+00:14:39,860 --> 00:14:43,220
+bicarb والمكوناته، فمن المفضل أدّي اللي هو Sodium
+
+209
+00:14:43,220 --> 00:14:47,710
+bicarb لحالهفما حتى في الـ Ketoacidosis، يعني لا
+
+210
+00:14:47,710 --> 00:14:52,610
+يفضل إن أندي صدر بكر إلا إذا كان المريض تسيبير
+
+211
+00:14:52,610 --> 00:14:58,670
+Ketoacidosis وكانت الـ pH مؤدلة أقل من 7.2، طبعا
+
+212
+00:14:58,670 --> 00:15:01,810
+الطبيعة لسه مابوت 35، يعني لو كتو تسيبر
+
+213
+00:15:01,810 --> 00:15:06,850
+Ketoacidosis والباقي الـ pH عنده 7.25، فإنها لسه
+
+214
+00:15:06,850 --> 00:15:09,930
+ماندهوش مايكافر، هذا على الهامش يعني، طيب؟
+
+215
+00:15:11,550 --> 00:15:14,110
+التريتمنت اللي اريد ان اوصلكم هو ان انا في كل حالة
+
+216
+00:15:14,110 --> 00:15:19,010
+لازم اعرف ال cause تبعها عن طريق اولا ان انا ادى
+
+217
+00:15:19,010 --> 00:15:21,450
+by carb حسب الحالة، ايش اللي بتحتاج و ايش ال
+
+218
+00:15:21,450 --> 00:15:24,110
+parameters التانية بتأتي و ايش ال criteria of
+
+219
+00:15:24,110 --> 00:15:24,810
+disease هذا
+
+220
+00:15:27,900 --> 00:15:31,640
+إلا إذا، مش عارف أنا أي حاجة، لكن الـDH جالمن 7.1
+
+221
+00:15:31,640 --> 00:15:35,080
+في حالة هذه، إيش ما يكون المرض لازم تدبعي، طبعا في
+
+222
+00:15:35,080 --> 00:15:38,760
+أسوأ الظروف ممكن نعمل إحنا عشان نحسن الحمضية طبقة
+
+223
+00:15:38,760 --> 00:15:41,520
+المريض، اللي هو Dialysis، يعني غسيلة
+
+224
+00:15:41,520 --> 00:15:45,160
+الـChemodialysis، خاصة في حالات الـIntoxication
+
+225
+00:15:45,390 --> 00:15:49,170
+اللي بيكون شارب بحول أو فيه مندو رينا الفالية و ال
+
+226
+00:15:49,170 --> 00:15:52,870
+kidney متقطلة تماما يعني مش قادرة تشتغل فضل الطر،
+
+227
+00:15:52,870 --> 00:15:56,870
+إيش نسوي؟ نعمله Dialysis الـ Metabolic Alkalosis
+
+228
+00:15:56,870 --> 00:16:00,930
+الصورة هنا عكس الصورة اللي حكيناها قبل شوية تماما
+
+229
+00:16:00,930 --> 00:16:06,920
+كيف يعني عكسها؟ يعني المشكلةفي الـ kidney، أه هي
+
+230
+00:16:06,920 --> 00:16:09,860
+هي لأنه متابولي، لكن بدل من أيه الـ Acidosis،
+
+231
+00:16:09,860 --> 00:16:12,480
+Alkalosis، ديش يعني Alkalosis؟ يعني الـ pH بدل ما
+
+232
+00:16:12,480 --> 00:16:16,340
+كانت منخفضة، هنق عالية، أكتر من سبعة ومن خمسة أرمض
+
+233
+00:16:16,340 --> 00:16:20,780
+طايل، و .. وفي هذه الحالة إيش هيكون السبب يا
+
+234
+00:16:20,780 --> 00:16:26,340
+جماعة؟ هيكون السبب أكيد تراكم الـ Bicarb، إيش؟
+
+235
+00:16:26,340 --> 00:16:31,200
+تراكم الـ Bicarb، تراكم الـ Bicarb، أه، زي إيش
+
+236
+00:16:31,200 --> 00:16:36,610
+يعني تراكم الـيعني مثلًا واحد مصراندو الرينالفيليا
+
+237
+00:16:36,610 --> 00:16:40,430
+فجأة بطلت الكلية تشتغل و تطلع urine حسين البكارة
+
+238
+00:16:40,430 --> 00:16:45,110
+وتتحوش بجسمه هي الجهتين الرينالفيليا بتتفسك بها
+
+239
+00:16:45,110 --> 00:16:52,330
+مشاكل طب وإيش كمان؟وكمان يا جماعة استخدام الـ
+
+240
+00:16:52,330 --> 00:16:54,810
+diuretics بحاجة ذاتها طب الـ diuretics يا أستاذ
+
+241
+00:16:54,810 --> 00:17:01,210
+بتخليني أطلع بول كتير فالمفروض أنه زي ما أطلع بول
+
+242
+00:17:01,210 --> 00:17:04,950
+كتير المفروض أنه أفقد by car و التالي مايصيرش
+
+243
+00:17:04,950 --> 00:17:06,230
+الكلوز يصير أسيدوز
+
+244
+00:17:09,640 --> 00:17:14,300
+الـ Increased Exertion of Chloride بالنسبة للتناقص
+
+245
+00:17:14,300 --> 00:17:19,200
+وكميات اللي هتخرج من الـ Chloride هتكون بالنسبة
+
+246
+00:17:19,200 --> 00:17:24,120
+للبياكربونيات أكتر وخاصة لما يكون المرض يستخدم نوب
+
+247
+00:17:24,120 --> 00:17:28,660
+ديورتيكزاي اللازيكس فبالتالي تعملوا Metabolic
+
+248
+00:17:28,660 --> 00:17:32,960
+Alkalosis إذا الـ Metabolic Alkalosis له مسببات
+
+249
+00:17:32,960 --> 00:17:36,480
+كتير زي ما احنا يعني
+
+250
+00:17:37,840 --> 00:17:41,420
+بسرعة هي كممكن نعرف إنه إذا كان عنده Hypokalemia
+
+251
+00:17:41,420 --> 00:17:44,520
+بقولش ولا بشرب، Dehydration إذا أنا ما .. ما ..
+
+252
+00:17:44,520 --> 00:17:48,580
+مابش ليش بطلع منه Vomiting كتير طبعا و بالذات الـ
+
+253
+00:17:48,580 --> 00:17:52,620
+vomiting لإن المعدة الوسط طبعها حامض فلما نفقد ..
+
+254
+00:17:52,620 --> 00:17:55,660
+بما الـ vomiting كتير نفقد حامضيات من جسمه مابخش
+
+255
+00:17:55,660 --> 00:18:00,780
+الـ BW الخلوزز في حاجات تانية إنه يكون عنده مثلا
+
+256
+00:18:00,780 --> 00:18:04,060
+Excessive Adrenocorticosteroid hormone أو يكون
+
+257
+00:18:04,060 --> 00:18:10,110
+عنده اللي هو Hypokalemiaهذا برضه حق يسرق فيه إنه
+
+258
+00:18:10,110 --> 00:18:13,670
+يصير في عند المريض هذا الكلوسيز بغض النظر عن
+
+259
+00:18:13,670 --> 00:18:17,410
+الأسباب أنا بدنا نشوف إيش اللي ممكن يصير بعد ما
+
+260
+00:18:17,410 --> 00:18:21,350
+أنا لجيت إن الحالة عبارة عن حالة لإنه بصراحة
+
+261
+00:18:21,350 --> 00:18:25,890
+الأسباب كل حالة بدك تحكي المرض تبعها بدك تحكي فيه
+
+262
+00:18:25,890 --> 00:18:29,010
+بصفة فاضة فإحنا في كتير من الأوراد اللي هنحكي عنها
+
+263
+00:18:29,010 --> 00:18:32,390
+later on إحنا لجيت موضوعنا كيف نفسر ال energy
+
+264
+00:18:32,390 --> 00:18:35,870
+تمام؟ فأنا مش معرف إيش هي الأمراض جهد ما أنا معرف
+
+265
+00:18:35,870 --> 00:18:39,850
+إنه أنتتستطيع إنك تفسر الحالة لو قرأت Blood Gap
+
+266
+00:18:39,850 --> 00:18:43,970
+يعني لو أنا في عندك AVG موجود، أه موجود عندك قيم
+
+267
+00:18:43,970 --> 00:18:47,890
+للـDH، بعدين موجود عندك قيم للـCO2، بعدين موجود
+
+268
+00:18:47,890 --> 00:18:51,230
+عندك قيم للـBicarb، من الموقعات هدول التلاتة
+
+269
+00:18:51,230 --> 00:18:54,490
+تستطيع تقولي إيش هي الحالة، هى Metabolic Acidosis
+
+270
+00:18:54,490 --> 00:18:58,330
+ولا Metabolic Argyrosis، وبعدين تقولي إذا كان في
+
+271
+00:18:58,330 --> 00:19:03,430
+compensation ولا ماكانش في compensation، تمام؟و
+
+272
+00:19:03,430 --> 00:19:07,770
+هحكيلكوا أنا في آخر المحاضرة إيش الاختلاف بينه،
+
+273
+00:19:07,770 --> 00:19:11,010
+أين ال compensation اللي بيسميهم partial و
+
+274
+00:19:11,010 --> 00:19:14,950
+complete compensation طبعا، طبعا، طيب، اللي لما
+
+275
+00:19:14,950 --> 00:19:19,110
+بيكون في عندي excessive اللي هو alkaline، يعني أنا
+
+276
+00:19:19,110 --> 00:19:22,330
+في عندي حالة من ال metabolic alkalosis، طبعا، إيش
+
+277
+00:19:22,330 --> 00:19:25,570
+بيكون في عندي؟ بيكون في عندي bicarbonateطيب، إيش
+
+278
+00:19:25,570 --> 00:19:31,110
+بدها تزوّل الـ Lung؟ إيش بدها تزوّل الـ Lung؟ طب
+
+279
+00:19:31,110 --> 00:19:35,050
+إيش بدها تزوّل الـ Lung؟ بدها تزوّل المزاوقة، إذا
+
+280
+00:19:35,050 --> 00:19:38,010
+بدها تزوّل الحموضة طب كيف بتزوّل الحموضة؟ بتزوّل
+
+281
+00:19:38,010 --> 00:19:41,130
+تانو أكسيد الكربون، هو تانو أكسيد الكربون إذا،
+
+282
+00:19:41,130 --> 00:19:44,590
+Disease بيعمل حموضة، طب وكيف بتزوّل تانو أكسيد
+
+283
+00:19:44,590 --> 00:19:49,770
+الكربون؟ بيعمل accumulation للـ CO2 بكل بساطة أقل
+
+284
+00:19:49,770 --> 00:19:53,260
+الأدنى المرة، دي التنفس، أه، Bravo، صحبالقلل عدد
+
+285
+00:19:53,260 --> 00:19:55,960
+مرات التنفس يعني بتعمل الـ Hypopigmentation هذا
+
+286
+00:19:55,960 --> 00:20:01,140
+هيخلّي المريض أنه يسير اندوز الـCO2 retention
+
+287
+00:20:01,140 --> 00:20:07,680
+وبالتالي الـ retention للـCO2 حاول يحسن حالة
+
+288
+00:20:07,680 --> 00:20:11,580
+الحنضية الأيضية الموجودة فينا اللي هو Metabolic
+
+289
+00:20:11,580 --> 00:20:13,280
+Acidosis وبالتالي
+
+290
+00:20:15,550 --> 00:20:20,210
+لو كينيكال مانيفيستاشن و المالكه هتكون بتختف من كل
+
+291
+00:20:20,210 --> 00:20:24,590
+مرض لأ مرض حسب إيش هو ال complaint اللي عند المريض
+
+292
+00:20:24,590 --> 00:20:27,330
+هل هو من related voting ولا هل .. بس كل أيدي و كل
+
+293
+00:20:27,330 --> 00:20:31,590
+الأحوال هلاجه أن المريض تعبان و حلاجه عنده خدال في
+
+294
+00:20:31,590 --> 00:20:36,650
+أطرافه هلاجي عنده دوخة و بالذات إرهاب في العضلات
+
+295
+00:20:36,650 --> 00:20:43,650
+علاجه علاج الكوز علاجه علاج الكوز تمام؟يعني لازم
+
+296
+00:20:43,650 --> 00:20:45,650
+ايش ال cause اللي عمل المرض هو يتقلل لما انت
+
+297
+00:20:45,650 --> 00:20:49,310
+بتعالج المرض ببنت الموضوع بس موضوع الكالسيوم اللي
+
+298
+00:20:49,310 --> 00:20:52,610
+بدي أحكيلكوا فيه كلمتين في حاجة اسمها ionized
+
+299
+00:20:52,610 --> 00:20:55,330
+calcium مش هذا ال ionized calcium هذا ال free
+
+300
+00:20:55,330 --> 00:20:59,150
+living الكالسيوم اللي مش مرتبط مش مرتبط إيه هو
+
+301
+00:20:59,150 --> 00:21:03,610
+الكالسيوم أصلا هذا أصلا هو intracellular إيش
+
+302
+00:21:07,450 --> 00:21:11,830
+يعني من الـ Minerals اللي هي إيش؟ والمركبات mainly
+
+303
+00:21:11,830 --> 00:21:17,450
+Intracellular مش Extracellular طيب Okay بس طبعا
+
+304
+00:21:17,450 --> 00:21:21,190
+فيه منه موجود في الدم الدليل اللي احنا بنعمل إيش؟
+
+305
+00:21:21,190 --> 00:21:24,090
+Serum Calcium أه موجود منه في الدم بس اللي موجود
+
+306
+00:21:24,090 --> 00:21:28,270
+منه في الدم مكون مرتبط في البروتين تبع الدم اللي
+
+307
+00:21:28,270 --> 00:21:31,890
+هو في الألبومين آه ولذلك حتى في حالة اسمها ب
+
+308
+00:21:31,890 --> 00:21:35,330
+«Sido» اللي هو «Sidohypocalcemia» نتيجة
+
+309
+00:21:35,330 --> 00:21:39,230
+Hypoalbuminemiaفي معادلة اللي أخدتها medical
+
+310
+00:21:39,230 --> 00:21:44,130
+surgical one أنه ممكن يكون مريض ماعندهش البوكالسية
+
+311
+00:21:44,130 --> 00:21:48,190
+لكن عشان عنده hypoalbuminia فهو واضح أنه
+
+312
+00:21:51,620 --> 00:21:54,520
+هيبوكالسينيا، طبعا، يعني هذا دليل من أن الكارسيوم
+
+313
+00:21:54,520 --> 00:21:57,680
+جدا مرتبط في الألبومين، طب و بولار على الكلام هذا،
+
+314
+00:21:57,680 --> 00:22:02,480
+يدوب أو يعني يدوب 60%، مش يدوب، الكمية اللي بتضال
+
+315
+00:22:02,480 --> 00:22:06,740
+من الكارسيوم اللي بتضالها free عاشها في الجسم هيك،
+
+316
+00:22:06,740 --> 00:22:12,160
+في ال blood لحالها، مش مرتبطة، هي هذه الليبتشتغل
+
+317
+00:22:12,160 --> 00:22:15,060
+وبتأثر على الـ Function سبعة وتسعة أما الـ
+
+318
+00:22:15,060 --> 00:22:20,380
+Unbounded هذا مرضي، ماقدرش يتصرف طيب، عشان هيك
+
+319
+00:22:20,380 --> 00:22:25,320
+الهيبوكالسينيا ممكن تعمل مشكلة كبيرة إذا كانت في
+
+320
+00:22:25,320 --> 00:22:31,430
+الـ Unbounded هذاعشان يعني في دكاترة كتير لما بيجي
+
+321
+00:22:31,430 --> 00:22:35,490
+واحد بيقوله أنا بتشنج و بعمله فحص الـ Total
+
+322
+00:22:35,490 --> 00:22:38,690
+Calcium بيلاقيه كويس الـ Total Calcium اللي هو حد
+
+323
+00:22:38,690 --> 00:22:41,990
+اسمه الـ Bounded و الـ Unbounded فبروح بيقوله إيه
+
+324
+00:22:41,990 --> 00:22:46,290
+عشان أعملي لو سمحت الـ Ionized Calcium يعني اللي
+
+325
+00:22:46,290 --> 00:22:49,790
+ممكن يأثر على وظائف الجسم اللي بيأثر على ال body
+
+326
+00:22:49,790 --> 00:22:54,170
+function هذا لـ Free Calcium Level طيب روح بيعمله
+
+327
+00:22:54,170 --> 00:23:02,620
+فممكن يكون هنا Lowطيب واش دخل هذا الموضوع نه؟
+
+328
+00:23:02,620 --> 00:23:09,100
+جالك الـ Ionized Calcium هذا ممكن يرتبط مع الـ
+
+329
+00:23:09,100 --> 00:23:14,380
+Protein Molecule تمام؟ وبالتالي هيعمل Hydrogen Ion
+
+330
+00:23:14,380 --> 00:23:21,440
+لنفس الـالألبومين اللي موجود عندنا وبالتالي هذا
+
+331
+00:23:21,440 --> 00:23:27,760
+هيخلّي ارتباطات الـ Ionized Calcium في البروتين
+
+332
+00:23:27,760 --> 00:23:34,300
+أكتر ولمّا بتزيد ارتباطات الـ Calcium هذا في
+
+333
+00:23:34,300 --> 00:23:39,980
+البروتين هذا هيخلّي أن الـ BHT لو تقصد PND
+
+334
+00:23:40,270 --> 00:23:45,930
+الكالوسوس حالة الالكالوسوس بحجزها بتزود إمكانية
+
+335
+00:23:45,930 --> 00:23:49,070
+إرتباط الكالسيوم هذا في البروتين
+
+336
+00:23:52,640 --> 00:23:56,980
+إنه احنا عرفنا إنه في حد اسمها bounded calcium
+
+337
+00:23:56,980 --> 00:24:01,320
+وفيه free الـ free هذا طول ما هو موجود هو بيعمل
+
+338
+00:24:01,320 --> 00:24:05,380
+الـ function تبعات الجسم الـ alkalosis الـ
+
+339
+00:24:05,380 --> 00:24:08,260
+metabolic alkalosis اللي موجود هنا من مشاكله إنه
+
+340
+00:24:08,260 --> 00:24:14,840
+بيزود الإرتباط طبع الكالسيوم في البروتينات فإيش
+
+341
+00:24:14,840 --> 00:24:17,600
+حاسين إن ده؟ إذا الـ promote increase in protein
+
+342
+00:24:17,600 --> 00:24:23,250
+bindingEasy-free كالسيوم هيخلّي الـ Ionized
+
+343
+00:24:23,250 --> 00:24:25,990
+كالسيوم الـ Free اللي بيأثر على الـ Function تبع
+
+344
+00:24:25,990 --> 00:24:30,590
+كل الـ Body جليل وبالتالي إيش هذا هيعمل؟ هيعمل
+
+345
+00:24:30,590 --> 00:24:35,310
+فعلا مشاكل والموضوع مرتبط في مين؟ في الـ Alkalosis
+
+346
+00:24:35,310 --> 00:24:39,090
+إذا أنا من ضمن الـ Metabolic Alkalosis اللي عرفته
+
+347
+00:24:39,090 --> 00:24:41,850
+عرفت كمان إن الـ Metabolic Alkalosis ده ممكن
+
+348
+00:24:41,850 --> 00:24:45,310
+يتأثرلي على الـ Free كالسيوم اللي موجود في الجسم
+
+349
+00:24:45,310 --> 00:24:50,660
+وسيعمل عند المريض مشاكل اللي هدأ بالتشلجاتأه نتيجة
+
+350
+00:24:50,660 --> 00:24:55,920
+أن الـ Free Calcium أتأثر بسبب حالة الـ Alkalosis
+
+351
+00:24:55,920 --> 00:24:59,700
+أزدادت قدرته على الإرتباط في البروتين بعكس الـ
+
+352
+00:24:59,700 --> 00:25:03,040
+Acidosis، ماذا يحصل في الـ Acidosis؟ لأ، في حالة
+
+353
+00:25:03,040 --> 00:25:06,640
+الـ Acidosis الـ Acidosis بحالة ذاته بيجلل
+
+354
+00:25:06,640 --> 00:25:11,840
+الإرتباط الكالسيوم في البروتين وبالتالي الـ Free
+
+355
+00:25:11,840 --> 00:25:16,100
+Calcium مش ماله، مكون عالي الـ Free Calcium مش
+
+356
+00:25:16,100 --> 00:25:25,050
+مكون، مكونعالي وهذا برضه ممكن يعمل مشاكل لأنه برضه
+
+357
+00:25:25,050 --> 00:25:31,010
+لما بيزيد ال calcium في ال blood برضه ممكن يعمل
+
+358
+00:25:31,010 --> 00:25:41,250
+نوع من اللي هو التصلب تبع الأنسجة والعضلات
+
+359
+00:25:41,930 --> 00:25:48,290
+هك احنا خلصنا الـ Metabolic Acidosis و الـ
+
+360
+00:25:48,290 --> 00:25:52,550
+Metabolic
+
+361
+00:25:52,550 --> 00:25:56,410
+Alkalosis صحيح تمام؟ و بدنا نحكي عن ال Respiratory
+
+362
+00:25:56,410 --> 00:26:00,950
+Acidosis و ال Respiratory Alkalosis و بعد هيك بدنا
+
+363
+00:26:00,950 --> 00:26:07,110
+نحكي عن ال compensation و نشوف كيف خطوات ترجمة ال
+
+364
+00:26:07,110 --> 00:26:11,620
+blood gases ان شاء الله رب العالمين هذابدي أخليكوا
+
+365
+00:26:11,620 --> 00:26:16,120
+يا في الفيديو أو في المحاضرة القادمة يعطيكم
+
+366
+00:26:16,120 --> 00:26:20,200
+العافية والسلام عليكم ورحمة الله
+
diff --git a/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/c4LhutotWdI.srt b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/c4LhutotWdI.srt
new file mode 100644
index 0000000000000000000000000000000000000000..950dee7f05838a7ab6df0506aff241df5c118f52
--- /dev/null
+++ b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/c4LhutotWdI.srt
@@ -0,0 +1,1975 @@
+
+1
+00:00:07,090 --> 00:00:09,890
+بسم الله الرحمن الرحيم السلام عليكم ورحمة الله
+
+2
+00:00:09,890 --> 00:00:14,150
+وبركاته اليوم
+
+3
+00:00:14,150 --> 00:00:20,090
+إن شاء الله رب العالمين نحكي عن المحاضرة الأولى في
+
+4
+00:00:20,090 --> 00:00:25,310
+Introduction to Critical Care Nursing مصاد للرعاية
+
+5
+00:00:25,310 --> 00:00:34,630
+الحديثة للتمريض أو الرعاية الحرجة أو تمريض الرعاية
+
+6
+00:00:34,630 --> 00:00:37,840
+الحرجة، معكم إن شاء الله رب العالمين، هتكون الدكتور
+
+7
+00:00:37,840 --> 00:00:41,160
+خالد جمال فضورة، Assistant Professor of
+
+8
+00:00:41,160 --> 00:00:49,540
+Epidemiology. طبعاً الحمد لله رب العالمين، أنا يعني
+
+9
+00:00:49,540 --> 00:00:54,460
+عملت في التمريض المركّز لأكثر من 12 سنة
+
+10
+00:00:54,460 --> 00:00:58,980
+كنت Registered
+
+11
+00:00:58,980 --> 00:01:04,280
+Nurse في الـ ICU في مستشفى الشفاء وفي مستشفى القدس
+
+12
+00:01:04,280 --> 00:01:11,780
+أيضاً، وكنت رئيس قسم الـ ICU الخاصة بالقلب المفتوح
+
+13
+00:01:11,780 --> 00:01:15,780
+Open Heart Surgery Cardiac Care Intensive Care
+
+14
+00:01:15,780 --> 00:01:25,540
+Unit Post Cardiac Surgery. طبعاً كذلك كنت رئيس قسم
+
+15
+00:01:25,540 --> 00:01:31,460
+إنعاش مركّز في مستشفى الخدمات العامة لجراحة القلب
+
+16
+00:01:31,460 --> 00:01:32,480
+المفتوح.
+
+17
+00:01:34,520 --> 00:01:38,500
+إن شاء الله رب العالمين، في هذا الـ course هنتناول مع
+
+18
+00:01:38,500 --> 00:01:44,080
+بعض مقدمة عن الـ Critical Care Nursing. إيش يعني
+
+19
+00:01:44,080 --> 00:01:48,040
+الـ ICU؟ إيش يعني الـ Critical Care Nurse؟ وإيش
+
+20
+00:01:48,040 --> 00:01:51,260
+يعني الـ Critically Ill Patients؟ كيف بعمل
+
+21
+00:01:51,260 --> 00:01:54,520
+assessment لـ Critically Ill Patient؟ وبحدد إن هو
+
+22
+00:01:54,520 --> 00:01:58,720
+ليه يكون أنه Critically Ill؟ إيش مواصفات الـ ICU؟ إيش
+
+23
+00:01:58,720 --> 00:02:02,440
+مواصفات المكان اللي بيستقبل فيه حالات الحرجة
+
+24
+00:02:02,440 --> 00:02:06,240
+وبيتعامل معاها؟ كم هي الحالات الحرجة؟ إيش هي الـ
+
+25
+00:02:06,240 --> 00:02:11,580
+Ethical Considerations للناس اللي بنعالجهم في الـ ICU؟
+
+26
+00:02:11,580 --> 00:02:15,600
+وإيش ممكن إحنا نواجهه من ethical dilemmas؟ إيش هي
+
+27
+00:02:15,600 --> 00:02:18,760
+المشاكل والـ stress اللي بنواجهه؟ وإيه الـ burnout
+
+28
+00:02:18,760 --> 00:02:22,060
+Syndrome؟ اللي ممكن يصير في نتيجة العمل في
+
+29
+00:02:22,060 --> 00:02:25,960
+الأماكن الـ high-acuity، نسميها؟ بعدين هندخل للـ
+
+30
+00:02:25,960 --> 00:02:30,320
+unit الثاني، وقدرنا نحكي في لبّ الموضوع اللي هو الـ
+
+31
+00:02:30,320 --> 00:02:36,260
+acid-base balance. إيش هو التوازن تبع الـ Acid-Base
+
+32
+00:02:36,260 --> 00:02:39,260
+اللي ربنا خلقه، الحمضية والقلوية في جسم الإنسان،
+
+33
+00:02:39,260 --> 00:02:42,640
+إيش هو التعريف تبعه، إيش هو الـ Buffer System هذا
+
+34
+00:02:42,640 --> 00:02:47,360
+النظام اللي بيعمل الإتزان في الجسم، بيحافظ عليه، إيش
+
+35
+00:02:47,360 --> 00:02:52,060
+هم الأجهزة، إيش الحالات الفسيولوجية والمَرَضية اللي
+
+36
+00:02:52,060 --> 00:02:59,950
+بتصير نتيجة خربطة أو اضطراب في حالة الإتزان الـ
+
+37
+00:02:59,950 --> 00:03:06,370
+Acid-Base الحمضية القاعدية في الجسم، وموضوع الجهاز
+
+38
+00:03:06,370 --> 00:03:13,330
+التنفس الاصطناعي كمقدمة، وموضوع مهم جدًا لمواضيع
+
+39
+00:03:13,330 --> 00:03:16,770
+الـ Respiratory Illnesses اللي في الـ Chapter الثالث
+
+40
+00:03:16,770 --> 00:03:20,450
+اللي هو الـ Acute Respiratory Failure و Acute
+
+41
+00:03:20,450 --> 00:03:22,490
+Respiratory Distress Syndrome، الـ ARDS،
+
+42
+00:03:22,490 --> 00:03:27,410
+والـ Pneumothorax والـ Pleurisy والـ Hemothorax
+
+43
+00:03:27,410 --> 00:03:34,530
+كل هذه المواضيع هيكون يعني تفصيلها وشرحها معانا،
+
+44
+00:03:34,530 --> 00:03:41,630
+وهيكون علاجها أو الطريقة اللي بنستخدمها الـ
+
+45
+00:03:41,630 --> 00:03:44,030
+Supportive Management of the Respiratory System
+
+46
+00:03:44,030 --> 00:03:49,770
+لـ Most Obese Respiratory Diseases and
+
+47
+00:03:49,770 --> 00:03:53,730
+Acid-Base Balance Disturbances Disorders will be
+
+48
+00:03:53,730 --> 00:03:57,170
+treated by، اللي هو الـ Mechanical Ventilator، فالـ
+
+49
+00:03:57,170 --> 00:04:01,690
+Mechanical Ventilator سيتحدث في التفاصيل، ومن ثم
+
+50
+00:04:01,690 --> 00:04:08,310
+سنقوم بالحديث عن تغيير، أو تحديث، تغيير الـ Hemodynamics
+
+51
+00:04:08,310 --> 00:04:12,050
+(Repeated word removed)
+
+52
+00:04:12,050 --> 00:04:13,550
+(Repeated word removed)
+
+53
+00:04:13,550 --> 00:04:16,810
+(Repeated word removed)
+
+54
+00:04:16,810 --> 00:04:18,960
+(Repeated word removed) أو الـ Hemodynamic Stability
+
+55
+00:04:18,960 --> 00:04:24,020
+ومراقبة الحالة الطبيعية في مجلس التعامل التقليدي بما يسمى
+
+56
+00:04:24,020 --> 00:04:29,200
+Invasive و Non-Invasive methods. لذلك سنتحدث أيضًا عن
+
+57
+00:04:29,200 --> 00:04:32,840
+المشاكل العصبية والمشاكل التنفسية
+
+58
+00:04:32,840 --> 00:04:36,340
+(Repeated phrase removed)
+
+59
+00:04:36,340 --> 00:04:39,140
+(Repeated phrase removed)
+
+60
+00:04:39,140 --> 00:04:41,560
+(Repeated phrase removed)
+
+61
+00:04:41,560 --> 00:04:43,540
+(Repeated phrase removed)
+
+62
+00:04:43,540 --> 00:04:44,160
+(Repeated phrase removed)
+
+63
+00:04:44,160 --> 00:04:47,840
+(Repeated phrase removed) ومشكلة الصدمة الخاصة
+
+64
+00:04:47,840 --> 00:04:50,740
+(Repeated phrase removed)
+
+65
+00:04:50,740 --> 00:04:53,320
+(Repeated phrase removed)
+
+66
+00:04:53,320 --> 00:04:53,480
+(Repeated phrase removed)
+
+67
+00:04:53,480 --> 00:04:55,920
+(Repeated phrase removed)
+
+68
+00:04:55,920 --> 00:04:59,160
+(Repeated phrase removed)
+
+69
+00:04:59,160 --> 00:05:00,880
+(Repeated phrase removed)
+
+70
+00:05:00,880 --> 00:05:04,480
+(Repeated phrase removed)
+
+71
+00:05:04,480 --> 00:05:10,280
+(Repeated phrase removed)
+
+72
+00:05:10,280 --> 00:05:16,500
+الصدمة، على المادة وأنتم مبسوطين ومرتاحين وما تتحلّلوش
+
+73
+00:05:16,500 --> 00:05:23,140
+همّلك. وزّع المحاضرة الأولى، هذه عبارة عن مقدمة بسيطة
+
+74
+00:05:23,140 --> 00:05:27,600
+وتلخيص في المادة ككل. اللي شرحته توا هو تلخيص
+
+75
+00:05:27,600 --> 00:05:34,340
+لإيش هناخذه خلال الفصل كاملاً بالإضافة إلى Chapter
+
+76
+00:05:34,340 --> 00:05:37,980
+الحروق. أنا نسيت أحطه في الـ slide.  الشابتر الـ burn
+
+77
+00:05:37,980 --> 00:05:41,580
+لأن أعتقد أنكم ما أخذتوّه.
+
+78
+00:05:44,060 --> 00:05:49,120
+وخاصة أنه موضوع الـ Burn من المواضيع اللي بيكون
+
+79
+00:05:49,120 --> 00:05:54,480
+فيه Need  لأن المريض يدخل الـ ICU. الآن هنبدأ نحكي عن
+
+80
+00:05:54,480 --> 00:05:58,320
+الجزء الأول في الـ unit الأولى، وهو نحكي عن
+
+81
+00:05:58,320 --> 00:06:00,260
+الـ Background عن الـ ICU.
+
+82
+00:06:02,470 --> 00:06:07,750
+الفيديو اللي عملناه  كان مباشر لكن أنا بعيد هنا
+
+83
+00:06:07,750 --> 00:06:10,350
+Definition of Critical Care Nursing. أشرح عن
+
+84
+00:06:10,350 --> 00:06:13,830
+Critical Care Nursing بمعنى أن الـ Critical Care
+
+85
+00:06:13,830 --> 00:06:18,510
+Nurse، هذا هو الممرض الـ practitioner اللي بيتعامل
+
+86
+00:06:18,510 --> 00:06:22,390
+مع الناس اللي عندها life-threatening problems، اللي
+
+87
+00:06:22,390 --> 00:06:27,010
+بيتعامل مع الناس اللي عندها مشاكل بتهدد حياتها
+
+88
+00:06:27,010 --> 00:06:34,190
+بالخطر، والـ والناس اللي بيكونوا زي ما بنسميها
+
+89
+00:06:34,190 --> 00:06:42,570
+معرضين للموت لو استمرت حالة تطور حالتهم بالسلب، فهذا
+
+90
+00:06:42,570 --> 00:06:46,190
+اسمه Critically Ill Patient.
+
+91
+00:06:49,010 --> 00:06:52,770
+لما بحكي أنا Critical Care، إيش معناها؟ معناها إنه
+
+92
+00:06:52,770 --> 00:06:58,350
+أقدّم رعاية لمرضى حياتهم مهددة بالخطر. الـ Critical
+
+93
+00:06:58,350 --> 00:07:02,670
+Care Nurse مين هو؟ هو الشخص المؤهل، الـ
+
+94
+00:07:02,670 --> 00:07:07,250
+Professional Nurse اللي بيستطيع إنه يتعامل مع
+
+95
+00:07:07,250 --> 00:07:11,990
+الناس اللي عندها الـ Critical أو اللي عندها Life
+
+96
+00:07:11,990 --> 00:07:15,090
+Threatening Conditions أو Problems، أو مش بس
+
+97
+00:07:15,090 --> 00:07:19,340
+المريض، والـ Family التابع له كمان. هذا هو الشخص
+
+98
+00:07:19,340 --> 00:07:25,540
+المؤهل لكلام هذا، عن طريق إنه بياخد Course في ICU أو
+
+99
+00:07:25,540 --> 00:07:29,920
+Critical Care Nursing، أو عن طريق إنه بياخد Master في
+
+100
+00:07:29,920 --> 00:07:33,980
+Critical Care Nursing، أو عن طريق إنه بياخد High
+
+101
+00:07:33,980 --> 00:07:39,860
+Diploma، بعد ما بيخلص General Nursing، بياخد High
+
+102
+00:07:39,860 --> 00:07:44,360
+Diploma in Critical Care Nursing. هذا هو الشخص اللي
+
+103
+00:07:44,770 --> 00:07:49,350
+بيتعامل وبيحق له أن يتعامل مع الـ Critically Ill
+
+104
+00:07:49,350 --> 00:07:56,090
+Patient، ويطلق عليه Critical Care Registered Nurse.
+
+105
+00:07:56,090 --> 00:07:59,610
+عشان هي الـ Critically Ill Patients، مين هم؟ زي ما
+
+106
+00:07:59,610 --> 00:08:07,510
+حكينا، الناس اللي عندهم أمراض تهدد حياتهم، سواء عن
+
+107
+00:08:07,510 --> 00:08:13,820
+طريق أنه فيه مرض أو أمراض تهدد حياته حاليًا، عن
+
+108
+00:08:13,820 --> 00:08:17,480
+طريق أنه فيه أكثر من Vital Organ، أو Vital Organ
+
+109
+00:08:17,480 --> 00:08:27,380
+محدد فيه خلل في عمله، أو إن احتماليه وضعه في هذا
+
+110
+00:08:27,380 --> 00:08:33,560
+الوضع سوف يؤدي إلى حصول خلل في Vital Organs، أو
+
+111
+00:08:33,560 --> 00:08:38,360
+أكثر من Vital Organ. يعني مثلًا، للتوضيح، لو جينا
+
+112
+00:08:38,360 --> 00:08:47,810
+نحكي عن شخص شاب، وفجأة راح يتدرب في الجيش، وهو يعني
+
+113
+00:08:47,810 --> 00:08:52,290
+ما كانش بيعمل رياضة قبل هيك، ومش متعود على ممارسة
+
+114
+00:08:52,290 --> 00:08:56,930
+الأعمال والمجهودات الشاقة. طيب إيش صار معه فجأة؟
+
+115
+00:08:56,930 --> 00:09:03,360
+بدأ يتدرب، وبدأ يعمل مجهودات شاقة، أكثر من احتمال
+
+116
+00:09:03,360 --> 00:09:08,700
+أو من قوته أو من تحمّل اللي بتتحمله عضلاته
+
+117
+00:09:08,700 --> 00:09:15,920
+تبعته. فبالتالي صار فيه Overuse، إرهاق للعضلات. لما صار فيه
+
+118
+00:09:15,920 --> 00:09:21,120
+Overuse، إرهاق للعضلات، بدأت العضلات تتكسر نتيجة الـ Overuse
+
+119
+00:09:21,120 --> 00:09:27,450
+تبعها. بدأت تفرز حاجة بنسميها الـ Myoglobin، اللي
+
+120
+00:09:27,450 --> 00:09:35,250
+هو إنزيم تبع العضلة، اللي بيطلع من العضلة وبيصل
+
+121
+00:09:35,250 --> 00:09:40,270
+للدم. وبعد ما يصل للدم، كل الـ Myoglobin هذا اللي
+
+122
+00:09:40,270 --> 00:09:43,710
+نتيجة الـ destruction تبع الـ muscle بيطلع، بيصل
+
+123
+00:09:43,710 --> 00:09:48,090
+لوين؟ للدم، من الدم للـ kidney. لما بيصل للـ kidney
+
+124
+00:09:48,090 --> 00:09:54,940
+بسبب تراكمه بشكل كبير، بيؤدي إلى فشل في الـ Kidneys
+
+125
+00:09:54,940 --> 00:09:57,820
+بسبب حاجة الـ Acute Renal Failure. هذه الحالة
+
+126
+00:09:57,820 --> 00:10:02,400
+بيسموها Rhabdomyolysis. Rhabdomyolysis، Myo من عضلة،
+
+127
+00:10:02,400 --> 00:10:07,220
+lysis يعني تحلل، تكسر، تكسر في العضلة.
+
+128
+00:10:11,090 --> 00:10:17,170
+اللي هو التكسر في إنزيمات العضلات، فبيؤدي إلى الـ
+
+129
+00:10:17,170 --> 00:10:20,890
+Acute Renal Failure. لو أنا جالي المريض وهو في
+
+130
+00:10:20,890 --> 00:10:25,410
+الحالة هذه، وفجأة لقيت إن كمية البول صارت عنده
+
+131
+00:10:25,410 --> 00:10:29,830
+ قليلة، وإنزيمات العضلات لقيتها مرتفعة جدًا عنده، زي
+
+132
+00:10:29,830 --> 00:10:34,590
+الـ CK مثلًا، لقيتها مرتفعة كثير. الآن أنا بعرف إن هذا
+
+133
+00:10:34,590 --> 00:10:38,430
+المريض لو تركته من غير Management، ومن غير اللي هو
+
+134
+00:10:38,430 --> 00:10:42,730
+حاجة بنسميها Forced Diuresis، إنه ياخد كميات من الـ
+
+135
+00:10:42,730 --> 00:10:48,110
+Fluid، وجرعات من الـ Lasix أيضًا، في حس أنه يشجّع
+
+136
+00:10:48,110 --> 00:10:53,730
+الكلية أن تشتغل وتدر البول، وإلّا هيتوقف عندها
+
+137
+00:10:53,730 --> 00:10:58,310
+الكلية تمامًا، ويدخل في Acute Renal Failure. إذًا
+
+138
+00:10:58,310 --> 00:11:03,230
+هذا مثال أنا طرحته بس عشان تعرفوا كيف أنه أنا ممكن
+
+139
+00:11:03,230 --> 00:11:06,190
+أعالج الموضوع إذا كان فيه Impairment في الـ Vital
+
+140
+00:11:06,190 --> 00:11:09,710
+Organ. فيه Already Renal Failure، فهو Critically Ill، أو
+
+141
+00:11:09,710 --> 00:11:16,220
+أنا بتوقع Potential إن هذا لو ما تدخّلنا هيصير عنده، أو
+
+142
+00:11:16,220 --> 00:11:19,860
+موضوع ثاني، وكثير عنده Respiratory Failure. مريض
+
+143
+00:11:19,860 --> 00:11:24,440
+جايك أزمته من COPD، أو بالهاتف الـ Respiratory Rate
+
+144
+00:11:24,440 --> 00:11:28,300
+عالي. لو أنت ما عملتش معه في الآخر، هيخش في
+
+145
+00:11:28,300 --> 00:11:32,020
+Respiratory Failure. عشان هيك، في أي مكان
+
+146
+00:11:34,640 --> 00:11:37,720
+والشخص متأكد من أنه سيموت لا يمكن أن نقول له أنه
+
+147
+00:11:37,720 --> 00:11:39,120
+(Repeated word removed)
+
+148
+00:11:39,120 --> 00:11:40,900
+(Repeated word removed)
+
+149
+00:11:40,900 --> 00:11:44,480
+(Repeated word removed)
+
+150
+00:11:44,480 --> 00:11:46,760
+(Repeated word removed)
+
+151
+00:11:46,760 --> 00:11:47,240
+(Repeated word removed)
+
+152
+00:11:47,240 --> 00:11:53,920
+(Repeated word removed)
+
+153
+00:11:53,920 --> 00:12:03,780
+(Repeated word removed)  فيه، يعني ما فيش أي أمل إنه يصير عنده
+
+154
+00:12:03,780 --> 00:12:10,680
+تحسن ويصير Good Prognosis. برضه هذا ما بيكونش فيه
+
+155
+00:12:10,680 --> 00:12:14,760
+Need  لأنّه مركز. ها، كيف يعني؟ إذا بتقول Critically
+
+156
+00:12:14,760 --> 00:12:18,140
+Ill و Life Threatening Condition، هدول بيكونوا هم
+
+157
+00:12:18,140 --> 00:12:22,580
+معناهم لـ Critically Ill. كيف بتقول لما بيكون المريض
+
+158
+00:12:22,580 --> 00:12:27,600
+يعني الموت عنده حتمي، بيبطل بده Intensive Care. آه،
+
+159
+00:12:27,600 --> 00:12:31,880
+لما بيكون عنده الموت حتمي، صار إيش أهمية إن أنا
+
+160
+00:12:31,880 --> 00:12:36,100
+أراعيه بشكل Intensive؟ أقدّم له Intensive Care؟
+
+161
+00:12:39,200 --> 00:12:44,060
+ما لهاش أي أهمية، لأن مش هأحسن من النهاية المعروفة.
+
+162
+00:12:44,060 --> 00:12:48,160
+زي مثلًا الحالات اللي عندها Multi-Organ System
+
+163
+00:12:48,160 --> 00:12:51,400
+Failure. واحد عنده Cancer في الـ Brain، وصار عنده
+
+164
+00:12:51,400 --> 00:12:55,180
+Metastasis، أو Cancer في الـ Lung، خليني أقول، وصار عنده
+
+165
+00:12:55,180 --> 00:12:59,320
+Metastasis للـ Brain، وخش في Renal Failure. فالمريض هذا
+
+166
+00:12:59,320 --> 00:13:03,000
+صار فيه عنده Respiratory Failure، وصار فيه عنده
+
+167
+00:13:03,000 --> 00:13:09,670
+Kidney Failure، وصار فيه عنده اللي هو الـ Neurological
+
+168
+00:13:09,670 --> 00:13:13,790
+Failure. يعني الـ Nervous System تبعتة. وكمان إيش الـ
+
+169
+00:13:13,790 --> 00:13:16,410
+Glasgow Coma Scale  ده ما صار مثلًا تلاتة. يعني صار ما فيش
+
+170
+00:13:16,410 --> 00:13:23,530
+عنده Consciousness، بطل Conscious، بطل Oriented. فصار
+
+171
+00:13:23,530 --> 00:13:31,540
+فيه عندي تلاتة Organs أساسية: جهاز العصبي، الجهاز الـ
+
+172
+00:13:31,540 --> 00:13:36,820
+Circulatory، لأنه بعد الـ Kidney Failure هيحصّل برضه
+
+173
+00:13:36,820 --> 00:13:41,160
+Heart Failure، لأنه ما بيتصفّى السوائل تبع الجسم، ما
+
+174
+00:13:41,160 --> 00:13:46,320
+بتنطرحش، وبالتالي صار فيه أكثر من Organ فيه Failure،
+
+175
+00:13:46,320 --> 00:13:48,760
+الـ Kidney فيها Failure، الـ Lung فيها Failure،
+
+176
+00:13:48,760 --> 00:13:51,900
+الـ Brain فيه Failure. وبالتالي هذا المريض إيش؟
+
+177
+00:13:51,900 --> 00:13:57,380
+يعني توقعنا لتحسنه؟ مستحيل، مستحيل التلاتة
+
+178
+00:13:57,380 --> 00:14:01,140
+حاجات هدول يطيبوا، التلاتة Organs هدول يتحسنوا
+
+179
+00:14:01,140 --> 00:14:07,190
+ويشفوا ويرجع المريض، ويرجع المريض أنه يكون إيش؟ والـ
+
+180
+00:14:07,190 --> 00:14:12,730
+Pain، طبعًا هذا المريض بالأغلب Will Die. علشان هيك،
+
+181
+00:14:12,730 --> 00:14:16,890
+النوع العلاج المقدم له،
+
+223
+00:17:39,190 --> 00:17:43,350
+Nurse أنه يشتغلوا في الـ catheter lab نفسها الـ
+
+224
+00:17:43,350 --> 00:17:46,490
+Preparation وفي الـ Post of Receiving تبقى الـ
+
+225
+00:17:46,490 --> 00:17:49,690
+Patient بعد الـ Catheter Lab بإنه يكون High
+
+226
+00:17:49,690 --> 00:17:53,790
+-Risky لأنه يخشى بـ Dysrhythmia أو بـ Bleeding وفيه
+
+227
+00:17:53,790 --> 00:17:59,090
+حاجات كتير فبده Invasive Monitoring وبده لأنه يمكن
+
+228
+00:17:59,090 --> 00:18:03,490
+يصير عنده Bleeding ويصير عنده Dysrhythmia وبده ECG
+
+229
+00:18:03,490 --> 00:18:07,850
+Monitoring وعلشان هيك كمان الـ Emergency
+
+230
+00:18:07,850 --> 00:18:10,630
+Departments من الحاجات الـ Critically
+
+231
+00:18:12,920 --> 00:18:16,620
+من الـ Hot Area إلى الـ Critical Care Nurse يعني
+
+232
+00:18:16,620 --> 00:18:20,240
+ممكن يشتغل فيها ومطمأن أنه يشتغل فيها وأيضاً
+
+233
+00:18:20,240 --> 00:18:24,860
+Recovery Room اللي في غرف العمليات كل هذه الأماكن
+
+234
+00:18:24,860 --> 00:18:27,660
+اللي في غرف العمليات عارفين Recovery Room غرفة
+
+235
+00:18:27,660 --> 00:18:30,380
+الإنعاش بعد ما يطلع المريض من العملية لازم يكون
+
+236
+00:18:30,380 --> 00:18:35,180
+فيه Critical Care Nurse موجود عشان يشتغل مع المريض
+
+237
+00:18:35,180 --> 00:18:38,420
+لأنه بيكون في life-threatening condition خمس، عشر
+
+238
+00:18:38,420 --> 00:18:42,640
+دقائق إذا عدوا بسلام هيطلع المريض يكمل هذا إن شاء
+
+239
+00:18:42,640 --> 00:18:45,740
+الله كويس، otherwise ممكن المريض يصير عنده
+
+240
+00:18:45,740 --> 00:18:50,040
+suffocation يمكنه يخش بـ relapse من الاناستيزيا
+
+241
+00:18:50,040 --> 00:18:53,300
+ويفقد الـ conscious level تبعته يخش بـ ريطه
+
+242
+00:18:53,300 --> 00:18:58,420
+الـ failure again فهذه من الأماكن جداً المهمة أنه
+
+243
+00:18:58,420 --> 00:19:03,450
+يشتغل فيها الـ Critical Care Nurse طبعاً أنا أحب
+
+244
+00:19:03,450 --> 00:19:07,750
+أضيف لكم على الكلام هذا أنه مش بس هذه الأماكن اللي
+
+245
+00:19:07,750 --> 00:19:11,930
+بيشتغل فيها الـ Critical Care Nurse لأ كمان في
+
+246
+00:19:11,930 --> 00:19:16,130
+أماكن ثانية زي الـ Home Care Nursing لأن هذا
+
+247
+00:19:16,130 --> 00:19:22,450
+الممرض هو ممرض قادر على أنه يتعامل مع الحالات
+
+248
+00:19:22,450 --> 00:19:33,130
+الحرجة في البيوت ويقدم لها الرعاية الطبية اللازمة
+
+249
+00:19:33,130 --> 00:19:44,430
+Okay
+
+250
+00:19:44,430 --> 00:19:50,670
+طيب
+
+251
+00:19:52,190 --> 00:19:55,130
+بعد مدرسة مدرسة يمكن أن يكون مدرساً مدرساً
+
+252
+00:19:55,130 --> 00:20:20,610
+مدرساً مدرساً مدرساً مدرساً مدرساً
+
+253
+00:20:22,060 --> 00:20:31,040
+أو يعني يستطيع أنه يـ find out اللي هو مشاكل معينة
+
+254
+00:20:31,040 --> 00:20:36,200
+ويحاول يعمل لها research عشان يوصل لـ نتيجة معينة من
+
+255
+00:20:36,200 --> 00:20:39,980
+الناس اللي كتير كويسين يُعرفونه managers هم
+
+256
+00:20:39,980 --> 00:20:44,900
+الـ critical care nurses ولذلك يمكن تلاحظوا في معظم
+
+257
+00:20:44,900 --> 00:20:51,850
+مستشفيات القطاع الخاص عمل بالإناء المركزة يعني معظمهم
+
+258
+00:20:51,850 --> 00:20:57,250
+رؤساء أقسام ومشرفين ومدراء مستشفيات حتى الـ
+
+259
+00:20:57,250 --> 00:21:01,970
+clinical care nurse, clinical nurse specialists, and
+
+260
+00:21:01,970 --> 00:21:07,130
+nurse practitioners حكيناهم قبل كده. The critical care
+
+261
+00:21:07,130 --> 00:21:09,530
+nurse is responsible for the identification,
+
+262
+00:21:09,530 --> 00:21:13,010
+intervention, and management of clinical problems to
+
+263
+00:21:13,010 --> 00:21:18,790
+improve patient care, intervention and families. واحد يقولنا
+
+264
+00:21:18,790 --> 00:21:20,930
+كل شوية الله يقولنا، فماشي دخلنا إحنا في الـ
+
+265
+00:21:20,930 --> 00:21:26,650
+families؟ لأ، الـ families إلها دور، إحنا معانا دور كبير
+
+266
+00:21:26,650 --> 00:21:33,170
+في الـ nursing وفي اللي هو الـ critical care nurse
+
+267
+00:21:33,170 --> 00:21:37,210
+اللي له دور كبير مع الـ family، كيف؟ تو إحنا حكينا
+
+268
+00:21:37,210 --> 00:21:41,370
+إن الـ critical care nurse بدّه يكون كمان nurse
+
+269
+00:21:41,370 --> 00:21:44,570
+educator، مش ضروري يكون بس educator للـ student
+
+270
+00:21:44,570 --> 00:21:48,400
+nurses، كمان للـ families، هدول كتير، ويكون في حالات
+
+271
+00:21:48,400 --> 00:21:53,680
+بتحتاج أن الـ family هم اللي يقدموا الخدمة، وحتى
+
+272
+00:21:53,680 --> 00:21:57,800
+ممكن زي ما حكيت أنا إن الـ Home Care المريض هذا
+
+273
+00:21:57,800 --> 00:22:02,040
+يكون وضعه critically ill وبعد ذلك يتحسن، بس يخش في
+
+274
+00:22:02,040 --> 00:22:06,600
+مرحلة من الحاجة
+
+275
+00:22:06,600 --> 00:22:10,240
+للـ Palliative Therapy زي الناس اللي بتصير عندهم
+
+276
+00:22:10,240 --> 00:22:14,040
+Quadriplegia وخلص ما فيش إمكانية إنه يبطّل الـ
+
+277
+00:22:14,040 --> 00:22:17,120
+Quadriplegia، بس بيصير طول عمره بده أنه بده
+
+278
+00:22:17,120 --> 00:22:21,260
+mechanical ventilator وبده حد يعمله hygiene وبده
+
+279
+00:22:21,260 --> 00:22:27,180
+حد يطعّمه وبده حد يشربه وبده حد يعمله self-care
+
+280
+00:22:27,180 --> 00:22:31,620
+hygiene زي ما حكينا، أو body care, health hygiene
+
+281
+00:22:31,620 --> 00:22:38,150
+فبالتالي بعد ما يقضي فترة معينة من وجوده في
+
+282
+00:22:38,150 --> 00:22:41,530
+العناية المركزة ممكن ينطلع على مركز تأهيل، في
+
+283
+00:22:41,530 --> 00:22:46,090
+النهاية بده يرجع للبيت وبده تكون الـ
+
+284
+00:22:46,090 --> 00:22:50,910
+family جزء من الناس اللي بيرعوه، حتى لو كان في home
+
+285
+00:22:50,910 --> 00:22:56,210
+care، ناس بتيجي تزوره، من الصعب أنه يغطي 24 ساعة
+
+286
+00:22:56,210 --> 00:23:01,210
+ممكن يعمله visit وكل يوم لعدد ساعات معينة، ويقيم
+
+287
+00:23:01,210 --> 00:23:05,870
+وضعه، وأكبر واجهة هيكون الأهل هم نفسهم اللي
+
+288
+00:23:05,870 --> 00:23:10,610
+بيقوموا برعاية المريض هذا، فبالتالي دورنا إنه
+
+289
+00:23:10,610 --> 00:23:16,390
+معهم، نعملهم education ونعلمهم على كل حاجة، حتى
+
+290
+00:23:16,390 --> 00:23:19,450
+الـ suctioning من الـ tracheostomy إذا كان ليه
+
+291
+00:23:19,450 --> 00:23:26,870
+tracheostomy، والـ feeding، والـ hygiene، حتى، وكمان
+
+292
+00:23:26,870 --> 00:23:31,270
+الطعام، والتعامل مع الـ gastrostomy وكل الأمور هذه، لذلك
+
+293
+00:23:31,270 --> 00:23:39,950
+يعني يجب أن الـ family يكون دورها مُقنّن، مُقَرّر
+
+294
+00:23:39,950 --> 00:23:43,430
+ومعلوم، إنه "توفير خدمة مباشرة للطب"، "توفير خدمة
+
+295
+00:23:43,430 --> 00:23:44,690
+مباشرة للطب"، "توفير خدمة مباشرة للطب"، "توفير خدمة
+
+296
+00:23:44,690 --> 00:23:46,270
+مباشرة للطب"، "توفير خدمة مباشرة للطب"، "توفير خدمة
+
+297
+00:23:46,270 --> 00:23:47,170
+مباشرة للطب"، "توفير خدمة مباشرة للطب"، "توفير خدمة
+
+298
+00:23:47,170 --> 00:23:50,190
+مباشرة للطب"، "توفير خدمة مباشرة للطب"، "توفير
+
+299
+00:23:50,190 --> 00:23:58,010
+خدمة مباشرة للطب"، "توفير خدمة مباشرة للطب"، "توفير
+
+300
+00:23:58,010 --> 00:24:02,690
+خدمة مباشرة للـ
+
+301
+00:24:02,730 --> 00:24:08,250
+وبجمع data عن الحالة اللي موجودة عندي، سواء كانت
+
+302
+00:24:08,250 --> 00:24:13,390
+subjective data أو objective data، وبعدين بحاول أحط
+
+303
+00:24:13,390 --> 00:24:17,090
+nursing diagnosis للمشاكل اللي موجودة، وبعدين بعمل
+
+304
+00:24:17,090 --> 00:24:20,770
+planning، أحلّ فيها كل nursing diagnosis حطيته
+
+305
+00:24:20,770 --> 00:24:24,230
+وبعدين ببدأ أطبّق الـ plan بتاعتي، وبعدين بعمل
+
+306
+00:24:24,230 --> 00:24:29,080
+evaluation للـ Interventions اللي أنا سوّيتها، و
+
+307
+00:24:29,080 --> 00:24:32,880
+بشوف إني وصلت للـ Goals اللي أنا already
+
+308
+00:24:32,880 --> 00:24:41,320
+حطيته في مرحلة الـ Assessment أو في... أو
+
+309
+00:24:41,320 --> 00:24:44,620
+في مرحلة، عفواً، الـ Planning، بعد ما أنا عملت
+
+310
+00:24:44,620 --> 00:24:47,160
+Planning، وصلت لـ Problems، حددت الـ Problems اللي
+
+311
+00:24:47,160 --> 00:24:49,800
+موجودة في الـ Planning، وحطيت Goals إن أنا بدي أعملها
+
+312
+00:24:49,800 --> 00:24:55,930
+Achievement، تمام؟ فـ Nursing Process، بس القصة إن
+
+313
+00:24:55,930 --> 00:25:05,930
+المريض critically ill، okay، الـ organization of ICU
+
+314
+00:25:05,930 --> 00:25:10,390
+كيف الـ ICU بتكون يعني منظّمة يا جماعة، الـ ICU
+
+315
+00:25:10,390 --> 00:25:14,310
+requires an intelligent planning that it must keep
+
+316
+00:25:14,310 --> 00:25:17,910
+the needs of the hospital and its location. One ICU
+
+317
+00:25:17,910 --> 00:25:26,840
+may not cater to all needs. أكيد ICU واحدة مش
+
+318
+00:25:26,840 --> 00:25:32,300
+هتكون تكفي في المستشفى، لكل المستشفى، وليس ذلك زي
+
+319
+00:25:32,300 --> 00:25:37,120
+ما شفنا، شفنا يعني إنه فيه أكتر من ICU مثلًا
+
+320
+00:25:37,120 --> 00:25:41,640
+the institute may plan its beds into multiple units
+
+321
+00:25:41,640 --> 00:25:44,260
+under separate management by single discipline
+
+322
+00:25:44,260 --> 00:25:48,900
+specialists, like medical ICU، surgical ICU، burn
+
+323
+00:25:48,900 --> 00:25:51,840
+ICU، trauma ICU،
+
+324
+00:25:53,920 --> 00:25:57,620
+Multidisciplinary ICUs require more than a single
+
+325
+00:25:57,620 --> 00:26:03,740
+specialty. ممكن يعني إحنا نعمل الـ ICU تبعنا ونحدد
+
+326
+00:26:03,740 --> 00:26:08,260
+إن هدول الأسرة للـ medical، هدول للجراحة، هدول للـ burn
+
+327
+00:26:08,260 --> 00:26:15,830
+هدول للـ trauma، وطبعاً في ناس بيعملوا يعني طريقة أفضل
+
+328
+00:26:15,830 --> 00:26:20,490
+وبيفصلوهم نهائياً، بيعملوا هذه واحدة كاملة للـ Cardiac
+
+329
+00:26:20,490 --> 00:26:24,090
+خاصة، مش بس الـ Meds بيستبعدوها، وبيكون مكانها بعيد
+
+330
+00:26:24,090 --> 00:26:28,050
+خالص، هذه واحدة كاملة بس للـ Surgical، للناس بعد
+
+331
+00:26:28,050 --> 00:26:31,290
+العمليات الجراحية اللي بيحتاجوا ICU وسموها Surgical
+
+332
+00:26:31,290 --> 00:26:35,990
+ICU، هذه ICU للمديكال، للناس اللي عندها مشاكل طبيعية
+
+333
+00:26:35,990 --> 00:26:41,090
+وناس هادية الـ Gynecology، للناس اللي في المستشفى
+
+334
+00:26:41,090 --> 00:26:43,350
+المواليد، أو يصيروا critically ill اللي بدهم ICU
+
+335
+00:26:43,350 --> 00:26:50,190
+هادية الـ Unit للناس تبعهم، هادية الـ Cardio ICU
+
+336
+00:26:50,190 --> 00:26:52,930
+هادية الـ Post-Catheterization Unit للناس اللي بعد
+
+337
+00:26:52,930 --> 00:26:53,570
+الـ قسطرة
+
+338
+00:27:00,490 --> 00:27:05,170
+ده عشان هي حسب إمكانياتهم، طبعاً العالم الآن حتى ميل
+
+339
+00:27:05,170 --> 00:27:08,430
+إلى التخصصية، فيه أنواع الجراحات، يعني مثلًا في
+
+340
+00:27:08,430 --> 00:27:12,970
+الباطنية، خليني أقول أولاً في الباطنية، المرضى الـ
+
+341
+00:27:12,970 --> 00:27:17,690
+Pulmonology، مرضى الصدرية والأمراض الرئوية، لحالهم،
+
+342
+00:27:17,870 --> 00:27:21,910
+مرضى الأمراض الأخرى، بيحطوهم لحالهم، مرضى القلب من ضمن
+
+343
+00:27:21,910 --> 00:27:26,270
+الباطنية لحالهم، بيعملوا لهم ICU منفصلة، الـ ICU في
+
+344
+00:27:26,270 --> 00:27:30,970
+الجراحة، للـ Urologic ICU، للأمراض العصبية، عمليات
+
+345
+00:27:30,970 --> 00:27:34,350
+المخ والأعصاب، عمليات الـ كذا، كل هذا ما يتعلق
+
+346
+00:27:34,350 --> 00:27:37,850
+بالأعصاب، هدول لهم ICU لحالهم، عمليات العظام
+
+347
+00:27:37,850 --> 00:27:38,710
+الـ Cyclical
+
+348
+00:27:41,300 --> 00:27:46,760
+بننزله على ICU خصوصي، للـ Orthopedic ICU، وبعض اللي
+
+349
+00:27:46,760 --> 00:27:50,140
+هو الـ Hand Surgery، والنيورولوجيك اللي هي الـ
+
+350
+00:27:50,140 --> 00:27:55,330
+Peripheral Neurosurgery، لأنها تُعتبر مناطق يعني
+
+351
+00:27:55,330 --> 00:27:59,730
+معقمة، عالية التعقيد، غير عن العمليات الجراحية اللي
+
+352
+00:27:59,730 --> 00:28:02,610
+بتصير في البطن، البطن يُعتبر Dirty، فعشان ايه
+
+353
+00:28:02,610 --> 00:28:04,790
+الـ General Surgery اللي بيسموها ده بقى الـ GI
+
+354
+00:28:04,790 --> 00:28:10,850
+System، اللي عادة ICU لحالها، لأنها تُعتبر أقل إيش يعني
+
+355
+00:28:10,850 --> 00:28:14,650
+Sterility، بتنقل في البطن، عادة في الـ intestine والـ
+
+356
+00:28:14,650 --> 00:28:18,820
+stomach والـ colon، وهذه كلها مناطق مش clean
+
+357
+00:28:18,820 --> 00:28:23,520
+بالمقارنة لما بنحكي مثلًا في واحد بيغيّر مفصل مثلًا
+
+358
+00:28:23,520 --> 00:28:27,720
+واحد عامل joint replacement، وعمليته طولت واستغرقت
+
+359
+00:28:27,720 --> 00:28:32,700
+أربع ساعات، وبعد هيك بدهم يعملوا له smooth extubation
+
+360
+00:28:32,700 --> 00:28:37,140
+بنسميه، أو واحد عمل brain surgery، وبعد ما عمل brain
+
+361
+00:28:37,140 --> 00:28:41,600
+surgery، وخيط الجرح، وعاني الـ tumor من الـ brain، بدهم
+
+362
+00:28:42,360 --> 00:28:46,680
+يودّوه على ICU for smooth extubation عشان يعملوا له
+
+363
+00:28:46,680 --> 00:28:49,600
+extubation يعني تدريجي، ويفصلوا عن جهاز التنفس
+
+364
+00:28:49,600 --> 00:28:53,040
+الصناعي، فمش مقبول أنه يودّوه على نفس العناية اللي
+
+365
+00:28:53,040 --> 00:28:57,360
+مع مريض عملوا له استئصال لـ tumor من الـ abdomen من
+
+366
+00:28:57,360 --> 00:29:01,520
+الـ colon، وفتحوا البطن تبعه، وإنه منفلورا مليانة
+
+367
+00:29:01,520 --> 00:29:08,290
+حواليه، هذه عملية مش التعقيم صحيح، وهذه عملية مش
+
+368
+00:29:08,290 --> 00:29:11,950
+التعقيم، لكن الـ sterility ما بين العملية تبع
+
+369
+00:29:11,950 --> 00:29:13,730
+الـ general surgery والعملية تبع الـ terminal
+
+370
+00:29:13,730 --> 00:29:21,030
+surgery بكتير مختلفة، عشان هي في three models of ICU
+
+371
+00:29:21,030 --> 00:29:27,330
+فيها تلاتة يعني نمطات أو أنماط، أو إيش بيطلع جمعها
+
+372
+00:29:27,330 --> 00:29:32,670
+بكلمة، طيب، للموديل، للموديلات، تبقى الـ ICU فيها three
+
+373
+00:29:32,670 --> 00:29:35,750
+models، الأولاني اسمه open model، إيش يعني open
+
+374
+00:29:35,750 --> 00:29:41,270
+model؟ أماه، أماه، in this model, physician admits
+
+375
+00:29:41,270 --> 00:29:46,010
+patients and discharges them in the open unit. الدكتور بيعمل
+
+376
+00:29:46,010 --> 00:29:49,530
+admission للحالة، دي الحالة بدل ما تروح ICU، بيعالجوا و
+
+377
+00:29:49,530 --> 00:29:52,510
+بيخرجوها كمان وقت ما هو حسّ الحالة صارت تمام
+
+378
+00:29:52,510 --> 00:29:55,370
+وترجع على اقتصاد، بيعملها discharge، which allowed
+
+379
+00:29:55,370 --> 00:29:57,970
+many different members of the medical staff to
+
+380
+00:29:57,970 --> 00:30:01,750
+manage patients in ICU. وبالتالي
+
+381
+00:30:02,960 --> 00:30:06,220
+وبالتالي ما فيش دكتور في جلب العناية المركزة، يا جماعة
+
+382
+00:30:06,220 --> 00:30:10,360
+أنا دكتور باطنة بشوف إن الحالة دي، ودي ICU، بعملها
+
+383
+00:30:10,360 --> 00:30:13,560
+admission، بعالجها في الـ ICU، بتعامل مع الـ
+
+384
+00:30:13,560 --> 00:30:16,480
+nurses هنا، و بقت حالتها مستقرة كويسة، بعملها
+
+385
+00:30:16,480 --> 00:30:20,020
+discharge، وبطلّعها، فكل الـ الذكاء يرجع يكون طبيب
+
+386
+00:30:20,020 --> 00:30:27,130
+ICU أو مش طبيب ICU، يعني طبيب قرّر اللي هو احتياج
+
+387
+00:30:27,130 --> 00:30:30,730
+المريض لخدمة الـ ICU، وهذه الطريقة موجودة منها في
+
+388
+00:30:30,730 --> 00:30:35,290
+مستشفيات بريطانيا، ولذلك لا يوجد طبيب ICU في هذه
+
+389
+00:30:35,290 --> 00:30:39,350
+النظام، لأ، في الـ nurses هم كل حاجة، بيجي الطبيب وهو
+
+390
+00:30:39,350 --> 00:30:42,550
+يمكن أن يحصل دخول، كذا، كطبيب باطنة، اللي بعده طبيب
+
+391
+00:30:42,550 --> 00:30:45,550
+قلب، اللي بعده طبيب أعصاب، حسب إيش مناه الـ ICU
+
+392
+00:30:45,550 --> 00:30:50,260
+وبيدخل الحالة ويكتب خطة العلاج ويمشي، تاني يوم بيروح
+
+393
+00:30:50,260 --> 00:30:53,760
+عليها، تالت يوم آه أنا شايفها صارت كويسة، أنا أعمله
+
+394
+00:30:53,760 --> 00:30:56,260
+الـ Discharge، بكتب الـ Discharge، وطبعاً بنسق و
+
+395
+00:30:56,260 --> 00:30:59,780
+بطلّعها على القسم إن هو نسق معاه، فهذه طريقة الـ
+
+396
+00:30:59,780 --> 00:31:04,120
+Open Model. الـ Closed Model، الـ Closed Model لأ
+
+397
+00:31:04,120 --> 00:31:07,480
+هاد الـ Admission والـ Discharge والـ Referral
+
+398
+00:31:07
+
+445
+00:34:49,810 --> 00:34:54,590
+مهمة مثل الـFaculty Group لاحظ حتى في البناء باللغة
+
+446
+00:34:54,590 --> 00:34:59,110
+بحاول أن يكون الـICU قريبة من أقسام العمليات، قريبة
+
+447
+00:34:59,110 --> 00:35:03,540
+من الـEmergency Department، قريبًا من الأقسام الـ
+
+448
+00:35:03,540 --> 00:35:08,960
+Hot، زي قسم القسطرة، يعني إذا أنا عملت قسطرة، الـICU لقسم
+
+449
+00:35:08,960 --> 00:35:11,900
+القسطرة لازم تكون قريبة منه، في نفس الـlevel، في
+
+450
+00:35:11,900 --> 00:35:15,560
+نفس الطابق، مش تكون في طابق مختلف، إذا أنا عملت ICU
+
+451
+00:35:15,560 --> 00:35:21,100
+للجراحة، فلازم تكون في نفس طابق العمليات، إذا أنا
+
+452
+00:35:21,100 --> 00:35:26,960
+أعمل ICU، عشان أي مريض ما أبعده كتير، نازلة
+
+453
+00:35:26,960 --> 00:35:30,500
+الأقسام الجراحية برضه لازم تكون في نفس المبنى، مش
+
+454
+00:35:30,500 --> 00:35:34,160
+هيكون الـICU في مبنى، والأقسام الجراحية في مبنى
+
+455
+00:35:34,160 --> 00:35:38,360
+آخر، هذه لازم يراها من الدماغ، there should be a
+
+456
+00:35:38,360 --> 00:35:42,740
+sufficient number of lifts available، لازم يكون عدد
+
+457
+00:35:42,740 --> 00:35:46,620
+المصاعد في المبنى متوافق، رخاصة إذا كانت الـICU
+
+458
+00:35:46,620 --> 00:35:50,790
+مثلاً في طابق أرضي، أو ربما في نفس الطابق اللي فيه
+
+459
+00:35:50,790 --> 00:35:54,390
+العمليات، لكن بقية الأقسام اللي ما رجعت عبّوها في
+
+460
+00:35:54,390 --> 00:35:55,990
+الطابق الثالث أو الرابع
+
+461
+00:35:58,900 --> 00:36:04,440
+لفت مخصص، أو أسانسير مخصص لنقل الحالات الحرجة، هاي
+
+462
+00:36:04,440 --> 00:36:08,520
+عشان ما أروحش إيه الحاجة، الأسانسير، والله في ناس في
+
+463
+00:36:08,520 --> 00:36:13,660
+الدور السفلي تتأخر، ما أنصحش، ICU with fewer than 4
+
+464
+00:36:13,660 --> 00:36:18,760
+beds are not cost effective, and over 20 beds are
+
+465
+00:36:18,760 --> 00:36:26,610
+unmanageable، لما يكون الـICU يا جماعة أقل من أربعة
+
+466
+00:36:26,610 --> 00:36:31,410
+أسرّة، يعني إحنا عاملين ICU بسريرين، هذه بتكون
+
+467
+00:36:31,410 --> 00:36:36,670
+تكلفتها عالية كتير، لإنه يعني إن أنت جايب سريرين أو
+
+468
+00:36:36,670 --> 00:36:44,490
+ثلاثة، هتحتاج تقريبًا نفس الطاقة، يعني كده مثلاً لو
+
+469
+00:36:44,490 --> 00:36:49,690
+أنت عندك أربعة
+
+470
+00:36:49,690 --> 00:36:53,570
+beds، ممكن two nurses يشتغلوا معهم، يكونوا بكفاءة، كل
+
+471
+00:36:53,570 --> 00:36:58,150
+ممرض ياخد اثنين، تمام؟ الـideal كيف أنه نجمع؟
+
+472
+00:36:58,150 --> 00:37:01,250
+الـideal أنه لما تكون الحالة hot، تشتغل معها one
+
+473
+00:37:01,250 --> 00:37:04,450
+nurse لـone patient، بس هاد لما تكون الحالة لسة
+
+474
+00:37:04,450 --> 00:37:08,410
+hot، يعني طالعة من العمليات ولسة CPI، يعني very
+
+475
+00:37:08,410 --> 00:37:12,110
+critical، تمام؟ الحالة ما بتظلش طول الوقت يا جماعة
+
+476
+00:37:12,110 --> 00:37:16,430
+زي هيك، ممكن تظلها هيك، ثلاث ساعات، ست ساعات،
+
+477
+00:37:16,430 --> 00:37:20,050
+اثنتي عشرة ساعة، بعدين بتصير stability، وفي الأغلب بعد
+
+478
+00:37:20,050 --> 00:37:24,950
+ثلاث ساعات، كل الحالات بتخش في restabilization، بتبدأ
+
+479
+00:37:24,950 --> 00:37:28,190
+تصير مستقرة، وبيبدأ التعامل معاها يصير أهدأ
+
+480
+00:37:28,190 --> 00:37:32,110
+وبالتالي بيصير كل nurse يتعامل مع two patients
+
+481
+00:37:32,110 --> 00:37:39,770
+لاحظين كل nurse مع two patients، وبالتالي أربعة أسرّة
+
+482
+00:37:39,770 --> 00:37:44,330
+يعني بدي بس إنهم two nurses، وخلاص، أول ما بتيجي
+
+483
+00:37:44,330 --> 00:37:50,310
+الحالة hot، اثنين بيشتغلوا معاها لدرجة
+
+484
+00:37:50,310 --> 00:37:53,670
+إنّه بيصير two nurses لـone patient، بس هذا لفترة،
+
+485
+00:37:53,670 --> 00:37:57,550
+لفترة قصيرة، بعدين بياخذها واحد لحاله، واحد
+
+486
+00:37:57,550 --> 00:38:01,410
+nurse بيشتغل مع الحالة، طبعاً معه حالة ثانية
+
+487
+00:38:01,410 --> 00:38:05,730
+بس الحالة الثانية call، ففي ساعة أو ساعتين لو شغل
+
+488
+00:38:05,730 --> 00:38:10,230
+عنها، مش هتتأثر كتير، لإنها أصبحت call، أو زميله ممكن
+
+489
+00:38:10,230 --> 00:38:14,090
+يهتم بالحالة هذه الـcall، بينما تستقر حالتها
+
+490
+00:38:14,370 --> 00:38:19,190
+فالـKey اللي بيشتغلوا عليه في الـICU، إنّه ممكن إن
+
+491
+00:38:19,190 --> 00:38:22,290
+إحنا نقسم حسب إيش نوع الـICU، وإيش طبيعة الحالات
+
+492
+00:38:22,290 --> 00:38:25,750
+اللي بيعملها، وبينعمل إلها admission، One nurse
+
+493
+00:38:25,750 --> 00:38:29,850
+لـTwo patients، One nurse لـOne patient، One nurse
+
+494
+00:38:29,850 --> 00:38:33,090
+لـTwo patients، ممكن إنّه Two nurses لثلاثة
+
+495
+00:38:33,090 --> 00:38:37,030
+patients، تمام؟ عادة إن إذا كانت الـICU أكثر من
+
+496
+00:38:37,030 --> 00:38:40,670
+عشرين سرير، بتصير عملية السيطرة عليها عملية صعبة، لإن
+
+497
+00:38:40,670 --> 00:38:44,920
+الطاقة بتصير كبيرة كتير، الشيء الجيد هو الـ
+
+498
+00:38:44,920 --> 00:38:48,280
+Intensive
+
+499
+00:38:48,280 --> 00:38:55,780
+Care
+
+500
+00:38:55,780 --> 00:39:13,380
+Equipments
+
+501
+00:39:14,440 --> 00:39:18,660
+الشاشة المراقبة «Multi-Screen»، بدي اللي هو «Live
+
+502
+00:39:18,660 --> 00:39:22,360
+Support»، و«Emergency Station Devices»، يعني بدي DC
+
+503
+00:39:22,360 --> 00:39:25,600
+شوك، وبيدي الـ«Energy Scope»، وبيدي الـ«Emergency
+
+504
+00:39:25,600 --> 00:39:28,840
+Control» الكامل، لأنه «Light Threatening Condition»
+
+505
+00:39:28,840 --> 00:39:31,740
+فيه الـ«Diagnostic Devices» كتير، بحتاجها زي الـ
+
+506
+00:39:31,740 --> 00:39:35,120
+«Blood Gases»، و«Machines»، كل شيء اللي أنا بحتاجه
+
+507
+00:39:35,120 --> 00:39:38,350
+أن أعمله، زي اللي ممكن أحتاج أن أعمله، اللي هو
+
+508
+00:39:38,350 --> 00:39:44,350
+البرونكوسكوب، في الـICU، ممكن أحتاج أن أركّب له الـ
+
+509
+00:39:44,350 --> 00:39:48,990
+Central Line، عشان آخد الـCVB، فممكن، ممكن أحتاج
+
+510
+00:39:48,990 --> 00:39:54,070
+أركّب له الـArterial Line، عشان آخد الـInvasive
+
+511
+00:39:54,070 --> 00:39:58,110
+Blood Pressure، فبالتالي مش زي القسطرة، في حاجات كتير
+
+512
+00:39:58,110 --> 00:40:01,530
+بتلزمني، هنشوفها من وحدة «Patient Monitoring
+
+513
+00:40:01,530 --> 00:40:04,330
+Equipment»، طب عشان أنا أعمل Monitoring للـpatient،
+
+514
+00:40:04,330 --> 00:40:09,010
+إيش بده؟ بالـAcute Care Physiologic Monitoring
+
+515
+00:40:09,010 --> 00:40:14,200
+System، اللي هو الـMonitor Screen، وبده برسوركوميتر
+
+516
+00:40:14,200 --> 00:40:17,620
+يكون طالع منه برسوركوميتر، وبده Intracranial
+
+517
+00:40:17,620 --> 00:40:20,720
+Pressure Monitor، ممكن يكون طالع منه Transducer
+
+518
+00:40:20,720 --> 00:40:27,260
+عشان يقيس لي الـICP، تمام؟ نفس الـTransducer هذا
+
+519
+00:40:27,260 --> 00:40:32,720
+ممكن يستخدم يقيس لي الـCDP، وممكن يكون في عندي
+
+520
+00:40:32,720 --> 00:40:37,000
+أجهزة Monitor، جهاز يقول لي وقت شغل المرير، بدأ يتنفس
+
+521
+00:40:37,000 --> 00:40:41,360
+ولا لأ، هذا الـMonitor Screen اللي بنحكي عنه، طبعاً
+
+522
+00:40:41,360 --> 00:40:44,320
+هذا portable، زي ما أنتم شايفين، بس الـ«مونيتورات»
+
+523
+00:40:44,320 --> 00:40:47,560
+الكبيرة اللي بتشوفوها في المستشفى، بتكون أكبر من هنا
+
+524
+00:40:47,560 --> 00:40:51,480
+وفيها options كتير، طالع منها هذا الـ«Prop» اللي
+
+525
+00:40:51,480 --> 00:40:55,040
+بيعمل قياس للـOxygen Saturation، بتسميه «Pulse
+
+526
+00:40:55,040 --> 00:40:58,960
+Oximeter»، هذا جهاز بس «Pulse Oximeter» لحاله، بيقيس
+
+527
+00:40:58,960 --> 00:41:01,600
+الـ«Pulse Oximeter»، وبيقيس الـ«Heart Rate» من
+
+528
+00:41:01,600 --> 00:41:05,790
+الإصبع، من الـ«Peripheral»، من الـFinger، هذا الجهاز
+
+529
+00:41:05,790 --> 00:41:11,770
+اللي هو لأنه في الـICU بيسموه Amia Monitor، لما
+
+530
+00:41:11,770 --> 00:41:16,830
+يبطل الطفل فجأة يتنفس، بيصير يزمر، لأنه بيشتغل على
+
+531
+00:41:16,830 --> 00:41:23,010
+الـmovement تبع الـchest، هذا الجهاز اللي هو بيقيس
+
+532
+00:41:23,010 --> 00:41:30,130
+الـIntracranial Pressure، جدّاش الـICP، جدّاش الـ
+
+533
+00:41:30,130 --> 00:41:34,230
+Pressure داخل الـIntracranial، كل هذه اللي بتكون
+
+534
+00:41:34,230 --> 00:41:37,070
+يعني هذا موجود في كل مكان، هذا موجود في كل مكان، هذا
+
+535
+00:41:37,070 --> 00:41:40,090
+بس موجود في الخزانة، وهذا بس موجود في الـ
+
+536
+00:41:40,090 --> 00:41:45,180
+Neurologic ICP، كمان نحتاج للحاجات اللي بتلزمني لـ
+
+537
+00:41:45,180 --> 00:41:48,040
+Resuscitation، أولاً الـVentilator، الـVentilator
+
+538
+00:41:48,040 --> 00:41:51,080
+هو من أهم الحاجة اللي بيعمل Respiratory
+
+539
+00:41:51,080 --> 00:41:54,960
+Resuscitation، الـInfusion Pump، لإنه أنا بكون راكب
+
+540
+00:41:54,960 --> 00:41:59,160
+عليه اللي هو Dopamine، Dobutamine، Noradrenaline
+
+541
+00:41:59,160 --> 00:42:05,100
+وهذه بنسميها Inotropic Drugs، ووظيفتها تعمل اللي هو
+
+542
+00:42:05,100 --> 00:42:10,320
+Heart Resuscitation، إنعاش للقلب، وفي عندنا الـ
+
+543
+00:42:10,320 --> 00:42:15,160
+Crash Cart، في عندنا الـIntra-aortic Balloon Pump، بالـ
+
+544
+00:42:15,160 --> 00:42:20,660
+Intra-aortic Balloon Pump، من برضه من ضمن الحاجات اللي هي
+
+545
+00:42:20,660 --> 00:42:29,480
+بتعمل يعني Resuscitation برضه للـHeart، عن طريق إن
+
+546
+00:42:29,480 --> 00:42:34,200
+هو يعني هنشرحه بالتفصيل إحنا في Cardiology، بس
+
+547
+00:42:34,200 --> 00:42:45,880
+الفكرة عامة سريعة عنه، إنّه بيضعوا الـIntra-
+
+548
+00:42:45,880 --> 00:42:50,640
+aortic Balloon Pump في الأورط، فبيصير ينفخ، لما
+
+549
+00:42:50,640 --> 00:42:57,000
+ينفخ، وظيفته يزيد التروية تبع عضلة القلب نفسها، فلما
+
+550
+00:42:57,000 --> 00:43:05,930
+يزيد التروية تبع عضلة القلب نفسها، اللي هو
+
+551
+00:43:05,930 --> 00:43:11,810
+بيحسن من قوة عضلة القلب، وبيحسن من كفاءة عمل عضلة
+
+552
+00:43:11,810 --> 00:43:16,690
+القلب، وبالتالي هذا Resuscitation للـHeart، تمام؟
+
+553
+00:43:16,690 --> 00:43:22,090
+هنشوف مثلاً عضلة القلب، وانتشار الدم بالضبط، نقدر نشوف القلب
+
+554
+00:43:22,090 --> 00:43:27,350
+اللي هو، أو الـIntra-aortic Balloon Pump، لما تنفخ
+
+555
+00:43:27,350 --> 00:43:33,490
+ترجع الدم لعضلة القلب نفسها، في الـSystole، أو في
+
+556
+00:43:33,490 --> 00:43:38,450
+الـDiastole، وكيف تتم العملية بالضبط، وإيش أهمية
+
+557
+00:43:38,450 --> 00:43:43,140
+الـIntra-aortic Balloon، طبعاً الـCrash Cart اللي
+
+558
+00:43:43,140 --> 00:43:46,400
+هي عربة طوارئ، الـEmergency Trolley اللي حكينا عنه
+
+559
+00:43:46,400 --> 00:43:49,640
+اللي فيه كل شيء، فيه لارِندوسكوب، وفيه متيوبات، وفيه
+
+560
+00:43:49,640 --> 00:43:53,060
+كل ما هو مطلوب، طبعاً في حاجة اللي حكينا عنها، الـ
+
+561
+00:43:53,060 --> 00:43:56,440
+Diagnostic Equipment، نحتاج حاجات كتير، قلنا إحنا
+
+562
+00:43:57,490 --> 00:44:02,150
+بالـBlood Gas Analysis، الـDevice هذا كمان بنحتاج
+
+563
+00:44:02,150 --> 00:44:05,570
+Mobile X-Ray، يكون فيه عندنا جهاز لتصوير الأشعة
+
+564
+00:44:05,570 --> 00:44:08,690
+متحرك، لإن ما تقدرش الـCritical Inpatient تنزله
+
+565
+00:44:08,690 --> 00:44:13,730
+على الأشعة، أو تطلع، عادة نقدر نقول الأشعة بتكون تحت الأرض
+
+566
+00:44:13,730 --> 00:44:16,990
+تنزله على الأشعة عشان يتصور، ولا حتى عشان يعمل
+
+567
+00:44:16,990 --> 00:44:20,650
+Ultrasound، ولا حتى عشان يعمل Echo، فبالتالي بتلاقي
+
+568
+00:44:20,650 --> 00:44:24,750
+في الـICU فيه جهاز Portable Ultrasound، فيه
+
+569
+00:44:24,750 --> 00:44:30,610
+Portable Echo، تمام؟ Mobile X-ray، Blood gas
+
+570
+00:44:30,610 --> 00:44:36,230
+analyzer، حتى الكثير من الـICUs بيكون فيها الـCBC
+
+571
+00:44:36,230 --> 00:44:40,330
+والـChemistry Machine موجودة داخل الـICU، كأنه
+
+572
+00:44:40,330 --> 00:44:48,570
+بيحكي عن مستشفى صغير، هو الـICU بيكون كأنه محتويات
+
+573
+00:44:48,570 --> 00:44:54,570
+مستشفى كاملة فيه، ليش؟ لأن عندنا، هنشوف في الـ
+
+574
+00:44:55,320 --> 00:44:59,580
+الشخصيات اللي بيشتغلوا في الـICU، من هم، هنلاقي إنّه
+
+575
+00:44:59,580 --> 00:45:03,540
+إحنا كل أنواع الناس اللي بتشتغل داخل المستشفى
+
+576
+00:45:03,540 --> 00:45:09,320
+كاملة، لازم يكونوا موجودين في الـICU بشكل دائم، تمام؟
+
+577
+00:45:09,320 --> 00:45:19,270
+أعتقد أنّه وقت المحاضرة يعني حوالي نصف ساعة، فبدي
+
+578
+00:45:19,270 --> 00:45:25,290
+أخلي الـICU admission للمحاضرة الثانية اللي بدي
+
+579
+00:45:25,290 --> 00:45:30,070
+أسجلها بعد هذه إن شاء الله، فخلينا نوقف التسجيل
+
+580
+00:45:30,070 --> 00:45:34,510
+لهذا، ونبدأ بالتسجيل الجديد من أن الـICU admission
+
+581
+00:45:34,510 --> 00:45:35,370
+criteria
diff --git a/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/c4LhutotWdI_postprocess.srt b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/c4LhutotWdI_postprocess.srt
new file mode 100644
index 0000000000000000000000000000000000000000..816070d6a5ecd10aafcf94f37351e6d0d2f8ebde
--- /dev/null
+++ b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/c4LhutotWdI_postprocess.srt
@@ -0,0 +1,2324 @@
+1
+00:00:07,090 --> 00:00:09,890
+بسم الله الرحمن الرحيم السلام عليكم ورحمة الله
+
+2
+00:00:09,890 --> 00:00:14,150
+وبركاته اليوم
+
+3
+00:00:14,150 --> 00:00:20,090
+إن شاء الله رب العالمين نحكي عن المحاضرة الأولى في
+
+4
+00:00:20,090 --> 00:00:25,310
+introduction to critical care nursing مصاد للرعاية
+
+5
+00:00:25,310 --> 00:00:34,630
+الحديثة للتمريد أو الرعاية الحرجة أو تمريد الرعاية
+
+6
+00:00:34,630 --> 00:00:37,840
+الحرجةمعكم إن شاء الله رب العالمين هتكون الدكتور
+
+7
+00:00:37,840 --> 00:00:41,160
+خالد جمال فضورة Assistant professor of
+
+8
+00:00:41,160 --> 00:00:49,540
+epidemiology طبعاً الحمد لله رب العالمين أنا يعني
+
+9
+00:00:49,540 --> 00:00:54,460
+عملت في التسمة اللي هنا المركزة لأكتر من 12 سنة
+
+10
+00:00:54,460 --> 00:00:58,980
+كنت Registered
+
+11
+00:00:58,980 --> 00:01:04,280
+nurse في ال ICU في مستشفى الشيطان وفي مستشفى القدس
+
+12
+00:01:04,280 --> 00:01:11,780
+أيضاًوكنت رئيس خصم الـICU الخاصة بالقلب المفتوح
+
+13
+00:01:11,780 --> 00:01:15,780
+Open Heart Surgery Cardiac Care Intensive Care
+
+14
+00:01:15,780 --> 00:01:25,540
+Unit Post Cardiac Surgery طبعاً كذلك كنت رئيس خصم
+
+15
+00:01:25,540 --> 00:01:31,460
+انهار مركزة في مستشفى خدمة العامة لجراحة القلب
+
+16
+00:01:31,460 --> 00:01:32,480
+المفتوح
+
+17
+00:01:34,520 --> 00:01:38,500
+إن شاء الله رب العالمين في هذا الcourse هنتناول مع
+
+18
+00:01:38,500 --> 00:01:44,080
+بعض مقدمة عن الـ Critical Care Nursing إيش يعني
+
+19
+00:01:44,080 --> 00:01:48,040
+الـ ICU؟ إيش يعني الـ Critical Care Nurse؟ وإيش
+
+20
+00:01:48,040 --> 00:01:51,260
+يعني الـ Critical Ill Patients؟ كيف بعمل
+
+21
+00:01:51,260 --> 00:01:54,520
+assessment لـ Critical Ill Patient؟ وبحدد إن هو
+
+22
+00:01:54,520 --> 00:01:58,720
+كوين أنه Critical Ill؟ إيش مواصفات الـ ICU؟ إيش
+
+23
+00:01:58,720 --> 00:02:02,440
+مواصفات المكان اللي بيستقبل فيه حالات الحرجة
+
+24
+00:02:02,440 --> 00:02:06,240
+وبيتعامل معاها؟ميه هم الحالات الحارجة؟ إيش هي الـ
+
+25
+00:02:06,240 --> 00:02:11,580
+Ethical consideration للناس اللي بناروا في ال ICU؟
+
+26
+00:02:11,580 --> 00:02:15,600
+وإيش ممكن إحنا نتواجهنا ethical dilemma؟ إيش هي
+
+27
+00:02:15,600 --> 00:02:18,760
+المشاكل والـ stress اللي متواجهنا؟ وإيه ال burnout
+
+28
+00:02:18,760 --> 00:02:22,060
+syndrome؟ اللي ممكن يتصير في نتيجة العمل في
+
+29
+00:02:22,060 --> 00:02:25,960
+الأماكن الـ hot carriers نسميها؟ بعدين هندخل لل
+
+30
+00:02:25,960 --> 00:02:30,320
+unit التاني وقدرنا نحكي في لب الموضوع اللي هو ال
+
+31
+00:02:30,320 --> 00:02:36,260
+acid-base balance إيش هوالتوازن تبع الـ Acid Base
+
+32
+00:02:36,260 --> 00:02:39,260
+اللي ربنا قامله الحمضية والقلوية في جسم الإنسان،
+
+33
+00:02:39,260 --> 00:02:42,640
+إيش هو التعريف طبعه، إيش هو الـ Puffer System هذا
+
+34
+00:02:42,640 --> 00:02:47,360
+النظام اللي بيعمل الإتزان في الجسم محافظ عليه، إيش
+
+35
+00:02:47,360 --> 00:02:52,060
+هم الأجهزة، إيش الحالات الأفلالية والمراضية اللي
+
+36
+00:02:52,060 --> 00:02:59,950
+بتسير نتيجة خربطة أو اضطراب في حالة الإتزانالـ
+
+37
+00:02:59,950 --> 00:03:06,370
+Acid Base الحمضية القاعدية في الجسم وموضوع الجهاز
+
+38
+00:03:06,370 --> 00:03:13,330
+التنفس الاصطناعي كمقدمة وموضوع مهم جدًا لمواضيع
+
+39
+00:03:13,330 --> 00:03:16,770
+الـ Respiratory illness اللي في الـ Chapter التالت
+
+40
+00:03:16,770 --> 00:03:20,450
+اللي هو الـ Acute Respiratory Failure و Acute
+
+41
+00:03:20,450 --> 00:03:22,490
+Respiratory Distress Syndrome الـ ERDS
+
+42
+00:03:22,490 --> 00:03:27,410
+والفلورينالكوليزم والفلورينالايديمة والكيموتوراكس
+
+43
+00:03:27,410 --> 00:03:34,530
+كل هذه المواضيعهتكون يعني تفصيلها وشرحها معانا
+
+44
+00:03:34,530 --> 00:03:41,630
+وهيكون علاجها أو الطريقة اللي بتستخدم الـ
+
+45
+00:03:41,630 --> 00:03:44,030
+Supportive Management of the Respiratory System
+
+46
+00:03:44,030 --> 00:03:49,770
+لـMost Obese Diseases Respiratory Diseases and
+
+47
+00:03:49,770 --> 00:03:53,730
+Acid-Based Balance Disturbance Disorders will be
+
+48
+00:03:53,730 --> 00:03:57,170
+treated byاللي هو الـ Mechanical Ventilator فالـ
+
+49
+00:03:57,170 --> 00:04:01,690
+Mechanical Ventilator سيتحدث في التفاصيل ومن ثم
+
+50
+00:04:01,690 --> 00:04:08,310
+سنقوم بالتغيير لتحديث تغيير الهيمو-ديناميكا
+
+51
+00:04:08,310 --> 00:04:12,050
+البرمجية البرمجية البرمجية البرمجية البرمجية
+
+52
+00:04:12,050 --> 00:04:13,550
+البرمجية البرمجية البرمجية البرمجية البرمجية
+
+53
+00:04:13,550 --> 00:04:16,810
+البرمجية البرمجية البرمجية البرمجية البرمجية
+
+54
+00:04:16,810 --> 00:04:18,960
+البرمجية البرمجيةأو الـ Herodynamic Stability
+
+55
+00:04:18,960 --> 00:04:24,020
+ومراقبة للطبيعي في مجلس التعامل التقليدي بما يسمى
+
+56
+00:04:24,020 --> 00:04:29,200
+Invasive وInvasive method لذلك سنتحدث أيضًا عن
+
+57
+00:04:29,200 --> 00:04:32,840
+المشاكل العضلية والمشاكل الهوائية المشاكل الهوائية
+
+58
+00:04:32,840 --> 00:04:36,340
+والمشاكل الهوائية والمشاكل الهوائية والمشاكل
+
+59
+00:04:36,340 --> 00:04:39,140
+الهوائية والمشاكل الهوائية والمشاكل الهوائية
+
+60
+00:04:39,140 --> 00:04:41,560
+والمشاكل الهوائية والمشاكل الهوائية والمشاكل
+
+61
+00:04:41,560 --> 00:04:43,540
+الهوائية والمشاكل الهوائية والمشاكل الهوائية
+
+62
+00:04:43,540 --> 00:04:44,160
+والمشاكل الهوائية والمشاكل الهوائية والمشاكل
+
+63
+00:04:44,160 --> 00:04:47,840
+الهوائية والمشاكل الهوائهو مشكلة التشوك الخاصة
+
+64
+00:04:47,840 --> 00:04:50,740
+ومشكلة التشوك الخاصة ومشكلة التشوك الخاصة ومشكلة
+
+65
+00:04:50,740 --> 00:04:53,320
+التشوك الخاصة ومشكلة التشوك الخاصة ومشكلة التشوك
+
+66
+00:04:53,320 --> 00:04:53,480
+الخاصة ومشكلة التشوك الخاصة ومشكلة التشوك الخاصة
+
+67
+00:04:53,480 --> 00:04:55,920
+ومشكلة التشوك الخاصة ومشكلة التشوك الخاصة ومشكلة
+
+68
+00:04:55,920 --> 00:04:59,160
+التشوك الخاصة ومشكلة التشوك الخاصة ومشكلة التشوك
+
+69
+00:04:59,160 --> 00:05:00,880
+الخاصة ومشكلة التشوك الخاصة ومشكلة التشوك الخاصة
+
+70
+00:05:00,880 --> 00:05:04,480
+ومشكلة التشوك الخاصة ومشكلة التشوك الخاصة ومشكلة
+
+71
+00:05:04,480 --> 00:05:10,280
+التشوك الخاصة ومشكلة
+
+72
+00:05:10,280 --> 00:05:16,500
+التشوعلى المادة وانتم مبسوطين ومرتاحين وما تحللوش
+
+73
+00:05:16,500 --> 00:05:23,140
+هملك وزاد المحاضرة الأولى هذه عبارة عن مقدمة بسيطة
+
+74
+00:05:23,140 --> 00:05:27,600
+وتأليف في المادة ككل اللي شرحته تاويه هو تلقيس
+
+75
+00:05:27,600 --> 00:05:34,340
+لإيش هناخد فيه خلال الفصل كاملا بالإضافة إلى شبطر
+
+76
+00:05:34,340 --> 00:05:37,980
+الحروق أنا نسيت أحطه في ال slice الشبطر ال burn
+
+77
+00:05:37,980 --> 00:05:41,580
+لإن أعتقد أنكم ما أخدتهوش
+
+78
+00:05:44,060 --> 00:05:49,120
+وخاصة أنه موضوع الـ Burn من المواضيع اللي بيكون
+
+79
+00:05:49,120 --> 00:05:54,480
+Need لإن المريض يدخل الـICU الآن هنبدأ نحكي عن
+
+80
+00:05:54,480 --> 00:05:58,320
+الشق الأول في الـUnity الأولى وهو نحكي عن
+
+81
+00:05:58,320 --> 00:06:00,260
+الـBackground عن الـICU
+
+82
+00:06:02,470 --> 00:06:07,750
+الفيديو اللي عملناه بات مباشر لكن أنا بعيد هنا
+
+83
+00:06:07,750 --> 00:06:10,350
+Definition of Critical Care Nursing أشعر عن
+
+84
+00:06:10,350 --> 00:06:13,830
+Critical Care Nursing بمعنى أن الـ Critical Care
+
+85
+00:06:13,830 --> 00:06:18,510
+Nurse هذا هو الممرج الـ practitioner اللي بتعامل
+
+86
+00:06:18,510 --> 00:06:22,390
+مع الناس اللي عندها life threatening problems اللي
+
+87
+00:06:22,390 --> 00:06:27,010
+بتعامل مع الناس اللي عندها مشاكل بتهدد حياتها
+
+88
+00:06:27,010 --> 00:06:34,190
+بالخطر والـوالناس اللي بيكونوا زي ما بنسميها
+
+89
+00:06:34,190 --> 00:06:42,570
+معرضين لالموت لو استمرت تطور حالتهم بالسوق فهذا
+
+90
+00:06:42,570 --> 00:06:46,190
+اسمه Critically Ill Patient
+
+91
+00:06:49,010 --> 00:06:52,770
+لما بحكي أنا Critical Care إيش معناها؟ معناها إنه
+
+92
+00:06:52,770 --> 00:06:58,350
+أقدّم رعاية لمريد حياته مهددة بالخطر الـ Critical
+
+93
+00:06:58,350 --> 00:07:02,670
+Care Nurse مين هو؟ هو الشخص المؤهل الـ
+
+94
+00:07:02,670 --> 00:07:07,250
+Professional Nurse اللي بيستطيع إنه يتعامل مع
+
+95
+00:07:07,250 --> 00:07:11,990
+الناس اللي عندها الـ Critical أو اللي عندها Life
+
+96
+00:07:11,990 --> 00:07:15,090
+Threatening Conditions أو Problems أو مش بس
+
+97
+00:07:15,090 --> 00:07:19,340
+المريض، و الـ Family التابعته كمانهذا هو الشخص
+
+98
+00:07:19,340 --> 00:07:25,540
+المؤهل لكلام هذا عن طريق إنه بياخد course ICU أو
+
+99
+00:07:25,540 --> 00:07:29,920
+Critical Care Nursing أو عن طريق إنه بياخد master
+
+100
+00:07:29,920 --> 00:07:33,980
+Critical Care Nursing أو عن طريق إنه بياخد high
+
+101
+00:07:33,980 --> 00:07:39,860
+diploma بعد ما بيخلص general nursing بياخد high
+
+102
+00:07:39,860 --> 00:07:44,360
+diploma in Critical Care Nursing هذا هو الشخص اللي
+
+103
+00:07:44,770 --> 00:07:49,350
+بيتعامل وبيحقله أن يتعامل مع الـ Critical Ill
+
+104
+00:07:49,350 --> 00:07:56,090
+Patient ويطلق عليه Critical Care Registered Nurse
+
+105
+00:07:56,090 --> 00:07:59,610
+عشان هي الـ Critical Ill Patient مين هم زي ما
+
+106
+00:07:59,610 --> 00:08:07,510
+حكينا الناس اللي عندهم يعني ما يهدد حياتهم سواء عن
+
+107
+00:08:07,510 --> 00:08:13,820
+طريق أنه فيه اندوأو أمراض تهدد حياته حاليًا عن
+
+108
+00:08:13,820 --> 00:08:17,480
+طريق أنه فيه أكتر من Vital organs أو Vital organs
+
+109
+00:08:17,480 --> 00:08:27,380
+محدد فيه خلل في عملهأو إن احتماليت وضعه في هذا
+
+110
+00:08:27,380 --> 00:08:33,560
+الوضع سوف يؤدي إلى حصول خلل في Vital organs أو
+
+111
+00:08:33,560 --> 00:08:38,360
+أكتر من Vital organs يعني مثلًا للتوضيح، لو جينا
+
+112
+00:08:38,360 --> 00:08:47,810
+نحكي عن شخصشاب وفجأة راح يتدرب في الجيش وهو يعني
+
+113
+00:08:47,810 --> 00:08:52,290
+ماكانش بعمل رياضة قبل هيك ومش متعود على ممارسة
+
+114
+00:08:52,290 --> 00:08:56,930
+الأعمال والمجهودات الشاقة طيب إيه صار معاه فجأة
+
+115
+00:08:56,930 --> 00:09:03,360
+بدأ يتدرب وبدأ يعمل مجهودات شاقة أكتر منالاحتمال
+
+116
+00:09:03,360 --> 00:09:08,700
+أو من القوة أو من التحمل اللي بتتحمله العضلات
+
+117
+00:09:08,700 --> 00:09:15,920
+تبعته فبالتالي صار P&O إرهاق للعضلات لما صار P&O
+
+118
+00:09:15,920 --> 00:09:21,120
+إرهاق للعضلات بدأت العضلات تتكرز نتيجة الـ Overuse
+
+119
+00:09:21,120 --> 00:09:27,450
+تبعتهابدأت تفرس حاجة بنسميها الـMyoglobulin اللي
+
+120
+00:09:27,450 --> 00:09:35,250
+هو الانزيم تبع العضلة اللي بيطلع من العضلة وبيصل
+
+121
+00:09:35,250 --> 00:09:40,270
+للدم وبعد ما يصل للدم كل الـMyoglobulin هذا اللي
+
+122
+00:09:40,270 --> 00:09:43,710
+نتيجة الـdestruction تبع ال muscle بيطلع بيصل
+
+123
+00:09:43,710 --> 00:09:48,090
+لوين؟ للدم، من الدم للـ kidney لما بيصل للـ kidney
+
+124
+00:09:48,090 --> 00:09:54,940
+بسبب تجنب بشكل كبير بيؤدي إلىفشل في الـ Kidneys
+
+125
+00:09:54,940 --> 00:09:57,820
+بسبب حاجة الـ Acute Renal Failure هذه الحالة
+
+126
+00:09:57,820 --> 00:10:02,400
+بيسموها Rhabdomyolysis Rhabdomyolysis Myo من عضلة
+
+127
+00:10:02,400 --> 00:10:07,220
+ربد يعني ربد تكسر تكسر في العضلة
+
+128
+00:10:11,090 --> 00:10:17,170
+اللي هو التكسر في أنزمات العضلات فبيؤدي إلى الـ
+
+129
+00:10:17,170 --> 00:10:20,890
+Acute Renal Failure لو أنا جالي المريض هو في
+
+130
+00:10:20,890 --> 00:10:25,410
+الحالة هذه وفجأة لجأت إن كمية البول صارت عنده
+
+131
+00:10:25,410 --> 00:10:29,830
+لجيوريا وأنزمات العضلات لجيتها مرتفعة جدا عنده زي
+
+132
+00:10:29,830 --> 00:10:34,590
+الـCK مثلا لجيتها مرتفعة كتير الآن أنا بعرف إن هذا
+
+133
+00:10:34,590 --> 00:10:38,430
+المريض لو تركته من غير Managementومن غير اللي هو
+
+134
+00:10:38,430 --> 00:10:42,730
+حاجة بنسميها force diuresis إنه ياخد كميات من الـ
+
+135
+00:10:42,730 --> 00:10:48,110
+Fluidوجرعات من الـ Lasix أيضًا في حس أنه يشجع
+
+136
+00:10:48,110 --> 00:10:53,730
+الكيليا أن تشتغل و تدر البول وإلا هيتوقف عنده
+
+137
+00:10:53,730 --> 00:10:58,310
+الكيليا كاملة ويدخل في acute renal failure إذًا
+
+138
+00:10:58,310 --> 00:11:03,230
+هذا مثال أنا طرحته بس عشان تعرفوا كيف أنه أنا ممكن
+
+139
+00:11:03,230 --> 00:11:06,190
+أعالج الموضوع إذا كان فيه impairment في الvital
+
+140
+00:11:06,190 --> 00:11:09,710
+organ فيه already renal failure بهو critical il أو
+
+141
+00:11:09,710 --> 00:11:16,220
+أنا بتوقع potential إن هذا لو مدخلنش هيصير عندهأو
+
+142
+00:11:16,220 --> 00:11:19,860
+موضوع تاني و كويسين عنده respiratory failure مريض
+
+143
+00:11:19,860 --> 00:11:24,440
+جايك أزمتك مققه COPD أو بالهاتف الrespiratory rate
+
+144
+00:11:24,440 --> 00:11:28,300
+عالي لو انت ماتعملتش معاه في الاخر حيث خش ب
+
+145
+00:11:28,300 --> 00:11:32,020
+respiratory failure عشان هيك في أي مكان
+
+146
+00:11:34,640 --> 00:11:37,720
+والشخص متأكد من أنه ينجح لا يمكن أن يقول له أنه
+
+147
+00:11:37,720 --> 00:11:39,120
+ليس هناك إجراء لتعامل التعامل التعامل التعامل
+
+148
+00:11:39,120 --> 00:11:40,900
+التعامل التعامل التعامل التعامل التعامل التعامل
+
+149
+00:11:40,900 --> 00:11:44,480
+التعامل التعامل التعامل التعامل التعامل التعامل
+
+150
+00:11:44,480 --> 00:11:46,760
+التعامل التعامل التعامل التعامل التعامل التعامل
+
+151
+00:11:46,760 --> 00:11:47,240
+التعامل التعامل التعامل التعامل التعامل التعامل
+
+152
+00:11:47,240 --> 00:11:53,920
+التعامل التعامل التعامل التعامل التعامل التعامل
+
+153
+00:11:53,920 --> 00:12:03,780
+التعامل التعيتوفى، يعني مافيش أي أمل إنه يصير عنده
+
+154
+00:12:03,780 --> 00:12:10,680
+تحسن ويصير good prognosis برضه هذا مابكونش فيه
+
+155
+00:12:10,680 --> 00:12:14,760
+need لأ لأنه مركز، ها كيف يعني إذا بتقول critical
+
+156
+00:12:14,760 --> 00:12:18,140
+ill و life threatening condition هدولة بيكونوا هم
+
+157
+00:12:18,140 --> 00:12:22,580
+معناهم ل critical ill كيف بتقول لما بيكونالمريض
+
+158
+00:12:22,580 --> 00:12:27,600
+يعني الموت عنده حتمي بيبطل بده intensive care آه
+
+159
+00:12:27,600 --> 00:12:31,880
+لما بكون عنده الموت حتمي صار إيش أهمية إن أنا
+
+160
+00:12:31,880 --> 00:12:36,100
+أراعاه بشكل intensive أقدّم له intensive care
+
+161
+00:12:39,200 --> 00:12:44,060
+ما ليهاش أي أهمية لإن مش هأحسن من النهاية المعروفة
+
+162
+00:12:44,060 --> 00:12:48,160
+زي مثلا الحالات اللي عنده Multi-Organ System
+
+163
+00:12:48,160 --> 00:12:51,400
+Failure واحد عنده Cancer الـBrain وصار عنده
+
+164
+00:12:51,400 --> 00:12:55,180
+Metastasis أو Cancer Lung خليني أقول وصار عنده
+
+165
+00:12:55,180 --> 00:12:59,320
+Metastasis للـBrain وخش مرينال Failure فالمريض هذا
+
+166
+00:12:59,320 --> 00:13:03,000
+صار فيه عنده Respiratory Failure وصار فيه عنده
+
+167
+00:13:03,000 --> 00:13:09,670
+Kidney Failure وصار فيه عنده اللي هوالـ Neurologic
+
+168
+00:13:09,670 --> 00:13:13,790
+Failure يعني الـ Neurosystem تبقى و كمان إيش الـ
+
+169
+00:13:13,790 --> 00:13:16,410
+Glasgow-Columbus ده ما صار مثلا تلاتة يعني صار فيش
+
+170
+00:13:16,410 --> 00:13:23,530
+هندو Consciousness بطل Conscious بطل Oriented فصار
+
+171
+00:13:23,530 --> 00:13:31,540
+في عندي تلت organs أساسيةجهاز العصبي الجهاز الـ
+
+172
+00:13:31,540 --> 00:13:36,820
+circulatory لأنه بعد الـ kidney failure حصيب برضه
+
+173
+00:13:36,820 --> 00:13:41,160
+heart failure لأنه ما مصلعش السوائل تبع الجسم ما
+
+174
+00:13:41,160 --> 00:13:46,320
+بتنطرحش وبالتالي صار فيه أكتر من organ فيهFailure،
+
+175
+00:13:46,320 --> 00:13:48,760
+الـ kidney فيها Failure، الـ lung فيها Failure،
+
+176
+00:13:48,760 --> 00:13:51,900
+الـ brain فيه Failure وبالتالي هذا المريض إيش؟
+
+177
+00:13:51,900 --> 00:13:57,380
+يعني توقعنا لماذا تحسنه؟ مستحيل، مستحيل التلت
+
+178
+00:13:57,380 --> 00:14:01,140
+حاجات هدولة يطيبوا التلت organs هدولة يتحسنوا
+
+179
+00:14:01,140 --> 00:14:07,190
+ويشفوا ويرجع المريض ويرجع المريض أنه يكون إيش؟والـ
+
+180
+00:14:07,190 --> 00:14:12,730
+Pain طبعا هذا المريض بالأغلب will die علشان هيك
+
+181
+00:14:12,730 --> 00:14:16,890
+النوع العلاج المقدم له والرعاية اللي بتحتاجها
+
+182
+00:14:16,890 --> 00:14:22,070
+اسمها palliative care palliative care يعني علاج
+
+183
+00:14:22,070 --> 00:14:28,990
+تصويري إلى أن يقضي الله أمرا كان مفعولا إذا المريض
+
+184
+00:14:28,990 --> 00:14:32,550
+اللي مافيش خوف على حياته ووضعه stable مابيدوش
+
+185
+00:14:32,550 --> 00:14:36,980
+intensive care المريض اللي مات مؤكدكان نتيجة إنه
+
+186
+00:14:36,980 --> 00:14:45,120
+في عنده أكتر منأو organ failure مثلا أو cancer أو
+
+187
+00:14:45,120 --> 00:14:51,440
+whatever ومعروف إنه can not survive هذا برضه يعني
+
+188
+00:14:51,440 --> 00:14:55,240
+الـ certain تبعه الـ bias تبعه الـ certain أكيد
+
+189
+00:14:55,240 --> 00:14:59,900
+برضه مابيحتاجش instance of care ومحتاج palliative
+
+190
+00:14:59,900 --> 00:15:04,780
+care تمام؟ وال palliative care يعني في مقدمة سريعة
+
+191
+00:15:04,780 --> 00:15:12,870
+عنها هي بقى التقديلالريعية اللازمة للمريض الغير
+
+192
+00:15:12,870 --> 00:15:19,290
+مرجو من شفاءه بحيث يحافظ على آدميته يعني بياخد كل
+
+193
+00:15:19,290 --> 00:15:23,710
+الإلاجات اللي أو عفوًا الحقوق اللي لازمة له مش
+
+194
+00:15:23,710 --> 00:15:27,010
+بالضروري أطلاقًا تكون أدوية أو إلاجة مش بالضروري
+
+195
+00:15:27,010 --> 00:15:32,030
+كتير في Valley of Care بيحاولوا يخفضوا كل الأدوية
+
+196
+00:15:32,030 --> 00:15:36,390
+ويردولوااللي هو الـCare اللي هي زي الـ Hygiene
+
+197
+00:15:36,390 --> 00:15:43,650
+الترطيب للـ Oral Cavity الـ Mouth Hygiene الـ Nose
+
+198
+00:15:43,650 --> 00:15:48,710
+و الـ Ear Hygiene شوية Fluid عشان ما يصيبش
+
+199
+00:15:48,710 --> 00:15:52,490
+Dehydration ممكن يردوله اللي هو رعي الـ Feeding
+
+200
+00:15:52,490 --> 00:15:56,370
+سواء عن الـ Big Tube أو الـ Gastrostomy أو عن طريق
+
+201
+00:15:56,370 --> 00:15:59,850
+الـ Mesogastric وفي الأغلب بيحاولوا بيعملوهم Big
+
+202
+00:15:59,850 --> 00:16:06,540
+Tube أو اللي هو Gastrostomyتمام، هذا اللي هو الـ
+
+203
+00:16:06,540 --> 00:16:12,400
+Palliative Care عادة للناس اللي بين الـ two groups
+
+204
+00:16:12,400 --> 00:16:14,860
+هدول الناس اللي مافيش خطر على حياتها و الناس اللي
+
+205
+00:16:14,860 --> 00:16:18,160
+أكيد بدهم يموتوا ممكن يكون المريض اللي هو
+
+206
+00:16:18,160 --> 00:16:23,840
+critically ill و بده رعاية حرية طب إيه الدور
+
+207
+00:16:23,840 --> 00:16:30,850
+الممرض في الحالات هذه؟والـ Critical Care Nurses
+
+208
+00:16:30,850 --> 00:16:34,330
+work in a wide variety of settings أقوى يعني
+
+209
+00:16:34,330 --> 00:16:37,510
+بيشتغل في الـ Intensive Care Unit تبع الأطفال
+
+210
+00:16:37,510 --> 00:16:40,910
+وبيشتغل في الـ Pediatric Intensive Care Unit تبع
+
+211
+00:16:40,910 --> 00:16:45,110
+الأطفال وبيشتغل في الـ Unit Intensive Care Unit
+
+212
+00:16:45,110 --> 00:16:53,070
+تبع الأطفال الموليد Unit من يوم لـ 28 يوم وبيشتغل
+
+213
+00:16:53,070 --> 00:16:56,800
+في الـ Infantالـ Intensive Care Unit اللي هي من
+
+214
+00:16:56,800 --> 00:17:03,820
+بعد 28 يوم لغاية سنة و أكتر من سنة لغاية 12 سنة
+
+215
+00:17:03,820 --> 00:17:08,180
+اللي نسميها بـ Theatric Intensive Care Unit وبعد
+
+216
+00:17:08,180 --> 00:17:11,560
+ذلك ممكن نشتغل في الـ Cardiac Care Unit اللي هي
+
+217
+00:17:11,560 --> 00:17:17,140
+خاصة بالناس اللي عندها مشاكل في القلب زي الـ
+
+218
+00:17:17,140 --> 00:17:20,770
+Congestive Heart Failure و زي الـ Coronaryأو الـ
+
+219
+00:17:20,770 --> 00:17:26,170
+Acute Coronary Syndrome اللي بيسموها الـ ACS وبعد
+
+220
+00:17:26,170 --> 00:17:30,710
+ذلك يمكن هذا ينعملوا catheter lab يعني ينعملوا
+
+221
+00:17:30,710 --> 00:17:35,770
+قسطرة للقلب وينعملوا catheterization وبالتالي بيدك
+
+222
+00:17:35,770 --> 00:17:39,190
+من الأماكن اللي بيشتغل فيها الـ Critical Care
+
+223
+00:17:39,190 --> 00:17:43,350
+Nurse أنه يشتغلوا في ال catheter lab نفسهاالـ
+
+224
+00:17:43,350 --> 00:17:46,490
+Preparation وفي الـ Post of Receiving تبقى الـ
+
+225
+00:17:46,490 --> 00:17:49,690
+Patient بعد الـ «Catheter Lab» بإنه يكون High
+
+226
+00:17:49,690 --> 00:17:53,790
+-Risky إنه يخشي بـ Dysrhythmia أو بـ Bleeding وفيه
+
+227
+00:17:53,790 --> 00:17:59,090
+حاجات كتير فبده Invasive Monitoring وبده لأنه يمكن
+
+228
+00:17:59,090 --> 00:18:03,490
+يصير عنده Bleeding ويصير عنده Dysrhythmia وبده ECG
+
+229
+00:18:03,490 --> 00:18:07,850
+Monitoring وعلشان هيك كمان الـ Emergency
+
+230
+00:18:07,850 --> 00:18:10,630
+Departments من الحاجات الـ Critically
+
+231
+00:18:12,920 --> 00:18:16,620
+من الـ Hot Area إلى الـ Critical Care Nurse يعني
+
+232
+00:18:16,620 --> 00:18:20,240
+ممكن يشتغل فيها ومطموك إنه يشتغل فيها وأيضا
+
+233
+00:18:20,240 --> 00:18:24,860
+Recovery Room اللي في غرف العمليات كل هذه الأماكن
+
+234
+00:18:24,860 --> 00:18:27,660
+اللي في غرف العمليات عارفين Recovery Room غرفة
+
+235
+00:18:27,660 --> 00:18:30,380
+الإنعاف بعد ما يطلع المالي من العملية لازم يكون
+
+236
+00:18:30,380 --> 00:18:35,180
+فيه Critical Care Nurseموجود عشان يشغل مع المريض
+
+237
+00:18:35,180 --> 00:18:38,420
+لإنه بيكون في life-threatening condition خمس، عشر
+
+238
+00:18:38,420 --> 00:18:42,640
+دقائق إذا عدوا بسلام هيطلع المريض يكمل هذا ان شاء
+
+239
+00:18:42,640 --> 00:18:45,740
+الله كويس otherwise ممكن المريض يسيل عنده
+
+240
+00:18:45,740 --> 00:18:50,040
+suffocation يمكنه يخش بـrelapse من الاناستيزيا
+
+241
+00:18:50,040 --> 00:18:53,300
+ويفقد الـconscious level تبعته يخش برهيطه
+
+242
+00:18:53,300 --> 00:18:58,420
+الـfailure again فهذه من الأماكن جدا المهمة أنه
+
+243
+00:18:58,420 --> 00:19:03,450
+يشتغل فيهاالـ Critical Care Nurse طبعاً أنا بحب
+
+244
+00:19:03,450 --> 00:19:07,750
+أضيفكم على الكلام هذا إنه مش بس هذه الأماكن اللي
+
+245
+00:19:07,750 --> 00:19:11,930
+بيشتغل فيها الـ Critical Care Nurse لأ كمان في
+
+246
+00:19:11,930 --> 00:19:16,130
+أماكن تانية زي الـ Home Care Nursing لأن هذا
+
+247
+00:19:16,130 --> 00:19:22,450
+الممرض هو ممرض قادر على إنه يتعامل مع الحالات
+
+248
+00:19:22,450 --> 00:19:33,130
+الحرجةفي البيوت ويقدملها الرعاية الطبية اللازمة
+
+249
+00:19:33,130 --> 00:19:44,430
+Okay
+
+250
+00:19:44,430 --> 00:19:50,670
+طيب
+
+251
+00:19:52,190 --> 00:19:55,130
+بعد مدرسة مدرسة يمكن أن يكون مدرساً مدرساً مدرساً
+
+252
+00:19:55,130 --> 00:20:20,610
+مدرساً مدرساً مدرساً مدرساً مدرساً
+
+253
+00:20:22,060 --> 00:20:31,040
+أو يعني يستطيع أنه يـfind out اللي هو مشاكل معينة
+
+254
+00:20:31,040 --> 00:20:36,200
+ويحاول يعملها research عشان يوصل لرزقرة معينة من
+
+255
+00:20:36,200 --> 00:20:39,980
+الناس اللي كتير كويسين يُعرفونه managers هم
+
+256
+00:20:39,980 --> 00:20:44,900
+الـcritical care nurses ولذلك يمكن تلاحظوا في معظم
+
+257
+00:20:44,900 --> 00:20:51,850
+مستشفيات القطاع من عمل بالإناء المركزةيعني معظمهم
+
+258
+00:20:51,850 --> 00:20:57,250
+رؤساء أقسام ومشربين ومدرع مستشفيات حتى الـ
+
+259
+00:20:57,250 --> 00:21:01,970
+clinical care nurse clinical nurse specialists and
+
+260
+00:21:01,970 --> 00:21:07,130
+nurse practitioners حكيناهم دولة the critical care
+
+261
+00:21:07,130 --> 00:21:09,530
+nurse is responsible for the identification
+
+262
+00:21:09,530 --> 00:21:13,010
+intervention and management of clinical problem to
+
+263
+00:21:13,010 --> 00:21:18,790
+improve care intervention and familiesواحد يقولنا
+
+264
+00:21:18,790 --> 00:21:20,930
+كل شوية الله يقولنا فماشي دخلنا أحنا في ال
+
+265
+00:21:20,930 --> 00:21:26,650
+families لأ ال families إلها إحنا معانا دور كبير
+
+266
+00:21:26,650 --> 00:21:33,170
+في ال nursing وفي اللي هو ال critical care nurse
+
+267
+00:21:33,170 --> 00:21:37,210
+اللي له دور كبير مع ال family كيف؟ تو إحنا حكينا
+
+268
+00:21:37,210 --> 00:21:41,370
+إن ال critical care nurse بدي يكون كمان nurse
+
+269
+00:21:41,370 --> 00:21:44,570
+educator مش ضروري يكون بس educator لل student
+
+270
+00:21:44,570 --> 00:21:48,400
+nurses كمان لل families هدولكثير ويكون في حالات
+
+271
+00:21:48,400 --> 00:21:53,680
+انت بتحتاج ان الـ Family هم اللي قدموا الخدمة وحتى
+
+272
+00:21:53,680 --> 00:21:57,800
+ممكن زي ما حكيت انا ان الـ Home Care المريض هذا
+
+273
+00:21:57,800 --> 00:22:02,040
+يكون وضعه critically ill وبعد ذلك يتحسن بس يخش في
+
+274
+00:22:02,040 --> 00:22:06,600
+مرحلة من الحاجته
+
+275
+00:22:06,600 --> 00:22:10,240
+للـ Palliative Therapy زي الناس اللي بتصير عندك
+
+276
+00:22:10,240 --> 00:22:14,040
+ودريبليجياوخلص مافيش إمكانية إنه يبطّر الـ
+
+277
+00:22:14,040 --> 00:22:17,120
+Quadriplegia بس بيصير طول أمره دي بالده أنه بده
+
+278
+00:22:17,120 --> 00:22:21,260
+mechanical ventilator وبده حد يعمله hygiene وبده
+
+279
+00:22:21,260 --> 00:22:27,180
+حد يطعمه وبده حد يشربه وبده حد يعمله self-care
+
+280
+00:22:27,180 --> 00:22:31,620
+hygiene زي ما حكينا أو body care health hygiene
+
+281
+00:22:31,620 --> 00:22:38,150
+فبالتالي بعد ما يقضي في فترة معينة منووجوده في
+
+282
+00:22:38,150 --> 00:22:41,530
+العناء المركزة ممكن ينطلع على مركز تأيير في
+
+283
+00:22:41,530 --> 00:22:46,090
+النهاية بده يقول ما قاله إلى البيت وبده تكون ال
+
+284
+00:22:46,090 --> 00:22:50,910
+family جزء من الناس اللي بيرعوه حتى لو كان في home
+
+285
+00:22:50,910 --> 00:22:56,210
+care ناس بييجي بيزوره من الصعب انه يغطي 24 ساعة
+
+286
+00:22:56,210 --> 00:23:01,210
+ممكن يعمله visit وكل يوم لعدد ساعات معينة ويقيم
+
+287
+00:23:01,210 --> 00:23:05,870
+وضعه وأعظم الواجهة هيكون الأهل هم نفسهم اللي
+
+288
+00:23:05,870 --> 00:23:10,610
+بيقوموا برعايةالمريض هذا فبالتالي احنا دورنا انه
+
+289
+00:23:10,610 --> 00:23:16,390
+معهم ان نعملهم education ونعلمهم على كل حاجة حتى
+
+290
+00:23:16,390 --> 00:23:19,450
+ال suctioning من التليكيوستومي إذا كان ليه
+
+291
+00:23:19,450 --> 00:23:26,870
+تليكيوستومي و ال feeding و ال hygiene حتى وكمان
+
+292
+00:23:26,870 --> 00:23:31,270
+الطعم و التعامل مع الجاسترستم وكل الأمور هذه لذلك
+
+293
+00:23:31,270 --> 00:23:39,950
+يعني يجب انه ال family تكونيعني دورها مقنع مقروف
+
+294
+00:23:39,950 --> 00:23:43,430
+ومقلوم إنه «توفير خدمة مباشرة للطب» «توفير خدمة
+
+295
+00:23:43,430 --> 00:23:44,690
+مباشرة للطب» «توفير خدمة مباشرة للطب» «توفير خدمة
+
+296
+00:23:44,690 --> 00:23:46,270
+مباشرة للطب» «توفير خدمة مباشرة للطب» «توفير خدمة
+
+297
+00:23:46,270 --> 00:23:47,170
+مباشرة للطب» «توفير خدمة مباشرة للطب» «توفير خدمة
+
+298
+00:23:47,170 --> 00:23:50,190
+مباشرة للطب» «توفير خدمة مباشرة للطب» «توفير
+
+299
+00:23:50,190 --> 00:23:58,010
+خدمة مباشرة للطب» «توفير خدمة مباشرة للطب» «توفير
+
+300
+00:23:58,010 --> 00:24:02,690
+خدمة مب
+
+301
+00:24:02,730 --> 00:24:08,250
+وبجمع data عن الحالة اللي موجودة عندى سواء كانت
+
+302
+00:24:08,250 --> 00:24:13,390
+subjective data أو objective data وبعدين بحاول أحط
+
+303
+00:24:13,390 --> 00:24:17,090
+nursing diagnosis للمشاكل اللي موجودة وبعدين بعمل
+
+304
+00:24:17,090 --> 00:24:20,770
+planning أحل فيها كل nursing diagnosis حطيته
+
+305
+00:24:20,770 --> 00:24:24,230
+وبعدين ببدأ أطبق في ال plan تبعتي وبعدين بعمل
+
+306
+00:24:24,230 --> 00:24:29,080
+evaluationلأ، الـ Interventions اللي أنا سويتهم و
+
+307
+00:24:29,080 --> 00:24:32,880
+بشوف حالي أوصلت لـ الـ Goals اللي أنا already
+
+308
+00:24:32,880 --> 00:24:41,320
+حطيته في مرحلة الـ Assessment أو في .. أو
+
+309
+00:24:41,320 --> 00:24:44,620
+في مرحلة عفواً لـ Planning بعد ما أنا عملت
+
+310
+00:24:44,620 --> 00:24:47,160
+Planning وصلت لـ Problems حددت الـ Problems اللي
+
+311
+00:24:47,160 --> 00:24:49,800
+دولة في الـ Planning وحطيت Goals إن أنا بدي أعملها
+
+312
+00:24:49,800 --> 00:24:55,930
+Achievement، تمام؟ فـ Nursing Processبس القصة إن
+
+313
+00:24:55,930 --> 00:25:05,930
+المريض critically ill okay ال organization of ICU
+
+314
+00:25:05,930 --> 00:25:10,390
+كيف ال ICU بتكون يعني منظمة يا جماعة ال ICU
+
+315
+00:25:10,390 --> 00:25:14,310
+requires an intelligent planning that it must keep
+
+316
+00:25:14,310 --> 00:25:17,910
+the need of the hospital and its location one ICU
+
+317
+00:25:17,910 --> 00:25:26,840
+may not may notكتر to all needs أكيد ICU واحدة مش
+
+318
+00:25:26,840 --> 00:25:32,300
+هتكون تتكفي في المستشفى لكل المستشفى وليس ذلك زي
+
+319
+00:25:32,300 --> 00:25:37,120
+ما شوفته أنت شوفتين يعني أنه فيه أكتر من ICU مثلًا
+
+320
+00:25:37,120 --> 00:25:41,640
+ال institute may plan bits into multiple units
+
+321
+00:25:41,640 --> 00:25:44,260
+under separate management by single discipline
+
+322
+00:25:44,260 --> 00:25:48,900
+specialists like medical ICU، surgical ICU، burn
+
+323
+00:25:48,900 --> 00:25:51,840
+ICU، trauma ICU،
+
+324
+00:25:53,920 --> 00:25:57,620
+Multidisciplinary require more than a single
+
+325
+00:25:57,620 --> 00:26:03,740
+specialty ممكن يعني احنا نعمل ال ICU تبعينا ونحدد
+
+326
+00:26:03,740 --> 00:26:08,260
+ان هدول الأسرة لل medical هدول الجراحة هدول الburn
+
+327
+00:26:08,260 --> 00:26:15,830
+هدول ال trauma وطبعا في ناس بيعملوا يعنيطريقة أفضل
+
+328
+00:26:15,830 --> 00:26:20,490
+وبيفصلوهم نهائيًا بعملوا هذه واحدة كاملة للـ Pair
+
+329
+00:26:20,490 --> 00:26:24,090
+خاصة مش بس الـ Meds استبعدتها وبيكون مكانها بعيد
+
+330
+00:26:24,090 --> 00:26:28,050
+خالص هذه واحدة كاملة بس للـ Surgical للناس بعد
+
+331
+00:26:28,050 --> 00:26:31,290
+العملات الجراحية اللي بيحتاجوا ICU وسموها Surgical
+
+332
+00:26:31,290 --> 00:26:35,990
+ICU هذه ICU للميديكالللناس اللي عندها مشاكل طبيعية
+
+333
+00:26:35,990 --> 00:26:41,090
+وناس هادلة الـ Gynecology للناس اللي في المستشفى
+
+334
+00:26:41,090 --> 00:26:43,350
+المولودة أو يصيروا كريتيكا لإيه اللي بدهم ICU
+
+335
+00:26:43,350 --> 00:26:50,190
+هادلة الـ Unit للناس تبعهم هادلة الـ Cardio ICU
+
+336
+00:26:50,190 --> 00:26:52,930
+هادلة الـ Post-Catheterization Unit للناس اللي بعد
+
+337
+00:26:52,930 --> 00:26:53,570
+القصرة
+
+338
+00:27:00,490 --> 00:27:05,170
+ده عشان هي حسب إمكانياتهم طبعا العالم الآن حتى ميل
+
+339
+00:27:05,170 --> 00:27:08,430
+إلى التخصصية فيه أنواع الجراحات يعني مثلا في
+
+340
+00:27:08,430 --> 00:27:12,970
+الباطنة، خلّيني أقول أول في الباطنة، المرضى الـ
+
+341
+00:27:12,970 --> 00:27:17,690
+Palmonology مرضى الصدرية والأمراض الرئوية لحالة
+
+342
+00:27:17,870 --> 00:27:21,910
+مرضة الأمراض الأخرى بيحطهم لحال، مرضة القلب من ضمن
+
+343
+00:27:21,910 --> 00:27:26,270
+الباطنة لحال، بيعملهم ICU منفصلة، الـICU في
+
+344
+00:27:26,270 --> 00:27:30,970
+الجراحة للـUrologic ICU للأمراض العصبية، عمليات
+
+345
+00:27:30,970 --> 00:27:34,350
+المخ والعصاب، عمليات الـكذا، كل هذا ما يتعلق
+
+346
+00:27:34,350 --> 00:27:37,850
+بالعصاب هدول، انهم ICU لحالة، عمليات العظام
+
+347
+00:27:37,850 --> 00:27:38,710
+الـcyclical
+
+348
+00:27:41,300 --> 00:27:46,760
+بنزلوه على ICU خصوص للـ Orthopedic ICU وبعض اللي
+
+349
+00:27:46,760 --> 00:27:50,140
+هو الـ Hand Surgery والنيورولوجيك اللي هي الـ
+
+350
+00:27:50,140 --> 00:27:55,330
+Peripheral Neurosurgery لأنها تُعتبرمناطق يعني
+
+351
+00:27:55,330 --> 00:27:59,730
+معقمة عالية التعقيد غير عن العمليات الجراحية اللي
+
+352
+00:27:59,730 --> 00:28:02,610
+بتصير في البطن البطن يُعتبر Dirty فعشان ايه
+
+353
+00:28:02,610 --> 00:28:04,790
+الـGeneral Surgery اللي بيسميها ده بقى الـGI
+
+354
+00:28:04,790 --> 00:28:10,850
+System اللي عادة ICU لحال لإنه تُعتبر أقل إيش يعني
+
+355
+00:28:10,850 --> 00:28:14,650
+Sterility تتنقل في البطن عادة في ال-intestine وال
+
+356
+00:28:14,650 --> 00:28:18,820
+-stomach وال-colons وهذه كل إيه تمناطقمش clean
+
+357
+00:28:18,820 --> 00:28:23,520
+بالمقارنة لما بنحكي مثلا في واحد مغير مفصل مثلا
+
+358
+00:28:23,520 --> 00:28:27,720
+واحد عامل joint replacement وعمليته طولت واستغرقت
+
+359
+00:28:27,720 --> 00:28:32,700
+أربع ساعات وبعد هيك بدهم يعملوله smooth extubation
+
+360
+00:28:32,700 --> 00:28:37,140
+بنسميه أو واحد عمل brain surgery وبعد ما عمل brain
+
+361
+00:28:37,140 --> 00:28:41,600
+surgery وخيط الجيس وعاني ال tumor من ال brain بدهم
+
+362
+00:28:42,360 --> 00:28:46,680
+يودّوه على ICU for smooth extubation عشان يعملوله
+
+363
+00:28:46,680 --> 00:28:49,600
+extubation يعني تدريجي ويفسروا عن جهاز التنافس
+
+364
+00:28:49,600 --> 00:28:53,040
+الصناعي فمش مقبول أن يودّوه على نفس العناية اللي
+
+365
+00:28:53,040 --> 00:28:57,360
+مع مريض عملوله استقصاء لـ tumor من الـ abdomen من
+
+366
+00:28:57,360 --> 00:29:01,520
+الـ colon وفتحوا البطن تبعه وإنه منفلورا مليانة
+
+367
+00:29:01,520 --> 00:29:08,290
+حواليههذه عملية أه مش التحتعقيم صحيح وهذه عملية أه
+
+368
+00:29:08,290 --> 00:29:11,950
+مش التحتعقيم لكن الـ sterility ما بين العملية تبع
+
+369
+00:29:11,950 --> 00:29:13,730
+ال general surgery والعملية تبع ال terminal
+
+370
+00:29:13,730 --> 00:29:21,030
+surgery بكتير مفرد عشان هي في three model of ICU
+
+371
+00:29:21,030 --> 00:29:27,330
+فيها تلت يعني نمطات أو أنطاولا إيش بيطلع جمعها
+
+372
+00:29:27,330 --> 00:29:32,670
+بكلمة طبع للموديل للموديل تبقى ال ICU فيه three
+
+373
+00:29:32,670 --> 00:29:35,750
+models الأولاني اسمه open model ماشيعني open
+
+374
+00:29:35,750 --> 00:29:41,270
+model؟ أماه أماه in this time physician admit
+
+375
+00:29:41,270 --> 00:29:46,010
+three and discharge في ال open unitالدكتور بيعمل
+
+376
+00:29:46,010 --> 00:29:49,530
+admission للحالة دي الحالة بدل ICU بيعلجها و
+
+377
+00:29:49,530 --> 00:29:52,510
+بيخرجها كمان وقت ما هو قلق الحالة ليها التماثر
+
+378
+00:29:52,510 --> 00:29:55,370
+وترجع على اقتصاد بيعملها discharge which allowed
+
+379
+00:29:55,370 --> 00:29:57,970
+many different members of the medical staff to
+
+380
+00:29:57,970 --> 00:30:01,750
+manage patients in ICU وبالتاني
+
+381
+00:30:02,960 --> 00:30:06,220
+والتالي مافيش دكتور في جلب الإناء المركز يا جماعة
+
+382
+00:30:06,220 --> 00:30:10,360
+أنا دكتور باطنة بشوف إن الحالة ده وده ICU بعملها
+
+383
+00:30:10,360 --> 00:30:13,560
+additional ICU بعالجها في ال ICU بتعامل مع ال
+
+384
+00:30:13,560 --> 00:30:16,480
+nurses هنا و بقت ما ملليها سالتي كويسة بعملها
+
+385
+00:30:16,480 --> 00:30:20,020
+discharge و بطلّها فكل الذكائة ترى ممكن يكون طبيب
+
+386
+00:30:20,020 --> 00:30:27,130
+ICU أو مش طبيب ICU يعني طبيب قرراللي هو احتياج
+
+387
+00:30:27,130 --> 00:30:30,730
+المريض لخدمة الـ ICU وهذه الأمنة موجودة منها في
+
+388
+00:30:30,730 --> 00:30:35,290
+مستشفيات بريطانيا ولذلك لا يوجد طبيب ICU في هذه
+
+389
+00:30:35,290 --> 00:30:39,350
+النمرة لأ في ال nurses هم كل حاجة بيجي الطبيب وهو
+
+390
+00:30:39,350 --> 00:30:42,550
+يمكن أن يحصل دخول كذا كطبيب باطنة، اللي بعده طبيب
+
+391
+00:30:42,550 --> 00:30:45,550
+قلب، اللي بعده طبيب أعصاب، حسب إيش مناه ال ICU
+
+392
+00:30:45,550 --> 00:30:50,260
+وبدخل الحالة ويكتب خطبة العلاج ويمشيتاني يوم بمر
+
+393
+00:30:50,260 --> 00:30:53,760
+عليها، تالتي يوم اه انا شايفة صدق واسم انا اعمله
+
+394
+00:30:53,760 --> 00:30:56,260
+الـ Discharge بكتب الـ Discharge وطبعا بنصق و
+
+395
+00:30:56,260 --> 00:30:59,780
+بطلعها على القسم ان هو نصق معاه فهذا طريقة الـ
+
+396
+00:30:59,780 --> 00:31:04,120
+Open Model الـ Closed Model، الـ Closed Model لأ
+
+397
+00:31:04,120 --> 00:31:07,480
+هاد الـ Admission و الـ Discharge و الـ Referral
+
+398
+00:31:07,480 --> 00:31:12,060
+Policies are under the control of Intensivists في
+
+399
+00:31:12,060 --> 00:31:18,670
+دكتور أخصائي عناية مركزة اسمه Intensivistوهو هذا
+
+400
+00:31:18,670 --> 00:31:22,230
+الموجود في الانهاء المركزة بيتصل فيه اثنينه الطبيب
+
+401
+00:31:22,230 --> 00:31:27,610
+بيقوله في عندي حالة في الباطنة وضعها كذا كذا كذا
+
+402
+00:31:27,610 --> 00:31:33,730
+كذا وانا اعتقد او بدي إليها ICU management بروح ال
+
+403
+00:31:33,730 --> 00:31:38,290
+ICU دكتور بعمل تقييم للحالة وبتناقش هو وإيه الطبيب
+
+404
+00:31:38,290 --> 00:31:44,590
+الباطنة اللي موجود أو الجراحة أو أيا كان تمام؟ويا
+
+405
+00:31:44,590 --> 00:31:48,110
+أما بيقتنع منه إنه فعلاً هذا بيدعى الـ «ICU
+
+406
+00:31:48,110 --> 00:31:52,570
+Management» بيقوله Okay وبيجيبها وبيتولد الـ
+
+407
+00:31:52,570 --> 00:31:57,990
+Intensiveist لـ Treatment تبعتها ثم بيقرر الـ
+
+408
+00:31:57,990 --> 00:32:00,970
+Intensiveist إن حالتك صالة كويسة ومتنقلة، لا
+
+409
+00:32:00,970 --> 00:32:06,290
+Discharge، لو سمحت نصق مع القسم اللي عندك علشان
+
+410
+00:32:06,290 --> 00:32:10,290
+إحنا بدنا نطلقها وجهد السرير ويقولنا أي سرير عشان
+
+411
+00:32:10,290 --> 00:32:14,230
+نتكلم التمرينالذن اللي مقرر الـ Intensivist هو
+
+412
+00:32:14,230 --> 00:32:18,870
+اللي قرر آه إنها بتحتاج دخول و يدخلها هو اللي قرر
+
+413
+00:32:18,870 --> 00:32:25,050
+العلاج تبعها هو اللي قرر إيه ده يصير الـ Discharge
+
+414
+00:32:26,280 --> 00:32:30,820
+بينما الطبيب تبعها كان فقط عرض الحالة إنه هذه
+
+415
+00:32:30,820 --> 00:32:34,880
+الحالة إحنا مش لازم نتعامل معاها في القسم وهي
+
+416
+00:32:34,880 --> 00:32:38,360
+أصبحت فيها life-threatening condition والمريض مرجو
+
+417
+00:32:38,360 --> 00:32:42,380
+منه يعني good prognosis فبالتالي إحنا لو سمحت بدنا
+
+418
+00:32:42,380 --> 00:32:47,280
+intensive care له بيجي دكتور ال ICU بيقيل وبيحدد
+
+419
+00:32:47,280 --> 00:32:53,310
+وبيوافق الدكتور أو بيقولوا لأ كلامك عفواًمبالغ فيه
+
+420
+00:32:53,310 --> 00:32:56,750
+المريض ما عندهوش life threatening condition وضعه
+
+421
+00:32:56,750 --> 00:33:01,310
+كويس ممكن يضيف على ال management حاجة أعطوله كذا
+
+422
+00:33:01,310 --> 00:33:06,890
+لو سمحته أو يقترح عرضه على طبيب آخر يقول أنا شايف
+
+423
+00:33:06,890 --> 00:33:11,610
+إن المشكلة إلها علاقة بكذا فلو سمحته رفوع على طبيب
+
+424
+00:33:11,610 --> 00:33:16,670
+كذا يعني يكون له راية العرض اللي هو التالت أو
+
+425
+00:33:16,670 --> 00:33:19,390
+المدر التالت في
+
+426
+00:33:20,830 --> 00:33:25,850
+المدلات تبعة الـ ICU اسمه الـ Hybrid Model which
+
+427
+00:33:25,850 --> 00:33:30,210
+combines aspects of open and closed وهو عبارة عن
+
+428
+00:33:30,210 --> 00:33:34,310
+combination بين هذا و هذا، إيش يعني؟ يعني تي طلعوا
+
+429
+00:33:34,310 --> 00:33:39,690
+كده، by stuffing the ICU with an attending
+
+430
+00:33:39,690 --> 00:33:45,770
+physician and or team to work in tandem with
+
+431
+00:33:45,770 --> 00:33:51,760
+primary physicians يعني فيه في الـ ICU الـلكن
+
+432
+00:33:51,760 --> 00:33:56,700
+السلطة، لا الـ Intensivist أو السلطة طبعاً الـ
+
+433
+00:33:56,700 --> 00:34:03,780
+Intensivist مش مطلقة، مش مطلقة هو بيشاور أو بيقرر
+
+434
+00:34:03,780 --> 00:34:06,780
+مثلا الطبيب الـ Physician العادي في القسم إنه هذه
+
+435
+00:34:06,780 --> 00:34:11,140
+الحالة بدها ICU، ببلغ طبيب الـ ICU طبيب الـ ICU
+
+436
+00:34:11,140 --> 00:34:16,160
+بيحضرلها السير، فدي بينهم مشاورة لكن مش هندم إنه
+
+437
+00:34:16,160 --> 00:34:19,120
+أنا أقول لأ لأ لأ طبيب زي هنا closed، بس أنا
+
+438
+00:34:19,120 --> 00:34:23,070
+المقررلأ هذا بيقولوا هذا جيد ده وهذا بيوافق okay
+
+439
+00:34:23,070 --> 00:34:28,010
+فبيدخلوها العلاج التانية اللي بيحطوا خطة مشتركة ال
+
+440
+00:34:28,010 --> 00:34:31,710
+discharge التانية اللي بتوافقوا على أنه تطلع
+
+441
+00:34:31,710 --> 00:34:36,150
+الحالة لو صارت no need inفي الـICU، لا عليك أن
+
+442
+00:34:36,150 --> 00:34:40,910
+تبقى في الـICU أكتر وإخراجك سيكون أسوأ هذه هي
+
+443
+00:34:40,910 --> 00:34:46,410
+الـmodels اللي معروفة كيف احنا بنشتغل داخل الـICU
+
+444
+00:34:46,410 --> 00:34:49,810
+الـICU يجب أن يكون مقفل في مقفل تقريبًا لمنطقة
+
+445
+00:34:49,810 --> 00:34:54,590
+مهمة مثل الـFaculty Group لاحظ حتى في البناء ببلغ
+
+446
+00:34:54,590 --> 00:34:59,110
+بحاول أن يكون الـICU قريبة من أقسام العمليات قريبة
+
+447
+00:34:59,110 --> 00:35:03,540
+من الـEmergency Departmentقريبًا من الأقسام الـ
+
+448
+00:35:03,540 --> 00:35:08,960
+Hot زي قسم القسترة يعني إذا أنا عمل قسترة ICU لقسم
+
+449
+00:35:08,960 --> 00:35:11,900
+القسترة لازم تكون قريبًا منه في نفس ال level في
+
+450
+00:35:11,900 --> 00:35:15,560
+نفس الطابق مش تكون في طابق مختلف إذا أنا عمل ICU
+
+451
+00:35:15,560 --> 00:35:21,100
+للجراحة فلازم تكون في نفس طبيعي العملياتإذا أنا
+
+452
+00:35:21,100 --> 00:35:26,960
+أعمل ICU عشان أي مريض ببسط أوبتعد كتير، النازله
+
+453
+00:35:26,960 --> 00:35:30,500
+الأقسام الجراحية برضه لازم تكون في نفس المبنى مش
+
+454
+00:35:30,500 --> 00:35:34,160
+هيتكون الـICU في مبنى والأقسام الجراحية في مبنى
+
+455
+00:35:34,160 --> 00:35:38,360
+آخر، هذه لازم يراها من الدماغ there should be a
+
+456
+00:35:38,360 --> 00:35:42,740
+sufficient number of lifts available لازم يكون عدد
+
+457
+00:35:42,740 --> 00:35:46,620
+المصاعد في المبنى متوافق رخاصة إذا كانت الـICU
+
+458
+00:35:46,620 --> 00:35:50,790
+مثلا في طابق أرضيوربما في نفس الطابق اللي فيه
+
+459
+00:35:50,790 --> 00:35:54,390
+العمليات لكن بقيت الأقسام اللي ماري جيت عبّوها في
+
+460
+00:35:54,390 --> 00:35:55,990
+الطابق التالت أو الرابع
+
+461
+00:35:58,900 --> 00:36:04,440
+لفت مخصص أو أسنسير مخصص لنقل الحالات الحرجة هاي
+
+462
+00:36:04,440 --> 00:36:08,520
+عشان ماروحش إيه الحاجة الأسنسير والله في ناس في
+
+463
+00:36:08,520 --> 00:36:13,660
+الدور السفر تتسرقش مانصحش ICU with fewer than 4
+
+464
+00:36:13,660 --> 00:36:18,760
+beds are not cost effective and over 20 beds are
+
+465
+00:36:18,760 --> 00:36:26,610
+unmanageable لما يكون ال ICUيا جماعة أقل من أربعة
+
+466
+00:36:26,610 --> 00:36:31,410
+سرر يعني إحنا عاملين ICU بالسريرين هذه بتكون
+
+467
+00:36:31,410 --> 00:36:36,670
+تكلفتها عالية كتير لإنه يعني إن أنت جايب سريرين أو
+
+468
+00:36:36,670 --> 00:36:44,490
+تلاتة هتحتاج تقريبًا نفس الطاقة يعني كده مثلًا لو
+
+469
+00:36:44,490 --> 00:36:49,690
+أنت في عندك أربعة
+
+470
+00:36:49,690 --> 00:36:53,570
+beds ممكن two nurses يشتغلوا معهم يكونوا بكافةكل
+
+471
+00:36:53,570 --> 00:36:58,150
+الممرض ياخد تنتين، تمام؟ الـ ideal كيف أنه نجسم؟
+
+472
+00:36:58,150 --> 00:37:01,250
+الـ ideal أنه لما تكون الحالة hot تشتغل معها one
+
+473
+00:37:01,250 --> 00:37:04,450
+nurse ل one patient، بس هاجة لما تكون الحالة لسه
+
+474
+00:37:04,450 --> 00:37:08,410
+hot، يعني طالعة من العمليات ولسه CPI، يعني very
+
+475
+00:37:08,410 --> 00:37:12,110
+critical، تمام؟الحالة ما بتظلش طول الوقت يا جماعة
+
+476
+00:37:12,110 --> 00:37:16,430
+زي هيكة ممكن تظلها هيكة تلت ساعات، ست ساعات،
+
+477
+00:37:16,430 --> 00:37:20,050
+اتناشر ساعة، بعدين بتصير stability وفي الأغلب بعد
+
+478
+00:37:20,050 --> 00:37:24,950
+تلت ساعات كل الحالات بتخش في restabilization بتبدأ
+
+479
+00:37:24,950 --> 00:37:28,190
+تصير مستقرة وبيبدأ التعامل معاها يصير أرود
+
+480
+00:37:28,190 --> 00:37:32,110
+وبالتالي بيصير كل nurse يتعامل مع two patients
+
+481
+00:37:32,110 --> 00:37:39,770
+لاحظين كل nurse مع two patients وبالتاليأربع بيتز
+
+482
+00:37:39,770 --> 00:37:44,330
+يعني بدي بس إنهم two nurses وخلاص أول مابتيش
+
+483
+00:37:44,330 --> 00:37:50,310
+الحالة hot اتنين بيشتغلوا معاها لدرجة
+
+484
+00:37:50,310 --> 00:37:53,670
+إنه بيصير two nurse ل one patient بس هذا لفترة،
+
+485
+00:37:53,670 --> 00:37:57,550
+لفترة تساعد دماغ، بعدين بيخدها واحد لحاله، واحد
+
+486
+00:37:57,550 --> 00:38:01,410
+nurse بيشتغل مع الحالةطبعاً مكون معاه حالة تانية
+
+487
+00:38:01,410 --> 00:38:05,730
+بس الحالة التانية call ففي ساعة أو ساعتين لو شغل
+
+488
+00:38:05,730 --> 00:38:10,230
+عنها مش هتتأثر كتير لإنها أصبحت call أو زميله ممكن
+
+489
+00:38:10,230 --> 00:38:14,090
+يعتقد بالحالة هذه ال call ده بينما تستقر حالته
+
+490
+00:38:14,370 --> 00:38:19,190
+فالـKey اللي بيشتغلوا عليه في الـICU إنه ممكن إن
+
+491
+00:38:19,190 --> 00:38:22,290
+إحنا نقسم حسب إيش نوع الـICU وإيش طبيعة الحالات
+
+492
+00:38:22,290 --> 00:38:25,750
+اللي بيعملها وبينعمل إلها admission One nurse
+
+493
+00:38:25,750 --> 00:38:29,850
+لـTwo patients، One nurse لOne patient، One nurse
+
+494
+00:38:29,850 --> 00:38:33,090
+لTwo patients، ممكن إنه Two nurses لتلاتة
+
+495
+00:38:33,090 --> 00:38:37,030
+patients، تمام؟ عادة إن إذا كانت الـICU أكتر من
+
+496
+00:38:37,030 --> 00:38:40,670
+عشرين سنين بتصير عملية السيطرة عليه عملية صعبة لإن
+
+497
+00:38:40,670 --> 00:38:44,920
+الطاقة بيصير كبيرة كتيرالشيء الجيد هو الـ
+
+498
+00:38:44,920 --> 00:38:48,280
+Intensive
+
+499
+00:38:48,280 --> 00:38:55,780
+Care
+
+500
+00:38:55,780 --> 00:39:13,380
+Equipments
+
+501
+00:39:14,440 --> 00:39:18,660
+الشاشة المراقبة «Multi-Screen» بدي اللي هو «Live
+
+502
+00:39:18,660 --> 00:39:22,360
+Support» و«Emergency Station Devices» يعني بدي DC
+
+503
+00:39:22,360 --> 00:39:25,600
+شوك وبيدي الـ «Energy Scope» وبيدي الـ «Emergency
+
+504
+00:39:25,600 --> 00:39:28,840
+Control» الكامل لأنه «Light Threatening Condition»
+
+505
+00:39:28,840 --> 00:39:31,740
+فيه الـ «Diagnostic Devices» كتير بحتالي زي الـ
+
+506
+00:39:31,740 --> 00:39:35,120
+«Blood Gases» و«Machines» كل الشيء اللي أنا بحتالي
+
+507
+00:39:35,120 --> 00:39:38,350
+أن أعمله زي اللي ممكن أحتاج أن أعملاللي هو
+
+508
+00:39:38,350 --> 00:39:44,350
+البرونكسكوب في الـ ICU ممكن أحتاج أن أركبله الـ
+
+509
+00:39:44,350 --> 00:39:48,990
+Central Line عشان أخد الـCVB فممكن ممكن أحتاج
+
+510
+00:39:48,990 --> 00:39:54,070
+أركبله الـ Arterial Line عشان أخد الـ Invasive
+
+511
+00:39:54,070 --> 00:39:58,110
+Blood Pressure فبالتالي مش زي القصر، في حاجات كتير
+
+512
+00:39:58,110 --> 00:40:01,530
+بتلزمني، هنشوفها من وحدة «Patient Monitoring
+
+513
+00:40:01,530 --> 00:40:04,330
+Equipment» طب عشان أنا أعمل Monitoring للpatient،
+
+514
+00:40:04,330 --> 00:40:09,010
+إيش بده؟بالـ Acute Care Physiologic Monitoring
+
+515
+00:40:09,010 --> 00:40:14,200
+Systemاللي هو الـ Monitor Screen وبدّي برسوكزوميتر
+
+516
+00:40:14,200 --> 00:40:17,620
+يكون طالع منه برسوكزوميتر وبدّي Intracranial
+
+517
+00:40:17,620 --> 00:40:20,720
+Pressure Monitor ممكن يكون طالع منه Transducer
+
+518
+00:40:20,720 --> 00:40:27,260
+علشان يجيسلي الـ ICP تمام؟ نفس الـ Transducer هذا
+
+519
+00:40:27,260 --> 00:40:32,720
+ممكن يستخدم يجيسلي الـ CDP وممكن يكون في عندي
+
+520
+00:40:32,720 --> 00:40:37,000
+أبريه Monitor جهاز يقوللي وقت شغل المرير بدأ يتنفس
+
+521
+00:40:37,000 --> 00:40:41,360
+ولا لأ هذا الـ Monitor Screen اللي بنحكي عنهطبعاً
+
+522
+00:40:41,360 --> 00:40:44,320
+هذا portable زي ما انتوا شايفين بس الـ «مونوترات»
+
+523
+00:40:44,320 --> 00:40:47,560
+الكبيرة اللي بتشوفها في المستشفى بتكون أكبر من هنا
+
+524
+00:40:47,560 --> 00:40:51,480
+وفيها options كتير طالع منها هذا ال «Prop» اللي
+
+525
+00:40:51,480 --> 00:40:55,040
+بيعمل قياس للـ Oxygen Saturation بتسميه «Pulse
+
+526
+00:40:55,040 --> 00:40:58,960
+Oximeter» هذا جهاز بس «Pulse Oximeter» لحال بجسد
+
+527
+00:40:58,960 --> 00:41:01,600
+ال «Pulse Oximeter» و بجسد ال «Heart Rate» من
+
+528
+00:41:01,600 --> 00:41:05,790
+الأصبع من ال«Peripheral»من الـ Finger، هذا الجهاز
+
+529
+00:41:05,790 --> 00:41:11,770
+اللي هو لأنيه في الـ ICU بيسموه Amia Monitor لما
+
+530
+00:41:11,770 --> 00:41:16,830
+يبطل الطفل فجأة يتنفس، يصار يزمر لأنه بيشتغل على
+
+531
+00:41:16,830 --> 00:41:23,010
+ال movement تبع ال chestهذا الجهاز اللي هو بيغسل
+
+532
+00:41:23,010 --> 00:41:30,130
+الـ Intracranial Pressure جداش الـ ICP جداش الـ
+
+533
+00:41:30,130 --> 00:41:34,230
+Pressure داخل الـ Intracranial كل هذه اللي بتكون
+
+534
+00:41:34,230 --> 00:41:37,070
+يعني هذا موجود في كل مكان هذا موجود في كل مكان هذا
+
+535
+00:41:37,070 --> 00:41:40,090
+بس موجود في الخضانة وهذا بس موجود في الـ
+
+536
+00:41:40,090 --> 00:41:45,180
+Neurologic ICPكمان نحتاج للحاجات اللي بتلزمنا لـ
+
+537
+00:41:45,180 --> 00:41:48,040
+Resuscitation أولا الـ Ventilator الـ Ventilator
+
+538
+00:41:48,040 --> 00:41:51,080
+هو من أهم الحاجة اللي بيعمل Respiratory
+
+539
+00:41:51,080 --> 00:41:54,960
+Resuscitation الـ Infusion Pump لإنه أنا بكون مركب
+
+540
+00:41:54,960 --> 00:41:59,160
+عليه اللي هو Dubamine, Dubutamine, Noradrenaline
+
+541
+00:41:59,160 --> 00:42:05,100
+وهذه بنسميها Intropic Drug وزوجتها تعمل اللي هو
+
+542
+00:42:05,100 --> 00:42:10,320
+Heart Resuscitation، إن عاشت للقلبوفي عندنا الـ
+
+543
+00:42:10,320 --> 00:42:15,160
+Crush Card في عندنا الـ Intraortic Palomba بالـ
+
+544
+00:42:15,160 --> 00:42:20,660
+Intraortic Palomba من برضه من ضمن الحاجات اللي هي
+
+545
+00:42:20,660 --> 00:42:29,480
+بتعمل يعني Resuscitation برضه للـ Heart عن طريق ان
+
+546
+00:42:29,480 --> 00:42:34,200
+هو يعني هنشرحه بالتفصيل احنا في Cardiology بس
+
+547
+00:42:34,200 --> 00:42:45,880
+الفكرة عامة سريعة عنهإن هو بيضعوا الـ Intra
+
+548
+00:42:45,880 --> 00:42:50,640
+-Aortic Balloon Bomb في الأورطة فبيصير ينفخ لما
+
+549
+00:42:50,640 --> 00:42:57,000
+ينفخ وظيفته يزود التاروة تبع عضلة القلب نفسها فلما
+
+550
+00:42:57,000 --> 00:43:05,930
+بيزود التاروة تبع العرضعضلة القلب نفسها اللي هو
+
+551
+00:43:05,930 --> 00:43:11,810
+بيحسن من قوة عضلة القلب وبيحسن من كفاءة عمل عضلة
+
+552
+00:43:11,810 --> 00:43:16,690
+القلب وبالتالي هذا Resuscitation للـ Heart تمام؟
+
+553
+00:43:16,690 --> 00:43:22,090
+هنشوف مثلًا عضلة القلب وانتش بالظبط نقدر القلب
+
+554
+00:43:22,090 --> 00:43:27,350
+اللي هوأو الـ Intra-Aortic Balloon Bomb لما تنفخ
+
+555
+00:43:27,350 --> 00:43:33,490
+ترجع الدم لعضلة القلب نفسها في الـ Cystole أو في
+
+556
+00:43:33,490 --> 00:43:38,450
+الـ Diastole وكيف تتم القالية بالظبط وإيش أهمية
+
+557
+00:43:38,450 --> 00:43:43,140
+الـ Intra-Aortic Balloonطبعاً الـ Crash Cart اللي
+
+558
+00:43:43,140 --> 00:43:46,400
+هي عربة طوارئ الـ Emergency Trolley اللي حكينا عنه
+
+559
+00:43:46,400 --> 00:43:49,640
+اللي فيه كل شيء فيه لاريندوسكوب وفيه متيوبات وفيه
+
+560
+00:43:49,640 --> 00:43:53,060
+كل ما هو مطلوب طبعاً في حاجة اللي حكينا عنها الـ
+
+561
+00:43:53,060 --> 00:43:56,440
+Diagnostic Equipment نحتاج حاجات كتير، قولنا احنا
+
+562
+00:43:57,490 --> 00:44:02,150
+بالـ Blood Gas Analysis الـ Device هذا كمان بنحتاج
+
+563
+00:44:02,150 --> 00:44:05,570
+Mobile X-Ray يكون فيه عنده جهاز لتصوير الأشعة
+
+564
+00:44:05,570 --> 00:44:08,690
+متحدة لإن ما تقدرش الـ Critical Inpatient أنزله
+
+565
+00:44:08,690 --> 00:44:13,730
+على الأشعة أو أطل عادة نقسم الأشعة بتكون تحت الأرض
+
+566
+00:44:13,730 --> 00:44:16,990
+أنزله على الأشعة عشان يتصور ولا حتى عشان يعمل
+
+567
+00:44:16,990 --> 00:44:20,650
+Ultrasound ولا حتى عشان يعمل Echo فبالتالي بتلاقي
+
+568
+00:44:20,650 --> 00:44:24,750
+في ال ICU فيه جهاز Portable Ultrasound فيه
+
+569
+00:44:24,750 --> 00:44:30,610
+Portable Echo تمام؟موبايل إكسري، Blood gas
+
+570
+00:44:30,610 --> 00:44:36,230
+analyzer حتى الكثير من الـICUs بيكون فيها الـCBC
+
+571
+00:44:36,230 --> 00:44:40,330
+والـChemistry Machine موجودة داخل الـICU كإنه
+
+572
+00:44:40,330 --> 00:44:48,570
+بيحكي عن مستشفى صغير هو الـICU بيكون كإنه محتويات
+
+573
+00:44:48,570 --> 00:44:54,570
+مستشفى كاملة فيه، ليش؟ لأن عندنا هنشوف في الـ
+
+574
+00:44:55,320 --> 00:44:59,580
+الشخصيات اللي بيشتغلوا في ال ICU من هم هنجد انه
+
+575
+00:44:59,580 --> 00:45:03,540
+احنا كل انواع الناس اللي بتشتغل داخل المستشفى
+
+576
+00:45:03,540 --> 00:45:09,320
+كاملة لازم يكونوا موجودين في ال ICU بشكل دائم تمام
+
+577
+00:45:09,320 --> 00:45:19,270
+اعتقد انهوقت المحاضرة يعني حوالي نصف ساعة فبدي
+
+578
+00:45:19,270 --> 00:45:25,290
+أخلي الـICU admission للمحاضرة التانية اللي بدي
+
+579
+00:45:25,290 --> 00:45:30,070
+أسجلها بعد هذه إن شاء الله فخلينا نوقف التسجيل
+
+580
+00:45:30,070 --> 00:45:34,510
+لهذا ونبدأ بالتسجيل الجديد من ان الـICU admission
+
+581
+00:45:34,510 --> 00:45:35,370
+criteria
+
diff --git a/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/c4LhutotWdI_raw.srt b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/c4LhutotWdI_raw.srt
new file mode 100644
index 0000000000000000000000000000000000000000..e6a06197cd41582d59de728a90868e1b005764c5
--- /dev/null
+++ b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/c4LhutotWdI_raw.srt
@@ -0,0 +1,2336 @@
+1
+00:00:07,090 --> 00:00:09,890
+بسم الله الرحمن الرحيم السلام عليكم ورحمة الله
+
+2
+00:00:09,890 --> 00:00:14,150
+وبركاته اليوم
+
+3
+00:00:14,150 --> 00:00:20,090
+إن شاء الله رب العالمين نحكي عن المحاضرة الأولى في
+
+4
+00:00:20,090 --> 00:00:25,310
+introduction to critical care nursing مصاد للرعاية
+
+5
+00:00:25,310 --> 00:00:34,630
+الحديثة للتمريد أو الرعاية الحرجة أو تمريد الرعاية
+
+6
+00:00:34,630 --> 00:00:37,840
+الحرجةمعكم إن شاء الله رب العالمين هتكون الدكتور
+
+7
+00:00:37,840 --> 00:00:41,160
+خالد جمال فضورة Assistant professor of
+
+8
+00:00:41,160 --> 00:00:49,540
+epidemiology طبعاً الحمد لله رب العالمين أنا يعني
+
+9
+00:00:49,540 --> 00:00:54,460
+عملت في التسمة اللي هنا المركزة لأكتر من 12 سنة
+
+10
+00:00:54,460 --> 00:00:58,980
+كنت Registered
+
+11
+00:00:58,980 --> 00:01:04,280
+nurse في ال ICU في مستشفى الشيطان وفي مستشفى القدس
+
+12
+00:01:04,280 --> 00:01:11,780
+أيضاًوكنت رئيس خصم الـICU الخاصة بالقلب المفتوح
+
+13
+00:01:11,780 --> 00:01:15,780
+Open Heart Surgery Cardiac Care Intensive Care
+
+14
+00:01:15,780 --> 00:01:25,540
+Unit Post Cardiac Surgery طبعاً كذلك كنت رئيس خصم
+
+15
+00:01:25,540 --> 00:01:31,460
+انهار مركزة في مستشفى خدمة العامة لجراحة القلب
+
+16
+00:01:31,460 --> 00:01:32,480
+المفتوح
+
+17
+00:01:34,520 --> 00:01:38,500
+إن شاء الله رب العالمين في هذا الcourse هنتناول مع
+
+18
+00:01:38,500 --> 00:01:44,080
+بعض مقدمة عن الـ Critical Care Nursing إيش يعني
+
+19
+00:01:44,080 --> 00:01:48,040
+الـ ICU؟ إيش يعني الـ Critical Care Nurse؟ وإيش
+
+20
+00:01:48,040 --> 00:01:51,260
+يعني الـ Critical Ill Patients؟ كيف بعمل
+
+21
+00:01:51,260 --> 00:01:54,520
+assessment لـ Critical Ill Patient؟ وبحدد إن هو
+
+22
+00:01:54,520 --> 00:01:58,720
+كوين أنه Critical Ill؟ إيش مواصفات الـ ICU؟ إيش
+
+23
+00:01:58,720 --> 00:02:02,440
+مواصفات المكان اللي بيستقبل فيه حالات الحرجة
+
+24
+00:02:02,440 --> 00:02:06,240
+وبيتعامل معاها؟ميه هم الحالات الحارجة؟ إيش هي الـ
+
+25
+00:02:06,240 --> 00:02:11,580
+Ethical consideration للناس اللي بناروا في ال ICU؟
+
+26
+00:02:11,580 --> 00:02:15,600
+وإيش ممكن إحنا نتواجهنا ethical dilemma؟ إيش هي
+
+27
+00:02:15,600 --> 00:02:18,760
+المشاكل والـ stress اللي متواجهنا؟ وإيه ال burnout
+
+28
+00:02:18,760 --> 00:02:22,060
+syndrome؟ اللي ممكن يتصير في نتيجة العمل في
+
+29
+00:02:22,060 --> 00:02:25,960
+الأماكن الـ hot carriers نسميها؟ بعدين هندخل لل
+
+30
+00:02:25,960 --> 00:02:30,320
+unit التاني وقدرنا نحكي في لب الموضوع اللي هو ال
+
+31
+00:02:30,320 --> 00:02:36,260
+acid-base balance إيش هوالتوازن تبع الـ Acid Base
+
+32
+00:02:36,260 --> 00:02:39,260
+اللي ربنا قامله الحمضية والقلوية في جسم الإنسان،
+
+33
+00:02:39,260 --> 00:02:42,640
+إيش هو التعريف طبعه، إيش هو الـ Puffer System هذا
+
+34
+00:02:42,640 --> 00:02:47,360
+النظام اللي بيعمل الإتزان في الجسم محافظ عليه، إيش
+
+35
+00:02:47,360 --> 00:02:52,060
+هم الأجهزة، إيش الحالات الأفلالية والمراضية اللي
+
+36
+00:02:52,060 --> 00:02:59,950
+بتسير نتيجة خربطة أو اضطراب في حالة الإتزانالـ
+
+37
+00:02:59,950 --> 00:03:06,370
+Acid Base الحمضية القاعدية في الجسم وموضوع الجهاز
+
+38
+00:03:06,370 --> 00:03:13,330
+التنفس الاصطناعي كمقدمة وموضوع مهم جدًا لمواضيع
+
+39
+00:03:13,330 --> 00:03:16,770
+الـ Respiratory illness اللي في الـ Chapter التالت
+
+40
+00:03:16,770 --> 00:03:20,450
+اللي هو الـ Acute Respiratory Failure و Acute
+
+41
+00:03:20,450 --> 00:03:22,490
+Respiratory Distress Syndrome الـ ERDS
+
+42
+00:03:22,490 --> 00:03:27,410
+والفلورينالكوليزم والفلورينالايديمة والكيموتوراكس
+
+43
+00:03:27,410 --> 00:03:34,530
+كل هذه المواضيعهتكون يعني تفصيلها وشرحها معانا
+
+44
+00:03:34,530 --> 00:03:41,630
+وهيكون علاجها أو الطريقة اللي بتستخدم الـ
+
+45
+00:03:41,630 --> 00:03:44,030
+Supportive Management of the Respiratory System
+
+46
+00:03:44,030 --> 00:03:49,770
+لـMost Obese Diseases Respiratory Diseases and
+
+47
+00:03:49,770 --> 00:03:53,730
+Acid-Based Balance Disturbance Disorders will be
+
+48
+00:03:53,730 --> 00:03:57,170
+treated byاللي هو الـ Mechanical Ventilator فالـ
+
+49
+00:03:57,170 --> 00:04:01,690
+Mechanical Ventilator سيتحدث في التفاصيل ومن ثم
+
+50
+00:04:01,690 --> 00:04:08,310
+سنقوم بالتغيير لتحديث تغيير الهيمو-ديناميكا
+
+51
+00:04:08,310 --> 00:04:12,050
+البرمجية البرمجية البرمجية البرمجية البرمجية
+
+52
+00:04:12,050 --> 00:04:13,550
+البرمجية البرمجية البرمجية البرمجية البرمجية
+
+53
+00:04:13,550 --> 00:04:16,810
+البرمجية البرمجية البرمجية البرمجية البرمجية
+
+54
+00:04:16,810 --> 00:04:18,960
+البرمجية البرمجيةأو الـ Herodynamic Stability
+
+55
+00:04:18,960 --> 00:04:24,020
+ومراقبة للطبيعي في مجلس التعامل التقليدي بما يسمى
+
+56
+00:04:24,020 --> 00:04:29,200
+Invasive وInvasive method لذلك سنتحدث أيضًا عن
+
+57
+00:04:29,200 --> 00:04:32,840
+المشاكل العضلية والمشاكل الهوائية المشاكل الهوائية
+
+58
+00:04:32,840 --> 00:04:36,340
+والمشاكل الهوائية والمشاكل الهوائية والمشاكل
+
+59
+00:04:36,340 --> 00:04:39,140
+الهوائية والمشاكل الهوائية والمشاكل الهوائية
+
+60
+00:04:39,140 --> 00:04:41,560
+والمشاكل الهوائية والمشاكل الهوائية والمشاكل
+
+61
+00:04:41,560 --> 00:04:43,540
+الهوائية والمشاكل الهوائية والمشاكل الهوائية
+
+62
+00:04:43,540 --> 00:04:44,160
+والمشاكل الهوائية والمشاكل الهوائية والمشاكل
+
+63
+00:04:44,160 --> 00:04:47,840
+الهوائية والمشاكل الهوائهو مشكلة التشوك الخاصة
+
+64
+00:04:47,840 --> 00:04:50,740
+ومشكلة التشوك الخاصة ومشكلة التشوك الخاصة ومشكلة
+
+65
+00:04:50,740 --> 00:04:53,320
+التشوك الخاصة ومشكلة التشوك الخاصة ومشكلة التشوك
+
+66
+00:04:53,320 --> 00:04:53,480
+الخاصة ومشكلة التشوك الخاصة ومشكلة التشوك الخاصة
+
+67
+00:04:53,480 --> 00:04:55,920
+ومشكلة التشوك الخاصة ومشكلة التشوك الخاصة ومشكلة
+
+68
+00:04:55,920 --> 00:04:59,160
+التشوك الخاصة ومشكلة التشوك الخاصة ومشكلة التشوك
+
+69
+00:04:59,160 --> 00:05:00,880
+الخاصة ومشكلة التشوك الخاصة ومشكلة التشوك الخاصة
+
+70
+00:05:00,880 --> 00:05:04,480
+ومشكلة التشوك الخاصة ومشكلة التشوك الخاصة ومشكلة
+
+71
+00:05:04,480 --> 00:05:10,280
+التشوك الخاصة ومشكلة
+
+72
+00:05:10,280 --> 00:05:16,500
+التشوعلى المادة وانتم مبسوطين ومرتاحين وما تحللوش
+
+73
+00:05:16,500 --> 00:05:23,140
+هملك وزاد المحاضرة الأولى هذه عبارة عن مقدمة بسيطة
+
+74
+00:05:23,140 --> 00:05:27,600
+وتأليف في المادة ككل اللي شرحته تاويه هو تلقيس
+
+75
+00:05:27,600 --> 00:05:34,340
+لإيش هناخد فيه خلال الفصل كاملا بالإضافة إلى شبطر
+
+76
+00:05:34,340 --> 00:05:37,980
+الحروق أنا نسيت أحطه في ال slice الشبطر ال burn
+
+77
+00:05:37,980 --> 00:05:41,580
+لإن أعتقد أنكم ما أخدتهوش
+
+78
+00:05:44,060 --> 00:05:49,120
+وخاصة أنه موضوع الـ Burn من المواضيع اللي بيكون
+
+79
+00:05:49,120 --> 00:05:54,480
+Need لإن المريض يدخل الـICU الآن هنبدأ نحكي عن
+
+80
+00:05:54,480 --> 00:05:58,320
+الشق الأول في الـUnity الأولى وهو نحكي عن
+
+81
+00:05:58,320 --> 00:06:00,260
+الـBackground عن الـICU
+
+82
+00:06:02,470 --> 00:06:07,750
+الفيديو اللي عملناه بات مباشر لكن أنا بعيد هنا
+
+83
+00:06:07,750 --> 00:06:10,350
+Definition of Critical Care Nursing أشعر عن
+
+84
+00:06:10,350 --> 00:06:13,830
+Critical Care Nursing بمعنى أن الـ Critical Care
+
+85
+00:06:13,830 --> 00:06:18,510
+Nurse هذا هو الممرج الـ practitioner اللي بتعامل
+
+86
+00:06:18,510 --> 00:06:22,390
+مع الناس اللي عندها life threatening problems اللي
+
+87
+00:06:22,390 --> 00:06:27,010
+بتعامل مع الناس اللي عندها مشاكل بتهدد حياتها
+
+88
+00:06:27,010 --> 00:06:34,190
+بالخطر والـوالناس اللي بيكونوا زي ما بنسميها
+
+89
+00:06:34,190 --> 00:06:42,570
+معرضين لالموت لو استمرت تطور حالتهم بالسوق فهذا
+
+90
+00:06:42,570 --> 00:06:46,190
+اسمه Critically Ill Patient
+
+91
+00:06:49,010 --> 00:06:52,770
+لما بحكي أنا Critical Care إيش معناها؟ معناها إنه
+
+92
+00:06:52,770 --> 00:06:58,350
+أقدّم رعاية لمريد حياته مهددة بالخطر الـ Critical
+
+93
+00:06:58,350 --> 00:07:02,670
+Care Nurse مين هو؟ هو الشخص المؤهل الـ
+
+94
+00:07:02,670 --> 00:07:07,250
+Professional Nurse اللي بيستطيع إنه يتعامل مع
+
+95
+00:07:07,250 --> 00:07:11,990
+الناس اللي عندها الـ Critical أو اللي عندها Life
+
+96
+00:07:11,990 --> 00:07:15,090
+Threatening Conditions أو Problems أو مش بس
+
+97
+00:07:15,090 --> 00:07:19,340
+المريض، و الـ Family التابعته كمانهذا هو الشخص
+
+98
+00:07:19,340 --> 00:07:25,540
+المؤهل لكلام هذا عن طريق إنه بياخد course ICU أو
+
+99
+00:07:25,540 --> 00:07:29,920
+Critical Care Nursing أو عن طريق إنه بياخد master
+
+100
+00:07:29,920 --> 00:07:33,980
+Critical Care Nursing أو عن طريق إنه بياخد high
+
+101
+00:07:33,980 --> 00:07:39,860
+diploma بعد ما بيخلص general nursing بياخد high
+
+102
+00:07:39,860 --> 00:07:44,360
+diploma in Critical Care Nursing هذا هو الشخص اللي
+
+103
+00:07:44,770 --> 00:07:49,350
+بيتعامل وبيحقله أن يتعامل مع الـ Critical Ill
+
+104
+00:07:49,350 --> 00:07:56,090
+Patient ويطلق عليه Critical Care Registered Nurse
+
+105
+00:07:56,090 --> 00:07:59,610
+عشان هي الـ Critical Ill Patient مين هم زي ما
+
+106
+00:07:59,610 --> 00:08:07,510
+حكينا الناس اللي عندهم يعني ما يهدد حياتهم سواء عن
+
+107
+00:08:07,510 --> 00:08:13,820
+طريق أنه فيه اندوأو أمراض تهدد حياته حاليًا عن
+
+108
+00:08:13,820 --> 00:08:17,480
+طريق أنه فيه أكتر من Vital organs أو Vital organs
+
+109
+00:08:17,480 --> 00:08:27,380
+محدد فيه خلل في عملهأو إن احتماليت وضعه في هذا
+
+110
+00:08:27,380 --> 00:08:33,560
+الوضع سوف يؤدي إلى حصول خلل في Vital organs أو
+
+111
+00:08:33,560 --> 00:08:38,360
+أكتر من Vital organs يعني مثلًا للتوضيح، لو جينا
+
+112
+00:08:38,360 --> 00:08:47,810
+نحكي عن شخصشاب وفجأة راح يتدرب في الجيش وهو يعني
+
+113
+00:08:47,810 --> 00:08:52,290
+ماكانش بعمل رياضة قبل هيك ومش متعود على ممارسة
+
+114
+00:08:52,290 --> 00:08:56,930
+الأعمال والمجهودات الشاقة طيب إيه صار معاه فجأة
+
+115
+00:08:56,930 --> 00:09:03,360
+بدأ يتدرب وبدأ يعمل مجهودات شاقة أكتر منالاحتمال
+
+116
+00:09:03,360 --> 00:09:08,700
+أو من القوة أو من التحمل اللي بتتحمله العضلات
+
+117
+00:09:08,700 --> 00:09:15,920
+تبعته فبالتالي صار P&O إرهاق للعضلات لما صار P&O
+
+118
+00:09:15,920 --> 00:09:21,120
+إرهاق للعضلات بدأت العضلات تتكرز نتيجة الـ Overuse
+
+119
+00:09:21,120 --> 00:09:27,450
+تبعتهابدأت تفرس حاجة بنسميها الـMyoglobulin اللي
+
+120
+00:09:27,450 --> 00:09:35,250
+هو الانزيم تبع العضلة اللي بيطلع من العضلة وبيصل
+
+121
+00:09:35,250 --> 00:09:40,270
+للدم وبعد ما يصل للدم كل الـMyoglobulin هذا اللي
+
+122
+00:09:40,270 --> 00:09:43,710
+نتيجة الـdestruction تبع ال muscle بيطلع بيصل
+
+123
+00:09:43,710 --> 00:09:48,090
+لوين؟ للدم، من الدم للـ kidney لما بيصل للـ kidney
+
+124
+00:09:48,090 --> 00:09:54,940
+بسبب تجنب بشكل كبير بيؤدي إلىفشل في الـ Kidneys
+
+125
+00:09:54,940 --> 00:09:57,820
+بسبب حاجة الـ Acute Renal Failure هذه الحالة
+
+126
+00:09:57,820 --> 00:10:02,400
+بيسموها Rhabdomyolysis Rhabdomyolysis Myo من عضلة
+
+127
+00:10:02,400 --> 00:10:07,220
+ربد يعني ربد تكسر تكسر في العضلة
+
+128
+00:10:11,090 --> 00:10:17,170
+اللي هو التكسر في أنزمات العضلات فبيؤدي إلى الـ
+
+129
+00:10:17,170 --> 00:10:20,890
+Acute Renal Failure لو أنا جالي المريض هو في
+
+130
+00:10:20,890 --> 00:10:25,410
+الحالة هذه وفجأة لجأت إن كمية البول صارت عنده
+
+131
+00:10:25,410 --> 00:10:29,830
+لجيوريا وأنزمات العضلات لجيتها مرتفعة جدا عنده زي
+
+132
+00:10:29,830 --> 00:10:34,590
+الـCK مثلا لجيتها مرتفعة كتير الآن أنا بعرف إن هذا
+
+133
+00:10:34,590 --> 00:10:38,430
+المريض لو تركته من غير Managementومن غير اللي هو
+
+134
+00:10:38,430 --> 00:10:42,730
+حاجة بنسميها force diuresis إنه ياخد كميات من الـ
+
+135
+00:10:42,730 --> 00:10:48,110
+Fluidوجرعات من الـ Lasix أيضًا في حس أنه يشجع
+
+136
+00:10:48,110 --> 00:10:53,730
+الكيليا أن تشتغل و تدر البول وإلا هيتوقف عنده
+
+137
+00:10:53,730 --> 00:10:58,310
+الكيليا كاملة ويدخل في acute renal failure إذًا
+
+138
+00:10:58,310 --> 00:11:03,230
+هذا مثال أنا طرحته بس عشان تعرفوا كيف أنه أنا ممكن
+
+139
+00:11:03,230 --> 00:11:06,190
+أعالج الموضوع إذا كان فيه impairment في الvital
+
+140
+00:11:06,190 --> 00:11:09,710
+organ فيه already renal failure بهو critical il أو
+
+141
+00:11:09,710 --> 00:11:16,220
+أنا بتوقع potential إن هذا لو مدخلنش هيصير عندهأو
+
+142
+00:11:16,220 --> 00:11:19,860
+موضوع تاني و كويسين عنده respiratory failure مريض
+
+143
+00:11:19,860 --> 00:11:24,440
+جايك أزمتك مققه COPD أو بالهاتف الrespiratory rate
+
+144
+00:11:24,440 --> 00:11:28,300
+عالي لو انت ماتعملتش معاه في الاخر حيث خش ب
+
+145
+00:11:28,300 --> 00:11:32,020
+respiratory failure عشان هيك في أي مكان
+
+146
+00:11:34,640 --> 00:11:37,720
+والشخص متأكد من أنه ينجح لا يمكن أن يقول له أنه
+
+147
+00:11:37,720 --> 00:11:39,120
+ليس هناك إجراء لتعامل التعامل التعامل التعامل
+
+148
+00:11:39,120 --> 00:11:40,900
+التعامل التعامل التعامل التعامل التعامل التعامل
+
+149
+00:11:40,900 --> 00:11:44,480
+التعامل التعامل التعامل التعامل التعامل التعامل
+
+150
+00:11:44,480 --> 00:11:46,760
+التعامل التعامل التعامل التعامل التعامل التعامل
+
+151
+00:11:46,760 --> 00:11:46,760
+التعامل التعامل التعامل التعامل التعامل التعامل
+
+152
+00:11:46,760 --> 00:11:46,760
+التعامل التعامل التعامل التعامل التعامل التعامل
+
+153
+00:11:46,760 --> 00:11:47,240
+التعامل التعامل التعامل التعامل التعامل التعامل
+
+154
+00:11:47,240 --> 00:11:53,920
+التعامل التعامل التعامل التعامل التعامل التعامل
+
+155
+00:11:53,920 --> 00:12:03,780
+التعامل التعيتوفى، يعني مافيش أي أمل إنه يصير عنده
+
+156
+00:12:03,780 --> 00:12:10,680
+تحسن ويصير good prognosis برضه هذا مابكونش فيه
+
+157
+00:12:10,680 --> 00:12:14,760
+need لأ لأنه مركز، ها كيف يعني إذا بتقول critical
+
+158
+00:12:14,760 --> 00:12:18,140
+ill و life threatening condition هدولة بيكونوا هم
+
+159
+00:12:18,140 --> 00:12:22,580
+معناهم ل critical ill كيف بتقول لما بيكونالمريض
+
+160
+00:12:22,580 --> 00:12:27,600
+يعني الموت عنده حتمي بيبطل بده intensive care آه
+
+161
+00:12:27,600 --> 00:12:31,880
+لما بكون عنده الموت حتمي صار إيش أهمية إن أنا
+
+162
+00:12:31,880 --> 00:12:36,100
+أراعاه بشكل intensive أقدّم له intensive care
+
+163
+00:12:39,200 --> 00:12:44,060
+ما ليهاش أي أهمية لإن مش هأحسن من النهاية المعروفة
+
+164
+00:12:44,060 --> 00:12:48,160
+زي مثلا الحالات اللي عنده Multi-Organ System
+
+165
+00:12:48,160 --> 00:12:51,400
+Failure واحد عنده Cancer الـBrain وصار عنده
+
+166
+00:12:51,400 --> 00:12:55,180
+Metastasis أو Cancer Lung خليني أقول وصار عنده
+
+167
+00:12:55,180 --> 00:12:59,320
+Metastasis للـBrain وخش مرينال Failure فالمريض هذا
+
+168
+00:12:59,320 --> 00:13:03,000
+صار فيه عنده Respiratory Failure وصار فيه عنده
+
+169
+00:13:03,000 --> 00:13:09,670
+Kidney Failure وصار فيه عنده اللي هوالـ Neurologic
+
+170
+00:13:09,670 --> 00:13:13,790
+Failure يعني الـ Neurosystem تبقى و كمان إيش الـ
+
+171
+00:13:13,790 --> 00:13:16,410
+Glasgow-Columbus ده ما صار مثلا تلاتة يعني صار فيش
+
+172
+00:13:16,410 --> 00:13:23,530
+هندو Consciousness بطل Conscious بطل Oriented فصار
+
+173
+00:13:23,530 --> 00:13:31,540
+في عندي تلت organs أساسيةجهاز العصبي الجهاز الـ
+
+174
+00:13:31,540 --> 00:13:36,820
+circulatory لأنه بعد الـ kidney failure حصيب برضه
+
+175
+00:13:36,820 --> 00:13:41,160
+heart failure لأنه ما مصلعش السوائل تبع الجسم ما
+
+176
+00:13:41,160 --> 00:13:46,320
+بتنطرحش وبالتالي صار فيه أكتر من organ فيهFailure،
+
+177
+00:13:46,320 --> 00:13:48,760
+الـ kidney فيها Failure، الـ lung فيها Failure،
+
+178
+00:13:48,760 --> 00:13:51,900
+الـ brain فيه Failure وبالتالي هذا المريض إيش؟
+
+179
+00:13:51,900 --> 00:13:57,380
+يعني توقعنا لماذا تحسنه؟ مستحيل، مستحيل التلت
+
+180
+00:13:57,380 --> 00:14:01,140
+حاجات هدولة يطيبوا التلت organs هدولة يتحسنوا
+
+181
+00:14:01,140 --> 00:14:07,190
+ويشفوا ويرجع المريض ويرجع المريض أنه يكون إيش؟والـ
+
+182
+00:14:07,190 --> 00:14:12,730
+Pain طبعا هذا المريض بالأغلب will die علشان هيك
+
+183
+00:14:12,730 --> 00:14:16,890
+النوع العلاج المقدم له والرعاية اللي بتحتاجها
+
+184
+00:14:16,890 --> 00:14:22,070
+اسمها palliative care palliative care يعني علاج
+
+185
+00:14:22,070 --> 00:14:28,990
+تصويري إلى أن يقضي الله أمرا كان مفعولا إذا المريض
+
+186
+00:14:28,990 --> 00:14:32,550
+اللي مافيش خوف على حياته ووضعه stable مابيدوش
+
+187
+00:14:32,550 --> 00:14:36,980
+intensive care المريض اللي مات مؤكدكان نتيجة إنه
+
+188
+00:14:36,980 --> 00:14:45,120
+في عنده أكتر منأو organ failure مثلا أو cancer أو
+
+189
+00:14:45,120 --> 00:14:51,440
+whatever ومعروف إنه can not survive هذا برضه يعني
+
+190
+00:14:51,440 --> 00:14:55,240
+الـ certain تبعه الـ bias تبعه الـ certain أكيد
+
+191
+00:14:55,240 --> 00:14:59,900
+برضه مابيحتاجش instance of care ومحتاج palliative
+
+192
+00:14:59,900 --> 00:15:04,780
+care تمام؟ وال palliative care يعني في مقدمة سريعة
+
+193
+00:15:04,780 --> 00:15:12,870
+عنها هي بقى التقديلالريعية اللازمة للمريض الغير
+
+194
+00:15:12,870 --> 00:15:19,290
+مرجو من شفاءه بحيث يحافظ على آدميته يعني بياخد كل
+
+195
+00:15:19,290 --> 00:15:23,710
+الإلاجات اللي أو عفوًا الحقوق اللي لازمة له مش
+
+196
+00:15:23,710 --> 00:15:27,010
+بالضروري أطلاقًا تكون أدوية أو إلاجة مش بالضروري
+
+197
+00:15:27,010 --> 00:15:32,030
+كتير في Valley of Care بيحاولوا يخفضوا كل الأدوية
+
+198
+00:15:32,030 --> 00:15:36,390
+ويردولوااللي هو الـCare اللي هي زي الـ Hygiene
+
+199
+00:15:36,390 --> 00:15:43,650
+الترطيب للـ Oral Cavity الـ Mouth Hygiene الـ Nose
+
+200
+00:15:43,650 --> 00:15:48,710
+و الـ Ear Hygiene شوية Fluid عشان ما يصيبش
+
+201
+00:15:48,710 --> 00:15:52,490
+Dehydration ممكن يردوله اللي هو رعي الـ Feeding
+
+202
+00:15:52,490 --> 00:15:56,370
+سواء عن الـ Big Tube أو الـ Gastrostomy أو عن طريق
+
+203
+00:15:56,370 --> 00:15:59,850
+الـ Mesogastric وفي الأغلب بيحاولوا بيعملوهم Big
+
+204
+00:15:59,850 --> 00:16:06,540
+Tube أو اللي هو Gastrostomyتمام، هذا اللي هو الـ
+
+205
+00:16:06,540 --> 00:16:12,400
+Palliative Care عادة للناس اللي بين الـ two groups
+
+206
+00:16:12,400 --> 00:16:14,860
+هدول الناس اللي مافيش خطر على حياتها و الناس اللي
+
+207
+00:16:14,860 --> 00:16:18,160
+أكيد بدهم يموتوا ممكن يكون المريض اللي هو
+
+208
+00:16:18,160 --> 00:16:23,840
+critically ill و بده رعاية حرية طب إيه الدور
+
+209
+00:16:23,840 --> 00:16:30,850
+الممرض في الحالات هذه؟والـ Critical Care Nurses
+
+210
+00:16:30,850 --> 00:16:34,330
+work in a wide variety of settings أقوى يعني
+
+211
+00:16:34,330 --> 00:16:37,510
+بيشتغل في الـ Intensive Care Unit تبع الأطفال
+
+212
+00:16:37,510 --> 00:16:40,910
+وبيشتغل في الـ Pediatric Intensive Care Unit تبع
+
+213
+00:16:40,910 --> 00:16:45,110
+الأطفال وبيشتغل في الـ Unit Intensive Care Unit
+
+214
+00:16:45,110 --> 00:16:53,070
+تبع الأطفال الموليد Unit من يوم لـ 28 يوم وبيشتغل
+
+215
+00:16:53,070 --> 00:16:56,800
+في الـ Infantالـ Intensive Care Unit اللي هي من
+
+216
+00:16:56,800 --> 00:17:03,820
+بعد 28 يوم لغاية سنة و أكتر من سنة لغاية 12 سنة
+
+217
+00:17:03,820 --> 00:17:08,180
+اللي نسميها بـ Theatric Intensive Care Unit وبعد
+
+218
+00:17:08,180 --> 00:17:11,560
+ذلك ممكن نشتغل في الـ Cardiac Care Unit اللي هي
+
+219
+00:17:11,560 --> 00:17:17,140
+خاصة بالناس اللي عندها مشاكل في القلب زي الـ
+
+220
+00:17:17,140 --> 00:17:20,770
+Congestive Heart Failure و زي الـ Coronaryأو الـ
+
+221
+00:17:20,770 --> 00:17:26,170
+Acute Coronary Syndrome اللي بيسموها الـ ACS وبعد
+
+222
+00:17:26,170 --> 00:17:30,710
+ذلك يمكن هذا ينعملوا catheter lab يعني ينعملوا
+
+223
+00:17:30,710 --> 00:17:35,770
+قسطرة للقلب وينعملوا catheterization وبالتالي بيدك
+
+224
+00:17:35,770 --> 00:17:39,190
+من الأماكن اللي بيشتغل فيها الـ Critical Care
+
+225
+00:17:39,190 --> 00:17:43,350
+Nurse أنه يشتغلوا في ال catheter lab نفسهاالـ
+
+226
+00:17:43,350 --> 00:17:46,490
+Preparation وفي الـ Post of Receiving تبقى الـ
+
+227
+00:17:46,490 --> 00:17:49,690
+Patient بعد الـ «Catheter Lab» بإنه يكون High
+
+228
+00:17:49,690 --> 00:17:53,790
+-Risky إنه يخشي بـ Dysrhythmia أو بـ Bleeding وفيه
+
+229
+00:17:53,790 --> 00:17:59,090
+حاجات كتير فبده Invasive Monitoring وبده لأنه يمكن
+
+230
+00:17:59,090 --> 00:18:03,490
+يصير عنده Bleeding ويصير عنده Dysrhythmia وبده ECG
+
+231
+00:18:03,490 --> 00:18:07,850
+Monitoring وعلشان هيك كمان الـ Emergency
+
+232
+00:18:07,850 --> 00:18:10,630
+Departments من الحاجات الـ Critically
+
+233
+00:18:12,920 --> 00:18:16,620
+من الـ Hot Area إلى الـ Critical Care Nurse يعني
+
+234
+00:18:16,620 --> 00:18:20,240
+ممكن يشتغل فيها ومطموك إنه يشتغل فيها وأيضا
+
+235
+00:18:20,240 --> 00:18:24,860
+Recovery Room اللي في غرف العمليات كل هذه الأماكن
+
+236
+00:18:24,860 --> 00:18:27,660
+اللي في غرف العمليات عارفين Recovery Room غرفة
+
+237
+00:18:27,660 --> 00:18:30,380
+الإنعاف بعد ما يطلع المالي من العملية لازم يكون
+
+238
+00:18:30,380 --> 00:18:35,180
+فيه Critical Care Nurseموجود عشان يشغل مع المريض
+
+239
+00:18:35,180 --> 00:18:38,420
+لإنه بيكون في life-threatening condition خمس، عشر
+
+240
+00:18:38,420 --> 00:18:42,640
+دقائق إذا عدوا بسلام هيطلع المريض يكمل هذا ان شاء
+
+241
+00:18:42,640 --> 00:18:45,740
+الله كويس otherwise ممكن المريض يسيل عنده
+
+242
+00:18:45,740 --> 00:18:50,040
+suffocation يمكنه يخش بـrelapse من الاناستيزيا
+
+243
+00:18:50,040 --> 00:18:53,300
+ويفقد الـconscious level تبعته يخش برهيطه
+
+244
+00:18:53,300 --> 00:18:58,420
+الـfailure again فهذه من الأماكن جدا المهمة أنه
+
+245
+00:18:58,420 --> 00:19:03,450
+يشتغل فيهاالـ Critical Care Nurse طبعاً أنا بحب
+
+246
+00:19:03,450 --> 00:19:07,750
+أضيفكم على الكلام هذا إنه مش بس هذه الأماكن اللي
+
+247
+00:19:07,750 --> 00:19:11,930
+بيشتغل فيها الـ Critical Care Nurse لأ كمان في
+
+248
+00:19:11,930 --> 00:19:16,130
+أماكن تانية زي الـ Home Care Nursing لأن هذا
+
+249
+00:19:16,130 --> 00:19:22,450
+الممرض هو ممرض قادر على إنه يتعامل مع الحالات
+
+250
+00:19:22,450 --> 00:19:33,130
+الحرجةفي البيوت ويقدملها الرعاية الطبية اللازمة
+
+251
+00:19:33,130 --> 00:19:44,430
+Okay
+
+252
+00:19:44,430 --> 00:19:50,670
+طيب
+
+253
+00:19:52,190 --> 00:19:55,130
+بعد مدرسة مدرسة يمكن أن يكون مدرساً مدرساً مدرساً
+
+254
+00:19:55,130 --> 00:20:20,610
+مدرساً مدرساً مدرساً مدرساً مدرساً
+
+255
+00:20:22,060 --> 00:20:31,040
+أو يعني يستطيع أنه يـfind out اللي هو مشاكل معينة
+
+256
+00:20:31,040 --> 00:20:36,200
+ويحاول يعملها research عشان يوصل لرزقرة معينة من
+
+257
+00:20:36,200 --> 00:20:39,980
+الناس اللي كتير كويسين يُعرفونه managers هم
+
+258
+00:20:39,980 --> 00:20:44,900
+الـcritical care nurses ولذلك يمكن تلاحظوا في معظم
+
+259
+00:20:44,900 --> 00:20:51,850
+مستشفيات القطاع من عمل بالإناء المركزةيعني معظمهم
+
+260
+00:20:51,850 --> 00:20:57,250
+رؤساء أقسام ومشربين ومدرع مستشفيات حتى الـ
+
+261
+00:20:57,250 --> 00:21:01,970
+clinical care nurse clinical nurse specialists and
+
+262
+00:21:01,970 --> 00:21:07,130
+nurse practitioners حكيناهم دولة the critical care
+
+263
+00:21:07,130 --> 00:21:09,530
+nurse is responsible for the identification
+
+264
+00:21:09,530 --> 00:21:13,010
+intervention and management of clinical problem to
+
+265
+00:21:13,010 --> 00:21:18,790
+improve care intervention and familiesواحد يقولنا
+
+266
+00:21:18,790 --> 00:21:20,930
+كل شوية الله يقولنا فماشي دخلنا أحنا في ال
+
+267
+00:21:20,930 --> 00:21:26,650
+families لأ ال families إلها إحنا معانا دور كبير
+
+268
+00:21:26,650 --> 00:21:33,170
+في ال nursing وفي اللي هو ال critical care nurse
+
+269
+00:21:33,170 --> 00:21:37,210
+اللي له دور كبير مع ال family كيف؟ تو إحنا حكينا
+
+270
+00:21:37,210 --> 00:21:41,370
+إن ال critical care nurse بدي يكون كمان nurse
+
+271
+00:21:41,370 --> 00:21:44,570
+educator مش ضروري يكون بس educator لل student
+
+272
+00:21:44,570 --> 00:21:48,400
+nurses كمان لل families هدولكثير ويكون في حالات
+
+273
+00:21:48,400 --> 00:21:53,680
+انت بتحتاج ان الـ Family هم اللي قدموا الخدمة وحتى
+
+274
+00:21:53,680 --> 00:21:57,800
+ممكن زي ما حكيت انا ان الـ Home Care المريض هذا
+
+275
+00:21:57,800 --> 00:22:02,040
+يكون وضعه critically ill وبعد ذلك يتحسن بس يخش في
+
+276
+00:22:02,040 --> 00:22:06,600
+مرحلة من الحاجته
+
+277
+00:22:06,600 --> 00:22:10,240
+للـ Palliative Therapy زي الناس اللي بتصير عندك
+
+278
+00:22:10,240 --> 00:22:14,040
+ودريبليجياوخلص مافيش إمكانية إنه يبطّر الـ
+
+279
+00:22:14,040 --> 00:22:17,120
+Quadriplegia بس بيصير طول أمره دي بالده أنه بده
+
+280
+00:22:17,120 --> 00:22:21,260
+mechanical ventilator وبده حد يعمله hygiene وبده
+
+281
+00:22:21,260 --> 00:22:27,180
+حد يطعمه وبده حد يشربه وبده حد يعمله self-care
+
+282
+00:22:27,180 --> 00:22:31,620
+hygiene زي ما حكينا أو body care health hygiene
+
+283
+00:22:31,620 --> 00:22:38,150
+فبالتالي بعد ما يقضي في فترة معينة منووجوده في
+
+284
+00:22:38,150 --> 00:22:41,530
+العناء المركزة ممكن ينطلع على مركز تأيير في
+
+285
+00:22:41,530 --> 00:22:46,090
+النهاية بده يقول ما قاله إلى البيت وبده تكون ال
+
+286
+00:22:46,090 --> 00:22:50,910
+family جزء من الناس اللي بيرعوه حتى لو كان في home
+
+287
+00:22:50,910 --> 00:22:56,210
+care ناس بييجي بيزوره من الصعب انه يغطي 24 ساعة
+
+288
+00:22:56,210 --> 00:23:01,210
+ممكن يعمله visit وكل يوم لعدد ساعات معينة ويقيم
+
+289
+00:23:01,210 --> 00:23:05,870
+وضعه وأعظم الواجهة هيكون الأهل هم نفسهم اللي
+
+290
+00:23:05,870 --> 00:23:10,610
+بيقوموا برعايةالمريض هذا فبالتالي احنا دورنا انه
+
+291
+00:23:10,610 --> 00:23:16,390
+معهم ان نعملهم education ونعلمهم على كل حاجة حتى
+
+292
+00:23:16,390 --> 00:23:19,450
+ال suctioning من التليكيوستومي إذا كان ليه
+
+293
+00:23:19,450 --> 00:23:26,870
+تليكيوستومي و ال feeding و ال hygiene حتى وكمان
+
+294
+00:23:26,870 --> 00:23:31,270
+الطعم و التعامل مع الجاسترستم وكل الأمور هذه لذلك
+
+295
+00:23:31,270 --> 00:23:39,950
+يعني يجب انه ال family تكونيعني دورها مقنع مقروف
+
+296
+00:23:39,950 --> 00:23:43,430
+ومقلوم إنه «توفير خدمة مباشرة للطب» «توفير خدمة
+
+297
+00:23:43,430 --> 00:23:44,690
+مباشرة للطب» «توفير خدمة مباشرة للطب» «توفير خدمة
+
+298
+00:23:44,690 --> 00:23:46,270
+مباشرة للطب» «توفير خدمة مباشرة للطب» «توفير خدمة
+
+299
+00:23:46,270 --> 00:23:47,170
+مباشرة للطب» «توفير خدمة مباشرة للطب» «توفير خدمة
+
+300
+00:23:47,170 --> 00:23:47,170
+مباشرة للطب» «توفير خدمة مباشرة للطب» «توفير خدمة
+
+301
+00:23:47,170 --> 00:23:50,190
+مباشرة للطب» «توفير خدمة مباشرة للطب» «توفير
+
+302
+00:23:50,190 --> 00:23:58,010
+خدمة مباشرة للطب» «توفير خدمة مباشرة للطب» «توفير
+
+303
+00:23:58,010 --> 00:24:02,690
+خدمة مب
+
+304
+00:24:02,730 --> 00:24:08,250
+وبجمع data عن الحالة اللي موجودة عندى سواء كانت
+
+305
+00:24:08,250 --> 00:24:13,390
+subjective data أو objective data وبعدين بحاول أحط
+
+306
+00:24:13,390 --> 00:24:17,090
+nursing diagnosis للمشاكل اللي موجودة وبعدين بعمل
+
+307
+00:24:17,090 --> 00:24:20,770
+planning أحل فيها كل nursing diagnosis حطيته
+
+308
+00:24:20,770 --> 00:24:24,230
+وبعدين ببدأ أطبق في ال plan تبعتي وبعدين بعمل
+
+309
+00:24:24,230 --> 00:24:29,080
+evaluationلأ، الـ Interventions اللي أنا سويتهم و
+
+310
+00:24:29,080 --> 00:24:32,880
+بشوف حالي أوصلت لـ الـ Goals اللي أنا already
+
+311
+00:24:32,880 --> 00:24:41,320
+حطيته في مرحلة الـ Assessment أو في .. أو
+
+312
+00:24:41,320 --> 00:24:44,620
+في مرحلة عفواً لـ Planning بعد ما أنا عملت
+
+313
+00:24:44,620 --> 00:24:47,160
+Planning وصلت لـ Problems حددت الـ Problems اللي
+
+314
+00:24:47,160 --> 00:24:49,800
+دولة في الـ Planning وحطيت Goals إن أنا بدي أعملها
+
+315
+00:24:49,800 --> 00:24:55,930
+Achievement، تمام؟ فـ Nursing Processبس القصة إن
+
+316
+00:24:55,930 --> 00:25:05,930
+المريض critically ill okay ال organization of ICU
+
+317
+00:25:05,930 --> 00:25:10,390
+كيف ال ICU بتكون يعني منظمة يا جماعة ال ICU
+
+318
+00:25:10,390 --> 00:25:14,310
+requires an intelligent planning that it must keep
+
+319
+00:25:14,310 --> 00:25:17,910
+the need of the hospital and its location one ICU
+
+320
+00:25:17,910 --> 00:25:26,840
+may not may notكتر to all needs أكيد ICU واحدة مش
+
+321
+00:25:26,840 --> 00:25:32,300
+هتكون تتكفي في المستشفى لكل المستشفى وليس ذلك زي
+
+322
+00:25:32,300 --> 00:25:37,120
+ما شوفته أنت شوفتين يعني أنه فيه أكتر من ICU مثلًا
+
+323
+00:25:37,120 --> 00:25:41,640
+ال institute may plan bits into multiple units
+
+324
+00:25:41,640 --> 00:25:44,260
+under separate management by single discipline
+
+325
+00:25:44,260 --> 00:25:48,900
+specialists like medical ICU، surgical ICU، burn
+
+326
+00:25:48,900 --> 00:25:51,840
+ICU، trauma ICU،
+
+327
+00:25:53,920 --> 00:25:57,620
+Multidisciplinary require more than a single
+
+328
+00:25:57,620 --> 00:26:03,740
+specialty ممكن يعني احنا نعمل ال ICU تبعينا ونحدد
+
+329
+00:26:03,740 --> 00:26:08,260
+ان هدول الأسرة لل medical هدول الجراحة هدول الburn
+
+330
+00:26:08,260 --> 00:26:15,830
+هدول ال trauma وطبعا في ناس بيعملوا يعنيطريقة أفضل
+
+331
+00:26:15,830 --> 00:26:20,490
+وبيفصلوهم نهائيًا بعملوا هذه واحدة كاملة للـ Pair
+
+332
+00:26:20,490 --> 00:26:24,090
+خاصة مش بس الـ Meds استبعدتها وبيكون مكانها بعيد
+
+333
+00:26:24,090 --> 00:26:28,050
+خالص هذه واحدة كاملة بس للـ Surgical للناس بعد
+
+334
+00:26:28,050 --> 00:26:31,290
+العملات الجراحية اللي بيحتاجوا ICU وسموها Surgical
+
+335
+00:26:31,290 --> 00:26:35,990
+ICU هذه ICU للميديكالللناس اللي عندها مشاكل طبيعية
+
+336
+00:26:35,990 --> 00:26:41,090
+وناس هادلة الـ Gynecology للناس اللي في المستشفى
+
+337
+00:26:41,090 --> 00:26:43,350
+المولودة أو يصيروا كريتيكا لإيه اللي بدهم ICU
+
+338
+00:26:43,350 --> 00:26:50,190
+هادلة الـ Unit للناس تبعهم هادلة الـ Cardio ICU
+
+339
+00:26:50,190 --> 00:26:52,930
+هادلة الـ Post-Catheterization Unit للناس اللي بعد
+
+340
+00:26:52,930 --> 00:26:53,570
+القصرة
+
+341
+00:27:00,490 --> 00:27:05,170
+ده عشان هي حسب إمكانياتهم طبعا العالم الآن حتى ميل
+
+342
+00:27:05,170 --> 00:27:08,430
+إلى التخصصية فيه أنواع الجراحات يعني مثلا في
+
+343
+00:27:08,430 --> 00:27:12,970
+الباطنة، خلّيني أقول أول في الباطنة، المرضى الـ
+
+344
+00:27:12,970 --> 00:27:17,690
+Palmonology مرضى الصدرية والأمراض الرئوية لحالة
+
+345
+00:27:17,870 --> 00:27:21,910
+مرضة الأمراض الأخرى بيحطهم لحال، مرضة القلب من ضمن
+
+346
+00:27:21,910 --> 00:27:26,270
+الباطنة لحال، بيعملهم ICU منفصلة، الـICU في
+
+347
+00:27:26,270 --> 00:27:30,970
+الجراحة للـUrologic ICU للأمراض العصبية، عمليات
+
+348
+00:27:30,970 --> 00:27:34,350
+المخ والعصاب، عمليات الـكذا، كل هذا ما يتعلق
+
+349
+00:27:34,350 --> 00:27:37,850
+بالعصاب هدول، انهم ICU لحالة، عمليات العظام
+
+350
+00:27:37,850 --> 00:27:38,710
+الـcyclical
+
+351
+00:27:41,300 --> 00:27:46,760
+بنزلوه على ICU خصوص للـ Orthopedic ICU وبعض اللي
+
+352
+00:27:46,760 --> 00:27:50,140
+هو الـ Hand Surgery والنيورولوجيك اللي هي الـ
+
+353
+00:27:50,140 --> 00:27:55,330
+Peripheral Neurosurgery لأنها تُعتبرمناطق يعني
+
+354
+00:27:55,330 --> 00:27:59,730
+معقمة عالية التعقيد غير عن العمليات الجراحية اللي
+
+355
+00:27:59,730 --> 00:28:02,610
+بتصير في البطن البطن يُعتبر Dirty فعشان ايه
+
+356
+00:28:02,610 --> 00:28:04,790
+الـGeneral Surgery اللي بيسميها ده بقى الـGI
+
+357
+00:28:04,790 --> 00:28:10,850
+System اللي عادة ICU لحال لإنه تُعتبر أقل إيش يعني
+
+358
+00:28:10,850 --> 00:28:14,650
+Sterility تتنقل في البطن عادة في ال-intestine وال
+
+359
+00:28:14,650 --> 00:28:18,820
+-stomach وال-colons وهذه كل إيه تمناطقمش clean
+
+360
+00:28:18,820 --> 00:28:23,520
+بالمقارنة لما بنحكي مثلا في واحد مغير مفصل مثلا
+
+361
+00:28:23,520 --> 00:28:27,720
+واحد عامل joint replacement وعمليته طولت واستغرقت
+
+362
+00:28:27,720 --> 00:28:32,700
+أربع ساعات وبعد هيك بدهم يعملوله smooth extubation
+
+363
+00:28:32,700 --> 00:28:37,140
+بنسميه أو واحد عمل brain surgery وبعد ما عمل brain
+
+364
+00:28:37,140 --> 00:28:41,600
+surgery وخيط الجيس وعاني ال tumor من ال brain بدهم
+
+365
+00:28:42,360 --> 00:28:46,680
+يودّوه على ICU for smooth extubation عشان يعملوله
+
+366
+00:28:46,680 --> 00:28:49,600
+extubation يعني تدريجي ويفسروا عن جهاز التنافس
+
+367
+00:28:49,600 --> 00:28:53,040
+الصناعي فمش مقبول أن يودّوه على نفس العناية اللي
+
+368
+00:28:53,040 --> 00:28:57,360
+مع مريض عملوله استقصاء لـ tumor من الـ abdomen من
+
+369
+00:28:57,360 --> 00:29:01,520
+الـ colon وفتحوا البطن تبعه وإنه منفلورا مليانة
+
+370
+00:29:01,520 --> 00:29:08,290
+حواليههذه عملية أه مش التحتعقيم صحيح وهذه عملية أه
+
+371
+00:29:08,290 --> 00:29:11,950
+مش التحتعقيم لكن الـ sterility ما بين العملية تبع
+
+372
+00:29:11,950 --> 00:29:13,730
+ال general surgery والعملية تبع ال terminal
+
+373
+00:29:13,730 --> 00:29:21,030
+surgery بكتير مفرد عشان هي في three model of ICU
+
+374
+00:29:21,030 --> 00:29:27,330
+فيها تلت يعني نمطات أو أنطاولا إيش بيطلع جمعها
+
+375
+00:29:27,330 --> 00:29:32,670
+بكلمة طبع للموديل للموديل تبقى ال ICU فيه three
+
+376
+00:29:32,670 --> 00:29:35,750
+models الأولاني اسمه open model ماشيعني open
+
+377
+00:29:35,750 --> 00:29:41,270
+model؟ أماه أماه in this time physician admit
+
+378
+00:29:41,270 --> 00:29:46,010
+three and discharge في ال open unitالدكتور بيعمل
+
+379
+00:29:46,010 --> 00:29:49,530
+admission للحالة دي الحالة بدل ICU بيعلجها و
+
+380
+00:29:49,530 --> 00:29:52,510
+بيخرجها كمان وقت ما هو قلق الحالة ليها التماثر
+
+381
+00:29:52,510 --> 00:29:55,370
+وترجع على اقتصاد بيعملها discharge which allowed
+
+382
+00:29:55,370 --> 00:29:57,970
+many different members of the medical staff to
+
+383
+00:29:57,970 --> 00:30:01,750
+manage patients in ICU وبالتاني
+
+384
+00:30:02,960 --> 00:30:06,220
+والتالي مافيش دكتور في جلب الإناء المركز يا جماعة
+
+385
+00:30:06,220 --> 00:30:10,360
+أنا دكتور باطنة بشوف إن الحالة ده وده ICU بعملها
+
+386
+00:30:10,360 --> 00:30:13,560
+additional ICU بعالجها في ال ICU بتعامل مع ال
+
+387
+00:30:13,560 --> 00:30:16,480
+nurses هنا و بقت ما ملليها سالتي كويسة بعملها
+
+388
+00:30:16,480 --> 00:30:20,020
+discharge و بطلّها فكل الذكائة ترى ممكن يكون طبيب
+
+389
+00:30:20,020 --> 00:30:27,130
+ICU أو مش طبيب ICU يعني طبيب قرراللي هو احتياج
+
+390
+00:30:27,130 --> 00:30:30,730
+المريض لخدمة الـ ICU وهذه الأمنة موجودة منها في
+
+391
+00:30:30,730 --> 00:30:35,290
+مستشفيات بريطانيا ولذلك لا يوجد طبيب ICU في هذه
+
+392
+00:30:35,290 --> 00:30:39,350
+النمرة لأ في ال nurses هم كل حاجة بيجي الطبيب وهو
+
+393
+00:30:39,350 --> 00:30:42,550
+يمكن أن يحصل دخول كذا كطبيب باطنة، اللي بعده طبيب
+
+394
+00:30:42,550 --> 00:30:45,550
+قلب، اللي بعده طبيب أعصاب، حسب إيش مناه ال ICU
+
+395
+00:30:45,550 --> 00:30:50,260
+وبدخل الحالة ويكتب خطبة العلاج ويمشيتاني يوم بمر
+
+396
+00:30:50,260 --> 00:30:53,760
+عليها، تالتي يوم اه انا شايفة صدق واسم انا اعمله
+
+397
+00:30:53,760 --> 00:30:56,260
+الـ Discharge بكتب الـ Discharge وطبعا بنصق و
+
+398
+00:30:56,260 --> 00:30:59,780
+بطلعها على القسم ان هو نصق معاه فهذا طريقة الـ
+
+399
+00:30:59,780 --> 00:31:04,120
+Open Model الـ Closed Model، الـ Closed Model لأ
+
+400
+00:31:04,120 --> 00:31:07,480
+هاد الـ Admission و الـ Discharge و الـ Referral
+
+401
+00:31:07,480 --> 00:31:12,060
+Policies are under the control of Intensivists في
+
+402
+00:31:12,060 --> 00:31:18,670
+دكتور أخصائي عناية مركزة اسمه Intensivistوهو هذا
+
+403
+00:31:18,670 --> 00:31:22,230
+الموجود في الانهاء المركزة بيتصل فيه اثنينه الطبيب
+
+404
+00:31:22,230 --> 00:31:27,610
+بيقوله في عندي حالة في الباطنة وضعها كذا كذا كذا
+
+405
+00:31:27,610 --> 00:31:33,730
+كذا وانا اعتقد او بدي إليها ICU management بروح ال
+
+406
+00:31:33,730 --> 00:31:38,290
+ICU دكتور بعمل تقييم للحالة وبتناقش هو وإيه الطبيب
+
+407
+00:31:38,290 --> 00:31:44,590
+الباطنة اللي موجود أو الجراحة أو أيا كان تمام؟ويا
+
+408
+00:31:44,590 --> 00:31:48,110
+أما بيقتنع منه إنه فعلاً هذا بيدعى الـ «ICU
+
+409
+00:31:48,110 --> 00:31:52,570
+Management» بيقوله Okay وبيجيبها وبيتولد الـ
+
+410
+00:31:52,570 --> 00:31:57,990
+Intensiveist لـ Treatment تبعتها ثم بيقرر الـ
+
+411
+00:31:57,990 --> 00:32:00,970
+Intensiveist إن حالتك صالة كويسة ومتنقلة، لا
+
+412
+00:32:00,970 --> 00:32:06,290
+Discharge، لو سمحت نصق مع القسم اللي عندك علشان
+
+413
+00:32:06,290 --> 00:32:10,290
+إحنا بدنا نطلقها وجهد السرير ويقولنا أي سرير عشان
+
+414
+00:32:10,290 --> 00:32:14,230
+نتكلم التمرينالذن اللي مقرر الـ Intensivist هو
+
+415
+00:32:14,230 --> 00:32:18,870
+اللي قرر آه إنها بتحتاج دخول و يدخلها هو اللي قرر
+
+416
+00:32:18,870 --> 00:32:25,050
+العلاج تبعها هو اللي قرر إيه ده يصير الـ Discharge
+
+417
+00:32:26,280 --> 00:32:30,820
+بينما الطبيب تبعها كان فقط عرض الحالة إنه هذه
+
+418
+00:32:30,820 --> 00:32:34,880
+الحالة إحنا مش لازم نتعامل معاها في القسم وهي
+
+419
+00:32:34,880 --> 00:32:38,360
+أصبحت فيها life-threatening condition والمريض مرجو
+
+420
+00:32:38,360 --> 00:32:42,380
+منه يعني good prognosis فبالتالي إحنا لو سمحت بدنا
+
+421
+00:32:42,380 --> 00:32:47,280
+intensive care له بيجي دكتور ال ICU بيقيل وبيحدد
+
+422
+00:32:47,280 --> 00:32:53,310
+وبيوافق الدكتور أو بيقولوا لأ كلامك عفواًمبالغ فيه
+
+423
+00:32:53,310 --> 00:32:56,750
+المريض ما عندهوش life threatening condition وضعه
+
+424
+00:32:56,750 --> 00:33:01,310
+كويس ممكن يضيف على ال management حاجة أعطوله كذا
+
+425
+00:33:01,310 --> 00:33:06,890
+لو سمحته أو يقترح عرضه على طبيب آخر يقول أنا شايف
+
+426
+00:33:06,890 --> 00:33:11,610
+إن المشكلة إلها علاقة بكذا فلو سمحته رفوع على طبيب
+
+427
+00:33:11,610 --> 00:33:16,670
+كذا يعني يكون له راية العرض اللي هو التالت أو
+
+428
+00:33:16,670 --> 00:33:19,390
+المدر التالت في
+
+429
+00:33:20,830 --> 00:33:25,850
+المدلات تبعة الـ ICU اسمه الـ Hybrid Model which
+
+430
+00:33:25,850 --> 00:33:30,210
+combines aspects of open and closed وهو عبارة عن
+
+431
+00:33:30,210 --> 00:33:34,310
+combination بين هذا و هذا، إيش يعني؟ يعني تي طلعوا
+
+432
+00:33:34,310 --> 00:33:39,690
+كده، by stuffing the ICU with an attending
+
+433
+00:33:39,690 --> 00:33:45,770
+physician and or team to work in tandem with
+
+434
+00:33:45,770 --> 00:33:51,760
+primary physicians يعني فيه في الـ ICU الـلكن
+
+435
+00:33:51,760 --> 00:33:56,700
+السلطة، لا الـ Intensivist أو السلطة طبعاً الـ
+
+436
+00:33:56,700 --> 00:34:03,780
+Intensivist مش مطلقة، مش مطلقة هو بيشاور أو بيقرر
+
+437
+00:34:03,780 --> 00:34:06,780
+مثلا الطبيب الـ Physician العادي في القسم إنه هذه
+
+438
+00:34:06,780 --> 00:34:11,140
+الحالة بدها ICU، ببلغ طبيب الـ ICU طبيب الـ ICU
+
+439
+00:34:11,140 --> 00:34:16,160
+بيحضرلها السير، فدي بينهم مشاورة لكن مش هندم إنه
+
+440
+00:34:16,160 --> 00:34:19,120
+أنا أقول لأ لأ لأ طبيب زي هنا closed، بس أنا
+
+441
+00:34:19,120 --> 00:34:23,070
+المقررلأ هذا بيقولوا هذا جيد ده وهذا بيوافق okay
+
+442
+00:34:23,070 --> 00:34:28,010
+فبيدخلوها العلاج التانية اللي بيحطوا خطة مشتركة ال
+
+443
+00:34:28,010 --> 00:34:31,710
+discharge التانية اللي بتوافقوا على أنه تطلع
+
+444
+00:34:31,710 --> 00:34:36,150
+الحالة لو صارت no need inفي الـICU، لا عليك أن
+
+445
+00:34:36,150 --> 00:34:40,910
+تبقى في الـICU أكتر وإخراجك سيكون أسوأ هذه هي
+
+446
+00:34:40,910 --> 00:34:46,410
+الـmodels اللي معروفة كيف احنا بنشتغل داخل الـICU
+
+447
+00:34:46,410 --> 00:34:49,810
+الـICU يجب أن يكون مقفل في مقفل تقريبًا لمنطقة
+
+448
+00:34:49,810 --> 00:34:54,590
+مهمة مثل الـFaculty Group لاحظ حتى في البناء ببلغ
+
+449
+00:34:54,590 --> 00:34:59,110
+بحاول أن يكون الـICU قريبة من أقسام العمليات قريبة
+
+450
+00:34:59,110 --> 00:35:03,540
+من الـEmergency Departmentقريبًا من الأقسام الـ
+
+451
+00:35:03,540 --> 00:35:08,960
+Hot زي قسم القسترة يعني إذا أنا عمل قسترة ICU لقسم
+
+452
+00:35:08,960 --> 00:35:11,900
+القسترة لازم تكون قريبًا منه في نفس ال level في
+
+453
+00:35:11,900 --> 00:35:15,560
+نفس الطابق مش تكون في طابق مختلف إذا أنا عمل ICU
+
+454
+00:35:15,560 --> 00:35:21,100
+للجراحة فلازم تكون في نفس طبيعي العملياتإذا أنا
+
+455
+00:35:21,100 --> 00:35:26,960
+أعمل ICU عشان أي مريض ببسط أوبتعد كتير، النازله
+
+456
+00:35:26,960 --> 00:35:30,500
+الأقسام الجراحية برضه لازم تكون في نفس المبنى مش
+
+457
+00:35:30,500 --> 00:35:34,160
+هيتكون الـICU في مبنى والأقسام الجراحية في مبنى
+
+458
+00:35:34,160 --> 00:35:38,360
+آخر، هذه لازم يراها من الدماغ there should be a
+
+459
+00:35:38,360 --> 00:35:42,740
+sufficient number of lifts available لازم يكون عدد
+
+460
+00:35:42,740 --> 00:35:46,620
+المصاعد في المبنى متوافق رخاصة إذا كانت الـICU
+
+461
+00:35:46,620 --> 00:35:50,790
+مثلا في طابق أرضيوربما في نفس الطابق اللي فيه
+
+462
+00:35:50,790 --> 00:35:54,390
+العمليات لكن بقيت الأقسام اللي ماري جيت عبّوها في
+
+463
+00:35:54,390 --> 00:35:55,990
+الطابق التالت أو الرابع
+
+464
+00:35:58,900 --> 00:36:04,440
+لفت مخصص أو أسنسير مخصص لنقل الحالات الحرجة هاي
+
+465
+00:36:04,440 --> 00:36:08,520
+عشان ماروحش إيه الحاجة الأسنسير والله في ناس في
+
+466
+00:36:08,520 --> 00:36:13,660
+الدور السفر تتسرقش مانصحش ICU with fewer than 4
+
+467
+00:36:13,660 --> 00:36:18,760
+beds are not cost effective and over 20 beds are
+
+468
+00:36:18,760 --> 00:36:26,610
+unmanageable لما يكون ال ICUيا جماعة أقل من أربعة
+
+469
+00:36:26,610 --> 00:36:31,410
+سرر يعني إحنا عاملين ICU بالسريرين هذه بتكون
+
+470
+00:36:31,410 --> 00:36:36,670
+تكلفتها عالية كتير لإنه يعني إن أنت جايب سريرين أو
+
+471
+00:36:36,670 --> 00:36:44,490
+تلاتة هتحتاج تقريبًا نفس الطاقة يعني كده مثلًا لو
+
+472
+00:36:44,490 --> 00:36:49,690
+أنت في عندك أربعة
+
+473
+00:36:49,690 --> 00:36:53,570
+beds ممكن two nurses يشتغلوا معهم يكونوا بكافةكل
+
+474
+00:36:53,570 --> 00:36:58,150
+الممرض ياخد تنتين، تمام؟ الـ ideal كيف أنه نجسم؟
+
+475
+00:36:58,150 --> 00:37:01,250
+الـ ideal أنه لما تكون الحالة hot تشتغل معها one
+
+476
+00:37:01,250 --> 00:37:04,450
+nurse ل one patient، بس هاجة لما تكون الحالة لسه
+
+477
+00:37:04,450 --> 00:37:08,410
+hot، يعني طالعة من العمليات ولسه CPI، يعني very
+
+478
+00:37:08,410 --> 00:37:12,110
+critical، تمام؟الحالة ما بتظلش طول الوقت يا جماعة
+
+479
+00:37:12,110 --> 00:37:16,430
+زي هيكة ممكن تظلها هيكة تلت ساعات، ست ساعات،
+
+480
+00:37:16,430 --> 00:37:20,050
+اتناشر ساعة، بعدين بتصير stability وفي الأغلب بعد
+
+481
+00:37:20,050 --> 00:37:24,950
+تلت ساعات كل الحالات بتخش في restabilization بتبدأ
+
+482
+00:37:24,950 --> 00:37:28,190
+تصير مستقرة وبيبدأ التعامل معاها يصير أرود
+
+483
+00:37:28,190 --> 00:37:32,110
+وبالتالي بيصير كل nurse يتعامل مع two patients
+
+484
+00:37:32,110 --> 00:37:39,770
+لاحظين كل nurse مع two patients وبالتاليأربع بيتز
+
+485
+00:37:39,770 --> 00:37:44,330
+يعني بدي بس إنهم two nurses وخلاص أول مابتيش
+
+486
+00:37:44,330 --> 00:37:50,310
+الحالة hot اتنين بيشتغلوا معاها لدرجة
+
+487
+00:37:50,310 --> 00:37:53,670
+إنه بيصير two nurse ل one patient بس هذا لفترة،
+
+488
+00:37:53,670 --> 00:37:57,550
+لفترة تساعد دماغ، بعدين بيخدها واحد لحاله، واحد
+
+489
+00:37:57,550 --> 00:38:01,410
+nurse بيشتغل مع الحالةطبعاً مكون معاه حالة تانية
+
+490
+00:38:01,410 --> 00:38:05,730
+بس الحالة التانية call ففي ساعة أو ساعتين لو شغل
+
+491
+00:38:05,730 --> 00:38:10,230
+عنها مش هتتأثر كتير لإنها أصبحت call أو زميله ممكن
+
+492
+00:38:10,230 --> 00:38:14,090
+يعتقد بالحالة هذه ال call ده بينما تستقر حالته
+
+493
+00:38:14,370 --> 00:38:19,190
+فالـKey اللي بيشتغلوا عليه في الـICU إنه ممكن إن
+
+494
+00:38:19,190 --> 00:38:22,290
+إحنا نقسم حسب إيش نوع الـICU وإيش طبيعة الحالات
+
+495
+00:38:22,290 --> 00:38:25,750
+اللي بيعملها وبينعمل إلها admission One nurse
+
+496
+00:38:25,750 --> 00:38:29,850
+لـTwo patients، One nurse لOne patient، One nurse
+
+497
+00:38:29,850 --> 00:38:33,090
+لTwo patients، ممكن إنه Two nurses لتلاتة
+
+498
+00:38:33,090 --> 00:38:37,030
+patients، تمام؟ عادة إن إذا كانت الـICU أكتر من
+
+499
+00:38:37,030 --> 00:38:40,670
+عشرين سنين بتصير عملية السيطرة عليه عملية صعبة لإن
+
+500
+00:38:40,670 --> 00:38:44,920
+الطاقة بيصير كبيرة كتيرالشيء الجيد هو الـ
+
+501
+00:38:44,920 --> 00:38:48,280
+Intensive
+
+502
+00:38:48,280 --> 00:38:55,780
+Care
+
+503
+00:38:55,780 --> 00:39:13,380
+Equipments
+
+504
+00:39:14,440 --> 00:39:18,660
+الشاشة المراقبة «Multi-Screen» بدي اللي هو «Live
+
+505
+00:39:18,660 --> 00:39:22,360
+Support» و«Emergency Station Devices» يعني بدي DC
+
+506
+00:39:22,360 --> 00:39:25,600
+شوك وبيدي الـ «Energy Scope» وبيدي الـ «Emergency
+
+507
+00:39:25,600 --> 00:39:28,840
+Control» الكامل لأنه «Light Threatening Condition»
+
+508
+00:39:28,840 --> 00:39:31,740
+فيه الـ «Diagnostic Devices» كتير بحتالي زي الـ
+
+509
+00:39:31,740 --> 00:39:35,120
+«Blood Gases» و«Machines» كل الشيء اللي أنا بحتالي
+
+510
+00:39:35,120 --> 00:39:38,350
+أن أعمله زي اللي ممكن أحتاج أن أعملاللي هو
+
+511
+00:39:38,350 --> 00:39:44,350
+البرونكسكوب في الـ ICU ممكن أحتاج أن أركبله الـ
+
+512
+00:39:44,350 --> 00:39:48,990
+Central Line عشان أخد الـCVB فممكن ممكن أحتاج
+
+513
+00:39:48,990 --> 00:39:54,070
+أركبله الـ Arterial Line عشان أخد الـ Invasive
+
+514
+00:39:54,070 --> 00:39:58,110
+Blood Pressure فبالتالي مش زي القصر، في حاجات كتير
+
+515
+00:39:58,110 --> 00:40:01,530
+بتلزمني، هنشوفها من وحدة «Patient Monitoring
+
+516
+00:40:01,530 --> 00:40:04,330
+Equipment» طب عشان أنا أعمل Monitoring للpatient،
+
+517
+00:40:04,330 --> 00:40:09,010
+إيش بده؟بالـ Acute Care Physiologic Monitoring
+
+518
+00:40:09,010 --> 00:40:14,200
+Systemاللي هو الـ Monitor Screen وبدّي برسوكزوميتر
+
+519
+00:40:14,200 --> 00:40:17,620
+يكون طالع منه برسوكزوميتر وبدّي Intracranial
+
+520
+00:40:17,620 --> 00:40:20,720
+Pressure Monitor ممكن يكون طالع منه Transducer
+
+521
+00:40:20,720 --> 00:40:27,260
+علشان يجيسلي الـ ICP تمام؟ نفس الـ Transducer هذا
+
+522
+00:40:27,260 --> 00:40:32,720
+ممكن يستخدم يجيسلي الـ CDP وممكن يكون في عندي
+
+523
+00:40:32,720 --> 00:40:37,000
+أبريه Monitor جهاز يقوللي وقت شغل المرير بدأ يتنفس
+
+524
+00:40:37,000 --> 00:40:41,360
+ولا لأ هذا الـ Monitor Screen اللي بنحكي عنهطبعاً
+
+525
+00:40:41,360 --> 00:40:44,320
+هذا portable زي ما انتوا شايفين بس الـ «مونوترات»
+
+526
+00:40:44,320 --> 00:40:47,560
+الكبيرة اللي بتشوفها في المستشفى بتكون أكبر من هنا
+
+527
+00:40:47,560 --> 00:40:51,480
+وفيها options كتير طالع منها هذا ال «Prop» اللي
+
+528
+00:40:51,480 --> 00:40:55,040
+بيعمل قياس للـ Oxygen Saturation بتسميه «Pulse
+
+529
+00:40:55,040 --> 00:40:58,960
+Oximeter» هذا جهاز بس «Pulse Oximeter» لحال بجسد
+
+530
+00:40:58,960 --> 00:41:01,600
+ال «Pulse Oximeter» و بجسد ال «Heart Rate» من
+
+531
+00:41:01,600 --> 00:41:05,790
+الأصبع من ال«Peripheral»من الـ Finger، هذا الجهاز
+
+532
+00:41:05,790 --> 00:41:11,770
+اللي هو لأنيه في الـ ICU بيسموه Amia Monitor لما
+
+533
+00:41:11,770 --> 00:41:16,830
+يبطل الطفل فجأة يتنفس، يصار يزمر لأنه بيشتغل على
+
+534
+00:41:16,830 --> 00:41:23,010
+ال movement تبع ال chestهذا الجهاز اللي هو بيغسل
+
+535
+00:41:23,010 --> 00:41:30,130
+الـ Intracranial Pressure جداش الـ ICP جداش الـ
+
+536
+00:41:30,130 --> 00:41:34,230
+Pressure داخل الـ Intracranial كل هذه اللي بتكون
+
+537
+00:41:34,230 --> 00:41:37,070
+يعني هذا موجود في كل مكان هذا موجود في كل مكان هذا
+
+538
+00:41:37,070 --> 00:41:40,090
+بس موجود في الخضانة وهذا بس موجود في الـ
+
+539
+00:41:40,090 --> 00:41:45,180
+Neurologic ICPكمان نحتاج للحاجات اللي بتلزمنا لـ
+
+540
+00:41:45,180 --> 00:41:48,040
+Resuscitation أولا الـ Ventilator الـ Ventilator
+
+541
+00:41:48,040 --> 00:41:51,080
+هو من أهم الحاجة اللي بيعمل Respiratory
+
+542
+00:41:51,080 --> 00:41:54,960
+Resuscitation الـ Infusion Pump لإنه أنا بكون مركب
+
+543
+00:41:54,960 --> 00:41:59,160
+عليه اللي هو Dubamine, Dubutamine, Noradrenaline
+
+544
+00:41:59,160 --> 00:42:05,100
+وهذه بنسميها Intropic Drug وزوجتها تعمل اللي هو
+
+545
+00:42:05,100 --> 00:42:10,320
+Heart Resuscitation، إن عاشت للقلبوفي عندنا الـ
+
+546
+00:42:10,320 --> 00:42:15,160
+Crush Card في عندنا الـ Intraortic Palomba بالـ
+
+547
+00:42:15,160 --> 00:42:20,660
+Intraortic Palomba من برضه من ضمن الحاجات اللي هي
+
+548
+00:42:20,660 --> 00:42:29,480
+بتعمل يعني Resuscitation برضه للـ Heart عن طريق ان
+
+549
+00:42:29,480 --> 00:42:34,200
+هو يعني هنشرحه بالتفصيل احنا في Cardiology بس
+
+550
+00:42:34,200 --> 00:42:45,880
+الفكرة عامة سريعة عنهإن هو بيضعوا الـ Intra
+
+551
+00:42:45,880 --> 00:42:50,640
+-Aortic Balloon Bomb في الأورطة فبيصير ينفخ لما
+
+552
+00:42:50,640 --> 00:42:57,000
+ينفخ وظيفته يزود التاروة تبع عضلة القلب نفسها فلما
+
+553
+00:42:57,000 --> 00:43:05,930
+بيزود التاروة تبع العرضعضلة القلب نفسها اللي هو
+
+554
+00:43:05,930 --> 00:43:11,810
+بيحسن من قوة عضلة القلب وبيحسن من كفاءة عمل عضلة
+
+555
+00:43:11,810 --> 00:43:16,690
+القلب وبالتالي هذا Resuscitation للـ Heart تمام؟
+
+556
+00:43:16,690 --> 00:43:22,090
+هنشوف مثلًا عضلة القلب وانتش بالظبط نقدر القلب
+
+557
+00:43:22,090 --> 00:43:27,350
+اللي هوأو الـ Intra-Aortic Balloon Bomb لما تنفخ
+
+558
+00:43:27,350 --> 00:43:33,490
+ترجع الدم لعضلة القلب نفسها في الـ Cystole أو في
+
+559
+00:43:33,490 --> 00:43:38,450
+الـ Diastole وكيف تتم القالية بالظبط وإيش أهمية
+
+560
+00:43:38,450 --> 00:43:43,140
+الـ Intra-Aortic Balloonطبعاً الـ Crash Cart اللي
+
+561
+00:43:43,140 --> 00:43:46,400
+هي عربة طوارئ الـ Emergency Trolley اللي حكينا عنه
+
+562
+00:43:46,400 --> 00:43:49,640
+اللي فيه كل شيء فيه لاريندوسكوب وفيه متيوبات وفيه
+
+563
+00:43:49,640 --> 00:43:53,060
+كل ما هو مطلوب طبعاً في حاجة اللي حكينا عنها الـ
+
+564
+00:43:53,060 --> 00:43:56,440
+Diagnostic Equipment نحتاج حاجات كتير، قولنا احنا
+
+565
+00:43:57,490 --> 00:44:02,150
+بالـ Blood Gas Analysis الـ Device هذا كمان بنحتاج
+
+566
+00:44:02,150 --> 00:44:05,570
+Mobile X-Ray يكون فيه عنده جهاز لتصوير الأشعة
+
+567
+00:44:05,570 --> 00:44:08,690
+متحدة لإن ما تقدرش الـ Critical Inpatient أنزله
+
+568
+00:44:08,690 --> 00:44:13,730
+على الأشعة أو أطل عادة نقسم الأشعة بتكون تحت الأرض
+
+569
+00:44:13,730 --> 00:44:16,990
+أنزله على الأشعة عشان يتصور ولا حتى عشان يعمل
+
+570
+00:44:16,990 --> 00:44:20,650
+Ultrasound ولا حتى عشان يعمل Echo فبالتالي بتلاقي
+
+571
+00:44:20,650 --> 00:44:24,750
+في ال ICU فيه جهاز Portable Ultrasound فيه
+
+572
+00:44:24,750 --> 00:44:30,610
+Portable Echo تمام؟موبايل إكسري، Blood gas
+
+573
+00:44:30,610 --> 00:44:36,230
+analyzer حتى الكثير من الـICUs بيكون فيها الـCBC
+
+574
+00:44:36,230 --> 00:44:40,330
+والـChemistry Machine موجودة داخل الـICU كإنه
+
+575
+00:44:40,330 --> 00:44:48,570
+بيحكي عن مستشفى صغير هو الـICU بيكون كإنه محتويات
+
+576
+00:44:48,570 --> 00:44:54,570
+مستشفى كاملة فيه، ليش؟ لأن عندنا هنشوف في الـ
+
+577
+00:44:55,320 --> 00:44:59,580
+الشخصيات اللي بيشتغلوا في ال ICU من هم هنجد انه
+
+578
+00:44:59,580 --> 00:45:03,540
+احنا كل انواع الناس اللي بتشتغل داخل المستشفى
+
+579
+00:45:03,540 --> 00:45:09,320
+كاملة لازم يكونوا موجودين في ال ICU بشكل دائم تمام
+
+580
+00:45:09,320 --> 00:45:19,270
+اعتقد انهوقت المحاضرة يعني حوالي نصف ساعة فبدي
+
+581
+00:45:19,270 --> 00:45:25,290
+أخلي الـICU admission للمحاضرة التانية اللي بدي
+
+582
+00:45:25,290 --> 00:45:30,070
+أسجلها بعد هذه إن شاء الله فخلينا نوقف التسجيل
+
+583
+00:45:30,070 --> 00:45:34,510
+لهذا ونبدأ بالتسجيل الجديد من ان الـICU admission
+
+584
+00:45:34,510 --> 00:45:35,370
+criteria
+
diff --git a/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/cy8gkI3Bil0.srt b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/cy8gkI3Bil0.srt
new file mode 100644
index 0000000000000000000000000000000000000000..f14a78e39fdbe68a796533934fad1571170b4f47
--- /dev/null
+++ b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/cy8gkI3Bil0.srt
@@ -0,0 +1,1517 @@
+1
+00:00:02,700 --> 00:00:05,640
+بسم الله الرحمن الرحيم السلام عليكم ورحمة الله
+
+2
+00:00:05,640 --> 00:00:09,260
+وبركاته، اليوم إن شاء الله رب العالمين، هنكمل
+
+3
+00:00:09,260 --> 00:00:12,320
+محاضرتنا في اللي هو Respiratory Tract Disorders
+
+4
+00:00:12,320 --> 00:00:19,000
+كنا حكينا مع بعض في المحاضرة السابقة عن الـARDS
+
+5
+00:00:19,000 --> 00:00:22,780
+اللي هي الـ Acute Respiratory Distress Syndrome
+
+6
+00:00:23,540 --> 00:00:27,860
+حكينا في الـ Acute respiratory distress syndrome،
+
+7
+00:00:27,860 --> 00:00:32,020
+أيش المرض، كيف التشخيص، والـX-ray
+
+8
+00:00:32,020 --> 00:00:33,980
+كيف بيكون شكلها، الـ medical management، شو
+
+9
+00:00:33,980 --> 00:00:36,920
+بنسويه، أيش أهمية الـ mechanical ventilator في الـ
+
+10
+00:00:36,920 --> 00:00:40,600
+management والـ high peep، عشان نمنع الـ collapse، ثم من
+
+11
+00:00:40,600 --> 00:00:45,010
+ضمن الحاجات كمان حكينا أنه ما فيش pharmacological
+
+12
+00:00:45,010 --> 00:00:48,710
+دواء معين للـ ARDS، غير إنهم يعني ممكن يستخدموا
+
+13
+00:00:48,710 --> 00:00:53,630
+الـ surfactant replacement عشان يحسنوا الوضع
+
+14
+00:00:53,630 --> 00:01:00,030
+داخل الـ alveoli، لكن مهم
+
+15
+00:01:00,030 --> 00:01:06,670
+جدا كمان أنه نخفف الضغط في الـ Pulmonary Artery
+
+16
+00:01:06,670 --> 00:01:11,130
+لأنه بيصير Pulmonary Artery Hypertension، حكينا أنه
+
+17
+00:01:11,130 --> 00:01:15,010
+عشان نعرف قد إيش الضغط داخل الـ Pulmonary Artery
+
+18
+00:01:15,010 --> 00:01:21,110
+ممكن نستخدم Swan Ganz catheter اللي وظيفتها أنها
+
+19
+00:01:21,110 --> 00:01:26,780
+تعرف قد إيش الضغط داخل الـ Pulmonary Artery، وعرفنا
+
+20
+00:01:26,780 --> 00:01:33,060
+أن الضغط داخل البلمونري أرتري، إذا كان أقل من 15
+
+21
+00:01:33,060 --> 00:01:44,140
+أو أقل من 18 يعني maximum، بيكون معناه أنه المريض
+
+22
+00:01:44,140 --> 00:01:47,880
+المشكلة
+
+23
+00:01:47,880 --> 00:01:50,720
+تبعته فيه الـ Lung، ويكون الموضوع له علاقة بالـ
+
+24
+00:01:50,720 --> 00:01:58,680
+ARDS، لكن لو كان الـ Pulmonary Artery Pressure كان
+
+25
+00:01:58,680 --> 00:02:03,820
+أكثر من 18، معناه أنه Cardiac Issue، حكينا أن الـ
+
+26
+00:02:03,820 --> 00:02:08,780
+Swan Ganz Catheter هي دي بتتركب عن طريق أنهم
+
+27
+00:02:08,780 --> 00:02:13,540
+بيركبوا Central Line من الـ internal jugular أو الـ
+
+28
+00:02:13,540 --> 00:02:16,860
+jugular أو Subclavian Veins، زي ما أنا بشرح هان
+
+29
+00:02:16,860 --> 00:02:20,620
+Subclavian، إنها من الـ internal jugular أو الـ jugular أو
+
+30
+00:02:20,620 --> 00:02:20,800
+الـ jugular أو الـ jugular أو الـ jugular
+
+31
+00:02:20,800 --> 00:02:25,060
+لما في النهاية نستقر في الـ Thoracic Vein، بننزل
+
+32
+00:02:25,060 --> 00:02:29,240
+على الـ Superior Vena Cava، بعدين بنستقر اللي هو
+
+33
+00:02:29,540 --> 00:02:33,640
+في الـ Right Atrium، بنستقر في الـ normal Central
+
+34
+00:02:33,640 --> 00:02:36,560
+Line، ممكن تكون just before entering the Right
+
+35
+00:02:36,560 --> 00:02:40,120
+Atrium، اللي هو الـ Central Venous Pressure بنسميه
+
+36
+00:02:40,120 --> 00:02:44,140
+بيوقف يعني بنسميه الـ Central Venous Pressure، لكن في
+
+37
+00:02:44,140 --> 00:02:45,320
+الـ Swan
+
+38
+00:02:47,420 --> 00:02:50,200
+بنكمل، بنروح على الـ right ventricle، ومن الـ right
+
+39
+00:02:50,200 --> 00:02:53,480
+ventricle بنطلع على الـ pulmonary artery، في الـ
+
+40
+00:02:53,480 --> 00:02:57,880
+pulmonary artery بيكون فيه هنا بالون زي ما أنتو
+
+41
+00:02:57,880 --> 00:03:00,720
+شايفينه، أما بيكون فيه two بالون، بالون هنا و بالون
+
+42
+00:03:00,720 --> 00:03:07,100
+قبل منه، المهم الـ pulmonary wedge pressure اللي هو
+
+43
+00:03:07,100 --> 00:03:16,190
+وظيفته أنه يعني يقيس الضغط داخل البلمونري أرتري،
+
+44
+00:03:16,190 --> 00:03:20,390
+وسيئة الـ closure، والـ pressure يعني سيئة الـ
+
+45
+00:03:20,390 --> 00:03:24,890
+closure، يعني سيئة، ما بيصير inflation للبالون، إذا
+
+46
+00:03:24,890 --> 00:03:29,110
+بيكون الضغط داخل البلمونري أرتري هذا، بنقيس عليه
+
+47
+00:03:29,110 --> 00:03:34,490
+بنحدد إذا كان الموضوع له علاقة في الـ lung ولا له علاقة
+
+48
+00:03:34,490 --> 00:03:42,420
+في الـ heart، من الإجراءات اللي إحنا بنستخدمها
+
+49
+00:03:42,420 --> 00:03:45,480
+طبعاً حكينا عليك أن كلمة manifestation بتكون في
+
+50
+00:03:45,480 --> 00:03:49,520
+الـ ARDS وحكينا بها كويس، بس بدنا نعرف بالنسبة لها
+
+51
+00:03:49,520 --> 00:03:53,700
+علاج الـ Pulmonary Hypertension، حكينا أنه من أحسن
+
+52
+00:03:53,700 --> 00:03:59,520
+الأدوية اللي ممكن تعالج فيها الـ Hypertension،
+
+53
+00:03:59,520 --> 00:04:04,120
+الـ phosphodiesterase inhibitors، هي عبارة عن
+
+54
+00:04:04,120 --> 00:04:08,880
+مشتقات السيلدينافيل اللي هي الـ Viagra ومشتقاته
+
+55
+00:04:10,360 --> 00:04:15,140
+طبعاً، و هذه الأدوية اللي هي معروفة حالياً لعلاج
+
+56
+00:04:15,140 --> 00:04:21,840
+العجز الجنسي، لكن هي في الأصل علاجات استخدمت في
+
+57
+00:04:21,840 --> 00:04:27,240
+علاج الـ Pulmonary Hypertension وتقليل الضغط داخل
+
+58
+00:04:27,240 --> 00:04:31,800
+الـ Pulmonary Artery، هذا كانت يعني مراجعة بسيطة أو
+
+59
+00:04:31,800 --> 00:04:36,300
+تعليق بسيط أو زيادة حبة على الـ Swan Ganz Catheter
+
+60
+00:04:36,300 --> 00:04:38,520
+وكيف بتنحط
+
+61
+00:04:41,840 --> 00:04:45,280
+وبالضبط، إيش هو الـ Pulmonary hypertension؟
+
+62
+00:04:45,280 --> 00:04:48,840
+وإيش أحسن الطرق لعلاجه؟ حالياً، هنحكي عن واحد من
+
+63
+00:04:48,840 --> 00:04:52,360
+الـ Pulmonary heart diseases، يعني مرض اللي له علاقة
+
+64
+00:04:52,360 --> 00:04:56,540
+بين القلب والرئتين، عشان هيك بيسموه Cor Pulmonale
+
+65
+00:04:56,540 --> 00:05:02,000
+إيش يعني Cor Pulmonale؟ يعني في الأصل هو عبارة عن
+
+66
+00:05:02,000 --> 00:05:07,500
+تضخم في الـ right ventricle، يعني enlargement في
+
+67
+00:05:07,500 --> 00:05:12,220
+الـ right ventricle بسبب
+
+68
+00:05:12,220 --> 00:05:15,200
+الـ heart، يعني condition in which the right
+
+69
+00:05:15,200 --> 00:05:18,740
+ventricle of the heart is enlarged with or without
+
+70
+00:05:18,740 --> 00:05:22,420
+right sided heart failure، ممكن يكون فيه heart
+
+71
+00:05:22,420 --> 00:05:26,680
+failure أو ما فيش heart failure خالص، لكن الـ
+
+72
+00:05:26,680 --> 00:05:30,600
+right ventricle بيضل يتضخم، لأنه كل ما بيجي بيطلع
+
+73
+00:05:30,600 --> 00:05:33,620
+الـ right ventricle، اللي بيطلع الدم يا جماعة، للـ blood
+
+74
+00:05:33,620 --> 00:05:36,900
+على الـ lungs، عشان إيش يصير؟ عبر الـ .. عبر مين؟ عبر
+
+75
+00:05:36,900 --> 00:05:39,720
+الـ pulmonary artery، عشان إيش يصير لها؟ يصير لها
+
+76
+00:05:39,720 --> 00:05:44,760
+oxygenation، وبعدين يرجع للـ blood من الـ lung عبر الـ
+
+77
+00:05:44,760 --> 00:05:48,720
+pulmonary veins على الـ heart عشان يصب في الـ left
+
+78
+00:05:48,720 --> 00:05:51,680
+atrium، ومن الـ left atrium ينزل على الـ left
+
+79
+00:05:51,680 --> 00:05:53,820
+ventricle، ومن الـ left ventricle يطلع الـ blood
+
+80
+00:05:53,820 --> 00:05:59,900
+عبر الأورطة على كل الجسم، لكن اللي بيصير أنه
+
+81
+00:06:00,790 --> 00:06:05,890
+أنه لما بيطلع الدم من الـ right ventricle، رجعنا
+
+82
+00:06:05,890 --> 00:06:09,550
+على الجهة اليمين من الـ right ventricle، وبيطلع
+
+83
+00:06:09,550 --> 00:06:15,410
+يودي blood عبر الـ pulmonary artery على الـ lung
+
+84
+00:06:15,410 --> 00:06:18,370
+نرجع للصورة ها عشان نشوف هيئته
+
+85
+00:06:21,430 --> 00:06:26,210
+الـ blood يا جماعة نزل هنا في الـ Right Atrium، نزل على
+
+86
+00:06:26,210 --> 00:06:29,090
+الـ Right Ventricle، وبعد الـ Right Ventricle عبر
+
+87
+00:06:29,090 --> 00:06:33,630
+البلمونري أرتري يودي الدم لمين؟ على الرئتين
+
+88
+00:06:33,630 --> 00:06:39,190
+Right و Left، تمام؟ الآن، لما يكون الرئة فيها مشكلة
+
+89
+00:06:39,190 --> 00:06:42,830
+زي إيش مشكلة؟ زي الـ COPD مثلاً (Chronic
+
+90
+00:06:42,830 --> 00:06:45,950
+Obstructive Pulmonary Disease)، Pulmonary Fibrosis،
+
+91
+00:06:45,950 --> 00:06:52,270
+الـ TB، whatever، اه؟ فبتصير الرئة ما عندهاش القدرة
+
+92
+00:06:52,270 --> 00:06:57,750
+إنها تستقبل الدم من الـ heart بشكل إيقاعي، بشكل
+
+93
+00:06:57,750 --> 00:07:01,490
+منتظم،  متعمل للـ oxygenation، فبتصير تتأخر في استقبال
+
+94
+00:07:01,490 --> 00:07:06,070
+الدم، وبتحاول إنها تأجله، طب إيش اللي هيصير؟ هيصير
+
+95
+00:07:06,070 --> 00:07:10,510
+أنه هيحتقن الدم داخل الـ Right Ventricle، هذا هذا،
+
+96
+00:07:10,510 --> 00:07:14,790
+هيصير هنا كتير فيه دم، مش .. مش .. مش .. يعني
+
+97
+00:07:14,790 --> 00:07:19,430
+ماعندوش الفرصة إنه يروح على الرئتين ويقوم بالدور
+
+98
+00:07:19,430 --> 00:07:22,630
+اللي هو يصير له Oxygenation، فبيصير إيش؟ فيه بيصير
+
+99
+00:07:22,630 --> 00:07:27,440
+يتضخم الـ right ventricle، إذن تضخم الـ right
+
+100
+00:07:27,440 --> 00:07:30,100
+ventricle، condition in which the right ventricle
+
+101
+00:07:30,100 --> 00:07:34,320
+of the heart enlarges، يكبر، سواء فيه heart failure
+
+102
+00:07:34,320 --> 00:07:37,520
+أو ما عنديش، المشكلة الأساسية مش في الـ heart failure،
+
+103
+00:07:37,520 --> 00:07:41,580
+المشكلة الأساسية، the most frequent cases is severe
+
+104
+00:07:41,580 --> 00:07:46,430
+COPD، الناس اللي عندها COPD، يعني الـ lung تبعتها مش
+
+105
+00:07:46,430 --> 00:07:51,690
+شغالة كويس، إيش اللي هيصير فيها؟ هيصير الدم داخل
+
+106
+00:07:51,690 --> 00:07:56,590
+الـ Pulmonary Artery يزيد كتير، والضغط يزيد ويصير
+
+107
+00:07:56,590 --> 00:07:59,210
+Pulmonary Artery Hypertension، اللي طول الوقت اللي
+
+108
+00:07:59,210 --> 00:08:05,890
+كنا بنحكي عنه، وبالتالي الدم هيصير له ارتجاع ويعني
+
+109
+00:08:05,890 --> 00:08:10,390
+يتحوش في الـ Right Ventricle، وبالتالي الـ Right
+
+110
+00:08:10,390 --> 00:08:15,500
+Ventricle هيظل يعمل dilatation، وبالتالي بيصير فيه
+
+111
+00:08:15,500 --> 00:08:19,800
+إيش؟ enlargement، بتضخم حجمه، وبصير مبين أن الـ Right
+
+112
+00:08:19,800 --> 00:08:26,800
+ventricle أكبر من باقي الجسم، وعشان هيك يا جماعة
+
+113
+00:08:26,800 --> 00:08:30,000
+الـ Cor Pulmonale
+
+114
+00:08:30,000 --> 00:08:37,900
+هي حالة مرضية دائماً مصاحبة لمتلازمات الصدر أو أي
+
+115
+00:08:37,900 --> 00:08:46,340
+خلل في الرئتين يؤدي إلى خلل في الـ heart أو يؤدي
+
+116
+00:08:46,340 --> 00:08:50,840
+إلى تضخم في الـ right ventricle واحتقان الدم فيه
+
+117
+00:08:50,840 --> 00:08:55,420
+طبعاً هذا أساساً هو نتيجة الـ pulmonary
+
+118
+00:08:55,420 --> 00:09:03,620
+hypertension، نتيجة زيادة الضغط في الـ pulmonary artery،
+
+119
+00:09:03,620 --> 00:09:06,860
+تمام؟ الآن، إيش الـ Clinical Manifestation عند
+
+120
+00:09:06,860 --> 00:09:10,700
+الناس هدول؟ عادة الناس هدول يا جماعة، الـ Clinical
+
+121
+00:09:10,700 --> 00:09:12,860
+Manifestations اللي عندهم هي الـ Clinical
+
+122
+00:09:12,860 --> 00:09:15,980
+Manifestations تبع الـ Underlying Disease، يعني هو
+
+123
+00:09:15,980 --> 00:09:19,520
+أصلاً إيش ماله؟ هو أصلاً COPD patient؟ okay، هيكون
+
+124
+00:09:19,520 --> 00:09:25,140
+عنده كل الأعراض تبع الـ COPD patient بالإضافة إلى
+
+125
+00:09:25,140 --> 00:09:29,260
+أنه صار عنده enlargement في الـ اللي هو الـ right
+
+126
+00:09:29,260 --> 00:09:32,540
+ventricle، يعني لو روحنا عملنا echocardiogram
+
+127
+00:09:32,540 --> 00:09:37,480
+للـ patient هذا، هلاقي أن الـ right ventricle عنده
+
+128
+00:09:37,480 --> 00:09:43,640
+متضخم، طبعاً هذا هيخلي كمية الدم اللي بترجع للقلب
+
+129
+00:09:43,640 --> 00:09:50,180
+عبر الـ right atrium، يعني برضه الكمية كتير هتكون
+
+130
+00:09:50,180 --> 00:09:53,420
+يعني بيجي دم، بقى الـ right ventricle لسه مش هيفضي اللي
+
+131
+00:09:53,420 --> 00:09:57,000
+عنده، تمام؟ فعشان هيك الـ patient هذا دائماً هيكون عنده
+
+132
+00:09:57,000 --> 00:10:00,460
+neck vein distended، طيب، وفوق هذا بالنسبة لي فوق
+
+133
+00:10:00,460 --> 00:10:03,300
+الـ neck vein هتكون distended، طب من تحت هيكون فيه
+
+134
+00:10:03,300 --> 00:10:07,780
+عنده lower limb edema، إذاً من أهم الأعراض أنه
+
+135
+00:10:07,780 --> 00:10:10,280
+هلاقي edema في الـ feet والـ legs، يعني lower limb
+
+136
+00:10:10,280 --> 00:10:15,380
+edema، وفوق هلاقي distension في الـ neck vein
+
+137
+00:10:16,610 --> 00:10:18,970
+distinctions يعني الـ jugular veins، حيث يكون فيهم
+
+138
+00:10:18,970 --> 00:10:23,490
+distinction، يعني معبين دم، لأنه مش بيسهل خروج الدم
+
+139
+00:10:23,490 --> 00:10:28,310
+يروح ينزل على القلب عبر الـ right atrium، وبعدين
+
+140
+00:10:28,310 --> 00:10:30,670
+يروح على الـ right ventricle، لأن الـ right ventricle
+
+141
+00:10:30,670 --> 00:10:35,380
+شبعان ومعمل محتقن، مش عارف يودي الدم اللي عنده
+
+142
+00:10:35,380 --> 00:10:39,580
+لأن الرئتين ما بيستقبلوش منه، وبالتالي شوية شوية
+
+143
+00:10:39,580 --> 00:10:44,620
+هيصير الـ blood يرشح، الدم يرشح من الرئتين ويعمل
+
+144
+00:10:44,620 --> 00:10:49,100
+pleural effusion، وطبعاً ممكن المريض يكون فيه
+
+145
+00:10:49,100 --> 00:10:53,280
+endocarditis، وكمان يكون الـ heart يصير يعمل heart
+
+146
+00:10:53,280 --> 00:10:58,020
+murmur، كمان يا جماعة، الـ liver هيكون بدأ حجمه يكبر
+
+147
+00:10:58,020 --> 00:11:05,740
+لأنه بيحتقن في السينوس عبر الـ portal vein أيضاً
+
+148
+00:11:05,740 --> 00:11:11,500
+فبيصير برضه الـ enlargement في الـ liver، الـ
+
+149
+00:11:11,500 --> 00:11:15,300
+medical management للناس هدول، عشان نحسن وضع
+
+150
+00:11:15,300 --> 00:11:19,920
+المريض هذا، أولاً يا جماعة، بيتم بالشكل الأساسي على
+
+151
+00:11:19,920 --> 00:11:24,770
+أنه نراقب ونعالج الحالة المرضية تبع الـ lung، هو
+
+152
+00:11:24,770 --> 00:11:28,470
+من إيش صار عنده Cor Pulmonale، من الـ COPD ولا من الـ
+
+153
+00:11:28,470 --> 00:11:33,430
+Lung Fibrosis، نحاول نحسن الحالة المرضية تبعته عشان
+
+154
+00:11:33,430 --> 00:11:38,330
+ما تزيدش عنده الـ Cor Pulmonale والـ enlargement في
+
+155
+00:11:38,330 --> 00:11:44,850
+الـ right ventricle، أحسن حاجة أن نخلّي المريض هذا
+
+156
+00:11:45,170 --> 00:11:50,310
+وضعه يتأقلم وما يزيدش سوءاً، أنه ندّيه Oxygen
+
+157
+00:11:50,310 --> 00:11:56,870
+Supplement، قد إيش؟ 24 ساعة، من 16 لـ 24 ساعة في
+
+158
+00:11:56,870 --> 00:12:00,730
+اليوم، هل يظل 16 ساعة لـ Oxygen في اليوم؟ اه
+
+159
+00:12:00,730 --> 00:12:04,670
+الأبحاث بتثبت أنه كل ما يظل المريض على Continuous
+
+160
+00:12:04,670 --> 00:12:12,690
+Oxygen، كل ما الـ Hypoxemia بتقل في جسمه، لأنه هو هيندو
+
+161
+00:12:12,690 --> 00:12:16,570
+بمشكلة، بيعتبر رئته مش شغالة كويس، وكل ما أنا أديته
+
+162
+00:12:16,570 --> 00:12:20,830
+Oxygen على low rate طبعاً، بس continuous، أنا بالتالي
+
+163
+00:12:20,830 --> 00:12:24,690
+هحسم الـ Pulmonary function، وأقلل الـ reduction in
+
+164
+00:12:24,690 --> 00:12:29,830
+pulmonary vascular resistance، وهذا هيخلي المريض الـ
+
+165
+00:12:29,830 --> 00:12:33,850
+right ventricle عنده ما يضطرش يجهد ويتضخم
+
+166
+00:12:33,850 --> 00:12:38,170
+وبالتالي أمنع right sided heart failure،
+
+167
+00:12:38,170 --> 00:12:46,850
+تمام؟ عشان هيك الـ oxygen هو يعني حجر الزاوية مهم جداً
+
+168
+00:12:46,850 --> 00:12:52,970
+في علاج المرضى اللي عندهم Cor Pulmonale، طبعاً زي ما
+
+169
+00:12:52,970 --> 00:12:56,510
+حكيت، أصلاً هم بيكونوا COPD patients، فبيدّوا طبعاً كنت
+
+170
+00:12:56,510 --> 00:12:59,870
+بيدّوا للمريض يعني 24 ساعة كنتيونيوس oxygen،
+
+171
+00:12:59,870 --> 00:13:05,010
+طبعاً زمان كان الموضوع جداً مرهق، كان بيحتاج جهاز
+
+172
+00:13:05,010 --> 00:13:09,270
+oxygen، ويظل المريض متصل عليه ويبقى مجبر يجرّه برّه، جرّه
+
+173
+00:13:10,150 --> 00:13:15,110
+أسهل في جهاز صغير اسمه Oxygen Concentrator، إن شاء
+
+174
+00:13:15,110 --> 00:13:19,630
+الله، المرة الجاية بحاول أحط لكم صورته أو لو كتبتوا
+
+175
+00:13:19,630 --> 00:13:24,890
+على جوجل Oxygen Concentrator، هتشوفوا جهاز صغير، بس
+
+176
+00:13:24,890 --> 00:13:32,250
+بتشبّكه في الكهربا وإله humidifier، وإنت بتحط كام
+
+177
+00:13:32,250 --> 00:13:35,980
+
+223
+00:17:11,350 --> 00:17:15,730
+other causes of السَّبْتَكَ زي البيرمصارفي عنده sepsis
+
+224
+00:17:15,730 --> 00:17:22,910
+ممكن يصير عنده thrombus من  
+
+225
+00:17:22,910 --> 00:17:29,120
+اللي هو infected thrombus  الناس هدول هيصير في عندهم
+
+226
+00:17:29,120 --> 00:17:34,100
+empowerment كتير في الـ lung لأنه وفي شغل الـ
+
+227
+00:17:34,100 --> 00:17:37,160
+lung وفي الـ function تباعتها لأن مافي جزء أصبح
+
+228
+00:17:37,160 --> 00:17:40,920
+من الـ lung كبير مابيعملش gas exchange و
+
+229
+00:17:40,920 --> 00:17:51,060
+infarct تمام؟ علشان هيك الـ الـ الـ الـ الـ الـ
+
+230
+00:17:51,060 --> 00:17:55,180
+البلبوناري embolism ممكن كثير حاجات أمراض أخرى
+
+231
+00:17:55,180 --> 00:17:59,020
+تؤدي إليها مش بس الـDVT إنه يكون مثلاً عنده المريض
+
+232
+00:17:59,020 --> 00:18:03,600
+Atrial Fibrillation إيش يعني؟ يعني هو عنده أصلاً
+
+233
+00:18:03,600 --> 00:18:09,200
+ارتجاف أذيني في اللي هو عضلة القلب هذا يا جماعة
+
+234
+00:18:09,200 --> 00:18:14,600
+بيهيئي الفرصة أصلاً لتكوين إيش؟ الـ Thrombus في الـ
+
+235
+00:18:14,600 --> 00:18:18,340
+Atriums وبالتالي هتنزل الـ Thrombus من الـ Atrial
+
+236
+00:18:18,340 --> 00:18:22,400
+Chamber على الـ Ventricle بالذات اللي هو الـ Right
+
+237
+00:18:22,400 --> 00:18:26,600
+Ventricle وبالتالي ممكن تنتقل لأماكن أخرى كمان من
+
+238
+00:18:26,600 --> 00:18:33,420
+الحاجات اللي معروفة أنها بتساعد في تكوين الـ
+
+239
+00:18:33,420 --> 00:18:40,280
+Thrombus Formation يا جماعة اللي هو الراحة
+
+240
+00:18:40,770 --> 00:18:45,490
+الكتيرة يعني المرضى سواء كان بالـ Bed rest أو هو
+
+241
+00:18:45,490 --> 00:18:49,930
+أصلاً الـ Sedentary lifestyle مستوى يعني أو طريقة
+
+242
+00:18:49,930 --> 00:18:53,030
+حياته ما بيتحركش فيها كتير دائماً قاعد، دائماً بيشتغل
+
+243
+00:18:53,030 --> 00:18:57,410
+على مكتب، دائماً بيسافر كتير، الناس اللي بيسافروا
+
+244
+00:18:57,410 --> 00:19:02,150
+كتير ومسافات طويلة سواء باص أو سيارة أو في الطيارة
+
+245
+00:19:02,150 --> 00:19:06,490
+لمسافات طويلة عادة يا جماعة بيرتفع لديهم إيش
+
+246
+00:19:06,840 --> 00:19:11,380
+DVT ولا يرتفع  اللي يصير عنده DVT بعدها كإيش
+
+247
+00:19:11,380 --> 00:19:15,000
+المرحلة التالية ممكن تكون إنه يخش بجلطة رئوية لازم
+
+248
+00:19:15,000 --> 00:19:19,280
+أو إنه يخش كمان في قصور قلبي يا جماعة تمام ما يكوارث
+
+249
+00:19:19,280 --> 00:19:22,700
+الـ infarction لأن كل الحاجات اللي حكيتها هذه سواء
+
+250
+00:19:22,700 --> 00:19:27,260
+إنه بيسافر كتير أو إنه سافر مسافات طويلة أو إنه
+
+251
+00:19:27,260 --> 00:19:33,360
+ما بيتحركش كتير نتيجة شغله إنه بيضل في المكتب طوال اليوم
+
+252
+00:19:33,360 --> 00:19:37,920
+مثلاً، هذا كل الحاجات بتؤدي إلى إنه يصيب فيه
+
+253
+00:19:37,920 --> 00:19:41,060
+إمكانية لـ Thrombus Formation في الجسم بقى إن ما
+
+254
+00:19:41,060 --> 00:19:43,740
+بيصيب Thrombus Formation ما حدا هيعرف وين
+
+255
+00:19:43,740 --> 00:19:48,060
+الـ Thrombus هذه هتمشي وتستقر إذا مشيت في Arteries
+
+256
+00:19:48,060 --> 00:19:52,020
+هتأدي إلى إنه ممكن تستقر في الـ Coronary Arteries وتؤدي إلى
+
+257
+00:19:52,020 --> 00:19:56,480
+Myocardial Infarction وإذا مشيت في الـ Veins
+
+258
+00:19:56,480 --> 00:20:00,190
+ممكن تستقر في الـ right ventricle ومن الـ right
+
+259
+00:20:00,190 --> 00:20:05,030
+ventricle إلى الـ pulmonary arteries وتستقر في أحد الـ
+
+260
+00:20:05,030 --> 00:20:07,710
+lungs في branches من الـ pulmonary arteries وتعمل
+
+261
+00:20:07,710 --> 00:20:11,710
+pulmonary infarction عشان هيك الـ clinical
+
+262
+00:20:11,710 --> 00:20:18,310
+manifestation للمريض عنده pulmonary أو pulmonary
+
+263
+00:20:18,310 --> 00:20:21,790
+embolism صحيح أنه هيكون المريض أصبح dyspneic لأنه
+
+264
+00:20:21,790 --> 00:20:27,490
+في جزء من الـ lung حكينا infarcted ما بيشتغلش أو ما
+
+265
+00:20:27,490 --> 00:20:31,510
+بيقومش بوظيفته اللي هي الـ Gas Exchange وكمان هيكون
+
+266
+00:20:31,510 --> 00:20:35,410
+فيه عنده severe chest pain يا جماعة زي كأنه .. زي
+
+267
+00:20:35,410 --> 00:20:38,630
+كأنه إيش؟ عنده myocardial infarction يعني هيجي
+
+268
+00:20:38,630 --> 00:20:41,810
+المريض إيش في صدره؟ آه وجع في صدري، chest pain
+
+269
+00:20:41,810 --> 00:20:47,630
+وكمان، بس حاجة كويسة ثانية إنه عادة بيكون الـ .. أو
+
+270
+00:20:47,630 --> 00:20:51,670
+يعني ممكن يكون، مش عادة ممكن يكون إن الـ pain تبقى
+
+271
+00:20:51,670 --> 00:20:57,480
+للمريض ده مختلفة عن الـ MI ماذا يعني الفرق بينهم؟ إنهم
+
+272
+00:20:57,480 --> 00:21:00,920
+ممكن يكونوا مصاحبين مع بعض، لماذا؟ لأنه ممكن يكون في
+
+273
+00:21:00,920 --> 00:21:05,540
+عنده pleurisy كمان أو يصير عنده pleurisy اللي هو
+
+274
+00:21:05,540 --> 00:21:09,560
+من الـ infarction اللي صار في منطقة معينة يصير
+
+275
+00:21:09,560 --> 00:21:13,500
+pleuritis زي ما حكينا في الـ pleurisy
+
+276
+00:21:17,170 --> 00:21:22,310
+المريض زي ما حكينا ممكن يجي بأعراض زي myocardial
+
+277
+00:21:22,310 --> 00:21:25,790
+infarction من ناحية الـ chest pain هيجي عنده
+
+278
+00:21:25,790 --> 00:21:29,770
+severe hypoxia واضح جداً إنه hypoxic الـ
+
+279
+00:21:29,770 --> 00:21:34,120
+saturation تبعتة low المريض هيجي بتاعته المريض
+
+280
+00:21:34,120 --> 00:21:36,440
+حجيء الـ Fever لأنه في منطقة كبيرة صار لها
+
+281
+00:21:36,440 --> 00:21:39,200
+انفاركت بعد شوية حيصير اندو fever حيجي الـ
+
+282
+00:21:39,200 --> 00:21:42,680
+diaphoresis إجهاد لإنه الـ diaphoresis بسبب إنه
+
+283
+00:21:42,680 --> 00:21:47,040
+مجهد في عملية التنفس وبالنسبة له عملية صعبة مجهدة
+
+284
+00:21:47,040 --> 00:21:50,660
+حيجي شوية شوية حيصير اندو كاف علامة كتير كتير
+
+285
+00:21:50,660 --> 00:21:55,620
+مهمة يا جماعة في موضوع الـ Pulmonary Embolism إنه
+
+286
+00:21:55,620 --> 00:22:02,350
+ممكن تلاقي شوية skin rash أو petechiae rash
+
+287
+00:22:02,350 --> 00:22:05,650
+بالذات يعني بتعرفوا الـ petechiae rash يعني إنه
+
+288
+00:22:05,650 --> 00:22:10,970
+بيكون عبارة عن نقط يعني
+
+289
+00:22:10,970 --> 00:22:15,790
+إيش بده .. يعني النقط هذه بتعرفوا إيش تعريف الـ
+
+290
+00:22:15,790 --> 00:22:19,030
+petechiae rash يعني هي عبارة عن انفجار في الـ
+
+291
+00:22:19,030 --> 00:22:23,070
+capillaries فبيطلع إيش؟ شوية دم وبتظهر على الـ
+
+292
+00:22:23,070 --> 00:22:26,070
+skin بس وين هي دي عادة بنلاقيها؟ في منطقة الـ
+
+293
+00:22:26,070 --> 00:22:29,080
+neck لو جيت  بَحَثت على منطقة الـ neck و الـ
+
+294
+00:22:29,080 --> 00:22:32,720
+shoulder تبقى المريض يلاحظ كده الـ neck و الـ
+
+295
+00:22:32,720 --> 00:22:41,150
+shoulder ممكن تلاقي نقط بيضاء rash هذا من العلامات
+
+296
+00:22:41,150 --> 00:22:44,730
+اللي بتخليك تعرف إن هذا could be pulmonary
+
+297
+00:22:44,730 --> 00:22:47,650
+embolism كمان ممكن نلاقي زي الـ petechiae
+
+298
+00:22:47,650 --> 00:22:50,570
+هذه يا جماعة في الـ sclera في الـ sclera لو شفنا
+
+299
+00:22:50,570 --> 00:22:54,150
+بياض العين تبع المريض هذا ممكن نشوف هذه الحاجة
+
+300
+00:22:54,150 --> 00:23:01,090
+عشان هيك هذه تعتبر من أهم العلامات إلى جانب
+
+301
+00:23:01,090 --> 00:23:04,610
+العلامات اللي حكينا عنها إن الـ patient بيجي dyspneic،
+
+302
+00:23:04,610 --> 00:23:09,750
+بيجي anxiety، distress، بيجي diaphoresis، بيجي
+
+303
+00:23:09,750 --> 00:23:14,470
+pleuritic chest pain وباقي
+
+304
+00:23:14,470 --> 00:23:20,080
+الحاجات اللي حكينا عنها طبعاً من وسائل التشخيص غير
+
+305
+00:23:20,080 --> 00:23:23,160
+إنه نعمل صورة X-Ray العادية أو غير إنه الـ
+
+306
+00:23:23,160 --> 00:23:26,700
+Physical Examination ونحترم شكواه ونشوف إن
+
+307
+00:23:26,700 --> 00:23:31,750
+علاماته هذه could be pulmonary embolism الـ
+
+308
+00:23:31,750 --> 00:23:36,690
+ECG could be useful في الحالات هذه يا جماعة خاصة
+
+309
+00:23:36,690 --> 00:23:40,050
+إن المريض بيجي بـ Sinus Tachycardia يعني heart
+
+310
+00:23:40,050 --> 00:23:45,390
+rate عالي بس منتظم لأن الموضوع مش خلل في القلب،
+
+311
+00:23:45,390 --> 00:23:49,190
+Sinus الـ PR Interval بتكون Depression،
+
+312
+00:23:49,190 --> 00:23:54,270
+لاحظوا الـ PR Interval، Depression مش هحكي لكم كتير
+
+313
+00:23:54,270 --> 00:23:58,660
+في الـ ECG عشان لسة أنتم ما درستوا موضوع الـ Heart
+
+314
+00:23:58,660 --> 00:24:02,580
+إن شاء الله يعني مستقبلاً بتصيروا أنتم عارفين أكثر
+
+315
+00:24:02,580 --> 00:24:07,040
+في موضوع الـ Heart أو لما نشرح الـ ECG بيكون
+
+316
+00:24:07,040 --> 00:24:13,340
+الموضوع أسهل وممكن نرجع نحكي عن العلامات اللي بتكون
+
+317
+00:24:13,340 --> 00:24:17,420
+في الـ MI وفي الـ Pulmonary Embolism وكل نوع من
+
+318
+00:24:17,420 --> 00:24:23,010
+الأمراض الـ ECG من الحاجات المهمة كتير اللي بتلزمنا
+
+319
+00:24:23,010 --> 00:24:25,630
+نعملها نعمل للمريض Arterial Blood Gases أحد الـ
+
+320
+00:24:25,630 --> 00:24:28,630
+Diagnostic Procedures اللي ممكن نعملها الـ
+
+321
+00:24:28,630 --> 00:24:31,250
+Arterial Blood Gases هتوضح لي يا جماعة حاجة مهمة
+
+322
+00:24:31,250 --> 00:24:36,350
+جداً أن المريض هيكون عنده hypoxemia هي أهم علامة
+
+323
+00:24:36,350 --> 00:24:39,250
+مميزة زي ما احنا فاكرين في الـ ARDS بنحكي إن
+
+324
+00:24:39,250 --> 00:24:42,170
+الـ hypoxemia يعني الـ PO2 الـ partial pressure
+
+325
+00:24:42,170 --> 00:24:49,810
+للأكسجين أقل من 60 طبعاً ممكن الـ CO2 حسب وضع
+
+326
+00:24:49,810 --> 00:24:53,170
+المريضة إذا المريضة جاية بتأكد لي أكيد هلاقي hypo
+
+327
+00:24:53,170 --> 00:24:57,230
+capnia لأن فيه washing out للـ CO2 لكن إذا
+
+328
+00:24:57,230 --> 00:25:01,130
+المريض بدأ يتعب ويصير hypoventilation هيبدأ يصير
+
+329
+00:25:01,130 --> 00:25:04,590
+فيه ارتفاع في الـ CO2 في الأول عادة بيجي المريض
+
+330
+00:25:04,590 --> 00:25:07,570
+بـ hypoxemia لأنه بيجي بالنسبة لـ metabolic rate
+
+331
+00:25:07,570 --> 00:25:13,010
+عالي  Okay بالنسبة للحاجات المهمة أيضاً ل
+
+332
+00:25:13,010 --> 00:25:17,170
+as a diagnosis أنه نعمل للمريض هذا pulmonary
+
+333
+00:25:17,170 --> 00:25:21,470
+angiography علشان نشوف بالظبط وين المنطقة في الـ
+
+334
+00:25:21,470 --> 00:25:27,240
+lung اللي مش فيها ما بيوصلهاش دم عشان هيك
+
+335
+00:25:27,240 --> 00:25:31,100
+الـ angiography يعني بيحقنوا صبغة و بيصوروا فبالتالي
+
+336
+00:25:31,100 --> 00:25:33,460
+بيشوفوا ما بيوصلهاش صبغة في الأماكن فبالتالي بيشوفوا
+
+337
+00:25:33,460 --> 00:25:35,840
+في الـ lung بالظبط وين المنطقة اللي ما بيوصلهاش دم
+
+338
+00:25:35,840 --> 00:25:42,040
+و infarcted area الـ CT أيضاً هي يعني could be could
+
+339
+00:25:42,040 --> 00:25:46,920
+be so helpful إنها بتحدد لي المنطقة طبعاً الـ CT أو
+
+340
+00:25:46,920 --> 00:25:50,620
+Magnetic Resonance Image MRI عشان يتحدد لي وين
+
+341
+00:25:50,620 --> 00:25:55,350
+المنطقة بالظبط في الرئتين اللي فيها الـ Damage or
+
+342
+00:25:55,350 --> 00:26:00,150
+infarction الـ Medical Management للـ Pulmonary
+
+343
+00:26:00,150 --> 00:26:07,350
+Embolism يا جماعة بنبدأ أولاً التعامل معاه بشكل
+
+344
+00:26:07,350 --> 00:26:12,250
+emergency أول ما بيجي على الطوارئ وبكون الوضع  بكون
+
+345
+00:26:12,250 --> 00:26:16,110
+critical أكيد أنه احنا بدنا نحطه في bed rest ما
+
+346
+00:26:16,110 --> 00:26:22,830
+تحاولش تنيم المريض يعني spine على الآخر لأنه نفسه
+
+347
+00:26:22,830 --> 00:26:26,550
+هتبقى تعبانة فخلّيه في fowler position حاول تديله
+
+348
+00:26:26,550 --> 00:26:33,530
+oxygen علشان يتحسن من الـ Hypoxemia اللي عنده الـ
+
+349
+00:26:33,530 --> 00:26:39,070
+Low Saturation طبعاً بعد هيك هتتم يعني  نسحب
+
+350
+00:26:39,070 --> 00:26:43,490
+التحليل ونعمل إجراءات تشخيصية لحتى نعرف إيش الوضع
+
+351
+00:26:43,490 --> 00:26:46,090
+اللي عند المريض بالظبط ومجرد ما يتحدد إن هذا
+
+352
+00:26:46,090 --> 00:26:50,550
+المريض عنده Pulmonary Embolism هيبدأ يا جماعة يفكروا
+
+353
+00:26:50,550 --> 00:26:56,330
+بإنهم يدوا أدوية مذيبة للجلطة يعني بيسموها
+
+354
+00:26:56,330 --> 00:27:02,560
+Thrombolytic Therapy وكمان أدوية Anticoagulant طب
+
+355
+00:27:02,560 --> 00:27:05,840
+إيش وظيفة الـ Anticoagulant اللي بتمنع التجلطات؟
+
+356
+00:27:05,840 --> 00:27:10,400
+ما هو صار عنده جلطة وخلص؟ آه وظيفتها هنا إنها تمنع
+
+357
+00:27:10,400 --> 00:27:15,280
+الـ further accumulation أو further formation
+
+358
+00:27:15,280 --> 00:27:18,100
+لـ thrombus يعني ما نخلّي thrombus تكبر في
+
+359
+00:27:18,100 --> 00:27:22,740
+حجمها كمان وكمان لأنه مجرد ما صارت هيكون هي يعني
+
+360
+00:27:22,740 --> 00:27:26,740
+في طريق مسدود و الـ platelets هتبدأ تعمل فوقها
+
+361
+00:27:26,740 --> 00:27:29,620
+Aggregation و Aggregation و Aggregation وبدل ما
+
+362
+00:27:29,620 --> 00:27:33,440
+حجمها كذا يصير أكبر وأكبر وأكبر فبنعطيه
+
+363
+00:27:33,440 --> 00:27:38,910
+Anticoagulation علشان و anti-aggregant كمان من الـ
+
+364
+00:27:38,910 --> 00:27:42,490
+Anticoagulant المعروفين الـ Aspirin من الـ
+
+365
+00:27:42,490 --> 00:27:47,290
+Anticoagulant المعروفين الهيبارين والكلبيكس  تمام؟
+
+366
+00:27:47,290 --> 00:27:50,290
+و الـ Thrombolytic Therapy عادي نبدأ نديه
+
+367
+00:27:50,290 --> 00:27:56,510
+علشان إيش تسوي علشان تبدأ تحلل الجلطة هذه وتدوبها
+
+368
+00:27:56,510 --> 00:28:01,870
+وترجع للمنطقة يصير لها Perfusion طبعاً من الطرق
+
+369
+00:28:01,870 --> 00:28:09,140
+كمان يا جماعة إنه ممكن يتدخّلوا بالقسطرة أو
+
+370
+00:28:09,140 --> 00:28:12,840
+interventional catheterization أو surgical
+
+371
+00:28:12,840 --> 00:28:17,200
+intervention يخشوا على الوريد أو يحاولوا يوصلوا
+
+372
+00:28:17,200 --> 00:28:20,660
+لـ embolus إذا كانوا عارفين وين الـ vessel هذا
+
+373
+00:28:20,660 --> 00:28:24,960
+ومحدد طبعاً
+
+374
+00:28:24,960 --> 00:28:27,900
+هنا أنا بلخّص الـ Emergency Management لما يجيك على
+
+375
+00:28:27,900 --> 00:28:32,680
+المريض كيف بدك تتعامل معاه كيف بدك تبدأ بالـ  بتحطه
+
+376
+00:28:32,680 --> 00:28:36,160
+في الـ bed rest تديله الـ oxygen تركب IV Cannula
+
+377
+00:28:36,160 --> 00:28:40,360
+تبدأ تشخص
+
+378
+00:28:40,360 --> 00:28:44,990
+تاخد Blood Gases وتحاول أن تعمل له الـ CT
+
+379
+00:28:44,990 --> 00:28:47,890
+و angiography عشان تعرفوا إن المريض إذا كان عنده
+
+380
+00:28:47,890 --> 00:28:52,570
+Hypotension تديله supportive management زي
+
+381
+00:28:52,570 --> 00:28:59,950
+الدوبامين والدوبيوتامين علشان ترفع
+
+382
+00:28:59,950 --> 00:29:01,990
+الضغط وتحسن الـ
+
+383
+00:29:04,620 --> 00:29:08,160
+الـ Blood Pressure اللي عنده طبعاً ممكن يحتاج
+
+384
+00:29:08,160 --> 00:29:13,800
+المريض لو صار عنده تطور لصار عنده Arrhythmia أو
+
+385
+00:29:13,800 --> 00:29:17,780
+صار فيه احتقان أو بدأ يخش بـ Heart Failure نبدأ
+
+386
+00:29:17,780 --> 00:29:21,280
+ندّي Diuretics وندّي Anti-Arrhythmic Therapy كل
+
+387
+00:29:21,280 --> 00:29:25,600
+هذه الحاجات يعني الـ pain السيفير اللي إجا عنده
+
+388
+00:29:25,600 --> 00:29:28,820
+بيكون بدنا نتعامل معاه وندّيله مورفين لو المريض
+
+389
+00:29:28,820 --> 00:29:32,740
+الـ Hypoxemia تبعته زادت والـ hypercapnia زادت كتير وخش في
+
+390
+00:29:32,740 --> 00:29:33,440
+Respiratory
+
+391
+00:29:36,400 --> 00:29:40,660
+أو ممكن في الأول يكون الـ Respiratory Alkalosis يا
+
+392
+00:29:40,660 --> 00:29:45,800
+جماعة لأنه يكون الـ hypercapnia كتير والـ CO2 واطي كتير
+
+393
+00:29:45,800 --> 00:29:49,740
+فممكن ندخل في الـ Respiratory Alkalosis ففي كل
+
+394
+00:29:49,740 --> 00:29:52,960
+الأحوال حيكون محتاج Mechanical Ventilator
+
+395
+00:29:55,240 --> 00:30:00,220
+حكينا عن الـ Anticoagulation بشكل مفصل وحكينا عن
+
+396
+00:30:00,220 --> 00:30:04,840
+إيش هي الأدوية اللي كتير بتستخدم سواء الـ Heparin
+
+397
+00:30:04,840 --> 00:30:08,560
+أو الكليكس  وحكينا عن الـ Thrombolytic Therapy
+
+398
+00:30:08,560 --> 00:30:
+
+445
+00:33:42,400 --> 00:33:50,120
+فوق اللي هم الـ thigh بحيث أنها تسهل الـ venous
+
+446
+00:33:50,120 --> 00:33:54,280
+return و lymphatic drainage كله وخلّي يصير فيه
+
+447
+00:33:54,280 --> 00:33:58,080
+إمكانية أن يرجع بشكل أسهل. طبعاً، في ناس ممكن تستخدم
+
+448
+00:33:58,080 --> 00:34:01,880
+crib bandage بس بيحكي دايماً أنه عشان تستخدم
+
+449
+00:34:01,880 --> 00:34:06,140
+crib bandage فيه criteria معينة، الأهم فيها أنك
+
+450
+00:34:06,140 --> 00:34:12,280
+لازم تبدأ من أول القدم، مش من أول الساق، وتسيب
+
+451
+00:34:12,280 --> 00:34:16,920
+القدم، وبالتالي في منطقة بتكون محتقنة، وهتلاقي بعد
+
+452
+00:34:16,920 --> 00:34:22,440
+شوية أن القدمين صار فيهما إِدِيمة كويس. من الحاجات
+
+453
+00:34:22,440 --> 00:34:26,540
+كمان المهمة إذا ما أنت بتتعامل مع مريض post-op،
+
+454
+00:34:26,540 --> 00:34:31,480
+عادةً عشان نتفادى هذا الخطر، إنه early
+
+455
+00:34:31,480 --> 00:34:37,540
+immobilization، أخليه يتحرك بدري وأخليه يمشي بدري.
+
+456
+00:34:37,540 --> 00:34:42,300
+كل ما أنا خليت المريض يمشي بدري، كل ما أنا وما كانش
+
+457
+00:34:42,300 --> 00:34:46,240
+فيه مانع طبعاً إنه يمشي، كل ما أنا عند الخطر تبع إنه
+
+458
+00:34:46,240 --> 00:34:47,600
+يصير endothrombus.
+
+459
+00:34:50,030 --> 00:34:55,370
+لو كنت تتعامل مع مريض بده يأخذ thrombolytic
+
+460
+00:34:55,370 --> 00:34:58,430
+therapy، لازم يكون طول الوقت هذا المريض under your
+
+461
+00:34:58,430 --> 00:35:02,150
+monitor، لأنه ممكن جداً يخش في hypertension، لازم
+
+462
+00:35:02,150 --> 00:35:04,930
+يكون على monitor ويكون في dysrhythmia. إذا كان
+
+463
+00:35:04,930 --> 00:35:09,610
+المريض عنده ألم،  أنت كطبيب، بدك زي ما حكينا، ممكن
+
+464
+00:35:09,610 --> 00:35:13,270
+تدّي الـ pre-prescribed pain killers، وكمان بدك
+
+465
+00:35:13,270 --> 00:35:15,510
+تخلي المريض في comfortable position، لأن الـ
+
+466
+00:35:15,510 --> 00:35:20,010
+position و الـ oxygen ممكن يقلل الألم، وكمان نعمل
+
+467
+00:35:20,010 --> 00:35:27,090
+للمريض اللي هو support. المحاضرة
+
+468
+00:35:27,090 --> 00:35:32,120
+الجاي، أو هيك احنا بنكون خلصنا الـ pulmonary
+
+469
+00:35:32,120 --> 00:35:38,200
+embolism، علشان هيك هنتوقف عند الـ pulmonary
+
+470
+00:35:38,200 --> 00:35:45,940
+embolism ونكمل
+
+471
+00:35:45,940 --> 00:35:47,680
+المحاضرة الجاي، أعطيكم العافية.
diff --git a/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/cy8gkI3Bil0_postprocess.srt b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/cy8gkI3Bil0_postprocess.srt
new file mode 100644
index 0000000000000000000000000000000000000000..4c00f47c3ff4ce5b49ddff8bd92ed639cd44e8ef
--- /dev/null
+++ b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/cy8gkI3Bil0_postprocess.srt
@@ -0,0 +1,1884 @@
+1
+00:00:02,700 --> 00:00:05,640
+بسم الله الرحمن الرحيم السلام عليكم ورحمة الله
+
+2
+00:00:05,640 --> 00:00:09,260
+وبركاته اليوم إن شاء الله رب العالمين هنكمل
+
+3
+00:00:09,260 --> 00:00:12,320
+محاضرتنا في اللي هو Respiratory Tract Disorders
+
+4
+00:00:12,320 --> 00:00:19,000
+كنا حكينا مع بعض في المحاضرة السابقة عن الـ ARDS
+
+5
+00:00:19,000 --> 00:00:22,780
+اللي هي الـ Acute Respiratory Distress Syndrome
+
+6
+00:00:23,540 --> 00:00:27,860
+حكينا في الـ Acute respiratory distress، السندروم،
+
+7
+00:00:27,860 --> 00:00:32,020
+أيش المرض، كيف الصين والسينتران سبعته، الـ X-ray
+
+8
+00:00:32,020 --> 00:00:33,980
+كيف بيكون شكلها، الـ medical management، شو
+
+9
+00:00:33,980 --> 00:00:36,920
+بنسويه، أيش أهمية الـ mechanical ventilator في الـ
+
+10
+00:00:36,920 --> 00:00:40,600
+management والـ high بيب، عشان نمنع الكلاب، ثم من
+
+11
+00:00:40,600 --> 00:00:45,010
+ضمن الحاجات كمان حكيناإنه مافيش «pharmacological»
+
+12
+00:00:45,010 --> 00:00:48,710
+كرب معين للـ «ARD» أصغر إنهم يعني ممكن يستخدموا
+
+13
+00:00:48,710 --> 00:00:53,630
+الـ «surfactant replacement» عشان يحسنوا الوضع
+
+14
+00:00:53,630 --> 00:01:00,030
+داخل الـ «alveoli» لكن مهم
+
+15
+00:01:00,030 --> 00:01:06,670
+جدا كمان إنه نخفف الضغط فيالـ Pulmonary Artery
+
+16
+00:01:06,670 --> 00:01:11,130
+لإنه بيصير Pulmonary Artery Hypertension حكينا إنه
+
+17
+00:01:11,130 --> 00:01:15,010
+عشان نعرف قداش الضغط داخل الـ Pulmonary Artery
+
+18
+00:01:15,010 --> 00:01:21,110
+ممكن نستخدم لسوانس GANS كاتيتار اللي وظيفتها إنها
+
+19
+00:01:21,110 --> 00:01:26,780
+تعرف قداش الضغط داخل الـ Pulmonary«أرتري» وعرفنا
+
+20
+00:01:26,780 --> 00:01:33,060
+إن الضغط داخل البلمونري «أرتري» إذا كان أقل من 15
+
+21
+00:01:33,060 --> 00:01:44,140
+أو أقل من 18 يعني maximum بكونمعناه إنه المريض
+
+22
+00:01:44,140 --> 00:01:47,880
+المشكلة
+
+23
+00:01:47,880 --> 00:01:50,720
+تبعته فيه الـ Lung ويكون الموضوع اللي علاقة بالـ
+
+24
+00:01:50,720 --> 00:01:58,680
+ARDS لكن لو كان الـ Pulmonary Artery Pressure كان
+
+25
+00:01:58,680 --> 00:02:03,820
+أكتر من 18 معناه إنه Cardiac Issue حكينا إن الـ
+
+26
+00:02:03,820 --> 00:02:08,780
+Swan's Gland Catheter هي دي بتتركب عن طريقإنهم
+
+27
+00:02:08,780 --> 00:02:13,540
+بيركبوا Central Line من الـ «إنترن» أو الـ
+
+28
+00:02:13,540 --> 00:02:16,860
+«جاجولار» أو Subclavian Veins زي ما أنا بقشر «هان»
+
+29
+00:02:16,860 --> 00:02:20,620
+Subclavian إنها من الـ «إنترن» أو الـ «جاجولار» أو
+
+30
+00:02:20,620 --> 00:02:20,800
+الـ «جاجولار» أو الـ «جاجولار» أو الـ «جاجولار»
+
+31
+00:02:20,800 --> 00:02:25,060
+لما في النهاية نستقر في الـ «Thoracic Vein» بنزل
+
+32
+00:02:25,060 --> 00:02:29,240
+على الـ «Superior Vena Cava» بعدين بنستخر اللي هو
+
+33
+00:02:29,540 --> 00:02:33,640
+في الـRight Atrium بنستقرش في الـNormal الـCentral
+
+34
+00:02:33,640 --> 00:02:36,560
+Line ممكن تكون just before entering the Right
+
+35
+00:02:36,560 --> 00:02:40,120
+Atrium اللي هو الـCentral Venous Pressure بنسميه
+
+36
+00:02:40,120 --> 00:02:44,140
+بيوقف يعني بنسمه الـCentral Venous Pressure لكن في
+
+37
+00:02:44,140 --> 00:02:45,320
+الـSwan
+
+38
+00:02:47,420 --> 00:02:50,200
+بنكمل، بنروح على الـ right ventricle ومن الـ right
+
+39
+00:02:50,200 --> 00:02:53,480
+ventricle بنطلع على الـ pulmonary artery في الـ
+
+40
+00:02:53,480 --> 00:02:57,880
+pulmonary artery بيكون فيه هنا بلون زي ما انتوا
+
+41
+00:02:57,880 --> 00:03:00,720
+شايفينه أما بيكون فيه two بلون، بلون هنا و بلون
+
+42
+00:03:00,720 --> 00:03:07,100
+قبل منه المهم الـ pulmonary wedge pressure اللي هو
+
+43
+00:03:07,100 --> 00:03:16,190
+وظيفتهإنه يعني قسل الضغط داخل البلمونة الارتري
+
+44
+00:03:16,190 --> 00:03:20,390
+سيئة الـ closure و ال pressure يعني سيئة الـ
+
+45
+00:03:20,390 --> 00:03:24,890
+closure يعني سيئة ما بيصير inflation للبلون أداش
+
+46
+00:03:24,890 --> 00:03:29,110
+بيكون الضغط داخل البلمونة الارتري هذا جنان عليه
+
+47
+00:03:29,110 --> 00:03:34,490
+بنحدد إذا كان الموضوع إيه علاقة في الـlung ولا إيه
+
+48
+00:03:34,490 --> 00:03:42,420
+علاقة في الـheartمن الإلاجات اللي إحنا بنستخدمها
+
+49
+00:03:42,420 --> 00:03:45,480
+طبعا حكينا عليك إن الكلمة manifestation تبقى في
+
+50
+00:03:45,480 --> 00:03:49,520
+الـRDS وحكينا بيها كويس بس بدنا نعرف بالنسبالها
+
+51
+00:03:49,520 --> 00:03:53,700
+علاج الـPulmonary Hypertension حكينا إنه من أحسن
+
+52
+00:03:53,700 --> 00:03:59,520
+الأدوية اللي ممكن يعالجوا فيهاالـHypertension،
+
+53
+00:03:59,520 --> 00:04:04,120
+الـ«فوسفو داستيريز انهيبيتورز» الهي عبارة عن
+
+54
+00:04:04,120 --> 00:04:08,880
+مراكبات السيليدينافيل اللي هي الـViagra ومراكباته
+
+55
+00:04:10,360 --> 00:04:15,140
+طبعاً و هذه الأدوية اللي هي معروفة حالياً لعلاج
+
+56
+00:04:15,140 --> 00:04:21,840
+العجز الجنسي لكن هي في الأصل علاجات استخدمت في
+
+57
+00:04:21,840 --> 00:04:27,240
+علاج الـ Pulmonary Hypertension وتقليل الضغط داخل
+
+58
+00:04:27,240 --> 00:04:31,800
+الـ Pulmonary Artery هذا كانت يعني مراجعة بسيطة أو
+
+59
+00:04:31,800 --> 00:04:36,300
+تعليق بسيط أو زيادة حبة على الـSwan Gans Catheter
+
+60
+00:04:36,300 --> 00:04:38,520
+وكيف بتنحط
+
+61
+00:04:41,840 --> 00:04:45,280
+وبالظبط، إيش هو الـ Pulmonary heart hypertension؟
+
+62
+00:04:45,280 --> 00:04:48,840
+وإيش أحسن الطرق لعلاجه؟ حاليًا، هنحكي عن واحد من
+
+63
+00:04:48,840 --> 00:04:52,360
+الـ Pulmonary heart disease يعني مرض اللي له علاقة
+
+64
+00:04:52,360 --> 00:04:56,540
+بين القلب والرقتين، عشان هيك بيسموه Core Pulmonal
+
+65
+00:04:56,540 --> 00:05:02,000
+إيش يعني Core Pulmonal؟ يعنيفي الأصل هو عبارة عن
+
+66
+00:05:02,000 --> 00:05:07,500
+تضخم في الـ right ventricle يعني enlargement في
+
+67
+00:05:07,500 --> 00:05:12,220
+الـ right ventricle بسبب
+
+68
+00:05:12,220 --> 00:05:15,200
+الـ heart يعني condition in which the right
+
+69
+00:05:15,200 --> 00:05:18,740
+ventricle of the heart enlarged with or without
+
+70
+00:05:18,740 --> 00:05:22,420
+right sided heart failureممكن يكون فيه heart
+
+71
+00:05:22,420 --> 00:05:26,680
+failure أو مش مافيش heart failure كامل لكن ال
+
+72
+00:05:26,680 --> 00:05:30,600
+right ventricل بيضلوا يتضخم لإنه كل ما بيجي بيطلع
+
+73
+00:05:30,600 --> 00:05:33,620
+ال right ventric اللي بيطلع أمين يا جماعة ل blood
+
+74
+00:05:33,620 --> 00:05:36,900
+على ال lungs عشان إيش يصير عبر ال .. عبر مين؟ عبر
+
+75
+00:05:36,900 --> 00:05:39,720
+ال pulmonary artery عشان إيش يصير لها؟ يصير لها
+
+76
+00:05:39,720 --> 00:05:44,760
+oxygenation و بعدين يرجع ل blood من ال lungعبر الـ
+
+77
+00:05:44,760 --> 00:05:48,720
+pulmonary veins على الـ heart عشان يصب في الـ left
+
+78
+00:05:48,720 --> 00:05:51,680
+atrium ومن الـ left atrium ينزل على الـ left
+
+79
+00:05:51,680 --> 00:05:53,820
+ventricle ومن الـ left ventricle يطلع الـ blood
+
+80
+00:05:53,820 --> 00:05:59,900
+عوين عبر الأورطة على كل الجسم لكن اللي بيصير أنه
+
+81
+00:06:00,790 --> 00:06:05,890
+إنه لما بيطلع الدم من الـ right ventricle رجعنا
+
+82
+00:06:05,890 --> 00:06:09,550
+على الجهة اليمين من الـ right ventricle ورد يطلع
+
+83
+00:06:09,550 --> 00:06:15,410
+يودّي blood عبر الـ pulmonary artery على ال lung
+
+84
+00:06:15,410 --> 00:06:18,370
+نرجع للصورة ها عشان نشوف هياته
+
+85
+00:06:21,430 --> 00:06:26,210
+الـBlood جماعة نزل هنا في الـRight Atrium نزل على
+
+86
+00:06:26,210 --> 00:06:29,090
+الـRight Ventricle وبعد الـRight Ventricle عبر
+
+87
+00:06:29,090 --> 00:06:33,630
+البلمونة الارتراب يودّي الدم عمين على الرئتين
+
+88
+00:06:33,630 --> 00:06:39,190
+Right وLeft، تمام؟ الآن، لما يكون الرئة فيها مشكلة
+
+89
+00:06:39,190 --> 00:06:42,830
+زي إيش مشكلة؟ زي الـCOPD مثلًا «Chronic
+
+90
+00:06:42,830 --> 00:06:45,950
+Obstructive Pulmonary Disease» «Stigma Fibrosis»
+
+91
+00:06:45,950 --> 00:06:52,270
+الـTB، whatever، أه؟فبتصير الرئيس ما عندهاش القدرة
+
+92
+00:06:52,270 --> 00:06:57,750
+إنها تستقبل الدم من الـheart بشكل إيقويسي، بشكل
+
+93
+00:06:57,750 --> 00:07:01,490
+منتظر متعمل للـoxygenation فبتصير تتأخر في استقبال
+
+94
+00:07:01,490 --> 00:07:06,070
+الدم وبتحاول إنها تأجله، طب إيش اللي هيصير؟هيصير
+
+95
+00:07:06,070 --> 00:07:10,510
+إنه هيحتقن الدم داخل الـRight Ventricle هذا هذا،
+
+96
+00:07:10,510 --> 00:07:14,790
+هيصير هنا كتير فيه دم مش .. مش .. مش .. يعني
+
+97
+00:07:14,790 --> 00:07:19,430
+ماعندوش الفرصة إنه يروح على الرئتين ويقوم بالدور
+
+98
+00:07:19,430 --> 00:07:22,630
+اللي هو يصير له Oxygenation فبيصير إيش؟ فيه بيصير
+
+99
+00:07:22,630 --> 00:07:27,440
+يتضخمالـ right ventricle إذن تضخم الـ right
+
+100
+00:07:27,440 --> 00:07:30,100
+ventricle condition in which the right ventricle
+
+101
+00:07:30,100 --> 00:07:34,320
+of the heart enlarges يكبر سواء إنتي heart failure
+
+102
+00:07:34,320 --> 00:07:37,520
+أو ماعنديش المشكلة الأساسية مش في ال heart failure
+
+103
+00:07:37,520 --> 00:07:41,580
+المشكلة الأساسية the most frequent cases is severe
+
+104
+00:07:41,580 --> 00:07:46,430
+COPD الناس اللي عندها COPD يعني ال lung تبعتهامش
+
+105
+00:07:46,430 --> 00:07:51,690
+شغالة كويس، إيش اللي هيصير فيها؟ هيصير الدم داخل
+
+106
+00:07:51,690 --> 00:07:56,590
+الـ Pulmonary Artery يزيد كتير، والضغط يقلع ويصير
+
+107
+00:07:56,590 --> 00:07:59,210
+Pulmonary Artery Hypertension اللي طول السنة اللي
+
+108
+00:07:59,210 --> 00:08:05,890
+كنا بنحكي عنه وبالتالي الدم هيصير له ارتجاع ويعني
+
+109
+00:08:05,890 --> 00:08:10,390
+يتحوش في الـRight Ventricle وبالتالي الـRight
+
+110
+00:08:10,390 --> 00:08:15,500
+Ventricle هيظل يعملDilatation وبالتالي بيصير فيه
+
+111
+00:08:15,500 --> 00:08:19,800
+إيش Enlargement بتضخم حجمه وبصير مبين إنه الـRight
+
+112
+00:08:19,800 --> 00:08:26,800
+ventricle أكبر من باقي الجسم وعشان هيك يا جماعة
+
+113
+00:08:26,800 --> 00:08:30,000
+الـCorpulmonal
+
+114
+00:08:30,000 --> 00:08:37,900
+هي حالة مرضية دائما مصاحبة لمتلازمات الصدر أو أي
+
+115
+00:08:37,900 --> 00:08:46,340
+خلل في الرئتينيؤدي إلى خلال في الـ heart أو يؤدي
+
+116
+00:08:46,340 --> 00:08:50,840
+إلى تضخم في الـ right ventricle واحتقان الدم فيه
+
+117
+00:08:50,840 --> 00:08:55,420
+طبعا هذا بالاساس هو نتيجة الـ pulmonary
+
+118
+00:08:55,420 --> 00:09:03,620
+hypertension نتيجة زيادة الضغط في الـ pulmonaryR3،
+
+119
+00:09:03,620 --> 00:09:06,860
+تمام؟ الآن، إيش الـ Clinical Manifestation عند
+
+120
+00:09:06,860 --> 00:09:10,700
+الناس هدول؟ عادة الناس هدول يا جماعة الـ Clinical
+
+121
+00:09:10,700 --> 00:09:12,860
+Manifestations اللي عندهم هي الـ Clinical
+
+122
+00:09:12,860 --> 00:09:15,980
+Manifestations تبع الـ Underlying Disease، يعني هو
+
+123
+00:09:15,980 --> 00:09:19,520
+أصلا إيش ماله؟ هو أصلا CUVD Patient؟ Okay، هيكون
+
+124
+00:09:19,520 --> 00:09:25,140
+عنده كل العلمات تبع الـCUVD Patient بالإضافة إلى
+
+125
+00:09:25,140 --> 00:09:29,260
+إنه صار عنده enlargement في الـاللي هو الـ right
+
+126
+00:09:29,260 --> 00:09:32,540
+ventricle يعني لو روحنا عملنا ايكوكارديوغرام
+
+127
+00:09:32,540 --> 00:09:37,480
+للpatient هذا هلاقي انه ال right ventricle عنده
+
+128
+00:09:37,480 --> 00:09:43,640
+متضخم طبعا هذا هيخلي كمية الدم اللي بترجع للقلب
+
+129
+00:09:43,640 --> 00:09:50,180
+عبر ال right atriumيعني برضه التانية كتير هتكون
+
+130
+00:09:50,180 --> 00:09:53,420
+يعني بيجي دم بقى الـ Adventric لسه مش هنفضّي اللي
+
+131
+00:09:53,420 --> 00:09:57,000
+عنده، تمام؟ فعشان هيك نبيز هذا دايماً هيكون عنده
+
+132
+00:09:57,000 --> 00:10:00,460
+neck vein distended طيب و تحت هذا بالنسبالي فوق
+
+133
+00:10:00,460 --> 00:10:03,300
+الـneck vein هتكون distended طب من تحت هيكون فيه
+
+134
+00:10:03,300 --> 00:10:07,780
+عنده lower limb قديمة، إذا من أهم العلمات أنه
+
+135
+00:10:07,780 --> 00:10:10,280
+هلاقي قديمة في الـfit و الـlazy يعني lower limb
+
+136
+00:10:10,280 --> 00:10:15,380
+قديمة و فوق هلاقي distinction في الـneck vein
+
+137
+00:10:16,610 --> 00:10:18,970
+نكفينز يعني الـ jugular veins حيث يكون فيهم
+
+138
+00:10:18,970 --> 00:10:23,490
+distinction يعني معبين دم لإنه مش بيسهل عمال الدم
+
+139
+00:10:23,490 --> 00:10:28,310
+يروح ينزل على القلب عبر ال right atrium وبعدين
+
+140
+00:10:28,310 --> 00:10:30,670
+يروح على ال right ventricle لإن ال right ventricle
+
+141
+00:10:30,670 --> 00:10:35,380
+شبعان ومعمال محتقانمش عارف هو دي الدم اللي عنده
+
+142
+00:10:35,380 --> 00:10:39,580
+لأنه الرئتين مابيستقبلوش منه وبالتالي شويه شويه
+
+143
+00:10:39,580 --> 00:10:44,620
+هصير ال blood يرشح الدم يرشح من الرئتين ويعمل
+
+144
+00:10:44,620 --> 00:10:49,100
+plural effusion وطبعا ممكن المريض يكون في
+
+145
+00:10:49,100 --> 00:10:53,280
+endocarditis وكمان يكون ال heart يصير يعمل heart
+
+146
+00:10:53,280 --> 00:10:58,020
+murmur كمان يا جماعة ال liver هيكون بدأ حجمه يكبر
+
+147
+00:10:58,020 --> 00:11:05,740
+لإنه بيحتقن في السواق العبرالـ Portal Vein أيضًا
+
+148
+00:11:05,740 --> 00:11:11,500
+فبيصير برضه الـ enlargement في الـ liver ال
+
+149
+00:11:11,500 --> 00:11:15,300
+medical management للناس هدولة عشان انحسن وضع
+
+150
+00:11:15,300 --> 00:11:19,920
+المريض هذا أولا يا جماعة بيتمت بالشكل الأساسي على
+
+151
+00:11:19,920 --> 00:11:24,770
+أنه أنتتراقب وتقالج الحالة المرضية تبع الـ Lung هو
+
+152
+00:11:24,770 --> 00:11:28,470
+من أيش صار عنده Corpulmonal من الـ COD ولا من الـ
+
+153
+00:11:28,470 --> 00:11:33,430
+Lung Fibrosis تحاول تحسن الحالة تبعته المرضية عشان
+
+154
+00:11:33,430 --> 00:11:38,330
+ما تزيدش عنده الـ Corpulmonal والـ enlargement في
+
+155
+00:11:38,330 --> 00:11:44,850
+الـ right ventricle أحسن حاجة أن نخلّي المريض هذا
+
+156
+00:11:45,170 --> 00:11:50,310
+وضعه يتأقلم ومايزيدش سوء إنه نديه Oxygen
+
+157
+00:11:50,310 --> 00:11:56,870
+Supplement قداش لـ 24 ساعة من 16 لـ 24 ساعة في
+
+158
+00:11:56,870 --> 00:12:00,730
+اليوم وهل يظل 16 ساعة لـ Oxygen في اليوم؟ آه
+
+159
+00:12:00,730 --> 00:12:04,670
+الأبحاث بتثبت إنه كل ما يضار المريض على Continuous
+
+160
+00:12:04,670 --> 00:12:12,690
+Oxygen كل ما الـ Hypoxemiaبتقل بجسمه لأن هو هيندو
+
+161
+00:12:12,690 --> 00:12:16,570
+مشكلة بيعتبر مش شغاليني كويس وكل ما أنا أديته
+
+162
+00:12:16,570 --> 00:12:20,830
+Oxygen على low rate طبعا بس continuous أنا بالتالي
+
+163
+00:12:20,830 --> 00:12:24,690
+هحسم الـ Pulmonary function و أقل ال reduction in
+
+164
+00:12:24,690 --> 00:12:29,830
+pulmonary vascular resistance وهذا هيخل المريض ال
+
+165
+00:12:29,830 --> 00:12:33,850
+right ventricle عنده مايضالوش استجهيد و يتضخم
+
+166
+00:12:33,850 --> 00:12:38,170
+وبالتالي أملي rights are decided heart failure
+
+167
+00:12:38,170 --> 00:12:46,850
+تمام؟عشان هيك ال oxygen هو يعني حجر زاوية مهم جدا
+
+168
+00:12:46,850 --> 00:12:52,970
+في إلاج المرضى اللي عندهم core pulmonal طبعا زي ما
+
+169
+00:12:52,970 --> 00:12:56,510
+حكيت أصلا هم بيكونوا CUD patient فبيدوروا طبعا كنت
+
+170
+00:12:56,510 --> 00:12:59,870
+بيدوا يد مريض يعني 24 ساعة كنتون يواصلون oxygen
+
+171
+00:12:59,870 --> 00:13:05,010
+طبعا زمان كان الموضوع جدا مرهق كان بحتاجه إجرار
+
+172
+00:13:05,010 --> 00:13:09,270
+oxygen ويظل المريض متصل عليها ويبدر جره بره جره
+
+173
+00:13:10,150 --> 00:13:15,110
+أسهل في جهاز صغير اسمه Oxygen Regenerator إن شاء
+
+174
+00:13:15,110 --> 00:13:19,630
+الله المرة الجاية بحاول أحطلكوا صورته أو لو كتبتوا
+
+175
+00:13:19,630 --> 00:13:24,890
+على جوجل Oxygen Regenerator هتشوفوا جهاز صغير بس
+
+176
+00:13:24,890 --> 00:13:32,250
+تشبكه في الكهربا وإله humidifier وإنت بتحط أكام
+
+177
+00:13:32,250 --> 00:13:35,980
+لتر بار minute بدك مثلاًتلاتة لتر بيرمينت بيصير هو
+
+178
+00:13:35,980 --> 00:13:38,960
+يولدها بأكسجين من الهواء الجو اللي حواليه يشفط
+
+179
+00:13:38,960 --> 00:13:45,480
+ويؤدي أكسجين بتركيب حسب كام لتر بيرمينت بدك خمسة
+
+180
+00:13:45,480 --> 00:13:49,800
+لتر بيرمينت، ستة لتر بيرمينت، تمام؟ وإله باربيش
+
+181
+00:13:49,800 --> 00:13:54,560
+اللي هو nasal cannula أو nasal catheter والـ tube
+
+182
+00:13:54,560 --> 00:13:59,180
+هذا عادة يا جماعة بيكون طويل كتير، بحيث أنه، يعني
+
+183
+00:13:59,180 --> 00:14:03,310
+بالأمطارأو تلاتين متر أو أربعين متر، بس إنه خلّي
+
+184
+00:14:03,310 --> 00:14:09,050
+الإنسان اللي بيحتاج هذاالـ Management يقدر يمارس
+
+185
+00:14:09,050 --> 00:14:12,430
+مهام الوظيفة سواء لو كان في مكتبه أو سواء لو كانت
+
+186
+00:14:12,430 --> 00:14:15,270
+سته بدأت تشتغل في دارها بس تبقى طول الوقت و هي
+
+187
+00:14:15,270 --> 00:14:19,890
+حاطة الـ Oxygen لأنهم لاقوا إنه الـ Oxygen الـ
+
+188
+00:14:19,890 --> 00:14:24,650
+Continuous هذا بيقلل من الـ Hypoxemia و بيقلل من
+
+189
+00:14:24,650 --> 00:14:29,310
+أو بيمنع سوء حالة الـ ال patients اللي عندهم كرب
+
+190
+00:14:29,310 --> 00:14:34,270
+المنال وبالتالي هيقلل الفرصة لزيادة الـEnlargement
+
+191
+00:14:34,270 --> 00:14:39,510
+في الـRight، Ventricle، تمام؟ الموضوع اللي بعد هيك
+
+192
+00:14:39,510 --> 00:14:42,870
+اللي هنحكي فيه يا جماعة هو الـ Pulmonary Embolism
+
+193
+00:14:42,870 --> 00:14:48,650
+أتمنى تكونوا فهمته الموضوع الأولاني الـ Pulmonary
+
+194
+00:14:49,650 --> 00:14:56,170
+الـ Hembolism هو موضوع أيضًا من الحاجات المهمة
+
+195
+00:14:56,170 --> 00:15:00,690
+جدًا لازم نعرفها والتي مرتبطة بأمراض الرئتين السبب
+
+196
+00:15:00,690 --> 00:15:05,630
+الرئيسي في معظم الـ Pulmonary Hembolisms اللي
+
+197
+00:15:05,630 --> 00:15:10,410
+بتسير أنه يمكن يكون فيه Deep Vein Thrombosis يعني
+
+198
+00:15:10,410 --> 00:15:16,730
+في جلطة في أحد الشرايين، عفوا، أحد الـ Veins،
+
+199
+00:15:16,730 --> 00:15:22,620
+الـماذا يسمونها؟الأوري دا العميقة
+
+200
+00:15:22,620 --> 00:15:27,280
+الـ «central» يعني تمام؟ وللواحد من ال «veins» دول
+
+201
+00:15:27,280 --> 00:15:31,020
+صار فيه إيش؟ جلطة «Thrombus» طبعا الـ «Thrombus»
+
+202
+00:15:31,020 --> 00:15:35,720
+هذه could be blood formation تتكون طبعا ممكن تكون
+
+203
+00:15:35,720 --> 00:15:39,960
+فات يا جماعة لو كان المريض عامل مثلا
+
+204
+00:15:42,900 --> 00:15:46,880
+يعني orthopedic surgery واحد كان عنده long bone
+
+205
+00:15:46,880 --> 00:15:50,040
+fracture وانكسرات، هذا عادة ما يكون فيه جوا ال
+
+206
+00:15:50,040 --> 00:15:55,820
+bone، احنا عارفين انه بيكون فيه endoالـ Pomaro هدا
+
+207
+00:15:55,820 --> 00:16:00,300
+عبارة عن إيش؟ عبارة عن دهون، تمام؟ فممكن هنا
+
+208
+00:16:00,300 --> 00:16:05,360
+يطلعوا تعملوا Embolism علشان هيك الـThrombus هاي
+
+209
+00:16:05,360 --> 00:16:12,060
+لو طلعت ومشت في الـ في الـ bloodstream، مشت في أحد
+
+210
+00:16:12,060 --> 00:16:17,960
+الـ ال veins، بالتالي هتروح علىتستقر أنها ترجع على
+
+211
+00:16:17,960 --> 00:16:20,060
+الـRight Atrium ومن الـRight Atrium هترجع على
+
+212
+00:16:20,060 --> 00:16:22,200
+الـRight Ventricle ومن الـRight Ventricle هتنطلق
+
+213
+00:16:22,200 --> 00:16:26,280
+عبر البلمونري آرتري عالمي على الـLung ممكن يا
+
+214
+00:16:26,280 --> 00:16:31,900
+جماعة أن أحد ال branches من البلمونري آرتريز هذه
+
+215
+00:16:31,900 --> 00:16:38,200
+تروح واصلاها و تروح مش سكرةالـBlood supply اللي
+
+216
+00:16:38,200 --> 00:16:42,280
+بيجي للرقم من المنطقة هذه وبالتالي تعمل فيها
+
+217
+00:16:42,280 --> 00:16:48,040
+بلمونري Infarction بلمونري Infarction Most
+
+218
+00:16:48,040 --> 00:16:50,980
+commonly بلمونري Inflammation is due to blood clot
+
+219
+00:16:50,980 --> 00:16:54,280
+أو ترمبس زي ما حكينا اللي ممكن تكون الترمبس هذي
+
+220
+00:16:54,280 --> 00:16:58,920
+air أو fat أو energy confluent حتى لو كانت ست حامل
+
+221
+00:16:58,920 --> 00:17:05,630
+أو حاجة أو septicيعني ممكن تكون bacterial thrombus
+
+222
+00:17:05,630 --> 00:17:11,350
+في حالات السبتك والناس اللي يعني عندهم سبتسيميا أو
+
+223
+00:17:11,350 --> 00:17:15,730
+other causes of السبتك زي البيرمصارفي عنده sepsis
+
+224
+00:17:15,730 --> 00:17:22,910
+ممكن يصير عنده thrombus من من
+
+225
+00:17:22,910 --> 00:17:29,120
+اللي هو infected thrombusالناس هدول هيصير في عندهم
+
+226
+00:17:29,120 --> 00:17:34,100
+empowerment كتير في الـ «لنغ» لأنه وفي شغل الـ
+
+227
+00:17:34,100 --> 00:17:37,160
+«لنغ» وفي الـ «function» تباعتها لأن مافي جزء أصبح
+
+228
+00:17:37,160 --> 00:17:40,920
+من الـ «لنغ» كبير مابيعملش «gas exchange» و
+
+229
+00:17:40,920 --> 00:17:51,060
+«infarct» تمام؟ علشان هيك الـ الـ الـ الـ الـ الـ
+
+230
+00:17:51,060 --> 00:17:55,180
+البلبوناري symbolismممكن كثير حاجات أمراض أخرى
+
+231
+00:17:55,180 --> 00:17:59,020
+تتأدي إليها مش بس الـDVT إنه يكون مثلا عنده المريض
+
+232
+00:17:59,020 --> 00:18:03,600
+Atrial Fibrillation إيش يعني؟ يعني هو عنده أصلا
+
+233
+00:18:03,600 --> 00:18:09,200
+ارتجاف وذيني في اللي هو عضلة القلب هذا يا جماعة
+
+234
+00:18:09,200 --> 00:18:14,600
+بيهيئي الفرصة أصلا لتكوين إيش؟الـ Thrombus في الـ
+
+235
+00:18:14,600 --> 00:18:18,340
+Atriums وبالتالي هتنزل الـ Thrombus من الـ Atrial
+
+236
+00:18:18,340 --> 00:18:22,400
+Chamber على الـ Ventricle بالذات اللي هو الـ Right
+
+237
+00:18:22,400 --> 00:18:26,600
+Ventricle وبالتالي ممكن تنتقل لأماكن أخرى كمان من
+
+238
+00:18:26,600 --> 00:18:33,420
+الحاجات اللي معروفة أنها بتساعد في تكوين الـ
+
+239
+00:18:33,420 --> 00:18:40,280
+Thrombus Formation يا جماعة اللي هو الراحة
+
+240
+00:18:40,770 --> 00:18:45,490
+الكتيرة يعني المرضى سواء كان بالـ Dreadin أو هو
+
+241
+00:18:45,490 --> 00:18:49,930
+أصلا الـ Sedentary lifestyle مستوى يعني أو طريقة
+
+242
+00:18:49,930 --> 00:18:53,030
+حياته مابتحركش فيها كتير دايما قاعد، دايما بشتغل
+
+243
+00:18:53,030 --> 00:18:57,410
+على مكتب، دايما بسافر كتير، الناس اللي بيسافروا
+
+244
+00:18:57,410 --> 00:19:02,150
+كتير ومسافات طويلة سواء باص أو سيارة أو في الطيارة
+
+245
+00:19:02,150 --> 00:19:06,490
+لمسافات طويلة عادة يا جماعة ترسك نفسي لعندهم إيش
+
+246
+00:19:06,840 --> 00:19:11,380
+DVT و لا ترسك اللي يصير عنده DVT بعدها كإيش
+
+247
+00:19:11,380 --> 00:19:15,000
+المرحلة التالية ممكن تكون إنه يخش بلمونة رقم بلازم
+
+248
+00:19:15,000 --> 00:19:19,280
+أو إنه يخش كمان في قمقايا يا جماعة تمام ما يكوارد
+
+249
+00:19:19,280 --> 00:19:22,700
+ال infarction لإن كل الحاجات اللي حكيتها هذه سواء
+
+250
+00:19:22,700 --> 00:19:27,260
+إنه بدردني كتير أو إنه سافر مسافات طويلة أو إنه
+
+251
+00:19:27,260 --> 00:19:33,360
+مابتحركش كتير نتيجة شغله إنه بيضلوا في مكتبخياط
+
+252
+00:19:33,360 --> 00:19:37,920
+مثلًا، هذا كل الحاجات بتؤدي إلى إنه يصيب فيه
+
+253
+00:19:37,920 --> 00:19:41,060
+إمكانية لـThrombus Formation في الجسم بقى إن ما
+
+254
+00:19:41,060 --> 00:19:43,740
+بيصيب Thrombus Formation ماحدش هيعرف وين
+
+255
+00:19:43,740 --> 00:19:48,060
+الـThrombus هذه هتمشي وتستقر إذا مشيت في Arteries
+
+256
+00:19:48,060 --> 00:19:52,020
+هتأمن إنه ممكن تستقر في الـCoronary Arteries وتأمن
+
+257
+00:19:52,020 --> 00:19:56,480
+إنه Myocardial Infarction وإذا مشيت في الـVeins
+
+258
+00:19:56,480 --> 00:20:00,190
+ممكن تستقر فيالـ right ventricle ومن الـ right
+
+259
+00:20:00,190 --> 00:20:05,030
+ventricle الـ pulmonary arteries وتستقر في أحد الـ
+
+260
+00:20:05,030 --> 00:20:07,710
+lungs في branches من الـ pulmonary arteries وتعمل
+
+261
+00:20:07,710 --> 00:20:11,710
+pulmonary infarction عشان هيك ال clinical
+
+262
+00:20:11,710 --> 00:20:18,310
+manifestation لمريد عنده pulmonary أو pulmonary
+
+263
+00:20:18,310 --> 00:20:21,790
+embolism صحيح أنه هيكون المريض صار dyslexic لأنه
+
+264
+00:20:21,790 --> 00:20:27,490
+في جزء من الـ lung حكينا infarcted ما بشتغلشأو ما
+
+265
+00:20:27,490 --> 00:20:31,510
+بيقومش بوظيفته اللي هي الـ Gas Exchange وكمان هكون
+
+266
+00:20:31,510 --> 00:20:35,410
+فيه عنده severe chest pain يا جماعة زي كأنه .. زي
+
+267
+00:20:35,410 --> 00:20:38,630
+كأنه إيش؟ عنده myocardial infarction يعني حيجي
+
+268
+00:20:38,630 --> 00:20:41,810
+المريض إيش في صدره؟ آه واجع في صدري، chest pain
+
+269
+00:20:41,810 --> 00:20:47,630
+وكمان، بس حاجة كويسة تانية إنه عادة بيكون ال .. أو
+
+270
+00:20:47,630 --> 00:20:51,670
+يعني ممكن يكون، مش عادة ممكن يكون إن الـpain تبقى
+
+271
+00:20:51,670 --> 00:20:57,480
+المريضة ده غير عن الـMIماذا يعني الفرق بينهم؟ إنهم
+
+272
+00:20:57,480 --> 00:21:00,920
+ممكن يكونوا مصاحب للنفس، لماذا؟ لأنه ممكن يكون في
+
+273
+00:21:00,920 --> 00:21:05,540
+عنده pleurisy كمان أو يصير عنده pleurisy اللي هو
+
+274
+00:21:05,540 --> 00:21:09,560
+من الـinfarction اللي صار في منطقة معينة يصير
+
+275
+00:21:09,560 --> 00:21:13,500
+pleuritis زي ما حكينا في الـpleurisy
+
+276
+00:21:17,170 --> 00:21:22,310
+المريض زي ما حكينا ممكن ييجي بألمات زي «myocardial
+
+277
+00:21:22,310 --> 00:21:25,790
+infarction» من ناحية الـ «chest pain» هييجي عنده
+
+278
+00:21:25,790 --> 00:21:29,770
+«severe hypoxia» واضح جدا إنه «hypoxic» الـ
+
+279
+00:21:29,770 --> 00:21:34,120
+«saturation» تبعه «low» المريض هييجي بتاعتهالمريض
+
+280
+00:21:34,120 --> 00:21:36,440
+حيجي الـ Fever لأنه في منطقة كبيرة صار لها «اند
+
+281
+00:21:36,440 --> 00:21:39,200
+باركن» بعد شوية حصير اندو fever حيجي ال «كاف
+
+282
+00:21:39,200 --> 00:21:42,680
+ديافوريسيز» إجهاد لإنه الـ «ديافوريسيز» بسبب إنه
+
+283
+00:21:42,680 --> 00:21:47,040
+مجهد في عملية التنفس و بالنسبة له عملية صعبة مجهدة
+
+284
+00:21:47,040 --> 00:21:50,660
+حيجي شوية شوية أصير «اندو كاف» علامة كتير كتير
+
+285
+00:21:50,660 --> 00:21:55,620
+مهمة يا جماعة في موضوع الـ Pulmonary Implosion إنه
+
+286
+00:21:55,620 --> 00:22:02,350
+ممكن تلاقي شوية skin«Rash» أو «Petechia rash»
+
+287
+00:22:02,350 --> 00:22:05,650
+بالذات يعني بتعرف الـ «Petechia rash» يعني إنه
+
+288
+00:22:05,650 --> 00:22:10,970
+بيكون عبارة عن نقط يعني
+
+289
+00:22:10,970 --> 00:22:15,790
+إيش بده .. يعني النقط هذه بتعرفوا إيش تعريف الـ
+
+290
+00:22:15,790 --> 00:22:19,030
+«Petechia rash» يعني هي عبارة عن انفجار في الـ
+
+291
+00:22:19,030 --> 00:22:23,070
+«Capillaries» فبطلع إيش؟ شوية دم وبتعلم تقت الـ
+
+292
+00:22:23,070 --> 00:22:26,070
+«Skin» بس وين هي دي عادة بنلاقيها؟ في منطقة الـ
+
+293
+00:22:26,070 --> 00:22:29,080
+«Neck»لو جيتك طلعت على المنطقة الـ neck و الـ
+
+294
+00:22:29,080 --> 00:22:32,720
+shoulder تبقى المريض تلاحظ كده الـ neck و ال
+
+295
+00:22:32,720 --> 00:22:41,150
+shoulder ممكن تلاقيمقاط بتيش ياراش هذا من العلامات
+
+296
+00:22:41,150 --> 00:22:44,730
+اللي خلّت خلّيك تعرف إن هذا could be pulmonary
+
+297
+00:22:44,730 --> 00:22:47,650
+embolism كمان ممكن نلاقي زي الـ Petit Charrache
+
+298
+00:22:47,650 --> 00:22:50,570
+هذه يا جماعة في الـ Sclera في الـ Sclera لو شوفنا
+
+299
+00:22:50,570 --> 00:22:54,150
+بياض الأين تبع المريض هذا ممكن نشوف هذه الحاجة
+
+300
+00:22:54,150 --> 00:23:01,090
+علشان هيك هذه تعتبرمن أهم العلامات إلى جانب
+
+301
+00:23:01,090 --> 00:23:04,610
+العلامات اللي حكينا عنهم إن الpatient بيجي dysnet،
+
+302
+00:23:04,610 --> 00:23:09,750
+بيجي anxiety، distress، بيجي diaphoresis، بيجي
+
+303
+00:23:09,750 --> 00:23:14,470
+endoskeletal pain وباقي
+
+304
+00:23:14,470 --> 00:23:20,080
+الحاجات اللي حكيناعنها طبعاً من وسائل التشخيص غير
+
+305
+00:23:20,080 --> 00:23:23,160
+إنه نعمل علامة X-Ray العادية أو غير إنه الـ
+
+306
+00:23:23,160 --> 00:23:26,700
+Physical Examination ونحترم الشكوه تبعته ونشوف إن
+
+307
+00:23:26,700 --> 00:23:31,750
+علاماته تبعته هذه could be pulmonary embolismالـ
+
+308
+00:23:31,750 --> 00:23:36,690
+ECG could be useful في الحالات هادية يا جماعة خاصة
+
+309
+00:23:36,690 --> 00:23:40,050
+إنه المريض بيجي بالـ Sinus Tachycardia يعني heart
+
+310
+00:23:40,050 --> 00:23:45,390
+rate عالي بس منتظم لأن الموضوع مش خلل في القلب،
+
+311
+00:23:45,390 --> 00:23:49,190
+Sinus الـ VR Interval تبعته بتكون Depression،
+
+312
+00:23:49,190 --> 00:23:54,270
+لاحظوا الـ VR Interval، Depression مش هحكيكوا كتير
+
+313
+00:23:54,270 --> 00:23:58,660
+في الـ ECG عشان لسه أنتوا مافكتوش موضوعالـ Heart
+
+314
+00:23:58,660 --> 00:24:02,580
+إن شاء الله يعني مستقبلاً بيسيط أنتموا عارفين أكتر
+
+315
+00:24:02,580 --> 00:24:07,040
+في موضوع الـ Heart أو لما نشرح الـ ECG بيكون
+
+316
+00:24:07,040 --> 00:24:13,340
+الموضوع أسهل وممكن نرجع نحكي عن العلمات اللي بتكون
+
+317
+00:24:13,340 --> 00:24:17,420
+في الـMI وفي الـ Pulmonary Embolism وكل نوع من
+
+318
+00:24:17,420 --> 00:24:23,010
+الأمراضالـ ECG من الحاجات المهمة كثير اللي بتلزمنا
+
+319
+00:24:23,010 --> 00:24:25,630
+نعملها نعمل للمريض Artillery Blood Gases أحد الـ
+
+320
+00:24:25,630 --> 00:24:28,630
+Diagnostic Procedures اللي ممكن نعملها الـ
+
+321
+00:24:28,630 --> 00:24:31,250
+Artillery Blood Gases هتوضحلي يا جماعة حاجة مهمة
+
+322
+00:24:31,250 --> 00:24:36,350
+جدا أن المريض هيكون عندهhypoxemia هي أهم علامة
+
+323
+00:24:36,350 --> 00:24:39,250
+مميزة زي ما احنا فاكرين في الـARDS بنحكي إن
+
+324
+00:24:39,250 --> 00:24:42,170
+الـhypoxemia يعني الـPO2 الـpartial pressure
+
+325
+00:24:42,170 --> 00:24:49,810
+للأكسجين أقل من 60 طبعاً ممكن الـCO2 حسب وضع
+
+326
+00:24:49,810 --> 00:24:53,170
+العيانة إذا العيانة جاي بتاكدني أكيد هلاقي hypo
+
+327
+00:24:53,170 --> 00:24:57,230
+-cabemia لإنه في washing outللـ «CO2» لكن إذا
+
+328
+00:24:57,230 --> 00:25:01,130
+العيان بدأ يتعب ويصير «hypoventilation» هيبدأ يصير
+
+329
+00:25:01,130 --> 00:25:04,590
+فيه attention للـ «CO2» في الأول عادة بيجي المريض
+
+330
+00:25:04,590 --> 00:25:07,570
+بـ «hypokamia» لأنه بيجي بالنسبة لـ «calorie rate»
+
+331
+00:25:07,570 --> 00:25:13,010
+عالي وتكبنية okay بالنسبة للحاجات المهمة أيضا ل
+
+332
+00:25:13,010 --> 00:25:17,170
+«as a diagnosis» أنه نعمل للمريض هذا «pulmonary
+
+333
+00:25:17,170 --> 00:25:21,470
+angiography» علشان نشوف بالظبط وين المنطقة في ال
+
+334
+00:25:21,470 --> 00:25:27,240
+«lung» اللي مشيعني ما بيوصلهاش دم عشان هيك
+
+335
+00:25:27,240 --> 00:25:31,100
+الـangiography يعني بيعدوا صبغة و بيصوروا فبالتالي
+
+336
+00:25:31,100 --> 00:25:33,460
+بيقرأوا ما بيوصلوا صبغة في البلاد فبالتالي بيقرأوا
+
+337
+00:25:33,460 --> 00:25:35,840
+في الـLang بالظبط وين المنطقة اللي ما بيوصلهاش دم
+
+338
+00:25:35,840 --> 00:25:42,040
+وInfarcted area الـCT أيضًا هي يعني could be could
+
+339
+00:25:42,040 --> 00:25:46,920
+be so helpful إنها تحدد ليه المنطقة طبعًا الـCT أو
+
+340
+00:25:46,920 --> 00:25:50,620
+Magnetic Resonance Image MRI عشان يتحدد ليه وين
+
+341
+00:25:50,620 --> 00:25:55,350
+المنطقة بالظبط الريعتين اللي فيهاالـ Damage or
+
+342
+00:25:55,350 --> 00:26:00,150
+Impartial الـ Medical Management للـ Pulmonary
+
+343
+00:26:00,150 --> 00:26:07,350
+Endolism يا جماعةبنقل أولا التعامل معاه بشكل
+
+344
+00:26:07,350 --> 00:26:12,250
+emergency أول ما بيجي على الطوارئ وبكون الوضع تبقى
+
+345
+00:26:12,250 --> 00:26:16,110
+critical أكيد أنه احنا بدنا نحطه في bed rest ما
+
+346
+00:26:16,110 --> 00:26:22,830
+تحاولش تنايم العيان يعني spine على الآخر لأنه نفسه
+
+347
+00:26:22,830 --> 00:26:26,550
+تبقى تعبان فخلّيه in a fowler position حاول تديله
+
+348
+00:26:26,550 --> 00:26:33,530
+exogen علشان يتحسنمن الـ Hypoxemia اللي عنده الـ
+
+349
+00:26:33,530 --> 00:26:39,070
+Low Saturation طبعا بعد هيكة هتتم يعني أسحب
+
+350
+00:26:39,070 --> 00:26:43,490
+التحليل وعمل إجراءات تشخصية لبنما يعرف إيش الوضع
+
+351
+00:26:43,490 --> 00:26:46,090
+اللي عند المريض بالظبط ومجرد ما يتحدد إن هذا
+
+352
+00:26:46,090 --> 00:26:50,550
+المريض هو بالمونري أمبوليزم هيبدو يا جماعة يفكروا
+
+353
+00:26:50,550 --> 00:26:56,330
+بإنهم يدوا أدوية مذيبة للجلطة يعني بيسموها
+
+354
+00:26:56,330 --> 00:27:02,560
+ThrombolyticTherapy وكمان أدوية Anticoagulant طب
+
+355
+00:27:02,560 --> 00:27:05,840
+إيش وظيفة الـ Anticoagulant اللي بتمنع التجلطات؟
+
+356
+00:27:05,840 --> 00:27:10,400
+ما هو صار عنده جلطة وخلص؟ آه الوظيفة هان إنه نمنع
+
+357
+00:27:10,400 --> 00:27:15,280
+الـ Farter accumulationأو Farther Formation
+
+358
+00:27:15,280 --> 00:27:18,100
+لـLithrombus يعني ما نخلّيش Lithrombus تكبر في
+
+359
+00:27:18,100 --> 00:27:22,740
+حجمها كمان وكمان لأنه مجرد ما صارت هيكون هي يعني
+
+360
+00:27:22,740 --> 00:27:26,740
+في طريق مسدود و الـPlatelet هتبدأ تعمل فوقها
+
+361
+00:27:26,740 --> 00:27:29,620
+Aggregation و Aggregation و Aggregation وبدل ما
+
+362
+00:27:29,620 --> 00:27:33,440
+حجمها كذا يصير أكبر وأكبر وأكبر فبندل
+
+363
+00:27:33,440 --> 00:27:38,910
+Anticoagulation علشانوAnti-aggregant كمان من الـ
+
+364
+00:27:38,910 --> 00:27:42,490
+Anticoagulant المعروفين الـ Aspirin من الـ
+
+365
+00:27:42,490 --> 00:27:47,290
+Anticoagulant المعروفين الهيبارين والكليكسان تمام؟
+
+366
+00:27:47,290 --> 00:27:50,290
+والـ Thermopolitic Therapy عادي أبدأ أدي أدري
+
+367
+00:27:50,290 --> 00:27:56,510
+علشان إيش تسوي علشان تبدأ تحلل الجلطة هذه و تدوبها
+
+368
+00:27:56,510 --> 00:28:01,870
+و ترجع المنطقة يصير لها Perfusion طبعاً من الطرق
+
+369
+00:28:01,870 --> 00:28:09,140
+كمان يا جماعة أنه ممكنيتدخّلوا بالقسطرة أو
+
+370
+00:28:09,140 --> 00:28:12,840
+interventional catheterization أو surgical
+
+371
+00:28:12,840 --> 00:28:17,200
+intervention يخشوا على الرأى أو يحاولوا أويينه
+
+372
+00:28:17,200 --> 00:28:20,660
+لـLimbolism إذا كانوا عارفين وين الـVessel هذا
+
+373
+00:28:20,660 --> 00:28:24,960
+ومحدد طبعاً
+
+374
+00:28:24,960 --> 00:28:27,900
+هنا أنا بلخص الـEmergency Management لما يجيك على
+
+375
+00:28:27,900 --> 00:28:32,680
+المريض كيف بدك تتعامل معاه كيف بدك تبدأ بالـبتحطه
+
+376
+00:28:32,680 --> 00:28:36,160
+في الـ Potassium تدل الـ Oxygen تركب IV Cannula
+
+377
+00:28:36,160 --> 00:28:40,360
+تبدأ تشخص
+
+378
+00:28:40,360 --> 00:28:44,990
+تاخد Blood Gases وتحاول أن تنسق لهاالـ CT
+
+379
+00:28:44,990 --> 00:28:47,890
+وAndrographي عشان تعرفوا إن المريض إذا كان عنده
+
+380
+00:28:47,890 --> 00:28:52,570
+Hypotension تديله supportive management زي
+
+381
+00:28:52,570 --> 00:28:59,950
+الدوبامين والدوبيوتامين علشان ترفع
+
+382
+00:28:59,950 --> 00:29:01,990
+الضغط وتحسن الـ
+
+383
+00:29:04,620 --> 00:29:08,160
+الـBlood Pressure اللي عنده طبعاً ممكن يحتاج
+
+384
+00:29:08,160 --> 00:29:13,800
+المريض لو صار عنده تطور لصار عنده Arrhythmia أو
+
+385
+00:29:13,800 --> 00:29:17,780
+صار فيه احتقان أو بدأ يخش بـHeart Failure نبدأ
+
+386
+00:29:17,780 --> 00:29:21,280
+ندّي Diuretics وندّي Anti-Arrhythmic Therapy كل
+
+387
+00:29:21,280 --> 00:29:25,600
+هذه الحاجات يعني الـPain السيفير اللي إجا عنده
+
+388
+00:29:25,600 --> 00:29:28,820
+بيكون بدنا نتعامل معاه وندّيله مورفين لو المريض
+
+389
+00:29:28,820 --> 00:29:32,740
+الـHypoxia تبعته زادت والتكيميا زادت كتير وخش في
+
+390
+00:29:32,740 --> 00:29:33,440
+Respiratory
+
+391
+00:29:36,400 --> 00:29:40,660
+أو ممكن في الأول يكون الـ Respiratory Alkalosis يا
+
+392
+00:29:40,660 --> 00:29:45,800
+جماعة لأنه يكون الكبنية كتير والـ CO2 واطي كتير
+
+393
+00:29:45,800 --> 00:29:49,740
+فممكن ندخل في الـ Respiratory Alkalosis ففي كل
+
+394
+00:29:49,740 --> 00:29:52,960
+الأحوال حيكون بحتاج Mechanical Ventilator
+
+395
+00:29:55,240 --> 00:30:00,220
+حكينا عن الـ Anticoagulation بشكل مفصل وحكينا عن
+
+396
+00:30:00,220 --> 00:30:04,840
+إيش هي الأدوية اللي كتير تستخدم سواء الـ Heparin
+
+397
+00:30:04,840 --> 00:30:08,560
+أو الكليكسان وحكينا عن الـ Thrombolytic Therapy
+
+398
+00:30:08,560 --> 00:30:12,600
+الأدوية اللي كتير بتستخدم و بالذات أن الـ
+
+399
+00:30:12,600 --> 00:30:16,100
+Thrombolytic Therapy دوة اسمها الـ Stryptokinase
+
+400
+00:30:16,100 --> 00:30:19,040
+الـ Stryptokinase هو مُركّب أصلاً من بكتيريا الـ
+
+401
+00:30:19,040 --> 00:30:21,240
+Strypto ومخدوها
+
+402
+00:30:23,120 --> 00:30:27,060
+وبيجهزوا منها مُركّب وظيفته إنه لما بيخش على الجسم
+
+403
+00:30:27,060 --> 00:30:32,280
+وبيعطوه بيروح بيدور على الـ «ترمبس» وبيبدأ يتفاعل
+
+404
+00:30:32,280 --> 00:30:36,860
+مع الـ «ترمبس» هذه ويحللها، يعملها destruction
+
+405
+00:30:36,860 --> 00:30:41,880
+وبالتالي المريض هذا اللي أنا لازم أو بدي أديره
+
+406
+00:30:41,880 --> 00:30:46,390
+«سريبتو كاينيز»فيه criteria معينة لازم يكون بتتطبق
+
+407
+00:30:46,390 --> 00:30:51,390
+على المريض يعني أنا بدأ أدى دوة بدوّب الجلطة أو
+
+408
+00:30:51,390 --> 00:30:56,090
+بحلل الجلطة اللي موجودة لكن لازم at least من
+
+409
+00:30:56,090 --> 00:30:59,610
+المريض هذا يعني لإن أنا بتوقع أن الدم يصير فيه
+
+410
+00:30:59,610 --> 00:31:03,090
+سيولة فمش معقول يكون مريض مثلا عامل عملية recently
+
+411
+00:31:03,090 --> 00:31:07,970
+قبل 24 ساعة و 48 ساعة و أجي أديله thrombolytic
+
+412
+00:31:07,970 --> 00:31:13,750
+agent مش معقول مريضعنده مشاكل أصلاً زي الـ
+
+413
+00:31:13,750 --> 00:31:15,830
+Hemophilia في الـ Blood روح قدّي Electrophobic
+
+414
+00:31:15,830 --> 00:31:21,070
+Agent بتدور على حل أكتر أمن Electrophobic Therapy
+
+415
+00:31:21,070 --> 00:31:23,750
+ففيه criteria و Contraindication
+
+416
+00:31:26,190 --> 00:31:29,830
+معتبرة، must be considered في حالات الـ
+
+417
+00:31:29,830 --> 00:31:33,110
+Thrombolytic Therapy الـ Surgical Management برضه
+
+418
+00:31:33,110 --> 00:31:38,790
+حكينا عنه من شوية كيف ممكن سواء كان عن طريق إنهم
+
+419
+00:31:38,790 --> 00:31:43,030
+يعملوا Surgery ويعينوا لـ Clot هادة أو حاليًا صار
+
+420
+00:31:43,030 --> 00:31:48,490
+في اللي هي الـ «Catheterization» زي ما حكينا
+
+421
+00:31:48,490 --> 00:31:52,240
+«Interventional Catheterization» زي ما بيخشوا فيفي
+
+422
+00:31:52,240 --> 00:31:56,440
+مرضى الـMI وبيعينه لـThrombus ممكن نقشه على
+
+423
+00:31:56,440 --> 00:32:00,960
+الـPulmonary Artery Branch اللي إذا كان محدد وقريب
+
+424
+00:32:00,960 --> 00:32:04,840
+ويحاول إنه يعين لـThrombus هذه الـNursing
+
+425
+00:32:04,840 --> 00:32:07,580
+Management تبعتنا هتكون في الموضوع تبع
+
+426
+00:32:07,580 --> 00:32:14,490
+الـPulmonary Embolismكثيرة، أهمها لو تم التعامل مع
+
+427
+00:32:14,490 --> 00:32:19,570
+المريض بأي من الأدوية وهو الآن منون في القسم إنه
+
+428
+00:32:19,570 --> 00:32:25,810
+أنا بدي أمنع الـ Thrombus Formation يعني إنها
+
+429
+00:32:25,810 --> 00:32:33,210
+تستمر وتزيد عن طريق إن المريض هذاسواء هو أو غيره،
+
+430
+00:32:33,210 --> 00:32:37,090
+لو حتى مريض ما كانش اندوبلموريومبوليزم، آه، لكن
+
+431
+00:32:37,090 --> 00:32:40,690
+ممكن يصير اندو عشان هو عامل عملية وهو بتدردن، إيش
+
+432
+00:32:40,690 --> 00:32:44,530
+اللي بيعمل ال .. ال .. أو ممكن يطور الحالة؟ إنه
+
+433
+00:32:44,530 --> 00:32:48,130
+يخش الـDVT، لو بدردن ممكن يخش الـDVT، لو خش الـDVT
+
+434
+00:32:48,130 --> 00:32:51,850
+إيش ممكن يصير؟ ممكن يتطور لبلموريومبوليزم، إذا أنا
+
+435
+00:32:51,850 --> 00:32:57,940
+كان يارس وظيفتي أن أمنعالـ DVT إنها الـ Fear عشان
+
+436
+00:32:57,940 --> 00:33:02,520
+هي كان مهم إن المريض في السرير أخليه يحاول يعمل
+
+437
+00:33:02,520 --> 00:33:06,840
+Bombing Exercise كيف يعني؟ يعني يحرك في عضلات
+
+438
+00:33:06,840 --> 00:33:12,000
+رجليه ويدفعهم حتى لو ممنوع يمشي هو هو ممنوع يمشي
+
+439
+00:33:12,000 --> 00:33:16,660
+نتيجة إنه عامل مثلًا عنده Neck Femur Fractureمريض
+
+440
+00:33:16,660 --> 00:33:19,940
+تاني عامل recent abdominal surgery مش معناه انه
+
+441
+00:33:19,940 --> 00:33:23,580
+ممنوع يتحرك الاسرير كمان لو هو المفروض انه يظل في
+
+442
+00:33:23,580 --> 00:33:27,660
+الاسرير وفيه ما يمنع انه يتحرك اه بدنا نلبسه حاجة
+
+443
+00:33:27,660 --> 00:33:36,020
+اسمها اللي هو stocks اللي هو عبارة عن حاجة زي ال
+
+444
+00:33:37,640 --> 00:33:42,400
+الجوارب بتلخبص من القدم من أخمص القدم من تحت لأ
+
+445
+00:33:42,400 --> 00:33:50,120
+فوق اللي هم الـThigh بحيث أنها تسهل الـ «Venous
+
+446
+00:33:50,120 --> 00:33:54,280
+Return» و«Lymphatic Drainage» كله وخلّي يصير فيه
+
+447
+00:33:54,280 --> 00:33:58,080
+إمكانية أن يرجع بشكل أسهل طبعاً في ناس ممكن تستخدم
+
+448
+00:33:58,080 --> 00:34:01,880
+«Crip Bandage» بس بيحكي دايماً أنه عشان تستخدم
+
+449
+00:34:01,880 --> 00:34:06,140
+«Crip Bandage» فيه criteria معينةالأهم فيها أنك
+
+450
+00:34:06,140 --> 00:34:12,280
+لازم تبدأ من أول القدم مش من أول الساق و تسيب
+
+451
+00:34:12,280 --> 00:34:16,920
+القدم وبالتالي في منطقة بتكون محتقنة و هتلاقي بعد
+
+452
+00:34:16,920 --> 00:34:22,440
+شوية أن القدنين صار فيهم إدينةكويس، من الحاجات
+
+453
+00:34:22,440 --> 00:34:26,540
+كمان المهمة إذا ما أنت بتتعامل مع مريض post-op
+
+454
+00:34:26,540 --> 00:34:31,480
+عادة عشان نتفادى هذا الخطر إنه early
+
+455
+00:34:31,480 --> 00:34:37,540
+immobilization أخليه يتحرك بدري و أخليه يمشي بدري
+
+456
+00:34:37,540 --> 00:34:42,300
+كل ما أنا خليت المريض يمشي بدري كل ما أنا وماكانش
+
+457
+00:34:42,300 --> 00:34:46,240
+فيه مانع طبعا إنه يمشي كل ما أنا عند الخطر تبع إنه
+
+458
+00:34:46,240 --> 00:34:47,600
+يصير endothrombus
+
+459
+00:34:50,030 --> 00:34:55,370
+لو كنت تتعامل مع مريض بده يأخذ «Thrombolytic
+
+460
+00:34:55,370 --> 00:34:58,430
+Therapy» لازم يكون طول الوقت هذا المريض under your
+
+461
+00:34:58,430 --> 00:35:02,150
+monitor لأنه ممكن جدا يخش في hypertension لازم
+
+462
+00:35:02,150 --> 00:35:04,930
+يكون على monitor ويكون في dysrhythmia إذا كان
+
+463
+00:35:04,930 --> 00:35:09,610
+المريض عنده بين، انت كنيرز، بدك زي ما حكيناممكن
+
+464
+00:35:09,610 --> 00:35:13,270
+تدّي الـ Pre-Prescribed Pain Killers وكمان بدك
+
+465
+00:35:13,270 --> 00:35:15,510
+تخلي المريض في comfortable position لإن ال
+
+466
+00:35:15,510 --> 00:35:20,010
+position و ال oxygen ممكن يقلله القلم و كمان نعمل
+
+467
+00:35:20,010 --> 00:35:27,090
+للمريض اللي هو support المحاضرة
+
+468
+00:35:27,090 --> 00:35:32,120
+الجايأو هيك احنا بنكون خلصنا الـ Pulmonary
+
+469
+00:35:32,120 --> 00:35:38,200
+embolism علشان هيك هنتوقف عند الـ Pulmonary
+
+470
+00:35:38,200 --> 00:35:45,940
+embolism ونكمل
+
+471
+00:35:45,940 --> 00:35:47,680
+المحاضرة الجاي، أعطيكوا العافية
+
diff --git a/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/cy8gkI3Bil0_raw.json b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/cy8gkI3Bil0_raw.json
new file mode 100644
index 0000000000000000000000000000000000000000..e988e8198558880eb5e3f18ef9e96c3e713518dc
--- /dev/null
+++ b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/cy8gkI3Bil0_raw.json
@@ -0,0 +1 @@
+{"segments": [{"id": 1, "seek": 2278, "start": 2.7, "end": 22.78, "text": "بسم الله الرحمن الرحيم السلام عليكم ورحمة الله وبركاته اليوم إن شاء الله رب العالمين هنكمل محاضرتنا في اللي هو Respiratory Tract Disorders كنا حكينا مع بعض في المحاضرة السابقة عن الـ ARDS اللي هي الـ Acute Respiratory Distress Syndrome", "tokens": [3555, 38251, 21984, 34892, 5016, 27842, 34892, 5016, 32640, 21136, 37440, 25894, 24793, 4032, 2288, 35571, 3660, 21984, 4032, 26890, 4117, 9307, 3224, 45595, 20498, 36145, 13412, 16606, 21984, 12602, 3555, 18863, 45340, 9957, 8032, 1863, 24793, 1211, 3714, 5016, 46958, 43500, 8315, 8978, 13672, 1829, 31439, 5015, 9501, 4745, 1765, 578, 4208, 10400, 9122, 8315, 11331, 4117, 1829, 8315, 20449, 45030, 11242, 8978, 9673, 5016, 46958, 25720, 21136, 16758, 28671, 18871, 2423, 39184, 8943, 11844, 13672, 1829, 39896, 2423, 39184, 5097, 1169, 5015, 9501, 4745, 9840, 735, 44545], "avg_logprob": -0.1144097207321061, "compression_ratio": 1.6972477064220184, "no_speech_prob": 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هذا ممكن نشوف هذه الحاجة علشان هيك هذه تعتبر", "tokens": [2304, 4587, 41193, 39894, 1829, 8592, 7251, 9640, 33599, 23758, 9154, 18863, 37440, 9307, 13672, 1829, 16490, 1211, 11703, 2655, 16490, 1211, 11703, 1829, 4117, 37279, 28480, 36145, 23758, 727, 312, 8331, 46386, 4605, 401, 1434, 9122, 2304, 7649, 3714, 43020, 8717, 15040, 38436, 30767, 1829, 2423, 39184, 10472, 270, 761, 2284, 6000, 29538, 35186, 10874, 15042, 27884, 8978, 2423, 39184, 2747, 75, 1663, 8978, 2423, 39184, 2747, 75, 1663, 45164, 13412, 38688, 8315, 4724, 1829, 46958, 16247, 9957, 6055, 3555, 3615, 9673, 16572, 11242, 23758, 3714, 43020, 8717, 8592, 38688, 29538, 21542, 26108, 3660, 11203, 8592, 7649, 39896, 4117, 29538, 6055, 34268, 26890], "avg_logprob": -0.33869046937851677, "compression_ratio": 1.625, "no_speech_prob": 7.569789886474609e-06, "words": [{"start": 1355.11, "end": 1355.75, "word": "مقاط", "probability": 0.5346476236979166}, {"start": 1355.75, "end": 1356.19, "word": " بتيش", "probability": 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distress، بيجي diaphoresis، بيجي endoskeletal pain وباقي الحاجات اللي حكينا", "tokens": [27842, 5551, 16095, 18863, 37440, 9307, 30731, 10874, 7649, 3555, 18863, 37440, 9307, 13672, 1829, 11331, 4117, 1829, 8315, 18871, 16095, 36145, 2423, 29752, 4724, 1829, 7435, 1829, 15243, 7129, 12399, 4724, 1829, 7435, 1829, 9119, 12399, 24516, 12399, 4724, 1829, 7435, 1829, 1026, 13957, 2706, 271, 12399, 4724, 1829, 7435, 1829, 917, 329, 330, 2631, 304, 1822, 4032, 3555, 995, 38436, 21542, 26108, 9307, 13672, 1829, 11331, 4117, 1829, 8315], "avg_logprob": -0.2376302041941219, "compression_ratio": 1.608974358974359, "no_speech_prob": 5.960464477539063e-08, "words": [{"start": 1377.45, "end": 1377.91, "word": "من", "probability": 0.90283203125}, {"start": 1377.91, "end": 1378.83, "word": " أهم", "probability": 0.95654296875}, {"start": 1378.83, "end": 1380.23, "word": " العلامات", "probability": 0.8321940104166666}, {"start": 1380.23, "end": 1380.51, "word": " إلى", "probability": 0.9755859375}, {"start": 1380.51, "end": 1381.09, "word": " جانب", "probability": 0.9807942708333334}, {"start": 1381.09, "end": 1381.63, "word": " العلامات", "probability": 0.9619140625}, {"start": 1381.63, "end": 1381.73, "word": " اللي", "probability": 0.944580078125}, {"start": 1381.73, "end": 1382.27, "word": " حكينا", "probability": 0.990234375}, {"start": 1382.27, "end": 1383.03, "word": " عنهم", "probability": 0.8818359375}, {"start": 1383.03, "end": 1383.19, "word": " إن", "probability": 0.3291015625}, {"start": 1383.19, "end": 1383.53, "word": " الpatient", "probability": 0.791259765625}, {"start": 1383.53, "end": 1383.81, "word": " بيجي", "probability": 0.970947265625}, {"start": 1383.81, "end": 1384.61, "word": " dysnet،", "probability": 0.181182861328125}, {"start": 1384.61, "end": 1385.23, "word": " بيجي", "probability": 0.9439697265625}, {"start": 1385.23, "end": 1386.67, "word": " anxiety،", "probability": 0.734375}, {"start": 1386.67, "end": 1388.05, "word": " distress،", "probability": 0.87255859375}, {"start": 1388.05, "end": 1388.39, "word": " بيجي", "probability": 0.8804931640625}, {"start": 1388.39, "end": 1389.41, "word": " diaphoresis،", "probability": 0.761865234375}, {"start": 1389.41, "end": 1389.75, "word": " بيجي", "probability": 0.9793701171875}, {"start": 1389.75, "end": 1390.77, "word": " endoskeletal", "probability": 0.669384765625}, {"start": 1390.77, "end": 1391.39, "word": " pain", "probability": 0.7353515625}, {"start": 1391.39, "end": 1394.47, "word": " وباقي", "probability": 0.7611083984375}, {"start": 1394.47, "end": 1395.53, "word": " الحاجات", "probability": 0.9915364583333334}, {"start": 1395.53, "end": 1395.71, "word": " اللي", "probability": 0.990478515625}, {"start": 1395.71, "end": 1396.19, "word": " حكينا", "probability": 0.9912109375}], "temperature": 1.0}, {"id": 63, "seek": 141128, "start": 1396.5, "end": 1411.28, "text": "عنها طبعاً من وسائل التشخيص غير إنه نعمل علامة X-Ray العادية أو غير إنه الـ Physical Examination 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" وسائل", "probability": 0.98291015625}, {"start": 1399.2, "end": 1399.82, "word": " التشخيص", "probability": 0.88125}, {"start": 1399.82, "end": 1400.08, "word": " غير", "probability": 0.960693359375}, {"start": 1400.08, "end": 1400.36, "word": " إنه", "probability": 0.74755859375}, {"start": 1400.36, "end": 1400.58, "word": " نعمل", "probability": 0.9783528645833334}, {"start": 1400.58, "end": 1400.92, "word": " علامة", "probability": 0.5521647135416666}, {"start": 1400.92, "end": 1401.24, "word": " X", "probability": 0.72265625}, {"start": 1401.24, "end": 1401.42, "word": "-Ray", "probability": 0.72119140625}, {"start": 1401.42, "end": 1401.94, "word": " العادية", "probability": 0.9137369791666666}, {"start": 1401.94, "end": 1402.1, "word": " أو", "probability": 0.53515625}, {"start": 1402.1, "end": 1402.3, "word": " غير", "probability": 0.979248046875}, {"start": 1402.3, "end": 1402.68, "word": " إنه", "probability": 0.848876953125}, {"start": 1402.68, "end": 1403.16, "word": " الـ", "probability": 0.847412109375}, {"start": 1403.16, "end": 1403.56, "word": " Physical", "probability": 0.459716796875}, {"start": 1403.56, "end": 1404.26, "word": " Examination", "probability": 0.875}, {"start": 1404.26, "end": 1404.76, "word": " ونحترم", "probability": 0.92861328125}, {"start": 1404.76, "end": 1405.12, "word": " الشكوه", "probability": 0.8055419921875}, {"start": 1405.12, "end": 1405.56, "word": " تبعته", "probability": 0.8922119140625}, {"start": 1405.56, "end": 1405.98, "word": " ونشوف", "probability": 0.9512939453125}, {"start": 1405.98, "end": 1406.7, "word": " إن", "probability": 0.69775390625}, {"start": 1406.7, "end": 1407.36, "word": " علاماته", "probability": 0.83740234375}, {"start": 1407.36, "end": 1407.68, "word": " تبعته", "probability": 0.634063720703125}, {"start": 1407.68, "end": 1407.92, "word": " هذه", "probability": 0.492431640625}, {"start": 1407.92, "end": 1408.48, "word": " could", "probability": 0.6240234375}, {"start": 1408.48, "end": 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"end": 1458.22, "text": "الـ Heart إن شاء الله يعني مستقبلاً بيسيط أنتموا عارفين أكتر في موضوع الـ Heart أو لما نشرح الـ ECG بيكون الموضوع أسهل وممكن نرجع نحكي عن العلمات اللي بتكون في الـMI وفي الـ Pulmonary Embolism وكل نوع من الأمراض", "tokens": [6027, 39184, 13569, 36145, 13412, 16606, 21984, 37495, 22653, 3714, 14851, 4587, 3555, 15040, 14111, 4724, 1829, 3794, 1829, 9566, 14739, 39237, 14407, 6225, 9640, 5172, 9957, 5551, 4117, 2655, 2288, 8978, 3714, 2407, 11242, 45367, 2423, 39184, 13569, 34051, 5296, 15042, 8717, 46309, 5016, 2423, 39184, 19081, 38, 4724, 1829, 30544, 9673, 2407, 11242, 45367, 5551, 3794, 3224, 1211, 4032, 2304, 43020, 8717, 47341, 3615, 8717, 5016, 4117, 1829, 18871, 18863, 19528, 9307, 13672, 1829, 39894, 30544, 8978, 2423, 39184, 13808, 4032, 41185, 2423, 39184, 35568, 46386, 3968, 17460, 1434, 4032, 28820, 8717, 45367, 9154, 16247, 29973, 46958], "avg_logprob": -0.2645312386751175, "compression_ratio": 1.56, "no_speech_prob": 5.7220458984375e-06, "words": 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"text": "فيه criteria معينة لازم يكون بتتطبق على المريض يعني أنا بدأ أدى دوة بدوّب الجلطة أو بحلل الجلطة اللي موجودة لكن لازم at least من المريض هذا يعني لإن أنا بتوقع أن الدم يصير فيه سيولة فمش معقول يكون مريض مثلا عامل عملية recently قبل 24 ساعة و 48 ساعة و أجي أديله thrombolytic agent مش معقول مريض", "tokens": [41185, 3224, 11101, 20449, 9957, 3660, 5296, 31377, 2304, 7251, 30544, 39894, 2655, 9566, 3555, 4587, 15844, 9673, 16572, 11242, 37495, 22653, 41850, 47525, 10721, 5551, 3215, 7578, 11778, 2407, 3660, 47525, 2407, 11703, 3555, 25724, 1211, 9566, 3660, 34051, 4724, 5016, 1211, 1211, 25724, 1211, 9566, 3660, 13672, 1829, 3714, 29245, 23328, 3660, 44381, 5296, 31377, 2304, 412, 1935, 9154, 9673, 16572, 11242, 23758, 37495, 22653, 5296, 28814, 1863, 41850, 39894, 30543, 3615, 14739, 32748, 2304, 7251, 9381, 13546, 8978, 3224, 8608, 1829, 12610, 3660, 6156, 2304, 8592, 20449, 39648, 7251, 30544, 3714, 16572, 11242, 50113, 15040, 6225, 10943, 1211, 6225, 42213, 10632, 3938, 12174, 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4724, 9957, 12399, 16472, 2655, 9122, 1863, 13546, 11622, 12399, 47525, 4117, 30767, 1829, 19446, 11331, 4117, 1829, 8315], "avg_logprob": -0.25758043964310445, "compression_ratio": 1.504201680672269, "no_speech_prob": 2.86102294921875e-06, "words": [{"start": 2090.03, "end": 2090.55, "word": "لو", "probability": 0.668701171875}, {"start": 2090.55, "end": 2090.85, "word": " كنت", "probability": 0.817626953125}, {"start": 2090.85, "end": 2091.55, "word": " تتعامل", "probability": 0.848046875}, {"start": 2091.55, "end": 2091.69, "word": " مع", "probability": 0.97802734375}, {"start": 2091.69, "end": 2092.15, "word": " مريض", "probability": 0.9886067708333334}, {"start": 2092.15, "end": 2092.67, "word": " بده", "probability": 0.45770263671875}, {"start": 2092.67, "end": 2093.49, "word": " يأخذ", "probability": 0.7835693359375}, {"start": 2093.49, "end": 2095.37, "word": " «Thrombolytic", "probability": 0.608154296875}, {"start": 2095.37, "end": 2095.89, "word": " Therapy»", "probability": 0.9189453125}, {"start": 2095.89, "end": 2096.25, "word": " لازم", "probability": 0.85791015625}, {"start": 2096.25, "end": 2096.55, "word": " يكون", "probability": 0.9736328125}, {"start": 2096.55, "end": 2096.85, "word": " طول", "probability": 0.976318359375}, {"start": 2096.85, "end": 2097.27, "word": " الوقت", "probability": 0.98583984375}, {"start": 2097.27, "end": 2097.49, "word": " هذا", "probability": 0.814453125}, {"start": 2097.49, "end": 2097.83, "word": " المريض", "probability": 0.9892578125}, {"start": 2097.83, "end": 2098.11, "word": " under", "probability": 0.38671875}, {"start": 2098.11, "end": 2098.43, "word": " your", "probability": 0.8291015625}, {"start": 2098.43, "end": 2098.95, "word": " monitor", "probability": 0.9609375}, {"start": 2098.95, "end": 2099.57, "word": " لأنه", "probability": 0.8605143229166666}, {"start": 2099.57, "end": 2099.75, "word": " ممكن", "probability": 0.93896484375}, {"start": 2099.75, "end": 2100.05, "word": " جدا", "probability": 0.932373046875}, {"start": 2100.05, "end": 2100.51, "word": " يخش", "probability": 0.9423828125}, {"start": 2100.51, "end": 2100.71, "word": " في", "probability": 0.77587890625}, {"start": 2100.71, "end": 2101.27, "word": " hypertension", "probability": 0.409912109375}, {"start": 2101.27, "end": 2102.15, "word": " لازم", "probability": 0.9602864583333334}, {"start": 2102.15, "end": 2102.35, "word": " يكون", "probability": 0.98095703125}, {"start": 2102.35, "end": 2102.51, "word": " على", "probability": 0.8935546875}, {"start": 2102.51, "end": 2102.83, "word": " monitor", "probability": 0.4287109375}, {"start": 2102.83, "end": 2103.09, "word": " ويكون", "probability": 0.6258951822916666}, {"start": 2103.09, "end": 2103.27, "word": " في", "probability": 0.37646484375}, {"start": 2103.27, "end": 2104.21, "word": " dysrhythmia", "probability": 0.75927734375}, {"start": 2104.21, "end": 2104.69, "word": " إذا", "probability": 0.889404296875}, {"start": 2104.69, "end": 2104.93, "word": " كان", "probability": 0.9931640625}, {"start": 2104.93, "end": 2105.31, "word": " المريض", "probability": 0.9908854166666666}, {"start": 2105.31, "end": 2105.71, "word": " عنده", "probability": 0.959228515625}, {"start": 2105.71, "end": 2106.15, "word": " بين،", "probability": 0.4812825520833333}, {"start": 2106.15, "end": 2106.37, "word": " انت", "probability": 0.65576171875}, {"start": 2106.37, "end": 2107.19, "word": " كنيرز،", "probability": 0.65400390625}, {"start": 2107.19, "end": 2107.71, "word": " بدك", "probability": 0.8037109375}, {"start": 2107.71, "end": 2108.29, "word": " زي", "probability": 0.8994140625}, {"start": 2108.29, "end": 2108.37, "word": " ما", "probability": 0.9873046875}, {"start": 2108.37, "end": 2108.85, "word": " حكينا", "probability": 0.988525390625}], "temperature": 1.0}, {"id": 95, "seek": 212753, "start": 2109.03, "end": 2127.53, "text": "ممكن تدّي الـ Pre-Prescribed Pain Killers وكمان بدك تخلي المريض في comfortable position لإن ال position و ال oxygen ممكن يقلله القلم و كمان نعمل للمريض اللي هو support المحاضرة الجاي", "tokens": [2304, 43020, 6055, 3215, 11703, 1829, 2423, 39184, 6001, 12, 47, 495, 18732, 24943, 17526, 433, 4032, 24793, 7649, 47525, 4117, 6055, 9778, 20292, 9673, 16572, 11242, 8978, 4619, 2535, 5296, 28814, 1863, 2423, 2535, 4032, 2423, 9169, 3714, 43020, 7251, 4587, 1211, 1211, 3224, 25062, 19528, 4032, 9122, 2304, 7649, 8717, 25957, 1211, 5296, 19528, 16572, 11242, 13672, 1829, 31439, 1406, 9673, 5016, 46958, 25720, 25724, 47302], "avg_logprob": -0.3086503519528154, "compression_ratio": 1.4385026737967914, "no_speech_prob": 7.033348083496094e-06, "words": [{"start": 2109.03, "end": 2109.61, "word": "ممكن", "probability": 0.67822265625}, {"start": 2109.61, "end": 2110.01, "word": " تدّي", "probability": 0.49053955078125}, {"start": 2110.01, "end": 2110.15, "word": " الـ", "probability": 0.79443359375}, {"start": 2110.15, "end": 2110.49, "word": " Pre", "probability": 0.10467529296875}, {"start": 2110.49, "end": 2111.03, "word": "-Prescribed", "probability": 0.588623046875}, {"start": 2111.03, "end": 2111.65, "word": " Pain", "probability": 0.56396484375}, {"start": 2111.65, "end": 2112.19, "word": " Killers", "probability": 0.8994140625}, {"start": 2112.19, "end": 2112.91, "word": " وكمان", "probability": 0.7840169270833334}, {"start": 2112.91, "end": 2113.27, "word": " بدك", "probability": 0.75927734375}, {"start": 2113.27, "end": 2113.61, "word": " تخلي", "probability": 0.7556966145833334}, {"start": 2113.61, "end": 2113.93, "word": " المريض", "probability": 0.9720052083333334}, {"start": 2113.93, "end": 2114.11, "word": " في", "probability": 0.90087890625}, {"start": 2114.11, "end": 2114.59, "word": " comfortable", "probability": 0.2421875}, {"start": 2114.59, "end": 2115.01, "word": " position", "probability": 0.9462890625}, {"start": 2115.01, "end": 2115.37, "word": " لإن", "probability": 0.8008626302083334}, {"start": 2115.37, "end": 2115.51, "word": " ال", "probability": 0.83154296875}, {"start": 2115.51, "end": 2115.77, "word": " position", "probability": 0.365478515625}, {"start": 2115.77, "end": 2116.17, "word": " و", "probability": 0.6904296875}, {"start": 2116.17, "end": 2116.85, "word": " ال", "probability": 0.736328125}, {"start": 2116.85, "end": 2117.51, "word": " oxygen", "probability": 0.6103515625}, {"start": 2117.51, "end": 2117.89, "word": " ممكن", "probability": 0.9658203125}, {"start": 2117.89, "end": 2118.51, "word": " يقلله", "probability": 0.849853515625}, {"start": 2118.51, "end": 2119.01, "word": " القلم", "probability": 0.8056640625}, {"start": 2119.01, "end": 2119.39, "word": " و", "probability": 0.89404296875}, {"start": 2119.39, "end": 2119.65, "word": " كمان", "probability": 0.8829752604166666}, {"start": 2119.65, "end": 2120.01, "word": " نعمل", "probability": 0.9794921875}, {"start": 2120.01, "end": 2120.67, "word": " للمريض", "probability": 0.9686279296875}, {"start": 2120.67, "end": 2121.11, "word": " اللي", "probability": 0.88525390625}, {"start": 2121.11, "end": 2121.55, "word": " هو", "probability": 0.990234375}, {"start": 2121.55, "end": 2123.83, "word": " support", "probability": 0.92431640625}, {"start": 2123.83, "end": 2127.09, "word": " المحاضرة", "probability": 0.9022216796875}, {"start": 2127.09, "end": 2127.53, "word": " الجاي", "probability": 0.560546875}], "temperature": 1.0}, {"id": 96, "seek": 214767, "start": 2129.12, "end": 2147.68, "text": "أو هيك احنا بنكون خلصنا الـ Pulmonary embolism علشان هيك هنتوقف عند الـ Pulmonary embolism ونكمل المحاضرة الجاي، أعطيكوا العافية", "tokens": [10721, 2407, 39896, 4117, 1975, 5016, 8315, 44945, 30544, 16490, 1211, 9381, 8315, 2423, 39184, 35568, 46386, 4605, 401, 1434, 11203, 8592, 7649, 39896, 4117, 8032, 29399, 30543, 5172, 43242, 2423, 39184, 35568, 46386, 4605, 401, 1434, 4032, 1863, 24793, 1211, 9673, 5016, 46958, 25720, 25724, 47302, 12399, 5551, 3615, 9566, 1829, 4117, 14407, 18863, 31845, 10632], "avg_logprob": -0.1985452627313548, "compression_ratio": 1.4097222222222223, "no_speech_prob": 1.3172626495361328e-05, "words": [{"start": 2129.12, "end": 2129.64, "word": "أو", "probability": 0.909423828125}, {"start": 2129.64, "end": 2129.92, "word": " هيك", "probability": 0.47698974609375}, {"start": 2129.92, "end": 2130.18, "word": " احنا", "probability": 0.7498372395833334}, {"start": 2130.18, "end": 2130.5, "word": " بنكون", "probability": 0.890869140625}, {"start": 2130.5, "end": 2131.2, "word": " خلصنا", "probability": 0.9498291015625}, {"start": 2131.2, "end": 2131.7, "word": " الـ", "probability": 0.88623046875}, {"start": 2131.7, "end": 2132.12, "word": " Pulmonary", "probability": 0.805908203125}, {"start": 2132.12, "end": 2132.96, "word": " embolism", "probability": 0.759033203125}, {"start": 2132.96, "end": 2134.22, "word": " علشان", "probability": 0.8230794270833334}, {"start": 2134.22, "end": 2135.14, "word": " هيك", "probability": 0.9931640625}, {"start": 2135.14, "end": 2136.76, "word": " هنتوقف", "probability": 0.921875}, {"start": 2136.76, "end": 2137.18, "word": " عند", "probability": 0.974609375}, {"start": 2137.18, "end": 2137.6, "word": " الـ", "probability": 0.94677734375}, {"start": 2137.6, "end": 2138.2, "word": " Pulmonary", "probability": 0.903076171875}, {"start": 2138.2, "end": 2140.38, "word": " embolism", "probability": 0.9591471354166666}, {"start": 2140.38, "end": 2145.94, "word": " ونكمل", "probability": 0.890869140625}, {"start": 2145.94, "end": 2146.66, "word": " المحاضرة", "probability": 0.9737548828125}, {"start": 2146.66, "end": 2147.0, "word": " الجاي،", "probability": 0.6552734375}, {"start": 2147.0, "end": 2147.28, "word": " أعطيكوا", "probability": 0.8282063802083334}, {"start": 2147.28, "end": 2147.68, "word": " العافية", "probability": 0.8815104166666666}], "temperature": 1.0}], "language": "ar", "language_probability": 1.0, "duration": 2149.26225, "duration_after_vad": 2127.5656249999965}
\ No newline at end of file
diff --git a/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/cy8gkI3Bil0_raw.srt b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/cy8gkI3Bil0_raw.srt
new file mode 100644
index 0000000000000000000000000000000000000000..4c00f47c3ff4ce5b49ddff8bd92ed639cd44e8ef
--- /dev/null
+++ b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/cy8gkI3Bil0_raw.srt
@@ -0,0 +1,1884 @@
+1
+00:00:02,700 --> 00:00:05,640
+بسم الله الرحمن الرحيم السلام عليكم ورحمة الله
+
+2
+00:00:05,640 --> 00:00:09,260
+وبركاته اليوم إن شاء الله رب العالمين هنكمل
+
+3
+00:00:09,260 --> 00:00:12,320
+محاضرتنا في اللي هو Respiratory Tract Disorders
+
+4
+00:00:12,320 --> 00:00:19,000
+كنا حكينا مع بعض في المحاضرة السابقة عن الـ ARDS
+
+5
+00:00:19,000 --> 00:00:22,780
+اللي هي الـ Acute Respiratory Distress Syndrome
+
+6
+00:00:23,540 --> 00:00:27,860
+حكينا في الـ Acute respiratory distress، السندروم،
+
+7
+00:00:27,860 --> 00:00:32,020
+أيش المرض، كيف الصين والسينتران سبعته، الـ X-ray
+
+8
+00:00:32,020 --> 00:00:33,980
+كيف بيكون شكلها، الـ medical management، شو
+
+9
+00:00:33,980 --> 00:00:36,920
+بنسويه، أيش أهمية الـ mechanical ventilator في الـ
+
+10
+00:00:36,920 --> 00:00:40,600
+management والـ high بيب، عشان نمنع الكلاب، ثم من
+
+11
+00:00:40,600 --> 00:00:45,010
+ضمن الحاجات كمان حكيناإنه مافيش «pharmacological»
+
+12
+00:00:45,010 --> 00:00:48,710
+كرب معين للـ «ARD» أصغر إنهم يعني ممكن يستخدموا
+
+13
+00:00:48,710 --> 00:00:53,630
+الـ «surfactant replacement» عشان يحسنوا الوضع
+
+14
+00:00:53,630 --> 00:01:00,030
+داخل الـ «alveoli» لكن مهم
+
+15
+00:01:00,030 --> 00:01:06,670
+جدا كمان إنه نخفف الضغط فيالـ Pulmonary Artery
+
+16
+00:01:06,670 --> 00:01:11,130
+لإنه بيصير Pulmonary Artery Hypertension حكينا إنه
+
+17
+00:01:11,130 --> 00:01:15,010
+عشان نعرف قداش الضغط داخل الـ Pulmonary Artery
+
+18
+00:01:15,010 --> 00:01:21,110
+ممكن نستخدم لسوانس GANS كاتيتار اللي وظيفتها إنها
+
+19
+00:01:21,110 --> 00:01:26,780
+تعرف قداش الضغط داخل الـ Pulmonary«أرتري» وعرفنا
+
+20
+00:01:26,780 --> 00:01:33,060
+إن الضغط داخل البلمونري «أرتري» إذا كان أقل من 15
+
+21
+00:01:33,060 --> 00:01:44,140
+أو أقل من 18 يعني maximum بكونمعناه إنه المريض
+
+22
+00:01:44,140 --> 00:01:47,880
+المشكلة
+
+23
+00:01:47,880 --> 00:01:50,720
+تبعته فيه الـ Lung ويكون الموضوع اللي علاقة بالـ
+
+24
+00:01:50,720 --> 00:01:58,680
+ARDS لكن لو كان الـ Pulmonary Artery Pressure كان
+
+25
+00:01:58,680 --> 00:02:03,820
+أكتر من 18 معناه إنه Cardiac Issue حكينا إن الـ
+
+26
+00:02:03,820 --> 00:02:08,780
+Swan's Gland Catheter هي دي بتتركب عن طريقإنهم
+
+27
+00:02:08,780 --> 00:02:13,540
+بيركبوا Central Line من الـ «إنترن» أو الـ
+
+28
+00:02:13,540 --> 00:02:16,860
+«جاجولار» أو Subclavian Veins زي ما أنا بقشر «هان»
+
+29
+00:02:16,860 --> 00:02:20,620
+Subclavian إنها من الـ «إنترن» أو الـ «جاجولار» أو
+
+30
+00:02:20,620 --> 00:02:20,800
+الـ «جاجولار» أو الـ «جاجولار» أو الـ «جاجولار»
+
+31
+00:02:20,800 --> 00:02:25,060
+لما في النهاية نستقر في الـ «Thoracic Vein» بنزل
+
+32
+00:02:25,060 --> 00:02:29,240
+على الـ «Superior Vena Cava» بعدين بنستخر اللي هو
+
+33
+00:02:29,540 --> 00:02:33,640
+في الـRight Atrium بنستقرش في الـNormal الـCentral
+
+34
+00:02:33,640 --> 00:02:36,560
+Line ممكن تكون just before entering the Right
+
+35
+00:02:36,560 --> 00:02:40,120
+Atrium اللي هو الـCentral Venous Pressure بنسميه
+
+36
+00:02:40,120 --> 00:02:44,140
+بيوقف يعني بنسمه الـCentral Venous Pressure لكن في
+
+37
+00:02:44,140 --> 00:02:45,320
+الـSwan
+
+38
+00:02:47,420 --> 00:02:50,200
+بنكمل، بنروح على الـ right ventricle ومن الـ right
+
+39
+00:02:50,200 --> 00:02:53,480
+ventricle بنطلع على الـ pulmonary artery في الـ
+
+40
+00:02:53,480 --> 00:02:57,880
+pulmonary artery بيكون فيه هنا بلون زي ما انتوا
+
+41
+00:02:57,880 --> 00:03:00,720
+شايفينه أما بيكون فيه two بلون، بلون هنا و بلون
+
+42
+00:03:00,720 --> 00:03:07,100
+قبل منه المهم الـ pulmonary wedge pressure اللي هو
+
+43
+00:03:07,100 --> 00:03:16,190
+وظيفتهإنه يعني قسل الضغط داخل البلمونة الارتري
+
+44
+00:03:16,190 --> 00:03:20,390
+سيئة الـ closure و ال pressure يعني سيئة الـ
+
+45
+00:03:20,390 --> 00:03:24,890
+closure يعني سيئة ما بيصير inflation للبلون أداش
+
+46
+00:03:24,890 --> 00:03:29,110
+بيكون الضغط داخل البلمونة الارتري هذا جنان عليه
+
+47
+00:03:29,110 --> 00:03:34,490
+بنحدد إذا كان الموضوع إيه علاقة في الـlung ولا إيه
+
+48
+00:03:34,490 --> 00:03:42,420
+علاقة في الـheartمن الإلاجات اللي إحنا بنستخدمها
+
+49
+00:03:42,420 --> 00:03:45,480
+طبعا حكينا عليك إن الكلمة manifestation تبقى في
+
+50
+00:03:45,480 --> 00:03:49,520
+الـRDS وحكينا بيها كويس بس بدنا نعرف بالنسبالها
+
+51
+00:03:49,520 --> 00:03:53,700
+علاج الـPulmonary Hypertension حكينا إنه من أحسن
+
+52
+00:03:53,700 --> 00:03:59,520
+الأدوية اللي ممكن يعالجوا فيهاالـHypertension،
+
+53
+00:03:59,520 --> 00:04:04,120
+الـ«فوسفو داستيريز انهيبيتورز» الهي عبارة عن
+
+54
+00:04:04,120 --> 00:04:08,880
+مراكبات السيليدينافيل اللي هي الـViagra ومراكباته
+
+55
+00:04:10,360 --> 00:04:15,140
+طبعاً و هذه الأدوية اللي هي معروفة حالياً لعلاج
+
+56
+00:04:15,140 --> 00:04:21,840
+العجز الجنسي لكن هي في الأصل علاجات استخدمت في
+
+57
+00:04:21,840 --> 00:04:27,240
+علاج الـ Pulmonary Hypertension وتقليل الضغط داخل
+
+58
+00:04:27,240 --> 00:04:31,800
+الـ Pulmonary Artery هذا كانت يعني مراجعة بسيطة أو
+
+59
+00:04:31,800 --> 00:04:36,300
+تعليق بسيط أو زيادة حبة على الـSwan Gans Catheter
+
+60
+00:04:36,300 --> 00:04:38,520
+وكيف بتنحط
+
+61
+00:04:41,840 --> 00:04:45,280
+وبالظبط، إيش هو الـ Pulmonary heart hypertension؟
+
+62
+00:04:45,280 --> 00:04:48,840
+وإيش أحسن الطرق لعلاجه؟ حاليًا، هنحكي عن واحد من
+
+63
+00:04:48,840 --> 00:04:52,360
+الـ Pulmonary heart disease يعني مرض اللي له علاقة
+
+64
+00:04:52,360 --> 00:04:56,540
+بين القلب والرقتين، عشان هيك بيسموه Core Pulmonal
+
+65
+00:04:56,540 --> 00:05:02,000
+إيش يعني Core Pulmonal؟ يعنيفي الأصل هو عبارة عن
+
+66
+00:05:02,000 --> 00:05:07,500
+تضخم في الـ right ventricle يعني enlargement في
+
+67
+00:05:07,500 --> 00:05:12,220
+الـ right ventricle بسبب
+
+68
+00:05:12,220 --> 00:05:15,200
+الـ heart يعني condition in which the right
+
+69
+00:05:15,200 --> 00:05:18,740
+ventricle of the heart enlarged with or without
+
+70
+00:05:18,740 --> 00:05:22,420
+right sided heart failureممكن يكون فيه heart
+
+71
+00:05:22,420 --> 00:05:26,680
+failure أو مش مافيش heart failure كامل لكن ال
+
+72
+00:05:26,680 --> 00:05:30,600
+right ventricل بيضلوا يتضخم لإنه كل ما بيجي بيطلع
+
+73
+00:05:30,600 --> 00:05:33,620
+ال right ventric اللي بيطلع أمين يا جماعة ل blood
+
+74
+00:05:33,620 --> 00:05:36,900
+على ال lungs عشان إيش يصير عبر ال .. عبر مين؟ عبر
+
+75
+00:05:36,900 --> 00:05:39,720
+ال pulmonary artery عشان إيش يصير لها؟ يصير لها
+
+76
+00:05:39,720 --> 00:05:44,760
+oxygenation و بعدين يرجع ل blood من ال lungعبر الـ
+
+77
+00:05:44,760 --> 00:05:48,720
+pulmonary veins على الـ heart عشان يصب في الـ left
+
+78
+00:05:48,720 --> 00:05:51,680
+atrium ومن الـ left atrium ينزل على الـ left
+
+79
+00:05:51,680 --> 00:05:53,820
+ventricle ومن الـ left ventricle يطلع الـ blood
+
+80
+00:05:53,820 --> 00:05:59,900
+عوين عبر الأورطة على كل الجسم لكن اللي بيصير أنه
+
+81
+00:06:00,790 --> 00:06:05,890
+إنه لما بيطلع الدم من الـ right ventricle رجعنا
+
+82
+00:06:05,890 --> 00:06:09,550
+على الجهة اليمين من الـ right ventricle ورد يطلع
+
+83
+00:06:09,550 --> 00:06:15,410
+يودّي blood عبر الـ pulmonary artery على ال lung
+
+84
+00:06:15,410 --> 00:06:18,370
+نرجع للصورة ها عشان نشوف هياته
+
+85
+00:06:21,430 --> 00:06:26,210
+الـBlood جماعة نزل هنا في الـRight Atrium نزل على
+
+86
+00:06:26,210 --> 00:06:29,090
+الـRight Ventricle وبعد الـRight Ventricle عبر
+
+87
+00:06:29,090 --> 00:06:33,630
+البلمونة الارتراب يودّي الدم عمين على الرئتين
+
+88
+00:06:33,630 --> 00:06:39,190
+Right وLeft، تمام؟ الآن، لما يكون الرئة فيها مشكلة
+
+89
+00:06:39,190 --> 00:06:42,830
+زي إيش مشكلة؟ زي الـCOPD مثلًا «Chronic
+
+90
+00:06:42,830 --> 00:06:45,950
+Obstructive Pulmonary Disease» «Stigma Fibrosis»
+
+91
+00:06:45,950 --> 00:06:52,270
+الـTB، whatever، أه؟فبتصير الرئيس ما عندهاش القدرة
+
+92
+00:06:52,270 --> 00:06:57,750
+إنها تستقبل الدم من الـheart بشكل إيقويسي، بشكل
+
+93
+00:06:57,750 --> 00:07:01,490
+منتظر متعمل للـoxygenation فبتصير تتأخر في استقبال
+
+94
+00:07:01,490 --> 00:07:06,070
+الدم وبتحاول إنها تأجله، طب إيش اللي هيصير؟هيصير
+
+95
+00:07:06,070 --> 00:07:10,510
+إنه هيحتقن الدم داخل الـRight Ventricle هذا هذا،
+
+96
+00:07:10,510 --> 00:07:14,790
+هيصير هنا كتير فيه دم مش .. مش .. مش .. يعني
+
+97
+00:07:14,790 --> 00:07:19,430
+ماعندوش الفرصة إنه يروح على الرئتين ويقوم بالدور
+
+98
+00:07:19,430 --> 00:07:22,630
+اللي هو يصير له Oxygenation فبيصير إيش؟ فيه بيصير
+
+99
+00:07:22,630 --> 00:07:27,440
+يتضخمالـ right ventricle إذن تضخم الـ right
+
+100
+00:07:27,440 --> 00:07:30,100
+ventricle condition in which the right ventricle
+
+101
+00:07:30,100 --> 00:07:34,320
+of the heart enlarges يكبر سواء إنتي heart failure
+
+102
+00:07:34,320 --> 00:07:37,520
+أو ماعنديش المشكلة الأساسية مش في ال heart failure
+
+103
+00:07:37,520 --> 00:07:41,580
+المشكلة الأساسية the most frequent cases is severe
+
+104
+00:07:41,580 --> 00:07:46,430
+COPD الناس اللي عندها COPD يعني ال lung تبعتهامش
+
+105
+00:07:46,430 --> 00:07:51,690
+شغالة كويس، إيش اللي هيصير فيها؟ هيصير الدم داخل
+
+106
+00:07:51,690 --> 00:07:56,590
+الـ Pulmonary Artery يزيد كتير، والضغط يقلع ويصير
+
+107
+00:07:56,590 --> 00:07:59,210
+Pulmonary Artery Hypertension اللي طول السنة اللي
+
+108
+00:07:59,210 --> 00:08:05,890
+كنا بنحكي عنه وبالتالي الدم هيصير له ارتجاع ويعني
+
+109
+00:08:05,890 --> 00:08:10,390
+يتحوش في الـRight Ventricle وبالتالي الـRight
+
+110
+00:08:10,390 --> 00:08:15,500
+Ventricle هيظل يعملDilatation وبالتالي بيصير فيه
+
+111
+00:08:15,500 --> 00:08:19,800
+إيش Enlargement بتضخم حجمه وبصير مبين إنه الـRight
+
+112
+00:08:19,800 --> 00:08:26,800
+ventricle أكبر من باقي الجسم وعشان هيك يا جماعة
+
+113
+00:08:26,800 --> 00:08:30,000
+الـCorpulmonal
+
+114
+00:08:30,000 --> 00:08:37,900
+هي حالة مرضية دائما مصاحبة لمتلازمات الصدر أو أي
+
+115
+00:08:37,900 --> 00:08:46,340
+خلل في الرئتينيؤدي إلى خلال في الـ heart أو يؤدي
+
+116
+00:08:46,340 --> 00:08:50,840
+إلى تضخم في الـ right ventricle واحتقان الدم فيه
+
+117
+00:08:50,840 --> 00:08:55,420
+طبعا هذا بالاساس هو نتيجة الـ pulmonary
+
+118
+00:08:55,420 --> 00:09:03,620
+hypertension نتيجة زيادة الضغط في الـ pulmonaryR3،
+
+119
+00:09:03,620 --> 00:09:06,860
+تمام؟ الآن، إيش الـ Clinical Manifestation عند
+
+120
+00:09:06,860 --> 00:09:10,700
+الناس هدول؟ عادة الناس هدول يا جماعة الـ Clinical
+
+121
+00:09:10,700 --> 00:09:12,860
+Manifestations اللي عندهم هي الـ Clinical
+
+122
+00:09:12,860 --> 00:09:15,980
+Manifestations تبع الـ Underlying Disease، يعني هو
+
+123
+00:09:15,980 --> 00:09:19,520
+أصلا إيش ماله؟ هو أصلا CUVD Patient؟ Okay، هيكون
+
+124
+00:09:19,520 --> 00:09:25,140
+عنده كل العلمات تبع الـCUVD Patient بالإضافة إلى
+
+125
+00:09:25,140 --> 00:09:29,260
+إنه صار عنده enlargement في الـاللي هو الـ right
+
+126
+00:09:29,260 --> 00:09:32,540
+ventricle يعني لو روحنا عملنا ايكوكارديوغرام
+
+127
+00:09:32,540 --> 00:09:37,480
+للpatient هذا هلاقي انه ال right ventricle عنده
+
+128
+00:09:37,480 --> 00:09:43,640
+متضخم طبعا هذا هيخلي كمية الدم اللي بترجع للقلب
+
+129
+00:09:43,640 --> 00:09:50,180
+عبر ال right atriumيعني برضه التانية كتير هتكون
+
+130
+00:09:50,180 --> 00:09:53,420
+يعني بيجي دم بقى الـ Adventric لسه مش هنفضّي اللي
+
+131
+00:09:53,420 --> 00:09:57,000
+عنده، تمام؟ فعشان هيك نبيز هذا دايماً هيكون عنده
+
+132
+00:09:57,000 --> 00:10:00,460
+neck vein distended طيب و تحت هذا بالنسبالي فوق
+
+133
+00:10:00,460 --> 00:10:03,300
+الـneck vein هتكون distended طب من تحت هيكون فيه
+
+134
+00:10:03,300 --> 00:10:07,780
+عنده lower limb قديمة، إذا من أهم العلمات أنه
+
+135
+00:10:07,780 --> 00:10:10,280
+هلاقي قديمة في الـfit و الـlazy يعني lower limb
+
+136
+00:10:10,280 --> 00:10:15,380
+قديمة و فوق هلاقي distinction في الـneck vein
+
+137
+00:10:16,610 --> 00:10:18,970
+نكفينز يعني الـ jugular veins حيث يكون فيهم
+
+138
+00:10:18,970 --> 00:10:23,490
+distinction يعني معبين دم لإنه مش بيسهل عمال الدم
+
+139
+00:10:23,490 --> 00:10:28,310
+يروح ينزل على القلب عبر ال right atrium وبعدين
+
+140
+00:10:28,310 --> 00:10:30,670
+يروح على ال right ventricle لإن ال right ventricle
+
+141
+00:10:30,670 --> 00:10:35,380
+شبعان ومعمال محتقانمش عارف هو دي الدم اللي عنده
+
+142
+00:10:35,380 --> 00:10:39,580
+لأنه الرئتين مابيستقبلوش منه وبالتالي شويه شويه
+
+143
+00:10:39,580 --> 00:10:44,620
+هصير ال blood يرشح الدم يرشح من الرئتين ويعمل
+
+144
+00:10:44,620 --> 00:10:49,100
+plural effusion وطبعا ممكن المريض يكون في
+
+145
+00:10:49,100 --> 00:10:53,280
+endocarditis وكمان يكون ال heart يصير يعمل heart
+
+146
+00:10:53,280 --> 00:10:58,020
+murmur كمان يا جماعة ال liver هيكون بدأ حجمه يكبر
+
+147
+00:10:58,020 --> 00:11:05,740
+لإنه بيحتقن في السواق العبرالـ Portal Vein أيضًا
+
+148
+00:11:05,740 --> 00:11:11,500
+فبيصير برضه الـ enlargement في الـ liver ال
+
+149
+00:11:11,500 --> 00:11:15,300
+medical management للناس هدولة عشان انحسن وضع
+
+150
+00:11:15,300 --> 00:11:19,920
+المريض هذا أولا يا جماعة بيتمت بالشكل الأساسي على
+
+151
+00:11:19,920 --> 00:11:24,770
+أنه أنتتراقب وتقالج الحالة المرضية تبع الـ Lung هو
+
+152
+00:11:24,770 --> 00:11:28,470
+من أيش صار عنده Corpulmonal من الـ COD ولا من الـ
+
+153
+00:11:28,470 --> 00:11:33,430
+Lung Fibrosis تحاول تحسن الحالة تبعته المرضية عشان
+
+154
+00:11:33,430 --> 00:11:38,330
+ما تزيدش عنده الـ Corpulmonal والـ enlargement في
+
+155
+00:11:38,330 --> 00:11:44,850
+الـ right ventricle أحسن حاجة أن نخلّي المريض هذا
+
+156
+00:11:45,170 --> 00:11:50,310
+وضعه يتأقلم ومايزيدش سوء إنه نديه Oxygen
+
+157
+00:11:50,310 --> 00:11:56,870
+Supplement قداش لـ 24 ساعة من 16 لـ 24 ساعة في
+
+158
+00:11:56,870 --> 00:12:00,730
+اليوم وهل يظل 16 ساعة لـ Oxygen في اليوم؟ آه
+
+159
+00:12:00,730 --> 00:12:04,670
+الأبحاث بتثبت إنه كل ما يضار المريض على Continuous
+
+160
+00:12:04,670 --> 00:12:12,690
+Oxygen كل ما الـ Hypoxemiaبتقل بجسمه لأن هو هيندو
+
+161
+00:12:12,690 --> 00:12:16,570
+مشكلة بيعتبر مش شغاليني كويس وكل ما أنا أديته
+
+162
+00:12:16,570 --> 00:12:20,830
+Oxygen على low rate طبعا بس continuous أنا بالتالي
+
+163
+00:12:20,830 --> 00:12:24,690
+هحسم الـ Pulmonary function و أقل ال reduction in
+
+164
+00:12:24,690 --> 00:12:29,830
+pulmonary vascular resistance وهذا هيخل المريض ال
+
+165
+00:12:29,830 --> 00:12:33,850
+right ventricle عنده مايضالوش استجهيد و يتضخم
+
+166
+00:12:33,850 --> 00:12:38,170
+وبالتالي أملي rights are decided heart failure
+
+167
+00:12:38,170 --> 00:12:46,850
+تمام؟عشان هيك ال oxygen هو يعني حجر زاوية مهم جدا
+
+168
+00:12:46,850 --> 00:12:52,970
+في إلاج المرضى اللي عندهم core pulmonal طبعا زي ما
+
+169
+00:12:52,970 --> 00:12:56,510
+حكيت أصلا هم بيكونوا CUD patient فبيدوروا طبعا كنت
+
+170
+00:12:56,510 --> 00:12:59,870
+بيدوا يد مريض يعني 24 ساعة كنتون يواصلون oxygen
+
+171
+00:12:59,870 --> 00:13:05,010
+طبعا زمان كان الموضوع جدا مرهق كان بحتاجه إجرار
+
+172
+00:13:05,010 --> 00:13:09,270
+oxygen ويظل المريض متصل عليها ويبدر جره بره جره
+
+173
+00:13:10,150 --> 00:13:15,110
+أسهل في جهاز صغير اسمه Oxygen Regenerator إن شاء
+
+174
+00:13:15,110 --> 00:13:19,630
+الله المرة الجاية بحاول أحطلكوا صورته أو لو كتبتوا
+
+175
+00:13:19,630 --> 00:13:24,890
+على جوجل Oxygen Regenerator هتشوفوا جهاز صغير بس
+
+176
+00:13:24,890 --> 00:13:32,250
+تشبكه في الكهربا وإله humidifier وإنت بتحط أكام
+
+177
+00:13:32,250 --> 00:13:35,980
+لتر بار minute بدك مثلاًتلاتة لتر بيرمينت بيصير هو
+
+178
+00:13:35,980 --> 00:13:38,960
+يولدها بأكسجين من الهواء الجو اللي حواليه يشفط
+
+179
+00:13:38,960 --> 00:13:45,480
+ويؤدي أكسجين بتركيب حسب كام لتر بيرمينت بدك خمسة
+
+180
+00:13:45,480 --> 00:13:49,800
+لتر بيرمينت، ستة لتر بيرمينت، تمام؟ وإله باربيش
+
+181
+00:13:49,800 --> 00:13:54,560
+اللي هو nasal cannula أو nasal catheter والـ tube
+
+182
+00:13:54,560 --> 00:13:59,180
+هذا عادة يا جماعة بيكون طويل كتير، بحيث أنه، يعني
+
+183
+00:13:59,180 --> 00:14:03,310
+بالأمطارأو تلاتين متر أو أربعين متر، بس إنه خلّي
+
+184
+00:14:03,310 --> 00:14:09,050
+الإنسان اللي بيحتاج هذاالـ Management يقدر يمارس
+
+185
+00:14:09,050 --> 00:14:12,430
+مهام الوظيفة سواء لو كان في مكتبه أو سواء لو كانت
+
+186
+00:14:12,430 --> 00:14:15,270
+سته بدأت تشتغل في دارها بس تبقى طول الوقت و هي
+
+187
+00:14:15,270 --> 00:14:19,890
+حاطة الـ Oxygen لأنهم لاقوا إنه الـ Oxygen الـ
+
+188
+00:14:19,890 --> 00:14:24,650
+Continuous هذا بيقلل من الـ Hypoxemia و بيقلل من
+
+189
+00:14:24,650 --> 00:14:29,310
+أو بيمنع سوء حالة الـ ال patients اللي عندهم كرب
+
+190
+00:14:29,310 --> 00:14:34,270
+المنال وبالتالي هيقلل الفرصة لزيادة الـEnlargement
+
+191
+00:14:34,270 --> 00:14:39,510
+في الـRight، Ventricle، تمام؟ الموضوع اللي بعد هيك
+
+192
+00:14:39,510 --> 00:14:42,870
+اللي هنحكي فيه يا جماعة هو الـ Pulmonary Embolism
+
+193
+00:14:42,870 --> 00:14:48,650
+أتمنى تكونوا فهمته الموضوع الأولاني الـ Pulmonary
+
+194
+00:14:49,650 --> 00:14:56,170
+الـ Hembolism هو موضوع أيضًا من الحاجات المهمة
+
+195
+00:14:56,170 --> 00:15:00,690
+جدًا لازم نعرفها والتي مرتبطة بأمراض الرئتين السبب
+
+196
+00:15:00,690 --> 00:15:05,630
+الرئيسي في معظم الـ Pulmonary Hembolisms اللي
+
+197
+00:15:05,630 --> 00:15:10,410
+بتسير أنه يمكن يكون فيه Deep Vein Thrombosis يعني
+
+198
+00:15:10,410 --> 00:15:16,730
+في جلطة في أحد الشرايين، عفوا، أحد الـ Veins،
+
+199
+00:15:16,730 --> 00:15:22,620
+الـماذا يسمونها؟الأوري دا العميقة
+
+200
+00:15:22,620 --> 00:15:27,280
+الـ «central» يعني تمام؟ وللواحد من ال «veins» دول
+
+201
+00:15:27,280 --> 00:15:31,020
+صار فيه إيش؟ جلطة «Thrombus» طبعا الـ «Thrombus»
+
+202
+00:15:31,020 --> 00:15:35,720
+هذه could be blood formation تتكون طبعا ممكن تكون
+
+203
+00:15:35,720 --> 00:15:39,960
+فات يا جماعة لو كان المريض عامل مثلا
+
+204
+00:15:42,900 --> 00:15:46,880
+يعني orthopedic surgery واحد كان عنده long bone
+
+205
+00:15:46,880 --> 00:15:50,040
+fracture وانكسرات، هذا عادة ما يكون فيه جوا ال
+
+206
+00:15:50,040 --> 00:15:55,820
+bone، احنا عارفين انه بيكون فيه endoالـ Pomaro هدا
+
+207
+00:15:55,820 --> 00:16:00,300
+عبارة عن إيش؟ عبارة عن دهون، تمام؟ فممكن هنا
+
+208
+00:16:00,300 --> 00:16:05,360
+يطلعوا تعملوا Embolism علشان هيك الـThrombus هاي
+
+209
+00:16:05,360 --> 00:16:12,060
+لو طلعت ومشت في الـ في الـ bloodstream، مشت في أحد
+
+210
+00:16:12,060 --> 00:16:17,960
+الـ ال veins، بالتالي هتروح علىتستقر أنها ترجع على
+
+211
+00:16:17,960 --> 00:16:20,060
+الـRight Atrium ومن الـRight Atrium هترجع على
+
+212
+00:16:20,060 --> 00:16:22,200
+الـRight Ventricle ومن الـRight Ventricle هتنطلق
+
+213
+00:16:22,200 --> 00:16:26,280
+عبر البلمونري آرتري عالمي على الـLung ممكن يا
+
+214
+00:16:26,280 --> 00:16:31,900
+جماعة أن أحد ال branches من البلمونري آرتريز هذه
+
+215
+00:16:31,900 --> 00:16:38,200
+تروح واصلاها و تروح مش سكرةالـBlood supply اللي
+
+216
+00:16:38,200 --> 00:16:42,280
+بيجي للرقم من المنطقة هذه وبالتالي تعمل فيها
+
+217
+00:16:42,280 --> 00:16:48,040
+بلمونري Infarction بلمونري Infarction Most
+
+218
+00:16:48,040 --> 00:16:50,980
+commonly بلمونري Inflammation is due to blood clot
+
+219
+00:16:50,980 --> 00:16:54,280
+أو ترمبس زي ما حكينا اللي ممكن تكون الترمبس هذي
+
+220
+00:16:54,280 --> 00:16:58,920
+air أو fat أو energy confluent حتى لو كانت ست حامل
+
+221
+00:16:58,920 --> 00:17:05,630
+أو حاجة أو septicيعني ممكن تكون bacterial thrombus
+
+222
+00:17:05,630 --> 00:17:11,350
+في حالات السبتك والناس اللي يعني عندهم سبتسيميا أو
+
+223
+00:17:11,350 --> 00:17:15,730
+other causes of السبتك زي البيرمصارفي عنده sepsis
+
+224
+00:17:15,730 --> 00:17:22,910
+ممكن يصير عنده thrombus من من
+
+225
+00:17:22,910 --> 00:17:29,120
+اللي هو infected thrombusالناس هدول هيصير في عندهم
+
+226
+00:17:29,120 --> 00:17:34,100
+empowerment كتير في الـ «لنغ» لأنه وفي شغل الـ
+
+227
+00:17:34,100 --> 00:17:37,160
+«لنغ» وفي الـ «function» تباعتها لأن مافي جزء أصبح
+
+228
+00:17:37,160 --> 00:17:40,920
+من الـ «لنغ» كبير مابيعملش «gas exchange» و
+
+229
+00:17:40,920 --> 00:17:51,060
+«infarct» تمام؟ علشان هيك الـ الـ الـ الـ الـ الـ
+
+230
+00:17:51,060 --> 00:17:55,180
+البلبوناري symbolismممكن كثير حاجات أمراض أخرى
+
+231
+00:17:55,180 --> 00:17:59,020
+تتأدي إليها مش بس الـDVT إنه يكون مثلا عنده المريض
+
+232
+00:17:59,020 --> 00:18:03,600
+Atrial Fibrillation إيش يعني؟ يعني هو عنده أصلا
+
+233
+00:18:03,600 --> 00:18:09,200
+ارتجاف وذيني في اللي هو عضلة القلب هذا يا جماعة
+
+234
+00:18:09,200 --> 00:18:14,600
+بيهيئي الفرصة أصلا لتكوين إيش؟الـ Thrombus في الـ
+
+235
+00:18:14,600 --> 00:18:18,340
+Atriums وبالتالي هتنزل الـ Thrombus من الـ Atrial
+
+236
+00:18:18,340 --> 00:18:22,400
+Chamber على الـ Ventricle بالذات اللي هو الـ Right
+
+237
+00:18:22,400 --> 00:18:26,600
+Ventricle وبالتالي ممكن تنتقل لأماكن أخرى كمان من
+
+238
+00:18:26,600 --> 00:18:33,420
+الحاجات اللي معروفة أنها بتساعد في تكوين الـ
+
+239
+00:18:33,420 --> 00:18:40,280
+Thrombus Formation يا جماعة اللي هو الراحة
+
+240
+00:18:40,770 --> 00:18:45,490
+الكتيرة يعني المرضى سواء كان بالـ Dreadin أو هو
+
+241
+00:18:45,490 --> 00:18:49,930
+أصلا الـ Sedentary lifestyle مستوى يعني أو طريقة
+
+242
+00:18:49,930 --> 00:18:53,030
+حياته مابتحركش فيها كتير دايما قاعد، دايما بشتغل
+
+243
+00:18:53,030 --> 00:18:57,410
+على مكتب، دايما بسافر كتير، الناس اللي بيسافروا
+
+244
+00:18:57,410 --> 00:19:02,150
+كتير ومسافات طويلة سواء باص أو سيارة أو في الطيارة
+
+245
+00:19:02,150 --> 00:19:06,490
+لمسافات طويلة عادة يا جماعة ترسك نفسي لعندهم إيش
+
+246
+00:19:06,840 --> 00:19:11,380
+DVT و لا ترسك اللي يصير عنده DVT بعدها كإيش
+
+247
+00:19:11,380 --> 00:19:15,000
+المرحلة التالية ممكن تكون إنه يخش بلمونة رقم بلازم
+
+248
+00:19:15,000 --> 00:19:19,280
+أو إنه يخش كمان في قمقايا يا جماعة تمام ما يكوارد
+
+249
+00:19:19,280 --> 00:19:22,700
+ال infarction لإن كل الحاجات اللي حكيتها هذه سواء
+
+250
+00:19:22,700 --> 00:19:27,260
+إنه بدردني كتير أو إنه سافر مسافات طويلة أو إنه
+
+251
+00:19:27,260 --> 00:19:33,360
+مابتحركش كتير نتيجة شغله إنه بيضلوا في مكتبخياط
+
+252
+00:19:33,360 --> 00:19:37,920
+مثلًا، هذا كل الحاجات بتؤدي إلى إنه يصيب فيه
+
+253
+00:19:37,920 --> 00:19:41,060
+إمكانية لـThrombus Formation في الجسم بقى إن ما
+
+254
+00:19:41,060 --> 00:19:43,740
+بيصيب Thrombus Formation ماحدش هيعرف وين
+
+255
+00:19:43,740 --> 00:19:48,060
+الـThrombus هذه هتمشي وتستقر إذا مشيت في Arteries
+
+256
+00:19:48,060 --> 00:19:52,020
+هتأمن إنه ممكن تستقر في الـCoronary Arteries وتأمن
+
+257
+00:19:52,020 --> 00:19:56,480
+إنه Myocardial Infarction وإذا مشيت في الـVeins
+
+258
+00:19:56,480 --> 00:20:00,190
+ممكن تستقر فيالـ right ventricle ومن الـ right
+
+259
+00:20:00,190 --> 00:20:05,030
+ventricle الـ pulmonary arteries وتستقر في أحد الـ
+
+260
+00:20:05,030 --> 00:20:07,710
+lungs في branches من الـ pulmonary arteries وتعمل
+
+261
+00:20:07,710 --> 00:20:11,710
+pulmonary infarction عشان هيك ال clinical
+
+262
+00:20:11,710 --> 00:20:18,310
+manifestation لمريد عنده pulmonary أو pulmonary
+
+263
+00:20:18,310 --> 00:20:21,790
+embolism صحيح أنه هيكون المريض صار dyslexic لأنه
+
+264
+00:20:21,790 --> 00:20:27,490
+في جزء من الـ lung حكينا infarcted ما بشتغلشأو ما
+
+265
+00:20:27,490 --> 00:20:31,510
+بيقومش بوظيفته اللي هي الـ Gas Exchange وكمان هكون
+
+266
+00:20:31,510 --> 00:20:35,410
+فيه عنده severe chest pain يا جماعة زي كأنه .. زي
+
+267
+00:20:35,410 --> 00:20:38,630
+كأنه إيش؟ عنده myocardial infarction يعني حيجي
+
+268
+00:20:38,630 --> 00:20:41,810
+المريض إيش في صدره؟ آه واجع في صدري، chest pain
+
+269
+00:20:41,810 --> 00:20:47,630
+وكمان، بس حاجة كويسة تانية إنه عادة بيكون ال .. أو
+
+270
+00:20:47,630 --> 00:20:51,670
+يعني ممكن يكون، مش عادة ممكن يكون إن الـpain تبقى
+
+271
+00:20:51,670 --> 00:20:57,480
+المريضة ده غير عن الـMIماذا يعني الفرق بينهم؟ إنهم
+
+272
+00:20:57,480 --> 00:21:00,920
+ممكن يكونوا مصاحب للنفس، لماذا؟ لأنه ممكن يكون في
+
+273
+00:21:00,920 --> 00:21:05,540
+عنده pleurisy كمان أو يصير عنده pleurisy اللي هو
+
+274
+00:21:05,540 --> 00:21:09,560
+من الـinfarction اللي صار في منطقة معينة يصير
+
+275
+00:21:09,560 --> 00:21:13,500
+pleuritis زي ما حكينا في الـpleurisy
+
+276
+00:21:17,170 --> 00:21:22,310
+المريض زي ما حكينا ممكن ييجي بألمات زي «myocardial
+
+277
+00:21:22,310 --> 00:21:25,790
+infarction» من ناحية الـ «chest pain» هييجي عنده
+
+278
+00:21:25,790 --> 00:21:29,770
+«severe hypoxia» واضح جدا إنه «hypoxic» الـ
+
+279
+00:21:29,770 --> 00:21:34,120
+«saturation» تبعه «low» المريض هييجي بتاعتهالمريض
+
+280
+00:21:34,120 --> 00:21:36,440
+حيجي الـ Fever لأنه في منطقة كبيرة صار لها «اند
+
+281
+00:21:36,440 --> 00:21:39,200
+باركن» بعد شوية حصير اندو fever حيجي ال «كاف
+
+282
+00:21:39,200 --> 00:21:42,680
+ديافوريسيز» إجهاد لإنه الـ «ديافوريسيز» بسبب إنه
+
+283
+00:21:42,680 --> 00:21:47,040
+مجهد في عملية التنفس و بالنسبة له عملية صعبة مجهدة
+
+284
+00:21:47,040 --> 00:21:50,660
+حيجي شوية شوية أصير «اندو كاف» علامة كتير كتير
+
+285
+00:21:50,660 --> 00:21:55,620
+مهمة يا جماعة في موضوع الـ Pulmonary Implosion إنه
+
+286
+00:21:55,620 --> 00:22:02,350
+ممكن تلاقي شوية skin«Rash» أو «Petechia rash»
+
+287
+00:22:02,350 --> 00:22:05,650
+بالذات يعني بتعرف الـ «Petechia rash» يعني إنه
+
+288
+00:22:05,650 --> 00:22:10,970
+بيكون عبارة عن نقط يعني
+
+289
+00:22:10,970 --> 00:22:15,790
+إيش بده .. يعني النقط هذه بتعرفوا إيش تعريف الـ
+
+290
+00:22:15,790 --> 00:22:19,030
+«Petechia rash» يعني هي عبارة عن انفجار في الـ
+
+291
+00:22:19,030 --> 00:22:23,070
+«Capillaries» فبطلع إيش؟ شوية دم وبتعلم تقت الـ
+
+292
+00:22:23,070 --> 00:22:26,070
+«Skin» بس وين هي دي عادة بنلاقيها؟ في منطقة الـ
+
+293
+00:22:26,070 --> 00:22:29,080
+«Neck»لو جيتك طلعت على المنطقة الـ neck و الـ
+
+294
+00:22:29,080 --> 00:22:32,720
+shoulder تبقى المريض تلاحظ كده الـ neck و ال
+
+295
+00:22:32,720 --> 00:22:41,150
+shoulder ممكن تلاقيمقاط بتيش ياراش هذا من العلامات
+
+296
+00:22:41,150 --> 00:22:44,730
+اللي خلّت خلّيك تعرف إن هذا could be pulmonary
+
+297
+00:22:44,730 --> 00:22:47,650
+embolism كمان ممكن نلاقي زي الـ Petit Charrache
+
+298
+00:22:47,650 --> 00:22:50,570
+هذه يا جماعة في الـ Sclera في الـ Sclera لو شوفنا
+
+299
+00:22:50,570 --> 00:22:54,150
+بياض الأين تبع المريض هذا ممكن نشوف هذه الحاجة
+
+300
+00:22:54,150 --> 00:23:01,090
+علشان هيك هذه تعتبرمن أهم العلامات إلى جانب
+
+301
+00:23:01,090 --> 00:23:04,610
+العلامات اللي حكينا عنهم إن الpatient بيجي dysnet،
+
+302
+00:23:04,610 --> 00:23:09,750
+بيجي anxiety، distress، بيجي diaphoresis، بيجي
+
+303
+00:23:09,750 --> 00:23:14,470
+endoskeletal pain وباقي
+
+304
+00:23:14,470 --> 00:23:20,080
+الحاجات اللي حكيناعنها طبعاً من وسائل التشخيص غير
+
+305
+00:23:20,080 --> 00:23:23,160
+إنه نعمل علامة X-Ray العادية أو غير إنه الـ
+
+306
+00:23:23,160 --> 00:23:26,700
+Physical Examination ونحترم الشكوه تبعته ونشوف إن
+
+307
+00:23:26,700 --> 00:23:31,750
+علاماته تبعته هذه could be pulmonary embolismالـ
+
+308
+00:23:31,750 --> 00:23:36,690
+ECG could be useful في الحالات هادية يا جماعة خاصة
+
+309
+00:23:36,690 --> 00:23:40,050
+إنه المريض بيجي بالـ Sinus Tachycardia يعني heart
+
+310
+00:23:40,050 --> 00:23:45,390
+rate عالي بس منتظم لأن الموضوع مش خلل في القلب،
+
+311
+00:23:45,390 --> 00:23:49,190
+Sinus الـ VR Interval تبعته بتكون Depression،
+
+312
+00:23:49,190 --> 00:23:54,270
+لاحظوا الـ VR Interval، Depression مش هحكيكوا كتير
+
+313
+00:23:54,270 --> 00:23:58,660
+في الـ ECG عشان لسه أنتوا مافكتوش موضوعالـ Heart
+
+314
+00:23:58,660 --> 00:24:02,580
+إن شاء الله يعني مستقبلاً بيسيط أنتموا عارفين أكتر
+
+315
+00:24:02,580 --> 00:24:07,040
+في موضوع الـ Heart أو لما نشرح الـ ECG بيكون
+
+316
+00:24:07,040 --> 00:24:13,340
+الموضوع أسهل وممكن نرجع نحكي عن العلمات اللي بتكون
+
+317
+00:24:13,340 --> 00:24:17,420
+في الـMI وفي الـ Pulmonary Embolism وكل نوع من
+
+318
+00:24:17,420 --> 00:24:23,010
+الأمراضالـ ECG من الحاجات المهمة كثير اللي بتلزمنا
+
+319
+00:24:23,010 --> 00:24:25,630
+نعملها نعمل للمريض Artillery Blood Gases أحد الـ
+
+320
+00:24:25,630 --> 00:24:28,630
+Diagnostic Procedures اللي ممكن نعملها الـ
+
+321
+00:24:28,630 --> 00:24:31,250
+Artillery Blood Gases هتوضحلي يا جماعة حاجة مهمة
+
+322
+00:24:31,250 --> 00:24:36,350
+جدا أن المريض هيكون عندهhypoxemia هي أهم علامة
+
+323
+00:24:36,350 --> 00:24:39,250
+مميزة زي ما احنا فاكرين في الـARDS بنحكي إن
+
+324
+00:24:39,250 --> 00:24:42,170
+الـhypoxemia يعني الـPO2 الـpartial pressure
+
+325
+00:24:42,170 --> 00:24:49,810
+للأكسجين أقل من 60 طبعاً ممكن الـCO2 حسب وضع
+
+326
+00:24:49,810 --> 00:24:53,170
+العيانة إذا العيانة جاي بتاكدني أكيد هلاقي hypo
+
+327
+00:24:53,170 --> 00:24:57,230
+-cabemia لإنه في washing outللـ «CO2» لكن إذا
+
+328
+00:24:57,230 --> 00:25:01,130
+العيان بدأ يتعب ويصير «hypoventilation» هيبدأ يصير
+
+329
+00:25:01,130 --> 00:25:04,590
+فيه attention للـ «CO2» في الأول عادة بيجي المريض
+
+330
+00:25:04,590 --> 00:25:07,570
+بـ «hypokamia» لأنه بيجي بالنسبة لـ «calorie rate»
+
+331
+00:25:07,570 --> 00:25:13,010
+عالي وتكبنية okay بالنسبة للحاجات المهمة أيضا ل
+
+332
+00:25:13,010 --> 00:25:17,170
+«as a diagnosis» أنه نعمل للمريض هذا «pulmonary
+
+333
+00:25:17,170 --> 00:25:21,470
+angiography» علشان نشوف بالظبط وين المنطقة في ال
+
+334
+00:25:21,470 --> 00:25:27,240
+«lung» اللي مشيعني ما بيوصلهاش دم عشان هيك
+
+335
+00:25:27,240 --> 00:25:31,100
+الـangiography يعني بيعدوا صبغة و بيصوروا فبالتالي
+
+336
+00:25:31,100 --> 00:25:33,460
+بيقرأوا ما بيوصلوا صبغة في البلاد فبالتالي بيقرأوا
+
+337
+00:25:33,460 --> 00:25:35,840
+في الـLang بالظبط وين المنطقة اللي ما بيوصلهاش دم
+
+338
+00:25:35,840 --> 00:25:42,040
+وInfarcted area الـCT أيضًا هي يعني could be could
+
+339
+00:25:42,040 --> 00:25:46,920
+be so helpful إنها تحدد ليه المنطقة طبعًا الـCT أو
+
+340
+00:25:46,920 --> 00:25:50,620
+Magnetic Resonance Image MRI عشان يتحدد ليه وين
+
+341
+00:25:50,620 --> 00:25:55,350
+المنطقة بالظبط الريعتين اللي فيهاالـ Damage or
+
+342
+00:25:55,350 --> 00:26:00,150
+Impartial الـ Medical Management للـ Pulmonary
+
+343
+00:26:00,150 --> 00:26:07,350
+Endolism يا جماعةبنقل أولا التعامل معاه بشكل
+
+344
+00:26:07,350 --> 00:26:12,250
+emergency أول ما بيجي على الطوارئ وبكون الوضع تبقى
+
+345
+00:26:12,250 --> 00:26:16,110
+critical أكيد أنه احنا بدنا نحطه في bed rest ما
+
+346
+00:26:16,110 --> 00:26:22,830
+تحاولش تنايم العيان يعني spine على الآخر لأنه نفسه
+
+347
+00:26:22,830 --> 00:26:26,550
+تبقى تعبان فخلّيه in a fowler position حاول تديله
+
+348
+00:26:26,550 --> 00:26:33,530
+exogen علشان يتحسنمن الـ Hypoxemia اللي عنده الـ
+
+349
+00:26:33,530 --> 00:26:39,070
+Low Saturation طبعا بعد هيكة هتتم يعني أسحب
+
+350
+00:26:39,070 --> 00:26:43,490
+التحليل وعمل إجراءات تشخصية لبنما يعرف إيش الوضع
+
+351
+00:26:43,490 --> 00:26:46,090
+اللي عند المريض بالظبط ومجرد ما يتحدد إن هذا
+
+352
+00:26:46,090 --> 00:26:50,550
+المريض هو بالمونري أمبوليزم هيبدو يا جماعة يفكروا
+
+353
+00:26:50,550 --> 00:26:56,330
+بإنهم يدوا أدوية مذيبة للجلطة يعني بيسموها
+
+354
+00:26:56,330 --> 00:27:02,560
+ThrombolyticTherapy وكمان أدوية Anticoagulant طب
+
+355
+00:27:02,560 --> 00:27:05,840
+إيش وظيفة الـ Anticoagulant اللي بتمنع التجلطات؟
+
+356
+00:27:05,840 --> 00:27:10,400
+ما هو صار عنده جلطة وخلص؟ آه الوظيفة هان إنه نمنع
+
+357
+00:27:10,400 --> 00:27:15,280
+الـ Farter accumulationأو Farther Formation
+
+358
+00:27:15,280 --> 00:27:18,100
+لـLithrombus يعني ما نخلّيش Lithrombus تكبر في
+
+359
+00:27:18,100 --> 00:27:22,740
+حجمها كمان وكمان لأنه مجرد ما صارت هيكون هي يعني
+
+360
+00:27:22,740 --> 00:27:26,740
+في طريق مسدود و الـPlatelet هتبدأ تعمل فوقها
+
+361
+00:27:26,740 --> 00:27:29,620
+Aggregation و Aggregation و Aggregation وبدل ما
+
+362
+00:27:29,620 --> 00:27:33,440
+حجمها كذا يصير أكبر وأكبر وأكبر فبندل
+
+363
+00:27:33,440 --> 00:27:38,910
+Anticoagulation علشانوAnti-aggregant كمان من الـ
+
+364
+00:27:38,910 --> 00:27:42,490
+Anticoagulant المعروفين الـ Aspirin من الـ
+
+365
+00:27:42,490 --> 00:27:47,290
+Anticoagulant المعروفين الهيبارين والكليكسان تمام؟
+
+366
+00:27:47,290 --> 00:27:50,290
+والـ Thermopolitic Therapy عادي أبدأ أدي أدري
+
+367
+00:27:50,290 --> 00:27:56,510
+علشان إيش تسوي علشان تبدأ تحلل الجلطة هذه و تدوبها
+
+368
+00:27:56,510 --> 00:28:01,870
+و ترجع المنطقة يصير لها Perfusion طبعاً من الطرق
+
+369
+00:28:01,870 --> 00:28:09,140
+كمان يا جماعة أنه ممكنيتدخّلوا بالقسطرة أو
+
+370
+00:28:09,140 --> 00:28:12,840
+interventional catheterization أو surgical
+
+371
+00:28:12,840 --> 00:28:17,200
+intervention يخشوا على الرأى أو يحاولوا أويينه
+
+372
+00:28:17,200 --> 00:28:20,660
+لـLimbolism إذا كانوا عارفين وين الـVessel هذا
+
+373
+00:28:20,660 --> 00:28:24,960
+ومحدد طبعاً
+
+374
+00:28:24,960 --> 00:28:27,900
+هنا أنا بلخص الـEmergency Management لما يجيك على
+
+375
+00:28:27,900 --> 00:28:32,680
+المريض كيف بدك تتعامل معاه كيف بدك تبدأ بالـبتحطه
+
+376
+00:28:32,680 --> 00:28:36,160
+في الـ Potassium تدل الـ Oxygen تركب IV Cannula
+
+377
+00:28:36,160 --> 00:28:40,360
+تبدأ تشخص
+
+378
+00:28:40,360 --> 00:28:44,990
+تاخد Blood Gases وتحاول أن تنسق لهاالـ CT
+
+379
+00:28:44,990 --> 00:28:47,890
+وAndrographي عشان تعرفوا إن المريض إذا كان عنده
+
+380
+00:28:47,890 --> 00:28:52,570
+Hypotension تديله supportive management زي
+
+381
+00:28:52,570 --> 00:28:59,950
+الدوبامين والدوبيوتامين علشان ترفع
+
+382
+00:28:59,950 --> 00:29:01,990
+الضغط وتحسن الـ
+
+383
+00:29:04,620 --> 00:29:08,160
+الـBlood Pressure اللي عنده طبعاً ممكن يحتاج
+
+384
+00:29:08,160 --> 00:29:13,800
+المريض لو صار عنده تطور لصار عنده Arrhythmia أو
+
+385
+00:29:13,800 --> 00:29:17,780
+صار فيه احتقان أو بدأ يخش بـHeart Failure نبدأ
+
+386
+00:29:17,780 --> 00:29:21,280
+ندّي Diuretics وندّي Anti-Arrhythmic Therapy كل
+
+387
+00:29:21,280 --> 00:29:25,600
+هذه الحاجات يعني الـPain السيفير اللي إجا عنده
+
+388
+00:29:25,600 --> 00:29:28,820
+بيكون بدنا نتعامل معاه وندّيله مورفين لو المريض
+
+389
+00:29:28,820 --> 00:29:32,740
+الـHypoxia تبعته زادت والتكيميا زادت كتير وخش في
+
+390
+00:29:32,740 --> 00:29:33,440
+Respiratory
+
+391
+00:29:36,400 --> 00:29:40,660
+أو ممكن في الأول يكون الـ Respiratory Alkalosis يا
+
+392
+00:29:40,660 --> 00:29:45,800
+جماعة لأنه يكون الكبنية كتير والـ CO2 واطي كتير
+
+393
+00:29:45,800 --> 00:29:49,740
+فممكن ندخل في الـ Respiratory Alkalosis ففي كل
+
+394
+00:29:49,740 --> 00:29:52,960
+الأحوال حيكون بحتاج Mechanical Ventilator
+
+395
+00:29:55,240 --> 00:30:00,220
+حكينا عن الـ Anticoagulation بشكل مفصل وحكينا عن
+
+396
+00:30:00,220 --> 00:30:04,840
+إيش هي الأدوية اللي كتير تستخدم سواء الـ Heparin
+
+397
+00:30:04,840 --> 00:30:08,560
+أو الكليكسان وحكينا عن الـ Thrombolytic Therapy
+
+398
+00:30:08,560 --> 00:30:12,600
+الأدوية اللي كتير بتستخدم و بالذات أن الـ
+
+399
+00:30:12,600 --> 00:30:16,100
+Thrombolytic Therapy دوة اسمها الـ Stryptokinase
+
+400
+00:30:16,100 --> 00:30:19,040
+الـ Stryptokinase هو مُركّب أصلاً من بكتيريا الـ
+
+401
+00:30:19,040 --> 00:30:21,240
+Strypto ومخدوها
+
+402
+00:30:23,120 --> 00:30:27,060
+وبيجهزوا منها مُركّب وظيفته إنه لما بيخش على الجسم
+
+403
+00:30:27,060 --> 00:30:32,280
+وبيعطوه بيروح بيدور على الـ «ترمبس» وبيبدأ يتفاعل
+
+404
+00:30:32,280 --> 00:30:36,860
+مع الـ «ترمبس» هذه ويحللها، يعملها destruction
+
+405
+00:30:36,860 --> 00:30:41,880
+وبالتالي المريض هذا اللي أنا لازم أو بدي أديره
+
+406
+00:30:41,880 --> 00:30:46,390
+«سريبتو كاينيز»فيه criteria معينة لازم يكون بتتطبق
+
+407
+00:30:46,390 --> 00:30:51,390
+على المريض يعني أنا بدأ أدى دوة بدوّب الجلطة أو
+
+408
+00:30:51,390 --> 00:30:56,090
+بحلل الجلطة اللي موجودة لكن لازم at least من
+
+409
+00:30:56,090 --> 00:30:59,610
+المريض هذا يعني لإن أنا بتوقع أن الدم يصير فيه
+
+410
+00:30:59,610 --> 00:31:03,090
+سيولة فمش معقول يكون مريض مثلا عامل عملية recently
+
+411
+00:31:03,090 --> 00:31:07,970
+قبل 24 ساعة و 48 ساعة و أجي أديله thrombolytic
+
+412
+00:31:07,970 --> 00:31:13,750
+agent مش معقول مريضعنده مشاكل أصلاً زي الـ
+
+413
+00:31:13,750 --> 00:31:15,830
+Hemophilia في الـ Blood روح قدّي Electrophobic
+
+414
+00:31:15,830 --> 00:31:21,070
+Agent بتدور على حل أكتر أمن Electrophobic Therapy
+
+415
+00:31:21,070 --> 00:31:23,750
+ففيه criteria و Contraindication
+
+416
+00:31:26,190 --> 00:31:29,830
+معتبرة، must be considered في حالات الـ
+
+417
+00:31:29,830 --> 00:31:33,110
+Thrombolytic Therapy الـ Surgical Management برضه
+
+418
+00:31:33,110 --> 00:31:38,790
+حكينا عنه من شوية كيف ممكن سواء كان عن طريق إنهم
+
+419
+00:31:38,790 --> 00:31:43,030
+يعملوا Surgery ويعينوا لـ Clot هادة أو حاليًا صار
+
+420
+00:31:43,030 --> 00:31:48,490
+في اللي هي الـ «Catheterization» زي ما حكينا
+
+421
+00:31:48,490 --> 00:31:52,240
+«Interventional Catheterization» زي ما بيخشوا فيفي
+
+422
+00:31:52,240 --> 00:31:56,440
+مرضى الـMI وبيعينه لـThrombus ممكن نقشه على
+
+423
+00:31:56,440 --> 00:32:00,960
+الـPulmonary Artery Branch اللي إذا كان محدد وقريب
+
+424
+00:32:00,960 --> 00:32:04,840
+ويحاول إنه يعين لـThrombus هذه الـNursing
+
+425
+00:32:04,840 --> 00:32:07,580
+Management تبعتنا هتكون في الموضوع تبع
+
+426
+00:32:07,580 --> 00:32:14,490
+الـPulmonary Embolismكثيرة، أهمها لو تم التعامل مع
+
+427
+00:32:14,490 --> 00:32:19,570
+المريض بأي من الأدوية وهو الآن منون في القسم إنه
+
+428
+00:32:19,570 --> 00:32:25,810
+أنا بدي أمنع الـ Thrombus Formation يعني إنها
+
+429
+00:32:25,810 --> 00:32:33,210
+تستمر وتزيد عن طريق إن المريض هذاسواء هو أو غيره،
+
+430
+00:32:33,210 --> 00:32:37,090
+لو حتى مريض ما كانش اندوبلموريومبوليزم، آه، لكن
+
+431
+00:32:37,090 --> 00:32:40,690
+ممكن يصير اندو عشان هو عامل عملية وهو بتدردن، إيش
+
+432
+00:32:40,690 --> 00:32:44,530
+اللي بيعمل ال .. ال .. أو ممكن يطور الحالة؟ إنه
+
+433
+00:32:44,530 --> 00:32:48,130
+يخش الـDVT، لو بدردن ممكن يخش الـDVT، لو خش الـDVT
+
+434
+00:32:48,130 --> 00:32:51,850
+إيش ممكن يصير؟ ممكن يتطور لبلموريومبوليزم، إذا أنا
+
+435
+00:32:51,850 --> 00:32:57,940
+كان يارس وظيفتي أن أمنعالـ DVT إنها الـ Fear عشان
+
+436
+00:32:57,940 --> 00:33:02,520
+هي كان مهم إن المريض في السرير أخليه يحاول يعمل
+
+437
+00:33:02,520 --> 00:33:06,840
+Bombing Exercise كيف يعني؟ يعني يحرك في عضلات
+
+438
+00:33:06,840 --> 00:33:12,000
+رجليه ويدفعهم حتى لو ممنوع يمشي هو هو ممنوع يمشي
+
+439
+00:33:12,000 --> 00:33:16,660
+نتيجة إنه عامل مثلًا عنده Neck Femur Fractureمريض
+
+440
+00:33:16,660 --> 00:33:19,940
+تاني عامل recent abdominal surgery مش معناه انه
+
+441
+00:33:19,940 --> 00:33:23,580
+ممنوع يتحرك الاسرير كمان لو هو المفروض انه يظل في
+
+442
+00:33:23,580 --> 00:33:27,660
+الاسرير وفيه ما يمنع انه يتحرك اه بدنا نلبسه حاجة
+
+443
+00:33:27,660 --> 00:33:36,020
+اسمها اللي هو stocks اللي هو عبارة عن حاجة زي ال
+
+444
+00:33:37,640 --> 00:33:42,400
+الجوارب بتلخبص من القدم من أخمص القدم من تحت لأ
+
+445
+00:33:42,400 --> 00:33:50,120
+فوق اللي هم الـThigh بحيث أنها تسهل الـ «Venous
+
+446
+00:33:50,120 --> 00:33:54,280
+Return» و«Lymphatic Drainage» كله وخلّي يصير فيه
+
+447
+00:33:54,280 --> 00:33:58,080
+إمكانية أن يرجع بشكل أسهل طبعاً في ناس ممكن تستخدم
+
+448
+00:33:58,080 --> 00:34:01,880
+«Crip Bandage» بس بيحكي دايماً أنه عشان تستخدم
+
+449
+00:34:01,880 --> 00:34:06,140
+«Crip Bandage» فيه criteria معينةالأهم فيها أنك
+
+450
+00:34:06,140 --> 00:34:12,280
+لازم تبدأ من أول القدم مش من أول الساق و تسيب
+
+451
+00:34:12,280 --> 00:34:16,920
+القدم وبالتالي في منطقة بتكون محتقنة و هتلاقي بعد
+
+452
+00:34:16,920 --> 00:34:22,440
+شوية أن القدنين صار فيهم إدينةكويس، من الحاجات
+
+453
+00:34:22,440 --> 00:34:26,540
+كمان المهمة إذا ما أنت بتتعامل مع مريض post-op
+
+454
+00:34:26,540 --> 00:34:31,480
+عادة عشان نتفادى هذا الخطر إنه early
+
+455
+00:34:31,480 --> 00:34:37,540
+immobilization أخليه يتحرك بدري و أخليه يمشي بدري
+
+456
+00:34:37,540 --> 00:34:42,300
+كل ما أنا خليت المريض يمشي بدري كل ما أنا وماكانش
+
+457
+00:34:42,300 --> 00:34:46,240
+فيه مانع طبعا إنه يمشي كل ما أنا عند الخطر تبع إنه
+
+458
+00:34:46,240 --> 00:34:47,600
+يصير endothrombus
+
+459
+00:34:50,030 --> 00:34:55,370
+لو كنت تتعامل مع مريض بده يأخذ «Thrombolytic
+
+460
+00:34:55,370 --> 00:34:58,430
+Therapy» لازم يكون طول الوقت هذا المريض under your
+
+461
+00:34:58,430 --> 00:35:02,150
+monitor لأنه ممكن جدا يخش في hypertension لازم
+
+462
+00:35:02,150 --> 00:35:04,930
+يكون على monitor ويكون في dysrhythmia إذا كان
+
+463
+00:35:04,930 --> 00:35:09,610
+المريض عنده بين، انت كنيرز، بدك زي ما حكيناممكن
+
+464
+00:35:09,610 --> 00:35:13,270
+تدّي الـ Pre-Prescribed Pain Killers وكمان بدك
+
+465
+00:35:13,270 --> 00:35:15,510
+تخلي المريض في comfortable position لإن ال
+
+466
+00:35:15,510 --> 00:35:20,010
+position و ال oxygen ممكن يقلله القلم و كمان نعمل
+
+467
+00:35:20,010 --> 00:35:27,090
+للمريض اللي هو support المحاضرة
+
+468
+00:35:27,090 --> 00:35:32,120
+الجايأو هيك احنا بنكون خلصنا الـ Pulmonary
+
+469
+00:35:32,120 --> 00:35:38,200
+embolism علشان هيك هنتوقف عند الـ Pulmonary
+
+470
+00:35:38,200 --> 00:35:45,940
+embolism ونكمل
+
+471
+00:35:45,940 --> 00:35:47,680
+المحاضرة الجاي، أعطيكوا العافية
+
diff --git a/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/gj5qIreau7E.srt b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/gj5qIreau7E.srt
new file mode 100644
index 0000000000000000000000000000000000000000..285b5aa763f6c293bfb19db0f5fc94f1a5295025
--- /dev/null
+++ b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/gj5qIreau7E.srt
@@ -0,0 +1,2462 @@
+1
+00:00:02,600 --> 00:00:09,480
+بسم الله الرحمن الرحيم، أُصعد الله أوقاتكم جميعًا
+
+2
+00:00:09,480 --> 00:00:16,300
+يعني،
+
+3
+00:00:16,300 --> 00:00:24,760
+هنبدأ من الأول، حكينا أنَّ الشوك لها
+
+4
+00:00:24,760 --> 00:00:31,280
+أنواع عديدة، الأربع أنواع الأساسية للـShock اللي
+
+5
+00:00:31,280 --> 00:00:40,920
+شبهناهم بتشبيهات، يعني عطينا مثل: لو أحد يريد زراعة
+
+6
+00:00:40,920 --> 00:00:46,540
+قطعة أرض، يجب أن يكون لديه أربعة مصادر أساسية، يجب أن
+
+7
+00:00:46,540 --> 00:00:55,260
+يكون لديه مضخة (pump)، مصدر مياه، ويجب أن
+
+8
+00:00:55,260 --> 00:00:59,260
+يكون لديه أنابيب (pipes) أو tubes
+
+9
+00:00:59,260 --> 00:01:04,280
+لنقل المياه، ويجب أن يكون لديه محابس
+
+10
+00:01:04,280 --> 00:01:11,780
+أو valves للتحكم في وصول المياه. هذا بالنسبة
+
+11
+00:01:11,780 --> 00:01:15,060
+للزراعة. حكينا أنه بالضبط هذا ما يحدث في جسم
+
+12
+00:01:15,060 --> 00:01:21,360
+الإنسان. لو كانت المشكلة في المضخة نفسها (pump itself)، يعني كان
+
+13
+00:01:21,360 --> 00:01:27,380
+المضخة التي تنقل الدم إلى جميع أجزاء الجسم، وهي
+
+14
+00:01:27,380 --> 00:01:33,260
+القلب، فإن هذه تُسمى
+
+15
+00:01:33,260 --> 00:01:36,580
+Cardiogenic Shock. من هذا التعريف، لنفهم المعنى
+
+16
+00:01:36,580 --> 00:01:41,320
+لو كانت المشكلة في أن مصدر الماء أصلاً هو الذي
+
+17
+00:01:41,320 --> 00:01:46,160
+غير موجود أو فيه نقص (deficiency)، تُسمى هذه
+
+18
+00:01:46,160 --> 00:01:51,750
+Hypovolemic Shock. لو كانت المشكلة في الأنابيب (pipes)
+
+19
+00:01:51,750 --> 00:01:55,950
+نفسه، "pipe failure"، الأنابيب التي تنقل
+
+20
+00:01:55,950 --> 00:02:00,210
+الماء، كانت واسعة جداً، كما يحدث في
+
+21
+00:02:00,210 --> 00:02:04,230
+الـDistributive Shock، وسنرى أن كل نوع من هذه
+
+22
+00:02:04,230 --> 00:02:06,210
+الأنواع، يعني، يأتي تحته أنواع فرعية، وبالذات
+
+23
+00:02:06,210 --> 00:02:09,670
+الـDistributive Shock، يوجد تحته أنواع كثيرة مثل
+
+24
+00:02:09,670 --> 00:02:14,910
+الـSeptic Shock، وToxic Shock، يعني
+
+25
+00:02:14,910 --> 00:02:20,600
+الـAnaphylactic Shock، المرتبطة بالسموم أو أي
+
+26
+00:02:20,600 --> 00:02:23,160
+نوع من الحساسية (allergy) أو أي
+
+27
+00:02:23,160 --> 00:02:24,560
+نوع من الحساسية (allergy) أو أي
+
+28
+00:02:24,560 --> 00:02:27,220
+نوع من الحساسية (allergy) أو أي
+
+29
+00:02:27,220 --> 00:02:28,220
+نوع من الحساسية (allergy) أو أي
+
+30
+00:02:28,220 --> 00:02:28,960
+نوع من الحساسية (allergy) أو أي
+
+31
+00:02:28,960 --> 00:02:30,920
+نوع من الحساسية (allergy) أو أي
+
+32
+00:02:30,920 --> 00:02:32,180
+نوع من الحساسية (allergy) أو أي
+
+33
+00:02:32,180 --> 00:02:34,940
+نوع من الحساسية (allergy) أو أي
+
+34
+00:02:34,940 --> 00:02:47,960
+نوع من الحساسية (allergy) أو أي  نوع من الحساسية (allergy) أو
+
+35
+00:02:47,960 --> 00:02:51,690
+أي شيء وظيفته التحكم في وصول الدم، عامل
+
+36
+00:02:51,690 --> 00:02:55,070
+انسداد (Obstruction)، يعيق وصول الدم. وحكينا أن هذا يحدث
+
+37
+00:02:55,070 --> 00:02:57,970
+نتيجة ضغط (pressure) على الخلايا (B-cell) كما في
+
+38
+00:02:57,970 --> 00:03:01,870
+النزيف الصدري (Tension Pneumothorax). كيف تكون الخلايا (B-cell)؟  يعني، القلب قادر على
+
+39
+00:03:01,870 --> 00:03:07,710
+النبض، لا يوجد فشل في المضخة (pump failure)، كمية الدم (amount of blood)
+
+40
+00:03:07,710 --> 00:03:14,970
+متوفرة (already)، يوجد دم موجود ويمكنه الوصول إلى الأنسجة، لكن،
+
+41
+00:03:14,970 --> 00:03:18,810
+لا يوجد صدمة فرط حجم الدم (hypervolemic shock)، لكن المشكلة أن هناك
+
+42
+00:03:18,810 --> 00:03:25,670
+شيئاً يُسبب انسداد (obstruction)، مانعاً تدفق
+
+43
+00:03:25,670 --> 00:03:31,070
+الدم، يُطلق (release) الدم، يعني،  إرواء (perfusion) لباقي
+
+44
+00:03:31,070 --> 00:03:34,730
+أجزاء الجسم. هذا ما سميناه الصدمة الانسدادي (Obstructive shock)، و
+
+45
+00:03:34,730 --> 00:03:37,870
+أعطينا مثالاً واضحاً عليه وهو النزيف الصدري (tension pneumothorax).
+
+46
+00:03:37,870 --> 00:03:43,180
+كيف يكون القلب ينبض، كمية الدم (amount of blood) متوفرة (already)
+
+47
+00:03:43,180 --> 00:03:50,590
+متوفرة، لكن لا توجد طريقة لخروج الدم من القلب لتغذية
+
+48
+00:03:50,590 --> 00:03:55,450
+جميع الأعضاء الأخرى بسبب النزيف الصدري (pneumothorax)، بسبب
+
+49
+00:03:55,450 --> 00:04:01,090
+الضغط، وهو ضغط الهواء طبعاً، الذي يمنع وصول
+
+50
+00:04:01,090 --> 00:04:06,150
+الدم إلى الأعضاء الأخرى لتغذيتها، حسنًا؟
+
+51
+00:04:12,220 --> 00:04:15,360
+مجرد تكرار
+
+52
+00:04:15,360 --> 00:04:17,080
+تكرار
+
+53
+00:04:17,080 --> 00:04:25,000
+تكرار
+
+54
+00:04:38,390 --> 00:04:42,570
+حكينا أنَّ الشوك من ناحية نظرية هو عدم القدرة على تلبية (Inability to meet)
+
+55
+00:04:42,570 --> 00:04:45,270
+احتياجات الخلايا من الأكسجين (cellular requirements for oxygen). لماذا؟ لأنَّني
+
+56
+00:04:45,270 --> 00:04:48,250
+عندما أقول أنَّ المريض يعاني من صدمة، فهذا يعني أنَّه أصبح هناك
+
+57
+00:04:48,250 --> 00:04:51,970
+انخفاض حاد في ضغط الدم (practically severe hypotension)، ضغط الدم
+
+58
+00:04:51,970 --> 00:04:58,070
+منخفض جداً، ولهذا السبب، من الناحية النظرية، أصبح
+
+59
+00:04:58,070 --> 00:05:03,680
+إرواء الأنسجة (perfusion) قليلاً، وبالتالي احتياجات الأكسجين (Oxygen)
+
+60
+00:05:03,680 --> 00:05:08,800
+لم تُلبّى (not met). لذا، الأعضاء (organ)، يعني كل الخلايا (cells)
+
+61
+00:05:08,800 --> 00:05:12,940
+لا تصلها الكمية الكافية من الأكسجين، وبالتالي
+
+62
+00:05:12,940 --> 00:05:17,260
+الأنسجة (tissue) التي تتكون من مجموعة الخلايا (cells) تكون أنسجة (tissue)
+
+63
+00:05:17,260 --> 00:05:22,660
+ تابعة للعضو (tissue) المعين، سواء كان رئة (lung)
+
+64
+00:05:22,660 --> 00:05:26,260
+سواء كانت كبد (liver)، عضلة (muscle)، أو أي شيء آخر (whatever)
+
+65
+00:05:26,260 --> 00:05:30,780
+ستعاني من فشل (failure). وعندما تكون الصدمة حادة (severe)
+
+66
+00:05:30,780 --> 00:05:35,990
+(shock)، يحدث انخفاض حاد في ضغط الدم (severe hypotension)، لا تصل جميع الأعضاء
+
+67
+00:05:35,990 --> 00:05:40,710
+الدم الكافي. لو نظرنا إلى الدماغ، عندما يحدث فيه
+
+68
+00:05:40,710 --> 00:05:45,990
+انخفاض في الإرواء (low perfusion)، وفي النهاية ماذا يحدث؟ لا يوجد (no)
+
+69
+00:05:45,990 --> 00:05:49,490
+إرواء (perfusion)، لا يوجد دم يصل نهائياً (because of severe)
+
+70
+00:05:49,490 --> 00:05:54,410
+انخفاض حاد في ضغط الدم (hypotension). ماذا سيحدث؟ سيحدث فشل (failure)
+
+71
+00:05:54,410 --> 00:05:57,510
+في الجهاز العصبي المركزي (central nervous system)، فيصبح المريض فاقداً للوعي (unconscious).
+
+72
+00:05:57,510 --> 00:06:02,910
+أما الكلى (kidney)، الكلى أيضاً تعاني من انخفاض في الإرواء (low perfusion)، انخفاض
+
+73
+00:06:02,910 --> 00:06:05,890
+إخراج البول (urine output) بسبب ماذا؟ بسبب فشل الكلى (kidney)
+
+74
+00:06:05,890 --> 00:06:08,510
+(failure). يعني، تصاب الكلى أولاً (injured)
+
+75
+00:06:08,510 --> 00:06:13,690
+على أي حال (anyway)، الكلى لم تعد تعمل بكفاءة (functionally well) كما
+
+76
+00:06:13,690 --> 00:06:16,530
+الدماغ، وظيفته أن يكون متيقظاً (alert) وواعياً (conscious)
+
+77
+00:06:16,530 --> 00:06:21,100
+لم تعد تعمل بكفاءة (functionally well).  صار عندك إيش؟ فشل في النظام (system)
+
+78
+00:06:21,100 --> 00:06:23,800
+(failure)، صار الجهاز العصبي المركزي (central nervous system) به فشل (failure)
+
+79
+00:06:23,800 --> 00:06:27,220
+صار في الكلى (kidney) فشل (failure).
+
+80
+00:06:27,220 --> 00:06:32,180
+طبعاً، كلما استمرت الصدمة (shock) لفترة أطول، كلما زاد
+
+81
+00:06:32,180 --> 00:06:37,160
+فشل الأعضاء (system organ failure)، يزيد عدد الأعضاء المتضررة (more than one organ)
+
+82
+00:06:37,160 --> 00:06:39,900
+وبالتالي، قد يدخل المريض في حالة فشل متعدد الأعضاء (multi organ system failure).
+
+83
+00:06:39,900 --> 00:06:43,920
+وبالتالي تصبح الصدمة (shock) لا رجعة فيها (irreversible shock).
+
+84
+00:06:43,920 --> 00:06:49,970
+لهذا السبب، نقول أنَّ الاستقرار الديناميكي الهيدروديناميكي (Hemodynamic Stability) هو أهم
+
+85
+00:06:49,970 --> 00:06:54,430
+شيء للحفاظ على المريض مستقراً ديناميكياً (Stable Hemodynamically).
+
+86
+00:06:54,430 --> 00:06:57,930
+كيف؟ يعني يكون ضغط دمه (Blood Pressure) جيداً
+
+87
+00:06:57,930 --> 00:07:01,470
+وبالتالي، الإرواء (Perfusion) الذي يذهب إلى الكلى (Kidney) يذهب
+
+88
+00:07:01,470 --> 00:07:05,420
+إلى الدماغ (Brain) بشكل جيد، نتيجة معدل ضربات القلب المُعوّض (Compensated Heart)
+
+89
+00:07:05,420 --> 00:07:08,080
+Rate، نتيجة حجم الضربة الكافي (Enough Stroke Volume).
+
+90
+00:07:08,080 --> 00:07:11,520
+وبالتالي، الدفع القلبي (cardiac output)، ما هو الدفع القلبي؟ الذي
+
+91
+00:07:11,520 --> 00:07:16,100
+هو حجم الضربة (Stroke Volume) مضروباً في معدل ضربات القلب (Heart Rate)، لأنَّني
+
+92
+00:07:16,100 --> 00:07:19,500
+أتحدث عن الدفع القلبي (cardiac output)، يعني أتحدث عن كمية الدم التي
+
+93
+00:07:19,500 --> 00:07:25,800
+يقذفها القلب في الدقيقة الواحدة (per one minute). معدل ضربات القلب (Heart Rate) نفترض
+
+94
+00:07:25,800 --> 00:07:32,550
+80 نبضة في الدقيقة (80 beats per minute). حجم الضربة (Stroke Volume) كيف
+
+95
+00:07:32,550 --> 00:07:35,510
+نحسبه؟ تقريباً (Roughly) ملليلتر واحد
+
+96
+00:07:35,510 --> 00:07:38,730
+(one milliliter) لكل كيلوغرام (per kg). يعني، وزنه 70 كيلوغراماً، من المفترض أنَّه
+
+97
+00:07:38,730 --> 00:07:44,170
+يضخ في كل مرة (pumping) حوالي 70 مل (ML)، 70 مل،
+
+98
+00:07:44,170 --> 00:07:54,130
+تكرار
+
+99
+00:07:54,130 --> 00:07:55,290
+تكرار
+
+100
+00:07:55,290 --> 00:07:57,170
+تكرار
+
+101
+00:07:57,170 --> 00:08:02,840
+تكرار
+
+102
+00:08:02,840 --> 00:08:08,020
+كافية، وإذا كان إرواء الكلى (renal perfusion)، إرواء الدماغ (brain)
+
+103
+00:08:08,020 --> 00:08:14,520
+(perfusion)،  جميع الإرواءات (perfusion)  للأعضاء كافية،
+
+104
+00:08:14,520 --> 00:08:18,400
+فالمريض يكون مستقراً ديناميكياً (dynamically stable)، إلا إذا كان
+
+105
+00:08:18,400 --> 00:08:22,860
+ضغط الدم (blood pressure) منخفضاً، كما نرى في هذا الرسم التوضيحي (diagram)،
+
+106
+00:08:22,860 --> 00:08:25,720
+يوضح كيف، عندما ينخفض ضغط الدم (blood pressure) كثيراً، كيف
+
+107
+00:08:25,720 --> 00:08:31,340
+يصبح أقل؟ انخفاض في إرواء الأنسجة (Tissue Perfusion) يؤدي إلى
+
+108
+00:08:31,340 --> 00:08:34,700
+تجمع الخلايا (Cellular Aggregation). لماذا يحدث هذا التجمع؟ لأنَّه
+
+109
+00:08:34,700 --> 00:08:41,560
+لا يوجد ماء كافٍ في الأوعية الدموية (vessels).
+
+110
+00:08:41,560 --> 00:08:46,760
+وبالتالي، يحدث انسداد دقيق (Microcirculatory Obstruction)، هذا
+
+111
+00:08:46,760 --> 00:08:50,820
+يؤدي إلى تفاقم الحالة (worsen the situation). لذلك ترون انخفاض (decreased)
+
+112
+00:08:50,820 --> 00:08:55,100
+إرواء الأنسجة (Tissue perfusion) يؤدي إلى هذا. هنا عندما
+
+113
+00:08:55,100 --> 00:08:58,400
+يكون هناك انخفاض في إرواء الأنسجة (Tissue Perfusion)، يؤدي إلى
+
+114
+00:08:58,400 --> 00:09:01,280
+حماض استقلابي (Metabolic Acidosis). رأينا أنَّه غالباً ما يكون هناك
+
+115
+00:09:01,280 --> 00:09:04,200
+حماض استقلابي (Metabolic Acidosis) لدى المرضى الذين يعانون من الصدمة (Shocked Patient).
+
+116
+00:09:04,200 --> 00:09:09,640
+وهذا يؤدي إلى أنَّ عضلة القلب نفسها (Heart Muscle itself) أيضاً
+
+117
+00:09:09,640 --> 00:09:14,940
+لا تتغذى جيداً كباقي الأعضاء، وبالتالي، الدفع القلبي (cardiac output)، ماذا سيحدث له؟ سينخفض، وبالتالي
+
+118
+00:09:14,940 --> 00:09:18,500
+سيحدث أيضاً انخفاض (decrease) في ضغط الدم (blood pressure) أكثر فأكثر (more and)
+
+119
+00:09:18,500 --> 00:09:23,120
+(more)، وبالتالي تتفاقم الحالة (worse)، أسوأ، تمام؟ لهذا
+
+120
+00:09:23,120 --> 00:09:26,940
+السبب، لهذا السبب نلاحظ أنَّ... من... بمجرد (once)
+
+121
+00:09:26,940 --> 00:09:32,150
+يحدث انخفاض في ضغط الدم (there is decrease in blood pressure)، نبدأ ندخل في
+
+122
+00:09:32,150 --> 00:09:35,350
+حلقة مفرغة (continuous decrease blood pressure)، انخفاض مستمر في ضغط الدم
+
+123
+00:09:35,350 --> 00:09:39,730
+(continuous decrease blood pressure).  ينخفض إرواء الأنسجة (tissue perfusion)،  عضلة القلب بعد فترة
+
+124
+00:09:39,730 --> 00:09:42,830
+تضعف، يزداد الانخفاض (decrease) في ضغط الدم (blood pressure)  لأنَّه
+
+125
+00:09:42,830 --> 00:09:47,510
+يقل حجم الضربة (stroke volume)، وتكون هذه عملية مستمرة، إلا إذا
+
+126
+00:09:47,510 --> 00:09:51,980
+تم إنعاش المريض (Resuscitation) وعلاج سبب (Cause of)
+
+127
+00:09:51,980 --> 00:10:00,040
+الصدمة (Shock) لدى المريض ومعرفة سبب الصدمة (Cause of Shock). يعني إذا
+
+128
+00:10:00,040 --> 00:10:03,180
+كان نوع الصدمة (Shock)  Cardiogenic Shock،  هنا نحتاج
+
+129
+00:10:03,180 --> 00:10:06,220
+نتحدث عن العلاج (treatment)، باختصار (in brief) لأنَّه
+
+130
+00:10:06,220 --> 00:10:10,160
+سنتحدث عنه بالتفصيل. يعني، إذا كان السبب (Cause)
+
+131
+00:10:10,160 --> 00:10:12,320
+Cardiogenic Shock،  سأقوم بعمل أي شيء يساعد
+
+132
+00:10:12,320 --> 00:10:15,540
+القلب على العودة للانقباض بشكل جيد (to contract well). وإذا كانت المشكلة
+
+133
+00:10:15,540 --> 00:10:20,590
+Hypovolemic، سأعطي المريض سوائل (Fluids)
+
+134
+00:10:20,590 --> 00:10:24,050
+مثل كريستالويد (Crystalloid) و كولويد (Colloid) ودم (blood) حسب احتياجاته (according to his)
+
+135
+00:10:24,050 --> 00:10:28,550
+(needs)، حسناً (okay)، ووفقاً لمستوى الهيموجلوبين لديه (according to his hemoglobin).  إذا كان
+
+136
+00:10:28,550 --> 00:10:35,490
+السبب (cause) للصدمة نقص حجم الدم (hypovolemic shock)  نزيفاً (hemorrhage)، سيحتاج إلى
+
+137
+00:10:35,490 --> 00:10:41,440
+دم (blood).  إذا كان سبب الصدمة (cause of hypovolemic shock) هو الإسهال
+
+138
+00:10:41,440 --> 00:10:46,040
+أو كثرة التبول (polyuria)،  زيادة في إخراج البول (increased output)، يعني
+
+139
+00:10:46,040 --> 00:10:50,660
+مريض مصاب بكثرة التبول والإسهال (polyuria, diarrhea) ربما بسبب مرض السكري (diabetes) ربما
+
+140
+00:10:50,660 --> 00:10:53,880
+التهاب المعدة والأمعاء (gastroenteritis)،  مهما كان السبب (whatever)
+
+141
+00:10:53,880 --> 00:10:58,300
+(whatever was the cause) ، ستحتاج إلى تصحيح ذلك. إذا كانت الصدمة (hepavolumic shock)  نقص حجم
+
+142
+00:10:58,300 --> 00:11:01,640
+الدم، ستحتاج إلى تصحيح حجم السوائل (correct the fluid volume).  إذا
+
+143
+00:11:01,640 --> 00:11:05,440
+كانت الصدمة  Cardiogenic Shock، ستحتاج إلى دعم القلب (you need to)
+
+144
+00:11:05,440 --> 00:11:06,900
+تكرار
+
+145
+00:11:06,900 --> 00:11:13,460
+تكرار
+
+146
+00:11:13,460 --> 00:11:20,220
+تكرار
+
+147
+00:11:20,990 --> 00:11:25,930
+والسلسلة من الأحداث التي أدت إلى أن تكون هذه الحالة خطيرة
+
+148
+00:11:25,930 --> 00:11:31,750
+لذلك، سنتعامل مع الصدمة (Shock) بشكل خاص بناء على سببها (related to the cause)
+
+149
+00:11:31,750 --> 00:11:37,580
+المتعلق بالصدمة، وليس بسبب الصدمة نفسها (not because of shock). حسنًا، تقريباً،
+
+150
+00:11:37,580 --> 00:11:38,780
+تكرار
+
+151
+00:11:38,780 --> 00:11:40,740
+تكرار
+
+152
+00:11:40,740 --> 00:11:42,520
+تكرار
+
+153
+00:11:42,520 --> 00:11:44,660
+تكرار
+
+154
+00:11:44,660 --> 00:11:47,860
+تكرار
+
+155
+00:11:47,860 --> 00:11:58,900
+تكرار
+
+156
+00:11:58,900 --> 00:12:02,240
+لذلك، إذا كان هناك إرواء غير كافٍ للجلد ينتهي
+
+157
+00:12:02,240 --> 00:12:07,160
+بإضعاف وظيفة الجلد وسوء حالته، وحركة الجلد، وإذا لم
+
+158
+00:12:07,160 --> 00:12:10,040
+تتحرك بسرعة، ماذا سيحدث؟ حماض استقلابي (Metabolic Acidosis).
+
+159
+00:12:10,040 --> 00:12:13,800
+حماض استقلابي (Metabolic Acidosis) سيسبب الموت.
+
+160
+00:12:13,800 --> 00:12:17,480
+حسنًا، هذه بعض الأفكار المرضية، الأفكار
+
+161
+00:12:17,480 --> 00:12:23,240
+الفيزيولوجية المتعلقة بمخطط الموت في بعض الحالات
+
+162
+00:12:23,240 --> 00:12:24,620
+من الإصابات.
+
+163
+00:12:27,110 --> 00:12:32,610
+مهم جداً فقط للتوضيح، لكن هنا مرة أخرى نتحدث عن
+
+164
+00:12:32,610 --> 00:12:34,570
+تكرار
+
+165
+00:12:34,570 --> 00:12:35,810
+تكرار
+
+166
+00:12:35,810 --> 00:12:38,970
+تكرار
+
+167
+00:12:38,970 --> 00:12:39,430
+تكرار
+
+168
+00:12:39,430 --> 00:12:42,330
+تكرار
+
+169
+00:12:42,330 --> 00:12:44,390
+تكرار
+
+170
+00:12:44,390 --> 00:12:47,910
+تكرار
+
+171
+0
+
+223
+00:16:04,360 --> 00:16:07,720
+parameters هتحكيلنا عن إن patient هذا had a
+
+224
+00:16:07,720 --> 00:16:10,260
+hypovolemic shock غير إن الـ blood pressure low
+
+225
+00:16:10,260 --> 00:16:15,520
+الـ urine output low maybe إن الـ consciousness
+
+226
+00:16:15,520 --> 00:16:17,700
+level هتشوف في الـ sinus symptoms بيصير فيه
+
+227
+00:16:17,700 --> 00:16:21,620
+deterioration لأن الـ brain صار مش بتغذّق كويس
+
+228
+00:16:21,620 --> 00:16:24,440
+كمان لو كان في أندر ماري الـ central venous
+
+229
+00:16:24,440 --> 00:16:28,240
+pressure صبكليفن، انترنجاجل، whatever المهم إن كان
+
+230
+00:16:28,240 --> 00:16:34,370
+فينا central venous الـ Central Line ورايح على اللي
+
+231
+00:16:34,370 --> 00:16:37,870
+هو الـ Thoracic Vein الـ Thoracic Vein الـ
+
+232
+00:16:37,870 --> 00:16:42,790
+Thoracic Vein الـ Thoracic Vein الـ Thoracic
+
+233
+00:16:42,790 --> 00:16:43,170
+Vein الـ Thoracic Vein الـ Thoracic Vein الـ
+
+234
+00:16:43,170 --> 00:16:43,850
+Thoracic Vein الـ Thoracic Vein الـ Thoracic
+
+235
+00:16:43,850 --> 00:16:44,150
+Vein الـ Thoracic Vein الـ Thoracic Vein الـ
+
+236
+00:16:44,150 --> 00:16:44,230
+Thoracic Vein الـ Thoracic Vein الـ Thoracic
+
+237
+00:16:44,230 --> 00:16:46,530
+Vein الـ Thoracic Vein الـ Thoracic Vein الـ
+
+238
+00:16:46,530 --> 00:16:51,010
+Thoracic Vein الـ Thoracic Vein الـ Thoracic
+
+239
+00:16:51,010 --> 00:16:54,290
+Vein الـ Thoracic Vein الـ طبعًا لأن اللي بيرجع
+
+240
+00:16:54,290 --> 00:16:57,270
+عمّا حكينا بـ Venous Pressure الـ Venous اللي تاني
+
+241
+00:16:57,270 --> 00:17:00,490
+أشماله بقلب بالتالي المفروض أن يكون الـ Venous
+
+242
+00:17:00,490 --> 00:17:04,190
+Pressure أو الـ Central Venous Pressure Low الحاجة
+
+243
+00:17:04,190 --> 00:17:07,730
+التانية هيكون فيها إن إيش؟ Low cardiac output، ما
+
+244
+00:17:07,730 --> 00:17:10,110
+زال اللي بيجي قليل، إيش بيكون اللي بيطلع؟ أكيد
+
+245
+00:17:10,110 --> 00:17:14,250
+قليل، عشان هيك زي ما حكينا الـ Systemic Vascular
+
+246
+00:17:14,250 --> 00:17:17,050
+Resistance، إيش بيحصل فيها؟ بدها تزيد، عشان تحاول
+
+247
+00:17:17,050 --> 00:17:19,710
+تعمل compensation The arterial blood pressure may
+
+248
+00:17:19,710 --> 00:17:25,570
+be normal or low، عشان هيك في أول مراحل الشوك،
+
+249
+00:17:25,570 --> 00:17:28,650
+بيكون
+
+250
+00:17:28,650 --> 00:17:34,310
+المريض إيش ماله؟ بكون لسه دقته كويس، آه طب احنا
+
+251
+00:17:34,310 --> 00:17:38,070
+حكينا إنه من أهم علامات الـ shock إنه يكون فيها
+
+252
+00:17:38,070 --> 00:17:41,950
+potential، آه بس هذا بيكون في الـ late stage يعني
+
+253
+00:17:41,950 --> 00:17:47,230
+بدل المريض يفقد السيطرة ويفقد الإمكانية على التحكم
+
+254
+00:17:47,230 --> 00:17:51,950
+و الـ compensation فهو خلاص صار exhausted وفقد
+
+255
+00:17:51,950 --> 00:17:56,930
+قدرته على المواجهة، فعشان هيك لأن
+
+256
+00:17:59,380 --> 00:18:04,380
+نوعين من الـ hypovolemic shock في إيش بنحكي عنه
+
+257
+00:18:04,380 --> 00:18:07,980
+absolute hypovolemia absolute hypovolemia إيش
+
+258
+00:18:07,980 --> 00:18:15,540
+يعني؟ water and electrolyte losses الـ absolute
+
+259
+00:18:15,540 --> 00:18:20,940
+hypovolemia يعني يعني كمية السوائل اللي خرجت من
+
+260
+00:18:20,940 --> 00:18:23,940
+الجسم خرجت وخرجت إلى الأبد يعني مش هي الموجودة في
+
+261
+00:18:23,940 --> 00:18:27,440
+الجسم بس شت صار لها shifting عشان هي كفي نوع تاني
+
+262
+00:18:30,130 --> 00:18:34,030
+مثموش Absolute اسمه الـ Partial في الـ Partial
+
+263
+00:18:34,030 --> 00:18:39,850
+هايبوفولينيا الـ الـ الـ water بتكون في الجسم بس
+
+264
+00:18:39,850 --> 00:18:43,550
+صار لها shifting من الـ Intravascular للـ
+
+265
+00:18:43,550 --> 00:18:48,890
+Interstitial Space للـ Interstitial Space هذا زي
+
+266
+00:18:48,890 --> 00:18:54,440
+مين؟ زي الـ burn الـ burn والـ sepsis هذا ما نسميه
+
+267
+00:18:54,440 --> 00:18:59,340
+absolute أنا المفروض فيه عنوان بنسميه partial
+
+268
+00:18:59,340 --> 00:19:02,520
+hypovolemia لكن الـ absolute hypovolemia إيش
+
+269
+00:19:02,520 --> 00:19:05,200
+الـ absolute hypovolemia؟ كمية الـ fluid اللي أنت
+
+270
+00:19:05,200 --> 00:19:08,780
+فقط نفقتها إلى الأبد زي الدياريا، البوليوريا،
+
+271
+00:19:08,780 --> 00:19:11,740
+النزيف فقط قدامه صار absolute hypovolemia ما حتش
+
+272
+00:19:11,740 --> 00:19:14,780
+موجود في جسمك at all لكن لو لسه موجود في جسمك هذا
+
+273
+00:19:14,780 --> 00:19:17,960
+مش absolute هذا partial فعشان هيك هو بصار shifting
+
+274
+00:19:17,960 --> 00:19:23,790
+من الـ intravascular للـ Extravascular في
+
+275
+00:19:23,790 --> 00:19:27,210
+الـ Third Space، في الـ Interstitial Space، تمام؟
+
+276
+00:19:27,210 --> 00:19:30,350
+اللي كنت أنا بدي أحكيه لـ Stages تبعت الشك زي ما
+
+277
+00:19:30,350 --> 00:19:35,150
+كنا بنحكي في الـ slide هاي، إنه رغم إنه الـ Cardiac
+
+278
+00:19:35,150 --> 00:19:39,630
+Output بقل والـ CVP بيكون Low، إلا إن الـ Blood
+
+279
+00:19:39,630 --> 00:19:45,930
+Pressure لسه بيكون Normal لأن الـ Systemic Vascular
+
+280
+00:19:45,930 --> 00:19:49,550
+Resistance لسه بيكون High ومسكة، عاملة،
+
+281
+00:19:49,550 --> 00:19:54,690
+يعني لسه عاملة Blood Pressure كويس وما انهرتش أمام
+
+282
+00:19:54,690 --> 00:19:58,530
+الـ Decreased Low أو الـ Decreased Cardiac Output
+
+283
+00:19:58,530 --> 00:20:03,510
+عشان هيك بنلاحظ إن في الـ Shock بنلاقي فيه
+
+284
+00:20:07,040 --> 00:20:13,840
+Four Stages بنسموها أو Faces في الـ Phase الأولى
+
+285
+00:20:13,840 --> 00:20:17,960
+أو في الـ Stage الأولى للـ Shock لاحظ أن الـ Blood
+
+286
+00:20:17,960 --> 00:20:24,620
+Pressure بيكون Normal رغم أن الـ Heart Rate لسه
+
+287
+00:20:24,620 --> 00:20:28,060
+بيكون تقريبا أقل من 100 طبعا أقل من 100 ممكن يكون
+
+288
+00:20:28,060 --> 00:20:32,320
+عند شاب إذا كان رياضي يكون الـ Normal Heart Rate
+
+289
+00:20:32,320 --> 00:20:38,960
+تبعه 50، فلما يكون عنده أقل من 100، 90، 80، بالنسبة
+
+290
+00:20:38,960 --> 00:20:43,260
+إليه high لكن لسه الـ blood pressure ما صارش
+
+291
+00:20:43,260 --> 00:20:48,950
+decreased. However، إن المريض فقد حوالي نص لتر أو أول
+
+292
+00:20:48,950 --> 00:20:53,390
+لتر إلا ربع واخدين بالكوا الـ Blood pressure الـ
+
+293
+00:20:53,390 --> 00:20:55,970
+Blood loss لو كان Hypovolemic shock because of
+
+294
+00:20:55,970 --> 00:21:00,670
+hemorrhage فبكون هو فقد حوالي أكتر من وحدة دم وحتى
+
+295
+00:21:00,670 --> 00:21:05,840
+إلا شوية ولسه الـ Blood pressure تبعه مسك حاله،
+
+296
+00:21:05,840 --> 00:21:11,760
+Normal، آه علشان هيك، مش لما إحنا بس بدنا نجد إن
+
+297
+00:21:11,760 --> 00:21:15,040
+المريض تبعنا Severe Hypotension، بحكي عنه Shock
+
+298
+00:21:15,040 --> 00:21:21,500
+ممكن هو لسه يكون مش Hypotension، لكن هو فيه بدأ
+
+299
+00:21:21,500 --> 00:21:25,440
+يصير Shock،  بتعرف؟ بتعرف من Parameters تانية
+
+300
+00:21:25,440 --> 00:21:30,120
+بتعرف من Parameters تانية زي الـ Heart Rate إنه
+
+301
+00:21:30,120 --> 00:21:35,000
+بدأ يعلق وصار حوالي مية، مية وعشرين الـ
+
+302
+00:21:35,000 --> 00:21:38,460
+Respiratory rate تبقى المريض بيطلع شوية يعني في
+
+303
+00:21:38,460 --> 00:21:43,020
+حدود الـ Normal بس لسه بس يعني الـ body يمشي مع
+
+304
+00:21:43,020 --> 00:21:47,340
+أنه يصير تكيبنية ليش؟ لأنه حكينا التعريف تبع الشُك
+
+305
+00:21:47,340 --> 00:21:52,580
+إيش؟ Oxygen Perfusion لأ، Inadequate، Inadequate
+
+306
+00:21:52,580 --> 00:21:56,580
+Oxygen Perfusion إذا كان الـ جسم يبقى قاول يعمل
+
+307
+00:21:56,580 --> 00:22:00,040
+تكيبنية عشان يزود الـ Respiratory rate علشان يزود
+
+308
+00:22:00,040 --> 00:22:05,510
+كمية الأكسجين ويصلح الـ hypoxemia اللي صارت في الدم
+
+309
+00:22:05,510 --> 00:22:12,350
+الـ urine output لسه بيكون أكتر من 30 مليلتر يعني
+
+310
+00:22:12,350 --> 00:22:19,530
+لو بدنا نحكي بالـ kilogram بيكون المريض بيجيب
+
+311
+00:22:19,530 --> 00:22:25,290
+حوالي نص مليلتر لكل kilogram من وزنه لكن في الـ
+
+312
+00:22:25,290 --> 00:22:28,650
+stage التانية نص مليلتر لكل kilogram من وزنه في
+
+313
+00:22:28,650 --> 00:22:31,510
+الـ stage التانية لاحظوا أن المريض بيكون فقط حوالي
+
+314
+00:22:31,510 --> 00:22:34,900
+لتر ونص، وبالتالي بيبدأ يصيب الـ Decrease في الـ
+
+315
+00:22:34,900 --> 00:22:36,980
+Blood Pressure وبالتالي الـ Heart Rate بيبدأ يزيد
+
+316
+00:22:36,980 --> 00:22:41,700
+عن 100، بيكون بين 100 و120، تمام؟ والـ Urine
+
+317
+00:22:41,700 --> 00:22:44,920
+Output يا جماعة، بيبدأ يقل والمريض بيبدأ يصير
+
+318
+00:22:44,920 --> 00:22:49,660
+Untrustful ليش؟ لأنه الـ Oxygen صار Low وأول
+
+319
+00:22:49,660 --> 00:22:53,060
+علامات الـ Hypoxia والـ Hypoxemia أنه بيكون الـ
+
+320
+00:22:53,060 --> 00:22:57,140
+Patient إيش ماله؟ Restless بيصير Distressed
+
+321
+00:22:57,140 --> 00:23:02,430
+لأنه مافيش Oxygen يعني صار فيه Air Hunger يعني هو
+
+322
+00:23:02,430 --> 00:23:07,990
+الـ tissue صارت ماعندهاش good oxygenation في الـ
+
+323
+00:23:07,990 --> 00:23:10,490
+third stage بيبقى يصير الـ heart rate كتير أكتر من
+
+324
+00:23:10,490 --> 00:23:14,350
+120، أحسنتوا، كل ما ببدأ بحكي بحكي عن الـ heart rate
+
+325
+00:23:14,350 --> 00:23:18,410
+عشان هي كتير سؤال بيجي في الـ MCQ في الامتحانات
+
+326
+00:23:18,410 --> 00:23:21,760
+أنه مين هو الـ first indicator للـ shock؟ الـ Heart
+
+327
+00:23:21,760 --> 00:23:25,300
+Rate مش الـ Blood Pressure، الـ Blood Pressure هذا
+
+328
+00:23:25,300 --> 00:23:28,700
+بيصير Late بعد الـ Stage الأولى بيكون الـ patient
+
+329
+00:23:28,700 --> 00:23:31,680
+in shock وفي Stage 1 ولسه الـ Blood Pressure طبعا
+
+330
+00:23:31,680 --> 00:23:34,940
+كويس في الـ Shock في الـ Stage التانية بيبدأ الـ
+
+331
+00:23:34,940 --> 00:23:37,840
+Blood Pressure يقل وبيبدأ الـ Heart Rate تزيد
+
+332
+00:23:37,840 --> 00:23:41,160
+أكتر، لذلك الـ Heart Rate كل ما بيزيد أكتر كل ما
+
+333
+00:23:41,160 --> 00:23:44,600
+بيخليني أعرف وين المريض تبقى أيه في which stage of
+
+334
+00:23:44,600 --> 00:23:47,960
+shock يعني هنجيك مريض الـ Heart Rate تبعه فوق
+
+335
+00:23:47,960 --> 00:23:52,410
+الـ 140، لو كاردياك كوز شايف أنا فيه source of
+
+336
+00:23:52,410 --> 00:23:55,730
+bleeding وماعندهوش  dysrhythmia،
+
+337
+00:23:55,730 --> 00:24:01,090
+sinus tachycardia، آه هذا مؤكد أنه بدأ يخش
+
+338
+00:24:01,090 --> 00:24:04,930
+فيه مرحلة متقدمة من الشك بشوف الـ blood pressure
+
+339
+00:24:04,930 --> 00:24:09,750
+بلاقيه low كتير مثلا الـ blood pressure 80 على 40،
+
+340
+00:24:09,750 --> 00:24:13,790
+آه severely shocked قد إيش ممكن فاقد على طول حضرتك
+
+341
+00:24:13,790 --> 00:24:21,340
+لازم تعرف أنه هنا at least المريض فاقد 2 لتر، طبعا
+
+342
+00:24:21,340 --> 00:24:23,160
+هو مصادر الـ hemorrhage وأنا شايف مصادر الـ
+
+343
+00:24:23,160 --> 00:24:25,440
+hemorrhage والـ heart rate جاي فوق الـ 140، blood
+
+344
+00:24:25,440 --> 00:24:29,860
+pressure low أقل من 90 على 60، 80 على 40 مثلا،
+
+345
+00:24:29,860 --> 00:24:34,340
+بتعرف إن المريض هذا فاقد at least two units دماء،
+
+346
+00:24:34,340 --> 00:24:39,360
+two liters blood، okay؟ وطبعا الـ urine output، لو
+
+347
+00:24:39,360 --> 00:24:42,380
+بدك تشوف الـ urine output، هتلاقي إيش؟ مافيش urine
+
+348
+00:24:42,380 --> 00:24:46,260
+output، لأنه مافيش perfusion، طبعا؟ ولو بدنا نطلع
+
+349
+00:24:46,260 --> 00:24:49,300
+على نسبة retrograde، هتلاقي severe tachypnea، أكتر
+
+350
+00:24:49,300 --> 00:24:55,500
+من 35، ليش؟ بده يعمل .. بده يحاول يعمل Oxygenation،
+
+351
+00:24:55,500 --> 00:24:59,540
+هذه كتير كتير مهمة في .. بالذات في أقسام الطوارئ،
+
+352
+00:24:59,540 --> 00:25:02,100
+أول ما بيجي المريض، بنتعامل معاه، بنبدأ نتعامل معاه،
+
+353
+00:25:02,100 --> 00:25:05,640
+بنبدأ ناخد Vital Signs إليه، باخد بالي جدا من الـ
+
+354
+00:25:05,640 --> 00:25:08,620
+Respiratory Rate تبعه، من الـ Saturation تبعه، من الـ
+
+355
+00:25:08,620 --> 00:25:12,380
+urine output، زي ما حكينا، طبعا بتأكد الـ
+
+356
+00:25:12,380 --> 00:25:16,180
+heart rate والـ blood pressure قبل كل حاجة لكن
+
+357
+00:25:16,180 --> 00:25:20,000
+برضه بوجود الحاجات هذه، heart rate 140 أو 150 okay
+
+358
+00:25:20,000 --> 00:25:22,940
+ممكن stress، طب خليني أشوف الـ blood pressure لأ Low
+
+359
+00:25:22,940 --> 00:25:28,540
+كمان، طيب لأ هيك بدأ يصير الوضع خطير، طب الـ urine
+
+360
+00:25:28,540 --> 00:25:29,380
+output بعمل
+
+361
+00:25:31,940 --> 00:25:36,020
+مساج للـ bladder، ممكن أركب catheter، ممكن أركب
+
+362
+00:25:36,020 --> 00:25:43,060
+catheter، ممكن أركب catheter، ممكن أركب catheter، ممكن
+
+363
+00:25:43,060 --> 00:25:43,260
+أركب catheter، ممكن أركب catheter، ممكن أركب catheter،
+
+364
+00:25:43,260 --> 00:25:45,900
+ممكن أركب catheter، ممكن أركب catheter، ممكن أركب
+
+365
+00:25:45,900 --> 00:25:48,080
+catheter، ممكن أركب catheter، ممكن أركب catheter، ممكن
+
+366
+00:25:48,080 --> 00:25:49,820
+أركب catheter، ممكن أركب catheter، ممكن أركب catheter،
+
+367
+00:25:49,820 --> 00:25:49,920
+ممكن أركب catheter، ممكن أركب catheter، ممكن أركب
+
+368
+00:25:49,920 --> 00:25:51,860
+catheter، ممكن أركب catheter، ممكن أركب  لأتحصل على
+
+369
+00:25:51,860 --> 00:25:58,520
+مصدر IV للمريض، إنه يكون في عندك مصدر IV source
+
+370
+00:25:58,520 --> 00:26:03,040
+علشان تبدأ تدعي سوائل للمريض من خلاله، وإلا الـ
+
+371
+00:26:03,040 --> 00:26:06,160
+patient بعدها هيصير collapse وهيصير severe
+
+372
+00:26:06,160 --> 00:26:08,620
+vasoconstriction، هو already أصلا فيه severe
+
+373
+00:26:08,620 --> 00:26:11,480
+vasoconstriction، حكينا ليش؟ يجب أن يعمل
+
+374
+00:26:11,480 --> 00:26:15,090
+compensation يحاول يرفع الـ Blood Pressure
+
+375
+00:26:15,090 --> 00:26:19,350
+فبتكون هنا من الصعوبة بما كان أنك تحاول تركب
+
+376
+00:26:19,350 --> 00:26:24,810
+للمريض إيش كاني، لذلك هنا جدا مهم إنه نحاول نضع
+
+377
+00:26:24,810 --> 00:26:30,730
+للمريض IV Access، two large bore cannulae، و لأ مش واحدة
+
+378
+00:26:30,730 --> 00:26:35,310
+بس، حاول تكون large bore، لأنه as early as possible كل
+
+379
+00:26:35,310 --> 00:26:39,750
+ماكان أسرع كل ماكان أحسن للمريض وإلنا علشان نقدر
+
+380
+00:26:39,750 --> 00:26:43,280
+ننقذ المريض، الـ Stages هذه مهمة وبيجي منها كتير
+
+381
+00:26:43,280 --> 00:26:46,680
+أسئلة في الامتحان، أنا شرحتها لما كان كفاية الـ
+
+382
+00:26:46,680 --> 00:26:50,340
+Cardogen Hit، بيكون إحنا حكينا عن الـ Hypovolemic
+
+383
+00:26:50,340 --> 00:26:54,500
+Shock كمسبب يعني كأهم مسببات الـ Hypovolemic الـ
+
+384
+00:26:54,500 --> 00:26:58,140
+Hemorrhagic Shock وحكينا عن الـ Stages تبعتها، لو بدي
+
+385
+00:26:58,140 --> 00:27:01,040
+أحكي عن الـ Cardiogenic Shock طبعا هنحكي عن الإلاج
+
+386
+00:27:01,040 --> 00:27:06,200
+كل واحدة بالآخر لحد Cardiogenic Shock لما بنحكي عن
+
+387
+00:27:06,200 --> 00:27:10,100
+الكاردوجينك شوك بنحكي إنه فيه dependent on poor
+
+388
+00:27:10,100 --> 00:27:13,300
+pump function يعني القصة في إن القلب نفسه هو اللي
+
+389
+00:27:13,300 --> 00:27:16,260
+تعبان، الـ pump، الموتور اللي بيطلق ميه من الطابق
+
+390
+00:27:16,260 --> 00:27:19,300
+الأول للطابق الرابع هو اللي فيه مشكلة فهو بيطلعش
+
+391
+00:27:19,300 --> 00:27:22,880
+ميه، هو نفسه الموتور نص إحصان وإحنا بدنا موتور إيش؟
+
+392
+00:27:22,880 --> 00:27:26,420
+اتنين إحصان، تمام؟ القلب الـ ejection fraction تبعه
+
+393
+00:27:26,420 --> 00:27:30,870
+عشرين، خمسة عشر بدل ما هو المفروض يكون ستين، acute
+
+394
+00:27:30,870 --> 00:27:34,710
+catastrophic failure of the left ventricular pump
+
+395
+00:27:34,710 --> 00:27:38,810
+function، دائما بنحكي لما يحصل left-sided heart
+
+396
+00:27:38,810 --> 00:27:43,590
+failure هذا معناه أن
+
+445
+00:30:56,100 --> 00:30:58,380
+وبالتالي pump failure، this is the mean of
+
+446
+00:30:58,380 --> 00:31:04,440
+cardiogenic shock، ممكن يكون بريكارديتس اللي عمل ال
+
+447
+00:31:04,440 --> 00:31:10,460
+myopathy، مش بس MI، ممكن يكون myocarditis، يمكن يكون
+
+448
+00:31:10,460 --> 00:31:16,380
+septic myocardial، يعني المريض فيه أندوسيبسيز، وال
+
+449
+00:31:16,380 --> 00:31:21,880
+heart صار إيش؟ بسبب septic myocardial depression، بسبب إطّل هو
+
+450
+00:31:21,880 --> 00:31:26,920
+بيوصل، ودام ممكن يكون Cardiotoxicity، Pharmacologic
+
+451
+00:31:26,920 --> 00:31:31,280
+Cardiotoxicity، مريض بياخد Digitalis toxicity، صار
+
+452
+00:31:31,280 --> 00:31:35,960
+عنده مثلاً بياخد Dioxin، وصار عنده failure من الـ من
+
+453
+00:31:35,960 --> 00:31:37,300
+الـ Dioxin، فبطل
+
+454
+00:31:40,390 --> 00:31:43,210
+يعني يستطيع إنه يعمل complete contraction، و
+
+455
+00:31:43,210 --> 00:31:45,650
+complete relaxation، لأنه بيصير إيه إيش؟ زي ما إحنا
+
+456
+00:31:45,650 --> 00:31:49,070
+عارفين الـbradycardia كتير، فبيصير ممكن هو
+
+457
+00:31:49,070 --> 00:31:53,370
+الـdioxin بنقطعه عشان الـinotropic positive inotropic لكن
+
+458
+00:31:53,370 --> 00:31:55,690
+معروف إن الـdigitalis toxicity، لو أخدنا
+
+459
+00:31:55,690 --> 00:31:59,950
+الـdioxin وماكانش فيه good drug level، إطلعنا عن
+
+460
+00:31:59,950 --> 00:32:03,090
+الـdrug level اللي مطلوب، وخش المرضي في الـtoxicity،
+
+461
+00:32:03,090 --> 00:32:07,370
+بيبقى بيصير إيش؟ الـinotropy depression، ببطل عم يشتغل
+
+462
+00:32:07,370 --> 00:32:13,690
+زي ما هو المفروض، ميكانيكال، حكينا عن الفلفات والـ
+
+463
+00:32:13,690 --> 00:32:16,550
+Arrhythmia، حكينا عن أن معظم أنواع الـArrhythmia
+
+464
+00:32:16,550 --> 00:32:21,270
+يمكن تعمل Cardiogenic Shock، هذه هي الـCauses تبع
+
+465
+00:32:21,270 --> 00:32:24,210
+الكاردوجينك شوك، وبنحكي عن الـDistributive أو
+
+466
+00:32:24,210 --> 00:32:27,790
+بيسموها Vasogenic، Vasogenic، ليش؟ لأن المشكلة
+
+467
+00:32:27,790 --> 00:32:30,650
+حكينا وين؟ في الـvessels، في الـvessels نفسها، إيش
+
+468
+00:32:30,650 --> 00:32:34,050
+بيصير فيها؟ Severe Vaso، ده إيه؟ dilatation، Poor
+
+469
+00:32:34,050 --> 00:32:38,460
+Vascular Tone، وهي الـPeripheral Circulation، الـ
+
+470
+00:32:38,460 --> 00:32:44,120
+Vessels بتصير Dilated، علشان هيك، إيش بيصير؟ الـ
+
+471
+00:32:44,120 --> 00:32:48,460
+blood اللي فيها ما بعملش ضغط، لأنه هي Dilated كتير
+
+472
+00:32:48,460 --> 00:32:51,280
+وين هذا بيصير؟ بيصير هذا في الـSeptic Shock، في
+
+473
+00:32:51,280 --> 00:32:54,460
+الـSeptic Shock بيصير لإن في Increased Permeability بسبب
+
+474
+00:32:54,460 --> 00:32:59,720
+الـsepsis بتخرب، فبيصير Severe Vasodilatation، وبيصير كل
+
+475
+00:32:59,720 --> 00:33:01,200
+الـIntravascular
+
+476
+00:33:03,990 --> 00:33:07,710
+الـFluid طلعت للـExtravascular، للـInterstitial
+
+477
+00:33:07,710 --> 00:33:12,410
+Space، وبالتالي الـVessels
+
+478
+00:33:12,410 --> 00:33:19,510
+فضيت، صارت واسعة لكن ما فيش فيها حاجة تعبيها، في
+
+479
+00:33:19,510 --> 00:33:22,210
+الـToxic بيصير نفس الحاجة، في الـAnaphylactic
+
+480
+00:33:22,210 --> 00:33:25,510
+بيصير نفس الحاجة، بسبب استمرار الـRelease كميات
+
+481
+00:33:25,510 --> 00:33:30,410
+كبيرة، ويصير الـVasodilation، وبرضه الـFluid كله
+
+482
+00:33:30,410 --> 00:33:36,810
+بتطلع على الـExtracellular أو Extravascular، وما
+
+483
+00:33:36,810 --> 00:33:42,270
+بيضلش إيش في الـIntravascular، تمام؟ في الـ
+
+484
+00:33:42,270 --> 00:33:49,450
+Sepsis، حكينا due to infection، في كل الأنواع تبع
+
+485
+00:33:49,450 --> 00:33:55,630
+الـDistributive Shock، سواء كانت Septic أو
+
+486
+00:33:55,630 --> 00:33:59,030
+Neurogenic، آه، أنا نسيت أحكي عن الـNeurogenic
+
+487
+00:33:59,030 --> 00:34:02,690
+Shock، الـNeurogenic Shock يا جماعة، إلها قصة
+
+488
+00:34:02,690 --> 00:34:06,390
+مهمة جداً، يجب أن إحنا نتطرق إليها، الـNeurogenic
+
+489
+00:34:06,390 --> 00:34:09,970
+Shock، نوع من أنواع الـDistributive Shock، صحيح
+
+490
+00:34:09,970 --> 00:34:16,840
+لكن الـNeurogenic Shock فيها فرق مميز عن جميع
+
+491
+00:34:16,840 --> 00:34:22,300
+أنواع الشوك، أن الـheart rate ما يكون تاكيكارديا،
+
+492
+00:34:22,300 --> 00:34:26,060
+ما يكون براديكارديا، طب ليش؟ طب هو مش المفروض أن
+
+493
+00:34:26,060 --> 00:34:30,240
+الـblood pressure low؟ آه، طب وبالتالي مش المفروض
+
+494
+00:34:30,240 --> 00:34:33,140
+أن الـheart يبدأ يعمل compensation، ويصير يطلع؟
+
+495
+00:34:33,140 --> 00:34:38,610
+آه، طب و ليش؟ الـHeart Rate Bradycardia، مش
+
+496
+00:34:38,610 --> 00:34:41,630
+تاكيكارديا، لأنه في الـNeurogenic Shock المسألة
+
+497
+00:34:41,630 --> 00:34:45,050
+هنا بتختلف، لأن الأعصاب بتتحكم في الموضوع، كيف؟
+
+498
+00:34:45,050 --> 00:34:49,810
+Central Nervous System، لما نكون شغالين، جماعة بتحكم
+
+499
+00:34:49,810 --> 00:34:54,030
+في تصرفاتنا وفي حركاتنا، الـSympathetic Nervous
+
+500
+00:34:54,030 --> 00:34:57,420
+System، لكن لما يحدث الـCentral Nervous System
+
+501
+00:34:57,420 --> 00:35:01,720
+Depression، أو بيصير Trauma، أو Injury، أو أي سبب، يسبب
+
+502
+00:35:01,720 --> 00:35:04,900
+أدى إلى أن الـCentral Nervous System يوقف مين؟
+
+503
+00:35:04,900 --> 00:35:06,600
+يعني الـCentral Nervous System؟ يعني الـBrain
+
+504
+00:35:06,600 --> 00:35:12,020
+والـSpinal Cord، هدول صار فيهم أي حاجة أدت إلى
+
+505
+00:35:12,020 --> 00:35:16,240
+أنهم يصير فيهم Stop للـFunction، سبقتهم زي مثلاً
+
+506
+00:35:16,240 --> 00:35:24,100
+Trauma، Severe Compression، whatever، okay، قصة،صار
+
+507
+00:35:24,100 --> 00:35:29,020
+بطل فيه السيال العصبي، بطل مستمر، لأنه صار في منطقة
+
+508
+00:35:29,020 --> 00:35:32,020
+في عندها cat، في عندها compression، بطل في
+
+509
+00:35:32,020 --> 00:35:35,720
+continuity، طيب إيش اللي بده يصير؟ بده يصير إنه
+
+510
+00:35:35,720 --> 00:35:38,800
+sympathetic nervous system بده يوقف، وبالتالي
+
+511
+00:35:38,800 --> 00:35:41,200
+هيشتغل حاجة اسمها الـparasympathetic nervous
+
+512
+00:35:41,200 --> 00:35:43,920
+system، هذه اللي بتشتغل، وإحنا إيش؟ وإحنا نايمين يا
+
+513
+00:35:43,920 --> 00:35:46,830
+جماعة، لما بننام، الـSympathetic Nervous System
+
+514
+00:35:46,830 --> 00:35:49,570
+بتوقف، مين يشتغل؟ بيشتغل الـparasympathetic، الـ
+
+515
+00:35:49,570 --> 00:35:51,610
+Parasympathetic Nervous System. Sympathetic Nervous System لما
+
+516
+00:35:51,610 --> 00:35:55,190
+بيكون شغال، إيش بيسوي يا جماعة؟ Fight or Flight،
+
+517
+00:35:55,190 --> 00:35:59,350
+بيخليك أنت قادر تتحرك، تواجه، تشرب، تعمل، تدافع،
+
+518
+00:35:59,350 --> 00:36:03,710
+قادر تعمل كل إيش؟ active، طب ولما بتنام، بيشتغل
+
+519
+00:36:03,710 --> 00:36:06,970
+الـParasympathetic Nervous System، إيش بيصير؟
+
+520
+00:36:06,970 --> 00:36:14,070
+بيصير Sleep and Digest، إذا Parasympathetic nervous
+
+521
+00:36:14,070 --> 00:36:18,790
+system بيشتغل معنا وإحنا نايمين، فبيعمل كل إيش؟
+
+522
+00:36:18,790 --> 00:36:24,110
+لإيش؟ لتحت، يعني الـblood pressure بنزل، الـheart
+
+523
+00:36:24,110 --> 00:36:31,570
+rate بنزل، آه، إذاً عشان هيك في الـNeurogenic shock
+
+524
+00:36:31,570 --> 00:36:35,010
+because of stop of sympathetic nervous system
+
+525
+00:36:35,010 --> 00:36:37,890
+والشغل بيصير للـParasympathetic nervous system
+
+526
+00:36:37,890 --> 00:36:41,830
+فبنلاقي إن الـheart rate إيش بيصير فيه؟ Decreased،
+
+527
+00:36:41,830 --> 00:36:44,970
+however، إن الـpatient shocked، والـblood pressure تبعه
+
+528
+00:36:44,970 --> 00:36:50,470
+low، لكن الـheart rate تبعه بيكون برضه low، هذه من
+
+529
+00:36:50,470 --> 00:36:54,090
+أهم علامات هذا الـpatient أنه Neurogenic shock،
+
+530
+00:36:54,090 --> 00:36:54,670
+okay؟
+
+531
+00:36:57,440 --> 00:37:00,580
+طبعاً كلهم بيشتركوا في أن الـRenal Perfusion
+
+532
+00:37:00,580 --> 00:37:03,760
+هيكون Low، وبالتالي الـUrine Output هيكون Low، لما
+
+533
+00:37:03,760 --> 00:37:06,160
+بدنا نحكي عن الـUrine Output يا جماعة، كتير حكيتها
+
+534
+00:37:06,160 --> 00:37:10,320
+كتير،  بالمحاضرة كمان، مرة بعيدة، كيف بعرف أنه الـUrine
+
+535
+00:37:10,320 --> 00:37:13,780
+Output عند المريض هذا Low؟ بدي أشوف وزنه، أهم حاجة
+
+536
+00:37:13,780 --> 00:37:18,520
+أشوف وزنه، وما فيش حاجة تقول لي باليوم بيجيب كذا، لأ
+
+537
+00:37:18,520 --> 00:37:24,960
+ما فيش إيش اسمه؟ باليوم، إحنا بنشوف بالساعة، كم ملي
+
+538
+00:37:24,960 --> 00:37:33,720
+لتر، البول كل ساعة، فهو يعتمد على كمية الشخص اللي
+
+539
+00:37:33,720 --> 00:37:37,520
+بيزنّه، لو كان الشخص يزن 70 كيلو جرام، لو مريض
+
+540
+00:37:37,520 --> 00:37:42,380
+يزن 70 كيلو جرام، فإن كمية البول الطبيعية 1
+
+541
+00:37:42,380 --> 00:37:49,350
+إلى 2 ملي لتر/hour، إذا الـNormal urine output per
+
+542
+00:37:49,350 --> 00:37:53,330
+kg per hour، أنه المريض يكون بيجيب واحد إلى اتنين
+
+543
+00:37:53,330 --> 00:37:59,230
+milliliter لكل كيلوجرام من وزنه في الساعة، يعني
+
+544
+00:37:59,230 --> 00:38:04,210
+لوزنه 70 kilogram، المفروض أنه بيجيب 70 ملي  بول
+
+545
+00:38:04,210 --> 00:38:09,370
+في الساعة، تمام؟ لما بيصير المريض شوك، أكيد
+
+546
+00:38:09,370 --> 00:38:14,330
+أنه الـurine output هيقل، وهيقل يا جماعة عن نص
+
+547
+00:38:14,330 --> 00:38:19,210
+milliliter per hour، عن نص ملي لتر لكل كيلو جرام من
+
+548
+00:38:19,210 --> 00:38:23,150
+وزنه per hour، يعني وزنه هو 70، مش هيجيب حتى الـ30
+
+549
+00:38:23,150 --> 00:38:27,490
+ملي لتر في الساعة، هيجيب أقل، دليل أنه شوك، okay؟
+
+550
+00:38:27,490 --> 00:38:31,050
+هذا بالنسبة للـurine output، ومن أهم علامات، على
+
+551
+00:38:31,050 --> 00:38:35,430
+فكرة تحسن الشوك، أنه الـurine output يبدأ يتحسن،
+
+552
+00:38:35,430 --> 00:38:38,610
+إذا الـurine output بدأ المريض يجيب بول كويس،
+
+553
+00:38:38,610 --> 00:38:43,250
+معناه أنه بدأ يصير في عنده good perfusion للكلى
+
+554
+00:38:43,250 --> 00:38:46,130
+وما زال في good perfusion للكلى، بيبقى في good
+
+555
+00:38:46,130 --> 00:38:54,680
+perfusion على كل الـorgans طبعاً
+
+556
+00:38:54,680 --> 00:38:57,940
+إحنا متوقعين إنه يكون فيه Metabolic Acidosis في
+
+557
+00:38:57,940 --> 00:39:03,120
+حالة الشوك، بذات الـseptic shock والـhypovolemic
+
+558
+00:39:03,120 --> 00:39:03,540
+shock
+
+559
+00:39:07,230 --> 00:39:10,690
+الـObstructive Shock، الـObstructive Shock يا
+
+560
+00:39:10,690 --> 00:39:15,230
+جماعة، زي ما حكينا إنه قصة إنه كأنه فيه شبر مسكر
+
+561
+00:39:15,230 --> 00:39:19,050
+على البربيج اللي بتوصل الميه، بدل ما هي ماشية و
+
+562
+00:39:19,050 --> 00:39:21,650
+تمام، وتمام، لأ، فيه واحد مسكر الشبر، Obstructive
+
+563
+00:39:21,650 --> 00:39:28,360
+حكينا محابس، تمام؟ عدوها المحبس، مش شبر، الضغط تبع
+
+564
+00:39:28,360 --> 00:39:31,220
+الهواء زي في حالة الـPneumothorax أو الـCardiac
+
+565
+00:39:31,220 --> 00:39:35,940
+Tamponade، القصة أنه في الـblood في القلب موجود، و
+
+566
+00:39:35,940 --> 00:39:39,560
+القلب قادر إنه يعمل pumping، لكن بيجي يعمل pumping
+
+567
+00:39:39,560 --> 00:39:42,940
+ما فيش vessels تقبل، ليه؟ الـvessels مضغوط عليها
+
+568
+00:39:42,940 --> 00:39:47,800
+because of air، في الـexample تبع الـTension Pneumo
+
+569
+00:39:47,800 --> 00:39:51,220
+thorax، okay، ففيه air كتير، ضغط على الـIntra
+
+570
+00:39:51,220 --> 00:39:54,420
+thoracic الـvessels، وبالتالي، ليش إمكانية أن الـblood
+
+571
+00:39:54,420 --> 00:39:57,760
+يروح فيها، وبالتالي هذه Obstructive shock، إذا بتعمل
+
+572
+00:39:57,760 --> 00:40:01,400
+Release للـPressure، هذا المريض بيتحسن، لو كان
+
+573
+00:40:01,400 --> 00:40:05,700
+Obstructive Shock، ويعني لو كان Tension
+
+574
+00:40:05,700 --> 00:40:09,140
+Pneumothorax هو اللي عامل الـPressure، والمريض كان
+
+575
+00:40:09,140 --> 00:40:11,640
+Severely Shocked to Hypotension، الحالة إنك تعمل
+
+576
+00:40:11,640 --> 00:40:15,480
+Release، بقى الـchest tube طلع، بتبدأ الـvessels
+
+577
+00:40:15,480 --> 00:40:18,180
+ترتاح، بيبدأ الـheart يعمل pumping ويعمل good
+
+578
+00:40:18,180 --> 00:40:21,830
+perfusion، وتنتهي المشكلة، شفنا كيف؟ عشان هيك من
+
+579
+00:40:21,830 --> 00:40:25,490
+الأمثلة، الـPulmonary Edema، الـPulmonary Embolism،
+
+580
+00:40:25,490 --> 00:40:28,530
+الـTension Pneumothorax، الـCardiac Tamponade،
+
+581
+00:40:28,530 --> 00:40:31,410
+كل هذه من أهم الأسباب اللي بتعمل الـShock، زي ما
+
+582
+00:40:31,410 --> 00:40:37,850
+شوفنا، وبنعيد وبنكرر إنه الشوك كل ما بتستمر، كل ما
+
+583
+00:40:37,850 --> 00:40:45,850
+بيصير يعني exhausting للجسم، بالأول بيكون فيه good
+
+584
+00:40:45,850 --> 00:40:49,050
+vasoconstriction، عشان يعمل good blood pressure
+
+585
+00:40:49,050 --> 00:40:53,050
+رغم إنه أنت ما فيش مثلاً عندك سوائل في جسمك، رغم إن
+
+586
+00:40:53,050 --> 00:40:56,670
+القلب بطل يضخ كويس، فبتروح تعمل الـmuscle
+
+587
+00:40:56,670 --> 00:41:00,630
+constriction، بس كل ما تتقدم الشوك وماحدش يعني، كل ما
+
+588
+00:41:00,630 --> 00:41:03,250
+اتقدمت حالة المريض، وماحدش ساعد المريض
+
+589
+00:41:03,250 --> 00:41:07,190
+بـsupportive drugs، إذا كانت Cardiogenic، بـfluid
+
+590
+00:41:07,190 --> 00:41:09,330
+therapy، إذا كان Hypovolemic، therapy، إذا كان
+
+591
+00:41:12,880 --> 00:41:15,600
+إذا ما حلينا مشكلة الـObstructive
+
+592
+00:41:15,600 --> 00:41:19,800
+Shock، whatever، هيضايق المريض، لوين؟ لأنه يصير
+
+593
+00:41:19,800 --> 00:41:22,980
+exhausted، فالـvessels اللي كانت عم تضيق، عشان تضغط،
+
+594
+00:41:22,980 --> 00:41:25,560
+عشان تقلل الـdiameters، تبقى، تبقى تحافظ على blood
+
+595
+00:41:25,560 --> 00:41:29,120
+pressure كويس، إيش بيصير فيها؟ بالآخر بيصير
+
+596
+00:41:29,120 --> 00:41:33,380
+vasoparalysis، ترخي، وخلاص، بتسلم أمرها لله،
+
+597
+00:41:33,380 --> 00:41:37,680
+وبتقول لك ده برحالك، أنا عملت اللي عليّ، ومش يعني
+
+598
+00:41:37,680 --> 00:41:45,410
+أكتر من هيك ما فيش، تمام؟ عشان هيك، بنحكي، هنا بيحكينا
+
+599
+00:41:45,410 --> 00:41:47,530
+في الـslide هذه عن الـSympathetic Nervous
+
+600
+00:41:47,530 --> 00:41:50,970
+System، وكيف بيصير الـVasoconstriction،
+
+601
+00:41:50,970 --> 00:41:54,490
+الـIncreased Respiratory Rate، حكينا أنه مع كل الـ
+
+602
+00:41:55,670 --> 00:42:00,010
+مع كل شوك، عادةً بيبدأ الـRespiratory rate يرتفع، عشان
+
+603
+00:42:00,010 --> 00:42:02,290
+ذلك يا جماعة، دائماً نتطلع في الـpupils نلاقيهم
+
+604
+00:42:02,290 --> 00:42:05,350
+dilated، نتطلع في الـRespiratory rate، نلاقي المريض
+
+605
+00:42:05,350 --> 00:42:09,710
+بدأ يصير يتنفس بسرعة، لأنه Air hunger، Oxygen hunger،
+
+606
+00:42:09,710 --> 00:42:14,470
+يعني الـtissues ما بتوصلهاش Oxygen، okay، هو الدنيا
+
+607
+00:42:14,470 --> 00:42:17,510
+مفتوحة أو الـlung end تبعه وما فيش فيها مشكلة، بس
+
+608
+00:42:17,510 --> 00:42:21,220
+المشكلة أنه ما فيش Oxygen، صارت كمية الدم ما بتكفيش، أو
+
+609
+00:42:21,220 --> 00:42:24,600
+القلب ما عنده كمية دم كافية، أو عنده مبلغ، بس
+
+610
+00:42:24,600 --> 00:42:29,400
+ما فيش وسيلة توصل، أو الـvessels صارت كتير واسعة، فكمية الدم
+
+611
+00:42:29,400 --> 00:42:33,320
+because إن الـvessels كتير dilated، مش بتروح للـ
+
+612
+00:42:33,320 --> 00:42:38,800
+organs، كلها ما بتتوزعش، عشان هي اسمها distributed،
+
+613
+00:42:38,800 --> 00:42:47,050
+ما بتتوزعش كويس، كل هذا سيجعل المريض يفقد السيطرة
+
+614
+00:42:58,850 --> 00:43:01,950
+Gasping and breathing، ليش؟ خلاص، سلم، صار فيه
+
+615
+00:43:01,950 --> 00:43:05,790
+peripheral paralysis، vasoparalysis، الـ
+
+616
+00:43:05,790 --> 00:43:08,390
+respiratory rate بيبدأ يقل خ
+
+667
+00:46:49,550 --> 00:46:55,830
+قديمة، hypotensive، weak pulses، oliguria،
+
+668
+00:46:55,830 --> 00:47:00,070
+presentation of hypovolemic shock حكيناها،
+
+669
+00:47:00,070 --> 00:47:05,510
+نيجي لـ distributive shock، حيكون المريض ربما يعني
+
+670
+00:47:05,510 --> 00:47:08,010
+إذا كان septic shock، حيكون عنده fever، إذا كان
+
+671
+00:47:08,010 --> 00:47:10,950
+toxins، ربما حيكون عنده fever، آه، بس كلهم حيكون
+
+672
+00:47:10,950 --> 00:47:13,670
+فيهم tachycardia، لكن إذا كان الـ  neurogenic shock،
+
+673
+00:47:13,670 --> 00:47:19,170
+حيكون الـ bradycardia، كلهم حيكون فيهم، كلهم حيكون
+
+674
+00:47:19,170 --> 00:47:24,210
+فيهم hypertension و oliguria، لكن هنا الـ lungs حيكون
+
+675
+00:47:24,210 --> 00:47:26,630
+clear، يا جماعة، مش ممكن زي في الـ cardiogenic shock
+
+676
+00:47:26,630 --> 00:47:29,370
+هنا في الـ cardiogenic اللي ممكن يكون فيه بلمونة
+
+677
+00:47:29,370 --> 00:47:34,430
+القديمة، لأنه congested في الـ fluid في الـ lungs، لكن
+
+678
+00:47:34,430 --> 00:47:37,750
+في الـ distributive القصة لأ، مافيش congestion ولا
+
+679
+00:47:37,750 --> 00:47:43,190
+حاجة، القصة إنه إيش؟ الـ lungs فاضية، و الـ vessels هي
+
+680
+00:47:43,190 --> 00:47:45,150
+اللي واسعة كتير، عشان هي الـ neck veins أنا
+
+681
+00:47:45,150 --> 00:47:50,210
+بيكونوا، يا جماعة، flat، neck veins، مافيش، مش
+
+682
+00:47:50,210 --> 00:47:53,210
+هتلاقي descended neck veins، ومحتبس السوق، لأ، لأ
+
+683
+00:47:53,210 --> 00:47:57,790
+المشكلة هو أصلا distributed، يعني واسعين كتير الـ
+
+684
+00:47:57,790 --> 00:48:05,740
+vessels everywhere، okay؟ عشان هيك الـ الـ الـ plan
+
+685
+00:48:05,740 --> 00:48:09,340
+تبعتنا أنه نتعرف على المريض، على recognition of
+
+686
+00:48:09,340 --> 00:48:16,680
+shock as early as possible، تمام؟ ونبدأ نعالج في
+
+687
+00:48:16,680 --> 00:48:22,280
+المريض من الباب هذا في الـ emergency، الـ emergency
+
+688
+00:48:22,280 --> 00:48:24,620
+تبعتنا، الـ notion سوية يا جماعة، حكيت عنها أنا في
+
+689
+00:48:24,620 --> 00:48:31,360
+أول محاضرة، أنه نبدأ نركب للمريض IV access، وأنا أبدأ
+
+690
+00:48:31,360 --> 00:48:36,920
+أشوف إذا كان الـ airway اللي تبقى المريض صار بدأ
+
+691
+00:48:36,920 --> 00:48:41,280
+يخش الـ exhausted، المريض وصار الـ respiratory rate
+
+692
+00:48:41,280 --> 00:48:44,040
+كتير عنده عالي، فبكون أنا بدي أعمل respiratory
+
+693
+00:48:44,040 --> 00:48:47,820
+support، maybe يحتاج mechanical ventilation، maybe
+
+694
+00:48:47,820 --> 00:48:51,680
+mask ventilation، أنه أنا بدي أبدأ أسيطر على المريض
+
+695
+00:48:51,680 --> 00:48:57,470
+أديله أنا oxygen، هوقف الـ process تبعت الـ
+
+696
+00:48:57,470 --> 00:49:00,830
+increased respiratory rate المستمرة اللي عنده اللي
+
+697
+00:49:00,830 --> 00:49:03,770
+هو بيعملها as compensation عشان يحسن الـ oxygen
+
+698
+00:49:03,770 --> 00:49:07,230
+الـ oxygen demand عند المريض عالي جداً، يا جماعة، الـ
+
+699
+00:49:07,230 --> 00:49:10,530
+oxygen consumption عالي، ببدأ أحقق أنا للأخر للمريض
+
+700
+00:49:10,530 --> 00:49:13,790
+at least نزل oxygen، at least نزل oxygen، بحطه في
+
+701
+00:49:13,790 --> 00:49:17,350
+high-Fowler position، بحطوش في high-Fowler position
+
+702
+00:49:17,350 --> 00:49:22,770
+لأن المريض بيكون "shocked" وبالتالي
+
+703
+00:49:22,770 --> 00:49:26,590
+"hypotension"، فإن أحطه في "high-Fowler position"
+
+704
+00:49:26,590 --> 00:49:30,110
+هذا هيأثر على الـ "mental state" تبعته، فلأ، احنا
+
+705
+00:49:30,110 --> 00:49:34,110
+بنحطله أكسجين، بنحاول نخل المريض في "shock
+
+706
+00:49:34,110 --> 00:49:36,950
+position"، يكون رجليه مرفوعين، إذا الأمور "unstable"،
+
+707
+00:49:36,950 --> 00:49:39,250
+الأهم أنه أنا أكون عندي
+
+708
+00:49:43,370 --> 00:49:46,870
+وأبدأ التعامل مع المريض طبعاً على حسب وضع الحالة
+
+709
+00:49:46,870 --> 00:49:49,590
+إذا كان المريض هيبقى full of fluid، هبقى بدي أحط
+
+710
+00:49:49,590 --> 00:49:53,990
+two large bore cannulae، وأبدأ أدّي fluid
+
+711
+00:49:53,990 --> 00:49:57,450
+crystalloids، ده ما بنبدأ، لكن إذا كانت  cardiogenic فيه
+
+712
+00:49:57,450 --> 00:50:03,140
+بلمونة قديمة، مش هيظبط الموضوع، بدي inotropes، ثم بدي
+
+713
+00:50:03,140 --> 00:50:05,180
+... هنشوف الاتفاق اللي هي الـ cardiogenic shock،
+
+714
+00:50:05,180 --> 00:50:09,400
+إذا بدي أنا أعرف أيش نوع الـ shock اللي عند المريض
+
+715
+00:50:09,400 --> 00:50:14,820
+عشان أبدأ أتعامل معها وأعالج فيها، عشان هي كده
+
+716
+00:50:14,820 --> 00:50:18,840
+عادةً نـ determine the cause, often obvious based on
+
+717
+00:50:18,840 --> 00:50:21,820
+history، لازم أكون عارف عن المريض، هو المريض عرض
+
+718
+00:50:21,820 --> 00:50:24,380
+لـ trauma وصار عنده hypovolemic shock، ونتيجة
+
+719
+00:50:24,380 --> 00:50:29,720
+hemorrhage ولا... ولا septic يعني هو عنده septicemia
+
+720
+00:50:29,720 --> 00:50:33,300
+من الـ history هتعرف آه، وقصدها ومش قصدها من الـ
+
+721
+00:50:33,300 --> 00:50:36,440
+history هتعرف إيش وضع المريض، consider distributive
+
+722
+00:50:36,440 --> 00:50:39,660
+spinal ولا... ولا عنده spinal shock، شكله فيه
+
+723
+00:50:39,660 --> 00:50:43,060
+bradycardia أو فيه إيش، آه، وده falling down، بدك
+
+724
+00:50:43,060 --> 00:50:48,780
+تعرف إيش نوع الشوك عشان تبدأ تتعامل معها في الـ
+
+725
+00:50:48,780 --> 00:50:50,460
+cardiogenic shock، restore blood pressure،
+
+726
+00:50:50,460 --> 00:50:54,140
+mechanical and breathing support، ongoing cardiac disease،
+
+727
+00:50:54,140 --> 00:50:57,120
+أهم حاجة أنه هنبدأ ندّي اللي هو antibiotics
+
+728
+00:50:57,120 --> 00:51:00,720
+و drugs وحاجات تبقى أسئلة، إنه إيش نمنع عضلة القلب
+
+729
+00:51:00,720 --> 00:51:03,480
+إنها تموت، لإن مافيش بيوصل لـ cardiogenic shock،
+
+730
+00:51:03,480 --> 00:51:07,780
+القصة هو  قصور القلب نفسه، هي ما بتترواش، كويس؟ لكن
+
+731
+00:51:07,780 --> 00:51:10,020
+it's a hypovolemic، fluid resuscitation، it's a
+
+732
+00:51:10,020 --> 00:51:12,160
+distributive، برضه fluid resuscitation، و
+
+733
+00:51:12,160 --> 00:51:17,220
+vasopressors، وكمان بدنا حاجة أدوية تضيّق الـ blood
+
+734
+00:51:17,220 --> 00:51:22,850
+vessels، هدولة، عشان هيك يا جماعة الـ management
+
+735
+00:51:22,850 --> 00:51:27,550
+تبع الشوك بتعتمد على إيش نوع الشوك نفسها، لكن في
+
+736
+00:51:27,550 --> 00:51:31,070
+كل الحالات لازم أنا أحاول أن أحسن الـ oxygen تبع
+
+737
+00:51:31,070 --> 00:51:34,970
+المريض، إذا ماقدرتش أحسن الـ oxygen وأحافظ على
+
+738
+00:51:34,970 --> 00:51:39,850
+saturation أكتر من 92%، وحالياً بيقولوا أكتر من
+
+739
+00:51:39,850 --> 00:51:47,050
+94%، بكون المريض بده oxygen، طبعاً حطينا له oxygen
+
+740
+00:51:47,050 --> 00:51:51,250
+support، مع الـ oxygen support، ما حطيتله ونزل
+
+741
+00:51:51,250 --> 00:51:56,890
+كانيولا مثلاً وما اتحسنش عن 94%، لازم تفكر بالـ
+
+742
+00:51:56,890 --> 00:52:01,590
+intubation، يكون أنا عامله طبعاً ملائم على other
+
+743
+00:52:01,590 --> 00:52:05,130
+parameters، أنا أبدأ أفكر بإنه why not to intubate
+
+744
+00:52:05,130 --> 00:52:10,710
+this patient، طبعاً الـ hypotension عشان نحسنه يا
+
+745
+00:52:10,710 --> 00:52:14,350
+جماعة بقى
+
+746
+00:52:14,350 --> 00:52:18,710
+نحسنه بحاجات كتير من ضمنها الـ fluid، أنه ندّي كميات
+
+747
+00:52:18,710 --> 00:52:20,850
+من الـ fluid، عادةً الـ fluid اللي بنديها بنبدأ
+
+748
+00:52:20,850 --> 00:52:23,290
+بالـ crystalloid، وبعدين الـ colloid، حاجاتها نشوف
+
+749
+00:52:23,290 --> 00:52:29,910
+بعدين ممكن ندّي أدوية vasopressors، من ضغط حجم
+
+750
+00:52:29,910 --> 00:52:32,730
+الأوعية الدموية الـ pistols، وبالتالي أعمل بعض الدم
+
+751
+00:52:32,730 --> 00:52:37,950
+وبعدين الـ vasopressors نفسها، من أمثلتها إنه ممكن
+
+752
+00:52:37,950 --> 00:52:42,210
+يكون dobutamine drug زي الدوبامين، يعني هو
+
+753
+00:52:42,210 --> 00:52:47,290
+vasopressor وهو positive inotrope، لأن الدوبامين
+
+754
+00:52:47,290 --> 00:52:51,450
+بيشتغل على beta-1 receptors، وبالتالي بيشتغل على
+
+755
+00:52:51,450 --> 00:52:53,510
+الـ heart muscle، بيعمل الـ stimulation لـ cardiac
+
+756
+00:52:53,510 --> 00:52:57,290
+muscle itself، فبيعملها بزود الـ contractions تبعتها
+
+757
+00:52:57,290 --> 00:53:02,390
+however، إن الـ rate كمان هيزيد، القصة المنيحة إن
+
+758
+00:53:02,390 --> 00:53:05,070
+الدوبامين كمان بيشتغل على الـ alpha receptors، إذا
+
+759
+00:53:05,070 --> 00:53:08,090
+أنا زودت الـ dose، يعني لو أنا أشتغلت في الدوبامين
+
+760
+00:53:08,090 --> 00:53:11,970
+أو زودت الـ dose تبعت الدوبامين 10 mcg per
+
+761
+00:53:11,970 --> 00:53:17,110
+kilogram per minute، من 10 إلى 20، هنا بكون أنا
+
+762
+00:53:17,110 --> 00:53:19,750
+بشغل على alpha receptors، وبالتالي أنا بعمل
+
+763
+00:53:19,750 --> 00:53:23,630
+vasopressor، بضغط الـ vessels، بعمل لها فيها
+
+764
+00:53:23,630 --> 00:53:26,630
+vasoconstriction، بقول هذا بحقق لي ارتفاع في ضغط
+
+765
+00:53:26,630 --> 00:53:29,250
+الدم، however، إن هذا ممكن يعمل لي مشاكل peripheral
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الـBessel، الـBiometer تبعه زي هيك، كيف هيكون الدم؟ هيكون الدم كتير واطل، لأن هدول مش هيعمله resistant على الـWall، على الـInternal Wall", "tokens": [6027, 148, 48506, 6156, 7435, 10721, 3660, 9122, 2304, 10632, 32748, 2304, 13672, 1829, 8978, 25724, 38251, 1436, 295, 5701, 2259, 3080, 10386, 654, 12174, 1211, 2655, 12399, 20328, 9640, 2655, 6055, 1211, 9307, 3660, 2733, 12399, 6055, 1211, 9307, 3660, 2733, 8978, 8717, 36178, 2423, 39184, 33, 47166, 12399, 2423, 39184, 33, 72, 13606, 6055, 3555, 3615, 3224, 30767, 1829, 39896, 4117, 12399, 9122, 33911, 39896, 30544, 32748, 2304, 22807, 39896, 30544, 32748, 2304, 9122, 2655, 13546, 4032, 41193, 1211, 12399, 5296, 33456, 8032, 3215, 12610, 37893, 39896, 25957, 43761, 20383, 15844, 2423, 39184, 54, 336, 12399, 15844, 2423, 39184, 4575, 7481, 9551], "avg_logprob": -0.28973213377453033, "compression_ratio": 1.5603448275862069, "no_speech_prob": 4.172325134277344e-07, "words": [{"start": 898.98, "end": 899.44, "word": "الآن", "probability": 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1160.62, "text": "الـburn والـsepsis هذا ما نسميه absolute أنا المفروض فيه عنوان بنسميه partial hypovolemia لكن الـabsolute hypovolemia إيش الـabsolute hypovolemia؟ كمية الـfluid اللي أنت فقط نفقتها إلى الأبد زي الدياريا، البوليوريا، الهموريش فقط قدامه صار absolute hypovolemia ماحتش موجود في جسمك at all لكن لو لسه موجود في جسمك هذا مش absolute هذا partial فعشان هيك هو بصار shifting من الـintravascular لـ", "tokens": [6027, 39184, 21763, 16070, 39184, 405, 1878, 271, 23758, 19446, 8717, 38251, 1829, 3224, 8236, 41850, 9673, 5172, 32887, 11242, 8978, 3224, 18871, 2407, 7649, 44945, 38251, 1829, 3224, 14641, 2477, 2259, 3080, 10386, 654, 44381, 2423, 39184, 17243, 401, 1169, 2477, 2259, 3080, 10386, 654, 11933, 1829, 8592, 2423, 39184, 17243, 401, 1169, 2477, 2259, 3080, 10386, 654, 22807, 9122, 2304, 10632, 2423, 39184, 49253, 327, 13672, 1829, 14739, 2655, 6156, 47432, 8717, 5172, 38149, 11296, 30731, 16247, 44510, 30767, 1829, 2423, 16254, 9640, 25528, 12399, 29739, 12610, 1829, 13063, 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"temperature": 1.0}, {"id": 131, "seek": 312581, "start": 3110.09, "end": 3125.81, "text": "ما حطيتله نزل كانيون مثلا وما اتحسنش عن 94% لازم تفكر بالـ Intubation يكون أنا عامله طبعا ملاقا على other parameters أنا أبدأ أفكر بإنه why not to intubate this patient", "tokens": [15042, 11331, 9566, 36081, 43761, 8717, 11622, 1211, 9122, 7649, 1829, 11536, 50113, 15040, 4032, 15042, 1975, 2655, 5016, 3794, 1863, 8592, 18871, 30849, 4, 5296, 31377, 2304, 6055, 5172, 37983, 20666, 39184, 5681, 836, 399, 7251, 30544, 41850, 6225, 10943, 43761, 23032, 3555, 3615, 995, 3714, 15040, 4587, 995, 15844, 661, 9834, 41850, 5551, 44510, 10721, 5551, 5172, 37983, 4724, 28814, 1863, 3224, 983, 406, 281, 560, 836, 473, 341, 4537], "avg_logprob": -0.3505993150684932, "compression_ratio": 1.3567567567567567, "no_speech_prob": 2.384185791015625e-07, "words": [{"start": 3110.09, "end": 3110.27, "word": "ما", "probability": 0.08013916015625}, {"start": 3110.27, "end": 3110.75, "word": " حطيتله", "probability": 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زودت الـ Dose يعني لو أنا أشتغلت في الدوبامين أو زودت الـ Dose تبعت الدوبامين عشرة Mic per kilogram per minute", "tokens": [1211, 33456, 32748, 37746, 10943, 9957, 4724, 1829, 8592, 2655, 17082, 1211, 15844, 33286, 12, 16, 1300, 1336, 830, 46599, 6027, 2655, 6027, 1829, 4724, 1829, 8592, 2655, 17082, 1211, 15844, 2423, 39184, 13569, 3569, 2160, 4724, 1829, 25957, 1211, 2423, 39184, 3998, 2776, 5296, 39184, 11877, 13921, 3569, 2160, 2564, 6156, 21292, 25957, 1211, 11296, 4724, 11622, 23328, 2423, 39184, 44659, 830, 6055, 3555, 34268, 11296, 2908, 36145, 2423, 39184, 49583, 9122, 2304, 7649, 39896, 11622, 25708, 25062, 9381, 3660, 9673, 1863, 1829, 5016, 3660, 36145, 32748, 37746, 10943, 9957, 9122, 2304, 7649, 4724, 1829, 8592, 2655, 17082, 1211, 15844, 2423, 39184, 20588, 1300, 1336, 830, 11933, 15730, 41850, 30767, 23328, 2655, 2423, 39184, 413, 541, 37495, 22653, 45164, 41850, 5551, 8592, 2655, 17082, 1211, 2655, 8978, 32748, 37746, 10943, 9957, 34051, 30767, 23328, 2655, 2423, 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3181.53, "end": 3182.19, "word": " المنيحة", "probability": 0.732861328125}, {"start": 3182.19, "end": 3182.39, "word": " إن", "probability": 0.71240234375}, {"start": 3182.39, "end": 3183.25, "word": " الدوبامين", "probability": 0.962646484375}, {"start": 3183.25, "end": 3183.53, "word": " كمان", "probability": 0.9456380208333334}, {"start": 3183.53, "end": 3183.87, "word": " بيشتغل", "probability": 0.9895833333333334}, {"start": 3183.87, "end": 3183.95, "word": " على", "probability": 0.943359375}, {"start": 3183.95, "end": 3184.11, "word": " الـ", "probability": 0.73681640625}, {"start": 3184.11, "end": 3184.23, "word": " Alpha", "probability": 0.81640625}, {"start": 3184.23, "end": 3184.73, "word": " Receptors", "probability": 0.77294921875}, {"start": 3184.73, "end": 3185.07, "word": " إذا", "probability": 0.828857421875}, {"start": 3185.07, "end": 3185.37, "word": " أنا", "probability": 0.6298828125}, {"start": 3185.37, "end": 3185.93, "word": " زودت", "probability": 0.8992513020833334}, {"start": 3185.93, "end": 3186.33, "word": " الـ", "probability": 0.81396484375}, {"start": 3186.33, "end": 3186.55, "word": " Dose", "probability": 0.75244140625}, {"start": 3186.55, "end": 3186.75, "word": " يعني", "probability": 0.90966796875}, {"start": 3186.75, "end": 3186.89, "word": " لو", "probability": 0.9521484375}, {"start": 3186.89, "end": 3187.07, "word": " أنا", "probability": 0.7919921875}, {"start": 3187.07, "end": 3187.51, "word": " أشتغلت", "probability": 0.9039713541666666}, {"start": 3187.51, "end": 3187.61, "word": " في", "probability": 0.7509765625}, {"start": 3187.61, "end": 3188.09, "word": " الدوبامين", "probability": 0.911865234375}, {"start": 3188.09, "end": 3188.73, "word": " أو", "probability": 0.98779296875}, {"start": 3188.73, "end": 3189.13, "word": " زودت", "probability": 0.88818359375}, {"start": 3189.13, "end": 3189.23, "word": " الـ", "probability": 0.91552734375}, {"start": 3189.23, "end": 3189.33, "word": " Dose", "probability": 0.8076171875}, {"start": 3189.33, "end": 3189.59, "word": " تبعت", "probability": 0.86474609375}, {"start": 3189.59, "end": 3190.13, "word": " الدوبامين", "probability": 0.966064453125}, {"start": 3190.13, "end": 3191.39, "word": " عشرة", "probability": 0.8108723958333334}, {"start": 3191.39, "end": 3191.69, "word": " Mic", "probability": 0.29345703125}, {"start": 3191.69, "end": 3191.97, "word": " per", "probability": 0.1888427734375}, {"start": 3191.97, "end": 3192.39, "word": " kilogram", "probability": 0.78564453125}, {"start": 3192.39, "end": 3192.81, "word": " per", "probability": 0.91455078125}, {"start": 3192.81, "end": 3193.15, "word": " minute", "probability": 0.919921875}], "temperature": 1.0}, {"id": 135, "seek": 320925, "start": 3194.99, "end": 3209.25, "text": "من عشر إلى عشرين، هنا بكون أنا بشغل على الف ريسبتورز وبالتالي أنا بعمل Vasopressors، بزغر الـVessels، بعمل لها فيها Vasoconstriction، بقول هذا بحقق لي ارتفاع في ضغط الدم، however إن هذا ممكن يعمل لي 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0.437255859375}, {"start": 3195.97, "end": 3196.49, "word": " عشرين،", "probability": 0.761199951171875}, {"start": 3196.49, "end": 3196.75, "word": " هنا", "probability": 0.312255859375}, {"start": 3196.75, "end": 3196.99, "word": " بكون", "probability": 0.444580078125}, {"start": 3196.99, "end": 3197.11, "word": " أنا", "probability": 0.71484375}, {"start": 3197.11, "end": 3197.39, "word": " بشغل", "probability": 0.782470703125}, {"start": 3197.39, "end": 3197.49, "word": " على", "probability": 0.76806640625}, {"start": 3197.49, "end": 3197.71, "word": " الف", "probability": 0.483642578125}, {"start": 3197.71, "end": 3198.27, "word": " ريسبتورز", "probability": 0.7454020182291666}, {"start": 3198.27, "end": 3198.73, "word": " وبالتالي", "probability": 0.92529296875}, {"start": 3198.73, "end": 3198.99, "word": " أنا", "probability": 0.7685546875}, {"start": 3198.99, "end": 3199.75, "word": " بعمل", "probability": 0.9861653645833334}, {"start": 3199.75, "end": 3201.09, "word": " Vasopressors،", "probability": 0.60137939453125}, {"start": 3201.09, "end": 3202.03, "word": " بزغر", "probability": 0.7568359375}, {"start": 3202.03, "end": 3202.99, "word": " الـVessels،", "probability": 0.6788330078125}, {"start": 3202.99, "end": 3203.29, "word": " بعمل", "probability": 0.9513346354166666}, {"start": 3203.29, "end": 3203.39, "word": " لها", "probability": 0.405517578125}, {"start": 3203.39, "end": 3203.63, "word": " فيها", "probability": 0.956787109375}, {"start": 3203.63, "end": 3204.63, "word": " Vasoconstriction،", "probability": 0.7613699776785714}, {"start": 3204.63, "end": 3204.79, "word": " بقول", "probability": 0.2984619140625}, {"start": 3204.79, "end": 3204.97, "word": " هذا", "probability": 0.30029296875}, {"start": 3204.97, "end": 3205.47, "word": " بحقق", "probability": 0.9410400390625}, {"start": 3205.47, "end": 3205.61, "word": " لي", "probability": 0.71142578125}, {"start": 3205.61, "end": 3206.07, "word": " ارتفاع", "probability": 0.780364990234375}, {"start": 3206.07, "end": 3206.21, "word": " في", "probability": 0.84521484375}, {"start": 3206.21, "end": 3206.63, "word": " ضغط", "probability": 0.9700520833333334}, {"start": 3206.63, "end": 3207.21, "word": " الدم،", "probability": 0.9353841145833334}, {"start": 3207.21, "end": 3207.45, "word": " however", "probability": 0.826171875}, {"start": 3207.45, "end": 3207.67, "word": " إن", "probability": 0.5693359375}, {"start": 3207.67, "end": 3207.85, "word": " هذا", "probability": 0.64794921875}, {"start": 3207.85, "end": 3208.09, "word": " ممكن", "probability": 0.75244140625}, {"start": 3208.09, "end": 3208.41, "word": " يعمل", "probability": 0.9348958333333334}, {"start": 3208.41, "end": 3208.47, "word": " لي", "probability": 0.24365234375}, {"start": 3208.47, "end": 3208.91, "word": " مشاكل", "probability": 0.990234375}, {"start": 3208.91, "end": 3209.25, "word": " peripheral", "probability": 0.57373046875}], "temperature": 1.0}], "language": "ar", "language_probability": 1.0, "duration": 3219.2609375, "duration_after_vad": 3144.1949999999883}
\ No newline at end of file
diff --git a/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/gj5qIreau7E_raw.srt b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/gj5qIreau7E_raw.srt
new file mode 100644
index 0000000000000000000000000000000000000000..e8bf3658f43b93971ac9665301f12cf615e14ac2
--- /dev/null
+++ b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/gj5qIreau7E_raw.srt
@@ -0,0 +1,3076 @@
+1
+00:00:02,600 --> 00:00:09,480
+بسم الله الرحمن الرحيم أصعد الله أوقاتكم جميعًا
+
+2
+00:00:09,480 --> 00:00:16,300
+يعني،
+
+3
+00:00:16,300 --> 00:00:24,760
+هنبدأ من الأول، حكينا أن الشُك لها
+
+4
+00:00:24,760 --> 00:00:31,280
+أنواع عديدةالأربع أنواع الأساسية للـ Shock اللي
+
+5
+00:00:31,280 --> 00:00:40,920
+شبهناهم بتشبيهات يعني عطينا مثل لو حد بده يزرع
+
+6
+00:00:40,920 --> 00:00:46,540
+قطعة أرض بده يكون في عنده أربع مصادر أساسية بده
+
+7
+00:00:46,540 --> 00:00:55,260
+يكون في عنده pump مطور ميّه، مصدر ميّهوبدي يكون
+
+8
+00:00:55,260 --> 00:00:59,260
+فيه عنده pipes تيوبز
+
+9
+00:00:59,260 --> 00:01:04,280
+عشان يوصل فيها الميه وبدي يكون فيه عنده محابس
+
+10
+00:01:04,280 --> 00:01:11,780
+وvalves عشان يتم التحكم في وصول المياه هذا بالنسبة
+
+11
+00:01:11,780 --> 00:01:15,060
+للزراعة حكينا انه بالظبط هي اللي بيصير في جسم
+
+12
+00:01:15,060 --> 00:01:21,360
+الإنسان لو كان المشكلة فيهالـ Pump itself يعني كان
+
+13
+00:01:21,360 --> 00:01:27,380
+المضخة اللي بدها توصل الدم لكل أجزاء الجسم وهي
+
+14
+00:01:27,380 --> 00:01:33,260
+القلب هي اللي فيها المشكلة إذا بكون هذه اسمها
+
+15
+00:01:33,260 --> 00:01:36,580
+Cardogenic Shock من حس التعريف عشان نفهم المفادة
+
+16
+00:01:36,580 --> 00:01:41,320
+لو كانت المشكلة في أن مصدر الميه أصلا هو اللي
+
+17
+00:01:41,320 --> 00:01:46,160
+مافيش موجود أو فيه deficiency بتكون هذه اسمة
+
+18
+00:01:46,160 --> 00:01:51,750
+Hypovolamic Shockلو كان المشكلة في الـ«بايبز»
+
+19
+00:01:51,750 --> 00:01:55,950
+نفسها «pipe failure» اللي الـ«تيوبز» اللي بتوصل
+
+20
+00:01:55,950 --> 00:02:00,210
+المية هي اللي كانت كتير واسعة زي ما بيصير في
+
+21
+00:02:00,210 --> 00:02:04,230
+الـ«distributive shock» وحنشوف إن كل نوع من دول
+
+22
+00:02:04,230 --> 00:02:06,210
+الأنواع يعني بيجي تحته، يعني بالذات
+
+23
+00:02:06,210 --> 00:02:09,670
+الـ«distributive shock» بيجي كتير تحتها أنواع زي
+
+24
+00:02:09,670 --> 00:02:14,910
+الـ«septic shock» والـ«toxins» الـ«shock» يعني
+
+25
+00:02:14,910 --> 00:02:20,600
+الـ«anaphylactic shock» related to toxins orأو أي
+
+26
+00:02:20,600 --> 00:02:23,160
+نوع من الـ Allergy أو أي نوع من الـ Allergy أو أي
+
+27
+00:02:23,160 --> 00:02:24,560
+نوع من الـ Allergy أو أي نوع من الـ Allergy أو أي
+
+28
+00:02:24,560 --> 00:02:27,220
+نوع من الـ Allergy أو أي نوع من الـ Allergy أو أي
+
+29
+00:02:27,220 --> 00:02:28,220
+نوع من الـ Allergy أو أي نوع من الـ Allergy أو أي
+
+30
+00:02:28,220 --> 00:02:28,960
+نوع من الـ Allergy أو أي نوع من الـ Allergy أو أي
+
+31
+00:02:28,960 --> 00:02:30,920
+نوع من الـ Allergy أو أي نوع من الـ Allergy أو أي
+
+32
+00:02:30,920 --> 00:02:32,180
+نوع من الـ Allergy أو أي نوع من الـ Allergy أو أي
+
+33
+00:02:32,180 --> 00:02:32,180
+نوع من الـ Allergy أو أي نوع من الـ Allergy أو أي
+
+34
+00:02:32,180 --> 00:02:32,180
+نوع من الـ Allergy أو أي نوع من الـ Allergy أو أي
+
+35
+00:02:32,180 --> 00:02:34,940
+نوع من الـ Allergy أو أي نوع من الـ Allergy أو أي
+
+36
+00:02:34,940 --> 00:02:47,960
+نوع من الـ Allergy أو أي نوع من الـ Allergy أو
+
+37
+00:02:47,960 --> 00:02:51,690
+أي ناللي وظيفتها تتحكم في وصول الدم عاملة
+
+38
+00:02:51,690 --> 00:02:55,070
+Obstruction معانعة وصول الدم وحكينا إن هذا بيصير
+
+39
+00:02:55,070 --> 00:02:57,970
+نتيجة pressure على الـB-cell زي في الـTension
+
+40
+00:02:57,970 --> 00:03:01,870
+نيموثوركس كيف بتكون الـB-cell يعني القلب قادر على
+
+41
+00:03:01,870 --> 00:03:07,710
+إنه ينبض مافيش bomb failure الـ«amount of blood»
+
+42
+00:03:07,710 --> 00:03:14,970
+already فيه دم موجود وممكن إنه يصل للدسملكن، يعني
+
+43
+00:03:14,970 --> 00:03:18,810
+مافيش hypervolumic shock لكن المشكلة أنه فيه
+
+44
+00:03:18,810 --> 00:03:25,670
+something making obstruction عامل منع لإنه الـ
+
+45
+00:03:25,670 --> 00:03:31,070
+blood هذا يسيل له release يعني الـ perfusion لباقي
+
+46
+00:03:31,070 --> 00:03:34,730
+أنحاء الجسم هذا اللي سمينا الـ Obstructive shock و
+
+47
+00:03:34,730 --> 00:03:37,870
+أعطينا أكتر مثل عليه اللي هو tension pneumothorax
+
+48
+00:03:37,870 --> 00:03:43,180
+كيف يكون القلببنبض الـ amount of blood already
+
+49
+00:03:43,180 --> 00:03:50,590
+availableليس هناك طريقة لتخلص الدم من القلب لتشغّل
+
+50
+00:03:50,590 --> 00:03:55,450
+جميع الأعضاء الآخرين بسبب تنسيق النموثوركس بسبب
+
+51
+00:03:55,450 --> 00:04:01,090
+الضغط اللي هو ضغط الهواء بالطبع اللي يمنع المشاركة
+
+52
+00:04:01,090 --> 00:04:06,150
+من الدم إلى الأعضاء الآخرين لتشغّلهم، حسنًا؟
+
+53
+00:04:12,220 --> 00:04:15,360
+هو مجرد مجرد مجرد مجرد مجرد مجرد مجرد مجرد مجرد
+
+54
+00:04:15,360 --> 00:04:17,080
+مجرد مجرد مجرد مجرد مجرد مجرد مجرد مجرد مجرد مجرد
+
+55
+00:04:17,080 --> 00:04:25,000
+مجرد مجرد مجرد مجرد مجرد
+
+56
+00:04:38,390 --> 00:04:42,570
+حكينا إن الشُك من ناحية نظرية Inability to meet
+
+57
+00:04:42,570 --> 00:04:45,270
+cellular requirements for oxygen، ليش؟ لأنه أنا
+
+58
+00:04:45,270 --> 00:04:48,250
+لما بحكي إنه في patient شُك، معناه إنه صار فيه
+
+59
+00:04:48,250 --> 00:04:51,970
+practically severe hypotension، blood pressure
+
+60
+00:04:51,970 --> 00:04:58,070
+تبعه شماله كتير واطي، وعشان هيك صار من ناحية نظرية
+
+61
+00:04:58,070 --> 00:05:03,680
+الـperfusion للتشوقليل وبالتالي الـ Oxygen
+
+62
+00:05:03,680 --> 00:05:08,800
+requirements not meted So الـ organ يعني كل cells
+
+63
+00:05:08,800 --> 00:05:12,940
+ما بيوصلهاش الكمية الكافية من ال Oxygen وبالتالي
+
+64
+00:05:12,940 --> 00:05:17,260
+ال tissue اللي في مجموعة ال cells بتكون tissue ال
+
+65
+00:05:17,260 --> 00:05:22,660
+tissue التابع لل organ المعين هذا سواء كان lung
+
+66
+00:05:22,660 --> 00:05:26,260
+سواء كان liver سواء كان muscle سواء كان whatever
+
+67
+00:05:26,260 --> 00:05:30,780
+هتكون فيها failure فيها failure ولمّا بيكون severe
+
+68
+00:05:30,780 --> 00:05:35,990
+shockبيصير severe hypotension بيصير كل ال organs
+
+69
+00:05:35,990 --> 00:05:40,710
+مابوصلهاش دم لو بنتطلع على ال brain لما بيصير فيه
+
+70
+00:05:40,710 --> 00:05:45,990
+low perfusion low perfusion وبالآخر بيصير ايش؟ no
+
+71
+00:05:45,990 --> 00:05:49,490
+perfusion مافيش دم واصله خالص because of severe
+
+72
+00:05:49,490 --> 00:05:54,410
+hypotension طب واش اللي بده يصير؟ بده يصيرfailure
+
+73
+00:05:54,410 --> 00:05:57,510
+في الـ central nervous system فهيصير unconscious
+
+74
+00:05:57,510 --> 00:06:02,910
+طب لو ال kidney، ال kidney كذلك low perfusion، low
+
+75
+00:06:02,910 --> 00:06:05,890
+urine output because of إيش؟ because of kidney
+
+76
+00:06:05,890 --> 00:06:08,510
+failure يعني، بصير طبعا kidney injured بالأول
+
+77
+00:06:08,510 --> 00:06:13,690
+anyway إنه ال kidney بطل functionally well زي ما
+
+78
+00:06:13,690 --> 00:06:16,530
+ال brain كان وظيفته تكون alert و صاحب و conscious
+
+79
+00:06:16,530 --> 00:06:21,100
+بطل functionally well صار أنت عندك إيش؟الـ system
+
+80
+00:06:21,100 --> 00:06:23,800
+failure فصار الـ central nervous system صار فيه
+
+81
+00:06:23,800 --> 00:06:27,220
+failure صار ال kidney ال kidney صار فيها failure
+
+82
+00:06:27,220 --> 00:06:32,180
+فطبعا كل ما بتظل ال shock continuous كل ما ال
+
+83
+00:06:32,180 --> 00:06:37,160
+system organ failure بيصير more than one organ
+
+84
+00:06:37,160 --> 00:06:39,900
+وبالتالي ممكن يخشجك في multi organ system failure
+
+85
+00:06:39,900 --> 00:06:43,920
+وبالتالي بتكون ال shockhead irreversible shock
+
+86
+00:06:43,920 --> 00:06:49,970
+علشان هيكبنحكي إن الـ Hemodynamic Stability هي أهم
+
+87
+00:06:49,970 --> 00:06:54,430
+حاجة في إنه تخلّي المريض Stable Hemodynamically
+
+88
+00:06:54,430 --> 00:06:57,930
+كيف يعني؟ يعني يكون الـ Blood Pressure تبعه كويس
+
+89
+00:06:57,930 --> 00:07:01,470
+وبالتالي الـ Perfusion اللي بيروح للـ Kidney بيروح
+
+90
+00:07:01,470 --> 00:07:05,420
+للـ Brain كويس نتيجة إنه في عندهCompensated Heart
+
+91
+00:07:05,420 --> 00:07:08,080
+Rate نتيجة إنه فيه عنده Enough Stroke Volume
+
+92
+00:07:08,080 --> 00:07:11,520
+بالتالي كيكاردك أوتبوت، إيش الكاردك أوتبوت؟ اللي
+
+93
+00:07:11,520 --> 00:07:16,100
+هو الـ Stroke Volume ضرب الـ Heart Rate لإن أنا
+
+94
+00:07:16,100 --> 00:07:19,500
+بحكي عن كيكاردك أوتبوت يعني بحكي عن كمية الدم اللي
+
+95
+00:07:19,500 --> 00:07:25,800
+بدوخها القلب per one minute الـ Heart Rate بعمل
+
+96
+00:07:25,800 --> 00:07:32,550
+نفترض 80 beats per minuteالـ Stroke Volume كيف
+
+97
+00:07:32,550 --> 00:07:35,510
+نحسب الـ Stroke Volume؟ يعني Roughly one
+
+98
+00:07:35,510 --> 00:07:38,730
+milliliter per kg يعني وزره سبعين كيلو المفروض أنه
+
+99
+00:07:38,730 --> 00:07:44,170
+بيطلع في كل pumping about سبعين ML، سبعين مل،
+
+100
+00:07:44,170 --> 00:07:54,130
+سبعين مل، سبعين مل، سبعين مل، سبعين مل، سبعين مل،
+
+101
+00:07:54,130 --> 00:07:55,290
+سبعين مل، سبعين مل، سبعين مل، سبعين مل، سبعين مل،
+
+102
+00:07:55,290 --> 00:07:57,170
+سبعين مل، سبعين مل، سبعين مل، سبعين مل، سبعين مل،
+
+103
+00:07:57,170 --> 00:07:57,170
+سبعين مل، سبعين مل، سبعين مل، سبعين مل، سبعين مل،
+
+104
+00:07:57,170 --> 00:08:02,840
+سبعين مل، سبعين مل، سبعإذا كانت الـ cardiac output
+
+105
+00:08:02,840 --> 00:08:08,020
+كافية، فإذا كانت الـ renal perfusion، الـ brain
+
+106
+00:08:08,020 --> 00:08:14,520
+perfusion، كل الـ perfusion لجميع الأعضاء كافية،
+
+107
+00:08:14,520 --> 00:08:18,400
+فالطبيعي مستقل بشكل ديناميكي، إلا إذا كانت الـ
+
+108
+00:08:18,400 --> 00:08:22,860
+blood pressure أقل، كما نرى في الدياجرام هذه،
+
+109
+00:08:22,860 --> 00:08:25,720
+فأوضح إن كيف لما الـ blood pressure كثير بنزل، كيف
+
+110
+00:08:25,720 --> 00:08:31,340
+يصبح أقل؟في الـ Tissue Perfusion هذا بيقدي إلى
+
+111
+00:08:31,340 --> 00:08:34,700
+Cellular Aggregation ليش بيصير Aggregation؟ لأنه
+
+112
+00:08:34,700 --> 00:08:41,560
+ما فيه ماء كافي في الـ في الـ في الـ vessels
+
+113
+00:08:41,560 --> 00:08:46,760
+وبالتالي بيصير Microcirculatory Obstruction هذا
+
+114
+00:08:46,760 --> 00:08:50,820
+هيقدّي إلى إنه زود الحالة سوء عشان هيك بتشوفوا الـ
+
+115
+00:08:50,820 --> 00:08:55,100
+Decreased Tissue Perfusion بيقدي لهذا وهذاهنا لما
+
+116
+00:08:55,100 --> 00:08:58,400
+يكون هناك تقليل من الـ Tissue Perfusion بيؤدي لإنه
+
+117
+00:08:58,400 --> 00:09:01,280
+يصير Metabolic Acidosis شوفنا إنه عادة بيكون فيه
+
+118
+00:09:01,280 --> 00:09:04,200
+Metabolic Acidosis مع الناس الـ Shocked Patient
+
+119
+00:09:04,200 --> 00:09:09,640
+وهذا بيؤدي لإن الـ Heart Muscle itself برضه
+
+120
+00:09:09,640 --> 00:09:14,940
+مابتتغزعش زي بقية ال organs وبالتاليعشان هيك الـ
+
+121
+00:09:14,940 --> 00:09:18,500
+cardiac output إيش بده يصير فيه؟ بده يقل وبالتالي
+
+122
+00:09:18,500 --> 00:09:23,120
+بده يصير برضه decrease في blood pressure more and
+
+123
+00:09:23,120 --> 00:09:26,940
+more وبالتالي بتصير الحالة worse، أسوأ، تمام؟ عشان
+
+124
+00:09:26,940 --> 00:09:32,150
+هيكعشان هيك بنلاحظ إنه من الـ... من الـ... و once
+
+125
+00:09:32,150 --> 00:09:35,350
+there is decrease in blood pressure نبدأ نمشي في
+
+126
+00:09:35,350 --> 00:09:39,730
+نفس أو في حلقة continuous decrease blood pressure
+
+127
+00:09:39,730 --> 00:09:42,830
+بيقل الـ tissue perfusion الـheart muscle بعد شوية
+
+128
+00:09:42,830 --> 00:09:47,510
+بتضعف، بزود ال decrease في blood pressure لأنه
+
+129
+00:09:47,510 --> 00:09:51,980
+بيزيد ال stroke volume و بتكون عملية مستمرةإلا إذا
+
+130
+00:09:51,980 --> 00:10:00,040
+تم إنعاش المريض وعمل Resuscitation للـ Cause of
+
+131
+00:10:00,040 --> 00:10:03,180
+Shock للمريض ومعرفة الـ Cause of Shock يعني إذا
+
+132
+00:10:03,180 --> 00:10:06,220
+كان الـ Shock Cardogenic Shock هي كان بدنا يعني
+
+133
+00:10:06,220 --> 00:10:10,160
+احنا نحكي في ال treatment بس in brief يعني لأنه
+
+134
+00:10:10,160 --> 00:10:12,320
+هنحكي فيه بالتفصيل يعني إذا كان الـ Cause
+
+135
+00:10:12,320 --> 00:10:15,540
+Cardogenic Shock مكون أنا بدي أعمل أي حاجة تساعد
+
+136
+00:10:15,540 --> 00:10:20,590
+القلب أنه يرجع to contract wellوإذا كان المشكلة
+
+137
+00:10:20,590 --> 00:10:24,050
+Hypovolemic بكون أنا بتدد المريض Fluids
+
+138
+00:10:24,050 --> 00:10:28,550
+كريستالويتز و كلويتز و blood according to his
+
+139
+00:10:28,550 --> 00:10:32,330
+needs okay and according to his hemoglobin إذا كان
+
+140
+00:10:32,330 --> 00:10:35,490
+ال cause of hypovolemic shock hemorrhage بكون بده
+
+141
+00:10:35,490 --> 00:10:41,440
+blood إذا كان ال cause ofهيبوفلومك شوك هو صين مضرب
+
+142
+00:10:41,440 --> 00:10:46,040
+على الطعام او بوليوريا يعني increased output يعني
+
+143
+00:10:46,040 --> 00:10:50,660
+مريض بوليوريا دياريا due to maybe diabetes maybe
+
+144
+00:10:50,660 --> 00:10:53,880
+gastroenteritis whatever whatever was the cause
+
+145
+00:10:53,880 --> 00:10:58,300
+then you need to correct so if it was hepavolumic
+
+146
+00:10:58,300 --> 00:11:01,640
+shock you need to correct the fluid volume if it
+
+147
+00:11:01,640 --> 00:11:05,440
+was cardiogenic shock you need toوهو يدعم القلب
+
+148
+00:11:05,440 --> 00:11:06,900
+بمجرد مجرد مجرد مجرد مجرد مجرد مجرد مجرد مجرد مجرد
+
+149
+00:11:06,900 --> 00:11:13,460
+مجرد مجرد مجرد مجرد مجرد مجرد مجرد مجرد مجرد مجرد
+
+150
+00:11:13,460 --> 00:11:20,220
+مجرد
+
+151
+00:11:20,990 --> 00:11:25,930
+والسلسل الدمية التي أدت إلى المهمة أن تكون مصابة
+
+152
+00:11:25,930 --> 00:11:31,750
+لذلك سوف نتعامل بـShock بشكل مرتبط بسبب السبب
+
+153
+00:11:31,750 --> 00:11:37,580
+المتعلق بـShock ما كان بسبب الشوكحسنًا، تقريبًا،
+
+154
+00:11:37,580 --> 00:11:38,780
+تقريبًا، تقريبًا، تقريبًا، تقريبًا، تقريبًا،
+
+155
+00:11:38,780 --> 00:11:40,740
+تقريبًا، تقريبًا، تقريبًا، تقريبًا، تقريبًا،
+
+156
+00:11:40,740 --> 00:11:42,520
+تقريبًا، تقريبًا، تقريبًا، تقريبًا، تقريبًا،
+
+157
+00:11:42,520 --> 00:11:44,660
+تقريبًا، تقريبًا، تقريبًا، تقريبًا، تقريبًا،
+
+158
+00:11:44,660 --> 00:11:47,860
+تقريبًا، تقريبًا، تقريبًا، تقريبًا، تقريبًا،
+
+159
+00:11:47,860 --> 00:11:58,900
+تقريبًا، تقريبًا، تقريبًا، تقريبًا، تقريبًا،
+
+160
+00:11:58,900 --> 00:12:02,240
+تلذلك، إذا كان هناك غير مناسبة تشوية من الجلد التي
+
+161
+00:12:02,240 --> 00:12:07,160
+تنتهي في مفاوضة الجلد والسلوك والجلد تتحرك وإذا لم
+
+162
+00:12:07,160 --> 00:12:10,040
+تتحرك بسرعة، ماذا سيحدث؟ ميطابولك أسودوسيس
+
+163
+00:12:10,040 --> 00:12:13,800
+ميطابولك أسودوسيس سيسبب في موت، سيسبب في موت،
+
+164
+00:12:13,800 --> 00:12:17,480
+حسنًا، هذا بعض الأفكار الدميولوجيكية، الأفكار
+
+165
+00:12:17,480 --> 00:12:23,240
+الدميولوجيكية تتعلق بمخطط الموت في بعض الأحيان من
+
+166
+00:12:23,240 --> 00:12:24,620
+التحريكات
+
+167
+00:12:27,110 --> 00:12:32,610
+مهم جدًا فقط للتوضيح ولكن هنا مرة أخرى نتحدث عن
+
+168
+00:12:32,610 --> 00:12:34,570
+تنسيق التنسيق التنسيق التنسيق التنسيق التنسيق
+
+169
+00:12:34,570 --> 00:12:35,810
+التنسيق التنسيق التنسيق التنسيق التنسيق التنسيق
+
+170
+00:12:35,810 --> 00:12:38,970
+التنسيق التنسيق التنسيق التنسيق التنسيق التنسيق
+
+171
+00:12:38,970 --> 00:12:39,430
+التنسيق التنسيق التنسيق التنسيق التنسيق التنسيق
+
+172
+00:12:39,430 --> 00:12:42,330
+التنسيق التنسيق التنسيق التنسيق التنسيق التنسيق
+
+173
+00:12:42,330 --> 00:12:44,390
+التنسيق التنسيق التنسيق التنسيق التنسيق التنسيق
+
+174
+00:12:44,390 --> 00:12:47,910
+التنسيق التنسيق التنسيق التن
+
+175
+00:12:52,470 --> 00:12:58,390
+وهي مستعمرة كما قلنا سبتك أو نيورجينك أو
+
+176
+00:12:58,390 --> 00:13:01,810
+أنافيلاكتك أو مستعمرة مثل بيريكيلودايتس أو
+
+177
+00:13:01,810 --> 00:13:02,310
+بريكيلودايتس أو بريكيلودايتس أو بريكيلودايتس أو
+
+178
+00:13:02,310 --> 00:13:03,430
+بريكيلودايتس أو بريكيلودايتس أو بريكيلودايتس أو
+
+179
+00:13:03,430 --> 00:13:03,590
+بريكيلودايتس أو بريكيلودايتس أو بريكيلودايتس أو
+
+180
+00:13:03,590 --> 00:13:04,590
+بريكيلودايتس أو بريكيلودايتس أو بريكيلودايتس أو
+
+181
+00:13:04,590 --> 00:13:04,590
+بريكيلودايتس أو بريكيلودايتس أو بريكيلودايتس أو
+
+182
+00:13:04,590 --> 00:13:08,090
+بريكيلودايتس أو بريكيلودايتس أو بريكيلودايتس أو
+
+183
+00:13:08,090 --> 00:13:17,990
+بريكيلودايتس أو
+
+184
+00:13:17,990 --> 00:13:18,230
+بريكيل
+
+185
+00:13:23,730 --> 00:13:27,790
+السبب الأولى للموت في هذه النوع من الـ Casualties
+
+186
+00:13:27,790 --> 00:13:29,910
+يعني الـ Multiple Casualties خاصةً لما يكون هناك
+
+187
+00:13:29,910 --> 00:13:34,370
+أصابات كثيرة عادةً اللي بيكون سبب الـ Dying سبب
+
+188
+00:13:34,370 --> 00:13:36,870
+الناس هدولة في الـ Multiple Casualties أنه يكونوا
+
+189
+00:13:36,870 --> 00:13:39,490
+خشوا بـ Hypovolomic Shock وليس Resuscitated Well
+
+190
+00:13:39,490 --> 00:13:43,550
+وهذا بيكون السبب هو في الـ Death تبعهم عشان هي
+
+191
+00:13:43,550 --> 00:13:47,190
+اللي بيصير في الـ Hypovolomic Shock الـ Loss of
+
+192
+00:13:47,190 --> 00:13:50,950
+Circulatory Volume الـ Circulatory Volume بقل كتير
+
+193
+00:13:50,950 --> 00:13:54,800
+لأنه مافيه FluidالـVessels صار، فـ«Decrease Venous
+
+194
+00:13:54,800 --> 00:13:58,140
+Retain» بالتالي، الـ«Venous Retain» اللي أصلاً بده
+
+195
+00:13:58,140 --> 00:14:01,020
+يرجع للـ«Right Atrium» بيصيرله «Decrease» يعني
+
+196
+00:14:01,020 --> 00:14:03,820
+الـ«Volume» بقل وبالتالي «Decrease of Cardiac
+
+197
+00:14:03,820 --> 00:14:07,340
+Chamber» الـ«Plane» تبع الـ«Right Atrium» بقل
+
+198
+00:14:07,340 --> 00:14:09,800
+علشان هيك الـ«Cardiac Output» إيش بده يطلع، إذا
+
+199
+00:14:09,800 --> 00:14:12,560
+أصلا اللي بيجيله قليل إيش بده يطلع منه قليل، يعني
+
+200
+00:14:12,560 --> 00:14:15,920
+الـ«Stroke Volume» الـ«Cardiac Output» بقل، لكن
+
+201
+00:14:15,920 --> 00:14:19,820
+سبحان الله على طول الـ«Systemic Vascular
+
+202
+00:14:19,820 --> 00:14:22,560
+Resistance» إيش بيصير فيهابتزيد الـ Systemic
+
+203
+00:14:22,560 --> 00:14:26,660
+Vascular Resistance بتزيد، ليش؟ عشان تعمل شوية
+
+204
+00:14:26,660 --> 00:14:32,240
+Vasopressol يعني تعمل شوية Vasoconstriction علشان
+
+205
+00:14:32,240 --> 00:14:36,580
+ترفع ضغط الدم Because of decrease of cardiac
+
+206
+00:14:36,580 --> 00:14:40,000
+output قلة كمية الدم اللي بتطلع على الفيسل كانت
+
+207
+00:14:40,000 --> 00:14:44,780
+الفيسل زي هيك، نفترض، وهذا كانت مثلا عاملة ضغط 21
+
+208
+00:14:44,780 --> 00:14:50,220
+ع 80كمية الدم اللي كانت تيجي نفترض أو كانت في
+
+209
+00:14:50,220 --> 00:14:52,900
+الجسم كانت في خمسة لتر في الجسم in general
+
+210
+00:14:52,900 --> 00:14:56,580
+والبيسليز كانت زي هي، تمام؟ كانت هذا عملية لضغط
+
+211
+00:14:56,580 --> 00:15:01,500
+مائة وعشرين على دمانين، الآنالآن فجأة كمية الدم
+
+212
+00:15:01,500 --> 00:15:04,460
+اللي في الجسم Because of Hypovolemia قلت، صارت
+
+213
+00:15:04,460 --> 00:15:08,900
+تلاتة liter، تلاتة liter في نفس الـBessel،
+
+214
+00:15:08,900 --> 00:15:11,560
+الـBiometer تبعه زي هيك، كيف هيكون الدم؟ هيكون
+
+215
+00:15:11,560 --> 00:15:16,000
+الدم كتير واطل، لأن هدول مش هيعمله resistant على
+
+216
+00:15:16,000 --> 00:15:20,420
+الـWall، على الـInternal Wallالـ Blood Vessel
+
+217
+00:15:20,420 --> 00:15:23,100
+علشان هيك إيش بيروح بالجسم بيسوي بيقلل الـ
+
+218
+00:15:23,100 --> 00:15:26,280
+Systemic بيزود الـ Systemic Vascular Resistance
+
+219
+00:15:26,280 --> 00:15:29,740
+وبالتالي إيش بيسوي بيعمل Vase Constriction فبيصير
+
+220
+00:15:29,740 --> 00:15:34,680
+الـ Vessel بس الـ Diameter تبعه أقل هيك بشكل هذا
+
+221
+00:15:34,680 --> 00:15:39,380
+وبالتالي هذا بيحققلي ارتفاع في ضغط الدم أحسب المين
+
+222
+00:15:39,950 --> 00:15:46,370
+على حسب الـDiameter of Vessel، وكويس؟ هذه كمبنصة
+
+223
+00:15:46,370 --> 00:15:50,530
+الميكانيزم للجسم، بس الجسم مش هيستطيع أنه يستمر
+
+224
+00:15:50,530 --> 00:15:54,090
+بالشكل هذا على طول، يعني بيعمل الحاجة هذه as
+
+225
+00:15:54,090 --> 00:15:59,410
+compensation، لكن بالآخر بدهم أنك انت توقف معاه
+
+226
+00:15:59,410 --> 00:16:04,360
+وتساعده، فعلشان هي لو احنا بدنانشوف الـ other
+
+227
+00:16:04,360 --> 00:16:07,720
+parameters هتحكيلنا عن إن الـ patient هذا had a
+
+228
+00:16:07,720 --> 00:16:10,260
+hypovolemic shock غير إن الـ blood pressure low
+
+229
+00:16:10,260 --> 00:16:15,520
+الـ urine output low maybe إن الـ consciousness
+
+230
+00:16:15,520 --> 00:16:17,700
+level هتشوف في الـ sinus symptoms بيصير فيه
+
+231
+00:16:17,700 --> 00:16:21,620
+deterioration لإن الـ brain صار مش بتغذّق كويس
+
+232
+00:16:21,620 --> 00:16:24,440
+كمان لو كان في أندر ماري الـ central venous
+
+233
+00:16:24,440 --> 00:16:28,240
+pressure صبكليفن، انترنجاجل، whatever المهم إن كان
+
+234
+00:16:28,240 --> 00:16:34,370
+فينا central venousالـ Central Line ورايح على اللي
+
+235
+00:16:34,370 --> 00:16:37,870
+هو الـ «Toracic Vein» الـ «Toracic Vein» الـ
+
+236
+00:16:37,870 --> 00:16:42,790
+«Toracic Vein» الـ «Toracic Vein» الـ «Toracic
+
+237
+00:16:42,790 --> 00:16:43,170
+Vein» الـ «Toracic Vein» الـ «Toracic Vein» الـ
+
+238
+00:16:43,170 --> 00:16:43,850
+«Toracic Vein» الـ «Toracic Vein» الـ «Toracic
+
+239
+00:16:43,850 --> 00:16:44,150
+Vein» الـ «Toracic Vein» الـ «Toracic Vein» الـ
+
+240
+00:16:44,150 --> 00:16:44,230
+«Toracic Vein» الـ «Toracic Vein» الـ «Toracic
+
+241
+00:16:44,230 --> 00:16:46,530
+Vein» الـ «Toracic Vein» الـ «Toracic Vein» الـ
+
+242
+00:16:46,530 --> 00:16:51,010
+«Toracic Vein» الـ «Toracic Vein» الـ «Toracic
+
+243
+00:16:51,010 --> 00:16:54,290
+Vein» الـ «Toracic Vein» الـطبعًا لأن اللي بيرجع
+
+244
+00:16:54,290 --> 00:16:57,270
+عمّا حكينا بـVenous Pressure الـVenous اللي تاني
+
+245
+00:16:57,270 --> 00:17:00,490
+أشماله بقلب بالتالي المفروض أن يكون الـVenous
+
+246
+00:17:00,490 --> 00:17:04,190
+Pressure أو الـCentral Venous Pressure Low الحاجة
+
+247
+00:17:04,190 --> 00:17:07,730
+التانية هيكون فيها إن إيش؟Low cardiac output، ما
+
+248
+00:17:07,730 --> 00:17:10,110
+زال اللي بيجي قليل، إيش بيكون اللي بيطلع؟ أكيد
+
+249
+00:17:10,110 --> 00:17:14,250
+قليل، عشان هيك زي ما حكينا الـ Systemic Vascular
+
+250
+00:17:14,250 --> 00:17:17,050
+Resistance، إيش بيحصل فيها؟ بدها تزيد، عشان تحاول
+
+251
+00:17:17,050 --> 00:17:19,710
+تعمل compensation The arterial blood pressure may
+
+252
+00:17:19,710 --> 00:17:25,570
+be normal or low، عشان هيك في أول مراحل الشوك،
+
+253
+00:17:25,570 --> 00:17:28,650
+بيكون
+
+254
+00:17:28,650 --> 00:17:34,310
+المريض إيش ماله؟بكون لسه دقته كويس، آه طب احنا
+
+255
+00:17:34,310 --> 00:17:38,070
+حكينا إنه من أهم علامات ال shock إنه يكون فيها
+
+256
+00:17:38,070 --> 00:17:41,950
+potential، آه بس هذا بيكون في ال late stage يعني
+
+257
+00:17:41,950 --> 00:17:47,230
+بدل المريض يفقد السيطرة ويفقد الإمكانية على التحكم
+
+258
+00:17:47,230 --> 00:17:51,950
+و ال compensation فهو خلاص صار exhausted وفقد
+
+259
+00:17:51,950 --> 00:17:56,930
+قدرته على المواجهة، فعشان هيك لأن
+
+260
+00:17:59,380 --> 00:18:04,380
+نوعين من الـ «hypovolemic shock» في إيش بنحكي عنه
+
+261
+00:18:04,380 --> 00:18:07,980
+«absolute hypovolemia» «absolute hypovolemia» إيش
+
+262
+00:18:07,980 --> 00:18:15,540
+يعني؟ «water and electrolyte losses» الـ «absolute
+
+263
+00:18:15,540 --> 00:18:20,940
+hypovolemia» يعني يعني كمية السوائل اللي خرجت من
+
+264
+00:18:20,940 --> 00:18:23,940
+الجسم خرجت وخرجت إلى الأبد يعني مش هي الموجودة في
+
+265
+00:18:23,940 --> 00:18:27,440
+الجسم بس شت صار لها shifting عشان هي كفي نوع تاني
+
+266
+00:18:30,130 --> 00:18:34,030
+مثموش Absolute اسمه الـ Partial في الـ Partial
+
+267
+00:18:34,030 --> 00:18:39,850
+هايبوفولينيا الـ الـ الـ water بتكون في الجسم بس
+
+268
+00:18:39,850 --> 00:18:43,550
+صار لها shifting من الـ Intravascular لل
+
+269
+00:18:43,550 --> 00:18:48,890
+Interstitial Space لل Interstitial Space هذا زي
+
+270
+00:18:48,890 --> 00:18:54,440
+مين؟ زي ال bearالـburn والـsepsis هذا ما نسميه
+
+271
+00:18:54,440 --> 00:18:59,340
+absolute أنا المفروض فيه عنوان بنسميه partial
+
+272
+00:18:59,340 --> 00:19:02,520
+hypovolemia لكن الـabsolute hypovolemia إيش
+
+273
+00:19:02,520 --> 00:19:05,200
+الـabsolute hypovolemia؟ كمية الـfluid اللي أنت
+
+274
+00:19:05,200 --> 00:19:08,780
+فقط نفقتها إلى الأبد زي الدياريا، البوليوريا،
+
+275
+00:19:08,780 --> 00:19:11,740
+الهموريش فقط قدامه صار absolute hypovolemia ماحتش
+
+276
+00:19:11,740 --> 00:19:14,780
+موجود في جسمك at all لكن لو لسه موجود في جسمك هذا
+
+277
+00:19:14,780 --> 00:19:17,960
+مش absolute هذا partial فعشان هيك هو بصار shifting
+
+278
+00:19:17,960 --> 00:19:23,790
+من الـintravascular لـالـ Extravascular wave في
+
+279
+00:19:23,790 --> 00:19:27,210
+الـ Third Space، في الـ Interstitial Space، تمام؟
+
+280
+00:19:27,210 --> 00:19:30,350
+اللي كنت انا بدي أحكيه لـ Stages تبعت الشك زي ما
+
+281
+00:19:30,350 --> 00:19:35,150
+كنا بنحكي في الـ slide هاي، إنه رغم إنه الـ Cardic
+
+282
+00:19:35,150 --> 00:19:39,630
+Output بقل والـ CDB بكون Low،إلا إن الـBlood
+
+283
+00:19:39,630 --> 00:19:45,930
+Pressure لسه بيكون Normal لأن الـSystem of
+
+284
+00:19:45,930 --> 00:19:49,550
+Vascular Resistance لسه بيكون High ومسكة، عاملة،
+
+285
+00:19:49,550 --> 00:19:54,690
+يعني لسه عاملة Blood Pressure كويس وما انهرتش أمام
+
+286
+00:19:54,690 --> 00:19:58,530
+الـDecreased Low أو الـDecreased Cardiac Output
+
+287
+00:19:58,530 --> 00:20:03,510
+عشان هيك بنلاحظ إن في الـShock بنلاقي فيه
+
+288
+00:20:07,040 --> 00:20:13,840
+Four Stages بنسموها أو Faces في الـ Phase الأولى
+
+289
+00:20:13,840 --> 00:20:17,960
+أو في الـ Stage الأولى للـ Shock لاحظ أن الـ Blood
+
+290
+00:20:17,960 --> 00:20:24,620
+Pressure بكون Normal رغم أن الـ Heart Rate لسه
+
+291
+00:20:24,620 --> 00:20:28,060
+بكون تقريبا أقل من 100 طبعا أقل من 100 ممكن يكون
+
+292
+00:20:28,060 --> 00:20:32,320
+عند شاب إذا كان رياضي يكون الـ Normal Heart Rate
+
+293
+00:20:32,320 --> 00:20:38,960
+تبعه 50فلما يكون عنده أقل من 100، 90، 80، بالنسبة
+
+294
+00:20:38,960 --> 00:20:43,260
+إليه high لكن لسه ال blood pressure ماصارش
+
+295
+00:20:43,260 --> 00:20:48,950
+decreasedHowever إن المريض فقد حوالي نص لتر أو أول
+
+296
+00:20:48,950 --> 00:20:53,390
+أتر إلا ربع واخدين بالكوا الـ Blood pressure الـ
+
+297
+00:20:53,390 --> 00:20:55,970
+Blood loss لو كان Hypovolemic shock because of
+
+298
+00:20:55,970 --> 00:21:00,670
+homerage فبكون هو فقد حوالي أكتر من واحدة دم وحتين
+
+299
+00:21:00,670 --> 00:21:05,840
+إلا شوية ولسة الـ Blood pressure تبعهمسك حاله،
+
+300
+00:21:05,840 --> 00:21:11,760
+Normal، آه علشان هيك، مش لما إحنا بس بدنا نجد إن
+
+301
+00:21:11,760 --> 00:21:15,040
+المريض تبعنا Severe Hypotension، بحكي عنه Shock
+
+302
+00:21:15,040 --> 00:21:21,500
+ممكن هو لسه يكون مش Hypotension، لكن هو فيه بدأ
+
+303
+00:21:21,500 --> 00:21:25,440
+يصير Shock كم بتدعرف؟ بتدعرف من Parameters تانية
+
+304
+00:21:25,440 --> 00:21:30,120
+بتدعرف من Parameters تانية زي الـHeart Rate إنه
+
+305
+00:21:30,120 --> 00:21:35,000
+بدأ يعلق وصح حصار حوالين المية، اتنينالـ
+
+306
+00:21:35,000 --> 00:21:38,460
+Respiratory rate تبقى المريض بطلع شوية يعني في
+
+307
+00:21:38,460 --> 00:21:43,020
+قدوده الـ Normal بس لسه بس يعني ال body يمشي مع
+
+308
+00:21:43,020 --> 00:21:47,340
+أنه يصير تكيبنية ليش؟ لأنه حكينا التعريف تبع الشُك
+
+309
+00:21:47,340 --> 00:21:52,580
+إيش Oxygen Perfusion لأ، Inadequate، Inadequate
+
+310
+00:21:52,580 --> 00:21:56,580
+Oxygen Perfusion إذا كان ال جسم يبقى قاول يعمل
+
+311
+00:21:56,580 --> 00:22:00,040
+تكيبنية عشان يزود ال Respiratory rate علشان يزود
+
+312
+00:22:00,040 --> 00:22:05,510
+كمية الأكسجين وتصلق الhypoxemiaاللي صارت في الدم
+
+313
+00:22:05,510 --> 00:22:12,350
+الـ urine output لسه بيكون أكتر من 30 مليلتر يعني
+
+314
+00:22:12,350 --> 00:22:19,530
+لو بدنا نحكي بالـ kilogram بيكون المريض بيجيب
+
+315
+00:22:19,530 --> 00:22:25,290
+حوالين نص مليلتر لكل kilogram من وزنه لكن في الـ
+
+316
+00:22:25,290 --> 00:22:28,650
+stage التانية نص مليلتر لكل kilogram من وزنه في
+
+317
+00:22:28,650 --> 00:22:31,510
+الـ stage التانية لاحظوا أن المريض بيكون فقط حوالي
+
+318
+00:22:31,510 --> 00:22:34,900
+لتر و نصوبالتالي بيبدأ يصيب الـ Decrease في الـ
+
+319
+00:22:34,900 --> 00:22:36,980
+Blood Pressure وبالتالي الـ Heart Rate بيبدأ يزيد
+
+320
+00:22:36,980 --> 00:22:41,700
+عن 100، بيكون بين 100 و120، تمام؟ والـ Urine
+
+321
+00:22:41,700 --> 00:22:44,920
+Output يا جماعة، بيبدأ يقل و المريض بيبدأ يصير
+
+322
+00:22:44,920 --> 00:22:49,660
+Untrustful ليش؟ لأنه الـ Oxygen صار low وأول
+
+323
+00:22:49,660 --> 00:22:53,060
+علامات الـ Hypoxia والـ Hypoxemia أنه بيكون الـ
+
+324
+00:22:53,060 --> 00:22:57,140
+Patient إيش ماله؟ Restlessness بيصير Distressed
+
+325
+00:22:57,140 --> 00:23:02,430
+لأنه مافيش Oxygen يعني صار فيه Air Hangarيعني هو
+
+326
+00:23:02,430 --> 00:23:07,990
+الـ tissue صارت ماعندهاش good oxygenation في الـ
+
+327
+00:23:07,990 --> 00:23:10,490
+third stage بيبقى يصير ال heart rate كتير أكتر من
+
+328
+00:23:10,490 --> 00:23:14,350
+120 أحسنتوا كل ما ببدأ بحكي بحكي عن ال heart rate
+
+329
+00:23:14,350 --> 00:23:18,410
+عشان هي كده كتير سؤال بيجي في ال MCQ في الامتحانات
+
+330
+00:23:18,410 --> 00:23:21,760
+أنه مين هو ال first indicator لل shock؟الـ Heart
+
+331
+00:23:21,760 --> 00:23:25,300
+Rate مش الـ Blood Pressure الـ Blood Pressure هذا
+
+332
+00:23:25,300 --> 00:23:28,700
+بيصير Late بعد الـ Stage الأولى بيكون ال patient
+
+333
+00:23:28,700 --> 00:23:31,680
+in shock وفي Stage 1 و لسه الـ Blood Pressure طبعا
+
+334
+00:23:31,680 --> 00:23:34,940
+كويس في الـ Shock في الـ Stage التانية بيبدأ الـ
+
+335
+00:23:34,940 --> 00:23:37,840
+Blood Pressure يقل و بيبدأ الـ Heart Rate تزيد
+
+336
+00:23:37,840 --> 00:23:41,160
+أكتر لذلك الـ Heart Rate كل ما بيزيد أكتر كل ما
+
+337
+00:23:41,160 --> 00:23:44,600
+بيخليني أعرف وين المريض تبقى أيه في which stage of
+
+338
+00:23:44,600 --> 00:23:47,960
+shock يعني هنجيك مريض الـ Heart Rate تبعه فوق
+
+339
+00:23:47,960 --> 00:23:52,410
+الـ140لو كارديا كوز شايف أنا فيه source of
+
+340
+00:23:52,410 --> 00:23:55,730
+bleeding وماعندهوش قلب وماعندهو فيش dysrhythmia،
+
+341
+00:23:55,730 --> 00:24:01,090
+sinus، tachycardia، أه هذا مكون أكيد أنه بدأ يخش
+
+342
+00:24:01,090 --> 00:24:04,930
+فيه مرحلة متقدمة من الشك بشوف ال blood pressure
+
+343
+00:24:04,930 --> 00:24:09,750
+بلاقيه low كتير مثلا ال blood pressure 80 على 40،
+
+344
+00:24:09,750 --> 00:24:13,790
+أه severely shocked قدش مكون فاقد على طول حضرتك
+
+345
+00:24:13,790 --> 00:24:21,340
+لازم تعرف أنه هنا at least المريض فاقد 2 لترطبعاً
+
+346
+00:24:21,340 --> 00:24:23,160
+هو مصادر الـ hemorrhage وأنا شايف مصادر الـ
+
+347
+00:24:23,160 --> 00:24:25,440
+hemorrhage والـ heart rate جاي فوق الـ140، blood
+
+348
+00:24:25,440 --> 00:24:29,860
+pressure low أقل من 90 على 60، 80 على 80 مثلا،
+
+349
+00:24:29,860 --> 00:24:34,340
+بتعرف إن المريض هذا فاقد at least two units دماء،
+
+350
+00:24:34,340 --> 00:24:39,360
+two liters blood، okay؟ وطبعاً ال urine output، لو
+
+351
+00:24:39,360 --> 00:24:42,380
+بدك تشوف ال urine output، هتلاقي أيش؟ مافيش urine
+
+352
+00:24:42,380 --> 00:24:46,260
+output، لأنه مافيش perfusion، طبعاً؟ ولو بدنا نطلع
+
+353
+00:24:46,260 --> 00:24:49,300
+على نسبة retrograde، هتلاقي severe tachypnea، أكتر
+
+354
+00:24:49,300 --> 00:24:55,500
+من 35ليش؟ بده يعمل .. بده يحاول يعمل Oxygenation،
+
+355
+00:24:55,500 --> 00:24:59,540
+هذه كتير كتير مهمة في .. بالذات في أقصاد الطوارئ،
+
+356
+00:24:59,540 --> 00:25:02,100
+أول عيوز المرضى، بنتعامل معاه، بنبدأ نتعامل معاه،
+
+357
+00:25:02,100 --> 00:25:05,640
+بنبدأ ناخد Vital Sign إليه، باخد بالي جدا من ال
+
+358
+00:25:05,640 --> 00:25:08,620
+Respiratory Rate تبعه، من ال Saturation تبعه، من
+
+359
+00:25:08,620 --> 00:25:12,380
+ال urine output زي ركبتهوالخسارة طبعا بتأكد الـ
+
+360
+00:25:12,380 --> 00:25:16,180
+heart rate و ال blood pressure قبل كل حاجة لكن
+
+361
+00:25:16,180 --> 00:25:20,000
+برضه بوجود الحاجات هذه heart rate 400 أو 400 okay
+
+362
+00:25:20,000 --> 00:25:22,940
+ممكن stress طب خليني أشوف ال blood pressure لأ low
+
+363
+00:25:22,940 --> 00:25:28,540
+كمان طيب لأ هيك بدأ يصير الوضع خطير طب يقولون
+
+364
+00:25:28,540 --> 00:25:29,380
+output بعمل
+
+365
+00:25:31,940 --> 00:25:36,020
+مساج للـ bladder، ممكن ركّب كاتيتر، ممكن ركّب
+
+366
+00:25:36,020 --> 00:25:43,060
+كاتيتر، ممكن ركّب كاتيتر، ممكن ركّب كاتيتر، ممكن
+
+367
+00:25:43,060 --> 00:25:43,260
+ركّب كاتيتر، ممكن ركّب كاتيتر، ممكن ركّب كاتيتر،
+
+368
+00:25:43,260 --> 00:25:45,900
+ممكن ركّب كاتيتر، ممكن ركّب كاتيتر، ممكن ركّب
+
+369
+00:25:45,900 --> 00:25:48,080
+كاتيتر، ممكن ركّب كاتيتر، ممكن ركّب كاتيتر، ممكن
+
+370
+00:25:48,080 --> 00:25:49,820
+ركّب كاتيتر، ممكن ركّب كاتيتر، ممكن ركّب كاتيتر،
+
+371
+00:25:49,820 --> 00:25:49,920
+ممكن ركّب كاتيتر، ممكن ركّب كاتيتر، ممكن ركّب
+
+372
+00:25:49,920 --> 00:25:51,860
+كاتيتر، ممكن ركّب كاتيتر، ممكن ركّب كاتلتحصل على
+
+373
+00:25:51,860 --> 00:25:58,520
+مصدر IV للمريض إنه يكون في عندك مصدر IV source
+
+374
+00:25:58,520 --> 00:26:03,040
+علشان تبدأ تدعي اتعود سواء للمريض من خلاله وإلا ال
+
+375
+00:26:03,040 --> 00:26:06,160
+patient بعدها هيصير collapse وهيصير severe
+
+376
+00:26:06,160 --> 00:26:08,620
+vasoconstriction هو already أصلا فيه severe
+
+377
+00:26:08,620 --> 00:26:11,480
+vasoconstriction حكينا ليش؟ يجب أن يعمل
+
+378
+00:26:11,480 --> 00:26:15,090
+compensation يحاول يرفع ميلالـBlood Pressure
+
+379
+00:26:15,090 --> 00:26:19,350
+فبتكون هنا من الصعوبة بما كان أنك تحاول تركب
+
+380
+00:26:19,350 --> 00:26:24,810
+للمريض إيش كاني لذلك هنا جدا مهم إنه نحاول نضع
+
+381
+00:26:24,810 --> 00:26:30,730
+للمريض IV Axis two large pore كاني و لأ مش واحدة
+
+382
+00:26:30,730 --> 00:26:35,310
+بس حاول تكون large باس إنه as early as possible كل
+
+383
+00:26:35,310 --> 00:26:39,750
+مكان أسرع كل مكان أحسن للمريض و لإلنا علشان نقدر
+
+384
+00:26:39,750 --> 00:26:43,280
+ننقذ المريضالـ Stages هذه مهمة وبيجي منها كتير
+
+385
+00:26:43,280 --> 00:26:46,680
+أسئلة في الانتحان أنا شرحتها لما كان كفاية الـ
+
+386
+00:26:46,680 --> 00:26:50,340
+Cardogen Hit بيكون إحنا حكينا عن الـ Hypovolemic
+
+387
+00:26:50,340 --> 00:26:54,500
+Shock كمسبب يعني كأهم مسببات الـ Hypovolemic الـ
+
+388
+00:26:54,500 --> 00:26:58,140
+Homologic Shock وحكينا عن الـ Stages سبقتها لو بدى
+
+389
+00:26:58,140 --> 00:27:01,040
+أحكي عن الـ Cardogenic Shock طبعا هنحكي عن الإلاج
+
+390
+00:27:01,040 --> 00:27:06,200
+كل واحدة بالآخر لحدكاردوجينك شوك لما بنحكي عن
+
+391
+00:27:06,200 --> 00:27:10,100
+الكاردوجينك شوك بنحكي إنه فيه dependent on poor
+
+392
+00:27:10,100 --> 00:27:13,300
+pump function يعني القصة في إن القلب نفسه هو اللي
+
+393
+00:27:13,300 --> 00:27:16,260
+تعبان ال pump الموتور اللي بيطلق ميه من الطابق
+
+394
+00:27:16,260 --> 00:27:19,300
+الأول للطابق الرابع هو اللي فيه مشكلة فهو بيطلعش
+
+395
+00:27:19,300 --> 00:27:22,880
+ميه هو نفسه الموتور نص إحصان وإحنا بدنا موتور إيش؟
+
+396
+00:27:22,880 --> 00:27:26,420
+إتنين إحصان تمام؟ القلب ال ejection fraction تبعه
+
+397
+00:27:26,420 --> 00:27:30,870
+عشرين، خمستاشر بدل ما هو المفروض يكون ستينacute
+
+398
+00:27:30,870 --> 00:27:34,710
+catastrophic failure of the left ventricular pump
+
+399
+00:27:34,710 --> 00:27:38,810
+function دائما بنحكي لما يحصل lift-sided heart
+
+400
+00:27:38,810 --> 00:27:43,590
+failure هذا معناه أن الطلب ما بيكون الـperfusion
+
+401
+00:27:43,590 --> 00:27:47,630
+تبقى بقى لإنه left heart failure معناه أن الأورطة
+
+402
+00:27:47,630 --> 00:27:50,770
+يعني left ventricle لما بيعمل contraction لما
+
+403
+00:27:50,770 --> 00:27:53,910
+بيعمل contraction ضعيفة للأورطة فشي كاردك اوتبوت
+
+404
+00:27:53,910 --> 00:27:59,050
+كتير يطلع من ال heart ويوصل علىالـ Perfusion يعني
+
+405
+00:27:59,050 --> 00:28:03,530
+كل الـ organs سبعت الجسم عشان هيك دايما من علامات
+
+406
+00:28:03,530 --> 00:28:06,410
+الـ «Left-sided heart failure» أيش حكيناه؟
+
+407
+00:28:06,410 --> 00:28:08,910
+بالمنارة «أديمة» However إنه في الـ «Right-sided
+
+408
+00:28:08,910 --> 00:28:11,450
+heart failure» دايما من علاماتها بتكون إيه؟ «Lower
+
+409
+00:28:11,450 --> 00:28:15,390
+limb edema» Okay؟ ليش؟ لأنه في الـ «Right-sided
+
+410
+00:28:15,390 --> 00:28:18,550
+heart failure» المشكلة في إنه الـ «فيروس» اللي
+
+411
+00:28:18,550 --> 00:28:23,010
+يتحرك اللي بيجي قليل تمام؟ فمابرجعش كله فبضله كله
+
+412
+00:28:23,010 --> 00:28:26,270
+«E» to «H» مع الجرافيت اللي تحت فبتلاقي «Lower
+
+413
+00:28:26,270 --> 00:28:30,650
+limb edema»على أية حال، الـ Cardiogenic Shock من
+
+414
+00:28:30,650 --> 00:28:32,970
+أيش ممكن يصير Cardiogenic؟ من أيش يعني ممكن يسكون
+
+415
+00:28:32,970 --> 00:28:35,810
+الـ heart في bomb failure؟ من حاجات كتير، أنه
+
+416
+00:28:35,810 --> 00:28:38,510
+مثلًا صار المريض عنده MI، حاجة Cardiogenic Shock
+
+417
+00:28:38,510 --> 00:28:41,810
+because of MI هو ال heart نفسه، العضلة ما
+
+418
+00:28:41,810 --> 00:28:46,610
+بتتراواش، يتراواش ال MI ال coronary arteries، اللي
+
+419
+00:28:46,610 --> 00:28:50,650
+وظيفتها تغذي القلب نفسه، مسكرة، occluded، وبالتالي
+
+420
+00:28:50,650 --> 00:28:55,110
+أيش بيصير؟ ال myocardialالقلب نفسه، الـmyocardium،
+
+421
+00:28:55,110 --> 00:28:58,870
+ما بتتغزس، ما بيوصلش blood وبالتالي، وبالتالي،
+
+422
+00:28:58,870 --> 00:29:04,170
+مافيش إمكانية أنه القلب أو الـheart muscle نفسها
+
+423
+00:29:04,170 --> 00:29:09,570
+تشتغل بالكبسيث تباعتها، بتكون efficient مش قادرة
+
+424
+00:29:09,570 --> 00:29:13,590
+أنها تكون كما يجب أو أن يكون فيه discipline يعني
+
+425
+00:29:13,590 --> 00:29:17,030
+المفروض إن القلب بيعمل contraction و relaxation
+
+426
+00:29:17,030 --> 00:29:20,630
+contraction و relaxation طب لما يصير القلب فجأة
+
+427
+00:29:20,630 --> 00:29:27,340
+يعملما زي Ventricular Fibrillation أو بلاش
+
+428
+00:29:27,340 --> 00:29:29,880
+Ventricular Fibrillation Atrial Fibrillation بس
+
+429
+00:29:29,880 --> 00:29:36,060
+الـ Atrium هم الأعمالين بيرتعشوا زيادة عن اللزوم و
+
+430
+00:29:36,060 --> 00:29:40,880
+مش انتظام مع العدد الإنقباضات طبعة الـ ventricle
+
+431
+00:29:43,570 --> 00:29:49,510
+Sopraventricular تاكيكارديا أو أي حاجة في الأترام
+
+432
+00:29:49,510 --> 00:29:54,370
+أترالفابريليشن أو أترالفلتر أو أي حاجة مختلفة طبعا
+
+433
+00:29:54,370 --> 00:29:56,630
+الفرق أن الـSopraventricular بتكون Regular زي ما
+
+434
+00:29:56,630 --> 00:30:01,030
+حكينا في الـCardiology والأنواع التانية اللي هي
+
+435
+00:30:01,030 --> 00:30:04,910
+الأترالفابريليشن والأترالفلتر ممكن تكون Irregular
+
+436
+00:30:05,960 --> 00:30:10,780
+كل الـDysrhythmias هذه هتأثر على إنه
+
+437
+00:30:10,780 --> 00:30:16,020
+الـContractions التبع القلب والـBlood الـPerfusion
+
+438
+00:30:16,020 --> 00:30:19,300
+اللي بيطلع اللي المفروض يطلع من الـBlood Community
+
+439
+00:30:19,300 --> 00:30:22,040
+الدم عشان تعمل الـPerfusion بيكون قليل وابتدت
+
+440
+00:30:22,040 --> 00:30:25,260
+هيتكشش المريض إذا ما استمر استمر المريض على الحالة
+
+441
+00:30:25,260 --> 00:30:31,240
+هذه من الـDysrhythmia بالآخر هيكش المريض بشكالـ
+
+442
+00:30:31,240 --> 00:30:33,560
+mechanical ممكن تكون مسألة mechanical الـ
+
+443
+00:30:33,560 --> 00:30:37,540
+tricuspid أو الـ mitral valve هما اللي فيهم إيه
+
+444
+00:30:37,540 --> 00:30:41,340
+المشكلة فمثلا الـ regurgitation أو فيه stenosis أو
+
+445
+00:30:41,340 --> 00:30:45,700
+أو كل هذا هيخلق أنه فيه heart failure أو حكينا عن
+
+446
+00:30:45,700 --> 00:30:49,000
+الالدنيا أو حكينا عن الـ myopathy زي ال myocardial
+
+447
+00:30:49,000 --> 00:30:53,300
+infarction okay إذا كان في حاجة من الحاجات دول ال
+
+448
+00:30:53,300 --> 00:30:56,100
+pump هيصير فيها failure ال heart هيصير فيه failure
+
+449
+00:30:56,100 --> 00:30:58,380
+وبالتالي pump failure this is the mean of
+
+450
+00:30:58,380 --> 00:31:04,440
+cardiogenic shockممكن يكون بريكارديتس اللي عمل ال
+
+451
+00:31:04,440 --> 00:31:10,460
+myopathy مش بس MI ممكن يكون myocarditis يمكن يكون
+
+452
+00:31:10,460 --> 00:31:16,380
+septic myocardial يعني المريض فيه أندوسيبسيز و ال
+
+453
+00:31:16,380 --> 00:31:21,880
+heart صار إيش؟بسبتك ميوكارديا ديبريشي بسبتك بطل هو
+
+454
+00:31:21,880 --> 00:31:26,920
+بيوصل ودام ممكن يكون Cardiotoxicity Pharmacologic
+
+455
+00:31:26,920 --> 00:31:31,280
+Cardiotoxicity مريض بياخد Digital toxicity صار
+
+456
+00:31:31,280 --> 00:31:35,960
+عنده مثلا بياخد Dioxin وصار عنده failure من ال من
+
+457
+00:31:35,960 --> 00:31:37,300
+ال Dioxin فبطل
+
+458
+00:31:40,390 --> 00:31:43,210
+يعني يستطيع إنه يعمل complete contraction و
+
+459
+00:31:43,210 --> 00:31:45,650
+complete relaxation لأنه بيصير إيه إيش؟ زي ما أحنا
+
+460
+00:31:45,650 --> 00:31:49,070
+عارفين الـbradycardia كتير، فبصير ممكن هو
+
+461
+00:31:49,070 --> 00:31:53,370
+الـdioxin بنقطع عشان الـintro، positive intro لكن
+
+462
+00:31:53,370 --> 00:31:55,690
+معروف إن الـdigital is toxicity، لو أخدنا
+
+463
+00:31:55,690 --> 00:31:59,950
+الـdioxin وماكانش فيه good drug level، إطلعنا عن
+
+464
+00:31:59,950 --> 00:32:03,090
+الـdrug level اللي مطلوب وخشوا المرضي الـtoxicity،
+
+465
+00:32:03,090 --> 00:32:07,370
+بيبقى بيصير إيش الـendodepression، ببطل عم يشتغل
+
+466
+00:32:07,370 --> 00:32:13,690
+زي ما هو المفروضميكانيكال حكينا عن الفلفات والـ
+
+467
+00:32:13,690 --> 00:32:16,550
+Arrhythmia حكينا عن أن معظم أنواع الـ Arrhythmia
+
+468
+00:32:16,550 --> 00:32:21,270
+يمكن تعمل Cardogenic Shock هذه هي الـ Causes تبع
+
+469
+00:32:21,270 --> 00:32:24,210
+الكاردوجينك شوكلة وبنحكي عن الـ Distributive أو
+
+470
+00:32:24,210 --> 00:32:27,790
+بيسموها Basogenic، Basogenic ليش؟ لأن المشكلة
+
+471
+00:32:27,790 --> 00:32:30,650
+حكينا وين؟ في الـPipe، في الـBussels نفسها، إيش
+
+472
+00:32:30,650 --> 00:32:34,050
+بيصير فيها؟ Severe Baso ده إيه لاتيجي، Poor
+
+473
+00:32:34,050 --> 00:32:38,460
+Bascular Toneوهي الـ Peripheral Circulation الـ
+
+474
+00:32:38,460 --> 00:32:44,120
+Vessels بتصير Dilated علشان هيك، إيش بيصير؟ الـ
+
+475
+00:32:44,120 --> 00:32:48,460
+Blood اللي فيها مابش عامل ضغط لأنه هي Dilated كتير
+
+476
+00:32:48,460 --> 00:32:51,280
+وين هذا بيصير؟ بيصير هذا في الـ Septic Shock في
+
+477
+00:32:51,280 --> 00:32:54,460
+الـ Septic Shock بيصير لإن تشوف Permeability بسبب
+
+478
+00:32:54,460 --> 00:32:59,720
+سفسف بتخرب فبيصير Severe Vasodilatation وبيصير كل
+
+479
+00:32:59,720 --> 00:33:01,200
+الـ Intrabascular
+
+480
+00:33:03,990 --> 00:33:07,710
+الـFluid طلعت للـExtra Vascular للـInterstitial
+
+481
+00:33:07,710 --> 00:33:12,410
+Space وبالتالي الـVessels
+
+482
+00:33:12,410 --> 00:33:19,510
+فضيت، صارت واسعة لكن مافيش فيها حاجة تعبيها في
+
+483
+00:33:19,510 --> 00:33:22,210
+الـToxic بيصير نفس الحاجة، في الـAnaphylactic
+
+484
+00:33:22,210 --> 00:33:25,510
+بيصير نفس الحاجة بسبب استمير الـRelease كميات
+
+485
+00:33:25,510 --> 00:33:30,410
+كبيرة ويصير الـPossibilitation وبرضه الـFluid كله
+
+486
+00:33:30,410 --> 00:33:36,810
+بتطلع على الـExtraCellular أو Extravascular وما
+
+487
+00:33:36,810 --> 00:33:42,270
+بيضلش إيش في الـ Intravascular، تمام؟ في الـ
+
+488
+00:33:42,270 --> 00:33:49,450
+Sepsis حكينا due to infectionفي كل الأنواع تبعت
+
+489
+00:33:49,450 --> 00:33:55,630
+الـ «Distributive Shock» سواء كانت «Septic» أو
+
+490
+00:33:55,630 --> 00:33:59,030
+«Neurogenic» آه، أنا نسيت أحكي عن الـ «Neurogenic
+
+491
+00:33:59,030 --> 00:34:02,690
+Shock» الـ «Neurogenic Shock» يا جماعة، إلها قصة
+
+492
+00:34:02,690 --> 00:34:06,390
+مهمة جدا، يجب أنه إحنا نتطرق إليها الـ «Neurogenic
+
+493
+00:34:06,390 --> 00:34:09,970
+Shock» نوع من أنواع الـ «Distributive Shock»، صحيح
+
+494
+00:34:09,970 --> 00:34:16,840
+لكن الـ «Neurogenic Shock»فيها فرق مميز عن جميع
+
+495
+00:34:16,840 --> 00:34:22,300
+أنواع الشُك أن الـ heart rate مايكون تاكي كارديا،
+
+496
+00:34:22,300 --> 00:34:26,060
+مايكون برادي كارديا، طب ليش؟ طب هو مش المفروض أن
+
+497
+00:34:26,060 --> 00:34:30,240
+الـ blood pressure low؟ أه، طب وبالتالي مش المفروض
+
+498
+00:34:30,240 --> 00:34:33,140
+أن الـ heart يبدأ يعمل compensation ويصير يطلع؟
+
+499
+00:34:33,140 --> 00:34:38,610
+أه، طب و ليش؟الـ Heart Rate Bradycardia مش
+
+500
+00:34:38,610 --> 00:34:41,630
+تاكيكارديا لأنه في الـ Neurogenic Shock المسألة
+
+501
+00:34:41,630 --> 00:34:45,050
+هنا بتختلف لإن الأعصاب بتتحكم في الموضوع كيه؟
+
+502
+00:34:45,050 --> 00:34:49,810
+Central Nervous System لما نكون شغالة جماعة بتحكم
+
+503
+00:34:49,810 --> 00:34:54,030
+في تصرفاتنا وفي حركاتنا الـ Sympathetic Nervous
+
+504
+00:34:54,030 --> 00:34:57,420
+Systemلكن لما يحدث الـ Central Nervous System
+
+505
+00:34:57,420 --> 00:35:01,720
+Depression أو بيصير Trauma أو Injury أو أي سببريشن
+
+506
+00:35:01,720 --> 00:35:04,900
+أدى إلى أن الـ Central Nervous System يوقف مين
+
+507
+00:35:04,900 --> 00:35:06,600
+يعني الـ Central Nervous System؟ يعني الـ Brain
+
+508
+00:35:06,600 --> 00:35:12,020
+والـ Spinal Cord هدولة صار فيهم أي حاجة أدت إلى
+
+509
+00:35:12,020 --> 00:35:16,240
+أنهم يصير لهم Stop للـ Function سبقتهم زي مثلا
+
+510
+00:35:16,240 --> 00:35:24,100
+Trauma، Severe Compression، whatever، okay قصةصار
+
+511
+00:35:24,100 --> 00:35:29,020
+بطل فيه السيلان العصبي بطل مستمر لأنه صار في منطقة
+
+512
+00:35:29,020 --> 00:35:32,020
+في عندها cat في عندها compression بطل في
+
+513
+00:35:32,020 --> 00:35:35,720
+continuity طيب إيش اللي بده يصير؟ بده يصير إنه
+
+514
+00:35:35,720 --> 00:35:38,800
+sympathetic nervous system بده يوقف وبالتالي
+
+515
+00:35:38,800 --> 00:35:41,200
+هيشتغل حاجة اسمها البارا sympathetic nervous
+
+516
+00:35:41,200 --> 00:35:43,920
+system هذه اللي بتشتغل وإحنا إيش؟ وإحنا نايمين يا
+
+517
+00:35:43,920 --> 00:35:46,830
+جماعة لما بننامالـ Sympathetic Nervous System
+
+518
+00:35:46,830 --> 00:35:49,570
+تتوقف، من يشتغل؟ بيشتغل البعض، الـ Sympathetic
+
+519
+00:35:49,570 --> 00:35:51,610
+Nervous System. Sympathetic Nervous System لما
+
+520
+00:35:51,610 --> 00:35:55,190
+بيكون شغال، إيش بيسوي يا جماعة؟ Fight or Fly،
+
+521
+00:35:55,190 --> 00:35:59,350
+بيخليك أنت قادر تتحرك، تواجه، تشرب، تعمل، تدافع،
+
+522
+00:35:59,350 --> 00:36:03,710
+قادر تعمل كل إيش active طب و لما بتنام، بيشتغل
+
+523
+00:36:03,710 --> 00:36:06,970
+البعض الـ Sympathetic Nervous System، إيش بيصير؟
+
+524
+00:36:06,970 --> 00:36:14,070
+بيصير sleep and digestإذا برا sympathetic nervous
+
+525
+00:36:14,070 --> 00:36:18,790
+system بيشتغل معانا و احنا نايمين فبيعمل كل إيش
+
+526
+00:36:18,790 --> 00:36:24,110
+لإيش لتحت يعني ال blood pressure بنزل ال heart
+
+527
+00:36:24,110 --> 00:36:31,570
+rateبنزل، أها، إذا عشان هي في الـ Neurogenic shock
+
+528
+00:36:31,570 --> 00:36:35,010
+because of stop of sympathetic nervous system
+
+529
+00:36:35,010 --> 00:36:37,890
+والشغل بيصير لـ Parasympathetic nervous system
+
+530
+00:36:37,890 --> 00:36:41,830
+فبنلاقي إن ال heart rate أيش بيصير فيه؟ Decreased،
+
+531
+00:36:41,830 --> 00:36:44,970
+however إن ال patient شك و ال blood pressure تبعه
+
+532
+00:36:44,970 --> 00:36:50,470
+low لكن ال heart rate تبعه بيكون برضه low هذه من
+
+533
+00:36:50,470 --> 00:36:54,090
+أهم علامات من هذا ال patient أنه Neurogenic shock،
+
+534
+00:36:54,090 --> 00:36:54,670
+okay؟
+
+535
+00:36:57,440 --> 00:37:00,580
+طبعاً كلهم بيشتركوا في أن الـ Renal Perfusion
+
+536
+00:37:00,580 --> 00:37:03,760
+هيكون Low وبالتالي الـ Urine Output هيكون Low لما
+
+537
+00:37:03,760 --> 00:37:06,160
+بدنا نحكي عن الـ Urine Output يا جماعة كتير حكيتها
+
+538
+00:37:06,160 --> 00:37:10,320
+كتير محاضرة كمان مرة بعيدة كيف بعرف أنه الـ Urine
+
+539
+00:37:10,320 --> 00:37:13,780
+Output عند المريض هذا Low بدي أشوف وزنه أهم حاجة
+
+540
+00:37:13,780 --> 00:37:18,520
+أشوف وزنه ومافيش حاجة تقولي باليوم بيجيب كذا لأ
+
+541
+00:37:18,520 --> 00:37:24,960
+مافيش إيش اسمه باليوم إحنا بنشوف بالساعةكم مللي
+
+542
+00:37:24,960 --> 00:37:33,720
+لتر الهواتف كل ساعة، فهو يعتمد على كمية الشخص اللي
+
+543
+00:37:33,720 --> 00:37:37,520
+يواجهه، لو كان الشخص يواجه 70 كيلو جرام، لو مريض
+
+544
+00:37:37,520 --> 00:37:42,380
+يواجه 70 كيلو جرام، فإن نسخة الهواتف الطبيعية 1
+
+545
+00:37:42,380 --> 00:37:49,350
+إلى 2 ملي لترhour إذا الـ Normal urine output per
+
+546
+00:37:49,350 --> 00:37:53,330
+kg per hour أنه المريض يكون بيجيب واحد لاتنين
+
+547
+00:37:53,330 --> 00:37:59,230
+milliliter لكل كيلوجرام من وزنه في الساعة يعني
+
+548
+00:37:59,230 --> 00:38:04,210
+لوزنه سبعين kilogram المفروض أنه بيجيب سبعين أمال
+
+549
+00:38:04,210 --> 00:38:09,370
+urine في الساعة تمام؟ لما بيصير المريض شغل أكيد
+
+550
+00:38:09,370 --> 00:38:14,330
+أنه ال urine output هيقل و هيقل يا جماعة عن نص
+
+551
+00:38:14,330 --> 00:38:19,210
+milliliter per hourعن نص مليلتر لكل كيلو جرام من
+
+552
+00:38:19,210 --> 00:38:23,150
+وزنه per hour يعني الوزن هو 70 مش هجيب حتى الـ 30
+
+553
+00:38:23,150 --> 00:38:27,490
+مليلتر في الساعة هجيب أقل، دليل أنه shock، okay؟
+
+554
+00:38:27,490 --> 00:38:31,050
+هذا بالنسبة للـ urine output ومن أهم علامات، على
+
+555
+00:38:31,050 --> 00:38:35,430
+فكرة تحسن الشوك أنه ال urine output يبدأ يتحسن،
+
+556
+00:38:35,430 --> 00:38:38,610
+إذا ال urine output بدأ المريض يجيب بول كويس،
+
+557
+00:38:38,610 --> 00:38:43,250
+معناه أنه بدأ يصير في عنده gut perfusions للكدنى
+
+558
+00:38:43,250 --> 00:38:46,130
+وما زال في gut perfusions للكدنى، بيبقى في gut
+
+559
+00:38:46,130 --> 00:38:54,680
+perfusionعلى كل الـ organs طبعا
+
+560
+00:38:54,680 --> 00:38:57,940
+إحنا متفكير إنه هكون فيه أنه متابولك أسيدوست في
+
+561
+00:38:57,940 --> 00:39:03,120
+حالة الشك بذات الـ septic shock و الـ hypogamic
+
+562
+00:39:03,120 --> 00:39:03,540
+shock
+
+563
+00:39:07,230 --> 00:39:10,690
+الـ Obstructive Shock الـ Obstructive Shock يا
+
+564
+00:39:10,690 --> 00:39:15,230
+جماعة زي ما حكينا إنه قصة إنه كأنه فيه شبر مسكر
+
+565
+00:39:15,230 --> 00:39:19,050
+على البربيج اللي بتوصل الميه بدل ما هي ماشية و
+
+566
+00:39:19,050 --> 00:39:21,650
+تمام و تمام لأ في واحد مسكر الشبر Obstructive
+
+567
+00:39:21,650 --> 00:39:28,360
+حكينا محابس تمام عدوها المحبس مش شبرالضغط تبع
+
+568
+00:39:28,360 --> 00:39:31,220
+الهواء زي في حالة الـ «نيمو توراكس» أو الـ «كادك
+
+569
+00:39:31,220 --> 00:39:35,940
+تانبونين» القصة أنه في الـ blood في القلب موجود و
+
+570
+00:39:35,940 --> 00:39:39,560
+القلب قادر إنه يعمل pumping لكن بيجي يعمل pumping
+
+571
+00:39:39,560 --> 00:39:42,940
+مافيش vessels تقبل ليه؟ ال vessels مضغوط عليها
+
+572
+00:39:42,940 --> 00:39:47,800
+because of air في ال example تبع الـ «تنش نيمو
+
+573
+00:39:47,800 --> 00:39:51,220
+توراكس» okay ففي air كتير ضغط على ال «إنترال
+
+574
+00:39:51,220 --> 00:39:54,420
+تراكت» ال vessels وبالتالي ليش إمكانية أن ال blood
+
+575
+00:39:54,420 --> 00:39:57,760
+يروح فيها وبالتالي هذه Obstructive shockإذا بتعمل
+
+576
+00:39:57,760 --> 00:40:01,400
+Release للـ Pressure هذا المريض بيتحسن لو كان
+
+577
+00:40:01,400 --> 00:40:05,700
+Obstructive Shock ويعني لو كان Tension
+
+578
+00:40:05,700 --> 00:40:09,140
+Pneumothorax هو اللي عامل الـ Pressure والمريض كان
+
+579
+00:40:09,140 --> 00:40:11,640
+Severely Shocked to Hypotension الحالة انك تعمل
+
+580
+00:40:11,640 --> 00:40:15,480
+Release بقى الـ Chester tube طلع بتبدأ ال vessels
+
+581
+00:40:15,480 --> 00:40:18,180
+ترتاح بيبدأ ال heart يعمل pumping ويعمل good
+
+582
+00:40:18,180 --> 00:40:21,830
+protrusion وتنتهي المشكلةشوفنا كيف؟ عشانك من
+
+583
+00:40:21,830 --> 00:40:25,490
+الأمثلة الـ Palmonar Edema، الـ Palmonar Embolism،
+
+584
+00:40:25,490 --> 00:40:28,530
+الـ Tension Pneumothorax، الـ Cardiac Tamponade،
+
+585
+00:40:28,530 --> 00:40:31,410
+كل هذه من أهم الأسباب اللي بتعمل الـ Shock زي ما
+
+586
+00:40:31,410 --> 00:40:37,850
+شوفناوبنعيد وبنكرر إنه الشوك كل ما بتستمر، كل ما
+
+587
+00:40:37,850 --> 00:40:45,850
+بيصير يعني exhausted للجسم، بالأول بيكون فيه good
+
+588
+00:40:45,850 --> 00:40:49,050
+vasoconstriction عشان يعملك good blood pressure
+
+589
+00:40:49,050 --> 00:40:53,050
+رغم إنه انت مافيش مثلا عندك سوائل في جسمك، رغم إن
+
+590
+00:40:53,050 --> 00:40:56,670
+القلب بطل يضخ كويسفبتروح تعمل الـ muscle
+
+591
+00:40:56,670 --> 00:41:00,630
+constriction بس كل ما تتقدم الشك وماحدش يعني كل ما
+
+592
+00:41:00,630 --> 00:41:03,250
+اتقدمت ملعقة المريض وماحدش ساعد المريض
+
+593
+00:41:03,250 --> 00:41:07,190
+بـsupportive drug إذا كانت كاردوجينيك بـfluid
+
+594
+00:41:07,190 --> 00:41:09,330
+therapy إذا كان هيدراشين تيرابي إذا كان
+
+595
+00:41:12,880 --> 00:41:15,600
+إذا ما حللناش المشكلة تبقى ده الـ Obstructive
+
+596
+00:41:15,600 --> 00:41:19,800
+Shock، whatever، هيضايقش المريض لوين، لأنه يصير
+
+597
+00:41:19,800 --> 00:41:22,980
+exhausted، فالـmesses اللي كانت عم تضيق عشان تظغ،
+
+598
+00:41:22,980 --> 00:41:25,560
+عشان تقلل الـdiameters تبقى، تبقى تحافظ على blood
+
+599
+00:41:25,560 --> 00:41:29,120
+pressure كويس، إيش بيصير فيها؟ بالآخر بيصير
+
+600
+00:41:29,120 --> 00:41:33,380
+vasoparalysis، ترخي وخلاص، بتسلم أمرها للله،
+
+601
+00:41:33,380 --> 00:41:37,680
+وبتقولك ده برحالك، أنا عملت اللي عليا، ومش يعني
+
+602
+00:41:37,680 --> 00:41:45,410
+أكتر من هيك مافيشتمام؟ عشان هي كبنحكي، هنا بيحكينا
+
+603
+00:41:45,410 --> 00:41:47,530
+في الـ «سلايد» هذه عن الـSympathetic Nervous
+
+604
+00:41:47,530 --> 00:41:50,970
+System وكيف بيصير الـVasoconstriction،
+
+605
+00:41:50,970 --> 00:41:54,490
+الـIncreased Respiratory Rate حكينا أنه مع كل الـ
+
+606
+00:41:55,670 --> 00:42:00,010
+مع كل شك عادة يبدأ الـ Respiratory rate يرتفع عشان
+
+607
+00:42:00,010 --> 00:42:02,290
+ذلك يا جماعة دايما نتطلع في ال pupils نلاقيهم
+
+608
+00:42:02,290 --> 00:42:05,350
+dilated نتطلع في ال Respiratory rate نلاقي العيان
+
+609
+00:42:05,350 --> 00:42:09,710
+بدأ يصير تكيبنك لأنه Air hunger، Oxygen hunger،
+
+610
+00:42:09,710 --> 00:42:14,470
+يعني ال tissue مابوصلاش Oxygen، okay هو الدنيا
+
+611
+00:42:14,470 --> 00:42:17,510
+مفتوحة أو long end تبعت و مافيش فيها مشكلة، بس
+
+612
+00:42:17,510 --> 00:42:21,220
+المشكلة أنه مافيش end صار كمية الدم كذا تحملأو
+
+613
+00:42:21,220 --> 00:42:24,600
+القلب في عنده كمية دم كافية أو في عنده مبلوغين بس
+
+614
+00:42:24,600 --> 00:42:29,400
+مافيش قلب يوصل أو الفسل صارت كتير واسعة فكمية الدم
+
+615
+00:42:29,400 --> 00:42:33,320
+because ان الفسل is كتير dilated مش بتروح لل
+
+616
+00:42:33,320 --> 00:42:38,800
+organs كلها بتتوزعش، عشان هي اسمها distributed،
+
+617
+00:42:38,800 --> 00:42:47,050
+مابتتوزعش كويسكل هذا سيجعل المريض يفقد السيطرة
+
+618
+00:42:58,850 --> 00:43:01,950
+Gasping and breathing، ليش؟ خلاص، سلم، صار فيه
+
+619
+00:43:01,950 --> 00:43:05,790
+peripheral paralysis، buzz paralysis، ال
+
+620
+00:43:05,790 --> 00:43:08,390
+respiratory rate بيبدأ يقل خالص، ال blood pressure
+
+621
+00:43:08,390 --> 00:43:13,330
+بيصير unmeasurable، بالمرة مافيش blood pressure،
+
+622
+00:43:13,330 --> 00:43:16,350
+المريض بيصير غايب عن الواعي خالص، مابتاخش الكومة،
+
+623
+00:43:16,350 --> 00:43:23,740
+لإن ال brain خلاص بطل يوصل دم، okay؟طبعاً عشان هيك
+
+624
+00:43:23,740 --> 00:43:26,960
+العلامات زي ما أحنا شايفين يعني في الـ compensated
+
+625
+00:43:26,960 --> 00:43:31,840
+بيكون في تكيكارديا وفي ال decompensated برضه بيكون
+
+626
+00:43:31,840 --> 00:43:36,900
+في تكيكارديا يعني لسه القلب بيكون شغال لكن بالآخر
+
+627
+00:43:36,900 --> 00:43:40,240
+يا جماعة بيبدأ القلب كمانبيصير الـ Predicate يخلص،
+
+628
+00:43:40,240 --> 00:43:43,060
+حتى القلب اللي كان compensation، ني-compensated،
+
+629
+00:43:43,060 --> 00:43:46,220
+ماتطل قادر يعمل compensation، فبوقف، هو بيصير
+
+630
+00:43:46,220 --> 00:43:49,960
+Predicate، خلاص، بطل، يعني مش قادر يضله يجاري
+
+631
+00:43:49,960 --> 00:43:53,420
+معاك، يحاول أنه يحسن الوضع، فهو بيصير Predicate
+
+632
+00:43:53,420 --> 00:43:57,400
+يعنيالـ skin بيكون white و cool، moist، بيكون
+
+633
+00:43:57,400 --> 00:44:05,180
+بارد، و بيكون لونه بيبدأ يصير زي جلد الجثث إذا
+
+634
+00:44:05,180 --> 00:44:08,860
+بتشوف كده، بيبدأ يصير شاحب خالص، كأنه أبيض
+
+635
+00:44:13,610 --> 00:44:17,230
+في الـ… في الـ«decompensated» يا جماعة، في
+
+636
+00:44:17,230 --> 00:44:20,810
+الـ«decompensated» بكون التعرض جدا شديد، دا
+
+637
+00:44:20,810 --> 00:44:25,730
+يافوريسيز بشكل كبير، ليش؟ كأنه الجسم بيسلم، خلاص،
+
+638
+00:44:25,730 --> 00:44:30,810
+بيصير يفقد، مش مـ… مش مـ… ماصارش عنده القدرة أو مش
+
+639
+00:44:30,810 --> 00:44:33,950
+ضايل عنده القدرة يظل محافظ على كمية السواق اللي هي
+
+640
+00:44:33,950 --> 00:44:36,950
+اللي هو محتاجها الجسم هو بيصير يطلع حتى عن طريق
+
+641
+00:44:36,950 --> 00:44:41,380
+الـskinالـBlood Pressure يا جماعة بكون كتير،
+
+642
+00:44:41,380 --> 00:44:46,440
+Unmeasurable، مش بس قليل، Level of Conscious في
+
+643
+00:44:46,440 --> 00:44:48,380
+الـCompensated، بكون فيه Alter في Level of
+
+644
+00:44:48,380 --> 00:44:53,360
+Conscious في الـCompensated،
+
+645
+00:44:53,360 --> 00:44:59,960
+هيبقوا يقولوا مكشوف، لكن في الـDecompensated، بكون
+
+646
+00:45:02,440 --> 00:45:05,500
+خلاص المريض بيصير disoriented و بيخشوا في كومة
+
+647
+00:45:05,500 --> 00:45:13,840
+عشان نبدأ يا جماعة بنحكي أنه نهتم جدا في مسألة الـ
+
+648
+00:45:13,840 --> 00:45:18,680
+tachycardia والـ blood pressure وما نقيمش بس
+
+649
+00:45:18,680 --> 00:45:23,900
+المريض على حكاية ضغطه لأنه الضغط يا جماعة لحاله،
+
+650
+00:45:23,900 --> 00:45:26,840
+shock is not the same thing as blood pressure a
+
+651
+00:45:26,840 --> 00:45:30,420
+failing blood pressure is a late sign of shockلما
+
+652
+00:45:30,420 --> 00:45:34,980
+مريضك بيكون ضغط واطب بيكون هو at least في ال stage
+
+653
+00:45:34,980 --> 00:45:37,560
+two ممكن يكون في ال stage three أو ال stage four
+
+654
+00:45:37,560 --> 00:45:44,100
+تمام؟ عشان هي تدور على المريض قبل ما يبدأ يخش في
+
+655
+00:45:44,100 --> 00:45:47,800
+ال hypertension لأنه بيكون already shocked برضه بس
+
+656
+00:45:47,800 --> 00:45:53,810
+لسه ماخشش في ال hypertension okay anyway احناحكينا
+
+657
+00:45:53,810 --> 00:45:56,490
+عن الـFinding و الـClinical Manifestation تبع
+
+658
+00:45:56,490 --> 00:46:00,630
+الـHypovolemic بما فيه الكفاية ابنجي نحكي عن
+
+659
+00:46:00,630 --> 00:46:03,950
+الـClinical Manifestation تبع الـCardiogenic Shock
+
+660
+00:46:03,950 --> 00:46:07,590
+طبعا حكينا عن ما فيه الكفاية و ملخصك مره مره لإن
+
+661
+00:46:07,590 --> 00:46:10,010
+الـOutput بجلد Blood Pressure بجلد Skin بيكون
+
+662
+00:46:10,010 --> 00:46:13,810
+Coil، Coil و Moisture و Mental Stiffness تبدأ
+
+663
+00:46:13,810 --> 00:46:17,450
+تتغير Metabolic Acidosis أنا جماعة في كل مرحلة
+
+664
+00:46:17,450 --> 00:46:20,550
+يعني بنشرح إيش الفرق بين Cardogenic وHypovolemic
+
+665
+00:46:25,130 --> 00:46:29,090
+بعد اللي treatment هنبدأ فيهم كذلك الان احنا نحكي
+
+666
+00:46:29,090 --> 00:46:31,070
+في الـ sun و السمس و طبعات ال cardiogenic shock
+
+667
+00:46:31,070 --> 00:46:36,030
+أكيد كلها يتبسط عارفينها ال nick vein اجمالها
+
+668
+00:46:36,030 --> 00:46:39,210
+هتكون واحد عنده cardiogenic shock هكون distended
+
+669
+00:46:39,210 --> 00:46:44,250
+مثلا دستندد
+
+670
+00:46:44,250 --> 00:46:49,550
+ولا مش دستندد جاجولار فين دستندد دستنشن بلمونة
+
+671
+00:46:49,550 --> 00:46:55,830
+قديمة hypotensiveالـ weak pulses، الـ oliguria،
+
+672
+00:46:55,830 --> 00:47:00,070
+الـ presentation of hypovolemic shock حكيناها،
+
+673
+00:47:00,070 --> 00:47:05,510
+نيجي لـ distributive shock حيكون المريض ربما يعني
+
+674
+00:47:05,510 --> 00:47:08,010
+إذا كان septic shock، حيكون عنده fever، إذا كان
+
+675
+00:47:08,010 --> 00:47:10,950
+toxins، ربما حيكون عنده fever، أه، بس كلهم حيكون
+
+676
+00:47:10,950 --> 00:47:13,670
+فيهم tachycardia، لكن إذا كان الـ eugenic shock،
+
+677
+00:47:13,670 --> 00:47:19,170
+حيكون الـ bradycardia، كلهم حيكون فيهمكلهم حيكون
+
+678
+00:47:19,170 --> 00:47:24,210
+فيهم hypertension وoliguria لكن هنا الـ lung هيكون
+
+679
+00:47:24,210 --> 00:47:26,630
+clear يا جماعة مش ممكن زي في الـ cardiogenic shock
+
+680
+00:47:26,630 --> 00:47:29,370
+هنا في الـ cardiogenic اللي ممكن يكون في بلمونه
+
+681
+00:47:29,370 --> 00:47:34,430
+القديمة لأنه congested في ال fluid في ال lungs لكن
+
+682
+00:47:34,430 --> 00:47:37,750
+في الـ distributive القصة لأ مافيش congestion ولا
+
+683
+00:47:37,750 --> 00:47:43,190
+حاجة القصة إنه إيش؟الـ Lung فاضين، والـ Vessels هي
+
+684
+00:47:43,190 --> 00:47:45,150
+اللي واسعة كتير، عشان هي الـ Neck Vein أناش
+
+685
+00:47:45,150 --> 00:47:50,210
+بيكونوا، يا جماعة، Flat، Neck Veins، مافيش، مش
+
+686
+00:47:50,210 --> 00:47:53,210
+هتلاقي descended neck veins ومحتبس السوق، لأ، لأ
+
+687
+00:47:53,210 --> 00:47:57,790
+المشكلة هو أصلا Distributed، يعني واسعين كتير الـ
+
+688
+00:47:57,790 --> 00:48:05,740
+Vessels everywhere، okay؟عشان هيك الـ الـ الـ plan
+
+689
+00:48:05,740 --> 00:48:09,340
+تبعتنا أنه نتعرف على المريض على recognition of
+
+690
+00:48:09,340 --> 00:48:16,680
+shock as early as possible تمام؟ ونبدأ نعالج في
+
+691
+00:48:16,680 --> 00:48:22,280
+المريض من الباب هذا في ال emergency ال emergency
+
+692
+00:48:22,280 --> 00:48:24,620
+تبعتنا، ال notion سوية يا جماعة حكيت عنها أنا في
+
+693
+00:48:24,620 --> 00:48:31,360
+أول محاضرة أنه نبدأ نركب للمريض ID accessوأنا أبدأ
+
+694
+00:48:31,360 --> 00:48:36,920
+أشوف إذا كان الـ Airway اللي تبقى المريض صار بدأ
+
+695
+00:48:36,920 --> 00:48:41,280
+يخش الـ Exhausted المريض وصار ال Respiratory التي
+
+696
+00:48:41,280 --> 00:48:44,040
+كتير عنده عالي فبكون أنا بدي أعمل Respiratory
+
+697
+00:48:44,040 --> 00:48:47,820
+Support maybe يحتاج Mechanical Ventilation maybe
+
+698
+00:48:47,820 --> 00:48:51,680
+Mask Ventilation أنه أنا بدي أبدأ أسيطر على المريض
+
+699
+00:48:51,680 --> 00:48:57,470
+أديله أنا Oxygenهوقف الـ process تبعت الـ
+
+700
+00:48:57,470 --> 00:49:00,830
+Increased respiratory rate المستمرة اللي عنده اللي
+
+701
+00:49:00,830 --> 00:49:03,770
+هو بيعملها as compensation عشان يحسن الـ Oxygen
+
+702
+00:49:03,770 --> 00:49:07,230
+الـ Oxygen demand عند المريض عالي جدا جماعة ال
+
+703
+00:49:07,230 --> 00:49:10,530
+Oxygen consumption عالي ببدأ أحقق أنا للأخر للمريض
+
+704
+00:49:10,530 --> 00:49:13,790
+at least نزل Oxygen at least نزل Oxygen بحطه في
+
+705
+00:49:13,790 --> 00:49:17,350
+high-polar circuit بحطوش في high-polar position
+
+706
+00:49:17,350 --> 00:49:22,770
+لأن المريضبتير بيكون «shocked» وبالتالي
+
+707
+00:49:22,770 --> 00:49:26,590
+«hypotension» فإن أحطه في «high follower position»
+
+708
+00:49:26,590 --> 00:49:30,110
+هذا هيأثر على ال «mental state» تبعته، فلأ، احنا
+
+709
+00:49:30,110 --> 00:49:34,110
+بنحطله أكسيجين، بنحاول نخل المريض في «shock
+
+710
+00:49:34,110 --> 00:49:36,950
+position» يكون رجليه مرفقين إذا الأمور «unstable»،
+
+711
+00:49:36,950 --> 00:49:39,250
+الأهم أنه أنا أكون عندي
+
+712
+00:49:43,370 --> 00:49:46,870
+وأبدأ التعامل مع المريض طبعا على حسب وضع الحالة
+
+713
+00:49:46,870 --> 00:49:49,590
+إذا كان المريض هيبقى full of chalk هبقى بدي أحط
+
+714
+00:49:49,590 --> 00:49:53,990
+two large pours of cannula و أبدأ أدى fluid
+
+715
+00:49:53,990 --> 00:49:57,450
+كريستالويز، ده ما بنبدأ، لكن إذا كانت جينيكسكو فيه
+
+716
+00:49:57,450 --> 00:50:03,140
+بلمونة قديمةمش هيظبط الموضوع، بدي انتروب، ثم بدي
+
+717
+00:50:03,140 --> 00:50:05,180
+.. هنشوف الاتفاق اللي هي الـ cardiogenic shock،
+
+718
+00:50:05,180 --> 00:50:09,400
+إذا بدي أنا أعرف أيش نوع ال shock اللي عند المريض
+
+719
+00:50:09,400 --> 00:50:14,820
+علشان أبدأ أتعامل معها و أعالج فيها، عشان هي كده
+
+720
+00:50:14,820 --> 00:50:18,840
+عادة ن determine the cause, often obvious based on
+
+721
+00:50:18,840 --> 00:50:21,820
+history، لازم أكون عارف عن المريض، هو المريضعرض
+
+722
+00:50:21,820 --> 00:50:24,380
+للـ trauma وصار عنده hypovolemic shock وبنتيجة
+
+723
+00:50:24,380 --> 00:50:29,720
+homerage ولا .. ولا septic يعني هو عنده eurosepsis
+
+724
+00:50:29,720 --> 00:50:33,300
+من ال history هتعرف اه وقصدها ومش قصدها من ال
+
+725
+00:50:33,300 --> 00:50:36,440
+history هتعرف ايش وضع المريض consider distributed
+
+726
+00:50:36,440 --> 00:50:39,660
+spinal ولا .. ولا عنده spinal shock شكله فيه
+
+727
+00:50:39,660 --> 00:50:43,060
+bradycardia أو فيه ايش اه وده falling down بدك
+
+728
+00:50:43,060 --> 00:50:48,780
+تعرف ايش نوع الشك علشانتبدأ تتعامل معها في الـ
+
+729
+00:50:48,780 --> 00:50:50,460
+«Cardiogenic shock» «Restored blood pressure
+
+730
+00:50:50,460 --> 00:50:54,140
+mechanical and breathing ongoing cardiac disease»
+
+731
+00:50:54,140 --> 00:50:57,120
+أهم حاجة أنه هنبدأ ندّي اللي هو «antibiotics»
+
+732
+00:50:57,120 --> 00:51:00,720
+و«drugs» وحاجات تبقى اسئلة إنه إيش نمنع عضلة القلب
+
+733
+00:51:00,720 --> 00:51:03,480
+إنها تموت لإنها مافيش بيوصل لـ «cardogenic shock»
+
+734
+00:51:03,480 --> 00:51:07,780
+القصة هو الغضب القلب نفسه هي مابتترواش، كويس؟ لكن
+
+735
+00:51:07,780 --> 00:51:10,020
+it's a hypovolemic fluid resuscitation it's a
+
+736
+00:51:10,020 --> 00:51:12,160
+distributive برضه fluid resuscitation و
+
+737
+00:51:12,160 --> 00:51:17,220
+vasopressor وكمان بدنا حاجة أدويةتديّق الـ blood
+
+738
+00:51:17,220 --> 00:51:22,850
+vessels هدولةعشان هيك يا جماعة الـ «Management»
+
+739
+00:51:22,850 --> 00:51:27,550
+تبع الشُك بتعتمد على إيش نوع الشُك نفسها، لكن في
+
+740
+00:51:27,550 --> 00:51:31,070
+كل أيتهم لازم أنا أحاول أن أحسن الـ «Oxygen» تبع
+
+741
+00:51:31,070 --> 00:51:34,970
+المريض إذا ماقدرتش أحسن الـ «Oxygen» و أحافظ على
+
+742
+00:51:34,970 --> 00:51:39,850
+«Saturation» أكتر من 92% و حالياً بقولوا أكتر من
+
+743
+00:51:39,850 --> 00:51:47,050
+94%، بكون المريض بده Oxygen طبعاً حطنا له Oxygen
+
+744
+00:51:47,050 --> 00:51:51,250
+Support، مع الـ «Oxygen Support»ما حطيتله نزل
+
+745
+00:51:51,250 --> 00:51:56,890
+كانيون مثلا وما اتحسنش عن 94% لازم تفكر بالـ
+
+746
+00:51:56,890 --> 00:52:01,590
+Intubation يكون أنا عامله طبعا ملاقا على other
+
+747
+00:52:01,590 --> 00:52:05,130
+parameters أنا أبدأ أفكر بإنه why not to intubate
+
+748
+00:52:05,130 --> 00:52:10,710
+this patientطبعاً الـ Hypotension عشان نحسنه يا
+
+749
+00:52:10,710 --> 00:52:14,350
+جماعة بقى
+
+750
+00:52:14,350 --> 00:52:18,710
+حسنه بحاجات كتير من ضمنها الـ Fluid أنه ند كميات
+
+751
+00:52:18,710 --> 00:52:20,850
+من الـ Fluid عادةً الـ Fluid اللي بنديها بنبدأ
+
+752
+00:52:20,850 --> 00:52:23,290
+بالـ Crystalloid و بعدين الـ Colloid، حاجاتها نشوف
+
+753
+00:52:23,290 --> 00:52:29,910
+بعد كممكن ند أدوية Vasopressorsمن صحيحة الحجم
+
+754
+00:52:29,910 --> 00:52:32,730
+الأوية الدموية الـ Pistols وبالتالي أعمل بعض الدم
+
+755
+00:52:32,730 --> 00:52:37,950
+وبعدين الـ Vasopressors نفسها من أمثلتها إنه ممكن
+
+756
+00:52:37,950 --> 00:52:42,210
+يكون Introbex Drug زي الدبامين، يعني هو
+
+757
+00:52:42,210 --> 00:52:47,290
+Vasopressors وهو Positive Introleلأن الدوبامين
+
+758
+00:52:47,290 --> 00:52:51,450
+بيشتغل على Beta-1 Receptors وبالتالي بيشتغل على
+
+759
+00:52:51,450 --> 00:52:53,510
+الـ Heart Muscle بيعمل الـ Simulation لـ Cardiac
+
+760
+00:52:53,510 --> 00:52:57,290
+Muscle itself فبيعملها بزود الـ Contractors تبعتها
+
+761
+00:52:57,290 --> 00:53:02,390
+However إن الـ Rate كمان هيزيد القصة المنيحة إن
+
+762
+00:53:02,390 --> 00:53:05,070
+الدوبامين كمان بيشتغل على الـ Alpha Receptors إذا
+
+763
+00:53:05,070 --> 00:53:08,090
+أنا زودت الـ Dose يعني لو أنا أشتغلت في الدوبامين
+
+764
+00:53:08,090 --> 00:53:11,970
+أو زودت الـ Dose تبعت الدوبامين عشرة Mic per
+
+765
+00:53:11,970 --> 00:53:17,110
+kilogram per minuteمن عشر إلى عشرين، هنا بكون أنا
+
+766
+00:53:17,110 --> 00:53:19,750
+بشغل على الف ريسبتورز وبالتالي أنا بعمل
+
+767
+00:53:19,750 --> 00:53:23,630
+Vasopressors، بزغر الـVessels، بعمل لها فيها
+
+768
+00:53:23,630 --> 00:53:26,630
+Vasoconstriction، بقول هذا بحقق لي ارتفاع في ضغط
+
+769
+00:53:26,630 --> 00:53:29,250
+الدم، however إن هذا ممكن يعمل لي مشاكل peripheral
+
diff --git a/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/icAigPXOkrE.srt b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/icAigPXOkrE.srt
new file mode 100644
index 0000000000000000000000000000000000000000..bc4d97801bd86730fe589daa69aabc5c1c714eab
--- /dev/null
+++ b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/icAigPXOkrE.srt
@@ -0,0 +1,1358 @@
+1
+00:00:01,570 --> 00:00:04,810
+بسم الله الرحمن الرحيم السلام عليكم ورحمة الله
+
+2
+00:00:04,810 --> 00:00:08,650
+وبركاته إن شاء الله رب العالمين اليوم هنحكي عن الـ
+
+3
+00:00:08,650 --> 00:00:11,970
+mechanical ventilator محاضرة عملية كيف ممكن تشغل الـ
+
+4
+00:00:11,970 --> 00:00:16,750
+mechanical ventilator لو مريضك يحتاج mechanical
+
+5
+00:00:16,750 --> 00:00:22,190
+ventilation الجهاز اللي هنستخدمه Trigger Savina
+
+6
+00:00:22,830 --> 00:00:29,430
+جهاز مشهور طبعاً فيه منه موديلات أحدث ولكن الفكرة
+
+7
+00:00:29,430 --> 00:00:33,130
+في تشغيل جهاز تنفّس صناعي سواء في Trigger سفينة
+
+8
+00:00:33,130 --> 00:00:36,370
+أو نوع ثاني أو الموديل هذا من الـ Trigger أو النوع
+
+9
+00:00:36,370 --> 00:00:41,330
+الأحدث منه هي نفس الفكرة في كل الأجهزة نفس الحاجات
+
+10
+00:00:41,330 --> 00:00:44,310
+اللي إحنا هنتعلمها ونفس الـ parameters والـ
+
+11
+00:00:44,310 --> 00:00:48,490
+settings بنعملها مع كل الأجهزة خلينا نشوف واحدة
+
+12
+00:00:48,490 --> 00:00:54,640
+واحدة، إيش الخطوات اللي إحنا لازم نعملها؟ بداية لازم
+
+13
+00:00:54,640 --> 00:00:59,800
+أتأكد أن الجهاز اللي هندي فيه Corrugated tube
+
+14
+00:00:59,800 --> 00:01:04,620
+المناسبة اللي بدي أشبكها للمريض، ولازم نعرف أن
+
+15
+00:01:04,620 --> 00:01:09,340
+الـ Corrugated tube هذه أولاً هي نوعين، فيه نوع مناسب
+
+16
+00:01:09,340 --> 00:01:14,880
+للأدلت وفيه نوع حجمه أصغر للـ Pediatric تمام؟ تشوفوا
+
+17
+00:01:14,880 --> 00:01:20,990
+كيف الـ Adult كيف الخامة تبعته بينما الـ Pediatric كيف
+
+18
+00:01:20,990 --> 00:01:25,430
+الـ diameter تبعه أقل، فإحنا بنتعامل مع أدلت، فخلّينا
+
+19
+00:01:25,430 --> 00:01:28,510
+نشتغل على الأدلت، الـ corrugated tube، هنشوف إن الـ
+
+20
+00:01:28,510 --> 00:01:31,810
+corrugated tube عبارة عن أنبوبتين، فيه
+
+21
+00:01:31,810 --> 00:01:35,670
+connection هذه اللي بتتّصل بالـ Trachea للـ Tube
+
+22
+00:01:35,670 --> 00:01:41,190
+وهنا فيه واحد فيهم إله Water trap والتاني مافيش فيه
+
+23
+00:01:41,190 --> 00:01:46,380
+Water trap، بديهياً اللي بده يطلع من المريض الـ
+
+24
+00:01:46,380 --> 00:01:48,940
+Expiration هو اللي هيكون متصل في الـ Water trap
+
+25
+00:01:48,940 --> 00:01:53,160
+عشان الـ Expiration تبعه بيكون فيه اللي هو بخار
+
+26
+00:01:53,160 --> 00:01:56,420
+ماء من الـ Expiration، فبالتالي هذا الـ Trap عشان
+
+27
+00:01:56,420 --> 00:02:01,980
+يصيد هذا البخار اللي بيطلع ويمنعه من وصوله للجهاز
+
+28
+00:02:01,980 --> 00:02:06,100
+والتاني الـ Inspiratory اللي بيجي من الجهاز للمريض
+
+29
+00:02:06,100 --> 00:02:10,720
+لما  مش هيكون فيه Water trap، الحاجة التانية اللي
+
+30
+00:02:10,720 --> 00:02:17,200
+لازم أشبك هدول صح بناء على الإشارات اللي
+
+31
+00:02:17,200 --> 00:02:20,960
+على الجهاز، نشوف إنه مدخل الـ Mechanical Ventilator
+
+32
+00:02:20,960 --> 00:02:25,620
+يعني فيه سهم لبرا، يعني هذا بيعطي للمريض النفس، يبقى
+
+33
+00:02:25,620 --> 00:02:31,860
+هذا الـ Inspiration، هنا بيرجع النفس للمريض، يعني هذا
+
+34
+00:02:31,860 --> 00:02:36,080
+الـ Expiration تمام؟ لازم نعرف أن عملية الـ
+
+35
+00:02:36,080 --> 00:02:38,580
+Breathing في الـ Mechanical Ventilation هي عملية
+
+36
+00:02:38,580 --> 00:02:42,620
+Active، لأ اللي هو الـ Inspiration عملية Active لكن
+
+37
+00:02:42,620 --> 00:02:47,860
+عودة النفس من المريض لجهازه عملية Passive بتتم
+
+38
+00:02:47,860 --> 00:02:51,620
+نتيجة أنه في High Pressure في الـ Intra Thoracic
+
+39
+00:02:51,620 --> 00:02:55,060
+Pressure يعني بيكون عالي فبيرجع الهواء للماشين
+
+40
+00:02:55,060 --> 00:03:01,500
+Passive، هذه هي الحاجة التانية، يجب أن نتأكد أن الـ
+
+41
+00:03:01,500 --> 00:03:05,940
+filters الخاص بجهاز والـ Oxygen Sensor هم مُغيّرين
+
+42
+00:03:05,940 --> 00:03:08,380
+هذا اسمه Oxygen Sensor أو Flow Sensor
+
+43
+00:03:10,870 --> 00:03:16,170
+اللي هو الـ Filter بتتغيّر عشان في الـ Expiration الـ
+
+44
+00:03:16,170 --> 00:03:20,290
+Filters شايفين كيف هذا علشان الـ Expiration طبعاً
+
+45
+00:03:20,290 --> 00:03:25,530
+المريض، يعني Infection Control، ما تخشّش هذه الـ
+
+46
+00:03:25,530 --> 00:03:29,930
+Filters على البكتيريا أو الحاجات اللي Could make
+
+47
+00:03:29,930 --> 00:03:33,070
+Infection على الجهاز، وتتغيّر من كل مريض ومريض
+
+48
+00:03:33,070 --> 00:03:36,950
+فإحنا بنحطه بالطريقة هاي وبنثبته لأن أي خلل فيه
+
+49
+00:03:36,950 --> 00:03:39,970
+لو كانت هذه عاملة هيك مش مثبتة بالطريقة هاي بيصير
+
+50
+00:03:39,970 --> 00:03:43,690
+فيه Leakage وبالتالي بيصير فيه Miss في الـ Tidal
+
+51
+00:03:43,690 --> 00:03:47,470
+Volume اللي بنوديه للعيان، هنا الـ Flow Sensor هذا
+
+52
+00:03:47,470 --> 00:03:51,090
+برضه بتركّب بالطريقة هذه زي ما إحنا شايفين هيك
+
+53
+00:03:51,090 --> 00:03:55,810
+هيك، آه، لاحظين كمان مرة، هيك، آه، بيدخل هنا فيه
+
+54
+00:03:55,810 --> 00:03:56,550
+له مكان
+
+55
+00:04:02,870 --> 00:04:10,310
+الحاجتين هدول عملناهم، وتأكدنا أن الجهاز أصلاً
+
+56
+00:04:10,310 --> 00:04:16,670
+مشبوك في الـ Oxygen، لأن الجهاز يشتغل على أن يأخذ
+
+57
+00:04:16,670 --> 00:04:21,050
+كمية من الـ Oxygen بتدخل على حاجة اسمها Air Mixer
+
+58
+00:04:21,050 --> 00:04:25,070
+في الجهاز، فإن Air Mixer زمان كانت الأجهزة الـ Air
+
+59
+00:04:25,070 --> 00:04:29,250
+Mixer يكون برا ويكون فيه Two Tube، واحد Oxygen و
+
+60
+00:04:29,250 --> 00:04:34,230
+واحد Air بس، هوا الـ… الـ Air Mixer هيعمل Fraction
+
+61
+00:04:34,230 --> 00:04:38,350
+تبع الأكسجين اللي أنا بدّيه، يعني مثلاً أنا بدي 40%
+
+62
+00:04:38,960 --> 00:04:44,280
+يعني 40% Oxygen و60% هوا، لأن إحنا عادي ما بنتنفسش
+
+63
+00:04:44,280 --> 00:04:49,660
+100% Oxygen Saturation، إحنا عادي بنتنفس 21% اللي
+
+64
+00:04:49,660 --> 00:04:53,820
+هو الـ Ambient Air اللي بيحتوي 21% من الـ Oxygen
+
+65
+00:04:53,820 --> 00:04:58,700
+فلما بيكون في Patient بكون أكيد أن الـ Demands تبعت
+
+66
+00:04:58,700 --> 00:05:04,220
+الـ Oxygen عنده أكتر، بنزود عن الـ 21، أربعين، خمسين
+
+67
+00:05:04,220 --> 00:05:07,040
+ستين، سبعين، في حالات نادرة ممكن نحطه على مية في
+
+68
+00:05:07,040 --> 00:05:11,360
+المية، بس Don't forget that Oxygen is a drug, so it
+
+69
+00:05:11,360 --> 00:05:15,500
+has a toxicity، عشان هي ما حدش بيفضل أن الـ Oxygen
+
+70
+00:05:15,500 --> 00:05:20,580
+يظل على High Concentration لمدة طويلة، ولذلك الـ
+
+71
+00:05:20,580 --> 00:05:26,000
+Common أنه يستخدم بين الـ 40 لـ 60%، Okay، فأتأكد أن
+
+72
+00:05:26,000 --> 00:05:26,580
+أنا مشغّل
+
+73
+00:05:31,270 --> 00:05:39,070
+و أتأكد أن الكهربا تبقى مشبوكة بطريقة صح، هيك
+
+74
+00:05:39,070 --> 00:05:45,130
+لأنه ممكن جداً أن يكون هناك مشكلة في البطارية، لأنه
+
+75
+00:05:45,130 --> 00:05:48,670
+فيه بطارية آه، لأنه ممكن جداً أن يكون هناك مشكلة
+
+76
+00:05:48,670 --> 00:05:51,890
+فلازم يكون مشبوك في الكهربا، هذه الـ Connection و
+
+77
+00:05:51,890 --> 00:06:00,350
+أتأكد أن أنا عندي الـ Corrugated Tube بالطريقة الصح
+
+78
+00:06:00,350 --> 00:06:05,310
+للمريض تمام، فأحط هذا زي ما حكينا، Yes, by Rotary
+
+79
+00:06:05,310 --> 00:06:13,710
+دائماً ما أخليش أغراض نازلة لتحت، وهذا X by Rotary جداً
+
+80
+00:06:13,710 --> 00:06:18,430
+يعني فيه حاجة اسمها اللي هو Lung Test ممكن أشبكها فيه
+
+81
+00:06:18,430 --> 00:06:23,270
+علشان لما نبدأ يطلع كمية الهواء، أبحث من خلالها الـ
+
+82
+00:06:23,270 --> 00:06:28,030
+Inflation والـ Quality تبع الجهاز، Okay، أنا شبّكت كل
+
+83
+00:06:28,030 --> 00:06:33,030
+الأمور، والآن بدي أعمل Switch On للجهاز، بدي أشغّل
+
+84
+00:06:33,030 --> 00:06:37,470
+الجهاز، وسيب الجهاز يعمل Preparation، Device
+
+85
+00:06:37,470 --> 00:06:42,530
+بيسموها Preparation، دائماً يا جماعة نعرف أنه الـ
+
+86
+00:06:42,530 --> 00:06:49,100
+زر اللي موجود عشان التشغيل، تبقى الجهاز يكون ورا، فيه
+
+87
+00:06:49,100 --> 00:06:52,920
+الكثير أجهزة بيكون عليهم لوحة عشان مش Accidental، أي
+
+88
+00:06:52,920 --> 00:06:57,480
+واحد خبط فيه اللي يصير له إيش Off، هذه حاجة، الحاجة
+
+89
+00:06:57,480 --> 00:06:58,020
+التانية
+
+90
+00:07:07,560 --> 00:07:12,100
+المرحلة، المفروض أن أنا بسيب الجهاز يعمل الـ
+
+91
+00:07:12,100 --> 00:07:16,860
+Calibration اللي هو O2 Sensor، بعمل Check لكل الـ
+
+92
+00:07:16,860 --> 00:07:20,140
+Device، هذا الـ Device Check، أسيب الجهاز يعمل الـ
+
+93
+00:07:20,140 --> 00:07:23,520
+Device Check تبعتها، وإلّا أنا ممكن أبدأ عملية
+
+94
+00:07:23,520 --> 00:07:26,660
+Ventilation لمريض أثناء فيه مشكلة، لأن لو في هو
+
+95
+00:07:26,660 --> 00:07:29,320
+عنده Leakage في مكان معين، لو في مشكلة في Sensor
+
+96
+00:07:29,320 --> 00:07:32,730
+لو في مشكلة في Filter، هيحكي فوراً إنه فيه Leakage
+
+97
+00:07:32,730 --> 00:07:36,830
+في المكان الفلاني أو فيه مشكلة فيه الـ Sensor تمام؟
+
+98
+00:07:36,830 --> 00:07:43,270
+لما أتأكد ويحكي لي هو إنه Okay، كل الـ Sensors مافيش
+
+99
+00:07:43,270 --> 00:07:47,760
+فيها مشكلة، يعني هيكتب لي Please wait، فأنا أتوقع أنه
+
+100
+00:07:47,760 --> 00:07:55,000
+بيحصل الأمور كويسة، وبيحصل، بيتشيك أنه بيحصل
+
+101
+00:07:55,000 --> 00:08:01,140
+الأمور كويسة، وبيحصل الأمور كويسة، وبيحصل الأمور
+
+102
+00:08:01,140 --> 00:08:01,820
+كويسة، وبيحصل الأمور كويسة، وبيحصل الأمور كويسة، و
+
+103
+00:08:01,820 --> 00:08:03,120
+بيحصل الأمور كويسة، وبيحصل الأمور كويسة، وبيحصل
+
+104
+00:08:03,120 --> 00:08:03,580
+الأمور كويسة، وبيحصل الأمور كويسة، وبيحصل الأمور
+
+105
+00:08:03,580 --> 00:08:05,200
+بيحصل الأمور كويسة، وبيحصل الأمور كويسة، وبيحصل
+
+106
+00:08:05,200 --> 00:08:10,760
+الأمور كويسة، وبيحصل الأمور
+
+107
+00:08:10,760 --> 00:08:17,240
+كويس، بيصير يدّي كل مرة 500، غيرهم مش، لو أنا مثلاً بتوجه
+
+108
+00:08:17,240 --> 00:08:21,660
+أعمل الـ Check هذا وبدأت أشغله، بيصير يدّي المريض 500
+
+109
+00:08:21,660 --> 00:08:26,180
+لكن فعلياً مثلاً بيدّيله 400 و50، لأنه فيه 50 هو
+
+110
+00:08:26,180 --> 00:08:29,840
+ما عملش Standardization، إن هدول مش من ضمن الـ
+
+111
+00:08:29,840 --> 00:08:34,130
+Ventilation، فالـ Device Check هذا مهم، بعد أن
+
+112
+00:08:34,130 --> 00:08:38,770
+أقوم بتحقيق الـ، أقوم بتحقيق الـ settings المهمة
+
+113
+00:08:38,770 --> 00:08:45,790
+أن أقوم بتحقيق الـ Mode اللي أريد أن أشغّل الهاتف
+
+114
+00:08:45,790 --> 00:08:48,450
+عليه، أقبل كل حاجة، أريد أن أعرف أن أريد أن أشغّل
+
+115
+00:08:48,450 --> 00:08:52,650
+الهاتف على Volume Cycle أو Pressure Control أو
+
+116
+00:08:52,650 --> 00:08:55,850
+Volume Control أو Pressure Control، ثم أقوم بتحقيق
+
+117
+00:08:55,850 --> 00:09:00,290
+الـ Mode اللي أريد أن أشغّل عليه، بعدين طبعاً لكل Mode
+
+118
+00:09:00,290 --> 00:09:04,530
+فيه Settings معينة، إيش هو الـ Tidal Volume، إيش هو
+
+119
+00:09:04,530 --> 00:09:08,330
+الـ Rate اللي أنا بدّي، خلينا نشوف الحاجات هذه واحدة
+
+120
+00:09:08,330 --> 00:09:13,450
+واحدة، يعني بداية ثاني، إحنا عادةً في الأدلت بنشغّل
+
+121
+00:09:13,450 --> 00:09:18,070
+على Volume Control، يعني بتكون وسيلة التحكم هي
+
+122
+00:09:18,070 --> 00:09:23,950
+عندنا في الحجوم، يعني أنا بحجم الهواء اللي أنا بدّي
+
+123
+00:09:23,950 --> 00:09:27,230
+أحطه للمريض، اللي عن طريق ضبط الـ Volume هيكون
+
+124
+00:09:27,230 --> 00:09:31,650
+التحكم، إذا اخترت إنّه Volume Control، كيف هختار هذا
+
+125
+00:09:31,650 --> 00:09:40,930
+الكلام، لو أنا اخترت، لاحظوا هنا في الـ Settings هو
+
+126
+00:09:40,930 --> 00:09:47,850
+هنا، عشان إنه مختار As AMV Already، خلينا إحنا نبطّل
+
+127
+00:09:47,850 --> 00:09:48,690
+الـ As AMV
+
+128
+00:10:09,730 --> 00:10:14,550
+الجهاز مش راضي
+
+129
+00:10:14,550 --> 00:10:18,490
+يشتغل، على أي حال، الأجهزة الحديثة اللي عادةً فيهم Mode
+
+130
+00:10:18,490 --> 00:10:21,050
+اللي هو الـ Synchronized Intermittent من ذاته الـ
+
+131
+00:10:21,050 --> 00:10:25,590
+Ventilation، SIMV هو الـ Common Mode اللي إحنا
+
+132
+00:10:25,590 --> 00:10:28,290
+بنستخدمه في الـ Adult
+
+133
+00:10:31,740 --> 00:10:37,540
+اسمه SIMV، طبعاً فيه CMV وفيه ACMV، الـ CMV
+
+134
+00:10:37,540 --> 00:10:40,720
+Controlled Mandatory Ventilation، بيستخدم عادةً لما
+
+135
+00:10:40,720 --> 00:10:45,060
+يكون المريض Completely Under Anesthesia أو
+
+136
+00:10:45,060 --> 00:10:47,660
+Completely Paralyzed، حتى يكون واخد Muscle Relaxant
+
+137
+00:10:47,660 --> 00:10:52,220
+فهذا الـ Mode عادةً بيستخدم في العمليات، لكن عادةً
+
+138
+00:10:52,220 --> 00:10:56,160
+إحنا في الـ ICU أو في الـ Emergency بنستخدم الـ SIMV
+
+139
+00:10:56,160 --> 00:10:58,560
+Synchronized Intermittent Mandatory Ventilation
+
+140
+00:10:58,560 --> 00:11:03,280
+الهدف من الـ Synchronization مع المريض، إنه يكون مهيئين
+
+141
+00:11:03,280 --> 00:11:08,340
+لحظة نفطم المريض عن الجهاز في أي لحظة، فعشان
+
+142
+00:11:08,340 --> 00:11:14,600
+هيك بنختار الـ SIMV Mode، هو أنا Selected Already
+
+143
+00:11:14,600 --> 00:11:19,160
+أجرّب لو أختار مثلاً، سيّباتة، عشان بس بدي أشوف أيوة
+
+144
+00:11:19,160 --> 00:11:22,880
+أنه هيشتغل، لو أردت أن أُدخُل على مود ثاني اسمه سي
+
+145
+00:11:22,880 --> 00:11:26,700
+باب، هيه، السي باب هذا Pressure Mode، الـ SIMV هنا
+
+146
+00:11:26,700 --> 00:11:30,080
+Volume Mode، لكن السي باب هذا Pressure Mode طبعاً
+
+147
+00:11:30,080 --> 00:11:34,600
+حاجة، كان الـ SIMV وحاجة كان السي باب كأهم Modes كويس
+
+148
+00:11:34,600 --> 00:11:40,160
+نرجع على الـ SIMV، اخترت أنا الـ SIMV Mode، مازال أنا
+
+149
+00:11:40,160 --> 00:11:45,700
+اخترت S,I,M,V، زي ما حكينا الـ Mode هذا Volume
+
+150
+00:11:45,700 --> 00:11:50,260
+Control، فبالتالي بدي أحدد أنا الـ Tidal Volume، عادةً
+
+151
+00:11:50,260 --> 00:11:53,820
+الـ Tidal Volume هاي الـ زر تبعه Vt مكتوب عليه بالـ
+
+152
+00:11:53,820 --> 00:11:59,680
+milliliter لكل milliliter تمام؟ الـ Tidal Volume اللي
+
+153
+00:11:59,680 --> 00:12:04,120
+بنحتاجه للمرضى عادةً من ستة إلى ثمانية milliliter
+
+154
+00:12:04,120 --> 00:12:08,080
+لكل كيلوجرام، لكل كيلوجرام من وزن المريض، المقصود
+
+155
+00:12:08,080 --> 00:12:12,060
+فيه اللي هو الـ Ideal Body Weight، يعني مش مريض وزنه
+
+156
+00:12:12,060 --> 00:12:16,000
+130 كيلوجرام، أبدأ أضرب في 130 كيلوجرام لأ، أبدأ
+
+157
+00:12:16,000 --> 00:12:19,000
+أشوف الـ Ideal Body Weight، كيف ممكن أعرف الـ Ideal
+
+158
+00:12:19,000 --> 00:12:22,280
+Body Weight من الـ Height تبع المريض، من طول المريض
+
+159
+00:12:22,280 --> 00:12:25,400
+فيه كتير أجهزة، حتى إذا أنت حاطط له طول المريض، حاطط له
+
+160
+00:12:25,400 --> 00:12:30,300
+طول المريض 160 سم، هو على طول بيحسب الـ Ideal Body
+
+161
+00:12:30,300 --> 00:12:37,530
+Weight،الأفضل هي أن تتوقع من طول المريض وتحسبه و
+
+162
+00:12:37,530 --> 00:12:41,790
+تضعه، لأنه كما نفهم أن الـ Lung Cavity والـ
+
+163
+00:12:41,790 --> 00:12:45,230
+Thoracic Cavity لن يتغير عند زيادة حجم أو وزن
+
+164
+00:12:45,230 --> 00:12:49,880
+المريض، من ستة لثمانية مللي لتر لكل كيلوجرام، نعتبر
+
+165
+00:12:49,880 --> 00:12:54,240
+أن في عندي مريض وزنه سبعين كيلو مثلاً، سبعين كيلو
+
+166
+00:12:54,240 --> 00:12:58,740
+بدي أدّيله على ثمانية، سبعة بثمانية، 560
+
+167
+00:12:58,740 --> 00:13:02,240
+نفرض هاي 560 وبدي أعملها 60 مثلاً، هاي
+
+168
+00:13:02,240 --> 00:13:05,980
+560، لاحظ أنا عملت 60، Okay، صار تمام، بروح
+
+169
+00:13:05,980 --> 00:13:12,170
+بعمله، Okay، برضه كمان مرة، نفرض بحطه 600، بطلع 600
+
+170
+00:13:12,170 --> 00:13:16,790
+وبعدين Okay، صار 600، بدي أرجع 560، بضغط عليها
+
+171
+00:13:16,790 --> 00:13:22,380
+وأرجع 560، نفرض، بس 560؟ Okay، هذا الـ
+
+172
+00:13:22,380 --> 00:13:25,360
+Tidal Volume، عملنا أول حاجة، طيب، وغير الـ Tidal
+
+173
+00:13:25,360 --> 00:13:28,100
+Volume، إيش بالزمني؟
+
+223
+00:17:06,220 --> 00:17:10,580
+الطبيعي لما بنبدأ نطلق النفس بنضل نطلق في النفس
+
+224
+00:17:10,580 --> 00:17:15,260
+نطلق في النفس لما بيصير الضغط داخل ال lungs in a
+
+225
+00:17:15,260 --> 00:17:20,380
+thoracic pressure أقل من ضغط الهواء الجوي يعني
+
+226
+00:17:20,380 --> 00:17:24,780
+سالب، يعني التعادل مع ضغط الهواء الجوي هي نقطة
+
+227
+00:17:24,780 --> 00:17:30,210
+الصفر، لكن إحنا في الطبيعي لما بنعمل expiration ..
+
+228
+00:17:30,210 --> 00:17:34,410
+بنضلنا نعمل expiration لغاية ما يصير الضغط negative
+
+229
+00:17:34,410 --> 00:17:39,250
+لحد بيخلي easy إنه النفس اللي بعده ينطلق
+
+230
+00:17:39,250 --> 00:17:43,970
+للضغط من الـ .. أو الهوامش، الضغط العالي للضغط الذي
+
+231
+00:17:43,970 --> 00:17:48,970
+صار لنا أقل تماماً، فإحنا بروح نعمل إيش على طول؟ بيجي
+
+232
+00:17:48,970 --> 00:17:52,490
+بتدخل الهواء، وبنعمل inspiration ثانية، وبنضلنا
+
+233
+00:17:52,490 --> 00:17:56,310
+ناخد لغاية ما يصير الضغط زي ما حكينا positive، الضغط
+
+234
+00:17:56,310 --> 00:18:00,350
+داخلنا أكثر من الهواء الخارجي، ليش؟ علشان نكون قادرين إنه
+
+235
+00:18:00,350 --> 00:18:05,570
+إيش؟ نطلع هذا اللي هو في الـ expiration، الآن هذا نفس
+
+236
+00:18:05,570 --> 00:18:09,850
+الكلام بده يصير عن طريق الجهاز، ولكن الفرق صغير أنه
+
+237
+00:18:09,850 --> 00:18:13,870
+في الـ expiration، لما أنا أخدت النفس بشبه أطلق
+
+238
+00:18:14,970 --> 00:18:19,050
+ما بدوش أظن، أطلق لما أخش للثالث؟ لأ، قبل ما أخش
+
+239
+00:18:19,050 --> 00:18:22,750
+للثالث، لسه أنا في الموجة فوق الزفير كمان بدي أرجع
+
+240
+00:18:22,750 --> 00:18:27,390
+يبدأ نفس أشدّه إيه؟ هذا هو الـ FRC، إيش يعني؟ يعني الـ
+
+241
+00:18:27,390 --> 00:18:31,330
+FRC هي كمية الهواء التي تبقى residual في الـ lungs
+
+242
+00:18:31,330 --> 00:18:37,210
+بعد إنهاء الـ expiration، تبقى كمية الهواء بحيث أنها
+
+243
+00:18:37,210 --> 00:18:40,010
+تبقى residual محبوسة، وعاملة شوية inflation في الـ
+
+244
+00:18:40,010 --> 00:18:44,470
+lungs بحيث أنه يجي النفس اللي بعدها فيكون أسهل على
+
+245
+00:18:44,470 --> 00:18:49,190
+المريض أن يأخذه، dial up، لإنها شوية inflation كويس
+
+246
+00:18:49,190 --> 00:18:53,290
+علشان هيك، لو نقرب الشاشة، لو سمحت، شوف لو الـ FRC
+
+247
+00:18:53,290 --> 00:18:57,150
+مثلاً عملناها عشرة، طلع كيف الـ FRC، لو عملناها عشرة
+
+248
+00:18:57,150 --> 00:19:00,510
+عشان يكون واضح، مثلاً شوف الخط هذا اللي بحكي لكم
+
+249
+00:19:00,510 --> 00:19:05,710
+عليه قد إيش ارتفع؟ شايفين قد إيش صار غليظة فوق الزفير؟
+
+250
+00:19:05,710 --> 00:19:10,270
+تمام، خد بالك لو أنا بدي أنزل الـ FRC مثلاً، أرجعه
+
+251
+00:19:12,270 --> 00:19:17,410
+أخليه 2 عشان يكون الفرق واضح، لاحظوا كيف صار الـ
+
+252
+00:19:17,410 --> 00:19:21,350
+residual هذا هو الـ volume of air الذي ضاق الـ
+
+253
+00:19:21,350 --> 00:19:25,970
+remain في الـ lungs بعد الـ expiration، تمام؟ علشان هيك
+
+254
+00:19:25,970 --> 00:19:28,830
+كل هي تكون، ربما صرتوا عارفين أن الـ FRC هذا كثير
+
+255
+00:19:28,830 --> 00:19:32,650
+مهم في حالات أن أنا بدي أعمل inflation أكثر
+
+256
+00:19:32,650 --> 00:19:35,830
+للـ alveoli مثلاً في المرضى لـ chronic obstructive
+
+257
+00:19:35,830 --> 00:19:39,490
+pulmonary disease، COPD، لما تكون الـ alveoli عندهم
+
+258
+00:19:39,490 --> 00:19:43,640
+obstructed، اسمها المونة الرئوية، أنا بأعملها شوية
+
+259
+00:19:43,640 --> 00:19:47,080
+أش افتح الـ sacs تبعها، تمام؟ أو في البلمونة القديمة
+
+260
+00:19:47,080 --> 00:19:50,100
+واحد عنده البلمونة القديمة، والـ sacs تبع الـ
+
+261
+00:19:50,100 --> 00:19:53,880
+alveoli مليانة في الـ fluid، فإحنا بدنا نوسع الـ
+
+262
+00:19:53,880 --> 00:19:57,200
+diameter تبعها علشان يبدأ يصير فيها gas exchange
+
+263
+00:19:57,200 --> 00:20:01,360
+فبنزود الـ FRC، قالت الناس دول بيحتاجوا الـ FRC أكثر من
+
+264
+00:20:01,360 --> 00:20:05,630
+خمسة، هي على ثمانية، تسعة، up to ten، كويس؟ إذا هذا
+
+265
+00:20:05,630 --> 00:20:08,690
+الفيديو عرفنا، هذا معنى مع كل mode، مع الـ SIMV، مع الـ
+
+266
+00:20:08,690 --> 00:20:16,340
+CMV، مع الـ ACVM، مع الـ CPAP، نشوف إيش شرحنا الـ FRC
+
+267
+00:20:16,340 --> 00:20:18,900
+و pressure above FRC، لأن إذا حطيت أنا الـ FRC خمسة
+
+268
+00:20:18,900 --> 00:20:22,580
+حيكون الـ pressure above FRC الـ double، okay؟ والـ
+
+269
+00:20:22,580 --> 00:20:24,920
+FRC حكينا عنه، نضايق الحاجة اسمها الـ inspiratory
+
+270
+00:20:24,920 --> 00:20:30,560
+time، الـ inspiratory time هذه هي في الحقيقة بتستخدم
+
+271
+00:20:30,560 --> 00:20:34,600
+أكثر في الـ pressure mode أو في الـ pressure control
+
+272
+00:20:34,600 --> 00:20:41,060
+لما بكون أنا حاطط للمريض rate مثلاً 14، للحساب خلينا
+
+273
+00:20:41,060 --> 00:20:49,410
+نعمل 10 عشان بتفهم على طول أسرع، عشرة
+
+274
+00:20:52,170 --> 00:20:55,690
+الآن عشرة، طيب العشرة التنفسات هذه، ولو ممكن الجهاز
+
+275
+00:20:55,690 --> 00:20:58,950
+ما بفهمش، لأن أنا مش هتطلع inspiratory time، أروح في
+
+276
+00:20:58,950 --> 00:21:03,010
+أول جزء من الدقيقة يدخل العشر تنفسات، نفس اثنين
+
+277
+00:21:03,010 --> 00:21:06,910
+ثلاثة، أربعة، في عشر ثواني، ويخلص كل نفس بثانية مثلاً
+
+278
+00:21:06,910 --> 00:21:11,730
+طيب، وبقية الدقيقة مشكلة، فعشان هيك أنا لازم أنظم
+
+279
+00:21:11,730 --> 00:21:15,250
+أعمل control لعملية النفس هذه عن طريق أن أحجز أن الـ
+
+280
+00:21:15,250 --> 00:21:20,200
+inspiratory time يتم بوقت معين، وقلت لازم يكون فيه
+
+281
+00:21:20,200 --> 00:21:25,060
+وقت لـ expiratory time، فعشان هيك إحنا
+
+282
+00:21:25,060 --> 00:21:28,660
+عملنا I:E ratio، inspiratory:expiratory time ratio
+
+283
+00:21:28,660 --> 00:21:32,480
+فيه ratio للـ inspiration والـ expiration اللي هو واحد
+
+284
+00:21:32,480 --> 00:21:37,340
+لاثنين، يعني إحنا بناخد النفس وبنطلق النفس في بعض
+
+285
+00:21:37,340 --> 00:21:41,970
+عملية الـ، الزمن الذي عملنا فيه inspiration يعني
+
+286
+00:21:41,970 --> 00:21:45,930
+إذا أنا أخدت one second عشان أعمل inspiration
+
+287
+00:21:45,930 --> 00:21:49,150
+بأطلق النفس في two seconds، وإذا أخدت two seconds
+
+288
+00:21:49,150 --> 00:21:53,290
+عشان أعمل inspiration بأطلق النفس، الـ inspiration
+
+289
+00:21:53,290 --> 00:21:57,770
+في four seconds، فالضائف two، ضاعفهم أربعة، أربعة
+
+290
+00:21:57,770 --> 00:22:01,790
+seconds، اه، إذا الـ one breath كلها inspiration والـ
+
+291
+00:22:01,790 --> 00:22:07,530
+الـ inspiration أخذ مني عشرة تنفسات تقريباً تقريباً
+
+292
+00:22:07,530 --> 00:22:12,190
+تقريباً تقريباً
+
+293
+00:22:12,190 --> 00:22:17,910
+تقريباً تقريباً تقريباً تقريباً تقريباً تقريباً تقريباً
+
+294
+00:22:17,910 --> 00:22:17,930
+تقريباً تقريباً تقريباً تقريباً تقريباً تقريباً تقريباً
+
+295
+00:22:17,930 --> 00:22:24,550
+تقريباً تقريباً تقريباً تقريباً، عشرة تنفسات، كل نفس
+
+296
+00:22:24,550 --> 00:22:31,230
+.. six .. كل نفس six seconds، عشرة تنفسات هي ستون
+
+297
+00:22:31,230 --> 00:22:34,050
+ثانية، بالنسبة لـ rate time .. بالنسبة لـ rate
+
+298
+00:22:34,050 --> 00:22:37,670
+time، كل العشرة تنفسات بالنسبة لـ rate time تبعهم
+
+299
+00:22:37,670 --> 00:22:43,370
+كم؟ عشرون ثانية من الستين، هدول عشرة، اثنين في
+
+300
+00:22:43,370 --> 00:22:47,870
+عشرة، عشرون ثانية، مش هيك؟ إذا عشرون ثانية على الـ
+
+301
+00:22:47,870 --> 00:22:52,480
+rate، الـ rate اللي هو عندي عشرة، يبقى كل نفس ثانيتين زي
+
+302
+00:22:52,480 --> 00:22:55,600
+ما حكينا، إذا أنا بروح بأعمل الـ inspiratory time هي
+
+303
+00:22:55,600 --> 00:23:01,460
+أقل كم؟ ثانيتين، لاحظوا، أنا بمجرد ما أعمل الـ
+
+304
+00:23:01,460 --> 00:23:07,480
+inspiratory time ثانيتين، الـ I:E ratio كم صار؟ 1 إلى 2
+
+305
+00:23:07,480 --> 00:23:10,520
+أنا شرحت هذه عشان أنتم تفهموها، لكن مش مطلوب منك
+
+306
+00:23:10,520 --> 00:23:14,060
+أن أنت تقعد تحسب، لو أنا بدأت، افترض أنه حاطط الـ rate
+
+307
+00:23:14,060 --> 00:23:18,180
+على عشرة هياته، وبدأت أروح أعمل الـ inspiratory time
+
+308
+00:23:18,180 --> 00:23:22,300
+بدأت أطلع على I:E ratio، لما يصير 1 إلى 2، ها، 1 إلى 2
+
+309
+00:23:22,300 --> 00:23:29,470
+غير، غير، لما يصير 1 إلى 2، ها، ها، هيو صار واحد لاثنين
+
+310
+00:23:29,470 --> 00:23:35,490
+طلع صار ثانيتين لحاله، لأن هو عارف أن الـ I:E واحد
+
+311
+00:23:35,490 --> 00:23:38,950
+لاثنين، بمجرد ما أنت بتعمل الـ inspiratory
+
+312
+00:23:38,950 --> 00:23:41,850
+expiratory ratio واحد إلى اثنين، بكون الـ
+
+313
+00:23:41,850 --> 00:23:44,630
+inspiratory time two seconds، يعني الـ two seconds
+
+314
+00:23:44,630 --> 00:23:48,250
+في عشرة، يعني الـ inspiratory time في الدقيقة كلها
+
+315
+00:23:48,470 --> 00:23:52,690
+عشرون ثانية، وبالتالي أربعون ثانية for expiration
+
+316
+00:23:52,690 --> 00:23:56,250
+هاي عملنا الـ tidal volume، عملنا الـ inspiratory
+
+317
+00:23:56,250 --> 00:23:59,490
+time، عملنا الـ rate، عملنا الـ oxygen fraction، حطينا
+
+318
+00:23:59,490 --> 00:24:02,610
+الـ pressure، عملنا الـ pressure above FRC، وحطينا الـ
+
+319
+00:24:02,610 --> 00:24:05,930
+FRC، طيب، إيش في حاجات ثانية مهمة قبل ما أحكي في
+
+320
+00:24:05,930 --> 00:24:08,130
+الحاجات الثانية المهمة؟ بدي أحكي عن موضع ثاني اسمه
+
+321
+00:24:08,130 --> 00:24:11,750
+CPAP، لو أنا روحت ضغطت ضغطة طويلة على الـ CPAP
+
+322
+00:24:13,020 --> 00:24:17,600
+بقلب الجهاز لـ CPAP mode، الـ CPAP mode هذا هو الـ weaning
+
+323
+00:24:17,600 --> 00:24:22,440
+mode، يعني المريض صار عنده قدرة على التنفس وأنا بدي
+
+324
+00:24:22,440 --> 00:24:26,500
+أحطه على التنفس لحاله، وبده أحطه على الـ CPAP
+
+325
+00:24:26,500 --> 00:24:29,220
+الـ CPAP بمميزته أنه لا يقطع زي ما أنتم شايفين
+
+326
+00:24:29,220 --> 00:24:34,040
+tidal volume ولا rate، يعني المريض المفروض
+
+327
+00:24:34,040 --> 00:24:37,240
+أنه بده يتحكم في هذا الـ volume لحاله، المريض بده
+
+328
+00:24:37,240 --> 00:24:40,520
+يتحكم في عدد مرات التنفس في الدقيقة لحاله، طب أنا
+
+329
+00:24:40,520 --> 00:24:46,780
+إيش مساويله؟ أنا بس بدي أديله ضغط، لذلك الـ CPAP هو
+
+330
+00:24:46,780 --> 00:24:51,340
+عبارة عن continuous PEEP، اه، لذلك إيش، إيش، إيش الـ
+
+331
+00:24:51,340 --> 00:24:55,060
+PEEP كان؟ positive end expiratory pressure، طب إيش
+
+332
+00:24:55,060 --> 00:24:59,820
+هو الـ CPAP؟ هو continuous positive airway pressure
+
+333
+00:24:59,820 --> 00:25:03,560
+هو continuous positive airway pressure، إذا هو
+
+334
+00:25:03,560 --> 00:25:06,800
+عبارة عن continuous PEEP، إذا إيه؟ إيش يعني
+
+335
+00:25:06,800 --> 00:25:10,140
+continuous PEEP؟ يعني continuous residual volume
+
+336
+00:25:10,140 --> 00:25:14,520
+يضل في الـ lungs بحيث إن المريض يستطيع أن يعمل
+
+337
+00:25:14,520 --> 00:25:20,070
+عملية النفس spontaneously لحاله، كويس؟ في كل مرة
+
+338
+00:25:20,070 --> 00:25:22,750
+ويتحكم في الـ tidal volume وفي الـ rate المناسب لما
+
+339
+00:25:22,750 --> 00:25:25,910
+بيصير fit for extubation، طب إيش في حاجات ثانية
+
+340
+00:25:25,910 --> 00:25:31,890
+ممكن نعرفها عن الجهاز؟ لاحظ هنا في زر للـ
+
+341
+00:25:31,890 --> 00:25:34,910
+nebulizer، يعني لو أنا بدي أجي أعمل للمريض على
+
+342
+00:25:34,910 --> 00:25:39,010
+الـ ventilator وإله endotracheal tube، nebulizer
+
+343
+00:25:39,010 --> 00:25:43,930
+تبخيرة،  Ventolin،  Decord، whatever، إيش اللي بيصير؟ اه
+
+344
+00:25:43,930 --> 00:25:48,630
+المرة هذه، هروح على الـ inspiration، يعني هنا هيكون
+
+345
+00:25:48,630 --> 00:25:55,670
+فيه adapter تبع النبيولايزر بنشبكه فيه، وبكون الـ
+
+346
+00:25:55,670 --> 00:25:59,810
+adapter  وهيكون فيه connection يعني tube وبتيجي
+
+347
+00:25:59,810 --> 00:26:09,790
+على زر تبع النبيولايزر، هي هي، شايفين هذا بنشبكه فيه
+
+348
+00:26:09,790 --> 00:26:13,370
+نفس الـ oxygen tube هياته، هي عليه علامة تبخيرة
+
+349
+00:26:13,370 --> 00:26:19,170
+وبتروح، وأنت ضغط هنا على النبيولايزر بيصير إيش؟ طلع هذا
+
+350
+00:26:19,170 --> 00:26:23,850
+الذرة ده، بيعمل هواء عشان فيه .. لو في حد بيتحرك، لو في
+
+351
+00:26:23,850 --> 00:26:28,330
+ورقة ولا حاجة، هيكون
+
+352
+00:26:28,330 --> 00:26:34,570
+واضح جداً أنه إيش؟ بيطلق هواء، مافيش معنى حاجة كاملة لأ
+
+353
+00:26:34,570 --> 00:26:40,290
+ما .. هذا مش .. okay، no problem، okay، هذه واحدة، طيب
+
+354
+00:26:40,290 --> 00:26:47,190
+هذه واحدة، الحاجة الثانية O2 Suction، إيش يعني؟ يعني
+
+355
+00:26:47,190 --> 00:26:50,690
+لما أنا بدي أعمل suction للمريض، بدي أديله .. أرجع
+
+356
+00:26:50,690 --> 00:26:54,670
+على ASMV، بدي
+
+357
+00:26:54,670 --> 00:26:59,750
+أديله suction عشان أعمله .. بدي أديله oxygen عشان
+
+358
+00:26:59,750 --> 00:27:02,150
+أعمله suction، فلازم أعمله حاجة نسميها hyper
+
+359
+00:27:02,150 --> 00:27:05,790
+oxygenation، so hyper oxygenation، أنا بدي oxygen
+
+360
+00:27:05,790 --> 00:27:08,530
+fraction one hundred percent، مية في المية، بمجرد
+
+361
+00:27:08,530 --> 00:27:12,710
+ما أضغط على O2 suction، بروح بيدّي المريض oxygen
+
+362
+00:27:22,670 --> 00:27:27,370
+بمجرد ما أضغط على O2 suction، بروح بيدّي المريض أكسجين
+
+363
+00:27:27,370 --> 00:27:28,550
+100%
+
+364
+00:27:31,500 --> 00:27:42,920
+فقط لـ 3 دقائق، لأن أنا بأعمل تفصيل للمريض، وبعد
+
+365
+00:27:42,920 --> 00:27:49,360
+تفصيله بأعمل switch لـ ventilator وإدارة الأكسجين تبع
+
+366
+00:27:49,360 --> 00:27:53,580
+التفصيل، الهدف منه أن أعمل
+
+367
+00:27:59,380 --> 00:28:04,380
+إذا كنت أريد أن أوقف النفس لسبب أنني أشتغل أو أشرح
+
+368
+00:28:04,380 --> 00:28:13,970
+أو أدغط عليها، فهذا يوقف النفس، موقف صحيح .. موقف
+
+369
+00:28:13,970 --> 00:28:20,830
+الصحيح .. موقف
+
+370
+00:28:20,830 --> 00:28:21,810
+الصحيح .. موقف الصحيح .. موقف الصحيح .. موقف
+
+371
+00:28:21,810 --> 00:28:22,270
+الصحيح .. موقف الصحيح .. موقف الصحيح .. موقف
+
+372
+00:28:22,270 --> 00:28:22,290
+الصحيح .. موقف الصحيح .. موقف الصحيح .. موقف
+
+373
+00:28:22,290 --> 00:28:22,410
+الصحيح .. موقف الصحيح .. موقف الصحيح .. موقف
+
+374
+00:28:22,410 --> 00:28:26,370
+الصحيح .. موقف الصحيح .. موقف الصحيح .. موقف
+
+375
+00:28:26,370 --> 00:28:34,810
+الصحيح .. موقف الصحيح .. طيب، هنا في الـ alarm، الـ alarm
+
+376
+00:28:34,810 --> 00:28:39,090
+off، وفي الـ alarm، الـ alarm، الـ alarm، الـ alarm، الـ alarm، الـ alarm، الـ alarm
+
+377
+00:28:39,090 --> 00:28:43,510
+الـ alarm، الـ alarm، الـ alarm، الـ alarm، الـ alarm، الـ alarm، الـ alarm، الـ alarm
+
+378
+00:28:43,510 --> 00:28:47,050
+الـ alarm، الـ alarm، الـ alarm، الـ alarm، الـ alarm، الـ alarm، الـ alarm، الـ alarm
+
+379
+00:28:47,050 --> 00:28:47,490
+الـ alarm، الـ alarm، الـ alarm، الـ alarm، الـ alarm، الـ alarm، الـ alarm، الـ alarm
+
+380
+00:28:47,490 --> 00:28:47,590
+الـ alarm، الـ alarm، الـ alarm، الـ alarm، الـ alarm، الـ alarm، الـ alarm، الـ alarm
+
+381
+00:28:47,590 --> 00:28:48,110
+الـ alarm، الـ alarm، الـ alarm، الـ alarm، الـ alarm، الـ alarm، الـ alarm، الـ alarm
+
+382
+00:28:48,110 --> 00:28:50,450
+الـ alarm، الـ alarm، الـ alarm، الـ alarm، الـ alarm، الـ alarm، الزر تبع
+
+383
+00:28:50,450 --> 00:28:55,410
+الـ setting هذا بتعطيني قد إيش بدك الـ flow تبع الـ AC
+
+384
+00:28:55,410 --> 00:28:59,930
+يعني المعدل انسياب الهواء اللي ماشي، يعني سرعة
+
+385
+00:28:59,930 --> 00:29:03,670
+انسياب الهواء، قد إيش بدك يكون؟ عادة ما بين الثلاثين
+
+386
+00:29:03,670 --> 00:29:09,460
+لأربعين، بتلاحظ أنه بالـ .. بالـ millibar، بر إيش؟ بـ
+
+387
+00:29:09,460 --> 00:29:14,500
+second، تمام؟ بعدين الـ trigger .. إيش الـ trigger؟
+
+388
+00:29:14,500 --> 00:29:19,960
+الـ trigger sensitivity هي حساسية الجهاز في المريض
+
+389
+00:29:19,960 -->
\ No newline at end of file
diff --git a/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/icAigPXOkrE_postprocess.srt b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/icAigPXOkrE_postprocess.srt
new file mode 100644
index 0000000000000000000000000000000000000000..6d8879b9fa4a0acd9e1d0bfc7eb346657c13598f
--- /dev/null
+++ b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/icAigPXOkrE_postprocess.srt
@@ -0,0 +1,1720 @@
+1
+00:00:01,570 --> 00:00:04,810
+بسم الله الرحمن الرحيم السلام عليكم ورحمة الله
+
+2
+00:00:04,810 --> 00:00:08,650
+وبركاته ان شاء الله رب العالمين اليوم هنحكي عن ال
+
+3
+00:00:08,650 --> 00:00:11,970
+mechanical ventilator محاضرة عملية كيف ممكن تشغل
+
+4
+00:00:11,970 --> 00:00:16,750
+mechanical ventilator لو أمرضك يحتاج mechanical
+
+5
+00:00:16,750 --> 00:00:22,190
+ventilation الجهاز اللي هنستخدمه trigger Savina
+
+6
+00:00:22,830 --> 00:00:29,430
+جهاز مشهور طبعا فيه منه موديلات أحدث ولكن الفكرة
+
+7
+00:00:29,430 --> 00:00:33,130
+في تشغيل جهاز تنقف الصناعة سواء في trigger سفينة
+
+8
+00:00:33,130 --> 00:00:36,370
+أو نوع تاني أو الموديل هذا من ال trigger أو النوع
+
+9
+00:00:36,370 --> 00:00:41,330
+الأحدث منه هي نفس الفكرة في كل الأجهزة نفس الحاجات
+
+10
+00:00:41,330 --> 00:00:44,310
+اللي احنا هنتعلمها و نفس ال parameters و ال
+
+11
+00:00:44,310 --> 00:00:48,490
+settings بنعملها مع كل الأجهزة خلينا نشوف واحدة
+
+12
+00:00:48,490 --> 00:00:54,640
+واحدة أيش الخطوات اللي احنا لازم نعملهابداية لازم
+
+13
+00:00:54,640 --> 00:00:59,800
+اتأكد ان الجهاز اللى هندي فيه كوريجايتد اتيوب
+
+14
+00:00:59,800 --> 00:01:04,620
+المناسبة اللى بدى اشبكها للمريض و لازم نعرف ان
+
+15
+00:01:04,620 --> 00:01:09,340
+الكوريجايتد اتيوب هذه اولا هي نوعين فى نوع مناسب
+
+16
+00:01:09,340 --> 00:01:14,880
+للادر وفى نوع حجمه اصغر للبيدياتريك تمام؟ تشوفين
+
+17
+00:01:14,880 --> 00:01:20,990
+كيف الادركيف الخمالة تبعته بينما ال pediatric كيف
+
+18
+00:01:20,990 --> 00:01:25,430
+ال diameter تبعه أقل فإحنا بنتعامل مع أدب فخلّينا
+
+19
+00:01:25,430 --> 00:01:28,510
+نشتغل على الأدب ال corrugated tube هنشوف إن ال
+
+20
+00:01:28,510 --> 00:01:31,810
+corrugated tube عبارة عن تبين بالتيهيو fy
+
+21
+00:01:31,810 --> 00:01:35,670
+connection هذه اللي بتنش بالفرندوتراكية للتيوب
+
+22
+00:01:35,670 --> 00:01:41,190
+وهنا في واحد فيهم إله water trap والتاني مافيش فيه
+
+23
+00:01:41,190 --> 00:01:46,380
+water trapبديهيًا اللي بده يطلع من المريض الـ
+
+24
+00:01:46,380 --> 00:01:48,940
+expiration هو اللي هيكون متصل في ال water trap
+
+25
+00:01:48,940 --> 00:01:53,160
+عشان ال expiration تبعناه بيكون فيه اللي هو بخار
+
+26
+00:01:53,160 --> 00:01:56,420
+ماء من ال expiration فبالتالي هذا ال trap عشان
+
+27
+00:01:56,420 --> 00:02:01,980
+يصيد هذه البخار اللي بيطلع و يمنعه من وصوله للجهاز
+
+28
+00:02:01,980 --> 00:02:06,100
+والتاني ال inspiratory اللي بيجي من الجهاز للمريض
+
+29
+00:02:06,100 --> 00:02:10,720
+لما مش هيكون فيه water trapالحاجة التانية اللي
+
+30
+00:02:10,720 --> 00:02:17,200
+لازم أشبك هدولة صح بناء على الإشارات اللي
+
+31
+00:02:17,200 --> 00:02:20,960
+على الجهاز نشوف أنه مدخل ال mechanical ventilator
+
+32
+00:02:20,960 --> 00:02:25,620
+يعني فيه سهم لبرا يعني هذا بيعطي للمريض النفس يبقى
+
+33
+00:02:25,620 --> 00:02:31,860
+هذا ال inspiration هنا بيرجع النفس للمريض يعنيهذا
+
+34
+00:02:31,860 --> 00:02:36,080
+ال expiration تمام؟ لازم نعرف ان عملية ال
+
+35
+00:02:36,080 --> 00:02:38,580
+breathing في ال mechanical ventilation هي عملية
+
+36
+00:02:38,580 --> 00:02:42,620
+active لأ اللي هو ال inspiration عملية active لكن
+
+37
+00:02:42,620 --> 00:02:47,860
+عودة النفس لمن المريض لجهازه عملية passive بتتم
+
+38
+00:02:47,860 --> 00:02:51,620
+نتيجة انه في high pressure في ال intra thoracic
+
+39
+00:02:51,620 --> 00:02:55,060
+pressure يعني بيكون عالي فبيرجع الهواء للماشين
+
+40
+00:02:55,060 --> 00:03:01,500
+passiveهذه هي الحاجة التانية يجب أن نتأكد أن ال
+
+41
+00:03:01,500 --> 00:03:05,940
+filters الخاص بجهاز و ال oxygen sensor هم مغيّرين
+
+42
+00:03:05,940 --> 00:03:08,380
+هذا اسمه oxygen sensor أو flow sensor
+
+43
+00:03:10,870 --> 00:03:16,170
+اللي هو ال filter بتغير عشان في ال expiration ال
+
+44
+00:03:16,170 --> 00:03:20,290
+filters شايفين كيف هذا علشان ال expiration طبعا
+
+45
+00:03:20,290 --> 00:03:25,530
+المريض ما يعني infection control ما تخشش هذه ال
+
+46
+00:03:25,530 --> 00:03:29,930
+filters على البكتيريا أو الحاجات اللي could make
+
+47
+00:03:29,930 --> 00:03:33,070
+infectionعلى الجهاز و تتغير من كل مريض و مريض
+
+48
+00:03:33,070 --> 00:03:36,950
+فاحنا بنحطه بالطريقة هاي و بنثبته لإن أي خلل فيه
+
+49
+00:03:36,950 --> 00:03:39,970
+لو كانت هذه عاملة هيك مش مثبتة بالطريقة هاي بيصير
+
+50
+00:03:39,970 --> 00:03:43,690
+فيه leakage و بالتالي بيصير فيه miss في ال tidal
+
+51
+00:03:43,690 --> 00:03:47,470
+volume اللي بنوديه للعيان هنا ال flow sensor هذا
+
+52
+00:03:47,470 --> 00:03:51,090
+برضه بتركب بالطريقة هذه زي ما احنا شايفين هيك
+
+53
+00:03:51,090 --> 00:03:55,810
+هياته سبت لاحظين كمان مرة هياته ها بيدخل هنا فيه
+
+54
+00:03:55,810 --> 00:03:56,550
+له مكان
+
+55
+00:04:02,870 --> 00:04:10,310
+الحاجتين هدولة عملناهم و اتأكدنا ان الجهاز اصلا
+
+56
+00:04:10,310 --> 00:04:16,670
+مشبوك في ال oxygen لان الجهاز يشتغل على ان يأخذ
+
+57
+00:04:16,670 --> 00:04:21,050
+كمية من ال oxygen بتدخل على حاجة اسمها air mixer
+
+58
+00:04:21,050 --> 00:04:25,070
+في الجهازفان air mixer زمان كانت الأجهزة ال air
+
+59
+00:04:25,070 --> 00:04:29,250
+mixer يكون برا و يكون فيه two tube واحد أكسجين و
+
+60
+00:04:29,250 --> 00:04:34,230
+واحد air بس هوا ال .. ال air mixer هيعمل فراكشن
+
+61
+00:04:34,230 --> 00:04:38,350
+تبع الأكسجين اللي أنا بديه يعني مثلا انا بدي 40%
+
+62
+00:04:38,960 --> 00:04:44,280
+يعني 40% أكسجين و 60% هوا لإن احنا عادي ما بنتنفسش
+
+63
+00:04:44,280 --> 00:04:49,660
+100% oxygen saturation احنا عادي بنتنفس 21% اللي
+
+64
+00:04:49,660 --> 00:04:53,820
+هو ال ambient air اللي بيحتوي 21% من ال oxygen
+
+65
+00:04:53,820 --> 00:04:58,700
+فلما بيكون في patient بكون أكيد ان ال demands تبقت
+
+66
+00:04:58,700 --> 00:05:04,220
+ال oxygen عنده أكتربنزود عن ال 21 اربعين خمسين
+
+67
+00:05:04,220 --> 00:05:07,040
+ستين سبعين في الامر جاسي ممكن نحطه على مية في
+
+68
+00:05:07,040 --> 00:05:11,360
+المية بس don't forget that oxygen is a drug so it
+
+69
+00:05:11,360 --> 00:05:15,500
+has a toxicity عشان هي ماحدش بيفضل ان ال oxygen
+
+70
+00:05:15,500 --> 00:05:20,580
+يظل على high concentration لمدة طويلة ولذلك ال
+
+71
+00:05:20,580 --> 00:05:26,000
+common انه يستخدم بين ال 40 ل 60% okay فأتأكد ان
+
+72
+00:05:26,000 --> 00:05:26,580
+انا مشغول
+
+73
+00:05:31,270 --> 00:05:39,070
+و اتاكد ان الكهربا تبقى مشبوكا بطريقة صح حياته
+
+74
+00:05:39,070 --> 00:05:45,130
+لإنه ممكن جدا ان يكون هناك مشكلة في البطارية لإنه
+
+75
+00:05:45,130 --> 00:05:48,670
+فيه بطارية اه لإنه ممكن جدا ان يكون هناك مشكلة
+
+76
+00:05:48,670 --> 00:05:51,890
+فلازم يكون مشبوك في الكهربا هذي ال connection و
+
+77
+00:05:51,890 --> 00:06:00,350
+اتاكد ان انا عندي ال corrugated tubeبالطريقة الصح
+
+78
+00:06:00,350 --> 00:06:05,310
+للمريض تمام فأحط هذا زي ما حكينا yes by rotary
+
+79
+00:06:05,310 --> 00:06:13,710
+دائما مخليش أغراض نزلين لتحت وهذا x by rotary جدا
+
+80
+00:06:13,710 --> 00:06:18,430
+يعني في حد اسمها اللي هو lung test ممكن أشبكها فيه
+
+81
+00:06:18,430 --> 00:06:23,270
+علشان لما نبدو يطلع كمية الهواء أبحث من خلالها ال
+
+82
+00:06:23,270 --> 00:06:28,030
+inflation و ال quality تبع الجهاز okayأنا شبكت كل
+
+83
+00:06:28,030 --> 00:06:33,030
+الأمور و الأن بدي أعمل switch on للجهاز بدي أشغل
+
+84
+00:06:33,030 --> 00:06:37,470
+الجهاز و سيب الجهاز يعمل preparation device
+
+85
+00:06:37,470 --> 00:06:42,530
+بيسموها preparation دائما يا جماعة نعرف أنه الذر
+
+86
+00:06:42,530 --> 00:06:49,100
+اللي موجود عشان التشغيل تبقى الجهاز يكون ورافي
+
+87
+00:06:49,100 --> 00:06:52,920
+الكثير أجهزة بيكون عليهم لوحة عشان مش إكسيدنتل أي
+
+88
+00:06:52,920 --> 00:06:57,480
+واحد خبط فيه اللي يصير له إيش off هذه حاجة الحاجة
+
+89
+00:06:57,480 --> 00:06:58,020
+التانية
+
+90
+00:07:07,560 --> 00:07:12,100
+المرحلة المفروض ان انا بسيب الجهاز يعمل ال
+
+91
+00:07:12,100 --> 00:07:16,860
+calibration اللي هو O2 sensor بعمل check لكل ال
+
+92
+00:07:16,860 --> 00:07:20,140
+device هذا ال device ال check اسيب الجهاز يعمل ال
+
+93
+00:07:20,140 --> 00:07:23,520
+device ال check تبقى وإلا انا ممكن ابدأ عملية
+
+94
+00:07:23,520 --> 00:07:26,660
+ventilation لمريض أثناء فيه مشكلة لأن لو في هو
+
+95
+00:07:26,660 --> 00:07:29,320
+عنده leakage في مكان معين لو في مشكلة في sensor
+
+96
+00:07:29,320 --> 00:07:32,730
+لمن في مشكلةفى filter هيحكي فورا إنه فيه leakage
+
+97
+00:07:32,730 --> 00:07:36,830
+في المكان الفلاني أو فيه مشكلة فيه ال sensor تمام؟
+
+98
+00:07:36,830 --> 00:07:43,270
+لما اتأكد ويحكي لي هو انه okay كل ال sensors مافيش
+
+99
+00:07:43,270 --> 00:07:47,760
+فيها مشكلة يعني هيكتب لي please waitفانا اتوقع انه
+
+100
+00:07:47,760 --> 00:07:55,000
+بيحصل الامور كويسة و بيحصل الهاتف يتشيك انه بيحصل
+
+101
+00:07:55,000 --> 00:08:01,140
+الامور كويسة و بيحصل الامور كويسة و بيحصل الامور
+
+102
+00:08:01,140 --> 00:08:01,820
+كويسة و بيحصل الامور كويسة و بيحصل الامور كويسة و
+
+103
+00:08:01,820 --> 00:08:03,120
+بيحصل الامور كويسة و بيحصل الامور كويسة و بيحصل
+
+104
+00:08:03,120 --> 00:08:03,580
+الامور كويسة و بيحصل الامور كويسة و بيحصل الامور
+
+105
+00:08:03,580 --> 00:08:05,200
+بيحصل الامور كويسة و بيحصل الامور كويسة و بيحصل
+
+106
+00:08:05,200 --> 00:08:10,760
+الامور كويسة و بيحصل الامور
+
+107
+00:08:10,760 --> 00:08:17,240
+كو بيصير يده كل مرة 500 غيرهم مش لو انا مثلا بتوجه
+
+108
+00:08:17,240 --> 00:08:21,660
+اعمل ال check هذا و بدأت اشغله بيصير يد المريض 500
+
+109
+00:08:21,660 --> 00:08:26,180
+لكن فعليا مثلا بيديله 400 و 50 لأنه فيه 50 هو
+
+110
+00:08:26,180 --> 00:08:29,840
+ماعملش standardization ان هدولا مش من ضمن ال
+
+111
+00:08:29,840 --> 00:08:34,130
+ventilation ف ال device ال check هذا مهمبعد ان
+
+112
+00:08:34,130 --> 00:08:38,770
+اقوم بتحقيق الهاتف اقوم بتحقيق الـ settings المهم
+
+113
+00:08:38,770 --> 00:08:45,790
+ان اقوم بتحقيق ال mood اللى اريد ان اشغل الهاتف
+
+114
+00:08:45,790 --> 00:08:48,450
+عليه اقبل كل حاجة اريد ان اعرف ان اريد ان اشغل
+
+115
+00:08:48,450 --> 00:08:52,650
+الهاتف على volume cycle او pressure control او
+
+116
+00:08:52,650 --> 00:08:55,850
+volume control او pressure control ثم اقوم بتحقيق
+
+117
+00:08:55,850 --> 00:09:00,290
+ال mood اللى اريد ان اشغل عليهبعدين طبعا لكل mood
+
+118
+00:09:00,290 --> 00:09:04,530
+فيه settings معينة ايش هو ال title volume ايش هو
+
+119
+00:09:04,530 --> 00:09:08,330
+ال rate اللي انا بدي اخلينا نشوف الحاجات هذه واحدة
+
+120
+00:09:08,330 --> 00:09:13,450
+واحدة يعني بداية تاني احنا عادة في الادار بنشغل
+
+121
+00:09:13,450 --> 00:09:18,070
+على volume control يعني بتكون وسيلة التحكم هي
+
+122
+00:09:18,070 --> 00:09:23,950
+عندنا فيالحجوم يعني انا بحجم الهواء اللى انا بدى
+
+123
+00:09:23,950 --> 00:09:27,230
+احطه للمريض اللى عن طريق تايدة ال volume هيكون
+
+124
+00:09:27,230 --> 00:09:31,650
+التحكم اذا اخترت انه volume control كيف هختار هذا
+
+125
+00:09:31,650 --> 00:09:40,930
+الكلام لو انا اخترت لاحظوا هنا في ال settings هو
+
+126
+00:09:40,930 --> 00:09:47,850
+هنا عشان انه مختار as amv already خلينا احنا نبطل
+
+127
+00:09:47,850 --> 00:09:48,690
+ال as amv
+
+128
+00:10:09,730 --> 00:10:14,550
+الجهاز مش راضي
+
+129
+00:10:14,550 --> 00:10:18,490
+يفصل على أي حال الاجهزة هدوء اللي عادة فيهم mood
+
+130
+00:10:18,490 --> 00:10:21,050
+اللي هو الـ synchronize intermittent من ذاته ال
+
+131
+00:10:21,050 --> 00:10:25,590
+ventilation SIMV هو ال common mood اللي احنا
+
+132
+00:10:25,590 --> 00:10:28,290
+بنستخدمه في ال adult
+
+133
+00:10:31,740 --> 00:10:37,540
+اسمه SIMV طبعاً في CMV و في ال ACMV ال CMV
+
+134
+00:10:37,540 --> 00:10:40,720
+Controlled Mandatory Ventilation بيستخدم عادة لما
+
+135
+00:10:40,720 --> 00:10:45,060
+يكون المريض completely under anesthesia أو
+
+136
+00:10:45,060 --> 00:10:47,660
+completely paralyzed حتى يكون ماخد مصر relaxed
+
+137
+00:10:47,660 --> 00:10:52,220
+فهذا ال mood عادة بيستخدم في العمليات لكن عادة
+
+138
+00:10:52,220 --> 00:10:56,160
+احنا في ال ICU او في ال emergency بنستخدم ال SIMV
+
+139
+00:10:56,160 --> 00:10:58,560
+Synchronized Intermittent Mandatory Ventilation
+
+140
+00:10:58,560 --> 00:11:03,280
+الهدف منالسينكرونيزيشن مع المريض انه يكون مهيئين
+
+141
+00:11:03,280 --> 00:11:08,340
+حالنا لانه نفطم المريض عن الجهاز في اي لحظة فعشان
+
+142
+00:11:08,340 --> 00:11:14,600
+هيك بنختار ال SIMV mode هو انا selected already
+
+143
+00:11:14,600 --> 00:11:19,160
+اجرب لو اختار مثلا سيباتة عشان بس بدي اشوف ايوة
+
+144
+00:11:19,160 --> 00:11:22,880
+انها هيشتغللو أردت أن أنخل على مودي تاني اسمه سي
+
+145
+00:11:22,880 --> 00:11:26,700
+باب هيته السي باب هذا pressure mode ال SIMV هنا
+
+146
+00:11:26,700 --> 00:11:30,080
+volume mode لكن السي باب هذا pressure mode طبعا
+
+147
+00:11:30,080 --> 00:11:34,600
+حاح كان ال SIMV وحاح كان السي باب كأهم moods كويس
+
+148
+00:11:34,600 --> 00:11:40,160
+نرجع على ال SIMV اخترت انا ال SIMV moodمازال انا
+
+149
+00:11:40,160 --> 00:11:45,700
+اخترت S,I,M,V زي ما حكينا ال mood هذا volume
+
+150
+00:11:45,700 --> 00:11:50,260
+control فبالتالي بدي احدد انا ال tidal volume عادة
+
+151
+00:11:50,260 --> 00:11:53,820
+ال tidal volume هاي الذر تبعه Vt مكتوب عليه بال
+
+152
+00:11:53,820 --> 00:11:59,680
+milliliter ل milliliter تمام؟ ال tidal volume اللي
+
+153
+00:11:59,680 --> 00:12:04,120
+بنحتاجه للمرضى عادة من ستة إلى تمانية milliliter
+
+154
+00:12:04,120 --> 00:12:08,080
+لكل كيلو جراملكل كيلو جرام من وزن المريض المقصود
+
+155
+00:12:08,080 --> 00:12:12,060
+فيه اللي هو ال ideal body weight يعني مش مريض وزنه
+
+156
+00:12:12,060 --> 00:12:16,000
+130 كيلو جرام بدأ أضرب في 130 كيلو جرام لأ بدأ
+
+157
+00:12:16,000 --> 00:12:19,000
+أشوف ال ideal body weight كيف ممكن أعرف ال ideal
+
+158
+00:12:19,000 --> 00:12:22,280
+body weight من ال height تبع المريض من طول المريض
+
+159
+00:12:22,280 --> 00:12:25,400
+في كتير أجهزة حتى إذا انت حاططله طول المريض حاططله
+
+160
+00:12:25,400 --> 00:12:30,300
+طول المريض 160 سنة هو على طول بيحسب ال ideal body
+
+161
+00:12:30,300 --> 00:12:37,530
+weightالأفضل هي أن تتوقع من طول المريض و تحسبه و
+
+162
+00:12:37,530 --> 00:12:41,790
+تضعه لأنه كما نفهم أن الـ lung cavity و الـ
+
+163
+00:12:41,790 --> 00:12:45,230
+thoracic cavity لن يتغير عند زيادة حجم أو وزن
+
+164
+00:12:45,230 --> 00:12:49,880
+المريضمن ستة ل تمانية مليلتر لكل كيلو جرام نعتبر
+
+165
+00:12:49,880 --> 00:12:54,240
+ان في عندى مريض وزنه سبعين كيلو مثلا سبعين كيلو
+
+166
+00:12:54,240 --> 00:12:58,740
+بدي أديله على تمانية سبعة بتمانية خمسمية و ستين
+
+167
+00:12:58,740 --> 00:13:02,240
+نفترض هاي خمسمية و بدي أعملها او ستين مثلا هاي
+
+168
+00:13:02,240 --> 00:13:05,980
+خمسمية لاحظ أنا عملت او ستين okay صار تمام بروح
+
+169
+00:13:05,980 --> 00:13:12,170
+بعملهOkay برس كمان مرة افترض بحطه ستمية بطلع ستمية
+
+170
+00:13:12,170 --> 00:13:16,790
+و بعدين okay صار ستمية بدي ارجع خمسمية بضغط عليها
+
+171
+00:13:16,790 --> 00:13:22,380
+و برجع خمسمية نفترضبساعة الخمسمية؟ okay هذا الـ
+
+172
+00:13:22,380 --> 00:13:25,360
+tidal volume عملنا أول حاجة طيب و غير ال tidal
+
+173
+00:13:25,360 --> 00:13:28,100
+volume إيش بالزمني؟ يعني أنا في ال tidal volume
+
+174
+00:13:28,100 --> 00:13:31,840
+إيش هو ال tidal volume؟ كمية الهواء اللي بده يديها
+
+175
+00:13:31,840 --> 00:13:36,980
+الجهاز للمريض كل نفس هذا ال tidal volume طيب إيش
+
+176
+00:13:36,980 --> 00:13:40,020
+كمان؟ بدي أحدد أكم نفس بدي أد للمريض في الدقيقة
+
+177
+00:13:40,020 --> 00:13:43,340
+الواحدة frequency إيش يعني ال respiratory rate؟ ال
+
+178
+00:13:43,340 --> 00:13:46,380
+respiratory rate نفترض إنه إحنا بدنا نديه و نطلع
+
+179
+00:13:46,380 --> 00:13:51,060
+حتى الجهاز عادة بيكتب كلمة Fيعني frequency breathe
+
+180
+00:13:51,060 --> 00:13:55,080
+per minute نفترض بدنا نديله 14 نفس في الدقيقة
+
+181
+00:13:55,080 --> 00:14:04,460
+بنوصلها بنعمل 14 enter تمام 14 نفس في الدقيقة okay
+
+182
+00:14:04,460 --> 00:14:08,640
+بعد هي كده إيش بدنا نحدد ال O2؟ concentration
+
+183
+00:14:10,770 --> 00:14:14,690
+الـ O2 concentration يعني الـ Oxygen fraction كده
+
+184
+00:14:14,690 --> 00:14:17,870
+بدنا نفترض ان احنا بدنا خمسين في المية Oxygen بص
+
+185
+00:14:17,870 --> 00:14:23,550
+عليها خمسين في المية Oxygen هي خمسينOkay, Enter
+
+186
+00:14:23,550 --> 00:14:27,350
+تمام إذا انصرت محددة تاعتها ال volume ال frequency
+
+187
+00:14:27,350 --> 00:14:31,170
+ال oxygen fraction طيب في حاجة اسمها ال
+
+188
+00:14:31,170 --> 00:14:34,570
+inspiratory time هأجل حاكي فيها شوية في عندي هنا
+
+189
+00:14:34,570 --> 00:14:39,210
+اللي هو ال pressure ال inspiratory pressure يعني
+
+190
+00:14:39,210 --> 00:14:45,150
+قداش بده يعمل inspiratory pressureعادة ما بكونش
+
+191
+00:14:45,150 --> 00:14:48,850
+يعني عاملينه اربعين او maximum maximum ما بكونش
+
+192
+00:14:48,850 --> 00:14:52,470
+اكتر من خمسين bar
+
+193
+00:14:54,410 --> 00:14:59,170
+لأنه اكتر من الخمسين بيصير فيه risk ل ال part
+
+194
+00:14:59,170 --> 00:15:04,330
+trauma فاحنا عادة ما بين الأربعين و الخمسين حسب
+
+195
+00:15:04,330 --> 00:15:08,610
+وضع المريض لما بيكون المريض stiff lung اه ممكن انه
+
+196
+00:15:08,610 --> 00:15:13,030
+احنا نحتاج نزود ال pressure شوية في هنا حاجة اسمها
+
+197
+00:15:13,030 --> 00:15:16,730
+ال beep و في هنا pressure above beep هاي اسمها
+
+198
+00:15:16,730 --> 00:15:19,670
+pressure above beep يعني قداش pressure فوق ال beep
+
+199
+00:15:19,670 --> 00:15:24,340
+ال beep ايش هوالـ Beep هو عبارة عن موض مصاحب لكل
+
+200
+00:15:24,340 --> 00:15:27,940
+موض يعني انا حاطط على اسئلة V وفيه Beep انا حاطط
+
+201
+00:15:27,940 --> 00:15:32,240
+على سي باب وفيه Beep ايش ال Beep اللي هو ال
+
+202
+00:15:32,240 --> 00:15:35,580
+positive end expiratory pressure ايش يعني؟ لاحظ
+
+203
+00:15:35,580 --> 00:15:38,520
+هلق معايا بالشاشة لو سمحت لحظة يا جماعة هاي ال
+
+204
+00:15:38,520 --> 00:15:44,240
+inspiration بيصير بعدين بيصير expiration مش هيك؟
+
+205
+00:15:44,240 --> 00:15:47,180
+تمام؟ اللي في النص هذه فترة ال pause اللي بتصير
+
+206
+00:15:47,180 --> 00:15:51,570
+فيها ايش؟احتباس الهوى داخل ال lung عشان تصبح عملية
+
+207
+00:15:51,570 --> 00:15:55,530
+ال gas exchange وانا بحب اؤكد على نقطة ماحدش عمره
+
+208
+00:15:55,530 --> 00:16:00,010
+يفكر ان جهاز تنافس صناعي هو lung صناعية لأ it's a
+
+209
+00:16:00,010 --> 00:16:05,030
+machine just breathed for you هي عبارة عن هو عبارة
+
+210
+00:16:05,030 --> 00:16:10,000
+عن machineجهاز يقوم بعملية التنفس لك عن طريق يعطيك
+
+211
+00:16:10,000 --> 00:16:13,620
+نفس و ياخد منك النفس او يسيبك تطلق النفس اللي
+
+212
+00:16:13,620 --> 00:16:17,820
+حكينا انه بيطلع passive لكن هو مابيعملش جهاز
+
+213
+00:16:17,820 --> 00:16:22,200
+exchange مابيعملش جهاز exchange ال lung هي اللي
+
+214
+00:16:22,200 --> 00:16:27,790
+لازم تعمل جهاز exchange هو اعطاك النفسالان النافس
+
+215
+00:16:27,790 --> 00:16:33,530
+اللي بده يعطيه كنا بنحكي في ال beep كويس؟ اه عملنا
+
+216
+00:16:33,530 --> 00:16:37,230
+inspiration قولنا ال beep انه positive end
+
+217
+00:16:37,230 --> 00:16:40,530
+expiratory pressure اه يعني بنحكي في ال expiratory
+
+218
+00:16:40,530 --> 00:16:45,010
+الخط هذا يعني انا لما بحكي في ال expiratory المريض
+
+219
+00:16:45,010 --> 00:16:50,490
+بده يكون عنده نهاية مجبه لل expiration ايش يعني؟
+
+220
+00:16:50,490 --> 00:16:56,670
+يعني مابدوش ينزل لتحت بص هنا السفرفوق السفر موجب،
+
+221
+00:16:56,670 --> 00:17:00,530
+مش هيك؟ تحت من السفر، بتكون السالب، طب إيش يعني؟
+
+222
+00:17:00,530 --> 00:17:06,220
+يعني المريض أخد النفطبدا يطلق في النفس احنا في
+
+223
+00:17:06,220 --> 00:17:10,580
+الطبيعي لما بنبدأ نطلق بالنفس بنضل نطلق في النفس
+
+224
+00:17:10,580 --> 00:17:15,260
+نطلق في النفس لما بيصير الضغط داخل ال lung in a
+
+225
+00:17:15,260 --> 00:17:20,380
+thoracic pressure اقل من ضغط الهواء الجوي يعني
+
+226
+00:17:20,380 --> 00:17:24,780
+سالب يعني التعادل مع ضغط الهواء الجوي هي نقطة
+
+227
+00:17:24,780 --> 00:17:30,210
+الصفرلكن إحنا في الطبيعي لما بنعمل expiration ..
+
+228
+00:17:30,210 --> 00:17:34,410
+بنضلنا نعمل expiration لغاية ما يصير الضغط إنا
+
+229
+00:17:34,410 --> 00:17:39,250
+negative حده بيخلي easy إنه النفس اللي بعده ينطق
+
+230
+00:17:39,250 --> 00:17:43,970
+للضغط من ال .. أو الهوامن الضغط العالى للضغط اللى
+
+231
+00:17:43,970 --> 00:17:48,970
+صار لنا أقل تمام فاحنا بروح نعمل إيش على طول بيجي
+
+232
+00:17:48,970 --> 00:17:52,490
+بتصرى بالهوى و بنعمل inspiration تانى و بنضلنا
+
+233
+00:17:52,490 --> 00:17:56,310
+ناخد لما يصير الضغط زى ما حكينا positive الضغط
+
+234
+00:17:56,310 --> 00:18:00,350
+داخلنا أكتر من الهوى جهة ليش علشان نكون قادرين إنه
+
+235
+00:18:00,350 --> 00:18:05,570
+إيشانطلع هذا اللي هو في ال expiration الان هذا نفس
+
+236
+00:18:05,570 --> 00:18:09,850
+الكلام بده يصير عن طريق الجهاز ولكن الفرق صغير انه
+
+237
+00:18:09,850 --> 00:18:13,870
+في ال expiration لما أنا أخدت النفس بشبط أطلق
+
+238
+00:18:14,970 --> 00:18:19,050
+مابدوش اظن اطلق لما اخش للثالث لأ قبل ما اخش
+
+239
+00:18:19,050 --> 00:18:22,750
+للثالث لسه انا في الموجة فوق الزفر كمان بدي ارجع
+
+240
+00:18:22,750 --> 00:18:27,390
+يبدأ نفس اشده ايه؟ هذا هو ال bb ايش يعني؟ يعني ال
+
+241
+00:18:27,390 --> 00:18:31,330
+bb هي كمية الهواء اللي بيبقى residual في ال lung
+
+242
+00:18:31,330 --> 00:18:37,210
+بعد انهاء ال expiration يبقى كمية الهواء بحيث انها
+
+243
+00:18:37,210 --> 00:18:40,010
+تبقى residual محبوسة وعملة شوية inflation في ال
+
+244
+00:18:40,010 --> 00:18:44,470
+lung بحيث انه يجي النفس اللي بعدها فيكونأسهل على
+
+245
+00:18:44,470 --> 00:18:49,190
+المريض ان ياخدوا dial up لانج شوية inflation كويس
+
+246
+00:18:49,190 --> 00:18:53,290
+علشان هيك لو نقرب الشاشة لو اسمح شوف لو ال beep
+
+247
+00:18:53,290 --> 00:18:57,150
+مثلا عملناها عشرة طلع كيف ال beep لو عملناها عشرة
+
+248
+00:18:57,150 --> 00:19:00,510
+عشان يكون واضح مثلا شوف الخط هذا اللي بحكيلكوا
+
+249
+00:19:00,510 --> 00:19:05,710
+عليه قداش ارتفع شايفين قده صار غليظه فوق السفر
+
+250
+00:19:05,710 --> 00:19:10,270
+تمام خد بالك لو انا بدي أنزل ال beep مثلا ارجعه
+
+251
+00:19:12,270 --> 00:19:17,410
+خلّيه 2 عشان يكون الفرق واضح لاحظوا كيف صار ال
+
+252
+00:19:17,410 --> 00:19:21,350
+residual هذا هو ال volume of air اللي ضايق ال
+
+253
+00:19:21,350 --> 00:19:25,970
+remain في ال lung بعد ال expiration تمام؟ عشان هيك
+
+254
+00:19:25,970 --> 00:19:28,830
+كل هي تكون ربما صرتوا عارفين ان ال beef هذا كتير
+
+255
+00:19:28,830 --> 00:19:32,650
+مهم في حالات ان انا بدي اعمل inflation اكتر
+
+256
+00:19:32,650 --> 00:19:35,830
+للalveoli مثلا في المرضى ل chronic obstructive
+
+257
+00:19:35,830 --> 00:19:39,490
+pulmonary disease COPD لما تكون الalveoli عندهم
+
+258
+00:19:39,490 --> 00:19:43,640
+obstructive اسمهبالمونة الرزيسية انا بتعملها شوية
+
+259
+00:19:43,640 --> 00:19:47,080
+اش افتح ال sack تبعها تمام او في البلمونة القديمة
+
+260
+00:19:47,080 --> 00:19:50,100
+واحد عنده البلمونة القديمة و ال sack تبع ال ال
+
+261
+00:19:50,100 --> 00:19:53,880
+alveoli مليان في ال fluid فاحنا بدنا نوسع ال
+
+262
+00:19:53,880 --> 00:19:57,200
+diameter تبعتها علشان يبدأ يصير فيها gas exchange
+
+263
+00:19:57,200 --> 00:20:01,360
+فبنزود ال b بقالت الناس دول بيحتاجوا ال b أكتر من
+
+264
+00:20:01,360 --> 00:20:05,630
+خمسةهي على تمانية تسعة up to ten كويس اذا هذا
+
+265
+00:20:05,630 --> 00:20:08,690
+الفيديو عرفناه هذا معنى مع كل mood مع ال SINV مع
+
+266
+00:20:08,690 --> 00:20:16,340
+ال CMV مع ال ACMV مع ال CPAPنشوف إيش شرحنا ال beep
+
+267
+00:20:16,340 --> 00:20:18,900
+و pressure above beep لإن إذا حط أنا ال beep خمسة
+
+268
+00:20:18,900 --> 00:20:22,580
+حيكون ال pressure above beep ال double okay و ال
+
+269
+00:20:22,580 --> 00:20:24,920
+beep حكينا عنه نضايق الحاجة اسمها ال inspiratory
+
+270
+00:20:24,920 --> 00:20:30,560
+time ال inspiratory time هذه هي في الحقيقة بتستخدم
+
+271
+00:20:30,560 --> 00:20:34,600
+أكتر في ال pressure mood أو في ال pressure control
+
+272
+00:20:34,600 --> 00:20:41,060
+لما بكون أنا حاطط للمريض rate مثلا 14 للحساب خلينا
+
+273
+00:20:41,060 --> 00:20:49,410
+نعمل 10 عشانبتفهم على طول أسرع عشرة
+
+274
+00:20:52,170 --> 00:20:55,690
+الان عشرة طيب العشرة التنفسات هاد و لو ممكن الجهاز
+
+275
+00:20:55,690 --> 00:20:58,950
+مابفهمش لإن أنا مش هتطلع inspiratory time فاروح في
+
+276
+00:20:58,950 --> 00:21:03,010
+أول جزء من الدقيقة يدخل العشر تنفسات نفس اتنين
+
+277
+00:21:03,010 --> 00:21:06,910
+تلاتة اربعة في عشر ثواني و يخلص كل نفس بثاني مثلا
+
+278
+00:21:06,910 --> 00:21:11,730
+طيب و بقية الدقيقة مشكلة فعشانك انا انازم انظم
+
+279
+00:21:11,730 --> 00:21:15,250
+اعمل control عملية النفس هاد عن طريق احجز ان ال
+
+280
+00:21:15,250 --> 00:21:20,200
+inspiratory timeيتم بوقت معين و قلت لازم يكون فيه
+
+281
+00:21:20,200 --> 00:21:25,060
+وقت لـ E الـ expiratory time فعشان هيك ربنا احنا
+
+282
+00:21:25,060 --> 00:21:28,660
+عملنا IE ratio inspiratory expiratory time ratio
+
+283
+00:21:28,660 --> 00:21:32,480
+فيه ratio لـ expiration و expiration اللي هو واحد
+
+284
+00:21:32,480 --> 00:21:37,340
+لاتنين يعني احنا بناخد النفس و بنطلق نفس في بعض
+
+285
+00:21:37,340 --> 00:21:41,970
+عملية الاشالزمن اللي عملنا فيه inspiration يعني
+
+286
+00:21:41,970 --> 00:21:45,930
+إذا أنا أخدت one second عشان أعمل inspiration
+
+287
+00:21:45,930 --> 00:21:49,150
+بطلّق النفس في two seconds وإذا أخدت two second
+
+288
+00:21:49,150 --> 00:21:53,290
+عشان أعمل inspiration بطلّق النفس ال inspiration
+
+289
+00:21:53,290 --> 00:21:57,770
+في four seconds فالضائف two ضائفهم اربع اربع
+
+290
+00:21:57,770 --> 00:22:01,790
+seconds اه إذا ال one breath كلهيته inspiration و
+
+291
+00:22:01,790 --> 00:22:07,530
+ال inspiration أخد منيعشرة تنفسات تقريبا تقريبا
+
+292
+00:22:07,530 --> 00:22:12,190
+تقريبا تقريبا
+
+293
+00:22:12,190 --> 00:22:17,910
+تقريبا تقريبا تقريبا تقريبا تقريبا تقريبا تقريبا
+
+294
+00:22:17,910 --> 00:22:17,930
+تقريبا تقريبا تقريبا تقريبا تقريبا تقريبا تقريبا
+
+295
+00:22:17,930 --> 00:22:24,550
+تقريبا تقريبا تقريبا تقريبا تقعشر تنفسيات كل نفس
+
+296
+00:22:24,550 --> 00:22:31,230
+.. six .. كل نفس six seconds عشر تنفسيات هي ستين
+
+297
+00:22:31,230 --> 00:22:34,050
+تمانية بالنسبة لراتوير تايم .. بالنسبة لراتوير
+
+298
+00:22:34,050 --> 00:22:37,670
+تايم كل العشر تنفسيات بالنسبة لراتوير تايم تبعهم
+
+299
+00:22:37,670 --> 00:22:43,370
+أكام؟ عشرين ثانية من الستين هدولة عشرة اتنين في
+
+300
+00:22:43,370 --> 00:22:47,870
+عشرة عشرين ثانية مش هيك؟ اذا عشرين ثانية على ال
+
+301
+00:22:47,870 --> 00:22:52,480
+rate ال rate اللي هو عندي عشرة يبقى كل نفسسنتين زي
+
+302
+00:22:52,480 --> 00:22:55,600
+ما حكينا اذا انا بروح بعمل ال inspiratory time هى
+
+303
+00:22:55,600 --> 00:23:01,460
+نقل كم؟ سنتين لاحظ عد انا بمجرد ما اعمل ال
+
+304
+00:23:01,460 --> 00:23:07,480
+inspiratory time سنتين ال IE ratio كم صار؟1 إلى 2
+
+305
+00:23:07,480 --> 00:23:10,520
+انا شرحت هذه عشان انتوا تفهموها لكن مش مطلوب منك
+
+306
+00:23:10,520 --> 00:23:14,060
+ان انت تقعد تحسب لو انا بدأ افترض انه حاطط ال rate
+
+307
+00:23:14,060 --> 00:23:18,180
+على عشرة هياته و بدأ اروح اعمل ال inspiratory time
+
+308
+00:23:18,180 --> 00:23:22,300
+بدأ اطلع على اي ratio لما يصير 1 إلى 2 ها 1 إلى 2
+
+309
+00:23:22,300 --> 00:23:29,470
+غير غير لما يصير 1 إلى 2 ها هاهيو صار واحد لاتنين
+
+310
+00:23:29,470 --> 00:23:35,490
+طلع صار ثانيتين لحاله لأن هو عارف ان ال IE واحد
+
+311
+00:23:35,490 --> 00:23:38,950
+لاتنين بمجرد ما انت بتعمله ال inspiratory
+
+312
+00:23:38,950 --> 00:23:41,850
+expiratory ratio واحد إلى اتنين بكون ال
+
+313
+00:23:41,850 --> 00:23:44,630
+inspiratory time two seconds يعني ال two seconds
+
+314
+00:23:44,630 --> 00:23:48,250
+في عشرة يعني ال inspiratory time في الدقيقة كلها
+
+315
+00:23:48,470 --> 00:23:52,690
+عشرين ثانية وبالتالي اربعين ثانية for expiration
+
+316
+00:23:52,690 --> 00:23:56,250
+هاي عملنا ال tidal volume عملنا ال inspiratory
+
+317
+00:23:56,250 --> 00:23:59,490
+time عملنا ال rate عملنا ال oxygen fraction حطينا
+
+318
+00:23:59,490 --> 00:24:02,610
+ال pressure عملنا ال pressure above V وحطينا ال
+
+319
+00:24:02,610 --> 00:24:05,930
+beep طيب إيش في حاجات تانية مهمة قبل ما أحكي في
+
+320
+00:24:05,930 --> 00:24:08,130
+الحاجات التانية المهمة بدي أحكي عن موضع تاني اسمه
+
+321
+00:24:08,130 --> 00:24:11,750
+سي باب لو أنا روحت دقات دعسة طويلة على السي باب
+
+322
+00:24:13,020 --> 00:24:17,600
+بقلب الجهاز لسباب مود السيباب مود هذا هو الويمينج
+
+323
+00:24:17,600 --> 00:24:22,440
+مود يعني المريض صار عنده قدرة على التنفس وانا بده
+
+324
+00:24:22,440 --> 00:24:26,500
+احطه على التنفس لحاله و بده احطه على السيباب
+
+325
+00:24:26,500 --> 00:24:29,220
+السيباب بمميزته انه لا يقطع زي ما انتوا شايفين
+
+326
+00:24:29,220 --> 00:24:34,040
+تايدا ال volumeمافيش ولا rate يعني المريض المفروض
+
+327
+00:24:34,040 --> 00:24:37,240
+انه بده يتحكم في هذا ال volume لحاله المريض بده
+
+328
+00:24:37,240 --> 00:24:40,520
+يتحكم في عدد مرات التنفس في الدقيقة لحاله طب انا
+
+329
+00:24:40,520 --> 00:24:46,780
+اش مساويله انا بس يديله بصها بيب لذلك ال سيباب هو
+
+330
+00:24:46,780 --> 00:24:51,340
+عبارة عن continuous beep اه لذلك ايش ايش ايش ال
+
+331
+00:24:51,340 --> 00:24:55,060
+beep كان positive end expiratory pressure طب ايش
+
+332
+00:24:55,060 --> 00:24:59,820
+هو السيبابهو continuous positive airway pressure
+
+333
+00:24:59,820 --> 00:25:03,560
+هو continuous positive airway pressure إذا هو
+
+334
+00:25:03,560 --> 00:25:06,800
+عبارة عن continuous بيب إذا إيه؟ إيش يعني
+
+335
+00:25:06,800 --> 00:25:10,140
+continuous بيب؟ يعني continuous residual volume
+
+336
+00:25:10,140 --> 00:25:14,520
+يضله في ال lung بحيث إن المرضي يستطيع أن يعمل
+
+337
+00:25:14,520 --> 00:25:20,070
+عملية النفس spontaneously لحالهكويس في كل مرة
+
+338
+00:25:20,070 --> 00:25:22,750
+ويتحكم في الـ tidal volume وفي ال rate المناسب لما
+
+339
+00:25:22,750 --> 00:25:25,910
+بيصير fit for extubation طب إيش في حاجات تانية
+
+340
+00:25:25,910 --> 00:25:31,890
+ممكن نعرفها عن الجهاز لاحظ هنا في زر ل ال
+
+341
+00:25:31,890 --> 00:25:34,910
+nebulizer يعني لو أنا بدي أجي أعمل للمريض إلا على
+
+342
+00:25:34,910 --> 00:25:39,010
+ال ventilator وإله endotracheal tube نبوليزر
+
+343
+00:25:39,010 --> 00:25:43,930
+تبخيرة فنتولين ديكورد whatever إيش اللي بيصير؟ أه
+
+344
+00:25:43,930 --> 00:25:48,630
+المرة هذه هروح على ال inspiration يعني هناهيكون
+
+345
+00:25:48,630 --> 00:25:55,670
+فيه adapter هه تبع النبيولايزر بنشبك فيه وبكون ال
+
+346
+00:25:55,670 --> 00:25:59,810
+adapter هه وبكون فيه connection يعني تيوب وبتيجي
+
+347
+00:25:59,810 --> 00:26:09,790
+على زر تبع النبيولايزر هى هى شايفين هذا بنشبك فيه
+
+348
+00:26:09,790 --> 00:26:13,370
+نفس ال oxygen ال tube هياته هي عليه علامة تبخيرة
+
+349
+00:26:13,370 --> 00:26:19,170
+وبتروح وانت ضغط هناعلى النبلازر بيصير ايش؟ طلع هذا
+
+350
+00:26:19,170 --> 00:26:23,850
+الذرب ده يعمل هوا عشان فيه .. لو في حد تتحرك لو في
+
+351
+00:26:23,850 --> 00:26:28,330
+ورقة ولا حاجة هيكون
+
+352
+00:26:28,330 --> 00:26:34,570
+واضح جدا انه ايش بطلق هوا مافيش معنى حاجة كاملة لأ
+
+353
+00:26:34,570 --> 00:26:40,290
+ما .. هذا مش .. okay no problem okay هذه واحدة طيب
+
+354
+00:26:40,290 --> 00:26:47,190
+هذه واحدةالحاجة التانية O2 Suction إيش يعني؟ يعني
+
+355
+00:26:47,190 --> 00:26:50,690
+لما أنا بدي أعمل suction لمريد بدي أديله .. أرجع
+
+356
+00:26:50,690 --> 00:26:54,670
+على ASAMV بدي
+
+357
+00:26:54,670 --> 00:26:59,750
+أديله suction عشان أعمله .. بدي أديله oxygen عشان
+
+358
+00:26:59,750 --> 00:27:02,150
+أعمله suction فلازم أعمله حاجة نسميها hyper
+
+359
+00:27:02,150 --> 00:27:05,790
+oxygenation so hyper oxygenation أنا بدي oxygen
+
+360
+00:27:05,790 --> 00:27:08,530
+fraction one hundred percent مية في المية بمجرد
+
+361
+00:27:08,530 --> 00:27:12,710
+بقص على O2 suction بروح بيد العيال oxygen
+
+362
+00:27:22,670 --> 00:27:27,370
+مجرد ما اضغط على O2 suction بروح بيد المريض اكسجين
+
+363
+00:27:27,370 --> 00:27:28,550
+100%
+
+364
+00:27:31,500 --> 00:27:42,920
+فقط لـ 3 دقيقة لان انا باعمل تفصيل للمريض و بعد
+
+365
+00:27:42,920 --> 00:27:49,360
+تفصيله باعمل شركة فنتليتر و ادارة اكسجين تبع
+
+366
+00:27:49,360 --> 00:27:53,580
+التفصيل الهدف منه ان اعمل
+
+367
+00:27:59,380 --> 00:28:04,380
+إذا كنت أريد أن أوقف النفس لسبب أنني أشتغل أو أشرح
+
+368
+00:28:04,380 --> 00:28:13,970
+أو أدغط عليها، فهذا يوقف النفسموقف الصحيح .. موقف
+
+369
+00:28:13,970 --> 00:28:20,830
+الصحيح .. موقف
+
+370
+00:28:20,830 --> 00:28:21,810
+الصحيح .. موقف الصحيح .. موقف الصحيح .. موقف
+
+371
+00:28:21,810 --> 00:28:22,270
+الصحيح .. موقف الصحيح .. موقف الصحيح .. موقف
+
+372
+00:28:22,270 --> 00:28:22,290
+الصحيح .. موقف الصحيح .. موقف الصحيح .. موقف
+
+373
+00:28:22,290 --> 00:28:22,410
+الصحيح .. موقف الصحيح .. موقف الصحيح .. موقف
+
+374
+00:28:22,410 --> 00:28:26,370
+الصحيح .. موقف الصحيح .. موقف الصحيح .. موقف
+
+375
+00:28:26,370 --> 00:28:34,810
+الصحيح .. موقف الصحيح ..طيب هنا في ال الارم الارم
+
+376
+00:28:34,810 --> 00:28:39,090
+off وفي الارم الارم الارم الارم الارم الارم الارم
+
+377
+00:28:39,090 --> 00:28:43,510
+الارم الارم الارم الارم الارم الارم الارم الارم
+
+378
+00:28:43,510 --> 00:28:47,050
+الارم الارم الارم الارم الارم الارم الارم الارم
+
+379
+00:28:47,050 --> 00:28:47,490
+الارم الارم الارم الارم الارم الارم الارم الارم
+
+380
+00:28:47,490 --> 00:28:47,590
+الارم الارم الارم الارم الارم الارم الارم الارم
+
+381
+00:28:47,590 --> 00:28:48,110
+الارم الارم الارم الارم الارم الارم الارم الارم
+
+382
+00:28:48,110 --> 00:28:50,450
+الارم الارم الارم الارم الارم الارم الارالزر تبع
+
+383
+00:28:50,450 --> 00:28:55,410
+ال setting هذا بتديلي قداش بدك ال flow تبع ال ACC
+
+384
+00:28:55,410 --> 00:28:59,930
+يعني المعدل انسياب الهواء اللي ماشي يعني سرعة
+
+385
+00:28:59,930 --> 00:29:03,670
+انسياب الهواء قداش بدك هيكون عادة ما بين التلاتين
+
+386
+00:29:03,670 --> 00:29:09,460
+لاربعينبتلاحظ انه بال .. بال millibar بر إيش؟ ب
+
+387
+00:29:09,460 --> 00:29:14,500
+second تمام؟ بعدين ال trigger .. ايش ال trigger؟
+
+388
+00:29:14,500 --> 00:29:19,960
+ال trigger sensitivity هي حساسية الجهاز في المريض
+
+389
+00:29:19,960 --> 00:29:23,680
+عشان يعرف مين هو انشط ال breathing مين هيبدأ عملية
+
+390
+00:29:23,680 --> 00:29:27,480
+النفس كويس كل ما بزود ال trigger يعني بمنع انه ال
+
+391
+00:29:27,480 --> 00:29:33,350
+جهاز يحس في المريض كل ما ..بخلّي ال trigger واطي
+
+392
+00:29:33,350 --> 00:29:37,290
+يعني واحد اتنين تلاتة اه معناه انه حس في المريض و
+
+393
+00:29:37,290 --> 00:29:42,610
+خلّي فيه index sensitivity بحيث انه المريض يعني
+
+394
+00:29:42,610 --> 00:29:45,750
+شارك في عملية النفس و لو بدل بده يعمل initiation
+
+395
+00:29:45,750 --> 00:29:50,390
+الجهاز المفروض انه يعمل stop في حد هنا VT Apnea
+
+396
+00:29:50,390 --> 00:29:56,750
+ايش يعني؟VT أبنية و F أبنية ايش يعني F يعني
+
+397
+00:29:56,750 --> 00:30:00,110
+frequency يعني ال rate تبع الأبنية و VT يعني ال
+
+398
+00:30:00,110 --> 00:30:03,610
+tidal volume تبع الأبنية اه هذه ميزة جدا مهمة
+
+399
+00:30:03,610 --> 00:30:06,510
+قاملونها في الجهاز لو انا فرضا حاطط مريض على سي
+
+400
+00:30:06,510 --> 00:30:11,110
+باب تمام السي باب حكينا مش هيعطي tidal volume و مش
+
+401
+00:30:11,110 --> 00:30:17,650
+هيعطي respiratory rate كويس و فجأة المريض اللي لدي
+
+402
+00:30:17,650 --> 00:30:22,850
+بطل ياخد tidal volume و بطل ياخد rateصار exhausted
+
+403
+00:30:22,850 --> 00:30:28,250
+وما مش قادر ان ياخد التنفسات لحاله فورا راح الجهاز
+
+404
+00:30:28,250 --> 00:30:32,310
+يقلب على حاجة اسمها ابنيا mood او ابنيا
+
+405
+00:30:32,310 --> 00:30:36,090
+ventilation وحيث يبدأ يد للمريض ال tidal volume
+
+406
+00:30:36,090 --> 00:30:39,610
+اللي انا حاطه هنا ده احترازيا و ال frequency اللي
+
+407
+00:30:39,610 --> 00:30:45,250
+انا حاطه هنا حتى لو المريض طلععلى سي باب يعني حتى
+
+408
+00:30:45,250 --> 00:30:49,030
+لو هو على سي باب بالشكل هذا روح على alarm reset
+
+409
+00:30:49,030 --> 00:30:51,890
+هتلاقي انه باخد الطيب ال volume و ال rate هدوله
+
+410
+00:30:51,890 --> 00:30:54,870
+رغم انه على سي باب وهنا مابياخدش حاجة هذا في حال
+
+411
+00:30:54,870 --> 00:30:59,490
+ان المريض ايش مابيتنفسش هذا أهمية عشان ذلك لو انا
+
+412
+00:30:59,490 --> 00:31:02,390
+روحت .. وين .. وين مشكلته هذا؟ لو انا روحت يا
+
+413
+00:31:02,390 --> 00:31:06,570
+جماعة مريضي محطوله سي باب وعملتله disconnection
+
+414
+00:31:06,570 --> 00:31:10,170
+عشان اعمله مثلا suction الجهاز ايش باعتبر ان
+
+415
+00:31:10,170 --> 00:31:11,430
+المريض بطر يتنفس
+
+416
+00:31:14,000 --> 00:31:17,940
+أنا مش عارف و ماعملتش alarm reset بروح برجع بشبك
+
+417
+00:31:17,940 --> 00:31:20,920
+المريض بتكون عملية ال winning اللي أنا بعملها
+
+418
+00:31:20,920 --> 00:31:25,040
+فاشلة لإيش؟ لأن المريض صار على اسقى IMV و تايدا ال
+
+419
+00:31:25,040 --> 00:31:28,360
+volume و rate بس أنا موجود جاني واضح أن هو على C
+
+420
+00:31:28,360 --> 00:31:35,120
+-band تمام؟ وهذه مشكلة كبيرة بتكون يعني أنا حاولت
+
+421
+00:31:35,120 --> 00:31:41,060
+أن أشرح بس الحاجات المتعلقة في الجهازفي حاجات كتير
+
+422
+00:31:41,060 --> 00:31:46,320
+مهمة في مراقبة المريض هو على جهاز التناقص الصناعي
+
+423
+00:31:46,320 --> 00:31:49,500
+كيف لازم أراقب ال saturation كيف لازم أراقب ال
+
+424
+00:31:49,500 --> 00:31:54,340
+blood gas analysis عملية waning أو طروقها لكن ال
+
+425
+00:31:54,340 --> 00:31:58,790
+session هذا أو الفيديو هذا كانمخصص علينا انه بيحكي
+
+426
+00:31:58,790 --> 00:32:02,390
+بس على ال settings كيف انا لازم لو كان في عندي
+
+427
+00:32:02,390 --> 00:32:04,890
+جهاز تنافس صناعي ايش الحاجات اللي بدي اعملها
+
+428
+00:32:04,890 --> 00:32:09,430
+settings و بدي اضبطها علشان اشغلها او اشغل مريض
+
+429
+00:32:09,430 --> 00:32:13,330
+على جهاز تنافس الصناعي شكرا جزيلا لكم و يعطيكم
+
+430
+00:32:13,330 --> 00:32:13,530
+العافية
+
diff --git a/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/icAigPXOkrE_raw.json b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/icAigPXOkrE_raw.json
new file mode 100644
index 0000000000000000000000000000000000000000..e1445b694e1c082f246138b166716f59de6cec62
--- /dev/null
+++ b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/icAigPXOkrE_raw.json
@@ -0,0 +1 @@
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هيعمل فراكشن تبع الأكسجين اللي أنا بديه يعني مثلا انا بدي 40%", "tokens": [5172, 7649, 1988, 24063, 30767, 2304, 7649, 25961, 2655, 16247, 7435, 3224, 11622, 3660, 2423, 1988, 24063, 7251, 30544, 4724, 23557, 4032, 7251, 30544, 8978, 3224, 732, 9917, 36764, 24401, 5551, 4117, 3794, 7435, 9957, 4032, 36764, 24401, 1988, 4724, 3794, 8032, 14407, 2423, 4386, 2423, 1988, 24063, 39896, 25957, 1211, 6156, 23557, 4117, 8592, 1863, 6055, 3555, 3615, 16247, 4117, 3794, 7435, 9957, 13672, 1829, 41850, 4724, 16254, 3224, 37495, 22653, 50113, 15040, 1975, 8315, 4724, 16254, 3356, 4], "avg_logprob": -0.25347221044846524, "compression_ratio": 1.6384180790960452, "no_speech_prob": 9.5367431640625e-07, "words": [{"start": 262.61, "end": 263.03, "word": "فان", "probability": 0.48065185546875}, {"start": 263.03, "end": 263.23, "word": " air", "probability": 0.427490234375}, {"start": 263.23, "end": 263.59, "word": " mixer", "probability": 0.85205078125}, {"start": 263.59, "end": 264.01, "word": " زمان", 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"text": "بنزود عن ال 21 اربعين خمسين ستين سبعين في الامر جاسي ممكن نحطه على مية في المية بس don't forget that oxygen is a drug so it has a toxicity عشان هي ماحدش بيفضل ان ال oxygen يظل على high concentration لمدة طويلة ولذلك ال common انه يستخدم بين ال 40 ل 60% okay فأتأكد ان انا مشغول", "tokens": [3555, 1863, 11622, 23328, 18871, 2423, 5080, 1975, 25513, 3615, 9957, 16490, 2304, 3794, 9957, 8608, 2655, 9957, 8608, 3555, 3615, 9957, 8978, 2423, 10943, 2288, 10874, 995, 3794, 1829, 3714, 43020, 8717, 5016, 9566, 3224, 15844, 3714, 10632, 8978, 9673, 10632, 4724, 3794, 500, 380, 2870, 300, 9169, 307, 257, 4110, 370, 309, 575, 257, 45866, 6225, 8592, 7649, 39896, 19446, 24401, 8592, 4724, 33911, 11242, 1211, 16472, 2423, 9169, 7251, 19913, 1211, 15844, 1090, 9856, 32767, 41891, 23032, 2407, 26895, 3660, 35525, 8848, 23275, 2423, 2689, 16472, 3224, 7251, 14851, 9778, 40448, 49374, 2423, 3356, 5296, 4060, 4, 1392, 6156, 10721, 2655, 10721, 4117, 3215, 16472, 1975, 8315, 37893, 17082, 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ان يكون هناك مشكلة في البطارية لإنه فيه بطارية اه لإنه ممكن جدا ان يكون هناك مشكلة فلازم يكون مشبوك في الكهربا هذي ال connection و اتاكد ان انا عندي ال corrugated tube", "tokens": [2407, 1975, 2655, 995, 4117, 3215, 16472, 33251, 3224, 25513, 995, 6055, 3555, 4587, 7578, 37893, 3555, 2407, 4117, 995, 4724, 9566, 16572, 28671, 20328, 5016, 11331, 1829, 9307, 3224, 5296, 28814, 1863, 3224, 3714, 43020, 10874, 28259, 16472, 7251, 30544, 34105, 4117, 37893, 28820, 3660, 8978, 29739, 9566, 9640, 10632, 5296, 28814, 1863, 3224, 8978, 3224, 4724, 9566, 9640, 10632, 1975, 3224, 5296, 28814, 1863, 3224, 3714, 43020, 10874, 28259, 16472, 7251, 30544, 34105, 4117, 37893, 28820, 3660, 6156, 1211, 31377, 2304, 7251, 30544, 37893, 3555, 2407, 4117, 8978, 33251, 3224, 25513, 995, 8032, 8848, 1829, 2423, 4984, 4032, 1975, 2655, 995, 4117, 3215, 16472, 1975, 8315, 18871, 16254, 2423, 38576, 697, 770, 9917], "avg_logprob": -0.39331896037890995, "compression_ratio": 2.0638297872340425, "no_speech_prob": 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الهدف من", "tokens": [32277, 2304, 3224, 318, 6324, 53, 23032, 3555, 3615, 995, 14111, 8978, 20424, 53, 4032, 8978, 2423, 8157, 44, 53, 2423, 20424, 53, 4839, 28850, 15458, 4745, 28290, 16067, 4724, 1829, 14851, 9778, 40448, 6225, 18513, 3660, 5296, 15042, 7251, 30544, 9673, 16572, 11242, 2584, 833, 31750, 42464, 34051, 2584, 41919, 11331, 49975, 7251, 30544, 3714, 47283, 3215, 3714, 9381, 2288, 14628, 6156, 3224, 15730, 2423, 9268, 6225, 18513, 3660, 4724, 1829, 14851, 9778, 40448, 8978, 18863, 42213, 1829, 9307, 44381, 6225, 18513, 3660, 1975, 5016, 8315, 8978, 2423, 38123, 1975, 2407, 8978, 2423, 7473, 44945, 14851, 9778, 40448, 2423, 318, 6324, 53, 26155, 14613, 1602, 5751, 15548, 317, 15458, 4745, 28290, 16067, 2423, 3224, 3215, 5172, 9154], "avg_logprob": -0.2710084068675001, "compression_ratio": 1.6474820143884892, "no_speech_prob": 1.7762184143066406e-05, "words": [{"start": 631.7399999999999, "end": 632.56, "word": "اسمه", "probability": 0.73583984375}, {"start": 632.56, 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rate المناسب لما بيصير fit for extubation طب إيش في حاجات تانية ممكن نعرفها عن الجهاز لاحظ هنا في زر ل ال nebulizer يعني لو أنا بدي أجي أعمل للمريض إلا على ال ventilator وإله endotracheal tube نبوليزر تبخيرة فنتولين ديكورد whatever إيش اللي بيصير؟ أه المرة هذه هروح على ال inspiration يعني هنا", "tokens": [4117, 45865, 3794, 8978, 28242, 3714, 25720, 4032, 36081, 5016, 24793, 8978, 2423, 39184, 9422, 304, 5523, 4032, 41185, 2423, 3314, 9673, 8315, 35457, 5296, 15042, 4724, 1829, 9381, 13546, 3318, 337, 1279, 836, 399, 23032, 3555, 11933, 1829, 8592, 8978, 11331, 26108, 9307, 6055, 7649, 10632, 3714, 43020, 8717, 3615, 28480, 11296, 18871, 25724, 3224, 31377, 20193, 5016, 19913, 34105, 8978, 30767, 2288, 5296, 2423, 408, 12176, 6545, 37495, 22653, 45164, 41850, 4724, 16254, 5551, 7435, 1829, 5551, 25957, 1211, 5296, 19528, 16572, 11242, 11933, 15040, 15844, 2423, 27498, 1639, 4032, 28814, 43761, 917, 310, 81, 6000, 304, 9917, 8717, 3555, 12610, 1829, 11622, 2288, 6055, 3555, 9778, 48923, 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1895.68, "end": 1895.9, "word": " بس", "probability": 0.966552734375}, {"start": 1895.9, "end": 1896.34, "word": " الحاجات", "probability": 0.9964192708333334}, {"start": 1896.34, "end": 1897.24, "word": " المتعلقة", "probability": 0.940673828125}, {"start": 1897.24, "end": 1898.34, "word": " في", "probability": 0.97607421875}, {"start": 1898.34, "end": 1899.4, "word": " الجهاز", "probability": 0.9794921875}], "temperature": 1.0}, {"id": 85, "seek": 191636, "start": 1899.8, "end": 1916.36, "text": "في حاجات كتير مهمة في مراقبة المريض هو على جهاز التناقص الصناعي كيف لازم أراقب ال saturation كيف لازم أراقب ال blood gas analysis عملية waning أو طروقها لكن ال session هذا أو الفيديو هذا كان", "tokens": [41185, 11331, 26108, 9307, 9122, 2655, 13546, 3714, 16095, 3660, 8978, 3714, 23557, 4587, 49401, 9673, 16572, 11242, 31439, 15844, 10874, 3224, 31377, 16712, 8315, 4587, 9381, 31767, 8315, 3615, 1829, 9122, 33911, 5296, 31377, 2304, 5551, 23557, 4587, 3555, 2423, 27090, 9122, 33911, 5296, 31377, 2304, 5551, 23557, 4587, 3555, 2423, 3390, 4211, 34178, 356, 17122, 6225, 42213, 10632, 261, 8415, 34051, 23032, 2288, 30543, 11296, 44381, 2423, 5481, 23758, 34051, 27188, 1829, 16254, 2407, 23758, 25961], "avg_logprob": -0.26938290912893753, "compression_ratio": 1.6020942408376964, "no_speech_prob": 3.600120544433594e-05, "words": [{"start": 1899.8, "end": 1900.24, "word": "في", "probability": 0.260009765625}, {"start": 1900.24, "end": 1900.62, "word": " حاجات", "probability": 0.9161783854166666}, {"start": 1900.62, "end": 1901.06, "word": " كتير", "probability": 0.7178548177083334}, {"start": 1901.06, "end": 1901.74, "word": " مهمة", "probability": 0.97119140625}, {"start": 1901.74, "end": 1903.22, "word": " في", "probability": 0.7216796875}, {"start": 1903.22, "end": 1904.08, "word": " مراقبة", "probability": 0.965087890625}, {"start": 1904.08, "end": 1904.54, "word": " المريض", "probability": 0.9384765625}, {"start": 1904.54, "end": 1904.72, "word": " هو", "probability": 0.49755859375}, {"start": 1904.72, "end": 1904.92, "word": " على", "probability": 0.7861328125}, {"start": 1904.92, "end": 1905.22, "word": " جهاز", "probability": 0.9708658854166666}, {"start": 1905.22, "end": 1905.68, "word": " التناقص", "probability": 0.868408203125}, {"start": 1905.68, "end": 1906.32, "word": " الصناعي", "probability": 0.971923828125}, {"start": 1906.32, "end": 1907.02, "word": " كيف", "probability": 0.860107421875}, {"start": 1907.02, "end": 1907.28, "word": " لازم", "probability": 0.8942057291666666}, {"start": 1907.28, "end": 1907.6, "word": " أراقب", "probability": 0.885498046875}, {"start": 1907.6, "end": 1907.68, "word": " ال", "probability": 0.8681640625}, {"start": 1907.68, "end": 1908.22, "word": " saturation", "probability": 0.5703125}, {"start": 1908.22, "end": 1908.7, "word": " كيف", "probability": 0.747314453125}, {"start": 1908.7, "end": 1909.0, "word": " لازم", "probability": 0.9899088541666666}, {"start": 1909.0, "end": 1909.4, "word": " أراقب", "probability": 0.9742431640625}, {"start": 1909.4, "end": 1909.5, "word": " ال", "probability": 0.63525390625}, {"start": 1909.5, "end": 1909.72, "word": " blood", "probability": 0.90771484375}, {"start": 1909.72, "end": 1909.98, "word": " gas", "probability": 0.8671875}, {"start": 1909.98, "end": 1910.7, "word": " analysis", "probability": 0.7230631510416666}, {"start": 1910.7, "end": 1911.92, "word": " عملية", "probability": 0.79443359375}, {"start": 1911.92, "end": 1912.36, "word": " waning", "probability": 0.530120849609375}, {"start": 1912.36, "end": 1912.66, "word": " أو", "probability": 0.1602783203125}, {"start": 1912.66, "end": 1913.5, "word": " طروقها", "probability": 0.8648681640625}, {"start": 1913.5, "end": 1913.84, "word": " لكن", "probability": 0.54541015625}, {"start": 1913.84, "end": 1914.34, "word": " ال", "probability": 0.447021484375}, {"start": 1914.34, "end": 1914.64, "word": " session", "probability": 0.449462890625}, {"start": 1914.64, "end": 1914.96, "word": " هذا", "probability": 0.444580078125}, {"start": 1914.96, "end": 1915.14, "word": " أو", "probability": 0.40478515625}, {"start": 1915.14, "end": 1915.76, "word": " الفيديو", "probability": 0.9444580078125}, {"start": 1915.76, "end": 1916.0, "word": " هذا", "probability": 0.74658203125}, {"start": 1916.0, "end": 1916.36, "word": " كان", "probability": 0.92724609375}], "temperature": 1.0}, {"id": 86, "seek": 193353, "start": 1917.01, "end": 1933.53, "text": "مخصص علينا انه بيحكي بس على ال settings كيف انا لازم لو كان في عندي جهاز تنافس صناعي ايش الحاجات اللي بدي اعملها settings و بدي اضبطها علشان اشغلها او اشغل مريض على جهاز تنافس الصناعي شكرا جزيلا لكم و يعطيكم العافية", "tokens": [2304, 9778, 9381, 9381, 11203, 9957, 995, 16472, 3224, 4724, 1829, 5016, 4117, 1829, 4724, 3794, 15844, 2423, 6257, 9122, 33911, 1975, 8315, 5296, 31377, 2304, 45164, 25961, 8978, 18871, 16254, 10874, 3224, 31377, 6055, 8315, 36178, 20328, 8315, 3615, 1829, 1975, 1829, 8592, 21542, 26108, 9307, 13672, 1829, 4724, 16254, 1975, 25957, 1211, 11296, 6257, 4032, 4724, 16254, 1975, 11242, 3555, 9566, 11296, 11203, 8592, 7649, 1975, 8592, 17082, 1211, 11296, 1975, 2407, 1975, 8592, 17082, 1211, 3714, 16572, 11242, 15844, 10874, 3224, 31377, 6055, 8315, 36178, 31767, 8315, 3615, 1829, 13412, 4117, 23557, 10874, 11622, 1829, 15040, 5296, 24793, 4032, 37495, 9566, 1829, 24793, 18863, 31845, 10632], "avg_logprob": -0.2359374993226745, "compression_ratio": 1.8934010152284264, "no_speech_prob": 0.00021314620971679688, "words": [{"start": 1917.01, "end": 1917.75, "word": "مخصص", "probability": 0.783538818359375}, {"start": 1917.75, "end": 1918.15, "word": " علينا", "probability": 0.4384765625}, {"start": 1918.15, "end": 1918.43, "word": " انه", "probability": 0.6318359375}, {"start": 1918.43, "end": 1918.79, "word": " بيحكي", "probability": 0.82607421875}, {"start": 1918.79, "end": 1919.09, "word": " بس", "probability": 0.81982421875}, {"start": 1919.09, "end": 1919.47, "word": " على", "probability": 0.6357421875}, {"start": 1919.47, "end": 1920.17, "word": " ال", "probability": 0.85107421875}, {"start": 1920.17, "end": 1920.51, "word": " settings", "probability": 0.75146484375}, {"start": 1920.51, "end": 1921.09, "word": " كيف", "probability": 0.885986328125}, {"start": 1921.09, "end": 1921.37, "word": " انا", "probability": 0.889892578125}, {"start": 1921.37, "end": 1921.71, "word": " لازم", "probability": 0.99072265625}, {"start": 1921.71, "end": 1921.85, "word": " لو", "probability": 0.92236328125}, {"start": 1921.85, "end": 1922.07, "word": " كان", "probability": 0.98388671875}, {"start": 1922.07, "end": 1922.19, "word": " في", "probability": 0.673828125}, {"start": 1922.19, "end": 1922.39, "word": " عندي", "probability": 0.6689453125}, {"start": 1922.39, "end": 1922.57, "word": " جهاز", "probability": 0.9962565104166666}, {"start": 1922.57, "end": 1922.83, "word": " تنافس", "probability": 0.8697916666666666}, {"start": 1922.83, "end": 1923.35, "word": " صناعي", "probability": 0.9404296875}, {"start": 1923.35, "end": 1923.77, "word": " ايش", "probability": 0.4416097005208333}, {"start": 1923.77, "end": 1924.17, "word": " الحاجات", "probability": 0.9874674479166666}, {"start": 1924.17, "end": 1924.31, "word": " اللي", "probability": 0.868896484375}, {"start": 1924.31, "end": 1924.49, "word": " بدي", "probability": 0.622314453125}, {"start": 1924.49, "end": 1924.89, "word": " اعملها", "probability": 0.9129638671875}, {"start": 1924.89, "end": 1925.29, "word": " settings", "probability": 0.8935546875}, {"start": 1925.29, "end": 1925.47, "word": " و", "probability": 0.8984375}, {"start": 1925.47, "end": 1925.83, "word": " بدي", "probability": 0.766845703125}, {"start": 1925.83, "end": 1926.69, "word": " اضبطها", "probability": 0.937109375}, {"start": 1926.69, "end": 1927.35, "word": " علشان", "probability": 0.93505859375}, {"start": 1927.35, "end": 1928.27, "word": " اشغلها", "probability": 0.8958984375}, {"start": 1928.27, "end": 1928.75, "word": " او", "probability": 0.898193359375}, {"start": 1928.75, "end": 1929.13, "word": " اشغل", "probability": 0.9705810546875}, {"start": 1929.13, "end": 1929.43, "word": " مريض", "probability": 0.8709309895833334}, {"start": 1929.43, "end": 1929.61, "word": " على", "probability": 0.71533203125}, {"start": 1929.61, "end": 1929.93, "word": " جهاز", "probability": 0.9921875}, {"start": 1929.93, "end": 1930.39, "word": " تنافس", "probability": 0.9451497395833334}, {"start": 1930.39, "end": 1931.43, "word": " الصناعي", "probability": 0.9788818359375}, {"start": 1931.43, "end": 1932.09, "word": " شكرا", "probability": 0.8527018229166666}, {"start": 1932.09, "end": 1932.53, "word": " جزيلا", "probability": 0.67108154296875}, {"start": 1932.53, "end": 1932.77, "word": " لكم", "probability": 0.51123046875}, {"start": 1932.77, "end": 1932.93, "word": " و", "probability": 0.75244140625}, {"start": 1932.93, "end": 1933.33, "word": " يعطيكم", "probability": 0.7667236328125}, {"start": 1933.33, "end": 1933.53, "word": " العافية", "probability": 0.7696126302083334}], "temperature": 1.0}], "language": "ar", "language_probability": 1.0, "duration": 1936.0798125, "duration_after_vad": 1871.248749999996}
\ No newline at end of file
diff --git a/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/icAigPXOkrE_raw.srt b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/icAigPXOkrE_raw.srt
new file mode 100644
index 0000000000000000000000000000000000000000..c452e7ab1f7729b4d9d6ee5aa593ac938bfd936a
--- /dev/null
+++ b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/icAigPXOkrE_raw.srt
@@ -0,0 +1,1756 @@
+1
+00:00:01,570 --> 00:00:04,810
+بسم الله الرحمن الرحيم السلام عليكم ورحمة الله
+
+2
+00:00:04,810 --> 00:00:08,650
+وبركاته ان شاء الله رب العالمين اليوم هنحكي عن ال
+
+3
+00:00:08,650 --> 00:00:11,970
+mechanical ventilator محاضرة عملية كيف ممكن تشغل
+
+4
+00:00:11,970 --> 00:00:16,750
+mechanical ventilator لو أمرضك يحتاج mechanical
+
+5
+00:00:16,750 --> 00:00:22,190
+ventilation الجهاز اللي هنستخدمه trigger Savina
+
+6
+00:00:22,830 --> 00:00:29,430
+جهاز مشهور طبعا فيه منه موديلات أحدث ولكن الفكرة
+
+7
+00:00:29,430 --> 00:00:33,130
+في تشغيل جهاز تنقف الصناعة سواء في trigger سفينة
+
+8
+00:00:33,130 --> 00:00:36,370
+أو نوع تاني أو الموديل هذا من ال trigger أو النوع
+
+9
+00:00:36,370 --> 00:00:41,330
+الأحدث منه هي نفس الفكرة في كل الأجهزة نفس الحاجات
+
+10
+00:00:41,330 --> 00:00:44,310
+اللي احنا هنتعلمها و نفس ال parameters و ال
+
+11
+00:00:44,310 --> 00:00:48,490
+settings بنعملها مع كل الأجهزة خلينا نشوف واحدة
+
+12
+00:00:48,490 --> 00:00:54,640
+واحدة أيش الخطوات اللي احنا لازم نعملهابداية لازم
+
+13
+00:00:54,640 --> 00:00:59,800
+اتأكد ان الجهاز اللى هندي فيه كوريجايتد اتيوب
+
+14
+00:00:59,800 --> 00:01:04,620
+المناسبة اللى بدى اشبكها للمريض و لازم نعرف ان
+
+15
+00:01:04,620 --> 00:01:09,340
+الكوريجايتد اتيوب هذه اولا هي نوعين فى نوع مناسب
+
+16
+00:01:09,340 --> 00:01:14,880
+للادر وفى نوع حجمه اصغر للبيدياتريك تمام؟ تشوفين
+
+17
+00:01:14,880 --> 00:01:20,990
+كيف الادركيف الخمالة تبعته بينما ال pediatric كيف
+
+18
+00:01:20,990 --> 00:01:25,430
+ال diameter تبعه أقل فإحنا بنتعامل مع أدب فخلّينا
+
+19
+00:01:25,430 --> 00:01:28,510
+نشتغل على الأدب ال corrugated tube هنشوف إن ال
+
+20
+00:01:28,510 --> 00:01:31,810
+corrugated tube عبارة عن تبين بالتيهيو fy
+
+21
+00:01:31,810 --> 00:01:35,670
+connection هذه اللي بتنش بالفرندوتراكية للتيوب
+
+22
+00:01:35,670 --> 00:01:41,190
+وهنا في واحد فيهم إله water trap والتاني مافيش فيه
+
+23
+00:01:41,190 --> 00:01:46,380
+water trapبديهيًا اللي بده يطلع من المريض الـ
+
+24
+00:01:46,380 --> 00:01:48,940
+expiration هو اللي هيكون متصل في ال water trap
+
+25
+00:01:48,940 --> 00:01:53,160
+عشان ال expiration تبعناه بيكون فيه اللي هو بخار
+
+26
+00:01:53,160 --> 00:01:56,420
+ماء من ال expiration فبالتالي هذا ال trap عشان
+
+27
+00:01:56,420 --> 00:02:01,980
+يصيد هذه البخار اللي بيطلع و يمنعه من وصوله للجهاز
+
+28
+00:02:01,980 --> 00:02:06,100
+والتاني ال inspiratory اللي بيجي من الجهاز للمريض
+
+29
+00:02:06,100 --> 00:02:10,720
+لما مش هيكون فيه water trapالحاجة التانية اللي
+
+30
+00:02:10,720 --> 00:02:17,200
+لازم أشبك هدولة صح بناء على الإشارات اللي
+
+31
+00:02:17,200 --> 00:02:20,960
+على الجهاز نشوف أنه مدخل ال mechanical ventilator
+
+32
+00:02:20,960 --> 00:02:25,620
+يعني فيه سهم لبرا يعني هذا بيعطي للمريض النفس يبقى
+
+33
+00:02:25,620 --> 00:02:31,860
+هذا ال inspiration هنا بيرجع النفس للمريض يعنيهذا
+
+34
+00:02:31,860 --> 00:02:36,080
+ال expiration تمام؟ لازم نعرف ان عملية ال
+
+35
+00:02:36,080 --> 00:02:38,580
+breathing في ال mechanical ventilation هي عملية
+
+36
+00:02:38,580 --> 00:02:42,620
+active لأ اللي هو ال inspiration عملية active لكن
+
+37
+00:02:42,620 --> 00:02:47,860
+عودة النفس لمن المريض لجهازه عملية passive بتتم
+
+38
+00:02:47,860 --> 00:02:51,620
+نتيجة انه في high pressure في ال intra thoracic
+
+39
+00:02:51,620 --> 00:02:55,060
+pressure يعني بيكون عالي فبيرجع الهواء للماشين
+
+40
+00:02:55,060 --> 00:03:01,500
+passiveهذه هي الحاجة التانية يجب أن نتأكد أن ال
+
+41
+00:03:01,500 --> 00:03:05,940
+filters الخاص بجهاز و ال oxygen sensor هم مغيّرين
+
+42
+00:03:05,940 --> 00:03:08,380
+هذا اسمه oxygen sensor أو flow sensor
+
+43
+00:03:10,870 --> 00:03:16,170
+اللي هو ال filter بتغير عشان في ال expiration ال
+
+44
+00:03:16,170 --> 00:03:20,290
+filters شايفين كيف هذا علشان ال expiration طبعا
+
+45
+00:03:20,290 --> 00:03:25,530
+المريض ما يعني infection control ما تخشش هذه ال
+
+46
+00:03:25,530 --> 00:03:29,930
+filters على البكتيريا أو الحاجات اللي could make
+
+47
+00:03:29,930 --> 00:03:33,070
+infectionعلى الجهاز و تتغير من كل مريض و مريض
+
+48
+00:03:33,070 --> 00:03:36,950
+فاحنا بنحطه بالطريقة هاي و بنثبته لإن أي خلل فيه
+
+49
+00:03:36,950 --> 00:03:39,970
+لو كانت هذه عاملة هيك مش مثبتة بالطريقة هاي بيصير
+
+50
+00:03:39,970 --> 00:03:43,690
+فيه leakage و بالتالي بيصير فيه miss في ال tidal
+
+51
+00:03:43,690 --> 00:03:47,470
+volume اللي بنوديه للعيان هنا ال flow sensor هذا
+
+52
+00:03:47,470 --> 00:03:51,090
+برضه بتركب بالطريقة هذه زي ما احنا شايفين هيك
+
+53
+00:03:51,090 --> 00:03:55,810
+هياته سبت لاحظين كمان مرة هياته ها بيدخل هنا فيه
+
+54
+00:03:55,810 --> 00:03:56,550
+له مكان
+
+55
+00:04:02,870 --> 00:04:10,310
+الحاجتين هدولة عملناهم و اتأكدنا ان الجهاز اصلا
+
+56
+00:04:10,310 --> 00:04:16,670
+مشبوك في ال oxygen لان الجهاز يشتغل على ان يأخذ
+
+57
+00:04:16,670 --> 00:04:21,050
+كمية من ال oxygen بتدخل على حاجة اسمها air mixer
+
+58
+00:04:21,050 --> 00:04:25,070
+في الجهازفان air mixer زمان كانت الأجهزة ال air
+
+59
+00:04:25,070 --> 00:04:29,250
+mixer يكون برا و يكون فيه two tube واحد أكسجين و
+
+60
+00:04:29,250 --> 00:04:34,230
+واحد air بس هوا ال .. ال air mixer هيعمل فراكشن
+
+61
+00:04:34,230 --> 00:04:38,350
+تبع الأكسجين اللي أنا بديه يعني مثلا انا بدي 40%
+
+62
+00:04:38,960 --> 00:04:44,280
+يعني 40% أكسجين و 60% هوا لإن احنا عادي ما بنتنفسش
+
+63
+00:04:44,280 --> 00:04:49,660
+100% oxygen saturation احنا عادي بنتنفس 21% اللي
+
+64
+00:04:49,660 --> 00:04:53,820
+هو ال ambient air اللي بيحتوي 21% من ال oxygen
+
+65
+00:04:53,820 --> 00:04:58,700
+فلما بيكون في patient بكون أكيد ان ال demands تبقت
+
+66
+00:04:58,700 --> 00:05:04,220
+ال oxygen عنده أكتربنزود عن ال 21 اربعين خمسين
+
+67
+00:05:04,220 --> 00:05:07,040
+ستين سبعين في الامر جاسي ممكن نحطه على مية في
+
+68
+00:05:07,040 --> 00:05:11,360
+المية بس don't forget that oxygen is a drug so it
+
+69
+00:05:11,360 --> 00:05:15,500
+has a toxicity عشان هي ماحدش بيفضل ان ال oxygen
+
+70
+00:05:15,500 --> 00:05:20,580
+يظل على high concentration لمدة طويلة ولذلك ال
+
+71
+00:05:20,580 --> 00:05:26,000
+common انه يستخدم بين ال 40 ل 60% okay فأتأكد ان
+
+72
+00:05:26,000 --> 00:05:26,580
+انا مشغول
+
+73
+00:05:31,270 --> 00:05:39,070
+و اتاكد ان الكهربا تبقى مشبوكا بطريقة صح حياته
+
+74
+00:05:39,070 --> 00:05:45,130
+لإنه ممكن جدا ان يكون هناك مشكلة في البطارية لإنه
+
+75
+00:05:45,130 --> 00:05:48,670
+فيه بطارية اه لإنه ممكن جدا ان يكون هناك مشكلة
+
+76
+00:05:48,670 --> 00:05:51,890
+فلازم يكون مشبوك في الكهربا هذي ال connection و
+
+77
+00:05:51,890 --> 00:06:00,350
+اتاكد ان انا عندي ال corrugated tubeبالطريقة الصح
+
+78
+00:06:00,350 --> 00:06:05,310
+للمريض تمام فأحط هذا زي ما حكينا yes by rotary
+
+79
+00:06:05,310 --> 00:06:13,710
+دائما مخليش أغراض نزلين لتحت وهذا x by rotary جدا
+
+80
+00:06:13,710 --> 00:06:18,430
+يعني في حد اسمها اللي هو lung test ممكن أشبكها فيه
+
+81
+00:06:18,430 --> 00:06:23,270
+علشان لما نبدو يطلع كمية الهواء أبحث من خلالها ال
+
+82
+00:06:23,270 --> 00:06:28,030
+inflation و ال quality تبع الجهاز okayأنا شبكت كل
+
+83
+00:06:28,030 --> 00:06:33,030
+الأمور و الأن بدي أعمل switch on للجهاز بدي أشغل
+
+84
+00:06:33,030 --> 00:06:37,470
+الجهاز و سيب الجهاز يعمل preparation device
+
+85
+00:06:37,470 --> 00:06:42,530
+بيسموها preparation دائما يا جماعة نعرف أنه الذر
+
+86
+00:06:42,530 --> 00:06:49,100
+اللي موجود عشان التشغيل تبقى الجهاز يكون ورافي
+
+87
+00:06:49,100 --> 00:06:52,920
+الكثير أجهزة بيكون عليهم لوحة عشان مش إكسيدنتل أي
+
+88
+00:06:52,920 --> 00:06:57,480
+واحد خبط فيه اللي يصير له إيش off هذه حاجة الحاجة
+
+89
+00:06:57,480 --> 00:06:58,020
+التانية
+
+90
+00:07:07,560 --> 00:07:12,100
+المرحلة المفروض ان انا بسيب الجهاز يعمل ال
+
+91
+00:07:12,100 --> 00:07:16,860
+calibration اللي هو O2 sensor بعمل check لكل ال
+
+92
+00:07:16,860 --> 00:07:20,140
+device هذا ال device ال check اسيب الجهاز يعمل ال
+
+93
+00:07:20,140 --> 00:07:23,520
+device ال check تبقى وإلا انا ممكن ابدأ عملية
+
+94
+00:07:23,520 --> 00:07:26,660
+ventilation لمريض أثناء فيه مشكلة لأن لو في هو
+
+95
+00:07:26,660 --> 00:07:29,320
+عنده leakage في مكان معين لو في مشكلة في sensor
+
+96
+00:07:29,320 --> 00:07:32,730
+لمن في مشكلةفى filter هيحكي فورا إنه فيه leakage
+
+97
+00:07:32,730 --> 00:07:36,830
+في المكان الفلاني أو فيه مشكلة فيه ال sensor تمام؟
+
+98
+00:07:36,830 --> 00:07:43,270
+لما اتأكد ويحكي لي هو انه okay كل ال sensors مافيش
+
+99
+00:07:43,270 --> 00:07:47,760
+فيها مشكلة يعني هيكتب لي please waitفانا اتوقع انه
+
+100
+00:07:47,760 --> 00:07:55,000
+بيحصل الامور كويسة و بيحصل الهاتف يتشيك انه بيحصل
+
+101
+00:07:55,000 --> 00:08:01,140
+الامور كويسة و بيحصل الامور كويسة و بيحصل الامور
+
+102
+00:08:01,140 --> 00:08:01,820
+كويسة و بيحصل الامور كويسة و بيحصل الامور كويسة و
+
+103
+00:08:01,820 --> 00:08:03,120
+بيحصل الامور كويسة و بيحصل الامور كويسة و بيحصل
+
+104
+00:08:03,120 --> 00:08:03,580
+الامور كويسة و بيحصل الامور كويسة و بيحصل الامور
+
+105
+00:08:03,580 --> 00:08:03,580
+كويسة و بيحصل الامور كويسة و بيحصل الامور كويسة و
+
+106
+00:08:03,580 --> 00:08:05,200
+بيحصل الامور كويسة و بيحصل الامور كويسة و بيحصل
+
+107
+00:08:05,200 --> 00:08:10,760
+الامور كويسة و بيحصل الامور
+
+108
+00:08:10,760 --> 00:08:17,240
+كو بيصير يده كل مرة 500 غيرهم مش لو انا مثلا بتوجه
+
+109
+00:08:17,240 --> 00:08:21,660
+اعمل ال check هذا و بدأت اشغله بيصير يد المريض 500
+
+110
+00:08:21,660 --> 00:08:26,180
+لكن فعليا مثلا بيديله 400 و 50 لأنه فيه 50 هو
+
+111
+00:08:26,180 --> 00:08:29,840
+ماعملش standardization ان هدولا مش من ضمن ال
+
+112
+00:08:29,840 --> 00:08:34,130
+ventilation ف ال device ال check هذا مهمبعد ان
+
+113
+00:08:34,130 --> 00:08:38,770
+اقوم بتحقيق الهاتف اقوم بتحقيق الـ settings المهم
+
+114
+00:08:38,770 --> 00:08:45,790
+ان اقوم بتحقيق ال mood اللى اريد ان اشغل الهاتف
+
+115
+00:08:45,790 --> 00:08:48,450
+عليه اقبل كل حاجة اريد ان اعرف ان اريد ان اشغل
+
+116
+00:08:48,450 --> 00:08:52,650
+الهاتف على volume cycle او pressure control او
+
+117
+00:08:52,650 --> 00:08:55,850
+volume control او pressure control ثم اقوم بتحقيق
+
+118
+00:08:55,850 --> 00:09:00,290
+ال mood اللى اريد ان اشغل عليهبعدين طبعا لكل mood
+
+119
+00:09:00,290 --> 00:09:04,530
+فيه settings معينة ايش هو ال title volume ايش هو
+
+120
+00:09:04,530 --> 00:09:08,330
+ال rate اللي انا بدي اخلينا نشوف الحاجات هذه واحدة
+
+121
+00:09:08,330 --> 00:09:13,450
+واحدة يعني بداية تاني احنا عادة في الادار بنشغل
+
+122
+00:09:13,450 --> 00:09:18,070
+على volume control يعني بتكون وسيلة التحكم هي
+
+123
+00:09:18,070 --> 00:09:23,950
+عندنا فيالحجوم يعني انا بحجم الهواء اللى انا بدى
+
+124
+00:09:23,950 --> 00:09:27,230
+احطه للمريض اللى عن طريق تايدة ال volume هيكون
+
+125
+00:09:27,230 --> 00:09:31,650
+التحكم اذا اخترت انه volume control كيف هختار هذا
+
+126
+00:09:31,650 --> 00:09:40,930
+الكلام لو انا اخترت لاحظوا هنا في ال settings هو
+
+127
+00:09:40,930 --> 00:09:47,850
+هنا عشان انه مختار as amv already خلينا احنا نبطل
+
+128
+00:09:47,850 --> 00:09:48,690
+ال as amv
+
+129
+00:10:09,730 --> 00:10:14,550
+الجهاز مش راضي
+
+130
+00:10:14,550 --> 00:10:18,490
+يفصل على أي حال الاجهزة هدوء اللي عادة فيهم mood
+
+131
+00:10:18,490 --> 00:10:21,050
+اللي هو الـ synchronize intermittent من ذاته ال
+
+132
+00:10:21,050 --> 00:10:25,590
+ventilation SIMV هو ال common mood اللي احنا
+
+133
+00:10:25,590 --> 00:10:28,290
+بنستخدمه في ال adult
+
+134
+00:10:31,740 --> 00:10:37,540
+اسمه SIMV طبعاً في CMV و في ال ACMV ال CMV
+
+135
+00:10:37,540 --> 00:10:40,720
+Controlled Mandatory Ventilation بيستخدم عادة لما
+
+136
+00:10:40,720 --> 00:10:45,060
+يكون المريض completely under anesthesia أو
+
+137
+00:10:45,060 --> 00:10:47,660
+completely paralyzed حتى يكون ماخد مصر relaxed
+
+138
+00:10:47,660 --> 00:10:52,220
+فهذا ال mood عادة بيستخدم في العمليات لكن عادة
+
+139
+00:10:52,220 --> 00:10:56,160
+احنا في ال ICU او في ال emergency بنستخدم ال SIMV
+
+140
+00:10:56,160 --> 00:10:58,560
+Synchronized Intermittent Mandatory Ventilation
+
+141
+00:10:58,560 --> 00:11:03,280
+الهدف منالسينكرونيزيشن مع المريض انه يكون مهيئين
+
+142
+00:11:03,280 --> 00:11:08,340
+حالنا لانه نفطم المريض عن الجهاز في اي لحظة فعشان
+
+143
+00:11:08,340 --> 00:11:14,600
+هيك بنختار ال SIMV mode هو انا selected already
+
+144
+00:11:14,600 --> 00:11:19,160
+اجرب لو اختار مثلا سيباتة عشان بس بدي اشوف ايوة
+
+145
+00:11:19,160 --> 00:11:22,880
+انها هيشتغللو أردت أن أنخل على مودي تاني اسمه سي
+
+146
+00:11:22,880 --> 00:11:26,700
+باب هيته السي باب هذا pressure mode ال SIMV هنا
+
+147
+00:11:26,700 --> 00:11:30,080
+volume mode لكن السي باب هذا pressure mode طبعا
+
+148
+00:11:30,080 --> 00:11:34,600
+حاح كان ال SIMV وحاح كان السي باب كأهم moods كويس
+
+149
+00:11:34,600 --> 00:11:40,160
+نرجع على ال SIMV اخترت انا ال SIMV moodمازال انا
+
+150
+00:11:40,160 --> 00:11:45,700
+اخترت S,I,M,V زي ما حكينا ال mood هذا volume
+
+151
+00:11:45,700 --> 00:11:50,260
+control فبالتالي بدي احدد انا ال tidal volume عادة
+
+152
+00:11:50,260 --> 00:11:53,820
+ال tidal volume هاي الذر تبعه Vt مكتوب عليه بال
+
+153
+00:11:53,820 --> 00:11:59,680
+milliliter ل milliliter تمام؟ ال tidal volume اللي
+
+154
+00:11:59,680 --> 00:12:04,120
+بنحتاجه للمرضى عادة من ستة إلى تمانية milliliter
+
+155
+00:12:04,120 --> 00:12:08,080
+لكل كيلو جراملكل كيلو جرام من وزن المريض المقصود
+
+156
+00:12:08,080 --> 00:12:12,060
+فيه اللي هو ال ideal body weight يعني مش مريض وزنه
+
+157
+00:12:12,060 --> 00:12:16,000
+130 كيلو جرام بدأ أضرب في 130 كيلو جرام لأ بدأ
+
+158
+00:12:16,000 --> 00:12:19,000
+أشوف ال ideal body weight كيف ممكن أعرف ال ideal
+
+159
+00:12:19,000 --> 00:12:22,280
+body weight من ال height تبع المريض من طول المريض
+
+160
+00:12:22,280 --> 00:12:25,400
+في كتير أجهزة حتى إذا انت حاططله طول المريض حاططله
+
+161
+00:12:25,400 --> 00:12:30,300
+طول المريض 160 سنة هو على طول بيحسب ال ideal body
+
+162
+00:12:30,300 --> 00:12:37,530
+weightالأفضل هي أن تتوقع من طول المريض و تحسبه و
+
+163
+00:12:37,530 --> 00:12:41,790
+تضعه لأنه كما نفهم أن الـ lung cavity و الـ
+
+164
+00:12:41,790 --> 00:12:45,230
+thoracic cavity لن يتغير عند زيادة حجم أو وزن
+
+165
+00:12:45,230 --> 00:12:49,880
+المريضمن ستة ل تمانية مليلتر لكل كيلو جرام نعتبر
+
+166
+00:12:49,880 --> 00:12:54,240
+ان في عندى مريض وزنه سبعين كيلو مثلا سبعين كيلو
+
+167
+00:12:54,240 --> 00:12:58,740
+بدي أديله على تمانية سبعة بتمانية خمسمية و ستين
+
+168
+00:12:58,740 --> 00:13:02,240
+نفترض هاي خمسمية و بدي أعملها او ستين مثلا هاي
+
+169
+00:13:02,240 --> 00:13:05,980
+خمسمية لاحظ أنا عملت او ستين okay صار تمام بروح
+
+170
+00:13:05,980 --> 00:13:12,170
+بعملهOkay برس كمان مرة افترض بحطه ستمية بطلع ستمية
+
+171
+00:13:12,170 --> 00:13:16,790
+و بعدين okay صار ستمية بدي ارجع خمسمية بضغط عليها
+
+172
+00:13:16,790 --> 00:13:22,380
+و برجع خمسمية نفترضبساعة الخمسمية؟ okay هذا الـ
+
+173
+00:13:22,380 --> 00:13:25,360
+tidal volume عملنا أول حاجة طيب و غير ال tidal
+
+174
+00:13:25,360 --> 00:13:28,100
+volume إيش بالزمني؟ يعني أنا في ال tidal volume
+
+175
+00:13:28,100 --> 00:13:31,840
+إيش هو ال tidal volume؟ كمية الهواء اللي بده يديها
+
+176
+00:13:31,840 --> 00:13:36,980
+الجهاز للمريض كل نفس هذا ال tidal volume طيب إيش
+
+177
+00:13:36,980 --> 00:13:40,020
+كمان؟ بدي أحدد أكم نفس بدي أد للمريض في الدقيقة
+
+178
+00:13:40,020 --> 00:13:43,340
+الواحدة frequency إيش يعني ال respiratory rate؟ ال
+
+179
+00:13:43,340 --> 00:13:46,380
+respiratory rate نفترض إنه إحنا بدنا نديه و نطلع
+
+180
+00:13:46,380 --> 00:13:51,060
+حتى الجهاز عادة بيكتب كلمة Fيعني frequency breathe
+
+181
+00:13:51,060 --> 00:13:55,080
+per minute نفترض بدنا نديله 14 نفس في الدقيقة
+
+182
+00:13:55,080 --> 00:14:04,460
+بنوصلها بنعمل 14 enter تمام 14 نفس في الدقيقة okay
+
+183
+00:14:04,460 --> 00:14:08,640
+بعد هي كده إيش بدنا نحدد ال O2؟ concentration
+
+184
+00:14:10,770 --> 00:14:14,690
+الـ O2 concentration يعني الـ Oxygen fraction كده
+
+185
+00:14:14,690 --> 00:14:17,870
+بدنا نفترض ان احنا بدنا خمسين في المية Oxygen بص
+
+186
+00:14:17,870 --> 00:14:23,550
+عليها خمسين في المية Oxygen هي خمسينOkay, Enter
+
+187
+00:14:23,550 --> 00:14:27,350
+تمام إذا انصرت محددة تاعتها ال volume ال frequency
+
+188
+00:14:27,350 --> 00:14:31,170
+ال oxygen fraction طيب في حاجة اسمها ال
+
+189
+00:14:31,170 --> 00:14:34,570
+inspiratory time هأجل حاكي فيها شوية في عندي هنا
+
+190
+00:14:34,570 --> 00:14:39,210
+اللي هو ال pressure ال inspiratory pressure يعني
+
+191
+00:14:39,210 --> 00:14:45,150
+قداش بده يعمل inspiratory pressureعادة ما بكونش
+
+192
+00:14:45,150 --> 00:14:48,850
+يعني عاملينه اربعين او maximum maximum ما بكونش
+
+193
+00:14:48,850 --> 00:14:52,470
+اكتر من خمسين bar
+
+194
+00:14:54,410 --> 00:14:59,170
+لأنه اكتر من الخمسين بيصير فيه risk ل ال part
+
+195
+00:14:59,170 --> 00:15:04,330
+trauma فاحنا عادة ما بين الأربعين و الخمسين حسب
+
+196
+00:15:04,330 --> 00:15:08,610
+وضع المريض لما بيكون المريض stiff lung اه ممكن انه
+
+197
+00:15:08,610 --> 00:15:13,030
+احنا نحتاج نزود ال pressure شوية في هنا حاجة اسمها
+
+198
+00:15:13,030 --> 00:15:16,730
+ال beep و في هنا pressure above beep هاي اسمها
+
+199
+00:15:16,730 --> 00:15:19,670
+pressure above beep يعني قداش pressure فوق ال beep
+
+200
+00:15:19,670 --> 00:15:24,340
+ال beep ايش هوالـ Beep هو عبارة عن موض مصاحب لكل
+
+201
+00:15:24,340 --> 00:15:27,940
+موض يعني انا حاطط على اسئلة V وفيه Beep انا حاطط
+
+202
+00:15:27,940 --> 00:15:32,240
+على سي باب وفيه Beep ايش ال Beep اللي هو ال
+
+203
+00:15:32,240 --> 00:15:35,580
+positive end expiratory pressure ايش يعني؟ لاحظ
+
+204
+00:15:35,580 --> 00:15:38,520
+هلق معايا بالشاشة لو سمحت لحظة يا جماعة هاي ال
+
+205
+00:15:38,520 --> 00:15:44,240
+inspiration بيصير بعدين بيصير expiration مش هيك؟
+
+206
+00:15:44,240 --> 00:15:47,180
+تمام؟ اللي في النص هذه فترة ال pause اللي بتصير
+
+207
+00:15:47,180 --> 00:15:51,570
+فيها ايش؟احتباس الهوى داخل ال lung عشان تصبح عملية
+
+208
+00:15:51,570 --> 00:15:55,530
+ال gas exchange وانا بحب اؤكد على نقطة ماحدش عمره
+
+209
+00:15:55,530 --> 00:16:00,010
+يفكر ان جهاز تنافس صناعي هو lung صناعية لأ it's a
+
+210
+00:16:00,010 --> 00:16:05,030
+machine just breathed for you هي عبارة عن هو عبارة
+
+211
+00:16:05,030 --> 00:16:10,000
+عن machineجهاز يقوم بعملية التنفس لك عن طريق يعطيك
+
+212
+00:16:10,000 --> 00:16:13,620
+نفس و ياخد منك النفس او يسيبك تطلق النفس اللي
+
+213
+00:16:13,620 --> 00:16:17,820
+حكينا انه بيطلع passive لكن هو مابيعملش جهاز
+
+214
+00:16:17,820 --> 00:16:22,200
+exchange مابيعملش جهاز exchange ال lung هي اللي
+
+215
+00:16:22,200 --> 00:16:27,790
+لازم تعمل جهاز exchange هو اعطاك النفسالان النافس
+
+216
+00:16:27,790 --> 00:16:33,530
+اللي بده يعطيه كنا بنحكي في ال beep كويس؟ اه عملنا
+
+217
+00:16:33,530 --> 00:16:37,230
+inspiration قولنا ال beep انه positive end
+
+218
+00:16:37,230 --> 00:16:40,530
+expiratory pressure اه يعني بنحكي في ال expiratory
+
+219
+00:16:40,530 --> 00:16:45,010
+الخط هذا يعني انا لما بحكي في ال expiratory المريض
+
+220
+00:16:45,010 --> 00:16:50,490
+بده يكون عنده نهاية مجبه لل expiration ايش يعني؟
+
+221
+00:16:50,490 --> 00:16:56,670
+يعني مابدوش ينزل لتحت بص هنا السفرفوق السفر موجب،
+
+222
+00:16:56,670 --> 00:17:00,530
+مش هيك؟ تحت من السفر، بتكون السالب، طب إيش يعني؟
+
+223
+00:17:00,530 --> 00:17:06,220
+يعني المريض أخد النفطبدا يطلق في النفس احنا في
+
+224
+00:17:06,220 --> 00:17:10,580
+الطبيعي لما بنبدأ نطلق بالنفس بنضل نطلق في النفس
+
+225
+00:17:10,580 --> 00:17:15,260
+نطلق في النفس لما بيصير الضغط داخل ال lung in a
+
+226
+00:17:15,260 --> 00:17:20,380
+thoracic pressure اقل من ضغط الهواء الجوي يعني
+
+227
+00:17:20,380 --> 00:17:24,780
+سالب يعني التعادل مع ضغط الهواء الجوي هي نقطة
+
+228
+00:17:24,780 --> 00:17:30,210
+الصفرلكن إحنا في الطبيعي لما بنعمل expiration ..
+
+229
+00:17:30,210 --> 00:17:34,410
+بنضلنا نعمل expiration لغاية ما يصير الضغط إنا
+
+230
+00:17:34,410 --> 00:17:39,250
+negative حده بيخلي easy إنه النفس اللي بعده ينطق
+
+231
+00:17:39,250 --> 00:17:43,970
+للضغط من ال .. أو الهوامن الضغط العالى للضغط اللى
+
+232
+00:17:43,970 --> 00:17:48,970
+صار لنا أقل تمام فاحنا بروح نعمل إيش على طول بيجي
+
+233
+00:17:48,970 --> 00:17:52,490
+بتصرى بالهوى و بنعمل inspiration تانى و بنضلنا
+
+234
+00:17:52,490 --> 00:17:56,310
+ناخد لما يصير الضغط زى ما حكينا positive الضغط
+
+235
+00:17:56,310 --> 00:18:00,350
+داخلنا أكتر من الهوى جهة ليش علشان نكون قادرين إنه
+
+236
+00:18:00,350 --> 00:18:05,570
+إيشانطلع هذا اللي هو في ال expiration الان هذا نفس
+
+237
+00:18:05,570 --> 00:18:09,850
+الكلام بده يصير عن طريق الجهاز ولكن الفرق صغير انه
+
+238
+00:18:09,850 --> 00:18:13,870
+في ال expiration لما أنا أخدت النفس بشبط أطلق
+
+239
+00:18:14,970 --> 00:18:19,050
+مابدوش اظن اطلق لما اخش للثالث لأ قبل ما اخش
+
+240
+00:18:19,050 --> 00:18:22,750
+للثالث لسه انا في الموجة فوق الزفر كمان بدي ارجع
+
+241
+00:18:22,750 --> 00:18:27,390
+يبدأ نفس اشده ايه؟ هذا هو ال bb ايش يعني؟ يعني ال
+
+242
+00:18:27,390 --> 00:18:31,330
+bb هي كمية الهواء اللي بيبقى residual في ال lung
+
+243
+00:18:31,330 --> 00:18:37,210
+بعد انهاء ال expiration يبقى كمية الهواء بحيث انها
+
+244
+00:18:37,210 --> 00:18:40,010
+تبقى residual محبوسة وعملة شوية inflation في ال
+
+245
+00:18:40,010 --> 00:18:44,470
+lung بحيث انه يجي النفس اللي بعدها فيكونأسهل على
+
+246
+00:18:44,470 --> 00:18:49,190
+المريض ان ياخدوا dial up لانج شوية inflation كويس
+
+247
+00:18:49,190 --> 00:18:53,290
+علشان هيك لو نقرب الشاشة لو اسمح شوف لو ال beep
+
+248
+00:18:53,290 --> 00:18:57,150
+مثلا عملناها عشرة طلع كيف ال beep لو عملناها عشرة
+
+249
+00:18:57,150 --> 00:19:00,510
+عشان يكون واضح مثلا شوف الخط هذا اللي بحكيلكوا
+
+250
+00:19:00,510 --> 00:19:05,710
+عليه قداش ارتفع شايفين قده صار غليظه فوق السفر
+
+251
+00:19:05,710 --> 00:19:10,270
+تمام خد بالك لو انا بدي أنزل ال beep مثلا ارجعه
+
+252
+00:19:12,270 --> 00:19:17,410
+خلّيه 2 عشان يكون الفرق واضح لاحظوا كيف صار ال
+
+253
+00:19:17,410 --> 00:19:21,350
+residual هذا هو ال volume of air اللي ضايق ال
+
+254
+00:19:21,350 --> 00:19:25,970
+remain في ال lung بعد ال expiration تمام؟ عشان هيك
+
+255
+00:19:25,970 --> 00:19:28,830
+كل هي تكون ربما صرتوا عارفين ان ال beef هذا كتير
+
+256
+00:19:28,830 --> 00:19:32,650
+مهم في حالات ان انا بدي اعمل inflation اكتر
+
+257
+00:19:32,650 --> 00:19:35,830
+للalveoli مثلا في المرضى ل chronic obstructive
+
+258
+00:19:35,830 --> 00:19:39,490
+pulmonary disease COPD لما تكون الalveoli عندهم
+
+259
+00:19:39,490 --> 00:19:43,640
+obstructive اسمهبالمونة الرزيسية انا بتعملها شوية
+
+260
+00:19:43,640 --> 00:19:47,080
+اش افتح ال sack تبعها تمام او في البلمونة القديمة
+
+261
+00:19:47,080 --> 00:19:50,100
+واحد عنده البلمونة القديمة و ال sack تبع ال ال
+
+262
+00:19:50,100 --> 00:19:53,880
+alveoli مليان في ال fluid فاحنا بدنا نوسع ال
+
+263
+00:19:53,880 --> 00:19:57,200
+diameter تبعتها علشان يبدأ يصير فيها gas exchange
+
+264
+00:19:57,200 --> 00:20:01,360
+فبنزود ال b بقالت الناس دول بيحتاجوا ال b أكتر من
+
+265
+00:20:01,360 --> 00:20:05,630
+خمسةهي على تمانية تسعة up to ten كويس اذا هذا
+
+266
+00:20:05,630 --> 00:20:08,690
+الفيديو عرفناه هذا معنى مع كل mood مع ال SINV مع
+
+267
+00:20:08,690 --> 00:20:16,340
+ال CMV مع ال ACMV مع ال CPAPنشوف إيش شرحنا ال beep
+
+268
+00:20:16,340 --> 00:20:18,900
+و pressure above beep لإن إذا حط أنا ال beep خمسة
+
+269
+00:20:18,900 --> 00:20:22,580
+حيكون ال pressure above beep ال double okay و ال
+
+270
+00:20:22,580 --> 00:20:24,920
+beep حكينا عنه نضايق الحاجة اسمها ال inspiratory
+
+271
+00:20:24,920 --> 00:20:30,560
+time ال inspiratory time هذه هي في الحقيقة بتستخدم
+
+272
+00:20:30,560 --> 00:20:34,600
+أكتر في ال pressure mood أو في ال pressure control
+
+273
+00:20:34,600 --> 00:20:41,060
+لما بكون أنا حاطط للمريض rate مثلا 14 للحساب خلينا
+
+274
+00:20:41,060 --> 00:20:49,410
+نعمل 10 عشانبتفهم على طول أسرع عشرة
+
+275
+00:20:52,170 --> 00:20:55,690
+الان عشرة طيب العشرة التنفسات هاد و لو ممكن الجهاز
+
+276
+00:20:55,690 --> 00:20:58,950
+مابفهمش لإن أنا مش هتطلع inspiratory time فاروح في
+
+277
+00:20:58,950 --> 00:21:03,010
+أول جزء من الدقيقة يدخل العشر تنفسات نفس اتنين
+
+278
+00:21:03,010 --> 00:21:06,910
+تلاتة اربعة في عشر ثواني و يخلص كل نفس بثاني مثلا
+
+279
+00:21:06,910 --> 00:21:11,730
+طيب و بقية الدقيقة مشكلة فعشانك انا انازم انظم
+
+280
+00:21:11,730 --> 00:21:15,250
+اعمل control عملية النفس هاد عن طريق احجز ان ال
+
+281
+00:21:15,250 --> 00:21:20,200
+inspiratory timeيتم بوقت معين و قلت لازم يكون فيه
+
+282
+00:21:20,200 --> 00:21:25,060
+وقت لـ E الـ expiratory time فعشان هيك ربنا احنا
+
+283
+00:21:25,060 --> 00:21:28,660
+عملنا IE ratio inspiratory expiratory time ratio
+
+284
+00:21:28,660 --> 00:21:32,480
+فيه ratio لـ expiration و expiration اللي هو واحد
+
+285
+00:21:32,480 --> 00:21:37,340
+لاتنين يعني احنا بناخد النفس و بنطلق نفس في بعض
+
+286
+00:21:37,340 --> 00:21:41,970
+عملية الاشالزمن اللي عملنا فيه inspiration يعني
+
+287
+00:21:41,970 --> 00:21:45,930
+إذا أنا أخدت one second عشان أعمل inspiration
+
+288
+00:21:45,930 --> 00:21:49,150
+بطلّق النفس في two seconds وإذا أخدت two second
+
+289
+00:21:49,150 --> 00:21:53,290
+عشان أعمل inspiration بطلّق النفس ال inspiration
+
+290
+00:21:53,290 --> 00:21:57,770
+في four seconds فالضائف two ضائفهم اربع اربع
+
+291
+00:21:57,770 --> 00:22:01,790
+seconds اه إذا ال one breath كلهيته inspiration و
+
+292
+00:22:01,790 --> 00:22:07,530
+ال inspiration أخد منيعشرة تنفسات تقريبا تقريبا
+
+293
+00:22:07,530 --> 00:22:12,190
+تقريبا تقريبا
+
+294
+00:22:12,190 --> 00:22:17,910
+تقريبا تقريبا تقريبا تقريبا تقريبا تقريبا تقريبا
+
+295
+00:22:17,910 --> 00:22:17,930
+تقريبا تقريبا تقريبا تقريبا تقريبا تقريبا تقريبا
+
+296
+00:22:17,930 --> 00:22:17,930
+تقريبا تقريبا تقريبا تقريبا تقريبا تقريبا تقريبا
+
+297
+00:22:17,930 --> 00:22:17,930
+تقريبا تقريبا تقريبا تقريبا تقريبا تقريبا تقريبا
+
+298
+00:22:17,930 --> 00:22:17,930
+تقريبا تقريبا تقريبا تقريبا تقريبا تقريبا تقريبا
+
+299
+00:22:17,930 --> 00:22:24,550
+تقريبا تقريبا تقريبا تقريبا تقعشر تنفسيات كل نفس
+
+300
+00:22:24,550 --> 00:22:31,230
+.. six .. كل نفس six seconds عشر تنفسيات هي ستين
+
+301
+00:22:31,230 --> 00:22:34,050
+تمانية بالنسبة لراتوير تايم .. بالنسبة لراتوير
+
+302
+00:22:34,050 --> 00:22:37,670
+تايم كل العشر تنفسيات بالنسبة لراتوير تايم تبعهم
+
+303
+00:22:37,670 --> 00:22:43,370
+أكام؟ عشرين ثانية من الستين هدولة عشرة اتنين في
+
+304
+00:22:43,370 --> 00:22:47,870
+عشرة عشرين ثانية مش هيك؟ اذا عشرين ثانية على ال
+
+305
+00:22:47,870 --> 00:22:52,480
+rate ال rate اللي هو عندي عشرة يبقى كل نفسسنتين زي
+
+306
+00:22:52,480 --> 00:22:55,600
+ما حكينا اذا انا بروح بعمل ال inspiratory time هى
+
+307
+00:22:55,600 --> 00:23:01,460
+نقل كم؟ سنتين لاحظ عد انا بمجرد ما اعمل ال
+
+308
+00:23:01,460 --> 00:23:07,480
+inspiratory time سنتين ال IE ratio كم صار؟1 إلى 2
+
+309
+00:23:07,480 --> 00:23:10,520
+انا شرحت هذه عشان انتوا تفهموها لكن مش مطلوب منك
+
+310
+00:23:10,520 --> 00:23:14,060
+ان انت تقعد تحسب لو انا بدأ افترض انه حاطط ال rate
+
+311
+00:23:14,060 --> 00:23:18,180
+على عشرة هياته و بدأ اروح اعمل ال inspiratory time
+
+312
+00:23:18,180 --> 00:23:22,300
+بدأ اطلع على اي ratio لما يصير 1 إلى 2 ها 1 إلى 2
+
+313
+00:23:22,300 --> 00:23:29,470
+غير غير لما يصير 1 إلى 2 ها هاهيو صار واحد لاتنين
+
+314
+00:23:29,470 --> 00:23:35,490
+طلع صار ثانيتين لحاله لأن هو عارف ان ال IE واحد
+
+315
+00:23:35,490 --> 00:23:38,950
+لاتنين بمجرد ما انت بتعمله ال inspiratory
+
+316
+00:23:38,950 --> 00:23:41,850
+expiratory ratio واحد إلى اتنين بكون ال
+
+317
+00:23:41,850 --> 00:23:44,630
+inspiratory time two seconds يعني ال two seconds
+
+318
+00:23:44,630 --> 00:23:48,250
+في عشرة يعني ال inspiratory time في الدقيقة كلها
+
+319
+00:23:48,470 --> 00:23:52,690
+عشرين ثانية وبالتالي اربعين ثانية for expiration
+
+320
+00:23:52,690 --> 00:23:56,250
+هاي عملنا ال tidal volume عملنا ال inspiratory
+
+321
+00:23:56,250 --> 00:23:59,490
+time عملنا ال rate عملنا ال oxygen fraction حطينا
+
+322
+00:23:59,490 --> 00:24:02,610
+ال pressure عملنا ال pressure above V وحطينا ال
+
+323
+00:24:02,610 --> 00:24:05,930
+beep طيب إيش في حاجات تانية مهمة قبل ما أحكي في
+
+324
+00:24:05,930 --> 00:24:08,130
+الحاجات التانية المهمة بدي أحكي عن موضع تاني اسمه
+
+325
+00:24:08,130 --> 00:24:11,750
+سي باب لو أنا روحت دقات دعسة طويلة على السي باب
+
+326
+00:24:13,020 --> 00:24:17,600
+بقلب الجهاز لسباب مود السيباب مود هذا هو الويمينج
+
+327
+00:24:17,600 --> 00:24:22,440
+مود يعني المريض صار عنده قدرة على التنفس وانا بده
+
+328
+00:24:22,440 --> 00:24:26,500
+احطه على التنفس لحاله و بده احطه على السيباب
+
+329
+00:24:26,500 --> 00:24:29,220
+السيباب بمميزته انه لا يقطع زي ما انتوا شايفين
+
+330
+00:24:29,220 --> 00:24:34,040
+تايدا ال volumeمافيش ولا rate يعني المريض المفروض
+
+331
+00:24:34,040 --> 00:24:37,240
+انه بده يتحكم في هذا ال volume لحاله المريض بده
+
+332
+00:24:37,240 --> 00:24:40,520
+يتحكم في عدد مرات التنفس في الدقيقة لحاله طب انا
+
+333
+00:24:40,520 --> 00:24:46,780
+اش مساويله انا بس يديله بصها بيب لذلك ال سيباب هو
+
+334
+00:24:46,780 --> 00:24:51,340
+عبارة عن continuous beep اه لذلك ايش ايش ايش ال
+
+335
+00:24:51,340 --> 00:24:55,060
+beep كان positive end expiratory pressure طب ايش
+
+336
+00:24:55,060 --> 00:24:59,820
+هو السيبابهو continuous positive airway pressure
+
+337
+00:24:59,820 --> 00:25:03,560
+هو continuous positive airway pressure إذا هو
+
+338
+00:25:03,560 --> 00:25:06,800
+عبارة عن continuous بيب إذا إيه؟ إيش يعني
+
+339
+00:25:06,800 --> 00:25:10,140
+continuous بيب؟ يعني continuous residual volume
+
+340
+00:25:10,140 --> 00:25:14,520
+يضله في ال lung بحيث إن المرضي يستطيع أن يعمل
+
+341
+00:25:14,520 --> 00:25:20,070
+عملية النفس spontaneously لحالهكويس في كل مرة
+
+342
+00:25:20,070 --> 00:25:22,750
+ويتحكم في الـ tidal volume وفي ال rate المناسب لما
+
+343
+00:25:22,750 --> 00:25:25,910
+بيصير fit for extubation طب إيش في حاجات تانية
+
+344
+00:25:25,910 --> 00:25:31,890
+ممكن نعرفها عن الجهاز لاحظ هنا في زر ل ال
+
+345
+00:25:31,890 --> 00:25:34,910
+nebulizer يعني لو أنا بدي أجي أعمل للمريض إلا على
+
+346
+00:25:34,910 --> 00:25:39,010
+ال ventilator وإله endotracheal tube نبوليزر
+
+347
+00:25:39,010 --> 00:25:43,930
+تبخيرة فنتولين ديكورد whatever إيش اللي بيصير؟ أه
+
+348
+00:25:43,930 --> 00:25:48,630
+المرة هذه هروح على ال inspiration يعني هناهيكون
+
+349
+00:25:48,630 --> 00:25:55,670
+فيه adapter هه تبع النبيولايزر بنشبك فيه وبكون ال
+
+350
+00:25:55,670 --> 00:25:59,810
+adapter هه وبكون فيه connection يعني تيوب وبتيجي
+
+351
+00:25:59,810 --> 00:26:09,790
+على زر تبع النبيولايزر هى هى شايفين هذا بنشبك فيه
+
+352
+00:26:09,790 --> 00:26:13,370
+نفس ال oxygen ال tube هياته هي عليه علامة تبخيرة
+
+353
+00:26:13,370 --> 00:26:19,170
+وبتروح وانت ضغط هناعلى النبلازر بيصير ايش؟ طلع هذا
+
+354
+00:26:19,170 --> 00:26:23,850
+الذرب ده يعمل هوا عشان فيه .. لو في حد تتحرك لو في
+
+355
+00:26:23,850 --> 00:26:28,330
+ورقة ولا حاجة هيكون
+
+356
+00:26:28,330 --> 00:26:34,570
+واضح جدا انه ايش بطلق هوا مافيش معنى حاجة كاملة لأ
+
+357
+00:26:34,570 --> 00:26:40,290
+ما .. هذا مش .. okay no problem okay هذه واحدة طيب
+
+358
+00:26:40,290 --> 00:26:47,190
+هذه واحدةالحاجة التانية O2 Suction إيش يعني؟ يعني
+
+359
+00:26:47,190 --> 00:26:50,690
+لما أنا بدي أعمل suction لمريد بدي أديله .. أرجع
+
+360
+00:26:50,690 --> 00:26:54,670
+على ASAMV بدي
+
+361
+00:26:54,670 --> 00:26:59,750
+أديله suction عشان أعمله .. بدي أديله oxygen عشان
+
+362
+00:26:59,750 --> 00:27:02,150
+أعمله suction فلازم أعمله حاجة نسميها hyper
+
+363
+00:27:02,150 --> 00:27:05,790
+oxygenation so hyper oxygenation أنا بدي oxygen
+
+364
+00:27:05,790 --> 00:27:08,530
+fraction one hundred percent مية في المية بمجرد
+
+365
+00:27:08,530 --> 00:27:12,710
+بقص على O2 suction بروح بيد العيال oxygen
+
+366
+00:27:22,670 --> 00:27:27,370
+مجرد ما اضغط على O2 suction بروح بيد المريض اكسجين
+
+367
+00:27:27,370 --> 00:27:28,550
+100%
+
+368
+00:27:31,500 --> 00:27:42,920
+فقط لـ 3 دقيقة لان انا باعمل تفصيل للمريض و بعد
+
+369
+00:27:42,920 --> 00:27:49,360
+تفصيله باعمل شركة فنتليتر و ادارة اكسجين تبع
+
+370
+00:27:49,360 --> 00:27:53,580
+التفصيل الهدف منه ان اعمل
+
+371
+00:27:59,380 --> 00:28:04,380
+إذا كنت أريد أن أوقف النفس لسبب أنني أشتغل أو أشرح
+
+372
+00:28:04,380 --> 00:28:13,970
+أو أدغط عليها، فهذا يوقف النفسموقف الصحيح .. موقف
+
+373
+00:28:13,970 --> 00:28:20,830
+الصحيح .. موقف
+
+374
+00:28:20,830 --> 00:28:21,810
+الصحيح .. موقف الصحيح .. موقف الصحيح .. موقف
+
+375
+00:28:21,810 --> 00:28:22,270
+الصحيح .. موقف الصحيح .. موقف الصحيح .. موقف
+
+376
+00:28:22,270 --> 00:28:22,270
+الصحيح .. موقف الصحيح .. موقف الصحيح .. موقف
+
+377
+00:28:22,270 --> 00:28:22,290
+الصحيح .. موقف الصحيح .. موقف الصحيح .. موقف
+
+378
+00:28:22,290 --> 00:28:22,410
+الصحيح .. موقف الصحيح .. موقف الصحيح .. موقف
+
+379
+00:28:22,410 --> 00:28:22,410
+الصحيح .. موقف الصحيح .. موقف الصحيح .. موقف
+
+380
+00:28:22,410 --> 00:28:22,410
+الصحيح .. موقف الصحيح .. موقف الصحيح .. موقف
+
+381
+00:28:22,410 --> 00:28:26,370
+الصحيح .. موقف الصحيح .. موقف الصحيح .. موقف
+
+382
+00:28:26,370 --> 00:28:34,810
+الصحيح .. موقف الصحيح ..طيب هنا في ال الارم الارم
+
+383
+00:28:34,810 --> 00:28:39,090
+off وفي الارم الارم الارم الارم الارم الارم الارم
+
+384
+00:28:39,090 --> 00:28:43,510
+الارم الارم الارم الارم الارم الارم الارم الارم
+
+385
+00:28:43,510 --> 00:28:47,050
+الارم الارم الارم الارم الارم الارم الارم الارم
+
+386
+00:28:47,050 --> 00:28:47,490
+الارم الارم الارم الارم الارم الارم الارم الارم
+
+387
+00:28:47,490 --> 00:28:47,490
+الارم الارم الارم الارم الارم الارم الارم الارم
+
+388
+00:28:47,490 --> 00:28:47,590
+الارم الارم الارم الارم الارم الارم الارم الارم
+
+389
+00:28:47,590 --> 00:28:47,590
+الارم الارم الارم الارم الارم الارم الارم الارم
+
+390
+00:28:47,590 --> 00:28:48,110
+الارم الارم الارم الارم الارم الارم الارم الارم
+
+391
+00:28:48,110 --> 00:28:50,450
+الارم الارم الارم الارم الارم الارم الارالزر تبع
+
+392
+00:28:50,450 --> 00:28:55,410
+ال setting هذا بتديلي قداش بدك ال flow تبع ال ACC
+
+393
+00:28:55,410 --> 00:28:59,930
+يعني المعدل انسياب الهواء اللي ماشي يعني سرعة
+
+394
+00:28:59,930 --> 00:29:03,670
+انسياب الهواء قداش بدك هيكون عادة ما بين التلاتين
+
+395
+00:29:03,670 --> 00:29:09,460
+لاربعينبتلاحظ انه بال .. بال millibar بر إيش؟ ب
+
+396
+00:29:09,460 --> 00:29:14,500
+second تمام؟ بعدين ال trigger .. ايش ال trigger؟
+
+397
+00:29:14,500 --> 00:29:19,960
+ال trigger sensitivity هي حساسية الجهاز في المريض
+
+398
+00:29:19,960 --> 00:29:23,680
+عشان يعرف مين هو انشط ال breathing مين هيبدأ عملية
+
+399
+00:29:23,680 --> 00:29:27,480
+النفس كويس كل ما بزود ال trigger يعني بمنع انه ال
+
+400
+00:29:27,480 --> 00:29:33,350
+جهاز يحس في المريض كل ما ..بخلّي ال trigger واطي
+
+401
+00:29:33,350 --> 00:29:37,290
+يعني واحد اتنين تلاتة اه معناه انه حس في المريض و
+
+402
+00:29:37,290 --> 00:29:42,610
+خلّي فيه index sensitivity بحيث انه المريض يعني
+
+403
+00:29:42,610 --> 00:29:45,750
+شارك في عملية النفس و لو بدل بده يعمل initiation
+
+404
+00:29:45,750 --> 00:29:50,390
+الجهاز المفروض انه يعمل stop في حد هنا VT Apnea
+
+405
+00:29:50,390 --> 00:29:56,750
+ايش يعني؟VT أبنية و F أبنية ايش يعني F يعني
+
+406
+00:29:56,750 --> 00:30:00,110
+frequency يعني ال rate تبع الأبنية و VT يعني ال
+
+407
+00:30:00,110 --> 00:30:03,610
+tidal volume تبع الأبنية اه هذه ميزة جدا مهمة
+
+408
+00:30:03,610 --> 00:30:06,510
+قاملونها في الجهاز لو انا فرضا حاطط مريض على سي
+
+409
+00:30:06,510 --> 00:30:11,110
+باب تمام السي باب حكينا مش هيعطي tidal volume و مش
+
+410
+00:30:11,110 --> 00:30:17,650
+هيعطي respiratory rate كويس و فجأة المريض اللي لدي
+
+411
+00:30:17,650 --> 00:30:22,850
+بطل ياخد tidal volume و بطل ياخد rateصار exhausted
+
+412
+00:30:22,850 --> 00:30:28,250
+وما مش قادر ان ياخد التنفسات لحاله فورا راح الجهاز
+
+413
+00:30:28,250 --> 00:30:32,310
+يقلب على حاجة اسمها ابنيا mood او ابنيا
+
+414
+00:30:32,310 --> 00:30:36,090
+ventilation وحيث يبدأ يد للمريض ال tidal volume
+
+415
+00:30:36,090 --> 00:30:39,610
+اللي انا حاطه هنا ده احترازيا و ال frequency اللي
+
+416
+00:30:39,610 --> 00:30:45,250
+انا حاطه هنا حتى لو المريض طلععلى سي باب يعني حتى
+
+417
+00:30:45,250 --> 00:30:49,030
+لو هو على سي باب بالشكل هذا روح على alarm reset
+
+418
+00:30:49,030 --> 00:30:51,890
+هتلاقي انه باخد الطيب ال volume و ال rate هدوله
+
+419
+00:30:51,890 --> 00:30:54,870
+رغم انه على سي باب وهنا مابياخدش حاجة هذا في حال
+
+420
+00:30:54,870 --> 00:30:59,490
+ان المريض ايش مابيتنفسش هذا أهمية عشان ذلك لو انا
+
+421
+00:30:59,490 --> 00:31:02,390
+روحت .. وين .. وين مشكلته هذا؟ لو انا روحت يا
+
+422
+00:31:02,390 --> 00:31:06,570
+جماعة مريضي محطوله سي باب وعملتله disconnection
+
+423
+00:31:06,570 --> 00:31:10,170
+عشان اعمله مثلا suction الجهاز ايش باعتبر ان
+
+424
+00:31:10,170 --> 00:31:11,430
+المريض بطر يتنفس
+
+425
+00:31:14,000 --> 00:31:17,940
+أنا مش عارف و ماعملتش alarm reset بروح برجع بشبك
+
+426
+00:31:17,940 --> 00:31:20,920
+المريض بتكون عملية ال winning اللي أنا بعملها
+
+427
+00:31:20,920 --> 00:31:25,040
+فاشلة لإيش؟ لأن المريض صار على اسقى IMV و تايدا ال
+
+428
+00:31:25,040 --> 00:31:28,360
+volume و rate بس أنا موجود جاني واضح أن هو على C
+
+429
+00:31:28,360 --> 00:31:35,120
+-band تمام؟ وهذه مشكلة كبيرة بتكون يعني أنا حاولت
+
+430
+00:31:35,120 --> 00:31:41,060
+أن أشرح بس الحاجات المتعلقة في الجهازفي حاجات كتير
+
+431
+00:31:41,060 --> 00:31:46,320
+مهمة في مراقبة المريض هو على جهاز التناقص الصناعي
+
+432
+00:31:46,320 --> 00:31:49,500
+كيف لازم أراقب ال saturation كيف لازم أراقب ال
+
+433
+00:31:49,500 --> 00:31:54,340
+blood gas analysis عملية waning أو طروقها لكن ال
+
+434
+00:31:54,340 --> 00:31:58,790
+session هذا أو الفيديو هذا كانمخصص علينا انه بيحكي
+
+435
+00:31:58,790 --> 00:32:02,390
+بس على ال settings كيف انا لازم لو كان في عندي
+
+436
+00:32:02,390 --> 00:32:04,890
+جهاز تنافس صناعي ايش الحاجات اللي بدي اعملها
+
+437
+00:32:04,890 --> 00:32:09,430
+settings و بدي اضبطها علشان اشغلها او اشغل مريض
+
+438
+00:32:09,430 --> 00:32:13,330
+على جهاز تنافس الصناعي شكرا جزيلا لكم و يعطيكم
+
+439
+00:32:13,330 --> 00:32:13,530
+العافية
+
diff --git a/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/u1q_2vGOzh0.srt b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/u1q_2vGOzh0.srt
new file mode 100644
index 0000000000000000000000000000000000000000..983114a30a55e786a89b5a99fe21605033440f38
--- /dev/null
+++ b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/u1q_2vGOzh0.srt
@@ -0,0 +1,1682 @@
+1
+00:00:02,140 --> 00:00:05,180
+بسم الله الرحمن الرحيم بسم الله والصلاة والسلام على
+
+2
+00:00:05,180 --> 00:00:07,760
+رسول الله، اليوم إن شاء الله محاضرتنا عن الـ
+
+3
+00:00:07,760 --> 00:00:12,600
+mechanical ventilator. يعني بداية mechanical
+
+4
+00:00:12,600 --> 00:00:16,120
+ventilation. إيش mechanical ventilation؟ باختصار
+
+5
+00:00:16,120 --> 00:00:19,880
+نحكي mechanical ventilator is a machine that can
+
+6
+00:00:19,880 --> 00:00:24,970
+breathe for you. بس إذا الـ «ميكانيكال فنتيلاتيون»
+
+7
+00:00:24,970 --> 00:00:29,710
+هي عبارة عن جهاز ميكانيكي يخفف لك هذه وظيفتها
+
+8
+00:00:29,710 --> 00:00:34,870
+الـ «فنتيلاتيون» هو دعم حياة مدعوم، دعم حياة
+
+9
+00:00:34,870 --> 00:00:37,110
+مدعوم، دعم حياة، دعم حياة، دعم
+
+10
+00:00:37,110 --> 00:00:37,310
+حياة، دعم حياة، دعم حياة، دعم
+
+11
+00:00:37,310 --> 00:00:37,590
+حياة، دعم حياة، دعم حياة، دعم حياة، دعم
+
+12
+00:00:37,590 --> 00:00:40,770
+حياة، دعم حياة، دعم حياة، دعم حياة، دعم حياة، دعم
+
+13
+00:00:40,770 --> 00:00:49,530
+حياة، دعم
+
+14
+00:00:50,070 --> 00:00:53,130
+اللي بيصير فيه good oxygenation للدم، بيرجع
+
+15
+00:00:53,130 --> 00:00:57,850
+للقلب، Oxygenated blood، القلب بيعمله، بيعمله
+
+16
+00:00:57,850 --> 00:01:02,370
+فبـ
+
+17
+00:01:02,370 --> 00:01:06,410
+ما حكينا، القلب بيعمله pumping وبالتالي بيصير
+
+18
+00:01:06,410 --> 00:01:10,650
+فيه reperfusion لـ oxygenated blood. إذا
+
+19
+00:01:10,650 --> 00:01:18,250
+الـ mechanical ventilator cannot work the lung's work
+
+20
+00:01:18,250 --> 00:01:25,890
+at all. الشغل الميكانيكي يتنفس فقط لك، ولكن مش ممكن
+
+21
+00:01:25,890 --> 00:01:31,150
+يشتغل شغل الرئة نفسها. So the basic effects of
+
+22
+00:01:31,150 --> 00:01:34,070
+mechanical ventilation are improved oxygenation
+
+23
+00:01:34,070 --> 00:01:38,110
+and carbon dioxide elimination. بعملك الـ Breathing
+
+24
+00:01:38,110 --> 00:01:44,090
+Pattern، بتاخد هوا بالـ Inspiration و تطلع هوا في
+
+25
+00:01:44,090 --> 00:01:47,710
+الـ Expiration. إذا الـ Movement، الـ Breathing
+
+26
+00:01:47,710 --> 00:01:50,650
+Pattern هذه أنت مش قادر تعملها because of any
+
+27
+00:01:50,650 --> 00:01:57,110
+cause، unconscious، toxins، coma، head trauma،
+
+28
+00:01:57,110 --> 00:01:59,010
+whatever،
+
+29
+00:02:00,940 --> 00:02:04,940
+الـ Mechanical Ventilator بيقوم بالدور هذا لك. So
+
+30
+00:02:04,940 --> 00:02:07,800
+this is decrease the work of breathing and improve
+
+31
+00:02:07,800 --> 00:02:12,300
+patient comfort. لأن أنت ما بتبذل جهد عشان تتنفس، فيه
+
+32
+00:02:12,300 --> 00:02:16,000
+شخص يتنفس مكانك. إذا إيش الـ indications للـ
+
+33
+00:02:16,000 --> 00:02:18,220
+mechanical ventilator؟ من هم الناس اللي بيحتاج أن
+
+34
+00:02:18,220 --> 00:02:23,080
+نحطهم على mechanical ventilator؟ مريض صار فجأة عنده
+
+35
+00:02:23,080 --> 00:02:27,740
+acute respiratory failure. acute كيف يعني acute؟
+
+36
+00:02:27,740 --> 00:02:32,330
+يعني فجأة صار عنده need إنه بده Respiratory
+
+37
+00:02:32,330 --> 00:02:35,530
+support. الـ «فاليور الميكانيكال» الـ «فاليور
+
+38
+00:02:35,530 --> 00:02:36,490
+الميكانيكال» الـ «فاليور الميكانيكال» الـ «فاليور
+
+39
+00:02:36,490 --> 00:02:37,790
+الميكانيكال» الـ «فاليور الميكانيكال» الـ «فاليور
+
+40
+00:02:37,790 --> 00:02:38,490
+الميكانيكال» الـ «فاليور الميكانيكال» الـ «فاليور
+
+41
+00:02:38,490 --> 00:02:39,350
+الميكانيكال» الـ «فاليور الميكانيكال» الـ «فاليور
+
+42
+00:02:39,350 --> 00:02:42,970
+الميكانيكال» الـ «فاليور الميكانيكال» الـ «فاليور
+
+43
+00:02:42,970 --> 00:02:47,190
+الميكانيكال» الـ
+
+44
+00:02:47,190 --> 00:02:49,690
+«فاليور الميكانيكال» الـ «فاليور الميكانيكال» الـ
+
+45
+00:02:49,690 --> 00:02:53,550
+«فاليور الميكانيكال» الـ «ف
+
+46
+00:02:54,590 --> 00:02:58,250
+ممكن يكون musculoskeletal abnormalities زي الـ flared
+
+47
+00:02:58,250 --> 00:03:02,670
+chest، infectious disease زي مثلًا severe lung
+
+48
+00:03:02,670 --> 00:03:06,490
+pneumonia أو tuberculosis. هذا يؤدي فجأة لإن المريض
+
+49
+00:03:06,490 --> 00:03:10,750
+يبطل عنده القدرة على أن يتنفس لحاله أو إن يكون فيه
+
+50
+00:03:10,750 --> 00:03:15,350
+abnormalities of pulmonary gas exchange. مريض مثلًا
+
+51
+00:03:15,350 --> 00:03:20,710
+عنده obstructive lung disease زي الأزمة، chronic
+
+52
+00:03:20,710 --> 00:03:23,290
+bronchitis، emphysema.
+
+53
+00:03:25,790 --> 00:03:29,650
+والآن صارت المشكلة عنده في الـ Gas Exchange بالرئة.
+
+54
+00:03:29,650 --> 00:03:34,090
+الـ Fibrosis، الرئة اللي فيها أذية، Chronic Obstructive
+
+55
+00:03:34,090 --> 00:03:37,930
+Pulmonary Disease. هدول الناس عندهم مشكلة في الـ
+
+56
+00:03:37,930 --> 00:03:41,090
+Gas Exchange itself. فعشان هيك
+
+57
+00:03:44,400 --> 00:03:48,020
+بصارت الرئة ما بتقدر تعمل دورها بشكل كويس، ومش قادرة
+
+58
+00:03:48,020 --> 00:03:51,820
+تعمل compensation. صار فيه failure في الـ respiratory
+
+59
+00:03:51,820 --> 00:03:55,680
+فبنحط الـ mechanical ventilator عشان يساعد الرئة.
+
+60
+00:03:55,680 --> 00:04:02,660
+بمواصفات مختلفة، هنشوف كيف إنها تبدأ تعمل «Gas
+
+61
+00:04:02,660 --> 00:04:06,040
+Exchange». بالنسبة للـ «Breathing Rate» والـ «Tidal
+
+62
+00:04:06,040 --> 00:04:09,180
+Volume» اللي سنقوم بعمله «Pre-Setting». لأن المريض
+
+63
+00:04:09,180 --> 00:04:12,700
+بطل قادر أن يأخذ الـ «Rate» المناسب والـ «Tidal
+
+64
+00:04:12,700 --> 00:04:16,620
+Volume» المناسب. «Cardiac»، سنشوف ما معنى الـ «Rate»
+
+65
+00:04:16,620 --> 00:04:21,140
+وما معنى «Tidal Volume». بس، يجب أن نعرف إنه فيه
+
+66
+00:04:21,140 --> 00:04:24,820
+Indications للـ «ميكانيكال فنتليتور» ممكن تكون
+
+67
+00:04:24,820 --> 00:04:29,210
+Acute زي الـ «Acute Respiratory Failure»، أو إشارة
+
+68
+00:04:29,210 --> 00:04:32,770
+لـ Mechanical Ventilator بسبب تغيرات حرارة
+
+69
+00:04:32,770 --> 00:04:37,070
+الجسدية، بسبب تغيرات غير عادية، أو فشل، أو فشل، أو
+
+70
+00:04:37,070 --> 00:04:37,890
+فشل، أو فشل، أو فشل، أو فشل، أو فشل، أو فشل، أو
+
+71
+00:04:37,890 --> 00:04:39,950
+فشل، أو فشل، أو فشل، أو فشل، أو فشل، أو فشل، أو
+
+72
+00:04:39,950 --> 00:04:42,230
+فشل، أو فشل، أو فشل، أو فشل، أو فشل، أو فشل، أو
+
+73
+00:04:42,230 --> 00:04:44,290
+فشل، أو فشل، أو فشل، أو فشل، أو فشل، أو فشل، أو
+
+74
+00:04:44,290 --> 00:04:44,610
+فشل، أو فشل، أو فشل، أو فشل، أو فشل، أو فشل، أو
+
+75
+00:04:44,610 --> 00:04:47,230
+فشل، أو فشل، أو فشل، أو فشل، أو فشل، أو فشل، أو
+
+76
+00:04:47,230 --> 00:04:52,960
+فشل، أو فشل. Or congestive heart failure. القلب بطل
+
+77
+00:04:52,960 --> 00:04:57,760
+إيش؟ قبل شوية كنا بنحكي عن الدم كيف بيطلع من الـ
+
+78
+00:04:57,760 --> 00:05:01,480
+قلب، بيروح للرئة، و بيرجع للقلب. طب إذا الـ
+
+79
+00:05:01,480 --> 00:05:06,300
+قلب فيه failure سيئة، مش هيكون فيه إمكانية إنه
+
+80
+00:05:06,300 --> 00:05:10,700
+نعمل distribution للـ oxygenated blood، ويمكن أصلاً
+
+81
+00:05:10,700 --> 00:05:15,340
+يكون القلب مش قادر أصلاً إنه يودي الـ blood على الـ
+
+82
+00:05:15,340 --> 00:05:19,840
+رئة عشان يصير فيه oxygenation. هذا سيجعل المريض يدخل
+
+83
+00:05:19,840 --> 00:05:22,280
+في شوَك كاردوجينيكي «شوك»، لأنه ليس بإمكاننا أن نجعله
+
+84
+00:05:22,280 --> 00:05:23,340
+شوَك كاردوجينيكي «شوك»، بل بإمكاننا أن نجعله شوَك
+
+85
+00:05:23,340 --> 00:05:26,440
+كاردوجينيكي
+
+86
+00:05:26,440 --> 00:05:30,120
+«support». لأنه ليس كل مريض اللي يدخل له شوَك
+
+87
+00:05:30,120 --> 00:05:31,080
+كاردوجينيكي «support»، لديه برنامج بالرئة
+
+88
+00:05:31,080 --> 00:05:36,150
+الباثولوجي. «للطبيعي في تشكيك كاردوجيني أو تشكيك
+
+89
+00:05:36,150 --> 00:05:41,690
+دماغي مغلق». «المطالب من نظام الهواتف قد تتسلط على
+
+90
+00:05:41,690 --> 00:05:45,770
+تحطم الكاردوفاسكولر». «لذلك، المساعدة على الطبيعي
+
+91
+00:05:45,770 --> 00:05:49,610
+بطريقة ميكانيكية». «يمكنها تقليل المطالب عن
+
+92
+00:05:49,610 --> 00:05:54,970
+القلب». تمام؟ هو ده هيعمل يعني allowing a patient
+
+93
+00:05:54,970 --> 00:06:00,680
+to recover. عشان هيك الـ Criteria for Institutional
+
+94
+00:06:00,680 --> 00:06:04,080
+Ventilator Support. أنا لما ببدأ أقرر المريض هذا
+
+95
+00:06:04,080 --> 00:06:09,260
+كويس إن أنا أعمله Intubation وأحطه على Mechanical
+
+96
+00:06:09,260 --> 00:06:14,400
+Ventilator، ببدأ أطلع على الـ Pulmonary Parameters
+
+97
+00:06:14,400 --> 00:06:17,780
+وعلى Arterial Blood Gases. مثلًا الـ Pulmonary
+
+98
+00:06:17,780 --> 00:06:21,280
+Parameters، ببدأ أشوف الـ Respiratory Rate بيكون
+
+99
+00:06:21,280 --> 00:06:22,800
+أكثر من 35.
+
+100
+00:06:27,520 --> 00:06:32,440
+إذا كان الـ Respiratory Rate أكثر من 35، معناه أن
+
+101
+00:06:32,440 --> 00:06:39,000
+المريض بيتنفس كتير، بيكون بده support. إذا كان الـ
+
+102
+00:06:39,000 --> 00:06:43,500
+tidal volume المريض بياخده أقل من 5 ملليلتر لكل
+
+103
+00:06:43,500 --> 00:06:48,040
+كيلوغرام من وزنه، بيكون المريض بياخد very shallow
+
+104
+00:06:48,040 --> 00:06:54,760
+breaths. إذا كان الـ Vital Capacity، إذا يعني عملنا
+
+105
+00:06:54,760 --> 00:06:57,480
+قياس للـ Vital Capacity اللي بياخده، أكتر حاجة ممكن
+
+106
+00:06:57,480 --> 00:07:03,260
+يخدها المريض، ولاقيناها يعني
+
+107
+00:07:03,260 --> 00:07:12,900
+أقل من ضعف الـ tidal volume، بيكون المريض يعني بحتاج
+
+108
+00:07:12,900 --> 00:07:17,020
+mechanical ventilator. الـ arterial blood gases كان
+
+109
+00:07:17,020 --> 00:07:22,230
+الـ pH تبع المريض أقل من 7.25، يعني عنده severe
+
+110
+00:07:22,230 --> 00:07:25,870
+acidosis، بكون المريض بده mechanical ventilator. إذا
+
+111
+00:07:25,870 --> 00:07:30,190
+كان الـ الـ PCO2 تبع المريض، partial pressure تبع
+
+112
+00:07:30,190 --> 00:07:33,870
+الـ oxygen في الـ blood أقل من ستين، بكون المريض
+
+113
+00:07:33,870 --> 00:07:35,750
+بده mechanical ventilator، بده الـ respiratory
+
+114
+00:07:35,750 --> 00:07:39,430
+support. إذا كان الـ PCO2، partial pressure تبع
+
+115
+00:07:39,430 --> 00:07:45,000
+ثاني أكسيد الكربون، الـ CO2، أكثر من خمسين، بكون
+
+116
+00:07:45,000 --> 00:07:49,120
+لازم أنا أعمل consideration للـ ventilation اللي
+
+117
+00:07:49,120 --> 00:07:53,080
+بيكون indicated. طبعًا، إيش يعني الـ vital capacity؟
+
+118
+00:07:53,080 --> 00:07:57,040
+هي الـ maximum amount of air a person can expel
+
+119
+00:07:57,040 --> 00:08:00,720
+from the lungs after a maximum inhalation. يعني
+
+120
+00:08:00,720 --> 00:08:04,960
+أنت بتاخد inhalation أكتر شيء، maximum،
+
+121
+00:08:04,960 --> 00:08:07,020
+وبعدين تطلع، وهذا اسمه vital capacity.
+
+122
+00:08:09,560 --> 00:08:12,880
+الكمية اللي بتطلع منك في الـ Expiration بعد ما
+
+123
+00:08:12,880 --> 00:08:16,940
+تأخد Maximum Inhalation، هي هتكون أكبر كمية ممكن
+
+124
+00:08:16,940 --> 00:08:20,180
+تعملها Expiration أنت، تمام؟ هذه اسمها Vital
+
+125
+00:08:20,180 --> 00:08:25,520
+Capacity. إذا
+
+126
+00:08:25,520 --> 00:08:30,920
+بتكون يا جماعة أقل من ضعف الـ Tidal Volume اللي أنت
+
+127
+00:08:30,920 --> 00:08:34,180
+المفروض بتاخده، بتكون Vital Capacity عندك Very Low.
+
+128
+00:08:35,800 --> 00:08:39,300
+لما بنحكي tidal volume، إيش يعني الـ tidal volume؟
+
+129
+00:08:39,300 --> 00:08:45,220
+الـ tidal volume يا جماعة هو
+
+130
+00:08:45,220 --> 00:08:50,460
+عبارة عن كمية الهواء اللي أنت ممكن تاخدها خلال الـ
+
+131
+00:08:50,460 --> 00:08:55,100
+inspiration أو الـ expiration بدون أي مجهود، يعني
+
+132
+00:08:55,100 --> 00:08:57,820
+بشكل طبيعي. إذاً كمية الهواء اللي أنا باخدها في
+
+133
+00:08:57,820 --> 00:09:04,360
+نفس واحد من غير effort، من غير تعب، من غير مجهود،
+
+134
+00:09:04,360 --> 00:09:08,460
+هذه عبارة عن الـ tidal volume. قد إيشها تقريبًا بتساوي
+
+135
+00:09:08,460 --> 00:09:11,960
+زمان كان يحكوا 1 ملليلتر لكل كيلوغرام body
+
+136
+00:09:11,960 --> 00:09:15,480
+weight. الآن يحكوا من ستة إلى ثمانية ملليلتر
+
+137
+00:09:15,480 --> 00:09:19,900
+لكل كيلوغرام body weight. تمام؟
+
+138
+00:09:26,400 --> 00:09:29,300
+زي ما حكينا الـ tidal volume،  بنعرف من إنه الـ
+
+139
+00:09:29,300 --> 00:09:34,720
+tidal volume الطبيعي لمعظم الناس حوالي 500 ملليلتر
+
+140
+00:09:34,720 --> 00:09:42,020
+في كل نفس. هذه بعض يعني تعريفات مهمة:  tidal Volume،
+
+141
+00:09:42,020 --> 00:09:44,480
+إيش يعني؟ Residual Volume، إيش يعني؟ Residual
+
+142
+00:09:44,480 --> 00:09:45,920
+Volume، إيش يعني؟ Expiratory Reserve Volume، إيش يعني؟
+
+143
+00:09:45,920 --> 00:09:48,700
+Residual Volume، إيش يعني؟ طبعًا نحكي Residual
+
+144
+00:09:48,700 --> 00:09:53,400
+Volume يعني الكمية اللي بتضل من الهواء بعد ما تعمل
+
+145
+00:09:53,400 --> 00:09:57,580
+الـ Expiration، بعد ما تعمل Maximum Exhalation، لسه
+
+146
+00:09:57,580 --> 00:10:01,280
+بيضل فيه كمية حوالي 1200 ملليلتر في الرئة، لأن
+
+147
+00:10:01,280 --> 00:10:06,030
+عمرها ما الرئة بتصير ولا إيش فيها ولا لأ، لسه بتظلها
+
+148
+00:10:06,030 --> 00:10:10,570
+inflated، بس مش severely expanded. يعني زي لما أنت
+
+149
+00:10:10,570 --> 00:10:16,350
+بتكون واخد deep breathing، عملت
+
+150
+00:10:16,350 --> 00:10:19,530
+الـ maximum expiration، لسه بظل فيها minimum 1200
+
+151
+00:10:19,530 --> 00:10:20,590
+ملليلتر.
+
+152
+00:10:26,180 --> 00:10:29,120
+موضوعنا الـ Mechanical Ventilator. لو أنا صار فيه
+
+153
+00:10:29,120 --> 00:10:32,220
+عندي مريض وبيحتاج الـ Mechanical Ventilator، وبنقول
+
+154
+00:10:32,220 --> 00:10:35,620
+إنه في البداية الـ Mechanical Ventilation هذا
+
+155
+00:10:35,620 --> 00:10:41,590
+عبارة عن Two Main Types. فيه حاجة اسمها Negative
+
+156
+00:10:41,590 --> 00:10:48,310
+Pressure Ventilator، وطبعًا هذه قديمة جدًا، يمكن فيه
+
+157
+00:10:48,310 --> 00:10:52,690
+الآن استحدثوا منها حاجة، هورّجيكوا يعني على المبدأ
+
+158
+00:10:52,690 --> 00:10:55,950
+الـ Negative Pressure Ventilator، عشان بنحكي قديمة
+
+159
+00:10:55,950 --> 00:10:59,890
+يعني برضه لازالوا بياخدوا من الأفكار بتاعتها، وفيه
+
+160
+00:10:59,890 --> 00:11:04,270
+عملوا حاجة جديدة منها تساعد الناس، بس الفرق بين الـ
+
+161
+00:11:04,270 --> 00:11:06,490
+Negative Pressure Ventilator والـ Positive
+
+162
+00:11:06,490 --> 00:11:11,060
+Pressure Ventilator، من الاسم Negative يعني أكيد إنه
+
+163
+00:11:11,060 --> 00:11:16,940
+احنا ما بنتدخلش كتير في المريض. كيف يعني؟ يعني شي
+
+164
+00:11:16,940 --> 00:11:24,080
+إنْ باسل. عشان هيك بيسموها الـ Iron lungs. كل بساطة لو
+
+165
+00:11:24,080 --> 00:11:30,860
+بدنا نتطلع على الصورة، المريض بيكون داخل جهاز الـ
+
+166
+00:11:30,860 --> 00:11:37,020
+lung بتاعته، عليه حواليها air، الـ air هذا بيزيد
+
+167
+00:11:37,020 --> 00:11:42,560
+الضغط، يعني حجمه بيزيد فبيزيد الضغط على الرئة.
+
+168
+00:11:42,560 --> 00:11:46,120
+فبيعمل pressure على الرئة. بعد شوية الـ air بيسير
+
+169
+00:11:46,120 --> 00:11:50,580
+release، بيطلع هذا الـ air، الـ ambient air المحيط فيك
+
+170
+00:11:50,580 --> 00:11:55,660
+يعني okay، بيطلع الهواء برا، فبيقل الضغط في الرئة.
+
+171
+00:11:55,660 --> 00:12:02,060
+بتعمل relaxation. لما بتعمل contraction، إيش بيصير؟
+
+172
+00:12:02,060 --> 00:12:06,200
+Expiration. لو بتعمل relaxation، بيصير Inspiration.
+
+173
+00:12:06,200 --> 00:12:09,500
+وبالتالي أنت بيحصل لك عملية تنفس من جهة الـ
+
+174
+00:12:09,500 --> 00:12:12,720
+non-invasive، من غير ما يحطوا أنبوبة أنتر تريكال ويضخوا
+
+175
+00:12:12,720 --> 00:12:16,500
+فيك أو في المريض أي كمية من الهواء. أنت المسؤول إنك
+
+176
+00:12:16,500 --> 00:12:20,890
+تاخد الـ amount of air اللي بتناسبك، وأنت المسؤول إنك
+
+177
+00:12:20,890 --> 00:12:24,570
+تطلق الـ amount of air هذه، ولكن فيه pressure على
+
+178
+00:12:24,570 --> 00:12:27,
+
+223
+00:15:28,710 --> 00:15:32,650
+بدأ تخشّ إلها ضوابط، قداش بدأ تكون كمية الهواء،
+
+224
+00:15:32,650 --> 00:15:35,890
+قداش الـ frequencies تبعتها، تكون قداش بدأ تبحق،
+
+225
+00:15:35,890 --> 00:15:40,340
+يعني قداش يكون الـ rate، عن كم يجب أن يكون الـ
+
+226
+00:15:40,340 --> 00:15:44,400
+Concentration
+
+227
+00:15:44,400 --> 00:15:48,440
+of Oxygen فيها، ستجد هذا الكلام في الـ Settings
+
+228
+00:15:48,440 --> 00:15:48,900
+Extra
+
+229
+00:15:51,490 --> 00:15:55,690
+يعني هنا بيحكينا في الـ «سلايد» هذه كيف بالظبط
+
+230
+00:15:55,690 --> 00:16:01,210
+بتصير العملية تبع حركة الـ «دياجرام» during
+
+231
+00:16:01,210 --> 00:16:03,870
+inhalation. طبعاً كلنا عارفين إنه في
+
+232
+00:16:03,870 --> 00:16:07,410
+الـ«إنسبايراشن» الـ«دياجرام» بيتحرك عشان يعمل
+
+233
+00:16:07,410 --> 00:16:11,110
+«full lung expanded». في الـ«إكسبايراشن» بيطلع الـ
+
+234
+00:16:11,110 --> 00:16:15,250
+diaphragm لفوق مع حركة الـ intercostal muscles، و
+
+235
+00:16:15,250 --> 00:16:21,690
+الـ lungs الـ CCT بتعمل pressure فتخليك تعمل
+
+236
+00:16:21,690 --> 00:16:26,830
+expiration، وبالعكس لما بتعمل inspiration.
+
+237
+00:16:29,690 --> 00:16:32,530
+Types of Positive Pressure اللي بهمنا احنا في
+
+238
+00:16:32,530 --> 00:16:35,070
+الموضوع. Negative Pressure في الـ Ventilation حكينا
+
+239
+00:16:35,070 --> 00:16:40,410
+إنه Old Fashion، وحكيت إنه فيه حاجة يعني حديثة
+
+240
+00:16:40,410 --> 00:16:45,470
+بيستخدموها عشان تساعد الناس، و Negative هفرجيكوا
+
+241
+00:16:45,470 --> 00:16:50,530
+إياها. فبنركز على الـ Pressure Cycle Ventilator، الـ
+
+242
+00:16:50,530 --> 00:16:52,030
+Pressure Cycle Ventilator
+
+243
+00:16:55,740 --> 00:16:58,200
+أو بنركز على الـ Pressure Support Ventilation اللي
+
+244
+00:16:58,200 --> 00:17:04,080
+بنقسمه لثلاثة أنواع، ممكن يكون pressure cycle أو
+
+245
+00:17:04,080 --> 00:17:10,460
+volume cycle أو time cycle. إيش الفرق بين pressure
+
+246
+00:17:10,460 --> 00:17:17,220
+cycle و volume cycle و time cycle؟ هدول كلهم إيش؟
+
+247
+00:17:17,220 --> 00:17:21,640
+positive pressure. pressure cycle يعني قليل
+
+248
+00:17:21,640 --> 00:17:29,110
+الاستخدام. القصة فيه أننا نعتمد على pressure أو فرق
+
+249
+00:17:29,110 --> 00:17:32,410
+الـ pressure في كمية الهواء اللي بدها تخش للمريض
+
+250
+00:17:32,410 --> 00:17:36,270
+في كل مرة. يعني أنا في الـ Volume Cycle اللي بدها
+
+251
+00:17:36,270 --> 00:17:38,410
+أبدأ أشرح فيه عشان يبين الفرق بينه وبين الـ
+
+252
+00:17:38,410 --> 00:17:41,930
+pressure. أنا بكون حاطط للمريض كمية الهواء اللي
+
+253
+00:17:41,930 --> 00:17:46,830
+المفروض تخش للمريض في كل نفس، نقطة 500 CC. طبعاً كيف
+
+254
+00:17:46,830 --> 00:17:54,830
+بنحدده؟ 500 CC طبعاً
+
+255
+00:17:54,830 --> 00:17:58,110
+كيف بنحدده؟ 500 CC طبعاً كيف بنحدده؟ 500 CC طبعاً
+
+256
+00:17:58,110 --> 00:17:58,170
+كيف بنحدده؟ 500 CC طبعاً كيف بنحدده؟ 500 CC طبعاً
+
+257
+00:17:58,170 --> 00:17:58,650
+كيف بنحدده؟ 500 CC طبعاً كيف بنحدده؟ 500 CC طبعاً
+
+258
+00:17:58,650 --> 00:17:58,930
+كيف بنحدده؟ 500 CC طبعاً كيف بنحدده؟ 500 CC طبعاً
+
+259
+00:17:58,930 --> 00:17:59,090
+كيف بنحدده؟ 500 CC طبعاً كيف بنحدده؟ 500 CC طبعاً
+
+260
+00:17:59,090 --> 00:17:59,590
+كيف بنحدده؟ 500 CC طبعاً كيف بنحدده؟ 500 CC طبعاً
+
+261
+00:17:59,590 --> 00:18:05,140
+كيف بنحدده؟ 500 CC طبعاً كيف بنحدده؟ 500 CC طبعاً. طيب،
+
+262
+00:18:05,140 --> 00:18:08,460
+الـ Volume Cycle Ventilator، الـ Volume Cycle
+
+263
+00:18:08,460 --> 00:18:13,200
+Ventilator. افترضنا إننا بدنا نحط 500 CC للمريض،
+
+264
+00:18:13,200 --> 00:18:18,260
+okay؟ إذن، في كل breathing، المريض هياخد 500 CC.
+
+265
+00:18:18,260 --> 00:18:24,060
+هدول هيعملوا ضغط معين. إذا زادت الضغط نتيجة وجود مثلاً
+
+266
+00:18:24,060 --> 00:18:29,080
+Secretions تانية، أو حدّ يحدد الـ Pressure Alarm
+
+267
+00:18:29,080 --> 00:18:33,320
+إنه فيه إنكريز في الـ pressure، بير بار هجيسلي
+
+268
+00:18:33,320 --> 00:18:36,920
+يعطيني إنه فيه increase في الـ pressure، لكن في الـ
+
+269
+00:18:36,920 --> 00:18:40,540
+pressure cycle أنا بكون عامل set لـ pressure بس
+
+270
+00:18:40,540 --> 00:18:44,600
+بكون حاكم الجهاز، إنه أنا بدي الـ pressure مايزيدش عن
+
+271
+00:18:44,600 --> 00:18:48,680
+مثلاً خمسة وعشرين، والـ pressure اللي بدي يكون داخل
+
+272
+00:18:48,680 --> 00:18:51,020
+الـ lungs مثلاً خمسة وعشرين، فهو بيصير في الـ
+
+273
+00:18:51,020 --> 00:18:54,720
+expiration يقل الـ pressure. لما بدّي أعمل
+
+274
+00:18:54,720 --> 00:18:58,060
+inspiration تاني بيضلّ يعطيه لما يوصل الـ
+
+275
+00:18:58,060 --> 00:19:02,640
+pressure لعين 25. هذه الفرق في الـ volume cycle،
+
+276
+00:19:02,640 --> 00:19:07,980
+لأ، احنا فيه بنجيب volume من الـ tidal volume.
+
+277
+00:19:09,300 --> 00:19:12,900
+بندّيهم كل مرة. The peak inspiratory pressure must
+
+278
+00:19:12,900 --> 00:19:17,820
+be monitored in volume modes because it varies
+
+279
+00:19:17,820 --> 00:19:19,900
+from breed to breed. زي ما حكينا، ممكن يزيد
+
+280
+00:19:19,900 --> 00:19:23,260
+secretions في المريض، أو spontaneous breathing، فعشان هيك
+
+281
+00:19:23,260 --> 00:19:27,460
+لازم احنا نراقب الـ Peak Inspiratory Pressure مع كل
+
+282
+00:19:27,460 --> 00:19:31,080
+نفس، لوين بيصل، وبنكون عاملين Setting إنه إذا زاد عن 50
+
+283
+00:19:31,080 --> 00:19:34,540
+أعمل الـ alarm، علشان أشوف إيش المشكلة، يمكن المريض
+
+284
+00:19:34,540 --> 00:19:37,520
+fighting، يمكن يعني أنا بخشّ 500 لكن هو fighting
+
+285
+00:19:37,520 --> 00:19:39,980
+عامل Resistant، عامل Bite للـ Tube.
+
+286
+00:19:42,790 --> 00:19:46,670
+الـ 500 مش بلاقي مكان. إذا كان فيه atelectasis، هو
+
+287
+00:19:46,670 --> 00:19:51,210
+المريض fighting، مالهوش، مافيش full expansion
+
+288
+00:19:51,210 --> 00:19:54,630
+للـ lungs، مالهوش مكان يعدّي فيه، فبيصير جاهز يديني
+
+289
+00:19:54,630 --> 00:19:58,990
+الـ alarm. الـ Time
+
+290
+00:19:58,990 --> 00:20:02,150
+Cycle، إيش اللي بيحصل في الـ Time Cycle؟ إنّ أنا
+
+291
+00:20:02,150 --> 00:20:05,050
+بكون محدّد الـ time، والـ Volume and Pressure is variable
+
+292
+00:20:05,050 --> 00:20:09,550
+according to pressure or ventilator
+
+293
+00:20:12,840 --> 00:20:17,920
+كيف يعني؟ يعني الـ Ventilator بـ pushes air in to
+
+294
+00:20:17,920 --> 00:20:24,900
+long until pre-set time has elapsed. The volume of
+
+295
+00:20:24,900 --> 00:20:29,200
+air patients receive is regularly regulated by the
+
+296
+00:20:29,200 --> 00:20:32,660
+length of inspiration and flow rate of the air.
+
+297
+00:20:32,820 --> 00:20:37,060
+إيش يعني؟ يعني أنا بدي إياه، إنّه يوصل للـ volume
+
+298
+00:20:37,060 --> 00:20:42,250
+اللي بدي إياه في زمن معيّن، ثانيتين، أو أربع ثواني مثلاً، إنّه
+
+299
+00:20:42,250 --> 00:20:48,110
+يصير inspiration. الـ flow أنا بكون محدّد الـ flow تبع
+
+300
+00:20:48,110 --> 00:20:52,070
+الـ air، لكن مش محدّد كمية الهواء بالظبط، أنها تكون
+
+301
+00:20:52,070 --> 00:20:56,010
+خمسمية، لأ، محدّد الـ flow مثلاً، نفترض
+
+302
+00:20:59,100 --> 00:21:04,820
+خمسمية، أو نفترض خمسة لتر في الدقيقة، وأنا محدّد إنّ
+
+303
+00:21:04,820 --> 00:21:09,600
+الـ Inspiration Cycle تكون Two Seconds، فهيدخل
+
+304
+00:21:09,600 --> 00:21:14,200
+المريض على الـ flow الـ preset، إنّه خمسة لتر زي ما
+
+305
+00:21:14,200 --> 00:21:17,040
+افترضنا في الدقيقة، هيدخل في خلال الثانيتين هدول
+
+306
+00:21:17,040 --> 00:21:22,060
+كمية الهواء اللي عاش في هذا الوقت من الـ flow اللي
+
+307
+00:21:22,060 --> 00:21:24,320
+جاي بمقدار خمسة لتر في الدقيقة.
+
+308
+00:21:27,290 --> 00:21:33,490
+عادةً بنستخدم الـ Time Cycled هذا في
+
+309
+00:21:33,490 --> 00:21:38,470
+الحضانات، ولو أنه Limited يعني.
+
+310
+00:21:42,800 --> 00:21:46,200
+بدنا نحكي الآن، إذا نلخّص اللي حكيناه، إنّه الـ «Positive
+
+311
+00:21:46,200 --> 00:21:50,220
+Pressure Ventilator» فيه ثلاثة أنواع: الـ Pressure
+
+312
+00:21:50,220 --> 00:21:54,660
+Cycle، و Volume Cycle، و Time Cycle. حكينا إنّه
+
+313
+00:21:54,660 --> 00:22:01,700
+الـ Volume Cycle هي الـ «Commonly Used Cycle of
+
+314
+00:22:01,700 --> 00:22:05,580
+Ventilation»، عادةً بنستخدمها، لإنه بتكون وهي مناسبة
+
+315
+00:22:05,580 --> 00:22:07,160
+جداً للـ Adults.
+
+316
+00:22:08,970 --> 00:22:12,830
+الـ Modes of Ventilation. ما هي الـ Modes اللي
+
+317
+00:22:12,830 --> 00:22:18,510
+نستخدمها عشان نشغل الـ Mechanical Ventilator
+
+318
+00:22:18,510 --> 00:22:22,650
+عليها؟ يا جماعة، الـ Ventilator يعني مش شبه الكمبيوتر، أنا
+
+319
+00:22:22,650 --> 00:22:25,090
+دلوقتي في الكمبيوتر، يعني أنت عندك كمبيوتر، بس بدّك
+
+320
+00:22:25,090 --> 00:22:29,830
+نظام تشغيل. يعني أنا عشان أفتح PowerPoint بدّي
+
+321
+00:22:29,830 --> 00:22:31,930
+Microsoft Office، فيه PowerPoint، Microsoft
+
+322
+00:22:31,930 --> 00:22:36,450
+PowerPoint طبعاً. ف أنا بدّي نظام تشغيل عشان أبدأ أحطّ
+
+323
+00:22:36,450 --> 00:22:42,130
+الـ data أو الـ parameters اللي أنا بدّي إياها، كويس؟
+
+324
+00:22:42,130 --> 00:22:45,530
+فعشان هيك كل Mode له parameters معيّنة، ف أنا بختار الـ
+
+325
+00:22:45,530 --> 00:22:47,930
+Mode، وبعدين بختار الـ parameters اللي بتناسب الـ
+
+326
+00:22:47,930 --> 00:22:55,710
+Mode. أشهر الـ Modes المشهورة للـ ventilation؟ في
+
+327
+00:22:55,710 --> 00:23:00,710
+طبعاً للـ volume فيه Modes، وللـ pressure فيه Modes.
+
+328
+00:23:01,270 --> 00:23:04,150
+مش حكينا إنّه فيه Volume Cycle وفيه Pressure Cycle؟
+
+329
+00:23:06,380 --> 00:23:10,880
+الـ Volume Modes المشهورة جداً، واحد اسمه
+
+330
+00:23:10,880 --> 00:23:14,060
+«Controlled Mandatory Ventilation»، «Controlled
+
+331
+00:23:14,060 --> 00:23:17,140
+Mandatory Ventilation». الثاني اسمه «Assist
+
+332
+00:23:17,140 --> 00:23:20,340
+Control»، «Assist Control Mandatory Ventilation».
+
+333
+00:23:20,340 --> 00:23:22,180
+يعني «Control Mandatory Ventilation»، بس فيه
+
+334
+00:23:22,180 --> 00:23:26,140
+assistant اللي بتعطيه، الفرق من كل واحد. الثالث اسمه
+
+335
+00:23:26,140 --> 00:23:29,540
+«Intermittent Mandatory Ventilation»، IMV. الرابع
+
+336
+00:23:29,540 --> 00:23:32,060
+اسمه «Synchronized Intermittent Mandatory
+
+337
+00:23:32,060 --> 00:23:37,610
+Ventilation». تمام؟ الـ Pressure Modes، هدول زي الـ
+
+338
+00:23:37,610 --> 00:23:40,190
+Pressure Control Ventilation، والـ Pressure
+
+339
+00:23:40,190 --> 00:23:42,510
+Support Ventilation، والـ Continuous Positive
+
+340
+00:23:42,510 --> 00:23:47,890
+Airway Pressure، والـ Positive and Expiratory
+
+341
+00:23:47,890 --> 00:23:59,210
+Pressure، والـ Non-invasive Bilevel
+
+342
+00:23:59,210 --> 00:24:02,820
+Positive Airway Pressure Ventilation. Non-invasive
+
+343
+00:24:02,820 --> 00:24:06,300
+Bilevel Positive Airway Pressure Ventilation، «بي
+
+344
+00:24:06,300 --> 00:24:11,040
+باب» بنسميه. حنبدأ نفصل في كل واحد منهم بالظبط
+
+345
+00:24:11,040 --> 00:24:14,760
+ونشوف كيف بيشتغل بكل بساطة. لما بنحكي عن
+
+346
+00:24:14,760 --> 00:24:19,090
+الـ controlled mandatory ventilation، الـ «Control of
+
+347
+00:24:19,090 --> 00:24:21,430
+Mandatory Ventilation»، له advantage و له
+
+348
+00:24:21,430 --> 00:24:25,610
+disadvantage؟ طب هو إيش أصلاً بيسوي؟ هو بيدي كمية
+
+349
+00:24:25,610 --> 00:24:29,570
+هواء للمريض بـ «preset». أنا عامل الـ settings للهواء، أنا بدي أدي
+
+350
+00:24:29,570 --> 00:24:34,250
+المريض مثلاً 500 CC tidal volume، 12 مرة في
+
+351
+00:24:34,250 --> 00:24:39,250
+الدقيقة، آه okay. بس في هذه الحالة لازم يكون
+
+352
+00:24:39,250 --> 00:24:45,270
+المريض مافيش عنده أي interaction. يعني لازم المريض
+
+353
+00:24:45,270 --> 00:24:51,080
+يكون مُسَكِّت، ياخد كل كمية الهواء هذه من غير ما
+
+354
+00:24:51,080 --> 00:24:55,900
+يستطيع إنه ياخد نفس ثاني. علشان هيك الـ advantage
+
+355
+00:24:55,900 --> 00:24:59,820
+إنّ
+
+356
+00:24:59,820 --> 00:25:04,200
+الـ muscles تبع الـ patient حالتها ما بتتحركش، بس
+
+357
+00:25:04,200 --> 00:25:05,160
+بالجهاز.
+
+358
+00:25:07,780 --> 00:25:11,680
+لكن الـ disadvantage إنّ المريض لا يستطيع أن يبدأ
+
+359
+00:25:11,680 --> 00:25:17,220
+نفسه لحاله، لا يستطيع أن يشارك في عملية النفس، أو
+
+360
+00:25:17,220 --> 00:25:28,940
+يبدأ هو عملية النفس. عشان هيك المريض
+
+361
+00:25:28,940 --> 00:25:33,420
+يجب أن ياخد Muscle Relaxant، عشان أمشي على control
+
+362
+00:25:33,420 --> 00:25:35,980
+dependent ventilation، لإنه مش مسموح له يشارك
+
+363
+00:25:35,980 --> 00:25:39,060
+في عملية التنفس، وبالتالي هذا من أهم الـ disadvantages
+
+364
+00:25:39,060 --> 00:25:44,380
+تبع الـ Mode هذا، إنّه أنا بدّي، ساعة ما أحطّ الـ
+
+365
+00:25:44,380 --> 00:25:48,100
+mechanical ventilator، أبدأ أفكّر في الساعة اللي أنا
+
+366
+00:25:48,100 --> 00:25:50,420
+بدّي أعمله weaning، وأفطمه عن الـ mechanical
+
+367
+00:25:50,420 --> 00:25:55,640
+ventilator. آه، إذن هذا الـ Mode مش مناسب، لإنه
+
+368
+00:25:55,640 --> 00:25:59,820
+بيخلي المريض يظلّ أكثر وقت ممكن dependent على الـ
+
+369
+00:25:59,820 --> 00:26:07,170
+mechanical ventilator. طيب، إيش الحل؟ حاولوا يحلّوا
+
+370
+00:26:07,170 --> 00:26:12,110
+الموضوع شويّة، وتطوّر، فعملوا assist control mode، دي
+
+371
+00:26:12,110 --> 00:26:16,370
+يعني خلّوا الـ patient may initiate a breath on his
+
+372
+00:26:16,370 --> 00:26:23,650
+own، إنّه أنت المريض ممكن يبدأ، هو يبدأ عملية النفس
+
+373
+00:26:23,650 --> 00:26:27,990
+لكن في كل مرة المريض بيبدأ بياخد الـ preset tidal
+
+374
+00:26:27,990 --> 00:26:31,610
+volume، بياخد اللي أنا already حاطّه، بياخد 500
+
+375
+00:26:31,610 --> 00:26:36,220
+مثلاً، ومش بس في عدد الـ breaths اللي أنا حطّيت 12
+
+376
+00:26:36,220 --> 00:26:37,080
+يعني بدّي ياخد 12
+
+377
+00:26:40,120 --> 00:26:43,060
+القصة هي إنّه يستطيع إنّه يعمل initiation
+
+378
+00:26:43,060 --> 00:26:46,140
+للـ breathing، لكن الـ ventilator بيستطيع إنشاء
+
+379
+00:26:46,140 --> 00:26:49,600
+الـ breathing، اللي بيكون مُدار في الـ preset tidal
+
+380
+00:26:49,600 --> 00:26:53,320
+volume. أنا حاطط الـ 500، مش اللي بده إياه، مش زي ما هو
+
+381
+00:26:53,320 --> 00:26:56,180
+بده إياه. الـ total respiratory rate is determined by
+
+382
+00:26:56,180 --> 00:27:00,080
+the number of spontaneous inspirations initiated by
+
+383
+00:27:00,080 --> 00:27:05,020
+the patient plus the number of breaths set on the
+
+384
+00:27:05,020 --> 00:27:10,360
+ventilator. أنا حاطط له إنّه ياخد 12، الـ 12 اللي أنا
+
+385
+00:27:10,360 --> 00:27:15,120
+كاتبهم، أو عامل setting لهم، هياخد إيش؟ لازم ياخدهم.
+
+386
+00:27:16,490 --> 00:27:20,950
+أوكي، هو يبدأ عملية التنفس، يبدأ أهلاً وسهلاً، كل مرة
+
+387
+00:27:20,950 --> 00:27:24,070
+بيبدأ، الجهاز بيدّيه الخمسمية اللي هي محطوطة setting.
+
+388
+00:27:24,070 --> 00:27:29,410
+بده ياخد كمان، الجهاز حيسمح له، حيديله برضه كمان إيش؟
+
+389
+00:27:29,410 --> 00:27:33,130
+كمان خمسمية زيادة، كل مرة. لأن هذا الـ volume اللي
+
+390
+00:27:33,130 --> 00:27:36,830
+مسموح ياخده، لمن بده يبدأ عملية نفس، مثلاً هو خمسمية
+
+391
+00:27:36,830 --> 00:27:40,050
+زي ما أنا عامل pre-setting. عشان هيك واضح جداً إنّه
+
+392
+00:27:40,050 --> 00:27:47,070
+أنا جاعد بزود الـ respiratory rate، أو بزود كمية
+
+393
+00:27:47,070 --> 00:27:51,750
+الـ «minute volume»، خلّينا نسميها، يعني كمية الهواء
+
+394
+00:27:51,750 --> 00:27:54,550
+اللي بتخشّ للمريض في الدقيقة الواحدة، اللي هي إيش
+
+395
+00:27:54,550 --> 00:27:58,110
+عبارة؟ عبارة عن الـ tidal volume اللي بخشّها للمريض
+
+396
+00:27:58,110 --> 00:28:03,410
+ضرب الـ rate. إذا المريض أنا حاطط له 12، وبيعمل مثلاً 8
+
+397
+00
+
+445
+00:31:36,400 --> 00:31:39,660
+exploration،  أعطيه، في مصطفى الطريق، فلس المريض، يأخذ
+
+446
+00:31:39,660 --> 00:31:44,060
+بس 150، والمفروض يأخذ 500، okay الجهاز يكمل، و
+
+447
+00:31:44,060 --> 00:31:48,710
+بِيعطيه 350، وبنحسب عليه نفس، ممتاز. إذًا هذا إيش
+
+448
+00:31:48,710 --> 00:31:51,410
+الـMode اسمه؟ هذا الـMode اسمه Synchronized،
+
+449
+00:31:51,410 --> 00:31:52,970
+Intermittent  من الـDetergent، يعني هو
+
+450
+00:31:52,970 --> 00:31:55,310
+الـIntermittent من الـDetergent الـVentilation، بس
+
+451
+00:31:55,310 --> 00:31:58,490
+فيه Synchronization بينه وبين التنفس، فيه تناغم
+
+452
+00:31:58,490 --> 00:32:02,550
+بينه وبين التنفس، فيه تزامن بينه وبين التنفس، كيف
+
+453
+00:32:02,550 --> 00:32:06,870
+تزامن؟ إن وقت ما فيه نفس، المريض بدّه يأخذه ويحصل
+
+454
+00:32:06,870 --> 00:32:07,230
+دفعة
+
+455
+00:32:10,530 --> 00:32:14,830
+فعشان هيك فيه بينه وبين التنفس تناغم «Breeze at
+
+456
+00:32:14,830 --> 00:32:17,030
+tidal volume» «Breeze at tidal rate» احنا بنحطّه
+
+457
+00:32:17,030 --> 00:32:20,710
+«Tidal Volume» وبنحطّه «Rate» و «Alpha2» اللي هو الـ
+
+458
+00:32:20,710 --> 00:32:24,130
+«Oxygen Fraction» بين 30% و40% أكسجين، لكن
+
+459
+00:32:24,130 --> 00:32:28,090
+«Additional spontaneous breeze at tidal volume and
+
+460
+00:32:28,090 --> 00:32:30,930
+rate determined by patient» بدّه يأخذ كمان «Tidal
+
+461
+00:32:30,930 --> 00:32:33,650
+Volume»، يأخذ، بدّه يأخذ كمان «Rate»، يأخذ، بس مافيش
+
+462
+00:32:33,650 --> 00:32:38,330
+حيصير تعرض، مش هيكون في risk للباروتروما.عادة يتم
+
+463
+00:32:38,330 --> 00:32:42,290
+استخدامها مع الضغط لتقليل عمل الاختصار عادةً
+
+464
+00:32:42,290 --> 00:32:46,010
+نكون محاطين نشوف Mode ثاني معاه، إذا اسمه  بيب اللي
+
+465
+00:32:46,010 --> 00:32:49,710
+هو Pressure Support عشان يعمل مساعدة in between
+
+466
+00:32:49,710 --> 00:32:53,030
+the ventilator delivers the breath بين الـ breath
+
+467
+00:32:53,030 --> 00:32:55,830
+تابع الـventilator والـ breath الثاني الـ patient is
+
+468
+00:32:55,830 --> 00:32:59,050
+able to breathe spontaneously at his own pace
+
+469
+00:32:59,050 --> 00:33:02,750
+and rate with no assistance from the
+
+470
+00:33:02,750 --> 00:33:05,810
+ventilator. بين الـventilator breath والـ ventilator
+
+471
+00:33:05,810 --> 00:33:09,550
+breath، المريض بياخذ نفس، الجهاز بيسيبك تاخد نفس
+
+472
+00:33:09,550 --> 00:33:13,850
+أنت أو بأي  tidal volume بدّك إياه. However, unlike the
+
+473
+00:33:13,850 --> 00:33:18,270
+AC mode اللي هو الـAssistant Control mode، any
+
+474
+00:33:18,270 --> 00:33:21,290
+breath taken above the set rate are spontaneous
+
+475
+00:33:21,290 --> 00:33:25,270
+breaths taken through the ventilator circuit.
+
+476
+00:33:25,270 --> 00:33:27,530
+تمام؟
+
+477
+00:33:30,560 --> 00:33:35,760
+إذن، مش زي الـPressure أو الـAssistant Control بين
+
+478
+00:33:35,760 --> 00:33:39,060
+الـVentilator والمريض، بدّه يأخذ نفس، فرق
+
+479
+00:33:39,060 --> 00:33:44,080
+بِدّيك 500، لأ، أي نفس أنت بتستطيع، يعني عندك القدرة
+
+480
+00:33:44,080 --> 00:33:47,180
+تاخد 500 بتاخد، عندك القدرة تاخد 200 بس، بيسيبك
+
+481
+00:33:47,180 --> 00:33:49,660
+تاخد 200، مافيش إجبار، الـVentilator والمريض
+
+482
+00:33:49,660 --> 00:33:52,720
+are synchronized with the patient’s
+
+483
+00:33:52,720 --> 00:33:54,860
+spontaneous breathing، there’s no force، مافيش
+
+484
+00:33:54,860 --> 00:33:58,680
+اتنين بيخشوا مع بعض، used to wean the patient from
+
+485
+00:33:58,680 --> 00:34:01,100
+the mechanical ventilator. عشان هيك هذا أحسن Mode
+
+486
+00:34:01,100 --> 00:34:04,440
+بيساعدني عندما بدّي أقرّر أفصل أو أعمل weaning
+
+487
+00:34:04,440 --> 00:34:07,420
+للمريض. هو already أنا من أول ما حطيته عليه، من أول
+
+488
+00:34:07,420 --> 00:34:09,980
+ما حطيته عليه وأنا بسمح له أنه يأخذ spontaneous
+
+489
+00:34:09,980 --> 00:34:15,660
+breathing. عندما أريد أن ينفصل معانا الجهاز ويعمل الـ
+
+490
+00:34:15,660 --> 00:34:18,700
+weaning، أنا بأقلل التنفسات الإجبارية اللي أريد أن
+
+491
+00:34:18,700 --> 00:34:22,320
+أعطيهم وأعتمد على نفسه أكثر لما أوصل لمرحلة أني
+
+492
+00:34:22,320 --> 00:34:24,880
+أضعه على Mode ثاني، في Mode اسمه
+
+493
+00:34:24,880 --> 00:34:28,520
+الـCPAP اللي هو ما بيعطيهوش لا tidal volume ولا
+
+494
+00:34:28,520 --> 00:34:32,020
+rate وبس بحافظ على ضغط ثابت داخل الـ lung. هنشوف
+
+495
+00:34:32,020 --> 00:34:37,460
+كيف السبب الآن، لكن الكثير من الأسئلة فيها. ده مقدمة
+
+496
+00:34:37,460 --> 00:34:44,090
+ممتازة للـ weaning. أولًا الـ advantage تبعته
+
+497
+00:34:44,090 --> 00:34:47,270
+بيعمل Synchronization مع المريض فمفيش risk للـ
+
+498
+00:34:47,270 --> 00:34:52,930
+باروتروما، مافيش إنّي أنا أعطيه predetermined
+
+499
+00:34:52,930 --> 00:34:58,730
+volume زي الـ AC mode، وبالتالي الـ risk
+
+500
+00:34:58,730 --> 00:35:02,430
+للـhyperventilation مش موجود لإنه المريض مش مجبور
+
+501
+00:35:02,430 --> 00:35:05,130
+إنّه كل ما بده يعمل initiative breathing بياخد الـ
+
+502
+00:35:05,130 --> 00:35:06,850
+tidal volume اللي أنا أعمله، فمفيش
+
+503
+00:35:06,850 --> 00:35:10,750
+hyperventilation، مافيش barotrauma، عشان يسمّوه الـ
+
+504
+00:35:10,750 --> 00:35:14,670
+Mode الرحيم، رحيم، يعني ده اللي قاله، يعني على الآخر
+
+505
+00:35:14,670 --> 00:35:18,090
+a regular series of breaths are scheduled but the
+
+506
+00:35:18,090 --> 00:35:21,230
+ventilator needs patients effort and schedule is
+
+507
+00:35:21,230 --> 00:35:26,570
+mandatory breath is based on the calculated need
+
+508
+00:35:26,570 --> 00:35:30,990
+of the patient. إيش بدّك أحلى من هذا؟ الـ advantage
+
+509
+00:35:30,990 --> 00:35:33,610
+تبعته زي ما شفنا بتترجم بـ «patient
+
+510
+00:35:33,610 --> 00:35:37,770
+ventilatory interaction» «less hemodynamic effect»
+
+511
+00:35:37,770 --> 00:35:40,890
+والـ disadvantage تبعته «high work of breath than
+
+512
+00:35:40,890 --> 00:35:43,870
+CMV or AC»
+
diff --git a/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/u1q_2vGOzh0_postprocess.srt b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/u1q_2vGOzh0_postprocess.srt
new file mode 100644
index 0000000000000000000000000000000000000000..8c1291d9436fccfd65d5319e96f2013ec55487c9
--- /dev/null
+++ b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/u1q_2vGOzh0_postprocess.srt
@@ -0,0 +1,2048 @@
+1
+00:00:02,140 --> 00:00:05,180
+بسم الله الرحمن الرحيم بسم الله الصلاة والسلام على
+
+2
+00:00:05,180 --> 00:00:07,760
+رسول الله اليوم إن شاء الله محاضرتنا عن الـ
+
+3
+00:00:07,760 --> 00:00:12,600
+mechanical ventilator يعني بداية mechanical
+
+4
+00:00:12,600 --> 00:00:16,120
+ventilation إيش mechanical ventilation؟ باختصار
+
+5
+00:00:16,120 --> 00:00:19,880
+نحكي mechanical ventilator is a machine that can
+
+6
+00:00:19,880 --> 00:00:24,970
+breathe for you، بسإذا الـ «ميكانيكال فنتيلاتيون»
+
+7
+00:00:24,970 --> 00:00:29,710
+هي عبارة عن «مشيين» ميكانيكالي يخفف لك هذه وظيفتها
+
+8
+00:00:29,710 --> 00:00:34,870
+الـ «فنتيلاتيون» هو مجلس حياة مدعوم مجلس حياة
+
+9
+00:00:34,870 --> 00:00:37,110
+مدعوم مجلس حياة مدعوم مجلس حياة مجلس حياة مجلس
+
+10
+00:00:37,110 --> 00:00:37,310
+حياة مجلس حياة مجلس حياة مجلس حياة مجلس حياة مجلس
+
+11
+00:00:37,310 --> 00:00:37,590
+حياة مجلس حياة مجلس حياة مجلس حياة مجلس حياة مجلس
+
+12
+00:00:37,590 --> 00:00:40,770
+حياة مجلس حياة مجلس حياة مجلس حياة مجلس حياة مجلس
+
+13
+00:00:40,770 --> 00:00:49,530
+حياة مجلس ح
+
+14
+00:00:50,070 --> 00:00:53,130
+اللي بيصير فيه good oxygenation للبلد بيرجع
+
+15
+00:00:53,130 --> 00:00:57,850
+للـheart Oxygenated blood الـheart بيعمله بيعمله
+
+16
+00:00:57,850 --> 00:01:02,370
+فزي
+
+17
+00:01:02,370 --> 00:01:06,410
+ما حكينا الـheart بيعمله pumping وبالتالي بيصير
+
+18
+00:01:06,410 --> 00:01:10,650
+فيه أنا بـrefusion ل oxygenated blood إذا
+
+19
+00:01:10,650 --> 00:01:18,250
+الـmechanical ventilator cannot work the lung work
+
+20
+00:01:18,250 --> 00:01:25,890
+at allالشغل الميكانيكي يتنفس فقط لك ولكن مش ممكن
+
+21
+00:01:25,890 --> 00:01:31,150
+يشتغل شغل الـ lung itself. So the basic effects of
+
+22
+00:01:31,150 --> 00:01:34,070
+mechanical ventilation are improved oxygenation
+
+23
+00:01:34,070 --> 00:01:38,110
+and carbon dioxide elimination.بعملك الـ Breathing
+
+24
+00:01:38,110 --> 00:01:44,090
+Pattern بتاخد هوا بالـ Inspiration و تطلع هوا في
+
+25
+00:01:44,090 --> 00:01:47,710
+الـ Expiration إذا الـ Movement، الـ Breathing
+
+26
+00:01:47,710 --> 00:01:50,650
+Pattern هذه انت مش قادر تعملها because of any
+
+27
+00:01:50,650 --> 00:01:57,110
+cause، unconscious، toxins، coma، head trauma،
+
+28
+00:01:57,110 --> 00:01:59,010
+whatever،
+
+29
+00:02:00,940 --> 00:02:04,940
+الـ Mechanical Ventilator بيقدّي الدور هذا إلىك So
+
+30
+00:02:04,940 --> 00:02:07,800
+this is decrease the work of breathing and improve
+
+31
+00:02:07,800 --> 00:02:12,300
+patient comfort لأن أنت مابتنكش جهد عشان تتنفس في
+
+32
+00:02:12,300 --> 00:02:16,000
+someone breathe for you إذا إيش ال indication ال
+
+33
+00:02:16,000 --> 00:02:18,220
+mechanical ventilator؟ من هم الناس اللي بيحتاج أن
+
+34
+00:02:18,220 --> 00:02:23,080
+نحطهم mechanical ventilator؟ مريض صار فجأة عنده
+
+35
+00:02:23,080 --> 00:02:27,740
+acute respiratory failure acute كيف يعني acute؟
+
+36
+00:02:27,740 --> 00:02:32,330
+يعني فجأة صار عنده needإنه بدّوا Respiratory
+
+37
+00:02:32,330 --> 00:02:35,530
+support الـ «فايلير الميكانيكال» الـ «فايلير
+
+38
+00:02:35,530 --> 00:02:36,490
+الميكانيكال» الـ «فايلير الميكانيكال» الـ «فايلير
+
+39
+00:02:36,490 --> 00:02:37,790
+الميكانيكال» الـ «فايلير الميكانيكال» الـ «فايلير
+
+40
+00:02:37,790 --> 00:02:38,490
+الميكانيكال» الـ «فايلير الميكانيكال» الـ «فايلير
+
+41
+00:02:38,490 --> 00:02:39,350
+الميكانيكال» الـ «فايلير الميكانيكال» الـ «فايلير
+
+42
+00:02:39,350 --> 00:02:42,970
+الميكانيكال» الـ «فايلير الميكانيكال» الـ «فايلير
+
+43
+00:02:42,970 --> 00:02:47,190
+الميكانيكال» الـ
+
+44
+00:02:47,190 --> 00:02:49,690
+«فايلير الميكانيكال» الـ «فايلير الميكانيكال» الـ
+
+45
+00:02:49,690 --> 00:02:53,550
+«فايلير الميكانيكال» الـ «ف
+
+46
+00:02:54,590 --> 00:02:58,250
+ممكن يكون myoskeletal abnormalities زي الـflared
+
+47
+00:02:58,250 --> 00:03:02,670
+chest infectious disease زي مثلًا severe lung
+
+48
+00:03:02,670 --> 00:03:06,490
+pneumonia أو tuberculosis هذا يؤدي فجأة لإن المريض
+
+49
+00:03:06,490 --> 00:03:10,750
+يبطل عنده القدرة على أن يتنفس لحاله أو إن يكون فيه
+
+50
+00:03:10,750 --> 00:03:15,350
+abnormalities of pulmonary gas exchange مريض مثلًا
+
+51
+00:03:15,350 --> 00:03:20,710
+عنده obstructive lung disease زي الأزمة، chronic
+
+52
+00:03:20,710 --> 00:03:23,290
+bronchitis، emphysema
+
+53
+00:03:25,790 --> 00:03:29,650
+والآن صارت المشكلة عنده في الـ Gas Exchange بلمون
+
+54
+00:03:29,650 --> 00:03:34,090
+الـ Fibrosis، بلمون الأذيمة، Chronic Obstructive
+
+55
+00:03:34,090 --> 00:03:37,930
+Pulmonary Disease هدول الناس عندهم مشكلة في الـ
+
+56
+00:03:37,930 --> 00:03:41,090
+Gas Exchange itself فعشان هيك
+
+57
+00:03:44,400 --> 00:03:48,020
+بصارت الـ lung مابتقدش دورها بشكل كويس ومش قادرة
+
+58
+00:03:48,020 --> 00:03:51,820
+تعمل compensation صار فيه failure في ال respirator
+
+59
+00:03:51,820 --> 00:03:55,680
+فبنحط ال mechanical ventilator عشان يساعد ال lung
+
+60
+00:03:55,680 --> 00:04:02,660
+موات مختلفة هنشوف كيف إنها تبدأ تعمل«جاز
+
+61
+00:04:02,660 --> 00:04:06,040
+إكسيتشينج» بالنسبة للـ «بريفنغ ريت» والـ «تايدال
+
+62
+00:04:06,040 --> 00:04:09,180
+فوليوم» اللي سنقوم بعمله «Pre-Setting» لأن المرضي
+
+63
+00:04:09,180 --> 00:04:12,700
+بطل قادر أن يأخذ الـ «ريت» المناسب والـ «تايدال
+
+64
+00:04:12,700 --> 00:04:16,620
+فوليوم» المناسب «كارديا»، سنشوف ما يعني الـ «ريت»
+
+65
+00:04:16,620 --> 00:04:21,140
+وما يعني «تايدال فوليوم» بس، يجب أن نعرف إنه فيه
+
+66
+00:04:21,140 --> 00:04:24,820
+Indications لـ «ميكانيكال فنتليتور» ممكن تكون
+
+67
+00:04:24,820 --> 00:04:29,210
+Acute زي الـ «اكيوت ريسبارات الفاليار»أو إشارة
+
+68
+00:04:29,210 --> 00:04:32,770
+لـMechanical Ventilator بسبب تغيير الحرارة
+
+69
+00:04:32,770 --> 00:04:37,070
+الحضارية بسبب غيارات غير عادية أو فشل أو فشل أو
+
+70
+00:04:37,070 --> 00:04:37,890
+فشل أو فشل أو فشل أو فشل أو فشل أو فشل أو فشل أو
+
+71
+00:04:37,890 --> 00:04:39,950
+فشل أو فشل أو فشل أو فشل أو فشل أو فشل أو فشل أو
+
+72
+00:04:39,950 --> 00:04:42,230
+فشل أو فشل أو فشل أو فشل أو فشل أو فشل أو فشل أو
+
+73
+00:04:42,230 --> 00:04:44,290
+فشل أو فشل أو فشل أو فشل أو فشل أو فشل أو فشل أو
+
+74
+00:04:44,290 --> 00:04:44,610
+فشل أو فشل أو فشل أو فشل أو فشل أو فشل أو فشل أو
+
+75
+00:04:44,610 --> 00:04:47,230
+فشل أو فشل أو فشل أو فشل أو فشل أو فشل أو فشل أو
+
+76
+00:04:47,230 --> 00:04:52,960
+فشل أو فشOr congestive heart failure الـ heart بطل
+
+77
+00:04:52,960 --> 00:04:57,760
+إيش؟ قبل شوية كده بنحكي عن ال blood كيف بطلع من ال
+
+78
+00:04:57,760 --> 00:05:01,480
+heart بروح ال lung وبرجع ل ال heart طب إذا ال
+
+79
+00:05:01,480 --> 00:05:06,300
+heart في failure سيئة مش هيكون فيه ممكنية لإنه
+
+80
+00:05:06,300 --> 00:05:10,700
+نعمل distribution لل oxygenated blood ويمكن أصلا
+
+81
+00:05:10,700 --> 00:05:15,340
+يكون القلب مش قادر أصلا إنه يودي ال blood على ال
+
+82
+00:05:15,340 --> 00:05:19,840
+lung علشان يسيله oxygenationهذا سيجعل المرض يدخل
+
+83
+00:05:19,840 --> 00:05:22,280
+في شك كاردوجينيكي «شوك» لأنه ليس بإمكاننا أن نجعله
+
+84
+00:05:22,280 --> 00:05:23,340
+شك كاردوجينيكي «شوك»، بل بإمكاننا أن نجعله شك
+
+85
+00:05:23,340 --> 00:05:26,440
+كاردوجينيكي
+
+86
+00:05:26,440 --> 00:05:30,120
+«support» لأنه ليس كل المرض اللي يدخل له شك
+
+87
+00:05:30,120 --> 00:05:31,080
+كاردوجينيكي «support» لديه برامج البنمون
+
+88
+00:05:31,080 --> 00:05:36,150
+الباثولوجي«للطبيعي في تشكيك كاردوجيني أو تشكيك
+
+89
+00:05:36,150 --> 00:05:41,690
+دماغ مغلق» «المطالب من نظام الهواتف قد يتسلط على
+
+90
+00:05:41,690 --> 00:05:45,770
+تحطم الكاردوفاسكولر» «لذلك، المساعدة على الطبيعي
+
+91
+00:05:45,770 --> 00:05:49,610
+بطارية ميكانيكالية» «يمكنها تقليل المطالب عن
+
+92
+00:05:49,610 --> 00:05:54,970
+الدماغ» تمام؟ هو ده هيعمل يعني allowing a patient
+
+93
+00:05:54,970 --> 00:06:00,680
+to recoverعشان هيك الـ Criteria for Institutional
+
+94
+00:06:00,680 --> 00:06:04,080
+Ventilator Support أنا لما بدأ أقرر المريض هذا
+
+95
+00:06:04,080 --> 00:06:09,260
+كويس إن أنا أعمله Intubation وأحطه على Mechanical
+
+96
+00:06:09,260 --> 00:06:14,400
+Ventilator بدأ أطلع على الـ Pulmonary Parameters
+
+97
+00:06:14,400 --> 00:06:17,780
+وعلى Arterial Blood Gases مثلا الـ Pulmonary
+
+98
+00:06:17,780 --> 00:06:21,280
+Parameters بدأ أشوف الـ Respiratory Rate بيكون
+
+99
+00:06:21,280 --> 00:06:22,800
+أكتر من 35
+
+100
+00:06:27,520 --> 00:06:32,440
+إذا كان الـ Respiratory Rate أكتر من 35، معناه أن
+
+101
+00:06:32,440 --> 00:06:39,000
+المريض تكبني كتير، بيكون بده support إذا كان الـ
+
+102
+00:06:39,000 --> 00:06:43,500
+tidal volume المريض بياخده أقل من 5 مليلتر لكل
+
+103
+00:06:43,500 --> 00:06:48,040
+kilogram من وزنه، بيكون المريض بياخد very shallow
+
+104
+00:06:48,040 --> 00:06:54,760
+briefing، إذا كانالـ Vital Capacity إذا يعني عملنا
+
+105
+00:06:54,760 --> 00:06:57,480
+قياس للـ Vital Capacity اللي بيخدها أكتر حاجة ممكن
+
+106
+00:06:57,480 --> 00:07:03,260
+يخدها المريض ولاقيناها يعني
+
+107
+00:07:03,260 --> 00:07:12,900
+ضعف الـ tidal volume بيكون المريض يعني بحتاج
+
+108
+00:07:12,900 --> 00:07:17,020
+mechanical ventilator الـ arterial blood gases كان
+
+109
+00:07:17,020 --> 00:07:22,230
+الـ pH تبع المريض أقل من 7.25يعني عنده severe
+
+110
+00:07:22,230 --> 00:07:25,870
+acidosis بكون المريض بده mechanical ventilator إذا
+
+111
+00:07:25,870 --> 00:07:30,190
+كان الـ الـ PCO2 تبع المريض partial pressure تبع
+
+112
+00:07:30,190 --> 00:07:33,870
+الـ oxygen في الـ blood أقل من ستين بكون المريض
+
+113
+00:07:33,870 --> 00:07:35,750
+بده mechanical ventilator بده الـ respiratory
+
+114
+00:07:35,750 --> 00:07:39,430
+support إذا كان الـ PCO2 partial pressure تبع
+
+115
+00:07:39,430 --> 00:07:45,000
+التاني اكسيد الكربون الـ CO2 أكتر من خمسينبكون
+
+116
+00:07:45,000 --> 00:07:49,120
+لازم أنا أعمل consideration للـ ventilation اللي
+
+117
+00:07:49,120 --> 00:07:53,080
+بيكون indicated طبعا، إيش يعني الـ vital capacity؟
+
+118
+00:07:53,080 --> 00:07:57,040
+هي الـ maximum amount of oxygen person can expel
+
+119
+00:07:57,040 --> 00:08:00,720
+from the lungs after a maximum inhalation، يعني
+
+120
+00:08:00,720 --> 00:08:04,960
+أنت كده بتقدر تفض inhalation أكتر إيش، maximum،
+
+121
+00:08:04,960 --> 00:08:07,020
+وبعدين تطلع وهذا اسمه vital capacity
+
+122
+00:08:09,560 --> 00:08:12,880
+الكمية اللي بتطلع منك في الـ Expiration بعد ما
+
+123
+00:08:12,880 --> 00:08:16,940
+تأخد Maximum Inhalation هي هتكون أكبر كمية ممكن
+
+124
+00:08:16,940 --> 00:08:20,180
+تعملها Expiration انت، تمام؟ هذي اسمها Vital
+
+125
+00:08:20,180 --> 00:08:25,520
+Capacity إذا
+
+126
+00:08:25,520 --> 00:08:30,920
+بتكون يا جماعة أقل من ضعف الـTidal Volume اللي أنت
+
+127
+00:08:30,920 --> 00:08:34,180
+المفروض بتاخده، بتكون Vital Capacity عندك Very Low
+
+128
+00:08:35,800 --> 00:08:39,300
+لما بنحكي tidal volume، إيش يعني الـ tidal volume؟
+
+129
+00:08:39,300 --> 00:08:45,220
+ال tidal volume يا جماعة هو
+
+130
+00:08:45,220 --> 00:08:50,460
+عبارة عن كمية الهواء اللي أنت ممكن تاخدها خلال ال
+
+131
+00:08:50,460 --> 00:08:55,100
+inspiration أو ال expiration بدون أي مجهود، يعني
+
+132
+00:08:55,100 --> 00:08:57,820
+بشكل طبيعي، إذاً كمية الهواء اللي أنا باخدها في
+
+133
+00:08:57,820 --> 00:09:04,360
+نفس الواحدمن غير effort، من غير تعب، من غير مجهود،
+
+134
+00:09:04,360 --> 00:09:08,460
+هذه عبارة عن الـ tidal volume قداشها تقريبا بتساوي
+
+135
+00:09:08,460 --> 00:09:11,960
+زمان كان يحكوا واحد milliliter لكل kilogram body
+
+136
+00:09:11,960 --> 00:09:15,480
+weight، الآن يحكوا من ستة إلى تمانية milliliter
+
+137
+00:09:15,480 --> 00:09:19,900
+لكل kilogram body weight، تمام؟
+
+138
+00:09:26,400 --> 00:09:29,300
+زي ما حكينا الـ tidal volume ابنعت من إنه الـ
+
+139
+00:09:29,300 --> 00:09:34,720
+tidal volume الطبيعي لمعظم الناس حوالي 500 ملي لتر
+
+140
+00:09:34,720 --> 00:09:42,020
+في كل نفسهذه بعض يعني تعريفات مهمة تلدى الـ Volume
+
+141
+00:09:42,020 --> 00:09:44,480
+إيش يعني؟ Residual Volume إيش يعني؟ Residual
+
+142
+00:09:44,480 --> 00:09:45,920
+Volume إيش يعني؟ Expiration Volume إيش يعني؟
+
+143
+00:09:45,920 --> 00:09:48,700
+Residual Volume إيش يعني؟ طبعا نحكي Residual
+
+144
+00:09:48,700 --> 00:09:53,400
+Volume يعني الكمية اللي بتضل من الهواء بعد ما تعمل
+
+145
+00:09:53,400 --> 00:09:57,580
+إيش Expiration بعد ما تعمل Maximum Exhalation لسه
+
+146
+00:09:57,580 --> 00:10:01,280
+بيضل في كمية حوالي 1200 مليلتر في الـLung لأن
+
+147
+00:10:01,280 --> 00:10:06,030
+عمرهاش الـLung بتصيرولا إيش فيها ولا لأ لسه بتظلها
+
+148
+00:10:06,030 --> 00:10:10,570
+inflated بس مش severely expanded يعني زي لما أنت
+
+149
+00:10:10,570 --> 00:10:16,350
+بتكون ماخد deep breathing عملت
+
+150
+00:10:16,350 --> 00:10:19,530
+ال maximum expiration لسه بظل فيها minimum 1200
+
+151
+00:10:19,530 --> 00:10:20,590
+ملي لتر
+
+152
+00:10:26,180 --> 00:10:29,120
+موضوعنا الـ Mechanical Ventilator لو أنا صار فيه
+
+153
+00:10:29,120 --> 00:10:32,220
+عندي مريض وبيحتاج الـ Mechanical Ventilator وبنقول
+
+154
+00:10:32,220 --> 00:10:35,620
+إنه في البداية الـ Mechanical Ventilation هذا
+
+155
+00:10:35,620 --> 00:10:41,590
+عبارة عن Two Main Typesفي حاجة اسمها Negative
+
+156
+00:10:41,590 --> 00:10:48,310
+Pressure Ventilator وطبعاً هذه قديمة جداً يمكن فيه
+
+157
+00:10:48,310 --> 00:10:52,690
+الآن استحدثت منها حاجة هفرجيكوا يعني على المبدأ
+
+158
+00:10:52,690 --> 00:10:55,950
+الـ Negative Pressure Ventilator عشان بنحكي قديمة
+
+159
+00:10:55,950 --> 00:10:59,890
+يعني برضه لازال يبقوا بخدوا من الأفكار تبعتها وفيه
+
+160
+00:10:59,890 --> 00:11:04,270
+عملوا حاجة جديدة منها تساعد الناس بس الفرق بين الـ
+
+161
+00:11:04,270 --> 00:11:06,490
+Negative Pressure Ventilator والـ Positive
+
+162
+00:11:06,490 --> 00:11:11,060
+Pressure Ventilator من الإسم Negative يعني أكيدإنه
+
+163
+00:11:11,060 --> 00:11:16,940
+احنا مابنتدخلش كتير في المريض كيف يعني؟ يعني تشي
+
+164
+00:11:16,940 --> 00:11:24,080
+انبازل عشان هيك بيسموها الـIron lungs كل بساطة لو
+
+165
+00:11:24,080 --> 00:11:30,860
+بدنا نتطلع على الصورة المريض بيكون داخل جهاز ال
+
+166
+00:11:30,860 --> 00:11:37,020
+lung تبعته عليها حواليها air ال air هذا بيزيد
+
+167
+00:11:37,020 --> 00:11:42,560
+الضغطيعني حجمه بيزيد فبيزيد الضغط على ال lung
+
+168
+00:11:42,560 --> 00:11:46,120
+فبعمل pressure على ال lung بعد شوية ال air بيسيله
+
+169
+00:11:46,120 --> 00:11:50,580
+release بطلع هذا ال air ال ambient air المحيط فيك
+
+170
+00:11:50,580 --> 00:11:55,660
+يعني okay بطلع ال هوا برا فبقل الضغط فال lung
+
+171
+00:11:55,660 --> 00:12:02,060
+بتعمل relaxation لما بتعملContraction، إيش بيصير؟
+
+172
+00:12:02,060 --> 00:12:06,200
+Expiration لو بتعمل Relaxation، بيصير Inspiration
+
+173
+00:12:06,200 --> 00:12:09,500
+وبالتالي انت بيحققولك عملية تنفس من جهة الـ
+
+174
+00:12:09,500 --> 00:12:12,720
+Invasive من غير ما يحطوا انتوا تركيا تيوب ويضخوا
+
+175
+00:12:12,720 --> 00:12:16,500
+فيك أو في المريض any amount of air انت المسئول انك
+
+176
+00:12:16,500 --> 00:12:20,890
+تاخد ال amount of air اللي بتناسبكوانت المسئول انك
+
+177
+00:12:20,890 --> 00:12:24,570
+تطلق الـ amount of air هادي ولكن في pressure على
+
+178
+00:12:24,570 --> 00:12:27,510
+ال lung زي اللي بيعملوا تقوم الفيزيو تراب بإيديهم
+
+179
+00:12:27,510 --> 00:12:34,590
+عشان يساعدك to exhale and inspire it بس عن طريق ال
+
+180
+00:12:34,590 --> 00:12:38,350
+pressure اللي بيعملوا الهواء عشان هيك ال negative
+
+181
+00:12:38,350 --> 00:12:41,050
+pressure ventilator اللي بيسموها ال iron lung ده
+
+182
+00:12:41,050 --> 00:12:44,030
+create a negative pressure environment around the
+
+183
+00:12:44,030 --> 00:12:47,930
+patient's chest‏and sucking air into the lungs
+
+184
+00:12:47,930 --> 00:12:51,990
+‏بالتالي لما بزيد ال pressure حواليك ‏بعمل ضغط
+
+185
+00:12:51,990 --> 00:12:56,330
+عليك بعمل pressure ‏فبخليك تطلع الهواء من ال chest
+
+186
+00:12:56,330 --> 00:13:01,970
+من الأتناء ‏بعدين
+
+187
+00:13:01,970 --> 00:13:07,550
+بقل ال pressure ‏بطلع من الهواء اللي حواليك ‏بطلع
+
+188
+00:13:07,550 --> 00:13:11,130
+من برا شوية هواء فبقل الضغط ‏فبتعمل relaxation
+
+189
+00:13:14,690 --> 00:13:17,730
+إنها تعمل الـ Inspiration إنها تشير إلى أن المريض
+
+190
+00:13:17,730 --> 00:13:20,690
+يجب أن يكون لديه لغة إلاستيسية لازم يكون أصلا
+
+191
+00:13:20,690 --> 00:13:25,510
+المريض الإلاستيسي لغته كويسة لغته لغته لغته لغته
+
+192
+00:13:25,510 --> 00:13:26,070
+لغته لغته لغته لغته لغته لغته لغته لغته لغته لغته
+
+193
+00:13:26,070 --> 00:13:26,890
+لغته لغته لغته لغته لغته لغته لغته لغته لغته لغته
+
+194
+00:13:26,890 --> 00:13:27,230
+لغته لغته لغته لغته لغته لغته لغته لغته لغته لغته
+
+195
+00:13:27,230 --> 00:13:29,150
+لغته لغته لغته لغته لغته لغته لغته لغته لغته لغته
+
+196
+00:13:29,590 --> 00:13:33,690
+الذي يتطلب الانتباه من الطائرة لكن الـ Positive
+
+197
+00:13:33,690 --> 00:13:36,930
+Pressure Ventilation اللي هو الآن حاليًا مستخدم
+
+198
+00:13:36,930 --> 00:13:40,910
+بشكل واعي يزيد الضغط في الطائرة من خلال
+
+199
+00:13:40,910 --> 00:13:43,850
+الـEndotracheal أو الـTracheostomy يعني أنا حاطط
+
+200
+00:13:43,850 --> 00:13:49,370
+Endotracheal انتباه تيوب في داخل التراكية وبالتالي
+
+201
+00:13:49,370 --> 00:13:56,760
+و بعمل فيه«Push to amount of air» حسب «Tidal
+
+202
+00:13:56,760 --> 00:14:00,460
+volume preceded» أنا عامله وحسب frequency أنا
+
+203
+00:14:00,460 --> 00:14:03,680
+عاملها، يعني rate معين أكتر مرة بدليش هذا يصير،
+
+204
+00:14:03,680 --> 00:14:08,680
+عشر مرات، اتناشر مرة في الدقيقة براميتر معينة بحيث
+
+205
+00:14:08,680 --> 00:14:11,840
+الـ«pressure» يكون كذا بحيث كمية الـ«oxygen» في
+
+206
+00:14:11,840 --> 00:14:16,680
+الهواء اللي خاشش هذا كمية الهواء هذه تكون كذاأو
+
+207
+00:14:16,680 --> 00:14:20,100
+لأنه احنا يا جماعة ماتنفسش كل اللي ماتنفس وكسوجين،
+
+208
+00:14:20,100 --> 00:14:23,740
+احنا نتنفس الهواء، الهواء تركيز الوكسوجين قدش فيه
+
+209
+00:14:24,980 --> 00:14:29,280
+21% فقط، وليس الهواء اللي حوالنا تركيز الأكسجين في
+
+210
+00:14:29,280 --> 00:14:35,100
+21% فاحنا بنتنفس تركيز الأكسجين في 21% وكذلك
+
+211
+00:14:35,100 --> 00:14:38,860
+المريض، بدنا نديله كمية هوا، بس مش كلها بدتكون
+
+212
+00:14:38,860 --> 00:14:43,860
+pure oxygen مش 100% أكسجين، مش 100% أكسجين، لأ،
+
+213
+00:14:43,860 --> 00:14:47,560
+لازم تكون فيها تركيز لأن أكسجين في النهاية is a
+
+214
+00:14:47,560 --> 00:14:53,150
+drug، so you cannot give 100% أكسجين، لأن ربنايعني
+
+215
+00:14:53,150 --> 00:14:58,430
+لو إن الـ Oxygen 100% مش مضرر، يا رب نخلّقنا اللي
+
+216
+00:14:58,430 --> 00:15:02,250
+هو اللي بنتنفس 100% Oxygen، ليش نخلّق التركيز 21%؟
+
+217
+00:15:02,250 --> 00:15:05,130
+لأن أحنا هذا اللي بنحتاجه، أه okay ممكن أحيانًا ال
+
+218
+00:15:05,130 --> 00:15:08,590
+demand تبعتنا حاجتنا لل Oxygen تزيد، أه ممكن عشان
+
+219
+00:15:08,590 --> 00:15:12,790
+هيك أحنا في المريض اللي Intubated ممكن نديله تركيز
+
+220
+00:15:12,790 --> 00:15:19,490
+أكتر من 21% فيه، أرقم من 21%40%، 50%، 60%، بس أكتر
+
+221
+00:15:19,490 --> 00:15:23,750
+بنبدأ نكون في حذر لإنه أكتر من 8% بتبدأ risk تبع
+
+222
+00:15:23,750 --> 00:15:28,710
+الـ Oxygen toxicity تزيد عشان هي كمية الهواء اللي
+
+223
+00:15:28,710 --> 00:15:32,650
+بدأ تخش إلها ضوابط، قداش بدأ تكون كمية الهواء،
+
+224
+00:15:32,650 --> 00:15:35,890
+قداش ال frequencies تبعتها، تكون قداش بدأ تبحق،
+
+225
+00:15:35,890 --> 00:15:40,340
+يعني قداش يكون ال rateعن كم يجب أن يكون الـ
+
+226
+00:15:40,340 --> 00:15:44,400
+Concentration
+
+227
+00:15:44,400 --> 00:15:48,440
+of Oxygen فيها، ستجد هذا الكلام في الـ Setting
+
+228
+00:15:48,440 --> 00:15:48,900
+Extra
+
+229
+00:15:51,490 --> 00:15:55,690
+يعني هنا بيحكينا في الـ «سلايد» هذه كيف بالظبط
+
+230
+00:15:55,690 --> 00:16:01,210
+بتصير العملية تبع حركة الـ «دياجرام» during
+
+231
+00:16:01,210 --> 00:16:03,870
+inhalation طبعاً كلنا عارفين إنه في
+
+232
+00:16:03,870 --> 00:16:07,410
+الـ«إنسبايراشن» الـ«دياجرام» بالخلاتات عشان يعمل
+
+233
+00:16:07,410 --> 00:16:11,110
+«full lung expanded» في الـ«إكسبايراشن»بطلع الـ
+
+234
+00:16:11,110 --> 00:16:15,250
+diaphragm لفوق مع حركة الـ intercostal muscle و
+
+235
+00:16:15,250 --> 00:16:21,690
+الـ lung الـ CCT بتعمل pressure فتخليك تعمل
+
+236
+00:16:21,690 --> 00:16:26,830
+expiration و بالعكس لما بتعمل inspiration
+
+237
+00:16:29,690 --> 00:16:32,530
+Types of Positive Pressure اللي بهمنا أحنا في
+
+238
+00:16:32,530 --> 00:16:35,070
+الموضوع Negative Pressure في الـ Ventilation حكينا
+
+239
+00:16:35,070 --> 00:16:40,410
+إنه Old Fashion حكيت إنه فيه إنه حاجة يعني حديثة
+
+240
+00:16:40,410 --> 00:16:45,470
+بيستخدموها عشان تساعد الناس و Negative هفرجيكوا
+
+241
+00:16:45,470 --> 00:16:50,530
+إياها فبنركز على الـ Pressure Cycle Ventilator الـ
+
+242
+00:16:50,530 --> 00:16:52,030
+Pressure Cycle Ventilator
+
+243
+00:16:55,740 --> 00:16:58,200
+أو بنركز على الـ Post Pressure Ventilation اللي
+
+244
+00:16:58,200 --> 00:17:04,080
+بنقسم له تلت أنواعممكن يكون pressure cycle أو
+
+245
+00:17:04,080 --> 00:17:10,460
+volume cycle أو time cycle إيش الفرق بين pressure
+
+246
+00:17:10,460 --> 00:17:17,220
+cycle و volume cycle و time cycle؟ هدولة كلهم إيش؟
+
+247
+00:17:17,220 --> 00:17:21,640
+positive pressure pressure cycle يعني قليل
+
+248
+00:17:21,640 --> 00:17:29,110
+لاستخدامه القصة فيه أننا نعتمد على pressureأو فرق
+
+249
+00:17:29,110 --> 00:17:32,410
+الـ Pressure في كمية الهواء اللي بدها تخش للمريض
+
+250
+00:17:32,410 --> 00:17:36,270
+في كل مرة يعني أنا في الـ Volume Cycle اللي بدها
+
+251
+00:17:36,270 --> 00:17:38,410
+أبدأ أشرح فيه عشان يبين الفرق بينه و بين ال
+
+252
+00:17:38,410 --> 00:17:41,930
+pressure أنا بكون حاطط للمريض كمية الهواء اللي
+
+253
+00:17:41,930 --> 00:17:46,830
+المفروض تخش للمريض في كل نفس نقطة 500 CCطبعا كيف
+
+254
+00:17:46,830 --> 00:17:54,830
+بنحدده؟ 500 CC طبعا
+
+255
+00:17:54,830 --> 00:17:58,110
+كيف بنحدده؟ 500 CC طبعا كيف بنحدده؟ 500 CC طبعا
+
+256
+00:17:58,110 --> 00:17:58,170
+كيف بنحدده؟ 500 CC طبعا كيف بنحدده؟ 500 CC طبعا
+
+257
+00:17:58,170 --> 00:17:58,650
+كيف بنحدده؟ 500 CC طبعا كيف بنحدده؟ 500 CC طبعا
+
+258
+00:17:58,650 --> 00:17:58,930
+كيف بنحدده؟ 500 CC طبعا كيف بنحدده؟ 500 CC طبعا
+
+259
+00:17:58,930 --> 00:17:59,090
+كيف بنحدده؟ 500 CC طبعا كيف بنحدده؟ 500 CC طبعا
+
+260
+00:17:59,090 --> 00:17:59,590
+كيف بنحدده؟ 500 CC طبعا كيف بنحدده؟ 500 CC طبعا
+
+261
+00:17:59,590 --> 00:18:05,140
+كيف بنحدده؟ 500 CC طبعا كيف بنحدده؟ 500 CC طبعطيب،
+
+262
+00:18:05,140 --> 00:18:08,460
+الـ Volume Cycle Ventilator الـ Volume Cycle
+
+263
+00:18:08,460 --> 00:18:13,200
+Ventilator افترضنا إننا بدنا نحط 500 CC للمريض،
+
+264
+00:18:13,200 --> 00:18:18,260
+okay؟ إذن، في كل breathing، المريض هياخد 500 CC
+
+265
+00:18:18,260 --> 00:18:24,060
+هدول هيعملوا ضغط معين إذا زادت ضغط نتيجة وجود مثلا
+
+266
+00:18:24,060 --> 00:18:29,080
+Secretions تانية أو حد يحدين الـ Pressure Alarm
+
+267
+00:18:29,080 --> 00:18:33,320
+إنه فيهإنكريز في الـ pressure بير بار هجيسلي
+
+268
+00:18:33,320 --> 00:18:36,920
+يعطيني إنه فيه increase في ال pressure لكن في ال
+
+269
+00:18:36,920 --> 00:18:40,540
+pressure cycle أنا بكون عامل set ل repressure بس
+
+270
+00:18:40,540 --> 00:18:44,600
+بكون حاكل الجهاز إنه أنا بدي ال pressure مازيدش عن
+
+271
+00:18:44,600 --> 00:18:48,680
+مثلا خمسة و عشرين و ال pressure اللي بدي يكون داخل
+
+272
+00:18:48,680 --> 00:18:51,020
+ال lung مثلا خمسة و عشرين فهو بيصير في ال
+
+273
+00:18:51,020 --> 00:18:54,720
+expiration يقل ال pressureلما بدّي جدّي
+
+274
+00:18:54,720 --> 00:18:58,060
+inspiration تاني بيضلوا يعطيه لما يوصل الـ
+
+275
+00:18:58,060 --> 00:19:02,640
+brochure لعين 25، هذه الفرق في الـ volume cycle،
+
+276
+00:19:02,640 --> 00:19:07,980
+لأ احنا فيه بريست volume من الـ tidal volume
+
+277
+00:19:09,300 --> 00:19:12,900
+بندّيهم كل مرة The peak inspiratory pressure must
+
+278
+00:19:12,900 --> 00:19:17,820
+be monitored in volume moods because it varies
+
+279
+00:19:17,820 --> 00:19:19,900
+from breed to breed زي ما حكينا ممكن زاد
+
+280
+00:19:19,900 --> 00:19:23,260
+desecration في المريض أخر spontaneous فعشان هيك
+
+281
+00:19:23,260 --> 00:19:27,460
+لازم احنا نراقبالـ Peak Inspiratory Pressure مع كل
+
+282
+00:19:27,460 --> 00:19:31,080
+نفس لوين بيصل وبنكون عاملين Setting إنه إذا زي 50
+
+283
+00:19:31,080 --> 00:19:34,540
+أعمل اللار علشان أري أشوف إيش المشكلة يمكن المريض
+
+284
+00:19:34,540 --> 00:19:37,520
+Fighting يمكن يعني أنا بخشش 500 لكن هو Fighting
+
+285
+00:19:37,520 --> 00:19:39,980
+عامل Resistant عامل Bite للـ Tube
+
+286
+00:19:42,790 --> 00:19:46,670
+الـ500 مش يفلقين مكان، إذا كان فيه step lung هو
+
+287
+00:19:46,670 --> 00:19:51,210
+المريض fighting، مالهمش، مافيش full expansion
+
+288
+00:19:51,210 --> 00:19:54,630
+للـlung، مالهمش مكان يعدوا فيه، فبصير جاهز يديني
+
+289
+00:19:54,630 --> 00:19:58,990
+الـLung الـTime
+
+290
+00:19:58,990 --> 00:20:02,150
+Cycle، إيش اللي هيخلف في الـTime Cycle؟ إن أنا
+
+291
+00:20:02,150 --> 00:20:05,050
+بكون تعدى الـVolume and Pressure is variable
+
+292
+00:20:05,050 --> 00:20:09,550
+according to pressure or ventilator
+
+293
+00:20:12,840 --> 00:20:17,920
+كيف يعني؟ يعني الـ Ventilator بـ bushes air in too
+
+294
+00:20:17,920 --> 00:20:24,900
+long until pre-set time has elapsed. The volume of
+
+295
+00:20:24,900 --> 00:20:29,200
+air patients receive is regularly regulated by the
+
+296
+00:20:29,200 --> 00:20:32,660
+length of inspiration and flow rate of the air.
+
+297
+00:20:32,820 --> 00:20:37,060
+إيش يعني؟ يعني أنا بدي له أنه التعدى للـ volume
+
+298
+00:20:37,060 --> 00:20:42,250
+بدي يخش في زمن سانيتينوتسمح له أربع ثواني مثلا أنه
+
+299
+00:20:42,250 --> 00:20:48,110
+يصير Inspiration الـFlow أنا بكون محدد الـFlow تبع
+
+300
+00:20:48,110 --> 00:20:52,070
+الـAir لكن مش محدد كمية الهواء بالظبط أنها تكون
+
+301
+00:20:52,070 --> 00:20:56,010
+خمسمية، لأ محدد الـFlow مثلا يكون نفترض
+
+302
+00:20:59,100 --> 00:21:04,820
+خمسمية أو نفترض خمسة لتر في الدقيقة وانا محدد ان
+
+303
+00:21:04,820 --> 00:21:09,600
+الـ Inspiration Cycle تكون Two Seconds فهيدخل
+
+304
+00:21:09,600 --> 00:21:14,200
+المريض على الـ Flow الـ Preset انه خمسة لتر زي ما
+
+305
+00:21:14,200 --> 00:21:17,040
+افترضنا في الدقيقة هيدخل في خلال السنيتين هدول
+
+306
+00:21:17,040 --> 00:21:22,060
+كمية الهواء اللي عاش في هذا الوقت من الـ Flow اللي
+
+307
+00:21:22,060 --> 00:21:24,320
+جاي بمقدار خمسة لتر في الدقيقة
+
+308
+00:21:27,290 --> 00:21:33,490
+عادةً بستخدم الـTime Cycled هذا في
+
+309
+00:21:33,490 --> 00:21:38,470
+الحضانات ولو أنه Limited يعني
+
+310
+00:21:42,800 --> 00:21:46,200
+بدنا نحكي الآن إذا نلقي تلخصنا إنه الـ «Positive
+
+311
+00:21:46,200 --> 00:21:50,220
+Pressure Ventilator» يلو تلت أنواع الـP Pressure
+
+312
+00:21:50,220 --> 00:21:54,660
+Cycle وVolume Cycle وTime Cycle حكينا إنه
+
+313
+00:21:54,660 --> 00:22:01,700
+الـVolume Cycle هي الـ«Commonly Used Cycle of
+
+314
+00:22:01,700 --> 00:22:05,580
+Ventilation» عادة نستخدمها لإنه بيكون وهي المناسبة
+
+315
+00:22:05,580 --> 00:22:07,160
+جدا للـAdult
+
+316
+00:22:08,970 --> 00:22:12,830
+الـ Modes of Ventilation ما هي الـ Modes اللي
+
+317
+00:22:12,830 --> 00:22:18,510
+نستخدمها عشان نشغل الـ Mechanical Ventilator
+
+318
+00:22:18,510 --> 00:22:22,650
+عليها؟ يا جماعة الـ Ventilator يعني مش شبهه أنا
+
+319
+00:22:22,650 --> 00:22:25,090
+دلوقتي في الكمبيوتر يعني أنت عندك كمبيوتر بس بدك
+
+320
+00:22:25,090 --> 00:22:29,830
+نظام تشغيل يعني أنا عشان أفتح PowerPoint بدي
+
+321
+00:22:29,830 --> 00:22:31,930
+Microsoft Office فيه PowerPoint Microsoft
+
+322
+00:22:31,930 --> 00:22:36,450
+PowerPointطبعاً فانا بدي نظام تشغيل عشان أبدأ أحط
+
+323
+00:22:36,450 --> 00:22:42,130
+ال data أو ال parameters اللي أنا بديها، كويس؟
+
+324
+00:22:42,130 --> 00:22:45,530
+فعشان هي كل mood له parameters معينة فانا بختار ال
+
+325
+00:22:45,530 --> 00:22:47,930
+moods و بعدين بختار ال parameters اللي بتناسب ال
+
+326
+00:22:47,930 --> 00:22:55,710
+moods أشهى ال moods المشهورة للventilation؟ في ND
+
+327
+00:22:55,710 --> 00:23:00,710
+طبعاً لل volume فيه moods ولل repressor فيه moods
+
+328
+00:23:01,270 --> 00:23:04,150
+مش حاكينا إنه فيه Volume Cycle وفيه Pressure Cycle
+
+329
+00:23:06,380 --> 00:23:10,880
+الـ Volume Modes المشهورة جدا واحد اسمه
+
+330
+00:23:10,880 --> 00:23:14,060
+«Controlled Mandatory Ventilation» «Controlled
+
+331
+00:23:14,060 --> 00:23:17,140
+Mandatory Ventilation» التاني اسمه «Assist
+
+332
+00:23:17,140 --> 00:23:20,340
+Control» «Assist Control Mandatory Ventilation»
+
+333
+00:23:20,340 --> 00:23:22,180
+يعني «Control Mandatory Ventilation» بس فيه
+
+334
+00:23:22,180 --> 00:23:26,140
+assistant اللي بتعطوف الفرق من كل واحد التالت اسمه
+
+335
+00:23:26,140 --> 00:23:29,540
+«Intermittent Mandatory Ventilation» IMV الرابع
+
+336
+00:23:29,540 --> 00:23:32,060
+اسمه «Synchronized Intermittent Mandatory
+
+337
+00:23:32,060 --> 00:23:37,610
+Ventilation»تمام؟ الـ Pressure Modes هدولة زي الـ
+
+338
+00:23:37,610 --> 00:23:40,190
+Pressure Control Ventilation و الـ Pressure
+
+339
+00:23:40,190 --> 00:23:42,510
+Support Ventilation و الـ Continuous Positive
+
+340
+00:23:42,510 --> 00:23:47,890
+Airway Pressure و الـ Positive and Expiratory
+
+341
+00:23:47,890 --> 00:23:59,210
+Pressure و الـ Non-invasive Bilevel
+
+342
+00:23:59,210 --> 00:24:02,820
+Positive Airway Pressure VentilationNon-invasive
+
+343
+00:24:02,820 --> 00:24:06,300
+by Level Positive Airway Pressure Ventilation «بي
+
+344
+00:24:06,300 --> 00:24:11,040
+باب» بنسميه حنبدأ نفصل في كل واحد منهم بالظبط
+
+345
+00:24:11,040 --> 00:24:14,760
+ونشوف كيف بيشتغل بكل بساطة لما بنحكي عن
+
+346
+00:24:14,760 --> 00:24:19,090
+الـcontrolled mandatory ventilationالـ «Control of
+
+347
+00:24:19,090 --> 00:24:21,430
+Mandatory Ventilation» له advantage ولا
+
+348
+00:24:21,430 --> 00:24:25,610
+disadvantage؟ طب هو إيش أصلا بيسوي؟ هو بيدي كمية
+
+349
+00:24:25,610 --> 00:24:29,570
+هوة للمريض بـ «Reset» أنا عامل الهواء، أنا بدي أدي
+
+350
+00:24:29,570 --> 00:24:34,250
+المريض مثلا 500 CC تايدال بوليوم 12 مرة في
+
+351
+00:24:34,250 --> 00:24:39,250
+الدقيقة، أه، okay بس في هذه الحالة لازم يكون
+
+352
+00:24:39,250 --> 00:24:45,270
+المريض مافيش عنده أي interaction يعني لازم المريض
+
+353
+00:24:45,270 --> 00:24:51,080
+يكون مسلمويأخذ كل الكمية الهواء هذه من غير ما
+
+354
+00:24:51,080 --> 00:24:55,900
+يستطيع إنه يأخذ نفس تاني علشان ذلك الـ advantage
+
+355
+00:24:55,900 --> 00:24:59,820
+إن
+
+356
+00:24:59,820 --> 00:25:04,200
+الـ muscles تبعت ال patient لحالة ما بتتحركش، بس
+
+357
+00:25:04,200 --> 00:25:05,160
+بالجهاز
+
+358
+00:25:07,780 --> 00:25:11,680
+لكن الـ Disadvantage أن المريض لا يستطيع أن يبدأ
+
+359
+00:25:11,680 --> 00:25:17,220
+نفسه لحاله لا يستطيع أن يشارك في عملية النفس أو
+
+360
+00:25:17,220 --> 00:25:28,940
+يبدأ هو عملية النفس عشان هيك المريض
+
+361
+00:25:28,940 --> 00:25:33,420
+يجب أن يأخذ مستر رلاكسانعشان أمشي على control
+
+362
+00:25:33,420 --> 00:25:35,980
+dependent or ventilation لأنه مش مسموح ليشارك
+
+363
+00:25:35,980 --> 00:25:39,060
+عملية التنفس وبالتالي هذا من أهم ال disadvantages
+
+364
+00:25:39,060 --> 00:25:44,380
+تبع ال mood هذا إنه أنا بدي ساعة ما أحط ال
+
+365
+00:25:44,380 --> 00:25:48,100
+mechanical ventilator أبدأ أفكر في الساعة اللي أنا
+
+366
+00:25:48,100 --> 00:25:50,420
+بدي أعمله weaning و أفطم عن ال mechanical
+
+367
+00:25:50,420 --> 00:25:55,640
+ventilator آه، إذن هذا ال mood مش هينسبني لأنه
+
+368
+00:25:55,640 --> 00:25:59,820
+بيخلي المريض يظل أكتر وقت ممكن dependent على ال
+
+369
+00:25:59,820 --> 00:26:07,170
+mechanical ventilatorطيب، إيش الحل؟ حاولوا يحلوا
+
+370
+00:26:07,170 --> 00:26:12,110
+الموضوع شوية تقدم فعملوا assist control mode دي
+
+371
+00:26:12,110 --> 00:26:16,370
+يعني خلوا الـ patient may initiate a breath on his
+
+372
+00:26:16,370 --> 00:26:23,650
+own أنه أنت المريض ممكن يبدأ هو يبدأ عملية النفس
+
+373
+00:26:23,650 --> 00:26:27,990
+لكن في كل مرة المريض بيبدأ بياخد الـ preset tidal
+
+374
+00:26:27,990 --> 00:26:31,610
+volume بياخد اللي أنا already حاطه، بياخد 500
+
+375
+00:26:31,610 --> 00:26:36,220
+مثلاًومش بس في عدد الـ «Return» اللي أنا حطيت 12
+
+376
+00:26:36,220 --> 00:26:37,080
+يعني بدي أخد 12
+
+377
+00:26:40,120 --> 00:26:43,060
+القصة هي إنه يستطيع إنه يعمل initiation
+
+378
+00:26:43,060 --> 00:26:46,140
+للـbreathing لكن الـclient يستطيع إنشاء
+
+379
+00:26:46,140 --> 00:26:49,600
+الـbreathing اللي يتم إدارته في الـpreced tidal
+
+380
+00:26:49,600 --> 00:26:53,320
+volume أنا حامل الـ3500 مش اللي بدهويا مش زي ما هو
+
+381
+00:26:53,320 --> 00:26:56,180
+بدهو الـtotal respiratory rate is determined by
+
+382
+00:26:56,180 --> 00:27:00,080
+the number of spontaneous inspiration initiated by
+
+383
+00:27:00,080 --> 00:27:05,020
+the patient plus the number of breathes set on the
+
+384
+00:27:05,020 --> 00:27:10,360
+ventilatorأنا حاططله إنه ياخد 12، الـ 12 اللي أنا
+
+385
+00:27:10,360 --> 00:27:15,120
+كاتبهم أو عامل setting لهم، هياخد إيه؟ لازم ياخدهم
+
+386
+00:27:16,490 --> 00:27:20,950
+أوكي هو يبدأ عملية التنفس يبدأ أهلا وسهلا كل مرة
+
+387
+00:27:20,950 --> 00:27:24,070
+بيبدأ الجهاز بتدله الخمسمية اللي هي محتوطة sitting
+
+388
+00:27:24,070 --> 00:27:29,410
+بده ياخد كمان جهاز حيسمحله حيديله برضه كمان ايش
+
+389
+00:27:29,410 --> 00:27:33,130
+كمان خمسمية زيادة كل مرة لأن هذا ال volume اللي
+
+390
+00:27:33,130 --> 00:27:36,830
+مسموح ياخده لمن بده يبدأ عملية نفس مثلا هو خمسمية
+
+391
+00:27:36,830 --> 00:27:40,050
+زي ما أنا عامل pre-sitting عشان هيك واضح جدا أنه
+
+392
+00:27:40,050 --> 00:27:47,070
+أنا جاعد بزود ال respiratory rate لـأو بزود كمية
+
+393
+00:27:47,070 --> 00:27:51,750
+الـ «minute volume» خلّينا نسميها يعني كمية الهواء
+
+394
+00:27:51,750 --> 00:27:54,550
+اللي بتخشط المريض في الدقيقة الواحدة اللي هي إيش
+
+395
+00:27:54,550 --> 00:27:58,110
+عبارة؟ عبارة عن الـ tidal volume اللي بخشط المريض
+
+396
+00:27:58,110 --> 00:28:03,410
+ضارب ال rate إذا المريض أنا حاططه 12 و باخد مثلا 8
+
+397
+00:28:03,410 --> 00:28:07,090
+لحالة سبونتينات صار 20 respiratory rate كل مرة
+
+398
+00:28:07,090 --> 00:28:17,430
+باخد فيه 500 اللي هو 20 ضارب 500فهي صارت عشر تلاف
+
+399
+00:28:17,430 --> 00:28:22,310
+CC في الـ Minute Volume تبعه في كل دقيقة هذا عمل
+
+400
+00:28:22,310 --> 00:28:27,230
+للمريض Hyperventilationخلّى الـ «CO2» يتسير واطي،
+
+401
+00:28:27,230 --> 00:28:30,010
+إذًا من الـ advantage تبعه إنه بيخلّي ال patient
+
+402
+00:28:30,010 --> 00:28:33,810
+يعمل initiation ويشارك في عملية النفس كinitiation
+
+403
+00:28:33,810 --> 00:28:36,410
+de-breathing وهذا بيخلّي ال muscle تبع ال
+
+404
+00:28:36,410 --> 00:28:40,910
+«breathing» تبع ال patient يعني تبع ال «breathing»
+
+405
+00:28:40,910 --> 00:28:45,830
+كويسة، ليش؟ لأنها active، مش بس بس الجهاز بتنفس
+
+406
+00:28:45,830 --> 00:28:48,970
+إليها، لأ هو بيشارك، بيبدأ يعمل عملية النفس بس
+
+407
+00:28:48,970 --> 00:28:53,190
+بياخد ال «tidal volume» اللي احنا already حطينهلكن
+
+408
+00:28:53,190 --> 00:28:55,970
+المشكلة تبعته، طبعاً هذا محتاج الـ Sedation لأن
+
+409
+00:28:55,970 --> 00:28:58,610
+المريض لازم يكون صاحي مازال يدرد عملية النفط، لكن
+
+410
+00:28:58,610 --> 00:29:03,390
+المشكلة تبعته بالـ Hyperventilation طب إننا نخلص
+
+411
+00:29:03,390 --> 00:29:06,410
+من مشكلة الـ Hyperventilation، جال إحنا مانعش إلا
+
+412
+00:29:06,410 --> 00:29:11,240
+نخل المريض مش بسإشارة، لأ، بنخلّيه يشارك في عملية
+
+413
+00:29:11,240 --> 00:29:14,560
+النفس وياخد الـ tidal volume اللي بدّويا مش الـ
+
+414
+00:29:14,560 --> 00:29:19,000
+preset اللي احنا بناحطينه كل مرة خمسمية، خمسمية
+
+415
+00:29:19,000 --> 00:29:22,480
+فعمله mood اسمه «Intermittent Mendatory
+
+416
+00:29:22,480 --> 00:29:26,960
+Ventilation» آه، يعني الإجبارية متقطعة يعني بين
+
+417
+00:29:26,960 --> 00:29:30,560
+النفس الإجباري والنفس الإجباري في إمكانية المريض
+
+418
+00:29:30,560 --> 00:29:35,040
+ياخد نفس وبالـ tidal volume اللي هو بدويا مش بالـ
+
+419
+00:29:35,040 --> 00:29:39,230
+tidal volumeاللي احنا لما already عاملينه pre
+
+420
+00:29:39,230 --> 00:29:42,490
+-setting اللي هو بيديه ياخد 200 وياخد 200 و300
+
+421
+00:29:42,490 --> 00:29:48,730
+و300 المشكلة هنا اعتبر انه بين النفس الإجباري
+
+422
+00:29:48,730 --> 00:29:51,970
+والنفس الإجباري إيجي المريض بياخد نفس في نفس الوقت
+
+423
+00:29:51,970 --> 00:29:57,550
+فهيبقوش نفسين هو أخد 200 والجهاز قدله 500 نفس
+
+424
+00:29:57,550 --> 00:30:01,730
+الوقت خش طيب ده volume كبيرإذا الـ Client
+
+425
+00:30:01,730 --> 00:30:05,030
+increases spontaneous at any tidal volume between
+
+426
+00:30:05,030 --> 00:30:07,950
+the mechanical bridges اللي هم الإجباريات، إذا الـ
+
+427
+00:30:07,950 --> 00:30:11,990
+disadvantage هنا أنه ممكن يصير كمية هو تخش كتيرة،
+
+428
+00:30:11,990 --> 00:30:15,310
+هذا بيسميه بارا trauma بارا من ال pressure، يعني
+
+429
+00:30:15,310 --> 00:30:20,450
+بارا اللي هو واحدة في قياس الضغط البار، بارا
+
+430
+00:30:20,450 --> 00:30:24,330
+trauma يعني trauma بسبب الضغط، عشان هي اسمها بارا
+
+431
+00:30:24,330 --> 00:30:30,650
+traumaتمام؟ إذن الـ primary disadvantage is a
+
+432
+00:30:30,650 --> 00:30:34,590
+chance for brief stacking، therefore care should
+
+433
+00:30:34,590 --> 00:30:37,550
+be taken to set high pressure limit properly to
+
+434
+00:30:37,550 --> 00:30:46,010
+reduce risk of barotrauma، إذن لسه، لسه النفس أو
+
+435
+00:30:46,010 --> 00:30:52,400
+ال mood هذاما حلش المشكلة طب كيف نحل المشكلة؟ نحل
+
+436
+00:30:52,400 --> 00:30:56,520
+المشكلة إنه نمنع إنه يلقي نفس الإجباري تبع المريض
+
+437
+00:30:56,520 --> 00:31:01,600
+مع نفس الإجبار اللي بدي يديه جهاز للمريض مع النفس
+
+438
+00:31:01,600 --> 00:31:04,080
+الـ spontaneous اللي بدي ياخده المريض طب كيف
+
+439
+00:31:04,080 --> 00:31:08,300
+نمنعها هاي؟ عن طريق الـSynchronization خاصية اسمها
+
+440
+00:31:08,300 --> 00:31:11,720
+الـTrigger Sensitivity حطوها في الجهاز، إيش
+
+441
+00:31:11,720 --> 00:31:20,720
+وظيفتها؟من يبدأ الـ Briefing؟ من يبدأ عملية النفس؟
+
+442
+00:31:20,720 --> 00:31:23,360
+أنت مريض ولا جهاز؟
+
+443
+00:31:28,840 --> 00:31:32,840
+المريض بده يبدأ أوجه في جهاز، أصبر، لما المريض
+
+444
+00:31:32,840 --> 00:31:36,400
+يخلص، بعدين أنت بتديه، خلص، عمل inspiration، عمل
+
+445
+00:31:36,400 --> 00:31:39,660
+exploration، أديه، في مصطفى الطريق فلس المريض، أخد
+
+446
+00:31:39,660 --> 00:31:44,060
+بس 150، و المفروض ياخد 500، okay الجهاز بيكمله، و
+
+447
+00:31:44,060 --> 00:31:48,710
+بيديه 350، و بنحسب عليه نفس، ممتازإذاً هذا إيش
+
+448
+00:31:48,710 --> 00:31:51,410
+الـMode اسمه؟ هذا الـMode اسمه Synchronized،
+
+449
+00:31:51,410 --> 00:31:52,970
+Intermittent من الـDetergent، يعني هو
+
+450
+00:31:52,970 --> 00:31:55,310
+الـIntermittent من الـDetergent الـVentilation، بس
+
+451
+00:31:55,310 --> 00:31:58,490
+فيه Synchronization بينه وبين العيال، فيه تنامم
+
+452
+00:31:58,490 --> 00:32:02,550
+بينه وبين العيال، فيه تزامن بينه وبين العيال، كيف
+
+453
+00:32:02,550 --> 00:32:06,870
+تزامن؟ إن وقت ما فيه نفس، المريض بدي يأخذه ويحصل
+
+454
+00:32:06,870 --> 00:32:07,230
+دوقة
+
+455
+00:32:10,530 --> 00:32:14,830
+فعشان هي كفي بينه وبين الأيان تناغم «Breeze at
+
+456
+00:32:14,830 --> 00:32:17,030
+tidal volume» «Breeze at tidal rate» احنا بيحطيه
+
+457
+00:32:17,030 --> 00:32:20,710
+«Tidal Volume» وحطيه «Rate» و «Alpha2» اللي هو الـ
+
+458
+00:32:20,710 --> 00:32:24,130
+«Oxygen Fraction» بيننا 30% و40% أكسجين لكن
+
+459
+00:32:24,130 --> 00:32:28,090
+«Additional spontaneous breeze at tidal volume and
+
+460
+00:32:28,090 --> 00:32:30,930
+rate determined by patient» بدي ياخد كمان «Tidal
+
+461
+00:32:30,930 --> 00:32:33,650
+Volume» ياخد، بدي ياخد كمان «Rate» ياخد، بس مافيش
+
+462
+00:32:33,650 --> 00:32:38,330
+حيصير تعرض، مش هيكون في risk للبرترومةعادة يتم
+
+463
+00:32:38,330 --> 00:32:42,290
+استخدامها بالمدفع الضغط لتقليل عمل الاختصار عادة
+
+464
+00:32:42,290 --> 00:32:46,010
+نكون محاطين نشوف mood تاني معاه إذا اسمه بيب اللي
+
+465
+00:32:46,010 --> 00:32:49,710
+هو pressure support عشان يعمل مساعدة in between
+
+466
+00:32:49,710 --> 00:32:53,030
+the ventilator delivers the breath بين ال breath
+
+467
+00:32:53,030 --> 00:32:55,830
+تبع ال ventilator و ال breath التاني ال patient is
+
+468
+00:32:55,830 --> 00:32:59,050
+able to breathe spontaneously at his own pedal
+
+469
+00:32:59,050 --> 00:33:02,750
+point and rate with no assistant from the
+
+470
+00:33:02,750 --> 00:33:05,810
+ventilatorبين الventilator breathe و ال ventilator
+
+471
+00:33:05,810 --> 00:33:09,550
+بت breathe المريض بيسيبك الجهاز بيسيبك تاخد نفس
+
+472
+00:33:09,550 --> 00:33:13,850
+انت أو بأي تعدد volume بدك هي however unlike the
+
+473
+00:33:13,850 --> 00:33:18,270
+ASA mode اللي هو ال assistant control mode any
+
+474
+00:33:18,270 --> 00:33:21,290
+breathe taken above the set rate are spontaneous
+
+475
+00:33:21,290 --> 00:33:25,270
+breathing taken through the ventilator circuit
+
+476
+00:33:25,270 --> 00:33:27,530
+تمام؟
+
+477
+00:33:30,560 --> 00:33:35,760
+إذن، مش زي الـPressure أو الـAssistant Control بين
+
+478
+00:33:35,760 --> 00:33:39,060
+الـVentilator وVentilator المريض بدي ياخد نفس فرق
+
+479
+00:33:39,060 --> 00:33:44,080
+بديك 500، لأ، أي نفس أنت بتستطيع، يعني عندك القدرة
+
+480
+00:33:44,080 --> 00:33:47,180
+تاخد 500 بتاخد، عندك القدرة تاخد 200 بس، بسيبك
+
+481
+00:33:47,180 --> 00:33:49,660
+تاخد 200، مافيش إجبار، Ventilator وVentilator
+
+482
+00:33:49,660 --> 00:33:52,720
+المريض are synchronizedwith the patient
+
+483
+00:33:52,720 --> 00:33:54,860
+spontaneous breathing، there's no five، مافيش
+
+484
+00:33:54,860 --> 00:33:58,680
+اتنين بيخشوا مع بعض used to wean the patient from
+
+485
+00:33:58,680 --> 00:34:01,100
+the mechanical ventilator عشان هيك هذا أحسن node
+
+486
+00:34:01,100 --> 00:34:04,440
+بيساعدني عندما بدي أقرر أفصل أو أعمل weaning
+
+487
+00:34:04,440 --> 00:34:07,420
+للمريض هو already أنا من يوت ما حطيته عليه، من أول
+
+488
+00:34:07,420 --> 00:34:09,980
+ما حطيته عليه وانا باسمحله أنه ياخد spontaneous
+
+489
+00:34:09,980 --> 00:34:15,660
+breathingعندما أريد أن ينفط معانا الجهاز ويعمل الـ
+
+490
+00:34:15,660 --> 00:34:18,700
+weaning أنا أقلل التنفسات الإجبارية اللي أريد أن
+
+491
+00:34:18,700 --> 00:34:22,320
+أعطيهم وأتمد على نفسه أكتر لما أوصل لمرحلة أني
+
+492
+00:34:22,320 --> 00:34:24,880
+أضعه على موضع تاني في موضع الـ pressure موضع اسمه
+
+493
+00:34:24,880 --> 00:34:28,520
+الـ C-gap اللي هو مابيعطيهوش ولا tidal volume ولا
+
+494
+00:34:28,520 --> 00:34:32,020
+rate وبس بحافظه عشوائة pressure داخل ال lung هنشوف
+
+495
+00:34:32,020 --> 00:34:37,460
+كيف السيباب الآن لكن الكثير الأسئلة فيها ده مقدمة
+
+496
+00:34:37,460 --> 00:34:44,090
+ممتازة للـالـ weaning أولاً الـ advantage تبعته
+
+497
+00:34:44,090 --> 00:34:47,270
+بيعمل synchronization مع المريض ففيش risk لا
+
+498
+00:34:47,270 --> 00:34:52,930
+البراترومة مافيش أنه أنا أديله predetermined
+
+499
+00:34:52,930 --> 00:34:58,730
+volume زي الـ AC mood وبالتاليالريسك
+
+500
+00:34:58,730 --> 00:35:02,430
+للـhyperventilation مش موجود لإنه المريض مش مجبر
+
+501
+00:35:02,430 --> 00:35:05,130
+إنه كل ما بده يعمل initiative leading بياخد الـP6
+
+502
+00:35:05,130 --> 00:35:06,850
+ده ال volume اللي أنا أعمله، فمافيش
+
+503
+00:35:06,850 --> 00:35:10,750
+hyperventilation، مافيش barotrauma، عشان يسموه ال
+
+504
+00:35:10,750 --> 00:35:14,670
+mood الرحيم، رحيميعني ده اللي قاله يعني على الآخر
+
+505
+00:35:14,670 --> 00:35:18,090
+a regular series of breaths are scheduled but the
+
+506
+00:35:18,090 --> 00:35:21,230
+ventilators needs patients afford and schedule is
+
+507
+00:35:21,230 --> 00:35:26,570
+mandatory breath is based on the calculated need
+
+508
+00:35:26,570 --> 00:35:30,990
+of the patient، إيش بدك أحلى من هذا؟الـ advantage
+
+509
+00:35:30,990 --> 00:35:33,610
+تبعته زي ما شُفنا بتاربنتيه بـ «patient
+
+510
+00:35:33,610 --> 00:35:37,770
+ventilatory interaction» «less hemodynamic effect»
+
+511
+00:35:37,770 --> 00:35:40,890
+والـ disadvantage تبعته «high work of breed than
+
+512
+00:35:40,890 --> 00:35:43,870
+CMV or BC»
+
diff --git a/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/u1q_2vGOzh0_raw.json b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/u1q_2vGOzh0_raw.json
new file mode 100644
index 0000000000000000000000000000000000000000..f19ca1d9664d54e94f428e5815882c65aff4be46
--- /dev/null
+++ b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/u1q_2vGOzh0_raw.json
@@ -0,0 +1 @@
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6.74, "end": 6.84, "word": " شاء", "probability": 0.968994140625}, {"start": 6.84, "end": 6.92, "word": " الله", "probability": 0.9482421875}, {"start": 6.92, "end": 7.46, "word": " محاضرتنا", "probability": 0.90615234375}, {"start": 7.46, "end": 7.58, "word": " عن", "probability": 0.96044921875}, {"start": 7.58, "end": 7.76, "word": " الـ", "probability": 0.70361328125}, {"start": 7.76, "end": 8.0, "word": " mechanical", "probability": 0.459228515625}, {"start": 8.0, "end": 8.84, "word": " ventilator", "probability": 0.9287109375}, {"start": 8.84, "end": 11.12, "word": " يعني", "probability": 0.86572265625}, {"start": 11.12, "end": 11.54, "word": " بداية", "probability": 0.8878580729166666}, {"start": 11.54, "end": 12.6, "word": " mechanical", "probability": 0.94140625}, {"start": 12.6, "end": 13.36, "word": " ventilation", "probability": 0.9365234375}, {"start": 13.36, "end": 13.82, "word": " إيش", "probability": 0.7355550130208334}, {"start": 13.82, "end": 14.14, "word": " 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"temperature": 1.0}, {"id": 45, "seek": 102008, "start": 1015.74, "end": 1020.08, "text": "أو بنركز على الـ Post Pressure Ventilation اللي بنقسم له تلت أنواع", "tokens": [10721, 2407, 44945, 31747, 11622, 15844, 2423, 39184, 10223, 6776, 540, 28290, 16067, 13672, 1829, 44945, 4587, 38251, 46740, 6055, 1211, 2655, 14739, 14407, 3615], "avg_logprob": -0.20913461653085855, "compression_ratio": 1.0208333333333333, "no_speech_prob": 0.0, "words": [{"start": 1015.74, "end": 1016.04, "word": "أو", "probability": 0.925048828125}, {"start": 1016.04, "end": 1016.54, "word": " بنركز", "probability": 0.7159016927083334}, {"start": 1016.54, "end": 1016.74, "word": " على", "probability": 0.931640625}, {"start": 1016.74, "end": 1016.88, "word": " الـ", "probability": 0.9326171875}, {"start": 1016.88, "end": 1017.04, "word": " Post", "probability": 0.30078125}, {"start": 1017.04, "end": 1017.48, "word": " Pressure", "probability": 0.628173828125}, {"start": 1017.48, "end": 1018.0, "word": " Ventilation", "probability": 0.970458984375}, {"start": 1018.0, "end": 1018.2, "word": " اللي", "probability": 0.88232421875}, {"start": 1018.2, "end": 1018.72, "word": " بنقسم", "probability": 0.9514973958333334}, {"start": 1018.72, "end": 1018.96, "word": " له", "probability": 0.6181640625}, {"start": 1018.96, "end": 1019.62, "word": " تلت", "probability": 0.9051106770833334}, {"start": 1019.62, "end": 1020.08, "word": " أنواع", "probability": 0.9710286458333334}], "temperature": 1.0}, {"id": 46, "seek": 104718, "start": 1021.02, "end": 1047.18, "text": "ممكن يكون pressure cycle أو volume cycle أو time cycle إيش الفرق بين pressure cycle و volume cycle و time cycle؟ هدولة كلهم إيش؟ positive pressure pressure cycle يعني قليل لاستخدامه القصة فيه أننا نعتمد على pressure", "tokens": [2304, 43020, 7251, 30544, 3321, 6586, 34051, 5523, 6586, 34051, 565, 6586, 11933, 1829, 8592, 27188, 2288, 4587, 49374, 3321, 6586, 4032, 5523, 6586, 4032, 565, 6586, 22807, 8032, 3215, 12610, 3660, 28242, 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زي", "probability": 0.96337890625}, {"start": 2094.13, "end": 2094.31, "word": " الـ", "probability": 0.64794921875}, {"start": 2094.31, "end": 2094.67, "word": " AC", "probability": 0.497802734375}, {"start": 2094.67, "end": 2096.35, "word": " mood", "probability": 0.5751953125}, {"start": 2096.35, "end": 2097.23, "word": " وبالتالي", "probability": 0.92255859375}], "temperature": 1.0}, {"id": 94, "seek": 211221, "start": 2098.21, "end": 2112.21, "text": "الريسك للـhyperventilation مش موجود لإنه المريض مش مجبر إنه كل ما بده يعمل initiative leading بياخد الـP6 ده ال volume اللي أنا أعمله، فمافيش hyperventilation، مافيش barotrauma، عشان يسموه ال mood الرحيم، رحيم", "tokens": [6027, 16572, 3794, 4117, 24976, 39184, 3495, 610, 2475, 16067, 37893, 3714, 29245, 23328, 5296, 28814, 1863, 3224, 9673, 16572, 11242, 37893, 3714, 7435, 26890, 36145, 3224, 28242, 19446, 47525, 3224, 7251, 25957, 1211, 11552, 5775, 4724, 1829, 47283, 3215, 2423, 39184, 47, 21, 11778, 3224, 2423, 5523, 13672, 1829, 41850, 5551, 25957, 43761, 12399, 6156, 15042, 41185, 8592, 9848, 2475, 16067, 12399, 19446, 41185, 8592, 2159, 310, 424, 5544, 12399, 6225, 8592, 7649, 7251, 38251, 2407, 3224, 2423, 9268, 34892, 5016, 32640, 12399, 12602, 5016, 32640], "avg_logprob": -0.2855113768442111, "compression_ratio": 1.5144230769230769, "no_speech_prob": 7.927417755126953e-06, "words": [{"start": 2098.21, "end": 2098.73, "word": "الريسك", "probability": 0.640716552734375}, {"start": 2098.73, "end": 2099.25, "word": " للـhyperventilation", "probability": 0.8207194010416666}, {"start": 2099.25, "end": 2099.45, "word": " مش", "probability": 0.81787109375}, {"start": 2099.45, "end": 2099.97, "word": " موجود", "probability": 0.98779296875}, {"start": 2099.97, "end": 2100.55, "word": " لإنه", "probability": 0.63800048828125}, {"start": 2100.55, "end": 2101.89, "word": " المريض", "probability": 0.9386393229166666}, {"start": 2101.89, "end": 2102.05, "word": " مش", "probability": 0.98681640625}, {"start": 2102.05, "end": 2102.43, "word": " مجبر", "probability": 0.9114583333333334}, {"start": 2102.43, "end": 2102.69, "word": " إنه", "probability": 0.787109375}, {"start": 2102.69, "end": 2102.81, "word": " كل", "probability": 0.96337890625}, {"start": 2102.81, "end": 2102.91, "word": " ما", "probability": 0.95654296875}, {"start": 2102.91, "end": 2103.09, "word": " بده", "probability": 0.60986328125}, {"start": 2103.09, "end": 2103.31, "word": " يعمل", "probability": 0.9903971354166666}, {"start": 2103.31, "end": 2103.67, "word": " initiative", "probability": 0.498291015625}, {"start": 2103.67, "end": 2103.93, "word": " leading", "probability": 0.447998046875}, {"start": 2103.93, "end": 2104.37, "word": " بياخد", "probability": 0.7822265625}, {"start": 2104.37, "end": 2105.13, "word": " الـP6", "probability": 0.8275146484375}, {"start": 2105.13, "end": 2105.37, "word": " ده", "probability": 0.673828125}, {"start": 2105.37, "end": 2105.43, "word": " ال", "probability": 0.8544921875}, {"start": 2105.43, "end": 2105.65, "word": " volume", "probability": 0.7236328125}, {"start": 2105.65, "end": 2105.79, "word": " اللي", "probability": 0.903564453125}, {"start": 2105.79, "end": 2105.93, "word": " أنا", "probability": 0.64453125}, {"start": 2105.93, "end": 2106.53, "word": " أعمله،", "probability": 0.73529052734375}, {"start": 2106.53, "end": 2106.85, "word": " فمافيش", "probability": 0.918701171875}, {"start": 2106.85, "end": 2107.81, "word": " hyperventilation،", "probability": 0.67242431640625}, {"start": 2107.81, "end": 2108.05, "word": " مافيش", "probability": 0.9104817708333334}, {"start": 2108.05, "end": 2109.99, "word": " barotrauma،", "probability": 0.6850830078125}, {"start": 2109.99, "end": 2110.15, "word": " عشان", "probability": 0.9637044270833334}, {"start": 2110.15, "end": 2110.69, "word": " يسموه", "probability": 0.7408447265625}, {"start": 2110.69, "end": 2110.75, "word": " ال", "probability": 0.751953125}, {"start": 2110.75, "end": 2110.91, "word": " mood", "probability": 0.75048828125}, {"start": 2110.91, "end": 2111.77, "word": " الرحيم،", "probability": 0.7900390625}, {"start": 2111.77, "end": 2112.21, "word": " رحيم", "probability": 0.9581705729166666}], "temperature": 1.0}, {"id": 95, "seek": 212911, "start": 2112.73, "end": 2129.11, "text": "يعني ده اللي قاله يعني على الآخر a regular series of breaths are scheduled but the ventilators needs patients afford and schedule is mandatory breath is based on the calculated need of the patient، إيش بدك أحلى من هذا؟", "tokens": [40228, 22653, 11778, 3224, 13672, 1829, 50239, 3224, 37495, 22653, 15844, 6024, 95, 34740, 257, 3890, 2638, 295, 33769, 366, 15678, 457, 264, 27498, 3391, 2203, 4209, 6157, 293, 7567, 307, 22173, 6045, 307, 2361, 322, 264, 15598, 643, 295, 264, 4537, 12399, 11933, 1829, 8592, 47525, 4117, 5551, 5016, 23942, 9154, 23758, 22807], "avg_logprob": -0.5048295216126876, "compression_ratio": 1.403225806451613, "no_speech_prob": 0.0, "words": [{"start": 2112.73, "end": 2113.17, "word": "يعني", "probability": 0.56536865234375}, {"start": 2113.17, "end": 2113.47, "word": " ده", "probability": 0.28912353515625}, {"start": 2113.47, "end": 2113.55, "word": " اللي", "probability": 0.97998046875}, {"start": 2113.55, "end": 2113.79, "word": " قاله", "probability": 0.434173583984375}, {"start": 2113.79, "end": 2113.93, "word": " يعني", "probability": 0.641845703125}, {"start": 2113.93, "end": 2114.13, "word": " على", "probability": 0.91455078125}, {"start": 2114.13, "end": 2114.67, "word": " الآخر", "probability": 0.8416341145833334}, {"start": 2114.67, "end": 2115.35, "word": " a", "probability": 0.123779296875}, {"start": 2115.35, "end": 2115.69, "word": " regular", "probability": 0.9345703125}, {"start": 2115.69, "end": 2116.23, "word": " series", "probability": 0.8935546875}, {"start": 2116.23, "end": 2116.49, "word": " of", "probability": 0.9794921875}, {"start": 2116.49, "end": 2116.81, "word": " breaths", "probability": 0.2459716796875}, {"start": 2116.81, "end": 2117.15, "word": " are", "probability": 0.9482421875}, {"start": 2117.15, "end": 2117.61, "word": " scheduled", "probability": 0.5849609375}, {"start": 2117.61, "end": 2117.93, "word": " but", "probability": 0.74365234375}, {"start": 2117.93, "end": 2118.09, "word": " the", "probability": 0.85791015625}, {"start": 2118.09, "end": 2118.73, "word": " ventilators", "probability": 0.6513671875}, {"start": 2118.73, "end": 2119.09, "word": " needs", "probability": 0.59375}, {"start": 2119.09, "end": 2119.61, "word": " patients", "probability": 0.488525390625}, {"start": 2119.61, "end": 2120.01, "word": " afford", "probability": 0.73095703125}, {"start": 2120.01, "end": 2120.41, "word": " and", "probability": 0.8544921875}, {"start": 2120.41, "end": 2120.77, "word": " schedule", "probability": 0.42919921875}, {"start": 2120.77, "end": 2121.23, "word": " is", "probability": 0.207275390625}, {"start": 2121.23, "end": 2122.85, "word": " mandatory", "probability": 0.480224609375}, {"start": 2122.85, "end": 2123.47, "word": " breath", "probability": 0.2301025390625}, {"start": 2123.47, "end": 2123.65, "word": " is", "probability": 0.86962890625}, {"start": 2123.65, "end": 2124.11, "word": " based", "probability": 0.9404296875}, {"start": 2124.11, "end": 2124.39, "word": " on", "probability": 0.9599609375}, {"start": 2124.39, "end": 2124.63, "word": " the", "probability": 0.8427734375}, {"start": 2124.63, "end": 2125.53, "word": " calculated", "probability": 0.94189453125}, {"start": 2125.53, "end": 2126.57, "word": " need", "probability": 0.64501953125}, {"start": 2126.57, "end": 2127.05, "word": " of", "probability": 0.97412109375}, {"start": 2127.05, "end": 2127.23, "word": " the", "probability": 0.90771484375}, {"start": 2127.23, "end": 2127.81, "word": " patient،", "probability": 0.573486328125}, {"start": 2127.81, "end": 2127.99, "word": " إيش", "probability": 0.744384765625}, {"start": 2127.99, "end": 2128.27, "word": " بدك", "probability": 0.86181640625}, {"start": 2128.27, "end": 2128.51, "word": " أحلى", "probability": 0.6900227864583334}, {"start": 2128.51, "end": 2128.69, "word": " من", "probability": 0.97900390625}, {"start": 2128.69, "end": 2129.11, "word": " هذا؟", "probability": 0.6307373046875}], "temperature": 1.0}, {"id": 96, "seek": 214387, "start": 2130.33, "end": 2143.87, "text": "الـ advantage تبعته زي ما شُفنا بتاربنتيه بـ «patient ventilatory interaction» «less hemodynamic effect» والـ disadvantage تبعته «high work of breed than CMV or BC»", "tokens": [6027, 39184, 5002, 6055, 3555, 34268, 3224, 30767, 1829, 19446, 13412, 10859, 5172, 8315, 39894, 9640, 3555, 29399, 1829, 3224, 4724, 39184, 4657, 29752, 27498, 4745, 9285, 5933, 4657, 1832, 8636, 34988, 1802, 5933, 16070, 39184, 24292, 6055, 3555, 34268, 3224, 4657, 21454, 589, 295, 18971, 813, 20424, 53, 420, 14359, 5933], "avg_logprob": -0.44103772235366534, "compression_ratio": 1.2105263157894737, "no_speech_prob": 0.0, "words": [{"start": 2130.33, "end": 2130.57, "word": "الـ", "probability": 0.67431640625}, {"start": 2130.57, "end": 2130.99, "word": " advantage", "probability": 0.494384765625}, {"start": 2130.99, "end": 2131.41, "word": " تبعته", "probability": 0.7379150390625}, {"start": 2131.41, "end": 2131.57, "word": " زي", "probability": 0.829345703125}, {"start": 2131.57, "end": 2131.65, "word": " ما", "probability": 0.97509765625}, {"start": 2131.65, "end": 2132.01, "word": " شُفنا", "probability": 0.82696533203125}, {"start": 2132.01, "end": 2132.85, "word": " بتاربنتيه", "probability": 0.4293924967447917}, {"start": 2132.85, "end": 2133.01, "word": " بـ", "probability": 0.4835205078125}, {"start": 2133.01, "end": 2133.61, "word": " «patient", "probability": 0.4361572265625}, {"start": 2133.61, "end": 2134.11, "word": " ventilatory", "probability": 0.5306396484375}, {"start": 2134.11, "end": 2135.15, "word": " interaction»", "probability": 0.892578125}, {"start": 2135.15, "end": 2135.61, "word": " «less", "probability": 0.4622802734375}, {"start": 2135.61, "end": 2136.39, "word": " hemodynamic", "probability": 0.9443359375}, {"start": 2136.39, "end": 2137.77, "word": " effect»", "probability": 0.930908203125}, {"start": 2137.77, "end": 2138.07, "word": " والـ", "probability": 0.5423583984375}, {"start": 2138.07, "end": 2138.59, "word": " disadvantage", "probability": 0.78759765625}, {"start": 2138.59, "end": 2139.15, "word": " تبعته", "probability": 0.932373046875}, {"start": 2139.15, "end": 2139.47, "word": " «high", "probability": 0.80224609375}, {"start": 2139.47, "end": 2139.91, "word": " work", "probability": 0.93310546875}, {"start": 2139.91, "end": 2140.09, "word": " of", "probability": 0.58740234375}, {"start": 2140.09, "end": 2140.45, "word": " breed", "probability": 0.0880126953125}, {"start": 2140.45, "end": 2140.89, "word": " than", "probability": 0.8515625}, {"start": 2140.89, "end": 2141.81, "word": " CMV", "probability": 0.923828125}, {"start": 2141.81, "end": 2142.37, "word": " or", "probability": 0.6865234375}, {"start": 2142.37, "end": 2143.87, "word": " BC»", "probability": 0.875}], "temperature": 1.0}], "language": "ar", "language_probability": 1.0, "duration": 2150.098125, "duration_after_vad": 2065.0624999999936}
\ No newline at end of file
diff --git a/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/ubz1LLA7UOE_postprocess.srt b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/ubz1LLA7UOE_postprocess.srt
new file mode 100644
index 0000000000000000000000000000000000000000..630c1814b0df44a8ae44799126f59b37cdf87f8c
--- /dev/null
+++ b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/ubz1LLA7UOE_postprocess.srt
@@ -0,0 +1,876 @@
+1
+00:00:01,280 --> 00:00:04,020
+بسم الله الرحمن الرحيم السلام عليكم ورحمة الله
+
+2
+00:00:04,020 --> 00:00:07,780
+وبركاته اليوم إن شاء الله رب العالمين بنكمل
+
+3
+00:00:07,780 --> 00:00:10,500
+محاضرتنا التالتة والأخيرة في الـ Mechanical
+
+4
+00:00:10,500 --> 00:00:14,140
+Ventilation كنا بنحكي في الـ Ventilator Setting
+
+5
+00:00:14,140 --> 00:00:17,360
+الـ Parameters تبعت الـ Ventilator
+
+6
+00:00:19,300 --> 00:00:22,580
+بإعدادات بالعربي لما بدي أشتغل و أشبك mechanical
+
+7
+00:00:22,580 --> 00:00:25,480
+ventilator على مريض، إيش الحاجات اللي لازم أحطها؟
+
+8
+00:00:25,480 --> 00:00:29,700
+بدأنا نحكي في الـ fraction of inspired oxygen،
+
+9
+00:00:29,700 --> 00:00:33,000
+الـFIO2، بعدين الـtidal volume، بعدين الـbeaky
+
+10
+00:00:33,000 --> 00:00:36,560
+flow، وبعدين الـrespiratory rate، اللي هو
+
+11
+00:00:36,560 --> 00:00:40,140
+الـfrequency، وبعدين إيش علاقة الـminute volume،
+
+12
+00:00:40,140 --> 00:00:42,020
+اللي هو إيش علاقة الـrespiratory rate بالـtidal
+
+13
+00:00:42,020 --> 00:00:45,680
+volume، وبعدين بدأنا نحكي عن الـinspiratory
+
+14
+00:00:47,620 --> 00:00:52,700
+أو ما يسمونه IE Inspiration to Expiration Rate
+
+15
+00:00:52,700 --> 00:00:57,200
+اللي هو بنسميه الـInspiratory Time وبعدين وقفنا
+
+16
+00:00:57,200 --> 00:01:02,340
+عندها والآن بدنا نكمل معكم عن الـSci وإن شاء الله
+
+17
+00:01:02,340 --> 00:01:09,560
+رب العالمين هنختم في المحاضرة هذه الـMechanicalالـ
+
+18
+00:01:09,560 --> 00:01:16,400
+Mechanical Ventilation نرجع للـ «صي» الصي يا جماعة
+
+19
+00:01:16,400 --> 00:01:21,140
+هذه حاجة كانت موجودة في الأجهزة يمكن الأجهزة
+
+20
+00:01:21,140 --> 00:01:25,000
+الحديثة مافيش فيها صي لأنها مش كتير بتلزم اللي هي
+
+21
+00:01:25,000 --> 00:01:28,880
+عبارة عن تنهيدة يعني يعني أنت بتحط للمريض كل خمس
+
+22
+00:01:28,880 --> 00:01:35,300
+لعشر دقائق أنه المريض ياخد يعني
+
+23
+00:01:38,670 --> 00:01:41,270
+أو ضعف الـ tidal volume تبعه يعني إذا أنا حاططله
+
+24
+00:01:41,270 --> 00:01:45,630
+خمسمية tidal volume كل عشر دقائق ياخد tidal volume
+
+25
+00:01:45,630 --> 00:01:50,990
+بس يكون ألف، ضعف الخمسمية اللي بياخدهم، كنوع من
+
+26
+00:01:50,990 --> 00:01:57,190
+التنهيد، ليش؟ لأننا الناس طبيعي أنه كل أربع ساعات
+
+27
+00:01:57,190 --> 00:02:03,270
+أو تمام ساعات بتلاقي أو يعنيفي الساعة ممكن يعمله
+
+28
+00:02:03,270 --> 00:02:07,930
+أربع على تمان مرات أنه يتنهد كيف يعني أنه في كل
+
+29
+00:02:07,930 --> 00:02:12,810
+ساعة تلاقي الواحد بحتاج أنه ياخد نفس أكبر من النفس
+
+30
+00:02:12,810 --> 00:02:17,350
+ال regular للي باخده ياخد ضعف كمية النفس تبعته
+
+31
+00:02:17,350 --> 00:02:20,810
+فراهوا حطوا ال «صي هادي» إنك تحط له setting إنه يد
+
+32
+00:02:20,810 --> 00:02:26,710
+للمريض واحد و نص لاتنيندرب الـ Tidal Volume يعني 1
+
+33
+00:02:26,710 --> 00:02:30,330
+.5 دق في نص الـ Tidal Volume أو دق فين الـ Tidal
+
+34
+00:02:30,330 --> 00:02:37,890
+Volume كنوع من الـ Washing out للـ CO2 طبعاً الـ
+
+35
+00:02:37,890 --> 00:02:43,270
+Peak انسبراته لـ Pressure هذه الجهاز هيديلك alarm
+
+36
+00:02:43,270 --> 00:02:47,290
+عندها لما يوصل الـ Pressure داخل Lung للـ Peak
+
+37
+00:02:47,290 --> 00:02:51,310
+القمة تبع الـ Pressure هيك صار الـ Pressure يعني
+
+38
+00:02:51,310 --> 00:02:54,920
+مش مسموح أكتر من هيكبالنسبة للشباب، إذا كانت مدرسة
+
+39
+00:02:54,920 --> 00:03:00,140
+الـ Peak Airway Pressure مقارنة بـ 45
+
+40
+00:03:00,140 --> 00:03:06,380
+cmH2O، أكتر من 45 سنتمتر ميّه، فرصة البراترومة
+
+41
+00:03:06,380 --> 00:03:08,700
+تزداد، وإذا كانت مدرسة البراترومة مقارنة بـ 45
+
+42
+00:03:08,700 --> 00:03:12,880
+cmH2O، أكتر من 50 cmH2O، فرصة البراترومة تزداد،
+
+43
+00:03:12,880 --> 00:03:13,260
+وإذا كانت مدرسة البراترومة مقارنة بـ 45 cmH2O،
+
+44
+00:03:13,260 --> 00:03:15,640
+فرصة البراترومة تزداد، وإذا كانت مدرسة البراترومة
+
+45
+00:03:15,640 --> 00:03:16,300
+مقارنة بـ 45 cmH2O، فرصة البراترومة تزداد، وإذا
+
+46
+00:03:16,300 --> 00:03:17,960
+كانت مدرسة الممكن يزيد ال pressure إذا المريض كان
+
+47
+00:03:17,960 --> 00:03:21,100
+عامل resistant كان بقاوم الجهاز ممكن يزيد ال
+
+48
+00:03:21,100 --> 00:03:23,260
+pressure يا جماعة إذا كان المريض عنده secretion
+
+49
+00:03:23,260 --> 00:03:27,920
+صار فيه هوا و secretions في نفس ال .. ال .. ال ..
+
+50
+00:03:28,880 --> 00:03:31,500
+الـ Capacity اللي بالمفروض ينحط فيها الـ 500 أو
+
+51
+00:03:31,500 --> 00:03:34,740
+الـ 600 سنة هوا لكن صار فيه كمان 50 سنة Secretion
+
+52
+00:03:34,740 --> 00:03:38,020
+فصارت هيك فيه pressure كتير داخل الـ lung بدك
+
+53
+00:03:38,020 --> 00:03:41,340
+تعمله suction أو في kinking في الـ tube متني فال
+
+54
+00:03:41,340 --> 00:03:45,340
+pressure جاعد الفلوريد تبعه اختل لإنه في منطقة
+
+55
+00:03:45,340 --> 00:03:49,020
+صارت أيش ضيقة أو المريض عامل stiff مريض Acidation
+
+56
+00:03:49,020 --> 00:03:52,800
+وماليوسيداشن مش كافي تمام؟ فعشان هيك هذه الحالات
+
+57
+00:03:52,800 --> 00:03:57,350
+اللي بتخليهم بس أسمع ال alarm تيك تيكمكون معناه إن
+
+58
+00:03:57,350 --> 00:04:02,810
+الـ pressure بدأ يزيد عند العيان نتيجة سبب من
+
+59
+00:04:02,810 --> 00:04:06,830
+الأسباب اللي حكيناها«Sensitivity» حكينا عنه
+
+60
+00:04:06,830 --> 00:04:10,430
+«Trigger Sensitivity» هو حكينا مجس في الجهاز
+
+61
+00:04:10,430 --> 00:04:14,050
+وظيفته يعرف «who initiated the brief» المريض ولا
+
+62
+00:04:14,050 --> 00:04:20,170
+الجهاز عشان يسمح للمريض أنه يصير بينه وبين الجهاز
+
+63
+00:04:20,170 --> 00:04:24,390
+«Synchronization» تناغم مايصيرش يمنع أو يعني
+
+64
+00:04:24,390 --> 00:04:28,150
+مايصيرش عندهم عند المريض «paratroma» أو يمنع حدوط
+
+65
+00:04:28,150 --> 00:04:33,150
+الـ «paratroma» عندهمعادةً بنحط الـ «trigger
+
+66
+00:04:33,150 --> 00:04:37,290
+sensitivity» من «-1» لـ «-2» سانفونيتر ميّن
+
+67
+00:04:40,080 --> 00:04:44,460
+الـ alarm تبع الفنتلاتر توي كنا بنحكي عنها و بنحكي
+
+68
+00:04:44,460 --> 00:04:48,180
+مافيش alarm في الفنتلاتر to be dismissed مافيش
+
+69
+00:04:48,180 --> 00:04:52,860
+يعني alarm في الفنتلاتر مش خطير ال alarm بدك تروح
+
+70
+00:04:52,860 --> 00:04:59,940
+تشوف إيش المشكلة فورا لإنه أي ventilator قرر alarm
+
+71
+00:04:59,940 --> 00:05:01,940
+معناه إنه فيه problem
+
+72
+00:05:04,520 --> 00:05:08,580
+يا فيه source of oxygen خس، يا فيه low battery، يا
+
+73
+00:05:08,580 --> 00:05:14,100
+فيه resistant، يا فيه king king، يا فيه abnia
+
+74
+00:05:14,100 --> 00:05:16,600
+ventilation، جهاز فبطل، يعني مافيه electricity
+
+75
+00:05:16,600 --> 00:05:21,740
+loss فبطل شغال، شغال على كهربا، شغال على مصدر
+
+76
+00:05:21,740 --> 00:05:25,460
+الكهربا اللي كان شغال عليه، فصل، لازم تروح تشوف
+
+77
+00:05:25,460 --> 00:05:26,780
+إيش السبب
+
+78
+00:05:29,840 --> 00:05:33,620
+بنحكي دايما عشان نحسن الـ Oxygenation يا جماعة يا
+
+79
+00:05:33,620 --> 00:05:37,900
+بنعدل الـ I.E. Ratio يا بنزود الـ Peak يا بنزود
+
+80
+00:05:37,900 --> 00:05:42,760
+الـ Up I.O.2 لكن عشان أحسن الـ Ventilation إذا أنا
+
+81
+00:05:42,760 --> 00:05:47,580
+عملت Blood Gas لمريد و لاجيت إن الـ CO2 تبعه مثلا
+
+82
+00:05:47,580 --> 00:05:52,780
+عالي بعرف أنا إنه أنا عشان أحسن الـ CO2 و أعمل
+
+83
+00:05:52,780 --> 00:05:56,360
+Washing Out يا بدى أزود الـ Tidal Volume يا بزدود
+
+84
+00:05:56,360 --> 00:06:01,940
+الـ Rateيا بدى أزود الـ Pressure إذا عشان أعمل
+
+85
+00:06:01,940 --> 00:06:05,780
+Washing Out لـ CO2 مثلا عشان أحسن الـ Ventilation
+
+86
+00:06:05,780 --> 00:06:09,340
+وأعمل الـ Retention وأحسن الـ Retention تبع الـ
+
+87
+00:06:09,340 --> 00:06:13,820
+CO2 ممنفعش أروح أزود الـ Oxygen Fraction بقى و 40
+
+88
+00:06:13,820 --> 00:06:19,380
+أحطه 60% وأقولك بتحسن هي مش ممكن يتحسن ها بتحسن
+
+89
+00:06:19,380 --> 00:06:26,070
+إذا أنا زودت الـ Frequencyأو الـ Frequency هي بس
+
+90
+00:06:26,070 --> 00:06:29,750
+زوّت تعيد الـ Volume بدل ما يخش 500 يخش 600 هو لإن
+
+91
+00:06:29,750 --> 00:06:33,790
+المريض بيقول ربما هو بحتاج 600 بس أنا مقدر وزنه
+
+92
+00:06:33,790 --> 00:06:41,070
+غلطهندو سي و رتو ريتينشن صار فعشان هيك دايما نتميز
+
+93
+00:06:41,070 --> 00:06:45,870
+لما بدي أحسن ال ventilation و أحسن الـ CO2
+
+94
+00:06:45,870 --> 00:06:49,150
+retention اللي موجود عندي بتعامل مع increase لل
+
+95
+00:06:49,150 --> 00:06:53,910
+rate و increase لل volume أو ال pressure مش ال
+
+96
+00:06:53,910 --> 00:06:58,250
+FIO2 تبع المريض
+
+97
+00:07:09,350 --> 00:07:12,850
+طبعًا يا جماعة، هنا بنحكي عن المريض هو محطوط على
+
+98
+00:07:12,850 --> 00:07:16,710
+جهاز Ventilator عادةً بيظلوا مشبوك على ECG
+
+99
+00:07:16,710 --> 00:07:20,270
+Monitoring عشان نراقب أي تغيرات في الـECG
+
+100
+00:07:20,270 --> 00:07:25,950
+Saturation Monitoring باستمرار كمان كل عدد من
+
+101
+00:07:25,950 --> 00:07:29,010
+الساعات لازم نعمل المريض يعني الـDepends حسب وضع
+
+102
+00:07:29,010 --> 00:07:31,610
+العيال عشان هيك ما قلتش عدد معين يعني في عيال ممكن
+
+103
+00:07:31,610 --> 00:07:35,850
+نعمله كل ساعتين في ممكن أربع حسب اللي هو Blood
+
+104
+00:07:35,850 --> 00:07:42,870
+Gasesفحسب وضع العيان نعمل الـBlood Gas اللي بتناسب
+
+105
+00:07:42,870 --> 00:07:45,830
+مع وضع المريض يعني إذا أنا المريض unstable هعمل
+
+106
+00:07:45,830 --> 00:07:49,290
+Blood Gas و أغير في الـventilator وبعد ساعتين لازم
+
+107
+00:07:49,290 --> 00:07:56,030
+أعمل تاني، أعمل تاني عشان إيش، أحدد التغير اللي
+
+108
+00:07:56,030 --> 00:07:58,430
+أنا عملته، أحسن وضع العيان ولا لأ؟
+
+109
+00:08:08,580 --> 00:08:15,400
+هذا الكلام كلهيته في الـ slide هذي، يعني أنا حكيته
+
+110
+00:08:15,400 --> 00:08:19,960
+من ضمن الحكاية «مافيش داعي نعيد» أنا عارف طبعا إن
+
+111
+00:08:19,960 --> 00:08:24,140
+انتوا طيبتوا خالص المحاضرة دسمة
+
+112
+00:08:25,120 --> 00:08:29,300
+هذا الـ slide بتحكيلك عن الـ high pressure alarms
+
+113
+00:08:29,300 --> 00:08:34,080
+لما بديلك برضه أنا حكيت عنها يعني لما بديك الجهاز
+
+114
+00:08:34,080 --> 00:08:37,300
+بديه high pressure يا أما المرض بيعمل cuff، يا أما
+
+115
+00:08:37,300 --> 00:08:40,780
+بيعمل biting، يا أما في secretion، يا أما في
+
+116
+00:08:40,780 --> 00:08:44,040
+kinking، حكينا برضه عنهاولو كان الـ Low Pressure
+
+117
+00:08:44,040 --> 00:08:49,340
+يعني أنه ممكن أن يتحرك ليكا لو كان في Low
+
+118
+00:08:49,340 --> 00:08:51,600
+Pressure، إيش ده؟ طب ليش جهاز Low Pressure؟ يعني
+
+119
+00:08:51,600 --> 00:08:58,260
+في ليكا يا جماعة، يا أما الـ Tube، الـ Cuff تبعها
+
+120
+00:08:58,260 --> 00:09:02,960
+مش Inflated تبع الـ Endotrache الـ Tube، بيكون مش
+
+121
+00:09:02,960 --> 00:09:06,860
+Inflated فبالتالي الهواء بيخش و بيلاقي مكان يطلع
+
+122
+00:09:06,860 --> 00:09:11,020
+منه، فمش كله يتبعو روح للمريض
+
+123
+00:09:12,060 --> 00:09:16,780
+يا أما أصلاً الـ «سيركل» مثلاً فيه فقب أو فيه
+
+124
+00:09:16,780 --> 00:09:22,200
+«واتريدراب» ومش «closed» كويس فبالتالي فيه
+
+125
+00:09:22,200 --> 00:09:27,520
+«leakage» يجب أن تاخد بالة من الحاجات هدولة أو مرض
+
+126
+00:09:27,520 --> 00:09:31,960
+يقولوا «chest tube» والـ«chest tube» بيهرب الهواء
+
+127
+00:09:31,960 --> 00:09:34,060
+بيطلع عامال من اللي بيخش من الفنتلات وبيطلع من
+
+128
+00:09:34,060 --> 00:09:38,650
+الـ«chest tube»الـ weaning يا جماعة احنا حكينا
+
+129
+00:09:38,650 --> 00:09:41,850
+عنها حكينا عنها و احنا بنحكي عن السيباب و حكينا
+
+130
+00:09:41,850 --> 00:09:44,470
+انه اصلا بنحط المريض على أسن بيه بيكون مرحلة من
+
+131
+00:09:44,470 --> 00:09:49,090
+مراحل الـ weaning بعد ما اتحسن و بنحطه على السيباب
+
+132
+00:09:49,090 --> 00:09:51,110
+و السيباب عرفنا انه
+
+133
+00:09:53,340 --> 00:09:58,220
+مرحلة ما بياخدش المريض فيها الـ tidal volume ولا
+
+134
+00:09:58,220 --> 00:10:00,660
+rate من الجهاز، لأ بيعتمد على نفسه بس الجهاز
+
+135
+00:10:00,660 --> 00:10:05,840
+بحققله continuous speed في مرحلة قبل الـ CBAP كانت
+
+136
+00:10:05,840 --> 00:10:09,820
+اسمها الـ T-Tube مش كتير بيستخدموها الجهد، بالعكس
+
+137
+00:10:09,820 --> 00:10:14,960
+بطلوا يفضلوها ومديش أقول التغات، لكن ما بطل حد
+
+138
+00:10:16,200 --> 00:10:21,680
+يفضلها لإنها ممكن تعمل أتيلاكتس عند المريض لإنه
+
+139
+00:10:21,680 --> 00:10:28,720
+بيكون المريض بتنفس من خلال الـ tube عن طريق T-tube
+
+140
+00:10:28,720 --> 00:10:32,620
+بكل بساطة إنه إحنا بنجيب source of oxygen بحيث إن
+
+141
+00:10:32,620 --> 00:10:36,840
+يكونفيه Reservoir يعني بيجيب Corregated الـ«تيوب»
+
+142
+00:10:36,840 --> 00:10:39,980
+عادي تبع الـVentilator ومنحط فيه Source of Oxygen
+
+143
+00:10:39,980 --> 00:10:44,280
+تلتين وتلت تطلق المريض منه Expiration ومشبوك T
+
+144
+00:10:44,280 --> 00:10:48,020
+اللي هو إيش على في الـTube تبع المريض يعني إذا فيه
+
+145
+00:10:48,020 --> 00:10:51,260
+عندي T جاي فيها Source Oxygen Corregated الـTube
+
+146
+00:10:52,220 --> 00:10:55,400
+المريض بياخد الهواء، بيطلق المريض، ففيه tool تاني
+
+147
+00:10:55,400 --> 00:10:59,180
+يطلع من المريض الـ Expiration هذا بطل يستخدموه
+
+148
+00:10:59,180 --> 00:11:02,840
+لأنها بتعمل atilactasis عند المرضى عشان يتنفس من
+
+149
+00:11:02,840 --> 00:11:06,620
+خلال اللي هو انبوب ضيق من غير pressure مش زي اللي
+
+150
+00:11:06,620 --> 00:11:09,060
+يكون على بنت يدر ع سيباب ولا على سيام بيتش
+
+151
+00:11:09,060 --> 00:11:11,840
+pressure يعمل inflation للناس، ممكن يعمل عنده
+
+152
+00:11:11,840 --> 00:11:17,110
+atilactasis ولذلك بطلوا يفضلوهاطبعاً لو بنعمل
+
+153
+00:11:17,110 --> 00:11:20,290
+Extubation أهم حاجة بنحكيها أنه لازم تكون جاهز لـ
+
+154
+00:11:20,290 --> 00:11:24,070
+Re-Intubation لازم تكون فيه عندك كل حاجة Set up a
+
+155
+00:11:24,070 --> 00:11:27,630
+new O2 delivery Have equipment ready to re
+
+156
+00:11:27,630 --> 00:11:30,310
+-intubate، Hyper-oxygenate the patient، Suction
+
+157
+00:11:30,310 --> 00:11:33,750
+the patient عشان أنا بدك تعمل Suction و تقيم الـ
+
+158
+00:11:33,750 --> 00:11:37,050
+Tube، عمله Unbow، Hyper-oxygenate the patient well
+
+159
+00:11:37,050 --> 00:11:41,290
+beforeاللي هو اعمل Extubation اعمل ايه؟ اعمل
+
+160
+00:11:41,290 --> 00:11:46,670
+Suction للبيت يتأكد انه فيه Endoclear بقدي اندفلات
+
+161
+00:11:46,670 --> 00:11:49,730
+الاندوتوب كاف اسحب
+
+162
+00:11:51,820 --> 00:11:55,040
+الـ «Remove tube suction and secretion in mouth
+
+163
+00:11:55,040 --> 00:11:58,320
+and throat» ممكن يكون صرفة في الـ «Troat» تبع
+
+164
+00:11:58,320 --> 00:12:00,240
+المريض «Secretion» على الـ «Bacteria» تعملها
+
+165
+00:12:00,240 --> 00:12:03,200
+«Suction» بعدين حطه على «Nasal Canyon» أو «Oxygen
+
+166
+00:12:03,200 --> 00:12:05,480
+Mask» حسب وضع المريض «Monitor for signs and
+
+167
+00:12:05,480 --> 00:12:08,100
+symptoms of respiratory distress» شوفوا تقبل مش
+
+168
+00:12:08,100 --> 00:12:10,000
+تقبل، رقب الـ«Blood Gases» تبعه، رقب
+
+169
+00:12:10,000 --> 00:12:13,340
+الـ«Saturation» تبعه، الـ«Vital Sign» تبعه، خلّي
+
+170
+00:12:13,340 --> 00:12:17,020
+المريض قاعد في وضع مريح في «Semi-Fowler Position»
+
+171
+00:12:17,020 --> 00:12:24,590
+وبالتالي هيك بتكونالمريض تحت المراقبة وبكون الـ
+
+172
+00:12:24,590 --> 00:12:28,550
+Extubation آمن وانتش المريض بيبدأ يتعب بتكون انت
+
+173
+00:12:28,550 --> 00:12:33,870
+جاهزين لإنه نتدخل قبل بيكون معاك طبيب قبل ما انه
+
+174
+00:12:33,870 --> 00:12:37,770
+تفكر في الـ Reintubation ممكن نعمل support للمريض
+
+175
+00:12:37,770 --> 00:12:44,350
+بـ Physiotherapy كاف، تبخير، Bronchodilators يعني
+
+176
+00:12:44,350 --> 00:12:48,330
+اللي نخليه يعدى من مرحلة انه يحتاج ال ventilator
+
+177
+00:12:48,330 --> 00:12:52,500
+تانيةالـ Criteria of Successful Weaning عشان أعرف
+
+178
+00:12:52,500 --> 00:12:57,400
+أنا أنه فعلا ال patient مابحتاجش re-intubation، ال
+
+179
+00:12:57,400 --> 00:13:00,880
+patient awake، oriented، alert، cooperated، مش الـ
+
+180
+00:13:00,880 --> 00:13:04,500
+CO2 عالي، عشان هيك مش awake و مش alert، ال patient
+
+181
+00:13:04,500 --> 00:13:07,120
+كان لإنه عارفين الـ CO2 لما بيبدأ يعلق، مع ال
+
+182
+00:13:07,120 --> 00:13:10,120
+hyperventilation و يصير الـ CO2 ناركوزز، تفضل مرضى
+
+183
+00:13:10,120 --> 00:13:14,640
+ينامبطل alert، الpatient كان cuff عنده جاج
+
+184
+00:13:14,640 --> 00:13:17,180
+ريفليكس، و عنده cuff reflex، و breath effectively،
+
+185
+00:13:17,180 --> 00:13:20,680
+أنا شايف ال lung expansion كويس، there is no
+
+186
+00:13:20,680 --> 00:13:24,760
+bronchospasm طبعا، وبالتالي بتلاقي الهيمو دانامك
+
+187
+00:13:24,760 --> 00:13:27,240
+stable، وضع ال tetrapolim الكويس اللي باخده
+
+188
+00:13:27,240 --> 00:13:29,740
+العيانة، أنا مش هجيسه، بس بشوف، ممكن هجيسه
+
+189
+00:13:29,740 --> 00:13:32,860
+بالـSperometer، هشوف عن طريق الـDirosperometer،
+
+190
+00:13:32,860 --> 00:13:36,660
+هشوف كده بطلع expiration، فبعرف كده باخد
+
+191
+00:13:36,660 --> 00:13:40,260
+inspirationوراقب الـ Blood Gases تبعه، وشوف الـ
+
+192
+00:13:40,260 --> 00:13:45,080
+Saturation تبعه طول الوقت يكون أعلى من 95% ويكون
+
+193
+00:13:45,080 --> 00:13:48,160
+معناه إن شاء الله Successful Extubation الـ
+
+194
+00:13:48,160 --> 00:13:50,100
+Complication تبع الـ Mechanical Ventilation يا
+
+195
+00:13:50,100 --> 00:13:52,740
+جماعة، أهم Complication بدي أحكي فيها، حكينا عن
+
+196
+00:13:52,740 --> 00:13:55,500
+البرترومو، حكينا عن البربنتيل، حكينا عن كل الحاجات
+
+197
+00:13:55,500 --> 00:13:59,240
+هذه، حاجة اسمها الـ Nasocomial Pneumonia أو الـ
+
+198
+00:13:59,240 --> 00:14:01,720
+Ventilator Associated Pneumonia، اسمها دي جديد،
+
+199
+00:14:01,720 --> 00:14:11,530
+اسمها«Ventilator-Associated Pneumonia» «VCP»
+
+200
+00:14:11,530 --> 00:14:15,430
+«Ventilator-Associated Pneumonia» أعطيناك وإحنا
+
+201
+00:14:15,430 --> 00:14:26,730
+homeworkإنكوا تكتبوننا إيش هي العوامل اللي بتزود
+
+202
+00:14:26,730 --> 00:14:30,530
+ال ventilator associated pneumonia وإيش هي ال
+
+203
+00:14:30,530 --> 00:14:33,310
+prevention measures اللي أنا ممكن أعملها عشان أقل
+
+204
+00:14:33,310 --> 00:14:36,210
+ال ventilator associated pneumonia، هذا همورك
+
+205
+00:14:36,210 --> 00:14:40,190
+عليكم وال nursing management هذه لمريض intubated
+
+206
+00:14:40,190 --> 00:14:47,190
+حسب ال nursing diagnosis هدولةأنتم المطلوبين أن
+
+207
+00:14:47,190 --> 00:14:54,170
+تعملوا عليهم Nursing Interventions فهنا في محطوتكم
+
+208
+00:14:54,170 --> 00:15:00,130
+الـInterventions مثال،
+
+209
+00:15:00,130 --> 00:15:05,290
+الـGoal كيف بدنا monitor and evaluate client
+
+210
+00:15:05,290 --> 00:15:06,850
+response
+
+211
+00:15:09,860 --> 00:15:17,000
+وPatient Airway، وهذه المعاملات المطلوبة من
+
+212
+00:15:17,000 --> 00:15:21,700
+حضراتكم أن تعملوا أربع نيرسينج دياجنوس على مريض
+
+213
+00:15:21,700 --> 00:15:28,380
+انتبيت وتعملوا لهم لكل واحد نيرسينج، لكل نيرسينج
+
+214
+00:15:28,380 --> 00:15:29,600
+دياجنوس أربع نيرسينج
+
+215
+00:15:33,290 --> 00:15:38,930
+التكنيك تبع السكشن في فيديو سأرفعه لكي تشاهدوا كيف
+
+216
+00:15:38,930 --> 00:15:42,770
+بالظبط المفروض نعمل سكشن سواء في هذا يعني عملي
+
+217
+00:15:42,770 --> 00:15:48,010
+الموضوع closed section و open section سأرفعه لك
+
+218
+00:15:48,010 --> 00:15:52,710
+على الموقع وهكذا خلصنا هذا ال chapter أعطيكم
+
+219
+00:15:52,710 --> 00:15:56,950
+العافية و تحياتي لكم والسلام عليكم ورحمة الله
+
diff --git a/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/ubz1LLA7UOE_raw.json b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/ubz1LLA7UOE_raw.json
new file mode 100644
index 0000000000000000000000000000000000000000..f9f3b4d38d2d2b87c6371d153a6bd68bd288fd64
--- /dev/null
+++ b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/ubz1LLA7UOE_raw.json
@@ -0,0 +1 @@
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Ratio يا بنزود الـ Peak يا بنزود الـ Up I.O.2 لكن عشان أحسن الـ Ventilation إذا أنا عملت Blood Gas لمريد و لاجيت إن الـ CO2 تبعه مثلا عالي بعرف أنا إنه أنا عشان أحسن الـ CO2 و أعمل Washing Out يا بدى أزود الـ Tidal Volume يا بزدود الـ Rate", "tokens": [3555, 1863, 5016, 4117, 1829, 11778, 47302, 15042, 6225, 8592, 7649, 8717, 5016, 3794, 1863, 2423, 39184, 16489, 8647, 399, 35186, 10874, 15042, 27884, 35186, 44945, 22488, 1211, 2423, 39184, 286, 13, 36, 13, 24269, 1004, 35186, 44945, 11622, 23328, 2423, 39184, 43604, 35186, 44945, 11622, 23328, 2423, 39184, 5858, 286, 13, 46, 13, 17, 44381, 6225, 8592, 7649, 5551, 5016, 3794, 1863, 2423, 39184, 28290, 16067, 11933, 15730, 41850, 6225, 42213, 2655, 17428, 24025, 5296, 29973, 25708, 4032, 20193, 7435, 36081, 36145, 2423, 39184, 3002, 17, 6055, 3555, 3615, 3224, 50113, 15040, 6225, 6027, 1829, 45030, 28480, 41850, 36145, 3224, 41850, 6225, 8592, 7649, 5551, 5016, 3794, 1863, 2423, 39184, 3002, 17, 4032, 5551, 25957, 1211, 3027, 571, 5925, 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new file mode 100644
index 0000000000000000000000000000000000000000..c12399d4f605dee1522e9fd02c355c1beda8caa8
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@@ -0,0 +1 @@
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{"start": 100.25, "end": 100.67, "word": " «acute", "probability": 0.78369140625}, {"start": 100.67, "end": 101.13, "word": " respiratory", "probability": 0.94970703125}, {"start": 101.13, "end": 101.53, "word": " distress", "probability": 0.95654296875}, {"start": 101.53, "end": 102.03, "word": " syndrome»", "probability": 0.97021484375}, {"start": 102.03, "end": 102.31, "word": " بدها", "probability": 0.757568359375}, {"start": 102.31, "end": 102.67, "word": " شوية", "probability": 0.9236653645833334}, {"start": 102.67, "end": 103.39, "word": " تركيز", "probability": 0.96923828125}, {"start": 103.39, "end": 104.35, "word": " لو", "probability": 0.849609375}, {"start": 104.35, "end": 104.85, "word": " طلعنا", "probability": 0.9637451171875}, {"start": 104.85, "end": 105.03, "word": " مع", "probability": 0.986328125}, {"start": 105.03, "end": 105.89, "word": " بعض", "probability": 0.989501953125}, {"start": 105.89, "end": 106.39, "word": " على", "probability": 0.87255859375}, {"start": 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"word": " Pronchules", "probability": 0.499908447265625}, {"start": 120.36, "end": 121.12, "word": " وبتنتفي", "probability": 0.64569091796875}, {"start": 121.12, "end": 121.94, "word": " Alveoli", "probability": 0.7264811197916666}, {"start": 121.94, "end": 122.32, "word": " عشان", "probability": 0.923828125}, {"start": 122.32, "end": 122.68, "word": " تعمل", "probability": 0.9825846354166666}, {"start": 122.68, "end": 123.0, "word": " عملية", "probability": 0.9860026041666666}, {"start": 123.0, "end": 123.18, "word": " الـ", "probability": 0.6494140625}, {"start": 123.18, "end": 123.34, "word": " Gas", "probability": 0.391845703125}, {"start": 123.34, "end": 123.98, "word": " Exchange", "probability": 0.6868489583333334}, {"start": 123.98, "end": 124.54, "word": " هذه", "probability": 0.368408203125}, {"start": 124.54, "end": 125.1, "word": " التكبير", "probability": 0.8519287109375}, {"start": 125.1, "end": 125.58, "word": " لواحدة", "probability": 0.85821533203125}, {"start": 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"word": " الناس", "probability": 0.8518880208333334}, {"start": 1051.62, "end": 1051.8, "word": " دول", "probability": 0.918701171875}, {"start": 1051.8, "end": 1052.12, "word": " بيصير", "probability": 0.9176025390625}, {"start": 1052.12, "end": 1052.6, "word": " لها", "probability": 0.379638671875}, {"start": 1052.6, "end": 1053.22, "word": " بيصير", "probability": 0.86328125}, {"start": 1053.22, "end": 1053.58, "word": " decrease", "probability": 0.1798095703125}, {"start": 1053.58, "end": 1053.78, "word": " في", "probability": 0.5517578125}, {"start": 1053.78, "end": 1053.78, "word": " ال", "probability": 0.77880859375}, {"start": 1053.78, "end": 1054.42, "word": " Surfactant", "probability": 0.767822265625}, {"start": 1054.42, "end": 1054.9, "word": " و", "probability": 0.60693359375}, {"start": 1054.9, "end": 1055.2, "word": " بيصير", "probability": 0.896240234375}, {"start": 1055.2, "end": 1055.68, "word": " دمج", "probability": 0.6134033203125}, {"start": 1055.68, "end": 1055.92, "word": " في", "probability": 0.9873046875}, {"start": 1055.92, "end": 1056.08, "word": " ال", "probability": 0.7666015625}, {"start": 1056.08, "end": 1057.3, "word": " capillary،", "probability": 0.4962158203125}, {"start": 1057.3, "end": 1058.0, "word": " ال", "probability": 0.18603515625}, {"start": 1058.0, "end": 1058.5, "word": " membranes", "probability": 0.700439453125}, {"start": 1058.5, "end": 1058.62, "word": " و", "probability": 0.5302734375}, {"start": 1058.62, "end": 1058.8, "word": " عشان", "probability": 0.8680013020833334}, {"start": 1058.8, "end": 1058.92, "word": " هيك", "probability": 0.935302734375}, {"start": 1058.92, "end": 1059.28, "word": " بيحاولوا", "probability": 0.9378255208333334}, {"start": 1059.28, "end": 1059.72, "word": " يدوقوا", "probability": 0.820068359375}, {"start": 1059.72, "end": 1060.34, "word": " Surfactant", "probability": 0.825927734375}, {"start": 1060.34, "end": 1060.68, "word": " عشان", "probability": 0.9783528645833334}, {"start": 1060.68, "end": 1061.02, "word": " يهيئوا", "probability": 0.87275390625}, {"start": 1061.02, "end": 1061.56, "word": " الفرصة", "probability": 0.975830078125}, {"start": 1061.56, "end": 1062.34, "word": " لـ", "probability": 0.640625}, {"start": 1062.34, "end": 1063.16, "word": " Recovery", "probability": 0.62353515625}], "temperature": 1.0}, {"id": 50, "seek": 108091, "start": 1065.77, "end": 1080.91, "text": "عادةً بيستخدموه في الـ Neonate لأنه أصلاً بيكون Fish and Homes are fact and okay احنا هنوقف عند النقطة هذه ونكمل في الـ Pulmonary Embolism في الفيديو القادم يعطيكم", "tokens": [3615, 18513, 3660, 14111, 4724, 1829, 14851, 9778, 40448, 2407, 3224, 8978, 2423, 39184, 1734, 266, 473, 5296, 33456, 3224, 5551, 9381, 15040, 14111, 4724, 1829, 30544, 18096, 293, 389, 18168, 366, 1186, 293, 1392, 1975, 5016, 8315, 8032, 1863, 30543, 5172, 43242, 28239, 47432, 3660, 29538, 4032, 1863, 24793, 1211, 8978, 2423, 39184, 35568, 46386, 3968, 17460, 1434, 8978, 27188, 1829, 16254, 2407, 25062, 18513, 2304, 37495, 9566, 1829, 24793], "avg_logprob": -0.3977864699231254, "compression_ratio": 1.355191256830601, "no_speech_prob": 4.4405460357666016e-05, "words": [{"start": 1065.7700000000002, "end": 1066.6100000000001, "word": "عادةً", "probability": 0.64019775390625}, {"start": 1066.6100000000001, "end": 1067.45, "word": " بيستخدموه", "probability": 0.8617117745535714}, {"start": 1067.45, "end": 1067.65, "word": " في", "probability": 0.89208984375}, {"start": 1067.65, "end": 1068.27, "word": " الـ", "probability": 0.807861328125}, {"start": 1068.27, "end": 1068.95, "word": " Neonate", "probability": 0.5857747395833334}, {"start": 1068.95, "end": 1069.73, "word": " لأنه", "probability": 0.6818033854166666}, {"start": 1069.73, "end": 1070.09, "word": " أصلاً", "probability": 0.82861328125}, {"start": 1070.09, "end": 1070.29, "word": " بيكون", "probability": 0.8675130208333334}, {"start": 1070.29, "end": 1070.53, "word": " Fish", "probability": 0.181884765625}, {"start": 1070.53, "end": 1070.81, "word": " and", "probability": 0.78173828125}, {"start": 1070.81, "end": 1071.07, "word": " Homes", "probability": 0.3885498046875}, {"start": 1071.07, "end": 1071.25, "word": " are", "probability": 0.420166015625}, {"start": 1071.25, "end": 1071.49, "word": " fact", "probability": 0.4130859375}, {"start": 1071.49, "end": 1071.69, "word": " and", "probability": 0.1947021484375}, {"start": 1071.69, "end": 1072.25, "word": " okay", "probability": 0.26611328125}, {"start": 1072.25, "end": 1072.57, "word": " احنا", "probability": 0.8076171875}, {"start": 1072.57, "end": 1073.13, "word": " هنوقف", "probability": 0.915283203125}, {"start": 1073.13, "end": 1073.55, "word": " عند", "probability": 0.97607421875}, {"start": 1073.55, "end": 1074.83, "word": " النقطة", "probability": 0.9698893229166666}, {"start": 1074.83, "end": 1074.99, "word": " هذه", "probability": 0.499267578125}, {"start": 1074.99, "end": 1075.69, "word": " ونكمل", "probability": 0.944580078125}, {"start": 1075.69, "end": 1075.81, "word": " في", "probability": 0.8427734375}, {"start": 1075.81, "end": 1075.97, "word": " الـ", "probability": 0.509765625}, {"start": 1075.97, "end": 1076.31, "word": " Pulmonary", "probability": 0.5654296875}, {"start": 1076.31, "end": 1077.13, "word": " Embolism", "probability": 0.6556803385416666}, {"start": 1077.13, "end": 1077.79, "word": " في", "probability": 0.8837890625}, {"start": 1077.79, "end": 1079.63, "word": " الفيديو", "probability": 0.86962890625}, {"start": 1079.63, "end": 1080.37, "word": " القادم", "probability": 0.9959309895833334}, {"start": 1080.37, "end": 1080.91, "word": " يعطيكم", "probability": 0.908935546875}], "temperature": 1.0}], "language": "ar", "language_probability": 1.0, "duration": 1082.2124375, "duration_after_vad": 1063.0443750000004}
\ No newline at end of file
diff --git a/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/woBR5RVlPBA_raw.srt b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/woBR5RVlPBA_raw.srt
new file mode 100644
index 0000000000000000000000000000000000000000..0c2f92475b0937ddaeab7a5304454b12b411f89a
--- /dev/null
+++ b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/woBR5RVlPBA_raw.srt
@@ -0,0 +1,940 @@
+1
+00:00:01,850 --> 00:00:04,870
+السلام عليكم ورحمة الله وبركاته إن شاء الله رب
+
+2
+00:00:04,870 --> 00:00:08,810
+العالمين اليوم هنحكي عن الـ Acute respiratory
+
+3
+00:00:08,810 --> 00:00:13,590
+distress syndrome إيش هو الـ Acute respiratory
+
+4
+00:00:13,590 --> 00:00:17,970
+distress syndrome؟ إيش ال pathophysiology تبع
+
+5
+00:00:17,970 --> 00:00:23,950
+المرض؟ كيف بيصير؟ إيش ال signs و ال symptoms؟ يعني
+
+6
+00:00:23,950 --> 00:00:28,770
+العلمات و ال clinical manifestations تبع ال
+
+7
+00:00:28,770 --> 00:00:33,130
+diseaseوإيه الـ «Treatment»؟ كيف بيتم علاج الـ
+
+8
+00:00:33,130 --> 00:00:37,250
+«Acute Respiratory Distress Syndrome»؟ بنعرف الـ
+
+9
+00:00:37,250 --> 00:00:41,890
+«Acute Respiratory Distress Syndrome» إنه يعني
+
+10
+00:00:41,890 --> 00:00:50,590
+«Inflammatory Process» بتصير في الـ «Lung Tissue»
+
+11
+00:00:50,590 --> 00:00:52,630
+بيقدّي إلى
+
+12
+00:00:56,210 --> 00:01:03,810
+يعني Major Dysfunction للـPulmonary Function طبعاً
+
+13
+00:01:03,810 --> 00:01:06,370
+معروف إن الـMortality Rate في الـAcute Respiratory
+
+14
+00:01:06,370 --> 00:01:10,230
+Distress Syndrome عالية كتير مع أن الكلام إن هي
+
+15
+00:01:10,230 --> 00:01:16,390
+حالة acute حادة Rapidly deteriorated الـonset
+
+16
+00:01:16,390 --> 00:01:21,810
+تبعها سريع والـ deterioration تبعها Rapidly
+
+17
+00:01:21,810 --> 00:01:24,630
+Progressive بتطور بسرعة على الأسواق
+
+18
+00:01:28,310 --> 00:01:33,030
+كيف الـ «pathology» تبع المرض وكيف بيصير عملتلكوا
+
+19
+00:01:33,030 --> 00:01:38,830
+الـ «chart» عشان يسهل العملية لأنه شوية الـ «acute
+
+20
+00:01:38,830 --> 00:01:41,530
+distress syndrome» «acute respiratory distress
+
+21
+00:01:41,530 --> 00:01:46,850
+syndrome» بدها شوية تركيز لو طلعنا مع بعض على ال
+
+22
+00:01:46,850 --> 00:01:51,920
+«lung» يعني هي .. يعنيالـ Trachea في الـ Pronchus
+
+23
+00:01:51,920 --> 00:01:58,780
+أنا أعتبر أنه في أنها الـ Lung في أن هنا بتتفر على
+
+24
+00:01:58,780 --> 00:02:03,180
+الـ Pronchules وبتنتفي Alveoli عشان تعمل عملية الـ
+
+25
+00:02:03,180 --> 00:02:06,840
+Gas Exchange هذه التكبير لواحدة من الـ Alveoli
+
+26
+00:02:06,840 --> 00:02:14,800
+اللي بيكونوا هنا أقرب عليكم أكترزي ما بنعرف إحنا
+
+27
+00:02:14,800 --> 00:02:20,660
+الـ Alveoli فيها يعني في قلبها فيه «ساك» «ساك» هذا
+
+28
+00:02:20,660 --> 00:02:26,060
+تجويف وظيفته يعمل «gas exchange» عن طريق إنه بيجي
+
+29
+00:02:26,060 --> 00:02:32,190
+arterial بـ bloodأو يعني بيجي الـ Arterial Blood
+
+30
+00:02:32,190 --> 00:02:37,350
+عفوا من الـ Palmonary Artery بيجي فيه يعني الـ Non
+
+31
+00:02:37,350 --> 00:02:41,450
+-Oxygenated Blood من الـ Palmonary Artery بيجي من
+
+32
+00:02:41,450 --> 00:02:45,750
+القلب على الرئتين من الـ Palmonary Artery بيجي Non
+
+33
+00:02:45,750 --> 00:02:50,670
+-Oxygenated Blood، هاياته أزرق، تمام؟ إيش بده؟ بده
+
+34
+00:02:50,670 --> 00:02:55,010
+Oxygen فالـ Alveoli ساكتبها إيش فيه هوا تفيه قداش
+
+35
+00:02:55,010 --> 00:03:00,310
+فيه Oxygen، تركيزه 21% بياخدبصير عبر الـ
+
+36
+00:03:00,310 --> 00:03:03,990
+Capillaries الموجودة جاز إكسيتشانجي بياخد الأكسجين
+
+37
+00:03:03,990 --> 00:03:09,070
+و بطلع Oxygenated Blood بيروح على البلمونري، إيش؟
+
+38
+00:03:09,070 --> 00:03:14,170
+بيروح على البلمونري Veins اللي هما two على ال
+
+39
+00:03:14,170 --> 00:03:18,230
+right و two على الrift اللي بيرجعوا ال blood من ال
+
+40
+00:03:18,230 --> 00:03:24,360
+lung ل ال heartطبعًا بعد ما بياخدوا الأكسجين بتطلع
+
+41
+00:03:24,360 --> 00:03:27,840
+الـCO2 تاني أكسيد الكربون علشان احنا
+
+42
+00:03:27,840 --> 00:03:34,960
+بالـExpiration نطلعه تمام؟ اللي بيصير في الـARDS
+
+43
+00:03:34,960 --> 00:03:44,260
+إنه بيصير في accumulation للـfluid في الـcapillary
+
+44
+00:03:45,530 --> 00:03:50,630
+في الـCapillary Membrane هذا اللي هنا بيصير فيه
+
+45
+00:03:50,630 --> 00:03:55,510
+احتقال للسوائل وتجمع له السوائل السوائل because of
+
+46
+00:03:55,510 --> 00:04:02,310
+underlying causes لأن نتيجة مرض معين في الجسم ممكن
+
+47
+00:04:02,310 --> 00:04:08,950
+أن يكون السببممكن أن يكون السبب Direct Causes يعني
+
+48
+00:04:08,950 --> 00:04:15,110
+مثلا Pneumonia Aspiration Inhalation لجاز او Smoke
+
+49
+00:04:15,110 --> 00:04:19,230
+او whatever توكسين وممكن يكون السبب indirect يا
+
+50
+00:04:19,230 --> 00:04:23,850
+جماعة يعني مش في ال lung السبب برا ال lung زي ال
+
+51
+00:04:23,850 --> 00:04:28,440
+sepsisأه، يعني الـSevere sepsis في الجسم كلهيته
+
+52
+00:04:28,440 --> 00:04:31,720
+هذا بيعمل عارفين أحنا أن الـsepsis in general
+
+53
+00:04:31,720 --> 00:04:35,300
+بيعمل alteration في الـtissue permeability فيه خلل
+
+54
+00:04:35,300 --> 00:04:38,340
+في الـpermeability النفاذية الإختيارية تبعت من
+
+55
+00:04:38,340 --> 00:04:43,460
+الـtissue وتبعت اللي بتتحكم في انتقال
+
+56
+00:04:43,460 --> 00:04:46,660
+الـelectrolytes
+
+57
+00:04:46,660 --> 00:04:50,600
+يعني والـfluid، الـfluid والـelectrolytes فبتصير
+
+58
+00:04:50,600 --> 00:04:54,590
+فيه أو الburn كذلك من الأمثلة والحاجاتاللي معروفة
+
+59
+00:04:54,590 --> 00:05:00,230
+إنها بتعمل إيش؟ Alteration في الـTissue
+
+60
+00:05:00,230 --> 00:05:03,190
+Burnability لما بيصير هذا الكلام in direct causes
+
+61
+00:05:03,190 --> 00:05:06,610
+ممكن يأثر على الـLung والسوائل اللي محتقنة هنا
+
+62
+00:05:06,610 --> 00:05:10,030
+نتيجة يصير فيه damage في الـCapillary Membrane هنا
+
+63
+00:05:10,030 --> 00:05:14,550
+يصير فيه damage في الـCapillary Membrane الـDamage
+
+64
+00:05:14,550 --> 00:05:18,860
+هذا يطلق إيش يا جماعة؟تطلّق الـ Fluid تروح تصير
+
+65
+00:05:18,860 --> 00:05:22,100
+الـ Fluid تتحوّش لما بيصير الـ Damage هنا وتهتج
+
+66
+00:05:22,100 --> 00:05:25,380
+تصير ال Fluid تتكوّم في المنطقة هذه زي ما أحنا
+
+67
+00:05:25,380 --> 00:05:28,360
+شايفين ال Fluid تصير تتكوّم هنا إيش يعني صارت
+
+68
+00:05:28,360 --> 00:05:31,440
+Fluid في قلب الساك يعني إيش؟ يعني صار حاجة زي ال
+
+69
+00:05:31,440 --> 00:05:34,740
+.. إيش؟ زي البلمونة القديمة، قوله لأ صار بلمونة
+
+70
+00:05:34,740 --> 00:05:41,170
+القديمةطبعاً هذا هيأدى لإنه الـ surfactant تبع الـ
+
+71
+00:05:41,170 --> 00:05:45,730
+lung اتقل وبالتالي لما بيقل ال surfactant تبع ال
+
+72
+00:05:45,730 --> 00:05:50,330
+lung من جلب ال alveoli أو في ال alveoli هيتأدى
+
+73
+00:05:50,330 --> 00:05:54,470
+لإنه كل ال alveoli هذه هتصير إليها collapse و
+
+74
+00:05:54,470 --> 00:05:58,250
+هتضبر على بعض وهذا هيعملى حد بنسميه إيش ال
+
+75
+00:05:58,250 --> 00:06:02,930
+atelactasis اللي بيعمل atelactasis أخدناها تمام؟
+
+76
+00:06:03,520 --> 00:06:09,420
+الـ Atelactasis هاي لما بتكرر هذا الكلام ليش في
+
+77
+00:06:09,420 --> 00:06:12,700
+الـAlveoli واحدة في عدة الـAlveoli هادا هاخل
+
+78
+00:06:12,700 --> 00:06:16,620
+المريض الـLung Compliance تبعته إيه صار فيها قلت
+
+79
+00:06:16,620 --> 00:06:20,800
+إذعان الـLung وقدرة دخول الهوى وإنها تعمل عملت
+
+80
+00:06:20,800 --> 00:06:25,200
+الـGas Exchange قلت بكتير وبالتالي صار فيه
+
+81
+00:06:25,200 --> 00:06:29,180
+Decrease في الـLung Compliance وصار فيه Embared في
+
+82
+00:06:29,180 --> 00:06:33,530
+الـGas Exchangeوكمان الـ Respiratory Rate يعني
+
+83
+00:06:33,530 --> 00:06:37,010
+الصين والسمط مش هيكون وضع إنه Respiratory Rate
+
+84
+00:06:37,010 --> 00:06:42,110
+هيسيب بزيدي كتير تمام؟ وزيادة الـ Respiratory Rate
+
+85
+00:06:42,110 --> 00:06:46,990
+يا جماعة هتخلي رغم إنه فيه Respiratory Rate عالي
+
+86
+00:06:46,990 --> 00:06:50,770
+لكن الـ Oxygen الـ Partial Pressure تبع الـ Oxygen
+
+87
+00:06:50,770 --> 00:06:56,550
+أشمله هيكون Low فهيكون أقل من 60 لكن الـ CO2
+
+88
+00:06:56,550 --> 00:07:00,870
+because ofعالية الـ respiratory rate يعني المريض
+
+89
+00:07:00,870 --> 00:07:08,710
+بعمل washing out للـ CO2 يعني بغسل بشطف الـ CO2
+
+90
+00:07:08,710 --> 00:07:14,690
+لأنه بيعمل expiration كتير فعكون
+
+91
+00:07:14,690 --> 00:07:21,480
+الـ CO2 عنده low واطللكن هذا في الأول بعد شوية
+
+92
+00:07:21,480 --> 00:07:24,700
+زمان المريض بيصير exhausted بالتعب فبيصير عنده
+
+93
+00:07:24,700 --> 00:07:27,300
+hyperventilation وبيصير مش قادر ياخد نفس فبيصير
+
+94
+00:07:27,300 --> 00:07:31,560
+accumulation للـCO2 لأن كل hyperventilation فيه
+
+95
+00:07:31,560 --> 00:07:35,980
+CO2 accumulation وhypercapnia وبالتالي المريض بيخش
+
+96
+00:07:35,980 --> 00:07:42,360
+في حالة من الـmetabolicمن الـ Respiratory Acidosis
+
+97
+00:07:42,360 --> 00:07:45,080
+وطبعاً يمكن أن يكون السبب سبسيز في السلسل
+
+98
+00:07:45,080 --> 00:07:48,060
+أندوميتابولك و Respiratory Acidosis
+
+99
+00:07:50,890 --> 00:07:54,110
+الأهم حاجة اللي نعرفها إن الـ Respiratory أو الـ
+
+100
+00:07:54,110 --> 00:07:57,590
+Acute Respiratory Syndrome هي نوع من أنواع الـ
+
+101
+00:07:57,590 --> 00:08:03,950
+Respiratory Failure الأكيوت، تمام؟ وبالتالي، اللي
+
+102
+00:08:03,950 --> 00:08:08,470
+بيصير فيها إنه بيصير فيه Decrease في الجاز X
+
+103
+00:08:08,470 --> 00:08:13,920
+-Chain، بيقل الجازعشان بيجيلي الجاز إكس تشينج
+
+104
+00:08:13,920 --> 00:08:18,480
+بيصير نتيجة
+
+105
+00:08:18,480 --> 00:08:21,820
+الـ collapse اللي صار في الـ alveoli ونتيجة ال
+
+106
+00:08:21,820 --> 00:08:26,710
+fluid اللي طلعت على الـ alveoli وملت ال sackاللي
+
+107
+00:08:26,710 --> 00:08:31,970
+صار فيه Hypoxemia وعرفنا الـ Causes وشوفنا كيف الـ
+
+108
+00:08:31,970 --> 00:08:35,250
+Sign و الـ Symptoms مع بعض، هنعيدها بس بدي ألخصلكم
+
+109
+00:08:35,250 --> 00:08:38,210
+إيش يعني من كل الكلام اللي أنا حكيته هذا؟ إيش أنتم
+
+110
+00:08:38,210 --> 00:08:42,850
+تتخلوا في مخكم و تحفظوا عن الـARDS؟ بنحكي إن لما
+
+111
+00:08:42,850 --> 00:08:47,490
+بنقول ARDS
+
+112
+00:08:47,490 --> 00:08:54,710
+A يعني اتلاك تاسيس بيحدث في الـAlveolarاللي هو
+
+113
+00:08:54,710 --> 00:08:59,290
+الدمج في الـcapillary من الـBrain وبالتالي هيصير
+
+114
+00:08:59,290 --> 00:09:01,630
+بعدها زي ما احنا عارفين الـPulmonary قديمة
+
+115
+00:09:01,630 --> 00:09:07,250
+هتنطلساك بالمياه وهيصير Refractory Hypoxemia إذن
+
+116
+00:09:07,250 --> 00:09:10,350
+الـR إنه فيه Refractory Hypoxemia إيش يعني؟ يعني
+
+117
+00:09:10,350 --> 00:09:13,750
+حتى لو قدنا المريض أكسوجين مابيتحسنش الأكسوجين
+
+118
+00:09:13,750 --> 00:09:17,590
+تبعه ليش مابيتحسنش الأكسوجين؟ لإن الـLung نفسها
+
+119
+00:09:17,590 --> 00:09:23,770
+ماعندهاش إيشما عندهاش قدرة إنها تشتغل صح و تعمل
+
+120
+00:09:23,770 --> 00:09:27,570
+gas exchange الحاجة التانية لإنه فيه تهتك في ال
+
+121
+00:09:27,570 --> 00:09:31,250
+capillaries أصلا كمان مش بس بالمنارة قديمة، تمام؟
+
+122
+00:09:32,010 --> 00:09:36,210
+ويمكن هذا اللي بيميز الـ ARDS عن البلمونة الاديمة
+
+123
+00:09:36,210 --> 00:09:39,590
+الـ Cardogenic تبع الـ Heart إنه هذه مافيش فيها
+
+124
+00:09:39,590 --> 00:09:42,670
+Damage في الـ Capillary ومجرد ما المريض يبدأ ياخد
+
+125
+00:09:42,670 --> 00:09:46,730
+Diuretics بيبدأ يختلق السوائل من الجسم ويترحى والـ
+
+126
+00:09:46,730 --> 00:09:53,660
+lung بترجع بـ Clear و بتحسن الوضع فورا لكن فيهالـ
+
+127
+00:09:53,660 --> 00:09:57,620
+ARDS لأ ما بتحسنش لإنه It's non-cardogenic
+
+128
+00:09:57,620 --> 00:10:02,160
+بالمنورة القديمة السبب مش قصور في عضلة القلب السبب
+
+129
+00:10:02,160 --> 00:10:10,120
+لأ something else يعني lead to ARDS في حاجة تانية
+
+130
+00:10:10,120 --> 00:10:12,840
+أدت إلى إن المرض يخش في Acute Respiratory Distress
+
+131
+00:10:12,840 --> 00:10:16,240
+Syndrome ويصير أنه Respiratory Failure الـ
+
+132
+00:10:16,240 --> 00:10:20,420
+deterioration بكون سريع الـ A-Atelictis والـR
+
+133
+00:10:20,420 --> 00:10:21,800
+-refractory
+
+134
+00:10:23,440 --> 00:10:27,700
+هيبوكسينيا و D-decreased lung compliance في ناكل
+
+135
+00:10:27,700 --> 00:10:30,860
+المريض إيش بيكون؟ Stiff lung حتى لما تيجي و بدك
+
+136
+00:10:30,860 --> 00:10:34,220
+تديله بالأنبو و بالماسك بتلاقي ال lung مسكرة ما
+
+137
+00:10:34,220 --> 00:10:37,280
+حكينا عن الـalcoholic labs فهو بيروح الهواء مش
+
+138
+00:10:37,280 --> 00:10:42,080
+قادر الهواء إنه إيش يفوت فبيكون فيه stiffالـ Lung
+
+139
+00:10:42,080 --> 00:10:46,480
+بنحكي عنها ولذلك حتى لما بنقالج المرض في الـ
+
+140
+00:10:46,480 --> 00:10:48,480
+Mechanical Ventilator راح نشوف في العلاج الآن
+
+141
+00:10:48,480 --> 00:10:53,700
+بيكون احنا بدنا نقالجه بـ High Deep بنحط Deep أكتر
+
+142
+00:10:53,700 --> 00:11:01,350
+من عشرة centimeter water علشان أوأو 7 بار أو 10
+
+143
+00:11:01,350 --> 00:11:06,050
+بار علشان نستطيع أن نفتح الـ «ألغراي» هذه ويصير
+
+144
+00:11:06,050 --> 00:11:11,270
+فيها airiation يعني تصير فيها هوا بدخل ويبدأ تصير
+
+145
+00:11:11,270 --> 00:11:15,550
+أعمال الـ «جاز إفسترشينج» وهذا مش بالسهل الـ «S»
+
+146
+00:11:15,550 --> 00:11:20,230
+في الـ «ARDS» اللي هي الـ «Surfactant Decrease»
+
+147
+00:11:20,230 --> 00:11:23,070
+الـ «Surfactant» تجيل من الـ «Round» فماذا يحصل؟
+
+148
+00:11:24,700 --> 00:11:28,140
+بتصير مافيش عنده قدرة على عمل الـGas Exchange
+
+149
+00:11:28,140 --> 00:11:31,980
+والـHyaline Membrane بيصل له Damage وبالتالي
+
+150
+00:11:31,980 --> 00:11:36,860
+الـAccurate Respiratory Distress Syndrome هي من
+
+151
+00:11:36,860 --> 00:11:41,900
+أكتر المشاكل اللي بتصير في الـLung وكتابة الـRapid
+
+152
+00:11:41,900 --> 00:11:44,880
+Deterioration وعشان هيك الـMortality Rate تبعتها
+
+153
+00:11:44,880 --> 00:11:48,480
+عالية زي أن احنا حكينا إن الـSign والـSymptom
+
+154
+00:11:48,480 --> 00:11:53,840
+صاروا Clear إن المريض لازم يكون في عنده Dyspneaو
+
+155
+00:11:53,840 --> 00:11:58,200
+تاكيبنيا وبالتالي الـ heart rate بيبدأ يقلق،
+
+156
+00:11:58,200 --> 00:12:02,020
+compensation بيصير تاكيكارديا، تمام؟ إذا
+
+157
+00:12:02,020 --> 00:12:05,420
+تاكيكارديا fast breathing اللي هي تاكيبنيا،
+
+158
+00:12:05,420 --> 00:12:07,840
+reduced في ال lung compliance لإنه بتصير في
+
+159
+00:12:07,840 --> 00:12:13,190
+أتلاكسس بتسكر ال lungمن الـclinical symptoms بسبب
+
+160
+00:12:13,190 --> 00:12:16,250
+طبعا Hypoxemia أهم حاجة لو رفشفت ال saturation تبع
+
+161
+00:12:16,250 --> 00:12:19,790
+المريض هيكون ايش واطق كمان هيكون في peripheral
+
+162
+00:12:19,790 --> 00:12:23,950
+cyanosis ليش؟ لأنه مافيش good perfusion بيصير لل
+
+163
+00:12:23,950 --> 00:12:29,130
+tissue في أشعة الأطراف فيها أزرقاق ليش؟ من ال bad
+
+164
+00:12:29,130 --> 00:12:34,500
+perfusion من ال bad oxygenationالـ Mental state
+
+165
+00:12:34,500 --> 00:12:39,240
+تبعت المريض هتبدأ تصير فيها Confusion ليش؟ لأنه
+
+166
+00:12:39,240 --> 00:12:42,380
+برضه المريض confused because of low oxygen و ال
+
+167
+00:12:42,380 --> 00:12:46,200
+pain بالنسبة له أهم حاجة ال oxygen يوصله كفاية
+
+168
+00:12:46,200 --> 00:12:51,440
+عشان إيش يتروىويشتغل جيدًا، فسيكون هناك تغيير في
+
+169
+00:12:51,440 --> 00:12:53,540
+الـMental Status طبعًا المرض بيكون Distress لأنه
+
+170
+00:12:53,540 --> 00:12:56,860
+Hypoxemia لذلك من أهم العلمات الـHypoxemia لذلك
+
+171
+00:12:56,860 --> 00:13:01,520
+بنحتاج نعمل للمريض إيش يا جماعة ABG Blood Gas
+
+172
+00:13:01,520 --> 00:13:05,540
+Analysis علشان إيش نشوف مستويات الـPartial
+
+173
+00:13:05,540 --> 00:13:08,960
+Pressure تبع الـOxygen واللي هنلاقيه أقل من 60
+
+174
+00:13:08,960 --> 00:13:15,700
+أكيد والـCO2 في الأول هيكون فيهاللي هو Decrease
+
+175
+00:13:15,700 --> 00:13:19,880
+أيضًا للـ «CO2» يعني هيكون واطي يعني أقل من خمسة و
+
+176
+00:13:19,880 --> 00:13:28,820
+تلاتين خمسة و تلاتين لـ «CO2» في الدم هيكون أقل من
+
+177
+00:13:28,820 --> 00:13:36,720
+خمسة و تلاتين بينما للـ Oxygen هيكون أقل من ستين
+
+178
+00:13:39,620 --> 00:13:44,840
+طبعاً من العلامات كمان الـ X-Ray هيكون فيها Bad
+
+179
+00:13:44,840 --> 00:13:48,660
+Infiltration واضح جدا، لاحظوا الـ Normal Lung كيف؟
+
+180
+00:13:48,660 --> 00:13:53,440
+و الـ ARDS كيف بتكون الـ Lung Wide، Full of Fluid
+
+181
+00:13:54,510 --> 00:13:59,250
+وهذا بيصير زي ما حكينا سريع جدا الـ causes زي ما
+
+182
+00:13:59,250 --> 00:14:01,930
+حكينا فيه direct causes وفي indirect causes لو
+
+183
+00:14:01,930 --> 00:14:07,590
+direct معناها إنه إنه فيه pneumonia فيه trauma للـ
+
+184
+00:14:07,590 --> 00:14:12,230
+lung itself فيه aspiration لكن ال indirect ممكن
+
+185
+00:14:12,230 --> 00:14:18,360
+يكون substance ممكن يكون bam ممكن يكون toxinsشرحنا
+
+186
+00:14:18,360 --> 00:14:22,500
+الـ Pathophysiology كويس مع بعض وفهمناها وحكينا
+
+187
+00:14:22,500 --> 00:14:26,060
+عشان نعمل، عرفنا إيش هي الـSin والـSymptom وعرفنا
+
+188
+00:14:26,060 --> 00:14:31,380
+إنه لازم نعمل يعني ABG عشان نتشخص نعمل Blood Gas
+
+189
+00:14:31,380 --> 00:14:39,550
+ونشوف الـPCO2 والـPزي O2 وميني لازم يكون فيه PO2
+
+190
+00:14:39,550 --> 00:14:45,630
+low يعني hypoxemia ال chest x-ray بيكون فيها bad
+
+191
+00:14:45,630 --> 00:14:49,870
+infiltration bilateral على الجهتين الإلاج يا جماعة
+
+192
+00:14:49,870 --> 00:14:55,900
+في كمان حاجة أنا كنت بدي أحكيها اللي هوأحياناً
+
+193
+00:14:55,900 --> 00:14:58,960
+علشان شخصهم يعرفوا إذا Cardiac Caused ولا مش
+
+194
+00:14:58,960 --> 00:15:01,020
+Cardiac Caused بيحطوا حاجة اسمه Swans Gang
+
+195
+00:15:01,020 --> 00:15:06,700
+Catheter الـSwans Gang Catheter هان هيحطوا
+
+196
+00:15:06,700 --> 00:15:09,700
+Catheter زي الـCentral Line بس مش هتوقف في
+
+197
+00:15:09,700 --> 00:15:15,010
+الـRight Atrium لأ هتنزلعلى الـ right ventricle
+
+198
+00:15:15,010 --> 00:15:18,630
+وبعدين هتطلع عبر الـ pulmonary artery وتستقر في
+
+199
+00:15:18,630 --> 00:15:21,510
+الـ pulmonary artery وتقيس حاجة بيسموها الـ
+
+200
+00:15:21,510 --> 00:15:24,790
+pulmonary wedge pressure هذي بيسموها الـ swine's
+
+201
+00:15:24,790 --> 00:15:30,330
+catheter هتقيس الـ pulmonary wedge pressure يعني
+
+202
+00:15:30,790 --> 00:15:35,030
+الضغط داخل الـ Pulmonary artery أثناء الـ Closure
+
+203
+00:15:35,030 --> 00:15:38,750
+يعني لما بيصير Inflation للبلون بقسل الضغط في
+
+204
+00:15:38,750 --> 00:15:42,890
+اللحظات هذه وبعدين بيصير Deflation عشان الدم يعدي
+
+205
+00:15:42,890 --> 00:15:48,250
+الهدف منخياس الـ Pulmonary Blood Pressure إنه نعرف
+
+206
+00:15:48,250 --> 00:15:51,470
+إذا كان الـ Pulmonary Blood Pressure يعني من 15 لـ
+
+207
+00:15:51,470 --> 00:15:56,670
+18 أقل من 18، بيعتبروا إن الموضوع ARDS لكن إذا كان
+
+208
+00:15:56,670 --> 00:16:00,070
+الـ Pulmonary Blood Pressure أكتر من 18، بيكون
+
+209
+00:16:00,070 --> 00:16:04,780
+الموضوع له علاقة بالـفي الـ heart يعني Cardiac
+
+210
+00:16:04,780 --> 00:16:11,960
+issue بالنسبة للعلاج، العلاج يا جماعة للمرضى
+
+211
+00:16:11,960 --> 00:16:15,920
+اللي عنده ARDS بالدرجة الأولى بنعالج الـ
+
+212
+00:16:15,920 --> 00:16:19,480
+underlying disease يعني من إيش هو صار عنده الـ
+
+213
+00:16:19,480 --> 00:16:23,840
+ARDS؟ من sepsis، من burn، من pneumonia
+
+214
+00:16:26,230 --> 00:16:31,250
+مدعم للمرحلة اللي هو فيها لازم نحطه على mechanical
+
+215
+00:16:31,250 --> 00:16:37,670
+ventilator و بالذات high beamلأ الـ Mechanical
+
+216
+00:16:37,670 --> 00:16:42,570
+Ventilator with High Beep Mechanical Ventilator
+
+217
+00:16:42,570 --> 00:16:47,570
+with High Beep علشان يعمل Inflation طبعاً هذا إله
+
+218
+00:16:47,570 --> 00:16:51,350
+مشاكله إنه بيكون High Beep صح بيعمل Inflation في
+
+219
+00:16:51,350 --> 00:16:54,590
+القلب والعين ويمكن يحسن الـ Respiratory Function
+
+220
+00:16:54,590 --> 00:16:57,970
+لكن الـ Intraturric Pressure بشكل عام بيكون عالي
+
+221
+00:16:57,970 --> 00:17:02,100
+كتير، هذا بيعملالضغط على الـBlood vessels ممكن
+
+222
+00:17:02,100 --> 00:17:06,740
+يعمل Hypotension ممكن يأثر على الـPerfusion تبع
+
+223
+00:17:06,740 --> 00:17:10,320
+الـBrain أيضًا، فلازم يكون فيه توازن في المسألة
+
+224
+00:17:10,320 --> 00:17:15,360
+هذه، طبعًا الـHigh concentration تبع الـOxygen of
+
+225
+00:17:15,360 --> 00:17:19,760
+IO2 ممكن يؤدي إلى toxicity برضه، Oxygen toxicity
+
+226
+00:17:22,460 --> 00:17:27,620
+من ضمن العلاج تبع الـ «ARDS» أحيانًا بيستخدموا الـ
+
+227
+00:17:27,620 --> 00:17:30,500
+Surfactant لإنه أحنا حكينا إنه بشكل أساس ما يوجد
+
+228
+00:17:30,500 --> 00:17:33,580
+Surfactant عند الناس دول بيصير لها بيصير decrease
+
+229
+00:17:33,580 --> 00:17:38,000
+في ال Surfactant و بيصير دمج في ال capillary، ال
+
+230
+00:17:38,000 --> 00:17:40,340
+membranes و عشان هيك بيحاولوا يدوقوا Surfactant
+
+231
+00:17:40,340 --> 00:17:43,160
+عشان يهيئوا الفرصة لـ Recovery
+
+232
+00:17:45,770 --> 00:17:50,290
+عادةً بيستخدموه في الـ Neonate لأنه أصلاً بيكون
+
+233
+00:17:50,290 --> 00:17:53,550
+Fish and Homes are fact and okay احنا هنوقف عند
+
+234
+00:17:53,550 --> 00:17:57,790
+النقطة هذه ونكمل في الـ Pulmonary Embolism في
+
+235
+00:17:57,790 --> 00:18:00,910
+الفيديو القادم يعطيكم
+
diff --git a/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/wswv63T8KBY.srt b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/wswv63T8KBY.srt
new file mode 100644
index 0000000000000000000000000000000000000000..5636b34d8a8f2da210d3e501ea045657cb6f9a0e
--- /dev/null
+++ b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/wswv63T8KBY.srt
@@ -0,0 +1,1721 @@
+1
+00:00:00,000 --> 00:00:05,500
+بسم الله الرحمن الرحيم السلام عليكم ورحمة الله
+
+2
+00:00:05,500 --> 00:00:10,260
+وبركاته اليوم إن شاء الله رب العالمين سنستكمل مع
+
+3
+00:00:10,260 --> 00:00:13,900
+بعض محاضرة نهائية في الـArterial Blood Gases
+
+4
+00:00:13,900 --> 00:00:20,680
+Analysis وسنلخص ما حكيناها المرة اللي فاتت، و سنبدأ
+
+5
+00:00:20,680 --> 00:00:26,240
+في الإجابة على بعض الأسئلة التي بعضكم سأل عنها
+
+6
+00:00:26,240 --> 00:00:32,320
+خلال مناقشات الـWhatsApp.  حكينا المرة الفاتت عن
+
+7
+00:00:32,320 --> 00:00:35,340
+الـMetabolic Acidosis والـMetabolic Alkalosis
+
+8
+00:00:35,340 --> 00:00:38,840
+وسنبدا اليوم الحديث عن الـRespiratory Acidosis و
+
+9
+00:00:38,840 --> 00:00:41,880
+Respiratory Alkalosis. وبعد ذلك إن شاء الله رب
+
+10
+00:00:41,880 --> 00:00:44,540
+العالمين سنضع خلاصة حول كيفية تحليل  blood gases، كيف
+
+11
+00:00:44,540 --> 00:00:52,280
+يمكنني القيام بذلك. بالأمس، عندما حكينا عن الـ
+
+12
+00:00:56,280 --> 00:00:59,840
+أمس عندما حكينا عن الـMetabolic Acidosis، حكينا عن
+
+13
+00:00:59,840 --> 00:01:04,420
+الـAnion Gap.  كثير من الناس سألوني لماذا الـAnion Gap
+
+14
+00:01:04,420 --> 00:01:09,280
+هكذا؟ المعادلة الجاهزة تقول من 12 إلى 16، يعني 14
+
+15
+00:01:09,280 --> 00:01:14,680
+بلاس ماينس 2.  احفظوها: 14 ± 2. هذا هو الـ
+
+16
+00:01:14,680 --> 00:01:22,720
+Normal Anion Gap. طبعاً الـNormal Anion Gap،  الناس
+
+17
+00:01:22,720 --> 00:01:26,180
+تقول أن هناك معادلة أخرى في الكتاب، ومكتوب قيم أقل
+
+18
+00:01:26,180 --> 00:01:30,800
+ونقولها بكل بساطة: المعادلة عندما تحتوي
+
+19
+00:01:30,800 --> 00:01:34,160
+على البوتاسيوم، الذي هو تقريباً أربعة، فإن هذه هي القيم
+
+20
+00:01:34,160 --> 00:01:37,940
+الحقيقية. طبعاً، إذا أردت استثناء البوتاسيوم،
+
+21
+00:01:37,940 --> 00:01:41,500
+لماذا نستثنيه؟ لأن البوتاسيوم ليس من السهل أن يكون عند
+
+22
+00:01:41,500 --> 00:01:45,940
+الجميع متساوياً.  يعني، عندك حالة من الـHypo أو الـ
+
+23
+00:01:45,940 --> 00:01:49,320
+Hyperkalemia يكون ذا دلالة، ويكون معروفاً، وبقية
+
+24
+00:01:49,320 --> 00:01:54,960
+الناس، معظمهم، يكون البوتاسيوم لديهم مستقراً حول الأربعة
+
+25
+00:01:54,960 --> 00:01:58,700
+لأنه، كما قلنا، البوتاسيوم الطبيعي من 3.5
+
+26
+00:01:58,700 --> 00:02:01,720
+إلى 5.5، فمعظم الناس يكون لديهم حوالي
+
+27
+00:02:01,720 --> 00:02:05,520
+الأربعة، وليس من السهل أن يكون لدى المرء Hypo أو
+
+28
+00:02:05,520 --> 00:02:09,360
+Hyperkalemia، لأن الموضوع يكون خطيراً، فمن الممكن أن
+
+29
+00:02:09,360 --> 00:02:13,380
+إذا أردت استثناء الأربعة، تنقص من المعادلة هذه الأربعة
+
+30
+00:02:13,380 --> 00:02:17,120
+وتعتبر هذا هو الـNormal، إذا لم تكن تحسب
+
+31
+00:02:17,120 --> 00:02:17,600
+البوتاسيوم.
+
+32
+00:02:21,430 --> 00:02:25,150
+فأنت تعتمد على الـNormal Anion Gap، وهو
+
+33
+00:02:25,150 --> 00:02:29,850
+أربعة عشر ± اثنين، okay؟ تمام، هذا بالنسبة للـ
+
+34
+00:02:29,850 --> 00:02:34,270
+Metabolic Acidosis، والـAnion Gap حكينا عنها
+
+35
+00:02:34,270 --> 00:02:36,930
+المرة اللي فاتت.  هناك من سأل أيضاً عن الـ
+
+36
+00:02:36,930 --> 00:02:39,770
+Metabolic Alkalosis، وكيف يحدث مع حالات استخدام مدرات البول،
+
+37
+00:02:39,770 --> 00:02:45,630
+فنقول لهم: أولاً، في الـMetabolic Acidosis، نحن
+
+38
+00:02:45,630 --> 00:02:50,160
+حكينا أنه من الممكن جداً أن يحدث، ماذا؟ في الـMetabolic
+
+39
+00:02:50,160 --> 00:02:53,650
+Acidosis، من الممكن أن يحدث مع مدرات البول،  يحدث Metabolic
+
+40
+00:02:53,650 --> 00:02:56,530
+Acidosis.  طيب، عندما تتناول مدرات البول، تفقد ربما أنك
+
+41
+00:02:56,530 --> 00:03:00,990
+تفقد سوائل كثيرة، ومن ضمنها  Bicarbonate، ستعمل الـ
+
+42
+00:03:00,990 --> 00:03:04,430
+كلى على طرح  Bicarbonate كثير، لكن،  لنعتبر أن الكلى
+
+43
+00:03:04,430 --> 00:03:09,310
+لا تزال قادرة على طرح Bicarbonate كثير، من الممكن أن يحدث
+
+44
+00:03:09,310 --> 00:03:14,170
+لديك ما يسمى Metabolic Acidosis، ولكن، ستبدأ الكلى على الفور
+
+45
+00:03:14,170 --> 00:03:17,950
+في إنتاج Bicarbonate أيضاً،
+
+46
+00:03:17,950 --> 00:03:23,410
+ل تعويض الفقدان الذي حدث. وهو
+
+47
+00:03:23,410 --> 00:03:28,510
+يختلف، فمثلاً،  Loop Diuretics مثل اللازيكس،
+
+48
+00:03:28,510 --> 00:03:33,530
+تختلف عن Thiazide، بأنها ستزيد كمية
+
+49
+00:03:33,530 --> 00:03:38,770
+إخراج الكلوريد بالنسبة للبيكربونات،
+
+50
+00:03:38,770 --> 00:03:44,650
+كمية الإخراج الخاصة بالكلوريد
+
+51
+00:03:44,650 --> 00:03:50,450
+بالنسبة  للبيكربونات تكون
+
+52
+00:03:50,450 --> 00:03:56,010
+ماذا؟ تكون البيكربونات أكثر، ولذلك تحدث
+
+53
+00:03:56,010 --> 00:04:00,750
+حالة قلوية في الدم، Metabolic Alkalosis.
+
+54
+00:04:00,750 --> 00:04:04,510
+ما الذي يسببها؟ نوع مدرات البول.  هناك استخدامات لـ
+
+55
+00:04:04,510 --> 00:04:09,790
+مدرات البول. تمام؟ تمام.  بالنسبة لـ... أيضاً،  هناك من سأل
+
+56
+00:04:09,790 --> 00:04:15,270
+عن، أعتقد قبل أن ندخل هنا، عن الضغط الجزئي للأكسجين،
+
+57
+00:04:15,270 --> 00:04:17,110
+الضغط الجزئي للأكسجين،
+
+58
+00:04:24,050 --> 00:04:28,230
+حكينا أن الضغط الجزئي للأكسجين من 75
+
+59
+00:04:28,230 --> 00:04:32,390
+% إلى 100%، والهيموغلوبين من 80% إلى 100%.  طيب، ماذا يعني الضغط الجزئي؟
+
+60
+00:04:32,390 --> 00:04:37,130
+الضغط الجزئي؟  يقال: "هو كمية الضغط التي يساهم بها غاز معين،
+
+61
+00:04:37,130 --> 00:04:42,030
+أي غاز،  في الضغط الكلي."
+
+62
+00:04:42,030 --> 00:04:50,070
+جزء، أي غاز معين، يساهم في الضغط الكلي،  مثلاً،  ماذا يعني هذا؟
+
+63
+00:04:50,070 --> 00:04:51,370
+مثلاً،  ماذا يعني هذا؟
+
+64
+00:04:57,260 --> 00:05:04,460
+نحن عادةً نأخذ الهواء الذي نتنفسه على مستوى
+
+65
+00:05:04,460 --> 00:05:11,580
+سطح البحر، صحيح؟ الضغط الكلي 100%. هذه الـ100%
+
+66
+00:05:11,580 --> 00:05:17,520
+هل كلها أكسجين؟ لا،  بل تساهم بنسبة 21% من الـ100%،  فيه
+
+67
+00:05:17,520 --> 00:05:24,350
+21% فقط هواء.  إذاً،  كمية الهواء التي تشكله، أنا
+
+68
+00:05:24,350 --> 00:05:27,650
+أتحدث عن الهواء، ليس عن جسم الإنسان، كمية الهواء،
+
+69
+00:05:27,650 --> 00:05:31,530
+الضغط الجزئي للأكسجين في الهواء الجوي هذا
+
+70
+00:05:31,530 --> 00:05:38,590
+ماذا؟ 21%.  طيب، أنا أخذت هذه الكمية. طيب، هذه
+
+71
+00:05:38,590 --> 00:05:42,150
+كمية الأكسجين الموجودة، التي نحن مهتمون بها، 21%،
+
+72
+00:05:42,150 --> 00:05:45,770
+هل هذه كمية الأكسجين فقط الموجودة لدينا؟  ليست هذه الكمية فقط من الأكسجين.
+
+73
+00:05:45,770 --> 00:05:51,310
+فإن الضغط الجزئي للأكسجين في الحويصلات الرئوية الخاصة بي؟
+
+74
+00:06:02,220 --> 00:06:06,720
+وكذلك ثاني أكسيد الكربون، وكذلك ثاني أكسيد الكربون.
+
+75
+00:06:06,720 --> 00:06:13,480
+لنبدأ بالجزء الجديد من المحاضرة.  سنتحدث عن الـ
+
+76
+00:06:13,480 --> 00:06:16,180
+Respiratory Acidosis. نقول ببساطة أن الـ
+
+77
+00:06:16,180 --> 00:06:22,760
+Respiratory Acidosis هي حالة من اضطراب
+
+78
+00:06:22,760 --> 00:06:27,660
+غازات الدم، وهو من اضطرابات توازن الحمض والقاعدة،
+
+79
+00:06:27,660 --> 00:06:32,240
+يتجه نحو زيادة الحموضة. طيب، ولماذا تسمى Respiratory؟
+
+80
+00:06:32,240 --> 00:06:35,840
+آه،  يعني السبب هو فشل رئوي، أو
+
+81
+00:06:35,840 --> 00:06:38,480
+فشل تنفسي، أو ما يسمى ventilatory failure.
+
+82
+00:06:38,480 --> 00:06:43,460
+طيب، ماذا يعني هذا؟ آه،  أقول أن في Respiratory
+
+83
+00:06:43,460 --> 00:06:48,850
+Acidosis،  الحموضة،  يعني الـpH منخفضة.  الحموضة،  أنا
+
+84
+00:06:48,850 --> 00:06:54,310
+دائماً أقول:  الحموضة مرتبطة بـ
+
+85
+00:06:54,310 --> 00:06:58,250
+CO2.  تعلمنا أن زيادة CO2 تسبب
+
+86
+00:06:58,250 --> 00:07:01,670
+حموضة.  فلا داعي لحفظ كل هذه المصطلحات.  عندما تسمع Respiratory Acidosis،
+
+87
+00:07:01,670 --> 00:07:04,950
+إذاً، Respiratory Acidosis  يعني الـpH منخفضة،  CO2 مرتفع،
+
+88
+00:07:04,950 --> 00:07:09,170
+وبالتالي، المريض هذا لديه CO2 مرتفع، يعني
+
+89
+00:07:09,170 --> 00:07:13,330
+لا يتنفس بشكل جيد،  لا يقوم بطرح
+
+90
+00:07:13,700 --> 00:07:17,720
+CO2،  لا يقوم بإزالة CO2
+
+91
+00:07:17,720 --> 00:07:23,800
+وبالتالي، CO2  ماذا؟  محجوز.  إذاً،  ماذا سيحدث
+
+92
+00:07:23,800 --> 00:07:26,760
+عندما يكون CO2 محجوزاً لديه؟  يحدث ما يسمى
+
+93
+00:07:26,760 --> 00:07:31,800
+فرط ثاني أكسيد الكربون، Hypercapnia، تمام؟
+
+94
+00:07:31,800 --> 00:07:35,600
+هذا يحدث مع من؟  يحدث مع مرضى الانسداد الرئوي المزمن، ومع
+
+95
+00:07:35,600 --> 00:07:39,520
+الذين يعانون من قصور القلب الرئوي، ومع الذين يعانون من
+
+96
+00:07:39,520 --> 00:07:46,360
+فشل تنفسي بسبب مثلاً،  أدوية مخدرة،  تناول
+
+97
+00:07:46,360 --> 00:07:53,750
+أدوية، تناول كودايين،  تناول أدوية مخدرة. وأيضاً أي شخص
+
+98
+00:07:53,750 --> 00:07:57,490
+ليس لديه القدرة على التنفس،  لأن لديه مثلاً
+
+99
+00:07:57,490 --> 00:08:02,270
+إصابة بالحجاب الحاجز،  العصب الذي يتحكم في الـ
+
+100
+00:08:02,270 --> 00:08:09,450
+الحجاب الحاجز مصاب،  ربما بسبب مرض يتحكم في
+
+101
+00:08:09,450 --> 00:08:12,150
+أعصاب عضلات التنفس لديه مشكلة،  مثل الـ
+
+102
+00:08:12,150 --> 00:08:15,670
+وهذه الأمراض تحدث فيها ضعف في الـ... ما أقوله
+
+103
+00:08:15,670 --> 00:08:19,810
+هو أن هناك ضعفاً في الـ... ما أقوله
+
+104
+00:08:19,810 --> 00:08:24,550
+هو عدم قدرة الجسم على التنفس التلقائي
+
+105
+00:08:24,550 --> 00:08:27,330
+بشكل صحيح، وبالتالي هو
+
+106
+00:08:27,330 --> 00:08:30,850
+تحت التهوية،
+
+107
+00:08:30,850 --> 00:08:37,390
+يعني معدل التنفس لديه منخفض،  يعني بطيء،
+
+108
+00:08:37,390 --> 00:08:40,730
+سأشرح لك،  لا داعي لأي شيء آخر،  Respiratory
+
+109
+00:08:40,730 --> 00:08:45,870
+acidosis،  تعني انخفاض في معدل التنفس،
+
+110
+00:08:45,870 --> 00:08:51,470
+وبالتالي زيادة في CO2،  في Hypercapnia
+
+111
+00:08:51,470 --> 00:08:59,930
+ويسمى تسمم ثاني أكسيد الكربون،  تمام؟ وأيضاً هذا سيؤدي إلى؟
+
+112
+00:08:59,930 --> 00:09:03,150
+انخفاض في الـpH، لأن Respiratory
+
+113
+00:09:03,150 --> 00:09:08,660
+Acidosis. وعرفت أن هذا يحدث مع أي مرض يسبب
+
+114
+00:09:08,660 --> 00:09:12,200
+عدم قدرة الجسم على التنفس، أي شيء يسبب
+
+115
+00:09:12,200 --> 00:09:15,640
+فشل تنفسي بسبب ضعف عضلي، بسبب
+
+116
+00:09:15,640 --> 00:09:20,900
+مرض في الجهاز العصبي المركزي،  كل من سكتة دماغية،
+
+117
+00:09:20,900 --> 00:09:26,500
+وصعوبة في التنفس،  مرضى السمنة،  تمام؟  كل من
+
+118
+00:09:26,500 --> 00:09:30,380
+التخدير،  كل من التخدير،  التنويم، أصبح الأمر واضحاً جداً،
+
+119
+00:09:30,380 --> 00:09:34,710
+تمام؟ والعلامات السريرية؟  والله
+
+120
+00:09:34,710 --> 00:09:41,270
+أصبحت واضحة.  شخص لديه CO2 مرتفع،  سيبدأ بالنعاس،
+
+121
+00:09:41,270 --> 00:09:45,810
+صحيح؟  ينعس،  ماذا يحدث؟  آه،  CO2  عندما يزيد في الجسم،
+
+122
+00:09:45,810 --> 00:09:50,450
+يسبب حالة من النعاس الشديد،  إلى درجة أنه
+
+123
+00:09:50,450 --> 00:09:53,310
+لا يستطيع أن يستيقظ، وبالتالي هذا يكون لديه ماذا؟
+
+124
+00:09:53,310 --> 00:09:57,190
+فرط ثاني أكسيد الكربون،  Hypercapnia،  يعني عندما ترى شخصاً يدخن
+
+125
+00:09:57,190 --> 00:10:01,430
+كثيراً،  دائماً نعسان،  دائماً نائم،  اعرف على الفور أنه لديه
+
+126
+00:10:01,430 --> 00:10:04,450
+Hypercapnia. عندما تكون في المحاضرة، والباب
+
+127
+00:10:04,450 --> 00:10:09,310
+مغلق،  والدكتور يشرح،  وتشعر بأنك بدأت تشعر بالنعاس،  اقرأ و
+
+128
+00:10:09,310 --> 00:10:15,330
+ارفع رأسك، أصبح رأسك ثقيل،  اعرف على الفور أن CO2 بدأ يرتفع في
+
+129
+00:10:15,330 --> 00:10:19,690
+جسمك،  ولازم تطلب من الدكتور أن يفتح الباب،  أن يفتح
+
+130
+00:10:19,690 --> 00:10:23,090
+الشباك،  هو المكان المناسب، لأن CO2 بدأ يرتفع لديك.
+
+131
+00:10:23,090 --> 00:10:27,110
+CO2  عندما يرتفع ويتجاوز الـ60،  ماذا يفعل؟  يسبب
+
+132
+00:10:27,110 --> 00:10:31,360
+شعوراً بالامتلاء في الرأس،  يقول لك: أشعر
+
+133
+00:10:31,360 --> 00:10:36,280
+برأسي ثقيل.  لماذا؟  لأنه يسبب توسع الأوعية الدموية الدماغية،
+
+134
+00:10:36,280 --> 00:10:42,020
+vasodilatation،  يتسبب في التمدد،  توسع في الـ
+
+135
+00:10:42,020 --> 00:10:47,840
+الأوعية الدموية الدماغية، وبالتالي ماذا سيحدث؟
+
+136
+00:10:47,840 --> 00:10:53,160
+سيحدث،  بسبب تراكم التمدد هذا،
+
+137
+00:10:53,160 --> 00:10:57,340
+سيجعل تدفق الدم إلى الدماغ أعلى
+
+138
+00:10:57,340 --> 00:11:00,500
+وبالتالي تشعر بثقل رأسك،  لأن كمية الدم أصبحت أكثر فيه
+
+139
+00:11:00,500 --> 00:11:04,720
+فجأة. تمام؟  كمية الدم الموجودة فيه، وبالتالي
+
+140
+00:11:04,720 --> 00:11:10,620
+يزيد لديك شعور بثقل الرأس، تمام؟ تمام. من الأشياء
+
+141
+00:11:10,620 --> 00:11:15,020
+أيضاً،  أن يصبح الشخص يعاني من نقص الأكسجة، والـ
+
+142
+00:11:15,020 --> 00:11:19,660
+تشبع الأكسجين عنده طبعاً منخفضة، سيحدث
+
+143
+00:11:19,660 --> 00:11:24,160
+هناك نقص أكسجين،  انخفاض تأكسج الدم،  تمام؟  وبالتالي ماذا سيحدث
+
+144
+00:11:24,160 --> 00:11:28,520
+يا جماعة؟  سيحدث لديه،  بسبب نقص الأكسجة،
+
+145
+00:11:28,520 --> 00:11:32,420
+اضطراب نظم القلب،  القلب لن ينبض بشكل جيد، فهو
+
+146
+00:11:32,420 --> 00:11:36,480
+من الممكن جداً أن يدخل في الرجفان البطيني،  تمام؟
+
+147
+00:11:36,480 --> 00:11:41,590
+من الممكن جداً أن يدخل في الرجفان البطيني. هؤلاء
+
+148
+00:11:41,590 --> 00:11:45,970
+الأشخاص قد يكون لديهم ارتفاع بوتاسيوم دموي سريري،  لأن
+
+149
+00:11:45,970 --> 00:11:51,830
+البيكربونات،  عفواً،  عندما يرتفع،  يشجع
+
+150
+00:11:51,830 --> 00:11:58,650
+البوتاسيوم على الخروج من الخلية،  تمام؟
+
+151
+00:11:59,820 --> 00:12:02,740
+قد ينتج ارتفاع بوتاسيوم دموي مع انتقال أيونات الهيدروجين
+
+152
+00:12:02,740 --> 00:12:05,940
+إلى داخل الخلية،  كيف يعني؟  مسبباً تحول
+
+153
+00:12:05,940 --> 00:12:08,320
+البوتاسيوم خارج الخلية، بالضبط،  شايفين كيف؟
+
+154
+00:12:08,320 --> 00:12:11,920
+البوتاسيوم  يُشجّع على الخروج من الخلية،  لماذا؟  نحن
+
+155
+00:12:11,920 --> 00:12:14,840
+نتحدث هنا عن حالة حمضية،  حالة من
+
+156
+00:12:14,840 --> 00:12:18,360
+الحمضية،  أي أيونات الهيدروجين،  المحاضرة الأولى،
+
+157
+00:12:18,360 --> 00:12:22,270
+قلنا أن أيونات الهيدروجين تكون كثيرة.  عندما
+
+158
+00:12:22,270 --> 00:12:25,530
+يكون  أيونات الهيدروجين كثيرة،  يبدأ الجسم في التخلص من
+
+159
+00:12:25,530 --> 00:12:28,590
+هذه الحموضة من الدم، وأين تدخل؟  تدخل إلى داخل الخلية،
+
+160
+00:12:28,590 --> 00:12:31,110
+لكي يدخل شيء إلى الخلية،  يجب أن يخرج شيء،  يدخل
+
+161
+00:12:31,110 --> 00:12:33,130
+الهيدروجين،  من يخرج؟  يخرج البوتاسيوم،  يصبح
+
+162
+00:12:33,130 --> 00:12:36,870
+البوتاسيوم خارج الخلية،  عالي،  حالة من ارتفاع بوتاسيوم الدم،
+
+163
+00:12:36,870 --> 00:12:41,430
+رائع. سأعود الآن إلى هذه الشريحة، على نقطة مهمة،  نقطة
+
+164
+00:12:41,430 --> 00:12:44,170
+قيادة الأكسجين،  والأشخاص الذين لديهم CO2
+
+165
+00:12:44,170 --> 00:12:48,090
+مرتفع،  الأشخاص الذين لديهم CO2  مرتفع، عندما
+
+166
+00:12:48,090 --> 00:12:52,810
+يكون لديهم مثلاً أكثر من 50،  بشكل مزمن،
+
+167
+00:12:52,810 --> 00:12:57,250
+يقال لك: لا تعطي هذا المريض أكسجيناً بكثرة،  دع
+
+168
+00:12:57,250 --> 00:13:00,570
+الأكسجين من 1 إلى 3 لترات في الساعة
+
+169
+0
+
+223
+00:16:47,950 --> 00:16:51,310
+حكيتي أن في الـ Respiratory Acidosis بيكون فيه
+
+224
+00:16:51,310 --> 00:16:54,930
+تراكم للـ CO2 بسبب الـ Hypoventilation. طب آه، إيش
+
+225
+00:16:54,930 --> 00:16:59,370
+أفهمت؟ أفهمت أن في الـ Respiratory Alkalosis حيكون
+
+226
+00:16:59,370 --> 00:17:04,810
+فيه اللي هو Depression للـ CO2 بسبب الـ
+
+227
+00:17:04,810 --> 00:17:08,730
+Hyperventilation. آه، والله، كلامك صحيح، آه، حيكون
+
+228
+00:17:08,730 --> 00:17:15,410
+الـ CO2 اللي هو منخفض وأقل من 35 نتيجة أن المريض
+
+229
+00:17:15,410 --> 00:17:21,180
+يتنفس عدد مرات تنفس أكثر من الطبيعي، فبيكون اسمه
+
+230
+00:17:21,180 --> 00:17:25,600
+Hyperventilation. يعني هو بيعمل good washing out لـ
+
+231
+00:17:25,600 --> 00:17:34,600
+CO2. يعني أي حاجة بتعمل نفس الشيء بهذا الشكل هيكون معناها
+
+232
+00:17:34,600 --> 00:17:37,620
+أنّه هتدخل المريض في Respiratory Alkalosis، برافو
+
+233
+00:17:37,620 --> 00:17:41,060
+عليه، حتى لو كانت Compensatory. هنشوف قصة الـ
+
+234
+00:17:41,060 --> 00:17:43,600
+Compensatory. طب وإيش فيه حاجات بتخلي الواحد يعمل
+
+235
+00:17:43,600 --> 00:17:48,060
+تَنفُّساً سريعاً؟ واحد بيقول لي أصلاً أنا من أول ما سمعتك
+
+236
+00:17:48,060 --> 00:17:51,520
+فكرتك بتعيط، بقوله آه صحيح، الـ Emotional Stress هو
+
+237
+00:17:51,520 --> 00:17:55,300
+بيعمل Respiratory Alkalosis لأنه بيخليك تصير
+
+238
+00:17:55,300 --> 00:17:58,540
+تَنفُّساً سريعاً، بيقول لي آه والله صحيح، طب واللي بيجري؟
+
+239
+00:17:58,850 --> 00:18:01,570
+بالهدوء، بيصير برضه ممكن يخش في الـ Respiratory
+
+240
+00:18:01,570 --> 00:18:06,590
+Alkalosis، ممكن. هاه طيب، طب وطيب؟ لأ، لأن اللي
+
+241
+00:18:06,590 --> 00:18:12,850
+بيجري يعني Healthy، يعني الشيء مرحلي يعني، تمام؟
+
+242
+00:18:12,850 --> 00:18:16,490
+لكن إذا والله Anxiety و Stress و سابق، المواضيع
+
+243
+00:18:16,490 --> 00:18:19,710
+هتخرب، أوكي، طيب.
+
+244
+00:18:24,100 --> 00:18:29,840
+إيش فيه كمان؟ أفهمنا عن الـ Respiratory Alkalosis
+
+245
+00:18:29,840 --> 00:18:36,500
+أن الـ CO2 حيكون منخفض، وحيكون في حالات زي اللي هو
+
+246
+00:18:36,500 --> 00:18:42,140
+الـ Stress أو حالات زي، أحكي لكم قصة في
+
+247
+00:18:42,140 --> 00:18:44,380
+الـ Compensation. هي نَفَس بس، يعني حالات مثلاً زي
+
+248
+00:18:44,380 --> 00:18:49,590
+الـ DKA. آه، ديكي إيه؟ بتيجي بتَنفُّساً سريعاً ولا لأ؟ آه
+
+249
+00:18:49,590 --> 00:18:53,210
+بتَنفُّساً سريعاً، بس أصحّ تقول عنها الـ Respiratory
+
+250
+00:18:53,210 --> 00:18:55,550
+Alkalosis. الـ Respiratory Alkalosis اللي هي
+
+251
+00:18:55,550 --> 00:18:59,390
+Compensation اللي عندها، يعني كيف؟ يعني هي جاية
+
+252
+00:18:59,390 --> 00:19:03,760
+بحالة من الـ Metabolic Acidosis. مثال، هي هذه الحالة
+
+253
+00:19:03,760 --> 00:19:06,920
+مثال هي الـ DKA، ضابطة الكيتو أسيدوسيز، بيكون
+
+254
+00:19:06,920 --> 00:19:11,500
+عندها حالة من الـ Metabolic Acidosis. طيب، الآن
+
+255
+00:19:11,500 --> 00:19:14,800
+الـ Metabolic Acidosis هذا بيعمل Compensation،
+
+256
+00:19:14,800 --> 00:19:19,400
+بيعمل تعويض، فالجسم بسبب الـ Acidosis
+
+257
+00:19:19,400 --> 00:19:22,780
+العالية اللي عنده، بيصير بيعمل يحسن الوضع. مين مسؤول
+
+258
+00:19:22,780 --> 00:19:25,480
+عن تحسين الوضع؟ في الـ lungs اللي هي بدها تعمل
+
+259
+00:19:25,480 --> 00:19:29,970
+Compensation؟ الـ CO2؟ طب إيش بنعمل وأنا عندي
+
+260
+00:19:29,970 --> 00:19:33,330
+Acidosis أصلاً؟ طب والـ CO2 مسؤول عن الـ Acidosis، إذا
+
+261
+00:19:33,330 --> 00:19:38,090
+لو أنا قلّلت الـ CO2، بقى ممكن أحسّن الحالة. فكيف ببدأ
+
+262
+00:19:38,090 --> 00:19:41,790
+أقلّل الـ CO2 أنا؟ بخلي المريض يعمل Washing Out
+
+263
+00:19:41,790 --> 00:19:47,050
+يتنفس بسرعة، اللي سمّيناه Kussmaul Breathing، فاكرينه؟
+
+264
+00:19:47,050 --> 00:19:52,730
+تمام. أنا بس حابب التنوع عشان ترجعوا تتذكروا، وعشان
+
+265
+00:19:52,730 --> 00:19:55,710
+برضه بدنا احنا هالجّهة الثانية، بدنا نخش في الـ
+
+266
+00:19:55,710 --> 00:19:58,630
+Compensation. لما بيجي بدنا نخش في الـ Compensation
+
+267
+00:19:58,630 --> 00:20:05,390
+على فكرة وأنا بحكي برضه تذكّرت سؤال لأحد
+
+268
+00:20:05,390 --> 00:20:07,870
+الأخوات، كانت سألته بس خلصنا الـ Compensation
+
+269
+00:20:07,870 --> 00:20:12,800
+هرجع له. في الـ Metabolic Acidosis، كانت واحدة سألت
+
+270
+00:20:12,800 --> 00:20:17,080
+يعني إيش الـ Compensation؟ الـ Compensation بكل
+
+271
+00:20:17,080 --> 00:20:21,260
+بساطة يا جماعة، يعني الاستجابة اللي بدها تصير لحالة
+
+272
+00:20:21,260 --> 00:20:24,400
+الـ
+
+273
+00:20:24,400 --> 00:20:29,640
+acid-base disorder اللي عندك. يعني إذا كانت الحالة
+
+274
+00:20:29,640 --> 00:20:34,800
+Metabolic، بيحا يُستَجيب سواء أسيدوس أو ألكالوس، الـ
+
+275
+00:20:34,800 --> 00:20:39,040
+Respiratory. طب وإذا كانت الحالة Respiratory، مين
+
+276
+00:20:39,040 --> 00:20:42,640
+بدّه يستجيب؟ الـ Metabolic. طب مين بيستجيب أسرع؟ الـ
+
+277
+00:20:42,640 --> 00:20:45,380
+Respiratory. آه، عارفين هاي، تمام؟ لأن حكيناها،
+
+278
+00:20:45,380 --> 00:20:49,260
+قلنا within minutes، بشتغل، لكن الـ kidneys بتشتغل
+
+279
+00:20:49,260 --> 00:20:53,540
+within days، okay؟ الكلام هذا اللي هنا
+
+280
+00:20:53,540 --> 00:20:56,880
+كيف بيشتغل، هلخصّه، الكابل slide هذه أسهل، شوفوا كده
+
+281
+00:20:58,520 --> 00:21:01,740
+الـ Compensation بيصير بالطريقة هذه. إذا كانت أنا
+
+282
+00:21:01,740 --> 00:21:06,300
+في عندي حالة من الـ Respiratory Acidosis، بيكون الـ
+
+283
+00:21:06,300 --> 00:21:11,840
+CO2 مرتفعة يا جماعة، وبالتالي الـ Compensation اللي
+
+284
+00:21:11,840 --> 00:21:21,100
+بدّه يصير عبارة عن Metabolic. Metabolic. أيوة
+
+285
+00:21:21,420 --> 00:21:24,720
+الـ Bicarbonate بنزل، يعني Metabolic Acidosis.
+
+286
+00:21:24,720 --> 00:21:29,960
+Metabolic Acidosis. عفوًا، أنا إيش حكيت؟
+
+287
+00:21:29,960 --> 00:21:34,720
+Metabolic Acidosis، يعني بدّه يقابله Metabolic
+
+288
+00:21:34,720 --> 00:21:43,740
+Alkalosis. Metabolic Alkalosis، تمام؟
+
+289
+00:21:43,740 --> 00:21:49,140
+طيب، إذا
+
+290
+00:21:49,140 --> 00:22:01,480
+كان هنا هذا السهم، يبدو أن هدول محطوطين بالخطأ. طيب،
+
+291
+00:22:01,480 --> 00:22:04,440
+الـ Compensation، عفواً، الـ Compensation هنا، أيوة،
+
+292
+00:22:04,440 --> 00:22:10,320
+إذا لما يكون في عندي الـ CO2 مرتفع، إيش بيصير؟
+
+293
+00:22:10,320 --> 00:22:13,660
+Respiratory Acidosis. الـ Compensation اللي بيصير،
+
+294
+00:22:13,660 --> 00:22:18,300
+Increase في الـ Bicarbonate. إيش هذا اسمه؟ Metabolic؟
+
+295
+00:22:20,380 --> 00:22:24,760
+Alkalosis. Metabolic Alkalosis طبعاً. طب لو كان
+
+296
+00:22:24,760 --> 00:22:31,000
+المشكلة عندي Respiratory Alkalosis. Respiratory
+
+297
+00:22:31,000 --> 00:22:35,140
+Alkalosis. الـ CO2 بيكون منخفض. الـ Bicarbonate إيش
+
+298
+00:22:35,140 --> 00:22:38,800
+بيصير؟ كيف بيصير الـ Compensation؟ بنخفض كمان،
+
+299
+00:22:38,800 --> 00:22:43,520
+ليه؟ لأنّه هو مسؤول عن الـ Alkaline. طب أنا المشكلة
+
+300
+00:22:43,520 --> 00:22:45,820
+عندي أن الـ Respiratory Alkalosis فيه already
+
+301
+00:22:45,820 --> 00:22:51,500
+Washing out للـ CO2. الـ Respiratory الـ CO2 منخفض، له
+
+302
+00:22:51,500 --> 00:22:54,520
+نتيجة أن الـ Respiratory Rate عالي، وعمل الـ
+
+303
+00:22:54,520 --> 00:22:58,340
+Respiratory Alkalosis. فإيش الحل؟ الحل أن الـ
+
+304
+00:22:58,340 --> 00:23:04,940
+Bicarbonate يصير له كمان ينخفض من نفسه. فعشان لما بيقل هو
+
+305
+00:23:04,940 --> 00:23:09,720
+في الدم عن اللي هو مثلاً الـ 24، هي منحة من الإتزان
+
+306
+00:23:09,720 --> 00:23:15,140
+تمام؟ طيب، لو كان في عندي Metabolic اللي هو
+
+307
+00:23:15,140 --> 00:23:21,320
+Metabolic Acidosis. Metabolic Acidosis. الـ Bicarbonate
+
+308
+00:23:21,320 --> 00:23:24,640
+بشكل أصلي منخفض، ما هو مسؤول عن القاعدية، لما
+
+309
+00:23:24,640 --> 00:23:27,520
+بييجي بيعمل Metabolic Acidosis، تمام؟
+
+310
+00:23:27,520 --> 00:23:30,580
+الـ Compensation إيش هيحصل؟ هييجي للـ CO2، لأن الـ CO2
+
+311
+00:23:30,580 --> 00:23:33,400
+في الـ Lungs هو المسؤول عن الحمضية. لما أصلاً الوضع
+
+312
+00:23:33,400 --> 00:23:36,520
+عندي في الدم Metabolic Acidosis، بيحاول يقلل من
+
+313
+00:23:36,520 --> 00:23:39,880
+نفسه، لأنه مسؤول عن الحمضية، عشان يعمل قاعدية ويعدّل
+
+314
+00:23:40,130 --> 00:23:46,350
+اللي يرجع للـ Balance. لكن لو كان Metabolic اللي هو
+
+315
+00:23:46,350 --> 00:23:49,170
+الـ Alkalosis، يعني الـ Bicarbonate أصلاً كتير. طب إيش
+
+316
+00:23:49,170 --> 00:23:52,370
+الـ CO2 بدّه يسوي؟ بدّه يحاول يزيد من نفسه، بدّه يحاول
+
+317
+00:23:52,370 --> 00:23:57,490
+الـ CO2 يزيد من نفسه في الدم، علشان يحسّن حالة الـ
+
+318
+00:23:57,490 --> 00:24:02,600
+Alkalosis الموجودة، تمام؟ هذا باختصار اللي هو كيف
+
+319
+00:24:02,600 --> 00:24:06,860
+بدها تصير عملية الـ Compensation. إيش يعني؟ كمان
+
+320
+00:24:06,860 --> 00:24:10,620
+مرة، في حالة الـ Respiratory Acidosis، عادة بيكون الـ
+
+321
+00:24:10,620 --> 00:24:16,040
+CO2 هو اللي مرتفع، وبالتالي الـ Bicarbonate بيتحرك علشان
+
+322
+00:24:16,040 --> 00:24:22,340
+يُحسّن الموضوع، فبيروح بيزيد من حاله، علشان يعادل الـ
+
+323
+00:24:22,340 --> 00:24:25,000
+Acidity الموجودة، لأن هذا الـ Bicarbonate مسؤول عن
+
+324
+00:24:25,000 --> 00:24:30,840
+القاعدة، وهذا الـ CO2 مسؤول عن الحمضية، تمام؟ في
+
+325
+00:24:30,840 --> 00:24:33,260
+حالة أن الـ Respiratory Alkalosis، يعني الـ CO2
+
+326
+00:24:33,260 --> 00:24:36,500
+المنخفض، المسؤول عن الحمضية منخفض، فعمل الـ
+
+327
+00:24:36,500 --> 00:24:40,720
+Alkalosis. فبيروح المسؤول عن القاعدة أصلاً في الجسم
+
+328
+00:24:40,720 --> 00:24:46,560
+يقلل من حاله، علشان يقلل القاعدية الموجودة، بحيث
+
+329
+00:24:46,560 --> 00:24:50,420
+يعمل شوية حموضة، عشان يعدّل حالة الـ Respiratory
+
+330
+00:24:50,420 --> 00:24:54,100
+Alkalosis، تمام؟ ولذلك دائماً أريدكم تفهموا، لما
+
+331
+00:24:54,100 --> 00:24:58,660
+بنحكي Respiratory Acidosis، بيكون المعادلة الـ
+
+332
+00:24:58,660 --> 00:25:02,380
+Compensation يعني تبعها، التعويض تبعها، عن طريق بدل
+
+333
+00:25:02,380 --> 00:25:06,720
+Respiratory، Metabolic، وبدل Acidosis، Alkalosis،
+
+334
+00:25:06,720 --> 00:25:09,820
+مفهوم؟ طيب، الـ Respiratory Alkalosis، بدل
+
+335
+00:25:09,820 --> 00:25:13,420
+Respiratory، Metabolic، بدل Alkalosis، Acidosis،
+
+336
+00:25:13,420 --> 00:25:17,200
+بيكون الـ Compensation تبعها Metabolic Acidosis
+
+337
+00:25:17,200 --> 00:25:21,040
+وبالعكس هنا، ما عندي حالة من Metabolic Acidosis زي
+
+338
+00:25:21,040 --> 00:25:26,280
+حالة الـ DKA. إيش في الـ Bicarbonate هو اللي له، أيوة،
+
+339
+00:25:26,280 --> 00:25:31,000
+تمام؟ الـ Bicarbonate هو اللي له. طب إيش اللي بدّه يسوي
+
+340
+00:25:31,000 --> 00:25:34,160
+الـ CO2؟ الـ CO2،  تولّسه حكينا، بيحاول أنّه الـ
+
+341
+00:25:34,160 --> 00:25:38,560
+Bicarbonate له. يعني في عندي أنا القاعدة في الجسم قليلة
+
+342
+00:25:38,560 --> 00:25:43,420
+فبيحاول أنّه الـ CO2 يزيد قاعدة الجسم، هو مسؤول عن
+
+343
+00:25:43,420 --> 00:25:46,920
+إيش؟ عن الحمضية. يعني زيادته بتعمل حموضة، فبيحاول
+
+344
+00:25:46,920 --> 00:25:50,600
+يقلل من نفسه عشان يزيد القاعدة تبع الجسم، عشان
+
+345
+00:25:50,600 --> 00:25:54,480
+يعادل الحموضة هذه. إذا بيعمل Respiratory Alkalosis
+
+346
+00:25:54,480 --> 00:25:58,580
+اللي توّ حكينا عنها. وهنا بالعكس، لو كان عندي الـ
+
+347
+00:25:58,580 --> 00:26:01,820
+Bicarbonate هو اللي مرتفع، يبقى فيه عندي حالة من
+
+348
+00:26:01,820 --> 00:26:06,860
+القاعدية، تمام. بيروح الـ CO2 و بيرتفع علشان يعمل
+
+349
+00:26:06,860 --> 00:26:10,160
+شوية حموضة ويحسّن حالة الـ Alkalosis. فبيروح بيعمل
+
+350
+00:26:10,160 --> 00:26:13,660
+Respiratory Acidosis. الكومبنسيشن بيكون Respiratory
+
+351
+00:26:13,660 --> 00:26:17,680
+Acidosis، علشان يصلّح الـ Metabolic Alkalosis، تمام؟
+
+352
+00:26:17,840 --> 00:26:21,220
+كيف أنا بدّي، طيب، أمسك Blood Gas أستاذ وأفسر هذا
+
+353
+00:26:21,220 --> 00:26:24,400
+الكلام؟ والله اللي فهمته أنت في الـ Compensation
+
+354
+00:26:24,400 --> 00:26:28,160
+هذا والقصص، ولا تلتفت ولا حاجة. هم عندك 6 خطوات أو
+
+355
+00:26:28,160 --> 00:26:31,760
+5 خطوات بدّك تمشي عليهم. سيبوا من كل المكتوب هذا، و
+
+356
+00:26:31,760 --> 00:26:35,380
+ركّزوا معه في الشريحة هذه لحالها. أول حاجة، تطلع في
+
+357
+00:26:35,380 --> 00:26:39,060
+الشكل العام للمريض، إيش حال المريض؟ والله مريض ده
+
+358
+00:26:39,060 --> 00:26:43,980
+بتعرف إيش حاله؟ مريض جالس وجديد ولا مش قادر يتنفس
+
+359
+00:26:43,980 --> 00:26:44,480
+من مرة؟
+
+360
+00:26:47,220 --> 00:26:56,200
+هو معروف أنه Type 1 Diabetes، وممكن خشّ في DKA و
+
+361
+00:26:56,200 --> 00:27:00,660
+لا، مريض مابانِيم، ومش عارفين إيش ما له؟ آه، ما بتاخذ
+
+362
+00:27:00,660 --> 00:27:05,800
+impression. طب بعدها أعمل له PR؟ آه والله صح، بأعمل أنا
+
+363
+00:27:05,800 --> 00:27:09,680
+Blood Gases. فبقى أشوف الـ pH. طيب، إيش هتلاقيه؟ يا
+
+364
+00:27:09,680 --> 00:27:13,260
+هتلاقيه عالي، يا هتلاقيه واطي، آه والله صح. إذا كان
+
+365
+00:27:13,260 --> 00:27:17,960
+الـ pH مرتفع، معناته أنه رايح مع الـ Alkalosis، مش عارف
+
+366
+00:27:17,960 --> 00:27:21,960
+إيش نوعها، أما الـ Alkalosis، تمام؟ لكن إذا كان واطي
+
+367
+00:27:21,960 --> 00:27:26,850
+منخفض الـ pH، معناته أنه فيه Acidosis، يعني إيش؟ الـ
+
+368
+00:27:26,850 --> 00:27:29,290
+Acidosis. لكن الـ Respiratory لما تقول لك لسه مش
+
+369
+00:27:29,290 --> 00:27:32,670
+عارفين. طيب، خطوة ثانية، إيش نسوي؟ بقول لك والله لو سمحت
+
+370
+00:27:32,670 --> 00:27:36,810
+شوف لي الـ CO2 والـ Bicarbonate. مين نشوف أول؟ الـ CO2
+
+371
+00:27:36,810 --> 00:27:43,380
+أصحّ  تنسوا مين نشوف أول؟ الـ CO2 أصحّ تنسى، ليش؟
+
+372
+00:27:43,380 --> 00:27:48,240
+الـ CO2 أول، لأن الـ CO2 أي مشكلة فيه فورًا راح
+
+373
+00:27:48,240 --> 00:27:50,780
+يعمل Disturbance في الـ acid-base balance، لإنه
+
+374
+00:27:50,780 --> 00:27:56,340
+حكينا أنّه الرئتين بيستجيبوا أسرع. طيب، okay. شفت أنا الـ
+
+375
+00:27:56,340 --> 00:28:00,100
+CO2 فيه مشكلة ولّا ما فيه مشكلة. وبعدين شفت الـ
+
+376
+00:28:00,100 --> 00:28:03,840
+Bicarbonate فيه مشكلة ولّا ما فيه مشكلة. بس بصراحة
+
+377
+00:28:03,840 --> 00:28:06,920
+أنا مش قادر أحدّد، لأن كده جيت في هذا، مش في الـ CO2
+
+378
+00:28:06,920 --> 00:28:11,000
+مشكلة، وفي الـ Bicarbonate مشكلة، فأنا مش قادر أحدّد هل
+
+379
+00:28:11,000 --> 00:28:14,760
+الـ CO2 هو المشكلة، ولّا هو Compensation؟ ولّا الـ
+
+380
+00:28:14,760 --> 00:28:17,520
+Bicarbonate هو المشكلة، ولّا هو التغيير اللي فيه
+
+381
+00:28:17,520 --> 00:28:21,540
+Compensation؟ فبدّك تدلّني، بنقول لك Bravo عليه، روح
+
+382
+00:28:21,540 --> 00:28:28,630
+اعمل شوف هذا، مين فيهم اللي ممكن يعمل Compensation
+
+383
+00:28:28,630 --> 00:28:32,970
+للتاني، ما زال فيه اختلاف، والإثنين فيهم Changes،
+
+384
+00:28:32,970 --> 00:28:35,970
+شوف مين اللي ممكن يعمل Compensation للتاني. كيف
+
+385
+00:28:35,970 --> 00:28:40,690
+يعني؟ يا شو، يعني، إذا كان الـ pH عندك Low، مثلاً،
+
+386
+00:28:40,690 --> 00:28:47,600
+منخفض، تمام؟ واللي وجدت أن الـ CO2 عندك مرتفع، آه
+
+387
+00:28:47,600 --> 00:28:49,940
+يبقى فيه خلال، لما زال الـ CO2 مرتفع، يبقى فيه خلال،
+
+388
+00:28:49,940 --> 00:28:56,480
+okay. وبعدين إطلعت وجدت الـ Bicarbonate أيضًا مرتفع،
+
+389
+00:28:56,480 --> 00:29:00,560
+تيجي على طول أنت بتحسبها، هو الـ Bicarbonate لما يرتفع
+
+390
+00:29:00,560 --> 00:29:07,610
+بيعمل Acidosis، مش الـ pH قلنا تولّه؟ آه. طيب، الـ Bicarbonate
+
+391
+00:29:07,610 --> 00:29:11,03
+
+445
+00:32:49,970 --> 00:32:55,490
+الـ pH منخفضة، الـ CO2 عالي، والـ bicarb يا بده يكون
+
+446
+00:32:55,490 --> 00:33:00,630
+طبيعي، يا بده يرتفع عشان يعمل compensation، بس في الـ
+
+447
+00:33:00,630 --> 00:33:06,420
+chronic، بِيرتفع زيادة كتير، عشان هيك بتلاقي خمسة و
+
+448
+00:33:06,420 --> 00:33:09,120
+خمسين، خمسة وأربعين، عند الناس الـChronic
+
+449
+00:33:09,120 --> 00:33:12,300
+الـChronic يعني أقصد الـChronic Respiratory
+
+450
+00:33:12,300 --> 00:33:15,980
+Acidosis، ذات و أنا COPD، طب ويه؟ ضيق التنفس؟
+
+451
+00:33:15,980 --> 00:33:19,800
+قبل Acute Respiratory Alkalosis؟  ما في حاجة، ما زال
+
+452
+00:33:19,800 --> 00:33:23,900
+Respiratory Alkalosis، طب أنت لاحظ في
+
+453
+00:33:23,900 --> 00:33:28,800
+الـRespiratory Acidosis، عكس بعض، الـpH Low والـCO2
+
+454
+00:33:28,800 --> 00:33:34,520
+هو اللي إيش؟ اللي مرتفع، لكن هي برضه عكس بعض، بس
+
+455
+00:33:34,520 --> 00:33:39,020
+الـpH هي اللي فوق، والـCO2 هو اللي منخفض، و
+
+456
+00:33:39,020 --> 00:33:42,020
+الـBicarb مالوش دعوة إلا إذا بدي يعملوا
+
+457
+00:33:42,020 --> 00:33:45,660
+compensation، طب إيش هيسوي؟ يأكل كثير، تعافي، برافو
+
+458
+00:33:45,660 --> 00:33:47,940
+عليكوا، بدي يقولوا لما زال الـAlkalosis هو بديه
+
+459
+00:33:47,940 --> 00:33:52,240
+يَحسّن حالة الـAlkalosis، فبديه يحاول يقلل من نفسه
+
+460
+00:33:52,240 --> 00:33:56,500
+عشان، برافو عليكوا، إيش يعمل؟ يعمل حالة من الحمضية
+
+461
+00:33:56,730 --> 00:34:00,150
+فبس القصة إن عند الناس الـChronic Respiratory
+
+462
+00:34:00,150 --> 00:34:05,550
+Acidosis بتلاقي بيكون قليل، زيادة، أكثر من الناس
+
+463
+00:34:05,550 --> 00:34:08,870
+الأكيوت، بس هذه كل القصة، كيف صار الـBlood Gases
+
+464
+00:34:08,870 --> 00:34:14,270
+والـInterpretation تبعته، أعتقد سهل كتير، وهيك يكون
+
+465
+00:34:14,270 --> 00:34:19,210
+كل الأسهم عندك وتستطيع تخلّي عليهم أي معادلة، وهنا
+
+466
+00:34:19,210 --> 00:34:24,850
+تلخيصك سريع لكل اللي حكيته أنا، لما كان عندي إبلاط
+
+467
+00:34:24,850 --> 00:34:27,730
+غاز، نفس اللي حكينا، تتطلع على البيئة، يعني هذه
+
+468
+00:34:27,730 --> 00:34:33,390
+الرسمة تقريباً هي نفسها بالظبط، اللي هي الرسمة هذه،
+
+469
+00:34:33,390 --> 00:34:39,010
+تمام؟ بس هي شبه الأرقام، Okay، هيك ممكن يا جماعة،
+
+470
+00:34:39,010 --> 00:34:43,170
+يعطيكم ألف عافية، خلصنا المحاضرة هذه، تمام، بس أنا
+
+471
+00:34:43,170 --> 00:34:48,950
+بصراحة تذكرت، بدي أرجع لسؤال زميلة، اللي إجت في
+
+472
+00:34:48,950 --> 00:34:55,170
+بالي، عن الـMetabolic Acidosis، في إيه؟ كانت
+
+473
+00:34:55,170 --> 00:34:57,350
+بتسألني عن الـPotassium، أظن
+
+474
+00:35:01,160 --> 00:35:07,720
+في الـMetabolic Acidosis؟
+
+475
+00:35:07,720 --> 00:35:12,520
+Alkalosis؟
+
+476
+00:35:12,520 --> 00:35:12,900
+Alkalosis؟ Alkalosis؟ Alkalosis؟
+
+477
+00:35:12,900 --> 00:35:12,920
+Alkalosis؟ Alkalosis؟ Alkalosis؟
+
+478
+00:35:12,920 --> 00:35:13,000
+Alkalosis؟ Alkalosis؟ Alkalosis؟
+
+479
+00:35:13,000 --> 00:35:13,020
+Alkalosis؟ Alkalosis؟ Alkalosis؟
+
+480
+00:35:13,020 --> 00:35:13,080
+Alkalosis؟ Alkalosis؟ Alkalosis؟
+
+481
+00:35:13,080 --> 00:35:20,120
+Alkalosis؟
+
+482
+00:35:20,120 --> 00:35:24,160
+Alkalosis؟
+
+483
+00:35:24,160 --> 00:35:30,460
+أو تعمل Metabolic Alkalosis، بما يحكي، إذا
+
+484
+00:35:30,460 --> 00:35:34,540
+فاكرين أنتو الـHyperaldosteronism، إيش بيصير
+
+485
+00:35:34,540 --> 00:35:38,860
+فيها؟ بيصير يعني الغدة الـSuprarenal gland، أو
+
+486
+00:35:38,860 --> 00:35:43,600
+بيسموها الـAdrenal gland، بتطلع اللي هو Aldosterone
+
+487
+00:35:43,600 --> 00:35:48,630
+كتير، بتطلع ألدوستيرون كتير، إيش يعني الألدوستيرون؟
+
+488
+00:35:48,630 --> 00:35:51,810
+عارفين إن الـAdrenal gland هي عبارة عن Cortex
+
+489
+00:35:51,810 --> 00:35:55,810
+وMedulla؟ الـCortex بتطلع اللي هي الألدوستيرون
+
+490
+00:35:55,810 --> 00:35:59,110
+والكورتيزول، والMedulla بتطلع الـAdrenaline والنور
+
+491
+00:36:00,100 --> 00:36:04,280
+فلما في واحد عنده الـHyperaldosteronism، يعني
+
+492
+00:36:04,280 --> 00:36:08,260
+الـAdrenal gland، من الـCortex تبعها، من القشرة
+
+493
+00:36:08,260 --> 00:36:11,400
+تبعها، بتطلع ألدوستيرون كتير، طب إيش بيسوي لما
+
+494
+00:36:11,400 --> 00:36:14,860
+بيصير ألدوستيرون كتير؟ آه، لما بيصير ألدوستيرون
+
+495
+00:36:14,860 --> 00:36:18,480
+كتير، بيعمل retention للـwater، وبيعمل loss
+
+496
+00:36:18,480 --> 00:36:21,200
+للبوتاسيوم كتير، لما يصير loss للبوتاسيوم، إيش
+
+497
+00:36:21,200 --> 00:36:25,440
+بيصير؟ بيدخل المريض في حالة من الـHypokalemia
+
+498
+00:36:25,440 --> 00:36:28,000
+طب لما تصير حالة من الـHypokalemia، إيش بيصير؟
+
+499
+00:36:28,210 --> 00:36:34,870
+ولما يصبح الحالة من الهيبوكاليميا، بيضطر أنه نقص
+
+500
+00:36:34,870 --> 00:36:40,570
+البوتاسيوم كتير، يعني بيأثر على أنه يعمل Metabolic
+
+501
+00:36:40,570 --> 00:36:42,350
+Acidosis بطريقة تانية يا جماعة
+
+502
+00:36:48,800 --> 00:36:55,320
+In which the potassium leaves the intracellular
+
+503
+00:36:55,320 --> 00:37:02,820
+to the extracellular، بيغادر
+
+504
+00:37:02,820 --> 00:37:05,900
+الـintracellular إلى الـextracellular space،
+
+505
+00:37:05,900 --> 00:37:09,300
+مش على الـblood، طبعاً؟ هلأ، صار إيش الخلية
+
+506
+00:37:09,300 --> 00:37:14,910
+مالها؟ فيها نقص البوتاسيوم، فيها طلع منها بوتاسيوم
+
+507
+00:37:14,910 --> 00:37:18,790
+فبيروح بيدخل بداله ماشي هيدروجين أيون، طلع منها
+
+508
+00:37:18,790 --> 00:37:22,390
+بوتاسيوم أيون، بيروح بيدخل بداله هيدروجين أيون
+
+509
+00:37:22,390 --> 00:37:25,570
+الهيدروجين زيادته مسؤولة عن إيش؟ أو هو أصلاً مسؤول عن
+
+510
+00:37:25,570 --> 00:37:29,910
+إيش؟ عن الحمضية، تمام؟ تمام، فلمّا كلّ في البلد هيعمل
+
+511
+00:37:29,910 --> 00:37:34,550
+Metabolic Alkalosis، تمام؟ بس أنا بدّي أؤكد على هذا
+
+512
+00:37:34,550 --> 00:37:44,770
+عشان وين القرار؟ هنا، إنه هنا، اللي هو هنا to
+
+513
+00:37:44,770 --> 00:37:51,330
+extracellular space، يعني intracellular
+
+514
+00:37:51,330 --> 00:37:57,030
+شفت؟ to extracellular space، in exchange for
+
+515
+00:37:57,030 --> 00:37:59,290
+اللي هو الهيدروجين، الهيدروجين، وين
+
+516
+00:37:59,290 --> 00:38:02,990
+بيروح؟ داخل الـcell، تمام، هذا التفسير الأول لكيف
+
+517
+00:38:02,990 --> 00:38:06,630
+بيصير، أو الألدوستيرون كيف بيعمل اللي هو
+
+518
+00:38:06,630 --> 00:38:12,970
+Hypokalemia، التفسير الثاني إن الـsecond effect
+
+519
+00:38:12,970 --> 00:38:16,570
+in the presence of Hypokalemia، هيدروجين سكريشن
+
+520
+00:38:16,570 --> 00:38:19,130
+in the proximal and distal tubule increase
+
+521
+00:38:19,130 --> 00:38:22,930
+الهيدروجين بتصير كتير فيه هيدروجين، وبعدها هذا
+
+522
+00:38:22,930 --> 00:38:27,600
+بيخلّي Reabsorption of bicarb، فيه هيدروجين أيون
+
+523
+00:38:27,600 --> 00:38:33,820
+كتير، بيصير يتحد مع اللي هو الـCO2، والماء الموجود
+
+524
+00:38:33,820 --> 00:38:38,480
+H2O اللي موجود، H2O اللي موجود، وبيصير يعمل
+
+525
+00:38:38,480 --> 00:38:41,660
+Reabsorption، بيكون اللي هو الـBicarb، وبيعمله
+
+526
+00:38:41,660 --> 00:38:44,280
+Reabsorption، فبيصير اللي بيقعد بالـBicarb ده
+
+527
+00:38:44,280 --> 00:38:48,070
+مسؤول عن القاعدية، فبيعملك Metabolic Alkalosis، هذه
+
+528
+00:38:48,070 --> 00:38:50,810
+اللي هي تفسير ليش الـAldosteronism، أو الـ
+
+529
+00:38:50,810 --> 00:38:56,390
+Hyperaldosteronism، بيعمل اللي هو Hypokalemia،
+
+530
+00:38:56,390 --> 00:39:02,650
+وليش الـHypokalemia والـAldosteronism
+
+531
+00:39:02,650 --> 00:39:08,890
+بيعملوا اللي هو Metabolic Alkalosis، هيك أنهينا
+
+532
+00:39:08,890 --> 00:39:12,990
+المحاضرة، وسمحونا على الإطالة اللي بالآخر
+
+533
+00:39:17,640 --> 00:39:21,140
+سامحونا على الإطالة بالآخر، ونعود إلى موضوع
+
+534
+00:39:21,140 --> 00:39:26,900
+الـBlood Gases، نكون إنتهينا منه، ويعطيكم ألف عافية
+
+535
+00:39:26,900 --> 00:39:31,200
+وإن شاء الله رب العالمين بنشوفكم على خير وسلامة في
+
+536
+00:39:31,200 --> 00:39:34,840
+الـMechanical Ventilator Lectures القادمة، إن شاء
+
+537
+00:39:34,840 --> 00:39:35,040
+الله
diff --git a/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/wswv63T8KBY_postprocess.srt b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/wswv63T8KBY_postprocess.srt
new file mode 100644
index 0000000000000000000000000000000000000000..a3584df2e9a1c327459a4905d195da6a9d442f2c
--- /dev/null
+++ b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/wswv63T8KBY_postprocess.srt
@@ -0,0 +1,2148 @@
+1
+00:00:00,000 --> 00:00:05,500
+بسم الله الرحمن الرحيم السلام عليكم ورحمة الله
+
+2
+00:00:05,500 --> 00:00:10,260
+وبركاته اليوم إن شاء الله رب العالمين هنستكمل مع
+
+3
+00:00:10,260 --> 00:00:13,900
+بعض محاضرة نهائية في الـArterial Blood Gases
+
+4
+00:00:13,900 --> 00:00:20,680
+Analysis وبنلخص اللي حكيناها المرة اللي فاتت وبدأ
+
+5
+00:00:20,680 --> 00:00:26,240
+أحاول أجاوب بعض الأسئلة اللي يعني بعضكم سأل من
+
+6
+00:00:26,240 --> 00:00:32,320
+خلال مناقشات الـWhatsApp عنهاحكينا المرة الفاتة عن
+
+7
+00:00:32,320 --> 00:00:35,340
+الـ Metabolic Acid Doses والـ Metabolic Alkalosis
+
+8
+00:00:35,340 --> 00:00:38,840
+وبدنا اليوم نحكي عن الـ Respiratory Acid Doses و
+
+9
+00:00:38,840 --> 00:00:41,880
+Respiratory Alkalosis وبعد ذلك إن شاء الله رب
+
+10
+00:00:41,880 --> 00:00:44,540
+العالمين نعمل conclusion على أي blood gases كيف
+
+11
+00:00:44,540 --> 00:00:52,280
+ممكن أن أنا أعملها، بارح لما حكينا عن الـ
+
+12
+00:00:56,280 --> 00:00:59,840
+بيرن لما حكينا عن الـ Metabolic Acidosis حكينا عن
+
+13
+00:00:59,840 --> 00:01:04,420
+الـ Onion Gap في ناس كتير سئلتني ليش الـ Onion Gap
+
+14
+00:01:04,420 --> 00:01:09,280
+هان المعادلة الجاهزة بتحكي أنه من 12 ل 16 يعني 14
+
+15
+00:01:09,280 --> 00:01:14,680
+plus minus 2 احفظوها 14 plus minus 2 هذا الـ
+
+16
+00:01:14,680 --> 00:01:22,720
+Normal Onion Gapطبعاً الـ Normal Onion Gap الناس
+
+17
+00:01:22,720 --> 00:01:26,180
+تقول إن هناك معادلة تانية في الكتاب ومكتوب قيم أقل
+
+18
+00:01:26,180 --> 00:01:30,800
+وبنحكيها بكل بساطة المعادلة عندما تكون فيها بتحتوي
+
+19
+00:01:30,800 --> 00:01:34,160
+البوتاسيوم اللي هو تقريباً أربعة فهي هذا القيم
+
+20
+00:01:34,160 --> 00:01:37,940
+تباعتها الحقيقية، طبعاً إذا بدك تستثني البوتاسيوم،
+
+21
+00:01:37,940 --> 00:01:41,500
+لماذا أستثنيه؟ لأن البوتاسيوم مش بسهل أن يكون عند
+
+22
+00:01:41,500 --> 00:01:45,940
+الناس مختلف، يعني عندكبحالة من الـ Hypo أو الـ
+
+23
+00:01:45,940 --> 00:01:49,320
+Hyperkalemia بكون Significant وبكون معروف وبقية
+
+24
+00:01:49,320 --> 00:01:54,960
+الناس معظم البتاسم عندهم بكون مستقر حوالين الأربعة
+
+25
+00:01:54,960 --> 00:01:58,700
+لأنه زي ما حكينا أنه أصلا البتاسم الطبيعي من تلاتة
+
+26
+00:01:58,700 --> 00:02:01,720
+و نص لخمسة و نص فمعظم الناس بيكونوا في حوالين
+
+27
+00:02:01,720 --> 00:02:05,520
+الأربعة ومش بالسهل أن يكون الواحد عنده Hypo أو
+
+28
+00:02:05,520 --> 00:02:09,360
+Hyperkalemia لأن الموضوع بيكون خطير فممكن أنت ساعة
+
+29
+00:02:09,360 --> 00:02:13,380
+لو بدك تستثنىالاربعة تنقص من المعادلة لهذه الاربعة
+
+30
+00:02:13,380 --> 00:02:17,120
+وتعتبر هذا هو الـ Normal إذا لم تكن تحسب
+
+31
+00:02:17,120 --> 00:02:17,600
+البوتاسيوم
+
+32
+00:02:21,430 --> 00:02:25,150
+فانت بتعتمد اللي هو الـ Normal Onion Gap اللي هو
+
+33
+00:02:25,150 --> 00:02:29,850
+plus minus أربعة أتاشر أربعة أتاشر plus minus
+
+34
+00:02:29,850 --> 00:02:34,270
+اتنين، okay؟ تمام، هذا بالنسبالي اللي هو الـ
+
+35
+00:02:34,270 --> 00:02:36,930
+Metabolic Acid Doses والـ Onion Gap حكينا عنها
+
+36
+00:02:36,930 --> 00:02:39,770
+المرة اللي فاتت، في ناس كمان سألون عن الـ
+
+37
+00:02:39,770 --> 00:02:45,630
+Metabolic Kalosis كيف بيصير مع حالات الـ Diotics،
+
+38
+00:02:45,630 --> 00:02:50,160
+بنحكي لهمأولاً في الـ Metabolic Acidosis أحنا
+
+39
+00:02:50,160 --> 00:02:53,650
+حكينا إنه يمكن جدا يصير هنا إيشفي الـ Metabolic
+
+40
+00:02:53,650 --> 00:02:56,530
+Acidosis ممكن يصير مع الـ Diuretics يصير Metabolic
+
+41
+00:02:56,530 --> 00:03:00,990
+Acidosis طب كده انت ماخد Diuretics بتفقد ربما انك
+
+42
+00:03:00,990 --> 00:03:04,430
+بتفقد Fluid كتير من ضمنها هيطلع Bicarb هتعمل ال
+
+43
+00:03:04,430 --> 00:03:09,310
+kidney بيكارب كتير لكن ناخد بأنه مازال ال kidney
+
+44
+00:03:09,310 --> 00:03:14,170
+ممكن تطلع بيكارب كتير ممكن يصير عندك اللي هو
+
+45
+00:03:14,170 --> 00:03:17,950
+Metabolic Acidosis بس فورا هتبدأ تشتغل وتصنع برضه
+
+46
+00:03:17,950 --> 00:03:23,410
+ال kidney بيكارب كتير عشان الفقدان اللي عندهاوهو
+
+47
+00:03:23,410 --> 00:03:28,510
+بيختلف فمثلًا الـ Loop Diuretics اللي زي الأمثال
+
+48
+00:03:28,510 --> 00:03:33,530
+اللاذكس بتختلف عن الـ Thiazide بإنها هتخلّي كمية
+
+49
+00:03:33,530 --> 00:03:38,770
+الـ Excretion of Cloride بالنسبة للـ Bicarbonate
+
+50
+00:03:38,770 --> 00:03:44,650
+كمية الـ Excretion الإفراز تبع الـ Cloride اللي
+
+51
+00:03:44,650 --> 00:03:50,450
+بتعمله بالنسبة للتناسب مع الـ Bicarbonate بكون
+
+52
+00:03:50,450 --> 00:03:56,010
+إيش؟بيكون الـ Bicarbonate أكتر فعلشان هيك بتصير
+
+53
+00:03:56,010 --> 00:04:00,750
+الحالة تبعت الدم حالة قلوية Metabolic Alkalosis
+
+54
+00:04:00,750 --> 00:04:04,510
+هذا مين بيسببه؟ نوع الـ Diuretics، فيه اتعمال الـ
+
+55
+00:04:04,510 --> 00:04:09,790
+Diuretics، تمام؟ تمام، بالنسبة لـ .. كمان في حد
+
+56
+00:04:09,790 --> 00:04:15,270
+سأل عن، أعتقد قبل ما نخش هان، عن الـ Partial
+
+57
+00:04:15,270 --> 00:04:17,110
+Pressure تبع الـ Oxygen
+
+58
+00:04:24,050 --> 00:04:28,230
+حكينا إن الـ «partial pressure» تبع الأكسجين من 75
+
+59
+00:04:28,230 --> 00:04:32,390
+% لـ 100% و التلكوك من 80% ل 100% طب إيش يعني الـ
+
+60
+00:04:32,390 --> 00:04:37,130
+«partial pressure»؟ قال لك «it is the amount of
+
+61
+00:04:37,130 --> 00:04:42,030
+pressure a particular gas contributes أي غاز يعني
+
+62
+00:04:42,030 --> 00:04:50,070
+جزء أي غاز معين بيحتوي to the total pressure» for
+
+63
+00:04:50,070 --> 00:04:51,370
+example إيش يعني؟
+
+64
+00:04:57,260 --> 00:05:04,460
+نحن عادةً بناخد الهواء اللي بنفنفسه هذا على مستوى
+
+65
+00:05:04,460 --> 00:05:11,580
+سطح البحر يعني تمام؟ الضغط تبقى 100% هدول الـ100%
+
+66
+00:05:11,580 --> 00:05:17,520
+هيكونوا مكسوجين؟ لأ، بس Contribute 21% of 100% فيه
+
+67
+00:05:17,520 --> 00:05:24,350
+21% بس هواء إذا كمية الهواءاللي بيشكلها، ها أنا
+
+68
+00:05:24,350 --> 00:05:27,650
+بحكي عن الهواء مش عن جسم الإنسان كمية الهواء،
+
+69
+00:05:27,650 --> 00:05:31,530
+الضغط الـpartially تبع الأكسجين في الهواء الجو هذا
+
+70
+00:05:31,530 --> 00:05:38,590
+كده؟ 21% بيشكل، طب أنا أخدت الكمية هذه، طب هذا
+
+71
+00:05:38,590 --> 00:05:42,150
+كمية الأكسجين اللي فيها اللي احنا متفجرين هنا 21%،
+
+72
+00:05:42,150 --> 00:05:45,770
+هلجيتها؟ مش هدها مننا، ان هو من فيها أكسجين كده
+
+73
+00:05:45,770 --> 00:05:51,310
+تعمل partial pressure على الـalveoli تبعتي؟
+
+74
+00:06:02,220 --> 00:06:06,720
+وكذلك سمكسيد الكربون وكذلك سمكسيد الكربون هكذا
+
+75
+00:06:06,720 --> 00:06:13,480
+نبدأ بالجزء الجديد من المحاضرةبنحكي عن الـ
+
+76
+00:06:13,480 --> 00:06:16,180
+Respiratory Acidosis بنقول بساطة إن الـ
+
+77
+00:06:16,180 --> 00:06:22,760
+Respiratory Acidosis هي حالة من إضطراب
+
+78
+00:06:22,760 --> 00:06:27,660
+غزّات الدم اللي هو من الـ Acid Base Disorderفي
+
+79
+00:06:27,660 --> 00:06:32,240
+رايحة في اتجاه الـH في الـAcidosis طب و ليش اسمها
+
+80
+00:06:32,240 --> 00:06:35,840
+Respiratory؟ أه يعني السبب إنه فيه lung failure أو
+
+81
+00:06:35,840 --> 00:06:38,480
+respiratory failure أو بيسموها ventilatory failure
+
+82
+00:06:38,480 --> 00:06:43,460
+طب إيش يعني؟ أه مازال أنا بقول إنه في Respiratory
+
+83
+00:06:43,460 --> 00:06:48,850
+Acidosisأسيدوسيز يعني الـ pH منخفضة أسيدوسيز أنا
+
+84
+00:06:48,850 --> 00:06:54,310
+دايماً يعني اتعلم أن الـ «أسيدوسيز» متعالقة بالـ
+
+85
+00:06:54,310 --> 00:06:58,250
+«CO2» أسيدوسيز اتعلمنا أن زيادة الـ «CO2» بتعمل
+
+86
+00:06:58,250 --> 00:07:01,670
+أسيدوسيز فما كل هذه المصطلحات بدك تحطها في مخك أول
+
+87
+00:07:01,670 --> 00:07:04,950
+ما تسمع «Respiratory Acidosis» إذن Respiratory
+
+88
+00:07:04,950 --> 00:07:09,170
+Acidosis يعني الـ «PH» منخفضة الـ «CO2» مرتفعة
+
+89
+00:07:09,170 --> 00:07:13,330
+وبالتالي المريض هذا واحد عنده «CO2» مرتفعش يعني
+
+90
+00:07:13,700 --> 00:07:17,720
+يعني ما بتنفسش منيح ما بيعملش Washing out للـ
+
+91
+00:07:17,720 --> 00:07:23,800
+«CO2» وبالتالي الـ «CO2» مالو محتجز إذا إيش حيصير
+
+92
+00:07:23,800 --> 00:07:26,760
+لما الـ «CO2» محتجز عنده؟ بيصير حالة اسمها
+
+93
+00:07:26,760 --> 00:07:31,800
+«Hypercapnia» ارتفاع في تاني أكسيد الكربون، تمام؟
+
+94
+00:07:31,800 --> 00:07:35,600
+هذه مع مين بتصير؟ بتصير مع الناس الـ «COPD» ومع
+
+95
+00:07:35,600 --> 00:07:39,520
+الناس اللي عندهم كوربالمونال ومع الناس اللي عندهم
+
+96
+00:07:39,520 --> 00:07:46,360
+Respiratory failure due toمثلًا، ناركوتكس، ماخد
+
+97
+00:07:46,360 --> 00:07:53,750
+أدوية، ماخد كترامال، ماخد أدوية مخدرةوكمان أي حد
+
+98
+00:07:53,750 --> 00:07:57,490
+مافيش عنده القدرة على التنفس علشان مثلًا عنده
+
+99
+00:07:57,490 --> 00:08:02,270
+diaphragmatic injury العصب اللي بتحكم في الـ
+
+100
+00:08:02,270 --> 00:08:09,450
+diaphragm في إصابة ممكن علشان في عنده مرض بتحكم في
+
+101
+00:08:09,450 --> 00:08:12,150
+عصابه عضلات التنفس عنده فيها مشكلة زي الـ
+
+102
+00:08:12,150 --> 00:08:15,670
+Maltesemia Gravis والجالين-Paris Syndrome هدول
+
+103
+00:08:15,670 --> 00:08:19,810
+أشمالهم بيصير فيه weakness في الـاللي أنا بحكيه
+
+104
+00:08:19,810 --> 00:08:24,550
+إنه عدم قدرة البناء آدم على إنه يعمل spontaneous
+
+105
+00:08:24,550 --> 00:08:27,330
+respiration بطريقة صحيحة وبالتالي هو
+
+106
+00:08:27,330 --> 00:08:30,850
+hypoventilation،
+
+107
+00:08:30,850 --> 00:08:37,390
+يعني الـrespiratory rate شماله، واطي، يعني بردبني،
+
+108
+00:08:37,390 --> 00:08:40,730
+أفهمك، خلاص، مديش تقولي ولا حاجة، respiratory
+
+109
+00:08:40,730 --> 00:08:45,870
+acidosis، معناها في decrease في الـrespiratory
+
+110
+00:08:45,870 --> 00:08:51,470
+rateوبالتالي فى increase في الـ CO2 في Hypercapnia
+
+111
+00:08:51,470 --> 00:08:59,930
+وبيسميه CO2 Narcosis تمام؟ وأيضاً هذا هيعمل ليه؟
+
+112
+00:08:59,930 --> 00:09:03,150
+اللي هو decrease في الـ pH لأنه الـ Respiratory
+
+113
+00:09:03,150 --> 00:09:08,660
+Acidosis وعرفت إن هذا بيصير معقول مرض بيعملاللي هو
+
+114
+00:09:08,660 --> 00:09:12,200
+عدم قدرة الجسم على التنفس أي حاجة بتعمل
+
+115
+00:09:12,200 --> 00:09:15,640
+Respiratory Failure due to muscle weakness due to
+
+116
+00:09:15,640 --> 00:09:20,900
+nervous central nervous system illness كل واحد CVA
+
+117
+00:09:20,900 --> 00:09:26,500
+وGasping and Breathing، برن استم متأثر، تمام؟ كل
+
+118
+00:09:26,500 --> 00:09:30,380
+واحد Sedation، كل واحد Anesthesia، فيمنها وضحت
+
+119
+00:09:30,380 --> 00:09:34,710
+خالص، تمام؟والـ Clinical Manifestation إيش؟ و الله
+
+120
+00:09:34,710 --> 00:09:41,270
+صارت واضحة واحد عنده الـ CO2 عالي هكون بدأ ينعس،
+
+121
+00:09:41,270 --> 00:09:45,810
+صح؟ ينعس، إيش دخل؟ آه الـ CO2 بس يزيد في الجسم،
+
+122
+00:09:45,810 --> 00:09:50,450
+بعمل إن الناس حالة من النقاس الشديد لدرجة إنه
+
+123
+00:09:50,450 --> 00:09:53,310
+مقدرش يصحى، وبالتالي هذا يكون عنده إيش؟
+
+124
+00:09:53,310 --> 00:09:57,190
+Hypercapnia، يعني لما تشوف مثلا سيدك اللي بدخن
+
+125
+00:09:57,190 --> 00:10:01,430
+كتير دايما نعسان ودايما نايمإعرف فورًا إن هو عنده
+
+126
+00:10:01,430 --> 00:10:04,450
+Hypercapnia لما أنت بتكون في المحاضرة و الباب
+
+127
+00:10:04,450 --> 00:10:09,310
+مسكّر و الدكتور بيشرح و تحس عليك بدأت تتتوج إقرأ و
+
+128
+00:10:09,310 --> 00:10:15,330
+راسك صار دجيل إعرف فورًا إن الـCO2 بدأ يرفع في
+
+129
+00:10:15,330 --> 00:10:19,690
+جسمك و أنت لازم تطلب من الدكتور افتح الباب افتح
+
+130
+00:10:19,690 --> 00:10:23,090
+الشباب اهو المكان لإن انت الـCO2 بدأ يرفع عندك
+
+131
+00:10:23,090 --> 00:10:27,110
+الـCO2 لما بيرفع و بزيد عن الـ60 إيش بيعمل؟ بيعمل
+
+132
+00:10:27,110 --> 00:10:31,360
+Feelingوهو الـ Fulness in the head، يقولّك حاسس
+
+133
+00:10:31,360 --> 00:10:36,280
+راسي تقل، ليش؟ لأنه بيعمل الـ cerebrovascular
+
+134
+00:10:36,280 --> 00:10:42,020
+vasodilatation، بيعمل الـ dilatation، توسع فيه الـ
+
+135
+00:10:42,020 --> 00:10:47,840
+cerebrovascularاللي هو Vessel وبالتالي إيش هيصير؟
+
+136
+00:10:47,840 --> 00:10:53,160
+هيصير بسبب أنه بتراكم أكتر الـDilatation هادا
+
+137
+00:10:53,160 --> 00:10:57,340
+هيخلّي الـFlow تبع الـBlood على الـBrain أعلى
+
+138
+00:10:57,340 --> 00:11:00,500
+وبالتالي بتحس راسك لأن كمية الدم صارت أكتر فيه
+
+139
+00:11:00,500 --> 00:11:04,720
+فبعلة، تمام؟ كمية الدم اللي موجودة فيه وبالتالي
+
+140
+00:11:04,720 --> 00:11:10,620
+بزود عندك شعور بثقل الرأس، تمام؟ تمام، من الحاجات
+
+141
+00:11:10,620 --> 00:11:15,020
+كمان أنه ممكنتصبح واحد عنده Hypoxia والـ
+
+142
+00:11:15,020 --> 00:11:19,660
+Saturation عنده طبعاً ما زال السوقته بتطلع حيصير
+
+143
+00:11:19,660 --> 00:11:24,160
+فيه low oxygen وhypoxemia تمام؟ وبالتالي إيش حيصير
+
+144
+00:11:24,160 --> 00:11:28,520
+يا جماعة؟ حيصير فيه عنده because of hypoxemia
+
+145
+00:11:28,520 --> 00:11:32,420
+dysrhythmia القلب حيصير يتطرف، مابتغزاش كويس فهو
+
+146
+00:11:32,420 --> 00:11:36,480
+ممكن جدا يخش الـ Ventricular-Fibrelation تمام؟
+
+147
+00:11:36,480 --> 00:11:41,590
+ممكن جدا يخش الـ Ventricular-Fibrelationالناس
+
+148
+00:11:41,590 --> 00:11:45,970
+هدولة ممكن يصير عندهم «high bar» كلينية لأن
+
+149
+00:11:45,970 --> 00:11:51,830
+الـ«بوتاسيوم»، عفوا، الـ«سيوتيو» لما بيزيد، بيشجع
+
+150
+00:11:51,830 --> 00:11:58,650
+اللي هو الـ«بوتاسيوم» أنه يطلع برا الخلية، تمام؟
+
+151
+00:11:59,820 --> 00:12:02,740
+hyperkalemia may result as hydrogen concentration
+
+152
+00:12:02,740 --> 00:12:05,940
+move into cell كيف يعني؟ Causing shift of
+
+153
+00:12:05,940 --> 00:12:08,320
+potassium out of the cell بالظبط، شايفين كيف؟
+
+154
+00:12:08,320 --> 00:12:11,920
+البوتاسيوم بتشجع أنه يطلع برا الخلية، ليش؟ احنا
+
+155
+00:12:11,920 --> 00:12:14,840
+قاعدين بنحكي هنا في حالة من الحمضية، حالة من
+
+156
+00:12:14,840 --> 00:12:18,360
+الحمضية يعني الـhydrogen ion المحاضرة الأولى،
+
+157
+00:12:18,360 --> 00:12:22,270
+قولنا الـhydrogen ion بتكون كتيرأيوان، لما
+
+158
+00:12:22,270 --> 00:12:25,530
+الـHydrogen أيوم بكون كتير، بتصير بتتطر تتخلص من
+
+159
+00:12:25,530 --> 00:12:28,590
+حالة من الدم، و أين بتدخش؟ بتدخش في جانب الخلية،
+
+160
+00:12:28,590 --> 00:12:31,110
+عشان تدخش أشي في الخلية لازم أشي يطلع، خاش
+
+161
+00:12:31,110 --> 00:12:33,130
+الـHydrogen، مين بيطلع؟ بيطلع الـPotassium، بيصير
+
+162
+00:12:33,130 --> 00:12:36,870
+الـPotassium برا، عالي، حالة من الـHyper-Kalemia،
+
+163
+00:12:36,870 --> 00:12:41,430
+Bravo، بتدرجع بس للـslide هذه على نقطة مهمة، نقطة
+
+164
+00:12:41,430 --> 00:12:44,170
+الـOxygen Drive، والناس اللي بيكون عندهم الـBCA2
+
+165
+00:12:44,170 --> 00:12:48,090
+عالي،الناس اللي بيكون عندهم الـ DCU تعالى لما
+
+166
+00:12:48,090 --> 00:12:52,810
+بيكون مثلا عندهم أكتر من خمسين وبشكل إي-chronic
+
+167
+00:12:52,810 --> 00:12:57,250
+بيقولّك اصحك تد المريض هذا أكسيجيني كتير خلّي
+
+168
+00:12:57,250 --> 00:13:00,570
+الأكسيجين إذا بده أكسيجين من واحد لتلاتة ملي لتر
+
+169
+00:13:00,570 --> 00:13:05,430
+per hour وما تزودش عقل، طب ليش؟ أنا بدي الأكسيجين،
+
+170
+00:13:05,430 --> 00:13:13,000
+خلّيه يتحسن، لأالأكسجين اللي هتدّيه هيخلّي عدر
+
+171
+00:13:13,000 --> 00:13:16,300
+مرات التنفس يقلل؟ آه يقلل عدر المرات التنفس
+
+172
+00:13:16,300 --> 00:13:21,900
+وبالتالي هيستمر الـCO2 في الارتفاع طب ليه؟ آه ليش؟
+
+173
+00:13:21,900 --> 00:13:26,320
+لأنه إحنا بنتنفس عن طريق زيادة تانوكسيد الكربون
+
+174
+00:13:26,320 --> 00:13:29,940
+كيف؟ يعني جسمي أنا بعرف إنه زاد تانوكسيد الكربون
+
+175
+00:13:29,940 --> 00:13:33,920
+شوية الـbrain بدي order اتنفس ليش؟ لأنه زاد؟ آه طب
+
+176
+00:13:33,920 --> 00:13:39,270
+باخد نفستمام؟ طيب، الناس الـ Chronic دايما الـ
+
+177
+00:13:39,270 --> 00:13:42,710
+«CO2» اللي هو «Chronic» رسب راتبه لـ Acidosis
+
+178
+00:13:42,710 --> 00:13:45,450
+دايما الـ «CO2» عنده مهالي شوية وقت «COPD»
+
+179
+00:13:45,450 --> 00:13:50,010
+ماعندهوش من 35 إلى 45، عنده دايما خمسة أو خمسين،
+
+180
+00:13:50,010 --> 00:13:55,850
+ستين، طيب، وإيش بيصير؟ بيصير إنه عادة عشان الجسم
+
+181
+00:13:55,850 --> 00:14:02,250
+متعود على high «CO2» ينسى إنه، أقولك لو سمحت، صار
+
+182
+00:14:02,250 --> 00:14:07,440
+متأقلم على إن الـ «CO2» عاليطيب، لو روحت أنا
+
+183
+00:14:07,440 --> 00:14:11,080
+عزيزتي الطين، بلى هو جايب سيؤته عالي، مرة أزود من
+
+184
+00:14:11,080 --> 00:14:15,880
+الـ60، جايب 80 و 90 و تعبان، آه، و روحت أنا والله
+
+185
+00:14:15,880 --> 00:14:18,820
+بدي حاطف راطف، حاطف الـOxygen وعالتلي هيك، عشان
+
+186
+00:14:18,820 --> 00:14:23,200
+المشكلة مش في الـOxygen، ها، المشكلة فيها عدد مرات
+
+187
+00:14:23,200 --> 00:14:27,200
+التنفس، أنا بدي أزود عدد مرات التنفس، عشان أشطف
+
+188
+00:14:27,200 --> 00:14:30,480
+الـOxygen، الـLithium Oxide الكربون المتراكم، عشان
+
+189
+00:14:30,480 --> 00:14:34,500
+إيش أسوي، أعمل Washing Out لـLithium Oxide الكربون
+
+190
+00:14:34,500 --> 00:14:38,600
+المتراكم،أطلعه، مش بس إن أنا أزود الـ Oxygen، طب
+
+191
+00:14:38,600 --> 00:14:41,120
+وطول ما أنا أزود الـ Oxygen، إيش بيسوي؟ ولا حاجة،
+
+192
+00:14:41,120 --> 00:14:44,200
+بيزيد الطيل بالك، كيف يعني؟ يعني أنت بتزود الـ
+
+193
+00:14:44,200 --> 00:14:47,980
+Oxygen، فالجسم بيقول، هاي في Oxygen، ليش هتنفس؟
+
+194
+00:14:47,980 --> 00:14:52,670
+خلاص، اللي عنده عشي، ليش يزفر إيديه؟فأقول خلاص
+
+195
+00:14:52,670 --> 00:14:58,290
+مافي Oxygen ليش أتنفس؟ بتزيد المشكلة أكتر ولذلك
+
+196
+00:14:58,290 --> 00:15:02,890
+هنا بتتكون حالة من اللي بيسموها Carbon Dioxide
+
+197
+00:15:02,890 --> 00:15:07,190
+Narcosis، تمام؟ تمام، طب ماشي أسوي لهم؟ دول الناس
+
+198
+00:15:07,190 --> 00:15:10,690
+اللي عندهم Respiratory Acidosis، بكل بساطة هدول يا
+
+199
+00:15:10,690 --> 00:15:16,740
+جماعة، بدهم تعملوا لهمتنافس صناعي أو بالعربية الـ
+
+200
+00:15:16,740 --> 00:15:22,480
+Respiratory Support يعني كل حاجة ممكنة أنك تزوّد
+
+201
+00:15:22,480 --> 00:15:26,560
+عدد مرات التنافس عنده كويس كتير طب واش يسوي؟ حطه
+
+202
+00:15:26,560 --> 00:15:31,860
+فولار بوزشين؟ اه طب نحن حطيه فولار بوزشينحاول
+
+203
+00:15:31,860 --> 00:15:38,620
+السبب اللي مخليه برادي بنياء تقضي عليه إذا هو ماخد
+
+204
+00:15:38,620 --> 00:15:42,720
+نار كوتينك أديله الـ Antidote، آه صحيح، يعني إذا
+
+205
+00:15:42,720 --> 00:15:45,420
+ماخد مروفين أو ترمال أو بيويت أديله إيش الـ
+
+206
+00:15:45,420 --> 00:15:51,640
+Antidote؟ اللي هو الناركان، بتحسن، بتنفسبس بيبطل
+
+207
+00:15:51,640 --> 00:15:54,760
+براددني، بيصيري كويس، بيصيري أعمل الـ Washing out،
+
+208
+00:15:54,760 --> 00:15:58,080
+تمام؟ طيب البلمونة الاديمة جاي؟ الـCOPD، اني مش
+
+209
+00:15:58,080 --> 00:16:00,760
+عايز أبطل طيبه أنا من الـCOPD؟ لأ، اعمله
+
+210
+00:16:00,760 --> 00:16:04,680
+Respiratory Support عن طريق أنه أنت تتنفس عنه، أنا
+
+211
+00:16:04,680 --> 00:16:10,220
+أتنفس عنه، كيف؟ أه، أبطله Endotracheal Tube وابدأ
+
+212
+00:16:10,220 --> 00:16:13,540
+أشبكله حد اسمه Mechanical Ventilation اللي هو
+
+213
+00:16:13,540 --> 00:16:16,980
+حيكون محاضراتنا القادمة إن شاء الله رب العالمين
+
+214
+00:16:18,590 --> 00:16:21,990
+تمام، هك خلص مكون الـ Respiratory Acidosis؟ آه،
+
+215
+00:16:21,990 --> 00:16:24,870
+وبدنا نخش في الـ Respiratory Alkalosis، ممتاز، طب
+
+216
+00:16:24,870 --> 00:16:27,130
+وإيش بيفرق الـ Respiratory Acidosis عن الـ
+
+217
+00:16:27,130 --> 00:16:30,150
+Alkalosis؟ العكس، الموضوع في الـ Respiratory، أه
+
+218
+00:16:30,150 --> 00:16:32,690
+في الـ Respiratory، يعني في الـ Lung، بس اللهم إنه
+
+219
+00:16:32,690 --> 00:16:35,810
+بدل ما سيؤته كان عالي في الـ Acidosis، هنا في الـ
+
+220
+00:16:35,810 --> 00:16:39,690
+Alkalosis سيؤته هيكون فيه إيش؟ واطي، منخفض، أه طب
+
+221
+00:16:39,690 --> 00:16:44,390
+يعني أقل من أكم؟ أقل من 35 طب كويس، طب إيش يعني
+
+222
+00:16:44,390 --> 00:16:47,950
+هنا معناه؟ أنا بدأت أفهم يا أستاذ، ليش؟لأن انت
+
+223
+00:16:47,950 --> 00:16:51,310
+حكيتي إن في الـ Respiratory Acidosis بيكون فيه
+
+224
+00:16:51,310 --> 00:16:54,930
+تراكم للـ CO2 بسبب الـ Hypoventilation طب آه، إيش
+
+225
+00:16:54,930 --> 00:16:59,370
+افهمت؟ افهمت إن في الـ Respiratory Alkalosis حيكون
+
+226
+00:16:59,370 --> 00:17:04,810
+فيه اللي هو Depression للـ CO2 بسبب الـ
+
+227
+00:17:04,810 --> 00:17:08,730
+Hyperventilation آه، والله، كلامك صحيح، آه، حيكون
+
+228
+00:17:08,730 --> 00:17:15,410
+الـ CO2 اللي هو منخفض وأقل من 35 نتيجة إنه المريض
+
+229
+00:17:15,410 --> 00:17:21,180
+بتنفسعدد مرات تنفس أكتر من الطبيعي فبكون اسمه
+
+230
+00:17:21,180 --> 00:17:25,600
+hyperventilation يعني هو بيعمل جايد washing out لـ
+
+231
+00:17:25,600 --> 00:17:34,600
+CO2 يعني أي حاجة بتعملنفس بالشكل هذا هيكون معناها
+
+232
+00:17:34,600 --> 00:17:37,620
+إنه هتدخل المريض بـ Respiratory Alkalosis، برافو
+
+233
+00:17:37,620 --> 00:17:41,060
+عليه، حتى لو كانت Compensatory، هنشوف قصة الـ
+
+234
+00:17:41,060 --> 00:17:43,600
+Compensatory طب وإيش فيه حاجات بتخلي الواحد يعمل
+
+235
+00:17:43,600 --> 00:17:48,060
+تاكيبنية؟ واحد بيقولّي أصلا أنا من أول ما سمعتك
+
+236
+00:17:48,060 --> 00:17:51,520
+فكرتك بتعيط، بقوله أه صحيح الـEmotional Stress، هو
+
+237
+00:17:51,520 --> 00:17:55,300
+بيعمل Respiratory Alkalosis لأنه بيخليك يصير
+
+238
+00:17:55,300 --> 00:17:58,540
+تاكيبنية، بيقولي أه والله صحيح، طب و اللي بيجري؟
+
+239
+00:17:58,850 --> 00:18:01,570
+بالهد، بيصير برضه ممكن يخش في الـSperatory
+
+240
+00:18:01,570 --> 00:18:06,590
+Alkalosis، ممكن هاه طيب، طب و طيب؟ لأ، لأن اللي
+
+241
+00:18:06,590 --> 00:18:12,850
+بيجري يعني Healthy، يعني الاشي مرحلي يعني، تمام؟
+
+242
+00:18:12,850 --> 00:18:16,490
+لكن إذا والله Anxiety و Stress و سابق، المواضيع
+
+243
+00:18:16,490 --> 00:18:19,710
+هتخرب، أوكي، طيب
+
+244
+00:18:24,100 --> 00:18:29,840
+إيش فيه كمان؟ أفهمنا عن الـRespiratory Alkalosis
+
+245
+00:18:29,840 --> 00:18:36,500
+إن الـCO2 حيكون منخفض وحيكون في حالات زي اللي هو
+
+246
+00:18:36,500 --> 00:18:42,140
+الـStress أو حالات زي، أحكيكم قصة في
+
+247
+00:18:42,140 --> 00:18:44,380
+الـCompensation هي نفة بس، يعني حالات مثلا زي
+
+248
+00:18:44,380 --> 00:18:49,590
+الـDKAأه ديكي إيه؟ بتيجي بتاكيبنيها ولا لأ؟ أه
+
+249
+00:18:49,590 --> 00:18:53,210
+بتاكيبنيها، بس اصحك تقول عنها الـ Respiratory
+
+250
+00:18:53,210 --> 00:18:55,550
+Alkalosis الـ Respiratory Alkalosis اللي هي
+
+251
+00:18:55,550 --> 00:18:59,390
+compensation اللي عندها، يعني كيف؟ يعني هي جاية
+
+252
+00:18:59,390 --> 00:19:03,760
+بحالة من الـ Metabolic Acidosisمثال، هي هذه الحالة
+
+253
+00:19:03,760 --> 00:19:06,920
+مثال هي الـ «DKA» ضابية الـ «كيتو أسيدوسيز» بكون
+
+254
+00:19:06,920 --> 00:19:11,500
+عندها حالة من الـ «ميتابوليك أسيدوسيز» طيب، الآن
+
+255
+00:19:11,500 --> 00:19:14,800
+الـ «ميتابوليك أسيدوسيز» هذا بيده compensation،
+
+256
+00:19:14,800 --> 00:19:19,400
+بيده يعمل تعويض، فالجسم بسبب الـ «أسيدوسيز»
+
+257
+00:19:19,400 --> 00:19:22,780
+العالية اللي عنده بيصير بيده يحسن الوضع، مين مسؤول
+
+258
+00:19:22,780 --> 00:19:25,480
+عن تحسين الوضع في الـ lung اللي هي بده تعمل
+
+259
+00:19:25,480 --> 00:19:29,970
+compensation؟الـCO2؟ طب إيش ننسا و أنا عندي
+
+260
+00:19:29,970 --> 00:19:33,330
+Acidosis أصلا؟ طب والـCO2 مسئول عن الـAcidosis إذا
+
+261
+00:19:33,330 --> 00:19:38,090
+لو أنا قللت الـCO2 بقى ممكن أحسن الحالة فكيف بدأ
+
+262
+00:19:38,090 --> 00:19:41,790
+أقلل الـCO2 أنا؟ بخلّي المريض يعمل Washing Out
+
+263
+00:19:41,790 --> 00:19:47,050
+يتنفس بسرعة اللي سمناه Cosmal Breathing فاكرينه؟
+
+264
+00:19:47,050 --> 00:19:52,730
+تمام أنا بس حابب التنوع عشان ترجعوا تتذكروافعشان
+
+265
+00:19:52,730 --> 00:19:55,710
+برضه بدنا احنا هالجهة تانية بدنا نخش في الـ
+
+266
+00:19:55,710 --> 00:19:58,630
+Compensation لما بيجي بدنا نخش في الـ Compensation
+
+267
+00:19:58,630 --> 00:20:05,390
+على فكرة و أنا بحكي برضه اتذكرت سؤال لأحد
+
+268
+00:20:05,390 --> 00:20:07,870
+الأخوات كانت سألته بس خلصوا الـ Compensation
+
+269
+00:20:07,870 --> 00:20:12,800
+هرجعلهفي الـ Metabolic Acidosis كانت واحدة سقلة
+
+270
+00:20:12,800 --> 00:20:17,080
+يعني ايش الـ compensation؟ الـ compensation بكل
+
+271
+00:20:17,080 --> 00:20:21,260
+بساطة يا جماعة يعني الاستجابة اللي بدها تصير لحالة
+
+272
+00:20:21,260 --> 00:20:24,400
+الـ
+
+273
+00:20:24,400 --> 00:20:29,640
+acid base disorder اللي عندك يعني إذا كانت الحالة
+
+274
+00:20:29,640 --> 00:20:34,800
+metabolicميحا يستجيب سواء أسدوس أو ألكالوس، الـ
+
+275
+00:20:34,800 --> 00:20:39,040
+Respiratory طب وإذا كانت الحالة Respiratory، مين
+
+276
+00:20:39,040 --> 00:20:42,640
+بده يستجيب؟ الـ Metabolite طب مين بيستجيب أسرع؟ ال
+
+277
+00:20:42,640 --> 00:20:45,380
+Respiratory، أه عارفين هاي، تمام؟ لإن حكيناها،
+
+278
+00:20:45,380 --> 00:20:49,260
+قولنا within minute، بشتغل، لكن ال kidney تشتغل
+
+279
+00:20:49,260 --> 00:20:53,540
+within day، within days، okay؟ الكلام هذا اللي هنا
+
+280
+00:20:53,540 --> 00:20:56,880
+كيف بيشتغل، هلخصه الكابل slide هذه أسهل، شوفوا كده
+
+281
+00:20:58,520 --> 00:21:01,740
+الـ Compensation بيصير بالطريقة هذه إذا كانت أنا
+
+282
+00:21:01,740 --> 00:21:06,300
+في اندي حالة من الـ Respiratory أسيدوسيز بكون الـ
+
+283
+00:21:06,300 --> 00:21:11,840
+CO2 مرتفعة يا جماعة وبالتالي الـ Compensation اللي
+
+284
+00:21:11,840 --> 00:21:21,100
+بده يصير عبارة عن Metabolicish Metabolicish أيوة
+
+285
+00:21:21,420 --> 00:21:24,720
+الـ «بيكارب» بنزل يعني «ميتابوليك أسيدوسيز»
+
+286
+00:21:24,720 --> 00:21:29,960
+«ميتابوليك أسيدوسيز» عفوًا أنا إيش حاكينا؟
+
+287
+00:21:29,960 --> 00:21:34,720
+«ميتابوليك أسيدوسيز» يعني بده يقابلها «ميتابوليك
+
+288
+00:21:34,720 --> 00:21:43,740
+ألكاليوسيز» «ميتابوليك ألكاليوسيز»، تمام؟
+
+289
+00:21:43,740 --> 00:21:49,140
+طيب إذا
+
+290
+00:21:49,140 --> 00:22:01,480
+كانهنا هذا السهم يبدو إن هدول محططين بالخطأ طيب،
+
+291
+00:22:01,480 --> 00:22:04,440
+الـ compensation عفوا، الـ compensation هنا، أيوة،
+
+292
+00:22:04,440 --> 00:22:10,320
+إذا لما يكون في عندي الـ CO2 مرتفع، إيش بيصير؟
+
+293
+00:22:10,320 --> 00:22:13,660
+Respiratory Acidosis الـ compensation اللي بيصير،
+
+294
+00:22:13,660 --> 00:22:18,300
+increase في الـ bi-carb إيش هذا اسمه؟ Metabolic؟
+
+295
+00:22:20,380 --> 00:22:24,760
+الكالوسيز نيتابوليك الكالوسيز طبعاً طب لو كان
+
+296
+00:22:24,760 --> 00:22:31,000
+المشكلة أندي Respiratory alkalosis Respiratory
+
+297
+00:22:31,000 --> 00:22:35,140
+alkalosis الـ CO2 بيكون منخفض الـ Bicarb إيش
+
+298
+00:22:35,140 --> 00:22:38,800
+بيصير؟ كيف بيصير الـ compensation؟ بنخفض كمان،
+
+299
+00:22:38,800 --> 00:22:43,520
+ليه؟ لأن هو مسؤول عن الـ alkaline طب أنا المشكلة
+
+300
+00:22:43,520 --> 00:22:45,820
+أندي أن الـ Respiratory alkaline فيه already
+
+301
+00:22:45,820 --> 00:22:51,500
+washing out للـ CO2 ال Respiratoryالـ CO2 منخفض له
+
+302
+00:22:51,500 --> 00:22:54,520
+نتيجة إن الـ Respiratory Rate عالي وعمل الـ
+
+303
+00:22:54,520 --> 00:22:58,340
+Respiratory Alkalosis فإيش الحل؟ الحل إن الـ
+
+304
+00:22:58,340 --> 00:23:04,940
+Bicarb يصير له كمان يجلل من نفسه فعشان لما بقل هو
+
+305
+00:23:04,940 --> 00:23:09,720
+في الدم عن اللي هو مثلا الـ 24 هي منحة من الإتزان
+
+306
+00:23:09,720 --> 00:23:15,140
+تمام؟طيب، لو كان في اندي Metabolic اللي هو
+
+307
+00:23:15,140 --> 00:23:21,320
+Metabolic Acidosis Metabolic Acidosis الـBicarb
+
+308
+00:23:21,320 --> 00:23:24,640
+شماله أصلا منخفض، ما هو مسئول عن القاعدية لما
+
+309
+00:23:24,640 --> 00:23:27,520
+بيجيل بيعمل Metabolic Acidosis تمام؟
+
+310
+00:23:27,520 --> 00:23:30,580
+الـCompensation إيش هيحصل؟ هيجيل للـCO2 لأن الـCO2
+
+311
+00:23:30,580 --> 00:23:33,400
+في الـLung هو المسئول عن الأندية لما أصلا الوضع
+
+312
+00:23:33,400 --> 00:23:36,520
+اندي في الدم Metabolic Acidosis بيحاول يقلل من
+
+313
+00:23:36,520 --> 00:23:39,880
+نفسه لأنه مسئول عن الأندية عشان يعمل قاعدية ويعدل
+
+314
+00:23:40,130 --> 00:23:46,350
+اللي يرجع للـ Balance لكن لو كان Metabolic اللي هو
+
+315
+00:23:46,350 --> 00:23:49,170
+الـ Alkalosis يعني الـ Bicarb أصلاً كتير طب إيش
+
+316
+00:23:49,170 --> 00:23:52,370
+الـ CO2 بده يسوي؟ بده يحاول يزيد من نفسه بده يحاول
+
+317
+00:23:52,370 --> 00:23:57,490
+الـ CO2 يزيد من نفسه في الدم علشان يحسن حالة الـ
+
+318
+00:23:57,490 --> 00:24:02,600
+Alkalosis الموجودة تمام؟ هذا باختصاراللي هو كيف
+
+319
+00:24:02,600 --> 00:24:06,860
+بدها تصير عملية الـ Compensation إيش يعني؟ كمان
+
+320
+00:24:06,860 --> 00:24:10,620
+مرة، في حالة الـ Resveratol Acidosis عادة بكون الـ
+
+321
+00:24:10,620 --> 00:24:16,040
+CO2 هو اللي مرتفع وبالتالي الـ Bicarb بيتحرك علشان
+
+322
+00:24:16,040 --> 00:24:22,340
+يحسن الموضوع فبروح بيزود من حاله علشان يعادل الـ
+
+323
+00:24:22,340 --> 00:24:25,000
+Acidity الموجودة لأن هذا الـ Bicarb مسئول عن
+
+324
+00:24:25,000 --> 00:24:30,840
+القاعدة وهذا الـ CO2 مسئول عن الـالحمضية، تمام؟ في
+
+325
+00:24:30,840 --> 00:24:33,260
+حالة إن الـ Respiratory Alkalosis يعني الـ CO2
+
+326
+00:24:33,260 --> 00:24:36,500
+المنخفض المسؤول عن الحمضية منخفض فعمل الـ
+
+327
+00:24:36,500 --> 00:24:40,720
+Alkalosis فبروح المسؤول عن القاعدة أصلاً في الجسم
+
+328
+00:24:40,720 --> 00:24:46,560
+يقلل من حاله علشان يجلّي القاعدية الموجودة بحيث
+
+329
+00:24:46,560 --> 00:24:50,420
+يعمل شوية حموظة عشان يعدل حالة الـ Respiratory
+
+330
+00:24:50,420 --> 00:24:54,100
+Alkalosis، تمام؟ ولذلك دايما أريدكوا تفهموا، لما
+
+331
+00:24:54,100 --> 00:24:58,660
+بنحكي Respiratory Acidosisبكون المعادلة الـ
+
+332
+00:24:58,660 --> 00:25:02,380
+Compensation يعني تبعها التعويض تبعها عن طريق بدل
+
+333
+00:25:02,380 --> 00:25:06,720
+Respiratory ميتابولك وبدل Acidosis، Alkalosis،
+
+334
+00:25:06,720 --> 00:25:09,820
+مفهوم؟ طيب، ال Respiratory Alkalosis بدل
+
+335
+00:25:09,820 --> 00:25:13,420
+Respiratory ميتابولك، بدل Alkalosis، Acidosis،
+
+336
+00:25:13,420 --> 00:25:17,200
+بكون ال Compensation تبعها ميتابولك أسيدوسيس
+
+337
+00:25:17,200 --> 00:25:21,040
+وبالعكس هنا، ماعندي حالة ميني ميتابولك أسيدوسيس زي
+
+338
+00:25:21,040 --> 00:25:26,280
+حالة الـDKA، إيش في الـBicarb هو اللي له، أيوة،
+
+339
+00:25:26,280 --> 00:25:31,000
+تمام؟الـ Bicarb هو اللي له طب إيش اللي بده يسوي
+
+340
+00:25:31,000 --> 00:25:34,160
+الـ CO2؟ الـ CO2 تو لسه حكينا بيحاول إنه الـ
+
+341
+00:25:34,160 --> 00:25:38,560
+Bicarb له يعني في عند أنا القاعدة في الجسم قليلة
+
+342
+00:25:38,560 --> 00:25:43,420
+فبيحاول إنه الـ CO2 يزود قاعدة الجسم هو مسؤول عن
+
+343
+00:25:43,420 --> 00:25:46,920
+إيش؟ عن العنضية يعني زيادته بتعمل حموظة فبيحاول
+
+344
+00:25:46,920 --> 00:25:50,600
+يقلل من نفسه عشان يزود القاعدة تبع الجسم عشان
+
+345
+00:25:50,600 --> 00:25:54,480
+يعادل الحموظة هذه إذا بيعمل respiratory alkalosis
+
+346
+00:25:54,480 --> 00:25:58,580
+اللي تو حكينا عنهاوهنا بالعكس لو كان عندى الـ
+
+347
+00:25:58,580 --> 00:26:01,820
+bicarb هو اللى مرتفع يبقى فيه عندى حالة من
+
+348
+00:26:01,820 --> 00:26:06,860
+القاعدية تمام بروح الـ suit وبيرتفع علشان يعمل
+
+349
+00:26:06,860 --> 00:26:10,160
+شوية حموضة ويحسن حالة الـ alkalosis فبروح بعمل
+
+350
+00:26:10,160 --> 00:26:13,660
+respiratory acidosis الكمبنسيشن بكون respiratory
+
+351
+00:26:13,660 --> 00:26:17,680
+acidosis علشان يصلح الـ metabolite alkalosis تمام؟
+
+352
+00:26:17,840 --> 00:26:21,220
+كيف انا بدي طيب امسك blood gas استاذ و افسر هذا
+
+353
+00:26:21,220 --> 00:26:24,400
+الكلام؟ والله اللي خمتنا انت في ال compensation
+
+354
+00:26:24,400 --> 00:26:28,160
+هذا و القصص ولا تلتقم ولا حاجة هم عندك 6 خطوات أو
+
+355
+00:26:28,160 --> 00:26:31,760
+5 خطوات بدك تمشي عليهم سيبوكوا من كل المكتوب هذا و
+
+356
+00:26:31,760 --> 00:26:35,380
+ركزوا معاه في الشريحة هذه لحالها أول حاجة تطلع في
+
+357
+00:26:35,380 --> 00:26:39,060
+الشكل العام للمريض، إيش مانو المريض؟ والله مريض ده
+
+358
+00:26:39,060 --> 00:26:43,980
+بتعرف إيش مانو؟ مريض جاسي و جديد ولا مش قادر يتنفس
+
+359
+00:26:43,980 --> 00:26:44,480
+من مرة؟
+
+360
+00:26:47,220 --> 00:26:56,200
+هو معروف انه type 1 diabetes وممكن خشش في DKA و
+
+361
+00:26:56,200 --> 00:27:00,660
+لا مريض مابنايم و مش عارفين ايش ماله؟ اه مابتاخده
+
+362
+00:27:00,660 --> 00:27:05,800
+impression طب بعد هي اعمله PRأه والله صح بعمله أنا
+
+363
+00:27:05,800 --> 00:27:09,680
+blood gases فبقى أشوف الـ pH طيب إيش هتلاقيه؟ يا
+
+364
+00:27:09,680 --> 00:27:13,260
+هتلاقيه عالي يا هتلاقيه واطي، أه والله صح إذا كان
+
+365
+00:27:13,260 --> 00:27:17,960
+الـ pH مرتفع، معناه إنه رايح مع الكلينيا، مش عارف
+
+366
+00:27:17,960 --> 00:27:21,960
+إيش نوعها، أما الكلوسيز، تمام؟ لكن إذا كان واطي
+
+367
+00:27:21,960 --> 00:27:26,850
+مخفض الـ pH، معناه إنه فيه أسيدينيا، يعني إيش؟الـ
+
+368
+00:27:26,850 --> 00:27:29,290
+Acidosis لكن الـ Respirator لما تقولك لسه مش
+
+369
+00:27:29,290 --> 00:27:32,670
+عارفين طيب خطوة تاتة إيش نسوي بقولك والله لو سمحت
+
+370
+00:27:32,670 --> 00:27:36,810
+شوفلي الـ CO2 والـ Bicarb مين أشوف أول الـ CO2
+
+371
+00:27:36,810 --> 00:27:43,380
+أصحكوا تنسوا مين نشوف أولالـ CO2 أصحى تنسى، ليش؟
+
+372
+00:27:43,380 --> 00:27:48,240
+الـ CO2 أول لإن الـ CO2 أي مشكلة فيه فورًا راح
+
+373
+00:27:48,240 --> 00:27:50,780
+يعمل disturbance في الـ acid base balance لإنه
+
+374
+00:27:50,780 --> 00:27:56,340
+حكينا إن الرقم تستجيب أسرع طيب، okay شفت أنا الـ
+
+375
+00:27:56,340 --> 00:28:00,100
+CO2 في مشكلةولّا فيش فيه مشكلة و بعدين شوفت الـ
+
+376
+00:28:00,100 --> 00:28:03,840
+Buy Card فيه مشكلة ولّا فيش فيه مشكلة بس بصراحة
+
+377
+00:28:03,840 --> 00:28:06,920
+أنا مش قادر أحدد لإن كده جيت في هذا مش في الـ CO2
+
+378
+00:28:06,920 --> 00:28:11,000
+مشكلة وفي الـ Buy Card مشكلة فانا مش قادر أحدد هل
+
+379
+00:28:11,000 --> 00:28:14,760
+الـ CO2 هو المشكلة ولّا هو compensation؟ ولا الـ
+
+380
+00:28:14,760 --> 00:28:17,520
+Buy Card هو المشكلة ولّا هو التغير اللي فيه
+
+381
+00:28:17,520 --> 00:28:21,540
+compensation؟ فبدك ادّلني، بنقولك Bravo عليه، روح
+
+382
+00:28:21,540 --> 00:28:28,630
+اعملشوف هذا، مين فيهم اللي ممكن يعمل compensation
+
+383
+00:28:28,630 --> 00:28:32,970
+للتاني، ما زال فيه اختلاف، والاتنين فيهم changes،
+
+384
+00:28:32,970 --> 00:28:35,970
+شوف مين اللي ممكن يعمل compensation للتاني، كيف
+
+385
+00:28:35,970 --> 00:28:40,690
+يعني، يا شو، يعني، إذا كان الـDH عندك low، مثلا،
+
+386
+00:28:40,690 --> 00:28:47,600
+منخفض، تمام؟واللي وجدت أن الـCO2 عندك مرتفع، آه
+
+387
+00:28:47,600 --> 00:28:49,940
+يبقى فيه خلال لما زال الـCO2 مرتفع، يبقى فيه خلال،
+
+388
+00:28:49,940 --> 00:28:56,480
+okay وبعدين اتطلعت وجدت الـBicarb أيضًا مرتفع،
+
+389
+00:28:56,480 --> 00:29:00,560
+تيجي على طول أنت بتحسبها هو الـBicarb لما يبتفع
+
+390
+00:29:00,560 --> 00:29:07,610
+بعمل Acidosis، مش الـBH قلنا تولهأه طيب الـ Bicarb
+
+391
+00:29:07,610 --> 00:29:11,030
+لما يرتفع بيعمل الـ Acidosis؟ لأ، بينفعش، يبقى
+
+392
+00:29:11,030 --> 00:29:14,070
+المشكلة اللي عاملها الـ CO2 والـ Bicarb هنعمل الـ
+
+393
+00:29:14,070 --> 00:29:17,530
+Compensation، تمام؟ بعدين تطلع على الـ Onion Gap
+
+394
+00:29:17,530 --> 00:29:20,770
+عشان تعرف إيش نوع الـ Acidosis، إذا فيه Acidosis،
+
+395
+00:29:20,770 --> 00:29:25,770
+بعدين حط الـ Diagnosis تبعك، برضه، واضح إن هي حاجة
+
+396
+00:29:25,770 --> 00:29:29,550
+أسرع، حاضر، أذكركم أول في الـ Onion Gap إذا فاكرين
+
+397
+00:29:29,550 --> 00:29:34,450
+Onion Gap؟لسة تاوي كنا بنحكي عنها بس بدك تشوف قد
+
+398
+00:29:34,450 --> 00:29:37,210
+انت الـ «ماريت» تبعه هو طلع مع الـ «high onion
+
+399
+00:29:37,210 --> 00:29:40,810
+gap» نتيجة إن الـ«lung» فيها، عفوا أقول،
+
+400
+00:29:40,810 --> 00:29:44,010
+الـ«kidney» فيها يعني «not producing enough
+
+401
+00:29:44,010 --> 00:29:46,070
+bicarbonates» وهي اللي فيها مشكلة زي
+
+402
+00:29:46,070 --> 00:29:50,190
+الـ«ketoacidosis» ولا «normal» زي الديارية، يعني
+
+403
+00:29:50,190 --> 00:29:52,770
+الـ«onion gap» حسب تلاجتها «normal» لكن فيه
+
+404
+00:29:52,770 --> 00:29:55,370
+«metabolic acidosis» ولا «low» زي الأمور اللي
+
+405
+00:29:55,370 --> 00:29:57,850
+بتكون متعلقة بنقص البروتين، الدم، اللي هو
+
+406
+00:29:57,850 --> 00:30:01,060
+الـ«albumin»عشان أوضح الـQ&A اللي جت أكتر و
+
+407
+00:30:01,060 --> 00:30:05,640
+أخلّيكم تشوفوا كيف بدي أنا أعرف بالظبط القصة أنت
+
+408
+00:30:05,640 --> 00:30:10,640
+اتطلعت على المريض وجدت الـBH عنده Low طلعت على
+
+409
+00:30:10,640 --> 00:30:16,800
+الـBicarb وجدته برضه Low الـBH Low يعني Acidosis
+
+410
+00:30:16,800 --> 00:30:20,880
+الـBicarb Low تمام تمام يبقى هذا
+
+411
+00:30:25,380 --> 00:30:28,260
+مثابوليك أسدوسيس، طب إيش أخبار الـCO2؟ والله
+
+412
+00:30:28,260 --> 00:30:33,380
+لاجأته له يا سيدي كمان، آه يبدأ الـlaw هنا لأنه
+
+413
+00:30:33,380 --> 00:30:37,680
+compensation، تمام؟ كيف compensation يا أستاذ؟ كيف
+
+414
+00:30:37,680 --> 00:30:41,730
+أرفض؟ لأن هو المفروض أنه يكون طبيعيفي الـ
+
+415
+00:30:41,730 --> 00:30:44,690
+Metabolic Acidosis الـ BCO2 ما لهش دور، المفروض
+
+416
+00:30:44,690 --> 00:30:48,150
+يكون صبيعي إلا إذا بده يشتغل أسكم فانتشار بيصير له
+
+417
+00:30:48,150 --> 00:30:51,590
+دور، فبكون إيش؟ Low، ليش بيقول؟ لأنه مسول عن
+
+418
+00:30:51,590 --> 00:30:56,470
+الحنضية، فبروح بجلل من حاله عشان يحسن الحنضية اللي
+
+419
+00:30:56,470 --> 00:31:01,030
+موجودة هنا، تمام؟ آه، آه، بدأنا هيك نفع، إذا نطلع
+
+420
+00:31:01,030 --> 00:31:06,630
+مع الأسهم، كله Low، BH Low، Bicarb Low، CO2 Low،
+
+421
+00:31:06,630 --> 00:31:09,890
+Metabolic Acidosisوالله شاك اللي هالجيت بدنا
+
+422
+00:31:09,890 --> 00:31:13,490
+نفهمها دي نظرية الأسهم الكويسة يعني أنا بروح بكتب
+
+423
+00:31:13,490 --> 00:31:17,090
+الـBH و بكتب الـBicarb و بكتب الـCO2 عندي و بصير
+
+424
+00:31:17,090 --> 00:31:21,890
+أبدأ أحط أسهم الـBH low الـBicarb low و الـCO2
+
+425
+00:31:21,890 --> 00:31:26,310
+كمان low لازم تكون metabolic acidosis طب هتنشوف لو
+
+426
+00:31:26,310 --> 00:31:29,570
+كانت metabolic alkalosis بختلف الوضع؟ آه بختلف
+
+427
+00:31:30,660 --> 00:31:32,980
+بتقولي طبعا يا أستاذ مش خايف أطلع خبط بين
+
+428
+00:31:32,980 --> 00:31:35,460
+الـ«ميتابولك ألكالوسس» والـ«ميتابولك أسيدوسس» أنا
+
+429
+00:31:35,460 --> 00:31:39,760
+ممكن أطلع خبط بين الـ«ميتابولك أسيدوسس» مثلا واللي
+
+430
+00:31:39,760 --> 00:31:43,280
+هو الـ«رسبيراتوري أسيدوسس» هي اللي خايف أطلع خبط
+
+431
+00:31:43,280 --> 00:31:45,660
+منه، بقول له هل بتبقى مفرجك؟ بس خلينا نشوف
+
+432
+00:31:45,660 --> 00:31:48,960
+الـ«ميتابولك ألكالوسس» الـ«BH» الشمالها مرتفعة
+
+433
+00:31:48,960 --> 00:31:53,640
+والـ«Bicarb» مرتفعة والـ«CO2» هتلاقيه مرتفع أو
+
+434
+00:31:53,640 --> 00:31:58,970
+Normalمازال ميتابوليك، يبقى الموضوع متعلق في
+
+435
+00:31:58,970 --> 00:32:04,270
+الـBicarb عشان هيك مرتفع، عفوا، الـBicarb مرتفع،
+
+436
+00:32:04,270 --> 00:32:08,430
+فهيكون الـBH مرتفع الـCO2 هيكون طبيعي، Normal،
+
+437
+00:32:08,430 --> 00:32:12,550
+هيبدأ يرتفع عشان يزود الحمضية عشان يحسن الحلق
+
+438
+00:32:12,550 --> 00:32:17,010
+الـAlkalosis الموجودة، عارف كويس بعد هيك، نشوف
+
+439
+00:32:17,010 --> 00:32:23,480
+الـAcute Respiratory Acidosisسواء acute و لا
+
+440
+00:32:23,480 --> 00:32:27,380
+chronic يا جماعة الاحظين ان الـ pH هيكون low لكن
+
+441
+00:32:27,380 --> 00:32:35,320
+الـ CO2 هيكون عالي الـ CO2 عالي هذا بيخدف نهائيا
+
+442
+00:32:35,320 --> 00:32:37,840
+عن الـ metabolic acid doses لأن في الـ metabolic
+
+443
+00:32:37,840 --> 00:32:44,970
+acid doses إيش كان كله؟ كله lowفاكرين؟ كله low،
+
+444
+00:32:44,970 --> 00:32:49,970
+نرجع لهم، كله low لكن في ال respiratory عكس بعض
+
+445
+00:32:49,970 --> 00:32:55,490
+الـ pH منخفضة الـ CO2 عالي والـ bicarb يا بده يكون
+
+446
+00:32:55,490 --> 00:33:00,630
+طبيعي يا بده يرتفع عشان يعمل compensation بس في ال
+
+447
+00:33:00,630 --> 00:33:06,420
+chronic برتفع زيادة كتيرعشان هيك بتلاقي خمسة و
+
+448
+00:33:06,420 --> 00:33:09,120
+خمسين، خمسة و أربعين عند الناس الـChronic
+
+449
+00:33:09,120 --> 00:33:12,300
+الـChronic يعني أقصد الـChronic Respiratory
+
+450
+00:33:12,300 --> 00:33:15,980
+Acidosis ذات و أنا COPD طب ويه؟ سياكة بدين النفس؟
+
+451
+00:33:15,980 --> 00:33:19,800
+قبل Acute Respiratory Alkalosis؟ مول حاجة، ما زال
+
+452
+00:33:19,800 --> 00:33:23,900
+Respiratory Alkalosis طب أنت لاحظ في
+
+453
+00:33:23,900 --> 00:33:28,800
+الـRespiratory Acidosis عكس بعض الـBH-Low والـCO2
+
+454
+00:33:28,800 --> 00:33:34,520
+هو اللي إيش؟اللي مرتفع، لكن هي برضه عكس بعض بس
+
+455
+00:33:34,520 --> 00:33:39,020
+الـBH هي اللي فوق و الـCO2 هو اللي منخفض و
+
+456
+00:33:39,020 --> 00:33:42,020
+الـBicarb مالوش دعوة إلا إذا بديوا يعملوا
+
+457
+00:33:42,020 --> 00:33:45,660
+compensation طب إيش هيسوي؟ أكل كثير تعافي، برافو
+
+458
+00:33:45,660 --> 00:33:47,940
+عليكوا، بديوا يقولوا لما زال الـAlkalosis هو بديه
+
+459
+00:33:47,940 --> 00:33:52,240
+يحسن حالة الـAlkalosis، فبديه يحاول يقلل من نفسه
+
+460
+00:33:52,240 --> 00:33:56,500
+عشان، برافو عليكوا، إيش يعمل؟ يعمل حالة من الحمضية
+
+461
+00:33:56,730 --> 00:34:00,150
+فبس القصة إن عند الناس لـChronic Respiratory
+
+462
+00:34:00,150 --> 00:34:05,550
+Alkalosis بتلاقي بيكون قليل، زيادة، أكتر من الناس
+
+463
+00:34:05,550 --> 00:34:08,870
+الأكيوت، بس هذه كل القصة كيف صار الـBlood Gases
+
+464
+00:34:08,870 --> 00:34:14,270
+والـInterpretation تبعته، أعتقد سهل كتيروهيك يكون
+
+465
+00:34:14,270 --> 00:34:19,210
+كل الأسهم عندك وتستطيع تخلّي عليهم أي معادلة وهنا
+
+466
+00:34:19,210 --> 00:34:24,850
+تلخيصك سريع لكل اللي حكيته أنا لما كان عندي إبلاط
+
+467
+00:34:24,850 --> 00:34:27,730
+جاز نفس اللي حكينا تتطلع على البيئة يعني هذه
+
+468
+00:34:27,730 --> 00:34:33,390
+الرسمة تقريبا هي نفسة بالظبط اللي هي الرسمة هذه،
+
+469
+00:34:33,390 --> 00:34:39,010
+تمام؟ بس هي شبه الأرقامOkay، هيك ممكن يا جماعة،
+
+470
+00:34:39,010 --> 00:34:43,170
+يعطيكم ألف عافية، خلصنا المحاضرة هذه تمام، بس أنا
+
+471
+00:34:43,170 --> 00:34:48,950
+بصراحة تذكرت، بدي أرجع لسؤال زميلة كو اللي إجت في
+
+472
+00:34:48,950 --> 00:34:55,170
+بالي، عن الـMetabolic Acidosis، في إيه؟ كانت
+
+473
+00:34:55,170 --> 00:34:57,350
+بتسألني عن الـPotassium أظن
+
+474
+00:35:01,160 --> 00:35:07,720
+في الـ «ميتابوليك أسيدوسيز»؟ «مستقيقة»؟ «هان»؟
+
+475
+00:35:07,720 --> 00:35:12,520
+«الكالوسيز»؟
+
+476
+00:35:12,520 --> 00:35:12,900
+«الكالوسيز»؟ «الكالوسيز»؟ «الكالوسيز»؟
+
+477
+00:35:12,900 --> 00:35:12,920
+«الكالوسيز»؟ «الكالوسيز»؟ «الكالوسيز»؟
+
+478
+00:35:12,920 --> 00:35:13,000
+«الكالوسيز»؟ «الكالوسيز»؟ «الكالوسيز»؟
+
+479
+00:35:13,000 --> 00:35:13,020
+«الكالوسيز»؟ «الكالوسيز»؟ «الكالوسيز»؟
+
+480
+00:35:13,020 --> 00:35:13,080
+«الكالوسيز»؟ «الكالوسيز»؟ «الكالوسيز»؟
+
+481
+00:35:13,080 --> 00:35:20,120
+«الكالوسيز»؟
+
+482
+00:35:20,120 --> 00:35:24,160
+«الكالوسيز»؟
+
+483
+00:35:24,160 --> 00:35:30,460
+«الكالوسأو تعمل ميتابولك ألكالوسيز بما يحكي، إذا
+
+484
+00:35:30,460 --> 00:35:34,540
+فاكرين أنتوا الـHyper-aldosteronism إيش بيصير
+
+485
+00:35:34,540 --> 00:35:38,860
+فيها؟ بيصير يعني الغدة الـSupra-renal gland أو
+
+486
+00:35:38,860 --> 00:35:43,600
+بيسموها الـAdrenal gland بتطلع اللي هو Aldosterone
+
+487
+00:35:43,600 --> 00:35:48,630
+كتيربتطلع ألدستيرون كتير، إيش يعني الألدستيرون؟
+
+488
+00:35:48,630 --> 00:35:51,810
+عارفين إن الـAdrenal gland هي عبارة عن Cortex
+
+489
+00:35:51,810 --> 00:35:55,810
+وMedulla؟ الـCortex بتطلع اللي هي الألدستيرون
+
+490
+00:35:55,810 --> 00:35:59,110
+والكرتزول والMedulla بتطلع الـAdrenaline والنور
+
+491
+00:36:00,100 --> 00:36:04,280
+فلما في واحد عنده الـ «hyperaldosteronism» يعني
+
+492
+00:36:04,280 --> 00:36:08,260
+الـ Adrenal gland من الـ Cortex تبعها، من القشرة
+
+493
+00:36:08,260 --> 00:36:11,400
+تبعها، بتطلع ألدستيرون كتير، طب إيش بيسوي لما
+
+494
+00:36:11,400 --> 00:36:14,860
+بيصير ألدستيرون كتير؟ آه، لما بيصير ألدستيرون
+
+495
+00:36:14,860 --> 00:36:18,480
+كتير، بيعمل «retention» للـ water و بيعمل «loss»
+
+496
+00:36:18,480 --> 00:36:21,200
+للبوتاسيوم كتير، لما يصير «loss» للبوتاسيوم، إيش
+
+497
+00:36:21,200 --> 00:36:25,440
+بيصير؟ بداخل المريض في حالة من الـ «hypokalemia»
+
+498
+00:36:25,440 --> 00:36:28,000
+طب لما تصير حالة من الـ «hypokalemia»، إيش بيصير؟
+
+499
+00:36:28,210 --> 00:36:34,870
+ولمّا يصبح الحالة من الهيبوكاليميا بيضطر أنه نقص
+
+500
+00:36:34,870 --> 00:36:40,570
+البوتاسيوم لكتير يعني بيأثر على أنه يعمل متابولك
+
+501
+00:36:40,570 --> 00:36:42,350
+ألسي دوسلس بطريقة تانية يا جماعة
+
+502
+00:36:48,800 --> 00:36:55,320
+In which the potassium leaves الـ Intracellular
+
+503
+00:36:55,320 --> 00:37:02,820
+على الـ Extracellular بغادر
+
+504
+00:37:02,820 --> 00:37:05,900
+الـ Intracellular على الـ Extracellular الـ space،
+
+505
+00:37:05,900 --> 00:37:09,300
+مش على الـ blood، طبعاً؟ هلأ، صار إيش الخلية
+
+506
+00:37:09,300 --> 00:37:14,910
+مالها؟فيها نقص البوتاسيوم فيها طلع منها بتاسيوم
+
+507
+00:37:14,910 --> 00:37:18,790
+فبروح بدخل بداله ماشي هيدروجين ايون طلع منها
+
+508
+00:37:18,790 --> 00:37:22,390
+بتاسيوم ايون بروح بدخل منها فيها هيدروجين ايون
+
+509
+00:37:22,390 --> 00:37:25,570
+الهيدروجين زيادته مسئول عن إيش أو هو أصلا مسئول عن
+
+510
+00:37:25,570 --> 00:37:29,910
+إيش عن الأندية تمام تمام فلمّا كل في البلد هيعمل
+
+511
+00:37:29,910 --> 00:37:34,550
+ميتابوليكالكالوسيز تمام؟ بس أنا بدأ أؤكد على هذا
+
+512
+00:37:34,550 --> 00:37:44,770
+عشان وين القرار؟ هنا إنه هنااللي هو هنا «to
+
+513
+00:37:44,770 --> 00:37:51,330
+extracellular space» يعني «إنتراسيلولار
+
+514
+00:37:51,330 --> 00:37:57,030
+شفت» «to extracellular space» «in exchange for»
+
+515
+00:37:57,030 --> 00:37:59,290
+اللي هو الـ «الهيدروجين» الـ «الهيدروجين» وين
+
+516
+00:37:59,290 --> 00:38:02,990
+بروح؟ داخل الـ «سيل» تمام، هذا التفسير الأول لكيف
+
+517
+00:38:02,990 --> 00:38:06,630
+بيصير أو الـ «الدوستيرون» كيف بيعمل اللي هو
+
+518
+00:38:06,630 --> 00:38:12,970
+«hypokalemia»التفسير التاني إن الـ Second effect
+
+519
+00:38:12,970 --> 00:38:16,570
+in the presence of hypokalemia هيدروجين سيكريشيل
+
+520
+00:38:16,570 --> 00:38:19,130
+in the proximal and distal tubule increase
+
+521
+00:38:19,130 --> 00:38:22,930
+الهيدروجين بتصير كتير فيه هيدروجين طاي وبعدها هذا
+
+522
+00:38:22,930 --> 00:38:27,600
+بيخلّي Reabsorption of bicarbفيه هيدروجين آيون
+
+523
+00:38:27,600 --> 00:38:33,820
+كتير بيصير يتحد مع اللي هو الـ «CO2»، المي الموجود
+
+524
+00:38:33,820 --> 00:38:38,480
+«H2O» اللي موجود «H2O» اللي موجود و بيصير يعمل
+
+525
+00:38:38,480 --> 00:38:41,660
+«Reabsorption» بيكون اللي هو الـ «Bicarb» و بيعمله
+
+526
+00:38:41,660 --> 00:38:44,280
+«Reabsorption» فبيصير اللي بيقعد بالـ «Bicarb» ده
+
+527
+00:38:44,280 --> 00:38:48,070
+مسئول عن القاعدية فبيعملك «Metabolic Alkalosis»هذه
+
+528
+00:38:48,070 --> 00:38:50,810
+اللي هي تفسير ليش الـ «الدوستيرونيزم» أو الـ
+
+529
+00:38:50,810 --> 00:38:56,390
+«hyperaldosteronism» بيعمل اللي هو «هيبوكاليميا»
+
+530
+00:38:56,390 --> 00:39:02,650
+وليش الـ «هيبوكاليميا» و«الدوستيرونيزم»
+
+531
+00:39:02,650 --> 00:39:08,890
+بيعملوا اللي هو «metabolic alkalosis» هيك أنهينا
+
+532
+00:39:08,890 --> 00:39:12,990
+المحاضرة وسمحون على الإطالة اللي بالآخر
+
+533
+00:39:17,640 --> 00:39:21,140
+سامحونا على الإطالة بالآخر ونعود إلى موضوع
+
+534
+00:39:21,140 --> 00:39:26,900
+الـBlood Gases نكون إنتهينا منه ويعطيكم ألف عافية
+
+535
+00:39:26,900 --> 00:39:31,200
+وإن شاء الله رب العالمين بنشوفكم على خير وسلامة في
+
+536
+00:39:31,200 --> 00:39:34,840
+الـMechanical Ventilator Lectures القادمة إن شاء
+
+537
+00:39:34,840 --> 00:39:35,040
+الله
+
diff --git a/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/wswv63T8KBY_raw.json b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/wswv63T8KBY_raw.json
new file mode 100644
index 0000000000000000000000000000000000000000..930d34b8a8c3dd80b13012df3b58ece094434527
--- /dev/null
+++ b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/wswv63T8KBY_raw.json
@@ -0,0 +1 @@
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{"start": 21.28, "end": 21.56, "word": " بعض", "probability": 0.7431640625}, {"start": 21.56, "end": 22.14, "word": " الأسئلة", "probability": 0.99365234375}, {"start": 22.14, "end": 23.22, "word": " اللي", "probability": 0.96533203125}, {"start": 23.22, "end": 25.04, "word": " يعني", "probability": 0.833251953125}, {"start": 25.04, "end": 25.58, "word": " بعضكم", "probability": 0.9820963541666666}, {"start": 25.58, "end": 26.04, "word": " سأل", "probability": 0.9674479166666666}, {"start": 26.04, "end": 26.24, "word": " من", "probability": 0.2418212890625}, {"start": 26.24, "end": 26.74, "word": " خلال", "probability": 0.96875}, {"start": 26.74, "end": 27.7, "word": " مناقشات", "probability": 0.91845703125}, {"start": 27.7, "end": 28.26, "word": " الـWhatsApp", "probability": 0.85693359375}, {"start": 28.26, "end": 28.7, "word": " عنها", "probability": 0.997314453125}], "temperature": 1.0}, {"id": 2, "seek": 5228, "start": 30.76, "end": 52.28, "text": "حكينا المرة الفاتة عن الـ Metabolic Acid Doses والـ Metabolic Alkalosis وبدنا اليوم نحكي عن الـ Respiratory Acid Doses و Respiratory Alkalosis وبعد ذلك إن شاء الله رب العالمين نعمل conclusion على أي blood gases كيف ممكن أن أنا أعملها، بارح لما حكينا عن الـ", "tokens": [5016, 4117, 1829, 8315, 9673, 25720, 27188, 9307, 3660, 18871, 2423, 39184, 6377, 26956, 5097, 327, 413, 4201, 16070, 39184, 6377, 26956, 967, 19990, 8211, 4032, 44510, 8315, 45595, 20498, 8717, 5016, 4117, 1829, 18871, 2423, 39184, 5015, 9501, 4745, 5097, 327, 413, 4201, 4032, 5015, 9501, 4745, 967, 19990, 8211, 46599, 22488, 29910, 23275, 36145, 13412, 16606, 21984, 12602, 3555, 18863, 45340, 9957, 8717, 25957, 1211, 10063, 15844, 36632, 3390, 21452, 9122, 33911, 3714, 43020, 14739, 41850, 5551, 25957, 1211, 11296, 12399, 4724, 9640, 5016, 5296, 15042, 11331, 4117, 1829, 8315, 18871, 2423, 39184], "avg_logprob": -0.22233072745924196, "compression_ratio": 1.7302325581395348, "no_speech_prob": 1.4424324035644531e-05, "words": [{"start": 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بتاكيبنيها، بس اصحك تقول عنها الـ Respiratory Alkalosis الـ Respiratory Alkalosis اللي هي compensation اللي عندها، يعني كيف؟ يعني هي جاية بحالة من الـ Metabolic Acidosis", "tokens": [10721, 3224, 11778, 1829, 4117, 1829, 11933, 1829, 3224, 22807, 39894, 1829, 7435, 1829, 39894, 995, 4117, 1829, 3555, 22653, 11296, 49429, 5296, 10721, 22807, 5551, 3224, 39894, 995, 4117, 1829, 3555, 22653, 11296, 12399, 4724, 3794, 1975, 9381, 5016, 4117, 6055, 39648, 18871, 11296, 2423, 39184, 5015, 9501, 4745, 967, 19990, 8211, 2423, 39184, 5015, 9501, 4745, 967, 19990, 8211, 13672, 1829, 39896, 19644, 13672, 1829, 43242, 11296, 12399, 37495, 22653, 9122, 33911, 22807, 37495, 22653, 39896, 10874, 995, 10632, 4724, 5016, 6027, 3660, 9154, 2423, 39184, 6377, 26956, 5097, 7895, 271], "avg_logprob": -0.24883644948614406, "compression_ratio": 1.6307692307692307, "no_speech_prob": 0.0, "words": [{"start": 1125.73, "end": 1126.17, "word": "أه", "probability": 0.422943115234375}, {"start": 1126.17, "end": 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"word": " المي", "probability": 0.693359375}, {"start": 2313.38, "end": 2313.82, "word": " الموجود", "probability": 0.841796875}, {"start": 2313.82, "end": 2314.78, "word": " «H2O»", "probability": 0.85546875}, {"start": 2314.78, "end": 2314.96, "word": " اللي", "probability": 0.900390625}, {"start": 2314.96, "end": 2315.42, "word": " موجود", "probability": 0.9847005208333334}, {"start": 2315.42, "end": 2316.44, "word": " «H2O»", "probability": 0.87490234375}, {"start": 2316.44, "end": 2316.78, "word": " اللي", "probability": 0.98681640625}, {"start": 2316.78, "end": 2317.16, "word": " موجود", "probability": 0.9918619791666666}, {"start": 2317.16, "end": 2317.24, "word": " و", "probability": 0.5224609375}, {"start": 2317.24, "end": 2317.72, "word": " بيصير", "probability": 0.83306884765625}, {"start": 2317.72, "end": 2318.48, "word": " يعمل", "probability": 0.9641927083333334}, {"start": 2318.48, "end": 2319.76, "word": " «Reabsorption»", "probability": 0.7776285807291666}, {"start": 2319.76, "end": 2320.24, "word": " بيكون", "probability": 0.7545572916666666}, {"start": 2320.24, "end": 2320.46, "word": " اللي", "probability": 0.982666015625}, {"start": 2320.46, "end": 2320.62, "word": " هو", "probability": 0.98681640625}, {"start": 2320.62, "end": 2320.74, "word": " الـ", "probability": 0.926025390625}, {"start": 2320.74, "end": 2321.22, "word": " «Bicarb»", "probability": 0.7572265625}, {"start": 2321.22, "end": 2321.3, "word": " و", "probability": 0.53955078125}, {"start": 2321.3, "end": 2321.66, "word": " بيعمله", "probability": 0.8570556640625}, {"start": 2321.66, "end": 2322.48, "word": " «Reabsorption»", "probability": 0.90625}, {"start": 2322.48, "end": 2322.88, "word": " فبيصير", "probability": 0.69683837890625}, {"start": 2322.88, "end": 2323.04, "word": " اللي", "probability": 0.891845703125}, {"start": 2323.04, "end": 2323.3, "word": " بيقعد", "probability": 0.760498046875}, {"start": 2323.3, "end": 2323.48, "word": " بالـ", "probability": 0.833251953125}, {"start": 2323.48, "end": 2324.08, "word": " «Bicarb»", "probability": 0.89052734375}, {"start": 2324.08, "end": 2324.28, "word": " ده", "probability": 0.837158203125}, {"start": 2324.28, "end": 2324.54, "word": " مسئول", "probability": 0.7191569010416666}, {"start": 2324.54, "end": 2324.68, "word": " عن", "probability": 0.953125}, {"start": 2324.68, "end": 2325.24, "word": " القاعدية", "probability": 0.67767333984375}, {"start": 2325.24, "end": 2325.76, "word": " فبيعملك", "probability": 0.8782958984375}, {"start": 2325.76, "end": 2326.46, "word": " «Metabolic", "probability": 0.6686279296875}, {"start": 2326.46, "end": 2327.52, "word": " Alkalosis»", "probability": 0.765869140625}], "temperature": 1.0}, {"id": 99, "seek": 235298, "start": 2327.55, "end": 2352.99, "text": "هذه اللي هي تفسير ليش الـ «الدوستيرونيزم» أو الـ «hyperaldosteronism» بيعمل اللي هو «هيبوكاليميا» وليش الـ «هيبوكاليميا» و«الدوستيرونيزم» بيعملوا اللي هو «metabolic alkalosis» هيك أنهينا المحاضرة وسمحون على الإطالة اللي بالآخر", "tokens": [3224, 24192, 13672, 1829, 39896, 6055, 36178, 13546, 32239, 8592, 2423, 39184, 4657, 6027, 3215, 2407, 14851, 13546, 11536, 1829, 11622, 2304, 5933, 34051, 2423, 39184, 4657, 3495, 610, 3976, 7096, 266, 1434, 5933, 4724, 1829, 25957, 1211, 13672, 1829, 31439, 4657, 3224, 1829, 3555, 2407, 4117, 6027, 32640, 25528, 5933, 4032, 20292, 8592, 2423, 39184, 4657, 3224, 1829, 3555, 2407, 4117, 6027, 32640, 25528, 5933, 4032, 36784, 6027, 3215, 2407, 14851, 13546, 11536, 1829, 11622, 2304, 5933, 4724, 1829, 25957, 1211, 14407, 13672, 1829, 31439, 4657, 5537, 26956, 44220, 8211, 5933, 39896, 4117, 14739, 3224, 1829, 8315, 9673, 5016, 46958, 25720, 4032, 38251, 5016, 11536, 15844, 33688, 9566, 6027, 3660, 13672, 1829, 20666, 148, 95, 34740], "avg_logprob": -0.2057733020540011, "compression_ratio": 1.8829268292682926, "no_speech_prob": 9.298324584960938e-06, "words": [{"start": 2327.55, "end": 2328.07, "word": "هذه", "probability": 0.652587890625}, {"start": 2328.07, "end": 2328.31, "word": " اللي", "probability": 0.550018310546875}, {"start": 2328.31, "end": 2328.57, "word": " هي", "probability": 0.95458984375}, {"start": 2328.57, "end": 2329.23, "word": " تفسير", "probability": 0.99169921875}, {"start": 2329.23, "end": 2329.87, "word": " ليش", "probability": 0.582763671875}, {"start": 2329.87, "end": 2330.05, "word": " الـ", "probability": 0.94873046875}, {"start": 2330.05, "end": 2330.55, "word": " «الدوستيرونيزم»", "probability": 0.7904385653409091}, {"start": 2330.55, "end": 2330.69, "word": " أو", "probability": 0.4609375}, {"start": 2330.69, "end": 2330.81, "word": " الـ", "probability": 0.867431640625}, {"start": 2330.81, "end": 2332.19, "word": " «hyperaldosteronism»", "probability": 0.785919189453125}, {"start": 2332.19, "end": 2333.13, "word": " بيعمل", "probability": 0.89599609375}, {"start": 2333.13, "end": 2333.53, "word": " اللي", "probability": 0.861083984375}, {"start": 2333.53, "end": 2334.01, "word": " هو", "probability": 0.986328125}, {"start": 2334.01, "end": 2336.39, "word": " «هيبوكاليميا»", "probability": 0.832470703125}, {"start": 2336.39, "end": 2337.39, "word": " وليش", "probability": 0.7774251302083334}, {"start": 2337.39, "end": 2338.15, "word": " الـ", "probability": 0.904541015625}, {"start": 2338.15, "end": 2338.95, "word": " «هيبوكاليميا»", "probability": 0.9296875}, {"start": 2338.95, "end": 2342.65, "word": " و«الدوستيرونيزم»", "probability": 0.8998209635416666}, {"start": 2342.65, "end": 2344.03, "word": " بيعملوا", "probability": 0.91572265625}, {"start": 2344.03, "end": 2344.33, "word": " اللي", "probability": 0.976318359375}, {"start": 2344.33, "end": 2344.73, "word": " هو", "probability": 0.98388671875}, {"start": 2344.73, "end": 2345.97, "word": " «metabolic", "probability": 0.7383626302083334}, {"start": 2345.97, "end": 2347.07, "word": " alkalosis»", "probability": 0.9568684895833334}, {"start": 2347.07, "end": 2347.47, "word": " هيك", "probability": 0.58428955078125}, {"start": 2347.47, "end": 2348.89, "word": " أنهينا", "probability": 0.84039306640625}, {"start": 2348.89, "end": 2349.39, "word": " المحاضرة", "probability": 0.9930419921875}, {"start": 2349.39, "end": 2349.89, "word": " وسمحون", "probability": 0.70660400390625}, {"start": 2349.89, "end": 2350.11, "word": " على", "probability": 0.74658203125}, {"start": 2350.11, "end": 2351.01, "word": " الإطالة", "probability": 0.88671875}, {"start": 2351.01, "end": 2351.53, "word": " اللي", "probability": 0.9287109375}, {"start": 2351.53, "end": 2352.99, "word": " بالآخر", "probability": 0.9598388671875}], "temperature": 1.0}, {"id": 100, "seek": 237504, "start": 2357.64, "end": 2375.04, "text": "سامحونا على الإطالة بالآخر ونعود إلى موضوع الـBlood Gases نكون إنتهينا منه ويعطيكم ألف عافية وإن شاء الله رب العالمين بنشوفكم على خير وسلامة في الـMechanical Ventilator Lectures القادمة إن شاء الله", "tokens": [3794, 10943, 5016, 2407, 8315, 15844, 33688, 9566, 6027, 3660, 20666, 148, 95, 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ونعود", "probability": 0.6268310546875}, {"start": 2359.8, "end": 2360.2, "word": " إلى", "probability": 0.5009765625}, {"start": 2360.2, "end": 2361.14, "word": " موضوع", "probability": 0.8807373046875}, {"start": 2361.14, "end": 2361.6, "word": " الـBlood", "probability": 0.75673828125}, {"start": 2361.6, "end": 2362.12, "word": " Gases", "probability": 0.83740234375}, {"start": 2362.12, "end": 2362.8, "word": " نكون", "probability": 0.494873046875}, {"start": 2362.8, "end": 2364.38, "word": " إنتهينا", "probability": 0.753271484375}, {"start": 2364.38, "end": 2364.88, "word": " منه", "probability": 0.954345703125}, {"start": 2364.88, "end": 2365.92, "word": " ويعطيكم", "probability": 0.84501953125}, {"start": 2365.92, "end": 2366.32, "word": " ألف", "probability": 0.9111328125}, {"start": 2366.32, "end": 2366.9, "word": " عافية", "probability": 0.970703125}, {"start": 2366.9, "end": 2367.18, "word": " وإن", "probability": 0.8701171875}, {"start": 2367.18, "end": 2367.36, "word": " شاء", "probability": 0.981201171875}, {"start": 2367.36, "end": 2367.48, "word": " الله", "probability": 0.9404296875}, {"start": 2367.48, "end": 2367.74, "word": " رب", "probability": 0.93603515625}, {"start": 2367.74, "end": 2368.46, "word": " العالمين", "probability": 0.99267578125}, {"start": 2368.46, "end": 2369.4, "word": " بنشوفكم", "probability": 0.830078125}, {"start": 2369.4, "end": 2369.7, "word": " على", "probability": 0.9677734375}, {"start": 2369.7, "end": 2370.44, "word": " خير", "probability": 0.97900390625}, {"start": 2370.44, "end": 2371.04, "word": " وسلامة", "probability": 0.768310546875}, {"start": 2371.04, "end": 2371.2, "word": " في", "probability": 0.75927734375}, {"start": 2371.2, "end": 2372.04, "word": " الـMechanical", "probability": 0.87421875}, {"start": 2372.04, "end": 2372.96, "word": " Ventilator", "probability": 0.9029947916666666}, {"start": 2372.96, "end": 2373.88, "word": " Lectures", "probability": 0.909423828125}, {"start": 2373.88, "end": 2374.52, "word": " القادمة", "probability": 0.9837239583333334}, {"start": 2374.52, "end": 2374.7, "word": " إن", "probability": 0.9228515625}, {"start": 2374.7, "end": 2374.84, "word": " شاء", "probability": 0.98681640625}, {"start": 2374.84, "end": 2375.04, "word": " الله", "probability": 0.95068359375}], "temperature": 1.0}], "language": "ar", "language_probability": 1.0, "duration": 2385.2930625, "duration_after_vad": 2318.636593749996}
\ No newline at end of file
diff --git a/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/xzJXVXMLQCM.srt b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/xzJXVXMLQCM.srt
new file mode 100644
index 0000000000000000000000000000000000000000..560b03c0f1bd4bcdfe09938c43c5a96dd9cfa32d
--- /dev/null
+++ b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/xzJXVXMLQCM.srt
@@ -0,0 +1,2013 @@
+1
+00:00:02,600 --> 00:00:05,800
+بسم الله الرحمن الرحيم السلام عليكم ورحمة الله
+
+2
+00:00:05,800 --> 00:00:11,320
+وبركاته، اليوم إن شاء الله رب العالمين، هنحكي عن الـ
+
+3
+00:00:11,320 --> 00:00:16,700
+invasive hemodynamic monitoring، هذا الـ chapter
+
+4
+00:00:16,700 --> 00:00:21,880
+الهدف الأساسي منه أنه نتعرف على الـ hemodynamic
+
+5
+00:00:21,880 --> 00:00:28,750
+stability، وكيف بدأناعمل مراقبة للـ hemodynamic
+
+6
+00:00:28,750 --> 00:00:33,030
+stability، ونكتشف أي unstability فيها، وما هي
+
+7
+00:00:33,030 --> 00:00:38,630
+الوسائل اللي نستخدمها عشان نعمل monitoring، طبعاً
+
+8
+00:00:38,630 --> 00:00:41,530
+هنشوف أنه مش بس الـ monitor، اللي هو ممكن يعمل
+
+9
+00:00:41,530 --> 00:00:47,930
+monitoring للـ patient، اللي أقصد monitor screen، مش
+
+10
+00:00:47,930 --> 00:00:51,570
+بس هي، في حاجات تانية، بالذات في الـ ICU أو في الـ
+
+11
+00:00:51,570 --> 00:00:56,190
+critical ill patients، نستخدمها. فأولاً، يعني إيش يعني
+
+12
+00:00:56,190 --> 00:01:00,090
+Hemodynamic Stability؟
+
+13
+00:01:00,090 --> 00:01:04,710
+طبعاً، قبل ما أبدأ أشرح، وفي الموضوع هذا، هنشوف اللي
+
+14
+00:01:04,710 --> 00:01:10,330
+هو أهم موضوع بتعلق في الـHemodynamic Stability
+
+15
+00:01:10,330 --> 00:01:14,170
+والـUnstability تبعيتها، اللي هي تصير الـ patient
+
+16
+00:01:14,170 --> 00:01:17,810
+shock، فهيكون الموضوع التاني، اللي هو شرح موضوع
+
+17
+00:01:17,810 --> 00:01:22,330
+الشوك بأنواعه المختلفة. الآن، بالدرجة الأولى، بنتعرف
+
+18
+00:01:22,330 --> 00:01:27,080
+على إيش يعني Hemodynamic Stability، وإيش هي
+
+19
+00:01:27,080 --> 00:01:30,400
+الوسائل invasive اللي بنستخدمها عشان نعمل من
+
+20
+00:01:30,400 --> 00:01:34,900
+خلالها monitoring، اللي هي hemodynamic، معناها
+
+21
+00:01:34,900 --> 00:01:38,780
+الـ movement of blood through closed circulatory
+
+22
+00:01:38,780 --> 00:01:42,860
+system. مش هي مشكلة blood في closed circulatory
+
+23
+00:01:42,860 --> 00:01:48,040
+system بتتحرك، بيعمل perfusion لكل الجسم، من ضمنها
+
+24
+00:01:48,040 --> 00:01:51,240
+الكلية، والكلية بتعمل urination للـ waste اللي
+
+25
+00:01:51,240 --> 00:01:58,500
+بدهاش إياه، والـ fluid اللي زايدة، وبتضل القسق للـ
+
+26
+00:01:58,500 --> 00:02:05,120
+blood، الـ heart يعمل pumping، يروح على الـ lungs
+
+27
+00:02:05,120 --> 00:02:08,900
+تعمل oxygenation، يرجع على الـ heart، الـ heart يعمل
+
+28
+00:02:09,010 --> 00:02:13,390
+pumping، ويعمل perfusion لكل الـ organs تبع الجسم،
+
+29
+00:02:13,390 --> 00:02:17,050
+وزي ما حكينا، من ضمنها الكلية. كل ما هذه العملية
+
+30
+00:02:17,050 --> 00:02:23,150
+مستمرة بالطريقة الصحيحة هذه، كل ما مافيش عندي مشكلة.
+
+31
+00:02:24,280 --> 00:02:28,360
+once إنه بيصير فيه end effect في واحدة من المشاكل
+
+32
+00:02:28,360 --> 00:02:33,440
+هذه، هيتأثر كل الـ circulatory system هذا، سواء كان
+
+33
+00:02:33,440 --> 00:02:37,580
+فيه ضعف عضلة القلب نفسها، أو في قلة السوائل الموجودة
+
+34
+00:02:37,580 --> 00:02:45,220
+في الجسم، أو في عدم قدرة السوائل إنها تمشي، أو
+
+35
+00:02:45,220 --> 00:02:50,930
+سريانها في داخل الأوعية الدموية، سواء نتيجة ضغط شديد
+
+36
+00:02:50,930 --> 00:02:58,250
+عليها، أو يعني فوق هذه الأوعية الدموية، أو إن
+
+37
+00:02:58,250 --> 00:03:01,410
+الأوعية الدموية هذه، صارت الـ diameters تبعها
+
+38
+00:03:01,410 --> 00:03:04,450
+dilated كتير، وصارت كمية السوائل اللي موجودة لا تشكل
+
+39
+00:03:04,450 --> 00:03:08,550
+فيها أي حجم بحيث أنها تعمل ضغط دم. هذه كل اللي
+
+40
+00:03:08,550 --> 00:03:13,550
+حكيتها، يعني هي يعني علامات shock، أو أنواع الـ shock.
+
+41
+00:03:15,070 --> 00:03:19,610
+لذلك، عشان أعرف أن المريض بتبقى في أي مرحلة، لازم أكون
+
+42
+00:03:19,610 --> 00:03:24,090
+عنده مراقبة مستمرة، والمراقبة هذه، عادة إحنا
+
+43
+00:03:24,090 --> 00:03:27,030
+بنستخدمها مع الناس اللي هم critically ill، عن
+
+44
+00:03:27,030 --> 00:03:30,170
+طريق الـ Vital Signs. الـ Vital Signs يعني أنا بشوف
+
+45
+00:03:30,170 --> 00:03:33,270
+الـ Blood Pressure تبعه، بس في طريقة non-invasive،
+
+46
+00:03:33,270 --> 00:03:35,530
+وبشوف الـ Respiratory Rate، وبشوف الـ Temperature،
+
+47
+00:03:35,530 --> 00:03:39,410
+وبشوف الـ Heart Rate. لكن في الـ ICU، وفي
+
+48
+00:03:39,410 --> 00:03:41,150
+الـ Critically
+
+49
+00:03:43,140 --> 00:03:47,500
+أو في الـ Emergency Rooms، أو كل الـ Critically Ill
+
+50
+00:03:47,500 --> 00:03:51,440
+Patients، نكون بنتابعه بطرق أكتر حساسية من بس أن
+
+51
+00:03:51,440 --> 00:03:57,820
+أعرف الـ Vital Signs تبعته، عشان هي أنا هستخدم
+
+52
+00:03:57,820 --> 00:04:03,540
+الـ Monitoring Screen، عشان أشوف الـ ECG تبعه، وأشوف
+
+53
+00:04:03,540 --> 00:04:06,280
+الـ Heart Rate تبعه، وأشوف الـ Respiratory Rate،
+
+54
+00:04:06,280 --> 00:04:10,530
+وRhythm تبعه كمان. وطبعاً، زي ما حكينا، في الـ monitor
+
+55
+00:04:10,530 --> 00:04:13,470
+screen، أنا بشوف الـ heart rate، و الـ rhythm تبع الـ
+
+56
+00:04:13,470 --> 00:04:18,930
+heart، لإني بشوف الـ ECG في one lead. وكمان ممكن نركب
+
+57
+00:04:18,930 --> 00:04:22,070
+للمريض حاجة نسميها central venous pressure، أو
+
+58
+00:04:22,070 --> 00:04:26,490
+pulmonary artery pressure، أو حاجة اسمها اللي هو الـ
+
+59
+00:04:26,490 --> 00:04:31,340
+invasive Blood Pressure، يعني مش بس اللي هي
+
+60
+00:04:31,340 --> 00:04:34,860
+Intra-Arterial Blood Pressure. الـ Blood Pressure
+
+61
+00:04:34,860 --> 00:04:37,940
+اللي احنا بنقيسه عادةً، وبنعرفه عن طريق الكف، فده
+
+62
+00:04:37,940 --> 00:04:41,200
+اسمه اسمه برضه Arterial Blood Pressure. هاخدوا
+
+63
+00:04:41,200 --> 00:04:45,140
+بالكوا بس، non invasive basic، يعني من غير أن أنا اخترق
+
+64
+00:04:45,140 --> 00:04:53,010
+الشريان، أنا من فوق الشريان بعمل البراشر هذا. الشديد
+
+65
+00:04:53,010 --> 00:04:57,490
+بيعمل، أو بيؤدي إلى انقطاع وصول الدم من الشريان إلى
+
+66
+00:04:57,490 --> 00:05:01,810
+الجزء، إذا أنا رابطها على الدراع، إلى الجزء السفلي
+
+67
+00:05:01,810 --> 00:05:08,730
+من الدراع، وبعدين ببدأ أنا أعمل deflation للبالون،
+
+68
+00:05:09,770 --> 00:05:14,690
+وببدأ أسمع في النبضة الأولى اللي بيبدأ يتدفق فيها
+
+69
+00:05:14,690 --> 00:05:19,010
+الدم، وهذا بيكون الـ systole، ولما ينتهي تماماً بيكون
+
+70
+00:05:19,010 --> 00:05:20,990
+هذا الـ diastole. هذه الطريقة اللي كلكم
+
+71
+00:05:20,990 --> 00:05:24,510
+بتعرفوها، بس أنا الآن بدي أعمل طريقة أكتر حساسية، و
+
+72
+00:05:24,510 --> 00:05:30,050
+بدي أركب arterial catheter، أو arterial cannula،
+
+73
+00:05:30,050 --> 00:05:33,390
+يعني cannula في الـ artery نفسه، اللي يكون الـ
+
+74
+00:05:33,390 --> 00:05:36,210
+radial artery، اللي هو يستخدم عادةً. الـ Arterial
+
+75
+00:05:36,210 --> 00:05:40,110
+Monitoring، واللي بيسميه Invasive Blood Pressure،
+
+76
+00:05:41,140 --> 00:05:44,800
+وأبدأ أشوف الضغط عن طريق الـ مونيتور، واستخدامه
+
+77
+00:05:44,800 --> 00:05:48,700
+اللي هو transducer، يوصلي في الـ مونيتور، ويديني
+
+78
+00:05:48,700 --> 00:05:53,400
+قراءة للـ Blood Pressure، كل Systole، وكل
+
+79
+00:05:53,400 --> 00:05:56,720
+Diastole. هيديني لهم قراءة دقيقة. كان الـ Systolic
+
+80
+00:05:56,720 --> 00:05:59,080
+Blood Pressure في الضغط هذه، والـ Diastolic Blood
+
+81
+00:05:59,080 --> 00:06:01,880
+Pressure في الضغط هذه، أو في الـ Pit هذه. يعني كل
+
+82
+00:06:01,880 --> 00:06:04,360
+Pit، ما هي Systole و Diastole. الـ Pit اللي
+
+83
+00:06:04,360 --> 00:06:07,140
+بعدهم، هيكون فيه Systole و Diastole مختلفة.
+
+84
+00:06:09,950 --> 00:06:13,450
+الـ Arterial Line، وفيه مركب Invasive Blood
+
+85
+00:06:13,450 --> 00:06:17,290
+Pressure، هتجد على الـ Monitor إن الـ Continuous
+
+86
+00:06:17,290 --> 00:06:19,570
+Change في الـ Reading تبقى في Blood Pressure، لأنها
+
+87
+00:06:19,570 --> 00:06:24,010
+مع كل Reading بتدي قراءة مختلفة. طبعاً، و الـ
+
+88
+00:06:24,010 --> 00:06:26,970
+Central Venous Pressure، اللي هنحكي عنه بالتفصيل،
+
+89
+00:06:26,970 --> 00:06:33,050
+اللي هو وظيفته إنه يقيس مستوى، أو حجم السوائل، أو
+
+90
+00:06:33,050 --> 00:06:37,090
+الضغط اللي بتشكله السوائل فعلياً، في وريد مركزي،
+
+91
+00:06:38,270 --> 00:06:42,210
+وبالتالي، أنا من خلال كمية الضغط هذه اللي بتشكّلها
+
+92
+00:06:42,210 --> 00:06:45,650
+السوائل في الوريد المركزي، بستطيع أن أعرف اللي هو
+
+93
+00:06:45,650 --> 00:06:49,650
+حجم هذه السوائل في الجسم، وأحدد إذا كان المريض اللي
+
+94
+00:06:49,650 --> 00:06:52,710
+أنا بتعامل معاه هو hypervolemic ولا hypovolemic.
+
+95
+00:06:54,380 --> 00:06:58,220
+الاعتماد والمقارنة مع مقاييس أخرى، اللي هي blood
+
+96
+00:06:58,220 --> 00:07:01,620
+pressure كام، بالإضافة للـ CVP، يعني اللي أنا عارفه
+
+97
+00:07:01,620 --> 00:07:05,460
+الـ urine output كمان كام، الـ heart rate كام. إذا كل
+
+98
+00:07:05,460 --> 00:07:09,060
+هذه على بعض، لما تكون stable، بكون المريض تبعينه
+
+99
+00:07:09,060 --> 00:07:12,560
+hemodynamically stable. لما بكون فيها خلل، بكون فيه
+
+100
+00:07:12,560 --> 00:07:16,240
+خلل في الـ hemodynamic، وبيصير المريض unstable، عشان
+
+101
+00:07:16,240 --> 00:07:25,920
+هي قياسات مهمة، لازم نعملها، ونشوفها، ونتبعها في
+
+102
+00:07:25,920 --> 00:07:29,340
+المريض اللي هو critically ill، أو الـ ICU
+
+103
+00:07:29,340 --> 00:07:33,960
+patients، علشان أستطيع أن أعرف هو hemodynamically
+
+104
+00:07:33,960 --> 00:07:35,660
+stable أو unstable.
+
+105
+00:07:38,640 --> 00:07:41,600
+طبعاً، زي ما حكينا، أن يكون الـ patient stable
+
+106
+00:07:41,600 --> 00:07:44,880
+hemodynamically، معناه إنه بده يكون مافيش عنده علامات
+
+107
+00:07:44,880 --> 00:07:48,640
+الـ shock. لاحظ زي ما بحكيلك، weakness، و pallor،
+
+108
+00:07:48,640 --> 00:07:50,920
+و confusion، و cold، و diminished، و absent
+
+109
+00:07:50,920 --> 00:07:53,120
+pulse، و cardiac arrhythmia، و low blood
+
+110
+00:07:53,120 --> 00:07:57,080
+pressure. يعني كل أي تخلل هيؤدي إلى إيش؟ بالآخر
+
+111
+00:07:57,080 --> 00:08:00,560
+لـ shock. يعني هذه علامات الـ shock، لو ما كانتش
+
+112
+00:08:00,560 --> 00:08:03,180
+عند المريض، بيكون الـ patient stable. كيف بتعرف
+
+113
+00:08:03,180 --> 00:08:06,260
+الـ stability هذه؟ عن طريق، حكينا إنه ممكن نركب
+
+114
+00:08:06,260 --> 00:08:11,250
+الـ CVP، عشان نتقيس الـ Central Venous Pressure،
+
+115
+00:08:11,250 --> 00:08:16,510
+أو إنه نركب الـ Swan Ganz Catheter، اللي بيسموها
+
+116
+00:08:16,510 --> 00:08:19,290
+الـ Pulmonary Artery Pressure، عشان نتقيس الـ
+
+117
+00:08:19,290 --> 00:08:22,330
+Pulmonary Artery Pressure، والـ Cardiac Output. طبعاً،
+
+118
+00:08:22,330 --> 00:08:26,550
+عشان نركب الحاجات هذه، بحتاج، أو الـ Arterial
+
+119
+00:08:26,550 --> 00:08:32,150
+Line كمان. بحتاج من أهم المؤشرات هذه اللي أنتم
+
+120
+00:08:32,150 --> 00:08:37,890
+بتعرفوها. هنعرف إنه لما بنركب CVP مثلاً، هنحتاج الـ
+
+121
+00:08:37,890 --> 00:08:42,560
+Central Line نفسه. وهنتكلم الآن على الـ Central
+
+122
+00:08:42,560 --> 00:08:45,900
+Lines، وأنواعها اللي ممكن نركبها. لكن بدي تعرف كمان
+
+123
+00:08:45,900 --> 00:08:50,280
+إنه بيكون بدنا حاجة اسمها Flush System. الـ Flush
+
+124
+00:08:50,280 --> 00:08:54,880
+System هذا، عبارة عن محلول ملحي، ولكن عليه اللي هو
+
+125
+00:08:54,880 --> 00:09:03,660
+كمية من الهيبارين، حوالي اللي هو لكل 500 CC بنحط له
+
+126
+00:09:03,690 --> 00:09:08,650
+هو 1000 وحدة هيبارين، يعني خمسة آلاف International
+
+127
+00:09:08,650 --> 00:09:15,330
+Units، بحيث يكون تركيز الهيبارين واحد من ألف، أو حتى
+
+128
+00:09:15,330 --> 00:09:22,470
+بنحط، يعني الـ 1000 وحدة ممكن نحطها حتى على الألف. طبعاً،
+
+129
+00:09:22,470 --> 00:09:30,520
+وحنكون بنحتاج الـ Stop Cock، وبنحتاج اللي هو عندما
+
+130
+00:09:30,520 --> 00:09:35,040
+يكون هنا حاجة اسمها transducer. هذا شرحه عملي
+
+131
+00:09:35,040 --> 00:09:42,120
+أسهل، فأنا مش هدخل في تفاصيل دقيقة في الموضوع، لأنه
+
+132
+00:09:42,120 --> 00:09:45,940
+المفروض إنه يشرح عملي، لكن هرفع لكم فيديو بوضح كيف
+
+133
+00:09:45,940 --> 00:09:50,160
+بية عملية تركيب الـ central line، وكيف بية عملية قياسه.
+
+134
+00:09:50,940 --> 00:09:53,880
+بدي إياكوا تعرفوا إنه في حاجات مهمة، تكون عارفها، إنه
+
+135
+00:09:53,880 --> 00:09:56,540
+في حاجة مثلاً اسمها الـ pressure bag. يعني لما بكون
+
+136
+00:09:56,540 --> 00:09:59,880
+أنا راكب مثلاً arterial line، للمريض، ما زال أنا ..
+
+137
+00:09:59,880 --> 00:10:04,850
+حكيت إنه في الـ arterial line، أنا فيه قنية
+
+138
+00:10:04,850 --> 00:10:08,470
+في داخل الشريان. الشريان معروف إنه فيه pressure،
+
+139
+00:10:08,470 --> 00:10:11,390
+فقدرة ضغط يطلع من القنية هذه. لذلك، القنية
+
+140
+00:10:11,390 --> 00:10:15,410
+هذه، هي نوع خاص من القنيات اللي لها valve، وكمان
+
+141
+00:10:15,410 --> 00:10:19,590
+لازم تنشبك في line، و الـ line هذه، مشبوك طبعاً في زي
+
+142
+00:10:19,590 --> 00:10:23,250
+ما حكينا، flush system، اللي هو كيس محلول وفيه هيبارين،
+
+143
+00:10:23,250 --> 00:10:27,310
+و saline line، وكمان محطوط في الـ pressure bag. هذه الـ
+
+144
+00:10:27,310 --> 00:10:30,850
+bag، الـ bag هذه، برفع، يعني بكون عامل pressure فيها
+
+145
+00:10:30,850 --> 00:10:34,930
+حوالي 300 ملي متر زئبق، تمام، بحيث أنها تكون أعلى من
+
+146
+00:10:34,930 --> 00:10:39,830
+ضغط الدم تبع المريض. وهذا إيش هيسوي؟ هيمنع ارتجاع
+
+147
+00:10:39,830 --> 00:10:46,550
+الدم من الـ line للـ system هذا، يعني للـ IV line اللي
+
+148
+00:10:46,550 --> 00:10:49,910
+مش مشبوك في المحلول هذا. ومش بس هيك، الـ system هذا
+
+149
+00:10:49,910 --> 00:10:53,790
+الـ Flush System لحاله، بنحط 3-5 سم مكعب اللي هو
+
+150
+00:10:53,790 --> 00:10:56,070
+Saline، من غير الهيبارين، الـ saline اللي إحنا
+
+151
+00:10:56,070 --> 00:11:00,390
+حاطينه، كل ساعة. الهدف منه إنه يعمل washing، يعني
+
+152
+00:11:00,390 --> 00:11:03,070
+ويمنع الـ clotting، يعني يعمل الـ flushing، ويمنع الـ
+
+153
+00:11:03,070 --> 00:11:07,190
+clotting وارتجاع الدم في داخل الشريان، أو في داخل
+
+154
+00:11:07,190 --> 00:11:11,760
+الـ IV line هذا. كويس؟ وهذا كله ينطبق بالذات على الـ
+
+155
+00:11:11,760 --> 00:11:15,580
+Arterial line هذا. إحنا كمان بنعمله مع الـ CVP، لما
+
+156
+00:11:15,580 --> 00:11:17,980
+بنركب الـ Central Venous Pressure. ولكن بما إنه
+
+157
+00:11:17,980 --> 00:11:22,240
+الضغط تبع الـ Central Line، أو الضغط داخل الوريد
+
+158
+00:11:22,240 --> 00:11:26,660
+المركزي، عادةً مش زي الـ artery، فممكن إنه أنا أركب
+
+159
+00:11:26,660 --> 00:11:29,540
+Central Venous Pressure من غير الـ Flush System، و
+
+160
+00:11:29,540 --> 00:11:33,880
+الـ Pressure Bag هذه، لأن الـ Pressure داخل الـ
+
+161
+00:11:33,880 --> 00:11:38,310
+Central Line مش هيكون كبير، وممكن يخلي الدم يرتجع. هو
+
+162
+00:11:38,310 --> 00:11:39,070
+الـ CVP
+
+163
+00:11:42,470 --> 00:11:45,890
+يعني الـ Clotting، أو يصير ارتجاع للدم في الـ Line،
+
+164
+00:11:45,890 --> 00:11:49,870
+ويصير الـ Clotting. طبعاً،  باحتاج أن يكون هنا
+
+165
+00:11:49,870 --> 00:11:54,970
+Transducer هذا، عشان هو الوسيلة اللي هتعمل Change،
+
+166
+00:11:54,970 --> 00:12:01,250
+أو تعمل توصيل للـ data من المريض للـ Monitor. وهو
+
+167
+00:12:01,250 --> 00:12:05,390
+اللي هنعمله، وهنعمل Calibration، عشان يبدأ الجهاز من
+
+168
+00:12:05,390 --> 00:12:12,030
+نقطة الصفر، اللي أنا أحددها. هيبدأ يقيس اللي هو
+
+169
+00:12:12,030 --> 00:12:16,190
+الضغط، سواء في الوريد المركزي، أو في الشريان، بعد ما أحدد
+
+170
+00:12:16,190 --> 00:12:20,790
+نقطة الصفر.  سأجد ضغط فوق الصفر، هذا يقرأ
+
+171
+00:12:20,790 --> 00:12:27,390
+ليها، ويديني إياها الـ Amplifier. والمونيتورات الآن، عادة
+
+172
+00:12:27,390 --> 00:12:36,470
+صوتها عالي، والـ Electrical Science تبعها موجودة،
+
+173
+00:12:36,470 --> 00:12:45,680
+مش محتاج أن يكون فيه، إنه فيه amplifier، وأموره جاهزة.
+
+174
+00:12:45,680 --> 00:12:50,500
+الـ Central Venous Catheter، لو بدنا نحكي عنها
+
+1
+
+223
+00:16:52,060 --> 00:16:55,080
+يعني بيسموه الـstretch تبع الـheart muscle at the
+
+224
+00:16:55,080 --> 00:17:00,140
+end of the stool. كم القلب عنده قدرة إنه يعمل
+
+225
+00:17:00,140 --> 00:17:04,340
+relaxation و stretching عشان يأخذ أكبر كمية من
+
+226
+00:17:04,340 --> 00:17:08,040
+الدم، بدها تجيه، اللي هيدلني عليه اللي هو الـ
+
+227
+00:17:08,040 --> 00:17:11,760
+central venous pressure. لو كان عالي، معناه إن كمية
+
+228
+00:17:11,760 --> 00:17:16,120
+السوائل هذه أكثر من اللي بيتحملها القلب، وكمية
+
+229
+00:17:16,120 --> 00:17:22,400
+السوائل التي القلب لا يستطيع أن يتعامل معها، فهي عاملة
+
+230
+00:17:22,400 --> 00:17:26,640
+له overload. ولو كانت أقل من خمسة معناه أنه
+
+231
+00:17:26,640 --> 00:17:29,720
+الـcentral venous pressure هنا له معناه أنه كمية
+
+232
+00:17:29,720 --> 00:17:33,220
+السوائل اللي بتيجي، أفضل للقلب في الـpreload هي
+
+233
+00:17:33,220 --> 00:17:37,920
+قليلة، فعشان هيك القلب ما بضخ كويس، وإذا كان هيكون فيه
+
+234
+00:17:37,920 --> 00:17:42,200
+مشكلة برضه في الـafterload. طيب، إيش الفرق بين الـ
+
+235
+00:17:42,200 --> 00:17:45,440
+different insertion لـ الـ Central
+
+236
+00:17:45,440 --> 00:17:47,460
+Line، سواء من الـ Sub-Clavian أو من الـ Jugular
+
+237
+00:17:47,460 --> 00:17:51,820
+vein؟ بنحكي إنه من الـSub-Clavian، هذا مكان كثير
+
+238
+00:17:51,820 --> 00:17:55,260
+كويس، وطبعا هيدي... يعني هخش أنا في Large Vessel،
+
+239
+00:17:55,260 --> 00:18:01,080
+أه؟ و... و هجيب منه الـ CVP، وهذه حاجة كثيرة كويسة،
+
+240
+00:18:01,080 --> 00:18:05,120
+وطبعا الـdressing تبقى سهلة لإنه في مكان أنظف في الـ
+
+241
+00:18:05,120 --> 00:18:09,450
+chest، لكن الخطورة تبعته إنه أنا لو ممكن يصير
+
+242
+00:18:09,450 --> 00:18:14,130
+لو لا قدر الله فيه bleeding، أو يعني المريض هذا risk
+
+243
+00:18:14,130 --> 00:18:18,770
+لأنه يصير عنده bleeding، هيكون uncontrollable، صعب
+
+244
+00:18:20,160 --> 00:18:25,280
+لأنه Deep كمان، هذا قريب من الـ Pleural Space، الـ
+
+245
+00:18:25,280 --> 00:18:27,900
+Pleural Cavity، وبالتالي أنا ممكن during insertion
+
+246
+00:18:27,900 --> 00:18:32,000
+نعمل للمريض Pneumothorax أو Hemothorax، الـ Internal
+
+247
+00:18:32,000 --> 00:18:35,900
+Jugular يعتبر أقل خطورة من ناحية إنه يعمل
+
+248
+00:18:35,900 --> 00:18:39,260
+Hemothorax و Pneumothorax، لكن نفس الموضوع بالنسبة للـ
+
+249
+00:18:39,260 --> 00:18:45,780
+Bleeding. وبالنسبة للمرضى اللي عندهم مشاكل أصلاً
+
+250
+00:18:45,780 --> 00:18:49,280
+في الـ clotting مثلاً، برضه هيسببلهم، أو هيكون صعب
+
+251
+00:18:49,280 --> 00:18:56,020
+التعامل معه، لكن الـadvantage تبعته أنه سهل أني
+
+252
+00:18:56,020 --> 00:19:03,520
+(لحظة أردت على التليفون وبعدين أكمل) والـadvantage
+
+253
+00:19:03,520 --> 00:19:07,720
+تبع الـ Internal Jugular زي ما حكينا أنه من
+
+254
+00:19:11,830 --> 00:19:15,210
+Pneumothorax أو Hemothorax عند المرضى، والـ
+
+255
+00:19:15,210 --> 00:19:18,350
+accessibility تبعته عالية، خاصة إذا ما كان فيه عند
+
+256
+00:19:18,350 --> 00:19:20,830
+المريض مشاكل في الـ clotting، اللي هي من أهم المشاكل
+
+257
+00:19:20,830 --> 00:19:26,990
+هو إنه مش هقدر أجيب منه CVP. ومن مميزاته إنه لو كان
+
+258
+00:19:26,990 --> 00:19:29,650
+المريض high risk لـ bleeding، وأنا بدي وسيلة إنه أد
+
+259
+00:19:29,650 --> 00:19:33,290
+عوّض فيها سوائل، مكون كويس، لإنه حتى لو كان high risk
+
+260
+00:19:33,290 --> 00:19:36,150
+لـ bleeding، وصار معاه bleeding، ممكن فيه إمكانية
+
+261
+00:19:36,150 --> 00:19:39,650
+إني أعمل stop لـ bleeding هذا، لإنه إيش
+
+262
+00:19:39,880 --> 00:19:46,500
+Controllable، يعني ممكن أتحكم فيه. لكن من الـ
+
+263
+00:19:46,500 --> 00:19:50,360
+Disadvantage برضه تبعته إنه هو في منطقة Dirty، و
+
+264
+00:19:50,360 --> 00:19:58,380
+Infection Rate هو عالي جداً، وعشان هيك لا يُفضل الـ
+
+265
+00:19:58,380 --> 00:20:06,840
+Brachial. من مشاكله إنه بدي Large يعني
+
+266
+00:20:06,840 --> 00:20:12,600
+catheter، علشان أنا أصل وأستطيع أن أقيس منه الـCVP.
+
+267
+00:20:12,600 --> 00:20:15,800
+فيه كمان حاجة مهمة، أنه لما أنا ببدأ أدخل من
+
+268
+00:20:15,800 --> 00:20:17,820
+الـ basilic أو ببدأ أدخل في الـ median basilic أو
+
+269
+00:20:17,820 --> 00:20:23,240
+الـ Cephalic veins، فدولها عادةً veins طويلة، وأنا
+
+270
+00:20:23,240 --> 00:20:26,680
+بدي أقدر أمشي فيهم، علشان إيش؟ أصل للـ axillary، ومن
+
+271
+00:20:26,680 --> 00:20:30,640
+بعدها أبدأ أنزل في الـ thoracic.  فإحنا عارفين إن الـ
+
+272
+00:20:30,640 --> 00:20:37,220
+veins فيها Valves، عشان تمنع الارتجاع
+
+273
+00:20:37,220 --> 00:20:41,240
+تبع الدم. فأنا لما بأخش في الـ veins هدول، هعمل
+
+274
+00:20:41,240 --> 00:20:46,040
+Destruction للـ Valves هذه، ولذلك لا تُعتبر طريقة
+
+275
+00:20:46,040 --> 00:20:51,200
+مُثلى لتركيب الـ Central Line، ويُفضل دائماً الـ
+
+276
+00:20:51,200 --> 00:20:55,360
+Internal Jugular أو الـ Subclavian، إذا كان لا
+
+277
+00:20:55,360 --> 00:21:00,800
+يوجد Contraindications طبعاً.
+
+278
+00:21:02,130 --> 00:21:04,330
+عندما نتحدث عن الـ factors اللي بتأثر في الـ
+
+279
+00:21:04,330 --> 00:21:08,830
+CVP، حكينا إحنا، هيأثر في الـ CVP، إذا كان فيه
+
+280
+00:21:08,830 --> 00:21:12,810
+Systemic Vasodilation، إذا كل الجسم، الـ vessels
+
+281
+00:21:12,810 --> 00:21:17,150
+تبعته dilated، برضه الـ Central Venous Veins هتكون
+
+282
+00:21:17,150 --> 00:21:21,730
+dilated، وبالتالي هيكون الـ CVP القراءة تبعته
+
+283
+00:21:21,730 --> 00:21:27,810
+واطية، يعني لأنه فيه dilatation في الـ Vena Cava
+
+284
+00:21:27,810 --> 00:21:33,700
+وبالتالي هيديني إن كمية السوائل اللي فيه قليلة. إذا
+
+285
+00:21:33,700 --> 00:21:36,020
+كان فيه Right Ventricular Failure، أو فيه
+
+286
+00:21:36,020 --> 00:21:38,180
+Tricuspid أو Mitral Valve Disease، أو
+
+287
+00:21:38,180 --> 00:21:41,600
+Pulmonary Hypertension، هذه هتأثر في قراءات الـ
+
+288
+00:21:41,600 --> 00:21:46,960
+CVP، وما بكون أنا مضطر إن أستخدم CVP يا
+
+289
+00:21:46,960 --> 00:21:53,480
+جماعة لما بكون أنا لازم أعمل Hemodynamic Monitoring
+
+290
+00:21:53,480 --> 00:21:58,140
+وأراقب كل حاجة بشكل دقيق. لما بكون أنا محتاج إن
+
+291
+00:21:58,140 --> 00:22:03,140
+أركّب IV Access، وما فيش إمكانية إن أحط Peripheral Access
+
+292
+00:22:03,140 --> 00:22:04,020
+يعني الـ cannulas.
+
+293
+00:22:07,130 --> 00:22:09,650
+الـ peripheral vein. فأنا محتاج أن أركّب Central
+
+294
+00:22:09,650 --> 00:22:15,230
+line، لما أنا بكون بدي أستخدم، أو بدي أعطي المريض IV
+
+295
+00:22:15,230 --> 00:22:19,410
+للفترة طويلة، وأنا محتاج أن أسحب منه تحاليل في اليوم
+
+296
+00:22:19,410 --> 00:22:23,310
+خمس، ست مرات كثيرة، أعمله مثلاً blood gas، متابعة
+
+297
+00:22:23,310 --> 00:22:28,240
+كثيرة، سواء من الـ vein أو من الـ artery، أو بدي أعمل
+
+298
+00:22:28,240 --> 00:22:31,340
+CBC follow-up و chemistry follow-up، مثلاً كل أربع
+
+299
+00:22:31,340 --> 00:22:36,240
+ساعات، أو إيش يعني؟ كل ما في عندي مريض بده استخدام IV
+
+300
+00:22:36,240 --> 00:22:40,960
+بشكل طويل، وساعات تحليل طويلة، بيكون أحسن أن
+
+301
+00:22:40,960 --> 00:22:44,880
+أكون مركّبله Central Line، أحسن ما كل مرة أعمله
+
+302
+00:22:46,700 --> 00:22:53,460
+إنفشن في مكان جديد، أو أن أركّب له أكثر من كانولا.
+
+303
+00:22:53,460 --> 00:22:56,720
+لما بكون بدي أدّي أدوية حساسة عن طريق الـ Infusion Pump
+
+304
+00:22:56,720 --> 00:23:01,700
+زي الدوبامين، والـ Adrenaline، والنورادرينالين، أو
+
+305
+00:23:01,700 --> 00:23:04,820
+الـ Sedation، إذا كان في عندي فترة طويلة من الـ Sedation
+
+306
+00:23:04,820 --> 00:23:08,460
+بكون محتاجة أن أنا أحطها، أو أحياناً بكون الـ Total
+
+307
+00:23:08,460 --> 00:23:11,420
+Parenteral Nutrition، يا جماعة، الـ molecular weight
+
+308
+00:23:11,420 --> 00:23:15,280
+تبعه عالي، فما بنفعش ندّي الأدوية هذه في الـ
+
+309
+00:23:15,280 --> 00:23:18,780
+Peripheral Vein، لإنها تعمل Thrombophlebitis، تمام؟
+
+310
+00:23:21,830 --> 00:23:26,670
+حكينا عن هذا، عندما نعمل blood sampling كثير، طبعاً
+
+311
+00:23:26,670 --> 00:23:31,970
+والحاجة المهمة، أنه أنا بدي أقيس الـ CVP لهذا المريض
+
+312
+00:23:31,970 --> 00:23:34,850
+أحياناً بنركّب الـ Central Line، يا جماعة، عشان نعمل
+
+313
+00:23:34,850 --> 00:23:38,550
+إيش؟ اللي هو الـ Temporary Pacemaker، لمريض اللي هو
+
+314
+00:23:38,550 --> 00:23:43,410
+في Pacing، عشان أدخل Wire، وأدخله على اللي هو الـ
+
+315
+00:23:43,410 --> 00:23:47,570
+Right Atrium، عشان، وأركّب فيه اللي هو الـ Pacemaker
+
+316
+00:23:47,570 --> 00:23:51,310
+عشان يبدأ يعمل Stimulation، أو يبدأ يعمل Pacing. كل
+
+317
+00:23:51,310 --> 00:23:54,790
+هذه هي الـ Indications تبع الـ Central Line. الـ
+
+318
+00:23:54,790 --> 00:23:58,870
+Central Line له أكثر من نوع، فيه منهم Single، وفيه منهم
+
+319
+00:23:58,870 --> 00:24:04,810
+يعني له تيوب واحد، وفيه double، و triple lumen، يعني
+
+320
+00:24:04,810 --> 00:24:09,490
+فيه لتيوبين، وثلاثة تيوبين، وثلاثة تيوبين، و
+
+321
+00:24:09,490 --> 00:24:09,790
+ثلاثة تيوبين، وثلاثة تيوبين، وثلاثة تيوبين، و
+
+322
+00:24:09,790 --> 00:24:09,910
+ثلاثة تيوبين، وثلاثة تيوبين، وثلاثة تيوبين، و
+
+323
+00:24:09,910 --> 00:24:10,130
+ثلاثة تيوبين، وثلاثة تيوبين، وثلاثة تيوبين، و
+
+324
+00:24:10,130 --> 00:24:10,830
+ثلاثة تيوبين، وثلاثة تيوبين، وثلاثة تيوبين، و
+
+325
+00:24:10,830 --> 00:24:12,610
+ثلاثة تيوبين، وثلاثة تيوبين، وثلاثة تيوبين، و
+
+326
+00:24:12,610 --> 00:24:18,690
+ثلاثة تيوبين، و
+
+327
+00:24:18,690 --> 00:24:27,410
+ثلاثة تيوبين، وثلاثة تيوبين.
+
+328
+00:24:27,410 --> 00:24:27,530
+و
+
+329
+00:24:33,760 --> 00:24:37,420
+المهم اللي بدي إيّاكم تعرفوه، ما تفكروا أنه بما أنه
+
+330
+00:24:37,420 --> 00:24:40,380
+أشوف في صورة بس الـ Central Line هنا، عشان يكون
+
+331
+00:24:40,380 --> 00:24:50,720
+الشرح أسهل، الصورة مبسّطة شوية، وأنا...
+
+332
+00:24:50,720 --> 00:24:58,390
+طيب لحظة، مهمّ نركز، بس أيوة، لحظة هاي الـ
+
+333
+00:24:58,390 --> 00:25:01,910
+lumens، هاي واحد، اثنين، ثلاثة، اعتبر إنه NDH هذه
+
+334
+00:25:01,910 --> 00:25:04,110
+طبعاً هي swine gains، لكن الـ Central Line زيها
+
+335
+00:25:04,110 --> 00:25:07,270
+بالظبط، بس مش طويلة بهذه الطول، على أي حال، اعتبروا
+
+336
+00:25:07,270 --> 00:25:09,230
+إن هذا الـ Central Line، وهي الـ lumens اللي بحكي
+
+337
+00:25:09,230 --> 00:25:12,610
+عنها. اللي كنت بدي أحكي فيه، إنكم ما تفكروا إن الـ
+
+338
+00:25:12,610 --> 00:25:16,480
+lumens هدول، بالأخير، لما بوصل الـ drug تبعك من الـ
+
+339
+00:25:16,480 --> 00:25:19,520
+lumen هذا، والـ drug بوصل من الـ lumen هذا، إن
+
+340
+00:25:19,520 --> 00:25:22,540
+هم بيختلطوا مع بعض، لأ، الـ lumen هذا ماشي من
+
+341
+00:25:22,540 --> 00:25:29,730
+أول الطريق لآخره، صدقني، هو الـ tube، والثاني كذلك،
+
+342
+00:25:29,730 --> 00:25:33,890
+والثالث كذلك، عاملين بالظبط زي حكاية سلك الكهرباء
+
+343
+00:25:33,890 --> 00:25:36,670
+اللي بيكون فيه الـ cable الكبير، اللي بيكون فيه ثلاث
+
+344
+00:25:36,670 --> 00:25:42,850
+خطوط، أحمر، وأصفر، أو أسود مثلاً، لكن كل واحد فيهم ماشي
+
+345
+00:25:42,850 --> 00:25:46,610
+لحاله، وعليه غلاف، والكهرباء بتمشي فيه لحالها، من غير
+
+346
+00:25:46,610 --> 00:25:50,870
+ما تخلط مع الكهرباء اللي في الخط الثاني، تمام؟ وهذا
+
+347
+00:25:50,870 --> 00:25:55,930
+هي أهمية إننا بنحط الـ Central Line أكثر من
+
+348
+00:25:55,930 --> 00:25:59,630
+lumen، وبنضمن إنه ما يصيرش بينهم reaction، لأن كل
+
+349
+00:25:59,630 --> 00:26:05,590
+واحد فيهم بيمشي لحاله، وبصبّ في منطقة مختلفة كمان. يا
+
+350
+00:26:05,590 --> 00:26:09,090
+جماعة، كيف يعني؟ يعني هتلاقي على الـ Central Line
+
+351
+00:26:09,090 --> 00:26:13,370
+مكتوب إن هذا مثلاً Proximal، وهذا Distal، وهذا
+
+352
+00:26:13,370 --> 00:26:18,720
+Medial مثلاً. الـ Proximal هتلاقي بصبّ إيش؟ الـ
+
+353
+00:26:18,720 --> 00:26:23,860
+Proximal قريب، الـ Distal بعيد، والـ
+
+354
+00:26:27,240 --> 00:26:30,700
+Medial، تمام. والـ Medial هيكون في المنتصف، فهيكون الـ
+
+355
+00:26:30,700 --> 00:26:36,060
+Proximal هو الأقرب، الـ Distal هيكون بعيد، والـ Medial
+
+356
+00:26:36,060 --> 00:26:42,440
+هيكون في المنتصف، تمام. لما بدنا نركّب الـ Central
+
+357
+00:26:42,440 --> 00:26:45,380
+venous pressure، وبدنا نقيس منه الـ CVP، يا جماعة،
+
+358
+00:26:45,380 --> 00:26:53,260
+ضروري نحط، أو نركّب الـ Central Line، أو الـ
+
+359
+00:26:53,260 --> 00:26:58,980
+Line نفسه تبع الـ CVP، في الـ Distal Lumen، مش
+
+360
+00:26:58,980 --> 00:27:02,240
+في واحد ثاني، مش في الـ Medial، ولا الـ Proximal،
+
+361
+00:27:02,240 --> 00:27:07,760
+عشان يكون بيديني الـ Tip البعيدة، اللي مش بتكون
+
+362
+00:27:07,760 --> 00:27:12,620
+جانبية، يعني هي مش بتكون على الـ Lumen من الجانب من
+
+363
+00:27:12,620 --> 00:27:16,160
+هنا، أو من هنا، لأ، بتكون من الـ Tip تبعته، عشان ما
+
+364
+00:27:16,160 --> 00:27:22,730
+تتأثرش، وإذا كانت خابطة و راكزة على الـ Wall،
+
+365
+00:27:22,730 --> 00:27:28,250
+فبالتالي هيصير الـ fluid اللي بيطلع منها، بيصير
+
+366
+00:27:28,250 --> 00:27:30,510
+Resistant، لأنه خابطة في الـ Wall. لكن الـ Distal
+
+367
+00:27:30,510 --> 00:27:38,010
+عادةً بتكون مفتوحة، أمامها الـ flow تبع الـ fluid.
+
+368
+00:27:38,010 --> 00:27:41,230
+كنا
+
+369
+00:27:41,230 --> 00:27:45,960
+بنحكي عنها هنا، عن أنواعها، وحكينا عن الـ TPN، حتى لو
+
+370
+00:27:45,960 --> 00:27:51,400
+بدنا نستخدمه. وطبعاً لما بنركّب يا جماعة Central
+
+371
+00:27:51,400 --> 00:27:54,920
+Line، وفيه Multi-Lumen، لازم لكل واحد منهم نحط label فيه،
+
+372
+00:27:54,920 --> 00:27:58,740
+إيش هذا؟ في هذا نحط CVP، والثاني نكتب فيه والله إحنا
+
+373
+00:27:58,740 --> 00:28:03,120
+حابين ندّي فيه الـ TPN، والثالث مثلاً حاطين فيه الـ
+
+374
+00:28:03,120 --> 00:28:06,020
+Maintenance Fluid، أو الـ Infusion تبع الدوبامين.
+
+375
+00:28:06,020 --> 00:28:10,160
+لازم نعمل label لكل واحد فيهم، عشان ما يصيرش إختلاط.
+
+376
+00:28:10,160 --> 00:28:13,080
+ودائماً، دائماً، نعرف إن المريض اللي مركّبله الـ
+
+377
+00:28:13,080 --> 00:28:18,640
+Central Line، وإله مركّب فيه Infusion Drug، ما بنفعش
+
+378
+00:28:18,640 --> 00:28:23,100
+تيجي تعمل الـ flush، وتعمل flush لأي medication، لإنك
+
+379
+00:28:23,100 --> 00:28:27,750
+هتعمل flush لِكمية كبيرة من الدواء اللي موجود في الـ
+
+380
+00:28:27,750 --> 00:28:30,870
+Central Line، وتخلي المريض يأخذها فجأة، مع إنه ممكن
+
+381
+00:28:30,870 --> 00:28:34,630
+أنت تكون مركّب مثلاً دوبامين على rate خمسة مليليتر per
+
+382
+00:28:34,630 --> 00:28:38,790
+hour، تصوّر إنه أنت تيجي من مكان قريب من الـ
+
+383
+00:28:38,790 --> 00:28:43,430
+Central Line، وتروح عامل flush لـ Verapamil مثلاً، وإن هو
+
+384
+00:28:43,430 --> 00:28:46,770
+أصلاً غلط يعني، في الـ ICU، وإنه ممكن تدّي flush، ولكن
+
+385
+00:28:46,770 --> 00:28:53,500
+بلاش Verapamil، قدّيت عشرة سي سي flush، راحت
+
+386
+00:28:53,500 --> 00:28:59,580
+عملت flush لكل كمية تبع الدوبامين اللي كان في الـ
+
+387
+00:28:59,580 --> 00:29:03,380
+Central Line، عملت في إيش؟ في moments، مع إنّ همّ طب
+
+388
+00:29:03,380 --> 00:29:06,360
+الكمية هذه مش أقل من ثلاثة سي سي، طب المريض بياخد خمسة
+
+389
+00:29:06,360 --> 00:29:10,800
+milliliter في الـ hour كلها، راحت أنت مدّيتها في
+
+390
+00:29:10,800 --> 00:29:14,560
+لحظة، فإيش بيحصل في الضغط؟ لذلك، ممنوع نهائياً مريض
+
+391
+00:29:14,560 --> 00:29:17,620
+ماشي على infusing drug، نروح إحنا من الـ
+
+445
+00:33:09,930 --> 00:33:14,290
+المصطرة أو الـ monometer، اللي هي إيش وظيفتها؟ أشوف
+
+446
+00:33:14,290 --> 00:33:23,910
+بس هنا هيّاتها المصطرة، وهي عند المريض، وفي
+
+447
+00:33:23,910 --> 00:33:32,870
+كيس محلول مشبوك فوق بيغذّي المصطرة، وهو كيس محلول
+
+448
+00:33:32,870 --> 00:33:36,730
+بيغذّي المصطرة، ومن المصطرة طالع Line Extension
+
+449
+00:33:36,730 --> 00:33:41,330
+Tube، ورايح لمين؟ للمريض، ومشبوك في الـ Central Line
+
+450
+00:33:41,330 --> 00:33:44,990
+اللي مركب عند المريض، تمام؟ الآن بدي أعمل حاجة
+
+451
+00:33:44,990 --> 00:33:48,950
+اللي بنسميها الـ Zeroing، تمام؟ إيش الـ Zeroing
+
+452
+00:33:48,950 --> 00:33:54,170
+هذا؟ أنه يكون المريض ونقطة الصفر اللي في المصطرة،
+
+453
+00:33:54,170 --> 00:33:57,790
+هاي الصفر اللي في المصطرة والمريض على نفس المستوى،
+
+454
+00:33:57,790 --> 00:34:02,370
+تمام؟ ليش؟ عشان لما أبدأ أنا أعبي سائل في المصطرة
+
+455
+00:34:02,370 --> 00:34:08,010
+وبعدين أسمح للسائل ينزل من المصطرة للمريض، وإن ما
+
+456
+00:34:08,010 --> 00:34:11,370
+بيصير بتساوى الـ pressure في المريض وفي المصطرة،
+
+457
+00:34:11,370 --> 00:34:16,630
+هتوقف السائل اللي كان بينساب من المصطرة للمريض،
+
+458
+00:34:16,630 --> 00:34:21,570
+هينزل من الضغط الأعلى للضغط الأقل، لما يتساوى،
+
+459
+00:34:21,570 --> 00:34:24,650
+هيوقف، هيكون هو هذا الـ pressure اللي جوا عند
+
+460
+00:34:24,650 --> 00:34:28,190
+المريض، خمسة سنتيمتر ماء، يا ستة سنتيمتر ماء، وإن
+
+461
+00:34:28,190 --> 00:34:31,350
+واجف، هو هذا الضغط اللي جوا عند المريض، اتساوى
+
+462
+00:34:31,350 --> 00:34:36,540
+الضغط هنا مع هنا، عشان يتساوى الضغطين، ويكون هذا
+
+463
+00:34:36,540 --> 00:34:39,740
+الارتفاع هو الضغط اللي هي لازم يكون، النقطة تبقى
+
+464
+00:34:39,740 --> 00:34:44,700
+الصفر، تبقيهم واحدة، وإلا لو كان هذه اعتبره المصطرة
+
+465
+00:34:44,700 --> 00:34:51,140
+هذه نزلت لتحت، وودّاني هنا ثمانية، وبدل ما هو الـ 0
+
+466
+00:34:51,140 --> 00:34:55,800
+تبقى هكذا، لأ هي هكذا، يعني هكذا الـ 7 أعتبره بيكون هذه
+
+467
+00:34:55,800 --> 00:35:00,260
+القراءة فيها غش، زي الميزان اللي واحد حاطط في قاع
+
+468
+00:35:00,260 --> 00:35:05,620
+الميزان نص كيلو، ووزن جاء كيلو، فذاك نص كيلو، تمام؟
+
+469
+00:35:05,620 --> 00:35:12,060
+فكيف الخطوات بالترتيب؟ إذا واحد بشبك أنا المريض، أو
+
+470
+00:35:12,060 --> 00:35:16,760
+بجيب مصطرة، والمصطرة بغزيها في 500 CC Fluid مثلاً
+
+471
+00:35:16,760 --> 00:35:20,680
+بتغزي المصطرة، تستوب كوك، يعني أطالع منه extension
+
+472
+00:35:20,680 --> 00:35:22,880
+الـ tube، وأروح على الـ central line تبع المريض
+
+473
+00:35:22,880 --> 00:35:27,380
+بعمل zeroing، الصفر عند المريض يكون الصفر مع الصفر
+
+474
+00:35:27,380 --> 00:35:30,420
+عند المصطرة، يكون هو الصفر عند المريض، طب الصفر عند
+
+475
+00:35:30,420 --> 00:35:35,400
+المصطرة، أرفَعناها صفر، طب الصفر عند المريض أين؟ الصفر
+
+476
+00:35:35,400 --> 00:35:38,740
+عند المريض، هذا عبارة عن تقاطع نقطتين، مين هما
+
+477
+00:35:38,740 --> 00:35:43,340
+النقطتين؟ النقطة الأولى هي الـ mid-axillary line
+
+478
+00:35:43,340 --> 00:35:46,280
+مع الـ fifth intercostal space، وين بتقاطعوا في
+
+479
+00:35:46,280 --> 00:35:50,400
+النقطة هذه؟ هذه النقطة هي بدها تكون على نفس مستوى بالظبط
+
+480
+00:35:50,400 --> 00:35:53,940
+نقطة الصفر، طب كيف أوزنهم يكونوا على نفس مستوى بالظبط؟
+
+481
+00:35:53,940 --> 00:35:57,660
+يا أما بعينك، يا أما بالعين، يا أما باستخدام ميزان
+
+482
+00:35:57,660 --> 00:36:01,350
+الماء، شايفين هذا ميزان الماء؟ عندما تصبح نقطة
+
+483
+00:36:01,350 --> 00:36:04,310
+الصفر عند المريض، عندما تصبح نقطة الهواء هذه في
+
+484
+00:36:04,310 --> 00:36:09,840
+ميزان الماء في النصف، بيكون، أه صارت الآن هذه
+
+485
+00:36:09,840 --> 00:36:14,260
+مستقيمة 100%، يعني الزاوية 180 درجة، عند زاوية 180
+
+486
+00:36:14,260 --> 00:36:17,720
+درجة هنا بتلاقي نقطة الهواء هذه في نص الميزان،
+
+487
+00:36:17,720 --> 00:36:21,140
+معناه الآن أن نقطة الصفر هنا هي نقطة الصفر هناك،
+
+488
+00:36:21,140 --> 00:36:26,500
+طيب بعد ذلك إيش بدي أسوي؟ أول حاجة بفتح الـ fluid
+
+489
+00:36:26,500 --> 00:36:30,580
+من الـ saline اللي فوق فوق، direct، I mean، للمريض،
+
+490
+00:36:30,580 --> 00:36:33,820
+ليش؟ عشان أشوف الـ flow، لازم كل flow إيش ماله؟
+
+491
+00:36:33,820 --> 00:36:39,800
+running، running، تمام؟ طب ليش؟ عشان ما يكونش فيه مادة لو
+
+492
+00:36:39,800 --> 00:36:42,980
+كان مش running، حيكون فيه Resistance،  حيكون قراءة CVP
+
+493
+00:36:42,980 --> 00:36:47,080
+عالية، طب okay، فتحته لقيته running، تمام، تمام، الآن
+
+494
+00:36:47,080 --> 00:36:50,560
+بتروح بتسكر، وبتعبى المصطرة، يعني بغير الاتجاه تبع
+
+495
+00:36:50,560 --> 00:36:54,100
+الـ stop cock هذا، زي ما هو، أنا فتح زي ما أنتم
+
+496
+00:36:54,100 --> 00:36:57,380
+شايفين، فتح المحلول اللي جاي، بغذي المصطرة، فتحته على
+
+497
+00:36:57,380 --> 00:37:03,160
+المريض running، تمام، تمام، بعد هيك بفتح عشان إيش؟ أعبي
+
+498
+00:37:03,160 --> 00:37:05,440
+المصطرة، ببدأ أنتيلي هالسائل، شايفين؟ في
+
+499
+00:37:05,440 --> 00:37:08,620
+المصطرة، في المصطرة، أيوة، بدأ هنا، عفواً، ننتلي،
+
+500
+00:37:08,620 --> 00:37:12,120
+ننتلي، ننتلي، ننتلي، تمام، انتلت المصطرة، كويس،
+
+501
+00:37:12,120 --> 00:37:18,260
+الآن ببدأ أفتح من المصطرة على المريض، بفتح من
+
+502
+00:37:18,260 --> 00:37:21,780
+المصطرة على المريض، اللي هو لما بفتح من المصطرة على
+
+503
+00:37:21,780 --> 00:37:24,600
+المريض، مبدأ إيش؟ ينزل، ينزل، ينزل، ينزل، ينزل،
+
+504
+00:37:24,600 --> 00:37:24,680
+ينزل، ينزل، ينزل، ينزل، ينزل، ينزل، ينزل، ينزل،
+
+505
+00:37:24,680 --> 00:37:26,000
+ينزل، ينزل، ينزل، ينزل، ينزل، ينزل، ينزل، ينزل،
+
+506
+00:37:26,000 --> 00:37:26,020
+ينزل، ينزل، ينزل، ينزل، ينزل، ينزل، ينزل، ينزل،
+
+507
+00:37:26,020 --> 00:37:33,120
+ينزل، ينزل، ينزل، ينزل، ينزل، ينزل، ينزل، ينزل، ي
+
+508
+00:37:33,150 --> 00:37:36,610
+خالص، بيضلوا يعملوا حاجة بنسميها Fluctuation مع
+
+509
+00:37:36,610 --> 00:37:40,490
+إيش؟ مع حركة النفس، لما يبدأ يعمل الـ Fluctuation
+
+510
+00:37:40,490 --> 00:37:43,910
+هذا مع حركة النفس، يعني بيطلع واحد وبنزل واحد، بيطلع
+
+511
+00:37:43,910 --> 00:37:50,310
+واحد أو اثنين وبنزل اثنين، بيكون هو عند النقطة هذه
+
+512
+00:37:50,310 --> 00:37:54,230
+هو الـ CVP، فمثلاً عند خمسة، صار يطلع شوية وينزل شوية
+
+513
+00:37:54,230 --> 00:37:58,990
+يعني هو الـ CVP خمسة تبع المريض هذا، تمام، برضه يعني
+
+514
+00:37:58,990 --> 00:38:02,800
+من خلال الفيديو إن شاء الله هيكون الوضع أوضح، واضح،
+
+515
+00:38:02,800 --> 00:38:05,760
+مع أنه أعتقد أنه يعني أنا شرحته ما فيه الكفاية،
+
+516
+00:38:05,760 --> 00:38:09,660
+okay؟ وبنكون سجلنا هذه القراءة، هذه طريقة قياس
+
+517
+00:38:09,660 --> 00:38:13,060
+طبعاً الـ CVP عن طريق اللي هو الماء، لذلك بنسجل أن
+
+518
+00:38:13,060 --> 00:38:20,760
+الـ CVP خمسة مثلاً، سنتيمتر، ماء، okay؟ طبعاً،
+
+519
+00:38:20,760 --> 00:38:23,760
+عندما يكون لدينا Transducer، سنقوم بنفس الشيء، بس
+
+520
+00:38:23,760 --> 00:38:27,880
+سنشبك كل هذا الكلام على Transducer، وسنقوم بالـ
+
+521
+00:38:27,880 --> 00:38:32,800
+Zeroing، يعني سأقول للجهاز إنه بعد ما عملت الـ
+
+522
+00:38:32,800 --> 00:38:35,300
+Zeroing، الـ Pressure، بعد ما أعمل إيش في الـ
+
+523
+00:38:35,300 --> 00:38:39,500
+Zeroing لـ Transducer نفسه، هو سيكون بالظبط عامله
+
+524
+00:38:39,500 --> 00:38:43,760
+اللي هو مع نقطة الصفر تبع المريض، ويكونوا على نفس
+
+525
+00:38:43,760 --> 00:38:48,310
+المستوى، وأثبته في المصطرة اللي جنب المريض، أو في
+
+526
+00:38:48,310 --> 00:38:51,110
+الـ stand اللي جنب المريض، وبعدها أعمل للجهاز
+
+527
+00:38:51,110 --> 00:38:53,970
+calibration، إنه هذه نقطة الـ Zero، الـ Zero اللي
+
+528
+00:38:53,970 --> 00:38:59,110
+بنسميها Zeroing، وبعدها يقدر الجهاز يقيس، فبيديني إيش
+
+529
+00:38:59,110 --> 00:39:02,990
+فيه فوق هذا الـ Zero، وبيشار بيديني إياه، ويقرأ لي
+
+530
+00:39:02,990 --> 00:39:10,850
+إياه، وزي ما شفنا إنه الضغط الشعري أقل من الضغط ال
+
+531
+00:39:10,850 --> 00:39:12,550
+... ال ... ال ... ال ... ال ... ال ... ال ... ال ...
+
+532
+00:39:12,550 --> 00:39:13,450
+ال ... ال ... ال ... ال ... ال ... ال ... ال ... ال ...
+
+533
+00:39:13,450 --> 00:39:14,570
+... ال ... ال ... ال ... ال ... ال ... ال ... ال ...
+
+534
+00:39:14,570 --> 00:39:15,410
+ال ... ال ... ال ... ال ... ال ... ال ... ال ... ال ...
+
+535
+00:39:15,410 --> 00:39:15,430
+... ال ... ال ... ال ... ال ... ال ... ال ... ال ...
+
+536
+00:39:15,430 --> 00:39:18,130
+ال ... ال ... ال ... ال ... ال ... ال ...  تمام؟ هذا هو
+
+537
+00:39:18,130 --> 00:39:24,870
+المؤشر تبع الـ CVP، وهي جات هنا، بيديني ده كله أزرق
+
+538
+00:39:24,870 --> 00:39:31,350
+وبيديني هنا إنه الـ CVP قديش الرقم تبعه، ثمانية،
+
+539
+00:39:31,350 --> 00:39:36,750
+سبعة،  وات، وات، وات، وات، وات، وات، وات، وات، وات،
+
+540
+00:39:36,750 --> 00:39:37,410
+وات، وات، وات، وات، وات، وات، وات، وات، وات، وات،
+
+541
+00:39:37,410 --> 00:39:40,010
+وات، وات، وات، وات، وات، وات، وات، وات، وات، وات،
+
+542
+00:39:40,010 --> 00:39:42,070
+وات، وات، وات، وات، وات، وات، وات، وات، وات، وات،
+
+543
+00:39:42,070 --> 00:39:46,110
+وات، وات، وات،
+
+544
+00:39:50,190 --> 00:39:52,910
+حتى في الـ Open Heart Surgeons بطلوا يستخدموها،
+
+545
+00:39:52,910 --> 00:39:55,470
+لأن فيه وسائل ثانية كثيرة بتخليني أعرف الـ
+
+546
+00:39:55,470 --> 00:39:58,430
+Pulmonary Artery Pressure قديش، والـ Lung Pressure
+
+547
+00:39:58,430 --> 00:40:02,610
+حتى و Cardiac Output، هي يعني كانت مميزتها أنك
+
+548
+00:40:02,610 --> 00:40:04,930
+تعرفي الـ Cardiac Output، لكن الآن بالـ
+
+549
+00:40:04,930 --> 00:40:07,770
+Calculations بيقدروا يعرفوا كل الحاجات هذه، فمش
+
+550
+00:40:07,770 --> 00:40:11,870
+محتاجين إنهم يركبوا Swan Ganz Swan Ganz Catheter
+
+551
+00:40:11,870 --> 00:40:17,190
+عشان يعرفوها، هي فكرتها كانت أنه أنت فيه Catheter
+
+552
+00:40:17,190 --> 00:40:21,780
+طويلة، وبتدخل هذا الـ catheter لما نوصفه للـ
+
+553
+00:40:21,780 --> 00:40:23,960
+pulmonary artery، وفي الـ pulmonary artery هذه
+
+554
+00:40:23,960 --> 00:40:31,400
+بيكون فيها بالون، فالبالون بينفخ في لحظة الـ
+
+555
+00:40:31,400 --> 00:40:38,560
+diastole، يعني وفي اللحظة هذه بياخد قياس للـ
+
+556
+00:40:38,560 --> 00:40:43,200
+pulmonary artery pressure، كام كمية الضغط اللي فيه،
+
+557
+00:40:43,200 --> 00:40:45,780
+ومن خلالها بيحددوا طبعاً
+
+558
+00:40:51,130 --> 00:40:54,590
+الـ lung أكتر من طبقات، تكون مشكلة related عادة
+
+559
+00:40:54,590 --> 00:40:58,610
+للقلب، هذه الصورة اللي أنا بدور عليها، إنها تشوف أن أنتَ
+
+560
+00:40:58,610 --> 00:41:01,330
+بتدخل قثطار زي الـ central line عادي، لكن بيختلف، بيمشي
+
+561
+00:41:01,330 --> 00:41:03,650
+بيكمل لما يوصل الـ right ventricle، ومن الـ right
+
+562
+00:41:03,650 --> 00:41:08,110
+ventricle، بيطلع من الـ right ventricle، sorry، من الـ
+
+563
+00:41:08,110 --> 00:41:12,130
+right ventricle، هيمشي ويطلع حياته لما نوصل لوين؟
+
+564
+00:41:12,130 --> 00:41:17,680
+للـ pulmonary، دي طبعاً هو إيش يعني، عالـ Pulmonary
+
+565
+00:41:17,680 --> 00:41:20,660
+Artery، لو عارفين إحنا الـ Pulmonary Artery تروح
+
+566
+00:41:20,660 --> 00:41:24,940
+في Right وفي Left، فهتخليه يروح على واحد منهم
+
+567
+00:41:24,940 --> 00:41:28,140
+من الـ Pulmonary Arteries، وبالتالي هيبدأ يقيس في
+
+568
+00:41:28,140 --> 00:41:33,260
+حاجة اسمها إيش؟ الـ Pulmonary Lung Pressure، آه،
+
+569
+00:41:33,260 --> 00:41:42,920
+والـ Pulmonary Artery Pressure، ما
+
+570
+00:41:42,920 --> 00:41:49,100
+عادش هذا الكلام يعني حيوي ولا، ولا فيه حد بيرضى إنه
+
+571
+00:41:49,100 --> 00:41:52,960
+يستخدم Swan Ganz Catheter عشان الحاجات هذه، الآن في
+
+572
+00:41:52,960 --> 00:41:57,180
+وسائل كثيرة متطورة، خاصة بقى لوجود الـ Cardiac
+
+573
+00:41:57,180 --> 00:42:02,320
+Catheterization اللي بتحل مشاكل المرضى، يعني بيجي
+
+574
+00:42:02,320 --> 00:42:06,200
+المريض في picture of angina، أو MRI، بيعملوا
+
+575
+00:42:06,200 --> 00:42:09,720
+catheterization وبيحلوا المشكلة اللي مخلية تخش
+
+576
+00:42:09,720 --> 00:42:13,120
+في cardiogenic shock، زمان كانت الأمور بتتوقف على
+
+577
+00:42:13,120 --> 00:42:17,730
+متابعة المريض اللي عنده cardiogenic shock وعنده
+
+578
+00:42:17,730 --> 00:42:20,270
+unstable angina، لكن الآن لأ، الـ Interventional
+
+579
+00:42:20,270 --> 00:42:23,610
+Cardiology حلت المشكلة، لأنهم بيعملوله Stent
+
+580
+00:42:23,610 --> 00:42:27,410
+ويطلعوه من الشك، وبرجعوا القلب، برجعوا الـ Ejection
+
+581
+00:42:27,410 --> 00:42:32,870
+Fraction لقى القلب، بعد ما أنه يعني السبب اللي مقد
+
+582
+00:42:32,870 --> 00:42:37,990
+لإنه الـ Ejection Fraction يصير له يروح، سواء كان
+
+583
+00:42:37,990 --> 00:42:45,370
+Coronary Thrombosis أو حتى إذا كان يعني mitral
+
+584
+00:42:45,670 --> 00:42:52,690
+valve regurgitation أو stenosis، فيه بنعمل repair أو بنعمل
+
+585
+00:42:52,690 --> 00:42:57,390
+replacement لفالف، سواء كان يعني فالف للمشكلة، أو
+
+586
+00:42:57,390 --> 00:43:01,730
+اللي هو coronary artery problem، بتنحل، أو حتى لو
+
+587
+00:43:01,730 --> 00:43:07,850
+كانت congenital problem، بتنحل، تمام، هي تقريباً هذه
+
+588
+00:43:07,850 --> 00:43:11,550
+هي الحاجات اللي أنا كنت، طبعاً بالنسبة للـ Arterial
+
+589
+00:43:11,550 --> 00:43:16,100
+line، الـ Arterial line بدي أحكي يعني هنا، من أهم
+
+590
+00:43:16,100 --> 00:43:20,640
+مشاكل الـ artery، يعني ممكن يصير مكان الـ artery، إذا
+
+591
+00:43:20,640 --> 00:43:24,480
+كان فيه أي تعامل خطأ، أو تسربت أي نقطة، هو أن يصير
+
+592
+00:43:24,480 --> 00:43:31,100
+فيه إيش؟ ischemia، لأن نقطة هو معناها إنها
+
+593
+00:43:31,100 --> 00:43:35,460
+منعت وصول blood، الـ artery عن الدم، هيمشي هيك، طبعاً بطل
+
+594
+00:43:35,460 --> 00:43:39,260
+الدم يوصل هيك، فبالتالي هتصير في المنطقة هذه الـ
+
+595
+00:43:39,260 --> 00:43:42,400
+ischemia، هذه المشاكل تبعت الـ Arterial Lines، لو
+
+596
+00:43:42,400 --> 00:43:44,620
+اتركبنا Arterial Lines، زي الـ Arterial Lines
+
+597
+00:43:44,620 --> 00:43:47,220
+المتابعة اللي هو في الـ Intensive Blood Pressure
+
+598
+00:43:47,220 --> 00:43:55,020
+الـ Vascular Disorder، مش هنضطر نتكلم عنها في خلال الشرح
+
+599
+00:43:55,020 --> 00:44:00,820
+هذا، إن شاء الله يعني، هذا هأسسني وأروح على موضوع
+
+600
+00:44:00,820 --> 00:44:08,120
+الشوك فورًا، ونبدأ نحكي عن الشوك وأنواع الشوك، هيّاته،
+
+601
+00:44:08,120 --> 00:44:14,680
+أنواع الشوك، وكيف بدنا نعمل management للشوك، وإن
+
+602
+00:44:14,680 --> 00:44:18,880
+شاء الله هرْفع لكم الفيديوهات تبعها، يعطيكم العافية
+
+603
+00:44:18,880 --> 00:44:25,600
+وأي سؤال يعني، على وسائل الاتصال اللي بنستخدمها
+
+604
+00:44:25,600 --> 00:44:29,000
+هنجاوبكم، والسلام عليكم ورحمة الله
diff --git a/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/xzJXVXMLQCM_postprocess.srt b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/xzJXVXMLQCM_postprocess.srt
new file mode 100644
index 0000000000000000000000000000000000000000..5e7dcddeac477854ad0b6631e96d550ade6bf21e
--- /dev/null
+++ b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/xzJXVXMLQCM_postprocess.srt
@@ -0,0 +1,2416 @@
+1
+00:00:02,600 --> 00:00:05,800
+بسم الله الرحمن الرحيم السلام عليكم ورحمة الله
+
+2
+00:00:05,800 --> 00:00:11,320
+وبركاته اليوم إن شاء الله رب العالمين هنحكي عن ال
+
+3
+00:00:11,320 --> 00:00:16,700
+invasive hemodynamic monitoring ال chapter هذا
+
+4
+00:00:16,700 --> 00:00:21,880
+الهدف الأساسي منه أنه نتعرف على ال hemodynamic
+
+5
+00:00:21,880 --> 00:00:28,750
+stability وكيف بديأعمل مراقبة للـ hemodynamic
+
+6
+00:00:28,750 --> 00:00:33,030
+stability وأكتشف أي unstability فيها وما هي
+
+7
+00:00:33,030 --> 00:00:38,630
+الوسائل اللي أستخدمها عشان أعمل monitoring طبعاً
+
+8
+00:00:38,630 --> 00:00:41,530
+هنشوف إنه مش بس الـ monitor اللي هو ممكن يعمل
+
+9
+00:00:41,530 --> 00:00:47,930
+monitoring للpatient اللي أقصد monitor screen مش
+
+10
+00:00:47,930 --> 00:00:51,570
+بس هي، في حاجات تانية بالذات في ال ICU أو في ال
+
+11
+00:00:51,570 --> 00:00:56,190
+critical ill patients نستخدمهافأولاً يعني إيش يعني
+
+12
+00:00:56,190 --> 00:01:00,090
+Hemodynamic Stability؟
+
+13
+00:01:00,090 --> 00:01:04,710
+طبعاً قبل ما أبدأ أشرح وفي الموضوع هذا هنشوف اللي
+
+14
+00:01:04,710 --> 00:01:10,330
+هو أهم موضوع بتعلق في الـHemodynamic Stability
+
+15
+00:01:10,330 --> 00:01:14,170
+والـUnstability تبعيتها اللي هي تصير ال patient
+
+16
+00:01:14,170 --> 00:01:17,810
+shock فهيكون الموضوع التاني اللي هو شرحنا موضوع
+
+17
+00:01:17,810 --> 00:01:22,330
+الشك بأنواعها المختلفة الآن بالدرجة الأولى بنتعرف
+
+18
+00:01:22,330 --> 00:01:27,080
+على إيش يعني Hemo«Dynamic Stability» وإيش هي
+
+19
+00:01:27,080 --> 00:01:30,400
+الوسائل «invasive» اللي بنستخدمها عشان نعمل من
+
+20
+00:01:30,400 --> 00:01:34,900
+خلالها «monitoring» اللي هي «hemodynamic» معناها
+
+21
+00:01:34,900 --> 00:01:38,780
+الـ «movement of blood through closed circulatory
+
+22
+00:01:38,780 --> 00:01:42,860
+system» مش هي هو مشكلة blood في closed circulatory
+
+23
+00:01:42,860 --> 00:01:48,040
+system بتحرك، بيعمل «perfusion» لكلالجسم من ضمنها
+
+24
+00:01:48,040 --> 00:01:51,240
+الكيليا والكيليا بتعمل urination للـ waste اللي
+
+25
+00:01:51,240 --> 00:01:58,500
+بدهاش إياه وال fluid اللي زايدة وبتضل القسق للـ
+
+26
+00:01:58,500 --> 00:02:05,120
+blood الـ heart يعمل pumping يروح على ال lungs
+
+27
+00:02:05,120 --> 00:02:08,900
+تعمل oxygenation يرجع على ال heart ال heart يعمل
+
+28
+00:02:09,010 --> 00:02:13,390
+بومبينج ويعمل Perfusion لكل ال organs تبع الجسم
+
+29
+00:02:13,390 --> 00:02:17,050
+وزي ما حكينا من ضمنها الكلية كل ما هذه الأملية
+
+30
+00:02:17,050 --> 00:02:23,150
+مستمرة بالطريقة الصحيحة هذه كل ما مافيش عندي مشكلة
+
+31
+00:02:24,280 --> 00:02:28,360
+once إنه بيصير فيه end effect في واحدة من المشاكل
+
+32
+00:02:28,360 --> 00:02:33,440
+هذه هيتأثر كل الـ circulatory system هذا سواء كان
+
+33
+00:02:33,440 --> 00:02:37,580
+في ضعف عضلة القلب نفسها أو في قلة السوائل الموجودة
+
+34
+00:02:37,580 --> 00:02:45,220
+في الجسم أو في عدم قدرة السوائل إنها تمشي أو
+
+35
+00:02:45,220 --> 00:02:50,930
+سريانها في داخلالأوعية الدموية سواء نتيجة ضغط شديد
+
+36
+00:02:50,930 --> 00:02:58,250
+عليها أو يعني فوق هذه الأوعية الدموية أو إن
+
+37
+00:02:58,250 --> 00:03:01,410
+الأوعية الدموية هذه صارت الـ diameters تبعها
+
+38
+00:03:01,410 --> 00:03:04,450
+dilated كتير وصارت كمية السواء اللي موجودة لا تشكل
+
+39
+00:03:04,450 --> 00:03:08,550
+فيها أي حجم بحيث أنها تعمل ضغط دم هذه كل اللي
+
+40
+00:03:08,550 --> 00:03:13,550
+حكيتها يعني هي يعني علامات shock أو أنواع ال shock
+
+41
+00:03:15,070 --> 00:03:19,610
+لذلك عشان أعرف أن مالي بتبقى في أي مرحلة لازم أكون
+
+42
+00:03:19,610 --> 00:03:24,090
+عنده مراقبة مستمرة والمراقبة هذه عادة إحنا
+
+43
+00:03:24,090 --> 00:03:27,030
+بنستخدمها مع الناس اللي ماشي critically ill عن
+
+44
+00:03:27,030 --> 00:03:30,170
+طريق الـVital Sign الـVital Sign يعني أنا بشوف
+
+45
+00:03:30,170 --> 00:03:33,270
+الـBlood Pressure تبعه بس في طريقة non-invasive
+
+46
+00:03:33,270 --> 00:03:35,530
+وبشوف الـRespiratory Rate وبشوف الـTemperature
+
+47
+00:03:35,530 --> 00:03:39,410
+وبشوف الـHeart Rate لكن في الـICU وفي
+
+48
+00:03:39,410 --> 00:03:41,150
+الـCritically
+
+49
+00:03:43,140 --> 00:03:47,500
+أو في الـEmergency Rooms أو كل الـCritically Ill
+
+50
+00:03:47,500 --> 00:03:51,440
+Patients نكون بنتابعه بطرق أكتر حساسية من بس أن
+
+51
+00:03:51,440 --> 00:03:57,820
+أعرف الـVital Signs تبعته عشان هي أنا هستخدم
+
+52
+00:03:57,820 --> 00:04:03,540
+الـMonitoring Screen عشان أشوف الـECG تبعه وأشوف
+
+53
+00:04:03,540 --> 00:04:06,280
+الـHeart Rate تبعه وأشوف الـRespiratory Rate
+
+54
+00:04:06,280 --> 00:04:10,530
+وRhythm تبعه كمانوطبعا زي ما حكينا في ال monitor
+
+55
+00:04:10,530 --> 00:04:13,470
+screen أنا بشوف ال heart rate و ال rhythm تبع ال
+
+56
+00:04:13,470 --> 00:04:18,930
+heart لإني بشوف ال ECG في one lead وكمان ممكن نركب
+
+57
+00:04:18,930 --> 00:04:22,070
+للمريض حاجة نسميها central venous pressure أو
+
+58
+00:04:22,070 --> 00:04:26,490
+بالmonary artery pressure أو حاجة اسمها اللي هو ال
+
+59
+00:04:26,490 --> 00:04:31,340
+invasiveالـ Blood Pressure يعني مش بس اللي هي
+
+60
+00:04:31,340 --> 00:04:34,860
+Intra-Arterial Blood Pressure الـ Blood Pressure
+
+61
+00:04:34,860 --> 00:04:37,940
+اللي احنا بنقيصه عادة و بنعرفه عن طريق الكف فده
+
+62
+00:04:37,940 --> 00:04:41,200
+اسمه اسمه برضه Arterial Blood Pressure ها خدوا
+
+63
+00:04:41,200 --> 00:04:45,140
+بالكوا بس none in basic يعني من غير ان انا اخترق
+
+64
+00:04:45,140 --> 00:04:53,010
+الشريان انا من فوق الشريان بعملالبراشر هذا الشديد
+
+65
+00:04:53,010 --> 00:04:57,490
+بيعمل أو بيؤدي إلى انقطاع وصول الدم من الشريان إلى
+
+66
+00:04:57,490 --> 00:05:01,810
+الجزء إذا أنا رابطها على الدراع إلى الجزء السفلي
+
+67
+00:05:01,810 --> 00:05:08,730
+من الدراع وبعدين ببدأ أنا أعمل deflation للبالون
+
+68
+00:05:09,770 --> 00:05:14,690
+وببدأ أسمع في النبضة الأولى اللى بيبدأ يتدفق فيها
+
+69
+00:05:14,690 --> 00:05:19,010
+الدم وهذا بيكون الـ systole ولمّا انت تماما بيكون
+
+70
+00:05:19,010 --> 00:05:20,990
+هذا الـ diastole هذا الطريقة اللى كلهيتكوا
+
+71
+00:05:20,990 --> 00:05:24,510
+بتعرفوها بس أنا الأن بدي أعمل طريقة أكتر حساسية و
+
+72
+00:05:24,510 --> 00:05:30,050
+بدي أركب arterial catheter أو arterial cannula
+
+73
+00:05:30,050 --> 00:05:33,390
+يعني cannula في الـ artery نفسه اللى يكون ال
+
+74
+00:05:33,390 --> 00:05:36,210
+radial artery اللى هو يستخدم عادةالـ Arterial
+
+75
+00:05:36,210 --> 00:05:40,110
+Monitoring و اللي بيسميه Invasive Blood Pressure
+
+76
+00:05:41,140 --> 00:05:44,800
+وأبدأ أشوف الضغط عن طريق الـ «مونوتور» واستخدامه
+
+77
+00:05:44,800 --> 00:05:48,700
+اللي هو «transducer» يوصلي في الـ «مونوتور» ويديني
+
+78
+00:05:48,700 --> 00:05:53,400
+قراءة للـ «Blood Pressure» كل «Systole» وكل
+
+79
+00:05:53,400 --> 00:05:56,720
+«Diastole» هيديني لهم قراءة جداش كان الـ «Systolic
+
+80
+00:05:56,720 --> 00:05:59,080
+Blood Pressure» في الضغط هذه والـ «Diastolic Blood
+
+81
+00:05:59,080 --> 00:06:01,880
+Pressure» في الضغط هذه أو في الـ «Pit» هذه يعني كل
+
+82
+00:06:01,880 --> 00:06:04,360
+«Pit» ما هي «Systole» و«Diastole» الـ «Pit» اللي
+
+83
+00:06:04,360 --> 00:06:07,140
+بعدهم هيكون فيه «Systole» و«Diastole» مختلفة
+
+84
+00:06:09,950 --> 00:06:13,450
+الـ Arterial Line وفيه مركّب Invasive Blood
+
+85
+00:06:13,450 --> 00:06:17,290
+Pressure هتجد على الـ Monitor إن الـ Continuous
+
+86
+00:06:17,290 --> 00:06:19,570
+Change في الـ Reading تبقى بـ Blood Pressure لأنها
+
+87
+00:06:19,570 --> 00:06:24,010
+مع كل Reading بتدّي قراءة مختلفة طبعاً و الـ
+
+88
+00:06:24,010 --> 00:06:26,970
+Central Venous Pressure اللي هنحكي عنه بالتقصيد
+
+89
+00:06:26,970 --> 00:06:33,050
+اللي هو وظيفته إنه يقيسل مستوى أو حجم السوائل أو
+
+90
+00:06:33,050 --> 00:06:37,090
+الضغط اللي بتشكله السوائل فعلياً فيه وريد مركزي
+
+91
+00:06:38,270 --> 00:06:42,210
+وبالتالي أنا من خلال كمية الضغط هذه اللي بتشكلها
+
+92
+00:06:42,210 --> 00:06:45,650
+السوائل في الوريد المركزي بستطيع أن أعرف اللي هو
+
+93
+00:06:45,650 --> 00:06:49,650
+حجم هذه السوائل في الجسم وأحدد إذا كان المريض اللي
+
+94
+00:06:49,650 --> 00:06:52,710
+أنا بتعامل معاه هو hypervolumic ولا hypervolumic
+
+95
+00:06:54,380 --> 00:06:58,220
+الاعتماد والمقارنة مع مقاييس أخرى اللي هي blood
+
+96
+00:06:58,220 --> 00:07:01,620
+pressure كام بالإضافة لل CBP يعني اللي أنا عارفه
+
+97
+00:07:01,620 --> 00:07:05,460
+ال urine output كمان كام ال heart rate كام إذا كل
+
+98
+00:07:05,460 --> 00:07:09,060
+هذه على بعض لما تكون stable بكون المريض تبعينه
+
+99
+00:07:09,060 --> 00:07:12,560
+hemodynamically stable لما بكون فيها خلل بكون فيه
+
+100
+00:07:12,560 --> 00:07:16,240
+خلل فيه ال hemodynamic و بطل المريض unstable عشان
+
+101
+00:07:16,240 --> 00:07:25,920
+هي كفيهإجراءات مهمة لازم نعملها ونشوفها ونتبعها في
+
+102
+00:07:25,920 --> 00:07:29,340
+المريض اللي هو «critically ill» أو الـ «ICU
+
+103
+00:07:29,340 --> 00:07:33,960
+patients» علشان أستطيع أن أعرف هو «hemodynamically
+
+104
+00:07:33,960 --> 00:07:35,660
+stable» أو «unstable»
+
+105
+00:07:38,640 --> 00:07:41,600
+طبعًا زي ما حكينا أن يكون الـ «patient» «stable»
+
+106
+00:07:41,600 --> 00:07:44,880
+«hemodynamic» معناه إنه بده يكون مافيش عنده علامات
+
+107
+00:07:44,880 --> 00:07:48,640
+الـ «shock» لاحظ زي ما بحكيلك «weakness» و «baler»
+
+108
+00:07:48,640 --> 00:07:50,920
+و «confusion» و «cold» و «diminished» و «absent
+
+109
+00:07:50,920 --> 00:07:53,120
+pulse» و «cardic arrhythmia» و «low blood
+
+110
+00:07:53,120 --> 00:07:57,080
+pressure» يعني كل أي تخلل هيقدّي إلى إيش؟ بالآخر
+
+111
+00:07:57,080 --> 00:08:00,560
+لـ «shock» يعني هذه علامات الـ «shock» لو ماكنتش
+
+112
+00:08:00,560 --> 00:08:03,180
+عند المرض بيكون الـ «patient» «stable» كيف بتعرف
+
+113
+00:08:03,180 --> 00:08:06,260
+الـ «stability» هذه عن طريق حكينا إنه ممكن نركب
+
+114
+00:08:06,260 --> 00:08:11,250
+الـ «CBD»؟عشان نتقيس الـ Central Venous Pressure
+
+115
+00:08:11,250 --> 00:08:16,510
+أو إنه نركّب الـ Swans Gang Catheter اللي بيسموها
+
+116
+00:08:16,510 --> 00:08:19,290
+الـ Pulmonary Artery Pressure عشان نتقيس الـ
+
+117
+00:08:19,290 --> 00:08:22,330
+Pulmonary Artery Pressure والـ Cardiac Output طبعا
+
+118
+00:08:22,330 --> 00:08:26,550
+عشان نركّب الحاجات هدول بحتاج وأو الـ Arterial
+
+119
+00:08:26,550 --> 00:08:32,150
+Line كمان بحتاجمن أهم المؤدات هذه اللي يابو
+
+120
+00:08:32,150 --> 00:08:37,890
+تعرفوها هنعرف إنه لما بنركب CBP مثلا هنحتاج الـ
+
+121
+00:08:37,890 --> 00:08:42,560
+Central Line نفسهوهنتقرف الآن على الـ Central
+
+122
+00:08:42,560 --> 00:08:45,900
+Lines وأنواع هون ممكن نركبها لكن بديك تعرف كمان
+
+123
+00:08:45,900 --> 00:08:50,280
+إنه بيكون بدنا حاجة اسمها Flush System الـ Flush
+
+124
+00:08:50,280 --> 00:08:54,880
+System هذا عبارة عن محلول ملحي ولكن عليك اللي هو
+
+125
+00:08:54,880 --> 00:09:03,660
+كمية من الهيبرين حوالي اللي هو لكل 500 CC بنحط له
+
+126
+00:09:03,690 --> 00:09:08,650
+هو واحد صانطي هبارين يعني خمس تلاف International
+
+127
+00:09:08,650 --> 00:09:15,330
+Unit بحيث يكون التركيز الهبارين واحد من ألف أو حتى
+
+128
+00:09:15,330 --> 00:09:22,470
+بنحط يعني الصانطي ممكن نحطه حتى على الألف طبعاً
+
+129
+00:09:22,470 --> 00:09:30,520
+وحنكون بنحتاج الـ Stop Cock وبنحتاج اللي هوعندما
+
+130
+00:09:30,520 --> 00:09:35,040
+يكون هنا حاجة اسمها «transducer» هذا شرحه عملي
+
+131
+00:09:35,040 --> 00:09:42,120
+أسهل فأنا مش هأدخل في تفاصيل دقيقة في الموضوع لأنه
+
+132
+00:09:42,120 --> 00:09:45,940
+المفروض أنه يشرح عملي لكن هرفع لكم فيديو بوضّح كيف
+
+133
+00:09:45,940 --> 00:09:50,160
+قليت تركيب الـ «central line» وكيف قليت قياسه
+
+134
+00:09:50,940 --> 00:09:53,880
+بتبديكوا تعرفوا أنه في حاجات مهمة تكون عارفة أنه
+
+135
+00:09:53,880 --> 00:09:56,540
+في حاجة مثلا اسمه الـ pressure bag يعني لما بكون
+
+136
+00:09:56,540 --> 00:09:59,880
+أنا مركّب مثلا arterial line لمريد مازال أنا كم ..
+
+137
+00:09:59,880 --> 00:10:04,850
+حكيت إنه في ال arterial line أنا فيه هنديكانيولة
+
+138
+00:10:04,850 --> 00:10:08,470
+في داخل الشريان الشريان معروف أنه فيه pressure
+
+139
+00:10:08,470 --> 00:10:11,390
+فقدام الحسين يطلع من الكانيولة هذه لذلك الكانيولة
+
+140
+00:10:11,390 --> 00:10:15,410
+هذه هي نوع خاص من الكانيولات اللي لها valve وكمان
+
+141
+00:10:15,410 --> 00:10:19,590
+لازم تنشبك في line و ال line هذه مشبوك طبعا في زي
+
+142
+00:10:19,590 --> 00:10:23,250
+ما حكينا flush system اللي هو كيس محلول وفيه برينه
+
+143
+00:10:23,250 --> 00:10:27,310
+برنسا line وكمان محطوط في ال pressure bag هذه ال
+
+144
+00:10:27,310 --> 00:10:30,850
+bag ال bag هذه برفعطب يعني بكون عامل pressure فيها
+
+145
+00:10:30,850 --> 00:10:34,930
+لإن 300 ميلي متر ذئبق تمام بحيث أنها تكون أعلى من
+
+146
+00:10:34,930 --> 00:10:39,830
+ضغط الدم تبع المريض وهذا إيش هتسوي؟ هتمنع ارتجاع
+
+147
+00:10:39,830 --> 00:10:46,550
+الدم منهالـ R3 للـ System هذا يعني للـ IV-6 اللي
+
+148
+00:10:46,550 --> 00:10:49,910
+مش مشبوك في المحلول هذا ومش بس هيك الـ System هذا
+
+149
+00:10:49,910 --> 00:10:53,790
+الـ Flush System لحاله حاد ثلاثة لخمسة صنطي اللي
+
+150
+00:10:53,790 --> 00:10:56,070
+هو Saline من اسم الهيبراني السالين اللي احنا
+
+151
+00:10:56,070 --> 00:11:00,390
+حاطينه كل ساعة الهدف منه انه يعمل Washing يعني
+
+152
+00:11:00,390 --> 00:11:03,070
+ويمنع ال Clothing يعني يعمل ال Flushing ويمنع ال
+
+153
+00:11:03,070 --> 00:11:07,190
+Clothing وارتجاع الدم في داخل الشريعة أو في داخل
+
+154
+00:11:07,190 --> 00:11:11,760
+ال IV-6 هذاكويس وهذا كله ينطبق بالذات على الـ
+
+155
+00:11:11,760 --> 00:11:15,580
+Arterial line هذا احنا كمان بعمله مع الـ CDD لما
+
+156
+00:11:15,580 --> 00:11:17,980
+بنركب الـ Central Venous Pressure ولكن بما انه
+
+157
+00:11:17,980 --> 00:11:22,240
+الضغط تبقى الـ Central Line أو الضغط داخل الوريد
+
+158
+00:11:22,240 --> 00:11:26,660
+المركزي عادة مش زي الـ Artery فممكن انه انا اركب
+
+159
+00:11:26,660 --> 00:11:29,540
+Central Venous Pressure من غير الـ Flush System و
+
+160
+00:11:29,540 --> 00:11:33,880
+الـ Pressure Bag هذه لأن الـ Pressure داخل الـ
+
+161
+00:11:33,880 --> 00:11:38,310
+Central Line مش هالجد كبير وممكن يخلي الدم يرتجعهو
+
+162
+00:11:38,310 --> 00:11:39,070
+الـ CRS
+
+163
+00:11:42,470 --> 00:11:45,890
+يعني الـ Clotting أو يصير ارتجاع للدم في الـ Line
+
+164
+00:11:45,890 --> 00:11:49,870
+ويصير الـ Clotting طبعاً بحاجة أن يكون هنا
+
+165
+00:11:49,870 --> 00:11:54,970
+Transducer هذا عشان هو الوسيلة اللي هتعمل Change
+
+166
+00:11:54,970 --> 00:12:01,250
+أو تعمل توصيل لل data من المريض لـ Monitor وهو
+
+167
+00:12:01,250 --> 00:12:05,390
+اللي هنطلق وهنعمل Calibration عشان يبدأ الجهاز من
+
+168
+00:12:05,390 --> 00:12:12,030
+نقطة الصفر اللي أنا حدد هيبدأ يقيص اللي هوالضغط
+
+169
+00:12:12,030 --> 00:12:16,190
+سواء في الوريد المركزي أو في الشريان بعد ما أحدد
+
+170
+00:12:16,190 --> 00:12:20,790
+نقطة في الصفر سأجدد فيه ضغط فوق الصفر هذا يقرأ
+
+171
+00:12:20,790 --> 00:12:27,390
+ليها ويدينيها الـ Amplifier والمونوترات الآن عادة
+
+172
+00:12:27,390 --> 00:12:36,470
+صوتها عالي والـ Electrical Science تبعتها موجودة
+
+173
+00:12:36,470 --> 00:12:45,680
+مش محتاج أن يكون فيهإنه فيه amplifier واموره جاهزة
+
+174
+00:12:45,680 --> 00:12:50,500
+الـ «Central Venus Catheter» لو بدنا نحكي عنها
+
+175
+00:12:50,500 --> 00:12:54,960
+بالتفصيل بأول
+
+176
+00:12:54,960 --> 00:12:58,120
+حالة بنحكي إنه في مواضيع كتير بنحط منها «Central
+
+177
+00:12:58,120 --> 00:13:06,960
+Venus Catheter» الهدف منها إنه أنا أصل الـ
+
+178
+00:13:06,960 --> 00:13:07,600
+«Thoracic Vein»
+
+179
+00:13:11,140 --> 00:13:14,720
+ولمّا أسيل أنا في الـ Plastic Vein اللي هو قبل
+
+180
+00:13:14,720 --> 00:13:19,480
+الأصول إلى الـ Right Atrium بالظبط، تمام؟ بدي أشوف
+
+181
+00:13:19,480 --> 00:13:25,440
+كمية السوائل والـ Pressure اللي عامله الـ Blood في
+
+182
+00:13:25,440 --> 00:13:31,160
+الوريد المركزي هذا عشان أعرف من خلاله اللي هو حجم
+
+183
+00:13:31,160 --> 00:13:36,200
+السوائل في الجسم وحاجة المريض لسوائل أكتر أو هو
+
+184
+00:13:36,200 --> 00:13:39,300
+المريض يعني عنده كمية من السوائل
+
+185
+00:13:42,170 --> 00:13:47,170
+لـ diuretics عشان تخفف هذه السوائل طب من وين؟ نحنا
+
+186
+00:13:47,170 --> 00:13:56,690
+ممكن نحط الـ central line هذا عدة طرق ممكن تحطها
+
+187
+00:14:04,070 --> 00:14:09,530
+إذاً في أماكن كتير ممكن أنا أدخل منها علشان أستطيع
+
+188
+00:14:09,530 --> 00:14:14,470
+أن أقيس الـCDP يعني مثلا ممكن ندخل من الـinternal
+
+189
+00:14:14,470 --> 00:14:19,450
+jugular ونستقر في اللي هو الـthoracic
+
+190
+00:14:20,750 --> 00:14:26,010
+قبل أن نصل إلى الـRight Atrium أو أن ندخل من
+
+191
+00:14:26,010 --> 00:14:29,490
+الـSubclavian دين كل ما سيأدوا إلى أن أذهب إلى
+
+192
+00:14:29,490 --> 00:14:32,190
+الـSuperior Vena Cava
+
+193
+00:14:36,770 --> 00:14:42,170
+أقيص الـ CVP لكن في أماكن تانية ممكن أحط فيها من
+
+194
+00:14:42,170 --> 00:14:46,290
+خلالها Central Line لكن ماكنش قادر أن أصل لـ
+
+195
+00:14:46,290 --> 00:14:49,950
+Thoracic Vein وبالتالي ما بنفع أقيص منها CVP زي
+
+196
+00:14:49,950 --> 00:14:53,570
+الـFemoral Vein أو الـPraecal الـPraecal فين
+
+197
+00:14:53,570 --> 00:14:57,190
+بالمناسبة ممكن جدا أخش من الـPraecal لكن بدي Long
+
+198
+00:14:57,190 --> 00:15:01,030
+Line علشان أوصل لـThoracic Vein علشان أنا بدأ أخش
+
+199
+00:15:01,030 --> 00:15:03,950
+من الـPraecal، لكن الـPraecal يعني وين؟ يعني في
+
+200
+00:15:03,950 --> 00:15:06,590
+الـAnticubital
+
+201
+00:15:08,330 --> 00:15:13,710
+ممكن أدخل على الـ cephalic أو الـ basalic vein ومن
+
+202
+00:15:13,710 --> 00:15:16,250
+الـ cephalic أو الـ basalic vein أبقى نمشي على الـ
+
+203
+00:15:16,250 --> 00:15:19,110
+axillary vein و بعدين أدخل على ال thoracic vein،
+
+204
+00:15:19,110 --> 00:15:24,190
+تمام؟ فحنشوف في جدول الآن ال advantage و ال
+
+205
+00:15:24,190 --> 00:15:26,750
+disadvantage لكل واحد فيهم، بس اللي بدني أعرفه في
+
+206
+00:15:26,750 --> 00:15:29,190
+النهاية، أنا هستقر في الـ
+
+207
+00:15:32,040 --> 00:15:37,160
+عشان أقيس الـ «Central Venus Pressure» إذا كان من
+
+208
+00:15:37,160 --> 00:15:41,560
+خمسة لعشرة سنتمتر water اللي هو تقابلها حوالي من
+
+209
+00:15:41,560 --> 00:15:45,680
+اتنين لستة ملي متر ذئبق بكون معناه إن أنا عندي
+
+210
+00:15:45,680 --> 00:15:52,980
+Normal Central Venus Pressure طبعا
+
+211
+00:15:52,980 --> 00:16:01,460
+علشان نقيس هذا لازملازم أننا نكون المريض محطوط في
+
+212
+00:16:01,460 --> 00:16:06,980
+position معين ونكون عاملين Zeroing ونشوف مع بعض
+
+213
+00:16:06,980 --> 00:16:12,740
+كيف قليد قياسه بالخطوات الهدف
+
+214
+00:16:12,740 --> 00:16:16,960
+من قياس الـCDD بالحقيقة زي ما حكينا أنه أنا أكون
+
+215
+00:16:16,960 --> 00:16:20,960
+عارف بالظبط الـ
+
+216
+00:16:22,090 --> 00:16:25,530
+الـ Right Ventricular Feeling Pressure أو بيسموه
+
+217
+00:16:25,530 --> 00:16:30,250
+الـ Preload يعني كام قدرة الـ Right Ventricle على
+
+218
+00:16:30,250 --> 00:16:37,360
+الـ Complete Relaxation علشان ياخد إيش؟أكبر كمية
+
+219
+00:16:37,360 --> 00:16:41,480
+من الـBlood اللي تجيله من الـRight Atrium، تمام؟
+
+220
+00:16:41,480 --> 00:16:44,020
+إذا هي طريقة غير مباشرة عشان تخليني أعرف
+
+221
+00:16:44,020 --> 00:16:47,960
+الـpreload تبع الـheart كيف وضعه، وإيش يعني هو
+
+222
+00:16:47,960 --> 00:16:52,060
+الـpreload؟ الـpreload اللي هو الـdilatation أو
+
+223
+00:16:52,060 --> 00:16:55,080
+يعني بيسموه الـstretch تبع الـheart muscle at the
+
+224
+00:16:55,080 --> 00:17:00,140
+end of the stoolكم القلب عنده قدرة إنه يعمل
+
+225
+00:17:00,140 --> 00:17:04,340
+relaxation و stretching عشان يأخذ أكبر كمية من
+
+226
+00:17:04,340 --> 00:17:08,040
+الدم بدها تجيه اللي هيدلني عليه اللي هو الـ
+
+227
+00:17:08,040 --> 00:17:11,760
+central venus برشا لو كان عالي، معناه إن كمية
+
+228
+00:17:11,760 --> 00:17:16,120
+السوائل هادة أكتر مناللي بيتحملها القلب وكمية
+
+229
+00:17:16,120 --> 00:17:22,400
+السوائل القلب لا يستطيع أنه يتعامل معها فهي عاملة
+
+230
+00:17:22,400 --> 00:17:26,640
+له overload ولو كانت له أقل من خمسة معناه أنه
+
+231
+00:17:26,640 --> 00:17:29,720
+الـcentral venous pressure هنا له معناه أنه كمية
+
+232
+00:17:29,720 --> 00:17:33,220
+السوائل اللي بتيجي أفضل للقلب في الـpreload هي
+
+233
+00:17:33,220 --> 00:17:37,920
+قليلة فعشان هي القلب مابضخش كويس وإتالي هيكون فيه
+
+234
+00:17:37,920 --> 00:17:42,200
+مشكلة برضه في الـafterloadطيب، إيش الفرق بين الـ
+
+235
+00:17:42,200 --> 00:17:45,440
+الـ الـ الـ different insertion لـ الـ Central
+
+236
+00:17:45,440 --> 00:17:47,460
+Line سواء من الـ Sub-Clavian أو من الـ Turner's
+
+237
+00:17:47,460 --> 00:17:51,820
+Jaguar؟ بنحكي إنه من الSub-Clavian، هذا مكان كتير
+
+238
+00:17:51,820 --> 00:17:55,260
+كويس و طبعا هيدي .. يعني هخش أنا في Large Vessel،
+
+239
+00:17:55,260 --> 00:18:01,080
+أه؟ و .. و هجيس منه الـ CVV و هذه حاجة كتير كويسة،
+
+240
+00:18:01,080 --> 00:18:05,120
+طبعا ال dressing تبقى سهل لإنه في مكان أنظيف ال
+
+241
+00:18:05,120 --> 00:18:09,450
+chest، لكن الخطورة تبعتهإنه انا لو ممكن بده يصير
+
+242
+00:18:09,450 --> 00:18:14,130
+لو لأ قدر الله في bleeding أو يعني المريض هذا risk
+
+243
+00:18:14,130 --> 00:18:18,770
+لإنه يصير عنده bleeding هيكون uncontrollable صعب
+
+244
+00:18:20,160 --> 00:18:25,280
+لأنه Deep كمان هذا قريب من الـ Plural Space الـ
+
+245
+00:18:25,280 --> 00:18:27,900
+Plural Cavity وبالتالي أنا ممكن during insertion
+
+246
+00:18:27,900 --> 00:18:32,000
+نعمل للمريض نيموثوركس أو Hemothorax الـ Internal
+
+247
+00:18:32,000 --> 00:18:35,900
+Jugular يعتبر أقل خطورة من ناحية إنه يعمل
+
+248
+00:18:35,900 --> 00:18:39,260
+Hemothorax وNemothorax لكن نفس الموضوع بالنسبة للـ
+
+249
+00:18:39,260 --> 00:18:45,780
+Bleeding وبالنسبة للـالمرضى اللي عندهم مشاكل أصلاً
+
+250
+00:18:45,780 --> 00:18:49,280
+في الـ «نيت» مثلاً برضه هيسببلهم أو هيكون صعب
+
+251
+00:18:49,280 --> 00:18:56,020
+التعامل معاه لكن الـ advantage تبعتهم أنه سهل أني
+
+252
+00:18:56,020 --> 00:19:03,520
+لحظة أردت على التليفون وبعدين أكمل و ال advantage
+
+253
+00:19:03,520 --> 00:19:07,720
+تبعت ال «إنترنت جيجل» زي ما حكينا أنه من
+
+254
+00:19:11,830 --> 00:19:15,210
+«ليموثوركس» أو «hemothorax» عند المرضى والـ
+
+255
+00:19:15,210 --> 00:19:18,350
+accessibility تبعته عالية خاصة إذا ما كان فيه عند
+
+256
+00:19:18,350 --> 00:19:20,830
+المريض مشاكل في الـ «نت» اللي فيه مرال من المشاكل
+
+257
+00:19:20,830 --> 00:19:26,990
+هو إنه مش هقدر أجيس منه CBP ومن مميزاته إنه لو كان
+
+258
+00:19:26,990 --> 00:19:29,650
+المريض high risk لـ bleeding وانا بدي وسيلة إنه أد
+
+259
+00:19:29,650 --> 00:19:33,290
+عوض فيها سوائل مكون كويس لإنه حتى لو كان high risk
+
+260
+00:19:33,290 --> 00:19:36,150
+لـ bleeding وصار معاه bleeding ممكن فيه إني
+
+261
+00:19:36,150 --> 00:19:39,650
+إمكانية إن أعمل stop لـ bleeding هذا لإنه إيش
+
+262
+00:19:39,880 --> 00:19:46,500
+«Controllable» يعني ممكن أتحكم فيه لكن من الـ
+
+263
+00:19:46,500 --> 00:19:50,360
+«Disadvantage» برضه تبعته إن هو في منطقة «Dirty» و
+
+264
+00:19:50,360 --> 00:19:58,380
+«Infection Rate»هو عالي جدا وعشان هيك لا يفضل الـ
+
+265
+00:19:58,380 --> 00:20:06,840
+«Brachial» ساعت من مشاكله إنه بدي Largeيعني
+
+266
+00:20:06,840 --> 00:20:12,600
+catheter علشان أنا أصل وأستطيع أن أقيس منه الـCVB
+
+267
+00:20:12,600 --> 00:20:15,800
+في كمان حاجة مهمة أنه لما أنا بدأ أدخل من
+
+268
+00:20:15,800 --> 00:20:17,820
+الـPracula جماعة أو بدأ أدخل في البيزانيك أو
+
+269
+00:20:17,820 --> 00:20:23,240
+الـCephalic veins فدولها عادة veins يعني long وانا
+
+270
+00:20:23,240 --> 00:20:26,680
+بدي أقدر نماشي فيهم علشان إيش أصل للـaxillary ومن
+
+271
+00:20:26,680 --> 00:20:30,640
+بعدها أبدأ أنزل في التورسيك فأنا عارفين إحنا أن ال
+
+272
+00:20:30,640 --> 00:20:37,220
+veins فيها إيشفيها الـ «Valves» عشان تمنع الارتجاع
+
+273
+00:20:37,220 --> 00:20:41,240
+تبع الدم فأنا لما بخش في الـ «Veins» هدول هعمل
+
+274
+00:20:41,240 --> 00:20:46,040
+Destruction للـ «Valves» هذه ولذلك لا تُعتبر طريقة
+
+275
+00:20:46,040 --> 00:20:51,200
+مثلة لتركيب الـ «Central Line» ويفضوا دائما الـ
+
+276
+00:20:51,200 --> 00:20:55,360
+«Internal Juggle» أو الـ «Subclavian» إذا كان لا
+
+277
+00:20:55,360 --> 00:21:00,800
+يوجد Contra Indications طبعاً
+
+278
+00:21:02,130 --> 00:21:04,330
+عندما نتحدث عن الـ «فاكتور» اللي بتأثر في الـ
+
+279
+00:21:04,330 --> 00:21:08,830
+«CBD» حكينا أحنا، هيأثر في الـ «CBD» إذا كان فيه
+
+280
+00:21:08,830 --> 00:21:12,810
+Systemic Vasodilatation إذا كل الجسم، الـVessels
+
+281
+00:21:12,810 --> 00:21:17,150
+تبعته dilated برضه الـCentral Venous Veins هتكون
+
+282
+00:21:17,150 --> 00:21:21,730
+dilated وبالتالي هيكون الـ«CBD» القراءة تبعته
+
+283
+00:21:21,730 --> 00:21:27,810
+واطية يعني لأنه في الـDilatation في الـVena Cava
+
+284
+00:21:27,810 --> 00:21:33,700
+وبالتالي هيدينيإن كمية السوائل اللي فيه قليلة إذا
+
+285
+00:21:33,700 --> 00:21:36,020
+كان فيها «Rise Ventricular Failure» أو فيه
+
+286
+00:21:36,020 --> 00:21:38,180
+«Tricuspid» أو «Balmoral Valve Disease» أو
+
+287
+00:21:38,180 --> 00:21:41,600
+«Balmoral Hypertension» هذه هتأثر في قلقات الـ
+
+288
+00:21:41,600 --> 00:21:46,960
+«CVB» وماكنش أنا بكون مضطر إن أستخدم «CVB» يا
+
+289
+00:21:46,960 --> 00:21:53,480
+جماعةلما يكون أنا لازم أعمل Hemodynamic Monitoring
+
+290
+00:21:53,480 --> 00:21:58,140
+وأراقب كل حاجة بشكل دقيق لما بكون أنا محتاج إن
+
+291
+00:21:58,140 --> 00:22:03,140
+أركب IV Axis ومافيش إمكانية إن أحط Peripheral Axis
+
+292
+00:22:03,140 --> 00:22:04,020
+يعني الكنولات
+
+293
+00:22:07,130 --> 00:22:09,650
+الـ peripheral vein فانا محتاج ان اركب central
+
+294
+00:22:09,650 --> 00:22:15,230
+line لما انا بكون بدي استخدم او بدي اعطي المريض IV
+
+295
+00:22:15,230 --> 00:22:19,410
+لفترة طويلة وانا محتاج ان اسحب منه تحليم في اليوم
+
+296
+00:22:19,410 --> 00:22:23,310
+خمس، ست مرات كتيرة، اعمله مثلا blood gas متابعة
+
+297
+00:22:23,310 --> 00:22:28,240
+كتيرة سواء من ال vein أو من ال arteryأو بدي أعمل
+
+298
+00:22:28,240 --> 00:22:31,340
+CDC follow-up وchemistry follow-up مثلا كل أربع
+
+299
+00:22:31,340 --> 00:22:36,240
+ساعات أو إيش يعني كل ما في عند مريض بده استخدام IV
+
+300
+00:22:36,240 --> 00:22:40,960
+بشكل طويل وساعة تحليل لموضوع طويلة بيكون أحسن أن
+
+301
+00:22:40,960 --> 00:22:44,880
+أكون مركّبله Central Line أحسن مضل كل مرة أعمله
+
+302
+00:22:46,700 --> 00:22:53,460
+إنفاجيا في مكان جديد أو أن أركّب له أكتر من كانولا
+
+303
+00:22:53,460 --> 00:22:56,720
+لما بكون بدي أدري حساسة عن طريق الـ Infusion Pump
+
+304
+00:22:56,720 --> 00:23:01,700
+زي الدوبامين و الـ Adrenaline و النورادرينالين أو
+
+305
+00:23:01,700 --> 00:23:04,820
+الـ Sedation إذا كان في عنديأكتر من الـ Sedation
+
+306
+00:23:04,820 --> 00:23:08,460
+بكون محتاجة أن أنا أحطها أو أحيانا بكون الـ Total
+
+307
+00:23:08,460 --> 00:23:11,420
+Parenteral Nutrition يا جماعة ال molecular weight
+
+308
+00:23:11,420 --> 00:23:15,280
+تبعه عالي فبنفعش تنعطل الأدوية هذه في اللي هو الـ
+
+309
+00:23:15,280 --> 00:23:18,780
+Peripheral Vein لإنها تعمل Thrombophlebitis تمام؟
+
+310
+00:23:21,830 --> 00:23:26,670
+حكينا عن ذلك عندما نعمل blood sampling كثير طبعاً
+
+311
+00:23:26,670 --> 00:23:31,970
+والحاجة المهمة أنه أنا بدي أقيس الـCBP لهذا المريض
+
+312
+00:23:31,970 --> 00:23:34,850
+أحياناً بنركب الـCentral Line يا جماعة عشان نعمل
+
+313
+00:23:34,850 --> 00:23:38,550
+إيش؟اللي هو الـ Temporary Pacemaker لمريض اللي هو
+
+314
+00:23:38,550 --> 00:23:43,410
+Pacing Y عشان أدخل Wire و أدخله على اللي هو الـ
+
+315
+00:23:43,410 --> 00:23:47,570
+Right Atrium عشان و أركب فيه اللي هو الـ Pacemaker
+
+316
+00:23:47,570 --> 00:23:51,310
+عشان يبدأ يعمل Stimulation أو يبدأ يعمل Pacing كل
+
+317
+00:23:51,310 --> 00:23:54,790
+هذه هي الـ Indications تبع الـ Central Line الـ
+
+318
+00:23:54,790 --> 00:23:58,870
+Central Line له أكتر من نوع فيه منهم Single و منهم
+
+319
+00:23:58,870 --> 00:24:04,810
+يعني لهتيوب واحد وفيه double و triple لومن يعني
+
+320
+00:24:04,810 --> 00:24:09,490
+فيه لطيوبين و تلاتة لطيوبين و تلاتة لطيوبين و
+
+321
+00:24:09,490 --> 00:24:09,790
+تلاتة لطيوبين و تلاتة لطيوبين و تلاتة لطيوبين و
+
+322
+00:24:09,790 --> 00:24:09,910
+تلاتة لطيوبين و تلاتة لطيوبين و تلاتة لطيوبين و
+
+323
+00:24:09,910 --> 00:24:10,130
+تلاتة لطيوبين و تلاتة لطيوبين و تلاتة لطيوبين و
+
+324
+00:24:10,130 --> 00:24:10,830
+تلاتة لطيوبين و تلاتة لطيوبين و تلاتة لطيوبين و
+
+325
+00:24:10,830 --> 00:24:12,610
+تلاتة لطيوبين و تلاتة لطيوبين و تلاتة لطيوبين و
+
+326
+00:24:12,610 --> 00:24:18,690
+تلاتة لطيوبين و
+
+327
+00:24:18,690 --> 00:24:27,410
+تلاتة لطيوبين و تلاتة لطيوبين
+
+328
+00:24:27,410 --> 00:24:27,530
+و
+
+329
+00:24:33,760 --> 00:24:37,420
+المهم اللي بديكوا تعرفوه، ما تفكروش أنه بما أنه
+
+330
+00:24:37,420 --> 00:24:40,380
+أشوف في صورة بس الـCentral Line هنا عشان يكون
+
+331
+00:24:40,380 --> 00:24:50,720
+الشرق أسهل الصورة البيضة شوية، و أنا،
+
+332
+00:24:50,720 --> 00:24:58,390
+طيب لحظة، مهم مش ماشينا كتير، بس أيوةلحظي هاي الـ
+
+333
+00:24:58,390 --> 00:25:01,910
+lumens، هاي واحد، اتنين، تلاتة، اعتبر انه NDH هذه
+
+334
+00:25:01,910 --> 00:25:04,110
+طبعا هي swine gains لكن الـ central line زيها
+
+335
+00:25:04,110 --> 00:25:07,270
+بالظبط بس مش طويل بهذه الطولة على أي حالة اعتبروا
+
+336
+00:25:07,270 --> 00:25:09,230
+ان هذا الـ central line وهي ال lumens اللي بحكي
+
+337
+00:25:09,230 --> 00:25:12,610
+عنها اللي كنت بدي احكي فيه ان اصحك تفكر ان ال
+
+338
+00:25:12,610 --> 00:25:16,480
+lumens هدولة بالاخر لما بوصلالـ Drug تبعك من الـ
+
+339
+00:25:16,480 --> 00:25:19,520
+Lumen هادهان والـ Drug بوصل من الـ Lumen هادهان إن
+
+340
+00:25:19,520 --> 00:25:22,540
+هما بختبطوا مع بعض، لأ الـ Lumen هادهان ماشي من
+
+341
+00:25:22,540 --> 00:25:29,730
+أول الطريق لآخر ماده الصدق هو الـ Tubeوالتاني كذلك
+
+342
+00:25:29,730 --> 00:25:33,890
+والتالت كذلك عاملين بالظبط زي حكاية سلك الكهربا
+
+343
+00:25:33,890 --> 00:25:36,670
+اللي بيكون فيه الـCable الكبير اللي بيكون فيه تلت
+
+344
+00:25:36,670 --> 00:25:42,850
+خطوط أحمر وأصفر أو أصمر مثلا لكن كل واحد فيهم ماشي
+
+345
+00:25:42,850 --> 00:25:46,610
+لحاله وعليه غلاب والكهربا بتمشي فيه لحالها من غير
+
+346
+00:25:46,610 --> 00:25:50,870
+ما تفتلط مع الكهربا اللي في الخط التاني تمام؟ وهذا
+
+347
+00:25:50,870 --> 00:25:55,930
+هي أهمية أننابنحط الـ «central line» أكتر من
+
+348
+00:25:55,930 --> 00:25:59,630
+«lumen» وبنضمن أنه مايصيرش بينهم reaction لأن كل
+
+349
+00:25:59,630 --> 00:26:05,590
+واحد فيهم بيمشي لحاله وبصب في منطقة مختلفة كمان يا
+
+350
+00:26:05,590 --> 00:26:09,090
+جماعة كيف يعني؟ يعني هتلاقي على الـ «central line»
+
+351
+00:26:09,090 --> 00:26:13,370
+مكتوب أن هذا مثلا «proximal» وهذا «distant» وهذا
+
+352
+00:26:13,370 --> 00:26:18,720
+«medial» مثلا الـ «proximal» هتلاقي بصب إيش؟الـ
+
+353
+00:26:18,720 --> 00:26:23,860
+Proximal قريبًا الـ Distal بصوت آخر واحد
+
+354
+00:26:27,240 --> 00:26:30,700
+هن ديستر تمام و ال media هيكون في المصدر فهيكون ال
+
+355
+00:26:30,700 --> 00:26:36,060
+proximal هن أقرب واحد ديستر هيكون بعيد و ال media
+
+356
+00:26:36,060 --> 00:26:42,440
+هيكون في المصدر تمام لما بدنا نركب ال central
+
+357
+00:26:42,440 --> 00:26:45,380
+venous pressure و بدنا نقيس منه ال CDP يا جماعة
+
+358
+00:26:45,380 --> 00:26:53,260
+ضروري نحط أو نركب الالـ «Central Line» أو الـ
+
+359
+00:26:53,260 --> 00:26:58,980
+«Line» نفسه تبع الـ «CVP» في الـ «Distal Lumen» مش
+
+360
+00:26:58,980 --> 00:27:02,240
+في واحد تاني مش في الـ «V» و لا الـ «Proximal»
+
+361
+00:27:02,240 --> 00:27:07,760
+عشان يكون بيديني الـ«Tip» البعيدة اللي مش بتكون
+
+362
+00:27:07,760 --> 00:27:12,620
+جدارية يعني هي مش بتكون على الـ«Lumen» من الجنب من
+
+363
+00:27:12,620 --> 00:27:16,160
+هنا أو من هنا لأ بتكون من الـ«Tip» تبعته عشان ما
+
+364
+00:27:16,160 --> 00:27:22,730
+تتأثرش فيلو كانت خابطة وراقزة على الـ Wall
+
+365
+00:27:22,730 --> 00:27:28,250
+فبالتالي هيصير الـ Fluid اللي بيطلع منها بيصير
+
+366
+00:27:28,250 --> 00:27:30,510
+Resistant لأنه خابطة في الـ Wall لكن الـ Distil
+
+367
+00:27:30,510 --> 00:27:38,010
+عادة بتكون مفتوحة أمامها الـ Flow تبع الـ Fluid
+
+368
+00:27:38,010 --> 00:27:41,230
+كنا
+
+369
+00:27:41,230 --> 00:27:45,960
+بنحكي عنها هناعن أنواعهم وحكينا عن الـ TPN حتى لو
+
+370
+00:27:45,960 --> 00:27:51,400
+بدنا نستخدمه وطبعاً لما بنركب يا جماعة Central
+
+371
+00:27:51,400 --> 00:27:54,920
+Line وفيه Multi-Loom لازم كله منه نحط label فيه
+
+372
+00:27:54,920 --> 00:27:58,740
+إيش هذا في هذا بس CBP التاني نكتب فيه والله أحنا
+
+373
+00:27:58,740 --> 00:28:03,120
+حابب ند فيه الـ TPN التالت مثلا حاطين فيهالـ
+
+374
+00:28:03,120 --> 00:28:06,020
+Maintenance Fluid أو الـ Infusion تبع الدوبامين
+
+375
+00:28:06,020 --> 00:28:10,160
+لازم نعمل label لكل واحد فيهم عشان مايصيرش الأخبطة
+
+376
+00:28:10,160 --> 00:28:13,080
+ودايمًا دايمًا يعرف إن المرضي اللي مركّبله الـ
+
+377
+00:28:13,080 --> 00:28:18,640
+Central Line وإله مركّب فيه Infusion Drug بنفعش
+
+378
+00:28:18,640 --> 00:28:23,100
+تيجي تعمل الـ Stop وتعمل بوشلة أي medication لإنك
+
+379
+00:28:23,100 --> 00:28:27,750
+هتعمل بوشلة كمية كبيرة من الدوة اللي موجود فيهالـ
+
+380
+00:28:27,750 --> 00:28:30,870
+Central Line و تخلّي المرض يقودها فجأة مع إنه ممكن
+
+381
+00:28:30,870 --> 00:28:34,630
+أنت تكون امركب مثلا دوبامين على رد خمسة مليلتر per
+
+382
+00:28:34,630 --> 00:28:38,790
+hour تصور أنه أنت تيجي من منطقة قريب من الـ
+
+383
+00:28:38,790 --> 00:28:43,430
+Central Line وتروح عامل مدّي فيروسفين مثلا وإن هو
+
+384
+00:28:43,430 --> 00:28:46,770
+أصلا غلط يعني في ال ICU وإنه ممكن تدّي بوش ولكن
+
+385
+00:28:46,770 --> 00:28:53,500
+بلاش فيروسفين قدّيت عشرة ساعات صلاة بوشفانت روحت
+
+386
+00:28:53,500 --> 00:28:59,580
+عملت بُش لكل كمية تبع الدوبامين اللي كان في الـ
+
+387
+00:28:59,580 --> 00:29:03,380
+central line عملت في إيش؟ في moments مع إن هم طب
+
+388
+00:29:03,380 --> 00:29:06,360
+الكمية ده مش أقل من تلاتة CC طب المريض بياخد خمسة
+
+389
+00:29:06,360 --> 00:29:10,800
+milliliter في ال hour كلها روحت أنت مدّليها في
+
+390
+00:29:10,800 --> 00:29:14,560
+لحظة فإيش بتحصل في الضغط؟ لذلك منمو نهائيًا مريض
+
+391
+00:29:14,560 --> 00:29:17,620
+ماشي على infusing drug نروح احنا من ال stop cook
+
+392
+00:29:17,620 --> 00:29:23,790
+القريب نروح هنا عاملين إيش؟ بُشأي medication حتى
+
+393
+00:29:23,790 --> 00:29:27,930
+لو اضطريت أو جيت أعمل حاجة لازم أخد بيها space و
+
+394
+00:29:27,930 --> 00:29:33,230
+أسحب كل الكمية هذه و بعدين إيش أعمل ال irrigation
+
+395
+00:29:33,230 --> 00:29:39,290
+إذا اضطريت أن أعمل كيف؟
+
+396
+00:29:40,380 --> 00:29:45,040
+كيف بدي أركب الـ Central Line وإيش بدي أجهز بدل ما
+
+397
+00:29:45,040 --> 00:29:48,860
+نحكي عنه بدي أرفعلكم فيديو بيوضح كيف القفبات وفيها
+
+398
+00:29:48,860 --> 00:29:53,960
+كل الإجراءات والـ Equipment هذه اللي أمامكم فيديو
+
+399
+00:29:53,960 --> 00:29:57,880
+جدا سهل ومريح جدا وموضوعه فيه الـ Equipment وفيه
+
+400
+00:29:57,880 --> 00:30:02,900
+التفصيل المملكة وخطوة كيف بدي أعملوها وليش عشان
+
+401
+00:30:02,900 --> 00:30:08,120
+أريحكم ويكون شرح أوضح بكتير تمام كل هذا الكلام
+
+402
+00:30:08,120 --> 00:30:13,840
+هنشرحه فيالـ Central Line وهي طريقة ادخاله وطبعاً
+
+403
+00:30:13,840 --> 00:30:19,060
+أول حاجة بيحدد الطبيب المكان اللي بيدخل فيه سواء
+
+404
+00:30:19,060 --> 00:30:22,120
+من الـ Central Line على الـ «طلب» تبع الـ
+
+405
+00:30:22,120 --> 00:30:26,780
+Clavicular Bone وبعدين بدخل فيه الـ Needle بعد ما
+
+406
+00:30:26,780 --> 00:30:30,480
+بدخل فيه الـ Needle بيحدد قط لقمعه بلط بقيني الـ
+
+407
+00:30:30,480 --> 00:30:33,980
+Needle و بخشش Wire و بعد ما بخشش الـ Wire بعمل
+
+408
+00:30:35,300 --> 00:30:37,940
+بطلّق الـ needle خالص وبعدين بعمل dilatation كله
+
+409
+00:30:37,940 --> 00:30:40,960
+حتشوفوه في الفيديو بس بدي أوصله لكم الفكرة وبعد ما
+
+410
+00:30:40,960 --> 00:30:44,540
+بخشش بعمل dilatation بقيم ال dilator وبخشش ال
+
+411
+00:30:44,540 --> 00:30:49,680
+catheter وبعد ما بخشش ال catheter بثبتها بخطان
+
+412
+00:30:49,680 --> 00:30:54,160
+يعني sheet
+
+413
+00:30:54,160 --> 00:31:00,340
+تبعت قسطرة
+
+414
+00:31:01,980 --> 00:31:05,320
+وطبعًا بعدها لازم يركّب زي ما أحنا شايفين لازم
+
+415
+00:31:05,320 --> 00:31:08,680
+يعمل الـ X-Ray عشان يشوف أين مستوى الـ Depth تبع
+
+416
+00:31:08,680 --> 00:31:13,120
+الـ Central Line أه طبعًا في خلال مراحله هاي ممكن
+
+417
+00:31:13,120 --> 00:31:16,040
+جدًا مريض يخش في Bradycardia لإنه يصير Stimulation
+
+418
+00:31:16,040 --> 00:31:21,700
+للـVagus nerve ممكن يلاقي إنه الـCentral Line Deep
+
+419
+00:31:21,700 --> 00:31:27,020
+ويحتاج إنه يرفعه شوية تمام؟ طبعًا لازم يتأكد من
+
+420
+00:31:27,020 --> 00:31:29,980
+إنه برضه الـDirection تبعه إنه ماشي ونزل على
+
+421
+00:31:29,980 --> 00:31:33,030
+الـHeart فعلا مش طلع فوقعلى الـ carotid كل هذه
+
+422
+00:31:33,030 --> 00:31:35,370
+الحاجات اللي هتشوفوها في الفيديو الـ complication
+
+423
+00:31:35,370 --> 00:31:37,150
+تبعته زي ما حكينا هو يمكنه يعمل cardiac
+
+424
+00:31:37,150 --> 00:31:39,730
+dysrhythmia يمكنه يعمل نيموهيمو ثوركس يمكنه يعمل
+
+425
+00:31:39,730 --> 00:31:43,170
+أصلا bleeding أو hematoma في المكان تبعه ممكن كتير
+
+426
+00:31:43,170 --> 00:31:48,290
+حاجات تتصير انه يصير شوية extravasation أو الـ
+
+427
+00:31:48,290 --> 00:31:51,830
+guide أو ال wire يا جماعة يعني أحد المرات بذكر أنه
+
+428
+00:31:51,830 --> 00:31:54,530
+مرة سحل ال wire كلهيته في المريض وحتاج المريض يعمل
+
+429
+00:31:54,530 --> 00:31:59,270
+open heart عشان يطلقه منه ال wire ال wire اللي هو
+
+430
+00:31:59,270 --> 00:32:07,270
+طبعا طويل زي ما انتوا بتعرفواالقياس تبعه هحكي على
+
+431
+00:32:07,270 --> 00:32:10,530
+الصورة كيف بننقصه أهم حاجة يا جماعة أنه أنا فيه
+
+432
+00:32:10,530 --> 00:32:16,040
+عندى مريض نايمطبعاً بدي أحكي حاجة لإن في كتير ناس
+
+433
+00:32:16,040 --> 00:32:20,980
+بتفكر إن مابنفعش أقيص CBP لمريد إلا إذا كان في
+
+434
+00:32:20,980 --> 00:32:24,380
+اللي هو Supine Position أو نام على دهره لأ حتى لو
+
+435
+00:32:24,380 --> 00:32:28,400
+كان المريض يعني Sitting Position ممكن أعمل Zeroing
+
+436
+00:32:28,400 --> 00:32:34,160
+وأقيص اللي هو الـCBP الفكرة إنه أنا بدي أكون فيه
+
+437
+00:32:34,160 --> 00:32:37,980
+أندي مريض أحدد على المريض الـZero Point إيش يعني؟
+
+438
+00:32:37,980 --> 00:32:43,760
+يعني من بعد هذه النقطةمن بعد هذه النقطة وفوق، كم
+
+439
+00:32:43,760 --> 00:32:47,580
+فيه pressure في هذا المكان؟ وين هذا المكان؟ اللي
+
+440
+00:32:47,580 --> 00:32:52,760
+هو الـCentral Vein اللي أنا فيه، كويس، طيب، كيف
+
+441
+00:32:52,760 --> 00:32:57,780
+بدي أحدد القصة هذه؟ بدي يكون في عندي كيس محلول،
+
+442
+00:32:57,780 --> 00:33:00,800
+fluid، وطبعا عارفين إن أحطه، حكينا إن فيه هبرنازل
+
+443
+00:33:00,800 --> 00:33:05,630
+سماعي، okayوالكيس المحلول هذا نازل، اعتبره هذا أن
+
+444
+00:33:05,630 --> 00:33:09,930
+هو الكيس المحلول ونازل على اللي هي حاجة بنسميها
+
+445
+00:33:09,930 --> 00:33:14,290
+المصرة أو الـ monometer اللي هي إيش وظيفته، أشوف
+
+446
+00:33:14,290 --> 00:33:23,910
+بس هناهيّاتها المصطرة، وهي عند المريض، وفي
+
+447
+00:33:23,910 --> 00:33:32,870
+كيس محلول مشبوك فوق بيغذّي المصطرة، وهو كيس محلول
+
+448
+00:33:32,870 --> 00:33:36,730
+بيغذّي المصطرة، ومن المصطرة طالع Line Extension
+
+449
+00:33:36,730 --> 00:33:41,330
+Tubeورايح لمين؟ للمريض ومشبوك في الـ Central Line
+
+450
+00:33:41,330 --> 00:33:44,990
+اللي مركب عند المريض، تمام؟ الآن بدي أعمل حاجة
+
+451
+00:33:44,990 --> 00:33:48,950
+اللي بنسميها الـ Zeroing تمام، إيش الـ Zeroing
+
+452
+00:33:48,950 --> 00:33:54,170
+هذا؟ إنه يكون المريض ونقطة الصفر اللي في المصطرة،
+
+453
+00:33:54,170 --> 00:33:57,790
+هاي الصفر اللي في المصطرة والمريض على نفس المستوى،
+
+454
+00:33:57,790 --> 00:34:02,370
+تمام؟ ليش؟ عشان لما أبدأ أنا أعبي سائل في المصطرة
+
+455
+00:34:02,370 --> 00:34:08,010
+وبعدين أسمح للسائل ينزل من المصطرة للمريضوإن ما
+
+456
+00:34:08,010 --> 00:34:11,370
+بيصير بتساوى ال pressure في المريض وفي المصطرة،
+
+457
+00:34:11,370 --> 00:34:16,630
+هتوقف السائل اللي جاعت بينساب من المصطرة للمريض،
+
+458
+00:34:16,630 --> 00:34:21,570
+هينزل من الضغط الأعلى للضغط الأقل، لما يتساوى،
+
+459
+00:34:21,570 --> 00:34:24,650
+هيوقف، هيكون هو هذا ال pressure اللي جوا عند
+
+460
+00:34:24,650 --> 00:34:28,190
+المريض، خمسة سنتمتر مال، يا ستة سنتمتر مال، وإن
+
+461
+00:34:28,190 --> 00:34:31,350
+واجف هو هذا الضغط اللي جوا عند المريض، اتساوى
+
+462
+00:34:31,350 --> 00:34:36,540
+الضغط هان مع هان، عشان يتساوى الضغطينويكون هذا
+
+463
+00:34:36,540 --> 00:34:39,740
+الارتفاع هو الضغط اللي هي لازم يكون النقطة تبقية
+
+464
+00:34:39,740 --> 00:34:44,700
+الصفر تبقيتهم واحدة وإلا لو كان هذي أعتبره المصر
+
+465
+00:34:44,700 --> 00:34:51,140
+هذي نزل لتحت ووداني هنا تمانية وبدل ما هو الـ0
+
+466
+00:34:51,140 --> 00:34:55,800
+تبقى ها لأ هي هيك يعني هيك الـ7 أعتبره بيكون هذه
+
+467
+00:34:55,800 --> 00:35:00,260
+القراءة فيها غش زي الميزان اللي واحد حاطط في قاع
+
+468
+00:35:00,260 --> 00:35:05,620
+الميزان نص كيلو ووزن لجاءت كيلو فداك نص كيلوتمام؟
+
+469
+00:35:05,620 --> 00:35:12,060
+فكيف الخطوات بالترتيب؟ إذا واحد بشبك أنا المريض أو
+
+470
+00:35:12,060 --> 00:35:16,760
+بجيب مصطرة والمصطرة بغزيها في 500 CC Fluid مثلا
+
+471
+00:35:16,760 --> 00:35:20,680
+بتغزي المصطرة تيستوب كوك يعني أطالق منه extension
+
+472
+00:35:20,680 --> 00:35:22,880
+الـ tube و أروح على الـ central line تبع المريض
+
+473
+00:35:22,880 --> 00:35:27,380
+بعمل zeroing السفر عند المريض يكون السفر مع السفر
+
+474
+00:35:27,380 --> 00:35:30,420
+عند المصطرة يكون هو السفر عند المريض طب السفر عند
+
+475
+00:35:30,420 --> 00:35:35,400
+المصطرة أرفناها سفرطب الصفر عند المريض أين؟ الصفر
+
+476
+00:35:35,400 --> 00:35:38,740
+عند المريض هذا عبارة عن تقاطعه نقطتين، مين هما
+
+477
+00:35:38,740 --> 00:35:43,340
+النقطتين؟ النقطة الأولى هي الـ mid-axillary line
+
+478
+00:35:43,340 --> 00:35:46,280
+مع ال fifth intercostal space، وين بتقاطعه في
+
+479
+00:35:46,280 --> 00:35:50,400
+النقطة هذه؟ هذه النقطة هي بدها تكون جبال بالظبط
+
+480
+00:35:50,400 --> 00:35:53,940
+نقطة الصفر، طب كيف أوزنهم يكونوا جبال بعض بالظبط؟
+
+481
+00:35:53,940 --> 00:35:57,660
+يا أما بعينك، يا أما بالعين، يا أما باستخدام ميزان
+
+482
+00:35:57,660 --> 00:36:01,350
+الميّه، شايفينوا هذا ميزان الميّه؟عندما تصبح نقطة
+
+483
+00:36:01,350 --> 00:36:04,310
+السفر عند المريض، عندما تصبح نقطة الهواء هادى في
+
+484
+00:36:04,310 --> 00:36:09,840
+ميزان الميّهفي النصف بيكون أه صارت الآن هذه
+
+485
+00:36:09,840 --> 00:36:14,260
+مستقيمة 100% يعني الزاوية 180 درجة عند زاوية 180
+
+486
+00:36:14,260 --> 00:36:17,720
+درجة هنا بتلاقي نقطة الهواء هذه في نص الميزان
+
+487
+00:36:17,720 --> 00:36:21,140
+معناه الآن أن نقطة الصفر هنا هي نقطة الصفر هناك
+
+488
+00:36:21,140 --> 00:36:26,500
+طيب بعد ذلك إيش بده أسوي؟ أول حاجة بفتح ال fluid
+
+489
+00:36:26,500 --> 00:36:30,580
+من ال saline اللي فوق فوق، direct أ mean المريض
+
+490
+00:36:30,580 --> 00:36:33,820
+ليش؟ عشان أشوف ال flow لازم كل flow إيش ماله؟
+
+491
+00:36:33,820 --> 00:36:39,800
+runningRunning تمام؟ طب ليش؟ عشان مايكونش مادة لو
+
+492
+00:36:39,800 --> 00:36:42,980
+كان مش Running حكون فيه Resistance حدين قراءة CBD
+
+493
+00:36:42,980 --> 00:36:47,080
+عالية طب okay فتحته لقيته Running تمام تمام الآن
+
+494
+00:36:47,080 --> 00:36:50,560
+بتروح بتسكر و بتعب بالمصطرة يعني بغير الاتجاه تبع
+
+495
+00:36:50,560 --> 00:36:54,100
+ال stop book هذا زي ما هو أنا فتح زي ما انتوا
+
+496
+00:36:54,100 --> 00:36:57,380
+شايفين فتح المحلول اللي جاي بغز المصطرة فتحه على
+
+497
+00:36:57,380 --> 00:37:03,160
+المريض Running تمام تمام بعد هيكبفتح عشان إيش؟ أعب
+
+498
+00:37:03,160 --> 00:37:05,440
+المسطرة، ببدأ ينتلي هاي السائق، شايفين؟ في
+
+499
+00:37:05,440 --> 00:37:08,620
+المسطرة، في المسطرة، أيوة، بدأ هنا، عفوا، ننتلي،
+
+500
+00:37:08,620 --> 00:37:12,120
+ننتلي، ننتلي، ننتلي، تمام، انتلت المسطرة، كويس،
+
+501
+00:37:12,120 --> 00:37:18,260
+الآن ببدأ أفتح من المسطرة على المريضبفتح من
+
+502
+00:37:18,260 --> 00:37:21,780
+المسطرة على المريض اللي هو لما بفتح من المسطرة على
+
+503
+00:37:21,780 --> 00:37:24,600
+المريض مبدأ إيه؟ ينزل، ينزل، ينزل، ينزل، ينزل،
+
+504
+00:37:24,600 --> 00:37:24,680
+ينزل، ينزل، ينزل، ينزل، ينزل، ينزل، ينزل، ينزل،
+
+505
+00:37:24,680 --> 00:37:26,000
+ينزل، ينزل، ينزل، ينزل، ينزل، ينزل، ينزل، ينزل،
+
+506
+00:37:26,000 --> 00:37:26,020
+ينزل، ينزل، ينزل، ينزل، ينزل، ينزل، ينزل، ينزل،
+
+507
+00:37:26,020 --> 00:37:33,120
+ينزل، ينزل، ينزل، ينزل، ينزل، ينزل، ينزل، ينزل، ي
+
+508
+00:37:33,150 --> 00:37:36,610
+خالص بيضلوا يعملوا حاجة بنسميها Fluctuation مع
+
+509
+00:37:36,610 --> 00:37:40,490
+إيش؟ مع حركة النفس لما يبدأ يعمل الـ Fluctuation
+
+510
+00:37:40,490 --> 00:37:43,910
+هذا مع حركة النفس يعني بطلع واحد و بنزل واحد، بطلع
+
+511
+00:37:43,910 --> 00:37:50,310
+واحد او اتنين و بنزل اتنين، بكون هو عند النقطة هذه
+
+512
+00:37:50,310 --> 00:37:54,230
+هو الـCDD فمثلا عند خمسة صار يطلع شوية و ينزل شوية
+
+513
+00:37:54,230 --> 00:37:58,990
+يعني هو الـCDD خمسة تبع المريض هذا تمام برضه يعني
+
+514
+00:37:58,990 --> 00:38:02,800
+من خلال الفيديو ان شاء الله هتكونالوضع أوضح، واضح،
+
+515
+00:38:02,800 --> 00:38:05,760
+مع أنه اعتقد انه يعني انا شراحته مافيه الكفاية،
+
+516
+00:38:05,760 --> 00:38:09,660
+okay؟ وبنكون سجلنا هذه القراءة، هذه طريقة قياس
+
+517
+00:38:09,660 --> 00:38:13,060
+طبعا الـCDD عن طريق اللي هو الميه، لذلك بنسجل ان
+
+518
+00:38:13,060 --> 00:38:20,760
+الـCDD خمسة مثلا، سانتي، نتر، water، okay؟طبعًا،
+
+519
+00:38:20,760 --> 00:38:23,760
+عندما يكون لدينا Transducer، سنقوم بنفس الشيء بس
+
+520
+00:38:23,760 --> 00:38:27,880
+سنشبك كل هذا الكلام على Transducer وسنقوم بالـ
+
+521
+00:38:27,880 --> 00:38:32,800
+Zeroing يعني سأقول للجهاز إنه بعد ما أعملت الـ
+
+522
+00:38:32,800 --> 00:38:35,300
+Zeroing، الـ Pressure بعد ما أعمل أيش في الـ
+
+523
+00:38:35,300 --> 00:38:39,500
+Zeroing لـ Transducer نفسه، هو سيكون بالظبط عامله
+
+524
+00:38:39,500 --> 00:38:43,760
+اللي هو مع نقطة الصفر تبع المريض ويكونوا على نفس
+
+525
+00:38:43,760 --> 00:38:48,310
+المستوى وأثابتهفي المصطرة اللي جنب المريض أو في
+
+526
+00:38:48,310 --> 00:38:51,110
+الـ Stand اللي جنب المريض وبعدها أعمل للجهاز
+
+527
+00:38:51,110 --> 00:38:53,970
+calibration إنه هذه نقطة الـ Zero الـ Zero اللي
+
+528
+00:38:53,970 --> 00:38:59,110
+بنسميها Zeroing وبعدها يقدر الجهاز يقيس فبديني إيش
+
+529
+00:38:59,110 --> 00:39:02,990
+في فوق هذا الـ Zero وبراشار بديني إياه ويقرألي
+
+530
+00:39:02,990 --> 00:39:10,850
+إياه وزي ما شفنا إنه الدغط الذئبقي أقل من الدغط ال
+
+531
+00:39:10,850 --> 00:39:12,550
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+532
+00:39:12,550 --> 00:39:13,450
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+533
+00:39:13,450 --> 00:39:14,570
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+534
+00:39:14,570 --> 00:39:15,410
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+535
+00:39:15,410 --> 00:39:15,430
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+536
+00:39:15,430 --> 00:39:18,130
+ال .. ال .. ال .. ال .. ال .. ال .. التمام؟ هذا هو
+
+537
+00:39:18,130 --> 00:39:24,870
+المؤشر تبع الـCVB وهي جاتوه هنا بيديني ده كله أزرق
+
+538
+00:39:24,870 --> 00:39:31,350
+وبيديني هنا إنه الـCVB جدش الرقم تبعه تمانية،
+
+539
+00:39:31,350 --> 00:39:36,750
+سبعة، وات، وات، وات، وات، وات، وات، وات، وات، وات،
+
+540
+00:39:36,750 --> 00:39:37,410
+وات، وات، وات، وات، وات، وات، وات، وات، وات، وات،
+
+541
+00:39:37,410 --> 00:39:40,010
+وات، وات، وات، وات، وات، وات، وات، وات، وات، وات،
+
+542
+00:39:40,010 --> 00:39:42,070
+وات، وات، وات، وات، وات، وات، وات، وات، وات، وات،
+
+543
+00:39:42,070 --> 00:39:46,110
+وات، وات، وات،
+
+544
+00:39:50,190 --> 00:39:52,910
+حتى في الـ Open Heart Surgeons بطلوا يستخدموها
+
+545
+00:39:52,910 --> 00:39:55,470
+لأنه في وسائل تانية كتير بتخليني أعرف الـ
+
+546
+00:39:55,470 --> 00:39:58,430
+Pulmonary Artery Pressure جداش و الـ Lung Pressure
+
+547
+00:39:58,430 --> 00:40:02,610
+حتى و Cardiac Output هي يعني كانت مميزتها أنك
+
+548
+00:40:02,610 --> 00:40:04,930
+تعرفي الـ Cardiac Output لكن الآن بالـ
+
+549
+00:40:04,930 --> 00:40:07,770
+Calculations بيقدروا يعرفوا كل الحاجات هذه فمش
+
+550
+00:40:07,770 --> 00:40:11,870
+محتاجين إنهم يركبوا Swans Gans Swans Gans Catheter
+
+551
+00:40:11,870 --> 00:40:17,190
+عشان يعرفوها هي فكرتها كانت أنه انت فيه Catheter
+
+552
+00:40:17,190 --> 00:40:21,780
+طويلةوبتدخل هذا الـ catheter لما نتوصف للـ
+
+553
+00:40:21,780 --> 00:40:23,960
+pulmonary artery وفي الـ pulmonary artery هذه
+
+554
+00:40:23,960 --> 00:40:31,400
+بيكون فيها بالون فالبالون بينفخ في لحظة الـ
+
+555
+00:40:31,400 --> 00:40:38,560
+diastole يعني وفي اللحظة هذه بياخد قياس للـ
+
+556
+00:40:38,560 --> 00:40:43,200
+pulmonary artery pressure كام كمية الضغط اللي فيه
+
+557
+00:40:43,200 --> 00:40:45,780
+ومن خلالها بيحددوا طبعاً
+
+558
+00:40:51,130 --> 00:40:54,590
+الـ lung أكتر من طبقات تكون مشكلة related عادة
+
+559
+00:40:54,590 --> 00:40:58,610
+للقلب هذه الصورة اللي أنا بدورها انها تشايف ان انت
+
+560
+00:40:58,610 --> 00:41:01,330
+بخش شهانة زي الـ central line عادي لكن بيختلف تمشي
+
+561
+00:41:01,330 --> 00:41:03,650
+بيكمل لما يوصل ال right ventricle ومن ال right
+
+562
+00:41:03,650 --> 00:41:08,110
+ventricle بيطلع من ال right ventricle sorry من ال
+
+563
+00:41:08,110 --> 00:41:12,130
+right ventricle هيمشي و يطلع حياته لما نوصل لوين
+
+564
+00:41:12,130 --> 00:41:17,680
+لالpalmona دي طبعا هو إيش يعنيعالـ Pulmonary
+
+565
+00:41:17,680 --> 00:41:20,660
+Artery، لو عارفين أحنا الـ Pulmonary Artery تروح
+
+566
+00:41:20,660 --> 00:41:24,940
+في Right و في Left، فهتبروا أنه يروح على واحد منهم
+
+567
+00:41:24,940 --> 00:41:28,140
+من الـ Pulmonary Arteries وبالتالي هيبدأ يقسل في
+
+568
+00:41:28,140 --> 00:41:33,260
+حاجة اسمها إيه الـ Pulmonary Lung Pressure آه،
+
+569
+00:41:33,260 --> 00:41:42,920
+والـ Pulmonary Artery Pressure ما
+
+570
+00:41:42,920 --> 00:41:49,100
+عادش هذا الكلام يعني حيوي ولاولا في حد بيرضى إنه
+
+571
+00:41:49,100 --> 00:41:52,960
+يستخدم سوان غنز كاتيتر عشان الحاجات هذه الآن في
+
+572
+00:41:52,960 --> 00:41:57,180
+وسائل كتير مختورة خاصة بقى لوجود الـ Cardiac
+
+573
+00:41:57,180 --> 00:42:02,320
+Catheterization اللي بتحل مشاكل المرضى يعني بيجي
+
+574
+00:42:02,320 --> 00:42:06,200
+المريض في picture of angina أو MRI بيعملوا
+
+575
+00:42:06,200 --> 00:42:09,720
+catheterization و بيحلوا المشكلة اللي مخالية تخش
+
+576
+00:42:09,720 --> 00:42:13,120
+في cardiogenic shock زمان كانت الأمور بتتوقف على
+
+577
+00:42:13,120 --> 00:42:17,730
+متابعة المريض اللي عنده cardiogenic shockوعنده
+
+578
+00:42:17,730 --> 00:42:20,270
+unstable angina لكن الآن لأ الـ «Interventional
+
+579
+00:42:20,270 --> 00:42:23,610
+Cardiology» حلت المشكلة لأنهم بيعملوله «Stint»
+
+580
+00:42:23,610 --> 00:42:27,410
+ويطلعوه من الشك وبرجعوا القلب برجعوا الـ «Ejection
+
+581
+00:42:27,410 --> 00:42:32,870
+Fraction» لقى القلب بعد ما أنه يعني السبب اللي مقد
+
+582
+00:42:32,870 --> 00:42:37,990
+لإنه الـ «Ejection Fraction» يصير له يروح سواء كان
+
+583
+00:42:37,990 --> 00:42:45,370
+«Coronary Thrombosis» أو حتى إذا كان يعني «mitral»
+
+584
+00:42:45,670 --> 00:42:52,690
+فالب ريجيرج أو استينوسس فيه بنعمل repair أو بنعمل
+
+585
+00:42:52,690 --> 00:42:57,390
+replacement لفالف سواء كان يعني فالف للمشكلة أو
+
+586
+00:42:57,390 --> 00:43:01,730
+اللي هو coronary artery problem بتنحل أو حتى لو
+
+587
+00:43:01,730 --> 00:43:07,850
+كانت congenital problem بتنحل تمام هي تقريبا هذه
+
+588
+00:43:07,850 --> 00:43:11,550
+هي الحاجات اللي أنا كنت طبعا بالنسبة للـArterial
+
+589
+00:43:11,550 --> 00:43:16,100
+line الـArterial line بدي أحكي يعني هنا منمن أهم
+
+590
+00:43:16,100 --> 00:43:20,640
+مشاكل الارتري لله يعني ممكن يصير مكان الارتري إذا
+
+591
+00:43:20,640 --> 00:43:24,480
+كان فيه أي تعامل خطأ أو تسربت أي نقطة هو أن يصير
+
+592
+00:43:24,480 --> 00:43:31,100
+في إيد كل هيتها ischemia لإن نقطة هو معناها إنها
+
+593
+00:43:31,100 --> 00:43:35,460
+منعت وصول blood الارتري عن الدم هيمشي هيكطبعاً بطل
+
+594
+00:43:35,460 --> 00:43:39,260
+الدم يوصل هيك فبالتالي هتصير في المنطقة هذه الـ
+
+595
+00:43:39,260 --> 00:43:42,400
+Scheme هدن المشاكل تبعت الـ Arterial Lines لو
+
+596
+00:43:42,400 --> 00:43:44,620
+اتركبنا Arterial Lines زي الـ Arterial Lines
+
+597
+00:43:44,620 --> 00:43:47,220
+المتابعة اللي هو في الـ Intensive Blood Pressure
+
+598
+00:43:47,220 --> 00:43:55,020
+الـ Vascular Disorder مش هنضطرقلها في خلال الشرح
+
+599
+00:43:55,020 --> 00:44:00,820
+هذا إن شاء الله يعني هذا هأسسني و أروح على موضوع
+
+600
+00:44:00,820 --> 00:44:08,120
+الشك فورا ونبدأ نحكي عنالشُك وأنواع الشُك، هياته،
+
+601
+00:44:08,120 --> 00:44:14,680
+أنواع الشُك وكيف بدنا نعمل management لالشُك وان
+
+602
+00:44:14,680 --> 00:44:18,880
+شاء الله هرفعكوا الفيديوهات تبعها يعطيكم العافية
+
+603
+00:44:18,880 --> 00:44:25,600
+وأي سؤال يعني على وسائل الاتصال اللي بنستخدمها
+
+604
+00:44:25,600 --> 00:44:29,000
+هنجوبكوا والسلام عليكم ورحمة الله
+
diff --git a/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/xzJXVXMLQCM_raw.json b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/xzJXVXMLQCM_raw.json
new file mode 100644
index 0000000000000000000000000000000000000000..21bf95ca163fcd95c4fc71ad9f00f106b6226e86
--- /dev/null
+++ b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/xzJXVXMLQCM_raw.json
@@ -0,0 +1 @@
+{"segments": [{"id": 1, "seek": 2378, "start": 2.6, "end": 23.78, "text": "بسم الله الرحمن الرحيم السلام عليكم ورحمة الله وبركاته اليوم إن شاء الله رب العالمين هنحكي عن ال invasive hemodynamic monitoring ال chapter هذا الهدف الأساسي منه أنه نتعرف على ال hemodynamic stability وكيف بدي", "tokens": [3555, 38251, 21984, 34892, 5016, 27842, 34892, 5016, 32640, 21136, 37440, 25894, 24793, 4032, 2288, 35571, 3660, 21984, 4032, 26890, 4117, 9307, 3224, 45595, 20498, 36145, 13412, 16606, 21984, 12602, 3555, 18863, 45340, 9957, 8032, 1863, 5016, 4117, 1829, 18871, 2423, 30894, 8636, 34988, 11028, 2423, 7187, 23758, 2423, 3224, 3215, 5172, 16247, 3794, 32277, 1829, 9154, 3224, 14739, 3224, 8717, 2655, 3615, 28480, 15844, 2423, 8636, 34988, 11826, 4032, 4117, 33911, 4724, 16254], "avg_logprob": -0.15760416507720948, "compression_ratio": 1.6318407960199004, "no_speech_prob": 2.5153160095214844e-05, "words": [{"start": 2.6, "end": 2.88, "word": "بسم", "probability": 0.829345703125}, {"start": 2.88, 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{"start": 816.2, "end": 817.02, "word": " المريض", "probability": 0.9892578125}, {"start": 817.02, "end": 817.42, "word": " يعني", "probability": 0.80078125}, {"start": 817.42, "end": 818.54, "word": " عنده", "probability": 0.96923828125}, {"start": 818.54, "end": 818.92, "word": " كمية", "probability": 0.9970703125}, {"start": 818.92, "end": 819.1, "word": " من", "probability": 0.97900390625}, {"start": 819.1, "end": 819.3, "word": " السوائل", "probability": 0.94873046875}], "temperature": 1.0}, {"id": 37, "seek": 83669, "start": 822.17, "end": 836.69, "text": "لـ diuretics عشان تخفف هذه السوائل طب من وين؟ نحنا ممكن نحط الـ central line هذا عدة طرق ممكن تحطها", "tokens": [1211, 39184, 1026, 540, 83, 1167, 6225, 8592, 7649, 6055, 9778, 5172, 5172, 29538, 21136, 2407, 16373, 1211, 23032, 3555, 9154, 4032, 9957, 22807, 8717, 5016, 8315, 3714, 43020, 8717, 5016, 9566, 2423, 39184, 5777, 1622, 23758, 6225, 41891, 23032, 2288, 4587, 3714, 43020, 6055, 5016, 9566, 11296], "avg_logprob": 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"probability": 0.963134765625}, {"start": 827.85, "end": 829.95, "word": " نحط", "probability": 0.9195963541666666}, {"start": 829.95, "end": 831.57, "word": " الـ", "probability": 0.93310546875}, {"start": 831.57, "end": 832.67, "word": " central", "probability": 0.290771484375}, {"start": 832.67, "end": 833.05, "word": " line", "probability": 0.94970703125}, {"start": 833.05, "end": 833.47, "word": " هذا", "probability": 0.73095703125}, {"start": 833.47, "end": 835.33, "word": " عدة", "probability": 0.662841796875}, {"start": 835.33, "end": 835.75, "word": " طرق", "probability": 0.8626302083333334}, {"start": 835.75, "end": 836.03, "word": " ممكن", "probability": 0.97998046875}, {"start": 836.03, "end": 836.69, "word": " تحطها", "probability": 0.9512939453125}], "temperature": 1.0}, {"id": 38, "seek": 85945, "start": 844.07, "end": 859.45, "text": "إذاً في أماكن كتير ممكن أنا أدخل منها علشان أستطيع أن أقيس الـCDP يعني مثلا ممكن ندخل من الـinternal jugular ونستقر في اللي هو 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vein و بعدين أدخل على ال thoracic vein، تمام؟ فحنشوف في جدول الآن ال advantage و ال disadvantage لكل واحد فيهم، بس اللي بدني أعرفه في النهاية، أنا هستقر في الـ", "tokens": [2304, 43020, 5551, 3215, 9778, 1211, 15844, 2423, 39184, 45026, 4947, 299, 34051, 2423, 39184, 987, 304, 299, 30669, 4032, 27842, 2423, 39184, 45026, 4947, 299, 34051, 2423, 39184, 987, 304, 299, 30669, 5551, 3555, 4587, 7578, 8717, 2304, 8592, 1829, 15844, 2423, 39184, 6360, 46367, 30669, 4032, 39182, 9957, 5551, 3215, 9778, 1211, 15844, 2423, 11588, 326, 299, 30669, 12399, 46811, 10943, 22807, 6156, 5016, 1863, 8592, 38688, 8978, 10874, 3215, 12610, 6024, 48506, 2423, 5002, 4032, 2423, 24292, 5296, 28820, 36764, 24401, 8978, 16095, 12399, 4724, 3794, 13672, 1829, 47525, 22653, 5551, 3615, 28480, 3224, 8978, 28239, 11296, 10632, 12399, 41850, 8032, 14851, 4587, 2288, 8978, 2423, 39184], "avg_logprob": -0.3262950439710875, "compression_ratio": 1.780701754385965, "no_speech_prob": 4.8041343688964844e-05, "words": 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996.13, "text": "الـ Right Ventricular Feeling Pressure أو بيسموه الـ Preload يعني كام قدرة الـ Right Ventricle على الـ Complete Relaxation علشان ياخد إيش؟", "tokens": [6027, 39184, 1779, 28290, 42750, 29945, 6776, 540, 34051, 4724, 1829, 38251, 2407, 3224, 2423, 39184, 6001, 2907, 37495, 22653, 9122, 10943, 12174, 3215, 25720, 2423, 39184, 1779, 28290, 1341, 306, 15844, 2423, 39184, 34687, 25886, 399, 11203, 8592, 7649, 7251, 47283, 3215, 11933, 1829, 8592, 22807], "avg_logprob": -0.18424478794137636, "compression_ratio": 1.2171052631578947, "no_speech_prob": 1.1920928955078125e-07, "words": [{"start": 982.09, "end": 982.37, "word": "الـ", "probability": 0.731689453125}, {"start": 982.37, "end": 982.75, "word": " Right", "probability": 0.5849609375}, {"start": 982.75, "end": 983.51, "word": " Ventricular", "probability": 0.8330078125}, {"start": 983.51, "end": 983.87, "word": " Feeling", "probability": 0.415283203125}, {"start": 983.87, "end": 984.71, "word": " Pressure", 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Drug بنفعش تيجي تعمل الـ Stop وتعمل بوشلة أي medication لإنك هتعمل بوشلة كمية كبيرة من الدوة اللي موجود فيه", "tokens": [6027, 39184, 30437, 719, 33612, 327, 34051, 2423, 39184, 11537, 5704, 6055, 3555, 3615, 32748, 37746, 10943, 9957, 5296, 31377, 2304, 8717, 25957, 1211, 7645, 5296, 28820, 36764, 24401, 8978, 16095, 6225, 8592, 7649, 19446, 1829, 9381, 13546, 8592, 16247, 9778, 3555, 9566, 3660, 4032, 28259, 32640, 14111, 995, 11778, 995, 32640, 14111, 995, 7251, 3615, 28480, 36145, 9673, 43042, 1829, 13672, 1829, 3714, 31747, 11703, 3555, 43761, 2423, 39184, 9701, 14670, 4032, 28814, 43761, 3714, 31747, 11703, 3555, 8978, 3224, 11537, 5704, 35806, 4724, 1863, 5172, 3615, 8592, 6055, 1829, 7435, 1829, 6055, 25957, 1211, 2423, 39184, 5535, 34683, 25957, 1211, 4724, 2407, 8592, 37977, 36632, 13851, 5296, 28814, 1863, 4117, 8032, 2655, 25957, 1211, 4724, 2407, 8592, 37977, 9122, 2304, 10632, 9122, 3555, 48923, 9154, 32748, 2407, 3660, 13672, 1829, 3714, 29245, 23328, 8978, 3224], 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\ No newline at end of file
diff --git a/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/xzJXVXMLQCM_raw.srt b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/xzJXVXMLQCM_raw.srt
new file mode 100644
index 0000000000000000000000000000000000000000..375374ab54ec04965300f953bbc94417a35c5d59
--- /dev/null
+++ b/PL9fwy3NUQKwagmpQFjpprkq8XcOqfsOVQ/xzJXVXMLQCM_raw.srt
@@ -0,0 +1,2420 @@
+1
+00:00:02,600 --> 00:00:05,800
+بسم الله الرحمن الرحيم السلام عليكم ورحمة الله
+
+2
+00:00:05,800 --> 00:00:11,320
+وبركاته اليوم إن شاء الله رب العالمين هنحكي عن ال
+
+3
+00:00:11,320 --> 00:00:16,700
+invasive hemodynamic monitoring ال chapter هذا
+
+4
+00:00:16,700 --> 00:00:21,880
+الهدف الأساسي منه أنه نتعرف على ال hemodynamic
+
+5
+00:00:21,880 --> 00:00:28,750
+stability وكيف بديأعمل مراقبة للـ hemodynamic
+
+6
+00:00:28,750 --> 00:00:33,030
+stability وأكتشف أي unstability فيها وما هي
+
+7
+00:00:33,030 --> 00:00:38,630
+الوسائل اللي أستخدمها عشان أعمل monitoring طبعاً
+
+8
+00:00:38,630 --> 00:00:41,530
+هنشوف إنه مش بس الـ monitor اللي هو ممكن يعمل
+
+9
+00:00:41,530 --> 00:00:47,930
+monitoring للpatient اللي أقصد monitor screen مش
+
+10
+00:00:47,930 --> 00:00:51,570
+بس هي، في حاجات تانية بالذات في ال ICU أو في ال
+
+11
+00:00:51,570 --> 00:00:56,190
+critical ill patients نستخدمهافأولاً يعني إيش يعني
+
+12
+00:00:56,190 --> 00:01:00,090
+Hemodynamic Stability؟
+
+13
+00:01:00,090 --> 00:01:04,710
+طبعاً قبل ما أبدأ أشرح وفي الموضوع هذا هنشوف اللي
+
+14
+00:01:04,710 --> 00:01:10,330
+هو أهم موضوع بتعلق في الـHemodynamic Stability
+
+15
+00:01:10,330 --> 00:01:14,170
+والـUnstability تبعيتها اللي هي تصير ال patient
+
+16
+00:01:14,170 --> 00:01:17,810
+shock فهيكون الموضوع التاني اللي هو شرحنا موضوع
+
+17
+00:01:17,810 --> 00:01:22,330
+الشك بأنواعها المختلفة الآن بالدرجة الأولى بنتعرف
+
+18
+00:01:22,330 --> 00:01:27,080
+على إيش يعني Hemo«Dynamic Stability» وإيش هي
+
+19
+00:01:27,080 --> 00:01:30,400
+الوسائل «invasive» اللي بنستخدمها عشان نعمل من
+
+20
+00:01:30,400 --> 00:01:34,900
+خلالها «monitoring» اللي هي «hemodynamic» معناها
+
+21
+00:01:34,900 --> 00:01:38,780
+الـ «movement of blood through closed circulatory
+
+22
+00:01:38,780 --> 00:01:42,860
+system» مش هي هو مشكلة blood في closed circulatory
+
+23
+00:01:42,860 --> 00:01:48,040
+system بتحرك، بيعمل «perfusion» لكلالجسم من ضمنها
+
+24
+00:01:48,040 --> 00:01:51,240
+الكيليا والكيليا بتعمل urination للـ waste اللي
+
+25
+00:01:51,240 --> 00:01:58,500
+بدهاش إياه وال fluid اللي زايدة وبتضل القسق للـ
+
+26
+00:01:58,500 --> 00:02:05,120
+blood الـ heart يعمل pumping يروح على ال lungs
+
+27
+00:02:05,120 --> 00:02:08,900
+تعمل oxygenation يرجع على ال heart ال heart يعمل
+
+28
+00:02:09,010 --> 00:02:13,390
+بومبينج ويعمل Perfusion لكل ال organs تبع الجسم
+
+29
+00:02:13,390 --> 00:02:17,050
+وزي ما حكينا من ضمنها الكلية كل ما هذه الأملية
+
+30
+00:02:17,050 --> 00:02:23,150
+مستمرة بالطريقة الصحيحة هذه كل ما مافيش عندي مشكلة
+
+31
+00:02:24,280 --> 00:02:28,360
+once إنه بيصير فيه end effect في واحدة من المشاكل
+
+32
+00:02:28,360 --> 00:02:33,440
+هذه هيتأثر كل الـ circulatory system هذا سواء كان
+
+33
+00:02:33,440 --> 00:02:37,580
+في ضعف عضلة القلب نفسها أو في قلة السوائل الموجودة
+
+34
+00:02:37,580 --> 00:02:45,220
+في الجسم أو في عدم قدرة السوائل إنها تمشي أو
+
+35
+00:02:45,220 --> 00:02:50,930
+سريانها في داخلالأوعية الدموية سواء نتيجة ضغط شديد
+
+36
+00:02:50,930 --> 00:02:58,250
+عليها أو يعني فوق هذه الأوعية الدموية أو إن
+
+37
+00:02:58,250 --> 00:03:01,410
+الأوعية الدموية هذه صارت الـ diameters تبعها
+
+38
+00:03:01,410 --> 00:03:04,450
+dilated كتير وصارت كمية السواء اللي موجودة لا تشكل
+
+39
+00:03:04,450 --> 00:03:08,550
+فيها أي حجم بحيث أنها تعمل ضغط دم هذه كل اللي
+
+40
+00:03:08,550 --> 00:03:13,550
+حكيتها يعني هي يعني علامات shock أو أنواع ال shock
+
+41
+00:03:15,070 --> 00:03:19,610
+لذلك عشان أعرف أن مالي بتبقى في أي مرحلة لازم أكون
+
+42
+00:03:19,610 --> 00:03:24,090
+عنده مراقبة مستمرة والمراقبة هذه عادة إحنا
+
+43
+00:03:24,090 --> 00:03:27,030
+بنستخدمها مع الناس اللي ماشي critically ill عن
+
+44
+00:03:27,030 --> 00:03:30,170
+طريق الـVital Sign الـVital Sign يعني أنا بشوف
+
+45
+00:03:30,170 --> 00:03:33,270
+الـBlood Pressure تبعه بس في طريقة non-invasive
+
+46
+00:03:33,270 --> 00:03:35,530
+وبشوف الـRespiratory Rate وبشوف الـTemperature
+
+47
+00:03:35,530 --> 00:03:39,410
+وبشوف الـHeart Rate لكن في الـICU وفي
+
+48
+00:03:39,410 --> 00:03:41,150
+الـCritically
+
+49
+00:03:43,140 --> 00:03:47,500
+أو في الـEmergency Rooms أو كل الـCritically Ill
+
+50
+00:03:47,500 --> 00:03:51,440
+Patients نكون بنتابعه بطرق أكتر حساسية من بس أن
+
+51
+00:03:51,440 --> 00:03:57,820
+أعرف الـVital Signs تبعته عشان هي أنا هستخدم
+
+52
+00:03:57,820 --> 00:04:03,540
+الـMonitoring Screen عشان أشوف الـECG تبعه وأشوف
+
+53
+00:04:03,540 --> 00:04:06,280
+الـHeart Rate تبعه وأشوف الـRespiratory Rate
+
+54
+00:04:06,280 --> 00:04:10,530
+وRhythm تبعه كمانوطبعا زي ما حكينا في ال monitor
+
+55
+00:04:10,530 --> 00:04:13,470
+screen أنا بشوف ال heart rate و ال rhythm تبع ال
+
+56
+00:04:13,470 --> 00:04:18,930
+heart لإني بشوف ال ECG في one lead وكمان ممكن نركب
+
+57
+00:04:18,930 --> 00:04:22,070
+للمريض حاجة نسميها central venous pressure أو
+
+58
+00:04:22,070 --> 00:04:26,490
+بالmonary artery pressure أو حاجة اسمها اللي هو ال
+
+59
+00:04:26,490 --> 00:04:31,340
+invasiveالـ Blood Pressure يعني مش بس اللي هي
+
+60
+00:04:31,340 --> 00:04:34,860
+Intra-Arterial Blood Pressure الـ Blood Pressure
+
+61
+00:04:34,860 --> 00:04:37,940
+اللي احنا بنقيصه عادة و بنعرفه عن طريق الكف فده
+
+62
+00:04:37,940 --> 00:04:41,200
+اسمه اسمه برضه Arterial Blood Pressure ها خدوا
+
+63
+00:04:41,200 --> 00:04:45,140
+بالكوا بس none in basic يعني من غير ان انا اخترق
+
+64
+00:04:45,140 --> 00:04:53,010
+الشريان انا من فوق الشريان بعملالبراشر هذا الشديد
+
+65
+00:04:53,010 --> 00:04:57,490
+بيعمل أو بيؤدي إلى انقطاع وصول الدم من الشريان إلى
+
+66
+00:04:57,490 --> 00:05:01,810
+الجزء إذا أنا رابطها على الدراع إلى الجزء السفلي
+
+67
+00:05:01,810 --> 00:05:08,730
+من الدراع وبعدين ببدأ أنا أعمل deflation للبالون
+
+68
+00:05:09,770 --> 00:05:14,690
+وببدأ أسمع في النبضة الأولى اللى بيبدأ يتدفق فيها
+
+69
+00:05:14,690 --> 00:05:19,010
+الدم وهذا بيكون الـ systole ولمّا انت تماما بيكون
+
+70
+00:05:19,010 --> 00:05:20,990
+هذا الـ diastole هذا الطريقة اللى كلهيتكوا
+
+71
+00:05:20,990 --> 00:05:24,510
+بتعرفوها بس أنا الأن بدي أعمل طريقة أكتر حساسية و
+
+72
+00:05:24,510 --> 00:05:30,050
+بدي أركب arterial catheter أو arterial cannula
+
+73
+00:05:30,050 --> 00:05:33,390
+يعني cannula في الـ artery نفسه اللى يكون ال
+
+74
+00:05:33,390 --> 00:05:36,210
+radial artery اللى هو يستخدم عادةالـ Arterial
+
+75
+00:05:36,210 --> 00:05:40,110
+Monitoring و اللي بيسميه Invasive Blood Pressure
+
+76
+00:05:41,140 --> 00:05:44,800
+وأبدأ أشوف الضغط عن طريق الـ «مونوتور» واستخدامه
+
+77
+00:05:44,800 --> 00:05:48,700
+اللي هو «transducer» يوصلي في الـ «مونوتور» ويديني
+
+78
+00:05:48,700 --> 00:05:53,400
+قراءة للـ «Blood Pressure» كل «Systole» وكل
+
+79
+00:05:53,400 --> 00:05:56,720
+«Diastole» هيديني لهم قراءة جداش كان الـ «Systolic
+
+80
+00:05:56,720 --> 00:05:59,080
+Blood Pressure» في الضغط هذه والـ «Diastolic Blood
+
+81
+00:05:59,080 --> 00:06:01,880
+Pressure» في الضغط هذه أو في الـ «Pit» هذه يعني كل
+
+82
+00:06:01,880 --> 00:06:04,360
+«Pit» ما هي «Systole» و«Diastole» الـ «Pit» اللي
+
+83
+00:06:04,360 --> 00:06:07,140
+بعدهم هيكون فيه «Systole» و«Diastole» مختلفة
+
+84
+00:06:09,950 --> 00:06:13,450
+الـ Arterial Line وفيه مركّب Invasive Blood
+
+85
+00:06:13,450 --> 00:06:17,290
+Pressure هتجد على الـ Monitor إن الـ Continuous
+
+86
+00:06:17,290 --> 00:06:19,570
+Change في الـ Reading تبقى بـ Blood Pressure لأنها
+
+87
+00:06:19,570 --> 00:06:24,010
+مع كل Reading بتدّي قراءة مختلفة طبعاً و الـ
+
+88
+00:06:24,010 --> 00:06:26,970
+Central Venous Pressure اللي هنحكي عنه بالتقصيد
+
+89
+00:06:26,970 --> 00:06:33,050
+اللي هو وظيفته إنه يقيسل مستوى أو حجم السوائل أو
+
+90
+00:06:33,050 --> 00:06:37,090
+الضغط اللي بتشكله السوائل فعلياً فيه وريد مركزي
+
+91
+00:06:38,270 --> 00:06:42,210
+وبالتالي أنا من خلال كمية الضغط هذه اللي بتشكلها
+
+92
+00:06:42,210 --> 00:06:45,650
+السوائل في الوريد المركزي بستطيع أن أعرف اللي هو
+
+93
+00:06:45,650 --> 00:06:49,650
+حجم هذه السوائل في الجسم وأحدد إذا كان المريض اللي
+
+94
+00:06:49,650 --> 00:06:52,710
+أنا بتعامل معاه هو hypervolumic ولا hypervolumic
+
+95
+00:06:54,380 --> 00:06:58,220
+الاعتماد والمقارنة مع مقاييس أخرى اللي هي blood
+
+96
+00:06:58,220 --> 00:07:01,620
+pressure كام بالإضافة لل CBP يعني اللي أنا عارفه
+
+97
+00:07:01,620 --> 00:07:05,460
+ال urine output كمان كام ال heart rate كام إذا كل
+
+98
+00:07:05,460 --> 00:07:09,060
+هذه على بعض لما تكون stable بكون المريض تبعينه
+
+99
+00:07:09,060 --> 00:07:12,560
+hemodynamically stable لما بكون فيها خلل بكون فيه
+
+100
+00:07:12,560 --> 00:07:16,240
+خلل فيه ال hemodynamic و بطل المريض unstable عشان
+
+101
+00:07:16,240 --> 00:07:25,920
+هي كفيهإجراءات مهمة لازم نعملها ونشوفها ونتبعها في
+
+102
+00:07:25,920 --> 00:07:29,340
+المريض اللي هو «critically ill» أو الـ «ICU
+
+103
+00:07:29,340 --> 00:07:33,960
+patients» علشان أستطيع أن أعرف هو «hemodynamically
+
+104
+00:07:33,960 --> 00:07:35,660
+stable» أو «unstable»
+
+105
+00:07:38,640 --> 00:07:41,600
+طبعًا زي ما حكينا أن يكون الـ «patient» «stable»
+
+106
+00:07:41,600 --> 00:07:44,880
+«hemodynamic» معناه إنه بده يكون مافيش عنده علامات
+
+107
+00:07:44,880 --> 00:07:48,640
+الـ «shock» لاحظ زي ما بحكيلك «weakness» و «baler»
+
+108
+00:07:48,640 --> 00:07:50,920
+و «confusion» و «cold» و «diminished» و «absent
+
+109
+00:07:50,920 --> 00:07:53,120
+pulse» و «cardic arrhythmia» و «low blood
+
+110
+00:07:53,120 --> 00:07:57,080
+pressure» يعني كل أي تخلل هيقدّي إلى إيش؟ بالآخر
+
+111
+00:07:57,080 --> 00:08:00,560
+لـ «shock» يعني هذه علامات الـ «shock» لو ماكنتش
+
+112
+00:08:00,560 --> 00:08:03,180
+عند المرض بيكون الـ «patient» «stable» كيف بتعرف
+
+113
+00:08:03,180 --> 00:08:06,260
+الـ «stability» هذه عن طريق حكينا إنه ممكن نركب
+
+114
+00:08:06,260 --> 00:08:11,250
+الـ «CBD»؟عشان نتقيس الـ Central Venous Pressure
+
+115
+00:08:11,250 --> 00:08:16,510
+أو إنه نركّب الـ Swans Gang Catheter اللي بيسموها
+
+116
+00:08:16,510 --> 00:08:19,290
+الـ Pulmonary Artery Pressure عشان نتقيس الـ
+
+117
+00:08:19,290 --> 00:08:22,330
+Pulmonary Artery Pressure والـ Cardiac Output طبعا
+
+118
+00:08:22,330 --> 00:08:26,550
+عشان نركّب الحاجات هدول بحتاج وأو الـ Arterial
+
+119
+00:08:26,550 --> 00:08:32,150
+Line كمان بحتاجمن أهم المؤدات هذه اللي يابو
+
+120
+00:08:32,150 --> 00:08:37,890
+تعرفوها هنعرف إنه لما بنركب CBP مثلا هنحتاج الـ
+
+121
+00:08:37,890 --> 00:08:42,560
+Central Line نفسهوهنتقرف الآن على الـ Central
+
+122
+00:08:42,560 --> 00:08:45,900
+Lines وأنواع هون ممكن نركبها لكن بديك تعرف كمان
+
+123
+00:08:45,900 --> 00:08:50,280
+إنه بيكون بدنا حاجة اسمها Flush System الـ Flush
+
+124
+00:08:50,280 --> 00:08:54,880
+System هذا عبارة عن محلول ملحي ولكن عليك اللي هو
+
+125
+00:08:54,880 --> 00:09:03,660
+كمية من الهيبرين حوالي اللي هو لكل 500 CC بنحط له
+
+126
+00:09:03,690 --> 00:09:08,650
+هو واحد صانطي هبارين يعني خمس تلاف International
+
+127
+00:09:08,650 --> 00:09:15,330
+Unit بحيث يكون التركيز الهبارين واحد من ألف أو حتى
+
+128
+00:09:15,330 --> 00:09:22,470
+بنحط يعني الصانطي ممكن نحطه حتى على الألف طبعاً
+
+129
+00:09:22,470 --> 00:09:30,520
+وحنكون بنحتاج الـ Stop Cock وبنحتاج اللي هوعندما
+
+130
+00:09:30,520 --> 00:09:35,040
+يكون هنا حاجة اسمها «transducer» هذا شرحه عملي
+
+131
+00:09:35,040 --> 00:09:42,120
+أسهل فأنا مش هأدخل في تفاصيل دقيقة في الموضوع لأنه
+
+132
+00:09:42,120 --> 00:09:45,940
+المفروض أنه يشرح عملي لكن هرفع لكم فيديو بوضّح كيف
+
+133
+00:09:45,940 --> 00:09:50,160
+قليت تركيب الـ «central line» وكيف قليت قياسه
+
+134
+00:09:50,940 --> 00:09:53,880
+بتبديكوا تعرفوا أنه في حاجات مهمة تكون عارفة أنه
+
+135
+00:09:53,880 --> 00:09:56,540
+في حاجة مثلا اسمه الـ pressure bag يعني لما بكون
+
+136
+00:09:56,540 --> 00:09:59,880
+أنا مركّب مثلا arterial line لمريد مازال أنا كم ..
+
+137
+00:09:59,880 --> 00:10:04,850
+حكيت إنه في ال arterial line أنا فيه هنديكانيولة
+
+138
+00:10:04,850 --> 00:10:08,470
+في داخل الشريان الشريان معروف أنه فيه pressure
+
+139
+00:10:08,470 --> 00:10:11,390
+فقدام الحسين يطلع من الكانيولة هذه لذلك الكانيولة
+
+140
+00:10:11,390 --> 00:10:15,410
+هذه هي نوع خاص من الكانيولات اللي لها valve وكمان
+
+141
+00:10:15,410 --> 00:10:19,590
+لازم تنشبك في line و ال line هذه مشبوك طبعا في زي
+
+142
+00:10:19,590 --> 00:10:23,250
+ما حكينا flush system اللي هو كيس محلول وفيه برينه
+
+143
+00:10:23,250 --> 00:10:27,310
+برنسا line وكمان محطوط في ال pressure bag هذه ال
+
+144
+00:10:27,310 --> 00:10:30,850
+bag ال bag هذه برفعطب يعني بكون عامل pressure فيها
+
+145
+00:10:30,850 --> 00:10:34,930
+لإن 300 ميلي متر ذئبق تمام بحيث أنها تكون أعلى من
+
+146
+00:10:34,930 --> 00:10:39,830
+ضغط الدم تبع المريض وهذا إيش هتسوي؟ هتمنع ارتجاع
+
+147
+00:10:39,830 --> 00:10:46,550
+الدم منهالـ R3 للـ System هذا يعني للـ IV-6 اللي
+
+148
+00:10:46,550 --> 00:10:49,910
+مش مشبوك في المحلول هذا ومش بس هيك الـ System هذا
+
+149
+00:10:49,910 --> 00:10:53,790
+الـ Flush System لحاله حاد ثلاثة لخمسة صنطي اللي
+
+150
+00:10:53,790 --> 00:10:56,070
+هو Saline من اسم الهيبراني السالين اللي احنا
+
+151
+00:10:56,070 --> 00:11:00,390
+حاطينه كل ساعة الهدف منه انه يعمل Washing يعني
+
+152
+00:11:00,390 --> 00:11:03,070
+ويمنع ال Clothing يعني يعمل ال Flushing ويمنع ال
+
+153
+00:11:03,070 --> 00:11:07,190
+Clothing وارتجاع الدم في داخل الشريعة أو في داخل
+
+154
+00:11:07,190 --> 00:11:11,760
+ال IV-6 هذاكويس وهذا كله ينطبق بالذات على الـ
+
+155
+00:11:11,760 --> 00:11:15,580
+Arterial line هذا احنا كمان بعمله مع الـ CDD لما
+
+156
+00:11:15,580 --> 00:11:17,980
+بنركب الـ Central Venous Pressure ولكن بما انه
+
+157
+00:11:17,980 --> 00:11:22,240
+الضغط تبقى الـ Central Line أو الضغط داخل الوريد
+
+158
+00:11:22,240 --> 00:11:26,660
+المركزي عادة مش زي الـ Artery فممكن انه انا اركب
+
+159
+00:11:26,660 --> 00:11:29,540
+Central Venous Pressure من غير الـ Flush System و
+
+160
+00:11:29,540 --> 00:11:33,880
+الـ Pressure Bag هذه لأن الـ Pressure داخل الـ
+
+161
+00:11:33,880 --> 00:11:38,310
+Central Line مش هالجد كبير وممكن يخلي الدم يرتجعهو
+
+162
+00:11:38,310 --> 00:11:39,070
+الـ CRS
+
+163
+00:11:42,470 --> 00:11:45,890
+يعني الـ Clotting أو يصير ارتجاع للدم في الـ Line
+
+164
+00:11:45,890 --> 00:11:49,870
+ويصير الـ Clotting طبعاً بحاجة أن يكون هنا
+
+165
+00:11:49,870 --> 00:11:54,970
+Transducer هذا عشان هو الوسيلة اللي هتعمل Change
+
+166
+00:11:54,970 --> 00:12:01,250
+أو تعمل توصيل لل data من المريض لـ Monitor وهو
+
+167
+00:12:01,250 --> 00:12:05,390
+اللي هنطلق وهنعمل Calibration عشان يبدأ الجهاز من
+
+168
+00:12:05,390 --> 00:12:12,030
+نقطة الصفر اللي أنا حدد هيبدأ يقيص اللي هوالضغط
+
+169
+00:12:12,030 --> 00:12:16,190
+سواء في الوريد المركزي أو في الشريان بعد ما أحدد
+
+170
+00:12:16,190 --> 00:12:20,790
+نقطة في الصفر سأجدد فيه ضغط فوق الصفر هذا يقرأ
+
+171
+00:12:20,790 --> 00:12:27,390
+ليها ويدينيها الـ Amplifier والمونوترات الآن عادة
+
+172
+00:12:27,390 --> 00:12:36,470
+صوتها عالي والـ Electrical Science تبعتها موجودة
+
+173
+00:12:36,470 --> 00:12:45,680
+مش محتاج أن يكون فيهإنه فيه amplifier واموره جاهزة
+
+174
+00:12:45,680 --> 00:12:50,500
+الـ «Central Venus Catheter» لو بدنا نحكي عنها
+
+175
+00:12:50,500 --> 00:12:54,960
+بالتفصيل بأول
+
+176
+00:12:54,960 --> 00:12:58,120
+حالة بنحكي إنه في مواضيع كتير بنحط منها «Central
+
+177
+00:12:58,120 --> 00:13:06,960
+Venus Catheter» الهدف منها إنه أنا أصل الـ
+
+178
+00:13:06,960 --> 00:13:07,600
+«Thoracic Vein»
+
+179
+00:13:11,140 --> 00:13:14,720
+ولمّا أسيل أنا في الـ Plastic Vein اللي هو قبل
+
+180
+00:13:14,720 --> 00:13:19,480
+الأصول إلى الـ Right Atrium بالظبط، تمام؟ بدي أشوف
+
+181
+00:13:19,480 --> 00:13:25,440
+كمية السوائل والـ Pressure اللي عامله الـ Blood في
+
+182
+00:13:25,440 --> 00:13:31,160
+الوريد المركزي هذا عشان أعرف من خلاله اللي هو حجم
+
+183
+00:13:31,160 --> 00:13:36,200
+السوائل في الجسم وحاجة المريض لسوائل أكتر أو هو
+
+184
+00:13:36,200 --> 00:13:39,300
+المريض يعني عنده كمية من السوائل
+
+185
+00:13:42,170 --> 00:13:47,170
+لـ diuretics عشان تخفف هذه السوائل طب من وين؟ نحنا
+
+186
+00:13:47,170 --> 00:13:56,690
+ممكن نحط الـ central line هذا عدة طرق ممكن تحطها
+
+187
+00:14:04,070 --> 00:14:09,530
+إذاً في أماكن كتير ممكن أنا أدخل منها علشان أستطيع
+
+188
+00:14:09,530 --> 00:14:14,470
+أن أقيس الـCDP يعني مثلا ممكن ندخل من الـinternal
+
+189
+00:14:14,470 --> 00:14:19,450
+jugular ونستقر في اللي هو الـthoracic
+
+190
+00:14:20,750 --> 00:14:26,010
+قبل أن نصل إلى الـRight Atrium أو أن ندخل من
+
+191
+00:14:26,010 --> 00:14:29,490
+الـSubclavian دين كل ما سيأدوا إلى أن أذهب إلى
+
+192
+00:14:29,490 --> 00:14:32,190
+الـSuperior Vena Cava
+
+193
+00:14:36,770 --> 00:14:42,170
+أقيص الـ CVP لكن في أماكن تانية ممكن أحط فيها من
+
+194
+00:14:42,170 --> 00:14:46,290
+خلالها Central Line لكن ماكنش قادر أن أصل لـ
+
+195
+00:14:46,290 --> 00:14:49,950
+Thoracic Vein وبالتالي ما بنفع أقيص منها CVP زي
+
+196
+00:14:49,950 --> 00:14:53,570
+الـFemoral Vein أو الـPraecal الـPraecal فين
+
+197
+00:14:53,570 --> 00:14:57,190
+بالمناسبة ممكن جدا أخش من الـPraecal لكن بدي Long
+
+198
+00:14:57,190 --> 00:15:01,030
+Line علشان أوصل لـThoracic Vein علشان أنا بدأ أخش
+
+199
+00:15:01,030 --> 00:15:03,950
+من الـPraecal، لكن الـPraecal يعني وين؟ يعني في
+
+200
+00:15:03,950 --> 00:15:06,590
+الـAnticubital
+
+201
+00:15:08,330 --> 00:15:13,710
+ممكن أدخل على الـ cephalic أو الـ basalic vein ومن
+
+202
+00:15:13,710 --> 00:15:16,250
+الـ cephalic أو الـ basalic vein أبقى نمشي على الـ
+
+203
+00:15:16,250 --> 00:15:19,110
+axillary vein و بعدين أدخل على ال thoracic vein،
+
+204
+00:15:19,110 --> 00:15:24,190
+تمام؟ فحنشوف في جدول الآن ال advantage و ال
+
+205
+00:15:24,190 --> 00:15:26,750
+disadvantage لكل واحد فيهم، بس اللي بدني أعرفه في
+
+206
+00:15:26,750 --> 00:15:29,190
+النهاية، أنا هستقر في الـ
+
+207
+00:15:32,040 --> 00:15:37,160
+عشان أقيس الـ «Central Venus Pressure» إذا كان من
+
+208
+00:15:37,160 --> 00:15:41,560
+خمسة لعشرة سنتمتر water اللي هو تقابلها حوالي من
+
+209
+00:15:41,560 --> 00:15:45,680
+اتنين لستة ملي متر ذئبق بكون معناه إن أنا عندي
+
+210
+00:15:45,680 --> 00:15:52,980
+Normal Central Venus Pressure طبعا
+
+211
+00:15:52,980 --> 00:16:01,460
+علشان نقيس هذا لازملازم أننا نكون المريض محطوط في
+
+212
+00:16:01,460 --> 00:16:06,980
+position معين ونكون عاملين Zeroing ونشوف مع بعض
+
+213
+00:16:06,980 --> 00:16:12,740
+كيف قليد قياسه بالخطوات الهدف
+
+214
+00:16:12,740 --> 00:16:16,960
+من قياس الـCDD بالحقيقة زي ما حكينا أنه أنا أكون
+
+215
+00:16:16,960 --> 00:16:20,960
+عارف بالظبط الـ
+
+216
+00:16:22,090 --> 00:16:25,530
+الـ Right Ventricular Feeling Pressure أو بيسموه
+
+217
+00:16:25,530 --> 00:16:30,250
+الـ Preload يعني كام قدرة الـ Right Ventricle على
+
+218
+00:16:30,250 --> 00:16:37,360
+الـ Complete Relaxation علشان ياخد إيش؟أكبر كمية
+
+219
+00:16:37,360 --> 00:16:41,480
+من الـBlood اللي تجيله من الـRight Atrium، تمام؟
+
+220
+00:16:41,480 --> 00:16:44,020
+إذا هي طريقة غير مباشرة عشان تخليني أعرف
+
+221
+00:16:44,020 --> 00:16:47,960
+الـpreload تبع الـheart كيف وضعه، وإيش يعني هو
+
+222
+00:16:47,960 --> 00:16:52,060
+الـpreload؟ الـpreload اللي هو الـdilatation أو
+
+223
+00:16:52,060 --> 00:16:55,080
+يعني بيسموه الـstretch تبع الـheart muscle at the
+
+224
+00:16:55,080 --> 00:17:00,140
+end of the stoolكم القلب عنده قدرة إنه يعمل
+
+225
+00:17:00,140 --> 00:17:04,340
+relaxation و stretching عشان يأخذ أكبر كمية من
+
+226
+00:17:04,340 --> 00:17:08,040
+الدم بدها تجيه اللي هيدلني عليه اللي هو الـ
+
+227
+00:17:08,040 --> 00:17:11,760
+central venus برشا لو كان عالي، معناه إن كمية
+
+228
+00:17:11,760 --> 00:17:16,120
+السوائل هادة أكتر مناللي بيتحملها القلب وكمية
+
+229
+00:17:16,120 --> 00:17:22,400
+السوائل القلب لا يستطيع أنه يتعامل معها فهي عاملة
+
+230
+00:17:22,400 --> 00:17:26,640
+له overload ولو كانت له أقل من خمسة معناه أنه
+
+231
+00:17:26,640 --> 00:17:29,720
+الـcentral venous pressure هنا له معناه أنه كمية
+
+232
+00:17:29,720 --> 00:17:33,220
+السوائل اللي بتيجي أفضل للقلب في الـpreload هي
+
+233
+00:17:33,220 --> 00:17:37,920
+قليلة فعشان هي القلب مابضخش كويس وإتالي هيكون فيه
+
+234
+00:17:37,920 --> 00:17:42,200
+مشكلة برضه في الـafterloadطيب، إيش الفرق بين الـ
+
+235
+00:17:42,200 --> 00:17:45,440
+الـ الـ الـ different insertion لـ الـ Central
+
+236
+00:17:45,440 --> 00:17:47,460
+Line سواء من الـ Sub-Clavian أو من الـ Turner's
+
+237
+00:17:47,460 --> 00:17:51,820
+Jaguar؟ بنحكي إنه من الSub-Clavian، هذا مكان كتير
+
+238
+00:17:51,820 --> 00:17:55,260
+كويس و طبعا هيدي .. يعني هخش أنا في Large Vessel،
+
+239
+00:17:55,260 --> 00:18:01,080
+أه؟ و .. و هجيس منه الـ CVV و هذه حاجة كتير كويسة،
+
+240
+00:18:01,080 --> 00:18:05,120
+طبعا ال dressing تبقى سهل لإنه في مكان أنظيف ال
+
+241
+00:18:05,120 --> 00:18:09,450
+chest، لكن الخطورة تبعتهإنه انا لو ممكن بده يصير
+
+242
+00:18:09,450 --> 00:18:14,130
+لو لأ قدر الله في bleeding أو يعني المريض هذا risk
+
+243
+00:18:14,130 --> 00:18:18,770
+لإنه يصير عنده bleeding هيكون uncontrollable صعب
+
+244
+00:18:20,160 --> 00:18:25,280
+لأنه Deep كمان هذا قريب من الـ Plural Space الـ
+
+245
+00:18:25,280 --> 00:18:27,900
+Plural Cavity وبالتالي أنا ممكن during insertion
+
+246
+00:18:27,900 --> 00:18:32,000
+نعمل للمريض نيموثوركس أو Hemothorax الـ Internal
+
+247
+00:18:32,000 --> 00:18:35,900
+Jugular يعتبر أقل خطورة من ناحية إنه يعمل
+
+248
+00:18:35,900 --> 00:18:39,260
+Hemothorax وNemothorax لكن نفس الموضوع بالنسبة للـ
+
+249
+00:18:39,260 --> 00:18:45,780
+Bleeding وبالنسبة للـالمرضى اللي عندهم مشاكل أصلاً
+
+250
+00:18:45,780 --> 00:18:49,280
+في الـ «نيت» مثلاً برضه هيسببلهم أو هيكون صعب
+
+251
+00:18:49,280 --> 00:18:56,020
+التعامل معاه لكن الـ advantage تبعتهم أنه سهل أني
+
+252
+00:18:56,020 --> 00:19:03,520
+لحظة أردت على التليفون وبعدين أكمل و ال advantage
+
+253
+00:19:03,520 --> 00:19:07,720
+تبعت ال «إنترنت جيجل» زي ما حكينا أنه من
+
+254
+00:19:11,830 --> 00:19:15,210
+«ليموثوركس» أو «hemothorax» عند المرضى والـ
+
+255
+00:19:15,210 --> 00:19:18,350
+accessibility تبعته عالية خاصة إذا ما كان فيه عند
+
+256
+00:19:18,350 --> 00:19:20,830
+المريض مشاكل في الـ «نت» اللي فيه مرال من المشاكل
+
+257
+00:19:20,830 --> 00:19:26,990
+هو إنه مش هقدر أجيس منه CBP ومن مميزاته إنه لو كان
+
+258
+00:19:26,990 --> 00:19:29,650
+المريض high risk لـ bleeding وانا بدي وسيلة إنه أد
+
+259
+00:19:29,650 --> 00:19:33,290
+عوض فيها سوائل مكون كويس لإنه حتى لو كان high risk
+
+260
+00:19:33,290 --> 00:19:36,150
+لـ bleeding وصار معاه bleeding ممكن فيه إني
+
+261
+00:19:36,150 --> 00:19:39,650
+إمكانية إن أعمل stop لـ bleeding هذا لإنه إيش
+
+262
+00:19:39,880 --> 00:19:46,500
+«Controllable» يعني ممكن أتحكم فيه لكن من الـ
+
+263
+00:19:46,500 --> 00:19:50,360
+«Disadvantage» برضه تبعته إن هو في منطقة «Dirty» و
+
+264
+00:19:50,360 --> 00:19:58,380
+«Infection Rate»هو عالي جدا وعشان هيك لا يفضل الـ
+
+265
+00:19:58,380 --> 00:20:06,840
+«Brachial» ساعت من مشاكله إنه بدي Largeيعني
+
+266
+00:20:06,840 --> 00:20:12,600
+catheter علشان أنا أصل وأستطيع أن أقيس منه الـCVB
+
+267
+00:20:12,600 --> 00:20:15,800
+في كمان حاجة مهمة أنه لما أنا بدأ أدخل من
+
+268
+00:20:15,800 --> 00:20:17,820
+الـPracula جماعة أو بدأ أدخل في البيزانيك أو
+
+269
+00:20:17,820 --> 00:20:23,240
+الـCephalic veins فدولها عادة veins يعني long وانا
+
+270
+00:20:23,240 --> 00:20:26,680
+بدي أقدر نماشي فيهم علشان إيش أصل للـaxillary ومن
+
+271
+00:20:26,680 --> 00:20:30,640
+بعدها أبدأ أنزل في التورسيك فأنا عارفين إحنا أن ال
+
+272
+00:20:30,640 --> 00:20:37,220
+veins فيها إيشفيها الـ «Valves» عشان تمنع الارتجاع
+
+273
+00:20:37,220 --> 00:20:41,240
+تبع الدم فأنا لما بخش في الـ «Veins» هدول هعمل
+
+274
+00:20:41,240 --> 00:20:46,040
+Destruction للـ «Valves» هذه ولذلك لا تُعتبر طريقة
+
+275
+00:20:46,040 --> 00:20:51,200
+مثلة لتركيب الـ «Central Line» ويفضوا دائما الـ
+
+276
+00:20:51,200 --> 00:20:55,360
+«Internal Juggle» أو الـ «Subclavian» إذا كان لا
+
+277
+00:20:55,360 --> 00:21:00,800
+يوجد Contra Indications طبعاً
+
+278
+00:21:02,130 --> 00:21:04,330
+عندما نتحدث عن الـ «فاكتور» اللي بتأثر في الـ
+
+279
+00:21:04,330 --> 00:21:08,830
+«CBD» حكينا أحنا، هيأثر في الـ «CBD» إذا كان فيه
+
+280
+00:21:08,830 --> 00:21:12,810
+Systemic Vasodilatation إذا كل الجسم، الـVessels
+
+281
+00:21:12,810 --> 00:21:17,150
+تبعته dilated برضه الـCentral Venous Veins هتكون
+
+282
+00:21:17,150 --> 00:21:21,730
+dilated وبالتالي هيكون الـ«CBD» القراءة تبعته
+
+283
+00:21:21,730 --> 00:21:27,810
+واطية يعني لأنه في الـDilatation في الـVena Cava
+
+284
+00:21:27,810 --> 00:21:33,700
+وبالتالي هيدينيإن كمية السوائل اللي فيه قليلة إذا
+
+285
+00:21:33,700 --> 00:21:36,020
+كان فيها «Rise Ventricular Failure» أو فيه
+
+286
+00:21:36,020 --> 00:21:38,180
+«Tricuspid» أو «Balmoral Valve Disease» أو
+
+287
+00:21:38,180 --> 00:21:41,600
+«Balmoral Hypertension» هذه هتأثر في قلقات الـ
+
+288
+00:21:41,600 --> 00:21:46,960
+«CVB» وماكنش أنا بكون مضطر إن أستخدم «CVB» يا
+
+289
+00:21:46,960 --> 00:21:53,480
+جماعةلما يكون أنا لازم أعمل Hemodynamic Monitoring
+
+290
+00:21:53,480 --> 00:21:58,140
+وأراقب كل حاجة بشكل دقيق لما بكون أنا محتاج إن
+
+291
+00:21:58,140 --> 00:22:03,140
+أركب IV Axis ومافيش إمكانية إن أحط Peripheral Axis
+
+292
+00:22:03,140 --> 00:22:04,020
+يعني الكنولات
+
+293
+00:22:07,130 --> 00:22:09,650
+الـ peripheral vein فانا محتاج ان اركب central
+
+294
+00:22:09,650 --> 00:22:15,230
+line لما انا بكون بدي استخدم او بدي اعطي المريض IV
+
+295
+00:22:15,230 --> 00:22:19,410
+لفترة طويلة وانا محتاج ان اسحب منه تحليم في اليوم
+
+296
+00:22:19,410 --> 00:22:23,310
+خمس، ست مرات كتيرة، اعمله مثلا blood gas متابعة
+
+297
+00:22:23,310 --> 00:22:28,240
+كتيرة سواء من ال vein أو من ال arteryأو بدي أعمل
+
+298
+00:22:28,240 --> 00:22:31,340
+CDC follow-up وchemistry follow-up مثلا كل أربع
+
+299
+00:22:31,340 --> 00:22:36,240
+ساعات أو إيش يعني كل ما في عند مريض بده استخدام IV
+
+300
+00:22:36,240 --> 00:22:40,960
+بشكل طويل وساعة تحليل لموضوع طويلة بيكون أحسن أن
+
+301
+00:22:40,960 --> 00:22:44,880
+أكون مركّبله Central Line أحسن مضل كل مرة أعمله
+
+302
+00:22:46,700 --> 00:22:53,460
+إنفاجيا في مكان جديد أو أن أركّب له أكتر من كانولا
+
+303
+00:22:53,460 --> 00:22:56,720
+لما بكون بدي أدري حساسة عن طريق الـ Infusion Pump
+
+304
+00:22:56,720 --> 00:23:01,700
+زي الدوبامين و الـ Adrenaline و النورادرينالين أو
+
+305
+00:23:01,700 --> 00:23:04,820
+الـ Sedation إذا كان في عنديأكتر من الـ Sedation
+
+306
+00:23:04,820 --> 00:23:08,460
+بكون محتاجة أن أنا أحطها أو أحيانا بكون الـ Total
+
+307
+00:23:08,460 --> 00:23:11,420
+Parenteral Nutrition يا جماعة ال molecular weight
+
+308
+00:23:11,420 --> 00:23:15,280
+تبعه عالي فبنفعش تنعطل الأدوية هذه في اللي هو الـ
+
+309
+00:23:15,280 --> 00:23:18,780
+Peripheral Vein لإنها تعمل Thrombophlebitis تمام؟
+
+310
+00:23:21,830 --> 00:23:26,670
+حكينا عن ذلك عندما نعمل blood sampling كثير طبعاً
+
+311
+00:23:26,670 --> 00:23:31,970
+والحاجة المهمة أنه أنا بدي أقيس الـCBP لهذا المريض
+
+312
+00:23:31,970 --> 00:23:34,850
+أحياناً بنركب الـCentral Line يا جماعة عشان نعمل
+
+313
+00:23:34,850 --> 00:23:38,550
+إيش؟اللي هو الـ Temporary Pacemaker لمريض اللي هو
+
+314
+00:23:38,550 --> 00:23:43,410
+Pacing Y عشان أدخل Wire و أدخله على اللي هو الـ
+
+315
+00:23:43,410 --> 00:23:47,570
+Right Atrium عشان و أركب فيه اللي هو الـ Pacemaker
+
+316
+00:23:47,570 --> 00:23:51,310
+عشان يبدأ يعمل Stimulation أو يبدأ يعمل Pacing كل
+
+317
+00:23:51,310 --> 00:23:54,790
+هذه هي الـ Indications تبع الـ Central Line الـ
+
+318
+00:23:54,790 --> 00:23:58,870
+Central Line له أكتر من نوع فيه منهم Single و منهم
+
+319
+00:23:58,870 --> 00:24:04,810
+يعني لهتيوب واحد وفيه double و triple لومن يعني
+
+320
+00:24:04,810 --> 00:24:09,490
+فيه لطيوبين و تلاتة لطيوبين و تلاتة لطيوبين و
+
+321
+00:24:09,490 --> 00:24:09,790
+تلاتة لطيوبين و تلاتة لطيوبين و تلاتة لطيوبين و
+
+322
+00:24:09,790 --> 00:24:09,910
+تلاتة لطيوبين و تلاتة لطيوبين و تلاتة لطيوبين و
+
+323
+00:24:09,910 --> 00:24:10,130
+تلاتة لطيوبين و تلاتة لطيوبين و تلاتة لطيوبين و
+
+324
+00:24:10,130 --> 00:24:10,830
+تلاتة لطيوبين و تلاتة لطيوبين و تلاتة لطيوبين و
+
+325
+00:24:10,830 --> 00:24:12,610
+تلاتة لطيوبين و تلاتة لطيوبين و تلاتة لطيوبين و
+
+326
+00:24:12,610 --> 00:24:18,690
+تلاتة لطيوبين و
+
+327
+00:24:18,690 --> 00:24:27,410
+تلاتة لطيوبين و تلاتة لطيوبين
+
+328
+00:24:27,410 --> 00:24:27,530
+و
+
+329
+00:24:33,760 --> 00:24:37,420
+المهم اللي بديكوا تعرفوه، ما تفكروش أنه بما أنه
+
+330
+00:24:37,420 --> 00:24:40,380
+أشوف في صورة بس الـCentral Line هنا عشان يكون
+
+331
+00:24:40,380 --> 00:24:50,720
+الشرق أسهل الصورة البيضة شوية، و أنا،
+
+332
+00:24:50,720 --> 00:24:58,390
+طيب لحظة، مهم مش ماشينا كتير، بس أيوةلحظي هاي الـ
+
+333
+00:24:58,390 --> 00:25:01,910
+lumens، هاي واحد، اتنين، تلاتة، اعتبر انه NDH هذه
+
+334
+00:25:01,910 --> 00:25:04,110
+طبعا هي swine gains لكن الـ central line زيها
+
+335
+00:25:04,110 --> 00:25:07,270
+بالظبط بس مش طويل بهذه الطولة على أي حالة اعتبروا
+
+336
+00:25:07,270 --> 00:25:09,230
+ان هذا الـ central line وهي ال lumens اللي بحكي
+
+337
+00:25:09,230 --> 00:25:12,610
+عنها اللي كنت بدي احكي فيه ان اصحك تفكر ان ال
+
+338
+00:25:12,610 --> 00:25:16,480
+lumens هدولة بالاخر لما بوصلالـ Drug تبعك من الـ
+
+339
+00:25:16,480 --> 00:25:19,520
+Lumen هادهان والـ Drug بوصل من الـ Lumen هادهان إن
+
+340
+00:25:19,520 --> 00:25:22,540
+هما بختبطوا مع بعض، لأ الـ Lumen هادهان ماشي من
+
+341
+00:25:22,540 --> 00:25:29,730
+أول الطريق لآخر ماده الصدق هو الـ Tubeوالتاني كذلك
+
+342
+00:25:29,730 --> 00:25:33,890
+والتالت كذلك عاملين بالظبط زي حكاية سلك الكهربا
+
+343
+00:25:33,890 --> 00:25:36,670
+اللي بيكون فيه الـCable الكبير اللي بيكون فيه تلت
+
+344
+00:25:36,670 --> 00:25:42,850
+خطوط أحمر وأصفر أو أصمر مثلا لكن كل واحد فيهم ماشي
+
+345
+00:25:42,850 --> 00:25:46,610
+لحاله وعليه غلاب والكهربا بتمشي فيه لحالها من غير
+
+346
+00:25:46,610 --> 00:25:50,870
+ما تفتلط مع الكهربا اللي في الخط التاني تمام؟ وهذا
+
+347
+00:25:50,870 --> 00:25:55,930
+هي أهمية أننابنحط الـ «central line» أكتر من
+
+348
+00:25:55,930 --> 00:25:59,630
+«lumen» وبنضمن أنه مايصيرش بينهم reaction لأن كل
+
+349
+00:25:59,630 --> 00:26:05,590
+واحد فيهم بيمشي لحاله وبصب في منطقة مختلفة كمان يا
+
+350
+00:26:05,590 --> 00:26:09,090
+جماعة كيف يعني؟ يعني هتلاقي على الـ «central line»
+
+351
+00:26:09,090 --> 00:26:13,370
+مكتوب أن هذا مثلا «proximal» وهذا «distant» وهذا
+
+352
+00:26:13,370 --> 00:26:18,720
+«medial» مثلا الـ «proximal» هتلاقي بصب إيش؟الـ
+
+353
+00:26:18,720 --> 00:26:23,860
+Proximal قريبًا الـ Distal بصوت آخر واحد
+
+354
+00:26:27,240 --> 00:26:30,700
+هن ديستر تمام و ال media هيكون في المصدر فهيكون ال
+
+355
+00:26:30,700 --> 00:26:36,060
+proximal هن أقرب واحد ديستر هيكون بعيد و ال media
+
+356
+00:26:36,060 --> 00:26:42,440
+هيكون في المصدر تمام لما بدنا نركب ال central
+
+357
+00:26:42,440 --> 00:26:45,380
+venous pressure و بدنا نقيس منه ال CDP يا جماعة
+
+358
+00:26:45,380 --> 00:26:53,260
+ضروري نحط أو نركب الالـ «Central Line» أو الـ
+
+359
+00:26:53,260 --> 00:26:58,980
+«Line» نفسه تبع الـ «CVP» في الـ «Distal Lumen» مش
+
+360
+00:26:58,980 --> 00:27:02,240
+في واحد تاني مش في الـ «V» و لا الـ «Proximal»
+
+361
+00:27:02,240 --> 00:27:07,760
+عشان يكون بيديني الـ«Tip» البعيدة اللي مش بتكون
+
+362
+00:27:07,760 --> 00:27:12,620
+جدارية يعني هي مش بتكون على الـ«Lumen» من الجنب من
+
+363
+00:27:12,620 --> 00:27:16,160
+هنا أو من هنا لأ بتكون من الـ«Tip» تبعته عشان ما
+
+364
+00:27:16,160 --> 00:27:22,730
+تتأثرش فيلو كانت خابطة وراقزة على الـ Wall
+
+365
+00:27:22,730 --> 00:27:28,250
+فبالتالي هيصير الـ Fluid اللي بيطلع منها بيصير
+
+366
+00:27:28,250 --> 00:27:30,510
+Resistant لأنه خابطة في الـ Wall لكن الـ Distil
+
+367
+00:27:30,510 --> 00:27:38,010
+عادة بتكون مفتوحة أمامها الـ Flow تبع الـ Fluid
+
+368
+00:27:38,010 --> 00:27:41,230
+كنا
+
+369
+00:27:41,230 --> 00:27:45,960
+بنحكي عنها هناعن أنواعهم وحكينا عن الـ TPN حتى لو
+
+370
+00:27:45,960 --> 00:27:51,400
+بدنا نستخدمه وطبعاً لما بنركب يا جماعة Central
+
+371
+00:27:51,400 --> 00:27:54,920
+Line وفيه Multi-Loom لازم كله منه نحط label فيه
+
+372
+00:27:54,920 --> 00:27:58,740
+إيش هذا في هذا بس CBP التاني نكتب فيه والله أحنا
+
+373
+00:27:58,740 --> 00:28:03,120
+حابب ند فيه الـ TPN التالت مثلا حاطين فيهالـ
+
+374
+00:28:03,120 --> 00:28:06,020
+Maintenance Fluid أو الـ Infusion تبع الدوبامين
+
+375
+00:28:06,020 --> 00:28:10,160
+لازم نعمل label لكل واحد فيهم عشان مايصيرش الأخبطة
+
+376
+00:28:10,160 --> 00:28:13,080
+ودايمًا دايمًا يعرف إن المرضي اللي مركّبله الـ
+
+377
+00:28:13,080 --> 00:28:18,640
+Central Line وإله مركّب فيه Infusion Drug بنفعش
+
+378
+00:28:18,640 --> 00:28:23,100
+تيجي تعمل الـ Stop وتعمل بوشلة أي medication لإنك
+
+379
+00:28:23,100 --> 00:28:27,750
+هتعمل بوشلة كمية كبيرة من الدوة اللي موجود فيهالـ
+
+380
+00:28:27,750 --> 00:28:30,870
+Central Line و تخلّي المرض يقودها فجأة مع إنه ممكن
+
+381
+00:28:30,870 --> 00:28:34,630
+أنت تكون امركب مثلا دوبامين على رد خمسة مليلتر per
+
+382
+00:28:34,630 --> 00:28:38,790
+hour تصور أنه أنت تيجي من منطقة قريب من الـ
+
+383
+00:28:38,790 --> 00:28:43,430
+Central Line وتروح عامل مدّي فيروسفين مثلا وإن هو
+
+384
+00:28:43,430 --> 00:28:46,770
+أصلا غلط يعني في ال ICU وإنه ممكن تدّي بوش ولكن
+
+385
+00:28:46,770 --> 00:28:53,500
+بلاش فيروسفين قدّيت عشرة ساعات صلاة بوشفانت روحت
+
+386
+00:28:53,500 --> 00:28:59,580
+عملت بُش لكل كمية تبع الدوبامين اللي كان في الـ
+
+387
+00:28:59,580 --> 00:29:03,380
+central line عملت في إيش؟ في moments مع إن هم طب
+
+388
+00:29:03,380 --> 00:29:06,360
+الكمية ده مش أقل من تلاتة CC طب المريض بياخد خمسة
+
+389
+00:29:06,360 --> 00:29:10,800
+milliliter في ال hour كلها روحت أنت مدّليها في
+
+390
+00:29:10,800 --> 00:29:14,560
+لحظة فإيش بتحصل في الضغط؟ لذلك منمو نهائيًا مريض
+
+391
+00:29:14,560 --> 00:29:17,620
+ماشي على infusing drug نروح احنا من ال stop cook
+
+392
+00:29:17,620 --> 00:29:23,790
+القريب نروح هنا عاملين إيش؟ بُشأي medication حتى
+
+393
+00:29:23,790 --> 00:29:27,930
+لو اضطريت أو جيت أعمل حاجة لازم أخد بيها space و
+
+394
+00:29:27,930 --> 00:29:33,230
+أسحب كل الكمية هذه و بعدين إيش أعمل ال irrigation
+
+395
+00:29:33,230 --> 00:29:39,290
+إذا اضطريت أن أعمل كيف؟
+
+396
+00:29:40,380 --> 00:29:45,040
+كيف بدي أركب الـ Central Line وإيش بدي أجهز بدل ما
+
+397
+00:29:45,040 --> 00:29:48,860
+نحكي عنه بدي أرفعلكم فيديو بيوضح كيف القفبات وفيها
+
+398
+00:29:48,860 --> 00:29:53,960
+كل الإجراءات والـ Equipment هذه اللي أمامكم فيديو
+
+399
+00:29:53,960 --> 00:29:57,880
+جدا سهل ومريح جدا وموضوعه فيه الـ Equipment وفيه
+
+400
+00:29:57,880 --> 00:30:02,900
+التفصيل المملكة وخطوة كيف بدي أعملوها وليش عشان
+
+401
+00:30:02,900 --> 00:30:08,120
+أريحكم ويكون شرح أوضح بكتير تمام كل هذا الكلام
+
+402
+00:30:08,120 --> 00:30:13,840
+هنشرحه فيالـ Central Line وهي طريقة ادخاله وطبعاً
+
+403
+00:30:13,840 --> 00:30:19,060
+أول حاجة بيحدد الطبيب المكان اللي بيدخل فيه سواء
+
+404
+00:30:19,060 --> 00:30:22,120
+من الـ Central Line على الـ «طلب» تبع الـ
+
+405
+00:30:22,120 --> 00:30:26,780
+Clavicular Bone وبعدين بدخل فيه الـ Needle بعد ما
+
+406
+00:30:26,780 --> 00:30:30,480
+بدخل فيه الـ Needle بيحدد قط لقمعه بلط بقيني الـ
+
+407
+00:30:30,480 --> 00:30:33,980
+Needle و بخشش Wire و بعد ما بخشش الـ Wire بعمل
+
+408
+00:30:35,300 --> 00:30:37,940
+بطلّق الـ needle خالص وبعدين بعمل dilatation كله
+
+409
+00:30:37,940 --> 00:30:40,960
+حتشوفوه في الفيديو بس بدي أوصله لكم الفكرة وبعد ما
+
+410
+00:30:40,960 --> 00:30:44,540
+بخشش بعمل dilatation بقيم ال dilator وبخشش ال
+
+411
+00:30:44,540 --> 00:30:49,680
+catheter وبعد ما بخشش ال catheter بثبتها بخطان
+
+412
+00:30:49,680 --> 00:30:54,160
+يعني sheet
+
+413
+00:30:54,160 --> 00:31:00,340
+تبعت قسطرة
+
+414
+00:31:01,980 --> 00:31:05,320
+وطبعًا بعدها لازم يركّب زي ما أحنا شايفين لازم
+
+415
+00:31:05,320 --> 00:31:08,680
+يعمل الـ X-Ray عشان يشوف أين مستوى الـ Depth تبع
+
+416
+00:31:08,680 --> 00:31:13,120
+الـ Central Line أه طبعًا في خلال مراحله هاي ممكن
+
+417
+00:31:13,120 --> 00:31:16,040
+جدًا مريض يخش في Bradycardia لإنه يصير Stimulation
+
+418
+00:31:16,040 --> 00:31:21,700
+للـVagus nerve ممكن يلاقي إنه الـCentral Line Deep
+
+419
+00:31:21,700 --> 00:31:27,020
+ويحتاج إنه يرفعه شوية تمام؟ طبعًا لازم يتأكد من
+
+420
+00:31:27,020 --> 00:31:29,980
+إنه برضه الـDirection تبعه إنه ماشي ونزل على
+
+421
+00:31:29,980 --> 00:31:33,030
+الـHeart فعلا مش طلع فوقعلى الـ carotid كل هذه
+
+422
+00:31:33,030 --> 00:31:35,370
+الحاجات اللي هتشوفوها في الفيديو الـ complication
+
+423
+00:31:35,370 --> 00:31:37,150
+تبعته زي ما حكينا هو يمكنه يعمل cardiac
+
+424
+00:31:37,150 --> 00:31:39,730
+dysrhythmia يمكنه يعمل نيموهيمو ثوركس يمكنه يعمل
+
+425
+00:31:39,730 --> 00:31:43,170
+أصلا bleeding أو hematoma في المكان تبعه ممكن كتير
+
+426
+00:31:43,170 --> 00:31:48,290
+حاجات تتصير انه يصير شوية extravasation أو الـ
+
+427
+00:31:48,290 --> 00:31:51,830
+guide أو ال wire يا جماعة يعني أحد المرات بذكر أنه
+
+428
+00:31:51,830 --> 00:31:54,530
+مرة سحل ال wire كلهيته في المريض وحتاج المريض يعمل
+
+429
+00:31:54,530 --> 00:31:59,270
+open heart عشان يطلقه منه ال wire ال wire اللي هو
+
+430
+00:31:59,270 --> 00:32:07,270
+طبعا طويل زي ما انتوا بتعرفواالقياس تبعه هحكي على
+
+431
+00:32:07,270 --> 00:32:10,530
+الصورة كيف بننقصه أهم حاجة يا جماعة أنه أنا فيه
+
+432
+00:32:10,530 --> 00:32:16,040
+عندى مريض نايمطبعاً بدي أحكي حاجة لإن في كتير ناس
+
+433
+00:32:16,040 --> 00:32:20,980
+بتفكر إن مابنفعش أقيص CBP لمريد إلا إذا كان في
+
+434
+00:32:20,980 --> 00:32:24,380
+اللي هو Supine Position أو نام على دهره لأ حتى لو
+
+435
+00:32:24,380 --> 00:32:28,400
+كان المريض يعني Sitting Position ممكن أعمل Zeroing
+
+436
+00:32:28,400 --> 00:32:34,160
+وأقيص اللي هو الـCBP الفكرة إنه أنا بدي أكون فيه
+
+437
+00:32:34,160 --> 00:32:37,980
+أندي مريض أحدد على المريض الـZero Point إيش يعني؟
+
+438
+00:32:37,980 --> 00:32:43,760
+يعني من بعد هذه النقطةمن بعد هذه النقطة وفوق، كم
+
+439
+00:32:43,760 --> 00:32:47,580
+فيه pressure في هذا المكان؟ وين هذا المكان؟ اللي
+
+440
+00:32:47,580 --> 00:32:52,760
+هو الـCentral Vein اللي أنا فيه، كويس، طيب، كيف
+
+441
+00:32:52,760 --> 00:32:57,780
+بدي أحدد القصة هذه؟ بدي يكون في عندي كيس محلول،
+
+442
+00:32:57,780 --> 00:33:00,800
+fluid، وطبعا عارفين إن أحطه، حكينا إن فيه هبرنازل
+
+443
+00:33:00,800 --> 00:33:05,630
+سماعي، okayوالكيس المحلول هذا نازل، اعتبره هذا أن
+
+444
+00:33:05,630 --> 00:33:09,930
+هو الكيس المحلول ونازل على اللي هي حاجة بنسميها
+
+445
+00:33:09,930 --> 00:33:14,290
+المصرة أو الـ monometer اللي هي إيش وظيفته، أشوف
+
+446
+00:33:14,290 --> 00:33:23,910
+بس هناهيّاتها المصطرة، وهي عند المريض، وفي
+
+447
+00:33:23,910 --> 00:33:32,870
+كيس محلول مشبوك فوق بيغذّي المصطرة، وهو كيس محلول
+
+448
+00:33:32,870 --> 00:33:36,730
+بيغذّي المصطرة، ومن المصطرة طالع Line Extension
+
+449
+00:33:36,730 --> 00:33:41,330
+Tubeورايح لمين؟ للمريض ومشبوك في الـ Central Line
+
+450
+00:33:41,330 --> 00:33:44,990
+اللي مركب عند المريض، تمام؟ الآن بدي أعمل حاجة
+
+451
+00:33:44,990 --> 00:33:48,950
+اللي بنسميها الـ Zeroing تمام، إيش الـ Zeroing
+
+452
+00:33:48,950 --> 00:33:54,170
+هذا؟ إنه يكون المريض ونقطة الصفر اللي في المصطرة،
+
+453
+00:33:54,170 --> 00:33:57,790
+هاي الصفر اللي في المصطرة والمريض على نفس المستوى،
+
+454
+00:33:57,790 --> 00:34:02,370
+تمام؟ ليش؟ عشان لما أبدأ أنا أعبي سائل في المصطرة
+
+455
+00:34:02,370 --> 00:34:08,010
+وبعدين أسمح للسائل ينزل من المصطرة للمريضوإن ما
+
+456
+00:34:08,010 --> 00:34:11,370
+بيصير بتساوى ال pressure في المريض وفي المصطرة،
+
+457
+00:34:11,370 --> 00:34:16,630
+هتوقف السائل اللي جاعت بينساب من المصطرة للمريض،
+
+458
+00:34:16,630 --> 00:34:21,570
+هينزل من الضغط الأعلى للضغط الأقل، لما يتساوى،
+
+459
+00:34:21,570 --> 00:34:24,650
+هيوقف، هيكون هو هذا ال pressure اللي جوا عند
+
+460
+00:34:24,650 --> 00:34:28,190
+المريض، خمسة سنتمتر مال، يا ستة سنتمتر مال، وإن
+
+461
+00:34:28,190 --> 00:34:31,350
+واجف هو هذا الضغط اللي جوا عند المريض، اتساوى
+
+462
+00:34:31,350 --> 00:34:36,540
+الضغط هان مع هان، عشان يتساوى الضغطينويكون هذا
+
+463
+00:34:36,540 --> 00:34:39,740
+الارتفاع هو الضغط اللي هي لازم يكون النقطة تبقية
+
+464
+00:34:39,740 --> 00:34:44,700
+الصفر تبقيتهم واحدة وإلا لو كان هذي أعتبره المصر
+
+465
+00:34:44,700 --> 00:34:51,140
+هذي نزل لتحت ووداني هنا تمانية وبدل ما هو الـ0
+
+466
+00:34:51,140 --> 00:34:55,800
+تبقى ها لأ هي هيك يعني هيك الـ7 أعتبره بيكون هذه
+
+467
+00:34:55,800 --> 00:35:00,260
+القراءة فيها غش زي الميزان اللي واحد حاطط في قاع
+
+468
+00:35:00,260 --> 00:35:05,620
+الميزان نص كيلو ووزن لجاءت كيلو فداك نص كيلوتمام؟
+
+469
+00:35:05,620 --> 00:35:12,060
+فكيف الخطوات بالترتيب؟ إذا واحد بشبك أنا المريض أو
+
+470
+00:35:12,060 --> 00:35:16,760
+بجيب مصطرة والمصطرة بغزيها في 500 CC Fluid مثلا
+
+471
+00:35:16,760 --> 00:35:20,680
+بتغزي المصطرة تيستوب كوك يعني أطالق منه extension
+
+472
+00:35:20,680 --> 00:35:22,880
+الـ tube و أروح على الـ central line تبع المريض
+
+473
+00:35:22,880 --> 00:35:27,380
+بعمل zeroing السفر عند المريض يكون السفر مع السفر
+
+474
+00:35:27,380 --> 00:35:30,420
+عند المصطرة يكون هو السفر عند المريض طب السفر عند
+
+475
+00:35:30,420 --> 00:35:35,400
+المصطرة أرفناها سفرطب الصفر عند المريض أين؟ الصفر
+
+476
+00:35:35,400 --> 00:35:38,740
+عند المريض هذا عبارة عن تقاطعه نقطتين، مين هما
+
+477
+00:35:38,740 --> 00:35:43,340
+النقطتين؟ النقطة الأولى هي الـ mid-axillary line
+
+478
+00:35:43,340 --> 00:35:46,280
+مع ال fifth intercostal space، وين بتقاطعه في
+
+479
+00:35:46,280 --> 00:35:50,400
+النقطة هذه؟ هذه النقطة هي بدها تكون جبال بالظبط
+
+480
+00:35:50,400 --> 00:35:53,940
+نقطة الصفر، طب كيف أوزنهم يكونوا جبال بعض بالظبط؟
+
+481
+00:35:53,940 --> 00:35:57,660
+يا أما بعينك، يا أما بالعين، يا أما باستخدام ميزان
+
+482
+00:35:57,660 --> 00:36:01,350
+الميّه، شايفينوا هذا ميزان الميّه؟عندما تصبح نقطة
+
+483
+00:36:01,350 --> 00:36:04,310
+السفر عند المريض، عندما تصبح نقطة الهواء هادى في
+
+484
+00:36:04,310 --> 00:36:09,840
+ميزان الميّهفي النصف بيكون أه صارت الآن هذه
+
+485
+00:36:09,840 --> 00:36:14,260
+مستقيمة 100% يعني الزاوية 180 درجة عند زاوية 180
+
+486
+00:36:14,260 --> 00:36:17,720
+درجة هنا بتلاقي نقطة الهواء هذه في نص الميزان
+
+487
+00:36:17,720 --> 00:36:21,140
+معناه الآن أن نقطة الصفر هنا هي نقطة الصفر هناك
+
+488
+00:36:21,140 --> 00:36:26,500
+طيب بعد ذلك إيش بده أسوي؟ أول حاجة بفتح ال fluid
+
+489
+00:36:26,500 --> 00:36:30,580
+من ال saline اللي فوق فوق، direct أ mean المريض
+
+490
+00:36:30,580 --> 00:36:33,820
+ليش؟ عشان أشوف ال flow لازم كل flow إيش ماله؟
+
+491
+00:36:33,820 --> 00:36:39,800
+runningRunning تمام؟ طب ليش؟ عشان مايكونش مادة لو
+
+492
+00:36:39,800 --> 00:36:42,980
+كان مش Running حكون فيه Resistance حدين قراءة CBD
+
+493
+00:36:42,980 --> 00:36:47,080
+عالية طب okay فتحته لقيته Running تمام تمام الآن
+
+494
+00:36:47,080 --> 00:36:50,560
+بتروح بتسكر و بتعب بالمصطرة يعني بغير الاتجاه تبع
+
+495
+00:36:50,560 --> 00:36:54,100
+ال stop book هذا زي ما هو أنا فتح زي ما انتوا
+
+496
+00:36:54,100 --> 00:36:57,380
+شايفين فتح المحلول اللي جاي بغز المصطرة فتحه على
+
+497
+00:36:57,380 --> 00:37:03,160
+المريض Running تمام تمام بعد هيكبفتح عشان إيش؟ أعب
+
+498
+00:37:03,160 --> 00:37:05,440
+المسطرة، ببدأ ينتلي هاي السائق، شايفين؟ في
+
+499
+00:37:05,440 --> 00:37:08,620
+المسطرة، في المسطرة، أيوة، بدأ هنا، عفوا، ننتلي،
+
+500
+00:37:08,620 --> 00:37:12,120
+ننتلي، ننتلي، ننتلي، تمام، انتلت المسطرة، كويس،
+
+501
+00:37:12,120 --> 00:37:18,260
+الآن ببدأ أفتح من المسطرة على المريضبفتح من
+
+502
+00:37:18,260 --> 00:37:21,780
+المسطرة على المريض اللي هو لما بفتح من المسطرة على
+
+503
+00:37:21,780 --> 00:37:24,600
+المريض مبدأ إيه؟ ينزل، ينزل، ينزل، ينزل، ينزل،
+
+504
+00:37:24,600 --> 00:37:24,680
+ينزل، ينزل، ينزل، ينزل، ينزل، ينزل، ينزل، ينزل،
+
+505
+00:37:24,680 --> 00:37:26,000
+ينزل، ينزل، ينزل، ينزل، ينزل، ينزل، ينزل، ينزل،
+
+506
+00:37:26,000 --> 00:37:26,020
+ينزل، ينزل، ينزل، ينزل، ينزل، ينزل، ينزل، ينزل،
+
+507
+00:37:26,020 --> 00:37:33,120
+ينزل، ينزل، ينزل، ينزل، ينزل، ينزل، ينزل، ينزل، ي
+
+508
+00:37:33,150 --> 00:37:36,610
+خالص بيضلوا يعملوا حاجة بنسميها Fluctuation مع
+
+509
+00:37:36,610 --> 00:37:40,490
+إيش؟ مع حركة النفس لما يبدأ يعمل الـ Fluctuation
+
+510
+00:37:40,490 --> 00:37:43,910
+هذا مع حركة النفس يعني بطلع واحد و بنزل واحد، بطلع
+
+511
+00:37:43,910 --> 00:37:50,310
+واحد او اتنين و بنزل اتنين، بكون هو عند النقطة هذه
+
+512
+00:37:50,310 --> 00:37:54,230
+هو الـCDD فمثلا عند خمسة صار يطلع شوية و ينزل شوية
+
+513
+00:37:54,230 --> 00:37:58,990
+يعني هو الـCDD خمسة تبع المريض هذا تمام برضه يعني
+
+514
+00:37:58,990 --> 00:38:02,800
+من خلال الفيديو ان شاء الله هتكونالوضع أوضح، واضح،
+
+515
+00:38:02,800 --> 00:38:05,760
+مع أنه اعتقد انه يعني انا شراحته مافيه الكفاية،
+
+516
+00:38:05,760 --> 00:38:09,660
+okay؟ وبنكون سجلنا هذه القراءة، هذه طريقة قياس
+
+517
+00:38:09,660 --> 00:38:13,060
+طبعا الـCDD عن طريق اللي هو الميه، لذلك بنسجل ان
+
+518
+00:38:13,060 --> 00:38:20,760
+الـCDD خمسة مثلا، سانتي، نتر، water، okay؟طبعًا،
+
+519
+00:38:20,760 --> 00:38:23,760
+عندما يكون لدينا Transducer، سنقوم بنفس الشيء بس
+
+520
+00:38:23,760 --> 00:38:27,880
+سنشبك كل هذا الكلام على Transducer وسنقوم بالـ
+
+521
+00:38:27,880 --> 00:38:32,800
+Zeroing يعني سأقول للجهاز إنه بعد ما أعملت الـ
+
+522
+00:38:32,800 --> 00:38:35,300
+Zeroing، الـ Pressure بعد ما أعمل أيش في الـ
+
+523
+00:38:35,300 --> 00:38:39,500
+Zeroing لـ Transducer نفسه، هو سيكون بالظبط عامله
+
+524
+00:38:39,500 --> 00:38:43,760
+اللي هو مع نقطة الصفر تبع المريض ويكونوا على نفس
+
+525
+00:38:43,760 --> 00:38:48,310
+المستوى وأثابتهفي المصطرة اللي جنب المريض أو في
+
+526
+00:38:48,310 --> 00:38:51,110
+الـ Stand اللي جنب المريض وبعدها أعمل للجهاز
+
+527
+00:38:51,110 --> 00:38:53,970
+calibration إنه هذه نقطة الـ Zero الـ Zero اللي
+
+528
+00:38:53,970 --> 00:38:59,110
+بنسميها Zeroing وبعدها يقدر الجهاز يقيس فبديني إيش
+
+529
+00:38:59,110 --> 00:39:02,990
+في فوق هذا الـ Zero وبراشار بديني إياه ويقرألي
+
+530
+00:39:02,990 --> 00:39:10,850
+إياه وزي ما شفنا إنه الدغط الذئبقي أقل من الدغط ال
+
+531
+00:39:10,850 --> 00:39:12,550
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+532
+00:39:12,550 --> 00:39:13,450
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+533
+00:39:13,450 --> 00:39:14,570
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+534
+00:39:14,570 --> 00:39:15,410
+ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال
+
+535
+00:39:15,410 --> 00:39:15,430
+.. ال .. ال .. ال .. ال .. ال .. ال .. ال .. ال ..
+
+536
+00:39:15,430 --> 00:39:18,130
+ال .. ال .. ال .. ال .. ال .. ال .. التمام؟ هذا هو
+
+537
+00:39:18,130 --> 00:39:24,870
+المؤشر تبع الـCVB وهي جاتوه هنا بيديني ده كله أزرق
+
+538
+00:39:24,870 --> 00:39:31,350
+وبيديني هنا إنه الـCVB جدش الرقم تبعه تمانية،
+
+539
+00:39:31,350 --> 00:39:36,750
+سبعة، وات، وات، وات، وات، وات، وات، وات، وات، وات،
+
+540
+00:39:36,750 --> 00:39:37,410
+وات، وات، وات، وات، وات، وات، وات، وات، وات، وات،
+
+541
+00:39:37,410 --> 00:39:40,010
+وات، وات، وات، وات، وات، وات، وات، وات، وات، وات،
+
+542
+00:39:40,010 --> 00:39:40,010
+وات، وات، وات، وات، وات، وات، وات، وات، وات، وات،
+
+543
+00:39:40,010 --> 00:39:42,070
+وات، وات، وات، وات، وات، وات، وات، وات، وات، وات،
+
+544
+00:39:42,070 --> 00:39:46,110
+وات، وات، وات،
+
+545
+00:39:50,190 --> 00:39:52,910
+حتى في الـ Open Heart Surgeons بطلوا يستخدموها
+
+546
+00:39:52,910 --> 00:39:55,470
+لأنه في وسائل تانية كتير بتخليني أعرف الـ
+
+547
+00:39:55,470 --> 00:39:58,430
+Pulmonary Artery Pressure جداش و الـ Lung Pressure
+
+548
+00:39:58,430 --> 00:40:02,610
+حتى و Cardiac Output هي يعني كانت مميزتها أنك
+
+549
+00:40:02,610 --> 00:40:04,930
+تعرفي الـ Cardiac Output لكن الآن بالـ
+
+550
+00:40:04,930 --> 00:40:07,770
+Calculations بيقدروا يعرفوا كل الحاجات هذه فمش
+
+551
+00:40:07,770 --> 00:40:11,870
+محتاجين إنهم يركبوا Swans Gans Swans Gans Catheter
+
+552
+00:40:11,870 --> 00:40:17,190
+عشان يعرفوها هي فكرتها كانت أنه انت فيه Catheter
+
+553
+00:40:17,190 --> 00:40:21,780
+طويلةوبتدخل هذا الـ catheter لما نتوصف للـ
+
+554
+00:40:21,780 --> 00:40:23,960
+pulmonary artery وفي الـ pulmonary artery هذه
+
+555
+00:40:23,960 --> 00:40:31,400
+بيكون فيها بالون فالبالون بينفخ في لحظة الـ
+
+556
+00:40:31,400 --> 00:40:38,560
+diastole يعني وفي اللحظة هذه بياخد قياس للـ
+
+557
+00:40:38,560 --> 00:40:43,200
+pulmonary artery pressure كام كمية الضغط اللي فيه
+
+558
+00:40:43,200 --> 00:40:45,780
+ومن خلالها بيحددوا طبعاً
+
+559
+00:40:51,130 --> 00:40:54,590
+الـ lung أكتر من طبقات تكون مشكلة related عادة
+
+560
+00:40:54,590 --> 00:40:58,610
+للقلب هذه الصورة اللي أنا بدورها انها تشايف ان انت
+
+561
+00:40:58,610 --> 00:41:01,330
+بخش شهانة زي الـ central line عادي لكن بيختلف تمشي
+
+562
+00:41:01,330 --> 00:41:03,650
+بيكمل لما يوصل ال right ventricle ومن ال right
+
+563
+00:41:03,650 --> 00:41:08,110
+ventricle بيطلع من ال right ventricle sorry من ال
+
+564
+00:41:08,110 --> 00:41:12,130
+right ventricle هيمشي و يطلع حياته لما نوصل لوين
+
+565
+00:41:12,130 --> 00:41:17,680
+لالpalmona دي طبعا هو إيش يعنيعالـ Pulmonary
+
+566
+00:41:17,680 --> 00:41:20,660
+Artery، لو عارفين أحنا الـ Pulmonary Artery تروح
+
+567
+00:41:20,660 --> 00:41:24,940
+في Right و في Left، فهتبروا أنه يروح على واحد منهم
+
+568
+00:41:24,940 --> 00:41:28,140
+من الـ Pulmonary Arteries وبالتالي هيبدأ يقسل في
+
+569
+00:41:28,140 --> 00:41:33,260
+حاجة اسمها إيه الـ Pulmonary Lung Pressure آه،
+
+570
+00:41:33,260 --> 00:41:42,920
+والـ Pulmonary Artery Pressure ما
+
+571
+00:41:42,920 --> 00:41:49,100
+عادش هذا الكلام يعني حيوي ولاولا في حد بيرضى إنه
+
+572
+00:41:49,100 --> 00:41:52,960
+يستخدم سوان غنز كاتيتر عشان الحاجات هذه الآن في
+
+573
+00:41:52,960 --> 00:41:57,180
+وسائل كتير مختورة خاصة بقى لوجود الـ Cardiac
+
+574
+00:41:57,180 --> 00:42:02,320
+Catheterization اللي بتحل مشاكل المرضى يعني بيجي
+
+575
+00:42:02,320 --> 00:42:06,200
+المريض في picture of angina أو MRI بيعملوا
+
+576
+00:42:06,200 --> 00:42:09,720
+catheterization و بيحلوا المشكلة اللي مخالية تخش
+
+577
+00:42:09,720 --> 00:42:13,120
+في cardiogenic shock زمان كانت الأمور بتتوقف على
+
+578
+00:42:13,120 --> 00:42:17,730
+متابعة المريض اللي عنده cardiogenic shockوعنده
+
+579
+00:42:17,730 --> 00:42:20,270
+unstable angina لكن الآن لأ الـ «Interventional
+
+580
+00:42:20,270 --> 00:42:23,610
+Cardiology» حلت المشكلة لأنهم بيعملوله «Stint»
+
+581
+00:42:23,610 --> 00:42:27,410
+ويطلعوه من الشك وبرجعوا القلب برجعوا الـ «Ejection
+
+582
+00:42:27,410 --> 00:42:32,870
+Fraction» لقى القلب بعد ما أنه يعني السبب اللي مقد
+
+583
+00:42:32,870 --> 00:42:37,990
+لإنه الـ «Ejection Fraction» يصير له يروح سواء كان
+
+584
+00:42:37,990 --> 00:42:45,370
+«Coronary Thrombosis» أو حتى إذا كان يعني «mitral»
+
+585
+00:42:45,670 --> 00:42:52,690
+فالب ريجيرج أو استينوسس فيه بنعمل repair أو بنعمل
+
+586
+00:42:52,690 --> 00:42:57,390
+replacement لفالف سواء كان يعني فالف للمشكلة أو
+
+587
+00:42:57,390 --> 00:43:01,730
+اللي هو coronary artery problem بتنحل أو حتى لو
+
+588
+00:43:01,730 --> 00:43:07,850
+كانت congenital problem بتنحل تمام هي تقريبا هذه
+
+589
+00:43:07,850 --> 00:43:11,550
+هي الحاجات اللي أنا كنت طبعا بالنسبة للـArterial
+
+590
+00:43:11,550 --> 00:43:16,100
+line الـArterial line بدي أحكي يعني هنا منمن أهم
+
+591
+00:43:16,100 --> 00:43:20,640
+مشاكل الارتري لله يعني ممكن يصير مكان الارتري إذا
+
+592
+00:43:20,640 --> 00:43:24,480
+كان فيه أي تعامل خطأ أو تسربت أي نقطة هو أن يصير
+
+593
+00:43:24,480 --> 00:43:31,100
+في إيد كل هيتها ischemia لإن نقطة هو معناها إنها
+
+594
+00:43:31,100 --> 00:43:35,460
+منعت وصول blood الارتري عن الدم هيمشي هيكطبعاً بطل
+
+595
+00:43:35,460 --> 00:43:39,260
+الدم يوصل هيك فبالتالي هتصير في المنطقة هذه الـ
+
+596
+00:43:39,260 --> 00:43:42,400
+Scheme هدن المشاكل تبعت الـ Arterial Lines لو
+
+597
+00:43:42,400 --> 00:43:44,620
+اتركبنا Arterial Lines زي الـ Arterial Lines
+
+598
+00:43:44,620 --> 00:43:47,220
+المتابعة اللي هو في الـ Intensive Blood Pressure
+
+599
+00:43:47,220 --> 00:43:55,020
+الـ Vascular Disorder مش هنضطرقلها في خلال الشرح
+
+600
+00:43:55,020 --> 00:44:00,820
+هذا إن شاء الله يعني هذا هأسسني و أروح على موضوع
+
+601
+00:44:00,820 --> 00:44:08,120
+الشك فورا ونبدأ نحكي عنالشُك وأنواع الشُك، هياته،
+
+602
+00:44:08,120 --> 00:44:14,680
+أنواع الشُك وكيف بدنا نعمل management لالشُك وان
+
+603
+00:44:14,680 --> 00:44:18,880
+شاء الله هرفعكوا الفيديوهات تبعها يعطيكم العافية
+
+604
+00:44:18,880 --> 00:44:25,600
+وأي سؤال يعني على وسائل الاتصال اللي بنستخدمها
+
+605
+00:44:25,600 --> 00:44:29,000
+هنجوبكوا والسلام عليكم ورحمة الله
+