معلومات طبية مهمة Important medical information | United States America (US)

Create: 2025-06-25 Update: 2025-06-27 06:04:33

" المصائب لا تأتي فرادى"

استقبال الطوارئ

ياسمين 29 سنة آنسة مهندسة معمارية

مافيش تاريخ مرضي يذكر
بس معروفة إنها بتشتغل تحت ضغط طول الوقت

جاية الطوارئ بتنهج وشها شاحب
حاطة ايديها على صدرها من الألم

قالت وهي مش قادرة تكمل جملتها

"قلبي بيدق جامد مش قادرة أخد نفسي صدري واجعني أوي"

Clinical Analysis

بدأت الأعراض من يومين وبتزيد تدريجي

Fever = 38.9°C

HR = 130 bpm

RR = 28/min

BP = 90/55

SpO₂ = 88% on room air

متوترة جدًا بتتكلم بصعوبة وبتقول إن الألم في صدرها بيزيد مع النفس

أول تفكير: Pulmonary Embolism؟

✔️ ECG: Sinus tachycardia
✔️ D-dimer: Elevated
✔️ ABG: Hypoxia + mild respiratory alkalosis

✅ التشخيص الأولي:
Acute Pulmonary Embolism

بدأنا على طول

Oxygen

IV fluids بحذر

Enoxaparin (therapeutic dose)

لكن

بعد 6 ساعات

بدأت تدخل في confusion
مستواها العقلي بيتدهور
وبدأت تقول حاجات مش مترابطة
ولما جينا نكلمها... ماعرفتناش!

قلنا لأ كده مش PE وبس

الـ PE يتحسن على العلاج وده مخها بيروّح أكتر!

طلبنا

✅ MRI Brain → جات المفاجأة

Multiple small foci of restricted diffusion in cortical and subcortical areas

ولقينا

Microinfarcts
منتشره... شكلها embolic origin

بس إيه ده؟ منين جات؟

كان في الرئة طب وده في المخ ؟

و جات اللحظة المضيئة وقت ما بحط oximeter في أيده شوفت ضافرها فيه splinter heamorrhage
بدأنا نربط الخيوط

بسال أهلها هي راحت لدكتور اسنان قريب ؟

أهلها قالوا إنها من 20 يوم كانت بتشتكي من ألم في الأسنان وراحت لدكتور أسنان عملها خلع ضرس وقال عندها خراج بسيط

Wait...

خلع ضرس؟
بـ fever؟
وبدأت بعدها أعراض emboli متعددة؟
خلاص هي Infective Endocarditis

Investigations

✅ Blood cultures → Positive for Streptococcus viridans

✅ ESR, CRP → Very high

✅ TEE (Transesophageal Echo) → Vegetation on mitral valve ~1.2 cm

🎯 التشخيص النهائي:

Infective Endocarditis with septic emboli (brain & lung)
التهاب في بطانة القلب هو عدوى تصيب بطانة حجرات القلب او صمامات القلب

بدأنا العلاج

IV Ceftriaxone + Gentamicin

Antiepileptics بسبب التشنجات

ICU Monitoring

بعد أسبوع

بدأت تفوق شوية

بعد شهر:

رجعت العيادة... لابسة أبيض وأسود

جابتلي شوكولاتة وقالت:

"أنا كنت هموت من خراج؟!"

قلت لها:

"الخراج لو ما اتنضفش... ممكن يبعته القلب هدية للمخ!"

الدرس
Multiple embolic phenomena in a febrile patient = Infective Endocarditis until proven otherwise.

معلومات طبية مهمة Important medical information

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معلومات طبية مهمة Important medical information

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" المصائب لا تأتي فرادى"

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