• Hello Everybody . i am Introducing "The Comprehensive Guide in Hernia" by Dr. Atef Ahmed – Your Ultimate Resource for Hernia Knowledge!

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    Are you seeking a definitive source to demystify the complexities of hernia? Look no further! Dr. Atef Ahmed presents a comprehensive masterpiece that promises to be your go-to reference for all things hernia-related. "The Comprehensive Guide in Hernia" is a treasure trove of insights, offering a wealth of information and practical solutions to tackle hernia concerns with confidence.

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    Curious about the different types of hernias, their causes, or potential treatments? Dr. Atef Ahmed provides clear and concise answers to all your burning hernia questions. Whether you're a patient, caregiver, or medical professional, this book simplifies the intricacies of hernia, ensuring you're well-informed every step of the way.

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    Real-Life Case Scenarios in Hernia:
    Explore real-world scenarios and gain insight into how hernia cases are managed by medical professionals. Dr. Atef Ahmed presents a collection of intriguing case studies, providing a behind-the-scenes look at the challenges and triumphs faced in hernia treatment. These scenarios serve as invaluable learning tools for healthcare practitioners and students alike.

    "The Comprehensive Guide in Hernia" by Dr. Atef Ahmed is your one-stop resource for all things hernia-related. Whether you're a healthcare professional looking to expand your expertise or someone dealing with hernia concerns personally, this book offers a holistic approach to understanding, managing, and conquering hernia issues.

    Don't miss out on this invaluable resource! Grab your copy today and embark on a journey toward hernia knowledge and mastery like never before. Dr. Atef Ahmed's wealth of experience and dedication to simplifying complex medical topics will leave you equipped and empowered to take control of your hernia-related challenges.

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    Hello Everybody . i am Introducing "The Comprehensive Guide in Hernia" by Dr. Atef Ahmed – Your Ultimate Resource for Hernia Knowledge! https://youtu.be/Sjdat8Wpxiw get Your copy from amazon https://www.amazon.com/dp/B0CHN9XSL7 other books of the author http://www.amazon.com/author/dratef https://youtu.be/Sjdat8Wpxiw Are you seeking a definitive source to demystify the complexities of hernia? Look no further! Dr. Atef Ahmed presents a comprehensive masterpiece that promises to be your go-to reference for all things hernia-related. "The Comprehensive Guide in Hernia" is a treasure trove of insights, offering a wealth of information and practical solutions to tackle hernia concerns with confidence. 📘 Unparalleled Answers to Your Hernia Questions: Curious about the different types of hernias, their causes, or potential treatments? Dr. Atef Ahmed provides clear and concise answers to all your burning hernia questions. Whether you're a patient, caregiver, or medical professional, this book simplifies the intricacies of hernia, ensuring you're well-informed every step of the way. 📚 Test Your Knowledge with MCQs in Hernia: Challenge yourself with a series of thought-provoking Multiple Choice Questions (MCQs) specifically designed to enhance your understanding of hernia. Dr. Atef Ahmed's expertise shines through as he guides you through these interactive exercises, making learning about hernia both engaging and informative. 💡 Proven Tips and Tricks in Hernia Management: Navigate the world of hernia management like a pro! This book is brimming with invaluable tips and tricks to help you or your patients effectively manage hernia-related issues. Dr. Atef Ahmed's practical advice will empower you to make informed decisions and ensure the best possible outcomes. 🏥 Real-Life Case Scenarios in Hernia: Explore real-world scenarios and gain insight into how hernia cases are managed by medical professionals. Dr. Atef Ahmed presents a collection of intriguing case studies, providing a behind-the-scenes look at the challenges and triumphs faced in hernia treatment. These scenarios serve as invaluable learning tools for healthcare practitioners and students alike. "The Comprehensive Guide in Hernia" by Dr. Atef Ahmed is your one-stop resource for all things hernia-related. Whether you're a healthcare professional looking to expand your expertise or someone dealing with hernia concerns personally, this book offers a holistic approach to understanding, managing, and conquering hernia issues. Don't miss out on this invaluable resource! Grab your copy today and embark on a journey toward hernia knowledge and mastery like never before. Dr. Atef Ahmed's wealth of experience and dedication to simplifying complex medical topics will leave you equipped and empowered to take control of your hernia-related challenges. get Your copy from amazon https://www.amazon.com/dp/B0CHN9XSL7 other books of the author http://www.amazon.com/author/dratef https://youtu.be/Sjdat8Wpxiw #Hernia #HerniaSurgery #HerniaBook #HerniaAwareness #HerniaSupport #lifes1 #hernia #herniateddisc #herniarepair #herniatreatment #herniasurgery #herniateddiscexercises #herniateddisctreatment #herniateddisk #herniadiscal #herniasymptoms #herniakailaj #herniaoperation
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  • How to Repair an Enterocutaneous Fistula Laparoscopically: A step-by-step guide


    https://yt6.pics.ee/5485mw
    https://youtu.be/C7LYMTOH-JQ
    https://twitter.com/DrATEFAHMED/status/1681039319836905472?s=20
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    Laparoscopic Repair for Enterocutaneous Fistula

    An enterocutaneous fistula is an abnormal connection between the intestine and the skin. It can be caused by a number of factors, including surgery, infection, and inflammation. Fistulas can be very difficult to treat, and they can often lead to serious complications, such as infection, sepsis, and malnutrition.

    Laparoscopic repair is a minimally invasive surgical procedure that can be used to treat enterocutaneous fistulas. This procedure involves making a few small incisions in the abdomen, and then using a laparoscope (a thin, tube-like instrument with a camera) to visualize the fistula and surrounding tissues. The fistula is then repaired using sutures or staples.

    Laparoscopic repair is a safe and effective procedure for treating enterocutaneous fistulas. It has a number of advantages over traditional open surgery, including:

    Shorter hospital stay
    Less pain
    Faster recovery
    Smaller scars
    In this video, we will discuss the anatomy of enterocutaneous fistulas, the causes of fistulas, the symptoms of fistulas, and the treatment options for fistulas. We will also discuss the benefits of laparoscopic repair for enterocutaneous fistulas.

    If you are interested in learning more about laparoscopic repair for enterocutaneous fistula, please watch this video. We hope that this video will provide you with the information you need to make an informed decision about your treatment options.



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    How to Repair an Enterocutaneous Fistula Laparoscopically: A step-by-step guide https://yt6.pics.ee/5485mw https://youtu.be/C7LYMTOH-JQ https://twitter.com/DrATEFAHMED/status/1681039319836905472?s=20 https://www.instagram.com/p/Cuz-1r2sUk9/?utm_source=ig_web_copy_link&igshid=MzRlODBiNWFlZA== #laparoscopicsurgeon #bowel #Enterocutaneous #fistulakit #laparoscopicrepair #enterocutaneousfistula #fistula #surgery #medical #health #doctor #nurse #healthcare #laparoscopic #minimallyinvasive #procedure #surgery #treatment #recovery #patient #outcomes #complications #casestudy #video #youtube #learn #education #information #enterocutaneous #fistularepair #fistulasurgery #fistulatreatment #laparoscopicsurgery #minimallyinvasivesurgery #surgeryvideo #youtubevideo #educationalvideo #informativevideo #learnaboutsurgery #learnaboutfistula #learnaboutlaparoscopicsurgery #surgeryexplained #fistulaexplained #laparoscopicsurgeryexplained #howtorepairafistula #howtoperformlaparoscopicfistularepair #stepbystepguide #patientjourney #patientoutcomes #complicationstowatchfor #whattoexpectaftersurgery #whattoaskyourdoctor #whattoexpectduringrecovery #fistulapatients #fistulasurvivors #fistulacommunity #fistulasupport #laparoscopicfistulasupport #laparoscopicsurgerysupport #surgerysupport #medicalsupport #healthcaresupport #youtubesupport #youtubecommunity #youtubeeducation #youtubelearning #fistulaawareness #laparoscopicfistulaawareness #surgeryawareness #medicalawareness #healthcareawareness #youtubeawareness #youtubeeducationawareness #youtubelearningawareness Laparoscopic Repair for Enterocutaneous Fistula An enterocutaneous fistula is an abnormal connection between the intestine and the skin. It can be caused by a number of factors, including surgery, infection, and inflammation. Fistulas can be very difficult to treat, and they can often lead to serious complications, such as infection, sepsis, and malnutrition. Laparoscopic repair is a minimally invasive surgical procedure that can be used to treat enterocutaneous fistulas. This procedure involves making a few small incisions in the abdomen, and then using a laparoscope (a thin, tube-like instrument with a camera) to visualize the fistula and surrounding tissues. The fistula is then repaired using sutures or staples. Laparoscopic repair is a safe and effective procedure for treating enterocutaneous fistulas. It has a number of advantages over traditional open surgery, including: Shorter hospital stay Less pain Faster recovery Smaller scars In this video, we will discuss the anatomy of enterocutaneous fistulas, the causes of fistulas, the symptoms of fistulas, and the treatment options for fistulas. We will also discuss the benefits of laparoscopic repair for enterocutaneous fistulas. If you are interested in learning more about laparoscopic repair for enterocutaneous fistula, please watch this video. We hope that this video will provide you with the information you need to make an informed decision about your treatment options. #laparoscopicrepair #enterocutaneousfistula #fistula #surgery #medical #health #doctor #nurse #healthcare #laparoscopic #minimallyinvasive #procedure #surgery #treatment #recovery #patient #outcomes #complications #casestudy #video #youtube #learn #education #information #enterocutaneous #fistularepair #fistulasurgery #fistulatreatment #laparoscopicsurgery #minimallyinvasivesurgery #surgeryvideo #youtubevideo #educationalvideo #informativevideo #learnaboutsurgery #learnaboutfistula #learnaboutlaparoscopicsurgery #surgeryexplained #fistulaexplained #laparoscopicsurgeryexplained #howtorepairafistula #howtoperformlaparoscopicfistularepair #stepbystepguide #patientjourney #patientoutcomes #complicationstowatchfor #whattoexpectaftersurgery #whattoaskyourdoctor #whattoexpectduringrecovery #fistulapatients #fistulasurvivors #fistulacommunity #fistulasupport #laparoscopicfistulasupport #laparoscopicsurgerysupport #surgerysupport #medicalsupport #healthcaresupport #youtubesupport #youtubecommunity #youtubeeducation #youtubelearning #fistulaawareness #laparoscopicfistulaawareness #surgeryawareness #medicalawareness #healthcareawareness #youtubeawareness #youtubeeducationawareness #youtubelearningawareness
    YT6.PICS.EE
    How to Repair an Enterocutaneous Fistula Laparoscopically: A step-by-step guide / Laparoscopic
    #laparoscopicsurgeon #bowel #Enterocutaneous #fistulakit #laparoscopicrepair #enterocutaneousfistula #fistula #surgery #medical #health #doctor #nurse
    0 Comments 1 Shares 52782 Views
  • Unlock your true potential as a medical professional with "The Healing Touch: A Comprehensive Guide to Becoming a Successful Doctor." This insightful and empowering book is designed to provide aspiring doctors and seasoned professionals alike with the essential tools and guidance they need to excel in their careers.

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    Unlock your true potential as a medical professional with "The Healing Touch: A Comprehensive Guide to Becoming a Successful Doctor." This insightful and empowering book is designed to provide aspiring doctors and seasoned professionals alike with the essential tools and guidance they need to excel in their careers. https://twitter.com/DrATEFAHMED/status/1679896498518077446?s=20 https://youtu.be/Pwgr8wg_VQ8 Full Copy Of The book https://www.amazon.com/dp/B0CBVPNFV6 Free Sample of the book https://t.me/no1doctors/27955 Written by experienced physician and healthcare expert, Dr.Atef , this comprehensive guide delves into the key aspects of being a successful doctor, offering valuable insights, practical advice, and inspiring anecdotes. From navigating medical school to thriving in a professional practice, Dr. Atef covers every stage of the journey, providing readers with the wisdom they need to flourish in their chosen field. Inside "The Healing Touch," you will discover: Proven strategies for excelling in medical school and residency programs, including tips for effective studying, time management, and securing competitive placements. Insightful guidance on choosing a specialty that aligns with your passions and strengths, along with practical steps for developing expertise in your chosen field. In-depth discussions on the importance of patient care, empathy, and communication skills in building meaningful connections with patients. Practical advice for managing challenges and overcoming obstacles, including stress management techniques, self-care practices, and strategies for maintaining a healthy work-life balance. Expert insights on professional development, lifelong learning, and staying abreast of the latest medical research and advancements. Inspiring stories and real-life examples from successful doctors who have made a significant impact in their communities and beyond. "The Healing Touch" goes beyond the technical aspects of medicine and explores the qualities and mindset that set successful doctors apart. With its engaging writing style and actionable advice, this book serves as a trusted companion for those embarking on their medical journey or seeking to elevate their current practice. Whether you are a medical student, resident, or experienced physician, "The Healing Touch" will equip you with the knowledge, skills, and inspiration needed to make a lasting impact in the lives of your patients and the field of medicine. Order your copy of "The Healing Touch: A Comprehensive Guide to Becoming a Successful Doctor" today and take the first step towards unlocking your true potential in the world of healthcare. https://twitter.com/DrATEFAHMED/status/1679896498518077446?s=20 https://youtu.be/Pwgr8wg_VQ8 Full Copy Of The book https://www.amazon.com/dp/B0CBVPNFV6 Free Sample of the book https://t.me/no1doctors/27955 #doctor #doctors #doctorlife #healthcare #health #medicine #medical #nurse #nurses #hospital #surgery #patient #prescription #diagnosis #treatment #wellness #fitness #healthy #nutrition #mentalhealth #disease #injury #emergency #research #education #advocacy #technology #innovation #futureofhealthcare #doctorswithoutborders #redcross #cdc #who #ama #aarp #healthline #webmd #mayoclinic #nprhealth
    0 Comments 2 Shares 46614 Views
  • "The Art of Patient Communication" is a comprehensive guidebook that delves into the essential skills and strategies healthcare professionals need to master effective communication with their patients. Written by dr Atef Ahmed Abdelrahim, an experienced consultant surgeon and versatile author, this book offers invaluable insights and practical techniques to enhance patient interactions and improve healthcare outcomes.

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    Drawing upon his extensive medical expertise and passion for literature, dr.atef explores the delicate art of patient communication with compassion and empathy. Through this book, healthcare professionals will learn how to navigate diverse patient needs, break down complex medical information, and create an environment of trust and understanding.

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    Discover the transformative power of communication and elevate your patient interactions with "The Art of Patient Communication." Get ready to enhance your communication skills, inspire patient trust, and create a truly patient-centered healthcare experience.

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    "The Art of Patient Communication" is a comprehensive guidebook that delves into the essential skills and strategies healthcare professionals need to master effective communication with their patients. Written by dr Atef Ahmed Abdelrahim, an experienced consultant surgeon and versatile author, this book offers invaluable insights and practical techniques to enhance patient interactions and improve healthcare outcomes. https://twitter.com/DrATEFAHMED/status/1613851483614908416?s=20 https://www.amazon.com/dp/B0CB21H9V7 Free Sample Of the Book https://t.me/no1doctors/27837 https://youtu.be/kEpVNzcQMyM https://twitter.com/DrATEFAHMED/status/1613851483614908416?s=20 https://www.instagram.com/reel/CuVIw2xsjJC/?utm_source=ig_web_copy_link&igshid=MzRlODBiNWFlZA== Drawing upon his extensive medical expertise and passion for literature, dr.atef explores the delicate art of patient communication with compassion and empathy. Through this book, healthcare professionals will learn how to navigate diverse patient needs, break down complex medical information, and create an environment of trust and understanding. https://www.amazon.com/dp/B0CB21H9V7 Free Sample Of the Book https://t.me/no1doctors/27837 This insightful resource covers a wide range of topics, including active listening, empathy, cultural sensitivity, communicating difficult diagnoses, addressing patient emotions, and fostering shared decision-making. With real-world examples, case studies, and practical exercises, readers will gain the necessary skills to connect with patients on a deeper level and provide patient-centered care. https://www.amazon.com/dp/B0CB21H9V7 Free Sample Of the Book https://t.me/no1doctors/27837 "The Art of Patient Communication" is not just for healthcare professionals; it is also valuable for students, educators, and anyone interested in improving their communication skills in a healthcare setting. Whether you are a seasoned healthcare provider or just starting your medical career, this book will empower you to communicate effectively, build lasting relationships with your patients, and make a positive impact on their healthcare journey. https://www.amazon.com/dp/B0CB21H9V7 Free Sample Of the Book https://t.me/no1doctors/27837 Discover the transformative power of communication and elevate your patient interactions with "The Art of Patient Communication." Get ready to enhance your communication skills, inspire patient trust, and create a truly patient-centered healthcare experience. https://www.amazon.com/dp/B0CB21H9V7 Free Sample Of the Book https://t.me/no1doctors/27837 https://youtu.be/kEpVNzcQMyM https://twitter.com/DrATEFAHMED/status/1613851483614908416?s=20 https://www.instagram.com/reel/CuVIw2xsjJC/?utm_source=ig_web_copy_link&igshid=MzRlODBiNWFlZA== #patientcommunication #effectivepatientcommunication #patientcare #empathy #listeningskills #rapportbuilding #asktherightquestions #clearinstructions #followup
    Like
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  • "Parathyroid Disorders Unveiled" pdf
    by Dr.Atef Ahmed

    Download the book for free


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    A comprehensive guide that aims to demystify the complex world of parathyroid diseases. This book is designed for medical professionals, students, and anyone interested in understanding the intricacies of parathyroid disorders, their diagnosis, management, and the impact on patients' lives.

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  • The comprehensive Guide In Hernia For Medical
    Students , Doctors & Patients PDF

    Download It Free Now And Share the Links with Your Friends

    https://youtu.be/ZFUl-Zw7LF0

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  • The comprehensive Guide In Hernia For Medical
    Students , Doctors & Patients PDF

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  • Which of the following components of an infection prevention bundle has the most significant impact in reducing surgical site infections in elective colorectal surgery patients?

    A. Preoperative shower with 4% chlorhexidine gluconate
    B. Mechanical bowel preparation
    C. Intraoperative abdominal irrigation with antibiotic
    D. Mechanical bowel preparation combined with oral
    antibiotics
    E. Dedicated instruments for wound closure

    ANSWER: D

    Surgical site infections (SSIs) after colorectal surgery are a significant cause of morbidity and mortality and remain an important national quality indicator. Mechanical bowel preparation plus oral antibiotics was a mainstay in colorectal
    surgery for decades, but several publications questioned the efficacy of mechanical bowel preparation. Numerous randomized controlled trials failed to show any decrease in SSIs or anastomotic leak. A major criticism of these trials was
    omission of the oral antibiotic portion of the standard bowel preparation. The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) retrospectively evaluated 4999 patients who underwent
    colectomy.

    Patients who had a combined mechanical bowel preparation and oral antibiotics had a lower 30-day rate of superficial SSIs, anastomotic leak, and 30-day readmission,
    compared with mechanical bowel preparation alone. Infection prevention bundles are used to reduce the rates of infection related to central line insertions and mechanical ventilation. Several interventions in the preoperative and

    perioperative arenas are proposed to reduce the rates of SSI in colorectal patients, and institutions have grouped them together in an infection prevention bundle. One group studied
    the impact of each component of the infection prevention bundles: mechanical bowel preparation plus oral antibiotics, preoperative chlorhexidine shower, preoperative hair
    clipping, skin preparation with a standard chlorhexidine alcohol solution, intraoperative antibiotic irrigation, and a clean closure protocol with dedicated instruments.
    Multivariate analysis showed that the mechanical bowel preparation with oral antibiotics had the greatest effect on
    reducing SSIs.
    Which of the following components of an infection prevention bundle has the most significant impact in reducing surgical site infections in elective colorectal surgery patients? A. Preoperative shower with 4% chlorhexidine gluconate B. Mechanical bowel preparation C. Intraoperative abdominal irrigation with antibiotic D. Mechanical bowel preparation combined with oral antibiotics E. Dedicated instruments for wound closure ANSWER: D Surgical site infections (SSIs) after colorectal surgery are a significant cause of morbidity and mortality and remain an important national quality indicator. Mechanical bowel preparation plus oral antibiotics was a mainstay in colorectal surgery for decades, but several publications questioned the efficacy of mechanical bowel preparation. Numerous randomized controlled trials failed to show any decrease in SSIs or anastomotic leak. A major criticism of these trials was omission of the oral antibiotic portion of the standard bowel preparation. The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) retrospectively evaluated 4999 patients who underwent colectomy. Patients who had a combined mechanical bowel preparation and oral antibiotics had a lower 30-day rate of superficial SSIs, anastomotic leak, and 30-day readmission, compared with mechanical bowel preparation alone. Infection prevention bundles are used to reduce the rates of infection related to central line insertions and mechanical ventilation. Several interventions in the preoperative and perioperative arenas are proposed to reduce the rates of SSI in colorectal patients, and institutions have grouped them together in an infection prevention bundle. One group studied the impact of each component of the infection prevention bundles: mechanical bowel preparation plus oral antibiotics, preoperative chlorhexidine shower, preoperative hair clipping, skin preparation with a standard chlorhexidine alcohol solution, intraoperative antibiotic irrigation, and a clean closure protocol with dedicated instruments. Multivariate analysis showed that the mechanical bowel preparation with oral antibiotics had the greatest effect on reducing SSIs.
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  • Should All Patients With Breast Cancer Be Offered Multigene Panel Testing?

    https://dratefahmed.blogspot.com/2020/11/should-all-patients-with-breast-cancer.html
    Should All Patients With Breast Cancer Be Offered Multigene Panel Testing? https://dratefahmed.blogspot.com/2020/11/should-all-patients-with-breast-cancer.html
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  • A 65-year-old woman with well controlled type 2 diabetes mellitus presents with perforated appendicitis. She is taken to the operating room for exploration, drainage of intraabdominal abscess, and ileocecectomy. She is admitted to the surgical intensive care unit postoperatively in septic shock.
    Overnight, she is resuscitated with 9 L crystalloid. She is now on norepinephrine and vasopressin infusions to keep her mean arterial pressure above 65 mm Hg. On postoperative day 1, she is hypoxic with pulmonary edema on chest x-ray.
    Her serum potassium is 5.9 mmol/L, her serum creatinine increased from 1.5 to 5.4 mg/dL (0.4-1.3 mg/dL), her serum blood urea nitrogen is 60 mg/dL (7-20 mg/dL), her serum bicarbonate is 13 mmol/L (20-29 mmol/L), and her pH is 7.21. Her urine output is 0.3 mL/kg/hour for the last 12 hours.

    What is the next step in managing her renal failure?

    A. Continuous renal replacement therapy
    B. Intermittent hemodialysis
    C. Furosemide 80 mg intravenously
    D. Dopamine infusion
    E. Sodium bicarbonate infusion

    ANSWER: A
    Acute kidney injury in the postoperative period is associated with increased morbidity and mortality. Two classification systems were proposed in the early 2000s: the RIFLE criteria
    and the Acute Kidney Injury Network (AKIN) staging system. These systems provide concise definitions of the extent of injury and prognosis. Both systems consider increases in serum creatinine, either an absolute number or an
    increase from baseline, and urine output criteria. This patient had a marked increase in serum creatinine and has oliguria.
    According to the RIFLE criteria, she has Failure; she is in AKIN stage III.
    Additionally, she is acidemic, with a serum pH of 7.21 and bicarbonate of 13 mmol/L (20-29 mmol/L), and hyperkalemic. She also shows evidence of volume overload with hypoxemia and radiographic evidence of pulmonary
    edema.
    This patient has several indications for renal
    replacement therapy.


    Data regarding the optimal modality and timing of renal replacement therapy are conflicting. However, when patients are hemodynamically abnormal and require vasopressor support, a continuous mode of renal replacement therapy is preferred. Continuous modes require smaller volumes of
    blood to be removed at a time compared with intermittent hemodialysis and are better tolerated in hypotensive patients.
    A sodium bicarbonate infusion is used for patients with acidosis; however, starting a sodium bicarbonate infusion is generally not recommended until the serum pH is less than
    7.15. Also, there are no data confirming any reduction in morbidity and mortality for its use in renal failure.
    Aggressive diuretic therapy used in the early stages of AKI to treat volume overload and hyperkalemia is possible.
    However, once a patient advances to renal failure, renal replacement therapy is the preferred modality of management. Low-dose dopamine infusions were once
    erroneously thought to be renal protective via a mechanism of increased renal blood flow. There are currently no data to support the use of a dopamine infusion as prevention or
    treatment of AKI.
    A 65-year-old woman with well controlled type 2 diabetes mellitus presents with perforated appendicitis. She is taken to the operating room for exploration, drainage of intraabdominal abscess, and ileocecectomy. She is admitted to the surgical intensive care unit postoperatively in septic shock. Overnight, she is resuscitated with 9 L crystalloid. She is now on norepinephrine and vasopressin infusions to keep her mean arterial pressure above 65 mm Hg. On postoperative day 1, she is hypoxic with pulmonary edema on chest x-ray. Her serum potassium is 5.9 mmol/L, her serum creatinine increased from 1.5 to 5.4 mg/dL (0.4-1.3 mg/dL), her serum blood urea nitrogen is 60 mg/dL (7-20 mg/dL), her serum bicarbonate is 13 mmol/L (20-29 mmol/L), and her pH is 7.21. Her urine output is 0.3 mL/kg/hour for the last 12 hours. What is the next step in managing her renal failure? A. Continuous renal replacement therapy B. Intermittent hemodialysis C. Furosemide 80 mg intravenously D. Dopamine infusion E. Sodium bicarbonate infusion ANSWER: A Acute kidney injury in the postoperative period is associated with increased morbidity and mortality. Two classification systems were proposed in the early 2000s: the RIFLE criteria and the Acute Kidney Injury Network (AKIN) staging system. These systems provide concise definitions of the extent of injury and prognosis. Both systems consider increases in serum creatinine, either an absolute number or an increase from baseline, and urine output criteria. This patient had a marked increase in serum creatinine and has oliguria. According to the RIFLE criteria, she has Failure; she is in AKIN stage III. Additionally, she is acidemic, with a serum pH of 7.21 and bicarbonate of 13 mmol/L (20-29 mmol/L), and hyperkalemic. She also shows evidence of volume overload with hypoxemia and radiographic evidence of pulmonary edema. This patient has several indications for renal replacement therapy. Data regarding the optimal modality and timing of renal replacement therapy are conflicting. However, when patients are hemodynamically abnormal and require vasopressor support, a continuous mode of renal replacement therapy is preferred. Continuous modes require smaller volumes of blood to be removed at a time compared with intermittent hemodialysis and are better tolerated in hypotensive patients. A sodium bicarbonate infusion is used for patients with acidosis; however, starting a sodium bicarbonate infusion is generally not recommended until the serum pH is less than 7.15. Also, there are no data confirming any reduction in morbidity and mortality for its use in renal failure. Aggressive diuretic therapy used in the early stages of AKI to treat volume overload and hyperkalemia is possible. However, once a patient advances to renal failure, renal replacement therapy is the preferred modality of management. Low-dose dopamine infusions were once erroneously thought to be renal protective via a mechanism of increased renal blood flow. There are currently no data to support the use of a dopamine infusion as prevention or treatment of AKI.
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