tag:blogger.com,1999:blog-76021872390410135592024-03-13T14:19:20.931-07:00Did I Ask For It Stat?yublockahttp://www.blogger.com/profile/11634478211102253572noreply@blogger.comBlogger82125tag:blogger.com,1999:blog-7602187239041013559.post-62791328388643587282012-08-24T18:58:00.000-07:002012-08-24T18:58:13.184-07:00Dead Space Ventilation<div dir="ltr" style="text-align: left;" trbidi="on">
<b>Dead space</b> is the <b>volume of air which is inhaled but does not take part in gas exchange either because it remains in the conducting airways or in alveoli that are poorly perfused</b> i.e. not all the air in each breath is able to be used for the exchange of oxygen and carbon dioxide.<br />
<br />
The total dead space (also known as physiological dead space) is the sum of the anatomical dead space plus the alveolar dead space.
<br />
<h2>
Anatomic dead space</h2>
Approx one-third tidal volume ~150mL in a healthy adult.
<br />
<h2>
Alveolar dead space</h2>
<div style="text-align: left;">
</div>
<ul style="text-align: left;">
<li>Sum of the volumes of alveoli which have little or no blood flowing through their adjacent pulmonary capillaries i.e., <b>alveoli that are ventilated but not perfused</b>, and where, as a result, no gas exchange can occur.</li>
<li><b>Alveolar dead space is negligible in healthy individuals</b>, but can increase dramatically in some lung diseases due to <i>ventilation-perfusion mismatch</i>.</li>
</ul>
<br />
<a href="http://www.paramedicine.com/pmc/End_Tidal_CO2_files/droppedImage_5.png" imageanchor="1" style="clear: left;"><img border="0" height="202" src="http://www.paramedicine.com/pmc/End_Tidal_CO2_files/droppedImage_5.png" width="320" /></a>
<br />
<h2>
References</h2>
<br />
<ul style="text-align: left;">
<li>http://en.wikipedia.org/wiki/Dead_space_(physiology)</li>
<li>http://www.paramedicine.com/pmc/End_Tidal_CO2.html</li>
</ul>
</div>
yublockahttp://www.blogger.com/profile/11634478211102253572noreply@blogger.com8tag:blogger.com,1999:blog-7602187239041013559.post-45992913895890275032012-08-24T16:25:00.002-07:002012-08-24T16:25:20.800-07:00Plateau effect<div dir="ltr" style="text-align: left;" trbidi="on">
Takes 4-5 half lifes for a medication to reach plateau effect.</div>
yublockahttp://www.blogger.com/profile/11634478211102253572noreply@blogger.com0tag:blogger.com,1999:blog-7602187239041013559.post-60201132734136829452012-08-22T19:19:00.001-07:002012-08-22T19:19:54.761-07:00Cryoprecipitate<div dir="ltr" style="text-align: left;" trbidi="on">
<div style="text-align: left;">
<ul style="text-align: left;">
<li>A frozen blood product prepared from plasma</li>
<li>Each 15 mL unit typically contains 100 IU of factor VIII, 250 mg of fibrinogen, as well as von Willebrand factor (vWF) and factor XIII.</li>
<li>Used commonly for DIC to keep fibrinogen levels > 1.0.</li>
<li>1 unit of cryo per 5kg patient weight will increase fibrinogen by about 100 mg/dL. Therefore number of bags = 0.2 x weight (kg) to provide about 100mg/dL fibrinogen.<!--1--></li>
<li>Many institutions use a standard dose of 10 units and then repeat if needed.
</li>
</ul>
</div>
<h2>
References</h2>
<ul style="text-align: left;">
<li>http://en.wikipedia.org/wiki/Cryoprecipitate</li>
<li>http://reference.medscape.com/drug/cryo-cryoprecipitate-999498</li>
<li>http://www.transfusion.com.au/sites/default/files/iTRANSFUSE%202.2%20CRYO.pdf</li>
<li>http://www.perthhaematology.com.au/cryo.ht</li>
</ul>
</div>
yublockahttp://www.blogger.com/profile/11634478211102253572noreply@blogger.com0tag:blogger.com,1999:blog-7602187239041013559.post-50740343985788428582012-08-22T18:32:00.001-07:002012-08-22T18:32:47.601-07:00Anuric renal failure<div dir="ltr" style="text-align: left;" trbidi="on">
<h2>
Anuric renal failure</h2>
<br />
<ul style="text-align: left;">
<li>Urea rises by 10 per day, Cr rises by 100 per day</li>
</ul>
<br />
<h2>
References</h2>
<div>
<ul style="text-align: left;">
<li>http://www.rph.wa.gov.au/nephrology/Acute_renal_failure.html</li>
<li>http://www.doctorslounge.com/nephrology/diseases/acute_renal_failure.htm</li>
<li>http://web.up.ac.za/sitefiles/file/45/1335/4101/Tuesday%20Academic%20Meetings/N%20Grabowski%204%20May%202011%20diagnosis%20of%20renal%20failure.pdf</li>
</ul>
</div>
</div>
yublockahttp://www.blogger.com/profile/11634478211102253572noreply@blogger.com0tag:blogger.com,1999:blog-7602187239041013559.post-80207753283121269362012-08-22T17:16:00.001-07:002012-08-22T17:17:11.297-07:00Management of VF arrest<div dir="ltr" style="text-align: left;" trbidi="on">
<h2>
Passive rewarming</h2>
<ul style="text-align: left;">
<li><b>Temperature is very important during rewarming as temperature commonly overshoots normal</b>. Warming the patient too quickly or allowing continued shivering causes <b>dangerous electrolyte shifts, leading to potentially lethal arrhythmias</b>. </li>
<li>Controlled rewarming of 0.15° to 0.5° C per hour is recommended. </li>
<li>To maintain tight temperature control throughout rewarming a neuromuscular blockade is usually employed. </li>
<li>Careful fluid monitoring during rewarming is crucial because of the <b>vasodilation</b> that accompanies a body temperature rise. Volume replacement may be needed to prevent fluid deficit and <b>hypotension</b>.</li>
<li><b>Electrolytes shift out of the cells back into the serum during rewarming</b>, so frequent electrolyte monitoring is needed during this phase to prevent critically elevated levels. Slow, controlled rewarming allows the kidneys to excrete excess potassium, preventing <b>hyperkalemia</b>.
</li>
<li><b>Hypoglycemia</b> can occur during rewarming as the insulin resistance of earlier hypothermia phases diminishes. Glucose levels must be monitored frequently, with insulin titration and dextrose boluses used as needed to maintain the patient within ordered ranges.</li>
</ul>
<br />
<h2>
References</h2>
<ul style="text-align: left;">
<li>http://www.americannursetoday.com/article.aspx?id=8014&fid=7986</li>
<li>http://ccforum.com/content/16/S2/A25/ </li>
</ul>
</div>
yublockahttp://www.blogger.com/profile/11634478211102253572noreply@blogger.com13tag:blogger.com,1999:blog-7602187239041013559.post-57051789422237069852011-05-04T20:01:00.000-07:002011-05-04T20:05:21.397-07:00DCRDCR = cardioversion (direct current reversion)<br /><h2>References</h2><ul><li>Monash Heart, <a href="http://www.monashheart.org.au/content/Document/MonashHeart_DCR.pdf">http://www.monashheart.org.au/content/Document/MonashHeart_DCR.pdf</a></li><li><a href="http://www.racgp.org.au/afp/200707/200707kistler2.pdf">http://www.racgp.org.au/afp/200707/200707kistler2.pdf</a></li></ul>yublockahttp://www.blogger.com/profile/11634478211102253572noreply@blogger.com0tag:blogger.com,1999:blog-7602187239041013559.post-3803524113674687712011-05-04T04:53:00.000-07:002011-05-04T05:28:47.323-07:00Pantoprazole infusionFor actively bleeding ulcers give pantoprazole bolus followed by infusion.<br /><ul><li>LOading dose: Pantoprazole 80mg IV in 100ml of NaCl 0.9% or 5% glucose over 20 - 30 minutes<br /></li><li>Infusion:<br /></li><ul><li>Pantoprazole 200mg in Dextrose 5% 500mL at 20mL/hr (each mL is 0.4mg , 20mL/hr = 8mg/hr, 1mg =2.5mL)</li><li>Pantoprazole 80mg in N/Saline 100mL at 10mL/hr (each mL is 0.8mg , 10mL/hr = 8mg/hr,1mg=1.25mL)</li></ul></ul><h2>References</h2><ul><li>Pantoprazole infusion guidelines, <a href="http://www.philippelefevre.com/JHH-ICU-guidelines/adult-drug-infussions/pantoprazole-infusion.pdf">http://www.philippelefevre.com/JHH-ICU-guidelines/adult-drug-infussions/pantoprazole-infusion.pdf</a><br /></li><li><a href="http://www.medscape.com/viewarticle/530262">Pantoprazole Infusion as Adjuvant Therapy to Endoscopic Treatment in Patients With Peptic Ulcer Bleeding: Prospective Randomized Controlled Trial</a>, medscape.com<br /></li></ul>yublockahttp://www.blogger.com/profile/11634478211102253572noreply@blogger.com5tag:blogger.com,1999:blog-7602187239041013559.post-19200717603628769812011-01-25T00:22:00.000-08:002011-01-25T00:45:27.160-08:00Blood Gas normal values <br /><table bordercolorlight="#000000" border="1" cellspacing="0"><br /><tbody><tr><br /><td><br /></td><br /><td>Arterial</td><br /><td>Venous</td><br /></tr><br /><tr><br /><td>pH</td><br /><td><span class="currency_converter_text">7.35</span><span class="currency_converter_text">-</span><span class="currency_converter_text">7.45</span></td><br /><td><span class="currency_converter_text">7.3</span><span class="currency_converter_text">-</span><span class="currency_converter_text">7.35</span></td><br /></tr><br /><tr><br /><td><span class="currency_converter_text">pCO</span><span title="Convert this amount" class="currency_converter_link">2</span></td><br /><td><span class="currency_converter_text">35</span><span class="currency_converter_text">-</span><span class="currency_converter_text">45</span></td><br /><td><span class="currency_converter_text">45</span><span class="currency_converter_text">-</span><span class="currency_converter_text">46</span><span class="currency_converter_text"> (good representation of ventilation)</span></td><br /></tr><br /><tr><br /><td><span class="currency_converter_text">pO</span><span title="Convert this amount" class="currency_converter_link">2</span></td><br /><td><span class="currency_converter_text">80</span><span class="currency_converter_text">-</span><span class="currency_converter_text">100</span></td><br /><td><span class="currency_converter_text">20</span><span class="currency_converter_text">-</span><span class="currency_converter_text">80</span><span class="currency_converter_text"> (uninterprable)</span></td><br /></tr><br /><tr><br /><td><span class="currency_converter_text">SaO</span><span title="Convert this amount" class="currency_converter_link">2</span></td><br /><td><span class="currency_converter_text">95</span><span class="currency_converter_text">-</span><span class="currency_converter_text">100</span></td><br /><td><br /></td><br /></tr><br /><tr><br /><td><span class="currency_converter_text">HCO</span><span title="Convert this amount" class="currency_converter_link">3</span><span class="currency_converter_text">-</span></td><br /><td><span class="currency_converter_text">22</span><span class="currency_converter_text">-</span><span class="currency_converter_text">28</span></td><br /><td><br /></td><br /></tr><br /><tr><br /><td>BE</td><br /><td><span class="currency_converter_text">+/- </span><span title="Convert this amount" class="currency_converter_link">3</span></td><br /><td><br /></td><br /></tr><br /></tbody></table><br /> yublockahttp://www.blogger.com/profile/11634478211102253572noreply@blogger.com0tag:blogger.com,1999:blog-7602187239041013559.post-50208647960631064082010-12-07T03:23:00.000-08:002010-12-07T03:37:27.747-08:00Resources for lumbar puncture<ul><li>http://www.med.uottawa.ca/procedures/lp/index.htm</li><li>http://www.articlealley.com/article_596234_17.html</li><li>http://www.unboundmedicine.com/harrisons/ub/view/Harrisons-Manual-of-Medicine/148408/all/Lumbar_Puncture,<br /></li></ul>yublockahttp://www.blogger.com/profile/11634478211102253572noreply@blogger.com0tag:blogger.com,1999:blog-7602187239041013559.post-55873675122044271312010-11-30T02:17:00.000-08:002010-11-30T02:55:35.841-08:00Resources for central line insertion<h2>Central lines in general</h2><ul><li>http://egret.psychol.cam.ac.uk/medicine/Central_line_insertion.pdf</li><li>http://www.nda.ox.ac.uk/wfsa/html/u12/u1213_01.htm<br /></li><li>http://www.proceduresconsult.com/medical-procedures/central-venous-line-placement-AN-procedure.aspx<br /></li></ul><h2>Internal jugular lines</h2><ul><li>http://www.anwresidency.com/simulation/guide/ij.html<br /></li></ul>yublockahttp://www.blogger.com/profile/11634478211102253572noreply@blogger.com0tag:blogger.com,1999:blog-7602187239041013559.post-59652125862479783072010-05-09T18:30:00.000-07:002010-05-20T05:09:46.142-07:00AMIs and thrombolysis<h2>ECG changes indicating AMI</h2><ul><li><span style="font-style: italic;">High probability of MI</span>: <span style="font-weight: bold;"><span class="currency_converter_text">p</span>ersistent ST elevation of ≥ 1 mm in two contiguous limb leads </span><span>or </span><span style="font-weight: bold;">ST-segment elevation of ≥ 2 mm in two contiguous chest leads</span> or the presence of<span style="font-weight: bold;"> new LBBB</span>.</li><li><span style="font-style: italic;">Intermediate probability of MI</span>: are <span style="font-weight: bold;">ST depression</span>, <span style="font-weight: bold;">T-wave inversion</span>, and other nonspecific ST-T wave abnormalities.</li><li><span style="font-weight: bold;">Q waves</span><span> = old MI</span><span style="font-weight: bold;"><br /></span></li></ul><h2>DDxes</h2><ul><li><a href="http://en.wikipedia.org/wiki/Aortic_dissection#Chest_X-ray">Aortic dissection</a></li><li>Pericarditis (would show on all leads)<br /></li><li>Pulmonary embolism</li></ul><h2>Management options<br /></h2><ul><li>Patients with <span style="font-style: italic;">persistent ST elevation</span> should be considered for <span style="font-weight: bold;">reperfusion therapy</span> (thrombolysis or primary PCI).<br /></li><li>Those <span style="font-style: italic;">without ST elevation</span> will be diagnosed with either NSTEMI if cardiac marker levels are elevated or with unstable angina if serum cardiac marker levels provide no evidence of myocardial injury. Patients presenting with no ST-segment elevation are not candidates for immediate thrombolytics but should receive <span style="font-weight: bold;">anti-ischemic therapy</span> and may be candidates for PCI urgently or during admission.</li></ul><h2>Medical Management</h2><ul><li><span class="currency_converter_text"><span style="font-weight: bold;">Aspirin </span>(</span><span title="Convert this amount" class="currency_converter_link"><span title="Convert this amount" class="currency_converter_link">300</span></span><span class="currency_converter_text"> mg) should be given unless already taken or contraindicated (grade A recommendation), and should preferably be given early (eg, by emergency or ambulance personnel).</span></li><li><span class="currency_converter_text"><a href="http://en.wikipedia.org/wiki/Clopidogrel"><span style="font-weight: bold;">Clopidogrel </span></a></span><span class="currency_converter_text"> should be given in addition to aspirin</span><span class="currency_converter_text"> for patients undergoing PCI with a stent </span><span class="currency_converter_text">(loading-dose of </span><span title="Convert this amount" class="currency_converter_link"><span title="Convert this amount" class="currency_converter_link">300</span></span><span class="currency_converter_text">–</span><span title="Convert this amount" class="currency_converter_link"><span title="Convert this amount" class="currency_converter_link">600</span></span><span class="currency_converter_text"> mg</span><span class="currency_converter_text">), or</span><span class="currency_converter_text"> for fibrinolytic therapy</span> <span class="currency_converter_text">(</span><span title="Convert this amount" class="currency_converter_link"><span title="Convert this amount" class="currency_converter_link">300</span></span><span class="currency_converter_text"> mg)</span>. <span class="currency_converter_text">Clopidogrel </span><span title="Convert this amount" class="currency_converter_link"><span title="Convert this amount" class="currency_converter_link">75</span></span><span class="currency_converter_text"> mg daily should be continued for at least a month after fibrinolytic therapy, and for up to </span><span title="Convert this amount" class="currency_converter_link"><span title="Convert this amount" class="currency_converter_link">12</span></span><span class="currency_converter_text"> months after stent implantation, depending on the type of stent. </span></li><li><span style="font-weight: bold;">Antithrombin</span> therapy to inhibit the coagulation cascade, and for patients underdoing PCI. For patients getting streptokinase, whether to heparinise depends on the anti-thrombotic agent. Clexane (enoxaparin) bolus should be dosed at <span title="Convert this amount" class="currency_converter_link"><span title="Convert this amount" class="currency_converter_link">0.75</span></span><span class="currency_converter_text"> mg/kg.</span></li><li>Administer a <span style="font-weight: bold;">platelet glycoprotein (GP) IIb/IIIa-receptor antagonist</span> (eptifibatide, tirofiban, or abciximab) in addition to aspirin and unfractionated heparin, to patients with continuing ischemia or with other high-risk features and to patients in whom PCI is planned.</li><li><span class="currency_converter_text">An <span style="font-weight: bold;">ACE inhibitor</span> (Captopril) should be given orally within the first </span><span title="Convert this amount" class="currency_converter_link"><span title="Convert this amount" class="currency_converter_link"><span title="Convert this amount" class="currency_converter_link"><span title="Convert this amount" class="currency_converter_link"><span title="Convert this amount" class="currency_converter_link">24</span></span></span></span></span><span class="currency_converter_text"> hours of STEMI to patients with anterior infarction, pulmonary congestion, or left ventricular ejection fraction (LVEF) less than </span><span class="currency_converter_text"><span title="Convert this amount" class="currency_converter_link"><span title="Convert this amount" class="currency_converter_link"><span title="Convert this amount" class="currency_converter_link"><span title="Convert this amount" class="currency_converter_link">40</span></span></span></span></span><span class="currency_converter_text">% in the absence of hypotension.</span></li><li><span class="currency_converter_text">An <span style="font-weight: bold;">angiotensin receptor blocker</span> (valsartan or candesartan) should be administered to patients with STEMI who are intolerant of ACE inhibitors and who have either clinical or radiological signs of heart failure or LVEF less than </span><span class="currency_converter_text"><span title="Convert this amount" class="currency_converter_link"><span title="Convert this amount" class="currency_converter_link"><span title="Convert this amount" class="currency_converter_link"><span title="Convert this amount" class="currency_converter_link">40</span></span></span></span></span><span class="currency_converter_text">%.</span></li></ul><h2>Contraindications for fibrinolytic use in STEMI</h2>Absolute contraindications:<br /><ul><li>Prior intracranial hemorrhage (ICH)</li><li>Known structural cerebral vascular lesion</li><li> Known malignant intracranial neoplasm</li><li><span class="currency_converter_text">Ischemic stroke within </span><span title="Convert this amount" class="currency_converter_link"><span title="Convert this amount" class="currency_converter_link"><span title="Convert this amount" class="currency_converter_link"><span title="Convert this amount" class="currency_converter_link">3</span></span></span></span><span class="currency_converter_text"> months</span></li><li> Suspected aortic dissection</li><li> Active bleeding or bleeding diathesis (excluding menses)</li><li><span class="currency_converter_text"> Significant closed-head trauma or facial trauma within </span><span title="Convert this amount" class="currency_converter_link"><span title="Convert this amount" class="currency_converter_link"><span title="Convert this amount" class="currency_converter_link"><span title="Convert this amount" class="currency_converter_link">3</span></span></span></span><span class="currency_converter_text"> months</span></li></ul>Relative contraindications:<br /><ul><li>History of chronic, severe, poorly controlled hypertension</li><li><span class="currency_converter_text">Severe uncontrolled hypertension on presentation (SBP ></span><span title="Convert this amount" class="currency_converter_link"><span title="Convert this amount" class="currency_converter_link"><span title="Convert this amount" class="currency_converter_link"><span title="Convert this amount" class="currency_converter_link">180</span></span></span></span><span class="currency_converter_text"> mm Hg or DBP ></span><span title="Convert this amount" class="currency_converter_link"><span title="Convert this amount" class="currency_converter_link"><span title="Convert this amount" class="currency_converter_link"><span title="Convert this amount" class="currency_converter_link">110</span></span></span></span><span class="currency_converter_text"> mm Hg)</span></li><li><span class="currency_converter_text">Traumatic or prolonged (></span><span title="Convert this amount" class="currency_converter_link"><span title="Convert this amount" class="currency_converter_link"><span title="Convert this amount" class="currency_converter_link"><span title="Convert this amount" class="currency_converter_link">10</span></span></span></span><span class="currency_converter_text"> min) CPR or major surgery less than </span><span title="Convert this amount" class="currency_converter_link"><span title="Convert this amount" class="currency_converter_link"><span title="Convert this amount" class="currency_converter_link"><span title="Convert this amount" class="currency_converter_link">3</span></span></span></span><span class="currency_converter_text"> weeks</span></li><li><span class="currency_converter_text">Recent (within </span><span class="currency_converter_text"><span title="Convert this amount" class="currency_converter_link"><span title="Convert this amount" class="currency_converter_link"><span title="Convert this amount" class="currency_converter_link">2</span></span></span></span><span class="currency_converter_text">-</span><span class="currency_converter_text"><span title="Convert this amount" class="currency_converter_link"><span title="Convert this amount" class="currency_converter_link"><span title="Convert this amount" class="currency_converter_link">4</span></span></span></span><span class="currency_converter_text"> wk) internal bleeding</span></li><li>Noncompressible vascular punctures</li><li><span class="currency_converter_text">For streptokinase/anistreplase - prior exposure</span><span class="currency_converter_text"> or prior allergic reaction to these agents</span></li><li>Pregnancy</li><li>Active peptic ulcer</li><li><span class="currency_converter_text">Current use of anticoagulant (eg, warfarin sodium) that has produced an elevated international normalized ratio (INR) ></span><span title="Convert this amount" class="currency_converter_link"><span title="Convert this amount" class="currency_converter_link"><span title="Convert this amount" class="currency_converter_link"><span title="Convert this amount" class="currency_converter_link">1.7</span></span></span></span><span class="currency_converter_text"> or prothrombin time (PT) ></span><span title="Convert this amount" class="currency_converter_link"><span title="Convert this amount" class="currency_converter_link"><span title="Convert this amount" class="currency_converter_link"><span title="Convert this amount" class="currency_converter_link">15</span></span></span></span><span class="currency_converter_text"> seconds</span></li></ul><h2>Follow-up Patient Care</h2><ul><li>Patients should continue to receive beta-blockers, nitrates, and heparin, as indicated.</li><li>ACE inhibitors have been shown to improve survival rates in patients who have experienced an MI. In the acute setting, afterload reduction from ACE inhibitors may reduce the risk of CHF and sudden death.</li></ul><h2>References</h2><ul><li>eMedicine: <a href="http://emedicine.medscape.com/article/759321-overview">Myocardial Infarction</a></li><li><a href="http://vitualis.wordpress.com/2006/10/08/how-to-give-thrombolysis-in-acute-myocardial-infarction/">How to give thrombolysis in acute myocardial infarction</a></li><li>eMedicine: <a href="http://emedicine.medscape.com/article/811234-overview">Thrombolytic Therapy</a></li><li><a href="http://www.health.nsw.gov.au/policies/gl/2010/pdf/GL2010_003.pdf">NSW Rural Adult Emergency Clinical Guidelines</a></li><li>eMJA,<span class="currency_converter_text"> <a href="http://www.mja.com.au/public/issues/184_08_170406/suppl_170406_fm.html">Guidelines for the management of acute coronary syndromes </a></span><a href="http://www.mja.com.au/public/issues/184_08_170406/suppl_170406_fm.html"><span class="currency_converter_text">2006</span></a></li></ul><iframe style="border: 2px solid rgb(255, 107, 8); z-index: 100; position: absolute; top: 610px; left: 423px; background-color: white; display: none;" src="http://www.fxware.com/forex-currency/add-on/?a=75&up_l=en" scrolling="no" height="130" width="260"></iframe>yublockahttp://www.blogger.com/profile/11634478211102253572noreply@blogger.com3tag:blogger.com,1999:blog-7602187239041013559.post-8546924848692749652010-03-12T16:23:00.000-08:002010-03-12T16:26:18.185-08:00GuardianshipIf a patient refuses treatment...<br /><ul><li>If NOK agrees not to treat → OK but document it</li><li>If NOK thinks treatment should occur → need to go to guardianship tribunal<br /></li></ul>yublockahttp://www.blogger.com/profile/11634478211102253572noreply@blogger.com2tag:blogger.com,1999:blog-7602187239041013559.post-29862665013786323082010-01-17T14:10:00.000-08:002010-01-17T14:47:24.857-08:00AntibodiesAntibodies consist of <span style="font-weight: bold;">two Ig heavy chains</span> (blue) linked by disulfide bonds to <span style="font-weight: bold;">two Ig light chains</span> (green).<br /><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://upload.wikimedia.org/wikipedia/commons/thumb/b/bb/AntibodyChains.svg/317px-AntibodyChains.svg.png"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 271px; height: 211px;" src="http://upload.wikimedia.org/wikipedia/commons/thumb/b/bb/AntibodyChains.svg/317px-AntibodyChains.svg.png" alt="" border="0" /></a><br /><br /><h2>Heavy chains</h2>Heavy chains define the <span style="font-style: italic;">class </span>of immunoglobulin. There are 5 types of heavy chains:<br /><ol><li>α (Ig A)</li><li>δ (Ig D)</li><li>ε (Ig E)</li><li>γ (Ig G)</li><li>μ (Ig M)</li></ol>The immunoglobulin heavy chain gene complex has been assigned to <span style="font-weight: bold;">chromosome 14</span>.<br /><h2>Light chains</h2>There are 2 types of light chains:<br /><ol><li><span style="font-style: italic;">Lambda (λ)</span> - encoded by a gene on <span style="font-weight: bold;">chromosome 22</span></li><li><span style="font-style: italic;">Kappa (κ)</span> - encoded by a gene on <span style="font-weight: bold;">chromosome 2</span></li></ol>Ig light chains produced in neoplastic plasma cells (e.g. in multiple myeloma) are called <span style="font-weight: bold;">Bence Jones proteins</span>.<br /><h2>References</h2><ul><li>http://en.wikipedia.org/wiki/Immunoglobulin_heavy_chain</li><li>http://en.wikipedia.org/wiki/Immunoglobulin_light_chain<br /></li><li>http://en.wikipedia.org/wiki/Multiple_myeloma#Pathophysiology</li><li>http://www3.interscience.wiley.com/journal/120047597/abstract?CRETRY=1&SRETRY=0<br /></li></ul>yublockahttp://www.blogger.com/profile/11634478211102253572noreply@blogger.com0tag:blogger.com,1999:blog-7602187239041013559.post-44608276079043228732010-01-15T23:06:00.000-08:002010-01-15T23:12:58.546-08:00Well’s Criteria for DVT<h2>The Score</h2><ol><li><span style="font-weight: bold;">Active cancer</span> (treatment within last 6 months or palliative) -- 1 point</li><li><span style="font-weight: bold;">Calf swelling</span> >3 cm compared to other calf (measured 10 cm below tibial tuberosity) -- 1 point</li><li><span style="font-weight: bold;">Collateral superficial veins</span> (non-varicose) -- 1 point</li><li><span style="font-weight: bold;">Pitting edema</span> (confined to symptomatic leg) -- 1 point</li><li><span style="font-weight: bold;">Swelling of entire leg</span> - 1 point</li><li><span style="font-weight: bold;">Localized pain</span> along distribution of deep venous system—1 point</li><li><span style="font-weight: bold;">Paralysis, paresis, or recent cast immobilization</span> of lower extremities—1 point</li><li><span style="font-weight: bold;">Recently bedridden > 3 days</span>, or major surgery requiring regional or general anesthetic in past 4 weeks—1 point</li><li><span style="font-weight: bold;">Alternative diagnosis at least as likely</span>—Subtract 2 points</li></ol>Possible score -2 to 8<br /><h2>Interpretation</h2>Score of <span style="font-style: italic;">2 or higher</span> - deep vein thrombosis is <span style="font-weight: bold;">likely</span>. Consider imaging the leg veins.<br /> Score of <span style="font-style: italic;">less than 2</span> - deep vein thrombosis is <span style="font-weight: bold;">unlikely</span>. Consider blood test such as d-dimer test to further rule out deep vein thrombosis.<br /><h2>References</h2><ul><li>http://en.wikipedia.org/wiki/Deep_vein_thrombosis</li><li>http://emedicine.medscape.com/article/758140-overview<br /></li></ul>yublockahttp://www.blogger.com/profile/11634478211102253572noreply@blogger.com0tag:blogger.com,1999:blog-7602187239041013559.post-87661446649209701242010-01-12T21:47:00.000-08:002010-01-12T23:10:46.542-08:00CHAD2 (CHADS) scoreThe CHADS score is a clinical prediction rule for <span style="font-weight: bold;">estimating the risk of stroke</span> in patients with non-rheumatic atrial fibrillation (AF) and is <span style="font-weight: bold;">used to determine the degree of anticoagulation </span>therapy required.<br /><h2>To Score...</h2><span style="font-weight: bold;font-size:180%;" >C</span> ongestive heart failure (1 point)<br /><span style="font-weight: bold;font-size:180%;" >H</span> ypertension > 160mmHg systolic (or treated hypertension) (1 point)<br /><span style="font-weight: bold;font-size:180%;" >A</span> ge > 75 (1 point)<br /><span style="font-size:180%;"><span style="font-weight: bold;">D</span></span> iabetes (1 point)<br /><span style="font-weight: bold;font-size:180%;" >S</span> - previous stroke or TIA (2 points)<br /><h2>Risk of stroke based on CHADS score</h2><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="http://www.cardiology.org/tools/b89-31.gif"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 225px; height: 230px;" src="http://www.cardiology.org/tools/b89-31.gif" alt="" border="0" /></a><h2>Recommendations for anticoagulation</h2><ul><li><span style="font-style: italic;">High risk</span> (score >= 2) - warfarin (unless contrainidcated)</li><li><span style="font-style: italic;">Moderate risk</span> (score 1) - aspirin or warfarin<br /></li><li><span style="font-style: italic;">Low risk</span> (score 0) - aspirin<br /></li></ul><h2>References</h2><ul><li>http://en.wikipedia.org/wiki/CHADS_Score</li><li>http://www.cardiology.org/tools/risk_of_stroke_AF.html<br /></li></ul>yublockahttp://www.blogger.com/profile/11634478211102253572noreply@blogger.com0tag:blogger.com,1999:blog-7602187239041013559.post-84061836197637895742010-01-08T17:04:00.000-08:002010-01-08T17:28:30.366-08:00ABCD^2 (ABCD squared) post TIA stroke risk assessment tool<h2>The Tool</h2><span class="currency_converter_text"><span style="font-size:180%;"><span style="font-weight: bold;">A</span></span>GE: greater than or equal to </span><span title="Convert this amount" class="currency_converter_link"><span title="Convert this amount" class="currency_converter_link">60</span></span><span class="currency_converter_text"> years – </span><span title="Convert this amount" class="currency_converter_link"><span title="Convert this amount" class="currency_converter_link">1</span></span><span class="currency_converter_text"> point</span><br /><span class="currency_converter_text"><span style="font-weight: bold;font-size:180%;" >B</span>lood Pressure: Systolic >= </span><span title="Convert this amount" class="currency_converter_link"><span title="Convert this amount" class="currency_converter_link">140</span></span><span class="currency_converter_text">, diastolic >= </span><span title="Convert this amount" class="currency_converter_link"><span title="Convert this amount" class="currency_converter_link">90</span><span class="currency_converter_text"> </span></span><span class="currency_converter_text"> (when first assessed after TIA)</span><span class="currency_converter_text"> – </span><span title="Convert this amount" class="currency_converter_link"><span title="Convert this amount" class="currency_converter_link">1</span></span><span class="currency_converter_text"> point</span><br /><span class="currency_converter_text"><span style="font-size:180%;"><span style="font-weight: bold;">C</span></span>linical Features: <span style="font-style: italic;">unilateral weakness</span> – </span><span title="Convert this amount" class="currency_converter_link"><span title="Convert this amount" class="currency_converter_link">2</span></span><span class="currency_converter_text"> points, <span style="font-style: italic;">isolated speech disturbance</span> – </span><span title="Convert this amount" class="currency_converter_link"><span title="Convert this amount" class="currency_converter_link">1</span></span><span class="currency_converter_text"> point, other – zero</span><br /><span class="currency_converter_text"><span style="font-size:180%;"><span style="font-weight: bold;">D</span></span>uration of TIA symptoms: greater than or equal to </span><span title="Convert this amount" class="currency_converter_link"><span title="Convert this amount" class="currency_converter_link">60</span></span><span class="currency_converter_text"> minutes – </span><span title="Convert this amount" class="currency_converter_link"><span title="Convert this amount" class="currency_converter_link">2</span></span><span class="currency_converter_text"> points, </span><span title="Convert this amount" class="currency_converter_link"><span title="Convert this amount" class="currency_converter_link">10</span></span><span class="currency_converter_text"> to </span><span title="Convert this amount" class="currency_converter_link"><span title="Convert this amount" class="currency_converter_link">59</span></span><span class="currency_converter_text"> minutes – </span><span title="Convert this amount" class="currency_converter_link"><span title="Convert this amount" class="currency_converter_link">1</span></span><span class="currency_converter_text"> point, <</span><span title="Convert this amount" class="currency_converter_link"><span title="Convert this amount" class="currency_converter_link">10</span></span><span class="currency_converter_text"> minutes zero</span><br /><span class="currency_converter_text"><span style="font-size:180%;"><span style="font-weight: bold;">D</span></span>iabetes present – </span><span title="Convert this amount" class="currency_converter_link"><span title="Convert this amount" class="currency_converter_link">1</span></span><span class="currency_converter_text"> point</span> <p><span class="currency_converter_text">Estimated two day stroke risks determined by the ABCD^</span><span title="Convert this amount" class="currency_converter_link"><span title="Convert this amount" class="currency_converter_link">2</span></span><span class="currency_converter_text"> score:</span></p> <ul><li><span class="currency_converter_text">Score </span><span title="Convert this amount" class="currency_converter_link"><span title="Convert this amount" class="currency_converter_link">6</span></span><span class="currency_converter_text"> to </span><span title="Convert this amount" class="currency_converter_link"><span title="Convert this amount" class="currency_converter_link">7</span></span><span class="currency_converter_text">: <span style="font-style: italic;"> High </span>two day stroke risk (</span><span class="currency_converter_text"><span title="Convert this amount" class="currency_converter_link">8.1</span></span><span class="currency_converter_text">%)</span></li><li><span class="currency_converter_text">Score </span><span title="Convert this amount" class="currency_converter_link"><span title="Convert this amount" class="currency_converter_link">4</span></span><span class="currency_converter_text"> to </span><span title="Convert this amount" class="currency_converter_link"><span title="Convert this amount" class="currency_converter_link">5</span></span><span class="currency_converter_text">: <span style="font-style: italic;"> Moderate </span>two day stroke risk (</span><span class="currency_converter_text"><span title="Convert this amount" class="currency_converter_link">4.1</span></span><span class="currency_converter_text">%)</span></li><li><span class="currency_converter_text">Score </span><span title="Convert this amount" class="currency_converter_link"><span title="Convert this amount" class="currency_converter_link">0</span></span><span class="currency_converter_text"> to </span><span title="Convert this amount" class="currency_converter_link"><span title="Convert this amount" class="currency_converter_link">3</span></span><span class="currency_converter_text">: <span style="font-style: italic;"> Low </span>two day stroke risk (</span><span class="currency_converter_text"><span title="Convert this amount" class="currency_converter_link">1.0</span></span><span class="currency_converter_text">%)</span></li><li><span class="currency_converter_text">Score < </span><span title="Convert this amount" class="currency_converter_link"><span title="Convert this amount" class="currency_converter_link">1</span></span><span class="currency_converter_text">: <span style="font-style: italic;">Very low</span> two day stroke risk (</span><span class="currency_converter_text"><span title="Convert this amount" class="currency_converter_link">0.0</span></span><span class="currency_converter_text">%)</span></li></ul><h2>In versus outapatient management</h2><span style="font-size:100%;"><span style="font-weight: normal;"><span class="currency_converter_text">People with a high risk of stroke (ABCD</span><span title="Convert this amount" class="currency_converter_link">2</span><span class="currency_converter_text"> score of </span><span title="Convert this amount" class="currency_converter_link">4</span><span class="currency_converter_text"> or above) should have:</span></span></span><br /><ul style="font-weight: normal;"><li><span style="font-size:100%;"><span class="currency_converter_text">Aspirin (</span><span title="Convert this amount" class="currency_converter_link">300</span><span class="currency_converter_text"> mg daily) started immediately</span></span></li><li><span style="font-size:100%;"><span class="currency_converter_text">specialist assessment and investigation within </span><span title="Convert this amount" class="currency_converter_link">24</span><span class="currency_converter_text"> hours of onset of symptoms</span></span></li><li><span style="font-size:100%;">measures for secondary prevention introduced as soon as the diagnosis is confirmed, including discussion of individual risk factors</span></li></ul><span style="font-weight: normal;font-size:100%;" ><span class="currency_converter_text">People who are at lower risk of stroke (ABCD</span><span title="Convert this amount" class="currency_converter_link">2</span><span class="currency_converter_text"> score of </span><span title="Convert this amount" class="currency_converter_link">3</span><span class="currency_converter_text"> or below) should have:</span><br /></span><ul style="font-weight: normal;"><li><span style="font-size:100%;"><span class="currency_converter_text">Aspirin (</span><span title="Convert this amount" class="currency_converter_link">300</span><span class="currency_converter_text"> mg daily) started immediately</span></span></li><li><span style="font-size:100%;"><span class="currency_converter_text">specialist assessment and investigation as soon as possible, but definitely within </span><span title="Convert this amount" class="currency_converter_link">1</span><span class="currency_converter_text"> week of onset of symptoms</span></span></li><li><span style="font-size:100%;">measures for secondary prevention introduced as soon as the diagnosis is confirmed, including discussion of individual risk factors</span></li></ul><h2>Investigations</h2><ol><li><span style="font-weight: bold;">CT scan without enhancement</span> should be done in all patients to exclude other causes of neurological deficit (e.g. hemorrhage, subdural hematoma)</li><ul><blockquote><li>The presence of an infarct on CT is highly predictive of subsequent stroke</li> <li>Early CT showing hemorrhage makes carotid imaging unnecessary</li> </blockquote></ul> <li><span style="font-weight: bold;">Carotid imaging</span> should be done for all patients with symptoms in anterior circulation territory.</li><ul><blockquote><li>The presence of carotid disease is highly predictive of recurrent stroke.</li> <li>Consider CT angiogram if Carotid Ultrasound cannot be obtained in reasonable time.</li> </blockquote></ul> <li><span style="font-weight: bold;">ECG </span>and occasionally <span style="font-weight: bold;">Holter monitoring</span> to detect atrial fibrillation.</li> <li><span style="font-weight: bold;">ECHO </span>cardiogram for persons with suspect underlying cardiac abnormalities.</li> <li><span style="font-weight: bold;">Blood sugar</span> to detect extremes in glucose levels.</li></ol><h2>References</h2><ul><li><span class="currency_converter_text">http://bmhgt.com/</span><span class="currency_converter_text">2009</span><span class="currency_converter_text">/</span><span class="currency_converter_text">03</span><span class="currency_converter_text">/stroke-information-abcd</span><span title="Convert this amount" class="currency_converter_link">2</span><span class="currency_converter_text">/</span></li><li><span class="currency_converter_text">http://www.gpnotebook.co.uk/simplepage.cfm?ID=x</span><span title="Convert this amount" class="currency_converter_link">20080723164438749131</span></li><li><span class="currency_converter_text">http://www.palmedpage.com/Text_files/Neurology/ABCD/TIA%</span><span class="currency_converter_text">20</span><span class="currency_converter_text">Management.html</span></li><li><span class="currency_converter_text">http://www.stroke.org/site/DocServer/NSA_ABCD2_tool.pdf?docID=5981<br /></span></li></ul>yublockahttp://www.blogger.com/profile/11634478211102253572noreply@blogger.com8tag:blogger.com,1999:blog-7602187239041013559.post-77768610218973414202009-12-17T14:48:00.000-08:002009-12-17T14:52:52.296-08:00Paediatric elbow traumaYou can tell the approximate age of a child from the degree of bone replacement of cartilage on x-ray. Approximately :<br /><ul><li>Capitellum 'appears' at 2</li><li>Radial head at 4</li><li>Medial condyle at 6</li><li>Trochlea at 8</li><li>Olecranon at 10</li><li>Lateral condyle at 12 years of age</li></ul>The acronym CRMTOL is used to describe the usual order of appearance of all 6 elbow centers: capitellum, radial head, medial epicondyle, trochlea, olecranon, and lateral epicondyle.<br /><h2>References</h2><ul><li>http://www.pediatric-orthopedics.com/Topics/Bones/Humerus/humerus.html</li><li><a href="http://emedicine.medscape.com/article/415822-overview">Elbow Trauma, Pediatric</a> on eMedicine<br /></li></ul>yublockahttp://www.blogger.com/profile/11634478211102253572noreply@blogger.com0tag:blogger.com,1999:blog-7602187239041013559.post-84428204523612289922009-11-18T19:05:00.000-08:002009-11-18T19:17:56.746-08:00Sedation tips<ul><li>Don't use midazolam and olanzapine together as it can cause rapid onset respiratory depression. Clonazepam and olanzipine is a better combination.</li><li>Chlorpromazine is also good. Non-addictive, and comes as a liquid.<br /></li></ul>yublockahttp://www.blogger.com/profile/11634478211102253572noreply@blogger.com0tag:blogger.com,1999:blog-7602187239041013559.post-22552596733320479632009-11-04T17:18:00.000-08:002009-11-04T17:20:03.485-08:00Blood Products timingRBCs 1 unit q4h<br />FFP 1 unit q1h<br />Platelets 1 unit q30minutesyublockahttp://www.blogger.com/profile/11634478211102253572noreply@blogger.com0tag:blogger.com,1999:blog-7602187239041013559.post-50368090966073505092009-09-17T03:22:00.000-07:002009-09-17T03:24:14.889-07:00CTPA and renal functionGFR < 60 is borderline.yublockahttp://www.blogger.com/profile/11634478211102253572noreply@blogger.com0tag:blogger.com,1999:blog-7602187239041013559.post-10220828607403298182009-09-15T17:53:00.000-07:002009-09-15T17:58:14.183-07:00Home OxygenCriteria to qualify:<br /><ul><li><span class="currency_converter_text">pO</span><span title="Convert this amount" class="currency_converter_link">2</span><span class="currency_converter_text"> < 55 </span></li><li><span class="currency_converter_text">SaO</span><span title="Convert this amount" class="currency_converter_link">2</span><span class="currency_converter_text"> < 90% RA</span></li><li>Non-smoker!<br /></li></ul>Can be regular/PRN.yublockahttp://www.blogger.com/profile/11634478211102253572noreply@blogger.com0tag:blogger.com,1999:blog-7602187239041013559.post-76910609026622551102009-09-11T03:20:00.000-07:002009-09-11T03:25:27.865-07:00Hartmann's (Compound Sodium Lactate)Components (in mmols):<br /><ul><li>Na 129</li><li>K 5</li><li>Ca 2</li><li>Cl 109</li><li>bicarb 29<br /></li></ul>yublockahttp://www.blogger.com/profile/11634478211102253572noreply@blogger.com0tag:blogger.com,1999:blog-7602187239041013559.post-87349801583687739512009-08-22T21:08:00.000-07:002009-08-22T21:27:21.352-07:00Peutz–Jeghers syndrome<ul><li>Peutz–Jeghers syndrome is also known as hereditary intestinal polyposis syndrome.</li><li>An <span style="font-weight: bold;">autosomal dominant</span> genetic disease <span style="font-weight: bold;">characterized by the development of benign hamartomatous polyps in the GIT and hyperpigmented macules on the lips and oral mucosa</span>.</li><li>Prevalence of approximately 1 in 100,000 to 200,000 births.<br /></li></ul><h2>Diagnosis</h2>Need 2 of 3 of:<br /><ul><li>Family history</li><li>Mucocutaneous lesions causing patches of hyperpigmentation in the mouth and on the hands and feet.<br /><ul><li>Oral pigmentations are the first to appear and play an important part in early diagnosis. Intraorally, they are most frequently seen on the gingiva, hard palate and inside of the cheek. The mucosa of the lower lip is almost invariably involved as well.</li></ul></li><li> Hamartomatous polyps in the gastrointestinal tract. These are benign polyps with an extraordinarily low potential for malignancy.</li><li> <span style="font-weight: bold;">Mutation in the tumour supressor</span> gene STK11 on chromosome 19.</li></ul><h2>Natural history</h2><ul><li>Most patients will develop <span style="font-weight: bold;">melanotic macules</span> <span style="font-style: italic;">during the first year of life</span>.</li><li><span style="font-weight: bold;">Intussusception </span>usually <span style="font-style: italic;">first occurs between the ages of six and 18 </span>years old.<br /></li><li>Most people will have developed some form of <span style="font-weight: bold;">neoplastic disease</span> by age 60.</li><ul><li>Cumulative lifetime cancer risk begins to rise in middle age.</li><li>Cumulative risks by age 70 for all cancers, gastrointestinal (GI) cancers, and pancreatic cancer are 85%, 57%, and 11%, respectively.</li></ul></ul><h2>References</h2><ul><li>http://en.wikipedia.org/wiki/Peutz-Jeghers_syndrome</li><li>http://www.answers.com/topic/peutz-jeghers-syndrome<br /></li></ul>yublockahttp://www.blogger.com/profile/11634478211102253572noreply@blogger.com1tag:blogger.com,1999:blog-7602187239041013559.post-23159866691206173922009-06-14T01:48:00.000-07:002009-09-11T03:13:15.150-07:00IV FluidsStandard fluid regime for NBM patients:<br /><ul><li><span class="currency_converter_text">N/</span><span title="Convert this amount" class="currency_converter_link">2</span><span class="currency_converter_text"> * </span><span title="Convert this amount" class="currency_converter_link">2</span><span class="currency_converter_text"> bags</span></li><li><span title="Convert this amount" class="currency_converter_link">4</span><span class="currency_converter_text"> % dextrose + N/</span><span title="Convert this amount" class="currency_converter_link">5</span><span class="currency_converter_text"> + </span><span title="Convert this amount" class="currency_converter_link">30</span><span class="currency_converter_text">mmol KCl</span></li></ul>In terms of fluid requirements,<br /><ul><li><span class="currency_converter_text">65</span><span class="currency_converter_text">% of body is water (TBW)</span></li><li><span class="currency_converter_text">2</span><span class="currency_converter_text">/</span><span class="currency_converter_text">3</span><span class="currency_converter_text"> of this is intracellular, </span><span class="currency_converter_text">1</span><span class="currency_converter_text">/</span><span class="currency_converter_text">3</span><span class="currency_converter_text"> extracellular</span></li></ul>Ways you can lose electrolytes:<br /><ul><li>Vomiting → loss of K</li><li>Diarrhoea→ loss of K</li><li>Sweat→ loss of NaCl</li><li>Burns → loss of protein and Na</li><li><span class="currency_converter_text">Third space losses → loss of NaCl + H</span><span title="Convert this amount" class="currency_converter_link">20</span></li></ul>Ways to assess dehydration:<br /><ul><li>Urine dipstick - concentration</li><li>↑ Ur and ↑ Na</li></ul><span class="currency_converter_text">Correction of hypernatremia begins with a calculation of the fluid deficit. Predicted insensible and other ongoing losses are added to this number and the total is administered over </span><span title="Convert this amount" class="currency_converter_link">48</span><span class="currency_converter_text"> hours. Recheck serum electrolyte levels frequently during therapy. To avoid cerebral edema and associated complications, the serum sodium level should be raised by no more than </span><span title="Convert this amount" class="currency_converter_link">1</span><span class="currency_converter_text"> mEq/L every hour. In patients with chronic hypernatremia, an even more gradual rate is preferred.</span><br /><blockquote><span class="currency_converter_text">Free Water Deficit (L) = Body Weight (kg) X Percentage of Total Body Water (TBW) X ([Serum Na / </span><span title="Convert this amount" class="currency_converter_link">140</span><span class="currency_converter_text">] - </span><span title="Convert this amount" class="currency_converter_link">1</span><span class="currency_converter_text">)</span></blockquote>Percentage of TBW should be as follows:<br /><ul><li><span class="currency_converter_text">Young men - </span><span class="currency_converter_text">0.6</span><span class="currency_converter_text">%</span></li><li><span class="currency_converter_text">Young women and elderly men - </span><span class="currency_converter_text">0.5</span><span class="currency_converter_text">%</span></li><li><span class="currency_converter_text">Elderly women - </span><span class="currency_converter_text">0.4</span><span class="currency_converter_text">%</span></li></ul> Example:<br /><ul><li><span class="currency_converter_text"> A serum sodium level of </span><span title="Convert this amount" class="currency_converter_link">155</span><span class="currency_converter_text"> in a </span><span title="Convert this amount" class="currency_converter_link">60</span><span class="currency_converter_text">-kg young man represents a fluid deficit of </span><span title="Convert this amount" class="currency_converter_link">60</span><span class="currency_converter_text"> X </span><span title="Convert this amount" class="currency_converter_link">0.6</span><span class="currency_converter_text"> X ([</span><span title="Convert this amount" class="currency_converter_link">155</span><span class="currency_converter_text"> / </span><span title="Convert this amount" class="currency_converter_link">140</span><span class="currency_converter_text">] - </span><span title="Convert this amount" class="currency_converter_link">1</span><span class="currency_converter_text">) or </span><span title="Convert this amount" class="currency_converter_link">3.9</span><span class="currency_converter_text"> L</span><br /></li></ul><ul><li><span class="currency_converter_text"> With another </span><span title="Convert this amount" class="currency_converter_link">900</span><span class="currency_converter_text"> mL of insensible losses, the patient requires </span><span title="Convert this amount" class="currency_converter_link">4.8</span><span class="currency_converter_text"> L of fluid in the next </span><span title="Convert this amount" class="currency_converter_link">48</span><span class="currency_converter_text"> hours, resulting in an infusion rate of </span><span title="Convert this amount" class="currency_converter_link">100</span><span class="currency_converter_text"> mL/h.</span></li></ul><h2>SIADH</h2><ul><li><span class="currency_converter_text">Pure water depletion and ↑ Na → use </span><span class="currency_converter_text">4</span><span class="currency_converter_text">% D + N/</span><span title="Convert this amount" class="currency_converter_link">5</span><span class="currency_converter_text"> to treat it.</span></li><li>Stimulating the bowel e.g. abdo surgery → release of ADH → SIADH </li></ul><h2>References</h2><ul><li><span class="currency_converter_text">http://www.merck.com/mmpe/print/sec</span><span title="Convert this amount" class="currency_converter_link">12</span><span class="currency_converter_text">/ch</span><span title="Convert this amount" class="currency_converter_link">156</span><span class="currency_converter_text">/ch</span><span title="Convert this amount" class="currency_converter_link">156</span><span class="currency_converter_text">e.html</span></li><li><span class="currency_converter_text">http://emedicine.medscape.com/article/</span><span title="Convert this amount" class="currency_converter_link">766683</span><span class="currency_converter_text">-treatment</span><br /></li></ul>yublockahttp://www.blogger.com/profile/11634478211102253572noreply@blogger.com1tag:blogger.com,1999:blog-7602187239041013559.post-82457148848126898002009-06-14T01:04:00.000-07:002009-06-14T01:10:05.947-07:00Psych progress notes templateDay X<br />Meds <list><br /><br />Subjective<br /><ul><li>What they tell you<br /></li></ul>Objective<br /><ul><li>MSE</li></ul>Assessment<ul><li>What do they have? Are they getting better/worse?<br /></li></ul>Plan</list><br /><ol><li><list>care level</list></li><li><list>leave</list></li><ul><li><list>unescorted x __ hrs</list></li><li><list>escorted x __ hrs with ____</list></li></ul><li><list>Medications - any new ones/stopped ones/changes in doses?<br /></list></li><li><list>Investigations</list></li><li>Other things that need to be done e.g. call GP, family members etc..<br /></li></ol>yublockahttp://www.blogger.com/profile/11634478211102253572noreply@blogger.com0