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26 Cards in this Set
- Front
- Back
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What are the main side effects from first line RIPES TB drugs?
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Hepatitis (RIP)
Peripheral neuropathy (I) GI upset, Arthritis, gout flares (P) Uveitis, altered color vision (E) Tinnitus, hearing loss, kidney damage (S) |
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Besides immobilty and being bedridden, what are some causes of venous stasis?
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PREGNANCY
surgery cor pulmonale |
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What are the most common heritable hypercoagulable disorders?
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Factor V Leiden
Prothrombin G Hyperhomcysteinemia deficiencies of protein C, S, and AT3 are less common |
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Factor V Leiden contributes to what per cent of DVTs?
Prothrombin G mutation contributes to what percent of DVTs? |
20%
14% |
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What are the primary causes of acquired hypercoagulability?
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Hyperhomocystenemia
Anti-phospholipid antibody malignancy estrogens HIT |
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What drugs are associated with anti-phospholipid antibodies?
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Phenytoin, Hydralazine, Procainamide
Phenothiazines Oral contraceptives |
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Describe the difference between non-immune and immune forms of HIT.
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non-immune:
platelets remain > 100,000 occurs on days 1-5 of heparin NOT thrombogenic immune: platelets fall by >50% usually go < 100,000 occurs on days 5-14 of heparin HIGHLY THROMBOGENIC |
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What is the first step if you suspect HIT?
What are the next steps? |
Stop heparin!
start argatroban or lepirudin as substitute start long-term coumadin (3-6 months) |
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thrombocytopenia of 110,000 on day 3 of heparain
dx? tx? |
HIT type I, non-immune
not thrombogenic, can continue treatment |
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thrombocytopenia of 80 000 on day8 of heparain,
dx? tx? |
HIT type II, immune
thrombogenic stop heparain start argatroban or lepirudin start coumadin |
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What other pulmonary condition is PE mistaken for?
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COPD exacerbation
(either it's mistaken for COPDE, or occurs along with it; have a high threshold of suspicion in COPDE) |
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What % of calf vein thrombi propagate into the popliteal vein?
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20%
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What should you do if a patient with calf vein thrombosis cannot be anticoagulated?
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serial ultrasounds
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What are the signs and symptoms of PE?
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INCREASED A-a GRADIENT 95%
TACHYPNEA 92% DYSPNEA 80% PLEURISY 70% COUGH 50% TACYCARDIA 44% FEVER 40% HEMOPTYSIS 30% |
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PE probability is calculated with ? criteria.
Name the most important indicators. |
Well's criteria: low, intermediate, high
PE likely diagnosis Signs of DVT ... 3 pts HR > 100 immobilization 3d surgery in last 4m prior PE ...........................1.5 pts hemoptysis malignancy ........................1 pt <2, low, 2-6, intermediate, >6 high |
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CXR findings for PE
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cardiomegaly
enlarged PA elevated hemidiaphragm atelectasis pleural effusion Hampton's hump |
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CTPA missed what percent of outpatient PE?
ICU PE? What should we conclude? |
20-30%
up to 50% CTPA must be accompanied by at least one other test (e.g., D-dimer or CT venogram or duplex US) |
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What is the best way to use D-dimer wrt PE?
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Negative D-dimer is strong evidence against PE, if clinical suspicion is low
D-dimer is only validated for outpatients |
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Are cardiac enzymes elevated in PE?
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troponin elevated in 30-50% of moderate sized PE and above
BNP can be elevated; bad prognostic sign if > 90 |
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If CTPA is negative in ED, how do you evaluate?
If CTPA is negative in ICU, how do you evaluate? |
ED: Get D-dimer. If D-dimer negative, no PE. If D-dimer is positive, further tests (which?)
ICU: If clinical suspicion is low and CTPA is negative, then no PE! If clinical suspicion is intermediate or above, further testing In short: ED requires negative CTPA and negative D-dimer. ICU requires negative CTPA and LOW CLINICAL SUSPICION. |
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What rules out PE definitively?
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Normal V/Q
Normal angiogram Low probability V/Q and D-dimer <500 Low clinical suspicion and D-dimer <500 Negative CTPA and negative duplex US Low/intermediate probability V/Q + Low/intermediate clinical probability + D-dimer < 500 or serial negative duplex US |
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When would you use CTPA to assess for PE?
When would you use V/Q? |
CTPA: Previous PE
underlying lung disease V/Q: dye allergy (can't do CTPA) renal insufficiency (can't do CTPA) ? patients with normal CXR |
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When would you use duplex ultrasound to assess for PE?
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Can't do V/Q or CTPA:
pregnancy can't transport out of ICU |
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How do you treat PE outpatient?
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You don't. Hospitalize!
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How do you treat PE inpatient?
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Heparin or LMWH + coumadin
can consider thrombolytics IVC filter if can't anticoagulate |
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You should avoid LMW heparins in what patients?
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obese (> 150 kg)
renal failure (CrCl < 25) |
