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63 Cards in this Set
- Front
- Back
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PNA=pneumonia
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PNA
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PNA - clin man 4
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incr leukocytes
productive phlegm fever infiltrate on xray |
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PNA - 3 etiologies
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community
immune compromised facility |
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PNA - community orgs
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pneumococcal
HIB atypical |
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PNA - community atypicals
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chlamydia
legionella M. cattarhalis |
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PNA - community tx options
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levoquin
cipro ceftriaxone + azithromax |
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PNA - community penicillin does not cover
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atypicals
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PNA - community azithromycin covers
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atypicals
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PNA - facility additional orgs
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staph (MRSA)
pseudomonas |
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PNA - MRSA drugs
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vanco
linezolid |
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PNA - vanco dosage
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1g q12 OR
15 mg/kg up to 70 kg |
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PNA - linezolid dosage
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600 mg q 12
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PNA - pseudomonas drugs
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zosyn
levoquin cipro cefepime imipenem/merepenem tobramycin/gentamycin |
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PNA - facility single pseudomonas coverage
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vanco or linezolid
+ zosyn or imipinem |
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PNA - facility double pseudomonas coverage
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vanco or linezolid
+ zosyn or imipinem + tobramycin or levoquin |
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VTE=venous thromboembolism
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VTE
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VTE - 4 risk categories
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low
moderate high highest |
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VTE - low risk
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young
low risk surgery no risk factors |
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VTE - moderate risk
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no risk factor
moderate risk surgery |
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VTE - high risk
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CHF, MI, stroke, sepsis
trauma spinal trauma intubation immobilized >40 obese smoker malignancy pg hx of thromboembolism |
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VTE - highest risk
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major surgery (hip/knee_
> 40 high risk factors |
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VTE - low risk mgmt
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mechanical only
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VTE - moderate risk mgmt
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lmwh 40 mg sq qd
OR heparin 5000 unit sq bid |
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VTE - high risk mgmt
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lmwh 5000 unit sq q8
heparin 30 mg sq bid |
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VTE - highest risk mgmt
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high risk rx
PLUS mechanical mgmt |
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VTE - UF hep renal issues
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none
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VTE - UF hep have to monitor bc
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it includes large molecules that are not as effective in amounts that cannot be standardized
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VTE - UF hep inhibits which factors
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IIa
IX Xa XI XII |
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VTE - UF hep greater risk of
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HIT
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VTE - HIT
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heparin induced thrombocytopenia - and immune response 2-3 days after administration with previous exposure
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VTE - lmwh
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large molecules are enzymatically split off
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VTE - lmwh prefers
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factor Xa
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VTE - lmwh decr risk of
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HIT
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VTE - lmwh consideration
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must be reduced in cases of renal insufficiency
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VTE - fondiparinux HIT
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no risk because it doesn't combine with platelet factors
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VTE - fondiparinux consideration
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renal insufficiency
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VTE - clin man
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dyspnea
tachypnea tachycardia pleuritics hemoptysis |
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VTE - tachycardia neg predictive value
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70-80% negative if you don't have sx
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VTE - dx progression
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S/S - > d dimer -> leg evaluations
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VTE - which clots more likely to break off
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proximal ones
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VTE - ultrasound
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locate the vein, if you can't compress it you can expect a clot
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VTE - doppler
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measures velocity of blood flow; the higher the frequency of the sound, the higher the flow
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VTE - duplex
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combine US with doppler
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VTE - duplex sensitivity proximal leg
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95% detection rate
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VTE - duplex sensitivity calf
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misses 2/3
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VTE - VQ pressure gradient
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higher in bases, lower in apices
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VTE - VQ volume gradient
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higher in upper lobes, lower in bases
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VTE - VQ dont do in which pts
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anyone with lung dz
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VTE - VQ ratio high indicates
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dead space or pulmonary embolism
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VTE - VQ ratio low indicates
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poor ventilation state - chronic bronchitis, asthma, pulmonary edema
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VTE - VQ perfusion high in bases d/t
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gravity
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VTE - VQ ventilation higher in apices d/t
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gravity and the lung's weight creating less negative pressures in the bases
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VTE - VQ alveolar compliance higher in
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bases
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VTE - spiral CT 2 considerations
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pt must be still for 30 seconds
pt must tolerate contrast |
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VTE - spiral CT good for
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big vessels, but misses 2/3 of small vessels
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VTE - spiral CT mechanism
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IV contrast fills up arteries, looking for filling gap
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VTE - unstable tx
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thrombolytics
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VTE - thrombolytics
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alteplase
reteplase |
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VTE - alteplase dosage
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.6 mg/kg over 15 min
or 100 mg over 2 hours |
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VTE - reteplase dosage
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10 unit/repeat after 30 minutes
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VTE - stable tx
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heparin or
LMWH |
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VTE - heparin dosages
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80 unit/kg bolus
18 u/kg/hour until aPTT 45-70 |
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VTE - lmwh doages
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1 mg/kg bid
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