Day 5 - CV4 Vascular, Peds Flashcards
Indications for repair of AAA
(1) Diameter > 5.5 cm (2) Increase diameter by more than 0.5 cm in 6 mo. diameter (interval for abdominal US) (3) Sx
Pt pop for one-time screening US to detect AAA
All males, age 65-75, w/ any hx of smoking
Steps for w/u of pt w/ PAD considering surgical intervention
PE; ABI to confirm dx; Segmental pressures and/or LE Duplex Dopplers to confirm location; Lower extremity arteriogram to plan surgery; Surgical correction
PAD first-line
Smoking cessation, glucose/bp control, Cilostazol (better than Pentoxifylline; contraindcated for heart failure); ASA/Plavix reduce CAD; Statins;
Primary prevention of DVT
(1) Low dose unfractionated heparin (5000 subQ q 8-12 hr, post op) (2) LMWH (q 12 hr, may give higher dose q d) (3) Fondopauraneaux (if cannot tolerate heparin) (4) SCDs (5) Ambulation (6) Anticoagulation - Heparin, Warfarin (7) Compression stockings (not as good as SCDs) (8) ASA (not as good as anticoagulants)
Tx superficial thromphlebitis
NSAIDs, heat, limb elevation; If LE (saphrenous vein) above knee, may use anticoagulation to prevent DVT; If below knee (femoral vein), must be anticoagulated because considered DVT; if draining, suspect cellulitis, so give IV Vancomycin
Dx Kawasaki disease
Fever last 5+ days in addition to 4 of following CRASH sx: Conjunctivitis (b/l, nonexduative, painless), Rash (truncal), Adenopathy (cervical LN), Strawberry tongue (diffuse erythema of mucous membranes), Hands and feet have edema, induration, desquamation
Tx Kawasaki disease
IVIg usually w/i first 9 days ; High dose ASA; Special case: for giving kids ASA & NOT giving steroids in vasculitis; Echocardiogram in acute phase (check for aneurysmal dilation of cardiovasculature)
Ebstein’s anomaly: Cause, Findings, Tx
Materinal Li use; Tricuspid leaflets displaced into right ventricle = hypoplastic ventricle; TR & S, 80% PFO, Dilated R atrium, Increased risk of SVT & WPW; PE - widely split S2, TR; Prostaglandin E, Propanolol for SVT, Digoxin, Diuresis
