Indications/Contraindications Flashcards by Lindsey Shantzer

Indications for dialysis

AEOIU

-acidosis, electrolyte abnlties, fluid overload, toxic Ingestion, uremia

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Indications to sx treat hyperparathyroidism

Serum calcium >1mg/dL above ULN
OP: -2.5 at any site
Renal impairment (GFR)
Age

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When to do surgery with IE?

CHF or Ruptured valve/chordae ALWAYS
Prosthetic valve
Fungal endocarditis
Abscess
AV block as a result
Recurrent emboli while on antibiotics

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Indications for CABG?

3 vessels with at least 70% stenosis per vessel
Left MAIN coronary artery occlusion
2-vessel disease in pts with DM
Persistent sxs despite max med therapy

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Contraindications to thrombolytics?

to be used within 30 minutes for best results
Mortality benefit up to 12 hr

Major bleeding into the bowel or brain (not just heme+ stool)
Recent surgery (last 2 weeks)
HTN (180/110 +)
Nonhemorragic stroke within the last 6 mos

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Glycoprotein IIb/IIIa inhibitors (abciximab, tirofiban)

When to use?

ACS pts ABOUT to have angioplasty and stenting

Pts with NSTEMI (ST seg depression)

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Contraindications to breast feeding?

Herpes Breast infection
Maternal Varicella infxn 
Maternal HIV
Untreated maternal TB
Active substance abuse

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Indications for Exchange transfusion in hyperbilirubinemia in newborns?

Bilirubin 20-25mg/dL

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Indications for home O2 in COPD?

SpO2 : 55

Nocturnal hypoxia

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Indications for anti-D to benefit subsequent pregs?

28-32 weeks in Rh-neg mom
Within 72-hours of deliv Rh-pos baby
Spont, threatened, induced abortion
Ectopic pregancy
Molar pregnancy
Amniocentesis
Trauma
External Cephalic Version

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SIRS

T: >38, 90
RR: >20
WBC: >12K, or

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SBP Ascitis

SAAG >1.1
PMNs >250
Cx +

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Oral Iron in Pregnancy

Hgb

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Contraindications for MTX for Ectopic

Noncompliance
Liver disease
Immunodeficiency
Ectopic >3.5 cm or heartbeat auscultated

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When should preterm labor NOT be stopped by tocolytics?

I.e ALWAYS DELIVER THE BABY WHEN…

Maternal severe HTN
Maternal Cardiac Disease
Cervical Dilation >4cm
Maternal hemorrhage
Fetal death..
Chorioamnionitis

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Betamethasone in pregnancy?

24-34 weeks GA

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Intrauterine Transfusion with Rh Sensitization

Maternal antibody >1:16
Fetal cells Rh positive by amnio
Fetal bilirubin high
Percutaneous umbilical blood sample shows fetal anemia (hct)

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Contraindications for HRT in menopause

Hx of DVT/PE

Estrogen-dependent (Breast/Uterine) Cancer

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Indications for carotid endarterectomy

Asymptomatic Men: >60% stenosis
Symptomatic Men: >50% stenosis
(A)/symptomatic Women: >70% stenosis

Indications for a chest CT…

Hilar nodes- sarcoid
Mass lesions - cancer
Cavities - TB/aspergillus/nocardia/abscess
Interstitial lung disease (better than cxr)
Pulmonary embolism

Indications for MRI

MS
Posterior fossa lesions
Pituitary lesions
Brainstem
Facial structures: orbits/sinuses
Osteomyelitis (after xray)
Spinal cord/vertebral lesions

Indications for G-tube + PEG (GoLYTELY) flush following toxic ingestion?

Massive iron ingestion
Lithium
Swallowing drug-filled packets

Indications for hyperbaric oxygen in CO poisoning?

CNS involvement (seizure, AMS)
Cardiac involvement (ischemia)
Metabolic acidosis

Rabies Vaccination

Attack by stray/unprovoked dog

Animal displays AMS/odd behavior

When to get an Ethics Consult

1. ) Family/Pts want unnecessary/useless tests/treatments | 2. ) Capacity problems/Adv. Directive clarity problems

When to get a court order

1. ) Patient has NO capacity, and family members disagree | 2. ) Caregivers want to withdrawal care and ethics committee is equivocal

pRBC tranfusion for anemia

Hgb

Indications for delivery in preeclampsia (any of these)

1. ) BP >160/110 (x2) 4 hrs apart on bedrest 2. ) Plts 1.1 or doubled) 4. ) Transaminitis 5. ) Pulmonary edema 6. ) Visual/cerebral disturbances

C-section in HIV + mothers

Viral load > 1000

Indications for heparin in the setting of Chest pain/MI

Unstable angina Cardiac thrombus CHF on Echo

Indications for myringotomy/tympanostomy tubes

>3 infections in 6 mos, >4 infections in 12 mos

What is indicated for IUFD with low/normal fibrinogen/platelet count?

Induce labor

Indications for surgery in GERD?

Bleeding, strictures, Barrett's, max medical therapy

When does hemothorax go to OR? (initial: chest tube)

High output >1.5 L in chest tube >200 ccs/hr in first 4 hours

OR with bony trauma

Depressed skull fracture Open fx Displaced fx Femoral neck/intertrochanteric fx

Indications for MRI for back pain

Red flag signs + focal neuro deficit S/p + Xray or ESR findings for initial back pain workup (Red flags: pain at night, >50, hx malig, trauma, IVDU)

Indications for prophy (amoxicillin) for Endocarditis

1.Cardiac defect (prostehtic valve, prior IE, transplant w. valvulopathy, cyanotic heart disease) OR 2. Bacteremia risk (dental work, resp tract surgery) NOT MVP, MR, MS, AR, AS, HOCM, or ASD.

Indications for doxy within 72 hours of tickbite

Identified ixodes scapularis as the biter Attached >24-48 hrs Tick is engorged Endemic area Connecticut, Mass, NY, NJ, PA

Indications for starting HIV treatment

CD4 10000

Indications for stress ulcer with PPI

1. ) HEAD TRAUMA 2. ) Burns 3. ) Intubation 4. ) Coagulopathy (INR >1.5) WITH respiratory failure

Flexible bronchoscopy

FBO inhalation by youngster | C-spine injury requiring ET tube

When to hospitalize for PNA

``` Hypotension (SBP 30/ PaO2 30, Na 250 Pulse >125 AMS T. >104 >65 or + COPD, CHF,CKD, Liver disease ``` [CURB65]

Indications for sentinel node study in melanoma

> 1 mm depth

Indications for CRC serveillance in UC pts

start 8 years after diagnosis, then yearly

Indications for steroids during labor for lung maturity

24-34 weeks GA | L/S ration