Indications/Contraindications Flashcards
Indications for dialysis
AEOIU
-acidosis, electrolyte abnlties, fluid overload, toxic Ingestion, uremia
Indications to sx treat hyperparathyroidism
Serum calcium >1mg/dL above ULN
OP: -2.5 at any site
Renal impairment (GFR)
Age
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
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
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
Glycoprotein IIb/IIIa inhibitors (abciximab, tirofiban)
When to use?
ACS pts ABOUT to have angioplasty and stenting
Pts with NSTEMI (ST seg depression)
Contraindications to breast feeding?
Herpes Breast infection Maternal Varicella infxn Maternal HIV Untreated maternal TB Active substance abuse
Indications for Exchange transfusion in hyperbilirubinemia in newborns?
Bilirubin 20-25mg/dL
Indications for home O2 in COPD?
SpO2 : 55
Nocturnal hypoxia
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
SIRS
T: >38, 90
RR: >20
WBC: >12K, or
SBP Ascitis
SAAG >1.1
PMNs >250
Cx +
Oral Iron in Pregnancy
Hgb
Contraindications for MTX for Ectopic
Noncompliance
Liver disease
Immunodeficiency
Ectopic >3.5 cm or heartbeat auscultated
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
Betamethasone in pregnancy?
24-34 weeks GA
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)
Contraindications for HRT in menopause
Hx of DVT/PE
Estrogen-dependent (Breast/Uterine) Cancer
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
- ) Family/Pts want unnecessary/useless tests/treatments
2. ) Capacity problems/Adv. Directive clarity problems
When to get a court order
- ) 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)
- ) BP >160/110 (x2) 4 hrs apart on bedrest
- ) Plts 1.1 or doubled)
- ) Transaminitis
- ) Pulmonary edema
- ) 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
- ) HEAD TRAUMA
- ) Burns
- ) Intubation
- ) 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
