step 3 31 Flashcards
preventative care for SCD kids
1) transcranial doppler US for stroke prevention. If reduced velocity found, patients sould undergo chronic transfusion therapy.
2) routine vaccines + pneumovax, early meningococcal
3) penicillin for ppx against encapsulated bacteria
measles presentation
- prodrome of fever, cough, coryza, conjuctivitis then dark-red maculopapular rash that progress cephalocaudally
- spares palms/soles
measles treatment
supportive
vitamin A
complications of monochorionic diamnotic twin gestations
increased risk for twin-twin transfusion syndrome (arteries and veins on placenta anastomose)
complications of monochorionic monoamniotic gestations
cord entanglement (since the grow in the same sac, cords can become entangled)
risk of multiple gestations
increased risk of preterm delivery
complications of OSA
HTN, CAD, arrhythmias, heart failure
indications for CT scan after minor head trauma
Age over 65 Coagulopathy Drug or alcohol intoxication High risk injury mechanism High risk symptoms (amnesia, vomiting, seizure, HA, AMS, neuro deficits)
ARDS pathophys
lung injury leads to inflammation leads to increased pulmonary vascular permeability leads to fluid leakage into alveoli
ARDS clinical features
Patient with infection, trauma, massive transfusion, acute pancreatitis with acute onset respiratory distress and pulmonary edema not explained by HF
- also hypoxemia and bilateral lung opacities on imaging
ARDS ventilator management
Low TV (6-8 mL/kg) + high PEEP (10-20) + high FiO2 (maintain FiO2 less than 60% to avoid oxygen toxicity)
how to wean someone off ventilator
- Once oxygenating on low levels of PEEP, then decrease FiO2 to less than 40% before spontaneous breathing trial and extubation
other treatments for bipolar disorder
alternatives to lithium = lamotrigine, valproate
antipsychotics = quetiapine, lurasidone
HIT workup
Platelet factor 4 (HIT) antibody testing
unique features of postpartum depression
- inability to enjoy the infant
- persistently depressed mood
treatment of patient’s in respiratory failure who are DNR/DNI
opiates (MORPHINE). Opiates treat the sensation of dyspnea and air hunger that people feel at the end of life. Even though they cause respiratory depression.
acalculous cholecystitis clinical features
critically ill/ICU patient with unexplained fever + leukocytosis + jaundice
acalculous cholecystitis on imaging
gallbladder wall thickening without choleliths
acalculous cholecystitis management
percutaneous cholecystostomy (drainage)
nonreactive fetal NST suggests
fetal acidemia
other clinical relevance of anti-CCP antibodies
- associated with a more aggressive course (increased risk of rapidly progressive RA with joint erosions)
- also true for RF
neonatal polycythemia management
Monitor blood glucose + bilirubin (at risk for hypoglycemia and hyperbilirubinemia)
IV fluids
Glucose
Partial exchange transfusion
complications of sickle cell trait
- hematuria/papillary necrosis, hyposthenuria
- splenic infarction (at high altitudes, low oxygen tension can precipitate sickling), VTE, priapism
- exertional rhabdo
- overall risk is low
treatment of hydatiform mole
suction curettage
