A*******s
发帖数: 9638 | 1 1. For ischemic stroke, tpa if within 3 hours , otherwise supportive only.
fib,
No heparin for most strokes, but for A-fib or dissection, it depends.
Correct.
No consensus. Even TPA was proven safe but no enough data.
Probably not. But Coumadin is recommended afterwards.
fib, |
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A*******s
发帖数: 9638 | 2 No.
QuantiFERON®-TB Gold is an in vitro diagnostic test using peptide
cocktails simulating ESAT-6 and CFP-10 proteins to stimulate cells
in heparinized whole blood. These proteins are absent from all BCG
strains and from most non-tuberculosis mycobacteria with the
exception of M. kansasii, M. szulgai and M. marinum. |
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A*******s
发帖数: 9638 | 3 有一个病人，50岁， 一天前因为不能行走收住院， 第二天我order了MRI， 一个
spinal tap， 第三天night shift hospitalist告诉我MRI是normal，spinal tap不能
做， 因为病人on fragmin， 要等24hr。
我自己看了一下MRI， 这个病人有spinal abscess。 当天就手术了。
这个radiologist的误读让人很恼火， 可是这个fragmin更是火上浇油。 我不明白，
现在的hospitalist都用fragmin for DVT prophylaxis? Why not SCD + heparin for
high risk patients? 这个病人根本没有on SCD. |
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m*********6
发帖数: 609 | 4 我们这里DVT prophylaxis还是常规的heparin 5000 units sq, q8h， 偶尔也用lovenox，还没有看到一个用fragmin的
DVT |
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A*******s
发帖数: 9638 | 5 对， heparin + SCD.
Fragmin好像用于最严重的或者术后的情况。
lovenox，还没有看到一个用fragmin的 |
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m****8
发帖数: 7 | 6 If PTT> 150, hold for 1h according to protocol, do we give protamine to
reverse?
How long do we use for pt with ACS or DVT?
Thank you very much. |
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t*********m
发帖数: 360 | 7 are you in china or states? |
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w********e
发帖数: 762 | 8
没有活性出血的话,给protamine做啥?而且只能reverse 30到50%
你这问题问的,真不知道怎么回答你..
ACS.取决与下部的方案,一般地24小时到48小时.不是做了cath 放支架,CABG就是了.那
时就不用drip了啊.
DVT..要transition 到口服warfarin,INR 达到治疗水平.overlap 1-2 天就可以停了.. |
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A*******s
发帖数: 9638 | 9 Hospitalists like to give heparin drip for acute stroke patients with atrial
fibrillation. This is a controversial topic. Anticoagulation is indicated
for cardiac emboli and atrial fibrillation, but when stroke size is large,
anticoagulation would put patients on the risk of hemorrhagic transformation
. What should we do?
Here is a review article:
http://stroke.ahajournals.org/content/38/2/423.long
So we should not routinely anticoagulate acute stroke patients with a-fib.
However, if patients ... 阅读全帖 |
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P********r
发帖数: 92 | 10 'All my drugs come from Mexico. Never had a problem.' lol
****
Isn't this another round of debate on 'MADE in China'? It's more about US
jobs and bad economic downturn, isn't it?
i found this surprising since i have not been aware of the following, also
from this article:
'It is hard to believe that it already has been three years since the
contaminated blood thinner heparin, which authorities believe originated in
China, killed several people and caused multiple cases of serious illness.'
Wh... 阅读全帖 |
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A*******s
发帖数: 9638 | 12 Agree with newprozac.
Start heparin or LWMH for new onset TIA with A-fib until INR theraputic. |
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P*********8
发帖数: 168 | 13 if no contraindication, should be on coumadin. Not like DVT/PE, bridging
form heparin or LMWH is not required.
TIA itself does not require AC, should be treated like stroke, start ASA and
statin if not contraindicated.
terms |
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s**********t
发帖数: 217 | 14 I am talking about systemic thromyolytic treatment, like tPA. Not systemic
anticoagulation therapy, like heparin or LMWH. |
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R*******t
发帖数: 367 | 15 不是介入的，他们做的东西难，我这个是body IR，住院医时候训练的。
俺们的流程是plavix和coumadin以及Arixtra至少要停4-5天。heparin drip至少停六个
小时。baby aspirin没事。
Solid organ biopsy, such as thyroid, liver, kidney, etc., PLT至少75以上，
para/thoracentesis至少PLT在50以上，不然就得至少输血小板6 units，要不就不干。 |
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n*******c
发帖数: 501 | 16 D-Dimer
这个问题争论已久，现实是诊断PE最主要还是靠临床先评估risk，如果临床上一点都不
支持PE，那就宁愿不做，因为你知道negative不会改变结局，positive你也不会因此CT
，反而费尽心机解释，不如不做。high risk的你知道即使negative你也不放心最终也
是要CT的那就不如不做。所以order之前一定要自己能说服自己这个病人postive我就
orderCTA而negative我就不做CTA才行。
上面这个病人我是order了的，主要是因为我太想给她一个机会不做CTA的...这个病人
risk 主要是pregnancy和immobile due to RUQ pain，像“林海雪原”大哥说的，如果
doppler negative且d-dimer negative，我不会那么着急order CTA，除非临床上又发
生了变化比如血氧掉了或haemodynamically unstable，不过那样的话可能查不查也不
重要了，床边超声木有dissection就直接上heparin了... |
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A*******s
发帖数: 9638 | 17 Are these your attending's questions?
The answers are yes. Rare but yes.
ASA frequently causes skin bruises and sometimes GI ulcers/bleeding.
Heparin causes more internal bleeding. |
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M****a
发帖数: 577 | 18 第二周同样是从星期天开始，手术室开始恢复正常了，虽然有7月4日，但是这一周还是
有三天手术，多了4个新病人。从上一个intern“继承”下来的10个老病人，在我们两
个intern 磕磕绊绊的努力下，终于在星期二之前全部出院了。Intern的一个主要任务
就是送病人出院，这点内科外科没有区别。
Fellow也换了人，上一个fellow跑到另一个医院又开始做一个fellowship。我们这里CT
fellow的任务就是指挥intern，参加所有的手术，以及安排新的手术，每个星期只有
周六晚上才算off。新的fellow说话极快，一分钟可以吩咐20件事情，我们两个intern
只能赶紧记下来，回workroom对照一下，然后赶快把医嘱写了。他记性极好，白天如果
在楼道里碰到了，会问早上吩咐过的事情做得如何了，比如上午的CT scan结果出来没
有，swallow study的正式报告上怎么写的等等。
7月4日那天轮到我值班，我的co-intern不上工，除了CT surgery之外，从10AM-8PM，
整个外科的day cross-over pager我得带着。另外当天还有3个CT pr... 阅读全帖 |
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A*******s
发帖数: 9638 | 19 What you said are all reasonable, but now you are at the bedside, 5pm, all
tech
/radiologists are gone.
The first thing is to measure the BP. There are more than 20 mmHg
discrepancy on systolic BP. 2nd is to call the family, the abnormality
found on Doppler is from a surgeon's vascular lab, there must be some story
behind it. The daughter told me the discrepancy of BP was 70 and she was
told not to measure the BP on the right. There is a big clot in the
right arm but they could not do anything... 阅读全帖 |
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b*******y
发帖数: 12791 | 20 没打这个，不过肚皮上打过其他的大众的
护士说，防止乌青的一条是，推药要慢。 |
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d*******e
发帖数: 16 | 21 It's a blood thinner, stronger than Baby Asprin. I was prescribe with it
because of multiple miscarriages. |
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L*********h
发帖数: 44 | 22 唉，原来如此，我去年年初有过一次miscarriage. 可能是因为这个吧。 没办法，只好
继续在肚皮上戳洞了。 mm的用量是多少？ 我本来一直是5000，周日验血后医生让我加
大到6500。 唉，这针打得越来越痛了。 |
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