Urinary Incontinence = D.R.I.P.
D: drugs- diuretics, anticholinergics
R: restricted mobility
I: infection or impaction
P: polyuria : hyperglycemia, CHF
Differential of "i''s for generating DDx.
ischemic
infection
injury
indocrine
inherited
immunologic
infiltrative
insane
intoxication
idiot-pathic
i-did it
intern did it
4 Famous Discharge Criteria
Walking
Talking
Peeing
Pooping
7 components of an HPI
1. Location-Radiation
2. Quality
3. Quantity
4. Chronology
5. Situational
6. Aggravating and Alleviating Circumstances
7. Associated Manifestations
OLDCART Method for HPI/Complaints
Onset
Location
Duration
Character
Aggravating / Alleviating
Radiation
Temporal Factors (Time)
OPQRST Method for HPI/Complaints
O= Onset
P = Provoking / Pallating
Q = Quality
R = Radiates
S = Severity / Site
T = Time / Temporal Factors
TAILS for Microcytic Anemia
Thallasemia
Anemia of Chronic Disease
Iron Deficiency Anemia
Lead Poisoning
Sideroblastic Anemia -abnl production of red blood cells as part of myelodysplastic syndrome,
MUDPILES for metabolic acidosis
Methanol
Uremia
Diabetes
Paraldehyde
Infection, Iron, Isoniazid
Lactic Acidosis
Ethylene Glycol, Ethanol
Salicylates
MASH for H&P
Medications
Allergies
Surgeries
Hospitalizations
HALT for Target Cells
HbC Disease
Asplenia
Liver Disease
Thallassemia
Hypercoaguable workup List
Protein C def
Protein S def
Prothrombin 20210A
Factor V Leiden
MTHFR Gene mutation (use Homocysteine levels)
ANTI CARDIOLIPIN AB PANEL
LUPUS REFLEX < LUPUS CUSTOM ANTICOAGULANT PANEL>
Activated protein C resistance.
SIRS = 2 or more of the following
1. T <36 or > 38°C
2. HR > 90 bpm
3. RR> 20 bpm or PC02 < 32 mm Hg
4. WBC <4K or > 12K or >10% bands
Sepsis = SIRS + infection
Severe Sepsis = Sepsis + organ dysfunction, hypoperfusion, or hypotension.
Septic shock = Sepsis + refractory arterial hypotension or hypoperfusion abnormalities
TTP vs. HUS
Fever
Anemia
Thrombocytopenia
Renal Failure
Neurological manifestations
TTP is "FATRN" (fever,anemia,thrombocytopenia,renal failure.neurological symptoms)
remove F and T it becomes HUS
GI Prophylaxis
Indications — Based upon randomized trials and guideline recommendations from the American Society of Health System Pharmacists, stress ulcer prophylaxis should be administered to all critically ill patients who are at high risk for gastrointestinal (GI) bleeding [23,24]. Although there is disagreement about which clinical characteristics define high risk, we and others believe this includes patients with any of the following characteristics:
●Coagulopathy, defined as a platelet count <50,000 per m3, an International Normalized Ratio (INR) >1.5, or a partial thromboplastin time (PTT) >2 times the control value
●Mechanical ventilation for >48 hours
●History of GI ulceration or bleeding within the past year
●Traumatic brain injury, traumatic spinal cord injury, or burn injury
●Two or more of the following minor criteria: sepsis, an intensive care unit (ICU stay) >one week, occult GI bleeding for ≥six days, or glucocorticoid therapy (more than 250 mg hydrocortisone or the equivalent)
DVT Prophylaxis
For hospitalized medical patients without obvious risk factors for VTE, we recommend that anticoagulant thromboprophylaxis not be employed (Grade 1B). Options for this low risk group include early ambulation with or without mechanical methods of thromboprophylaxis.
●For most patients who are hospitalized with an acute medical illness, have at least one risk factor for VTE, and do not have an increased risk of bleeding, we recommend the use of prophylactic anticoagulation over mechanical methods (Grade 1B). (See 'Assignment of risk group' above.)
Based upon data from clinical trials for the prevention of VTE in medical patients, common conditions predisposing the patient for VTE include heart failure, acute exacerbations of chronic pulmonary disease, acute respiratory failure, stroke with lower limb paralysis, sepsis, and inflammatory bowel disease [16,30,56,76,84,85,96-109]. Additional risk factors include known thrombophilia, prolonged immobility, age >60 years, the presence of cancer, previous VTE, admission to an intensive care unit, and possibly elevated D-dimer [24,30,84,96-108,110,111]. Many medical patients have multiple risk factors at the time of admission. (See "Overview of the causes of venous thrombosis", section on 'Multiple acquired risk factors'.)
In prevention of VTE in medical patients, the following findings were noted [136]:
●There was no significant difference in the overall rate of VTE between BID (5.4/1000 patient-days) and TID (3.5/1000 patient-days) UFH heparin dosing. TID heparin showed a trend toward a decrease in PE (BID 1.5/1000 patient-days, TID 0.5/100 patient-days) and in proximal DVT plus PE (BID 2.3/1000 patient-days, TID 0.9/1000 patient-days).
●The risk for major bleeding was significantly greater with TID than with BID UFH dosing (BID 0.35/1000 patient-days, TID 0.96/1000 patient-days).
However, a second meta-analysis involving 16 studies found no difference between BID and TID UFH dosing in the relative risks for DVT, PE, death, or major bleeding [137].
