Sandbox vidit3: Difference between revisions
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{{fontcolor|#F8F8FF|Physical examination}} | {{fontcolor|#F8F8FF|Physical examination}} | ||
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{{Family tree|border=0| | | | | | | | |!| | | | | | |}} | {{Family tree|border=0| | | | | | | | | |!| | | | | | |}} | ||
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<div class="mw-customtoggle-box6" style="cursor: pointer; border-radius: 5px 5px 5px 5px; text-align: center; border: solid 1px #696969; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); background: #4682B4; width: 200%;"> | <div class="mw-customtoggle-box6" style="cursor: pointer; border-radius: 5px 5px 5px 5px; text-align: center; border: solid 1px #696969; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); background: #4682B4; width: 200%;"> | ||
{{fontcolor|#F8F8FF|Labs and tests}} | {{fontcolor|#F8F8FF|Labs and tests}} | ||
</div>}} | </div>}} | ||
{{Family tree|border=0| | | | | | | | |!| | | | | | |}} | {{Family tree|border=0| | | | | | | | | |!| | | | | | |}} | ||
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<div class="mw-customtoggle-box7" style="cursor: pointer; border-radius: 5px 5px 5px 5px; text-align: center; border: solid 1px #696969; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); background: #4682B4; width: 200%;"> | <div class="mw-customtoggle-box7" style="cursor: pointer; border-radius: 5px 5px 5px 5px; text-align: center; border: solid 1px #696969; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); background: #4682B4; width: 200%;"> | ||
{{fontcolor|#F8F8FF|Imaging studies}} | {{fontcolor|#F8F8FF|Imaging studies}} | ||
</div>}} | </div>}} | ||
{{Family tree|border=0| | | | | | | | |!| | | | | | |}} | {{Family tree|border=0| | | | | | | | | |!| | | | | | |}} | ||
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<div class="mw-customtoggle-box8" style="cursor: pointer; border-radius: 5px 5px 5px 5px; text-align: center; border: solid 1px #696969; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); background: #4682B4; width: 200%;"> | <div class="mw-customtoggle-box8" style="cursor: pointer; border-radius: 5px 5px 5px 5px; text-align: center; border: solid 1px #696969; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); background: #4682B4; width: 200%;"> | ||
{{fontcolor|#F8F8FF|Diagnostic features}} | {{fontcolor|#F8F8FF|Diagnostic features}} | ||
</div>}} | </div>}} | ||
{{Family tree|border=0| | | | |,|-|-|-|^|-|-|-|-|.| |}} | {{Family tree|border=0| | | | | |,|-|-|-|^|-|-|-|-|.| |}} | ||
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<div class="mw-customtoggle-box9" style="cursor: pointer; border-radius: 5px 5px 5px 5px; text-align: center; border: solid 1px #696969; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); background: #4682B4; width: 200%;"> | <div class="mw-customtoggle-box9" style="cursor: pointer; border-radius: 5px 5px 5px 5px; text-align: center; border: solid 1px #696969; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); background: #4682B4; width: 200%;"> | ||
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{{fontcolor|#F8F8FF|Non syncope loss of consciousness}} | {{fontcolor|#F8F8FF|Non syncope loss of consciousness}} | ||
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{{Family tree|border=0| | A11 | | | | | A12 | | | | A13 | A11= | {{Family tree|border=0| | A11 | | | | | A12 | | | | A13 | A11= | ||
<div class="mw-customtoggle-box11" style="cursor: pointer; border-radius: 5px 5px 5px 5px; text-align: center; border: solid 1px #696969; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); background: #4682B4; width: 200%;"> | <div class="mw-customtoggle-box11" style="cursor: pointer; border-radius: 5px 5px 5px 5px; text-align: center; border: solid 1px #696969; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); background: #4682B4; width: 200%;"> | ||
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{{fontcolor|#F8F8FF|Consider additional tests}} | {{fontcolor|#F8F8FF|Consider additional tests}} | ||
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{{Family tree|border=0| | | | A14 | | | | A15 | | | | A16 | |A14= | {{Family tree|border=0| | | | A14 | | | | A15 | | | | A16 | |A14= | ||
<div class="mw-customtoggle-box14" style="cursor: pointer; border-radius: 5px 5px 5px 5px; text-align: center; border: solid 1px #696969; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); background: #4682B4; width: 200%;"> | <div class="mw-customtoggle-box14" style="cursor: pointer; border-radius: 5px 5px 5px 5px; text-align: center; border: solid 1px #696969; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); background: #4682B4; width: 200%;"> | ||
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{{fontcolor|#F8F8FF|Consider alternative diagnoses}} | {{fontcolor|#F8F8FF|Consider alternative diagnoses}} | ||
</div>}} | </div>}} | ||
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{{fontcolor|#F8F8FF| | {{fontcolor|#F8F8FF|Immediate in-hospital monitoring}} | ||
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{{fontcolor|#F8F8FF|Single syncope}} | {{fontcolor|#F8F8FF|Single syncope}} | ||
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{{fontcolor|#F8F8FF|If suspicion of structural hear disease: <br> Order an echocardiography | {{fontcolor|#F8F8FF|If suspicion of structural hear disease: <br> Order an echocardiography}} | ||
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{{fontcolor|#F8F8FF|Was it in high risk setting? <br> Potential risk of physical injury <br> Occupational implications }} | {{fontcolor|#F8F8FF|Was it in high risk setting? <br> Potential risk of physical injury <br> Occupational implications }} | ||
</div>|border=0}} | </div>|border=0}} | ||
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{{fontcolor|#F8F8FF|Structural heart disease present <br> Treat accordingly}} | {{fontcolor|#F8F8FF|Structural heart disease present <br> Treat accordingly}} |
Revision as of 15:27, 26 March 2014
New
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|
Characterize the symptoms |
Drug | Adult dosage |
---|---|
Inhaled Short Acting β Agonists (SABA) | |
Albuterol/Bitolterol/Pirbuterol a) Nebulizer solution b) MDI | ♦ 2.5-5 mg every 20 minutes for 3 doses, then 2.5-10 mg every 1-4 hours as needed or 10-15 mg/hour continuously. ♦ 4-8 puffs every 20 mins upto 4 hours, then every 1-4 hours as needed. |
Levalbuterol a) Nebulizer solution b) MDI | ♦ 1.25-2.5 mg every 20 mins for 3 doses, then 1.25-5 mg every 1-4 hours as needed. ♦ 4-8 puffs every 20 mins upto 4 hours, then every 1-4 hours as needed. |
Anticholinergics | |
Ipratropium bromide a) Nebulizer solution b) MDI | ♦ 0.5 mg every 20 mins for 3 doses, then as needed. ♦ 8 puffs every 20 mins as needed for upto 3 hours. |
Ipratropium with albuterol a) Nebulizer solution (each 3 ml containing 0.5 mg ipratropium and 2.5 mg albuterol) b) MDI (each puff contains 18 mcg ipratropium and 90 mcg albuterol) | ♦ 3 ml every 20 mins for 3 doses, then as needed. ♦ 8 puffs every 20 mins as needed for 3 hours |
Systemic corticosteroids | |
Prednisone/Prednisolone/Methylprednisolone | ♦ 40-80 mg/day in 1 or 2 divided doses until peak expiratory flowrate (PEF) reaches 70% of personal best. |
Clinical course | Unstable |
---|---|
Physical examination | Signs of heart failure |
Functional class | IV |
6MWD | Less than 400 m |
Echocardiogram | RV Enlargement |
Hemodynamics | RAP high CI low |
BNP | Elevated/Increasing |
Treatment | Intravenous prostacyclin and/or combination treatment |
Frequency of evaluation | Q 1 to Q 3 months |
FC assessment | Every clinic visit |
6MWT | Every clinic visit |
Echocardiogram2 | Q 6 to Q 12 months/center dependent |
BNP | center dependent |
RHC | Q 6 to Q 12 months or clinical deterioration |