Acute Systemic lupus erythematosus (Acute SLE) is a multisystem autoimmune disease caused by autoantibodies and the deposition of immune complexes. The disease affects primarily women and has a higher prevalence among African Americans. A series of clinical findings is associated with acute SLE. These include a characteristic malar rash, photosensitivity, arthritis, serositis, and a discoid […]
According to the chest pain guidelines the faster the diagnosis can be made and the occlusion reversed, the more likely the patient is to salvage myocardial tissue and benefit from improved outcomes. Cardiovascular disease is a dominant cause of morbidity and mortality in the United States and acute myocardial infarction (MI) is one of the
Percutaneous coronary intervention or pci cardiac with stenting has revolutionized the care for patients with acute myocardial infarctions. Intracoronary stent placement in pci cardiac reduces the long-termrecurrence of stenosis. In addition, the combination of stenting with administration of glycoprotein IIb/IIIa (GP IIb/IIIa) inhibitor agents, which prohibit the binding of fibrinogen and proteins to platelets, has
Unfractionated heparin is a mixture of different weights of heparin (5 to 30k) that have varying effects on factors IIa, IXa, and Xa. Low-molecular-weight heparin (LMWH) is a subset of heparin (weight ~5k) that has activity on factor Xa, but not on IIa. LMWH has the advantage of less binding to protein and dose-independent clearance.
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What are the Indications for and Contraindications to Thrombolytics? Mr. XXX is a 66-year-old male who is postoperative day number one after hip replacement surgery and complains of acute onset of chest pain and shortness of breath. An electrocardiogram (ECG) is performed that shows new ST-segment elevation in leads II, III, and aVF. You are alone
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Fetal distress can be caused by a host of factors; most notably, hypoxemia and hypovolemia are dangerous for the viable fetus. It is not uncommon for a pregnant patient to be affected by critical illness. Examples of nonobstetric maladies that lead to intensive care unit admission among pregnant women are hematologic issues (venous thromboembolism and pulmonary embolus,
A woman in the third trimester of pregnancy is predisposed to supine hypotension syndrome in pregnancy while in the supine or sitting position due to the hemodynamic and anatomic changes of pregnancy. The large uterus of late pregnancy can compress the inferior vena cava (IVC) such that venous return is significantly reduced. This decreased preload
Acute spinal cord injury (SCI) is common with an estimated 8,000 to 10,000 new cases in the United States each year. The mean age of presentation is 31 years and the majority of patients are male. SCI is associated with significant long-term disability and mortality. Etiology Spinal cord injury has traditionally been classified as traumatic
When a patient returns from the operating room following spinal surgery it is important to establish with the surgical team any spine instability as well as the integrity of the dura. This information is critical should the patient need to be reintubated, vomit, or elevate the head of bed. There would be no greater catastrophe
Dural tear is a known complication of spinal surgeries, such as laminectomies, spinal fusions, and disc excisions. It most commonly occurs in the lumbar region. In general, the tear is noted at the time of operation when leakage of cerebrospinal fluid (CSF) is noted by the surgeon. A tear in the dura results in decompression
