doubt...misshyd , samy anyone ? - funny3

[ArchivalUser]

I will try thanks. I did it already I will try again. usualy i use lovenox if creatinine it's ok or not obese, too much headache on heparin to follow ptt. in your case is not anticoagulation contraindication because ptt was ok no ivc filter in this case just stop heparin and repeat PTT there is a chart for heparin management I don't think we need it for CCS

[ArchivalUser]

I changed my style, start enoxaprin instead of IV heparin, add warfarin, then continue monitor.

When ptt start increase to 68, I add IVC filter, then continue monitor, ptt is no more 68, then 68 and 5 min screen pop up at 15 min, so, soft ware is happy now.

But prolong ptt after heparin will be acceptable bt 60 to 80, right?

So , in this case, ivc filter should add or not?

In my feeling, software is happier after IVC filter. What do u think?

[ArchivalUser]

Oh I see, when I stop heparin, 5 min screen came out immediately, so it means software is waiting ...to stop heparin, Ok, I agree larned, I think I got it. No need IVC filter for this case.

Thanks a lot.

[ArchivalUser]

I just did it case 38 patient overweight BMI 27., creatinine 0.98 I start lovenox I did not order PTT, since it is lovenox I just order a base line PTT that was 27 than I order cbc just to check platelet than I start patient on warfarin and d/c home on day 2 on lovenox and warfarin with pt on Monday. Case ended. Ask Sami or Missy what they think

[ArchivalUser]

Oh yes, I did like u said. Makes sense.

We don't need to monitor ptt, so now smooth ending.

When I saw ptt result pop up with increasing, it made me think something was wrong. Yea, I agree.

Wait n see if we are wrong, hope they will correct us. Appreciate u time larned.

[ArchivalUser]

thank you for clarifying this point about low glucose levels. Appreciated. Some of us do not have access to ER protocols or ER phycians near by. So conversations like these tryly help.
Thanks @missyhyd and @ bumbaonline.

I think we need to define DKA - and uncontrolled DM which I think @larned - is also referring to in the question above.

Is the definition DKA based only on glucose level or is it a constellation of signs and symptoms? and how does one define uncontrollable DM.

[ArchivalUser]

The diagnosis of DKA is based on the demonstration of moderate or severe hyperglycemia, ketonemia, and metabolic acidosis. if acidosis isnt present, then it is unexplained or uncontrolled diabetes.

[ArchivalUser]

chandag you are right and sami2004 said it right. Definition of DKA must be established before we jump in and rx as DKA : WAIT FOR BMP. I also suggest listen to experienced physicians' like dr.red lectures or read uptodate.com or emedicine etc to get good guidelines. Taking advise from amateurs can not only cause confusion but will also hurt exam scores!!!

[ArchivalUser]

Misshyd,

Is there any option to get IV antibiotics apart from keeping the patient in hospital for long period? Like out patient, or home visit by nurse.

Example, cryptococcal Meningitis pt need iv amphotericin for 2 wks, herpes encephalitis pt need acyclovir for 2 to 3 wks, should I keep pt in hospital for only purpose of IV drugs, I have no idea of routine here.
Thank you.

[ArchivalUser]

friend forever...i answered it in other question...http://www.usmleforum.com/showthread.php?tid=581926