Acute Mitral Regurgitation - acute vs chronic Most common cause of acute: 1. Rupture chordae tendinae due to myxomatous disease, infectious endocarditis, rhemuatic heart disease 2. Rupture papillary muscle due to MI (2-7 days prior) Can get pulmonary edema, cardiogenic shock, mimics ARDS, PNA, difficult exam findings Echo enables you to quantify degree of MR; use color flow doppler echo to evalute for acute MR Persistent Tachycardia
Buergers disease
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Important questions to ask:
S&S - syncope, bleeding, dyspnea, trauma, fatigue, weakness Workup- What to expect with hemolytic process: - CBC (Hgb) - peripheral smear (takes some time, but will often give definitive dx) - retic count - increased - haptoglobin - decreased - bilirubin - LDH - increased - urinalysis - Coombs (direct and indirect) - Type and Cross Intrinsic vs Extrinsic Hemolysis - Intrinsic = structural or enzymatic defect - Extrinsic = mechanical or toxic destruction Key points
Why this matters!
How about a Score?
On exam AMS, HR>125, RR>30, SBP <90, Temp <35 or >40 Step 2. Use MD Calc Check boxes. Simple rule: With no high risk findings and women under 80, dischcarge and men under 70.
Urea >20 RR >30 Blood Pressure - SBP <90, DBP <60 Age >65 More of these is higher mortality in 30 days Blood Cx?
HCAP
Case 1 - 61 year old with Rapid Heart Rate
Case 2 - 30 year old with abdominal and rectal pain
Case 3 - 63 year old with dyspnea and uri symptoms
8 day old with Respiratory Distress, Mottling, and Hypoxia
Intermittent grunting Poor feeding No fevers Jaundiced DDX: Very Broad and includes terrible potential problem. Keep the following in mind! THE MISFITS
2 year old s/p Fall Fall not witnessed Possible LOC Fussy initially, then baseline Blood tinged emesis x 1 Neuro exam unremarkable To CT or Not to CT? PECARN Minor Head Injury Rule - see PedEMMorsel |
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