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CT Contrast and Kidneys (FAQ)

American College of Radiology Manual on Contrast Media (download pdf): 1) Do end-stage renal patients need urgent dialysis after a CT scan with IV contrast? No “Most low-osmolality iodinated contrast media are not protein-bound, have relatively low molecular weights, and are readily cleared by dialysis. Unless an unusually large volume of contrast medium is administered, or there is substantial underlying

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Pediatric Fever Protocols

There have been several attempts at building protocols for pediatric fever in order to determine what children 3 months and younger can be discharged home. The most commonly used protocols include the Rochester, Philadelphia, and now Step-by-Step. Although there is an exceptional comparison of these protocols (Step by Step not included) from Hui et al in 2012, the most important

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Antiplatelet Therapy and Intra-cranial Hemorrhage (ICH)

Treatment: Spontaneous ICH (intra-parenchymal) Studies suggest platelets may increase poor outcomes. (PATCH trial, etc) Note: trials excluded ruptured aneurysm, SDH and EDH Traumatic ICH (SDH, EPH) If neurosurgical intervention is NOT planned, recommendation is NOT to give platelets. If neurosurgical intervention IS planned within 24 hours: Obtain platelet function testing if possible If testing is normal, patient is anti-platelet resistant

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Angioedema

Treatment:  Control airway early if tongue swelling: Consider flex/fiber optic visualization Be prepared for surgical airway Consider ketamine for awake intubation, fiber optic nasopharyngeal intubation LMA is insufficient If cause unknown, treat as histamine related with epinephrine, H1 & H2 blockers, and corticosteroids. Meds: Epinephrine- IM preferred due to longer action 0.01 mg/kg of 1:1000, max 0.5 mg IM Do

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Varicella & Pregnancy

Treatment in pregnancy: Chicken Pox Infection Immunized or Hx of past infection: exposure: nothing to do. simple rash: acyclovir 800mg PO 5x/day for 7 days severe infection or pneumonia, admit for IV acyclovir and supportive care. Not Immunized: exposure: consider VZIG, give first dose within 96 hours if possible, and up to 10 days from exposure. simple rash: acyclovir 800mg

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Lyme Disease

Treatment:  PO – for rash, cranial nerve palsy, carditis, or arthritis Doxycycline 100mg PO BID x 14 days Amoxicillin  500mg PO TID x 14 days (use if pregnant) Cefuroxime 500mg PO BID x 14 days IV – for meningitis Ceftriaxone 2gm qD x 14 days Cefotaxime 2gm TID x 14 days Cause: Borrelia burgdorferi spirochete in the USA Borrelia afzelli,

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Preeclampsia

Criteria Pregnancy, 20 weeks gestation up to 6 weeks postpartum, AND Hypertension >140/90 x 2 (at least 4 hours apart) or >160/110 x 2 (minutes apart) in a woman who was previously normotensive AND any one of the following: Proteinuria, defined as urine dipstick >1+ or >0.3 g in a 24-hour period Platelets <100k/mcL Serum creatinine > 1.1 mg/dL Liver transaminases

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