Patients come and go so quickly that I hardly have the time to miss them before start taking on a new patient.
I did two warfarin discharge counsellings today. One was for a pt with DVT and another was for a pt with a PE. After my first patient, I realize that I should have a more consistent patient counselling format. This will ensure that I not miss any potential issues. It is also helpful to make the discussion relevant to the patient (ie. how much alcohol do you drink? do you play hockey? what time do you have breakfast?etc.)
COPD Didactics:
- environmental factors: coal plants, espasis ( old insulation), wood smoke
- complicaton: right sided heart failure ( cor pulmonale)
- co-morbidities related to medication therapy: glaucoma , osteoporosis ( steriods)
- dx: spirometer–> used in pt with sx….post bronchodilator less than 0.7 for FEV1/FVC
- asthma : not related to sputum production, reversible, episodic, allergy related, onset younger age, doe not progress
- corticosteroid correlate to increase risk of pneumonia
- TORCH: surrogate marker FEV1 favors steriod, 10% of COPD can be managed with inhaled corticosteriods
- neb: salbutamol, budesonide, ipratropiu<— can be given together
- start antibiotic if pt is showing systemic infection ( febrile, WBC increase)
- severe acute COPD exacerbation is related to gram negative bacterias
- acute COPD exacerbation: H. influ, M. Catarrhalis, S. pneumo
- abx use:
- simple: amox, doxy, septra, 2nd or 3rd gen ceph, extended spectrum macrolid
- severe: FQ, beta lactam / beta lactamse inhibitor
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