what is GTPAT?
part of obstetrical history taking. G (gravidity) = # of total pregnancies T (term) = full term deliveries P (preterm) = # of preterm deliveries A (abortion/miscarriage) L (Living children )
Taking the uterus and ovaries and sometimes cervix is a procedure known as _
Total hysterectomy
what are causes of S2 splitting during a cardiac exam
- physiologic spliting is normal
- persistent spliting during inspiration and expiration = heart disease in adults most likely RBBB; and RV pressure overload such as acute massive PE
what can be heard on pulm exam with a PE, 53% of the time
rales
what is an invasive but highly accurate way of measuring blood pressure constantly?
arterial line (excellent in pts with any type of shock)
What labs can be checked for inherited thrombophilia?
- activated protein C/Factor V Leiden, homocysteine level, functional assays of antithrombin III/protein C/ Protein S, antiphospholipid antibodies
what is the most common finding on a EKG in a pt with a PE?
nonspecific ST-T wave abnormalities and sinus tachycardia
what is the gold standard imaging choice for PE?
CT angiogram (CTA) of chest (PE protocol) - need to consider stability of pt before taking them to radiology
what can be seen on EKG that is indicative of PE?
s1 Q3 T3 (S in lead I, Q in lead III, and an inverted T wave in lead III)
What is tPA?
recombinant tissue type plasminogen activator (tPA, alteplase) clot buster
what hormones are pro-thrombotic?
- Hormone replacement therapy (HRT) of premarin (estrogen)
what is factor V leiden?
- mutant form of coagulation factor V –> insensitive to action of activated protein C, a natural anticoagulant –> increased risk of venous thromboembolism
what is Virchows triad?
Theory of pathogenesis of venous thromboembolism: 1)alteration in blood flow, 2) vascular endothelial injury; 3) alterations in constituents of blood
what is well’s criterdia?
Assessment for PE:
- clinical symptoms = 3pt
- other diagnosis less likely than PE = 3pt
- HR>100 = 1.5pt
- immobilization >3 days = 1.5pts
- Previous DVT/PE = 1.5
- Hemoptysis and malignancy= 1.0pt each
High = > 6pts
Moderate risk = 2-6 pts
low <2 pts
what are the contraindications for fibrinolytic therapy?
Absolute: prior intracranial hemorhage; known structural vascular lesion, malignant intracranial neoplasm; ischemic stroke with 3 months; aortic dissection; active bleeding; significant bclosed-head trauma
what are the types of shock?
hypovolemic = >65% (early) or <65 (late) tissue perfusion
Cardiogenic shock <65% tissue perfusion
Distributive (dec systemic vascular reisstance) > 65% tissue perfusion
what are the considerations/ algorithm to management of inherited thrombophilia?
Active VTE –> anticoagulation for at least 3-6 months
Family hx of VTE –> if homozygous/compound OR more than one thrombophilia OR antithrobin def OR additional risk factor –> prophylactic anticoagulation post-op, pregnancy, postpartum
No personal or family history of VTE, but with antithrobin def -> prophylactic anticoagulation postoperatively, during pregnancy, and postpartum. All other thrombophilias –> routine care, education
what is Mean arterial pressure (MAP)
diastolic BP + (systolic BP-diastolic BP) / 3
> 65 = good perfusion
< 65 = hypotension/hypoperfusion
