Commit 7e940f5f authored by deepthought's avatar deepthought

multiple minor changes, also fixing large error in DBP in brain attack sheet

parent 59bdaa87
......@@ -15,6 +15,11 @@ If you are interested in contributing you can do so via:
#### related free and open source medical resources:
* [Cureus](http://www.cureus.com/) - free and open source medical journal with CC-BY license
* EMRs:
* [OpenMRS](https://openmrs.org/) [[git]](https://github.com/openmrs) - MPL-2 license (GPL-compatible)
* [FreeMED](http://freemedsoftware.org/) [[git]](https://github.com/freemed) - GPL license
* [OpenEMR](https://www.open-emr.org/) [[git]](https://github.com/openemr) - GPL license
* [GNU Health](http://health.gnu.org/) [git?] - website confusing, can't find git page
* [OpenBCI](http://openbci.com/) - free and open source software and hardware for a rudimentary/experimental EEG setup
#### the FREE in open source
......
......@@ -126,7 +126,7 @@ Differential includes:
## Plan
labs: CBC       renal       LFTs       S-TSH       B12/MMA / folate       thiamine       RPR
labs: CBC       renal       LFTs       S-TSH       B12/MMA / folate       thiamine       RPR (AAN: VDRL non-routine, only if "clinically indicated")
EKG (consider if e.g. anticholinesterase inhibitor)
......@@ -136,6 +136,8 @@ memory education       brain-tips sheet
neuropsych (consider if MMSE > 15 & not done within last yr)
psych (if e/o depression)
sleep study (consider if snoring, non-restorative sleep, RBD symptoms)
rtnv (time frame?)?
......
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......@@ -242,8 +242,8 @@ Three most prevalent categories:
* dual antiplalelet therapy for 90 days (e.g. ASA 81 + clopidogrel 75) then monotherapy thereafter
* cholesterol lower agents - controversy re LDL targeting or not
* general recommendations have been to target LDL < 70
* new focus to use high or medium potency statins that lower cholest by ~30-50%
* most likely to benefit are those w:
* new focus to use high or medium potency statins that lower cholest by >=%50 or ~30-50%, respectively
* most likely to benefit from high/medium potency are those w:
* clinical atherosclerotic cardiovascular disease (atherosclerotic stroke/TIA or h/o coronary artery disease)
* LDL > 190 mg/dL
* DM age 40-75yo and LDL > 70
......@@ -268,9 +268,16 @@ Three most prevalent categories:
* cerebral venous thrombosis
* specific agents
* new oral anticoagulants with reported improved efficacy & safety over warfarin
* note w trials many exclude pts w recent stroke (e.g. in 2 wks prior)
* timing on initiation related to risk of intracranial hemorrhage:
* minimum of 24 hrs post-tPA
* increased size of infarct - generally longer time waited prior to anticoagulation initiation
* bridging:
* may use ASA (most commonly; w dc once therapeutic), heparin, or lovenox
* size infarct correlates w risk of hemorrhagic transformation - for vit K agents (expecting delay in full effect)
* consider 3-5 days small infarcts (less than ~1/3 MCA), 7-10 moderate (up to ~1/3 MCA), 14 days large (complete/near-complete MCA)
* not evidenced based
* no e/o benefit to ASA on top of coumadin
* glucose control
* target A1c < 7% (American Diabetes Association genreal recommendations)
* initial PO regimen: metformin 500 bid (don't start in hospital if doing more testing re contrast/renal-protection)
......@@ -295,12 +302,12 @@ Three most prevalent categories:
### cholesterol lowering agents (mainly from 2/2017 continuum)
#### high potency statins
#### high potency statins (estimated >= 50% reduction in LDL)
* atorvastatin 40-80
* rosuvastatin 20-40
#### moderate potency statins
#### moderate potency statins (estimated 30-50% reduction in LDL)
* atorvastatin 10-20
* rosuvastatin 5-10
......
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