https://wikem.org/w/api.php?action=feedcontributions&feedformat=atom&user=Alinker 2026-05-05T07:52:09Z User contributions MediaWiki 1.38.2 https://wikem.org/w/index.php?title=Lupus&diff=19098 2014-03-27T20:23:11Z

<p>Alinker: redirect</p> <hr /> <div>#REDIRECT [[Systemic Lupus Erythematosus]]</div>

Alinker https://wikem.org/w/index.php?title=Acute_respiratory_distress_syndrome&diff=18968 2014-03-26T17:21:45Z

<p>Alinker: minor changes</p> <hr /> <div>==Background==<br /> *Non-cardiogenic pulmonary edema due to lung capillary endothelial injury<br /> **Proteinaceous material accumulate in alveoli in a heterogeneous manner<br /> *Symptom of an underlying disease<br /> <br /> ==Clinical Features==<br /> *'''Diagnostic criteria'''&lt;ref&gt;Ferguson ND et. al. The Berlin definition of ARDS: an expanded rationale, justification, and supplementary material. Intensive Care Med. 2012 Oct;38(10):1573-82.&lt;/ref&gt;<br /> #New onset respiratory symptoms<br /> #Bilateral pulmonary opacities<br /> #Symptoms not explained by cardiac etiology or volume overload<br /> '''PaO2/FIO2 ratio'''<br /> *200-300 Mild<br /> *100-200 Moderate<br /> *&lt; 100 Severe<br /> *'''Presentation'''<br /> **Severe dyspnea<br /> **Hypoxemia<br /> **Diffuse crackles<br /> *'''Imaging'''<br /> **Diffuse patchy pulmonary infiltrates<br /> *'''Causes'''<br /> **[[Sepsis]]<br /> **[[Pancreatitis]]<br /> **[[Burns]]<br /> **Aspiration<br /> **Trauma<br /> **[[Submersion Injuries (Drowning)|Near drowning]]<br /> **Fat embolism<br /> **[[Amniotic Fluid Embolus|Amniotic fluid embolism]]<br /> <br /> ==Differential Diagnosis==<br /> *[[CHF]]<br /> *[[Pneumonia]]<br /> *[[PE]]<br /> *Diffuse alveolar hemorrhage<br /> *[[DIC]]<br /> <br /> ==Workup==<br /> *CXR<br /> *CBC<br /> *Chem 10<br /> *UA<br /> *LFT<br /> *Lipase<br /> *PT/PTT<br /> *Influenza (seasonal)<br /> *Blood cultures<br /> *Lactate<br /> *Consider bedside echo<br /> *Consider ABG/VBG<br /> *Consider BNP<br /> <br /> ==Management==<br /> *Treat underlying cause<br /> **Cover for sepsis<br /> ***Pneumonia in addition to other identified source<br /> **Tamiflu 75mg BID oral or NGT if influenza season &lt;ref&gt;http://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm&lt;/ref&gt;<br /> *Supplemental O2<br /> *[[Noninvasive Ventilation|Noninvasive ventilation]]<br /> **Limited data to support use<br /> *[[Ventilation (Main)|Ventilator Settings]]<br /> **Permissive hypercapnia<br /> **Tidal volume 6-8cc/kg of [http://www.mdcalc.com/ideal-body-weight/ ideal body weight]&lt;ref&gt;Brower RG, et al. &quot;Ventilation With Lower Tidal Volumes As Compared With Traditional Tidal Volumes For Acute Lung Injury And The Acute Respiratory Distress Syndrome&quot;. The New England Journal of Medicine. 2000. 342(18):1301-1308.&lt;/ref&gt;<br /> ***Limit barotrauma to healthy area of lung<br /> ***Increase PEEP to improve oxygenation<br /> **Maintain plateau pressures &lt; 30 &lt;ref&gt;Hansen-Flaschen et al. Acute respiratory distress syndrome: Clinical features and diagnosis.UpToDate accessed 3/26/14&lt;/ref&gt;<br /> **Ensure adequate sedation<br /> ***Better synchrony with vent<br /> ***Decreased oxygen consumption<br /> ***Less [[delirium]]<br /> ***Increased patient comfort<br /> **Prone ventilation<br /> ***Preliminary data suggests prone positioning may increase survival<br /> ***Consider for refractory hypoxemia<br /> <br /> ==Disposition==<br /> * Admit to ICU<br /> <br /> ==See Also==<br /> *[[Pulmonary edema]]<br /> *[[CHF]]<br /> *[[EBQ:ARDSnet Trial]]<br /> <br /> ==Sources==<br /> &lt;references/&gt;<br /> <br /> [[Category:Pulm]][[Category:Critical Care]]</div>

Alinker https://wikem.org/w/index.php?title=Acute_respiratory_distress_syndrome&diff=18967 2014-03-26T17:15:43Z

<p>Alinker: </p> <hr /> <div>==Background==<br /> *Non-cardiogenic pulmonary edema due to lung capillary endothelial injury<br /> **Proteinaceous material accumulate in alveoli in a heterogeneous manner<br /> *Symptom of an underlying disease<br /> <br /> ==Clinical Features==<br /> *'''Diagnostic criteria'''&lt;ref&gt;Ferguson ND et. al. The Berlin definition of ARDS: an expanded rationale, justification, and supplementary material. Intensive Care Med. 2012 Oct;38(10):1573-82.&lt;/ref&gt;<br /> #New onset respiratory symptoms<br /> #Bilateral pulmonary opacities<br /> #Symptoms not explained by cardiac etiology or volume overload<br /> '''PaO2/FIO2 ratio'''<br /> *200-300 Mild<br /> *100-200 Moderate<br /> *&lt; 100 Severe<br /> *'''Presentation'''<br /> **Severe dyspnea<br /> **Hypoxemia<br /> **Diffuse crackles<br /> *'''Imaging'''<br /> **Diffuse patchy pulmonary infiltrates<br /> *'''Causes'''<br /> **[[Sepsis]]<br /> **[[Pancreatitis]]<br /> **[[Burns]]<br /> **Aspiration<br /> **Trauma<br /> **[[Submersion Injuries (Drowning)|Near drowning]]<br /> **Fat embolism<br /> **[[Amniotic Fluid Embolus|Amniotic fluid embolism]]<br /> <br /> ==Differential Diagnosis==<br /> *[[CHF]]<br /> *[[Pneumonia]]<br /> *[[PE]]<br /> *Diffuse alveolar hemorrhage<br /> *[[DIC]]<br /> <br /> ==Workup==<br /> *CXR<br /> *CBC<br /> *Chem 10<br /> *UA<br /> *LFT<br /> *Lipase<br /> *PT/PTT<br /> *Influenza (seasonal)<br /> *Blood cultures<br /> *Lactate<br /> *Consider bedside echo<br /> *Consider ABG/VBG<br /> *Consider BNP<br /> <br /> ==Management==<br /> *Treat underlying cause<br /> **Cover for sepsis<br /> ***Pneumonia in addition to other identified source<br /> **Tamiflu 75mg BID oral or NGT if influenza season &lt;ref&gt;http://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm&lt;/ref&gt;<br /> *Supplemental O2<br /> *[[Noninvasive Ventilation|Noninvasive ventilation]]<br /> **Limited role as patients require prolonged ventilation<br /> *[[Ventilation (Main)|Ventilator Settings]]<br /> **Permissive hypercapnia<br /> **Tidal volume 6-8cc/kg of [http://www.mdcalc.com/ideal-body-weight/ ideal body weight]&lt;ref&gt;Brower RG, et al. &quot;Ventilation With Lower Tidal Volumes As Compared With Traditional Tidal Volumes For Acute Lung Injury And The Acute Respiratory Distress Syndrome&quot;. The New England Journal of Medicine. 2000. 342(18):1301-1308.&lt;/ref&gt;<br /> ***Limit barotrauma to healthy area of lung<br /> ***Increase PEEP to improve oxygenation<br /> **Maintain plateau pressures &lt; 30 &lt;ref&gt;Hansen-Flaschen et al. Acute respiratory distress syndrome: Clinical features and diagnosis.UpToDate accessed 3/26/14&lt;/ref&gt;<br /> **Ensure adequate sedation<br /> ***Better synchrony with vent<br /> ***Decreased oxygen consumption<br /> ***Less [[delirium]]<br /> ***Increased patient comfort<br /> <br /> ==Disposition==<br /> * Admit to ICU<br /> <br /> ==See Also==<br /> *[[Pulmonary edema]]<br /> *[[CHF]]<br /> *[[EBQ:ARDSnet Trial]]<br /> <br /> ==Sources==<br /> &lt;references/&gt;<br /> <br /> [[Category:Pulm]][[Category:Critical Care]]</div>

Alinker https://wikem.org/w/index.php?title=Pulmonary_edema&diff=18966 2014-03-26T17:04:48Z

<p>Alinker: links</p> <hr /> <div>==Background==<br /> *Cardiogenic vs Non-Cardiogenic (ARDS/Altitude/Neurogenic)<br /> *Mechanism of Cardiogenic<br /> **Failing heart &gt; pulm edema &gt; stress response &gt; incr afterload<br /> ***Incr afterload &gt; incr pulm edema<br /> *Pts often intravascularly depleted; avoid diuretics!<br /> <br /> ==Diagnosis==<br /> *Crackles<br /> *Respiratory distres<br /> <br /> ==Treatment==<br /> #CPAP/BiPAP with PEEP 6-8; titrate up to PEEP of 10-12<br /> #Nitroglycerin<br /> ##Dosing Options<br /> ###Loading dose: 400mcg/min x 2min<br /> ####With 100mg/250mL NTG in D5W, draw up 2mL (400mcg/mL), push over 2 min, equiv to above<br /> #####Helpful is RN unwilling to run at 400 mcg/min or delay in setting up drip<br /> ####Then drop to 100mcg/min and titrate up as needed<br /> ###Repeated sublingual 0.4 mg q1min until IV NTG (0.5-0.7 mcg/kg/min) is started<br /> ####Titrate IV NTG rapidly upward (200mcg/min or higher) until BP is controlled<br /> ##If NTG fails to reduce BP consider nitroprusside<br /> #ACEI<br /> ##After pt improves titrate off NTG as enaliprilat or captopril are started<br /> <br /> ==See Also==<br /> *[[Congestive Heart Failure (CHF)]]<br /> *[[Acute Respiratory Distress Syndrome]]<br /> <br /> ==Source==<br /> Tintinalli<br /> <br /> EMCrit Podcast 1<br /> <br /> <br /> [[Category:Cards]]</div>

Alinker https://wikem.org/w/index.php?title=Acute_respiratory_distress_syndrome&diff=18965 2014-03-26T17:01:35Z

<p>Alinker: corrections and content</p> <hr /> <div>==Background==<br /> *Non-cardiogenic pulmonary edema due to lung capillary endothelial injury<br /> **Proteinaceous material accumulate in alveoli in a heterogeneous manner<br /> *Symptom of an underlying disease<br /> <br /> ==Clinical Features==<br /> *'''Diagnostic criteria'''&lt;ref&gt;Ferguson ND et. al. The Berlin definition of ARDS: an expanded rationale, justification, and supplementary material. Intensive Care Med. 2012 Oct;38(10):1573-82.&lt;/ref&gt;<br /> #New onset respiratory symptoms<br /> #Bilateral pulmonary opacities<br /> #Symptoms not explained by cardiac etiology or volume overload<br /> '''PaO2/FIO2 ratio'''<br /> *200-300 Mild<br /> *100-200 Moderate<br /> *&lt; 100 Severe<br /> *'''Presentation'''<br /> **Severe dyspnea<br /> **Hypoxemia<br /> **Diffuse crackles<br /> *'''Imaging'''<br /> **Diffuse patchy pulmonary infiltrates<br /> *'''Causes'''<br /> **[[Sepsis]]<br /> **[[Pancreatitis]]<br /> **[[Burns]]<br /> **Aspiration<br /> **Trauma<br /> **[[Submersion Injuries (Drowning)|Near drowning]]<br /> **Fat embolism<br /> **[[Amniotic Fluid Embolus|Amniotic fluid embolism]]<br /> <br /> ==Differential Diagnosis==<br /> *[[CHF]]<br /> *[[Pneumonia]]<br /> *[[PE]]<br /> *Diffuse alveolar hemorrhage<br /> *[[DIC]]<br /> <br /> ==Workup==<br /> *CXR<br /> *CBC<br /> *Chem 10<br /> *UA<br /> *LFT<br /> *Lipase<br /> *PT/PTT<br /> *Influenza (seasonal)<br /> *Blood cultures<br /> *Lactate<br /> *Consider bedside echo<br /> *Consider ABG/VBG<br /> *Consider BNP<br /> <br /> ==Management==<br /> *Treat underlying cause<br /> **Cover for sepsis<br /> ***Pneumonia in addition to other identified source<br /> **Tamiflu 75mg BID oral or NGT if influenza season &lt;ref&gt;http://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm&lt;/ref&gt;<br /> *Supplemental O2<br /> *[[Noninvasive Ventilation|Noninvasive ventilation]]<br /> **<br /> *[[Ventilation (Main)|Ventilator Settings]]<br /> **Permissive hypercapnia<br /> **Tidal volume 6-8cc/kg of [http://www.mdcalc.com/ideal-body-weight/ ideal body weight]&lt;ref&gt;Brower RG, et al. &quot;Ventilation With Lower Tidal Volumes As Compared With Traditional Tidal Volumes For Acute Lung Injury And The Acute Respiratory Distress Syndrome&quot;. The New England Journal of Medicine. 2000. 342(18):1301-1308.&lt;/ref&gt;<br /> ***Limit barotrauma to healthy area of lung<br /> ***Increase PEEP to improve oxygenation<br /> **Maintain plateau pressures &lt; 30 &lt;ref&gt;Hansen-Flaschen et al. Acute respiratory distress syndrome: Clinical features and diagnosis.UpToDate accessed 3/26/14&lt;/ref&gt;<br /> <br /> ==Disposition==<br /> * Admit to ICU<br /> <br /> ==See Also==<br /> *[[Pulmonary edema]]<br /> *[[CHF]]<br /> *[[EBQ:ARDSnet Trial]]<br /> <br /> ==Sources==<br /> &lt;references/&gt;<br /> <br /> [[Category:Pulm]][[Category:Critical Care]]</div>

Alinker https://wikem.org/w/index.php?title=Acute_respiratory_distress_syndrome&diff=18964 2014-03-26T16:27:45Z

<p>Alinker: minor change</p> <hr /> <div>==Background==<br /> *Non-cardiogenic pulmonary edema due to lung capillary endothelial injury<br /> **Proteinaceous material accumulate in alveoli in a heterogeneous manner<br /> *Symptom of an underlying disease<br /> <br /> ==Clinical Features==<br /> *'''Diagnostic criteria'''<br /> #PaO2/FI02 &lt; 200<br /> #Cardiogenic pulmonary edema ruled out or wedge pressure &lt; 18<br /> *'''Imaging'''<br /> **Diffuse patchy pulmonary infiltrates<br /> *'''Causes'''<br /> **[[Sepsis]]<br /> **[[Pancreatitis]]<br /> **[[Burns]]<br /> **Aspiration<br /> **Trauma<br /> **[[Submersion Injuries (Drowning)|Near drowning]]<br /> **Fat embolism<br /> **[[Amniotic Fluid Embolus|Amniotic fluid embolism]]<br /> <br /> ==Differential Diagnosis==<br /> *[[CHF]]<br /> *[[Pneumonia]]<br /> *[[PE]]<br /> *Diffuse alveolar hemorrhage<br /> *Acute lung injury (PaO2/FIO2 &lt; 300)<br /> *<br /> <br /> ==Workup==<br /> *CXR<br /> *CBC<br /> *Chem 10<br /> *UA<br /> *LFT<br /> *Lipase<br /> *PT/PTT<br /> *Influenza (seasonal)<br /> *Blood cultures<br /> *Lactate<br /> *Consider bedside echo<br /> *Consider ABG/VBG<br /> <br /> ==Management==<br /> *Treat underlying cause<br /> **Cover for sepsis<br /> ***Pneumonia in addition to other identified source<br /> **Tamiflu 75mg BID oral or NGT if influenza season &lt;ref&gt;http://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm&lt;/ref&gt;<br /> *[[Ventilation (Main)|Ventilator Settings]]<br /> **Permissive hypercapnia<br /> **Tidal volume 6-8cc/kg of [http://www.mdcalc.com/ideal-body-weight/ ideal body weight]&lt;ref&gt;Brower RG, et al. &quot;Ventilation With Lower Tidal Volumes As Compared With Traditional Tidal Volumes For Acute Lung Injury And The Acute Respiratory Distress Syndrome&quot;. The New England Journal of Medicine. 2000. 342(18):1301-1308.&lt;/ref&gt;<br /> ***Limit barotrauma to healthy area of lung<br /> ***Increase PEEP to improve oxygenation<br /> **Maintain plateau pressures &lt; 30<br /> <br /> ==Disposition==<br /> * Admit to ICU<br /> <br /> ==See Also==<br /> *[[Pulmonary edema]]<br /> *[[CHF]]<br /> *[[EBQ:ARDSnet Trial]]<br /> <br /> ==Sources==<br /> &lt;references/&gt;<br /> <br /> [[Category:Pulm]][[Category:Critical Care]]</div>

Alinker https://wikem.org/w/index.php?title=Acute_respiratory_distress_syndrome&diff=18963 2014-03-26T16:26:12Z

<p>Alinker: content</p> <hr /> <div>==Background==<br /> *Non-cardiogenic pulmonary edema due to lung capillary endothelial injury<br /> **Proteinaceous material accumulate in alveoli in a heterogeneous manner<br /> *Symptom of an underlying disease<br /> <br /> ==Clinical Features==<br /> *'''Diagnostic criteria'''<br /> #PaO2/FI02 &lt; 200<br /> #Cardiogenic pulmonary edema ruled out or wedge pressure &lt; 18<br /> *'''Imaging'''<br /> **Diffuse patchy pulmonary infiltrates<br /> *'''Causes'''<br /> **[[Sepsis]]<br /> **[[Pancreatitis]]<br /> **[[Burns]]<br /> **Aspiration<br /> **Trauma<br /> **[[Submersion Injuries (Drowning)|Near drowning]]<br /> **Fat embolism<br /> **[[Amniotic Fluid Embolus|Amniotic fluid embolism]]<br /> <br /> ==Differential Diagnosis==<br /> *[[CHF]]<br /> *[[Pneumonia]]<br /> *[[PE]]<br /> *Diffuse alveolar hemorrhage<br /> *Acute lung injury<br /> * <br /> <br /> ==Workup==<br /> *CXR<br /> *CBC<br /> *Chem 10<br /> *UA<br /> *LFT<br /> *Lipase<br /> *PT/PTT<br /> *Influenza (seasonal)<br /> *Blood cultures<br /> *Lactate<br /> *Consider bedside echo<br /> *Consider ABG/VBG<br /> <br /> ==Management==<br /> *Treat underlying cause<br /> **Cover for sepsis<br /> ***Pneumonia in addition to other identified source<br /> **Tamiflu 75mg BID oral or NGT if influenza season &lt;ref&gt;http://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm&lt;/ref&gt;<br /> *[[Ventilation (Main)|Ventilator Settings]]<br /> **Permissive hypercapnia<br /> **Tidal volume 6-8cc/kg of [http://www.mdcalc.com/ideal-body-weight/ ideal body weight]&lt;ref&gt;Brower RG, et al. &quot;Ventilation With Lower Tidal Volumes As Compared With Traditional Tidal Volumes For Acute Lung Injury And The Acute Respiratory Distress Syndrome&quot;. The New England Journal of Medicine. 2000. 342(18):1301-1308.&lt;/ref&gt;<br /> ***Limit barotrauma to healthy area of lung<br /> ***Increase PEEP to improve oxygenation<br /> **Maintain plateau pressures &lt; 30<br /> <br /> ==Disposition==<br /> * Admit to ICU<br /> <br /> ==See Also==<br /> *[[Pulmonary edema]]<br /> *[[CHF]]<br /> *[[EBQ:ARDSnet Trial]]<br /> <br /> ==Sources==<br /> &lt;references/&gt;<br /> <br /> [[Category:Pulm]][[Category:Critical Care]]</div>

Alinker https://wikem.org/w/index.php?title=Acute_respiratory_distress_syndrome&diff=18962 2014-03-26T16:10:51Z

<p>Alinker: content</p> <hr /> <div>==Background==<br /> *Non-cardiogenic pulmonary edema<br /> <br /> ==Clinical Features==<br /> *'''Diagnostic criteria'''<br /> #PaO2/FI02 &lt; 200<br /> #Cardiogenic pulmonary edema ruled out or wedge pressure &lt; 18<br /> *Imaging<br /> **Diffuse patchy pulmonary infiltrates<br /> <br /> ==Differential Diagnosis==<br /> *[[CHF]]<br /> *[[Pneumonia]]<br /> *[[PE]]<br /> *Diffuse alveolar hemorrhage<br /> *Acute lung injury<br /> * <br /> <br /> ==Workup==<br /> *CXR<br /> *CBC<br /> *Chem 10<br /> *UA<br /> *LFT<br /> *Lipase<br /> *PT/PTT<br /> *Influenza (seasonal)<br /> *Blood cultures<br /> *Lactate<br /> *Consider bedside echo<br /> *Consider ABG/VBG<br /> <br /> ==Management==<br /> *Treat underlying cause<br /> **Cover for sepsis<br /> ***Pneumonia in addition to other identified source<br /> **Tamiflu 75mg BID oral or NGT if influenza season &lt;ref&gt;http://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm&lt;/ref&gt;<br /> *[[Ventilation (Main)|Ventilator Settings]]<br /> **Permissive hypercapnia<br /> **Tidal volume 6-8cc/kg of [http://www.mdcalc.com/ideal-body-weight/ ideal body weight]&lt;ref&gt;Brower RG, et al. &quot;Ventilation With Lower Tidal Volumes As Compared With Traditional Tidal Volumes For Acute Lung Injury And The Acute Respiratory Distress Syndrome&quot;. The New England Journal of Medicine. 2000. 342(18):1301-1308.&lt;/ref&gt;<br /> ***Limit barotrauma to healthy area of lung<br /> ***Increase PEEP to improve oxygenation<br /> ****Maintain plateau pressures &lt; 30<br /> <br /> ==Disposition==<br /> * Admit to ICU<br /> <br /> ==See Also==<br /> *[[Pulmonary edema]]<br /> *[[CHF]]<br /> *[[EBQ:ARDSnet Trial]]<br /> <br /> ==Sources==<br /> &lt;references/&gt;<br /> <br /> [[Category:Pulm]][[Category:Critical Care]]</div>

Alinker https://wikem.org/w/index.php?title=ARDS&diff=18961 2014-03-26T16:03:28Z

<p>Alinker: redirect</p> <hr /> <div>#REDIRECT [[Acute Respiratory Distress Syndrome]]</div>

Alinker https://wikem.org/w/index.php?title=User_talk:Rossdonaldson1&diff=18960 2014-03-26T15:59:24Z

<p>Alinker: new communication</p> <hr /> <div>This is much easier than I thought it would be.<br /> <br /> Test 10 <br /> <br /> &lt;br&gt; <br /> <br /> Hola Ross,&lt;br&gt; <br /> <br /> I don't know if you are the right contact, but anyone could answer here: http://www.wikem.org/wiki/Talk:Suggest_a_Software_Improvement&lt;br&gt; <br /> <br /> &lt;br&gt; <br /> <br /> Thanks <br /> <br /> [[User:Julien4|Julien4]] 01:20, 27 March 2013 (UTC)<br /> <br /> <br /> I'm definitely game to be the Resident Editor from U of Rochester. I'm going to reach out to some of the other residents I know. This is a concept I truly believe in, and would be stoked to help it grow. ~Aaron</div>

Alinker https://wikem.org/w/index.php?title=Acute_respiratory_distress_syndrome&diff=18959 2014-03-26T15:57:45Z

<p>Alinker: new note</p> <hr /> <div>==Background==<br /> *Non-cardiogenic pulmonary edema<br /> <br /> ==Clinical Features==<br /> *'''Diagnostic criteria'''<br /> #PaO2/FI02 &lt; 200<br /> #Cardiogenic pulmonary edema ruled out or wedge pressure &lt; 18<br /> *Imaging<br /> **Diffuse patchy pulmonary infiltrates<br /> <br /> ==Differential Diagnosis==<br /> *[[CHF]]<br /> *[[Pneumonia]]<br /> *[[PE]]<br /> *Diffuse alveolar hemorrhage<br /> *Acute lung injury<br /> * <br /> <br /> ==Workup==<br /> *CXR<br /> *CBC<br /> *Chem 10<br /> *UA<br /> *LFT<br /> *Lipase<br /> *PT/PTT<br /> *Influenza (seasonal)<br /> *Blood cultures<br /> *Lactate<br /> *Consider bedside echo<br /> *Consider ABG/VBG<br /> <br /> ==Management==<br /> *Treat underlying cause<br /> **Cover for sepsis<br /> ***Pneumonia in addition to other identified source<br /> **Tamiflu 75mg BID oral or NGT if influenza season &lt;ref&gt;http://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm&lt;/ref&gt;<br /> *Ventilator Settings<br /> **Permissive hypercapnia<br /> **Tidal volume 6-8cc/kg &lt;ref&gt;Brower RG, et al. &quot;Ventilation With Lower Tidal Volumes As Compared With Traditional Tidal Volumes For Acute Lung Injury And The Acute Respiratory Distress Syndrome&quot;. The New England Journal of Medicine. 2000. 342(18):1301-1308.&lt;/ref&gt;<br /> ***Limit barotrauma to healthy area of lung<br /> ***Increase PEEP to improve oxygenation<br /> ****Maintain plateau pressures &lt; 30<br /> <br /> ==Disposition==<br /> * Admit to ICU<br /> <br /> ==See Also==<br /> *[[Pulmonary edema]]<br /> *[[CHF]]<br /> *[[EBQ:ARDSnet Trial]]<br /> <br /> ==Sources==<br /> &lt;references/&gt;<br /> <br /> [[Category:Pulm]][[Category:Critical Care]]</div>

Alinker https://wikem.org/w/index.php?title=Acute_respiratory_distress_syndrome&diff=18958 2014-03-26T15:39:01Z

<p>Alinker: Created page with &quot;==Background== *Non-cardiogenic pulmonary edema ==Clinical Features== * ==Differential Diagnosis== *CHF *Pneumonia *PE *Diffuse alveolar hemorrhage * * ==Workup== * * * * ...&quot;</p> <hr /> <div>==Background==<br /> *Non-cardiogenic pulmonary edema<br /> <br /> ==Clinical Features==<br /> *<br /> <br /> ==Differential Diagnosis==<br /> *CHF<br /> *Pneumonia<br /> *PE<br /> *Diffuse alveolar hemorrhage<br /> *<br /> * <br /> <br /> ==Workup==<br /> *<br /> *<br /> *<br /> *<br /> <br /> ==Management==<br /> *Ventilator Settings<br /> **Tidal volume 6-8cc/kg &lt;ref&gt;Brower RG, et al. &quot;Ventilation With Lower Tidal Volumes As Compared With Traditional Tidal Volumes For Acute Lung Injury And The Acute Respiratory Distress Syndrome&quot;. The New England Journal of Medicine. 2000. 342(18):1301-1308.&lt;/ref&gt;<br /> *<br /> *<br /> *<br /> <br /> ==Disposition==<br /> * Admit to ICU<br /> <br /> ==See Also==<br /> *[[Pulmonary edema]]<br /> *[[CHF]]<br /> *[[EBQ:ARDSnet Trial]]<br /> <br /> ==Sources==<br /> &lt;references/&gt;<br /> <br /> [[Category:Pulm]][[Category:Critical Care]]</div>

Alinker https://wikem.org/w/index.php?title=EBQ:Transfusion_strategies_for_acute_upper_gastrointestinal_bleeding&diff=18936 2014-03-26T04:35:46Z

<p>Alinker: new article</p> <hr /> <div>{{JC info<br /> | title= Transfusion strategies for acute upper gastrointestinal bleeding<br /> | abbreviation= Transfusion strategies for acute upper gastrointestinal bleeding <br /> | expansion= Transfusion strategies for acute upper gastrointestinal bleeding<br /> | published= 2013 <br /> | author= Villanueva C. et al<br /> | journal= NEJM<br /> | year= 2013 <br /> | volume= 368<br /> | issue= 1<br /> | pages= 11-21<br /> | pmid= 23281973<br /> | fulltexturl= http://www.nejm.org/doi/full/10.1056/NEJMoa1211801<br /> | pdfurl= http://www.nejm.org/doi/pdf/10.1056/NEJMoa1211801<br /> }}<br /> <br /> ==Clinical Question==<br /> *Is a restrictive transfusion strategy superior to a liberal transfusion strategy in patients with upper GI bleeds?<br /> <br /> ==Conclusion==<br /> *Lower mortality in the restrictive transfusion group (hemoglobin threshold 7) 5% vs 9% (p=0.02)<br /> <br /> <br /> ==Major Points== <br /> *Transfusion threshold of hemoglobin 7g/deciliter if hemodynamically stable<br /> *Study excluded unstable patients <br /> <br /> ==Inclusion Criteria== <br /> *Age &gt;18<br /> *Melena or hematemasis<br /> *Consent to blood transfusion<br /> <br /> ==Exclusion Criteria==<br /> *Massive GI bleed<br /> *Lower GI bleeding<br /> *ACS<br /> *Stroke/TIA<br /> *Symptomatic PVD<br /> *Transfusion in the previous 90 days<br /> *Recent trauma or surgery<br /> *Decision by attending physician that patient should not get a specific therapy<br /> *Rockall score (assessment of future bleeding risk) of 0 with hemoglobin &gt; 12<br /> <br /> ==Interventions== <br /> *Transfusion threshold set at hgb 7 with target range 7-9 vs hgb 9 with target range 9-11<br /> <br /> <br /> ==Outcome==<br /> *Lower mortality with restrictive transfusion strategy 5% vs 9% (p=0.02) <br /> <br /> ===Primary Outcomes===<br /> *Death from any cause in the first 45 days<br /> **Lower with restrictive strategy<br /> <br /> ===Secondary Outcomes=== <br /> *Rate of in hospital hematemasis or melena with hemodynamic instability<br /> *2 point fall in hemoglobin in 6 hours<br /> *Number of patients requiring transfusion in each group<br /> <br /> <br /> ===Subgroup analysis===<br /> *Cirrhotic patients<br /> **Lower mortality with restrictive strategy in Child's class A and B<br /> **No difference in Child's class C<br /> **No significant difference when all cirrhotics taken as a group<br /> *Peptic ulcer disease<br /> **No significant difference<br /> <br /> <br /> ==Criticisms==<br /> *1 unit of pRBCs was transfused up front in both groups. Therefore, there was no true conservative transfusion group. The study suggests that a transfusion threshold of hgb 7 is superior, but cannot definitively answer the question as all patients in the study received a transfusion.<br /> *All patients received an EGD within 6 hours. This may not be always be achievable. The study findings may not be generalizable.<br /> *Massive GI bleeds, which were excluded from the trial, are not defined<br /> <br /> ==Funding==<br /> *No external funding<br /> <br /> ==Sources==<br /> <br /> <br /> &lt;references/&gt;<br /> <br /> [[Category:EBQ]][[Category:GI]]</div>

Alinker https://wikem.org/w/index.php?title=Rheumatoid_arthritis&diff=18931 2014-03-26T03:48:19Z

<p>Alinker: link</p> <hr /> <div>==Background==<br /> *Erosive polyarthritis<br /> <br /> ==Clinical Features==<br /> *Morning stiffness<br /> *Polyarthritis of MCP and PIP joints<br /> **Does NOT involve DIP joints<br /> **Wrists, elbows, shoulders, ankles, knees also commonly involved<br /> *Ulnar deviation at the wrist<br /> *Rheumatoid nodules<br /> <br /> ==Differential Diagnosis==<br /> *[[Septic Arthritis (General)|Septic athritis]]<br /> *Osteoarthritis<br /> *Viral arthritis<br /> *[[SLE]]<br /> *Psoriatic arthritis<br /> *[[Lyme disease]]<br /> *Gonococcal arthritis<br /> *[[Gout]]<br /> *[[Pseudogout]]<br /> *Juvenile idiopathic arthritis<br /> *Fibromyalgia<br /> <br /> ==Workup==<br /> *Xray affected joints<br /> *Rheumatoid factor<br /> *Anti-cyclic citrullinated peptide (CCP) antibodies<br /> *ANA<br /> *Consider [[arthrocentesis]]<br /> **WBC count typically 1,500-20,000<br /> <br /> ==Management==<br /> *NSAIDs<br /> **Symptomatic relief without slowing underlying disease<br /> *Glucocorticoids<br /> **Consider intraarticular injection if a single joint is inflammed<br /> **Systemic steroids reserved for moderate-severe flairs<br /> *Opiods have a limited role<br /> *Disease-modifying antirheumatic drug (DMARD)<br /> **Can be started by PMD or Rheumatologist after ER visit<br /> <br /> ==Disposition==<br /> *Refer to PMD or rheumatologist<br /> <br /> ==See Also==<br /> *[[Arthritis]]<br /> <br /> ==Sources==<br /> Up to Date</div>

Alinker https://wikem.org/w/index.php?title=Ovarian_hyperstimulation_syndrome&diff=18927 2014-03-26T02:41:12Z

<p>Alinker: </p> <hr /> <div>==Background==<br /> *Fertility treatments causing development of multiple follicles at once<br /> *Fluid shifts out of vasculature<br /> <br /> ==Clinical Features==<br /> *Ovarian enlargement<br /> *Movement of fluid out of vasculature<br /> **Ascites<br /> **Pleural effusions<br /> **Pericardial effusion<br /> **Hypotension<br /> *Electrolyte imbalances<br /> *DIC<br /> *Thromboembolism<br /> **Both venous and arterial<br /> *Hypervolemic hyponatremia<br /> *'''Beta-HCG may be positive if beta-HCG injection given as part of fertility treatment'''<br /> <br /> ==Differential Diagnosis==<br /> *[[Ectopic Pregnancy]]<br /> *Molar Pregnancy<br /> *[[Sepsis]]<br /> *[[PE]]<br /> <br /> ==Workup==<br /> *Urine pregnancy<br /> *Pelvic ultrasound<br /> *CBC<br /> *Chem 10<br /> *CXR<br /> *Progesterone level<br /> *Estradiol level<br /> *PT/PTT<br /> *Fibrinogen<br /> <br /> ==Management==<br /> *Fluid resuscitation<br /> *Therapeutic paracentesis if necessary<br /> *Self limited, resolved in 10-14 days<br /> *Urgent GYN consultation<br /> <br /> ==Disposition==<br /> *May require ICU admission for third spacing<br /> *Admit all but most mild cases to monitored setting<br /> <br /> ==See Also==<br /> [[Ectopic Pregnancy]]<br /> [[Shock]]<br /> <br /> ==Sources==<br /> Up to Date<br /> William's Gynecology<br /> <br /> <br /> [[Category:OB/GYN]]</div>

Alinker https://wikem.org/w/index.php?title=Ovarian_hyperstimulation_syndrome&diff=18926 2014-03-26T02:40:54Z

<p>Alinker: minor content</p> <hr /> <div>==Background==<br /> *Fertility treatments causing development of multiple follicles at once<br /> *Fluid shifts out of vasculature<br /> <br /> ==Clinical Features==<br /> *Ovarian enlargement<br /> *Movement of fluid out of vasculature<br /> **Ascites<br /> **Pleural effusions<br /> **Pericardial effusion<br /> **Hypotension<br /> *Electrolyte imbalances<br /> *DIC<br /> *Thromboembolism<br /> **Both venous and arterial<br /> *Hypervolemic hyponatremia<br /> '''*Beta-HCG may be positive if beta-HCG injection given as part of fertility treatment'''<br /> <br /> ==Differential Diagnosis==<br /> *[[Ectopic Pregnancy]]<br /> *Molar Pregnancy<br /> *[[Sepsis]]<br /> *[[PE]]<br /> <br /> ==Workup==<br /> *Urine pregnancy<br /> *Pelvic ultrasound<br /> *CBC<br /> *Chem 10<br /> *CXR<br /> *Progesterone level<br /> *Estradiol level<br /> *PT/PTT<br /> *Fibrinogen<br /> <br /> ==Management==<br /> *Fluid resuscitation<br /> *Therapeutic paracentesis if necessary<br /> *Self limited, resolved in 10-14 days<br /> *Urgent GYN consultation<br /> <br /> ==Disposition==<br /> *May require ICU admission for third spacing<br /> *Admit all but most mild cases to monitored setting<br /> <br /> ==See Also==<br /> [[Ectopic Pregnancy]]<br /> [[Shock]]<br /> <br /> ==Sources==<br /> Up to Date<br /> William's Gynecology<br /> <br /> <br /> [[Category:OB/GYN]]</div>

Alinker https://wikem.org/w/index.php?title=Ovarian_hyperstimulation_syndrome&diff=18923 2014-03-26T01:32:50Z

<p>Alinker: links</p> <hr /> <div>==Background==<br /> *Fertility treatments causing development of multiple follicles at once<br /> *Fluid shifts out of vasculature<br /> <br /> ==Clinical Features==<br /> *Ovarian enlargement<br /> *Movement of fluid out of vasculature<br /> **Ascites<br /> **Pleural effusions<br /> **Pericardial effusion<br /> **Hypotension<br /> *Electrolyte imbalances<br /> *DIC<br /> *Thromboembolism<br /> **Both venous and arterial<br /> <br /> ==Differential Diagnosis==<br /> *[[Ectopic Pregnancy]]<br /> *Molar Pregnancy<br /> *[[Sepsis]]<br /> *[[PE]]<br /> <br /> ==Workup==<br /> *Urine pregnancy<br /> *Pelvic ultrasound<br /> *CBC<br /> *Chem 10<br /> *CXR<br /> *Progesterone level<br /> *Estradiol level<br /> *PT/PTT<br /> *Fibrinogen<br /> <br /> ==Management==<br /> *Fluid resuscitation<br /> *Therapeutic paracentesis if necessary<br /> *Self limited, resolved in 10-14 days<br /> *Urgent GYN consultation<br /> <br /> ==Disposition==<br /> *May require ICU admission for third spacing<br /> *Admit all but most mild cases to monitored setting<br /> <br /> ==See Also==<br /> [[Ectopic Pregnancy]]<br /> [[Shock]]<br /> <br /> ==Sources==<br /> Up to Date<br /> William's Gynecology<br /> <br /> <br /> [[Category:OB/GYN]]</div>

Alinker https://wikem.org/w/index.php?title=Ovarian_hyperstimulation_syndrome&diff=18922 2014-03-26T00:45:34Z

<p>Alinker: new note</p> <hr /> <div>==Background==<br /> *Fertility treatments causing development of multiple follicles at once<br /> *Fluid shifts out of vasculature<br /> <br /> ==Clinical Features==<br /> *Ovarian enlargement<br /> *Movement of fluid out of vasculature<br /> **Ascites<br /> **Pleural effusions<br /> **Pericardial effusion<br /> **Hypotension<br /> *Electrolyte imbalances<br /> *DIC<br /> *Thromboembolism<br /> **Both venous and arterial<br /> <br /> ==Differential Diagnosis==<br /> *Ectopic pregnancy<br /> <br /> ==Workup==<br /> *Urine pregnancy<br /> *Pelvic ultrasound<br /> *CBC<br /> *Chem 10<br /> *CXR<br /> *Progesterone level<br /> *Estradiol level<br /> *PT/PTT<br /> *Fibrinogen<br /> <br /> ==Management==<br /> *Fluid resuscitation<br /> *Therapeutic paracentesis if necessary<br /> *Self limited, resolved in 10-14 days<br /> *Urgent GYN consultation<br /> <br /> ==Disposition==<br /> *May require ICU admission for third spacing<br /> *Admit all but most mild cases to monitored setting<br /> <br /> ==See Also==<br /> <br /> ==Sources==<br /> Up to Date<br /> William's Gynecology<br /> <br /> <br /> [[Category:OB/GYN]]</div>

Alinker https://wikem.org/w/index.php?title=Ovarian_hyperstimulation_syndrome&diff=18921 2014-03-26T00:37:05Z

<p>Alinker: Created page with &quot;==Background== *Fertility treatments causing development of multiple follicles at once *Fluid shifts out of vasculature ==Clinical Features== *Ovarian enlargement *Movement o...&quot;</p> <hr /> <div>==Background==<br /> *Fertility treatments causing development of multiple follicles at once<br /> *Fluid shifts out of vasculature<br /> <br /> ==Clinical Features==<br /> *Ovarian enlargement<br /> *Movement of fluid out of vasculature<br /> **Ascites<br /> **Pleural effusions<br /> **Pericardial effusion<br /> **Hypotension<br /> *Electrolyte imbalances<br /> *DIC<br /> *Thromboembolism<br /> <br /> ==Differential Diagnosis==<br /> *Ectopic pregnancy<br /> <br /> ==Workup==<br /> *Urine pregnancy<br /> *Pelvic ultrasound<br /> *CBC<br /> *Chem 10<br /> *CXR<br /> *Progesterone level<br /> *Estradiol level<br /> <br /> ==Management==<br /> <br /> ==Disposition==<br /> <br /> ==See Also==<br /> <br /> ==Sources==<br /> Up to Date<br /> William's Gynecology<br /> <br /> <br /> [[Category:OB/GYN]]</div>

Alinker https://wikem.org/w/index.php?title=Rheumatoid_arthritis&diff=18920 2014-03-26T00:14:03Z

<p>Alinker: new note</p> <hr /> <div>==Background==<br /> *Erosive polyarthritis<br /> <br /> ==Clinical Features==<br /> *Morning stiffness<br /> *Polyarthritis of MCP and PIP joints<br /> **Does NOT involve DIP joints<br /> **Wrists, elbows, shoulders, ankles, knees also commonly involved<br /> *Ulnar deviation at the wrist<br /> *Rheumatoid nodules<br /> <br /> ==Differential Diagnosis==<br /> *Septic athritis<br /> *Osteoarthritis<br /> *Viral arthritis<br /> *[[SLE]]<br /> *Psoriatic arthritis<br /> *[[Lyme disease]]<br /> *Gonococcal arthritis<br /> *[[Gout]]<br /> *[[Pseudogout]]<br /> *Juvenile idiopathic arthritis<br /> *Fibromyalgia<br /> <br /> ==Workup==<br /> *Xray affected joints<br /> *Rheumatoid factor<br /> *Anti-cyclic citrullinated peptide (CCP) antibodies<br /> *ANA<br /> *Consider [[arthrocentesis]]<br /> **WBC count typically 1,500-20,000<br /> <br /> ==Management==<br /> *NSAIDs<br /> **Symptomatic relief without slowing underlying disease<br /> *Glucocorticoids<br /> **Consider intraarticular injection if a single joint is inflammed<br /> **Systemic steroids reserved for moderate-severe flairs<br /> *Opiods have a limited role<br /> *Disease-modifying antirheumatic drug (DMARD)<br /> **Can be started by PMD or Rheumatologist after ER visit<br /> <br /> ==Disposition==<br /> *Refer to PMD or rheumatologist<br /> <br /> ==See Also==<br /> *[[Arthritis]]<br /> <br /> ==Sources==<br /> Up to Date</div>

Alinker https://wikem.org/w/index.php?title=Rheumatoid_arthritis&diff=18919 2014-03-25T23:58:56Z

<p>Alinker: Created page with &quot;==Background== *Erosive polyarthritis ==Clinical Features== *Polyarthritis ==Differential Diagnosis== *Septic athritis *Osteoarthritis *SLE *Psoriatic arthritis *Lyme ...&quot;</p> <hr /> <div>==Background==<br /> *Erosive polyarthritis<br /> <br /> ==Clinical Features==<br /> *Polyarthritis<br /> <br /> ==Differential Diagnosis==<br /> *Septic athritis<br /> *Osteoarthritis<br /> *[[SLE]]<br /> *Psoriatic arthritis<br /> *[[Lyme disease]]<br /> *Gonococcal arthritis<br /> *[[Gout]]<br /> *[[Pseudogout]]<br /> <br /> ==Workup==<br /> *Xray affected joints<br /> *Rheumatoid factor<br /> *Consider [[arthrocentesis]]<br /> <br /> ==Management==<br /> *NSAIDs<br /> **Symptomatic relief without slowing underlying disease<br /> *Glucocorticoids<br /> *Opiods have a limited role<br /> *Disease-modifying antirheumatic drug (DMARD)<br /> **Can be started by PMD or Rheumatologist after ER visit<br /> <br /> ==Disposition==<br /> *Refer to PMD or rheumatologist<br /> <br /> ==See Also==<br /> *[[Arthritis]]<br /> ==Sources==<br /> Up to Date</div>

Alinker https://wikem.org/w/index.php?title=Arthritis&diff=18914 2014-03-25T23:22:50Z

<p>Alinker: link</p> <hr /> <div>==DDX By Number of Affected Joints==<br /> #[[Monoarthritis]]<br /> ##Trauma-induced arthritis<br /> ##[[Septic Arthritis (General)|Nongonococcal septic arthritis]]<br /> ####[[Septic Arthritis (General)|Gonococcal septic arthritis]]<br /> ##Crystal-induced ([[Gout]], [[Pseudogout]])<br /> ##Osteoarthritis (acute)<br /> ##[[Lyme Disease]]<br /> ##Avascular necrosis<br /> ##Tumor<br /> ##[[Reactive Arthritis (Poststreptococcal)]]<br /> #Oligoarthritis<br /> ##[[Lyme Disease]]<br /> ##Reactive arthritis (Reiter syndrome)<br /> ##Ankylosing spondylitis<br /> ##[[Septic Arthritis (General)|Gonococcal arthritis]]<br /> ##[[Rheumatic Fever]]<br /> #Polyarthritis<br /> ##Rheumatoid arthritis<br /> ##[[SLE]]<br /> ##Viral arthritis<br /> ##Osteoarthritis (chronic)<br /> ##[[Serum Sickness]]<br /> ##Serum sickness–like reactions<br /> ##[[Reactive Arthritis (Poststreptococcal)]]<br /> ##[[Juvenile Idiopathic Arthritis]]<br /> <br /> ==DDX For Migratory Pattern==<br /> #[[Septic Arthritis (General)|Gonococcal arthritis]]<br /> #[[Acute Rheumatic Fever]]<br /> #[[Lyme Disease]]<br /> #Viral arthritis<br /> #SLE<br /> <br /> ==See Also==<br /> *[[Arthrocentesis]]<br /> *[[Diagnosis by Body Part (Main)]]<br /> <br /> ==Source==<br /> *Tintinalli<br /> <br /> [[Category:Ortho]]<br /> [[Category:Rheum]]</div>

Alinker https://wikem.org/w/index.php?title=Systemic_lupus_erythematosus&diff=18913 2014-03-25T23:14:45Z

<p>Alinker: edits</p> <hr /> <div>==Background==<br /> *Autoimmune disorder affecting all systems<br /> <br /> ==Epidemiology==<br /> *Female:Male 10:1<br /> *Peak in 20s-30s<br /> *More common in African Americans<br /> <br /> <br /> ==Clinical Features==<br /> '''Diagnostic Criteria:'''<br /> 4 out of 11 of the following:<br /> #Malar rash<br /> #Discoid rash<br /> #Photosensitivity<br /> #Oral ulcers<br /> #Arthritis (polyarticular)<br /> #Serositis (Pericarditis or pleuritis)<br /> #Renal disorder (renal failure, protenuria, casts)<br /> #Neurologic or psychotic symptoms<br /> #Hematologic (anemia, thrombocytopenia, or leukopenia)<br /> #Immunologic (+antibofy testing)<br /> #ANA (positive ANA)<br /> <br /> '''Organ system affected:'''<br /> *Cardiopulmonary<br /> **Pneumonia<br /> ***Cover for ''[[Listeria]]'' and ''[[Pseudmonas]]''<br /> **CAD<br /> ***More common and more complications post-PCI<br /> **[[PE]]<br /> **[[Pericarditis]]<br /> **[[Endocarditis]]<br /> ***Infectious and Libman-Sachs<br /> <br /> *Neuropsychiatric/Altered mental status<br /> **Non-convulsive status epilepticus<br /> **CNS vasculitis<br /> **[[Stroke]]<br /> **[[Encephalitis]]<br /> **[[Meningitis]]<br /> <br /> *Musculoskeletal<br /> **Arthritis<br /> ***Usually symmetric<br /> ***Consider septic arthritis if there is a single inflamed joint<br /> ****Cover for [[''Salmonella'']] in addition to standard coverage<br /> <br /> *GI<br /> **Lupus enteritis (mesenteric vasculitis)<br /> ***Most common cause of acute abdominal pain<br /> **[[Pancreatitis]]<br /> **PUD<br /> <br /> *Dermatologic<br /> **Malar rash across bridge of nose<br /> **Discoid rash, erythematous with scale<br /> **Treat with topical 1% hydrocortisone<br /> <br /> *Renal<br /> **Usually a nephritis<br /> **Can cause a glomerulonephrosis<br /> <br /> <br /> ==Differential Diagnosis==<br /> *Rheumatoid arthritis<br /> *Sjogren's syndrome<br /> *[[Dermatomyositis]]<br /> *Polymyositis<br /> *[[Stevens Johnson Syndrome and Toxic Epidermal Necrolysis|Stevens-Johnson syndrome]]<br /> *[[Stevens Johnson Syndrome and Toxic Epidermal Necrolysis|Toxic Epidermal Necrolysis]]<br /> *[[Septic arthritis]]<br /> *[[Lyme disease]]<br /> *Vasculitis<br /> *[[Acute Rheumatic Fever]]<br /> *[[Toxic Shock Syndrome]]<br /> *[[Thrombotic Thrombocytopenic Purpura (TTP)|TTP]]<br /> *[[Idiopathic Thrombocytopenic Purpura|ITP]]<br /> *[[DIC]]<br /> <br /> ==Workup==<br /> '''Undiagnosed'''<br /> *CBC<br /> *Chem 10<br /> *Urine pregnancy<br /> *ANA<br /> *ESR<br /> *UA<br /> *Bedside echo if ill or hypotensive<br /> *(Consider anti-DNA, anti-Smith, anti-Nuclear, anti-phospholipid)<br /> <br /> '''Flair'''<br /> *Bedside echo if ill or hypotensive<br /> *CBC<br /> *Chem<br /> *UA<br /> *Urine pregnancy<br /> *As directed by organ system involved<br /> <br /> ==Management==<br /> *Inflammatory complications<br /> **Methylprednisolone 1-2mg/kg in most cases<br /> *Infectious<br /> **Stress dose steroids with hydrocortisone 100mg IV Q8hr if on or recently on steroids<br /> <br /> *Dermatologic<br /> **Hydrocortisone 1% cream<br /> <br /> ==Disposition==<br /> *Suspected new diagnosis can have out patient workup if well appearing<br /> *Mild flairs can have expedited out patient management<br /> *Musculoskeletal symptoms can usually be managed as out patients<br /> *Chest pain requires urgent ACS evaluation<br /> *Infections usually require admission for antibiotics and systemic corticosteroids<br /> <br /> ==See Also==<br /> *[[Arthritis]]<br /> *[[Fever and Rash]]<br /> *[[Lupus Anticoagulant]]<br /> *[[Pericarditis]]<br /> *[[Pericardial Effusion and Tamponade]]<br /> *[[Acute Renal Failure]]<br /> *[[Adrenal Crisis]]<br /> <br /> ==Sources==<br /> *Rosen's<br /> *Up to date<br /> <br /> &lt;references/&gt;<br /> <br /> [[Category: Rheum]]</div>

Alinker https://wikem.org/w/index.php?title=Systemic_lupus_erythematosus&diff=18912 2014-03-25T23:07:12Z

<p>Alinker: disposition and formatting</p> <hr /> <div>==Background==<br /> *Autoimmune disorder affecting all systems<br /> <br /> ==Epidemiology==<br /> *Female:Male 10:1<br /> *More common in African Americans<br /> <br /> <br /> ==Clinical Features==<br /> '''Diagnostic Criteria:'''<br /> 4 out of 11 of the following:<br /> #Malar rash<br /> #Discoid rash<br /> #Photosensitivity<br /> #Oral ulcers<br /> #Arthritis (polyarticular)<br /> #Serositis (Pericarditis or pleuritis)<br /> #Renal disorder (renal failure, protenuria, casts)<br /> #Neurologic or psychotic symptoms<br /> #Hematologic (anemia, thrombocytopenia, or leukopenia)<br /> #Immunologic (+antibofy testing)<br /> #ANA (positive ANA)<br /> <br /> '''Organ system affected:'''<br /> *Cardiopulmonary<br /> **Pneumonia<br /> ***Cover for ''[[Listeria]]'' and ''[[Pseudmonas]]''<br /> **CAD<br /> ***More common and more complications post-PCI<br /> **[[PE]]<br /> **[[Pericarditis]]<br /> **[[Endocarditis]]<br /> ***Infectious and Libman-Sachs<br /> <br /> *Neuropsychiatric/Altered mental status<br /> **Non-convulsive status epilepticus<br /> **CNS vasculitis<br /> **[[Stroke]]<br /> **[[Encephalitis]]<br /> **[[Meningitis]]<br /> <br /> *Musculoskeletal<br /> **Arthritis<br /> ***Usually symmetric<br /> ***Consider septic arthritis if there is a single inflamed joint<br /> ****Cover for [[''Salmonella'']] in addition to standard coverage<br /> <br /> *GI<br /> **Lupus enteritis (mesenteric vasculitis)<br /> ***Most common cause of acute abdominal pain<br /> **[[Pancreatitis]]<br /> **PUD<br /> <br /> *Dermatologic<br /> **Malar rash across bridge of nose<br /> **Discoid rash, erythematous with scale<br /> **Treat with topical 1% hydrocortisone<br /> <br /> *Renal<br /> **Usually a nephritis<br /> **Can cause a glomerulonephrosis<br /> <br /> <br /> ==Differential Diagnosis==<br /> *Rheumatoid arthritis<br /> *Sjogren's syndrome<br /> *[[Dermatomyositis]]<br /> *Polymyositis<br /> *[[Stevens Johnson Syndrome and Toxic Epidermal Necrolysis|Stevens-Johnson syndrome]]<br /> *[[Stevens Johnson Syndrome and Toxic Epidermal Necrolysis|Toxic Epidermal Necrolysis]]<br /> *[[Septic arthritis]]<br /> *[[Lyme disease]]<br /> *Vasculitis<br /> *[[Acute Rheumatic Fever]]<br /> *[[Toxic Shock Syndrome]]<br /> *[[Thrombotic Thrombocytopenic Purpura (TTP)|TTP]]<br /> *[[Idiopathic Thrombocytopenic Purpura|ITP]]<br /> *[[DIC]]<br /> <br /> ==Workup==<br /> '''Undiagnosed'''<br /> *CBC<br /> *Chem 10<br /> *ANA<br /> *ESR<br /> *UA<br /> *Bedside echo if ill or hypotensive<br /> *(Consider anti-DNA, anti-Smith, anti-Nuclear, anti-phospholipid)<br /> <br /> '''Flair'''<br /> *Bedside echo if ill or hypotensive<br /> *CBC<br /> *Chem<br /> *UA<br /> *As directed by organ system involved<br /> <br /> ==Management==<br /> *Inflammatory complications<br /> **Methylprednisolone 1-2mg/kg in most cases<br /> *Infectious<br /> **Stress dose steroids with hydrocortisone 100mg IV Q8hr if on or recently on steroids<br /> <br /> *Dermatologic<br /> **Hydrocortisone 1% cream<br /> <br /> ==Disposition==<br /> *Suspected new diagnosis can have out patient workup if well appearing<br /> *Mild flairs can have expedited out patient management<br /> *Musculoskeletal symptoms can usually be managed as out patients<br /> *Chest pain requires urgent ACS evaluation<br /> *Infections usually require admission for antibiotics and systemic corticosteroids<br /> <br /> ==See Also==<br /> *[[Arthritis]]<br /> *[[Fever and Rash]]<br /> *[[Lupus Anticoagulant]]<br /> *[[Pericarditis]]<br /> *[[Pericardial Effusion and Tamponade]]<br /> *[[Acute Renal Failure]]<br /> *[[Adrenal Crisis]]<br /> <br /> ==Sources==<br /> *Rosen's<br /> *Up to date<br /> <br /> &lt;references/&gt;<br /> <br /> [[Category: Rheum]]</div>

Alinker https://wikem.org/w/index.php?title=Systemic_lupus_erythematosus&diff=18911 2014-03-25T23:00:53Z

<p>Alinker: edits</p> <hr /> <div>==Background==<br /> *Autoimmune disorder affecting all systems<br /> <br /> ==Epidemiology==<br /> *Female:Male 10:1<br /> *More common in African Americans<br /> <br /> <br /> ==Clinical Features==<br /> '''Diagnostic Criteria:'''<br /> 4 out of 11 of the following:<br /> #Malar rash<br /> #Discoid rash<br /> #Photosensitivity<br /> #Oral ulcers<br /> #Arthritis (polyarticular)<br /> #Serositis (Pericarditis or pleuritis)<br /> #Renal disorder (renal failure, protenuria, casts)<br /> #Neurologic or psychotic symptoms<br /> #Hematologic (anemia, thrombocytopenia, or leukopenia)<br /> #Immunologic (+antibofy testing)<br /> #ANA (positive ANA)<br /> <br /> '''Organ system affected:'''<br /> *Cardiopulmonary<br /> **Pneumonia<br /> ***Cover for ''[[Listeria]]'' and ''[[Pseudmonas]]''<br /> **CAD<br /> ***More common and more complications post-PCI<br /> **[[PE]]<br /> **[[Pericarditis]]<br /> **[[Endocarditis]]<br /> ***Infectious and Libman-Sachs<br /> <br /> *Neuropsychiatric/Altered mental status<br /> **Non-convulsive status epilepticus<br /> **CNS vasculitis<br /> **[[Stroke]]<br /> **[[Encephalitis]]<br /> **[[Meningitis]]<br /> <br /> *Musculoskeletal<br /> **Arthritis<br /> ***Usually symmetric<br /> ***Consider septic arthritis if there is a single inflamed joint<br /> ****Cover for [[''Salmonella'']] in addition to standard coverage<br /> <br /> *GI<br /> **Lupus enteritis (mesenteric vasculitis)<br /> ***Most common cause of acute abdominal pain<br /> **[[Pancreatitis]]<br /> **PUD<br /> <br /> *Dermatologic<br /> **Malar rash across bridge of nose<br /> **Discoid rash, erythematous with scale<br /> **Treat with topical 1% hydrocortisone<br /> <br /> *Renal<br /> **Usually a nephritis<br /> **Can cause a glomerulonephrosis<br /> <br /> <br /> ==Differential Diagnosis==<br /> *Rheumatoid arthritis<br /> *Sjogren's syndrome<br /> *[[Dermatomyositis]]<br /> *Polymyositis<br /> *[[Stevens Johnson Syndrome and Toxic Epidermal Necrolysis|Stevens-Johnson syndrome]]<br /> *[[Stevens Johnson Syndrome and Toxic Epidermal Necrolysis|Toxic Epidermal Necrolysis]]<br /> *[[Septic arthritis]]<br /> *[[Lyme disease]]<br /> *Vasculitis<br /> *[[Acute Rheumatic Fever]]<br /> *[[Toxic Shock Syndrome]]<br /> *[[Thrombotic Thrombocytopenic Purpura (TTP)|TTP]]<br /> *[[Idiopathic Thrombocytopenic Purpura|ITP]]<br /> *[[DIC]]<br /> <br /> ==Workup==<br /> '''Undiagnosed'''<br /> *CBC<br /> *Chem 10<br /> *ANA<br /> *ESR<br /> *UA<br /> *Bedside echo if ill or hypotensive<br /> *(Consider anti-DNA, anti-Smith, anti-Nuclear, anti-phospholipid)<br /> <br /> '''Flair'''<br /> *Bedside echo if ill or hypotensive<br /> *CBC<br /> *Chem<br /> *UA<br /> *As directed by organ system involved<br /> <br /> ==Management==<br /> *Inflammatory complications<br /> **Methylprednisolone 1-2mg/kg in most cases<br /> *Infectious<br /> **Stress dose steroids with hydrocortisone 100mg IV Q8hr if on or recently on steroids<br /> <br /> *Dermatologic<br /> **Hydrocortisone 1% cream<br /> <br /> ==Disposition==<br /> *Suspected new diagnosis can have out patient workup if well appearing<br /> *Mild flairs can have expedited out patient management<br /> *High-risk population, low threshold to admit<br /> <br /> ==See Also==<br /> *[[Arthritis]]<br /> *[[Fever and Rash]]<br /> *[[Lupus Anticoagulant]]<br /> *[[Pericarditis]]<br /> *[[Pericardial Effusion and Tamponade]]<br /> *[[Acute Renal Failure]]<br /> *[[Adrenal Crisis]]<br /> <br /> ==Sources==<br /> *Rosen's<br /> *Up to date<br /> <br /> &lt;references/&gt;<br /> <br /> [[Category: Rheum]]</div>

Alinker https://wikem.org/w/index.php?title=Systemic_lupus_erythematosus&diff=18910 2014-03-25T22:59:52Z

<p>Alinker: </p> <hr /> <div>==Background==<br /> *Autoimmune disorder affecting all systems<br /> <br /> ==Epidemiology==<br /> *Female:Male 10:1<br /> *More common in African Americans<br /> <br /> <br /> ==Clinical Features==<br /> '''Diagnostic Criteria:'''<br /> 4 out of 11 of the following:<br /> #Malar rash<br /> #Discoid rash<br /> #Photosensitivity<br /> #Oral ulcers<br /> #Arthritis (polyarticular)<br /> #Serositis (Pericarditis or pleuritis)<br /> #Renal disorder (renal failure, protenuria, casts)<br /> #Neurologic or psychotic symptoms<br /> #Hematologic (anemia, thrombocytopenia, or leukopenia)<br /> #Immunologic (+antibofy testing)<br /> #ANA (positive ANA)<br /> <br /> '''Organ system affected:'''<br /> *Cardiopulmonary<br /> **Pneumonia<br /> ***Cover for ''[[Listeria]]'' and ''[[Pseudmonas]]''<br /> **CAD<br /> ***More common and more complications post-PCI<br /> **[[PE]]<br /> **[[Pericarditis]]<br /> **[[Endocarditis]]<br /> ***Infectious and Libman-Sachs<br /> <br /> *Neuropsychiatric/Altered mental status<br /> **Non-convulsive status epilepticus<br /> **CNS vasculitis<br /> **[[Stroke]]<br /> **[[Encephalitis]]<br /> **[[Meningitis]]<br /> <br /> *Musculoskeletal<br /> **Arthritis<br /> ***Usually symmetric<br /> ***Consider septic arthritis if there is a single inflamed joint<br /> ****Cover for [[''Salmonella'']] in addition to standard coverage<br /> <br /> *GI<br /> **Lupus enteritis (mesenteric vasculitis)<br /> ***Most common cause of acute abdominal pain<br /> **[[Pancreatitis]]<br /> **PUD<br /> <br /> *Dermatologic<br /> **Malar rash across bridge of nose<br /> **Discoid rash, erythematous with scale<br /> **Treat with topical 1% hydrocortisone<br /> <br /> *Renal<br /> **<br /> <br /> <br /> ==Differential Diagnosis==<br /> *Rheumatoid arthritis<br /> *Sjogren's syndrome<br /> *[[Dermatomyositis]]<br /> *Polymyositis<br /> *[[Stevens Johnson Syndrome and Toxic Epidermal Necrolysis|Stevens-Johnson syndrome]]<br /> *[[Stevens Johnson Syndrome and Toxic Epidermal Necrolysis|Toxic Epidermal Necrolysis]]<br /> *[[Septic arthritis]]<br /> *[[Lyme disease]]<br /> *Vasculitis<br /> *[[Acute Rheumatic Fever]]<br /> *[[Toxic Shock Syndrome]]<br /> *[[Thrombotic Thrombocytopenic Purpura (TTP)|TTP]]<br /> *[[Idiopathic Thrombocytopenic Purpura|ITP]]<br /> *[[DIC]]<br /> <br /> ==Workup==<br /> '''Undiagnosed'''<br /> *CBC<br /> *Chem 10<br /> *ANA<br /> *ESR<br /> *UA<br /> *Bedside echo if ill or hypotensive<br /> *(Consider anti-DNA, anti-Smith, anti-Nuclear, anti-phospholipid)<br /> <br /> '''Flair'''<br /> *Bedside echo if ill or hypotensive<br /> *CBC<br /> *Chem<br /> *UA<br /> *As directed by organ system involved<br /> <br /> ==Management==<br /> *Inflammatory complications<br /> **Methylprednisolone 1-2mg/kg in most cases<br /> *Infectious<br /> **Stress dose steroids with hydrocortisone 100mg IV Q8hr if on or recently on steroids<br /> <br /> *Dermatologic<br /> **Hydrocortisone 1% cream<br /> <br /> ==Disposition==<br /> *Suspected new diagnosis can have out patient workup if well appearing<br /> *Mild flairs can have expedited out patient management<br /> *High-risk population, low threshold to admit<br /> <br /> ==See Also==<br /> *[[Arthritis]]<br /> *[[Fever and Rash]]<br /> *[[Lupus Anticoagulant]]<br /> *[[Pericarditis]]<br /> *[[Pericardial Effusion and Tamponade]]<br /> *[[Acute Renal Failure]]<br /> *[[Adrenal Crisis]]<br /> <br /> ==Sources==<br /> *Rosen's<br /> *Up to date<br /> <br /> &lt;references/&gt;<br /> <br /> [[Category: Rheum]]</div>

Alinker https://wikem.org/w/index.php?title=Systemic_lupus_erythematosus&diff=18908 2014-03-25T22:41:35Z

<p>Alinker: </p> <hr /> <div>==Background==<br /> *Autoimmune disorder affecting all systems<br /> <br /> ==Epidemiology==<br /> *Female:Male 10:1<br /> *More common in African Americans<br /> <br /> <br /> ==Clinical Features==<br /> '''Diagnostic Criteria:'''<br /> 4 out of 11 of the following:<br /> #Malar rash<br /> #Discoid rash<br /> #Photosensitivity<br /> #Oral ulcers<br /> #Arthritis (polyarticular)<br /> #Serositis (Pericarditis or pleuritis)<br /> #Renal disorder (renal failure, protenuria, casts)<br /> #Neurologic or psychotic symptoms<br /> #Hematologic (anemia, thrombocytopenia, or leukopenia)<br /> #Immunologic (+antibofy testing)<br /> #ANA (positive ANA)<br /> <br /> '''New Presentations'''<br /> <br /> <br /> <br /> '''Flairs'''<br /> *Cardiopulmonary<br /> **Pneumonia<br /> ***Cover for ''[[Listeria]]'' and ''[[Pseudmonas]]''<br /> **CAD<br /> ***More common and more complications post-PCI<br /> **[[PE]]<br /> **[[Pericarditis]]<br /> **[[Endocarditis]]<br /> ***Infectious and Libman-Sachs<br /> <br /> *Neuropsychiatric/Altered mental status<br /> **Non-convulsive status epilepticus<br /> **CNS vasculitis<br /> **[[Stroke]]<br /> **[[Encephalitis]]<br /> **[[Meningitis]]<br /> <br /> *Musculoskeletal<br /> **Arthritis<br /> ***Usually symmetric<br /> ***Consider septic arthritis if there is a single inflamed joint<br /> ****Cover for [[''Salmonella'']] in addition to standard coverage<br /> <br /> *GI<br /> **Lupus enteritis (mesenteric vasculitis)<br /> ***Most common cause of acute abdominal pain<br /> **Pancreatitis<br /> **PUD<br /> <br /> ==Differential Diagnosis==<br /> *Rheumatoid arthritis<br /> *Sjogren's syndrome<br /> *[[Dermatomyositis]]<br /> *Polymyositis<br /> *[[Stevens Johnson Syndrome and Toxic Epidermal Necrolysis|Stevens-Johnson syndrome]]<br /> *[[Stevens Johnson Syndrome and Toxic Epidermal Necrolysis|Toxic Epidermal Necrolysis]]<br /> *[[Septic arthritis]]<br /> *[[Lyme disease]]<br /> *Vasculitis<br /> *[[Acute Rheumatic Fever]]<br /> *[[Toxic Shock Syndrome]]<br /> *[[Thrombotic Thrombocytopenic Purpura (TTP)|TTP]]<br /> *[[Idiopathic Thrombocytopenic Purpura|ITP]]<br /> *[[DIC]]<br /> <br /> ==Workup==<br /> '''Undiagnosed'''<br /> *CBC<br /> *Chem 10<br /> *ANA<br /> *ESR<br /> *UA<br /> *Bedside echo if ill or hypotensive<br /> <br /> '''Flair'''<br /> *Bedside echo if ill or hypotensive<br /> *CBC<br /> <br /> <br /> <br /> <br /> ==Management==<br /> *Steroids<br /> **Stress-dose steroids if on or recently on chronic steroids<br /> **Inflammatory conditions: methylprednisolone 1-2mg/kg<br /> ***Pericarditis<br /> ***Lupus enteritis<br /> <br /> <br /> ==Disposition==<br /> *Suspected new diagnosis can have out patient workup if well appearing<br /> <br /> <br /> <br /> ==See Also==<br /> *[[Arthritis]]<br /> *[[Fever and Rash]]<br /> *[[Lupus Anticoagulant]]<br /> *[[Pericarditis]]<br /> *[[Pericardial Effusion and Tamponade]]<br /> *[[Acute Renal Failure]]<br /> *[[Adrenal Crisis]]<br /> <br /> ==Sources==<br /> *Rosen's<br /> *Up to date<br /> <br /> &lt;references/&gt;<br /> <br /> [[Category: Rheum]]</div>

Alinker https://wikem.org/w/index.php?title=Systemic_lupus_erythematosus&diff=18907 2014-03-25T22:31:45Z

<p>Alinker: </p> <hr /> <div>==Background==<br /> *Autoimmune disorder affecting all systems<br /> <br /> ==Epidemiology==<br /> *Female:Male 10:1<br /> *More common in African Americans<br /> <br /> <br /> ==Clinical Features==<br /> '''Diagnostic Criteria:'''<br /> 4 out of 11 of the following:<br /> #Malar rash<br /> #Discoid rash<br /> #Photosensitivity<br /> #Oral ulcers<br /> #Arthritis (polyarticular)<br /> #Serositis (Pericarditis or pleuritis)<br /> #Renal disorder (renal failure, protenuria, casts)<br /> #Neurologic or psychotic symptoms<br /> #Hematologic (anemia, thrombocytopenia, or leukopenia)<br /> #Immunologic (+antibofy testing)<br /> #ANA (positive ANA)<br /> <br /> '''New Presentations'''<br /> <br /> <br /> <br /> '''Flairs'''<br /> *Cardiopulmonary<br /> **Pneumonia<br /> ***Cover for ''[[Listeria]]'' and ''[[Pseudmonas]]''<br /> **CAD<br /> ***More common and more complications post-PCI<br /> **[[PE]]<br /> **[[Pericarditis]]<br /> **[[Endocarditis]]<br /> ***Infectious and Libman-Sachs<br /> <br /> *Neuropsychiatric/Altered mental status<br /> **Non-convulsive status epilepticus<br /> **CNS vasculitis<br /> **[[Stroke]]<br /> **[[Encephalitis]]<br /> **[[Meningitis]]<br /> <br /> *Musculoskeletal<br /> **Arthritis<br /> ***Usually symmetric<br /> ***Consider septic arthritis if there is a single inflamed joint<br /> ****Cover for [[''Salmonella'']] in addition to standard coverage<br /> <br /> ==Differential Diagnosis==<br /> *Rheumatoid arthritis<br /> *Sjogren's syndrome<br /> *[[Dermatomyositis]]<br /> *Polymyositis<br /> *[[Stevens Johnson Syndrome and Toxic Epidermal Necrolysis|Stevens-Johnson syndrome]]<br /> *[[Stevens Johnson Syndrome and Toxic Epidermal Necrolysis|Toxic Epidermal Necrolysis]]<br /> *[[Septic arthritis]]<br /> *[[Lyme disease]]<br /> *Vasculitis<br /> *[[Acute Rheumatic Fever]]<br /> *[[Toxic Shock Syndrome]]<br /> *[[Thrombotic Thrombocytopenic Purpura (TTP)|TTP]]<br /> *[[Idiopathic Thrombocytopenic Purpura|ITP]]<br /> *[[DIC]]<br /> <br /> ==Workup==<br /> '''Undiagnosed'''<br /> *CBC<br /> *Chem 10<br /> *ANA<br /> *ESR<br /> *UA<br /> *Bedside echo if ill or hypotensive<br /> <br /> '''Flair'''<br /> *Bedside echo if ill or hypotensive<br /> *CBC<br /> <br /> <br /> <br /> <br /> ==Management==<br /> *Steroids<br /> **Stress-dose steroids if on or recently on chronic steroids<br /> <br /> <br /> ==Disposition==<br /> *Suspected new diagnosis can have out patient workup if well appearing<br /> <br /> <br /> <br /> ==See Also==<br /> *[[Arthritis]]<br /> *[[Fever and Rash]]<br /> *[[Lupus Anticoagulant]]<br /> *[[Pericarditis]]<br /> *[[Pericardial Effusion and Tamponade]]<br /> *[[Acute Renal Failure]]<br /> *[[Adrenal Crisis]]<br /> <br /> ==Sources==<br /> *Rosen's<br /> *Up to date<br /> <br /> &lt;references/&gt;<br /> <br /> [[Category: Rheum]]</div>

Alinker https://wikem.org/w/index.php?title=Systemic_lupus_erythematosus&diff=18906 2014-03-25T22:25:29Z

<p>Alinker: </p> <hr /> <div>==Background==<br /> *Autoimmune disorder affecting all sysems<br /> <br /> ==Epidemiology==<br /> *Femaile:Male 10:1<br /> *More common in African Americans<br /> <br /> <br /> ==Clinical Features==<br /> '''Diagnostic Criteria:'''<br /> 4 out of 11 of the following:<br /> #Malar rash<br /> #Discoid rash<br /> #Photosensitivity<br /> #Oral ulcers<br /> #Arthritis (polyarticular)<br /> #Serositis (Pericarditis or pleuritis)<br /> #Renal disorder (renal failure, protenuria, casts)<br /> #Neurologic or psychotic symptoms<br /> #Hematologic (anemia, thrombocytopenia, or leukopenia)<br /> #Immunologic (+antibofy testing)<br /> #ANA (positive ANA)<br /> <br /> '''New Presentations'''<br /> <br /> <br /> <br /> '''Flairs'''<br /> *Cardiopulmonary<br /> **Pneumonia<br /> ***Cover for ''[[Listeria]]'' and ''[[Pseudmonas]]''<br /> **CAD<br /> **[[PE]]<br /> **[[Pericarditis]]<br /> **[[Endocarditis]]<br /> ***Infectious and Libman-Sachs<br /> <br /> *Neuropsychiatric/Altered mental status<br /> **Non-convulsive status epilepticus<br /> **CNS vasculitis<br /> **[[Stroke]]<br /> **[[Encephalitis]]<br /> <br /> *Musculoskeletal<br /> **Arthritis<br /> ***Usually symmetric<br /> ***Consider septic arthritis if there is a single inflamed joint<br /> ****Cover for [[''Salmonella'']] in addition to standard coverage<br /> <br /> ==Differential Diagnosis==<br /> *Rheumatoid arthritis<br /> *Sjogren's syndrome<br /> *[[Dermatomyositis]]<br /> *Polymyositis<br /> *[[Stevens Johnson Syndrome and Toxic Epidermal Necrolysis|Stevens-Johnson syndrome]]<br /> *[[Stevens Johnson Syndrome and Toxic Epidermal Necrolysis|Toxic Epidermal Necrolysis]]<br /> *[[Septic arthritis]]<br /> *[[Lyme disease]]<br /> *Vasculitis<br /> *[[Acute Rheumatic Fever]]<br /> *[[Toxic Shock Syndrome]]<br /> *[[Thrombotic Thrombocytopenic Purpura (TTP)|TTP]]<br /> *[[Idiopathic Thrombocytopenic Purpura|ITP]]<br /> *[[DIC]]<br /> <br /> ==Workup==<br /> '''Undiagnosed'''<br /> *CBC<br /> *Chem 10<br /> *ANA<br /> *ESR<br /> *UA<br /> *Bedside echo if ill or hypotensive<br /> <br /> '''Flair'''<br /> *Bedside echo if ill or hypotensive<br /> *CBC<br /> <br /> <br /> <br /> <br /> ==Management==<br /> *Steroids<br /> <br /> <br /> <br /> ==Disposition==<br /> <br /> <br /> <br /> <br /> ==See Also==<br /> *[[Arthritis]]<br /> *[[Fever and Rash]]<br /> *[[Lupus Anticoagulant]]<br /> *[[Pericarditis]]<br /> *[[Pericardial Effusion and Tamponade]]<br /> *[[Acute Renal Failure]]<br /> *[[Adrenal Crisis]]<br /> <br /> ==Sources==<br /> *Rosen's<br /> *Up to date<br /> <br /> &lt;references/&gt;<br /> <br /> [[Category: Rheum]]</div>

Alinker https://wikem.org/w/index.php?title=Systemic_lupus_erythematosus&diff=18904 2014-03-25T22:23:04Z

<p>Alinker: </p> <hr /> <div>==Background==<br /> *Autoimmune disorder affecting all sysems<br /> <br /> ==Epidemiology==<br /> *Femaile:Male 10:1<br /> *More common in African Americans<br /> <br /> <br /> ==Clinical Features==<br /> '''Diagnostic Criteria:'''<br /> 4 out of 11 of the following:<br /> #Malar rash<br /> #Discoid rash<br /> #Photosensitivity<br /> #Oral ulcers<br /> #Arthritis (polyarticular)<br /> #Serositis (Pericarditis or pleuritis)<br /> #Renal disorder (renal failure, protenuria, casts)<br /> #Neurologic or psychotic symptoms<br /> #Hematologic (anemia, thrombocytopenia, or leukopenia)<br /> #Immunologic (+antibofy testing)<br /> #ANA (positive ANA)<br /> <br /> '''New Presentations'''<br /> <br /> <br /> <br /> '''Flairs'''<br /> *Cardiopulmonary<br /> **Pneumonia<br /> ***Cover for ''[[Listeria]]'' and ''[[Pseudmonas]]''<br /> **CAD<br /> **[[PE]]<br /> **[[Pericarditis]]<br /> **[[Endocarditis]]<br /> ***Infectious and Libman-Sachs<br /> <br /> *Neuropsychartic/Altered mental status<br /> **Non-convulsive status epilepticus<br /> **CNS vasculitis<br /> **[[Stroke]]<br /> **[[Encephalitis]]<br /> <br /> <br /> *Musculoskeletal<br /> <br /> <br /> ==Differential Diagnosis==<br /> *Rheumatoid arthritis<br /> *Sjogren's syndrome<br /> *[[Dermatomyositis]]<br /> *Polymyositis<br /> *[[Stevens Johnson Syndrome and Toxic Epidermal Necrolysis|Stevens-Johnson syndrome]]<br /> *[[Stevens Johnson Syndrome and Toxic Epidermal Necrolysis|Toxic Epidermal Necrolysis]]<br /> *[[Septic arthritis]]<br /> *[[Lyme disease]]<br /> *Vasculitis<br /> *[[Acute Rheumatic Fever]]<br /> *[[Toxic Shock Syndrome]]<br /> *[[Thrombotic Thrombocytopenic Purpura (TTP)|TTP]]<br /> *[[Idiopathic Thrombocytopenic Purpura|ITP]]<br /> *[[DIC]]<br /> <br /> ==Workup==<br /> '''Undiagnosed'''<br /> *CBC<br /> *Chem 10<br /> *ANA<br /> *ESR<br /> *UA<br /> *Bedside echo if ill or hypotensive<br /> <br /> '''Flair'''<br /> *Bedside echo if ill or hypotensive<br /> *CBC<br /> <br /> <br /> <br /> <br /> ==Management==<br /> *Steroids<br /> <br /> <br /> <br /> ==Disposition==<br /> <br /> <br /> <br /> <br /> ==See Also==<br /> [[Arthritis]]<br /> [[Fever and Rash]]<br /> [[Lupus Anticoagulant]]<br /> [[Pericarditis]]<br /> [[Pericardial Effusion and Tamponade]]<br /> [[Acute Renal Failure]]<br /> [[Adrenal Crisis]]<br /> <br /> <br /> ==Sources==<br /> *Rosen's<br /> *Up to date<br /> <br /> &lt;references/&gt;<br /> <br /> [[Category: Rheum]]</div>

Alinker https://wikem.org/w/index.php?title=Systemic_lupus_erythematosus&diff=18857 2014-03-25T19:53:28Z

<p>Alinker: </p> <hr /> <div>==Background==<br /> *Autoimmune disorder<br /> <br /> ==Epidemiology==<br /> *Femaile:Male 10:1<br /> *More common in African Americans<br /> <br /> <br /> ==Clinical Features==<br /> '''Diagnostic Criteria:'''<br /> 4 out of 11 of the following:<br /> #Malar rash<br /> #Discoid rash<br /> #Photosensitivity<br /> #Oral ulcers<br /> #Arthritis (polyarticular)<br /> #Serositis (Pericarditis or pleuritis)<br /> #Renal disorder (renal failure, protenuria, casts)<br /> #Neurologic or psychotic symptoms<br /> #Hematologic (anemia, thrombocytopenia, or leukopenia)<br /> #Immunologic (+antibofy testing)<br /> #ANA (positive ANA)<br /> <br /> '''New Presentations'''<br /> <br /> <br /> <br /> '''Flairs'''<br /> <br /> <br /> <br /> ==Differential Diagnosis==<br /> *Rheumatoid arthritis<br /> *Sjogren's syndrome<br /> *[[Dermatomyositis]]<br /> *Polymyositis<br /> *[[Stevens Johnson Syndrome and Toxic Epidermal Necrolysis|Stevens-Johnson syndrome]]<br /> *[[Stevens Johnson Syndrome and Toxic Epidermal Necrolysis|Toxic Epidermal Necrolysis]]<br /> *[[Septic arthritis]]<br /> *[[Lyme disease]]<br /> *Vasculitis<br /> *[[Acute Rheumatic Fever]]<br /> *[[Toxic Shock Syndrome]]<br /> *[[Thrombotic Thrombocytopenic Purpura (TTP)|TTP]]<br /> *[[Idiopathic Thrombocytopenic Purpura|ITP]]<br /> *[[DIC]]<br /> <br /> ==Workup==<br /> '''Undiagnosed'''<br /> *CBC<br /> *Chem 10<br /> *ANA<br /> *ESR<br /> *UA<br /> *Bedside echo if ill or hypotensive<br /> <br /> '''Flair'''<br /> *Bedside echo if ill or hypotensive<br /> *CBC<br /> <br /> <br /> <br /> <br /> ==Management==<br /> *Steroids<br /> <br /> <br /> <br /> ==Disposition==<br /> <br /> <br /> <br /> <br /> ==See Also==<br /> [[Arthritis]]<br /> [[Fever and Rash]]<br /> [[Lupus Anticoagulant]]<br /> [[Pericarditis]]<br /> [[Pericardial Effusion and Tamponade]]<br /> [[Acute Renal Failure]]<br /> [[Adrenal Crisis]]<br /> <br /> <br /> ==Sources==<br /> *Rosen's<br /> *Up to date<br /> <br /> &lt;references/&gt;<br /> <br /> [[Category: Rheum]]</div>

Alinker https://wikem.org/w/index.php?title=Systemic_lupus_erythematosus&diff=18843 2014-03-25T19:42:54Z

<p>Alinker: </p> <hr /> <div>==Background==<br /> *Autoimmune disorder<br /> <br /> ==Epidemiology==<br /> *Femaile:Male 10:1<br /> *More common in African Americans<br /> <br /> <br /> ==Clinical Features==<br /> '''Diagnostic Criteria:'''<br /> <br /> <br /> <br /> '''New Presentations'''<br /> <br /> <br /> <br /> '''Flairs'''<br /> <br /> <br /> <br /> ==Differential Diagnosis==<br /> *Rheumatoid arthritis<br /> *Sjogren's syndrome<br /> *[[Dermatomyositis]]<br /> *Polymyositis<br /> *[[Stevens Johnson Syndrome and Toxic Epidermal Necrolysis|Stevens-Johnson syndrome]]<br /> *[[Stevens Johnson Syndrome and Toxic Epidermal Necrolysis|Toxic Epidermal Necrolysis]]<br /> *[[Septic arthritis]]<br /> *[[Lyme disease]]<br /> *Vasculitis<br /> *[[Acute Rheumatic Fever]]<br /> *[[Toxic Shock Syndrome]]<br /> *[[Thrombotic Thrombocytopenic Purpura (TTP)|TTP]]<br /> *[[Idiopathic Thrombocytopenic Purpura|ITP]]<br /> *[[DIC]]<br /> <br /> =='''Workup'''==<br /> <br /> ==Undiagnosed==<br /> *CBC<br /> *Chem 10<br /> *ANA<br /> *ESR<br /> *UA<br /> *Bedside echo if ill appearing<br /> <br /> ==Flair==<br /> *Bedside echo if ill or hypotensive<br /> *CBC<br /> <br /> <br /> <br /> <br /> ==Management==<br /> <br /> <br /> <br /> <br /> ==Disposition==<br /> <br /> <br /> <br /> <br /> ==See Also==<br /> [[Arthritis]]<br /> [[Fever and Rash]]<br /> [[Lupus Anticoagulant]]<br /> [[Pericarditis]]<br /> [[Acute Renal Failure]]<br /> [[Adrenal Crisis]]<br /> <br /> <br /> ==Sources==<br /> *Rosen's<br /> *Up to date<br /> <br /> &lt;references/&gt;<br /> <br /> [[Category: Rheum]]</div>

Alinker https://wikem.org/w/index.php?title=Systemic_lupus_erythematosus&diff=18833 2014-03-25T19:38:07Z

<p>Alinker: </p> <hr /> <div>==Background==<br /> *Autoimmune disorder<br /> <br /> ==Epidemiology==<br /> *Femaile:Male 10:1<br /> *More common in African Americans<br /> <br /> <br /> ==Clinical Features==<br /> <br /> <br /> <br /> <br /> <br /> ==Differential Diagnosis==<br /> *Rheumatoid arthritis<br /> *Sjogren's syndrome<br /> *[[Dermatomyositis]]<br /> *Polymyositis<br /> *[[Stevens Johnson Syndrome and Toxic Epidermal Necrolysis|Stevens-Johnson syndrome]]<br /> *[[Stevens Johnson Syndrome and Toxic Epidermal Necrolysis|Toxic Epidermal Necrolysis]]<br /> *[[Septic arthritis]]<br /> *[[Lyme disease]]<br /> *Vasculitis<br /> *[[Acute Rheumatic Fever]]<br /> *[[Toxic Shock Syndrome]]<br /> *[[Thrombotic Thrombocytopenic Purpura (TTP)|TTP]]<br /> *[[Idiopathic Thrombocytopenic Purpura|ITP]]<br /> *[[DIC]]<br /> <br /> ==Workup==<br /> <br /> ==Undiagnosed==<br /> *CBC<br /> *Chem 10<br /> *ANA<br /> *ESR<br /> *UA<br /> *Bedside echo if ill appearing<br /> <br /> ==Flair==<br /> *CBC<br /> *<br /> <br /> <br /> <br /> ==Management==<br /> <br /> <br /> <br /> <br /> ==Disposition==<br /> <br /> <br /> <br /> <br /> ==See Also==<br /> [[Arthritis]]<br /> [[Fever and Rash]]<br /> [[Lupus Anticoagulant]]<br /> [[Pericarditis]]<br /> [[Acute Renal Failure]]<br /> [[Adrenal Crisis]]<br /> <br /> <br /> ==Sources==<br /> *Rosen's<br /> *Up to date<br /> <br /> &lt;references/&gt;<br /> <br /> [[Category: Rheum]]</div>

Alinker https://wikem.org/w/index.php?title=Systemic_lupus_erythematosus&diff=18829 2014-03-25T19:25:52Z

<p>Alinker: Created page with &quot;==Background== ==Clinical Features== ==Differential Diagnosis== *Rheumatoid arthritis *Sjogren's syndrome *Dermatomyositis *Polymyositis *Stevens Johnson Syndrome and ...&quot;</p> <hr /> <div>==Background==<br /> <br /> ==Clinical Features==<br /> <br /> ==Differential Diagnosis==<br /> *Rheumatoid arthritis<br /> *Sjogren's syndrome<br /> *[[Dermatomyositis]]<br /> *Polymyositis<br /> *[[Stevens Johnson Syndrome and Toxic Epidermal Necrolysis|Stevens-Johnson syndrome]]<br /> *[[Stevens Johnson Syndrome and Toxic Epidermal Necrolysis|Toxic Epidermal Necrolysis]]<br /> *[[Septic arthritis]]<br /> *[[Lyme disease]]<br /> *<br /> *<br /> *<br /> <br /> ==Workup==<br /> <br /> ==Management==<br /> <br /> ==Disposition==<br /> <br /> ==See Also==<br /> [[Arthritis]]<br /> [[Fever and Rash]]<br /> <br /> <br /> ==Sources==<br /> *Rosen's<br /> *Up to date<br /> <br /> &lt;references/&gt;<br /> <br /> [[Category: Rheum]]</div>

Alinker https://wikem.org/w/index.php?title=Dermatomyositis&diff=18826 2014-03-25T18:32:52Z

<p>Alinker: link</p> <hr /> <div>==Background==<br /> *Inflammatory myopathy<br /> *Affects proximal muscles &gt; distal<br /> *Female:Male; 2:1<br /> *Peak incidence 40-50s<br /> <br /> ==Clinical Features==<br /> '''Muscular'''<br /> #Proximal greater than distal weakness<br /> *Deltoid and hip flexors<br /> *difficulty standing from a chair<br /> #Onset over months<br /> #Mild myalgias<br /> <br /> '''Dermatologic'''<br /> #Heliotrope rash on face scalp<br /> #Gottron's papules (rash on MCP, PIP, and DIP joints)<br /> #Shawl sign (rash above shoulders)<br /> <br /> '''Other'''<br /> #Cardiac (cardiomyopathy)<br /> #High association with malignancy<br /> #Interstial lung disease<br /> <br /> ==Differential Diagnosis==<br /> *Polymyositis<br /> *SLE<br /> *[[Guillain-Barre Syndrome]]<br /> *Drug Induced Myopathies (Statins)<br /> *[[Hypothyroidism]]<br /> *Limb Girdle Muscular Dystrophy<br /> *[[Rhabdomyolysis]]<br /> *[[Myesthenia Gravis]]<br /> *Pyomyositis<br /> *Viral myositis<br /> *[[Botulism]]<br /> <br /> ==Workup==<br /> *CK<br /> *ANA<br /> *Chem for creatinine<br /> *Troponin, can involve myocardium<br /> *EKG<br /> *Bedside PFTs (FEV1 and FVC)<br /> *UA for myoglobin<br /> *Consider malignancies<br /> <br /> ==Management==<br /> *Severe disease: Respiratory muscle symptoms of CHF<br /> **Methylprednisolone 1000mg/day x 3 days<br /> *Mild disease: Prednisone 1mg/kg/day (up to 80mg/day)<br /> **Taper after 6-8 weeks<br /> <br /> ==Disposition==<br /> *Admit to monitored bed for CHF symptoms, respiratory muscle weakness<br /> *Admit for dysphagia/aspiration risk<br /> *Out patient follow up with muscle biopsy for others<br /> <br /> ==See Also==<br /> *[[Weakness]]<br /> *Polymyositis<br /> *SLE<br /> *Rheumatoid arthritis<br /> <br /> ==Sources==<br /> Up to Date<br /> <br /> [[Category: Rheum]]</div>

Alinker https://wikem.org/w/index.php?title=Dermatomyositis&diff=18822 2014-03-25T18:13:20Z

<p>Alinker: format</p> <hr /> <div>==Background==<br /> *Inflammatory myopathy<br /> *Affects proximal muscles &gt; distal<br /> *Female:Male; 2:1<br /> *Peak incidence 40-50s<br /> <br /> ==Clinical Features==<br /> '''Muscular'''<br /> #Proximal greater than distal weakness<br /> *Deltoid and hip flexors<br /> *difficulty standing from a chair<br /> #Onset over months<br /> #Mild myalgias<br /> <br /> '''Dermatologic'''<br /> #Heliotrope rash on face scalp<br /> #Gottron's papules (rash on MCP, PIP, and DIP joints)<br /> #Shawl sign (rash above shoulders)<br /> <br /> '''Other'''<br /> #Cardiac (cardiomyopathy)<br /> #High association with malignancy<br /> #Interstial lung disease<br /> <br /> ==Differential Diagnosis==<br /> *Polymyositis<br /> *SLE<br /> *[[Guillain-Barre Syndrome]]<br /> *Drug Induced Myopathies (Statins)<br /> *[[Hypothyroidism]]<br /> *Limb Girdle Muscular Dystrophy<br /> *[[Rhabdomyolysis]]<br /> *[[Myesthenia Gravis]]<br /> *Pyomyositis<br /> *Viral myositis<br /> *[[Botulism]]<br /> <br /> ==Workup==<br /> *CK<br /> *ANA<br /> *Chem for creatinine<br /> *Troponin, can involve myocardium<br /> *EKG<br /> *Bedside PFTs (FEV1 and FVC)<br /> *UA for myoglobin<br /> *Consider malignancies<br /> <br /> ==Management==<br /> *Severe disease: Respiratory muscle symptoms of CHF<br /> **Methylprednisolone 1000mg/day x 3 days<br /> *Mild disease: Prednisone 1mg/kg/day (up to 80mg/day)<br /> **Taper after 6-8 weeks<br /> <br /> ==Disposition==<br /> *Admit to monitored bed for CHF symptoms, respiratory muscle weakness<br /> *Admit for dysphagia/aspiration risk<br /> *Out patient follow up with muscle biopsy for others<br /> <br /> ==See Also==<br /> *[[Weakness]]<br /> *Polymyositis<br /> *SLE<br /> *Rheumatoid arthritis<br /> <br /> ==Sources==<br /> Up to Date</div>

Alinker https://wikem.org/w/index.php?title=Dermatomyositis&diff=18821 2014-03-25T18:13:02Z

<p>Alinker: format</p> <hr /> <div>==Background==<br /> *Inflammatory myopathy<br /> *Affects proximal muscles &gt; distal<br /> *Female:Male; 2:1<br /> *Peak incidence 40-50s<br /> <br /> ==Clinical Features==<br /> '''Muscular'''<br /> #Proximal greater than distal weakness<br /> *Deltoid and hip flexors<br /> *difficulty standing from a chair<br /> #Onset over months<br /> #Mild myalgias<br /> <br /> '''Dermatologic'''<br /> #Heliotrope rash on face scalp<br /> #Gottron's papules (rash on MCP, PIP, and DIP joints)<br /> #Shawl sign (rash above shoulders)<br /> <br /> '''Other'''<br /> #Cardiac (cardiomyopathy)<br /> #High association with malignancy<br /> #Interstial lung disease<br /> <br /> ==Differential Diagnosis==<br /> *Polymyositis<br /> *SLE<br /> *[[Guillain-Barre Syndrome]]<br /> *Drug Induced Myopathies (Statins)<br /> *[[Hypothyroidism]]<br /> *Limb Girdle Muscular Dystrophy<br /> *[[Rhabdomyolysis]]<br /> *[[Myesthenia Gravis]]<br /> *Pyomyositis<br /> *Viral myositis<br /> *[[Botulism]]<br /> <br /> ==Workup==<br /> *CK<br /> *ANA<br /> *Chem for creatinine<br /> *Troponin, can involve myocardium<br /> *EKG<br /> *Bedside PFTs (FEV1 and FVC)<br /> *UA for myoglobin<br /> *Consider malignancies<br /> <br /> ==Management==<br /> *Severe disease: Respiratory muscle symptoms of CHF<br /> **Methylprednisolone 1000mg/day x 3 days<br /> *Mild disease: Prednisone 1mg/kg/day (up to 80mg/day)<br /> **Taper after 6-8 weeks<br /> <br /> ==Disposition==<br /> *Admit to monitored bed for CHF symptoms, respiratory muscle weakness<br /> *Admit for dysphagia/aspiration risk<br /> *Out patient follow up with muscle biopsy for others<br /> <br /> ==See Also==<br /> [[Weakness]]<br /> Polymyositis<br /> SLE<br /> Rheumatoid arthritis<br /> <br /> ==Sources==<br /> Up to Date</div>

Alinker https://wikem.org/w/index.php?title=Dermatomyositis&diff=18820 2014-03-25T18:12:09Z

<p>Alinker: links</p> <hr /> <div>==Background==<br /> *Inflammatory myopathy<br /> *Affects proximal muscles &gt; distal<br /> *Female:Male; 2:1<br /> *Peak incidence 40-50s<br /> <br /> ==Clinical Features==<br /> '''Muscular'''<br /> #Proximal greater than distal weakness<br /> *Deltoid and hip flexors<br /> *difficulty standing from a chair<br /> #Onset over months<br /> #Mild myalgias<br /> <br /> '''Dermatologic'''<br /> #Heliotrope rash on face scalp<br /> #Gottron's papules (rash on MCP, PIP, and DIP joints)<br /> #Shawl sign (rash above shoulders)<br /> <br /> '''Other'''<br /> #Cardiac (cardiomyopathy)<br /> #High association with malignancy<br /> #Interstial lung disease<br /> <br /> ==Differential Diagnosis==<br /> Polymyositis<br /> SLE<br /> [[Guillain-Barre Syndrome]]<br /> Drug Induced Myopathies (Statins)<br /> [[Hypothyroidism]]<br /> Limb Girdle Muscular Dystrophy<br /> [[Rhabdomyolysis]]<br /> [[Myesthenia Gravis]]<br /> Pyomyositis<br /> Viral myositis<br /> [[Botulism]]<br /> <br /> ==Workup==<br /> *CK<br /> *ANA<br /> *Chem for creatinine<br /> *Troponin, can involve myocardium<br /> *EKG<br /> *Bedside PFTs (FEV1 and FVC)<br /> *UA for myoglobin<br /> *Consider malignancies<br /> <br /> ==Management==<br /> *Severe disease: Respiratory muscle symptoms of CHF<br /> **Methylprednisolone 1000mg/day x 3 days<br /> *Mild disease: Prednisone 1mg/kg/day (up to 80mg/day)<br /> **Taper after 6-8 weeks<br /> <br /> ==Disposition==<br /> *Admit to monitored bed for CHF symptoms, respiratory muscle weakness<br /> *Admit for dysphagia/aspiration risk<br /> *Out patient follow up with muscle biopsy for others<br /> <br /> ==See Also==<br /> [[Weakness]]<br /> Polymyositis<br /> SLE<br /> Rheumatoid arthritis<br /> <br /> ==Sources==<br /> Up to Date</div>

Alinker https://wikem.org/w/index.php?title=Dermatomyositis&diff=18819 2014-03-25T18:09:01Z

<p>Alinker: links</p> <hr /> <div>==Background==<br /> *Inflammatory myopathy<br /> *Affects proximal muscles &gt; distal<br /> *Female:Male; 2:1<br /> *Peak incidence 40-50s<br /> <br /> ==Clinical Features==<br /> '''Muscular'''<br /> #Proximal greater than distal weakness<br /> *Deltoid and hip flexors<br /> *difficulty standing from a chair<br /> #Onset over months<br /> #Mild myalgias<br /> <br /> '''Dermatologic'''<br /> #Heliotrope rash on face scalp<br /> #Gottron's papules (rash on MCP, PIP, and DIP joints)<br /> #Shawl sign (rash above shoulders)<br /> <br /> '''Other'''<br /> #Cardiac (cardiomyopathy)<br /> #High association with malignancy<br /> #Interstial lung disease<br /> <br /> ==Differential Diagnosis==<br /> Polymyositis<br /> SLE<br /> [[Guillain-Barre Syndrome]]<br /> Drug Induced Myopathies (Statins)<br /> [[Hypothyroidism]]<br /> Limb Girdle Muscular Dystrophy<br /> [[Rhabdomyolysis]]<br /> [[Myesthenia Gravis]]<br /> Pyomyositis<br /> Viral myositis<br /> [[Botulism]]<br /> <br /> ==Workup==<br /> *CK<br /> *ANA<br /> *Chem for creatinine<br /> *Troponin, can involve myocardium<br /> *EKG<br /> *Bedside PFTs (FEV1 and FVC)<br /> *UA for myoglobin<br /> *Consider malignancies<br /> <br /> ==Management==<br /> *Severe disease: Respiratory muscle symptoms of CHF<br /> **Methylprednisolone 1000mg/day x 3 days<br /> *Mild disease: Prednisone 1mg/kg/day (up to 80mg/day)<br /> **Taper after 6-8 weeks<br /> <br /> ==Disposition==<br /> *Admit to monitored bed for CHF symptoms, respiratory muscle weakness<br /> *Admit for dysphagia/aspiration risk<br /> *Out patient follow up with muscle biopsy for others<br /> <br /> ==See Also==<br /> Polymyositis<br /> SLE<br /> Rheumatoid arthritis<br /> <br /> <br /> ==Sources==<br /> Up to Date</div>

Alinker https://wikem.org/w/index.php?title=Dermatomyositis&diff=18818 2014-03-25T17:55:31Z

<p>Alinker: new article</p> <hr /> <div>==Background==<br /> *Inflammatory myopathy<br /> *Affects proximal muscles &gt; distal<br /> *Female:Male; 2:1<br /> *Peak incidence 40-50s<br /> <br /> ==Clinical Features==<br /> '''Muscular'''<br /> #Proximal greater than distal weakness<br /> *Deltoid and hip flexors<br /> *difficulty standing from a chair<br /> #Onset over months<br /> #Mild myalgias<br /> <br /> '''Dermatologic'''<br /> #Heliotrope rash on face scalp<br /> #Gottron's papules (rash on MCP, PIP, and DIP joints)<br /> #Shawl sign (rash above shoulders)<br /> <br /> '''Other'''<br /> #Cardiac (cardiomyopathy)<br /> #High association with malignancy<br /> #Interstial lung disease<br /> <br /> ==Differential Diagnosis==<br /> Polymyositis<br /> SLE<br /> Guilanne Barre Syndrome<br /> Drug Induced Myopathies (Statins)<br /> Hypothyroidism<br /> Limb Girdle Muscular Dystrophy<br /> Rhabdomyositis<br /> Myesthenia gravis<br /> Pyomyositis<br /> Viral myositis<br /> Bolulism<br /> <br /> ==Workup==<br /> *CK<br /> *ANA<br /> *Chem for creatinine<br /> *Troponin, can involve myocardium<br /> *Bedside PFTs (FEV1 and FVC)<br /> *UA for myoglobin<br /> *Consider malignancies<br /> <br /> ==Management==<br /> *Severe disease: Respiratory muscle symptoms of CHF<br /> **Methylprednisolone 1000mg/day x 3 days<br /> *Mild disease: Prednisone 1mg/kg/day (up to 80mg/day)<br /> **Taper after 6-8 weeks<br /> <br /> ==Disposition==<br /> *Admit to monitored bed for CHF symptoms, respiratory muscle weakness<br /> *Admit for dysphagia/aspiration risk<br /> *Out patient follow up with muscle biopsy for others<br /> <br /> ==See Also==<br /> Polymyositis<br /> SLE<br /> Rheumatoid arthritis<br /> <br /> <br /> ==Sources==<br /> Up to Date</div>

Alinker https://wikem.org/w/index.php?title=Thrombotic_thrombocytopenic_purpura&diff=18814 2014-03-25T14:45:36Z

<p>Alinker: Clarified diagnosis and minor aditions to pathophys</p> <hr /> <div>==Background==<br /> *Pathophysiology<br /> **Insufficient ADAMTS-13 activity allows vWF multimers to accumulate in microcirculation<br /> ***Leads to platelet aggregation/thrombocytopenia and hemolysis of RBCs<br /> ****Platelet clots are transient, symptoms, especially neuro, can be in flux<br /> *Similar to but different from [[HUS]] (which is more common in peds)<br /> *[[Microangiopathic Hemolytic Anemia (MAHA)]] + low plts is TTP until proven otherwise<br /> *Can occur as a result of [[Plavix]] (clopidogrel) use (usually within first 2 wk of starting)<br /> <br /> ===Risk Factors===<br /> *Congenitally deficient ADAMTS-13 activity and:<br /> #Pregnancy<br /> #Infection<br /> #Inflammation<br /> #Medication use (quinolones, ticlopidine, clopidogrel)<br /> <br /> ==Clinical Features==<br /> *Pentad (rarely all present)<br /> #[[Microangiopathic Hemolytic Anemia (MAHA)]]<br /> #Thrombocytopenia<br /> #Fever<br /> #Renal pathology<br /> #CNS abnormalities (seizure, AMS, CVA, coma)<br /> *Neuro symptoms are often transient, may not be present in ED<br /> <br /> *TTP pentad mnemonic = FAT RN<br /> **Fever, Anemia, Thrombocytopenia, Renal, Neuro sx<br /> ***All features do not need to be present at the same time<br /> <br /> *Consider diagnosis without the full pentad<br /> **MAHA + Thrombocytopenia + any other feature<br /> <br /> ==DDX==<br /> *Other MAHAs (eg, [[HUS]], [[DIC]], [[malignant hypertension]])<br /> *[[ITP]]<br /> *[[Sepsis]]<br /> *[[SLE]]<br /> *[[HELLP]] syndrome<br /> **Difficult to distinguish<br /> **Anemia, plt count, and LDH tend to be more severe in TTP; LFTs more severe in HELLP<br /> <br /> == Work-Up ==<br /> <br /> *CBC with peripheral smear (anemia, '''schistocytes''', thrombocytopenia)<br /> *LDH (elevated)<br /> *Haptoglobin (decreased)<br /> *Reticulocyte count (appropriate)<br /> *UA (hemoglobinuria) <br /> *Creatinine (possibly elevated)<br /> *LFTs (increased bilirubin) <br /> *PT/PTT/INR (normal; differentiates from [[DIC]]) <br /> *Urine pregnancy (significant association between pregnancy and TTP)<br /> <br /> == Treatment ==<br /> <br /> *Plasma exchange (plasmapheresis) <br /> **Replaces defective or insufficient ADAMTS-13 and clears vWF multimers <br /> *Transfusion <br /> **Indicated if plasma exchange cannot be performed immediately <br /> **FFP <br /> ***Contains ADAMTS-13<br /> **Platelet (only for life-threatening bleeding or intracranial hemorrhage) <br /> ***Platelet infusion may lead to acutely worsened thrombosis, renal failure, and death<br /> *Splenectomy - 2nd line therapy<br /> <br /> ==Disposition==<br /> *Admit for plasma exchange<br /> <br /> ==See Also==<br /> *[[Microangiopathic Hemolytic Anemia (MAHA)]], [[HUS]], [[DIC]]<br /> *[[HELLP]], [[SLE]], [[Antiphospholipid Syndrome (APS)]]<br /> *[[ITP]]<br /> <br /> ==Source ==<br /> *Tintinalli<br /> *Harwood Nuss<br /> *Rosens<br /> [[Category:Heme/Onc]]</div>

Alinker