commit 7f11f8e3c557644f9abc9de9a94ace0873a644a8
parent 3c296ea2399bb966119f07e5a6ff305f5ac000b4
Author: Beau <cbeauhilton@gmail.com>
Date: Tue, 30 Nov 2021 23:46:50 -0600
update
Diffstat:
3 files changed, 105 insertions(+), 0 deletions(-)
diff --git a/learn/2021-11-22-mr.md b/learn/2021-11-22-mr.md
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+# Morning Report
+
+## Case
+
+CC: HA, vision loss 4mo
+
+HPI:
+64F, Korean, healthy (minor arthritis).
+Developed daily HA 4mo, intermittent but can last all day.
++jaw claudication, TTP both sides of head. Not positional. APAP w/o much improvement.
+No aura, some +n/v.
+1mo vision loss R eye lateral fields, blurry; R leg weakness, cannot lift leg.
+Daily subjective fevers,
+Mild weight loss.
+
+PCP started pred 20 2-3d with some improvement in arthralgias.
+
+PMH:
+HTN, OA
+
+Meds:
+lisinopril, pred 20 2-3d
+
+FH:
+not much known
+
+SHx:
+moved from Korea in 1980s, no smoking, no EtOH, works as seamstress
+
+PE:
+vss af, +proximal muscle weakness 2/5 R leg, plantar/dorsiflexion intact, sensation wnl. Reflexes 2+.
+Visual fields R sided lateral weakness, nondilated exam w/o macular edema. No rash, all joints wnl.
+
+Labs: Na 129, CBC 11.7, CRP low, ESR 3, INR wnl, LFT wnl.
+
+CXR: L apical PTX.
+CT: 1.8cm LUL mass, spiculated w pleural tenting.
+MRI brain/C spine: L lateral transverse sinus filling defect (not clearly thrombus)
+
+### Pearls
+
+- GCA ~20% have ESR wnl.
+- GCA is MCC otherwise unexplained fever >3wk in adults >60yo (~30%)
+- ESR is primarily measure of fibrinogen concentration, unlikely to drop fast w a few days of relatively low-dose steroids
+- some series describe an increased incidence of malignancy w/in 6-12mo of GCA dx, however it appears this may be mostly d/t increased follow-up and extensive workup
+
+
+## Case
+
+Eos 5200.
+
+DRESS Dx criteria
+- RegiSCAR score:
+ - fever >100.4
+ - LA
+ - eos
+ - >50% BSA rash or bx proven
+ - organ involvement (liver, kidney, lung, heart, muscle, pancreas)
+ - duration >15d
+ - exclusion of other causes (list of labs that need ordered)
+
+PREDICT-1 trial (HLA-B*5701 screening for ABC hypersensitivity)
diff --git a/learn/2021-11-22-noon-conf-acid-base-arroyo.md b/learn/2021-11-22-noon-conf-acid-base-arroyo.md
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+# Acid-base
+
+JP Arroyo
+
+H+ + HCO3- <---> H2O + CO2 ---> Vm
+
+Minute ventilation is a key but often overlooked part of the equation,
+need escape route for CO2.
+
+sugar + O2 ---> ATP + CO2 + H2O <---> H+ + HCO3- ---> CO2 ---> lungs ---> the world
+
+CO2 is a volatile acid, bc its H+ was donated.
+
+Nonvolatile acids: H2SO4 (e.g. muscle breakdown), HCl
+
+Kidney's roles in acid-base:
+
+Circulating: HCO3- 24meQ/L
+Acid production: 1 mEq H+/kg/day
+
+Offset acid production by:
+
+1. reabsorb HCO3-
+2. make new HCO3-
+3. excrete H+
+
+## acid base interpretation
+
+ABG HCO3- is trustworthy, need a concomitant BMP to assess true anion gap
+
+1. internal consistency (ABG and BMP should be drawn close temporally, results w/in about 2mEq)
+2. ?pH - <7.35 or >7.45
+3. assess for primary disorder, (is the compensation appropriate)?
+ - most concerning/difficult/common in sick patients is metabolic acidosis
+ - metabolic acidosis: low HCO3-
+ - metabolic acidosis ---> increased Vm
+ - 1.5(HCO3-) + 8 +/- 2 = predicted CO2
+4. AG (Na+ - (Cl- + HCO3-)) should be ~10
+5. dAG + HCO3- (delta anion gap plus bicarb)
+
+
+Practical: loaded ABG are ok, just don't directly compare the loaded ABG w the same time BMP (use one or the other as able)
diff --git a/learn/2021-11-29-noon-conference.md b/learn/2021-11-29-noon-conference.md
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+
