l****z
发帖数: 29846 | 1 By JENNIFER CORBETT DOOREN
The Food and Drug Administration said Wednesday it found 14 additional
Chinese companies supplied contaminated raw material to make heparin, a
widely used blood thinner.
The companies supplied the materials in 2008, when the FDA found a link
between contaminated heparin marketed by Baxter International Inc. to some
Chinese suppliers of the active ingredient used in heparin. The
contamination was linked to 80 deaths in U.S. patients and hundreds of
allergic reactions. T... 阅读全帖 |
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I*****y
发帖数: 6402 | 2 heparin is like DNA in terms of charge, so lots of transcription factors
like to bind heparin.
heparin |
|
c***y
发帖数: 615 | 3 知道heparin可以用来purify transcription factor. 最近看的一片文章里， heparin
与 target RNA 共同加到cell extract里， 想问一下， 这样是为了减少非特意性结
合吗？ 多谢。。。 |
|
l***d
发帖数: 1828 | 4 http://www.personalinjurylawyeramerica.com/medical/heparin.htm?gclid=CIbMxc7V8pECFQWnlgodPS5MyA
On February 11, 2008, the Food and Drug Administration ("FDA") announced
that the use of heparin in multi-dose vials made by Baxter International Inc
., has been tied to dangerous side effects in patients, including low blood
pressure, vomiting and difficulty breathing. The FDA reported up to 21
deaths and 448 allergic reactions may be linked to the blood thinning
product. As of February 28, 2008 Baxt |
|
d*******e
发帖数: 16 | 5 What I had is Lovenox ( similar medicine like Heparin ), my dosage is 30 mg
per day. Both Heparin and Lovenox is very easily to make the injection site
bruise, it's ok. You can try ice the spot before the injection, but I'm fine
doing it without icing step. |
|
a**********9
发帖数: 348 | 6 【 以下文字转载自 ChinaNews 讨论区 】
发信人: alexandria99 ( ), 信区: ChinaNews
标 题: Chinese fake heparin
发信站: BBS 未名空间站 (Mon May 5 00:15:46 2008)
中国供应商用过硫酸化的硫酸软骨素来冒充肝素，因为两者在化学性质上类似，前者来
自动物软骨，后者来自动物小肠，前者比后者便宜若干倍。硫酸软骨素本身无毒，是一
种保健食品，但过硫酸化的硫酸软骨素是可能导致过敏反应的。
上次中国供应商用有毒的化学物质三聚氰胺来冒充宠物食品中的蛋白质也是一样的道理。
更早还有中国供应商用有毒的化学物质替代甘油（二甘醇）来冒充甘油（丙三醇）。
中国化学专家在间接杀人。 |
|
a**********9
发帖数: 348 | 7 【 以下文字转载自 ChinaNews 讨论区 】
发信人: alexandria99 ( ), 信区: ChinaNews
标 题: Chinese fake heparin
发信站: BBS 未名空间站 (Mon May 5 00:15:46 2008)
中国供应商用过硫酸化的硫酸软骨素来冒充肝素，因为两者在化学性质上类似，前者来
自动物软骨，后者来自动物小肠，前者比后者便宜若干倍。硫酸软骨素本身无毒，是一
种保健食品，但过硫酸化的硫酸软骨素是可能导致过敏反应的。
上次中国供应商用有毒的化学物质三聚氰胺来冒充宠物食品中的蛋白质也是一样的道理。
更早还有中国供应商用有毒的化学物质替代甘油（二甘醇）来冒充甘油（丙三醇）。
中国化学专家在间接杀人。 |
|
a**********9
发帖数: 348 | 8 【 以下文字转载自 ChinaNews 讨论区 】
发信人: alexandria99 ( ), 信区: ChinaNews
标 题: Chinese fake heparin
发信站: BBS 未名空间站 (Mon May 5 00:15:46 2008)
中国供应商用过硫酸化的硫酸软骨素来冒充肝素，因为两者在化学性质上类似，前者来
自动物软骨，后者来自动物小肠，前者比后者便宜若干倍。硫酸软骨素本身无毒，是一
种保健食品，但过硫酸化的硫酸软骨素是可能导致过敏反应的。
上次中国供应商用有毒的化学物质三聚氰胺来冒充宠物食品中的蛋白质也是一样的道理。
更早还有中国供应商用有毒的化学物质替代甘油（二甘醇）来冒充甘油（丙三醇）。
中国化学专家在间接杀人。 |
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c***y
发帖数: 615 | 9 这里已经有target RNA, 再加heparin是为了降低背景吗? |
|
f*****s
发帖数: 104 | 10 以前一直用GE (amersham)的Heparin Sepharose CL-6B提纯几种transcription factor
. 现在发现市面上已经没这种产品了。有没有人知道是否有什么替代品？ |
|
e****s
发帖数: 1125 | 11 那用Heparin sepharose fast flow就行了。
factor |
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w*******d
发帖数: 7 | 12 我正在准备CCS，发现有些病例的处理才写到一半，时间才过7分钟左右，那个最后5分
钟医嘱就跳出来了，比如UNSTABLE ANGINA 病例，才写到给HEPARIN，后面的ICU还没有
送，最后5分钟医嘱就出来了，是怎么回事？急求指导。下周考。 |
|
L*********h
发帖数: 44 | 13 请问，有姐妹注射 HEPARIN 吗？我打了两个星期，肚皮上青一块紫一块的。老公看了
心痛的要命。有没有啥好方法？
也不知道打了干吗。医生说打就打了。不打行吗？
谢谢 |
|
发帖数: 1 | 14 12月26日 事实的真相
以前我们分析过，Augusta, GA 只是这个人体基地的一个点，而且我们也追踪到还有一
个点在加州。那么经过更多的分析，显示事实的真相可能是如此。这些地下通道是很久
以前就存在的，是为了战争或避难用的，后来在南北战争中，又充当奴隶逃跑到北方的
通道。那么在后来的后来，就被一些别有用心的人充当了非法活动的场地。而到了80年
代后，日本人就加入进来，把其改造成了一个军事，人体实验基地，成了报复美国的一
种手段。当然，我也强调历史和解，仇恨和解，但要在正确的认知，悔改下的和解。如
果一边在屠杀受害者，一边高谈和解，并千方百计掩盖事情真相的曝光，这不是悔改的
表现，最多是转移了屠杀的目标，我们不能原谅罪恶势力彼此勾结下的和解。根据分析
，这个基地的入口就在Deerfield, ILLinois. 世界每一个人都是这个基地的受害者，
都是这些大药厂的受害者，受害者以亿为单位来计算。你们很可能都在不知不觉中受到
了他们的伤害，请把信息传达到世界每一个角落，让我们一起携手和世界上最邪恶的势
力做顽强的斗争，他们现在还在屠杀无辜的受害者，每天在我家里杀人。请你们和我站
在... 阅读全帖 |
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h******c
发帖数: 10 | 15 我也认为她的上级住院甚至主治在推卸责任，但Du确实有无法推卸的责任。
主要的问题是作为医生她应该知道这个heparin应该不应该停？应该什么时候停？她应
该是有块一年经验的intern了，她应该知道停这个heparin的利害。看样子她同时把查
PTT也都给忘了。Heparin是半夜停的，就算一早要作造影也用不了怎么早就把heparin
停了吧。而且早晨查房，这一帮住院/主治就硬是没发现。
再有她也是没经验，那些术前的医嘱本应该让那些外科/放射科医生去写的，作为内科
的医生她至多也就是和外科/放射科医生沟通做好术前准备，而术前医嘱包括什么时间
停heparin是外科/放射科的事。这并不是逃避责任，而是对病人负责。Du的例子里，那
个angiogram到底做不做，什么时候做，这都只有放射科的才知道，应该让他们来决定
什么时间停heparin。Du应该做的是与放射科沟通，而不是听说早上要作造影，半夜就
把heparin停了。
一般讲手术前2-4小时应该停掉heparin drip，但这不是绝对的。根据病人的情况和手术的需要，有的时候需要继续heparin drip，这方面内科医生应该事先与外 |
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j********4
发帖数: 44 | 16 昨天上班,晚班护士交班说一个新病人的heparin drip just release hold around 6am.
我也没经验,没多问一句heparin 上了没上.等我到病房do assessment 才发现病人没上
heparin. 我忙着give 9am meds.到了9;30,我想起了这回事,就call MD,问要不要上.结果
此MD不是晚班的那个MD.她不知道heparin hold between 4am-6am 这回事.而我也不清楚
从order time 6pm-7am 这段时间heparin 上没上.plus,I completely forgot about the
release hold order.于是乎,MD want me restart heparin immediately, and this
incident must report into PORT(医院的内部事故处理系统).我就report了.还好,
patient's vss,也不知情. 现在下班回家,心里一直堵得慌.其实我要是直接上了药在0730
就没事了.我想,到时候,PORT 查起来 |
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f*******c
发帖数: 94 | 17 For this topic, why not ask me, in fact I am specialist in this area (
bioseparation). For Heparin，small MW heparin is not easy to be obtained
with high purity, it need specific enzyme digestion and downstream affinity
purification, virus need be clarified by membrane filtration and solvent
treatment. In addition recombinant heparin and synthesis heparin did not
show similar bioactivity or therapeutic results in clinic I and II test.
Heparin is a sugar with multiple SO3H group, it is not peptide |
|
V*****G
发帖数: 337 | 18 Here is my understanding about treatment of stroke, please correct me if I
was wrong.
1. For ischemic stroke, tpa if within 3 hours , otherwise supportive only.
No routine heparin regardless of dissection or not. But if there is A-fib,
can use heparin.
2. For homerrhagic stroke, control bp. Prevent increased icp, surgery if
indicated. R/o bleeding disease, No heparin.
3. Carrotid dissection is contradiction of heparin.
4. For vasospasm, give amlodipine, no beta blocker. Do we need heparin in
t... 阅读全帖 |
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s*******0
发帖数: 249 | 19 下夜班做交班报告时manager跑到我这里说让我走之前去他那里一趟。于是在做报告时
心里惴惴不安
的，心想这下可坏了，不知道哪里又捅娄子了。。 到了办公室后manager从电脑上掉出
来个
incident report,大概是说两个行期前的一天一个病人的heparin drip的drip rate 设
定的
跟系统里填写的不符，系统里写的是1200Units/hr,泵上却是1024Units/Hr,另外系统里
记录的
heparin bolus没有oder的记录。 然后又说下一个班的护士抽了一次ptt/pt/INR 结果
ptt
>145, pt也极高，只能停掉了heparin drip换成了lovenox. 好在我老当时脑子还没全
糊涂
（刚下12小时夜班），还记得当时的一些情行。我说记得当时的bolus的量是根据order
中调整
heparin drip rate计算公式算出来的,而且是有第二个人给核实的，不知道为什么会出
现这种情
况。于是manager就把当天的charting 记录掉了出来，看了看记录，发现当时我就这个
drip
rate change特地做了背书，说明根 |
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l*******8
发帖数: 1745 | 20 40y AAF severe obese,new onset massive PE, b/l upper and lower lobes and R
middle lobe pulmonary artery emboli, r back pain and sob 4 days, no any PMH
except psych histry, no travel histry, not taking OCP, no family histry of
DVT or PE, this is her first time onset
the key is vitals are stable, oxygenation is good on room air, little bit
sinus tacky, I report to PCP and asked him what his treatment plan is:
anticoagulation v.s. thrombolytic therapy ( acturally only unstable pt will
use thromboli... 阅读全帖 |
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p*******e
发帖数: 143 | 21 The recent heparin recall rising more concern over the safety of drugs made
in China. Oversulfated chondroin have been found in heparin. This
contaminant is a chemically altered from chondroitin that can mimic heparin
activity, but is cheaper to make. It is traced to Chinese processor that
supply heparin to baxter and other companies.
I met an old white lady recently asking for counseling. She just wanted to
know the medications she is currently taking are not made in China. I was
sad and very u |
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f*********1
发帖数: 189 | 22 A++. 请过来讲讲：
Can aspirin itself cause bleeding?
Can heparin itself cause bleeding?
Will heparin and aspirin together promote more bleeding?
What is the most easily bleeding site/organ for a patient on aspirin?
What is the most easily bleeding site/organ for a patient on heparin?
Aspirin and heparin have frequently showed up in USMLEs and been frequently
used clinically, but I am still 雾里看花，一知半解：）
在哪里看到一个不是医生的病人家属写的可怕的故事，印象是美国的几种抗凝药里，有
一种中国人如果用了，副作用比较大？ |
|
j****y
发帖数: 1714 | 23 Deadly Medicine
Prescription drugs kill some 200,000 Americans every year. Will that
number go up, now that most clinical trials are conducted overseas—on
sick Russians, homeless Poles, and slum-dwelling Chinese—in places where
regulation is virtually nonexistent, the F.D.A. doesn’t reach, and
“mistakes” can end up in pauper’s graves? The authors investigate the
globalization of the pharmaceutical industry, and the U.S. Government’s
failure to rein in a lethal profit machine.
BY DONALD L. BARLET... 阅读全帖 |
|
s******y
发帖数: 28562 | 24 Polysome purification and fractionation
(Based on Davies & Abe, 1995, Methods in Cell Biology, Vol 50, Chapter 15)
1. Prepare 4.6ml 15-60% sucrose gradients in 5ml polyallomer tubes (Beckman
#326819) by
pipetting 2.3ml of 60% sucrose in buffer B followed by 2.3ml of 15% sucrose
in buffer B
(slowly, drop by drop, against the wall). Cap the tubes with rubber stoppers
and lay tubes
horizontally for 3h @RT for sucrose to diffuse (or for 2h if making 10-40%
gradient). Place the
tubes again vertically... 阅读全帖 |
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y*****g
发帖数: 193 | 25 My patient today is a over 300lb male. He was admitted with firm distended
abdomen, SOB and hypotension. Physician suspected pt had pulmonary embolism,
and ordered heparin. The night shift nurse said No to physician about
heparin. If no test done to rule out internal bleeding, she will give none
of heparin. PEA arrest later,ACLS got pt back, hemoglobin found dropped from
11 to 5. Numerous blood products given. CT-scan later found a large
retroperitoneal hematoma 22cm*24cm, and pt also was found |
|
b********0
发帖数: 13 | 26 Baxter and BBraun are getting a huge profit from Made in China heparin. Even
Sanofi-Aventis is having a good deal by degrading China heparin to Lovenox
and making over 1b each year. They are well aware of taking advantage of
China heparin. However, when medical issues emerge like this one, to avoid
tedious law process, such as Vioxx with Merck, they have to find someone to
blame for and pull their own feet out of mud. Unfortunately, this time is
China. |
|
l******k
发帖数: 27533 | 27 Antithrombotic management for surgery:
Axillofemoral bypass surgery is not a procedure with minimum bleeding risk.
Actually, all cardiovascular surgeries have high bleeding risk.
Prior surgery: aspirin should be held for 5-7 days; It's appropriate to hold
warfarin and bridge it with parental short acting anticoagulant. warfarin
only needs to be held for 5 days. Bridging by enoxaparin is a good choice.
Make sure the last BID dose is given 12 hours before the surgery. It's not
necessary to change ... 阅读全帖 |
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f*********1
发帖数: 189 | 28 Questions:
Can aspirin itself cause bleeding?
Can heparin itself cause bleeding?
Will heparin and aspirin together promote more bleeding?
What is the most easily bleeding site/organ for a patient on aspirin?
What is the most easily bleeding site/organ for a patient on heparin?
Some who can help with the answers? thank you. |
|
T*R
发帖数: 36302 | 29 HEPARIN便宜吧，全世界的HEPARIN都是四川养猪场出的。
SCD可以吧？
我现在越来越懒。但是对待手术病人还是老实，都是按规矩来。该干什么干什么。
钱的 |
|
a**l
发帖数: 1166 | 30 请懂行的一定帮忙回答：
我父亲75，大概2年前开始没有任何预兆地摔跤，他最近几年查出来有轻微糖尿病，几
家医院做CT, 都说脑里有阴影（血栓），开始服阿斯皮林aspirin, 今年还是每一/二个
月要摔跤，我想问他这种情况能根治不？国外我看医生给病人输heparin, 查PTT， INR
, 我父亲现住在以疗养为主调老年医院，医院绝对没有提过输heparin, 我是否该给医
生建议，先在这里问一下再说； |
|
c*********r
发帖数: 541 | 31 来自主题: MedicalCareer版 - 请教啊！ 我觉得是不是怎么也要等cat scan出来才给heparin吧。我在er没见过谁上来就给
heparin的
just |
|
l*******8
发帖数: 1745 | 32 来自主题: MedicalCareer版 - 请教啊！ Same here, every patient if no major risk, all have heparin 5000 sc q12h or
lovenox 30 mg sc q12h as dvt prophylaxis,
and everyone use nexium 40 mg po qd as GI prophylaxis
人都是用heparin来DVT
prophylaxis. 在国内很少见用的，即使是大手术的病人，就看到有做心脏手术有用的
，也没见谁得DVT或PE了。
是不是我太孤陋寡闻了？谁来解一下惑。 |
|
k**********n
发帖数: 438 | 33 病人胳膊肿不肿？如果肿，血压测不准。我有一个病人就是这样，术后ICU给灌的一塌
糊涂，她血压总是偏低，用midodrine 10mg tid，护士还page我说低，都50多了，我赶
紧给了100ml albumin (ESRD on HD)。等跑过去一看病人很舒服，自己量了一下血压其
实是80多。你们dopamine drip在病房用吗?护士很强大。至于用 heparin drip，估计
就是像逆风MM说的，如果要是有可能做啥手术的，heparin drip比lovenox更容易控制
些。 |
|
yf
发帖数: 272 | 34 heparin drip and then coumadin
or low molecular weight heparin(fragmin or lovenox）and then coumadin if pt'
s renal function is good.
check PT/INR q weekly in the first month if stable, change to every month.
Need very good compliance and regular follow up. The course of treatment is
dependent on the cause of DVT or PE |
|
n***8
发帖数: 634 | 35 是 continue low molecular weight heparin 吧.
我FA 上肯定看到过, 说WAFARIN 通INACTIVATE PROTEIN C 导至皮肤坏死, 所以
HEPARIN 要和WAFARIN 共用一段时间的. |
|
u***e
发帖数: 611 | 36 这个阿三确实还挺极品的，我还从没碰到到这种会在attending面前当面告状的senior,
而且heparin drip一开始本来就该给bolus的，一开始APTT都还没到target range，怎
么会造成出血。而且heparin造成的出血，so what，一停drip就止住了。
residents |
|
r*****1
发帖数: 805 | 37 My CCS protocol:
P.S.：多有重复，谨防遗漏，仅供参考。
Screening test: General—Lipid profile/ multi-vitamin; Elderly—DEXA scan&
Calcium& VitD/ Colonscopy or FOBT/ vaccination; F-- >18yo Pap smear; >50yo
Mammogram; reproductive age- folate; menopause- Lipid/DEXA/FOBT; M-- >50yo
PSA; sickle cell dz child-prophylaxis w penicillin till 5yo, CF-prophylaxis
w Abx
Prophylaxis: Pantoprazole, pneumatic compression stocking;
Acute abd w perforation: triple Abx- Gentamycin/ Ampicillin/
Metronidazole (口诀：阿扁举旗庆国庆)
E... 阅读全帖 |
|
z******8
发帖数: 844 | 38 ☆─────────────────────────────────────☆
rhcrc11 (Rebel) 于 (Thu May 15 00:13:42 2014, 美东) 提到:
Step3考场壮烈回来。第一天挺累人，最后一个block甚至做到有心无力状，看着题反应
不过来，导致来不及做完。非常没有信心能否通过。所以match之前先考Step3的童鞋，
需要考前调整生物钟，坚持锻炼，提高耐力。
MCQ没有资格说，CCS有一点小感受，拿出来分享下。大家请轻拍砖。
复习资料：
UW 52 online cases : 基础。最好复习早起找高手一起过一遍，尽快摸熟软件，进入
状态。第二遍找一位水平相近童鞋过一遍，不断总结protocol. 考前迅速做一遍，熟练
运用protocol.
UW 41 offline cases: 我当时和partner每个case仔细做一遍，虽然不像online有反馈
，但对练临床思维，补充protocol非常有帮助。最后考试与41 case有异曲同工之处，
遇到复杂case也不慌神。
CD 6 cases： 最后再熟悉下考试软件。与UW相近，但... 阅读全帖 |
|
t********o
发帖数: 228 | 39 Just found out i passed it. Well, not a big surprise and finally, I can say
good by to USMLE
Material: MTB3 and UptoDate. Step 1/Step2: 250/249 but those were 3 years
ago. Step 3: 227. Time: on/off for 3 months.
Good luck to everybody.
Not a whole lot of thoughts about this test. if you can memorize MTB3 and UW
, then there should be NO problem to pass it.
here are some thoughts about this CCS (combined mine and others)
Step I: patients: VASCULAR
Vitals/Age/Sex/Chief complaint/Urgent sympt... 阅读全帖 |
|
m*******e
发帖数: 1886 | 40 关于heparin，你的preceptor是对的。我更＂过分＂，我经常把heparin hold, 然后去
忙另一个病人，15-20分钟后回来，flush the line well, waste the first 10cc
then get the blood I need。几次contaminated sample之后, 我觉得只有这样搞，
sample才让我放心。 |
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s*******y
发帖数: 1739 | 41 line draw，我的一个patient有central line and second patient had a picc line.
我的preceptor 告诉我抽血的时候，如果患者有heparin, 要stop heparin for 5
minutes and then draw line. if tpn， 要flush really well before line draw.
可是我的患者告诉我，nobody wait for 5 minutes. 请有经验的朋友clarify 一下。 |
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l**********t
发帖数: 1212 | 42 欧，是这样，我的PRECEPTOR 说正常情况是FLUSH 10CC, WASTE10CC, 然后DRAW LINE,
在FLUSH 10CC,最后换CAP。 我抽的时候看到以前的CAP上有干的血，应该是上一次抽完
没有换CAP。 这个步骤对吧。
要是有HEPARIN, TPN， 就要STOP 5-15分钟，然后FLUSH 20CC,WASTE 10CC, DRAW LINE
, FLUSH 10CC, CHANGE CAP, RECONNECT HEPARIN. RIGHT?
在 meanwhile (meanwhile) 的大作中提到: 】 |
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y******7
发帖数: 17 | 43 The following is what I collected when I was a student doing capstone in a
local hospital. Not sure if it is useful.
Lidocaine topical is a amide-type local anesthetic. for production of
topical anesthesia, relief of pain associated with postherpetic neuralgia,
reduction of gagging during dental procedures, prevention and control of
urethral pain, anesthetic lubricant for endotracheal intubation, and relief
of hemorrhoidal pain.
Polyethylene glycol(Miralax) is a nonabsorbed solution used to trea... 阅读全帖 |
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o******h
发帖数: 198 | 44 即日起 大家有空发一些匿名的病历讨论吧 熟悉一下病历书写和缩写吧
有不懂的可以提问 有工作经验的同学路过可以帮助回答
回帖的同学 第一部分请写你的问题， 第二部分请写你知道的答案 谢谢!
不会念医学单词的可以查这个 没有声音的 按允许pop up插件即可
http://www.merckmanuals.com/home/resources/pronunciations/index
xxx year old F with a pmh significant for dementia,asthma, dvt, pe in 2011,
htn, osteoporosis, rectal bleeding, new dvt rt. Leg 03/31 restarted on
Coumadin and lovenox, non verbal sent from NHF on 4/3 for drop in H/H 7/23.
On arrival V/S: 153/51, 74, 20, 99.4 and o2 100% on ra. Awake and non verbal
, neuro... 阅读全帖 |
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j*******1
发帖数: 266 | 45 “我个人不认为西医或者FDA的办法就是全对，但是你所想要推进的东西在目前的技术
手段下，我个人是绝对不赞成的。”
我个人认为西医或者FDA的办法是对的，但它有本身的限制。光学显微镜看到细菌的结
构是对的，但它看不到病毒的结构。什么是我所想要推进的东西在目前的技术手段？
Enoxaparin 和Pentosan Polysulfate sodium 是每个的通过FDA三期试验的药物，
Enoxaparin 是low-molecular-weight heparin，它们的分子量不同，但还是heparin (
C26H40N2O36S5)n，它的话性成分是(C26H40N2O36S5)n
http://en.wikipedia.org/wiki/Enoxaparin_sodium
Pentosan Polysulfate sodium 性质类似。
http://en.wikipedia.org/wiki/Pentosan_polysulfate
它们都是polymer, 分子量不同，基本结构一样，和我说谈到不同结构的compounds 是
不同的概念，它们能治我所说的第三类疾病？
“com... 阅读全帖 |
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s********4
发帖数: 64 | 46 CC: Axillofemoral bypass surgery for an occluded right limb
HPI: 62 yo male with antiphospholipid syndrome presents to VAMC for
scheduled axillofemoral bypass surgery on 10/22. Patient was instructed to
hold warfarin and start enoxaparin for bridging prior to surgery. Patient
was admitted pre-op on 10/21 and switched to a heparin drip for
anticoagulation. Surgery was completed successfully with no complications
on 10/22. Post operatively patient feels much better with minimal pain in
his fo... 阅读全帖 |
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Y**i
发帖数: 24 | 47 I am thinking the patient's HIT assay is positive, also the patient is
experiencing low platelets count(normal range is 150-450x10E3). so the
patient is experiencing HIT(heparin-induced thrombocytopenia. need to stop
heparin right away, and change to Argatroban or other anticoagulant.
我在这儿抛个砖，目的是引出个玉来。 |
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A*******s
发帖数: 9638 | 48 昨天晚上睡得晚， 3am医院ICU page我， 我迷迷糊糊打电话， 刚说我不oncall，对方
说了个名字，我一下子全醒了。
这个病人是我的一个老病人， 在医院工作，67岁，她有osler-weber-rendu disease，
epistaxis是常事， 最近出现A-Fib， 因为coumadin引起出血， 所以不能服。
一个星期以后， 她出现中风，因为出血的原因， 不能上heparin， 第二天她在医院又出现右手臂动脉栓塞。 所幸手术后没事。 没办法，她需要抗凝， 所以开始服用Pradaxa。
出院后epistaxis似乎没大问题， 没想到她出现贫血， 血色素只有6。 入院后输血， Pradaxa只能停掉。
(中文太难打了。。。）
I started her on heparin. Consulted GI/Surgery for endoscopy. Surgery did
the upper and lower GI scope and I was told she has possible AVM but no
active bleeding.
I do not kn... 阅读全帖 |
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A*******s
发帖数: 9638 | 49 I am aware of the study. Thanks for the link.
Her CHA2DS2-vasc score is 4, same as HAS-BLED Score. Risks for stroke and
bleeding are 2% and 8% respectively. But we can not only use the numbers.
These numbers tell us she is on high risks for stroke as well as bleeding.
She was not started on OAC after being found to have A-fib. After she had
the stroke, she was not started on heparin either. But on the 2nd day of stroke, she had
the 2nd emboli to right arm. Then she was started on heparin. Aft... 阅读全帖 |
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A*******s
发帖数: 9638 | 50 昨天晚上睡得晚， 3am医院ICU page我， 我迷迷糊糊打电话， 刚说我不oncall，对方
说了个名字，我一下子全醒了。
这个病人是我的一个老病人， 在医院工作，67岁，她有osler-weber-rendu disease，
epistaxis是常事， 最近出现A-Fib， 因为coumadin引起出血， 所以不能服。
一个星期以后， 她出现中风，因为出血的原因， 不能上heparin， 第二天她在医院又出现右手臂动脉栓塞。 所幸手术后没事。 没办法，她需要抗凝， 所以开始服用Pradaxa。
出院后epistaxis似乎没大问题， 没想到她出现贫血， 血色素只有6。 入院后输血， Pradaxa只能停掉。
(中文太难打了。。。）
I started her on heparin. Consulted GI/Surgery for endoscopy. Surgery did
the upper and lower GI scope and I was told she has possible AVM but no
active bleeding.
I do not kn... 阅读全帖 |
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