Wednesday, December 26, 2012

Corrigan's pulse / sign

Watson's water hammer pulse (whp), also known as collapsing pulse, cannonball pulse or pulsus celer, is used to describe a pulse with a rapid upstroke and descent, characteristically described in aortic regurgitation.

Although the term Corrigan's pulse has been used at times synonymously with whp,

Corrigan's pulse/sign is largely used to describe the abrupt distension and quick collapse of carotid pulse in aortic regurgitation whereas

the term 'water hammer pulse' is used for the characteristic pulse seen in peripheral arteries like the radial artery. It may be seen in a number of other conditions and with hyperdynamic circulation

Anti-coagulation for venous thromboembolism

Enoxaparin 1mg/kg twice daily in pts with normal renal function for 4-days alongwith

Warfarin 5mg per day

Target INR is 2-3

Other options are tinzaparin, fondaparinux or ufh

Tuesday, December 25, 2012

IV PPI in PEPTIC ULCER +/- Bleeding

Peptic ulcer bleeding:             Inj. Omeprazole

40mg  i.v.bolus then
6.7mg/h continuousinfusionx72h(160mg/d  after bolus) OR

80mg i.v. bolus  then  8mg/h  continuous  infusionx72h (192mg/dafterbolus)

Bleeding or severeerosive esophagitis: 40mgi.v.oncedailyfor7to10days

Pathologic hypersecretion/ZollingerEllisonsyndrome Stressulcerprophylaxis :

80mgi.v.every12hours;mayincreaseto80mgevery8hoursifneeded;may titratetohigherdosesdependingonacidoutput 80mgi.v.every12hfor24hfollowedby40