observership 2

Atrial fibrillation CHADS(2) score for stroke risk
C congestive heart failure 1
H  hypertension above 140/90  1
A >75                             1
D DM                             1
S previous stroke/TIA/thromboembolism  2

score                          Risk                           anticoagulation therapy
0                                  low                               none or aspirin daily
1                                 moderate                       aspirin or wafarin, aspirin daily or INR 2-3
2 or greater                 moderate or high            wafarin, raise INR 2-3 unless contraindication

OA joint change


asthma exacerbation
detecting the onset of an exacerbation
decrease in peak flow of greater 20% from normal  signals the deterioration
a fall to less than 50% of baseline signals severe attack
treatment:

• duoneb (inhaled albuterol/ipratropium)
• systemic glucocorticoids, for patients w/impending respiratory failure, give methylprednisolone 60-125 mg IV, for majority of less severe, give prednisolone 40-60 mg orally
• continue advair (Fluticasone and salmeterol, Beta;₂ Agonist Beta;₂-Adrenergic Agonist, Long-Acting, Corticosteroid, Inhalant (Oral))
• oxygen maintain SpO2>92%

loss of consciousness

systemic sclerosis