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#16
19.07.2011, 14:15
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Öèòàòà:
[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] Öèòàòà:
Öèòàòà:
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#17
19.07.2011, 14:20
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thorn, íà ×Ê âçÿëè ÷åðåç 40 ìèí ïîñëå ïîñòóïëåíèÿ â ÎÐÈÒ.
Àëãîðèòìû ó íàñ õðîìàþò, èíîãäà îíè äàæå ïàðàëèçîâàíû èìïðîâèçàöèåé. Òðîìáîëèçèñ ïî ñêîðîé. Ó íàñ - àíãèíîçíûå áîëè ðåöèäèâèðîâàëè, êóïèðîâàëè íàðêîòîé, íî ðåøèëè ïîéòè íà ×ÊÂ. 40 ìèíóò - óãîâîðû. Ñóäÿ ïî öèðêóëþ - ïîíÿòíî áûëî ÷òî ìíîãîñîñóäèñòîå ïîðàæåíèå. Âåçäå - ïîëíàÿ îêêëþçèÿ. Îò ÀÊØ îòêàçàëàñü â ïðèíöèïå. Çà ýòè 40 ìèí - èíôóçèÿ Èçîêåòà 20 ìë íà ôèçóøêå 200, â îïåðàöèîííóþ òîæå ñ òàêèì æå ôëàêîíîì. Èòîãî: òðåáîâàíèÿ 1ìë/êã áûëè âûïîëíåíû. Ïî ÝÊà - äèíàìèêà óäèâèòåëüíàÿ, ìû ãîðäèëèñü êàêîå òî âðåìÿ. Ïîêà íàñ íå âûçâàëè ÷åðåç 2 äíÿ. Íà ñåãîäíÿ: ìî÷è 2300 ìë, ôóðîñåìèä 120 ìã çà ñóòêè. Êðåàòèíèí â äèíàìèêå ñíèæàåòñÿ (248), ìî÷åâèíà òîæå (24). Ïëàíèðóåòñÿ ïåðåâîä èç ÎÐÈÒ â Ê/Î. Ïîëó÷àåòñÿ, ÷òî êîëõîçíûå ðåêîìåíäàöèè (ôóðîñåìèä 3 ãð, ãîðìîíû è ò.ä.) ïîáåäèëè. Ï.Ñ.: ýòî ïåðâàÿ ÊÈÍ â íàøåì öåíòðå. Îòñþäà ïàíèêà, ñêàíäàëû è ïðî÷åå.
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#18
19.07.2011, 14:29
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IODINATED CONTRAST AGENTS (Both ionic and non-ionic contrast agents): If the serum creatinine is > 1.5 mg/dl or GFR is < 60 ml/min/1.73m2, the radiologist will be notified. If the creatinine is > 1.5 in a diabetic patient, > 2.0 in a non-diabetic patient, or the GFR is < 30, and the referring physician and radiologist have determined that a contrast-enhanced imaging study must be done to obtain critical medical information, the contrast may be given after considering the following precautions:
1. Discuss the risks, benefits, and alternatives with the patient. 2. Obtain signed consent from the patient. If patient is unable to give consent, do not give contrast agent unless a physician obtains consent from responsible family members, or the referring physician provides a “double-doc” signed consent indicating the medical necessity of giving the contrast agent. The radiologist must write the order for contrast agent, including the specific agent, dose, and reason for taking the risk. 3. Patient should be treated with one of the following: a. Mucomyst (N-acetylcysteine) • Orally, 600 mg twice daily on the day before and the day of the contrast imaging study, or • Intravenously, 150 mg/kg over 30 minutes before contrast administration, followed by 50 mg/kg over 4 hours. b. Bicarbonate 150 mEq in 1000 cc D5W, 3ml/kg bolus, then 1 ml/kg/hr x 6 hours. 4. Adequate patient hydration must be maintained (See Section E). For patients with end stage renal disease who are on chronic peritoneal dialysis, non contrast should be considered and contrast should only be administered after discussion with the patient's nephrologist. For patients with end stage renal disease who are on chronic hemodialysis, the use of high osmolar agents should be avoided
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#19
19.07.2011, 14:35
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Öèòàòà:
Åñëè ïðèãîäèòñÿ êîìó, òî âîò òàêîé àëãîðèòì ó íàñ:
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#20
19.07.2011, 14:48
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Öèòàòà:
Öèòàòà:
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#22
19.07.2011, 15:23
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"Äîâîëüíî ñïîðíûå ðåêîìåíäàöèè ïî àöåòèëöèñòåèíó."
The popular regimen of oral acetylcysteine, 600 mg twice daily on the day before and on the day of administration of iodinated contrast media, is simple, inexpensive, and has few contraindications (although allergic reactions have been rarely reported). However, higher doses may be more effective if the agent is effective at all, and there is controversy over whether solid (not currently available in the USA) or liquid preparations are equally effective. Alternatively, an IV regimen beginning 30 minutes prior to contrast media administration may be considered (150 mg/kg in 200 ml of D5W over 30 minutes, followed by 50 mg/kg in 500 ml of D5W over 4 hours). However, IV administration may have a higher rate of adverse effects than oral administration..... [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
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#25
19.07.2011, 15:29
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Öèòàòà:
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#27
19.07.2011, 15:37
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FRSM, êîëè÷åñòâåííóþ îöåíêó ïðåäîñòàâèòü íå ñìîãó. Ñóáúåêòèâíî - ìíîãî, äîëãî. ß â ãðîìêîãîâðèòåëü ïðèçûâàë óñêîðèòü ïðîöåäóðó. Ïàðàëëåëüíî øëà èíôóçèÿ, îòâå÷àþùàÿ òðåáîâàíèÿì.
Ñêàæèòå ïîæàëóéñòà, êàêèå èìåííî äàííûå Âû áû õîòåëè óâèäåòü. ß èõ íàéäó.
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#29
19.07.2011, 15:47
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Ðå÷ü èäåò î ÕÏÍ, äåêîìïåíñèðîâàííîé ÊÈÍ. Êîëëåãè ïðîòèâ ìîåé ïîçèöèè. Ñ÷èòàþò, ÷òî ýòî ÷èñòàÿ ÎÏÍ. Íî ÌÛ ÒÎ ÇÍÀÅÌ
 Åñëè ñåðüåçíî, òî ìíå íåëîâêî. Óãîâàðèâàë íà êîðîíàðîãðàôèþ, â èòîãå-òàêèå ïðîáëåìû.ß ïðèñóòñòâîâàë ïðè ñòåíòèðîâàíèè. Ïðåäóïðåæàë æå. À íà óòðî êòî êðàéíèé? ß. Ìîæåò ýòî è ïðàâèëüíî.
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#30
19.07.2011, 16:02
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Öèòàòà:
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Ëèíåéíûé âèä
