Anticoagulation

-Heparin IV bolus 5000-10,000 Units (100 U/kg) IVP, then 1000-1500 U/h IV infusion (20 U/kg/h) [25,000 U in 500 mL D5W (50 U/mL)]. Check PTT 6 hours after initial bolus; adjust q6h until PTT to 1.5-2 times control (60-80 sec). Overlap heparin and Coumadin for at least 4 days and discontinue heparin when INR has been 2.0-3.0 for two consecutive days. -Enoxaparin (Lovenox) 1 mg/kg sq q12h for 5 days for uncomplicated pulmonary embolism. Overlap warfarin as outlined above.

-Warfarin (Coumadin) 5-10 mg PO qd for 2-3 d, then 2-5 mg PO qd. Maintain INR of 2.0-3.0. Coumadin is initiated on second day if the PTT is 1.5-2.0 times control. Check INR at initiation of warfarin and qd [tab 1, 2, 2.5, 3, 4, 5, 6, 7.5, 10 mg]. Thrombolytics (indicated if hemodynamic compromise):

Baseline Labs: CBC, INR/PTT, fibrinogen q6h.

Alteplase (recombinant tissue plasminogen activator, Activase): 100 mg

IV infusion over 2 hours, followed by heparin infusion at 15 U/kg/h to maintain PTT 1.5-2.5 x control OR

Streptokinase (Streptase): Pretreat with methylprednisolone 250 mg IV push and diphenhydramine (Benadryl) 50 mg IV push. Then give streptokinase, 250,000 units IV over 30 min, then 100,000 units/h for 24-72 hours. Initiate heparin infusion at 10 U/kg/hour; maintain PTT 1.5-2.5 x control.

10. Symptomatic Medications:

-Meperidine (Demerol) 25-100 mg IV prn pain.

-Docusate sodium (Colace) 100 mg PO qhs.

-Ranitidine (Zantac) 150 mg PO bid.

11. Extras: CXR PA and LAT, ECG, VQ scan; pulmonary angiography; Doppler scan of lower extremities.

12. Labs: CBC, INR/PTT, SMA7, ABG, cardiac enzymes. Protein C, protein S, antithrombin III, anticardiolipin antibody. UA . PTT 6 hours after bolus and q4-6h. INR at initiation of warfarin and qd.

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Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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