[CK - summary ] Warfarin chronic dose, dosing.

https://my.clevelandclinic.org/ccf/media/Files/anticoagulation-clinics/practical-tips-for-warfarin-dosing-and-monitoring.pdf

[CK[ TR band managment. 2HOURs and deflate 15mins

https://california.providence.org/~/media/Files/Providence%20CA/Torrance/care_of_the_patient_following_cardiac_catheterization.pdf

[CK] Acute infarct or TIA without evidence of mechanical or existing thrombus = NO AC. ONLY ASA for now!!! TIA WITHOUT AC! (1week)

https://www.uptodate.com/contents/antithrombotic-treatment-of-acute-ischemic-stroke-and-transient-ischemic-attack?search=tia&sectionRank=3&usage_type=default&anchor=H346089098&source=machineLearning&selectedTitle=5~150&display_rank=5#H1180709

ACUTE ANTITHROMBOTIC THERAPY: 1-2weeks to resume. If it's pretty small/TIA, then oral AC could be earlier after 24hours. Small: 1 week without IV. With PO(as early as after 24hours in cardioembolic with Coumadin! for the small but high risk of recur)Large: 2 weeks===> BiG  no!! ask neuro. mostly 2weeks.====> Small. Can be initiated in 1 week. but Early coumadin is still safe.. TIA.In patients with atrial fibrillation who suffer an ischemic stroke, acute antithrombotic therapy (algorithm 1 and algorithm 2) may be warranted both to reduce disability and the risk of early recurrent stroke, which is 3 to 5 percent in the first two weeks [11,12]. These benefits must be balanced against the risk of intracranial bleeding with antithrombotic therapy. The management of acute antithrombotic therapy in patients with stroke is discussed in detail elsewhere. (See "Antithrombotic treatment of acute ischemic stroke and transient ischemic attack".)

Anticoagulants were associated with a nonsignificant reduction in recurrent ischemic stroke within 7 to 14 days (3.0 versus 4.9 percent, odds ratio [OR] 0.68, 95% CI 0.44-1.06)

●Anticoagulants were associated with a statistically significant increase in symptomatic intracranial hemorrhage (2.5 versus 0.7 percent, OR 2.89, 95% CI 1.19-7.01)

●Anticoagulants and other treatments had a similar rate of death or disability at final follow-up (approximately 74 percent)

Thus, the results do not support early anticoagulant treatment of acute cardioembolic stroke [28].

While parenteral anticoagulation is not recommended during the first 48 hours after acute ischemic stroke, oral anticoagulation is recommended for secondary stroke prevention in patients with atrial fibrillation and other high-risk sources of cardiogenic embolism. The timing of its initiation for such patients is mainly dependent on the size of the infarct, which is presumed to correlate with the risk of hemorrhagic transformation. Thus, for medically stable patients with a small or moderate-sized infarct, warfarin can be initiated soon (after 24 hours) after admission with minimal risk of transformation to hemorrhagic stroke, while withholding anticoagulation for two weeks is generally recommended for those with large infarctions, symptomatic hemorrhagic transformation, or poorly controlled hypertension. (See "Stroke in patients with atrial fibrillation", section on 'Timing after acute ischemic stroke'.)

[CK] Temporary pacing

Place pad
- Rt. clavicle
- Lt. rib

PM
- manual
- HR 80
- increase until captured.

[CK] IVIG indication for OHT patient.

low IgG with....
+

1)Infection
2) esp. CMV -> CMV Ig

3)OHT rejection

concern) volume issue!

[CK] way of order gallium scan.

Gallium scan

NM: Infetion localization: Wholebody

[CK] Prep Stress test - no BB(for 48hours) no CCB(24hours) no caffein(24hourS)

Do not eat or drink caffeine products (chocolate, soda, tea, coffee or Excedrin®) for 24 hours before exam. Note: Decaffeinated products contain caffeine.

Consult your physician about going off beta blockers for 48 hours and calcium channel blockers 24 hours before your exam.

[CK] Get EKG lecture, ECHO lecture as much as []

https://ecgwaves.com/ecg-st-elevation-segment-ischemia-myocardial-infarction-stemi/

[CK] hypoimmunoglobulinemia MRN: 7194137

Dosing in different disorders — Dosing varies depending upon whether the IVIG is administered for the purpose of preventing infections in immunodeficient patients or for suppression of an inflammatory or autoimmune process.

Immune deficiencies — IVIG doses in the range of 400 to 800 mg/kg/month are usually used for replacement therapy in patients with immune deficiencies. Bolus doses may be given every three to four weeks. Typical starting doses are in the range of 400 to 600 mg/kg. Lower weekly doses are used for subcutaneous immunoglobulin replacement therapy (eg, 100 to 150 mg/kg weekly) [33,66]. The use of subcutaneous immune globulin (SCIG), including hyaluronidase- and nonhyaluronidase-containing preparations, is reviewed in detail separately. (See "Subcutaneous and intramuscular immune globulin therapy", section on 'Administration and dosing of SCIG'.)

Dosing of IVIG can be adjusted depending on the patient's progress (eg, frequency of infections). Some patients may need higher or more frequent doses to remain free from acute infections; to control chronic infections, particularly of the sinopulmonary tract; and/or to maintain target serum immunoglobulin G (IgG) levels. As such, dosing is quite variable among patients in that each patient may have their own dosing requirements [63,67]. Compared with subcutaneous dosing given more frequently, bolus IV dosing yields lower serum levels of IgG at the end of each dosing interval as the time for the next dose nears. Some patients will become more susceptible to infections during this period or feel otherwise unwell; this is commonly called "wear-off." (See "Immune globulin therapy in primary immunodeficiency".)

[CK] FEVER. Rectal >100.3 (Oral 99.5, Axillary 98.5)

• • If your 2-year-old child's oral temperature is 101°F (38.3°C), his or her rectal or ear temperature may be about 102°F (38.9°C). Remember, a child has a fever when his or her temperature is 100.4°F (38°C) or higher, measured rectally.
  • If your axillary temperature is 100°F (37.8°C), your oral temperature is about 101°F (38.3°C).

Comparison of temperatures in Fahrenheit by method

AXILLARY/FOREHEAD (°F)	ORAL (°F)	RECTAL/EAR (°F)
98.4–99.3	99.5–99.9	100.4–101
99.4–101.1	100–101.5	101.1–102.4
101.2–102	101.6–102.4	102.5–103.5
102.1–103.1	102.5–103.5	103.6–104.6
103.2–104	103.6–104.6	104.7–105.6

[CK] Noninvasive treatment for NSTEACS. 48hours of heparin at least ! ESSENCE Trial.

For patients undergoing a noninvasive (conservative) strategy who are receiving dual antiplatelet therapy, we suggest a minimum of 48 hours for the duration of anticoagulation.

[CK] PICC LINE PLACMENT. 48hours of negative culture. PREP(INR 2, NPO 4hr)

We wait 48 hrs to make sure that there is no growth.  That is what the Infectious Disease MDs have recommended.

We wait 48 hrs to make sure that there is no growth.  That is what the Infectious Disease MDs have recommended.

INR < 2.5(preferred 2.0) 

Contra indications

Positive MRSA screen – follow the MRSA policy

Platelet count below 50

Pyrexial due to infection

SVC obstruction

INR above 2.5

Lymphoedema or ANC clearance

Sensory or motor deficiency of the arm - PICC placement where there is significant sensory impairment might delay recognition of complications.

A PICC line is a Central catheter placed in the upper arm and used for long-term therapy with medications that would irritate peripheral veins over an extended time.

 1. Labs: If the patient is on anticoagulant therapy, a PT/INR and PTT will be needed prior to the procedure. If lab results are as current as the day of the procedure, orders will not be needed for a recheck

 2. Diet: If there is an indication for sedation during the procedure, the patient will need to be NPO 4hrs prior to the procedure. Otherwise, there are no restrictions. 3. Medications: Usually, routine meds are not withheld. If the patient is on anticoagulant therapy, orders will be needed for withholding these meds.

 4. If the patient is unable to give informed consent, please have the appropriate designee available to give consent, either by phone or in person. 

5. Radiologists place PICC’s by using ultrasound. Some conditions require the use of a contrast media (X-Ray dye) to visualize the vein. 


6. The catheter is usually placed in the non-dominate arm. The patients will be taught how to care for the catheter (usually by a home health nurse), and being able to use the dominant hand will make it more convenient for the patient.

[CK] Not normal in Shapiro but normal in QQ plot

You do not have a problem here. Your data my be slightly non-normal, but it is normal enough that it shouldn't pose any problems. Many researchers do statistical tests assuming normality with far less normaldata than those that you have.

I would trust your eyes. The density and Q-Q plots look reasonable, despite some slight positive skew on the tails. In my opinion, you do not need to worry about non-normality for these data.

You have an N of about 350, and p-values are very dependent on sample sizes. With a large sample, almost anything can be significant. This has been discussed here.

There are some incredible answers on this very popular post that basically comes to the conclusion that conducting a null-hypothesis significance test for non-normality is "essentially useless." The accepted answer on that post is a fabulous demonstration that, even when data were generated from a nearly Gaussian process, a high enough sample size makes the non-normal test significant.