Essential Facts on the Go: Internal Medicine (10 page)

II_4_b
Venous Thromboembolism/Pulmonary Embolism

Algorithm for PE Management

Reproduced with permission from Longo DL, et al.
Harrison’s Principles of Internal Medicine
, 18th ed. McGraw-Hill, 2012.

Anticoagulation Guidelines

• Unfractioned Heparin: bolus and continuous infusion, to achieve aPTT two to three times the upper limit of the laboratory normal,
or

• Enoxaparin 1 mg/kg twice daily with normal renal function,
or

• Dalteparin 200 U/kg once daily or 100 U/kg twice daily, with normal renal function,
or

• Tinzaparin 175 U/kg once daily with normal renal function,
or

• Fondaparinux weight-based once daily; adjust for impaired renal function

Warfarin

• Initiate once therapeutic on parenteral therapy

• Usual start dose is 5 mg

• Titrate to INR, target 2.0–3.0

• Continue parenteral anticoagulation for a minimum of 5 days and until two sequential INR values, at least 1 day apart, achieve the target INR range.

GASTROENTEROLOGY

III_1_a
Acute Pancreatitis

Etiology

Alcohol

Cholelithiasis

Trauma

Post-ERCP

Hypercalcemia

Hypertriglyceridemia

Drugs

Viral infections (mumps, CMV, coxsackie virus)

Pancreatic malignancy

Pancreas divisum