Inpatient Rehab Pearls and Principles – Slater

CONSULT, CONSULT, CONSULT! When to consult? Patient is well below their baseline functional status with potential for this to improve in a reasonable amount of time. Medical needs beyond typical capability of subacute care (SNF). Rehab diagnosis:  60% have to have a "rehab diagnosis" stroke, spinal cord injury, congenital deformity, amputation, major multiple trauma, femur… Continue reading Inpatient Rehab Pearls and Principles – Slater

Differentiating Conversion vs Factitious vs Malingering Disorders – Hughes

Difficulty is that these cannot be differentiated by self-report only; the clinician HAS to investigate other sources of information. CONVERSION Symptoms or deficits affecting voluntary motor or sensory functioning Actually very rare Commonly recurs (25% in the first year) Risk factors:  maladaptive personality traits (borderline, histrionic traits), history of childhood abuse/neglect, stressful life events may… Continue reading Differentiating Conversion vs Factitious vs Malingering Disorders – Hughes

Heparin-Induced Thrombocytopenia – Stuart

HIT occurs in 5% of patients exposed to heparin. Etiology:  Autoantibody to PF4-heparin complex. More common with UFH, in women, and with surgery. Thrombocytopenia is noted in 90%, thrombosis in 50%. Dx:  Lab:  HIT antibody testing:  PF4 antibody, IgG Clinical Dx:  Four T Score: 4 T's score [From UpToDate, 4/21/17]:  Calculating the score — The 4 T's… Continue reading Heparin-Induced Thrombocytopenia – Stuart

Tenets of Play Therapy for Difficult Patients – Hughes

Emotionally activated patients:  unmet childhood needs, pts will repeat themselves and their behaviors, result of trauma in childhood that resulted in failed development of coping skills in certain situations. Key skills: Structuring Skill: Setting the tone for the visit.  "I've got about 10 minutes, but I want to address your concerns..." Guides pts to understand… Continue reading Tenets of Play Therapy for Difficult Patients – Hughes

Idiopathic Thrombocytopenic Purpura (ITP) – Kaufman

ITP is an acquired disorder of platelets:  consider as either increased destruction or decreased production. Classified as primary (a dx of exclusion) vs secondary. Etiology:  Caused by anti-platelet IgG directed against membrane proteins of the platelets. Inciting events:  infection vs immune alteration.. Incidence:  highest in children, and increased incidence with increased age in adult. DDx:… Continue reading Idiopathic Thrombocytopenic Purpura (ITP) – Kaufman

Opportunistic Infections in Transplant Patients – McCarthy

Our case:  2015 renal transplant, nocardia diagnosed shortly after immunosuppressive therapy, possible hx of CMV. Common infections:  URI and UTI - are still common in the immunosuppressed.  Common things are common. Opportunistic infections: Viral:  CMV, JC, HBV, HCV, VZV, EBV, HSV Bacterial:  PCP, Listeria, Nocardia Fungal:  Aspergillus, TB Early Post-Transplantation:  Immediately post-op to 1 month… Continue reading Opportunistic Infections in Transplant Patients – McCarthy