Triptan Selection - Migraine Management Choosing triptans: • Reponse to given triptan do not predict to others • Try each triptan three times • Use < 10 times per month to avoid medication-overuse headache Rapidly progressing migraine attack: • Subcutaneous sumatriptan 6 mg or nasal spray sumatriptan 10 mg • Intranasal zolmitriptan 5mg • Fast-acting oral triptan preparation- eletriptan 40mg, rizatriptan 10 mg, zolmitriptan 2.5 mg • An additional pro-kinetic for example domperidone, 10mg Lack of triptan response: • Consider preventive • Try higher dose • Alternative triptan • Alternative formulation (subcutaneous, intranasal) • Combination therapy with NSAID (ibuprofen 800mg TDS or naproxen 500mg bid) doi:10.1136/practneurol-2015-001167 #Triptans #Migraine #Management #treatment #neurology #pharmacology #selection #headache #neurology

Echocardiogram Windows - Nomenclature Each view is described using three (3) components 1) Transducer Position or "Window" P: Parasternal A: Apical SC: Subcostal SSN: Suprasternal Notch 2) Echocardiographic Imaging Plane, e.g., LAX, SAX, or4C 3) Region or Structures Visualized, e.g., Mitral valve (MV), Aortic valve (AV) level, Two-chamber #Echocardiogram #Windows #Nomenclature #POCUS #cardiology #views #TTE #orientations

IV Fluid Composition and Effects on Plasma 0.9% Saline Ringer's Lactate Balanced Crystalloid #IVFluid #Composition #Plasma #comparison #Effects #nephrology #pharmacology

Petechiae/Purpura - Diagnostic Algorithm. Pathophysiology: 1) Represent the passage of erythrocytes from the intravascular to extravascular compartment 2) May be the result of disruption of vascular integrity (trauma, infection, vasculitis) or disorders of primary or secondary hemostasis. Palpable: 1) If lesions are palpable, this may suggest a more prominent underlying inflammatory process such as vasculiitis. 2) When cutaneous manifestations are identified, other small vessels may be affected (commonly renal and pulmonary #Diagnosis #Dermatology #Rash #Petechiae #Purpura #Palpable #Algorithm #Differential #Ddxof

Fluid-filled Rash - Diagnostic Algorithm. Pustule: 1) Pustules more commonly suggest an infectious process (bacterial, fungal) Vesiculobullous 1) Vesiculobullous lesions are generally more concerning 2) Loss of basic structural elements maintaining cohesion between keratinocytes in the epidermis, or between the epidermal layer and the dermis (near basement membrane zone). 3) Intraepidermal blisters tend to be flaccid, fragile and thin-roofed. 4) Subepidermal blisters have a thick roof and can remain intact when compressed 5) Often due to autoantibodies targeting structural proteins in the skin. #Diagnosis #Dermatology #Rash #FluidFilled #Vesciular #Pustular #Bullous #Algorithm #Differential #Ddxof