ABG Acid vs MAPPP

ABG Acid-Base eval walks a clinician through a stepwise approach to analyse ABG's and electrolytes in order to arrive at acid-base disorders and diagnostic ideas about ill patients. It is based mainly upon a worksheet developed by Dr. Erik Rupard from the medical literature. This tool not only yields answers, but just as importantly teaches the stepwise thinking process and the necessary concepts along the way. A clinician or learner will wind up with good information that assists patient care and should wind up a little smarter and more able to do it with less assistance the next time. It is a great support for those of us clinicians who use these tests only occasionally and don't have it memorized. The differential diagnoses include the classic mnemonics like MUDPILERS, CHAMPS, CLEVER PD, and HARDUPS, with explanations and examples. The app addresses such common questions as: * What are common causes of metabolic acidosis? respiratory alkalosis? * How do I calculate predicted pCO2? corrected bicarbonate? * What is the primary acid-base disorder? * Are additional acid-base disorders present, and if so, what are they? This app is written and intended for practicing clinicians like internists, family physicians, ER docs, cardiologists, pulmonologists, intensivists, and hospitalists; for resident physician trainees; for medical students; and of course for other clinician colleagues like NP's and PA's. As an educator and clinician, I am interested in feedback and I would be grateful for guidance on improving the tool. Notes of importance: - many thresholds and cutoffs are arbitrary and debatable, so you will have to use judgment to interpret which disorders are present and to what extent when suggested by the app - the app facilitates you to evaluate the data. If you make a mistake, the app will not argue with you. It will, at the end, offer to compare your work to the disorders that the app finds using the same algorithm - patients are more than the sums of their numbers and data, and they are often unique individuals. Use this information as a starting point in the evaluation of your patient and always do your own thinking!

Despite the considerable efficacy of antithrombotics and the increased number of oral anticoagulants now available, preventable bleeding and thrombotic events are still unacceptably common. While recently marketed agents require less laboratory monitoring, problems with the clinical management of anticoagulated patients persist, particularly in the peri-procedural period. Surgery and invasive medical interventions increase the risk of bleeding, while withholding anticoagulants increases the risk of thrombosis due to the underlying condition(s) for which anticoagulation was originally prescribed. The clinical team must therefore balance these competing risks and make educated decisions regarding the decision to interrupt oral anticoagulation for a medical procedure and, if interrupted, whether to "bridge" anticoagulation with injectable anticoagulants, such as low molecular weight heparin (LMWH) in warfarin treated patients. This guide is intended to: -Assist clinicians in the simultaneous evaluation of procedure-related bleeding risk and underlying risk of thrombosis -Guide decisions regarding the interruption of anticoagulation and the use of anticoagulant "bridging" -Provide detailed guidance for drug dosing and laboratory monitoring in the peri-procedural period -Encourage clear communication between clinicians involved in prescribing anticoagulants and performing invasive procedures This material was created by the multidisciplinary members of the Peri-Procedural Task Force of the New York State Anticoagulation Coalition and IPRO, the Medicare Quality Improvement Organization for New York State, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents do not necessarily reflect CMS policy. 10SOW-NY-AIM-7.3-14-01