Fatigue resident survival guide: Difference between revisions
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{{familytree | | | | | | | | | | | | | B01 | | | B01=<div style="float: left; text-align: left; width: 20em; padding:1em;">'''The history should also determine the characteristics, severity, and temporal pattern of fatigue:'''<BR>❑ Onset – Abrupt or gradual, relationship to illness or life event <BR>❑ Course – Stable, improving, or worsening <br>❑ Duration and daily pattern<BR>❑ Factors that alleviate or exacerbate it<BR>❑ Impact on daily life – Ability to work, socialize, participate in family activities<BR>❑ Accommodations that the patient/family has had to make to deal with symptom</div>}} | {{familytree | | | | | | | | | | | | | B01 | | | B01=<div style="float: left; text-align: left; width: 20em; padding:1em;">'''The history should also determine the characteristics, severity, and temporal pattern of fatigue:'''<BR>❑ Onset – Abrupt or gradual, relationship to illness or life event <BR>❑ Course – Stable, improving, or worsening <br>❑ Duration and daily pattern<BR>❑ Factors that alleviate or exacerbate it<BR>❑ Impact on daily life – Ability to work, socialize, participate in family activities<BR>❑ Accommodations that the patient/family has had to make to deal with symptom</div>}} | ||
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{{familytree | | | | | | | | | | | | | C01 | | | C01=<div style="float: left; text-align: left; width: 20em; padding:1em;">'''Initial workup for hemolysis:'''<br> ❑ Indirect [[bilirubin]] <br>❑ serum [[haptoglobin]] <br>❑ [[Lactate dehydrogenase]] level <br>❑ [[Reticulocyte]] count <br>❑ [[Urinalysis]]</div>}} | {{familytree | | | | | | | | | | | | | C01 | | | C01=<div style="float: left; text-align: left; width: 20em; padding:1em;">'''Initial workup for hemolysis:'''<br> ❑ Indirect [[bilirubin]] <br>❑ serum [[haptoglobin]] <br>❑ [[Lactate dehydrogenase]] level <br>❑ [[Reticulocyte]] count <br>❑ [[Urinalysis]]</div>}} | ||
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Revision as of 19:19, 7 August 2020
| Fatigue Resident Survival Guide |
|---|
| Overview |
| Causes |
| FIRE |
| Diagnosis |
| Treatment |
| Do's |
| Don'ts |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Tayyaba Ali, M.D.[2]
Synonyms and keywords:: Weakness, Tiredness, Lethargy, Debility
Overview
This section provides a short and straight to the point overview of the disease or symptom. The first sentence of the overview must contain the name of the disease.
Causes
Life Threatening Causes
Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.
Common Causes
- Infection
- Diabetes
- Hypercalcemia
- Anemia
- Rheumatologic diseases
- Neurologic injury
- Adrenal insufficiency
- Thyroid insufficiency
- Hepatic-insufficiency
- Renal insufficiency
- Cardiopulmonary diseases
- Congestive heart failure
- Chronic obstructive pulmonary disease
- Peripheral vascular disease
- Atypical angina
- Myopathy
- Medications
- Sedative-hypnotics
- Analgesics
- Antihypertensives
- Antidepressants
- Muscle relaxants
- Opioids
- Antibiotics
- Anticancer agents (like cisplatin and Etoposide)
- Substance abuse
- Psychological Causes:
- Depression
- Anxiety
- Somatization disorder
- Dysthymic disorder
- chronic fatigue syndrome
- Multiple sclerosis
- After malignancy treatment, patients can experience different patterns of fatigue from chemotherapy, radiation treatment, or surgery[1].
Diagnosis
The approach to diagnosis of fatigue is based on a step-wise testing strategy. Below is an algorithm summarising the identification and laboratory diagnosis of fatigue.
Seek proper history, ask patients to describe in their own words, what do they mean by fatigue? This will help distinguish fatigue from ❑ somnolence ❑ muscle weakness | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
The history should also determine the characteristics, severity, and temporal pattern of fatigue: ❑ Onset – Abrupt or gradual, relationship to illness or life event ❑ Course – Stable, improving, or worsening ❑ Duration and daily pattern ❑ Factors that alleviate or exacerbate it ❑ Impact on daily life – Ability to work, socialize, participate in family activities ❑ Accommodations that the patient/family has had to make to deal with symptom | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Initial workup for hemolysis: ❑ Indirect bilirubin ❑ serum haptoglobin ❑ Lactate dehydrogenase level ❑ Reticulocyte count ❑ Urinalysis | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| No laboratory evidence of hemolysis | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Consider differential diagnosis ❑ Iron deficiency anemia ❑ Anemia of chronic disease ❑ Vitamin B12 deficiency ❑ Folate deficiency | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Degmacytes | Normal cell morphology | Spherocytes | Elliptocytes | Shistocytes | Sickle shaped cells | Hypochromic, microcytic cells | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| G6PD deficiency | Sickle cell disease | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
H/o exercise, exertion, trauma or surgery? | Beta thalassemia | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Negative | Positive | No | Yes | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| CD55/59 | ❑ Drug induced hemolytic anemia ❑ Autoimmune disease | ❑Exercise induced hemolysis ❑Prosthetic heart valve ❑Severe aortic stenosis | Microangiopathic hemolytic anemia | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Positive | Negative | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Pre-eclampsia and eclampsia | Recent diarrhea | Decreased ADAMTS13 activity | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Paroxysmal nocturnal hemoglobinuria | Hereditary spherocytosis | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HELLP syndrome | Hemolytic uremic syndrome | Thrombotic thrombocytopenic purpura | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Treatment
Shown below is an algorithm summarizing the treatment of [[disease name]] according the the [...] guidelines.
Do's
- The content in this section is in bullet points.
Don'ts
- The content in this section is in bullet points.
References
- ↑ Greenberg DB (2002). "Clinical Dimensions of Fatigue". Prim Care Companion J Clin Psychiatry. 4 (3): 90–93. doi:10.4088/pcc.v04n0301. PMC 181235. PMID 15014735.