DrVirgo
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If we suspect it we have to treat with prednisone promptly to prevent blindness. (DO NOT wait for results of biopsy!)
BUT do we treat before even taking a biopsy, or do we take biopsy first, then treat?
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| cirus
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Give prednisone first, then take a biopsy, any delay puts the pt in a serious risk of sight loss..
The other complic is a thoracic aortic aneurism
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| DrVirgo
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Ok, then Prednisone FIRST before anything else... Thanks.
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| dr_arc
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treatment before investigatin for any medical emergency esp in cases where the risk of complications is high and the diagnosis can be made clinically.
so for temporal arteritis with the impending risk of visual loss. it is treat first. the biopsy can be taken later to confirm your clinical diagnosis and admin prednisone wont change the pathological findings which is why you dont need to debate whether or not to give steroid.but if you take a clinical scenario with an infection basis then yes you take a sample of whatever relevant fluid or tissue you are dealing with and then admin the treatment cos antibiotics in the system can damage your chances of finding the organism responsible.
a few other conditions where treatment takes precedence over any kind of investigation whatsoever, where you make an instant clinical diagnosis and begin treatment stat
.acute appendicitis.
. testicular torsion
i am trying to think of more, pls guys add to the list.
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| DrVirgo
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That makes sense dr_arc!
We should start a list -but most would be emergency situations and would be surgical, like in trauma and hemodyn. unstable give FLUIDS, blood, platelets, plasma, before doing lap or anything else....
Thinkin of more for IM... we should start a list of these.. good idea.
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| elitoki
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Temporal arteritis with myalgia+stiffness = polymyalgia rheumatica ( give corticosteroid in high dosis)
Temporal arteritis that had been treated with corticosteroid , now has myalgia = corticosteroid induced myalgia.
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| DrVirgo
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Corticoids to TREAT myalgia, but they CAUSE myalgia?
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| elitoki
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There are some drugs Known to Cause Myopathy:
Alcohol
Chloroquine
Cocaine
Corticosteroids
Hydroxychloroquine
Lipid-lowering agents such as =clofibrate, gemfibrozil, statin drugs
Penicillamine
Zidovudine
if myalgia or myopathy is started after treat temporal arteritis with steroid it could be caused by the treatment and no missdiagnosis of polymyalgia rheumatica. (Q of UW)
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| doyoudig
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Temporal Arterities by istelf also requires High Dose Steroids
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