本文へ移動
cccskills
無料GitHub で公開

es-cushing-vte-risk-factor-evaluation

This skill guides evaluation of venous thromboembolism (VTE) risk factors in Cushing's syndrome patients to prevent thrombotic complications. Use when assessing a CS patient for thrombotic risk, especially perioperatively; triggers include preoperative assessment, postoperative period (within 4-6 weeks), or presence of CS with additional risk factors such as prior VTE, immobilization, malignancy, or estrogen use.

dromlakhani/MD2SKILL
インストール方法を見る

含まれるファイル（1）

  • SKILL.md2.7 KB

SKILL.md（原文）

インストールする前に、エージェントに与えられる指示の中身を確認できます。

Evaluation for Venous Thromboembolism Risk Factors in Cushing's Syndrome

STEP 1 — Gather Information

Collect: surgical status (undergoing/planned surgery, recent surgery <4-6 weeks ago), history of VTE, current immobilization, active malignancy, estrogen use, obesity (BMI>30), known thrombophilias.

STEP 2 — Rule In / Rule Out

First binary fork: Is the patient undergoing surgery or within 4-6 weeks postop OR has prior VTE, current immobilization, active malignancy, or estrogen use?

  • If yes: Proceed to Step 3 for risk stratification.
  • If no: Proceed to Step 3 for low-risk classification.

STEP 3 — Classify or Stratify

If perioperative (surgery <4-6 weeks): Classify as Perioperative High Risk. Else if non-perioperative:

  • Classify as High Risk if prior VTE OR current immobilization OR active malignancy OR estrogen use.
  • Classify as Low Risk otherwise.

STEP 4 — Decide

If Perioperative High Risk: Recommend perioperative pharmacologic prophylaxis (e.g., LMWH) unless contraindicated. If High Risk (non-perioperative): Consider extended pharmacologic prophylaxis if hospitalized; otherwise, monitor for VTE signs and advise on early ambulation. If Low Risk: Routine clinical monitoring; no specific VTE prophylaxis unless hospitalized for other reasons.

Clinical Guardrails / Mimics / Pitfalls

Do not rely solely on D-dimer for VTE diagnosis in CS due to frequent false positives from inflammation. Avoid delaying prophylaxis in high-risk surgical CS patients due to bleeding risk concerns without hematology consultation. Remember that CS itself is a prothrombotic state; do not withhold prophylaxis based on normal coagulation studies.

Concrete Clinical Example

A 45-year-old woman with active Cushing's disease (post-transsphenoidal surgery 2 weeks ago) presents for follow-up. She has no prior VTE, is ambulating well, no malignancy, not on estrogen. Step 1: Recent surgery <4-6 weeks ago -> yes. Step 2: Perioperative yes -> proceed to Step 3. Step 3: Classified as Perioperative High Risk. Step 4: Recommend perioperative pharmacologic prophylaxis (e.g., enoxaparin 40 mg daily) until full ambulation.

Source: Treatment of Cushing’s Syndrome: An Endocrine Society Clinical Practice Guideline, Nieman et al., 2015, DOI: 10.1210/jc.2015-1818

レビュー

まだレビューはありません。使ってみた感想をお寄せください。

ログインしてレビューを書く

同じリポジトリのスキル

概要と使いどころ

780g-pump-adjustment

無料

Guide pump setting adjustments for the MiniMed 780G system based on CareLink data, using Medtronic's 3-step follow-up workflow. Use when a clinician has CareLink data for a 780G patient and wants to know what to change — which setting, by how much, and how to program it. Triggers include: "what do I adjust", "how to fix high TIR", "how to reduce hypos", "adjust ICR/ISF/basal", "SmartGuard settings", "780G pump settings review", or any question about optimising 780G therapy after reviewing a download.

日本語の概要は準備中です。原文の説明を表示しています。

dromlakhani/MD2SKILL132026年10月5日 更新

ata-acth-stim-test-interpretation

無料

Performs corticotropin stimulation test to diagnose adrenal insufficiency when morning cortisol is indeterminate (3-15 µg/dL). Triggers include morning cortisol 3-15 µg/dL requiring further AI testing.

日本語の概要は準備中です。原文の説明を表示しています。

dromlakhani/MD2SKILL132026年10月5日 更新

ata-adrenal-crisis-treatment

無料

Administers immediate parenteral injection of 50–100 mg hydrocortisone for suspected adrenal crisis secondary to adrenal insufficiency. Triggers include hypotension, hypoglycemia, or acute illness in a patient with known adrenal insufficiency.

日本語の概要は準備中です。原文の説明を表示しています。

dromlakhani/MD2SKILL132026年10月5日 更新

ata-aed-ai-education

無料

Clinicians educate adrenal insufficiency patients taking nondexamethasone glucocorticoids who initiate enzyme-inducing antiepileptic drugs about early signs of adrenal insufficiency. Trigger when an AI patient on nondexamethasone GC starts an enzyme-inducing AED such as phenytoin, carbamazepine, or oxcarbazepine.

日本語の概要は準備中です。原文の説明を表示しています。

dromlakhani/MD2SKILL132026年10月5日 更新

ata-aed-lt4-monitoring

無料

In central hypothyroidism patients receiving levothyroxine who initiate enzyme‑inducing antiepileptic drugs, the guideline recommends checking free T4 at least 6 weeks after AED start and increasing the levothyroxine dose if free T4 falls below the target range. Triggers include: central hypothyroidism patient on levothyroxine starting antiepileptic drug such as phenytoin, carbamazepine, or oxcarbazepine.

日本語の概要は準備中です。原文の説明を表示しています。

dromlakhani/MD2SKILL132026年10月5日 更新

ata-cortisol-cutoff-ai-diagnosis

無料

Applies serum cortisol cutoffs (<3 μg/dL indicates central adrenal insufficiency; >15 μg/dL likely excludes it) when evaluating morning cortisol for suspected adrenal insufficiency. Triggers include morning cortisol measurement in suspected AI and use when interpreting morning cortisol levels for adrenal insufficiency workup.

日本語の概要は準備中です。原文の説明を表示しています。

dromlakhani/MD2SKILL132026年10月5日 更新

dromlakhani のスキルをすべて見る

このスキルの問題を報告する