本文へ移動
cccskills
無料GitHub で公開

ata-surgery-day-gc-adjustment

Recommends adjusting glucocorticoid doses on the day of surgery based on illness severity and magnitude of surgical stress. Triggers when managing a patient requiring surgery needing perioperative glucocorticoid management, such as "patient on HC for central AI undergoing major abdominal surgery" or "patient with hypopituitarism scheduled for minor procedure".

dromlakhani/MD2SKILL
インストール方法を見る

含まれるファイル（1）

  • SKILL.md2.6 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。

Adjust glucocorticoid doses day of surgery per illness severity and stressor magnitude

STEP 1 — Gather Information

Collect patient's current daily hydrocortisone (HC) dose, type and expected duration of surgery, presence of acute illness or comorbidities, baseline adrenal function, and any concurrent medications that affect GC metabolism (e.g., enzyme-inducing AEDs).

STEP 2 — Rule In / Rule Out

Determine if surgical stress is minor/moderate or major. If minor/moderate (e.g., superficial skin procedure, cataract surgery), proceed to Step 3A; if major (e.g., abdominal, thoracic, orthopedic, neurosurgery), proceed to Step 3B.

STEP 3 — Classify or Stratify

3A Minor/Moderate Stress: Suggest 25–75 mg HC per 24 hours (usually given for 1–2 days), adjusted within the range based on illness severity (higher end for sepsis or significant comorbidities).
3B Major Stress: Suggest a 100 mg HC intravenous bolus followed by a continuous intravenous infusion of 200 mg HC per 24 hours (alternatively 50 mg IV every 6 hours).

STEP 4 — Decide

Administer the selected glucocorticoid regimen perioperatively. After 24–48 hours, taper to the patient's usual maintenance dose based on clinical recovery and reassessment of HPA axis function; if stress dosing exceeded 24 hours, consider a gradual taper over an additional day.

Clinical Guardrails / Mimics / Pitfalls

Avoid over-replacement; monitor for hyperglycemia, fluid retention, and cushingoid features. Do not use dexamethasone in pregnancy. Do not abruptly discontinue GCs after stress dosing without a taper. Consider the patient's baseline HC dose when selecting within the 25–75 mg range for minor/moderate stress.

Concrete Clinical Example

A 45‑year‑old woman on HC 15 mg daily for central adrenal insufficiency undergoes elective colectomy (major surgical stress). She receives 100 mg HC IV bolus at induction, then a continuous IV infusion of 200 mg HC over 24 hours. After 24 hours, the infusion is stopped and she resumes her usual 15 mg HC orally in divided doses.

Source: Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2016, DOI:10.1210/jc.2016-2118

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