20151130
林醫師
台大ER六分之一外傷
其他醫院三分之一外傷
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一個醫師一次看四十人
收入大約30
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檢驗費佔44%
暫留沒有錢
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救護車
台北四分鐘
雲林二十分鐘
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ICS; Incident
command system
黃醫師
Transfusion
Routine normal saline 2000 cc
曾醫師
Pre
oxygenation 1-2 min
WC
gesture 扣面罩
Check balloon
15cc
Single valve
6-8s完成
stylet不要超過Murphy's eye
Laryngoscope不要裝反
不要頂門牙
看著聲門
進去22-24cm後移除stylet
超過變成one lung ventilation
check位置:
聽診胃, 雙肺
打氣球
楊醫師
EKG
3 leads
左黑右白
心紅
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PEA;
Pulseless electrical activity鑑別診斷
5H6T
- Hypoxia/Hypoventilation
- Hypovolemia
- Hydrogenion; Metabolic acidosis
- Hyperkalemia
- Hypokalemia
- Toxin
- Tension pneumothorax (Deviation
trachea; tympanic percussion)
- Cardiac tamponade
- Thrombosis,coronary
- Thrombosis, pulmonary
- Trauma
方主任
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沒有酸性利尿
amphetamine雖然是鹼性
但中毒→hypercatabolism, hyperthermia→仍然要alkalinization
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Organophosphorus
intoxication→分泌物很多, 全身水水的
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Tonic
solution毒蠻牛
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Formepizole
methamol甲醇（假酒）、乙二醇（抗凍劑）、氯乙醇（催芽劑）解毒劑
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Fab
urine 代謝
Fc 免疫 macrophage切割後可能再度釋出
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Fasciculation抓大腿上臂可以感覺到
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PO2下降
1.Diffusion下降
2.FiO2下降
3.hypoventilation
(溺水)
4.V/Q
mismatch
5.shunt
PCo2上升
Only
hypoventilation
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Quinidine-like
type 1A blocker
治療
- NaHCO3
- Lidocaine
- MgSO4
陳教授
江醫師
林醫師
Case 1
No P wave?
- PSVT: Sudden onset
- Atrial flutter: 2:1 Fixation
- Sinus tachycardia: Variated rate
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DDx
1.Esophageal
lead
LA, P wave
放大atrium,
縮小ventricle
去Catheter room借
V1 V2
intercostal
2.Carotid
massage
Terminate->Sinus tachycardia
3P wave->QRS Terminate-> Atrial
flutter
3.Adenosion
Terminate
PSVT
Atrial
flutter 幾個p波之後terminate
錄下來協助診斷
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2顆quinidine兩小時再2顆
- Watch out Torsade de point
Atrial
flutter
- 多數是2,4,6:1
- 隨著Rate↓ 常常自己terminate
- 電燒99%治癒
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Pulmonary
hypertension
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Case
2
VPC
VT
No p wave
Atrial
fibrillation
Irregular QRS
non-sustain VT
Af
Thyroid
disease
Trazodone
- Torsade de point VT
- Prolong QT
不要用amiodarone
精神科用藥
萬分之一
Check
electrolyte
把K調到>3.5(4)
To avoid
Torsade de point
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Case 3
Four chamber dilatation(RVH, LVH,
PH)
Atrial
flutter fibrillation
Acute heart
failure
Pulmonary
hypertension
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AVR
檢驗上下接反
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RBBB with initial Q wave
Atrial septum
infarction
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Multiple System Atrophy
一種CNS疾病
------------
Non sustain
VT
Check Overdose
Aminophylline
Catecholamine
Beta agonist
Check Blood Gas
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Septal branch
LBBB
Narrow
QRS
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Alternative
bundle branch block
一下左一下右
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Autoimmune
Myocardial
fibrosis
沒有infarction卻有Q wave出現
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影像判讀
黃醫師
陳醫師
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Subphrenic
abscess
Bilateral
empyema
Mediastinum破出去
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Lung , kidney
abscess 打anti
Multiple 做VAS
Pleural 要
active drain
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COPD, smoker
Endobronchial lesion
Fixed Inspiratory Rhonchi
單一細支氣管
GGO
Crazy
paving sign
PJP
Viral
------------
病例鑑別診斷分析
陳醫師
蔡醫師
201540
Back
Acute
cholecystitis最常見
Salmonella
Adult
asymptomatic
Constipation,
rash
Rash
Meningococcus
Purpura,
rapid progress
Leptospirosis,
Weil's disease, second stage
Ebola
Ped.
Scarlet
Toxic shock
Pancytopenia
DIC
Intracellular
pathogen
Hematology
disease
Salmonella
Rocky
mountain disease
Viral
HIV
infectious mononucleosis like syndrome
201543
KUB
caterpillar sign
Olive
palpation
Metabolic alkaloidosis
Bird beak
sign
Single bubble
sign
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方主任-批判思考能力
PICO
- Patients, population: selection
bias
- Intervention: confounding factor
- Comparison
- Outcome
AJRCCM
美國胸腔學會
NHI Database
- No lab
- Only hospital mortality
- ICD inclusion
- No discharge information
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65656轉診服務中心
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蔡醫師
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GU; gastric ulcer
A1,2
H1,2
S1,2
Hemoclip
Active bleeding
看不到ulcer, 自費ppi
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EIS (endoscopic injection sclerotherapy)
EVL（endoscopic variceal ligation；）
Red color sign RCS
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Pediatric Emergency Care Applied Research Network (PECARN)
------------
黃醫師
Steroid induced contact dermatitis
機車車禍
Abcde
Exposure
Hyperextension 沒有骨折, 但有spinal cord concussion
過一陣子也許就好了, 觀察六小時
單側麻木CVA
NIHSS SCORE
低血糖
低血鈉
TIA觀察24小時
