目前日期文章:200811 (51)

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國境之南

 

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 Recently an old female patient admitted to our hospital due to CHF and acute on CRF.Previously she ever accepted left hip replacement twice and bilateral knee replacemnt nearly 2 decades ago.Infection work-up was also performed.We excluded lung infection and UTI via a series of tests/lab but to gall bladder and left knee.At last we consider the infection source coming from left knee.According to PE,erythema and swollen of left knee was noted and arthrocentesis was performed post consultiing orthologist.Synovial analysis disclosed WBC greater than 50000/cumm with PMN predominantly(>75%) and sugar is lower(30mg/dl).This result is compatible with septic knee.Therefore I post up synovial fluid analysis to differentiate from different types of knee disease.

 

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Indications   1.Suspected CNS Infection : Meningitis /Encephalitis 2.Evaluate for Hemorrhagic CVA (Subarachnoid Hemorrhage): Hemorrhage suspected despite negative Head CT /Head CT not available 3.Diagnostic Chemistry Evaluation :CSF Gamma Globulin (Multiple Sclerosis) 4.CSF Dynamics :Spinal block diagnosis (Queckenstedt test) /Normal Pressure Hydrocephalus evaluation :Katzman infusion/Radionucleotide cisternography 5.CSF Cytology :Carcinomatous Meningitis /Lymphomatous Meningitis 6.Therapeutic lumbar puncture:Methotrexate infusion (CNS Leukemia)/ Amphotericin B infusion (fungal Meningitis)/ Removal of fluid to decrease Intracranial Pressure: Pseudotumor Cerebri /Headache associated with Subarachnoid Hemorrhage

Contraindications   1.Local infection at lumbar puncture site 2.Cerebral mass lesion (risk of herniation) :Large brain abscess/ Brain Tumor (especially posterior fossa)/ Subdural Hematoma /Intracranial Hemorrhage 3.Papilledema 4.Uncorrected Bleeding Disorder :Severe Thrombocytopenia

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針對過去兩年胸腔科考題作一整理,如:CAP,asthma,COPD,常用藥物.........

 

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 未命名2.JPG 

 

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 Purpose of review
Hospitalization and mortality rates associated with heart failure are persistently high.

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此講義主要針對95.96年專師考題有關新陳代謝疾病的題目作一系列詳細解析,值得準專師仔細去閱讀

 

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用echo定位去on IV cathter,國外有人在做,台灣應該沒有人用吧......如果不好on的話一般直接on CVP 吧~~~不過能看看人家做也不錯喔

 

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頭部 CT 的判讀    

這個網站介紹了如何輕鬆看懂腦部電腦斷層,一次一各章節共16個章節,作者用深入淺出的方式解說,非常適合想學習如何看懂腦部 電腦斷層的人使用

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學習12導程心電圖有五大步驟:

1.Rhythm

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Contraindication for a-ine placement:

Coagulopathy

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術後CXR 適應症:

1.在穿刺的過程中抽到空氣啦

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遇見  詞/曲:林一峰
____G#___D#____Fm____C#____D#____G#

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1.前言:  目前全世界對於循環輔助上運用最廣泛的機械 主要作用在於減少心室後負荷量善舒 張期心臟冠狀動脈灌注量,   加強心臟內膜下灌注血量

 2.相關位置:

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稻香
KEY:A

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Assistant Professor Lynn Kosowicz performs the ultimate task of integrating all subspecialty techniques into one complete examination. Each system is highlighted in a distinct yet holistic manner. Careful selection of salient maneuvers are highlighted to yield key information that one might employ in a generalist assessment. We are reminded that physical examination is usually focused or directed based on a careful history.

 

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影片內容:

Professor Anne Parke demonstrates a thorough musculoskeletal exam including general inspection, active and passive movements and range of motion. Areas of common pathology are examined in depth and are supplemented with images of typical disease processes.

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心臟衰竭惡化的原因:

FAILURE:

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  摘要:
Intra-abdominal infections are an important cause of morbidity and mortality in the intensive care unit (ICU). Peritonitis can be classified as primary, secondary, or tertiary, the unique pathologic features reflecting the complex nature of the endogenous gut flora and the gut-associated immune system, and the alterations of these that occur in critical illness. Outcome is dependent on timely and accurate diagnosis, vigorous  resuscitation and antibiotic support, and decisive implementation of optimal source control measures, specifically the drainage of abscessesand collections of infected fluid, the debridement of necrotic infected tissue, and the use of definitive measures to prevent further contamination and to restore anatomy and function.Conclusions: Optimal management of intra-abdominal infection in the critically ill patient is based on the synthesis of evidence, an understanding of biologic principles, and clinical experience. An algorithm outlining a clinical approach to the ICU patient with complex intra-abdominal infection is presented.

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對於大家來說,臨床上評估神經系統是最複雜的,但對於簡單的神經測試即可約略知道疾病原因及位置~~因此神經測試以CNI~XII最為重要!!

 

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