Introduction:
l Disease spectrum from asymptomatic deep vein thrombosis to massive pulmonary embolism causing immediate death.
Introduction:
l Disease spectrum from asymptomatic deep vein thrombosis to massive pulmonary embolism causing immediate death.
內分泌急症是很不易診斷出來,但又是會致死的急症。因此對於疑似的病患都因針對危險因子,實驗室檢查,誘發因素,及身體評估加以診斷,進而予以適當的治療。
Thyroid storm 甲狀腺風暴
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.
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