woocy的秘密基地

 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.
 
INTRODUCTION — Synovial fluid analysis may be diagnostic in patients with bacterial infections or crystal-induced synovitis. The white cell count, differential count, cultures, Gram stain, and crystal search using polarized light microscopy are the most valuable studies . Noninflammatory fluids generally have fewer than 2000 white blood cells/mm3, with fewer than 75 percent polymorphonuclear leukocytes .

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

  
 
 

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  

Contraindication for a-ine placement:
Coagulopathy
Advanced atherosclerosis
Raynaud's phenomenon

術後CXR 適應症:
1.在穿刺的過程中抽到空氣啦
2.臨床進展胸痛/呼吸困難/低血氧
3.是重症加護病患或使用呼吸器者

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