聊療書

1. chest X-ray to rule out other cause

一個85歲女性, 在住院前已經高燒（接近39"C）一週, 住院後懷疑肺炎, 使用Cefuroxime治療後仍持續發燒、CXR未改善, 所以改成Pisutam

• alb：半衰期20天
• got：半衰期12~22小時
• gpt：半衰期37~57小時
• ggt屬於alk-P，存在於膽道表皮、腎臟胰臟
• PT：半衰期7小時；PT延長時施打vit.K若暫時恢復正常則較可能是obstructive jaundice，若無則較可能是hepatocellular jaundice
• drug induced abnormal liver function：anti (Cipro, Ketoconazole, Fluconazole, Isoniazid), 抗癲癇(Pheytoin, Carbamazepine), statins, NSAIDs, SU, drug abuse

在Poldi的FB上看到一個單字

survey:
Alcohol withdrawal

以下資料來自Drugs.com
 

台語受了日語的影響，念成「扣打」。

8/8父親節那天，除了收獲GARDEN客家小館的一頓大餐，能與親切健談的謝醫師與唐醫師見面真是收獲滿滿；當天主題是「社區醫療群之組織與運作」

今天許醫師講了安寧療護，原來即使在緊急狀況不小心插了管，若後來發現病人早就立過DNR意願書，或家屬都同意DNR並簽同意書，還是可以將維生系統中止。

昨天跟門診，有個家長提到之前小孩打國光疫苗後，眼睛一直眨（ㄓㄚˇ）一直眨，那時候的醫師說有點類似妥瑞氏症的表現，後來過了半年就自己好了。

• ICH outside the basal ganglia and thalamus area
• AVM, anticoagulation, tumor aneurysm of Willis circle
• ipsilateral focal headache, vomiting, drowsy consciousness
• •occipital hemorrhage: hemianopsia

  left temporal hemorrhage is aphasia & delirium 

  •

  frontal hemorrhage: arm weakness 
  

　　今天護理師學姐問我能不能將某病人的Ceftriaxone由IVD改成IVP, 這樣會比較方便快速，方便臨床工作。

「當發生心臟停止的早期，痛苦的喘息是非常普遍的，且會與正常的呼吸混淆。單獨偵測脈搏是不可靠的。就算是經過訓練的施救者來執行也需要更多的時間來判斷。所以施救者看到一個成人受難者，只要是無反應及沒有呼吸或沒有正常呼吸，必須馬上施行CPR。」
<div style="text-align:right;">──《心肺復甦術綜述》張永祥醫師 

甚麼是eAG？

eAG的全文是Estimated Average Glucose （估算的平均血糖），是依據Hb A1c 的濃度計算而得，就像依據creatinine計算出eGFR一樣。eAG是美國糖尿病學會（ADA）建議的新名詞。

　　人的意識和潛意識就像浮在海面上的冰山一樣，水面上的部份是意識，分成三層，水面下的潛意識則有五層。

　　跟肝內的第一次門診，是腹部超音波的檢查診。當初不太喜歡老師對病患的方式，因為病患一個人躺在檢查床上，吸氣閉氣呼氣好幾次配合檢查，期間看不到超音波的螢幕，心裡一定是很緊張，結束後問個幾句、想知道大致有沒有問題無可厚非。老師卻只留給他們一個背影，說門診再解釋。我覺得老師的態度很兇，也很不近人情。

Müller-Hinton medium is an microbiological growth medium that is commonly used for antibiotic susceptibility testing. It is also used to isolate and maintain Neisseria and Moraxella species.

It typically contains:

The features of this syndrome vary widely, even among members of the same family, and affect many parts of the body. Characteristic signs and symptoms may include birth defects such as congenital heart disease, defects in the palate, most commonly related to neuromuscular problems with closure (velo-pharyngeal insufficiency), learning disabilities, mild differences in facial features, and recurrent infections. Infections are common in children due to problems with the immune system's T-cell mediated response that in some patients is due to an absent or hypoplastic thymus. 22q11.2 deletion syndrome may be first spotted when an affected newborn has heart defects or convulsions from hypocalcemia due to malfunctioning parathyroid glands and low levels of parathyroid hormone (parathormone). Affected individuals may also have any other kind of birth defect including kidney abnormalities and significant feeding difficulties as babies. Autoimmune disorders such as hypothyroidism and hypoparathyroidism or thrombocytopenia (low platelet levels), and psychiatric illnesses are common late-occurring features. Microdeletions in chromosomal region 22q11.2 are associated with a 20 to 30-fold increased risk of schizophrenia.

Studies provide various rates of 22q11.2 deletion syndrome in schizophrenia, ranging from 0.5 to 2% and averaging about 1%, compared with the overall estimated 0.025% risk of the 22q11.2 deletion syndrome in the general population. Medical students may use the mnemonic CATCH-22 to describe DiGeorge's syndrome, with the 22 to remind one the chromosomal abmormality is found on the 22 chromosome: