Sepsis and EGDT

[1] Diagnostic criteria for sepsis, adapted from Levy et al.

[2] Early Goal-Directed Therapy (EGDT) Protocol (N Engl J Med 2001;345:1368-77.) EGDT should be started immediately and completed within 6 hours of recognition of severe sepsis/septic shock.

[Reference]

American Journal of Emergency Medicine (2007) 25, 564–571.

頭部外傷分類及 CT

[1] The European Federation of Neurosurgeons (EFNS) 對頭部外傷的分類：

[2] Minor 頭部外傷何時要做 CT？

[Reference]

British Journal of Anaesthesia 99 (1): 18–31 (2007).

doi:10.1093/bja/aem128.

輻射災害處理

Acute Radiation Syndrome (ARS) 這個 topic 有不少考試重點：

[1] 急性暴露之可能症狀及相對暴露劑量：


[2] ALC (淋巴球計數) 和預後之關係：


[3] ARS 之特殊治療：


[4] ARS 處理的 10 個重點：


要查看全文者，請參考：
http://dx.doi.org/10.1016/j.annemergmed.2005.01.020

Causes of Coma

There are several medical causes of coma. One of the easiest ways to remember these causes is to use the mnemonic AEIOU TIPS:

• A - alcohol (overdose / withdraw / Wernicke's encephalopathy)
• E - epilepsy or exposure (heat stroke, hypothermia) or electrolytes
• I - insulin (diabetic emergency - high/low sugar)
• O - overdose or oxygen deficiency
• U - uremia (metabolic) or underdose
• T - trauma (head injury) or toxicology
• I - infection / inflammation
• P - psychosis or poisoning
• S - stroke / SAH / shock / syncope

Septal hematoma

Typically soft and fluctuant when compressed, a septal hematoma is a collection of blood between the nasal mucosa and the cartilaginous septum. It may occur unilaterally or, more commonly, bilaterally following nasal trauma with or without associated nasal fracture. This urgent condition warrants immediate referral to an otolaryngologist.

Management of septal hematoma includes local anesthesia with needle aspiration or incision and drainage. Several days of nasal packing prevents reaccumulation of blood. Ideally, treatment occurs within a few hours of injury.1 If the hematoma is not cleared, the septal cartilage may become necrotic and result in a saddle nose deformity or septal perforation. Accumulated blood may become infected, and antibiotics should follow drainage if abscess is noted.

完整的個案：

http://www.aafp.org/afp/20060501/photo.html

Ottawa Knee Rule

A knee x-ray is only required for knee injury patients with any of these findings:

• age 55 or over
• isolated tenderness of the patella (no bone tenderness of the knee other than the patella)
• tenderness at the head of the fibula
• inability to flex to 90 degrees
• inability to weight bear both immediately and in the casualty department (4 steps - unable to transfer weight twice onto each lower limb regardless of limping)

Cholinergic 中毒症狀

原來北榮intern在run毒物科必須要記cholinergic症狀, 共15項 :

Muscarinic (口訣 : DUMBELS)

• Diarrhea
• Urination
• Miosis
• Bradycardia, bronchorrhea, bronchospasm
• Emesis
• Lacrimation
• Salivation, sweating

Nicotinic (口訣 : Monday, Tuesday, Wednesday, Thursday, Friday)

• Mydriasis
• Tachycardia
• Weakness
• Hypertension, hyperglycemia
• Fasciculation

CNS symptoms

• Confusion
• Convulsion
• Coma

所以organophosphate中毒的病人不一定都bradycardia或miosis, 毒物科老師說很多都會先有nicotinic症狀, 但大部份送到ER之後就以muscarinic症狀為主, 除非他家在ER附近....:P可能很多人都會了, 與大家分享

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