病例报告ppt（英文）.ppt

1、Case presentation96.09.04 Intern 胡學錦,Personal profile,Name : 吳O民 Gender : male Age : 46 years old Chart number : 16762291 Arrival date at ED : 96/08/20 Time : 04:15 am,Injury mechanism,Suffered from a traffic accident with drunken state this morning (04:00am) Suspect drunken driving 現場生命現象: drowsy a

2、nd irritable (E3V3M4) CC: Alcoholism with Traffic accident,Pre-hospital evaluation and management,Sent to KMUH ER by 119 Head :ILOC(?), dizziness(?), headache(?), nausea/vomiting(?), amnesia(?), vertigo(?)laceration wound over rt upper eyelid and earlobe Neck: pain, stiff, soreness(?) Chest: pain, d

3、yspnea(?) Abdomen: pain, discomfort(?) Limbs and skin : abrasion wound over bil. knee,AMPLE history,Allergies: unknown Medication: unknown Past illness: DM:(?) HTN:(?) Other systemic diseases(?) Operation history(?) Last Meal : (?),Initial evaluation (KMUH),A (airway) / B (breathing): Collar fixatio

4、n: (+) Airway: speech: (?) respiration: smooth airway obstruction sign (-) foreign body in the mouth (-) Trachea Breathing sound: clear,C (circulation): Rate: brachial a. , carotid a., femoral a. , dorsalis pedis a. Cuff BP : 105/45 mmHg Skin condition: appearance, temperature, humidity,D (disable):

5、 GCS: E2V2M5 Pupil response: od: 2 mm os: 2 mm E ( exposure ) : abrasion wound over nose and bil. maxillary area, laceration wound over rt. upper eyelid(2 cm) and earlobe(1 cm) abrasion wound over bil. knee,Secondary evaluation (KMUH ER),Chest X-ray AP 155:665-668,Methohexital has been used in adult

6、 emergency departments and has been found to produce rapid and brief sedation, especially for orthopedic procedures. Lerman et al studied 76 adult patients in a prospective observational study where IV methohexital had been used for a variety of procedures, and concluded that it caused clinically in

7、significant changes in hemodynamics and oxygenation. Although respiratory depression did occur, if significant it was brief and easily managed. Zink et al reported a consecutive case series of 102 patients (including 10 patients younger than 10 years) who received IV methohexital for various procedu

8、res. The authors concluded that methohexital is safe and effective in selected emergency department patients.,Current condition,Admission to 7B 27-1 GCS:E2 V2 M3 BP: 109/78 mmHg Pupil: R 2.5mm L 2.5mm, bilateral prompt reflex MP R L upper limb 2 1 lower limb 2 2 Plan : 1. keep Saxizon 100mg iv q8h s

9、econd day due to bilateral bronchus wheezing 2. Antibiotics: Tazocin 2 vial iv q8h day 9 3. Consult rehabilitation department,Thanks for attention,Lerman B, Yoshida D, Levitt MA. A prospective evaluation of the safety and efficacy of methohexital in the emergency department. Am J Emerg Med. 1996;14:351-354.,MTX caused clinically insignificant changes in hemodynamics or oxygenation, although respiratory depression did occur; significan