病例报告（英文）课件

1、Case presentation96.09.04 Intern 胡學錦Personal profileName : 吳O民 Gender : maleAge : 46 years oldChart number : 16762291Arrival date at ED : 96/08/20Time : 04:15 amInjury mechanismSuffered from a traffic accident with drunken state this morning (04:00am) Suspect drunken driving現場生命現象: drowsy and irrita

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

3、men: pain, discomfort(?)Limbs and skin : abrasion wound over bil. kneeInitial evaluation (KMUH)A (airway) / B (breathing):Collar fixation: (+)Airway: speech: (?) respiration: smoothairway obstruction sign (-) foreign body in the mouth (-) Trachea Breathing sound: clearC (circulation):Rate: brachial

4、a. , carotid a., femoral a. , dorsalis pedis a. Cuff BP : 105/45 mmHgSkin condition: appearance, temperature, humiditySecondary evaluation (KMUH ER)Chest X-ray AP & lateral view Cervical spine X-ray AP & lateral viewPelvis X-ray APBrain CT without contrast (due to drowsy consciousness and irritable

5、state, brain CT was hold for safety concern)Lab data (96/08/20)Lab data (96/08/20)Chest x-rayCervical spine X-rayPelvis X-rayAt 16:05Consciousness: coma GCS: E1V1M1 Pupil size: R/L:3.5/2.0 with negative light reflex BP: 150/78 mmHg PR:95/bpm. He was sent for emeregnt brain CTEmergent endotracheal in

6、tubation after Citosol sedation with paralytics (Genso)Under the impression of traumatic ICH and SDH with mass effect and midline shift, N/S was consult and he was sent to OR for emergent right craniectomy, SDH & ICH removal and ICH monitor insertion. Then, he was admitted to 7ENI-31 for further the

7、rapy. Post Operation 08/21, GCS:E1 VE M2ICP was controled during 1217mmHg, and glycerol was used. Fever up to 39, Sputum (+) were noted. Antibiotics: Cefazolin 1g iv q8h day 2 GentamicinDuring 08/2208/24, spiking fever up to 40 was noted. 08/25: The sputum culture collected on 8/22 showed Pseudomona

8、s aeruginosa, and antibiotics shifted to Tazocin 2 vial q8h. During 08/2608/28, persisted mild fever up to 39 was noted. Follow up brain CT on 8/28: (1) Rt contusion hemorrhage with resolution and perifocal edema (2) previous left EDH had no enlargementRemove ICP monitor on 08/2808/29: fever subside

9、d, remove endotracheal tube08/30: Transfer to NS wardQ:無法出ICU之併發症?Q:留觀待醒過程是否易delay diagnosis? Q:酒後躁動患者是否sedation後去做brain CT?Approach to neuroimaging in children 2007 UpToDate Sedation Sedation is rarely required for CT examinations in children because most CT examinations take only seconds or minute

10、s to perform, particularly when ultrafast helical/spiral or multidetector/multislice technology is used.High-resolution studies that require immobilization to avoid motion artifact (eg, temporal bone examination) are the exception. A newborn or young infant often can be examined during sleep (eg, af

11、ter a feeding or at the usual nap-time).Use of Intravenous Methohexital as a Sedative in Pediatric Emergency Departments Hanan Sedik, MD Arch Pediatr Adolesc Med.2001;155:665-668Methohexital has been used in adult emergency departments and has been found to produce rapid and brief sedation, especial

12、ly 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 insignificant changes in hemodynamics and oxygenation. Although respiratory depression di

13、d 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 procedures. The authors concluded that methohexital is safe and effective in selected emergenc

14、y department patients. Current conditionAdmission to 7B 27-1GCS:E2 V2 M3BP: 109/78 mmHgPupil: 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 second day due to bilateral bronchus wheezing2. Antibiotics: Tazocin 2 vial iv q8h day 93. Consult rehabilitation departmentLerman 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