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ANTIBIOTIC THERAPY5.2

 

台大醫院小兒部 李秉穎醫師

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簡易心律速率判讀

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【Rumack-Matthew nomogram】The original nomogram line separating possible toxicity from unlikely toxicity was based on a 4-hour ACT level of 200 micrograms/mL (1300 micromoles/L), but was subsequently modified in the U.S. by the FDA by moving the line to a 4-hour ACT level of 150 micrograms/mL (1000 micromoles/L) to increase the safety ⋯⋯margin for treatment decisions. The nomogram only directly applies to an ACT level obtained after a single exposure and during the window between 4 and 24 hours postingestion. Outcome prediction using this nomogram cannot be applied to ACT levels obtained outside this 20-hour window or with chronic or recurrent exposures.

急重症FB讀書會


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【普 拿疼】成人acetaminophen中毒劑量:(1) >10 g or 200 mg/kg as a single ingestion, (2) >10 g or 200 mg/kg over a 24-hour period, or (3) >6 g or 150 mg/kg per 24-hour period for at least 2 consecutive days. 只要病人自訴服用了 >12 g,就有 30% 病人的 4-hr ACT level 會 >200 mg/dL 及 6% 會出現 hepatotoxicity. [Tintinalli-7, Chp 184]
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兒童發燒處置建議


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電腦斷層檢查需相當的輻射劑量,才能獲得足夠的影像資訊以供診斷;一次常規頭部的斷層檢查劑量約為 2mSv、胸部為8mSv、腹部為10mSv;相對於一張傳統胸部X光為0.06mSv,而一般民眾每年可容許的輻射劑量為1mSv。
2到10mSv對人体還算是低劑量的,而這樣低劑量輻射到底對人体有什麼傷害,醫學界並無足夠經驗,也無法進行人体試驗。所有輻射傷害的研究,都來自長崎及廣島原爆的研究,而原子彈爆炸是屬高劑量的曝露,所以研究結果也不能完全類比於低劑量曝露的電腦斷層檢查。
美國食品藥物管理局對輻射傷害有以下總結:

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剛剛問婦產科醫師,是否PID他們都會做細菌培養,婦科醫師說,他們通常也不做,如果輕微的PID直接給予Doxycycline 100mg bid or tid x 10-14 days.

最好還是做PV,如果有lifting pain 比較能確認是PID.


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 2. Analgesia
Analysis of retrospective data16 has raised a question about the potentially adverse effects of morphine in patients with unstable angina (UA)/non–ST-elevation myocardial infarction (NSTEMI). As a result, the recommendation for morphine pain relief has been reduced to a Class IIa recommendation for that patient population. Use of morphine remains a Class I recommendation for patients with STEMI, however, because STEMI patients should either have received reperfusion or are not candidates for reperfusion, and continuing pain requires relief in either case (Table 2). Because of the known increased risk of cardiovascular events among patients taking cyclooxygenase-2 (COX-2) inhibitors and other nonsteroidal anti-inflammatory drugs (NSAIDs),17–19 these drugs should be discontinued immediately at the time of STEMI (see 2004 STEMI Guidelines, Section 7.12.5, for additional discussion). 3,15,20,21 A substudy analysis from the ExTRACT TIMI-25 (Enoxaparin and Thrombolysis Reperfusion for Acute Myocardial Infarction Treatment–Thrombolysis in Myocardial Infarction) trial22 demonstrated an increased risk of death, reinfarction, heart failure, or shock among patients who were taking NSAIDs within 7 days of enrollment. Longer-term management considerations and a discussion of the gradient of risk with the various NSAIDS are found in Section 7.12.5 of the 2004 STEMI Guidelines.15

 重點翻譯:

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