Queenie's 微笑的黃金

這幾天的晚班  總算告一小段落
真的快要日夜顛倒了

這個半夜  一個OHCA(Out Of Hospital Cardiac Arrest)的老人家 持續了一個小時的自動心肺復甦機(Thumper)的按壓  壓著壓著到了3點多 陸陸續續的有疑似hypoglycemia和SOB伴有Hypertensive crisis的case在C區等著  一樣到4點就快撐不太了的我  那Thumper的按壓還真的有像半夜數羊的作用  想要把ICH的CT review一下  偏偏腦袋使不了太多力……

因為在ER  終於發現29版Washington和32版內容真有不同的

R1就買的書  現在還是又買了一本32版

(合記可以宅配訂書又9折真的是貼心到極點阿 不禁還是想推的呀)

收到的32版Washington   內容定義就清楚得多了  

Hypertensive crisis

→Hypertensive emergencies

包括有accelerated hypertension, systolic BP>210 and diastolic BP>130, presenting with headache, blurred vision, focal neurologic symptoms, and malignant hypertension(papilledema). 需要immediate BP reduction by 20~25% to prevent end-organ damage

→Hypertensive urgencies

Substantial increase in BP, 通常是diastolic BP of 120~130mmHg, H/T患者約有1%的發生率, 有症狀的血壓上升但未有目標器官的損害

Measurement of serum amylase 用來區別是否為急性胰臟炎造成的腹痛.

After the onset：Begin to rise 3 to 6 hours and peaks in approximately 24 hours.

The values return to normal within 2 to 3 days after onset.

懷疑急性胰臟炎：presenting with epigastric upper abdominal pain that is acute in onset, rapidly increasing in severity, and persistent without relief.

Normal Values 
Adult:    53–123 U/L (0.88–2.05 nkat/L SI units) 
Elderly:   Slightly higher norms

Abnormal Values 
Increased   
Acute pancreatitis , Alcoholism   
Biliary obstruction , Cholelithiasis 〈膽石〉 
Diabetic ketoacidosis   
Hyperlipidemia , Hyperthyroidism 
Inflammation of salivary glands, Mumps 
Perforated peptic ulcer 
Pregnancy, Ruptured tubal pregnancy