一整個熱情阿 ER的每個夥伴學長姊主任
是耶 今天有人見到我 說我好像在"外面"很開心 有笑容 想想 對啊 ER真的可以學到很多
又開始有捨不得的感覺 不太想局限在18診還是幾診的框框裡 只是想多一點學到更多書本的印證→這樣真的很好念咧
只是 原本所屬的單位也許已經刻板印象我本來上的班 （我卻一點也不想解釋阿）
我真的偷偷崇拜起 外科主任(很像“神“) 還有內科主任和醫師(很像“仙“)
直覺式的感覺到病人的徵候和給適當的處置 也讓我對“華盛頓“勾起閱讀的興趣
Creatine kinase (CK) is an enzyme found primarily in the heart and skeletal muscles, and in smaller amounts in the brain. When the total CK level is substantially elevated, it usually indicates injury or stress to one or more of these areas.
When a muscle is damaged, CK leaks into the bloodstream. Determining which isoenzyme (specific form of CK) is elevated will help determine which tissue has been damaged. CK can be measured as the total enzyme in the serum, or each of its three isoenzymes may be measured. The isoenzymes include:
CK1(CPK-BB): produced primarily by brain tissue and smooth muscle of the lungs
CK2 (CPK-MB): produced primarily by heart tissue
CK3(CPK-MM): produced primarily by skeletal muscle
Isoenzymes
CK1(CPK-BB): 0–1%
CK2(CPK-MB): <3%
CK3(CPK-MM): 95–100%
CK, along with asparate aminotransferase (AST) and troponin, is assessed in the case of suspected myocardial infarction. It typically appears in the bloodstream within 3 to 6 hours of the tissue injury, with peak values occurring 18 to 24 hours postinjury. CK levels are usually elevated for approximately 2 to 3 days. Thus, CK is one of the first cardiac enzymes to become elevated following a myocardial infarction.
Total CPK廣泛存在於骨骼肌，當CK上昇時，可能是各種非心肌受損，因此對心肌損傷並不具特異性。CK-MB是一種非常好的急性心肌損傷標記，由於它具有優良的特異性，而且在急性心肌梗塞發作後 2 到 8 小時內會上昇。在病人到院後的 9 到 12 小時之間，連續每 2-4 小時測定一次 CK-MB，可藉由 CK-MB 有否上升的型態，來發現心肌有否受損。
Normal Values
Total CK
Female: 40–150 U/L (0.67–2.50 µkat/L SI units)
Male: 38–174 U/L (0.63–2.90 µkat/L SI units)
CK2 (CPK-MB) 0.6-6.3 ng/mL
Increased Total CK
Acute cerebrovascular disease Acute psychosis
Alcoholism Brain trauma
Cardiac defibrillation Cardiac surgery
Convulsions Delirium tremens
Dermatomyositis 皮肌炎
Electrical shock Hypokalemia
Hypothyroidism IM injections
Muscle inflammation Myocardial infarction
Myxedema
Polymyositis Progressive muscular dystrophy
Pulmonary infarction Rhabdomyolysis 橫紋肌溶解
Increased CK2 (CPK-MB) Isoenzyme
Acute myocardial infarction Cardiac defibrillation Congestive heart failure
Electrical injuries Malignant hyperthermia
Myocarditis Reye’s syndrome 雷氏症候群
Trauma to heart
下回補~
PSVT 高血鉀 Troponin-I
Hello Micky!
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