Jesus
85 y/o female was a victim of DM, HTN, PUD Hx. She felt general discomfort but can't state the specific complaint. Progressive drowsy was noted in recent 3 days, E3M4V1 today. She performed Brain CT at 8/16 with repot showed "Mininal Lacunar infartion at L't basal ganglion" . Prescribed oral medication by Neurologist after CT performed at the same day(8/16).
Today is 8/21 12:00.
Vital sign stable except borderline sinus tachycardia.Neck supple. Chest, abdomen exam within normal range.
Tracting her past history, Lab data showed as below :6/28: BUN=22, Cr=1.0, ALL data normal except albumin=3.0, K=3.3
Today, BUN=189, Cr=1.8, BUN/Cr ratio>100, K=8.7.....
我的"說說"又出事了
對family說, 可能在30分內心臟停止
結果
在第25分時....真的停了一下
人結果是有搶回來...
IMP: 1. ARF 2. Hyperkalemia 3. L't MCA infarciotn 4. VT post cardioversion
但重點不在這個case
而是同一時間的Traumatic DOA(asphyxia, 25 y/o male)
He is the brother of our nurse!!!
oh! my Holly God....Please.
為何都是年輕人?????
很不喜歡這種感覺
I got 2 critical p't at same time today too.Acute respiratory filure(by carbamate intoxication)one and the other TVD,CHF,Uremia,Pulmonary edema.
回覆刪除take easy !
we are only human.
your p't will remember you,as I niticed by another family today.
do not look down what you have done !
CVA related pre-renal azotemia. On central line for guidance is necessary. Take easy!
回覆刪除保重～這句話也是對我自己說的....
回覆刪除連著四天，每天都有一個主題串連.....
都有不同答案......
Tachycardia-->1. thyroid storm 2. VT 3. Af with shock, AMI 4. Tosade de point, but Mg high 5. Digoxin intoxication (VPCs-->short run VT)
Shock--> 1. Septic shock 2. Af with SVR (30-40bpm) 3. myocarditis R/O samonella infection 4. adrenal insufficiency 5. STEMI
Cons change--> 1. Brain stem stroke 2. Brain stem H x2 3. Ammonia=1170? 4. Sugar 1400
更不要說其他DOA, AMI, COPD, ICH那些是穿插其中插花的....看來我也該去拜拜了～
我們來成立 vacuum club 如何？
回覆刪除開個專屬的blog，讓"掃把"掃一掃地。