病毒打瞌睡了 a

腸
 (Malrotation and midgut volvulus)

(Kawasaki disease)
 要找出主要照顧者

( )

TOCC (review of systems)

: (quiet to active)所新 先
noninvasive

: / / BMI
:
OSCE

璐 這兩個
I
! !
 Case 1 :“ ”

15
o 2
o
.
.

(stridor)
o o o .

o
BT 38.4 C, HR 180, RR 60
on a

事鑣
Neck X ray

Steeple Sign (+)

O ?
 oo
Cfdsntnntion
epinephrine 使 tmwu 發炎 mucosa消腫
Vasoconstriction

oo
 1
(Croup, laryngotracheobronchitis)
1

(50%)
(barking
E cough) (stridor)
-
(90%)

狹窄 喘不救
 .
6 6
o
3-5/100
o
1-2
:
O O : Parainfluenza virus
typel
wuid也会
 o
X

Steeple sign
 Hifhenmltib
( ) 5合1疫苗後少
sin

Mlhteuuuiw
 Case 2 : “ ”

3
0 00
:
BT 38 C, HR 190, RR 60
, 90%
,
(diffuse wheezing)

下呼吸道㹟差

15
hheezngtfeuen 3個

?
 o
(inhalation therapy) 化痰尊物
X 非 以
及肢氣管炎是痰善住
沒有bwnuhspnsmn
 (Hyperinflation)
emphnteni

比normallung 更累更腹
1 消失
meshape
 (Acute bronchiolitis)

2 RSV o
(RSV)

(V/Q)

(shunting)
RSV

毖
 :
o
<95%

<3

(toxic appearance)

( >70/min)
 RSV

fsv eg 肺炎
是死狀治療 無特效藥
不 象都 抽
 (X)
o
(X)

o
(0.2%) 不須常規給

secondary bacteria infection

 Case 3: “ ( )”

albuterol

:
BT 36.6ºC, HR 130, RR 50, BP 120/80
89%
 A:
B: , ,
C: , , ,
Bnbility D: , GCS 15
exposure E: ,
fymtm S:
llergq A:
mediation M: – albuterol and Singulair
my P:
Lastmen L: 3
eoposwe
E:
?
 08
Bronchodilator

5 mg/kg hydrocortisone
2 mg/kg methylprednisolone
 :
o
:
(<3 )
插管 加護
(wheezing)

silent due
非常severe asthma
:

(wheezing)
(Rhonchi)
(Rales) Tripod position
Peak expiratory flow meters

( )
X
 X

Crackles
fiindnnnmnak
 ?

某側的某部位時 Super
:
-2 agonist
:
-2 agonist,
:
, magnesium
 Case 4 :

1 6
ooc
oo
BT 38.6 C, HR 120, RR 30
a
100%

紅突起纵 泡
?
?
fordhyhnion
 -

3 5 6
9

90%
5
o 5
-

-
oooo
80
8 12

: 2 10 3 5
-

o
 0
連退燒都嗜睡 持縝密集出現4可能
a
有
Mention

退燒時
其

驅時

42
1.
2.
3.
4.
5.
6.
7.
8.

9.
10.
 O
1.
1

2
o o(
3
o )
2.
1 500ppm
2

3.
o
1000ppm
 Case 5 :

oo

:
BT 38°C, HR 180, RR 50, SBP 78mmHg
97% Elttgcpx2
f分三 shock
 :
– dhydmim
–
–
•
o !

?
 o
20 (80 )

o8 X
最嚴重• (Malrotation and Midgut
Volvulus) ->
•
CO 開
•
• 先天出 就有症狀
• ( )
• o
•
Malrotation and Midgut Volvulus

1/500
50%
75% 90% 1
4% 8%.
CO 咖 膽汁 _maintain
Pathophysiology

A B
Midgut Volvulus

o
– X
–
OGI series

–
–
(UGI series)

指腸螺旋型
–ABCs
–
–
– !
– (Time is bowel ! )

!!

o !
Case 6 :“

, ,

go
.

:
– BT 37.9°C, HR 130, RR 18, SBP 75mmHg
– 98%
muscle guarding
?
•

80
•
•
• X
• :

(maltreatment)
80%~90% (ileo-colic)

腸包 腸

: J Med Cases 2012;3(1):84-88.

 5 9
3 2
–10%~25% 2
– : =2:1

2 90%

(Meckel
diverticulum)
繭且有驅歌
 (85%~90%) 間歇性哭鬧

(65%-80%)

( currant jelly stool) 歀 腸缺 壞死才有

吐 dehydration

(Dance sign)

o
(50%) o
•
– :
•
• Echo: Target sign
• (Absence of cecal gas and stool)
KUD • Meniscus sign (crescent sign) 無法部斷
•
KUB

確認無born perforation
嚴重 ia

Crescent Sign
sandwich sign

ET
Target sign
goldStandard

: J Med Cases 2012;3(1):84-88. 66

Target sign
 顯影劑從rutnm灌入

Barium reduction
砟號無 可
perfni.MI diut.in
才 做
• ABCs
–

–
–
–
ff lpufmton

– o
 ?

800
!!
!
 ? Yes !

VS
10% 2-5%
可同時處理病態性尿歌 復發
上
 (Kawasaki Disease)

(Mucocutaneous Lymph Node Syndrome)

:
6
ooo
60-70

72
major witeni

1.
CO ( )
O_o 只2但無分泌物
2. ( O O )
ein.mn
3. ( 1.5 )
o
4. o( )
5.
o o
o
15%
73
(ESR) C-reactive protein (CRP)
 乾裂 的

induration
dna

74
 盡快安排acdiaceeh
1.
20-25%

4.7%
1-2%

80%
需pnflu
2. (40%) (30%)
3.
4.
5.
75
CO
IVIG
䵣給予
CO
Aspirin

20-25%

10
3-10%

76
OSCE

“ “

“ TOCC
“
/ ? ( )
OSCE All Pass !!
 (Rash-causing childhood diseases)

Measles ( )
Scarlet fever (Group A streptococcus)
Rubella (German measles)
Erythema infectiosum (Fifth disease, Parvovirus B19)
Roseola infantum (HHV-6, HHV-7)

79