l**********t
发帖数: 1212 | 1 工作第三周了，经历了很多事。
第一件事是shift change report. After shift report, we do rounding with vital
signs. one of my patient came in with severe stroke with hx of CHF, ESRD,
HTN, DM and so on. I had her for two nights in a row. She looked alright,
alert but unable to speak. She noded or shook her head when being asked
questions and got frustrated when we could not figure out what she was
trying to tell us. I took care of her the whole night and her blood pressure
was kind of low, around 90/50 and the lowest |
|
a********n
发帖数: 438 | 2 有一点小小疑问啊，这个病人不是came in with severe stroke with hx of CHF,
ESRD,
HTN, DM and so on. 怎么后来又表示自己血压低？就这个病人的情况，她是STROKE进
来的，需要保持血压高点，才能保持brain perfusion. 还有，她是ESRD/CHF, 也是要
很小心的给fluid bolus.最好是医生能够review一下她的药，找出她血压持续低的原因。
vital
pressure |
|
o****n
发帖数: 9475 | 3 Adm via ED 2 days ago with blood glucose 700. Dx hyperplycemic Hyperosmolar
Nonketotic Syndrome
Medical and surgical history
Type 2 Diabetes x 4 yrs.
Hypertension (HTN) x 8yrs
Coronary artery disease (CAD) x___yrs
Alcohol (ETOH) abuse x 40 yrs
L inguinal herniorrhaphy x 10yrs
Cholestectomy x 15 yrs |
|
M******C
发帖数: 623 | 4 ☆─────────────────────────────────────☆
oxhorn (^_^) 于 (Mon Mar 21 20:55:02 2011, 美东) 提到:
type 2 病人急诊到ED，诊断了HHNS，hyperglycemia hyperosmolar Nonketotic state
,两天后Head to toe assessment:
IBW 150%
I/O 3600/1600
+2 edema L ankle
pedal pulses +0/3 bilateral
lung crackles
last BM 4 days ago
FSBS 200
ate 100% of lunch，complain of still hungry
HHNS的症状不是dehydration吗？什么情况下会I/O +？priority nursing diagnosis可
以是Excess fluid volume吗？
Excess fluid volume r/t decrease fluid volume output AMB I/O(+ 2000 ml)... 阅读全帖 |
|
Y***Y
发帖数: 232 | 5 不知道别的学校有没有这个考试, 我自己学校board pass rate >98%
中途所有学生必须参加HESI考试来汇报学习情况,也算是为ＮＣＬＥＸ做
准备的.
背景: BSN 加速版
暑假刚刚上完family nursing, 学校要求考mid curriculum HESI.需要850
分pass,否则下学期需要上一门课加强知识.总分好像1100到1200之间 (?不确定,
也不知道,没人告诉我们)一开始挺紧张的,因为平时基本每周都有考试,都是填鸭式
快速记忆,考完大脑自动清空,迎接下一次考试,这次考完,成绩9**,88%,
挺满意的,基本符合我平日成绩.
考题基本覆盖了迄今为止所有学过的护士科目,
包括: physical assessment,mental health,peds&OB,Drug,Math,
nursing research,还有就是成人护理critical thinking.
考题: 总共110道题目(这可能自己学校有权选择题目数量和难易程度,不是很确定,
各个学校可能有差异,看别的地方有说１２０题的), 总体不算难,涉及范围广,
比平日里学校考试要简单,题... 阅读全帖 |
|
o******h
发帖数: 198 | 6 My company is hiring RN manager in NYC . One of the
biggest healthcare system/company in NY with MLTC and PACE program . bi-week
paycheck, salary range 80-90K depend on your experience, knows about OASIS-
C，SAAM, CHHA or LTHHCP 2 -5 yrs expriences preferred，RN office Case
manager experience highly preferred. You need to finish monthly budget
documents, contact hospital, ST Rehab, long term facility, facilitate the in
and out hospitalization process, updated the treatment plan, contact PCP or
hos... 阅读全帖 |
|
o******h
发帖数: 198 | 7 即日起 大家有空发一些匿名的病历讨论吧 熟悉一下病历书写和缩写吧
有不懂的可以提问 有工作经验的同学路过可以帮助回答
回帖的同学 第一部分请写你的问题， 第二部分请写你知道的答案 谢谢!
不会念医学单词的可以查这个 没有声音的 按允许pop up插件即可
http://www.merckmanuals.com/home/resources/pronunciations/index
xxx year old F with a pmh significant for dementia,asthma, dvt, pe in 2011,
htn, osteoporosis, rectal bleeding, new dvt rt. Leg 03/31 restarted on
Coumadin and lovenox, non verbal sent from NHF on 4/3 for drop in H/H 7/23.
On arrival V/S: 153/51, 74, 20, 99.4 and o2 100% on ra. Awake and non verbal
, neuro... 阅读全帖 |
|
a*********4
发帖数: 352 | 8 版里最近几个姐妹都毕业工作了，大家都来分享考试，找工作，工作的经验，我从中也
受益不少。复习的时候就决定考过后来分享经验，回馈本版。我是2/10考试的，过了一
个春节才回来写经验分享，有一些考题已经忘记了，就把我还能记住的分享一下吧。
1. 报名
我们学校在毕业前完成了所有的临床课之后就可以报名，我把UNOFFICIAL TRANSCRIPT
email给他们（网上有EMAIL 地址），同时ORDER 一份OFFICIAL TRANSCRIPT 寄给他们
，AANP效率很高几天就收到EMAIL说已经APPROVE，再过了大概一个星期就收到寄来的
ATT，就可以预约考试时间。AANP给120天的时间，在这个120天内必须考试，不然要重
新申请，除非有特殊情况可以要求EXTEND.这些信息AANP网站跟很多复习书都有详细介
绍。我很多同学当时就考了试（2014年的8-9月，当时我们在做COMPREHENSIVE EXAM,还
没有毕业），但是他们拿不到正式的CERTIFICATE,等到毕了业，AANP 收到OFFICIAL
TRANSCRIPT 上有DEGREE POST DATE才... 阅读全帖 |
|
l****j
发帖数: 114 | 9 我正在上第三学期，第一学期刚开始写care plan确实很花时间，十几小时都做不完，
写几次速度就快起来了。我买了Davis drug guide online code，可以online查药，然
后就copy&paste到paper上，这一项就给我省下hours的时间。我也遇到一次clinical去
long term care病人不在的情况，前面十几小时的功课全白费，我和老师商量下来尽量
换一个很接近的case，比如primary diagnosis是一样的，这样很多research可以用原
来的。LTC里几乎人人都有HTN，COPD，DM什么的，总能找到类似的case。在clinical里
的时间，除了照顾自己的病人之外，我觉得挺空的，可以work on paper。
你千万不要放弃，不知道你有没有经验，但很多没有医疗经验的朋友同学都说第一个学
期是最难的，熬过去就好了。我因为有5年诊所medical assistant的经验，第一二学期
很轻松得过来了，反而觉得现在在hospital里有点不一样，还挺难的。每个学校的
setting都不一样，老师也不一样，我觉得有困难可以多和老... 阅读全帖 |
|
w**d
发帖数: 362 | 10 新手上班两个月，医生来看病人的时候，问句：How is this patient?
我都不知道怎么回答。医生到底想问什么？
通常，我就说：He is fine.糊弄过去。然后，医生就走进房间看病人去了。
有时想想挺沮丧的，忙碌了一上午，都不知道自己重点是什么。
交班，然后assessment, document, giving medicines, turn patient/2 hours,
document every 2 hours.
都忙这些很琐粹的事情。
比如一个respiratory failure + HTN + diabetes + liver damage, 很典型的一个病
人，
医生问：How is this patient?
病人半死不活的用呼吸机AC mode维持生命, 你叫我怎么回答这个问题？
我想说： 病人问题一大堆，但是目前VS被我们维持在正常范围。目前还死不了。
开玩笑，肯定不能这样说。
然后呢，医生问的问题，我有一半都不知道怎么回答。
比如，liver damage, How is pt, ptt? 我赶快打开电脑去查lab。
然后病人家属来了，问：ho... 阅读全帖 |
|
w**d
发帖数: 362 | 11 多谢您回复。
那天早上preceptor和我一走进病房，马上就发现异常。夜班RT把Ventilator调到了 AC
32 500 100%, peep 15. 这是开足马力确保病人不要在夜班去世。
白班RT来了，马上查ABG. 我们俩一算，paO2/FiO2=105, fatal rate 38-45%。马上打
电话给家属。
HR 125, 12-lead EKG显示A-fib with multiple PVC，但是没有MI。
peep 15是极限了，RT说他已经把ventilator弄到极限了。
到下午，我也把vasopressor弄到极限了。
都打到极限了，那为什么BP还是控制不住呢？该用的我们都用了。没招了,第一次感到
很无助。
事后想想，应该要弄个cvp和arterial pressure看看。
是什么导致的ARDS我也不太清楚。入院诊断是acute respiratory failure, UTI.
PMH: chronic hypercapnic respiratory failure, COPD, CHF, HTN.
%. |
|
w**d
发帖数: 362 | 12 多谢您回复。
那天早上preceptor和我一走进病房，马上就发现异常。夜班RT把Ventilator调到了 AC
32 500 100%, peep 15. 这是开足马力确保病人不要在夜班去世。
白班RT来了，马上查ABG. 我们俩一算，paO2/FiO2=105, fatal rate 38-45%。马上打
电话给家属。
HR 125, 12-lead EKG显示A-fib with multiple PVC，但是没有MI。
peep 15是极限了，RT说他已经把ventilator弄到极限了。
到下午，我也把vasopressor弄到极限了。
都打到极限了，那为什么BP还是控制不住呢？该用的我们都用了。没招了,第一次感到
很无助。
事后想想，应该要弄个cvp和arterial pressure看看。
是什么导致的ARDS我也不太清楚。入院诊断是acute respiratory failure, UTI.
PMH: chronic hypercapnic respiratory failure, COPD, CHF, HTN.
%. |
|
w**d
发帖数: 362 | 13 M, 87 yr, acute respiratory failure, PNA
Hx --- COPD, DM, CAD, CKD, CVA, TIA, HTN, PE, dementia.
when shift change, vital signs are normal, O sat 92% on 3L nasal cannula.
一晚上直到4AM都很平稳，没有异常。我抽血做CBC, CMP的时候RR 18, O sat 92% on
3L nasal cannula.
然后4：30AM 病人呼吸突然停止了。马上ambu bag, 但是HR, BP紧接着往下掉，马上启
动ACLS。Intubation is the only option, but pt has order of "do not
intubation (DNI).
打电话给家属确认，家属再次坚决不同意intubation。
Sadly, we lost him。
请问，之前一切正常，怎么会突然在4：30突然停止呼吸了呢？大家见过类似的情况吗？
这太可怕了。 |
|
n**********e
发帖数: 79 | 14 不会真的这么惨吧。。。这么intense 的课程读完了成了酒鬼，成了anxiety disorder
，有了HTN， 还pre DM （stress eating 太多），结果这么点儿钱。。 |
|
n**********e
发帖数: 79 | 15 不会真的这么惨吧。。。这么intense 的课程读完了成了酒鬼，成了anxiety disorder
，有了HTN， 还pre DM （stress eating 太多），结果这么点儿钱。。 |
|
s**4
发帖数: 490 | 16 oh man, I made almost the same mistake during my very first rotation last
year. physican called in hydroxyzine prn, but i took it as hydralazine.
since i know they are sound-alike drugs, i looked up the pt's profile.
ironically, the pt did have HTN. so i let it fly. fortunately, the pt was a
very careful pt and read insert for new rx all the time. so she called the
same night and got the drug changed.
i guess the catch here is hydralazine is very rarely prn outpatient.
happened
The |
|
l******k
发帖数: 27533 | 17 现在已经向这个方向发展了
医院里的internal clinic就是pharmacist来优化一些chronic disease therapy like
HTN and diabetes.还有anticoagulant clinic现在也越来越普遍了吧。干这些事情的
pharmacists都有权利修改处方的。 |
|
F*****y
发帖数: 92 | 18 It depends on what you are treating the patient for. If patient uses
Bystolic for HTN, metoprolol tartrate, atenolol or other beta blockers
should be as good as Bystolic. However, for heart failure (unlabeled
indication),carvedilol or metoprolol succinate should be a good alternative
for Bystolic. |
|
a*****8
发帖数: 2115 | 19 well, bystolic is not recommended for HF anyway. if it is for HTN or prevent
post-op arrth metoprolol is a good choice. |
|
m**s
发帖数: 520 | 20 架子上找不到有可能当天正在用没来得及归位。也有可能哪位大脑短路一下摆错了地。
还有就是真用完了。用完了或数量不够（很经常发生在每天）就需要order,同时需要通
知顾客（特别是还没来的),免得他们挤到店里，麻烦！脾气差的急急火火赶来，发现没
有药拿还发火。有的是refill缺货，可能病人不吃了就不用订了。HTN,DM等维持药
refill，如果估计病人还没吃完，可以通知病人truck day后来取。因为从第3方公司（
比如麦克森）进货总是贵很多。 |
|
m****p
发帖数: 404 | 21 原文
http://forums.studentdoctor.net/showthread.php?t=884279
念药学院的学长学姐有什么评论么
德州 加州 pharmacy school 一家一家的开 2015-2020 铁定会过饱和了吧
最后几段是讲his family 自己开店30年的经验/挫折
还有文中提到的 MTM 是什么缩写?
1st -- Before you jump on me, understand this: I am only speaking about what
I know from extensive analysis of the California market (maybe some of this
will translate into other states but again this is for California people
primarily). If you attend, UCSF, USC, Western, UCSD, etc this job market
post is for you.
2nd -- Feel... 阅读全帖 |
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b******8
发帖数: 1251 | 22 没有考过，不过今年毕业，现在学校已经给我们买了rxprep的网上题和书，做了一些没
有看到case题，不过实际我们上学有的学校学不到，很多东西rxprep上学到的。case的
话一般就是给个病人，现在吃什么药，然后现在的lab如何，然后就问药该怎么改，反
正至少要把 HTN, DM, HLP这三个记得滚瓜烂熟吧 |
|
b******8
发帖数: 1251 | 23 我，既没有在学校当任何leadership,也没有在外面上班，同学认识不到1半，属于学业
一般，人缘也一般的那种，commute,每天下课就不见人影了。
2013年：
- 学业结束，3.5 GPA，有什么用呀，我又不申请residency.
- NCPA business plan得了第二名，总算有点可以写在resume上的
- APPE开始：
1. specialty pharmacy: 这个我比较喜欢，工作轻松，还被病人感谢，有个specialty
,病人都是癌症呀之类的重病人，比较尊重人，就是工作太少，我们这地要是没人挪窝
的话，估计不胡有opening
2. am care,遇到了一个bitch preceptor,虽然最后人还是可以的，不过这个rotation
一直我就没有放松过，主要是warfarin clinic, MTM, 说实话，坐下来，我真的替那些
warfarin clinic的pharmacists惋惜，他们都是residency trained的，都能做更好的
事，warfarin clinic给病人check INR感觉就是护士的事，每天每人打10页的电话，... 阅读全帖 |
|
b******8
发帖数: 1251 | 24 我，既没有在学校当任何leadership,也没有在外面上班，同学认识不到1半，属于学业
一般，人缘也一般的那种，commute,每天下课就不见人影了。
2013年：
- 学业结束，3.5 GPA，有什么用呀，我又不申请residency.
- NCPA business plan得了第二名，总算有点可以写在resume上的
- APPE开始：
1. specialty pharmacy: 这个我比较喜欢，工作轻松，还被病人感谢，有个specialty
,病人都是癌症呀之类的重病人，比较尊重人，就是工作太少，我们这地要是没人挪窝
的话，估计不胡有opening
2. am care,遇到了一个bitch preceptor,虽然最后人还是可以的，不过这个rotation
一直我就没有放松过，主要是warfarin clinic, MTM, 说实话，坐下来，我真的替那些
warfarin clinic的pharmacists惋惜，他们都是residency trained的，都能做更好的
事，warfarin clinic给病人check INR感觉就是护士的事，每天每人打10页的电话，... 阅读全帖 |
|
u*******s
发帖数: 688 | 25 除了最基本的语法正确之外，怎么样写一篇能称为"beautiful"的语言严谨的临床医药
学论文？
细节见功力。
学院里一位大牛教授给所有的没写过book chapter的新人老师发了一份写作清单。我节
选一些贴出来。
文内不要出现it is, there is
文章内不要出现引用文献的作者名，文献名称，或journal的名称。
generic的药名不要大写。
一个句子，不要用缩写或者数字开头。
While的意思表示两者同时发生。绝大多数时候用although更合适。
Compared with是比较两者不同，compared to是比较两者相近。
避免用疾病形容病人：the hypertensive diabetic schizophrenic patient。Instead
, the patient had a history of HTN, DM, and schizo.
避免使用符号，除非是数据统计的部分。
十以内数字用单词写出来，除非是时间，距离，重量，等等
female/male是形容词。做名词的时候用 woman/man.
最后的reference里的文献标题不要每个单词... 阅读全帖 |
|
c****m
发帖数: 626 | 26 我也贡献一个：
MPJE（texas): 准备了一周吧， 95 分
2014 年有很多更新，用59页要注意updates。 个人推荐TPA 的law symposium， 上课
的老师直接给了我们一道考试题和答案～～
我还用了
Pass the Texas Pharmacy Law Exam: A Study Guide and Review for the Texas
MPJE
http://www.amazon.com/gp/product/0615655181/ref=oh_details_o04_
没有看书，直接做的练习题。
只有这本书有texas law 的练习题。
NAPLEX： 考完law 后有两周准备，其间由于technician 度假去了，被安排工作了50小
时。只考了100分。
只准备了常见的disease state. 用的RxPrep, 和quiz bank。 由于时间很紧，就只把
quiz bank的计算老老实实做完了。其它的章节就挑着看的。最后三天就完全没有看书
了，直接做quiz bank。
考试的时候出了一个小插曲吧。
刚开始考试，周围其他人考其它考试敲... 阅读全帖 |
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u*******s
发帖数: 688 | 27 Type 2 HIT is the deal breaker here. He cannot be discharged. 50% drop of
plt from baseline on 10/25. D/C heparin and UFH if used for flushing
catheters. Initiate argatroban 2 mcg/kg/min. I'm not sure how hospitals
would dose this drug over what long of a period. Monitor aPTT. Argatroban
can increase INR so when pt is restarting warfarin after plt is stable, this
is something to watch out for. Hgb low, consider pRBC.
Clindamycin 300 mg qid should be D/Ced because no benefit for post-op
prophylax... 阅读全帖 |
|
u****1
发帖数: 216 | 28 2013年prediabetes a1c 5.7-6.4%. 这类人群， 提倡减重和增加运动。 同时伴有htn
和水肿， thiazides类和loop类都同时升高血糖血脂。 torsemide, 口服loop类， 是
比较强的diuretics （相对thiazides类）。 还有一种k离子通道spring diuretics,
不升血糖。 但是同时病人又有心脏功能障碍和高血压，房颤， 使用k-sparing
diuretics， 有很大的危险。 可能现在而言， 利尿类使用这个还是不错的， 至少可
以降低血容量， 减低心脏负担。 同时降低血压。 至少可以减少水肿。
不知道各位前辈们什么评价。 |
|
u****1
发帖数: 216 | 29 2013年prediabetes a1c 5.7-6.4%. 这类人群， 提倡减重和增加运动。 同时伴有htn
和水肿， thiazides类和loop类都同时升高血糖血脂。 torsemide, 口服loop类， 是
比较强的diuretics （相对thiazides类）。 还有一种k离子通道spring diuretics,
不升血糖。 但是同时病人又有心脏功能障碍和高血压，房颤， 使用k-sparing
diuretics， 有很大的危险。 可能现在而言， 利尿类使用这个还是不错的， 至少可
以降低血容量， 减低心脏负担。 同时降低血压。 至少可以减少水肿。
不知道各位前辈们什么评价。 |
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V*****G
发帖数: 337 | 30 I have a real case, just roughly know the history, please bear with me.
A 62 yo w m c/o left shoulder pain for several days
Pain is dull, 6/10,
Caught a cold several days before onset of shoulder pain
With fatigue, slight short of breath
Non smoker
Past history is HTN x 15 years, on diuretics
No travel history
No trauma/injury history
Occupation: office based job
PE: normal
What is the next step? |
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V*****G
发帖数: 337 | 31 I have a real case, just roughly know the history, please bear with me.
A 62 yo w m c/o left shoulder pain for several days
Pain is dull, 6/10,
Caught a cold several days before onset of shoulder pain
With fatigue, slight short of breath
Non smoker
Past history is HTN x 15 years, on diuretics
No travel history
No trauma/injury history
Occupation: office based job
PE: normal
What is the next step? |
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a*******n
发帖数: 82 | 32 They are all valuable points!
She was given Zofran, Phenergan and compazine in the other hospital.
MRI of brain was done for evaluation of severe nausea.
For her PMH/PSH, significant for iron-deficiency anemia, treated with iron
supplements in the past; HTN; DLP; h/o C. diff colitis 6 months ago; pAF
with RVR 8 months ago; yearly normal mammogram; normal colonoscopy 3 years
ago; chronic lymphedema from lower extremities; lung nodule with stable CT
followup. She was on dig, amiodarone, coumadin, ... 阅读全帖 |
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a*******n
发帖数: 82 | 33 They are all valuable points!
She was given Zofran, Phenergan and compazine in the other hospital.
MRI of brain was done for evaluation of severe nausea.
For her PMH/PSH, significant for iron-deficiency anemia, treated with iron
supplements in the past; HTN; DLP; h/o C. diff colitis 6 months ago; pAF
with RVR 8 months ago; yearly normal mammogram; normal colonoscopy 3 years
ago; chronic lymphedema from lower extremities; lung nodule with stable CT
followup. She was on dig, amiodarone, coumadin, ... 阅读全帖 |
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A*******s
发帖数: 9638 | 34 ASA for primary prevention of HTN? Read more articles and then argue.
Do not take something for nothing. Medicine is the science.
I suggest you stay away from this topic, or you will get burned.
All springstep talked about are for secondary prevention of CVA/ACS. And he is wrong on ASA. But I do appreciate his input.
for
have |
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y******a
发帖数: 590 | 35 ASA 81mg daily can be given as primary prevention for CAD in a male pt >45
yo old, if there is no major contraindications.
For your friend, I assume that he only has HTN, without other PMHx or
pertinent social history, I will start him on HCTZ first. |
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y******a
发帖数: 590 | 36 I agree with you that the overall risk for CHD should be considered. But
even if pt has no h/o HTN, DM, etc, age itself is a risk factor, and USPSTF
recommend Asa for male older than 45 if no contraindications. It's a level
A rec. Here is the link
http://www.uspreventiveservicestaskforce.org/uspstf/uspsasmi.ht
10
high |
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A*******s
发帖数: 9638 | 37 ASA for primary prevention of HTN? Read more articles and then argue.
Do not take something for nothing. Medicine is the science.
I suggest you stay away from this topic, or you will get burned.
All springstep talked about are for secondary prevention of CVA/ACS. And he is wrong on ASA. But I do appreciate his input.
for
have |
|
y******a
发帖数: 590 | 38 ASA 81mg daily can be given as primary prevention for CAD in a male pt >45
yo old, if there is no major contraindications.
For your friend, I assume that he only has HTN, without other PMHx or
pertinent social history, I will start him on HCTZ first. |
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y******a
发帖数: 590 | 39 I agree with you that the overall risk for CHD should be considered. But
even if pt has no h/o HTN, DM, etc, age itself is a risk factor, and USPSTF
recommend Asa for male older than 45 if no contraindications. It's a level
A rec. Here is the link
http://www.uspreventiveservicestaskforce.org/uspstf/uspsasmi.ht
10
high |
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P*********8
发帖数: 168 | 40 pure HTN: fist line: diuretics such as HCTZ or chlorthalidone, then CCB,
such as nifedipine or amlodipine. if complicated by DM, ACEI or ARB will be
good |
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k********n
发帖数: 756 | 41 来自主题: Medicalpractice版 - a case 60 YOM HTN presents with sudden onset right arm numbness, weakness and pain
in the right shoulder and elbow when he was playing Golf. Stroke code was
called. +PE; questionable right NLF flatten, right arm strength 3-4/5
proximally and distally, Right arm had decreased sensation to light touch.
No other abn.
Time is brain. "Door to CT" time was about 10 min. What do you expect to see
? |
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n**z
发帖数: 26 | 42 来自主题: Medicalpractice版 - a case what does NLF stand for? sorry for my stupid Q.
stoke should be the first on differential list, but not necessary the answer
.How about branchial plexus compression? spinal compression 2ndary to trauma?
the reason I think so is that this pt has sudden onset during physical
activity, if stoke, more likely to be bleeding secondary to HTN, or aneurysm
, which most time cause more dramatic change, instead limited to only one
upper extremity.
nothing specific would be seen on head CT if not stroke. i... 阅读全帖 |
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V*****G
发帖数: 337 | 43 I do have a few questions to ask:
1st about the diagnosis: is diagnosis clear when the biopsy result is clear
or when gluten free diet worked? To me, it's the later. It will be more
helpful to ask patient if there is traveling history to Caribean, India,
Southeast Asia etc.If no such a history, then giving diagnosis when biopsy
result is clear might be reasonable to me. Maybe LZ said this somewhere in
the description that I missed. Anyway I am not clear no this at this point.
The other thing is... 阅读全帖 |
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y***d
发帖数: 33 | 44 I don't think there was a travel history. That was screened during her first
hospitalisation and we didn't go back and ask those questions again whenwe
got the path results back. Would have hake the case better if we did.
About when the diagnosis is confirmed, it was when she got better on gluten
free diet. before that we were highly suspicious but there was still a
little doubt because of those negative serologies. Our GI fellow told her
that he was 90% sure. Then she got better with gluten fre... 阅读全帖 |
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V*****G
发帖数: 337 | 45 I had this question for a long time. When a patient was admitted , shouldn't
we take care of majority of his/her problems, ideally all problems? Why do
we leave problems (eg her HTN) WHEN Discharged? I know this is kind of
common practice, isn't? Why?
first
whenwe
gluten
HLA |
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y***d
发帖数: 33 | 46 Ideally, one would want to take care of all problems before discharging the
patient. In reality, some of the more chronic issues take time to treat and
fine-tune. I'm not sure how your hospital is, but in my hospital, in-patient
service are covered by residents and hospitalists, who do not follow the
patient when they leave. So most of the time, non-urgent issues such as mild
HTN are left for the primary to take care off. Most of the primary docs in
our hospital system prefer it that way. If you... 阅读全帖 |
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A*******s
发帖数: 9638 | 47 84 yrs old WF, presented with right eye vision loss for the past 10 days.
Her left eye went blind 1 year ago. She was seen by an optometrist who
diagnosed her as GCA. Her daughter brought her to me for a 2nd opinion.
PMH: Left eye blindness for 1 year. DM. HTN and CRF.
On exam: Temporal tenderness bilaterally. VA: 20/70 OD, 20/400 OS. (+)APD.
fundoscopy suggests ischemic changes, no papillary edema.
Lab: ESR 20; CRP: 0.6.
What are you going to tell the daughter? |
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V*****G
发帖数: 337 | 48 Most likely optometrist is right. Just that ESR is normal.
But need to rule out:
Macular degeneration
Central artery embolization
DM opthalmopathy
HTN opthalmopathy
MS
Is there anything more in fundoscopy?
. |
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W***2
发帖数: 60 | 49 sorry for the second, I forgot the PE. Should be like this?
76 yo M p/w RUQ pain for 2 days with N/V. F/C. For the PMH, he had HTN, COPD
, CHF, Hypothyroidism, He is on Lasix, antenolol, ASA, Levothyroid. PSH:
gastric cancer 10 yrs ago, ventral Hernia repair 5 yrs ago.
PE indicated ABD soft, RUQ tenderness, no rebound, no guarding.
pt is afebrile, WBC 17, TB 1.2, DB 0.3. U/S showed GS. |
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A*******s
发帖数: 9638 | 50 今天被一个医生朋友的电话揪到了医院， 他给他一个亲戚做了个手术， 今天是第2天。
67 yrs old female had a cervical laminectomy for her cervical myelopathy
yesterday. Her initial symptoms include gait disturbance. After the surgery
, she was found to have a right arm weakness and right pupil dilatation. She
had been in respiratory failure after the surgery and currently she was on
biPAP.
ICU nurse was apparently panic after she saw the dilated right pupil which
was new and confirmed by her family members.
PMH: HTN， Glucoma.
Social/fami... 阅读全帖 |
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