a**l
发帖数: 1166 | 1 一看就是有经验的同行，我也最喜欢sedated & intubated的病人了，最好是confused
的，不然，病人及家属的闲言脆语就要搞死人； |
|
h*****r
发帖数: 44 | 2 医生问护士病人如何，是想要获得一些额外信息，毕竟护士跟病人一起的时间长得多。
例如病人在用呼吸机，我想知道当前参数下Sat是不是能维持，respiratory therapist
有没有改变参数，病人的sedation合不合理；对liver failure，用了lactuose后大便
次数如何，UOP如何，MS如何，有没bleeding…虽然很多信息都有document,但很多不是
及时更新的，如果你能告诉医生，会有很大帮助。另外就是病人家属有什么要求，很多
时候他们踫不到医生都是跟护士交流。 |
|
l******k
发帖数: 27533 | 3 nice search from Beer's list.
I don't look at it, but I believe the first generation antihistamine is not
contraindicated in the elderly. Reference is black and white, but the
patient is specific, the appropriate recommendation should be made based on
the patient's situation. Antihistamine is not the best drug for the elderly
insomnia, but for the healthy and the elderly in their sixties, we do
recommend first generation antihistamine especially the short half one like
chlorphenamine in the ph... 阅读全帖 |
|
f****o
发帖数: 2770 | 4 nice discussion~we don't know the entire patient profile, I agree with your
recommendations and I was also just giving options.
The TCA recommendation was not based on the Beer's list.
Antidepressants have been used for insomnia for long time, and TCAs have
been most rigorously studied compared to the other antidepressants. There
are a lot of review articles available for search through PubMed if you are
interested. TCAs are definitely appropriate options using at low dose and
they are very cost... 阅读全帖 |
|
u**o
发帖数: 136 | 5 combat trauma pharmacy (at least at the earliest stage in the ER) is pretty
simple and repetitive, after all most patients are perfectly healthy until
that moment.
paralyzing agent for rapid intubation
ketamine/propfol/fentanyl for pain control and sedation
antibiotic for infection control
TXA for coagulation if there is massive bleeding
keppra/hypertonic saline/mannitol for penetrating head trauma
blood/fluid for volume resuscitation (pressors are rarely used)
that is about much it... |
|
c****m
发帖数: 626 | 6 我也贴一个，不算难的。
Mr. T is a6'4''230 lb and very muscular 35 yo African American who has
recently been diagnosed with schizophrenia but otherwise quite healthy. He
has a tendency to become easily agitated. He has been placed on risperidone
(Risperdal) 4 mg, is doing well. Of the side effects listed below for
resperidone, which one might you be concerned about?
A. sedation
B. Elevated prolactin
C. weight gain
D. Cardiovascular effects. |
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c****m
发帖数: 626 | 7 答案是D, risperidone 会引起QT prolongation, cardiovacular effects should be
concerned even though he is young and otherwise healthy.
Sedation is a side effects but the patient is agitated, so it would be ok in
this case.
risperidone |
|
r********r
发帖数: 352 | 8 有 antihistamine 的药小宝宝还是尽量少用。这个formulation要是说用来治疗sore
throat 还有情可原。不过11个月的宝宝你怎么知道他喉咙痛呢？
治疗鼻塞我觉得不大make sense. diphenhydramine 的作用是dry you out, 所以可能
流鼻涕的症状会有所缓解。不过也会造成 sedating，至少我工作的医院里儿科病房没
见过给小宝宝用 benadryl 的。 |
|
w******3
发帖数: 36 | 9 benadryl 给小孩不一定cause sedation。
然后搂住，不知道你小孩到底怎么了，不过至少这个Combo药一般来说不会伤到你孩子
。我知道大家在上学的时候都学过把这个给小于2-6岁的会怎样怎样。。。我现在发现
其实只要不Overdose就应该没事儿。
还有，你小孩咳嗽如果不是严重的不得了的话，就让他咳嗽吧。。。这个reflex
mechanism有时候其实有好处。 |
|
N*******r
发帖数: 118 | 10 It's all depends.
If your question is "Would ALL crani require GA?", then the answer is NO.
Awake craniotomy with local and IV sedation is a common surgery for some
brain tumor.
For certain ICH, Burr Holes (or Burr-hole craniotomy) are usually done under
local anesthesia. |
|
b*****o
发帖数: 6080 | 11 那不好意思，我正是bedside nurse,不喜欢被外行说教，因为我认为外行不了解这行业
实际情形。抛开原帖说题外话，医生也好护士也好，在病人sedated状态时，经常无意
识开很多玩笑，这些玩笑如果病人醒着，一定会觉得非常不恰当。一直觉得gray's
anatomy拍得还算真实，体现了人无完人的精神，没有把医生刻画成神仙。别的行业也
一样，存在这样那样问题，人无完人。
PPPPPPPPPPP |
|
T***i
发帖数: 1354 | 12 哦，原来是同行：）
SEDATED状态时偶也不敢乱说话，可能偶是新手，比较胆小教条，不想给人抓辫子。偶
也的确看到有些老护士在一边工作一边说着笑话。这个幽默很有用，很容易拉近和病人
家属的关系，但是得真的幽默才行，否则像咱们亚洲人，都是SILENCE得多。 |
|
A*******s
发帖数: 9638 | 13 A real case of mine.
A 21 years old male with severe mental retardation, was sent to ER for
mental status change and ataxia.
He was found to be dehydrated and had a UTI. After the dehydration and
sepsis being corrected, he still could not walk. Because he was not able to
cooperate for MRI, a CT of C-Spine and L-spine was ordered. Results were
not remarkable.
The patient was discharged back to nursing home.
At the followup, his family member finally showed up and told me that about
1 month a... 阅读全帖 |
|
s********e
发帖数: 1596 | 14 来自主题: Medicalpractice版 - 高龄 根本就是没有希望啊，是一两个星期和一两个月的差别吧，而且病人完全没有quality
of life可言。那么大那么深的伤口，母亲说不疼，不让给药，可是给了药Vital Signs
就好很多。每天的睡眠时间不知道加起来有没有1-2小时，自然任何sedating的药都不
让给，怕病人醒不来。
我没有羡慕那些人，只是觉得至少应该想办法让他们有一点付出，省得他们没事找事，
惹事生非，做起决定都不会考虑对社会的负担。
再说一个实例，原来我儿科轮转的时候，有个孩子因为是父母的private insurance，
transplant的coverage有上限，只能拖延治疗。可是medicaid没有上限，大家讨论起来
也是很愤愤不平。 |
|
m****8
发帖数: 419 | 15 http://www.csmonitor.com/USA/2011/1006/Steve-Jobs-s-2005-Stanfo
My third story is about death.
When I was 17, I read a quote that went something like: "If you live each day as if it was your last, someday you'll most certainly be right." It made an impression on me, and since then, for the past 33 years, I have looked in the mirror every morning and asked myself: "If today were the last day of my life, would I want to do what I am about to do today?" And whenever the answer has been "No" for too... 阅读全帖 |
|
m****8
发帖数: 419 | 16 http://www.csmonitor.com/USA/2011/1006/Steve-Jobs-s-2005-Stanfo
My third story is about death.
When I was 17, I read a quote that went something like: "If you live each day as if it was your last, someday you'll most certainly be right." It made an impression on me, and since then, for the past 33 years, I have looked in the mirror every morning and asked myself: "If today were the last day of my life, would I want to do what I am about to do today?" And whenever the answer has been "No" for too... 阅读全帖 |
|
Q******1
发帖数: 489 | 17 About your child:
dental treatment depends on the size of caries at contact of teeth, oral
hygiene, and caries risks. S,T,K,and L are primary molars. usually they are
exfoliated around 11-12 years old. If there are caries, you have to restore
it.
If the caries are big, I prefer stainless steel crown (SSC) which can last
long time till exfoliation. If it is small, the amalgam filling are ok, but
you have to help your child clean teeth everyday and use floss, which clean
the contact surfaces of te... 阅读全帖 |
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b***u
发帖数: 746 | 18 I had some ridiculous psych consult as well.
Case#1. Cl for depression, as pt withdrawal, not willing to verbally
communicate with primary team. So I went to see pt, found he's pleasant and
talking fine, but noticed him spit frequently. Then I asked "your doc is
concerned you don't talk that much, is there anything bother you that makes
you not willing to talk?" pt replied "doc, you see I have so much saliva,
when I speak I need to spit all the time, so I don't bother to talk" .......
..
Case#2.... 阅读全帖 |
|
b***u
发帖数: 746 | 19 If you talk about catatonic pt, is a different issue, although pt does not
talk, we can observe affect, peculiar behavior/positioning, echolalia/
echopraxia etc. the case here is that the patient was completely sedated by
medication while on vent, so there's not much psych signs that we could rely
on to assess. Although certainly collateral info can be gathered, but the
main part, patient interview was missing, so cannot perform a full
assessment to give recs. especially this was a SA case, so a... 阅读全帖 |
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s**********t
发帖数: 217 | 20 For case#2,
every hospital has its own policy regarding suicidal attempt patient. The pt
need to be 302ed which need psych consult. It does not matter whether the
pt is intubated, sedated or not.
and
makes
..
, |
|
R*******t
发帖数: 367 | 21 核磁共振对小孩没有副作用。可是25个月的娃娃不能在扫描的时候hold still，大多需
要麻醉，conscious sedation甚至全麻。麻醉的潜在危险性比核磁更大。但是绝大多数
的孩子都没事，不用太担心。 |
|
A*******s
发帖数: 9638 | 22 Sorry I have to disagree with you on this one.
For a confused patient, you always try not to give sedation if possible. You
may assume she is having seizure, but where is evidence?
Assumptions are always wrong, believe it or not.
his
than |
|
L****n
发帖数: 12932 | 23 cataract can be done under local, topical or retrobulbar block. If they
received sedation (MAC), their complaint may not be valid.
a lot of patient file this kind and that kind of complaints for reasons
utterly not related to medical service, mostly stem from the huge bill they
received from hospital - unfortunately doctors and nurses have to endure the
consequences. Even though majority of this kind of suits dismissed, but
just been named in a lawsuit give you many headaches, as well as trouble... 阅读全帖 |
|
M****a
发帖数: 577 | 24 来自主题: Medicalpractice版 - 语言的艺术 MRI这样说就行了：
The machine is very claustrophobic. The space is like a shoe box. Many
people won't be able to handle it. I wouldn't do it to myself. (pause for 2
seconds) Do you still want to do it?
一般人一听shoe box就不干了，如果人家坚持，就这样说：
Sure. We may have to sedate you though, because we don't want you to move at
all.
如果人家还是坚持，就让MRI tech去说。 |
|
c********r
发帖数: 129 | 25 Your wisdom tooth looks like mine, I just had it removed last week, it is ok
.I didnot take sedation, only locally. I only feel it was not comfortable
for first week, can only eat soft ot liquid food. |
|
J*********l
发帖数: 1185 | 26 连接有问题。
Flexible bronchoscopy as a valuable tool in the evaluation of persistent
wheezing in children.
Erkan Cakir, Refika Hamutcu Ersu, Zeynep Seda Uyan, Sedat Oktem, Bulent
Karadag, Okan Yapar, Ozge Pamukcu, Fazilet Karakoc, Elif Dagli
Division of Pediatric Pulmonology, Marmara University, Istanbul, Turkey.
International journal of pediatric otorhinolaryngology (impact factor: 0.85)
. 10/2009; 73(12):1666-8. DOI:10.1016/j.ijporl.2009.08.016
Source: PubMed
ABSTRACT Persistent wheezing is a commo... 阅读全帖 |
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g*****d
发帖数: 991 | 27 VT Storm的治疗，首先是找病因，一般都有诱因，诸如，CAD，电解质紊乱。上
Dobutamine是乱上加乱。
药物上，Amio加BB。也用Amio加Lido。
有AICD，需Reprogram。特别是这个病例。心率160，病人是稳定的，不需要Shock。增
加ATP的长度和次数都很有效。
如果反复的AICD Firing，需要Deep Sedation上呼吸机保护病人。
最后，EPS Ablation。 |
|
n*******c
发帖数: 501 | 28 续...
一整晚夜班被这个VT storm搅得不可开交，今天接班时知道患者白天已经做了EPS，心
里大慰，可是正当我以为会度过平静的一晚时，又code了。
好家伙，EPS后就维持了几个小时，现在的VT，频率差不多200，反复的ATP，没有效果,
，血压开始往下掉了，没办法，AICD fire了，之后还出现过室颤，再次fire AICD，唉
，病人连续的被shock了好几次，每一次伴随一阵狂呼，痛苦异常，但是已经尽量的给
了很多镇静剂...
Amiodarone和Lignocaine都再次加上，可是形势不等人，下一步看来真的得deep
sedation上呼吸机了，不过就算那样如果VT还是发生，也不是长久之计啊... |
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A*******s
发帖数: 9638 | 29 这个说法确实有误导的意思。 脑死亡在临床上诊断有一定的难度，需要满足若干标准
，如果一个病人在昏迷状态，没有sedation，又没有生命指证，任何医生都会想到脑死
亡这个可能，包括林峰在内。
至于家属不放弃，医生又难以证明脑死亡，才有了林峰来看病人，而她到了以后，病人
很可能已经峰回路转。
退一万步说，林峰本人究竟做了什么让刘起死回生？ 真正关键的只是时间而已
可是，刘这样的生活质量真是她想要的吗？ |
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m**********r
发帖数: 2099 | 30 你说的protocol，对儿科麻醉来说，有许多routine，但不是临床protocol。protocol
是大家公认的操作规范而且protocol规定的很具体，例如药量，routine就是习惯成自
然的意思，可能每一个大夫都有自己的routine并不统一。
你说的这是两种不同的麻醉option，第一个操作是sedation，因为不太疼，时间也短，
但极短的时间里需要稍微深的麻醉;第二个操作是插管全麻，基本上是routine，所以某
种程度上对药物剂量上的拿捏第一种反而更高。
第一种这种比较短的麻醉，是根据当时病人情况来调整剂量，对小孩来说有时稍微多给
个3ml醒得就慢点，抑或有个麻醉大夫又加了versed，那就更慢，这还与孩子事先吃过
什么药有关系。第二种插管全麻，时间比较久，大约的有routine. |
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A*******s
发帖数: 9638 | 31 最近网上经常有一些医学问题，因为HIPPA的限制，我觉得直接回答具体病人的提问是
不能接受的，但针对某个疑难病例的讨论应该符合到版上来的医生的利益，所以我觉得
可以开展一下这样的活动，需要强调的是，所有病例都会被修改得面目全非，所以即使
病人或家属认为这个讨论有他们的影子，讨论内容只能用来学习和借鉴，不能用来照搬
， 否则后果自负。
我建议网友有疑难病例请先寄给版务，由他们修改后发表。
我先开个头，下面的病例已经修改：
【简单病历】
性别：女 年龄：48 1年前发现眼睛睁不开，在某医学院附属医院怀疑梅氏综合症（
Meige's syndrome）现面部、颈部、嘴部均不自主痉挛抽动，放松平躺时症状减轻，每
次抽动时，颈部大筋变硬，类似于人哭泣到极致时的啜泣，吃饭收到影响，容易在咀嚼
食物时突然不自主吸气。曾于北京多家医院多次注射Botox，均无显著效果，现服用药
物为：盐酸苯海索(Artane)每日一片、氟哌啶醇片（Haloperidol）每日一片。因该类
药品对记忆力有可能产生不了影响，曾试图停药，但一旦停药抽搐的就更加厉害。
【第二诊断治疗意见】
很同情这些病人的痛苦， 诊断不想多评... 阅读全帖 |
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m********1
发帖数: 45 | 32
谢谢你的回复。看你的id，应该是这方面的专家吧。
其实我还有一个疑问：一般这种情况最严重的就是脑损伤吧。为什么小孩醒来后，没有
继续做相关的脑损伤的检查或者评估？倒是口头说，一岁的时候能提供智力测试。那也
是半年以后的事情了。这是常规的处理方式吗？
肺有先天缺陷，但是asymptomatic的，手术前小孩各方面发育都是超平均水品很多的。
要不然，小孩估计都过不了这个劫。
主要是几个细节实在是让我吃惊。
1.进入ICU后，一个医生给我们讲解情况的时候，指着x光照片居然把哪个肺是有问题的
都搞错了且绝对不是口误。发现自己错了后，没说几句就溜了。
2.因为我们问了关于CT时麻醉的问题，这次surgeon和麻醉师跟我们说其实CT时不用
anesthesia，sedation就行了。在CT时，我们还和当时的麻醉师反复强调，有些医院做
这个CT是不anesthesia的。这是一个很明显的医院内部信息交流有问题的例子。
3.出事当时，医生给了我们一张气管镜的报告。一般来说这不都是电脑生成的吗？日期
居然是错的。
4.要是我们不提，医生都不说脑损伤的问题。当我们是文盲呢。
所以我们才想要当时手术室里... 阅读全帖 |
|
b******m
发帖数: 1451 | 33 【 以下文字转载自 Medicine 讨论区 】
发信人: tsiaojian (三宝太监), 信区: Medicine
标 题: 牙科FAQ（草稿）
发信站: BBS 未名空间站 (Tue Feb 24 19:35:39 2009)
准备慢慢写，欢迎补充 :-）
1. 看牙保险给报销么?
参见具体policy。健康保险如无明文提到exception，一般可以认为不报。看病之前，自学一下保险手册的关键条款（有生命危险或疼得天昏地暗者除外）。
2. 看牙咋省钱？
有保险的考虑适当拖延。到下一年可以用新报销额度。
自费买dental insurance：一般premium几百/年，一年最多报销两千，外加
waiting period，所以不一定合算。临时报佛脚的情况就不要考虑了。
dental discount plan：在参加计划的诊所可以立刻打折。比如Aetna Advantage Dental。
收入确实低的，在本地找免费或low cost诊所。这些地方可能有eligibility要求，很多只提供有限服务。
去附近的dental sc... 阅读全帖 |
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S*********9
发帖数: 45 | 34 我星期四刚做完，用了sedation, 一点感觉都没有，只是这两天有点spotting. 不过
我的是diagnostic的，医生看了看，里面没有什么问题就算了。如果你要弄掉疤痕，可
能是operative的，恢复时间可能要长一点，但恢复后应该对怀孕没有影响。 |
|
o*******n
发帖数: 2035 | 35 Lao C 厉害啊
中国和土耳其未来有望以本国货币进行双边贸易结算
Großansicht des Bildes mit der Bildunterschrift: 中国总理温家宝同土耳
其总理埃尔多安举行会晤中国总理温家宝周五同土耳其总理埃尔多安举行了会晤。双方
决定大力促进两国的经贸关系。土耳其总理还提出以土中两国的货币替代美元进行外贸
结算。土耳其与中国境内维吾尔人在宗教和血缘上的关系也是中国看重土耳其的一个原
因。
周五温家宝同土耳其总理埃尔多安以及土耳其政府的其他代表举行了会晤。据土耳其媒
体报道，温家宝强调说，希望他的访问为中国和土耳其之间的友谊打开新的篇章。
中国和土耳其希望加强双方之间的战略伙伴关系。到访的中国总理温家宝和土耳其总理
埃尔多安周五在安卡拉强调，为达到这个目标，双方应当扩大投资和加强贸易往来。两
国计划在今后的5年内将每年的贸易额从现在的170亿美元提升到500亿美元。2020年双
方的贸易额计划达到1千亿美元。
据土耳其媒体报道，埃尔多安向中国提出建议，在双方的贸易结算中使用中国和土耳其
货币替代美元。他说："我们的下一步建议是，利用土耳其... 阅读全帖 |
|
r*****g
发帖数: 7139 | 36 Committee votes 20-2 against recommending approval
* Drug contains "date rape" chemical
* Jazz shares halted during panel meeting
BETHESDA, Md., Aug 20 (Reuters) - A U.S. advisory panel on Friday rejected a
Jazz Pharmaceuticals Inc (JAZZ.O) medicine to treat the pain disorder
fibromyalgia amid concerns the product could be misused as a "date-rape"
drug.
A Food and Drug Administration advisory committee voted 20-2 against
recommending approval of sodium oxybate or JZP-6. The medicine contains a
f... 阅读全帖 |
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y*****l
发帖数: 5997 | 37 发信人: zijing (紫晶), 信区: Stock
标 题: Re: 看到这个噩耗，教授再也淡定不住了。
发信站: BBS 未名空间站 (Wed Oct 5 20:18:05 2011, 美东)
Stanford Report, June 14, 2005
'You've got to find what you love,' Jobs says
This is a prepared text of the Commencement address delivered by Steve Jobs,
CEO of Apple Computer and of Pixar Animation Studios, on June 12, 2005.
I am honored to be with you today at your commencement from one of the
finest universities in the world. I never graduated from college. Truth be
told, this is th... 阅读全帖 |
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c*********t
发帖数: 1861 | 38 哈哈，我一天就活过来了，一点不适的感觉都没有了
砸牙吐血向大家推荐 Leonard Merlo, 手艺精湛，童叟无欺。上来一句废话都不说，直
接卡卡卡三下，就给我拔了。下手又准又狠，整个过程不到1分钟。。。我甚至还没来得
及点上一根香烟。。。对了，我用的是 local anesthesia。完全没有必
要去sedation. |
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l****e
发帖数: 1627 | 39 来自主题: _PerfectMoms版 - 杯具！ to make you feel even better
DD just had his first dentist visit
apparently needs 4 fix ALREADY
the dentist wanted to sedate him to do it
i am still debating... |
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a********o
发帖数: 585 | 40 tell me and take your time
set free this soul of mine
freeze frame this sedate moment
lie me in your quiet ground
I understand your
tired eyes for these
tired homes and tired tress
i see the pain in those
brown eyes
fires burn in autumn skies |
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a*****i
发帖数: 4391 | 41 >From today's Daily Yomiuri:
Mad Capsules a prescription for mayhem
Darron Hargreaves Daily Yomiuri Staff Writer
THE MAD CAPSULE MARKETS
Zepp Tokyo, March 24
Just about every band that visits Japan makes puzzled comments or complaints
about sedate audiences that gaze vacantly at the stage when, back home, the
situation would call for moshing and screaming and general chaos.
If any foreign bands had witnessed the scene at Zepp Tokyo last Friday, they
would have been flippin' flabbergasted. The jo |
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