c*******9
发帖数: 122 | 1 Thank you so much, Emma.
You are so generous to share your experience. I learned a lot from you today
. Thanks!!
good nurse:
say thanks to nurse face to face, even can admit you didn't think about it (
excellent, exceeding average nurse). mention the name to the nurse manager
that we have great nursing team here
bad nurse:
confront the nurse. need some time to talk to your privately. state the fact
. is there any reason that u didn't do this? well, i asked you to d/c
aspirin yesterday and it hap... 阅读全帖 |
|
h*******y
发帖数: 1220 | 2 Picture this, a pt came in, with serious life threatening pneumonia, what do
you do?
answer:
2nd or 3rd generation 头孢 (cefuroxime, ceftriaxone), or penicillin+beta-
lactamase inhibitor+ vancomycin, which cover both typical G+ and G- bugs, e
.g. Pseudomonas
, MRSA, E coli...
combine with
Macrolides or doxycycline: atypical bugs...
in some cases, use fluoroquinolones only... |
|
h*******y
发帖数: 1220 | 3 Picture this, a pt came in, with serious life threatening pneumonia, what do
you do?
answer:
2nd or 3rd generation 头孢 (cefuroxime, ceftriaxone), or penicillin+beta-
lactamase inhibitor+ vancomycin, which cover both typical G+ and G- bugs, e
.g. Pseudomonas
, MRSA, E coli...
combine with
Macrolides or doxycycline: atypical bugs...
in some cases, use fluoroquinolones only... |
|
e****0
发帖数: 678 | 4 翻翻我的箱子底， 找到我自己临考前的单子。
•Pregnancy
CBC/BMP
Blood type and Rh
Atypical antibodies/rubella AB
UAUCX
HIV/RPR/HBSag
Chlamydia/pap smear
•All disease
Diet
Exercise
Consult/counseling/consent/vaccine/screening/monitoring
PT/OT
•Acute R distress
Oxygen
ABG
Chest X ray
Pulse oximetry q 1hour
•COPD/asthma PEFR+Elevated head of bed
•All arthritis
Synovial fluid
•All office cases
CBC/BMP, PT/PTT, UA/UCX, FOBT, LIPD/LFT, ESR/TSH, EKG/Glucometer/CXR
•Surgery
NPO/bedres... 阅读全帖 |
|
d****y
发帖数: 2180 | 5 ☆─────────────────────────────────────☆
daisyy (daisy) 于 (Wed Aug 22 19:53:02 2012, 美东) 提到:
请大家把记录的笔记，感想放到这个帖子下面，以便于收精华区。
同时也保证你成为以后会议的VIP.谢谢！
☆─────────────────────────────────────☆
tangbutian (糖不甜) 于 (Wed Aug 22 19:55:06 2012, 美东) 提到:
The art of language -- communicate effectively in clinical settings
重点讲在医院里的communication，怎样适应美国的文化，怎么在医院中混的如鱼得水
、风生水起～
关于英文：
细节参见麦地前阵子的那两个有关英文的帖子，补充一点非常重要的：不仅要多说、多
念，更重要的是写作能力，脑子里有多少东西嘴巴才能讲出来多少东西。对CMG来说口
音并不是致命问题，更严重的是语言组织能力差，有条件的最好take一门写作的课程。
语言是一门艺术... 阅读全帖 |
|
i**********d
发帖数: 853 | 6 1). 多发性硬化（MS）汇总
2). Endocarditis Treatment：vancomycin and gentamycin |
|
i**********d
发帖数: 853 | 7 1). 多发性硬化（MS）汇总
2). Endocarditis Treatment：vancomycin and gentamycin |
|
z******8
发帖数: 844 | 8 ☆─────────────────────────────────────☆
zhu84518 (Henry) 于 (Mon May 5 23:08:37 2014, 美东) 提到:
一个好的口诀胜读10遍书，记住的知识点那是经久不忘，真是受益匪浅。我和Jeff一起
学习的时候编了不少好的口诀，现在Jeff考试考完了，match完了，抽点时间和我一起
把我们之前的口诀总结出来，一来是奉献麦地，也希望能够帮助后来的同学，二来是防
止我们的口诀继续在那里吃灰，这可都是我们耗费了多少脑细胞的成果。我们打算每天
抽点时间把口诀贴到此贴，如果有同学有自己的口诀想要分享，欢迎跟帖！
☆─────────────────────────────────────☆
zhu84518 (Henry) 于 (Mon May 5 23:12:40 2014, 美东) 提到:
☆─────────────────────────────────────☆
zhu84518 (Henry) 于 (Mon May 5 23:19:23 2014, 美东) 提到:
Toxopl... 阅读全帖 |
|
h******e
发帖数: 152 | 9 Shawn：我的经历，我是match了两次，一个interview都没有，到处打电话去要面试，要
了六七个，最后还是没有match上，我的经历，比较曲折
我step1 step2都是240+， cs一次过，第一次申请的时候，九月十五号递交材料，我九
月四号，还考了step3，我觉得策略不对，没有把package整好。我06年本科毕业，国内
读了硕士，这边phd，我准备考版，第一年我把课都上完，很多频繁考试，第一年结束
，我才开始打算。曲折报名认证~~
考完step1，cs，ck，很多事情挤在一起，,到了14年八月，边做见习，考step3，move
到 new york，十四号到newyork十五号交上去材料，到了十月都没面试，我找了我的师
兄，找了本校面试，然后到处要面试，十一月份，要到interview，最后要到几个，内
科要了不少，主要是打电话，发email，我感觉面试还是不是很出色，要到interview，
感受不一样，要到的，把你当做backup，如果有空位，就把你递上去了。如果package
有很大硬伤，他们就看的很仔细。即使你面试很出色，整个package 不要有短板，不要... 阅读全帖 |
|
发帖数: 1 | 10 Step1于我，就如我死缠烂打但对我爱答不理的那个人。说不上满心痴爱，可能就是因
为越是得不到越想要。
而今，看清自己的真爱，撩起面纱，你的模样，我记住了。
曾经拥有过，也是幸福的。
人生开悟篇：
20岁的时候很懵懂，以为来到美国就能够找寻自己。当初在国内，就是受不了一眼能看
到自己老死的生活，觉得十分可怕，所以不管用什么方法，哪怕是“嫁人”也要来到美
国（说笑了)。 想体会“人生拥有无限的可能性”。正如乐嘉所说，大红色性格的人以
体验为主，觉得经历才是人生最值得回味的事情。事实证明，试了很多工作，还是无法
找到自己，原因是1. 挣得钱和“能力”不能对等；即便是挣很多钱/month（最多可以$
$$/day)依旧没有幸福感和自我存在感 。什么是自己的小宇宙？？一直很好奇。每天梦
想自己小宇宙的爆发。看了半天，找寻了半天，结果相中了board。原因有3：1. 非常
清晰但是又非常有challenge的career path；升级过程中不至于boring 2. 有里子有面
子；3.从小就要做医生，不违背自己的本心。但是事实是：
第一本FA是2010的，满心欢喜的买回来发现，生词太多。一学期... 阅读全帖 |
|
y**m
发帖数: 1049 | 11 1. NO.除非病人血压高太多,一般都先hold.
2. 是不是 1st-line我不知道,不过临床上常见是的vancomycin和flagyl.
soon |
|
u*****d
发帖数: 1009 | 12 aminoglycosides, vancomycin这类需药都要draw trough level,就是在下一个dose之
前(30-60分钟前)的drug level in blood |
|
r***6
发帖数: 193 | 13 我是外行,问个问题,为何VANCO要测PEAK/TROUGH?高了.低了又说明什么? |
|
u*****d
发帖数: 1009 | 14 too low = not killing the bacteria, causing resistance eventually
too high = toxicity (ototoxicity, nephrotoxicity) |
|
|
k******o
发帖数: 3328 | 16 恩,就是楼上说的那样,pretty much the same reason of monitoring
aminoglycosides |
|
p*******e
发帖数: 143 | 17 Vancomycin is used for MRSA. but if bacteria resistant, Zyvox ( Linezolid)
may be used. Both should be available in China. |
|
l*******g
发帖数: 4894 | 18 十分感谢。vancomycin已经在用了，那个linezoid上次用了一次，现在基本上医生的意
思建议再做手术，
这个daptomycin我查了WIKIPEDIA,看到他可以治疗Staphylococcus aureus，但没有只
说可以治疗MRSA。 另外就是这个药国内能买到吗？
我查到的结果是达托霉素，不知道对不对。 |
|
l******k
发帖数: 27533 | 19 Dificid™ (fidaxomicin) was finally approved for the treatment of C
difficile infection and may offer some advantage over vancomycin in
resistant infection. There are two new drugs, Victrelis™ (boceprevir)
and Incivek™ (telaprevir), for the treatment of Hepatitis C infection.
Another oral contraceptive, Orsythia™ Tablets (levonorgestrel and
ethinyl estradiol), has been approved. Edurant™ (rilpivirine) becomes
the fifth NNRTI approved for treating HIV. New generic ver... 阅读全帖 |
|
a*****8
发帖数: 2115 | 20 Things cover pseudomonas:
beta-lactam: zosyn, cefepime and ceftazidime (for ceph), carbapenem (except
ertapenem), monobactam (azetreonam)
FQN: except for moxi
aminoglycoside
colistin
--Cephalosporin does not cover entercoccus
--Cipro does not cover strep (that's why not a respiratory FQN)
--MRSA: vancomycin, dapto, linezolid, bactrim, clindamycin, doxycycline
--FQN very broad spectrum cover most gram +, gram - and anaerobes (except B.
Frag)
先看是gram+ 还是 gram -，再想药。
比如说： UTI，主要是gram -，所以3rd gener... 阅读全帖 |
|
a*****8
发帖数: 2115 | 21 for your second questions:
Lets put aside the fast kill or slow kill issue.
1. we are treating potential sepsis right, but where is the source, is it
skin-soft tissue or osteo, or bacteremia or pneumonia, cause the organisms
you want to cover may be different.
2. I am assuming pt has been in the hospital or LTCF for a long time, in
that case we do want to cover broadly
3. If we are treating skin and soft tissue infection due to his ulcer, it
usually gram positive directed, but if he is at a hig... 阅读全帖 |
|
a*****8
发帖数: 2115 | 22 with regard to fast kill and slow kill issue, honestly I have never
encounter that I need to base on fast kill and slow kill to make antibiotics
selection, Oncology maybe. I will need to look into that. Vancomycin is
slower bacterial killing when compared to nafacillin in MSSA infection.
Therefore, when someone is having S aureus endocarditis pending
susceptibility,some of the physician will use both vanc and nafacillin to
cover MSSA and MRSA. |
|
l******k
发帖数: 27533 | 23 赞美！
单独记下哪两个有anaerobes,哪两个有pseudomonas coverage会比较好
Institutional antibiogram指导灵活运用
Ceftaroline很直接呀，skin soft tissue MRSA infection. Ongoing clinical trial
for pneumonia indication. 一般病人fail or can not vancomycin才用这个，太贵
啦！
group
★ 发自iPhone App: ChineseWeb 8.7 |
|
l******k
发帖数: 27533 | 24 不是高手，抛砖引玉
1. May consider propranolol if still has recurrent variceal bleeding after
TIPS and portacaval shunt
2. If intra-abdominal infection is suspected and ABX is needed, vancomycin
should be started due to the Hx of MRSA wound infection, and metronidazole
should be added for anaerobic coverage. Cultures are needed.
3. change Protonix drip to BID IV push after 72 hours infusion if active
bleeding stopped
5. do iron panel. If need iron supplement, us IV iron, and D/C oral iron for
GI adverse ... 阅读全帖 |
|
b*****l
发帖数: 9499 | 25 【 以下文字转载自 Thoughts 讨论区 】
发信人: bigsail (vancomycin), 信区: Thoughts
标 题: Re: 问同学们一个问题哈
发信站: BBS 未名空间站 (Tue Nov 3 14:07:35 2009, 美东)
不管用啊，半峰高也被位移了。
我还努力画个图哈：
%
%
% ** **
% * * *
% * * *
%-*-------------*------------*----------
% * *
% * *
% **
%
%
变成
%
%
% ** **
% * * *
%* * |
|
m*********k
发帖数: 10521 | 26 [pennystock] kylelowry Oct 26 ● 发包子66个，给老牛的bac壮胆
10*66=660
成功奖励 10 伪币的用户: routing, hill168, penncircle, monomania, fattiger, fangxuanling, aizaza, ivylih, fenice420, adgang, Mitlm, yoyo38, icuris, Meixing, buckseye, purp, NBS, KeepBuying, n202, kedougumin, happy03, Samma, wetwild, gin118, Kaida, buaa, wpwhy, dcw, canhelp2007, qiaqiafeng, JuanJuan, summitzf, upload, gamay, anym, rivers, pololi, strongstorm, KevinsFather, biot, xixi77, yachtting, LkHj, riverabc, Parsons, tonyparker, tigerin... 阅读全帖 |
|
m*********k
发帖数: 10521 | 27 [JobHunting] done Dec 31 ● 2010的最后一天
20*147=2940
成功奖励 20 伪币的用户: ivymerci, story9988, yoofor, laridoff, kap, xiaoxiaoren, dalianmaomao, bibicat, getback, romeooe, bettywang, mymovie, tennisboy, spectral, lolhaha, iBull, sunny09, Jessicat, blackfriday, SexyBass, pyhome, vthokie, mitscv, meatoo, kfby, daxue, wenhao01, xnxky, XiaoLongRen, summitzf, aromaticin, yunella, eric7, alvincy79, YM56, mmitbbs, xiaohongxing, TheAnswer, vonphoebe, lithiummpap, vancomycin, haymeadow, Muro555, happyp... 阅读全帖 |
|
d**e
发帖数: 6098 | 28 谢谢
xiaoxiaoren, dalianmaomao, bibicat, getback, romeooe, bettywang, mymovie,
tennisboy, spectral, lolhaha, iBull, sunny09, Jessicat, blackfriday,
SexyBass, pyhome, vthokie, mitscv, meatoo, kfby, daxue, wenhao01, xnxky,
XiaoLongRen, summitzf, aromaticin, yunella, eric7, alvincy79, YM56, mmitbbs,
xiaohongxing, TheAnswer, vonphoebe, lithiummpap, vancomycin, haymeadow,
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skyfree, mywish, so2011223, watercoat, GC, csghyyq, marsm... 阅读全帖 |
|
m*********k
发帖数: 10521 | 29 [ebiz] yayaliu Apr 22. ● 来，发888个包子慰问在风雨中排队的战友/小护士
10*90=100
成功奖励 10 伪币的用户: daisychan, flyongrass, feishia, damingzhu,
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youareback, kingcrown, vancomycin, sirius314, NeedForSpeed, BCBill,
moonpolar, netmn, dou... 阅读全帖 |
|
m*********k
发帖数: 10521 | 30 [Stock]
102692 kbrhouston Nov 1 ● 庆祝新班主上任发588个包子
成功奖励 10 伪币的用户: lovefreedom, krobin, eventhere, sunwufan, daledale,
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|
m*********k
发帖数: 10521 | 31 [Stockcafeteria]
54356 fluezone Nov 17 ● 发包子20个
成功奖励 10 伪币的用户: Youngeagle, JuanJuan, wangsir, Coco123, BHistory,
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jingoshine
扣除俱乐部: Stockcafeteria金库现金:200 |
|
m*********k
发帖数: 10521 | 32 [Stockcafeteria]
54396 fluezone Nov 18 ● $88有奖竞猜今天的收盘
成功奖励 88 伪币的用户: fluezone, wangsir
成功奖励 10 伪币的用户: fluezone, wyemlyy, wangsir, fangxuanling,
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fatfatdragon, torontonian
扣除俱乐部:(Stockcafeteria)316伪币成功 |
|
m*********k
发帖数: 10521 | 33 [Stockcafeteria]
55700 fluezone Dec 9 ● 发50个包子祝愿俱乐部欣欣向荣
成功奖励 10 伪币的用户: YUYN, BHistory, flac, wangsir, Tardigrades,
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, ilyqy81, delldell, Liangxinxin, Seashores, tone, xfsong, sting,
fangxuanling, ti... 阅读全帖 |
|
m*********k
发帖数: 10521 | 34 [NewJerse] intelbot
22609 intelbot Dec 9 ● 嘿嘿.PD终于current了拉
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|
m*********k
发帖数: 10521 | 35 [NewJersey]
23855 dreamsun Dec 14 ● 【开仓放粮】NJ版务感谢所有版友支持
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|
m*********k
发帖数: 10521 | 36 [pennystock]
53194 yaokarl Dec 31 ● 发包子祝大家新年快乐！
首页 - 用户奖罚 家页
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m*********k
发帖数: 10521 | 37 [pennystock] Feb 8 ● 包子给我家人求个bless吧
成功扣除 550 伪币的用户: yysqq
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|
m*********k
发帖数: 10521 | 38 " 【SellAbroad】
kelly9988 Nov 21 . ● 本版发包子,祝大家感恩节愉快!一个ID一个包子.100个包子"
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|
m*********k
发帖数: 10521 | 39 [NewJersey] Marcus Jul 16 ● [BSSD] 1000 伪币， 发包子。 庆祝NJ的
好姑娘狂奔
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njbbs, ssqb, soloscar, wawz, delia, lpf6, crement, solobird2010, lillblues,
nicedayhere, Otaku08820, asus, kqxqx, zzx, flyfish999, QueenZ... 阅读全帖 |
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m*********k
发帖数: 10521 | 40 "[NewJersey]Marcus Jul 16 ● [BSSD] 再来2000伪币， 大大包子！ 恭喜本版
某著名美女ID！！"
成功奖励 10 伪币的用户: Marcus, garfieldw, Cert, MKZ, Kawai, workaholic,
whatwhenever, twin, intelbot, jkz737, mitccs, warley, laomo840, david2010,
cjiayun, momo00, jiangjinjiu, GentleWen, superpower, rorolee568, xiaoboat,
Ispy, lilycola, solari, lampard, MD20815, Mushimitbbs, foxrun123, Ewing,
viviansky, AUSTIN86, Suiyuan528, GrainSalt, BigMonster, esprit, retroplan,
FranklinDou, lpec, yechaox, njbbs, soloscar, ssqb, wawz, lpf6, cre... 阅读全帖 |
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m*********k
发帖数: 10521 | 41 "【Chemistry】
Lizi Aug 28. ● [bssd]还愿包"
成功奖励 10 伪币的用户: yugon, blueyes, patchouly, yuhuashi11, yaofans,
chuansuo, pengyu, Nark, amicus, cepm, yiliuer, philistin, mvon, bull2007,
dingdangX, sammix, agent99, Windyblue, leptosin, haibara, EDfan,
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y13560407813, singa, cider, wobest, chemlu, snowboston, nmg, tigermom,
Tomasulo, gamelife10, GoBlue, shxhqh, shhhl, sixfriends, evence,
wangfengwang, jobseeker123, BGSU, BG, aBigGuy, Maume... 阅读全帖 |
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p*******1
发帖数: 102 | 42 向大家介绍一下URGENT CARE
URGENT CARE就是介于家庭医生和医院的急诊室之间的一个看病的地方，它一般不需要
预约，是WALK IN，可以处理一些不是那么生命攸关的但却又让你觉得需要马上解决的
一些身体状况。比如哮喘，食物过敏，感冒，发烧，脚崴了， 呕吐，肚子痛，腹泻，
头疼，需要找家庭医生但是正好是周末或者晚上了，家庭医生不开门，头晕，小伤口需
要缝合，腰扭了，需要输液，吊盐水。父母来探亲没有保险，糖尿病，高血压。和急诊
室一样，
URGENT CARE可以马上当天就能看到医生，但是URGENT CARE的收费比急诊室便宜的多。
比如都是抽血，急诊室的收费标准和URGENT CARE的收费标准是不一样的，同样的服务，
URGENT CARE收费大概只有急诊室的25%。
那你就会问，为什么URGENT CARE会存在，因为现在急诊室的等待时间太长，很多病人
根本不需要去急诊室，
但是他们不知道URGENT CARE的存在，还是跑去了急诊室，结果就导致了急诊室的等待
时间越来越长，
URGENT CARE的出现就是为了减轻急诊室的负担，另外也是为了给医疗保险公司和病人
... 阅读全帖 |
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b******a
发帖数: 704 | 43 http://www.huffingtonpost.com/2012/05/11/flesh-eating-bacteria-
The Associated Press reported that the specific bacterium that infected Copeland is called Aeromonas hydrophila. This kind of bacteria usually causes diarrhea (when people swallow water contaminated with it), and cases where the bacteria cause flesh-eating diseases are very rare, the AP reported.
--------------------
From Wiki:
Necrotizing fasciitis Type I describes a polymicrobial infection, whereas Type II describes a monomicrobia... 阅读全帖 |
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A*******s
发帖数: 9638 | 44 我在想，这个case如果发生在中国， 那个缝22针的急诊医生会不会有麻烦？ 这个小女
孩即使活下来也是残废了。
Copeland is called Aeromonas hydrophila. This kind of bacteria usually
causes diarrhea (when people swallow water contaminated with it), and cases
where the bacteria cause flesh-eating diseases are very rare, the AP
reported.
Type II describes a monomicrobial infection. Many types of bacteria can
cause necrotizing fasciitis (e.g., Group A streptococcus (Streptococcus
pyogenes), Staphylococcus aureus, Vibrio vulnificus, Clostridium perfring... 阅读全帖 |
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b******a
发帖数: 704 | 45 Common Causes of Pneumonia
In a young patient without coexisting illnesses, there are many potential
infectious causes of pneumonia.1 The patient's history gives us several
clues that help in reducing the list of possible pathogens. This patient
underwent bronchoscopy and bronchoalveolar lavage. Negative bacterial
cultures argue against common, easy-to-culture bacterial pathogens.
Furthermore, the patient did not have a response to multiple, broad-spectrum
antibacterial therapy including erythro... 阅读全帖 |
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n*******c
发帖数: 501 | 46 每次回国见到以前同事谈到抗生素滥用，大家都禁不住摇头叹气。
十多年前在国内工作的时候，在三甲医院，当时的印象是，住院病人，用头孢三代非常
普通，例如罗氏芬，也用环丙沙星，氧氟沙星什么的，经常还用用美平，泰能，万古也
不陌生。而且经常的，这些药不分青红皂白一股脑下去，“联合用药”，从来不用普通
的青霉素（那个只是拿来皮试的，便宜嘛），也几乎没用过庆大霉素，很偶尔的时候用
过丁胺卡那，护士都跑来问。
十年后，在国外的类似三甲医院，日常用的很多Benzylpenicillin，flucloxacillin,
Gentamycin,小部分用Ceftriaxone, 很有效，用meropenem的非常少，Vancomycin更是
很明显有指征的少部分才用的。
发达国家现阶段的抗生素用药“等级”比不上十年前的国内城市！
怎能不出现严重的耐药问题？恶性循环之下，国内的细菌感染越来越难治疗，长此以往
，出现超级耐药菌只是时间问题。这还不包括医疗费用膨胀的其他社会问题。
量子战士说得好，“抗菌谱不吻合，或者抗生素用法不对（比如用
药不及时，量不足，中途停药等）而不能及时消灭细菌，外加免疫功能严重缺失，才... 阅读全帖 |
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n*******c
发帖数: 501 | 47 多谢各位回帖。
澄清几点
俺又看了俺的原帖，的确Ceftriaxone可能说少了，过去的一年里基本住院CAP都常规用
上了，不过再早一两年用Ceftriaxone和BenzylPenicilli的都不少...
本文为探讨国内抗生素应用，并无意探讨美国抗生素应用，本文指的也不是美国，之所
以国内国外的比较，是想说明在国内多数自费，医保限制严重的情况下还有这么高的昂
贵非适应症抗生素滥用，是多么的令人发指。
现阶段抗生素的用量多等级高，并不一定是处方者的不合理用药，而可能是该地区医院
耐药情况严重的表现。俺看了大家的反驳，心下大慰，俺医院也是地区里的大医院，并
有附属的移植中心，俺原来就觉得MRSA,ESBL,VRE咋这么多涅，现在看来，有可能还是
小巫见大巫...不过十年前的中国，俺相信没有这么多耐药，而很多抗生素的确是查房
医生为了一己私欲而随意乱用。
感染控制和抗生素使用肯定有地域和时间的差别，天大地大，争论不休的你我也许不过
是摸着大象的一群盲人？我也不认为在个例上国外的一定是对的，国内的一定是错的，
可是无可否认，国内不依据医疗指南办事用药随心所欲是个很严重的问题，希望Juzbo... 阅读全帖 |
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b*****l
发帖数: 8603 | 48 Endo--
A 57-year-old female with a past medical history (PMH) of hypertension (HTN)
and depression was admitted for mental status change and fever for 1 week.
On admission, she was diagnosed with multilobar pneumonia and antibiotic
treatment with azithromycin and Zosyn (piperacillin and tazobactam injection
) was started. Blood cultures showed gram positive cocci in clusters and
vancomycin was added. LP was negative for meningitis.
Home medications
Toprol XL (metoprolol succinate), Neurontin (ga... 阅读全帖 |
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n*******c
发帖数: 501 | 49 早起，又是繁忙一天的开始。
这个轮转是消化科，不能不说是胆战心惊的，虽说在国内轮转过这科，可是此一时也，
彼一时也，知识更新千变万化，国内的临床经验也非常短暂粗浅。
查房开始，病人A是从国内来探亲的，妻子是留学生，刚来没多久，英语还不利索，于
是就用中文交谈，一旁的印度Intern自然是云里雾里，呵呵，你们也有今天（以前也常
有印度病人，只会说印度不知道哪里的方言，俺也有云里雾里的时候）不过查房记录就
得自己写了，A说着自己的病情，原来他排黑便已经三天了，没有腹痛，一直以为是吃
太多巧克力，结果昨晚排便后一下晕倒，送到急诊查HB才60，紧急输血加PPI infusion
，嘿嘿，也亏他一个大男生，能捱这么久…有心的妻子把便盆拍了照片，唉呀，大滩的
malena，没说的，紧急胃镜，果然十二指肠球部溃疡出血，所幸血已止住，于是anti-
HP三联治疗，如果稳定，很快可以出院了。
病人B是一个酒精肝硬化的病人，还是执迷不悟，这不，再次酗酒入院，看看他的病史
，三次Variceal bleed做了Banding，一次SBP现在已经在吃norfloxacin，腹水每半年
抽一次，还有过encep... 阅读全帖 |
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d******g
发帖数: 258 | 50 Difficult case to discuss and to seek suggestions, please help!
15yo female with recent dx AML-M1 s/p DAE chemo in 8/15, twice IAE chemo in
9/15, BM biopsy noted for CR. Patient had fever, abd pain, and black stool
during the immune suppression state from the first chemo, improved after
antibiotics. All symptoms recurred with the last chemo and not responding
well to antibiotic, transferred to tertiary hospital after 40days treatment.
Ruled out intracranial infection, found to have multiple live... 阅读全帖 |
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