R******7
发帖数: 53 | 1 My sputum smear first two are negative, the third one still pending. But the
MD wants me to on TB medication right away. I heard the these medications
are highly toxic to liver and kidney. Any idea?
only |
|
y*********c
发帖数: 1014 | 2 I don't know what medication you supposed to take. I am taking INH right now
since my TB test result is positive. Although I had negative x-ray result,
my NP still put me on medication. It would mainly affect liver function, so
I have to make sure not drink any alcohol.
the |
|
|
|
R******7
发帖数: 53 | 5 三个Sputum Smear 都是negative,医生虽无法确诊但说如果不吃药不让我上班，我还是被逼吃了两个星期药，ALT AST升到 79 和 84，（吃药前都正常），过了一星期又复查 ASL 降到58， ALT 却升到144. 烦哪！！！！！！！！！！！！！！！ 真像慢性自杀，不是他杀！ |
|
y*********c
发帖数: 1014 | 6 你说我吃这个INH是不是也应该去查查阿？那你现在开工了吗？
是被逼吃了两个星期药，ALT AST升到 79 和 84，（吃药前都正常），过了一星期又复
查 ASL 降到58， ALT 却升到144. 烦哪！！！！！！！！！！！！！！！ 真像慢性自
杀，不是他杀！ |
|
R******7
发帖数: 53 | 7 你要查，当然要查，肝是你自己的，是致命的，不查不行！你只吃一种药ALT应该没我严重，我吃三种。
我那个医生，抽了血验了结果也不告一声，如果我不打电话催她，等多几天我的ALT都升到几百几千啦。现在才叫我停药两个星期。好在我还没开始工作，本来是九月开始，现在要等到十月。 |
|
s*******y
发帖数: 1739 | 8 你原来有没有结核的隐性感染啊,我原来曾经看过一个病人在国内,痰培养也没事,怀疑
以前有过隐性感染,得过结核的人,肺里的空洞是永远去不了的,但是有经验的放射科医
生应该能根据X 线看出来是不是活动期结核,( 它和陈旧性结核空洞有区别的).还有,让
我不明白的是,你痰培养三次都是阴性,为什么还要继续吃药,那末我可以反问医生了:什
么指标才会让我停药呢?因为结核空洞根本去不掉的,真是好笑! |
|
R******7
发帖数: 53 | 9 我2004年查X－ray还是正常的，这次说是有一点right apical inflitrate, 不是空洞
，医生怀疑是活动期结核，但我没症状。有人说也有可能是以前留下的scar。痰培养是
指sputum culture吧？（对不起我是美国毕业的）我那个痰培养要两个月后才能知到，
现在知道的是sputum smear， 不知中文怎么叫，三个smear都是negative。医生说要
吃药两个月等我的痰培养结果知道了才决定要不要降低药量，现在还是按活动期治疗。 |
|
l********z
发帖数: 5 | 10 痰培养和涂片没有查到结合杆菌很常见的，因为并不是你所有的痰都可以培养出结合杆
菌，但是胸片显示活动期结核在没有拿到痰培养证据之前是要治疗的。要是PPD阳性但
是胸片阴性，不用进行INH治疗，在国内这种情况非常常见，有部分原因是因为打过卡
介苗，至少在国内这种是不会治疗的。最新颁布的ATS（美国胸科协会）的指南说，对
于PPD阳性胸片阴性结核高发区来的人（包括中国），可以不用治疗。 |
|
n******i
发帖数: 11 | 11 Could you please provide the website link for 最新颁布的ATS（美国胸科协会）
的指南说，对于PPD阳性胸片阴性结核高发区来的人（包括中国），可以不用治疗。
Thanks in advance! |
|
G*******n
发帖数: 2041 | 12 如果没有health insurance，去学校的student health center一般交大概50块全搞定
。包括blood test，填表，种疫苗，cxr。
有保险的可以找自己的primary health provider，把学校要的表给他，他会要你去抽
血等等。 |
|
a********n
发帖数: 438 | 13 SOB
病人申诉“I CANN'T BREATH”第一步，还是要ASSESSMENT，VS 包括RR，SAT O2，有没
有nostril flare/using accessory muscle ，结合病史找原因，Pulmonary: PNA,
Pneumothorax, PE, Aspiration, bronchspasm, airway obstruction.
Cardiac: MI, CHF, arrhythmia, , 还有acidosis, sepsis, anemia, anxiety. 有没
有给新药？（allergic reaction), 肺音（fluid overload/asthma?). 先给氧气，酌情
处理，从simple face mask 到non- rebreather, 再打电话给医生，通常，会order
CXR, EKG, ABG.lasix, breathing treatment(beta agonist).这个时候RT 就是好伙伴
了，要找CHARGE帮忙，必要的时候CALL RAPID RESPOND TEAM, 最好ABG PO2〉 |
|
y*****g
发帖数: 193 | 14 ICU is a fun place to work, so many drama everyday!
Always ask questions, to your fellow Rns, to MDs, to pharmacists. Do your 12
hrs chart check carefully? if there is CXR order at 800pm, what is the
reason? reevaluate pleural effusion? 4 abdominal drains, what are they
located? any change of quality and quantity of drainage? therapeutic or
monitoring purposes? no/minimal drainage in 24hrs, do i need give a primary
team a call about taking drain out since you know pronlong drain equal to
increas |
|
l******i
发帖数: 39 | 15 http://www.globalrph.com/abbrev.htm 这个Website很好。
这些是些常用的：
* Ac: before meals
* ad lib: at will, as desired
* adm: admission, admitted
* ASAP: as soon as possible
* Bid: twice a day
* Bm: bowel movement
* BP: blood pressure
* BRP: bathroom privileges
* C: Centigrade, Celsius
* Cap: capsule
* CC: chief complaint
* cc: cubic centimeter
* c/o: complains of
* C02: carbon dioxide
* CPR: cardiopulmonary resuscitation
* CXR: chest x-ray
... 阅读全帖 |
|
b*****o
发帖数: 6080 | 16 今天第二个cabg病人，bumpy yet fun because i've learned more from this case.
if we suspect of bleeding (decreased sbp, cvp and even co, and massive
drainage from jp bulbs), stat cxr and h&h will help identify the real reason.
give albumin fast to maintain intravascular volume when both cvp and sbp are
low. sometimes, prbc transfusion is needed right away. |
|
o******h
发帖数: 198 | 17 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 |
|
o******h
发帖数: 198 | 18 请问谁知道 pe in 2011是什么意思？
请问谁知道 No focal pna是什么意思？
————————————————————————————————
phm-primary history
H/H: Hb and Ht
CXR -chest x-ray
abd -abdominal |
|
w**d
发帖数: 362 | 19 有个病人，ARDS。
早上测ABG, paO2/FiO2=105, pH 7.21.
BP每小时都在恶化。
Ventilator AC 24 500 80%, peep 15.
levophed drip increased from 5 to 30 mcg/min,
vasopressin drip added.
bicarb, fentanyl, versed drip added.
Page cardio doc, 半个小时都没有call back.
Call house doctor, 他也没有什么高招，该用的都用上了，就下个医嘱测CMP,mg,cbc,
CXR,12-lead EKG什么的。
BP后来测不到了，HR也开始往下掉。
这个情况该怎么办呢？ |
|
w**d
发帖数: 362 | 20 有个病人，ARDS。
早上测ABG, paO2/FiO2=105, pH 7.21.
BP每小时都在恶化。
Ventilator AC 24 500 80%, peep 15.
levophed drip increased from 5 to 30 mcg/min,
vasopressin drip added.
bicarb, fentanyl, versed drip added.
Page cardio doc, 半个小时都没有call back.
Call house doctor, 他也没有什么高招，该用的都用上了，就下个医嘱测CMP,mg,cbc,
CXR,12-lead EKG什么的。
BP后来测不到了，HR也开始往下掉。
这个情况该怎么办呢？ |
|
发帖数: 1 | 21 说说科研和nursing
其实很多读NURSING的都是有科研背景的，远的不说，THR就是以前读PHD的。以前还有
cell发了第一作者的转了NURSING，还有国内TOP2，美国芝加哥大学的博士读了NURSING
的。
读NURSING的女性居多，很多就是跟着老公出国，老公往往都是博士，博士后。所以不
要拿科研说事，那个东西没有啥神秘的，其实跑PCR就和RN打静脉一样，都是熟练工种
，没有什么高大上的。
而且科研这个东西，也要做对方向，科研就是挖矿，如果方向对了，就是事半功倍，不
然就是千老一辈子。
认识一个台湾人RN，自己有个哥哥就是数学系教授，还被中东的dubai的大学
请去讲课，带博士生什么的。 她就是一个RN，天天就在医院做一点paperwork，工
作轻松愉快。两个儿子，都是她帮忙在本地富人区给了首付，一个儿子是律师，也
娶了律师，买的三百万美金的大房子，然后两个孙子，儿媳妇买投资房都是那种一个月
物业费九千美金的。
还有一个儿子也是她给的首付在本地富人区买了房子，现在自己也是三套房子。
这个台湾RN从来也不加班，老公也只是一个牧师，教会的牧师没有钱的，一年最多四万
美金。... 阅读全帖 |
|
l******k
发帖数: 27533 | 22 More information is needed: patient's age,sex, weight and height....for the
new cholesterol guideline, any complaint of SOB? CXR? How long has the
patient been on current meds?
I don't think any anti-hypertensive med the patient on causes significant
chest pain. The lipid panel alone doesn't support statin use per new
guideline.
Uncontrolled peptic ulcer and alcohol intake may cause chest pain if the
patient doesn't have any other undiagnosed disease.
day |
|
f***e
发帖数: 140 | 23 54 years old female. overweight 237.6 lbs. No SOB. No CXR. No info on how
long has she been on current meds.
thanks.
the |
|
s********o
发帖数: 3319 | 24 【 以下文字转载自 MedicalCareer 讨论区 】
发信人: herby (小臭宝), 信区: MedicalCareer
标 题: [合集] 你有生以来做出的最佳临床诊断是什么？
发信站: BBS 未名空间站 (Thu Jun 2 00:01:26 2011, 美东)
☆─────────────────────────────────────☆
Aplusplus (Hakuna Matata) 于 (Sun Mar 27 11:11:49 2011, 美东) 提到:
首先我申明，我放弃我的ignore list， 欢迎所有ID参加。
每个医生护士或者其他相关人员， 无论在中国还是美国， 肯定都有一些case刻骨铭心
。 请大家把你印象最深的一例写出来， 与大家分享。 比方说， 清华男被鉈杀案，
那个中国来的护士就是诊断的关键， 相信本例就是她一辈子也忘不了的诊断。
我觉得这样的讨论有助于大家提高学医热情，丰富医学知识，开拓临床思维， 间接帮
助考版医生复习，准备CS，和 interview. 你要是能从中挑一个case让你PD
impressed，我想我的... 阅读全帖 |
|
s********o
发帖数: 3319 | 25 【 以下文字转载自 MedicalCareer 讨论区 】
发信人: herby (小臭宝), 信区: MedicalCareer
标 题: [合集] 你有生以来做出的最佳临床诊断是什么？
发信站: BBS 未名空间站 (Thu Jun 2 00:01:26 2011, 美东)
☆─────────────────────────────────────☆
Aplusplus (Hakuna Matata) 于 (Sun Mar 27 11:11:49 2011, 美东) 提到:
首先我申明，我放弃我的ignore list， 欢迎所有ID参加。
每个医生护士或者其他相关人员， 无论在中国还是美国， 肯定都有一些case刻骨铭心
。 请大家把你印象最深的一例写出来， 与大家分享。 比方说， 清华男被鉈杀案，
那个中国来的护士就是诊断的关键， 相信本例就是她一辈子也忘不了的诊断。
我觉得这样的讨论有助于大家提高学医热情，丰富医学知识，开拓临床思维， 间接帮
助考版医生复习，准备CS，和 interview. 你要是能从中挑一个case让你PD
impressed，我想我的... 阅读全帖 |
|
a*******n
发帖数: 82 | 26 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 |
|
a*******n
发帖数: 82 | 27 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 |
|
A*******s
发帖数: 9638 | 28 来自主题: Medicalpractice版 - a case If you don't take my advice, you will get killed in your residency. :)
My questions are:
1. Did you make the diagnosis on CXR or CT of the chest?
2. Did you give the TPA?
BTW, Do not use AAA for ascending aortic aneurysm. I know what you mean, but not the others. |
|
s******t
发帖数: 579 | 29 Order chest CT or CXR? BP? |
|
s******t
发帖数: 579 | 30 Order chest CT or CXR? BP? |
|
c****h
发帖数: 590 | 31 我们学校的某护士坚持要偶吃INH, 不然不给我TB clearance（结果老是被HR发通知）
。既然CXR没事, 请问此人是否把关太紧了一点？医生强迫你吃药，有法律依据吗？
多谢借用贵版！请查收包子。 |
|
A*******s
发帖数: 9638 | 32 1. A positive TB skin test only tells that a person has been infected with
TB bacteria. It does not tell whether the person has latent TB infection (
LTBI) or has progressed to TB disease. Other tests, such as a chest x-ray
and a sample of sputum, are needed to see whether the person has TB disease.
2. Many persons born outside of the United States have been BCG-vaccinated.
BCG vaccination may cause a positive reaction to the TB skin test, which may
complicate decisions about prescribing treatm... 阅读全帖 |
|
w***0
发帖数: 222 | 33 not a doctor here.
everything seems normal for age. normal kidney, normal cardiac fx (not sure
what does it mean by "polyvalvular regurgitation"? severe, trivial? seems
normal everything. the echo FS low but EF low normal.amazing CXR reports
even not understand what exactly means by such.
what makes you worry? |
|
w***0
发帖数: 222 | 34 not a doctor here.
everything seems normal for age. normal kidney, normal cardiac fx (not sure
what does it mean by "polyvalvular regurgitation"? severe, trivial? seems
normal everything. the echo FS low but EF low normal.amazing CXR reports
even not understand what exactly means by such.
what makes you worry? |
|
s**********t
发帖数: 217 | 35 The answer should be E. The patient has symptoms, physical exam, EKG, CXR to
support the diagnosis of pericardial effusion. You do not need an other
test, like ECHO to confirm the diagnosis. The patient is unstable, getting
tamponade. She needs to be treated now to release the pressure around the
heart. As Aplusplus said, it's weird to use the word paracentesis.
Paracentesis includes moving fluid from thorax, peritoneal, and pericardial,
ect. But most of time, it refers removal fluid from perit... 阅读全帖 |
|
A*******s
发帖数: 9638 | 36 来自主题: Medicalpractice版 - 结核抗体阳性 I have been tested positive since the first day I came to the states.
Always get a CXR for the annual. I am really, really tired of it. Maybe
someday I get a cancer, I'll blame these damn X-rays. |
|
n*******c
发帖数: 501 | 37 （续上回，先补充一下关于RUQ痛，这个东西妇产科是如临大敌，严阵以待的，所以一入院已经把所有检查包括腹部超声肝功能什么的都做了，确认没有问题的）
不知道怎么办的时候就是搬救兵的时候，危在旦夕，不找senior找谁？
马上打了电话，如此如此，这般这般…
就像大家建议的一样，我order了CTA。
补充说明一下，这个病人的d-dimer是刚好比阴性上限要高些，一点也不奇怪，pregnancy要找个d-dimer阴性的只怕还不容易呢。
“嘟嘟…嘟嘟”page又响了。
拿起电话，一个冷冷的女声，“…Did you just order the CTA for a 33wks
pregnant woman?”
原来是放射科的值班医生，“…What are you looking for?”“…mainly to rule out PE, also to investigate the cause of chest pain…patient is
hemodynamically stable however still in severe chest pain with positive d-di... 阅读全帖 |
|
T*R
发帖数: 36302 | 38 ？？？
你说你怎么排除患者原来就有TB的。
你做一个稍微大点手术，都知道要CARDIAC CLEARANCE。做个stress test什么的，但是
给这个药之前，你查过PPD/AFB/QUNTIFERON/CXR了吗？没有。没有你怎么就知道患者没
有TB？
你在美国读个医学院还要先查TB呢。
你这个回帖的素质也太低了吧？ |
|
u*******l
发帖数: 107 | 39 "是为了防止衣服上有金属性的物质对片子造成artifacts。女病人换成Gown，因为Bra
上的三排小勾环也会造成artifacts。我连项链和吊坠耳环都让她们摘掉。"
Just had my CXR taken. Cannot remove my diamond necklace, tech told me to
put it in my mouth, so it will not interfere the chest imaging. :) |
|
M****a
发帖数: 577 | 40 第二周同样是从星期天开始，手术室开始恢复正常了，虽然有7月4日，但是这一周还是
有三天手术，多了4个新病人。从上一个intern“继承”下来的10个老病人，在我们两
个intern 磕磕绊绊的努力下，终于在星期二之前全部出院了。Intern的一个主要任务
就是送病人出院，这点内科外科没有区别。
Fellow也换了人，上一个fellow跑到另一个医院又开始做一个fellowship。我们这里CT
fellow的任务就是指挥intern，参加所有的手术，以及安排新的手术，每个星期只有
周六晚上才算off。新的fellow说话极快，一分钟可以吩咐20件事情，我们两个intern
只能赶紧记下来，回workroom对照一下，然后赶快把医嘱写了。他记性极好，白天如果
在楼道里碰到了，会问早上吩咐过的事情做得如何了，比如上午的CT scan结果出来没
有，swallow study的正式报告上怎么写的等等。
7月4日那天轮到我值班，我的co-intern不上工，除了CT surgery之外，从10AM-8PM，
整个外科的day cross-over pager我得带着。另外当天还有3个CT pr... 阅读全帖 |
|
B****r
发帖数: 1737 | 41 看了三次医生，没有任何进展。可能下周要收入院了。小地方没有儿童医院，也不知道
该不该换个别的医生。恳请大家帮着瞧瞧 （病人情况如下）。万分感谢。
5 yo female with persistent cough x 14 days and fever x 10 days. Fever runs
102-104 F, but does normalize when given motrin or tylenol. Symptom no
improvement after 4 days of Azithromycin. Began to have loose stool /watery
diarrhea for past 3-4 days. She had complained of abdominal pain (mostly
peri-umbilical) intermittently for the past 2-3 weeks. Has a history of
problems with constipation. Slightly decreased PO intake, ... 阅读全帖 |
|
B****r
发帖数: 1737 | 42 Thanks a lot for your kind reply
They did consider incomplete kawasaki once....but she has no other symptoms
besides fever/cough/abdominal pain. Appendix abscess is not likely based on
normal u/s although the visualization is limited. They even did HIV test
which was negative.
No PPD has done yet, and CXR does not support it apparently.
I thought mostly likely viral infection, but persisting high fever really
worrisome. Plus, she frequently wakes up due to spiking fever or bad cough
in night,... 阅读全帖 |
|
m******r
发帖数: 1904 | 43 【 以下文字转载自 MedicalCareer 讨论区 】
发信人: Blazer (--), 信区: MedicalCareer
标 题: 求助：５岁小孩高烧１０天
发信站: BBS 未名空间站 (Sat Feb 2 23:01:40 2013, 美东)
看了三次医生，没有任何进展。可能下周要收入院了。小地方没有儿童医院，也不知道
该不该换个别的医生。恳请大家帮着瞧瞧 （病人情况如下）。万分感谢。
5 yo female with persistent cough x 14 days and fever x 10 days. Fever runs
102-104 F, but does normalize when given motrin or tylenol. Symptom no
improvement after 4 days of Azithromycin. Began to have loose stool /watery
diarrhea for past 3-4 days. She had complained of abdominal pain (mostly... 阅读全帖 |
|
J*********l
发帖数: 1185 | 44 【 以下文字转载自 MedicalCareer 讨论区 】
发信人: Jessiesgirl (喏念婆), 信区: MedicalCareer
标 题: [bssd]娃这是asthma吗？
发信站: BBS 未名空间站 (Mon Jun 17 23:36:13 2013, 美东)
娃persist ent wheezing差不多俩月了
病史如下，娃17months，有eczema，但是outgrow 了。fulltime in daycare
3月有咳嗽，流浓鼻涕。偶尔听到wheezing。和儿医提到wheezing，她说不要太容易给
娃贴标签。上抗生素10天，效果明显。
4月中搬家后，收拾院子。娃经常在边上玩。
娃开始明显wheezing，同时runny nose， cough。尤其是哭闹后明显。
5月初看儿医。当时在诊所做inhale albuterol。o2 sat 97%. 治疗前的o2 sat 没查，
娃哭闹厉害。儿医说，wheezing在albuterol 后有改善。开抗生素10天，和albuterol
液体。
10天后，runny nose 有改善。whee... 阅读全帖 |
|
