y******a
发帖数: 590 | 1 They (Dr.Kocik and Dr.Strong) definitely made a huge mistake in diagnosis.
Otherwise if pt was treated with nephrostomy tube and obstruction relieved,
plus IV antibiotics, pressor is not necessary in her case. I also wondered
how much fluid they gave before they started pt on pressor, without large
amount of fluid, vasopressor will cause more damage than its benefit.
Another issue is the communication with patient. pt should be informed the
side effect of vasopressors, and proper documentati |
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I****a
发帖数: 407 | 2 Sleepcoffee, I hope you are matched in cook county hospital which I believe
it is a great teaching hospital from my personal experience. Dr.Brendan
Reiley was the department chair when I was round and his morning report was
second to none, I was almost 顶礼膜拜 each time. It was such as loss as he
moved to Weill Cornell. It is true patients come straight from airport to
get treated. Below is what he wrote on JAMA (JAMA. 2004 Sep 8;292(10):1153-4
. A piece of my mind. In memoriam.)
The cops bring he... 阅读全帖 |
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I****a
发帖数: 407 | 3 Sleepcoffee, I hope you are matched in cook county hospital which I believe
it is a great teaching hospital from my personal experience. Dr.Brendan
Reiley was the department chair when I was round and his morning report was
second to none, I was almost 顶礼膜拜 each time. It was such as loss as he
moved to Weill Cornell. It is true patients come straight from airport to
get treated. Below is what he wrote on JAMA (JAMA. 2004 Sep 8;292(10):1153-4
. A piece of my mind. In memoriam.)
The cops bring he... 阅读全帖 |
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发帖数: 1 | 4 每个医院应该都有所谓的electrolyte protocol吧，只要医生自己order了protocol,
就可以根据protocol进行replacement. 但如何replace要根据病人的情况来制定方法。
K3.0在病人肾功能没有啥障碍的情况下给60-80都应该没啥问题，问题是根据病人的情
况如何补，比如病人本来就 GI sick, PO肯定不是好的选择，因为太难喝很有可能引起
呕吐。如果IV 给potassium普通IV给得极慢，一般给40 MEq IV 能花四小时 500 ML NS
+ KCL 130 ML/HR，但如果病人有central line access,专门有那种central access的
IVPB KCL 40MEq 100ml running at 50 ML/HR两小时就能给 40 MEq. 如果病人需要给
80只有普通IV并且没有啥恶心症状的话，给40 PO 给40 IV一般会比较好。
ARDS一般来说intensivist会尽量keep patient dry, 最有可能引起ARDS的就是
Pneumonia, 病人血压这么低是否是septic... 阅读全帖 |
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发帖数: 1 | 5 ???????????????? google find
Medical Witness: Seth Rich was going to live, but he was allowed to die…
Sat 10:40 am UTC, 20 May 2017
posted by Gordon Logan
[According to this witness, a graduate surgery resident, Seth Rich was going
to survive. It seems that, like Princess Diana, Seth Rich was allowed to
die. – Gordon Logan]
“4th year surgery resident here who rotated at WHC (Washington Hospital
Center) last year, it won’t be hard to identify me but I feel that I
shouldn’t stay silent.
Seth Rich... 阅读全帖 |
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T*R
发帖数: 36302 | 6 呵呵，熬得过去就活熬不过去就死还要医院干什么？
及时就医至少能在肺炎早期及时介入治疗，至少能尽量避免急性肾衰竭，避免很多并发
症。
中国医疗有很多弊端，但是城市来说，在医疗普及性方面比美帝强太多。
我上面说得那个例子，如果及时治疗，至少能避免气管切开，就算气管插管也比切开好
多了。这个过程可不是一天两天。
美帝这边，中小医院夜班里没有主治医生值班，很多轮转的住院医水平不够。比如ICU
来说，很多病人低血压/肾衰对补液不敏感或是没有指征，明明需要及时上central
line上pressor上CRRT，但是很多住院医手潮没有信心，就拖，继续输液输ALBUMIN，拖
到下一班。
很多护士都心知肚明，但是大都没人吭声。医生水平高低群众眼睛是雪亮的。
我干了十几年护士就多过一次嘴，劝一个中国留学生转到芝加哥大学医院去。因为他的
病越治越重，走着进来，快要躺着出去了。
还是那句话，很多因为FLU而死的病人都是被耽误了，或者自己的原因，或者医院的原
因，更或者医疗体制的原因。 |
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f*****n
发帖数: 378 | 7 感谢大家指点，已经弄好了，是starter后面的oil pressor sensor在漏油然后滴到了S
tarter上面，换了一个就好了。 |
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x******9
发帖数: 473 | 8 谢谢回复，昨天太晚了没人回我就下线了...
这样啊，真是很担心被abuse used，rental确实不好说，不知道会不会有啥类似后遗症
啥的。
我想去dealer大查一下，有个测引擎的什么pressor testing好像，不知道是个啥。
Thanks。 |
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b**o
发帖数: 5769 | 9 看起来相当的不错，不过这个太占位置了。家里厨房已经没有什么台面了。55555
我去walmart搞了个french pressor,一个咖啡磨，买了一包starbuck的豆子。还有一个
打牛奶泡的小东西。
刚才试了打奶泡的，还不错，不过没有来得及打豆子煮咖啡，就用速溶山寨了一下。
牛奶可能不够热，加进去咖啡凉了好多。不过口感还不错。 |
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g***r
发帖数: 285 | 10
跑,
not neonatologist, but most of early neonatal pneumonia is due to intra-
uterine aspiration of infected amniotic fluid, or tansplacental infection,
or aspiration of amniotic fluid during delivery,
the most causative agent is group b strep,
how sick is your baby? on the vent? on pressors? there is a big difference
between neonates and adults patients as far as prognosis goes,
those little things are very strong, especially it's full term, they bounce
back really quickly,
bless your heart and |
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g***r
发帖数: 285 | 11 hope you have a good neonatologist taking care of the baby, neonatology is
much different from adult medicine so i wouldn't know if which would be the
best diagnostic and treatment option,
i do know that when those little ones get sick, it definitely put everything
into perspective, that everything else in the world doesn't matter anymore,
that things we complained in our daily life, means nothing at all comparing
to that litte guy,
i've seen worse that come off the vent and pressors and are now |
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l*****t
发帖数: 3117 | 12 你还是要读一下code, 你这个可能就是某个sensor坏了, 或者是3档的pressor switch
坏了。都不是太难修。 |
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B*M
发帖数: 1418 | 13 【 以下文字转载自 Automobile 讨论区 】
发信人: BBM (宝宝妹~work hard), 信区: Automobile
标 题: ACDelco is ripoff
发信站: BBS 未名空间站 (Tue Jul 12 15:24:56 2005)
they suck!! My LG dropped his GMC Jimmy in ACDelco, and they didn't tell my LG
what the problem was, so LG thouhgt it wouldn't be a big deal, then today we
went to pick up the truck, the bill is $995. #@!^@%&&%&#
They changed the fuel injector and fuel pressor ..., both parts are $200, labo
r is $65 per hour, we never know they need to change those two parts....
A |
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t****u
发帖数: 10218 | 14 EFFECT OF MANIPULATED STATE AGGRESSION ON PAIN TOLERANCE
RICHARD STEPHENS, CLAIRE ALLSOP
School of Psychology, Keele University
Summary
Swearing produces a pain lessening (hypoalgesic) effect for many people; an
emotional response may be the underlying mechanism. In this paper, the role
of manipulated state aggression on pain tolerance and pain perception is
assessed. In a repeated-measures design, pain outcomes were assessed in
participants asked to play for 10 minutes a first-person shooter vi... 阅读全帖 |
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a**e
发帖数: 5094 | 15 pressors are given through central line.
for
shock
be |
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s*******r
发帖数: 174 | 16 来自主题: MedicalCareer版 - 殊途同归 这个月在icu,第一个call收的两个病人都是pneumonia/sepsis/septic shock.第一个83
岁，我收的时候他还好好的，冲我笑呢，就是sats低，lactate只有4。overnight就被
intubate拉，we did everything we need to do, 可他还是接着一天不如一天，挺了
一周，kidney开始down，platelets也开始drop，家里很快就决定withdraw care了。当
时还想着应该再给他一些时间。。。。
另外一个72，收得时候lactate7点几，一度11点几，ph7.0几，k7点几，fluids
,pressors, bicarb drip, dialysis。。。能用的全用了，当时觉得他肯定是不行的了
。。。。没想到一天一天好起来，前两天居然extubate了。。。就在我感叹年龄真是
icu病人的prognostic factor啊的时候，他还是tolerate不了拔管后的destress，面临
再度被intubate和long term weaning process， 刚上去看，已经决定comfort |
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s*******8
发帖数: 118 | 17 作为CMG开始时很容易忘记询问code status.开始一定要养成好习惯，不要认为大家都
是full code.我见过三十几岁DNR/DNI,而九十几岁的full code.问得时候要有耐心，不
要用太多的医学语言。很多人不知道intubaiton,CPR,defibrillator是啥意思...问完
后马上写到note上。如果病人没法做决定，一定要设法找到POA或是next of the kin.
当然有的人会事先写好遗嘱。还有的人只是DNR,而同意intubation.我一般会尽量说服
患者成为dnr/dni.另外不要混淆DNR/DNI和 comfort care.DNR/DN并不是放弃治疗，当
然你可以和病人或家属讨论细节比如是否用pressors（ICU病人）。开始前最好问问你
的senior如何pronounce death,都需要哪些paper work...
祝大家工作顺利！ |
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u***e
发帖数: 611 | 19 不是看的很明白
这里的心衰是指cardiogenic shock吧，我觉得dopamine在这里没国内用的多，pressor
我们基本上都首选levophed就是norepinephrine，即使是cardiogenic shock,而且一开
始你都不知道是不是cardiogenic,得放swan ganz. 我觉得dopamine血压不大吊的住的
，还是得上levophed, 有人喜欢用renal dose，但我也不知道到底有没有用，没尿的还
是没尿。我一般就喜欢直接上levophed，maximal了再考虑dopamine,直接titrate上去
，不用低计量。 另外用于cardiogenic shock的dobutamine我就没啥经验了，要请教一
下楼主。 |
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A******y
发帖数: 15 | 20 这么acute的病情，的确更像是感染引起的败血症以及并发症（黄疸，high-output心衰
，低血压/休克，DIC早期等等）。血象倾向于细菌感染而非肝病毒，在强力广谱抗生素
治疗下好转又恶化，一种可能是大量细菌死亡释放的毒素加强了免疫反应（白细胞升高
，发热，高crp, 血压下降等），另一种就是感染灶没有得到控制，还有就是耐药菌感
染。
那么第一个问题就是这个感染灶在哪里？右颈部疼痛肿大，有没有做CT去看看是不是
retropharyngeal/tonsillar abscess？腹部疼痛有没有CT abdomen/pelvis看看有没有
abscess?如果有的话可能需要手术引流才能得到足够的控制。尿检/尿液培养/超声看看
是不是尿路感染上行引起肾盂炎/脓肿？有没有关节肿痛排除septic joint?有没有胸片
排除肺炎？
至于药是否对症，这么多天的住院，血培养的结果和sensitivity应该已经有了吧？
同意ICU care, IVF,pressors/stress-dose steroids, broad-spectrum IV
antibiotic, O2 support... 阅读全帖 |
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A******y
发帖数: 15 | 21 这么acute的病情，的确更像是感染引起的败血症以及并发症（黄疸，high-output心衰
，低血压/休克，DIC早期等等）。血象倾向于细菌感染而非肝病毒，在强力广谱抗生素
治疗下好转又恶化，一种可能是大量细菌死亡释放的毒素加强了免疫反应（白细胞升高
，发热，高crp, 血压下降等），另一种就是感染灶没有得到控制，还有就是耐药菌感
染。
那么第一个问题就是这个感染灶在哪里？右颈部疼痛肿大，有没有做CT去看看是不是
retropharyngeal/tonsillar abscess？腹部疼痛有没有CT abdomen/pelvis看看有没有
abscess?如果有的话可能需要手术引流才能得到足够的控制。尿检/尿液培养/超声看看
是不是尿路感染上行引起肾盂炎/脓肿？有没有关节肿痛排除septic joint?有没有胸片
排除肺炎？
至于药是否对症，这么多天的住院，血培养的结果和sensitivity应该已经有了吧？
同意ICU care, IVF,pressors/stress-dose steroids, broad-spectrum IV
antibiotic, O2 support... 阅读全帖 |
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l****n
发帖数: 272 | 22 一天的时间太短了，一般ICU 的TRAVEL NURSE都有ICU的经验。所以上手比较快。ICU里
的病人都比较重，像呼吸机，很多的PRESSOR DRIP，很多的PROCEDURE。当然也有轻的
病人。我们医院的同事们一般对TRAVEL NURSE都很NICE。刚开始肯定不会给他们重的病
人，除非他们工作一段时间了能力很强，才会给他们重病人。医院与医院之间也有区别
，MANAGER好不好，有没有专门的医生管理ICU还是都是一些FP的医生等等。
是个挑战。不过也看你自己了，我有篇文章有介绍ICU夜班工作的，有兴趣你可以看看
。 |
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u**o
发帖数: 136 | 23 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... |
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h***d
发帖数: 53 | 24 搞清楚几个策略问题先
1. 必须通过FDA。从tong pressor到植入式心脏起搏器等都算医疗器械，甚至包括一些
纯软件的算法。和国内相仿，FDA也分三类，意味着难度和cost。你的产品属于哪一类？
2. who most likely pay your products？国家医保（及CMS）与private insurance，
hospitals/clinics，还是美国的distributors，或美国的医疗器械制造商？等等。然
后才是市场的问题
3. 专利？搞清楚你的产品及相关技术有没有踩着别人的脚
其他的问题再谈 |
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M****a
发帖数: 577 | 25 低血压这个问题昨天下午刚被pimp过，ICU+CT surgery 两个attending，盘问我们4个
intern （surgery+anes） 两个半小时。不过我们的问题是术后低血压，答案是从
preload，afterload和contractility三个方面逐个排除。处理方法上，MICU喜欢用
inotrope/pressor，SICU喜欢用inotrope/fluid. |
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g*******0
发帖数: 137 | 26 我有个consult病人低血压，但没啥异常感觉，体位改变也不头晕，我们就给了pressor
+IVF，nothing special， 后来也不知治好没反正sign off后没消息了 |
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h****y
发帖数: 9234 | 27 03年的,116xxx miles
看起来还成.
有如下mod,各位前辈来看看有无需要绕道的必要
I have a few mods on the car it has a cold air intake, front and rear strut
bars, c-pillar bar, progress 27mm rear sway bar and corsport sway bar end li
nks, buddy club short shifter, push to start engine button, jdm side markers
and emblems, energy suspension motor mount inserts, 18 inch alloy wheels wi
th two good tires and needs two tires as well, and just put in a new a/c com
pressor.
他说有所有原厂的件,也会一块给买家
如果这个和那个wrx都OK,大家建议哪辆呢? |
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