d****y
发帖数: 2180 | 1 adenoma也会出血的。 有些adenoma也是会癌变的。
http://emedicine.medscape.com/article/172674-overview
History of present illness
Most patients with colonic polyps are asymptomatic.
In symptomatic patients, the most common presenting symptom is rectal
bleeding. Other symptoms include diarrhea or constipation, often with
decreased stool caliber.
Villous adenomas of the rectum and distal colon can occasionally manifest as
a syndrome of severe diarrhea with massive fluid and electrolyte loss.
Chronic bleeding from c |
|
s******t
发帖数: 579 | 2 If you look at the pitcure carefully, you will find that it is an adenomatous
polyp (tubular adenoma) attached to the lumen by a stalk. It is round and w
/ a smooth surface. Polyps can cause rectal bleeding too.
I go with daisy. |
|
h***a
发帖数: 312 | 3 1. During an experiment, the following data are obtained from an
anesthetized dog:
Mean glomerular capillary hydrostatic pressure (HPGC) 45 mmHg
Mean Bowman space hydrostatic pressure (HPBS) 12 mmHg
Mean glomerular capillary oncotic pressure (piGC) 23 mmHg
Mean Bowman space oncotic pressure (piBS) 0 mmHg
Coefficient of filtration (Kf) 3.0 (mL/min)/mmHg
Renal Blood Flow 200 mL/min
Hematocrit 40%
Filtration Fraction 25%
An IV infusion of AngII is administered for 60 minutes. Which of the
fol... 阅读全帖 |
|
J********1
发帖数: 66 | 4 来自主题: MedicalCareer版 - CS考经 First Sight on door-way information.
Knock 3 times with confidence, a smile, walk in and say:
INTRODUCTION:
Hello, Mr/Ms ------- , I am Dr.xxx，the physician on duty
today.
Nice to meet you. (Shake hands only if the pt wants to. Don’t
shake hands with SPs in severe pain).
Is everything in the room all right for you?
Let me make you a little more comfortable. (open up the drape ..
.OPEN IT COMPLETELY... cover the legs in t... 阅读全帖 |
|
N****e
发帖数: 31 | 5 38yr, female, present to PAH on 4/4/10 with diarrhea for 4 days, initially
loose watery diarrhea, 3-4 times/days, now worse and loose watery stool
every hour, and blood mixed with the stool, medium volume, non-foul smelling
, with mild crampy abd pain. Have had 5 BMs since yesterday, and the last
one almost all blood. (+) subjective fever, no chills, no cough/SOB. Had a
course of antibiotics (Keflex) 2 weeks ago (3/9/10- 3/14/10).
PMHx: Kidney stones, Seizure disorders, Vit D deficiency
PSHx: S... 阅读全帖 |
|
z******1
发帖数: 666 | 6 I just came back from MD Anderson cancer center. I used to be
gastrointestinal surgeon in China. So I choose a PA rotation in surgical
oncology in MD Anderson. I found the surgeons there are great. There are
several progresses that definitely should be applied to practices in China.
It will increase survival rates of colon and rectal cancer patients.
I saw a japanese attending surgeon do an observation at same time with me.
Unfortunately I did not ask how he could be in the cancer center. My... 阅读全帖 |
|
z******1
发帖数: 666 | 7 http://www.mdanderson.org/patient-and-cancer-information/care-c
Dr.Curley is director. He is really excellent. He did surgery in liver
metastasis from colon cancer. In china most of this kind of patients were
given up. I did not see his contact information.
I followed Dr. Skibber. He is also great. His colon operation is perfect.He
is good at local invasion from colon or rectal cancer.He treat patients pre
and during operation with radiation.
Thank you for your 50 weibi.
as: 我想问一下这个center哪个胃... 阅读全帖 |
|
h***y
发帖数: 834 | 8 ☆─────────────────────────────────────☆
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，我想我的目的就达到了。
希望所有ID， 包括考生， resident， fellow， attending，PA/NP, nurse 和中国来
的医生不再从事医疗工作的， 都能奉献你的pearl. 英文中文都行。
我先来：
CC: Left leg pain for 5 days.
35 y... 阅读全帖 |
|
h***y
发帖数: 834 | 9 ☆─────────────────────────────────────☆
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，我想我的目的就达到了。
希望所有ID， 包括考生， resident， fellow， attending，PA/NP, nurse 和中国来
的医生不再从事医疗工作的， 都能奉献你的pearl. 英文中文都行。
我先来：
CC: Left leg pain for 5 days.
35 y... 阅读全帖 |
|
f****i
发帖数: 129 | 10 34.
A 57-year-old woman is brought to the emergency
department because of
abdominal pain for 12 hours. Over the past 3 hours,
the pain has become
severe and generalized. Over the past month, she has
had mild upper
abdominal discomfort that is relieved by eating. She
has a history of
recurrent migraines treated with sumatriptan as
needed. Her temperature
is 38.2 C (100.8 F), blood pressure is 170/95 mm Hg,
and pulse is
110/min. Abdominal examination shows mild distention;
there is marked
rigidity... 阅读全帖 |
|
m*******1
发帖数: 328 | 11 Except Genital and Rectal exams... |
|
m****d
发帖数: 156 | 12 My rule of thumb: I would spend as long as I can on closure. The purpose of
closure is to confirm that you got everything right from patient; you have
some but not definitive idea on what's going on ; and you have plan what to
do next based on current clues. Do mention any workup if it helps to justify
your judgement: say you need do rectal exam because you suspect colon
lesion, you need do brain function study(auditory evoked potential) for the
cause of hearing loss. In fact, more goal-oriented... 阅读全帖 |
|
e****0
发帖数: 678 | 13 • Exaggerated deep tendon reflexes can be seen in lock in syndrome.
• Non bleeding varices are managed with nonselective beta-
adrenergic antagonists, such as propranolol.
• Sclerotherapy, endoscopic band ligation, and surgery are
indicated after a patient has a first episode of variceal bleeding.
• TIPS is a last resort in variceal bleeding unresponsive to
medical and endoscopic intervention.
• Ischemic colitis
CT—thickening of eth bowel ... 阅读全帖 |
|
e****0
发帖数: 678 | 14 Endometrial hyperplasia types. Risk of cancer treatment
simple 1% Cyclic progestin
complex 3% Cyclic progestin
Simple atypical 8% THA or progestins
Complex atypical 29% THA or progestins
• Prolatinoma and hypothyroidism galactorrhea
• Anesthesia can reduce uterine activity if in the latent phase
• Contraceptive for lactating mother
Progestin-only oral contraceptive
• Pregnancy luteoma
African-ameri... 阅读全帖 |
|
e****0
发帖数: 678 | 15 • leukemia
ALL AML CLL
child adult elderly
BM lymphoblasts 25%myeloblasts
lab Lymphocyte 5000, mature-appearing cells
• Osgood-schlatters disease
Adolescent male athletes
Traction apophysitis—quadriceps tendon put the traction on the
apophysis of the tibial tubercle where patellar tendon inserts.
A firm mass =heterotopic bone formation
Pain can be reproduced by extending the kne... 阅读全帖 |
|
j****i
发帖数: 496 | 16 Female, 36y, no family hx of CRC or gyn cancers.
Personal hx of rectal cancer stage 1 pT1N0M0 s/p LAR w/TME in Dec 12, NED as
of Jun 13.
6mo hx of pelvic pain & diffuse abd pain, nausea, bloating, indigestion,
fatigue, weight loss. Acute onsite of LUQ pain radiating to back & McBurney
tenderness 3 wks ago, radiologists differ in opinion (omental infarct vs.
peploic appendagitis), not sure related to acute sx, both recommend
conservative tx. Pain still not resolving, currently managed w/ Ultram ... 阅读全帖 |
|
h******I
发帖数: 229 | 17 提心吊胆的一个多月过去了，早上看到score report available, 经过一个多小时的心
理建设以后，打开成绩单，过了。ICE 3个在borderline, 其他在比较靠近high
performance的地方，完全没有概念究竟自己做的那里好那里不好，觉得有必要记录一
下，也给后来的考友一些参考。
背景：YOG>10, step 1 平均分，没有考 step 2 ck.
准备： 3个月，kaplan辅导班， first aid CS.
复习初期：因为在cs大组里面没有找到合适的partner, 只好在usmleforum上找了一堆
亚非拉大联盟的战友，大家操着各种口音的英语，有的很难听懂，也很难找到固定的
partner. 比较幸运的是最后有一个巴基斯坦的女生和加拿大的和我名字一模一样的中
国人成为了比较固定partner,他们的水平都比我高很多，我完全没有概念的把FA的大
case过了一遍，他们也没有嫌弃我。十几天之后去参加kaplan辅导班，同样，也是亚非
拉联盟，还有两个墨西哥和加勒比的美国毕业生，年纪也都挺大的。这个学习班完全颠
覆了我对cs的印象，自己复习的时候总... 阅读全帖 |
|
h****8
发帖数: 278 | 18 A 57-year-old man is brought to the emergency department 30 minutes after he
was found on the floor of his house; he has left hip pain and shortness of
breath. He has renal failure but has missed his last two dialysis treatments
. His renal failure was caused by inadvertent ingestion of ethylene glycol.
His renal function did not improve, and he is currently on the
transplantation list. Medications include amlodipine and doxazosin. On
arrival, his temperature is 37.5 C (99.5 F), blood pressure i... 阅读全帖 |
|
d*********n
发帖数: 18 | 19 this one of my CS protocols, hope can help whoever going to take the test, I
don’t need any more.
not perfect, but good to figure out diagnosis, should not miss the diagnosis
,
do not need to ask all questions , must adjust base the case,
if better ideas, pleas modify to make easier for people who may need
Amenorrhea
Mental check list:
Pregnancy,
hyperprolatinemia,
hypothyroidism,
PCOS,
premature menopause,
depression
asheman syndrome,
anorexia nervosa,
strenuous exercise
Patricia Garrison, a 36... 阅读全帖 |
|
r*****1
发帖数: 805 | 20 My CCS protocol:
P.S.：多有重复，谨防遗漏，仅供参考。
Screening test: General—Lipid profile/ multi-vitamin; Elderly—DEXA scan&
Calcium& VitD/ Colonscopy or FOBT/ vaccination; F-- >18yo Pap smear; >50yo
Mammogram; reproductive age- folate; menopause- Lipid/DEXA/FOBT; M-- >50yo
PSA; sickle cell dz child-prophylaxis w penicillin till 5yo, CF-prophylaxis
w Abx
Prophylaxis: Pantoprazole, pneumatic compression stocking;
Acute abd w perforation: triple Abx- Gentamycin/ Ampicillin/
Metronidazole (口诀：阿扁举旗庆国庆)
E... 阅读全帖 |
|
z******8
发帖数: 844 | 21 ☆─────────────────────────────────────☆
rhcrc11 (Rebel) 于 (Thu May 15 00:13:42 2014, 美东) 提到:
Step3考场壮烈回来。第一天挺累人，最后一个block甚至做到有心无力状，看着题反应
不过来，导致来不及做完。非常没有信心能否通过。所以match之前先考Step3的童鞋，
需要考前调整生物钟，坚持锻炼，提高耐力。
MCQ没有资格说，CCS有一点小感受，拿出来分享下。大家请轻拍砖。
复习资料：
UW 52 online cases : 基础。最好复习早起找高手一起过一遍，尽快摸熟软件，进入
状态。第二遍找一位水平相近童鞋过一遍，不断总结protocol. 考前迅速做一遍，熟练
运用protocol.
UW 41 offline cases: 我当时和partner每个case仔细做一遍，虽然不像online有反馈
，但对练临床思维，补充protocol非常有帮助。最后考试与41 case有异曲同工之处，
遇到复杂case也不慌神。
CD 6 cases： 最后再熟悉下考试软件。与UW相近，但... 阅读全帖 |
|
A**********9
发帖数: 151 | 22 请教大家，Closure部分，需要提做Breast exam, Pelvic exam, Rectal exam这些没有
做的检查吗？我参加了Ximedus,他们没有讲，但是FA中的Closure 都提到了要和病人讲
做这些检查。 |
|
m********7
发帖数: 32 | 23 边听边做的记录，有些不准确或不全面的地方，欢迎大家指正和补充。
再次感谢几位前辈的分享！
CS webinar
Adrienne：
全职
熟悉fa大case
鉴别诊断做笔记
练两周后，上kaplan班，再练两周考试
应试的考试
不需要完美的英语，12个病人，10-12分钟交流，内容很熟悉，目的：得到你想要的信
息，诊断，病人想说的信息问出来；需要病人听得懂（简单的语言，语速不要太快，模
板，避免she/he, hands, tense这种错误，不用复杂的单词，地道，语调，语气：同情
等，不要像背书，脱口而出，跟情景语气等符合），病人的话听得懂（100%注意力，同
时要做笔记），避免彼此的重复，注意病人是否听着费力，不要经常用一种开头或
response，但是仍然要简单
CIS: 听懂病人情绪变化，病人暗示了，一定要接上给response, non-verbal, 打招呼
，眼神，坐得比病人低（病人心理出于劣势，仰视病人，不要站着- 感觉rush，没有足
够的关注），关心，身体前倾。情绪变化很subtle，要察觉到，安抚等。
洗手，开头介绍
急腹症，一直微笑，no!!!；不是很急的，可以... 阅读全帖 |
|
发帖数: 1 | 24 多谢前辈分享经验
请问ccs对于那种不需要紧急处理的平稳病人，真的要把所有查体都选上吗？
觉得对个胸痛病人查四肢或者breast rectal啥的很奇怪。。。
期待回复 |
|
b*2
发帖数: 5 | 25 嗯，确实有点奇怪的。不晓得为啥要get rectal temp. 对你爸爸地遭遇表示同情，可
从两一方面更加体现出中文护士的重要性。因为很多时候，即使你是在这里上学的学生
，老美说的话还是听不懂的。给你举个例子，即拿我来说，原来学CS，学statistics,
在美带了3年了。去ER看病，上来护士问what bought you here?我答 we drive here（
满自信的意味听懂了），然后护士说："no, I mean, what's your sickness blah
blahn.我恍然大悟。。在ER病房里，护士问how's your urinate,我晕，护士又问，how
's your pee? 再晕，心想从来名听说过啥是P。然后呢，护士无可奈何，只好做了个站
着撒尿的动作（好在他是男护士）我才恍然大悟。林外一个例子，学了护士后，又一次
我妈去ER,我就是全程翻译，而且还解释为啥这样做，要注意些啥，会不会痛等等，而
且基本上chest pain的treatment完全是我所预见到的。
我承认护士有好有坏，但我会做个好护士，但是好护士的定义绝对不包括to cry as |
|
m*******e
发帖数: 1886 | 26 c-diff 病人一天拉几十趟，你还没来得及给装rectal 那什么，还没cna.... |
|
y*****g
发帖数: 193 | 27 I still like working in ICU. Most of days are fun days.Occasionally,bad days
when swamped with back to back admissions with short of staff. Totally
depending on who you work with. Majority of our unit RNs are young, humor,
easy going, passionate with what we are doing. Nobody like code brown, and
if really diarrhea, using rectal bag or flexseal will save a lot of time.
Having buddies will make work much easiler! |
|
b*****o
发帖数: 6080 | 28 flaxiseal? 有不同的厂家，名字起的不一样，我有时管它叫rectal tube, 大家也都明
白。 |
|
l******0
发帖数: 1362 | 29 flaxiseal 或者是rectal tube：差别就是第一个插入后要打水，就像插完尿管后打水
一样；第二个不需要但很容易掉出来。
用这些装置一般是因为病人拉稀不止。 |
|
o******h
发帖数: 198 | 30 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 |
|
j******2
发帖数: 544 | 31 妈妈54岁，之前做过痔疮手术貌似有后遗症，又因为最近比较累，导致疑似脱肛。
请问应该吃什么药可以缓解？网上有很多中药方子，身处中西部大农村很难找全，所以
难以实现。请问西医建议吃什么药？有非处方药可以吃吗？上医院描述病情，是rectal
prolapse吗？
非常感谢！ |
|
s*******1
发帖数: 428 | 32 Reasons For Becoming An Anesthesiologist
8. You can intubate your friends at parties.
7. Have you ever met a happy internist?
6. You can comfort anxious patients with, "I know just how you feel. It's my
first anesthetic, too."
5. Any job where you can drive to work in green pajamas is a cool job.
4. You can cover your mistakes with Versed.
3. After spending the night with surgeons, they still won't respect you in
the morning.
2. If you get bored on the weekends, you can give yourself a spinal.
1... 阅读全帖 |
|
s********o
发帖数: 3319 | 33 【 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 | 34 【 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 |
|
M***8
发帖数: 61 | 35 some more to share:
HOSPITAL CHART BLOOPERS (Actual notations from hospital charts).
1 . The patient refused autopsy.
2. The patient has no previous history of suicides.
3. Patient has left white blood cells at another hospital.
4. She has no rigors or shaking chills, but her husband states she was very
hot in bed last night.
5. Patient has chest pain if she lies on her left side for over a year.
6. On the second day the knee was better and on the third day it disappeared.
7. The patient is t... 阅读全帖 |
|
M***8
发帖数: 61 | 36 some more to share:
HOSPITAL CHART BLOOPERS (Actual notations from hospital charts).
1 . The patient refused autopsy.
2. The patient has no previous history of suicides.
3. Patient has left white blood cells at another hospital.
4. She has no rigors or shaking chills, but her husband states she was very
hot in bed last night.
5. Patient has chest pain if she lies on her left side for over a year.
6. On the second day the knee was better and on the third day it disappeared.
7. The patient is t... 阅读全帖 |
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C*****D
发帖数: 1299 | 37 如果academic,那就减半. 准不准我也不敢断言,应该不会差太多,大家自己表态.俺可是
花工夫弄来和椅子讨价还价用的.
Compensation source: American Medical Group Association, 2010 and SK&A
projections
Physician count source: SK&A, A Cegedim Company, April 2011
Specialty Median Starting
Allergy & Immunology $249,674 $186,372
Anesthesiology $370,500 $329,875
Cardiac & Thoracic Surgery $516,322 $356,335
Cardiology $402,000 $294,920
Colon & Rectal Surgery $37... 阅读全帖 |
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C*****D
发帖数: 1299 | 38 如果academic,那就减半. 准不准我也不敢断言,应该不会差太多,大家自己表态.俺可是
花工夫弄来和椅子讨价还价用的.
Compensation source: American Medical Group Association, 2010 and SK&A
projections
Physician count source: SK&A, A Cegedim Company, April 2011
Specialty Median Starting
Allergy & Immunology $249,674 $186,372
Anesthesiology $370,500 $329,875
Cardiac & Thoracic Surgery $516,322 $356,335
Cardiology $402,000 $294,920
Colon & Rectal Surgery $37... 阅读全帖 |
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A*******s
发帖数: 9638 | 39 There are only two reasons not to do a rectal exam. One you don't have a
finger or two, the patient doesn't have a rectum. |
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A*******s
发帖数: 9638 | 40 There are two types of gloves we use : Sterile, protecting patients from
infection.; and non-sterile, prevent contamination from patients.
For example, we all wear non-sterile gloves for rectal exams.
Hope this will make your LP feel better. |
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A*******s
发帖数: 9638 | 41 There are two types of gloves we use : Sterile, protecting patients from
infection.; and non-sterile, prevent contamination from patients.
For example, we all wear non-sterile gloves for rectal exams.
Hope this will make your LP feel better. |
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A*******s
发帖数: 9638 | 42 哈哈哈。
再放两个连colon cancer/rectal Cancer都包了。 |
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A*******s
发帖数: 9638 | 43 来自主题: Medicalpractice版 - 周末笑话 这些都是medical records，据说都是真的， lol
1. She has no rigors or shaking chills , but her husband states she was very
hot in bed last night.
2. Patient has chest pain if she lies on her left side for over a year.
3. On the second day the knee was better, and on the third day it
disappeared.
4. The patient is tearful and crying constantly. She also appears to be
depressed.
5. The patient has been depressed since she began seeing me in 1993.
6. Discharge status: Alive but without my permission.
7. Healt... 阅读全帖 |
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s*****e
发帖数: 404 | 44 来自主题: Medicalpractice版 - 直肠癌求建议 The staging for rectal cancer is not based on the tumor size. |
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a******a
发帖数: 57 | 45 Was the surgery open or laparoscopic?
What kind of pain did the patient complain: shoulder refer pain? Sharp
incisional pain? Or cramping pain?
How many hours out of the surgery?
A couple of things you may consider: give rectal Tylenol 1g, then Iv toradol
30mg.
I personally agree with short term usage of meperidine 25-50mg Iv q2-3h, and
put pt on fentanyl patch( It takes about 8-12 hours to reach desired level);
Iv ketamine could be another choice, 10-20mg Iv bolus.
If the patient has ivda his... 阅读全帖 |
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f****o
发帖数: 2770 | 46 感谢大家支招
当时那个intern order了meperidine 12.5mg-25mg IVP Q4hrs for overnight until
day shift people come in。我也让这个order过了。
我也没啥办法了(其实可以oxycodone rectally，估计病人也不会同意的)
但是pain pharmacist不让我以后approve meperidine for pain，说seizure has been
reported after single dose meperidine in patient with normal renal function
. 但是呢，她又不给我一个recommendation，我就想说以后又发生酱紫的情况咋办。
那个病人手术之前有没有take long acting opioid/有无chronic pain issue我已经不
记得了。fentanyl patch onset很慢，等onset了天就亮了day shift就来了也就没我的
事情了。
fentanyl IVP不是说nurse不能push on ... 阅读全帖 |
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J*********4
发帖数: 1274 | 48
other
=====
Because the venous return of the lower 1/3 of rectal goes to Inferior vena
cava, whereas anything above will go to portal system, thus lower 1/3
metastasis to lung and the rest goes to liver.
My 2 cents |
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f**d
发帖数: 768 | 49 Device Measures Brain Temperature Non-Invasively: Monitoring Could Be
Critical in Life-Saving Cooling Therapy
ScienceDaily (May 2, 2011) — Doctors have long sought a way to directly
measure the brain's temperature without inserting a probe through the
skull. Now researchers have developed a way to get the brain's precise
temperature with a device the diameter of a poker-chip that rests on a
patient's head, according to findings presented May 1 at the annual
meeting of the Pediatric Academic Soci... 阅读全帖 |
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