急診筆記

HINTS (head impulse- nystagmus-Test of Skew)  診斷早期 posterior circulation stroke.  HINTS test 比 MRI 更準(敏感度99%) Kattah JC, Talkad AV, Wang DZ, Hsieh YH, Newman-Toker DE. HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging. Stroke. 2009 Nov;40(11):3504-10. Screening patients with AVS for one of 3 dangerous oculomotor signs (normal h-HIT, direction-changing nystagmus, skew deviation) appears to be more sensitive than MRI with DWI in detecting acute stroke in the first 24 to 48 hours after symptom onset. These “HINTS” to “INFARCT” could help reduce frontline misdiagnosis of patients with stroke in AVS and should be studied head-to-head for their comparative cost-effectiveness against neuroimaging by MRI DWI.  1 - Patients with peripheral vertigo will have abnormal (positive) head impulse testing, while patients with central vertigo typically have a normal (negative) head impulse tes

TG 長期控制的目標在 200 以下.  TG上升造成胰臟發炎. 超過 1000 以上可考慮血漿置換. 治療目標, 將TG降至 500 以下. 如果無法使用血漿置換. 可使用靜脈注射胰島素. 劑量 0.1-0.3u/kg/hr. 以 60 公斤重成人為例, 每小時 6-18u, 胰島素治療需每小時測血糖. 每 12 小時測量 TG. 治療目標也是將TG降到 500 以下.  其他治療方式與別的成因的胰臟炎相同: 空腹, 補充輸液, 止痛 Apheresis 分離術. 將血液某個成分使用機器分離移除. https://www.uptodate.com/contents/hypertriglyceridemia-induced-acute-pancreatitis#H8 Hypertriglyceridemia-induced acute pancreatitis Hypertriglyceridemia (HTG) Severe HTG (1000 to 1999 mg/dL, 11.3 to 22.5 mmol/L) Risk of acute pancreatitis — Mild hypertriglyceridemia is associated with a low risk of acute pancreatitis [2,9-11]. The risk increases progressively with serum triglyceride levels over 500 mg/dL (5.6 mmol/L) with the risk increasing markedly with levels over 1000 mg/dL (11.3 mmol/L) [10,12,13]. The risk of developing acute pancreatitis is approximately 5 percent with serum triglycerides >1000 mg/dL (11.3 mmol/L) and 10 to 20 percent with triglycerides >2000 mg/dL (22.6 mmol/L)  Secondary hypertriglyceridemia —