1. [X-Ray] Wrist
https://www.dropbox.com/s/qh9lobc26bnkj8w/%5B%E6%95%B4%E7%90%86%5DX-ray%20Wrist.doc?dl=0
2014年10月25日 星期六
2014年8月14日 星期四
[EKG] Normal Sinus Rhythm Definition
1. Atrial rate: 60 ~ 100
2. P-wave UPRIGHT in lead I, II, III, aVF (& aVL) 反之是ectopic atrial
3. PR-interval: 0.12 ~ 0.20 sec <0.12: preexcitation or AV-junctional; >0.2: AV-block
4. Every P FOLLOWED by QRS
5. Every QRS PRECEEDED BY P
6. TWI in V1 & aVR
2. P-wave UPRIGHT in lead I, II, III, aVF (& aVL) 反之是ectopic atrial
3. PR-interval: 0.12 ~ 0.20 sec <0.12: preexcitation or AV-junctional; >0.2: AV-block
4. Every P FOLLOWED by QRS
5. Every QRS PRECEEDED BY P
6. TWI in V1 & aVR
2014年7月28日 星期一
CSF Study
|
|
Normal
|
Bacterial
|
TB
|
Fungal
|
Aseptic
|
|
|
Opening
pressure
(mm
CSF)
|
9-18
|
18-30
|
9-18
|
|||
|
WBC
(/mm3)
|
0-5
|
100-10000
|
<
500
|
<
300
|
||
|
Glucose
(mg/dL)
|
50-75
|
<45
|
50-100
|
|||
|
Protein
(mg/dL)
|
15-40
|
100-1000
|
100-200
|
40-300
|
0-100
|
|
|
|
Normal
|
Bacterial
|
Viral
|
Neoplastic
|
Fungal
|
|
Opening pressure
(mm CSF)
|
< 170
|
>300
|
<300
|
200
|
300
|
|
WBC
(/mm3)
|
< 5
|
>
1000
|
<
1000
|
<
500
|
|
|
%
PMN
|
0
|
>80%
|
1~50%
|
||
|
Glucose
|
> 40
|
<
40
|
>
40
|
<
40
|
|
|
Protein
|
< 50
|
>
200
|
<
200
|
>
200
|
|
|
Gram
stain
|
-
|
+
|
-
|
||
|
Cytology
|
-
|
+
|
|||
2014年7月26日 星期六
[Drugs] Nitroglycerin
Nitroglycerin
(Millisrol) 5 mg/10ml è 0.5 mg/ml
Starting from 10 mcg/min (1.2 ml/hr);
Titrate by 5 mcg/min (0.6 ml/hr) every 3~5 min up to 20 mcg/min (2.4 ml/hr);
If still no response, Titrate by 10 mcg/min (1.2 ml/hr) up to 200 mcg/min (24 ml/hr)
(Nitrostat) 0.6 mg/tab
(Millisrol) 5 mg/10ml è 0.5 mg/ml
Starting from 10 mcg/min (1.2 ml/hr);
Titrate by 5 mcg/min (0.6 ml/hr) every 3~5 min up to 20 mcg/min (2.4 ml/hr);
If still no response, Titrate by 10 mcg/min (1.2 ml/hr) up to 200 mcg/min (24 ml/hr)
(Nitrostat) 0.6 mg/tab
2014年7月9日 星期三
[EKG] VT versus Abberancy
Favor VT:
1. Uniform QRS-polarity from V1~V6 統一QRS的axis是Positive或Negative
2. Capture beat 一堆wide QRS中有narrow QRS
3. Fusion beat 一堆wide QRS中有"中等寬度" QRS
4. AV-dissociation 一堆wide QRS中有occasional P wave
1. Uniform QRS-polarity from V1~V6 統一QRS的axis是Positive或Negative
2. Capture beat 一堆wide QRS中有narrow QRS
3. Fusion beat 一堆wide QRS中有"中等寬度" QRS
4. AV-dissociation 一堆wide QRS中有occasional P wave
[EKG] Ischemia? Infarction?
1. RV-infarction likely:
(a) STE in lead III > II
(b) STE in lead V1 > V2
(c) STD in lead V2 +STE or isoelectric in lead V1
2. WPW mimicking as AMI
(a) INFERIOR leads有large Q-wave ==> IMI
(b) V1有large R-wave ==> PMI
3. STE in aVR:
(a) + aVL: Left-Main
(b) + V1: Left-Main or proximal-LAD, 但若aVR > V1: Left-Main
4. Reciprocal changes (STD + TWI) in aVL:
(a) Inf. MI
(b) Ant. MI
(c) LVH
(d) LBBB
(e) Digitalis use
5. New Tall T-wave in V1: NEW-UPright T-wave in V1 + T-wave:V1>V6
(a) Ischemia (LCx or RCA)
(b) LVH
(c) LBBB
(d) High left ventricular voltage (Young athlete)
(e) Normal variant
6. Posterior-MI: 看lead V1~V3有無 (STD + UPright-T + Tall R-wave)
(a) STE in lead III > II
(b) STE in lead V1 > V2
(c) STD in lead V2 +STE or isoelectric in lead V1
2. WPW mimicking as AMI
(a) INFERIOR leads有large Q-wave ==> IMI
(b) V1有large R-wave ==> PMI
3. STE in aVR:
(a) + aVL: Left-Main
(b) + V1: Left-Main or proximal-LAD, 但若aVR > V1: Left-Main
4. Reciprocal changes (STD + TWI) in aVL:
(a) Inf. MI
(b) Ant. MI
(c) LVH
(d) LBBB
(e) Digitalis use
5. New Tall T-wave in V1: NEW-UPright T-wave in V1 + T-wave:V1>V6
(a) Ischemia (LCx or RCA)
(b) LVH
(c) LBBB
(d) High left ventricular voltage (Young athlete)
(e) Normal variant
6. Posterior-MI: 看lead V1~V3有無 (STD + UPright-T + Tall R-wave)
2014年5月20日 星期二
[EKG] Electrolytes
Hypokalemia
Prolonged
QT (Due to U waves)
ST-segment
Depression
Biphasic
T-waves (Down then up, unike Wellen’s waves)
PVC’s,
ventricular arrhythmias
Hyperkalemia
Tall T-wave
Prolonged PR
P-wave flattening
QRS widening
Sine wave
VF
Hyperkalemia
Tall T-wave
Prolonged PR
P-wave flattening
QRS widening
Sine wave
VF
Hypercalcemia
Short QT
ST-Elevation
STEMI Definition
1. New ST-elevation at the J point in at least 2 contiguous leads of：
(a) 2 mm (0.2 mV) in men in leads V2 –V3 ,or
(b) 1.5 mm (0.15 mV) in women in leads V2 –V3 ,and/or
(c) 1 mm (0.1mV) in other contiguous chest leads or the limb leads.
2. ST- depression in 2 precordial leads (V1 ~ V4 )
3. Multilead ST-depression with coexistent ST-elevation in lead aVR
4. Hyperacute T-wave changes (? 包含 de-Winter T-wave)
5. LBBB 要用Sgarbossa Criteria來定義 (new-LBBB但不符Sgarbossa Criteria不算)
(a) CONcordance STE > 1 mm 5-points
(b) STD > 1 mm in V1~V3 3-points
(c) DISCONcordance STE > 5 mm 2-points > 3-points的Sensitivity有98%
2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction
DOI: 10.1161/CIR.0b013e3182742cf6
(a) 2 mm (0.2 mV) in men in leads V2 –V3 ,or
(b) 1.5 mm (0.15 mV) in women in leads V2 –V3 ,and/or
(c) 1 mm (0.1mV) in other contiguous chest leads or the limb leads.
2. ST- depression in 2 precordial leads (V1 ~ V4 )
3. Multilead ST-depression with coexistent ST-elevation in lead aVR
4. Hyperacute T-wave changes (? 包含 de-Winter T-wave)
5. LBBB 要用Sgarbossa Criteria來定義 (new-LBBB但不符Sgarbossa Criteria不算)
(a) CONcordance STE > 1 mm 5-points
(b) STD > 1 mm in V1~V3 3-points
(c) DISCONcordance STE > 5 mm 2-points > 3-points的Sensitivity有98%
2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction
DOI: 10.1161/CIR.0b013e3182742cf6
2014年5月18日 星期日
常用(被考)又容易忘記的Parameters
1. Blood sugar:
(a) ROSC: 144~180
(b) tPA/stroke: 50~185
(c) Sepsis: < 180
2. Blood pressure:
(a) Ischemic stroke
(i) tPA (+): < 185/110
(ii) tPA (-): < 220/120
(b) Hemorrhagic stroke (ICH): < 180/105
(c) SAH: SBP < 160, MAP < 130
(d) Septic shock
(i) Sepsis-induced hypotension: SBP < 90 or decrease > 40 or < 2 SD below normal for age, or MAP < 70
(ii) With vasopressor: MAP > 65
3. NIHSS:
美國版 (11項，0~42分，不打tPA：< 4 or > 22)
台灣版，改成：
(a) 13項：[第 5項(左、右手臂之運動)，與第 6 項(左、右腿部之運動)，分別被獨立列為單題所致)]
(b) 0~38分：[第 9 項與第 13 項；英文版之第 7 項 limb ataxia 與第 11 項 extinction and inattention [formerly neglect]) 無反應的病人不評分 (以 0 分計)]
(c) 不打tPA：< 6 or > 25
(a) ROSC: 144~180
(b) tPA/stroke: 50~185
(c) Sepsis: < 180
2. Blood pressure:
(a) Ischemic stroke
(i) tPA (+): < 185/110
(ii) tPA (-): < 220/120
(b) Hemorrhagic stroke (ICH): < 180/105
(c) SAH: SBP < 160, MAP < 130
(d) Septic shock
(i) Sepsis-induced hypotension: SBP < 90 or decrease > 40 or < 2 SD below normal for age, or MAP < 70
(ii) With vasopressor: MAP > 65
3. NIHSS:
美國版 (11項，0~42分，不打tPA：< 4 or > 22)
台灣版，改成：
(a) 13項：[第 5項(左、右手臂之運動)，與第 6 項(左、右腿部之運動)，分別被獨立列為單題所致)]
(b) 0~38分：[第 9 項與第 13 項；英文版之第 7 項 limb ataxia 與第 11 項 extinction and inattention [formerly neglect]) 無反應的病人不評分 (以 0 分計)]
(c) 不打tPA：< 6 or > 25
2014年4月24日 星期四
[EKG] 整理自 ECGs for the Emergency Physicians Part 1
1. LVH strain pattern:
(a) Lateral leads: STD & Asymmetric TWI
(b) Right precordial leads: STE
2. Prominent R wave in lead V1 (R/S-ratio > 1), D/dx:
(a) RVH
(b) RV-strain/dilatation
(c) HOCM
(d) Dextrocardia
(e) Ventricular ectopy
(f) WPW
(g) Misplaced precordial leads
(口訣: WORD)
W: WPW, O: HOCM, R: RVH/RV-strain/RBBB, D: Dextrocardia
3. Acute massive pulmonary embolism likely:
(a) Tachycardia
(b) RAD
(c) incomplete RBBB
(d) S1Q3T3
(e) TWI in inferior and anteroseptal leads
4. Cyclic antidepressant overdose likely:
(a) Tachycardia
(b) RAD
(c) R-wave in lead aVR > 3mm
(d) QRS-prolonged
5. HOCM likely: (以下findings都是ventricular septum hypertrophy所致)
(a) large QRS in ALL leads
(b) tall R-wave in lead V1 & V2
(c) deep Q-wave in INFERO-LATERAL leads
6. Digoxin toxicity likely:
(a) Occasional VPCs
(b) "Hockey-stick" like appearance of terminal portion of R-wave
(c) Complete heart block with regular junctional or ventricular escape
(d) Atrial tachycardia with variable AV-block
7. WPW mimicking as AMI
(a) INFERIOR leads有large Q-wave ==> IMI
(b) V1有large R-wave ==> PMI
(a) Lateral leads: STD & Asymmetric TWI
(b) Right precordial leads: STE
2. Prominent R wave in lead V1 (R/S-ratio > 1), D/dx:
(a) RVH
(b) RV-strain/dilatation
(c) HOCM
(d) Dextrocardia
(e) Ventricular ectopy
(f) WPW
(g) Misplaced precordial leads
(口訣: WORD)
W: WPW, O: HOCM, R: RVH/RV-strain/RBBB, D: Dextrocardia
3. Acute massive pulmonary embolism likely:
(a) Tachycardia
(b) RAD
(c) incomplete RBBB
(d) S1Q3T3
(e) TWI in inferior and anteroseptal leads
4. Cyclic antidepressant overdose likely:
(a) Tachycardia
(b) RAD
(c) R-wave in lead aVR > 3mm
(d) QRS-prolonged
5. HOCM likely: (以下findings都是ventricular septum hypertrophy所致)
(a) large QRS in ALL leads
(b) tall R-wave in lead V1 & V2
(c) deep Q-wave in INFERO-LATERAL leads
6. Digoxin toxicity likely:
(a) Occasional VPCs
(b) "Hockey-stick" like appearance of terminal portion of R-wave
(c) Complete heart block with regular junctional or ventricular escape
(d) Atrial tachycardia with variable AV-block
7. WPW mimicking as AMI
(a) INFERIOR leads有large Q-wave ==> IMI
(b) V1有large R-wave ==> PMI
2014年3月14日 星期五
[Drugs] Antipsychotic for Sedation
1. Haloperidol (Haldol) 1-5mg IM/PO q1h (Max: 20-30mg/24h)
[SKH] HALDOL 5mg/amp; 5mg/tab
2. Droperidol (Dropel) 2.5-5mg
IM/IV Note black box regarding arrhythmias
[SKH]
DROPEL 2.5mg/amp
[SKH] ZYPREXA 10mg/vial; 5mg/tab
4. Risperidone (Risperdal) 25 mg IM Q2W/ 1-2mg PO (Max: 6mg/24h)
[SKH] RISPERDAL 37.5mg/vial; 2mg/tab; 1mg/ml
(NOT used in ER)
5. Ziprasidone (Geodon) 20mg IM q4h/ 10mg q2h (<
40mg/24h)
[SKH] GEODON 60mg/cap
[Drugs] Treatment of EPS
1. Diphenhydramine 50mg q4-5h
[SKH] DIPHENHYDRAMINE 30mg/1ml/amp
[SKH] DIPHENHYDRAMINE 30mg/1ml/amp
2. Trihexyphenidyl (Artane) 2mg/day ~ 5-15mg/day
[SKH] ARTANE 2mg/tab
[SKH] ARTANE 2mg/tab
3. Biperiden (Akineton) 2.5-5mg IM or 2mg PO
[SKH] BIPIDEN 5MG/1ML
4. Benztropine (Cogentin) 1-2mg PO or IM q 8-12h
2014年2月17日 星期一
[Drug] Vasopressor, Inotropics
Dopamine (Dopamine) (400mg/250ml/bag) è 1.6 mg/ml
|
mcg/kg/min
|
2
|
10
|
20
|
||||
|
mcg/kg/hr
|
120
|
600
|
1200
|
||||
|
mg/kg/hr
|
0.12
|
0.6
|
1.2
|
||||
|
40
|
mg/hr mg/ml
|
4.8
|
3
|
24
|
15
|
48
|
30
|
|
50
|
6
|
4
|
30
|
19
|
60
|
38
|
|
|
60
|
7.2
|
4.5
|
36
|
23
|
72
|
45
|
|
|
70
|
8.4
|
5
|
42
|
26
|
84
|
53
|
|
|
80
|
9.6
|
6
|
48
|
30
|
96
|
60
|
|
Dobutamine (Easydobu) (250mg/250ml/bag) è 1 mg/ml
|
mcg/kg/min
|
2.5
|
5
|
10
|
20
|
|
|
mcg/kg/hr
|
150
|
300
|
600
|
1200
|
|
|
mg/kg/hr
|
0.15
|
0.3
|
0.6
|
1.2
|
|
|
40
|
mg/ml
|
6
|
12
|
24
|
48
|
|
50
|
7.5
|
15
|
30
|
60
|
|
|
60
|
9
|
18
|
36
|
72
|
|
|
70
|
10.5
|
21
|
42
|
84
|
|
|
80
|
12
|
24
|
48
|
96
|
|
Epinephrine (Adrenaline) (1mg/ml/amp) è 1 mg/ml
(Bosmin) (0.1%/500ml/bot) è 0.5 mg/ml
1 % =
10 mg/ml (1:1000 = 1 mg/ml)
Norepinephrine (Levophed) (4mg/4ml/amp)
泡：2 amp in D5W 250 mlè0.03 mg/ml
|
mcg/min
|
0.5
|
1
|
2
|
5
|
10
|
20
|
30
|
|
mcg/hr
|
30
|
60
|
120
|
300
|
600
|
1200
|
1800
|
|
mg/hr
|
0.03
|
0.06
|
0.12
|
0.3
|
0.6
|
1.2
|
1.8
|
|
ml/hr
|
1
|
2
|
4
|
10
|
20
|
40
|
60
|
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