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

小麻

	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	-			+

Tintinnali 7e

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

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

[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

3. Olanzapine (Zyprexa)  5-10mg IM/ 10-20mg PO (Max: 20mg/24h) 

    [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

2. Trihexyphenidyl (Artane) 2mg/day ~ 5-15mg/day
    [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

[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