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目前顯示的是 七月, 2016的文章

吸入性肺炎(aspiration pneumonia)及經驗性抗生素

常發生部位: 右肺(因為右肺支氣管較垂直)未使用人工呼吸器患者: 吸入異物時患者體位是直立:右下肺葉的頂節吸入異物時患者體位是平躺:右上肺葉的下節 使用人工呼吸器患者:上肺葉,特別右上肺葉
常見致病菌口腔中厭氧菌anaerobes:bacteroides melaninogenicus, Fusobacterium nucleatum, aerobic streptococci(e.g. peptococcus, peptostreptococcus)GPC:Viridans streptococci, staphylococcus aureus, streptococci
經驗性抗生素 第一線 Amoxicillin-clavulanate 1.2gm IV Q8HAmpicillin-sulbactam 1.5gm IV Q6HCeftriaxone 2gm IV Q24H + Metronidazole 15mg/kg IV Q12H 第二線 Piperacillin-tazobactam 4.5gm IV Q6HVancomycin 1gm IV Q12H + Ceftazidime 2gm IV Q8H+ Metronidazole 15mg/kg IV Q12H
參考資料臨床使用抗生素手冊 第四版

連枷胸(Flial chest)

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定義:兩根以上相鄰肋骨有兩處以上骨折。造成paradoxical motion of chest wall(吸氣時內縮吐氣時外凸)
Ref: ATLS, 9th ed.
診斷:臨床診斷,視診和觸診palpation of abnormal respiratory motion and creptiation of rib or cartilage fractures。blunt trauma patients with paradoxical or reverse motion of a chest wall segment while spontaneously breathing。

重要性:pulmonary contusion所造成的lung injury和restricted chest wall movement associated with pain 是造成hypoxia 的主因Patients with flail chest have deranged respiratory mechanics and usually require positive pressure ventilation. 治療要點initial treatment: adequate ventilation, administration of humidifed oxygen and fluid resuscitation(avoid volume overload)definitive treatment: adequate oxygenation, administer judiciously and provide analgesia to improve ventilation。止痛應避免respiratory depressionlocal anesthetics 包含intermittent intercostal nerve block and intrapleural , extrepleural, or epidural anesthsia
參考資料 ATLS, 9th ed.Flail chest in MedscapeAcute care surgery