- 2月 26 週四 200923:27
異位性皮膚炎病理圖解
- 2月 12 週四 200900:32
愛用保險套
最近在本院放射科學超音波
跟著台灣醫界超音波第一把交椅-周主任,我實在學了不少
尤其他腹部超音波的診斷功力,可以說與電腦斷層相當
不過這不是今天的重點
重點是
我們在做超音波引導切片或穿刺的時候
原本大家都習慣用塑膠袋(我想各科都是醬)
但是在這裡
我們卻是用......保險套
在內層有塗上gel
因為很緊,不會像塑膠袋那樣有空隙,所以還滿好用的
這是一同受訓的谷醫師的手
還有另一個重點就是
要把中間那一粒擠到旁邊去才不會檔住視線
如圖
唯一的缺點大概就是......有點滑,所以要抓好
其次就是我個人的困擾......
不知為什麼,拿著這個東西在病人身上滑來滑去,我就是很想笑^^
- 1月 12 週一 200915:15
門診SOAP
CC:
Past history:
Personal history: alcohol(-), betel nut(-), cigarette(+): PPD for years, quit for years
Family history:
Location：位置
Quality：發作型態
Quantity/time course：發作歷時長短
Onset mode：疾病發作的型態或發作模式
Precipitating factors：環境或誘發因素
Exaggerating/exacerbating factors：加重因素
Relieving factors：緩解因素
Accompanying/associated symptoms：伴隨症狀
arrhyth-mia
rhino-rrhea
dia-rrhea
Consciousness: clear
HEENT: no anemic/pale conjunctiva, no icteric sclera, no tonsillar enlargement
CHEST: symmetric expansion, breath sounds: clear, no rales, no wheezing
HEART: regular heart beat, no murmur
ABDOMEN: flat and soft, normo-active bowel sound, no tenderness or rebounding pain, absent shifting dullness, Murphy's sign(-)
EXTREMITIES: no deformity, joint movement free
SKIN: normal turgor and color, no pitting edema, no petechia or ecchymosis
Past history:
Personal history: alcohol(-), betel nut(-), cigarette(+): PPD for years, quit for years
Family history:
Location：位置
Quality：發作型態
Quantity/time course：發作歷時長短
Onset mode：疾病發作的型態或發作模式
Precipitating factors：環境或誘發因素
Exaggerating/exacerbating factors：加重因素
Relieving factors：緩解因素
Accompanying/associated symptoms：伴隨症狀
arrhyth-mia
rhino-rrhea
dia-rrhea
Consciousness: clear
HEENT: no anemic/pale conjunctiva, no icteric sclera, no tonsillar enlargement
CHEST: symmetric expansion, breath sounds: clear, no rales, no wheezing
HEART: regular heart beat, no murmur
ABDOMEN: flat and soft, normo-active bowel sound, no tenderness or rebounding pain, absent shifting dullness, Murphy's sign(-)
EXTREMITIES: no deformity, joint movement free
SKIN: normal turgor and color, no pitting edema, no petechia or ecchymosis
- 1月 01 週四 200923:10
抗生素使用(鄭老大版 from無名氏)
VGH-TPE Microbiology Culture Report：
Amikacin
Ampicillin
Aztreonam
Cefazolin
Cefoperazone
Cefotaxime/Ceftizoxime
Ceftazidime
Cefuroxime
Ceftriaxone
Chloramphenicol
Clindamycin
Erythromycin
Gentamicin
Metronidazole
Flomoxef
Ciprofloxacin
Cefepime
Oxacillin
Penicillin-G
Tetracycline/Minocycline
Piperacillin/Tazobactam
Tobramycin/Netilmicin
Trimethoprim-sulfamethoxazole
Vancomycin
Teicoplanin
Imipenem
Amikin
Azactam
Tydine/Cephalexin/Keflex
CPZ
Claforan/Epocelin
Fortum
Zinnet/Zinacef
Rocephin
Cleocin
Rulid
Gentamycin
Anegyn
Flumarin
Ciproxin
Maxipime
Prostaphlin
Tazocin
Aminoglycosides
Bactar/Bacide/Bactrim
Tienam
- 12月 19 週五 200802:36
失眠藥物
Non-BZD
Stilnox 10mg
Imovane 7.5mg
BZD Hypnotics
Eurodin 2mg
Dormicun 7.5mg
Halcion 0.25mg
Flunitrazepam(Rohypnol, Modipanol) 2mg
Dalmadorm 15mg, 30mg
Anti-Depressant
Mesyrel 50mg
Remeron 30mg
Anti-Psychotics
Sulpiride 50mg 1# qid, 200mg 1/2# qn
Seroquel 25mg qn
Risperidone 1cc qn, 0.5cc/1cc bid
Olanzapine 5mg
Etumine 40mg
Wintermin 100mg, 1/4#
多夢 >>↓REM
BZD X
TCA Sinequan
Anti-depressants Mesyrel, Remeron
Anti-psycotics Olanzepine(+SSRI), Seroquel
Stilnox 10mg
Imovane 7.5mg
BZD Hypnotics
Eurodin 2mg
Dormicun 7.5mg
Halcion 0.25mg
Flunitrazepam(Rohypnol, Modipanol) 2mg
Dalmadorm 15mg, 30mg
Anti-Depressant
Mesyrel 50mg
Remeron 30mg
Anti-Psychotics
Sulpiride 50mg 1# qid, 200mg 1/2# qn
Seroquel 25mg qn
Risperidone 1cc qn, 0.5cc/1cc bid
Olanzapine 5mg
Etumine 40mg
Wintermin 100mg, 1/4#
多夢 >>↓REM
BZD X
TCA Sinequan
Anti-depressants Mesyrel, Remeron
Anti-psycotics Olanzepine(+SSRI), Seroquel
- 12月 17 週三 200814:33
門診開單
針扎
約聘 外包>>勞工保險職業傷病門診單 (職災單,人事室拿)
R, INT>>健保卡
健保(員工)5041或5099(健保也可), 健保卡號06(職業傷害)
組套>>尖物扎傷
部分負擔:勞保職業病傷害006
約聘 外包>>勞工保險職業傷病門診單 (職災單,人事室拿)
R, INT>>健保卡
健保(員工)5041或5099(健保也可), 健保卡號06(職業傷害)
組套>>尖物扎傷
部分負擔:勞保職業病傷害006
- 11月 16 週日 200801:30
自殺評估(悲傷的人SAD PERSONS)
SAD PERSONS SCALE
Sex 1 if patient is male, 0 if female (attempt女性是男性兩倍，但自殺成功男性是女性兩倍)
Sex 1 if patient is male, 0 if female (attempt女性是男性兩倍，但自殺成功男性是女性兩倍)
- 10月 30 週四 200823:58
皮膚科小筆記
Terminology
1
macule patch
papule plaque
nodule tumor
vesicle bulla (bullae) pustule wheal
2
scale
crust
fissure
erosion ulcer
lichenification
scar
atrophy
excoriation: linear erosion
Multiple, pruritic, oval, pea-sized, erythematous papules with scales over upper back for one year
purpura 壓不會退
erythema 壓會退 ,血管擴張
Topical use agent
medicated bath
polytar 1:8000 去scale
zephrine 1:10000
medicated bath qd: scrub bath with sulfur powder 5%
olive oil 洗去crust
simple ointment/vaseline after bath
ODT (Occlusive dressig technique)
wet dressing: direct/indirect
CBO Chlorpheniramine, Lidocaine, Hexachlorophene, Methyl Salicylate, Menthol, Camphor
ZnO: intertrigo, HSV1
止癢 1'+2'+sinequan qn , 冰敷
Steroids
prednisolone
0.5mg/kg anti-inflammation
1mg/kg immunosuppression
短 1 hydrocortisone
中 4 predisolone
5 methylprednisolone/triamcinolone
長30 dexamethasone/betamethasone
cream acute, 濕, 日, intertriginous area, face, genital
oint chronic, 乾, 厚, 夜, fussure ->lubrication, palms, soles
lotion hair
tachyphylaxis-> 改intermittent (擦3休2)
tail off 才不會reboud phenomenon
oral antibiotics作local apply易contact deramtitis
1 超強
clobesol
2 強
topsym
3 中強
septon
nerisone
45 中
elomet
topicon
6 弱
rinderon
locacorten
7 最弱
ureson
1
macule patch
papule plaque
nodule tumor
vesicle bulla (bullae) pustule wheal
2
scale
crust
fissure
erosion ulcer
lichenification
scar
atrophy
excoriation: linear erosion
Multiple, pruritic, oval, pea-sized, erythematous papules with scales over upper back for one year
purpura 壓不會退
erythema 壓會退 ,血管擴張
Topical use agent
medicated bath
polytar 1:8000 去scale
zephrine 1:10000
medicated bath qd: scrub bath with sulfur powder 5%
olive oil 洗去crust
simple ointment/vaseline after bath
ODT (Occlusive dressig technique)
wet dressing: direct/indirect
CBO Chlorpheniramine, Lidocaine, Hexachlorophene, Methyl Salicylate, Menthol, Camphor
ZnO: intertrigo, HSV1
止癢 1'+2'+sinequan qn , 冰敷
Steroids
prednisolone
0.5mg/kg anti-inflammation
1mg/kg immunosuppression
短 1 hydrocortisone
中 4 predisolone
5 methylprednisolone/triamcinolone
長30 dexamethasone/betamethasone
cream acute, 濕, 日, intertriginous area, face, genital
oint chronic, 乾, 厚, 夜, fussure ->lubrication, palms, soles
lotion hair
tachyphylaxis-> 改intermittent (擦3休2)
tail off 才不會reboud phenomenon
oral antibiotics作local apply易contact deramtitis
1 超強
clobesol
2 強
topsym
3 中強
septon
nerisone
45 中
elomet
topicon
6 弱
rinderon
locacorten
7 最弱
ureson