臨床病理討論會(huì)ppt課件(已修改)
2025-01-17 04:24 本頁面
【正文】 臨床病理討論會(huì) 小兒科：盧俊維醫(yī)師 放射科：吳金珠醫(yī)師 病理科：蕭正祥醫(yī)師 A 10 y/o girl Chief plaint: Chest disfort, vomiting and dry cough for one day Brief History Growth amp。 development: ? Weight: 22 kg (3rd10th percentile) ? Height: 130 cm (2550th percentile) ? Development milestone: within normal limit Past history ? Handfootmouth disease in 1998 ? Frequent URI and fever during childhood ? No drug or food allergy Brief History Family history: ? Her sister had fever and URI recently. Present Illness Fever and bilateral hand arthralgia attack once 1 month ago Chest disfort and cough since 9/11 afternoon, 2022 Visit LMD and URI was told Vomiting and chest tightness on 9/12 0 AM and 5 AM Present Illness 9/12 morning, visit LMD again, ECG showed arrhythmia Refer to 亞東 hospital Present Illness Findings at 亞東 hospital ? Clear consciousness, illlooking, pallor appearance, no cyanosis ? Irregular heart beat ? EKG: VPC bigeminy Present Illness Lab. findings at 亞東 hospital ? WBC 9000/mm3, Hb g/dl ? BUN 11 mg/dl, Cre mg/dl ? GOT 25 U/L, CK 665 U/L, CKMB 175 U/L Present Illness Echocardiogram at 亞東 hospital ? Multiple small VSDs, muscular trabecular type, at apex ? LV dyskinesia, LVEF 6070% ? Mild TR, mild MR Present Illness Management at 亞東 hospital ? Lidocaine iv drip ? Dopamine 10 mg/kg/min ? Refer to NTUH (2pm) Physical Examination Physical findings at NTUH ? Consciousness: lethargic, acute illlooking ? T/P/R: 37/140/25 BP 80/46 SaO2 97% ? HEENT: pale conjunctiva anicteric sclera mild cyanotic lip Physical Examination ? Neck: jugular venous engement ? Chest: bilateral basal r228。les ? Heart: irregularly irregular beats, distant heart sound no murmur Physical Examination ? Abdomen: no hepatomegaly hypoactive bowel sound ? Extremities: freely movable cold and cyanotic poor capillary refilling Initial Lab Data CBC: WBC Hb Hct Plt 8840 % 160 K Seg %, Lym %, Eos % BCS: BUN Cre Na K Cl Ca 141
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