臨床病理討論會(huì)ppt課件-展示頁
2025-01-14 04:24本頁面
【正文】 Course and Treatment 9/12 5pm (3 hr after admission) Progressive hypotension Sudden onset of a, BP drop (pulseless) EKG: ventricular tachycardia Start CPR (40 min) Start ECMO, transfer to SICU EKG (9/12, 5 PM) Course in SICU ECMO setting ? VA ECMO: 15 Fr R’t femoral artery, 19 Fr R’t femoral vein by cutdown ? Flow: 2022 ml/min ? Mean BP: 70 mmHg ? Urine output: ml/kg/hr Echocardiogram (9/13) Course in SICU VT persistent despite of cardioversion, Lidocaine, Amiodarone, MgSO4 9/12 ~ 9/17: ECMO 5 days ? Poor LV function ? Persistent lung edema (CXR, clinically) ? TnI slowly decrease ? Aline flatten, no pulsatile wave form Course in SICU Endomyocardial biopsy (9/14) ? Mild to moderate perivascular and interstitial lymphocyte infiltration ? Foci of myocyte degeneration ? Interstitial edema ? No giant cell Compatible with acute myocarditis Course in SICU LA drain (9/17): ? To depress LV, avoid thrombosis ? LA dome cannulation ? connecting to FV cannula ? ECMO ? FA ? LAP: 22 mmHg ? 10 mmHg Echocardiogram (9/17) Course in SICU 9/18, 4am ? Acute thrombosis at LA cannula and ECMO circuit ? poor flow ? CPR for 30 min. and emergent reset ECMO tubing ? Cons. After CPR: E1M1VT ? Light reflex (+) Course in SICU 9/19, 8am: gross hematuria and ECMO tube thrombosis ? reset ECMO Progressive dilated pupils, no light reflex, suspected hypoxic encephalopathy Remove ECMO on 9/23 (10th day) Lab data 9/12 9/13 9/14 9/15 9/16 9/17 TnI 100 74 CK 1040 9124 23421 26759 13864 7026 CKMB 196 368 687 403 207 101 Cre Bil Lab Data D A T E9 / 2 29 / 2 09 / 1 89 / 1 69 / 1 49 / 1 2Troponin I (ng/ml) 120100806040200D A T E9 / 2 29 / 2 09 / 1 89 / 1 69 / 1 49 / 1 2U/L8006004002000G O TC KM BLab Data Serology study。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 childhoo
教學(xué)課件相關(guān)推薦
鄂ICP備17016276號(hào)-1