Links2

Jerence Folder Vocaloid
Edit Lab | MyNote | To Do




PACS Chart
WebForm Echo

Dr Eye

septic shock

Glucocorticoid therapy may be beneficial to patients who have severe septic shock (defined as a systolic blood pressure ＜90 mmHg for more than one hour despite adequate fluid resuscitation plus vasopressor administration).
There are no high or moderate quality data to suggest that glucocorticoid therapy is beneficial to patients with less severe septic shock. (See "Clinical evidence" above).
Classification of adrenal reserve as adequate or inadequate fails to identify patients who are more likely to benefit from glucocorticoid therapy. (See "Clinical evidence" above).

We typically administer 50 mg of hydrocortisone every six hours or 100 mg of hydrocortisone every eight hours.

ideal body weight nutrition

men: Ideal Body Weight (in kilograms) = 50 + 2.3 kg per inch(2.54cm) over 5 feet(152.4cm).
women: Ideal Body Weight (in kilograms) = 45.5 + 2.3 kg per inch over 5 feet.

BMI=22 (both sex)
Calorie need=IBW*30Kcal/kg/day
Protein need=Patient current body weight*72.6g/day

acid base

HCO3 PCO2 同向：metabolic，反向：respiratory(氣體對流)

代償之delta＝系數*primary之delta

metabolic:
0.25*5　acidosis
0.25*3

respiratory
0104 acidosis
0204 alkalosis(hyperventilation)

IV urine alkalization

sodium bicarbonate 2 vial Q8H, then check urine PH(target＞7.2)
If ＜ 7.2, q8 -＞ Q6, else Q8 -＞ Q12

warm shock

病人可在warm shock時就爛掉(organ failure和lactic acidosis)，等BP掉時可能巳ischemic bowel等等而爛到不行了（腸子要切掉 etc.）

Warm shock: 尿減少 → HR↑,dyspnea(for compensate),organ failure(如ischemic bowel而想吐，這時HR不是因想吐不適而快，用beta blocker會將好不容易的代償除掉而死)

Sinus Tachycardia是要趕快找underlying處理掉（如hypovolumia），而不能用heart rate藥

過敏和septic shock早期因周邊血管擴張而warm之shock，
只有cardiogenic shock的HR沒上昇
稱之為shock應該都會有尿減少的問題

pneumonia lung edema

rhonchi: 水中咕嚕咕嚕聲　－－＞ sputum
crackle: 搓頭髮聲　－－＞　lung edema