救急「見学」
夜間の救急を見学した。まだ手順も何も分からないので、つったってただけ…。印象、わるかっただろうな〜…
●みた患者
・交通事故外傷
・熱発と呼吸困難
・偏頭痛?
・めまい
・気胸(SpO2 38まで低下…)
・一人暮らしの高齢者の寂しさから…
●興味深い疾患
頚椎変形で、自律神経がくるい、頚骨動脈から血が届かなくなるのか、めまいが起こることが…
季節の変わり目に多い
肩こりに併発することが多い
手指の痺れは特にないこと多い
(整形外科的には、ない、と言われるが…)
治療)肩の等尺運動
●確認した薬
・ベンゾジアゼピン
…寝ている間に筋弛緩させるものあり →肩こりとれる?
・筋緊張治療薬
リンラキサー(脊髄の反射経路の介在ニューロンを選択的に遮断)
テルネリン(中枢性アドレナリンα2作動→筋弛緩 副:抗コリン作用etc)
アロフト(広範囲な中枢の抑制。作用が弱いため、高齢者に使いやすい)
・ハルシオン
超短期型ベンゾジアゼピン系。前健忘(+)
・アネキセート(フルマゼニル)
ベンゾジアゼピン拮抗薬
→沈静と呼吸抑制の解除
・ダイアモックス(アセタゾラミド)
炭酸脱水酵素を抑制 → 眼圧低下、中枢神経系の刺激伝達抑制、利尿、メニエル治療、など
・メリスロン
内耳血管条の血流を増加 →内リンパ除去
内頸動脈の血流量を増加 →脳循環改善 forメニエル
・イソメニール(イソプロテレノール)
血管拡張作用・心送血量増加作用 →脳循環改善作用
内耳機能改善 for メニエル
●学んだ略語
・LOS = loss of consciousness
●疑問
・経鼻挿管と一般の挿管の使い分けは?
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