4/13(金) 当直
◆今日の気持ち
(膠原病科 2週目)
●今の目標
・大学病院の仕事を覚える
●今日の新患・診断
・細菌性髄膜炎??
・TB
・虫垂糞石
・Af
・頚椎損傷
・鼻出血
・統合失調症
・中耳炎
・喘息発作
・水虫→皮膚炎
・NASH
●今日の病院滞在時間
8時〜当直
●今日行ったこと・見たこと・知ったこと
・喘息は思いっきりはかせて、終末呼気を聞かないと…
・精神病の薬
→月経不順おきやすい。ドーパミンとまってプロラクチン増えるから
・TB
痰でてないなら感染力は少ない
・NSAIDsは動脈管を広げる…
・妊婦への抗生剤は、ペニシリン・セフェムが基本
・心発作は酒と関係あり
・耳鼻科で危なさを見分けるポイントは、「水が飲めるか」
・易感染者で、足が変な患者では…
両側同時蜂窩織炎はありえない
痛みのない蜂窩織炎は、DMなければ考えにくい
筋に沿って赤かったら膿の広がりが怪しいが、ひっかきやすいところが赤かったら、痒いだけなこと疑う
・喘息発作に…
ベネトリンsalbutamol 0.3ml (β1stim) とビソルボン bromberine (去痰)とNaCl 2ml 、とか。
・SpO2 93%届かないとやばい… 普通の喘息や肺炎ではそこまでは落ちない
・蜂巣肺 →たいていUIP、 スリガラス →たいていNSIP
・異型肺炎 マイコとか
WBCあがらず、CRP高く、乾燥した咳が強い
AZM ジスロマックがよく効く
・ウイルス肺炎は
スリガラス。抵抗力あるひとならまず起きない
・リスクある患者のステロイドDM」でのBSコントロール
毎日だんだんBSあがるパターン
食前 80〜120
食後2時間 <200、できれば<170を維持
ベイスン0.9mgにアマリールを1mg朝に加えてみたり…
・
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