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5/26 メモ

●菊池氏病
●木村病


●VZV & acyclovir
・水疱瘡、治療するなら24時間以内
・帯状疱疹、治療するなら72時間以内

●循環・血流量の評価
・左心系
 MAP、尿比重
・末梢
 lactate、ScvO2
・右心系
 edema、IVC、CVP
・心
 contraction
・肺動脈
 PAP
・肺静脈
 PCWP

●RAST
結果でてもなんとも言えないよ、と説明するべき

●胸水
・胃泡/横隔膜の間が5mm以上のとき、ある
・B-line
・横隔膜の裏、肺側が見通せるかをチェック

●いい薬がでているよ、と主治医を褒めるとよりよくかえせる

●大腸イレウスは…
バウヒン弁あるから、それ以上戻らない。人工肛門をすぐつくって逃げる。

●肺解剖
右 前→後
 1
3 2
4 5 6
7
8 9 10

左 前→後
1
3 2
4
5 6
8 9 10

●頚部気管支音
wheese 聞こえやすい、course crackle ときどき聞こえる
fine は末梢だから無理

強制呼気が大切

口を軽くあけた、肩の力抜いた、少し軽めの息が大切
正常なら呼気聞こえない

●葛根湯副作用
胃にくることあり

●cyproheptadine(ペリアクチン)
抗ヒスタミン薬 →アレルギー抑制
 抗コリン作用あり、痰が硬くなる→去痰上手くいかなくなることあり
 →喘息が悪化することが…

●喘息
ひどいと音が聞こえないことあり、胸郭運動チェック

●乳児では…
アセトアミノフェン使わない!!!
低体温が怖いから
ミルクのめないかもチェック。低栄養が怖い

●ヤバイ薬疹
target lesionあると、TENに行き易い

●viral BA
ステロイドつかってもいいよ

●人格障害
 自己評価低下、悲観的、衝動的、家族との関係希薄
→外から見ると頑張り屋のいい子
→悪い面を出せない
→シャットアウト 〜適応しようとする
 がむしゃらに頑張る

⇒「ほどほどの自己陶酔」
 「現実的な自分」
  ⇒自分探し、能力決定 ⇒ダメな自分を表現

●アルツハイマーは、
食べたかどうか忘れるのが典型的

うつの物忘れは、居場所は分かるのが基本

●VSRAD
海馬の萎縮を見る

●うつの診断のために
病前性格の評価が大切

責任感、秩序、執着

ストレスに弱い、責任感ない →神経症

●EEG spindle
αより短く、紡錘

●EEG 眠いと…
α↓、Θ↑(パンプ出現) →→spindle

●アルコール幻聴
抑うつになりやすい、場にそぐわない表情を出したりする
でもコンタクトは崩れない

●新生児に テオフィリン
気管支拡張、強心、利尿、冠血管拡張
…呼吸器離脱に

・NO も肺血管拡張

●新生児難聴
母親のトキソプラズマ
体重<1500
出生後髄膜炎
呼吸障害
核黄疸

●核黄疸
アルブミンと結合していない間接ビリルビンが脳細胞(大脳基底核、海馬回の灰白質、小脳歯状核など)に沈着 →黄染
risk : 未熟、薬物、仮死
予防 : 光線療法、交換輸血

●シーソー運動
呼気で腹が、吸気で胸がへっこむ

●生理的体重減少
生後3〜4日
…7〜10で出生時の体重に戻る

●シンギン
 呼気時に声門を絞る、うめき声

●チェック
・アミノ酸
 フェニルケトン尿症 1/8万人
 メープルシロップ尿症 1/50万人
 ホモシスチン尿症 1/17万人
・糖
 ガラクトース血症 1/4万人
・クレチン症 1/5000人
・副腎過形成 1/2万人

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