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080701 勉強メモ

●ST変化の見えないMI…
T大切
V4 ST↓、V4〜6・aVr T↓
→HTN性のものもあるけれど、回旋枝MI 90%もありうる!

●β-Dグルカン
半減期 個体差が大きい。
6時間〜半年まで…

●冷えるの
腰からか →腎
足先だけか →気滞

●本気の自殺
・首吊り
・飛び降り
・入水

●うつ
車にたとえると分かりやすい
・ガス欠
 ・燃費が悪い
 ・タンクが小さい
 ・地面が悪すぎる
 ・スピード出しすぎ

うちの先生とか…
「ごめん…。明日は休んでいいかな…?」
「先生、明日は日曜日ですよ」


「死なない約束」できるなら帰していい。本物のうつならまじめだから、約束敗れない。「指きりげんまん」

…人格障害だと、約束するとあぶない

躁鬱病は
平和好き、喧嘩嫌い、
負けず嫌い
人に疑われたくない
褒められたい、人のために仕事したい
 …医療従事者、リスク高い

●アスペルガー
表で操作する
突発に弱い
暗記得意

●人格障害
裏で操作する

●ADHD
●アルコール依存

●大量内服で怖いのは、
テグレトール(カルマバゼピン)
リーマス(リチウム)
三環系
 どれも意識障害はないのだが、心臓が止まる
 1ヵ月後に止まったり…
→48時間ICU

●リストカット
ぬうと、糸抜いたりする
ガーゼをあてておけばいい
医者と関わるための材料にしたりする

●リストカットや大量内服、死なないことをしっていて、やる
「切っていい?」と聞かれたら、「腱だけはきるなよ」

●ボーダーには
「私悲しいな…」と「I」で話すことが大切
「We」で話すと危険

●ボーダー
他人の感情を見抜く
とても敏感 変化を気にする
診察時間とか短くなったり、間合いが遠くなると、「私嫌われてないか…」と恐れる。忙しさなんて理解しちゃくれない。5〜10分とはじめから決めて、取り掛かるべし

●アルコール共依存
特に奥さん →会社とか、自分自身で電話させるとか誘導しないといけない
治す気のない依存症だから、困る。

借金だって、困らないと自覚しないもの

●アルコール離脱
酒5合飲んでいた人が飲まなくなると2〜3日で出てくる。

発熱、発汗(「玉のような」汗が出る)、意識障害、筋硬直、振戦、幻視
=悪性症候群

ポイントは、予防!
・ホリゾン 1A div  …眠くなったらすぐとめる
離脱するひとは、1Aじゃムリ。眠くならない!!
一日4Aくらい落とす。三日したら徐々に落としていく。1週間の中で、1Aずつ減らしていく

それでも眠くならないひとには…
セルシン5mg8〜10T4X
眠くなる人は、4〜6T4X

●事件起こした人
措置入院
警察→保健所と連絡

●眠剤
強くて短いやつは依存性つよい
 ハルシオン・デパス

●感覚は…

味・触・香・聴・見
…食欲なくなったうつはヤバイ!! 特に、味覚!!

●認知症
本人の自覚がないもの。
それをしつけようとすると、さらに認知症は進む。絶対に重くなる!!

相手が子どもだったら、できなかったことができるようになっていく。だからしつけがいい。上下関係もよい。

だが、高齢者は違う。できるようにはならない。
できたことができなくなっていく。馬鹿にされている感じがある
しかも、下から怒られる。
→逃げ出す。家出、徘徊。

しつけをやめれば100%治る

「物取られ妄想」
女性に多い
  …家事がとられる
いろいろやってもらってありがたい。でも馬鹿にされている感じがある。好きだけれど、嫌い  →理屈をつける!

妄想を減らすためには、世話をてきとーにすることが大切。手伝うほどに、悪化するもの。

●アルツハイマー
一見正常。
いきなり何分かみるひとには正常に見えてしまう。
状況依存性が壊れている。人間はだめ

●長谷川式
点数なんてどーでもいい。答え方が大切
アルツハイマーは周りをみて取り繕う
認知症は認知が乱れているだけだから計算はできる

が、うつは逆! 計算ができない

●せん妄
夕食後に薬剤投与、がポイント。寝ないんなら寝る前に薬剤を増やす

1)マイスリー、アモバン
第一選択。これでなるたけ抑える。でも、騒ぎ出したらもう効かない

2)ベンゾジアゼピン 中期以上
セルクエル
DMでなければ。

ちなみにベンゾジアゼピンの働きは、睡眠、抗不安、抗てんかん、筋弛緩(だから肩こりにデパスつかったりする)

3)リスパダール、ルーラン

「暴れた→よく寝れた→忘れた」せん妄
「眠れなかった→覚えている」うつ

セレネース
対して効かないくせに、誤嚥が頻発!

●癌にPSL
腫瘍融解症候群が起こることあり

●ALL
小児と高齢者の2峰性

●緑膿菌
細くてちっちゃい

●抗コリン
平滑筋緩める
→残尿増やす

●前立腺
中心溝をチェック

●後腹膜の出血
2000〜3000の出血でとまる…
輸液・輸血が間に合っていれば何とかなる

●腎盂腎炎
朝・夕に発熱

●静脈石
丸っこい。周りがしっかりしていて芯が抜けている

●尿管結石
金平糖のようなかんじ
まるっこいが、芯がしっかりしている

●男のカテーテル。前立腺のすぐ下後ろ向きににひっこみがある。ここにひっかかりやすい。だから、ペニスをしっかり前に突き出して曲がりが少なくすればいい

●DIC
基礎疾患をなおす。効く薬なんてない

●内外同時妊娠
1/100万人

●内卵巣同時妊娠
1/300万人

●肺癌、リンパ節転移 X線で…
傍気管支線の消失
 癌性リンパ管症
small cell 20〜30%は脳meta。予防的投与もしばしばされる

●S線側面
Aortaからの距離で、高さ、左右をチェック
三本の線、一番下が、左。
分岐部と左右をチェック

●前底神経炎
悪い方に向いて眼振出る。健側を向く

●アセチルシステイン
去痰薬。アセトアミノフェ中毒、造影剤からの腎保護に。
アメリカでは23セント、日本では2000円

●がん予後予測スコア (森田)

●QFT AIDSのとき、感度70%

●CMVアンチゲネミア
感染白血球の数。HIVだとアテにならない →PCR 5000がだいたいのcut off

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