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感染症いろいろ

・腹腔内感染症
CTがスタンダード、?
アッペだってスコアリング
 …CTは日本では普及しているから…

エコーは安全でよい

教育的にも診断でも重要
 でも、エコーで痛がっているひとに触るのは…
  痛がらずに手術に持っていくので
 CTはあとから確認できるし


cf 腸管を縫合するときにイソジン使うのも否定されている
 腹水培養、結果でその後が変わらないので今やらない

…高齢、術後粘るひとは、とるようにしている

・軟部感染症
CTをとるのは? ガス産生とか
コンパートメントとか 刺して圧を確認するのは?

CLDMだけでなく、ひらいて空気に晒すのも大切


・膠原病をメインにやっていると、β-DとかCMVアンチゲネミアとか測ってしまう。でも、陽性とでたときにいきなりジフルカン? どんなときに真菌たたく? CMV治療する?

→発想が違う
β-Dは診断ツール、というより 磁石
 どっちにいくのか、方向決定に使える
大切なのは診断
例えばポピュレーションによって、予想が違う
検査前確率 上がる

疑えば、測らないでいっちゃうこともあるけれど。

「診断ツールではない」


β-D ルーチン
効果があるかどうかは今後証明すべきだけれど。

でも、わけ分からない発熱があるから、とβ-Dを測るとわけ分からなくなる


・薬剤熱
週刊医学界新聞をみるべし

ラシックス・フルイトラン
 サルファアレルギーででることが
ベンゾジアゼピンで 熱出ることも

VCM
 熱の出方も激しくて、BPも下がって… (使用開始一ヵ月後)
 スティーブンはなかったが、無菌性膿瘍もでてきた

ライン感染 →CPFX
いきなりバイタル悪くなる
keyは「薬疹」

40度のいきなり発熱でも血行ある


・血液培養 救急外来は?
鼠径は避ける コンタミの率が高いから

消毒 ヨードとアルコール
 アルコールでもコンタミ率増えなかった、というところもあるけれど…
 すごく丁寧にスタッフ教育している
 イソジンは、しっかり意識されるから


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