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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