« 緩和ケア・予後予測スコア | メイン | Dr浅岡俊之の漢方 東洋医学の考え方 »

11/18 医学メモ

●モルヒネ効果判定
3mg粉末内服(オプソ5mgも可)
15〜20分で血中濃度上がり始め、1時間で最高血中濃度に
・傾眠傾向、呼吸回数(呼吸抑制)、嘔気 の副作用を評価

●MRのope基準
・CHFが出現しはじめ、内科的治療に反応しなくなったとき
・LAの大きさ

●倦怠感、ならステロイド
 テルネリンも手段

●うつスクリーニング
日中(特に朝)抑うつ気分が続く
ほとんど毎日、何をしても楽しくない。興味がわかない
体重減少or増加
不眠or過眠
精神不安、精神遅延
疲労or行動力低下
自分を価値のない人間と感じる、罪悪感をいだく
集中力低下or意思決定できない
死について何度も考える、自殺企図

●腫瘍随伴症候群
インスリン様成長因子-2
で低血糖… デカドロン4mg start

●梗塞
左MC 後ろの方 視野だけ!
右MC 後ろの方 失行だけ!
…麻痺でない

●子宮留膣腫
高齢者に起きる、子宮内の感染症。focus不明な熱源になりうる

●医療倫理の4分割法 白浜先生
・medical
・本人
・QOL
・環境

●RS3PE

●心筋梗塞
「ちくちくする痛み」を否定して、おもっ苦しい、といったらものすごくあやしい。

●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

トラックバック

このエントリーのトラックバックURL:
http://dream-hosp.net/cgi/mt/mt-tb.cgi/2694

コメント

What a lovely day for a 4139270! SCK was here

There are actually loads of particulars like that to take into consideration. That could be a nice point to carry up. I supply the thoughts above as basic inspiration however clearly there are questions just like the one you carry up the place crucial thing can be working in honest good faith. I don?t know if finest practices have emerged round things like that, but I am certain that your job is clearly identified as a good game. Each boys and girls feel the impression of just a second窶冱 pleasure, for the remainder of their lives.

What a lovely day for a 4690909! SCK was here

cannot explain in detail,

I got what you intend, saved to fav, very nice web site .

As I site possessor I believe the content matter here is rattling fantastic , appreciate it for your hard work. You should keep it up forever! Good Luck.

one hundred ninety five; one

Hテゥ c'est un grand poteau. Est-ce que je peux employer une partie lテ-dessus sur mon emplacement ? Je naturellement lierais テ votre emplacement ainsi les gens pourraient lire le plein article s'ils voulaient テ. Remercie l'une ou l'autre maniティre.

I have surfed the net more than three hours today, yet I never found any interesting article like yours. It's worth enough for me. Thanks.

I must express my thanks to the writer for rescuing me from this scenario. After looking through the the net and meeting views which are not helpful, I figured my life was done. Existing without the answers to the issues you have fixed through your review is a crucial case, and the kind which may have in a negative way damaged my entire career if I had not discovered your site. Your expertise and kindness in dealing with everything was very useful. I'm not sure what I would have done if I had not come across such a step like this. I'm able to at this point look ahead to my future. Thanks a lot so much for this high quality and amazing guide. I won't think twice to suggest your blog to any individual who wants and needs tips about this area.

I have been reading out a few of your posts and i can claim pretty nice stuff. I will surely bookmark your blog.

You...are...my...hero!!! I cant believe something like this exists on the internet! Its so true, so honest, and more than that you dont sound like an idiot! Finally, someone who knows how to talk about a subject without sounding like a kid who didnt get that bike he wanted for Christmas.

This domain seems to get a large ammount of visitors. How do you advertise it? It offers a nice individual spin on things. I guess having something useful or substantial to give info on is the most important factor.

Very nice site, I just came to know of it yesterday morning. Bookmarked this and also feel upon it. Thanks a lot,You had some nice ideas in the post, I enjoyed scaning it.

I dont think Ive read anything like this before. So good to find somebody with some original thoughts on this subject. thank for starting this up. This blog is something that is needed on the web, someone with a little originality. Good job for bringing something new to the internet!

What I wouldnt give to learn how you got your design to be so amazing! I mean it. Besides the website just being fantastic, this page is too sweet! Its not too flashy. It doesnt do too much with colours and things and the videos you use are perfect for this topic! Really, awesome site.

Easily, the post is really the greatest on this laudable topic. I concur with your conclusions and will thirstily look forward to your future updates. Saying cheers will not just be sufficient, for the brilliant c lucidity in your writing. I will instantly grab your rss feed to stay privy of any updates. Solid work and much success in your business enterprise!

What a lovely day for a 1416040! SCK was here

I like to spend my free time by scaning various internet recourses. Today I came across your blog and I located it is as one of the best free resources available! Well done! Keep on this quality!

Im no expert, but I think you just crafted a very good point point. You certainly comprehend what youre speaking about, and I can truly get behind that. Thanks for staying so upfront and so straightforward.

I think I will become a great follower.Just want to say your story is striking. The clarity in your post is simply striking and i can take for granted you are an expert on this subject.

I found so many interesting stuff in your blog especially its discussion. From the tons of comments on your articles, I guess I am not the only one having all the enjoyment here! keep up the good work.

I found your blog website on google and check a few of your early posts. Continue to maintain up the very good operate. I just further up your RSS feed to my MSN Information Reader. Seeking forward to reading more from you in a while!窶ヲ

I appreciate, cause I found just what I was looking for. You've ended my four day long hunt! God Bless you man. Have a great day. Bye

Oh my goodness! an amazing article dude. Thanks Nonetheless I am experiencing problem with ur rss . Don窶冲 know why Unable to subscribe to it. Is there anyone getting equivalent rss downside? Anybody who knows kindly respond. Thnkx

I have read a few good stuff here. Certainly worth bookmarking for revisiting. I surprise how much effort you put to make such a magnificent informative website.

I窶况e recently started a blog, the information you provide on this web site has helped me tremendously. Thank you for all of your time & work.

What a lovely day for a 193011! SCK was here

Thanks a bunch for sharing this with all of us you really know what you're talking about! Bookmarked. Kindly also visit my website =). We could have a link exchange agreement between us!

It窶冱 really a nice and useful piece of information. I am glad that you shared this helpful information with us. Please keep us up to date like this. Thank you for sharing.

You made some decent points there. I looked on the internet for the topic and found most people will approve with your site.

I just could not depart your site before suggesting that I really enjoyed the standard info a person provide for your visitors? Is going to be back often in order to check up on new posts

Wow! Thank you! I continually needed to write on my blog something like that. Can I take a fragment of your post to my website?

Very well written story. It will be helpful to anybody who usess it, including yours truly :). Keep up the good work - for sure i will check out more posts.

Hello, you used to write great, but the last several posts have been kinda boring窶ヲ I miss your super writings. Past few posts are just a little bit out of track! come on!

Well I certainly liked learning this. This particular subject acquired through you is extremely efficient with regard to accurate preparing.

After I originally commented I clicked the -Notify me when new comments are added- checkbox and now every time a comment is added I get four emails with the identical comment. Is there any way you may take away me from that service? Thanks!

This was novel. I wish I could read every post, but i have to go back to work now... But I'll return.

Oh my goodness! an incredible article dude. Thanks Nonetheless I'm experiencing issue with ur rss . Don窶冲 know why Unable to subscribe to it. Is there anyone getting identical rss drawback? Anyone who knows kindly respond. Thnkx

Oh my goodness! an incredible article dude. Thank you Nonetheless I'm experiencing issue with ur rss . Don窶冲 know why Unable to subscribe to it. Is there anybody getting similar rss drawback? Anyone who is aware of kindly respond. Thnkx

I would like to show my appreciation to the writer just for rescuing me from such a trouble. Right after browsing through the the net and meeting thoughts which are not productive, I was thinking my entire life was over. Existing minus the strategies to the problems you have solved as a result of your good posting is a critical case, as well as the ones which could have adversely affected my entire career if I hadn't come across your web blog. The skills and kindness in maneuvering all the details was useful. I don't know what I would've done if I had not come across such a solution like this. It's possible to at this point relish my future. Thanks a lot so much for the impressive and amazing guide. I will not hesitate to suggest your web site to anyone who needs guidance about this topic.

コメントを投稿