病例報(bào)告（英文）

Casepresentation

96.09.04

Intern胡學(xué)錦PersonalprofileName:吳O民

Gender:maleAge:46yearsoldChartnumber:16762291 ArrivaldateatED:96/08/20Time:04:15amInjurymechanismSufferedfromatrafficaccidentwithdrunkenstatethismorning(04:00am)Suspectdrunkendriving現(xiàn)場(chǎng)生命現(xiàn)象:drowsyandirritable

(E3V3M4)CC:AlcoholismwithTrafficaccidentPre-hospitalevaluationandmanagementSenttoKMUHERby119Head:ILOC(?),dizziness(?),headache(?),nausea/vomiting(?),amnesia(?),vertigo(?)

lacerationwoundoverr’tuppereyelidandearlobeNeck:pain,stiff,soreness…(?)Chest:pain,dyspnea…(?)Abdomen:pain,discomfort…(?)Limbsandskin:

abrasionwoundoverbil.kneeAMPLEhistoryAllergies:unknownMedication:unknownPastillness:DM:(?)HTN:(?)Othersystemicdiseases(?)

Operationhistory(?)LastMeal:(?)Initialevaluation(KMUH)A(airway)/B(breathing):Collarfixation:(+)Airway:speech:(?)

respiration:smoothairwayobstructionsign(-)foreignbodyinthemouth(-)TracheaBreathingsound:clearC(circulation):Rate:brachiala.,carotida.,

femorala.,dorsalis

pedisa.CuffBP:105/45mmHgSkincondition:

appearance,temperature,humidityD(disable):

GCS:E2V2M5Pupilresponse:

od:2mm

os:2mmE(exposure):abrasionwoundovernoseandbil.maxillaryarea,lacerationwoundoverr’t.uppereyelid(2cm)andearlobe(1cm)abrasionwoundoverbil.kneeSecondaryevaluation(KMUHER)ChestX-rayAP&lateralviewCervicalspineX-rayAP&lateralviewPelvisX-rayAPBrainCTwithoutcontrast(duetodrowsyconsciousnessandirritablestate,brainCTwasholdforsafetyconcern)Labdata(96/08/20)Labdata(96/08/20)Chestx-rayCervicalspineX-rayPelvisX-rayPlanCloseobservationwithplainingbrainCTstudyAt16:05Consciousness:coma

GCS:E1V1M1

Pupilsize:R/L:3.5/2.0withnegativelightreflex

BP:150/78mmHgPR:95/bpm.HewassentforemeregntbrainCTEmergentendotrachealintubationafterCitosolsedationwithparalytics(Genso)TentativediagnosisTraumaticICHandSDHwithmasseffectandmidlineshiftAlcoholismadditionr/oC-spineinjuryLeftearlobelaceration(1cm)Faciallaceration(2cm)AbrasionwoundoverbilateralkneesUndertheimpressionoftraumaticICHandSDHwithmasseffectandmidlineshift,N/SwasconsultandhewassenttoORforemergentrightcraniectomy,SDH&ICHremovalandICHmonitorinsertion.Then,hewasadmittedto7ENI-31forfurthertherapy.PostOperation08/21,GCS:E1VEM2

ICPwascontroledduring12~17mmHg,andglycerolwasused.Feverupto39℃,Sputum(+)werenoted.Antibiotics:Cefazolin1givq8hday2GentamicinDuring08/22~08/24,spikingfeverupto40℃wasnoted.08/25:Thesputumculturecollectedon8/22showedPseudomonasaeruginosa,andantibioticsshiftedtoTazocin2vialq8h.During08/26~08/28,persistedmildfeverupto39℃wasnoted.

FollowupbrainCTon8/28:

(1)R’tcontusionhemorrhagewithresolutionandperifocaledema

(2)previousleftEDHhadnoenlargementRemoveICPmonitoron08/2808/29:feversubsided,

removeendotrachealtube08/30:TransfertoNSward

Q:無法出ICU之併發(fā)癥?

Q:留觀待醒過程是否易delaydiagnosis?Q:酒後躁動(dòng)患者是否sedation後去做brainCT?Approachtoneuroimaginginchildren2007UpToDate

Sedation—SedationisrarelyrequiredforCTexaminationsinchildrenbecausemostCTexaminationstakeonlysecondsorminutestoperform,particularlywhenultrafasthelical/spiralormultidetector/multislicetechnologyisused.High-resolutionstudiesthatrequireimmobilizationtoavoidmotionartifact(eg,temporalboneexamination)aretheexception.Anewbornoryounginfantoftencanbeexaminedduringsleep(eg,afterafeedingorattheusualnap-time).Hepatictrauma:CTfindingsandconsiderationsbasedonourexperienceinemergencydiagnosticimaging

EuropeanJournalofRadiologyVol:50Issue:1,April,2004

p:59-66Inthecaseofnoncooperativepatients,presentingwithneurologicalsigns,sedationmayberequiredandalsoassistedventilationeventually,withcontinuousmonitoringofcardiacandrespiratoryparameters.UseofIntravenousMethohexitalasaSedativeinPediatricEmergencyDepartmentsHananSedik,MD

ArchPediatrAdolescMed.

2001;155:665-668Methohexitalhasbeenusedinadultemergencydepartmentsandhasbeenfoundtoproducerapidandbriefsedation,especiallyfororthopedicprocedures.Lermanetalstudied76adultpatientsinaprospectiveobservationalstudywhereIVmethohexitalhadbeenusedforavarietyofprocedures,andconcludedthatitcausedclinicallyinsignificantchangesinhemodynamicsandoxygenation.Althoughrespiratorydepressiondidoccur,ifsignificantitwasbriefandeasilymanaged.Zinketalreportedaconsecutivecaseseriesof102patients(including10patientsyoungerthan10years)whoreceivedIVmethohexitalforvariousprocedures.Theauthorsconcludedthatmethohexitalissafeandeffectiveinselectedemergencydepartmentpatients.CurrentconditionAdmissionto7B27-1GCS:E2V2M3BP:109/78mmHgPupil:R2.5mmL2.5mm,bilateralpromptreflexMPRLupperlimb21lowerlimb22Plan:1.keepSaxizon100mgiv