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2009年10月31日 星期六
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2009年9月19日 星期六
CURB-65
CURB-65, also known as the CURB criteria, predicting mortality in community acquired pneumonia and infection of any site.
Each risk factor scores one point, for a maximum score of 5:
- Confusion (defined as an AMT of 8 or less)
- Urea greater than 7 m mol /l (Blood Urea Nitrogen > 19)
- Respiratory rate of 30 breaths per minute or greater
- Blood pressure less than 90 mmHg systolic or diastolic blood pressure 60 mmHg or less
- age 65 or older
For Pneumonia
The risk of death increases as the score increases:
- 0—0.7%
- 1—3.2%
- 2—13.0%
- 3—17.0%
- 4—41.5%
- 5—57.0%
0-1 -> treat as an outpatient
2 -> consider a short stay in hospital or watch very closely as an outpatient
3-5 -> requires hospitalization with consideration as to whether they need to be in the ICU
For any infection
The risk of death increases as the score increases:
- 0 to 1 : <5%
- 2 to 3 : < 10% mortality
- 4 to 5 : 15-30% mortality
2009年9月17日 星期四
PSI or PORT Score
The pneumonia severity index [PSI] or PORT Score can use to calculate the probability of morbidity and mortality among patients with community acquired pneumonia.
Risk Class I pneumonia patient can be sent home on oral antibiotics.
Risk Class II-III pneumonia patient may be sent home with IV antibiotics or
treated and monitored for 24 hours in hospital.
Risk Class IV-V pneumonia patient should be hospitalized for treatment.
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Oral Hypoglycemic Agents
- Biguanides (Metformin) (Glibudon 500 mg) PC
- Sulphonylurea (Glipizide(Glidiab), Glimepride(Amaryl), Gliclazide(Diamicron)) AC
- TZD ( Rosiglitazone(Avandia) Qd->Bid, Pioglitazone(Actos) Qd) PO
- α glucosidase inhibitor (Acarbose) WM
- Rapid Acting Insulin Analog (Repaglinide(Novonorm), Nateglinide(Starlix))
- DPPS (GLP 1 – Glucagon like peptide 1) inhibitor, Sitagliptin (Januvia) 1# Qd
1. Biguanides (Metformin) (Glibudon 500 mg) PC
Dosage: Can give 250 mg -> 850 mg Bid Tid (max dose=850 mg tid)
Mechanism: - decrease liver gluconeogenesis (main action)
-Increase insulin sensitivity
Side Effects: GI upset, Diarrhoea (most common)
Lactic acidosis in CRI patients,
2. Sulphonylurea (Glipizide(Glidiab), Glimepride(Amaryl), Gliclazide(Diamicron)) AC
AC: 30 min before meal
Mechanism: -Increase insulin secretion
Side Effects: hypoglycemia
3. TZD ( Rosiglitazone(Avandia) Qd->Bid, Pioglitazone(Actos) Qd) PO
Dosage: Avandia 4 mg -> 8 mg (max dose) daily
Actos 15 mg -> 45 mg (max dose) Qd.
Mechanism: -Increase insulin sensitivity
- Increase insulin uptake form muscle and adipose tissue.
Action: takes 2 weeks to 6 weeks. Act at nuclear receptor.
Side Effects: Fluid retension(5~10%). CI: CHF class 3 or 4
Elevated GOT and GPT. Check 3 monthly.
More severe anaemia.
4. α glucosidase inhibitor (Acarbose) WM
Dosage: 50~200 mg tid (max dose)
Mechanism: -Inhibit glucosidase degradation of polycyclic to monocyclic.
Side Effects: Abdominal pain, diarrhea, flatus passage.
5. Rapid Acting Insulin Analog (Repaglinide(Novonorm), Nateglinide(Starlix))
Dosage: Novonorm 1~4 mg tid (max dose), Starlix 120 mg tid (max dose)
Action: rapid action, short duration.( one meal one dose, no meal no dose)
Can use in CRI and easy to have hypoglycemic patients.
Mechanism: -Increase insulin release
Side Effects: Abdominal pain, diarrhea, flatus passage.
6. DPPS (GLP 1 – Glucagon like peptide 1) inhibitor
Sitagliptin (Januvia) 1# Qd
Mechanism: -Increase insulin release
(depend on serum glucose concentration)
-decrease gastric emptying time
Side Effects: GI upset.
2009年8月26日 星期三
2009年8月24日 星期一
2009年8月22日 星期六
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EKG
EKG components:
- Rate
- Rhythm
- Axis
- Hypertrophy
- Induction
- Ischaemia
Rate and Rhythm
Axis
Hypertrophy
Induction
Ischaemia
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2009年8月3日 星期一
2009年8月2日 星期日
What is Insomnia?
Insomnia is a condition in which you have trouble falling or staying asleep.
Some people with insomnia may fall asleep easily but wake up too soon.
Other people may have the opposite problem, or they have trouble with both falling asleep and staying asleep.
The end result is poor-quality sleep that doesn't leave you feeling refreshed when you wake up.
10 Tips to Avoid Insomnia
- Be sure you have the right bed and mattress for your needs.
- Use the bed only for sleeping and sex.
- Therapists often use "reconditioning" as part of a treatment plan for insomnia.
- Establish a regular sleep-wake cycle.
- No afternoon nap. Don't have extra sleep on weekends.
- Limit your consumption of caffeine (chocolates and drinking cocoa and colas) in the afternoon and evening.
- No alcohol prior to bed. Quit smoking.
- Fit in some exercise during the day, but don't exercise strenuously right before bedtime.
- Eat light meals in the evening.
- Establish a "winding down" period in the evenings just prior to bedtime.
Insomnia Slide Show
What Are You Afraid Of?
A phobia is defined as the unrelenting fear of a situation, activity, or thing that causes one to want to avoid it. Women tend to be twice as likely to suffer from a phobia compared to men.
Different Types of Phobias:
- Social Phobia
- Agoraphobia
- Claustrophobia
- Zoophobia
- Acrophobia
- Aerophobia
- Blood-Injection-Injury Phobias
How are Phobias Treated?
- Desensitization
- Cognitive behavioral therapy
2009年8月1日 星期六
Types of Chronic Pain
- General somatic pain (pain from the outer body)
- Visceral pain (pain from the internal organs)
- Bone pain
- Muscle spasm (muscle cramps)
- Peripheral neuropathy (pain arising in the nerves leading from the head, face, trunk, or extremities to the spinal cord)
- Circulatory problems
- Headaches
Fibromyalgia Slide Show
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2009年7月26日 星期日
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