最容易被忽略掉的氣胸型態

Anteromedial Pneumothorax

Anteromedial pneumothoraces 可以分成兩種：
1. Superior type - hilum 以上，
2. Inferior type - hilum 以下。

A superior anteromedial pneumothorax may result in visualization of the superior vena cava or azygos vein on the right.

An inferior anteromedial pneumothorax may be evidenced by delineation of the heart border and a lucent cardiophrenic sulcus〔見下圖〕.

Notice the increased lucency of the cardiophrenic sulci in this patient with bilateral inferior anteromedial pneumothoraces〔注意看右邊heart border超明顯〕.


A CT scan confirms the diagnosis.

圖片來源：
University of Virginia Health Sciences Center, Department of Radiology

【瀕死呼吸】Agonal respiration

【瀕死呼吸】

Agonal respiration is an abnormal pattern of breathing characterized by shallow, slow (3-4 per minute), irregular inspirations followed by irregular pauses. They may also be characterized as gasping, labored breathing, accompanied by strange vocalizations and myoclonus.

簡單說，如果病人失去意識，呼吸之間間隔10秒以上，目擊者就得開始CPR。


Agonal respirations are commonly seen in cases of cardiac arrest, and may persist for several minutes after cessation of heartbeat. The presence of agonal respirations in these cases indicates a more favorable prognosis than in cases of cardiac arrest without agonal respirations.

The cause is due to cerebral ischemia, due to extreme hypoxia or even anoxia. Agonal breathing is an extremely serious medical sign requiring immediate medical attention, as the condition generally progresses to complete apnea and heralds death.

各種 CPR 版本比較

2010年的新版CPR有大變革！

【A】AHA 將 ABC 變成 CAB〔計程車〕！！


【B】North America、British、Australia 2009年版的 CPR：


一直以來，North America、British、Australia 就是敢和 AHA 提出不一樣的版本，日本也是，這就是為何有 local EBM 及專家共識來背書自己國家的急救指引是多麼重要的一件事。這兩個條件在台灣都不夠成熟！

AHA對於「計程車」版 CPR 的辯證：


---

補充：CPR 100/min 的節奏：

腔室(筋膜隔間)症候群

日期：99-10-06
地點：新光急診
對象：全體醫師
題目：Compartment Syndrome
檔案下載：http://jack119.org/mylectures/compartment.pdf