Acute complications of extremity trauma

日期：100-10-29
地點：新光醫院急診部
對象：全體醫師
題目：Acute complications of extremity trauma
檔案下載：http://tinyurl.com/4ymthpt

2010 AHA Guidelines 中所強調的 4C

http://tinyurl.com/425ezdv

2010 AHA Guidelines 中，對於 cardiac arrest 的處理，強調的 4C：

1. Cardiovert / defibrillate
2. CCR - cardiocerebral resuscitation
3. Cooling
4. Catheterization

原文網址：

http://www.medscape.com/viewarticle/734952

您瞭解今日的中國嗎？

 

http://dl.dropbox.com/u/10587862/documents/PRCChina.pdf 

台灣的競爭力正逐漸流失當中...，您，瞭解今日的中國嗎？

生物和化學恐怖攻擊

日期：100-09-07
地點：新光醫院急診部
對象：全體醫師
題目：生物和化學恐怖攻擊
檔案下載：http://tinyurl.com/693nt2v

病人的義務

在醫院裡，常常有長官或民眾要求醫護人員要盡其義務，
但，我們卻鮮少有人會注意，其實病人也有要盡其義務！



http://dl.dropbox.com/u/10587862/lectures/patientduty.pdf

用超音波協助打 CVC需不需要照X光呢？

用 ultrasound-guided 打 CVC，打完後到底需不需要照X光呢？

以下的研究告訴我們，如果是為了排除是否有氣胸，可以直接用超音波檢測，不必另外照X光。但是，如果要做CVC的定位，可能還是要照X光。

No pneumothoraces were detected on chest x-ray in 1202 asymptomatic patients after ultrasound-guided central venous line placement.

With ultrasound-guided central line placement, is a postinsertion chest x-ray still necessary to assess for pneumothorax? Researchers reviewed records for 1258 real-time, ultrasound-guided, internal jugular vein central line placements and 4 external jugular vein placements performed in 1066 patients during 4 years in the vascular and interventional radiology suite at a single U.S. hospital.

Postprocedure upright chest x-rays were obtained in 1202 patients (after an average of 65 minutes); supine chest x-rays were performed as part of routine care in 66 hospitalized and bedridden patients. No patient had symptoms or radiographic evidence of pneumothorax. The authors conclude that eliminating routine postprocedure x-rays would save time and costs and reduce radiation exposure.

Comment: This study was performed in a more controlled environment than an emergency department. Chest x-ray is not necessary after ultrasound-guided internal jugular vein cannulation when assessment of catheter positioning is not needed. When pneumothorax is suspected, bedside ultrasound for lung sliding likely is a better test than a chest x-ray (JW Emerg Med Nov 6 2009).

—
Kristi L. Koenig, MD, FACEP
Published in Journal Watch Emergency Medicine July 29, 2011

Citation(s): Oner B et al. Pneumothorax following ultrasound-guided jugular vein puncture for central venous access in interventional radiology: 4 years of experience. J Intensive Care Med 2011 Jul 14; [e-pub ahead of print]. (http://dx.doi.org/10.1177/0885066611415494)

影像教學：The elbow

http://jack119.org/mylectures/elbowfilms.pdf

日期：100-7-4

地點：新光醫院

對象：急診醫師、PGY、interns、clerks

題目：影像教學：The elbow