马偕医院小儿科部李宏昌摘要.pptVIP

馬偕醫院小兒科部 李宏昌 住院案例-1 5歲男童，診斷為464.4 Croup 病史：Fever with productive cough and hoarseness for 3 days. The cough sounds like barking. Progressive hoarseness and rhinorrhea was also noted 理學檢查：nose: some discharge; throat: injected; tonsil: Gr.II/IV. No exudates. Chest: symmetric expansion; breath sounds: bilateral rhonchi Chest X-Ray: bilateral perihilar infiltration with peribronchial cuffing 住院案例-1 核刪Pulmicort Nebulising suspension(IH) 核刪理由： 依所附文獻，IV form dexamethasone為首選，為何捨有效且便宜的療法 依據診斷/病況，無使用類固醇吸入劑治療之必要 申請理由：病童因Croup而入院，治療方法可用吸入性類固醇達到消腫、抗發炎的結果 Croup: Treatment Medication Author: Antonio Mu?iz, MD, Associate Professor of Emergency Medicine and Pediatrics, University of Texas Medical School at Houston; Updated: Nov 21, 2008 Cough is an important defense mechanism that plays a major role in maintaining the integrity of the airways and can be voluntary or involuntary. The pathophysiology of cough is incompletely understood. Cough is commonly triggered by mechanical or chemical stimulation of receptors in the pharynx, larynx, trachea and bronchi. Cough receptors also exist in the nose, paranasal sinuses, external auditory ear canals, tympanic membranes, parietal pleura, esophagus, stomach, pericardium and diaphragm. Summary of important points: ? Asthma is a common condition but it is not always the diagnosis in a coughing child. ? A careful clinical history is the key to diagnosis in asthma. ? Cough as the sole symptom of asthma is unusual. ? A family history of asthma, and family or personal history of atopy, eczema or allergic rhinitis, makes a diagnosis of asthma more likely. ? Physical examination may be normal in a child with asthma between episodes. ? The age at which children can perform spirometry is variable. ? In younger children, a trial of bronchodilator therapy with formal assessment of response may be appropriate if asthma is suspected. Diagnosing asthma in young children is difficult because children often: cough and wheeze with colds and chest infec