急诊医学年会临床病理讨论会 - 长庚急诊医学部.ppt

PER case presentation 報告者：翁一銘 第一年住院醫師 General Data 13-year-old boy Triage: 3 病患主訴咳嗽 Vital sign : BT 36.7℃ HR 91/min RR 22/min BP 116/48 mmHg GCS: E4V5M6 Chief Complaint 咳嗽5天 with yellowish sputum Present Illness 偶爾會咳, 每次一兩聲, yellowish sputum, 沒有發燒, 沒有旅遊史, 有咳嗽, 沒有流鼻水 有喉嚨痛, 沒有全身酸痛, 食慾正常, 活力正常 Aggravating factors(-) BWL(-)night sweating/fever(-)N/V(-)diarrhea(-) 三天前有吃感冒藥 (from LMD) His grandmother has chronic cough history Pale, malaise, exercise intolerance noted for 3-4 days SOB(+), dizziness(+), chest pain(-), palpitation(-) Abdominal pain(-)tarry stool(-)bleeding tendency(-) Hematuria(-)frequency(-)tea color urine(-) Past and Personal History 1. Scabies with oral medications since this Feb. for ? 2. Exposure/contact Hx(-)  沒有 早產 ? ? ? ? ?  沒有 蠶豆症  沒有 先天性疾病， 用藥史：沒有 過敏， smoking(-) 3. Denied previous anemia history or FHx Physical Examination 外觀：ill, pale 結膜：pale, anicteric sclera 喉嚨：正常, lip: pale 頸部：沒有 僵硬, 沒有 ?淋巴結腫大 胸(肺、心臟)： tachypnea, no accessory muscle use 沒有肺囉音, 沒有心雜音 腹部： 平坦, liver/spleen impalpable 沒有壓痛, 沒有反彈痛, 腹鳴正常 四肢： 活動正常, 沒有腫脹 沒有皮膚疹 Pallor without Anemia Textbook of Pediatric Emergency Medicine Ch. 59 Physiologic (“fair-skinned”) Respiratory distress Shock: septic, hypovolemic, neurogenic, cardiogenic, Anaphylactoid Skin edema Hypoglycemia and other metabolic derangements Pheochromocytoma  Pallor with Anemia Textbook of Pediatric Emergency Medicine Ch. 59 I. Decreased RBC or Hb production A. Nutritional deficiencies B. Aplastic anemias C. Abnormal heme/ hemoglobin synthesis II. Increased RBC Destruction A. Membrane defects B. Enzyme defects C. Hemoglobinopathies D. Immune hemolytic anemia E. Microangiopathic anemias III. Blood Loss A. Severe trauma B. Anatomic lesions: Meckels diverticulum/ Peptic u