同时有肌抽跃（myoclonic jerks）之症状或并发脑炎 - 长庚急诊医学部.ppt

Pediatric ED morbidity mortality conference Presenter: R2 劉潔玲 Supervisor:吳孟書醫師 Moderator:管仁澤主任 July 22nd, 2008 2008-05-23 20:43 LK PER Triage 4級 檢傷紀錄:發燒，無病容(表現活動力佳) Vital sign : BT 38.6℃ HR 166 /min RR 22 /min BP ? SpO2 : 99% Gender: Male Age: 3-year-2-month-old BW: 12kg(3rd percentile) BH: 91cm(3rd-10th percentile) GCS: E4V5M6 Chief complaint Fever and vomiting since today Present illness Fever(+) up to 38.9 c, chills(-) Cough(-), Rhinorrhea(-), Sore throat(-), Odynophagia(-), Ear-scratch(-) Hoarseness(-), SOB(-), Wheezing(-), Skin rashes(-) Vomiting(+)x several :nonbilious, postprandial Diarrhea(-) Headache(-) Abdominal pain(-) Urinary Frequency(-), Urgency(-) Activity: Well Appetite: Well Past History Admission history: AGE x 3 and tonsillitis x 1 at our hospital Chronic disease: α-thalassemia (α-thal-1 of SEA type, heterozygous) ; Failure to thrive ; no frequent or severe bacterial infection Operation history:nil Birth history: G1P1, term, C/S, BBW 2960gm, no perinatal insult Vaccination: up to date Development: as milestones Allergy: no known allergy to food or drug Primary survey PAT: unstable Physical Examination CONSCIOUSNESS:alert HEENT: Eye:injected conjuctiva(-) Ear: injected ear drum(-); Nose: grossly normal Throat: injected / Tonsil:not enlarged/ Oral:no ulcers NECK: Lymphadenopathy:(-) CHEST: Respiratory distress:(-), Abnormal sound:(-) B/S: clear, no crackle , no wheezing HEART:RHB, no murmur ABDOMEN: soft and flat, B/S:normoactive Tenderness:(-); Rebound pain(-); Muscle guarding(-) SKIN: Rashes(-) EXTREMITIES: Pitting edema:(-), Deformity(-) What else do you what about history or physical examination? Life-threatening Causes of Vomiting Other GI causes, especially appen