(精编)【医学教学课件】糖尿病患者并发气喘、声音嘶哑教学课件.pptVIP

糖尿病患者併發氣喘、聲音沙啞 台南新樓基督教醫院 新陳代謝科 徐維信醫師 案例 吳先生, 65 歲男性 主訴:氣喘及聲音沙啞數天。 病史:DM and hypertension for several years. 91-1,he was admitted due to syncope . DX: postural hypotension. 案例-吳先生 2/7, 2/8, 2/11, 2/12, He was sent to ER for help due to SOB. After treatment, he came back home. 91-2-12 night, 主訴:氣喘及聲音沙啞數天。 案例2-吳先生 After admission : 2nd day W1, 喉科Dr: 聲帶及周圍水腫。 案例2-吳先生 6th day W5, bronchoscope showed negative. I remove ETT. 10 minutes later, 案例2-吳先生 After CPR, consciousness recovery,but myoclonus was noted. 會診 Neuro chief Chen. 會診 CV chief Chou. 案例2-吳先生 10th day W2,(91-3-5). Neck CT was done. ENT Dr performed tracheostomy. Operation : Some fluid like substance. Bacteria culture : No Growth. 李家和醫師 Deep neck infection Location Sublingual Submandibular Submaxillary lateral pharyngeal Retroharyngeal pretrachea. 熱病, 2001 Deep neck infection Cause: poor dental hygiene, dental extraction, foreign bodies(toothpicks, fishbones) ? 熱病, 2001 Deep neck infection Are particular onerous, because pus in these location can cause airway obstruction spread contigugously mediastinum or carotid sheath. Lateral pharyngeal(parapharyngeal) Source--including Palatine tonsils Pharynx Parotid gland Infected LN--drain the pharynx and nose dental infection—esp 3rd mandibular molar Diabetics are particular susceptible to such infection. Lateral pharyngeal(parapharyngeal) Mode of spread Direct dissection through the facial space Direct extension from other communicating space within the neck. Lymphatic spread or septic thrombosis of peritonsillar vein Deep neck infection Pathogen Microorganism—polymicrobic Streptococcus sp Anaerobic Eikenella corrodens. 熱病, 2001 Lateral pharyngeal(parapharyngeal) Clinical manifestation 1. fever 2. leukocytosis 3. deep neck pain. 4. dysphagia or odynophagia may be present. Lateral pharyngeal(parapharyngeal) Physical examination may see Edema over the parotid gland On intraoral examination— medial bulging displa