癌症兒童的急症處理重点培训.ppt

出血性膀胱炎 (1) 症狀： 頻尿、 小便困難、 小便疼痛 造成原因：感染、放射治療、化學藥物 感染：Adenovirus, CMV, polyomavirus BK (BK virus) 化學藥物：Cyclophosphamide and Ifosfamide May occur hours to months 出血性膀胱炎 (2) 治療： Hydration 矯正凝血功能異常 On foley 膀胱灌洗 Ditropan, Baclofen, Belladonna, opioid Endoscopy and electrocoagulation Instillation of formalin, alum, PGE2 癌症病人的神經急症 意識不清 中風 (CVA) Seizure IT 藥物注射錯誤 Spinal cord compression Hyperleukocytosis 癌症病人意識不清 (1) Tumor Infection CVA Seizure DIC Therapy-related Leukoencephalopathy Metabolic Post-R/T somnolence Syndrome Hypotension Hypertension Dehydration Hypoxia Anemia Liver failure Depression 癌症病人意識不清 (2) 詢問病史時的注意事項 Status of malignancy Recent illness Fever Medication Chemotherapy and radiotherapy Seizure activity or similar episode 癌症病人意識不清 (3) 身體檢查時的注意事項 Consciousness level (coma scales) Breathing pattern Pupil size and reactivity Abnormal extraocular movement Rostrocaudal or central herniation Uncal herniation 癌症病人意識不清 (4) 實驗室檢查及評估 CBC, glucose, electrolytes, ammonia, hepatic and renal function, blood culture, coagulation profiles Emergent CT or MRI scan Lumbar puncture should not be performed until mass lesion be R/O 治療導致的意識不清(1) 頭部放射治療 類固醇: personality change, hallucination and psychosis HD-Ara-C: cerebellar dysfunction, seizure, coma, death HD-MTX: encephalopathy, seizure Ifosfamide: acute somnolence, neurologic deterioration, coma 治療導致的意識不清(2) 動脈注射BCNU, cisplatin: acute neurologic deterioration, seizure, stroke, encephalopathy 遺傳性缺乏 dihydropyrimidine dehydrogenase with 5-FU HD-thiotepa, BCNU: encephalopathy ATRA: pseudotumor cerebri 治療導致的意識不清(3) HD-narcotics: sedation, withdrawal symptoms Benzodiazepine: dysphoria HD-IL2: disorientation, confusion, paranoia, combativeness, somnolence, coma 干擾素: subacute somnolence, altered cognition, psychiatric symptoms, conceptual disorganization, focal neurologic deficit, cortical blindness, coma, death 意識不清 --- 治療 (1) IICP: Decadron, mannitol, hyperventilation 感染的可能: Broad-spectrum antibiotics Neurosurgical intervention if