【医学生物PPT】联合病例讨论.ppt

业精于勤荒于嬉 行成于思毁于随 →【医学生物PPT，欢迎收藏分享】豆丁网友 聯合病例討論 Present：PGY 王又德 Supervisor：鍾焜明醫師 Patient profile Name：李高X春 Gender：female Age：78 y/o Triage：1 Time：97/07/27 pm BP：193/105 T/P/R：36.1/88/12 Charter：can’t walk, on bed Oximeter：82% Chief complaint Chest tightness with short of breath tonight Present illness This 78 year old female presented to ED for Chest tightness with short of breath. Chest tightness was pressure-like without radiation. But she felt cold sweating. Orthopnea and dyspnea on exertion was also mentioned. Productive cough with yellowish sputum was noted. Her family denied that she had recently fever and chills. Besides, she found progressive yellowish skin in recent 2 weeks. She denied abdominal pain, vomiting and diarrhea. Past history Denied diabetes mellitus Hypertension for many years AMI with respiratory failure on 95/06 ESRD on H/D (QW2.4.6) for about 2 year Congestive heart faliure NYHA class III HCVD Past history Surgical history : a. Appendectomy for many years ago b. A-V shunt Smoking : denied Alcohol : denied Medications : Sigmart, Mucaine, Hematon, Cofsoline-codeine Sorbitrate, Inderal, Ticlid , Alinamin-F, Zyrtec, Gascon Family history No family history of diabetes mellitus, hypertension or malignancy. Physical examination Vital sign： BP：193/105 T/P/R：36.1/88/12 Cons.：alert, E4V5M6 HEENT：Conjunctivae：not anemic Sclera：icteric Neck：supple Chest：symmetrical expansion wheezing and rales RHB, no murmur Physical examination Abdomen： soft ,no tenderness, no rebounding pain no Murphy sign Extremity： warm, freely movable, no pitting edema, no deformity, no loss of pulsation First impression 1. Pulmonary edema (suspect CHF related or infection related) 2. Jaundice, susp. obstructive jaundice Plan On NRM mask, monitor Blood routine CXR,EKG CXR CXR Supine chest film shows: Mixed alveolar and interstitial infiltration over both l