临床病理讨论会课件.ppt

臨床病理討論會小兒科：盧俊維醫師放射科：吳金珠醫師

病理科：蕭正祥醫師临床病理讨论会

A10y/ogirlChiefcomplaint:Chestdiscomfort,vomitinganddrycoughforoneday临床病理讨论会

BriefHistoryGrowthdevelopment:Weight:22kg(3rd-10thpercentile)Height:130cm(25-50thpercentile)Developmentmilestone:withinnormallimitPasthistoryHand-foot-mouthdiseasein1998FrequentURIandfeverduringchildhoodNodrugorfoodallergy临床病理讨论会

BriefHistoryFamilyhistory:HersisterhadfeverandURIrecently.临床病理讨论会

PresentIllnessFeverandbilateralhandarthralgiaattackonce1monthagoChestdiscomfortandcoughsince9/11afternoon,2001VisitLMDandURIwastoldVomitingandchesttightnesson9/120AMand5AM临床病理讨论会

PresentIllness9/12morning,visitLMDagain,ECGshowedarrhythmiaReferto亞東hospital临床病理讨论会

PresentIllnessFindingsat亞東hospitalClearconsciousness,ill-looking,pallorappearance,nocyanosisIrregularheartbeatEKG:VPCbigeminy临床病理讨论会

PresentIllnessLab.findingsat亞東hospitalWBC9000/mm3,Hb13.5g/dlBUN11mg/dl,Cre0.6mg/dlGOT25U/L,CK665U/L,CK-MB175U/L临床病理讨论会

PresentIllnessEchocardiogramat亞東hospitalMultiplesmallVSDs,musculartrabeculartype,atapexLVdyskinesia,LVEF60-70%MildTR,mildMR临床病理讨论会

PresentIllnessManagementat亞東hospitalLidocaineivdripDopamine10mg/kg/minRefertoNTUH(2pm)临床病理讨论会

PhysicalExaminationPhysicalfindingsatNTUHConsciousness:lethargic,acuteill-lookingT/P/R:37/140/25BP80/46SaO297%HEENT:paleconjunctivaanictericscleramildcyanoticlip临床病理讨论会

PhysicalExaminationNeck:jugularvenousengorgementChest:bilateralbasalr?lesHeart:irregularlyirregularbeats,distantheartsoundnomurmur临床病理讨论会

PhysicalExaminationAbdomen:nohepatomegalyhypoactivebowelsoundExtremities:freelymovablecoldandcyanoticpoorcapillaryrefilling临床病理讨论会

InitialLabDataCBC:WBCHbHctPlt