2016年4月29日 星期五

新光醫院急診醫學科105年5月份醫師晨間研討會
日期
主題
報告者
指導者
05/02
tPA & IA Thrombectomy
葉旭霖醫師/神經內科
05/03
Painkyl®Fentanyl Buccal Soluble Film)&Thrombocytopenia專題講座
賴泓誌醫師
05/04
區域醫院急診陷阱
曾理銘醫師
北區急診聯合影像討論會(Abdominal Lesion
翁健瑞醫師
05/09

醫護討論會

(自拔管&遊民24hrs Holter事件)
連楚明醫師&劉玉香護理長
05/10
血友病診斷及治療
林立偉&周聖傑醫師
05/11
ER-GS聯合晨會
李俊毅
連楚明
05/16
MortalityMorbidity

高睿詩

許昕璘
李岱穎
洪世文
05/17
ER-Rad.聯合晨會
林秋梅&刁翠美醫師
05/18
北區急診聯合病例討論會
北榮急診主辦
05/23
Special Lecture
張志華醫師
05/24
Case Conference
謝宜庭
楊毓錚
05/25
Radiographic Examination in Pregnancy
陳欣伶醫師
05/30
急診福爾摩斯案例討論會
林立偉醫師
05/31
72hrs回診個案討論

林哲葦

蔡宇承
許瓅文

2016年3月23日 星期三

致力e化急重症社群網站教學,推展國際交流!

POCUS Academy
Point-of-care ultrasound is the visual stethoscope in the 21st century

Facebook社群網站,包含

  • 急重症FB讀書會 (公開)
  • 新光急診EKG & Image (不公開)


2013年9月7日 星期六

Endovascular vs. Open Repair of Ruptured AAA

Endovascular vs. Open Repair of Ruptured Abdominal Aortic Aneurysms

Allan S. Brett, MD Reviewing Reimerink JJ et al., Ann Surg 2013 Aug 258:248

In a randomized Dutch trial, outcomes were similar with the two procedures.

Although catheter-based endovascular aneurysm repair (EVAR) was introduced initially as a less invasive alternative to open surgery for elective repair of abdominal aortic aneurysms (AAAs), EVAR also has been used in cases of ruptured AAAs. Researchers in Amsterdam compared open repair and EVAR in this study of 395 patients with ruptured AAAs. During the study (2004–2011), an effort was made to treat all patients in Amsterdam with ruptured AAAs at the three hospitals involved in the trial.

Anatomy was suitable for EVAR in 155 patients, 116 of whom ultimately were randomized to EVAR or open repair. The incidence of the primary composite endpoint — death or severe complications at 30 days — was not significantly different in the two groups (42% vs. 47%; P=0.58). Taken separately, each of the primary endpoint components occurred with similar frequency in the EVAR and open-repair groups. Rates of death and serious complications remained similar in the treatment groups at 6 months.

COMMENT:
Among patients with ruptured abdominal aortic aneurysms and anatomy suitable for endovascular repair, outcomes with endovascular repair and open repair were similar. However, this study was conducted in a community where experienced centers were organized to offer around-the-clock emergency intervention for ruptured AAAs. August 27, 2013

2013年2月22日 星期五

新版Surviving Sepsis Campaign


New Surviving Sepsis Campaign Guidelines Released

These updated guidelines for management of severe sepsis and septic shock are based on broad agreement among a large group of international experts.

Background and Purpose: While evidence remains weak for many aspects of care, these guidelines, updated from 2008 and developed independent of industry funding, represent the most up-to-date international consensus for optimal resuscitation of septic patients.
Key Points:
Resuscitation Goals in First 6 Hours
  • Central venous pressure 8 to 12 mm Hg (grade 1C)
  • Mean arterial pressure (MAP) ≥65 mm Hg (grade 1C)
  • Urine output ≥0.5 mL/kg/hour (grade 1C)
Antimicrobials
  • Intravenous administration within 1 hour of recognition of septic shock (grade 1B) and severe sepsis without septic shock (grade 1C)
Fluids
  • Crystalloids as first choice for initial fluid resuscitation (grade 1B)
  • Initial minimum crystalloid challenge of 30 mL/kg (grade 1C)
Vasopressors and Inotropes
  • Norepinephrine as first choice (grade 1B) with epinephrine added or potentially substituted when adequate blood pressure cannot be maintained (grade 2B)
  • Phenylephrine not recommended except if norepinephrine is associated with serious arrhythmias, if cardiac output is high and blood pressure persistently low, or as salvage therapy when MAP target is not achieved (grade 1C)
  • Dobutamine infusion trial up to 20 µg/kg/minute administered or added to vasopressor in the case of myocardial dysfunction or ongoing signs of hypoperfusion (grade 1C)
Corticosteroids
  • No corticosteroids in the absence of refractory shock (grade 1D)
Blood Products
  • After tissue hypoperfusion is corrected, red blood cell transfusion only when hemoglobin concentration decreases to <7.0 g/dL, to a target hemoglobin concentration of 7.0–9.0 g/dL in adults (grade 1B)
Comment: Severe sepsis and septic shock require rapid identification and initiation of resuscitative measures. These guidelines, although based more on expert consensus than on evidence, should be familiar to all providers who care for patients with severe infections and used to guide initial treatment considerations.
— Kristi L. Koenig, MD, FACEP, FIFEM
Published in Journal Watch Emergency Medicine February 22, 2013
Citation(s):
Dellinger RP et al. Surviving sepsis campaign: International guidelines for management of severe sepsis and septic shock, 2012. Crit Care Med 2013 Feb; 41:580. (http://dx.doi.org/10.1097/CCM.0b013e31827e83af)