銅筋鐵肋的秘密基地

又見面了,從我手上出院,輾轉又成為我的病人,只不過換了個科.
約莫一個月前,在神內病房接手這個老伯.
本身兩側頸動脈狹窄放過支架,左側腎動脈狹窄也放了支架.
曾經左側MCA infarction,不過右側無力的情況在支架放置以及藥物治療後已有改善.

過了一定年齡的單身女性,常常感慨的是,好男人都已經死會了.
這個年代死會活標不稀奇,
不過還是有守舊派的教徒,堅持著某些原則.

看著他不但是NG decompression bag,連嘴巴都冒出了鮮血,
我想我是夠氣急敗壞的了!
交班前入了一個病人,聽說是老病號,
常常因為COPD with AE, secondary infection, 多次入住Chest ward.

他是個命理師,但可能沒算到08年的這個大關.
眼看嘴巴裡插著那跟管子就要到期了,
雖然sign了DNR,他的兒子還是認為救到底.

在過度變成一個工作狂之後,
猛然回頭,發覺深刻的片段是如此乏善可陳.
每一天的每一天,重要的是如何過日子,如何生活,
一時的成就或是一時的驕傲,

TEACHING TOPIC
1. Case: Renal Failure, Stiff Joints, and Skin Fibrosis
A 46-year-old woman with end-stage renal disease developed stiffness of her joints and skin. She had been well until 7 years before when an episode of group A streptococcal pneumonia complicated by septic shock left her with chronic kidney disease and peripheral neuropathy. The patient also has respiratory distress and congestive heart failure. What is the differential diagnosis?

話說明天是西洋情人節.
不過我可不是一個人的,嘿嘿,真的要驕傲一下了,
......................................

幾番考慮之後,我決定還是要履行我當初的承諾.
雖然已經花了好些錢在CD上頭,我還是用滑鼠點下"購買"的選項.

過年期間,病房總會適時縮編,
因此擁擠的病房就乾脆讓他塞爆,出清的病房就盡量不要超過一半的佔房率.
我分配到的病房是CV病房,雖然總會認為留下來的一定不平靜,
不過少了平時大進大出的導管病患,其實只要白天多留意,

TEACHING TOPIC
1. Case: Hemoptysis
CLINICAL PROBLEM-SOLVING
A 26-year-old man presented with a 1-month history of persistent cough productive of white sputum, which was occasionally tinged with blood. He reported mild pleuritic chest pain but had no dyspnea, fever, chills, night sweats, or weight loss. The patient had had no epistaxis or episodes of sinusitis. A course of azithromycin did not resolve his symptoms. His medical history was notable for pneumothorax and renal-artery dissection. What single disease could be responsible for these previous illnesses as well as his current hemoptysis?

Clinical Pearls
 Hemoptysis: Differential Diagnosis
Hemoptysis can be caused by diseases of the airways, particularly bronchitis or bronchiectasis. Other causes include bronchogenic carcinoma, metastatic cancer or bronchial carcinoid. Kaposi's sarcoma involving the airways may cause hemoptysis in patients infected with HIV. Hemoptysis can also arise from the lung parenchyma. Autoimmune diseases (such as SLE, mixed connective tissue diseases, etc.), cocaine inhalation, and infections (including tuberculosis, bacterial pneumonia, and lung abscess), as well as pulmonary embolism, pulmonary arteriovenous malformation, mitral stenosis, severe left heart failure, and Wegener's granulomatosis should also be included in the differential diagnosis of hemoptysis.
 Aspergillus in Respiratory Cultures
Aspergillus species are ubiquitous in the environment, and growth in respiratory cultures often represents contamination rather than infection. (A lung biopsy is needed for definitive diagnosis.) Common risk factors for invasive aspergillosis include severe neutropenia, hematopoietic stem-cell and solid-organ transplantation, HIV infection, and chronic granulomatous disease.