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[Gastroenterology] Abdomenial Trauma

Blunt Trauma
P.E.:較無診斷效果

Stable
FAST
胸腹部X光
胸部or胸腹區：胸腔鏡or腹腔鏡(非第一線工具)=>穩定的鈍傷病人

Unstable
1.Diagnostic Peritonial Lavage, DPL：Positive=>轉外科 Negative=>CT double check
Criteria：＞10ml blood or ＞10萬RBC or ＞500WBC or Food particle or Gram+ or billirubin+
2.剖腹探查

FAST(實質器官) DPL(中空器官-首選) CT(實質器官-首選 + 後腹腔-首選 + 中空器官)

Penatrating Trauma
P.E.:較有準確

Stable
胸部or胸腹區：胸腔鏡or腹腔鏡=>穿刺傷病人
腹部：Local Wound Exploration局部傷口探查
腰背部：Triple Contrast CT
KUB

Unstable
剖腹探查



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FAST中空器官和後腹腔不能
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外科腸胃道疾病照護

手術前 NPO 手術後 減壓引流管 Decompression - NG decompression  pressure:? - J-P drain - Hemovac drain 引流管 - Foley-sump drain:一般不用負壓引流，採free drainage     臨床經驗，負壓引流無特別情況， 術後照護重點： 1. 適當引流及腸胃道減壓 2. 營養建立：需長期靜脈營養？ 七天以上無法給予腸胃道。                         PPNLP\PPNNP\TPN
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[Phsiology] 溶液滲透度osmolaluty & osmolarity

Osmolarity is a measure of the osmoles of solute per liter of solution, while the osmolality is a measure of the osmoles of solute per kilogram of solvent . from http://en.wikipedia.org/wiki/Osmolarity Plasma osmolality Plasma osmolality is a measure of the concentration of substances such as sodium , chloride , potassium , urea , glucose , and other ions in human blood . It is calculated as the osmoles of solute per kilogram of solvent. Normal osmolality in plasma is about 280 - 303 milli-osmoles per kilogram. It is affected by changes in water content. To calculate plasma osmolarity (osmolality) use the following equation: P osm = 2[Na + ] + [Glucose]/18 + [ BUN ]/2.8 The above equation holds true if the glucose & ureas blood chemistry units are given as: mg/dL. If the units are given as: mmol/l; then the calculated osmolality is given by: P .OSM = 2[NA] + 2[K+] + [Urea] + [Glucose] Osmolality can be measured on an analytical instrument called an Osmometer....
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