z*i
发帖数: 58873 | 1 前面说Improvisation 是Jazz的灵魂，Swing是Jazz的脉搏，到了Syncopation，我能想
到的比较合适的比方就是Jazz多样活泼的表情了。
Syncopation，中文一般说切分音，顾名思义就是把一个节奏切开分开。使乐曲进行中
强拍和弱拍易位，强拍变成弱拍，或弱拍变成强拍。为了对比，先举一个简单的例子，
规规矩矩的没有syncopation的。拍子稳稳当当的强弱，强弱，唱起来也是一板一眼的
。好像一步一步的走路。
https://www.youtube.com/watch?v=yCjJyiqpAuU
然后再听听这个，也是简单的一个旋律，但是强弱节奏开始变化，同样的拍子，但是强
弱和音长都在变化。如果说那个twinkle twinkle little star是一步一步的走路，这
个he’s got the whole world in his hand 就有点像小孩子连蹦带跳了。
https://www.youtube.com/watch?v=lXtFqCw6rH8
其实在有了polyrhythm的 swing的概念上，syncopation几乎是必然的，因为... 阅读全帖 |
|
z*i
发帖数: 58873 | 2 前面说Improvisation 是Jazz的灵魂，Swing是Jazz的脉搏，到了Syncopation，我能想
到的比较合适的比方就是Jazz多样活泼的表情了。
Syncopation，中文一般说切分音，顾名思义就是把一个节奏切开分开。使乐曲进行中
强拍和弱拍易位，强拍变成弱拍，或弱拍变成强拍。
为了对比，先举一个简单的例子，规规矩矩的没有syncopation的。拍子稳稳当当的强
弱，强弱，唱起来也是一板一眼的。好像一步一步的走路。
https://www.youtube.com/watch?v=yCjJyiqpAuU
然后再听听这个，也是简单的一个旋律，但是强弱节奏开始变化，同样的拍子，但是强
弱和音长都在变化。如果说那个twinkle twinkle little star是一步一步的走路，这
个he’s got the whole world in his hand 就有点像小孩子连蹦带跳了。
https://www.youtube.com/watch?v=lXtFqCw6rH8
其实在有了polyrhythm的 swing的概念上，syncopation几乎是必然的，因为... 阅读全帖 |
|
d******n
发帖数: 12850 | 3 dance的时候经常有syncopated steps，要match音乐的Syncopation。版上的音乐老师
们，给偶详细科普一下Syncopation的涵义以及怎么辨别听出来吧。 |
|
R*******t
发帖数: 367 | 4 Time of flight will give you information of flow direction, while contrast
MRA doesn't. As long as there is flow in a vessel, retrograde or ante grade,
it will light up with contrast enhancement. In time of flight, retrograde
flow will lose signal and the vessel would be dark.
发信人: newprozac (中人), 信区: Medicalpractice
标 题: Re: 【case discussion】 Syncope
发信站: BBS 未名空间站 (Mon Feb 6 03:22:35 2012, 美东)
Very interesting case.
I wonder where the brain stem infarct is. Are they (with cerebellu... 阅读全帖 |
|
R*******t
发帖数: 367 | 5 Time of flight will give you information of flow direction, while contrast
MRA doesn't. As long as there is flow in a vessel, retrograde or ante grade,
it will light up with contrast enhancement. In time of flight, retrograde
flow will lose signal and the vessel would be dark.
发信人: newprozac (中人), 信区: Medicalpractice
标 题: Re: 【case discussion】 Syncope
发信站: BBS 未名空间站 (Mon Feb 6 03:22:35 2012, 美东)
Very interesting case.
I wonder where the brain stem infarct is. Are they (with cerebellu... 阅读全帖 |
|
n*******c
发帖数: 501 | 6 Very interesting case.
I wonder where the brain stem infarct is. Are they (with cerebellum infarct)
acute? How is the blood flow in vertebral arteries?
My impression is that the syncope was due to brain stem infarct rather than
SSS. SSS is probably an incidental finding.Having said that I haven't seen a
case with retrograde basilar flow from SSS(just realize our hosp doppler
ultrasound never reports basilar :( ）
Has the patient had syncope before?
Just for my curiosity. Did the MRA showing SSS ... 阅读全帖 |
|
A*******s
发帖数: 9638 | 7 1. Syncope is from brain stem ischemia due to SSS, brain stem infarct is
just a part of it.
2. Not sure about vertebral A direction, I would assume it would be
antegrade on the right and retrograde on the left.
3. No syncope before.
4. It is not uncommon to see a single artery stenosis (atherosclerosis)on
MRA or CTA.
infarct)
than
a
of |
|
n*******c
发帖数: 501 | 8 Very interesting case.
I wonder where the brain stem infarct is. Are they (with cerebellum infarct)
acute? How is the blood flow in vertebral arteries?
My impression is that the syncope was due to brain stem infarct rather than
SSS. SSS is probably an incidental finding.Having said that I haven't seen a
case with retrograde basilar flow from SSS(just realize our hosp doppler
ultrasound never reports basilar :( ）
Has the patient had syncope before?
Just for my curiosity. Did the MRA showing SSS ... 阅读全帖 |
|
A*******s
发帖数: 9638 | 9 1. Syncope is from brain stem ischemia due to SSS, brain stem infarct is
just a part of it.
2. Not sure about vertebral A direction, I would assume it would be
antegrade on the right and retrograde on the left.
3. No syncope before.
4. It is not uncommon to see a single artery stenosis (atherosclerosis)on
MRA or CTA.
infarct)
than
a
of |
|
h*********t
发帖数: 116 | 10 a 78 year old male with past medical history of hypertension and DM
presented with an syncopal episode and had MRI and MRA head/neck. The MRI
showed no acute findings but MRA showed right vetebral artery high grade
stenosis. echo normal, no history of afib or sss, telemetry did not reveal
any arrhthmia. what would you do about the right vetebral artery high grade
stenosis? do you think his syncope is related to this vetebral art stenosis?
thanks!!! |
|
A*******s
发帖数: 9638 | 11 A real case to share:
A 67 yrs old female, with a history of HTN, presented with syncope. She
complained of a sudden onset of vertigo then LOC for 1 min. She was very
confused at the admission.
PMH: HTN.
SH: No smoking/ETOH
FMH: HTN
ROS: not remarkable except mild confusion.
PE: VSS stable. BP: 140/80 bilaterally per record.
OA x 2 and CVS:irregularly irregular. Other exams were not remarkable.
CNC/CMP/PT/PTT: nl
Cardiac enzyme: neg
EKG showed A-Fib （new onset).
A CT of brain was neg.
Carotid ... 阅读全帖 |
|
n*******c
发帖数: 501 | 12 sounds like a posterior circulation TIA/stroke.Is neurological exam all
normal? Any oculomotor and pupillary abnormalities (top of the basilar)?
I would do a MRI including DWI and MRA of brain and neck.
She will need an ECHO to exclude intracardial thrombus (as the source of
emboli) and assess LV function (for CHADS2 score in a new AF) , also to
cover causes of cardiogenic syncope.
confusion makes me think about postictal. I would do a EEG if the above is
not conclusive.
I assume the blood gluco... 阅读全帖 |
|
A*******s
发帖数: 9638 | 13 sure， baozi会有的。
你说的对， 我也不明白，vascular surgeon更是说不可思议。 不过这是事实， 反复
量都没问题。
我来总结一下：
这个病人有两个问题： 1. A-fib 2.SSS
显然， syncope是因为SSS引起的VBI和相应的stroke而发生的。 MRI of brain，
carotid u/s and MRA of subclavian A证实了这一点。
问题是这个stroke是什么引起的？ 看上去像embolic， 因为有3个location。 从
subclavian是不可能的， 因为retrograde flow。 所以很可能是cardiac emboli， 原
因是A-fib。
病人refuse手术， 所以anticoagulation是唯一的治疗。
So far so good。 |
|
n*******c
发帖数: 501 | 14 I see.If this is the case. The patient would expect recurrent episodes if
leaving SSS untreated.
I thought this acute event is mainly due to the acute infarct because she
has no syncope before.
I am just wondering if the doppler ultrasound reported retrograde flow on
vertebral as well.
Again, thanks for sharing. |
|
A*******s
发帖数: 9638 | 15 A real case to share:
A 67 yrs old female, with a history of HTN, presented with syncope. She
complained of a sudden onset of vertigo then LOC for 1 min. She was very
confused at the admission.
PMH: HTN.
SH: No smoking/ETOH
FMH: HTN
ROS: not remarkable except mild confusion.
PE: VSS stable. BP: 140/80 bilaterally per record.
OA x 2 and CVS:irregularly irregular. Other exams were not remarkable.
CNC/CMP/PT/PTT: nl
Cardiac enzyme: neg
EKG showed A-Fib （new onset).
A CT of brain was neg.
Carotid ... 阅读全帖 |
|
n*******c
发帖数: 501 | 16 sounds like a posterior circulation TIA/stroke.Is neurological exam all
normal? Any oculomotor and pupillary abnormalities (top of the basilar)?
I would do a MRI including DWI and MRA of brain and neck.
She will need an ECHO to exclude intracardial thrombus (as the source of
emboli) and assess LV function (for CHADS2 score in a new AF) , also to
cover causes of cardiogenic syncope.
confusion makes me think about postictal. I would do a EEG if the above is
not conclusive.
I assume the blood gluco... 阅读全帖 |
|
A*******s
发帖数: 9638 | 17 sure， baozi会有的。
你说的对， 我也不明白，vascular surgeon更是说不可思议。 不过这是事实， 反复
量都没问题。
我来总结一下：
这个病人有两个问题： 1. A-fib 2.SSS
显然， syncope是因为SSS引起的VBI和相应的stroke而发生的。 MRI of brain，
carotid u/s and MRA of subclavian A证实了这一点。
问题是这个stroke是什么引起的？ 看上去像embolic， 因为有3个location。 从
subclavian是不可能的， 因为retrograde flow。 所以很可能是cardiac emboli， 原
因是A-fib。
病人refuse手术， 所以anticoagulation是唯一的治疗。
So far so good。 |
|
n*******c
发帖数: 501 | 18 I see.If this is the case. The patient would expect recurrent episodes if
leaving SSS untreated.
I thought this acute event is mainly due to the acute infarct because she
has no syncope before.
I am just wondering if the doppler ultrasound reported retrograde flow on
vertebral as well.
Again, thanks for sharing. |
|
A*******s
发帖数: 9638 | 19 I would not worry about the stenosis. It is irrelevant to syncope.
grade
stenosis? |
|
i*d
发帖数: 2640 | 20 请教
syncope查carotid u/s的具体目的都包括那些啊？普通常规的那种。总觉得用处很有限。 |
|
g***r
发帖数: 285 | 21
what you had was vasovagal syncope(or another name is neurocardiogenic
syncope),
syncope is a fancy term to describe the event of loss of consciousness, or
fainting, passing out,
regardless of mechanisms, the end result of syncope is transient diminished
perfusion of brain thus loss of consciousness,
vasovagal syncope is nearly always self limited and benign in nature, so i
wouldn't worry too much about it, |
|
A*******s
发帖数: 9638 | 22 Surgery/stenting for asymptomatic carotid artery stenosis over 70% is still
controversial.
The key is what caused syncope?
Left carotid artery stenosis usually is not the cause of syncope. Basilar
artery stenosis, however, could induce brain stem ischemia and cause vertigo
and syncope. I did not see basilar artery flow direction on the U/S. If retrograde, a
subclavian steal could cause the syncope.
So you may fix the carotid artery stenosis but not the syncope. The patient
has to be informed pri... 阅读全帖 |
|
A*******s
发帖数: 9638 | 23 I am just curious about your low heart rate. Syncope(昏厥) has multiple
causes. Sound like you were treated as vasovagal syncope(血管迷走神经昏厥).
Study shows 50% syncope is from vasovagal; 35% are cardiogenic(Heart）and
the rest are from seizures, etc.
I do not like to use Florinef, beta blocker, or other medications for
syncope without clinical diagnostic tests. There is an autonomic nerve
testing which is able to tell the mechanism. In your case, if I am right,
your low heart rate appears to be vagal ... 阅读全帖 |
|
s******h
发帖数: 103 | 24 Syncope: CT HEADS
Cardiac arrhythmia
TIA/Trauma
Hypotension/hypoglycemia
Epilepsy
Aortic stenosis/IHSS
Drug-induced
Syncope/convulsive syncope/vasovagal syncope |
|
i**********d
发帖数: 853 | 25 A postdoctoral position is immediately available in the laboratory of Julian
M. Stewart MD, PhD at the Center for Hypotension of New York Medical
College in Valhalla, New York. (www.syncope.org).
Our research concerns orthostatic intolerance and neurovascular regulation
with a current focus on postural tachycardia syndrome (POTS), vasovagal
syncope, and their relation to central and peripheral autonomic control. We
employ methods producing orthostatic stress (upright tilt) and simulated
hemorrha... 阅读全帖 |
|
g*2
发帖数: 658 | 26 临床上如果由于大脑低灌注hypoperfusion而引起短暂的失去意识，就是syncope。一般
要收治入院在telemetry unit, 除了详细的问病史和体检，还要作syncope workup, 包
括1）排除心脏的问题， 如心律失常，心脏瓣膜问题，心肌肥厚，心梗等，做一系列的
心肌酶谱和心电图，做心动图echocardiogram, 做holter, 如果需要还要做stress
test, cardioangiogram冠脉造影等 2)排除神经方面的问题，如seizure,椎基底动脉供
血不足，脑溢血/脑梗等，做CT head, EEG脑电图等 3）排除其他的问题比如体位性低
血压，血管迷走神经vasovagal，脱水，药物引起的等等。
还要根据病人的年龄和既往病史等信息来综合诊断。
我们这里老年病人syncope特别多。很少有年纪轻的。
楼主的心脏科医生应该做了其中的一些检查了吧。 |
|
z*i
发帖数: 58873 | 27 几乎所有艺术形式都有一个矛盾。一方面研究的学者们的和评论家对已经有的作品和实
践者进行系统的理论分类和概括，而另一方面实践者们则通过不断创新来突破已经建立
起来的体系。在这样一个几乎和猫和老鼠一样的很动态的过程里，定义是一件很尴尬的
事情。 如果不定义很难合适的放在一起通过对比和逻辑说清楚，如果强加定义却又显
得机械而失去里面独特而精彩的东西。
所以我对定义的态度是：定义是需要的，但是定义的目的是为了更好的faciliate
discussion on the subject matter，而不是简单的去用定义去界定或者下判断。 比
如，“jazz听起来俗气的” 或者 “摇滚乐缺乏艺术性”这类的说法，看似很强有力，
但是太过categorical而且带有强烈的感情色彩，却缺乏必要的支持和论证的过程，就
显得很莫名其 妙了。换句话说，定义也好，看法也罢，应该是好好讨论出火花的工，
而不应该是用来挖坑互喷的工具。 扯远了，回到Jazz。 ：）
究竟什么是Jazz? 既然Jazz是一种音乐形式，那就先听一堆再总结。
Jazz可以很舒缓(Billie Holiday - Autumn in ... 阅读全帖 |
|
z*i
发帖数: 58873 | 28 几乎所有艺术形式都有一个矛盾。一方面研究的学者们的和评论家对已经有的作品和实
践者进行系统的理论分类和概括，而另一方面实践者们则通过不断创新来突破已经建立
起来的体系。在这样一个几乎和猫和老鼠一样的很动态的过程里，定义是一件很尴尬的
事情。 如果不定义很难合适的放在一起通过对比和逻辑说清楚，如果强加定义却又显
得机械而失去里面独特而精彩的东西。
所以我对定义的态度是：定义是需要的，但是定义的目的是为了更好的faciliate
discussion on the subject matter，而不是简单的去用定义去界定或者下判断。 比
如，“jazz听起来俗气的” 或者 “摇滚乐缺乏艺术性”这类的说法，看似很强有力，
但是太过categorical而且带有强烈的感情色彩，却缺乏必要的支持和论证的过程，就
显得很莫名其 妙了。换句话说，定义也好，看法也罢，应该是好好讨论出火花的工，
而不应该是用来挖坑互喷的工具。 扯远了，回到Jazz。 ：）
究竟什么是Jazz? 既然Jazz是一种音乐形式，那就先听一堆再总结。
Jazz可以很舒缓(Billie Holiday - Autumn in ... 阅读全帖 |
|
z*i
发帖数: 58873 | 29 PS: 一个一个重新发这边来，其实我觉得我写的还蛮认真的……
几乎所有艺术形式都有一个矛盾。一方面研究的学者们的和评论家对已经有的作品和实
践者进行系统的理论分类和概括，而另一方面实践者们则通过不断创新来突破已经建立
起来的体系。在这样一个几乎和猫和老鼠一样的很动态的过程里，定义是一件很尴尬的
事情。 如果不定义很难合适的放在一起通过对比和逻辑说清楚，如果强加定义却又显
得机械而失去里面独特而精彩的东西。
定义是需要的，但是定义的目的是为了更好的faciliate discussion，而不是简单的去
用定义去界定或者下判断。 比如，“jazz听起来俗气的” 或者 “摇滚乐缺乏艺术性
”这类的说法，看似很强有力，但是太过笼统而且带有强烈的感情色彩，却缺乏必要的
支持和论证的过程，就显得很莫名其妙了。
究竟什么是Jazz? 既然Jazz是一种音乐形式，那就先听一堆再总结。
Jazz可以很舒缓(Billie Holiday - Autumn in New York)
https://www.youtube.com/watch?v=NO2Ij1eO-GQ
也可以很热闹 (Cowboy Beb... 阅读全帖 |
|
n*******c
发帖数: 501 | 30 I wonder if they have ruled out cardiogenic syncope. The patient has a
strong history of ischemic heart disease and had a CABG 2 years ago. How is
her LV function? If she has a poor LV function (say EF less than 40%) she is
at high risk of having ventricular arrhythmia which can present with
syncope or even sudden cardiac death. However, if posterior circulation
event is a concern, she will need a MRI+MRA. It does not convince me she had
a brain stem ischemic event with no other neurological si... 阅读全帖 |
|
A*******s
发帖数: 9638 | 31 again，we are talking about symptomatic and asymptomatic stenosis. For
asymptomatic carotid stenosis, although some data support surgery over drug,
the benefit is small and depend on life expectancy and surgical skills.
For this patient, her syncope is not caused by carotid stenosis. I always
question cardiology why order carotid u/s for syncope? Vascular surgeon may
say, r/o bilateral carotid stenosis, give me a break.
Asymptomatic carotid stenosis for CEA is controversial. The problem is th... 阅读全帖 |
|
A*******s
发帖数: 9638 | 32 24小时不睡啊，确实辛苦，我们以前是36小时，但晚上可以睡一会， 看运气，如果儿
科的急诊多就
没辙了。夜里两个医院间来回跑是最可恶的。
抗议一下这一段：“15：30 大学医院神经科病房。77岁老人高血压房颤中风病史因晕
厥待查入神经科，疑
是癫痫发作。多次心电图和心肌酶正常。无心脏科处理指证。真想说，Stupid的神经科
。”
除了vasovagal，syncope大多数是cardiogenic，与中风和癫痫没什么关系。心律失常
是最常见的，所以很多情况下病人出院需要带event monitor。而最新出台的新规矩不
提倡在syncope病人做carotid ultrasound就是要把syncope与CVA区分开来。
你这个病人我认为是心脏科问题，可怜神经科怎么收了这个病人，确实愚蠢，呵呵
★ 发自iPhone App: ChineseWeb 7.8 |
|
A*******s
发帖数: 9638 | 33 我不明白为什么大家都把syncope当stroke？ 去年神经科5大不可以就包括syncope不要
做carotid dopplar。 道理很简单，神志的改变必须是两侧大脑半球都有问题，TIA/
CVA却往往是一侧。
Subclavian steal syndrome应该是比较容易诊断的，但有多少医生测量双臂的血压？
所以这个病应该是underdiagnosed。 今天一个cardiologist看到这个case时感叹，我们
平时有多少syncope，有几个想到subclavian steal的？
这个病历我引以为骄傲的是我没有相信2个月前的医院carotid dopplar， 而是把一个
星期后她在诊所做的翻了出来。 报告中提到了右侧基底动脉的逆向flow，放射科医生
居然一带而过，没有提一下可能的鉴别诊断。 所以大多数医生都认为carotid就是看颈
动脉狭窄而已。 我因为认定这个病人的神志改变与carotid无关，所以特别关注了基底
动脉，终于功夫不负有心人。 |
|
g***r
发帖数: 285 | 34
if it always occurs during urination, then it's probably vasovagal,
when you look at syncope, always always try to differentiate between cardiac
vs. non-cardiac causes, because even though rare, cardiac syncope can be
fatal, |
|
g*****j
发帖数: 1211 | 35 Statistically, vagal stimulation (a kind of imbalance of neural signal in
the brain) is the most likely cause of such event (called syncope in
medicine). However, since your father has significant history of high blood
pressure and heart disease, it is worthwhile to do a check to rule out
other causes that can potentially be treated.
The potential causes for syncope can be numerous, ranging from heart issue
to respiratory issue to neural / brain problems. It is hard to decide what
exactly is |
|
u***e
发帖数: 611 | 36 In a 37 yo previously healthy female, most likely it's vasovagal syncope.
get the tilt table test done.
If u r really confused after the syncope, it could be seizure. an EEG and
MRI may help. |
|
y*****g
发帖数: 193 | 37 He need see a doctor stat, and check it out why he had the syncope and why
he lost his consciousness.
Frequent syncopes could be prodromal signs of a stroke. |
|
a**********2
发帖数: 3726 | 38 Lol, you said what I wanted to say. Yesterday when I saw this I wanted to
reply but felt it would be too long and useless cuz we really can't change
their stereotype on medical professionals. So just let them be.
Just a simply reply to LZ:
1. She had stroke before, do you know the chance of second stroke is high?
She had syncope or near syncope symptoms, as a doctor, of course we have to
rule out new stroke. If she happened to have one and doctor didn't do MRI
and admit her, you probably are sui... 阅读全帖 |
|
l*****y
发帖数: 5737 | 39 ☆─────────────────────────────────────☆
MakingWaves (making waves) 于 (Mon Dec 31 14:28:31 2012, 美东) 提到:
今年我妈住了两次院。现在我看， 好像都不是非住院不可的毛病。但医院从利益出发
，轻易建议住院, 过度治疗， 病人结果适得其反。
第一次是年初。一天早晨我妈起床上厕所，不知怎么就摔倒在床边，短暂昏迷。我爸随
后扶她去了医院。诊断是脑梗，收住院，点滴稀释血液的药， 同时点滴所谓有营养功
能的中药制剂。最多的时候，一天里输液有七种药品。我妈本来血压还不大高，输了几
天液，血压就高上去了， 腿走路都没劲了。她以前做过核磁共振， 当时大夫说，那结
果，不要说是六十多岁的人的，就算是四十多岁的人，都算正常。这次住院又作了核磁
共振，和一两年前比较，并无大变化，但脑梗的诊断不变。每次我妈抱怨不舒服，大夫
就再给加一种药输液。后来我妈实在受不了了，说，“走着进的医院， 住了几天，反
倒不能走路了”。终于在两个多星期后坚持出院。回家后， 不用那些药， 血压又正常
了，人有劲了, 也没再摔过... 阅读全帖 |
|
h***f
发帖数: 162 | 40 Based on a limited history, there are three problems: Anemia, eye blinking
issues, and episodes of syncope. Anemia and syncope can be linked, but
usually the anemia must be quite severe for a person to faint. Usually you
will also have tachycardia and other symptoms by that point.
I would suggest start with internal medicine/family practice. Then, if need
be, they can refer you to neurology or neuro-ophthalmology. |
|
n***a
发帖数: 1373 | 41 vasovagal syncope/syncope seizure。常见。不需检查。如果老复发，再查。如果再
有同种症状，马上做下或躺下。 |
|
t******l
发帖数: 10908 | 42 看完上面这些 video，就会发现，其实所谓的那些 “感性”，不过就是一些 space-
time-pattern，用一种 educated sporadic-chaotic 的方式，比如就这么整：
Spontaneous Symmetry Breaking
-- by timefall, 2016.04.18
You play major,
You play minor;
You sound augmented,
You sound diminished;
Then, ... (You gave me perfect-fifth?)
You syncopate left,
You swing right;
You swing loose,
You syncopate tight;
Then, you synchronize... (By the way, anybody know who is Bach?)
But who made your vibrato up,
And who made your vibrato down;
I don't know which pitc... 阅读全帖 |
|
i*******r
发帖数: 1075 | 43 刚看到。谢谢两位教导，完全低手，刚学到syncopation这词。
看了wiki觉得很有意思，说是syncopate大发了，就成了pop music里最大路的back
beat :)
符。 |
|
s********p
发帖数: 1319 | 44 Congrats!
You are so luck you happened to see this kind of syncope pt.,TTT, EP study
and TEE.
Follow this pt.and read some textbooks, you will get good feelings about the
differential diagnosis for syncope pt, which some times is of little bit
troubles
for clinicians.......
Congrats again. |
|
n*****n
发帖数: 119 | 45 别处看到的，觉得还不错，不排除有些拼写错误~
POMR (Problem-Oriented Medical Records)表格式住院病历
Biographical data:
一般项目：
Name Age Sex Marital status Nativity Race
姓名 年龄 性别 婚否 籍贯 民族
Occupation Date of admission Informant History
职业 入院日期 病史叙述者 病史
Chief complaint
主诉
History of present illness
现病史
Past history
既往史：
Previous health status: well ordinary bad Infectious diseases
平素健康状况： 良好 一般 较差 传染病史
Immunizations Allergies: N Y clinical manifestation
预防接种史 过敏史 无 有 临床表现
allergen: Trauma: Surgery:
过敏原 外伤... 阅读全帖 |
|
A*******s
发帖数: 9638 | 46 大家在学习过程中， 肯定看到很多有趣的，经典的临床综合症。 希望大家每人贡献一
个case， 图文并茂， 奖励办法由futurehw公布。
我开个头： Bow hunter's syndrome
It is named after how a bow hunter's who usually turn their head
significantly to shoot the bow and arrow. Bow Hunter's syndrome is a
condition where the contralateral vertebral artery is stenosed, compressed,
or occluded. Since the vertebral arteries supply blood to the posterior
portion of the cranium, then patients are going to have issues with sight,
vertigo and occasions of syncope. When the co... 阅读全帖 |
|
A*******s
发帖数: 9638 | 47 谜语4
扑通晕倒在地
答案：１. Vasovagal syncope
2. Cardiogenic syncope
3. Hypoglycemia
4. Pseudoseizure :) |
|
A*******s
发帖数: 9638 | 48 赞最后总结。
美国还真没有年龄限制开车的，不过大多数老人停止开车是因为家属的劝告。 到了一
定年龄他们好像每年都要亲自去renew驾照。
我们和你们一样， 几乎天天要面对这个驾照问题， 原则上说， 如果有过一次syncope
或seizure， 州法律是6个月不能开车， 但这一规定不是强制执行的， 所以医生要把
坏话说在前头， 明确告诉他们不能开车， 让他们复诊后再决定， 否则出了事就有
liability。 那个呼吸窘迫综合征的病人， 出了两次事， 我会把她的驾照吊销掉，
等她把问题解决后再重新给她做paperwork。
昨天在门诊随访我的一个老病人。93岁的老头，5年前放的心脏支架，现在有直
肠癌复发在做化疗。整个人精神不错，乐观，看样子活到个100岁也不成问题。临走时
寒暄几句。“您老开车来的？”“是啊”。“哦”。我无语。老头慢慢站起身来，对我
说，“我得慢着来，脚不方便啊”。看着老头一瘸一拐消失在门廊尽头，我想，会不会
有too old to drive的政策啊？前几个月，我还有个94岁的老头复诊，20多年前做过心
脏搭桥，还是在开车。当时我打趣的说，告诉我您老在哪条街上... 阅读全帖 |
|
r*****1
发帖数: 3465 | 49 别说屁话，你懂什么是Syncopated Notes 吗？ |
|
h***n
发帖数: 1275 | 50 试着自己写写
比如流行音乐 是个人就能写 搞清楚tempo 学几个和弦 最多加些syncopation
你要自己会写流行音乐了 你就发现流行音乐再也没法听了
然后多了解金属乐，这个更复杂一些 配器也更多一些
当你对金属乐的套路很了解了 你自然就会转向古典乐
洋大人科班，很早以前就对古典乐不爱玩了，experimental music , lab music都搞了
几十年了，synthesizer 出现都50年了，北美华人土鳖们还在推娃学钢琴。苍天啊 |
|
