l*****t
发帖数: 190 | 1 大家新年好！想请教几个问题，谢谢！
19 yo DKA comatose，bp 86/65，PR: 110, RR 17, SaO2 98% on 2L O2. next step?
A. Intubation B. IV fluid and Insulin
答案是B。不是说comatose的都插管吗？非常迷惑的说。
问题二：
五岁小儿otitis media while on prophylactic single dose amoxicilin at bed
time (原来有几次otitic media）. next ?
A.10 day oral amoxicillin B.consider tympaostomy tube placement.
Answer: A.
听说failure abx prophlaxis 是放tympaostomy tube的一个标准。不明白的说。
请不吝赐教！
谢谢了！ | a*******d
发帖数: 5 | 2 question #1
RR 17, SaO2 98% --> oxygenation is good, no indication for intubation
#1 rule for DKA --> bolus, bolus and bolus
question #2
tympaostomy tube placement only after acute event resolved. In reality, this
patient should be treated with augmentin instead of amoxicillin as
recurrent OM is an indication for augmentin. | u***e
发帖数: 611 | 3 插管的主要三个指证是 failure to maintain airway, oxygenation failure,
ventilation failure.
comatose的病人如果你觉得不能维持气道，不能清除分泌物，就插上管子。如果你预料
病人昏迷的原因除去后很快能恢复，比如opioid overdose，narcan一针下去就好那就
可以不插。像这个病人你如果觉得就是DKA引起的，fluid,insulin下去就会醒过来，就
不用插。
这个病人血压这么低，送来ER我觉得十有八九会被插管的，一般他们插管比较
aggressive. 插好了再找病因，慢慢处理。
【在 l*****t 的大作中提到】
: 大家新年好！想请教几个问题，谢谢！
: 19 yo DKA comatose，bp 86/65，PR: 110, RR 17, SaO2 98% on 2L O2. next step?
: A. Intubation B. IV fluid and Insulin
: 答案是B。不是说comatose的都插管吗？非常迷惑的说。
: 问题二：
: 五岁小儿otitis media while on prophylactic single dose amoxicilin at bed
: time (原来有几次otitic media）. next ?
: A.10 day oral amoxicillin B.consider tympaostomy tube placement.
: Answer: A.
: 听说failure abx prophlaxis 是放tympaostomy tube的一个标准。不明白的说。
| l*****t
发帖数: 190 | | r*****2
发帖数: 309 | 5 Based on new OM guideline. If patient used high dose amoxicillin within one
month and now has another acute OM, then use Augmentin. He can still be
given high dose amoxicillin if hasn't used it WITHIN 1 MONTH.
BTW: Never heard about prophylaxis of OM. Where did you find it? Abx
prophylaxis is out of date even in UTI patient. Too many drug resistant
bacteria.
this
【在 a*******d 的大作中提到】
: question #1
: RR 17, SaO2 98% --> oxygenation is good, no indication for intubation
: #1 rule for DKA --> bolus, bolus and bolus
: question #2
: tympaostomy tube placement only after acute event resolved. In reality, this
: patient should be treated with augmentin instead of amoxicillin as
: recurrent OM is an indication for augmentin.
| r*****2
发帖数: 309 | 6 Regarding DKA, sometimes even if SaO2 is alright, but if blood gas indicates
retaining CO2, this patient still should be intubated. I don't think these
questions are good one, caused too much confusion. | l*****t
发帖数: 190 | 7 roamer2 (angie)谢谢了。这几天没来板上看。这是从kaplan step 3 弄来的题。看来
，做kaplan是浪费时间了。没有做过临床，要考step 3心里发虚。。。十分感谢！ |
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