徴 71
71 0 5 71 80% 3 7 71, 7 3 7 71 tremor
ataxia 疱 疱 tremor 24 疱 myoclonic jerks
brief history present illness 1.general symptoms and signs 2. neurological symptoms and signs myoclonic 3. cardiopulmonary symptoms and signs
physical examinations 6 7 9 10 11 12 consciousness laboratory examinations electrocardiogram arterial blood gas chest X-Ray creatine phosphokinase MB creatine phosphokinase liver function test blood sugar electrolytes treatment 1. 2.
3. 39 >17,500/mm 3 2 1. 2. challenge 1/2 2/3 mannitol glycerol 1 2200 mg/dl 100 200 mg/dl D2.5% half saline 100 mg/dl 100 200 mg/dl 3.8 2O furosemide cmh 2mg/kg 1 qd-q6h 4. 5. lorazepam diazepam phenytoin phenobarbital 6. 1 15-30 2 3 mannitol 0.25g/kg glycerol <1g/kg/hr 4 hyperventilation therapy PaCO 2 25 35mmHg
7. A 1. midazolam morphine 2. arterial line 3. nitroprusside 0.5-3 µg /kg/min dobutamine 2-20 µg /kg/min milrinone 0.25-0.75 µg /kg/min 4. 1 9 2positive end-expiratory PEEP pressure 6-8cmH 2 O 3 mean MAP airway pressure 15cmH 2 O oxygen index = 2 X (MAP 100) X FiO PaO 2 13 high frequency oscillator mechanical ven 4 PT APTT
50% FiO 2 10-12 mg/dl 5. 6. B 60mmHg 70mmHg 70 2 mmhg dopamine µg /kg/min dobutamine 5-15 2-20 µg /kg/min epinephrine 0.05-0.4 µg /kg/min 8 cmh 2 O 5-10ml/kg 100-200 mg/dl epinephrine dopamine < 10 µg /kg/min transcranial Döppler ultrasonography
5 疱 1 150 2 ataxia cross hemiplegia specific cranial Ns lesion brainstem dysautonomia 3 Sepsis syndrome 4 1 2 3 4 1 gm/kg 12
* mmhg < 7 > 106 8 30 > 110 < 2 > 118 > 82 3 5 > 118 > 84 6 9 > 130 > 86 10 12 > 134 > 90 13 15 > 144 > 92 16 18 > 150 > 96 * Hycan et al. Task Force on Blood Pressure control in Children. Pediatrics 79:1, 1987. * mmhg 60-90 20-60 6 87-105 53-66 2 95-105 53-66 2 7 97-112 57-71 7 15 112-128 66-80 * Hazinski MF: Nursing Care of the Critically nd Ill ed. Child, St.Louis, 2 Mo: Mosby Year Book; 1992.
71 5 72 96 bpm <120 140-160 >160 / <30 30-40 40 > 1. 2. 3. 4. 1 2 2 3 2 5. : 1 myoclonic jerks 2 flaccid paralysis 3 3-5 2 3
6.
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