醫學筆記匯整 ED Notes

 

1. ANC= WBC count x (% PMNs + % bands)

2. Neutropenia 定義有的是 ANC <1500
    急診 textbook 是 ANC < 1000

3. 有一些 Low risk scores 可協助預測病人癒後 : MASCC, CISNE

4.  Low risk 病人在 textbook 上是可以考慮回家的
    ex. MASCC>=21 可以回家口服抗生素, 三天內回門診
    (但臨床上我真的沒用過這些 scoring system 讓病人回家就是了)

5. 抗生素起手式要 cover pseudomonas

6. 之前有過 multidrug-resistant bacteria 考慮 carbaenem

7. 要考慮加上 Vancomycin or teicoplanin 的狀況請看內文

Infectious source are often absent or muted in the neutropenic patient
because the lack of neutrophils impairs the inflammatory response
and diminishes the occurrence of expected findings.

缺乏發炎反應, 不只沒症狀, 連 Lab/Image 都較沒有 findings.

Thus, a pulmonary infection may have minimal cough,
have no productive phlegm, and lack radiographic infiltrates.

A kidney infection may not produce pyuria.