Towards Global Eminence K Y U N G H E E U N I V E R S I T Y Practical Lecture : 내과적 응급상황 #1 R4 최인승 상황별 대처방안 생각해보기

Towards Global Eminence K Y U N G H E E U N I V E R S I T Y Introduction

Towards Global Eminence K Y U N G H E E U N I V E R S I T Y Introduction

Towards Global Eminence K Y U N G H E E U N I V E R S I T Y Situation I

Towards Global Eminence K Y U N G H E E U N I V E R S I T Y Situation 1 : Altered mentality 상황 1 : 환자가 의식이 없어요 Physical Exam & History taking Acute or Chronic Underlying disease

Towards Global Eminence K Y U N G H E E U N I V E R S I T Y Situation 1 : Altered mentality 상황 1 : 환자가 의식이 없어요 Physical Exam & History taking Vital stable ? Shock No

Towards Global Eminence K Y U N G H E E U N I V E R S I T Y Situation 1 : Altered mentality 상황 1 : 환자가 의식이 없어요

Towards Global Eminence K Y U N G H E E U N I V E R S I T Y Situation 1 : Altered mentality 상황 1 : 환자가 의식이 없어요

Towards Global Eminence K Y U N G H E E U N I V E R S I T Y Situation 1 : Altered mentality 상황 1 : 환자가 의식이 없어요 Physical Exam & History taking Vital stable ? Shock Cardiogenic Septic Hypovolemic Etc. No

Towards Global Eminence K Y U N G H E E U N I V E R S I T Y Situation 1 : Altered mentality 상황 1 : 환자가 의식이 없어요 Physical Exam & History taking Vital stable ? Shock Hypoxemia RR O2 supply 전 ABGA Chest X-ray PTE No

Towards Global Eminence K Y U N G H E E U N I V E R S I T Y Situation 1 : Altered mentality 상황 1 : 환자가 의식이 없어요 Physical Exam & History taking Vital stable ? Shock Hypoxemia RR O2 supply 전 ABGA Chest X-ray PTE Cerebral infarct or Hemorrhage Hypoglycemia or HHS Hepatic encephalopathy Seizure Opioid overuse No Yes

Towards Global Eminence K Y U N G H E E U N I V E R S I T Y Situation II

Towards Global Eminence K Y U N G H E E U N I V E R S I T Y Situation 2 : Chest pain 상황 2 : 환자가 가슴이 아프다고 해요 History Taking 7 cardinal features Onset & Duration Location Characteristics Severity Radiating pain Modifying factors Associating Symptoms ACC/AHA guideline for stable ischemic heart disease 2012

Towards Global Eminence K Y U N G H E E U N I V E R S I T Y Situation 2 : Chest pain

Towards Global Eminence K Y U N G H E E U N I V E R S I T Y Situation 2 : Chest pain 상황 2 : 환자가 가슴이 아프다고 해요 History Taking 7 cardinal features Previous EKG, Echocardiography, Cardiac angiography EKG ST elevation, New onset LBBB Compare with previous EKG Heart enzyme CK : CKMB ratio Hyperacute phase Chest X-ray Pulmonary edema Aortic dissection

Towards Global Eminence K Y U N G H E E U N I V E R S I T Y Situation 2 : Chest pain

Towards Global Eminence K Y U N G H E E U N I V E R S I T Y Situation III

Towards Global Eminence K Y U N G H E E U N I V E R S I T Y Situation 3 : Cardiac arrest 상황 3 : 환자가 맥박이 없어요

Towards Global Eminence K Y U N G H E E U N I V E R S I T Y Situation IV

Towards Global Eminence K Y U N G H E E U N I V E R S I T Y Situation 4 : GI bleeding 상황 3 : 환자가 토혈을 했어요 Physical Exam & History taking 토혈 vs 객혈 r/o M-W syndrome L.C Hx, 복용약 확인 L-tube, DRE HematemesisHemoptysis Nausea, vomiting 동반 Food matrial 이 섞여있다 주로 커피색 Alkali Cough, sputum 동반 거품이 섞여있다 주로 선홍색 Acid

Towards Global Eminence K Y U N G H E E U N I V E R S I T Y Situation 4 : GI bleeding 상황 3 : 환자가 토혈을 했어요 Physical Exam & History taking High dose PPI Anemia study Transfusion 응급 지혈술 결정

Towards Global Eminence K Y U N G H E E U N I V E R S I T Y Conclusion Order 낼 때 용량 확인하는 버릇을 가지세요 모르는 게 있을 때 잠깐이라도 짬을 내서 Uptodate.com or Pubmed 찾아보는 습관을 가지세 요

Towards Global Eminence K Y U N G H E E U N I V E R S I T Y Thank you for your attention