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.

Presentation on theme: "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."— Presentation transcript:

1 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

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

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

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

5 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

6 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

7 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

8 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

9 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

10 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

11 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

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

13 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

14 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

15 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

16 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

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

18 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

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

21 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

22 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

23 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

24 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