儿童非创伤性手术急症.pptVIP

診斷工具(1/2)Eb*NormalelectrolyteandglucoselevelNormalurineanalysisNegativeurinetoxicologyscreenNormalbloodgasanalysisCBC-DCshowedaleukocytosiswithoutleftshiftandanormalHbandHct.BrainCTisnormalPAT:初級評估(1/2)Eb*PAT:Appearance:alertandfearlyWorkofbreath:non-laboredCirculation:paleconjunctivaeandmucousmembraneVitalsigns:HR140,RR24,BP100/60,T37°CWt15kg初級評估(2/2)Eb*A: Open,nostridorB: Non-labored,breathsoundsclearC: Paleconjunctivaeandmucousmembrane,skinwarmanddry, tachycardia,brachialpulsestrongD: TonenormalE: Nosignofinjury,norash重要病史Eb*S: largemountofbloodystool1A: Noallergies,formulafed2M:None3P: Bornfull-termNSVD,historyofbreakbloodystool4L: Justpriortoarrival5E: Normalfeeding6Normalexcept:詳細理學檢查Eb*HeadandNeck:paleconjunctivaeandmucousmembraneHeart:tachycardiawithsoft2/6systolicejectionmurmurattheLLSBAnus:Stoolisgrosslybloody.Noevidenceoffissure,trauma,ortags急診處置Eb*ABCs:O2withmask01Fluidresuscitation:IVwithN/S300CC02OGorNGtubeforsalinelavage03CBC-DC,PT/aPTT,typeandcrossmatch04Correctanemia:pRBC150ccifindicated05初步診斷Eb*Painlessrectalbleeding,cause?無痛性血便之鑑別診斷Eb*MeckeldiverticulumIntestinalpolypIntestinalduplicationsIntestinalhemangiomaArteriovenousmalformationCoagulopathyPUDInflammatoryboweldisease診斷工具Eb*ATc-99mpertechnetatescanLaparoscopyEsphagogastroduodenoscopyColonoscopyExploratorylaparotomy0102030405Tc-99mpertechnetatescanEb*ThediagnosisofMeckel’sdiverti-culumcanbeobtainedbyatechnetium-99mscintiscan.01Theradioactivitycanbeseeninthestomachandbladder,andthediverticulumisseeninthemid-abdomen.02Technetium-99mscanshowsectopicgastricmucosaSmallintestineMeckel’sdiverticulum結論優先定位出血位置:上消化道或下消化道有出血性腸阻塞或腹膜炎症狀者皆應緊急會診外科手術前應先解決低血容及貧血問題個案討論三Eb*歲男生