1、 Eb1小組 學教 (一)兒童非創傷性手術急症Eb2個案討論一一個四天大女嬰,家長主訴持續腹脹及血便,兩次配方 食皆不吃餵 ,持續睡覺.出生史方面則因母親有妊娠毒血症而提早於34週大時剖腹生產,出生體重3200公克,並順利於三天後出院.在家每三小時餵食配方奶60-100CC.Eb3初級評估(1/2)PAT Appearance: Lethargic, poorly responsive Work of breathing: Effortless tachypnea (Compensated for metabolic acidosis) Circulation: Delayed capilla
2、ry refill, cool, pallor, mottled extrimities, rapid pulse, poor skin turgor, abdominal wall erythemaEb4初級評估(2/2)Vital signHR 180bpm, RR 45/min, BP: 60/40 mmHg, BT 37.8C, BW 3010gmA: OpenB: Tachypnea, grunting, breath sounds clearC: Color pale, skin warm and dry, tachycardia,brachial pulse decreasedD
3、: Tone decreasedE: No sign of injury, no rashEb5重要病史 S: Bloody stool and abdominal distention A: No allergies, formulafed M: None P: Born premature,C/S due to maternal preeclampia L: Just prior to arrival but vomited E: No feeding since 6 hours agoEb6詳細理學檢查 Head, neck, lung, and heart examination ar
4、e normal except for tachycardia ABD: distended, bowel sound: hypoactive Skin:mildly shiny and erythematouos Femoral pulse(+) Capillary refill : delayedEb7診斷工具-Plain filmEb8檢驗工具 WBC 12000/mm3, Hb 12.0, PLT 78000mm3, S/L/M=90/3/4 ABG: PH=7.25 PCO2 34 PO2 65 HCO3 14 , BE=-8 Glucose 70, Na 135 k 4.3 Stool examination: OB(+)Eb9最後診斷 Hollow organ perforation with septic shock R/O Necrotizing Enterocoltis Eb10NEC典型發現 Metabolic acidosis Neutropenia Thrombocytopenia Pneumatosis intestinalis Intrahepatic portal venous gas Pneumoperitoneum
