5 / 1 0 / 1 2 4

1 / 2 0my . s o -‐‑ n e t . n e t . t w / h s i n g l i n 2 0 0 2 / a r t i c l e / a r t i c l e 2 _ 4 . h t ml

6/1( )

1 ����On Foley

Foley, , ….BI, , ….3M

2 ����On NG tube

NG tube, 50c.c. ,

3 ����NG tube size

16 , . irrigation, 14 irrigation

NG

, NG( , ),

30 , NG .

4 ����ABG

22 , , 10 .

5 ����

Nylon 3.0, Nylon 4.0, Nylon 5.0 6.0

Nylon , Dexon

6 ����SSD ( )

, , ,

, SSD . .

, , , 綁

, , 綁 .

7 ���� consciousness?

” ”. ” ?”, ” ?”,

. case, ” !”, “ ”…

, , ,

!

8 ����

5 / 1 0 / 1 2 4

2 / 2 0my . s o -‐‑ n e t . n e t . t w / h s i n g l i n 2 0 0 2 / a r t i c l e / a r t i c l e 2 _ 4 . h t ml

Normal saline , BI .

xylocain Normal saline

9 ����

Intern 啟 3F , , station

, , .

10

Intern, ,

, ” ”…( ), !

6/2( )

(1)��� Raccoon eye

Raccoon eye , suspect

(2)��� Battle’s sign

Battle’s sign , suspect ,

(3)��� Monteggia fracuture

fracture of the proximal ulna can be associated with dislocation of the radial head.

(3)Mon����� ���*DO

(4)��� Galeazzi fracture

fracture of the distal half of the radius can be associated with disruption of the distal radioulnar

joint. ( reverse Monteggia fracture)

(5)��� Greenstick fracture

children. One side of the fracture has broken and one side is bent. incomplete

break. It will involve only one side of bone. It is because the bone of children is more

pliable( ) than adults.

5 / 1 0 / 1 2 4

3 / 2 0my . s o -‐‑ n e t . n e t . t w / h s i n g l i n 2 0 0 2 / a r t i c l e / a r t i c l e 2 _ 4 . h t ml

(6)��� silver fork deformity

Colles’ fracture. Colles’ fracturesilver fork deformity .Colles; fracture distal radius

fracture, just above the wrist.

Silver for deformity swelling and an inability to use the wrist and hand.

(7)���Fever

(1)malignancy (2)autoimmune (3) infection. infection.

Infection : (1)Chest : cough, sputum (2)GI: diarrhea ( ,

virus, , , bactreria) (3)GU: UTI, stone

(8)���Appendicitis PE

(1) Psoas sign : . ,

.

(2) Obturator sign : Patrick sign , .

5 / 1 0 / 1 2 4

4 / 2 0my . s o -‐‑ n e t . n e t . t w / h s i n g l i n 2 0 0 2 / a r t i c l e / a r t i c l e 2 _ 4 . h t ml

(3) Rovsing sign: , RLQ pain.

(9)��� head trauma, liver cirrhosis, bleeding tendency. consciousnessnot clear, CT scan brain.

(10)��� station .

6/7( )

(1)���paraplegia, diplegia, tetraplegiaparaplegia : diplegia : involve, ( cerebral palsy )tetraplegia : (= quadriplegia)

(2)���PainNSAID acetaminophen , Cataflam, Pirocam, Aspegic, Keto.

Demerol Dacoton

(3)���Rowapraxin (Pipoxolan) :GI or urinary tract spasm.

( stone, ESWL, knocking pain, suspect APN. 查 , , )

5 / 1 0 / 1 2 4

5 / 2 0my . s o -‐‑ n e t . n e t . t w / h s i n g l i n 2 0 0 2 / a r t i c l e / a r t i c l e 2 _ 4 . h t ml

(4)���Penicillin testThe skin is observed closely for signs of a reaction, usually swelling and redness of the site - acontrolled hive with so-called wheal and flare. Results are usually obtained within about 20minutes, and several suspected allergens can be tested at the same time.

, .

(5)��� Right thigh pain + left lower back pain, 查

L-spine ,Urine routine KUB.

(6)��� , , ”” , ,

(7)��� , complain , NSP ,, .

, , , PRBC ,查 , 查 ,

NSP , . , ,.

(8)��� , , , ” ” ,N/S CD , , N/S , .

(9)��� , SSD. ” ”, ,, SSD, .

(10)� remove foley , 10c.c. balloon . on foley, , 3-way foley(size 18 20 ), ,

. !!

6/8( )

(1)���Appendicitis

shifting pain appetite vomiting bowel habitchange diarrhea rebounding pain

cough,

A positive cough sign (ie, sharp pain in the RLQ elicited by a voluntary cough) may be helpful inmaking the clinical diagnosis of localized peritonitis. Similarly, RLQ pain in response topercussion of a remote quadrant of the abdomen, or to firm percussion of the patient's heel,suggests peritoneal inflammation.

5 / 1 0 / 1 2 4

6 / 2 0my . s o -‐‑ n e t . n e t . t w / h s i n g l i n 2 0 0 2 / a r t i c l e / a r t i c l e 2 _ 4 . h t ml

The most common causes of luminal obstruction are fecaliths and lymphoid follicle hyperplasia

(2)��� CT , , ileus, , .

fecal impaction , .

(3)���Appendicitis criteria: MANTRELS score

&KDUDFWHULVWLF 6FRUH

0� �PLJUDWLRQ�RI�SDLQ�WR�WKH�5/4 �

$� �DQRUH[LD �

1� �QDXVHD�DQG�YRPLWLQJ �

7� �WHQGHUQHVV�LQ�5/4 �

5� �UHERXQG�SDLQ �

(� �HOHYDWHG�WHPSHUDWXUH �

/� �OHXNRF\WRVLV �

6� �VKLIW�RI�:%&�WR�WKH�OHIW �

7RWDO ��

Source.—Alvarado, 1986.

(4)���Abdominal pain , acute appendicitis. shifting pain,

McBurney point. , rebounding pain.

peritonitis , , impression.

(5)���Head trauma , , , , underlying cause ,

, .

(6)��� head trauma , , ER 6

( , 6 ),

, , ,

.

(7)���CT . , ,

, . , PE focal sign(neural

finding ), .

CT indication.

(8)��� oral cancer , , , .

5 / 1 0 / 1 2 4

7 / 2 0my . s o -‐‑ n e t . n e t . t w / h s i n g l i n 2 0 0 2 / a r t i c l e / a r t i c l e 2 _ 4 . h t ml

.

(9)����� , , . . ,.

(10)� CPR , , .

5 / 1 0 / 1 2 4

8 / 2 0my . s o -‐‑ n e t . n e t . t w / h s i n g l i n 2 0 0 2 / a r t i c l e / a r t i c l e 2 _ 4 . h t ml

6/9( )

(1)��� ,insulin , .

(2)��� , , , EKG., , , .

(3)���<1> 5th Intercostal space, 5th rib . , .( )

<2> , 10c.c.<3> local anesthetics . {1} , 1c.c. ,

{2} , , , . , , 5c.c. , 1c.c. , 1c.c, , 1c.c.

<4> , , kelly , ”啵”, , . .

<5> , , , , , , .

<6> , X-ray, .

(4)��� appendicitis shifting painAppendicitis , , , ,appendix

, , , ( ,third space), appendix , , .

Appendix shifting pain , , shifting pain.

<from Moore p.251>The nerve supply to the cecum and appendix derives from the sympathetic and parasympatheticnerves from the superior mesenteric plexus. The sympathetic nerve fibers originate in the lower thoracic part of the spinal cord.

5 / 1 0 / 1 2 4

9 / 2 0my . s o -‐‑ n e t . n e t . t w / h s i n g l i n 2 0 0 2 / a r t i c l e / a r t i c l e 2 _ 4 . h t ml

The parasympathetic nerve fibers derive from the vagus nerves.

Afferent nerve fibers from the appendix accompany the sympathetic nerves to the T10 segment of

the spinal cord.

(5)��� CT

, head trauma , , ,

CT, , , station CT indication

. , CT ,

. , .

(6)��� X-ray CT, last menstrual period.

, , urine β-hCG.

(7)��� shoulder X-ray, chest X-ray, ” ”

(8)��� pneumothorax , . X-ray lesion .

(9)��� CT, falx , falx bulging.

, falx, falx bulging.

(10) , !

6/10 ( )

(1)���Buscopan

,W�LV�XVHG�WR�UHOLHYH�FROLFN\�DEGRPLQDO�SDLQ�WKDW�LV�FDXVHG�E\�SDLQIXO�VSDVPV�LQ�WKH�PXVFOHV�RI�WKH

JDVWURLQWHVWLQDO��*,��RU�JHQLWRXULQDU\��*8��WUDFW�

$QWL�VSDPRGLF��DQWLFKROLQHUJLF

OHIW�IODQN�SDLQ��QR�NQRFNLQJ�SDLQ��.8% ILQGLQJ� 2%�

� %XVFRSDQ�� *8�WUDFW�PXVFOH� �

(2)��� , Erythromycin,

(3)���Bloody stool

R/O UGI bleeding, NG irrigation.

5 / 1 0 / 1 2 4

1 0 / 2 0my . s o -‐‑ n e t . n e t . t w / h s i n g l i n 2 0 0 2 / a r t i c l e / a r t i c l e 2 _ 4 . h t ml

(4)��� A , B , A

A B A, B

(5)��� , , . , 0.5cm()

(6)���SSD , ,, , SSD, , SSD,

.

(7)���RLQ painAppendicitis McBurney point local tenderness,

. , constipatoin. diarrhea, diverticulitis..

(8)��� , .

(9)��� : .

(10)��� Rule of nine

��� ���

值

5 / 1 0 / 1 2 4

1 1 / 2 0my . s o -‐‑ n e t . n e t . t w / h s i n g l i n 2 0 0 2 / a r t i c l e / a r t i c l e 2 _ 4 . h t ml

6/11 ( )

(1)����ophthalmalgia, eye pain

(2)���� ,

Novamin, Primperan ( EPS)

5 / 1 0 / 1 2 4

1 2 / 2 0my . s o -‐‑ n e t . n e t . t w / h s i n g l i n 2 0 0 2 / a r t i c l e / a r t i c l e 2 _ 4 . h t ml

(3)���� female 4 days ago laprascopy s/p ovary cyst, AAD,abdominal distenstion. Abdominal distention

abdominal distention ,surveyR/O ileus, bowel injury, Pelvic inflammatory disease

,bowel injury , , peritonitis.

muscle soft guarding

(4)���� feeding tube dislocation at , complain, NG tube , , , ,

. ” ”

(5)���� allergy, Solucortef + Vena

(6)����Compression fractureL-spine , vertebra , breast CA

<1> compression fracture metastasis, X-ray osteolytic lesion, lateral view , .

<2> trauma ,X-ray , ,

(7)���� cardiac arrest , , ,GCS score ,ABC(A: …B: ), on ambu, ventilator,

, . X-ray chest tube, dyspnea

ventilator …trauma pneumothorax, tension pneumothorax.( , ,saturation夠, )

(8)���� , on CVP,pneumothorax , , on CVP ,

.

(9)����On foley, size , BPH, Foley

(10) ( ), , ,.

5 / 1 0 / 1 2 4

1 3 / 2 0my . s o -‐‑ n e t . n e t . t w / h s i n g l i n 2 0 0 2 / a r t i c l e / a r t i c l e 2 _ 4 . h t ml

6/12 ( )

(1)���� Dermatome, ----C6, ----C7

C3— , L1—

C6— L3,L4—

5 / 1 0 / 1 2 4

1 4 / 2 0my . s o -‐‑ n e t . n e t . t w / h s i n g l i n 2 0 0 2 / a r t i c l e / a r t i c l e 2 _ 4 . h t ml

T4— L5—anterior ankle and foot

T10—

(2)���� injury, chief complaintCorrosive injury

(3)����Compartment syndrome physical finding 5PPain( ), Paresthesia, Pallor, Pulseless, Paralysis

(4)���� compartment syndromeleg, forearm(Compartment syndrome : increased pressure within these closed myofascial spaces causesdecreased perfusion and oxygen deprivation.)

(5)���� GYN, vaginal bleeding,, , , , ,

, , , ,.. .. ,

, , , !

(6)���� , , .

(7)����Forearm ulna radius Xulna humerus, ,ulna humerus

, radius

.

5 / 1 0 / 1 2 4

1 5 / 2 0my . s o -‐‑ n e t . n e t . t w / h s i n g l i n 2 0 0 2 / a r t i c l e / a r t i c l e 2 _ 4 . h t ml

(8)���� ,

, ,

station .

(9)����Rebounding pain

躺 ,

, , , rebounding pain.

(10) PE , soft muscle guarding

6/13 ( )

(1)���NG, Foley, CVP, , , IV line.

(2)��� airway

SpO2

(3)��� FAST scan Morison’s pouch

Morison’s pouch If a surgeon were to open you mid abdomen and pour in fluid into

the peritoneal space it would collect or “puddle” in the deepest (most dependent)

part of the supine abdomen. This happens to be between the liver and the kidney

and is called Morison’s Pouch.

5 / 1 0 / 1 2 4

1 6 / 2 0my . s o -‐‑ n e t . n e t . t w / h s i n g l i n 2 0 0 2 / a r t i c l e / a r t i c l e 2 _ 4 . h t ml

(4)���Morison’s pouch hepatorenal pouch, R/O internal bleeding.

(5)��� trauma patient BP , pulse.

(6)���Endotracheal tube carina 2~3cm

(7)��� 5th ICS, rib local, rib

, .

(8)��� intestinal obstruction(ileus), abdominal distention

NG decompression, intestine food

(9)��� citosol

5 / 1 0 / 1 2 4

1 7 / 2 0my . s o -‐‑ n e t . n e t . t w / h s i n g l i n 2 0 0 2 / a r t i c l e / a r t i c l e 2 _ 4 . h t ml

sedation muscle relaxant

(10)� tension pneumothorax,

,needle decompression.

6/15 ( )

(1)����

, wound care , laceration wound, ,

, , .

(2)���� dysmenorrhea

( Keto Pirocam, Buscopan),

(3)���� PE , , .

(4)���� , , Last menstrual period(LMP), plain

abdomen KUB, urine β-hCG, .

(5)���� , , ,

charge .

(6)���� central cord syndrome

Central cord syndrome (CCS) is an acute cervical spinal cord injury (SCI), characterized by

disproportionately greater motor impairment in upper compared to lower extremities, bladder

dysfunction, and variable degree of sensory loss below the level of injury. Although CCS has been

reported to occur more frequently among older persons with cervical spondylosis who sustain

hyperextension injury, it may occur in persons of any age and can be associated with various

etiologies, injury mechanisms, and predisposing factors. CCS is the most common incompleteSCI syndrome.

CCS most often occurs after hyperextension injury in an individual with long-standing cervical

spondylosis. Injury may result from both posterior pinching of the cord by buckled ligamentum

flavum or from anterior compression by osteophytes.

(7)���� , ,

omphalitis, .

Omphalitis ( )

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5 / 1 0 / 1 2 4

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In an adult, where the rare possibility of malignancy could be present, an abdominal and pelvic CT scanmight be helpful. Again, complete removal of the urachus is important. Simple needle or other drainageof the cyst will result in recurrence in at least one-third of patients, since the linings and structures arestill present. Surgery is sometimes indicated.

(8)����Staghorn stone , KUB .

5 / 1 0 / 1 2 4

1 9 / 2 0my . s o -‐‑ n e t . n e t . t w / h s i n g l i n 2 0 0 2 / a r t i c l e / a r t i c l e 2 _ 4 . h t ml

(9)���� OG tube, NG tube , , endo on ,

, , ,

.

(10)Foley , on Foley ,

, ” on Foley ?”, penis,

, VS R, ,

,

, on Foley

6/16 ( )

(1)���� KUB, bladder stone phleboliths

(2)���� tumor coffee-ground vomiting

GIST Gastrointestinal Stromal Tumor

(3)���� , ,

.

(4)����Vena ,

(5)���� , irrigation, ,

, , .( infection ,irrigation bacteria )

(6)���� , 10cm , tension

, 2-0 Nylon , Dexon.

(7)���� , burn center, .

(8)���� , allergy history NSAID ,

Demerol

(9)���� EKG, , filter

(10) KUB Plain abdomen, β-hCG

, , , .

6/17 ( )

5 / 1 0 / 1 2 4

2 0 / 2 0my . s o -‐‑ n e t . n e t . t w / h s i n g l i n 2 0 0 2 / a r t i c l e / a r t i c l e 2 _ 4 . h t ml

1 ���� , Murphy sign. ,,

2 ����on femoral CVP, (VAN), pulse 0.5~1cm ,local , , CVP

3 ����綁 值 , , ,

4 ���� , Demerol, Drug addiction

5 ����Head trauma ,shoulder .

6 ���� DOA , ABCD survey CVP, pulse,echo vein , , , .

7 ���� , , endo ,, endo,

8 ����CPR , , , CPR ,

9 ���� 啟 3F, ,

10 ABG, radial artery , 45~60 , femoral artery, 90