SSRI & Serotonin Syndrome

SSRI on Prezi

 Serotonin Syndrome

Sternbach 診斷標準(1991)： 必備條件加上十項主要條件的三項以上。 必備條件:

• 增加單一神經激胺作用的藥物劑量或加入另一種促進神經激胺作用的藥物。
• 排除其他因藥物疾病或神經精神疾病所導致的異常。

主要條件:

1. 神智改變
2. 躁動                             
3. 動作不協調                  
4. 肌跳躍(myoclonus)    
5. 顫抖                          
6. 震顫
7. 反射增強
8. 流汗
9. 腹瀉
10. 發燒

Hunter Serotonin Toxicity Criteria QJM 2003;96:635-42

一氧化碳中毒

Carbon Monoxide Poisoning from Sun YaiCheng

一氧化碳中毒 (AILS Course)

急性一氧化碳中毒的處置重點：

1. 急性一氧化碳中毒之病患，應立即給予高濃度氧氣治療 (100% O2)
2. 評估急性一氧化碳中毒病患的臨床症狀，以決定是否需高壓氧治療 (HBO)
   
3. 病患出院前須告知神經精神後遺症之風險 (Delayed Neuropsychologic Sequelae)
   

肝硬化 食道靜脈曲張出血的處置

Management of Varices and Variceal Hemorrhage in Cirrhosis

Management of Varices and Variceal Hemorrhage in Cirrhosis N Engl J Med March 4, 2010;362:823-32 Purpose of Therapy

1. Primary prophylaxis: prevent a first episode of variceal hemorrhage
2. Treatment of the acute bleeding episode
3. Secondary prophylaxis: prevention of recurrent variceal hemorrhage

Risk Stratification for Patients with Portal Hypertension 1. Esophagogastroduodenoscopy

• to evaluate the presence of varices, red wale marks, and variceal size

2. HVPG (hepatic venous pressure gradient)

• Portal hypertension is clinically significant when HVPG >10 mmHg, this pressure is the strongest predictor of the development of varices, clinical decompensation, and HCC.
• In patients with variceal hemorrhage, HVPG >20 mmHg (measured within 24 hours after admission) is the best predictor of a poor outcome.

3. Child-Turcotte-Pugh classification system

Treatment of Acute Variceal Hemorrhage Standard Therapy

1. Combination of vasoconstrictor (terlipressin, somatostatin, or octreotide, administered from the time of admission and maintained for 2 to 5 days) and endoscopic therapy (preferably endoscopic variceal ligation, performed at diagnostic endoscopy <12 hours after admission), together with short-term prophylactic antibiotics (either norfloxacin or ceftriaxone).
2. Placement of a TIPS is currently considered a salvage therapy for the 10 to 20% of patients in whom standard medical therapy fails.
3. Endoscopic variceal obturation is the best endoscopic technique to control acute hemorrhage and the TIPS is more effective than variceal obturation in preventing recurrent hemorrhage.