案例讨论教学

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1、案例討論教學新光醫院急診醫學科25歲男性1253222594.2.207:47pm家人陪同自行步入TRIAGE檢傷分級:IIT：39°C，P：94/min，R：18/min，BP：128/60mmHgChiefcomplaint主訴:Neckswelling頸部腫脹for2daysPresentillness現病史:在家不知有無fevercoughwithyellowishsputumfor2dayssorethroatfor2daysdyspneageneralsorenessnorhinorrheaPast

2、history:DeniedallergyDeniedsystemicdiseasePhysicalExaminationCons:clearH&N:conj:notpalesubmentalswelling下頷,tenderChest:coarseAbd:softExt:freelymovableImpression?Order7:50pmNecksofttissueviewWBC/DC,Hb,PltCRPN/Srun80ml/hKeto1ampIMstConsultENT8:20pmPCT()Ifnegat

3、ive,Augmentin1.2gst+q8hivBun/CreKeto,Danzen1#qidpo2daysOPDf/uResultWBC25550Seg89%Band4%Hb:16.4Platelet:197000CRP:10.1Bun/Cre:9/1.1Necksofttissueview:ENT:MildinjectedthroatPatentvocalcordImp:neckcellulitisr/osubmandibularsialadenitisOralVoren,Augmentin,Simage

4、l,DanzenOPDf/u.Order2/21amGenta-C80mgivdst+q8h2:25amNeckCTsccontrastMetronidazole1gstivthen500mgq6hivB/CIIVBGReconsultENT9:40amAdmissionandOPResultNeckCTLudwigangina:areviewofcurrentairwaymanagement.ArchivesofOtolaryngology--Head&NeckSurgery.MarpleBF.125(5):

5、596-9,1999May.Ludwig'sangina:aclinicalreview.EuropeanArchivesofOto-Rhino-Laryngology.SrirompotongS.Art-SmartT.260(7):401-3,Aug2003.Ludwig’sAnginaBackgroundHippocratesin1836,apostmortemfindings,KarlFriedrichWilhelmvonLudwigArapidlyprogressivegangrenouscelluli

6、tisoriginatinginsubmandibulargland.Inflammatorydistentionofthefascialplanesoftheneckcanleadtorespiratorytractobstructionanddeath.Itextendsbycontinuityratherthanlymphaticspread.Mortalityrateexceeds50%duringthepreantibioticera,attributedtooverwhelmingsepsis.Bu

7、tintheearly1900sthedeadlyroleofmechanicalrespiratoryobstructionwasrealized.Etiology>90%odontogenicinoriginPeritonsillarabsecessParapharyngealabscessesOrallacerationsMandibularfracturesSubmandibularsialadenitisPresentationNeckswellingToothpainProtrudingorelev

8、atedtongueFeverDysphagiaTrismusDifficultybreathingAsphyxiaPathogensBacterialisolatesareoftenmixed,comprisingbothaerobesandanaerobes.Mostlyalpha-hemolyticstreptococci,staphylococciandbacteroides.