Nutrition

基本營養：
30-35ml/kg (geriatrics 30 ml/kg), 1ml/kcal fed, 1500ml/m2 TBSA


Calories
1.Maintenance: 25-30kcal/kg actual wt unless obese
2.Hypercatabolic: 25-35 kcal/kg actual wt unless obese
3.Obesity: calculate needs using Adjusted Body Weight (AW) – 21-25 kcal/kg adjusted BW


***AW=IBW+{(actual wt-IBW)x.25}***


Protein
1.Maintenance: 1.0-1.2 gms/kg/IBW
2.Moderate stress: 1.2-1.5 gms/kg/IBW
3.Severe stress: 1.5-2.0 gms/kg/IBW

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The Shift

The first 3 numbers from the left (WBC total, bands, and neutrophils) are important because the total number of white blood cells increases when you have an acute infection, and the numbers of bands and neutrophils also increase, causing a shift in percentages because, as the percentage of bands and neutrophils increase, the percentages of the other cells must decrease. This then constitutes the "shift to the left."

取自：What Is a Shift to the Left in Blood Testing?

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あおい輝彦 - あなただけを

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Ventricular Arrhythmias

Slow Idioventricular escape rhythm：寬的QRS，速率30~40 beats/min


AIVR(Accelerated IdioVentricular Rhythm)：速率>40 beats/min，不超過110~120 beats/min


Ventricular Tachycardia：速率>120~130 beats/min


Ventricular Fibrillation：一定要會看！

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Light's criteria

Pleural effusion-->抽LDH, Protein

Exudative:
pleural fluid Protein/serum Protein > 0.5
pleural fluid LDH/LDH > 0.6
pleural fluid LDH > serum LDH 2/3 正常上限

sensitivity很高，negative-->「排除」, postive-->「不能確定」

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DKA

症狀：polyuria, polydispia, BW loss, nausea, vomiting, abdominal pain, tarchycardia, dehydration

可以灌水：N/S 500~1000 ml/hr，record I/O

可先給HRI 0.15U/kg，接下來泡100U+100ml N/S run 0.1U/kg/hr的速度，以+/-0.5~1U調整，1小時降血糖50~75，不要超過100，會encephalopathy。

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