Hyperlipidemia

TG: DM，酒，ESRD，hepatitis，B-blocker，estrogen，gucocorticoid
LDL：hypothyroidism，cholestasis，Thiazide


estrogen會同時升高TG、HDL


TC = HDL+LDL+TG/5

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CSF

Normal values (CSF):

CSF opening pressure: 50–180 mmH2O Glucose: 40–85 mg/dL. Protein (total): 15–45 mg/dL. Lactate dehyrogenase: 1/10 of serum level. Lactate: less than 35 mg/dL. Leukocytes (WBC): 0–5/µL (adults / children); up to 30/µL (newborns). Gram stain: negative. Culture: sterile. Specific gravity: 1.006–1.009. Syphilis serology: negative. Gross appearance: Normal CSF is clear and colorless. Differential: 60–70% lymphocytes; up to 30% monocytes     and macrophages; other cells 2% or less.

Bacterial Meningitis Glucose (mg/dL): Normal to marked decrease.  <40 mg/dL. Protein (mg/dL) (Marked increase)  > 250 mg/dL. WBCs (cells/µL) >500 (usually > 1000).  Early: May be < 100. Cell differential: Predominance of Neutrophils (PMNs) Culture: Positive Opening Pressure Elevated

Fungal Meningitis Glucose (mg/dL): <40 mg/dL (Low) Protein (mg/dL) (moderate to marked increase) 25 -500 mg/dL WBCs (cells/µL) Variable (10 -1000 cells/µL) <500cells/µL. Cell differential: Predominance of Lymphocytes Culture: Positive (fungal) Opening Pressure Variable

Tubercular Meningitis Glucose (mg/dL): <40 mg/dL (Low) Protein (mg/dL) (moderate to marked increase) 50 -500 mg/dL WBCs (cells/µL) Variable (10 -1000 cells/µL) <500cells/µL. Cell differential: Predominance of Lymphocytes Culture: Positive for AFB Opening Pressure Variable

Viral Meningitis Glucose (mg/dL): Normal   (> 40 mg/dL.) Protein (mg/dL) <100 mg/dL (moderate increase) WBCs (cells/µL) < 100 cells/µL. Cell differential: Early: neutrophils. Late: lymphocytes. Culture: Negative Opening Pressure Usually normal

文章取自此處

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Anti-arrhythmia

Class	Basic Mechanism	Comments
I	sodium-channel blockade	Reduce phase 0 slope and peak of action potential.
IA	- moderate	Moderate reduction in phase 0 slope; increase APD; increase ERP.
IB	- weak	Small reduction in phase 0 slope; reduce APD; decrease ERP.
IC	- strong	Pronounced reduction in phase 0 slope; no effect on APD or ERP.
II	beta-blockade	Block sympathetic activity; reduce rate and conduction.
III	potassium-channel blockade	Delay repolarization (phase 3) and thereby increase action potential duration and effective refractory period.
IV	calcium-channel blockade	Block L-type calcium-channels; most effective at SA and AV nodes; reduce rate and conduction.

引用自此

Class Ia Procainamide Quinidine Disopyramide	Class II Propranolol Atenolol Nadolol Metoprolol Pindolol Esmolol	Others Bretylium Digoxin Adenosine Phenylephrine Midodrine Fludrocortisone
Class Ib Lidocaine Mexiletine Phenytoin Moricizine	Class III Ibutalide Sotalol Amiodarone
Class 1c Flecainide Propafenone	Class IV Verapamil Diltiazem

Structure heart diseaseàI C

LV dysfunction or CADàIII

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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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