*수* 스토어

*수*

개인

팔로워0 팔로우

소개

등록된 소개글이 없습니다.

전문분야 등록된 전문분야가 없습니다.

판매자 정보

학교정보

입력된 정보가 없습니다.

직장정보

입력된 정보가 없습니다.

자격증

입력된 정보가 없습니다.

판매지수

판매중 자료수

35개
전체 판매량

162개
최근 3개월 판매량

0개
자료후기 점수

평균A+
자료문의 응답률

-

전체자료 35개

판매자 표지

Jellyfish sting, 해파리 쏘임

Jellyfish StingsMarine Biology Jellyfish consume fish, crustaceans, and mollusks by injecting venomous capsules called nematocysts into their prey The nematocysts are clustered along the jellyfish's tentacles and discharge rapidly On C ontactVenom Delivery and Properties M ost injuries occur when H umans blunder into their tentacles After skin contact , jellyfish nematocysts release a hollow barbed tube that injects a mixture of proteinaceous toxins into the victims' skin The venom enters the Dermis and Systemic circulation  Both Skin and Systemic symptoms  Immune reaction to the implanted barb of the nematocystDangerous Species Common local effects : Cutaneous pain Swelling RednessClinical Manifestations Local Envenomation Immediate pain at the time of the sting  A few mins later : Linear, red, urticarial lesions The lesions often burn intensely and may itch and throb The pain may radiate up the limb to the torso In some cases, papular urticarial eruptions can recur 7 to 14 days later and may be intensely pruritic Lesions usually resolve within 10 days or for weeksClinical Manifestations Systemic Envenomation Irukandji syndrome Mild to moderately painful local stinging sensation S evere generalized back, chest, and abdominal pain, vomiting, sweating, agitation, severe hypertension, tachycardia  M yocardial injury and pulmonary edema Fatal intracranial hemorrhage secondary to severe hypertension has also been reportedClinical Manifestations Systemic Envenomation Cardiorespiratory arrest by C. fleckeri Anaphylaxis(rare) : Oral mucosal swelling, wheezing, generalized urticaria, distributive shock Ocular sting : Burning pain, photophobia, epithelial keratitis, corneal stromal edema, endothelial cell swelling, anterior chamber inflammation : These usually resolve within 48 hoursOn site Management Manual removal of visible jellyfish tentacles Treatment of pain with hot water immersion or application of a hot pack Rubbing of the sting site should be prevented Irrigation of the sting site with vinegar to inactivate nematocysts T entacle removal by spraying the site with shaving cream Scraping them off by a thin plastic objectEmergency Department Management Treatment of Life-threatening Envenomation : Check up for appropriate first aid, pain control etc. Cardiotoxicity(Cardiac arrest or Cardiogenic shock) Antivenom must be administered quickly (ideally within one hour of sting) to be effective. The physician should administer one vial (20,000 units) intravenously over 5 to 10 minutes as the initial dose; dosing may be repeated up to a maximum of three vials for patients who remain in cardiogenic shock or cardiac arrest. Irukandji syndrome (generalized pain and severe hypertension) Severe pain should be managed by systemic opioid medications ( eg , fentanyl or morphine). Severe hypertension : nitroglycerin, sodium nitroprusside, phentolamine treatment of Irukandji syndrome with magnesium sulfate is associated with significantly reduced pain and blood pressureEmergency Department Management Anaphylaxis : Intramuscular or intravenous epinephrine Pain control : Oral NSAIDs, Systemic opioid medications ( eg , fentanyl or morphine)(if needed) Corneal stings : Liberal irrigation of the eyes with saline or, during first aid, seawater Delayed hypersensitivity : Oral antihistamines, topical corticosteroids{nameOfApplication=Show}

의/약학| 2023.07.10| 14페이지| 2,000원| 조회(92)

jellyfish sting, 해파리 쏘임, 영문고찰

미리보기

닫기
판매자 표지

Varix bleeding-SB tube

Balloon tamponade of Gastroesophageal Varices SB tubeIntroduction patients with gastroesophageal varices arrive at the ED Massive hematemesis Airway compromise Hemodynamic instability Critical anemia Thrombocytopenia Coagulopathy In patients with cirrhosis, varices account for up to 80% of cases of UGIB.SB tubeIndications Initial resuscitation Early endotracheal intubation Circulatory resuscitation : Blood transfusion , V asoactive agents , Antibiotics - Somatostatin, its synthetic analogue octreotide - Vasopressin, its synthetic analogue terlipressin Early endoscopy (Gold standard ) ★ - Sclerotherapy - Band ligation (TOC )Indications Balloon tamponade : unstable patients with massive hemorrhage Endoscopy is not available Endoscopy is unsuccessful at controlling bleeding Consultant physicians are unavailable Vasoactive agents have failed to stop bleeding temporizing measure! final attempt to control hemorrhage and prevent imminent deathContraindications History of esophageal stricture Recent esophageal or gastric surgery  Esophageal rupture risk ↑Procedure High risk for vomiting, aspiration, airway compromise  endotracheal intubation should be strongly considered patient who is not intubated  administration of appropriate analgesia and sedationProcedure 1) testing the esophageal and gastric balloons for air leaks 2 ) occlude the ports and maintain deflation of the balloon during insertion  coat the balloons with a thin layer of water-soluble lubricating jelly 3) the SB tube does not have an esophageal aspiration port  secure a nasogastric tube (NGT) to the tamponade tube with silk suturesProcedure 4 ) Head elevation (at least 45 degrees) or the left lateral decubitus position 5) Pass the tube at least to the 50cm mark and preferably to the maximum depth allowed by the length of the tube 6) After the tube is inserted, apply continuous suction to its gastric and esophageal aspiration portsProcedure 7 ) Inflate the gastric balloon with approximately 50 m L of air  chest radiograph : confirm the position of the gastric balloon 8) Inflate the gastric balloon to the recommended total volume of air  clamp the inflation and pressure-monitoring portsProcedure 10 ) Slowly pull the device back until resistance and apply continuous traction 11) If blood is obtained from either port  inflate the esophageal balloon to approximately 35 to 40 mm Hg . ( do not inflate the esophageal balloon to more than 45 mm Hg )Procedure 12) Once hemostasis is achieved, clamp the esophageal inflation port to prevent air leaks . 13) If blood continues to be obtained  it is usually indicative of an uncontrolled gastric varix .  increase the traction gradually to a maximum of 1.2 kg .Complications Airway obstruction Esophageal rupture Aspiration pneumonitis Pain Ulceration of lips, mouth, tongue, or nares Esophageal and gastric mucosal erosions{nameOfApplication=Show}

의/약학| 2023.07.10| 13페이지| 2,500원| 조회(130)

GI bleeding, Varix bleeding, 정맥류 출혈, SB tub..

미리보기

닫기
판매자 표지

sudden cardiac death (틴티날리)

Introduction and epidemiology Most episodes of sudden cardiac death(SCD) occur in the home Cardiac arrest in public place have a much better chance of survival : Initial recorded cardiac arrest rhythm is more likely to be ventricular fibrillation Circadian pattern of SCD and acute MI : most likely to occur within the first few hours after awakening from sleep – increased sympathetic stimulation Prevalence : older than 45~50yrs , 60% occurring in males.Pathophysiology Coronary artery disease Severe left ventricular dysfunction Cardiomyopathy Congenital heart disease Valvular heart disease Cardiac pacemaker and conducting system disease Hereditary channelopathies : Sudden arrhythmic death syndrome, Ion channel disease, Brugada syndrome, Early Repolarization syndrome, Long QT syndrome, Short QT syndrome, Catecholaminergic polymorphic ventricular tachycardiaCoronary Artery Disease Coronary atherosclerosis is present on autopsy in 80% of SCD Found in 70~80% of cardiac arrest victims who survive and undergo CAG Initial cardiac arrest rhythm : V.fib (or shockable rhythm) suggests that an ACS is the cause Severe Left Ventricular Dysfunction Severe LV dysfunction with reduced EF = best available predictor of sudden death risk EF ≤ 35%  primary candidates for an implantable cardioverter-defibrillator(ICD)Cardiomyopathy Cardiomyopathy with reduced LV function = predictor of SCD HCMP is the most common cardiovascular cause of SCD in young athletes  ICD is recommended Arrhythmogenic right ventricular cardiomyopathy - the ECG typically shows T-wave inversion in the right precordial leads(V 1-3 ) - Treatment of choice : ICDCongenital heart diseaseValvular Heart Disease Hemodynamically severe a ortic stenosis  effort-induced dyspnea, myocardial ischemia, and ventricular arrhythmias  syncope and SCD - A harsh, late-peaking systolic murmur - at the upper-right sternal border with radiation to the neck Cardiac Pacemaker and Conducting System Disease Sick sinus syndrome effects the heart’s primary pacemaker  can cause intermittent lightheadedness , syncope , or SCDHereditary Channelopathies Sudden Arrhythmic Death Syndrome SCD occurring out of hospital in relatively young adults(mostly men) often during sleep or at rest usually without any premonitory symptoms(including syncope) no anatomic abnormality identified at autopsy Brugada Syndrome most commonly affects men prominent J-wave with a characteristic downsloping ST-segmental elevation in ECG lead V1-3. risk of SCD in high can be prevented by ICD placementHereditary Channelopathies Early Repolarization Syndrome ECG: prominent, notch-like J wave on the QRS downslope, followed by upsloping ST-segment elevation Teenager or young adult with syncope of unknown origin and/or family history of SCD at early age  refer to cardiology (OPD f/u)Hereditary Channelopathies Long QT syndrome Prolongation of the corrected QT interval, syncope, SCD by TdP and V.fib hereditary or acquired (e.g., hypokalemia, hypomagnesemia, hypocalcemia, anorexia, ischemia, CNS pathology, levofloxacin, terfenadine-ketoconazole combinations, or certain antipsychotic or antiarrhythmic drugs). Management : avoidance of QT-prolonging drugs and high-intensity sports ICD placementHereditary Channelopathies Short QT syndrome An abnormally short corrected QT interval (i.e., 0.34 second) secondar y to hypercalcemia, hyperkalemia, acidosis, systemic inflammatory syndrome, myocardial ischemia, or increased vagal tone or inherited in an autosomal dominant genetic pattern. Catecholaminergic Polymorphic Ventricular Tachycardia Genetically determined disorder involving defective myocardial cellular calcium handling No characteristic abnormalities in the ECG pattern Sinus bradycardia – not otherwise explainableThe most common premonitory symptoms : chest discomfort, dyspnea, “not feeling well” The best opportunity for prevention is to recognize sign and symptoms of the syndromes that place a patient at higher risk of SCD  admit or refer such patients for proper evaluation and prophylaxis. Antiarrhythmic drug and device therapy Prevention of Sudden Cardiac Death{nameOfApplication=Show}

의/약학| 2023.07.02| 13페이지| 2,500원| 조회(135)

응급의학, 틴티날리, 급성심장사

미리보기

닫기
위암

2/23(금) 윤독 : 위암1. 조기 위암 vs. 진행위암- 조기 위암 : 암의 침윤이 점막밑층(sm)까지 왔으며, 고유근육층에는 도달하지 않은 상태- 진행 위암 : 암의 침윤이 고유근육층(mp)에 도달한 상태2. 조기위암의 육안적 분류- 두 가지 이상의 모양이 혼재해 있는 경우는 주병변을 앞에 표시, 부병변을 뒤에 표시- 조기 위암은 함몰성 병변이 m/c, IIc와 IIc+III가 전체 과반수3. 진행 위암의 Borrmann형 분류법4. 위암의 내시경 치료: EMR, ESD가. 절대 적응증1) 점막에 국한된 분화암(well and/or moderately differentiated adenocarcinoma)2) 장경 2cm 이하3) 궤양이나 궤양 반흔이 없고4) 암세포의 림프혈관 침범이 없는 경우나. 확대적응증1) 병변의 크기와 관계없이 궤양이 없는 점막내 분화형 선암2) 궤양이 있더라도 3cm 이하의 점막내 분화형 선암

의/약학| 2018.09.05| 2페이지| 1,000원| 조회(470)

위암, 위암분류, 위암 내시경 치료

미리보기

닫기
유방암치료

1. ER and/or PR (+) ⇒ Hormonal therapy- premenopausal : Tamoxifen- postmenopausal : Aromatase inhibitor2. ER and PR (-) ⇒ CTx.3. ER and/or PR (+)1) Lymph node (+) ⇒ CTx.2) Lymph node (-) : tumor size에 따라 치료 결정- 1cm 초과 : CTx.- 0.6~1cm : HER-2(3+)일 때, trastuzumab(herceptin)- 0.5cm이하 : CTx. 안함.1. 나이 45세 여자가 좌측 유방의 종괴로 병원을 방문하여 유방암 진단 받고 부분 절제술을 시행하였다. 이 환자의 수술 후 소견은 다음과 같다.[Primary tumor 2x1cm, Lymph node 16개에서 1개 전이 관찰, ER/PR/c-erb2(+/-/+++)향후 보조 치료는?1) ER or PR (+/-) ⇒ Hormonal therapy2) Lymph node (+), tumor size 1cm 초과 ⇒ CTx.3) c-erb2(+++) ⇒ Trastuzumab(herceptin)4) 부분절제술 시 LRF 방지 ⇒ RTx.즉, 보조치료로 “Hormonal therapy, CTx., Trastuzumab(herceptin), RTx."2. 65세 여자가 좌측 유방의 침윤성관상암(infiltrating ductal carcinoa)로 진단되어 유방 보존술을 시행하였다. 병리 조직 검사에서 종양의 크기는 3cm이었고, 액와 림프절 14개 중 2개에서 전이 소견을 보였으며 호르몬 수용체는 양성이었다. 치료는?종양의 크기 >1cm ⇒ CTx. / Lymph node(+) ⇒ CTx. /호르몬수용체 양성, 폐경 ⇒ Aromatase inhibitor / RTx.의 금기없음 ⇒ RTx.치료 : CTx. + RTx. + Aromatase inhibitor3. 40세 폐경 전 여자가 좌측 유방에 3cm의 종괴로 병원을 방문하여 유방암을 진단받았다. 근치적 유방 절제술을 시행하였고 술후 조직 검상에서 액와 림프절 전이는 없었으며 호르몬 수용체 음성, Her2 염색 1+로 관찰되었다. 이후 시행해야 할 치료는?

의/약학| 2018.09.05| 1페이지| 1,000원| 조회(178)

유방암, 혈종, 유방암치료, 호르몬치료, 유방종괴

미리보기

닫기