愛的(ATDE)翻轉學習(Flipped learning 『新生兒立即護理 · 教案之創新性 教學策略、教學活動及實施流程 愛的(ATDE)創造 思考教學模式 教學活動及實施流程
EUS教學_990729_Journal & Challenging Cases
Transcript of EUS教學_990729_Journal & Challenging Cases
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EUS_990729
Challenging cases & Journal Reading
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245
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GB stone
No wall thickening or
pericholecystic fluid
Positive sonographicMurphys sign
Ann Emerg Med. 2010;56:114-122
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A distended GBgallstones with ASGB wall thickening & multiple layeringpericholecystic fluid
Ann Emerg Med. 2010;56:114-122
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EPs and radiologists performance was similar
Ann Emerg Med. 2010;56:114-122
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Ann Emerg Med. 2010;56:114-122
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What this study adds to our knowledge ?
In this small, single-site study (164
patients, 43 EPs), emergency physiciansand radiologists performance was similar
Ann Emerg Med. 2010;56:114-122
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X-ray?
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Bedside US can accurately diagnose
pediatric clavicle fractures
100 pts & 43 clavicle
fractures by X-ray
US
Sensitivity 95%
Specificity 96%
Accuracy 96%
PPV: 95%
NPV 96%
ACADEMIC EMERGENCY MEDICINE 2010; 17:687693
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84M with dyspnea
Desaturation s/p thoracentesisfor Rt PLE Repeat CXR 3hrs later
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What do you see in this
postprocedural pneumothorax?
http://postprocedural%20ptx%20by%20us.avi/ -
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Ski Lift technique to assist CVC
placement
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Submassive Pulmonary Embolism71F, 4-hour history of chest pain,
worsening shortness of breath, nausea, dizziness, and chills
The McConnell sign (RV mid-segment dilation with apicalsparing) has been reported to be specific for submassive PE
http://submassive%20pulmonary%20embolism%20by%20us_1.mov/ -
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Submassive Pulmonary Embolism
RV pressure overload with a D-shaped left ventricle was present during both systoleand diastole, and a large dilated RV was present in parasternal short-axis view
http://submassive%20pulmonary%20embolism%20by%20us_2.mov/ -
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Submassive Pulmonary Embolism
The RV outflow tract parasternal short-axis view also showed right atrial (RA)pressure overload with the intra-atrial septum bulging into the left atrium
http://submassive%20pulmonary%20embolism%20by%20us_3.mov/ -
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Bubble Test to confirm CVC position
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5F, with cough and septic shock
http://1_lll%20pn%20with%20septic%20shock_5f_12950346/ -
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43M, cough with left chest pain
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67F, RUQ pain for 2 hours
SKH_ER
http://3_acute%20cholecystitis_67f_08882288/Acute%20cholecystitis_67F_08882288.wmvhttp://3_acute%20cholecystitis_67f_08882288/Acute%20cholecystitis_67F_08882288.wmv -
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31F, RUQ pain for half day
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85F, RUQ pain and sepsis
http://xn--5_gb%20empyema_85m_02856474_-ij10eyu1w2gqd/GB%20empyema_85M_02856474.wmvhttp://xn--5_gb%20empyema_85m_02856474_-ij10eyu1w2gqd/ -
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22M, RLQ pain
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49F, fever and left flank pain for 2 weeks
http://7_emphysematous%20pyelonephritis_49f_16171951/Emphysematous%20pyelonephritis_49F_16171951_1.wmvhttp://7_emphysematous%20pyelonephritis_49f_16171951/ -
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64F, fever and left inguinal pain
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53M, Buccal ca s/p op with left
submandibular swelling
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65M, MVA victim, left chest and
abdominal pain with hypotension
http://10_splenic%20laceration%20%26%20ptx_65m_10848085/http://10_splenic%20laceration%20%26%20ptx_65m_10848085/20100417_1700_Splenic%20laceration%20&%20PTX_65m_10848085.mpg -
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Cases of this month
1. Retrocardiac pneumonia2. LUL pneumonia
3. Acute cholecystitis
4. Acute cholecystitis
5. GB empyema
6. Retrocecal appendicitis
7. Emphysematous pyelonephritis
8. Left inguinal lymphadenopathy
9. Submandibular abscess
10.Traumatic pneumothorax and splenic laceration