Intern Note

ҁਜϣ৒х֖ӭঁ೽ϩ

1ǵ ߏ۪ Intern Note

2ǵ ОࢃᆂᙝᏢߏ‫ޑ‬General drugs

3ǵ Oral Hypoglycemic Agents by M42 ᑵΞϘᏢߏ

4ǵ ᑗֿੰΓதҔफ़Ոᑗᛰ from CMUH

5ǵ ϣࣽॶ੤Ћн

6ǵ ೀ౛ complaint ϐҔᛰ

7ǵ ॶ੤ on call

8ǵ ABG ‫ޑ‬ղ᠐

9ǵ Јॣղ᠐ᆒा

10ǵ ᡏనႝှ፦όѳᑽϐೀ࿼

11ǵ ٩ੱংဂϐ‫ל‬ғન٬Ҕচ߾ by ЦҺ፣ЬҺ

12ǵ λ‫לٽ‬ғન߄਱ by ݅ဃᑫᙴৣ

PSǺ
1ǵҁ Intern Note ࢂӭঁᔞਢ‫ޑ‬໣ӝǴྍԾᆛၡǵᙴଣႝတ฻Ǵ‫܌‬аᝄ਱ٰᇥ
ࢂؒԖ‫ޑ៾ހ‬ǼѝԖ࿶ၸλ‫ך׌‬ख़ཥ௨‫ހ‬᏾౛Զς^^
2ǵচҁѺᆉӧ Run ϣࣽϐ߻ֹԋԜЋнǴٰᔈбॶ੤ਔ‫܌‬ၶ‫ޑډ‬Ӛᅿ௃‫ݩ‬Ǵ
྽ਔς࿶ֹԋΖԋ(ѐԃϤДۭ)Ǵࡕٰ຾ΕϣࣽჴಞࡕǴ൩΋ӆӦ‫ۯ‬᪓Կ
Ϟ>.<όࣗ⁶ቑߓɴ

а΢ by CMU M44 ೾ࡹֻ

Intern ่‫ࡕ״‬ಃϤຼ 2008/05/25


 INTERN NOTE
PART 1 Order ᙴᡗ‫س‬಍ 3
PART 2 Common problems and work up
01. Fever 8
02. Chest pain 9
03. Abdominal pain 11
04. Hypertension and Hypotension 13
05. Hyperglycemia 13
06. GI bleeding 14
07. I/O imbalance 18
08. Short of breath 19
09. Seizure 21
10. Conscious change 22
11. Headache 23
12. Tachycardia and Bradycardia 23
13. PCT 24
14. BACK PAIN 25
PART 3 Post-OP Problems
01. Wound infection 26
02. Pain 26
03. N-G tube 26
04. IVFǴTry diet 26
05. ဉ೷䈜 27
06. Surgical drain 27
07. Chest tube 27
08. Foley Irrigation 27
09. Foley traction 28
10. Nelaton Tube 28
11. IICP 28
12. Diabetes Insipidus 28
PART 4 COMMON DRUGS
01. Pain 29
02. GI discomfort 30
AGE
Vomiting / Nausea / Hiccup
Abdominal pain
Gastric pain
Diarrhea

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 Constipation
Abdominal distension
Hemorrhoid
UGI bleeding
03. Rhinorrhea 32
04. Cough 32
05. Dizziness/ vertigo 33
06. ֽ೽ЗՈ 33
07. Insomnia 33
08. Oral ulcer 33
09. Oral candidiasis 34
10. AllergyǴskin itching 34
11. Burn 34
12. Hypoglycemia 34
13. HTN 34
14. Fever 35
15. Seizure 35
16. Others 36
PART 5 PROCEDURES
01. ABG 37
02. NG 38
03. Foley & ICP 38
04. EKG 39
05. On IV or ‫ܜ‬Ո 39
06. Intubation (On endo) 39
07. On central catheter (On CVP) 39
PART 6 Tools of the Trade
01. ABG 42
02. CXR 48
03. EKG 49
04. CBC/DC 50
05. ғϯ NaǴKǴCa 52
06. U/A 55
07. ᠋ບ 56
08. Oral Presentation 58
PART 7 ᙴੰᜢ߯&ᙴᕍᒱᇤ࿶ᡍፋ 60

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PART 1 Order ᙴᡗ‫س‬಍
! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! M92 ߉ࡏ㸿

Order ᙴᡗǺ໒‫ۈ‬ԋࣁ੿҅‫ޑ‬ᙴৣ
Intern ‫ـک‬ಞനε‫ޑ‬όӕ൩ࢂ Intern ໒‫ۈ‬ाௗ᝻‫ډ‬ᙴᡗǶ೭Ψࢂᙴৣനख़ा
‫ޑ‬πբǴᙴᡗ໒‫ޑ‬όܴόқǴៈγ൩ค‫୺ݤ‬ՉǴੰ஻൩ค‫ݤ‬ள‫ډ‬ᙴᕍǶӢࣁྣ
៝ੰ஻‫ޑ‬ε೽ϩπբǴхࡴඤᛰǵวᛰǵໆՈᓸǴ೿ࢂҗᙴৣ໒ᙴᡗԶҗៈγ
୺ՉǶඤѡ၉ᇥǴੰ‫္܊‬ᙴৣ൩ѝࢂ཮р΋஭቏ԶςǶ‫܌‬а྽‫ॺך‬ᗋࢂനλͪ
Ͷ‫ޑ‬ᙴৣǴӵՖᇥ‫ޑ‬మཱΞܴқǴᡣៈγ୺Չ‫ޑ‬ЈҒ௃ᜫǴ൩ࢂӚՏӧখ྽ჴ
ಞᙴৣਔाӳӳᏢಞ‫ޑ‬Ƕѝाգ‫ޑ‬ᙴᡗమཱޭ‫ۓ‬Ǵᇥளрၰ౛Ǵόᔉ‫ޑ‬ਔং຀
Ј‫؃‬௲ǴԾฅࡐ৒ܰគளࡐӭК‫ॺך‬ᗋाၗు‫ޑ‬ៈγᏢ‫ޑۊ‬൧ख़Ǵ྽ฅգ‫ޑ‬ჴ
ಞၸำ཮ࢂ໩ճѳ‫ک‬Ǵӭᇡ᛽ࡐӭܻ϶Ξό཮‫ک‬Γଆ‫୺ݾ‬ᘁǼ
ԖࡐӭࣽձࣁΑਏ౗ԖӚԄӚኬ‫ޑ‬ႝတ order ጄҁёа‫ޔ‬ௗЇҔǴᇴਔ໔ਔ
ߚத‫ޑ‬БߡǴѝࢂ೯த೿ၸ‫ܭ‬ᙁౣǴΨ཮೷ԋ໒ order ਔ۹ౣࡐӭ٣௃‫ޑ‬ಞᄍǶ
Ԗ‫ܭד‬ϣࣽ‫س‬಍ϐγӵ݀΋໒‫ۈ‬όࢂӧϣࣽ‫܈‬ઓϣ฻ࣽԶӧѦࣽ‫س‬ǴࣁΑೲࡋ
ёаኩਔ”ௗ‫(”ڙ‬όฅ੿‫଺཮ޑ‬όֹ)Ǵՠόा೏ಞᄍቹៜᘁǼӵ݀ࢂԖ‫ܭד‬Ѧࣽ
‫س‬಍‫ܴޑ‬Вϐࢃ൩࣮ԾρЈ௃୚Ǵ೭٠όࢂϙሶӳಞᄍ‫܈‬ᚯಞᄍ‫ޑ‬ୢᚒǴӢࣁ
ሦୱ౥ഖόӕ჊Ǽ
аΠ໒‫ۈ‬ϟಏӚᅿख़ाᙴᡗ‫ޑ‬໒‫ݙکݤ‬ཀ٣໨Ǻ
1. Admission OrderǺϺୟǼ‫ך‬གྷᅵ᝺Ǵ‫ך‬όाௗ New patient ୚Ǽ
‫ ۪ߏॺך‬internǴ໒ admission order ϐ߻Ǵ೯த཮Ӄ࣮ၸаΠΟ໨Ǻ
1.Րଣ೯‫ൂޕ‬ǺԖ VS ߐບਔΠ‫ޑޑ‬ບᘐаϷҬжा଺‫ޑ‬ೀ࿼ǴќѦੰΓς
࿶଺ၸব٤ᔠࢗǴႣ‫ۓ‬Ֆਔ໒Θ฻฻…
2.Past historyǺவᙑੰᐕ‫܈‬ႝတ΢ࢗ၌ၸѐ‫ߐޑ‬ບϷՐଣੰўǴԖব٤
underlying diseasesǴ ࡚ບ‫ੰޑ‬ᐕΨග‫ٮ‬ᙦ൤‫ޑ‬ၗૻǶ
3.ੰΓǺ೭ঁࢂനख़ा‫ੰ!!!ޑ‬ΓҞ߻‫ ޑ‬ConditionǴ Active problem ฻฻…
ЇҔԾ M92 ‫ ހ‬Intern Note ӂ‫ە‬Ǵࠧద
΋ঁཥੰΓٰᙴଣՐଣǴԖ‫ঁٿ‬΢ٰੰ‫ޑ܊‬೼৩Ǻ΋ঁࢂ࿶ၸՐଣ୍ܺύ
ЈǴќѦࢂ࿶ၸ࡚ບǶߐບӼ௨‫ੰޑ‬ΓӭъவՐܺ΢ੰ‫܊‬Ǵନߚࢂఁ΢Րܺ
Π੤ω཮җ࡚ບٰǶ΋૓வՐܺ΢ٰ‫ੰޑ‬Γӭъ೿ς࿶‫ֹܜ‬ՈǴ଺ֹ X Ӏ
‫ ک‬EKGǶόᆅࢂவবٰǴੰΓ೿཮஥๱Րଣ೯‫܊ੰډൂޕ‬ൔ‫ډ‬Ǵ೯தЬ‫ݯ‬
ᙴৣ೿཮ӧ΢य़ҬжੰΓԜԛՐଣा଺ϙሶǶӃ࣮Րଣ೯‫ൂޕ‬ӆ࣮ੰΓКၨ
ό཮೏ੰΓ΋ୢΟό‫ޕ‬ভǼவ࡚ບٰ‫ੰޑ‬Γ߾Ԗ࡚ບੰᐕёࢗ᎙Ƕ
ፎ ί ࿤ Ϫ ૶ Ǵ ྽ ៈ γ call գ ௗ New patient ਔ Ǵ Ӄ ‫ ע‬Ր ଣ ᙴ ᡗ ໒ ӳ Ǵ
Admission Note ᄌᄌӆѺǴӢࣁգόᇴ‫ז‬໒ orderǴӴॺ೿ؒ‫ܜݤ‬ՈวᛰǴੰ
ΓΨ཮೏බӧੰ‫܊‬Ǵ೭ࢂখ྽ intern ਔததབόమཱՠࢂࠅࡐख़ा‫ޑ‬΋ᗺǶ
аΠаጄ‫ٯ‬Ңጄ҅ዴ‫ ޑ‬Admission Order ໒‫ݤ‬ǶModified from Washington
ManualǺADCVAADINLM
@Admission Order
@Admitted on the service of Dr. XXX (ҁԛՐଣ‫ޑ‬Ь‫ݯ‬ᙴৣ)
@Diagnosis (1) ~ (10)Ǻಃ΋ঁບᘐाቪ೭ԛՐଣ‫ޑ‬চӢǶёаቪӭ໨ບᘐǴ
хࡴ underlying disease ೿ाቪǴຫ active ाቪ‫ޑ‬ຫ߻य़Ƕ

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@ConditionǺЬाԖΟᅿ‫ ݩރ‬StableǴGuardedǴCriticalǴ΋૓ѦࣽՐଣ໒Θ
‫ੰޑ‬Γ‫ݩރ‬ӭࣁ StableǴԶϣࣽੰ஻ӭࣁ GuardedǴӆٰ൩ࢂੰӒੰΓ
criticalǴ྽գाௗ೭ኬ‫ੰޑ‬Γਔፎҥ‫څ‬೯‫ޕ‬ՐଣᙴৣᏢߏǶ
@Vital signsǺाፎៈγλ‫ۆ‬ӭΦໆ΋ԛ Vital signǴϣѦࣽัԖόӕǶѦࣽ
ੰ஻࣬ჹᛙ‫ۓ‬Ǵӭъ໒‫ ࢂޑ‬Vital signs as ward routine(΋Ϻ‫ٿ‬ԛǴԐ΢ΐᗺ
‫ک‬Πϱϖᗺ)ǶԶϣࣽੰΓຎ௃‫ݩ‬Զ‫ۓ‬Ǵ΋૓த໒‫ޑ‬໒‫ ࢂݤ‬Vital signs q8h(ៈ
γ‫؂‬੤΋ԛǴ9AMǴ5PMǴ1AM)
@ActivityǺதҔ‫ޑ‬ΨࢂΟᅿ no limitationǴas tolerated in room(ε೽ϩ೿ࢂ໒
೭ঁ)Ǵbed rest(ࢌ٤੝ਸ௃‫཮ݩ‬Ҕ೭ঁ orderǴMain coronary artery stenosisǵ
SAHǵCVA ฻฻ੰΓததѸ໪ज़‫ ڋ‬bed rest)
@AllergyǺੰΓа߻ԖؒԖჹϙሶᛰ‫ނ‬Ԗၸ௵‫ੰޑ‬ўǻԖ٤੝ձ‫ޑ‬ᛰ‫ނ‬ϸᔈ
Ψाइᒵӧ೭Ƕ
@DietǺКၨதҔ‫ޑډ‬ԖΠӈ൳ᅿ
#Diet as tolerated ᒿߡӞǴᅰໆӞ
Ԗ٤੝ਸੰΓӵ݀ाज़‫ࢌڋ‬໨੝ձ‫ޑ‬ᔼᎦǴёаቪԋӵΠ‫ ޑ‬orderǺ
Diet ज़ protein<30g/day & salt< 3g/day
#NPO ࿣१
#DM dietǺᑗֿੰᓓǴத‫ـ‬Ԗ 1500Ǵ1800Ǵ2000kcal/day ΟᅿǴՠࢂ
ӢࣁࡐᜤӞǴԖ٤ੰΓਥҁόགྷुǶ‫܌‬аा‫ݙ‬ཀόࢂգ໒ΑੰΓ൩΋
‫ࢂۓ‬೭ኬӞভǼ೭ӆ௓‫ڋ‬Ոᑗਔࡐख़ाǴा૶ளၟᑗֿੰੰΓፁ௲Ƕ
#NG dietǺΨϩΟᅿ 1500Ǵ1800Ǵ2000kcal/dayǴӢவ NG ឲǴ‫܌‬аФ
ѪԋϩࣁЬǴԖ٤٢ᑗ௵ག‫ޑ‬Γ཮ᘞ‫غ‬ηǴёኩ hold ‫ׯ܈‬΋٤ե٢ᑗ
ФѪǶ
#Special dietǺ
Colon prepareǺ(ࢌ٤Ћೌ‫܂‬ဉηϼ๞཮໾‫)ډ‬
Colon prepareÆop ߻ΟϺ໒‫ۈ‬
1. oral form neomycin(250mg)+ erythromycin(250mg) +Spasgel Ӛ
1# qid * 3days
2. 3rd pre-op day=low residual diet (ե෦໯१)
3. 2nd pre-op day=liquid diet (ӄࢬ໯१)
4. 1st pre-op day=clear liquid diet (మࢬ໯१)
@IVFǺຏܴाҔϙሶᗺᅀǴᗺᅀ္ाуϙሶᛰǶ(೭٤ाу‫ޑ‬ᛰதத೿ाќ
Ѧ‫ډ‬ᛰᡗ္໒ᛰൂভǼ)‫ٯ‬ӵǺ
IVF D5S/D5W 1000cc + 20meq KCl run 100cc/hr
ඤԋύЎ‫ޑ‬ཀࡘ൩ࢂ 1000cc ΋х‫ ޑ‬D5S ‫ ک‬D5W ҬඹҔ 100cc/hr ‫ޑ‬ೲ
ࡋᅀǴᅀֹ 1000cc ‫ ޑ‬D5S ӆඤ D5W(‫܌‬а΋хाᅀΜλਔω཮ᅀ
ֹ)Ǵ‫؂‬хύाу 20 ༾྽ໆ‫ ޑ‬KCl
@NursingǺ੝ձाፎៈγೀ౛‫ޑ‬٣໨Ƕ೭೽ϩதҗӭঁ೽ϩಔӝԶԋǶ‫ٯ‬
ӵǺ
Record body weight qd
Record I/O q8h
Check Finger sugar ACǴPC qd x 3 days
Wound care with Aq-BI qd & prn ฻฻
@Lab & ExamǺ գ གྷ ᔅ ੰ Γ Ӽ ௨ ϙ ሶ ᔠ ࢗ ‫ ګ‬ǻ գ ࢂ ᙴ ৣ Ǵ ӳ ӳ ‫ ଺ ޑ‬٤
Differential diagnosis ϐࡕᅰ௃ѐ଺փǼӵགྷӼ௨੝ձ‫ޑ‬ᔠࢗ૶ளाӃၟՐଣ

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 ᙴৣൔഢভǼխள‫ډ‬ਔং্Ь‫ݯ‬ᙴৣ೏଼ߥԌᒲǶќѦǴੰΓӵ݀ӧՐܺ‫܈‬
࡚ບς࿶‫ܜ‬ၸՈ‫଺܈‬ၸᔠࢗ૶ளΨ೿ाӈрٰǴӧᔠࢗ‫ࡕޑ‬य़ຏܴ”ςբ”Ƕ
ఁ΢‫ࢃک‬යϺௗཥੰΓਔ‫܌‬Ԗ‫ޑ‬ᔠࢗ‫ܜ‬Ոӵ݀གྷଭ΢‫ޕ‬ၰၗ਑೿ा໒࡚ൂǴ
Ӣࣁᔠᡍ࠻೭٤ਔংѝ଺ stat ‫ޑ‬ᔠᡍǶߚ྽Ϻा଺‫ޑ‬ᔠࢗΨፎӧࡕय़ຏܴВ
යǶ
‫ݙ‬ཀǺ΋૓ U/A ֿన᜔ᔠा૶ள໒ Urine routine exam у΢ sediments
@MedicationsǺੰΓՐଣύգा๏ϙሶᛰ‫ګ‬ǻ
@‫ځ‬д੝ձೀ࿼
2. Pre-OP OrderǺ໒໒໒ǴٗሶӭΘǴѦࣽᙴৣ೿όӣৎ‫ޑ‬ୟǻ
Ћೌ߻ੰΓा଺ব٤ྗഢǻ٣ჴ΢Ћೌᅿᜪٗሶӭ‫؂‬ᅿ೿όϼ΋ኬǴۭΠ‫ޔ‬
ௗҔጄ‫ٯ‬ှᇥ΋૓‫ޑ܄‬চ߾εৎКၨ৒ܰΑှǶѝाҔགྷ‫ޑ‬൩ό཮ᅅ௞
orderǼ
Pre-OP OrderǺ
@OP will be performed on Вය (२Ӄ྽ฅाᡣៈγ‫ޕ‬ၰੰΓՖਔ໒Θ୚Ǽ)
@OP MethodǺXXX (ЋೌБ‫ݤ‬Ψा֋ນៈγ)
@OP siteǺLower abdomen… (೭ᅿЋೌ‫୏ޑ‬Θ೽Տӧব‫ګ‬ǻ)
@Sign operation and anesthesia permit (‫ޕ‬ၰ୏Θਔ໔Б‫ݤ‬೽Տ)
@Send patient to OR on call with chart and X-ray (ፎៈγ฻໒Θ‫܊‬೯‫ޕ‬ਔ໔ࡕ
ᡣੰΓೱੰᐕ‫ک‬Тη΋ଆଌѐ)
@NPO since midnight (ੰΓவϱ‫ڹ‬ΜΒᗺ൩όૈӞܿՋᘁǼόฅόૈഞᎈǼ)
@IVF D5S1/4 1000cc run 80cc/hr cm(cm ߄ coming morningǴܴԐӆ on IV ϐ
ཀ)
@Prepare PRBC 2U(ഢՈǴќѦຎ௃‫ݩ‬ёഢӄՈ‫܈‬ՈዀǴ࣮Ь‫ݯ‬ᙴৣԖؒԖ
ӧՐଣ೯‫ൂޕ‬΢Ҭж‫ࢂ܈‬ፎୢៈγ೭ᅿЋೌाόाഢՈ೿ёаǶΨा࣮࣮ੰ
Γೌ߻‫ܜޑ‬Ո data ԖؒԖ೦Ո฻Ƕ໒೭ঁ order ќѦሡा໒ഢՈൂǶ)
@ЋೌҔᛰϷ੝ਸೀ࿼ǺѦࣽЋೌӧೌ߻ྗഢਔΨѸ໪ᔅੰ஻Ӄྗഢӳ໒΋
٤ೌ߻‫ޑ‬ᛰ‫کނ‬௛ࡼǴε೽ϩाϪ໒ SKIN ‫ޑ‬Ћೌ೿ाӃ໒΋ଫ Cefazolin
500mg ᡣੰΓ஥ΕЋೌ‫܊‬ǶӧΠΘჄ໒Ҝጥ߻ΒΜϩដᓉે‫ݙ‬৔๏ϒੰΓǴ
ёԖਏ෧եೌࡕགࢉ‫ٳޑ‬วੱǶ‫ځ‬дǴႽ஁ౢࣽբ Laparoscopy ဎ๚᜔߻ा
ᔅੰΓឲဉǴӳᡣੰΓ‫ޑ‬ဉηό཮๞ᅈεߡǶ΢य़೭‫ ঁٿ‬order ёаቪԋǺ
Cefazolin sodium 500mg 1 vial iv push stat x 1 time (send to OR cm)
ཀࡘࢂܴϺԐ΢‫ע‬೭ᡞ Cefazolin ଌ‫ ډ‬OR(໒Θ‫)܊‬ѐ
Fleet enema 1pc supp (cm) stat x 1 time
ཀࡘࢂܴϺ΋εԐ൩ᔅੰΓឲဉ
Ԗ pre-op order ྽ฅΨԖ intra-op order ‫ ک‬post-op orderǴόၸ೭ӭъ೿ࢂՐଣ
ᙴৣ‫ޑ‬πբǶགྷ‫و‬Ѧࣽ‫ޑ‬ΓёаፎୢգԾρ‫ޑ‬ՐଣᙴৣᏢߏ‫ۆ‬Ǽ
3. Order RenewǺੰΓՐΑٗሶΦǴӳྠ֔Ǽ
྽ੰ஻Րଣຬၸ΋ࢤਔ໔Ǵ೯தࢂ΋‫ڬ‬Ǵ‫ࢂ܈‬Ћೌֹੰ஻௨਻Ǵёаவ࿣१
໒‫ۈ‬ӞܿՋਔǹԖਔংࢂੰΓ‫ݩރ‬ᡂϯӭǴϼӭ႟ණ‫ ޑ‬order ٬ள᏾ҁੰᐕ
໶໶‫ޑ‬Ǵࣁ৮୺ՉԖᇤǴៈγλ‫཮ۆ‬ፎգ order renewǶOrder renew ‫ޑ‬Б‫ݤ‬
൩ࢂाᙌ᎙ੰ஻ϐ߻‫ ޑ‬order ஒ‫܌‬Ԗੰ஻Ҟ߻ϝӧ୺Չ‫ޑ‬ᙴᡗ᏾౛΋ԛǶ‫܌‬
аനࡕ཮ၟ Admission Order ৡόӭ (ନΑ on service Ϸ diagnosis ฻όҔӆቪ
΋ԛ) ‫ٯ‬ӵǺ
Order renewǺ(аೌࡕ௨਻ੰΓࣁ‫)ٯ‬
Condition guarded

-5-
 Vital sign as ward routine
Sip water then on soft diet (ӃസНӆ၂೬ᓓ)
IVF D5S1/4 1000cc run 100cc/hr + 10meq KCl
Wound care N/S wet q8h
Medications…… (Renew ੰΓ‫܌‬Ԗ‫ޑ‬ᛰ‫)ނ‬
4. Transfer and On Service OrderǺ቎቎Ǵ࣮‫עך‬ᐭЋξ‫~ؾ‬ӄ~೽~ᙯ๏գǼ
ੰΓԖਔং཮ᙯࣽǴ‫ࢂ܈‬வуៈੰ‫܊‬ᙯрද೯ੰ‫܊‬Ǵ೭ঁਔংຎգࢂᙯੰΓ
‫ࢂ܈‬ௗੰΓ‫فޑ‬ՅǴϩձा໒ Transfer Order ‫ ܈‬On Service OrderǶ೯தவу
ៈੰ‫܊‬ᙯрٰ‫ੰޑ‬Γाᖄ๎ՐଣᙴৣᏢߏ࣮ၸǴՠࢂԖ٤ࣽϝ཮ा Intern ௗ
೭ኬ‫ੰޑ‬ΓǶБ‫ݤ‬εठᆶ Order Renew ৡόӭǶவуៈੰ‫܊‬ᙯр‫ੰޑ‬஻ӭъ
ςԖ Transfer Order ѝाྣ๱ӧࡕय़ӆ໒΋ҽ Receiving Order ൩ёаΑǶ૶
ளǴӵ݀գࢂᙯੰΓ๏ձࣽᙴৣǴί࿤ा໒΋ҽ Transfer OrderǴRenew ӳ
ੰΓ‫ޑ‬౜‫ރ‬ҔᛰωᆉࢂԖᘶᇮ‫ޑ‬ӳᙴৣǴόฅգ཮೏Γ࡟ԝǼ
‫ٯ‬ӵǺ(ࡕय़ࡴဦࢂ On service order)
Transfer Order (On service Order)
Transfer to Dr. XXX’s service (On the service of Dr. XXX)
ۭΠӕ order renew ‫ ܈‬admission order ໒‫ݤ‬Ƕ
5. MBD OrderǺੰΓाрଣΑǼ੿౏ǼΞϿ΋ҽ Progress Note ाѺǼ
@MBD orderǺ
@May be discharge(ຏܴВය)
@Return to Dr. XXX’s OPD on 4/17 afternoon (ፎୖྣЬ‫ݯ‬ᙴৣߐບਔ‫߄څ‬ӆ
ୢୢੰΓবϺԖ‫ޜ‬Ǵচ߾΢ੰΓрଣ΋‫ڬ‬Ѱѓ೿Ѹ໪ӣບ΋ԛǴԖਔाᔅੰ
ΓӕਔऊӣձࣽߐບǴ೭္εৎаࡕӆᡏ཮փǼ)
@໒ҥບᘐ᛾ܴਜ(ߏ۪‫ޑ‬ႝတᙴᡗፎᒧ໒ҥΌᅿບᘐ᛾ܴਜ)
@рଣ஥ᛰǺ໒٤ᛰᡣੰΓ஥ӣৎփǼ૶ளձ໒‫ډ‬ଞᏊ‫ޑ‬ᛰ‫ނ‬ঠǼ
6. Common orderǺMedicationǴProcedure…(аΠϟಏаЋቪᙴᡗࣁচ߾)
΋ঁֹ᏾‫ ޑ‬Order ᔈ၀хࡴ 1.ೀ࿼ 2.ԛኧ 3.ೀ࿼БԄ 4.ᓎ౗ 5.Ϻኧ
‫ٯ‬ӵǺ
Scanol 1# po stat (Scanol ΋ᗭҥջαܺ)
Cefazolin 500mg 1pc iv q8h for 7 days(Ԗ٤ᛰࠔёаຏܴᏊࠠ)
Check Finger sugar ACǴPCǴ3PMǴ9PM qd x 3 days(΋ϺѤԛՈᑗǴ
ΟϺ)
ۭΠග‫ٮ‬΋٤த‫ޑـ‬ᛰࠔҔ‫ݤ‬ᆶᓎ౗
Ҕ‫ݤ‬Ǻ
ᕭቪ ᇥܴ
po αܺ
iv (iv push) ᓉે‫ݙ‬৔
ivf (ivf drip) уӧᗺᅀύᅀ(ԖਔংाуຏाᅀӭΦǴ‫ٯ‬ӵ
Morphine 1pc ivf in 100cc N/S > 30min)
topi ֽ೽༡‫ܓ‬
supp ‫ߐع‬༞Ꮚ
inhalation ֎Ε
sublingual ՁΠ֖Т
sc ҜΠ‫ݙ‬৔
ouǴodǴos ᚈ౳Ǵѓ౳ǴѰ౳

-6-
 im ԼԺ‫ݙ‬৔
ACǴPC ໭߻Ǵ໭ࡕ

ᓎ౗
ᕭቪ ᇥܴ
stat ҥ‫څ‬๏ϒ
qd ΋Ϻ΋ԛ(Ԑ΢ΐᗺǴԐᓓ)
bid ΋Ϻ‫ٿ‬ԛ(9AMǴ5PMǴԐఁᓓ)
tid ΋ϺΟԛ(Οᓓ 9AMǴ1PMǴ 5PM)
qid ΋ϺѤԛ(Οᓓу‫ڹ‬৑ 9AMǴ 1PMǴ5PMǴ9PM)
q6h, q8h,q12h ‫؂‬൳λਔ΋ԛ
qod ‫؂‬႖΋Ϻ΋ԛ
qW1ǴW4 ‫ຼ؂‬΋ຼѤӚ΋ԛ
prn ሡाਔ٬Ҕ(ᒧ᏷៾ӧੰΓ)
prnǴq4h ‫؂‬൳λਔ၌ୢੰ஻΋ԛࢂցሡा(‫ݙ‬ཀǼ‫܌‬Ԗ prn
(q4h prn) ‫ ޑ‬order ೿ᔈ၀у΢చҹǴ‫ٯ‬ӵǺScanol 1# po
prnǴq4hǴif headache x 3 days ൩ࢂ‫؂‬Ѥλਔୢ΋
ԛੰΓ཮ό཮ᓐภाόाӞᛰ)
q4h&prn ‫؂‬൳λਔ൩ा΋ԛԶЪќѦёຎሡाᚐѦ prn ٬
Ҕ(‫ٯ‬ӵඤᛰ)
hs(qhs) ᅵ߻(΋૓ࢂఁ΢ΐᗺ๏)

ᛰࠔൂՏ
ᕭቪ ᇥܴ
pc(piece) ‫܌‬Ԗգόዕ‫ޑ‬ᛰࠔ೿ёаҔ೭ൂՏǴ࣬྽‫ܭ‬ύЎ
‫]ঁ[ޑ‬
amp(ampul) ࣒ዟλᛰ౟Ǵ္य़း‫ࢂޑ‬ᛰНǴ΢य़Ԗ΋ঁ࣒ዟ
ᓐाኘᘐǶ(ёаኘኘ࣮Ǵࡐӳ‫ވ‬Ǽ)
vial ࣒ዟᛰણλᡞηǴԖᐎҜᇂёу N/S ‫ ࢂ܈‬water
຾ѐ‫ע‬ણ‫ݰ‬໒ᡂᛰНǴࡐӭ‫ל‬ғનࢂ೭ᜪǴ‫ٯ‬ӵ
CefazolinǶ
tab(tablet) ᒭᏊǴԖؒԖ࣮ၸද৾ੵǻ
cap(capsule)ጤ៶Ǵථථ‫ޕ‬ၰփǼ

pk(pack) ΋х΋х‫ޑ‬ણ‫ނރ‬Ǵ‫ݰ‬Нസ(‫ٯ‬ӵ Kalimate)‫܈‬Ѧ

Ҕ೿Ԗ
gt ᅀǴӭࢂ౳ᛰН‫ൂޑ‬Տ
U [ൂՏ]Ǵӭࢂ٤Ҕໆाࡐᆒྗ‫ޑ‬ᛰ‫ނ‬Ǵ‫ٯ‬ӵ
insulin 10U ી৞નΜൂՏ
mlǴmg డϲǵడլǴԖ٤ᛰόҔ᏾Ѝ๏ाቪҔໆǶ

-7-
PART 2 Commom Problems & Work UP
01. Fever M92 ᲋᎔

#നத‫ ޑـ‬complainǺ
¾ Ӄୢλ‫ځۆ‬д vital signǴfever ऩ HRǴrespiratory R ั‫ז‬ឦ҅தǶ ऩ BP ե
λЈ septic shockǶ

¾ ࣮ࢂόࢂಃ΋ԛᐨǴऩ྽ࣽς‫ޕ‬ၰǴ଺ၸ blood cultureǴѺၸ antiǴёӃࢗ

΋Π blood culture ่݀Ǵ࣮౜ӧҔ‫ ޑ‬antiǴࢂց sensitive. ऩԖ sensitiveǴё
๏ scanol 1pc PO ੱ‫ݯރ‬ᕍǶ ฻Ԗਔ໔ӆ଺၁ಒϐ surveyǶ
9 ߏ۪‫ ޑ‬routineǺ(ό΋‫ࢂۓ‬ჹ‫)ޑ‬Ǵ>38.5 C-> ice packing. >39C->scanol
1pc POǶ

¾ ӵ݀೭ੰΓࢂಃ΋ԛӧᙴଣϣ feverǴ΋‫ۓ‬ा଺၁ಒϐ surveyǶ

¾ ӵ݀ੰΓςҔ anti ΋ࢤਔ໔ࡕԖ new onset fever ाख़ཥ survey

9 Fever চӢǺ infectionǴinflammation (autoimmune disease)Ǵtumor
feverǶInfection ՞ 90% а΢Ǵॶ੤ਔΨനதၶ‫ډ‬Ǵ‫ פ‬infection focusǶ
9 ࣮‫ځ‬д symptomsǺ
— Cough and rhinorrhea->URI
— Cough with much sputum->pneumonia ->᠋ breathing sound ёԵቾ
ྣ CXRǶԖ dyspnea ा‫ ܜ‬ABG ຑ՗ respiratory failure ‫ޑ‬Ӓᓀ‫܄‬Ƕ
— DysuriaǴfrequency and urgeny-> UTI->ᄟ knocking painǴ੮ U/AǶ
— Diarrhea and abdomen pain-> AGE
— ‫ي‬΢Ԗค‫ځ‬д line ӵ CVPǴdouble lumen ฻Ƕ->ё call RǴԵቾ౽
ନ೭٤ line ԶЪҥ‫څ‬բ culture
— Joint painǺarthritis? ाӃ௨ନ septicarthritisǴԖёૈࢂ gout attack-
> ๏ inteban and cleocinǶ
9 ΋٤୷ҁ‫ޑ‬ᔠࢗǺ٩ੰΓϐ symptomsǶ
— CBC/DCǴBlood cultureǶ
— U/AǴU/C
— CXR
9 ӵ݀ favor infectionǴё‫ ک‬R ૸ፕࢂց๏ anti
(๏ anti ߻΋‫ۓ‬ाԖ blood culture)

¾ ΋٤੝ਸϐ‫ݩރ‬
9 ՈనࣽϐੰΓǺऩ଺ֹ C/T ϐࡕ 1 week Ѱѓᐨଆٰा੝ձ‫ݙ‬ཀǶ೭ਔ
ܰ leukopenia. ࣮΋Π WBC count. ΋૓೿‫ޔ‬ௗ‫ ܜ‬B/C ๏
piperacillin+amikinǶࡼᙴৣϐੰΓ๏ scanol ϐ߻ा੝ձ‫ݙ‬ཀǴቪ΋ጇ
noteǶ
9 Leukopenia ੰΓջ٬Ԗ U/A ؒԖ pyuriaǴऩ s/s positiveǴૈёૈࢂ UTI
9 Tumor feverǴ೯தࢂ྽ࣽς rule out infectionǴё๏ naproxinǶ

-8-
02. Chest pain M92 Ј‫܃‬

# patient complain chest pain ΋‫ۓ‬ाଭ΢ѐ࣮!! (ӣ call Ӄୢ vital sign ࢂց stable)

# HistoryǺ
1. p’t Ԗค CAD ‫ ޑ‬history? ऩԖ documented CAD history Ъ chest pain character
‫ک‬ϐ߻‫ ޑ‬attack ΋ኬ‫ޑ‬၉ǴӃ྽଺ MI ೀ౛
2. Chest pain ‫ ޑ‬characterǺlocation ǴqualityǴseverityǴradiationǴdurationǴ
precipitating and relieving factors. Associated symptoms
3. Recent traumaǴinjuryǴor thoracic procedure

# PEǺ
1. vital signs ࢂց stable
2. neckǺJVE
3. ChestǺbreath sounds Ԗค decrease (pleural effusion)(pneumothoraxǴwith
hyperresonance on percussion)Ǵcrackles (pneumoniaǴpulmonary edema due to
congestive heart failure)Ǵwheezing…..
4. heartǺmurmurs
5. AbdomenǺexclude GI causes
6. extremitiesǺsuspect pulmonary embolism ਔा࣮Ԗค DVT ‫ ޑ‬signs(swellingǴ
erythemaǴpain)ǹ suspect aortic dissection ਔाᄗ peripheral pulse Ԗค
symmetric

# InvestigationǺ
1. EKGǺNEW T wave changesǴST depression or elevationǴnew Q wave. ऩ
ԖǴፎ૶‫ޑ‬ा call R.(૶ளाКၨа߻‫ ޑ‬EKGǴղᘐࢂցࣁཥ‫ޑ‬ᡂϯ)
2. ᚶᅪ MI ё‫ ܜ‬troponin-I and CK-MB
3. patient ऩࡐഹǴABG
4. CXR if pulmonary causes are suspected

# ManagementǺ
1. O2 nasal cannula 2-4L/min
2. anginaǺNTG sublingual 1# st. ‫؂‬႖ 5-10 min ё๏΋ᗭǴऩ๏‫ډ‬ಃΟᗭϝค
ਏǴፎଭ΢ call R (‫ݙ‬ཀǺSBP>90 mmHg ωё๏ NTG)
3. ऩղᘐࣁ anginaǴduty ਔวғ chest painǴा྽բ unstable anginaǺ1)check
CPKǴCKMBǴTn-I 2)EKG 3) IVǺNTGǴheparin
4. EKGǴCXRǴcardiac enzyme Ԗ findingsǴᚶᅪ MIǴaortic dissectionǴPEǴ
pneumothorax…฻Ǵፎ call R ‫ڐ‬շ΋ӕೀ౛. ϐࡕ‫ޑ‬ೀ౛চ߾όӧԜᙧॊǴ
Ԗ‫ޜ‬ਔፎୖԵӚ manualǶ
5. ऩࣁ GERDǴgastritis Їଆϐ chest discomfortǴё๏ fina ‫ ܈‬AMG ฻गᛰ଺ੱ
‫ރ‬ೀ౛. H2 blocker (ӵ gasterǴtagamet)ǴϷ omeprazole ໪Ԗ PES ൔ֋ωё٬
ҔǶ

-9-
# Differential diagnosisǺ
1. AMIǺsevereǴcrustingǴretrosternal painǶRadiates to armsǴneckǴjawǶ
Duration>30 min. associated with nauseaǴcold sweatingǴdyspneaǴ
palpitationǶ
2. angina pectorisǺੱ‫ރ‬՟ AMIǴՠำࡋၨᇸ༾ǴЪ may be relieved by NTGǶ
ऩ attack ‫ ޑ‬severityǴdurationǴfrequency ቚуǴा‫ݙ‬ཀ unstable angina ‫ޑ‬ё
ૈǶ
3. acute pericarditisǺsharpǴpleuritis chest pain. ֤ଆ‫܈‬۳߻໼ਔ཮ၨӳǹᙯ୏
‫ي‬ᡏਔ཮уቃǴFeverǴEKG ࢂ diffuse ‫ ޑ‬ST-T changeǶ
4. aortic dissectionǺsevereǴtearing painǹ may radiates to back. History of
hypertension or connective tissue disordersǶ
5. pulmonary embolismǺshould be suspected in any hospitalized patients who
develops acute SOB or chest painǼ
6. pneumothoraxǺacute onset chest painǴdyspneaǴdecreased breath soundsǴ
hyperresonance on percussionǶ
7. GI causesǺGERǴgastritisǴpeptic ulcer diseasesǴbiliary colicǴ
pancreatitis…..
8. musculoskeletal chest pain

ɁChest pain M92 ਁᄨ

I. Chest pain ‫ޑ‬ԋӢǺёૈҗ heartǴlungǴesophagus or musculoskeletal ೷ԋ
II. approach ‫ޑ‬Б‫ݤ‬
Ӄϩࢂ heart ೷ԋ‫ޑ‬Ǵ‫܈‬όࢂ heart ٰ‫ ޑ‬chest pain
Îߚ heart chest pain ๏ scanol ‫ځ܈‬д NSAIDs Зภ
ÎAnginaǺ๏ NTG
ÎAMIǺcall Ꮲߏ!!!!Ǵthen “MONA”Ǻ๏ morphineǴO2ǴNTGǴaspirin
III. ೀ౛ǺӃୢ history(ภ‫܄ޑ‬፦)ǴPE(᠋ບ)Ǵ଺ EKGǴၟϐ߻‫ ޑ‬EKG Кၨ
Îฅࡕ call Ꮲߏ೯ൔǴϐࡕёԵቾ๏ NTG test ‫ ܜ܈‬cardiac enzyme(ୢᏢߏ
ཀ‫)ـ‬
1. HistoryǺ
ୢੰΓภ‫ ޑ‬locationǴcharacterǴdurationǴfrequencyǴaggravating
factorǴrelieving factorǴԖค radiation pain Ϸ associated symptom/sign
Heart ‫ ޑ‬chest pain Ǻёϩࣁ
typical chest pain(angina pain)Ϸ atypical chest pain(ёૈࢂ AMIǴaorta
dissectionǴacute pericarditis)
z Typical chest painǺ
locationǺretrosternalǴsubsternal
characterǺpressure-likeǴconstrictingǴsqueezing(ҡᓐᓸӧૅ
α)
durationǺ< 10 mins
aggravated byǺexerciseǴemotional distress
relieved byǺrestingǴNTG use
radiationǺto left shoulderǴleft armǴneckǴlower jaw
associated s/sǺnauseaǴvomitingǴcold sweatingǴpalpitation

- 10 -
 z Atypical chest painǺ(‫ ک‬typical όӕ൩ࢂ atypical)
prolonged painǺ>30 mins
not relieved by rest or NTG
locationǴcharacterǴradiationǴassociated s/s ၟ typical ৡόӭ
2. PEǺԖค S4ǴBP ΢ϲǴpulse ቚ‫ז‬Ǵnew-onset murmur
3. EKGǺ
AMIǺೱុ 2 ঁ lead а΢ว౜Ԗ findingÎ call Ꮲߏ!!!
hyperacute T ÆST elevationÆT inversionÆpathologic Q wave
hyperacute T waveǺT wave ε‫ ܭ‬10 λ਱
pathologic Q waveǺQ wave > 1/4 R wave ωᆉ
4. ‫ ܜ‬cardiac enzymeǺ
stat ‫ܜ‬΋ԛ Troponin IǴtotal CKǴCK-MB(നӳୢ΋ΠᏢߏ)
ӵ݀ negative ϝமਗ਼ᚶᅪǴ4hr ࡕӆ follow ΋ԛ
5. NTG testǺ
NTG onset ࡐ‫ז‬Ǵ΋૓<3 mins(ऩԖਏੰΓ཮ᖍआǴՁΠ‫؟‬዗Ǵᓐภ)
ऩคਏǴ‫ ؂‬3-5min ๏΋ԛǴёೱុ๏ 3 ԛ

03.Abdominal Pain M92 ࠄ‫ݒ‬

#΋‫ۓ‬ाᅰ‫ז‬ѐ࣮ੰΓ!!ӧႝ၉ύୢ΋Πλ‫ ۆ‬vital sign!!

¾ २ाࣁ௨ନ surgical abdomen ‫཮ک‬ԝΓ‫ޑ‬Ǵ‫ ځ‬s/s ёૈӵΠǺ

1. Hypoactive BoS (pitfallsǺԖਔংဉηઇ௞ᗋࢂԖ normoactive BoS!)
(ӧ abdominal pain ਔǴbowel sound ೯த not diagnostic)
2. Muscular rigidity
3. Rebounding tenderness/ percussion tenderness
4. With vital sign changeǺeq. Orthostatic hypotensionǴtachycardiaǴ
hypotension( septic shockǴhypovolemic shock)Ǵhypertension(aortic dissection)
5. ภ‫ ډ‬Cold sweating (߄Ңภ‫ߚޑ‬த቉্Ǵፎвಒ଺ D/D)
6. ੰΓภ‫ډ‬όඪ୏‫ي‬ᡏǴೱᙌ‫ي‬೿όඪ (ёૈ diffuse peritonitis)
7. Severe distensionǺr/o intestinal obstructionǴileus
8. Severe abdominal pain but PE OK ा r/o ischemia bowel
а΢ੱ‫ރ‬ӧ approach ֹੰΓࡕऩϝค‫ݤ‬௨ନ surgical abdomen ‫܈‬ӒϷғ‫ޑڮ‬ё
ૈǴፎ call R ΋ଆೀ౛Ǽ

¾ ᙁൂ‫ ޑ‬approach Б‫ݤ‬Ǻ

9 Onset ຫ acute ाλЈǴr/o PPU
9 LocationǺ
— EpigastragiaÆ r/o gastritisǴulcer or pancreatitis
TxǺAMGǴTopaal….
— Lower abdomenÆconstipation or AGE
TxǺӕΠ
— RUQÆ BTIǴcholecystitis

- 11 -
 (ा‫ ܜ‬GOTǴGPTǴALPǴrGTǴBil-T)
TxǺIV and antibiotics Ǵ೭ёૈा call R.
9 PEǺrebounding pain Ǵmuscle guarding ฻ peritoneal sign
Î call R
9 PEǺbowels sound.
— HyperactiveǺÆ AGEǴfunctional GI dx
TxǺbuscopan
— HypoactiveÆileusǴabdomen distension
TxǺprimperan

¾ த‫ ـ‬D/DǺ
1. AGE( crampy or epigastric dullnessǴvomitingǴdiarrheaǴёૈӞ‫ډ‬όృϐ
१Ǵ fever+/- ǹ hyperactive BoSǴtenderness )
TxǺNPO ΋ᓓ + symptom relief
2. Constipation( lower abdomen crampyǴold ageǴനࡕ΋ԛ௨ߡՖਔǴໆӭ
ჲǴ ௨ߡಞᄍ)
TxǺdulcolax 1PC supp st. or fleet enema 1PC st. ٠๏ϒ೬ߡᏊ
3. Peptic ulcer disease( epigastric dullnessǴhunger painǴPH+ǹ tenderness)
TxǺ๏ antacid
4. Pancreatitis( postprandial epigastralgia with radiation to back)
TxǺNPO + demoral 1PC IM st
ऩੰΓςೕ߾ӧѺ demerolǴёԵቾ๏ ketorolac 1PC IV st or demoral C
(ղᘐόࢂ੿‫ੰޑ‬ω๏) 1PC IM st
5. Ascites( extremely distended) or SBP( ascitesǴrebounding pain+/-)
TxǺё call R ஥գ଺ tappingǴ໩ߡ໒ൂ଺ ascties routine and gram
stainǴAlbumin
6. Intestinal obstruction/ ileus( crampyǴdistendedǴvomiting or constipationǴ
PHǺlaparotomy+/-Ǻhigh-pitched hyperactive bowel sound or hypoactive
bowel soundǴhernia+/-)
MxǺplain abdomen stǴelectrolyte stǴBUN/Cr st
TxǺNPO + NG decompressionǴfluid supplementǴcorrect electrolyteǴ
٠ຎ plain abdomen ่݀଺຾΋‫؁‬ೀ౛(call R)
7. Drug effectǺeq. ColchicinesǴNSAIDsǴprimperanǴetc.
8. ձ‫ב‬ΑԵቾ AMIǴpneumonia ‫ ک‬DKA(λ࠸)!!

- 12 -
04.Hypertension and Hypotension M92 ᲋᎔

¾ ‫ک‬ௗ‫ځډ‬д‫ ޑ‬complian ΋ኬǴಃ΋ҹ٣ࢂाᕕှ‫ځ‬дϐ vital signǼ

¾ HypertensionǺ
9 ᕕှ΋ΠੰΓԖค hypertension historyǶୢੰΓԖคό๤ܺǴ നӳό
ाҔ adalatǴёаҔ NTG 1# SL..Adalate will increase AMI and stroke
incidenceǶ
9 Ԗค hypertension ‫ڈ‬ᐟӢηǴӵੵภ฻Ƕ
9 Stroke ‫ੰޑ‬ΓԖ hypertension ा‫ݙ‬ཀǶ΋૓ӧ large stroke ‫ޑ‬ಃ΋ຼ
ϣǴՈᓸӧ 1800~200mmHg ೿όाफ़Ǵаᆢ࡭ brain prefusionǶၸΑ΋
ຼёᄌᄌफ़ǶStroke ‫ੰޑ‬Γफ़ՈᓸҔ labetalol 1/2 PO stǶҔ Adalat ёૈ
཮೷ԋ vessel spasmǶ
9 Stroke Ϸ brain injury ੰΓԖ hypertension ा੝ձ‫ݙ‬ཀ HRǴऩՈᓸଯǴ
HR ᄌǴԖ vomiting Ϸ consciousness change λЈ IICPǴё call Ꮲߏ࣮
ाόा๏फ़တᓸᛰǶ
¾ Hypotension
9 ಃ΋ा،‫ੰࢂޑۓ‬Γࢂցࢂ shockǶShock ёૈѤަӇհǴֿໆϿǴΓ
࣮ଆٰཀ᛽όమǴcapillary refilling time ෧ϿǶ
9 ӵ݀Γ࣮ଆٰᗋӳǴа߻Ոᓸ൩όଯǴёᢀჸǶ
9 գा୔ϩ‫ੰࢂޑ‬Γࢂόࢂ shockǴᗋࢂа߻൩ՈᓸόଯǶӵ݀գ᝺ளੰ
Γࢂ shockǴനӳᗋࢂ call Ꮲߏٰ࣮࣮ǶOn CVPǴ฻ёૈाᏢߏೀ
౛Ƕգё଺‫ޑ‬٣ࢂ୔ϩ΋Π shock ‫ޑ‬চӢǶ
9 Hypovolemic shockǺੰΓԖ UGI bleeding? ‫ځ܈‬дѨՈǻ ऩԖǴӃ
challenge N/S 500 ml ഢՈǶ
9 Septic shockǺԖ infection ༏ǻࢂցԖ feverǶӕኬӃ challenge N/S
300~500mlǶ
9 Cardiogenic shockǺԖ AMI ‫ ܈‬heart dx history ༏ǻ Breathing sound ࢂց
Ԗ crackleǶ೭ਔёૈ൩όՉ໶ challenge N/S ନߚѝԖ right side heart
failureǶ
9 Anaphylactic shock

05.Hyperglycemia M92 ਁᄨ

z ӃୢੰΓԖคό๤ܺǺဎภǴഹǴdehydrationǴcoma ฻ǴऩؒԖ߾ё٩
Ᏽ sugar level ೀ౛
z Sugar level
60-200ǺOBS
200-250ǺRI 2U sc ‫ ܈‬OBS
250-300ǺRI 4U sc ‫ ܈‬OBS
300-350ǺRI 6U sc
350-400ǺRI 8U sc
>400ǺRI 10U sc

- 13 -
06.GI bleeding M92 ࠄ‫ ݒ‬modified by M93 ଼ֻ
όӕ‫ੰޑ‬Γೀ౛‫ޑ‬БԄΨ཮Ԗ‫܌‬όӕǴӧ೭္ѝࢂҔКၨ general ‫ޑ‬চ߾ٰ଺΋
٤ೀ౛Ƕ
ၶ‫ ډ‬GI bleeding ‫ੰޑ‬ΓǴ‫ޑ‬ೀ౛БԄЬाԖΠय़൳ঁ‫؁‬ᡯǼ
1. patient resuscitation and stabilization
2. assessment of onset and severity of bleeding
3. determination anatomic bleeding etiology
4. determination pathologic cause of bleeding
5. arrange further treatment
1ǵPatient resuscitation and stabilization
२Ӄ೏ call ਔǴӧႝ၉ύǴ൩ाၟៈγλ‫ ۆ‬check ABCǴvital sign ‫ک‬
conscious levelǶӵ݀ᛙ‫ۓ‬Ǵٗ൩‫وזז‬Ƕ ӵ݀όᛙ‫ۓ‬Ǵ൩າ‫ז‬΋ᗺǴࣗԿё
аԐᗺ call ΢य़‫ޑ‬ΓΠٰ coverǶ
‫ ډ‬bedside ࣮ੰΓǴӵ݀ੰΓཀ᛽໒‫”ۈ‬ච”Ǵ໒‫ۈ‬ഹǴᇥ၉໒‫ۈ‬όమཱǴO2
൩ёаό࠼਻‫ޑ‬Ҕ΢ѐǶӵ݀ੰΓ҅ӧεໆӗՈǴԖᐒ཮༞‫਻ډ‬ᆅ‫ࢂ܈‬գ᠋
‫ډ‬ό҅த‫֎ڥޑ‬ᖂǴёૈԖ aspiration or chocking ਔǴाԵቾ on endoǶ
೯தՐ຾ٰ‫ੰޑ‬Γ೿Ԗ IV lineǴؒԖ‫ޑ‬၉ᇴ‫ ז‬on ΋Ѝε΋ᗺ‫ޑ‬ǶȐਜ΢ࢂ
ᇥԖ active bleeding ‫ੰޑ‬Γሡा on 2 ଫ 18 ဦа΢‫ޑ‬ଞᓐǴ‫ࢂ܈‬΋Ѝ CVPȑੰ
Γ HR ΢ϲǴBP ௞Ǵ൩ёаԵቾᔅੰΓံ fluidǶӧᒡనϐ߻ǴाӃᡍ
CBCǴPT/aPTTǴCrǴliver enzyme ‫ک‬ഢՈ PRBC6U.ᗉխᒡనࡕ೷ԋ data ᡂ
ϯǶ
ӵ݀ vital sign ࡐό stableǴchallenge N/S or L/R 500mlǶӵ݀ᗋӳǴ൩ᡣ iv
run ‫ז‬΋ᗺǶ ၶ‫ډ‬Ԗ high risk for MI ‫ࢂ܈‬Ԗ MI history ‫ੰޑ‬ΓǴ൩ stat ଺΋஭
EKGǴ‫཮܂‬Ӣࣁ hypovolemic hypoxia ೷ԋ MI attackǶ
ჹ‫ ܭ‬high riskȐMIǴcirrhosisǴpulmonary function poorȑ* ‫ੰޑ‬ΓǴPRBC
ёаᇴ‫ז‬ᒡ΢ѐǴ‫׆‬ఈёаᡣ Hct ᆢ࡭ӧ 30 а΢(Hb 10)КၨӼӄǶӵ݀ࢂ଼
ந‫ࢂ܈‬ԃᇸ΋ᗺ‫ੰޑ‬ΓǴ‫ځ‬ჴ PRBC ൩ό࡚๱ᒡǴѝाᆢ࡭ӧ Hct ӧ 20 а΢
൩ՉΑ(Hb 8)ǶࡪೱϦ‫ޑ‬၉ǺȨbleeding Ԗϙሶӳ্‫ޑ܂‬Ǵံ΋ံ൩ӣٰΑǴ
ന‫ੰࢂޑ܂‬ΓԖϙሶ underline ‫ޑ‬ୢᚒ೭ਔংᛈрٰǴٗωࣁࢂ੿‫ ޑ‬criticalǴ
ᡂϯ཮ࡐ‫ז‬Ǽȩ
2ǵAssessment of onset and severity of bleeding
ௗΠٰ൩ࢂाຑ՗ѨՈໆ‫ޑ‬ӭϿǴаੰΓ‫ٰ࣮ރੱޑ‬ǴεཷӵΠǺ
<500cc vital sign stable
500-1000cc postural hypotension (dizziness)Ǵorthostatic hypotension**
1000-1500cc tachycardia
1500cc hypotension
ࡪྣёૈԖӭϿ loss ໆٰፓ᏾ IV ໆǶ
ନΑຑ՗ѨՈໆӭϿѦǴќѦा‫ݙ‬ཀ‫ޑ‬൩ࢂ೭ԛ‫ޑ‬рՈࢂ intermittent bleeding
‫ ࢂ܈‬continuous bleeding ‫ރޑ‬ᄊǶЬा᎞ history taking ‫ ک‬NG irrigation ٰ୔
ϩǴࡕय़཮ග‫ډ‬Ƕ
3ǵDetermination anatomic location and bleeding pattern
΢य़ᇥ‫ޑ‬Ǵࢂ acute bleeding ਔा଺‫ޑ‬٣௃ǶStable ӳੰΓࡕǴा଺Πय़‫ޑ‬
٣Ǽ
ղᘐࢂ UGIǵsmall bowel or colon аΠ***ǴϙሶচӢǴௗΠٰाӼ௨ϙሶᔠ
ࢗǶ

- 14 -
¾ GI bleeding ёаϩࣁ overt bleeding ‫ ک‬occult bleedingǶ
Overt bleeding ࢂࡰ hematemesisǴcoffee-ground emesisǴmelenaǴtarry
stoolǴblood tinged stool Ϸ hematocheziaǴԖ೭٤߄౜Ǵ‫ॺך‬ёаమཱܴқ
GI tract ԖрՈǶHematemesis ‫ ک‬show coffee ground ࢂ UGI bleeding. Melena
Ϸ tarry stool ೯தΨࢂ UGI bleedingǴՠࢂӵ݀ࢂ small bowel bleeding or
right colon bleeding ΨࢂԖёૈǶ ှᗲՈ೯த൩ࢂ lower GI ‫ޑ‬ୢᚒΑǴՠࢂ
Ψ Ԗ ё ૈ ࢂ ε ໆ UGI bleeding ೷ ԋ ‫ ޑ‬Ǵ ό ၸ ೭ ਔ ং ੰ Γ ೯ த ཮ Ԗ
hypotension ࣗԿ‫ז‬ा shockǼҗ‫ ܭ‬stool ा‫ ډ‬A-colon ω཮Кၨԋ‫׎‬Ǵӵ݀
Ԗ࣮‫ډ‬Ոํ coating ӧ stool Ѧय़‫ޑ‬၉Ǵ൩ाᚶᅪࢂ A-colon аΠ‫ ޑ‬lesionǶ
Occult bleeding ࡰ‫ ޑ‬chronic or intermittent GI bleedingǴԶؒԖ࣮‫ ډ‬gross
bleeding patternǶ ΋૓ٰᇥǴाԖ melena ‫׎‬ԋǴѸ໪ाԖ 50-100 ml ‫ޑ‬
blood ຾Ε stomach ύǶӵ݀ੰΓ‫؂‬Ϻ‫ޑ‬рՈໆλ‫ ܭ‬100mlǴ‫ ځ‬stool ёૈ
ࢂ҅த‫ޑ‬ኬηǶ‫܌‬а‫ॺך‬ёаҔ‫ঁٿ‬БԄٰղᘐǴಃ΋൩ࢂෳ stool OBǴ
ќѦ΋ঁ൩ࢂ࣮ੰΓԖؒԖӢࣁߏයᄌ‫܄‬рՈԶԖ IDA ‫߄ޑ‬౜Ƕ
4ǵDetermination pathologic cause of bleeding
ୢ history ‫ ଺ک‬physical examination****ࢂ‫ॺך‬Ьा‫ޑ‬πբǴΨࢂᙶమ٣௃ന‫ޔ‬
ௗ‫ޑ‬Б‫ݤ‬Ƕ
‫ॺך‬ୢ history ЬाԖѤҹ٣௃ाٰ୔ϩమཱ
(1) Ulcer bleeding or varice bleeding
(2) Upper or lower GI bleeding
(3) ੰΓ‫ ޑ‬hemostasis status
(4) ԖؒԖ‫ځ‬д underline disease
aǵulcer vs varice
೭‫ࢂੰঁٿ‬᏾ঁ GI bleeding നЬा‫ঁٿޑ‬চӢǴёࢂ‫ ځ‬natural courseǴ
rebleeding rate ‫ ک‬initial mortality ‫ ک‬morbidity ೿όӕǴ‫܌‬а‫ॺך‬ा୔ϩమ
ཱǶ
ੰΓ཮ ulcer bleeding ೯தϐ߻൩Ԗ ulcer historyǴ‫ߏࢂ܈‬යӧ٬Ҕ
NSAID or anticoagulantǶ཮ complain गภࡕँฅόภǴฅࡕ൩р౜໵ߡ
*****Ǵ initail mortality rate όଯǴӢࣁ཮ local spasmǴ‫܌‬аத཮ЗՐǴа
intermittent bleeding ߄౜ǶRebleeding time ೯தࢂӧ 3-5 ϺࡕǶၶ‫ډ‬೭ᅿ
௃‫׎‬Ǵाዴ‫ੰۓ‬ΓԖؒԖ PPU ‫ ࢂ܈‬pepticoaortic fistulaȐulcer ઇ‫ ډ‬aortaǴ
೭ਔ཮Ոࢬӵ‫ݙ‬ǴੰΓ΋Π൩ down ΠٰȑǶӵ݀ؒԖǴ൩ёа๏ PPIǴ
ံ fluid ฅࡕӆ௨ endoscope ൩ՉΑǶ
ёࢂӵ݀΋࣮‫ ࢂډ‬cirrosis or alcoholism ‫ੰޑ‬ΓǴाཱུࡋᚶᅪࢂ varice ઇ
ΑǶӢࣁ varice bleeding ‫ ޑ‬initial mortality rate ଯȐ>10ʘȑǴதத཮
continue bleeding Ȑ vein spasm ‫ ޑ‬Κ ໆ ϼ λ Α ȑ Ǵ ሡ ा ࡚ ଺ PES ѐ
ligationǴԖਔёаԵቾ٬Ҕ sandostatin or glycopressinǶ೭ᜪੰΓӧ 15 Ϻ
ϐϣ೿Ԗ rebleeding ‫ޑ‬ӒᓀǴrebleeding ‫ ޑ‬mortality rate ‫׳‬ଯǶ‫܌‬аၶ‫ډ‬೭
ኬ‫ੰޑ‬ΓाࡐλЈǶ
bǵupper or lower
Ьा‫୔ޑ‬ϩБԄ൩ࢂӵ΢य़‫܌‬ᇥ‫ٰޑ‬ϩձǶ೯த UGI bleedingǴதத཮
continuous bleedingǴ‫཮ॺך‬Кၨ্‫܂‬ǹԶ LGI bleeding ததࢂ intermittent
‫ޑ‬ǴКၨ཮ӼЈᗺǶ
cǵhemostasis status

- 15 -
 hemostasis status ཮ቹៜ‫ੰډ‬Γ bleeding ‫ޑ‬ᝄख़ࡋǶाୢੰΓԖؒԖӧܺ
Ҕ NSAID or anticoagulant Ǵ Ԗ ؒ Ԗ Ո న Б य़ ‫ ޑ‬੯ ੰ Ǵ check ੰ Γ ‫ޑ‬
plateletǴPT and aPTTǶ
dǵunderleine disease
ӵӕ΋໒‫ۈ‬ᇥ‫ޑ‬ǴाλЈ཮ό཮Ԗ MI attackǴჹ‫ ܭ‬high risk ‫ੰޑ‬ΓǴ‫ך‬
ॺाӭᜢЈдॺ΋ΠǶӢࣁ MI ٠ό΋‫཮ۓ‬ӧ bleeding ਔ൩ attackǴ‫܌‬аၸ
ࡕ‫ ޑ‬follow up Ψࢂࡐख़ा‫ޑ‬٣ǶନԜϐѦǴाୢੰΓа߻ԖؒԖ syncope
or pre-syncope ‫ ޑ‬history ‫ ࢂ܈‬bleeding ਔ཮ό཮Ԗ pre-syncope ‫ޑ‬ག᝺Ƕӵ݀
ԖǴ೭ᜪ‫ੰޑ‬Γӧֹӄ‫ݯ‬ᕍ߻Ǵाдॺ total bedrestǴаٛ syncope ਔຳॹ
೷ԋ head injuryǶ

Physical examination ‫ޑ‬၉Ǵ നख़ा‫ޑ‬൩ࢂ଺ digital examination ٰᔅ‫଺ॺך‬

᠘ձບᘐǶ ଺ digital ൩ёаዴ‫ੰۓ‬Γࢂόࢂ੿‫ޑ‬ှ tarry stool ‫ࢂ܈‬ՈߡΑǴӢ
ࣁੰΓததᇥှ໵ߡՠࢂ٠όࢂ tarry stoolǶ‫ॺך‬ёаୢੰΓᇥεߡࢂόࢂၟ
ᓐᎳᚑՅ΋ኬుԶЪؒԖԋ‫׎‬Ǵӧଛӝ digital ‫ٰ่݀ޑ‬ΠղᘐǶ
Tarry stool ЬाࢂӢࣁ heme ӧ GI tract ύ೏ bacteria ᙯඤࣁ PorphorinǴ‫܌‬а
཮Ԗᛅߙ‫ރ‬ǶӢࣁԖεໆ‫ ޑ‬S ӕਔౢғǴ‫܌‬а཮ՔԖൾૌ‫ښ‬Ƕዴ‫ ࢂۓ‬tarry
stool ϐ ࡕ Ǵ ω ٰ ଺ NG-irrigation ω К ၨ Ԗ ཀ က Ǽ ନ Ԝ ϐ Ѧ Ǵ ଺ digital
examination ᗋёа࣮࣮ԖؒԖ tumor Ǵhemorrhoid ‫ ࢂ܈‬polyp ߏӧ rectum ္
य़ӧ္य़Ǽ

ନΑ Digital examination ѦǴNG irrigation ࢂќѦ΋໨ղᘐ‫ޑ‬π‫ڀ‬ǶNG

irrigation Ҟ‫ޑ‬Ǻ
for diagnosisǺ࣮ੰΓӗ‫ࢂޑ‬ցࣁ੿Ǵ‫פ܈‬рՈ levelǶനख़ा‫ޑ‬Ǵ൩ࢂा୔
ϩрࢂ intermittent or continuous bleedingǶӵ݀΋‫ࢱޔ‬೿όଳ
ృ Ǵ ٗ ा ᝄ ख़ ᚶ ᅪ Ԗ continuous bleeding Ƕ ೭ ኬ ሡ ा ࡚ ଺
endoscope ٰೀ౛Ƕ
for endoscopyǺࢱ‫ ډ‬clearǴendoscope ‫ ޑ‬field ωό཮೿ࢂՈ༧Ǽ

ε೽ϩ UGI bleeding ‫ੰޑ‬ΓǴӧ NG irrigation ࡕǴёа࣮‫ ډ‬fresh bloodǴ

pink containǴblood clot or coffee-groundǶ‫܌‬а NG irrigation negative ‫ޑ‬၉Ǵε
೽ϩࢂ LGI ‫ޑ‬ୢᚒǶ ՠࢂԖ 15ʘ‫ੰޑ‬ΓǴдॺ‫ ޑ‬ulcer lesion area ࢂӧ
duodenum аΠǴtreizt ligament а΢ǴNG-irrigation ཮ࢂ negative ‫ޑ‬ȐӢࣁ
pyloric sphinctor ؒԖ໒ȑǶӵ݀ӧ NG-irrigation ύԖ࣮‫ ډ‬bile contain ‫ޑ‬၉Ǵ
ωёаКၨዴ‫ۓ‬᏾ঁ UGI ೿Ԗࢱ‫ډ‬Ǽ
5. Further evaluation and treatment
җ R ‫ ܈‬CR ،‫ࢂۓ‬ցाᆙ࡚ endoscopyǶ
ዴ‫ ۓ‬PUD ບᘐՠόᆙ࡚଺ endoscopy ‫ੰޑ‬ΓёԵቾӃ๏ omeprazoleǶ
ӵ݀ᛙ‫ۓ‬ΠٰǴ᝺ளؒԖрՈ‫ੰޑ‬ΓǴाӧ႖Ϻ follow ΋ΠǴ࣮࣮ Hb ԖؒԖ
ϲ΢ٰǴ΢ϲำࡋၟ‫܌‬ᒡ‫ޑ‬ՈԖؒԖ correlateǴӵ݀ᒡࡐӭՈǴHb ѝԖ΢ϲ
΋ᗺᗺǴ೭ኬ൩ाᚶᅪᗋԖӧрՈǶ
ௗΠٰ‫ݯޑ‬ᕍεཷ൩཮ࢂҗ΢य़‫ޑ‬ΓௗЋǴ‫܌‬а‫ך‬൩όӭගǶ

- 16 -
 ຏǺ
* MIǺ‫܂‬ᝩុԖ ischemia ᡂϯǶ CirrhosisǺӢࣁ coagulant function poorǴѨՈ
ໆ཮КၨӭǴ‫܌‬аाᒡӭ΋ᗺӸۭǶ Lung function poorǺ‫ ܂‬anemia ཮೷ԋ
compensatary tachypneaǴ೷ԋ pulmonary distress
** ёໆ orthostatic hemodynamic changeǺSBP फ़>10mmHgǴPR ϲ>15/min)
*** UGI ёа௨ panendoscopeǴ଺ angioǹcolon аΠёа࣮ coloscopeǹӵ݀ࢂ
small bowel ‫ޑ‬၉Ǵёа଺ angio ‫ ࢂ܈‬RBC scan όၸཀက೿όεǶ
**** ዴϪບᘐᗋࢂा᎞ᔠࢗ୚Ǽόၸϟҗ history ‫ ک‬PEǴ‫ॺך‬ωૈӼ௨ௗΠٰ
௨‫ޑ‬ᔠࢗǶ
*****ਥᏵᏢߏ‫ޑ‬ᇥ‫ݤ‬ǴӢࣁ heme ཮ύ‫ک‬गለǴ‫܌‬аੰΓ཮᝺ளКၨόภǶՠ
ࢂؒԖӧਜ΢࣮‫ډ‬೭ኬ‫௶ޑ‬ॊǶ

- 17 -
07. I/O imbalance M92 ࡘዝ

# ᜢ‫ ܭ‬I/O ‫ޑ‬ୢᚒࢂӧჴಞਔதத཮೏ call ‫ޑ‬ୢᚒ

΋૓ѝाԖ recall I/OǴpositive or negative 500 ml/day а΢λ‫ۆ‬൩ᔈ၀ൔ֋ᙴ
ৣǶ
¾ I/O positiveǺ
9 urine output ‫୼ى‬ǴԖ 7 8 ԭѰѓ
(adult urine output 1cc/kg/hrǴԿϿाԖ 0.5cc/kg/hr)
λ‫ۆ‬ӧीᆉ I/O ਔ٠ؒԖஒ insensible loss(300-500)Եቾ຾ѐǴ‫܌‬
аӵ݀+1000 ѰѓǴεཷ೿ᢀჸ൩ёаΑǼ
9 Urine output ό‫<( ى‬0.5c.c/kg/hr)( ΋Ϻλ‫ ܭ‬400-500)
z ӃԵቾ post renal obstructionǺࢂ᡿த‫ޑـ‬Ǽ
ӵ݀ੰΓ on foley ा࣮࣮ࢂόࢂ foley ༞ՐǴᄗᄗ bladder ᅍ
όᅍǴሡόሡाඤ foley or foley irrigationǴӵ݀ࢂ BPH on
foley ൩ӳΑǼ
z ؒԖ post renal obstructionǺԵቾ acute or chronic renal failure
‫ ঁܜ‬BUNǴCR ࣮࣮Ƕ
ӵ݀ࢂ renal failure Їଆ‫ ޑ‬oligouria
२Ӄ࣮ࢂόࢂԖ underlying disease
egǺDM Ǵischemic injuryǴdrugǴautoimmune disease ฻฻
s/s Ǻ fatigue Ǵ drowsy Ǵ N/V Ǵ kussmaul respiratory Ǵ basal
ralesǴedema...
LabǺBUN Cr increasedǴBUN/Cr =10/1ǴCCr Πफ़
Na(urine >20mmol/L)ǴFENa>1%
ೀ౛চ߾ाλЈ electrolyte imbalanceǴmetabolic acidosis
ੰΓाज़Нज़ protein
¾ I/O negativeǺvolume ό‫ى‬Ǵ hypovolumia
Challenge fluid
२ӃᗋࢂाӃΑှࢂϙሶኬ‫ੰޑ‬Γ
9 ߻ ΋ Ϻ খ ໒ ֹ Θ ‫ ੰ ޑ‬Γ ё ૈ җ ‫ ܭ‬blood loss а Ϸ ӧ Θ ‫܊‬
insensibileloss ‫܌‬а৒ܰวғǴӢࣁ hypovolemic status Їଆ‫ ޑ‬urine
decreaseǴӵ݀ skin turgoǴmucosa ࣮ଆٰଳ Ǵbreath sound clearǴ
vital sign stableǴёаԵቾ IV run ‫ז‬΋ᗺ ? ӵ݀ heart rate ‫ ז‬BP
down ߾ाԵቾ fluid challenge fluidǶ๏‫ݤ‬ΨࢂεᏢୢǴёа΋ԛ
๏ 200ccǴӵ݀ BP ؒӣٰӧ 200Ǵӵ݀Ԗ CVP ा‫ݙ‬ཀӵ݀
pressure ΢ϲ 5 ‫ ࢂ܈‬300cc 300cc CVP ΢ϲ 7 ൩ाλЈ pulmonary
edemaǶԖ٤ VS ഻៿๏ FFP ံНϩ໩ߡ܎ urineǴ೭൩࣮ vs ‫ޑ‬ᄊ
ࡋΑ΋૓ॶ੤ό཮๏Ǽ
9 Fever ёૈ೷ԋ fluid lossǴሡ‫ݙ‬ཀǶ
ӵ݀ೀ౛όٰ൩ call resident όҔϼ࠼਻Ǽ

- 18 -
08. Shortness of breath M92 ҏᙔ

*Ӄϩ acute or chronic

*Ӄ rule out аΠϖᅿ treatable emergent diseaseǺ1) Pneumothax. 2) Acute
pulmonary edema. 3) Severe acidosisǺDKAǴsepsis. 4) Cardiac temponade 5)
Pulmonary embolism

1ǵӧႝ၉ύӃୢమཱੰΓ‫ ޑ‬vital signsǴonset timeǴthe reason for admissionǹ

ऩЋᜐؒԖ‫ځ‬д‫׳‬ᆙ࡚‫ޑ‬٣Ǵനӳᅰ‫ז‬ѐ࣮ੰΓǹ ऩੰΓ௃‫ݩ‬Ӓ࡚Ǵ‫҅܈‬
ӳ‫و‬ό໒ (ӵ҅ӧ CPCR) ёፎ nurse ‫ޔ‬ௗӃ call R
2ǵ‫ז‬ೲ review chartǴхࡴੰΓ೭ԛΕଣ‫ޑ‬চӢǴҞ߻Րଣ‫ ޑ‬active problemsǴ
underlying diseases (MI hxǴasthmaǴCOPDǴESRD ...)
3ǵBedside
(1) ӆԛຑ՗ vital signsǴഹ‫ࠠޑ‬ᄊǴੰΓ‫ ޑ‬consciousnessǴऩ᝺ள௃‫ݩ‬ό
ჹǴᇴ‫ ז‬call RǴӧ R ҂‫ډ‬ϐ߻όाᚆ໒Ǵ٩ྣ R ‫ࡰޑ‬Ңೀ౛Ǵ٠೛‫ݤ‬
‫פ‬рഹ‫ޑ‬চӢ
(2) History takingǺхࡴ onset timeǴdurationǴassociated s/s (eg. chest
tightness/painǴN/VǴhemetemesis or coffee gound vomitusǴmelenaǴcold
sweatingǴ) recent choking history ( esp in elderlyǴCVAǴor unclear
consciousness pt)Ǵrecent procedures ( eg. brochoscopyǴchest tube
insertion...)Ǵprevious similar episode...
(3) PEǺ‫ݙ‬ཀഹ‫ࠠޑ‬ᄊ( shallowǴdeepǴparadoxical resparationǴ...) ࢂց
orthopneaǴJVEǴpitting edema palpation of neck and chest area for
subcutaneous emphysema ( esp pt received bronchoscopyǴchest tube
insertion or other procedures) ‫ݙ‬ཀ peripheral pulses breath soundsǺ
carcklesǴwheezesǴstridorǴdecrease or abscensce of BSǴsymmetric or
notǴabdǺsoft or distendedǴtender or pain
4ǵTxǺ
(1) ёჸ࣮ chartǴ࣮ੰΓന߈ࢂցԖၸᜪ՟‫ޑ‬௃‫׎‬ǴऩԖ feverǴࢂցς٬Ҕ
‫ל‬ғનǴऩคന߈‫ ޑ‬lab dataǴёԵቾ fever workup
(2) O2 nasal 2 l/min ໒‫ۈ‬ຎ௃‫ݩ‬΢ፓǴऩੰΓࡐഹǴ‫܈‬஭α‫֎ڥ‬Ǵё‫ޔ‬ௗҔ
maskǴऩԖ wheezesǴCOPD historyǴёԵቾ A+B stat
(3) ABG statǴdata ऊ 30min Կ 1 hr ཮рٰǴ૶ளѐࢗ٠ղ᠐Ǵ30 min ࡕӆ‫ܜ‬
΋ԛ gas КၨǴ٠‫ݙ‬ཀੰΓᖏ‫ ׉‬s/s ࢂցԖ‫ׯ‬๓
(4) EKG stat ( คፕࢂցԖ chest tightness/painǴЀ‫ځ‬ӧ CV ward ‫܈‬ԴΓǴନ
ߚዴ‫ۓ‬όࢂ heart ‫ޑ‬ୢᚒ)
(5) CXR stat (૶ளӃ࣮ന߈‫ ޑ‬CXR)
(6)ӵԖ heart failure historyǴbasal rales ԵቾѺ΋Ѝ lasix.
(7)renal failure historyǴԵቾѺ lasixǴ‫ ܈‬call R ࣮ाόा࡚ࢱ๝Ƕ
(8)੿‫ޑ‬ኖόՐǺ૶Ր ၀ on endo ਔ൩ा on endo. Ȑ྽ฅाӃ call Rȑ.
(9) OthersǺຎ௃‫ݩ‬Զ‫ۓ‬
#аΠӈрੰ‫܊‬ύத‫ـ‬ഹ‫ੰޑ‬Γ
1ǵ LungǺCOPD with AEǴasthmaǴpneumoniaǴpneumothoraxǴforeign
body aspirationǴpulmonary edemaǴpulmonary embolismǴmalignancy

- 19 -
 2ǵHeartǺcardiogenic pul edemaǴanginaǴAMIǴᗋၶၸ aortic dissection Ҕ
ഹ߄౜‫ޑ‬
3ǵ GIǺmassive ascitesǴinternal bleeding
5. OthersǺinfectionǴsepsisǴESRDǴsubcutaneous emphysemaǴacute loss of
blood or body fluidǴanaphylactic reaction to blood transfusionǴCNS lesions
( eg. CVA or brain metaǴCheyne-Stokes resp.) hyperventilation or psychologic

- 20 -
09. Seizure and epilepsy M92 λђ
Seizure ‫ ޑ‬subtypes ϩࡐӭᅿǴՠҔᛰࠅࡐൂપǴЬा٬Ҕ‫ ࢂޑ‬anticonvulsant
ᛰ‫ނ‬Ƕ೯த monotherapy(ൂપҔ΋ᅿ anticonvulsant ᛰ‫཮)ނ‬෧Ͽ drug interaction
‫ޑ‬ᐒ཮Ϸ adverse effect ‫ޑ‬ёૈ‫܄‬ǶதҔ‫ޑ‬ᛰࣁ Valium ( IF ੰ‫܊‬ԖϦᛰǴҞ߻ᇡ
ࣁ Ativan Кၨӳ)ǵDilantinǴዴᇡࣁᡜ⻯ࡕǴ൩ 1 amp IV ๏Πѐ୚Ǽ(૶ள slow
push)Ƕ೯தᛰ‫ ޑނ‬response ‫ז‬Ǵՠӵ݀วғ status epileptusǴ൩Ԗ΋঺ೀ౛ࢬำ
protocolǶ(ӧനࡕ)
# History takingǺOnsetǴdurationǴseizure pattern (focal/generalizeǴconscious
impairment during attack ǴauraǴpost-itcal s/s)ǹёаୢࢂցԖ epilepsy ‫ੰޑ‬ў
~хࡴ age of onsetǴchange of frequency recentlyǴdrug control ௃‫׎‬฻ǶԜѦΨ
ёаୢ΋٤࣬ᜢ s/s such as feverǵheadacheǵblurred visionǵstiff neckǵmental
impairment ฻Бߡբ D/DǶ
# Precipitating factors Ǻ த ‫ ޑ ـ‬х ࡴ emotional change Ǵ stress Ǵ light/sound
stimulation Ǵ intention-induced Ǵ infection Ǵ alcohol Ǵ cessation of medication
therapyǴsleep deprivationǴζ‫܄‬ᗋा‫ݙ‬ཀ MCǵpregnancyǵoral contraceptive
฻Ƕ
9 ԋΓத‫ـ‬চӢǺstrokeǴsystemic infectionǴwithdrawal from anticonvulsantǴ
alcoholic withdrawalǴmetabolic problemǴbrain tumor and idiopathic etcǶ
9 λܻ϶த‫ـ‬চӢǺCNS infectionǴsystemic infectionǴcongenital problemǴ
traumaǴmetabolic problemǴbirth injuryǴfebrile illnessǴidiopathicǶ
Diagnosis(Ӄዴᇡࢂց੿ࣁ seizure)
Analysis of a detailed clinical history (mostly important)Ǻa key feature of
epileptic seizures is their stereotypic nature
Sometimes EEG is helpful
CBC/DCǴBiochemistry (sugarǴelectrolyte ǺNaǴKǴMgǴSugar)
Brain CT/MRI or SPECT
CSF study (prn)
Present drug
Status Epilepticus ‫ۓ‬ကǺAn epileptic seizure ࡭ុຬၸ 30 minǴ‫ٿࢂ܈‬ԛೱុ‫ޑ‬
seizures ϐ໔ؒԖ consciousness ‫ ޑ‬full recoveryǶ
ManagementǺ
1. ӵ݀ѝࢂ΋ԛ focal seizureǴёѝᢀჸό๏ᛰǴ‫ܜ‬΋٤ CBCǴCaǴNaǴ
MgǴglucoseǴdilatin levelǴdepakin level (ӵ݀ԖӞᛰ‫ޑ‬၉)
2. Status epilepsy ‫܈‬ၨߏ‫ ޑ‬GTCǴ
aǵ Maintain ABCǴO2 nasal 2L/min
bǵ Valium or ativan 1pc st IV. Ativan ё IM ѺǶ
cǵ Neuro ࡌ᝼Ѻ ativanǴՠόࢂ‫܊ੰঁ؂‬೿ԖǶՠ΋‫ۓ‬೿Ԗ valium.
dǵ AtivanǴvalium ё try 3 ԛǴӵӆ‫ ܜ‬loading dilatin.
eǵ Dilatin loading Ǻ 6pc~8pc Ǵ ё loading ‫ ډ‬20 mg/kg. Maintain Ǻ 1pc
Q6h~Q8h.
fǵ ӆόՉǺҔ depakin ‫ ܈‬midazolamǴcall R փǶ
gǵ status epilepsy ਔ IV run ‫ז‬٤Ǵrecord I/OǴӢԖਔ཮ rhabodomyolysis
೷ԋ acute renal failureǶ

- 21 -
10. Conscious change M92 λђ
x ၶ‫ ډ‬LOC ‫ז‬ೲ REVIEW (A) Alchohol (B) BUN/ Cr (C) Cardiac/CNS (D)
Drug (E) ElectrolyteǴendocrine (G) Glucose (H) HE (I) Infection (K)
AKA
x Conscious change ࢂ΋ঁ medical emergencyǴሡ‫څ‬ό৒጗Ӧೀ౛ǴؒԖ‫ע‬
ඝ΋‫ۓ‬ा call R ೀ౛Ƕ(೯த conscious change ൩ࢂ call R ‫ ޑ‬indication )
x ಃ΋‫؁‬൩ࢂा check ‫ ځ‬vital signs ࢂցԖ stableǴӧᆢ࡭ vital signs stable
ϐࡕǴωѐ଺࣬ᜢ‫ޑ‬ᔠٰࢗ‫פ‬চӢǶ੮ཀ patient ࢂ ց Ԗ ventilatory
impairment ‫ޑ‬௃‫ݩ‬Ǵӵ݀ԖǴाᇴᆙᒥྣ࡚௱‫ޑ‬ಃ΋ঁ ABC triad ೀ౛ ~
AǺkeep Airway patentǶऩ patient Ԗ severe dyspnea/apneaǴፎ R ٰ on
EndoǶ
BǺBreathingǶຑ՗‫֎ڥ‬ǴԖഹਔ૶ள‫ ঁܜ‬GASǶ๏ O2 ٠ monitor PaO2
conc. (ՠ COPD patient ๏ O2 ाλЈ)Ƕ
CǺCirculationǶࡌҥ IVǴmonitor HR Ϸ BPǶӧ shock ‫ ޑ‬patient ‫ ځ‬fluid
resuscitation ࡐख़ाǶ
x Blood sample for CBC/DCǴglucoseǴelectrolyteǴBUNǴCaǴliver
emzymes (AST/ALTǴCreatinine)Ǵammonia levelǴPT & APTTǶ
x ᛙ‫ ۓ‬vital signs ࡕǴा໒‫ פۈ‬etiology ٠ correct ~
(1) ‫ז‬ೲ review ੰΓ‫ ޑ‬chartǴ࣮ࢂցԖ underlying diseases ೷ԋ‫࣬ޑ‬ᜢё
ૈ‫܄‬Ǵӵ DMǵMIǵCHFǵEpilepsyǵStrokeǵbrain tumorǵliver
failureǵESRDǵCOPDǵ hypothyroidismǵadrenal insufficiency ฻Ƕ
(2) History taking Бय़Ǵ‫ݙ‬ཀ conscious change ‫ ޑ‬onset (ӵ EpilepsyǴSAH
฻ sudden onset ǹ shock ࣁ acute onsetǹ hepatic encephalopathy Ǵ
electrolyte imbalance ฻ࣁ insidious/progressive onset )ੰΓ߈ٰࢂցԖ
traumaǴmedication change Ϸ medication control ‫ ޑ‬conditionǴ
alcohol/drug useǴаϷࢂցԖ infection ೷ԋ sepsis ‫ޑ‬ёૈǶΨा࣮ੰ
ΓࢂցԖ active bleeding ೷ԋ hypovolemic shock ‫ޑ‬௃‫׎‬Ƕ
(3) DM ੰΓाԵቾ hyper/hypoglycemia Ϸ DKAǹCV ੰΓा੮ཀ
cardiogenic shock (systolic BP drop)ǹNeuro ੰΓाԵቾࢂցϐ߻Ԗ
seizure attack (post-ictal sequale )ǴIICPǴmeningoencephalitisǴ‫ࢂ܈‬
progressive CVAǹPsychi ੰΓ၀ගٛࣁ suicideǵpsychogenic traumaǹ
electrolyte ‫ ޑ‬data ё r/o hyper/hyponatremiaǴhypercalcemia
(4) PE/NE Бय़ǺGCS scoreǴneck stiffness (meningitisǴcerebellar
herniation)Ǵfocal signs (myoclonus)Ǵbrainstem signs (EOM
limitationǴeye reflexǴmotor/sensory impairment or lossǴdizzinessǴ
dysarthriaǴdysphagiaǴdrop attack)Ǵrespiratory pattern
(hyperventilationǴCheyne-Stokes respirationǴKussmaul breathing)Ǵ
cyanosis of lip and nails
x ‫ځ‬дᒧ᏷‫܄‬ᔠࢗ‫ޑ‬Ӽ௨Ǻ
‹ UrineǺBZD
‹ Brain CTǺhemorrhageǴlarge infarctionǴbrain tumor
‹ Brain MRIǺbrainstem lesionǴADEMǴbrain tumor
‹ Endocrine testǺhypothyroidismǴadrenal insufficiency
‹ EEGǺseizureǴmetabolic encephalopathy

- 22 -
 ‹ CSF studyǺCSF infection/inflammation

11.Headache M92 ᲋᎔
¾ ੰ‫܊‬த‫ـ‬ϐ complainǶ90%೿ࢂ‫ޑ܄ؼ‬Ƕচ߾ࢂӵ݀ੰΓς࿶೭ኬภӳ൳
ԃΑǴ൩Кၨؒᜢ߯Ƕऩࢂ acute ‫ࢂ܈‬ภ‫کޑ‬а߻όӕǶ‫܈‬ӝ‫ٳ‬Ԗ vital
signǴconsciousness change ൩ाλЈǶ
¾ ୢ historyǺӵ݀ภΑࡐΦǴ‫ ୁٿ‬temporal ‫ ܈‬frontal region throbbing painǴ
ӭࢂ‫܄ؼ‬Ǵ๏ NSAID ջёǶӵ݀ࢂ acute วғǴੰΓၟգᇥவٰؒ೭ኬภ
ၸǴλЈ ICHǶӵ݀ੰΓӝ‫ٳ‬Ԗ vomitingǴblurred vision λЈ IICPǶӵ݀
ੰΓԖ focal sign complain ‫׳‬ाλЈǶԖࢬሷੂǴ‫܈‬೚ࢂ sinusitisǶ
¾ PEǺvital signǺfeverǴᚶᅪ menigitisǴ࣮Ԗค neck stiffnessǶBradycardia
Ϸ high BPǴᚶᅪ IICPǶNEǺ࣮΋Π cranial never Ϸ muscle powerǴԿϿ࣮
΋Π pupilǶ࣮΋ΠԖค kerning sign ‫ ک‬brudzinskin signǶ
¾ ሡ௨ନ‫ੰޑ‬ǴஒаΠ‫ੱ࡚ޑ‬௨ନࡕǺ‫ځ‬д‫ޑ܄ؼ‬ᓐภ๏ NSAID ջёǶ
9 IICPǺconsciousness changeǴvomitingǴblurred visionǴhigh BP Ϸ
bradycardiaǶा call R ๏फ़တᓸᛰǶ
9 Mass lesionǺhematoma ‫ ܈‬tumorǶёૈӝ‫ٳ‬Ԗ IICPǴख़ा‫ࢂޑ‬Ԗ focal
signǶऩࢂ SAH ཮ँฅภଆٰǴЪੰΓ཮ complain வؒ೭ሶภၸǴЪ
Ԗ neck stiffnessǶCall R ೀ౛Ƕ
9 MenigitisǺԖ feverǴneck stiffnessǴkerning signǶCall R ೀ౛Ƕ

12. Tachycardia and Bradycardia M92 ᲋᎔

¾ ୷ҁ΢೭ᅿ complainǴintern ಃ΋ҹा଺‫ޑ‬٣ࢂ଺΋஭ complete EKGǴղ
ᘐ‫ځ‬д vital sign ࢂց stableǶӵ݀౐ੋ‫ډ‬Ј᠌ࣽ‫ޑ‬Ҕᛰ೿ा call R ೀ౛Ƕ
¾ Bradycardia
9 ࣮΋ΠੰΓԖคό๤ܺǶࢂցа߻Јၢ൩ᄌǶ௨ନ΋٤ҔᛰЇଆ‫ޑ‬চ
ӢǶӵ B blocker ൩ԖёૈᡣЈၢᄌǶӵ݀ੰΓؒԖό๤ܺёᢀჸǶ
9 ଺ EKG ࣮ԖؒԖ AV blockǴӵၸԖ Mobitz typeII block а΢‫ ޑ‬IV
blocker ाᒬᏢߏᖄ๎Ј᠌ࣽ଺ peace makerǶӵ݀ࢂ sinus
bradycardiaǴё‫ܜ‬΋٤ electrolyteǴhyperkalemiaǴ‫ ܈‬hypocalcemia ࣮
ଆٰ‫܈‬೚Ⴝ bradycardiaǶ
9 όᆅࢂϙሶচӢЇଆ‫ ޑ‬bradycardiaǶऩੰΓԖՈᓸόᛙǴ‫܈‬ཀ᛽Ԗᡂ
ϯǶ٩ ACLS ᔈѺ atropineǶCall R ٰ،‫ۓ‬ाόाѺǶ
9 ԖਔੰΓऩࡐภǶЇଆ vasovagal reflex ‫܈‬೚Ψ཮ bradycardiaǶ
¾ Tachycardia
9 ୢ΋Π‫ځ‬д vital sign ऩԖ hypotension ‫ځ܈‬д discomfortǶ٩ ACSL ᔈ
‫ޔ‬ௗႝᔐǶ྽ฅा call RǶ
9 Intern ‫ޑ‬πբࢂଭ΢଺΋஭ EKGǶϐࡕന call R ٰ࣮Ƕ
9 Ӄϩࢂ wide ‫ ࢂ܈‬narrow ‫ ޑ‬trachycardiaǶWide trachycardia ёૈࢂ
VTǴcall R ٰ࣮ǶNarrow trachycardia ୔ϩࢂ Af ‫ ܈‬PSVTǶPSVT ёӃ
ࡪነ΋Πᓍ୏ેǶ ࡪϐ߻ाӃ᠋᠋ԖؒԖ Carotid bruit .Af ाϩ΋Πд
ࢂന߈วғ‫ޑ‬Ǵ‫܈‬ς࿶ࡐΦΑǶനӳ೿ call R ೀ౛Ƕ
9 Sinus trachycardiaǺ΋૓ΓΨό཮คጔคࡺ sinus trachycardiaǶࢗ΋Π
ੰΓԖคѨՈ‫ੵ܈‬ภǶ

- 23 -
13. PCT M93 ৎᄪ

1ǵ໺಍ skin test БԄ໻ჹ IgE-mediated reactions ԖႣෳሽॶǶ

2ǵ΋૓ၸ௵ϸᔈӵǺⶁഞ੶Ϸ‫ځ‬д‫ޑ‬Ҝጥ੶ǵᜪՈమੰϸᔈ‫܈‬ോ೽Нဍ฻ǹ
ᝄख़ਔ‫׳‬ёૈЇଆၸ௵‫܄‬ҶլǴ‫ځ‬วғ౗ऊ 0.015%~0.04%Ƕ
3ǵ྽ၸ௵ϸᔈวғਔᔈଭ΢ϒаଶᛰǴ٠٬Ҕ‫ל‬ಔᙃữᏊ(antihistamine)‫܈‬Ҝ፦
ᜪ‫ڰ‬ᎇ(corticosteroids)ٰ‫ݯ‬ᕍⶁഞ੶аϷ‫ځ‬д‫ޑ‬Ҝጥ੶‫܈‬ᜪՈమੰϸᔈǹ
Զวғᝄख़‫ޑ‬ၸ௵‫܄‬ҶլਔǴ߾ሡᆙ࡚‫׫‬ᆶ๝΢ဏન (epinephrine)ǵ਼਻
(oxygen)ǵaminophyllineǵIV steroid Ϸߥ࡭ੰ஻‫֎ڥ‬ၰ‫ޑ‬ᄣ೯Ƕ
4ǵჹ penicillin ၸ௵‫ޣ‬ჹ cephalosporins ΨёૈౢғҬΰၸ௵Ǵวғ౗՗ीऊࣁ
5-16%Ƕ

Is This Patient Allergic to Penicillin? (JAMA 2001ǹ 285Ǻ2498-2505)

1ǵӧੰўჹ penicillin Ԗၸ௵ϸᔈ‫ੰޑ‬ΓύǴҔ skin test ෳ‫ۓ‬Ǵ 80-90%‫ੰޑ‬Γ
ჹ penicillin ؒԖၸ௵ϸᔈǶ
2ǵऩੰўჹ penicillin Ԗ type I reactionǴ Ъ penicillin ࣁ२ᒧᛰ‫ނ‬Ǵ ёӃ଺ skin
testǴ Ӣε೽ϩ‫ੰޑ‬Γࣁ഍‫܄‬ϸᔈǹ ԶԖ഍‫܄‬ϸᔈ‫ੰޑ‬ΓύǴ 98%ӧ٬Ҕ
penicillin Πό཮ԖҺՖᝄख़ϸᔈǴ ‫ځ‬д 2%ࣁ IgE-mediated reaction (1.49%)
Ϸ a delayed reaction (0.63%)Ƕ
3ǵऩੰўჹ penicillin Ԗ type I reactionǴԖ໚‫ ܄‬penicillin skin test ่݀‫ޑ‬
likelihood ration ࣁ 1.9 (95% CIǴ1.5-2.5)Ǵ ऩੰўჹ penicillin ؒԖ type I
reactionǴԖ໚‫ ܄‬penicillin skin test ่݀‫ ޑ‬likelihood ration ࣁ 0.5 (95% CIǴ
0.4-0.6)Ƕ
4ǵThe frequency of allergic reactions within 24 hours of cephalosporin
administrationǺ5.6% for patients with penicillin allergy history (+) & skin test
(+) ǹ 1.7% for patients with penicillin allergy history (+) & skin test (-)
(Immunol Allergy Clin North Am. 1991ǹ11Ǻ611-633)

- 24 -
14.Back pain by M93 ਕྍ
Patients complain LBP (low back pain)ǴӃୢ history ٰϩࢂ ALBP (acute) or
CLBP (chronic)ǴӢࣁᖏ‫׉‬΢‫ޑ‬ೀ౛ό΋ኬǴ ALBP ‫ۓ‬ကࢂΟঁДϣ ೭ᜪ‫ੰޑ‬
ΓԖ 85% ёа full recoveryǶ
Back pain ٠ό฻ӕ root compressionǴ‫ځ‬д‫ ޑ‬para-vertebral structure ‫ޑ‬ୢᚒΨ
཮೷ԋ LBP Ƕ

Patient approach ǺӃ᠋ੰΓӵՖ‫׎‬৒ his/her pain natureǺ

1. Local pain Ǻ೯தҔЋࡰёᓸ‫ډ‬΋ local ‫ ޑ‬tender point
2. pain referred to back ऩࢂ referred painǴ೯த primary site ‫ޑ‬ภ཮‫ܴ׳‬ᡉǴe.g.
arising from pelvic or abdominal viscera Ǵ೭ਔᔈଞჹд‫ ޑ‬primary lesion բೀ
౛Ƕ
3. pain of spine origin Ǻ ೭΋ᜪ‫ ޑ‬pain ӭ཮ associated with ᖊ೽‫܈‬ᆲ೽‫ ޑ‬pain
4. radicular back pain Ǻcoughingǵ sneezing ฻ቚуဎᓸ‫୏ޑ‬բ཮ౢғ radiating
painǴᖏ‫׉‬΢‫߻ک‬΋໨ࢂࡐᜤ୔ϩ‫ޑ‬Ǵόၸఁ΢ॶ੤‫ޑ‬ਔংΨόҔϩࢂব΋
ᅿǴ Ӣࣁό཮ቹៜգ໒‫ ޑ‬medication Ǽ
5. pain related to muscle spasm ǺӭӢ࠮༈ό‫ؼ‬Їଆ

੿‫ࡐޑ‬໕‫ޑ‬၉Ǵ ໩ߡჹੰΓբፁ௲ Ǻ“temporary suspension of activity known to

increase mechanical stress on the spineǴsuch as heavy liftingǴprolonged sittingǴ
bending or twistingǴand straining at stoolǴmay be helpful.”….Harrison

PE Ǻ
1. abdominal palpation Ǻpancreaititis AAA
2. percussion of C-V angle ǺpyelonephritisǴadrenal diseaseǴL1-2 transverse
process Fx
3. inspectionǺnormal curveǴCervical lordosisǴThoracic kyphosisǴLumbar
lordosis ǴΨा࣮ԖؒԖ scoliosis
4. vertebra percussionǴऩࢂ bony spine origin ߾ᄟਔ೿཮ภ
5. Patrick signǺऩ positive ߾ᔈࢂ hip Զόࢂ spinal ‫ޑ‬ୢᚒ
6. SLRT Ǻऩ positive ߾ዴ‫ۓ‬Ԗ spinal origin ‫ޑ‬ୢᚒ ǴL5/S1 nerve root аϷ
sciatic nerve ‫ ډڙ‬stretching
7. reverse SLRT ǺL2-4 nerve root and femoral nerve
8. ќѦ୷ҁ‫ ޑ‬muscle powerǴDTRǴΨा଺΋Π

Tx Ǻ
܎܎ᚇᚇቪΑ΋୴ Ǵ‫ځ‬ჴ΋ѿ r/o other causesǴLBP ‫ޑ‬๏ᛰࡐൂપ Ǵ೯த೿ࢂ
໒ NSAIDs ‫ ܈‬acetaminophenǴऩࢂ᝺ளό୼ӆу muscle relaxant (೯த೿όሡ
ा) Ǵόा‫ב‬Αೱगᛰ΋ଆ໒๏дǶIbuprofen 1 pc + nacid 1 pc tid~qid po ൩ёа
ΑǼ

- 25 -
PART 3 Post-OP Problems
01.Wound infection M92 ‫ے‬ᑣ
ӧѦࣽೌࡕࢂ΋ঁόзΓඍ‫ޑז‬௃‫׎‬ǴՠӵՖղᘐ΋ঁ wound infectionǴΨ
ࢂ࣬྽ख़ा‫ ޑ‬surgical conceptǶ
Fever ࢂ΋ঁё‫ୖٮ‬Ե‫ޑ‬ख़ाࡰ኱ǴՠΨԖ‫ٯ‬Ѧ->
1. ೌࡕҥջр౜‫ ޑ‬feverǴ೯த‫ ک‬wound infection ၨคᜢೱǴӢࣁಒ๵ሡाਔ
໔ᕷ෗Ǵ‫ډ‬ၲёЇଆว‫ݹ‬ϸᔈਔ೯தςࢂೌࡕ 2ɴ3 Ϻ‫ޑ‬٣ΑǶԜਔ‫ ޑ‬fever
ёૈाԵቾࢂցࣁ drug feverǴ‫܈‬ഞᎈࡕЇଆǶ
2. ՠӧ immune compromised ‫ੰޑ‬ΓȐߏය malnutritionǴߏයܺҔ steroid ‫܈‬
cyclosporineǴࣗԿ HIV!ȑ‫ي‬΢ infection ёૈ٠ό཮Ԗ feverǴӢࣁխࣝ‫س‬಍
ؒԖૈΚϩ‫ ޑ୼ىݜ‬cytokine ٰЇଆ inflammatory responseǶ
ղᘐ wound infectionǺ࣮࣮ੰΓ‫ ޑ‬general condition->ࢂց ill lookingǴvital sign
ӵՖǻȐλЈ SIRS!!ȑѺ໒хಎ࣮໾αǴࢂցԖआဍ዗ภǻࢂցԖ pus
dischargeǻѺ໒໾αࢂցԖᜤᆪ‫ښ਻ޑ‬ǻȐpseudomonas infection Ԗ‫ځ‬ᐱ੝‫ښޑ‬
ၰȑ‫ ܜ‬CBC\DC ࣮ white count ԖคܹଯǻѸाਔёа࣮࣮ ESR ‫ ک‬CRPǶऩԖ
pus dischargeǴ߾଺ pus cultureǴբࣁВࡕ‫ ׯ‬antibiotics ‫ޑ‬٩ᏵǶ

02.Pain
ೌࡕੰΓനத‫ ޑـ‬complainǴੰΓऩؒԖး PCAǴߡ཮Ҕ demerol ٰЗภǶ
΋૓๏‫ ࢂݤ‬1 amp(50mg) IM ‫ݙ‬৔ǴऩੰΓԃइၨεǴᡏख़ၨᇸǴፎԾՉཤଜᏊ
ໆǴӢ demerol ᜪᛰ‫཮ނ‬Ԗ‫֎ڥڋ׭‬Ǵᓐཀྵ⧋Ј‫ޑ‬ୋբҔǶ50mg ‫ ޑ‬demerol ന
ӭ Q4H ๏΋ԛǴऩၶ΢΋Ϻ‫ډ‬ఁ֐๱ाѺЗภଞ‫ੰޑ‬ΓǴा‫ݙ‬ཀࢂցࣁ
demerol addictionǴჹбԜᜪੰΓനӳ൩ࢂҔ dermerol-C(൩ࢂᆢд‫ ڮ‬C)Ǵӕኬ
IM ‫ݙ‬৔Ƕ

M93 ۘྤ
໒Θֹ‫ੰޑ‬ΓǴ‫ي‬΢த཮Ԗ΋٤ሷगᆅǵֿᆅǵϷЇࢬᆅ฻฻ǶӧѦࣽੰ‫ྣ܊‬
៝ੰΓਔǴதத೿཮ၶ‫ـ‬ǶаΠ൩໒ֹΘੰΓ‫ي‬΢೭٤Їࢬᆅ‫ޑ‬ೀ౛଺΋ঁཷ
‫ޑ܄ۺ‬ϟಏǴЬाࢂଞჹᙴᏢεኴ‫ޑ‬ѦࣽੰΓࣁЬǺ
(1) ሷगᆅ (N-G tube)Ǻ΋૓ٰᇥѝाࢂԖ‫੃ע‬ϯၰϪ໒‫ޑޑ‬ЋೌǴೌࡕੰΓӭ
཮வ໒Θ‫܊‬஥΋Ѝ N-G рٰǴӆόฅ൩ࢂ໒Θ߻ཀ᛽όమ‫܈‬Ԗၸ CPR ‫ੰޑ‬
Γததӧ࡚௱ֹࡕΨ๏ on ΢΋చǶӢࣁЋೌϐࡕ‫ੰޑ‬Γ཮Ԗ paralytic ileus
‫ޑ‬ୢᚒǴ‫܌‬аǴN-G tube Ԝਔ‫فޑ‬Յࣁ decompressionǶҺՖЇࢬᆅ೿ा‫ݙ‬
ཀ፦‫ک‬ໆǴ‫܌‬аǴN-G tube ‫ޑ‬Їࢬ‫ނ‬Ψࢂ‫؂‬В progress note ‫܌‬ाइᒵǶN-G
tube ‫ܘ‬ନ‫ޑ‬ਔᐒΨࢂ‫ڗ‬،‫ܭ‬፦‫ک‬ໆǴӧ፦ؒԖୢᚒ‫ޑ‬௃‫ݩ‬ΠǴໆࢂ‫ځ‬ԛ‫ޑ‬Ե
ቾӢનǶόၸǴ٠ؒԖ΋ঁܴዴ‫ॶޑ‬ᇥܴՖਔёа‫ܘ‬ନ N-G tubeǴঁΓ‫ޑ‬࿶
ᡍࢂ 100~200ml ѰѓǶόၸੰΓЬᢀ‫ޑ‬ག‫ڙ‬ωࢂനख़ा‫ޑ‬Ǵ‫܌‬аǴό֫ӧЇ
ࢬໆϿਔǴӃ‫ ע‬N-G tube clamp ঁъϺ΋ϺǴ࣮࣮ੰΓ཮ό཮Ԗဎ๞གǴӆ
౽ନϐǶ
(2) IVF ‫ ک‬Trying diet ‫ޑ‬ਔᐒǺவ໒Θ‫ޑ܊‬рٰ‫ੰޑ‬Γ೯த೿཮ on IVFǴঁΓ
ಞᄍࢂ๏ post-op ‫ੰޑ‬Γ run D5W/D5SǴԖ٤௃‫ݩ‬Π཮ӆу΢ KClǶӵ݀ࢂ
ؒԖ୏‫ ډ‬GI tract ‫ޑ‬ЋೌǴੰΓ೯தࡐ‫ז‬൩ёаࡠൺ enteral feedingǴѝाੰ
Γёа oral intakeǴIVF ൩ёаଶЗǴКӵᇥࢂႽ஁ౢࣽ‫ޑ‬໒ဎЋೌǴ΋૓

- 26 -
 ࢂ฻ੰΓ௨਻൩ёа໒‫ ۈ‬try dietǴӵ݀ࢂ endoscope ໒‫ޑ‬Ǵ΋рٰ൩໒‫ۈ‬
sip waterǶӵ݀੃ϯၰԖ anastomosisǴ΋૓ࢂϖϺа΢ω໒‫ ۈ‬try dietǴ΋໒
‫ۈ‬Ψࢂவ sip water ໒‫ۈ‬Ǵฅӆ clear liquid dietǴfull liquid dietǴsoft dietǴӆ
ٰωࢂ҅த໯१Ƕᙁ‫ق‬ϐǴon diet ‫ޑ‬ਔᐒԐఁǴ‫ځ‬ჴε೽ҽࢂ‫ڗ‬،‫ܭ‬Ћೌਔ
ჹ੃ϯၰ manipulation ‫ޑ‬ำࡋǶԶ diet advance ‫ޑ‬ਔำǴࢂаੰΓ‫ޑ‬ϸᔈࣁ
ЬǶεৎёаӧ‫؂ޑࣽعޔ‬΋໔ੰ‫ډ࣮܊‬ჹ‫ܭ‬΢य़ග‫ޑډ‬Ӛᅿ diet ‫ޑ‬ᇥܴϷ
ᖐ‫ٯ‬Ƕჹ‫ ܭ‬IVF ‫ޑ‬๏ϒǴԖਜ΢ࢂᇥനӳૈᆢ࡭ӧ 1 ml/kg/hr ‫ޑ‬λߡໆٰୖ
Ե(ΨԖᏢߏᇥӧੰ‫ ܊‬0.5 ml/kg/hr а΢൩ёаΑ)Ƕ໒ֹΘ‫ੰޑ‬ΓନΑ໒Θਔ
Ӣ op-site ኪ៛೷ԋ‫ޑ‬НҽࢬѨѦǴϐࡕ΋٤ third space ‫ک‬΋٤ drainage tubes
‫ࢬޑ‬ѨΨࢂ࣬྽ёᢀǴ‫܌‬аǴೌࡕ‫ޑ‬ឪΕឪрໆइᒵࢂࡐख़ा‫ޑ‬Ƕ
(3) ဉ೷䈜Ǻӧ‫ࣽعޔ‬Кၨத࣮‫ډ‬Ƕ٩фૈ΢ٰϩ‫ޑ‬၉Ǵεठёϩࣁ‫ٿ‬ᅿǴ΋ࢂ
diversionǴΒࢂ decompressionǶ߻‫ࢂޣ‬΋૓ colonorectal cancer ‫ੰޑ‬ΓӢЋ
ೌ‫ݯ‬ᕍ‫ޑ‬ᜢ߯‫҉ޑ଺܌‬ᇻ‫܄‬೷䈜ǹ‫ࢂ܈‬Ӣࣁ anastomosis ӧၨ distal ᆄǴ‫ॺך‬
Ⴃය‫ ځ‬healing ཮ၨᄌԶ଺‫ޑ‬ኩਔ‫܄‬೷䈜Ǵϐࡕ཮ӆஒ‫“ځ‬take down“Ƕ΋ѿ
ဉϣ‫ډࢬނ‬೭ᅿ diversion ‫ޑ‬೷䈜‫ޑ‬䈜αǴဉϣ‫ނ‬൩཮‫ޔ‬ௗࢬрǴό཮ӆࢬ
‫ ډ‬distal ᆄǶќ΋ᜪ decompression ‫ޑ‬೷䈜ё‫ܭـ‬΋٤Ӣ carcimatosis ‫܌‬೷ԋ
‫ ޑ‬GI obstruction ‫ੰޑ‬ΓǶ୷ҁ΢Ǵဉ೷䈜‫ ޑ‬care ‫ؒࢂॺך‬ᐒ཮ၶ‫ޑډ‬Ǵд
ॺ೿཮ѐ ST room ѐ careǶ
(4) Surgical drainǺӧੰ‫܊‬ύǴКၨத‫ ޑـ‬drainage tube ԖΟᅿǺPenroseǵJ-P
tubeǵ‫ ک‬SumpǶPenrose ࢂ΋ᅿ open drainǴؒԖ suction ‫ޑ‬բҔǴ‫܌‬аǴӵ
݀ሡЇࢬ‫ޑ‬Їࢬన‫ޑ‬ໆၨӭЪࢂೱុࢬр‫ޑ‬၉Ǵёૈ൩ό፾ӝǶҁΓനத‫ـ‬
‫ ࢂޑ‬J-P drainǴ೭ࢂ΋ᅿ close suction drainǴ཮ќѦௗ΢΋ঁ vacuum ballǴ
೭ᅿ drain ‫ޑ‬ӳೀࢂ‫ॺך‬ёаၨᆒዴ‫ޑ‬ຑ՗Їࢬన‫ޑ‬፦‫ک‬ໆǴ΋૓ࢂλ‫ ܭ‬30
ml/8hrs ൩ё‫ܘ‬௞Ǵӧੰ‫ޑ܊‬၉Ǵѝा΋Ϻрٰ‫ޑ‬ໆഭ 70~80ml ѰѓǴVS ൩
཮Եቾ‫ܘ‬௞Ƕӵ݀Ԗ irrigation ‫ޑ‬ሡाǴ߾཮Եቾ‫ ܫ‬SumpǴѬࢂ multilumen
‫ޑ‬ᆅηǴࡺёаӕਔ irrigation ‫ ک‬drianǶ
(5) Chest tubeǺӧ CVS ‫܊ੰޑ‬ύၨத‫ډـ‬ǶନΑ‫ݙ‬ཀ፦‫ک‬ໆϐѦǴΨाຑ՗
chest tube ‫ޑ‬фૈǶ΋૓ёаћੰΓࠏ΋ΠǴ࣮࣮ௗ chest tube ‫ޑ‬ᡞηԖؒԖ
‫ݰݰ‬Ƕӵ݀ੰΓؒࠏǴΠय़‫ޑ‬ᡞη൩Ԗ‫ޑݰݰ‬၉Ǵ൩߄ҢੰΓᗋԖ air
leakǶ΋૓ໆӵ݀࡭ុӧ 100~200ml/dayǴ߾ёԵቾ‫ܘ‬௞Ƕόၸ΋‫ۓ‬ाӃ
follow ΋஭ CXRǴ࣮΋࣮ lung expansion ‫ޑ‬௃‫׎‬ӳόӳǶ

а΢൩ࢂ post-op care ཮ၶ‫ޑډ‬΋٤ tubeǶWound care ѝाӧ order ΢ቪ΢

ȨWound CD with Aq+BI qd & prnȩǴӆ኱ܴ wound ‫ޑ‬Տ࿼൩ӳΑ(ନΑ஁ౢࣽ
཮ा intern ඤ op ࡕಃ΋ԛ‫ޑ‬ᛰǴѦࣽவᓐ‫׀ډ‬೿ࢂ nurse ཮ඤ)Ƕѝा‫ݙ‬ཀԖค
wound infection ൩ӳǴ΋૓ࢂΎϺ൩ёа‫ܨ‬ጕǶ

M93 ࠧ໐
Foley Irrigation
‫ੰޑֿࣽݜ‬Γ໒ֹΘϐࡕத‫ޑـ‬ୢᚒ൩ࢂ hematuriaǴ೷ԋ Foley ୹ՐǴӢԜሡ
ा irrigationǷIrritation ‫ޑ‬ਔংᅰໆԿϿϖԭ CC а΢Ǵջ٬ς࿶೯Αᗋࢂᅰໆӭ
ࢱ΋ᗺǴᅰໆ‫္ע‬य़‫ޑ‬εՈ༧ࢱрٰǴёᗉխၸ΋‫ঁٿ‬λਔаࡕΞ୹ՐԶ೏λ
‫ۆ‬єെӣٰӆࢱ΋ԛǷӵ݀ว౜НѺள຾ѐ‫ܜ‬όϼрٰǴёа၂๱‫ ע‬Foley λ
Нౚ‫ޑ‬Н‫ܜ‬௞Ǵฅࡕ੃ࢥ Foley ៛ӧѦय़‫ޑ‬೽ϩǴ‫ ע‬Foley ۳ϣ௢ǴΨ൩ࢂፓ᏾

- 27 -
΋Π Foley ‫ޑ‬Տ࿼Ǵё٬ள irritation ‫׳‬໩ճǴՠፎ‫ݙ‬ཀค๵ǼќѦǵፎᅰໆӃ
‫ܜ‬ӆѺНǴаխচҁς࿶ࡐᅍ‫ޑ‬ᆮા‫ڙ‬όΑǶ

Foley traction
‫܌‬ᒏ Foley traction ࢂஒ Foley ܎‫ޔ‬ǴҔጤ஥‫ۓڰ‬ӧεᆲ΢Ǵᙖҗ஭Κٰ෧Ͽೌ
ࡕ bladder ‫ ޑ‬blood clot ୹Ր urethraǶԶ traction ೯த཮‫؂‬Ϻ‫ܫ‬᚞΋ᗺǴ଺‫ݤ‬ջࢂ
‫؂‬Ϻஒεᆲ΢‫ޑ‬ጤ஥۳ဎ೽Бӛ౽ঁ΋‫ٿ‬ϦϩǼ

Nelaton Tube
Nelaton ࢂঁᐊՅ‫ޑ‬೬ᆅǴբҔࢂ passive drainageǴத‫ࡕೌܭـ‬໾αऩԖ dead
space ‫ޑ‬ЇࢬǴNelaton ‫؂‬ϺሡᢀჸЇࢬ‫ޑ‬ໆаϷᚑՅǴऩЇࢬໆόӭЪଳృǴ
ё‫؂‬Ϻ advance 1cmǼ଺‫ݤ‬ջࢂӃஒ໾α੃ࢥǴฅࡕஒ Nelaton tube ۳Ѧ܎΋Ϧ
ϩǴӆஒ‫ۓڰ‬Ҕ‫ޑ‬଑દଞ۳‫ي‬ᡏୁ‫ۓڰ‬ǴϐࡕҔ Y ࠠથѲᙟᇂǴӆᙟа΋૓Б
‫׎‬થѲǶ

IICP
ᓐ೽ЋೌࡕੰΓǵ‫܈‬ᓐ೽Ѧ໾‫ੰޑ‬ΓǴ໪‫ݙ‬ཀԖค IICPǴ҅தΓ‫ޑ‬ᢅϣᓸᔈ၀
λ‫ ܭ‬10~15mmHgǴCSF ҅த‫ޑ‬ໆऊ 500cc/dayǶᢅϣᓸନΑёவੰΓੱ‫ރ‬ղ
ᘐ Ǻ headache ǵ nausea/vomiting ǵ conscious change ǵ papillary edema ǵ cushing
triad Ȑ hypertension ǵ bradycardia ǵ irregular respiration ȑ Ƕ ќ Ѧ Ψ ё а Ҕ ICP
monitor ٰ ࣮ Ǵ ICP monitor Б Ԅ Ԗ Ο ᅿ Ǻ intraparenchymal monitor ǵ
intraventricular monitorǵepidural monitorǶ
‫ݯ‬ᕍБԄǺᓐ‫ܩ‬ଯ 30~45 ࡋ
hyperventilationǺPaCO2 25~30 mmHg
MannitolǺ0.25~1mg/kg q4~6h
GlycerolǺ250cc BID
Diuretics

Diabetes Insipidus
ઓ࿶Ѧࣽ‫ੰޑ‬Γऩࢂ໒ pituitary tumorǴೌࡕा‫ݙ‬ཀࢂցԖ DIǷ
ӧѦࣽǴacute DI ‫ޑ‬চӢεӭࢂӢࣁೌࡕǵtraumaǵSAHǵ‫ ࢂ܈‬tumor ҁ‫ي‬ቹៜ
‫ ډ‬hypothalamic ǵ ‫ ࢂ ܈‬ઇ ᚯ ‫ ډ‬postetior pituitary Ƕ ੰ Γ ӵ ݀ Ԗ polyuria Ǵ
polydipsia ‫ ރ ੱ ޑ‬Ǵ ٠ Ъ Ԗ hypernatremia ǵ I/O negative ǵ urine output ຬ ၸ
100cc/hour а΢Ǵ߾ᚶᅪࢂցࢂ DIǶ Ԝਔёаᡍ serumǵurine osmolalityǴӵ݀
urine osmolality λ‫ ܭ‬300 mOsm/L Ъ serum [Na] ε‫ ܭ‬150 mEg/LǴ߾ёዴ‫ۓ‬ບᘐ
ࢂ DIǶ
DI ё຾΋‫؁‬ϩࣁ central type аϷ nephrogenic typeǴԜೀ‫ॺך‬ѝ࣮Ьाࢂ
neurosurgery ‫ ࢂ܈‬brain injury ࡕ‫ ޑ‬central DIǴ‫ݯ‬ᕍБԄࢂ٬Ҕ DDAVPȐ1-
desamino-8-D-arginine vasopressinȑǶ

- 28 -
PART 4 Common Drugs M92 ᕉᡕ гԈ ۘҏ
01.Pain
1. Pain
(‫܌‬Ԗ NSAID ࣣा‫ݙ‬ཀ allergyǴplateletǴbleeding tendencyǴGI upset ฻Ǵ
regular ܺҔਔനӳуगᛰ)
¾ Scanol(Acetaminophan)—1pc qid & st (΋Ϻόёຬၸ 8 ᗭ) liver cirrhosis
‫ੰޑ‬ΓाλЈ relative contraindication
¾ Inteban(Indomethacin)—1pc supp. St (platelet ϼեόёҔǴλ‫ࣽٽ‬ҔᛰǴ
> 20 kgw 1#)(λЈ renal failure)
¾ Ponstan(Mefenamic acid) 1# p.o. st or tid~qid
¾ Naposin(Naproxen)-- 250mg/tab 1~2 # st or bidǴ࿶ภǴମᜢ࿯‫ݹ‬Ǵtumor
pain
¾ Ketorolac—NSAIDsǴ1 Amp IM or IV stǴਏ݀‫ז‬ǴၨதҔ‫ੰܭ‬Γೌࡕੵ
ภǴ‫߻܈‬൳ᅿᏲόՐਔ
¾ Ibuprofen 1 # st & qid p.o.

ଞᏊǺ
„ Ketolorac im or iv st อਏ NSAID
„ Demerol 1/2~ 1 im Amp st ‫ ܈‬໒ֹΘЗภ q4h-prn * 2-3 Ϻ
„ Codeine im st or ઓѦ‫ ޑ‬SAH ੰΓӭа iv 2amp q4h-prn
„ ऩᚶᅪੰΓးภाଞ‫܈‬ς࿶ѺϼӭЗภΑǴёа໒ Demerol C(Vit C) or
N/S(ࡐภ) im st

аΠӧဍዦࣽ‫܈‬ЋೌࡕੰΓၨதҔǺ(ՠࢂԖёૈ཮‫ੰڋ׭‬Γ‫֎ڥ‬Ǵ‫ݙ‬ཀ٬Ҕ!!)
¾ Pain cocktail solu(Morphine)--5 ml p.o. st
¾ Codeine 1 # st & q4h prn or 1~3 # q3~6h & IM 1 Amp q4h
¾ Demerol(Meperidine) 1 Amp st & q4h prn (ߏ۪Ћೌࡕεӭࢂ໒೭ᅿ٠Ԗ
muscle relaxant ‫ޑ‬фҔ) or 1~3 # q3~4h p.o. Զ acute pancreatitis ‫ޑ‬ภаԜ
ᛰࣁЬǴόाѺ Morphine!
¾ Morphine 1Amp IM st(oncology ϐ pain Ҕ morphine όҔ demerol)

2. Migraine(όத࿘‫)ډ‬
Cafergot 2 # st p.o.ǴऩคਏǴ30 min ࡕӆ 1 # & Sibelium 2 # (ఁ΢ഢҔ)
Scanol

3. Muscle pain
¾ Rheumon gel(Etofenamate) 1 pc (Լ኷Ǵόё༡໾α)
¾ Methocarbamol(Carbamate)--500mg/tabǴ1~2 pc st or qid(ԼԺ᚞ԅǴᔅշ
ᅵ઀)
¾ Baclofen 1/2-1# bid-tid
¾ Dantrolene(Dantrium)
¾ Tizanidine 1/2-1# bidǴค߻‫ ޑޣٿ‬CNS sedation բҔ
¾ Tensolax 1~2# tid~qid p.o. (ԼԺ᚞ԅǴᔅշᅵ઀)
¾ Dorsiflex(Mephenoxalone)

- 29 -
4. Gouty arthritis
¾ Inteban--1 # supp. St or 2# p.o. st
¾ Colchicine--1 # st & q1~2h to stop pain(ੰΓ diarrhea ࡕ DC)
(ӢࡐϿԖੰΓёа toleranceǴ‫܌‬а‫ॺך‬த໒ 2# tid * 2 day -> 1# tid po)
¾ Allopurinol 1 # qd (࡚‫܄‬යόёҔ)
¾ Urinorm 2 # qd

5. GB stone pain (࿣Ҕ morphine)

¾ Buscopan 1 Amp IM st or 2 # p.o. st(neurogenic painǺoncologyǴDM
neuropathy)
¾ Cospanon 1~2 # tid

6. Trigerminal nerve pain (CNV)

¾ Tegretol 1 # st p.o. & qid
¾ NSAID
¾ Codeine

7. ‫ܜ‬โ myoclonus
¾ Clonazepam 1# st & qid
¾ Erispan 1# st & qid

02.GI discomfort
1. AGE (vomiting / diarrhea / abdominal cramping / bowel sound hyperactive)
࡚ບӃ໻๏സН‫܈‬у 1/2 ๤າǴᝄख़‫ ޣ‬NPO ๏ IV hydration ᡣဉगҶ৲
Ӄ NPO 4hrs
¾ Novamin--1 Amp IM st (Зӗ)
¾ Buscopan--1 Amp IM st (‫غ‬ηภ)
¾ Duspatalin--1# tid p.o. AC(‫ڋ׭‬ဉ᝸୏ǴGI spasm)

2. Vomiting / Nausea / Hiccup

¾ On NG – decompression (ೌࡕ ileus ೷ԋ abdominal distension)
¾ Primperan--1 Amp IM or IV st or 2 # qhs or 1 # tid/AC (ߦ GI motility)
¾ Novamin--1 Amp IM st (फ़ขቾǵЗӗ)
¾ Wintermin--1 Amp IM st (ЗѺⒹ)(όၸԜᛰ‫ ک‬NovaminǴPrimperan ೿ё
ૈЇଆ΋٤ dyskinetic or extrapyramidal syndrome ‫ރੱޑ‬ǴЀ‫ځ‬ӧԴΓ
ৎा‫ݙ‬ཀ)
¾ Cisapride--1~2 # p.o. tid or qidǴAC (ߦဉग᝸୏)(όૈ‫ ک‬erythromycin ‫ٳ‬
Ҕ)
¾ Triomin--1~2 # st p.o.
¾ Cephadol--1# st p.o.
གྷགྷӗ‫ޑ‬চӢǴऩόࢂࡐᝄख़΋‫ޔ‬ӗǴᡣ pt ‫ܿע‬ՋӗрٰϸԶКၨ๤ܺǴ
όѸ‫ޔ‬ௗགྷाѺ novamin

3. Abdominal pain (bowel sound hyperactive)

࣮ੰΓǴୢ hx ଺ PE ‫ ک‬ddxǴ௨ନ acute abdomen
¾ Primperan--1 Amp IM st or 2# qhs (non-specific abdominal painǴऩࢂ
cramping pain ཮ຫҔຫภ )

- 30 -
 ¾ Duspatalin--1# qid p.o. (‫ڋ׭‬ဉ᝸୏Ǵanti-spasm)
¾ Demerol--1 Amp IM st & q4h prn (ೌࡕ໾αภ)
¾ AMG--15 c.c. p.o. st (non-specific abdominal pain)
¾ Buscopan--1 Amp IM st or 2 # p.o. st (non-specific abdominal pain)

4. Gastric pain
¾ AMG(Aluminum Magnesium oral susp)-- 15 c.c. p.o. st (ᅪ՟गለၸӭǵग
ውᅬǵΜΒࡰဉውᅬǹԖ٩ೕ‫଺ࢂۓ‬ၸग᜔ዴ‫ۓ‬ውᅬωё regular ๏)ǹ
5-15ml q2h-qid
¾ Alugel--1~2# qid (཮ߡઝ)
¾ Fina--1# tiq p.o.
¾ Gasgel (Peichia)ǹNacidǹMgOǹUlcerin--1 # p.o. st or tid~qid(ᚶᅪࢂው
ᅬ‫ޑ‬ภёӃҔ)
¾ Calcium carbonate--1~4# qid (཮ߡઝ)(όၸԜᛰၨதҔٰံ Ca եǴ‫܈‬ႇ
ଯਔҔаᛙ‫ۓ‬ಒझጢ)
¾ AMGBowel sound hyperactiveÆDuspatalin 1# qid p.o. (‫ڋ׭‬ဉ᝸୏Ǵanti-
spasm)
¾ Buscopan 1 Amp IM st or 2 # p.o. st (‫ڋ׭‬ဉ᝸୏Ǵό፾Ҕ‫ ܭ‬stool
impaction)
¾ GasconǺёуೲग΢೽ဉ਻֎ԏǴfor gastric distention
¾ StrocainǺ֖ local anesthesiaǴёЗภ

5. Diarrhea (Ӄ check stool characteristics / bowel sound / fever / ࢂց٬Ҕ೬ߡᏊ)

¾ Kaopectin--15 c.c. p.o. st & qid (for watery diarrhea)
¾ Alugel--2# p.o. st
¾ Imodium(Loperamide)--1# st (மΚ⚓ǴԖ morphine ԋϩǴёуம
sphincter ԏᕭ)
¾ Buscopan--1 Amp IM st or 2# p.o. st
¾ Trancolon(Mepenzolate)--2# tidǴ(irritable bowel syndrome)

6. Constipation (check ࢂց٬Ҕ morphine ᜪᛰ‫ ނ‬or ៓Ꮚ)

¾ ႴᓰӭസНǴӭΠ‫׉‬ၮ୏ǴӭӞН݀ጫ๼
¾ Sennoside—1~2#Ǵhs
¾ Lactulose--15 ml bid (ёҔ‫ ܭ‬hepatic encephalopathy) AMG 15 ml st p.o. &
qid
¾ MgO 2# p.o. st & qidȐӞ 1#qid ࣁगᛰਏ݀ȑ
¾ Normacol 1-2# qd-bid
¾ Dulcolax 1# supp. St (‫ڈ‬ᐟဉၰ)ǴΨԖ oral form
¾ Fleet enema 1 pc (ឲဉ)Æ΋ឲᙔՅ౟η
¾ Magnesium citrate 250ml/bot மਏǴӃസ 125mlǴόՉӧസ 125ml
¾ Senokot 2# qhs (ቚуεߡໆ)
¾ Lactulose 15 ml bid (ёҔ‫ ܭ‬hepatic encephalopathy)
¾ Magvae 250 ml (Ћೌǵ೷ቹ߻Ҕ)

7. Abdominal distension
¾ On NG decompressionǴ༡ᖓ಻‫ݨ‬

- 31 -
 ¾ Cisapride--1~2 # p.o. tid/AC (ߦဉग᝸୏)
¾ Gascon--3~5 c.c. p.o. st & qid
¾ Primperan--1 # p.o. st & tid
or 1 Amp IM st (ਏ݀‫)ז‬
or 1 Amp + D5S 500 ml – run 100 ml/hr

8. Hemorrhoid
¾ Proctosedyl--1 pc or 1# supp. St or bid

9. UGI bleeding
a. Keep vital sign (ёҗ HR εཷ՗ी blood loss)
b. ԿϿ‫ٿ‬చ lineǴIV D5S 1000 ml + 20 meq KCl – run 100 c.c./hr
c. NPO  on NG irrigation then ϸ‫ ܜ‬+ decompression  Ulcerin 1 # st & q6h or
Alsanic 2 # qid(౜ӭ๏ Losac 1Amp st and q12h)
d. Zantac 1 Amp IV st and q12h for peptic ulcer
or Tagamel 1 Amp IV st & q6h
or Gaster 1 Amp IV st & q12h
e. Pitressin 10 Amp + D5W 500 ml – run 45 ml/hr for E-V bleeding
f. Check CBC/DCǴPT Ϸഢ 6 u PRBC (ຎ௃‫ݩ‬ᒡՈ)

03.Rhinorrhea
Foning 1# qid (ёЗภǴှ዗Ǵှሷ༞Æа߻ࢂ Rhin 1# tid)
Rhin--1# tid (ёЗภǴှ዗Ǵှሷ༞ࢬሷН)
Clarinase--1# bid.(጗ှၸ௵‫܄‬ሷ‫ݹ‬Ϸགߵੱ‫ރ‬Ǵၨό཮༐ᅵ)
Actifed syrup-- adultǺ10ml q4-6hǹchildǺ4mons-2yrsǺ1.25mlǴ2-4yrsǺ2.5mlǴ
4-6yrsǺ3.75mlǴ6-12yrsǺ5mlq4-6h. (཮ᑫᏟǴှሷ༞Ǵၸ௵‫܄‬ሷ‫)ݹ‬
Periactin--1# p.o. st & tid (཮༐ᅵǴёЗ᝚Ǵሷ‫ݹ‬ϷᒡՈϸᔈ)
Intal(nasal solu)1 bottle ቔᏊ--2 puffs in each nostril tid-qid (ၸ௵‫܄‬ሷ‫)ݹ‬

04.Cough
(Pneumonia όૈ΋‫ښ‬Зࠏ)

1. Зࠏϯ࿀
¾ CMA(cough mixture A)--15 c.c. tid~qid
¾ Bensau(Benzonatate)--100mg/cap100mg tid
¾ Secorine--10 ml tid~qid (λ‫ࣽٽ‬Ҕᛰ)
2. ϯ࿀
¾ Ambroxol hcl—AdultǺ30mg/tabǴ‫ ܈‬3mg/mlǴ100ml/botǹ30mg tidǴё
у‫ ډ‬60mg bid
¾ Robitussin(GuaifenesinǴGlyceryl guaiacolate) 20mg/mlǴ120ml/bot.ǹ
10~20 mlǴq4hǴ(2.4g/d.
¾ ќѦ࿀ϼᐚόӳࠏΨёҔ‫ݯ֎ڥ‬ᕍύ‫ ޑ‬sodium bicarbonate(߫ᆀ”J”)
3. Morphine ᜪЗࠏ
¾ CMB(cough mixture B)--15 c.c. tid~qidǴ֖Ԗ Codeine ԶЪࡐౡǴ‫܌‬а
DM ੰΓၨόӝҔ
¾ Medicon A--1# tid ‫ ܈‬Medicon syrup-- 4-6ml tid

- 32 -
 ¾ Codeine 1Amp IM st or 1/2 # p.o. qidǴനமਏՠϿҔ
ϡ ा‫ݙ‬ཀόा΋‫ޑښ‬ЗࠏǴԖ٤Ћೌၸࡕ‫ٯ(ޑ‬ӵᓐᓍ೽Ǵ਻ᆅϷૅ๚‫ޑ‬Ћೌ)
Ѹ໪ոΚࠏ࿀ǴόाӢࣁੰΓ complain ൩۹ౣΑ!

05.Dizziness / Vertigo
PrincipleǺWell hydration+ antihistamine +others
¾ Vena 1Amp IM st ‫ࢂ܈‬ҔӞ‫ ޑ‬Bena 50mg/capǹ25-50mg q4-6h prn
¾ Novamin 1 Amp IM st or 1~2# p.o.
¾ Cephadol(diphenidol) 1# tid
¾ Bonamin 1# p.o. st (ཀྵً߻Ӟ)
¾ Longifene 2# qd~tid
¾ Vena 1# q4h~q6h
¾ Stugeron 1# p.o. tid (Meniere disease)

06.ֽ೽ЗՈ
PrincipleǺԖਔ໪ check bleeding tendency when unknown etiology of bleeding
¾ Transamin--1 Amp IM st or 4 Amp in D5W 1000 c.c. ( 100c.c./ hr)
¾ Bosmin(Epinephrine) (‫ ܭ‬Heart diseaseǴCNS lesionǴPheochromocytoma
ाλЈ)
¾ Thrombase 1 vial--ቔ‫ܭ‬໾α߄य़
¾ થѲ compression

07.Insomnia
(BZD Ҕ‫ ܭ‬COPDǴRespiratory distressǴhepatic encephalopathy ϷԴΓाλЈ)
ᅵ઀ಞᄍό٫‫  ޣ‬ጜ
¾ Ativan(Lorazepam)—อਏ 1# st or hs (໪ߏයܺҔ‫)ޣ‬ǹќԖଞᏊǹ liver
жᖴǹ 2mg/ml/vial. IM 50g/kgǴup to a max of 4mgǹIVǴinitially44g
/kg or a total dose of 2mg(೯தࢂѺ΋Ѝ୚) ёҔ‫ ܭ‬alcohol withdraw
¾ Halcion(Triazolam)—อਏ 1/2~1# st or hs (neurosis ёҔ)ǹ renal жᖴ
¾ Xanax(Alprazolam)—อਏ 1/2~1# st (‫ל‬ขቾёҔ)
¾ Stilnox(Zolpidem)--1# st (ၨ፾ӝ‫ܭ‬ԴԃΓ٬Ҕ)
¾ Erispan(Fludiazepam)—อਏ 1# st or hs
¾ Valium(Diazepam)—ߏਏǴ2mg/tab.‫ ܈‬5mg/tabǹଞᏊ 10mg/2ml/ampǹ
1# (5mg) or 1 Amp IM (COPD όёҔǴёҔ‫ ܭ‬alcohol withdraw)
¾ Vena 1 Amp IM or IV or 1# p.o. st (anti-histamineǴӧ liver cirrhosis ੰΓ
ό፾Ҕ BZD ਔ)
аΠࡐϿҔ‫ډ‬Ǻ
¾ Balmarden 1# st (‫ځ‬дᛰό፾Ҕਔ)
¾ Dalmadorm 1# st (long acting benodiazepam)
¾ Pyrethia 1 Amp IM or IV st
¾ Mesyrel 1# st

08.Oral ulcer
¾ Kenalog(Triamcinolone)--1 pc( in orabaseǴointǴ0.1%Ǵ5g/tube)ᔔᏊ (Ҝ
ጥၸ௵ǵαઇ‫ )ݹ‬steroid ᜪᛰ‫ނ‬

- 33 -
 ¾ Dexaltin(Dexamethasone)--1 pc oint (plastibase)Ǵ0.1%Ǵ5g/tube. (У៱‫)ݹ‬
¾ Scodyl(Chlorhexidine)-- topicalǴto the gingival membranesǴ15ml rinse ‫ڇ‬
Уࡕ 30’’ bid (anti-bacterial)ǴाԾ຤

09.Oral candidiasis
¾ Mycostatin 1~3 # tid or 4 ml ᅋα qid

10.AllergyǴskin itching
Topical useǺё໩ߡ‫ݙ‬ཀ‫ځ‬ᏊࠠǺlotion and cream ၨమ౏Ǵ፾ӝহ‫ۑ‬٬Ҕ
¾ IchdermǺantihistamineǴൂપ᝚‫ډ׬‬आ
¾ Tropoderm oint 1 pc (ྒྷ੶ǵֿѲ੶)
¾ ZnO 1 pc (आ‫ި־‬Ҕ)
¾ Calcmine lotion 1 pc (З᝚ǵᠴ໾)
¾ Pasca gel 1 pc (३ෝဌǵҜ᠆)
¾ Proctosedyl supp for ౨የ
¾ Postrisan topical ӭҔ‫ܭ‬ౢࡕ‫ޑ‬౨የ
¾ Bacitracin-Neomycin ፾Ҕ‫ܭ‬΋૓໾αǴхࡴғౢ‫཮ޑ‬഍Ϫ໒

Other useǺ
¾ Vena--1 Amp IM or IV st (Antihistamine)ᒡՈࡕ‫ ܈‬PCA ٬Ҕࡕ‫ޑ‬ၸ௵த
Ҕ
¾ Periactin(Cyproheptadine)—1pcǴp.o. tid (གߵǵၸ௵Ǵλ‫ࣽٽ‬தҔᛰ)
¾ Cetirizine(Long-acting non-sedating antihistamine)--5-10mgǴQD (renal or
hepatic function ৡ‫ޑ‬Γόाуໆ) ጗ှၸ௵‫܄‬ሷ‫ݹ‬Ǵⶁഞ੶ǵၸ௵‫܄‬ཝ
᝚
¾ Hismanal 1 # pc qd (ό཮༐ᅵ)

11.Burn
‹ Fucidin 1 pc (λ໾α)
‹ Sulfasil 1 pc (ε໾α)Ǻࣁ cream ԋҽǴёߥྒྷǴ‫܌‬а཮Ҕӧ burn
patient
‹ Furacin ໳ՅᛰѲǺ໺ᇥύ‫ ࣁځ‬polysarrhcorideǴ཮֎НǴ፾ӝԖ
ᗺ wooing ‫ ޑ‬wound
‹ Madecassol ᛰણ
12.Hypoglycemia
glucose < 50 mg/dl (call R)
¾ Бᑗ
¾ Glucose 50 %--4 Amp IV st
¾ Re-check sugar F/S

13.HTN
(Ӄ‫פ‬চӢǴፎ‫ ـ‬PART 1. 4. HTN)
systolic BP > 160 mmHgǹ diastolic BP > 100 mmHg
ऩ patient ‫ ܭ‬border lineǴё๏ᛰǴё obsǴፎੰΓ፴‫׉‬Ҷ৲

- 34 -
คੱ‫ރ‬ӵᓐཀྵᓐภǴё obs ႖ъλਔ recheck
CVA patient ΋ຼϣࣁ acute stage όёᒿߡ๏ᛰफ़ BPǴаխΒࡋύ॥Ǽ
¾ ϮҔ Adalat (ऍ୯ FDA ଶҔ increase AMIǴstroke %)
¾ Labetalol (Trandate)--200mg/tabǴଞᏊ 25mg/5ml/ampǺ0.5~1 pc p.o. stǴ
ઓϣ‫܈‬ઓѦੰΓၨதҔ! ( IV 1amp stǴmonitor BP ϐࡕӆ๏ oral med )
¾ (A)ACEI (B)beta-blocker (C) Cb (D)diuretic ࣁѤε२ᒧǴԵቾ V/S and
side effect ٰᒧ
¾ ऩ acute ाफ़ BP ёᡣੰΓ֖ NTG ϐࡕ໒ long acting medicine.
ќѦऩࢂ࿘‫ ډ‬hypertension crisis or emergencyǴ߾Ѹ໪٬Ҕ IV Nitroprusside ‫܈‬
NitroglycerinǴҔ‫ݤ‬ፎୖԵ mannualǴՠനӳᗋࢂӃ call R!

14.Fever
࣮ੰΓǴୢ hxǴ଺ D/D
z InfectionǺURIǴURI……ሡԵቾ patient Ԗค wound or foley ϼΦΑ
z DehydrationǺ‫ݙ‬ཀ patient ϐ skin turgor
z Tumor feverǺёૈ཮Քᒿ๱ local tendernessǴёૈࢂӢࣁ C/T or RT ೷ԋ
tumor necrosis ԶЇଆ‫ޑ‬ว‫ݹ‬ϸᔈ
z Post-op feverǺ‫ܭ‬Ѧࣽੰ‫܊‬த‫ـ‬Æ߻ΟϺёૈࢂ lung atelactasisÆ᠋ breath
soundǴΟϺࡕωԵቾ w’d infection
z Drug feverÆଶᛰ࿶΢य़،‫ۓ‬
z Collagen-vascular disease

TxǺ
z < 38.5кǺice pillowÆ୼ alert ‫ ޑ‬nurse ೿ࢂᅵӇܾคਏω call գ
z > 38.5кǺऩँฅวᐨ൩ा଺ septic workǴᑽໆ଺ব٤ᔠࢗǺCXRǴU/AǴ
B/CǴu/c ฻Ǵ๏ anti ёᆶᏢߏ૸ፕǶऩࢂς࿶ԖӧҔ anti ‫ޑ‬ाࢗࢗ
sensitivity testǴ‫ځ‬д൩ࢂགྷᒤ‫ݤ‬फ़ྕÆ (NSAID നӳу΋ᗭ gasgel)
¾ HydrationǴIV run ‫ז‬΋ᗺ
¾ Scanol 1# st(΋Ϻόёຬၸ 8 ᗭ)
¾ Ponstan 1# tid ~ qid
¾ Naposin 2# st (࿶ภǴtumor fever)
¾ Indomethacin 1# supp ༞Ꮚ st (ջ intebanǴਏ݀மǴՠ platelet ե‫ޣ‬όा
Ҕ)
¾ Ketorolac iv drip or IM st
¾ Voltaren 1# supp st(λ‫ࣽٽ‬ҔᛰǴBW > 20Kgw 1#Ǵց߾Ҕ 1/2 # or 1/3 #)
z ऩԖ chillsǴ଺‫ ঺ٿ‬blood-culture (႖ 30min)(๏ anti ߻)

15.Status EpilepsyǺseizure > 30 min

#΋‫ۓ‬ाൔ֋ R or CRǼ
z Keep A(airway) B(blood gas) C(vital sign)ǹ Set IV line (normal saline)
z CheckǺCBC/DCǴBUNǴCrǴSugarǴBlood gasǴElectrolyte (CaǴMGǴ
NaǴK)Ǵanticonvulsive drug levelǴtoxic level (΋Ӆ 3 ᆅ+ SugarǴ‫܈‬а
finger stick st ‫ڗ‬ж)
z TxǺ

- 35 -
 ¾ Wernicke diseaseǺglucose 50% 2 Amp IV st + Thiamine 60~100 mg IM st
¾ Opioid overdoseǺNaloxone 0.4~2 mg IV st repeat q2min prn
¾ Valium (10mg/amp) 1 Amp IV slow push 2~4 minǴऩคਏǴ5min ࡕӆ
push 1 Ѝ( Max. doseǺ30mgǴtotal όຬၸ 3 Ѝ)
ӕਔǴDilantin initial 125 mgǴ10~15 mg/Kg tid (1 Ѝ 100mg)
‫ݙ‬ཀǺDilantin 9 Amp in N/S slow IV drip rate < 50 mg/minǴऩሡុҔ߾ 1 Amp
IVF q8h (ሡ EKG monitor ‫ݙ‬ཀ arrhythmia)
¾ 40 min ଓ data ( MgǴCaǴNaǴSugar཮Їଆ seizure)
„ on endo st
„ Phenobarbital 4~6mg/Kg IM st
„ Valium continuous IV drip ( < 200 mg / day)ǴλЈ‫ڋ׭֎ڥ‬ǴեՈ
ᓸ
‫ݙ‬ཀǺ10 mg/AmpǴ15 Amp/ normal saline 500 c.c.Ǵ20 c.c./ hr

16.Others
1. BPHǺ
¾ Consult Uro
¾ Tamsulosine(Selective 1-blocker) --0.2mg/capǴ2# qd
¾ Terazosin(Selective 1-blocker)--2mg/tabǴInitialǺ1mg qhs.
MaintenanceǺ5-10mg qd(‫ڀ‬Ԗ೽ϩफ़Ոᓸ‫ޑ‬ਏ݀)
2. ౳࿊आǵ ᝚
¾ Consult ౳ࣽ
¾ OSMD(Sulfamethoxazole)--1-2 drops qd-qid.

3. Uticaria/AngioedemaÆऩค respiratory distress ( stridor ΋‫ ۓ‬check )Ǵё๏

Vena 1 amp im st ฅࡕ OBSǹ ऩԖ stridorǴ‫ݙ‬ཀ airwayǴёҔ Bosmin 1 amp
inhalationǴाλЈ cardiac effect. ё๏ tropical drug use for s/s

4. Extrapyramidal syndrome (EPS)Æଶ induced drugsǴѺ Vena ‫܈‬๏‫ځ‬д

anticholinergics/antihistamine ӵ Biperiden(Akineton)
ਏΚமࡋǺVena< Artane < Akinetoneǹ ऩคਏǴाᚶᅪ Diagnosis

- 36 -
PART 5 Procedures M92 ֵৱ
01. Arterial Puncture Skills (Pun Gas)
൑ӝǺੰΓഹǴ೏Ꮲߏ orderǴៈγλ‫ܜۆ‬ό‫ډ‬ՈᙯԶा‫؃‬գ‫ે୏ܜ‬Ո..
த‫ޑܜ‬ӦБǺ(ί࿤όा‫פ‬Ԗ AV fistula & shunt ‫ޑ‬ӦБ)
1. Radial arteryǺfirst choiceǴന৒ܰᄗ‫ډ‬ՠࢂനಒǴstandard procedure ଺ϐ߻
ाӃ Allen's test
2. Brachial arteryǺ2nd choiceǴӧЋ‫ ظ‬antecubital fossa & biceps insertion ‫ޑ‬ϣ
߻ୁ
3. Femoral arteryǺthe last choiceǴ
(όၸ߃Ꮲ‫ޣ‬௢ᙚԜೀ)Ǵനಉ but
Տ࿼КၨుǴӵ݀΋ԛा‫ܜ‬ӳ൳
cc ‫ޑ‬၉ࡌ᝼‫ܜ‬ԜೀКၨ‫ז‬Ƕፎ‫ݙ‬
ཀ NAVY ‫ޑ‬௨ӈ໩‫ׇ‬Ǽ(კҢ)

# Procedure ӵΠǺ
1. ჹੰ஻Ϸৎឦှញаှନ anxiety
2. ᄗ pulsation ‫פ‬ӳӦБྗഢΠЋǴ
നӳԖག᝺‫ډ‬ᆅ৩Տ࿼Ϸ‫و‬ӛ
3. Πଞ߻ፎ૶ளΟ੃ puncture site &
գஒ‫ܫ‬࿼ӧ໾α‫ޑ‬Ћࡰ with aqBI & alcohol
4. ҂࡭ଞ฿ϐЋࡰᛙ‫ۓ‬ΠଞೀǴ‫ٿ‬ЍЋࡰԿ‫ٿે୏ܭ‬ᆄ (1.གྷႽ֨Ր୏ે‫ୁٿ‬
or 2.ЋࡰϩԿ‫"ޑે୏ܭ‬΢Πෞ"ǴགྷႽ‫ٿ‬ᗺೱԋ΋‫ޔ‬ጕ)Ǵ‫ࡰٿܭ‬ϐ໔຾ଞ.ଞ
ᓐϪαරӛ blood flow ٰྍ
5. ጗ᄌ‫ऀޑ‬ၸ skinǴаඝ฽БԄ࡭ଞ฿Ǵ຾ଞ‫ࡋف‬Ǻradial or brachialǺ45~60
ࡋǴfemoralǺ90 ࡋ(ࠟ‫ޔ‬຾ଞ)ǹёаᢀჸࢂցԖՈፂ຾ଞ฿ϣǴӵ݀ԖǴӃ
ᛙ‫ۓ‬ଞ฿&ᄌᄌӣ‫ൂ(ܜ‬Ћӣ‫ࢂ܈ܜ‬ќ΋ϐЋٰᔅԆ܎ǴѝाՈрளٰ൩ӳ)Ǵ
໩ճ‫ޑ‬၉ा൳ cc ൩Ԗ൳ cc. ӵ݀‫ޕ‬ၰ຾ΑՈᆅᆅ๚ࠅؒԖՈӣፂǴӣ‫ࠅܜ‬Ԗ
ՈǴёૈࢂ vein փ!
6. λઝ೘Ǻଞᓐ࿘‫ે୏ډ‬Ѧ߄ਔёаག᝺‫ډ‬Ԗ pulsationǴӕਔ syringe Ψ཮
ၢǹௗΠٰёаག᝺຾Ε୏ેԼԺᏛǶ‫ډ‬ၲᆅ๚ࡕ౛ፕ΢ёӕਔ࣮‫ډ‬Ԗ
pulsatile Ոፂ຾ଞ฿ǴԜਔᄌᄌӣ‫ܜ‬൩ ok!
7. ऩЋ਻ό٫‫ܜ‬ό‫ډ‬Ǵёа‫ע‬ଞᓐ౽рٰ΋ᗺӆ۳୏ેՏ࿼ӆ၂΋ԛ. (caution!
όाӕ΋ঁӦБ blind try ϼӭԛǴ੿‫ܜޑ‬ό‫ډ‬൩ඤӦБ‫ܜ‬Ǵόाཀ਻Ҕ٣!ම
࿶Ԗ complication วғ..)
8. ‫ډܜ‬ՈΑǴৰ഻‫!ی‬΋૓‫ ܜ‬1~2 cc in heparin syringe ջё
9. ‫ܜ‬рଞᓐِೲаથѲ‫܈‬ා෇ҔΚуᓸ‫ܭ‬໾αೀԿϿ 5min
10. ‫ ע‬sample Ҭ๏ៈγεΓջεф֋ԋǴଞᓐකΕ೬Е༞&Կ‫ܭ‬Ӈ༧Нύ

# Complications
1. DiscomfortǺ೭ঁ procedure ࡐภǴፎаӕ౛Ј࣬ࡑ
2. InfectionǺ૶ளΟ੃&ค๵ᢀ‫ۺ‬
3. HematomaǺӵ݀҂уᓸЗՈֹӄ۳۳཮ԖՈဍ‫׎‬ԋǴᝄख़཮Ԗ
compartment syndrome (5P)ౢғǴeven amputation!
4. ArteriospasmǺԖ‫ޑ‬ਔংӢࣁՈᆅӢଞ‫ڈ‬Զϸ৔‫܄‬ԏᕭ‫܌‬а‫ܜ‬ό‫ډ‬Ո.

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 5. Thrombus formationǺintima injury ཮ౢғ clot even thrombus Զߔ༞Ոࢬ

02. NG tube
9 For feeding & or decompression
„ FeedingǺpatient conscious disturbance or swallowing difficulties
„ DecompressionǺ‫غ‬η๞ǴvomitingǴӗ coffee ground vomitus ਔ
9 ૶ள check Տ࿼!!(᠋ stomachǴlung)ÆමԖ complication วғǺaspiration
pneumonia!!
9 ၶ‫ډ‬όଛӝտᚮ‫ ޑ‬patient ёፎ family Ͽໆᗯ१మНаշ‫ځ‬տᚮ
9 λ‫ۆ‬ъ‫ ڹ‬call ”NG Ծ‫ܘ‬ाख़ཥ on”ǴёӃୢ”NG ࢂ feeding or
decompression”Ǵऩࢂ feeding NG ё஥႖ВԐఃӞᛰ߻ӆ re-on
9 “ੰΓӗ coffee groundǴresident ाգ NG irrigation!”
„ ाௗ decompression
„ ឲ१‫ޜ‬ଞ‫ ܜ‬20CC Ѱѓ normal saline ឲΕ NGǴӆᄌᄌӣ‫ܜ‬ǴൂЋӣଞ
‫܈‬ᚈЋǴό‫ܥ‬Æ຾ѐᆶрٰεऊ࣬฻നӳǴऩག᝺Ո༧ьՐ߾όाฯ
ϸ‫ܜ‬

03. Foley catheter & ICP

9 த‫ـ‬൑ӝǺneurogenic bladder/ urine retention ‫ੰޑ‬ΓǴൺ଼ࣽǴΘ‫ ܊‬pre-OP
prepareǴpost ъ‫ي‬ഞᎈ‫ੰޑ‬ΓǴा੮ U/A or U/C..
9 Intern ӭॄೢ‫ੰ܄ت‬ΓᏤֿ
9 ‫ݙ‬ཀค๵ำ‫( ׇ‬Ӄഢӳ 10cc ‫ޜ‬ଞ with normal salineǴFoley bag ‫ܨ‬ӳ࿼‫ܭ‬
bedsideǴֿᆅനѦቫхး‫ܨ‬΋ъǴੰΓ࠮༈ᘍӳ or ፎ family ‫ڐ‬շ‫ੰ׬‬ΓÆ
‫ע‬ค๵хλЈ៽໒Ǵֿᆅ with ϣቫхး࿼‫ܭ‬ค๵хύÆ஥٢ጤЋ঺Æஒා
݄ϩձ࿼‫ ܭ‬iodine & మНύǴ‫ֿܨ‬ᆅϣቫхး+jelly ర΢ѐÆ1st ੃ࢥ glans
penisǴ೛‫ݤ‬Ҕ‫ٿ‬Ѝා݄ᙌ໒ prepuceÆᎎࢰτǴ΋Ћ৾ 2x2 થѲ‫׬‬Ր penis
ࡕ‫ۓڰ‬Ǵќ΋ЋӃ৾ iodine ා݄բ 2nd ੃ࢥࡕǴ৾ς‫ ݠ‬jelly ‫ֿޑ‬ᆅ጗ᄌක
ΕÆၸ prostate ёаག᝺ߔΚǴჹ‫ ܭ‬BPH ‫ੰޑ‬ΓाԖऐЈᄌᄌኖÆᅰໆක
‫ۭډ‬ωѺНౚ(ICP ؒԖНౚ)ӆ۳Ѧ܎аьՐрαǴձӧֿၰ൩‫ע‬НౚѺᅈ
ΑÆurine ࢬр‫ډ‬౯ηǴёаҔЋᔅԆᓸ suprapubic areaÆௗ΢ bagǴຠӳǴ
‫ۓڰ‬Æ ‫ډ֣৾ڱע‬Ԧ‫࠻ނ‬ҧӧᙴᕍቲక‫֣ڱނ‬ఏ)
9 කό຾ѐ࡛ሶᒤ?
„ ඤλဦ‫ ޑ‬Foley
„ ၶ‫ډ‬ᝄख़ BPH ‫ߓޑ‬դόाฯኖǴёаҔ lidocaine jelly ዎྖֿᆅӆ‫ܫ‬Ǵ
ќ΋ЋёᔅԆࡪነ penis ਥ೽ௗ߈ prostate Տ࿼Ǵε೽ϩёаှ،Ƕ
„ FailureÆձ࠼਻Ǵcall for help
9 λ‫ ۆ‬callǺ”ੰΓ urine வֿၰαᅅр”Ǻ
„ ε೽ϩࢂНౚؒѺᅈǶ‫ע‬Н‫ܜ‬рӆख़ཥѺᅈ‫܈‬ӭѺ൳˿˿຾ѐǴዴ‫ۓ‬
ԖьՐ(ьᆙ)рαǴ౛ፕ΢ёаှ،Ƕ
9 Remove Foley ਔፎዴ‫ۓ‬ς࿶‫ע‬Нౚ‫ܜ‬ଳω‫ܘ‬Ǵց߾ёа࣮‫ ډ‬suffered patient
& hematuria & angry family

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04. EKG resting/complete EKG
9 த‫ܭـ‬ǺPre-OP routine ाբ EKGǴCV ੰ‫܊‬ǴੰΓ complain chest
tightnessǴ೏Ꮲߏ order ਔ
9 բ EKG ϐ߻ाћੰΓόा໶୏ or ᇥ၉Ǵаխቚуᚇૻ
9 Limb leads & pre-cordial leads Տ࿼ा‫҅ܫ‬ዴǴց߾཮ቚуղ᠐‫֚ޑ‬ᜤࡋǶ
ό‫ޕ‬ၰ‫ޑ‬ёаୖԵᐒᏔ΢‫ޑ‬კҢǶ
9 Ԗ٤ lead ؒԖ show рٰǺcheck ࢂց detach ‫ࢂ܈‬ௗᓐ᚞ಥǴlimb leads ёа
‫ ݠ‬normal saline ‫ ࢂ܈‬jelly ቚу໺Ꮴࡋ
9 ଺ֹፎӧ EKG ൂη΢ mark ‫׉‬ဦ‫ۉ‬Ӝਔ໔ǹ CV ੰ‫ ܊‬F/U post PPM
(permant pacemaker) implant patient ཮ा‫؃‬ӆቪ with or without magnet
9 ௢ EKG ӣচೀፎ૶ளකႝǶ
9 EKG reading ‫ ـ‬other chapter!!

05. IV techniquesǺOn IV or ‫ܜ‬Ո

9 ៈγλ‫ޑۆ‬πբǴԜ໨‫מ‬᛬ςᄌᄌѨ໺Ƕ൩Ⴝࢌ‫ے‬௲ᙴଣ intern ਁਁԖ
ຒǺ”primary care όࢂ‫ך‬၀଺‫”ޑ‬Ǵin CGMHǴon IV Ψόࢂ‫ॺך‬၀଺‫ޑ‬Ƕ
9 ӳ‫ڻ‬ᝊᝊёаୖྣ internal medicine on call /2nd edition p.361

06. Endotracheal intubation

9 ၮ਻ό٫‫ޣ‬Ǵջ‫܌‬ᒏ”ࡐ‫ܮ‬Ǵද೯‫ܮ‬Ǵߚத‫”ܮ‬฻ભ‫ޑ‬ΓѸ཮Ƕ
9 ACLS ᆶჴሞ੿ΓԖৡຯǴ‫܌‬аԖᐒ཮ᅰໆ practice
9 ࣮‫ ډ‬vocal cord/ epiglottis ӆ‫ܫ‬Ǵblind try ε೽ϩ೿າ‫ ډ‬esophagus
9 කό຾ձ਻ᎨǴεόΑ൩ᓸ ambu ኖ‫ډ‬ഞᎈٰࣽӆᇥ

07. Central venous catherization/ on CVP

த‫ـ‬ਔᐒǺഞᎈࣽ general anesthesia ࡕӢࣁ hemodynamic unstable ाѺ(for CVP
monitor or iv fluid administration)ǹ ੰ‫ ܊‬peripheral line Ѻό‫܌ډ‬а on central
lineǹ ሡाอਔ໔๏ϒεໆᒡనਔǴiv challenge ฻฻ǴӢࣁԜ procedure ຎࣁ”
λࠠЋೌ”Ǵཱུࣁख़ຎค๵‫מ‬ѯǶ

Materials
1. CVP ΋ಔ
2. ค๵Ћ঺΋ୋǴࢰτ x1Ǵා݄ for sterilization
3. syringe 5 or 10 cc x1 + needle x1
4. local anesthesia (xylocaine 5-10 cc)Ǵ10cc ଞ฿ + needle x1
5. ᗺᅀς࿶ࢎӳΑ

ProceduresǺа neck CVPǴright internal jugular vein ࣁ‫ٯ‬

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1. set ӳԾρा‫ܿޑ‬ՋǺᎎӳค๵τ‫ܭ‬΋ঁᛙ‫ޑۓ‬ӦБǴ‫ځ‬΢‫ܫ‬࿼Ћ঺Ǵා
݄Ǵଞ฿ଞᓐǴCVP setǴค๵ࢰτǹ CVP catheter ‫׀‬ᆄᇂηӃ௽໒Ǵ‫ڗ‬΋٤
sterilized normal saline ӧࣧη္฻΋Π཮Ҕ‫ډ‬Ƕ
2. ፎੰΓᓐᙯѰᜐǺӵ݀ compliance ό٫ёаፎձΓҔЋඓᔅԆ‫ۓڰ‬ΠЃ&ᖍ
ᓌ‫ ޑ‬areaǴаόቹៜ੃ࢥय़ࣁЬǶ
3. ᄗ neck pulsationǺ೭ࢂ common carotid arteryǴ‫ॺך‬ाѺ‫وࢂޑ‬ӧ‫ځ‬Ѧୁ‫ޑ‬
internal jugular veinǴा‫ݙ‬ཀ‫ࢂޑ‬Ǻόࢂ pun GAS ഽ!!བᒱգ൩рӜΑ!! ߃Ꮲ
‫ޣ‬ёаӃᄗ sternal notch ۳ neck ‫ ޑو‬SCMǴ໩๱ SCM ᄗёа‫ ঁٿډפ‬belly
ҬᗺǴεཷӧ Adam’s apple ‫ޑ‬Нѳ level ೀёа‫ ډפ‬pulsation. ѰЋᄗ‫ډ‬ϐ
ࡕǴགྷႽΠଞೀ൩ӧ pulsation Ѧୁ۳ right nipple ‫ޑ‬Бӛ຾ଞǶ
4. ੃ࢥǺӚ‫ٿ‬Ѝ iodine ᆶ alcoholǴጄൎх‫ ڊ‬right internal jugular veinǴneck ‫ޔ‬
‫ ډ‬midlineǴright clavicular areaǴsupraclavicular fossa (Ӣࣁ΋ѿ neck Ѩ௳൩
ёаᙯԶѺ subclavian v.)
5. ᎎൂǺࢰτा៛р຾ଞೀǴ᏾஭ࢰτᅰໆҷຠੰΓ‫߄ޑ‬य़Ǵᙖ๱ iodine &
alcohol ‫ޑ‬ᗹ‫܄‬ΨёǶ
6. ‫ פ‬landmarkǺѰЋᄗ pulsationǴ‫ځ‬Ꭹӕ 3.௶ॊ
7. ‫ܜ‬ഞᛰ&Ѻ localǺፎӃ௦ӣ‫࠮ܜ‬༈ǴคӣՈѺΕഞᎈᛰᏊǶ
8. ຾‫ޜ‬ଞǺ໩ߡ traction skin Бߡ຾ଞǹ ΋य़ΠଞǴරӛ nipple ຾ΕǴѺ‫ډ‬Ո
ᆅ཮ӣՈǴ໩༈ӣ‫࣮࣮ܜ‬໩ό໩ǹ Ԝਔाߥ࡭ଞӧ vessel ύ٠ЪаѰЋ‫ڰ‬
‫ۓ‬ଞᆶଞᓐǶ
9. ৾ CVP set ύ‫ޑ‬ಉଞᆶଞ฿ǴѳՉখখ‫ ޑ‬needle БՏ຾ଞǴѰЋᔅԆ skin
tractionǴѓЋ৾ଞ฿૶ள keep negative pressureǴѺ‫ ډ‬vessel ΋ኬ཮ӣՈǶ
10. ‫ܘ‬рಃ΋݄ଞ฿ᆶଞᓐǴ྽ฅѰЋ٩ฅा‫ۓڰ‬аѺΕ‫ٗޑ‬ଫ needle & syringe

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11. ଌΕ guide wireǴഭΠ 5cm ៛рӧѦǴӆ‫ڗ‬р needle and syringeÆଌ dilator
for skin and soft tissue (dilator ৾߻ᆄ΋ᗺКၨӳଌ)Æ‫ܜ‬р dilatorǴ࿼Ε CVP
catheter (ёаୢᏢߏ catheter ा੮ӭϿߏࡋӧᡏѦ..)Ǵ΋ᜐ‫ܫ‬ਔ΋Ћा‫׬‬๱
guide wire ‫׀‬ᆄǴ೯த΋ό‫ݙ‬ཀ guide wire ཮າ຾ CVP catheter ϣǴ೭൩ᄐΑ!
12. ‫ڗ‬р guide wireǴtest catheter patent or not. ௗ΢ᗺᅀǴ࣮࣮ᅀ‫ޑ‬໩ό໩Ƕ
13. ‫ځ‬д‫ޑ‬൩Ҭ๏ nursing staff ୚!

Complications
1. InfectionǺfeverǴsepsisǴwound pus formation
2. ThrombusǺpulmonary hypertensionǴCVAǴetc
3. Guide wireǺ᏾݄শ‫ډ‬ҜጥаϣÆconsult CVS ‫ڗ‬рÆ೏ӈΕ໵Ӝൂ
4. PneumothoraxǺѺ subclavian vein ന৒ܰวғ
5. HematomaǺtrauma ‫ډ‬ԼԺ‫ ࢂ܈‬artery&ค፾྽ЗՈ

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PART 6 Tools of the Trade
01.ABG ࠧద

<ᖐ‫>ٯ‬ӧॶ੤ਔ೏ callǴԖ΋Տ 60 ྃ‫ޑ‬ЦԴդդǴԖ COPD ‫ ޑ‬historyǴന߈ဎ

ᘞΟϺǴO2 ‫ ޑ‬Nasal cannula ໒ 3LǴдँฅ᝺ளᓐภǴԶЪཀ᛽ຫٰຫኳጋǴ
༐ᅵǴ‫֎ڥ‬ຫٰຫഹǴVital sign ǺTǺ37.2 ࡋ PǺ100ǴRǺ32ǴLAB dataǺ
Na=144ǴK=4.86ǴCl= 111ǴǴCr=1.0ǴAlbumin=4ǴHb=10.9ǴHct=29.8.

*‫ࢂܭ‬գᔅд‫ܜ‬Α΋Ѝ ABG*
PH=7.21
PaCO2=64.8
PaO2=30.7
HCO3- =25.1
BE- = -2.8
SaO2= 80%

< PART 1 ‫֎ڥ‬૰ᆃ >

1. ղᘐࢂցԖ Respiratory failure
(Hypercapnic respiratory failureǺPaCO2> 45-55mmHg Ъ PH<7.35 )
(Hypoxic respiratory failureǺPaO2<60mmHg or SaO2< 90%)

PaCO2=64.8> 45-55 and PH=7.21<7.35ǹ PaO2=30.7<60 ǴSaO2=80%<90%

=>ੰΓӝ‫ٳ‬ଯᅹለՈϷલ਼‫֎ڥ܄‬૰ᆃ

2. ൨‫֎ڥפ‬૰ᆃ‫ޑ‬চӢ
চӢ Disease ੝ቻ
Hypercapnic Increased FeverǴsepsisǴseizure… P (A-a)
respiratory CO2 gradient
failure production ΢ϲ
(ଯᅹለՈ‫܄‬ Increased COPDǴathmaǴcystic fibrosisǴ P (A-a)
‫֎ڥ‬૰ᆃ) dead space saroidosis… gradient
PaCO2 ΢ϲ
> 45-55mmHg Decreased *CNSǺSpinal cord lesionǴdrug P(A-a)
Ъ PH<7.35 ventilation overdose (ᙼᓉᏊ฻)ǴIICP… gradient
*Peripheral nerveǺGuillain-Barre’ όᡂ
syndromeǴMG…
*Muscle disorderǺPolymyositisǴ
muscle dystrophy…
*Chest wall and pleural
abnormalityǺKyphoscoliosisǴ
respiratory muscle ੲЮǴ਻ૅǴ
pleural effusion…
*Lung and airway obstructionǺ
infectionǴtumorǴCOPD…

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 Hypoxic Shunt લ਼‫֎ڥ܄‬ ੿҅‫ ޑ‬shunt ค‫ݤ‬Ҕ 100
respiratory ૰ᆃததࢂ % O2 ‫ׯ‬๓
failure V-Q mismatch mix typeǴ
(લ਼‫܄‬ Low inspired ᜤаҔൂ΋
‫֎ڥ‬૰ᆃ) oxygen চӢှញ
PaO2<60mmHg Hypoventilation P(A-a) gradient όᡂ
or SaO2< 90% Diffusion
impairment
Low mixed-venous
oxygenation

3. ीᆉ P(A-a) gradientǺ‫ݰޤ‬ᆶ୏ેՈύ਼਻ఊࡋ

*P(A-a) gradient=PAO2-PaO2
={(PB ε਻ᓸ-PH2O Нϩᓸ)*FiO2 - PaCO2/RQ ‫֎ڥ‬୘} –PaO2
=(760-47)*FiO2 - PaCO2 / 0.8 - PaO2

(҅த‫ ޑ‬P(A-a) gradient Ǻ2.5+0.21* age)

(FiO2 ֎Ε‫਼ޑ‬ᐚࡋǺ[O2 +0.21(Vinsp-O2) / Vinsp]Ǵ‫ ਻ޜ‬21%Ǵnasal 3L ऊ
32 %)

=>ੰΓ‫ ޑ‬P(A-a) gradient=(760-47)*0.32 - 64.8/0.8 – 30.7 =116.64

=>ੰΓ҅த‫ ޑ‬P(A-a) gradient=2.5+0.21*60=15.1
=>ੰΓ‫ ޑ‬P(A-a) gradient ܴᡉ΢ϲ
feverǴsepsisǴseizure COPDǴathma…฻฻೿ाуаԵቾ

4. ଛӝ X-ray ‫ ޑ‬finding
Black (normal or hyperlucent) White (radiopaque)
PaO2<50Ǵ Pulmonary embolism Pulmonary edema (diffuse)
PACO2<40 Circulatory failure ARDS (diffuse)
(normocapnic) Shuht Infarction (localized)
Pneumonia (localized)
PaO2<50Ǵ COPD Severe ARDS
PACO2>40 Asthma Pulmonary embolism with
(hypercapnic) Hypoventilation respiratory depression
Pneumonia+COPD (localized)
Pneumonia+respiratory
distress (localized)

=>ੰΓ‫ ޑ‬X-ray ؒԖว౜ radiopaqueǴ‫܌‬аЦԴդդ೭ԛ‫֎ڥޑ‬૰ᆃǴၨёૈ

ࢂ COPD Їଆ.

5. ‫ݯ‬ᕍ
=>΋Տ COPD ੰΓ࡚‫܄‬วբǴനத‫ ࢂـ‬infectionǴќѦᗋԖ drug complianceǴ
air pollutionǴ pneumothoraxǴallergyǴpulmonary embolismǴheart failureǴ
asthma ฻฻

- 43 -
=>ӧ‫ॺך‬໒‫ ۈ‬DD р੿҅‫ޑ‬চӢ߻ ǴёаӃ๏ϒၨค্‫ݯ਻਼ޑ‬ᕍǴฅࡕਥᏵ
༐ᅵǴ॰࡙฻‫܄֎ڥ‬ለύࢥ‫ޑ‬ᖏ‫߄׉‬౜ǴϷ COPD historyǴёа๏ϒǴ
b2agonistǴanticholinergic ฻‫ݯ‬ᕍ underlying disease.
=>ЦԴդդ࿶ၸ‫ޑॺך‬ϩ‫ ݋‬historyǴPEǴlab ᗋԖа΢΋ೱՍ‫ ޑ‬DD ϐࡕ Ǵ௨
ନΑ pneumoniaǴ‫ڋ׭֎ڥ‬Ǵpulmonary embolismǴ਻ૅ฻฻চӢǴനࡕ᝺ளࢂ
COPD ௓‫ڋ‬ό٫‫܌‬Їଆ.ଞჹд‫ ޑ‬COPD ๏ϒ፾྽‫ݯ‬ᕍǴ௃‫ݩ‬Ψ‫ׯ‬๓Α.

6. Ֆਔሡा O2 Therapy? PaO2<60%ǴSaO2<90%

O2 flow(L/min) FiO2
Nasal cannula 1 0.24
2 0.28
3 0.32
4 0.36
5 0.40
Simple mask 5-8 0.40-0.60
Partial rebreathing mask 6-10 0.55-0.57
Nonbreathing mask 10-15 0.80-0.10
(Ԗ reservoir bagǴൂБӛ)

=>ੰΓᔈ๏ϒ਼਻‫ݯ‬ᕍǴᡣ PaO2 60-100mmHgǴSaO2>90%ǴλЈ FiO2>0.5

and >24hr ܰԖ਼ύࢥёૈ೷ԋ ARDS Ϸᠼᆢϯ. ќѦӵ݀٬Ҕ‫֎ڥ‬ᏔǴੰΓԖ
COPD ‫׳‬ाλЈ਻ૅ.

7. ੰΓࢂցሡाකᆅ on endo?
9 Indication of Endotracheal intubation
a. Initiation of mechanical ventilation
b. ߥៈ‫֎ڥ‬ၰ
c. Ҕ nasal cannula or mask ೿คਏ
d. ᗉխ֎Ε‫ݹޤ܄‬
e. ၸࡋඤ਻ treat IICP

9 mecanical ventilation ‫ࡰޑ‬኱

a. RR>35
b. inspiratory force <= 25 cm H2O
c. Vital capacity < 10-15 ml/Kg
d. PaO2<60mmHg with FiO2>60%
e. PaCO2>50 mmHg with PH<7.35
f. absent gag or cough reflex

=>ੰΓ࿶ၸ߃‫ݯޑ؁‬ᕍࡕǴऩࢂϝሡा mechanical ventilation ωૈᆢ࡭‫֎ڥ‬Ǵ

Ԝਔ߾ሡाԵቾකᆅǶICU ‫ޑ‬Γதᇥකᆅ৒ܰ‫ܘ‬ᆅᜤǴՠࢂԖਔ፾ਔ‫ޑ‬කᆅё
а٬ prognosis ၨ٫Ǵ‫܌‬а on endo ‫ޑ‬ਔᐒᗋࢂፎၨၗు‫ޑ‬Ꮲߏփ!

- 44 -
 < PART 2 ለᡵѳᑽ౦த >

Normal ABG valuesǺ

PH= 7.4 + 0.03
PCO2= 40 + 5 mmHg
HCO3= 24 + 4 meq/L

Primary acid base disturbanceǺ

HCO3 PaCO2
Metabolic acidosis  
Metabolic alkalosis  
Respiratory acidosis  
Respiarratory alkalosis  

1. २Ӄ࣮ PH ॶǴ،‫ۓ‬ለՈੱ acedemia ‫܈‬ᡵՈੱ alkalemia

=>ੰΓ PH=7.21ǴࡺࣁለՈੱ

2. ࣮ PaCO2 ‫ ک‬HCO3-ࢂցӕਔ΢ϲ‫܈‬ӕਔΠफ़
(ऩόࢂǴ߄Ңࣁష‫ࠠک‬ለᡵѳᑽምᛖǹ ऩࢂǴ߾ёૈࢂൂપࠠ‫ࢂ܈‬ష‫)ࠠک‬
=>PCO2=64.8>40 ΢ϲǴHCO3- = 25.1>24 ΢ϲ
ൂપ‫ࢂ܈‬ష‫ک‬ለᡵѳᑽ౦த

3. ᔠࢗжᓭࢂց፾྽
(Never overcompensation)
(Respiratory compensation immediatelyǹ metabolic compensation began at 6-
12hrǴmaximal at few days)

Compensation
Metabolic acidosisǺPaCO2=1.5 (HCO3) + 8 + 2 (ၨྗዴ)
HCO3 ‫؂‬Πफ़ 1 meq/LǴPaCO2 ΨΠफ़ 1.1-1.3 mmHg
Metabolic alkalosisǺHCO3 ‫؂‬΢ϲ 1 meq/LǴPaCO2 Ψ΢ϲ 0.5-1 mmHg
Acute respiratory acidosisǺ PaCO2 ‫؂‬΢ϲ 10 mmHg ǴHCO3 Ψ΢ϲ 1 meq/L
Chronic respiratory acidosisǺPaCO2 ‫؂‬΢ϲ 10 mmHg ǴHCO Ψ΢ϲ 3.5 meq/L
Acute respiarratory alkalosisǺPaCO2 ‫؂‬Πफ़ 10 mmHg ǴHCO3 ΨΠफ़ 2 meq/L
Chronic respiratory alkalosisǺPaCO2 ‫؂‬Πफ़ 10 mmHg ǴHCO3 ΨΠफ़ 5 meq/L

ߏ۪૶Ꮻ‫ݤ‬ Acidosis Alkalosis

Metabolic 1.2 0.7
Acute respiratory 0.1 0.2
Chronic respiratory 0.3 0.5
P.SǺ 1.2 ж߄ HCO3 ‫؂‬Πफ़ 1 meq/LǴPaCO2 ΨΠफ़ 1.2 mmHgǴ
0.1 ж߄ PaCO2 ‫؂‬΢ϲ 1 mmHg ǴHCO3 Ψ΢ϲ 0.1 meq/LǴᜪ௢!

=>ऩԵቾࢂжᖴ‫܄‬ለύࢥ
PaCO2=1.5*25.1+8+ 2= 44-48 <64.8
όૈൂપҔжᖴ‫܄‬ለύࢥှញǴӝ‫܄֎ڥٳ‬ለύࢥωӝ౛

- 45 -
=>ऩԵቾࢂ࡚‫܄֎ڥ܄‬ለύࢥ
PaCO2 ΢ϲ(64.8-40=24.8)ǴHCO3 Ψᔈ΢ϲ 24.8*0.1=2.48Ǵ
HCO3 ᔈ၀жᓭ΢ϲ‫ ډ‬24+2.48=26.8
ՠࢂੰΓ‫ ޑ‬HCO3 ѝԖ 25.1ǴচӢёૈࢂٰόϷ compensationǴᗋԖ൩ࢂӝ
‫ٳ‬Α΋ঁжᖴ‫܄‬ለύࢥ

่ፕǺԜੰΓࢂష
ష‫( ࠠک‬respiratory acidosis + metabolic acidosis)

4. ൨‫פ‬Ꮴठለᡵѳᑽ‫ޑ‬চӢ

1. Metabolic acidosisǺ
*High AG metabolic acidosis
চӢ ੝ቻ
Ketoacidosis DKAǴAlhoholic acidosis ketonuria(+)
Lactic acidosis SepsisǴischemiaǴ Latic acid ΢ϲ
respiratory failure…
Uremia GFR λ‫ ܭ‬20-30
Methanol intoxication OG>10
Salicylate OG<10
P.S OG = Osmolality Gap= (measured- calculated) plasma osmolality
Calculated plasma osmolality = 2 [Na]+ [glucose]/18 + [BUN]/2.8

*Normal anion gap metabolic acidosis

চӢ ੝ቻ
GI loss DiarrheaǴfistula… UAG (-) negative
RTA I ᇻᆄ H+ϩ‫ݜ‬ምᛖ UAG (+) Ǵ PH(urine)>5.5 Ǵ
K(plasma) low
RTA II ߈ᆄ HCO3 ֎ԏΠ UAG(+)Ǵ PH<5.5Ǵ K
फ़ low
RTA IV ଯ k ٬ NH3+ӝԋΠ UAG(+)Ǵ PH<5.5Ǵ K
फ़ high
P.S 1 RTA=renal tubular acidosis
P.S 2 urine anion gap { UAG= Na(u)+K (u)- Cl(u) }

*ीᆉ anion gap (AG) { AG =Na – (HCO3+Cl)}

( normal AG = 8-12Ǵ ҁଣ‫ ޑ‬AG normal ࣁ 6 )

=>ੰΓ‫ ޑ‬LABǺNa=144ǴCl= 111ǴHCO3=25.1ǴAlbumin=4 (Alb ϼե AG ा

ᕖ҅)
AG=144-(111+25.1)=8

=>ҁଣ‫ ޑ‬AG NORMAL ࣁ 6ǴSo this patient had high anion gap Metabolic
acidosis.

=>ЦԴդդ‫ ޑ‬metabolic acidosis ‫ޑ‬চӢԖёૈࢂ Latic acidosis ёаϩ‫ ݋‬lactic

acidǴଞჹ୷ҁ੯ੰ‫ݯ‬ᕍǴѸाਔံк HCO3-

- 46 -
=>( Цර҉Ꮲߏ command)
While facing acidosis or alkalosis problemǴwe shall take clinical data into account.
This COPD patient shall reasonable had chronic respiratory acidosis.
In his respiratory failureǴhe shall have acute respiratory acidosis superimposed.
These two acidosis resulted in his acidosis. HoweverǴhis bicarbonate cannot
explain those. That means he had some reasons to make his bicarbonate decreased.
That is metabolic acidosis.
And during respiratory failureǴhigh anion gap MA is more common.
That is this ABG.
Acute respiratory acidosis+ chronic respiratory acidosis+metabolic acidosis.
ClincallyǴmixed type is more common.

2. Metabolic alkalosisǺ
1. ࢬѨ H+ǺVomitingǴNGǴrenal …
2. Ѧٰᡵ‫ځ܈‬д‫ނ‬፦Ǻံк HCO3 ၸӭǴMilk alkai syndrome…
3. DiureticsǺӵ thiazide ௨рό֖ HCO3 ‫ޑ‬Нϩ
4. HypercapniaǺжᓭ࡚‫܄‬ለύࢥǴᇙ೷ၸӭ HCO3 ۘ҂௨р
5. HyperaldosteronismǺ੮ᡶ௨ႇǴեՈႇ = >K/H shift

3.Respiratory acidosisǺ
চӢ<PART 1>ςԖǴ‫҅ׯ‬ਥҁ੯ੰ‫ک‬೯਻ǴλЈ٬Ҕ HCO3Ǵᗉխ‫ޤ‬Нဍ

4.Respiratory alkalosisǺ
1. Hypoxemia
2. Respiratory center stimulationǴanxiety
3. Lung disease
4. Mechanical huperventilation

- 47 -
02.Chest X-ray ࿯ᒵԾ௲ᏯЋн

1. Quality of firm
Class AǺ
Trachea and bronchus ---visible
Thoracic spine and intervetebral space—just visible
Abdominal spine and intervetebral space---invisible
Retrocardiac lung marking---visible
Class BǺnot affecting reading
Class CǺmore than one criteria and not affecting reading
Class DǺcannot read

2. Projection & Position

T3 or T4 spinous processǺmidway of bilateral clavicle
T5 or T6 spinous processǺabove carina
Full- inspiratory film (At total lung capacity)ǺAnterior –R5 or R6
Posterior – R10

3. Bone frame work

Normal ---bell shape
COPD---Box shape
Funnel chest---rib as heart shape

4. Soft tissue

5. Diaphram
Right higher than leftǴbut no more than 4 cm
High of domeǺ1.5-2.0 cm
Diaphragm thicknessǺ5-8 mm
Distance between diaphragm and gastric bubble < 1 cm

6. Pleural cavity
*Pleural effusionǺcostalphrenic angle(blunting)Ǵmenicus sign
*PneumothoraxǺpleural line

7. Trachea
TracheaǺdiameter <2.0-2.5cm
Normal trachea wall thicknessǺ2-4mm
CarinaǺangle 75 ࡋ (left 30Ǵright45)

8. Hilum

9. Mediastium
Mediastinal widening Ǻ>8.5cm or > 25% of chest wall
(Anterior mediastinal mass 3T+1LǺThyroid massǴThymic massǴ
TeratomaǴlymphoma)

- 48 -
10.Heart
Cardiacthiracic (CT) ratio < = 0.5 in PA viewǴ< = 0.6 in AP view
RAEǺRA border to midline > = 4.5 cm
RVEǺapex left and upward
LAEǺloss of cardiac waistǴdouble contour shadowǴcarnial angleЊ 90Ƕ
LVEǺapex left and downward
*Heart failure தԖ pulmonary vein emgorgementǴKeley’s B lineǴ
Butterfly pulmonary edema

11.Lung
A.Consolidation
*Upper part of left heart border....anterior segment of LUL
*Left heart border....lingula
*Aortic knob......apical posterior sement of the LUL
*Right heart orter....RML
*Accending aorta.....RUL
*Upper part of left heart border.....RUL
*pneomonia தԖ airbroncogramǴSilhouett sign
B.Collapse or Lobetomy
C.Nodule<1cmǴTumor1-4cmǴMass>4cm
D.Pattern
*Alveolar patternǺAcinar shallowǺill-defined infiltractionǴaround 1cmǴ
ConfluenceǴairbroncogram
*Intestinal patternǺground grassǴreticulonodularǴKeley A B CǴ
Peribronchial cuffingǺwall thickness>1cm

03.EKG ࿯ᒵԾယ P ᖱက
1.Rhythm
2.Rate 300 150 100 75 60 50
3.PR interval 0.12---0.2
4.QRS duration < 0.09
5.QT intraval <0.44
6.Axis Ǻ-30~90
7.Interpretation

*Nornal P waveǺAxisǺ45~60 ࡋǴduration <0.11Ǵamputate<2.5 mm

*Right atrial hypertrophyǺP pulmonaleǴAmplitude>2.5mm
*Left atrial hypertrophyǺP mitralǴDuration > 0.12 sǴ
Negative compotent in V1>1mm
*Right Ventricular hypertrophy
R/S in V1 > 1(V1 R>SǴV6 S>R)
R ( V1) > 7mm
right axis deviation
*Left ventricular hypertrophy
R(V5 V6)+ S( V1) > 35mm
R(V5)> 26mm

- 49 -
*RBBBǺQRS > 0.12 sǴM shape in V1Ǵslurred S in V5 V6 I
*LBBBǺQRS>0.12 sǴM shape in V5 V6
Left anterior hemiblockǺQRS >30ǴQRS ቨࡋ҅த
Right anterior hemiblockǺQRS >120ǴQRS ቨࡋ҅த

*MI
1.EVOLUTION
Hyperacute ....tall-peaked T-wave
Injury......ST elevation
Necrosis...Pathologic Q wave(Q>0.04s and > 25%R)
IschemiaǺT inversion
2.LOCATION
septum...VI and V2
Apex(anterior)...V3V4
inferior ...IIǴIIIǴAVF
apico-septal or anterior-septal...V1-V4
anterior-lateral ...V3-V6
inferior-lateral..IIǴIIIǴAVFǴI ǴaVLǴV5ǴV6
strictly posterior wall...R/S inV1>1
posterior-lateral...R/S inV1>1 andQ in V5 V6 AVL and 1

*ST-T change
1. ISCHEMIA (primary)ǺJ piont elevated or isoelectricǴSvmmetric and
peaked T
2. SECONDARYǺA symmetrical T with steper acending limbǴDepressed ST
and lower J joint with convex ST.
3. NON-SPECIFIC ST-T CHANGE
inverted T wave except3ǴaVRǴAVLǴAVFǴV1ǴV2
flat T wave(T<1/10 R)
ST depression(>0.5mm and <2m )

04.CBC/DC ᗱຽ
‫܌‬ԖੰΓٰᙴଣ೿཮‫ ܜ‬CBC/DCǴੰΓ΋วᐨΨ཮‫ ܜ‬CBC/DCǴੰΓԖѨՈਔ
ाբຑ՗Ψ཮‫ ܜ‬CBC/DC ္य़‫ ޑ‬Hb+HCTǴੰΓԖ bleeding tendency Ψ཮‫ܜ‬
plateletǴ‫܌‬а CBC/DC ёаᇥࢂനੌᔲ‫ޑ‬ᔠࢗ໨Ҟ.

RBC Бय़Ǻ
1. Hb and HCT Ǻ೯த೭‫཮ঁٿ‬΋ଆ࣮ǴЀ‫ࢂځ‬ѝԖाຑ՗ѨՈ௃‫ݩ‬ਔǴ཮໒
ѝᡍ Hb+HCT ‫ ޑ‬orderǴՠࢂӧখѨՈࡕǴ‫ي‬ᡏ compensation mechanism ᗋ
ٰόϷံ‫ ى‬plasma volumeǴ‫܌‬аёૈ཮ள‫҅ډ‬த‫ ޑ‬Hb and HCTǴ‫܌‬аाଛ
ӝੰΓ‫ ޑ‬clinical appearance ‫ ک‬RBC count ٰዴ‫ۓ‬. ѦࣽੰΓ໒Θ߻നӳ Hb
㨭നӳε‫ ܭ‬10g/dLǶ
a. ΢ϲ ǺPhysiological Compensation ( Րӧଯੇ‫ܘ‬Ǵߏය tissue hypoxiaǴ
මԖ blood loss )ǴPathological compensation ( TumorǴ‫ٯ‬ӵ kidney tumor

- 50 -
 ཮ញ‫ ܫ‬EPO ٬ RBC ቚғǹ Myeloproliferative diseaseǴՠёૈՔԖ‫ځ‬д
cell line ቚу )
b. Πफ़ ǺAnemia ‫ۓޑ‬ကࢂ‫ت‬ғ Hb < 14g/dLǴHCT < 41%Ǵζғ Hb <
12g/dLǴHCT < 36%.ёૈࢂӢࣁ Decreased production ( IDAǴ
ThalassemiaǴMyelodysplastic syndromeǴMegaloblasti anemiaǴCRFǴ
HIV associatedǴPancytopenia )ǴIncreased destruction ( BleedingǴ
HemolysisǴSickle cell diseaseǴOrgan damageǴAutoimmuneǴG6PD
deficiency )Ƕ΋૓Զ‫ ق‬Hb 8g/dL ൩ёаᡣಔᙃԖ‫਼ٮ୼ى‬ໆǴӵ݀ࢂߏ
ය anemia ‫ੰޑ‬ΓǴࣗԿ Hb λ‫ܭ‬೭ঁॶΨؒԖੱ‫ރ‬ǴऩࢂሡाᒡՈǴ
1U PRBC ёаᡣ Hb ॶቚу 1Ƕ஁ౢࣽੰΓғౢֹऩ Hb λ‫ ܭ‬10g/dLǴ
๏ϒ៓Ꮚ Ferrous 357 ΋ᗭ QDǶ

2. MCV Ǻ࣮‫ ډ‬Hb+HCT Πफ़Ǵाӆଛӝ MCV ॶωԖ‫׳‬຾΋‫؁‬ບᘐǶMCV ҅

தॶऊӧ 80~100 ϐ໔Ƕ
a. MCV > 100 у΢ Hb+HCT Πफ़ ǺMegaloblastic anemiaǴхࡴ Folic acid
defiency ( alcoholismǴmalabsorbtionǴhemolysisǴpregnancy ) ‫ ک‬Vitamin
B12 defiency ( Pernicious anemiaǴGastrectomyǴGI bacterial
overgrowthǴIleal resection )
b. MCV < 80 у΢ Hb + HCT Πफ़ ǺIron-deficiency anemia ( уᡍ Fe +
TIBC level ዴ‫ۓ‬ບᘐ )ǴThalassemia ( ৎ௼ў ). ዴ‫ ࢂۓ‬IDA ‫ੰޑ‬Γёа
໒ҥ៓Ꮚ Citron ΋ᗭ TID. ा‫פ‬р IDA ‫ޑ‬চӢ(Any GI malignancy etc.)

3. RDW Ǻж߄Ӛঁ RBC ελ‫ޑ‬ϩණࡋǴRDW ຫε߄Ң RBC ελό΋Ǵ߄Ң

Ԗཥ‫ ޑ‬RBC ҅ӧ೏ᇙ೷рٰǴ‫ٯ‬ӵӧѨՈ‫ࢂ܈‬ྋՈࡕ. ‫܌‬а RDW ΢ϲਔǴ
ࠅ཮ள‫҅ډ‬தጄൎϣ‫ ޑ‬MCVǴӢࣁ೏ѳ֡௞ΑǶ

WBC Бय़Ǻ
қՈౚኧໆёаբࣁว‫ݹ‬ϸᔈ‫ࢂ܈‬གࢉ‫ୖޑ‬ԵǴଛӝᖏ‫ٰރੱ׉‬ղᘐ. ೯தࢂੰ
Γวᐨω཮གྷा࣮ WBC level Ǻ
1. ϲଯ ǺAcute infection ( ा‫ פ‬infectious sourceǴ‫ੰע‬Γவᓐ‫ډ‬ဌӆ࣮΋ԛǴ
ӆୢ΋ԛǴӵ݀Ԗ SIRSǴाଌ blood culrure ‫঺ٿ‬Ǵ٠у΢ antibiotic –
cefazolin + gentamicin )ǹ Leukemia ( ཮ଯ‫ࡐډ‬၅஭Ǵ٠Ъ differential count
཮࣮‫ ډ‬immature cell ‫ٯ‬ӵ promyelocyte ‫ ࢂ܈‬blast )ǹ Tissue inflammation or
necrosisǶ
2. ҅த Ǻёૈࢂၨόᝄख़‫ޑ‬གࢉǴ‫ࢂ܈‬ҁ‫ ي‬immune ၨৡ‫ੰޑ‬ΓǴ‫ٯ‬ӵ DMǴ
cirrhosis ‫ੰޑ‬ΓǶ
3. Πफ़ ǺNeutropenic fever ࢂࡐε‫ޑ‬ᚒҞǴሡा຾΋‫ ޑ؁‬surveyǴᙌᙌਜփ!
த‫ޑـ‬Ԗ Samonella infectionǴHIV infectionǴLeukemiaǶ
4. ‫܌‬а WBC ӭჲόૈ rule out or rule in infection. Clinical sign or symptoms are
more importantǶ

Կ‫ ܭ‬Differential countǴନߚࢂᚶᅪԖ SLE ‫ޑ‬ёૈǴόฅӚᅿಒझ‫ޑ‬ኧໆ٠όख़

ाǴЬाࢂ࣮ԖؒԖ “ Shift to left ”ǴΨ൩ࢂӛόԋዕ cell line ୃ౽Ƕӧ΋ঁᚶ
ᅪԖགࢉ‫ੰޑ‬ΓǴӵ݀ Differential count ‫ ޑ‬Band form ࣬ჹቚуǴឦ‫ܭ‬ၨᝄख़‫ޑ‬
གࢉǴाλЈ sepsisǶӧ Leukemia ଺ֹϯᕍ‫ੰޑ‬Γ཮ѐीᆉд‫ ޑ‬ANC –

- 51 -
absolute neutrophil countǴж߄ band form + segment form ‫ޑ‬ໆǴࢂ҅தԖ
immune function ‫ޑ‬ಒझǴٰຑ՗ࡠൺ‫ޑ‬௃‫ݩ‬Ƕ

Platelet Бय़Ǻ
Ոλ݈ኧໆቹៜੰΓᏉՈ‫ޑ‬фૈǴ‫܌‬аा໒Θ‫ੰޑ‬Γ཮‫׆‬ఈд‫ ޑ‬platelet ӧ
100000/mm3 а΢Ǵӵ݀ό୼ाԵቾᒡ platelet ( ࣮ attending ಞᄍ )Ƕӵ݀ Platelet
λ‫ ܭ‬50000/mm3 ཮ቚу bleeding ‫ޑ‬ᐒ཮‫ک‬ਔ໔Ǵӵ݀λ‫ ܭ‬20000/mm3 ৒ܰԖ
life-threatening bleedingǴ‫ٯ‬ӵ GI tractǴCNSǴँฅ‫ ޑ܄‬thrombocytopenia а
Trhombotic thrombocytopenic purpura നӒϷғ‫ڮ‬Ǵᖏ‫ރੱ׉‬хࡴ Ǻ(1)
consumptive thrombocytopenia (2) microangiopathic hemolytic anemia (3) fever (4)
renal dysfunction (5) fluctuating neurologic defecitǴՠࢂ߻‫ރੱঁٿ‬а‫୼ى‬ᄬԋບ
ᘐǶ‫ݯ‬ᕍБय़ǴੰΓाௗ‫ ڙ‬plasma exchangeǴ٠у΢ glucocorticoid ‫ ک‬antiplate
agent. ᒡ platelet ࢂ contraindicationǴѝ཮٬௃‫׳ݩ‬ᕪǶ

05.ғϯǺNa K Ca ‫ؼ‬ᆢ

~Hyponatremia~
Complaints by p’tǴfamily or nurseǺ
ँฅཀ᛽‫ރ‬ᄊ‫ׯ‬ᡂǴPǴ‫ܜ‬โǴᓐภǴ༐ᅵ

ӧຑ՗ੰўǵ౛Ꮲᔠࢗǵᙌ᎙ੰ‫ࡕٯ‬Ǵӵ݀ੰ஻ԖаΠੱ‫܈ރ‬ወӧ੯ੰ‫ޣ‬Ǵ
ሡᚶᅪԖ hyponatremia ϐёૈ‫܄‬Ǻ
1. ੰ஻ԖಥН౜ຝȐdehydration signȑ
2. ੰ஻Ԗᝄख़ vomitingǴdiarrheaǴburnǴbleeding
3. ੰ஻Ԗ๝Ӣ‫܄‬ճֿ౜ຝǴӵǺճֿᏊϐ٬ҔǴଯՈᑗǴ໔፦‫܄‬๝ੰǴacute
renal failure ‫ࡠޑ‬ൺය
4. Ԗӄ‫ي‬Нဍ౜ຝਔ
5. ࿶ບᘐԖ SIADHǴglucocorticoid deficiencyǴhypothyroidismǴpancreatitis
peritoritis

ᔠࢗǺё‫ܜ‬ՈᔠࢗǺNa+ǴBUN/CreatinineǴUrine Na+Ǵrecord I/O

‫ݯ‬ᕍǺѸ໪ஒ hyponatremia ϩᜪԋ hypovolemic stateǵeuvolemic stateǵ

hypervolemic stateǴόၸॶ੤ਔёಉϩࣁ‫ٿ‬ᅿǺ
A. systemic edematous stateȐӵǺcongenital heart failureȑ
a. ज़Нǵज़໊
b. ຑ՗ hypokalemia ำࡋǴຎ௃‫ݩ‬ᕖ҅ϐ
B. dehydration stateȐ߻ॊϐ 1.2.3.ȑ
ံ N/Sǹೲࡋόёϼ‫ז‬Ǵց߾Ԗ neurologic osmotic demyelination ϐӒᓀ

~Hypernatremia~
Complaints by p’tǴfamily or nurseǺ
ཀ᛽‫ރ‬ᄊ‫ׯ‬ᡂǴֽ೽ઓ࿶ੱ‫ރ‬Ǵᡜ⻯Ǵܶ଎Ǵα෰

- 52 -
ӧຑ՗ੰўǵ౛Ꮲᔠࢗǵᙌ᎙ੰ‫ࡕٯ‬Ǵӵ݀ੰ஻ԖаΠੱ‫܈ރ‬ወӧ੯ੰ‫ޣ‬Ǵ
ሡᚶᅪԖ hyponatremia ϐёૈ‫܄‬Ǻ
1. ዗ኪ៛ǴวᐨЪੰ஻คԾ೔‫ڗ‬НૈΚǴဎᘞȐЀ‫ ࢂځ‬osmotic diarrhea ‫܈‬
AGEȑ
2. ᅖ೸‫܄‬ճֿǺத‫ـ‬চӢԖଯՈᑗǵBUNǵIV mannitol
3. ֿ஝Ȑϩύኰ‫܄‬Ϸ๝‫ֿ܄‬஝‫ٿ‬ᅿȑ

ԜਔёӼ௨Πӈ‫ܜ‬ՈᔠࢗǺNa+Ǵurine volumnȐrecord I/OȑǴurine osmolarity

‫ݯ‬ᕍǺ࿶α‫܈‬࿶ሷगᆅ๏Нࢂ಄ӝғ౛‫ޑ܄‬БԄǴΨёаҔ half saline ‫܈‬

1/4salineǴᗉխံНϼ‫ז‬ǴаխᏤठ brain edema

~Hypokalemia~
Complaints by p’tǴfamily or nurseǺ
ԼԺ຀১ǵยᠱǵᡛᅯǵԼဇϸ৔फ़եǵߡઝǵ࠮༈‫܄‬եՈᓸǵଯՈᓸൾ
ϯǵЈࡓό᏾ǵ೯਻ό‫ى‬

ӧຑ՗ੰўǵ౛Ꮲᔠࢗǵᙌ᎙ੰ‫ࡕٯ‬Ǵӵ݀ੰ஻ԖаΠੱ‫܈ރ‬ወӧ੯ੰ‫ޣ‬Ǵ
ሡᚶᅪԖ hypokalemia ϐёૈ‫܄‬Ǻ
1. ೷ԋ K+౽Կ intracellular space ‫ޣ‬
Metabolic alkalosisǴinsulin therapyǴstress state
2. Non-renal K+ loss
VomittingǴmasive diarrheaǴexcessive sweating
3. Renal K+ loss
Use of DiureticsǴ࿶ບᘐԖ hyperaldosteronismǴcongenital adrenal
hyperplasiaǴCushing’s syndrome
ԜਔёӼ௨ᡍ K+

‫ݯ‬ᕍ
1. ᝄख़‫ ޑ‬hypokalemia ሡ੮ཀ aeehythmia Ϸ hypoventilation
2. ‫ ע‬KCl ‫ݰ‬ӧ N/S ϣҔᗺᅀ runȐόё‫ݰ‬ӧᑗНύǴᑗНёૈൾϯ
hypokalemiaȑ
3. ऩሡ IV push KClǴനӳගᒬᏢߏҔ EKG monitorȐᏊໆϷံкೲࡋሡຎੰΓ
‫ي‬ᡏ‫ݩރ‬Ϸ K+ level Զ‫ۓ‬ȑ
4. Closed follow up K+ level.

~Hyperkalemia~
Complaints by p’tǴfamily or nurseǺ
ArrythmiaȐϪ૶ǼȑɡA-V blockǴVFǴcardiac arrestǴ
neuromuscular weaknessǴparalysisǴhypoventilation
EKGǺtented TǴP decreaseǴPR prolongǴQRS wideningǴslow sinusoidal
pattern

ӧຑ՗ੰўǵ౛Ꮲᔠࢗǵᙌ᎙ੰ‫ࡕٯ‬Ǵӵ݀ੰ஻ԖаΠੱ‫܈ރ‬ወӧ੯ੰ‫ޣ‬Ǵ
ሡᚶᅪԖ hyperkalemia ϐёૈ‫܄‬Ǻ
1. Transcellular shift of K+

- 53 -
 a. Metabolic acidosis
b. Insulin ό‫ى‬ǴӵǺDKA
c. όΦ߻٬Ҕ succinylcholine
d. ੰ஻Ԗ chemotherapy sensitive malignancyȐӵǺleukemia lymphomaȑǴ
Ъ҅ӧ٬Ҕ chemotherapytumor lysis syndrome
2. Decreased renal excretion
a. ࡚‫܄‬/ᄌ‫܄‬๝૰ᆃ
b. ҅ӧ٬Ҕ heparin
c. ٬ҔΠӈᛰ‫ނ‬ǺKClǵK+-sparingǵdiureticsǵACEi ‫ ܈‬NSAID

ԜਔёӼ௨ᡍ K+ǵBUN/Creatininǵrecording I/O finger sugarȐDM ஻‫ޣ‬ȑǵ

complete EKG

Treatmentɡhyperkalemia ࢂϣ࡚ࣽੱǼ
1. ଶҔ‫ ڋ׭‬K+௨‫ޑݧ‬ᛰ‫ނ‬ǴӵǺ K+-sparingǵdiureticsǵACEiǵNSAIDǴଶЗ
ࡼѺ KCl
2. फ़ե cell menbrane depolarizationǺCalcium gluconate
3. ٬ K+຾ΕಒझǺInsulin+glucoseǴ2 adrenergic agonistǴNaHCO3ȐESRD p’t
όёҔȑ
4. ߦ K+௨‫ݧ‬Ǻloop diureticsǴthiazide diureticsǴsodium polystyreneǴsulfonate
ȐPOǴretention enemaȑ
5. ऩ p’t ࣁ renal failure ӝ‫ ٳ‬severe hyperkalemia ‫܈‬ჹа΢ᕍ‫ݤ‬คϸᔈ‫ޣ‬acute
hemodialysis
6. Closed follow up K+ level

~Hypocalcemia~
Complaints by p’tǴfamily or nurseǺ
Muscle crampǴtetanyǴparesthesiasǴcarpopedal spasmǴspasm of facial
muscleǴཀ᛽‫ރ‬ᄊ‫ׯ‬ᡂ

ӧຑ՗ੰўǵ౛Ꮲᔠࢗǵᙌ᎙ੰ‫ࡕٯ‬Ǵӵ݀ੰ஻ԖаΠੱ‫܈ރ‬ወӧ੯ੰ‫ޣ‬Ǵ
ሡᚶᅪԖ hypocalcemia ϐёૈ‫܄‬Ǻ
1. ϐ߻଺ၸ total/partial thyroidectomy
2. ੰ஻Ԗ history of hypoparathyroidismǴrenal failureǴVit D deficiencyǴacute
pancreatitisǴMgǴseptic shock
3. Trousseau’s sign positive =ɧӧՈᓸሺ‫ ޑ‬cuf ΢к਻٬ຬၸ p’t systolic
pressureǴӵԜ⢪ᆙੰΓЋᖉ 3mins ࡕǴp’t’sankle/hand Ԗยᠱ౜ຝǶ
4. Chvostek’s sign positiveǺᄟѺԸ߻ϐ facial nerve branch ཮Їଆᚑय़ԼԺ‫ܜ‬
୏Ƕ
ԜਔёᡍǺCa2+ǵPǵMgǵCreatininǵPTH

Treatment
1. ऩ p’t ന߈‫ ޑ‬albumin ॶୃեǴёҔᕖ҅ϦԄख़ᆉ Ca2+ level
Ca2+ level = Ca2+ෳໆॶ + (4-albumin) * 0.8
2. ࡚‫ݯ܄‬ᕍǺᏃೲှନੱ‫ރ‬ǴӃҔ Calcium gluconate IV joush ϐࡕӆҔ

- 54 -
 Calcium gluconate IVF ᅀ‫ݙ‬
3. ऩ p’t ԖեՈᗔǴሡᕖ҅ϐ

~Hypercalcemia~
Complaints by p’tǴfamily or nurseǺ
Kidneyɡpolyuriaǵrenal stone
GIɡnauseal vomittingǵconstipationǵdehydration
Neuroɡweakǵconfusionǵcoma

ӧຑ՗ੰўǵ౛Ꮲᔠࢗǵᙌ᎙ੰ‫ࡕٯ‬Ǵӵ݀ੰ஻ԖаΠੱ‫܈ރ‬ወӧ੯ੰ‫ޣ‬Ǵ
ሡᚶᅪԖ hypercalcemia ϐёૈ‫܄‬Ǻ
1. ੰ஻Ԗ hyperparathyroidism(PTH)‫ ܈‬malignancy(PTH)ϐੰў
2. ‫ځ‬дၨϿ‫ـ‬Їଆ hypercalcemia ϐ‫ݩރ‬ǺhyperthyroidismǴߏයޮ‫׉‬ǴVit D
ύࢥǴmilk-alkali syndrome…

ёᡍǺCa2+ǴPTH

‫ݯ‬ᕍ
࡚‫܄‬ೀ౛Ǻр౜ੱ‫ ܈ރ‬Ca2+ level > 12mg/dL ਔ
1. severe hypercalcemia ཮ಥНǴࡺ΋໒‫ۈ‬ᔈ challenge N/S Ȑ300~500mlȑǴϐ
ࡕӧന߃ 24hrs ϣ๏ 3~4 L ‫ ޑ‬N/S
2. ‫܍‬΢ǴN/S diuretics ёߦ຾ Ca2+௨‫ݧ‬Ǵόၸाᅱෳ heart functionǴrenal
functionǴNa+ǵK+ǵCa2+ǵMg2+levelǶᔈᗉխ๏ ThiazideȐ཮ઇᚯ Ca2+௨
‫ݧ‬ȑ
3. ค renal failure ‫ޣ‬Ҕ pamidronateǴ٠ຑ՗‫ ځ‬side effect ( Ca2+ǴPǴMg2+Ǵ
mild fever )
4. Ԗ renal failure ‫ޣ‬Ҕ Calcitonin

06.Urinary routine and sediment analysis ᲋᎔

¾ ϙሶਔংा଺ U/AǺ
9 ॶ੤ਔதၶ‫ډ‬ǺfeverǴdysuriaǴfrequency and urgency ᚶᅪ UTI ਔǶ
9 ੰΓ edemaǴᚶᅪԖ GNǴnephrotic syndrome ਔǴόதၶ‫ډ‬ǴՐଣ‫ޑ‬
GN ੰΓ೯த೿ࢂԴੰΓΑǶ
9 ᚶᅪ DKA ‫ ܈‬DM ਔǶ
9 Acute renal failure ᚶᅪԖ ATN ਔǶ
9 ֿనᚑՅ‫ׯ‬٠ᚶᅪԖՈֿਔǶ
9 ๝่ҡ

¾ U/A ‫ޑ‬໨ҞǺ
9 ColorǺred-> hematuriaǴmyogloginuriaȐᐉદԼྋှȑ
Brown-> tea color urine -> jaundice
9 TurbidityǺturbid->ёૈ UTI

- 55 -
 9 Sp gravityǺКख़եǺDI (ӧ NS ໒ֹ pituitary tumor ੰΓǴԖਔ཮࣮
‫ډ‬Ǵ) GN. Кख़ଯǺDMǴSIADH
9 PHǺpH ଯਔǴܰԖ CaǴMg ฻่ҡǴpH եਔǴܰԖ uric acid ่ҡ
9 LeukocyteǴnitriteǺр౜߄ҢԖ UTIǶLeukocyteǺୀෳ WBC ϣ‫ޑ‬
enzymeǶNitriteǺG(-)ω཮ positive nitrate->nitrite
9 ProteinǺр౜߄Ԗ GN or nephritic syndrome
9 GlucoseǺр౜߄Ԗ DM
9 KetoneǺ߄Ԗ DKA ‫ߏ܈‬යବᎧ
9 UrobilirubinǴbilirubinǺbilirubin ᔈ negativeǴр౜Եቾ jaundiceǴ
hepatobiliary disease
9 BloodǺୀෳ hemoglobinǴӵԖ blood ԶؒԖ RBCǴ߄ hemoglobinuria
or myoglobinuria
9 BacteriaǺр౜߄Ԗ UTIǴԖ΋٤ immune compromise ੰΓȐӵѺϯᕍ
‫ޑ‬ȑǴwhite count եǴUTI ёૈѝࢂֿύԖ bacteria Զค pyuria
9 RBCǺ౜ӧߏ۪኱ྗ<20/uLǶр౜߄Ԗ hematuriaǴd/d ࡐӭӵ stoneǴ
UTIǴtumor ฻
9 WBCǺॶ੤നதҔǴ౜ӧ኱ྗ<30/uLǶр౜߄Ԗ UTIǶाଛӝ
epithelium cell аଆ࣮ǶEpithelium cell ᔈຫեຫӳǶEpithelium cell
ଯǴcontamination ᐒ཮ຫଯ
9 Epithelium cellǺຫଯ߄Ңֿ੮όଳృǴԖவ vagina ٰ‫ޑ‬Ԧࢉ
9 CastǺhyalin castǺ҅தΨёԖǶGranular castǺᚶᅪ ATN or
tubulointerstitial dxǶRBC castǺᚶᅪ GN

07.Auscultation

1.Ј᠌᠋ບ Auscultation of HeartǺ(࿯ᒵ Delon Wu ᖱက)

1. S1Ǻclosure of mitral & Tricusp valveǴbest audible of apex
2. S2Ǻclosure of Arotic& pulmonary valveǴA2 component ǺAortic areaǴP2
componentǺpulmonary areaǴ normal dose not radiate to apex
3. Physiologic splitting of S2Ǻinspiration
4. Wide splitting of S2ǺFixed splitting in ASDǴPSǴcomplete right bundle
branch blockǴType A (left) preexcitation
5. Paradoxical splitting of S2ǺASǴComplete Bleft bundle branch blockǴ
Type B (right) bumdle branch blockǴangia pectoris
6. S3ǺRapid ventricular filling soundǴlow frequenceǴabsent in normal
adultǴPresent in child or hyperdynamic cardiovascular stateǴLV or RV
volume over load
7. S4ǺAterial contracting soundǴlow frequent & absent in normal heartǴ
Present in LV or RV pressue and compliance down
8. Systolic ejection murmurǺharsh Ǵrough & gruntingǴmid –systolicǴASǴ
PS
9. Pansystolic murmur or holosystolic murmurǴMR or TRǴVSD
10. Diastolic blowing murmurǺdecreasendoǴhigh frequencyǴAortic or
Pulmonary insufficiency

- 56 -
 11. Diastolic Rumbing murmurǺlow frequencyǴMS or TS.
12. Friction RubǺacute pericarditisǴThree componentǺsystolic Ǵdiastolic &
late diastolicǴchange Iwith position change

2. ‫᠋᠌ޤ‬ບ (Breathing Sound) (࿯ᒵ Dr.Ֆ݊ᑼ ֆりӀᖱက)

A.όೱុॣ‫܈‬ᛈ຋ॣ(Crackles) Ǻ
ࣁ໔ྂ‫ॣߚ܄‬኷‫ߚ܄‬தอኩ‫ޑ‬ᖂॣǴ‫ځ‬ᖂॣᜪ՟Ћࡰ௫୏ᓐᎳ‫܌‬ౢғ‫ޑ‬
ᖂॣǶ‫ځ‬ౢғ‫ޑ‬চӢԖΒǴ΋ࣁ֎਻ਔ‫ँ਻ޜ‬ฅѺ໒༥ഐ‫ޑ‬λ‫֎ڥ‬ၰ‫ޤ܈‬
‫ݰ‬ǴΒࣁ਻ᡏ೯ၸϩ‫܈ނݜ‬೽ϩߔ༞‫਻ޑ‬ၰ‫܌‬ౢғϐᚇॣǶѬёӧϩࣁ֎
਻Ԑයᛈ຋ॣϷ֎਻ఁයᛈ຋ॣǶ
* ֎਻Ԑයᛈ຋ॣǺӧ֎਻ࡕջଭ΢วғЪό཮࡭ុԿ֎਻҃යচӢǴх
ࡴᄌ‫܄‬Ѝ਻ᆅ‫ݹ‬Ϸ਻ഹ฻‫֎ڥ‬ၰ੯ੰǶ
* ֎਻҃යᛈ຋ॣǺёૈଆ‫਻֎ܭۈ‬ය‫߻ޑ‬ъ೽Ǵՠ΋‫ۓ‬໪࡭ុԿ֎਻҃
යǴচӢхࡴ‫ݹޤ‬ǵԐයᢠՈ‫܄‬Ј૰ᆃϷ໔፦‫ੰޤ܄‬฻‫ޤ‬ჴ፦ੰᡂǶ

B.ഹሳ(wheezing)Ǻ
ࣁૅ๚ϣ਻ၰ੟ઞ‫܌‬ౢғϐଯᓎǴЪ‫ॣڀ‬኷‫܄‬ϐೱុॣǴεӭӧӗ਻ය
р౜Ǵഹሳёӧ਻ഹᄌ‫܄‬Ѝ਻ᆅ‫܈ݹ‬Ј૰ᆃ‫ੰޑ‬Γ΢᠋‫ډ‬.ќѦԖΓஒၨե
ᓎ‫ޑ‬ഹሳॣǴᆀ଺ଳ៷ॣ(Rhonchi)‫ॣځ‬፦ᜪ՟ѺᗾᖂǴऩు‫ࠏ܈֎ڥ‬჌٬
ഹሳ੃ѨǴ߾߄ҢԜᖂॣࢂҗϩ‫܌ނݜ‬ЇଆǶ

C.ফሳ(Stridor)
ࣁ΢ᆄ਻ᆅ‫ࠒ܈‬ോ฻ε‫֎ڥ‬ၰߔ༞Ǵ‫܌‬ౢғ‫਻֎ޑ‬ය‫ޑ‬ೱុ‫ॣޑ‬኷‫܄‬ᖂ
ॣǴᖂॣ੝ቻࣁᜪ՟ᒗᓐᡳϐശћᖂǴёӧᖂ஥࿂࿄ǵ཮Ⴧ‫ݹ‬ǵ΢‫֎ڥ‬ၰ
ߔ༞฻ੰΓ᠋‫ډ‬ফሳǶ

D.Իጢነᔔॣ(pleural Rub)
҅த‫ޑ‬Իጢӧ‫֎ڥ‬ਔࢂؒԖᖂॣǴՠࢂӧԻጢว‫܈ݹ‬ቚࠆ‫ޑ‬௃‫׎‬ΠǴё
а᠋‫ډ‬ԻጢᑃᔔॣǴѬࢂ‫ڈ‬Ըόೱុ‫ޑ‬Ǵᜪ՟Ҝॠᑃᔔ቗቗ბბ‫ޑ‬ᖂॣǴ
ёаӧ֎਻҃යϷӗ਻߃ය᠋‫ډ‬ǶԻጢᑃᔔॣԖਔ᠋ଆٰ‫ک‬ᛈ຋ॣࡐႽǴ
ᑃᔔॣၨ‫ڈ‬ԸǴ೯தѝֽज़ӧၨλ୔ୱǴЪ‫਻ڥ‬ᆶ֎਻೿཮วғǴՠଽᅟ
ѝֽज़ӧ֎਻යǶ

3.ဉ᝸୏ॣ (Bowel peristaltic sound) (࿯ᒵ݅Ⴀٖ ‫݊ߙ׵‬ᖱက)

҅தဉ᝸ॣࣁଯᓎǴ‫ (ॣ៷ڞ‬gurgling sound)Ƕ‫ځ‬วғᓎ౗ࣁ‫ ؂‬5-15 ࣾ΋
ԛǶ‫؂‬΋ঁဉ᝸ॣёλ‫ܭ‬΋ࣾ‫ុ࡭܈‬ӳ൳ࣾǶဉॣЬࣁ਻ᡏᆶనᡏӧဉ᝸୏
ਔ࿶ၸဉၰ‫܌‬วрϐᖂॣǶ‫ځ‬วᖂ౗ᆶဉၰϣࢂցԖ१‫ނ‬Ϸ१‫੃ނ‬ϯ‫ޑ‬ำࡋ
ԖᜢǶӢԜ‫ځ‬ᓎ౗ϐᡂ౦ߚதεǶᖏ‫׉‬΢ဉॣϐ‫ׯ‬ᡂѝԖ‫ٿ‬ᅿၨԖཀကǺ΋
ࣁคဉॣ(absence of bowel sound)Ǵќ΋ࣁଯᓎϐуೲဉॣ (borborygmi)Ƕค
ဉॣϐບᘐሡाᩫ᠋ԿϿϖϩដЪ‫؂‬΋ঁ quadrant ԿϿ΋ϩដؒԖဉ᝸ॣω
ԋҥǶ೷ԋคဉॣϐচӢёࣁဎጢ‫ݹ‬ǴલՈ‫܄‬ဉ‫ݹ‬Ǵဉߔ༞҃ය‫܈‬ဎ೽Ћೌ
ೌࡕ฻Ƕဉॣуೲӭᆶဉग‫ݹ‬ԖᜢǶՠऩ‫ࣁځ‬ଯᓎ‫ٳ‬Ԗߎឦॣ߾ाᚶᅪԖԐ
ය‫܄‬ဉߔ༞Ƕဉߔ༞ೀϐဉॣ೯தၨεᖂǶԖਔё᠋‫ډ‬Нᐟᕏॣ(Succussion
splash) ‫܈‬ஒᝊ੝౟ϣϐНॹрϐᖂॣǶ

- 57 -
08. Oral Presentation m93 ଼ֻ

Presentaion case ჹ‫ܭ‬΋ঁᙴғٰᇥࢂࡐख़ा‫ޑ‬ǴВத૸ፕǵࢗ‫܊‬ǵmeetingǴ

ε‫ډ‬ᙴᏢ཮΢೿ࢂा཮ൔ caseǴԶ‫ॺך‬ӧ྽ intern ‫ޑ‬ਔং൳ЯϺϺ೿Ԗाൔ
case ‫ޑ‬ਔংǶ ࣁϙሶ‫ॺך‬ाൔ case ‫ګ‬ǻԖࡐӭࡐӭচӢ‫ޑ‬
1. ᕕှੰΓ‫ ޑ‬medical problem
2. ԏ໣Ԗճ‫ܭ‬ບᘐϷ‫ݯ‬ᕍ‫࣬ޑ‬ᜢ data(positive or negative)
3. ᏾౛ϩ‫܌݋‬ԏ໣‫ ٰޑ‬data ٠ЪԖచ౛‫ޑ‬ᇥрٰ
4. ૽ግ‫ؼ‬ӳ‫ྎޑ‬೯‫מ‬ѯϷᄽᖱ‫ೌמ‬Ƕ
5. ᎙᠐࣬ᜢЎ᝘ٰᙶమ೭ঁ੯ੰǴ᠘ձບᘐǴ੯ੰੰำϷႣࡕ
6. ᡄᒠϷӝ౛ϯ‫ޑ‬Πղᘐ
7. வൔ case ύᏢಞ

΋໒‫ۈ‬ൔ case ೿཮ᡣΓЋ‫ى‬ค௛ǴόၸᗋࢂԖ٤ guideline ёа‫ٮ‬εৎ଺٤ୖ

ԵǼ೭ࢂ࿯ᒵᇙ Sackett ǺEvidance base medicine ύԖᜢ presentation ‫ޑ‬೽ϩǴ
ჹ‫ ܭ‬presentation ཮ԖᔅշǶ
A. New case
1. ‫ۉ‬ӜǴ‫܄‬ձǵԃइǵՐଣВය
2. chief complaint
where of body location*
quality
quantityǴintensityǴdegree of imprairment
chromologyǴwhen it beginǴconstant/ episodicǴprogressive
aggravating or alleviating factor
associated symptoms
3. ၸѐԖؒԖวғ࣬՟‫ ޑ‬complaintǴӵ݀Ԗ྽ਔԖ଺ϙሶೀ౛Ǵ่݀ӵՖǻ
4. Pasr historyǴfamily historyǴsocial historyȐӵ݀ၟ CC ؒᜢǴ൩ᇥؒԖǴ
஥ၸ൩ёаΑȑ
5. ੰΓჹ‫ܭ‬дҁ‫ي‬੯ੰ‫کݤ࣮ޑ‬ȨੰΓ concernedȩϙሶ
6. Րଣਔ‫ ޑ‬condition
acute or chronic ill
severity
request what sort of help
7. physical finding
8. Ԗ଺ব٤ᔠࢗǴ่݀Ԗрٰ‫ޑ‬ाൔ data
9. ჹੰΓ‫ݩރޑ‬բ᏾౛Ǵа΋ѡᙁൂ‫ޑ‬ѡη߄ၲрٰ
10. നԖёૈ‫ ޑ‬diagnosis ‫ک‬ёૈ‫ ޑ‬DD
11. Ԗব٤ᔠࢗགྷाӼ௨‫ޑ‬
12. գჹੰΓ‫ޑ‬Ⴃࡕຑ՗
13. ‫ݯ‬ᕍीฝ(хࡴ IVǴҔᛰǴӼ௨ consult ‫ࢂ܈‬໒Θ฻)
14. ӵՖ monitor ‫ݯ‬ᕍ‫ޑ‬ӳόӳ

B. Old case or follow- up case

1. ‫ۉ‬Ӝǵ‫܄‬ձǵԃइǵՐଣВය
2. chief complaint when admission
3. vital sign today

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 4. ౜ӧԖӭϿ‫ ޑ‬active problemǶȐacitve problem ёаࢂ symptomǴsignǴ
eventǴdiagnosisǴinjuryǴpsycologic statusǴsocial predicament.ȑ
5. നख़ा‫ ޑ‬symptoms
6. നख़ा‫ ޑ‬signs
7. Ԗ଺ϙሶᔠࢗǴϷᔠ่ࢗ݀
8. ჹ‫ܭ‬೭ active problem ‫ޑ‬ှញϷບᘐ
9. ‫ݯ‬ᕍीฝ
10. ੰΓჹ‫ݯܭ‬ᕍ‫ޑ‬ϸᔈ
11. ௗΠٰჹ‫ܭ‬೭ୢᚒा଺ϙሶೀ౛
12. ჹ‫ ঁ؂ܭ‬active problem ೿ाख़ፄ 4-10
13. գჹ‫ܭ‬೭ੰΓ dischargeǴfollow up ‫ ک‬рଣࡕ‫ݯޑ‬ᕍीฝ
Ȑ೭΋ᗺԖᗺ֚ᜤǴ೯தႽ‫ॺך‬КၨؒԖ࿶ᡍ‫ ޑ‬intern ٰᇥǴჹ‫ੰܭ‬Γ‫ޑ‬
Ⴃࡕ‫ݯک‬ᕍҞ኱தத཮Ӣࣁᖏ‫׉‬࿶ᡍ‫ޑ‬ό‫܌ى‬аؒԖᒤ‫ݤ‬ඓඝளࡐӳǶό
ၸ೭൩ࢂ‫ॺך‬ाӛ R ‫ ک‬VS ፎ௲‫ޑ‬ӦБǶȑ
14. ჹ‫ܭ‬ບᘐǵ‫ݯ‬ᕍǵ‫ੰک‬Γ‫ޑ‬ϕ୏ǵӣѐ‫ޑۺ‬ਜԖόᔉ‫ޑ‬ӦБǶ

‫ځ‬ჴԖΓ᝺ளൔ case ࢂ΋ҹࡐྠ‫ޑ‬٣ǴόၸவԾρӧൔ case ‫ޑ‬ၸำύёаᏢ

‫ࡐډ‬ӭܿՋǶႴᓰεৎඓඝ‫ঁ؂‬ൔ case ‫ޑ‬ᐒ཮Ǵόᆅࢂӧࢗ‫܊‬Ǵॶ੤Ǵmeeting
‫ޑ‬ਔংǴ೿ૈӳӳ‫ޑ‬ൔ caseǶࣗԿၟӕᏢӧၡ΢ಠੰΓ‫ޑ‬ਔংǴΨёа྽଺ࢂ
ൔ case ‫ޑ‬ᐒ཮ӳӳግಞ΋ΠǶ

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PART 7 ᙴੰᜢ߯&ᙴᕍᒱᇤ࿶ᡍፋ M92 ጓᒠဂ

ᙴᙴᜢ߯
1. а൧ख़Ϸ϶๓‫ޑ‬ᄊࡋჹࡑԴৣаϷᏢߏ‫ۆ‬
2. Ꮲߏ‫ۊ‬ၟ‫ځ‬д intern ԆόၸٰਔǴёа፾ਔϩᏼπբǴԾρᅰໆόाቚуձ
Γ‫ॄޑ‬ᏼ
3. Ծρόૈೀ౛‫ޑ‬٣௃Ǵ΋‫ۓ‬ा call Ꮲߏ‫ۆ‬ǴόाԾρ΋ঁΓ‫܍‬ᏼೢҺ

ᙴៈᜢ߯
1. ၶ‫ډ‬ᄊࡋӳ‫ޑ‬ៈγёаӭಠ΋ಠǴёаᔅշӧॶ੤ਔᇸ᚞΋ᗺ
2. ၶ‫ ډ‬malignant ‫ޑ‬ៈγǴ‫ע‬Ծρ‫ޑ‬٣௃଺ӳǴόा౛Ӵ‫ࣁ܈‬Ӵғ਻
3. ᅰໆᗉխ‫ڮ‬зԄ‫ޑ‬ᇟ਻

ᙴੰᜢ߯
1. ᖱ၉ਔाλЈǴԖ΋٤၉ᇟǴ‫ॺך‬ёૈ᝺ள࡛ؒኬǴੰΓёૈ཮᝺ளԖ‫ߵڙ‬
ҍ‫ޑ‬ག᝺
2. Ԗሡा຾΋‫؁‬ှញ‫ޑ‬௃‫ࢂ܈ݩ‬Ծρค‫ݤ‬ೀ౛‫ݩރޑ‬Ǵၟৎឦ߄ܴԾρ‫يޑ‬
ϩǴှញమཱǴ཮ፎၗుᙴৣٰှ،
3. ‫ت‬ᙴৣࣁζੰ஻բᔠࢗਔǴ΋‫ۓ‬ाԖៈγλ‫ۆ‬ഉӕ

ᙴᕍᒱᇤ࿶ᡍፋ
1. Bp ଯǴϮᇸܰҔ adalat
2. λ‫ ࣽٽ‬Push ߻ዴᇡ‫ۉ‬Ӝ
3. ໒ order ዴᇡ‫׉‬ဦΓӜϷᛰ‫ނ‬Ӝᆀ
4. Compatment syndromeǴpulmonary embolismǴdeep vein thrombosisǴpost op
hematomaǴAMIǴStroke Ԑයੱ‫ރ‬όܴᡉǴा r/o
5. Ҕᛰ߻ाӃዴ‫ੰۓ‬ΓࢂցࢂᚶѫǴࢂց renal failureǴёૈԖব٤ୋբҔ
6. ᗉխ orde ೏࣮ᒱ
7. When you thought things could’t get ant worseǴit willǼ
8. ӭᆶ‫ځ‬дΓϩ٦ᙴᕍᒱᇤ‫ޑ‬࿶ᡍǴ෧Ͽӆวғ‫ޑ‬ᐒ཮Ǽ

ӜΓλᇟ
Delon WuǺᙴৣ‫فޑ‬ՅǺ 1.Professionalism 2.mannerism
ֺྷኴǺ‫࡭ޚ‬๱аੰΓࣁύЈ‫ޑ‬ЈᄊǴಖ‫଺ي‬΋ঁᙴᏢ‫ޑ‬Ꮲ২
ߠЎຐǺϙሶኬ‫ޑ‬ภࢂёа‫ ?ޑڙה‬เਢࢂձΓ‫ޑ‬ภ
‫׹‬ᖃܴǺటࣁᙴ‫ޣ‬ǴѸӃࣁΓΨ.
Б୷ӸǺຎੰซᒃ
WindflowǺғࢲ൩ࢂჹԾρ‫ޑ‬ғ‫ॄڮ‬ೢ

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0(02








0(02








 ‫ۯٺ‬ᖂ‫ࡢݬ‬Օ୮‫ړ‬Δଈ٣ஐ໛Օ୮ึ࣍ၞԵԱట‫إ‬ᜯ‫ݩ‬᠔ஃऱၸ੄ЁIntern doctorΖઌॾՕ୮ॣ૿ᜯࠩຍԫၸ
੄ழԫࡳ‫ך‬የጹ്ΕཚৱΕ‫֗א‬༬எऱ֨ൣΖ‫ڇ‬९ࢊឈྥ‫ڶ‬೚լ‫ݙ‬ऱՠ‫܂‬Δ‫܀‬ਢፖࠡ‫ה‬᠔ೃኔ฾ऱ‫ٵ‬ᖂֺለದࠐΔ
‫ݺ‬ଚ‫ڇ‬ຍᇙᖑ‫܂ڶ‬੡ԫ‫ۯ‬᠔ஃᚨ‫ڶ‬ऱഗ‫ᦞء‬ԺΔᜰՅ‫܂‬ᛀ਷Δၲᢐ࿛࿛Ζ‫܀‬ਢ૿ኙฒ‫ڍ‬հছᖂመথլམ‫ش‬መऱᢐ
ढழΔ‫ڕ‬۶ᙇᖗթ౨ሒࠩట‫إ‬ऱ᛭ய‫່֟֗א‬ऱ೫‫ش܂‬ΔઌॾՕ୮֨෻ຟ޲‫ڶ‬ଡࢍΖ‫֚ػڇ‬ᝫ‫ړ‬Δየܾየߣऱᖂ
९ࡪ‫אױ‬ᓮඒΔ‫܀‬ਢࠩԱඡՂଖఄࡋΛࢬ‫ڇ៽ྎא‬ຍᇙ٨ᜰԫࠄ Primary care ழᆖൄࠌ‫ࠩش‬ऱᢐढΔ‫ۯٺࠎא‬೶
‫ە‬Ζ
ຍࠄᢐढԫຝ։೶‫ە‬ᢐࠢऱࣹᇞΔ‫܀‬ਢՕຝ։থਢྎ៽ຍԫ‫۞ࠐڣ‬աऱࠌ‫ش‬ᆖ᧭Δࢬᒳᙀ‫ࠐנ‬ऱ RegimenΖ
ឈྥ‫۞א‬աऱᆖ᧭ࢬᒳᐊऱࣟ۫Δࢨ๺ᄎ‫ࠄڶ‬լ‫إ‬ᒔΔ‫܀‬ਢઌॾኙ‫ۯٺ‬ᖂ‫ߢۖࡢݬ‬ΔԫၲࡨऱྤࢬᔞൕΔլ‫ڶڕ‬
ଡ೶‫ە‬ऱࠉᖕΖྎ៽ԫၲࡨՈਢൕඡՂଖఄ๠෻ ComplaintΔᇬംᥨՓ՛ࡦൄ‫ش‬ऱᢐढΔለᣤૹழᇬംᖂ९ऱრߠΔ
‫֚ػ‬ழ٦೶‫׌ە‬ए᠔ஃऱࠌ‫ش‬ऄঞΔᖂ९ࡦऱࠌ‫ڤֱش‬࿛࿛Δ່৵ᆖመ۞աᜯ‫ݩ‬ऱ TrialΔթ‫ګݮ‬ຍԫ୚ RegimenΖ
ࢬ‫א‬ઌॾ೗‫א‬ழֲΔ‫ۯٺ‬ᖂ‫ࡢݬ‬ԫᑌ‫אױ‬ᕏ᎘༉ᑵΔᖞ෻‫נ‬᥆࣍۞աऱ Medication RegimenΔ༉઎൞ਢ‫֨شܡ‬ԱΖ
լመ༼ᙌ‫ۯٺ‬ԫរΔ‫ڇ‬९ࢊ‫ش‬ᢐᄷঞೈԱ‫ڻٺ‬റઝ‫א‬؆Δ༉᥆փઝऱ࿯ᢐֱ‫່ڤ‬ଖ൓೶‫ە‬Ζࠀॺਢࠡ‫ה‬᠔ஃլᄎ
‫ش‬ᢐΔۖਢ‫ࠄڶ‬ழଢࠀॺ‫إ‬ᒔΔ‫נ࣠ڕڼڂ‬෼ፖ‫ם֫ء‬ઌؐऱൣ‫ݮ‬ழΔᓮ‫ۯٺ‬ᖂ‫ڍאױࡢݬ‬೶‫ە‬փઝ᠔ஃऱ‫ش‬ᢐ
ֱऄΰ௽ܑਢ‫ء‬ೃ؆ઝ᠔ஃৰ‫ڍ‬ᢐढຟ႖࿯α Δࢨਢ਷઎ᢐࠢ࿛Δ೭ᓮ਷ଡֽᆵ‫נف‬Δլ૞‫ڼڂ‬਩Ղᙑᎄ฾ክΰ֠
ࠡรԫଡ Course run ഡขઝࢨਢ؆ઝऱ‫ٵ‬ᖂα Ζ‫ڇ‬վ‫ڣ‬ԮԶִհ৵Δᄅऱ R1 ലᄎၞԵ᠔ೃΔᎅኔ‫ڇ‬ऱΔೈԱ‫ءڇ‬
ೃኔ฾ऱᖂ९ࡦհ؆Δࠡ‫ה‬᠔ೃࠐऱᖂ९ࡦ‫ڶ‬ழଢటऱ޲‫شڶ‬ᢐᨠ࢚Ζᅝ൞‫ڇ‬ඡՂଖఄழΔ‫࣠ڕ‬టऱᤚ൓ᖂ९ࡦ
‫ڶ‬ംᠲழΔլ૞‫ܝ‬Ⴑ࣍ፖ‫ה‬ଚԫದಘᓵΔઌॾ‫ה‬ଚຟᄎᑗ࣍൷࠹ऱΖ
ඡՂଖఄਢ‫່ۯٺ‬౨ജᖂࠩࣟ۫ऱழଢΖಖ۰Δ๠෻ԫٙ Complaint ழΔ೭‫ؘ‬೚່ࠩഗ‫ء‬ऱ History taking and
PEΔຍᑌթ‫ڶ‬ഗ‫ء‬ऱ Impression ‫אױ‬࿯ᢐࢨਢ‫܂‬ᛀ਷Ζԫଡ່ૹ૞ऱᨠ࢚༼ࠎ࿯Օ୮ΔඡՂ๠෻ Complaint ࠀॺ
ਢ૞ए᛭ఐ൛Δۖਢ๠෻ఐ࿓‫א‬؆ࢨਢቃૠᄎ࿇‫س‬ऱડ࿇ࠃٙΖᜰࠏΔԫ‫ڂۯ‬੡լࣔ଺‫ߚڂ‬՗క࿀ऱ൛ृ۰ೃΔ
ᥨՓ՛ࡦ࣍ଖఄழ‫ܫ‬व൛ृսྥߚ՗࿀Δᓮ‫܃‬๠෻Ζຍழ‫׽܃‬૞ᒔࡳᇠൣ‫ݮ‬ፖ‫ڰ‬Ղ۰ೃழࠀྤࠟᑌΔۖॺࠡ‫ה‬ጹ
৺णउΔ‫܃‬༉‫אױ‬ፖ൛ृ‫܂‬ᇞᤩΖฅຶ်ឰፖᒔኔए᛭൛ृਢ‫׌‬ए᠔ஃऱ៭ຂΔ‫ݺ‬ଚ‫׽‬૞ᒔᎁ‫ڇ‬်एऱመ࿓խΔ
ඡՂլ૞‫נ‬෼ડ࿇णउΔࢨਢ‫נ‬෼ડ࿇णउ৵‫ݺ‬ଚፖ‫א‬ᒔኔ๠ᆜ‫ױܛ‬Ζࢬ‫ޢא‬ԫ‫ڻ‬ଖఄΔ༉ྫ‫ښڕ‬৺်৛ԫᑌΖ
Օીፖ‫ۯٺ‬։ࠆ‫ڕ‬۶๠෻ඡՂଖఄ Complaint ऱੌ࿓Δ‫א‬ଫ᥽ఐ൛‫ڜ‬٤‫ߪ۞֗א‬ᖂ฾ऱᖲᄎΚ
1Η ൷ᛧຏवΔ٣៬ᔹఐᖵΔԱᇞఐ൛‫ڻء‬۰ೃ‫ؾ‬ऱΕመ࿓Ε೚መऱᛀ਷ए᛭Ε‫ؾ֗א‬ছऱ‫࣠ګ‬Ι
2Η ਷ᔹհছਢ‫ڶܡ‬መ‫ٵ‬ᑌऱ ProblemΔૉ‫ڶ‬Δհছऱ᠔ஃΰլጥਢᅝઝࢨਢଖఄ᠔ஃαਢ‫ڕ‬۶೚๠ᆜ
ΰࢬ‫א‬Δ‫ۯٺ‬ᖂ‫ڶࡢݬ‬೚መٚ۶๠ᆜΔ๠෻ٚ۶ ComplaintΔᓮ೭‫ؘ‬ᐊ Duty noteΔԫֱ૿‫ ߻א‬Legal
problemΔԫֱ૿ᚥ‫ܗ‬հ৵ऱ᠔ஃΔԱᇞ൛ृఐൣαΙ
3Η ፖఐ൛‫ ܂‬History taking ‫ ֗א‬PEΰಾኙᇠ ComplaintαΖຍழՈ‫אױ‬ം֗ਢ‫ܡ‬հছ࿇‫س‬መ‫ٵ‬ᑌणउ
‫֗א‬հছऱ᠔ஃਢ‫ڕ‬۶๠ᆜΙ
4Η Հ Impressionΰ‫۞࣠ڕ‬ա‫ڶ‬ଡࢍऱᇩαΔ‫ܫ‬व൛ृ൞ऱ‫ؚ‬ጩΖ
5Η ᐊՀ Duty noteΙ
6Η ‫شࡳެ࣠ڕ‬ᢐΔ‫܀‬ਢլ堚ᄑऱᇩΔ‫אױ‬ᇬംᖂ९ࢨਢᥨՓ՛ࡦΰം‫ה‬ଚኙ࣍ຍጟणउழΔຏൄ‫אױ‬
ᙇᖗչᏖᢐढαΙ
7Η ‫۞࣠ڕ‬ա‫ڶ‬๠ᆜֱ‫ڤ‬ΰ࿯ᢐࢨਢ OBSЁრ‫ܛ‬ᨠኘ‫ױܛ‬α Δ‫ܫ‬व՛ࡦ৵ሖࠩ֘Ꮝΰᎅ‫ݺ‬ଚ޲‫ڶ‬ຍጟ‫ش‬
ऄࢨਢࠡ‫ה‬෻‫ط‬αΔຍழᚨղ՛ࡦ‫ג‬าᄮຏΖຏൄຍԫጟൣ‫ݮ‬ൄ‫ڇ‬؆ઝఐࢪ‫נ‬෼ΰ‫ڂ‬੡‫ڔ‬ଚ‫׽‬ᚩ൓
ࢬᘯऱ RoutineΔհ؆ऱຟᤚ൓ሔ֘ൄ๵αΙᅝྥ‫׼‬ԫֱ૿Ո‫ױڶ‬౨ਢ۞աऱง؈Δᓮፖ‫إޓא‬Ι
8Η ‫࣠ڕ‬઎‫ݙ‬൛ृ৵ᤚ൓۞աྤऄ๠ᆜΔᓮ Call duty RΔಖ൓Δ‫אױ‬೚ऱᛀ਷٣೚Δ‫ ڕ‬Blood gasΔgastric
lavage ࿛࿛Ζຏवᖂ९ழᓮ‫ ܂‬Case summery ‫֗א‬ຍଡ Complaint ‫܃‬ംࠩԱչᏖΔ઎ࠩԱչᏖΔ
೚Աୌࠄᛀ਷ΔᏁ૞ᖂ९ࡦ࿯ղչᏖ࠰‫ܗ‬࿛࿛Ζ
‫ڇ‬ຍᑌऱመ࿓խΔ༉‫אױ‬ᖂࠩ๺‫ڍ‬ऱࣟ۫Δ‫ץ‬ਔ෻ᖂᛀ਷‫؏ݾ‬Δം်‫؏ݾ‬Δ‫ش‬ᢐᄗ࢚Δࢨਢ‫܂‬១໢ऱ Case
report/summeryΖࢬ‫א‬Δଖఄழటऱਢᖂ฾ऱ່ࠋழᖲΖ
‫׼‬؆Δኙ࣍ԫࠄ৺එൄ‫ش‬ऱᢐढΔᅀᓮ‫ۯٺ‬ᖂ‫ࡢݬ‬೶‫ ە‬ACLS ֫‫ם‬ᇙ૿ऱ១տΰઌॾՕ୮ຟ‫ڶ‬ԫ‫ܣء‬α Ζ‫׼‬؆
ቝ՛ࠝઝ‫ش‬ᢐᕪၦΔྎ៽Ոᕣၦլ༼Δ‫ڂ‬੡‫ڇ‬՛ࠝઝழՕ୮ࠀլጩਢรԫᒵԳ୉ΰ‫ڇ‬՛ࠝઝ‫ࠌܛ‬ඡՂଖఄ൷ New
patient ࢨਢΔ੷۟๠෻ Complaintΰ‫ݺڇ‬ଚຍԫࡻਢ޲‫ڶ‬ຍଡՠ‫܂‬α ΔՕ୮ᝫਢԫࡳ૞ຏवᖂ९ࡦ Counter signαΔ
ۖ‫׊‬՛ࠝઝᄎ࿇ԫ‫ۖء‬ઝ֫‫ם‬Ղ૿ᄎ‫ڶ‬Ι‫הࠡڇ࣠ڕ‬ઝሖࠩ՛৘൛ृΔՈ‫ࠩאױ‬᠔᛭ᇷಛߓอᙇ๠ֱႃ਷ᇬΔՈ
‫אױ‬ऱࠩԫࠄᇷಛΖ‫׼‬؆Δሖࠩߛ᤿ഡՖΔԫࡳ૞ᇬംᡖ؋ऱ‫ױ‬౨ࢤΖ‫شڶ‬ᢐֱ૿ऱംᠲΔ‫ؚאױ‬ሽᇩࠩᢐ‫ݝ‬ᇬ
ംΖ‫ޢ‬ԫଡᥨ෻ీ‫ࠡڶٺ‬റ᥆ᢐ‫ݝ‬Δ‫ٻאױ‬ᥨՓ՛ࡦᇬംᇠሽᇩΖ
່৵Δ‫ݦ‬ඨՕ୮‫چڜؓאױ‬৫መຍԫ‫س‬խഄԫऱԫ‫ڣ‬ΔՈਢ່೯ᛯլ‫ڜ‬ऱԫ‫ڣ‬Ζ
ছ 1701ΰ԰Լԫᖂ‫ڣ‬৫α Δ851129 ພࢣᎮΰ‫־‬ਣྎ៽α
ᒳ࣍‫ا‬ഏ԰ԼԲ‫ڣ‬քִԼ؄ֲ
ठᦞࢬ‫ڶ‬
៬‫ٱ‬լߒ

Оࢃ෮ᙝ! 1
‫ؾ‬ᙕ
ԫΕ ൄ‫ش‬ᜍᐊ ................................................................................................................................. 3

ԲΕ ᇞᑷ᠜࿀ᕪΰAntipyretic analgesicsα.................................................................................. 3

ԿΕ ષᢐΰࠫᎨᕪΰAntacidsαΕષᆩᇞ࿂ᕪΰSpasmolyticsα
Ε֗‫ݼ‬ᑭጌᢐΰAnti-ulcerα . 5

؄Ε ַ࿀ᢐַ֗࿀᎖‫ܗ‬ᢐढΰAnalgesics and other co-therapeutic drugsα .............................. 7

նΕ ᠜ᙩ‫ڜ‬ఠᢐΕ‫ݼ‬壄壀ఐᢐढ‫᧼ݼ֗א‬わᢐढ ..................................................................... 9

քΕ ጵ‫ٽ‬ტকᢐΕ‫ิݼ‬៣₏Ε‫֗א‬যቬᢐ ............................................................................... 13

ԮΕ ࠡ‫ה‬ᆩષሐ‫ߗ֗א‬ᜬ‫ش‬ᢐ ................................................................................................... 16

ԶΕ ഗ‫זء‬᝔‫ش܂‬ᢐढΰMetabolism drugsα .......................................................................... 19

԰Ε ֨᦬ۨጥߓᢐढ ................................................................................................................... 24

ԼΕ ൄ‫ش‬հ؆‫ش‬ᢐढ ................................................................................................................... 30

ԼԫΕ ൄ‫ش‬հࣼ‫ݟ‬ሐᢐढ ............................................................................................................... 33

ԼԲΕ ࠡ‫ ה‬....................................................................................................................................... 34

Оࢃ෮ᙝ! 2
 ԫΕʳൄ‫ش‬ᜍᐊΰ݁੡ࢮԭ֮ᜍᐊΔࢬ‫א‬٤‫ټ‬༉լ‫ش‬वሐԱαΚ
ACΰ堩ছαΙPCΰ堩৵αΙQDΰ‫ֲޢ‬ԫ‫ڻ‬ΔՕᄗຟਢ‫ڰ‬Ղ԰រ࿯αΙBIDΰ‫ڻֲࠟޢ‬Δ09-17ΛαΙTID
ΰ‫ֲޢ‬Կ‫ڻ‬Δ09-13-17ΛαΙQIDΰ‫ֲޢ‬؄‫ڻ‬Δ09-13-17-21ΛαΙHSΰጕছ࿯ᢐαΙBIHSΰ௽௘‫ش‬ऄΔ
‫ףڻֲࠟޢ‬ጕছԫ‫ڻ‬Δ‫࣍شױ‬լᏁ૞ QID ‫܀‬ਢ TID ່৵ԫ‫ڻ‬࿯ᢐྤऄ Cover ‫࡙ת‬ᢐயழ‫ەאױ‬ᐞα
ΖQAH
ΰ‫ ޢ‬A ՛ழ࿯ԫ‫ڻ‬Δԫ౳ൄ‫ش‬ऱ‫ ڶ‬Q1HΔQ2HΔQ4HΔQ6Hΰԫ౳ਢ 06-12-18-24α
ΔQ8Hΰԫ౳ਢ
ΔQ12Hΰԫ౳ਢ 09-21Δ‫ڶ‬ழᄎ 12-24α
01-09-17α αΙstΰstat ‫ش‬ऄΔ੡ᜯழ࿯ᢐࢨਢጹ৺‫ش‬ᢐα
ΙIRRE
ΰirregularα
ΙPRNΰ‫ؘ‬૞ழΔᓮုࣔ‫ڇ‬չᏖයٙՀࠌ‫ش‬α
ΖPOΰper o.s.ᆖՑࣚ‫ش‬αΙIMΰࣹۜۚ୴αΙ
IVΰpush ᙩ౧ࣹ୴α
ΙIVFΰᙩ౧ᙁ෈Δຏൄ੡ለՕၦα
ΙIV dripΰຏൄ੡՛ၦዠࣹα
ΙTopiΰTopicalαΙ
OSΰؐณαΙODΰ‫׳‬ณα
ΙOUΰࠟณα
ΙsuppΰSuppository ႾᕪαΙgtt.ΰguttaΔԫዠऱრ৸αΙSub.
ΰSublingualΔۡՀαΙSCΰ‫ؼ‬Հࣹ୴ΔᥨՓଚ฾ክጠ Hypoα
ΙEnemaΰᥒᆩα
Ζ

ԲΕʳᇞᑷ᠜࿀ᕪΰAntipyretic analgesicsα
Κ!
‫ء‬ᣊᢐढ‫׌‬૞‫ֽא‬ᄘᎨᣊΔPyrine ᣊΔ‫֗א‬Ԭ㋝₏⍬ΰAcetaminophenαԿृ੡‫ז‬।ΖࠡխֽᄘᎨᣊ‫א‬
֗ Pyrine ᣊ‫ڂ‬੡‫ٵ‬ᑌࠠ‫ݼڶ‬࿇ङ‫ش܂‬Δ‫ۖڂ‬ጠ੡ NSAIDsΰNon-Steroid Antiinflammation DrugsΔॺᣊ
ࡐᔧ‫ݼ‬࿇ङᢐढαΔ‫܀‬ਢࣹრΔԬ㋝₏⍬‫ڂ‬੡լࠠ‫ݼڶ‬࿇ङ‫ش܂‬Δਚլ᥆࣍ NSAIDsΜֽᄘᎨᣊᢐढ‫ܛ‬
Aspirin ᣊᢐढΖ๺‫ڍ‬൛ृൄൄ‫ܫ‬व᠔ᥨԳ୉ࠡኙֺ࣍ࣥᣊᢐढΰPyrineαመඕΔլመࠃኔՂΔAspirin
ࠀॺਢֺࣥᣊᢐढΔ‫׽‬ਢ‫ڶ‬๺‫ڍ‬᠔ᥨԳ୉ΰ֠ࠡਢለ‫ڣ‬᎘ऱ᠔ஃαࠀլवሐࠟृਢլ‫ٵ‬ᢐढΖ‫ڻڂ‬ሖࠩ
ຍଡൣ‫ݮ‬ழΔ‫ڂ‬ᇠፖఐ൛ᇡาᇬംΔ‫ܶץ‬ਢ‫ڶܡ‬ᒔ֊ऱᢐढመඕ‫ټ‬໢Λ‫֗א‬࿇‫س‬ኙֺࣥߓᢐढመඕਢ‫ڇ‬
۶ழΛ‫ڂ‬੡ֺࣥߓᢐढᄎທ‫ګ‬ᣤૹऱ Hematologic disorders and MalignancyΔ‫ࠃڼڂ‬ኔՂ‫اڇ‬ഏԮԼ
‫זڣ‬բᆖດዬೖ‫ش‬Δ‫ף‬ՂֽᄘᎨᣊᢐढ᛭யᏅࠋΔ‫່ڼڂ‬२ᚨᇠբᆖ޲‫ڶ‬᠔ஃ‫ֺࣥشࠌڇ‬ᣊᢐढԱΖࢬ
‫ີءא‬ᆏ‫׌‬૞ಾኙ NSAIDs and Acetaminophen ࠐ೚տฯΖࣹრΚ‫ٺ࣍ط‬ᢐढឈྥ‫ڇ‬ᡖ؋࿛్ՕીՂ‫ڇ‬
‫֮ٺ‬᣸խ݁ઌ஁լ‫ڍ‬Δ‫܀‬ਢૉ‫ڶ‬ᡖ؋ഡՖᏁ‫ދ‬ᢐΔ‫ڇ‬ഡขઝ௽ܑᏁᘬᇬመᖂ९ࡪࢨਢ NSP ᖂࡪΰ‫ڕ‬
Indomethacin ਢ᥆࣍ Category BΔ‫܀‬ਢ‫ڂ‬੡ᄎᖄી‫ֽ֟྇ے‬Δࢬ‫א‬սႊࣹრα

1. NSAIDsΚ‫ ࠫލ‬Prostaglandin ऱ‫ۖګس‬ᖄી‫ݼ‬࿇ङ‫ش܂‬ΰ‫ٵ‬ழՈᐙ᥼ۨ՛ࣨ‫פ‬౨αΙ᠜࿀֗ᇞᑷ‫܂‬

‫ش‬ঞਢ‫ڂ‬੡‫ࠫލ‬Հီ‫׋‬ტᑷక࿀խᑐ
ᢐढ‫ټ‬ ೸঴‫ټ‬ΰ९ࢊൄ‫ृش‬α ១૪֗ࠌ‫ش‬ழᖲ

1. ່ഗ‫ء‬ীऱֽᄘᎨ፹ᕪΙ
2. ࣹრመඕ᧯ᔆΔԫ౳੡ IdiosyncraticΔٍ‫ܛ‬
௽ฆ᧯ᔆΔመඕऱ࿇‫س‬ፖᕪၦྤᣂΔۖਢଡ
Գ᧯ᔆऱംᠲΙ
3. ‫࣍ط‬ኙ࣍ᇞᑷ᠜࿀ய࣠բᆖ‫ࠋޓڶ‬ऱᄅ
AspirinΔ։੡Κ
ᢐΔ‫ ڼڂ‬Aspirin բᆖৰ֟‫࣍ش‬໢ొᇞᑷ᠜
1Η ASAΰ500mg/tabα
࿀Ι
Aspirin
4. ‫׌‬૞‫܂‬੡‫ۨݼ‬՛ࣨᕩႃᕪΔ‫࣋ڕ‬ᆜগण೯౧
(Acetylsalicylic 2Η Tapal / Bokey
֭ਮ৵Εᆰۨጥ௕Ⴞ৵ቃ߻٦௕Ⴞ࿛Ι
acid) ΰ100mg/capα
5. ԫ౳฾ክ‫ף‬ષᢐࠌ‫ش‬Δ‫ࠡڂ‬પᄎທ‫ ګ‬25%൛
ृ‫נ‬෼ષᑭጌ੷۟ਢ‫ۨנ‬ऱൣउΙឈྥ‫ڶ‬ઔ
ԫ౳݁੡ QD ࿯ղΖ
ߒਐ‫נ‬ԫឍ NSAID ૞ჸ಻પ 18 ឍࠫᎨᕪֱ
‫֟྇ڶ‬ᑭጌข‫س‬ᖲ෷Δ੷۟‫ڶ‬໴‫ܫ‬ਐ‫נ‬ჸ಻
ࠫᎨᕪࠌ‫࣐ޓش‬ᖄીᑭጌ࿇‫س‬Δ‫܀‬ਢ‫ڂ‬੡‫ݼ‬
ᑭጌᢐढ೜অᐉுᣤ௑Δࢬ‫ݺא‬ଚᝫਢ฾ክ
ჸ಻ԫ౳ࠫᎨᕪ࿯ᢐΖ

Оࢃ෮ᙝ! 3
 1. ೫‫ࣹ֗אش܂‬რࠃႈ‫ ٵ‬AspirinΙ
Inteban
2. ‫ַڇ‬࿀ΕᇞᑷΕ‫ݼ֗א‬࿇ङֱ૿݁᥆ՂଊΙ
ΰ25mg POα
3. ‫ڶࠠ࣍ط‬௕ᕪ‫ڤݮ‬Δ‫ڼڂ‬ኙ࣍ NPOΰᆃଇα
Indomethacin ΰ50mg suppα
൛ृ‫ךױ‬։‫شܓ‬Ι
ԫ౳ Q6H ࿯ղΔီൣ‫ۖݮ‬
4. ኙ࣍ቄࡐࢤᆮᓂङ࿛࿇ङࢬທ‫ګ‬ऱక࿀Δ
ࡳ
cellulitisΔ‫֗א‬ᣂᆏङΔ๬৵ַ࿀݁‫ڶ‬ய
Motrin(400mg)BID~Q6H
1. ೫‫ࣹ֗אش܂‬რࠃႈ‫ ٵ‬AspirinΙ
Ibuprofen syrup
2. ַ࿀ய࣠ለಯᗈய࣠‫ړ‬ΰ‫܀‬ਢ‫ڇ‬՛৘՗ঞਢ
ΰ20mg/ccα
Ibuprofen ൎԺऱಯᗈᢐα Ι
‫࣍ش‬՛৘Δ១໢ጩ੡‫ڻޢ‬
3. ྎ៽฾ክ‫࣍ش‬យᓂ࠹ჾທ‫ګ‬ऱక࿀Δ‫ڕ‬
࿯ֆְᑇऱԫ‫ת‬Δ‫ ڕ‬8 ֆ
TonsillitisΕPharyngitisΕLaryngitis ࿛Ι
ְ࿯ 4ccΔQ6H ࿯ղ
1. ೫‫ࣹ֗אش܂‬რࠃႈ‫ ٵ‬AspirinΙ
Ponsta
Mefenamic acid 2. ‫׌‬૞੡ַ࿀‫ش܂‬Δ௽ܑ‫࣍ش‬ᣂᆏక࿀Εۜۚ
250mg/capΔTID~QID
క࿀Ε࿀ଅ৺ࢤ࿇‫֫֗א܂‬๬৵ַ࿀Ι

Clinoril ‫׌‬૞‫࣍ش‬ᣂᆏక࿀Εۜۚక࿀Ε࿀ଅ৺ࢤ࿇‫א܂‬
Sulindac
200mg/tabΔBID ֗֫๬৵ַ࿀Ι

1. ‫ ڇ‬NSAIDs խ‫ױ‬ጩਢ່ൎऱಯᗈᢐΙַ࿀ய
Naposinΰ250mg/tabα
࣠ለլࣔ᧩Ι
Naptonΰ750mg/tabα
Naproxen 2. ௽ ௘ ࠌ ‫ ش‬ழ ᖲ Κ Tumor fever Ζ ๺ ‫ڶ ڍ‬
Space-occupying tumor ऱ൛ृᄎ‫ڶ‬ၜཚࢤ
ԫ౳੡250mg QD~Q6H
࿇೏ᗈ෼ွΔNaproxen ኙຍጟൣ‫ڶ່ݮ‬யΙ
1. ԫ౳‫ګ‬Գઝ֟‫ش‬Δ‫׌‬૞੡՛৘՗࿇ᗈ 40 ৫
KΚCataflamΰ25mg/tabα
‫א‬Ղಯᗈ‫ش‬Ι
Diclofenac NaΚVoltaren / Voren
2. Voren-G Gel 40g/tube ੡‫ݝ‬ຝჁࢳ௣ङַ
12.5mg/suppΔ75mg/tab
࿀ᢐढΙ
1. ഄԫ‫୴ࣹۚۜאױ‬Εᙩ౧ࣹ୴ࢨਢዠࣹऱ
NSAIDsΜΜ
Keto 2. ኙ࣍৺ࢤ࿀ଅऱᇞᑷ᠜࿀੡ଈᙇΜΜ
Ketorolac
ಾᕪΔ30mg/ml/amp 3. ‫ء‬ೃ৺်ൄ‫ش‬Δ‫܀‬ਢ‫ڇ‬փઝఐࢪࠀॺൄໂ
ᢐΔ‫ڶ‬ழ૞Ꮖᑇଡ՛ழΙ
4. ؆ઝ๬৵ַ࿀ൄ‫ش‬ΜΜ

1. ᙇᖗࢤ‫ ࠫލ‬Cox-2Δ‫ڶۖڂ‬ለ֟ऱۨ՛ࣨ‫ލ‬
ࠫ‫֗א‬ᑭጌข‫س‬෷Ι‫ݙॺࠀ܀‬٤റԫ‫ࠫލ‬
Mobic Cox-2Ι
Meloxicam
7.5mg/tab 2. ‫׌‬૞‫࣍ش‬ᣊଅᛘࢤᣂᆏङ‫֗א‬ಯ֏ࢤᣂᆏ
ङհַ࿀ΰᓮ೶ᔹ೜অ࿯‫ב‬๵ࡳα
3. ‫ڂ‬੡ࠀॺ௽ฆ‫ ࠫލ‬Cox-2Δ‫ڇ‬९ࢊ֟‫ش‬Ι

1. റԫࢤ‫ ࠫލ‬Cox-2Δਚ޲‫ۨڶ‬՛ࣨ‫֗אࠫލ‬
௣֏ሐᑭጌऱጊᐞΙ
2. ‫࣍ش‬ᣊଅᛘࢤᣂᆏङ‫֗א‬ಯ֏ࢤᣂᆏङհ
Celebrex
Celecoxib ַ࿀ΰᓮ೶ᔹ೜অ࿯‫ב‬๵ࡳΔԫ౳ 65 ᄣ‫א‬
200mg/capΔQD
ՂհᣊଅᛘࢤΕಯ֏ࢤᣂᆏङհ൛ृΔࢨਢ
ኙ࣍ࠡ‫ ה‬NSAIDs མᆖ‫נ‬෼መᆩષሐ‫ۨנ‬Δ
ࢨਢ෼۩ࠠ‫ڶ‬௣֏ሐᑭጌृ൓ࠌ‫ش‬α

1. ൄ‫ش‬ऱ NSAIDs ؆‫ش‬ᕪΖ

Rheumon gel
Etofenamate 2. ኙ࣍‫ݝ‬ຝ࿇ङ֧ದհక࿀ΰ‫ڕ‬ᣂᆏङαΔࢨ
5%Δ40g/tube
ਢۜۚᎨ࿀Δ݁‫ڶ‬᛭யΙ

Оࢃ෮ᙝ! 4
2. Ԭ㋝₏⍬ᣊΚ‫ؾ‬ছ‫ ڶ׽‬Acetaminophen ൄ‫ش‬Ζ‫׌‬૞‫ڇش܂‬Հီ‫׋‬ტᑷక࿀խᑐΔਚ։ᣊ੡
Non-narcotic antipyretic analgesics
Scanol/Panadol 1. ‫ء‬঴‫ڜ‬٤ࢤ೏Δ੡ Primary care ऱ‫ړ‬ᚥ֫Ι
500mgΔ່‫אױڍ‬࿯ࠩ 2# 2. ኙ࣍᎘৫࿇ᗈࢨਢॺ࿇ङࢤక࿀ࠠ‫ړߜڶ‬
Q6H~Q4H Δ ٍ ‫ܛ‬ ऱ‫ࠫލ‬ய࣠Δ௽ܑਢᙰ࿀ऱए᛭Δ੷ֺ۟ԫ
Acetaminophen
4mg~6mg/dayΔ‫܀‬ਢ֮᣸Ղ ࠄ຾ᔨַ࿀ᕪࠐ൓‫ړ‬Ι
৬ᤜԫ֚լ၌መ3.2mgΙ၌መ 3. ‫ࢤ੅ߗڶ‬Δਚᕣၦ൳ࠫ‫ڜڇ‬٤ᕪၦփΔԫ౳
6mg ੡ી੅ᕪၦ ຟ޲‫ڶ‬ംᠲΙ֎ࠓࣚ಺壄‫ش‬঴Ι

3. ࠡ‫ה‬ፖᇞᑷ᠜࿀ઌᣂհᢐढΚ‫׌‬૞੡࿀ଅए᛭ᢐढ

1. ৺ࢤ࿀ଅհַ࿀‫֗א‬ቃ߻৺ࢤ࿀ଅऱ࿇‫܂‬Ι
2. ޲‫ݼڶ‬࿇ङய࣠Δኙԫ౳ᣂᆏङٍྤᚥ‫ܗ‬Ι
0.5mt/tabΔԫ౳ QD to
3. ൄߠᆩષሐ೫‫ش܂‬Δ‫ߚڕ‬՗࿀Εࢮߚ՗Ι
Colchicine BID ࠌ‫ش‬Δᓮ֎၌ၦΔঅ
4. ؆ઝ᠔ஃ່໛ᦟ QID ࠌ‫ش‬Δࠩࢮߚ՗ழೖ
ᢞࢮߚ՗ΜΜ
ᢐΔᎅຍᑌ՗༉‫ڶ‬ए᛭ய࣠Δᓮ‫ٵ‬ᖂՏᆄլ
૞ᖂΜΜ

1. ଺‫܂ࠐشء‬੡‫ݼ‬ᛮᢐढΔլ՛֨๯࿇෼‫૾ڶ‬
‫ݟ‬Ꭸ‫פ‬౨Ι
2. ৺ࢤ࿀ଅհ৺ࢤཚ֎࿯ղΔ୲࣐ᖄીక࿀࿇
ᗈ‫ף‬ᏣΙ
Zyloric 3. ৺ࢤཚመ৵࿯ղΔ‫܂‬੡૾‫ݟ‬Ꭸए᛭Ι
Allopurinol
100mg/tab QD 4. ኙ࣍௽ࡳᆭᒆ‫ڇ‬࿯ղ֏ᖂए᛭ছ‫ދ‬ፖΰ‫ڕ‬
lymphomaΕleukemiaΕࢨਢኙ֏ᖂए᛭‫ڶ‬
೏ტ৫հᛮ఑α Δቃ߻ Tumorlysis syndrome
ΰ‫ڂ‬ᆭᒆՕၦధᡏΔᖄીՕၦுᎨ૾ᇞΔข
‫ س‬Hyperuricemiaα
Benemid
Probenecid আၞ‫ݟ‬ᎨඈइΔ‫܀‬ਢ‫ڇ‬९ࢊ֟‫ش‬
500mg/tab
৺ࢤ࿀ଅ๠ᆜհ summeryΚ
࿯ղ Colchicine + NSAIDsΰInteban or Ketorolacα
Δ‫ࠫލ‬క࿀࿇ᗈ఑णÆ৺ࢤཚመ৵ղ‫א‬堬ଇ൳ࠫ‫א‬
֗࿯ղ Allopurinol ૾‫ݟ‬ᎨΔࠀ‫ױ‬࿯ղ Colchicine ቃ߻Հԫ‫ڻ‬࿀ଅ৺ࢤ࿇‫܂‬Ζ

ԿΕʳષ ᢐ ΰ ࠫ Ꭸ ᕪ ΰ Antacids αΕ ષ ᆩ ᇞ ࿂ ᕪ ΰ Spasmolytics αΕ ֗ ‫ ݼ‬ᑭ ጌ ᢐ

ΰAnti-ulcerαΚ
1. Antacids and SpasmolyticsΚ
Ϩʳᆩષሐ‫ش‬ᢐ‫܂‬੡ࠫᎨᕪृΔ່ൄߠ੡ܶᔱΰ࣐ঁఽαΕܶ᝴ΰຌঁ‫ش܂‬α
Ε‫ृࠟ֗א‬ऱ෗‫ٽ‬፹ᕪΖ
ࠡ‫ܶה‬ၩࢨਢၪऱࠫᎨᕪ‫࣐୲࣍ط‬ທ‫᧯ګ‬փᠦ՗լؓᘝΔ‫ش֟ڼڂ‬Ζ
Ϩʳષᆩᇞ࿂ᕪຏൄ੡ࠫᎨᕪ‫ګ‬։ΰຏൄ੡ᔱᨖα‫ף‬Ղ೫ٌტ壀ᆖ‫ࠫލ‬ᕪΔ‫א‬ሒᆩᤘ೯‫ࠫލ‬ऱய࣠Ζ

ᢐढ‫ټ‬ ೸঴‫ټ‬ΰ९ࢊൄ‫ृش‬α ១૪֗ࠌ‫ش‬ழᖲ

1. ੡່ঁࡵൄ‫ش‬ऱࠫᎨᕪࠓ‫ ࠫލڶ‬Pepsin ऱ
‫ش܂‬Δਚ‫ڶ‬ഗ‫ء‬ऱ‫ݼ‬ᑭጌ‫ش܂‬Ι
Gelusil NacidΰQIDα
2. ੡ܶ᝴ᔱ෗‫ٽ‬ढΔਚլᐙ᥼ᜈঁ࿏৫Ι
3. ൄፖ NSAIDs ‫ދࠓٽ‬ᢐΙ

1. ܶᔱࠫᎨᕪΔ‫ڂ‬੡੡ᓤֱᢐΔܶ‫ڶ‬ᑭጌ័‫ٽ‬
Aldioxaΰ९ࢊ֟‫ش‬ຍଡ
PeichiaΰTID to QIDα ᕪΔਚኙ࣍ᑭጌऱቃ߻֗অᥨֺ Nacid ‫ړ‬Ι
‫ڗټ‬α
2. ྎ៽ֺለ໛ᦟ‫ ش‬Peichia ჸ಻ NSAIDs ࠌ‫ش‬Ι

Оࢃ෮ᙝ! 5
 1. ࢬ‫ڶ‬ષᢐխ່ঁࡵऱΙ
2. ໢ొࠠ‫ࠫڶ‬Ꭸய࣠ۖբΙ
Magnesium Oxide 250mg/tab Δ ‫ ܂‬੡ ࠫ Ꭸ
3. ຌঁய࣠լᙑΔਚ‫شࠌڶ࣠ڕ‬ષᢐऱ‫ؘ‬ႊࢤ
ΰMgOα ᕪΔ1# QID
֗ຌঁΔྎ៽ᄎᙇᖗ MgOΙ
4. ࣹრΔESRD ൛ृլࡵࠌ‫ش‬Δᄎ፝ᗨ‫᧯ڇ‬փΙ

1. ੡ᓤֱข঴Δܶᔱᨖ֗೫ٌტ壀ᆖ‫ࠫލ‬ᕪΙ
2. ૉ൛ृࢮߚ՗Δ‫ءشױ‬ข঴Δ‫ڶ‬࿏ঁய࣠Ι
3. ኙ࣍‫ڂ‬੡ᆩષᤘ೯መຒᖄીհߚ՗క࿀ΰ‫ڕ‬
AGE ࿛ Δ ൛ ृ ຏ ൄ ࣄ ৼ Abdominal
FinaΰTID to QIDα
Δ‫ױ‬Ցࣚ‫ڼ‬ᢐ Maintain ய࣠
cramping painα
ΰ৺ࢤཚ‫ شױ‬Buscopan ए᛭Δ੡ԫؓᄶۜ
‫ࠫލ‬ᕪα
4. ֟‫ڶ‬೫ٌტ壀ᆖ‫ࠫލ‬ᕪհ٤ߪࢤ೫‫ش܂‬Ι

1. ܶ᝴ᔱ෗‫ٽ‬ढΔࠠ‫ڶ‬অᥨષᕻΕַ࿀Ε‫֗א‬
‫ࠫލ‬ષᎨ։ࣼऱ‫ش܂‬Ι
Alumigel/AMG
Aluminum magnesia 2. ೜অ๵ࡳ‫ؘ‬ႊ‫ڶ‬ષᢴ໴‫ױֱܫ‬๠ֱΔ‫܀‬ਢ‫ء‬
ષࠂΔ10~20 mL QID
ข঴‫אױ‬࿍ཚྤષᢴ۸ᢞ࿯ղΙ
3. ‫ࠄڶ‬Գլფ໘Ι

Ulcerin ९ࢊբᆖৰ֟‫ش‬ ፖ Fina ᣊ‫ۿ‬

1. ੡լᏁષᢴ໴‫ױܛܫ‬࿯ղऱષᢐխ່ࠋऱ
ԫଡΰપքցԫឍα
2. ܶᤏᎨΰAlginic acidα‫֗א‬᝴ᨖΔ࠿ᣥ৵ࣚ
Topaal
Topaal ՀΔ‫ױ‬অᥨષᕻ‫֗א‬ଇሐΔቃ߻ᑭጌΙ
TID to QIDΔAC use
3. ‫ࠡ࣍ط‬অᥨଇሐ‫֗א‬ષᕻΔ߻ַષᎨಭੌऱ
௽ࢤΔ‫ؾ‬ছ Topaal ੡փઝए᛭ષଇሐಭੌ
ΰGERDαऱรԫᒵ‫ش‬ᢐ
2. ‫ݼ‬ᑭጌ‫ش‬ᢐΚຍᇙࢬᘯऱ‫ݼ‬ᑭጌᢐढΔ‫ܑ࣍ڶ‬հছ༼መऱષᢐΖԫࠐ᛭யᄕ೏ΔԫࠐᏁ૞‫ڶ‬ષᢴ໴
‫شࠌױֱܫ‬ΰ‫܀‬ਢጹ৺‫ش‬ᢐΔ‫ڕ‬ᆩષ‫ۨנ‬լ‫ૻڼڇ‬αΚ

1. ለ֟ࠌ‫ش‬Δ‫܀‬ਢய࣠լᙑΙ
Ulsanic 2. ए᛭ऱᖲࠫ੡অᥨ࠹ჾऱષᕻΔ‫ ݼ‬PepsinΙ
Sucralfate
500mg/tab 3. ‫ ڇ‬ਬ ࠄ ௽ ௘ ໱ ‫ ྤ ٽ‬ऄ ࠌ ‫ ش‬PPI ࢨ ਢ H2
blocker ழ༼ࠎ‫׼‬ԫᙇᖗΙ
1. ੡ PPIΰProton-Pump inhibitorα
Ι
2. ኙ࣍ Peptic ulcer ‫ ֗א‬GERD ݁‫ڶ‬ለ H2
Losec
blocker ‫ړޓ‬հ᛭யΙ
Omeprazole 20mg QD poΙIV/IVF 40mg
3. ੡ H. pyloriΰ৩॰ᝅඝථပαpositive հ
Q12H~Q8H
peptic ulcer Կ‫ٽ‬ԫ᛭ऄऱࠡխԫႈᢐढΰᇡ
઎ Washington manualα
1. ੡ H2 blocker agentΙ
2. ਍ᥛ‫ࠫލ‬ષᎨ։ࣼΙ
Tagamet
3. ए᛭ Peptic ulcer, GERD հᢐढΙ
Cimetidine 200mg/tab
4. ኙ࣍‫ڂ‬੡ ulcer ທ‫ګ‬ऱ৺ࢤ GI bleedingΔ੡
200mg/2ml/amp
ଈᙇᢐढΙ
5. ‫ אױ‬IV pushΙ
Ranitidine Zantac ९ࢊለ֟ࠌ‫ش‬ ‫ ٵ‬CimetidineΔ൫ለլᔞ‫ ٽ‬IV push
Famotidine GasterΰՑࣚࢨਢಾᕪα ‫ ٵ‬CimetidineΔ൫ለլᔞ‫ ٽ‬IV push

ॵုΚຝ։‫׌‬ए᠔ஃլ৬ᤜ՛৘՗‫ڶ‬᎘პષᑭጌࠓ‫ۨנ‬ழࠌ‫ ش‬PPI ࢨਢ H2-blockerΔ‫ڂ‬੡୲࣐ທ‫ګ‬ᆩ

փပመ৫ᏺ‫س‬ಭ۩ࢤᆖ‫ط‬ષᕻ႞Ցᖄી٤ߪပۨ఑ΖᅝྥΔጹ৺णउլૻ‫ڼ‬ᨠ࢚Ζ

Оࢃ෮ᙝ! 6
 ؄Εʳַ࿀ᢐַ֗࿀᎖‫ܗ‬ᢐढΰAnalgesics and other co-therapeutic drugsαΚ
Ϩʳ‫ء‬ᣊᢐढ‫׌‬૞‫ڶ‬հছ༼መऱ NSAIDsΔAcetaminophenΔ‫֗א‬ԫࠄ຾ᔨࢤᢐढΰNarcoticsα
Ζ
Ϩʳַ۟࣍࿀᎖‫ܗ‬ᢐढঞ‫אױ‬੡ԫࠄᣊࡐᔧ፹ᕪΕ೎ᙽۜᠾ‫ڥ‬ᕪΕ‫ݼ‬壄壀ᢐढΕ‫֗א‬᠜ᙩ‫ڜ‬ఠᕪΖ
ࠡխ᠜ᙩ‫ڜ‬ఠᕪ‫ݼ֗א‬壄壀ᢐढല࣍Հԫᆏᇡ૪Ζ
ᢐढ‫ټ‬ ೸঴‫ټ‬ΰ९ࢊൄ‫ृش‬α ១૪֗ࠌ‫ش‬ழᖲ
NSAIDs and
ᇡ઎รԫᆏᇞᑷ᠜࿀ᕪ
Acetaminophen
ጥࠫ‫ش‬ᢐΙ1.
‫ڇ‬९ࢊ‫׌‬૞‫࣍ش‬ᛮ‫أ‬ఐ൛հᆭᒆక࿀Δࠡ‫ה‬
2.
໱‫ٽ‬ለ֟ࠌ‫ش‬Δ௽ܑਢ֟‫࣍ش‬๬৵ַ࿀ΰೈ
Morphine
Ա ‫ ؾ‬ছ ԫ ࠄ PCA-Personal Control
10mg Δ ಾ ᕪ ࢨ ਢ ᙍ ᕪ
Analgesics ఐ൛۞൳‫ַڤ‬࿀αΙ
Morphine HCl Q6H/QID ࠩ 2# Q4H
3. ൎ௺ऱࡅ‫ࠫލܮ‬Εᆩષᤘ೯‫ࠫލ‬Δ‫شࠌڼڂ‬
Morphine Sulfateΰ९
ழ ᚨ ࣹ რ ఐ ൛ ࡅ ‫ ܮ‬pattern ‫ ֗ א‬Bowel
யᕪীα MST
soundΖ‫ ࣚࠓױ‬Laxativesΰᒷើᕪαࢨਢᆩ
९ ய ᕪ ী Δ 30mg/tab Δ
ષᤘ೯আၞᕪ߻ַ Paralysis ileusΙ‫ޢ‬։ᤪ
Q12H~Q8H լ‫ױ‬ᗣృ
ࡅ‫ܮ‬՛࣍ԶՀࢨਢ‫נ‬෼ Pin-point pupilΔᄕ
‫ױڶ‬౨।‫ق‬խ੅Ι‫ַ࣍ش‬࿀ለ֟‫נ‬෼
Addiction ൣउΙ
1. ੡ଖఄൄ‫ش‬ᢐ঴Δຏൄ‫ڇ‬؆ઝߓ່ൄࠌ‫ش‬Δ
ۖ‫ڇ‬փઝߓঞ‫ڂ‬੡ࠡ୲࣐ທ‫ ګ‬addiction ‫׊‬
ለ஁ऱַ࿀ய࣠ۖ֟‫ش‬Ι
2. ጥࠫᢐ঴Ι
3. ๬ ৵ ַ ࿀ Ε ۜ ۚ ࿇ ङ క ࿀ ΰ ‫ڕ‬
osteomyelitis)Εփ᦬࿇ङక࿀ΰ‫ ڕ‬Acute
pancreatitisΕacute hepatitis ᖄીߗ᦬ᆭՕ
ທ‫᦬ߗګ‬؆ᓂ෰‫ވ‬࿀ΰߗ᦬‫ڶ޲ߪء‬࿀ᤚ࠹
ᕴΔլᄎక࿀αΕᜬᦖङΕᜬጥङα࿛݁‫ڶ‬
௽யΔ௽ܑਢኙփ᦬࿇ङక࿀Δᕣၦլ૞ࠌ
‫ ش‬Morphine ࿛ ࠡ ‫ ה‬຾ ᔨ ַ ࿀ ᕪ Δ ‫ ڂ‬੡
Demerol
Demerol ‫ ڶ ߪ ء‬ᇞ ࿂ ᧑ ‫ ش ܂‬Δ ‫ַ ߻ א ױ‬
50mg/ml/amp
Meperidine HCl Pancreatic ductΕcyst ductΕor cholecystits
50mg/tab
ழᜬᦖ‫گޓ‬ᜍΔທ‫ګ‬ఐൣ༞֏Ζࢬ‫ڇא‬ષᆩ
Q4H~Q8H
ߗᜬփઝ੡փઝߓխለൄࠌ‫ءش‬ᢐऱઝܑ
4. ԫ ౳ ຑ ᥛ ࠌ ‫ ش‬Կ ֚ ‫ א‬Ղ Δ ᄕ ୲ ࣐ ທ ‫ګ‬
AddictionΔᓮ‫ٵ‬ᖂ೭‫ؘ‬ေ۷ఐ൛णኪࠌ‫ش‬Ι
5. ‫࣠ڕ‬ሖࠩ Addiction ൛ृΔ‫אױ‬࿯ղ Normal
saline 1ccΕor Vitamin C 1cc IM ‫֨܂‬෻֭਍
ΰᓮ֎‫္ܫ‬൛ृαΙ‫࣠ڕ‬ေ۷ս‫ַڶ‬࿀Ꮑ‫ޣ‬
‫܀‬ਢኙ Demerol addiction ृΔ‫ەאױ‬ᐞ‫ش‬
Keto ‫ף‬Ղ Ativan ࿛᠜ᙩ‫ڜ‬ఠᕪΰྎ៽໛ᦟ
ຍᑌ‫ش‬α Ι
6. ࡅ‫ࠫލܮ‬Εᆩષ‫ش܂ࠫލ‬ለ՛Δ‫܀‬ਢ‫ڶ‬๺‫ڍ‬
ԳᄎᙰᄉΖ‫ش܂‬ለ Morphine ‫ݶ‬Ζ
PCA(Personal control ੡຾ᔨઝറ᥆ַ࿀ए᛭Δԫ౳ᄎ‫ ش‬Morphine ࢨ
analgesicsα ਢࠡ‫ה‬ઌᣂַ࿀ᕪΰᇡาྎ៽լ堚ᄑα Ι
1. ַ࿀ய࣠լૉ MorphineΔ‫܀‬ઌኙՈለ‫ڜ‬٤Ι
2. ੡ጥࠫᢐ঴Ι
Codeine
Codeine phosphate 3. ྎ៽ԫ౳ᄎᙇᖗࠌ‫ ش‬CodeineΔຏൄ‫ڇ‬ΰ1α
30mg/tabΔ15mg/ml/amp
լᏁ૞ൎԺַ࿀‫܀‬ਢኙॺ຾ᔨַ࿀ᢐᕪய
࣠լࠋऱ൛ृΙΰ2αַযΖ

Оࢃ෮ᙝ! 7
 1. ጥࠫᢐ঴Ι
Tramal 2. ለ՛ऱ೫‫֗אش܂‬լᙑऱխᑐַ࿀ய࣠Δ‫ڂ‬
Tramadol
50mg/capΔ50mg/ml ‫ڼ‬ൄ‫ ࣍ش‬Outpatient ᛮ఑ַ࿀Ι
3. ಾᕪለ֟ࠌ‫ش‬Ι
1. Mcg=ugΔጥࠫ‫ش‬ᢐΙ
2. ངጩ‫֚ޢګ‬ᕪၦΚ25mcg/hr=0.6mg/day
3. ַ࿀ய࣠੡ࢬ‫ ڶ‬Narcotics խ່ࠋΔપ࿛࣍
Durogesic Morphine հ 100 ଍Ι
Fentanyl TTSΰ‫ؼ‬ᓅ၀
25mcg/hr ΰ દ ‫ ۥ‬α ֗ 4. ԫ౳Կ֚ངԫ‫ڻ‬၀ׂΙ
ׂα
50mcg/hrΰጸ‫ۥ‬α 5. ॣ‫شࠌڻ‬ழᏁપ 12 ՛ழऱছᦀழၴΙ
6. ೫‫ش܂‬՛Ι
7. ‫ڶ‬ಾᕪ๠ֱΔ੡຾ᔨઝ‫܂‬຾ᔨַ࿀‫ش‬Δԫ౳
ఐࢪլࠌ‫ش‬Ι
யᏝֺΚFentanylΚMorphineΚTramadolΚCodeine=100Κ1Κ1/5Κ1/6
ַ࿀᎖‫ܗ‬ᕪΚຍᇙտฯ‫ݝ‬ຝ຾ᔨᕪΕᣊࡐᔧΕ‫֗א‬೎ᙽۜᠾ‫ڥ‬ᕪΖ
1. ‫֨ݼ‬৳լᖞᢐढΰᇡߠ ACLS ֫‫ם‬αΙ
2. ৺်ᜓ‫ٽ‬հ‫ݝ‬ຝַ࿀ᕪΙࣹრመඕΙ
Xylocaine
3. Jelly ‫࣍شױ‬Ց࿺႞Ցַ࿀Εኙ࣋ᆜᖄ‫ݟ‬ጥ‫ڶ‬
Lidocaine HCl 1%Δ2% injectionΙ
ൎ௺క࿀ტࢨਢ‫ݟ‬ሐ႞Ցհ൛ृΕࢨਢኙ࣋
2% jelly
ᆜ NG tube ข‫س‬ᣤૹቭ‫୴֘ٷ‬հ൛ृ‫אױ‬
հ‫ז‬ཙΙ
1. ੡९ய೎ᙽۜᠾ‫ڥ‬ᕪΔլᐙ᥼‫إ‬ൄሎ೯Δ‫ױ‬
Robaxin ᒷᇞ‫ڂ‬੡ጹ്ΕৎႨࡐࡳΕࢨਢక࿀ᖄીհ
Methocarbamol
500mg/tab TID~QID ۜۚመඕტΰۜۚᎨ࿀αΙ
2. ԫ౳೫‫ߠ֟ش܂‬Ι
Dorsiflex 1. ‫ ٵ‬RobaxinΙഄ‫ش܂‬ᖲࠫฃ‫ڶ‬լ‫ٵ‬Ι
Mephenoxalone
200mg/tab TID~QID 2. ྎ៽໛ᦟ‫ش‬ຍԫឍΔ޲⅄෻‫ط‬Δᇿ‫ה‬ለᑵΖ
Baclon 1. ੡೎ᙽۜᠾ‫ڥ‬ᕪΙ
Baclofen
10mg/tab 2. ޲‫شࠌڶ‬ᆖ᧭Δ‫܀‬ਢ९ࢊԫຝ։᠔ஃᄎࠌ‫ش‬
1. ኙ࣍٤ߪࢤ‫ݼ‬࿇ङ‫ش܂‬ൎ௺Δ‫ڶڼڂ‬ൎ௺‫ݼ‬
ֽᆭ‫ش܂‬ΰ‫ڂ‬੡ङࢤ֘ᚨᖄીհֽᆭα Ι
2. ‫࣍شױڼڂ‬৺ࢤॄຝ࿇ङᖄીհኬࢤॄఐ
৺ࢤᏺ༞Ε௛໙৺ࢤᏺ༞ࢬທ‫ګ‬հۨ௜ᖺ৫
Հ૾Ε໙հൣ‫ݮ‬Ι
3. ‫࣍شױ‬౩᧮ჾ႞հ৺ࢤ Spinal shock ࢨਢᆰ
ֽ ᆭ Δ ቃ ߻ ჾ ႞ ຝ ‫ ڂ ۯ‬੡ Secondary
immune response ᖄી‫ޓ‬Օᒤ໮հჾ႞Ι
4. ‫ַڇ‬࿀ֱ૿‫ڂ࣍شױ‬ᚘ૰ᖄીհ壀ᆖక࿀
ΰຍᣊ൛ृԫ౳ᄎ‫ڶ‬ᄕ৫Ꭸ຾ऱլᔞტαΙ
Steroid
5. ‫ ࣍شױ‬Hormone replacement therapyΔ‫ش‬
࣍࠷‫ ז‬Adrenal gland insufficiency ᖄી‫ؼ‬
ᔆᣊࡐᔧ։ࣼլ٤Ι
6. ࣹრ೫‫ش܂‬Δ‫ڶ‬ၪֽዩఎΔᖄી٤ߪֽᆭΕ
ኒ‫ݟ‬Εሧመ‫܅‬Εsecondary adrenal gland
insufficiency ࿛Ι
7. ૉࠌ‫ش‬၌መԫࡌΔᚨᒷኬೖᢐΰTappingα Δ
ԫ౳੡ছࠟၜೖᢐԫ‫ת‬Δհ৵٦ೖᢐԫ‫ת‬Δ
թ‫ױ‬ೖᢐΙ
8. ࠌ‫ش‬ழԫࡳ૞ᒔࡳ޲‫ ڶ‬Infection signΜΜ
௽ࢤΚ‫ݶش܂‬ຒΔ‫࣍ش‬৺ࢤ๛ዿ፞࠷‫ז‬᛭ऄΔ৺
Hydrocortisone Solu-Cortef
ࢤ௛໙ΕCOPD with acute exacerbationΕSpinal
sodium succinate 100mg/2ml/vial
shockΰॺรԫᒵα࿛ΙயᏝለ஁Ζ

Оࢃ෮ᙝ! 8
 Solu-Medrol ௽ࢤΚயᏝለൎΔ‫߰ش܂‬ຒΔທ‫ ګ‬secondary
40mg/vial adrenal gland insufficiency հᖲᄎለ՛Ζ෼‫ڶڇ‬
Methylprednisolone
500mg/vial ຝ։౥࿺ઝ᠔ஃբᆖ৬ᤜኙ࣍ COPD ൛ृᚨร
sodium succinate
Metisone ԫᒵආ‫ڼ‬ᢐۖॺ Solu-cortefΖኙ࣍ Spinal shock
4mg/tab ੡รԫᒵ‫ش‬ᢐΖ
Dexamethasone Dexanΰ0.5mg/tabα ௽ࢤΚயᏝ່ൎΔ‫ش܂‬ለᒷኬΖ೫‫່֟ش܂‬Ζ‫ش‬
sodium phosphate DexaltinΰointΔ5g/tubeα ࣍Ꮑ૞९ཚࠌ‫ ش‬Steroid ऱ൛ृΖ

ֺለΚ೫‫ش܂‬ΚSolu-cortef > Solu-Medrol > Dexan

யᏝΚ Solu-cortef < Solu-Medrol < Dexanΰ‫אױ‬ൕ‫ה‬ଚ‫ޢ‬ԫ֭հᕪၦ൓वΔ‫ٵ‬ᑌயᏝΔࢬᏁ
հᕪၦֺ=100Κ40Κ5Δٍ‫ܛ‬யᏝֺ੡ Solu-cortefΚSolu-MedrolΚDexan પ੡ 1Κ3Κ20α
նΕʳ᠜ᙩ‫ڜ‬ఠᢐΕ‫ݼ‬壄壀ఐᢐढ‫᧼ݼ֗א‬わᢐढ
μSedativesΕHypnotics ΕNeurolepticΰanti-psychoticα drugsΕand Antiepileptic drugsν
Κ
‫׌‬૞‫ א‬Benzodiazepine ᣊ੡‫ז‬।Ζࠡ‫ה‬ቝ‫ิݼ‬៣₏‫ڶڂ‬Ⴐጕ೫‫ش܂‬ΔՈ‫ڼ࣍شױ‬Ζٍԫࠄ‫ݼ‬壄壀ఐᢐ
‫᧼ݼ֗א‬わᢐढኙ࣍‫ڜ‬ఠՈ‫ڶ‬᛭யΔਚԫࠓտฯΖ

1. BenzodiazepineΚ݁۟֟੡ร؄్ጥࠫᢐΰIntern լ‫ױ‬ၲ‫م‬รԿДรԫ్ጥࠫᢐα‫ີֱڶ‬༉‫אױ‬

ᢐढ‫ټ‬ ೸঴‫ټ‬ΰ९ࢊൄ‫ृش‬α ១૪֗ࠌ‫ش‬ழᖲ

1. ഗ‫ء‬ী benzodiazepineΙ࿍யᕪীΙ
2. ‫ࠡڂ‬᠜ᙩ‫ڜ‬ఠய‫ش‬၌ൎΔ‫܀‬ਢለ੡࿍
யΔਚ֟‫ڜ࣍ش‬ఠ‫ش܂‬Ι
3. ᜯ‫׌ݩ‬૞‫ ࣍ش‬Delirium ‫ ֗א‬Seizure
Valium ऱխַΰ‫܀‬լࠠ᛭யΔ‫׽‬ਢխַ
Diazepam
oral or IV or IM Delirium ‫ ֗א‬Seizure ऱၞ۩α
Ι
4. ࢬ‫ ڶ‬Benzodiazepine ᣊᢐढ݁Ꮑᔾߗ
᦬‫ז‬᝔Δਚߗ‫פ‬౨؈ᓳृ୲࣐ທ‫ګ‬೫
‫ףش܂‬Ꮳΰࡅ‫ࠫލܮ‬Ε९ጕլದΕࢨ
ਢ‫ۨ܅‬ᚘα Δᚨ‫ࣹڍ‬რΔᏁᓳᖞᕪၦΙ
1. யᏝ೏Δ໢ԫᕪၦ֟Δ‫ྡྷݼ‬ᐞ֗᠜ᙩ
‫ش܂‬Լ։᧩ထথ޲‫ڶ‬ৰൎ‫ڜ‬ఠ‫ش܂‬Ι
Erispan
2. ࿍யীΙ‫ؾ‬ছᜯ‫࣍شݩ‬ጹ്‫ྡྷ֗א‬ᐞ
Fludiazepam 0.25mg/tab PO
ທ‫ګ‬ऱۜۚጹᜒక࿀ΰ‫܂‬੡ۜۚᠾ‫ڥ‬
BID~TID
ᕪα‫ַ֗א‬যᕪΰ‫ڂ‬੡‫܅૾אױ‬যቬ
ऱۜۚ‫פ܂‬Δਚ‫᧩ڶ‬ထ᛭யΖ

1. ່ ൄ ‫ ش‬ऱ ‫ ڜ‬ఠ ᢐ Ι ੡ ࿍ ய ী
BenzodiazepineΙ
2. ९ཚࠌ‫࣐୲ش‬ທ‫ګ‬ᢐய૾‫܅‬Δ‫܀‬լ࣐
‫ᦥګ‬Ι
Ativan 3. ‫ אױ‬TID ࣚ‫ش‬Δ‫܂‬੡‫ྡྷݼ‬ᐞᕪΙ
Lorazepam
1mg/tabΔ2mg//ml/amp 4. ࣚ‫ش‬৵ᓮլ૞႖ၒΔᔔ‫ݩ‬Ղ‫܍א‬ಮ؈Ι
5. ԫ౳‫܂‬੡ጕఠᎈᖄཚ‫נ‬෼ംᠲऱ൛
ृΔய࣠ለ‫ړ‬ΰ‫ܛ‬լ࣐Եጕृα Δ‫܀‬ਢ
୲࣐խຜᤚᙌऱ൛ृய࣠ለ஁ΰ‫ڂ‬੡
ࠡ੡࿍யীαΙ

1. ࿍யীΔ੡รԿ్ጥࠫᢐΙ
Halcion
Triazolam 2. ኙ࣍ቄࡐࢤ؈ఠΕྡྷᐞΔ݁‫ڶ‬᛭யΙ
0.25mg/tab
3. ᥆࣍ለ৵ᒵᢐढΖ
1. խ९யীΔ၌ൎய‫ڜ‬ఠᕪΰࠉᖕ壄壀
Eurodin
Estazolam ઝ᠔ஃᘣߪᆖ᧭αΙ
2mg/tab
2. ৵ᒵ‫ش‬ᢐΔԫ౳੡壄壀റઝ᠔ஃ๠ֱΖ
Оࢃ෮ᙝ! 9
 1. լ᥆࣍ Benzodiazepine ᢐढΜ
2. ੡ Imidazopyridine ᢐढΔ౨‫ڇش܂‬
omega 1 ᙇᖗ‫ࠫލ‬Δਚ᥆࣍ၜᢰࢤ‫ڜ‬
ఠᕪΔྤྡྷᐞࢨਢ᠜ᙩ‫ش܂‬Ι
Stilnox
Zolpidem hemitartrate 3. Ոਢ່ൄ‫ش‬հ‫ڜ‬ఠᢐΜΜ‫ڂ‬੡ྤխᑐ
10mg/tab
ࢤ‫ش܂ࠫލ‬Δਚլᄎ‫ڶ‬ጕᙌ৵ᙰᄉհ
ൣउΙՈ޲‫ݹڶ‬ឰΕࠉᘸࢤऱംᠲΙ
4. ኙ࣍୲࣐խຜᤚᙌ൛ृ‫ڶ‬௽ܑ᛭யΙ
5. ࣹრࣚ‫ش‬৵ᓮՂ‫ݩ‬Δլ૞႖ၒΜ
1. ၌࿍ய BenzodiazapineΙ
2. ֟‫࣍ش‬ԫ౳ఐ൛Δ‫׌‬૞ࠌ‫ش‬ழᖲ੡༺
Dormicum ጥছᎈᖄጕఠΕ༺ጥ৵ࢨࠡ‫ה‬णउհ
Midazolam
5mg/ml/amp ᤥ೯‫ࠫލ‬Εࢨਢࣖಮ൛ृլ۞‫׌‬੒೯
ᖄીۨᚘՂ֒Ε‫ૹ֗א‬఑‫ף‬ᥨࢬᏁΕ
Delirium ࿛࿛Ζ
1. ࿍யী Benzodiazepine ᣊᢐढΙ
2. ‫ٺ‬ႈ‫݁ش܂‬᥆ൎ஖Ι
3. ԫ౳‫ྡྷݼ࣍ش‬ᐞ֗ጹ്ࠌ‫ش‬Ι‫ڜ࣍ش‬
Xanax
Alprazolam ఠᢐ‫ڶ‬ழᄎࠓࣚࠡ‫ה‬ᢐढΙ
0.5mg/tab
4. լ৬ᤜ९ཚࠌ‫ش‬Δ‫ ڶ‬Addiction ऱ‫ױ‬౨
ΰ൛ृᄎᎅԫࡳ૞‫پ‬ԫឍ៴࿫‫ۥ‬ᢐ
ՄΖ‫׼‬ΔAtivan ੡ለ෉៴‫ۥ‬αΙ

2. ‫ิݼ‬៣₏ΚAnti-histamineΖ
Ϩʳ‫ء‬ᣊᢐ঴݁౨‫ڶ‬ய‫ ࠫލ‬HistamineΔᖄી‫ݼ‬መඕ‫ش܂‬ΰ‫ڕ‬ᢐढΕଇढመඕ‫א‬ી UrticariaΕ࿇᣺
࿛఑णα Ζ
Ϩʳ৸ጕ᠜ᙩ੡ࠡ೫‫ش܂‬Δ‫ڜ܂࣍شױۖڂ‬ఠᕪΖ
ϨʳDiphenhydramine ੡ለ‫ڰײ‬հ‫ิݼ‬៣₏ᢐढΔ‫ڶ޲ڼڂ‬௽ࡳ‫ش‬ຜΔᏁ૞‫ิݼ‬៣₏ऱൣ‫אױ݁ݮ‬
ࠌ‫ش‬Δഄ௽ࡳ᛭யլૉᄅԫ‫ז‬ᢐढΔۖ‫׊‬৸ጕ‫່ش܂‬ൎΰ‫ڂ‬੡Ⴐጕ੡೫‫ش܂‬Δᄅᢐ݁๻ऄ‫װ‬ೈα Δ
ਚ‫ڜ࣍ش‬ఠᢐ‫ؾ‬ছ‫ شڶ׽‬DiphenhydramineΖࠡ‫ิݼה‬៣₏ᢐढհ৵‫ີ᥸׼‬ᆏտฯΖ
1. ່ൄ‫ش‬հ‫ิݼ‬៣₏Ι
2. ೈԱԫ౳መඕΕ᣺ఖΕ‫ؚ‬ᏴᚖΕੌᏗ
ֽհ؆Δኙ࣍ Motion sicknessΰ೯ᄉ
఑αՈ‫ڶ‬ᚥ‫ڦ‬Ζ೯ᄉ఑੡ࡌᢰࢤ
VertigoΔএ‫ڂ‬੡ؓᘝტ࠹ᕴհംᠲທ
‫ګ‬Δ‫ิݼشױ‬៣₏࿯ղ‫ޏ‬࿳ΔVena ੡
৺ࢤ఑णհᒷᇞழࠌ‫ش‬ΰಾᕪα ΔՑࣚ
ঞ֟‫ڼ࣍ش‬ΰ‫הࠡڶڂ‬റຂᢐढα Ι
3. ‫ྡྷݼ܂࣍شױ‬ᐞΕ᠜ᙩᕪΰՑࣚα Ι
4. ኙ࣍ Meniere’s diseaseΰම‫؍‬ዿּ
Vena
఑Δ‫ ڶ‬VertigoΔfluctuating hearing loss
30mg/ml/amp
and tinnitus հ Triadα
Δ‫܂ױ‬੡৺ࢤཚ
Diphenhydramine HCl
ᒷᇞհଈᙇᢐढΰ‫ٵ‬ᑌ੡ Peripheral
Bena/Benadryl
vertigoαΰಾᕪα Ι
50mg/tab
5. ‫ڜ࣍ش‬ఠᢐΰຏൄ‫ش‬ಾᕪα Δԫ౳լᏁ
௽ܑ᥽ᐞߗ࿽‫פ‬౨Ζ޲‫ڶ‬ൎ௺‫ڜ‬ఠய
‫ش‬Δ‫׽‬ਢ‫شܓ‬Ⴐጕհ೫‫ش܂‬᎖‫ܗ‬ఐ൛
ԵఠΔࢬ‫شࠌא‬৵սᏁፂ਍൛ृᔞᅝ
ऱጕఠᛩቼΖ‫ڼڂ‬ေ۷൛ृ؈ఠण
ኪΔૉॺৰᣤૹࠀ‫אױ‬൷࠹ಾᕪΔঞ
‫ەאױ‬ᐞ࿯ղΖ
6. ‫ڶ‬ழଢኙ࣍ቄࡐࢤ؈ఠऱ൛ृࠌ‫ءش‬
঴ࠓࣚ Ativan or Stilnox ‫ڶאױ‬լᙑհ
‫ڜ‬ఠ᛭யΙ
Оࢃ෮ᙝ! 10
 7. ‫࣍ ش‬ EPS ΰ Extrapyramidal
syndromeΚ‫ڶ‬լ۞‫ࢼ׌‬೯Εੁ᙭Εॆ
᧯Ꮬ࿏լᦫࠌ໦Ε‫֗א‬ዌଃܺᣄ
(Dysarthria)ऱ఑णΔຏൄ੡ਬࠄ௽ࡳ
ᢐढ֧ದΔհ৵ᄎ༼ࠩΖԫ౳լᄎ‫ڶ‬
‫ٲࡎس‬ᙠΔ‫׽‬ਢ൛ृ‫ߪء‬ৰլငࣚΔ
‫ٵڕ‬խߵԫ౳Ζຏൄᢐढທ‫ ګ‬EPS Օ
ી݁੡ Idiosyncraticΰ‫ࠄڶ‬Գ՛ᕪၦ༉
ᄎ‫נ‬෼ΔፖᕪၦΕࢨਢᙩ౧ࣹ୴ྤᣂα
‫ ֗א‬Dose-relatedΰՕᕪၦࢨਢ‫ط‬ᙩ
౧ࣹ୴թᄎ֧ದαα৺ࢤཚհรԫᒵ‫ش‬
ᢐΖຏൄૉਢྤயΔ‫ شࠌאױ‬Akineton
ΰ Biperiden α ۜ ۚ ࣹ ୴ ࢨ ਢ Ց ࣚ
Maintain ய࣠Ι
8. ൎ௺Ցྐტ੡່ࣔ᧩ऱ‫׼‬ԫ೫‫ش܂‬Ι

3. Neuroleptic or Antipsychotic drugsΚઌᅝ‫ڍ‬ጟᣊΔ‫܀‬ਢೈԱ壄壀ઝ‫א‬؆Δԫ౳ Primary care ᄎ

‫ࠩش‬ऱࠀլ‫ڍ‬Δႛ༉ൄߠࠐ೚տฯΖຏൄ‫ݼ‬壄壀‫ش‬ᢐ‫شړהࠡڶ‬ऱ᛭யΔԫࠓտฯΖ

1. ੡ঁࡵΕለ‫ڰ‬ཚऱ‫ݼ‬壄壀։ါ఑ᢐ
ढΔ‫ؾ‬ছս‫ڶ‬᠔ஃᄎࠌ‫ڼش‬ᣊᢐढ‫܂‬
੡൳ࠫ壄壀։ါ఑ΰSchizophreniaαΙ
2. ‫ڂ‬੡ᄅऱᢐढ‫נ‬෼Δਚ‫ڶ‬ൎ௺᠜ᙩ֗
‫ڜ‬ఠ‫ش܂‬ऱ Wintermin թዬዬ֟‫࣍ش‬
൳ࠫ壄壀։ါ఑ΰ‫ڂ‬੡ᄎທ‫ֲګ‬ൄ‫س‬
Wintermin ੒ऱլঁα Ι
50mg/tab 3. ‫ؾ‬ছᜯ‫່ݩ‬ൄ‫࣍ش‬ቄ ቄࡐࢤ Hiccupΰ‫ؚ‬
Chlorpromazine ♙α
ΔᜰՅ‫ڂ‬੡ Ileus ທ‫ګ‬ऱ HiccupΕ
ΰಾᕪ९ࢊ༓‫ྤ׏‬Գ ࢨਢ‫ڂ‬੡ᢐढᖄીխᑐ壀ᆖඕტທ‫ګ‬
ࠌ‫ش‬α ऱ‫♙ؚ‬ΰ‫ڕ‬ਬࠄ֏᛭ᢐढα Δ݁‫ލאױ‬
ࠫխᑐΔၞۖॴַ‫♙ؚ‬Ι
4. Ո‫ٷַ࣍شאױ‬Δ൫‫ז‬Ꮭ֜Օΰ‫ڜ‬ఠ
‫ش܂‬αΔਚ֟‫ش‬ΰམ‫ڶ‬൛ृࣚ‫ش‬መၦࣖ
ጕᑇ֚α Ι
5. ‫ڶ‬ທ‫ ګ‬QRS prolong ऱጊᐞΔഄ֟ߠΙ
6. ທ‫ ګ‬EPSΔ֟ߠΖ
1. ए᛭৺ࢤᤡ‫ڐ‬ΰDeliriumαଈᙇᢐढΙ
2. ‫ڕ‬ఐ൛‫נ‬෼‫ڶ‬႞Գႜ‫ٻ‬ऱ Psychosis
ழ Ո ‫ ش ࠌ א ױ‬ΰ Schizophrenia Ε
maniaα Ι‫ٵ‬ᑌ‫ڶ‬᠜ᙩ‫ڜ‬ఠய࣠Ι
3. ྎ៽฾ክ‫ ش‬Ativan ‫܂‬รԫᒵᢐढΕհ
৵‫ ش‬ValiumΔ‫ޓ‬৵‫ ش‬HadolΔ‫׌‬૞ਢ
‫ڂ‬੡ࠌ‫ ش‬Hadol ‫ڶ‬ଅᙠࢤΖ‫܀‬ਢኙ‫ݼ‬
Haldol / Serenace
৺ࢤᤡ‫֗ڐ‬ડ࿇ࢤ壄壀णኪᝫਢ‫א‬
5mg/tabΔ5mg/ml/amp
Haloperidol Hadol ய່࣠ൎΖ‫܀‬ਢ९ཚए᛭ᚨ‫א‬壄
壀ઝറຂᢐढ੡‫׌‬Δຍᇙլ‫ףڍ‬տฯΙ
ಾᕪ່੡ൄ‫ش‬ΔIM or IV
4. ೫‫ش܂‬Κ‫ ٵ‬WinterminΙ
5. ່ՕऱଅᙠΔ੡ Neuroleptic malignant
syndromeΰNMSα Δ‫ ڇ‬Wintermin and
Novamin ༓‫׏‬լᄎ‫ڶ‬Ζ൛ृᄎ࣍‫ދ‬ᢐ
৵ข‫ޓس‬ൎ௺ऱ֤ᤚΕ࿇‫ۀ‬Ε࿇ᗈΕ
᙮౧࿛መඕ఑णΔᣤૹᄎᖄી‫ڽ‬Ջΰ᥆
࣍ Idiosyncraticα
Ι

Оࢃ෮ᙝ! 11
 1. ‫֗ش܂‬೫‫ ٵش܂‬WinterminΔ‫܀‬ਢய࣠
ለ஁Δ೫‫ࢨߠ֟ش܂‬᎘პΔ‫ڼڂ‬༓‫׏‬
ྤႰጕΕQRS prolongΕ‫ݼ֗א‬壄壀ఐ
հ‫ش܂‬Δઌኙለ‫ڜ‬٤ΙEPS ൣउঞጩ
ਢൄߠΙ
2. ᜯ‫ٷַ࣍شݩ‬Δய࣠ॺൄ‫ړ‬ΰኙ࣍ᢐ
ढ֧ದհᄉఞທ‫ګ‬հቭ‫ٷ‬Δ‫ڕ‬຾ᔨ
ᕪΕ຾ᔨࢤַ࿀ᕪΕࢨਢ֏ᖂ᛭ऄᢐ
ढທ‫ګ‬α Ι
3. ྎ៽฾ክᇬം൛ृቭ‫ٷ‬ऱൣउΚૉ‫ڶ‬
᎘პᄉఞტ‫א‬ી⭫֨ທ‫ګ‬ऱቭ‫ٷ‬Δྎ
៽ᄎ‫ ش‬NovaminΔ۟࣍‫ڂ‬੡ Ileus ທ‫ګ‬
Novamin
Prochlorperazine ऱቭ‫ٷ‬ΰԫ౳ྤ壀ᆖࢤ⭫֨ტΔ‫܀‬ᄎ
5mg/tabΔ5mg/ml/amp
‫ڶ‬ᆮ࿾ΕঁఽΕࢨਢ Hypoactive bowel
sound ࿛ທ‫ګ‬ऱᆮ࿾⭫֨Δຏൄቭ‫ٷ‬
ऱ‫ڤݮ‬੡ ProjectileΕྤऄቃཚऱα Δঞ
‫הࠡش‬ᢐढΔᇡาൣउ٨࣍ࠡ‫ה‬ᆩષ
ሐ‫ش‬ᢐԫᆏΖ
4. ኙ࣍ྤऄࢨਢլ৬ᤜࠌ‫ ش‬Wintermin
‫܂‬੡‫♙ؚ‬ए᛭ऱ൛ृΔ‫ءشࠌאױ‬
ᢐΔՈ‫ڶ‬լᙑऱய࣠Ιַᄉఞய࣠᎘
პ Δ ኙ ࣍ Meniere’s disease ࢨ ਢ
Motion sickness ய࣠ለஇΔ‫הࠡڶ‬റ
ຂᢐढࠌ‫ش‬Δ‫׌‬૞ኙᢐढ֧ದհᄉఞ
‫ڶ‬ለࠋऱய࣠Ι
Ղ૪Կृ‫࣍ط‬ਢ៶ထॴឰ Dopamine receptor ۖข‫ݼس‬壄壀ఐ‫ش܂‬Δ‫࣐୲ڼڂ‬ທ‫ ګ‬EPSΕParkinsonism
ऱ༞֏Δࠀ‫᧼ૹף׊‬わऱ࿇‫س‬Ζࠡխ‫ א‬Hadol ທ‫ګ‬ऱᐙ᥼່ՕΔࠡ‫֟ृࠟה‬ທ‫᧼ګ‬わ‫ף‬ᏣΖਚ壄壀ઝ
᠔ஃԫ౳Ոਢլ֜৬ᤜመ৫ࠌ‫ ش‬HadolΖ

4. Antiepileptic drugsΚೈԱհছ༼መऱ Benzodiazepine հ؆Δ‫ڶ‬๺‫ڍ‬റ៭ऱ‫᧼ݼ‬わᢐढΔຝ։ࠠ‫ڶ‬

᠜ᙩ‫ڜ‬ఠ‫ش܂‬Δ‫ࠄڶ‬Ոኙַ࿀‫ڶ‬ᚥ‫ܗ‬Δࠡխ‫ࠄڶ‬Ո‫܂‬੡壄壀ઝ Mood stabilizerΰ壄壀᡹ࡳᕪα‫࣍ش‬ए
᛭ᤥ఑Δ‫א‬Հᇡ૪Κ
1. ੡‫᧼ݼ‬わᢐढհԫΔ‫ڂ‬੡‫ڶ‬ൎ௺᠜ᙩ
‫ڜ‬ఠ‫֗א‬՛ၦࡅ‫ش܂ࠫލܮ‬Δਚԫ౳
‫࣍ش׽‬ᖂ᤿ছࠝ࿙հ‫᧼ݼ‬わΔᖂ᤿৵
‫ګ֗א‬Գ‫ڂ‬੡ᄎᐙ᥼ֲൄ‫س‬੒Δਚ֟
Luminal
‫ش‬ΰೈॺ‫ૹ࣍ش‬఑‫ף‬ᥨࢨਢࣖಮ൛
Phenobarbital 30mg/tab
ृα
Ι‫࣍ڼڂ‬՛ࠝઝለൄࠌ‫ش‬Ι
100mg/ml/amp
2. ᕣၦլፖ Benzodiazepine ‫ݼ࣍شࠓٽ‬
᧼わΔ‫ڂ‬੡ᄎ‫ף‬ൎࡅ‫ࠫލܮ‬Ζ
3. ᚨᒔኔֺᅃᢐढਐ֧ૠጩࢬᏁᕪၦ֗
ઌᣂ೫‫ش܂‬
1. ‫᧼ݼ‬わᢐढऱԫጟΙ
2. ᠜ᙩ‫ش܂‬ൎΔ‫ڜ֟܀‬ఠ‫ش܂‬Ιਚ壄壀
Tegretol ઝ‫ش‬հ੡ Mood stabilizer ऱԫጟΙ
Carbamazepine 200mg/tab 3. ኙ࣍壀ᆖᚘ૰ທ‫ګ‬ऱᎨ຾క࿀ΔೈԱ
ԫ౳ TID ࠌ‫ش‬ ᣊࡐᔧհ؆Δ‫אױ‬ᙇᖗ‫ڼ‬ᢐढ‫܂‬੡ַ
࿀ᕪΰ‫݄ڕ‬೎壀ᆖ࿀Ε཮ၴᒌડ‫נ‬
࿛α
Δྎ៽ऱ່ფΙ
1. ੡‫᧼ݼ‬わ‫ش܂‬Δ‫ڶ‬Ցࣚ‫֗א‬ಾᕪΙ
Dilantin 2. լࠠ᠜ᙩ‫ڜ‬ఠ‫ش܂‬Δਚ‫ګ‬Գ‫֗א‬ᖂ᤿
Phenytoin
100mg/cap ࠝ࿙ൄ‫ش‬Ι
ΰDiphenylhydantoinα
100mg/2ml/amp 3. ᚨᒔኔֺᅃᢐढਐ֧ૠጩࢬᏁᕪၦ֗
ઌᣂ೫‫ش܂‬
Оࢃ෮ᙝ! 12
 1. ‫܂‬੡‫᧼ݼ‬わᢐढΰຏൄ੡รԲᒵα‫א‬
Valproic acid Depakine
֗ Mood stabilizerΙ
ΰValproate sodiumα 400mg/vial
2. ԫ౳ൣउ֟‫ش‬Ι

1. ኙ࣍ధ႞ଅΕ՗わΰEclampsiaαհ᧼
わ‫ڶ‬ᚥ‫ܗ‬Δԫ౳ᄎ‫ ࣍ش‬Preeclampsia
൛ृ‫א‬ቃ߻᧼わΙ
2. ‫ش܂઼ڜڶ‬Ι
3. ‫ش܂‬੡խᑐ壀ᆖ‫ࠫލ‬Δᄎ‫ڶ‬٤ߪ޿
10%Δ20ml/amp
Magnesium sulfate ᑷΕ֨൬࿛լᔞΔᙃܑխ੅ፖ‫ܡ‬੡ࡳ
ࣹ୴෈Δഡขઝൄ‫ش‬
ழྒྷၦ DTRΔ઎ਢ‫ڶܡ‬௣؈ऱൣ‫ݮ‬Ι
4. ௽௘‫ش‬ऄΚ֟ᑇ᠔ஃᄎ‫ش‬՛ၦࢨਢ໢
‫ڻ‬࿯ղ MgSO4 ࠐए᛭‫ڂ‬੡֏ᖂए᛭
֧ದऱ؄հ‫أ‬ጤ຾ᅤტΙ
5. խ੅ᇞ੅ᕪΚCalcium gluconateΙ

1. Mood stabilizerΙ
2. ྤ‫᧼ݼ‬わࢨ‫ڜ‬ఠ‫ش܂‬Ι
3. ᚨᇖ‫ ך‬NaΔ‫ ַ߻א‬Lithium መ৫٦‫ܮ‬
300mg/tab
Lithium ‫گ‬Ι
ᔶᨖ
4. መ৫ᗨ፝ᄎທ‫ګ‬խ੅Δ‫ڕ‬რᢝᑓᒫ
࿛Δਚ࿽‫פ‬౨Ꮍᡶृᆃ‫ش‬Δۖԫ౳൛
ृᏁ጑ྒྷۨ෈ᖺ৫Ι
Akineton 1. ‫׌‬૞‫אش‬ए᛭ EPSΙ
ॵᙕΚBiperiden HCl
2mg/tabΔ5mg/ml/amp 2. ኙ࣍ Parkinsonism Ո‫ڶ‬ए᛭ய࣠Ι
5. Other hypnotics and sedativesΚ
1. ‫ݶ‬ຒ֧ᖄ‫ڜ‬ఠΰપ 30 ։ᤪαΔ਍ᥛ 4
՛ழ‫א‬ՂΔ֟ࡅ‫ش܂ࠫލܮ‬Ι
Chloral hydrate 10%Δ100mg/ml
2. ‫ڇ‬९ࢊ‫ؾ‬ছ‫࣍ش‬՛ࠝઝ൛ृᛀ਷ছհ
PremedicationΙ
1. ൎய᠜࿀ᇞᠦࢤ຾ᔨᕪΔԫ౳‫࣍ش‬؆
Ketalar ઝ֫๬Ι
Ketamine HCl
500mg/10ml/vial 2. ‫ؾ‬ছఐࢪᄎ‫ڼࠩش‬ᢐՕᄗ‫ڶ׽‬՛ࠝઝ
‫ף‬ᥨఐࢪΔ‫܂‬੡᠜ᙩᕪΙ

քΕʳጵ‫ٽ‬ტকᢐΕ‫ิݼ‬៣₏Ε‫֗א‬যቬᢐ
ΰDrugs for common coldΕantitussiveΕ and anti-histamine agentsαΚ
Ϩʳ‫׌‬૞տฯԫ౳ൄ‫ش‬ऱጵ‫ٽ‬ტকᢐΖ
Ϩʳൄߠऱტক఑णլ؆‫ۚۜ׏‬Ꭸ࿀Εఒ໎Ε‫ؚ‬ᏴᚖΕੌᏗֽΕᏗႾΕ‫֗א‬যቬ࿛Δਚԫ౳ጵ‫ٽ‬ტ
কᢐܶ‫ַڶ‬࿀ᕪΕ‫ิݼ‬៣₏Δ‫ַ֗א‬য‫ګ‬։Κ
1. Anti-histamine agentsΚए᛭‫ؚ‬ᏴᚖΕੌᏗֽΕᏗႾ࿛መඕࢤᏗङ఑णΔ‫הࠡ֗א‬መඕ఑Ζࢬ‫ݼڶ‬
ิ៣₏݁‫ٵڶ‬ᑌ‫פ‬யΔ൫‫ޢ‬ଡข঴‫ޣ္ࠡڶ‬Δ֗ኙ೫‫ش܂‬հ‫گ‬ᚹΖ‫ڼڇ‬ऱ‫ิݼ‬៣₏੡റਐ H1-blocker
ۖߢΙH2-blocker ঞ‫܂‬੡‫ݼ‬ᑭጌᢐᕪΔհছբ૪Ζ
ᢐढ‫ټ‬ ೸঴‫ټ‬ΰ९ࢊൄ‫ृش‬α ១૪֗ࠌ‫ش‬ழᖲ
Diphenhydramine HCl Vena/BenaΰBenadrylα ᇡ઎รԼ଄Δ᠜ᙩ‫ڜ‬ఠᕪԫᆏΖ
1. ‫ ࣍ ش ׌‬ए ᛭ Motion sickness and
Cyclizine HCl ?
Meniere’s disease
Meclizine HCL Bonaminΰ25mg/tabα
2. ९ࢊ֟‫ش‬Δ‫הࠡڶ‬ᢐढለൄ‫ش‬Ι
1. ኙࢬ‫ิݼڶ‬៣₏ᢐᕪࢬ‫ڶ‬հ‫פ‬ய݁‫ڶ‬
Clarityne
Loratadine ൎயΙ
10mg/tab
2. ੡ᄅԫ‫ז‬፹ᕪΔ֟Ⴐጕ೫‫ش܂‬Ι
Оࢃ෮ᙝ! 13
 1. ᄅԫ‫ז‬፹ᕪΔ༓‫ྤ׏‬Ⴐጕ‫ش܂‬Ι
Zyrtec 2. ኙࢬ‫ڶ‬ऱ‫ڶ݁ش܂‬ൎயΔ‫׌‬૞‫࣍ش‬መ
Cetirizine
10mg/tab ඕࢤᏗङΕტকທ‫ګ‬հᏗႾΕੌᏗֽΕ
‫ؚ‬ᏴᚖΕ‫֗א‬መඕࢤ࿨ᓂङΙ
Periactinΰ4mg/tabα 1. ኙิ៣₏֗ Serotonin ࠠ‫ڶ‬਎‫ش܂ݼ‬Ι
Periactin syrupΰ2mg/5mlα 2. ᜯ‫່ݩ‬ൄ‫ڂ࣍ش‬੡ᢐढທ‫ګ‬ऱ‫ؼ‬ᓅ᣺
Cyproheptadine HCl
‫ޢ‬ֆְ‫᜔֚ޢ‬ၦ 1ccΔٍ‫ܛ‬ ఖΕณᅪ᣺࿛‫ؼ‬ᓅ఑णΙ
ΰֆְ/4αcc QID or Q6H 3. ࠠ‫ڶ‬ᏺၞଇᐥऱ‫ش܂‬Ι
1. ܶ CalamineΕZinc oxide ࿛հੑ෈Ι
Caladryl 2. լ࿕ᤩঞយᆈ৫ৰ೏Ι
Calamine lotion
100ml/bot 3. ‫ݝ࣍ش‬ຝ᣺ఖΔ‫ױ‬ᔞ৫ַ᣺֗ᑮᄶ‫ؼ‬
ᓅΙ
1. Doxepine ੡‫ิݼ‬៣₏ΔՑࣹࣚ֗୴෈
‫׌‬૞‫܂‬੡‫ݼ‬壄壀ఐᢐࠌ‫ش‬Δ‫ش֟ڂ‬Δ
Ichderm
Doxepin HCl ਚྤ٨ᜰΙ
5% creamΔ15g/tube
2. Ichderm ኙ࣍‫ݝ‬ຝᛘఖΕ⼡ᅢఖΕ‫א‬
֗᣺ఖ݁‫ړߜڶ‬ய࣠Ι
2. ַযᢐᕪΰAnti-tussive agentα Κ‫׌‬૞‫ڶ‬ಾᕪΕՑࣚᕪΕ‫֗א‬ᗷᑠΖ
Ϩʳ‫אױ‬։੡᠜যᕪ‫֏֗א‬ᅠᕪࠟጟΚ
1. ᠜যᕪ‫אױ‬։੡խᑐࢤַযΕၜᢰࢤַযΔ‫֗א‬ᔾ֭௛ጥឩ്ַযԿጟΖ
2. ֏ᅠᕪऱ‫ش܂‬ᖲࠫ੡ᏺ‫֭ף‬௛ጥ෈᧯հ։ࣼΔ៶‫א‬࿕ᤩᖺᆈհᅠ෈Ζ
1. ೶઎รԿᆏַ࿀ᕪΰรԮ଄αհ༴૪Ι
Codeine phosphate Codeine
2. ੡խᑐ຾ᔨࢤַযᕪΔַযய࣠ൎΙ
ܶ Platycodon glaucus CMA ΰ Cough Mixture A 1. ဇ࠷‫ګٽ‬հ᠜যᗷᑠΔ࠺ᄕกΙ‫׌‬૞
ΰ ԫ ጟ ཬ ढ α հ ဇ ࠷ ढ solutionα ‫࣍ش‬᎘৫যቬΔࠀ‫ڶ‬᎘პ֏ᅠ‫פ‬யΙ
ΰ65mg/mlα 10~15ml TID~QID use ੡ൄ‫ش‬
1. ‫ڂ‬੡ܶ‫ ڶ‬Codeine ‫ګ‬։Δਚ᠜যய࣠
Codecol/Kosonin/CMB ለൎΙ
ΰ cough mixture B 2. ੡ለ੡ൎ௺հযቬΔ‫܀‬ਢլᏁࠌ‫ش‬೏
CMA + Codeine
solutionα ᕪၦհ Codeine ृ‫شࠌאױ‬Ι
10~15ml TID~QID use 3. ก৫‫ ࣍੷ޓ‬CMAΔਚᗷ‫ݟ‬ఐ൛ृጐၦ
լ૞ࠌ‫ش‬Ι
ᗷ ᑠ Δ ܶ ‫ ֭ ڶ‬௛ ጥ ௣ ᆭ ᕪ
ΰMethylephedrineαΕ‫ิݼ‬៣₏‫ݼ࣍ش‬መ
Methylephedrine +
Secorine ඕΰChlorpheniramineα
Δ‫ַ֗א‬য‫ش܂‬հ
Chlorpheniramine +
10~15ml TID~QID use GuaifenesinΔਚኙ࣍ԫ౳‫ڂ‬੡֭௛ጥመඕ
Guaifenesin
ࢨਢტকທ‫ګ‬հযቬ݁‫ڶ‬᛭யΙࠠ֟ၦথ
ᅠ‫פ‬யΙ
1. ੡‫ګٽ‬հᗷᑠΔ᠜যய‫ش‬ൎΔ‫ݶش܂‬Ζ
2. ᏺ‫֭ף‬௛ጥ։ࣼΔ‫ڶ‬থᅠ‫פ‬யΙ
Robitussin / Guafen
Guaifenesin 3. ‫֭ڶ‬௛ጥؓᄶۜᇞ࿂᧑‫ش܂‬Δਚኙ࣍
10~15ml TID~QID use
֭௛ጥመඕणउΔ௽ܑਢ Asthma ൛
ृ֧࿇հযቬΔ݁‫ڶ‬᛭யΙ
1ΗᗷᑠհᙇᖗΚຏൄ൛ृ੡೓যΕࢨਢ‫ڶ‬ᅠᣄযழΔ‫ەאױ‬ᐞࠌ‫ش‬ᗷᑠΔ‫ڶ‬ᑮ໫‫פ‬யΙ
2Η‫א‬Ղ؄ጟᗷᑠհࠌ‫ش‬ழᖲΔࠉྎ៽ᆖ᧭੡Κ՛যቬᙇ CMAΙለՕযቬᙇ CMB ࢨਢ SecorineΙ௛
໙൛ृࢨਢ‫֭ڶ‬௛ጥॴႾհᇄृ࿯ RobitussinΖ
3Ηࠡ‫ה‬ቝ Ventoline syrupΕBerotec syrup ࿛௛ጥឩ്ᕪհᗷᑠᣊীΔ‫ڶ׽‬՛ࠝઝለൄ‫ش‬Ζ
1. ൎ௺հ᠜যᕪΔྤ᠜࿀‫ش܂‬Εॺ຾ᔨ
ࢤ᠜যᕪΙ
Medicon 2. ‫ء‬঴‫ؾ‬ছբᆖ޲‫شࠌڶ‬Δ‫ڶڂ‬ཙ‫ז‬ᢐ
Dextromethorphan HBr
60ml/bot ढΙ
3. ᗷᑠᕪী‫࣍ش‬՛ࠝઝΔᓮ਷ᔹᢐࠢᕪ
ၦᎅࣔΙ

Оࢃ෮ᙝ! 14
 1. ‫ء‬঴੡ൄ‫ش‬հ᠜যᕪΙ
Medicon 20mg + Pot
Medicon-A 2. ܶ Cresolsulfonate ౨আ֭௛ጥ։ࣼ
Cresolsulfonate 90mg +
1 # TID~QID use ෈᧯Ιܶ Lysozyme ঞ‫אױ‬։ᇞᖺ
Lysozyme 20mg
ᅠΔআၞඈइ
1. ੡‫ޓ‬ᄅԫ‫ז‬հ᠜য‫ش‬ᢐΙ
2. ‫ॄࠫލ‬Εۛᓂၜᢰհ෰്ტ࠹ᕴۖ྇
֟যቬ֘୴Ι
Bensau
Benzonatate 3. լ‫ױ‬ᗣృࢨনᅷΙ
100mg/capΔTID~QID
4. ྎ៽ຏൄലհ࣋‫ڇ‬ለ৵ᒵࠌ‫ش‬ΰլመ
౥࿺ઝ᠔ஃ‫ױ‬౨ᄎऴ൷ࠌ‫ڼش‬ᢐۖሂ
መ Medicon-Aα Ι
1. ੡ԫറ᥆থᅠᢐᕪΙ
2. ԫֱ૿ᏺ‫֭ף‬௛ጥ։ࣼΔԫֱ૿আၞ
ॄऐ੺૿੒ࢤᕪհ։ࣼΔ‫ॄࡳڜ‬ऐΔ
ࠀআࠌᅠ෈ྤऄፋႃ‫ګ‬Օ։՗Δ‫ܓڶ‬
Ambroxol Mucosolvan
ඈ‫נ‬Ζ
hydrochloride 30mg/tab
3. ࣹრΔࢬ‫֏ڶڶ‬ᅠ‫פ‬யհᢐढ݁ᄎআ
ࠌ֭௛ጥ։ࣼΔਚૉਢ޲‫ڶ‬ᅠ෈ऱ൛
ृࢨਢ଺‫ء‬যቬ᎘პऱ൛ृΔ‫ױڶ‬౨
‫ڼڂ‬যቬ‫ף‬ᏣΙ
Jusomin
Sodium bicarbonate 0.3g/tab Jusomine inhalation ౨ജ‫ؚ‬ឰᅠ෈೏։՗
ΰfor inhalation therapyα ፋ‫ٽ‬Δ‫ۖڂ‬আၞඈᅠ
7%Δ20ml/amp
Acetylcysteine Acetinΰ200mg/3g/pkα ధᡏᅠ෈հយ๨‫ػ‬យ৫‫א‬ధᡏ᝶࿨Ζ‫ڇ‬९
ΰfor inhalation or sprayα Flutafinΰ200mg/capα ࢊለ֟‫ش‬Ζ
1. ੡ٌტ壀ᆖᘋᕿᕪΔ‫אױ‬আၞᏗយᓂ
პۨጥ‫گ‬ᜍΕ֭௛ጥឩ്Δਚ‫אױ‬ሒ
Ephedrine HCl
ַࠩযΕַੌᏗֽΕຏᏗհய࣠Ι
2. ‫܀‬ਢኙ࣍֨᦬ۨጥߓ‫ٵ‬ᑌ‫ش܂ڶ‬Ζਚ
DL-Methylephedrine
࿇ ୶ ‫ נ‬Methylephedrine and
HCl
PseudoephedrineΔ٤ߪࢤ֨᦬ۨጥ
֘ᚨ՛Δխᑐ֘ᚨΰ‫ڕ‬Κᘋᕿα՛Ι
Pseudoephedrine HCl
3. ԫ౳ઝ֟‫ش‬Δ‫׌‬૞ਢۘᏗ໫ઝൄ‫ش‬ΰ‫ء‬
ೃ੡ Pseudoephedrineα
3. ጵ‫ٽ‬ტকᢐΰDrugs for common coldαΚ
1. ආ‫ش‬ᠨᐋ Pseudoephedrine ਢ੡Ա಻
Pseudoephedrine total
‫ ٽ‬Loratadine ऱ९ய௽ࢤΔ፹ທԫ‫ڶ‬
120mg ΰ inner 60mg + Clarinase
९ய‫ش܂‬հᓤֱΙ
Outer 60mg α + 1# QD~BID
2. ਚ‫ױ‬ᒷᇞᏗႾΕੌᏗֽΕ‫ؚ‬ᏴᚖΕჽ
Loratadine 5mg
᣺Εੌณෝ࿛ტক఑णΖ
Actifed ΰ60ml/botα 1. ‫ګ‬Գઝ޲‫شڇڶ‬Δ‫ڶ׽‬՛ࠝઝ‫شڇ‬Δ
Pseudoephedrine 60mg
tab or syrupΔ९ࢊ‫ א‬syrup ਚ‫ڇ‬९ࢊ੡ Syrup ᕪীΙ
+ Triprolidine 2.5mgΰ‫ޢ‬
੡‫׌‬Ζ՛৘ࠌ‫ش‬੡Κ ΰֆְ/4α 2. ‫ ٵ‬ᑌ ܶ ‫ ڶ‬Ephedrine ᣊ ֗
10cc ۖߢα
cc QID or Q6H Anti-histamineΔਚ‫ ٵش܂‬ClarinaseΙ
Acetaminophen 150mg +
Chlorpheniramine
1. ٤யীጵ‫ٽ‬ტকᢐΙ
1.25mg + Medicon 7.5mg Foningΰcapα
2. ‫אش‬ᒷᇞᙰ࿀ΕۜۚᎨ࿀ΕመඕΕ‫ؚ‬
+ Methylephedrine 5mg 2# TID
ᏴᚖΕੌᏗֽΕযቬΕᏗႾ࿛఑णΙ
+ Guaifenesin 30mg +
Caffeine 15mgΕVitB1/B2

Оࢃ෮ᙝ! 15
 ԮΕʳࠡ‫ה‬ᆩષሐ‫ߗ֗א‬ᜬ‫ش‬ᢐΚ
‫ء‬ᆏտฯԫࠄࠡ‫ה‬ऱᆩષሐ‫ش‬ᢐΔհছբᆖտฯመષᢐΖ‫ٷַܶץ‬ᕪΕַ‫♙ؚ‬ΕַើᕪΕᒷើᕪΕ௣࿾
௛ᢐΕ೜ષᖞᆩᕪΕ‫֗א‬অߗᢐᕪΖ๺‫ڍ‬ᢐढ‫ڶڂ‬আᆩᤘ೯‫פ‬౨Δਚ‫ٵ‬ழ‫אڶ‬Ղᑇႈ‫פ‬౨Δਚᢐढᙇᖗ
ጤ઎൛ृൣउΖ

1. ໢ొַ‫ٷ‬ᕪַ֗‫♙ؚ‬ᕪΰAntiemetics and anti-hiccup agentsαΚ

1Ηᓮ೶ᔹรԼԫ଄ΰ᠜ᙩ‫ڜ‬ఠᢐԫᆏαΙ
Chlorpromazine Wintermin
2Ηխᑐࢤ‫ش܂‬Δ‫׌‬૞‫ࠐش‬௣ೈ‫♙ؚ‬Ι
1. ᓮ೶ᔹรԼԫ଄ΰ᠜ᙩ‫ڜ‬ఠᢐԫᆏαΙ
2. խᑐࢤ‫ش܂‬Δ֟೫‫ش܂‬Δ‫׌‬૞‫܂ࠐش‬੡‫ڂ‬੡
Prochlorperazine Novamin ᢐढΕ᎘პᄉఞΕ‫ ࠠהࠡ֗א‬Nausea ტᤚ
ທ‫ګ‬ቭ‫ٷ‬հַ‫ٷ‬ᕪΙ
3. ᎘პ‫ش܂♙ؚݼ‬Ι
1. Serotonin ਎‫ݼ‬ᕪΔࠠ‫ྡྷݼٷַڶ‬ᐞ‫ش܂‬Ι
2. ‫࣍ش‬௽ࡳ֏ᖂए᛭հรԫᒵַ‫ٷ‬ᕪΕ‫ڍ‬ᑇ֏
ᖂ ए ᛭ ࢨ ࣋ ୴ ᒵ ए ᛭ ኙ Novamin Ε
Zofran Primperan ྤߜ‫ړ‬հַ‫֘ٷ‬ᚨழΔ‫۞ױ‬၄ࠌ
Ondansetron
8mg/tabΔ2mg/ml ‫ش‬Ι
3. ೈ௽ࡳ֏ᖂए᛭ᢐढΔ‫ॺ࣍ش‬೜অ࿯‫ב‬հൣ
‫ݮ‬ழᏁ۞၄ΰપ 900 ցԫᕪαΔਚ Primary
care ֟‫ش‬Ι
1Η‫ ٵ‬ZofranΙ
Tropisetron Navobanΰ5mg/capα
2Η‫׏ۿ‬ለ੡९யΕ‫ޓ࣍ش‬৵ᒵַ‫ٷ‬Δለ֟ࠌ‫ش‬Ι

2. ࠠᓳᖞષᆩᖲ౨ۖીַ‫♙ؚ‬Εַ‫ٷ‬Εᆩષඈ़ΕᒷើΰLaxativesα֗௣࿾հᢐढΚ

1. ‫࣍ش܂‬ᆰიআࠌᆩષᖲ౨੒֏Δআၞષඈ
़Εᆩᤘ೯Δ‫ۖڂ‬ᒷᇞ‫ڂ‬੡ Ileus ᖄીհ‫ؚ‬
Primperan ♙Εቭ‫ٷ‬Εષ࿾௛ΕঁఽΕ‫ڼࠉ֗א‬আ আၞଇ
1. 3.84mg/tab ᐥΙ
PO AC TID use 2. ለ֟ࠡ‫ה‬խᑐ‫ش܂‬Ιࠠ‫ڶ‬᎘პַᄉ‫ش܂‬Ι
2. 10mg/amp 3. შ߻ EPSΙ
IMΕIVΕIVF 4. ྎ៽ࠌ‫ش‬ᄷঞΚ‫ڂ‬੡ᢐढ‫ش܂‬ข‫س‬ᙰᄉી⭫
Metoclopramide
֨ऱቭ‫♙ؚࢨٷ‬Κࠌ‫ ش‬NovaminΙ‫ڂ‬੡ᢐ
Primperan Resinate ढທ‫ګ‬հᆩᤘ೯྇ᒷΰ‫ڕ‬຾ᔨᢐΕ຾ᔨࢤַ
40mg/tab Δ ੡ ९ ய ᕪ ࿀ᕪα‫א‬ીᆩષ࿾௛ທ‫֨⭫ګ‬հቭ‫ࢨٷ‬ਢ‫ؚ‬
ীΖ‫ڶ‬ᗷᑠᕪীΰ՛ࠝ ♙Κࠌ‫ ش‬Primperanΰຏൄ‫ߚߠױ‬՗ቔದΕ
ઝ‫ش‬α Bowel sound ྇ᒷΔ‫֗א‬๕‫ݎࠡټ‬ડྥቭ‫ٷ‬α
5. ९யᕪԫ౳‫࣍ش‬ᣤૹቄࡐࢤષ࿾௛֗ቭ‫ٷ‬
൛ृΔԫ౳ൣ‫ش֟ݮ‬Ι
1. আၞᆩᢀ壀ᆖហ։ࣼ Acetylcholineΰٍ‫ܛ‬೫
ٌტ壀ᆖ੒֏α Δআၞᆩષᤘ೯֗ࠡ࠰ᓳࢤΙ
Prepulsid 2. ֟٤ߪ‫ش܂‬Ι
1. 10mg/tab 3. ኙ࣍ᆩષࢨਢଇሐಭੌΕᆩષ࿾௛ΕঁఽΕ
Cisapride AC useΔTID ௣֏լߜΕଇᐥլ஡Ε⭫֨ቭ‫ٷ‬Δ݁‫ߜڶ‬யΙ
2. ‫ڶ‬ᗷᑠᕪীΰ՛ࠝઝ 4. ‫ڼڶ‬ԫᎅΚPrimperan ‫ڇش܂‬Ղᆩષሐհய
‫ش‬α ࣠ለ‫ړ‬ΙCisapride ঞ‫׌‬૞‫ڇش܂‬Հ੄՛ᆩΙ
5. ᜯ‫׌៽ྎݩ‬૞‫ڇش‬Ꮑ᎘პআၞᆩᤘ೯Ε‫֗א‬
আၞଇᐥհ໱‫ٽ‬Ι

Оࢃ෮ᙝ! 16
 1. আષᤘ೯ඈ़Ε৩॰ឩ്Δፖ Primperan ᣊ
‫ۿ‬ऱ‫ ྤ܀شפ‬EPS ࿛հ೫‫ش܂‬Ι
Motilium
2. ٍ‫ڶ‬ൎԺַ‫ش܂ٷ‬Ι
Domperidone 10mg/tab
3. ᜯ‫ݩ‬Ղለൄ‫ ܂ش‬Primperan հཙ‫ז‬ᢐΔૉਢ
AC useΔTID
൛ृ‫ڂ‬੡ Primperan ‫נ‬෼ EPS ఑णΔ‫אױ‬
‫ە‬ᐞ‫ شޏ‬DomperidoneΖ
3. ᖞᆩ௣֏ᏺၞᕪΚ

੒ࢤࠂᎨ፹ᕪΔআၞ௣֏Δ՛ࠝઝൄ‫ش‬Ι‫ַڶ‬ើ
Lactomin Bioferminΰ।ଆᏓα
‫ش܂‬Ζ
ܶࠟጟଯདྷ੒ࢤࠂᎨပΰ‫ޢ‬໢‫ ٺۯ‬10 Ꮩပα
Δய
Infloran Berna Infloran
࣠‫ࠋޓ‬Δ൫Ꮑ۞၄Ζ՛ࠝઝൄ‫ش‬Ζ
4. ᒷើᕪΰLaxativesα֗ើᕪΰCatharticsαΚ৵ृ੡ᣤૹᆮើΙছृ‫׌‬૞੡ຌঁ‫ش܂‬Ζ Ղԫ੄հ
PrimperanΕCisaprideΕand Domperidone ݁‫ױ‬೚ᒷើᕪΖ
Magnesium Oxide ࠫᎨᕪΚ1# QID 1. ೶ᔹષᢐԫᆏΙ
ΰMgOα ᒷើᕪΚ1# TID~2# QID 2. ࿽ಐጣ൛ृ֎‫ش‬Ι
1. ࠨᖿՕᆩយᓂΔᏺ‫ۚۜף‬ᤘ೯Δ‫ֽࠫލ֗א‬
։‫گܮ‬ሒࠩຌঁய࣠Ι
20mg/tab 2. ‫ء‬঴ጩൎயᒷើᕪΔլ࣐ທ‫ګ‬ᆮើথ‫ړڶ‬ऱ
Sennosides
1#~2# HS ຌঁய࣠Δ‫׽׊‬Ꮑጕছࣚ‫ش‬Ι
3. ‫࣍ش‬࿽ಐጣ൛ृ‫ڣ۔֗א‬ԳΔࢨਢኙ࣍ MgO
޲‫֘ڶ‬ᚨհ൛ृΙ
1. আၞ࿨ᆩយᓂ։ࣼ֗ᤘ೯Ι
Dulcolax
2. ԫ౳ለൄ‫ش‬௕ᕪΔ‫܂‬੡‫ݶ‬ຒඈঁᎈᖄᕪΔ᥆
1. 5mg/tab
࣍ើᕪհԫጟΔ‫׌‬૞‫࣍ڇ‬ᎈᖄբᆖ‫ګس‬ᜈঁ
Bisacodyl PO QD/HS to BID
հඈइΙ
2. 10mg/supp
3. Ցࣚຏൄለ‫ڶ‬լᔞტΔֽঁհൣ‫ݮ‬Ζ‫׌‬૞‫ش‬
QD to Q4H
࣍ቄࡐীঁఽհᒷᇞ‫֫֗א‬๬ছຏᆩ‫ش‬Ι

1. ‫ߪء‬੡೏ၩᠦ՗հֽᕪΔᥒᆩ৵ᖄીၩᠦ՗
ၞԵऴᆩយᓂาઽΔ࠷‫נז‬ሧᠦ՗ֽ֗Δ‫ڂ‬
ۖข‫س‬ើᕪ‫ش܂‬Ι
Fleet enema 133ml/BT 2. ԫ౳‫࣍ش‬९Նঁఽࠓᜈ‫ګسف‬ழհᇞᕪΙ
3. ‫ڂ‬੡‫אױ‬ທ‫ګ‬ሧᠦ՗հඈइΔኙ࣍
Hyperkalemia ੡ࠡխԫጟጹ৺๠෻ֱ‫ڤ‬Δ୲
৵٦૪Ι

1. լᄎ๯ષᎨࢨᎧై։ᇞΔၞԵ࿨ᆩ৵๯าပ
։ᇞข‫س‬ᨖᣊΔᏺ‫ף‬ዶຘᚘΔᖄીᆩ෈ᏺ
‫س‬Δ‫ۖڂ‬ፂ਍យ৫֗ᜈঁၦΙ
2. Ո‫ڼڂ‬ᖄીᆩሐխසᠦ՗ऱᏺ‫ף‬Δല࿨ᆩሐ
Lactulose
Lactulose խհ NH3 ᠏֏੡ NH4+հᨖᣊඈ‫נ‬Δ྇֟Գ
15ml PO TID
᧯‫گܮ‬ऱ NH3 ࠀআࠌۨ෈ NH3 ၞԵᆩሐΔ
‫ ַ߻ۖڂ‬Ammonia ऱՂ֒Δ‫ش‬ ‫אش‬ए᛭֗ቃ
߻ HepatoencephalopathyΖਚ‫ء‬঴ऱ‫׌‬૞
ए᛭‫ش‬ຜ‫ڼڇ‬Ζ

Clyster ‫زܛ‬ई෺Ζᥒᆩ৵আၞֽ։ඈ‫נ‬Δ࿨ᆩᤘ೯Δ‫א‬
Glycerin Ball
20ml/Ball ֗ᏺ‫ף‬ᑮᄶ৫Ζ
၌ൎயើᕪΔԫ౳‫࣍ش‬؆ઝ֫๬ছΰ௽ܑਢᆩષ
Magvac
Magnesium citrate ֫๬αհ堚ᆩΖ‫ڇ‬ቄࡐࢤঁఽ൛ृࢨਢᆩॴႾທ
250ml/botΔֽᕪ
‫ګ‬հᆮຝᄕ৫ቔ࿾լᔞΔՈ‫شࠌאױ‬Ζ
Оࢃ෮ᙝ! 17
 1. ‫ء‬ೃ‫ڶ׽‬ऴᆩߙ॰؆ઝ‫شڼڶ‬ᢐΙ
Mineral oil 100ml/bot
2. ‫אױ‬ᥒᆩࢨਢՑࣚΔ၌ൎើᕪΔᅝ
ΰLiquid paraffinα ᣼ढई
Magnesium citrate ྤயழ‫ەאױ‬ᐞࠌ‫ش‬Ι

5. ַើᕪΰAnti-diarrhea agentsα
Κ

Fina ᇡᔹષᢐԫᆏΖַើ‫ش܂‬᎘პΔ‫׌‬૞੡९ཚ൳ࠫ
TID to QID հ‫ش‬Δ൳ࠫᆮ࿀Ζ৺ࢤཚᏁ‫הࠡش‬ᢐढΖ
1. ᆮຝ᦬ᕴհഡٌტ壀ᆖ‫ࠫލ‬ᕪΔਚ‫ױ‬ᒷᇞᆮ
ຝ᦬ᕴؓᄶۜ࿂᧑Εመඕሎ೯ທ‫ګ‬հక࿀Ι
Buscopan
Scopolamin 2. ‫ࠫލ‬ᆩષሐᤘ೯ਚ‫אױ‬ᒷᇞᆮើΙ
10mg/tab
(Hyoscine utylbromide) 3. ‫ش܂઼ڜ‬Ι
20mg/ml IM or IV
4. ൄ ‫ ࣍ ش‬AGE Δ Irritable bowel syndrome
ΰdiarrhea typeαհए᛭Ι
1. ੡ᆩሐֽ։‫ॵܮ‬ᕪΔ‫֟྇شܓ‬ᆩሐֽ։‫א‬ሒ
Kaopectin ַើய࣠Ι
Kaolin-pectin
10~15ml TID ~QID 2. ॺൄൄ‫ڶ׊ش‬யΔլመᚨፖ൛ृᎅࣔࠡ‫ش܂‬
ᖲࠫΔլᄎ‫ַܛمڶ‬ើ‫ش܂‬Ι
Imodium 1. ऴ൷‫࣍ش܂‬ᆩᕻΔ‫ࠡࠫލ‬መ৫ᤘ೯Δۖլᐙ
Loperamide HCl 2mg/tabΔԫၲࡨ٣ QD ᥼խᑐ壀ᆖΙ
࿯ղ‫ױܛ‬ 2. ၌ൎַើᕪΙ֎࿯መၦࢨ‫֚ڍ‬Δঅᢞ IleusΜ
1. ᄅԫ‫ ז‬Anti-cholinergic agentΔ௽ฆࢤᙇᖗ
‫࣍ش܂‬Հ௣֏ሐΰ࿨ᆩαΔ‫ࠡࠫލ‬መ৫ᤘ೯
Trancolon ࢨਢ࿂᧑Δਚ‫אױ‬ᇞೈՀᆩષሐΰ௽ܑਢ࿨
Mepenzolate bromide
7.5mg/tab ᆩαທ‫ګ‬հᆮ࿀ΕՀ྿հ఑णΖ‫ڂ‬੡ᖲ౨լ
࠰ᓳທ‫ګ‬հঁఽٍ‫ڶ‬᛭யΙ
2. ࣹრॹ٠ณ൛ृᚨᝩ‫شࠌ܍‬Ι
Duspatalin 1. ؓᄶۜᇞ࿂᧑ᕪΔ֠ࠡኙՕᆩ࿂᧑‫ڶ‬யΙ
Mebeverine
135mg/tabΔTID use 2. ለ֟‫ࠩش‬Ιྎ៽޲‫شڶ‬መΖ
6. ࠡ‫ה‬ᆩષሐ‫ش‬ᢐΚ
Gasconΰ20mg/mlα 1. ੡੺૿੒ࢤ‫ش܂‬Δ૾‫܅‬ᆮփ௛᧯პऐհ।૿
ᗷ ᑠ Δ ‫ ګ‬Գ 3cc~5cc ്Ժۖሒ௣ऐ‫ش܂‬Ι
Dimethicone
TID ~ QID Ι ՛ ৘ 2. ‫׌‬૞‫܂‬੡ྤऄᔾՂ૪ᔾᆩષᤘ೯ඈ़௣࿾
0.1cc/kg/doseΔTID ௛հᢐढሒࠩ௣࿾௛᛭யழࢬࠌ‫ش‬Ι

ܶ‫ڶ‬ᣊࡐᔧΕ‫ైسݼ‬Ε‫ݝ֗א‬ຝ຾ᔨᢐΔ‫܂‬੡ᒷ
Proctosedyl ointΔ15g/tube
ᇞจᒈక࿀Ε௣ᆭΕಯจᒈհ᛭யΙ
Posterisan Forte ointΔ0.25%Δ10g/tube จᒈᢐፏΖܶ‫ڶ‬ᣊࡐᔧ֗ࠡ‫ה‬ᢐढΔ௣ᆭΕַ࿀Ζ
7. ࠡ‫ߗה‬ᜬౠ࿛հᢐढΚ
1. ੡ԫ‫ܓ‬ᜬᕪΔআၞᜬ‫ైۥ‬ඈइΔᝩ‫܍‬ഔᗨΔ
ࠀ‫׊‬আၞ VitB1ΔB2ΔC հ‫گܮ‬ፖᚏ៲‫شܓ‬Δ
Ursodesoxycholic
আၞ௣֏Ꭷైऱ։ࣼΙ
acid Urso
2. ਚᜯ‫׌ݩ‬૞‫ ڶ࣍ش‬Cholestasis հ൛ृΕኬ
ΰ Ursodeoxycholic 100mg/tab
ࢤߗङআᜬ‫ت‬ඈइᝩ‫܍‬ഔᗨທ‫ߗګ‬าઽჾ
acidα
႞Ε‫ڶ֗א‬ᜬሐߓอॴႾඈइլႉழࠌ‫ش‬Ι
3. ᜬሐ‫ݙ‬٤ຨႾΕ৺ࢤෳᑊࢤߗङլࡵࠌ‫ش‬Ι
1. ੡֚ྥཬढဇ࠷ढΔࠠ‫ڶ‬অᥨߗาઽΔ᡹ࡳ
ߗาઽาઽᓂΔᝩ‫ߗ܍‬าઽధჾΕআ։ࣼᜬ
Durasilymarin
Silymarin ‫֗ت‬ඈइհ‫ش܂‬Ι
150mg/cap BID~TID
2. ਚ‫࣍شױ‬৺ࢤߗङհ᎖‫شܗ‬ᢐΙ
3. ᎖‫ א‬Vit B complex ‫ױ‬ᏺ‫ף‬অߗய࣠Ι
Оࢃ෮ᙝ! 18
 ጙֽ֏‫ٽ‬ढΕ౟ौΕ๨‫ػ‬ᔆհ։ᇞᎧైΰᓼ༼ᅂα Δ
Pancreatin ‫אش‬ᇖ‫ך‬Գ᧯ౠ᦬Ꭷై։ࣼլ٤ऱൣ‫ݮ‬Δ‫֫ڕ‬๬
֊ೈౠ᦬৵հᇖ‫ך‬Ζ
1. ‫ ࠫލ‬HBV հᓤ፹Ε྇֟ߗาઽ࿇ङᡏ‫אڽ‬
֗᧜ፂ֏ऱၞ۩Ι
Zeffix 2. ᓮᇡᔹᢐࠢᣂ࣍‫ڼ‬ᢐհ࿯‫ב‬๵ࡳΙ
Lamivudine 3-TC
150mg/tabΔQD use 3. ‫ؾ‬ছਐ‫נ‬ຑᥛࠌ‫ش‬ԫ‫אڣ‬Ղᄎທ‫ݼڶګ‬ᢐ
ࢤ հ Wild type HBV Օ ၦ ᓤ ፹ Δ ᖄ ી
Secondary infectionΔࠀທ‫ڼګ‬ᢐ؈ய৵࣠Ι
!
ԶΕʳഗ‫זء‬᝔‫ش܂‬ᢐढΰMetabolism drugsαΚ
‫ء‬ᣊᢐढԼ։᜗‫ڍ‬Δԫ౳‫ ࣍ش‬Intern ࢬᏁհ primary care ऱᢐढՕી։੡ᗷ‫ݟ‬ఐ‫ش‬ᢐΕ૾ۨ౟‫ش‬ᢐΕፂ
‫ࡎה‬ΕሽᇞᔆΕ᣼ढᔆΕ‫֟֗א‬ᑇ Hormone ፹ᕪΖ

1.ΰᗷ‫ݟ‬ఐए᛭ᕪαAnti-diabetic agentsΚInsulin and Oral-hypoglycemic agentΰOHAαΚ

1. ‫ؾ‬ছ९ࢊࠌ‫ش‬ऱઃ੡Գᣊౠ୾ై፹঴Ι
2. ԫ౳ۖߢΔ‫ޢ‬໢‫ ۯ‬RI ‫ ڇאױ‬in vitroΰ᧯
؆α௜֏ 5gmΰᢐࠢᐊ 2gmΔ‫܀‬ਢࠀլ
‫ٽ‬ᜯ‫شࠌݩ‬ऱᆖ᧭αऱᆿရᗷΔਚ‫אױ‬
‫܂‬੡ૠጩᇖ‫ך‬௽௘ൣउᇖ‫ך‬ᆿရᗷழऱ
ૠጩΰᜰࠏΚ‫إ‬ൄԳ‫ڇ‬ၲԸছᆃଇᄎ࿯
ղ D5S or D0.225SΔ‫פ࣍ط‬౨‫إ‬ൄΔլ
ᄎ‫ڶ‬೏ۨᗷൣ‫ݮ‬Ιૉਢᗷ‫ݟ‬ఐ൛ृΔԫ
౳ᄎ࿯ղ D5S/D0.225S 500ccΰપܶ
Glucose 25gmαխ‫ף‬Ե 4~5 ໢‫ۯ‬ऱ RI
ΰԫ౳‫ף‬Ե 4uΔૉਢૹ৫ᗷ‫ݟ‬ఐ൛ृթ
‫ە‬ᐞ 5u ੷۟ 6uΔ‫ۨ܅߻א‬ᗷα Δ‫׌‬૞ਢ
Cover ‫ף‬Եऱຍ 25gm glucoseΖᄎ‫஁ڶ‬
ฆਢ‫ڂ‬੡ଡԳኙ RI ऱ‫شܓ‬৫լ‫ٵ‬Ι‫࣠ڕ‬
ೈԱ૞ Cover ຍࠄ؆‫ף‬ऱᆿရᗷհ؆Δ
ᝫ‫ؘ‬ႊ‫࣍ش‬ए᛭೏ۨᗷऱൣ‫ݮ‬Δঞౠ୾
ైऱၦ༉‫ؘ‬ႊ၌መຍଡଖթ‫ش܂ڶ‬Ι
3. ၞԵԳ᧯৵ऱངጩᄷঞ༉լԫᑌΖ‫ڂ‬੡
Neutral insulin ‫ޢ‬ଡԳ᧯ᔆլ‫ٵ‬Ε᧯փངጩܶ‫ڶ‬ऱۨᗷ
Human Actrapid
ΰHm RIα ᜔ၦլ‫ٵ‬Ε٦‫ף‬Ղ᧯ᔆ஁ฆΔਚԫ౳ང
ጩᄷঞ੡ 1u RI ‫ ૾אױ‬20~50mg/dL ऱ
ᑇଖΖ
4. ࠉᖕ 2Ε3 ऱᄷঞΔՕી‫אױ‬ጩ‫ࢬנ‬Ꮑհ
ౠ୾ైٝၦΰ໢‫ڻ‬α Ι
5. ᓳᖞౠ୾ైᚨ‫ א‬Finger stick ೚਍ᥛ጑ྒྷ
ࠐᓳᖞΔ‫ۨ܅܍א‬ᗷΙԫ౳ຟਢྒྷ؄੄Κ
ACΔPCΔ3pmΔand 9pmΖ‫ګޏ‬Ցࣚ૾
ۨᗷᢐհ৵Δ༉‫੄ࠟڃޏאױ‬ΚAC and
PCΖ
6. ‫ڼ‬ᕪী੡࿍யীΔ‫߰ش܂‬ຒΔ਍ᥛழၴ
լ९Ζԫ౳‫ؼ‬Հࢨਢᙩࣹ࿯ղ৵ԫଡ՛
ழ‫ܛ‬ၲࡨ‫ڶ‬ய‫ش܂‬Δࠟଡ՛ழሒ່ࠩൎ
૾ۨᗷய࣠ΔԶ՛ழ৵؈‫װ‬யԺΙਚए
᛭ડ࿇ࢤ೏ۨᗷழ඿጑ྒྷए᛭৵ய࣠Δ
ᓮՕપࠟଡ՛ழ৵٦ྒྷۨᗷΔթਢ່ᑑ
ᄷऱΖ
7. ‫אش‬ए᛭ Emergent hyperkalemiaΔ‫ء‬ᆏ
࿑৵ᄎ༼

Оࢃ෮ᙝ! 19
 1. խயী RIΔயᏝࠡኔ‫ٺ‬ী RI ݁‫ٵ‬Δഄ‫܂‬
‫ش‬ழၴլ‫ٵ‬Ι
2. ࠟ՛ழ‫ܧ‬யΔԶ՛ழሒ່೏ए᛭‫ش܂‬Δ
਍ᥛપ 20 ՛ழΙ
3. ‫ش܂࣍ط‬ለᒷΔࢬ‫א‬Ꮑ‫࣍ش‬ए᛭ DKAΕ
NPH Insulin HM
NKHS Ε or Hyperkalemia Δ ݁ ᙇ ‫ش‬
ΰNPHΚNeutral Protamine Hm Monotard
ActrapidΔլᙇᖗխ९ய‫א‬Ղ RIΙ
Hagedornα
4. ए᛭ழᚨං۷൛ृԫ֚ࢬᏁհౠ୾ై᜔
ၦΔ٦։಻੡‫ڰ‬ඡਜ‫ؚ‬Δ‫ޢ‬ԫ‫ڻ‬ਜ‫ؚ‬٦
ေ۷ Actrapid and Monotard հֺૹΙ
5. ࢬ‫ۨ૾ڶ‬ᗷᢐढຟԫᑌΔૉທ‫ۨ܅ګ‬
ᗷΔ݁‫ױ‬Ցࣚᗷ࣠ࢨࣹ୴ᆿရᗷֽᇞೈΖ
1. ᄅԫ‫ ז‬Sulfonylureas ᢐढΔயᏝൎΔ‫܂‬
‫ش‬९Ι
2. ‫ء‬ᣊᢐढ‫׌‬૞ᏺ‫ף‬ౠ᦬ Beta-cell ։ࣼౠ
Glidiab ୾ైΖࢬ‫ ڶ‬OHA ݁ኙ Type 1 DM ྤயΜ
Glipizide
5mg/tab 3. ‫࣍ط‬ਢᏺ‫᧯ף‬փౠ୾ైհ։ࣼΔਚ‫ڼ‬ᣊ
ΰGlydiazinamideα
QD ၲࡨ࿯ղΔAC use ᢐ ढ መ ၦ ࣚ ‫ ش‬ᄎ ທ ‫ ٲ ګ‬ᙠ ऱ
HypoglycemiaΙ
4. ‫ٵ‬ᣊᢐढ‫ڇ‬९ࢊࡸ‫ ڶ‬GlimepirideΔՈ‫ڶ‬
Գࠌ‫ش‬Ι
1. ‫ء‬ᣊᢐढኙౠ᦬։ࣼౠ୾ై‫ݙ‬٤޲‫ڶ‬ᐙ
᥼Ι
2. ‫ڤֱش܂‬ᏺ‫ ף‬Glucolysis ข‫س‬౨ၦ‫֗א‬
Glucophage
‫ ࠫލ‬GlucogenesisΔᏺ‫ף‬ၜᢰኙ౨ၦऱ
500mg/tab
Metformin ሎ‫אش‬ሒࠩ૾ۨᗷ‫פ‬౨Ι
ԫ౳੡ 1# BID PC ၲ
3. ‫ڂ‬੡ࠡ‫ڤֱش܂‬լᐙ᥼᧯փౠ୾ైհ։
ࡨ࿯ղ
ࣼΔਚլᄎ֧ದ‫ٲ‬৺ऱ HypoglycemiaΙ
ਚ‫ؾ‬ছ‫ڶ‬ԫጟ‫ۨ܅‬ᗷ྇ॅऄ‫ܛ‬ਢ‫ش‬
Metformin ೚‫׌‬ᢐΙ
1. ᥆ ࣍ ᄅ ऱ ᢐ ढ Δ ‫ ش ܂‬੡
Alpha-glucosidase ᤁञࢤ‫ױ‬ಭ‫ࠫލ‬ᕪΔ
Glucobay
‫࢏אױ‬ᙈᗷᣊ‫ڇ‬՛ᆩऱ։ᇞΔ‫࢏ܛ‬ᙈ‫ܮ‬
50mg/tab
‫گ‬Ι
Acarbose ԫ౳ 1# TIDΔ塊ছࢨਢ
2. ࠉᅃࠡ௽ࢤΔᇠᢐ‫׌‬૞ऱ‫ش܂‬੡྇ᒷ堩
಻‫ٽ‬ၞଇনᅷԫ‫ࣚٵ‬
৵ۨᗷ֒೏ऱຒ෷Ζ‫ࠄڶ‬൛ृ堩৵ۨᗷ
‫ش‬
ᄎડྥ֒೏Δ‫ڼאאױ‬ᢐ൳ࠫΙਚ‫ױ‬໢
ᗑࠌ‫܂ࢨش‬੡ࠡ‫ה‬ᢐढհ᎖‫ܗ‬ए᛭Ζ
ࣹრΚ
1Η๠ᆜ DKA or NKHSΰHHNKα ΚAdequate hydration with insulinΰActrapidα supplementΙJusomine
use if pH<6.9Ι
2Ηྎ៽ኙ࣍ Type 2 DM ऱए᛭ RegimenΚGlipizide 1# QDÆ1# BIDÆΰGlipizide 1# TIDα or
ΰGlipizide 1# BID + Metformin 1# TIDαÆ Glipizide 1# TID + Metformin 1# TIDÆ Glipizide 2#
BID + Metformin 1# TIDÆ Glipizide 2# TID + Metformin 1# TIDΰwith or without bolus Acarboseα
ÆShift to RI
2. ૾ۨ౟‫ش܂‬ᕪΚ

1. ૾‫ ܅‬CholesterolΕTriglycerideΕLDLΕ
Lopid VLDL ‫༼֗א‬೏ HDLΰ‫ړ‬ऱᜬࡐᔧα Ι‫א‬
Gemfibrozil
300mg/capΔTID use ૾‫ ܅‬Atherosclerosis ऱ riskΙ
2. ᓮ೶ᔹ೜অ࿯‫ב‬๵ࡳΙ

Оࢃ෮ᙝ! 20
 1. ੡ԫ HMG-CoA ᝫ଺Ꭷైհറԫ‫ࠫލ‬
ᕪΔ‫ش܂‬ᣊ‫ ۿ‬GemfibrozilΔഄኙ࣍૾‫܅‬
LDL/Chol ratio and ༼ ೏ HDL/Chol
ratio ‫ޓڶ‬೏ऱ‫ش܂‬Δਚլ‫܀‬੡૾ۨ౟ᢐ
ढΔ‫ڶޓ‬ய૾‫ ܅‬Atherosclerosis ऱ riskΙ
Ι
Zocor 2. ԫឍല२նԼցΔਚ‫ٵ‬ᑌ೶ᅃ೜অ࿯‫ב‬
Simvastadin
20mg/tab QD or HS ๵ᒤΙ
3. ࡸ‫ הࠡڶ‬Stadin ᣊᢐढΔ݁‫ڶ‬᠔ஃࠌ
‫ش‬Δ஁ܑ‫ڇ‬ୌྎ៽լ堚ᄑΔ‫ڂ‬੡ྎ៽ᇿ
‫່ה‬ᑵΔਚຟ‫הش‬Ι
4. ‫ڶ‬ழᄎข‫ۚۜس‬Ꭸ࿀ऱ೫‫ش܂‬Δ੷۟ທ
‫ ګ‬RhabdomyolysisΔਚႊࣹრΰ֟ߠαΙ

3. ሽᇞᔆᢐढΰElectrolytesα
Κտฯൄ‫ش‬ऱሽᇞᔆᇖ‫ך‬ᕪ֗૾‫܅‬ᕪΔࠀ១૪ԫࠄ Emergency ऱ๠ᆜΖ
1. ‫ ॺ ࣠ ڕ‬ᣤ ૹ Hyponatremia Δ ‫ ׽‬Ꮑ ‫ش‬
Normal saline ᒷኬᇖ‫ױܛך‬Ι
Normal Salineΰ0.9%α
2. ՛ࠝઝࣹრΔᏁૠጩᇖ‫ך‬ၦΙ
Sodium Chloride
3. ૉ੡ HypernatremiaΔ‫׌‬૞ࠌ‫ش‬ԫࠄॺሽ
NaCl 10%ΰ֟‫ ش‬α
ᇞ ᄫ ෈ ΰ ‫ ڕ‬D5W α ࢨ ਢ ‫ ش‬Lactated
Ringer’s Solution ࠐ೚᧯෈࿕ᤩΙ
‫࣍ش‬৺ࢤ‫ז‬᝔ࢤᎨխ੅հᇖ‫ך‬Ζ១໢ጩऄ੡Κ
ABG ࢼ‫נ‬৵ HCO3 ऱଖ੡ XΔঞႊᇖ‫ך‬
Jusomin
Sodium Bicarbonate ΰ24-Xα/2 ຍᏖ‫֭ڍ‬ΖᜰࠏΔૉਢ
JusomineΚ
7% 20mL
HCO3=12Δঞႊᇖ‫ך‬ΰ24-12α/2=6 ֭Ιࠡ
խԫ‫ת‬ΰ3 ֭αIV pushΔ‫׼‬ԫ‫ת‬ঞ Slowly dripΖ
1. ࠌ‫ ش‬KCl ႊࣹრΔ݁੡‫ף‬Եរዠ‫ץ‬խᒷ
ኬࣹ୴Ζ
2. ԫ౳‫إ‬ൄԳ‫֚ޢ‬Ꮑ‫ޣ‬પ 40Д60meqΙᗷ
‫ݟ‬ఐΕ೏ۨᚘ൛ृΔᓮ൳ࠫપ 40meq ‫ܛ‬
‫ױ‬Ι࿽ಐጣ൛ृᕣၦլ૞ᠰ؆ࣹ୴ KClΙ
3. ᅝေ۷ Hypokalemia ൣउດዬ‫ޏ‬࿳ழΔ
‫ شޏ‬Slow-K ՑࣚԿ֚ؐ‫׳‬Ι
4. ԫ౳ Hypokalemia ᄎ‫נ‬෼֨෷լᖞΰ֟
ߠαΔለൄߠᆩᤘ೯྇ᒷΙ
5. Hyperkalemia ঞਢ‫נ‬෼֨൬Ε֨ሽቹխ
‫נ‬෼ Tent-TΰT ं೏৫၌መ R ंԿ։հ
ԲαΙ
KCl ΰ 20meq/10mL Δ 6. ए᛭ Emergency Hyperkalemia ‫ڶ‬༓
IVFα ጟֱऄΚ
Potassium Chloride aΗࠌ ‫ ش‬RI 5 Д 10u ‫ ؼ‬Հ ࢨ ਢ IV/IV
Slow-Kΰ250mg/tabΔ dripΖRI ‫אױ‬ലሧᠦ՗ shift ۟าઽ
TIDα փΔ‫෈ۨ܅૾ڼڂ‬խሧᠦ՗ऱᖺ৫Ζ
ࣹრΔᏁਊᅃհছ༼መऱ଺ঞૠጩࢬ
Ꮑऱ GlucoseΔԫࠓ࿯ղΔᝩ‫ۨ܅܍‬
ᗷΙ
bΗࠌ‫ ش‬Calcium gluconate ࣹ୴Ζຍਢ
ᣤૹ೏ۨሧழࠌ‫ش‬Δ‫ش܂‬ፖ RI ઌ
‫ٵ‬Δ‫܀‬ਢ‫ݶش܂‬Ζຏൄᄎ‫ڶ‬
Hyperkalemia ऱ ൛ ृ ຏ ൄ Ո ‫ڶ‬
HypocalcemiaΖ
cΗ Sodiume bicarbonateΚለ֟‫ش‬Δ‫ڂ‬
੡ய࣠լ‫ ڕ‬Calcium injectionΖ‫ش܂‬
‫ ٵ‬RIΖ
7. ‫א‬ՂԿጟֱऄ݁੡ല K shift ۟าઽփΔ
Оࢃ෮ᙝ! 21
 ۖࠀ޲‫ڶ‬ᒔኔലሧඈ‫᧯נ‬؆Δ‫ڼڂ‬ᔞ‫ش‬
࣍৺ࢤཚए᛭Δ࿛ Underlying ംᠲᇞެ
৵۞ྥ‫਀אױ‬༚Ζ‫܀‬ਢ‫࣠ڕ‬ਢ࿽ಐጣ൛
ृΔመ‫ڍ‬ሧᠦ՗ԫᑌඈլ‫װנ‬Δঞ່‫ړ‬
ऱ ֱ ‫ ڤ‬ਢ ੑ ࿽ Ι ‫ ڼ‬؆ ‫ ش ࠌ א ױ‬Fleet
enema + Calcium polystyrene
sulfonate powderΔ࿯ղᥒᆩΖհছᎅ
መ Fleet enema ੡೏ၩֽᕪΔ‫ף‬Ղၩృ
৵ᥒᆩΔ‫אױޓ‬ല᧯փऱሧᠦ՗ Shift ‫נ‬
᧯؆Δሒࠩඈइய࣠Ζ
Calcium Polystyrene Kalimate ‫׌‬૞‫࣍ش‬ኬࢤ೏ۨሧ఑ࢨਢॺጹ৺೏ۨሧհ
Sulfonate 5g/pk ൳ࠫΖ

1. ࣹ ୴ ࢨ ਢ Ց ࣚ Δ ‫ ࣍ ش‬Correct
Calcium Chloride 5%Δ20ml/amp hypocalcemiaΙ
Calcium Gluconate 10%Δ10ml/amp 2. ‫࣍ش‬ए᛭೏ۨሧΙ
3. ‫܂‬੡ Magnesium խ੅հᇞ੅ᕪΙ

1. ‫ ࠫލ‬Osteolysis cell ऱ‫ګس‬ፖ‫ګ‬ᑵΔ‫ڂ‬

ۖ‫ ࠫލ‬Osteolysis ऱ‫ش܂‬Ι
Aredia 2. ᜯ‫࣍شݩ‬೎ᛮ֧ದऱ೏ۨၩ఑Ε՛৘‫ګ‬
Pamidronate disodium
15mg/5mL ೎լ٤ऱए᛭Ι
3. ԫ‫ڻ‬ए᛭Ꮑ‫ګڶֱ֚ڍ‬யΙ
4. ຏൄࣹ୴৵୲࣐‫נ‬෼࿇ᗈऱൣ‫ݮ‬Ι

1. ᇡ઎รԼԿ଄ΔAntiepileptic drugsΙ
Magnesium sulfate 10%Δ20ml/amp 2. ԫ౳ൄ‫ ࣍ش‬Torsades de Pointes հए
᛭Ι
1. ए᛭ԫ౳՛෺ࢤຆۨΕ༞ࢤຆۨ݁‫ڶ‬யΙ
Ferrous Gluconate 200mg
2. ԫ౳੡ 1# TID ࣚ‫ش‬Ι
+ Vit B12/Vit C/Folic Cytron
3. ྎ៽฾ክ‫ڶڇ‬ለᣤૹᛜ塄౒‫׎‬ऱ൛ृΔ
acidΔetc
թࠌ‫ءش‬ᕪΙ
Ferric Polymaltose ໢ొᥳᕪΔ1# QD ࠌ‫ش‬Ζྎ៽ለൄ‫ش‬ᇠᢐΖ

1. ᓤֱհܶᅺᄫ෈Ζ
2. ‫ ࣍ ش ױ‬ए ᛭ Exophthalmos thyoid
goiterΙ
Lugol’s Solution
3. ௽ܑ‫ظ࣍ش‬णᆯ֫๬ছԫଡִΔ਍ᥛࣚ
‫ش‬Δ‫ظ܅૾אױ‬णᆯհ‫ז‬᝔෷Δ྇֟
VasculatureΔ‫א‬ᒔঅ֫๬ழ‫ۨנ‬౨૾‫܅‬Ι

4. ፂ‫הࠡ֗ࡎה‬᣼ढᔆΚԫ౳ఐࢪ֟‫ش‬Δႛ༉ൄߠ‫܂‬տฯΖ
1. ੡‫ګٽ‬հ Vit B1Ι
Prosultiamine Alinamin 2. ‫ڇ‬ఐࢪࠌ‫׌ش‬૞ਢ‫אױ‬ᒷᇞԫࠄ壀ᆖᎨ
Fursultiamine Alinamin-F ຾఑णΔ֠ࠡਢ֏᛭֧ದհ؄ॆ‫أ‬ጤ຾
ᅤΔ‫אױ‬ᇢ‫ش‬઎઎Ι
1. ԫ౳‫֫ڇ‬๬ࢨਢࠡ‫ڂ଺ה‬९ཚᆃଇழࠌ
‫ش‬Ι
2. ຏൄࣹԵរዠխᒷኬࣹ୴Ι
Vitamin B complex
3. Ո‫࣍شױ‬ቃ߻಺壄‫ݹ‬ឰข‫֤س‬ᤚΕ壀ᆖ
੅ࢤհቃ߻Δਚຠ಺൛ृૉᏁ९ཚ۰ೃ
‫ױ‬࿯հΙ

Оࢃ෮ᙝ! 22
 1. ‫࣍ش‬९ཚᆃଇ൛ृհᇖ‫ך‬Ι
Vitamin CΰAscorbic acidα
2. Demerol-C հࠌ‫ش‬Ι
1. ᓳᆏ՛ᆩ‫گܮ‬ၩհ౨ԺΔআၞ೎ᙽ᣼ढ
Calcitriolΰ੒ࢤ Vit D3α
֏Ι
CalciferolΰVitamin Dα
2. ‫࣍ش‬೎ᔆงᠾ఑Ι
1. ࠌ‫ ش‬TPN հ൛ृࠟၜࣹۜۚ୴ԫ‫ڻ‬Ι
Vitamin K 2. ‫ ࣍ش‬Coumadin ທ‫ګ‬հ‫ۨנ‬Δհ৺ࢤए
᛭ᕪΙ
5. ࠡ‫ה‬ൄ‫ ش‬Hormone ፹ᕪΚ
1. ‫࣍ش‬ੑ࿽൛ृΔ‫ڂ‬९ཚ࿽ಐጣழ࿽᦬፹
ທદۨ෺‫ైګس‬ᖲ౨Հ૾ΔᖄીຆۨΔ
ਚ৬ᤜᇖ‫ך‬Ζԫ౳੡ԫၜࠟ‫ڻ‬Δ‫ ٺ‬3000U
Epoetin BetaΰEPOα IMΙՈ‫ޢאױ‬ၜԫ‫ڻ‬Δ5000U IMΙ
2. Vit B12/Folic acidΙCalciumΙand EPO
‫ٽ‬ጠੑ࿽ԿᣪΔ੡ੑ࿽൛ृᚨᇠ૞ᇖ‫ך‬
ऱ‫ؘ‬ໂ঴Ι
Steroid ᇡ઎ַ࿀᎖‫ܗ‬ᕪΙ
1. ए᛭‫ڣޓ‬ཚլᔞΕ೎ᔆงᠾ఑Ε
2. ኙ࣍ᖲ౨ࢤ՗୰‫ۨנ‬հַۨ‫ڶ‬ᚥ‫ܗ‬Ι
Premarin
Conjugated Estrogens 3. ԫ౳೚‫ݙ‬٤՗୰֊ೈհ൛ृΔ‫אױ‬࿯
0.625mg/tab
ղΔ‫ڂ‬੡‫࣍ܗڶ‬႞Ց័‫ٽ‬Ι‫܀‬ਢ՗୰‫آ‬
֊ೈृΔլ‫شױ‬Δ‫ױڂ‬౨ທ‫ۜګ‬ᒆᏺ‫س‬Ι
1. ႓᧯ై፹ᕪΙ
Medroxyprogesterone Provera
2. ‫࣍ش‬՗୰փᓂฆ‫ۯ‬Ε࿛հए᛭ΰࣄዙΔ
Acetate 10mg/tab
ྎ៽ᇿ‫ה‬լᑵα
1. ႓᧯ైፖ೯ൣᖿైհ෗‫ٽ‬፹ᕪΙ
Cohormon 2. ‫֫ൃܜ࣍ش‬๬৵հ৺ࢤೖᆖ఑ଢᆢΔԫ
1ml/amp ౳ IM ࿯ղԫᕪ‫߰אױ‬ຒᇞೈլᔞ఑णΔ
਍ᥛࠟၜΙ
Calcitonin Miacalcic ‫ظ‬णᆯհ૾ၩైΔ‫࣍شאױ‬ए᛭೎ᔆงᠾ఑Ζ

1. ᆰি᧯৵ᆺ։ࣼհᖿైΰೈ‫ۨװ‬ጥ‫ף‬ᚘ
ైα
Ι‫ࠨאױ‬ᖿ՗୰๵৳‫گ‬ᜍΔ‫܂‬੡ႝข
Piton-S ‫ش܂‬Ι
Oxytocinΰႝขైα
10U/ml/amp 2. ‫࣍ش‬՗୰ۜᒆ֊ೈছ৵հࠌ‫ش‬Δ‫אױ‬ᏺ
‫ף‬՗୰‫گ‬ᜍΔሒַࠩۨ‫ؾ‬ऱΰ՗୰հ۞
࿇ࢤַۨਢᔾ୰ᜍሒ‫ګ‬ऱα
Ι

1. ੡‫ګٽ‬հ VasopressinΙ
2. আၞ՛ᆩპۨጥ‫گ‬ᜍΔ‫א‬ીߗ॰ᙩ౧‫ڃ‬
ੌ྇֟ۖ૾‫ߗ܅‬॰ᚘԺΔ‫ش܂‬਍ᥛΔ֟
֨᦬೯౧೫‫ش܂‬Δ‫ַۨ׊‬រ௽ฆΔਚԼ
։‫شړ‬Ι
Glypressin
Terlipressin 3. ‫ ׌‬૞ ‫ ࣍ ش‬Esophageal and Gastric
1mg/vial
varicesΰଇሐ֗ષᙩ౧ᒆα‫ۨנ‬Ζ‫ڂ‬ኬ
ࢤߗ࿏֏൛ृߗ॰౧ߓอ਍ᥛ೏ᚘΔ୲
࣐ທ‫ ګ‬Varices ऱข‫س‬ፖ‫ۨנ‬Ζਚጹ৺ַ
ۨ‫شױ‬ᇠᢐ঴Ι‫ڕ‬੡Օၦ‫֘ྤۨנ‬ᚨΔ
‫׽‬౨‫܂‬ષᢴַۨΖ‫ ڇ‬GI փઝൄ‫ش‬Ζ

Оࢃ෮ᙝ! 23
 ԰Εʳ֨᦬ۨጥߓᢐढΚ
Ϩʳ‫׌‬૞տฯ೏ۨᚘए᛭ᢐढΰ‫ܶץ‬ൄ‫ݟܓش‬ᕪα
Εൎ֨ᕪΰ‫ܶץ‬গण೯౧ឩ്ᕪα
Εᆰۨጥឩ്ᕪΕ
‫ݼ‬ᕩۨᕪፖַۨᕪ࿛Ζ
Ϩʳԫࠄ‫࣍ش‬ጹ৺ए᛭֨৳լᖞᢐढ‫ ڕ‬Adenosine ࿛‫ࣙ֗א‬ᚘΕ֨৳‫ף‬ຒᕪΰ‫ ڕ‬EpinephrineΕ
DopamineαΔᓮᇡߠ ACLS ՛֫‫ם‬Δ‫ء‬๠լ٦᠇૪Ζ
1. ൎ֨ᕪ֗ԫ౳অ֨ᕪΚ
ᢐढ‫ټ‬ ೸঴‫ټ‬ΰ९ࢊൄ‫ृش‬α ១૪֗ࠌ‫ش‬ழᖲ
1. ᜯ‫ݩ‬Ղլ৬ᤜՕ୮‫ڶڇ‬ᓤᠧփઝൣउհ൛
ृࢨਢࡸլᑵ൜ᇠᢐढΕլ堚ᄑ൛ृਢ‫ܡ‬൓
墿࣍ᇠᢐհൣ‫ݮ‬Հ۞۩‫ދ‬ፖΖᚨᐛᇬ‫׌‬ए᠔
ஃΕ۰ೃ᠔ஃհრߠࢨਢᅃᄎ֨᦬փઝറઝ
᠔ஃΰ‫ڂ‬੡‫ڇ‬փઝՕ୮ֺለ堚ᄑຍଡᢐΔ૞
‫ޣ‬ᄎለᣤ௑Ιࠡ‫ה‬ઝჶլ‫ړ‬Օ୮ຟ޲‫شڶ‬
መΚ
2. ԫ౳٣ stat Loadingΰ‫ ش‬IV ಾᕪα2 ampsΔ
հ৵਍ᥛՑࣚ 1# QDΔԫၜ጑ྒྷԫ‫ڻ‬ᢐढᖺ
0.25mg/tab ৫Ι
Digoxin
0.25mg/ml/amp 3. ‫׌‬૞੡‫ף‬ൎ֨ۜ‫گ‬ᜍ౨ԺΔ࢏९‫ش܂‬ழၴΔ
‫ޏ‬࿳֨ಐጣ఑णΙ
4. ᎘৫խ੅‫׌‬૞੡ GI upsetΔ‫ڕ‬ଇᐥլ஡Ε⭫
֨Εቭ‫ٷ‬Εᆮ࿀Εᆮើ࿛Ι
5. ࠌ‫ءش‬ᢐ່ࢢທ‫ ګ‬HypokalemiaΔਚፖᛩ‫ܓ‬
‫ݟ‬ᕪࠀ‫ࢨش‬ਢ Amphotericin Bΰ‫᧶ݼ‬ပ‫سݼ‬
ై α ੡ Contraindiation Ι ᣤ ૹ ທ ‫ګ‬
ArrhythmiaΙ
6. ‫ڕ‬Ꮑࠀ‫ش‬ຍࠄᢐढΔᓮ጑ྒྷሧᠦ՗ᖺ৫ࠀ‫׊‬
Continuous K supplementΖ
1. ੡ Xanthine հ૜‫س‬ढΔ‫׌‬૞੡ᏺ‫ף‬࿽࿭෺
ዶຘ౨Ժ֗ՠ‫܂‬෷Δਚ‫אױ‬ᒷᇞ֨᦬֗ၜᢰ
ֽ ዩ ఎ ऱ ൣ उ Δ ࠀ ‫ ֟ ྇ ׊‬Pulmonary
hypertensionΕPulmonary edema ऱൣ‫ݮ‬Δ
᥆࣍‫ࢤݟܓ‬ൎ֨ᕪΙ‫ࠃ܀‬ኔՂ‫ݟܓ‬ய࣠޲‫ڶ‬
ԫ౳‫ݟܓ‬ᕪ߷ᏖൎΙ
2. ‫ڰ‬ཚ‫א‬੡ᇠᣊᢐढႛ‫ش܂ݟܓڶ‬Δਚ֟‫ش‬Ι
‫܀‬ਢ෼‫ڇ‬ᎁ੡‫ڼ‬ᢐढ‫ݼڶ‬࿇ङ‫ش܂‬Δငᒷࡅ
‫ܮ‬Ε༛ᛩߓอհ‫ش܂‬ΰᖲࠫլࣔαΔਚ‫ؾ‬ছ
ॺൄൄߠΙ
3. ਚ‫ؾ‬ছ‫׌‬૞ࠌ‫ڼش‬ᢐढ‫܂‬੡ኬࢤ֭௛ጥ
ङΕCOPDΕAsthmaΕEmphysemaΕࢨਢ
100mg/tab
Aminophylline ‫ॄڶ‬೏ᚘΕॄֽᆭ൛ृհ९ཚ൳ࠫ‫ش‬ᢐΙ‫ڂ‬
250mg/10ml/amp
੡ Aminophylline ੡ಾᕪΔਚ‫ڼ‬ᢐ‫࣍ش‬۰ೃ
൳ࠫ‫֗א‬৺ࢤཚհࠌ‫ش‬Ι‫ڶ׼‬ՑࣚհᢐढΙ
4. ࠌ‫ֱش‬ऄΚ1 amp in D5S or D5W or N/S
500ccΔrun 60cc/hr ੡ standard dosageΙ
ࢨਢᖜ֨‫ ڶ‬Fluid overload ऱൣ‫ݮ‬ழΔ2 ֭
‫ ף‬500cc run 30cc/hrΖࣹრΔᏁჸ಻ IVAC
ΰࡳၦ IV pumpαࠌ‫ش‬Δ‫ڶ‬Ꮑ૞٦ᓳ೏ੌຒ
‫ױܛ‬Ζ
5. ೫‫ش܂‬ΚൄߠΜΜ‫׌‬૞੡ଇᐥլ஡Ε⭫֨Ε
ᆮើΕ‫֗א‬ᆮ࿀ΖᏁ጑ྒྷۨ෈ᖺ৫Δᝩ‫܍‬խ
੅Ζፖ Digoxin ჸ಻Ꮑ՛֨ Hypokalemia ‫א‬
֗೫‫ףش܂‬ൎΖ

Оࢃ෮ᙝ! 24
 1. ‫ ٵ‬AminophyllineΔ஁ܑ‫ڼ࣍ڇ‬ᢐ੡Ցࣚᕪ
Thoin SRΰ࿍யα
ীΙ
Theophylline 125mg/cap
2. ԫ౳ࠌ‫ ش‬Theolan 1# QD ‫ױܛ‬Ι
anhydrousΔ SR/LR Theolanΰ९யα
3. ኙ࣍ࢬ‫ڶ‬ኬࢤॄࢨਢ‫ॄڶ‬ᛮΕ௛໙ऱ൛ृઃ
200mg/cap
‫شࠌאױ‬Ι
1. Theophylline and Choline 1Κ1 ෗‫ٽ‬Δ‫ݟܓ‬
‫ش܂‬ለ໢ᗑ Theophylline ‫ړ‬Ι
Qxtriphylline
2. ԫ౳ఐࢪለ֟‫ش‬Δ‫׌‬૞ਢ౥࿺ઝ᠔ஃᄎࠌ
‫ش‬Δ‫ߠ֟܀‬Ι
1. ࿎ഗ֏‫ٽ‬ढ݁‫ڶ‬ឩ്গण೯౧ऱ‫شפ‬Δ‫شױ‬
࣍֨࿧࿀հए᛭ࢨਢ৺ࢤ֨ۜ඲Ⴞऱ᎖‫ܗ‬
‫ش‬ᢐΙ
ঋ ጠ එ ֨ ΰ NTG
Nitroglycerin 2. ۡՀׂܶΔԫ౳ 2 ։ᤪ৵఑णᒷᇞΔՑࣚய
Ιٍ‫୴ࣹڶ‬
sublingualα
ΰGlyceryl Trinitrateα ࣠஁Ι
෈֗‫ؼ‬ᓅ၀ׂ
3. ࣹრᙰᄉΕ‫ۨ܅‬ᚘΕᙰ࿀Εᜭᑪદऱ೫‫ش܂‬
ΰ݁‫ڂ‬੡ۨጥឩ്ທ‫ګ‬α Ι‫گ‬ᜍۨᚘ‫ ࣍܅‬95
‫א‬Հृ່‫ړ‬լ૞ࠌ‫ش‬Ι
1. ‫ٵ‬ᑌ‫ڶ‬গण೯౧ឩ്‫ش܂‬Δ‫܀‬ᒷኬ‫׊‬լൎ
Isordil
Isosorbide Dinitrate ௺Δ‫׌‬૞‫܂‬੡ቃ߻֨࿧࿀ऱ࿇‫س‬Ι
10mg/tabΔTIDДQID
2. ՛ၦऱᙰ࿀೫‫ش܂‬Δ९ཚࠌ‫ش‬௣؈Ι
Isosorbide Imdur
‫ ٵ‬IsordilΔ൫‫ش܂‬ለ߰ຒ‫׊‬९யΙ
Mononitrate 60mg/tabΔ0.5~1# QD

1. ‫ٵ‬ᑌ‫אױ‬ឩ്গण೯౧Δሒࠩᒷᇞ֨࿧࿀ऱ
‫ؾ‬ऱΙ‫܀‬ਢለ֟ࠌ‫ڼ࣍ش‬Ι
2. ‫ڶ࣍ط‬ൎ௺ऱᆰ‫أ‬ණ೯౧ឩ്‫ش܂‬Δਚ‫ڇ‬९
Persantin ࢊ‫ޢ‬ԫ‫ۯ‬ᆰ඲Ⴞխଅ൛ृ݁ Routine ࿯ղ
Dipyridamole 25mg/tab TID PersantinΙ
75mg/tab BID 3. ॣࡨᕪၦᓮ‫ ش‬25mg TIDΔ‫ܡ‬ঞঅᢞఐԳᙰ
࿀ᨃ‫א܃‬੡‫ה‬ԾխଅԱΜΜΜ
4. ‫ڶڕ‬ᙰ࿀఑णᓮ྇ၦΔ‫ַش‬࿀ᕪய࣠լࠋΙ
5. ࣹრ‫ۨ܅‬ᚘΙ

2. ೏ۨᚘए᛭ᕪΚ։੡ AΕBΕCΕD ؄ଡ CategoryΔ‫ڶٺ‬ᚌ౒រΖ

A ΚACEIΰAngiotensin-Converting Enzyme Inhibitorsαand A2AΰAngiotensin II antagonistαΖ

1. ੡९ࢊൄ‫ش‬ऱ ACEI ᣊᢐढΙ

2. ೈԱ Capoten ੡ԫ֚Կ‫אڻ‬؆Δࠡ塒੡९ய
ীΔQD ࠌ‫ױܛش‬Ι
3. ‫ࣙࠫލ‬ᚘై I ᠏᧢‫ࣙګ‬ᚘై IIΔਚ‫ױ‬ሒࠩ૾
ۨᚘ‫ش܂‬Ι
Captopril Capotenΰ25mg/tabα
4. ‫ء‬ᢐढ່Օᚌរ੡‫אױ‬ፖฒ‫ڍ‬ᢐढࠓࣚΔ޲
‫ڶ‬ᣤૹ٤ߪ೫‫ٲ֗ش܂‬ᙠΙፖ‫ݟܓ‬ᕪࠓࣚய
Enalapril Renitecΰ20mg/tabα
࣠‫ࠋޓ‬Ι
5. ່ൄߠऱ೫‫ش܂‬੡যቬΰપ 25%ऱ൛ृαΔ
Fosinopril Monoprilΰ10mg/tabα
ᄎ‫נ‬෼೓যणउΔਚ‫ڶ‬যቬ൛ृྎ៽༉լ࿯
ຍᢐԱΙ
6. ᔞ‫࣍ش‬ኬࢤ൳ࠫΔ৺ࢤ೏ۨᚘ࿯ຍᢐ޲‫ڶ‬რ
৸ΙਚඡՂଖఄ൛ृડྥۨᚘᡨ೏Δլ૞‫ش‬
ຍԫᣊऱᢐढΖ

Оࢃ෮ᙝ! 25
 1. ੡ A2A ऱᢐढΔլ‫ ࣍ٵ‬ACEIΔ‫ڂ‬੡֒ᚘై
II ս‫אױ‬ൕࠡ‫ګسֱچה‬Δਚ‫ڶ‬ழ ACEI ய
࣠լ᧩ထΙ‫ڼ‬ᣊᢐढ‫אױ‬௽ฆ‫ࣙࠫލ‬ᚘై
IIΔሒࠩ൳ࠫۨᚘΙ
Losartan Cozaarΰ50mg/tabα
2. ݁੡९யীΔQD ࣚ‫ش‬Ι
3. ‫ޓ‬ՕऱᚌរΔਢᇠᣊऱᢐढ༓‫ྤ׏‬೫‫ش܂‬Δ
Valsartan Diovanΰ80mg/tabα
੷۟‫ڶ‬ઔߒਐ‫נ‬ᇠᢐऱ೫‫ش܂‬՛࣍
PlaceboΜΜΜΛ
4. ‫ٵ‬ᑌΔ‫࣍ش‬ኬࢤ൳ࠫΔլᔞ‫ٽ‬৺ࢤཚΙ
5. ৰ၆Δឈྥྎ៽໛ᦟΔ‫܀‬ਢᓮ᠃შၲ‫م‬Ι
B Κ Beta-blocker ΰլ‫ ׽‬Beta-blockerΔࢬ‫ ڶ‬Sympathetic inhibitorΔܶ Alpha ݁ጩα
AlphaΚၜᢰۨጥឩ്Δທ‫ۨ૾ګ‬ᚘ BetaΚ ֨᦬ຒ෷྇ᒷΔᖄી૾ۨᚘΙ
1. ੡ Beta blockerΔ‫ڂ‬੡ࠠ֨᦬ᙇᖗࢤΔኙ࣍
௛໙൛ृለլࠠᐙ᥼Ιΰ‫܀‬ਢྎ៽฾ክኙ௛
໙൛ृངܑጟᢐढΔ‫߻א‬ᆄԫΔ‫ڂ‬੡
Beta-blocker ᄎທ‫ګ‬௛ጥ‫گ‬ᜍα Ι
Propranolol HCl Inderalΰ10mg/tabα 2. ࣹრ BradycardiaΙ
3. ԫ౳‫إ‬ൄԳ༓‫׏‬լᄎທ‫ ګ‬A-V blockΔ‫܀‬ਢ
Atenolol Ateolΰ100mg/tabα ‫ߪء‬੡ 2nd/3rd degree AV block ऱ൛ृᆃ
‫ش‬Ι
Carvedilol Dilatrendΰ25mg/tabα 4. ԫ౳լᐙ᥼֨ᙁ‫ۜ֨֗נ‬ൎ৫Δਚ֨ಐጣ൛
ृឈս‫شࠌאױ‬Δ‫܀‬ႊࣹრ Bradycardia ທ
‫ګ‬ऱ CHFΙ
5. ‫ڂ‬੡૾ ૾‫֨܅‬෷Δਚ‫ۜ֨࣍شאױ‬඲Ⴞհ᎖‫ܗ‬
᛭ऄΰ‫܅૾ڂ‬౛௜αΙ
1. ੡ Alpha and Beta blockerΔࠠ‫ڶ‬௽ฆࢤ‫܂‬
‫ش‬Δԫֱ૿ partial Alpha blocker ᖄીۨጥ
ឩ്Δԫֱ૿ Beta blocker ॴַ֨෷‫ז‬ᚍࢤ
֒೏Δਚ‫ףڶ‬ଊ‫ش܂‬Ι
2. অ‫ڶ‬ৎኪࢤۨᚘᓳᆏ‫פ‬౨Ι
Trandate
3. ࣹ୴ᕪী‫ ڶ࣍ش‬Hypertensive crises ऱழ
Labetalol HCl 200mg/tab
ଢΔࣹ୴ழၴᓮ೭‫ؘ‬Օ࣍ 2 ։ᤪΙ
25mg/5ml/amp
4. ࠡ‫ࣹה‬რࠃႈ೶ᅃ AtenololΙ
5. ឈࠠ‫ۨڶ‬ጥឩ്‫פ‬౨Δ‫܀‬ኙᆰ೯౧ᐙ᥼ለ
֟Δ‫܀‬ਢ່ದᒘլᄎທ‫ګ‬ᆰۨጥ‫گ‬ᜍΔਚ‫ش‬
࣍඲ ඲ Ⴞࢤᆰխଅ൛ृհ೏ۨᚘ‫ٲ‬ွΙᝩ‫܍‬
Secondary infarction ऱൣउ࿇‫س‬Ι
C ΚCalcium channel blockerΚ
1. ੡௽ฆࢤ‫ۨ࣍ش܂‬ጥऱၩᠦ՗ॴឰᕪΔ‫ؓڶ‬
ᄶۜᠾ‫ش܂ڥ‬Ι
2. ֟֨᦬‫ش܂‬Ι
3. ‫ۡ࣍شױ‬Հΰലᓄᦖჴధα‫֗א‬ՑࣚΖ‫࣍ط‬
‫ء‬ᢐ‫߰ش܂‬ຒ‫׊‬ൎ௺Δਚૉਢൕ‫شࠌآ‬መऱ
Adalat
൛ृΔൎ௺৬ᤜլ૞ࠌ‫ۡش‬ՀΙ࣐ທ‫ګ‬ᣤૹ
10mg/cap
‫ۨ܅‬ᚘΙ
Nifedipine Adalat OROS
4. լመՈ‫ڂ‬੡ຍଡ଺‫ڂ‬Δଖఄழኙ࣍Ꮑ૞૾ۨ
30mg/cap
ᚘऱ൛ृຍਢଡৰൄ‫ش‬ऱᢐढΙ
Felodipine
5. ࢬ‫ ڶ‬Calcium channel blocker ൛ृᚨࣹ
Plendil
რΔ୲࣐ທ‫᦬֨ګ‬ಐጣ‫ ֗א‬ArrhythmiaΕAV
5mg/tab
blockΔ‫܀‬ਢ Adalat ለ֟֨᦬೫‫ش܂‬Ι
6. ‫܂‬੡९ཚ൳ࠫ೏ۨᚘ৬ᤜ९யᕪীΔ‫ڂ‬੡‫ڼ‬
ᢐढ‫ش܂‬መ࣍߰ຒΔլᔞ‫ٽ‬९ཚ൳ࠫΙ
7. Felodipine ੡‫ۨࠠޓ‬ጥᙇᖗࢤऱᢐढΔ‫܀‬ਢ
ԫ౳ለլൄߠΙ
Оࢃ෮ᙝ! 26
 8. ‫᦬֨܅૾אױ‬౛௜ၦΔਚ‫ٵ‬ᑌ‫אױ‬ቃ߻֨ۜ
඲Ⴞ‫ۜ֨ڇ֗א‬඲Ⴞழ‫܂‬੡᎖‫شܗ‬ᢐΖլመ
ࣹრΔ‫ڂ‬੡֨ۜ඲Ⴞழ୲࣐ທ‫ګ‬
arrhythmiaΔ‫ڂ‬੡֨ۜᡏ‫ڽ‬ທ‫ ګ‬AV blockΔ
ਚࠀ‫ ش‬Calcium channel blocker ‫ޓ‬ᚨࣹრ
Arrhythmia ऱ࿇‫س‬Ι
1. ᇡ઎ AdalatΙ
2. ຍࠟଡᢐढ‫׌‬૞‫܂࣍ش‬੡‫֨ݼ‬৳լᖞ‫֗א‬
Verapamil HCl Isoptinΰ40mg/tabα ૾‫֨܅‬෷Ι૾ၜᢰۨᚘ‫ٵش܂‬ᑌՈ‫ڶ‬Δ‫܀‬ਢ
֨᦬‫ش܂‬ઌኙለ᧩ထΙ
Diltiazem HCl Herbesserΰ30mg/tabα 3. ࣹრ֨ಐጣ൛ृᕣၦլ૞ࠌ‫ش‬Δ୲࣐ທ‫ګ‬
CHFΙ
4. ࣹრ AV block and sick sinus syndromeΙ
D Κ DiureticsΚ
Aminophylline ᣊ ᇡ઎ร 24Ε25 ଄Ι
1. ੡ᨖᣊ‫෈ݟܓ‬ᕪΔ៶‫ط‬ๅᨖ֘ᚨሒࠩ‫܂ݟܓ‬
‫ش‬ΔྤરᢐࢤΔ‫܀‬ਢ୲࣐֧ದሽᇞᔆլؓᘝΙ
Benzyl Behydΰ4mg/tabα 2. ԫ౳‫࣍ش‬ჸ಻ࠡ‫ۨ૾ה‬ᚘᢐᕪ‫܂‬੡૾ۨᚘ
dihydrochlorothiazide
‫ش‬Δ‫ڂ‬੡ࠡ‫ݟܓ‬ய࣠ለ੡ᙈᒷΔਚլᔞ‫܂ٽ‬
Λ ৺ࢤๅֽΙ
HydroChlorothiazide
3. ࡸ‫֟྇࣍شױ‬ᆰ౩᧮෈Δए᛭ Pseudotumor
cerebriΙ
1. ੡່ൄ‫ش‬հᛩ‫ݟܓ‬ᕪΙ
2. ‫ אױ‬IVΕIMΕՑࣚΙ
3. ԫ౳‫࣍ش‬৺ࢤๅֽ‫ش‬ΰಾᕪα Δ‫ץ‬ਔ CHF ఑
णᒷᇞΕ৺ࢤ Pulmonary edemaΕᆮֽΕ
࿽ಐጣൎ૰ๅֽΰ‫ױࡸ࣠ڕ‬ඈ‫ݟ‬αΕ৺එழ
Fluid challenge ࠓঅᥨ࿽᦬հ‫ؾ‬ऱழΔ‫ױ‬ᏺ
‫ף‬࿽᦬ۨੌΔ‫࣍܍‬࿽᦬ᡏ‫ڽ‬Ι
Lasix
4. መ৫ࠌ‫ٵش‬ᑌኙ࿽᦬‫ࢤ੅ڶ‬Δਚᕣၦլ૞መ
Furosemide 20mg/2mL/amp
৫၌ၦΔ൫ૉਢ‫ڶ‬৺ૹ఑Ꮑ‫ޣ‬Δԫ౳ࠀྤૻ
40mg/tab QD
ࠫΙ
5. ‫ڶ‬ழ IV push ྤऄሒࠩ૞‫ޣ‬ழΔ‫ەאױ‬ᐞ
Continuous runΔࠀॺ‫ۯޢ‬᠔ஃ݁‫ױ‬൷࠹Ι
6. ല Lasix ‫ؚ‬Ե Albumin bottle փԫದዠࣹΔ
‫ףאױ‬ൎ᛭யΔ‫ڂ‬੡ Lasix ᄎፖ Albumin
bindingΔ࢏९‫ת‬ಐཚΙ
7. ࣹრሽᇞᔆ؈ᘝΙ
1. ੡অሧࢤ‫ݟܓ‬ᕪΔԫ౳‫ش‬ऄፖՑࣚ Lasix ஁
լ‫ڍ‬Δ‫܀‬ਢ‫׌‬૞‫ە࣍ش‬ᐞᏁ૞অ਍᧯փሧᠦ
Aldactone-A
Spironolactone ՗ᖺ৫հ൛ृΙ‫ݟܓ‬ய࣠ለ Lasix ஁Ι
25mg/tabΔTID
2. ԫ౳࿽ಐጣ൛ृᆃ‫ش‬Δຍរፖ Lasix լ‫ٵ‬Ι
3. ࣹრ९ཚࠌ‫ࢤߊڶش‬Ֆࠂ఑ऱ೫‫ش܂‬Ι
1. ੡ጙᎨℂᎧై‫ࠫލ‬ᕪΔ‫ࠀګس᧯෈ࠫލאױ‬
আ෈᧯ඈइΙ
2. ਚ‫࣍شאױ‬ए᛭ਬীॹ ॹ٠ณΰณছࢪֽਚ৫
Diamox
Acetazolamide ᏺ‫֗س‬ඈइܺᣄαΕ‫܂‬੡ԫ౳‫ݟܓ‬ᕪࠌ‫ش‬Ε
250mg/tab
֗ए ए᛭ Pseudotumor cerebriΙΰᜯ‫ݩ‬Ղ‫׌‬
૞‫܂‬੡ॹ٠ณ֗ Pseudotumor cerebri հए
᛭α Ιࠡ塒֟‫ش‬Ι
੡ ጵ ‫ ݟ ܓ ࢤ ٽ‬ᕪ Δ ܶ ‫ ڶ‬Behyd 50mg ‫֗ א‬
Moduretic 1~2# QD Amiloride HCl 5mgΖAmiloride ‫ڶ‬᎘৫অሧ‫פ‬
౨Δਚ‫ ܅྇אױ‬Behyd ທ‫ګ‬ऱ౒ሧயᚨΙ
Оࢃ෮ᙝ! 27
1Η ᙇᖗ૾ۨᚘᢐढᚨ‫׌נބ‬૞଺‫ڂ‬Δშᙇ ABCD ؄ՕᢐΙ‫ۨ࣠ڕ‬ᚘՂ֒ਢ‫ڂ‬੡‫ڶ‬լငࣚ‫ڇژ‬Δ‫ڕ‬ᙰ
࿀Ε‫ݟ‬ዩఎ࿛Δᚨᇠ٣ലຍࠄ଺‫װڂ‬ೈΔྤய৵٦‫ۨ૾א‬ᚘᢐढ‫ڂ܂‬ᚨΙ
2Η ԫ౳ᎅࠐΔA ᣊᢐढኙٚ۶ጟᣊհ೏ۨᚘ݁‫ڶ‬யΙ
3ΗCD ᣊᢐढኙ‫ڣ۔‬Գ‫ڶ‬௽ܑऱᚥ‫ܗ‬Δ‫ڂ‬੡‫᦬֨܅૾אױ‬૤๛Δ྇֟֨᦬հࠓ࿇఑Ι
Ι
3. ‫ݼ‬ᕩᕪፖַۨᕪΚ
1. ᇡ઎รԿ଄Ι
2. ‫ڂ‬੡੡‫ۨݼ‬՛ࣨᢐढΔਚ‫׌‬૞‫࣍ش‬ए᛭/ቃ߻
ࢬᘯऱ႓ ႓௕Ⴞΰٍ‫ܛ‬௕Ⴞऱዌ‫ګ‬ਢ‫ڂ‬੡౟ौ
ഔᗨທ‫ګ‬Δ‫ڂ‬੡౟ौഔᗨᏁ૞ۨ՛ࣨ։ࣼᎧ
ై‫ش܂‬αΔຍԫᣊຏൄ‫ܛ‬੡ Thrombosis or
Aspirin 500mg/tab
Thrombotic embolismΖ൛ृ௽ࢤਢॅ઴Ε
೏ۨ౟Δۨጥ‫ ڶ‬AtherosclerosisΖ
3. ᅝྥԫ౳௕Ⴞቃ߻Ո‫ش܂ڶ‬Ιຏൄ੡֨ۜ඲
Ⴞ֗ᆰ඲Ⴞቃ߻٦௕ႾΕ೚‫֨ݙ‬ᖄጥΕ֭ਮ
࣋ᆜ࿛݁ᄎࣚ‫ش‬Ι
1. ࠌ‫ش‬ᚨ೶ᅃ֫‫ࢨם‬ਢ‫׌‬ए᠔ஃհਐ‫ق‬Ι
2. ‫ ࣍ش‬Embolismΰદ௕Ⴞα ΰ֨৳լᖞ֧ದࢨ
ਢ‫ ڂ‬Hyperviscosity ທ‫ګ‬αऱቃ߻ፖए᛭Ε
৺ ࢤ ֨ ۜ ඲ Ⴞ հ ए ᛭ Ε Deep Vein
Thrombosis ए᛭Ε‫ ֗א‬Varicose veinΰᙩ
౧‫്ڴ‬α Ι
Heparin calcium Calciparine 3. ದࡨழၴ‫ݶ‬Δ਀༚ழၴપೖᢐ 2Д4 ՛ழ‫ܛ‬
‫ڶױ‬ய‫ڃ‬༚ΖਚᏁ૞‫ݼ‬ᕩए᛭հ൛ृΔૉਢ
Ꮑ૞֫๬Δԫ౳ᄎല Coumadin shift ‫ګ‬
HeparinΙ
4. ‫ ڶ׼‬Low molecular HaparinΔ‫נ֟྇ףޓ‬
ۨ‫ٲ‬ᙠΔ൫‫ؾ‬ছՕપ‫ڶ׽‬ੑ࿽൛ृࠌ‫ش‬Ι
5. ጑ྒྷ‫ݼ‬ᕩ‫פ‬౨Δ‫׌‬૞઎ aPTTΖ
1. Indication ‫ ٵ‬HeparinΔ൫‫אױ‬ՑࣚΔਚᔞ‫ٽ‬
Outpatient ࠌ‫ش‬Ι
2. ຏൄၲࡨࣚ‫ش‬৵ 48Д72 ՛ழթᄎ‫ش܂ڶ‬Δ
ਚรԫ‫ڻ‬጑ྒྷۨ෈ᕩۨ‫פ‬౨ᓮ‫ ֟۟ڇ‬48 ՛
ழ‫א‬৵Ι
3. ጑ྒྷழ઎ PT ऱଖΖԫ౳ࠐᎅΔAortic valve
replacementΰ८᥆፹αऱ൛ृ PT INRΰፖ
Coumadin Sodium Standard sample ऱֺଖα૞ፂ਍‫ ڇ‬1.5Д
Warfarin Sodium
5mg/tab 2.0 Ι Mitral/Tricuspid valve replacement
ΰMetalicαऱ൛ृঞਢ૞ፂ਍‫ ڇ‬2.0Д2.5Ι
ԫ ౳ Ꮑ ‫ ޣ‬ऱ ൛ ृ Օ ી Ո ਢ ፂ ਍ ‫ ڇ‬PT
INR=2.0 ؐ‫׳‬Ι
4. ದࡨኬ‫ٵ‬ᑌೖᢐய࣠਍ᥛՈՆΔਚൕ
Heparin to Coumadin or Coumadin to
Heparin ຟᏁ૞‫ڶ‬ԫ੄ Overlapping ऱழ੄Ι
5. ૉਢ‫ۨנڶ‬ႜ‫ٻ‬Δ‫ ش‬Vit K ᇞ੅Ι
1. ࠌ‫ش‬ऱ Indication ‫ ٵ‬AspirinΙ
2. ԫ౳ࠌ‫ش‬ऱ଺ঞਢ٣ࠌ‫ ش‬ASAΔ‫࣠ڕ‬ኙ࣍
Plavix ASA ‫ڶ‬መඕΕ‫ ڶ‬GI bleeding ऱ‫ױ‬౨ழࢨਢ
Clopidogrel
75mg/tab QD ષᑭጌ൛ृΔ‫ شޏאױ‬PlavixΖ
3. ຍଡᢐढ‫ڇ‬९ࢊൄ‫ش‬Δ‫܀‬ਢྎ៽‫ڇ‬ᢐࠢࡺྥ
‫ބ‬լࠩΔటਢࣄዙΙ
‫ ٵ‬Aspirin հ IndicationΔٍ੡‫ۨݼ‬՛ࣨ፹ᕪΖࠌ
Licodin
Ticlopidine HCl ‫ش‬ழᖲፖ Plavix ᣊ‫ۿ‬Δ‫܀‬ਢ։ܑΛྎ៽լ֜ᖠ
100mg/tab
൓Δ‫܀‬ຍଡᢐढ‫֟ڶ‬ᑇ᠔ஃᄎࠌ‫ش‬Δਚ༼‫נ‬Ζ
Оࢃ෮ᙝ! 28
 1. ല Plasminogen ᠏֏੡ PlasminΔ‫܂‬੡௕Ⴞ
ए᛭Ι
Urokinase 60000IU/vial 2. ৰ֟ࠌ‫࣍ش‬ए᛭௕ႾΔԫ౳ᄎ‫ࠩش‬ऱ໱‫ٽ‬Օ
ᄗ‫ڇڶ׽‬ੑ࿽‫ش‬ऱ Double lumenΕࢨਢ
PICCΕPort-A ᣤૹॴႾழ‫ޱ‬ੑࠌ‫ش‬Ι
1. ᇡ઎รԲԼԿ଄Ι
2. আၞ Prothrombin հ‫෈ۨ֗אګس‬ऱយᆈ
Vitamin KΕK1 10mg/ml/amp
৫Ιਚ‫ַۨאױ‬Δࢨਢ‫ ࣍ش‬Coumadin ທ‫ګ‬
ऱ೫‫ش܂‬հए᛭Ι
1. ᇡ઎รԲԼԿ଄Ι
Premarin 2. ‫אױ‬ᏺൎۨጥᕻࡌ໮ഗᔆհᕩᓄ֏ۖࡐထ
Conjugated Estrogens
0.625mg/tab ۨጥ‫ݩ‬Δ‫א‬ሒַࠩۨய࣠Ι
3. ‫ࢤߊڇ‬༓‫׏‬լ‫ش‬Ι
1. ‫ڂ‬੡࿽Ղᆯై‫אױ‬আၞۨጥ‫گ‬ᜍΔਚ‫شאױ‬
࣍‫ݝ‬ຝࠌ‫ش‬Δ‫܂‬੡ַۨ‫ش‬ຜΙ
2. ԫ౳‫ੌ࣍ش‬ᏗۨΕՑ࿺႞Ց‫ۨנ‬ΕBuccal ca
ທ‫ګ‬ऱ Tumor bleedingΕࠡ‫ݝה‬ຝ႞Ց‫ۨנ‬
࿛Δ݁‫ݝشאױ‬ຝऀ Bosmin ෈᧯‫ش‬Ժᚘ૰
Epinephrine Bosmin
ַۨΙ
(Adrenaline) 1mg/ml/amp
3. ԫ౳ૻጹ৺ࠌ‫ش‬ΰ‫ ڕ‬Tumor bleedingΔ‫ڂ‬੡
‫ࠩپ‬Օۨጥࢨਢ೯౧Δࢨਢ‫ߪء‬ᆭᒆۨ෈ࠎ
ᚨ‫ުך‬Δధါທ‫ۨנګ‬αຏൄྤऄ‫ش‬ԫ౳ᚘ
૰ַۨթࠌ‫ش‬ΰ‫ڂ‬੡ Bosmin ᄎ‫ڶ‬٤ߪ‫܂‬
‫ش‬ΔૉਢੌԵۨ෈խᝫਢլᔞᅝα Ι
1. ॺൄൄ‫ش‬ऱᢐढΔ‫׌‬૞‫ࠫލ‬௽ฆࢤ࿇ङ๨‫ػ‬
ᔆऱ‫ګس‬Δ‫ ࠫލא‬Fibrinolysis ऱ‫ش܂‬Δᕁ
ࡐ Fibrin ऱ࿨‫ٽ‬ൎ৫Δ‫ڼڂ‬ሒַࠩۨய࣠Ι
2. ਚ‫࣍شאױ‬ᣤૹ᧜ፂᄫᇞ఑ΕtPAΰ‫࣍ش׌‬
ए᛭ AMIΕPulmonary embolism ‫ش‬հ᧜ፂ
ᄫᇞᕪΔ‫ڂ‬੡ࠌ‫ױڶش‬౨࿇‫س‬ᣤૹऱ೫‫ش܂‬
‫ ֗א‬RiskΔ‫ڶ‬๺‫׌ڍ‬ए᠔ஃຟլ֜໛ᦟࠌ‫ش‬
ԱΔਚլղտฯαທ‫ګ‬հᣤૹ೫‫ش܂‬Ζ
3. ԫ౳փ‫ۨנ‬ऱַٍۨ‫شࠌאױ‬Δ‫ڕ‬
HemoptysisΰযۨαΕੌᏗۨΕࣼ‫ݟ‬ሐ‫ۨנ‬
ΰ‫ץ‬ਔፎ౞‫ۨנ‬Ε‫ݟ‬ሐ‫ۨנ‬α࿛Δྤ௽ฆࢤ
ַۨ‫ش‬ᢐழ݁‫شࠌאױ‬ΰ‫ ڕ‬Esophageal
varices ‫ شאױ‬GlypressinΕ‫ݝאױ‬ຝַۨ
հ‫ۨנ‬࿛Δຍࠄ‫אױ‬լ‫ ش‬Transaminα Ι
Transamin
4. ࣹრ‫ױڶ‬౨ທ‫ۨګ‬௕ऱ‫ګݮ‬Ι
250mg/amp
Tranexamine acid 5. ‫ڂ‬੡‫ݼڶ‬ङࢤ๨‫ػ‬ऱ‫ش܂‬ΔਚՈ‫࣍شאױ‬ԫ
ԫ౳‫ אױ‬Q6HДQ4H
ࠄ࿇ङࢤ఑णऱᒷᇞΙ
ࠌ‫ش‬
6. ࣹრΔ‫ء‬ᢐढ‫ ࣍ش‬Hematuria ਢ‫ڶ‬ञᤜࢤ
ऱΜԫ౳փઝ᠔ஃլ໛ᦟല Transamin ‫ش‬
࣍ۨ‫ݟ‬Ε‫܀‬ਢ؆ઝ᠔ஃຝ։ᄎ‫ش‬Δഗ‫ء‬Ղࢬ
‫ڶ‬᠔ஃՕᄗԫ‫ת‬ԫ‫ת‬Ζྎ៽ഗ‫ء‬Ղీ‫ڇ‬լࠌ
‫ش‬ᇠᢐ࣍ Hematuria ൛ृΰᅝྥΔ‫׌࣠ڕ‬ए
᠔ஃࢨਢᖂ९ࡦഒ਍༉޲‫ڶ‬ᙄऄαΔᇡาൣ
‫ݮ‬ඖ૪‫ڕ‬ՀΚԫ౳‫ڶ‬Օၦۨ‫ݟ‬ऱ൛ृΰլጥ
ਢ⅄଺‫ڂ‬α Δ٠‫ ش‬Transamin ࿛փઝ‫ش‬ᢐ ਢ
լജऱΖຏൄ๠෻଺ঞ੡Κ࣋ᆜ 3-way foley
ࠀ‫ ش׊‬Normal saline irrigationΰԫၲࡨ‫ױ‬
‫ א‬Full runΔ৵ࠐ‫ޢאױ‬՛ழ 500cc ኬኬ
૾αΔຍਢ੡ԱլᨃۨჇ‫׬‬۰‫ݟ‬ሐທ‫ྤګ‬ऄ
ඈ‫ݟ‬Ζ‫܀‬ਢመ࣍Օၦऱۨ‫ױݟ‬౨ԫֱ૿
irrigation ྤऄ֗ழ‫ޱ‬೓෣Εԫֱ૿ᄎທ‫ګ‬൛
Оࢃ෮ᙝ! 29
 ृመ৫؈ۨΔਚ່‫ړ‬ऱֱऄᝫਢ‫ش‬
Cystoscope Հ‫װ‬઎ࠀ‫׊‬ए᛭Ιۖԫ౳՛ၦ
ۨ‫ ݟ‬ऱ൛ृ‫ڶ޲࣠ڕ‬ᕩۨംᠲΔຏൄ‫ش‬
Irrigation ᎖‫ܗ‬Δ߻ַ‫ݟ‬ሐങႾ‫ױܛ‬ΔլᏁ
Transamin ‫ ۨ ַ ۩ ۞ ױ ܛ‬Δ ֘ ۖ ‫ ش‬Ա
Transamin հ৵ΔۨჇ୲࣐‫ګݮ‬Δലᖄી‫ݟ‬
ጥᆖൄങႾΔۖ‫ޱ׊‬Ո‫ޱ‬լൾΔ່৵‫شړ׽‬
Ժᥒੑࢨਢང‫ݟ‬ጥΔຍᑌஈᏺఐ൛լᔞ‫֗א‬
᠔ஃऱ߬໎Ζ‫ڶڼڂ‬๺‫ڍ‬Գࠀլ৬ᤜ‫ۨ࣍ش‬
‫ݟ‬൛ृ‫ܛ‬ਢ‫ڂ‬੡‫ڼڕ‬Ζ
4. ࠡ‫ה‬Κ
1. ੡૾ۨᚘᕪΔ‫׌‬૞ਢ Alpha 1-blockerΔࠀ‫׊‬
ࠠ‫ڶ‬՛ၦ૾ۨ౟ौ‫ش܂‬Ι
Hytrin 2. ‫ؾ‬ছᜯ‫ݩ‬Ղբᆖ֟‫ش‬ᇠᢐ‫ۨ૾܂‬ᚘ፹ᕪΔۖ
Terazosin
2mg/tab ਢ‫܂‬᥊
᥊ᥨᆯॅՕհए᛭Ι‫ڂ֟྇אױ‬੡ BPH
ທ‫ګ‬ऱඈ‫ܺݟ‬ᣄհ఑णΖԫ౳‫ڰ‬Ղ QD ࣚ‫ش‬
ԫឍ‫ױܛ‬Ζ
1. ᓮ೶ᅃ೜অ༓‫ב‬๵ࡳΔլฤ‫۞אױृٽ‬၄ࠌ
‫ش‬Ι
2. ‫ء‬ᢐ‫אױ‬ᏺၞ೎᧮փխࢤ෺հ։֏ΕᏺཷΕ
‫࣋ᤩ֗א‬Δ‫א‬ᏺ‫෈ۨף‬խխࢤ෺հᑇ‫ؾ‬
ΰANC=Absolute Neutrophil countΔ࿛࣍ۨ
෈խ Seg + Band ऱᑇၦΔ՛࣍ 500 ጠ੡
Ζ
Neutropeniaα
75ugΕ300ug 3. ‫ءڼڂ‬ᢐ‫׌‬૞ऱ Indication ੡Κ‫ڂ‬੡֏ᖂए
RHG-CSF
IVΕIVFΕor SC ᛭ທ‫ګ‬ऱ NeutropeniaΕ‫෈ۨߪء‬ఏఐທ‫ګ‬
ऱ NeutropeniaΕࢨਢٚ۶‫ױ‬౨‫ڂ‬੡‫ۨػ‬෺
መ‫܅‬ທ‫ګ‬ᣤૹߪ᧯ტ਩ऱ Neutropenia ण
ኪΔ݁‫شࠌאױ‬Ι
4. ԫ౳৬ᤜࠌ‫ ش‬75ug SCΔய່࣠‫ړ‬Δ‫ྤ࣠ڕ‬
ऄ‫ؼ‬Հࣹ୴ΰ‫ ڶڕ‬Bleeding tendencyα ΔᏁ
૞ᙩ౧ࣹ୴Δঞԫࡳ૞ᙇᖗ 300ugΔ‫ڂ‬੡ᙩ
ࣹய࣠ለ஁Ζ

ԼΕʳൄ‫ش‬հ؆‫ش‬ᢐढΚ
1. ‫ؼ‬ᓅ‫ش‬ᢐΚ
ᢐढ‫ټ‬ ೸঴‫ټ‬ΰ९ࢊൄ‫ृش‬α ១૪֗ࠌ‫ش‬ழᖲ
1. Օ෿ᇘ‫ޱ࣍ش‬ੑऱֽΖNormal saline ਢ‫ػ‬።
՗ऱΙDiswater ੡ԫ౳වပֽΔ႕።՗ऱΙ
Normal saline and 2. ຏൄ‫ޱ‬ੑ႞ՑΕយᓂ‫ ش‬Normal salineΔֺለ
Sterile water լ࿀Ιۖ Diswater ঞਢ‫࣍ش‬ᚴ਌‫ؼ‬ᓅΕࢨਢ
ΰDiswaterα ‫ ؚ‬Foley ऱ Cuff ‫ش‬ΖࣹრΔFoley ऱ Cuff
լ‫ شױ‬Normal saline ‫ؚ‬Δ‫ܡ‬ঞᄎ୲࣐࿨དྷΔ
๯՛ࡦ࿀ᒼΖ

Оࢃ෮ᙝ! 30
 1. ൄ‫ش‬հ௣੅ᢐֽΰᅺ෈αΙ
2. ९ࢊ‫ش‬ऱ։੡ࠟጟΚAqueous Better-Iodine
ΰ࿫‫ۥ‬ᑑ᧘α‫ ֗א‬Alcoholic Better-Iodine
ΰጸ‫ۥ‬ᑑ᧘αΖࠟृऱ஁ܑ‫࣍ڇ‬৵ृ‫಺ܶڶ‬
壄Δ‫ڼڂ‬ለ୲࣐ॵထ‫ؼڇ‬ᓅΕለ୲࣐೓ᛟΔ
ࠀ‫׊‬ᠱ‫ۥ‬ለ෍Ζ
Better Iodine / 3. ܶ಺壄հ‫ګ‬։ृΔԫ৳լ լ‫ࠐشױ‬ᚴ਌យᓂ।
Povidone Iodine
Betadine ૿ࢨ႞ՑΜᄎৰ࿀Δਚ༺‫ݟ‬ጥছհ௣੅Εᜓ
‫ٽ‬ছհ௣੅Ε؆ઝ֫๬‫ؼ‬ᓅ‫א‬Հᐋ్հ௣
੅Δ݁լ‫಺ܶشױ‬壄հ௣੅෈Ι
4. ‫ ڶ׼‬Better-Iodine surgical ScrubΔ‫ܛ‬؆ઝ
ࠧ ֫ ෈ Δ ‫ ش ڇ‬Alcohol Better-iodine ‫܂‬
Surgical field ௣੅հছᄎ٣‫ش‬ຍጟ႓‫ߌॅۥ‬
ֽჴੑΰ႓‫ۥ‬ᑑ᧘α Ι
1. ‫࣍ش‬႞Ց௣੅ΕᑆறΙ
2. ԫ౳ఐࢪΰຝ։αᄎໂ‫ڶ‬႓ᢐֽ౅ؒΔࠀ‫׊‬
٧࣍٧ᒣխΖ‫࣍شאױ‬௣ङַ࿀Ζ
Rivanol
3. Rivanol packing ፖ Ice Packing ऱࠌ‫ش‬ழ
Ethacridine ঋጠ႓ᢐֽΔ‫ڶ‬ຌፏ፹
ᖲΚԫ౳ Ice packing ‫࣍ش‬໢ొַ࿀Ε௣ᆭΕ
ᕪ
࿇ᗈழࠌ‫ش‬ΙRivanol packing ঞኙ࣍ᙩ౧࿇
ङΕۨጥ࿇ङທ‫ګ‬ऱక࿀௽ܑ‫ڶ‬யΖૉਢ‫ڶ‬
ᣤૹદᆭऱൣ‫ݮ‬Δ‫ەאױ‬ᐞ‫ش‬႓ᢐֽΖ
1. ‫ࢬܛ‬ᘯऱᜳ๛ईΰᇿጸई壄ৰቝαΖຏൄᙰ
࿀Ε‫ݝ‬ຝદఖΕመඕ࿇᣺Ε‫ױ‬٣‫ڼش‬ᢐ‫ݝ‬ຝ
ᚴ਌ᇢ઎઎Ι
2. ᙰᄉუ‫ٷ‬Ո‫ױ‬ԫᇢΙ
Menthol oil
50%Δ450ml/bot 3. ൛ृᆮ࿾լᔞΕߚ՗క࿀Δ‫ױ‬٣‫ش‬઎઎Ι
(Peppermint oil)
4. ‫ڼ‬ᢐய࣠լՕΔ‫܀‬ਢ‫ࠄڶ‬Գॣ‫شࠌޡ‬৵༉င
ࣚ‫ڍ‬ԱΔਚ‫אױ‬٣ᇢᇢ઎Ι
5. ‫ڇ‬ਬࠄ؆ઝߓΰ‫ڕ‬ഡขઝαᄎ‫ ش‬Menthol
packing ‫܂‬ႝঁऱֱ‫ڤ‬Ι
1. ९ࢊ‫ࠎڶ޲׏ۿ‬ᢐΙ
2. ԫ౳‫ؼ‬ᓅመ࣍೓ᛟທ‫ګ‬հ᣺ఖΕլᣤૹհ‫ݝ‬
ՅՓࣥ
ຝመඕΕధ‫ؼ‬Δ‫ەאױ‬ᐞᓮఐ൛۞۩᝜၇Յ
ՓࣥჁࢳ‫ױܛ‬Ι
Rheumon gel ൄ‫ش‬ऱ NSAIDs ؆‫ش‬ᕪΖኙ࣍‫ݝ‬ຝ࿇ङ֧ದհక
Etofenamate
5%Δ10g/tube ࿀ΰ‫ڕ‬ᣂᆏङα ΔࢨਢۜۚᎨ࿀Δ݁‫ڶ‬᛭யΙ

Calamine lotion Caladryl ᇡ઎รԼ؄଄Ι

1. ᇡ઎รԼ؄଄Ι
Ichderm
Doxepin HCl 2. ‫ء‬ᢐհַ᣺யֺ࣠ Caladryl ‫ףޓ‬ൎΔՈ‫ڶ‬௣
5% creamΔ15g/tube
ङய࣠Δਚቄࡐࢤ᣺ఖ‫ەאױ‬ᐞ‫ڼ‬ᢐΙ
1. ᇡ઎รԶΕร԰଄Ι
2. ຏൄ‫ิݼشࠌڇ‬៣₏؆‫ش‬ᢐᕪ‫܂‬੡ַ᣺ྤ
Dexamethasone
யΔ‫ەאױ‬ᐞ‫ءش‬ᣊᢐढΙ
Steroid ؆‫ش‬ᢐፏ Hydrocortisone
3. ኙ࣍ቄࡐ⼡຾ఖΕመඕΕ࿇ङక࿀Δ݁‫ڶ‬᛭
Etc.
யΙ
4. ٦‫ڻ‬ൎᓳΔჁࢳ๠‫ڶ‬ტ਩‫ױ‬౨Δլ૞ࠌ‫ش‬Μ
1. ኙ Gramΰ-α and ΰ+α݁‫ڶ‬ए᛭‫ݼ‬ပய࣠Δ
ਚ ኙ ࣍ । ‫ ؼ‬ᆖ ൄ ტ ਩ ࠩ ऱ
Bacitracin + Neomycin
StaphylococcusΕStreptococcus ࿛Δլጥ
ointment
ਢ‫ܡ‬ኙ Penicillin ‫ݼڶ‬ᢐࢤΔ݁‫ڶ‬ய࣠Ι
2. ‫׌‬૞‫ݼڶ׽‬ပய࣠Δ޲‫ַڶ‬࿀ַ᣺ய࣠Ι

Оࢃ෮ᙝ! 31
 1. ‫ڶ‬ᣊࡐᔧΕNeomycinΕ‫ิݼ֗א‬៣₏Δਚ
‫ݼאױ‬ပΕַ᣺Εַ࿀Ε‫ݼ֗א‬࿇ङΙ
2. ፖ Pure steroid ֺለΔ‫ڂ‬੡ܶ‫ైسݼڶ‬Δਚ
լ‫ش‬ᖜ֨ࠌ‫ش‬৵ທ‫ګ‬।‫ؼ‬႞Ցტ਩ऱൣ‫ݮ‬Ι
Neo-cortisone
Tropodermΰ९ࢊ៱ጠα 3. ྎ៽ԫ౳‫ڼش‬ᢐ࣍ࢬᘯ Wet desquamation
ΰ ܶ ‫ ڶ‬Neomycin Ε
Tricodexΰ‫ؾ‬ছᄅᢐα ऱൣउΰᛘࢤๅ‫ؼ‬αΖຏൄ೓ࢤๅ‫ؼ‬ԫ౳।
hydrocortisone Ε
15g/tube ‫آق‬႞֗ట‫ؼ‬Δլᄎ‫֜ڶ‬Օऱტ਩ᖲᄎΙۖ
Diphenylpyralineα
ᛘࢤๅ‫ؼ‬ᄎ‫ิڶ‬៣෈ዶ‫נ‬Δ୲࣐ტ਩Δ‫ڼش‬
ᢐለ৾ᅝΙ
4. ‫࣍ش‬ԫ౳ᑭᥓ႞ՑΕ࣋୴ए᛭հᅃ୴๠Ε՛
ᒤ໮ᘠᒈհए᛭Εַ᣺Ε‫ݼ֗א‬ပΖ
1. ‫ݝ‬ຝ‫گ‬ᚹΕঅᥨ‫ؼ‬ᓅΕ‫ݼ‬ပΕ߻ፍհ‫ش܂‬Ι
2. ԫ౳‫࣍ش‬ᑭᥓ႞ՑΔ‫ڕ‬ᣤૹ႞ՑᑭᥓΕᘠᒈ
հए᛭Ι
Zinc Oxide ointΔ20%Δ28.4g/tube
3. ௽௘‫ش܂‬Κኙ࣍Գՠߙ॰ທ⥗Δॵ२࠹ᆩ෈
ॿ፱ऱ‫ؼ‬ᓅַ࿀Εַ᣺Ε௣ᆭΔZnO ‫ڶ‬௽ܑ
᛭யΙ

Nizoral ᐖயࢤ‫᧶ݼ‬ပ؆‫ش‬ᢐፏΔྎ៽ᄎ۞աၲऱՕᄗ༉
Ketoconazole
2%Δ10g/tube ຍԫጟΔࠡ‫ה‬ऱᚨᇠᅃᄎ‫ؼ‬ᓅઝ‫ ܂‬CommentΖ

Sulfasil / Flamazine ᗍ႞ᢐፏΖܶᎬऱᛸ₏‫ైسݼ‬Δ‫ױ‬

९ࢊ່ൄ‫ش‬ऱᗍ
Silver Sulfadiazine
1%Δ50g/tube ‫ݼא‬ပΖ؆ઝՈൄ‫הࠡ࣍ش‬؆႞௣੅‫ش‬Ζ

2. Ց࿺ൄ‫ش‬ᢐढ

1. ‫ء‬঴‫׌‬૞੡փܶ᎘யᣊࡐᔧ፹ᕪΔࠀ‫࣍ܶ׊‬
Kenacort-A ௽௘ഗᔆհխΔ‫ڶאױ‬யঅᥨՑ࿺ᑭጌΕ႞
Triamcinolone
Ցփፏ ՑΔࠀ‫ַ׊‬࿀௣ᆭΙ
2. ‫׌‬एՑ࿺ధ੐ΕᑭጌΙ
1. ᣊࡐᔧՑփፏΔַ࿀ய࣠‫ ੷ޓ‬KenalogΔຏ
ൄՑփ႞Ցԫ֚۟ࠟ‫ױܛ‬ए័Ι
Dexaltin
Dexamethasone 0.1% 2. ‫׌‬एՑփᑭጌΕՑߡङ࿛Ι
0.1%Δ5g/tube
3. ࠉྥࣹრტ਩ऱ‫ױ‬౨ΔլመຏൄՑփፏᐙ᥼
ტ਩լᄎ֜ՕΙ
1. ‫׌‬૞‫࣍ش‬ए᛭Ց࿺࢚ఇပტ਩ΰᡈՑᒈαΔ
‫ڇ‬ԫࠄ‫ࠫލ੽܍‬൛ृΕ֏᛭൛ृ࿛ΔᆖൄᏁ
Nystatin Mycostatin
૞ࠌ‫ش‬Ι
2. ܶ‫ڇ‬Ꮿ֣փԫ੄ழၴ٦‫ױܛנٷ‬Ι

3. ൄ‫ش‬ณઝ‫ش‬ᢐΰԫ౳ఐࢪ‫ױ‬౨ᄎ‫ࠩش‬ऱαΚ

BSS ΰ Balance Salts ੡ॺൄ൷२Գ᧯ෝ෈ऱ‫ګٽ‬ᢐᕪΔ‫࣠ڕ‬ఐ൛૞ࠌ

15ml/bot
Solutionα ‫ױش‬౨Ꮑ۞၄Ι
Normal saline ່១໢ऱณᢐֽΖ
Steroid 1. ᣊࡐᔧณᢐፏΙ‫׌‬ए‫ڂ‬መඕ‫ైڂ‬ທ‫ګ‬ऱ Red
FML
ΰFluorometholone ለ eyeΕณᅪ᣺Εመඕࢤ࿨ᓂङ࿛Ι
0.02%Δ5ml/bot
ൄ‫ش‬α 2. ‫ڶڕ‬ტ਩ࢤณఏᓮ֎ࠌ‫ش‬Ι

ࣹრΔլ৬ᤜ‫༽ނڶ޲ڇ‬ऱൣउՀ࿯ղ൛ृณຝᢐढΔᚨᅃᄎณઝ੡ࠋΖ

Оࢃ෮ᙝ! 32
 ԼԫΕʳ ൄ‫ش‬հࣼ‫ݟ‬ሐᢐढΚ

1. ‫ݟ‬ሁ߻ፍᕪΚ
Ϩʳ‫ء‬ᣊᢐ঴੡௽ࡳհࣼ‫ݟ‬ሐ‫ైسݼ‬Δ‫෈ݟڂ‬ຏൄ੡‫ైسݼ‬խඈइऱ‫נ‬ՑΔਚ‫෈ݟ‬խᢐढᖺ৫ለ೏Ζ
Ϩʳຍᣊᢐढຏൄ੡ॺ௽ฆࢤհ௣੅ֽΔኙ࣍ഗ‫ࢨء‬ਢլࣔტ਩ᄭհఽ‫ݟ‬ሐტ਩Δ݁‫אױ‬ᇢᇢ઎Ζ

ᢐढ‫ټ‬ ೸঴‫ټ‬ΰ९ࢊൄ‫ृش‬α ១૪֗ࠌ‫ش‬ழᖲ

1. ᥆࣍ Macrodantin ᣊᢐढΔ‫ڶ‬ൎԺ‫ݼ‬ပ‫܂‬
‫ش‬Δ‫ݟڇ‬ሁխᖺ৫ለ೏Δਚ‫ ࣍شױ‬Gΰ+α Ε
Gΰ-αऱาပΙ
2. ຏൄ޲‫ڶ‬ર࠹ࢤംᠲΔլመսྥ‫ݼڶ‬ᢐပጟ
ऱ‫ڇژ‬Ι
Macrodantin
Nitrofurantoin 3. ‫࣍شױ‬᎘৫‫ݟ‬ሁტ਩Ε޲‫ڶ‬࿽ल࿽ङጊᐞऱ
100mg/tab
൛ृΕ޲‫ ڶ‬Sepsis ‫ױ‬౨ऱ൛ृΙ
4. ྎ៽ࠌ‫ش‬ᆖ᧭ᤚ൓լᙑ‫ش‬Δԫ౳໢ొऱ
Cystitis ‫אױ‬รԫᒵ٣‫ش‬ຍԫᣊᢐढΙ‫ڶ‬
APN ऱ ൛ ृ ༉ ለ լ ৬ ᤜ Ա ΰ ऴ ൷ ٣ ‫ش‬
Ι
Cephalosporin and Amino glycosideα

1. ‫ ٵ‬Nitrofurantoin հ IndicationΙ
Oxolin 2. ‫׌‬૞ኙ‫ڍ‬ᑇऱ Gΰ-α‫ڶ‬யΔ‫ץ‬ਔ Gΰ+αհ
Oxolinic acid
700mg/tab Staphylococcus aureus Δ ‫ ܀‬ਢ ኙ
Pseudomonas ྤயΙ

2. ‫ݟ‬ሁए᛭ᕪΚ‫ץ‬ਔԫࠄᇞೈ‫ݟ‬ሁլᔞ఑णऱൄ‫ش‬ᢐढΚ

1. ‫ء‬ᢐढ‫׌‬૞੡‫ݟ‬ሁ௣ङᕪΖ‫ڂ‬੡‫ݟ‬ሁ࿇ङΕ
Pyridium យᓂ࠹႞‫א‬ીհక࿀Ε޿ᑷΕ᙮‫ݟ‬Ε
Phenazopyridine HCl
100mg/tab UrgencyΕ݁‫ޏאױ‬࿳Ι
2. ࠌ‫ش‬৵‫෈ݟ‬ᄎ‫ܧ‬႓ᖪ‫ۥ‬Δ೭ᇿ൛ृᎅࣔΙ

1. ‫ء‬঴੡ࣼ‫ݟ‬ሐؓᄶۜᇞ࿂ᕪΔ‫ַึאױ‬క࿀
ທ‫ؓګ‬ᄶۜ࿂᧑Ε࿂᧑৵‫ࠋޓ‬ທ‫ګ‬క࿀հ༞
ࢤ༛ᛩΙ
Genurin
2. ‫ء‬঴‫׌‬૞‫܂‬੡ፎ౞Ε‫ݟ‬ሐ֫๬৵‫ݟ‬ሁక࿀լ
Flavoxate HCl 200mg/tab
ᔞΕ᙮
᙮‫ݟ‬ΕUrgency հ఑णᇞೈΙ
1# TIDДQID
3. ‫ڼڂ‬ኙ࣍ٚٚ ۶ທ‫ ګ‬FrequencyΕurgency
ऱ଺‫ڂ‬ΰUTIΕtrauma…α݁‫܂ڼאאױ‬఑
णᒷᇞΙ

1. ೫ٌტ壀ᆖᘋᕿᕪΔ‫׌‬૞‫ڇش܂‬ᆩሐ‫֗א‬ፎ
౞հؓᄶۜΙ
2. ᜯ‫ݩ‬Ղ‫אױ‬ᏺၞષᆩᤘ೯Δ‫܀‬ਢ֟‫شڼ࣍ش‬
ຜΙ
Urecholine
Bethanechol Chloride 3. ‫׌‬૞‫܂‬੡‫ڂ‬੡ፎ౞ྤԺທ‫෈ݟګ‬ዩఎऱ൛
25mg/tab
ृΕআၞඈ‫ݟ‬հᢐढΔ‫ڕ‬຾ᔨመ৵ඈ‫ݟ‬լ
ႉΕ‫ݟ‬ጥఎᆜመՆທ‫ګ‬ፎ౞ྤԺ࿛Ι
4. ԫ౳೫ٌტ壀ᆖᘋᕿᕪᚨࣹრऱΔ‫ڕ‬௛໙‫ף‬
Ꮳ࿛݁ᚨࣹრΔ൫ྎ៽޲‫ڶ‬ሖመΙ

Оࢃ෮ᙝ! 33
 ԼԲΕʳ ࠡ‫ה‬Κ

ᢐढ‫ټ‬ ೸঴‫ټ‬ΰ९ࢊൄ‫ृش‬α ១૪֗ࠌ‫ش‬ழᖲ

1. ‫ޏ‬࿳ᆰ Basal artery and Vertebral artery հ

༛ ᛩ Δ ࠀ ౨ ᓳ ᆏ CN VIII ऱ ᖲ ౨ Ε ‫ࠫ ލ‬
Cephadol NystagmusΔ‫א‬ए᛭փۘᎽᡶທ‫ګ‬ऱ Vertigo
Diphenidol HCl
25mg/tab ΰPeripheral vertigoΕMeniere’s diseaseαΙ
2. ‫ء‬ᢐ੡९ࢊ‫׌‬૞ए᛭ Meniere’s disease ऱ
‫ش‬ᢐΖࠡ塒ᓮ೶ᅃรԼԲ଄‫ิݼ‬៣₏ԫᆏΙ

ຍጟ՛෿ऱࣹ୴‫ֽش‬ፖՕ᧾ऱ Diswater լ‫ٵ‬Δೈ

Աྤပհ؆Δᝫലԫࠄ Pyrogenΰທ‫ګ‬࿇ᗈऱढ
ᔆα‫װ‬ೈΖ௽ܑ༼ࠩਢ‫ڂ‬੡‫ڶ‬ழଢᏁ૞ၲຍጟࣟ
Water for injection Diswater
۫ᄎ‫װ‬࿯൛ृࠌ‫ش‬ΰ௽ܑਢ‫ ܂‬CAPD ੑ࿽ऱ൛
ृΔൄൄᏁ૞‫ڃ‬୮۞ա಻‫ైسݼ‬α Ζຍழଢሽᆰᢐ
໢༉ਢ‫”ؚ‬Water for injection”Ζ

Inhalation therapyΚ
ଖఄழᆖൄሖࠩ௛໙࿇‫ࢨ܂‬ਢᏁ૞‫ܮ‬Ե‫ڤ‬ए᛭ऱ໱‫ٽ‬Δ‫ڼڇ‬ᇿՕ୮տฯለൄ‫ش‬ऱ༓ጟᢐढΚ

Bosmin inhalation ‫׌‬૞‫ڇ‬൛ृ‫ڶ‬Օ௛ሐॴႾऱൣ

Epinephrine उΰᄎ‫ ڶ‬Laryngeal stridorα
Ζຏൄਢ‫ڂ‬੡໫ᙰֽ
Bosmin
(Adrenaline) ᆭທ‫ګ‬ऱΔਚ‫ ܮ‬Bosmin ‫אױ‬ᚥ‫ۨܗ‬ጥ‫گ‬ᜍΔ྇
ֽ֟ᆭൣउΖ

1. Jusomine inhalation ౨ജ‫ؚ‬ឰᅠ෈೏։՗

ፋ‫ٽ‬Δ‫ۖڂ‬আၞඈᅠΖ‫׼‬؆Δࡸ‫ ڶ‬NaCl 3%
ᄫ෈ऱ‫ܮ‬Եए᛭Δᜯ‫ݩ‬լਢ‫ࠐش‬ए᛭‫ش‬Δۖ
Sodium bicarbonate Jusomin ਢ‫ࠐش‬ႝ ႝᅠ‫ش‬Ζ‫ࠄڶ‬൛ृ೓যྤᅠΔ੡Աఎ
ᅠ֏᧭Δ‫אױ‬ᇢ઎઎‫ ش‬3% NaCl ‫܂‬ႝᅠΖ
2. ࡅ‫ܮ‬ए᛭ஃլ৬ᤜ Stat ‫ ܮ‬JusomineΔ‫ڂ‬੡
૞ຑᥛ९ཚ‫ܮ‬թᄎ‫ڶ‬ᚥ‫ܗ‬Ι

ధᡏᅠ෈հយ๨‫ػ‬យ৫‫א‬ధᡏ᝶࿨Ζ‫ڇ‬९ࢊለ֟
Acetylcysteine
‫ش‬Ζ
1. ‫ܛ‬੡ Inhalation A + B հ AΙ
Atrovent
Ipratropium Bromide 2. ੡೫ٌტ壀ᆖ‫ࠫލ‬ᕪΔ‫֭ࠫލאױ‬௛ጥ࿂
0.5mg/2ml/vial
᧑Ι

1. ‫ܛ‬੡ Inhalation A + B հ BΙ
2. ੡ᙇᖗࢤ Beta2 agonistΔ‫אױ‬ᙇᖗࢤທ‫֭ګ‬
௛ጥឩ്ۖ֟֨᦬ۨጥ‫ش܂‬Ι
Albuterol Ventolin
3. A+B inhalation ኙ COPDΕࢨਢ Asthma ൛
(Salbutamol) 5mg/2.5ml/amp
ृ݁‫ڶ‬யΙ
4. ࡅ‫ܮ‬ए᛭ஃᎁ੡‫ ܮ‬A+B ‫אױ‬ຑᥛ‫ࠀܮ‬լᄎ
‫֜ڶ‬Օᐙ᥼Δլመԫ౳ຟਢ Q6H ‫ܮ‬Ι

ՕીՂᇠᎅऱᢐढຟᎅԱΔࢨ‫ڶ‬ᙊዥࢨਢᙑᎄΔᓮ‫ܶץڍڍ‬ДД

Оࢃ෮ᙝ! 34
ॵᙕΚԫᒧ‫ݙ‬ᖞऱ Admission order ᚨᇠ‫֟۟ܶץ‬ऱԼՕႈΰᓮ࿳‫ش‬ሽᆰ Admission orderα
Κ

Admission to the service of Dr.__________ΰ൞‫׽‬૞រ‫נ‬ຍԫႈΔ‫׌‬ए᠔ஃਢᓴሽᆰ۞աᄎ൅‫ࠐנ‬α

Ι
Diagnosisΰ1αΕΰ2αΕΰ3α……
ConditionΚguardedΰ‫ء‬ႈᎅࣔ൛ृऱൣउ‫ݺ‬ଚᚨᇠ೚۶ኪ৫Δԫ౳ຟਢᙇ GuardedαΙ
Vital signΚAs ward routineΰ‫ܫ‬वᥨՓᚨᇠ‫ڍ‬Նၦԫ‫ ڻ‬Vital signΔԫ౳ Ward routine ਢ BIDΔՈ‫אױ‬
ᙇ Q8HΕQ6HΕQ4H……Δ‫ڶڕ‬Ꮑ૞Δ‫אױ‬ᙇ Vital sign and GCS ߷ԫႈΔ‫ץ‬
ܶ૞ၦ Coma scaleα
Ι
Activity Κas toleratedΰૻࠫ൛ृ۩೯Δྤ௽௘Ꮑ‫ޣ‬ԫ౳ຟਢᐊ As toleratedΔ‫ה‬ᎁ੡‫אױ‬༉‫אױ‬Ιࠡ
‫ ڶה‬As tolerated in roomΰ‫ૻ׽‬ఐࢪփ੒೯α
Εbed rest……α
Ι
AllergyΚno known allergyΰ઎൛ृ‫ڶ‬ٚ۶ऱᢐढመඕ‫׾‬ΔᇡาધᙕαΙ
Diet Κas toleratedΰ൞‫אױ‬੡ఐ൛‫ە‬ၦ塊堬Ζྤ௽௘Ꮑ‫ޣ‬༉ᐊ As toleratedΔࢨਢ NPO since ۶ழΕ
DM diet 1500kcal/day……Δ‫הࠡڶ࣠ڕ‬૞‫ࣔုאױޣ‬Κૻᨖ 5g/dayΕૻሧ 40meq/dayΕ
ૻֽ࿛࿛α
Ι
IVFΚNilΰᏁլᏁ૞ run IVΔլᏁ૞༉ᐊ NilΔࢨਢ D5W/D5Sΰࠟृٌཙ runα run 50cc/hrΙૉਢᏁ૞
‫۫ࣟהࠡף‬Δ૞ုࣔΔ‫ ڕ‬KCl 5mLΰor 10meqα in D5S 1000cc run 60cc/hrα
Ι
Lab and examΚCBC/DCΕNaΕKΕCaΕBlood cultureΕBrain CT……ΰ੡ఐ൛‫ڜ‬ඈ‫ࠐآ‬૞೚ऱᛀ਷Δ
ࢼۨ૞֚ࣔԫ‫ࢼڰ‬ᝫਢ್ՂࢼΛᛀ਷۶ழ૞೚ΛຟᏁုࣔΙ‫׼‬؆Δૉਢൕ৺်ࢨਢ۰ೃࣚ೭
խ֨ՂࠐఐࢪऱΔ‫ױ‬౨բᆖ‫ڶ‬ԫࠄᛀ਷‫܂‬መԱΔᓮរᙇբ‫ ܂‬XXXXXXΔᨃࠡ‫ה‬᠔ஃ‫אױ‬Աᇞα
Ι
Medication ΚᏁ૞չᏖᢐढᓮ‫ڇ‬ሽᆰᢐ᧷ၲ‫م‬Δ൛ृ‫۞ڶ‬ໂᢐՈᓮုࣔ۶ጟᢐΕࠌ‫ش‬ٝၦΕ᙮෷࿛Ζ
հছ‫ ڇ‬IVF ๠‫࣠ڕ‬ၲ‫م‬Ա‫ ڕ‬KCl հ՛ၦរዠΔՈᓮಖ൓ᙁԵᢐ᧷փΙ‫׼‬؆ᓮ‫ە‬ၦਢ‫ܡ‬Ꮑ૞ Stat
࿯ᢐΔ‫ە֗א‬ၦᢐढٝၦജլജΔਢ‫ܡ‬ႊ‫ף‬Ꮖଈֲၦ࿛Ζ

ᓮ‫ٵ‬ᖂ᠃ಖຍ ADCVΕAADΕIVFΕLabΕMedication ຍԼՕႈΖ

ઌॾመլԱ‫ڍ‬ՆΔՕ୮ԫࡳ‫ګאױ‬੡ᚌߐऱ᠔ஃΔ‫ף‬ईᦗДД

Оࢃ෮ᙝ! 35
0(02








 Oral Hypoglycemic Agents (OHA)
᏾౛;ᑵΞϘ
Delay Glucose Absorption
z Acarbose 50mg
Mechanism: competitive inhibitor of brush border -glucosidase
Ϩ-glucosidase ല‫ڍ‬ᝰ᠏᧢੡໢ᝰΔࢬ‫ א‬acarbose ૞‫ڇ‬堩խࢨছ‫پ‬թ‫ڶ‬ய࣠
Ϩ‫࣠ڕ‬ທ‫ۨ܅ګ‬ᗷΔ૞ᇖ‫ך‬໢ᝰ
Dose: initial 0.5# BidШ1# Tid (75-300mg in 3 divided doses with first bite of food)
ADR: flatulance, diarrhea,Хhepatic aminotransferases(‫܀‬լᐙ᥼ߗ࿽‫פ‬౨)
Contraindication: inflammatory bowel disease, gastroparesis, Cr>2.0mg/dl
z Metformin
Increase Insulin Secretion ( cell Stimulant)
z Sulfonylureas
Pharmacokinetics: metabolism in liver and excretion by kidney
ϨEuglucon ࡉ Diamicron ऱ‫ז‬᝔ขढࡸ‫ ڶ‬20%‫ش܂‬Δਚທ‫ګ‬հ‫ۨ܅‬ᗷ‫ױ‬ሒ 3 ֚
Mechanism: bind sulfonylurea receptor to close ATP-sensitive K+ channel
Contraindication: impaired hepatic or renal function
ADR: hypoglycemia, weight gain, GI symptoms
¾ Chlorpropamide (Diabinese)ѧ‫ء‬ೃ޲‫ڶ‬
รԫ‫ז‬Δທ‫ګ‬հ‫ۨ܅‬ᗷ‫ױ‬ሒ 7~10 ֚
Ϩૉ‫ۨ܅‬ᗷఐԳਢࣚ‫ش‬်ࢬၲऱ OHA ‫ݮ׊‬ण੡ʳ ʳ ‫ܛ‬ਢ
¾ Glyburide 5mg (Euglucon)
Dose: initial 0.5# QDШ0.5# BidШ1# BidШ2# Bid
(1.25-20mg as single dose or in 2 divide doses)
¾ Gliclazide 30mg/MR(Modified Release) (Diamicron)
Dose: 1# QDШ4# QD (30-120mg as single dose) (1 ᙍ MR ઌᅝ࣍ Diamicron 80mg)
¾ Glimepiride 2mg (Amaryl)
Dose: 1# QDШ4# QD (1-4mg as single dose)
z Meglitinide Analogsѧshort half-life ᙟ塊ࣚ‫ش‬Δᔞ‫࣍ش‬լ๵৳堬ଇृ
Pharmacokinetics: metabolism in liver to inactive products
Mechanism: interact with ATP-sensitive K+ channel
Contraindication: impaired hepatic or renal function
ADR: hypoglycemia
¾ Repaglinide 1mg(NovoNorm)ѧBenzoic acid
Dose: 1# BidШ1# TidШ4# TidШ4# Qid
(4mg in 2 divided doses given 15 min before breakfast and dinner. Max: 16mg)
ϨKidney excretion<10%, ‫ ܀‬CrЊ3.0mg/dl սլ৬ᤜࠌ‫ش‬
ϨMetabolism by cytochrome P4503A4, ૉࠓ‫ۨ૾ش‬౟ᢐ Lopid ᄎࠌ‫࢏ش܂‬९
¾ Nateglinide 60mg (Starlix)ѧD-phenylalanine
Dose: 1# BidШ2 Tid (60 or 120mg 3 times a day before meals)
Increase Insulin Sensitivity
z Thiazolidinediones
Mechanism: bind PPAR-
to promote adipocyte differentiation, fatty acid uptake and storage,
and glucose uptake
ϨThiazolidinediones ਢ፹ທᄅऱ GLUT4Δਚ‫ش܂‬ኬΔ‫ڶ‬ழᏁքၜթߠய࣠
Metformin ਢ‫ش‬෼‫ڶ‬ऱ GLUT4Δਚ‫ش܂‬ለ‫ݶ‬
Contraindication: congestive heart failure class III or IV, ALTЊ2.5 ଍‫إ‬ൄଖ
ADR: edema, precipitate CHF in CVD patients, weight gain, hepatotoxicity (but no evidence)
¾ Rosiglitazone 4mg (Avandia)
Dose: 1# QdШ2# Qd (4-8mg as single dose or in 2 divided doses)
¾ Pioglitazone (Actos)ѧ‫ء‬ೃ޲‫ڶ‬
z Metformin
Decrease Hepatic Glucose Output
z Metformin 500mg
Mechanism: unclear
Contraindication: CrЊ1.5mg/dl in men, Њ1.4mg/dl in women, GFRЉ70ml/min, acidosis,
congestive heart failure, liver disease, severe hypoxia
ADR: GI symptoms, reduced vit. B12 absorption, lactic acidosis
Dose: 0.5# BidШ1# BidШ1# Tid
(1-2.5g. One tablet with meals 2 or 3 times daily. Max: 2550mg)
Drug Combination
z Sulfonylurea + Metformin (1.25mg/250mg, 2.5mg/500mg, 5mg/ 500mg)
ൄ‫ش‬: Glyburide 0.5# Qd + Metformin 0.5# Bid
z Sulfonylurea + Thiazolidinedines
z Sulfonylurea + NPH insulin (HS)ѧጕছ NPH ᨃ baseline ૾‫܅‬Δ堩৵ۨᗷՂ֒۞ྥ‫ૻڶ‬
When to Initiate Treatment
ၴሶ 2-3 ၜ‫ ڶ‬2 ‫ ڻ‬random plasma glucoseЊ200mg/dl
٣ᒔᎁߗ࿽‫פ‬౨ຟ޲ംᠲթၲࡨ࿯ᢐ
Ϩૉ‫ش׽‬ԫጟᢐΔᒇ՗‫ ش‬glyburideΔ઴՗‫ ش‬metformin
ϨImpaired glucose tolerance(IGT)ए᛭ᙇᖗհᚌ٣ႉ‫ݧ‬: (1st)lifestyle change (2nd)acarbose
(3rd)metformin
Generalizations
ϨயᏝΚsulfonylureas> metformin> thiazolidinediones> meglitinide analogs> -glucosidase inhibitor
ϨInsulin secretagogues ࡉ -glucosidase inhibitor ‫ۨ܅૾ܛمױ‬ᗷ
Metformin ࡉ thiazolidinediones ႊᑇၜ۟ᑇִթߠய

References

z Alvin CP: Diabetes Mellitus. In: Harrison’s Principles of Internal Medicine, 16th ed. Dennis LK et al. McGraw-Hill, 2005

z John HK et al: Pancreatic Hormones & Diabetes Mellitus. In: Basic & Clinical Endocrinology, 7th ed. Francis SG, David GG. McGraw-Hill, 2004

z Yki-Järvinen H. Thiazolidinediones. N Engl J Med 2004;351:1106-1118.

 ᑗֿੰΓதҔफ़Ոᑗᛰ
α ϩᜪ Sulphonylureas Insulin secretagogues Biguanide ͉- Thiazolidinediones
ܺ glucosidase
फ़ inhibitor
Ո Ӝᆀ Euglucon Minidiab Diamicron Diamicron MR Amaryl Novonorm Starlix Glucophage Glucobay Avandia Actos
ᑗ ȐGlyburideȑ ȐGlipizideȑ ȐGliclazideȑ ȐGliclazideȑ ȐGlimepirideȑ ȐRepaglinideȑ ȐNateglinideȑ ȐMetforminȑ ȐAcarboseȑ ȐRosiglitazoneȑ ȐPioglitazoneȑ
ᛰ ᓬᅟந ྐᑗֿ ۡஏլᓪ ۡஏլᓪ–࡭ុ‫܄‬ ᅦᅟી ᒍ‫ک‬ໜ ٬ᑗҥញ ৤Ꮉϯ ᗐ࿢ ఍ࡆ໡ ངִᑗ
‫ނ‬ ᛰ‫ނ‬
Ѧᢀ
໒‫ۈ‬ 1.5 λਔ 1 λਔ 2 λਔ 2 λਔ 0.5 λਔ 15 ϩដϣ 10-20 ϩដϣ ࡐ‫ז‬ 30 ϩដ 30 ϩដ 2 λਔ
բҔ
ਔ໔
࡭ុ 16-24 λਔ 12-14 λਔ ɩ24 λਔ ɪ24 λਔ 24 λਔ 4-6 λਔ 2-4 λਔ 5-6 λਔ 9 λਔ 24 λਔ 16-24 λਔ
ਔ໔
΋Ϻ 20mg 40mg 320mg 120mg 8mg 16mg 540mg 3000mg 300mg 8mg 45mg
നε Ȑ1 ᗭ 5mgȑ Ȑ1 ᗭ 5mgȑ Ȑ1 ᗭ 80mgȑ Ȑ1 ᗭ 30mgȑ Ȑ1 ᗭ 2mgȑ Ȑ1 ᗭ 1mgȑ Ȑ1 ᗭ 60mgȑ Ȑ1 ᗭ 500mgȑ Ȑ1 ᗭ 50mgȑ Ȑ1 ᗭ 4mgȑ Ȑ1 ᗭ 30mgȑ
Ꮚໆ
ܺҔ ໭߻ ໭߻ ໭߻ ໭߻/໭ࡕ ໭߻ ໭߻ ໭߻ ໭ࡕ ໭߻ ໭߻/໭ࡕ ໭߻/໭ࡕ
Б‫ݤ‬ ȐᒿᓓܺҔȑ ȐᒿᓓܺҔȑ ȐᒿᓓܺҔȑ

ી ી৞ન Lispro ᛰࠔኬҁ Aspart ᛰࠔኬҁ RI ᛰࠔኬҁ NPH ᛰࠔኬҁ Mixtard ᛰࠔኬҁ Lantus ᛰࠔኬҁ
৞ Ӝᆀ Insulin
ન glargine
ᇙ Ꮚໆ 300u/3ml 300u/3ml 300u/3ml 1000u/10ml
Ꮚ 1000u/10ml 1000u/10ml 1000u/10ml
Ѧᢀ ዂమ ዂమ ዂమ షᐜ షᐜ ዂమ
բҔ ೲਏ ೲਏ อਏ ύਏ ύอਏ ߏਏ
໒‫ ۈ‬0.2-0.5 λਔ 0.2-0.5 λਔ 0.5 λਔ 1.5 λਔ 0.5-1 λਔ 1.1 λਔ
բҔਔ໔
ଯঢ়ਔ໔ 0.5-1.5 λਔ 0.5-1.5 λਔ 2-3 λਔ 4-10 λਔ 2-8 λਔ ค
࡭ុਔ໔ 4-6 λਔ 4-6 λਔ 3-6 λਔ 10-16 λਔ 24 λਔ 24 λਔ

ύ୯ᙴᛰεᏢߕ೛ᙴଣ ᑗֿੰΓߥ଼௢ቶύЈ ᇙբ
0(02








 ϣࣽᙴৣॶ੤Ћн
01.ᙴᡗதҔᕭቪ...................................................................................................... - 3 -
02.΋૓ϣࣽೀ࿼...................................................................................................... - 3 -
(A) Fever ............................................................................................................... - 3 -
(B) Pain ................................................................................................................. - 3 -
Special ............................................................................................................... - 3 -
(C) Cough.............................................................................................................. - 4 -
(D) Dyspnea .......................................................................................................... - 4 -
(E) Ӽ઀ᛰ ........................................................................................................... - 4 -
a. ᇨᏤᅵ઀ ...................................................................................................... - 4 -
b. ‫ߏۯ‬ᅵ઀(ᅵ‫ډ‬΋ъᒬٰ) ........................................................................... - 4 -
c. ଞᏊ .............................................................................................................. - 4 -
(F) ‫ڋ‬ለᏊ/गᛰ................................................................................................... - 5 -
a. ೬ߡ .............................................................................................................. - 5 -
b. Зᘞ.............................................................................................................. - 5 -
(G) Muscle relaxant .............................................................................................. - 5 -
(H) ѦҔᛰ ........................................................................................................... - 5 -
(I) ၸ௵Ǵⶁഞ੶(antihistamine) ........................................................................ - 5 -
(J) ଯՈᓸ ............................................................................................................ - 6 -
(K) Convulsion disorder ....................................................................................... - 6 -
(L) ๞਻ ............................................................................................................... - 6 -
(M) I/O imbalance................................................................................................. - 6 -
(N) VomitingǴnausea .......................................................................................... - 6 -
03.Ј᠌ࣽ.................................................................................................................. - 6 -
(A) Ј᠌૰ᆃ ....................................................................................................... - 6 -
(B) લՈ‫܄‬Ј᠌ੰ ............................................................................................... - 7 -
(C) Ҷլ ............................................................................................................... - 8 -
(D) Јࡓό᏾ ....................................................................................................... - 8 -
04.ဉग‫ط‬ᖌࣽ.......................................................................................................... - 8 -
(A) ᚶᅪ UGI bleeding ........................................................................................ - 8 -
(B) ᚶᅪ LGI bleeding ......................................................................................... - 9 -
(C) ࡚‫܄‬ဎᘞ ....................................................................................................... - 9 -
(D) ‫ܶط‬଎ ........................................................................................................... - 9 -
(E) ࡚‫(ݹط܄‬GOT /GPTBilirubin) ................................................................ - 9 -
(F) ࡚‫܄‬ી᠌‫ ݹ‬.................................................................................................... - 9 -
(G) ࡚‫܄‬ᖌ៶‫ݹ‬Ǵ࡚‫܄‬ᖌᆅ‫ ݹ‬........................................................................... - 9 -
05.Ոనဍዦࣽ........................................................................................................ - 10 -
(A) Fever ............................................................................................................. - 10 -

-1-
 (B) Pain ............................................................................................................... - 10 -
(C) Insomnia ....................................................................................................... - 10 -
(D) Vomiting ....................................................................................................... - 10 -
ߕǺЗӗᏊ Antiemetic drugs ..................................................................... - 10 -
06.ૅ๚ࣽ................................................................................................................ - 12 -
(A) Dyspnea ........................................................................................................ - 12 -
(B) COPD ࡚‫܄‬วբ........................................................................................... - 12 -
a. ෧Ͽ਻ၰߔΚ ............................................................................................ - 12 -
b. ‫ݯ‬ᕍགࢉ.................................................................................................... - 12 -
c. ‫ׯ‬๓਼਻Ⴋ‫ ࡋک‬........................................................................................ - 12 -
(C) Asthma p’t ࡚‫܄‬วբϐೀ౛ ....................................................................... - 13 -
(D) Pneumonia p’t ‫ޑ‬ೀ౛................................................................................. - 13 -
07.๝᠌ࣽ................................................................................................................ - 13 -
(A) Hyperkalemia ............................................................................................... - 13 -
(B) Acute pulmonary edema ............................................................................... - 13 -
(C) First hemodialysis ......................................................................................... - 14 -

-2-
01.ᙴᡗதҔᕭቪ

iv (IV)intravenously cmcoming morning

im (IM)intramuscularly aaǹAAof each
inhinhalation stat ଭ΢๏ᛰ
SQǴSCsubcutaneously PRNas requiredǴwhenever necessary
SLsublingually Ampྋన‫ރ‬
POorally Vial ણ‫ރ‬
ACbefore meals qdonce a day
PCafter meals bidtwice a day
PRby rectum tidthree times a day
QMః໔ܺҔ qidfour times a day
qhsᅵ߻ܺҔ SRslow release
qNఁ໔ܺҔ

02.΋૓ϣࣽೀ࿼
(A) Fever
҂ၲ 38.5ʚǴҔ ice pillow
ε‫ ܭ‬38.5ʚǴ‫ ܜ‬CBC/DCǴ଺ blood count q15minØ2 ঺‫ྍੰפ‬ǶU/AǵU/C ‫܈‬
sputum culture
RxǺacetaminophen 500mg 1# po st ‫ ܈‬keto 30mg 1amp iv st

(B) Pain
NSAID ᜪᛰǴόёҔ‫ ܭ‬ulcer
αܺǺ acetaminophen 500mgǴponstan 250mgǴcataflam 25mg
ଞᏊǺ keto 30mg 1amp iv or im stǹaspirin 0.9g 1vail iv stǹvoren75mg 1amp im
st(ѺЋᖉёૈЇଆԼԺ๺ᕭ)ǹmeperidine 50mg 1amp iv or im stǹ
morphine 10mg 1amp iv
Special
ɈRAǴGoutǺdiclofenac 25mg 1# qid or 75mg 1# bidǴallopurinol(࡚‫܄‬යό
ёҔ)Ǵcolchicine
ɈΟΰઓ࿶ภǺtegretol
ɈࠒോภǺdiclofenac 25mg/75mg
Ɉ࿶ภ/ғ౛ภǺponstan250mg
Ɉဉ่ҡҔ morphine 10mg/30mg(SR)
ɈӵӢग‫ݹ‬ЇଆǴӧዴ‫ؒۓ‬Ԗ obstruction ௃‫ݩ‬Π(high pitch bowel sound)Ǵ
Ҕ Buscopan 1 amp im or keto 1amp iv st

-3-
(C) Cough
ϯ࿀Ǻmedicon AǴmucosolvan 30mg 1# qidǴregrow 60mg 1# bidǴ
acetylcysteine 200mg 1# tid-qid
ЗࠏǺmedicon AǴbensau 100mg 1# tid
ᛰНǺguaphen 5c.c qid(ቶ֋΢‫”ޑ‬ᒍКӇЈ”)Ǵsato(֖ codeine) 5c.c qidǴ
secorine 10c.c tid(ᆕӝགߵᑗዀ)

(D) Dyspnea
Ӄϩࢂ Lung or Heart or ‫ځ‬дচӢЇଆ  Ӄ‫ ܜ‬ABGǴO2
z Lung (᠋ບ)ǺdecreaseǺpneumothoraxǴpleural effusionǹ
wheezingǺCOPDǴAsthmaǹ
cracklsǺpneumonia
‫ݯ‬ᕍ‫ૅـ‬๚ࣽ೽ϩ
z HeartǺӃ᠋ heart soundǴբ EKG Ԗ ST-T changeǴ‫ ܜ‬cardiac enzyme
NTG 1# SL for Angina q5min x III ԛ(SBP>90mmHg ωё๏)
ੱ‫ރ‬ǴEKGǴcardiac enzyme ΟᅿύǴ‫ঁٿ‬Ԗ findingsǺ consult CV
Heart FailureǺ ຎ௃‫ݩ‬ё๏ϒ Lasix 1 amp iv (࣮λߡԖؒԖрٰ)Ǵdopamine
200mg 2amp in N/S 500 keep 20ml/min
ऩ ABGǴPH<7.2 ‫ ܈‬HCO3<15 ёံ sodium bicarbonate
Sodium bicarbonate ံ‫ݤ‬
Total BW*0.4*(desired [HCO3-]-measured[HCO3-])
=[HCO3-]deficit ΋ъໆௗ iv pushǴќ΋ъໆуΕ D5w ϣ drip12-24hr

(E) Ӽ઀ᛰ

a. ᇨᏤᅵ઀
xanax 0.5mg(ᙼ‫ۓ‬Ꮚ)
ativan 0.5mg 1# hs(onset ‫)ז‬
stilnox 10mg 1# hs(onset ‫ז‬Ǵduration อǴ႖Ϻᒬٰό཮Ԗஎᎈག)
vena 1 Amp IM (ճҔ༐ᅵୋբҔ)
diazepam 2mg ‫ݙ‬ཀ‫ڋ׭֎ڥ‬
b. ‫ߏۯ‬ᅵ઀(ᅵ‫ډ‬΋ъᒬٰ)
eurodin 2mg
zopiclone 7.5mg
haloperidol 1mg/5mg
flunitrazepam 2mg(FM2)ᆅ‫ڋ‬ᛰ
c. ଞᏊ
ativan 2mg iv/im(ёҔӧ acute psychosis)
haloperidol 5mg iv/im(ёҔӧ acute psychosis ᆶ ativan ҬඹѺ)
midazolam 15mg(onset ‫ז‬ǴதҔӧ intubation)
valium 10mg iv(а΢Ҕᛰ೿ёૈᏤठ‫ڋ׭֎ڥ‬ǴλЈ٬Ҕ)

-4-
(F) ‫ڋ‬ለᏊ/गᛰ
mucaineǴA.M.D(ፄБᛰ)ǴMgO 250mg(1#गᛰǴ2#೬ߡ)
ulsanic 500mg(ёҔӧකᆅࡕٛЗ stress ulcer)
H2-blocker(ग᜔ prove Ԗ ulcer ωёҔ)Ǻzantac 150mg
PPI(ग᜔ prove Ԗ ulcer ωёҔ)Ǻnexium 40mg 1# qd/acǴlansoprazole 30mgǴ
rabeprazole 20mgǴlosec 40mg iv(Ҕ‫ ܭ‬acute
bleedingǴNPO ਔ)Ǵzantac 40mg iv
dogmatyl 50mg 1# tid ёҔ‫ ܭ‬peptic ulcer
a. ೬ߡ
Mag. oxide 250mg 2# qid(๝૰ᆃੰΓόёҔ)Ǵsennoside 20mg 1#hsǴdulcolax
5mg 1# hsǴnormacol 7g/pack(ёቚуߡߡ‫ޑ‬ໆǴाଛ 200cc ໒НܺҔ)
b. Зᘞ
ӵ݀ࢂӞΑ೬ߡᏊω܎‫غ‬ηǴኩਔଶᛰ൩ёаǴόѸଭ΢๏Зᘞᛰ
kaopectin 30ml qidǴImodium 2mg 2# st(ၨம)

(G) Muscle relaxant

Baclofen 10mg 1# tidǴsolaxin 200mgǴparafon(ፄБ acetaminophen+solaxin)

(H) ѦҔᛰ
Skin itchǺᜪ‫ڰ‬ᎇ encort-A 15gmǴrinderon V cream 5gǴkenacomb cream 6gǴ
dermovate cream 5g/tubeǴtopsyn lotion 10g/BT
౨የǺposterisan 10g/tubeǴproctosedyl/supp(༞Ꮚ) 1pc bid
३ෝဌǺPasca gel 10g/tube(ଳҜጥ)Ǵbutenafine 10g/tube(೩໔)ǴketoconazoleǴ
sulconazole
आᖊǺzinc oxide 28g/tube(Ԗԏ⻃ਏ݀)
ѦኦԼԺለภǺvoren G
Oral ulcerǺdexaltin 5g/tube
ᐨ໾Ǻsilver sulfasil 20g/tubeǴ200g/can
Ҝጥ‫ف‬፦ϯǺUrea
‫ל‬ғનǺkigmin oph(֖ sulfamethoxazole ౳ᛰН)Ǵbacitracin-neomycin 30g/tube
࿃ηǺsinbaby
ᅋαНǺparmason 200ml/BT 10-20ml bid-tid

(I) ၸ௵Ǵⶁഞ੶(antihistamine)
vena 1 amp iv/imǴdecadron 4mg 1amp iv
З᝚Ǻperiactin 4mg 1# tidǴloratadine 10mg 1#qd(ߏਏǴό༐ᅵ)
ࢬሷНǺ actifed(ፄБ)1# tidǴclarinase(ፄБ) 1# bid

-5-
(J) ଯՈᓸ
ЋೌࡕภЗภǴֿ๞ICP
HeadacheǴChest Pain ёଭ΢ೀ౛ऩค s/s ߾ 15’ख़ෳ
ߏය HTNǴคੱ‫ރ‬ёόೀ౛

(K) Convulsion disorder

ativan or valium 1 amp im or iv ёុѺՠόຬၸ 3 ampǴӵ݀ؒԖଶЗǴёҔ
ativan or valium 10amp in N/S500 keep 20ml/hrǴ‫ ܈‬barbiturate
dilantin iv drip ‫؂‬ϩ<50 mg ǹ Loading doseǺ15mg/kg/dayǹ
Maintain doseǺ5mg/kg/day
(Dilantin 1Amp=250mgǴӵ݀ patient 60kgǴ߾ёҔ 3 amp уΕ N/S ύǴί࿤όा
уӧԖ glucose ϐᗺᅀύ཮่඲) ќѦǴIV<50mg/minǴ3 amp=750mgǴջ٬
ᅀೲ full run ؒᜢ߯ǴӢࣁόёૈӧ 15 ϩដϣ‫ע‬΋౟ N/S ѺֹǶा monitor Ոύ
dilantin ᐚࡋǶ)

(L) ๞਻
ᖓ಻‫غܓݨ‬ᙏ(meth oil packing)Ǵsimethicone 40mg 1# qid or primperan 1 amp
iv/im or 1# tid/ac

(M) I/O imbalance

P’t I & O όѳᑽǴৡ൳ԭʧค‫܌‬ᒏǴ‫ݙ‬ཀ electrolyteǴӵȘKșǴёံ KCl
10~20meq iv dripǶMentainance Dose KCl 30meq in 500ml N/S run 60 ʧ/hrǴ‫܈‬α
ܺ slow K 600mg 1# tid~qid

(N) VomitingǴnausea
Եቾ IICPǴဉߔ༞ǴpancreatitisǴϯᕍୋբҔǴprimperan 1amp iv/im or 1#
tid/qidǴNovamin 1amp iv/im ϯᕍୋբҔǴWintermine 0.5-1# po(ѺⒹ)Ǵ
Anti-HistamineǺVena 30mg iv/im stǴbonamin 25mg 1# tid

03.Ј᠌ࣽ
(A) Ј᠌૰ᆃ

ຑ՗Б‫ݤ‬Ǻ
(a)ੰўǺ၌ୢੰ஻ԖคЈ᠌ੰǻՖᅿЈ᠌ੰǻӵՖ೏ບᘐǻၸ۳‫ݯ‬ᕍϷ‫ځ‬
ᕍਏǶߦԋӢનࣁՖǻ‫֚֎ڥ‬ᜤ‫ޑ‬ᝄख़ࡋӵՖǻନၮ୏ਔ‫֚֎ڥ‬ᜤѦǴ
ࢂց཮‫ڹ‬໔ତഹϷᆄ֤‫֎ڥ‬Ƕதགੲ॰ѦǴࢂցதԖрհԠǻຑ‫ੰۓ‬஻
Ј૰ᆃᝄख़ࡋឦ NYHA фૈϩᜪ‫ݤ‬ಃ൳ભǶ

-6-
 (b)౛ᏢᔠࢗǺ౛ᏢᔠࢗǺа General appearanceǴmental stateǴvital
signsǴperfusionǴoxygenation ຑ՗Ј૰ᆃჹੰΓϐቹៜǴҗ‫ځ‬дቻংȐᓍ
ᓉેႴ๞ǵ‫ॣ៷ޤ‬ǵ‫ط‬ဍεǵΠަНဍǵЈᚇॣǴЈᘉε฻ȑё‫ޕ‬Ј૰ᆃ
ᝄख़ࡋǶ
(c)ჴᡍ࠻ᔠࢗ
(1)ճҔЈႝკǵૅ೽ X ӀᔠࢗǵЈ᠌ຬॣ‫ݢ‬Ϸ୏ે਻ᡏϩ‫݋‬ᔠࢗЈ᠌ ੰ
ϐੰӢϷЈ૰ᆃᝄख़ࡋǶ
(2)ᝄख़࡚‫܄‬Ј૰ᆃ஻‫߾ޣ‬ё‫ܫ‬Ε Swan-Ganz ЈᏤᆅаᅱෳՈࢬΚᏢ‫ݩ‬Ǵ
ᒿਔፓ᏾ᓉે‫ݙ‬৔மЈǴՈᆅᘉ஭‫܈‬ճֿᛰ‫ނ‬ϐᏊໆǶ
! ! ! (3)‫ځ‬дᔠࢗӵ๝фૈǵՈᑗᐚࡋǴBNPǴЈԼሇનǴNa+ǴK+ǴMg2+Ǵ
Ca2+ᚆηᐚࡋёа଺ࣁບᕍୖԵǶ
(d)‫ݯ‬ᕍǺdiureticsǴACEI(ARB)ǴNTGǴbeta-blockerǴinotropic agents (а
΢ᛰ‫ݙނ‬ཀԖค contraindication)‫ݯ‬ᕍуख़Ј૰ᆃӢη

(B) લՈ‫܄‬Ј᠌ੰ

ຑ՗ྗ߾Ǻ
(a) લՈ‫܄‬Ј᠌ੰӵՖϷՖਔ೏ບᘐǵᝄख़ำࡋǵၸ۳‫ݯޑ‬ᕍϷ‫ځ‬ᕍਏᆶୋ
բҔǶ
(b) ᖏ‫߄׉‬౜ࠠᄊࣁЈ็ภ (ᛙ‫ࠠۓ‬ǵόᛙ‫)ࠠۓ‬ǵЈԼఒ༞ǴલՈ‫܄‬ЈԼੰ
ᡂǴЈࡓό᏾‫₽܈‬ԝǶ C) લՈ‫܄‬Ј᠌ੰ‫ੰޑ‬ӢǺ ߷‫ે୏ރ‬ๆ‫ރ‬ฯϯǵ
߷‫ે୏ރ‬ยᠱ‫ځ܈‬д (ਵ༞ǵЬ୏ેগᚆϷ߷‫)ݹે୏ރ‬Ƕ D) ࢂցՔԖ
ӒᓀӢη (ᑗֿੰǵଯՈᓸੱǵ‫ྟܜ‬ǵଯિՈੱǵ߷‫ੰે୏ރ‬ৎ௼
ў) Ƕ E) ӕਔᑡ஻‫ޑ‬੯ੰǶԜ཮ቹៜ‫ݯ‬ᕍ‫ޑ‬،฼Ǻӵᑡ஻਻ഹੰ‫ޣ‬࿣
ҔΌࠠߔᘐᏊ (beta-blockers)Ƕ

ຑ՗Б‫ݤ‬Ǻ
(a) ੰўǺӵ߻‫܌‬ॊǴੰΓԖคᑗֿੰǵଯՈᓸǵ‫ྟܜ‬ǵଯિՈੱǵ߷‫୏ރ‬
ેੰৎ௼ў฻ੰўǶ‫ރੱځ‬Ԗคമբ‫ૅ܄‬඀ǵૅภǶ‫ੵځ‬ภՏ࿼ǵੵภ
‫܄‬፦ǵ൯৔೽Տǵ࡭ុਔ໔ǵჹᛰ‫ނ‬ϐϸᔈϷᒿՔੱ‫ߵ( ރ‬հԠǵᓐ
ܶǵཀྵലǵ਻ߦ)Ƕ
(b) ౛ᏢᔠࢗǺа౛Ꮲᔠࢗϐ߻ϖε໨ (General appearanceǵmental stateǵ
vital signsǵperfusionǵoxygenation) ٰຑ՗લՈ‫܄‬Ј᠌ੰჹੰΓϐቹ
ៜǶԶ‫ځ‬дቻং (ᓍ୏ેႴ๞ǵ‫ॣ៷ޤ‬ǵ‫ط‬ဍεǵΠަНဍǵЈᚇॣǵ
ΠަНဍǵЈᚇॣǵЈ᠌ᘉε฻)Ǵёа‫ޕ‬ၰલՈ‫܄‬Ј᠌ੰ‫ޑ‬ᝄख़ࡋǶ
(c) ჴᡍ࠻ᔠࢗ
Јႝკǵၮ୏‫܄‬Јႝკǵ✋ 201ǵЈԼឲ
(1)ߚߟ᠍‫܄‬ᔠࢗБ‫ݤ‬Ǵх֖ԖЈ

-7-
 ‫ݙ‬ቹႽ௟ᅲǵॄ಻Ј᠌ຬॣ‫ݢ‬฻Ƕߚߟ᠍‫܄‬ᔠࢗࣁ໚‫ੰޑ܄‬஻ӵឦଯ
Ӓᓀဂ (ӵ੟Јੱǵᛰ‫ނ‬௓‫ڋ‬ό‫ؼ‬ǵрՈጄൎεǵЈԼфૈό‫ؼ‬฻)
ᔈӆௗ‫ڙ‬ЈᏤᆅᔠࢗϷ߷‫ે୏ރ‬ឪቹǴаຑ՗߷‫ે୏ރ‬੟ઞᝄख़ำࡋ
ϷѰЈ࠻фૈ‫ڙ‬ཞำ ࡋǴբࣁ຾΋‫؁‬ЈᏤᆅϟΕ‫ݯ܄‬ᕍ‫܈‬ѦࣽЋೌ
‫ݯ‬ᕍϐख़ाୖԵǶ
ૅ೽ X Ӏǵ୏ેՈ਻ᡏϩ‫݋‬ǵՈᖌ‫ڰ‬ᎇᐚࡋǵ๝фૈǵ
(2)‫ځ‬дᔠࢗӵૅ
ՈᑗᐚࡋϷЈ
ЈԼሇન(CPK/CKMBǴTnI)ёа଺ࣁບᕍୖԵǶD)ᅪ՟
AMIǴፎೲ call CV doctor

(C) Ҷլ

ຑ՗Б‫ݤ‬Ǻ
(a) ੰўǺਥᏵੰΓੰўٰ‫פ‬рҶլёૈচӢǶӵрՈεໆᡏన഼Ѩ (Ⴭӗ
ဎᘞ) Їठ hypovolemic shockǶགࢉੱЇठ septic shockǶЈԼఒ༞‫܈‬Ј
ࡓό᏾Їठ cardiogenic shockǶЈхጢ༤༞‫܈‬஭Κ‫ૅ਻܄‬Їठ
extracardiac obstructive shock ฻Ƕ
(b) ౛Ꮲᔠࢗ
(1)ӃᏃ‫ࡼז‬а౛Ꮲᔠࢗǵх֖ general appearanceǵmental stateǵvital
signsǵ oxygenationǵperfusion ຑ՗Ҷլᝄख़ࡋǶ
(2)а،‫ۓ‬Ոᓸ‫ޑ‬Ԗϖ໨ӢηǺheart rateǵpreloadǵafterloadǵ
contractility Ϸ peripheral resistanceǶຎՖ‫ޣ‬Ԗୢᚒٰຑ՗Ոᓸफ़ե‫ޑ‬
ᐒᙯǶ
(c) ჴᡍ࠻ᔠࢗ
(1)ճҔૅ೽ X ӀᔠࢗǵЈႝკǵ୏ેՈ਻ᡏϩ‫ٰ݋‬ᇶշບᘐ
(2)Ј᠌ຬॣ‫ݢ‬კԖշ‫ܭ‬ຑ՗Ј᠌ԏᕭфૈϷບᘐᛐጢ੯ੰ (ӵ severe
ASǵMSǵpulmonary hypertension ) ‫܈‬Јхጢ༤༞
(3)CVP Ԗշ‫ܭ‬ຑ՗ RV preload Զ Swan-Ganz Ԗշ‫ܭ‬ຑ՗ LV preload
(4)୏ેՈ٢ለᐚࡋԖշ‫ܭ‬ຑ՗Ҷլࡠൺ௃‫ݩ‬ϷႣࡕǶ
(D) Јࡓό᏾
(a) EKG ( rhythmǴrateǴpatternsǴST-T change)
(b) ‫ݙ‬ཀ vital signsǴelectrolyteǴdrugs

04.ဉग‫ط‬ᖌࣽ
(A) ᚶᅪ UGI bleeding
Black stoolǴcoffee-ground vomitusǴfresh blood vomitus.
Losec 1 vial (40mg) iv q12h x 3daysǴNPOǴ௨ PES
ऩੰΓԖ liver cirrhosis hx.‫܈‬ଯࡋᚶᅪ EVǴGV bleeding (Alcoholism)Ǵ߾

-8-
 у΢ Somatosan 2Amp in N/S 500ccǴrun 20c.c/hr (ёӃ push 20cc in
3-5mins)
F/U HbǴഢ PRBC

(B) ᚶᅪ LGI bleeding

bloody stool
ऩੰΓ vital sign stableǴNPOǴfluid supplementǴF/U HbǴഢ PRBCǴ௨
Colonoscopy
ऩੰΓ vital sign unstableǴarrange angiography for checking possible
bleederǴ٠཮ບѦࣽ

(C) ࡚‫܄‬ဎᘞ
NPOǴFluid supplement
Kaopectin 15cc po qid ‫ ܈‬Smecta 1# pack po tid ~ qid
ऩӝ‫ ٳ‬feverǴᚶᅪ infectious diarrheaǴёӃҔ Baktar 2# po q6h or cipocin
2# q12h

(D) ‫ܶط‬଎
Lactulose 10 ~ 30cc po q4h~q6h (ᆢ࡭ watery diarrhea 3~4 times/day)
ऩࢂ grade 4 ϐ hepatic encephalopathy (Deep coma)Ǵё‫ٳ‬Ҕ neomycin
retention enema (2gm (8#) in lactulose 200cc or N/S 200cc q8h~q12h)
ऩੰΓӝ‫ٳ‬วᐨǴค‫ݤ‬௨ନ SBP ਔሡ٬Ҕ 3rd generation cefalosporin
(Claforan 2.0gm iv q8h)

(E) ࡚‫(ݹط܄‬GOT /GPTBilirubin)

Ӄ௨ନ viral hepatitis ‫ޑ‬ёૈ‫( ܄‬check HBsAgǴAnti-HBsAbǴHBeAgǴ
Anti-HBeAbǴAnti-HBc IgMǴAnti-HCV AbǴAnti-HAV IgM)
௨ abdominal echo
fluid supplement
ऩ PT Ԗ prolongationǴё๏ϒ Vit K 1Amp iv drip qd x 3days

(F) ࡚‫܄‬ી᠌‫ݹ‬
NPOǴfluid supplement (2000~3000cc/dayǴif no overt dehydration)
ऩ vomiting or ileusǴ߾‫ܫ‬ሷगᆅЇࢬ
ऩӝ‫ ٳ‬fever Զ vital sign ᛙ‫ۓ‬ǴҔ 1st generation Abx (Cefa+GM)
௨ Abdominal Echo
ဎภǴёҔ Demeral 50mg iv q4h~q6h prn or tamgesic 1# SL q6~8h prn

(G) ࡚‫܄‬ᖌ៶‫ݹ‬Ǵ࡚‫܄‬ᖌᆅ‫ݹ‬
NPOǴfluid supplement
ऩ vomiting or ileusǴ߾‫ܫ‬ሷगᆅЇࢬ

-9-
 ऩӝ‫ ٳ‬fever Զ vital sign ᛙ‫ۓ‬ǴҔ 1st generation Abx (Cefa+GM)
௨ Abdominal Echo

05.Ոనဍዦࣽ
(A) Fever
(1) Hx reviewǴPEǴLab (CBC/DCǴB/C)
(2) Appropriate symptom treatmentǴex. ScanolǴᗉխ٬Ҕ NSAIDsǴ৮Ԗ
bleeding tendency ϐဤǴ٠‫ݙ‬ཀ fluid ‫ݩރ‬
(3) ऩᚶᅪ etiology ࣁ infectionǴcover adequate antibioticsǴwatch ongoing
sepsis
(4) ऩࣁ neutropenic feverǴAbx ሡ cover GNBǴ੝ձࢂ Pseudomonas
aeruginosa
(5) ऩ neutropenic feverǴς٬Ҕ anti-pseudomonas broad spectrum antibiotics
ΟВа΢Ǵϝ active fever ‫ޣ‬ǴF/U B/C ࡕǴёу΢ anti-fungus agents
(ex. Fluconazole iv)Ǵ+/- anti-ORSA agents (Ԗ catheters ‫)ޣ‬

(B) Pain
(1) ऩߚ surgical condition
1. Acute onsetǴค bleeding tendency ‫ޣ‬Ǵёϒ Scanol or NSAIDs
2. Breakthrough pain (chronic analgesics use)Ǵst. Morphine iv
(2) Surgical conditionǴྣ཮Ѧࣽ

(C) Insomnia
(1) ค air-way disease ‫ޣ‬Ǵёϒ sedative agents
(2) ‫ځ‬дᛰ‫ނ‬ӵ Vena ҭё

(D) Vomiting
(1) ϯᕍࡕჍӗǴऩค EPS HxǴёϒ Primperan +/- Decadron
(2) ‫ځ‬дᛰ‫ނ‬ӵ VenaǴAtivan ҭё

ߕǺЗӗᏊ Antiemetic drugs

7.2.1. serotonin antagonistsȐӵ ondansetronǹgranisetronǹtropisetron ฻ȑ

7.2.1.1.ondansetron(ज़αܺᏊࠠ)ǹ(93/2/1)
1.ମᡎ౽෌஻‫ޣ‬ௗ‫ڙ‬ଯᏊໆϯᏢ‫ݯ‬ᕍਔǶ
2.ൾ‫܄‬ဍዦ஻‫ޣ‬٬Ҕ cisplatin Ꮚໆຬၸ 50mg/sqM ёႣٛ‫܄‬٬Ҕ΋
ВᏊໆǶ
3.ൾ‫܄‬ဍዦ஻‫ޣ‬٬Ҕ cisplatin Ꮚໆຬၸ 50mg/sqM Ъวғᝄख़‫ۯ‬ᒨ

- 10 -
 ‫܄‬ჍӗǴ٬Ҕ dexamethasone Ϸ metoclopramide คਏϐੰ‫ٯ‬Ǵ‫؂‬
ᕍำ٬ҔаόளຬၸϖВࣁচ߾Ƕ໪ᔠߕੰᐕᄔाϷ٬Ҕ
dexamethasone Ϸ metoclopramide คਏϐ૶ᒵǶ
4.ௗ‫ڙ‬ဎ೽‫ܫ‬৔ྣ৔ϐᕎੱੰΓǴள٩Πӈೕጄ٬Ҕ
(1)total body or half body irradiation
(2)pelvis or upper abdominal region of single irradiation dose> 6 Gy
(3) ဎ ೽ ‫ ܫ‬৔ ‫ ݯ‬ᕍ ύ ౢ ғ Ⴭ ӗ Ǵ ࿶ ٬ Ҕ dexamethasone ǵ
metoclopramide ‫ ܈‬prochlorperazine ฻໺಍ЗӗᏊคਏǴϝว
ғᝄख़Ⴭӗϐ஻‫ޣ‬Ƕ
7.2.1.2. ondansetron(ज़‫ݙ‬৔Ꮚࠠ)ǹgranisetron(αܺᏊࠠǵ‫ݙ‬৔Ꮚࠠ)ǹ
tropisetron(αܺᏊࠠǵ‫ݙ‬৔Ꮚࠠ) (93/2/1)
1. Ոన༸ಒझ౽෌஻‫ޣ‬ௗ‫ڙ‬ଯᏊໆϯᏢ‫ݯ‬ᕍਔǶ
2. ൾ‫܄‬ဍዦ஻‫ޣ‬Ϸ॥ᔸխࣝ੯ੰȐӵआඬ‫܄‬ਫ਼የǵᜪ॥ᔸ‫܄‬ᜢ࿯
‫ݹ‬ǵ‫ن‬ՋМੱǵҜԼ‫ݹ‬/ӭว‫܄‬Լ‫ݹ‬ǵฯҜੱǵՈᆅ‫ݹ‬฻ȑ஻‫ޣ‬٩
Πॊ௃‫׎‬٬ҔǺ
(1) ߻ ॊ ஻ ‫ ޣ‬ೀ Б ଯ ठӗ‫܄‬ᛰࠔǴёႣٛ‫܄‬٬Ҕ Ondansetron
8~32mgǵGranisetron 1~3mgǵTropisetron5mg ΋ВᏊໆǶѸ
ाਔ‫ځ‬٬ҔаόளຬၸϖВࣁচ߾Ƕऩวғᝄख़‫ۯ‬ᒨ‫܄‬Ⴭ
ӗǴள‫ޔ‬ௗ٬ҔǴ‫؂‬ᕍำ٬ҔόளຬၸϖВࣁচ߾Ƕ
(2) ߻ ॊ ஻ ‫ ޣ‬ೀ Б ύ ठӗ‫܄‬ᛰࠔǴёႣٛ‫܄‬٬Ҕ Ondansetron
8~32mgǵGranisetron 1~3mgǵTropisetron 5mg ΋ВᏊໆǶऩ
ว ғ ᝄ ख़ ‫ ۯ‬ᒨ ‫ ܄‬Ⴭ ӗ Ǵ ٬ Ҕ dexamethasone Ϸ
metoclopramide คਏϐੰ‫ٯ‬Ǵ‫؂‬ᕍำ٬ҔаόளຬၸϖВࣁ
চ߾Ƕੰᐕ໪Ԗ٬Ҕ dexamethasone Ϸ metoclopramide คਏ
ϐ૶ᒵǶ
3. ௗ‫ڙ‬ဎ೽‫ܫ‬৔ྣ৔ϐᕎੱੰΓǴள٩Πӈೕጄ٬Ҕ ondansetron
(ज़‫ݙ‬৔Ꮚࠠ)ǵgranisetron(ज़‫ݙ‬৔Ꮚࠠ)฻ᛰࠔǺ
(1) total body or half body irradiation
(2) pelvis or upper abdominal region of single irradiation dose> 6
Gy
(3) ဎ ೽ ‫ ܫ‬৔ ‫ ݯ‬ᕍ ύ ౢ ғ Ⴭ ӗ Ǵ ࿶ ٬ Ҕ dexamethasone ǵ
metoclopramide ‫ ܈‬prochlorperazine ฻໺಍ЗӗᏊคਏǴϝว
ғᝄख़Ⴭӗϐ஻‫ޣ‬Ƕ
ഢຏǺ
1.ଯठӗ‫܄‬ᛰࠔǺcisplatin(>50mg/m2 /day)Ǵcarmustine(ɪ250mg
/m2 /day) Ǵ cyclophosphamide (>1500mg/m2/day) Ǵ methotrexate

- 11 -
 (ɪ1.2gm/m2 /day)Ƕ
2.ύठӗ‫܄‬ᛰࠔǺcisplatin(ɪ30mg/ m2/dayǴɩ50mg/ m2/day)Ǵ
carmustine(ɦ250mg/m2/day)Ǵcyclophosphamide(ɩ1500
mg/m2/day)ǴDoxorubicin(ɪ45mg /m2 /day)Ǵepirubicin
(ɪ70mg/ m2 /day)ǴCPT-11Ǵidarubicin(ɪ10mg/ m2 /day)Ǵ
daunorubicin(ɪ60mg/ m2 /day )Ǵ
Dactinomycin(actinomycin-D)ǴArsenic trioxideǴMelphalan
(ɪ50 mg/m2/day)ǴCytarabineǴCarboplatinǴoxaliplatin Ǵ
ifosfamideǴMitoxantroneǴDacarbazine Ъ‫ځ‬٬ҔᏊໆࣁ΋૓Ϧ
ᇡ‫ݯ‬ᕍᏊໆ‫܈‬΢ॊೕ‫ۓ‬ᏊໆਔǶ

06.ૅ๚ࣽ
(A) Dyspnea
(1) ୔ձ primary causeǴऩࣁ cancer progressǴ‫ݙ‬ཀ vital signǴё st.
Morphine iv.
(2) Watch air-way aspirationǴobstructionǴwheezing dyspneaǴetc..

(B) COPD ࡚‫܄‬วբ

a. ෧Ͽ਻ၰߔΚ
2-agonist (ӵ ventolin nebulizer)Ǵࣁ࡚‫܄‬วբϐಃ΋ጕҔᛰǴᝄख़ੰΓёೱ
ុ๏ᛰ(15~30 ϩដ΋ԛǴೱុΟԛ)
anticholinergics (ӵ atrovent) ёᆶ 2-agonist ‫ٳ‬ҔǴMDI ࣁ 2 puffs q2~4hrǹ
nebulizer q6~8hr
theophylline or aminophyllineǴӵ phyllocontin (225mg) 1# bid
SteroidsǺp’t ऩԖܴᡉ‫ ޑ‬bronchospasm (wheezing dyspnea) ‫܈‬ҁٰ൩Ԗߏය
٬Ҕ steroid ਔǴёԵቾ٬ҔǶᏊໆ௴‫ۈ‬ё๏ solu-cortef 200mg q6hǴऊΟϺ
ࡕӆ taper
b. ‫ݯ‬ᕍགࢉ
ऩ X ӀԖܴᡉ‫ޣݹޤ‬྽‫ݹޤ‬ೀ౛Ǵё๏ϒ levofloxacinǴiv form augmentin or
unasyn (+ azithromycin)Ǵ‫܈‬ಃΒжа΢‫ ޑ‬cefalosporinǹऩ X Ӏคܴᡉ‫ݹޤ‬
‫ޣ‬Ǵё๏ϒ levofloxacin ‫ ܈‬amoxicillin ฻ᛰ‫ނ‬
c. ‫ׯ‬๓਼਻Ⴋ‫ࡋک‬
ෳ ABGǴऩ hypoxemiaǴё๏ϒ O2 N-C 2-4 l/minǴor 24-48% Venturi maskǹ
keep Pao2 > 60mmHg Ϸ SPO2 > 90%Ǵՠा‫ݙ‬ཀࢂցҁٰ൩Ԗ CO2
retentionÆ high FiO2 ёૈЇଆ CO2 narcosis

- 12 -
(C) Asthma p’t ࡚‫܄‬วբϐೀ౛
(1) 2-agonistǺӵ ventolin nebulizer inhalation q4~6hǴᝄख़ੰΓёೱុ๏ᛰ
(15-30 ϩដ΋ԛǴೱុ 3-6 ԛ)ǹsevere attack ёԵቾу΢ atrovent
(2) HydrocortisoneǺsolu-cortef 200mg q6h
(3) ࢂցу΢ aminophylline ۘค‫ۓ‬ፕ
(4) ԖեՈ਼౜ຝਔǴෳ ABG ٠๏ϒ਼਻Ǵ٠ᆙஏଓᙫ

(D) Pneumonia p’t ‫ޑ‬ೀ౛

ӃεཷҗੰўǴX ӀТǴᖏ‫ݩރ׉‬ղᘐੰΓࢂ‫܈ݹޤ܄୔ޗ‬ଣϣགࢉ‫ݹޤ‬Ƕ‫ޗ‬
୔‫ݹޤ܄‬ёӆϩࣁ‫ࠠڂ‬Ϸߚ‫ࠠڂ‬ǴӼᎦᐒᄬள‫ݹޤޑډ‬Ƕଣϣགࢉ‫ݹޤ‬Ԗ٤ᗋ
хࡴ֎Ε‫ݹޤ܄‬Ƕ΋૓‫ݹޤ܄୔ޗޑ‬ё๏ϒ penicillin G 300 ࿤ q6h + azithromicin
(250mg) 2# qd (๏ΟϺջё)Ǵऩၨᝄख़‫ੰޑ‬Γ(ӵӝ‫ځٳ‬дᏔ‫ޑ۔‬ୢᚒǴԃइ
εǴᖏ‫ݩރ׉‬όӳ฻)Ǵё๏ϒಃΒж‫܈‬ಃΟж‫ ޑ‬cefalosporinǴ‫ ܈‬augmentin or
unasynǴӆӝ‫ ٳ‬azithromycinǶ֎Ε‫ݹޤ܄‬ё๏ϒ high dose penicillinǴaugmentin
or unasynǴ฻ёа cover Ⴧ਼‫܄‬ಒ๵‫ޑ‬ᛰ‫ނ‬ǶԿ‫ܭ‬ӼᎦᐒᄬள‫ݹޤޑډ‬Ԗਔा
Եቾ๏‫ ל‬pseudomonas ‫ޑ‬ᛰ‫ނ‬Ǵӵ piprilǴtazocinǴciprofloxacin…฻. ‫ځ‬дᇶշ
‫܄‬ᕍ‫ݤ‬Ǵхࡴ O2 therapyǴmucolytic agentǴchest care ฻

07.๝᠌ࣽ
(A) Hyperkalemia
(1) Ӄዴ‫ۓ‬คྋՈǴး΢ EKG monitorǴcheck ABG(࣮ࢂց metabolic acidosis)
(2) Ԗ wide QRS ‫ ࢂ܈‬hyper acute T waveǴcalcium gluconate 1amp iv st(ёуѺԿ
QRS ᡂઞ)
(3) 50% glucose 4amp + insulin 8u iv stǴsodium bicarbonate 2~4amp iv stǴ
ventolin inhǴkayexalate 30g st then 15~30g qid
(4) recheck K
(5) ӵ݀ԖλߡёѺ furosemide 20mg/ampǴӵ݀ࢂதයՈన೸‫ੰ݋‬஻Ъ
K>6meq/LǴೱ๎ࢱ๝࠻ 1506Ǵ1507 ௨࡚ࢱ

(B) Acute pulmonary edema

(1) chestǺbilateral crackles breathing soundǴෳ oxymeterǴcheck ABGǴӵ݀Ԗ
consciousness change ‫ ܈‬pending respiratory failure ӃԵቾකᆅௗ‫֎ڥ‬Ꮤ
(2) ӵ݀ؒԖܴᡉ fluid overload ‫ޑ‬౜ຝ JVE(+)Ǵleg edemaǴा଺ EKGǴෳ
cardiac enzyme ௨ନ AMI
(3) ԖλߡǴё၂Ѻ furosemideǴSBP>100mmHg ёᅀ nitroglycerin 50mg/vial keep
0.6cc/hr(ё෧ᇸ dyspnea)
(4) ྣ CXR ዴ‫ۓ‬Ԗค pulmonary edema

- 13 -
(5) ӵ݀Ⴃ՗ੰΓёЍ࡭ 4 λਔό཮‫֎ڥ‬૰ᆃǴೱ๎ࢱ๝࠻ 1506Ǵ1507 ௨࡚ࢱ
(6) ӵ݀ࢂဎጢ೸‫ੰ݋‬ΓǴdyspnea ۘёǴёҔ 4.25% dialysate

(C) First hemodialysis

(1) on femoral double lumenǴೱ๎ࢱ๝࠻ 1506Ǵ1507 Ӽ௨ਔ໔
(2) hemodialysis orderǺdurationǺ3hrǴdialyzerǺDICEA-150(60kg а
Π)/DICEA-170(60Kg а΢)ǴdialysateǺ BCM caǺ3.0ǴBlood flowǺ
150~180ml/minǴheparin freeǴultrafiltrationǺຎੰΓНဍ‫ݩރ‬Զ‫ۓ‬Ǵനӭऊ
ᡏख़‫ ޑ‬6%
(3) ӵ݀ BUN ߚதଯ‫ੰ܈‬Γ body size λǴёа஥ mannitol 300ml/BT slow drip
3hrs during hemodialysis

- 14 -
ൄ‫ش‬ฃ፿ᎅࣔΝ
Œ iv (IV)Шintravenously
Œ im (IM)Шintramuscularly
Œ SQΔSCШsubcutaneously
Œ SLШsublingually
Œ POШorally
Œ ACШbefore meals
Œ PCШafter meals
Œ PRШby rectum
Œ QMШඣၴࣚ‫ش‬
Œ QhsΔhsШጕছࣚ‫ش‬
Œ cmШcoming morning
Œ aaΔAAШof each
Œ STATΔSTШ ್Ղ
Œ PRNШas required,
whenever necessary
Œ AmpШᄫ෈ण
Œ qdШonce a day
Œ bidШtwice a day
Œ tidШthree times a day
Œ qidШfour times a day
Œ ॣ‫شࠌڻ‬ᄅᢐᚨ٣៬ᔹ
ᢐࠢΔࣹრᕪၦ֗೫‫ش܂‬

Pain & Fever

1. Acetaminophen Ÿ Scanol 1# qid
SyrupΚBW*1.5CC per day
2. NSAID
AspirinΔTapal (for child)
ASAΔBrufenΔIntebanΔEcotrinΔPonstan
Naposin ( *‫ ڶ‬HSV infection ֎‫)ش‬
3. Codeine po. IV. IM. (‫ܮࡅࠫލڶ‬հ‫)!!!ش܂‬
4. Pain cocktail sol’n 10-20 c.c. po.
5. Demerol IM. 1gm/1kg
ࣹრࠃႈΚchildren virus infectionΔ‫ شݲ‬aspirin
1. Fever
‫آ‬ሒ 38.5кΔ‫ ش‬ice pillow
Օ࣍ 38.5кΔࢼ CBC/DCΔ೚ blood culture x II or III ୚ ‫ބ‬ఐᄭ
Rx ΚՕԳ Inteban 1# supp or Scanol 1# po
՛৘ Voltaren ‫ ޢ‬10kg 1# supp

2. Pain
*NSAID ᣊᢐΔլ‫ ࣍شױ‬ulcer
ՑࣚΚScanolΔPonstan
ಾᕪΚIndocin 1 Amp ivΔAcupan 1 Amp (խᑐַ࿀ᕪ)
DemerolΔMorphineШR (࣐‫)ᦥګ‬
z Special
ϨRAΔGout Ϋ IndocinΔAllopurinolΔColchicine
Ϩᣂᆏ࿀ Ϋ Clinoril

1
 Selective COX2 inhibitorΚCelecoxib 1#Bid
ϨTrigeminal n. pain Ϋ Tegretol
ϨSore throat Ϋ ScanolΔSolantalΔPonstanΔIbuprofen
Ϩᆩ࿨‫ شف‬Morphine
ϨTumor painΔFracture Ϋ Demerol imΔMorphine imΔPain Cocktail Sol’n po
Ϩ‫ڂڕ‬ષङ֧ದΔ‫ڇ‬ᒔࡳ޲‫ ڶ‬obstruction ൣउՀΔ‫ ش‬Buscopan 1 Amp im.

3. Cough
Dry coughΚMediconΔToclaseΔ1#qid
Intractable dry coughΚCMB 15 c.c. qid
Productive coughΚResplen 1#qid ΔCMA15cc qid

4. MucolyticsΚBisco 1# qid
Bisolvon 10 c.c. qid
‫ڶ‬ᖺᅠΚBisco 1# qid ~ 2# tid

5. Dyspnea
٣։ਢ Lung or Heart or ࠡ‫֧ڂ଺ה‬ದ Ш ٣ࢼ ABGΔLung (ᦫ်) Ϋ PneumothoraxΔCOPDΔ
AsthmaΔCancer MetaΔPneumoniaΔPleural effusion
RxΚ٣࿯ O2 Δ٦࿯֭௛ጥឩ്ᕪ
ΫӪ2 agonist (࣐ tremor)ΚBerotecΔVentolin
ΫAdrenergic agonistΚIpradol(po im.)
ΫSteroidΚ SoluCortef 1 Amp IV. qid or Decadrom 1 Amp IV qid
ΫAminophyllineΚPhyllocontinΔEuphylline 1# qid
Aminophylline 1# qid or IV.MmΔMeptin 1# BidΔ Theolan 1# Bid
ΫAnticholinergicΚatrovent
ϨʳIpradolΔAminophylline լ‫ ױ‬push ֜‫ݶ‬Δ2 Amp in D5W 500c.c. run BW c.c./hr and
ྒྷ blood concentration
(Side effectΚNauseaΔVomitingΔAbd. PainΔPalpitationΔCardiac arrest)

z Heart Ϋ ٣ᦫ heart soundΔ‫ ܂‬EKG

1. NTG 1# SL for Angina q5min x III ‫ڻ‬
2. MI or Ischemia Ϋ R
3. Heart FailureΚ
ီൣउ‫ױ‬࿯ղ Lasix (1 Amp IV or repeat intropic)
*ૉ ABGΔPH<7.2 ‫א‬૞ᇖ HCO3-
Total BW*0.4*(desired [HCO3-]-measured[HCO3-])
=[HCO3-]deficit
ԫ‫ת‬ၦ൷ iv pushΔ‫׼‬ԫ‫ת‬ၦ‫ף‬Ե D5w փ drip12-24hr

2
6. Hypnotic
Halcion 1# qhs (onset ‫ݶ‬Δduration ࿍)‫࣍ش‬լ࣐Եጕ
Benadryl 1 Amp IM (ࠠႰጕ೫‫)ش܂‬
*Ativan (0.5) 1# qhs (antianxiety) ‫ڜ‬٤
Valium(2)(5) 1# qhs ࣹრࡅ‫ࠫލܮ‬
*ԫ౳‫ ࣠ڕ‬liverΔkidney ‫ڶ‬ംᠲΔegΚCirrhosisΔUremiaΔCOPD հ pt ‫ א‬Ativan ֗ benadryl
੡ࡵ + Dormicum

7. Antacid
GasgelΔFina 1# qid(ൄ‫)ش‬
Nacid(ࠫᎨΔ‫ݼ‬ષ๨‫)ػ‬
Ulcerin(ࠫᎨΔblock parasympathetic n.)

8. ෈᧯ΚFenta 15c.c qid ԫ౳࣐ diarrhea

AMG 20c.c qid
Gelfps 1 pack tidΔqid—࣐ঁమ
Mucaine 10c.c qid (ࠠ຾ᔨַ࿀ய࣠)
*ԫ౳ࡵ Fenta 15c.c + Gelfos 1 pack ෗‫شࠌٽ‬Δխࡉࠡ side effect
*Tagamet 1# tid and 2# qhs
*Tagamet 1 Amp im g6h~Q8H ‫ ࣍ش‬MAJOR STRESS

9. Muscle relaxantΚ‫ ࣍ش܂‬CNSΚBaclon 1# qid

10. ؆‫ش‬ᢐ
Skin itch - Rinderon A creamΔUp ointΔPH oint
Esperson oint (ய່࣠ൎΔլ‫࣍ش‬ᜭՂࢨ genital organ )
Calamine lotion 60c.c.(ַ᣺Δ‫ױ‬एᅣ՗֗᧔႞)
จ ᒈ - Proctosedyl ointΔPosterisan forte lint
ଉ ཽᆬ - 1) Dry type ΚPusca gel.
2) Wet type ΚConesten (‫ٺ࣍شױ‬ᣊऱ fungus infection)
‫ؼ‬ᓅధ‫ ؼ‬- Cortimycin ointΔNeomycin oint.
ֽ ऐ - ٣‫ ش‬N/S wet dressing or ZnOΔRBZP ࿛‫گ‬ᚹᕪჁհ
؆ᑆַ࿀堚ළ - Rheumon gel (؆ઝൄ‫)ش‬
Oral Ulcer - Kenalog In OrabaseΔDelxatin
BURN - SulfasilΔFucidin
Eczema - Urea
HerpesΚAcyclovir
ntibiotics - 1. Neomycin OPH and ؆ઝ
2.Cortimycin OPH ᜭຝ

3
 3.Tetramycin
4.Furacin ؆ઝ႞Ց

11. መඕΔ⼡຾ఖΚVena 1# qidΔVena 1 Amp im

12. Anti-anxiety drug Κ‫ ܛ‬Minor Tranquilizer

९ய ΚLibrium 1# qid
Erispan 1# qid
Xanax 1/2 #qid
࿍ய ΚAtivan ΔSerenal 1# qid

13. H/T ๠ᆜ
1.֫๬৵mpainШַ࿀ nurine retentionШICP
2.HeadacheΔChest Pain ್Ղ๠෻Δૉྤ s/s ঞ 15 mins ૹྒྷ
3.९ཚ H/T ‫ױ‬լ๠෻ࢨ‫ݟܓף‬ᕪ

14. Hypertensive emergency

Diastolic pressure >120mmHg (‫ ڶ‬coronary artery ischemia ृլ‫)شױ‬
Adalate 1# SL st 30 ։৵ check BPΔ‫ױ‬ຑᥛ࿯

15. Convulsion disorder

*Valium 1 Amp im or iv ‫ױ‬ᥛ‫܀ؚ‬լ၌መ 3Amp ‫ڶ޲࣠ڕ‬ೖַΔ‫ شױ‬Barbiturate
*Dilantin iv drip ‫ޢ‬։<50 mgΙLoading dose 15mg/kg/dayΔ maintain dose 5mg/kg/day
(Dilantin 1Amp=250mgΔ‫ ࣠ڕ‬patient60kgΔঞ‫ شױ‬3Amp ‫ף‬Ե N/S խΔՏ Տᆄլ૞‫ڶڇף‬
glucose հរዠխШᄎ࿨དྷ)
‫׼‬؆ΔIV<50mg/minΔ3Amp=750mgΔ‫ࠌܛ‬ዠຒ full run ޲ᣂএ‫ڂ‬੡լ‫ױ‬౨‫ ڇ‬15 ։ᤪփ
‫ނ‬ԫ෿ N/S ‫ݙؚ‬Ζ ૞ monitor blood conc.

16. ࿾௛
Gascon 1~2c.c. qid or methol packing ࢳߚ៯
primperan 1 Amp im or 1# tid (AC)

17. ߚ՗࿀
ૉ‫ ڂ‬Hallow organ ৺ຒᤘ೯ࢬທ‫(ګ‬eq.enterocolitisΔ࿨‫ف‬Δcholecystitis)
Ш Buscopan 1 Amp im st

18. HypoglycemiaΚ
(ൄߠ࣍ࠌ‫ ش‬Hypoglycemic agent ऱ patient)
‫ א‬50%Glucose 1 Amp IV stΔྒྷ finger stickΔլജ٦‫ؚ‬

4
19. P’t I & O լؓᘝΔ஁༓‫ۍ‬чྤࢬᘯΔࣹრ electrolyteΔ‫ڕ‬θKιЦΔ‫ױ‬ᇖ KCl 10~20mEq iv
dripΖ
ϡMentainance Dose KCl 20meq in 1000ml N/S run 75 ч/hrΔᇖ slow K 1#tid~qid

20. Nasal obstructionΔrhinorrhea

Ш Antihistamine – RhinorrheaΙPseudoephedrine – Nasal obstruction
1 SyrupΚPeriactinΔDimentaneΔActifetΔBW*0.8cc per day
2 ྤ Sedation side effect ृΚClarityne ‫ ࣍ش‬Nasal allergy
3 Nasal ObstructionΚClarinase 1#Bid
4 RhinorrheaΚRhin (ܶ Scanol)ΔPeriactinΔPolaramineΔKetotifen

21. Cough
ྤᅠΚMedicon ToclaseΔCMB
‫ڶ‬ᅠΚResplenΔCMAΙ֏ᅠΚBisco
Robitussin 15 ч qid (dry cough ‫)ش‬ΔDM ՛֨
Codeine po. im. iv.Δࡅ‫ܮ‬լࠋृ՛֨Δᄎ apnea
Medicon (dry cough ‫ )ش‬po. im. Iv
CMB (ܶ codeinΔ՛֨ࠡ complication)
SecorineΚchild cough BW*1cc per day
֭௛ጥឩ് BerotecΔVentolin

22. VomitingΔNausea
٣ R/O I I C PΔGI obstructionΔpancreatitisΔC/T հ complain
Primperan 1amp IM/1Ϟtid or qid/IV st.
Novamine 1amp IM for C/T հ complication
Ͽprimperan iv dripЀNovamine im (ൄ‫)ش‬
Wintermine 1amp IM for ‫(♙ؚ‬Hiccup)
Anti-HistamineΚVena oral 25~50mg tid~qid
Ϟ Ϟ
Bonamine 1 tid or qid or 1 sac

23. Insomia
࿍ய Ativan 1# hs (‫זݶ‬᝔Δ‫۔‬ԳΔߗլ‫)شױृړ‬
Halcion 1# hs (‫ ڇ‬chest ‫ ڶ‬COPDΔrespiratory insufficient ֎‫)ش‬
o֟‫ ش‬barbiturate ᣊΔ‫ڜ‬٤ࢤ‫܅‬Δeg. Valium

24. Abdominal pain

(a) Gastric organ
gasgel 1Ϟqid(ለլᄎ constipationΔdiarrhea)
Fina 1Ϟqid(‫ڍپ‬ᄎ constipationΔᄵࡉ 2Ϟqid)

5
 Ϟ
Nasid 1 qid(‫ڍپ‬ᄎ diarrhea)
Ϟ
Ulcerin 1 qid(diarrhea & antispasm)
MgO 1 # Tid(stool softnerΔ‫ڍپ‬ᄎ diarrhea)
AMG ષࠂ 15~20 ч qid (‫ڍپ‬ᄎ diarrhea)
Tagamet(H2-blocker) 1# tid & 2#qhs

(b) ConstipationΚ٣ R/O intestinal obstruction

Dulcolax 1Ϟsupp st.
Fleet enema 1pc st. ෈᧯ᥒΰ‫ش‬ᢐլ࣐ழα
Ϟ
MgO 1 tid~qid ຌঁ
Ϟ
Senokot 2 hs(only) ຌঁ
Ϟ
Mitrolan 2 qid for constipation or diarrhea

(c) Diarrhea
Ϟ
Imodium 1 po st.ᢐࢤ֜ൎ
Kaopectin 15 ч st. or qid
CholestyraminΚ4gm/packΔ1 pack po. st.

Normal Data in ९ࢊ CBC/DC

RBC M 4.5-5.9 F 4.0-5.2 Million/CM
M
Hb. M 13.5-17.5 F 12-16 GM%
Hct. M 41-53 F 36-46 %
MCV 80-100 UMM
MCH 26-34 PG/CELL
MCHC 31-37 G/DL
Ret% 0.5-1.5% infant 2-5% %
Platelet 150-400 1000/CMM
WBC M 3.9-10.6 F 3.5-11 1000/CMM
Band <5% %
Seg 55-71% %
Mono 0-12% %
Eos 0-5% %
Bas 0-1% %
Lymph 20-56% %
RDW 11.5-14.5 %
ESR 0-15 MM/HR

6
Normal Data in ९ࢊ UA
Outlook yellowΔclear
SP. Gr. 1.005-1.030
PH 4.5-8.0
Protein (-)
Sugar (-)
Ketone (-)
Bilirubin (-)
Urobilinoge 0.1-1.0 EU/DL
n
RBC 0-2 /HPF
WBC 0-5 /HPF
Epithelium 0-5 /HPF
Granular (-)
Leukocyte (-)
Nitrate (-)
Blood (-)

Normal Data in ९ࢊ Blood Chemistry

HBA1C 4.6-6.2 %
GOT(AST) 0-34 U/L
GPT(ALT) 0-36 U/L
Alk-P.tase 28-94 U/L
Bilirubin T 0.0-1.3
Albumin 3.5-4.7 G%
BUN 6-21 MG%
Creatinine 0.4-1.4 MG%
Uric Acid 2.7-8.3 MG%
Ca 7.9-9.9 MEQ/L
P adult 2.4-4.7 child 4-7 MEQ/L
Na 134-148 MEQ/L
K 3.0-4.8 MEQ/L
Cl 97-107 MEQ/L
CO2 23-32 MEQ/L
Glucose(AC) 70-105 MG%
Glucose(PC) 70-120 MG%
T. Cholesterol <200 MG/DL
Triglyceride 30-150 MG/DL

7
Amylase 27-137 U/L
T.P. 6.3-8.0 G%
LD 47-140 U/L
ө-FP <20 MG/ML
CEA <5 MG/ML
C-peptide 7-8.31(PC)
0.47-3.15(AC)
T3 62-188 NG/DL
TSH 0.4-4.5 U/ML
!
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!!!)Buspwfou!2!bnq/,Wfoupmjo!2!bnq/*joi/!R7i,tubu!
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QTǺjg!OUHҔࡕόഹǴCQ!epxoǴёፓफ़OUH!
!
ɊBBce/!Qbjo!
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ɊGGfwfs!
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jgόՉʈ๏ᆶlfup!jn!
jgόՉʈ๏ᆶ!tujo!jn)֖btqjsjoȑ2!wjbm!Ȑ1/:!nh!ȑ!
!!!+Ifnb!‫ੰޑ‬ΓԖਔሡ΢bouj!.!)Ub{pdjo!5/6hǴ3!wjbm!R7i!,!Hfoubnjdjo!91!nh!R23i*!
!
ɊOOfvuspqfojd!gfwfs!
!!!oofvuspqfojdǺBODɦ6110nn4!
!!!GfwfsǺtjohmf!ufnqfsbuvsfɧ49/4!ps!ɧ49!qfstjtu!pwfs!bu!mfbtu!2!ipvs!
!!!BoujǺujnfoujo!ps!gpsuvn!,!bnjophmzdptjef)bnjljo!ps!hfoubnjdjo*!

8
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!
ɊTTfj{vsf!buubdl!
!!!Bujwbo!)1/2!nh0lh*!jw!qvtiǴӃqvti!2!bnqǴ2!njoࡕؒଶӆqvti!2!bnqǴ2!njoࡕؒଶ
ӆqvti!2!bnq!
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ऊ!31!njo*!
ʈtujmmǺsf.mpbejoh!6nh0lh!
ʈpo!foep!)Epsnjdjvn!203!bnq*!
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211NE0njo!
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9
0(02








 On Call
1. High B.P.Ǻnew onset CVA(infarction)
SBP<220ǴDBP<130ɨɧobservation
SBP>220ǴDBP>130ɨɧTrandate(Labetalol) 1 amp(25mg) IV ST
Repeat every ten minutesǴup to 160mg
if still poor responseǴtry Nitroprusside

ନΑ new onset CVA Ѧ

a. Adalat(Nifedipine) 1# SL or PO if SBPɧ180 mmHg
(ContraindicationǺASǴunstable anginaǴAMI)
b. Trandate(Labetalol) 1 amp IV ST
(ContraindicationǺdigitalis resistant heart failureǴasthma)

2. Low B.P.ǺDC ཮फ़Ոᓸ‫ޑ‬ᛰ(LasixǴValiumǴPropofol…)

࣮ heart rateǴurine outputǴpatient’s appearance
Heart rate and urine output normal ɨɧobservation(physiologic)
Cardiogenic shockɨɧDobutamineɠDopamine
Non-cardiogenic shockǴHRʅand urine output ʆ(compensatory)
ɨɧ fluid challenge(2-5 rule)
ᒡ ColloidǴFFP
Dopamine
Levophed
Ϩʳ Fluid challenge 2-5 ruleǺ
CVP initial X
Challenge 200 mlǴCVP<X+2Ǵӆ challenge 500 ml
X+2< CVP <X+5Ǵ߾ challenge 200 ml
CVP>X+5Ǵ߾ stop fluid challengeǴ‫ׯ‬Ҕ Dopamine
Ϩʳ Neck CVP insertion(ෳ CVP level ωྗǴԖ ventilator ‫ޣ‬Ǵा෧௞ PEEPǴ‫܌‬а
നӳ off ventilator ӆ checkǴѺֹፎྣ X-ray ࣮Տ࿼(4th intercostal spaceǴ
hilar)Ǵfluid level ा‫୼ى‬Ǵ๏ϲᓸᏊωԖཀကǴց߾཮೷ԋ tachycardia and
peripheral vasoconstrictionǴЪਏ݀όӳǶ
Ϩʳ Dopamine Ҕ‫ݤ‬Ǻ4 amp(800 mg)ɠN/S 500 c.c.(double dose)
2 amp+ 500 c.c.(single dose)
2 ampɠ250 c.c.(Βӝ΋)
Dopaminenergic RǺ2-3 μg/kg/minǴincrease renal and splenic blood flow
1 RǺ4-8 μg/kg/min
 RǺɧ8 μg/kg/min(ωԖϲᓸਏ݀)
 ExǺ70 KgǴ3μg/kg/minǴ๏ 8 drops(ml/hr)ǴҔ฻Кભኧፓ᏾Ꮚໆᅀኧ
Double doseǺ26.6 Ø ᅀኧ / B.W.ɨμg/kg/min
Single doseǺ13.3 Ø ᅀኧ / B.W.ɨμg/kg/min

ɀɀࢱ๝ࡕՈᓸեǴёӃϿໆံН(200 c.c.)ǴऩϝեǴё๏ Dopamineɀɀ

3. OliguriaǺ
Ӄ௨ନ obstructionǴOn foleyǴirrigationǴecho
If no obstructionǴcheck renal function and compared with previous dataǴavoid
nephrotoxic drugsǶ
Ոᓸեਔ‫ي‬ᡏౢғߥៈբҔǴԾฅคֿǴς᛾ჴҔճֿᏊ‫ ࢂ܈‬Dopamine renal
dose ჹႣࡕό཮ԖᔅշǶ

4. AsystoleǴPEA(D/DǺ6H6T)Ǻ
ћћ ABC(CPR)ǴO2(on endo)ǴIV(Atropine 1 ampǴBosmin 1 amp)Ǵmonitor(EKG)
ऩ show Torsades de Pointes ๏ MgSO4 1 ampǴDC shock(360J)

5. Sodium Bicarbonate ๏‫ݤ‬Ǻ

check Blood GasǺPHɦ7.2 ω๏(Ӣ‫܂‬ϼለ೷ԋ hyperkalemia induced cardiac
arrest)Ǵ࣮ BE ॄӭϿ
ExǺBase ExcessǺɡ8ǴIV push 4 ampǴ4 amp slow IV drip

6. DyspneaǺ࣮ pateint Ԗค cyanosisǴ๏ O2Ǵ࣮ O2 oximeterǴբ EKGǴ‫ ܜ‬blood

gas to R/O CO2 retensionǴD/D CO2 retension or O2 saturation down
AllergyǺBosmin 0.3 ml inhalationǴSC

bronchospasmǺ
Βӝ΋ǺAtrovent + Berotec(Ventolin) inhalation or
Οӝ΋ǺVentolin + Bosmin + Decadron(Ӛ 1 amp) inhalation
Solucortef(hydrocortisone) 2 amp ST(excerbation of COPDǺ0.5 ampȐ50mgȑ
Q6H Ø 3 days*!
NfuizmqsfeojtpmpofǺ42/36!nh!r7i!
Aminophylline(2 amp + N/S 500 c.c(pump)Ǵkeep 21 drops)ǺcontroversialǴside
effectǺ tachycardia

Heart failure or ascitiesǺ

Lasix 2 amp ST(if blood pressure is acceptable)
 AMI(check EKGǴCKMBǴTroponin I q6h)Ǻ
MONA therapy with HeparinǴconsider PTCA

Pulmonary emboliΚ
ֹӄค‫ݤ‬௨ନǴby clinicalǴӵ݀ࢗό‫ډ‬চӢ΋‫ۓ‬ाԵቾǴЀ‫ ࢂځ‬EKG Ԗ
S1Q3T3 patternǴόၸࡐϿ‫ـ‬Ǵε೽ҽа sinus tachycardia ٰ߄౜Ǵ‫܌‬аऩԖ
unexplained hypoxemiaǴD-Dimer increaseǴCXR Ԗ wedge shapeǴӵ݀ PE ࣁ
୤΋ԵໆǴvital sign unstableǴ൩ӃҔ Heparin or LMWH(EnoxaparinǴ
Clexane)60 mg SC q12hǴՠ D-D dimer ӧ old ageǴinfectionǴinflammationǴ
pregnancy ࣣ཮΢ܹ

7. Conscious changeǺD/DǴfind cause and treat

ᆙ࡚‫ݩރ‬Ӄ௨ନǺsugarǴABGǴEKGǴhemorrhage(բ non contrast brain CT)Ǵ
electrolytesǴsepsis

8. FeverǺfind cause and treat

obtain cultureǺS/CǴU/RǴblood culture Ø 2Ǵbed soreǴcatheter related
lumbar puncture, thoracentesis, abdominal tapping if necessary
Reduce temperatureǺscanolǴketo if fever>38.3ʚ
increase IV fluid
Empiric antibiotics if infection sign was noted(࣮೽Տ)

9. RI insulin pump for HHNKǴDKAǴDM with poor control(Sugar>500 mg/dm*

a. HydrationǺDKAǺ100 ml/KgǴHHNKǺ150 ml/kg
b. Plasma osmolarityǺ2ȜNa+ȝ+ȜGlucoseȝ/18 +ȜBUNȝ/2.8
c. DKAǺif PH<7.1Ǵӆံ Sodium Bicarbonate
d. ST RI 10-15 U(ё๏ёό๏)
e. RI pump (100U RI +N/S 100c.c.)
ExǺ70 kgǴ100 U RI + N/S 100 c.c. drip(1 c.c.=1 U)(0.1 U/Kg/hr)
Blood sugar(mg/dl) ᅀኧ
<200 DC Ъ IV ‫ׯ‬ԋ 5%glucose0.45N/S 500c.c.
200-250 1
250-300 2
300-350 3
350-400 4
400-450 5
450-500 6
>500 7
ձ‫ב‬Α check sugar q2h-q4hǴcheck K+ q4h-q6hǴcheck Mg2+ initially
Ӣࣁ๏ RI ཮फ़ե potassium(transcellular shift)Ǵ‫܌‬а
Potassium concentration Give? mEq over next hour
<3 40
3-4 30
4-5 20
5-6 10
>6 0
฻ sugar stable and well intakeǴीᆉ total dose of insulin/day Ѥ฻ҽ
multiple daily injection:ǺRI__tid/acǴNPH__hsǴcheck sugar qidac

10. HyperglycemiaǺif sugar > 250Ǵgive RI X U SC stat

1 U RI ऊёफ़ 20ɴ30 mg/dm!cmppe!hmvdptf!
‫܌‬а Xɨ(sugar-250)/20ɴ30

11. HypoglycemiaǺ50% glucose 2 amp iv push stat and check data l~2 hr later

12. HyperkalemiaǺ
Calcium gluconate ӃѺ 1 amp for cell membrane stabalization
ӆ๏ RI 8 U+D50W 4 amp(5 g sugarɨ1 U)
KayexalateȐKalimateȑ30 gm QID
Sodium BicarbonateǺӧ severe metabolic acidosis ωҔ
Thiazide
H/D if intractable hyperkalemia

13. HypokalemiaǺKCl 1 amp(40mEq) AT or PO TID with meals(if water restriction)

slow K(8mEq)
࣮ deficiencyǴᆉ TTKG
A decrease of 1 mEq/L in the plasma K+ concentration may represent a total body
K+ deficit of 200-400mEq.

14. HyponatremiaǺෳ urine NaǴurine OsmǴblood OsmǴD/DǴR/O Adrenal

insufficiency
ค symptomǺ0.9 %N/S
Ԗ symptomǺ3% NaCl (όёံϼ‫ז‬Ǵց߾཮೷ԋ central pontine myelinolysis)
Na+ <120Ǻ3% NaCl
ExǺ໊લϿໆɨ(135ɡ౜ӧ data) Ø 0.6(male) Ø body weight
0.5(female)
 3%NaCl 500 mlɨ512 mEq
70Kg maleǺNa+ɨ115 Ӆલ(135ɡ115)Ø0.6Ø70ɨ840 mEq
ံ໊‫ޑ‬ೲࡋόૈຬၸ 1-2 mEq/L/hourǴ24 hrs ϣόૈຬၸ 8 Eq/L
‫܌‬а΋Ϻϣѝૈံ 70Ø0.6Ø8ɨ336 Eq
336ø24ø0.513ɨ27 ml/hr(ᅀኧ)
‫ז‬ೲᆉ‫ݤ‬Ǻ24 hrs ံ΋౟ 3%NaCl 500 mlǴ‫܌‬а 20 ᅀǴϐࡕӆ check
PSǺNa ӧ hyperglycemia ਔ཮फ़եǴcorrect Na=Na + 1.4Ø(sugarɡ100)Ǵ‫܌‬а
όा΋‫ ډـ‬Na ե൩ံǶ

15. HypernatremiaǺ
Water deficitɨȐplasma Naɡ140ȑ/140 Ø 0.6(male) Ø body weight
0.5(female)
લ‫ޑ‬Нϩϩԋ 2-3 days ံкǴIV Ҕ 0.45% NaClǵD5W

16. HypercalcemiaǺ
Ӄ hydration Կ fluid status ‫ࡕ୼ى‬๏ lasixǴՠा‫ݙ‬ཀӕਔံк potassium.

17. SeizureǺfind cause and treat

a. Acute seizure attackǺValiumǴAtivan
b. DilantinǺloading 10mg/kgǴmaintain dose 1 amp Q8H IVǴkeep Dilantin level
10-20 mg/dlǴαܺਏ݀Ψόᒱ 1# PO TIDǶ
c. LuminalǺloading 3 amp IM STǴmaintain dose 1 amp HS IM

18. ක endo ᒧဦǺadultǺfemale 7.0-7.5Ǵmale 7.5-8.0

කֹ૶‫ ྣޑ‬X-rayǴlocation ࣁ carina ΢Б 3-5 cmǴfixed 22 cm first

19. Ventilator setǺ

z AC modeǴFiO2Ǻ100%ǴRRǺ10-15/min
z Tidal volumeǺ10-12 L/kgǴbut 6-8 L/kg (ARDS)
z PEEPǺCOPDǺ3-5 cm H2OǴMax < 15( adjust 3-5 cmH2O every time to achieve
PaO2> 60ʝand FiO2ɦ60ʝ)ǴARDSǺ10-15 cm H2O
z Trigger sensitivityǺ-1 to –2 cmH2O
z Flow rateǺ5-20 L/min
z Flow sensitivityǺ2 L/min
z Inspiratory flowǺ60 L/min
z I/E ratioǺ
1:2 to 1:4 (COPD)
1:1 to 1:2ȐARDSȑ
0(02








 ABG?
ABG

ABG

30
---- oxygenation
Allen test
1-2 ---- ventilation
( ----
xylocaine
) ----
5 c.c. 0.5c.c.(1:1000) Heparin
Solution Heparin
coating Heparin *ABG H+ O2 CO2
60 HCO3- SaO2

3c.c.
5

ABG

ABG
ABG ABG

pH = 7.4 ---- PaO2 oxygenation

+
H ---- PaCO2 ventilation
---- A-aDO2
PaCO2 = 40 mmHg CO2 ----
ventilation

PaO2 = 95 mmHg O2
pH = 7.36 - 7.44
oxygenation PaCO2 = 36 - 44 mmHg
HCO3 = 22 - 26 meq/L
HCO3- = 24meq/L bicarbonate
buffer
metabolic component a) pH
b) PaCO2 HCO3-
BE =0 Base excess
metabolic component c) pH pH
<7.36 pH>7.44
SaO2 = 97.5% HB O2 d)
oxygenation e)
 ALLEN TEST? ABG

1 Heparin ABG Heparin

Allen test collateral circulation PaO2 PCO2 syringe
test 0.5c.c. heparin 2c.c. 25%
PaCO2 PaCO2
20%
ABG PaO2
-pH
Heparin (25000 iu/ml)
pH
Allen test *1 5c.c. dead space 0.2c.c.
3c.c. Heparin

2) PO2
PCO2 PO2
PCO2

3 ABG
20 PCO2 PO2 pH
Leukocytosis
ABG 4 C
PaO2 Hypoxemia

plasma
O2 O2 (98%)
Hemoglobin Hypoxemia
plasma O2 PaO2 <
(partial 80mmHg
pressure) O2
mild : PaO2 ~ 60 - 80mmHg
PaO2 moderate: PaO2 = 40 - 60mmHg
severe : PaO2< 40mmHg
PaO2 O2 PaO2 40-70mmHg
Fi O2 PaO2
60 1 PaO2 80mmHg
PaO2 1mmHg
O2 therapy
oxygenation
 Hypoxemia PaCO2

CO2
1.V/Q mismatch : Ventilation perfusion CO2
PaCO2
ventilation
V/Q mismatch)
1. Alveolar ventilation CO2 diffuse
2.Shunting :
CO2 ventilation Alveolar
( ventilation
2. dead space ventilation: ventilation
3. PaO2
(O2) Anatomic dead space:
oropharynx nasopharynx tracheo bronchial
airway
2.2c.c./kg
70 150c.c. anatomic dead
4. (Diffusion defect) space
-- — — Alveolar dead space
Alveolar ventilation pu-capillary
5. Alveolar
PaCO2 PaO2 Alveolar dead
space
PaO2 choking COPD CNS
depression PaCO2 Alveolar ventilation
VT=300ml Alveolar gas equation?
R=24/m Alveolar gas equation
PaCO2=60mmHg
Hyperventilation PaCO2
PAO2 = (PB PH2O) FiO
Hyper Hypoventilation R

Hyperventilation PaCO2<35mmHg PB = ~ 760mmHg

Hyperventilation PH2O = ~ 47mmHg
PaCO2 FiO2 =
R = ~ 0.8
Hypoventilation PaCO2 > 45mmHg
Hyper Hypo ventilation
PCO2

minute ventilation = 24 300 =7200 ml/min

minute ventilation PaCO2>
45 Hypoventilation

dead
space ventilation CO2
PaCO2 A-aDO2?

A-aDO2 =PAO2 - PaO2

= [ FiO2 ( 713 ) - PaCO2 (1.25) ] - PaO2
* (acid)
PaO2 90mmHg PaCO2
1 volatile acid
40mmHg
H2CO3
volatile acid CO2
A-aDO2=150 - 1.25 PaCO2 - PaO2
13000 meq =150 - 50 - 90
=10 mmHg
2 non volatile acid
dietary acid lactic acid keto acid A-aDO2 10-12 mmHg

nonvolatile acid 50-150 meq A-aDO2 A-aDO2

A-aDO2
+
CO2 + H2O H2CO3 H +HCO3
PaCO2= H2CO3= Respiratory component
PaCO2 = H2CO3 = pH FiO2 10 % 5-7mmHg
FiO2 = 1.0 A-aDO2 120mmHg
CO2
PaCO2 A-aDO2 0.04
70 A-aDO2
28mmHg
 pH=7.52
PaCO2 = 32mmHg
PaO2 = 600mmHg
FiO2 = 100 % Base
pH = = 24 / 1.2 = 20 / 1
Acid
p’t A p’t B
2) pH = 7.32 pH = 7.33 pH PCO2 / H2CO3
PaCO2= 57 PaCO2 = 56
PaO2 = 72 PaO2 = 61 PaCO2 HCO3
FiO2= 0.21 .FiO2 = 0.21 PCO2 / HCO3
pH pH

1 PaCO2 HCO3 H+
2 PaCO2 HCO3 H+
3 HCO3 CO2
4 HCO3 CO2

5
~6

PCO2 50mmHg
Hypercapnia(ventilation failure)

PaCO2

Hypercapnia
1. Respiratory center depression : CNS
sleep apnea)
2. Neuromuscular disorders : Myasthenia gravisus
Guillian-Barre Syndrome
3. Chest wall disorder: Scoliosis, flail chest
4. Upper airway obstruction
5. Pulmonary disorders : COPD, asthma, pneumothorax

PaCO2
1
2 PaCO2

3 PaCO2 PaO2

respiratory acidosis 100% O2

Jusomin
0(02








 ֨ଃ‫ܒ‬ឰ壄૞ By Alex Ho 2002/8

ᅝ‫ࡳࡐ܃‬ԫរΔࠡᦫ֨ଃऱႉ‫ݧ‬Κ
1. ᦫ S1 S2 ‫᧢ྤڶ‬ՕΕ᧢՛Λ
2. ‫ྤڶ‬ᠰ؆ऱ֨ଃΛ (‫گ࣍ۯ‬ᜍཚΛင്ཚΛ / ለᔾ२ S1ΛS2 Λ)
3. ‫ ྤڶ‬Murmur (‫گ‬ᜍཚ? <٤ཚ? խཚ?> င്ཚ? ࢨਢ‫گ‬ᜍཚင്ཚຟ
‫)? ڶ‬

ϥʳ Abnormal S1 S2
Type ‫ױ‬౨ข‫ڂ଺س‬
Accentuated S1 1. ೏֨ᙁ‫נ‬ၦ
(S1 ฆൄՕᜢ) 2. Mitral valve stenosis
Diminished S1 1. 1 degree AV block
2. Mitral valve ၩ֏
Abnormal
3. ؐ֨৛‫گ‬ᜍԺ૾‫܅‬
S1
4. ᩀۨࢤ֨ಐጣ
5. গण೯౧ఏఐ
Varying S1 1. 3 degree AV block
(ൎ৫᧢֏լࡳ) 2. ֨ሂ‫ݙ‬٤լ๵৳(‫ ڕ‬atrial fibrillation)
Split S1 1. RBBB
Accentuated S2 1. ‫׌‬೯౧௿ా
Abnormal 2. ॄ೯౧௿ా
S2 3. ᧯༛ᛩ೏ᚘ
4. ॄ೯౧೏ᚘ
Deminished S2 1. ౥ኢছ৵உᏺ‫ף‬
2. ‫׌‬೯౧ᡰၩ֏
3. ॄ೯౧ᙄၩ֏
Split S2 1. ॄ೯౧೏ᚘ
2. ॄ೯౧ᙄ௿ా
3. RBBB

ϥʳ ‫گ‬ᜍཚᠰ؆֨ଃΚ
Early ejection Type ‫ױ‬౨ข‫ڂ଺س‬
sound ‫׌‬೯౧ᡰᏴ୴ଃ 1. Aortic valve stenosis
2. Բᆺ‫׌‬೯౧ᡰ
ॄ೯౧ᡰᏴ୴ଃ 1. Pulmonary artery dilation
2. Pulmonary hypertension
3. Pulmonary valve stenosis
Click Systolic clicks 1. ൄߠ࣍ mitral valve prolapseΔ‫ ڂ‬mitral
valve լ‫إ‬ൄ‫چ‬ᘉԵ֨ࢪխ
ϥʳ င്ཚᠰ؆֨ଃ
ᦫ်௽ᐛ ‫ױ‬౨ข‫ڂ଺س‬
Opening snap 1. ֺ S3 ‫ޓ‬ᔾ२ 1. ൄߠ࣍ mitral valve stenosis Δ‫ڂ‬௿
S2 ాऱ mitral valve ‫ؚ‬ၲࢬીΖ
2. ૞‫ش‬ᓂ૿ࠐᦫ
S3 1. ؐೡॎለ࣐ᦫࠩ 1. ‫س‬෻ࢤ S3
2. ‫ ش‬bell ࠐᦫ 2. ֨ۜ‫گ‬ᜍԺՀ૾ (ൄߠ࣍ heart
3. ለլᔾ२ S2 failure)
S4 1. ጹ൷࣍ S1 հছ ֨৛Ⴤ‫ॴך‬Ժᏺ‫ࢬף‬ທ‫ګ‬Κ
(‫ڶ׽‬ຍଡֺለᔾ 2. ‫ ش‬bell ࠐᦫ 1. Hypertension
२ S1) 2. Coronary artery disease
3. Aortic valve stenosis
4. Myocardial disease

ϥʳ ࣹრΚ
ᅝᦫࠩᠰ؆֨ଃለᔾ२Κ
S1 Ш ‫ؘ‬ႊ‫ە‬ᐞΚ(1) Split S1 (2) Aortic ejection sound
(3) Pulmonary ejection sound (4) systolic click (5) S4
S2 Ш ‫ؘ‬ႊ‫ە‬ᐞΚ(1) Split s2 (2) Opening snap (3) S3

ϥʳ ᠰ؆֨ଃΚ
‫گ‬ᜍཚᠰ؆֨ଃΚ٤ຝຟᔾ२ S1
င്ཚᠰ؆֨ଃΚೈԱ S4 հ؆Δࠡ塒ຟֺለᔾ२ S2

ϥʳ Heart MurmurΚ
Type ఐ᧢ ᦫ်‫؏ݾ‬
‫گ‬ᜍխཚᠧଃ Aortic stenosis 1. ‫׳‬ೡรԲۛၴᦫࠩ
2. ఐԳ݄ထ‫ٻ‬ছႜ࣐ᦫࠩ
Hypertrophic cardiomyopathy 1.ؐೡรԿร؄ۛၴᦫࠩ
2.ᢧՀழᄎ྇இ
Pulmonary stenosis 1.ؐೡรԲۛၴᦫࠩ
٤‫گ‬ᜍཚᠧଃ Mitral valve regurgitation 1. ֨‫ۯڞ‬ᆜᦫࠩ
Tricuspid valve regurgitation 2. ؐೡ౥೎Հᒴᦫࠩ
Ventricular septum defect 2.ؐೡ 3 4 5 ۛၴᦫࠩ

င്ཚᠧଃ Aortic regurgitation ؐೡรԲۛၴᦫࠩ

Mitral stenois ֨‫ۯڞ‬ᆜ

င്ཚΕ‫گ‬ᜍཚ Pericardial friction rub

ຟ‫ڶ‬ᠧଃ Patent ductus arteriosus
Venous hum
 ʳ Գ᧯٤ߪֽܶၦપ‫ૹ᧯۾‬ऱ ˉ˃ʸʿࠡխԿ։հԲ੡าઽփ෈ʿԿ։հԫ੡าઽ؆෈ʿʳ ࠡխ ˄˂ˇ ऱ
˄ˈ
าઽ؆෈։‫ۨڇ܉‬ጥփʿˆ˂ˇ ։‫ۨڇ܉‬ጥ؆ऱาઽၴᎼʻ˧˴˵˿˸ʳ˄ʳʼ Ζᜯ‫ݩ‬Ղൄ‫א‬དྷᔆʻ˖̅̌̆̇˴˿˿̂˼˷ʼ֗ᓄᔆ
ʻ˖̂˿˿̂˼˷˴˿ʼᄫ෈‫܂‬੡֫๬ழࢨૹ఑൛ृհ᧯෈༚ྼʿᓄᔆᄫ෈౨‫ݶ‬ຒᇖ‫෈᧯ך‬ʿપ‫׽‬Ꮑདྷᔆᄫ෈ऱ ˄˂ˆ
ၦ‫ױܛ‬ሒࠩઌ࿛ऱ֨ᙁ‫נ‬ၦᏺ‫ף‬ऱய࣠Ζ᧯փპۨጥ‫࠹ྤڇ‬ჾՀʿኙ࣍ᄫ෈ऱᇖ‫ڶך‬ৰ‫ړ‬ऱર࠹ࢤʿ
‫ڇ܀‬࿇ङ֘ᚨழലᏺ‫ۨף‬ጥऱዶຘࢤʻ˧˴˵˿˸ʳ˅ʳʼ˄ʿࠌ෈᧯‫ۨط‬ጥዶ‫נ‬ທ‫ګ‬าઽၴᔆֽᆭۖᐙ᥼‫ٺ‬ᕴࡴ
‫פ‬౨ʿۖᓄᔆᄫ෈‫ۨط‬ጥዶ‫۟נ‬าઽၴᔆʿ๯٦‫࢏ޓ஁گܮ‬९ೖఎาઽၴᔆٍᏺൎาઽၴᔆֽᆭʿਚ
࿯ղ෈᧯ᇖ‫ך‬ழᏁေ۷֗጑ྒྷ᧯փֽٝΕሽᇞᔆؓᘝ֗᧯փۨੌ೯Ժ೶ᑇऱणउΖʳ ʳ

˧˴˵˿˸ʳ˄ʳˁʳ ࠏΚԫߊࢤʳ ˊ˃ʳ˾˺ ٤ߪֽܶၦʻˇ˅˟ʼհ։‫ڕ܉‬Հʳ ʳ

16L (1/3) ʳ 4L(1/4)ʳ 32L(2/3) ʳ

12L (3/4)ʳ
ۨጥփʳ ʳ
าઽၴᎼʳ ʳ

ʳ ʳ ʳ ʳ ʳ ʳ ʳ ʳ ʳ ʳ ʳ ʳ ʳ ʳ ʳ ʳ ʳ ʳ ʳ ʳ ʳ ʳ ʳ ʳ ʳ ʳ ʳ ʳ ʳ ʳ าઽ؆෈ʳ ʳ ʳ ʳ ʳ ʳ ʳ ʳ ʳ ʳ ʳ ʳ ʳ ʳ ʳ ʳ ʳ ʳ ʳ าઽփ෈ʳ ʳ ʳ ʳ ʳ ʳ ʳ ʳ

˧˴˵˿˸ʳ˅ʳˁ˖̂́˷˼̇˼̂́̆ʳ˴̆̆̂˶˼˴̇˸˷ʳ̊˼̇˻ʳ˼́˶̅˸˴̆˸˷ʳ˶˴̃˼˿˿˴̅̌ʳ˿˸˴˾ʳ ʳ

Acute respiratory distress syndrome ʳ Disseminated intravascular coagulation ʳ Pancreatitis ʳ

Anaphylaxis ʳ Drug overdose (salicylates, cocaine, opioids) ʳ Sepsis ʳ

Aspiration pneumonia ʳ Inhalation injury ʳ Thromboembolism ʳ

Bacterial or viral pneumonia ʳ Head injury ʳ Trauma ʳ

Burn ʳ Massive blood transfusion ʳ Venom exposures ʳ

Cardiopulmonary bypass ʳ Near drowning ʳ

˔ˁ᧯෈ᇖ‫ך‬ေ۷֗጑ྒྷֱऄ ˄ʿˉʿ˄˄ʿ˄ˆΚʳ ʳ

— ᨠኘ‫ؼ‬ᓅΕយᓂणउʻ‫ڶڕ‬ๅֽழ‫ؼ‬ᓅ೓Εយᓂ։ࣼ྇֟ʼʳ ʳ

— ᧯ૹऱ᧢֏ʳ ʳ

— ሽᇞᔆؓᘝʻ‫ ڕ‬ˡ˴ʾʳ ऱ᧢֏ൣ‫ݮ‬ʼ֗࿽‫פ‬౨ေ۷ʳ ʳ

— ᜔෈᧯ᙁ‫נ‬Եၦऱؓᘝʻ‫ڕ‬堬ଇ᥊࠷ၦΕᙁ෈ၦΕ᧯෈ੌ؈Ε‫෈ݟ‬ඈೈၦፂ਍۟֟ ˃ˁˈ̀˿˂˾˺˂˻̅…
࿛ʼʳ ʳ

— ˖˩ˣΚ˖˸́̇̅˴˿ʳ̉˸́̂̈̆ʳ̃̅˸̆̆̈̅˸ʳ խ֨ᙩ౧ᚘʿ‫إ‬ൄଖΚ˅ˀˋʳ˶̀˛˅ˢ˂˄ˁˆˉʳːʳ˖˩ˣʳʻ˼́ʳ̀̀˛˺ʼʿᄫ෈ᇖ‫ך‬
ழ‫ױ‬ሒ ˄ˈ̀̀˛˺ˉʿ࣍ᜯ‫ݩ‬Ղ‫ױ‬጑ီ‫᦬֨ڃ‬ऱۨၦ֗‫׳‬ೡ֨᦬‫פ‬౨ʿ‫ˈ ࠉױ‬ˀ˅ ऄঞʻ˧˴˵˿˸ʳ
ˆˀ˅ʼ‫܂‬੡ᄫ෈ᇖ‫ך‬ए᛭հਐᑑΖʳ ʳ

— ˣ˖˪ˣΚˣ̈˿̀̂́˴̅̌ʳ˶˴̃˼˿˿˴̅̌ʳ̊˸˷˺˸ʳ̃̅˸̆̆̈̅˸ ॄპۨጥ೯౧ᄔᚘʿ‫إ‬ൄଖΚˋˀ˄˅ʳ̀̀˛˺ˎʳ ʳ
 ˋ
˜˖˨ ൛ृ‫ˈ˄ ۟ױ‬ˀ˄ˋʳ̀̀˛˺ ʿ‫א‬጑ྒྷؐೡ֨᦬‫פ‬౨֗ᝩ‫˩˖ ܍‬ˣ ‫ॄڂ‬೯౧೏ᚘΕխ֨ᙩ
౧ۨ௕ࠌ ˖˩ˣ ᚘԺᏺ‫ף‬ʿທ‫ܒګ‬ឰᙑᎄʿ‫ەڼڂ‬ᐞ࣋ᆜॄ೯౧ᖄጥʻ̆̊˴́ˀ˺˴́̍ʼʿ‫א‬጑ྒྷ
ۨጥփᚘԺ֗‫ˊ ࠉױ‬ˀˆ ऄঞʻ˧˴˵˿˸ʳˆˀ˅ʼʿᓳᖞᔞᅝհᙁ෈ए᛭Ζʳ ʳ

— ࠡ‫ה‬Κ‫ࡎس‬ᐛွհᨠኘʻ֨ሂΕۨᚘΕࡅ‫…ܮ‬࿛ʼʳ ʳ

ૉ൛ृ‫ۨנ‬ႊ጑ྒྷʳ ˛˵Ε˛˶̇Εˣ˿˴̇˸˿˸̇ʳ ‫א‬ေ۷ਢ‫ࢨܡ‬ᇖ‫ך‬ᕩۨ‫ڂ‬՗Ζʻ˧˴˵˿˸ʳˆˀ˄ʼʳ ʳ

ۨੌ೯Ժ೶ᑇ‫ױ‬ေ۷ਢ‫شࠌܡ‬ᏺᚘࢨൎ֨ᕪʿʳ ʳ

೯౧௛᧯։࣫ʻ‫˛̃ ڕ‬Ε˕˿̂̂˷ʳ˿˴˶̇˴̇˸Ε˕˴̆˸ʳ˷˸˹˼˶˼̇ʼʿ‫܂ױ‬੡ေ۷᧯փᎨᨕؓᘝ֗Աᇞิ៣
౒௜ൣ‫ݮ‬ʳ ʳ

᧯෈༚ྼਐᑑ ˉʳˍ˖˜ʳˑˆ˟˂̀˼́˂̀˅Ε˩ˢ˅ˑ˄˃˃̀˿˂̀˼̀˂ʳ̀˅Ε˕˿̂̂˷ʳ˿˴˶̇˴̇˸ʳˏʳˇʳ̀̀̂˿˂˟ʳ ʳ

˕˴̆˸ʳ˷˸˹˼˶˼̇ˍʳˀˆʳ̇̂ʳʾˆʳ̀̀̂˿˂˟Ζʻ˖˜Κ˖˴̅˷˼˴˶ʳ˼́˷˸̋ʿʳ˩ˢ ˅Κˢ̋̌˺˸́ʳ̈̃̇˴˾˸ʼʳ ʳ

̇˴˵˿˸ʳˆˀ˄ ৺ࢤ‫ۨנ‬հေ۷֗๠ᆜ ˉʿ˄ˉʳ ʳ

˔̀̂̈́̇ʳ̂˹ʳ˵˿̂̂˷ʳ˿̂̆̆ʳ ʳ ˙˿̈˼˷ʳ̂˹ʳ˶˻̂˼˶˸ʳ ʳ
˅˃ʳʸʳ̂̅ʳ˿˸̆̆ʳʻ̆˿̂̊ʳ˿̂̆̆ʼʳ ʳ ˖̅̌̆̇˴˿˿̂˼˷̆ʳ ʳ

˅˃ˀˈ˃ʳʸʳʻ̆˿̂̊ʳ˿̂̆̆ʼʳ ʳ ˡ̂́̃̅̂̇˸˼́ʳ̃˿˴̆̀˴ʳ˸̋̃˴́˷˸̅̆ʳʻ˷˸̋̇̅˴́ʳ˴́˷ʳ˻˸̇˴̆̇˴̅˶˻ʼʳ

ˑˈ˃ʳʸʳʻ̆˿̂̊ʳ˿̂̆̆ʼʳ̂̅ʳ˅˃ʳʸʳʻ˴˶̈̇˸˿̌ʼʳ ˪˻̂˿˸ʳ˵˿̂̂˷ʳ̂̅ʳˣˣ˙ʳ˴́˷ʳ˙˙ˣʳ ʳ

ˋ˃ʳʸʳ̂̅ʳ̀̂̅˸ʳ˿̂̆̇ʳ ʳ ˔̆ʳ˴˵̂̉˸ʳʿʳ˵̈̇ʳ˹̂̅ʳ˸̉˸̅̌ʳˈʳ̈́˼̇̆ʳ̂˹ʳ˵˿̂̂˷ʳ˺˼̉˸́ʿʳ
˴˷̀˼́˼̆̇˸̅ʳ˄ˀ˅ʳ̈́˼̇̆ʳ̂˹ʳ˙˙ˣʳ˴́˷ʳ˄ˀ˅ʳ̈́˼̇̆ʳ̂˹ʳ̃˿˴̇˸˿˸̇̆ʳ̇̂ʳ
̃̅˸̉˸́̇ʳ̇˻˸ʳ˻˸̀̂˷˼˿̈̇˼̂́ʳ̂˹ʳ˶˿̂̇̇˼́˺ʳ˹˴˶̇̂̅̆ʳ˴́˷ʳ
˵˿˸˸˷˼́˺ˁʳ ʳ

ˣˣ˙ˍʳˣ˿˴̆̀˴ʳ̃̅̂̇˸˼́ʳ˹̅˴˶̇˼̂́ˎʳ˙˙ˣˍʳ˹̅˸̆˻ʳ˹̅̂̍˸́ʳ̃˿˴̆̀˴ʳ ʳ

ˠ˸́ʳˍ˧̂̇˴˿ʳ˵̂˷̌ʳ˹˿̈˼˷̆ˍʳˉ˃˃̀˿˂˾˺Ε˪˻̂˿˸ʳ˵˿̂̂˷ˍʳˉˉ̀˿˂˾˺Εˣ˿˴̆̀˴ˍʳˇ˃̀˿˂˾˺ʳʻʳ˩˴˿̈˸̆ʳ˸̋̃̅˸̆̆˸˷ʳ˹̂̅ʳ
˿˸˴́ʳ˵̂˷̌ʳ̊˸˼˺˻̇̆ʼʳ ʳ

˧˴˵˿˸ʳˆˀ˅ˍʳ˙˿̈˼˷ʳ̇˻˸̅˴̃̌ʳ ʳ

Guided by ʳ CVP (cmH2O) ʳ PCWP(mmHg) ʳ Infusion ʳ

Start ʳ <8 ʳ < 10 ʳ 200 ml/10min ʳ

ʳ < 12 ʳ < 14 ʳ 100 ml/10min ʳ

ʳ t 12 ʳ t 14 ʳ 50 ml/10min ʳ

During infusion ʳ increase > 5 ʳ increase > 7 ʳ Stop ʳ

After 10 min ʳ increase d 2 ʳ increase d 3 ʳ Continue ʳ

ʳ 2 < increase d 5 ʳ 3 < increase d 7 ʳ Wait 10 min ʳ

ʳ increase > 5 ʳ increase > 7 ʳ Stop ʳ

 After waiting 10 min ʳ Still increase > 2 ʳ Still increase > 3 ʳ Stop ʳ

ʳ increase d 2 ʳ increase d 3 ʳ Repeat ʳ

˄ˁ˔˷˴̃̇˸˷ʳ˹̅̂̀ʳ˪˸˼˿ʳˠ˛ʿʳ˛˸́́˼́˺ʳ˥˝ˍʳˡ˸̊ʳ˶̂́˶˸̃̇̆ʳ˼́ʳ̇˻˸ʳ˷˼˴˺́̂̆˼̆ʳ˴́˷ʳ˹˿̈˼˷ʳ̇̅˸˴̇̀˸́̇ʳ̂˹ʳ˶˼̅˶̈˿˴̇̂̅̌ʳ̆˻̂˶˾ˁʳ
˔́˸̆̇˻ʳ˔́˴˿˺ʳˈˋˍʳ˄˅ˇʿʳ˄ˌˊˌˎʳ̊˼̇˻ʳ̃˸̅̀˼̆̆˼̂́ˁʳ ʳ

˅ˁᜰࠏᎅࣔˍᄫ෈ၲࡨ࿯ղழ጑ྒྷ ˖˩ˣ ࢨ ˣ˖˪ˣˎૉ ˖˩ˣ ଖˏˋ ࢨ ˣ˖˪ˣ ଖˏ˄˃ʿঞᙁ෈࣍ ˄˃ ։

ᤪփ‫ױ‬࿯ղ ˅˃˃̀˿ˎૉ‫ڇ‬ᙁ෈ழࢨ ˄˃ ։ᤪ৵ʿࠡ ˖˩ˣ ଖᏺ‫ף‬ˑˈ ࢨ ˣ˖˪ˣ ଖᏺ‫ף‬ˑˊʿঞ‫ܛم‬ೖ
ַᙁ෈ˎૉ ˖˩ˣ ଖᏺ‫ף‬dʳ˅ ࢨ ˣ˖˪ˣ ଖᏺ‫ף‬dʳˆʿঞᙁ෈ᤉᥛ࿯ղΖʳ ʳ

˕ˁᄫ෈ጟᣊտฯ ˄ʿ˅ʿˉˍʳ ʳ

˴ˁདྷᔆᄫ෈ˍʳ ʳ

‫׌‬૞੡ܶၪᄫ෈ʿۖၪਢาઽ؆෈ऱ‫׌‬૞ᄫᔆʿፂ਍ۨጥփ؆ዶຘᚘʿԳ᧯ ˋ˃ʸऱาઽ
؆෈ਢ‫ۨ࣍ژ‬ጥ؆ʿਚᅝᇖ‫ך‬དྷᔆᄫ෈ழ‫׌‬૞੡าઽ؆෈౒‫׎‬ऱᇖ‫ך‬ʿપ‫˃˅ ڶ׽‬ʸऱ
ˡ˴˖˿ ‫ۨ࣍ژ‬ጥփຝΖᆿရᗷᄫ෈ឈྥਢ࿛്‫܀‬լܶၪʿ‫ݶױ‬ຒ։‫᧯۟܉‬փֽܶհ࿺
৛Ζ‫ٺ‬ᣊདྷᔆᄫ෈ʻ˧˴˵˿˸ʳˇʼʳ ʳ

ʳ ʻ˴ʼˁ˥˼́˺˸̅ʺ̆ʳ˟˴˶̇˴̇˸ˍփܶሧΕၩʿ࠷‫ז‬࿛്‫س‬෻ଇᨖֽփຝऱၪʿʳ˟˴˶̇˴̇˸ ᆖߗ᦬‫ז‬᝔‫˸̇˴́̂˵̅˴˶˼˕ ګ‬ʿ

‫᧯ڇ‬փࠠᒷᓢ‫ش܂‬ʿܶ‫˗ ڶ‬ˀ˟˴˶̇˴̇˸ ֗ ˟ˀ˟˴˶̇˴̇˸ ऱ෗‫ٽ‬ढᔆʿ‫ڇ‬Գ᧯ ˗ˀ˟˴˶̇˴̇˸
ऱ堚ೈ෷ለ ˟ˀ˟˴˶̇˴̇˸ ኬ ˆ˃ʸʿ‫إ‬ൄۨᑠ ˗ˀ˟˴˶̇˴̇˸ ᖺ৫ਢ՛࣍ ˃ˁ˃˅ʳ̀̀̂˿˂˿ʿ‫ڇ‬
ߗาઽ࠹ჾࢨߗ᦬ۨ෈ᥒੌၦ྇֟‫ۨ܅ࠓٽ‬௜ழʻપ‫إ‬ൄ௜௛堷ࡉऱ ˈ˃ʸʼʿ
ലᄎ྇֟ ˟˴˶̇˴̇˸ ऱ堚ೈ‫ז‬᝔ʿᅝՕၦࢨ९ཚࠌ‫̆ʺ̅˸˺́˼˥ ش‬ʳ˟˴˶̇˴̇˸ʳʿ‫᧯ڇ‬փ
˗ˀ˟˴˶̇˴̇˸ ֗ ˟ˀ˟˴˶̇˴̇˸ ‫ױ‬౨፝ᗨ֗༞֏ิ៣Ꭸխ੅ʿ˗ˀ˟˴˶̇˴̇˸ ᖺ৫Օ࣍ ˆʳ
̀̀̂˿˂˿ ழʿᄎທ‫ࢤߗګ‬ᆰࣖಮΖʳ ʳ

ʻ˵ʼˁ‫؀‬Օሽᇞᔆᙁ෈່ૹ૞‫ࠟڶ‬ଡ௽រΚ˄ˁܶ‫أڇױ ˸̇˴̇˸˶˔ ڶ‬࿑ิ៣᠏֏‫˸̇˴́̂˵̅˴˶˼˕ ګ‬ʿፖ

˟˴˶̇˴̇˸ Ꮑᆖߗ᦬‫ז‬᝔‫ࢬڶ‬լ‫ٵ‬ʿ‫ױ‬ቃ߻ࢨ‫ޏ‬࿳Ꭸխ੅Ζ˅ˁೈ༼ࠎሧΕ᝴ሽ
ᇞᔆ؆ʿ‫᠆ڶܶ׼‬༄ᛷᔆʿ‫ױ‬ቃ߻֗ए᛭‫܅‬ᛷۨ఑Ζʻ˧˴˵˿˸ʳˈʼʳ ʳ

˧˴˵˿˸ʳˇΕʳ དྷᔆᄫ෈ʳ ʳ

˜˩ʳ̆̂˿̈̇˼̂́ʳ ʳ ˢ̆̀̂˿˴˿˼̇ ˚˿̈˶̂̆˸ʳ ˡ˴ʳ ˖˿ʳʻ̀˘̄˂˿ʼʳ ˧̂́˼˶˼̇̌ʳ̅˸˿˴̇˼̉˸ʳ̇̂ʳ ˣ˛ʳ

̌ʳ ʳ ʻ̀˘̄˂˿ʼʳ ̃˿˴̆̀˴ʳ ʳ
ʳ ʻ˺ʳ˂˿ʳʼʳ
ʻ̀̂̆̀˂˿ʼʳ ʳ
ˈʸʳ ʳ ˗˂˪ʳ ʳ ˅ˊˋʳ ʳ ˈ˃ʳ ʳ ˀʳ ʳ ˀʳ ʳ ˜̆̂̇̂́˼˶ʳ ʳ ˈˁ˃ʳ
˄˃ʸʳ˗˂˪ʳ ʳ ˈˈˉʳ ʳ ˄˃˃ʳ ʳ ˀʳ ʳ ˀʳ ʳ ˻̌̃˸̅̇̂́˼˶ʳ ʳ ˈˁ˃ʳ
ˈ˃ʸʳ˗˂˪ʳ ʳ ˅ˊˋ˃ʳ ʳ ˈ˃˃ʳ ʳ ˀʳ ʳ ˀʳ ʳ ˻̌̃˸̅̇̂́˼˶ʳ ʳ ˈˁ˃ʳ
˃ˁˇˈʸʳˡ˴˖˿ʳ ʳ ˄ˈˇʳ ʳ ˴ʳ ʳ ˊˊʳ ʳ ˊˊʳ ʳ ˻̌̃̂̇̂́˼˶ʳ ʳ ˈˁˊʳ
˃ˁˌʸʳˡ˴˖˿ʳ ʳ ˆ˃ˋʳ ʳ ˴ʳ ʳ ˄ˈˇʳ ʳ ˄ˈˇʳ ʳ ˜̆̂̇̂́˼˶ʳ ʳ ˈˁˊʳ
ˆʸʳˡ˴˖˿ʳ ʳ ˄˃˅ˉʳ ʳ ˀʳ ʳ ˈ˄ˆʳ ʳ ˈ˄ˆʳ ʳ ˻̌̃˸̅̇̂́˼˶ʳ ʳ ˈˁˋʳ
ˊˁˈʸʳˡ˴˖˿ʳ ʳ ˅ˈˉˊʳ ʳ ˀʳ ʳ ˄˅ˋˆʳ ʳ ˄˅ˋˆʳ ʳ ˻̌̃˸̅̇̂́˼˶ʳ ʳ ˈˁˊʳ
 ˥˼́˺˸̅ʺ̆ʳ˟˴˶̇˴̇˸˵ʳ ʳ˅ˊˆʳ ʳ ˴ʳ ʳ ˄ˆ˃ʳ ʳ ˄˃ˌʳ ʳ ˜̆̂̇̂́˼˶ʳ ʳ ˉˁˊʳ

˴ˁʳ˔˿̆̂ʳ˴̉˴˼˿˴˵˿˸ʳ̊˼̇˻ʳˈʸʳ˷˸̋̇̅̂̆˸ˁʳ ʳ

˵ˁʳ˔˿̆̂ʳ˶̂́̇˴˼́̆ʳ˞ʳʻˇʳ̀˘̄˂˿ʼʿ˖˴ʳʻˆʳ̀˘̄˂˿ʼʿʳ˴́˷ʳ˿˴˶̇˴̇˸ʳʻ˅ˋʳ̀˘̄˂˿ʼˁʳ ʳ

˶ˁˣ˿˴̆̀˴ˍʳˢ̆̀̂˿˴˿˼̇̌ʳˍʳ˅ˊˈʳˀ˅ˌˈʳ̀̂̆̀˂˿ʳʻ̀̂̆̀˂˞˺ʼʳʿʳ̃˛ˍʳˊˁˆˈʳˀʳˊˁˇˈʳʳ ʳ

ᎅࣔΚʳ ʳ

ᄫ෈ʳ ʳ ௽រʳ ʳ
˗ˈ˪ʳ ʳ ֽٝᇖ‫ܶך‬ᆿရᗷʳ ʳ

ૻၪ൛ृʳ ʳ

ૉ࿯ղ ˄ʳ˟ʳ˗ˈ˪ ঞԿ։հԲ‫ڇ‬าઽփ෈ʻˉˉˊ̀˿ʼˎʳ Կ։հԫ‫ڇ‬าઽ؆

෈ʻࠡխ ˄˂ˇʻʳˋˆʳ̀˿ʼ։‫ۨڇ܉‬ጥփʿˆ˂ˇʳʻ˅ˈ˃̀˿ʼ։‫ڇ܉‬าઽၴᎼʼΖʳ ʳ
˃ˁˇˈʸʳ ֽٝᇖ‫ܶך‬ᆿရᗷʿ֗༼ࠎၪᠦ՗ʿʳ ૉ࿯ղ ˄˟ʳ˃ˁˇˈʸʳ˚˂˦ʿ‫ڇ‬าઽփ෈
˚˂˦ʳ ʳ ˆˆˆ̀˿ ۖ։‫܉‬าઽၴᎼ ˈ˃˃̀˿ʳʿ‫ۨڇ‬ጥփ ˄ˉˊ̀˿Ζʳ ʳ
ˡ˂˦ʳ ʳ
२‫ۿ‬࿛്෈ʿլܶཾᠦֽˎૉ࿯ղ ˄˟ʳˡ˂˦ʿ݁֌։‫ڇ܉‬าઽ؆෈ʿࠡխ ˄˂ˇ
։‫ۨڇ܉‬ጥփʿˆ˂ˇ ։‫ۨڇ܉‬ጥ؆ऱาઽၴᎼΖʳ ʳ

ʳʳʳ
˃ˁˇˈʸʳ ʳ ֽٝᇖ‫ך‬լܶᆿရᗷʳ ʳ
ˡ˂˦ʳ ʳ
˥˼́˺˸̅ʺ̆ʳ ሽᇞᔆܶၦ֗ዶຘᚘፖาઽ؆෈‫ٵ‬ʿૉ࿯ղ ˄˟ʳ˥˼́˺˸̅ʺ̆ʳ˟˴˶̇˴̇˸ʳ ല݁։
˟˴˶̇˴̇˸ʳ ʳ ‫ڇ܉‬าઽ؆෈ʿࠡխ ˄˂ˇ ։‫ۨڇ܉‬ጥփʿˆ˂ˇ ։‫ۨڇ܉‬ጥ؆ऱาઽၴᎼΖʳ

ʳʳ

˄ˊ
˧˴˵˿˸ʳˈΕ‫؀‬Օሽᇞᔆᙁ෈ ʳ ʳ

ʳʳ ‫ץ‬ᇘʳ ʳ ሽᇞᔆʻ̀˘̄˂˟ʼʳ ʳ ˚˿̈˶̂̆˸ʳ˖˴˿˂˟ʳ ʳˣ

ˣ˛ʳ ̀ˢ̆̀˂˟ʳ
ˡ˴ʳ ʳ ˞ʳ ʳ ˖˿ʳ ʳ ˣʳ ʳ ˠ˺ʳ ˔˶˸̇˴̇˸ʳ
ʻ̀˿ʼʳ ʳ ʻ˺ʳ˂ʳ˿ʳʼʳ ʳ
ʻ̀ˠ˂˟ʼʳ ʳʳ
ʳʳ
˧˴˼̇˴ʳˡ̂ˁ˄ʳ ˈ˃˃̀˿ʳ ʳ ˅ˈʳ ʳ ˄ˋʳ ʳ ˅˃ʳ ʳ ˉʳ ʳ ˆʳ ʳ ˅˃ʳ ʳ ˆˋʳ ʳ ˄˅ˌʳ ʳ ˈˀˉʳ ˆ˃˃ʳ ʳ
˧˴˼̇˴ʳˡ̂ˁ˅ʳ ˈ˃˃̀˿ʳ ʳ ˇ˃ʳ ʳ ˄˅ʳ ʳ ˅ˉʳ ʳ ˉʳ ʳ ʳʳ ˅˃ʳ ʳ ˆˆʳ ʳ ˄˄˅ʳ ʳ ˈˀˉʳ ˅ˋˊʳ ʳ
˧˴˼̇˴ʳˡ̂ˁˆʳ ˈ˃˃̀˿ʳ ʳ ˊˈʳ ʳ ˄˅ʳ ʳ ˉ˄ʳ ʳ ˉʳ ʳ ʳʳ ˅˃ʳ ʳ ˅˃ʳ ʳ ˉˋʳ ʳ ˈˀˉʳ ˅ˋˈʳ ʳ
˧˴˼̇˴ʳˡ̂ˁˇʳ ˈ˃˃̀˿ʳ ʳ ˄˄˃ʳ ʳ ˅˃ʳ ʳ ˄˃˅ʳ ˄˅ʳ ʳ ʳʳ ˄ˉʳ ʳ ˋʳ ʳ ˅ˊʳ ʳ ˈˀˉʳ ˆ˃˃ʳ ʳ
˧˴˼̇˴ʳˡ̂ˁˈʳ ˇ˃˃̀˿ʳ ʳ ˆˉʳ ʳ ˄ˋʳ ʳ ˄ˊʳ ʳ ˄˅ʳ ʳ ˆʳ ʳ ˅ˋʳ ʳ ˄˃˃ʳ ʳ ˆˇ˃ʳ ʳ ˈˀˉʳ ˉˉˌʳ ʳ

ʳʳ
 ʳʳ

ᎅࣔΚʳ ʳ

ʳʳ ௽រ֗ᔞᚨ఑ʳ ʳ
˧˴˼̇˴ʳˡ̂ˁ˄ʳ ʳ ˡ˴Ε˞Ε˖˿ʳ ਢ‫؀ٺ‬Օሽᇞᔆᙁ෈խܶၦ່‫܅‬Ι՛ࠝ‫ش‬ፂ਍෈ΕሽᇞᔆΕֽٝΕ
塄ٝᇖ‫ך‬ʳ ʳ
˧˴˼̇˴ʳˡ̂ˁ˅ʳ ʳ ‫ګ‬։ፖ ˧˴˼̇˴ʳˡ̂ˁ˄ ઌ‫ ܀ۿ‬ˡ˴Ε˖˿ ለ‫ˎڍ‬ᑷၦ֗ ˞ ܶၦለ‫܅‬ʳ ʳ

‫܂ױ‬੡՛ࠝࢨ‫ګ‬Գ‫ش‬ፂ਍෈ʳ ʳ
˧˴˼̇˴ʳˡ̂ˁˆʳ ʳ ˡ˴˖˿ ܶၦ‫˃ ۿ‬ˁˇˈʳʸˡ˂˦ʿ‫࣍شױ‬࿛്ࢤๅֽΕᗷ‫ݟ‬ఐࢤᎨխ੅ʳ ʳ
˧˴˼̇˴ʳˡ̂ˁˇʳ ʳ ˡ˴˖˿ ܶၦ‫˟ ۿ‬ˀ˥ʿʳˡ˴Ε˞Ε˖˿ ਢ‫؀ٺ‬Օሽᇞᔆᙁ෈խܶၦ່೏ʿ‫ࢤ്܅࣍شױ‬ๅ
ֽΕ‫܅‬ᛷۨ఑ʳʳ ʳ
˧˴˼̇˴ʳˡ̂ˁˈʳ ʳ ਢ‫؀ٺ‬Օሽᇞᔆᙁ෈խܶ ˔˶˸̇˴̇˸ ֗ᑷၦ່೏ʿ‫࣍شױ‬೏ᑷၦሽᇞᔆᇖ‫෈ך‬Ε‫܅‬
ᛷۨ఑ʳ ʳ

ʳʳ

˵ˁᓄᔆᄫ෈ ˄ʿˇʿˈʿˉˍʳ ʳ

ᓄᔆᄫ෈ਢՕ։՗ढᔆլ࣐ຏመპۨጥᕻʿ‫ڇ‬መ‫ڣ ˃ˊ װ‬๯࿇୶ࠌ‫ش‬ᅝ‫ۨ܂‬ጥփऱᘉ࿾ᕪʿࠉ
˦̇˴̅˿˼́˺ʳ˟˴̊ ᓄᔆᄫ෈᧩‫ق‬ᄎᏺ‫ۨף‬ጥփऱᘉ࿾ᚘʻˢ́˶̂̇˼˶ʳˣ̅˸̆̆̈̅˸ʼʿۖࠌᓄᔆᄫ෈‫ژ‬ఎ࣍ۨጥ
փʿ‫ۨࠌױ‬ጥ୲ၦᏺ‫ף‬ʿ௽ܑਢ‫୲ۨ܅‬հ৺ࢤ‫ृۨנ‬Ζᓄᔆᄫ෈ࠡ౒រਢኙփ‫ؼ‬ऱ႞୭ࡉࠌპۨ
ጥధါ֗լܶᕩۨ‫ڂ‬՗Εۨ՛ࣨΕદۨ෺‫ؘ‬૞ழսᏁᇖ‫ך‬ᇠ‫ګ‬ٝ፹ᕪʿ‫ؾ‬ছᜯ‫ڶݩ‬؄ጟᣊীऱ
ᓄᔆᄫ෈։ܑ੡ ˔˿˵̈̀˼́ʿʳ˗˸̋̇̅˴́̆ʿʳ˦̇˴̅˶˻ʿʳ˚˸˿˴̇˼́ʳʻ˧˴˵˿˸ʳˉʼΖʳʳ ʳ

ʻ˴ʼˁʳ˔˿˵̈̀˼́ʳ ʳ

ዌ‫˃ˋ ګ‬ʳʸऱۨᑠᓄᔆዶຘᚘʿٍਢᢐढΕሽᇞᔆʻ‫ڕ‬ၩΕ᝴ʼʳ ऱૹ૞ሎᙁ๨‫ػ‬ʿਢԳۨխᘉ࿾

ᚘʻˢ́˶̂̇˼˶ʳˣ̅˸̆̆̈̅˸ʼհ‫׌‬૞‫ګ‬ٝʿਢ٤ۨխհૹ૞Օ։՗ʿ‫הࠡڼڂ‬Գທ‫ۨشז‬ᑠຟፖ
˔˿˵̈̀˼́ ೚ֺለʿ፹ᕪਢ‫ط‬நۨ෣֏፹‫ګ‬ʿ‫ࠡڂ‬࿕‫ڶ‬Ε࣓၆ۖૻࠫࠡ‫ڇ‬ᜯ‫ݩ‬Ղऱࠌ‫ش‬Ζ‫ࠐ࣍ط‬
۞լ‫ٵ‬ऱଡ᧯հ٤ۨխဇ࠷ʿਚս‫ڶ‬ტ਩հᐞࠏ‫̆˼̇˼̇˴̃˸˛ ڕ‬ʿʳ˔˜˗˦ˎࠌ‫ش‬ழመඕ࿇‫س‬෷પ
˃ˁ˃˄˄ʳʸʿࠡ఑ण‫ڕ‬࿇ఖΕჽ᣺Ε࿇ᗈΕۨጥឩ്Ζ‫ڇ‬ԫઔߒኙᗍ႞൛ृ࿯ղ ˅ˈʳʸʳ˔˿˵̈̀˼́ʿ
࿇෼ۨᑠ୲ᗨᏺ‫˃ˇ ף‬ʳʸʿʳ ‫܀‬൛ृհ࿽࿭෺መៀຒ෷྇֟ʿឈྥࠡᖲ᠏ࡸլࣔʿʳ ‫ױ܀‬౨ਢ‫ڂ‬
੡ᏺ‫ࡌף‬໮ۨጥऱᘉ࿾ᚘʿʳ ۖ྇֟ၪΕֽඈ‫נ‬Ζ‫׼‬؆‫࣍ط‬ၩᄎࡉ ˔˿˵̈̀˼́ ᝶࿨ʿٍᏁࣹრ‫܅‬
ၩۨ఑࿇‫س‬ʿۖ‫ۜ֨ࠫލ‬ऱ‫פ‬౨Ζʳ ʳ ʳ ʳ ʳ

ʻ˵ʼˁʳ˗˸̋̇̅˴́̆ʳ ʳ

ਢ‫ٺ‬ጟ९৫ऱᆿရᗷፋ‫ٽ‬ढʿ‫ط‬ᓇᗷᆖาပ࿇Ꭷ፹‫ګ‬ʿ੡ऴᢸ‫ڤ‬࿨ዌʿࠉ։՗ၦլ‫ٵ‬։੡
˗˸̋̇̅˴́ˀˇ˃Εˊ˃Ι˗˸̋̇̅˴́ˀˇ˃ ਢ ˄˃ʳʸᄫ෈‫ ࣍ژ‬ˡ˴˖˿ խʿʳ˗˸̋̇̅˴́ˀˊ˃ ਢ ˉʳʸᄫ෈‫ ࣍ژ‬ˡ˴˖˿ խʿʳ
˗˸̋̇̅˴́ˀˇ˃ ೈ‫ױ‬ᏺ‫ۨף‬ጥփዶຘᚘʿՈ‫܂ױ‬੡ۨᑠ‫شז‬঴ʿ‫ش܂܀‬࿍ᑉΖ՛ऱᆿရᗷፋ‫ٽ‬ढৰ
‫ۨطݶ‬ጥփฝ۟าઽၴᎼࢨ๯࿽᦬堚ೈʿ‫ڇ‬ᣤૹ࿽‫פ‬౨լࠋृᏁ՛֨ࠌ‫ࢨش‬ᆃ‫ش‬Ζᅝᙁࣹ
˗˸̋̇̅˴́ˀˇ˃ ழۨᑠ୲ᗨൄ‫ױ‬ᏺ‫˄ ף‬ˀ˅ ଍ऱᙁԵၦΕ‫ ˆ ڇ܀‬՛ழ৵‫ڶش܂‬ԫ‫ת‬௣؈ʿˉ ՛ழ৵‫܂‬
 ‫˃ˉ ڶش‬ʳʸ௣؈Ζ˗˸̋̇̅˴́ˀˊ˃ ਢለՕऱᆿရᗷፋ‫ٽ‬ढʿ౨ለᒷኬ๯‫ז‬᝔ధᡏʿʳ ࠡ‫ژ‬ఎ‫ۨڇ‬ጥփ
ለՆʿᙁ෈৵ᆖ ˄˅ ՛ழʿપ‫ˈˆ ڶ‬ʳʸፋ‫ٽ‬ढ๯堚ೈΖۨ෈ֱ૿ᐙ᥼ࠉ։՗ၦլ‫ࢬٵ‬ᐙ᥼ऱۨ෈
យᆈ৫ٍլ‫ٵ‬ʿᅝ։՗ၦՕ࣍ ˉ ᆄृʻࠏ ˗˸̋̇̅˴́ˀˊ˃ʼ‫᧯ڇ‬؆ᇢ᧭ᄎեឫદۨ෺ᕩႃʿ‫ࠡشܓױ‬
௽ࢤ‫࣍ش‬ቃ߻෡ຝᙩ౧௕Ⴞ֗૾‫෈ۨ܅‬ऱយᆈ৫ʿ‫׌‬૞‫ط‬࿽᦬ඈइʿ࣐ທ‫෈ݟګ‬យᆈ৫ᏺ‫ף‬
ۖ࿇‫ݟۨس‬ऱ೫‫ش܂‬ʿʳ˗˸̋̇̅˴́ˀˇ˃ ‫ڂ‬։՗ၦ՛࣍ ˉ ᆄʿਚለլեឫᕩۨ‫ڂ‬՗࢏९ᕩۨழၴʿࠡ
࿇‫س‬መඕ֘ᚨለ ˚˸˿˴̇˼́̆ ֟Ζʳ ʳ

ʻ˶ʼˁʳ˦̇˴̅˶˻ʳ ʳ

˛˸̇˴̆̇˴̅˶˻ ਢԫጟ‫ګٽ‬ऱᖸృፋ‫ٽ‬ढʿຍጟᖸృፋ‫ٽ‬ढՕ՛᧢֏ৰՕʻ։՗ၦൕ ˄˃ˆˀˆʳ˫˄˃ˉʳ˗ʼʿ

ؓ݁։՗ၦਢ ˇˈ˫˄˃ˇ˗ʿᜯ‫شࠌױݩ‬ऱ፹ᕪ੡ ˉʸᄫ࣍࿛്ࢤ‫س‬෻ଇᨖֽᄫ෈ʿᓄᔆᘉ࿾ᚘ
ʻʳ˖̂˿˿̂˼˷ʳˢ́˶̂̇˼˶ʳˣ̅˸̆̆̈̅˸ʼ੡ ˅ˋʳ̀̀˛˺ʿ‫܂‬੡ᣊ‫ ́˼̀̈˵˿˔ ۿ‬ऱۨᑠ‫شז‬঴ʿࢬข‫س‬հ୲ᗨᘉ࿾ய
࣠ઌᅝ࣍ ˈʸʳ˔˿˵̈̀˼́ʿʳ ‫ ˻˶̅˴̇̆˴̇˸˛ ڂ‬੡ᖸృፋ‫ٽ‬ढᏁ٣ᆖۨ堚ᖸృ߸‫ޢ‬։ᇞ۟՛։՗٦‫ط‬࿽
᦬ඈೈʿਚ‫ ˻˶̅˴̇̆˴̇˸˛ شࠌڇ‬ழۨ堚ᖸృ߸‫ޢ‬ᄎᏺ‫˅ ۟ף‬ˀˆ ଍‫ױ׊‬౨਍ᥛ ˈ ֚հՆʿࠀլ।‫ڶق‬
ౠ᦬ङʿᚨ‫ۨא‬堚౟ौ߸‫ޢ‬ʻ˿˼̃˴̆˸ʼ‫܂‬੡်ឰ֗ಳ᠋ౠ᦬ङऱࠉᖕʿʳ˛˸̇˴̆̇˴̅˶˻ ౒រ੡ᄎեឫᕩۨ
‫ڂ‬՗ۖ࢏९ᕩۨழၴΖˣ˸́̇˴̆̇˴̅˶˻ ፹ᕪਢ‫ګߜޏ ˻˶̅˴̇̆˴̇˸˛ ط‬։՗ၦለ‫܅‬ऱ՛։՗ؓ݁։՗
ၦਢ ˅ˉˇ˃˃˃˗ʿ‫ڶ‬ለՕऱᓄᔆᘉ࿾ᚘ ˇ˃ʳ̀̀˛˺ʿࢬທ‫ګ‬ऱۨᑠ୲ᗨᘉ࿾ய࣠੡ࢬᙁ෈ऱ ˅ ଍ʿ
‫ش܂‬਍ᥛழၴ՛࣍ ˄˅ ՛ழʿ‫ۨڇ‬խ‫ז‬᝔‫ګ‬՛։՗ʿᆖ࿽᦬ඈइʿؓ݁‫ת‬ಐཚપ ˅ˁˈ˻̅̆ʿԫ֚৵પ
ˉ˃ʸ‫ݟط‬խඈ‫נ‬ʿᣤૹ࿽‫פ‬౨լࠋृᏁ՛֨ࠌ‫ࢨش‬ᆃ‫ش‬Ιለլᄎ‫ڶ‬መඕ෼ွʿፖ ˔˿˵̈̀˼́ ઌ‫ۿ‬
ለլեឫᕩۨ‫ڂ‬՗֗ۨ՛ࣨᕩႃΖˣ˸́̇˴̆̇˴̅˶˻ ๯ᎁ‫ۨػ࣍شױ‬෺‫װ‬ೈऄʻ˟˸̈˾˴̃˻˸̅˸̆˼̆ʼʿ࠰‫ܗ‬
ᏺൎ։ᠦ‫ۨػ‬෺ʿʳˣ˸́̇˴̆̇˴̅˶˻ʳ˄˃ʸൄ‫࣍ش‬৺်Ε˜˖˨ ۨ෈࿕ᤩհए᛭Εˉʸ‫ࠝؔ࣍شױ‬հ๠ᆜΖʳ ʳ

ʻ˷ʼˁʳ˚˸˿˴̇˼́̆ʳ ʳ

‫ؾ‬ছ‫ࠟڶ‬ጟ‫ڤݮ‬ऱ ˚˸˿˴̇˼́̆ ਢ‫ׄط‬ऱᓄᔆ፹‫ګ‬ʿԫ‫ైݟط‬᝶࿨‫˿˸˶˶˴̀˸˴˛ ڕ‬£ ؓ݁։՗ၦ

ˆˈ˃˃˃˗ʿ‫׼‬ԫ੡ʳ ˚˸˿̂˹̈̆˼́˸£ ؓ݁։՗ၦ ˆ˃˃˃˃˗ʳ ᓄᔆዶຘᚘ ˇˉˈʳ̀̀˛˅ˢʻˆˇ̀̀˛˺ʼʿ՛։՗‫ژ‬
‫ڶ‬ለՕऱದࡨᘉ࿾ᚘ‫ش܂‬ʿ‫܀‬ৰ‫ݶ‬ൕ༛ᛩխ‫ط‬࿽᦬ඈೈʿ‫ڇ‬࿽‫פ‬౨լࠋृᏁ՛֨ࠌ‫ش‬ʿۨጥᘉ
࿾୲ᗨ‫ڇش܂‬೜ൈृխપ ˆ ՛ழʿ‫ڇ܀‬ඓۨ఑൛ृ‫ش܂‬ለ࿍ʿ‫ైݟ‬᝶࿨ऱ ˚˸˿˴̇˼́̆ʳʻ˛˴˸̀˴˶˶˸˿£ʼ
ܶ‫ڶ‬ለ೏ऱၩʻˉˁ˅ˉʳ̀̀̂˿˂˿ʼˎሧʻˈˁ˄ʳ̀̀̂˿˂˿ʼՕ࣍ ˚˸˿̂˹̈̆˼́˸£ ܶၩʻ˃ˁˇʳ̀̀̂˿˂˿ʼˎሧʻ˃ˁˇʳ̀̀̂˿˂˿ʼʿਚ
˛˴˸̀˴˶˶˸˿£ʳ ࡉۨ෈ԫದᙁࣹലᄎᖄીᕩۨ֗ࠡ‫ה‬መඕ֘ᚨ࿇‫س‬ʿʳ˛˴˸̀˴˶˶˸˿£ መඕ࿇‫س‬෷
˃ˁ˄ˇˉʸˎʳ˚˸˿̂˹̈̆˼́˸£ መඕ࿇‫س‬෷ ˃ˁ˃ˉˉʸΖʳʳ ʳ

˧˴˵˿˸ʳˉΕᓄᔆᄫ෈ ˄ʳ ʳ
ʳ ʳ ʳ ʳ ʳ ˔˿˵̈̀˼́ʳ ʳ ʳ ʳ ʳ ʳ ʳ ˗˸̋̇̅˴́ʳ ʳ ˛˸̇˴̆̇˴̅˶ ˣ˸́̇˴̆̇˴̅˶˻ʳ ˚˸˿̂˹̈̆˼́˸£
˻ʳ ʳ
ʳ ʳ ˈʸʳ ʳ ʳ ʳ ʳ ˅ˈʸʳ ʳ ʳ ʳ ˇ˃ʳ ʳ ʳ ʳ ʳ ʳ ʳ ˊ˃ʳ ʳ ʻ˛˴˸̆ˀ̆̇˸̅˼˿ ̂̅ʳ
£
ʼʳ ʳ ˛˴˸̀˴˶˶˸˿£ʳ
ʳʳ ʳʳ ˄˃ʸʳˈ˃˃̀˿ʳ ʳ ˉʸʳ ʳ ʳ ˉʸʳ ˉʸʳˈ˃˃̀˿ʳ ʳ ʳ ʳ ˈ˃˃̀˿ʳ ʳ
ˈ˃˃̀˿ʳ ʳ ˈ˃˃̀˿ʳ
˄˃ʸʳˈ˃˃̀˿ʳ ˚˸˿˴̇˼́ʳ˄ˊˁˈ˺ʳ
˴
˔̉˸̅˴˺˸ʳ̀̂˿˸˶̈˿˴̅ʳ̊˸˼˺˻̇ʳ ˊ˃˃˃˃ʳ ʳ ʳ ʳ ˊ˃˃˃˃ʳ ˇ˃˃˃˃ʳ ʳ ʳ ʳ ˊ˃˃˃˃ʳ ˇˈ˃˃˃˃ʳ ʳ ˅ˉ˃˃˃˃ʳ ʳ ˆ˃˃˃˃ ʳ ʳ
ʻ˗ʼʳ ʳ
˄ˆ˃ˀ˄ˉ˃ʳ ʳ ˄ˆ˃ˀ˄ˉ˃ʳ ˄ˈˇʳ ʳ ʳ ʳ ʳ ʳ ˄ˈˇʳ ʳ ˄ˈˇʳ ʳ ʳ ˄ˈˇʳ ʳ ˄ˈˇ˴ʳ ʳ
ˡ˴ʾʳ˖˿ˀʳʻ̀˘̄˂˟ʼʳ ʳ ʳ ʳ ˆ˃˃ʳ ʳ ʳ ʳ ʳ ʳ ˄ˈ˃˃ʳ ʳ ʳ ˆ˃ˋʳ ʳ ʳ ʳ ʳ ʳ ˆ˃ˋʳ ʳ ˆ˄˃ʳ ʳ ʳ ˆ˅ˉʳ ʳ ˡ˔ʳ ʳ
˅˃ʳ ʳ ʳ ʳ ʳ ʳ ʳ ˊ˃ʳ ʳ
ˢ̆̀̂˿˴˿˼̇̌ʳʻ̀ˢ̆̀˂˿ʼʳ ʳ ˇ˃ ˊ˃ʳ ʳ ˆ˃ʳ ʳ ʳ ˇ˃ʳ ʳ ˆˇʳ ʳ
ˈ˃˃ʳ ʳ ʳ ʳ ʳ ʳ ˄ˊ˃˃ʳ
ˢ́˶̂̇˼˶ʳ̃̅˸̆̆̈̅˸ʳ ʳ ˈ˃˃ˀ˄˃˃˃ʳ ʳ ʳ ˈ˃˃ˀˊ˃˃ʳ ˈ˃˃ˀˊ˃˃ʳ ˉ˃˃ˀˋ˃˃ʳ ʳ ˈ˃˃ʳ ʳ
ʳʳ
ˣ˿˴̆̀˴ʳ̉̂˿̈̀˸ʳ˸̋̃˴́̆˼̂́ʳ ʳʳ ʳʳ ʳʳ ʳʳ
ʻ̀˿˂ˈ˃˃̀˿ʳ˼́˹̈̆˸˷ʼʳ ʳ ˏ˅ˇ˻̅ʳ ʳ ʳ ʳ ʳ ˏ˅ˇ˻̅ʳ
ˏˉ˻̅ʳ ʳ ʳ ʳ ʳ ʳ ʳ ˏ˅ˇ˻̅ʳ ʳ ʳ ˏˆˉ˻̅ʳ ʳ ˏ˄˅˻̅ʳ ʳ ˏˇ˻̅ʳ ʳ
˗̈̅˴̇˼̂́ʳ̂˹ʳ̉̂˿̈̀˸ʳ˸̋̃˴́̆˼̂́ʳ ʳ ʳ ʳ
ˏʳ˅˃̀˿˂˾˺˂˷ʳ ʳ ʳ ˏʳ˅˃̀˿˂˾˺˂˷ʳ ʳ ˏʳ˅ˋ̀˿˂˾˺˂˷ʳ ʳ ʳ ʳʳ
˄ˊ
ˏʳ˅˃̀˿˂˾˺˂˷

˗̂̆˸ʳ˿˼̀˼̇˴̇˼̂́ʳ ʳ ˃ˁ˃˄˄ʸʳ ʳ ʳ ʳ ˡ˔ʳ

˃ˁ˃˃ˊʸʳ ʳ ʳ ˃ˁ˃ˉˌʸʳ ˃ˁ˃ˋˈʸʳ ˡ˔ʳ ʳ ˃ˁ˃ˉˉʸ˴ʳ
˜́˶˼˷˸́˶˸ʳ̂˹ʳ˴˿˿˸̅˺˼˶ʳ
̅˸˴˶̇˼̂́ʳʳ ʳ
ࠐᄭʳ ʳ ۞٤ۨխ෣֏፹ ᓇᗷᆖาပ࿇Ꭷʳ ‫ۏد‬ᆖ֏ᖂ፹ທʳ ʳ ೯ढᓄᔆ༼
‫ګ‬ʳ ʳ ᅂʳ ʳ
Ꮭᙒ ˵ʳ ʳ ́̂ʳ˷˴̇˴ʳ ʳ ʳ #ʳˇʳ˫ʳ ˄ʳ ʳ ʳ ʳ ʳ ʳ ʳ ́̂ʳ˷˴̇˴ʳ ʳ ʳ ́̂ʳ˷˴̇˴ʳ ʳ ʳ ˉʸʳ ʳ ˄ˁ˅ʳ˫ʳ ʳʳ

ʳ ʳ ʳ ʳ ʳ ʳ ʳ ʳ ˄˃ʸʳ ʳ ˄ˁˋ˫ʳ ˄ˁ˅ʳ˫ʳ ʳ

ˡ˔ˍʳ́̂̇ʳ˴̉˴˼˿˴˵˿˸ʳ ʳ ʳ ʳ ʳ ʳ ʳ ʳ ʳ ʳ ʳ ˡ̂̅̀˴˿ʳ˶̂˿˿̂˼˷ʳ̂́˶̂̇˼˶ʳ̃̅˸̆̆̈̅˸ˍʳ˅ˇ̀̀˛˺ʳ ʳ

˴ˁ ˛˴˸̀˴˶˶˸˿£ ؓ݁։՗ၦ ˆˈ˃˃˃˗ʿܶ ˡ˴ʾʳ˖˿ˀˍ˄ˇˈʳʻ̀˘̄˂˟ʼʿመඕ࿇‫س‬෷ ˃ˁ˄ˇˉʸʳʳ ʳ

˵ˁʳ˨̆˼́˺ʳ̇˻˸ʳ̂˹ʳ˗˸̋̇̅˴́ʳˇ˃ʳ˴̆ʳ̇˻˸ʳ̀˸˴́̆ʳ̂˹ʳ˶̂̀̃˴̅˼̆̂́ˁʳ ʳ

ʳʳ

˖ˁሽᇞᔆլؓᘝհ๠ᆜ ˅ʿˉʿ˄˅ˍʳ ʳ

‫ڇ‬าઽփ෈‫׌‬૞ऱᠦ՗‫˞ ڶ‬ʾΕˠ˺ʾ˅ΕˣˢˇΩʿۖ‫ڇ‬าઽ؆෈‫׌‬૞ऱᠦ՗‫ ڶ‬ˡ˴ʾΕ˖˿ΩΕ˛˖ˢˆΩʿʳ ʳ

ۨᑠዶຘᚘ‫ױ‬ᆖ‫ۨࡳྒྷط‬ᑠխ່ࠠ‫ڶ‬ዶຘ౨Ժऱᄫᔆૠጩ‫ࠐנ‬Ζ೏ዶຘᚘ‫ۨࠓٽ‬ၪመ‫ڍ‬।‫᧯ق‬
փ؈ֽʿ‫܅‬ዶຘᚘ‫ۨࠓٽ‬ၪመ֟।‫᧯ق‬փֽٝመ‫ڍ‬Ζ‫ྒྷڕ‬൓ऱۨᑠዶຘᚘʿՕ࣍ૠጩ‫נ‬ऱۨᑠዶຘ
ᚘ ˄˃ʳ̀ˢ̆̀˂˾˺ ‫א‬Ղጠ੡ ˢ̆̀̂˿˴˿ʳ˺˴̃ʿ।‫ڶق‬Օၦࠠ‫ڶ‬ዶຘ౨Ժऱᄫᔆʻ‫ ڕ‬ˠ˴́́˼̇̂˿ʿʳ˺˿̌˶˸̅̂˿ʿʳ˿˼̃˼˷̆ʿʳ
̃̅̂̇˸˼́̆ʿʳ̀˸̇˻˴́̂˿ʿʳ˸̇˻˴́̂˿ˁˁ࿛ʼ‫آ‬๯ኘᤚࢨ೗ࢤ‫ۨ܅‬ၪ఑Ζʳ ʳ

ֆ‫ڤ‬Κዶຘᚘ ̀ˢ̆̀˂˾˺ʳːʳ˅ʳʻˡ˴ʾʾ˞ʾʼʳʾ˕˨ˡ˂ʳ˅ˁˋʳʾʳ˺˿̈˶̂̆˸˂ʳ˄ˋʳ ʳ

ԫΕၪʳ ʳ

ਢาઽ؆෈ऱ‫׌‬૞ၺᠦ՗ʿ‫إ‬ൄၪᖺ৫੡ ˄ˆˈˀ˄ˇˈʳ ̀˘̄˂˿ʿ᧯փၪᠦ՗ᖺ৫ฆൄᄎᐙ᥼᧯փֽؓ

ᘝΕ壀ᆖۜۚऱ‫פ‬౨Ζʳ ʳ
 ʻ˄ʼ‫܅‬ၪۨ఑ʳ ʳ

ਐۨ堚ၪᖺ৫‫˃ˆ˄ ࣍܅‬ʳ̀˘̄˂˿ʿေ۷‫܅‬ၪۨ఑ႊ‫ٵ‬ழ጑ྒྷۨᑠዶຘᚘΕ‫ݟ‬խዶຘᚘ֗‫ݟ‬ၪᖺ৫ʿ
‫ܗא‬်ឰఐ‫܂֗ڂ‬੡ए᛭ਐᑑΖ೗ࢤ‫܅‬ၪۨ఑ழࠡዶຘᚘਢ‫إ‬ൄऱʿൄߠ࣍೏౟ۨ఑ࢨ೏๨
‫ػ‬ᔆۨ఑ृʿ‫ڂ‬౟ᔆΕ๨‫ػ‬ᔆᄎᆜངၪլᏁ‫אף‬ᛶ‫܅إ‬ၪ఑Ζۖ‫ۨ܅‬ၪࠓ‫ڶ‬೏ዶຘᚘृΔൄ
ߠ࣍೏ۨᗷ൛ृʿࠡาઽփऱֽฝ۟าઽ؆ʿ࿨࣠࿕ᤩԱาઽ؆ၪᖺ৫ʿए᛭‫א‬ᛶ‫ࠡإ‬ᑨ‫ڇ‬ఐ
‫ڂ‬Ζᅝۨ堚ၪᠦ՗ᖺ৫‫˃˅˄ ࣍܅‬ʳ̀˘̄˂˿ ழʿൄᄎ‫נ‬෼఑ण‫֨⭫ڕ‬Εቭ‫ٷ‬ΕቧଇΕႰጕΕრᢝᑓ
ᒫ࿛Ζ‫܅‬ዶຘࢤ‫܅‬ၪۨ఑ፖาઽ؆෈᧯‫ڍ‬ኒࢨ‫إ‬ൄઃ‫ڶ‬ᣂএʿૉาઽ؆෈ᖺ৫‫إ‬ൄழʿඈೈ‫ظ‬
णᆯࢨ࿽Ղᆯ‫פ‬౨լߩʿঞఐ‫ڂ‬ፖ‫ݟܓݼ‬ᖿై։ࣼլᅝ఑ʻ˦˜˔˗˛ʼ‫ڶ‬ᣂʿ‫נ׊‬෼‫ݟ‬ዶຘᚘˑ˄˃˃ʳ
̀ˢ̆̀˂˾˺ʳ ֗‫ݟ‬ၪᖺ৫ˑ˅˃ʳ ̀˘̄˂˿ʿຏൄ࿇‫ ˛˗˔˜˦ س‬ऱൣउ‫ץ‬ਔ‫ڶ‬༞ࢤᆭᒆΕॄࡉխᑐ壀ᆖఏ
ఐΕ؆‫ڇ‬ᚘԺՀٍ֗Ꮑᝩ‫܍‬ԫࠄᄎࠨᖿ‫ݟܓݼ‬ᖿైʻ˔˗˛ʼ։ࣼऱᢐढʿ‫˸˷˼̀˴̃̂̅̃̅̂˿˻˖ ڕ‬Εʳ
˖̌˶˿̂̃˻̂̆̃˻˴̀˼˷˸Ε˕˴̅˵˼̇̈̅˴̇˸̆Ε˗˼̈̅˸̇˼˶Ε˜́˷̂̀˸̇˻˴˶˼́Εˠ̂̅̃˻˼́˸ ࿛Ζए᛭ ˦˜˔˗˛ ‫א‬൛ृ‫נ‬
෼ᣤૹ‫ۨ܅‬ၪࢨ۴‫ڶ‬఑णழழթ๠෻ʿ‫ݶױ‬ຒ‫ݟܓ‬ʻ˸̋ˍʳ˿˴̆˼̋ʼ֗ᇖ‫ݟطך‬խੌ؈ऱၪΕሧʿૉய
஁‫ףױ‬Ե ˗˸̀˸˶˿̂˶̌˶˿˼́˸ʳˆ˃˃ˀˉ˃˃ʳ̀˺˂˷ ਎‫ش܂ ˛˗˔ ݼ‬ʿൄࠌ‫˃ ش‬ˁˌʳʸʳˡ˂˦ ֗ ˞˖˟ʿᛶ‫ۨ۟إ‬堚ၪ
˄˅˃ʳ̀˘̄˂˿ ࢨᜯ‫ݩ‬఑णᇞೈΖᅝ‫܅‬ዶຘᚘ‫܅‬ၪۨ఑ࠡาઽ؆෈྇֟‫ݟ׊‬ၪᖺ৫ˏʳ˅˃ʳ̀˘̄˂˿ʿʳ ঞ
‫ א‬ˡ˂˦ ए᛭ˎૉาઽ؆෈ᏺ‫ֽ֗ף‬ᆭʿࠡ‫ݟ‬ၪᖺ৫ˏʳ ˅˃ʳ ̀˘̄˂˿ ൄߠ࣍֨ಐጣΕߗ࿏֏Ε࿽ఐ఑
ଢᆢʿૉၪᖺ৫ˑʳ˅˃ʳ̀˘̄˂˿ ൄߠ࣍࿽ಐጣʿए᛭‫א‬ಾኙᑨ‫ڇ‬ఐ‫ֽૻ֗ڂ‬ʻ˄ˀ˄ˁˈʳ˟˂˷ʳʼΕ‫܅‬ၪ ˄ˀˆ˺ʳ˂˷ʳ
ࡉ‫ݟܓ‬ᕪʻ˸̋ˍʳ ˿˴̆˼̋ʼࠌ‫ش‬ʿૉ൛ृ੡֨ಐጣ֧ದհ‫܅‬ၪۨ఑‫ףױ‬Ե ˔˖˘ ਎‫ݼ‬ᕪࠓ‫ݟܓش‬ᕪʿ‫ڶ‬
‫࣍ܗ‬ᛶ‫ࠡإ‬఑णΖʳ ʳ

ʻ˅ʼ೏ၪۨ఑ʳ ʳ

ਐۨ堚ၪᖺ৫೏࣍ ˄ˇˈʳ̀˘̄˂˿ ‫א‬Ղʿԫ౳‫ז‬।᧯փๅֽࢨ෈᧯᥊࠷྇֟ʻ‫ڕ‬൛ृྐ堬ᖲࠫ࠹ჾʿߪ

᧯ྤऄ໘ֽழʼʿఏఐᐙ᥼‫ݟڕ‬ഽ఑Ε‫܅‬ሧΕ೏ၩΕ࿽᦬ฆൄʿᢐढທ‫ګ‬࿽ࢤ‫ݟ‬ഽ఑‫̀̈˼˻̇˼˟ ڕ‬ʿʳ
˗˸̀˸˶˿̂˶̌˶˿˼́˸ʿʳˠ˸̇˻̂̋̌˹˿̈̅˴́˸ʿʳ˖̂˿˶˻˼˶˼́˸ʿʳˣ˻˸́̌̇̂˼́ʿʳ˩˼́˵˿˴̆̇˼́˸ʿʳ˔̀̃˻̂̇˸̅˼˶˼́ˀ˕ ࿛ʿ‫׼‬؆࿍யࢤ
˖̂̅̇˼˶̂̆̇˸̅̂˼˷̆ ٍᄎᎈᖄၪዩఎʿ೏ۨၪऱᜯ‫ݩ‬।෼ࠉᑨ‫ڇ‬ఏఐۖࡳΖᅝၪՕ࣍ ˄ˉ˃ʳ̀˘̄ʳ˂˿ ழʿ‫ױ‬
౨‫֨ڶ‬ཕ෗႖Εۜۚᘋᕿࢤᏺ‫ף‬ʿए᛭ழᏁေ۷೏ۨၪ֗าઽ؆෈‫ڍ‬ኒʿԫ౳ए᛭‫ֽ֧ۖ౒ڂ‬ದ
ऱ೏ၪۨʿ‫ࠉױ‬ֆ‫ڤ‬ૠጩ‫ࢬנ‬Ꮑᇖ෈ၦ ˅ʿֆ‫ֽ౒᧯ߪˍڤ‬ၦʻ˟ʼʳːʳ˧˕˪ʳ×^̃˿˴̆̀˴ʳˡ˴ʾ˂˄ˇ˃ʳЁ˄`ʿࠌ‫ˈ ش‬ʳ
ʸʳ˺˿̈˶̂̆˸ ࢨ ˃ˁˇˈʳʸʳˡ˴˖˿ ٣ᇖ‫תך‬ၦʿᛶ‫ۨإ‬ၪᖺ৫Ꮑˏʳ˄̀˸̄˂˟˂˻̅ ٦ေ۷ਢ‫ܡ‬ᇖߩ٤ၦʿࠀᛶ‫إ‬
ٚ۶ࠓ࿇ऱሽᇞᔆฆൄʿૉ‫ڂ‬ఏఐᐙ᥼ঞࠉఏఐᑨ‫ైڂڇ‬ए᛭ʿ‫ڕ‬խᑐࢤ‫ݟ‬ഽ఑ႊ࿯ղ
˩˴̆̂̃̅˸̆̆˼́ʿૉ੡࿽ᄭࢤ‫ݟ‬ഽ఑ए᛭‫א‬ᛶ‫ۨ܅إ‬ሧΕ೏ۨၩ੡‫ࢨ׌‬ೖ‫ױش‬౨႞୭࿽᦬ऱᢐढΖ
ʻ˧˕˪ˍʳ̇̂̇˴˿ʳ˵̂˷̌ʳ̊˴̇˸̅ʳːʳ˃ˁˉ×ʳ˾˺ʳʼʳʻ̈̆˸ʳ˃ˁˈʳ˼́ʳ˹˸̀˴˿˸̆ʿʳ˸˿˷˸̅˿̌ʿʳ̂̅ʳ˶˴˶˻˸˶̇˼˶ʳ̃˴̇˼˸́̇̆ʼ ˅ʳ ʳ

ԲΕሧʳ ʳ

ਢาઽփ෈‫׌‬૞ऱၺᠦ՗ʿ‫إ‬ൄܶၦપ ˇˁˈˀˈˁˈʳ̀˘̄˂˿ʿ‫׌‬૞ᆖ‫ط‬࿽᦬ඈೈʿਬࠄఐ෻ൣउᄎ‫᧢ޏ‬
ۨሧᖺ৫‫ڕ‬ᎨᨕլؓᘝΕ೏ዶຘᚘΕาઽᄫᇞࢨధᡏΕาઽ‫ףګٽ‬ຒΕౠ୾ై‫ڍ‬ኒΕ࿽ಐጣΕ
྇֟؆‫ࢤڇ‬᥊࠷Εᏺ‫ף‬࿽᦬֗ષᆩሐੌ؈ࢨᢐढ࿛‫݁ైڂ‬ᄎᐙ᥼ۨሧլؓᘝΖʳ ʳ

ʻ˄ʼ ‫ۨ܅‬ሧ఑ʳ ʳ

堬ଇխሧ᥊࠷྇֟Εᆖષᆩሐੌ؈ᏺ‫ࢨף‬ሧ‫ط‬าઽ؆෈ฝ۟าઽփ࿛‫ైڂ‬ʿࠌۨሧᖺ৫՛࣍
ˆʳ̀˘̄˂˿ʿ᎘პ‫ۨ܅‬ሧ‫׽‬૞ᛶ‫֧إ‬ದऱ଺‫ױܛڂ‬ʿᅝۨሧᖺ৫՛࣍ ˅ˁˈʳ̀˘̄˂˿ʿᜯ‫נݩ‬෼఑णʻ˄ʼ壀
 ᆖۜۚᎽᡶ‫ڕ‬ဠஇΕۜۚࢼ⛂Ε࿂᧑ΕۜྤԺᖄી຾ᅤࢨࡅ‫ܮ‬ಐጣʻ˅ʼ֨ۨጥฆൄΚ‫֨ڕ‬৳
լᖞΕኙֻ‫چ‬႓ऱඕტᏺ‫ף‬Εৎኪࢤ‫ۨ܅‬ᚘΕ֨ሽቹ᧢֏‫ץ‬ਔ ˧ ं᧢ؓΕ‫נ‬෼ ˨ ं֗ ˦˧
ंՀ૾ʻˆʼࠡ‫ה‬ఐ᧢Κ‫ڕ‬ኙᆿရᗷર࠹஁ᖄી೏ۨᗷΕঁఽΕᆩॴႾΕ‫ז‬᝔ࢤᨕխ੅Εၪዩ
ఎΖ‫׼‬؆ԫࠄᢐढऱࠌ‫ױٍش‬౨ᎈ࿇‫ۨ܅‬ሧऱ࿇‫ݟܓڕس‬ᕪΕE˅ ֭௛ጥឩ്ᕪΕਬࠄ‫سݼ‬
ైΰ˔̀̃˻̂̇˸̅˼˶˼́ˀ˕Ε˔̀˼́̂˺˿̌˶̂̆˼˷˸̆αΕᣊࡐᔧΕౠ୾ైΕ೏്ᆿရᗷᄫ෈Εᒷើᕪ࿛Ζ
‫ۨ܅‬ሧհए᛭‫א‬ᇖ‫ך‬ሧᨖ֗ቃ߻ሧੌ؈ʿኙ࣍֨᦬ఏ൛ࢨࠌ‫ृ ́˼̋̂˺˼˷ ش‬ʿ‫ޓ‬Ꮑࣹრ‫ۨ܅‬ሧࢬ
ᎈ࿇ऱ֨৳լᖞࢨֻ‫چ‬႓խ੅Ζʳ ʳ

ʻ˅ʼ ೏ۨሧ఑ʳ ʳ

ਐۨ堚ሧᖺ৫Օ࣍ ˈˁˈʳ̀˘̄˂˿ ‫א‬Ղʿ֧ದۨሧᏺ೏‫׌‬૞଺‫ڂ‬੡࿽᦬ඈइ྇֟‫׊‬؆‫ࢤڇ‬ሧ᥊࠷

ᏺ‫ף‬Εሧ‫ط‬าઽփ٦։‫۟܉‬าઽ؆෈Εᢐढᐙ᥼‫ڕ‬Օၦܶሧॹ᧶ైए᛭Ε˔˖˘ ‫ࠫލ‬ᕪΕ
ˡ˦˔˜˗̆Εঅሧী‫ݟܓ‬ᕪΕ˧ˠˣˀ˦ˠ˫Ε˖̌˶˿̂̆̃̂̅˼́˸Εࠡ‫ה‬ᢐढᐙ᥼ሧᠦ՗าઽփ؆᠏ฝ‫ֻڕ‬
‫چ‬႓Εౠ୾ై౒‫׎‬ΕEˀ࿽ՂᆯైॴឰᕪΕDˀ࿽ՂᆯైΕ࿛Ζᅝۨሧᖺ৫Օ࣍ʳ ˉˁˈʳ̀˘̄˂˿ʳ ᜯ‫ݩ‬
఑ण‫נ‬෼ʻ˄ʼۜۚ壀ᆖဠஇΕࡅ‫ܮ‬຾ᅤʻ˅ʼ֨᦬఑ण‫֨ڕ‬৳լᖞ‫ץ‬ਔ֨ሂ྇ᒷΕ֨৛ᦾ೯ʿ֨ሽ
ቹ᧢֏‫ץ‬ਔ ˧ ं᧢‫ڞ‬Ε˦˧ ंՀ૾Εˣ˥ ၴ၏࢏९Εˤ˥˦ ं᧢ᐈΕˣ ं᧢՛ࢨ௣؈Ζए᛭‫ؾ‬ᑑ
੡ʻ˄ʼঅᥨาઽ‫࠹܍‬ሧᠦ՗ᐙ᥼Δ‫ڕ‬ᙩ౧ࣹ୴ᆿရᗷၩʻ˅ʼ᠏ฝሧ‫ط‬าઽ؆ၞԵาઽփ෈ʿ‫ࣹڕ‬
୴ጙᎨසၪΕౠ୾ైΕ೏്ࢤᆿရᗷʻˆʼ྇֟٤ߪ᜔ሧၦ‫ڕ‬ၺᠦ՗ٌངᖫ౟ʻ˞˴̌˸̋˴˿˴̇˸ʼʳ ࢨຘ
࣫ʿ‫׼‬؆‫ݟܓ‬ᕪʻ˹̈̅̂̆˸̀˼˷˸ʼٍ‫ױ‬ᚥ‫ܗ‬࿽᦬ඈೈሧΖʳ ʳ

Οǵၩʳ ʳ

‫إ‬ൄۨ堚ၩᖺ৫੡ʳ ˋˁˈˀ˄˃ˁˈʳ̀˺˂˷˿ʿՕ‫ڍ‬ᑇऱၩ‫࣍ژ‬೎ᙽխʿ‫֟ڶ׽܀‬ᑇપ ˄ʳʸ‫ױ‬ፖาઽ؆෈۞

‫ط‬ၞ۩ٌངΖۨၩ᜔ၦऱ ˇʳʸᄎፖۨ堚‫ػ‬๨‫ػ‬࿨‫ٽ‬ʿ‫ػ܌ޢ‬๨‫ػ‬ʻ˔˿˵̈̀˼́ʼ࿨‫ٽ‬પ ˃ˁˋʳ̀˺ ۨၩʿ
ࢬ‫ۨא‬堚‫ػ‬๨‫ػ‬ऱᖺ৫ᐙ᥼ۨၩऱྒྷၦଖʿ‫܀‬ኙᠦ՗ীऱ੒֏ၩၦլᐙ᥼Ζ೫‫ظ‬णᆯᖿైࡉ
ፂ‫˗ ైس‬ʿຟਢၩࡉᛷ‫ڇ‬᫿փؓᘝऱ‫׌‬૞ᓳᆏढᔆΖʳ ʳ

ၩհீ‫إ‬ଖ=ၩհྒྷၦଖ+ʳ˃ˁˋʳʻ‫إ‬ൄհ‫ػ‬๨‫ػ‬ଖ-ྒྷၦࠩऱ‫ػ‬๨‫ػ‬ᖺ৫ʼʳ ʳ

ʻ˄ʼ‫ۨ܅‬ၩ఑ʳ ʳ

ਐۨ堚‫ػ‬๨‫ػ‬ऱᖺ৫‫إ‬ൄழʿࠡۨၩ᜔ၦʳˋˁˈʳ̀˺˂˷˿Ζൄߠ଺‫ڂ‬੡"೫‫ظ‬णᆯᖿైլߩࢨ౒‫"׎‬
ፂ‫˗ ైس‬Ε᝴౒‫"׎‬࿽᦬ఏఐ"ᆩ‫گܮ‬լߜࢨ᥊ଇլߩˁˁ࿛‫׼‬؆ᢐढ‫ܶڕ‬ᛷ፹ᕪΕ˖˴˿˶˼̇̂́˼́Ε
ˠ˼̇˻̅˴̀̌˶˼́Εˣ˻˸́̌̇̂˼́Ε˕˴̅˵˼̇̈̅˴̇˸̆Ε˔̀˼́̂˺˿̌˶̂̆˼˷˸̆Ε˖˼̀˸̇˼˷˼́˸Ε˛˸̃˴̅˼́Ε˧˻˸̂̃˻̌˿˿˼́˸Ε
ᎈ࿇‫ۨ܅‬᝴ऱᢐढΕ‫ݟܓ‬ᕪ࿛ຟ‫ױ‬౨ᎈ࿇‫ۨ܅‬ၩ఑Ζۨ堚ၩ᜔ၦʳˊ̀˺˂˷˿ ጠ੡ᣤૹ‫ۨ܅‬ၩ
఑ʿᜯ‫ݩ‬఑ण‫ڕ‬ল໫࿂᧑Ε֫ߩ⛂⛑Ε٤ߪࢤࢼ⛂Εࡅ‫זࢨࢤܮ‬᝔ࢤᨕխ੅Εང௛መ৫ʿ֨ሽ
ቹᐛွ੡ ˤˀ˧ ࢏९Ζए᛭৺ࢤ‫ۨ܅‬ၩʿ‫ױ‬ᙩ౧ᙁࣹ ˄˃ʳʸʳ˖˴˿˶˼̈̀ʳ˺˿̈˶̂́˴̇˸ʿૉ‫ڂ‬᝴౒‫֧ࢬ׎‬ದ
ঞᏁ࿯ղ᝴፹ᕪࠐᛶ‫ۨ܅إ‬ၩʿኬࢤ‫ۨ܅‬ၩঞ‫ױ‬Ցࣚၩࡉፂ‫˗ ైس‬Ε˄Dˀ˅ˈʻˢ˛ʼ˅ʳ
ʳ
ˀ˖˻̂˿˸˶˴˿˶˼˹˸̅̂˿ ‫ڂ‬լᏁٚ۶‫ז‬᝔᧢֏ʿࢬ‫א‬ኙ࿽ಐጣृለᔞࡵΖࠉ൛ृۨၩ֘ᚨެࡳࠌ‫ش‬ၦ֗
ழၴ९࿍ʿૉ࿽ಐጣृࠡ‫ۨ܅‬ၩए᛭‫ؘ‬ႊ‫ٵ‬ழૻࠫ᥊ଇᛷ֗ࠌ‫ܶش‬ᔱऱᛷ࿨‫ٽ‬ᕪʿ‫ַۨ߻א‬
ᛷᎨᨖመ‫֗ڍ‬ၩ᠏ฝΖʳ ʳ

ʻ˅ʼ೏ۨၩ఑ʳ ʳ
 ೏ۨၩ່ൄߠृ੡ၩൕ೎ᙰᤩ‫۟נ‬าઽ؆෈ʿۨၩ᜔ၦՕ࣍ ˄˄ʳ̀˺˂˷˿Ζൄߠఐ‫ڂ‬੡ᛮ఑Εۚ
ॕᆭᑌฆൄΕ଺࿇ࢤࢨᥛ࿇ࢤ೫‫ظ‬णᆯ‫פ‬౨շၞʻൄፖ৺ኬࢤ࿽ಐጣ‫ڶ‬ᣂʼʿࠡ‫ה‬ፖᢐढઌᣂ
‫ڕ‬ፂ‫˔ ైس‬Ε˗ʳ խ੅ΕၩΕᔶΕ˧˻˼˴̍˼˷˸̆Ε˘̆̇̅̂˺˸́̆Ε˧˴̀̂̋˼˹˸́Ζᜯ‫ݩ‬఑ण‫ࣖڕ‬ጕΕ壄壀෗
႖Ε᧼わΕۜ࿀Ε壀ᆖۜۚ֘୴྇இΕ‫ݟ࡙ݟڍ‬Ε೏ۨᚘΕ֨৳լᖞΕᆩષլᔞΖ೏ۨၩ
఑հए᛭࠷ެ࣍ၩᏺ‫ף‬ऱᣤૹ࿓৫ࡉ଺‫ڶ‬ఐ‫ڂ‬ʿۨၩ՛࣍ ˄ˆʳ̀˺˂˷˿ ழʿᛶ‫ڶ଺إ‬Ꮍᡶ‫ױܛ‬ʿ‫܀‬
ۨၩ᜔ၦՕ࣍ ˄ˈʳ̀˺˂˷˿ ࢨᜯ‫ݩ‬఑णᣤૹழʿঞᏁ߰ຒए᛭ʿए᛭ֱऄ੡"ᙩ౧ᙁԵ‫س‬෻ଇᨖֽ
ࠐᏺ‫ף‬าઽ؆෈ၦʿ‫ࠫލ‬࿽՛ጥኙၩऱ٦‫گܮ‬ʿ‫א‬আၞၩൕ‫ݟ‬խඈ‫נ‬ʿ‫ ˸˷˼̀˸̆̂̅̈˙ شࠓױ‬ᏺൎ
ய࣠Ζ"ʳ˖˴˿˶˼̇̂́˼́ ‫ࠫލ‬ధ೎าઽ੒೯ʿ‫ࠫލܛ‬ၩ‫ط‬೎փᤩ‫נ‬ऱຒ৫ࠌۨၩ૾‫ࠫލࡉ܅‬࿽᦬ኙ
ၩऱ٦‫گܮ‬Ζ"ʳˠ˼̇̅˴̀̌˶˼́ ‫ࠫލ‬ధ೎าઽኙ೎ᙽऱ٦‫گܮ‬ʿ‫ش܂‬ၲࡨழၴપ ˅ ֚ʿᢐய਍ᥛ
ˆˀ˄ˈ ֚ʿࠌ‫ش‬ᕪၦપ ˅ˈʳ̀˶˺˂˾˺˂˷ʿ‫ڶ࣍شױ‬೎᠏ฝࢨ༞ࢤᆭᒆ᧯෈ࢤ೏ۨၩ఑ʿൄߠ೫‫ش܂‬੡
⭫֨Εቭ‫ٷ‬Ζ"˕˼̃˻̂̆̃˻̂́˴̇˸ʻࠏ ˖˿̂˷̅˴́˴̇˸Εˣ˴̀˼˷̅̂́˴̇˸ʼ‫ࠫލ‬೎ऱ٦‫ࡉگܮ‬ຌิ៣ऱၩ֏Ζ"
‫ؼ‬ᔆࡐᔧࠌᆩષ‫྇گܮ‬இʿࠏ ˣ̅˸˷́˼̆̂˿̂́˸ʳˉ˃ˀˋ˃ʳ̀˺ʳ˂ʳ˷˴̌Ζˡ˦˔˜˗̆ ᛭ய‫آ‬ᒔࡳΖʳ ʳ

Ѥǵ᝴ʳ ʳ

᝴ਢԳ᧯փܶၦ‫۾‬ร ˇ ‫ۯ‬ऱၺᠦ՗ʿ‫׌‬૞‫࣍ૻݝ‬೎ᙽࡉۜۚาઽփʿ‫إ‬ൄଖ੡ ˄ˁˈˀ˅ʳ̀˘̄˂˿ʿۨ堚

᝴ᖺ৫ฆൄᄎᐙ᥼ߪ᧯౨ၦհႚᖄΖʳ ʳ

ʻ˄ʼ‫܅‬᝴ۨ఑ʳ ʳ

ਐۨ堚᝴ᖺ৫՛࣍ ˄ˁˈʳ̀˘̄˂˿ʿ᝴ऱ౒‫׎‬ൄ‫ڂ‬੡᥊ଇլߩࢨᆩષ‫ੌ෈ݟࢨ܅྇گܮ‬؈ᏺ‫ף‬ʿᢐ
ढᐙ᥼‫ݟܓڕ‬ᕪΕᒷើᕪΕ˔̀˼́̂˺˿̌˶̂̆˼˷˸̆Ε˔̀̃˻̂̇˸̅˼˶˼́ˀ˕Ε˙̂̆˶˴̅́˸̇Εˣ˸́̇˴̀˼˷˼́˸Ε˖˼̆̃˿˴́̇˼́Ε
˖̌˶˿̂̆̃̂̅˼́˸Ε˗˼˺˼̇˴˿˼̆Ε˔˿˶̂˻̂˿ ࿛ʿᜯ‫ݩ‬఑ण‫ڕ‬ષᆩլᔞΕࣖጕྤԺΕԳ௑‫᧢ޏ‬Ε֫ߩࢼ⛂Ε
ᔼᦾΕۜ᧜ፂ۞࿇ࢤ‫گ‬ᜍΖ‫נ‬෼‫܅‬᝴ۨ఑णࢨ‫ڶ‬ᣤૹ਍ᥛࢤۨ堚᝴՛࣍ ˄ʳ̀˘̄˂˿ʳ ழʿ༉Ꮑᙩ
౧ࣹ୴ ˠ˺˦ˢˇ ࢨՑࣚᇖ‫ܶך‬᝴፹ᕪΖʳ ʳ

ʻ˅ʼ೏᝴ۨ఑ʳ ʳ

ਐۨ堚᝴ᖺ৫Օ࣍ ˅ʳ̀˘̄˂˿ ‫א‬Ղʿൄ‫ڂ‬੡൷࠹ ˠ˺˦ˢˇ ए᛭Ε࿽ಐጣΕ‫ظ‬णᆯ‫פ‬౨‫܅‬ՀΕ˔˷˷˼̆̂́ʺ̆ʳ

˷˼̆˸˴̆˸Εᢐढ‫ڕైڂ‬ᔶᨖ᥊࠷መ‫ڍ‬Ζ೏᝴ۨ఑ᄎࠌ٤ߪ壀ᆖႚᖄ࠹ჾΕ˖ˡ˦ ‫ࠫލ‬ʿۨ堚᝴ᖺ
৫Օ࣍ ˈʳ̀˘̄˂˿ʿ֨ሽቹ‫נױ‬෼ ˣˀ˥ ၴཚ࢏९Εˤ˥˦ ंᏺᐈ֗ ˧ ंᏺ೏ʿۨ堚᝴ᖺ৫Օ࣍ ˄˃ʳ
̀˘̄˂˿ʿ෡ᐋۜᆧ֘୴௣؈Ε‫ۨ܅‬ᚘΕࡅ‫ࠫލܮ‬Ε֨‫گ‬ᜍլ٤Ε֨჻ೖַΖए᛭ழᏁૻࠫ؆ᄭ
ࢤ᝴ऱ᥊Եʿᣤૹ᝴խ੅ए᛭‫ױ‬ᙩ౧ࣹ୴ ˄˃ʸʳ˖˴˿˶˼̈̀ʳ˺˿̈˶̂́˴̇˸ʿࠓ‫ݟܓش‬ᕪࢨ ˡ˂˦ ‫א‬ᏺ‫ף‬᝴
ඈइʿ‫׼‬؆ຘٍ࣫‫ڶ‬ᚥ‫ܗ‬Ζʳ ʳ

ϖǵᛷʳ ʳ

ᛷ‫׌‬૞‫ڇژ‬೎ᙽխʿ֟ၦ‫ڇ‬าઽ؆෈ʿਢาઽփ‫׌‬૞ອᠦ՗ʿՈਢுᎨΕาઽᓂૹ૞ิ‫ګ‬ຝ։ʿ‫إ‬ൄ
ۨᛷᖺ৫੡ ˆˀˇˁˈʳ̀˺˂˷˿ʿፖาઽ౨ၦ‫ז‬᝔‫ڶ‬യ֊ᣂএΖʳ ʳ

ʻ˄ʼ ‫܅‬ᛷۨ఑ʳ ʳ

ۨ堚ᛷᖺ৫՛࣍ ˅ˁˈʳ̀˺˂˷˿ ጠ੡‫܅‬ᛷۨ఑ʿ‫׌‬૞‫ڂ‬੡‫྇گܮ‬இࢨ࿽᦬ඈೈᏺ‫ף‬ʿᢐढ‫ܶڕైڂ‬

ᔱࠫᎨᕪΕ˦̈˿˶̅˴˹˴̇˸Ε˖˴˿˶˼̈̀ʳ̆˴˿̇̆Ε˚˿̈˶̂̆˸Ε˜́̆̈˿˼́Ε˙̅̈˶̇̂̆˸Ε˚˿̌˶˸̅̂˿Εʳ ˘̃˼́˸̃˻̅˼́˸Ε˚˴̆̇̅˼́Ε
 ˟˴˶̇˴̇˸Ε˖̂̅̇˼˶̂̆̇˸̅̂˼˷̆Ζ‫܅‬ᛷۨ఑Օຝ։఑णઃፖาઽ౨ၦᚏ‫ิࡉ֟྇ژ‬៣փ௜௛լߩ‫ڶ‬
ᣂʿᜯ‫ݩ‬఑ण‫ۚۜڕ‬ဠஇΕტᤚฆൄΕࡅ‫ܮ‬ಐጣΕᄫۨΕۨ՛ࣨ‫פ‬౨ฆൄΕ᧼わΕ֨ۜ‫گ‬ᜍ
྇இΕࣖಮΖ᎘პ‫ۨ܅‬ᛷए᛭‫א‬ᛶ‫ڶ଺إ‬ᎽᡶΔૉਢᢐढᎈᖄঞᏁ‫ە‬ᐞਢ‫ܡ‬ೖᢐʿۨᛷ՛࣍
˄ʳ̀˺˂˷˿ ࢨ‫ڶ‬఑ण‫נ‬෼ழʿ‫א‬ᙩ౧ࣹ୴࿯ղܶᛷ፹ᕪ‫ ڕ‬ˣ̂̇˴̆̆˼̈̀ʳ̃˻̂̆̃˻˴̇˸ʳˋˀˉˇʳ̀ˠ˂˷˴̌ʿᅝۨ
堚ᛷᖺ৫Օ࣍ ˅ʳ̀˺˂˷˿ ழʿ‫شޏױ‬Ցࣚᛷ፹ᕪᇖ‫ך‬ʿ‫ٵ‬ழᏁ጑ྒྷሽᇞᔆ‫߻א‬࿇‫܅س‬ၩΕ೏ᛷᎨ
ۨ఑Ζʳ ʳ

ʻ˅ʼ ೏ᛷۨ఑ʳ ʳ

࿇‫׌س‬૞଺‫ڂ‬੡࿽ಐጣΕ೫‫ظ‬णᆯᖲ౨྇ಯΕᖩెۜᄫᇞΕᆭᒆᄫᇞ఑ଢᆢΕፂ‫˗ ైس‬
խ੅Ε‫ז‬᝔ࢨࡅ‫ࢤܮ‬Ꭸխ੅Εᛷ᥊࠷መၦΖए᛭‫א‬ᛷᎨᨖ࿨‫ٽ‬ᕪ੡‫׌‬ʻࠏ‫ܶڕ‬ᔱࢨၩ፹ᕪʼʿ
‫ڇ‬࿽‫פ‬౨լࠋ൛ृʿᏁᝩ‫܍‬ᔱ፝ᗨऱխ੅Ζࠌ‫ܶش‬ၩ፹ᕪᏁፂ਍ۨխၩΕᛷଊᗨᏁ՛࣍ ˊ˃ʿ
‫֟྇א‬ຌิ៣࿇‫س‬ၩ֏ऱ‫ٲ‬ᙠΖʳ ʳ

࿨፿ˍʳ ʳ

ኙૹ఑൛ृ࿯ղۨ෈༚ྼਢ‫ؘ‬ႊऱ,ᕣጥ‫ڶ‬๺‫ڍ‬ઔߒಾኙདྷᔆᄫ෈ፖᓄᔆᄫ෈೚ֺለ,‫ྤࠀ܀‬
ߩജऱᇷறᢞኔࠌ‫ش‬ᓄᔆᄫ෈౨ለ‫ޏ‬࿳൛ृհ‫ژ‬੒෷ࢨ‫ڽ‬Ջ෷,Օຝ։ᎁ੡དྷᔆᄫ෈ለ‫ݶ‬ຒ։
‫ࠩ܉‬าઽၴᎼ֗าઽփ,ۨᑠ୲ᗨᘉ࿾‫ش܂‬ለ஁,‫׊‬ᏁለՕၦऱདྷᔆᄫ෈‫܂‬੡ॣ‫܌ٖޡ‬൛ृ෈
᧯༚ྼऱᏁ૞,ፂ਍ۨੌ᡹ࡳᏁᓄᔆᄫ෈ऱ 2-6 ଍,ۖᓄᔆᄫ෈‫࣍شױ‬൛ृྤऄ‫࠹ݴ‬Օၦ෈᧯ᇖ
‫ך‬,‫܅‬๨‫ػ‬ᔆࢨᛜ塄լߜ,ᖞীૹ৬ழႊቃ߻௕Ⴞ࿛Ζ‫ڂ‬དྷᔆᄫ෈ঁࡵ‫֧ྤ׊‬ದ‫ۨנ‬Εტ਩հᐞ,
ૉ൛ृྤ෈᧯ૻࠫᚨ‫ױ‬ᙇ‫ش‬དྷᔆᄫ෈,‫܀‬൛ृૉਢ৺ࢤ‫ۨנ‬,ᓄᔆᄫ෈ለ౨‫ݶ‬ຒᇖ‫෈᧯ך‬ፂ਍
‫إ‬ൄ֨ᙁ‫נ‬ၦ,‫ڕ‬Ꮑ਍ᥛ෈᧯ᇖ‫୲ֺۨࢨך‬Օ࣍ 30 %,‫אױ‬དྷᔆᄫ෈ፖ 5-10 %ᓄᔆᄫ෈‫ א‬4 ֺ 1
಻‫ شࠌٽ‬6 ;ૉֺۨ୲՛࣍ 30 %ழ,Ꮑ‫ە‬ᐞᙁۨ,‫ڂ‬ᓄᔆᄫ෈լܶᕩۨ‫ڂ‬՗Εۨ՛ࣨΕદۨ෺‫ؘ‬૞
ழսᏁᇖ‫ך‬ᇠ‫ګ‬ٝ፹ᕪΖኙ࣍൛ृ᧯փሽᇞᔆլؓᘝࢬ֧ದऱ଺‫ڂ‬,ೈԱఏఐᐙ᥼؆ٍᚨ‫ە‬ᐞ
ᢐढࢬᎈ࿇ऱᑨ‫ైڂڇ‬,ᢐஃᚨ೶ፖए᛭ቸၷ࠰‫ܗ‬ᛀီ൛ृհᢐᖵ,ေ۷ਢ‫شࠌࢬڂܡ‬ऱᢐढ
ᐙ᥼ሽᇞᔆլؓᘝ,࿯ղᔞᅝऱए᛭৬ᤜ,ᝩ‫܍‬ዝ᧢‫ޓګ‬ᣤૹऱሽᇞᔆլؓᘝ,‫א‬ཚ൛ृ݁౨‫ڇ‬
ᔞᅝऱए᛭๠ᆜՀ,ᛧ൓່ࠋऱए᛭‫ګ‬யΖ
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 ٩ੱংဂϐ‫ל‬ғન٬Ҕচ߾
ኗዺΓǺЦҺ፣
Ї‫ق‬
‫ל‬ғન‫ޑ‬٬Ҕӵ݀٩ಃ΋жǵಃΒжǵ‫܈‬ಃΟжᅌ຾Ԅ‫ޑ‬٬Ҕࢂό҅ዴ‫ޑ‬Ƕ
Ӣࣁ‫ל‬ғનচؒԖжኧϐϩǴ‫ঁ؂‬ᛰ‫֡ނ‬Ԗ‫ځ‬Ԗਏ‫לޑ‬๵ጄൎǴӵՖ٩ੰΓ
ᖏ‫ޑ׉‬ၗ਑Ǵ౒ෳёૈ‫ޑ‬གࢉ೽ՏϷੰচ๵Ǵ຾Զᒧ᏷ӝ፾‫לޑ‬ғનǴ΋ᖐ
ஒੰ๵ឱྐǴωࢂ௱ࢲੰΓ‫ޑ‬όມ‫ߐݤ‬Ƕ൩ᙴৣ‫ޑ‬ҥ൑Զ‫ق‬ǴӵՖҗੰΓ‫ޑ‬
߄౜բрᖏ‫׉‬ບᘐǴ຾Զ౒ෳёૈ‫ޑ‬ठੰ๵Ǵᒧ᏷‫ى‬а఼ᇂ೭٤ಒ๵‫לޑ‬ғ
ન‫ݯ‬ᕍωࢂ‫ל‬ғન‫ޑ‬ന҅ዴ٬ҔБԄǶന٫‫לޑ‬ғનᆅ‫ࡹڋ‬฼๊ჹࢂᡣ‫؂‬Տ
ᙴৣ೿཮٬Ҕ‫ל‬ғનǴԶߚᡣ‫ל‬ғન໻ᏹᕵӧϿኧགࢉࣽᙴৣЋύǴԋࣁ‫ځ‬
΢Π‫ځ‬Ћϐπ‫ڀ‬Ƕ

‫ל‬ғનϐ୷ҁ٬Ҕচ߾

1. ΋ᅿಒ๵གࢉѝሡҔ΋ᅿᛰ‫ݯނ‬ᕍǴ٬Ҕӝ‫ݯٳ‬ᕍࣁ‫ٯ‬ѦǴόёຎࣁᔈ၀Ƕ
2. ‫؂‬΋ԛགࢉ‫ݯޑ‬ᕍᕍำനϿࣁΎϺ ȐхࡴαܺᛰӧϣȑǴԶЪᛰ‫ނ‬Ѹ໪
‫ى‬ໆǴа෧Ͽӆวϐᐒ཮ǹനӳӧΜѤϺϣଶᛰǴа෧Ͽ‫ל‬ᛰ๵ਲ਼ϐр౜Ƕ
3. ‫ݯ‬ᕍ҂‫ޕ‬གࢉਔᔈҔቶਏ‫ޑ‬ᛰ‫఼ނ‬ᇂ‫܌‬Ԗёૈ‫ޑ‬ठੰ๵ᅿǹ‫ݯ‬ᕍς‫ޕ‬གࢉ
ਔᔈᏃໆᒧҔઞਏ‫ޑ‬ᛰ‫ނ‬а෧Ͽჹဉग҅த๵ᘀ‫ޑ‬ፂᔐǶԜཷ‫ۺ‬ᆀࣁ
de-escalation therapyǶ
4. ‫ݯ‬ᕍς‫ޕ‬གࢉЪςҔ΢Ԗਏᛰ‫ނ‬ਔǴӵ݀ੰΓวᐨόଏǴᔈ२ӃԵቾౢғ
‫ٳ‬วੱǴ‫ٯ‬ӵ drug fever, abscess formation, or superinfection ฻Ƕᔈགྷᒤ‫ݤ‬
᛾ჴ‫܈‬௨ନϐǴԜਔ‫ޓ‬Ҟ‫ޑ‬ඤᛰࢂόჹ‫ޑ‬ǴӢࣁಒ๵ӧ‫ݯ‬ᕍၸำύౢғ‫ל‬
ᛰ‫ޑ܄‬ᐒ཮༾Я‫ځ‬༾ȐԖ‫ٯ‬ѦȑǶ
5. གࢉੱϐບᘐҗ‫ܭ‬ा฻୻ᎦߏрٰाԖ΋ࢤਔ໔Ǵ୻Ꭶߏрٰϐ߻ϐҔा
ћ଺ empirical therapyǶ਱ើМ഍‫܄‬๵җ‫זࡐ཮ܭ‬ౢғҶլǴߚத‫ݙ‬ख़
empirical therapyǹ਱ើМ໚‫܄‬๵җ‫ܭ‬ό཮ౢғҶլǴӢԜӭा฻ࡑ୻Ꭶр
ٰӆ‫ݯ‬ᕍǴᆀࣁ target therapzǶ

٩ੱংဂϐ‫ל‬ғન٬Ҕচ߾

൘ǵီᆂಔᙃ‫( ݹ‬cellulitis)
൨த‫ီޑ‬ᆂಔᙃ‫ݹ‬ёҗ Streptococcus ‫ ܈‬Staphylococcus aureus ‫܌‬ЇଆǴᖏ‫׉‬΢
ा᠘ձΒ‫ޣ‬٠ό৒ܰǴΨόΜϩख़ाǴӢࣁ oxacillin ჹΒ‫ޣ‬೿ԖਏǴؒ‫ݤ‬᠘
ձਔ‫ޔ‬ௗҔ΢ oxacillin ջёǶPenicillin ၸ௵ਔёаಃ΋ж cephalosporin ‫܈‬
clindamycin жඹǶ
аΠࣁ‫ݯ‬ᕍီᆂಔᙃ‫ݹ‬ਔҔᛰѸ໪‫ݙ‬ཀ‫ޑ‬੝ਸԵໆǺ
1. Eagle phenomenon
 ऩᚶᅪࣁ Streptococcus ‫܌‬Їଆ‫ီޑ‬ᆂಔᙃ‫ݹ‬ǴԶЪߟҍ‫ޑ‬ጄൎၨቶਔǴ
penicillin ‫ޑ‬ਏ݀཮җఠ๵ᡂԋ‫׭‬๵Ǵठ٬ᕍਏᡂৡǶԜਔёӝ‫ٳ‬٬Ҕ
penicillin G + clindamycin ཮Ԗၨ٫‫ޑ‬ਏ݀ǴԶЪ clindamycin ࣁೈқ⅋‫׭‬
‫ڋ‬ᏊǴёа෧Ͽಒ๵ࢥન‫ޑ‬ӝԋǴჹ‫ ܭ‬toxic sign Кၨܴᡉ‫ੰޑ‬ΓԜᅿᕍ‫ݤ‬
࣬྽όᒱǶ
2. ྽ီᆂಔᙃ‫ࢂݹ‬ӢѦ໾‫܌‬Їଆਔ
Ԝ ਔ ന Ԗ ё ૈ ‫ ޑ‬ठ ੰ ๵ ࣁ Staphylococcus aureus Ϸ Pseudomonas
aeruginosaǴӧ୻Ꭶۘ҂рٰ߻ё٬Ҕ oxacillin + aminoglycosideǵtazocinǵ
ಃΟж‫܈‬ಃѤж‫ ޑ‬quinolone ‫ݯ‬ᕍǶ
3. ྽ီᆂಔᙃ‫ࢂݹ‬ӢҜጥλ໾αௗ᝻Н‫܈‬Нғ୏෌‫ނ‬Զགࢉਔ
Ԝ ਔ ന Ԗ ё ૈ ‫ ޑ‬ठ ੰ ๵ ࣁ Aeromonas hydrophila( ఩ Н ) Ϸ Vibrio
vulnificus(ੇН)Ǵ೭ᜪੰচ๵ऩр౜ӧߚ‫ط‬ฯϯ‫ੰޑ‬Γ‫ي‬΢Ǵ٠ό཮ౢғ
ϼε‫ޑ‬ୢᚒǹՠऩр౜ӧ‫ط‬ฯϯ‫ੰޑ‬஻཮೷ԋࡐᝄख़‫௳ޑ‬Ո‫܄‬ҶլǴԜਔ
ᔈҥջ٬Ҕ ceftazidime + minocin ‫ ࢂ܈‬tienam or meropenemǶ
4. ᑗֿੰ‫ى‬
ᑗֿੰ‫ࢂى‬ӢՈనൻᕉό‫܌ؼ‬ЇଆǴ٠ߚྍ‫ܭ‬ಒ๵གࢉǴ‫ݯ‬ᕍ‫ޑ‬२ाࣁЋ
ೌǴόё஌ఈ‫ל‬ғનஒᑗֿੰ‫ݯى‬ӳǶऩ໾αၨᠢё٬Ҕ΋٤‫ל‬ғનǴх
ࡴ unasynǵaugmentinǵertapenemǵ‫܈‬ಃ΋ж cephalosporinsǶՠόѸ٩߄
य़໾α‫ޑ‬ಒ๵୻Ꭶٰ่݀๏ᛰǶ
5. ୏‫ࠈނ‬໾Їଆϐီᆂಔᙃ‫ݹ‬
ྕՈ୏‫ࠈނ‬໾аჇ਼๵Ϸ᜘ౚ๵ࣁനத‫ޑـ‬ठੰ๵ǴӢԜ unasyn ‫܈‬
augmentinǵertapenem ࣁന٫‫ޑ‬२ᒧᛰ‫ނ‬Ƕՠऩ೏հՈ୏‫ܲ܈ނ‬ᙝࠈ໾Ǵ
཮ԖࡐଯК‫ٯ‬р౜਱ើМ഍‫܄‬ఎ๵ǴΨԖࡐଯ‫ޑ‬ᐒ཮ౢғ௳Ո‫܄‬ҶլǶӢ
Ԝ ᙴ ৣ ऩ ว ౜ ੰ ஻ Ԗ shock ‫ ܈‬impending shock ᔈ ҥ ջ ๏ ϒ ಃ Ο ж
cephalosporinsǵtazocinǵ‫ ܈‬tienam or meropenem ‫ݯ‬ᕍǶ

ມǵ‫ݹޤ‬
‫ޑݹޤ‬ບᘐѸ໪ा‫ޤ‬೽ X Ӏᔠࢗр౜຾Չ‫੆ޑ܄‬ዎ౜ຝ(infiltration)Ǵӕਔӝ
‫ٳ‬วᐨϷ࣬ჹᔈϐૅ೽ੱ‫ރ‬ωᆉǶѝԖཱུϿኧ‫ٯ‬Ѧ௃‫ݩ‬Πω཮ؒԖ‫ޤ‬೽ X Ӏ
‫ޑ‬ᡂϯǴ‫ٯ‬ӵཱུࡋಥН‫܈‬қՈౚཱུե‫ޑ‬௃‫ݩ‬Πω཮р౜Ǵՠ೭๊ჹࢂ੝‫ٯ‬Ǵ
όёຎࣁதೕǶ
ບᘐр‫ࡕݹޤ‬Ѹ໪Ӄ୔ϩࢂ interstitial pattern ‫ ࢂ܈‬alveolar patternǴࡕ‫ۘޣ‬Ѹ
໪୔ϩࢂ‫܈ࠠ୔ޗ‬ଣϣࠠǶ
1. Interstitial pneumonitis
Interstitial pneumonitis ೯தࣁКၨϿ‫ـ‬ԶЪၨᜤບᘐ‫ޑ‬ठੰ๵‫܌‬ЇଆǴ‫ٯ‬
ӵੰࢥǵ่ਡ๵ǵᡖ๵ǵ‫܄ࠠڂߚ܈‬ಒ๵฻Ƕೀ౛‫ޑ‬ख़ᗺӧ‫ܭ‬ӵՖள‫҅ډ‬
ዴ‫ޑ‬ບᘐǴ೯தा࿶җᑈཱུ‫ߟޑ‬Ε‫܄‬ບᘐБԄωёள‫ډ‬ບᘐǶ
ੰΓ௃‫ݩ‬ऩόӒ࡚ǴёӃள‫ډ‬ບᘐࡕӆ‫ݯ‬ᕍǶӵ݀௃‫ݩ‬Ӓ࡚Ǵё๏ϒ
 TMP/SMX + erythromycin (or azithromycin) + anti-TB ‫ݯ‬ᕍǴ٠ᑈཱུ຾Չບ
ᘐπբǴࡑບᘐрٰࡕӆ‫ݯׯ‬ᕍǶ
2. ‫( ݹޤࠠ୔ޗ‬community-acquired pneumonia, CAP)
‫ݹޤࠠ୔ޗ‬നத‫ޑـ‬ठੰ๵Ϸനத‫ޑـ‬ठԝ๵֡ࣁ‫ݹޤ‬᜘ౚ๵
(Streptococcus pneumoniae)ǴӢԜ΋Ϫ‫ݯޑ‬ᕍ֡Ѹ໪ଞჹ‫ݹޤ‬᜘ౚ๵Զ೛
ीǶ٩Ѡ᡼౜Չ‫ݹޤ‬᜘ౚ๵‫לޑ‬ғન௵ག‫܄‬၂ᡍٰ่࣮݀Ǵ80%‫ݹޤޑ‬᜘
ౚ๵ჹ penicillin ‫ ޑ‬MIC ॶς࿶ >0.06 Pg/mlǴՠ‫ځ‬ύ๊ε೽ϩ MIC ॶϝ <1
Pg/mlǴѝԖཱུϿኧ‫ޑ‬๵ਲ਼ MIC ॶ >2 Pg/mlǶऩа҅த penicillin G 3MU q6h
‫ݯޑ‬ᕍБԄǴՈύ penicillin ϐᐚࡋёၲ 100 Pg/mlǴჹ‫ܭ‬΋૓‫ݯݹޤޑ‬ᕍ
ϝฅᆖᆖԖᎩǶ
ӵ݀‫ੰݹޤ‬஻٠҂р౜‫֎ڥ‬૰ᆃаϷൻᕉ૰ᆃ‫ޑ‬౜ຝਔǴᆀࣁᇸ‫ډ‬ύࡋ‫ޑ‬
‫ݹޤ‬ǴԜਔ‫ޑ‬२ᒧᛰ‫ނ‬ϝࣁ penicillin GǶऩੰ஻ࣁ COPD ‫ٳ‬ว secondary
infection ‫ ܈‬bronchopneumoniaǴԜਔ Hemophilus spp.Ψ཮՞Αࡐε‫ޑ‬Кख़
(ऊ 40%)ǴӢԜӕਔჹ Hemophilus spp.Ϸ Streptococcus pneumoniae Ԗਏ‫ޑ‬
unasyn ᆶ augmentin ߡԋࣁ२ᒧᛰ‫ނ‬ǹಃΒж cephalosporins ჹ Hemophilus
spp.ਏ݀όᒱǴՠჹ Streptococcus pneumoniae ‫ޑ‬ਏ݀ၨৡ(ѝԖ penicillin
‫ ޑ‬25-50%)Ǵឦ‫ܭ‬ԛᒧᛰ‫ނ‬Ƕಃ΋ж cephalosporins ӕਔჹ Hemophilus spp.
Ϸ Streptococcus pneumoniae ਏ݀֡ό٫ǴӢԜόࡌ᝼Ҕ‫ޤܭ‬೽གࢉǶ
ӵ݀‫ੰݹޤ‬஻ς࿶р౜‫֎ڥ‬૰ᆃаϷൻᕉ૰ᆃ‫ޑ‬౜ຝǴ‫ࢂ܈‬࿶߃ԛ‫ݯ‬ᕍਏ
݀ό٫ਔǴёаᒧҔჹ Streptococcus pneumoniae ਏ݀ၨ penicillin ࣁ٫‫ޑ‬
cefotaxime, ceftriaxone, cefepime, cefpirome, tienam, ‫ ܈‬meropenem ‫ݯ‬ᕍǴ‫܈‬
ൂᐱ٬ҔಃΟ‫܈‬ಃѤж‫ ޑ‬quinolone ҭёǶ‫ځ‬ύಃΟ‫܈‬ಃѤж‫ ޑ‬quinolone
(levofloxacin ‫ ܈‬moxifloxacin)‫ޤ‬೽‫ऀޑ‬೸Κஒ߈ 100%ǴКଆ beta-lactam ‫ޑ‬
10-20%ᓬຫࣗӭǴࢂख़ੱ‫ݹޤࠠ୔ޗ‬ϐ२ᒧᛰ‫ނ‬Ƕ
Ҟ߻җ‫ ܭ‬Streptococcus pneumoniae ჹआᡖનᜪᛰ‫לޑނ‬ᛰ‫܄‬ଯၲ 90%а
΢ǴӢԜआᡖનᜪᛰ‫ނ‬όёൂᐱҔٰ‫ݯ‬ᕍচӢόܴ‫ݹޤޑ‬Ƕՠࢂჹ‫ܭ‬ዴᇡ
‫܈‬ଯࡋᚶᅪࣁ atypical pathogen ‫܌‬Їଆϐ‫ݹޤ‬Ǵआᡖનᜪᛰ‫ނ‬ϝࣁ२ᒧǶ
3. ଣϣགࢉࠠ‫ݹޤ‬
ଣϣགࢉࠠ‫ޑݹޤ‬ԝΫ౗ࡐଯǴቹៜԝΫ౗നख़ा‫ޑ‬Ӣનࣁࢂցૈஒठੰ
๵΋ᔐԶύǴऩ‫ݯ‬ᕍύඤᛰёቚуऊΟ७ϐԝΫ౗Ƕଣϣགࢉࠠ‫ޑݹޤ‬ठ
ੰ๵аᆘᖋఎ๵ǵ‫ל‬ᛰ‫܄‬ဉϣ๵ǵаϷߎ໳Յဟ๻ౚ๵ࣁЬǶӵ݀ੰ஻Ӄ
߻٠҂٬Ҕ‫ל‬ғનǴᆘᖋఎ๵р౜‫ޑ‬ᐒ཮ၨեǴಃ΋ጕёа٬ҔಃΟж
cephalosporinsǹՠऩੰ஻Ӄ߻ς٬Ҕၸ‫ל‬ғનǴ߾Ԗࡐଯ‫ޑ‬ᐒ཮(60-70%)
ࢂᆘᖋఎ๵‫܌‬ЇଆǴಃ΋ጕ൩Ѹ໪Ҕ΢ᆘᖋఎ๵ᛰ‫ނ‬Ǵ‫ٯ‬ӵ tazocin, tienam,
meropenem, ceftazidime, cefepime, cefpirome ฻ᛰ‫ނ‬Ƕ

ୖǵಒ๵‫܄‬တጢ‫ݹ‬
ಒ๵‫܄‬တጢ‫ࣁݹ‬ϣ࡚ࣽੱǴऩόϒ‫ݯ‬ᕍԝΫ౗ 100%Ƕ྽ੰ஻߄౜วᐨǵᓐภǵ
 Ⴭӗਔ΋‫ۓ‬ाஒတጢ‫ݹ‬ӈΕ᠘ձບᘐǴ٠ҥջբૉ෎ऀ‫ڈ‬Ƕᙴৣҗᚶᅪတጢ
‫ݹ‬ǵૉ෎ऀ‫ڈ‬ǵ‫่݀ډ‬ղ᠐ǵҔᛰѸ໪ӧ΋ঁλਔϣֹԋωᆉϷ਱Ƕ྽ૉ෎
ऀ‫ڈ‬ϐ่݀р౜ WBC>5, neutrophil predominant, CSF sugar<50 or 50% of blood
sugar ਔ֡ᔈຎࣁಒ๵‫܄‬တጢ‫ݹ‬Ƕ
Ѡ ᡼ Ӧ ୔ ಒ ๵ ‫ ܄‬တ ጢ ‫ ݹ‬ന த ‫ ੰ ޑ ـ‬চ ๵ ࣁ Streptococcus pneumoniae,
Klebsiella pneumoniae, Neisseria meningitidis,Ϸ Hemophilus influenzae(ϖྃа
Π ) Ƕ ा ֹ ӄ ఼ ᇂ ‫ ܌‬Ԗ ੰ চ ๵ ё а ٬ Ҕ cefotaxime, ceftriaxone, cefepime,
cefpirome, tienam, or meropenem ‫ݯ‬ᕍǶ

စǵ‫سֿݜ‬಍གࢉ
όӢᏤֿᆅ‫܌‬೷ԋϐ‫سֿݜ‬಍གࢉǴठੰ๵а E. coli, Proteus mirabilis ࣁЬǴ
ӢԜಃ΋ጕ‫ݯ‬ᕍᛰ‫ނ‬аಃ΋ж cephalosporin + aminoglycoside ջёǶऩੰ஻ම
‫߈ܭ‬යௗ‫ڙ‬ၸ‫ל‬ғન‫ݯ‬ᕍǴाԵቾ‫ל‬ᛰ‫ ܄‬Gram(-)๵ਲ਼Ǵӕਔૈ఼ᇂ GNB ESBL
‫ל‬ᛰᐒᙯϷ AmpC ‫ל‬ᛰᐒᙯϐ ertapenem ྽ࢂന٫ᒧ᏷ǶऩԖᏤֿᆅ‫܌‬೷ԋϐ
‫سֿݜ‬಍གࢉǴPseudomonas aeruginosa ‫ޑ‬ᐒ཮൩ࡐଯǴёҔಃΒжа΢‫ޑ‬
quinolones ‫ ܈‬anti-pseudomonas ϐE-lactams ٰ‫ݯ‬ᕍǶ

Ҵǵဎ๚ϣགࢉ
ဎ๚ϣགࢉёϩԋဎጢ‫ݹ‬ǵဎ๚ϣᖋᅬǵϷମࣧ๚གࢉ
1. ဎጢ‫ݹ‬
߃ભဎጢ‫(ݹ‬primary peritonitis)߯ࡰಒ๵࿶җՈՉ຾Εဎጢ๚ϣ೷ԋག
ࢉǴठੰ๵๊ε೽ϩࣁ E. coliǴӢԜ൳Я‫܌‬Ԗ‫ޑ‬E-lactams ‫ל‬ғન೿ё٬ҔǶ
җ‫߃ܭ‬ભဎጢ‫ݹ‬εӭр౜ӧԖဎН‫ੰޑ‬஻‫ي‬΢Ǵ‫ځ‬ύԖࡐӭࢂ‫ط‬ฯϯ‫ޑ‬
ΓǴᔈᗉխ٬Ҕ aminoglycosideǶ
ԛભဎጢ‫(ݹ‬secondary peritonitis)߯ࡰगဉр౜ઇࢰǴ೷ԋεໆჇ਼Ϸሡ਼
๵ԡࢉဎጢ๚Ƕҗ‫ܭ‬ಒ๵ኧҞࡐӭǴѦࣽమࢱᆶঅံࢂനख़ा‫ݯޑ‬ᕍǴ‫ל‬
ғનѝࢂۚ‫ܭ‬ᇶ՘‫ޑ‬ӦՏǶ‫ל‬ғન‫ޑ‬ᒧ᏷аૈቶ‫఼ޑݱ‬ᇂ਱ើМ໚‫܄‬ǵ਱
ើМ഍‫܄‬ǵϷჇ਼๵‫ەࣁޣ‬Ƕԛભဎጢ‫לޑݹ‬ғન‫ݯ‬ᕍ߻Ѹ໪Ӄჹဎጢ‫ݹ‬
຾Չำࡋ‫ޑ‬ຑ՗Ƕ
ᇸ‫ډ‬ύࡋ‫ޑ‬ဎጢ‫ݹ‬Ǻཀࡰ PPU ࡕ 24 λਔϣ໒ΘǴ‫܈‬εဉઇ຋ࡕ 12 λਔϣ
໒ΘǴੰ஻ؒԖ shock ‫ރޑ‬ᄊǶԜਔё๏ϒ ertapenemǵmoxifloxacioǵunasyn
ൂ΋‫ݯ‬ᕍǵ‫ ܈‬clindamycin + aminoglycoside ‫ݯ‬ᕍǶ‫ځ‬ύ ertapenem ӕਔૈ
఼ᇂ‫܌‬Ԗ GNB ESBL ‫ל‬ᛰᐒᙯϷ AmpC ‫ל‬ᛰᐒᙯǴ྽ࢂന٫२ᒧᛰ‫ނ‬Ƕ
ख़ࡋ‫ޑ‬ဎጢ‫ݹ‬Ǻཀࡰ PPU 24 λਔࡕω໒ΘǴ‫܈‬εဉઇ຋ 12 λਔࡕω໒ΘǴ
ੰ஻р౜ shockǴcancer perforationǴϯᏢ‫ݯ‬ᕍࡕगဉઇ຋Ǵ‫ࢂ܈‬Ӣឲဉ‫܈‬
բϣ၂᜔Զஒဉၰ‫׋‬ઇǴ೿ᆉख़ࡋ‫ޑ‬ဎጢ‫ݹ‬Ƕᔈ٬Ҕ tienamǵmeropenemǵ
‫ ܈‬tazocin ‫ݯ‬ᕍǶ
Οભဎጢ‫(ݹ‬tertiary peritonitis)߯ࡰԛભဎጢ‫ࡕݹ‬٠҂ள‫ֹࡐډ‬๓‫ޑ‬ᙴᕍǴ
 ೷ԋဎ๚ϣ೽ࡐӭ‫ݠޑ‬ℚǴόܰ຾ՉЋೌమየǹ٠ЪԖࡐӭᕉნύ‫ޑ‬
PseudomonasǵS. aureus ‫ۯ‬ᆅၰ຾Εဎ๚೷ԋགࢉǶ‫ל‬ғન‫ݯ‬ᕍКྣख़ࡋ
ဎጢ‫ݹ‬Ǵՠਔ໔ёૈा‫ߏࡐܦ‬Ƕ
2. ဎ๚ϣᖋᅬ
ဎ๚ϣᖋᅬёϩԋҗൂ΋๵ਲ਼‫܈‬ӭख़๵ਲ਼‫܌‬Їଆ‫ޑ‬ᖋᅬǴ‫ޑޣٿ‬᠘ձа
Gram’s stain നྗǴӢࣁԖࡐӭ๵ࢂჇ਼๵೯த୻ᎦߏόрٰǴՠ‫ܓ‬Т࣮‫ޑ‬
‫ډ‬Ƕ
ൂ΋๵ਲ਼‫܌‬Їଆ‫ޑ‬ဎ๚ϣᖋᅬǴಒ๵ӭٰԾՈՉǶ‫ٯ‬ӵ‫ط‬ᖋᅬ‫ ޑ‬Klebsiella
pneumoniaeǴ๠᠌ᖋᅬ‫ ޑ‬Salmonella, S. aureus, Streptococcus, E. coli, ‫܈‬
Klebsiella pneumoniaeǴ๝᠌ᖋᅬ‫ ޑ‬E. coli, S. aureus, ‫ ܈‬StreptococcusǶ‫ݯ‬
ᕍ‫ޑ‬ख़ᗺࣁᖋᅬ‫ޑ‬ЇࢬǴӧۘ҂୻Ꭶрಒ๵߻ಃ΋ж cephalosporin ࣁӝ፾
‫ޑ‬ಃ΋ጕҔᛰǶ
ӭख़๵ਲ਼‫܌‬Їଆ‫ޑ‬ဎ๚ϣᖋᅬǴಒ๵ӭٰԾઇཞ‫ޑ‬ဉगၰǶ‫ݯ‬ᕍ‫ޑ‬ख़ᗺࣁ
ᖋᅬ‫ޑ‬ЇࢬϷဉगၰ‫ޑ‬অံǶӵ݀ѦࣽᙴৣԖ‫ע‬ඝૈஒ๊ε೽ϩᖋᅬЇࢬ
ଳృǴ‫ל‬ғનѝ໪‫ݮ‬Ҕᇸ‫ډ‬ύࡋ‫ޑ‬ဎጢ‫ޑݹ‬БԄջёǹӵ݀ᖋᅬؒ‫ֹݤ‬ӄ
ЇࢬଳృǴ‫ל‬ғન൩໪‫ݮ‬Ҕख़ࡋ‫ޑ‬ဎጢ‫ݯݹ‬ᕍБԄǶ
3. ମࣧ๚གࢉ
ମࣧ๚གࢉࣁ஁ࣽத‫߳ޑـ‬ज़ࠠဎ๚ϣགࢉǴёϩԋϣӢࠠϷѦӢࠠΒ
ᅿǶ
ϣӢࠠମࣧ๚གࢉ‫ޑ‬ಒ๵ӭٰԾ഍ၰǴ࿶җη৐ᓍα‫܈‬η৐ϣᗉѫᏔԶᘉ
ණ‫ډ‬ମࣧ๚೷ԋགࢉǶ೯தࣁӭख़๵ਲ਼གࢉǴЪхࡴࡐӭჇ਼๵ӧϣǶ‫ݯ‬
ᕍ а unasyn ǵ augmentin ǵ ertapenem ൂ ΋ ‫ ݯ‬ᕍ ǵ ‫ ܈‬clindamycin +
aminoglycoside ࣁ२ᒧǶ
ѦӢࠠମࣧ๚གࢉ‫ޑ‬ಒ๵ӭࣁ‫ੰੰ܄‬চ๵Ǵੰ஻‫ޑ‬੝ቻࣁ sexually-active
womenǴനத‫ޑـ‬ठੰ๵ࣁర๵Ϸ‫ܖ‬Պ๵Ƕ‫ݯ‬ᕍа ceftriaxone + azithromycin
ࣁ२ᒧǶ

ഌǵ௳ՈੱϷ௳Ո‫܄‬Ҷլ
௳Ոੱࣁ਱ើМ഍‫܄‬ఎ๵གࢉਔǴಒ๵ញ‫ޑܫ‬ϣࢥન‫܌‬೷ԋ‫ޑ‬ϸᔈǶ‫ל‬ғન
ϐ٬Ҕᗨёఠԝಒ๵Ǵՠҗ‫ܭ‬εໆϩှ‫ޑ‬ಒ๵ёញ‫ܫ‬рϷεໆ‫ޑ‬ϣࢥનǴ٬
‫׳ݩੰޑ‬ᝄख़ǴҶլ‫ܴ׳‬ᡉǶӢԜ௳ՈੱϷ௳Ո‫܄‬Ҷլ‫ݯޑ‬ᕍόёѝһᒘ‫ܭ‬
‫ל‬ғનϐ‫׫‬ϒǶӵՖаനᑈཱུ‫ޑ‬ᄊࡋ๏ੰ஻ံкᡏనǵߥ࡭ՈᓸϷ‫֎ڥ‬Ǵ྽
ࢂ௱ࢲੰ஻ϐόΒ‫ߐݤ‬Ƕ௳ՈੱϷ௳Ո‫܄‬Ҷլਔ‫ל‬ғનϐᒧҔᔈ٩ੰ஻߄౜
ϐੱংဂࣁᒧ᏷‫ޑ‬٩ᘜǹ‫ٯ‬ӵੰ஻ऩԖ‫ޤ‬೽ੱ‫ރ‬Ǵ‫ל‬ғન൩٩‫ݹޤ‬ϐྗ߾๏
ϒǹੰ஻ऩԖဎ೽ੱ‫ރ‬Ǵ‫ל‬ғન൩٩ဎ๚ϣགࢉϐྗ߾๏ϒǶ

ࢠǵମᓝᜢ࿯གࢉ
ମᓝᜢ࿯གࢉ‫ޑ‬ಒ๵ёٰԾ‫ܭ‬ՈՉ‫ٰ܈‬Ծ‫ܭ‬Ѧ໾Ƕ
 ՈՉ‫܄‬ମᓝᜢ࿯གࢉനத‫ޑـ‬๵ࣁ S. aures, TB, Streptococcus ‫ ܈‬SalmonellaǴ
ӧխࣝ҅த‫ޑ‬Γ Salmonella ‫ޑ‬ᐒ཮ၨեǴӢԜ oxacillin ‫܈‬ಃ΋ж cephalosporin
֡‫୼ى‬Ҕբಃ΋ጕ‫ݯ‬ᕍᛰ‫ނ‬Ƕ
Ѧ໾ࠠମᓝᜢ࿯གࢉ‫ޑ‬ठੰ๵߾ᅿᜪ࣬྽ӭǴѸ໪฻ಒ๵୻Ꭶ่݀ωёૈள
‫ډ‬ዴ‫ݯۓ‬ᕍǶӧ୻Ꭶۘ҂рٰ߻ёኩਔа oxacillin ‫܈‬ಃ΋ж cephalosporin +
aminoglycoside ‫ݯ‬ᕍǶ
ମᓝᜢ࿯གࢉਔ໒ΘమየाК‫ל‬ғન‫ݯ‬ᕍख़ाǴ໒Θమየ΋Бय़ёଌ୻ᎦԶ
ள‫ੰ҅੿ډ‬চ๵Ǵќ΋Бय़ёమନԝମǴჹ‫ݯ‬ᘰੰ஻ᔅշࡐεǶ

਎ǵTarget therapy
1ǵ୻Ꭶߏрಒ๵ࡕё٩‫௵ځ‬གࡋ၂ᡍ่݀๏ᛰǴՠԖ൳ᗺѸ໪‫ݙ‬ཀ
2ǵࢌ ٤ ಒ ๵ ӧ ‫ ݯ‬ᕍ ၸ ำ ύ ཮ ࿶ җ ௗ ᝻ ‫ ל ډ‬ғ ન Զ ೏ ᇨ Ꮴ р AmpC
hyperproducing strainǴӧཱུอਔ໔ϣ൩཮೷ԋ‫ݯ‬ᕍѨ௳ǶӢԜ࿘‫ډ‬೭ᜪಒ
๵ϐᝄख़གࢉ‫܈‬ᕍำၨߏ‫ޑ‬གࢉਔǴᔈᒧҔ Tienam, meropenem, ertapenem
฻ carbapenem ᜪ‫ޑ‬ᛰ‫ ܈ނ‬cefepime ‫ݯ‬ᕍǴаᗉխ‫ݯ‬ᕍѨ௳٠੮Π‫ל‬ᛰ‫܄‬
๵ਲ਼Ǵ೭΋ᜪಒ๵хࡴ:
Pseudomonas spp, Acinetobacter spp, Enterobacter cloacae, Citrobacter
freundii, Serratia marcescens, Proteus vulgaris, Morganella morganii,
Providencia spp.
ՠऩӧᕍำࡐอ‫ޑ‬੯ੰǴ‫ٯ‬ӵ urinary tract infection ਔϝё٩௵གࡋ၂ᡍ
่݀๏ᛰǶ
3ǵSalmonella spp җ‫ܭ‬ԖࡐଯК‫ ࢂٯ‬intracellular infectionǴӢԜѝёᒧҔ
ampicillin (amoxicillin, augmentin, unasyn), baktar, chloramphenicol,
ceftriaxone, fluoroquinones ฻ёऀ೸୏‫ނ‬ಒझጢ‫ޑ‬ᛰ‫ݯނ‬ᕍǶ
4ǵProstatitis ਔѝԖ baktar, erythromycin, fluoroquinones ёаऀ೸ prostateǶ
5ǵUremia ‫ੰޑ‬Γགࢉਔε೽ҽ‫ޑ‬E-lactams ‫ޑ‬ᐚࡋ֡όᛙ‫ۓ‬Ǵऩᚶᅪࢂ G(+)
ಒ๵གࢉਔё‫ຼ؂‬๏ϒ 1 gm vancomycinǴऩᚶᅪࢂ G(-) ಒ๵གࢉਔё‫؂‬
ԛࢱ๝ࡕ๏ϒ gentamicin or amikacinǶ
6ǵESBL producing strains Ҟ߻೏᛾ჴр౜ӧ K. pneumoniae, K. oxytoca, Ϸ E.
coli ύǶESBL ‫ޑ‬ዴᇡ࣬྽֚ᜤǴՠ‫ځ‬ёҗ΋૓௵ག‫܄‬၂ᡍ่݀ள‫ډ‬௢ፕǶ
ӵ݀௵གࡋ၂ᡍ่݀р౜ ceftriaxone, cefotaxime, azactam, ceftazidime Һ
Ֆ΋ঁ resistant ਔǴ൩൳Яёᇡ‫ ࣁۓ‬ESBL producing strainsǶESBL
producing strains ‫܌‬೷ԋ‫ ޑ‬mild to moderate infection ਔёҔ cefoxitin,
cefmetazole, flumarin, moxalactam, fluoroquinones,‫ ܈‬E-lactam/E-lactamase
inhibitor ᛰ‫ݯނ‬ᕍǴՠऩ࿘‫ډ‬ᝄख़གࢉਔ߾ᔈᒧҔ carbapenem(ertapenem,
tienam, meropenem) ᛰ‫ݯނ‬ᕍǶ
 注射抗生素 (乖乖手冊 一張表格的放大版) 若發現錯字，或有任何建議，歡迎來信 edit@pmed.info 或上網 http://pmed.info 留言 (修訂於2008年5月12日)
<1200g ~2000 g >2000 g 兒童
藥名 劑型 新生兒 滿月嬰兒 ~ 兒童 兒童重度感染 註
<1月 a7天 >7天 a7天 >7天 最大劑量
Penicillin G 1000萬 U/Vial 2.5萬 U/kg/dose Q12H Q12H Q8H Q8H Q6H 10~25萬 U/kg/day Q4~6H 五歲以上大葉肺炎
腦膜炎(non-GBS) 5萬 U/kg/dose Q12H Q8H Q8H Q6H 25~40萬 U/kg/day Q4~6H 2400 萬
GBS 腦膜炎 a7天: 25~45萬 U/kg/day Q8H >7天: 45萬 U/kg/day Q6H U/day
先天梅毒 5萬 U/kg/dose Q12H Q8H Q12H Q8H
Benzathin Penicillin G 5萬 U/kg/dose single dose 肌注 (無症狀的先天梅毒) Infant: 2.5~5萬U/kg/dose, (< 27 kg): 30~60萬U/dose, (>27 kg): 90萬U/dose 單次肌注
青
Ampicillin 500 mg/Amp 25 mg/kg/dose Q12H Q12H Q8H Q8H Q6H 100~200 mg/kg/day Q6H 12 g/day
黴
腦膜炎(non-GBS) 50 mg/kg/dose Q12H Q8H Q8H Q6H 200~400 mg/kg/day Q6H
素
類 GBS 腦膜炎 a7天: 200 mg/kg/day Q8H >7天: 300 mg/kg/day Q6H
Oxacillin (Prostaphlin®) 500 mg/Vial 25 mg/kg/dose Q12H Q12H Q8H Q8H Q6H 100~150 mg/kg/day Q6H 150~200 mg/kg/day Q4~6H 12 g/day 蜂窩組織炎、骨髓炎
Amoxicillin + Clavulanate 計算 Ampicillin 含量 乘1.2。
500 + 100 mg/vial 100 mgAMP/kg/day Q6~8H 5 vial/day
(Augmentin®) 中耳炎或五歲以下大葉肺炎
Ampicillin + Sulbactam 100~200 mgAMP/kg/ 200~300 mgAMP/kg/ 16 vial/ 計算 Ampicillin 含量 乘1.5。
500 + 250 mg/vial Q6H Q6H
(Unasyn®) day day day 吸入性肺炎(例如嗆奶引起)
Aztreonam (Azactam®) 1 g/Vial 30 mg/kg/dose Q12H Q12H Q8H Q8H Q6H 90~120 mg/kg/day Q6~8H
Imipenem (Tienam®) 500 mg/Vial 20 mg/kg/dose 18~24H Q12H Q12H Q12H Q8H 60~100 mg/kg/day Q6H 4 g/day < 3m/o: 100 mg/kg/day

Lactam
Meropenem (Mepem®) 250 mg/Vial 20 mg/kg/dose Q12H Q8H Q12H Q8H 60 mg/kg/day Q8H 120 mg/kg/day Q8H
胺 Gentamicin 80 mg/Amp 2.5 mg/kg/dose Q24H Q12H 8~12H Q12H Q8H 7.5 mg/kg/day Q8H
醣 Amikacin (Amikacin®) 250 mg/Vial 7.5 mg/kg/dose Q24H Q12H 8~12H Q12H Q8H 15~22.5 mg/kg/day Q8H
Cefazolin 一代 1 g/Vial 20 mg/kg/dose Q12H Q12H Q12H Q8H 50~100 mg/kg/day Q8H 6 g/day
750 mg/Vial 50~100 mg/kg/ Q12H Q12H Q12H Q12H 75~150 mg/kg/day Q8H 6 g/day
Cefuroxime (Zinacef®) 二
dose

1 g/Vial 90~100 mg/kg/ Q8H Q8H Q8H Q8H 80~100 mg/kg/day Q6~8H 100~160 mg/kg/day 4~6H 12 g/day
Cefoxitin (Mefoxin®) 二代
頭 dose
孢 Cefotaxime (Claforan®) 三 500 mg/Vial 50 mg/kg/dose Q12H Q12H Q8~12H Q8H Q6~8H 100~200 mg/kg/day Q6~8H
素 Q6H
225~300 mg/kg/day Q6H
腦膜炎加量 Cefotaxime a7天: 50 mg/kg/dose Q8H >7天: 75 mg/kg/dose Q6H 200 mg/kg/day 肺炎鏈球菌腦膜炎
類
Ceftazidime (Fortum®) 三 500 mg/Vial 50 mg/kg/dose Q12H Q12H Q8H 8~12H Q8H 100~150 mg/kg/day Q8H 6 g/day
50~75 Q12 ~ 腦膜炎 75mg/kg loading
Ceftriaxone(Rocephin®)三 500 mg/Vial 50 mg/kg/dose Q24H Q24H Q24H 50~75 mg/kg/day 24H
4 g/day Salmonellosis
Q24H 80~100 mg/kg/day Q12~24H
Cefepime (Maxipime®) 四 500 mg/Vial 30 mg/kg/dose Q12H Q12H Q12H Q12H 100 mg/kg/day Q12H 150 mg/kg/day Q8H Neutropenic fever
Piperacillin (Pipril®) 2 g / Vial 50 mg/kg/dose Q8H Q6H Q8H Q6H 200~300 mg/kg/day Q4~6H 24 g/day
Piperacillin + Tazobactam 150~300 mg Pip/kg/ 先計算Piperacillin含量，乘以
2 + 0.25 g/Vial Q6~8H 300~400 mg Pip/kg/day Q6H 9 vial/day
混 (Tazocin®) day 1.125
合 Ticarcillin + Clavulanate 先計算 Ticarcillin 含量，乘以
1.5 + 0.1 g/Vial 200 mg Tica/kg/day Q6~8H 300 mg Tica/kg/day Q4~6H
類 (Timentin®) (16 / 15)
Sulfamethoxazole +
400 + 80 mg /Vial 6~12 mgTMP/kg/day Q12H 15~20 mg TMP/kg/day Q6~8H 先計算 TMP 含量，再乘以6
Trimethoprim (Septrin®)
Ciprofloxacin (Ciproxin®) 100mg / 50mL/BT 20~30 mg/kg/day Q12H 0.8 g/day
Teicoplanin (Targocid®) 200 mg/Vial (NB ~ 2 m/o) 第一劑16 mg/kg/dose Q24H 嚴重感染者第三劑之後續用
(>2 m/o) 前三劑10 mg/kg/dose Q12H ，之後6 mg/kg/dose Q24H
其 之後8 mg/kg/dose Q24H 10 mg/kg/dose Q24H
他 Vancomycin 15 10~15 10~15 10~15 15~20 Q6~8H Q6H
500 mg/Vial 右列量mg/kg/dose Q24H Q12-18H Q8-12H Q8-12H Q8H
40 mg/kg/day 60 mg/kg/day 1 g/day
類
Metronidazole (Anegyn®) 500 mg/Vial 7.5 mg/kg/dose Q48H Q24H Q12H Q12H Q12H 30 mg/kg/day Q6H 厭氧菌(腸穿孔)
Chloramphenicol 1 g/Vial 25 mg/kg/dose Q24H Q24H Q24H Q12H 50~75 mg/kg/day Q6H 腦膜炎100mg/kg/day Q6H

★本表格主要參考 LEXI-COMP: Pediatric Dosage Handbook. 13ed. 少數藥品的劑量與 《Avery新生兒科教科書》、《熱病》存在些微差異。

★請看清楚 mg/kg/dose 與 mg/kg/day 不同，mg/kg/dose 對於新生兒劑量計算方便，也可節省版面空間，而 mg/kg/day 是病歷寫作比較好的表達方法。
★注意「成人一般劑量」與「成人最大用量」，未列在這個表格裡，兒童最大劑量不等於成人劑量。若有需要，請另行查閱藥典。
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