再分享一个intern care 的阿公
Tongue ca s/p op and CCRT, regular OPD followup , no evidence of recurrence
Just discharge from NTUH
- general weakness, dizziness, extremities tremor...etc.
nonspecific complaint
- Treat as electrolyte imbalance (hypokalemia), then discharge
at home , still progressive general weakness, delirium and poor oral intake
Admission again.
住院后是intern care的
因为delirium第一个照会的是精神科, 精神科跟他说应该workup 内科的问题
接着做了brian CT以及MRI, thyroid function ...etc.
有怀疑过stroke可是没照会过neurologist
接着就是阿公悲惨命运
delirium没找出原因,但R1值班时有抽过ABG,CO2 retension,戴过BiPAP,洗一洗就好了
后来stridor跑出来,consult ENT: Bilateral vocord palsy,suggest elective
tracheostomy(可惜阿公住在general ward,没做什么处理,不气切也要带着BiPAP睡啊)
直到有一天(两天后), CO2 retension >100 , hypercapnic respiratory failure
acidosis and hypotension(no fever but hypotehrmia, leukocytosis+band),
consciousness loss, dehydration