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1、臨床病理討論會小兒科：盧俊維醫師放射科：吳金珠醫師 病理科：蕭正祥醫師A10y/ogirlChiefcomplaint:Chestdiscomfort,vomitinganddrycoughforonedayBriefHistoryGrowth&development:Weight:22kg(3rd-10thpercentile)Height:130cm(25-50thpercentile)Developmentmilestone:withinnormallimitPasthistoryHand-foot-mouthdiseasein1998Frequ
2、entURIandfeverduringchildhoodNodrugorfoodallergyBriefHistoryFamilyhistory:HersisterhadfeverandURIrecently.PresentIllnessFeverandbilateralhandarthralgiaattackonce1monthagoChestdiscomfortandcoughsince9/11afternoon,2001VisitLMDandURIwastoldVomitingandchesttightnesson9/120AMand5AMPr
3、esentIllness9/12morning,visitLMDagain,ECGshowedarrhythmiaReferto亞東hospitalPresentIllnessFindingsat亞東hospitalClearconsciousness,ill-looking,pallorappearance,nocyanosisIrregularheartbeatEKG:VPCbigeminyPresentIllnessLab.findingsat亞東hospitalWBC9000/mm3,Hb13.5g/dlBUN11mg/dl,Cre0.6mg/
4、dlGOT25U/L,CK665U/L,CK-MB175U/LPresentIllnessEchocardiogramat亞東hospitalMultiplesmallVSDs,musculartrabeculartype,atapexLVdyskinesia,LVEF60-70%MildTR,mildMRPresentIllnessManagementat亞東hospitalLidocaineivdripDopamine10mg/kg/minRefertoNTUH(2pm)PhysicalExaminationPhysicalfindingsatNT
5、UHConsciousness:lethargic,acuteill-lookingT/P/R:37/140/25BP80/46SaO297%HEENT:paleconjunctivaanictericscleramildcyanoticlipPhysicalExaminationNeck:jugularvenousengorgementChest:bilateralbasalrälesHeart:irregularlyirregularbeats,distantheartsoundnomurmurPhysicalExaminationAbdomen:
6、nohepatomegalyhypoactivebowelsoundExtremities:freelymovablecoldandcyanoticpoorcapillaryrefillingInitialLabDataCBC:WBCHbHctPlt884012.737.2%160KSeg82.4%,Lym13.8%,Eos0.1%BCS:BUNCreNaKClCa12.80.631414.51042.41InitialLabDataVBG:pHpCO2pO2HCO3BE7.3647.427.326.9+1.4Cardiacenzyme:CPK(U/L
7、)CK-MBTroponinI(ng/ml)1040196.531.9CRP:0.53mg/dlInitialLabDataEKG(9/12):InitialLabDataEKG(9/12):InitialLabDataEKG(9/12):InitialLabDataEchocardiogram(9/12):LVenlargementLVEF45%MuscularVSDMildMR,TR,PREchocardiogram(9/12)CourseandTreatmentManagementForcardiogenicshock:Dopamine,Dobu
8、tamin,Primacor,LasixForventriculararrhythmia:Am
