加護病房查房日誌20191129
請問各位同學病人腦部外傷(TBI)後,會不會使用抗癲癇藥物來預防seizure?
基本上呢,早期創傷後seizure大概有30%的病人會在第一或兩周TBI後出現。此外若用持續監測electroencephalography (EEG),約有15-25%的病人會伴隨昏迷但沒有癲癇的發作,但可從EEG上看出來腦部有放電。基本上有些專家學者,在EEG的seizures,但是臨床上沒有症狀還是會持續給抗seizure的藥品。
預防早期的seizure,可以預防之後變成status epilepticus的風險,而且反覆的seizure發作還會增加CBF和ICP等併發症。
過往老師在SI的時候,就常看到用phenytoin 100 mg q8h IV。
在文獻部份,在Neurology 2003 Jan 14;60(1):10-6.得文獻指出,使用phenytoin 預防TBI病人的seizure風險可降到 0.37, 95% CI: 0.18-0.74。
的確,目前2017年的準則,Guidelines for the Management of Severe Traumatic Brain Injury, Fourth Edition.Carney N, Totten AM, O'Reilly C, Ullman JS, Hawryluk GW, Bell MJ, Bratton SL, Chesnut R, Harris OA, Kissoon N, Rubiano AM, Shutter L, Tasker RC, Vavilala MS, Wilberger J, Wright DW, Ghajar J Neurosurgery. 2017;80(1):6. ,建議腦部外傷後的前七天要使用phenytoin預防早發性創傷後癲癇,但有些學者是建議用levetiracetam,源自於Prospective, randomized, single-blinded comparative trial of intravenous levetiracetam versus phenytoin for seizure prophylaxis. Szaflarski JP, Sangha KS, Lindsell CJ, Shutter LA Neurocrit Care. 2010;12(2):165. 。
此外在某些研究中發現,phenytoin的累積劑量較高,較高的副作用發生率,還有長期認知異常的情況,而且在隨機對照研究中,指出levetiracetam和phenytoin用於NICU的病人,預防癲癇發生的效果相當。
老師想要問問看大家,現在是用phenytoin比較多呢?還是levetiracetam預防TBI後的seizure呢?
同時也有1部Youtube影片,追蹤數超過9,470的網紅Dominic Chin,也在其Youtube影片中提到,"clse2u (reimagined)” by Dominic Chin & Jean Seizure is out now on all streaming platforms! https://backl.ink/146973506 Dear Jean, Thank you for si...
seizure management 在 Nourul Wahab Depp Facebook 的精選貼文
Good morning and assalamualaikum...
I'm the next Bruce Lee! 😛😂 and he wake up like this! Hahaha
Hiyah...hiyah... katanya stability tendang tendang 😂😂😂
Oh demam nak boleh kung-fu rupanya 😂😂
1st fever in 2 years and he made us worried last night when he had a seizure. Papy @rolanddepp put his finger in Raphael's mouth and bit to bleed. No play play. When your kids kena tarik/sawan, please don't put finger in their mouth. Get a spoon or something metal to bite on.
Alhamdulillah so happy to see he wakes up happy after a shocking experience yesterday.
Thank you to #regencytower management for helping my parents in law when this happen. (We were 5min away from home)
Thanks to @princecourt medical center for the fantastic work on Raphael.
#raphaeldepp is okay now. His blood results are all good. #alhamdulillah
#yestowellness #deppfamily #thedepps #loveofmylife #herbalifebaby #herbalifefamily #herbalifekid #herbalifenutrition #littledepp
This kid has been giving all good nutritions. But still fall sick. Be careful of our surrounding... other may be contaminated food, air pollution and also water. Most important is nutrition. I cannot imagine to kids who are not well feed with good nutrition. Think and act now.
seizure management 在 Dominic Chin Youtube 的精選貼文
"clse2u (reimagined)” by Dominic Chin & Jean Seizure is out now on all streaming platforms!
https://backl.ink/146973506
Dear Jean,
Thank you for singing this beautiful song with me. This song was birthed out of a pure heartbreak in 2018, not only grieving a sudden loss of a loved one, I also experienced my first heartbreak. Even though things are just bleak (or worse) for me 2021, I'm just glad that my heart is not aching alone, and I'm sharing this moment with you too :') Love you always.
Dominic's Social Media:
Facebook: https://www.facebook.com/dominicchin.music
YouTube: youtube.com/dominicchin.music
Instagram: instagram.com/dominicchin.music
Jean's Social Media
Facebook: https://www.facebook.com/jeanseizure/
YouTube: https://www.youtube.com/c/JeanSeizure/
Instagram: https://www.instagram.com/jeanseizure/
Credits:
Art direction, photography & videography by FRAME THE FOLKS
Campaign planning, management, digital art & video post production by This Projective
Studio & equipment rental by JustRentLah
Fashion styling by Gabby G
Special thanks to Samson Sim & Mikelle Chin
Written by Dominic Chin
Performed by Dominic Chin, Jean Seizure
Produced by Edwin Wong, Nicholas Zach
Strings by Prisca Ho
Drums by Low Han Quan
Piano by Lee Ann Gie
Mixed by Evan Tan
Mastered by Adam Shah
Distributed by Umami Records
seizure management 在 A Guide to Seizure Management for Emergency Medical ... 的美食出口停車場
As an EMS responder, chances are you'll encounter a person either experiencing a seizure or just recovering from one. ... <看更多>