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張先生 (主訴 (咳血(量多) (Broncho PN, TB, Acute bronchitis, Lung CA,…
張先生
主訴
咳血(量多)
Broncho PN
TB
Acute bronchitis
Lung CA
Bronchiectasis
胃不適
喘
喉嚨痛
感冒
過去用藥？
Infection cause?
AE?
黃綠色痰
Congenital disease (gene)?
Immune compromise?
食慾、活動降低
PE
CXR
Bilateral infiltration
無會厭腫大
呼吸音：crackle, rales
輔助肌使用
聲音沙啞
Vital sign
HR: 98
RR: 24
BP: 118/80
BT: 37.2
Conscious clear
精神疲憊
基本資料
43 yr
51 kg, 171 cm, BMI 17.4
過去病史
支氣管擴張症
國中即被診斷
咳血
上次咳血：當兵時
旅遊史：無
動物接觸史：無
Bronchiectasis
Clinical symptoms
Dry cough (少)
Chronic cough
Much sputum (臭)
Mild hemoptysis (frequently)
Dyspnea (variable)
Mild fever
Chest tightness
BW loss
Diagnosis
CXR
Airway dilation
Multiple cyst
CT (gold standard)
Cylindrical: signet-ring sign
Varicose: tram track
Cystic
Types
Cylindrical
Varicose
Cystic
Medicine
BD
for control symptoms
Macrobid antibiotic
Erythromycin P.O.一直用
Steroid
非routine, immune disease
Hemoptysis
Hemoptysis vs. Hematamesis
Nausea & vomiting: X/O
Disease: lung/GI or hepatic
Asphyxia: O/X
Frothy/rarely frothy
Appearance: liquid/coffee ground
Color: bright red or pink/brown to black
pH: alkaline/acidic
Mixed with: macrophage or neutrophil/food particles
Diagnosis
Past history
Blood
Duration
Frequency
Amount
Bloody sputum
Accompanying symptoms
Image examination
CXR
CT
3D reconstruction
Laboratory tests
Bronchial fiber endoscopy
Massive hemoptysis: > 300ml/24hrs