再分享一個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.
住院後是intern care的
因為delirium第一個照會的是精神科, 精神科跟他說應該workup 內科的問題
接著做了brian CT以及MRI, thyroid function ...etc.
有懷疑過stroke可是沒照會過neurologist
接著就是阿公悲慘命運
delirium沒找出原因,但R1值班時有抽過ABG,CO2 retension,戴過BiPAP,洗一洗就好了
後來stridor跑出來,consult ENT: Bilateral vocord palsy,suggest elective
tracheostomy(可惜阿公住在general ward,沒做什麼處理,不氣切也要帶著BiPAP睡啊)
直到有一天(兩天後), CO2 retension >100 , hypercapnic respiratory failure
acidosis and hypotension(no fever but hypotehrmia, leukocytosis+band),
consciousness loss, dehydration