星期三, 4月 30, 2014
14 Tips I Wished I Knew In High School, But Hey, It is Not Too Late Now!!
1. Start saving for retirement
2. Take care of your body now!
3. Learn to manage and balance your time. Do not put things off for later
4. Figure out who you really are and become independent early
5. Travel as much as you can, remember that a larger world exists beyond your doorstep. Do not buckled down!
6. Pursue passion, not money
7. Ignore the voice that tells you to give up
8. Accept your mistakes and learn from them
9. You cannot have everything. Focus on doing one or two things very well
10. Overcome complacence! You must continue to grow and develop yourself
11. Nobody knows what they are doing or if they are doing the right thing. Take risks! 不要當乖乖牌!!!
12. Get as much education as possible, be it in the classroom or not
13. Do not spend time with people who do not treat you well, and be good to the people you care about. Invest in Your Family, do not wait until it is too late!
14. Put down your smartphone. Save some time to think for yourself
星期六, 3月 22, 2014
Extracorporeal Membrane Oxygenation (ECMO) Current Use and Evolving Applications
Introduction
1. Extracorporeal membrane oxygenation (ECMO) is increasingly being used for severe forms of respiratory failure.
2. Indications of ECMO have expanded beyond acute respiratory distress syndrome (ARDS) to include bridging therapy for pulmonary hypertensive crises, lung transplantations, and refractory hypoxemic/hypercarbic respiratory failure
Principles and Circuitry
1. Extracorporeal membrane oxygenation (ECMO) is increasingly being used for severe forms of respiratory failure.
2. Indications of ECMO have expanded beyond acute respiratory distress syndrome (ARDS) to include bridging therapy for pulmonary hypertensive crises, lung transplantations, and refractory hypoxemic/hypercarbic respiratory failure
Principles and Circuitry
N
Engl J Med 2011; 365:1905-1914
星期五, 3月 07, 2014
Daily Fluids and Nutrition
Fluid Management
1. Total body water (TBW): 60% of lean body weight in men, 50% in women
A. 2/3 Intracellular fluid (ICF), 1/3 Extracellular fluid (ECF)
B. TBW: 0.6 x W = X
C. Intravascular compartment: 1/4 x ECF = Y
D. Interstitial compartment: 3/4 x ECF = Z
2. Disturbances in TBW change serum osmalality and electrolyte concentrations. Majority of water contained in intracellular space, the loss of water alone does not typically result in hemodynamic changes.
3. Total body Na+: 85~90% of total body Na+ is extracellular, and constitutes predominate solute in ECF. Changes lead to contraction or expansion of ECF, manifests as volume depletion or expansion.
4. Maintenance fluids:
A. Minimum water requirements for daily fluid balance = U/O + Stool water loss + insensible losses + drain losses
a. Minimum urine output necessary = solute per day/(maximum amount of solute that can be excreted/L urine)
1) ~600 - 800 mOsm/d / 1, 200 mOsm/L in healthy kidneys = > 0.5 L/d
b. Water loss in stool ~ 200 mL/d
c. Insensible water losses:
1) Skin + respiratory tract: ~400 - 500 mL/d
2) Endogenous metabolism: ~250 - 350 mL/d
B. Total: 1400 mL/d or 60 mL/hr
C. 75 - 175 mEq Na+/d (2 g Na+ diet gives 86 mEq Na+/d)
a. 0.9%: 154 mEq/L
b. 0.45% 77 mEq/L
D. 20 - 60 mEq K+/d for normal renal function
E. 100 - 150 g/d dextrose given to minimize protein catabolism and prevent starvation keotacidosis
a. D5W 50 g dextrose/L
1. Total body water (TBW): 60% of lean body weight in men, 50% in women
A. 2/3 Intracellular fluid (ICF), 1/3 Extracellular fluid (ECF)
B. TBW: 0.6 x W = X
C. Intravascular compartment: 1/4 x ECF = Y
D. Interstitial compartment: 3/4 x ECF = Z
2. Disturbances in TBW change serum osmalality and electrolyte concentrations. Majority of water contained in intracellular space, the loss of water alone does not typically result in hemodynamic changes.
3. Total body Na+: 85~90% of total body Na+ is extracellular, and constitutes predominate solute in ECF. Changes lead to contraction or expansion of ECF, manifests as volume depletion or expansion.
4. Maintenance fluids:
A. Minimum water requirements for daily fluid balance = U/O + Stool water loss + insensible losses + drain losses
a. Minimum urine output necessary = solute per day/(maximum amount of solute that can be excreted/L urine)
1) ~600 - 800 mOsm/d / 1, 200 mOsm/L in healthy kidneys = > 0.5 L/d
b. Water loss in stool ~ 200 mL/d
c. Insensible water losses:
1) Skin + respiratory tract: ~400 - 500 mL/d
2) Endogenous metabolism: ~250 - 350 mL/d
B. Total: 1400 mL/d or 60 mL/hr
C. 75 - 175 mEq Na+/d (2 g Na+ diet gives 86 mEq Na+/d)
a. 0.9%: 154 mEq/L
b. 0.45% 77 mEq/L
D. 20 - 60 mEq K+/d for normal renal function
E. 100 - 150 g/d dextrose given to minimize protein catabolism and prevent starvation keotacidosis
a. D5W 50 g dextrose/L
星期六, 3月 01, 2014
[Taipei 台北] 忠孝復興 Caldo Cafe 咖朵咖啡 舒芙蕾 抹茶熔岩蛋糕 Soufflé and Matcha Green Tea Molten Lava Cake
Classic Soufflé with Caramel sauce and Mango Sorbet
Caldo Cafe 咖朵咖啡
Address: 台北市大安區復興南路一段107巷5弄2號 (忠孝復興站)
Phone: (02) 2731 8023
Website: https://www.facebook.com/caldocafe
Date: 2014/2/23 11:00 AM
Price: 680 NT + 10% = 748 NT
Father and Son Bonding Time
Dad has been very busy lately so I thought I would take him to a restful environment for him to relax for a bit。Caldo Cafe came to mind, because of the big popularity online。Plus, several colleagues have gone and highly recommend their coffee，souffle and molten lava cake。Once dad informed me that he was coming to Taipei to visit me，I immediately made the reservation。This place will be packed in the afternoon，and there are no time restraints on weekdays，so make sure you make the reservation early，like a couple of days before。
星期四, 2月 20, 2014
Neonates - General
1. Nutrition
A. 110 ~115 kcal/kg/day，growth rate: 30 g/day
B. Newborns usu. begin feeding within 6 hrs of life
C. Breastfed or formula fed Q3H~Q4H thereafter
a. The more often baby sucks on the nipple, the more milk will be produced.
D. If the child stops losing weight by 5 ~7 days, and begins to gain by 12 ~14 days, then feeding is okay.
E. No juice or water before 6 months
F. Solid food should be introduced btw 4-6 months。New foods needs to be introduced individually and a week apart to identify allergies and intolerance.
a. Bland to sweetest: Veggies --> green to orange --> fruits
b. Ready for solid foods?
1) Hand-to-mouth coordination
2) ↓ tongue protrusion reflex
3) Sits with support
4) Improved head control
5) Drooling
6) Opens mouth to spoon
A. < 6 wet diapers/day after age 1 wk，1 diaper/day for 1st wk
B. Continual hunger and crying
C. Continually sleepy and lethargic baby
D. <7 feeds/day
E. Long intervals btw feedings
F. Sleeping through the night w/o feeding
G. >10% wt loss
H. Increasing jaundice
A. 110 ~115 kcal/kg/day，growth rate: 30 g/day
B. Newborns usu. begin feeding within 6 hrs of life
C. Breastfed or formula fed Q3H~Q4H thereafter
a. The more often baby sucks on the nipple, the more milk will be produced.
D. If the child stops losing weight by 5 ~7 days, and begins to gain by 12 ~14 days, then feeding is okay.
E. No juice or water before 6 months
F. Solid food should be introduced btw 4-6 months。New foods needs to be introduced individually and a week apart to identify allergies and intolerance.
a. Bland to sweetest: Veggies --> green to orange --> fruits
b. Ready for solid foods?
1) Hand-to-mouth coordination
2) ↓ tongue protrusion reflex
3) Sits with support
4) Improved head control
5) Drooling
6) Opens mouth to spoon
A. < 6 wet diapers/day after age 1 wk，1 diaper/day for 1st wk
B. Continual hunger and crying
C. Continually sleepy and lethargic baby
D. <7 feeds/day
E. Long intervals btw feedings
F. Sleeping through the night w/o feeding
G. >10% wt loss
H. Increasing jaundice
星期三, 2月 19, 2014
[Taipei 台北] 忠孝敦化 PS TAPAS 西班牙餐酒館 香脆培根菠菜雞肉捲佐雪莉酒小紅莓醬 甜蜜熔岩巧克力蛋糕
PS Tapas 西班牙餐酒館
Address: 台北市大安區安和路一段21巷19號 (忠孝敦化站)
Phone:(02) 2740-3636
Website: https://www.facebook.com/PSTapas
Date: 2014/2/14 6:30 PM
Price: 1364 NT (including 10%)
Valentine's Day Special
How long does it take for both Valentine's AND the Lantern Festival (元宵節) to be on the SAME day? The answer is, 19 years!
Therefore for this rare holiday, I planned ahead and scheduled myself to be free for the night。After handing over the shift, I was set to embark on a culinary journey with Eunice to explore Spanish cuisine。Eunice hasn't had many chances to try Spanish food。She had only gone to La Paella once in Gongguan, which I thought was decent，but there are definitely better restaurants out there。Plus, I haven't had Tapas for a long while now, the last time was at the Tapeo Restaurant & Tapas Bar in Boston more than a year ago。There is room for improvement, but the $5 Tapas menu at Tapeo was cheaper compared to many other places。I decided to give it a try in Taiwan, and wanted to book MVSA Spanish Restaurant & Bar，but it was fully booked。So I went online to search for another。PS Tapas is highly recommended by Eztable and many bloggers，so I chose this restaurant for this very special night。
星期二, 2月 18, 2014
Peds - Acute Tummyache Differentials and Workup!
When should you call your senior, if there is one..
Acute Abdominal Pain by Age
Common to Uncommon
Acute Abdomen
1. Trauma
A. Motor vehicle collisions, falls, child abuse
2. Appendicitis
A. Most predictive: RLQ pain, abd. wall rigidity, and migration of periumbilical pain to the RLQ
B. Pediatric Appendicitis Score (PAS)
1. For 1-17 y/o, total 10 pts
2. Point System:
a. 2 pts: cough/percussion/hopping tenderness; RLQ tenderness;
b. 1 point: fever > 38° C, anorexia, N/V, migration of pain, WBC >10 000 cells/mm3 , and PMN >7500 cells/mm3
3. Score
PAS≧ 7: dx of appendicitis
PAS 3-6: Need image studies
PAS≦ 2: exclusion
(Reference: Journal of Pediatrics 153.2 (2008): 278-282)
C. Perforation rarely occurs within the first 24 hrs
3. Intussusception
A. 2 months - 2 yrs, peak at 6 months
B. Triad (<15%):
1. Intermittent, colicky pain (88%)
2. Palpable sausage-shaped abd. mass (48%)
3. Currant-jelly stool (25%)
Others: Inconsolable crying, drawing legs towards abd., bilious emesis. 15-20 min intervals. Progressive
C. Dx: Ultrasound
1. Target sign/coiled spring sign
2. Most common: ileocolic (95%)
D. Tx:
1. Hydrostatic (ex. Barium) /pneumatic enema under Ultrasound guidance <48 hrs of onset
2. Surgery (esp. small bowel)
4. Malrotation with midgut volvulus
1. S/S: Bilious/Non-bilious vomiting + abd. pain
5. Incarcerated inguinal hernia
1. S/S: irritable and crying, vomiting, abdominal distention, palpation of a firm inguinal mass that may extend to scrotum/labia majora in the groin
6. Adhesions with intestinal obstruction
1. Hx of abd. surgery + abd. pain
7. Necrotizing enterocolitis
1. S/S: vomiting, abd. distention, and tenderness
2. Prematurity, congenital heart diseases more common
8. Peptic ulcer disease
1. >10 yrs: Meds (ex. NSAIDs)/Stress
2. H.pylori less common
9. Ectopic pregnancy
1. Postmenarchal girls
2. S/S: abd. pain, amenorrhea, vaginal bleeding
Acute Abdominal Pain by Age
Common to Uncommon
| Age | Neonate | 2 m- 2yrs | 2 m - 5 yrs | >5 yrs |
| ER | Volvulus | Trauma | Trauma | Appendicitis |
| NEC | Incarcerated hernia | Appendicitis | Trauma | |
| Adhesions | Intussusception | Intussusception | DKA | |
| Foreign body ingestion | Foreign body ingestion | PPU | ||
| Hirschsprung disease | Adhesions | Adhesions | ||
| Adhesions | HUS | HUS | ||
| HUS | Primary bacterial peritonitis | Myocarditis/pericarditis | ||
| Primary bacterial peritonitis | ||||
| Common/ER | Colic | AGE | AGE | AGE |
| Viral illness | Viral illness | Viral illness | ||
| Pharyngitis | Constipation | |||
| Constipation | Pharyngitis |
Acute Abdomen
1. Trauma
A. Motor vehicle collisions, falls, child abuse
2. Appendicitis
A. Most predictive: RLQ pain, abd. wall rigidity, and migration of periumbilical pain to the RLQ
B. Pediatric Appendicitis Score (PAS)
1. For 1-17 y/o, total 10 pts
2. Point System:
a. 2 pts: cough/percussion/hopping tenderness; RLQ tenderness;
b. 1 point: fever > 38° C, anorexia, N/V, migration of pain, WBC >10 000 cells/mm3 , and PMN >7500 cells/mm3
3. Score
PAS≧ 7: dx of appendicitis
PAS 3-6: Need image studies
PAS≦ 2: exclusion
(Reference: Journal of Pediatrics 153.2 (2008): 278-282)
C. Perforation rarely occurs within the first 24 hrs
3. Intussusception
A. 2 months - 2 yrs, peak at 6 months
B. Triad (<15%):
1. Intermittent, colicky pain (88%)
2. Palpable sausage-shaped abd. mass (48%)
3. Currant-jelly stool (25%)
Others: Inconsolable crying, drawing legs towards abd., bilious emesis. 15-20 min intervals. Progressive
C. Dx: Ultrasound
1. Target sign/coiled spring sign
2. Most common: ileocolic (95%)
D. Tx:
1. Hydrostatic (ex. Barium) /pneumatic enema under Ultrasound guidance <48 hrs of onset
2. Surgery (esp. small bowel)
4. Malrotation with midgut volvulus
1. S/S: Bilious/Non-bilious vomiting + abd. pain
5. Incarcerated inguinal hernia
1. S/S: irritable and crying, vomiting, abdominal distention, palpation of a firm inguinal mass that may extend to scrotum/labia majora in the groin
6. Adhesions with intestinal obstruction
1. Hx of abd. surgery + abd. pain
7. Necrotizing enterocolitis
1. S/S: vomiting, abd. distention, and tenderness
2. Prematurity, congenital heart diseases more common
8. Peptic ulcer disease
1. >10 yrs: Meds (ex. NSAIDs)/Stress
2. H.pylori less common
9. Ectopic pregnancy
1. Postmenarchal girls
2. S/S: abd. pain, amenorrhea, vaginal bleeding
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