This was an advanced male(87-year-old)with refractory chronic eczema for over 40 years,based on his allergic constitution,accompanied with chronic kidney disease due to primary hypertension(CKD,phase 3).It was so diff...This was an advanced male(87-year-old)with refractory chronic eczema for over 40 years,based on his allergic constitution,accompanied with chronic kidney disease due to primary hypertension(CKD,phase 3).It was so difficult to tolerate the severe itching that the glucocorticoids(GC)had to be applied to it,but some new-onset respiratory symptoms,such as cough,dyspnea after exertion etc.,occurred to this patient.Some classical IPA images were found on his pulmonary CT scanning,which were further comfirmed by the positive findings of GM-test,and then a final diagnosis of IPA was accordingly established.Unfortunately,a persistent fever emerged after starting an antifungal therapy to the patient,and his IL-2 level was detected to be superhigh.As a response to allergic fever,GC was carefully given intravenously again to treat it,and it turned out to be totally improved since then;suggesting that systemic thinking(integrated with the other clinical evidences)is essential to diagnose IPA,and GC can also be used to improve its symptoms with the existence of antifungal therapy.展开更多
What methods would you choose apart from increasing sedatives for agitation in an advanced patient with hypercapnic encephalopathy due to AECOPD?This is a 94-year-old female who suffered from COPD for over 30 years,oc...What methods would you choose apart from increasing sedatives for agitation in an advanced patient with hypercapnic encephalopathy due to AECOPD?This is a 94-year-old female who suffered from COPD for over 30 years,occurred with an accelerated episode of cough,productive sputum and a dropping down to 86%in SatO₂due to a cold weather.A diagnosis of pulmonary encephalopathy(PE)was made on the basis of the subsequent agitation and delirium,and the sedatives,such as quatiepine and haloperidol,had to be given for her mental excitation respectively,but she still pulled out indwelling needle herself and refused to any infusion therapy.As an alternative,a vaporized therapy integrated with tea herb drinking had to be applied to relieving her agitation,being designed as the vaporization of the inhaled oxygenation by means of high-flow oxygenation device(HFOD),with an ampoule of ambroxol mixed into the inhaler and simultaneous drinking of TCM tea herb for reducing sputum,helping dissolve the mucoid bolts inside her terminal bronchioles when being infected.We thought that a better efficacy would be achieved for hypercapnic encephalopathy due to AECOPD if we concentrate on a good ventilation of small airway through the vaporized therapy.展开更多
文摘This was an advanced male(87-year-old)with refractory chronic eczema for over 40 years,based on his allergic constitution,accompanied with chronic kidney disease due to primary hypertension(CKD,phase 3).It was so difficult to tolerate the severe itching that the glucocorticoids(GC)had to be applied to it,but some new-onset respiratory symptoms,such as cough,dyspnea after exertion etc.,occurred to this patient.Some classical IPA images were found on his pulmonary CT scanning,which were further comfirmed by the positive findings of GM-test,and then a final diagnosis of IPA was accordingly established.Unfortunately,a persistent fever emerged after starting an antifungal therapy to the patient,and his IL-2 level was detected to be superhigh.As a response to allergic fever,GC was carefully given intravenously again to treat it,and it turned out to be totally improved since then;suggesting that systemic thinking(integrated with the other clinical evidences)is essential to diagnose IPA,and GC can also be used to improve its symptoms with the existence of antifungal therapy.
文摘What methods would you choose apart from increasing sedatives for agitation in an advanced patient with hypercapnic encephalopathy due to AECOPD?This is a 94-year-old female who suffered from COPD for over 30 years,occurred with an accelerated episode of cough,productive sputum and a dropping down to 86%in SatO₂due to a cold weather.A diagnosis of pulmonary encephalopathy(PE)was made on the basis of the subsequent agitation and delirium,and the sedatives,such as quatiepine and haloperidol,had to be given for her mental excitation respectively,but she still pulled out indwelling needle herself and refused to any infusion therapy.As an alternative,a vaporized therapy integrated with tea herb drinking had to be applied to relieving her agitation,being designed as the vaporization of the inhaled oxygenation by means of high-flow oxygenation device(HFOD),with an ampoule of ambroxol mixed into the inhaler and simultaneous drinking of TCM tea herb for reducing sputum,helping dissolve the mucoid bolts inside her terminal bronchioles when being infected.We thought that a better efficacy would be achieved for hypercapnic encephalopathy due to AECOPD if we concentrate on a good ventilation of small airway through the vaporized therapy.
