【整理】

• 好好整理給別人的東西，不僅容易收藏，也是給別人好印象。
• 好好整理別人給自己的東西，更是重溫與收藏別人對自己的期待，以及對人生的記憶與規 劃。懂得整理，才能安心、才有自信，也才能在人生中大步往前行。
• 整理周遭事物，等於整理心思，又等於整理生涯規劃。因為能掌握周邊訊息，會很有自信。對要走的路，就很安心、沒什麼好顧慮，因為沒有牽絆。
• 整理時，「in & out」都要注意。
• 留下有記憶點的東西 (戴勝益)

[ER]電焊把眼睛灼傷

        電焊把眼睛灼傷了，老流淚，疼的晚上睡不著，出現這個情況，叫做“急性電光性眼炎”，也就是急性結膜炎。因為非常難受，所以除了應該多閉眼休息外，可以用冷毛巾對眼睛進行冷敷，還應該帶墨鏡進行“避光”措施。

         Ultraviolet (UV) light corneal burn

 (1) 原因：注視電焊弧光 (welder’s arc) 或紫外線照射時間過長，造成角膜上皮之傷害。

 (2) 症狀及徵候：通常發生在暴露後6至12小時，眼睛產生疼痛、異物感、流淚、畏光及紅 眼，以fluorescein染色可見角膜點狀之螢光染色，使用局部麻藥會使症狀顯著緩解。

 (3) 處理與治療：

        􀂅 erythromycin ointment & cycloplegic drop with pressure patch 24小時 (若為雙眼，則patch較嚴重的一眼)

        􀂅 眼藥:

若症狀較不嚴重者可給予artificial tears qid

抗生素藥膏 ( gentamicin oint x 1 TB bid-tid)

Cycloplegic drop 

􀂅 口服藥物：(pain relief)

Scanol 1# qid or Voren 1# tid x 2 Days

􀂅 切記不可將麻藥讓病患帶回家使用

􀂅 隔日宜再至門診複查

新竹→草屯 134K單車之旅

老早想從新竹騎回南投了，上估狗map查了路線，預計是138K的路程，心想"應該不是很難吧"!?



2009.2.8 10:23AM
整裝完畢，從宿舍出發

10:24AM

宿舍門口出發前全裝備照

11:31AM

照相裝備為SonyT50，輕便短小的DC此時比大台的單眼好用多多

這裡是在西濱公路南下經過竹南交流道不遠處的竹南寶玄大橋上休息

此為苗栗竹南焚化爐

11:56AM

平日沿西濱公路騎車比想像中舒服多了，一來車少，二來從多半是和汽車分道竹南往下騎經過後龍觀海大橋不久，在西湖溪出海口有成群的大風車，剛好鐵道經過風車群附近，向來是許多玩家拍風車的據點

12:20PM
白沙屯7-11補給一下，順便蓋一下微笑台灣319鄉的章

13:24PM

不過在進通霄鎮前，前輪刺進鐵釘，只好就地換起內胎還好前一天有先去購買內胎，一切都在計畫中 :)

14:19PM

直接殺到高美濕地拍拍照囉，和假日的人滿為患相比，只有一個人的海邊反而感覺良好。不過天候不佳，無法看到經典的高美濕地夕陽 。下次再來 !

14:43PM

抵達西濱公路和中棲路口的台中港地標

15:48PM

抵達大肚鄉的追分車站。

話說回來，追分其實是日文「分岐路」的意思，早期縱貫線（海線）行至追分這裡之後路線開始分歧，其中一邊繼續沿海岸線通往彰化，另一邊則經成追線通往山線之成功車站。

內專考試前，應該來此購買[追分-成功]車票乙張，以求保佑。 : )

16:02AM

經過大肚溪橋抵達台一線往彰化市的其中一個入口「金馬路」，這是台1線的支線台1丙為彰化市外環道。純粹喜歡這個路名!

16:43PM

抵達芬草路進入下茄荖處的「我愛南投縣」石碑。

然後，再騎幾分鐘就到家啦 : )

總騎乘時間約為5小時多，平均時速26KM/HR，總里程134KM。

休息、拍照、吃喝、補胎時間約1小時多。

總花費約200元。

心裡的充實感，無價!!

Keane基音樂團_Crystal Ball

★
Who is the man I see
Where I'm supposed to be?
I lost my heart, I buried it too deep
Under the iron sea
Oh, crystal ball, crystal ball
Save us all, tell me life is beautiful
Mirror, mirror on the wall

★
Lines ever more unclear
I'm not sure I'm even here
The more I look the more I think that I'm
Starting to disappear
Oh, crystal ball, crystal ball
Save us all, tell me life is beautiful
Mirror, mirror on the wall
Oh, crystal ball, hear my song
I'm fading out, everything I know is wrong
So put me where I belong

★
I don't where I am
And I don't really care
I look myself in eye
There's no one there
I fall upon the earth
I call upon the air
But all I get is the same old vacant stare
Oh, crystal ball, crystal ball
Save us all, tell me life is beautiful
Mirror, mirror on the wall

★
Oh, crystal ball, hear my song
I'm fading out, everything I know is wrong
So put me where I belong

Foamy urine/bubbly urine 泡泡尿

隨著主治醫師查房時，主治醫師詢問病患：泡泡尿的情況有沒有改善呀？該病患為腎病症候群患者因嚴重水腫住院。不禁發愣了一下，我也經常會有尿中帶泡泡的情形呀，該不會有腎臟病吧？不是之前尿液檢查都正常嗎？不過話說回來，住院醫師都當兩三年了，這樣的"小"問題還不求甚解，似乎有點丟臉 :P

老樣子，Google it!

KingNet國家網路醫院
http://hospital.kingnet.com.tw/essay/essay.html?pid=8325&category=%E9%81%93%E8%81%BD%E4%B8%8D%E5%A1%97%E8%AA%AA

高雄榮民總醫院教研部醫學研究科主任　林興中醫師：
正常人每天會排出30 毫克以下的白蛋白，只要不超過30 mg即不要緊，這些蛋白經細菌分解而產生氣體，導致氣泡的出現，時間愈久，產生的氣泡愈多，故早上醒來的第一泡尿氣泡較多。
三軍總醫院內科部腎臟科主治醫師　林石化醫師：
沒有身體症狀的泡泡尿，多半是沒有腎疾病的。大多與飲食有關，例如尿液偏鹼性時，易起泡，為了確認有無問題，應看醫師做檢查。

→果然林石化教授所言字字珠璣，之前閱讀其著作和論文都有很大的收穫。[沒有身體症狀的泡泡尿，多半是沒有腎疾病的]→聽完這句話安心不少。


Foamy urine: What does it mean?
http://www.mayoclinic.com/health/foamy-urine/AN01702

Foamy urine is likely nothing to worry about if it happens only occasionally and isn't getting progressively more noticeable. It may just mean that you urinated rapidly, maybe with more concentrated urine — such as due to mild dehydration. You could drink more water to see if it goes away.
However, persistently foamy urine can be a sign of protein in your urine (proteinuria), which requires further evaluation. Large amounts of protein in urine may indicate a serious kidney problem.
If you're concerned about foamy urine, consult your doctor. He or she may recommend a urine analysis, which can detect protein in urine. If protein is detected in your urine, your doctor likely will recommend additional tests to determine the cause.

Answer by Mayo Clinic urologist Erik Castle, M.D.

→尿尿太"大港"使得進入馬桶後衝力太強勁，所以男性站著小便加上重力加速度，應該是比女生容易有泡泡產生。另外就是跟尿液濃度有關了，如果有輕微脫水，比方說喝太少水、運動完或是起床後第一次小便會容易出現泡泡尿。不過是不是有蛋白尿，還是應該做尿液分析比較準確。


阿倫的小結論：
Asymptomatic foamy urine
+ negative protein test in urine routine
= Rapid or concentrated urine
= Don't worry!

Hyperacute T-wave

今天evening nephro round Dr.楊請大家上台畫出MI和hyperkalemia其個別hyperacute T-wave。你能描述差異在哪並畫出來嗎?

Wikipedia:

The earliest electrocardiographic finding of acute myocardial infarction is sometimes the hyperacute T wave, which can be distinguished from hyperkalemia by the broad base and slight asymmetry.

http://en.wikipedia.org/wiki/Electrocardiogram#T_wave

→高血鉀的hyperacute T wave是寬底而有微小的不對稱。

UpToDate:

Peaked T waves —
Hyperacute or peaked T waves are usually the result of hyperkalemia. They are generally >10 mm in height as measured in the precordial leads, and >5 mm in height in the limb leads. The T wave is not only tall, but it is peaked and symmetric. This appearance is in contrast to the normal T wave which is asymmetric (the initial upstroke is slow while the end or downstroke is rapid).

In addition to hyperkalemia, hyperacute T waves may be seen in the early phases of an acute myocardial infarction or with myocardial ischemia, conditions which are associated with localized extracellular hyperkalemia. Tall T waves may also be seen in the presence of left ventricular hypertrophy, in which the amplitude of the QRS complex is increased, or may even be a normal variant; in these cases, the T waves are not peaked and still have an asymmetric morphology.

Hyperacute (peaked) T waves

Hyperacute T waves are >5 mm in the limb leads, and usually >10 mm in the precordial leads. They have a peaked, symmetric morphology.

http://www.uptodate.com/online/content/topic.do?topicKey=electuto/6828&selectedTitle=7~150&source=search_result#14

→高血鉀的T wave又高又尖又對稱。
有多高呢?在前胸導，常高於2大格；在肢導，長高於一大格。

→AMI早期可能看到hyperactue T wave
(基本理論是 localized "extra"cellular hyperkalemia，
我是第一次看到說明AMI有hyperactive T wave的原因，似乎蠻合理的)
這時後的T waves的確是有高起來，但是並沒有到 peaked的程度，
而且T wave的形狀是不對稱的。

ABC of clinical electrocardiography

The earliest signs of acute myocardial infarction are subtle and include increased T wave amplitude over the affected area. T waves become more prominent, symmetrical, and pointed ("hyperacute"). Hyperacute T waves are most evident in the anterior chest leads and are more readily visible when an old electrocardiogram is available for comparison. These changes in T waves are usually present for only five to 30 minutes after the onset of the infarction and are followed by ST segment changes.


















http://www.bmj.com/cgi/content/full/324/7341/831

→AMI的hyperacute T wave經常是MI剛開始5到30分鐘的心電圖表現，
過了半小時後就會開始ST chamge。

阿倫小筆記：

Tall, peaked, symmetrical, broad base T waves
= Hyperkalemia T wave !!

peaked,ㄚ是有多尖呢？應該是可以刺傷手指頭吧 :)




Tall, asymmetrical, very broad baseT waves

= AMI hyperacuteT wave !!

不對稱的T波是緩升陡降，為什麼會緩升是因為常伴隨ST segment change，如果詢問有胸痛情形，接下來應該是馬上進行近乎反射的動作：MONA+call CV man+評估thrombolytic agent使用。