CR任務

值班區域分配

12/13F：5CD, 7B, 7C, (7A,7D), 12CD, 13CD  交班會議地點：13D

14/15F：13AB, 14ABCD, 15C, 3D1, MICU      交班會議地點：14B

值班病房CPR處理原則

• • 目擊者：通知護理師啟動9595、開始壓胸

  • 支援人力抵達前可做的事：

    • 放急救板

    • 裝3合1監視器(注意rhythm)

    • 給點滴、給氧氣、Q3M給Bosmin

    • 一位護理師：計時+紀錄，每3分鐘到提醒要打Bosmin

    • 一位護理師：負責打Bosmin

    • 一位護理師：協助On Endo, Suction

    • 其它護理師：On cath、準備抽藥(Rolikan, Calcium)

  • 支援人力抵達後工作分配：

• • 1. Intern*2: 站病人兩旁。輪流壓胸

    2. Intern*1: 站腳側。抽ABG、拿病人標籤跑Gas(內科病房到3B;心臟科到5CVI)，結果出來立刻打電話報告病房總醫師

    3. Resident*1: 站頭側。放氣管內管

    4. (Resident*1: 放Femoral Catheter, 中央靜脈導管)

    5. (Resident*1: 推超音波，排除心包膜填塞、張力性氣胸、腹內出血)

    6. 該病房Resident*1：聯絡家屬、解釋病況、確認家屬想法(積極or消極)

• • CR:指揮者，確認每件任務都有人負責。每兩分鐘換手、檢查脈搏

  • 若初步5H5T沒查到原因，病人仍無ROSC，應考慮叫ECMO

Pre-BMT evaluation注意事項

請列印Pre-BMT checklist( (8.3), 逐項完成並打勾：

https://drive.google.com/file/d/1RjrmjQO-3WI12ny5Nr7f8a4UihRAgZ6I/view?usp=drive_link

完成後 將此表掃描上傳病歷

其它注意事項：

 1. 照會單一天最多發3科，先發牙科、泌尿/婦產科。並在照會單末留下護理站電話，提醒照會醫師訪視前可先來電確認病人在病室

 2. 雲林缺項先不驗：

• 13007CZP Stool Culture: Campylobacter

• 000P3303 Anti-A/anti-B(IgM) titer 

 3. 請跟VS確認

• 斷層掃描除了HRCT外，是否還有需要做其它部位

• 若為HLA不相合異體移植，是否加驗 12200B0P Leukocyte Flow PRA(健保)，或自費 37000 驗 000P3305 Single Antigen Flow PRA (DSA ) 

 4. 腹超、心超要先排。若腹超、心超於入院2天後還沒做到，請拜託檢查室盡早安排。

 5. 肺功能要排兩項檢查

• Lung volume wih FRC-標準肺量測定(包括 FRC測定)

• CO diffusing capacity-一氧化碳肺瀰散量測定

 6. 預計住院3個晚上完成所有檢查。

BM study 醫令

- BM study (A+B+C+血液室Flow+Iron stain) would be arranged today.

  - 請簽署：

    (1)骨髓檢查同意書 

    (2)剩餘檢體同意書(保存於台大醫院血液科至不限年、不與其他資料庫連結)   

    (3)剩餘檢體臘塊同意書

 - 請開立下列骨髓檢查醫令，並"填好"病理及"Cytogenetics委託單"

   1. TRE00009 Bone marrow aspiration and biopsy

   2. 08128B0P Bone marrow smear and Differentiation Count

   3. 25004C0W Surgical pathology Level IV

   4. 25007BZW Cytogenetics (hemopoietic disorder)

   5. 12206B0P Surface marker (immunophenotyping) for leukemia and lymphoma

   6. 08042C0P Bone marrow iron staining  

 - Contact me(before 14:00) for BM exam after above documents are available 

CR orientation

          https://www.notion.so/CR-orientation-eeb17e5495b840e198dc82a9d174e5c4?v=32ec6e2725cc4585a96322c4caa03d60

Bone marrow report template

• Peripheral blood

  • RBC: normocytic, normochromic, schistocytosis(-); WBC: adequate WBC count without circulating immature granulocytes; Platelet: adequate platelet count

• Marrow

  • Myeloid: age-adjusted normocellularity with ordered maturation

  • Erythroid: age-adjusted normocellularity with ordered maturation

• Abnormal/pattern: no excess of blast. No lymphoid aggregate. No hemophagocytosis. No foreign cell.

• Comments: please correlate with clinical manifestation, pathology  and flow cytometry results.

--骨髓報告片語--

PB:

adequate WBC and platelet counts, no lymphocytosis, no immature cells

anisocytosis

poikilocytosis

anisopoikilocytosis

polychromatophilic RBCs

platelet clumping

rouleaux formation

Leukemia:

no excess of blasts, no focal blast aggregation, no lymphocytosis, no basophilia, no eosinophilia

leukemic marrow, full of __blasts

nearly depleted

Lymphoma:

no lymphocytosis, no morphologically abnormal lymphoid cells

Dysplasia:

left-shifting maturation

irregular nuclei and megaloblastoid changes

dwarf megakaryocytes hyperplasia

micromegakaryocytes

multinucleation

hypolobulation

診斷:

No morphologic evidence of lymphoma involvement

Acute myeloid leukemia,

complete remission -blast <5%, ANC >1000, PLT >10k

with incomplete hematologic recovery

morphologic leukemia-free state -no hematologic recovery required

partial remission -blast 5~25% & decrease >50%

progressive disease -blast >50% and >15% increase, or >70% for 3m; PB >50% and 25k increase

stable disease

Myelodysplastic syndrome

Acute lymphoblastic leukemia

Comments:

Please correlate with clinical information.

consider to repeat BM study if indicated