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林口長庚醫院外放見聞

林口長庚醫院外放見聞. Presented by R2 林至芃 2000.10.24. 林口長庚醫院外放見聞. 兒童醫院門診常規手術 兒童醫院兒童顱顏異常整型 Trauma CVS Chest surgery Neurosurgery. 兒童醫院門診常規手術. No IV line, Gas induction <2 y/o Nurse 抱進開刀房 <10 Kg Bain circuit 所有小兒科的刀都捏 BAG， 不用 VENTILATOR 打

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林口長庚醫院外放見聞

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  1. 林口長庚醫院外放見聞 Presented by R2 林至芃 2000.10.24

  2. 林口長庚醫院外放見聞 • 兒童醫院門診常規手術 • 兒童醫院兒童顱顏異常整型 • Trauma • CVS • Chest surgery • Neurosurgery

  3. 兒童醫院門診常規手術 • No IV line, Gas induction • <2 y/o Nurse 抱進開刀房 • <10 Kg Bain circuit • 所有小兒科的刀都捏BAG，不用VENTILATOR 打 • CHEST 會被遮到的刀，都會在左胸前貼precordial stethoscope, frequent check!

  4. 兒童醫院兒童顱顏異常整型 • 頭顱異常部分-常見診斷: craniosynostosis 1.Cruzon disease 2.Apert syndrome術式: cranio-orbital plastymajor hemodynamic change:a.頭骨拿下時-release IICPb.頭皮夾拿掉後開始關頭皮c.hemovac 放入後開始吸血-dura irritationA-line+Neck CVP+ large bore IV line

  5. 兒童醫院兒童顱顏異常整型 • Cleft lip and palate在外科醫師準備的過程中 NA必須持續用手固定TUBE！以防被弄掉！ • 小孩若預期會困難插管要用fiber時應給atropine, midazolam, gas讓病人自呼等十到十五分鐘後再Nasal fiber intubation • VPI • 白色 stylet for 高位 glottis

  6. 林口長庚大開刀房- Trauma • Very large case numbers!! • Trauma GS • Trauma ortho • Effective resuscitation

  7. 林口長庚大開刀房- CVS • Induction drugs • PA catheter • NG • TEE • By-pass perfusionist • Post-bypass medication • beating heart CABG - CTS

  8. 林口長庚大開刀房- Chest • Nothing particular for Lung Ca • Trachea surgery team! • Rigid bronchoscopy • Pain control

  9. 林口長庚大開刀房- Neurosurgery • Induction • CVP • Brain mapping • Evoked potentials • TCD • No SjVO2 , no cerebral oxymetry • VS- NS, Pain,

  10. 林口長庚醫院外放怪聞 • Radical Hysterectomy- No CVP • Hypotensive anesthesia • universal F V.S RAE tube • Nasal intubation- jelly only! Tube suture! • CPR • 溫血器

  11. 林口長庚醫院外放見聞 • 長庚麻醉部分科：a.心血管胸腔麻醉科 7b.神經外科麻醉與疼痛控制 9c.一般麻醉科 9d.兒童醫院麻醉科 （VS８名）每月平均開刀量8000

  12. 林口長庚醫院外放見聞 • Teaching activity:7:30 amW2: journal meeting by VSW3: POR QC meetingW4: 全院grand roundW5: journal meeting W6: M/M conference • Resident training course

  13. Thanks for your attention!

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