實證醫學與急診處置－實例探討

Evidence-based Medicine and Emergency Management

廖士良(Shih-Liang Liao)

《北市醫學雜誌》 2卷10期 (2005/10) Pp. 963-973

https://doi.org/10.6200/TCMJ.2005.2.10.12

摘要

與急診有關的實證醫學研究，舉數例供參考。（一）成人輸血：若非急性失血，一般重症患者血紅素含量小於七克／公合(g/dl)輸血與小於十克／公合輸血的存活率相同。（二）盤尼西林皮膚過敏測試：口服藥不必做；有過嚴重過敏反應如剝落性皮炎或史帝文強生症候群，勿做。注射劑方面，若病人無過敏史，可不做測試直接使用針劑；有過敏史者，若皮膚測試陰性，可給藥。（三）急性腹痛合併發燒是急症，必須儘快做出診斷。安排電腦斷層有充分正當性，而且最好能打顯影劑。（四）急性腹痛非常不舒服，先給予病患止痛，不會影響正確診斷率。（五）遇生育年齡的女病患，需確定是否懷孕，以懷孕測試為認定標準，因為自認不會懷孕的病患中，有一成測試為陽性。（六）急性充血性心臟衰竭的急診患者，目前並無確切的指導準則可決定病患出院是否安全。

關鍵字

實證醫學 ； 輸血 ； 盤尼西林 ； 過敏測試 ； 急性腹痛 ； 發燒 ； 止痛劑 ； 懷孕測試 ； 充血性心臟衰竭

並列摘要

The following are some examples of Emergency Department evidence-based medicine. (1) Adult Blood Transfusion: if no acute blood loss has occurred, critical patients with Hb counts that have dropped below 7.0 g/dl, have the same survival rate after transfusion as those with Hb counts that have dropped below 10.0 g/dl. (2) Penicillin Skin Test: it is not necessary to perform a skin test before the use of oral penicillin. Patients with a history of Stevens-Johnson syndrome or exfoliative dermatitis attributable to penicillin should not undergo a skin test. Penicillin injections are permitted for those patients who are unlikely to have true penicillin allergic histories. However, for patients with a concerning history of penicillin allergy, a skin test should be performed. A negative skin test result means that injections are permissible. (3) Abdominal Computerized Tomography using Contrast Medium: this is appropriate for patients with acute abdominal pain and fever in the emergency department, to allow an accurate and quick diagnosis to be made. (4) Early Pain Relief for Acute Abdominal Pain: this does not interfere with diagnosis. (5) Pregnancy Testing: taking a patient's history is an unreliable method of excluding pregnancy for patients in the emergency department. The liberal use of pregnancy tests is supported because there is a 10% chance of pregnancy even when the patient does not think she is pregnant. (6) Discharge of a patient suffering Acute Congestive Heart Failure: there is no validated rule currently to help in making the decision regarding safe discharge from the emergency department.

並列關鍵字

abdominal pain ； congestive heart failure ； analgesics ； blood transfusion ； evidence-based medicine ； fever ； penicillin ； pregnancy test ； skin test