goodduck

step 1. 找出primary acid-base disorder
(1) 先看pH -> 決定acidosis或alkalosis
(2) 再看Paco2及pH兩者"變化方向(上或下)" -> 同向: metabolic ; 反向:respiratory (記法:呼吸一吐一吸,方向相反)

Keypoint: chronic inflammation involving genetic defect!
Clinical Manifestation
1. course: 60%(1歲前)->85%(5歲前)
2. dry skin!

[基本比較]
1. 大小: Parotid >  submandibular > sublingual
2. 分泌量: Submandibular> Parotid> sublingual
3. Parotid Gln. -> Stenson's Duct   ;   Submandibular -> Warthin's Duct

step1. 看症狀來決定嚴重度以及要不要給anti?
1. increased dyspnea
2. increased sputum purulency
3. increased sputum volume

1. minor withdrawal  symptoms (CNS hyperactivity)
    a. timing: within 6hr; if no pregress -> cessation in 24-48hr

[symptoms] -- 我還是覺得SM ACE PIGS 比up to date的口訣好記 =.=
1. Suicide
2. Mood

1928.1.4 : born in Lawrence, Massachusetts -> NY city grow up
1942 (14): Drop out school
1944 (16): into US Navy 
1946 (18): discharge from US NAVY -> become profession boxer ->
1951 (23): University of Oklahoma 

S. bovis
[Two No]
1. no valve abnormal (43%~72%)
2. no IV drug related

remember:  ask  "from onset to recovery"
                                         seizure                        syncope
precipitating                   none                            Valsava, emotion, Hx of heart disease
pre- symptom               aura(smell)                Nausea, diaphoresis, tunnel vision

[S&S]
1. forward decrease -> low C.O -> fatigue / exertional dyspnea -> LV failure
2. backflow -> LA pressure increase -> pulmonary HTN
3. chronic -> LV enlargement ->