Re: [新聞] 菜鳥醫師抽腹水 醫病缺乏互信引不安
※ 引述《carlchang (carlchang)》之銘言：
: 不過選Wintermin還是會比較麻煩啦，sedation太強，沒吃過的病人會睡成一團。
: 另外還有，Anticholinergic、alpha-1 antagonism的問題....
: 所以，要是我的話，我也是會先選Primperan吧？
: maybe加一點muscle relaxant/or BZD (一點evidence都沒的亂搞)
^^^^^^^^^^^^^^^^^^^^^^
我覺得這個就是重點了
現在一天到晚喊EBM
真的照著evidence的建議用藥
結果卻反而綁手綁腳
真的是很無奈啊
附註 : micromedex不是每個人或是醫院都有買liscense 所以我把網址丟上來
大家也不見得連的上
簡單貼一點重點上來囉
Simple, mechanical techniques should be tried before attempting drug therapy
for intractable hiccups ........
holding your breath; slowly drinking a glass of water; pressure on eyeballs;
swallowing; irritation of nasal mucosa to produce sneezing; mustard plaster,
ice bag, ethyl chloride spray, or ether applied to the epigastrium;
pressure over carotid sinus between thumb and forefinger for 1 minute,
grasping the artery at the midpoint of the anterior border of the
sternocleidomastoid; strong digital pressure over the phrenic nerves in their
course behind the sternoclavicular points; forceable traction of the tongue;
induction of nausea or vomiting by tickling the throat; gasping with sudden
fright, the Valsalva maneuver, hyperventilation, and drinking water from
the 'wrong side' of a glass ...........
The only drug approved by the FDA for the treatment of intractable hiccups is
chlorpromazine............
Only 1 randomized, double blind, placebo-controlled crossover study was
conducted to assess the efficacy of oral baclofen 15 mg/day and 30 mg/day for
the treatment of intractable hiccups. While patients reported no adverse
effects secondary to baclofen, this drug was unable to completely resolve
intractable hiccups in any patient..........
Evidence supporting drug treatment for intractable hiccups remains
inconclusive..............
If intractable hiccups remain resistant to the non-pharmacological techniques,
the strongest evidence to date supports the use of chlorpromazine 25 to 50 mg
administered intravenously, with a second dose within 2 to 4 hours
intravenously or intramuscularly. The patient should be monitored carefully
for anticholinergic side effects, particularly sedation......
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