急診短講006 ─ Sepsis Biomarker Time Trend

急診短講006 ─ Sepsis Biomarker Time Trend

IL-6, Lactate, PCT, CRP...

● Rapid (onset 1 hr, peak @ 2 hr): IL-6, IL-10, TNF-alpha (臨床上沒有常規檢測) 

● Early (onset 1-2 hr, peak @ 12 hr): PCT, lactate, suPAR (前兩者臨床上很實用！) 

● Intermediate (onset 6 hr, peak @ 48 hr): CRP (即使及時治療，前兩天還會持續爬升，小心解釋！) 

cite:

https://blog.ucdmc.ucdavis.edu/labbestpractice/index.php/2017/02/02/procalcitonin-for-antimicrobial-stewardship-and-the-management-of-sepsis/

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急診短講005 ─ PPI Dosage

急診短講005 ─ PPI Dosage

~40mg 的劑量 (一日一次)，

達標 (pH >4) 百分比中位數約 50%的，有 Lansoprazole & Omeprazole；

介於 50-75%的，有 Esomeprazole, Rabeprazole。

~80mg 的劑量 (一日兩次)，

達標 (pH >4) 百分比中位數約 50%-75%的，有 Pantoprazole；

大於 80%的，有 Lansoprazole, Omeprazole, Esomeprazole。

Original Data: Eur J Clin Pharmacol. 2009 Jan;65(1):19-31

ACG Clinical Guideline: Upper Gastrointestinal and Ulcer Bleeding.

Am J Gastroenterol. 2021 May 1;116(5):899-917. doi: 10.14309/ajg.0000000000001245.

PMID: 33929377 DOI: 10.14309/ajg.0000000000001245

a Continuous regimen, 80-mg (2amp) bolus followed by 8-mg/hr (~200mg, 5amp) infusion for 3 days. 

a Intermittent regimens, doses of 40 mg (1amp) 2 to 4 times daily for 3 days. An initial bolus of 80 mg (2amp) may be appropriate. 

b Standard PPI therapy (e.g., oral PPI once-daily).

參考：急診短講 ─ PPI 療效比較

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