29.3 🩺 內科專科考前版

29.3.0.1 📌 䞀頁重點

  • 22E 匷調HELP program、ICU delirium prevention bundle (ABCDEF)
  • Long-term cognitive sequelae of delirium 認可
  • Dexmedetomidine in ICU sedation 枛少 delirium
  • Taiwangeriatric service expansion

29.3.0.2 🧠 進階機蜉

  • Cholinergic deficiency
  • Inflammation (IL-6, CRP, TNF)
  • Stress response (cortisol)
  • Neurotransmitter imbalance (DA, glutamate, GABA)
  • Disrupted sleep / circadian

29.3.0.3 💊 進階治療

29.3.0.3.1 ABCDEF Bundle (ICU)
  • Assess pain
  • Both SAT (spontaneous awakening trial) + SBT (spontaneous breathing trial)
  • Choice of analgesia/sedationdexmedetomidine > BZD
  • Delirium monitoring
  • Early mobility
  • Family engagement
29.3.0.3.2 Antipsychotic Evidence
  • Haloperidol: traditional first-line, but RCTs show no mortality benefit
  • Quetiapine: better tolerated
  • Avoid prolonged useQT, EPS, fall risk
29.3.0.3.3 Long-term Cognitive Outcomes
  • Delirium associated with persistent cognitive decline
  • ICU delirium → 50% have cognitive impairment 1 year later

29.3.0.4 🌟 Pearls (8)

  1. Hypoactive 挏蚺率最高
  2. Delirium 是 mortality marker
  3. Dexmedetomidine > propofol > BZD for sedation in ICU
  4. Music therapy 有 evidence
  5. Family engagement 重芁
  6. PD/Lewy 甹 quetiapine
  7. Long-term cognitive sequelae 真寊存圚
  8. 最重芁 = 預防 > 治療

29.3.0.5 🔍 特殊情境

  • Post-op deliriumhip surgery, cardiac surgery
  • Cancer (paraneoplastic, brain mets, opioid)
  • HIV
  • ESRD (dialysis disequilibrium, uremic encephalopathy)
  • Cirrhosis (hepatic encephalopathy)

29.3.0.6 📍 台灣 Context

  • 健保 geriatric assessment
  • HELP program emerging
  • ICU sedation guidelines
  • äž­æ–‡ CAM å·² validated

29.3.0.7 ⚠ 老闆地雷

  1. Hypoactive 挏
  2. BZD for non-withdrawal
  3. Glucose before thiamine
  4. Restraint primary
  5. PD/Lewy 絊 haloperidol
  6. ICU 甹 BZD sedation routine
  7. 䞍評䌰 polypharmacy

29.3.0.8 🎓 內專重點

  1. CAM
  2. DELIRIUMS
  3. Treatment hierarchy
  4. Alcohol withdrawal
  5. ICU bundle (ABCDEF)
  6. Long-term sequelae
29.3.0.8.1 跚章節
  • Ch 30 Coma
  • Ch 31 Dementia
  • Ch 466 Substance use

29.3.0.9 📚 玢匕

⚠ AI 草皿。