Hospital Affairs - Some poorly organized notes...

!!!TSL score
*T: tenderness: 1(w/o frown) - 2(with frown) - 3(servere)
*S: swelling: 1(with wrinkle) - 2 - 3 (shining)
*L: limitation: 1(<25%) - 2 (25-50%) - 3 (50-75%) - 4(>75%)
recorded as TxSxLx.
!!!Other parameters
*local heat (This should be the 1st sign)
*erythema (predominant in some disease as crystal arthropathy and SLE)
*distribution (central? peripheral?)
*pattern

!!!Initial screen of joint disorders
*C-spine: lateral bending
*shoulder: abduction and external rotation (raise hands behind your head)
*elbow: pronation
*hand: fist, squeeze, fine precision pitch
*hip: internal rotation, Patrick's test
*knee: flexion
*foot: ???

!!!For which pathogen should we perform a acid-fast stain?
* Mycobacterium
* Nocardia
* Rhodococcus

* If the acute cholecystitis hit a patient suffering a chronic one, the gall bladder may not enlarge.

The information listed below was based on the experience from VGHKS if not mentioned otherwise.
!!!Dobutamine
*Supply: 250mg/20ml/Amp
*Dose: 2-20mcg/kg/min, initially 2.5-5mcg/kg/min
*Admixture: 500mg in D5W or 0.9%NaCl 250ml = 2000mcg/ml
*Administration: rate (ml/hr) = dose (mcg/kg/min) x BW/33.3
!!!Dopamine
*Supply: 200mg/5ml/Amp
*Dose:
**dopaminergic: 1-5mcg/kg/min
**beta-adrenergic: 5-10mcg/kg/min
**alpha-adrenergic: 10-20mcg/kg/min
*Admixture: 400mg in D5W or 0.9%NaCl 250ml = 1600mcg/ml
*Administration: rate (ml/hr) = dose (mcg/kg/min) x BW/26.6
!!!Epinephrine
*Supply: 1mg/ml/Amp
*Dose: 2-10mcg/min
*Admixture: 2mg in D5W or 0.9%NaCl 250ml = 8mcg/ml
*Administration: rate (ml/hr) = dose (mcg/kg/min) x 7.5
!!!Norepinephrine (levophed)
*Supply: 4mg/4ml/Amp
*Dose: 5-20mcg/min
*Admixture: 8mg in D5W or D5S 250ml = 32mcg/ml
*Administration: rate = dose (mcg/min)x 2
!!!Amiodarone
*Supply: 150mg/3ml/Amp
*Dose:
** loading: 150-300mg in 10min
** 1mg/min x 6hrs then 0.5mg/min x 18hrs
*Admixture: 900mg in D5W 450ml (bottle) = 2mg/ml 
*Administration: 30ml/hr x 6hrs then 15ml/hr x 18 hrs
!!!heparin
*Supply: 25000U/5ml/Vial
*Dose:
**loading: 60U/kg
**12U/kg/hr drip 48hrs
*Admixture: 25000U in D5W or 0.9%NaCl 250ml = 100U/ml
*Administration: BW/8 ml/hr
*Precaution: assess aPTT at 6,12,18,24 hr after administration
!!!Midazolam
*Supply: 5mg/5ml/amp
*Dose:
**loading: 0.03-0.3mg/kg (0.1mg/kg)
**maintenance: 0.05-0.2mg/kg/hr
*Admixture: 60mg in 0.9%NaCl 190ml = 0.24mg/ml
*Administration: loading with 5mg; initial maintenance 0.2 x BW???; rate (ml/hr) ~ dose x BW x 4
!!!NTG (nitroglycerin, glyceryl trinitrate, GTN )
*Supply: 50mg/100ml/bottle
*Dose: start with 10-20mcg/min, increase 5-10mcg/min every 5-10mins
*Admixture: 
*Administration: start with 1.2-2.4ml/hr
!!!furosemide (Lasix)
*Supply: 20mg/2ml/amp
*Dose:
**loading: 0.5-1mg/kg slow push
**maintenance: 0.1-0.75mg/kg/hr
*Admixture: 200mg in 0.9%NaCl 180ml = 1mg/ml
*Administration: start with BW/10 (ml/hr), adjust according to the urine output, rate (ml/hr) = dose x BW
!!!regular insulin (RI)
*Supply: 
*Dose: 
**loading 0.2U/kg
**maintenance: 0.1U/kg/hr
*Admixture: 50U in 0.9%NaCl 500ml = 0.1U/ml; 100U in 0.9%NaCl 100ml = 1U/ml
*Administration: rate = BW (with 0.1U/ml); rate = BW/10 or (blood glucose)/100 (with 1U/ml)
!!!Propofol
*Supply: 200mg/20ml/amp
*Dose: 
**loading: 0.25-1mg/kg
**maintenance: 1-6mg/kg/hr
*Admixture: 10mg/ml
*Administration: start with BW/10 (ml/hr), adjust according to sedation state, rate = dose x BW/10
!!!Lidocaine 2%
*Supply: 20mg/ml, 20ml/vial
*Dose: start with 1-1.5mg/kg, increase 0.5-0.75mg/kg every 5 min, up to 3mg/kg; maintenance: 2-4mg/min
*Admixture: 2000mg in D5W 150ml (total 250ml) = 8mg/ml
*Administration: maintenance 15-30 ml/hr; rate = dose x 7.5
!!!Isoproterenol
*Supply: 0.2mg/ml/amp
*Dose: 2-10mcg/min
*Admixture: 1mg in D5W or 0.9%NaCl 250ml = 4mcg/ml
*Administration: rate = dose x 15
!!!
*Supply:
*Dose:
*Admixture
*Administration
!!!
*Supply:
*Dose:
*Admixture
*Administration
!!!
*Supply:
*Dose:
*Admixture
*Administration

!!!Clinical presentation
*fever > 39C
*sore throat
*Sill's rash: urticaria-like
*pleurisy and pericarditis
*splenomegaly
*musculoskeletal features: arthralgia, myalgia, swollen joints.
!!!Laboratory findings
*WBC > 12k, neutrophil > 80%
*Liver function impairment
*ANA- (exclude infectious and autoimmune disease)
*Ferritin may be high (> 10^^4^^) but not necessarily

For patient with long term anemia, the yellow marrow may reconverse to the red marrow, which is different in MR images.

*In summary, our results show a U-shaped association between ABI and mortality, with significantly increased risk in both the <0.90 and >1.40 groups.  [Circulation. 2004;109:733-9.]
*Low ABI is associated with increased risk of CVD independent of the metabolic syndrome and other major CVD risk factors. [Diabetes Care. 2006;29:637-42.]

*3T1L:
**Thyroid
**Thymus
**Teratoma
**Lymphoma

For pure hypertension:
*if >55 y/o, then CCB first → C+D → A+B+C/D → Vasodilator / Alpha-blocker
*if <55 y/o, then ACEI first → A+B → A+B+C/D → Vasodilator / Alpha-blocker

!!ANA
IgM/A/G against intracuclear antigens
!!Method
*antigen source: Her-2 cell (buccal ca)
*Imagery: Fluoroscence-labeled anti-IgG Ab (No IgM/A)
*Incubation
** 20min for Ab-Ag
** 20min for Ab-Ab-Ag
!!Result
*titer: 2^^n^^ x 40, n = 1,2,3...
*pattern
**homogenous: chromosome (anti-dsDNA, anti-ssDNA, anti-histone, anti-chromosome, anti-nucleosome)
**speckled: nuclear matrix
**nucleolar: nucleolus
**centromere: centromere
**rim pattern: anti-dsDNA or antinuclear membrane (mitotic cell shows the difference)
!!Corresponding diseases
!!!homogenous pattern
!!!!anti-dsDNA
* SLE specific
!!!!anti-histone
* non-specific
* drug-induced lupus (also anti-ssDNA+): procanamide, quinidine, isoniazide, D-penicillamine, sulfasalazine
!!!Speckled pattern
!!!!anti-Sm (Sm: RNA splicing enzyme)
*SLE specific
!!!!anti-RNP
*MCTD (without other ANA)
*SLE
!!!!anti-SSA, SSB
*Sjögren's syndrome
*SLE (often presented with skin lesions)
*neonatal lupus
!!!!anti-Cenp-F
*specific ca.
!!!!anti-p-80 coilin
*various rheumatic disease
!!!!anti-PCNA
*SLE
!!!!anti-Ki
*Sjögren's syndrome
*SLE
!!!Nucleolar
[Under construction]
!!!Atypical pattern
!!!!anti-Scl-70 (Isotopomerase-I)
* scleroderma
!!!Centromere
!!!!mitotic cell kinetochore, CENP-A, CENP-B, CENP-C
*CREST syndrome
*primary biliary cirrhosis (PBC)
!!!Other pattern
!!!!anti-Jo-1
*polymyositis/dermatomyositis (increased risk of pulmonary fibrosis if this ANA+)
!!!!Ribosomal RNP
*SLE
!!!!Anti-mitochondrial Ab (AMA)
*primary biliary cirrhosis (PBC)
!!Other info
*scleroderma & SLE ~100% ANA+
*Other factors associated with ANA+
**Hepatitis B
**Hepatitis C
**lymphoma
**drug (homogenous pattern)
**old age (homogenous pattern)

!!!Association with stroke
*5% of patients with atrial fibrillation will get stroke (embolism) anually.
*1/5 strokes are related to atrial fibrillation.

!!Management
|Intravenous and orally administered pharmacological agents for heart rate control in patients with atrial fibrillation|c
|!Drug|!Loading dose|!Onset|!Maintenance dose|!Major SE|
|!Acute setting |>|>|>|>|
|Heart rate control in patients without accessory pathway |>|>|>|>|
|Esmolol |500 mcg/kg IV over 1 min |5min |60 to 200 mcg/kg/min IV |↓BP, HB, ↓HR, asthma, HF |
|Metoprolol |2.5 to 5 mg IV bolus over 2 min; up to 3 doses |5 min |NA |↓BP, HB, ↓HR, asthma, HF |
|Propranolol |0.15 mg/kg IV |5 min |NA |↓BP, HB, ↓HR, asthma, HF |
|Diltiazem |0.25 mg/kg IV over 2 min |2 to 7 min |5 to 15 mg/h IV |↓BP, HB, HF |
|Verapamil |0.075 to 0.15 mg/kg IV over 2 min |3 to 5 min |NA  |↓BP, HB, HF |
|Heart rate control in patients with accessory pathway |>|>|>|>|
|Amiodarone |150 mg over 10 min |Days |0.5 to 1 mg/min IV |↓BP, HB, pulmonary toxicity, skin discoloration, hypothyroidism, hyperthyroidism, corneal deposits, optic neuropathy, warfarin interaction, sinus bradycardia |
|Heart rate control in patients with heart failure and without accessory pathway |>|>|>|>|
|Digoxin |0.25 mg IV each 2 h, up to 1.5 mg |60 min or more |0.125 to 0.375 mg daily IV or orally |Digitalis toxicity, HB, ↓HR |
|Amiodarone |150 mg over 10 min |Days |0.5 to 1 mg/min IV |↓BP, HB, pulmonary toxicity, skin discoloration, hypothyroidism, hyperthyroidism, corneal deposits, optic neuropathy, warfarin interaction, sinus bradycardia |
|!Non-acute setting and chronic maintenance therapy |>|>|>|>|
|Heart rate control |>|>|>|>|
|Metoprolol |Same as maintenance dose |4 to 6 h |25 to 100 mg twice a day, orally |↓BP, HB, ↓HR, asthma, HF |
|Propranolol |Same as maintenance dose |60 to 90 min |80 to 240 mg daily in divided doses, orally |↓BP, HB, ↓HR, asthma, HF |
|Diltiazem |Same as maintenance dose |2 to 4 h |120 to 360 mg daily in divided doses; slow release available, orally |↓BP, HB, HF |
|Verapamil |Same as maintenance dose |1 to 2 h |120 to 360 mg daily in divided doses; slow release available, orally|↓BP, HB, HF, digoxin interaction |
|Heart rate control in patients with heart failure and without accessory pathway|>|>|>|>|
|Digoxin |0.5 mg by mouth daily |2 days |0.125 to 0.375 mg daily, orally |Digitalis toxicity, HB, ↓HR|
|Amiodarone |800 mg daily for 1 wk, orally; 600 mg daily for 1 wk, orally; 400 mg daily for 4 to 6 wk, orally |1 to 3 wk |200 mg daily, orally |↓BP, HB, pulmonary toxicity, skin discoloration, hypothyroidism, hyperthyroidism, corneal deposits, optic neuropathy, warfarin interaction, sinus bradycardia |
|Adapted from [[ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation|http://eurheartj.oxfordjournals.org/cgi/content/full/27/16/1979]]|c

For patients with alcoholism, 60% present with bilateral AVN.
For patient having steroid use, 90% present with bilateral AVN.

The clinical union precedes the radiological union by 3 months.

CRP is not likely to rise in patients with SLE, dermatomyositis, and scleroderma.

*The patient is conscious and give reliable information:
##E4V5M6
##No distracting pain
##Intoxication is not likely
*If the patient meet all the above items, check the followings:
##No neck pain
##No tenderness over neck region
##The patient can turn his/her head without pain

Now, it is OK to remove the collar.

"N-VICTIM"
* N - Neoplastic
* V - Vascular
* I -  Infection / Inflammation
* C - Congenital
* T - Traumatic
* I - Immunogenic
* M - Metabolic

* An adrenal tumor may be confused with a pancreatic tail carcinoma since they have similar location and both may contain cystic compartment and calcification. However, an adrenal tumor has its capsule.

CT-guided biopsy may induce pneumothorax in 20-30% cases. These pneumothorax are usually treated conservatively except for 2-5% of all CT-guided biopsy cases at which thoracotomy intubation are indicated.

If CK-MB > CK, then consider malignancy.

!!Indications
*ejection fraction of 35% or less
*moderate or severe heart failure (New York Heart Association [NYHA] class III or IV)
*prolonged QRS interval (≥120 msec)

Case: A 5 y/o child with scalp laceration wound, no fracture. What is your plan?

Initial steps
# Compression to stop bleeding
# Local analgesia
# Chloral hydrate (transrectal)
# Clear the wound with noraml saline
# Sterilaization

Before suture start, the followings should be done:
# Stop bleeding, remove clot
# Remove foreign body
# flush the wound with normal saline
# debridement and modify the wound

The outcome of endocrine tumors should be predicted by tumor behavior rather than cell morphology, since they are "high grade" by nature.

!!!Pathogens inducing rapidly progressing cellulitis
* Aeromonas
* Vibrio
* Group A Streptococcus
!!!Some difference between streptococcus and starphylococcus induced cellulitis
|!Cellulitis|!Group A Streptococcus|!Starphylococcus|
|risk|CABG, past Hx||
|Wound|no obvious wound, abrasion|obvious wound|
|margin*|blurred|clear|
|depth*|superficial|deep|
|lymphangitis|present|absent|
|skip lesions|+|-|
|lab test|ASOT (1 wk later)|smear|
|culture|few growth|growth|
|treatment|penicillin|oxacillin|
 *these are emperical

!!!Erysipelas and cellulutus
*In Europe: erysipelas = cellulitis
*In the US: some difference
||!Erysipelas|!Cellulitis|
|depth|superficial|deep|
|pain|more|less|
|erythema|obvious|less clear|
|involvement|epidermis and upper dermis|lower dermis and subcutaneous tissue|

!!!paclitaxel (Taxol)
*dose: 175mg x BSA
*administration: in D5W 500ml IVD for 3 hrs via non-PVC set
*monitor ECG during administration
!!!carboplatin
*dose: (CCR+25) x 5 (mg)
*administration: in D5W 500ml IV stat
!!!cisplatin
*dose: BSA x 50 (mg)
*administration: in 0.9%NaCl 500ml IV stat
!!!Ifosfamide (Holoxan)
*dose: 5-6g
*administration: in 5000ml 0.9%NaCl IV, keep for 24 hours
!!!!mesna (Mesnex)
*to prevent hemorrhagic cystitis after ifosfamide administration
*dose: 100mg/4ml(1amp) x 15amp
*administration: lactate Ringer's 3000ml IV stat with mesna 1g in each IV bottle, keep 24 hours
!!!lipo-doxorubicin
*dose: 40-50mg x BSA
*administration: in D5W 250mg IV over 1.5hr
!!!epirubicin
*dose: 50mg x BSA
*administration: in 0.9%NaCl 500ml IV stat
!!!topotecan
*dose: 1.5mg x BSA
*administration: in 0.9%NaCl 100ml IV qd x 5 days, slow drip > 30 mins.
!!!gemcitabine
*dose: 800-1000mg x BSA
*administration: in 500ml 0.9%NaCl IV stat < 30mins
!!!Bleomycin
*dose: 15mg
*administration: in 0.9%NaCl 500ml IVD for 24 hours x 3 days.
!!!Dacarbazine (DTIC)
*dose: 200mg x BSA
*administration: in 0.9%NaCl 500ml qd x 5 days
!!!methotrexate
*dose: 1mg/kg
*administration: in 0.9%NaCl 500ml IV qod (D1,3,5,7,9)
!!!irinotecan
*dose: 60mg x BSA
*administration: in 0.9% NaCl 250ml IV drip over 90mins stat
!!!Cyclophosphamide
*dose: 500mg x BSA
*administration: in 0.9%NaCl 500ml IV stat
!!!etoposide (VP-16)
*dose: 100mg x BSA
*administration: in 0.9% 5ooml IV for 6 hours x 3 days
!!! Vinorelbine
*dose: 50mg x BSA
*administration: in D5W 250mg IV over 1.5hr
!!!
*dose:
*administration:

Consider the followings:
** CPPD (Pseudogout)
** Gout
** Wilson's disesase
** Osteoarthritis

!!!Indications of operation
*open fracture
*shortening > 2cm
*sharp margin, high risk of open fracture
*neurovascular injuries
*painful nonunion for at least 2 months (in late stage)

/***
|Name:|CloseOnCancelPlugin|
|Description:|Closes the tiddler if you click new tiddler then cancel. Default behaviour is to leave it open|
|Version:|3.0.1 ($Rev: 3861 $)|
|Date:|$Date: 2008-03-08 10:53:09 +1000 (Sat, 08 Mar 2008) $|
|Source:|http://mptw.tiddlyspot.com/#CloseOnCancelPlugin|
|Author:|Simon Baird <simon.baird@gmail.com>|
|License:|http://mptw.tiddlyspot.com/#TheBSDLicense|
***/
//{{{
merge(config.commands.cancelTiddler,{

	handler_mptw_orig_closeUnsaved: config.commands.cancelTiddler.handler,

	handler: function(event,src,title) {
		this.handler_mptw_orig_closeUnsaved(event,src,title);
		if (!store.tiddlerExists(title) && !store.isShadowTiddler(title))
			story.closeTiddler(title,true);
	 	return false;
	}

});

//}}}

The closure of feeding jejunostomy is primarily done after healing of the epithelium followed by healing of the subcutaneous connective tissue. If the intestinal mucosa grow up into the fistula, non-healing may occur and debridement of the fistula may be required.

Name: MptwGreen
Background: #fff
Foreground: #000
PrimaryPale: #9b9
PrimaryLight: #385
PrimaryMid: #031
PrimaryDark: #020
SecondaryPale: #ffc
SecondaryLight: #fe8
SecondaryMid: #db4
SecondaryDark: #841
TertiaryPale: #eee
TertiaryLight: #ccc
TertiaryMid: #999
TertiaryDark: #666
Error: #f88

!!!!The presence of metamyelocyte or other immature cells imply the followings:
* Sepsis
* bone marrow involvment: eg. lyphoma.
* endoreticular system involvement: eg. fungus, tuberculosis, virus.

May be induced by ventilation with facial mask.

!Diagnosis
!!Criteria (3 of 5)
*FDP > 32mg/l
*PT INR > 1.5 or APTT > 50secs
*fibrinogen < 300mg% (150 at non-pregnant women)
*platelet < 10^^5^^/mm3
*antithrombin III < 80%
!Treatment
!!Ablate the underlying cause
*delivery
*stop bleeding
*antibiotic treatment
!!Correcting the coagulation process
!!fibrinogen
!!platelet
!!anticoagulant

!!Typical findings
!!! Lab
*lower WBC
*increased hematocrit
*platelet count decreased
*elevated liver enzymes (AST, ALT)
*normal PT, prolonged APTT

Loading with 0.25~0.5mg IV for the first day, then 0.125mg (0.5 tab) PO QD.

Dipyridamole (Persantin) dilates normal coronary arteries but not abnormal ones. This may induce "steal effect".

In VGHKS, we use 500mg (2 amp) in 250ml normal saline for IV continuous infusion.

!Management
# Adequate resuscitation
** Monitor vital signs
** 0.9% NaCl 500ml and Hemohes 500ml.
** Prepare for blood transfusion (Whole blood or PRBC)
# Hemostasis (try 1 of the followings)
** Terlipressin(1mg/amp) 2mg stat + 1mg q6h
** Somatostatin(3mg/amp) 3mg q12h (in 250ml 0.9% NaCl)
# Prevent hepatic encephalopathy
** antibiotics: in VGHKS, we use cefazolin 1g q8h
** lactulose ( Max. 40ml q4h )
** enema if needed
# Prevent and monitor rebleeding
** NPO + IV fluid ( eg. D10W 1000ml + D5-1/2S 500ml qd )
** Monitor: vital signs, NG color, stool color
** F/U Hb and coagulation profile
# If still bleeding, try
** Direct balloon compression.
** Emergent EGD
# Arrange EGD when stable, for ligation/bending or other method to stop/ablate the cause.

The two arteries left on the gastric tube are the right gastric artery and the right gastro-omental artery. The upper portion of gastric tube gain its blood supply through mucosal or other collateral circulation. Some surgeon would like to preserve an artery and vein and connect them to neck vessels. Colon tube has a better blood supply.

For a patient with gastric tube to undergo tracheostomy, the incision site should be deviated from the mid-line to avoid direct connection between the surgical space.

For a patient with cancer, metastasis is the first cause to be rulled out. The pain is not likely to be alleviated by muscle relaxant or hypnotics.

If myofascial pain is considered, try to induce the pain with specific posture.

/***
|Name:|ExtentTagButtonPlugin|
|Description:|Adds a New tiddler button in the tag drop down|
|Version:|3.2 ($Rev: 3861 $)|
|Date:|$Date: 2008-03-08 10:53:09 +1000 (Sat, 08 Mar 2008) $|
|Source:|http://mptw.tiddlyspot.com/#ExtendTagButtonPlugin|
|Author:|Simon Baird <simon.baird@gmail.com>|
|License|http://mptw.tiddlyspot.com/#TheBSDLicense|
***/
//{{{

window.onClickTag_mptw_orig = window.onClickTag;
window.onClickTag = function(e) {
	window.onClickTag_mptw_orig.apply(this,arguments);
	var tag = this.getAttribute("tag");
	var title = this.getAttribute("tiddler");
	// Thanks Saq, you're a genius :)
	var popup = Popup.stack[Popup.stack.length-1].popup;
	createTiddlyElement(createTiddlyElement(popup,"li",null,"listBreak"),"div");
	wikify("<<newTiddler label:'New tiddler' tag:'"+tag+"'>>",createTiddlyElement(popup,"li"));
	return false;
}

//}}}

!!Etiology
* Malignancy
* infection
** The most common cause of FUO in south Taiwan is tuberculosis.
* autoimmune disease

* Congenital
* Aquired
** Posterior tibial tendon dysfunction
** Arthrosis of the tarsometatarsal joints, which may be primary or secondary to a previous Lisfranc fracture or dislocation
** Charcot changes in the midfoot resulting from a peripheral neuropathy
** Talonavicular collapse resulting from trauma or RA

Glucosamine improves motion function but provides very limited pain relief.  ~ by Dr. Yu at CCH.

!!!present as polyarthritis
*drug use: diuretics, cyclosporine, alcohol
*tophaceous gout
*steroid withdraw
*chronic gout without control

!!!Management in acute stage
* NSAIDs/COX-2 inhibitors +- colchicine
** Indomethacin 50mg TID (suggested by UpToDate)
** Colchicine 500mg q1h until pain relief or diarrhea or up to 6mg
** e.g. Ketorolac 30mg + colchicine 500mg q1h
* For those who can't take the medication above (e.g. renal impairment), consider:
** Prednisolone IV 30-50mg/day or other equivalent for 1-2 days.
** Subcutaneous glucocorticoids or ACTH injection for those unable to recieve oral medication.

!!!When to lower the uric acid in the intercritical stage
#UA > 13 in male; 12 in female.
#tophi(+)
#renal stones(+)
#CAD risk
#...

!!!Allopurinol dosage adjustment
|CCr(ml/min)|100|80|60|40|20|<20|
|Dose(mg)|300|250|200|150|100|100 qod|

!!!Which pathogen is invisible under Gram's stain?
* Mycoplasma
* Chlamydia
* Rickettsia
* Legionella
* Mycobacterium

HELLP stands for ''H''emolysis, ''E''levated ''L''iver enzymes, and ''L''ow ''P''latelet.

!!Diagnostic Tools
* ELISA for screening
* Western blot for confrmation
* Viral load
** for immediate diagnosis during which the ELISA will not reveal the infection (15-28 days)
** for diagnosis of inheritant infection since the antibody is always positive in the first 0.5-1 year
!!Malignancy associated with AIDS
* Kaposi sarcoma: HHV8
* Invasice cervical carcinoma: HPV 16,18
* High or intermediate grade Burkkit's lymphoma: EBV
* Primary CNS lymphoma: EBV

/***
|Name:|HideWhenPlugin|
|Description:|Allows conditional inclusion/exclusion in templates|
|Version:|3.1 ($Rev: 3919 $)|
|Date:|$Date: 2008-03-13 02:03:12 +1000 (Thu, 13 Mar 2008) $|
|Source:|http://mptw.tiddlyspot.com/#HideWhenPlugin|
|Author:|Simon Baird <simon.baird@gmail.com>|
|License:|http://mptw.tiddlyspot.com/#TheBSDLicense|
For use in ViewTemplate and EditTemplate. Example usage:
{{{<div macro="showWhenTagged Task">[[TaskToolbar]]</div>}}}
{{{<div macro="showWhen tiddler.modifier == 'BartSimpson'"><img src="bart.gif"/></div>}}}
***/
//{{{

window.hideWhenLastTest = false;

window.removeElementWhen = function(test,place) {
	window.hideWhenLastTest = test;
	if (test) {
		removeChildren(place);
		place.parentNode.removeChild(place);
	}
};


merge(config.macros,{

	hideWhen: { handler: function(place,macroName,params,wikifier,paramString,tiddler) {
		removeElementWhen( eval(paramString), place);
	}},

	showWhen: { handler: function(place,macroName,params,wikifier,paramString,tiddler) {
		removeElementWhen( !eval(paramString), place);
	}},

	hideWhenTagged: { handler: function (place,macroName,params,wikifier,paramString,tiddler) {
		removeElementWhen( tiddler.tags.containsAll(params), place);
	}},

	showWhenTagged: { handler: function (place,macroName,params,wikifier,paramString,tiddler) {
		removeElementWhen( !tiddler.tags.containsAll(params), place);
	}},

	hideWhenTaggedAny: { handler: function (place,macroName,params,wikifier,paramString,tiddler) {
		removeElementWhen( tiddler.tags.containsAny(params), place);
	}},

	showWhenTaggedAny: { handler: function (place,macroName,params,wikifier,paramString,tiddler) {
		removeElementWhen( !tiddler.tags.containsAny(params), place);
	}},

	hideWhenTaggedAll: { handler: function (place,macroName,params,wikifier,paramString,tiddler) {
		removeElementWhen( tiddler.tags.containsAll(params), place);
	}},

	showWhenTaggedAll: { handler: function (place,macroName,params,wikifier,paramString,tiddler) {
		removeElementWhen( !tiddler.tags.containsAll(params), place);
	}},

	hideWhenExists: { handler: function(place,macroName,params,wikifier,paramString,tiddler) {
		removeElementWhen( store.tiddlerExists(params[0]) || store.isShadowTiddler(params[0]), place);
	}},

	showWhenExists: { handler: function(place,macroName,params,wikifier,paramString,tiddler) {
		removeElementWhen( !(store.tiddlerExists(params[0]) || store.isShadowTiddler(params[0])), place);
	}},

	hideWhenTitleIs: { handler: function(place,macroName,params,wikifier,paramString,tiddler) {
		removeElementWhen( tiddler.title == params[0], place);
	}},

	showWhenTitleIs: { handler: function(place,macroName,params,wikifier,paramString,tiddler) {
		removeElementWhen( tiddler.title != params[0], place);
	}},

	'else': { handler: function(place,macroName,params,wikifier,paramString,tiddler) {
		removeElementWhen( !window.hideWhenLastTest, place);
	}}

});

//}}}

In Taiwan, the most common cause of hypothyroidism is operation for hyperthyroidism.

The usual dose of thyroxine supplement is 1.6-1.7 mcg/kg/day.

*Shoulder: 
** internal rotation
** lateral rotation
** Y view (sipraspiinatus outlet view)
** axillary view
* Elbow
** lateral view for radial head
** cubital tunnel view
** Wath if the fat aligned near the joint becomes buldged (Sail sign): joint effusion
* Wrist
** Routine: AP + lateral
** For pisiform: carpal tunnel view, supination oblique view
** For scaphoid: ulnar deviation PA view
*Hand
** AP + Oblique view
* Knee
** Tunnel view: flexion 30-45 degree
* Ankle
** mortis view: for fibulo-tarsal space

* Meatastasis and liver abscess: rapid growing.
* Hepatocellular carcinoma (HCC): slow growing, aterial phase enhancement.

For low density liver lesions, consider:
* thrombus hemangioma
* HCC with low vascularity

To assess neuralforamens
* Lateral view for the lumbar spine
* Oblique view for the cervical spine

The lumbar disc space:
* Thickest at L4-L5
* The L5-S1 space is relative narrow compared to L4-L5

Tumor of the spine
* posterior column: osteoblastoma, osteoid osteoma, aneurysmal bone cyst (ABC)
* anterior column: Ewing's sarcoma, hemangioma, eosinophilic granuloma (EG), ...

!!Image features of some viral infection
!!!HSV-1
*MRI: medial temporal lobe involvement, with high-signal-intensity lesions on T2WI; lesions in inferomedial region of temporal lobes; initially, MRI may be normal.
*EEG: distinctive EEG pattern: PLEDs after first few days; 17% of patients have a mild or atypical pattern that does not include focal findings.
!!!HHV-6
*CT: multiple hypodense lesions in cerebral cortex, putamen, or internal capsule.
*EEG: diffuse slowing following seizure activity.
!!!CMV
*MRI: microglial nodule involvement; increased periventricular signal and possibly enlarged ventricles on T2WI.
!!!VZV
*MRI: multifocal large or small ischemic or hemorrhageic infarctions in cortical or subcortical gray and white matter; spherical subcortical demyelinated white matter lesion.
!!!EBV
*MRI: normal or diffuse edema, or high intensity lesions on T2WI; may befleeting or fluctuating, suggesting IME; aqueductal stenosis is a potential complication.
*EEG: usually generalized slowing; occasional bursts of activity.
!!!Arboviruses
*MRI: nonspecific abnormalities; occasionally, may have focal abnormality.
!!!!La Crosse
*MRI: focal lesions are confined to temporal lobe, often associated with focal EEG abnormality.
!!!!SLE virus
*MRI: 33% show substantia nigra edema on T2WI.
*EEG: possible seizure discharges.
!!!!EEE
*MRI: focal lesions in basal ganglia, thalami, and brainstem.
!!!!JE
*MRI: hyperintense areas on T2WI and hypointense areas on T1WI; occasionally, signs of hemorrhagic transformations;multiple lesions involving the brainstem, basal ganglia, and bilateral thalami. Follow-up MRI studies show small residual lesions only.
!!!!HIV
*MRI: atrophy, diffuse white-matter attenuation.
!!!Enteroviruses
*MRIL normal or with some effacement; focal lesions are rare; hippocampi lesions have been reported.

!!Methods
!!!cast/splint
!!!!principles
*as thin as possible
*fittness
!!!!materials
*POP: since 1870. Molding 5-10min
*synthetic: initially developed by 3M. 4 layer is suffecient. Molding 3min. Some product: Plus, soft cast, prima.
!!!traction
*skin: no more than 7 punds. only for temporal use or children
*skeletal: comonly used at distal femur, proximal tibia, calcaneus
!!Benefit
to prevent deformity
**angulation
**displacement / shortening / lengthening
**rotation ( high probability of nonunion )
!!Adverse effect
Over-traction more than 3-5mm leads to nonunion.

!!!Management
*cochicine
*danazol (androgen analog): RR~70%
*azathioprime: RR~30%
*cychlophosphamide: RR~30%
*IVIG
*Plasmapheresis
**suitable for those with pulmonary hemorrhage
**1 dose of cyclophosphamide should be administrated to suppress the B-cell rebound)
*Splenectomy: for cases refractory to medical Tx. only effective for 0.5 year.

The vegetation of viridans-group //Streptococci// induced infective endocarditis is usually small.

/***
|Name:|InstantTimestampPlugin|
|Description:|A handy way to insert timestamps in your tiddler content|
|Version:|1.0.10 ($Rev: 3646 $)|
|Date:|$Date: 2008-02-27 02:34:38 +1000 (Wed, 27 Feb 2008) $|
|Source:|http://mptw.tiddlyspot.com/#InstantTimestampPlugin|
|Author:|Simon Baird <simon.baird@gmail.com>|
|License:|http://mptw.tiddlyspot.com/#TheBSDLicense|
!!Usage
If you enter {ts} in your tiddler content (without the spaces) it will be replaced with a timestamp when you save the tiddler. Full list of formats:
* {ts} or {t} -> timestamp
* {ds} or {d} -> datestamp
* !ts or !t at start of line -> !!timestamp
* !ds or !d at start of line -> !!datestamp
(I added the extra ! since that's how I like it. Remove it from translations below if required)
!!Notes
* Change the timeFormat and dateFormat below to suit your preference.
* See also http://mptw2.tiddlyspot.com/#AutoCorrectPlugin
* You could invent other translations and add them to the translations array below.
***/
//{{{

config.InstantTimestamp = {

	// adjust to suit
	timeFormat: 'DD/0MM/YY 0hh:0mm',
	dateFormat: 'DD/0MM/YY',

	translations: [
		[/^!ts?$/img,  "'!!{{ts{'+now.formatString(config.InstantTimestamp.timeFormat)+'}}}'"],
		[/^!ds?$/img,  "'!!{{ds{'+now.formatString(config.InstantTimestamp.dateFormat)+'}}}'"],

		// thanks Adapted Cat
		[/\{ts?\}(?!\}\})/ig,"'{{ts{'+now.formatString(config.InstantTimestamp.timeFormat)+'}}}'"],
		[/\{ds?\}(?!\}\})/ig,"'{{ds{'+now.formatString(config.InstantTimestamp.dateFormat)+'}}}'"]
		
	],

	excludeTags: [
		"noAutoCorrect",
		"noTimestamp",
		"html",
		"CSS",
		"css",
		"systemConfig",
		"systemConfigDisabled",
		"zsystemConfig",
		"Plugins",
		"Plugin",
		"plugins",
		"plugin",
		"javascript",
		"code",
		"systemTheme",
		"systemPalette"
	],

	excludeTiddlers: [
		"StyleSheet",
		"StyleSheetLayout",
		"StyleSheetColors",
		"StyleSheetPrint"
		// more?
	]

}; 

TiddlyWiki.prototype.saveTiddler_mptw_instanttimestamp = TiddlyWiki.prototype.saveTiddler;
TiddlyWiki.prototype.saveTiddler = function(title,newTitle,newBody,modifier,modified,tags,fields,clearChangeCount,created) {

	tags = tags ? tags : []; // just in case tags is null
	tags = (typeof(tags) == "string") ? tags.readBracketedList() : tags;
	var conf = config.InstantTimestamp;

	if ( !tags.containsAny(conf.excludeTags) && !conf.excludeTiddlers.contains(newTitle) ) {

		var now = new Date();
		var trans = conf.translations;
		for (var i=0;i<trans.length;i++) {
			newBody = newBody.replace(trans[i][0], eval(trans[i][1]));
		}
	}

	// TODO: use apply() instead of naming all args?
	return this.saveTiddler_mptw_instanttimestamp(title,newTitle,newBody,modifier,modified,tags,fields,clearChangeCount,created);
}

// you can override these in StyleSheet 
setStylesheet(".ts,.ds { font-style:italic; }","instantTimestampStyles");

//}}}

* Apple core lesion at barium enema: colon cancer, aneurysm, ...
* Pear shape bladder: extrinsic compression
* Onion skin of perostium: laminated periosteal reaction ~ acute osteomyelitis, osteosarcoma, Ewing's sarcoma.
* Eggshell calcification at mediastinum: silicosis, amyloidosis, sarcoidosis.
* Rice grain calcification in muscle: cysticercosis ( Taenia solium )
* Popcorn calcification
** in lung: harmatoma.
** in breast: fibroadenoma.
** in T2WI at the 4th ventricle: hemangioma.
* Bamboo spine: ankylosing spondylitis.
* Honeycomb lung: IPF, pneumoconiosis, sarcoidosis, collagen disease.
* Coffee bean colon: sigmoid colon volvulus.
* Honda sign ( bone scan at sacrum: osteoporotic fracture )
* Tortoise shell liver: schistosomiasis.

Metaclopramide may be perscribe for partial obstruction (flatus+), but is contraindicated in total obstruction.

Pathological fracture likely.

[[Management of kidney stones (BMJ 2007;334:468-472) |http://www.bmj.com/cgi/content/full/334/7591/468]] [[(Local file)|documents/manage_kidney_stones.pdf]]

!!!Ligaments
*anterior cruciate ligament (ACL)
*posterior cruciate ligament (PCL)
*medial collateral ligament (MCL)
*lateral collateral ligament (LCL)
!!!Physical examinations
!!!!ACL
*Lachman test
*anterior drawer test
*pivot shift test
!!!!PCL
*posterior drawer test
!!!!MCL
*valgus stress test
!!!!LCL
*varus stress test
!!!Other
*terrible triad: ACL tear, posterior horn medial meniscus tear, MCL tear.

/***
|Name:|LessBackupsPlugin|
|Description:|Intelligently limit the number of backup files you create|
|Version:|3.0.1 ($Rev: 2320 $)|
|Date:|$Date: 2007-06-18 22:37:46 +1000 (Mon, 18 Jun 2007) $|
|Source:|http://mptw.tiddlyspot.com/#LessBackupsPlugin|
|Author:|Simon Baird|
|Email:|simon.baird@gmail.com|
|License:|http://mptw.tiddlyspot.com/#TheBSDLicense|
!!Description
You end up with just backup one per year, per month, per weekday, per hour, minute, and second.  So total number won't exceed about 200 or so. Can be reduced by commenting out the seconds/minutes/hours line from modes array
!!Notes
Works in IE and Firefox only.  Algorithm by Daniel Baird. IE specific code by by Saq Imtiaz.
***/
//{{{

var MINS  = 60 * 1000;
var HOURS = 60 * MINS;
var DAYS  = 24 * HOURS;

if (!config.lessBackups) {
	config.lessBackups = {
		// comment out the ones you don't want or set config.lessBackups.modes in your 'tweaks' plugin
		modes: [
			["YYYY",  365*DAYS], // one per year for ever
			["MMM",   31*DAYS],  // one per month
			["ddd",   7*DAYS],   // one per weekday
			//["d0DD",  1*DAYS],   // one per day of month
			["h0hh",  24*HOURS], // one per hour
			["m0mm",  1*HOURS],  // one per minute
			["s0ss",  1*MINS],   // one per second
			["latest",0]         // always keep last version. (leave this).
		]
	};
}

window.getSpecialBackupPath = function(backupPath) {

	var now = new Date();

	var modes = config.lessBackups.modes;

	for (var i=0;i<modes.length;i++) {

		// the filename we will try
		var specialBackupPath = backupPath.replace(/(\.)([0-9]+\.[0-9]+)(\.html)$/,
				'$1'+now.formatString(modes[i][0]).toLowerCase()+'$3')

		// open the file
		try {
			if (config.browser.isIE) {
				var fsobject = new ActiveXObject("Scripting.FileSystemObject")
				var fileExists  = fsobject.FileExists(specialBackupPath);
				if (fileExists) {
					var fileObject = fsobject.GetFile(specialBackupPath);
					var modDate = new Date(fileObject.DateLastModified).valueOf();
				}
			}
			else {
				netscape.security.PrivilegeManager.enablePrivilege("UniversalXPConnect");
				var file = Components.classes["@mozilla.org/file/local;1"].createInstance(Components.interfaces.nsILocalFile);
				file.initWithPath(specialBackupPath);
				var fileExists = file.exists();
				if (fileExists) {
					var modDate = file.lastModifiedTime;
				}
			}
		}
		catch(e) {
			// give up
			return backupPath;
		}

		// expiry is used to tell if it's an 'old' one. Eg, if the month is June and there is a
		// June file on disk that's more than an month old then it must be stale so overwrite
		// note that "latest" should be always written because the expiration period is zero (see above)
		var expiry = new Date(modDate + modes[i][1]);
		if (!fileExists || now > expiry)
			return specialBackupPath;
	}
}

// hijack the core function
window.getBackupPath_mptw_orig = window.getBackupPath;
window.getBackupPath = function(localPath) {
	return getSpecialBackupPath(getBackupPath_mptw_orig(localPath));
}

//}}}

* Acompannied by unilateral right side pleural effusion sometimes.
* unilateral left side pleural effusion is rarely seen.

* hyperdense noted at the other side suggests a congenital defect with contralateral stress reation.

MPTW is a distribution or edition of TiddlyWiki that includes a standard TiddlyWiki core packaged with some plugins designed to improve usability and provide a better way to organise your information. For more information see http://mptw.tiddlyspot.com/.

GettingStarted
TabTags

* "Exvert" is for general purpose, especially the skin.
* "Invert" is used in GI tract anastomosis.

* Vertical mattress is common
* Horizontal mattress is used in ligation of muscle and tendon.

If any level of mitral regurgitation coexists with mitral stenosis, balloon dilation should not be performed because it may worthen the regurgitation.

3% of MGUS will become multiple myeloma each year.

Name: MptwBlack
Background: #000
Foreground: #fff
PrimaryPale: #333
PrimaryLight: #555
PrimaryMid: #888
PrimaryDark: #aaa
SecondaryPale: #111
SecondaryLight: #222
SecondaryMid: #555
SecondaryDark: #888
TertiaryPale: #222
TertiaryLight: #666
TertiaryMid: #888
TertiaryDark: #aaa
Error: #300

This is in progress. Help appreciated.

Name: MptwBlue
Background: #fff
Foreground: #000
PrimaryPale: #cdf
PrimaryLight: #57c
PrimaryMid: #114
PrimaryDark: #012
SecondaryPale: #ffc
SecondaryLight: #fe8
SecondaryMid: #db4
SecondaryDark: #841
TertiaryPale: #eee
TertiaryLight: #ccc
TertiaryMid: #999
TertiaryDark: #666
Error: #f88

/***
|Name:|MptwConfigPlugin|
|Description:|Miscellaneous tweaks used by MPTW|
|Version:|1.0 ($Rev: 3646 $)|
|Date:|$Date: 2008-02-27 02:34:38 +1000 (Wed, 27 Feb 2008) $|
|Source:|http://mptw.tiddlyspot.com/#MptwConfigPlugin|
|Author:|Simon Baird <simon.baird@gmail.com>|
|License:|http://mptw.tiddlyspot.com/#MptwConfigPlugin|
!!Note: instead of editing this you should put overrides in MptwUserConfigPlugin
***/
//{{{
var originalReadOnly = readOnly;
var originalShowBackstage = showBackstage;

config.options.chkHttpReadOnly = false; 		// means web visitors can experiment with your site by clicking edit
readOnly = false;								// needed because the above doesn't work any more post 2.1 (??)
showBackstage = true;							// show backstage for same reason

config.options.chkInsertTabs = true;    		// tab inserts a tab when editing a tiddler
config.views.wikified.defaultText = "";			// don't need message when a tiddler doesn't exist
config.views.editor.defaultText = "";			// don't need message when creating a new tiddler 

config.options.chkSaveBackups = true;			// do save backups
config.options.txtBackupFolder = 'twbackup';	// put backups in a backups folder

config.options.chkAutoSave = (window.location.protocol == "file:"); // do autosave if we're in local file

config.mptwVersion = "2.4.4";

config.macros.mptwVersion={handler:function(place){wikify(config.mptwVersion,place);}};

if (config.options.txtTheme == '')
	config.options.txtTheme = 'MptwTheme';

// add to default GettingStarted
config.shadowTiddlers.GettingStarted += "\n\nSee also [[MPTW]].";

// add select theme and palette controls in default OptionsPanel
config.shadowTiddlers.OptionsPanel = config.shadowTiddlers.OptionsPanel.replace(/(\n\-\-\-\-\nAlso see AdvancedOptions)/, "{{select{<<selectTheme>>\n<<selectPalette>>}}}$1");

// these are used by ViewTemplate
config.mptwDateFormat = 'DD/MM/YY';
config.mptwJournalFormat = 'Journal DD/MM/YY';

//}}}

Name: MptwGreen
Background: #fff
Foreground: #000
PrimaryPale: #9b9
PrimaryLight: #385
PrimaryMid: #031
PrimaryDark: #020
SecondaryPale: #ffc
SecondaryLight: #fe8
SecondaryMid: #db4
SecondaryDark: #841
TertiaryPale: #eee
TertiaryLight: #ccc
TertiaryMid: #999
TertiaryDark: #666
Error: #f88

Name: MptwRed
Background: #fff
Foreground: #000
PrimaryPale: #eaa
PrimaryLight: #c55
PrimaryMid: #711
PrimaryDark: #500
SecondaryPale: #ffc
SecondaryLight: #fe8
SecondaryMid: #db4
SecondaryDark: #841
TertiaryPale: #eee
TertiaryLight: #ccc
TertiaryMid: #999
TertiaryDark: #666
Error: #f88

|Name|MptwRounded|
|Description|Mptw Theme with some rounded corners (Firefox only)|
|ViewTemplate|MptwTheme##ViewTemplate|
|EditTemplate|MptwTheme##EditTemplate|
|PageTemplate|MptwTheme##PageTemplate|
|StyleSheet|##StyleSheet|

!StyleSheet
/*{{{*/

[[MptwTheme##StyleSheet]]

.tiddler,
.sliderPanel,
.button,
.tiddlyLink,
.tabContents
{ -moz-border-radius: 1em; }

.tab {
	-moz-border-radius-topleft: 0.5em;
	-moz-border-radius-topright: 0.5em;
}
#topMenu {
	-moz-border-radius-bottomleft: 2em;
	-moz-border-radius-bottomright: 2em;
}

/*}}}*/

Name: MptwSmoke
Background: #fff
Foreground: #000
PrimaryPale: #aaa
PrimaryLight: #777
PrimaryMid: #111
PrimaryDark: #000
SecondaryPale: #ffc
SecondaryLight: #fe8
SecondaryMid: #db4
SecondaryDark: #841
TertiaryPale: #eee
TertiaryLight: #ccc
TertiaryMid: #999
TertiaryDark: #666
Error: #f88

|Name|MptwStandard|
|Description|Mptw Theme with the default TiddlyWiki PageLayout and Styles|
|ViewTemplate|MptwTheme##ViewTemplate|
|EditTemplate|MptwTheme##EditTemplate|

Name: MptwTeal
Background: #fff
Foreground: #000
PrimaryPale: #B5D1DF
PrimaryLight: #618FA9
PrimaryMid: #1a3844
PrimaryDark: #000
SecondaryPale: #ffc
SecondaryLight: #fe8
SecondaryMid: #db4
SecondaryDark: #841
TertiaryPale: #f8f8f8
TertiaryLight: #bbb
TertiaryMid: #999
TertiaryDark: #888
Error: #f88

|Name|MptwTheme|
|Description|Mptw Theme including custom PageLayout|
|PageTemplate|##PageTemplate|
|ViewTemplate|##ViewTemplate|
|EditTemplate|##EditTemplate|
|StyleSheet|##StyleSheet|

http://mptw.tiddlyspot.com/#MptwTheme ($Rev: 1829 $)

!PageTemplate
<!--{{{-->
<div class='header' macro='gradient vert [[ColorPalette::PrimaryLight]] [[ColorPalette::PrimaryMid]]'>
	<div class='headerShadow'>
		<span class='siteTitle' refresh='content' tiddler='SiteTitle'></span>&nbsp;
		<span class='siteSubtitle' refresh='content' tiddler='SiteSubtitle'></span>
	</div>
	<div class='headerForeground'>
		<span class='siteTitle' refresh='content' tiddler='SiteTitle'></span>&nbsp;
		<span class='siteSubtitle' refresh='content' tiddler='SiteSubtitle'></span>
	</div>
</div>
<!-- horizontal MainMenu -->
<div id='topMenu' refresh='content' tiddler='MainMenu'></div>
<!-- original MainMenu menu -->
<!-- <div id='mainMenu' refresh='content' tiddler='MainMenu'></div> -->
<div id='sidebar'>
	<div id='sidebarOptions' refresh='content' tiddler='SideBarOptions'></div>
	<div id='sidebarTabs' refresh='content' force='true' tiddler='SideBarTabs'></div>
</div>
<div id='displayArea'>
	<div id='messageArea'></div>
	<div id='tiddlerDisplay'></div>
</div>
<!--}}}-->

!ViewTemplate
<!--{{{-->
[[MptwTheme##ViewTemplateToolbar]]

<div class="tagglyTagged" macro="tags"></div>

<div class='titleContainer'>
	<span class='title' macro='view title'></span>
	<span macro="miniTag"></span>
</div>

<div class='subtitle'>
	(updated <span macro='view modified date {{config.mptwDateFormat?config.mptwDateFormat:"MM/0DD/YY"}}'></span>
	by <span macro='view modifier link'></span>)
	<!--
	(<span macro='message views.wikified.createdPrompt'></span>
	<span macro='view created date {{config.mptwDateFormat?config.mptwDateFormat:"MM/0DD/YY"}}'></span>)
	-->
</div>

<div macro="showWhen tiddler.tags.containsAny(['css','html','pre','systemConfig']) && !tiddler.text.match('{{'+'{')">
	<div class='viewer'><pre macro='view text'></pre></div>
</div>
<div macro="else">
	<div class='viewer' macro='view text wikified'></div>
</div>

<div class="tagglyTagging" macro="tagglyTagging"></div>

<!--}}}-->

!ViewTemplateToolbar
<!--{{{-->
<div class='toolbar'>
	<span macro="showWhenTagged systemConfig">
		<span macro="toggleTag systemConfigDisable . '[[disable|systemConfigDisable]]'"></span>
	</span>
	<span macro="showWhenTagged systemTheme"><span macro="applyTheme"></span></span>
	<span macro="showWhenTagged systemPalette"><span macro="applyPalette"></span></span>
	<span macro="showWhen tiddler.tags.contains('css') || tiddler.title == 'StyleSheet'"><span macro="refreshAll"></span></span>
	<span style="padding:1em;"></span>
	<span macro='toolbar closeTiddler closeOthers +editTiddler deleteTiddler > fields syncing permalink references jump'></span> <span macro='newHere label:"new here"'></span>
	<span macro='newJournalHere {{config.mptwJournalFormat?config.mptwJournalFormat:"MM/0DD/YY"}}'></span>
</div>
<!--}}}-->

!EditTemplate
<!--{{{-->
<div class="toolbar" macro="toolbar +saveTiddler saveCloseTiddler closeOthers -cancelTiddler cancelCloseTiddler deleteTiddler"></div>
<div class="title" macro="view title"></div>
<div class="editLabel">Title</div><div class="editor" macro="edit title"></div>
<div macro='annotations'></div>
<div class="editLabel">Content</div><div class="editor" macro="edit text"></div>
<div class="editLabel">Tags</div><div class="editor" macro="edit tags"></div>
<div class="editorFooter"><span macro="message views.editor.tagPrompt"></span><span macro="tagChooser"></span></div>
<!--}}}-->

!StyleSheet
/*{{{*/

/* a contrasting background so I can see where one tiddler ends and the other begins */
body {
	background: [[ColorPalette::TertiaryLight]];
}

/* sexy colours and font for the header */
.headerForeground {
	color: [[ColorPalette::PrimaryPale]];
}
.headerShadow, .headerShadow a {
	color: [[ColorPalette::PrimaryMid]];
}

/* separate the top menu parts */
.headerForeground, .headerShadow {
	padding: 1em 1em 0;
}

.headerForeground, .headerShadow {
	font-family: 'Trebuchet MS' sans-serif;
	font-weight:bold;
}
.headerForeground .siteSubtitle {
	color: [[ColorPalette::PrimaryLight]];
}
.headerShadow .siteSubtitle {
	color: [[ColorPalette::PrimaryMid]];
}

/* make shadow go and down right instead of up and left */
.headerShadow {
	left: 1px;
	top: 1px;
}

/* prefer monospace for editing */
.editor textarea, .editor input {
	font-family: 'Consolas' monospace;
	background-color:[[ColorPalette::TertiaryPale]];
}


/* sexy tiddler titles */
.title {
	font-size: 250%;
	color: [[ColorPalette::PrimaryLight]];
	font-family: 'Trebuchet MS' sans-serif;
}

/* more subtle tiddler subtitle */
.subtitle {
	padding:0px;
	margin:0px;
	padding-left:1em;
	font-size: 90%;
	color: [[ColorPalette::TertiaryMid]];
}
.subtitle .tiddlyLink {
	color: [[ColorPalette::TertiaryMid]];
}

/* a little bit of extra whitespace */
.viewer {
	padding-bottom:3px;
}

/* don't want any background color for headings */
h1,h2,h3,h4,h5,h6 {
	background-color: transparent;
	color: [[ColorPalette::Foreground]];
}

/* give tiddlers 3d style border and explicit background */
.tiddler {
	background: [[ColorPalette::Background]];
	border-right: 2px [[ColorPalette::TertiaryMid]] solid;
	border-bottom: 2px [[ColorPalette::TertiaryMid]] solid;
	margin-bottom: 1em;
	padding:1em 2em 2em 1.5em;
}

/* make options slider look nicer */
#sidebarOptions .sliderPanel {
	border:solid 1px [[ColorPalette::PrimaryLight]];
}

/* the borders look wrong with the body background */
#sidebar .button {
	border-style: none;
}

/* this means you can put line breaks in SidebarOptions for readability */
#sidebarOptions br {
	display:none;
}
/* undo the above in OptionsPanel */
#sidebarOptions .sliderPanel br {
	display:inline;
}

/* horizontal main menu stuff */
#displayArea {
	margin: 1em 15.7em 0em 1em; /* use the freed up space */
}
#topMenu br {
	display: none;
}
#topMenu {
	background: [[ColorPalette::PrimaryMid]];
	color:[[ColorPalette::PrimaryPale]];
}
#topMenu {
	padding:2px;
}
#topMenu .button, #topMenu .tiddlyLink, #topMenu a {
	margin-left: 0.5em;
	margin-right: 0.5em;
	padding-left: 3px;
	padding-right: 3px;
	color: [[ColorPalette::PrimaryPale]];
	font-size: 115%;
}
#topMenu .button:hover, #topMenu .tiddlyLink:hover {
	background: [[ColorPalette::PrimaryDark]];
}

/* make 2.2 act like 2.1 with the invisible buttons */
.toolbar {
	visibility:hidden;
}
.selected .toolbar {
	visibility:visible;
}

/* experimental. this is a little borked in IE7 with the button 
 * borders but worth it I think for the extra screen realestate */
.toolbar { float:right; }

/* fix for TaggerPlugin. from sb56637. improved by FND */
.popup li .tagger a {
   display:inline;
}

/* makes theme selector look a little better */
#sidebarOptions .sliderPanel .select .button {
  padding:0.5em;
  display:block;
}
#sidebarOptions .sliderPanel .select br {
	display:none;
}

/* make it print a little cleaner */
@media print {
	#topMenu {
		display: none ! important;
	}
	/* not sure if we need all the importants */
	.tiddler {
		border-style: none ! important;
		margin:0px ! important;
		padding:0px ! important;
		padding-bottom:2em ! important;
	}
	.tagglyTagging .button, .tagglyTagging .hidebutton {
		display: none ! important;
	}
	.headerShadow {
		visibility: hidden ! important;
	}
	.tagglyTagged .quickopentag, .tagged .quickopentag {
		border-style: none ! important;
	}
	.quickopentag a.button, .miniTag {
		display: none ! important;
	}
}

/* get user styles specified in StyleSheet */
[[StyleSheet]]

/*}}}*/

|Name|MptwTrim|
|Description|Mptw Theme with a reduced header to increase useful space|
|ViewTemplate|MptwTheme##ViewTemplate|
|EditTemplate|MptwTheme##EditTemplate|
|StyleSheet|MptwTheme##StyleSheet|
|PageTemplate|##PageTemplate|

!PageTemplate
<!--{{{-->

<!-- horizontal MainMenu -->
<div id='topMenu' macro='gradient vert [[ColorPalette::PrimaryLight]] [[ColorPalette::PrimaryMid]]'>
<span refresh='content' tiddler='SiteTitle' style="padding-left:1em;font-weight:bold;"></span>:
<span refresh='content' tiddler='MainMenu'></span>
</div>
<div id='sidebar'>
	<div id='sidebarOptions'>
		<div refresh='content' tiddler='SideBarOptions'></div>
		<div style="margin-left:0.1em;"
			macro='slider chkTabSliderPanel SideBarTabs {{"tabs \u00bb"}} "Show Timeline, All, Tags, etc"'></div>
	</div>
</div>
<div id='displayArea'>
	<div id='messageArea'></div>
	<div id='tiddlerDisplay'></div>
</div>

For upgrading. See [[ImportTiddlers]].
URL: http://mptw.tiddlyspot.com/upgrade.html

/***
|Description:|A place to put your config tweaks so they aren't overwritten when you upgrade MPTW|
See http://www.tiddlywiki.org/wiki/Configuration_Options for other options you can set. In some cases where there are clashes with other plugins it might help to rename this to zzMptwUserConfigPlugin so it gets executed last.
***/
//{{{

// example: set your preferred date format
//config.mptwDateFormat = 'MM/0DD/YY';
//config.mptwJournalFormat = 'Journal MM/0DD/YY';

// example: set the theme you want to start with
//config.options.txtTheme = 'MptwRoundTheme';

// example: switch off autosave, switch on backups and set a backup folder
//config.options.chkSaveBackups = true;
//config.options.chkAutoSave = false;
//config.options.txtBackupFolder = 'backups';

//}}}

* Bone scan may reveal no lesions.

!!Etiology
* //Staphylococcus aureas//
* //Samonella// ( In the 90's Taiwan, //Samonella choleraesuis// is the first cause of mycotic aneurysm.)
* Syphilis (at ascending aorta)
* Some GNB: eg. //Klebsiella pneumoniae//
* Meliodosis
* Tuberculosis

# The leakage rate was estimated to be 26-30%.
# Leackage in 1-3 days after surgery may indicate technical failure. Watch if mediastinitis occur.
# Leakage during 5-7 days after surgery may indicate tissue ischemia around the anastomosis site.

/***
|Name:|NewHerePlugin|
|Description:|Creates the new here and new journal macros|
|Version:|3.0 ($Rev: 3861 $)|
|Date:|$Date: 2008-03-08 10:53:09 +1000 (Sat, 08 Mar 2008) $|
|Source:|http://mptw.tiddlyspot.com/#NewHerePlugin|
|Author:|Simon Baird <simon.baird@gmail.com>|
|License|http://mptw.tiddlyspot.com/#TheBSDLicense|
***/
//{{{
merge(config.macros, {
	newHere: {
		handler: function(place,macroName,params,wikifier,paramString,tiddler) {
			wikify("<<newTiddler "+paramString+" tag:[["+tiddler.title+"]]>>",place,null,tiddler);
		}
	},
	newJournalHere: {
		handler: function(place,macroName,params,wikifier,paramString,tiddler) {
			wikify("<<newJournal "+paramString+" tag:[["+tiddler.title+"]]>>",place,null,tiddler);
		}
	}
});

//}}}

/***
|Name:|NewMeansNewPlugin|
|Description:|If 'New Tiddler' already exists then create 'New Tiddler (1)' and so on|
|Version:|1.1 ($Rev: 2263 $)|
|Date:|$Date: 2007-06-13 04:22:32 +1000 (Wed, 13 Jun 2007) $|
|Source:|http://mptw.tiddlyspot.com/empty.html#NewMeansNewPlugin|
|Author:|Simon Baird <simon.baird@gmail.com>|
|License|http://mptw.tiddlyspot.com/#TheBSDLicense|
!!Note: I think this should be in the core
***/
//{{{

String.prototype.getNextFreeName = function() {
       var numberRegExp = / \(([0-9]+)\)$/;
       var match = numberRegExp.exec(this);
       if (match) {
               var num = parseInt(match[1]) + 1;
               return this.replace(numberRegExp," ("+num+")");
       }
       else {
               return this + " (1)";
       }
}

config.macros.newTiddler.checkForUnsaved = function(newName) {
	var r = false;
	story.forEachTiddler(function(title,element) {
		if (title == newName)
			r = true;
	});
	return r;
}

config.macros.newTiddler.getName = function(newName) {
       while (store.getTiddler(newName) || config.macros.newTiddler.checkForUnsaved(newName))
               newName = newName.getNextFreeName();
       return newName;
}


config.macros.newTiddler.onClickNewTiddler = function()
{
	var title = this.getAttribute("newTitle");
	if(this.getAttribute("isJournal") == "true") {
		var now = new Date();
		title = now.formatString(title.trim());
	}

	title = config.macros.newTiddler.getName(title); // <--- only changed bit

	var params = this.getAttribute("params");
	var tags = params ? params.split("|") : [];
	var focus = this.getAttribute("newFocus");
	var template = this.getAttribute("newTemplate");
	var customFields = this.getAttribute("customFields");
	story.displayTiddler(null,title,template,false,null,null);
	var tiddlerElem = document.getElementById(story.idPrefix + title);
	if(customFields)
		story.addCustomFields(tiddlerElem,customFields);
	var text = this.getAttribute("newText");
	if(typeof text == "string")
		story.getTiddlerField(title,"text").value = text.format([title]);
	for(var t=0;t<tags.length;t++)
		story.setTiddlerTag(title,tags[t],+1);
	story.focusTiddler(title,focus);
	return false;
};

//}}}

[[MyPACS|http://www.mypacs.net/]]
[[Learning Radiology|http://www.learningradiology.com/]]

!!Classification
!!!!Insulin secretagogues
*Sulphonylurea
**Glimepiride (Amaryl)
**Glibencalmide (Euglucon)
**Gliclazide (Diamicron)
**Glipizide (Minidiab)
**Gliquidone (Glurenorm)
*Meglitinide (short acting)
**Benzoic acid: Repaglinide (Novonorm)
**δ-pheylalanine: Nateglinide (Starlix)
!!!!Insulin sensitizers
*Biguanides
**Metformin (Glucophage)
*Glitazones
**Rosiglitazone (Avandia)
**Pioglitazone (Actos)
!!!!Delayed glucose absorption / α-glucosidease inhibitors
**Acarbose (glucobay)
**Miglitol
**Voglibose
!!!!Depeptidyl peptidase IV inhibitors
**Sitdagliptin (Januvia)
**Vildagliptin (Glavus)

|Pharmacokinetics|c
|!OAA|!Dose(mg)|!Meta|!Excretion|!t~~1/2~~(hr)|!Onset(hr)|!Peak(hr)|!Duration(hr)|
|Glibenclamide Euglucon (5mg)| 2.5-20 | liver | K/B: 50/50 | 10 | 1.5 | 1-2 | 24 |
|Gliclazide Diamicron (80mg)| 40-320 | liver | K/B: 70/20 | 6-12 | 2-3 || 16-24 |
|Glipizide Minidiab (5mg)| 2.5-40 | liver | K: 68 | 2-4 | 1 | 0.5-2 | 15-24 |
|Gliquidone Glurenorm (30mg)| 15-180 | liver | K/B: 5/95 | 1.5 | 2-3 || 8-12 |
|Glimepiride Amaryl (2mg)| 1-8 | liver | K/B: 60/40 | 5-9 | 2 | 2-3 | 24 |
|Repaglinide Novonorm (1mg) | 1-16 | liver | K/B: 8 | 1 | 0.5 | 1 | <4 |
|Metformin Glucophage (500mg)| 500-3000 | - | K: 90 | 1.5-4.9 | 1.5 | 2-4 | 16-20 |
|Acarbose Glucobay (50mg)| 75-600 | GI | B | 1-2 | 0.5 || 4 |

!!!Sulphonylurea
*Mechanism: stimulate insulin secretion (activation of sulphonylurea receptors on β-cells, K channels X, Ca influx↑)
*Reduction in HbA~~1~~C: 1-2
*Advantages: lower fasting blood sugar
*Disadvantages: hypoglycemia, weight gain, hyperinsulinemia
*Contraindications: renal, liver disease
!!!Meglitinide
*Mechanism: stimulate insulin secretion, ATP-sensitive K channel X
*Reduction in HbA~~1~~C: 1-2 (weaker then sulphonylurea)
*Advantages: short onset, lower postprandial blood sugar
*Disadvantages: hypoglycemia
*Contraindications: liver disease
*rapidly asorbed from the intestine, complete metabolism in the liver and inactive biliary products.
*metabolism: P4503A4
*may be useful in patients with renal impairment or in the eldery
!!!!δ-Phenylalanine derivative
*mechanism similar to meglitinide
*rapidly asorbed from the intestine, peak within 1hr.
*metabolized in the liver; plasma half life: 1.5hr.

OCD; osteochondral fracture.

PSA may not rise in poorly differentiated prostate cancer

!Imaging
* cortex thickening
* bone enlargement
* from bone end to shaft

Post-traumatic myositis ossificans of the medial collateral ligament of the knee.

For those with recurrent malignant pleural effusion requiring repeated pericardiocentasis. Since the mean survival of these patients was estimated to be 3 months, peritoneal seeding was not of concern clinically.

Procedures:
* Incise the mid-line at the xiphoid area
* Remove the xiphoid process
* Open the pericardium, drain those fluid.
* Create a hole on the pericardium-diaphragm-peritoneum complex.
* Secure the hole (e.g. with hemo-clips....)
* Close the pericardial hole???
* Close the wound.

!Cardiovascular
* The resulst of estrogen
** activation of renin-angiotensin - aldosterone: increased blood volume
** secretion of PGI~~2~~, E~~2~~, NO: vasodilation, decreased resistance, lower BP.
* Cytotrophoblast invasion resulted in decreased resistance.
|Cardiac output (C.O.) during pregnancy|c
|!|!non-preg|!preg 20-24|!preg 28-32|!preg 38-40|!labor(early)|!labor(late)|!labor(2nd stage)|!postpartum|
|!C.O.(L/min)|5|6.8|7.1|5.8|6.2|7.2|8.9|9.3|
Interpretations:
*The increased C.O. in early most time of pregnancy is the result of both increased stroke volume and heart rate.
*The decreased C.O. in late pregnancy is caused by decreased stroke volume (the HR keeps rising) due to compression of the IVC.
*At the postpartum stage, no more IVC compression and delivery of placenta cause increased intravascular volume and increased preload, which is resbonsable for the highest cardiac output throughout the whole period. So it is not surprise that patients with heart failure have high risk of decompensation and pulmonary edema at this stage.
!The lungs and oxygenation
* Increased tidal volume: from 500 to 700ml
* Increased minute ventilation: 40% increase, from 7.5 to 10.5 L/min
** This effect is attributed to progesterone, which induce deep breath without significant increase in frequency.
** Therefore, ABG in a pregnant woman showed: PCO~~2~~ 30(27-32)mmHg; HCO~~3~~^^-^^ 20meq/L.
* The residual volume is reduced from 1500ml to 1200ml as the result of upward displacement of the diaphragm. This contributes to increased risk of atelectasis.
!Increased susceptibility to major cardiovascular and respiratory insult
* increased metabolic rate and O~~2~~ consumption.
* reduced FRC may induce collapse shunt and is associated with high mortality and morbidity of pneumonia.
* low HCO~~3~~^^-^^: less buffer to prevent acidosis
* low oncotic pressure and increased hydrostatic pressure: predisposed to pulmonary edema and peripheral edema.
* low vascular resistance, high uterine flow, and compression of vessels from the enlarged uterine: Intolerance to shock.
!Gastroenterological
*Nausea and vomiting: hyperemesis (other causes should be excluded first)
*Gastric reflux and long emptying time increases the risk of aspiration.
!Hematologic
* leukocytosis: may rise to 11k/cumm with normal differential count.
* anemia: dilutional anemia is physiological so only Hgb < 11g/dl is problematic.
* Hypercoagulation state resulted in increased risk of thromboembolism ~5x normal patients.
!The control of sugar
* HPL is a substance secreted from the placenta and increases insulin resistance. This is the major cause of gestational diabetes mellitus (GDM). As HPL decay within minutes, it is not necessary to administrate insulin for those with GDM after delivery.
* Glycosuria might develop easily compared to those non-pregnant patients.

Microadenoma < 1cm
On MRI dynamic contrast images: slow enhancement and slow decay compared to normal pituitary.

Consider asbestosis
[[Asbestos-Related Pleural Disease|http://www.learningradiology.com/archives06/COW%20199-Asbestos-related%20Pleural%20Disease/asbestosrelatedcorrect.html]]

Empyema might appear with similar images. However these lesions are likely to be continuous with less involvement of the medial side, which is different from pleural plaque resulting from abestosis.

!Imaging
** subpleural region: clear, symmetric.
** with progressive massive fibrosis: confluent nodules.

!Pathogens
!!Pathogens of community-aquired pneumonia (CAP)
#//Strepetococcus pneumoniae//
#//Mycoplasma pneumoniae//
#//Chlamydia pneumoniae//
#Virus
#//Staphylococcus aureus//
!!!Legionella
Available urine antigen test for legionella only include serotype 1, which means that a negative result does not exclude the diagnosis of legionella pneumonia.

!!Antibiotic treatment for pneumonia
!!!Strategy
*In the US, fluoroquinolone is the 1st line antimicrobial agent for CAP.
*in Taiwan, macrolide is the 1st line antimicrobial agent for CAP.
!!!Dosage
*Clindamycin: 600mg q8h
*Penicillin: 300mg q6h
*Levofloxacin: 500mg qd (for usual GNB pneumonia), 750mg (for pseudomonas pneumonia). Renal function should be considered.

!!Imaging
* CP angle lucency +pleural line.
* Massive spontaneous pneumothorax may present with pleural fluid / hydropneumothorax.
* A female with spontaneous pneumothorax + ground glass nodule on CXR: consider catamenia / endometrosis.

* 1357 rules
** D+1: atelectasis
** D+3: lines infection
** D+5: wound infection
** D+7: anastomotic leakage

!!Associated diseases
*HELLP syndrome
!!Pharmacological therapy
!!!MgSO~~4~~
*for prevention of seizures
*Dosage: 4g stat + 1~2 g/day (adjust according to urine output)
*other agents include diazepam and phenytoin ( only used after delivery )
!!!nifedipine
*5mg is prefered by VGHKS Dr. 卓
!!!labetalol
*400mg (80ml) in 0.9%NaCl 120ml; 20mg/hr=10ml/hr
*increase 20mg/hr every 30mins, max 160mg/hr
!!!ACE-i
*may induce cardiovascular system and CNS developmental defect in the 1st trimester
*may cause low perfusion pressure, fetal oligouria, limb defect, IUFD in the 2nd trimester
!!!Furosemide
*only used in treating pulmoary edema, CHF
*adverse effect: ototoxicity, low utetus-placenta flow, should no be perscribed in the 1st trimester and during breast feeding.
!!!Thiazide
*associated with low uterus-placenta perfusion and less breast secretion.

/***
|Name:|PrettyDatesPlugin|
|Description:|Provides a new date format ('pppp') that displays times such as '2 days ago'|
|Version:|1.0 ($Rev: 3646 $)|
|Date:|$Date: 2008-02-27 02:34:38 +1000 (Wed, 27 Feb 2008) $|
|Source:|http://mptw.tiddlyspot.com/#PrettyDatesPlugin|
|Author:|Simon Baird <simon.baird@gmail.com>|
|License:|http://mptw.tiddlyspot.com/#TheBSDLicense|
!!Notes
* If you want to you can rename this plugin. :) Some suggestions: LastUpdatedPlugin, RelativeDatesPlugin, SmartDatesPlugin, SexyDatesPlugin.
* Inspired by http://ejohn.org/files/pretty.js
***/
//{{{
Date.prototype.prettyDate = function() {
	var diff = (((new Date()).getTime() - this.getTime()) / 1000);
	var day_diff = Math.floor(diff / 86400);

	if (isNaN(day_diff))      return "";
	else if (diff < 0)        return "in the future";
	else if (diff < 60)       return "just now";
	else if (diff < 120)      return "1 minute ago";
	else if (diff < 3600)     return Math.floor(diff/60) + " minutes ago";
	else if (diff < 7200)     return "1 hour ago";
	else if (diff < 86400)    return Math.floor(diff/3600) + " hours ago";
	else if (day_diff == 1)   return "Yesterday";
	else if (day_diff < 7)    return day_diff + " days ago";
	else if (day_diff < 14)   return  "a week ago";
	else if (day_diff < 31)   return Math.ceil(day_diff/7) + " weeks ago";
	else if (day_diff < 62)   return "a month ago";
	else if (day_diff < 365)  return "about " + Math.ceil(day_diff/31) + " months ago";
	else if (day_diff < 730)  return "a year ago";
	else                      return Math.ceil(day_diff/365) + " years ago";
}

Date.prototype.formatString_orig_mptw = Date.prototype.formatString;

Date.prototype.formatString = function(template) {
	return this.formatString_orig_mptw(template).replace(/pppp/,this.prettyDate());
}

// for MPTW. otherwise edit your ViewTemplate as required.
// config.mptwDateFormat = 'pppp (DD/MM/YY)'; 
config.mptwDateFormat = 'pppp'; 

//}}}

* Symptoms: epitaxis, dyspnea.

For a patient with pulmonary edema, consider the following causes: ''pump failure'', ''rhythm-related problems'', and ''volume overload''.

*Management for pump failure
**If BP<70; then consider ''dopamine'' or ''levophed''.
**If 70<BP<100; then use ''dopamine'' when ''shock signs'' present, otherwise consider ''dobutamine''.
**If BP>100; then ''NTG'' and ''dobutamine '' are available options.
*Management for volume overload: MONL
**''Morphine''
**''Oxygen''
**''NTG''
**''Furosemide(Lasix)''

/***
|Name:|QuickOpenTagPlugin|
|Description:|Changes tag links to make it easier to open tags as tiddlers|
|Version:|3.0.1 ($Rev: 3861 $)|
|Date:|$Date: 2008-03-08 10:53:09 +1000 (Sat, 08 Mar 2008) $|
|Source:|http://mptw.tiddlyspot.com/#QuickOpenTagPlugin|
|Author:|Simon Baird <simon.baird@gmail.com>|
|License:|http://mptw.tiddlyspot.com/#TheBSDLicense|
***/
//{{{
config.quickOpenTag = {

	dropdownChar: (document.all ? "\u25bc" : "\u25be"), // the little one doesn't work in IE?

	createTagButton: function(place,tag,excludeTiddler) {
		// little hack so we can do this: <<tag PrettyTagName|RealTagName>>
		var splitTag = tag.split("|");
		var pretty = tag;
		if (splitTag.length == 2) {
			tag = splitTag[1];
			pretty = splitTag[0];
		}
		
		var sp = createTiddlyElement(place,"span",null,"quickopentag");
		createTiddlyText(createTiddlyLink(sp,tag,false),pretty);
		
		var theTag = createTiddlyButton(sp,config.quickOpenTag.dropdownChar,
                        config.views.wikified.tag.tooltip.format([tag]),onClickTag);
		theTag.setAttribute("tag",tag);
		if (excludeTiddler)
			theTag.setAttribute("tiddler",excludeTiddler);
    		return(theTag);
	},

	miniTagHandler: function(place,macroName,params,wikifier,paramString,tiddler) {
		var tagged = store.getTaggedTiddlers(tiddler.title);
		if (tagged.length > 0) {
			var theTag = createTiddlyButton(place,config.quickOpenTag.dropdownChar,
                        	config.views.wikified.tag.tooltip.format([tiddler.title]),onClickTag);
			theTag.setAttribute("tag",tiddler.title);
			theTag.className = "miniTag";
		}
	},

	allTagsHandler: function(place,macroName,params) {
		var tags = store.getTags(params[0]);
		var filter = params[1]; // new feature
		var ul = createTiddlyElement(place,"ul");
		if(tags.length == 0)
			createTiddlyElement(ul,"li",null,"listTitle",this.noTags);
		for(var t=0; t<tags.length; t++) {
			var title = tags[t][0];
			if (!filter || (title.match(new RegExp('^'+filter)))) {
				var info = getTiddlyLinkInfo(title);
				var theListItem =createTiddlyElement(ul,"li");
				var theLink = createTiddlyLink(theListItem,tags[t][0],true);
				var theCount = " (" + tags[t][1] + ")";
				theLink.appendChild(document.createTextNode(theCount));
				var theDropDownBtn = createTiddlyButton(theListItem," " +
					config.quickOpenTag.dropdownChar,this.tooltip.format([tags[t][0]]),onClickTag);
				theDropDownBtn.setAttribute("tag",tags[t][0]);
			}
		}
	},

	// todo fix these up a bit
	styles: [
"/*{{{*/",
"/* created by QuickOpenTagPlugin */",
".tagglyTagged .quickopentag, .tagged .quickopentag ",
"	{ margin-right:1.2em; border:1px solid #eee; padding:2px; padding-right:0px; padding-left:1px; }",
".quickopentag .tiddlyLink { padding:2px; padding-left:3px; }",
".quickopentag a.button { padding:1px; padding-left:2px; padding-right:2px;}",
"/* extra specificity to make it work right */",
"#displayArea .viewer .quickopentag a.button, ",
"#displayArea .viewer .quickopentag a.tiddyLink, ",
"#mainMenu .quickopentag a.tiddyLink, ",
"#mainMenu .quickopentag a.tiddyLink ",
"	{ border:0px solid black; }",
"#displayArea .viewer .quickopentag a.button, ",
"#mainMenu .quickopentag a.button ",
"	{ margin-left:0px; padding-left:2px; }",
"#displayArea .viewer .quickopentag a.tiddlyLink, ",
"#mainMenu .quickopentag a.tiddlyLink ",
"	{ margin-right:0px; padding-right:0px; padding-left:0px; margin-left:0px; }",
"a.miniTag {font-size:150%;} ",
"#mainMenu .quickopentag a.button ",
"	/* looks better in right justified main menus */",
"	{ margin-left:0px; padding-left:2px; margin-right:0px; padding-right:0px; }", 
"#topMenu .quickopentag { padding:0px; margin:0px; border:0px; }",
"#topMenu .quickopentag .tiddlyLink { padding-right:1px; margin-right:0px; }",
"#topMenu .quickopentag .button { padding-left:1px; margin-left:0px; border:0px; }",
"/*}}}*/",
		""].join("\n"),

	init: function() {
		// we fully replace these builtins. can't hijack them easily
		window.createTagButton = this.createTagButton;
		config.macros.allTags.handler = this.allTagsHandler;
		config.macros.miniTag = { handler: this.miniTagHandler };
		config.shadowTiddlers["QuickOpenTagStyles"] = this.styles;
		store.addNotification("QuickOpenTagStyles",refreshStyles);
	}
}

config.quickOpenTag.init();

//}}}

*CT scan: 
** Renal infarct: definitely no enhancement.
** Acute pyelonephritis: focal wedge shape lesion with less accentuation. Present of hydronephrosis.
** Renal cysts: no edematous change.
** DM nephropathy: thickened cortex.

/***
|Name:|RenameTagsPlugin|
|Description:|Allows you to easily rename or delete tags across multiple tiddlers|
|Version:|3.0 ($Rev: 5501 $)|
|Date:|$Date: 2008-06-10 23:11:55 +1000 (Tue, 10 Jun 2008) $|
|Source:|http://mptw.tiddlyspot.com/#RenameTagsPlugin|
|Author:|Simon Baird <simon.baird@gmail.com>|
|License|http://mptw.tiddlyspot.com/#TheBSDLicense|
Rename a tag and you will be prompted to rename it in all its tagged tiddlers.
***/
//{{{
config.renameTags = {

	prompts: {
		rename: "Rename the tag '%0' to '%1' in %2 tidder%3?",
		remove: "Remove the tag '%0' from %1 tidder%2?"
	},

	removeTag: function(tag,tiddlers) {
		store.suspendNotifications();
		for (var i=0;i<tiddlers.length;i++) {
			store.setTiddlerTag(tiddlers[i].title,false,tag);
		}
		store.resumeNotifications();
		store.notifyAll();
	},

	renameTag: function(oldTag,newTag,tiddlers) {
		store.suspendNotifications();
		for (var i=0;i<tiddlers.length;i++) {
			store.setTiddlerTag(tiddlers[i].title,false,oldTag); // remove old
			store.setTiddlerTag(tiddlers[i].title,true,newTag);  // add new
		}
		store.resumeNotifications();
		store.notifyAll();
	},

	storeMethods: {

		saveTiddler_orig_renameTags: TiddlyWiki.prototype.saveTiddler,

		saveTiddler: function(title,newTitle,newBody,modifier,modified,tags,fields,clearChangeCount,created) {
			if (title != newTitle) {
				var tagged = this.getTaggedTiddlers(title);
				if (tagged.length > 0) {
					// then we are renaming a tag
					if (confirm(config.renameTags.prompts.rename.format([title,newTitle,tagged.length,tagged.length>1?"s":""])))
						config.renameTags.renameTag(title,newTitle,tagged);

					if (!this.tiddlerExists(title) && newBody == "")
						// dont create unwanted tiddler
						return null;
				}
			}
			return this.saveTiddler_orig_renameTags(title,newTitle,newBody,modifier,modified,tags,fields,clearChangeCount,created);
		},

		removeTiddler_orig_renameTags: TiddlyWiki.prototype.removeTiddler,

		removeTiddler: function(title) {
			var tagged = this.getTaggedTiddlers(title);
			if (tagged.length > 0)
				if (confirm(config.renameTags.prompts.remove.format([title,tagged.length,tagged.length>1?"s":""])))
					config.renameTags.removeTag(title,tagged);
			return this.removeTiddler_orig_renameTags(title);
		}

	},

	init: function() {
		merge(TiddlyWiki.prototype,this.storeMethods);
	}
}

config.renameTags.init();

//}}}

!!Three-step approach
!!!Initial laparotomy
#four-quadrant packing is done initially with subsequent unpacking
#defining and manage major abdominal vascular injuries
#initial fix of the solid organ injuries
#finally controlling spillage of intestinal content
!!!!Indicattions of phase 1 surgery
These include initial body temperature less than 35°C, initial pH of less than 7.2 with a base deficit of less than 15 mmol/L in patients younger than 55 years of age or less than -6 mmol/L in patients older than 55 years, serum lactate greater than 5 mmol/L, and PT and/or PTT greater than 50% of normal.
!!!Secondary resuscitation
*correcting the metabolic abnormalities of massive hemorrhage
*reversing and preventing further hypothermia
*coagulopathy is treated aggressively with infusion of FFP and platelets until PT and PTT values are within normal limits
!!!!Return to surgery in this phase
#ongoing transfusion requirements / ongoing hemorrhage
#abdominal compartment syndrome
!!!Definitive operation

!!Antibiotic treatment for //Samonella//
* A - Ampicillin
* B - baktar (Cotrimazole)
* C - chloramphenicol
* C - Ciprofloxacin
* C - Ceftriaxone
Ciprofloxacin and Ceftriaxone are the current first-line treatment. The resistance to ampicillin, cotrimazole and chloramphenicol raised in recent years. Only use them if //in vitro// studies show suceptibility. Besides, azithromycin seems to be another option.

/***
|Name:|SaveCloseTiddlerPlugin|
|Description:|Provides two extra toolbar commands, saveCloseTiddler and cancelCloseTiddler|
|Version:|3.0 ($Rev: 5502 $)|
|Date:|$Date: 2008-06-10 23:31:39 +1000 (Tue, 10 Jun 2008) $|
|Source:|http://mptw.tiddlyspot.com/#SaveCloseTiddlerPlugin|
|Author:|Simon Baird <simon.baird@gmail.com>|
|License:|http://mptw.tiddlyspot.com/#TheBSDLicense|
To use these you must add them to the tool bar in your EditTemplate
***/
//{{{
merge(config.commands,{

	saveCloseTiddler: {
		text: 'done/close',
		tooltip: 'Save changes to this tiddler and close it',
		handler: function(ev,src,title) {
			var closeTitle = title;
			var newTitle = story.saveTiddler(title,ev.shiftKey);
			if (newTitle)
				closeTitle = newTitle;
			return config.commands.closeTiddler.handler(ev,src,closeTitle);
		}
	},

	cancelCloseTiddler: {
		text: 'cancel/close',
		tooltip: 'Undo changes to this tiddler and close it',
		handler: function(ev,src,title) {
			// the same as closeTiddler now actually
			return config.commands.closeTiddler.handler(ev,src,title);
		}
	}

});

//}}}

/***
|Name:|SelectThemePlugin|
|Description:|Lets you easily switch theme and palette|
|Version:|1.0 ($Rev: 3646 $)|
|Date:|$Date: 2008-02-27 02:34:38 +1000 (Wed, 27 Feb 2008) $|
|Source:|http://mptw.tiddlyspot.com/#SelectThemePlugin|
|Author:|Simon Baird <simon.baird@gmail.com>|
|License:|http://mptw.tiddlyspot.com/#TheBSDLicense|
!Notes
* Borrows largely from ThemeSwitcherPlugin by Martin Budden http://www.martinswiki.com/#ThemeSwitcherPlugin
* Theme is cookie based. But set a default by setting config.options.txtTheme in MptwConfigPlugin (for example)
* Palette is not cookie based. It actually overwrites your ColorPalette tiddler when you select a palette, so beware. 
!Usage
* {{{<<selectTheme>>}}} makes a dropdown selector
* {{{<<selectPalette>>}}} makes a dropdown selector
* {{{<<applyTheme>>}}} applies the current tiddler as a theme
* {{{<<applyPalette>>}}} applies the current tiddler as a palette
* {{{<<applyTheme TiddlerName>>}}} applies TiddlerName as a theme
* {{{<<applyPalette TiddlerName>>}}} applies TiddlerName as a palette
***/
//{{{

config.macros.selectTheme = {
	label: {
      		selectTheme:"select theme",
      		selectPalette:"select palette"
	},
	prompt: {
		selectTheme:"Select the current theme",
		selectPalette:"Select the current palette"
	},
	tags: {
		selectTheme:'systemTheme',
		selectPalette:'systemPalette'
	}
};

config.macros.selectTheme.handler = function(place,macroName)
{
	var btn = createTiddlyButton(place,this.label[macroName],this.prompt[macroName],this.onClick);
	// want to handle palettes and themes with same code. use mode attribute to distinguish
	btn.setAttribute('mode',macroName);
};

config.macros.selectTheme.onClick = function(ev)
{
	var e = ev ? ev : window.event;
	var popup = Popup.create(this);
	var mode = this.getAttribute('mode');
	var tiddlers = store.getTaggedTiddlers(config.macros.selectTheme.tags[mode]);
	// for default
	if (mode == "selectPalette") {
		var btn = createTiddlyButton(createTiddlyElement(popup,'li'),"(default)","default color palette",config.macros.selectTheme.onClickTheme);
		btn.setAttribute('theme',"(default)");
		btn.setAttribute('mode',mode);
	}
	for(var i=0; i<tiddlers.length; i++) {
		var t = tiddlers[i].title;
		var name = store.getTiddlerSlice(t,'Name');
		var desc = store.getTiddlerSlice(t,'Description');
		var btn = createTiddlyButton(createTiddlyElement(popup,'li'),name ? name : title,desc ? desc : config.macros.selectTheme.label['mode'],config.macros.selectTheme.onClickTheme);
		btn.setAttribute('theme',t);
		btn.setAttribute('mode',mode);
	}
	Popup.show();
	return stopEvent(e);
};

config.macros.selectTheme.onClickTheme = function(ev)
{
	var mode = this.getAttribute('mode');
	var theme = this.getAttribute('theme');
	if (mode == 'selectTheme')
		story.switchTheme(theme);
	else // selectPalette
		config.macros.selectTheme.updatePalette(theme);
	return false;
};

config.macros.selectTheme.updatePalette = function(title)
{
	if (title != "") {
		store.deleteTiddler("ColorPalette");
		if (title != "(default)")
			store.saveTiddler("ColorPalette","ColorPalette",store.getTiddlerText(title),
					config.options.txtUserName,undefined,"");
		refreshAll();
		if(config.options.chkAutoSave)
			saveChanges(true);
	}
};

config.macros.applyTheme = {
	label: "apply",
	prompt: "apply this theme or palette" // i'm lazy
};

config.macros.applyTheme.handler = function(place,macroName,params,wikifier,paramString,tiddler) {
	var useTiddler = params[0] ? params[0] : tiddler.title;
	var btn = createTiddlyButton(place,this.label,this.prompt,config.macros.selectTheme.onClickTheme);
	btn.setAttribute('theme',useTiddler);
	btn.setAttribute('mode',macroName=="applyTheme"?"selectTheme":"selectPalette"); // a bit untidy here
}

config.macros.selectPalette = config.macros.selectTheme;
config.macros.applyPalette = config.macros.applyTheme;

config.macros.refreshAll = { handler: function(place,macroName,params,wikifier,paramString,tiddler) {
	createTiddlyButton(place,"refresh","refresh layout and styles",function() { refreshAll(); });
}};

//}}}

There is no universal criteria for microdilution or macrodilution method in the practice of measuring SIT and SBT. However, it still provide information for //in vitro// bactericidal success. 
!!Definition
* Serum inhibitory titer(SIT): the last "clear" one in serial dilution.
* Serum bactericidal titer(SBT): the last "sterile" one with no bacterial growth in serial dilution.
!!Sampling time
* Peak value
** IV: 60 min after a 30 min infusion.
** IM: 60 min after injection
** Oral: 90 min after intake
*Trough value
** 0~30 min prior to the next dose
!!Acceptable Values
* SIT: 1:16
* SBT: 1:8 (for //Staphylococcus//, 1:32 is required)
!!Application
*infective endocarditis: SXT > 1:8 is recommended.
*osteomyelitis
*acute suppurative arthritis
*....
!!Resistance
*SIT / SBT > 4x implies the possibility of resistance
*may indicate prolonged treatment
*may indicate adjuvant treatment: for cell wall acting antibiotics, rifampin or aminoglycoside are available ajuvents.

----
!!Why are the antimicrobial agents not effective?
* wrong diagnosis
* wrong drug
* wrong dose
* focal lesion with less drug penetration
* drug intercation
* superimposed infection

A.K.A. Sinding-Larsen and Johansson syndrome, Larsen-Johansson syndrome, Mau’s syndrome

traction tedinopathy with calcification in the proximal attachement of the patellar tendon, which may be partially avulsed.

Some poorly organized notes...

Hospital Affairs

!!!Steroids
||!hydrocortisone|!prednisolone|!methylprednsiolone|!dexamethasone|
|Potency|1|4|5|20-25|
|half-life (supression of ACTH)|6-8hr|8-16hr|8-16hr|16-36hr|
|Minerocorticoid activity|strong|moderate|weak|very weak|
|Other properties||||penetrating BBB|

!!!Dosage
*0-0.5mg/kg/day: anti-inflammatory dose
*0.5-1mg/kg/day: immuno-supression / large dose
*1-3mg/kg/day: very large dose
!!!!physiological dose
*male: 7.5-10mg/day
*female: 5-7.5mg/day

!!!Aorticopulmonary window shunt
side-to-side anastamosis between ascending aorta and left pulmonary artery (reversible procedure)
*used in Tetralogy of Fallot
!!!Blalock-Hanlon Procedure
surgical creation of ASD
*used in Complete transposition 
!!!Blalock-Taussig shunt
end-to-side anastomosis of subclavian artery to pulmonary artery, performed ipsilateral to innominate artery/opposite to aortic arch
*used in Tetralogy of Fallot
*used in tricuspid atresia c pulmonic stenosis 
!!!Fontan procedure
*external conduit from R atrium to pulmonary trunk (= venous return enters pulmonary artery directly)
*closure of ASD: floor constructed from flap of atrial wall and roof from piece of prosthetic material
used in Tricuspid atresia 
!!!Glenn shunt
end-to-side shunt between distal end of right pulmonary artery and IVC; reserved for patients with cardiac defects in which total correction is not anticipated
*used in Tricuspid atresia 
!!!Pott shunt
side-to-side anastomosis between descending aorta + left pulmonary artery
*used in Tetralogy of Fallot
!!!Mustard procedure
#removal of atrial septum
#pericardial baffle placed into common atrium such that systemic venous blood is rerouted into left ventricle and pulmonary venous return into right ventricle and aorta
used in Complete Transposition 
!!!Rashikind procedure
balloon atrial septostomy
*used in Complete transposition 
!!!Rastelli procedure
external conduit (Dacron) with porcine valve connecting RV to pulmonary trunk
*used in Transposition 
!!!Waterson-Cooley shunt
side-to-side anastomosis between ascending aorta and right pulmonary artery extrapericardial (WATERSON) or intrapericaridial (COOLEY)
*used in Tetralogy of Fallot

Adpated from http://www.learningradiology.com/notes/cardiacnotes/surgicalcorrectivepage.htm

Surgical treatment of PTB continues to have an unflagging role in the management of this disease. 
#Pulmonary resection in patients with multidrug-resistant PTB is defended by some authors, but conclusive data do not exist to make one think that it should be a routine option for this type of patient. 
#Surgical treatment of tubercular pulmonary sequelae, such as destroyed lung, bronchiectases, and cavern tuberculosis, is well established. Its indications mark the presence of serious complications, such as persistent bronchorrhea, repeated pulmonary superinfections, aspergillomas, and massive hemoptysis. 
#The surgical and diagnostic management of a patient with PTB in whom a bronchogenic carcinoma is present does not substantially differ from cases in the general population. The prognosis depends fundamentally on the state of the neoplasia. 
#There are other complications that can be treated surgically with good results, such as large bronchotracheal compressions with childhood mediastinal tuberculosis lymphadenitis.
Ref: // Freixinet J. Surgical indications for treatment of pulmonary tuberculosis.
World J Surg. 1997 Jun;21(5):475-9 //

----

!!!Potential Indications for Surgery for Pulmonary Tuberculosis
#Open positive cavity after 3 to 6 months of chemotherapy, especially if resistant mycobacteria
#Persistent positive sputum with pathology (destroyed lung, atelectasis, bronchiectasis, bronchostenosis) amenable to resection
#Negative sputum but destroyed lung, blocked cavity, tuberculoma—consider for resection
#Localized infection with atypical mycobacteria
#Tuberculous bronchiectasis of lower and middle lobes (usually occurs in upper lobes—good drainage; lower and middle lobes do not drain well)
#Open negative cavities if thick walled, slow response, or unreliable patient
#To exclude cancer
#Recurrent or persistent hemoptysis: resection if greater than 600 mL of blood is lost in 24 hours or less
#Pleural disease where indicated

Ref: //Townsend: Sabiston Textbook of Surgery, 17th ed.//

!!!Lupus nephritis
!!!!After Tx
*complete remission: daily protein loss < 0.5g
*partial remission: daily protein loss 0.5~1g
*fixed proteinuria: daily protein loss 2g, stable
** may indicate renal biopsy to confirm no active inflammation

!!!Hematologic involmenet
*hemolythic anemia (but the most common anemia is that of chronic disease)
**Comb test
***Direct: antibodies on RBC
***Indirect: antibodies in serum
**reticulocytosis: (Hct/45)xP% > 2% or absolute > 10^^5^^
*leukopenia (2 times)
*lymphopenia (2 times)
*thrombocytopenia (1 times)

!!!Flare-up
Lupus flare-up mimics its initial presentation.

<<allTags excludeLists>>

<<tabs txtMoreTab "Tags" "All Tags" TabAllTags "Miss" "Missing tiddlers" TabMoreMissing "Orph" "Orphaned tiddlers" TabMoreOrphans "Shad" "Shadowed tiddlers" TabMoreShadowed>>

<<allTags excludeLists [a-z]>>

/***
|Name:|TagglyTaggingPlugin|
|Description:|tagglyTagging macro is a replacement for the builtin tagging macro in your ViewTemplate|
|Version:|3.1 ($Rev: 4092 $)|
|Date:|$Date: 2008-03-24 12:32:33 +1000 (Mon, 24 Mar 2008) $|
|Source:|http://mptw.tiddlyspot.com/#TagglyTaggingPlugin|
|Author:|Simon Baird <simon.baird@gmail.com>|
|License:|http://mptw.tiddlyspot.com/#TheBSDLicense|
!Notes
See http://mptw.tiddlyspot.com/#TagglyTagging
***/
//{{{
config.taggly = {

	// for translations
	lingo: {
		labels: {
			asc:        "\u2191", // down arrow
			desc:       "\u2193", // up arrow
			title:      "title",
			modified:   "modified",
			created:    "created",
			show:       "+",
			hide:       "-",
			normal:     "normal",
			group:      "group",
			commas:     "commas",
			sitemap:    "sitemap",
			numCols:    "cols\u00b1", // plus minus sign
			label:      "Tagged as '%0':",
			excerpts:   "excerpts",
			descr:      "descr",
			slices:     "slices",
			contents:   "contents",
			sliders:    "sliders",
			noexcerpts: "title only"
		},

		tooltips: {
			title:    "Click to sort by title",
			modified: "Click to sort by modified date",
			created:  "Click to sort by created date",
			show:     "Click to show tagging list",
			hide:     "Click to hide tagging list",
			normal:   "Click to show a normal ungrouped list",
			group:    "Click to show list grouped by tag",
			sitemap:  "Click to show a sitemap style list",
			commas:   "Click to show a comma separated list",
			numCols:  "Click to change number of columns",
			excerpts: "Click to show excerpts",
			descr:    "Click to show the description slice",
			slices:    "Click to show all slices",
			contents: "Click to show entire tiddler contents",
			sliders:  "Click to show tiddler contents in sliders",
			noexcerpts: "Click to show entire title only"
		}
	},

	config: {
		showTaggingCounts: true,
		listOpts: {
			// the first one will be the default
			sortBy:     ["title","modified","created"],
			sortOrder:  ["asc","desc"],
			hideState:  ["show","hide"],
			listMode:   ["normal","group","sitemap","commas"],
			numCols:    ["1","2","3","4","5","6"],
			excerpts:   ["noexcerpts","excerpts","descr","slices","contents","sliders"]
		},
		valuePrefix: "taggly.",
		excludeTags: ["excludeLists","excludeTagging"],
		excerptSize: 50,
		excerptMarker: "/%"+"%/"
	},

	getTagglyOpt: function(title,opt) {
		var val = store.getValue(title,this.config.valuePrefix+opt);
		return val ? val : this.config.listOpts[opt][0];
	},

	setTagglyOpt: function(title,opt,value) {
		if (!store.tiddlerExists(title))
			// create it silently
			store.saveTiddler(title,title,config.views.editor.defaultText.format([title]),config.options.txtUserName,new Date(),"");
		// if value is default then remove it to save space
		return store.setValue(title,
			this.config.valuePrefix+opt,
			value == this.config.listOpts[opt][0] ? null : value);
	},

	getNextValue: function(title,opt) {
		var current = this.getTagglyOpt(title,opt);
		var pos = this.config.listOpts[opt].indexOf(current);
		// a little usability enhancement. actually it doesn't work right for grouped or sitemap
		var limit = (opt == "numCols" ? store.getTaggedTiddlers(title).length : this.config.listOpts[opt].length);
		var newPos = (pos + 1) % limit;
		return this.config.listOpts[opt][newPos];
	},

	toggleTagglyOpt: function(title,opt) {
		var newVal = this.getNextValue(title,opt);
		this.setTagglyOpt(title,opt,newVal);
	}, 

	createListControl: function(place,title,type) {
		var lingo = config.taggly.lingo;
		var label;
		var tooltip;
		var onclick;

		if ((type == "title" || type == "modified" || type == "created")) {
			// "special" controls. a little tricky. derived from sortOrder and sortBy
			label = lingo.labels[type];
			tooltip = lingo.tooltips[type];

			if (this.getTagglyOpt(title,"sortBy") == type) {
				label += lingo.labels[this.getTagglyOpt(title,"sortOrder")];
				onclick = function() {
					config.taggly.toggleTagglyOpt(title,"sortOrder");
					return false;
				}
			}
			else {
				onclick = function() {
					config.taggly.setTagglyOpt(title,"sortBy",type);
					config.taggly.setTagglyOpt(title,"sortOrder",config.taggly.config.listOpts.sortOrder[0]);
					return false;
				}
			}
		}
		else {
			// "regular" controls, nice and simple
			label = lingo.labels[type == "numCols" ? type : this.getNextValue(title,type)];
			tooltip = lingo.tooltips[type == "numCols" ? type : this.getNextValue(title,type)];
			onclick = function() {
				config.taggly.toggleTagglyOpt(title,type);
				return false;
			}
		}

		// hide button because commas don't have columns
		if (!(this.getTagglyOpt(title,"listMode") == "commas" && type == "numCols"))
			createTiddlyButton(place,label,tooltip,onclick,type == "hideState" ? "hidebutton" : "button");
	},

	makeColumns: function(orig,numCols) {
		var listSize = orig.length;
		var colSize = listSize/numCols;
		var remainder = listSize % numCols;

		var upperColsize = colSize;
		var lowerColsize = colSize;

		if (colSize != Math.floor(colSize)) {
			// it's not an exact fit so..
			upperColsize = Math.floor(colSize) + 1;
			lowerColsize = Math.floor(colSize);
		}

		var output = [];
		var c = 0;
		for (var j=0;j<numCols;j++) {
			var singleCol = [];
			var thisSize = j < remainder ? upperColsize : lowerColsize;
			for (var i=0;i<thisSize;i++) 
				singleCol.push(orig[c++]);
			output.push(singleCol);
		}

		return output;
	},

	drawTable: function(place,columns,theClass) {
		var newTable = createTiddlyElement(place,"table",null,theClass);
		var newTbody = createTiddlyElement(newTable,"tbody");
		var newTr = createTiddlyElement(newTbody,"tr");
		for (var j=0;j<columns.length;j++) {
			var colOutput = "";
			for (var i=0;i<columns[j].length;i++) 
				colOutput += columns[j][i];
			var newTd = createTiddlyElement(newTr,"td",null,"tagglyTagging"); // todo should not need this class
			wikify(colOutput,newTd);
		}
		return newTable;
	},

	createTagglyList: function(place,title) {
		switch(this.getTagglyOpt(title,"listMode")) {
			case "group":  return this.createTagglyListGrouped(place,title); break;
			case "normal": return this.createTagglyListNormal(place,title,false); break;
			case "commas": return this.createTagglyListNormal(place,title,true); break;
			case "sitemap":return this.createTagglyListSiteMap(place,title); break;
		}
	},

	getTaggingCount: function(title) {
		// thanks to Doug Edmunds
		if (this.config.showTaggingCounts) {
			var tagCount = store.getTaggedTiddlers(title).length;
			if (tagCount > 0)
				return " ("+tagCount+")";
		}
		return "";
	},

	getExcerpt: function(inTiddlerTitle,title,indent) {
		if (!indent)
			indent = 1;

		var displayMode = this.getTagglyOpt(inTiddlerTitle,"excerpts");
		var t = store.getTiddler(title);

		if (t && displayMode == "excerpts") {
			var text = t.text.replace(/\n/," ");
			var marker = text.indexOf(this.config.excerptMarker);
			if (marker != -1) {
				return " {{excerpt{<nowiki>" + text.substr(0,marker) + "</nowiki>}}}";
			}
			else if (text.length < this.config.excerptSize) {
				return " {{excerpt{<nowiki>" + t.text + "</nowiki>}}}";
			}
			else {
				return " {{excerpt{<nowiki>" + t.text.substr(0,this.config.excerptSize) + "..." + "</nowiki>}}}";
			}
		}
		else if (t && displayMode == "contents") {
			return "\n{{contents indent"+indent+"{\n" + t.text + "\n}}}";
		}
		else if (t && displayMode == "sliders") {
			return "<slider slide>\n{{contents{\n" + t.text + "\n}}}\n</slider>";
		}
		else if (t && displayMode == "descr") {
			var descr = store.getTiddlerSlice(title,'Description');
			return descr ? " {{excerpt{" + descr  + "}}}" : "";
		}
		else if (t && displayMode == "slices") {
			var result = "";
			var slices = store.calcAllSlices(title);
			for (var s in slices)
				result += "|%0|<nowiki>%1</nowiki>|\n".format([s,slices[s]]);
			return result ? "\n{{excerpt excerptIndent{\n" + result  + "}}}" : "";
		}
		return "";
	},

	notHidden: function(t,inTiddler) {
		if (typeof t == "string") 
			t = store.getTiddler(t);
		return (!t || !t.tags.containsAny(this.config.excludeTags) ||
				(inTiddler && this.config.excludeTags.contains(inTiddler)));
	},

	// this is for normal and commas mode
	createTagglyListNormal: function(place,title,useCommas) {

		var list = store.getTaggedTiddlers(title,this.getTagglyOpt(title,"sortBy"));

		if (this.getTagglyOpt(title,"sortOrder") == "desc")
			list = list.reverse();

		var output = [];
		var first = true;
		for (var i=0;i<list.length;i++) {
			if (this.notHidden(list[i],title)) {
				var countString = this.getTaggingCount(list[i].title);
				var excerpt = this.getExcerpt(title,list[i].title);
				if (useCommas)
					output.push((first ? "" : ", ") + "[[" + list[i].title + "]]" + countString + excerpt);
				else
					output.push("*[[" + list[i].title + "]]" + countString + excerpt + "\n");

				first = false;
			}
		}

		return this.drawTable(place,
			this.makeColumns(output,useCommas ? 1 : parseInt(this.getTagglyOpt(title,"numCols"))),
			useCommas ? "commas" : "normal");
	},

	// this is for the "grouped" mode
	createTagglyListGrouped: function(place,title) {
		var sortBy = this.getTagglyOpt(title,"sortBy");
		var sortOrder = this.getTagglyOpt(title,"sortOrder");

		var list = store.getTaggedTiddlers(title,sortBy);

		if (sortOrder == "desc")
			list = list.reverse();

		var leftOvers = []
		for (var i=0;i<list.length;i++)
			leftOvers.push(list[i].title);

		var allTagsHolder = {};
		for (var i=0;i<list.length;i++) {
			for (var j=0;j<list[i].tags.length;j++) {

				if (list[i].tags[j] != title) { // not this tiddler

					if (this.notHidden(list[i].tags[j],title)) {

						if (!allTagsHolder[list[i].tags[j]])
							allTagsHolder[list[i].tags[j]] = "";

						if (this.notHidden(list[i],title)) {
							allTagsHolder[list[i].tags[j]] += "**[["+list[i].title+"]]"
										+ this.getTaggingCount(list[i].title) + this.getExcerpt(title,list[i].title) + "\n";

							leftOvers.setItem(list[i].title,-1); // remove from leftovers. at the end it will contain the leftovers

						}
					}
				}
			}
		}

		var allTags = [];
		for (var t in allTagsHolder)
			allTags.push(t);

		var sortHelper = function(a,b) {
			if (a == b) return 0;
			if (a < b) return -1;
			return 1;
		};

		allTags.sort(function(a,b) {
			var tidA = store.getTiddler(a);
			var tidB = store.getTiddler(b);
			if (sortBy == "title") return sortHelper(a,b);
			else if (!tidA && !tidB) return 0;
			else if (!tidA) return -1;
			else if (!tidB) return +1;
			else return sortHelper(tidA[sortBy],tidB[sortBy]);
		});

		var leftOverOutput = "";
		for (var i=0;i<leftOvers.length;i++)
			if (this.notHidden(leftOvers[i],title))
				leftOverOutput += "*[["+leftOvers[i]+"]]" + this.getTaggingCount(leftOvers[i]) + this.getExcerpt(title,leftOvers[i]) + "\n";

		var output = [];

		if (sortOrder == "desc")
			allTags.reverse();
		else if (leftOverOutput != "")
			// leftovers first...
			output.push(leftOverOutput);

		for (var i=0;i<allTags.length;i++)
			if (allTagsHolder[allTags[i]] != "")
				output.push("*[["+allTags[i]+"]]" + this.getTaggingCount(allTags[i]) + this.getExcerpt(title,allTags[i]) + "\n" + allTagsHolder[allTags[i]]);

		if (sortOrder == "desc" && leftOverOutput != "")
			// leftovers last...
			output.push(leftOverOutput);

		return this.drawTable(place,
				this.makeColumns(output,parseInt(this.getTagglyOpt(title,"numCols"))),
				"grouped");

	},

	// used to build site map
	treeTraverse: function(title,depth,sortBy,sortOrder) {

		var list = store.getTaggedTiddlers(title,sortBy);
		if (sortOrder == "desc")
			list.reverse();

		var indent = "";
		for (var j=0;j<depth;j++)
			indent += "*"

		var childOutput = "";
		for (var i=0;i<list.length;i++)
			if (list[i].title != title)
				if (this.notHidden(list[i].title,this.config.inTiddler))
					childOutput += this.treeTraverse(list[i].title,depth+1,sortBy,sortOrder);

		if (depth == 0)
			return childOutput;
		else
			return indent + "[["+title+"]]" + this.getTaggingCount(title) + this.getExcerpt(this.config.inTiddler,title,depth) + "\n" + childOutput;
	},

	// this if for the site map mode
	createTagglyListSiteMap: function(place,title) {
		this.config.inTiddler = title; // nasty. should pass it in to traverse probably
		var output = this.treeTraverse(title,0,this.getTagglyOpt(title,"sortBy"),this.getTagglyOpt(title,"sortOrder"));
		return this.drawTable(place,
				this.makeColumns(output.split(/(?=^\*\[)/m),parseInt(this.getTagglyOpt(title,"numCols"))), // regexp magic
				"sitemap"
				);
	},

	macros: {
		tagglyTagging: {
			handler: function (place,macroName,params,wikifier,paramString,tiddler) {
				var refreshContainer = createTiddlyElement(place,"div");
				// do some refresh magic to make it keep the list fresh - thanks Saq
				refreshContainer.setAttribute("refresh","macro");
				refreshContainer.setAttribute("macroName",macroName);
				if (params[0])
					refreshContainer.setAttribute("title",params[0]);
				else {
        			refreshContainer.setAttribute("title",tiddler.title);
				}
				this.refresh(refreshContainer);
			},

			refresh: function(place) {
				var title = place.getAttribute("title");
				removeChildren(place);
				addClass(place,"tagglyTagging");
				if (store.getTaggedTiddlers(title).length > 0) {
					var lingo = config.taggly.lingo;
					config.taggly.createListControl(place,title,"hideState");
					if (config.taggly.getTagglyOpt(title,"hideState") == "show") {
						createTiddlyElement(place,"span",null,"tagglyLabel",lingo.labels.label.format([title]));
						config.taggly.createListControl(place,title,"title");
						config.taggly.createListControl(place,title,"modified");
						config.taggly.createListControl(place,title,"created");
						config.taggly.createListControl(place,title,"listMode");
						config.taggly.createListControl(place,title,"excerpts");
						config.taggly.createListControl(place,title,"numCols");
						config.taggly.createTagglyList(place,title);
					}
				}
			}
		}
	},

	// todo fix these up a bit
	styles: [
"/*{{{*/",
"/* created by TagglyTaggingPlugin */",
".tagglyTagging { padding-top:0.5em; }",
".tagglyTagging li.listTitle { display:none; }",
".tagglyTagging ul {",
"	margin-top:0px; padding-top:0.5em; padding-left:2em;",
"	margin-bottom:0px; padding-bottom:0px;",
"}",
".tagglyTagging { vertical-align: top; margin:0px; padding:0px; }",
".tagglyTagging table { margin:0px; padding:0px; }",
".tagglyTagging .button { visibility:hidden; margin-left:3px; margin-right:3px; }",
".tagglyTagging .button, .tagglyTagging .hidebutton {",
"	color:[[ColorPalette::TertiaryLight]]; font-size:90%;",
"	border:0px; padding-left:0.3em;padding-right:0.3em;",
"}",
".tagglyTagging .button:hover, .hidebutton:hover, ",
".tagglyTagging .button:active, .hidebutton:active  {",
"	border:0px; background:[[ColorPalette::TertiaryPale]]; color:[[ColorPalette::TertiaryDark]];",
"}",
".selected .tagglyTagging .button { visibility:visible; }",
".tagglyTagging .hidebutton { color:[[ColorPalette::Background]]; }",
".selected .tagglyTagging .hidebutton { color:[[ColorPalette::TertiaryLight]] }",
".tagglyLabel { color:[[ColorPalette::TertiaryMid]]; font-size:90%; }",
".tagglyTagging ul {padding-top:0px; padding-bottom:0.5em; margin-left:1em; }",
".tagglyTagging ul ul {list-style-type:disc; margin-left:-1em;}",
".tagglyTagging ul ul li {margin-left:0.5em; }",
".editLabel { font-size:90%; padding-top:0.5em; }",
".tagglyTagging .commas { padding-left:1.8em; }",
"/* not technically tagglytagging but will put them here anyway */",
".tagglyTagged li.listTitle { display:none; }",
".tagglyTagged li { display: inline; font-size:90%; }",
".tagglyTagged ul { margin:0px; padding:0px; }",
".excerpt { color:[[ColorPalette::TertiaryDark]]; }",
".excerptIndent { margin-left:4em; }",
"div.tagglyTagging table,",
"div.tagglyTagging table tr,",
"td.tagglyTagging",
" {border-style:none!important; }",
".tagglyTagging .contents { border-bottom:2px solid [[ColorPalette::TertiaryPale]]; padding:0 1em 1em 0.5em;",
"  margin-bottom:0.5em; }",
".tagglyTagging .indent1  { margin-left:3em;  }",
".tagglyTagging .indent2  { margin-left:4em;  }",
".tagglyTagging .indent3  { margin-left:5em;  }",
".tagglyTagging .indent4  { margin-left:6em;  }",
".tagglyTagging .indent5  { margin-left:7em;  }",
".tagglyTagging .indent6  { margin-left:8em;  }",
".tagglyTagging .indent7  { margin-left:9em;  }",
".tagglyTagging .indent8  { margin-left:10em; }",
".tagglyTagging .indent9  { margin-left:11em; }",
".tagglyTagging .indent10 { margin-left:12em; }",
"/*}}}*/",
		""].join("\n"),

	init: function() {
		merge(config.macros,this.macros);
		config.shadowTiddlers["TagglyTaggingStyles"] = this.styles;
		store.addNotification("TagglyTaggingStyles",refreshStyles);
	}
};

config.taggly.init();

//}}}

/***
InlineSlidersPlugin
By Saq Imtiaz
http://tw.lewcid.org/sandbox/#InlineSlidersPlugin

// syntax adjusted to not clash with NestedSlidersPlugin
// added + syntax to start open instead of closed

***/
//{{{
config.formatters.unshift( {
	name: "inlinesliders",
	// match: "\\+\\+\\+\\+|\\<slider",
	match: "\\<slider",
	// lookaheadRegExp: /(?:\+\+\+\+|<slider) (.*?)(?:>?)\n((?:.|\n)*?)\n(?:====|<\/slider>)/mg,
	lookaheadRegExp: /(?:<slider)(\+?) (.*?)(?:>)\n((?:.|\n)*?)\n(?:<\/slider>)/mg,
	handler: function(w) {
		this.lookaheadRegExp.lastIndex = w.matchStart;
		var lookaheadMatch = this.lookaheadRegExp.exec(w.source)
		if(lookaheadMatch && lookaheadMatch.index == w.matchStart ) {
			var btn = createTiddlyButton(w.output,lookaheadMatch[2] + " "+"\u00BB",lookaheadMatch[2],this.onClickSlider,"button sliderButton");
			var panel = createTiddlyElement(w.output,"div",null,"sliderPanel");
			panel.style.display = (lookaheadMatch[1] == '+' ? "block" : "none");
			wikify(lookaheadMatch[3],panel);
			w.nextMatch = lookaheadMatch.index + lookaheadMatch[0].length;
		}
   },
   onClickSlider : function(e) {
		if(!e) var e = window.event;
		var n = this.nextSibling;
		n.style.display = (n.style.display=="none") ? "block" : "none";
		return false;
	}
});

//}}}

[>img[VPW|images/VPW.gif][http://www.chestjournal.org/cgi/content/full/122/6/2087/F1]]
Point 1 is the origin of the left subclavian artery as it exits the aortic arch. Point 2 represents the superior vena cava crossing the right mainstem bronchus. VPW is calculated between the perpendicular lines separating these two points.

* While standing
** VPW < 43mm: lung injury
** VPW < 53mm but > 43mm: cardic >renal, lung injury
** VPW > 53mm: renal > cardic, lung injury
* While supine
** With infiltration
*** VPW > 70mm: hydrostatic edema ~ heart or kidney edema
*** VPW < 70mm: permiability edema ~ ARDS, hemorrhage
** No infiltration
*** VPW > 70mm Volume overload, I/O imbalance.
*** VPW < 70mm Normal, diuretics use? bleeding?
1 liter of total blood volume is associated with 5mm increase in VPW.

* Increased permiability of pulmonary vessels
** Mountain sick: increased permiability without diffuse aveoloar damage (DAD)
** ARDS: increased permiability with DAD.

# CT presontrast: high density lesion
# Wall calcification
# Laminated on MR images
* > 2.5cm = giant aneursym
* No peripheral edema if no rupture  occurs.

/***
|Name:|ToggleTagPlugin|
|Description:|Makes a checkbox which toggles a tag in a tiddler|
|Version:|3.1.0 ($Rev: 4907 $)|
|Date:|$Date: 2008-05-13 03:15:46 +1000 (Tue, 13 May 2008) $|
|Source:|http://mptw.tiddlyspot.com/#ToggleTagPlugin|
|Author:|Simon Baird <simon.baird@gmail.com>|
|License:|http://mptw.tiddlyspot.com/#TheBSDLicense|
!!Usage
{{{<<toggleTag }}}//{{{TagName TiddlerName LabelText}}}//{{{>>}}}
* TagName - the tag to be toggled, default value "checked"
* TiddlerName - the tiddler to toggle the tag in, default value the current tiddler
* LabelText - the text (gets wikified) to put next to the check box, default value is '{{{[[TagName]]}}}' or '{{{[[TagName]] [[TiddlerName]]}}}'
(If a parameter is '.' then the default will be used)
* TouchMod flag - if non empty then touch the tiddlers mod date. Note, can set config.toggleTagAlwaysTouchModDate to always touch mod date
!!Examples
|Code|Description|Example|h
|{{{<<toggleTag>>}}}|Toggles the default tag (checked) in this tiddler|<<toggleTag>>|
|{{{<<toggleTag TagName>>}}}|Toggles the TagName tag in this tiddler|<<toggleTag TagName>>|
|{{{<<toggleTag TagName TiddlerName>>}}}|Toggles the TagName tag in the TiddlerName tiddler|<<toggleTag TagName TiddlerName>>|
|{{{<<toggleTag TagName TiddlerName 'click me'>>}}}|Same but with custom label|<<toggleTag TagName TiddlerName 'click me'>>|
|{{{<<toggleTag . . 'click me'>>}}}|dot means use default value|<<toggleTag . . 'click me'>>|
!!Notes
* If TiddlerName doesn't exist it will be silently created
* Set label to '-' to specify no label
* See also http://mgtd-alpha.tiddlyspot.com/#ToggleTag2
!!Known issues
* Doesn't smoothly handle the case where you toggle a tag in a tiddler that is current open for editing
* Should convert to use named params
***/
//{{{

if (config.toggleTagAlwaysTouchModDate == undefined) config.toggleTagAlwaysTouchModDate = false;

merge(config.macros,{

	toggleTag: {

		createIfRequired: true,
		shortLabel: "[[%0]]",
		longLabel: "[[%0]] [[%1]]",

		handler: function(place,macroName,params,wikifier,paramString,tiddler) {
			var tiddlerTitle = tiddler ? tiddler.title : '';
			var tag   = (params[0] && params[0] != '.') ? params[0] : "checked";
			var title = (params[1] && params[1] != '.') ? params[1] : tiddlerTitle;
			var defaultLabel = (title == tiddlerTitle ? this.shortLabel : this.longLabel);
			var label = (params[2] && params[2] != '.') ? params[2] : defaultLabel;
			var touchMod = (params[3] && params[3] != '.') ? params[3] : "";
			label = (label == '-' ? '' : label); // dash means no label
			var theTiddler = (title == tiddlerTitle ? tiddler : store.getTiddler(title));
			var cb = createTiddlyCheckbox(place, label.format([tag,title]), theTiddler && theTiddler.isTagged(tag), function(e) {
				if (!store.tiddlerExists(title)) {
					if (config.macros.toggleTag.createIfRequired) {
						var content = store.getTiddlerText(title); // just in case it's a shadow
						store.saveTiddler(title,title,content?content:"",config.options.txtUserName,new Date(),null);
					}
					else 
						return false;
				}
				if ((touchMod != "" || config.toggleTagAlwaysTouchModDate) && theTiddler)
						theTiddler.modified = new Date();
				store.setTiddlerTag(title,this.checked,tag);
				return true;
			});
		}
	}
});

//}}}

|Glycemic treatment goal|c
|| !American Diabetic Association (ADA)|!American Association of Endocrinologits|!International Diabetic Federation(IDF) |
|A1C (%)| < 7 | < 6.5 | < 6.5 |
|Fasting plasma glucose (mg%)| 90-130 | < 110 | < 110 |
|2-h postprnadial plasma glucose (mg%)| <180 | < 140 | <135 |

In Taiwan, the prevalence of tuberculosis is high, so we prefer macrolide in treating atypical pneumonia rather than fluoroquinolone to prevent the emergence of anti-TB drug resistance.
----
Chest CT images interpretted by experienced radiologists may be useful in detecting tuberculosis with sensitivity of 70%.
----
Among those anti-TB drugs, streptomycin is the only one that cause renal function impairment.

Estimated postprandial blood sugar = (HbA1C-5) x 35 + 100

All patient start to take OHA should be told the risk of hypoglycemia.

HbA1C may be within normal range in those having anemia, sickle cell disease, or under hemodialyis.

* Direct: To remove dead tissue while retracting the dressing
* Indirect: To prevent removal of the growing tissue

* Dry dressing
**For clear wound, covering and sterilization is optional.
* Wet dressing
** If the wound is clean, there is no need to add iodine solution.
** If the wound is not clean, consider use a 0.5x or 0.25x proviodine solution to keep the slow-releasing antiseptic effect. (Iodine diluted to 50~100x contains the highest ion form carrying the antiseptic effect, but will be lost when vaporized.)
** acetic acid is used for pseudomonas infection.
** While daily change dressing > 6 times, it is fine to use normal saline only without antiseptics even if the wound is not clean.

!!!!in anaphylaxis
* 0.3mg IM/IV q3min
!!!!in upper aireway obstruction
* 0.3mg IM/IV q15min, not exceed 1mg