1. CASE DISCUSSION 醫學六 王家泰 醫學六 王家泰

2. History Name : 陳 XX Ward ： 11A 9-2 Date of Admission : 92/03/22 Age : 33 y/o Sex : Female

3. History Chief Complaint : Wound infection after spinal surgery ‧ Present illness : This 33 y/o female patient is a case of hydrocephalus s/p V-P shunt 3 years ago in 萬芳醫院， She also had ankylosing spondylitis with kyphotic deformity and received T12-L4 multiple level osteotomy without instrumentation on 92/03/03 and complete of instrumentation on 92/03/07 and correctability was 50 degrees at 慈濟醫院。

4. History Wound infection was noted that she received debridement and removal of implant on 92/03/12 and second debridement on 92/03/17.Body cast was applied. Wound culture showed Acinetobacter and Proteus mirabilis and Tienam was used as antibiotics. She was then referred to our hospital for further management. Past History : DM(-), HTN(-), and denied other systemic disease

5. History Drug or food allergy : denied Previous OP history : hydrocephalus s/p V-P shunt 3 yrs ago, ankylosing spondylitis with kyphotic deformity s/p T12-L4 multiple level osteotomy, debridement for 2 times due to wound infection. Smoking(-), alcohol drinking (-) Family history : non-contribution

6. Physical Examination Consciousness : clear JOMAC : intact E4M5V6 Vital signs : stationary HEENT : Conjunctiva : pink Sclera : non-icteric Pupil : isocoric Light reflex : L/R : +/+ JVE : nil LAP : nil Goiter : nil ‧ Chest : Breathing sound : clear symmetric expansion Heart : RHB, no murmur was noted

7. Physical Examination Abdomen : Bowel sound : normal active Liver/Spleen : impalpable No tenderness and rebounding pain was noted OP marker : nil ‧ Extremities : No edema and ecchymosis was noted Impression : Wound infection s/p PD + PI

8. Lab Data C-reactive protein : ‧ WBC count : Seg.: 03/22 6.89 03/22 23400 03/24 4.50 03/24 16540 84.4% 03/27 8.73 03/27 14380 79.8% 03/31 4.48 04/07 6650 70.3% 04/03 5.87 04/07 6.12 04/10 9.01

9. Wound Culture 03/27 : Proteus mirabilis 3+ 04/02 : Proteus mirabilis 2+ PDRAB 1+ 04/10 → 隔離室 （ 11B 22-1 ）

10. Anesthesia

11. Anesthesia

12. Anesthesia

13. Anesthesia

14. Anesthesia

15. Anesthesia

16. Anesthesia