過敏性休克使用腎上腺素每 5-15 分鐘給予一次肌肉注射

2005 ACLS 建議. 肌肉注射epinephrine 5-15 分鐘給一次.
Epinephrine
–Absorption and subsequent achievement of maximum plasma concentration after subcutaneous administration is slower and may be significantly delayed with shock.10,11 Thus, intramuscular (IM) administration is favored.
Administer epinephrine by IM injection early to all patients with signs of a systemic reaction, especially hypotension, airway swelling, or definite difficulty breathing.
Use an IM dose of 0.3 to 0.5 mg (1:1000) repeated every 15 to 20 minutes if there is no clinical improvement.
–Administer IV epinephrine if anaphylaxis appears to be severe with immediate life-threatening manifestations.
Use epinephrine (1:10 000) 0.1 mg IV slowly over 5 minutes. Epinephrine may be diluted to a 1:10 000 solution before infusion.
An IV infusion at rates of 1 to 4 μg/min may prevent the need to repeat epinephrine injections frequently.
–Close monitoring is critical because fatal overdose of epinephrine has been reported.3,14
–Patients who are taking β-blockers have increased incidence and severity of anaphylaxis and can develop a paradoxical response to epinephrine.15 Consider glucagon as well as ipratropium for these patients (see below).
https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.105.166568

2015指引. 使用 2010 ACLS建議, 沒有新的變動
The recommended dose is 0.2 to 0.5 mg (1:1000) IM to be repeated every 5 to 15 minutes in the absence of clinical improvement (Class I, LOE C).
https://eccguidelines.heart.org/tables/2015-guidelines-update-part-10-recommendations/

皮膚理學檢查描述 signs of skin lesion

primary skin lesion. 

1.斑（Macule）：皮膚顏色改變，界限分明，未突起之平面，通常小於1公分，如雀斑、瘀斑。
2.斑塊（Patch）：如上述之病變，但大於1公分之病變，如白斑病（Vitiligo）。
3.丘疹（Papule）：平坦突起，可觸摸得到之病變，但皮表未破損，通常小於0.5公分，如痣。
4.丘斑（Plaque）：比丘疹大之平坦突起，常由丘疹合併而成。
5.結節（Nodule）：突起之硬結，0.5-2公分。
6.腫瘤（Tumor）：突起之硬結大於２公分。
7.風疹塊（Wheal）：不規則之平坦突起，如蚊叮後之突起、蕁麻疹之突起。
8.小水泡（Vesicle）：小於0.5-2公分的皮膚突起，其界限分明且包含漿液，如單純性泡疹（Herpes Simplex）
9.水泡（Bulla）：大於2公分以上之皮膚突起，界限分明且包含漿液，如二度燒傷時的水泡。
10.膿泡（Pustule）：包含膿汁的皮膚突起，如粉刺（Acne）、膿泡疹（Impetigo）。

secondary skin lesion 
1.糜爛（Erosion）：表皮缺失之潮濕表面，但無出血現象，癒合後無疤痕
2.潰瘍（Ulcer）：皮膚表面及較深組織缺失，會出血，癒合後結疤。
3.裂隙（Fissure）：皮膚上線狀裂縫，面小但是可能深。


1.痂皮（Crust）：血清、膿汁和血液的乾燥物。
2.鱗屑（Crust）：表皮乾燥脫落的薄片。如頭皮屑、牛皮癬。
3.苔癬化（Lichenification）：皮膚變厚、變粗、皮膚上的紋理十分明顯，甘變異性皮膚炎。
4.萎縮（Atrophy）：皮膚變薄，紋理不明、皮表顯得發亮。如動脈供給不良之皮膚。
5.疤痕（Scar）：癒傷後修補傷口的纖維組織，常比正常皮膚色澤淺，且沒有紋理。
6.疤痕疣（Keloid）：增生之疤痕組織，常凸起皮表且呈樹突狀分枝。

Pathology on line/ Skin nontumor > Common terms

Definition / general

Acantholysis: loss of intercellular connections (desmosomes) between keratinocytes; occurs in pemphigus vulgaris and related disorders; causes change in cell shape from polygonal to round

Acanthosis: thickening of epidermis (squamous layer); rete ridges usually extend deeper into dermis

Atrophy: thinning of epidermis, associated with age or disease

Basophilic degeneration: age and sunlight related changes of collagen and elastic fibers

Blister 水泡: vesicle or bullae

Bullae 大水泡/大皰 : fluid filled area > 5 mm; either intraepidermal or subepidermal; intraepidermal bullae are due to spongiosis or acantholysis; subepidermal bullae are due to extensive papillary dermal edema

Calcinosis 鈣沉積: deposit of calcium

Colloid bodies膠體 : also called Civatte bodies; apoptotic keratinocytes, are oval / round, immediately above or below epidermal basement membrane

Comedo 毛囊漏斗擴張 : hair follicle infundibulum is dilated and plugged with keratin and lipids

Cyst: encapsulated cavity or sac lined by true epithelium

Dyskeratosis 角化異常 : abnormal, premature keratinization of keratinocytes below granular cell layer; often have brightly eosinophilic cytoplasm

Epidermolysis 表皮分解 : alteration of granular layer with perinuclear clear spaces, swollen and irregular keratohyalin granules, increased thickness of granular layer; different from acantholysis

Epidermotropism: atypical lymphocytes present in epidermis (seen in cutaneous T cell lymphoma)

Erosion: discontinuity of skin causing partial loss of epidermis (compare to ulceration)

Excoriation: deep linear scratch, often self-induced

Exocytosis: normal appearing lymphocytes in epidermis (spongiotic dermatitis)

Horn: conical mass of cornifed cells

Hydropic (liquefactive) degeneration: basal cells become vacuolated, separated and disorganized

Hyperkeratosis: thickened cornified layer, often with prominent granular layer; keratin may be abnormal; either orthokeratotic (hyperkeratosis is exaggeration of normal pattern of keratinization with no nuclei in cornified layer) or parakeratotic (hyperkeratosis has retained nuclei in cornified layer)

Lentiginous: linear pattern of melanocytic proliferation within epidermal basal cell layer

Leukocytoclasis: karyorrhexis and destruction of neutrophils; occurs with neutrophilic vasculitis (also called leukocytoclastic vasculitis)

Lichenification: thick, rough skin with prominent skin markings usually due to repeated rubbing

Lichenoid interface change: destruction of basal keratinocytes, causing remodeling of basement membrane zone; also bandlike lymphocytic infiltrate

Macule: circumscribed flat colored area of any size

Nodule: solid, deeply extending lesion > 5 mm

Oncholysis: loss of integrity of nail substance

Papillomatosis: outward overgrowth of epidermis with elongation of dermal papillae

Papule: elevated and solid area, 5 mm or less

Parakeratosis: cells of cornified layer retain their nuclei, often less prominent or absent granular layer; normal for mucous membranes

Patch: flat discoloration > 5 mm

Papule: solid elevated lesion < 5 mm

Plaque: elevated flat topped area, usually > 5 mm

Poikiloderma: combination of atrophy, telangiectasia and pigmentary changes

Purpura: extravasation of red blood cells into the skin or mucous membranes

Pustule: intraepidermal or subepidermal vesicle or bullae filled with neutrophils

Scale: dry, horny, platelike excrescence usually due to imperfect cornification

Scale crust: parakeratotic debris, degenerating inflammatory cells and tissue exudate on surface of epidermis

Sinus: tract connecting cavities to each other or to the surface

Spongiosis: intraepidermal edema, causing splaying apart of keratinocytes in stratum spinosum (resembling a sponge), vesicles due to shearing of desmosomes

Ulceration: discontinuity of skin causing complete loss of epidermis and possible loss of dermis

Vesicle: fluid filed area, 5 mm or less

Wheal: itchy, transient, elevated area with variable blanching and erythema, due to dermal edema