1/24(水) セミナー参加
◆今日の気持ち
(外科 4ヶ月目)
・今日はカンファ前に余裕があった。新患が少なかったのはあるが、よかった。
・問診、やっぱりまだ歯車が合いきらない。聞き忘れがある。何がいかんのか? 疾患が気になるため感度の高い質問をついしてしまう。特異度の高い質問ではずしていかないと、だめ。鑑別もあらためて丁寧にあげてみよう。
・最近救急をみていない。けれど不満はあまりない。やっぱり、逃げたかったのだろう。回復。
・循環器の薬は苦手…。資料は買ったけれど読む暇がない…。
・感染症。サンフォードと培養に頼ってしまい、微生物を治療前に推定しておく、という基本を最近やっていなかったことを認識。
・免疫不全のセミナー、とても勉強になった。しかし、あててもらったのだがまともに答えられず。悔しさをかみしめる。軽快の見込みある免疫不全患者は診ていないのはあるけれど、基本をおさえていれば、思考はできたはずで。
・治療は第一線の専門家に任せるしかないが、入り口、の診断は完全でありたい。
●目指す医師像
まずは、医者
●今の目標
・外科を味わいきる
・「マクギーの身体診断学」を読み終える
●今日の新患・診断
●今日の病院滞在時間
5時〜20時半
●今日行ったこと・見たこと・知ったこと
・外科カンファ
・CVポート設置 外まわり
・開腹胃廊設置 麻酔、タキった…
・セミナー 免疫不全時の感染症
・イレウス
腹水あるとき注意。絞扼性かtumorの可能性あり。多ければ、抜いて調べる。
・縫合
メスで切った創は閉じやすい。少し間をあけてもくっつく
・感染症の基本
host, focus, organism。鑑別あげて、確率を事前に推定して整理し培養してから、治療と観察。サンフォードはお手軽にやるための、そしてわからないとき安全を確保するための、ツール。診断は、その先。
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