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1/25(木)

◆今日の気持ち
(外科 4ヶ月目)
・感染症治療の基本。Host, focus, organism, 鑑別、検査・治療、観察、再思考。肩の力を抜いて、organismを病理にかえて考えてみると、そういえば、それは西洋医学すべての分野の基本だ。基本にのっとることが、たいせつで。
・terminal GCaの無尿。腎不全…と自分は思考停止していたら、尿管への播種で、実は手があって…。病理を追求しきることが、西洋医ではとても重要で。思考停止をするべきときもあるが、それはそれを自覚した上でするべきで。
・プレゼンは、聞き手の思考を整理できるようにしなければ。そのためにはフォーマットを身につけることが大切。Patient, focus, 病理、鑑別、検査・治療、観察、再思考のとき注目するポイント。特に前半をきちんと。
・病院での勉強。自分で決断できる、勘を働かせるチャンスをつかむことが大切。
・感染以外の発熱。そこのバランス感覚は重要。
・先輩Drの聴診は、真似できない…
・「ルーチン」の重みを思い知る。認知症など問診できず症状も見えにくい患者は大切なものがひっかかることもある。それでも研修医のうちはわかった上でもルーチンではなく五感で感じれるようになることが大切なのだろうけれど。
・プレゼンテーションが下手。気持ちが診断まで焦りすぎ。基礎情報・所見を共有した上で、鑑別まで届かないとプレゼンの意味がない。急がばまわれ。スピードをだす能力はまだないのだから、一歩いっぽ。
・気づかないうちに手を怪我していた…。感染防御には気を使わないと…
・奇をてらわずまず標準で

●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
・腹膜播種で尿管狭窄
・骨折 → 脂肪塞栓 → ARDS

●今日の病院滞在時間
7時半〜19時半

●今日行ったこと・見たこと・知ったこと
・double J 見学
「手術研修医マニュアル」を読んだ。文章がわかりやすくてよかった。「べからず集百選」がよかった。「手術とは何か、手術手技とはなにか、手術における技術とは何か、この技術を如何に記録するか、手術の技術に関する情報交換のあり方、手術手技の向上は如何に計られるべきか」の言葉が印象に残った

・針は手で持たず、セッシで
・脂肪塞栓
 ステロイド。パルスで。高圧酸素で脂肪滴小さくなるので、施設あるなら有効!
・ARDS
 エラスターゼ阻害薬、ひどくなる前にやらなければ意味ない。易感染性にも注意。

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