2/16(金) セミナー参加
◆今日の気持ち
(整形外科 3週目)
・睡眠不足….体調管理は大切で
●目指す医師像
まずは、医者
●今の目標
・整形外科を味わいきる
●今日の新患・診断
・陳旧性骨折にまぎれた舟状骨折?
●今日の病院滞在時間
7時半〜18時半
●今日行ったこと・見たこと・知ったこと
・頚椎造影
・脊柱管造影
・コラーゲン摂取の効能
・手動脈
尺骨がmain。損傷したら、血管外科に頼んでバイパス、が早い。血流チェックはアレンよりcapillary refillingが早いことが多い
・中手骨
示指・中指は動かない。骨折しても問題ないこと多い
・CM関節
DIPの次にOAおこりやすい
・舟状骨骨折
専門家でも読みにくいことあり。偽関節になりやすい
・指の骨折
屈曲時の回旋変形に注目
・green stick fracture
・爪損傷 Schiller法
・腹腔内感染症
混合感染が多い。横隔膜より下は、腸管内にE.coliよりずっと多い嫌気性菌、特にβラクタマーゼを産生するBacteroides fragilisがいることが、問題! これが悪さをする。だからβラクタマーゼ阻害剤などが必要になる。…よって、横隔膜より上の消化管からの感染症はアンピシリンで十分。
腸球菌はいても、悪さはしないことが多い。コンプロマイズドでなければ。
メトロニダゾールは腸管からの吸収よく嫌気性菌に有効
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