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2/2(金)

◆今日の気持ち
(整形外科 2日目)
・指導医から叱られたときのことばがかっこよかった。「自己満足の検査をするな」痛いして検査させたらその日のうちに検査の結果を患者に伝えにいけ、と。うん。そうがんばろう。
・整形外科の研修が始まった。今までは6ヶ月とか4ヶ月とかの長い期間を回ったが、今回は1ヶ月だけ…。ぽやぽやしていると過ぎ去りそう…。早いところ学ぶべきポイントを見極めて勉強しないと…
・2月は脳外は暇、とのこと。不思議。
・整形は独特の用語が多い…。そのつど聞いて、覚えねば…。
・早めに患者を掴まないと…。とりあえず、なれた検査データで掴んでみよう。カルテ・伝票整理を明日までに終らせる。週末に一部の患者だけでもレントゲンをじっくり眺めてみよう…。

●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
「手・足・腰診療スキルアップ」を読み終える

●今日の新患・診断
・顎脱臼
・梅毒

●今日の病院滞在時間
7時半〜24時

●今日行ったこと・見たこと・知ったこと
・頚椎造影
・ルート造影

・大腿骨頚部骨折で気をつけること
 足背動脈・膝窩動脈で、出血等チェック
・整形で気をつけるべきこと
 ヒ骨神経麻痺。大腿骨頚部骨折などでヒ骨で神経を押さえてしまう…。Tinelでチェック。
 外傷は仕事中かそうでないか。既往歴。喘息、局所麻酔アレルギー(歯科などで聞く)、DM、骨折歴
・頚椎後彎変形に後方除圧は効果なし。オリジナルカラムが狭ければ後彎除圧の適応。
・頚椎での選択的椎弓切除術。昔やられていたが、ヘルニアを起こしたり、脊椎損傷になったり…。でこぼこができるし、先まで削りすぎたり…。顕微鏡が発達した今、もう一度やられている。他、広く除圧して骨を埋めて固定させる方法も。しかし神経症状はいいけれど、筋肉に負担がかかったり…。固定しないで動かす手段もある。削る範囲の決定にはアライメントが重要。必ずしもCTやミエロだけで白黒決めれるものでなく、感覚が重要。

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