2/20(火)
◆今日の気持ち
(整形外科 4週目)
●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
・脳震盪
・肘脱臼
・トウ骨近位端骨折
・脊椎カリエス?
●今日の病院滞在時間
7時半〜19時
●今日行ったこと・見たこと・知ったこと
・頚椎前方除圧
・整形カンファ
・痙攣。アシドーシス、白血球上昇あることあり。筋からか。
・圧迫骨折のフォロー。寝返りがうてるかどうか、がポイント。
・アンプタで、BK= below knee, AK= above knee
・カリエスCT。膿瘍、椎体ではなく椎間板から広がっている所見がみられる。圧迫骨折なら椎間所見
・頚椎ope。前から入るとすぐに脊椎に届く。後ろからより早い。浮腫・血腫が怖いためope後注意。
・大腿骨頚部骨折。ope後すぐに加重するとどうしても縮む。加重は遅らせる、ということも症例によっては手段。
・舟状骨骨折。「手首A→P尺骨位」がわかりやすい
・四肢骨折。内出血のため時間が立つと変色することあり
・脊椎損傷。深部感覚障害と譫妄重なり「ずっと立たされている」と訴えることあり
・脱臼。ゆっくりひっぱれば、はまる。けれど骨折の有無は必ずチェック。整復で骨折したのではない、と証明するためにも
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