2/28(水)
◆今日の気持ち
(整形外科 最終日)
・整形がいよいよおわる…。といっても次の脳外科は春は暇だから整形のopeにみっちりはいるよていだけれど。
・糸結びをほめてもらえた
●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
・変形性股関節症
・手掌刺傷、differenciation↓、時間経過と共に回復…血腫?
●今日の病院滞在時間
8時〜18時半
●今日行ったこと・見たこと・知ったこと
・ばね指ope
・指関節授動術
・THA
・THAで、臼部にガイドワイヤーで穴をあける。血流悪くなった変形部に血流を届けるため。
・腱鞘麻酔。麻酔が10ml必要な指ブロックとは違い2mlで麻酔がすむ。念のため3mlつかうけれど。背側に届かない(背側だけ追加の必要あり)のと、麻酔が効くまで時間がかかるのが短所。麻酔時の痛みも強い。掌側から骨に当たるまで針をいれ、30秒くらい時間をかけるつもりでゆっくり注入。
・指ブロック。掌側4ml、背側1mlをトウ側尺側二回にやる
・腱鞘の手術は術後すぐ動かす。そのため縫合は解けないようにマットレス。すぐ動かさないと癒着する。癒着していたものは繰り返し癒着しやすい。opeの回数重ねるほど癒着ひどくなる。
・ope終わりタニケットをといた後はじっくり圧迫止血。再還流直後は血流が増える。そのときに圧迫していないと包帯が血だらけに…。フラッシュバックが終れば手を離してもよい。
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