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3/14(水) セミナー参加

◆今日の気持ち
(脳外科 3週目)
・糸結びは不安なくなってきたけれど針使いが苦手…。まっすぐ構えて腋をしめて手首だけで針の曲率通りに手をかえす!
・眠かった…
・点滴と経口の抗生剤の違いについてふとわからなくなった。点滴の方が血中濃度が高くなる…という考え方はevidenceはどうなのだろう? 別に経口の量を増やしてもいいのかもしれないし。保険適応はそれくらいの量になるとなさそうだけれど。

●今の目標
・脳外科を味わいきる

●今日の新患・診断
・高脂血症 橋本病なし 痩せ型高齢 原因は??

●今日の病院滞在時間
当直〜18時半

●今日行ったこと・見たこと・知ったこと
・慢性硬膜下血腫ope
・星状神経節ブロック

・Afからsinusに戻ったときに、血栓が飛ぶ
・前頭葉内側に排尿中枢あり。そこやられると失禁などおこる

・感染症セミナー 皮膚軟部組織感染症
 Impetigo, せつ、丹毒、蜂窩織炎、NSTI
 症例「NSTI。直腸穿孔から。培養でE.colがでたからユナシン投与」
 →疑問: 他の菌もいても検出できなかったという可能性は?
 →直腸穿孔なら大きくは、E.coli、緑膿菌、嫌気性菌を考える。E.coliを培養できるなら緑膿菌がいればまずつかまる。問題は嫌気性菌がいるかいないかで、培養はしにくいこともあるが、臨床症状から最後は考える

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