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3/2(金) セミナー参加

◆今日の気持ち
(脳外科 1週目)
・最近気がつくと呼吸がとまっている。意識しないと十分量呼吸できない。気合が入りすぎか?
・opeは解剖・病理を自分の眼で確かめられるところがいいな。内科の、確かめられない不確実さ・不安さもそれはそれでおもしろいけれど。
・視診て重要。先入観を持つべし。

●目指す医師像
まずは、医者

●今の目標
・脳外科を味わいきる

●今日の新患・診断
・SAHクリッピング後視力↓。何??

●今日の病院滞在時間
7時〜17時半

●今日行ったこと・見たこと・知ったこと
・クリッピング後脳血管angio
・小児上腕骨内果骨折整復ope

・肩関節セミナー
・院内感染セミナー

・脳外科回診でチェックすべきこと。
 意識レベル(GCS)。麻痺。脳神経。循環・呼吸。より自然な状態にもっていけるように…
・脳死判定基準。深昏睡、自発呼吸なし、低体温・低血圧・低年齢・薬物の除外。
・脳幹反射。
 前庭動眼反射、角膜反射、対光反射など
・Angio。鼠径ヘルニアに注意。クリップは骨条件で…
・骨成長停止。平均は男子なら17〜18歳くらい、女子なら15〜16くらい。その前の骨折は注意。
・頚椎。ヘルニアなら神経根で片側の障害、脊髄症なら両側の障害。ほとんどは後者だが、前者の可能性も頭にとめておかないといけない
・Spurling test。危険だからやらないほうがいい。確かめたかったら、「天井見て」といってさらに自力で斜めに動かさせ、確かめればいい。さらに反対側の肩を押し下げると感度が上がる

・肩関節可動域、不安感テスト
・肩筋力test
・インピンジメント症候群、肩板断裂、肩関節脱臼

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