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3/6(火)

◆今日の気持ち
(脳外科 2週目)
・なんかあやしいな…と思ったらしっかりつめとかないといけない…
・電気メス。なかなか指導医のようには使えない…
・脳外科opeの出血は、結んで止血できないのが慣れないうちは怖いな…

●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
・慢性硬膜下血腫
・中枢性Na利尿
・MRSA陽性 コロナイズか?
・CPA

●今日の病院滞在時間
8時〜20時

●今日行ったこと・見たこと・知ったこと
・今週は学生がついている
・慢性硬膜下血腫ope 執刀
・整形カンファ
・肺炎

・脳動脈瘤コイリング。
 頚部が広いとき、分岐が多いとき、小さすぎるとき、は非適応。まあ、カテーテルを何本も入れて補助しながらやる医師もいるが。
・クリッピング
 手術しにくい後循環・椎骨動脈系はコイルが第一選択
・慢性硬膜下血腫CT
 isodensityはみにくいが、きちんとよむこと。受傷直後でもうっすら薄い膜がみえることも多い
・慢性硬膜下血腫手術
 頭頂の方は手術しにくいしなおりにくい
・骨壊死とOAの見分け方
 関節の片方のみがだめになっていたら壊死を疑う
・骨折のMRI
 T2スターはとても強調される
・骨折はずれなければ観察
・骨折にかさなった靭帯損傷。
 なんでも治しているとかたくなってしまうから、骨修復できないときなどでなければ放置で回復まつ
・スワローテールサイン
 脊柱管狭窄でもともと関節が狭いタイプだと、ハの字が平行に

・脳外科のope前
 意識レベル、握力、長谷川式、が最低限
・硬膜下血腫
 かたさを持った麻痺、弛緩がない、が特徴的。錐体外路成分があるからか?
・硬膜下血腫ope後頭痛
 たいてい、頭蓋内に残ったAirがあったまって膨れて、が原因のことが多い。特に、吐くほどだったら可能性高い。ソセゴンiv後の頭痛の可能性もある。反対側が急に膨れる可能性もある。いずれにせよ、空気が入らないように徹底的に工夫する、という考え方もある

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