怎样成为好医生PPT课件.ppt

怎样成为好医生Whatmakesagooddoctor,怎样成为优秀的全科医生”,1,Whatmakesagooddoctor什么是好医生,“Thedoctorshouldhaveakinddisposition,greatpatience,meticulousfreedomfromprejudice,anunderstandingofhumannatureresultingfromanabundantknowledgeoftheworld,adroitnessinconversationandaspecialloveofhiscalling”GGreisinger1840Big3attributes-caring,responsibility,knowledge,“医生应该有良好的气质，极大的耐心，谨慎地不带成见，通过丰富的阅历理解人的属性，机智灵敏地与别人交谈，对病人充满爱心”GGreisinger18403个重点：关怀责任知识,2,12条指导原则,好医生应该有自己的指导原则。我认为，作为这个崇高和伟大的职业群体的一员，我们应该努力地让病人、同行和社会把我们看成一流的专业人员。,3,Developrapportginger;looktothehorizonNightmares:anti-epilepticsphenytoin;epilumHiccups:breakfastquestion;20mlspiritinteaspoonsugar;breathhold+iceErectiledysfunction:Viagraetc;considerischaemicheartdiseasePrematureejaculation:SSRIegProzacdailyPremenstrualtension:SSRI10daysbeforeM,晕车晕船:塞住一只耳朵，生姜，眼看前方做恶梦:抗癫痫药，苯妥英，丙戊酸钠呃逆，打嗝:早餐问题;20ml酒加一小勺糖;屏住呼吸冰勃起困难:伟哥;考虑是否患冠心病早泻:选择性5-羟色胺再吸收抑制剂SSRI，如百忧解，每天1次经前期紧张:月经来前10天吃SSRI,33,Paininthekneetrap奇怪的膝盖疼,Hipjoint-L3innervationKneepain-thinkhipBewarechildrenwithslippedupperfemoralepiphysis,髋关节L3神经支配膝盖疼要想到臀部问题儿童要注意是否上股骨端脱臼,34,Tenniselbow网球肘肌腱炎,Musclestrengtheningexercisesbestfortendonitis肌肉强度练习，对肌腱炎有好处Formedialepicondylitis(tenniselbow)-extensorsofwrist医学上的肱骨上髁炎（网球肘）-腕伸展肌,35,Trochantericbursalgia大转子滑囊炎,Commoninfemales45-50yearsPainonoutsidehip-?referredasfarasfootPainlyingonhipatnightLimpRxPhysio&exercisesMassageTrialNSAIDsInjectionlocalanaestheticandcorticosteroid,45-50岁以上妇女常见髋外侧疼可能波及到脚夜间髋部疼痛走路跛行处方理疗和锻炼按摩非类固醇抗炎药局部麻醉剂注射以及皮质类固醇,36,TreatmentofPlantarfasciitis足底筋膜炎的治疗,OrthoticaidsegRoseinsoleHydrotherapy-hotandcoldwater30secondseachalternate15timesTherapeuticfootmassageExercisesNSAIDS-3weeksInjectionundertibialnerveblock,矫正器，如罗斯鞋垫水疗冷热水每30秒交替一次，共做30次治疗性足按摩锻炼非类固醇抗炎药3周注射胫骨神经封闭,37,Torsionoftesticle“atimebomb”睾丸扭转定时炸弹,CommoncauseoflitigationAgerange5-15(earlyteens)85%salvageablewithin6hoursMostlostwithdelaysoninvestigationReferimmediatelytosurgeon/centreTeenageboysmaybediagnosedasappendicitis,常见的诉讼原因年龄范围5-15岁(青少年早期)85%的病例可以在6个小时内得以挽救大多数不可挽回的病例耽误在检查上立刻转诊到外科或医学中心年轻男孩可能被误诊为阑尾炎,38,Removalofforeignbodies清除异物,Splinterundernail扎在指甲里的碎片Fishhook钓鱼钩Splinterinskin扎在皮肤里的碎片,39,Pulledelbowinchildren儿童的牵引肘,Reducebysupination用反掌姿势复位,40,Simpletraumatrapsandtips小外伤的陷阱和要诀,Missingaforeignbody:glass,gravel,splinters,needleMissingarupturedtendonExposedjointcapsuleinwrist:watchfistpunchBites-human,cats,dogsHighpressureguns-oilandpaintStabwounds:nerves,tendonsCutfingerortoeTourniquetleftonfingerBewarejumpingfromheightontofeet-fractures,concussBewarepainfulelbowinchildBewarescaphoidfractureafterfallonoutstretchedhand,没找到扎在身体里的异物：玻璃，沙砾，碎片，针没找到断裂的肌腱腕关节囊暴露：拳击咬伤人，猫，狗高压枪油或油漆暴露伤:神经，肌腱切手指或脚趾止血带留在手指上当心从高处跳下骨折，脑震荡当心儿童的肘痛当心舟骨骨折摔倒后手触地,41,Neckdysfunction-muscleenergytherapy颈部功能失常肌能治疗,Asimplesafetreatment简单安全的治疗,42,Backpaintreatment背痛的治疗,Mobilisation&manipulation搬运和操作Exercises练习,43,Management-lifestyleadvice-NEAT疾病管理对生活方式的建议,N=Nutrition:optimaldiet,lowfat合理营养：优化饮食结构，低脂饮食，维生素，矿物质，多喝水E=Exercise:physicalactivity加强锻炼：让身体活动起来A=Avoidtoxins-cats：caffeine,alcohol,tobacco,sugar,salt,socialdrugs远离毒物：咖啡因，酒精，烟草，糖，毒品T=Tranquillity-rest&recreation,stressmanagement,yoga,meditation,goodsleep心态平静：休息娱乐、减少压力，瑜伽，静坐,44,Hypertension高血压,Lifestylemodification-alcohol,smokingetcManageassociatedconditionsegdiabetesMedication-need4-6weekstrial1.startwithACE/ARBorCCBorthiazide2.ACE/ARB+CCB(bestevidence)orthiazide3.ACE/ARB+CCB+thiazide,改变生活方式吸烟，饮酒等管理好相关的疾病，如糖尿病用药需要4-6周的试验先用血管紧张素转换酶抑制剂ACE/血管紧张素受体拮抗剂ARB或钙通道阻滞剂CCB或噻嗪类利尿剂ACE/ARB+CCB(证据显示效果最好)或噻嗪类利尿剂ACE/ARB+CCB+噻嗪类利尿剂,45,Diabetesmellitus-stepupmanagement糖尿病建立管理计划,Lifestylemanagement-diet,exerciseOralmonotherapy-metformin(choice1)orsulfonylureaCombinationoraltherapymetformin+sulfonylurea(?Gliptin)AddaglitazoneorotheragentAddinsulin-isophaneorlongacting,管理生活方式饮食，锻炼单药口服治疗甲福明二甲双胍(首选)或者磺脲联合口服治疗甲福明二甲双胍磺脲（或格列汀）加格列酮加胰岛素精蛋白胰岛素或长效胰岛素,46,Urinarytractinfection(uncomplicated)尿路感染（无并发症）,UrinedipstickMicro-culture(cleancatch)Highfluidintake-?wait3dayandseeruleAntibiotics-trimethoprimorcephalexinAlkaliniserespeciallyseveredysuriaRepeatMCU1to2weeksafterABcourseConsiderfurtherinvestigation,尿常规显微培养给大量液体？等3天看结果抗生素甲氧苄氨嘧啶或头孢氨苄碱化剂，特别是严重的排尿困难12周后重复膀胱造影检查，afterABcourse考虑进一步检查,47,Sore(streptococcal)throat咽痛（链球菌感染）,4keyfeaturesandindicationforpenicillinFever38CTendercervicallymphadenopathyTonsillarexudateNocoughOthers:those3-25yearswithpresumptiveGABHSfromspecialcommunitieswithahighincidenceofrheumaticfever,4个病症，需要用青霉素发烧38C颈部淋巴结肿大扁桃体渗出液不咳嗽另外：特定的风湿热高发社区325岁人群A组-溶血性链球菌,48,Otitismedia-children儿童中耳炎,PossibleclinicalindicatorsforantibioticsSickchildwithfeverVomitingRed-yellowbulgingeardrumLossofdrumlandmarksPersistfeverandpainafter3daysofaconservativeapproach,可以使用抗生素的临床指标儿童虚弱，发烧呕吐耳鼓蓬出耳鼓边缘消失保守治疗3天后持续发烧和疼痛,49,Otitismediainchildren-2儿童中耳炎2,RestinwarmroomwithadequatehumidityParacetamolsuspensioninhighdosageDecongestantsonlyifnasalcongestionAntibioticsasindicatedegamoxycillin40mg/kg/din3divideddosesfor7daysFollowupincludinghearingin10days,休息房间保持温暖和适宜的湿度大剂量扑热息痛输液如果充血，给抗充血剂抗生素，如阿莫西林40mg/kg/d，分每天3次，用7天10天内随访，包括耳检查,50,Thinkfastwithinfarction对血栓的快速考虑,Interventiontimerul