重点：osce考试详解-冯立宗

重点：osce考试详解-冯立宗 以下所有内容为本人结合各种资料综合而成的，仅供参考，如有纰漏，还请谅解。 短站(每个站8分钟，1分钟给考官打分) 一、内、外、儿科问诊SP 给一个病例，进行问诊、做出初步诊断。 注意:由SP打分，没有监考老师，可以放轻松点。对SP要有礼貌，要有医师的从容镇定，有条不紊地问下来是时间充足的。 二、诊疗操作1 腹腔穿刺、胸腔穿刺、骨髓穿刺(含儿科骨穿)、腰椎穿刺(含儿科腰穿)。 所有都要事先签署知情同意书。 1.胸腔穿刺术 1) 备好用品并带到床旁。确认患者身份，向患者介绍自己，穿刺目的。 2) 摆好反向骑跨位。 3) 洗手，戴口罩，帽子，准备好4条胶带。 4) 确定穿刺点，通过叩诊选择实音最明显的部位，然后做标记。 5) 穿刺点部位皮肤消毒>15cm，消毒利多卡因瓶盖 6) 确定穿刺包有效日期，开包，戴无菌手套，铺洞巾并嘱咐助手用胶带将其固 定。 7) 检查胸穿针和胶皮管/三通管是否通畅(检查完记得关闭) 。 8) 2%利多卡因(3-5ml)，在下一肋骨上缘先打皮丘(15?进针)，后逐层麻醉。 麻醉过程中边回抽边进针。(麻醉前告知患者要打麻醉了，会有点痛，让她 不要乱动) 9) 见有胸液流出，则退针1-2mm注射麻药浸润壁层胸膜。 10) 拔针，并用无菌纱布压住。 11) 操作者左手食中指固定穿刺处皮肤，右手拿无菌纱布握住穿刺针(16 or 18 号)，在下一肋骨上缘进行穿刺，当穿透壁层胸膜时可有突然落空感。 12) 让助手将穿刺针用止血钳夹紧，然后操作者将注射器与胶皮管接好，打开三 通管开关即可抽液。 13) 抽满后先关闭三通管开关，再卸下注射器。然后自己将抽出液注射到3个试 管里。 14) 抽吸完毕后，拔出穿刺针，压迫穿刺点片刻，局部消毒后覆盖无菌纱布，用rAt present, we have formed a "three-three" Park. …… Industrial Park, according to ... ... The instructions of comrade, focus on development needs in the next decade, based on the original, and then extended the 6 square kilometers. Of the Park, to further improve the roads, power supply, communications, water supply and drainage and sewage pipe network and other infrastructure, to achieve full coverage of infrastructure and interconnection with the facilities and raise capacity. Each park to determine 1 leading industries, in particular stone Materials, cans, gloves, through guided, force and other measures to promote the "road company" Park, industrial agglomeration. Currently, to focus on building better ... ... Industrial Park, ... ... Wood Park as the starting area of the industrial park, planners need to take out plan, start construction as soon as possible, undertake in a timely manner ... ... Transfer of the wood industry. This opportunity slip by, so the timing must be tight. Second is to optimize government service. Low efficiency of government services, departments do not coordinate the views of businesses large, poor business environment, it is ... ... Short Board, decide to change. We will continue to deepen reform of the administrative examination and approval system, good digestion, implement the Government canceled, adjustment and devolution of administrative examination and approval matters, strengthen the existing supervision in matters of administrative power, has made it clear to cancel, are not allowed to keep or disguised approval. To do list list of administrative powers and responsibilities 胶布固定，嘱患者静卧休息2-4h，并检查有无气胸。 Tips:1.有胸片的要先看胸片，然后左右两边都要叩诊,最后确定为左侧 2.穿刺点常取: a) 肩胛下线7-9肋间 b) 腋后线7-8肋间 c) 腋中线6-7肋间 d) 腋前线5肋间 3.先让助手确认是否为利多卡后,自己准备抽的时候也要让他给你再次确认是否为利多卡因 4.注意事项: a) 减压首次不超过600ml，以后每次不超过1000ml b) 两次抽吸时间间隔为5-7天 c) 禁止在第九肋间以下穿刺 2.腹腔穿刺术 1) 准备物品:将皮肤消毒用品、无菌手套、局麻药物、治疗用药和腹穿包携至 操作地点。腹穿包应有注射器、腹穿针、标本瓶、孔巾等 2) 站在患者右侧，确认患者身份并向患者自我介绍，说明穿刺目的，消除顾虑; 洗手，戴口罩，帽子，准备2条胶布 3) 术前嘱病人排尿排空膀胱，以免穿刺时损伤。 4) 腹穿前帮患者量血压和腹围，检查移动性浊音 5) 取平卧位，选择适宜的穿刺点，并做好标志: ?左下腹脐与髂前上棘连线中、外1,3交点，此处不易损伤腹壁动脉，最 为常用; ?脐与耻骨联合连线中点上方1.0cm、偏左或偏右1.5cm处，此处无重要器 官且易愈合; ?侧卧位，在脐水平线与腋前线或腋中线之延长线相交处，此处常用于诊断 性穿刺; ?少量积液，尤其有包裹性分隔时，须在B超指导下定位穿刺。 6) 消毒穿刺点2次(15cm)，消毒利多卡因瓶盖 7) 检查穿刺包有效日期后打开包，戴无菌手套铺洞巾后，检查物品是否齐全， 有效。 8) 用2%利多卡因进行麻醉(15?打皮丘，随后垂直) 9) 术者左手固定穿刺部皮肤，右手持穿刺针采用Z形穿刺法 -50ml针筒连接三通10) 当有落空感时，让助手帮忙固定穿刺针，操作者则用20 管进行抽液。抽液后自己将抽出液注射到试管内(3管)。 11) 放液后拔出穿刺针，覆盖消毒纱布，以手指压迫数分钟，再用胶布固定。 12) 放液完毕后测量腹围，血压，脉搏，观察变化。 13) 嘱病人静卧休息 注意事项: a) 若患者出现头晕心悸血压降等反应立即停止 b) 每次放液不超过3000ml rAt present, we have formed a "three-three" Park. …… Industrial Park, according to ... ... The instructions of comrade, focus on development needs in the next decade, based on the original, and then extended the 6 square kilometers. Of the Park, to further improve the roads, power supply, communications, water supply and drainage and sewage pipe network and other infrastructure, to achieve full coverage of infrastructure and interconnection with the facilities and raise capacity. Each park to determine 1 leading industries, in particular stone Materials, cans, gloves, through guided, force and other measures to promote the "road company" Park, industrial agglomeration. Currently, to focus on building better ... ... Industrial Park, ... ... Wood Park as the starting area of the industrial park, planners need to take out plan, start construction as soon as possible, undertake in a timely manner ... ... Transfer of the wood industry. This opportunity slip by, so the timing must be tight. Second is to optimize government service. Low efficiency of government services, departments do not coordinate the views of businesses large, poor business environment, it is ... ... Short Board, decide to change. We will continue to deepen reform of the administrative examination and approval system, good digestion, implement the Government canceled, adjustment and devolution of administrative examination and approval matters, strengthen the existing supervision in matters of administrative power, has made it clear to cancel, are not allowed to keep or disguised approval. To do list list of administrative powers and responsibilities c) 绝对禁忌症:DIC Tips:尽管穿刺点在左边，但还是得站在右侧操作 打麻醉时，边进针边回抽，所有穿刺都这样 用一块纱布裹住穿刺针近端，防止手套上滑石粉进入患者体内 大量输液时，用8/9号针头 大量放液后，需束以多头腹带，以防腹压骤降、内脏血管扩张引起血压下降或休克。 3.腰椎穿刺术 1) 操作者备齐物品至床旁 2) 确认患者身份，并向患者自我介绍说明穿刺目的，消除顾虑;嘱患者排空 大小便 3) 操作者戴好口罩帽子，口罩，洗手 4) 帮助病人摆好体位 5) 确定穿刺点 6) 消毒穿刺点(15cm)，消毒利多卡因瓶盖 7) 检查穿刺包有效日期后将其打开，戴无菌手套，铺洞巾 8) 检查穿刺包内穿刺针(用9号)拔出针芯后能否插回。 9) 操作者左手固定穿刺点周围皮肤，右手持穿刺针(PS:需用两块纱布，一 块垫在掌心像骨穿一样，另一块包裹穿刺针近端，以防滑石粉入患者体 内)，将穿刺针斜面向头端与穿刺平面垂直缓慢进针，针尖稍斜向头部。 10) Feel到落空感后，缓慢将针芯抽出(先不要完全抽出)，看到有脑脊液 流出。 11) 拿压力计，注意要先用食指按压压力计上端。此时抽出针芯接上压力计， 并嘱咐病人放松，腿稍伸直。 12) 测压完毕后，撤除压力计，插入针芯。 st13) 随后拿试管收集3管2-5ml脑脊液送检，将针芯插回去。(检查内容:1 ndrd生化,2细菌,3细胞) 14) 术毕，拔针，覆盖消毒纱布，按压数分钟，点状消毒，胶布固定 15) 让病人去枕平卧4-6小时，多饮盐开水，避免低颅压头痛 禁忌症: a) 颅内高压,脑疝 b) 穿刺部位感染, c) 全身严重感染,休克 d) 高位颈椎肿瘤 体位: a) 弯腰侧卧位 b) 背与床面直 c) 屈颈抱膝 rAt present, we have formed a "three-three" Park. 10„„ Industrial Park, according to ... ... The instructions of comrade, focus on development needs in the next decade, based on the original, and then extended the 6 square kilometers. Of the Park, to further improve the roads, power supply, communications, 本科一班 冯立宗 water supply and drainage and sewage pipe network and other infrastructure, to achieve full coverage of infrastructure and interconnection with the facilities and raise capacity. Each park to determine 1 leading industries, in particular stone Materials, cans, gloves, through guided, force and other measures to promote the "road company" Park, industrial agglomeration. Currently, to focus on building better ... ... Industrial Park, ... ... Wood Park as the starting area of the industrial park, planners need to take out plan, start construction as soon as possible, undertake in a timely manner ... ... Transfer of the wood industry. This opportunity slip by, so the timing must be tight. Second is to optimize government service. Low efficiency of government services, departments do not coordinate the views of businesses large, poor business environment, it is ... ... Short Board, decide to change. We will continue to deepen reform of the administrative examination and approval system, good digestion, implement the Government canceled, adjustment and devolution of administrative examination and approval matters, strengthen the existing supervision in matters of administrative power, has made it clear to cancel, are not allowed to keep or disguised approval. To do list list of administrative powers and responsibilities d) 垫一枕头保持脊柱伸直 e) 儿童则让助手一手挽其头部，另一手挽双下肢腘窝处并抱紧 穿刺点: 两侧髂脊最高点与后正中线交点，相当于3-4腰椎间 两块纱布乃监考腰穿的老师要求…尽管许老师没说过.. 压颈试验(Queckenstedt) 阴性:压颈升压，恢复快 阳性:压颈不升 压颈缓升，恢复慢 Tips:腰穿模型很给力，压力足以将水压出压力计…此乃传说中的脑疝…现实 中遇到,你得马上停止腰穿! 常见并发症: a) 头痛:最常见 b) 脑疝:最危险 c) 腰背痛&神经根痛 d) 感染 4.骨髓穿刺术 1) 术前检查患者止凝血功能 2) 备好物品至床旁，确认患者身份,并向患者自我介绍和解释 3) 操作者戴口罩帽子,洗手，准备2条胶布 4) 确定穿刺点，并帮助患者摆好体位 a) 髂前上棘穿刺点:髂前上棘后1-2cm b) 髂后上棘穿刺点 c) 胸骨穿刺点:胸骨柄或胸骨体相当于1,2肋间隙的位置 d) 腰椎棘突穿刺点:T11-12或L1-3其中之一为穿刺点 5) 消毒穿刺部位(15cm),消毒利多卡因瓶盖 6) 检查并打开穿刺包 7) 戴无菌手套，铺洞巾 8) 检查骨髓穿刺针，并调整适合长度 9) 用2%利多卡因做局部皮肤、皮下及骨膜麻醉 10) 用左手的拇示指固定穿刺部位，以右手持针向骨面垂直刺入，当针尖触及骨 质后则将穿刺针围绕针体长轴旋转，缓缓钻刺骨质 11) 有落空感且穿刺针固定在骨内时，则表示已进入骨髓腔 12) 拔出针芯，放于无菌盘内 13) 接上干燥注射器，抽吸前告知病人会有轻微锐痛，随即吸0.1-0.2ml，抽吸完 毕，将针芯迅速插入 14) 将骨髓液滴在一张玻片上，自己推片8张 15) 左手取无菌纱布置于针孔处，右手拔穿刺针，按压1-2min后点状消毒再用胶 布固定 16) 做外周血检查，推片2-3张 17) 穿刺后注意局部有无出血，嘱病人静卧2-4h 18) 询问病人还是否需要别的帮助，随即收拾物品离开病房。 rAt present, we have formed a "three-three" Park. …… Industrial Park, according to ... ... The instructions of comrade, focus on development needs in the next decade, based on the original, and then extended the 6 square kilometers. Of the Park, to further improve the roads, power supply, communications, water supply and drainage and sewage pipe network and other infrastructure, to achieve full coverage of infrastructure and interconnection with the facilities and raise capacity. Each park to determine 1 leading industries, in particular stone Materials, cans, gloves, through guided, force and other measures to promote the "road company" Park, industrial agglomeration. Currently, to focus on building better ... ... Industrial Park, ... ... Wood Park as the starting area of the industrial park, planners need to take out plan, start construction as soon as possible, undertake in a timely manner ... ... Transfer of the wood industry. This opportunity slip by, so the timing must be tight. Second is to optimize government service. Low efficiency of government services, departments do not coordinate the views of businesses large, poor business environment, it is ... ... Short Board, decide to change. We will continue to deepen reform of the administrative examination and approval system, good digestion, implement the Government canceled, adjustment and devolution of administrative examination and approval matters, strengthen the existing supervision in matters of administrative power, has made it clear to cancel, are not allowed to keep or disguised approval. To do list list of administrative powers and responsibilities 绝对禁忌:血友病 髂骨穿刺:1.5cm 胸骨穿刺:1.0cm Ps:在手掌垫纱布防止穿刺针弄破手套 注射器&穿刺针必须干燥防溶血 没错～就是自己推～时刻记得考试时你是很难喊动助手的～ 确实要眼睁睁看着穿刺针扎在骨头上,然后自己推片。这只能怪袖手旁观的助手~ 不太清楚外周血要不要真做，还是跟老师说说就好。因为没有工具给你做。 三、诊疗操作2 1、动脉穿刺(血气 分析 定性数据统计分析pdf销售业绩分析模板建筑结构震害分析销售进度分析表京东商城竞争战略分析 ) 2、成人静脉穿刺(静脉采血、输液)(三查七对～～操作后记录～～) 3、小儿头皮静脉穿刺 4、穿脱隔离衣 5、插胃管(别忘了吞咽) 6、吸氧(开关离开患者操作～检查密闭性～消毒鼻孔～) 7、导尿术 8、吸痰 1.动脉穿刺术 1.适应症:输血、输液、有创持续动脉血压检测、动脉血气分析 2.禁忌症:穿刺部位感染、凝血功能障碍 3.准备:1)沟通 2)备皮(视情况) 3)准备物品(清洁盘、消毒、穿刺针、肝素生理盐水、加压装置、胶带、纱布) 4.步骤:(桡动脉) 1)戴好口罩帽子，确定患者，确定穿刺点。 2)腕背伸位，下面加一小垫，常规皮肤消毒(碘伏2或者碘酊1+酒精2) 3)带无菌手套(或者消毒拇指、食指和中指)，将注射器用肝素生理盐水冲洗，以左手食指和中指在腕关节桡侧动脉波动明显处固定。 4)右手池注射器，在两指间垂直或与动脉走向40?角刺入。刺入动脉时可见鲜红色血液直升入注射器(无须负压)。 5)操作完毕，迅速拔出针头，按压5-10分钟。针头插入木塞中(血气分析防氧化)。 6)收拾、关怀。 rAt present, we have formed a "three-three" Park. 10„„ Industrial Park, according to ... ... The instructions of comrade, focus on development needs in the next decade, based on the original, and then extended the 6 square kilometers. Of the Park, to further improve the roads, power supply, communications, 本科一班 冯立宗 water supply and drainage and sewage pipe network and other infrastructure, to achieve full coverage of infrastructure and interconnection with the facilities and raise capacity. Each park to determine 1 leading industries, in particular stone Materials, cans, gloves, through guided, force and other measures to promote the "road company" Park, industrial agglomeration. Currently, to focus on building better ... ... Industrial Park, ... ... Wood Park as the starting area of the industrial park, planners need to take out plan, start construction as soon as possible, undertake in a timely manner ... ... Transfer of the wood industry. This opportunity slip by, so the timing must be tight. Second is to optimize government service. Low efficiency of government services, departments do not coordinate the views of businesses large, poor business environment, it is ... ... Short Board, decide to change. We will continue to deepen reform of the administrative examination and approval system, good digestion, implement the Government canceled, adjustment and devolution of administrative examination and approval matters, strengthen the existing supervision in matters of administrative power, has made it clear to cancel, are not allowed to keep or disguised approval. To do list list of administrative powers and responsibilities 2.静脉穿刺术 1.适应症:输液、输营养、输血、中心静脉压测定 2.准备:1)沟通2)准备物品(清洁盘、穿刺针、药品、消毒、胶带、纱布) 3.步骤:(股静脉) 1)戴好口罩帽子，三查七对。 2)确定穿刺点，患者取平卧位，穿刺下肢轻微外展外旋，在腹股沟韧带中点内下方1.5-3.0cm，股动脉搏动内侧为穿刺点。 3)(桡动脉要绑橡胶带)，常规消毒，带无菌手套。右手持注射器向左手食指、中指固定的穿刺点刺入，进针方向与皮肤呈30?-45?，与血流同向，边进针边抽吸，缓慢刺入。 4)当穿刺针进入静脉后，可见静脉血压回流进针管内，再进针2-4mm即可。 5)穿刺完毕，拔出针头并消毒皮肤，盖无菌纱布，局部压迫3-5分钟。 6)收拾、关怀。 3、小儿头皮静脉穿刺 同上。 4.穿脱隔离衣 1) 带好帽子口罩，卷袖过肘，手持衣领，取下隔离衣，清洁面向自己 2) 持衣领两端向外折齐，露肩袖内口，右手持衣领，左手伸入袖口，依法传入 右手 3) 两手顺衣领到领后将扣子扣好，再扣肩扣和袖扣 4) 左右手分别将两侧隔离衣边缘捏起(不能触到内面)，并在身后对齐，向一 侧折叠，压住折叠处。 5) 将腰带在背后交叉，回到前面打活结，不能使折叠处松散 6) 扣上隔离衣下缘扣子 7) 松开后缘下不扣子，将腰带在前面打活结。 8) 解开袖口，在肘部将部分袖子塞入袖内，消毒双手。 9) 洗手顺序为:左右前臂---左右腕部---左右手背---左右手掌---左右手指缝---左 右手指甲指尖 10) 流水洗手时要使腕部低于肘部,使污水从前臂流下指尖 11) 解开领口,右手伸入另一衣袖内,落下衣袖过手,再用衣袖遮住的手捏住另一衣 袖的外面将其拉下 12) 两手转换,将手从袖内退出,两手将隔离衣领对齐,挂在衣钩上 5.胃插管术 一、插管+鼻饲 1) 洗手,戴口罩,备齐用物至床旁,向病人解释 2) 患者取半卧位,颌下铺治疗巾,用手电筒检查鼻腔是否通畅 3) 清洁鼻孔,取2块无菌纱布放入治疗碗内,倒上石蜡油 rAt present, we have formed a "three-three" Park. …… Industrial Park, according to ... ... The instructions of comrade, focus on development needs in the next decade, based on the original, and then extended the 6 square kilometers. Of the Park, to further improve the roads, power supply, communications, water supply and drainage and sewage pipe network and other infrastructure, to achieve full coverage of infrastructure and interconnection with the facilities and raise capacity. Each park to determine 1 leading industries, in particular stone Materials, cans, gloves, through guided, force and other measures to promote the "road company" Park, industrial agglomeration. Currently, to focus on building better ... ... Industrial Park, ... ... Wood Park as the starting area of the industrial park, planners need to take out plan, start construction as soon as possible, undertake in a timely manner ... ... Transfer of the wood industry. This opportunity slip by, so the timing must be tight. Second is to optimize government service. Low efficiency of government services, departments do not coordinate the views of businesses large, poor business environment, it is ... ... Short Board, decide to change. We will continue to deepen reform of the administrative examination and approval system, good digestion, implement the Government canceled, adjustment and devolution of administrative examination and approval matters, strengthen the existing supervision in matters of administrative power, has made it clear to cancel, are not allowed to keep or disguised approval. To do list list of administrative powers and responsibilities 4) 戴手套,打开胃管包装,润滑胃管前端15-20cm 5) 量胃管进入胃内的长度(发际至剑突) 6) 一手用纱布包裹胃管,另一手用镊子夹胃管,沿一侧鼻孔轻轻插入。 7) 当插入14-16cm处(咽喉),嘱患者做吞咽动作,此时将胃管向前推进。 8) 插入深度45-55cm后,检查胃管是否在胃内(打气气过水声，回抽，放入水中 看有无气泡)。 9) 用胶带固定胃管于鼻翼与颊部。 10) 再用无菌纱布包裹胃管末端,固定于枕边。 11) 鼻饲前,先用注射器回抽检查胃管是否在胃内,在缓慢注入少量温开水。 12) 鼻饲完毕后,必须再注入少量温开水冲净胃管。 二、拔管 13) 拔管前先向患者解释,铺治疗巾,并置碗盘于病人颌下。 14) 去掉别针和胶带,用纱布包裹鼻孔处的胃管。 15) 嘱病人进行深呼吸,轻柔一次性将导管拔出。 16) 用纱布包裹抽出的胃管,放碗盘内。 17) 清洁病人口鼻,车治疗巾。 18) 整理物品离开。 6.鼻导管吸氧术 1) 将氧气筒推至患者床旁右侧，并向患者解释以取得合作。 2) 用手电筒检查患者鼻腔，随后用棉签清洁鼻腔。 3) 开关总开关以除尘。 4) 接氧表，装湿化瓶(水不超过1/2) 5) 检查气密性及氧气是否充足: 开,关总开关---开,关流量表。 6) 准备两条胶带。 。 7) 戴手套 8) 打开治疗巾，用无菌持物钳将放在铁盒内的鼻导管及玻璃管，纱布夹出并放 在治疗碗内。放好持物钳。 9) 将氧管与湿化瓶相连。 10) 用弯盘内的镊子夹取玻璃管，用手将其与氧气管连接好。 11) 用镊子夹取鼻导管连接端(有孔端留在治疗碗内)，用手将其与玻璃管相连 12) 开总开关，将流量表调至2L/min(球的上缘到刻度2) 。 13) 检查鼻导管出气是否正常。 14) 将鼻导管轻轻插入鼻腔内，长度为鼻尖至耳垂距离的2/3。 15) 将鼻导管用胶布固定，一个固定于鼻尖，另一个固定在颧骨旁。 16) 用别针固定氧管于床头。 17) 记录给氧开始时间及氧流量后，询问患者是否有别的需要后才离开。 18) 给氧完毕后，须跟病人说明结束吸氧并进行人文关怀。 19) 取下鼻导管，并用纱布帮患者擦拭 。 20) 关总开关---关流量表---拔氧管。 21) 记录给氧结束时间。 22) 整理后，询问病人是否有别的需要后才离开。 rAt present, we have formed a "three-three" Park. 10„„ Industrial Park, according to ... ... The instructions of comrade, focus on development needs in the next decade, based on the original, and then extended the 6 square kilometers. Of the Park, to further improve the roads, power supply, communications, 本科一班 冯立宗 water supply and drainage and sewage pipe network and other infrastructure, to achieve full coverage of infrastructure and interconnection with the facilities and raise capacity. Each park to determine 1 leading industries, in particular stone Materials, cans, gloves, through guided, force and other measures to promote the "road company" Park, industrial agglomeration. Currently, to focus on building better ... ... Industrial Park, ... ... Wood Park as the starting area of the industrial park, planners need to take out plan, start construction as soon as possible, undertake in a timely manner ... ... Transfer of the wood industry. This opportunity slip by, so the timing must be tight. Second is to optimize government service. Low efficiency of government services, departments do not coordinate the views of businesses large, poor business environment, it is ... ... Short Board, decide to change. We will continue to deepen reform of the administrative examination and approval system, good digestion, implement the Government canceled, adjustment and devolution of administrative examination and approval matters, strengthen the existing supervision in matters of administrative power, has made it clear to cancel, are not allowed to keep or disguised approval. To do list list of administrative powers and responsibilities 黄色垃圾桶:污染垃圾 黑色垃圾桶:生活垃圾 吸氧浓度(%)=21+4×氧流量(L/min) 给氧浓度: 低浓度给氧<35% 中浓度给氧35%~60% 高浓度给氧>60% 操作时问患者有无不适。 7.导尿术(一次导尿不固定) 1) 洗手,戴口罩,推治疗车至床旁(右侧),核对并向患者解释。 2) 站在患者右侧,帮患者脱对侧裤子,盖在近侧腿部,并盖上浴巾,对侧腿用被子遮 盖。 3) 患者取仰卧屈膝位,两腿略外展,暴露会阴。(不是膀胱截石位) 4) 垫垫巾。 5) 将消毒液倒入装有棉球的治疗碗内。 6) 将碗盘及治疗碗拿到垫巾上。 7) 左手戴手套后进行第一次消毒。 原则:由上到下,由外到内,棉球只能用一次 (男性:阴阜2-大腿内侧2-阴茎上方2-阴茎下方2(提起)-尿道口1-龟头至冠状沟环形消毒2-尿道口1) (女性:阴阜2-大腿内侧2-大阴唇2-小阴唇2(拨开)-尿道口1-尿道口至阴道口2-尿道口至肛门1) 8) 脱手套,并放入治疗碗内,将碗盘和治疗碗放到治疗车第二层。 9) 拿起导尿包,检查器消毒日期。 10) 打开导尿包,检查该导尿包物品是否齐全。 11) 用无菌持物钳将装有4个棉球的小杯夹到边缘。 12) 将消毒液倒入小杯里。 13) 戴无菌手套,铺洞巾。 14) 用针筒检查尿管是否通畅,用止血钳夹取石蜡油棉球润滑导尿管。 15) 进行第二次消毒。 (男性:尿道口1-龟头至冠状沟2-尿道口1) (女性:尿道口1-尿道口至阴道2-尿道口1) 16) 左手固定不动,右手将碗盘移走,将治疗碗移到臀部。 17) 用止血钳夹取导尿管插入尿道,见有尿再入1-2cm。 18) 左手下移固定好导尿管,右手用止血钳夹紧导尿管。 19) 准备好无菌试管后,打开止血钳,用无菌试管取中段尿约5ml.然后用止血钳夹 管。 20) 放好无菌试管 。 21) 继续放尿. 放完后夹管.然后拔管并帮人擦拭。 22) 标本送检,倒掉碗内尿液,收拾用品后脱手套。 rAt present, we have formed a "three-three" Park. …… Industrial Park, according to ... ... The instructions of comrade, focus on development needs in the next decade, based on the original, and then extended the 6 square kilometers. Of the Park, to further improve the roads, power supply, communications, water supply and drainage and sewage pipe network and other infrastructure, to achieve full coverage of infrastructure and interconnection with the facilities and raise capacity. Each park to determine 1 leading industries, in particular stone Materials, cans, gloves, through guided, force and other measures to promote the "road company" Park, industrial agglomeration. Currently, to focus on building better ... ... Industrial Park, ... ... Wood Park as the starting area of the industrial park, planners need to take out plan, start construction as soon as possible, undertake in a timely manner ... ... Transfer of the wood industry. This opportunity slip by, so the timing must be tight. Second is to optimize government service. Low efficiency of government services, departments do not coordinate the views of businesses large, poor business environment, it is ... ... Short Board, decide to change. We will continue to deepen reform of the administrative examination and approval system, good digestion, implement the Government canceled, adjustment and devolution of administrative examination and approval matters, strengthen the existing supervision in matters of administrative power, has made it clear to cancel, are not allowed to keep or disguised approval. To do list list of administrative powers and responsibilities 23) 帮病人穿好裤子。 Tips:插入时叫病人张口呼吸，倒消毒液,标签向手心，碗盘贴近病人臀部 。 男:15-20cm 女:4-6cm 8.吸痰术 1) 准备好物品，向患者解释。 2) 洗手，戴手套，帽子。 3) 吸痰前需要给患者吸纯氧1-2min。 4) 铺治疗巾。 5) 检查患者口腔，鼻腔。 6) 连接吸痰器电源，并检查其是否正常运作，并将负压调至40-50KPa(机器上显 示0.04-0.05)。 7) 用无菌持物钳夹取吸痰管并将其与吸痰器导管相连。 8) 用碗盘内的镊子夹取吸痰管，用生理盐水试吸。 9) 将患者的头转向操作者的一侧。 10) 用镊子持吸痰管插入鼻腔入鼻咽部。 11) 脚踩开关，边左右旋转吸痰管边慢慢将痰液吸出，动作要轻柔。吸痰管退出 后，要抽吸生理盐水冲洗，以防导管被痰液堵塞，更换无菌吸痰管 12) 再经口腔进入口腔咽喉部 。 13) 重复第11步后，经口腔入气管吸痰，吸痰操作如前所述。吸痰管退出后， 要抽吸生理盐水冲洗，以防导管被痰液堵塞。 14) 吸痰完毕后，分离吸痰管，将吸痰管放入装有消毒液的瓶子中。整理物品。 15) 记录痰的性质，量，色 注意事项: 1，多处吸引，要更换吸引导管，并且顺序是鼻子，咽部，气管。如果有气管开口的，先气管，然后鼻子，咽部。 2，每次吸痰不超过15秒 3，吸痰器的使用: 如果是开按钮开关的，放松T形管侧孔无负压，按住时有 也可以直接关上侧孔，当脚踩开关时，有负压(这种更为方便，特别是对于那些用久了很吵的机器，一直开着会觉得很吵 四、外科技能1 1、外科基本技能(消毒、铺巾、穿手术衣、戴手套、皮肤缝合、胃穿孔修补术、拆线)。 1.消毒: 范围: (1)头部手术皮肤消毒范围:头及前额。 rAt present, we have formed a "three-three" Park. 10„„ Industrial Park, according to ... ... The instructions of comrade, focus on development needs in the next decade, based on the original, and then extended the 6 square kilometers. Of the Park, to further improve the roads, power supply, communications, 本科一班 冯立宗 water supply and drainage and sewage pipe network and other infrastructure, to achieve full coverage of infrastructure and interconnection with the facilities and raise capacity. Each park to determine 1 leading industries, in particular stone Materials, cans, gloves, through guided, force and other measures to promote the "road company" Park, industrial agglomeration. Currently, to focus on building better ... ... Industrial Park, ... ... Wood Park as the starting area of the industrial park, planners need to take out plan, start construction as soon as possible, undertake in a timely manner ... ... Transfer of the wood industry. This opportunity slip by, so the timing must be tight. Second is to optimize government service. Low efficiency of government services, departments do not coordinate the views of businesses large, poor business environment, it is ... ... Short Board, decide to change. We will continue to deepen reform of the administrative examination and approval system, good digestion, implement the Government canceled, adjustment and devolution of administrative examination and approval matters, strengthen the existing supervision in matters of administrative power, has made it clear to cancel, are not allowed to keep or disguised approval. To do list list of administrative powers and responsibilities (2)口、唇部手术皮肤消毒范围:面唇、颈及上胸部。 3)颈部手术皮肤消毒范围:上至下唇，下至乳头，两侧至斜方肌前缘。(甲( 状腺手术) (4)锁骨部手术皮肤消毒范围:上至颈部上缘，下至上臂上1,3处和乳头上缘，两侧过腋中线。5 r( Z) J; _- [ ~7 W (5)胸部手术皮肤消毒范围:(侧卧位)前后过中线，上至锁骨及上臂1,3处，下过肋缘& I4 Y0 G" ~+ S$ t) } (6)乳腺根治手术皮肤消毒范围:前至对侧锁骨中线，后至腋后线，上过锁骨及上臂，下过肚脐平行线。如大腿取皮，则大腿过膝，周圈消毒。+ i. B$ _+ w! a3 (7)上腹部手术皮肤消毒范围:上至乳头、下至耻骨联合，两侧至腋中线。(胃大切手术) (8)下腹部手术皮肤消毒范围:上至剑突、下至大腿上1,3，两侧至腋中线。(阑尾炎手术) (9)腹股沟及阴囊部手术皮肤消毒范围:上至肚脐线，下至大腿上1,3，两侧至腋中线" T# i9 \$ Z% |" ?2 X (10)颈椎手术皮肤消毒范围:上至颅顶，下至两腋窝连线。 (11)胸椎手术皮肤消毒范围:上至肩，下至髂嵴连线，两侧至腋中线。 /(12)腰椎手术皮肤消毒范围:上至两腋窝连线，下过臀部，两侧至腋中线。, z/(13)肾脏手术皮肤消毒范围:前后过中线，上至腋窝，下至腹股沟( S+ `1 14)会阴部手术皮肤消毒范围:耻骨联合、肛门周围及臀，大腿上1,3j; ?$ ( 内侧。 (15)四肢手术皮肤消毒范围:周圈消毒，上下各超过一个关节 五、外科技能2(注意看视频) 1、外科院前急救(止血、包扎、固定、搬运)(少量流血是按压包扎，流血不止止血带止血贴标签):根据病例，涉及到橡皮止血带使用、气压止血带的使用、颈托的使用、断肢处理、受伤肢体处理等。 2、换药(换药前后洗手，消毒液～～感染伤口戴手套，手的位置，镊子别上举，垃圾扔另一个盘里) 注意:外科需要自己准备物品，要熟悉换药、拆线需要什么用具(没有打包好的换药包)，选择什么消毒液，拆线用什么剪刀。熟悉才不会浪费很多时间，因为准备物品也是算在8分钟里面的。取物品时不能用手去抓，要拿持物钳取～这个很重要，没有无菌观念可以导致不及格～ rAt present, we have formed a "three-three" Park. …… Industrial Park, according to ... ... The instructions of comrade, focus on development needs in the next decade, based on the original, and then extended the 6 square kilometers. Of the Park, to further improve the roads, power supply, communications, water supply and drainage and sewage pipe network and other infrastructure, to achieve full coverage of infrastructure and interconnection with the facilities and raise capacity. Each park to determine 1 leading industries, in particular stone Materials, cans, gloves, through guided, force and other measures to promote the "road company" Park, industrial agglomeration. Currently, to focus on building better ... ... Industrial Park, ... ... Wood Park as the starting area of the industrial park, planners need to take out plan, start construction as soon as possible, undertake in a timely manner ... ... Transfer of the wood industry. This opportunity slip by, so the timing must be tight. Second is to optimize government service. Low efficiency of government services, departments do not coordinate the views of businesses large, poor business environment, it is ... ... Short Board, decide to change. We will continue to deepen reform of the administrative examination and approval system, good digestion, implement the Government canceled, adjustment and devolution of administrative examination and approval matters, strengthen the existing supervision in matters of administrative power, has made it clear to cancel, are not allowed to keep or disguised approval. To do list list of administrative powers and responsibilities 1.止血 1)指压止血法 是用于动脉出血的一种临时止血方法。依据动脉分布情况，操作时用手指、手掌或拳头在出血部位的近心端，用力将该动脉压在骨上，以切断血流，达到止血的目的。适用于头、面、颈部和四肢。具体指压点有: (1)颞动脉指压点:位于耳屏前方，颧弓根部，用于眼睛以上部位、头顶部和额部出血，用拇指压向颞弓。 (2)面动脉指压点:位于咬肌前缘下端，可压迫下颌角前约2.0cm处(有时需两侧同时压迫才能止血)，用于眼睛以下，下颌骨以上部位出血。 (3)颈总动脉指压点:位于气管与胸锁乳突肌之间，平环状软骨处，用中间的三个指头放在搏动的动脉上，拇指放在颈后，将动脉压向第6颈椎横突上，用于头面部、颈部出血。但需注意:不能两边同时压迫止血，压迫过程中密切注意观察有无晕厥表现，疑有脊髓损伤时，要保持颈部制动。 (4)锁骨下动脉指压点:位于胸锁关节至锁骨中点引一弓形线，弓背最高点距锁骨上1cm，用示指、中指在锁骨上窝向下压至第一肋骨上，操作时须保持上肢与身体平行。用于肩部、腋部、上臂出血。 。(5)肱动脉指压点:位于肱二头肌内侧沟，操作时上肢外展与身体成90角，手掌向上，用一手支撑病人的上臂，另一手的拇指放上臂中段肱二头肌内侧沟处，触模到动脉搏动，其余四指放在肱骨的后边，捏紧肱骨压迫肱动脉。用于前臂出血。 (6)桡、尺动脉指压点:桡、尺动脉分别位于桡骨茎突与桡侧屈腕腱之间尺侧腕屈肌与指浅屈肌之间。两手拇指同时按压手腕横纹稍上处的内、外侧搏动点，用于手部出血。 (7)指掌侧固有动脉指压点:位于指部两侧，用拇指、示指同时压向第一指骨，用于手指出血。 (8)股动脉指压点:位于腹股沟中点稍下方，摸到股动脉跳动后，双手掌重叠在其上，用力压向骨盆缘，用于下肢出血。 (9)胫后动脉:位于内踝与跟腱之间，用于足底出血。 (10)足背动脉:位于足背的内外踝连线的中点，用于足部出血。 3)橡胶止血带止血法:?将衬垫置于恰当部位;?展开左手掌，用左手拇指、rAt present, we have formed a "three-three" Park. 10„„ Industrial Park, according to ... ... The instructions of comrade, focus on development needs in the next decade, based on the original, and then extended the 6 square kilometers. Of the Park, to further improve the roads, power supply, communications, 本科一班 冯立宗 water supply and drainage and sewage pipe network and other infrastructure, to achieve full coverage of infrastructure and interconnection with the facilities and raise capacity. Each park to determine 1 leading industries, in particular stone Materials, cans, gloves, through guided, force and other measures to promote the "road company" Park, industrial agglomeration. Currently, to focus on building better ... ... Industrial Park, ... ... Wood Park as the starting area of the industrial park, planners need to take out plan, start construction as soon as possible, undertake in a timely manner ... ... Transfer of the wood industry. This opportunity slip by, so the timing must be tight. Second is to optimize government service. Low efficiency of government services, departments do not coordinate the views of businesses large, poor business environment, it is ... ... Short Board, decide to change. We will continue to deepen reform of the administrative examination and approval system, good digestion, implement the Government canceled, adjustment and devolution of administrative examination and approval matters, strengthen the existing supervision in matters of administrative power, has made it clear to cancel, are not allowed to keep or disguised approval. To do list list of administrative powers and responsibilities 食指持止血带一端约,,,,,cm处，头端朝向小指，手背放在衬垫上;?将长的尾端绕肢体一圈，压住头端段;?再绕一圈，并用左手食指、中指夹住止血带下拉引出小圈，系成活结。 4)充气止血带止血法:将袖带绑在伤口的近心端并充气，上肢压力为250,300mmHg，下肢为300,500mmHg。 用止血带止血应注意:?上止血带部位要准确，应扎在伤口的近心端，尽量靠近伤口，上臂不可扎在下1,3处，以防损伤桡神经;?止血带下应加衬垫，松紧度要适当，以刚达到远端动脉搏动消失为度;?上止血带的病人应有标记，注明开部位、始时间与放松时间，便于转运时了解情况;?使用止血带时应尽量缩短时间，以1小时内为宜，最长不超过5小时，其间一般每隔40,50分钟放松一次，每次3,5分钟，再在该平面上但不在同一部位绑扎。放松前要改用加压或指压止血法止血，松解时要缓慢，以防发生大出血。?要严密观察伤情及患肢情况，注意止血带有否脱落或绑扎过紧等现象，并予以及时调整。要注意肢体保暖。 5)加压止血法 是最简单，最有效的止血方法，适用于:伤面大，渗血多的毛细血管出血，如皮肤撕脱伤，擦伤等;中小静脉出血，如锐器伤。 (1)找出并暴露伤口，必要时可以剪开或撕开衣服; (2)迅速检查损伤部位末梢的脉搏和神经功能; (3)用灭菌纱布，灭菌医用无纺布(也可用清洁毛巾、布料、手帕等代替)，直接覆盖伤口上，再用手掌在上面直接压迫，或用绷带或布带加压包扎。 6)填塞止血法 用无菌敷料或干净的布料填入较深较大的伤口内，外加大块敷料加压包扎。一般用于穿通伤、腋窝、肘窝、腘窝或腹股沟等处的伤口。 2.包扎(三角巾使用不知考不考，觉得有必要自己看) 1)螺旋形包扎法:用于包扎直径基本相同的部位如上臂、手指、躯干、大腿等。操作步骤:?将绷带环行缠绕二圈;?稍微倾斜(<30?)，螺旋向上缠绕;?每周遮盖上周的1/3~1/2;?将绷带再次环行缠绕二圈，固定。 2)螺旋反折包扎法(折转法):用于直径大小不等的部位如前臂、小腿等。操作步骤:?将绷带环行缠绕二圈;?稍微倾斜(<30?)，螺旋向上缠绕;?每周均把绷带向下反折，遮盖其上周的1/3 ~1/2，反折部位应相同，使之成一rAt present, we have formed a "three-three" Park. …… Industrial Park, according to ... ... The instructions of comrade, focus on development needs in the next decade, based on the original, and then extended the 6 square kilometers. Of the Park, to further improve the roads, power supply, communications, water supply and drainage and sewage pipe network and other infrastructure, to achieve full coverage of infrastructure and interconnection with the facilities and raise capacity. Each park to determine 1 leading industries, in particular stone Materials, cans, gloves, through guided, force and other measures to promote the "road company" Park, industrial agglomeration. Currently, to focus on building better ... ... Industrial Park, ... ... Wood Park as the starting area of the industrial park, planners need to take out plan, start construction as soon as possible, undertake in a timely manner ... ... Transfer of the wood industry. This opportunity slip by, so the timing must be tight. Second is to optimize government service. Low efficiency of government services, departments do not coordinate the views of businesses large, poor business environment, it is ... ... Short Board, decide to change. We will continue to deepen reform of the administrative examination and approval system, good digestion, implement the Government canceled, adjustment and devolution of administrative examination and approval matters, strengthen the existing supervision in matters of administrative power, has made it clear to cancel, are not allowed to keep or disguised approval. To do list list of administrative powers and responsibilities 直线;?将绷带再次环行缠绕二圈，固定。注意不可在伤口上或骨隆突处反折。 3)“8”字形包扎法:用于直径不一的部位或屈曲的关节如肘、肩、髋、膝等。操作步骤:?屈曲关节后在关节远心端环形包扎两周;?右手将绷带从右下越过关节向左上绷扎，绕过后面，再从右上(近心端)越过关节向左下绷扎，使呈“8”字形，每周覆盖上周1/3~1/2;?环形包扎2周固定。 4)回返包扎法:用于包扎没有顶端的部位如指端、头部、截肢残端。操作步骤:?环形包扎两周;?右手将绷带向上反折与环形包扎垂直，先覆盖残端中央，再交替覆盖左右两边，左手固定住反折部分，每周覆盖上周1/3~1/2;?再将绷带反折环形包扎2周固定 注意:1. 包扎伤口时，先简单清创再包扎。手及赃物不要触及伤口，不要用水冲洗伤口(除化学伤外)，突出体腔外的内脏不要回纳，伤口内异物不要随意取出。 2. 包扎时要牢靠、松紧要适宜。 3. 包扎时要使病人舒适。用胸带要注意呼吸，包扎肢体要注意保持功能位。皮肤皱褶处骨隆突处应用棉垫或纱布等作衬垫，需要抬高肢体时，应给适当的扶托物。 4. 包扎方向从远心端向近心端包扎，要将指(趾)短外露，以便观察血运情况。绷带固定时结应放在肢体的外侧面，忌在伤口上、骨隆突处或易于受压的部位打结。 5. 解除绷带时，先解开固定结或取下胶布，然后以两手互相传递松解。紧急时或绷带已被伤口分泌物浸透干涸时，可用剪刀剪开。 3.固定 骨折的临时固定的目的是，减轻伤员的疼痛，防止因骨折端移位刺伤邻近的组织及血管神经，同时骨折固定是防止创伤性休克的一项有效措施。动作要轻巧，固定要牢靠，松紧要适度，皮肤与夹板之间要垫适量的软物，尤其是夹板两端骨突出处和空隙部位更要注意，以防局部受压引起缺血坏死。 固定方法 上臂骨折 于患侧腋窝内垫以棉垫或毛巾在上臂外侧安放垫好的夹板或其它代用品，绑好后，使肘关节屈曲90度，将患肢捆于胸前，再用三角巾或绷带将其悬吊于胸前。 rAt present, we have formed a "three-three" Park. 10„„ Industrial Park, according to ... ... The instructions of comrade, focus on development needs in the next decade, based on the original, and then extended the 6 square kilometers. Of the Park, to further improve the roads, power supply, communications, 本科一班 冯立宗 water supply and drainage and sewage pipe network and other infrastructure, to achieve full coverage of infrastructure and interconnection with the facilities and raise capacity. Each park to determine 1 leading industries, in particular stone Materials, cans, gloves, through guided, force and other measures to promote the "road company" Park, industrial agglomeration. Currently, to focus on building better ... ... Industrial Park, ... ... Wood Park as the starting area of the industrial park, planners need to take out plan, start construction as soon as possible, undertake in a timely manner ... ... Transfer of the wood industry. This opportunity slip by, so the timing must be tight. Second is to optimize government service. Low efficiency of government services, departments do not coordinate the views of businesses large, poor business environment, it is ... ... Short Board, decide to change. We will continue to deepen reform of the administrative examination and approval system, good digestion, implement the Government canceled, adjustment and devolution of administrative examination and approval matters, strengthen the existing supervision in matters of administrative power, has made it clear to cancel, are not allowed to keep or disguised approval. To do list list of administrative powers and responsibilities 前臂骨折 用衬好的两块夹板或代用物，分别置于患侧前臂及手的掌侧及背侧，以布带或绷带绑好，再以三角巾或绷带将臂悬吊于胸前。 大腿骨折 用长木板放在患肢及躯干外侧，将髋关节、大腿中段、膝关节、小腿中段踝关节同时固定。 小腿骨折 用两从大腿中段到脚根的夹板，置于小腿内、外侧加垫后分段固定，无夹板时，也可用健肢固定。 骨盆骨折固定 用一条带状三角巾的中段放于腰骶部，绕髋前至小腹部打结固定，再用另一条带状三角巾中段放于小腹正中，绕髋后至腰骶部打结固定。 颈椎骨折固定 伤员仰卧，在头枕部垫一薄枕，使头部成正中位，头部不要前屈或后仰，再在头的两侧各垫枕头服卷，最后用一条带子通过伤员额部固定头部，限制头部前后左右晃动。 胸、腰椎骨折固定 使伤员平直仰卧在硬质木板或其他板上，在伤处垫一薄枕，使脊柱稍向上突，然后用几条带子把伤员固定，使伤员不能左右转动。 4.搬运 1.整个急救过程看，搬运是急救医疗不可分割的重要组成部分，仅仅将搬运视作简单体力劳动的观念是一种错误的观念。 2.搬伤员应注意: 1)呼吸、心跳骤停伤员，先复苏、后搬运。 2)创面出血的伤员先止血，后搬运。 3)骨折伤员先固定，后搬运。 4)过程中如发生呼吸心跳停止或出血等应停下来进行复苏或止血。 3搬运的几项原则 了解伤病员的体重和搬运器械(工具)的大致重量， 了解自己的体力限制，若估计两人能抬起，即可提抬;若不能则应召唤别人帮忙。一般来说 两人成对地工作，以保持平衡。 • 救护人员在搬运时，应清楚地、经常地交谈，以保持协调一致。 4搬运的方法 (1担架搬运法 这是一种常用的方法。对重伤员一定要用担架搬运抬送。搬运伤员的担架可用专用担架，也可就地取材，用木板、竹竿、绳子、木棍和帆布等作成简易担架。 脑伤伤员在搬运途中要用衣服等软物将头部垫好，设法减少颠簸，注意维持呼吸道通畅。 椎伤伤员的搬运 这类伤员的搬运时，需3--4人协助，1人托住伤员头部保持头部原来的姿势，另几人托肩背部及臀、下肢，以防断骨压迫脊髓，然后动作一致地将伤员移至硬单架上，并用衣物等将伤员头部、颈部直到肩部都塞紧垫实，再用枕颌牵引，将头部连用枕头，担架一起捆住，伤员躯干也与担架一起固定，然后一起抬离事故地点。 胸腰椎骨折伤员的搬运 由3--4人协作，将伤员平托到硬单架上进行搬运伤员取仰位。 rAt present, we have formed a "three-three" Park. …… Industrial Park, according to ... ... The instructions of comrade, focus on development needs in the next decade, based on the original, and then extended the 6 square kilometers. Of the Park, to further improve the roads, power supply, communications, water supply and drainage and sewage pipe network and other infrastructure, to achieve full coverage of infrastructure and interconnection with the facilities and raise capacity. Each park to determine 1 leading industries, in particular stone Materials, cans, gloves, through guided, force and other measures to promote the "road company" Park, industrial agglomeration. Currently, to focus on building better ... ... Industrial Park, ... ... Wood Park as the starting area of the industrial park, planners need to take out plan, start construction as soon as possible, undertake in a timely manner ... ... Transfer of the wood industry. This opportunity slip by, so the timing must be tight. Second is to optimize government service. Low efficiency of government services, departments do not coordinate the views of businesses large, poor business environment, it is ... ... Short Board, decide to change. We will continue to deepen reform of the administrative examination and approval system, good digestion, implement the Government canceled, adjustment and devolution of administrative examination and approval matters, strengthen the existing supervision in matters of administrative power, has made it clear to cancel, are not allowed to keep or disguised approval. To do list list of administrative powers and responsibilities 腹部受伤伤员的搬运 伤员应仰卧于单担架上，膝下用衣物垫高，使腿屈曲，腹壁松驰。在运送前，必须对腹部进行包扎。如有脏器膨出，千万不要送回，要用纱布将脏器围好，或用瓷碗盖上后再包扎，包扎后再搬运。 骨盆伤伤员的搬运 要使伤员仰卧于担架上，双膝下垫衣物，使髋部放松，减少骨盆部痛疼。 肢体离断伤的搬运 进行急救处理时，要将断肢用消毒的清洁敷料包好，也可用干净的布片、毛巾等代替，在不让断肢受热的情况下，火速将断肢送到医院，离断伤近端用止血带止血法止血。 昏迷伤伤员的搬运 让伤员侧卧或俯卧，胸部垫高点，使其口鼻向下，既不影响呼吸，又能顺利排出口鼻中的分泌物，伤员有假牙时必须取出。 休克伤员 病人取平卧位，不用枕头，或脚高头低位，搬运时用普通担架即可。 呼吸困难的伤员 病人取坐位，不能背驮。用软担架(床单、被褥)搬运时注意不能使病人躯干屈曲。如有条件，最好用折叠担架(或椅)搬运。 (2)徒手搬运法 搬运伤员过程中凭人力和技巧，不使用任何器具。该法适用于狭窄的阁楼和通道等担架或其他简易搬运工具无法通过的地方。实用，但因其对搬运者来说比较劳累，有时容易给伤病员带来不利影响。 搀扶法 适用于病情较轻、能够站行走的伤病员。 适于年幼伤病者，体轻者没有骨折，伤势不重，是短距离搬运的最抱持法 佳方法。 5.换药 1. 用手取下外层敷料(勿用镊子)，再用镊子揭去紧贴创口的内层敷料，揭除敷料的方向与伤口纵向方向平行。与伤口粘住的最里层敷料，应先用盐水浸湿后再揭去，以免损伤肉芽组织或引起创面出血。 2.用两把镊子操作，一把接触伤口，另一把接触敷料(注意两把镊子不能互换或彼此接触)。用酒精棉球清洁伤口周围皮肤，用盐水棉球清洁创面并吸去分泌物。清洗时由内向外(化脓创口则由外向内擦试)。勿使酒精流入创口引起疼痛和损伤组织。 3.分泌物过多且创面较深时宜用生理盐水冲洗。 4. 去除过度生长的肉芽组织、腐败组织或异物等。高出皮肤或坏死肉芽组织可用剪刀剪平或先用硝酸银棒腐蚀再用生理盐水中和;肉芽组织水肿较明显时可用高渗盐水湿敷。 5.观察伤口的深度及有无引流不畅等情况，再用酒精棉球清除污染皮肤上的分泌物。最后用消毒敷料覆盖创面(一般创面可用消毒凡士林纱布覆盖，必要时用引流物)，包扎固定。 六、妇产科基本技能 rAt present, we have formed a "three-three" Park. 10„„ Industrial Park, according to ... ... The instructions of comrade, focus on development needs in the next decade, based on the original, and then extended the 6 square kilometers. Of the Park, to further improve the roads, power supply, communications, 本科一班 冯立宗 water supply and drainage and sewage pipe network and other infrastructure, to achieve full coverage of infrastructure and interconnection with the facilities and raise capacity. Each park to determine 1 leading industries, in particular stone Materials, cans, gloves, through guided, force and other measures to promote the "road company" Park, industrial agglomeration. Currently, to focus on building better ... ... Industrial Park, ... ... Wood Park as the starting area of the industrial park, planners need to take out plan, start construction as soon as possible, undertake in a timely manner ... ... Transfer of the wood industry. This opportunity slip by, so the timing must be tight. Second is to optimize government service. Low efficiency of government services, departments do not coordinate the views of businesses large, poor business environment, it is ... ... Short Board, decide to change. We will continue to deepen reform of the administrative examination and approval system, good digestion, implement the Government canceled, adjustment and devolution of administrative examination and approval matters, strengthen the existing supervision in matters of administrative power, has made it clear to cancel, are not allowed to keep or disguised approval. To do list list of administrative powers and responsibilities 妇科:阴道窥器使用、双合诊、取阴道分泌物、宫颈刮片、诊刮、上环、后穹隆穿刺(开灯～无菌观念，双合诊后别乱摸，要取分泌物别润滑窥阴器) 产科:测量宫高腹围、四步触诊、听胎心音、内外骨盆测量(会提问宫高和怀孕周数联系，测量骨盆前校正，要说具体位置和体位) 1.妇科检查 i. 检查前嘱咐病人排空膀胱 ii. 男同胞记得叫小护士站旁边 iii. 确认有性生活，没有来月经才能做阴道检查和二合诊 iv. 臀下垫垫单 v. 患者取膀胱截石位 vi. 告知可能引起不适，并让让病人放松。 vii. 洗手，戴口罩，帽子 一、外阴检查 a) 观察外阴发育及阴毛分布情况 b) 大小阴唇有无炎症，溃疡，赘生物，阴蒂长度(<2.5cm) c) 屏气向下用力有无子宫脱垂、阴道壁膨出 二、阴道窥器检查 1) 左手戴手套，外阴消毒3次:1个棉球小阴唇---大阴唇---阴阜---大腿内侧--- 肛周(循环三次) 2) 右手用大钳子将窥器从那个大铁锅(不知道叫什么，意会就好)里夹出来， 生理盐水润滑窥器后，左手拇食指分开小阴唇,右手持窥器斜行沿阴道后壁缓 慢插入阴道内 3) 边推进边将窥器转正并张开两叶,暴露宫颈、阴道壁及穹窿。 4) 旋转窥器观察阴道壁粘膜色泽，有无溃疡，赘生物，分泌物的量色味 5) 夹住宫颈并固定窥器，用消毒棉签取阴道穹窿分泌物，让助手放入装有生理 盐水的试管内。随后用另一棉签擦净阴道穹窿(取完分泌物再观察宫颈) 6) 观察宫颈大小，颜色，形状。注意有无糜烂，息肉，赘生物 7) 用无菌拭子插入宫颈停留5s，留着送检 8) 用蓝色柄头长得像扫把的玩意在宫颈口旋转5圈 因后面要做检查，所以不能用润滑油来润滑~ 无菌拭子查衣/支原体,淋球菌 白柄查HPV 蓝柄&木刮片查脱落细胞 9) 用木制的刮片在宫颈轻刮1圈，让助手送检 rAt present, we have formed a "three-three" Park. …… Industrial Park, according to ... ... The instructions of comrade, focus on development needs in the next decade, based on the original, and then extended the 6 square kilometers. Of the Park, to further improve the roads, power supply, communications, water supply and drainage and sewage pipe network and other infrastructure, to achieve full coverage of infrastructure and interconnection with the facilities and raise capacity. Each park to determine 1 leading industries, in particular stone Materials, cans, gloves, through guided, force and other measures to promote the "road company" Park, industrial agglomeration. Currently, to focus on building better ... ... Industrial Park, ... ... Wood Park as the starting area of the industrial park, planners need to take out plan, start construction as soon as possible, undertake in a timely manner ... ... Transfer of the wood industry. This opportunity slip by, so the timing must be tight. Second is to optimize government service. Low efficiency of government services, departments do not coordinate the views of businesses large, poor business environment, it is ... ... Short Board, decide to change. We will continue to deepen reform of the administrative examination and approval system, good digestion, implement the Government canceled, adjustment and devolution of administrative examination and approval matters, strengthen the existing supervision in matters of administrative power, has made it clear to cancel, are not allowed to keep or disguised approval. To do list list of administrative powers and responsibilities 10) 用白色柄头长得像试管刷的玩意插入宫颈旋转5圈 11) 取样完毕后，将窥器松开后，关闭退出阴道 12) 用干净的纱布擦拭一下外阴 三、双合诊 1) 更换新的无菌手套 2) 一手的两指涂润滑油，顺阴道后壁轻轻插入，另一手掌心朝下手指平放在腹 部平脐处 3) 查子宫:阴道内两指放宫颈后方向上向前抬举宫颈，腹部手指向下往后按压 腹壁，从脐逐渐向耻骨联合部位移动(前倾前屈位) 4) 查附件:手指移向穹窿一侧，往上门诊，另一手从同侧下腹壁髂嵴，由上往 下按压腹壁，与阴道内手指互相对合。(未触及附件) 5) 检查完毕，手指退出阴道，并用纱布擦净患者外阴。 6) 协助患者穿衣裤 考试的时候不一定所有的取样工具都有(如没有白柄和蓝柄)，大家考试见机行事 第8和第9为同一性质，选其一做即可 查完记得小形容一下子宫和附件大小，形状，位置，质地和活动度 2.产科胎儿检查(看视频) 一、一般情况检查 1) 检查体重,血压,水肿情况 2) 嘱孕妇检查前排空膀胱,仰卧双腿略屈稍分开 3) 检查者站在孕妇右侧 二、视诊 1) 注意腹形及大小 三、测量宫高&腹围 1) 测量时孕妇取伸腿仰卧位 2) 手于腹部触诊确定宫底高度，从耻骨联合上缘中点沿腹中线到宫底的高度为 宫高 3) 绕脐一周的腹周径为腹围 四、产科四步触诊 1) 前三部面对孕妇头部，最后一步面向孕妇足部 2) 第一步手法:两手置于宫底部，触摸宫底高度，估计胎儿大小与妊娠周数是 否相符;然后以两手指腹相对交替轻推，判断宫底部的胎儿部分。 3) 第二步手法:检查者两手分别置于腹部左右两侧，一手固定，另一手轻轻深 按检查，两手交替 4) 第三步手法:检查者右手拇指与其余四指分开，置于耻骨联合上方握住胎先 露部，判断先露部是胎头或胎臀，左右推动以确定是否衔接。 5) 第四步手法:检查者左右手分别置于胎先露部的两侧，向骨盆入口方向往下rAt present, we have formed a "three-three" Park. 10„„ Industrial Park, according to ... ... The instructions of comrade, focus on development needs in the next decade, based on the original, and then extended the 6 square kilometers. Of the Park, to further improve the roads, power supply, communications, 本科一班 冯立宗 water supply and drainage and sewage pipe network and other infrastructure, to achieve full coverage of infrastructure and interconnection with the facilities and raise capacity. Each park to determine 1 leading industries, in particular stone Materials, cans, gloves, through guided, force and other measures to promote the "road company" Park, industrial agglomeration. Currently, to focus on building better ... ... Industrial Park, ... ... Wood Park as the starting area of the industrial park, planners need to take out plan, start construction as soon as possible, undertake in a timely manner ... ... Transfer of the wood industry. This opportunity slip by, so the timing must be tight. Second is to optimize government service. Low efficiency of government services, departments do not coordinate the views of businesses large, poor business environment, it is ... ... Short Board, decide to change. We will continue to deepen reform of the administrative examination and approval system, good digestion, implement the Government canceled, adjustment and devolution of administrative examination and approval matters, strengthen the existing supervision in matters of administrative power, has made it clear to cancel, are not allowed to keep or disguised approval. To do list list of administrative powers and responsibilities 深按; 五、胎心音检查 , 妊娠18,20周，靠近胎背上方的孕妇腹壁; . 枕先露时，胎心音在脐左(右)下方; . 臀先露时，胎心音在脐左(右)上方; . 肩先露时，胎心音在靠近脐部下方听得最清楚。 抬头:硬且浮球感 胎臀:大而软，形状不规则 胎背:平坦饱满 四肢:凹凸不平 未衔接:胎先露浮动 已衔接:胎先露固定 进一步确诊胎先露及胎先露部入盆的程度 Ps:每次至少听诊1分钟; 正常胎心率:120,160次/分 六、骨盆外测量 1) 髂棘间径:孕妇取伸腿仰卧位，测量两髂前上棘外缘的距离，正常值为23,6cm。 2 2) 髂嵴间径:孕妇取伸腿仰卧位，测量两髂嵴外缘最宽的距离，正常值为25,28cm。 3) 骶耻外径:孕妇取左侧卧位，右腿伸直，左腿屈曲，测量第5腰椎棘突下至耻骨联合上缘中点的距离，正常值为18,20cm，第5腰椎棘突下相当于米氏菱形窝的上角。此径线可间接推测骨盆入口前后径长度，是骨盆外测量中最重要径线。 4) 坐骨结节间径(出口横径):孕妇取仰卧位，两腿向腹部弯曲，双手抱双膝。测量两坐骨结节内侧缘的距离，正常值为8.5,9.5，也可用检查者的手拳测量，若能容纳成人横置手拳，即属正常。 七、急救技能 1、心肺复苏 2、电击除颤(提问除颤仪类型，电除颤并发症和处理) 3、气管插管(左手拿喉镜) 1.CPR 1) 确定环境是否安全 2) 检查对方是否有意识，如:喂，你怎么啦～ 3) 摆好体位,解开上衣及裤带 4) 扫描胸部观察是否有呼吸5s(数1001-1005) rAt present, we have formed a "three-three" Park. …… Industrial Park, according to ... ... The instructions of comrade, focus on development needs in the next decade, based on the original, and then extended the 6 square kilometers. Of the Park, to further improve the roads, power supply, communications, water supply and drainage and sewage pipe network and other infrastructure, to achieve full coverage of infrastructure and interconnection with the facilities and raise capacity. Each park to determine 1 leading industries, in particular stone Materials, cans, gloves, through guided, force and other measures to promote the "road company" Park, industrial agglomeration. Currently, to focus on building better ... ... Industrial Park, ... ... Wood Park as the starting area of the industrial park, planners need to take out plan, start construction as soon as possible, undertake in a timely manner ... ... Transfer of the wood industry. This opportunity slip by, so the timing must be tight. Second is to optimize government service. Low efficiency of government services, departments do not coordinate the views of businesses large, poor business environment, it is ... ... Short Board, decide to change. We will continue to deepen reform of the administrative examination and approval system, good digestion, implement the Government canceled, adjustment and devolution of administrative examination and approval matters, strengthen the existing supervision in matters of administrative power, has made it clear to cancel, are not allowed to keep or disguised approval. To do list list of administrative powers and responsibilities 5) 呼救，让旁人打120 6) 判断有无颈动脉搏动7s(数1001-1007) 7) 胸外按压(30次/15-18s) 8) 清除口腔异物 9) 畅通呼吸道(仰头举颏法:一手置于前额使头部后仰，另一手的食指与中指置于下颌骨近下颏处，举起下颏。仰头抬颈法:一手置于病人前额，并压住前额使头后仰，另一手放在病人颈后，将颈部托起)使得耳垂，下颌骨呈直线与地面垂直。(给他贴个保鲜纸) 10) 人工呼吸2次:平静吸一口气,捏住对方鼻子,吹气1s，并观察胸腹是否胀起，吹完后松开鼻子，让其自然呼气，再重复一次 11) 循环5次后，再次检查有无呼吸及颈动脉搏动，无效则继续。 患者心搏骤停时的表现 1，意识突然丧失，患者昏倒于各种场合 2，面色苍白或转为紫绀 3，瞳孔散大 4，颈动脉搏动消失，心音消失 5，部分患者可有短暂而缓慢叹气样呼吸或有短暂抽搐，伴头眼偏斜，随即全身肌肉松弛 按压有效的主要指标: (1)按压时能扪及大动脉搏动 (2)患者面色、口唇、指甲及皮肤等色泽再度转红 (3)扩大的瞳孔再度缩小 (4)出现自主呼吸 (5)神志逐渐恢复，出现睫毛反射、对光反射，眼球活动，肢体活动等。 检查完记得告诉考官对方无呼吸及脉搏 施老师说颈动脉搏动 标准 excel标准偏差excel标准偏差函数exl标准差函数国标检验抽样标准表免费下载红头文件格式标准下载 是数5s，但7s也不会扣分„ . 有效按压要点: a) 用力按压:保证按压深度:成人胸骨下陷至少5cm，5,13岁儿童大约5cm，婴幼儿至少达到1/3胸廓前后径，约4cm b) 快速按压:至少100次/分 c) 持续按压:间断时间<10s d) 保证每次按压胸壁完全回弹:不能冲击式猛压，下压及向上放松的时间应相等 e) 按压与人工呼吸比例:30:2 2.电除颤 1) 连接电极:红(右上)---黄(左上)---绿(左下) 2) 让助手继续做胸外按压 3) 接通AED电源,并开启AED,选择非同步相放电 4) 观察心电图是否有房颤 5) 拿电极板,涂以导电糊并涂抹均匀 6) 调到150/200J，然后充电 rAt present, we have formed a "three-three" Park. 10„„ Industrial Park, according to ... ... The instructions of comrade, focus on development needs in the next decade, based on the original, and then extended the 6 square kilometers. Of the Park, to further improve the roads, power supply, communications, 本科一班 冯立宗 water supply and drainage and sewage pipe network and other infrastructure, to achieve full coverage of infrastructure and interconnection with the facilities and raise capacity. Each park to determine 1 leading industries, in particular stone Materials, cans, gloves, through guided, force and other measures to promote the "road company" Park, industrial agglomeration. Currently, to focus on building better ... ... Industrial Park, ... ... Wood Park as the starting area of the industrial park, planners need to take out plan, start construction as soon as possible, undertake in a timely manner ... ... Transfer of the wood industry. This opportunity slip by, so the timing must be tight. Second is to optimize government service. Low efficiency of government services, departments do not coordinate the views of businesses large, poor business environment, it is ... ... Short Board, decide to change. We will continue to deepen reform of the administrative examination and approval system, good digestion, implement the Government canceled, adjustment and devolution of administrative examination and approval matters, strengthen the existing supervision in matters of administrative power, has made it clear to cancel, are not allowed to keep or disguised approval. To do list list of administrative powers and responsibilities 7) 放置电极板:右侧第2肋间以及左腋前线第5肋间，两板之间距离>10cm，电极板与皮肤之间不要留空隙 8) 让周围人离开床边 9) 放电 10) 点击即后进行心电监测与记录 11) 放好电极板，关机 据说是高老师监考电除颤,她说调到200J.到时候大家见机行事 放置电极板时切记不要将电极板压在测心电图的电极上~~ 3.气管插管操作步骤 一、插管 1) 备齐用具，戴口罩，帽子，手套 2) 检查鼻腔，口腔有无阻塞。口腔有无义齿 3) 将患者摆好体位，用球囊呼吸器给患者吹气。按2-3次后交给助手。(5-6s按压一次) 4) 操作者此时要检查导管气囊是否漏气，喉镜是否有电，用石蜡油润滑导管(真人不需要，模型要)将铜丝插入气管导管，并将其弄成适当的弯度，戴听诊器 5) 操作者用右手拇指和食指将患者嘴巴打开，左手拿喉镜从口腔右侧放入，将舌体推向左侧，随后继续深入，见会厌。 6) 看见声门后，将导管从口腔右侧放入并插入到声门，(此时自己将铜丝拔出)拔出后继续进入气管 7) 放置齿垫，退出喉镜，然后检查导管是否在气管内。方法为: a. 按压患者胸壁，用耳朵感觉导管是否有气体排出; b. 连接球囊呼吸器，戴听诊器比较双肺上中下声音是否对称;(5-6s按压一次) c. 听上腹部，是否有气过水声 8) 将气囊充气3-5ml。 10) 将口塞和导管用胶带固定，随后用另外两条胶带分别固定在鼻唇沟外(大概位置而已,怎么顺眼怎么贴)和下颌 二、拆除装置 11) 将气囊气全部吸出，拆掉口塞和导管的固定，随后将导管拔出，再取出齿垫。 12) 整理好用品离开 C型手法压面罩，E型手法抬下颌 体位:头部垫枕头，把患者头后仰，使下颌与乳突连线与床面垂直 Tips:将Curved blade插入一半就好,插太深进食管几率大 向上抬时注意切勿以患者的牙齿为支点来抬喉镜，以免破坏患者牙齿。尽管已经烂了 插入19-23cm 操作时间不可超过30s，以防患者缺氧 检查导管是否在气管内全部都需要自己操作， rAt present, we have formed a "three-three" Park. …… Industrial Park, according to ... ... The instructions of comrade, focus on development needs in the next decade, based on the original, and then extended the 6 square kilometers. Of the Park, to further improve the roads, power supply, communications, water supply and drainage and sewage pipe network and other infrastructure, to achieve full coverage of infrastructure and interconnection with the facilities and raise capacity. Each park to determine 1 leading industries, in particular stone Materials, cans, gloves, through guided, force and other measures to promote the "road company" Park, industrial agglomeration. Currently, to focus on building better ... ... Industrial Park, ... ... Wood Park as the starting area of the industrial park, planners need to take out plan, start construction as soon as possible, undertake in a timely manner ... ... Transfer of the wood industry. This opportunity slip by, so the timing must be tight. Second is to optimize government service. Low efficiency of government services, departments do not coordinate the views of businesses large, poor business environment, it is ... ... Short Board, decide to change. We will continue to deepen reform of the administrative examination and approval system, good digestion, implement the Government canceled, adjustment and devolution of administrative examination and approval matters, strengthen the existing supervision in matters of administrative power, has made it clear to cancel, are not allowed to keep or disguised approval. To do list list of administrative powers and responsibilities 要自己连接球囊呼吸器给助手按压，不能让助手自己安装 Ps:这里总共有3条胶带 八、职业道德、沟通技巧 今年出现的病例比如:1、肝癌病人，家属不同意告知病人，如何处理知情同意权的问题。2、颅脑外伤患者，不愿意出院，劝其出院。3、截肢手术告知。4、癌症告知。5、孕妇死胎劝其引产。6、孕妇流产后告知，等等 注意:沟通技能:根据病例进行有效的沟通，选择座位时不要坐在病人的对面，要坐在病人的旁边(45?)表示亲切。注意倾听，不要随意打断病人，有效沟通取得双方双赢。 肝癌病人，家属不同意告知病人，如何处理知情同意权的问题。 病人的知情同意权就是病人有权知道自己的病情，并可以对医务人员所采取的医疗措施决定取舍，知情同意的实质是患者方在事实病人自主权的基础上，向医疗方进行医疗服务授权委托的行为。 患者不仅对自己疾病的病因，诊断方法，治疗原则以及可能的预后等有知情的权利!而且对医师治疗上的决定!可行使同意或否决的权利!这就是知情同意权。 世界医学会《医师专业独立与自由宣言》中强调医师必须尊重与支持病人的权利，医师应关心和尊重病人! 应提供有关的医疗资料供病人参考!在病人接受检查治疗或人体实验前应给予充分的说明!在其完全了解和同意后才可施行!病人有权利经病人接受和拒绝治疗!医师应尊重病人的选择和决定[1]，未同意时不可以随便采取治疗措施，除非在紧急情况中， 也就是说!医生在实施这些行为之前必须让患者知道，并取得患者的同意，或者说得到患者的授权。 患者一旦被确诊患了癌症"犹如被判了死刑无法面对和接受这一事实!那么对于癌症患者是应该尊重病人的知情权而告知病人实情，还是遵守保密的原则对病人隐瞒病情。对此不同人士有不同看法，多数医务人员和病人家属普遍认为,癌症病人的病情应当向本人保密"这也成为我国过去知情同意 制度 关于办公室下班关闭电源制度矿山事故隐患举报和奖励制度制度下载人事管理制度doc盘点制度下载 的基本内涵之一! 另外一部分医务人员认为"及时告知患者病情"有利于建立双方协作和交流机制，从而促进诊疗措施的顺利实施! 就病人而言，虽说接受这一事实需要勇气和时间。但也有一些晚期癌症病人常常抱怨没有及时得到病情信息，未能安排好身前身后事，以至临终前尚留有许多遗撼! 知情权与保密权似乎存在矛盾!在尊重知情权与尊重保密原则发生冲突，面临面临伦理学选择进退两难时，一些原则可以帮助我们更仔细合理地做出决定:即无伤害，行善，自律，公正，诚实#机密。重要的不是病人是否知情，是否签署了知情同意书，而是在实践中如何从对病人最有益的角度出发去实施这项制度! 知情和同意是两项权利，知情有绝对的也有相rAt present, we have formed a "three-three" Park. 10„„ Industrial Park, according to ... ... The instructions of comrade, focus on development needs in the next decade, based on the original, and then extended the 6 square kilometers. Of the Park, to further improve the roads, power supply, communications, 本科一班 冯立宗 water supply and drainage and sewage pipe network and other infrastructure, to achieve full coverage of infrastructure and interconnection with the facilities and raise capacity. Each park to determine 1 leading industries, in particular stone Materials, cans, gloves, through guided, force and other measures to promote the "road company" Park, industrial agglomeration. Currently, to focus on building better ... ... Industrial Park, ... ... Wood Park as the starting area of the industrial park, planners need to take out plan, start construction as soon as possible, undertake in a timely manner ... ... Transfer of the wood industry. This opportunity slip by, so the timing must be tight. Second is to optimize government service. Low efficiency of government services, departments do not coordinate the views of businesses large, poor business environment, it is ... ... Short Board, decide to change. We will continue to deepen reform of the administrative examination and approval system, good digestion, implement the Government canceled, adjustment and devolution of administrative examination and approval matters, strengthen the existing supervision in matters of administrative power, has made it clear to cancel, are not allowed to keep or disguised approval. To do list list of administrative powers and responsibilities 对的，有的必须告知，有的告知要根据情况掌握分寸，同意也是相对的，病人可以同意或不同意。 因此"临床上可以因地制宜，因人制宜，区分不同对象的心理，生理特点。 长站(每站16分钟，2分钟给考官打分) 一、内外科面试 主要以上过课的病为主，根据所给病例做出诊断、进一步检查、鉴别诊断、具体治疗 方案 气瓶 现场处置方案 .pdf气瓶 现场处置方案 .doc见习基地管理方案.doc关于群访事件的化解方案建筑工地扬尘治理专项方案下载 。常考的病例有:COPD、哮喘、肺炎、肺Ca、气胸，冠心病，心肌梗死心律失常，风心病，感染性心内膜炎，消化性溃疡，胰腺炎并休克，肝硬化(肝性脑病)，SLE，类风湿关节炎，糖尿病，甲亢，再障、白血病，ITP，慢性肾小球肾炎、肾功能衰竭等 二、体格检查 根据所给病例回答需做那些体格检查，考官再挑其中一部分让学生操作。操作部分主要有:肺部检查、心脏检查、腹部检查、神经系统检查。(肺部检查:感染的，淋巴结、呼吸道检查要说，后肺部叩诊位置，手法，听诊注意对比。心脏检查:扣后量出来，判断心界是否扩大。请用术语。别体态正常、营养正常、呼吸正常、心界正常什么什么的……) 辅助检查站(选择题) 心电图、实验室(包括骨髓片)检查、X片、CT rAt present, we have formed a "three-three" Park. …… Industrial Park, according to ... ... The instructions of comrade, focus on development needs in the next decade, based on the original, and then extended the 6 square kilometers. Of the Park, to further improve the roads, power supply, communications, water supply and drainage and sewage pipe network and other infrastructure, to achieve full coverage of infrastructure and interconnection with the facilities and raise capacity. Each park to determine 1 leading industries, in particular stone Materials, cans, gloves, through guided, force and other measures to promote the "road company" Park, industrial agglomeration. Currently, to focus on building better ... ... Industrial Park, ... ... Wood Park as the starting area of the industrial park, planners need to take out plan, start construction as soon as possible, undertake in a timely manner ... ... Transfer of the wood industry. This opportunity slip by, so the timing must be tight. Second is to optimize government service. Low efficiency of government services, departments do not coordinate the views of businesses large, poor business environment, it is ... ... Short Board, decide to change. We will continue to deepen reform of the administrative examination and approval system, good digestion, implement the Government canceled, adjustment and devolution of administrative examination and approval matters, strengthen the existing supervision in matters of administrative power, has made it clear to cancel, are not allowed to keep or disguised approval. To do list list of administrative powers and responsibilities