First, measure blood pressure.
A. Preoperative preparation
1. Item preparation: sphygmomanometer, stethoscope.
2. Self-preparation: wear a mask, a hat and wash your hands in your mouth.
3. Patient preparation: inform the patient of the purpose of the operation and obtain cooperation.
B. Operation
1. The client rests in a quiet environment for 5 ~ 10 minutes, and adopts supine position or sitting position, with the upper limbs exposed, straight and slightly abduction.
2. Check whether the mercury column of the sphygmomanometer is at the "0" point, and it should be at the same level as the elbow and heart of the subject (sitting flat between the fourth ribs and lying flat on the armpit midline).
3. Air cuff binding: The cuff airbag is aligned with the surface of brachial artery, and evenly clings to the skin of upper arm. The lower edge of cuff is 2 ~ 3 cm above the elbow bar. Its tightness is appropriate (it is appropriate to insert a finger).
4. Stethoscope placement: The examiner touches the brachial artery pulse at the cubital fossa (about 65438±0cm away from the center of cubital fossa), covers the stethoscope body, places the stethoscope body on the cubital fossa brachial artery, and gently presses the body to make it closely contact with the skin, but not excessively or with the cuff.
5. Measurement process: Inflate air into the air jacket and auscultate while inflating. When the brachial artery pulse disappears, the mercury column will rise again by 20 ~ 30mmhg, and then slowly deflate (making the mercury column drop at a speed of about 2 ~ 6mm/s). Observe the mercury column with both eyes, and read the blood pressure value according to the change of the pulse sound of auscultation artery and the position of mercury column. When the first sound is heard, the value is systolic blood pressure, and when the sound disappears, the value is diastolic blood pressure.
C. Report
It is required to measure twice, take the average value (orally) and report the measured blood pressure, and the value is correct. Report systolic blood pressure first, then diastolic blood pressure. Tidy up your things, tilt 45 and turn off the sphygmomanometer. Systolic blood pressure is 65438 0.20mmhg, and diastolic blood pressure is 80mmHg.
Second, cardiopulmonary resuscitation
Clinical scene
In the park, you found an old gentleman suddenly fell to the ground, unable to respond, cyanotic lips, and his carotid pulse was not touched. Cardiopulmonary resuscitation is needed immediately.
Requirements: Please perform cardiopulmonary resuscitation (medical simulator) on the patient. (It takes 5 cycles).
Key points of operation
First, judgment.
1. Evaluate whether the site environment is safe.
2. Pat the patient's shoulder with both hands and call the patient to see if there is any response. "Hey, what's the matter with you? The patient is unconscious. "
Second, call for help.
Immediately call other personnel to help dial 120, "Brother, please help me dial 120".
Third, judge the heartbeat and breathing.
Untie your coat, touch the carotid artery, observe the chest fluctuation and judge your heartbeat and breathing. If the heartbeat and breathing stop, perform cardiopulmonary resuscitation immediately. 100 1, 1002 1007, the patient had no carotid artery fluctuation and no spontaneous breathing.
Fourth, cardiac compression
1. Preparation: Take off your clothes, loosen your belt, expose your chest, take off your pillow, and quickly make the patient lie flat on a flat or hard board.
2. Chest compressions for 30 times (15 ~ 18 seconds):
(1) The roots of both palms overlap at the junction of the middle and lower sternum 1/3. Lift your fingers without touching the chest wall, straighten your wrists and elbows, and press down vertically by body gravity. The time of pressing and relaxing is the same, and the palm does not leave the pressing part when relaxing. Count: "0 1, 02,0330". (2) Frequency: 100 ~ 120 times/minute. Depth: 5~6cm for adults, 5 ~ 6 cm for children and 4cm for infants.
Five, open the airway
1. Cleaning the respiratory tract: Turn the patient's head to one side, take off the denture, and clean the foreign body in the oral cavity and nasal cavity.
Six, artificial respiration
1. Lift the patient's jaw upward with the right hand, and hold the patient's nostril with the thumb and forefinger of the left hand.
2. After inhaling calmly, put your lips close to the patient's lips and completely wrap them. Take the patient's chest as the standard, and blow deeply and quickly into the patient's mouth for more than 1 s; The blowing volume is 500 ~ 600 ml each time.
3. Make the patient open his mouth, loosen the fingers holding his nose, observe the recovery of his chest, and then carry out the next artificial respiration.
Seven, press 30 times per chest, artificial respiration 2 times, at least 5 cycles.
Eight, the patient's condition evaluation: the carotid artery pulsates, the original mydriasis shrinks again, spontaneous breathing occurs, consciousness gradually recovers, eyelash reflex and light reflex appear, and the color of face, lips, nails and skin turns red again. If resuscitation is effective, wait for 120 to be sent to the hospital for further treatment.
Finally, I want to give you some suggestions for practical exercises:
1. You should show a sense of urgency during the exam.
2. Remember to put the simulated person on a hard bed or on the ground, unbutton the collar, take off the pillow and lie flat.
3 before artificial respiration, pay attention to remove foreign bodies from the patient's mouth and keep the respiratory tract unobstructed.
4. Key points of postoperative report: compression position, compression depth, compression frequency, compression blowing ratio, and open airway standard.
These are the answers to the job interview of military and civilian medicine.