Although my writing is eloquent, I have only given injections to a few patients, and their blood vessels are straight, so I dare not go up with the lowest difficulty coefficient and high difficulty coefficient. ...
I also learned how to deal with a fever. The most commonly used method is to take antipyretic and analgesic drugs. Such as aspirin 0.3-0.6 g l times, three times a day, half an hour after meals. In addition to drug cooling, physical cooling can also be used. Commonly used methods are: ① Alcohol bath, in which 30%-50% alcohol is used to gently rub the patient's neck, chest, armpit, upper limbs, palm and back, groin, lower limbs, instep and instep. 15- 30 minutes each time. The advantage of alcohol rubbing bath is mild, unlike drug cooling, which is difficult to control and has side effects, and can be carried out at any time; ② Cold compress: A cold towel or ice cap is usually placed on the patient's head, and an ice pack can also be placed in the armpit or groin.
Although clinical practice is very hard, I still like those internship days.
Through this internship, I fully realized the mission of "saving lives, relieving pain, preventing diseases and rehabilitating health care" undertaken by medical workers. Sun Simiao, a "medical sage" in the Tang Dynasty, wrote in Qian Jin Fang that a great doctor is sincere: "Any great doctor who treats a disease must be calm, want nothing, put great sorrow first, and swear to save the suffering of cold." Therefore, while mastering advanced medical technology, medical students should also have the character of loving their jobs, being honest and serving the people wholeheartedly, and carry forward the humanitarian spirit of saving lives, so as to make better contributions to the country's medical and health undertakings.
The week of the second clinic passed quickly. During these seven days, I got a general impression on the environment of community hospitals, which also gave me some thoughts.
Probably influenced by the warm environment of the family area clinic when I was a child, I always kept my little wish to be a community doctor. Because I think community doctors have more time and energy to form a good trust and emotional foundation with patients' families, which is very helpful to improve patients' compliance in the specific environment of China. Outpatients come and go every day, and many just look at the doctor, which is very bad for the majority of patients with chronic diseases in China. Some patients have a strong distrust of doctors, which is not unrelated to the current medical environment, but also related to the busy work of doctors and the lack of time and energy to communicate with patients. For these two problems, I always think that community doctors with a sense of responsibility and superb medical skills are a solution to the problem.
These days in the community clinic, I have more confidence in this point, because I have gained a lot of knowledge and moved here.
The teacher in the second consulting room is very knowledgeable and deeply respected by patients. This is what I like about general practitioners very much. They all look kind and low-key, but they have extensive knowledge that specialists in big hospitals can't underestimate. They seem to be handy, but in fact they are the first guardians of patients. Although the time to see each patient is still limited, they are still more enthusiastic and kind than specialists, and they need more education and guidance for patients. In particular, many patients have been treated in large hospitals, and doctors have not missed any opportunity to receive education while prescribing medicine in the second outpatient department. This makes me more convinced that doctors in big hospitals may have a deeper understanding of the latest knowledge and have more confidence in drug use, but community doctors play no less important role in patient education than they do.
Unfortunately, I didn't go home the day I was arranged to go home, and I lost a good opportunity to learn more about the work of community doctors. But that day in the intelligence screening clinic of children's health care, I felt the irreplaceable important role of community doctors in patients' basic health care, and also reminded me of the warm experience of vaccinating or seeing a doctor in the infirmary of my family when I was a child. It is conceivable that this kind of more considerate medical behavior is very necessary for the maternal and child health protection of many patients with weak medical concepts.
Of course, the second clinic has many benefits, but I still feel some problems that I have to face. Generally speaking, the second outpatient department is also a part of the Third Hospital of Beijing Medical University, so the comprehensive level is very good, except for 1.5 million community residents, which brings many patients in the surrounding communities. Although many patients can see a doctor at home, it is very convenient, but every consulting room of such a huge patient group is still overcrowded, patients still have to wait, doctors are also very busy, each patient gets no more time than big hospitals, doctors and patients are not particularly familiar with each other, and the education for patients is not particularly effective, which makes me feel a little sorry. However, this may be the inevitable product of the unbalanced medical conditions in China. Good hospitals are overcrowded, and the second clinic is no exception. With the strong support of the Third Hospital, the doctors in the second outpatient department have better re-education conditions, but compared with the specialists in big hospitals, they still lack many high-level learning opportunities such as attending high-level seminars and international conferences. Therefore, in the treatment, it is likely that some specialists will have different treatment opinions, which is not only unfavorable to the treatment of patients, but also unfavorable to the growth of general practitioners themselves. Accordingly, in this era when laboratory examination is highly dependent on high-precision medical testing instruments, there is also a certain gap between community hospitals and large hospitals, which is also a factor limiting the scope of diagnosis and treatment in community hospitals.
The new medical reform is under way. This short one-week internship experience makes me believe that community hospitals, as an important part of medical reform, will be paid more and more attention, get more and more medical resources and play an increasingly important role.
On _ _ _ _ 20th, under the guidance of the teacher, we went to _ _ _ city hospital at 8: 00 am-12.
Before this, we have already understood the purpose and focus of this internship and the discipline and requirements that need to be paid attention to during the internship. Biomedical engineering in our hospital focuses on the principles and clinical uses of various medical instruments, medical instruments and equipment. The purpose of this internship is to let us have a perceptual and intuitive understanding of all kinds of instruments and equipment we have learned, so as to link and combine the theory in books with the technology in reality.
The area of the municipal hospital is not very large, but the equipment and instruments are still complete, with advanced technical equipment and treatment methods. So we visited four departments in the morning, radiology, endocrinology, laboratory and equipment. I learned a lot and gained a lot in this process.
Because hospitals are places where special people gather, patients need a quiet environment. Therefore, during the internship, we must pay attention to maintaining order and avoiding loud noises, so as not to affect the normal work of the hospital. At the same time, in the process of visiting, we should always pay attention to and record valuable information content, instead of skimming and getting nothing.
I. Radiology
Under the guidance of the teacher, we visited many computer rooms, which can be summarized into three types: general radiation, ct and mri. Let's talk specifically about PUFA's representative equipment, Dr. Philips. Dr is a direct digital X-ray photography system, which consists of electronic cassette, scanning controller, system controller and image monitor. It directly converts X-ray photons into digital images through electronic cassette, which is generalized direct digital X-ray photography.
At present, the widely used dr mainly uses flat panel detector to scan and directly read out the image signals generated by X-rays. The imaging principle is that X-ray signals are first converted into visible light, which is gathered by a algae film layer (tft) composed of photodiodes, and then directly read by a special reading circuit and sent to a computer system for processing. At present, flat-panel probes are divided into indirect conversion digital photography (iddr) represented by amorphous silicon and direct conversion digital photography (ddr) represented by amorphous selenium. Working principle of indirect conversion of amorphous silicon into digital photographic film.
Dr is generally composed of high voltage generator, X-ray tube and bracket, flat panel detector and system controller. Compared with the traditional X-ray signal, the dr system uses the X-ray receiver to replace the traditional intensifying screen and film for flat panel detection, which realizes the digitization of X-ray signal, high dynamic range, high spatial resolution and density resolution, and further reduces the exposure agent.
The quality of digital image and the amount of image information contained can be comparable to that of traditional X-ray imaging. The image processing system can adjust the contrast, so it can achieve the best visual effect; The tolerance range of photographing conditions is large; The patient received less X-rays. Image information can be stored and transmitted by magnetic disk or optical disk, which is the advantage of digital image. Digital images and traditional X-ray images are overlapping images of the photographed parts, so the parts that can be photographed by traditional X-ray can also be imaged by dr, and the observation and analysis of dr images are the same as those of traditional X-ray. The difference is that the dr image is composed of a certain number of pixels.
Digital image is superior to traditional X-ray imaging in displaying bone structure, articular cartilage and soft tissue, and quantitative analysis of mineral salt content is also feasible. Digital images can easily show mediastinal structures such as blood vessels and trachea. The detection rate of nodular lesions is higher than that of traditional X-ray images, but it is not as good as traditional X-ray images in displaying pulmonary interstitial and alveolar lesions. Dr is superior to traditional X-ray images in observing calcium-containing diseases such as intestinal pneumatosis, pneumoperitoneum and calculus.
Tomography using digital images is superior to X-ray tomography.
Gastrointestinal double contrast radiography is superior to traditional X-ray radiography in displaying gastric cells, tiny lesions and intestinal mucosal folds. Dr is a new imaging technology, which is superior to the traditional X-ray image in many aspects, but it is still difficult to replace the traditional X-ray image in terms of cost performance. In clinical application, dr is not as irreplaceable as ct and mri.
The quality of digital image and the amount of image information contained can be comparable to that of traditional X-ray imaging. The image processing system can adjust the contrast, so it can achieve the best visual effect; The tolerance range of photographing conditions is large; The patient received less X-rays. Image information can be stored and transmitted by magnetic disk or optical disk, which is the advantage of digital image. Digital images and traditional X-ray images are overlapping images of the photographed parts, so the parts that can be photographed by traditional X-ray can also be imaged by dr, and the observation and analysis of dr images are the same as those of traditional X-ray. The difference is that the dr image is composed of a certain number of pixels.
Digital image is superior to traditional X-ray imaging in displaying bone structure, articular cartilage and soft tissue, and quantitative analysis of mineral salt content is also feasible. Digital images can easily show mediastinal structures such as blood vessels and trachea. The detection rate of nodular lesions is higher than that of traditional X-ray images, but it is not as good as traditional X-ray images in displaying pulmonary interstitial and alveolar lesions. Dr is superior to traditional X-ray images in observing calcium-containing diseases such as intestinal pneumatosis, pneumoperitoneum and calculus.
Tomography using digital images is superior to X-ray tomography.
Gastrointestinal double contrast radiography is superior to traditional X-ray radiography in displaying gastric cells, small lesions and intestinal mucosal folds. Dr is a new imaging technology, which is superior to the traditional X-ray image in many aspects, but it is still difficult to replace the traditional X-ray image in terms of cost performance. In clinical application, dr is not as irreplaceable as ct and mri.
Second, endocrinology department
In endocrinology department, we mainly understand the function of doctor workstation system. The main function of doctor workstation is to help doctors write and maintain daily prescriptions and medical records in a standardized and efficient way. Consult the hospital drug information. Improve the medical records, prescriptions, application forms and diagnosis templates of individuals, hospitals and departments, and operate quickly and conveniently.
The doctor workstation system centers on electronic medical records, supports hospitals to establish outpatient medical records database, provides an efficient platform for doctors to manage electronic medical records and electronic prescriptions, provides an effective means for statistical analysis of medical records in the future, and plays an important role in improving hospital management and doctors' medical level. At the same time, support the use of hospital one-card or medical insurance card to establish continuous medical information for patients, improve the level of diagnosis and treatment and service for patients, and then improve the loyalty of patients; Electronic prescription meets the latest standards of the Ministry of Health.
After the implementation of the doctor workstation system, doctors can easily obtain patients' past medical records, past medical records, medication records, examination reports, current disease development, various examination results and so on. , through the computer to write prescriptions and various examination applications, record the patient's condition and development, and use the computer for auxiliary analysis when encountering intractable diseases in the diagnosis process. At the same time, it is convenient to obtain relevant medical knowledge, consult medical data such as diagnosis and treatment routine, drug information and test information of various diseases.
Doctor workstation system can be integrated with charge management, outpatient and emergency management, laboratory examination, hospitalization management and other systems.
Its main functions are as follows:
1. Dynamically generate patient information for waiting and seeing a doctor.
2. Provide doctors with auxiliary diagnosis and analysis functions.
3. Make a list for the patient. The system has a built-in laboratory examination library with complete items, which provides explanations and tips for examination items according to the needs of doctors.
4. Prescription and injection list for patients. The system has a simple and easy-to-use prescription generator, as well as a rich library of western medicine, Chinese patent medicine and Chinese herbal medicine, which provides explanations and tips on drug management and drug compatibility taboos according to the needs of doctors.
5, generate medical records for patients. The electronic medical record generator is built in the system, and the database of chief complaints and signs of Chinese and western medicine is provided, with thousands of standard entries, which is convenient for doctors to call.
6. Definition of commonly used prescription templates used by doctors.
7. The definition of hospital doctors' public prescription template.
8, doctors commonly used medical record management. Doctors define the corresponding available prescription, optional prescription and outpatient medical record template according to the disease type.
9, outpatient archives information query, including complete prescriptions, fees, medical records, test results, inspection reports, video reports.
10, outpatient medical records statistical analysis table, customized statistics table according to hospital needs.
1 1, system attribute settings, including workstation type, consultation department, registration category, medicine receiving area, medical record prescription printing method, default printer, etc.
The doctor workstation system not only embodies the patient-centered service concept, but also is a powerful medical assistant for doctors, which can help doctors quickly improve outpatient efficiency and diagnosis and treatment level. When doctors diagnose diseases and encounter intractable diseases, they can use this system for auxiliary analysis. When doctors prescribe drugs, they can get the tips of systematic drug incompatibility and standardized drug use in medical insurance policy. Networking can also enable outpatient doctors to quickly get feedback on examination, imaging and pathological examination results.
Third, the clinical laboratory
In the laboratory, the teacher mainly shows us the instruments. Laboratory instruments mainly include biochemical analyzer, blood cell analyzer, blood gas analyzer, chemiluminescence immunoassay analyzer, urine sediment analyzer, coagulation analyzer, automatic blood rheometer, automatic bacterial culture analyzer, microbial identification and drug sensitivity analyzer, centrifuge, biological safety cabinet and so on.
Biochemical analyzer and blood cell analyzer are widely used in hospitals, and we mainly introduce them.
The principle of biochemical analyzer: the absorption of different atoms is measured by spectral technology. There are two main methods, one is colorimetry and the other is indirect method. Significance: Biochemical analyzer is an instrument for detecting and analyzing biochemical substances, which provides information basis for clinical diagnosis and treatment of diseases, recovery and health status. City _ _ hospital is using Beckman's instruments. The teacher also introduced other brands, including Hitachi, Hisense Kangmei, Siemens, Roche, Abbott and Toshiba.
Blood cell analyzers are divided into three types of blood cell analyzers and five types of blood. Principle of blood cell analyzer: According to the non-conductive characteristics of blood cells, blood cell counting and volume measurement are carried out based on detecting the resistance change caused by suspended blood cells passing through counting holes in electrolyte solution. This method is called resistance method. Significance: It not only improves the accuracy of experimental results, but also provides a number of experimental indicators, which plays an important role in the diagnosis and differential diagnosis of diseases. Its brands include American Beckman, American Abbott, French ab_, Japanese Haisen Kangmei, Japanese Optoelectronic, German Siemens, Danish Hot Capital and so on.
Four. equipment division
In the Equipment Department, we learned a lot about health and safety operation, some equipment operation specifications, instrument maintenance and other knowledge, and understood the work responsibilities of the Equipment Department.
Its responsibilities include:
1, under the leadership of the dean and the competent dean, responsible for the procurement, supply, management and maintenance of medical equipment in the hospital.
2. According to the declaration of pre-purchased equipment in all subjects, prepare the annual equipment demand plan and submit it to the dean for approval.
3, responsible for the approval of large equipment demonstration, research, bidding and procurement, installation and acceptance.
4, do a good job in equipment maintenance, which can reduce failures, increase service life, ensure medical quality and improve economic benefits.
5, establish and improve all kinds of instruments and equipment data files, timely collect and archive all kinds of use and maintenance data.
6. Establish and improve various equipment management systems and implement scientific and standardized equipment management.
7, understand the use of equipment in each department, found that the equipment problem timely report to the hospital leadership.
8. Be responsible for guiding and training equipment users.
I worked as an intern in the city hospital all morning so quickly. Although it was only half a day, I benefited a lot in the process of learning. I believe it will play a very good role in my future work and study.
/kloc-from 0/2: 45 to 4: 30 in the afternoon, we practiced in Yan Chai Hospital. I visited the clinical laboratory and learned about the methods of detecting coronary heart disease, defibrillator and ultrasonic diagnostic instrument.
In the laboratory, I saw a lot of equipment, and a series of assembly line operations greatly improved the work efficiency. We studied the chemiluminescence immunoassay analyzer. Chemiluminescence labeling immunoassay, also known as chemiluminescence immunoassay, is an immunoassay method that directly labels antigens or antibodies with chemiluminescence reagents. Chemiluminescence immunoassay analyzer consists of two parts, namely, immune reaction system and chemiluminescence analysis system.
Chemiluminescence analysis system uses chemiluminescence substances to form excited state intermediates through catalysis of catalysts and oxidation of oxidants. When this excited state intermediate returns to a stable ground state, it emits photons at the same time, and the photon yield is measured by a luminous signal measuring instrument. The immune reaction system is to directly label luminescent substances (intermediates that generate excited states under the excitation of reactants) on antigens (chemiluminescence immunoassay) or antibodies (immunochemical immunoassay), or to act on luminescent substrates through enzymes.
Urine sediment analyzer: Fully automatic urine sediment analyzer is a routine inspection equipment that uses microscopic image automatic identification technology to automatically locate and capture the visible components in urine, and automatically identify and count the visible components in urine through morphological methods. It is mainly used for routine urine analysis in clinical laboratories and nephrology laboratories.
The main method to detect coronary heart disease is to run on an instrument similar to a treadmill. After running for a certain distance and a certain inclination, connect the instrument and observe the electrocardiogram of the heart through a calculator to check whether the patient has coronary heart disease.
At the same time, the teacher also introduced the defibrillator to us. Direct current cardioversion is an effective method to treat rapid ectopic arrhythmia with electric energy and turn it into sinus rhythm. It can be divided into synchronous cardioversion and asynchronous cardioversion: synchronous cardioversion means that the defibrillator is excited and discharged by R-wave electrical signals, and asynchronous cardioversion means that the defibrillator can discharge at any time of the cardiac cycle.
During cardioversion in vitro, the electrode plate has two placement positions. One is called anteroposterior position, that is, an electrode piece is placed in the subscapular area of the back; The other piece is placed at the level of 3~4 intercostal space on the left edge of sternum. Some people think that this way has more current through the heart, so it needs less electricity and can reduce potential complications. This method is suitable for selective cardioversion. The other is to place an electrode plate between 2~3 ribs (the bottom of the heart) on the right edge of the sternum. The other piece is placed in the fifth intercostal space (apex) of the left axillary front line. This method is rapid and simple, and is suitable for emergency electric shock defibrillation. The distance between two electrode plates should not be
Ultrasonic diagnostic instrument includes Doppler auscultation diagnostic instrument, ultrasonic Doppler pulse meter, ultrasonic Doppler blood flow meter, etc. It is a non-invasive examination method, which is used in obstetrics to check the blood circulation of fetal heart, fetus and placenta. Diagnosis of cardiovascular, brain, hepatobiliary, pancreatic, spleen, kidney, eye, abdominal and pelvic masses, serous cavity effusion, breast, thyroid, adrenal gland, bladder and peripheral vascular diseases.
The principle of the instrument is that the oscillating part of the instrument sends out ultrasonic waves with a certain frequency and sends them to the detected part through the probe. If the interface moves towards the probe, the echo frequency is higher than the transmitting frequency, and when the interface is far away from the probe, the echo frequency decreases. The difference between them is called difference frequency. The difference frequency is proportional to the moving speed of the interface. The Doppler signal can be analyzed, processed, amplified or detected or displayed on the screen of an oscilloscope, and a conclusion can be drawn.
Practice summary
The internship is over. During this short internship, I gained a lot. If summed up in simple words, my words will be pale, at least we can't express them accurately and clearly, but we have benefited a lot. Thanks to the teacher's guidance, we will embark on our respective jobs with a more proactive working attitude, more solid operational skills and richer theoretical knowledge. I think this substantial internship will be an unforgettable time in my life!
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