Sau keeb kwm kho mob yog ib theem hauv kev kawm ntawm cov tub ntxhais kawm kho mob hauv tsev kawm qib siab thiab tsev kawm qib siab. Yog li, lawv kawm piav qhia txog qhov tshwj xeeb nosology nrog tag nrho cov tsos mob, anamnesis. Lawv yuav kawm paub yuav ua li cas thiaj kuaj tau tus kab mob, siv txoj kev kho mob li cas hauv ib kis.
Ntau cov kauj ruam hauv kev sau keeb kwm kho mob yog kev kawm dawb huv thiab tsis siv hauv kev kho mob. Tab sis tib yam tsis tuaj yeem hais rau seem hu ua "Local Status". Cov theem no tseem ceeb heev rau kev kuaj xyuas kom raug. Nws yuav tau tham hauv kab lus no.
Cas chart
Ua ntej tig mus rau cov yam ntxwv ntawm kev piav qhia cov xwm txheej hauv zos hauv ntau yam pathologies, cia peb txheeb xyuas cov txheej txheem dav dav rau kev sau tus neeg mob keeb kwm. Nws muaj cov hauv qab no qhov tseem ceeb:
- Passport part - qhia tag nrho lub npe ntawm tus neeg mob, poj niam los txiv neej, hnub yug, qhov chaw nyob thiab ua haujlwm.
- Kev tsis txaus siab - piav qhia meej yam tus neeg mob yws txog, qhov mob hnyav ntawm cov tsos mob.
- Amnesis ntawm tus kab mob - suav nrog cov lus piav qhia ntawm kev txhim kho cov tsos mob hauv qhov tsis muaj zog los ntawm qhov pib ntawm tus kab mob mus rau tsev kho mob.
- Anamnesis ntawm lub neej -kawm seb cov kab mob, kev raug mob thiab kev ua haujlwm uas tus neeg mob raug kev txom nyem, nws loj hlob thiab txhim kho li cas. Nrhiav tsev neeg thiab keeb kwm tsis haum.
- Cov ntaub ntawv ntawm kev tshuaj xyuas lub hom phiaj - lub xeev ntawm tag nrho cov kabmob thiab cov kab ke ntawm tus neeg mob tau maj mam qhia. Cov txheej txheem tsis cuam tshuam los ntawm cov txheej txheem pathological tau piav qhia luv luv.
- Local status - ib ntu uas piav qhia meej txog qhov chaw ntawm cov txheej txheem pathological.
- Kev kuaj mob ua ntej.
- Survey plan and results.
- Differential Diagnosis - Qhov kev kuaj mob xav tias yog piv nrog ob lossis peb lwm yam kab mob uas muaj cov tsos mob zoo sib xws.
- Kev kuaj mob - qhia txog kab mob hauv qab, kab mob sib kis thiab teeb meem, yog tias muaj.
- Kev kho - qhia tshuaj, daim ntawv tso tawm, txoj kev tswj hwm thiab kev tswj hwm ib hnub twg.
- Daim ntawv teev cov kev soj ntsuam - tus neeg mob tus mob tau sau tseg txhua hnub ntawm nws nyob hauv tsev kho mob.
- Epicrisis - piav qhia luv luv ntawm keeb kwm kho mob.
- Hnub, kos npe.
Kev piav qhia ntawm qhov xwm txheej hauv zos
Ntu ntawm cov ntaub ntawv keeb kwm, uas piav qhia qhov chaw ntawm cov txheej txheem pathological, yuav tsum yog ib qho ntawm cov ncauj lus kom ntxaws. Cais cov yam ntxwv tshwj xeeb ntawm cov xwm txheej hauv zos nyob rau hauv cov ntaub ntawv keeb kwm ntawm cov xwm txheej sib txawv yuav raug piav qhia nyob rau hauv cov tshooj uas cuam tshuam.
Tus qauv dav dav rau kev sau ntu no yog dab tsi? Rau txhua yam pathology, nws yuav tsum muaj cov khoom hauv qab no:
- tus neeg mob txoj haujlwm;
- statedaim tawv nqaij: xim, noo noo, elasticity, kub hauv zos, muaj pob los yog puas;
- txoj hauj lwm ntawm lub limb lossis lub cev thaum nws los txog rau kev raug mob lossis kev phais mob;
- palpation ntawm qhov chaw ntawm kev loj hlob ntawm cov txheej txheem pathological;
- percussion (tapping) ntawm no department;
- auscultation (mloog) yog tias muaj kev puas tsuaj rau lub ntsws, lub plawv lossis txoj hnyuv.
Kev tshuaj xyuas
Thaum piav txog cov xwm txheej hauv zos, tus kws kho mob ua ntej txhua yam tshuaj xyuas qhov chaw ntawm cov kab mob. Txhawm rau ua qhov kev tshuaj ntsuam xyuas kom paub meej tshaj plaws, koj yuav tsum ua raws qee cov cai.
Nyob ntawm qhov mob hnyav ntawm tus neeg mob, nws raug tshuaj xyuas hauv lub supine, zaum lossis sawv. Nyob rau tib lub sij hawm, mloog yog them tsis tau tsuas yog rau qhov chaw ntawm lub pathology, tab sis kuj muab piv nrog symmetrical intact thaj chaw. Vim tias dab tsi yog pathological rau ib tus neeg yog tus qauv zoo rau lwm tus.
Kev kuaj mob ntawm tus neeg mob tsuas yog ua tiav nrog nws qhov tshwm sim tag nrho.
Piav qhia txog txoj haujlwm ntawm tus neeg mob, qhia nws hom tshwj xeeb:
- nquag - qhia tias qhov kev puas tsuaj tsis hnyav thiab tsis cuam tshuam rau tus neeg mob tus cwj pwm;
- passive - txiav txim siab hauv cov mob hnyav;
- forced - tus neeg mob siv txoj haujlwm tshwj xeeb los txo nws tus mob.
Yog tias txoj haujlwm tau piav qhia raws li kev yuam, nco ntsoov qhia raws nraim li cas tus neeg mob nyob. Vim qhov no yuav ua rau muaj kev kuaj mob tshwj xeeb.
Kev tshuaj xyuas kuj tseem ceebdaim tawv nqaij npog. Muaj cov tsos mob tshwj xeeb. Yog li ntawd, cov lus piav qhia ntawm cov tawv nqaij mob kuj yuav tsum tau them nyiaj mloog.
Yog tias muaj qhov liab liab lossis hemorrhages, lawv tus lej, qhov loj me, cov duab, xim thiab thaj chaw raug qhia. Yog tias pom pob liab liab, qhia lawv hom: petechiae, ecchymosis, papules, vesicles, thiab lwm yam.
Yog tias kuaj pom edema, piav qhia lawv qhov sib xws, sib kis ceev, qhov ntev, xim thiab kub ntawm daim tawv nqaij saum lawv.
Technique of palpation, percussion, auscultation Kev palpation
Thaum palpating qhov chaw ntawm cov txheej txheem pathological, xyuam xim rau cov yam ntxwv hauv qab no:
- hloov pauv ntawm daim tawv nqaij kub;
- muaj cov ntsaws ruaj ruaj lossis, hloov pauv, muag;
- mob ntawm palpation, thiab qhov mob tshwm sim;
- muaj leeg nro;
- muaj cov ntsaws ruaj ruaj tob hauv lub cev.
Yog tus kws kho mob xav tias muaj lub foob, nws yuav tsum qhia meej. Nws yog ib qho tsim nyog los qhia qhov chaw, qhov loj, qhov mob, qhov ntau, qhov sib xws, qhov sib xws, qhov xwm ntawm nws qhov chaw (bumpy lossis du).
Percussion yog ua tiav nrog ob txhais tes. Tus ntiv tes ntawm ib txhais tes muab tso rau ntawm qhov chaw cuam tshuam, thiab maj mam tapping yog nqa tawm nrog tus ntiv tes nruab nrab ntawm lwm tus. Lub suab ntawm percussion tej zaum yuav luv, du, dull, los yog ringing.
Auscultation tuaj yeem txiav txim siab qhov ua pa ntawm lub plawv, lub suab nrov, muaj suab nrov hauv lub ntsws, lub plawv thiab cov hnyuv, crepitus hauv cov pob txha hauv pob txha.
piav qhia ntawm pob txha
Kev piav qhia ntawm cov xwm txheej hauv zos thaum twgqhov tawg yuav tsum muaj cov hauv qab no:
- yam ntxwv ntawm deformity ntawm tus txha caj ceg raug mob;
- muaj lossis tsis muaj kev puas tsuaj rau daim tawv nqaij;
- kev muaj tus mob pathological limb mobility thiab crepitus;
- nrog lub limb asymmetry;
- yam ntxwv ntawm qhov ntim ntawm kev ua haujlwm nquag thiab tsis muaj zog;
- muaj peev xwm txav tau cov pob qij txha nyob ze.
Piv txwv li, nrog pob txha ntawm txoj cai clavicle, lub zos xwm txheej yuav zoo li no: "Lub xub pwg nyom sab xis yog qis dua, deformation tau pom nyob rau hauv peb sab nraud ntawm lub clavicle. Kuj tseem muaj me ntsis hemorrhage subcutaneous. Kev txav mus los ntawm pathological tau txiav txim siab ntawm palpation, lub suab ntawm crepitation ntawm cov pob txha tawg tau hnov ntawm auscultation "Tus neeg mob tsis tuaj yeem abduct caj npab vim qhov mob. Muaj kev sib hloov ntawm sab caj npab sab hauv. Muaj kev xyaum tsis muaj kev txav mus los ntawm qhov chaw ntawm lub cev. lub xub pwg nyom".
Kev piav qhia ntawm hlawv
Thaum sau cov xwm txheej hauv zos ntawm qhov kub hnyiab, koj yuav tsum tau xyuam xim rau cov yam ntxwv hauv qab no:
- localization thiab thaj tsam ntawm qhov txhab;
- seb puas yog lub epidermis (txheej txheej ntawm daim tawv nqaij) exfoliated;
- puas muaj pob khaus, nws muaj dab tsi (ntub lossis qhuav);
- tawv nqaij;
- muag ntug;
- yog npuas txiav txim siab, lawv cov ntsiab lus yog dab tsi;
- hnub nyoog ntawm qhov kub hnyiab.
Raws li piv txwv, peb muab cov lus piav qhia ntawm qhov kub hnyiab ntawm sab ceg: "Ib qho kub hnyiab tau pom ntawm daim tawv nqaij hauv thaj tsam ntawm pob taws sab xis, uas nyob 2/3 ntawm ko taw.nto yog nyob rau hauv ib tug qhuav scab. Lub qhov txhab muaj qhov tsis sib xws, npog nrog granulations. Cov kua dej serous-purulent tawm ntawm qhov txhab."
Kev piav qhia lub qhov txhab
Thaum sau cov xwm txheej hauv zos thaum muaj kev puas tsuaj rau daim tawv nqaij, cov yam ntxwv hauv qab no tau piav qhia:
- kev puas tsuaj thaj chaw;
- puab thiab qhov txhab loj;
- puas muaj ntshav;
- mob ntawm qhov txhab npoo;
- yam ntawm daim tawv nqaij ib ncig ntawm qhov raug mob: lawv cov xim, o, mob.
Yog li, ib qho kev piav qhia ntawm lub zos qhov chaw ntawm lub qhov txhab incised yuav zoo li no: "Muaj qhov txhab nyob rau sab nraub qaum ntawm sab xis thib peb ntawm lub xub pwg nyom, nws muaj qhov tsis sib xws, zoo li lub ntxaiv. Nws qhov ntev yog 6 cm, dav - 0.9 cm. Los ntawm sab xis kawg ntawm lub qhov txhab, muaj ob qho ntxiv incisions nyob rau hauv parallel, lawv qhov ntev yog 1 thiab 1.2 cm, raws li qhov tob ntawm lub qhov txhab yog 0.5 cm"
Kev piav qhia ntawm tus kab mob abscess
Muaj ob hom txheej txheem purulent ntawm cov ntaub so ntswg: abscess thiab phlegmon. Cov tom kawg yog qhov dav, diffuse purulent o. Nws tsis muaj ciam teb tshwj xeeb thiab nyiam kis ntau dua. Ib qho abscess, nyob rau hauv lem, yog ib qho mob hauv zos. Nws yog fenced tawm ntawm cov ntaub so ntswg nyob ib puag ncig nrog kev pab los ntawm ib lub capsule.
Thaum piav qhia txog cov xwm txheej hauv cheeb tsam ntawm cov kab mob abscess, cov yam ntxwv ntawm kev kuaj mob (cov tawv nqaij xim, muaj edema) thiab cov ntaub ntawv palpation (mob, softening ntawm cov ntaub so ntswg, cov tawv nqaij kub) yog qhia. Kuj tseem nco ntsoov qhia qhov loj thiab qhov chawabscess.
Piv txwv ntawm cov lus piav qhia ntawm tus kab mob abscess: "Yog hais tias suppuration ntawm cov ntaub so ntswg ntawm lub pob tw, tom qab txhaj tshuaj, liab thiab o ntawm daim tawv nqaij hla qhov chaw txhaj tshuaj yog sau tseg. Qhov chaw nruab nrab yog txiav txim siab los ntawm palpation, qhov kub ntawm daim tawv nqaij saum toj no nce, daim tawv nqaij yog edematous."
Kev piav qhia ntawm angioedema
Quincke's edema yog ib qho kev tsis haum tshuaj uas tshwm sim thaum lub cev tsis zoo rau qee yam tshuaj. Tus mob no tshwm sim sai sai thiab tuaj yeem ua rau tuag taus yog tias tsis kho sai.
Cov xwm txheej hauv zos hauv Quincke's edema yog tus yam ntxwv los ntawm o ntawm daim tawv nqaij, cov rog subcutaneous thiab cov mucous membranes. Nws feem ntau tshwm sim hauv cov cheeb tsam hauv qab no ntawm lub cev:
- lips;
- forehead;
- cheeks;
- eyelids;
- scrotum;
- txhuam;
- rov qab ko taw.
Yog hais tias lub ntsws o o, tus neeg mob txhawj xeeb txog kev nqhis dej, hnoos. Muaj kev ua txhaum ntawm nqos thiab ua pa nyuaj. Nrog edema ntawm txoj hnyuv, tus neeg mob yws ntawm xeev siab, ntuav, colic hauv cov hnyuv.
Feem ntau, cov tub ntxhais kawm cov ntaub ntawv keeb kwm piav qhia qhov o ntawm lub ntsws. Nws tshwm sim feem ntau thiab yuav tsum tau ua sai sai.
Zoo kawg
Txhua tus menyuam kawm ntawv ntawm lub tsev kawm kho mob lossis lub tsev kawm ntawv yuav tsum muaj peev xwm sau cov xwm txheej hauv zos kom raug. Yog hais tias, thaum piav txog lub hom phiaj xwm txheej ntawm lub cev uas tsis cuam tshuam los ntawm cov txheej txheem, ib yam dab tsi tuaj yeem ploj mus, ces qhov no txhua yam yuav tsum tau piav qhia ntau npaum li qhov ua tau. Los ntawm qhov zootus kws kho mob yuav characterize qhov chaw ntawm kev loj hlob ntawm cov txheej txheem pathological, ntxiv kev kuaj mob thiab kev kho mob nyob ntawm. Nws kuj tseem ceeb heev rau kev saib xyuas tus kab mob nyob rau lub sijhawm.
