教你用英语查房 交接班 原创

“Tools” are extremely necessary to perform a proper physical exam. No physician should ever begin rounds without a stethoscope and penlight in his coat pocket. Although he may not always carry a tongue blade, chopsticks or a teaspoon could be substituted for the oropharyngeal exam. Inspection of the oral mucosa may faciltate diagnosis of such diseases as pharyngitis, tonsillitis, mucositis, oral candidiasis or oral ulcerations, each of which may present clues to such diseases as SLE, HIV infection, herpes simplex, leukemia, megaloblastic anemia, or Behcet's disease.
血气分析报告提示pH为7.50，二氧化碳分压（PC O2 ）为30毫米汞柱，氧分压（P O2 ）为46毫米汞柱。转入重症监护室1小时后，患者接受气管插管、机械通气。
Adequate preparation for patient rounds is essential for efficient, quality patient care. Poor preparation not only prolongs patient rounds, but worse it may delay “timely” decisions concerning the patient treatment, and even delay recovery and discharge. Ultimately it may compromise the quality of medical care and ominously even result in premature death!
查房准备早晨8点30分，开始查房。今天，我们和呼吸内科的医生一起查房。1107号病房患者是史密斯先生，65岁，昨天下午入院。查房小组由7人组成，包括呼吸内科的主治医生、专科住院医生、住院医生和3名医学生。先由昨天受治患者并完成病历的住院医生报告病情。史密斯先生表现为咽痛、咳嗽多痰、气促，发烧已有5天，在当地一家小医院住院时静脉用丁胺卡那针剂治疗无效，以肺炎转入我院治疗。患者家属将病历及胸透片、化验单等资料交给了一位住院医生，并被遣忘在值班室。一个医学生迅速地到护理站将记录拿了过来。检查提示，昨晚患者的心率和呼吸频率均显著增快。住院医生迅速复查了这名患者，先是肺部听诊，然后检查患者咽喉部。体格检查完毕后，他注意到患者右肺底有湿罗音，咽喉部有脓性分泌物。未提供昨天患者的胸片、血细胞和血气分析的结果。漏查血气分析。然后，主诊医生迅速地检查了一下患者，注意到患者双侧肺底有湿罗音，血压90／60毫米汞柱（mmHg），心率120次／分，呼吸20次／分。他迅速开出血气分析和胸透片的检查医嘱。我们一边等待结果，一边让护士查一下血氧饱和度，结果血氧饱和度（SaO2）仅为86%。患者被迅速转移到重症监护室。
The obvious importance of a stethoscope for physical examination should need no explanation. Lung auscultation may detect rales, rhonchi or wheezes; valuable clues to such illnesses as pneumonia, asthma or congestive heart failure （CHF）. Decreased breath sounds may be noted with a pleural effusion, COPD, atelectasis and pneumothorax. The Cardiologist uses the stethoscope for cardiac auscultation; listening carefully to detect irregular rhythms, an S3 or S4 often noted in CHF and heart murmurs heard with stenotic valve lesions. Likewise, the stethoscope allows the examiner to detect mid systolic clicks in mitral valve prolapse and pericardial friction rubs.
工具对检查极其重要。任何一个医生在开始查房时至少要有听诊器和笔式电筒，也许他不一定总带着压舌板，但可以设法用筷子或勺子等代替进行口咽部的检查。检查口腔粘膜有助于咽炎、扁桃体炎、粘膜炎、口腔白色念珠菌病或是口腔溃疡的诊断，从而为系统性红斑狼疮（SLE）、艾滋病（AIDS）、单纯疱疹、白血病、恶性贫血或Behcet病等疾病提供线索。
医学英语阅读：查房准备(中对照)
Preparation for Patient RoundsIt's 8: 30 AM, time to begin patient rounds. Today we'll make patient rounds with the pulmonary team. In room 1107, we find 65yr. old Mr. Smith who was admitted yesterday afternoon. The pulmonary team includes the attending physician, senior pulmonary fellow, junior resident, and 3 medical students. The admitting junior resident who admitted the patient the previous day begins the case presentation. Mr. Smith presents with a sore throat, productive cough and shortness of breath; he's been febrile for 5 days; his illness failed to respond to IV Annkacin given during his hospitalization at a small local hospital so he was transferred to our hospital with the diagnosis of pneumonia. His family brought his medical records including a Chest X- ray and lab reports performed in the local hospital, but the junior resident left them in his on-call sleeping room. One of the medical students quickly retrieves the nursing chart from the nursing station. Review of the vitals is noteworthy for a progressive increasing pulse and respiratory rate during the night. The junior resident now briefly reexamines the patient, lung auscultation, and then the pharynx. After completing the physical exam, he notes the patient has "crackles" in the right lung base and purulent pharyngeal exudate. No results of yesterday's Chest X-ray, CBC, and ABG were provided. An ABG or pulse oximetry forgotten. Further examination notes bilateral diffuse crackles, BP 90/60,pulse 120, resp.32/min. He orders a stat ABG and Chest X- ray and while waiting we request the nurse check the patient's O2 saturation using pulse oximetry and discover the O2 saturation is only 80%. Urgent arrangements are made to transfer the patient to ICU.
A subsequent ABG shows pH 7.50, PC O2 30rnnff/g and P O2 46mm Hg. Within 1 hr. of ICU admission, the patient requires intubation and mechanical ventilation.
查房准备首先是要了解患者目前的状况，这些信息可以通过查房前的病历回顾，包括护理记录和床边评估等获得。接着是收集患者现有的实验室、X线和病理报告以备查房时使用。有时查房前可能拿不到正式报告，但可以通过电话或病区的计算机先得到初步报告。这些结果可以在查房时供查房小组讨论，这将有利于疾病的早期诊断和治疗