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BURNS AND PLASTIC
BURNS
Infections in burn patients
1. Introduction
Infection remains the leading cause of death among patients hospitalized for
burns. The risk of burn wound infection is directly correlated to the extent of the burn
and is related to impaired resistance resulting from disrupt ion of the skin’s
mechanical integrity and generalized immune suppression. Bacterial burn wound
infections and mortality from burn wound infection decrease with rapid burn
debridement and wound closure and the use of effective topical and systemic
antimicrobial chemotherapies. Overall mortality rates from burn wound infection
remain high. Though advances in local burn therapies, including the judicious use of
antimicrobials, has reduced infectious complications from large burns, secondary
opportunistic Infections always complicate and alter the course of the illness. This is
prevalent especially in patients sustaining larger burns (>40% total body surface area
[TBSA] and in children less than 4 years of age. An analysis of the common isolates
from the burn wound and blood cultures and their sensitivity patterns would help to
formulate an institutional drug policy for the patients admitted to the Burn Unit.
2. Material and methods
This is a retrospective analysis of isolates and their sensitivity patterns from the
culture of wound swabs of patients admitted to the Burns unit of Kanchi Kamakoti
Childs Trust Hospital, Chennai from December 1998 to December 2004.
A total of
535 samples were processed during this period. Wound swabs were taken from the
burn wounds and cultured. Blood cultures were also sent simultaneously. The isolates
were identified and their antibiotic sensitivity determined using Kirby–Bauer disc
diffusion technique. If an isolate is resistant to any one of the cephalosporins
(cefotaxime, ceftazidime) confirmatory tests for an ESBL enzyme is performed by
demonstrating increased susceptibility to cefotaxime and ceftazidime in the presence
1
of clavulanic acid as clavulanic acid inhibits ESBL enzymes and lowers the MIC of
cephalosporins.
3. Results
A total of 535 samples were studied during these 6 years. Single isolates were
seen in 84% and multiple isolates in 9%. Forty samples were reported to be sterile
(7%). The commonest isolate was Pseudomonas species in 41% followed by
Staphylococcus aureus (37%), Escherechia coli (10%), Klebsiella (10%) and
anaerobes in (2%). Gramnegative bacilli especially Pseudomonas were found to be
highly sensitive to carbapenams followed by amino-glycosides and quinolones. The
isolates from the burn wound and blood culture were found to be the same in our
institution. E. coli and Klebsiella were usually found to be ESBL producers and the
rates were 37%.
4. Discussion
In the present study solitary isolates were more common than multiple isolates.
This is in contrast to other studies were multiple isolates were more common.
However, the observation by Kaushik et al. was similar to ours. In their study,
Kaushik et al. found Pseudomonas as the most common isolate which was similar to
the observation made in our study. Antibiotic sensitivity patterns served as a useful
guideline for choosing the appropriate antibiotic.
When we analyzed the sensitivity patterns of our isolates we found that
Pseudomonas which was the commonest isolate was most sensitive to carbapenams
followed by aminoglycosides and quinolones. Quinoloneswere found to be most
suitable against Pseudomonas followed by aminoglycosides in the study done by
Kaushik et al. Grampositive cocci were found to be highly sensitive to cloxacillin,
amoxycillin clavulanic acid and Vancomycin.
The extended spectrum beta lactamase (ESBL) rates of Gram-negative bacilli
were 37%. ESBL are likely to give false susceptibility to third generation
cephalosporins thereby misleading the clinicians about the choice of antibiotic.
Therefore, it is essential to screen for ESBL in Gram-negative isolates especially E.
coli and Klebsiella. Methicillin resistant Staphylococcus aureus (MRSA) rates were
2
insignificant. While there was no mention about ESBL rates in the studies done by
Kaushik et al. and Revathy et al. the observation made by Taylor et al. was similar to
our study.
To conclude solitary isolates were more common with Pseudomonas and
Staphylococcus forming the main organisms. The antibiotic sensitivity patterns and
periodic surveillance of ESBL and MRSA rates were useful in choosing the
appropriate antibiotic against the isolated organisms.
PLASTIC
Impact of Complications on Patient Satisfaction
in Breast Reconstruction
Background: The development of a complication after surgery can be difficult for
both patient and surgeon. With a growing body of literature evaluating patient
satisfaction after breast reconstruction, few studies directly focus on the impact of
surgical complications on satisfaction. This study analyzed the effect of complications
on general and aesthetic satisfaction after breast reconstruction.
Methods: All women at an academic institution undergoing breast reconstruction
between 1999 and 2006 were identified. Patient demographics and history of
complications were collected. A questionnaire adapted from the Michigan Breast
Reconstruction Outcomes Survey was administered examining general and aesthetic
satisfaction. Patients with complications were compared with
patients with no complications.
Results: Overall, 716 women underwent 932 reconstructions; 233 patients had a
complication. Patient demographics and response rate were similar between the two
groups (overall response rate 75.4 percent). Development of a complication correlated
with increased odds of aesthetic dissatisfaction. Other predictors of dissatisfaction
were older age, reconstruction with an implant, and a longer time interval between
reconstruction and survey, while autologous reconstruction was a predictor of
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satisfaction. Among patients with a complication, implant reconstruction and
mastectomy for prophylaxis were significant predictors of dissatisfaction.
Conclusions: Aesthetic satisfaction after breast reconstruction is lower in patients
developing a complication, older patients, and those receiving an implant
reconstruction. Furthermore, patients with a prophylactic mastectomy are more likely
than those with a therapeutic mastectomy to be dissatisfied when complications arise.
These relationships are important, as measures to improve quality and decrease
complications can directly improve patient satisfaction.
Patient Selection
A retrospective review was performed of all patients undergoing postmastectomy
breast reconstruction at Beth Israel Deaconess Medical Center from January of 1999
to December of 2006. Procedures were performed by seven different surgeons over
this time frame. Patients who had reconstruction of partial mastectomy, salvage
mastectomy, and congenital breast defects were excluded. There were 716 women
who underwent 932 breast reconstructions. During the 23.3 months of mean
follow-up time, 233 patients (287 reconstructions) developed complications requiring
additional surgical management (complication group), and 483 patients (645
reconstructions) did not develop any significant complications (no complication
group). Nine patients (six responders) with bilateral reconstructions known to have a
different type of reconstruction for each breast (e.g., autologous and
implant/expander) were excluded in the satisfaction analysis. Data on patient
demographics and complications were gathered retrospectively from the online
medical records, office charts, and inpatient medical records.
Assessment of Complications
The onset of complications in the study population was assessed using an extensive
retrospective analysis of the patients’ online medical records, office charts, and
inpatient hospital records. The complications included in this analysis were those
requiring additional surgical management. Complications included infection,
hematoma, seroma, mastectomy skin flap loss, abdominal hernia or bulge, total and
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partial flap loss, open wound, fat necrosis, capsular contracture, implant rupture,
extrusion, malposition, and rippling. Patients with bilateral breast reconstructions
were considered to have a complication if one or both breasts had developed a
complication.
5
From Townsend: Sabiston Textbook of Surgery, 18th ed. 2007
Copyright © 2007 Saunders, An Imprint of Elsevier
SAFER SURGICAL SYSTEMS (1)
Surgical services represent JCSs amenable to improved effectiveness, improved
efficiency, and improved safety with focused management practices and
professional leadership. Improving surgical safety, particularly operating room
safety, will require surgeons to assume their responsibility to lead the surgical
JCS. Many surgeons currently lead efforts to improve surgical safety. The
following paragraphs describe some of these efforts and delineate additional
opportunities to prevent adverse events, errors, and accidents.
Team Development
Systems include people working with artifacts to accomplish goals: teams.
Consequently, addressing systems of care begins with an examination of the
people in the system forming the team. In surgical care the team includes
surgeons, anesthesiologists, anesthetists, nurses, allied health personnel, and
administrators. To work effectively in surgical teams the people require
competency,
proficiency,
continued
learning,
and
skill
development.
Competency refers to the cognitive skills and knowledge required to practice a
profession. Proficiency is the ability to execute a task at a consistently optimum
level and outcome. Learning is the acquisition of new knowledge. Maintaining
surgical competency and proficiency requires a long-term, perhaps endless
process that begins with the selection of trainees. Because some individuals learn
and acquire skill faster than others do, the training process should possess
continual, objective, standardized assessments of cognition and technical skills.
These processes should then continue beyond the training period into continuing
6
professional practice to provide continuing assessment of established surgeons
for revalidation and recertification. Practicing surgical professionals of all
disciplines require opportunities for continuing acquisition of new knowledge
and new technical skills. Because of the rapidly increasing volume of new
knowledge and new technology, learning and development of new skills assume
increasing importance for maintaining patient safety.[24]
Surgical professionals need reliable performance assessment in the form of
regularly provided outcome data such as morbidity rates, mortality rates, cure
rates, and patient postoperative quality-of-life assessments. In addition, some
system for analyzing and evaluating anonymous incident, error, and accident
reports could promote safety in surgical practice. The U.S. Congress enacted
laws permitting collection of such data without risk of legal discovery. The
Agency for Healthcare Research and Quality is developing federal regulations to
permit health care organizations to form patient safety organizations for the
purpose of examining data on medical errors and accidents.
Surgeons have a special responsibility to promote safety by providing leadership
to surgical teams. Surgeon leaders must have sufficient experience and surgical
volume to sustain a high level of proficiency. A surgeon leader who understands
the system will implement good team management and promote optimal
performance of all involved professionals by focusing on the interests of the
patient. Leadership requires the physical presence of the surgeon in the operating
room.
A safety-oriented surgical system would include measures to identify impaired
members of the team, including surgeons, anesthesiologists, anesthetists, nurses,
allied health professionals, and administrators. These problems occur
infrequently but can pose threats to patient safety when they occur. Our
profession has not addressed this matter as well in the past as it must in the
future. Team leaders should develop processes for recognizing impaired
members. Impairments include substance abuse, mental illness, and physical
7
illness. In addition, recognition and correction of declining competency and
proficiency should promote safety. Teams should also recognize and correct
behavioral problems causing disruption in the workplace. Professionals who
cannot work effectively with others or who are abusive to others, including
personnel and patients, must undergo rehabilitation. Institutional or team leaders
should identify problem staff members early and take corrective action in a
timely manner. A system of professional accountability must be objective, based
on data; it must be fair and apply to everyone in the system; and it must respond
with prompt and effective treatment with the goal of enabling all to continue
professional practice.[25]
Surgeons, anesthesiologists, nurses, and allied health professionals recognize the
importance of teamwork in the operating room. For many operations,
pathologists play a crucial role in safe, effective surgery and smooth conduct of
surgical procedures. A high-performance operating room requires good
communication among all surgical team members because breakdowns in
communication can lead to errors, adverse events, and accidents compromising
patient safety. Medical team training can improve communication in the
operating room. Operating room teams can use crew resource management
(CRM) principles to enhance communication and patient safety. CRM principles
include didactic instruction, interactive participation, role-playing, training films,
and clinical vignettes. Awad and coworkers investigated CRM quantitatively and
concluded, “Medical team training using CRM principles can improve
communication in the operating room, ensuring a safer environment that leads to
decreased adverse events.”[26(p773)]
Gap Protection
Cook and colleagues introduced the useful concept of gaps and recognized that
gaps provide opportunities for errors and accidents.[27] Gaps, or discontinuities,
may produce loss of information, loss of momentum, or interruptions in delivery
8
of care. Fortunately, gaps rarely lead to failure or produce errors because nurses,
technicians, clerks, or physicians anticipate, identify, and bridge most gaps.
Organizational boundaries, changes in authority or responsibility, different roles
of professionals, and divisions of labor produce gaps. For example, shift
changes, patient transfer to different units within a hospital, patient transfer
between hospitals, discharge to a rehabilitation facility, and discharge home
produce gaps in care. Gaps can occur within the activities of a single practitioner,
for example, when a nurse divides attention between two or more patients.
Organizational change or the introduction of new technology can cause new gaps
or disrupt bridges spanning established gaps. System complexity creates gaps in
care, and information can be lost. Every transition in care constitutes a gap. The
increasing fragmentation of medical care produces more gaps. Structured
handoff routines and checklists can decrease information loss at gaps. A dozen or
more gaps or handoffs can occur between evaluation in the clinic, surgical
admission unit, operating room, recovery room, ICU, and surgical ward and
discharge from the hospital. Each gap requires a handoff.
Handoff routines can include reading back orders and instructions, face-to-face
review of clinical information, or handoff information technology resources.
Checklists and standardized orders can also minimize loss of information at
handoffs. Checklists can simplify preoperative planning, operating room
scheduling, admission scheduling, night-before instructions, preoperative details
(briefing), and postoperative care (Fig. 11-3). A system can apply
standardization to admission and preoperative orders, postoperative orders,
transition orders, discharge orders, and discharge instructions. Guidelines,
clinical pathways, protocols, and algorithms can also facilitate bridging of gaps.
All these gap transition artifacts prompt routine, necessary action at system gaps,
can be customized for individual patients, and are effective, inexpensive,
low-tech, and efficient.[27]
9
Figure 11-3 Checklists such as this one can maximize effective
communication at gaps and during handoffs along the continuum of
surgical care.
(Courtesy of the Department of Surgery, University of California, San
Francisco.)
The Joint Commission for Accreditation of Healthcare Organizations (JCAHO), the
American College of Surgeons (ACS), and the Veterans Administration Health
System (VAHS) recommend processes for preoperative review to promote safety and
eliminate errors in patient and surgical site identification, as well as other important
considerations.[28–30] The ACS, JCAHO, and VAHS endorse a preoperative briefing or
time-out before every surgical procedure. Box 11-4 shows the JCAHO
recommendations for its time-out procedure. This guide stipulates essential topics for
preoperative discussion by all members of the surgical team and a checklist to verify
that all personnel, all necessary equipment, and all necessary processes have been
accomplished or are in place before making the incision or beginning the procedure.
Development of a preoperative briefing guide and the related checklists can begin
with the patient's first encounter with the surgical team. This first encounter can
initiate an iterative process that produces a checklist for review by members of the
surgical team on the preoperative evening in elective cases. The preoperative time-out
in the operating room will then verify all items on the list. After the operation,
members of the surgical team will bridge the gap between the operating room and the
recovery room or the ICU.
Box 11-4
JCAHO Time-Out Immediately Before Starting a Procedure
Must be conducted in the location where the procedure will be performed, just
before starting the procedure. It must involve the entire operative team, use
10
active communication, be briefly documented, such as in a checklist (the
organization should determine the type and amount of documentation), and
must, at the least, include the following:
▪
Correct patient identity
▪
Correct site and side
▪
Agreement on the procedure to be performed
▪
Correct patient position
▪
Availability of correct implants and any special equipment or special
requirements
The organization should have processes and systems in place for reconciling
differences in staff responses during the time-out
Adapted from the Joint Commission on Accreditation of Healthcare Organizations.
Universal
Protocol,
2006.
Available
http://jointcommission.org?PatientSafety/UniversalProtocol
at
. Retrieved October
27, 2006.
Improvements in Information Technology
Federal and state governments and all health industry stakeholders assign high
priority to the application of information technology for increasing the safety and
quality of health care. With the leadership of the Department of Health and
Human Services, 13 government agencies, professional organizations, private
foundations, providers, and vendors formed an organization, the National Health
Information
Infrastructure
(NHII),
to
promote
the
development
and
implementation of information technology systems and programs to support the
development of a national health care system. Box 11-5 lists the goals and
11
objectives of a national health information technology system. This task will
require unprecedented leadership from government, industry, and the health
professions. In addition, the project faces substantial financial challenges. As it
develops over time, a national health information infrastructure will undoubtedly
improve the quality and safety of health care.[31] However, the health care
industry should introduce new information technology with care and deliberation
because such new technology could create tighter coupling in the system and
produce unforeseen challenges in system control and unanticipated opportunities
for error.[23]
Box 11-5
Goals of the National Health Information Infrastructure
▪ National platform for standards
▪ Confidentiality
▪ Electronic medical records
▪ Computerized physician order entry
▪ Electronic prescriptions
▪ Quality improvement databases
▪ Repositories of best evidence
▪ Computer-assisted decision support
▪ Prompts and reminder systems
From U.S. Department of Health and Human Services. National Health Information
Infrastructure
(NIIH
2002-2004),
http://aspe.hhs.gov/sp/NHII/index.html
2006.
Available
. Retrieved October 27, 2006.
12
at
Nonetheless, computerized physician order entry and computerized prescription
writing already show promise for reducing medical errors. Information
technology provides multiple opportunities for improving patient safety; for
example, computerized rounding and sign-out systems have the potential to
improve the continuity of care and facilitate the bridging of gaps. Van Eaton and
associates, working in an academic medical center, developed a centralized,
Web-based computerized rounding and sign-out system that securely stores
information, automatically downloads patient data, and prints the data to
rounding, sign-out, and progress note templates. Authorized users could access
the system from any hospital workstation or from their own computers. The
centralized computer allowed residents to organize patient lists, enter detailed
sign-out information, and compile “to do” lists. Residents could add patient data
to other team's lists when cross-covering or consulting. The system produced
sign-out reports and rounding lists that included clinical data and laboratory
values downloaded from the hospital clinical information systems. This team
evaluated the system in a prospective randomized trial involving six general
surgery services and eight internal medicine services. Helping residents cope
with the limitations of the 80-hour work week motivated this project, which
succeeded in this objective by decreasing rounding time. However, the system
also enhanced patient care by decreasing the number of patients missed on
resident rounds and improved the continuity of care. Although a teaching
hospital developed this system, the method and the principles developed should
work in any hospital.[32]
13
Pre-operative Assessment
By Wang Xiang
Department of Neurosurgery, West China Hospital

Preoperative assessment aims to:
o
Reduce morbidity and mortality associated with surgery
o
Prevent unnecessary cancellations
o
Reduce hospital stay
Aim of preoperative planning

Inform patient of the proposed procedure

Obtain informed consent for the procedure

Assess pre-existing medical conditions

Plan pre and postoperative management of these conditions
Issues that should be discussed

Time of admission and starving instructions

Management of usual medication

Any specific pre-operative preparation that may be required

Transport to theatre

Any specific anaesthetic issues

Anticipated duration of surgery

Likely recovery period

Need for drains, catheters

Likely discharge date

Need for dressing change or specific postoperative care

Follow up requirements

Likely date of return to work or full activity
14
Important medical diseases that increase morbidity and mortality

Ischaemic heart disease

Congestive cardiac failure

Hypertension

Cardiac arrhythmias

Chronic respiratory disease

Diabetes mellitus

Endocrine dysfunction

Chronic renal failure

Nephrotic syndrome

Obstructive jaundice
Advantages of pre-admission clinic

Allows pre-operative optimisation of patients

Reduces duration of hospital stay

Reduces risk of unnecessary cancellations

Guidelines minimise unnecessary preoperative investigations
Elements of the Surgical Safety Checklist.
Sign in
Before induction of anesthesia, members of the team (at least the nurse and an
anesthesia professional) orally confirm that:

The patient has verified his or her identity, the surgical site and procedure, and
consent

The surgical site is marked or site marking is not applicable

The pulse oximeter is on the patient and functioning

All members of the team are aware of whether the patient has a known allergy

The patient’s airway and risk of aspiration have been evaluated and
appropriate equipment and assistance are available

If there is a risk of blood loss of at least 500 ml (or 7 ml/kg of body weight, in
children), appropriate access and fluids are available
15
Time out
Before skin incision, the entire team (nurses, surgeons, anesthesia professionals, and
any others participating in the care of the patient) orally:

Confirms that all team members have been introduced by name and role

Confirms the patient’s identity, surgical site, and procedure

Reviews the anticipated critical events

Surgeon reviews critical and unexpected steps, operative duration, and
anticipated blood loss

Anesthesia staff review concerns specific to the patient

Nursing staff review confirmation of sterility, equipment availability, and
other concerns

Confirms that prophylactic antibiotics have been administered ≤60 min before
incision is made or that antibiotics are not indicated

Confirms that all essential imaging results for the correct patient are displayed
in the operating room
Sign out
Before the patient leaves the operating room:

Nurse reviews items aloud with the team

Name of the procedure as recorded

That the needle, sponge, and instrument counts are complete (or not
applicable)That the specimen (if any) is correctly labeled, including with the
patient’s name

Whether there are any issues with equipment to be addressed

The surgeon, nurse, and anesthesia professional review aloud the key concerns
for the recovery and care of the patient
16
A Brief Introduction to Drug Instructions
说明书的表达方式包括:
instructions, labels, fact sheet, package insert, directions,
descriptions,
结构:
leaflet
1. drug names
药品名称
2. description
性状
3. pharmacological actions
药理作用
4. indications
适应症
5. contraindications
禁忌症
6. dosage and administration
剂量和用法
7. adverse reactions
副作用
8. precautions
注意事项
9. package
包装
10. storage
储存方法
11. others
其他
1. Drug names 常见的药品名称:
商品名 (trade name or proprietary name);
注册名 (registered name);
通用名 (generic name);
化学名 (chemical name)
药品名称的翻译法可采用音译, 意译, 音意合译及谐音译意等方法.
1) 音译: 按英文药品名称的读音译成相同或相近的汉语.
如:
Rulide
罗力得
Amoxicillin
阿莫西林
2) 意译: 按药品名称的含义译成相应的汉语.
如:
Cholic Acid
Techracyclin
胆酸
四环素
3) 音意合译: 药品名称中一部分用音译法, 一部分用意译法.
如:
Medemycin
Erythromycin
麦迪霉素
17
红霉素
4) 谐音译意: 以音译为原则,选择谐音的汉字,既表音,又表意.
如:
Webilin
Doriden
胃必灵
多睡丹
2. Descriptions (性状)
Other names:
chemical structure (化学结构);
composition (成分);
physical and chemical properties (理化性质)
1) 常用词组：
be derived from (由...提取);
be obtained (制得);
contain (含有);
be prepared from (由...制备);
consist of (由...组成) ;
have/possess
(有)
2) 表示性质的词类：
injection (注射剂);
solution (溶液);
tablets (片剂);
liquid (液体);
powder (粉末);
solid (固体);
stable (稳定的);
unstable (不
稳定);
3.
tasteless (无味的);
soluble (可溶的);
insoluble（不可溶的）;
odorless（无臭的）;
crystalline (结晶的);
color (颜色)
Pharmacological actions (药理作用)
Other names include:
clinical effects (临床效果);
mechanism of action (作用机理);
mode of action (作用方式);
pharmacological properties (药理性质)
1) 常用词：
动词
absorb (吸收);
act on / exert action on (作用于);
produce (产生)
result in(导致);
maintain (维持);
promote (促进);
excrete (排泄);
inhibit (抑制);
demonstrate (显示);
exhibit (显示);
indicate (表明);
show (表明);
suggest (表明);
accumulate (积蓄);
prevent (预防);
形容词
average (平均的);
mean (平均的);
18
minimum (最低的,最小的);
maximum (最高的,最大的);
be related to (与...有关的);
be sensitive to
be active against (对---有效);
(对...敏感的);
be effective against (对---有效);
be resistant to (...有耐药性的)
名词
activity (活性);
distribution (分布);
excretion (排泄);
mechanism (机理);
half life (半衰期);
tolerance (耐受性);
toxicity (毒性);
in vitro（体外）;
in vivo （体内）,
serum concentration (血清浓度);
4.
Indications (适应症)
多为疾病名或致病菌的名称
diabetes (糖尿病);
如:
plasm level (血浆浓度)
hypertension (高血压);
gram-positive (革兰氏阳性菌);
streptococcus (链球菌);
virus
(病毒);
gram-negative (革兰氏阴性菌);
staphylococcus (葡萄球菌)
常用词组
be active agaist (对...有效);
be administered in (适用于);
be indicated in/ for (适用于);
be in/ for the treatment of (用于治疗);
be intended to (适用于);
be used to/ for/ as (用于);
be recommended for (推荐用于);
be employed to (用于);
be associated/ conbined with (与...联合使用)
be compatible with（与...配伍使用）;
be concomitant with（与...共同使用）,
together with (与...共同使用）;
in conjunction with（与... 结合使用）.
5. 禁忌症
(contraindications)
1) 特殊患者：
in pregnancy (妊娠期);
lactation (哺乳期);
pregnant woman (孕妇);
the first trimester of pregnancy (妊娠的头三个月）
children under---years of age (...岁以下儿童);
19
2) 对---过敏:
be allergic / hypersensitive to;
present allergy/
hypersensitivity to;
患有---疾病者
patient with----
patient suffering from -----
3) 常出现的疾病名:
severe anemia (严重贫血);
cardiac failure (心力衰竭);
liver/ hepatic damage (肝损伤);
impairment of kidney (肾损伤);
cardiac (renal) insufficiency (心或肾功能不全);
6. Dosage and Administration (剂量和用法)
Other names include:
mode of application (用法);
direction for use (用法);
How to use (用法);
posology (剂量学);
dosage (用量);
Route of administration (给药途径);
1) 表示剂量的术语：
average dose (平均剂量);
量);
divided dose (分次剂量);
indicated dose (有效剂量);
daily dose (日剂
initial/ beginning/ starting dose (首
次剂量);
maintenance dose (维持剂量);
fatal/ lethal dose (致死量);
overdose (过
量);
therapeutic dose (治疗剂量);
maximum dose (最大剂量);
usual/normal dose (常用剂量);
single dose (单次剂量);
minimum dose (最小剂量);
standard dose (标准剂量);
2) 给药次数表示法:
daily / per day / every day (每日);
every---hours (每隔...小时);
twice daily (每日两次);
every other day (每隔一天);
once a week (每周一次);
divided into-----doses (分...次);
in two or three divided doses (分为二或三次)
3) 给药对象:
infants (婴儿,幼儿);
newborns (新生儿);
20
baby (婴儿);
children (儿童);
adults (成年人);
pregnant women (孕妇);
debilitated patients (体弱患者);
senile/elderly patients (老年
患者)
4) 给药方式:
parenterally (肠道外给药);
intraperitoneally (腹腔内给药);
locally (局部给药);
intravenously (静脉内给药);
intramuscularly (肌内给药);
intragluteally (臀肌内给药);
orally=by mouth (OS) (口服给药);
per rectum =pro recto (直肠给药)
by the intravenous infusion/ perfusion
(静脉输注);
by aerosol (喷雾给药);
by phleboclysis (静脉输液);
by enema (灌肠);
by the intranasal route (鼻内给药);
by drip phleboclysis (点滴静脉输液);
5) 常用给药或用药的动词:
给药: give;
indicate;
use;
用药: take (服用) ;
employ;
administer
inhale (吸入);
swallow (吞服);
spray (喷雾);
inject (注射);
apply to (涂于, 敷于)
7. 用于表示副作用的术语:
Adverse / side/ unwanted reactions, side-effects, by-effects
1) 常见毒副作用：
allergic/ hypersensitive/ anaphylactic reactions (过敏反应);
local reactions (局部反应);
systematic reactions (全身反应);
skin reaction (皮肤反应);
);
dizziness (眩晕);
flush (潮红);
thirst (口渴);
皮疹);
倦);
coma (昏迷);
nausea (恶心);
fatigue (疲倦);
anorexia (厌食
rash (
tiredness (疲
spasm (痉挛)
2) 表示停药的动词：
abandon ;
discontinue ;
cease;
suspend;
terminate;
withdraw.
21
stop;
3) 其他常见词汇:
reversible (可逆的);
irreversible (不可逆的);
severe (严重的);
mild (轻微的);
temporary (暂时的);
transient (短暂的);
disappear (消失);
give rise to (产生);
lead to (导致);
manifest (表明, 显示);
result from (由...引起);
result in (导致)
8. 注意事项： cautions;
precautions;
note;
N.B.=nota bene 注意
常见的检查项目:
blood count (血细胞记数);
liver function (肝功);
renal function (肾功);
clotting time (凝血时间);
blood picture or hemogram (血象);
serum concentration (血清浓度);
serum creatinine test (肌酸酐检查);
creatinine clearance (清除率);
urine routine (尿常规)
9. 包装：pack, package, supply, presentation, availability
1) 常用的包装单位：
pack (包);
bottle (瓶);
tube (管);
vial (玻璃小瓶),
box (盒);
ampoule =ampule (安瓿);
2) 常见剂型：
injection (针剂);
drops (滴剂);
aerosal / spray/ inhaler (气雾剂)
ointment (软膏),
liniment (搽剂),
suppositotories (栓剂)
cream (乳膏),
syrup (糖浆),
granule (颗粒),
ampoule (针剂);
powder (粉剂);
pill (丸剂);
oral solution (口服液);
degrees (糖衣丸);
cream (乳膏);
tablets (片剂);
capsules (胶囊)
sugar-coated tablets (糖衣
片);
10. storage (储存):
keep in a cool and dry place (存于阴凉干燥处);
22
prevent moisture (防潮);
away from light/ heat =protect from light/ heat (避光或热);
away from children =out of the reach of children (勿让儿童接触)
11. others:
validity (有效期);
expiry (Exp.) date （失效期
shelf/ storage life （储存期限）;
stability (稳定性)
）;
Package Insert
GENERIC NAME: NORFLOXACIN - ORAL (nor-FLOX-uh-sin)
BRAND NAME(S): Noroxin (诺氟沙星)
WARNING: This medication may rarely cause tendon damage (e.g., tendinitis,
tendon rupture) during or after treatment. Your risk for tendon problems is greater if
you are over 60 years of age, if you are taking corticosteroids (such as prednisone), or
if you have had a kidney, heart or lung transplant. Stop exercising, rest, and seek
immediate medical attention if you develop joint/muscle/tendon pain or swelling.
USES: Norfloxacin is used to treat a variety of bacterial infections. This medication
belongs to a class of drugs called quinolone antibiotics. It works by stopping the
growth of bacteria.This antibiotic treats only bacterial infections. It will not work for
virus infections (e.g., common cold, flu). Unnecessary use or overuse of any antibiotic
can lead to its decreased effectiveness.
HOW TO USE: Read the Medication Guide provided by your pharmacist before you
start taking norfloxacin and each time you get a refill. If you have any questions,
consult your doctor or pharmacist.Take this medication by mouth, usually twice a day,
at least 1 hour before or 2 hours after a meal or dairy products (e.g., milk, yogurt).
Take with a full glass of water (8 ounces or 240 milliliters). The dosage is based on
your medical condition and response to treatment. Drink plenty of fluids while taking
this medication unless your doctor tells you otherwise.Take this medication at least 2
hours before or 2 hours after taking any drugs that contain magnesium, aluminum, or
calcium. Some examples include quinapril, certain forms of didanosine
(chewable/dispersible buffered tablets or pediatric oral solution), vitamins/minerals,
23
and antacids. Follow the same instructions if you take calcium-enriched juice,
bismuth subsalicylate, sucralfate, iron, and zinc. These medications/products bind
with norfloxacin and prevent its full absorption. Antibiotics work best when the
amount of medicine in your body is kept at a constant level. It is important not to miss
a dose. To help you remember, take this medication at the same times every
day.Continue to take this medication until the full prescribed amount is finished, even
if symptoms disappear after a few days. Stopping the medication too early may allow
bacteria to continue to grow, which may result in a return of the infection.Tell your
doctor if your condition persists or worsens.
SIDE EFFECTS: See also Warning section. Nausea, diarrhea, dizziness,
lightheadedness, or headache may occur. If any of these effects persist or worsen, tell
your doctor or pharmacist promptly. Seek immediate medical attention if any of these
rare but very serious side effects occur: severe dizziness, fainting, fast/irregular
heartbeat. Norfloxacin may rarely cause serious nerve problems that may be
reversible if identified and treated early. Do not use anti-diarrhea products or narcotic
pain medications if you have any of the following symptoms because these products
may make them worse. Tell your doctor immediately if you develop: persistent
diarrhea, abdominal or stomach pain/cramping, blood/mucus in your stool. Use of this
medication for prolonged or repeated periods may result in oral thrush or a new
vaginal yeast infection. Contact your doctor if you notice white patches in your mouth,
a change in vaginal discharge, or other new symptoms. A very serious allergic
reaction to this drug is rare. However, seek immediate medical attention if you notice
any of the following symptoms of a serious allergic reaction: rash, itching/swelling
(especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a
complete list of possible side effects. If you notice other effects not listed above,
contact your doctor or pharmacist.In the US -Call your doctor for medical advice
about side effects. You may report side effects to FDA at 1-800-FDA-1088.
PRECAUTIONS: Before taking norfloxacin, tell your doctor or pharmacist if you
are allergic to it; or to other quinolone antibiotics such as ciprofloxacin, gemifloxacin,
levofloxacin, moxifloxacin, or ofloxacin; or if you have any other allergies. Before
using this medication, tell your doctor or pharmacist your medical history, especially
of: certain metabolic disorder (G6PD deficiency), diabetes, heart problems (e.g.,
recent heart attack), joint/tendon problems (e.g., tendonitis, bursitis), kidney disease,
certain muscle problem (myasthenia gravis), nervous system disorder (e.g., peripheral
neuropathy), seizure disorder, conditions that increase your risk of seizures (e.g.,
brain/head injury, brain tumors, cerebral atherosclerosis). Norfloxacin may cause a
24
condition that affects the heart rhythm (QT prolongation). QT prolongation can
infrequently result in serious (rarely fatal) fast/irregular heartbeat and other symptoms
(such as severe dizziness, fainting) that require immediate medical attention. The risk
of QT prolongation may be increased if you have certain medical conditions or are
taking other drugs that may affect the heart rhythm (see also Drug Interactions
section). Before using norfloxacin, tell your doctor or pharmacist if you have any of
the following conditions: certain heart problems (heart failure, slow heartbeat, QT
prolongation in the EKG), family history of certain heart problems (QT prolongation
in the EKG, sudden cardiac death). Low levels of potassium or magnesium in the
blood may also increase your risk of QT prolongation. This risk may increase if you
use certain drugs (such as diuretics/"water pills") or if you have conditions such as
severe sweating, diarrhea, or vomiting. This medication may rarely cause serious
changes in blood sugar levels, especially if you have diabetes. Watch for symptoms of
high blood sugar including increased thirst and urination. Also watch for symptoms of
low blood sugar such as nervousness, shakiness, fast heartbeat, sweating, or hunger.
Check your blood sugar regularly as directed by your doctor and report any changes.
If you experience symptoms of low blood sugar, you may raise your blood sugar by
using glucose tablets/gel or eating a quick source of sugar such as table sugar, honey,
or candy, or drinking fruit juice or non-diet soda. Tell your doctor immediately about
the reaction and the use of this product. To help prevent low blood sugar, eat meals on
a regular schedule, and do not skip meals.This drug may make you dizzy. Do not
drive, use machinery, or do any activity that requires alertness until you are sure you
can perform such activities safely. Limit alcoholic beverages.This medication may
make you more sensitive to the sun. Avoid prolonged sun exposure, tanning booths,
and sunlamps. Use a sunscreen and wear protective clothing when outdoors. Caution
is advised when using this medication in children younger than 18 years because they
may be at greater risk for joint/tendon problems. Kidney function declines as you
grow older. This medication is removed by the kidneys. Therefore, older adults may
be more sensitive to its side effects (e.g., blood sugar or tendon problems), especially
if they are also taking corticosteroids (e.g., prednisone, hydrocortisone). During
pregnancy, this medication should be used only when clearly needed. Discuss the
risks and benefits with your doctor. It is not known whether this drug passes into
breast milk. Therefore, breastfeeding is not recommended while taking this drug.
Consult your doctor before breast-feeding.
DRUG INTERACTIONS: See also the How to Use section.Your doctor or
pharmacist may already be aware of any possible drug interactions and may be
25
monitoring you for them. Do not start, stop, or change the dosage of any medicine
before checking with them first. This drug should not be used with the following
medication because very serious interactions may occur: strontium.If you are
currently using the medication listed above, tell your doctor or pharmacist before
starting norfloxacin. Many drugs besides norfloxacin may affect the heart rhythm (QT
prolongation), including amiodarone, dofetilide, procainamide, quinidine, sotalol,
certain macrolide antibiotics (e.g., erythromycin, clarithromycin), and certain
antipsychotic medications (e.g., pimozide, thioridazine, ziprasidone), among others.
Therefore, before using norfloxacin, report all medications you are currently using to
your doctor or pharmacist.Before using this medication, tell your doctor or pharmacist
of all prescription and nonprescription/herbal products you may use, especially of:
live bacterial vaccines (e.g., typhoid, BCG), "blood thinners" (e.g., warfarin),
corticosteroids (e.g., prednisone, hydrocortisone), cyclosporine, drugs removed from
your body by certain liver enzymes (such as clozapine, duloxetine, ropinirole, tacrine,
tizanidine), drugs for diabetes (e.g., glyburide, insulin), nonsteroidal
anti-inflammatory drugs (NSAIDs such as ibuprofen, naproxen), probenecid, urinary
alkalinizers (e.g., potassium/sodium citrate). Also report the use of drugs that might
increase seizure risk when combined with this medication such as isoniazid (INH),
phenothiazines (e.g., chlorpromazine), theophylline, or tricyclic antidepressants (e.g.,
amitriptyline), among others. Consult your doctor or pharmacist for details.Avoid
drinking large amounts of beverages containing caffeine (coffee, tea, colas), eating
large amounts of chocolate, or taking over-the-counter products that contain caffeine.
This drug may increase and/or prolong the effects of caffeine.This document does not
contain all possible interactions. Therefore, before using this product, tell your doctor
or pharmacist of all the products you use. Keep a list of all your medications with you,
and share the list with your doctor and pharmacist.
OVERDOSE: If overdose is suspected, contact your local poison control center or
emergency room immediately. US residents can call the US National Poison Hotline
at 1-800-222-1222. Canada residents can call a provincial poison control center.
NOTES: Do not share this medication with others.This medication has been
prescribed for your current condition only. Do not use it later for another infection
unless told to do so by your doctor. A different medication may be necessary in that
case. Laboratory and/or medical tests (e.g., kidney function, complete blood count,
blood glucose) may be performed periodically to monitor your progress or check for
side effects. Consult your doctor for more details.
26
MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is near the
time of the next dose, skip the missed dose and resume your usual dosing schedule.
Do not double the dose to catch up.
STORAGE: Store at room temperature at 77 degrees F (25 degrees C) away from
light and moisture. Brief storage between 59-86 degrees F (15-30 degrees C) is
permitted. Do not store in the bathroom. Keep all medicines away from children and
pets. Do not flush medications down the toilet or pour them into a drain unless
instructed to do so. Properly discard this product when it is expired or no longer
needed. Consult your pharmacist or local waste disposal company for more details
about how to safely discard your product.
27
Case History
The main contents of a complete case history
•
一般项目 general/statistical/biographical data
•
主诉
•
现病史 Present illness (P.I.)
•
既往史 Past History (P.H.)
•
个人史 Personal History (Per. H.)/Social History
•
家族史 Family History (F.H.)
•
系统回顾 System Review, Review of Systems
•
体格检查 Physical Examination
•
实验室检查 Laboratory Data
•
初步诊断(印象) Impression(Imp.)/Diagnosis
Chief Complaints (C.C.)
1. General Data
•
Full name
•
Sex / Gender
•
Age
•
Date of Birth(DOB)
•
Race/Color
•
Religious
•
Occupation
•
Address
•
Marital Status：
•
Reliability：
•
Supplier/Complainter/Source of History
•
Date of Record
2. Chief Complaints
Common Symptoms
Black tarry stools
nausea
constipation
vomiting
orthopnea
dyspnea
28
Cough with yellow sputum
tachypnea
hemoptysis
hematemesis
melena
anorexia
emaciated
dyspepsia
Dizziness/vertigo
Blurred
vision
Jaundice/Icterus
cyanosis
palpitation
restlessness
表示症状持续时间的几种方式
1）症状+since+症状开始的时间点
sore throat since yesterday
2）症状+for+时间段
sore throat for two days
3）症状+时间段+in duration
cough with yellow sputum two years in duration
4）症状+of+时间段（名词所有格）+duration
night sweat of two week’s duration
3. Present Illness
•
Onset:
explosive, gradual, abrupt attack/sudden onset/began all of a sudden
•
Location:
in the left lumbar region, in the right upper quadrant of, in the … side of
•
Nature/feature:
afebrile, constinuous, persistant, paroxysmal, acute, chronic, spastic, palpable,
•
Severity:
bearable, unbearable, mild, moderate, medium-degree, severe, asymptomatic,
indistinct
•
Frequency:
recurrent, variable, relapsing, intermittent, occurred sporadically, frequent,
transient
•
Relation:
伴发
be accompanied by/be associated with
29
并发
erupt simultaneously
合并症
complication
继发症
sequel
接着发生
follow
诱发
induced
have relation to/with…/be related to…
与……有关
•
Development:
persist
持续
be more severe/worsen
have a relapse/recur
improve
改善
be relieved
缓解
aggravate
加剧
subside
减轻
disappear
消失
heal
恶化
复发
愈合
(fully)recover
痊愈
remained the same/was unchanged
•
无变化
Diagnoses and treatment
had…previous hospitalizations
was treated by the local physician
was referred to the hospital
was admitted for work-up
was treated symptomatically
•
The present status
Stools: constipation, undigested stools, formed stools, loose stools, keep one’s
bowels open
Urination: cloudy urine, oliguria, urinary incontinence, retention of urine,
hematuria, milky urine
Appetite: have a good/poor appetite, excessive appetite, lose one’s appetite,
capricious appetite
Sleep: have a good/poor sleep, insomnia, somnolence, paroxysmal sleep
Mental:in low/poor/great/high/royal spirits, lose one’s spirits, very energetic,
full of vigour, exhsusted/worn out, be down in spirits, depressed
Strength and weight: Feel quite strong again, A strong constitution /
delicate constitution; Lose weight
/
Gain weight; In poor health
30
A
4. Past History
Main contents
•
Previous state of health:
He had excellent health until the present illness began.
She was in good/poor health in the past.
He was apparent healthy most of his life.
•
Previous illnesses
•
Vaccination and infectious diseases
•
Allergy to drugs or other substances
Tuberculosis, hepatitis, pneumonia, cholecystectomy, appendectomy,
splenectomy, nephrectomy
5. Personal History
Main contents
•
Life style and habit
•
Occupation and working condition
•
Travelling
•
Marriage and child-bearing
•
Menstruation
6. Family History
•
Record the health status of the patient’s family, usually immediate family. But
if necessary, F.H. also includes the health status of the patient’s extended
family.
7. Physical Examination
这部分可使用简单语句表达，可以省略动词和冠词。
基本检查方法：inspection 视
palpation 触
percussion 叩
auscultation 听
Examination of general appearance（全身状态检查）
1) Temperature: oral/axillary/rectal temperature
The temperature was …℃ when taken by mouth/orally/rectal/axillary.
He measured/took/checked a temperature of …℃.
2) Pulse
31
Rapid pulse
脉频
Slow pulse
脉缓
Had a weak pulse
脉搏微弱
Pulse was thread-like.
脉弱如丝
No pulse palpable.
摸不到脉
radial/femoral/carotid artery pulsation
intermittent pulse
间歇脉
pulse deficit
脉搏短绌
Corrigan pulse/water hammer pulse
Pulsus alternans
交替脉
Pulsus paradoxus
奇脉
No palpable dorsalis pedis on the right.
桡动脉/股动脉/颈动脉搏动
水冲脉
右侧足背动脉未触及。
3) Respiration
Tachypnea: rapid breathing
Bradypnea: slow breathing
Dyspnea: difficult breathing
Apnea: no breathing
Hyperpnea: hyperventilation
Nasal alar breathing:
过度呼吸
鼻翼呼吸
Three depression sign:
三凹征
4) Blood pressure
Sitting BP
lying BP
standing BP
Check/take/measure BP
BP rose/elevated
血压升高
Had some drop in BP
BP remained stable
BP was labile
测血压
血压下降
血压稳定
血压不稳定
5) Physical development and nutrition
Habitus
体型
asthenic type 无力型
hypersthenic type
sthenic type
超力型
正力型
32
Gigantism
巨人症
dwarfism
Obese
侏儒症
肥胖
thin and frail
cachectic
瘦弱
恶病质
Be of average build and nutritional level
Well-nourished
发育营养一般
营养佳
Moderately nourished
营养中等
Mal-nourished, under-nourished, poorly nourished, dystrophy
营养不良
General conditions appears good 好/fair 尚可/normal 正常/poor 不良
6) Facial expression
Alert and cooperative
神清合作
Looked/Appeared acutely/chronically ill
Mitral face
二尖瓣面容
Sardonic face
苦笑面容
Moon face
满月面容
Masked face
面具面容
Critically face
病危面容
Dull appearance
Agitated
7) Position
呈急/慢性病容
表情淡漠
表情激动
体位
Gait 步态
Active/passive/compulsive position
自动/被动/强迫体位
Supine/prone/lateral/upright position
仰卧位/俯卧位/侧卧位/直立位
Left lateral recumbent
Orthopnea
端坐呼吸
Squatting
强迫蹲位
Opisthotonos
角弓反张位
Lordosis
脊柱前凸
kyphosis
脊柱后凸
scoliosis
脊柱侧弯
Propulsion
左侧卧位
慌张步态
shuffling gait/staggering gait
scissor gait
剪刀步态
Steppage/footdrop gait
swaying gait
蹒跚步态
跨阈步态
摇摆步态
33
waddling gait
鸭步
Hemiplegic gait
偏瘫步态
ataxic gait
共济失调步态
Skin
Distribution of hair is normal
毛发分布正常
Hair and nails are normal
毛发指甲均正常
Baldness
秃发
Dyhydrated
脱水
Pitting edema
压陷性水肿
Inelastic
无弹性
Flabby skin
松弛的皮肤
Pigmentation
色素沉着
Localized depigmentation
Petechia
出血点
Purpura
紫癜
ecchymosis
局部色素脱失
瘀斑
splinter hemorrhage
片状出血
hematoma
血肿
butterfly rash
蝶形斑
spider angioma
蜘蛛痣
nodule
结节
ulcer
溃疡
ulcer associated with exudate and crust formation
scar
瘢痕
keloids
瘢痕疙瘩
溃疡伴渗出物及结痂
Lymph nodes
Regional lymph node
局部淋巴结
Cervical lymph node
颈部淋巴结
Subaxillary lymph node
腋下淋巴结
Submaxillary lymph node
颌下淋巴结
Submental lymph node
颏下淋巴结
Supraclavicular lymph node
Inguinal lymph node
锁骨上淋巴结
腹股沟淋巴结
Lymph nodes are enlarged and palpable
Generalized lymphadenopathy
淋巴结肿大、可扪及
淋巴结普遍增大
34
Freely movable
可移动
Nontender/ no tender on pressure
Hard and firm
无压痛
质硬
Without palpable evidence of superficial lymph nodes enlargement
浅表淋巴结未扪及
Head and Neck
Head is normal in contour/shape/configuration and symmetrical.
头部外形正常及对称。
Microcephalia 小颅
large skull
巨颅
squared skull
方颅
Face somewhat bloated
面部轻度浮肿
Face covered with cold sweat
满面冷汗
Congestion of conjunctiva
结膜充血
Diplopia, double vision
复视
Jaundice in sclera
巩膜黄染
The pupils are round and equal, reactive to light and accommodation(PERRLA).
两侧瞳孔等大等圆，光反射、调节反射正常。
Color vision is abnormal
Visual disturbance
色觉异常
视力障碍
Septum acutely deviated to the left 鼻
中隔极度左偏
No tenderness on/over nasal sinuses
鼻窦无压痛
Pharynx free of congestion
咽部无充血
Trachea on the midline/Trachea not deviated
Trachea deviated to the right/left.
气管居中
气管偏右/偏左。
Jugular veins not distented
颈静脉不怒张
Thorax
The chest is symmetrical.
胸廓对称。
thorax with an increase in anteroposterior diameter
flat chest
扁平胸
barrel chest
桶装胸
funnel chest
漏斗胸
subcutaneous emphysema
胸廓前后径增加
皮下气肿
equal respiration movements bilaterally
两侧呼吸运动相等
Expiration is prolonged and inspiration is gasping.
35
呼吸延长，吸气困难
Normal vocal fremitus throughout both lungs.
两肺语颤正常
Vocal fremitus diminished/exaggerated/absent over …lobe
…
侧语颤减弱/增强/消失
Both lungs were resonant to percussion.
两肺叩清
There was dullness to percussion on the … side. …
The chest is clear to auscultation.
Scattered rales
散在啰音
dry rales
干啰音
moist rales
湿啰音
fine rales
小水泡音
medium rales
中等啰音
coarse rales
大水泡音
crepitus
捻发音
wheezes
哮鸣音
sonorous rales
鼾音
drumlike resonance/tympany
hyperresonance
胸部听诊无异常。
鼓音
过清音
audible pleural friction rub
胸膜摩擦音
massive pleural effusion
大量胸腔积液
heaves
侧叩浊
心前区隆起
apex/apical beat/impulse
心尖搏动
point of maximum impulse PMI
心尖搏动最强点
apex beat markedly accentuated
心尖搏动显著增强
ejection murmur
喷射期杂音
systolic murmur
收缩期杂音
diastolic murmur
舒张期杂音
constinuous murmur
连续性杂音
holosystolic
全收缩期
blowing
吹风样
rumbling
隆隆样
Abdomen
Abdominal distention/The abdomen is protuberant.
Abdominal retraction
腹部凹陷
scaphoid abdomen
舟状腹
rebound tenderness
反跳痛
fluid thrill
液波震颤
36
腹部膨隆
shifting dullness
移动性浊音
gurgling
气过水声
No masses present on palpation.
bowel sounds
未触及包块
肠鸣音
Genitalia, Anus and Rectum
phimosis
包茎
redundant prepuce
包皮过长
Testis had failed to descend and can not be palpated.
normal distribution of the pubic hair
marital outlet
已婚外阴
cystocele
膀胱膨出
阴毛正常分布
external genitalia was not examined
rectal digital examination
睾丸未下降，未能扪及
外生殖器未查
直肠指检
Neurological Examination
anosmia: loss of sense of smell
嗅觉丧失
olfactory hallucination
嗅幻觉
auditory hallucination
听幻觉
visual hallucination
视幻觉
paralysis
瘫痪
hemiplegia
偏瘫
paraplegia
截瘫
spastic paraparesis
痉挛性麻痹
muscle strength
肌力
muscular tone
肌张力
rigidity
强直性
cogwheel rigidity
齿轮强直
tremor
震颤
chorea
舞蹈样动作
athetosis
手足徐动
tetany
手足搐搦
ataxia
共济失调
finger-nose test
指鼻试验
heel-knee-tibia test
跟膝胫试验
alternate motion
轮替动作
anesthesia
感觉丧失
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paresthesia
感觉异常
hyperesthesia
感觉过敏
superficial reflex
浅反射:
corneal reflex
角膜反射,
abdominal reflex
腹壁反射,
cremasteric reflex
提睾反射,
plantar reflex
跖反射
deep reflex
深反射:
biceps reflex
肱二头肌反射,
triceps reflex
肱三头肌反射,
wrist jerk
桡骨骨膜反射,
patellar reflex
膝腱反射,
Achilles reflex
跟腱反射
pathological reflex
病理反射
ankle clonus
踝阵挛
patella clonus
髌阵挛
sign of meningeal irritation
脑膜刺激征:
tonic neck
颈强直,
Kernig’s sign
克氏征,
Brudzinski’s sign
布氏征
reflex present/active
反射存在
reflex weak/hypoactive/decreased/depressed
反射减弱
reflex absent/disappeared areflexic
反射消失
reflex over-active/exaggerated hyperreflexic
反射亢进
reflex questionable
有无反射尚不肯定
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