#1
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Ñïàñèáî áîëüøîå äîêòîð, çà Âàø îòâåò.
Ìíå óæå íà÷àëî êàçàòüñÿ, ÷òî âðà÷àì íå ìåñòî íà "ñêîðîé". 90% âûçûâîâ ìîãëè áû âûïîëíÿòñÿ ñð. ìåä. ïåðñîíàëîì èëè äàæå òàêñè. |
#2
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Ñïåöèàëèçèðîâàííàÿ âðà÷åáíàÿ ïîìîùü íà äîãîñïèòàëüíîì ýòàïå.
Ê ñîæàëåíèþ, âîçìîæíî Âû è ïðàâû... Íî íå ñòîèò òàê, íåñêîëüêî óíè÷èæèòåëüíî, äóìàòü "î ñðåäíåì ìåäïåðñîíàëå". Äàæå â Ìîñêâå îêîëî 60-70% âñåõ âûçîâîâ âûïîëíÿþò ôåëüäøåðñêèå áðèãàäû. Ò.æ. ñóùåñòâóåò ïîëîæåíèå, ÷òî ÔÁ, ïðè îòñóòñòâèè ñâîáîäíûõ áðèãàä íóæíîãî òèïà (âðà÷åáíûõ, ñïåö), íàïðàâëÿåòñÿ íà âûçîâ ñ ëþáûì ïîâîäîì, è ê âçðîñëûì, è ê äåòÿì. À ýòî ìîæåò áûòü ÷òî óãîäíî. - è "1 ìåñÿö, íå äûøèò", è ÄÒÏ, è îãíåñòðåë è ò.ä. Íî ,"ïîëèòèêà ïàðòèè" ñåé÷àñ òàêîâà, ÷òî ïðèíèìàþòñÿ àáñîëþòíî âñå îáðàùåíèÿ íà "03", "÷åøåòñÿ ïÿòêà", óòðèðóþ, êîíå÷íî... Ïîýòîìó è ñîçäàåòñÿ òàêîå âïå÷àòëåíèå î ÑÌÏ. Íî "äåíü íà äåíü" íå ïðèõîäèòñÿ. Ìîæíî è íà 6,9,8 áðèãàäå çà ñóòêè òîëüêî ÝÊà ñíèìàòü è òàáëåòêè ðàçäàâàòü, à ìîæíî öåëûå ñóòêè òðóáèòü, ñòàâèòü ÖÂ, ÂÝÊÑ, ïðîâîäèòü ÒËÒ.  öåëîì, ðàáîòà äëÿ âðà÷à-ñïåöèàëèñòà íîðìàëüíàÿ, íî, êàê ìíå êàæåòñÿ, ëó÷øå ñîâìåùàòü è â ñòàöèîíàðå
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#3
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Îé, äà íå äàé Áîã ó Âàñ ñëîæèëîñü òàêîå ïðåâðàòíîå ìíåíèå! ß ñàìà åùå íå ñîâñåì âðà÷. ß òîëüêî î ðåíòàáåëüíîñòè. Íåïðàâèëüíî íàâåðíîå ãâîçäè çàêàëà÷èâàòü çîëîòûì ìîëîòêîì, êîãäà ïîä ðóêîé æåëåçíûé.  ÑØÀ íàñêîëüêî ìíå èçâåñòíî àáñîëþòíîå áîëüøèíñòâî âûçîâîâ "Ñêîðîé" âûïîëíÿåòñÿ ìåäñåñòðàìè è ïàðàìåäèêàìè è âðîäå íè÷åãî, ñïðàâëÿþòñÿ.
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#4
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Öèòàòà:
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#5
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"...à ðàáîòàòü ñ àïïàðàòóðîé íà íèõ íèêòî íå ìîæåò-ÍÅ ÎÁÓ×ÅÍÛ!"
 Âåëèêîáðèòàíèè ïàðàìåäèê - óíèâåðñèòåòñêîå îáðàçîâàíèå ïî ïðîãðàììå: Programme Overview The programme will run over three years, comprising 50 per cent theory and 50 per cent practice, with a strong focus on clinical skills. Level 1 will set the foundation in basic physical and behavioural sciences. It will also consist of a practice-based module which will be assessed through a portfolio of practice assessment. In Level 2 and Level 3 you will be taught the principles of assessment, care delivery, evidence and research, and management of self and others. You will have the opportunity to apply theory to practice within various practice settings. Within Level 3 you will have the opportunity to complete a four week ‘elective experience’. This experience will provide you with an opportunity to explore an aspect of care which is of particular interest. It will enable you to develop your research skills and an understanding of the scientific basis of paramedic practice. In order to proceed on the programme, during Level 1 you will be required to pass a D1, D2 and C1 driving test. The D1 and D2 tests are conducted by the Ambulance Trust. Students will be expected to obtain the C1 driving test, the costs of which may be reimbursed when they successfully complete the programme. In the University setting, teaching methods include: •Practical classes and the presentation of clinical skills scenarios •Lectures and tutorials •Student- and staff-led seminars •Study packs, reading lists, guided and annotated reading •Computer-aided learning and web-based teaching •Discussion groups •Enquiry-based learning Within the practice environment, teaching methods include shadowing, role modelling, demonstration, observation, practice under supervision, reflective dialogue and discussion groups. |
#6
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Íåñîâñåì êîððåêòíîå, íà ìîé âçãëÿä, ñðàâíåíèå. Òåìà îòäåëüíîé áîëüøîé äèñêóññèè. Ðàçíûå ñèñòåìû, ðàçíûå ïîäõîäû. Íàøå ãîñóäàðñòâî â áëèæàéøåå âðåìÿ, íàâåðîå, íå áóäåò ãîòîâî ê ïîäîáíûì ïåðåìåíàì. Äîïóñòèì, ïîïàâ ê áîëüíîìó ñ ÎÈÌ, ïàðàìåäèê ïðîâåäåò ñòàíäàðòíóþ òåðàïèþ (êèñëîðîä, îïèàòû, äåçàãðåãàíòû, àíòèêîàãóëÿíòû) è ãîñïèòàëèçèðóåò.  Ìîñêâå, äðóãèõ êðóïíûõ ãîðîäàõ, ïîïàâ ê ïîäîáíîìó ïàöèåíòó ñïåöáðèãàäà ðåàíèìàöèîííîãî ïðîôèëÿ â äîïîëíåíèå ê ïîäîáíîé ñòàíäàðò-òåðàïèè ìîæåò ïðîâåñòè ôàðìàêîëîãè÷åñêóþ ðåïåðôóçèþ, ïðè îòåêå ëåãêèõ è/èëè êàðäèîãåííîì øîêå ïðîâåñòè íåèíâàçèâíóþ/ èíâàçèâíóþ ðåñïèðàòîðíóþ ïîääåðæêó, ïðè íåîáõîäèìîñòè ñ ãëóáîêîé ñåäàöèåé. Ïðî ôàêòîð âðåìåíè ó òàêèõ ïàöèåíòîâ íåîáõîäèìîñòè ãîâîðèòü, ïî-ìîåìó, íåò. Òàê ÷òî, íà ìîé âçãëÿä, ïðåèìóùåñòâà ó íàøåé ñèñòåìû âñå- òàêè åñòü. Õîòÿ, óðîâíþ "àâòîìàòè÷åñêîãî" âûïîëíåíèÿ àëãîðèòìîâ ÑËÐ, èíâàçèâíûõ ìàíèïóëÿöèé ó íèõ ìîæíî (è íóæíî) ïîó÷èòüñÿ ìíîãèì ñîòðóäíèêàì íàøèõ ñëóæá ÑÌÏ.
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#7
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Öèòàòà:
1) Êîíå÷íî ïàðàìåäèêè â ÑØÀ ïðîâîäÿò âñå î ÷åì Âû ãîâîðèëè, âêëþ÷àÿ òî, ÷òî îòíîñèòñÿ ê êîìïåòåíöèè îòå÷åñòâåííûõ ñïåöáðèãàä. Âîò, íàïðèìåð, ññûëêà ñ ñàéòà: [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] Öèòàòà:
2) Êîíå÷íî ïàðàìåäèêè ïðîâîäÿò äîãîñïèòàëüíûé ÒËÒ (ôàðìàêîëîãè÷åñêàÿ ðåïåðôóçèÿ çâó÷èò, êîíå÷íî, êðàñèâåé). Âåñü èíòåðíåò óñåÿí ññûëêàìè íà ïîäîáíûé óñïåøíûé îïûò. Íàïðèìåð: [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] 3)×òî êàñàåòñÿ "ôàêòîðà âðåìåíè" - òî óâåðÿþ Âàñ Âû ãëóáîêî çàáëóæäàåòåñü. Îáû÷íàÿ ïðàêòèêà çàêëþ÷àåòñÿ â òîì, ôåëüäøåð èëè âðà÷ ëèíåéíîé áðèãàäû âûçûâàåò íà ñåáÿ ñïåöîâ, óáèâ íà ýòîì êó÷ó âðåìåíè, âìåñòî òîãî, ÷òîáû ïðîñòî òðàíñïîðòèðîâàòü áîëüíîãî â ñòàöèîíàð. ×òî êàñàåòñÿ ÎÈÌ, òî ñ ìîåé òî÷êè çðåíèÿ, íå íàäî áûòü ñåìè ïÿäåé âî ëáó ÷òî áû ïðîâåñòè áîëüíîìó ÒËÒ. Ñ ýòèì ìîæåò âîïîëíå ñïðàâèòñÿ îïûòíûé ôåëüäøåð, îñîáåííî åñëè åñòü âîçìîæíîñòü ïðîêîíñóëüòèðîâàòüñÿ ñî ñïåöèàëèñòîì ïî òåëåôîíó. |
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#8
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Óâàæàåìûé DmBlok, êàê âðà÷ ñïåöáðèãàäû, ìîãó çàâåðèòü Âàñ, ÷òî ñ ââåäåíèåì àëãîðèòìà ïðìåìà âûçîâîâ "ÎÊÑ" (íå èìååò íè÷åãî îáùåãî ñ êëèíè÷åñêèì ñîîòíîøåíèåì "îñòðîãî êîðîíàðíîãî ñèíäðîìà") ê áîëüíûì ñ îñòðîé êîðîíàðíîé ïàòîëîãèåé, ÷àùå âñåãî, ïîïàäàþò èìåííî ÊÐÁ, ÊÁ, ÁÈÒ, ÐÁ. Ïðàâäà, ìíîãî âîïðîñîâ ê "èñïîëíèòåëÿì", ò.å. äèñïåò÷åðàì, ÷àùå "ÎÊÑ1", êîòîðûé íàçíà÷àåòñÿ íà ñïåöáðèãàäû, îêàçûâàåòñÿ ÀÃ, äîðîñîïàòèåé, àáñòèíåíöèåé èëè äðóãîé êàðäèàëãèåé, íî ïðîöåíò "ïîïàäàíèé" ãäå -òî â ðàéîíå 40-60. Ïðàêòèêà ïðîâåäåíèÿ ÒËÒ ïàðàìåäèêàìè äàëåêî íå ïîâñåìåñòíà è èìååò ñêîðåå ýïèçîäè÷åñêèé õàðàêòåð. Êñòàòè, òîò æå èíòåðíåò óñåÿí ññûëêàìè î çàïðåòå âî ìíîãèõ ñòðàíàõ ïðîâåäåíèÿ èíòóáàöèè ïàðàìåäèêàìè, ïðèîðèòåò ëàðèíãåàëüíûì òðóáêàì, êîìáèòüþáàì...
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#9
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Êñòàòè, ýòî Âàì íàâåðíÿêà èçâåñòíî, "ìîëîäûå" ÎÈÌ ñåé÷àñ ãîñïèòàëèçèðóþòñÿ ïðåèìóùåñòâåííî â îïðåäåëåííîå êîë-âî "êîðîíàðíûõ" öåíòðîâ - Êàðäàíã, Ñêëèô, ÃÊÁ 15, 23, 81, Áîòêèíà è ò.ä. Òàê ÷òî ïðè äîðîæíîé ñèòóàöèè â Ìîñêâå è áîëüøèõ ðàññòîÿíèÿõ òàêàÿ ãîñïèòàëèçàöèÿ ìîæåò ðàñòÿíóòüñÿ ýäàê íà 50 - 120 è áîëåå ìèíóò, à âðåìÿ îæèäàíèÿ ëèíåéíîé áðèãàäîé ñïåöîâ ñåé÷àñ ðåäêî ïðåâûøàåò 20-30 ìèíóò... Ñóäèòå ñàìè.
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#10
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Ïðîãðàììà ïîäãîòîâêè ôåëüäøåðîâ - áîëåå 5000 ÷àñîâ (4 ãîäà). Ïðàâäà, êà÷åñòâî ýòîé ïîäãîòîâêè "õðàìàåò", íî ñåé÷àñ ýòî ïîâñåìåñòíàÿ áîëåçíü, è âûñøåé øêîëû â ò.÷. Îïÿòü æå âîïðîñû ìàòèâàöèè... À ôàðìàêîëîãè÷åñêàÿ ðåïåðôóçèÿ çâó÷èò íå òî ÷òî "êðàñèâåå", à äàæå íåñêîëüêî "íàóêîîáðàçíî", ÷òî â íåêîòîðûõ "íàóêîîáðàçíûõ" ó÷ðåæäåíèÿõ ïðèâåòñòâóåòñÿ . "Âëèÿíèå ëó÷åé ëóíû íà êîðíè äèêîé áóçèíû"
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#11
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Öèòàòà:
Îäíàêî Âû ìîæåòå ìíå îòâåòèòü, êàê âðà÷ ñïåöáðèãàäû, êàêîé ïðîöåíò äîãîñïèòàëüíûõ òðîìáîëèçèñîâ ïðèõîäèòñÿ íà âñå ñëó÷àè ÈÌ ñ êðèòåðèÿìè äëÿ ðåïåðôóçèîííîé òåðàïèè? Âòîðîé âîïðîñ, êàêèìè òàêèìè îñîáåííûìè íàâûêàìè íóæíî îáëàäàòü, ÷òî áû ïðîâîäèòü ÒËÒ äîãîñïèòàëüíî? ß äóìàþ, ÷òî ýïèçîäè÷åñêèé õàðàêòåð äîãîñïèòàëüíûõ ÒËÒ ïàðàìåäèêàìè (åñëè ýòî òàê) -ïî êðàéíåé ìåðå â áîëüøèõ ãîðîäàõ - îãðàíè÷åí â áîëüøåé ñòåïåíè âîçìîæíîñòÿìè áûñòðîé äîñòàâêè áîëüíîãî â ñïåöèàëèçèðîâàííûå ñòàöèîíàðû íà ïåðâè÷íóþ PCI. Öèòàòà:
Öèòàòà:
PS Åùå ïî òåìå: [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] |
#12
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Ïðîöåíò ÒËÒ ïðè íàëè÷èè êðèòåðèåâ è îòñóòñòâèè ïðîòèâîïîêàçàíèé è ñîáëþäåíèè âðåìåííûõ ïàðàìåòðîâ (äëÿ ÄÃÝ â Ìîñêâå ýòî 4-6 ÷àñîâ) äîñòàòî÷íî âûñîêèé (îêîëî 70- 80), ïî ãîðîäó â öåëîì, ê ñîæàëåíèþ, íå ìîãó ñêàçàòü, íî êîëè÷åñòâî ïîñòîÿííî óâåëè÷èâàåòñÿ. Íà ìîé âçãëÿä, îñîáûõ íàâûêîâ è çíàíèé äëÿ ÒËÒ íå òðåáóåòñÿ. Âîïðîñ, êàê âñåãäà, âèäèìî ôèíàíñîâûé. Îñíàñòèòü òðîìáîëèòèêàìè, ìîíèòîðàìè ëåã÷å 150 ñ íåáîëüøèì ñïåöáðèãàä, ÷åì âñå 1200. Êñòàòè, â ñòàöèîíàðàõ ÒËÒ íå ïðîâîäÿò â " ïàëàòíûõ" îòäåëåíèÿõ, à âñå-òàêè â ÎÐÈÒ. Èíôîðìàöèÿ ïî çàïðåòó èòóáàöèè áûëà íà "rusanesth.ñîm", ðå÷ü øëà, ïî-ìîåìó, î Âåëèêîáðèòàíèè. Ññûëêàìè ñåé÷àñ îáåñïå÷èò íå ñìîãó, íî ýòó èíôàðìàöèþ íàéòè äîñòàòî÷íî ïðîñòî.
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#13
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Öèòàòà:
×òî êàñàåòñÿ ôèíàíñîâîãî âîïðîñà, òî íå ïûòàÿñü âíåäðÿòüñÿ â êîìïåòåíöèþ îðãàíèçàòîðîâ çäðàâîîõðàíåíèÿ, çàìå÷ó, ÷òî åñëè áû âìåñòî ìåòàëèçå íà 03, áûëà çàêóïëåíà áåëîðóññêàÿ ñòðåïòàçà, òî ìîæíî áûëî áû îñíàñòèòü òðîìáîëèòèêàìè âñå áðèãàäû, âêëþ÷àÿ ôèëèàëû. |
#14
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Ìåòàëèçå ñåé÷àñ îãðàíè÷åííîå êîëè÷åñòâî, àëüòåïëàçà ñ ïåðåáîÿìè, áîëåå ìàññîâî ïóðîëàçà. Ñòðåïòîêèíàçà äî íåäàâíåãî âðåìåíè ïîÿâëÿëàñü, ñåé÷àñ îêîëî ãîäà îòñóòñâóåò.
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#15
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