#1
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Predicting Pneumonia in Adults with Respiratory Illness
Ñîáñòâåííî, [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]. Êàê âàì âñå ýòî íðàâèòñÿ? Ëèõîðàäêà âûøå 37,8 èëè ×ÑÑ âûøå 100 èëè ×ÄÄ âûøå 20 - ïîêàçàíèå ê ðåíòãåíîãðàôèèè ãðóäíîé êëåòêè? Âåñîìî, ãðóáî, çðèìî!
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#2
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Íåóæåëè ýòîò âîïðîñ How can I predict whether a patient with cough has pneumonia? çàäàåò âðà÷?
À ñëàáî àíàìíåç ñîáðàòü, ïîñòóêàòü, ïîñëóøàòü??? |
#3
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Table 2
Simple Rule for Determining the Need for Chest Radiography in Patients with Acute Respiratory Illness -------------------------------------------------------------------------------- Chest radiography should be performed in: Any patient with at least one of the following abnormal vital signs: Temperature greater than 100� F (37.8� C) Heart rate greater than 100 beats per minute Respiratory rate greater than 20 beats per minute Any patient with at least two of the following clinical findings: Decreased breath sounds Crackles (rales) Absence of asthma |
#4
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Öèòàòà:
Absence of asthma íå îñâîáîæäàåò îò íàëè÷èÿ COPD, CHF... Âèäèìî êîëëåãè ïîïûòàëèñü óïðîñòèòü è óñêîðèòü ïîñòàíîâêó äèàãíîçà - ïíåâìîíèÿ, äëÿ óëó÷øåíèÿ ïðîãíîçà.
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Ýòî âñå äåéñòâèòåëüíî íåîáõîäèìî èëè òàê äîëæíî áûòü? |
#6
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Íà ýòó ñòàòüþ ÿ âîîáùå âûøåë ñëó÷àéíî, à òî÷íåå - êîâûðÿëñÿ â Archimedes îò Skyscape â ïîèñêàõ íå ïîìíþ ÷åãî è íàáðåë íà ýòîò êàëüêóëÿòîð. Âäîõíîâèëñÿ ïîèñêàìè äîêàçàòåëüíîé áàçû è âûøåë íà ýòó ñòàòüþ.
Ñóòü â òîì, ÷òî, ïîëó÷àåòñÿ, íàøè ðåêîìåíäàöèè "ïåéòå æèäêîñòü è íå ïðèñòàâàéòå", îñîáåííî ñ ó÷åòîì íûíåøåé ñèòóàöèè âîçìîæíî ñëåäóåò ïåðåñìîòðåòü â ñòîðîíó áîëåå øèðîêîãî èñïîëüçîâàíèÿ ðåíòãåíîãðàôèè? |
#7
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C îäíîé ñòîðîíû, â óïîìÿíóòîé íûíåøíåé ñèòóàöèè â íàøåé ïîëèêëèíèêå (ñóæó êîñâåííî) íàáëþäàåòñÿ áóì îáðàùåíèé ñ ðåñïèðàòîðíûìè ñèìïòîìàìè è ëèõîðàäêîé, â ñòàöèîíàðå - áóì îáðàùåíèé è íàïðàâëåíèé èç ïîëèêëèíèêè, ó ðåíòãåíîëîãîâ - îãðîìíûé íàïëûâ íàïðàâëåíèé íà ðåíòãåíîãðàôèþ ãðóäíîé êëåòêè, ÷òî, ñ ó÷åòîì ñèòóàöèè, âåäåò ê ÿâíîé ðåíòãåíîëîãè÷åñêîé ãèïåðäèàãíîñòèêå ïíåâìîíèé. Ìíîæåñòâî íåîáîñíîâàííûõ ãîñïèòàëèçàöèé ñ ñèìïòîìàìè ÎÐÇ, åñòü, ðàçóìååòñÿ, è îáîñíîâàííûå. ×àñòü ãîñïèòàëèçàöèé îáóñëîâëåíà æåëàíèåì íàçíà÷èòü (èëè ïîëó÷èòü) òàìèôëþ, ÷òî, â ñîîòâåòñòâèè ñ áåçóìíûìè óñòàíîâêàìè íàøåãî ìèíçäðàâà, âîçìîæíî òîëüêî â ñòàöèîíàðå, ïðè÷åì ïî ìåõàíèçìó, ñõîäíîìó ñ íàçíà÷åíèåì íàðêîòèêîâ. Ó âõîäà â ðåàíèìàöèþ (åäèíñòâåííîå îòäåëåíèå, îñíàùåííîå ïóëüñîêñèìåòðèåé) - î÷åðåäè (â íåêîòîðûå ìîìåíòû ýòî íå ïðåóâåëè÷åíèå) ïàöèåíòîâ, íàïðàâëåííûõ "èçìåðèòü ñàòóðàöèþ".
Ñ ó÷åòîì âñåé ýòîé ñóåòû, õî÷åòñÿ, ÷òîáû áûë êàêîé-òî èíñòðóìåíò äëÿ Predicting Pneumonia in Adults with Respiratory Illness, êðîìå physician judgment. Ïîñëåäíèé ÿâíî áóêñóåò â ñî÷åòàíèè ñ öèðêóëÿðàìè ìèíçäðàâà. Íî ñîìíåâàþñü, ÷òî ïðåäëîæåííûé àìåðèêàíöàìè èíñòðóìåíò êàê-òî ïîñïîñîáñòâîâàë áû óïîðÿäî÷èâàíèþ ýòîãî õàîñà... |
#8
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Öèòàòà:
Öèòàòà:
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#9
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Ê òîìó æå ìíå íå ïîíÿòíî âîò ÷òî. Ñîãëàñíî äðóãîìó èññëåäîâàíèþ, îñâåùåííîìó â ýòîé ñòàòüå (Heckerling è äð). Åñëè âçÿòü 3 ïðèçíàêà:
Temperature greater than 100�F (37.8�C) 1 Heart rate greater than 100 beats per minute 1 Crackles (rales) 1 Âìåñòå îíè ñîñòàâëÿþò 3 áàëëà. Ñîãëàñíî òàáëèöå, ïî äàííîìó èññëåäîâàíèþ, âåðîÿòíîñòü ïíåâìîíèè ó òàêîãî ïàöèåíòà ñîñòàâèò 8%(àìáóëàòîðíûå) è 22%(ñêîðîïîìîùíûå). Ò.å. ïîëó÷àåòñÿ, åñëè âçÿòü áîëüøå ïðèçíàêîâ äëÿ îòáîðà íà ðåíòãåíîãðàôèþ, òî âåðîÿòíîñòü îáíàðóæåíèÿ åùå íèæå, ÷åì â ïåðâîì èññëåäîâàíèè? Õîòÿ â ïåðâîì âûáèðàëîñü ìåæäó ëèõîðàäêîé âûøå 37,8, òàõèêàðäèåé áîëüøå ñòà. À òóò îíè â ñîâîêóïíîñòè, äà ïëþñ åùå è êðåïèòàöèÿ. Êàêîå-òî ñèëüíîå íåñîîòâåòñòâèå. ß ÷òî-òî íåïðàâèëüíî ïåðåâîæó èëè ïîíèìàþ???? |
#10
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