The main base of the chair is a gastroenterological and hepatobiliary branch offices 1 clinic Tashkent Medical Academy. Clinical base of the department completely fit the profile of training. The department has also actively used in the educational process Computing and presentation equipment . Most lectures and seminars prepared electronically using original photographs taken in the department and educational films . Implemented all the planned transfer of demonstration material with tables , overhead projectors for multimedia presentations . Equipment available at the department can take educational films for subsequent demonstrations during class.
Particular attention is paid to the teaching of therapy daily control students’ knowledge by conducting theoretical seminars , after a preliminary analysis of patients on this topic with a practical skills.
6-7 course classes are held on the subject of ” internal medicine training at the GP .” 6- course practical training under the qualifying characteristics are carried out on a stationary stage . 7 practical training course conducted on the basis of family clinics.
Purpose: GP therapy: Acquiring knowledge to implement a complete and correct diagnosis of diseases of the internal organs, acute recognition and appointment of full and effective treatment at RHU (UMC), depending on the categories of services or referral to a counselor, a specialist in another institution.
Acquisition of skills for the full, appropriate and necessary level of examination of patients, performing the required volume of procedures and manipulation at SVP (GWP).
Acquiring knowledge for clinical examination and implementation of measures for the rehabilitation of patients with chronic disease.
- Teach provide essential services in the field of prevention and public health.
2 . Instill students with the foundations of medical ethics , the ability to communicate with patients and their relatives .
3 . Teach the skill to carry out procedures and manipulation to provide urgent and emergency assistance to the hospital stage .
4 . Teach provide quality medical care to the population , run diagnostics, treatment , rehabilitation and medical examinations the most common diseases .
5 . Ability to plan a survey ( by organ systems ) patients .
- Teach the skill to interpret the results of laboratory and instrumental methods of examination .
- Teach the principles of preliminary and final examination diagnoses and differential diagnoses .
- To teach students the principles of complex pathogenetic treatment, prognosis and prevention.
- Improvement of previously obtained skills and mastery of new (list of skills attached).
Thematic plan of lectures for students of 6 course
- The family medicine
2 . Differential diagnosis of hypertension.
3 . Differential diagnosis of pain in the heart .
4 . Differential diagnosis of edema .
5 . Differential diagnosis of broncho syndrome
- Differential diagnosis for blackouts in the lungs.
- Differential diagnosis of abdominal pain . tactics GP
- Differential diagnosis of hepatomegaly and jaundice .
- Differential diagnosis with articular syndrome.
10 . Differential diagnosis with pathological proteinuria and urinary sediment.
Thematic plan of practical training for students of 6 course
- Fundamentals of family medicine. Working with the family . Functions GP . Features of work . Medical records . Public involvement . Doctor and patient rights . Ethics and deontology in the GPs. Features of work . Psychological climate in the family. Problems of religion and rituals. Family counseling .
2 . The art of communication . Counseling. Factors contributing to the conversation. Difficulties in communication . Interpersonal communication. Practical advice. Kinds of advice . Principles of counseling . Patient responsibility for their health.
3 . Prevention work in the GP . Effects of risk factors . Types of prevention. Promotion of healthy lifestyles . Food hygiene and living conditions . Preventive examinations , screening . Prevention of communicable and non-communicable diseases. Health education. Impact on major causes of morbidity and mortality. Promoting mental status. Environmental and occupational factors . Patient education , “school” .
4 . Differential diagnosis in practice GPs. Presumptive diagnosis . The most dangerous disease. Diagnostic errors . Disease simulators . Mental disorders and simulation .
5 . Cough with phlegm . Differential diagnosis in equity and segmental pulmonary blackouts . Lobar pneumonia , infiltrative pulmonary tuberculosis, pulmonary infarction . Tactics GPs.
- Differential diagnosis of community-acquired and nosocomial pneumonia. Different etiologies of pneumonia ( bacterial, viral , mycoplasma ) . Differentiated approach to treatment. Tactics GPs.
- Differential diagnosis of lung lesions with rounded .. Lobular pneumonia , tuberculoma , lung abscess , lung tumor , lung ehinokkok . Tactics GPs. Differential diagnosis in diffuse dissemmnatsii . Lobular pneumonia , hematogenous disseminated form of TBA – lung pneumoconiosis , cancer metastases . Tactics GPs.
- Chest pain associated with lung disease . Differential diagnosis of the dry and pleural effusion . Types of exudative pleurisy . Tactics GPs.
- Shortness of breath, choking. Differential diagnosis of diseases occurring with bronchial obstruction (asthma , COPD, lung tumors ) . Tactics GPs.
10 . Differential diagnosis of dyspnea in heart and lung disease . Circulatory failure and pulmonary insufficiency . Tactics GPs.
- Arrhythmias. Differential diagnosis of pacemaker migration , sick sinus syndrome , extrasystoles . Types of extrasystoles . Tactics GPs.
- Arrhythmias. Differential diagnosis of flicker and flutter , paroxysmal tachycardia syndrome WPW. Tactics GPs.
- Arrhythmias. Differential diagnosis with bolkadah : intraatrial , atrioventricular , intraventricular. Tactics GPs.
- Hypertension . Differential diagnosis of hypertension with renal hypertension. Risk factors , stage HD. , Types of renal hypertension ( renovascular and parenchymal ) . Tactics GPs.
- Hypertension . Differential diagnosis of hypertension with endocrine hypertension. Types of endocrine hypertension ( pheochromocytoma syndrome Cohn , Cushing’s syndrome , tiretoksikoz ) Tactic GPs.
- Hypertension . Differential diagnosis of hypertension with hemodynamic and cerebral hypertension ( traumatic brain injury , vertebrobasilar syndrome, arachnoiditis , encephalitis , brain tumors ) . Tactics GPs.
- Pain in the heart . Differential diagnosis of pain in stable angina, coronary artery disease with different FC . Tactics GPs.
- Pain in the heart . Differential diagnosis of pain in unstable angina ( new-onset , progressive , spontaneous , early post , early postoperative ) . Acute coronary syndrome . Tactics GPs.
- Pain in the heart . Differential diagnosis of pain in angina pectoris and myocardial infarction (clinical , laboratory , ECG) . Tactics GPs.
- Pain in the heart . Differential diagnosis of various clinical options stages of myocardial infarction . Complications of MI ( cardiogenic shock , pulmonary edema, ventricular aneurysm , Dressler’s syndrome ) . Tactics GPs.
- Pain in the heart . Differential diagnosis of myocarditis and myocardial dystrophy of different etiologies. Tactics GPs.
- Pain in the heart . Differential diagnosis of pulmonary embolism , aortic aneurysm , pericarditis . Tactics GPs.
- Cardiac murmurs and cardiomegaly . Differential diagnosis auscultation noise on top of the heart . Functional ( myocardial , anemic , when the blood , fever ) . Organic ( mitral valve stenosis, mitral orifice mitral valve prolapse ) . Tactics GPs.
- Cardiac murmurs and cardiomegaly . Differential diagnosis auscultation noise when the aorta defects ( rheumatoid, infectious endocarditis , atherosclerosis) , the aorta. Tactics GPs.
- Cardiac murmurs and cardiomegaly . Differential diagnosis of congenital heart disease . Tactics GPs.
- Cardiac murmurs and cardiomegaly . Differential diagnosis of different clinical forms of cardiomyopathy ( dilated , restrictive , hypertrophic , arrhythmogenic right ventricular dysplasia ) . Tactics GPs.
- Cardiac murmurs and cardiomegaly . Differential diagnosis between cardiomyopathies , valvular disease , coronary heart disease , hypertension . Tactics GPs.
- Cardiac murmurs and cardiomegaly . Differential diagnosis of CHF in stages and FC . Tactics GPs.
- Dysphagia . Differential diagnosis of esophagitis , reflux esophagitis , dysphagia in scleroderma and esophageal tumors . Tactics GPs.
- Abdominal pain. Differential diagnosis of gastritis and peptic ulcer disease ( gastric and duodenal ulcer 12 ) . Tactics GPs.
- Abdominal pain. Differential diagnosis of chronic cholecystitis and chronic pancreatitis . Tactics GPs.
- Abdominal pain. Differential diagnosis of ulcerative colitis and Crohn’s disease . Tactics GPs.
- Hepatomegaly . Differential diagnosis of active and inactive chronic hepatitis. Tactics GPs.
- Hepatomegaly . Differential diagnosis of chronic hepatitis and cirrhosis. Tactics GPs.
- Jaundice . Differential diagnosis of cholelithiasis with biliary- pancreatic tumors zone ( tumors of the liver , gallbladder, pancreas). Tactics GPs.
- Articular syndrome . Differential diagnosis of fever revmoticheskoy on the degree of activity . Differential diagnosis revmoticheskoy fever and rheumatoid arthritis ) . Tactics GPs.
- Articular syndrome . Differential diagnosis of seronegative spondyloarthritis (reactive arthritis, ankylosing Behterova , psoriatic arthritis ) Tactic GPs.
- Articular syndrome . Differential diagnosis of systemic lupus erythematosus, systemic scleroderma and dermatomyositis . Tactics GPs.
- Articular syndrome . Differential diagnosis of hemorrhagic vasculitis , nodules periarthritis and nonspecific aorto- arteritis . Tactics GPs.
- Change in urinary sediment . Differential diagnosis of the pathological urinary sediment . Proteinuria. Tactics GPs. Differential diagnosis of pyelonephritis , glomerulonephritis, and interstitial nephritis . Tactics GPs.
- Change in urinary sediment . Differential diagnosis of amyloidosis and nephropathy ( pregnant , diabetic , drug ) . Tactics GPs.
- Change in urinary sediment . Differential diagnosis of stages of chronic renal failure . Tactics GPs.
- Edema . Differential diagnosis of edema of different etiologies . Local ( allergic , vascular , inflammatory ) . General ( circulatory failure , renal, endocrine , hungry ) . Tactics GPs.
- Geriatrics . Problem of ” age norm .” Functional and organic changes during aging . Laws of the aging process. Mechanism of development of age-related changes . Physiology and food hygiene older .
45 . Motor mode and health . Features diet and motor mode in the elderly. Clinical manifestations of osteoporosis and prevention of fractures. Age osteoporosis prevention and treatment .
- Clinical manifestations of atherosclerosis and dynamic monitoring . Emphysema in the elderly. Age-related changes that predispose to the development of atherosclerosis and emphysema.
- Problems of the elderly with diseases of the gastrointestinal tract. Age-related changes that predispose to diseases of the gastrointestinal tract.
- Concerns of older diseases of the urinary system . Age-related changes that predispose to diseases of the urinary system .
Thematic plan of lectures for students 7 course
- sudden death
2 . Diagnosis and differential diagnosis of various clinical variants of myocardial infarction and its complications. Emergency and tactics GP
3 . Differential diagnosis of arrhythmias . Clinical and ECG diagnosis . Treatment and emergency care
4 . The differential diagnosis of cough , sputum and hemoptysis . tactics GP
5 . Gerontology and Geriatrics total
- Differential diagnosis of intestinal dysfunction. Dysbacteriosis . Modern principles of treatment and prevention
- Differential diagnosis in fevers . Tactics GPs.
- Differential diagnosis DSTD . tactics GP
- Differential diagnosis of nephrotic syndrome . tactics GP.
Thematic plan of practical course for students 7 course
- Fundamentals of family medicine. Functions GP . Features of work . Medical records . Home visits . Public involvement . Doctor and patient rights . Ethics and deontology in the GPs.
2 . Working with the family . Features of work . Psychological climate in the family. Problems religion rituals. Family counseling .
3 . The art of communication . Factors contributing to the conversation. Difficulties in communication . Interpersonal communication. practical Tips
4 . Counseling. . Kinds of advice . Principles of counseling . The patient’s responsibility for their own health
5 . Prevention in the GPs. Types of prevention. Promotion of healthy lifestyles . Food hygiene and living conditions . Preventive examinations , screening
- Prevention in the GPs. Prevention of communicable and non-communicable diseases. Immunization . Programs and Events
- Working with different groups. Children, adolescents , women (women of childbearing age , pregnant women) , men , the elderly . Workers in industries and agriculture
- Working with different groups. Socially disadvantaged people . Patients difficult patient dying patient . Issues of rehabilitation and medical examination . examination of disability
- Effects of risk factors . Health education. Impact on major causes of morbidity and mortality. Promoting mental status. Environmental and occupational factors . Patient education , “school”
10 . Medical travelers . Advice before traveling. Consultations after traveling . Immunization . Changing climate and time zones. Motion sickness and altitude sickness . Ground medical kit .
- Differential diagnosis in practice GPs. Presumptive diagnosis . The most dangerous disease. diagnostic errors
- Differential diagnosis in practice GPs. Disease simulators . Mental disorders and simulation
- Chest pain. Differential diagnosis of NDCs , CHD angina, PICS , myocarditis and myocardial dystrophy . Tactics GPs.
- Chest pain. Differential diagnosis of osteoarthritis of the spine, intercostal neuralgia, chest trauma , herpes zoster . Tactics GPs.
- Heartbeat. Differential diagnosis of arrhythmias
- Heartbeat. Differential diagnosis of arrhythmias, sinus tachycardia, respiratory arrhythmia , ekstrasisitoliya . tactics GP
- Heartbeat. Differential diagnosis of heart circulatory failure , anemia, tireotocsikosis. Tactics GP
- Headache . Differential diagnosis of hypertension and sclerotic hypertension. tactics GP
19. Headache . Primary and secondary prevention of hypertension in the health care environment . tactics GP
20. Cough with phlegm . Differential diagnosis of acute respiratory disease, SARS, acute bronchitis and pneumonia. tactics GP
21. Cough with phlegm . Prevention and treatment of respiratory diseases in the RHU .
22. Shortness of breath, choking. . Differential diagnosis of asthma, emphysema , pulmonary fibrosis . Chronic respiratory failure . tactics GP
23. Shortness of breath, choking. Principles of prevention and treatment of COPD under SAP. Tactics in the primary
24. Articular syndrome ( arthralgia, arthritis) . Differential diagnosis of rheumatism, rheumatoid arthritis and infectious arthritis . tactics GP
25. Articular syndrome ( arthralgia, arthritis) . Primary and secondary prevention and treatment of rheumatic conditions in primary care
26. Articular syndrome ( arthralgia, arthritis) . Differential diagnosis of osteoarthritis and gout . tactics GP
27. Dyspepsia ( heartburn, nausea , vomiting) . . Differential diagnosis of gastritis, duodenitis and peptic ulcer disease . tactics GP
28. Dyspepsia ( heartburn, nausea , vomiting) . Prevention and treatment of GDZ in primary health care
29. Dyspepsia ( heartburn, nausea , vomiting) . Differential diagnosis of biliary dyskinesia and cholecystitis. tactics GP
30. Dyspepsia ( heartburn, nausea , vomiting) . . Differential diagnosis of postcholecystectomy syndrome and diseases of operated stomach. tactics GP
31. Abdominal pain. . Differential diagnosis of diseases associated with pain in the epi -, meso and hypogastric regions. tactics GP
32. Diarrhea . Differential diagnosis of diarrhea infectious etiologies. tactics GP
- Diarrhea . Differential diagnosis of diarrhea noninfectious etiology. tactics GP
34. Diarrhea . Prevention and treatment of hypovitaminosis in various primary section health-care
35. Constipation . Differential diagnosis of irritable bowel syndrome , senile constipation and colon tumors . tactics GP
36. Hepatomegaly . Differential diagnosis of acute hepatitis , chronic hepatitis, alcoholic liver disease. tactics GP
37. Hepatomegaly . Differential diagnosis of the LC infectious and noninfectious etiologies. tactics GP
38. Dysuria . Differential diagnosis of acute and chronic pyelonephritis. tactics GP
39. Dysuria . Differential diagnosis of cystitis and urine acid diathesis . tactics GP
40. Fever . Fever of unknown origin. Character types of fevers , survey of fever . tactics GP
41. Fever . Differential diagnosis of fever in infectious diseases ( bacterial, viral ) . Tactics GPs. Differential diagnosis of fever in rheumatic diseases and malignant neoplasms . tactics GP
Basic Principles of Teaching
The basic principles of training physician – Bachelor is the need for integration , continuity in the teaching of biomedical disciplines. Doctor Bachelor should understand the issues of therapy , obstetrics and gynecology and other specialties in the amount necessary to provide emergency care , especially in an outpatient setting as a physician assistant . To do this necessary:
1. Differentiated learning new material based on the integration of previously earned .
2 . Consistent and gradual transition training from simpler to more complex theoretical and clinical material .
3 . Any form of the disease apart at the bedside with the analysis of research findings .
5 . Develop the students’ ability to continuously clinical thinking.
6. Develop students’ independence and sense of responsibility when dealing with patients.
7. For continuous monitoring of the quality of student learning in accordance with the goals and objectives.
At the Department published the following books :
1. Geriatrics . Tashkent 2012
How to Take a Patient’s Medical History
Taking a patient’s medical history is a necessary part of working in hospitals, health centers, doctors’ offices or other health care centers. It involves asking the patient about her reason for the visit, and then asking about her health history, as well as the histories of her immediate family members. It isn’t difficult, but, depending on the patient, it can be time consuming. Do your best to keep the patient focused, and take good notes as they speak.
Ask about the patient’s current problem, or the reason for the visit. This includes asking about the symptoms, how long the problem has existed, and if it has changed at all (gotten worse or better) in that time. You also need to ask if this particular complaint, or something similar, has been a problem before.
Find out which medications, if any, the patient is currently taking. Also ask about any recently taken medications. Sometimes the side effects of a particular medication can cause symptoms that require the patient to seek care. At this point, you will also probably ask for the patient’s weight and height, or even measure them yourself if needed.
Develop a medical history for the patient. What medications are they allergic to? What serious illnesses or injuries have they had in the past? This is essential information. If a patient is allergic to penicillin, for example, there are a range of medications that cannot be given. Taking the history of previous medical issues may allow you to see any connections between the conditions.
Inquire about the patient’s family medical history. This usually involves asking about the current and previous health issues of siblings, parents, aunts and uncles, and grandparents. As many conditions are genetic, knowing that there is a family history of diabetes, heart disease or some other health issue may be relevant to the patient’s current complaint.
Find out the patient’s social history. Does he or she smoke, drink or do drugs? Have they done any of these things in the past? Depending on the reason for the visit, you may also need to ask about the patient’s sexual history or their fitness and nutrition habits. This is also when you will ask about depression, anxiety and their current living situation and support.
Complete a systems review. Start at the head, and work your way down. Ask about any skin conditions, cramping, aches and pains, dizziness or any other problems the patient might have that they haven’t mentioned. Patients won’t always tell you everything, because they may think a symptom is unrelated or unimportant. When you take a patient’s medical history, you need to find out about these potential complaints, and put them into the notes. They may be essential to the diagnosis.
How to collect history in cardiac patients?
The most common and most important cardiac symptoms and history are:
Chest pain, tightness or discomfort.
Shortness of breath.
Syncope (‘blackouts’, ‘faints’, ‘collapse’) or dizziness.
Related cardiovascular history, including transient ischaemic attacks, stroke, peripheral vascular disease and peripheral oedema.
See separate articles Chest pain and Cardiac-type chest pain presenting in primary care.
Chest pain is very important as a symptom of heart disease, but is sometimes difficult to evaluate.
Location: usually in the front of the chest (retrosternal) but can also be in the upper abdomen, neck, jaw, left arm or left shoulder.
Radiation: may spread to the neck, jaw, back, left or right arm.
Nature: chest pain due to cardiac ischaemia is typically tight and crushing in quality.
Patients tend to describe the angina pains with the flat of their hand horizontally across the middle of their chest; they tend to describe oesophageal spasms with a clenched fist at the upper xiphisternum edge, moving in a vertical manner.
Patients may refer to anginal pain as indigestion.
Other features include duration, aggravating and relieving factors, and associated symptoms eg nausea and/or vomiting, sweating, dizziness, and palpitations.
See separate Breathlessness article.
Cardiac causes include severe pulmonary oedema, acute myocardial infarction, cardiac arrhythmia, pericarditis and pericardial effusion.
Dyspnoea on exertion is the most common type of dyspnoea and may precede other evidence of heart failure.
Orthopnoea: does the patient have to sleep propped up at night, and if so with how may pillows?
Any paroxysmal nocturnal dyspnoea or breathlessness at rest? These may last from minutes to hours and be accompanied by wheezing, sweating, distress, and cough with frothy or bloodstained sputum. This is commonly termed ‘cardiac asthma’, although uraemia may cause similar symptoms.
Cheyne-Stokes or periodic breathing: this often occurs during sleep, with a long cycle time, and may be found in chronic pulmonary oedema or poor cardiac output.
See separate Palpitations article.
Palpitations do not necessarily indicate any underlying cardiac pathology but may be presentation of a cardiac arrhythmia.
Description may be bumping, throbbing, or thumping.
Rhythm: ask the patient to tap out the rate and regularity; a missed beat or an extra large bump suggests extrasystoles.
Duration: sudden short episodes suggest paroxysmal tachycardia; longer duration with irregularities suggests atrial dysrhythmia.
Associated symptoms: pain, dyspnoea, feeling faint or syncope.
Other history to explore
Drugs/medication: prescribed, over-the-counter, or illegal drug abuse.
Duration, paroxysms or constant, dry or productive?
Associations: is it related to chest pains; any fever or shivering fits?
Sputum: colour, quantity, any haemoptysis?
Limb ischaemia, intermittent claudication.
Gastrointestinal symptoms: chronic heart failure may cause abdominal discomfort due to liver enlargement and abdominal distension.
May present with failure to thrive in children or weight loss in adults (although fluid retention caused by heart failure will cause an increase in body weight).
Urinary symptoms: oliguria can be an important symptom of heart failure.
Syncope of cardiac origin may closely resemble benign vasovagal attacks, and can be caused by aortic stenosis or regurgitation (or even pulmonary stenosis), or excessively fast or slow ventricular rate (heart block, atrial dysrhythmia, and paroxysmal tachycardia).
Dizziness, headache, and mental changes are not uncommon symptoms of severe hypertension, arterial degeneration and cardiac failure.
Past medical history
Enquire about any raised blood pressure, heart problems, fainting fits, dizziness or collapses.
Any heart attacks, any history of angina, any cardiac procedures or operations (type and date of intervention and outcome)?
Previous levels of lipids if ever checked or known.
Any history of rheumatic fever or heart problems as a child?
General: any other operations or illnesses, especially history of myocardial infarction, hyperlipidaemia, hypertension, strokes, diabetes?
Ask about hypertension, ischaemic heart disease, strokes, diabetes, hyperlipidaemia, congenital heart disease, early deaths (before the age of 60) in the family.
Include ensuring appropriate primary prevention of cardiovascular disease (including calculation of cardiovascular risk) and secondary prevention of cardiovascular disease.
Obesity: calculate body mass index (BMI); acute weight increase may indicate fluid retention and heart failure.
Diet: healthy or unhealthy.
Physical activity or inactivity, including exercise tolerance: is there anything that they cannot do because of any of the symptoms? It is best to try to quantify this – for example, inability to walk 50 yards rather than inability to walk. What changes have they had to make? For example, has the patient stopped walking up the stairs or stopped work because of angina and/or breathlessness?
Occupation: sedentary or active, and how active?
Stress levels; occupational and others.
Stages of performance of practical skills on 6 course
1. Curation of patients
2. The substantiation of the preliminary diagnosis.
3. Appointment of the plan of inspection
4. Interpretation clinical and immunodetection
5. Interpretation biochemical analyses
6. Interpretation given instrumental researches
7. Carrying out of the differential diagnosis
8. The substantiation of the definitive diagnosis
9. Rendering of the first medical assistance
(conditions of the category 2 CPC)
10. Appointment of the plan of treatment
(according to the category 4 CPC)
12. Registration of in-patient card
Peak expiratory flow
The peak expiratory flow (PEF), also called peak expiratory flow rate (PEFR) is a person’s maximum speed of expiration, as measured with a peak flow meter, a small hand-held device used to monitor a person’s ability to breathe out air. It measures the airflow through the bronchi and thus the degree of obstruction in the airways.
Peak flow readings are higher when patients are well and lower when the airways are constricted. From changes in recorded values, patients and doctors may determine lung functionality, severity of asthma symptoms and treatment.
First measure of precaution would be to check patient for signs and symptoms of asthmatic hypervolemia. This would indicate whether or not to even continue with the peak flow meter procedure. Measurement of PEFR requires training to correctly use a meter and the normal expected value depends on a patient’s sex, age and height. It is classically reduced in obstructive lung disorders such us
Due to the wide range of “normal” values and high degree of variability, peak flow is not the recommended test to identify asthma.
However, it can be useful in some circumstances.
A small portion of people with asthma may benefit from regular peak flow monitoring.
When monitoring is recommended, it is usually done in addition to reliever medication use.
When peak flow is being monitored regularly, the results may be recorded on a peak flow chart.
It is important to use the same peak flow meter every time.
1 The peak flow meter should read zero or its
lowest reading when not in use
Use the peak flow meter while standing up
Take in as deep a breath as possible
Place the peak flow meter in the mouth, with
the tongue under the mouthpiece
5 Close the lips tightly around the mouthpiece
Blow out as hard and fast as possible; do
not throw the head forward while blowing
Breathe a few normal breaths and then
repeat the procedures two more times. Write
down the highest number obtained. Do not
average the numbers.
Measuring Blood Pressure Manually
Starting from when you have done the checks and have the blood pressure cuff in place…
Step 1: Feel for the brachial pulse of the arm with the cuff on. This pulse is located in the inside of the elbow on the bone thats near your body…
Always use your fingers when taking a pulse, not your thumb, because there is a strong pulse in the thumb. You may confuse it with the actual pulse you are taking. We are taking the brachial pulse instead of theradial pulse -located on the wrist- because the brachial is closer to the area where the cuff is, and any changes could be felt more quicker. The differences are subtle, but present.
Step 2: Keep feeling the pulse and inflate the cuff until you cannot feel it anymore. Look at the dial and note the number on which the pointer has landed. This will give you a rough guide as to what the systole is. For example, the pointer has landed on 120mmHg. Deflate the cuff immediately.
Step 3: Wait a few minutes to give the persons arm a rest. In the meantime, you could put on your stethoscope and rub the diaphragm (end of the stethoscope you will use on the person’s skin) against the palm of you hand to warm it up a bit for the persons comfort.
Step 4: Place the diaphragm against the person’s arm where you had taken the brachial pulse. If you prefer, you could also slot the end of the stethoscope under the cuff.
Step 5: Remember the number on the dial ? Now add 20.
So 120 + 20 = 140. This new number is gonna be the number on the dial you will inflate the cuff to
The standard of the urgent help at a myocardium heart attack
1 Indications: physical and emotional rest; nitroglycerine, tablets or an aerosol on 0,4-0,5 mg sublingual, repeatedly; oxygenoteraphy; correction of arterial pressure and a heart rhythm; anaprillini 10-40 mg sublingual. oxygenoteraphy; correction of arterial pressure and a heart rhythm; anaprilini 10-40 mg sublingual
2 For anaesthesia (depending on expressiveness of a pain, age, a condition): – morphini to 10 mg or neuroleptoanalgesia: fentanili 0,05-0,1 mg, or promedoli 10-20 mg, or butorfanoli 1-2 mg s2,5-5 mg droperidolum are intravenously slowly fractional; – – and insufficient analgesia – intravenously 2,5 г analginum, against the raised arterial pressure-0,1 mg clonidinum
3 For restoration of a coronary blood-groove: as soon as possible (in the first 6, and at recurrent pains to 12 ч from the disease beginning) – streptokinase 1 500 000 DB intravenously drop-by-dropfor 30 mines after stream introductions of 30 mg prednisolon; if did not enter streptokinase – heparin 10 000 DB stream introduction, then 1000 ED/ch intravenously drop-by-drop; acetylsalicylic acid0,25 г to chew.
4 Under indications – special measures of preventive maintenance of ventricular fibrillation: lidocaine of 1 mg/kg intravenously and to 5 mg/kg intramuscularly; at contra-indications to lidocaine – anaprilini 20-40 mg sublingual or magnesium sulphate 2-2,5 г intravenously slowly or drop-by-drop.
5 At complications – corresponding treatment
6 Constantly to supervise a heart rhythm and conductivity.
7 Constantly to supervise a heart rhythm and conductivity
Key rules of cardiopulmonary resuscitation
1 Patient stack on an equal firm basis, with maximally thrown back head and the raised bottom extremities
2 Hands of the massing settle down one on another so, что¬бы the basis of the palm lying on a breast, was стро¬го on an average line on two cross-section fingers above xiphoid process
3 Breast Displacement to a backbone carry out smoothly on 4-5 sm, weight spending massage, without bending of hands.
4 Duration of each compression should be рав¬на to an interval between them, frequency – 90 in 1min; in hand pauses leave on a breast of the patient.
5 For carrying out ALV a head of the patient keep in overturned a condition and push forward its maxilla
6 Air blow into a mouth to the patient or in an air line, holding at this time a nose of the patient, or by means of a bag of Ambu with a hard mask; through each 5 massage movements with frequency of 12 times in 1
7 Whenever possible use 100 % oxygen and make intubation tracheas
8 At presence in a mouth of demountable tooth artificial limbs or other alien subjects they take fingers.
9 At regurgitation gastric contents use reception of Sellika (press a throat to a back wall of pharynx), a head of the patient for some seconds turn on one side, delete contents from an oral cavity and drinks with aspirator or a tampon.
10 Each 5 mines intravenously enter on 1 mg of adrenaline
11 Constantly supervise efficiency actions which judge on improvement of skin colour and mucous membranes, narrowing of pupils and their occurrence reactions on light, to renewal or improvement spontaneous breathing, to pulse occurrence on a carotid.
Technique of carrying out of indirect massage of heart.
1. 1 Immediately to put sick of the person upwards on a rigid bed with the raised feet (it increases blood return to heart), with the thrown back head.
2 It is necessary to rise sideways from the patient and to put hands palms one on another “cross-wise” in the field of the bottom third of breast.
3 Pressure should be made only proximal by a palm part in a point located on two cross-section fingers above xiphoid process.
4 Then it is necessary to bend forward so that shoulders of the doctor have appeared almost over a breast of the patient. Hands should be straight lines.
5 To Make pressing on a thorax a ledge ( proximal part) palms, but not fingers, it is strict in a direction to a backbone on depth 4-5 see
6 In this position it is necessary to remain approximately 0.5 with then pressure stops, and then it is made again. At massage carrying out it is used not only force of hands, but also all weight of a body.
7 Recommended frequency of massage – 60-80 pressings in a minute. At frequency less than 60 pressings in a minute are not created an effective blood-groove.
8 In intervals between pressings of a hand it is impossible to raise or remove from a breast. During massage fingers remain raised and should not concern edges. In order to avoid crisis of edges it is impossible to press on a lateral part of a thorax.
9 To Stop rhythmical squeezing of a breast it is possible only for some seconds (actually for time necessary for performance of breath «from a mouth in a mouth» if resuscitation is made by one doctor) as the blood-groove created by external massage makes only 20-40 % of the normal.
10 If the patient will be reanimated by one doctor after 15 massage movements 2 fast breaths «from a mouth in a mouth» are made. If resuscitation is carried out by two doctors after 5 massage movements 1 fast breath «from a mouth in a mouth» is made.
The standard of the urgent help at cardiogen shock
1 In the absence of the expressed stagnation in lungs: to lay the patient with raised at an angle 20 ° upper extremties oxygenoteraphy; pains – high-grade anaesthesia; correction HEART RATE (paroxysmal tachycardia with HEART RATE more than 150 in 1 mines – the absolute indication to ВИТ, a sharp bradycardia with HEART RATE less than 50 in 1 mines – to ECS); * – heparin10 000 ЕД intravenously streamly
2 In the absence of the expressed stagnation in lungs and signs high CVP: – 200 ml of 0,9 % of a solution of sodium of chloride intravenously drop-by-drop for 10 mines under control over arterial pressure, frequency of breath, HEART RATE , auscultative a picture of lungs and hearts (at increase of arterial pressure and absence signs blood induced hypervolemia – recycle liquid introduction by the same criteria).
3 Dofamin of 200 mg in 400 ml rheopoligluckin or 5 % infusion about 5 mkg / (kg-mines) before achievement are minimum probably level the AP; – there is no effect – in addition to appoint noradrenaline hydrothartrat 2-4 mg in 400 ml of a solution of glucose of 5 % intravenously drop-by-drop, gradually to raise speed of infusion about 4 mkg/mines before achievement is minimum possible level arterial pressure.
4 Monitoring the vital functions .
5 To Hospitalize after possible stabilisation
1. The Electric discharge Energy of the first electric discharge – 200 J. If VF after the first category remains, energy of repeated categories – from 200 to 300 J.
2 Intubation of a trachea and maintenance of venous access. If VF remains after the third category, it is necessary to renew the basic actions, to try intubate a trachea, to provide venous access and electrocardiogram monitoring.
3 Adrenaline. Standard doses of adrenaline – 1 mg в/в enter at least one-two time (it is possible to repeat each 3-5 mines). For lack of venous access adrenaline enter endotracheal (2-2.5 mg ).
4 The Electric discharge (360 J)
5 Lidocaine. A dose for sating в/в introductions – 1.5mg/kg on stream induction . Simultaneously begin lidocaine infusion in a supporting dose of 2 mg/minute
6 The Electric discharge (360 J)
7 To Search for removable reason VF . Metabolic infringements (diabetic ketoacidosis, hypercaliemia), hypotermia, hypovolemia, a poisoning or overdose (cocaine, triciclic energizers, narcotic analgetics),
8 High doses of adrenaline. To enter в/в with an interval no more 3-5мин. Without restrictions.
9 Sodium Bicarbonate. Through 10-15мин after the resuscitation beginning it is possible to enter empirically sodium bicarbonate – 1 mekv/kg в/в.
10 The Second jet introduction of lidocaine. If VF remains, it is possible to enter the second time lidocaine в/в stream ly 1.5mg/kg.
11 Repeated electric categories. (360 J)
12 Additional antifibrillator actions. Magnesium sulphate, , beta-blockers, amiodaron
13 After elimination VF immediately begin preventive antiaritmic treatment (lidocaine, amiodaronum)
The standard of the urgent help at a pulmonary edema.
1 To Set the patient to reduce venous return.
2 To Appoint 100 % oxygen through a mask for achievement of RaO2> 60 mm.my.cn.
3 Intravenously to enter loopback diuretics (furosemidi 40-100 mg or butametanidi 1 mg ); it is possible to apply smaller doses if the patient did not accept diuretics regularly.
4 Morphin 2-5 mg intravenously repeatedly; often apply to decrease the AP and short wind reduction; near at hand should be naloksan for action neutralisation of morphin.
5 To Lower postloading (intravenously sodium nitroprussidum 20 300 mkg/minutes, if систолическое the AP> 100 mm.my.cn. To adjust direct measurement the AP.
6 In the absence of fast improvement additional therapy is required. If the patient did not receive digitalis regularly, 75 % of a full therapeutic dose enter intravenously;
7 Aminofillin of 6 mg/kg intravenously in a current of 20 minutes, then 0.2-0.5 mg / (kg х hour); reduces a bronchospasm, raises contractility a myocardium and diuresis; can be at the initial stage instead of morphin, whether if infringement of breath by a hypostasis of lungs silt by the expressed obstructive disease (to X-ray a thorax) is not clearly caused.
8 If appointment of the diuretic has not caused fast диуреза, it is possible to lower blood volume exfusion a blue blood (250ml from an elbow vein) or by imposing of venous plaits on an extremity.
9 At preservation hypoxemia and hypercapnia make intubation tracheas.
The standard of the urgent help at sudden death
1. At impossibility immediate defibrillation : precardial blow; there is no effect – immediately to begin CPR as it is possible faster to provide carrying out possibility defibrillation .
2 The Closed massage of heart to spend with frequency 90 in 1 mines with a compression-decompression parity 1:1; more effective a method of an active compression-decompression.
3 ALV with accessible way (a parity of massage movements and breath 5:1, and at work of one doctor – 15: 2) to provide passableness of respiratory ways (to throw back a head to put forward the bottom jaw to enter an air line, under indications – to sanify respiratory ways); to use 100 % oxygen; intubate a trachea (no more than for 30); not to interrupt massage of heart and ALV more than on 30 with.
4 Cateterization the central or peripheral vein.
5 Adrenaline on 1 mg each 3-5 mines of carrying out CPR (the way of introduction hereinafter – see the note).
6 As soon as possible – defibrillation 200 J; there is no effect – defibrillation 300 J; there is no effect – defibrillation 360 J; there is no effect – to operate under item 7.
7 To Operate under the scheme: a medicine – massage of heart and ALV, through 30-60 with – defibrillation 360 J: lidocaine of 1,5 mg/kg – defibrillation 360 J; there is no effect – through 3-5 mines to repeat a lidocaine injection in the same dose and defibrillation 360 J; there is no effect – ornid 5 mg/kg – defibrillation 360 J; there is no effect – through 5 mines to repeat an injection ornid in dose 10 mg/kg – defibrillation 360 J; – – there is no effect – novocainamid 1 г (to 17 mg/kg) – defibrillation 360 J; – there is no effect – magnesium sulphate 2 г – defibrillation 360 J; – in pauses between categories to spend the closed massage of the heart and L WILLOWS.
Steps of treatment of myocardial infarction
Pain Knocking over.
3 Restoration of the main coronary blood-groove and prevention further trombogenesis.
4 The Prevention life-threatening aritmia of the heart.
5 Early revascularization and restriction of the sizes of a heart attack of a myocardium.
6 Treatment metabolic with cardioprotectors.
7 Normalization of functional condition SNS.
8 The Mode.
9 Dietetic therapy.
1. Has explained to the patient about forthcoming procedure and has checked up serviceability of the device: tape presence, grounding
2. Has laid the patient, has released from clothes that part of a body where put electrodes
3. Has greased with gel and has imposed electrodes on an extremity: the right hand – red, the left hand – yellow, the left foot – green, the right foot – black
4. On a thorax: 1 electrode red colour on the fourth intracostal space by a breast right edge
5. 2 yellow electrode on the fourth intracostal space on the breast left edge
6. 3 – green on the middle of a line of connecting 2 and 4 points
7. 4 – a brown electrode in the fifth intracostal space on left mediaclavicular lines
8. 5 black electrode in the fifth intracostal space on the left forward axillary line
9. 6 violet electrode in the fifth intracostal space on the left average axillary line
10. Has established necessary speed of movement of a tape and has included the device, pressing the button for removal and registration of signals of heart
11. After end of removal of an electrocardiogram cut out a tape, has removed electrodes and has combined them into place
12. Has registered ECG in magazine, has written down name , age and date of taking on an electrocardiogram tape.
Decoding of an electrocardiogram
1 The Estimation of quality of registration of an electrocardiogram. It is necessary to consider all record of an electrocardiogram and to estimate correctness and speed of record. 1. On an electrocardiogram to a tape should be present all registrated assignments. 2. On an electrocardiogram to a tape it is noted owe speed of record. 3. Previous REGISTRATED peak control (in a kind «p») should correspond to assignments to 10 mm.
2 The Analysis of a rhythm of heart. At the rhythm analysis it is necessary to define: • – correctness of a rhythm (a correct and wrong rhythm) • – an excitation
3 Calculation of number of warm reductions (HCF) At a correct rhythm calculation HCF is spent under the following formula: HCF =60 / R-R At a wrong rhythm calculation is spent also, but defined minimum and maximum ЧСС. Minimum ЧСС it is defined on duration of the greatest interval R-R, and maximum on the least interval R-R.
4 Definition of position of an electric axis of heart (EA). There are three positions EA: – Normal position ЭОС – Deviation ЭОС to the left – Deviation EA to the right.
5 Definition of a position of heart. It is necessary to define following positions of heart: – Normal (semivertical), Horizontal or Vertical.
6 The Analysis of a teeth «Р, Q, R, S and T». At the analysis it is necessary to pay attention on: • presence, polarity, duration, amplitude and the form.
7 The Analysis of interval Р-Q (or Р-R). It is carried out by measurement from the beginning of tooth Р prior to the beginning of tooth Q or R (in the absence of tooth Q). (In norm interval Р-Q (or Р-R) makes 0,12 – 0,20 “.)
Estimation of interval Q-Т. It is carried out by measurement from the beginning of tooth Q or R (in the absence of tooth Q) till the end of Т.
8 The Analysis of complex QRS. At the analysis it is necessary to pay attention on: • an interval • a transitive zone • the form
9 Analysis SТ (RS-) a segment. The piece from the end of tooth S (or R) prior to the beginning of tooth Т is estimated.
10 The Conclusion In the conclusion it is necessary to note the following: 1) Correctness of a rhythm (correct or wrong) 2) a rhythm Source 3) ЧСС 4) Positions EA and a position of heart 5) Presence of the revealed infringements.
Morgan Adams – Stoke analog emergency continuity.
1 atropine t / o or c / i 0.1% solution 0.6-0.75ml 3-4 time a day.
2 Izadrin c / i drop (1mg 5% – 250ml glucose solution 0.25mm / min speed), or a tablet under the tongue (1tab 2hr).
3 Alupent (astmopent) 0.05% -1ml 20ml’re going. 2-3 time / day sent, then 0.02 from every drink 4-6 hours.
4 committee of the proximal AV restrictions, without> 40 / min – EKS not to the right ventricular electrode preventive endocarditis empty.
5 Demand” mode, temporary or permanent EKS.
A list of practical skills and completion of the sequence:
1. Patients Supervision Out investigate the conditions for professional and systems (GP Type 1 service).
2. The preliminary diagnosis is based.
3. The inspection plan for attendance (GP 3.1 and 3.2 type services).
4. Clinical and immunological analysis of the study’s conclusion.
5. Analysis of the biochemical analysis.
6. Tools Analysis of the findings of the inspections.
7. Differential diagnosis.
8. The final diagnosis is based.
9. First doctor support (GP 4-party service).
11. Recommendations (GP 4-party service).
12. The complete history of the disease.