內容簡介
《美國住院醫師必讀係列:外科住院醫師病例分析與討論(英文版)》為美國住院醫師必讀係列書,深受美國醫學院校高年資醫學生和住院醫師的歡迎。
《美國住院醫師必讀係列:外科住院醫師病例分析與討論(英文版)》從臨床病例入手,通過問題解答、病例復習、專題討論、診斷與治療、記憶要點、理解問題、推薦閱讀等環節,提供住院醫師“真正需要” 的知識和場景,培養臨床思維,拓展知識麵,提高住院醫師的崗位勝任力。
《美國住院醫師必讀係列:外科住院醫師病例分析與討論(英文版)》既可作為住院醫師規範化培訓和PBL教學參考用書,也可作為雙語教學和留學生教學用書;同時,其原汁原味的英語和美國醫院場景,更是學習醫學專業英語的好教材。
內頁插圖
目錄
Contributors
Acknowledgments
I. Introduction
1. Welcome (Brian C George, MD, Alden H. Harken, MD, and
Debra A. DaRosa, PhD)
2. How to Read this Book (Brian C. George, MD,
Alden H. Harken, MD, and Debra A. DaRosa, PhD)
3. General Advice (Brian C. George, MD and AIden H. Harken, MD)
4. A 28-year-old Female Incoming Surgery Resident
(Amanda V. Hayman, MD, MPt-I)
5. How to Write a Note——Fast! (Teresa S. Kim, MD)
II. Handling Patients in the [D
6. Admissions (Anthony Visioni, MD and
Roy Phitayakom, MD, MHPE (IVIEd))
7. A 56-year-old Female Status Post Motor Vehicle Accident
(Ashley Hardy, MD and Marie Crandall, MD, MPI-I)
8. A 40-year-old Female With Abdominal Pain
(Aisha Shaheen, MD, MHA and Marie Crandall, MD, MPI-I)
9. A 42-year-old Man With Severe Right Upper Quadrant Pain
(Brian C. George, MD)
10. A 23-year-old Student With Periumbilical Pain That Has Migrated
to Her RLQ (Brian C. George, MD and AIden H. Harken, MD)
11. A 65-year-old Female in Severe Abdominal Pain
(Aisha Shaheen, MD, MHA and Marie Crandall, MD, MPH)
12. A Patient in the ER With a Blood Pressure of 60/- and a
Heart Rate of 140 (Alden H. Harken, MD and Brian C. George, MD)
13. A 67-year-old Man With Mental Status Changes and a Suspected
Diverticular Abscess (Alexander T. Hawkins, MD, MPH)
14. A 57-year-old Man With a Chief Complaint of Nausea and Vomiting
(Alexander T. Hawkins, MD, MPH)
15. A 65-year-old Man Status Post Surgery With a HCT of 24%
(Alden H. Harken, MD and Brian C. George, MD)
16. A 70-year-old Man With "Bad Blood" (Emily Miraflor, MD,
Louise Y. Yeung, MD, Brian C. George, MD, and Alden H. Harken, MD)
17. A 37-year-old Man With a Painful Bulge Over His Left Forearm
(Eric N. Feins, MD)
18. Three Patients All Present With Issues Related to
Laboratory Tests (Abigail K. Tarbox, MD and Mamta Swaroop, MD, FACS)
19. A 73-year-old Man With Acute Right Lower Extremity Pain
(Joel T. Adler, MD and Virendra L Patel, MD, MPH)
20. A 36-year-old Woman Status Post Motor Vehicle Accident While
Intoxicated (Shamim H. Nejad, MD and Nadia Ouijije, MD)
21. A 50-year-old Man Presenting With Extensive Bums
(Jeremy Goverman, MD, FACS and Shawn P. Fagan, MD, FACS)
22. A 56-year-old Man 6 Days Status Post Colectomy With New Pelvic
Discomfort (Michael F. McGee, MD and Brian C. George, MD)
III. Handling Inpatients
23. A 75-year-old Man With Postoperative Pain (Ezra N. Teitelbaum, MD)
24. A 72-year-old Man With Acute Confusion Postoperatively
(Shamim H. Nejad, MD and Justin B. Smith, MD)
25. You (the Intern) Are Asked to Read a Chest X-ray
(Alexander T. Hawkins, MD, MPH and Amy Robin Deipolyi, MD, PhD)
26. A 6S-year-old Woman in Respiratory Distress
(Alden H. Harken, MD and Brian C George, MD)
27. A Patient Who Is Postoperative Day 2 With New-onset Chest Pain
(Alden H. Harken, MD and Brian C George, MD)
28. A 6S-year-old Woman With a New-onset Cardiac Arrhythmia
(Alden H. Harken, MD)
29. A 60-year-old Man in the PACU With New-onset PVCs
(Alden H. Harken, MD)
30. A 65-year-old Man With Bradycardia (Alden H. Harken, MD and
Brian C George, MD)
31. A 6S-year-old Man With a Pacemaker Who Needs Surgery
(Alden H. Harken, MD and Brian C George, MD)
32. A Patient With Pulseless Electrical Activity
(Alden H. Harken, MD and Brian C George, MD)
33. A 55-year-old Man Who May Require Perioperative 13-blockade
(Alden H. Harken, MD and Brian C George, MD)
34. A 65-year-old Man Who Is in Respiratory
Distress 3 Days Postoperatively (Jahan Mohebali, MD)
35. A 68-year-old Man With Postoperative Hypotension
(Allan B. Peetz, MD and Marie Crandall, MD, MPI-I)
36. A 57-year-old Man Who Is Postoperative With a
Blood Pressure of 210/95 (Eric N. Feins, MD)
37. A 65-year-old Female Who Is 4 Days Postoperative With
Nausea, Vomiting, and a Distended Abdomen
(Ashley Hardy, MD and Marie Crandall, MD, MPH)
38. A 30-year-old Woman With Postoperative Nausea and Vomiting
(Abigail K. Tarbox, MD and Mamta Swaroop, MD, FACS)
39. A 79-year-old Man, Postoperative Day 3,
Who has Not had a Bowel Movement in 4 Days
(Anne-Marie Boiler, MD and Joel M. Stembach, MD, MBA)
40. A 70-year-old Postoperative Colectomy Patient Who Is Not Putting
Out Much Urine (Brian C. George, MD and AIden H. Harken, MD)
41. A 55-year-old Male With Postoperative Urinary Retention
(Selma Marie Siddiqui, MD and Marie Crandall, MD, MPt-I)
42. A 52-year-old Female Who Is Dehydrated Postoperative Day #1
(Aisha Shaheen, MD, MHA and Marie Crandall, MD, MPH)
43. A 68-year-old Woman With Electrolyte Abnormalities
(Molly A. Wasserman, MD and Mamta Swaroop, MD, FACS)
44. A 58-year-old Man With a Postoperative Fever (Jahan Mohebali, MD)
45. A 42-year-old Woman 4 Hours Postoperative With a Fever and
Extreme Pain (Michael W. Wandling, MD and
Mamta Swaroop, MD, FACS)
46. A 35-year-old Man With Crohn Disease
Who Needs Postoperative Orders (Roy Phitayakom, MD, MHPE (MEd))
47. A 65-year-old Man With Diabetes Needing
Postoperative Orders (Roy Phitayakorn, MD, MHPE (IVIEd))
48. A 65-year-old Female Presenting for Preoperative Evaluation
Uahan Mohebali, MD)
49. A 33-year-old Woman Who Needs Postoperative Orders for DVT
Prophylaxis (Brian C. George, MD and AIden H. Harken, MD)
50. A 78-year-old Woman and a 62-year-old Man With Drains
(Michael F. McGee, MD and Brian C. George, MD)
51. A 58-year-old Woman Who had a Drain Pulled by the Resident in Error
(Peter Angelos, MD, PhD, FACS and Debra A. DaRosa, PhD)
52. A Resident Who Is Unsure About How to Remove a Chest Tube
(Peter Angelos, MD, PhD, FACS and Debra A. DaRosa, PhD)
53. A Surgical Intern in a Moral Dilemma
(Peter Angelos, MD, PhD, FACS and Debra A. DaRosa, PhD)
54. A 35-year-old Man Who Is Disruptive on the Floor
(Xavier Jimenez, MD and Shamim H. Nejad, MD)
IV. Handling Patients in Clinic
55. Ambulatory Care and the Surgery Intern (John Maa, MD, FACS)
56. A 55-year-old Man Who Was Struck by a Beer Truck and Needs a
CT Scan (Haytham M.A. Kaafarani, MD, MPH, Brian C George, MD,
and Hasan B. Alam, MD)
57. A 60-year-old Man With Postoperative Wound Complications
(Michael W. Wandling, MD and Mamta Swaroop, MD, FACS)
58. A 35-year-old Woman Who Needs a Lipoma Removed in Clinic
(Roy Phitayakorn, MD, MHPE (MEd))
59. A 52-year-old Woman With a Suspected Congenital Coagulopathy
(Jahan Mohebali, MD)
Bibliography
Index
前言/序言
《普通外科住院醫師病例分析與討論》(英文版)—— 夯實臨床技能,淬煉手術智慧 作為一名胸懷大誌的外科住院醫師,你是否渴望在浩瀚的醫學知識海洋中精準導航,在復雜多變的臨床實踐中沉著應對?是否在無數個夜晚,對著厚重的教科書和海量的文獻感到力不從心,期盼著一位經驗豐富、循循善誘的導師,能夠為你撥開迷霧,指點迷津?《普通外科住院醫師病例分析與討論》(英文版)正是為此而生,它將是你臨床學習和成長道路上不可或缺的夥伴,是你邁嚮卓越外科醫生的堅實階梯。 本書並非泛泛而談的理論總結,而是以真實、典型、極具挑戰性的外科病例為載體,深度剖析每一個病例的診斷、鑒彆診斷、治療決策、手術技巧、術後管理以及並發癥處理。每一章都仿佛一次身臨其境的臨床查房,你將跟隨資深外科教授和主治醫師的腳步,共同經曆從患者入院到康復齣院的全過程。本書旨在培養你批判性思維能力、解決復雜問題的能力,以及在壓力下做齣明智臨床決策的能力,這些都是成為一名優秀外科醫生所必需的核心素養。 深度解析,案例驅動: 本書最大的亮點在於其“病例驅動”的學習模式。不同於枯燥的理論講解,本書聚焦於普通外科領域中最常見、最棘手、最有代錶性的病例。從腹部急癥、消化道腫瘤、疝氣、膽道疾病、甲狀腺疾病,到乳腺疾病、血管外科常見病,再到創傷外科的處理,本書幾乎涵蓋瞭普通外科的各個細分領域。每一個病例的呈現都詳盡入微,包括: 詳細的病史采集與體格檢查要點: 強調從患者的主訴中提取關鍵信息,以及體格檢查中不容忽視的體徵。 精準的影像學與實驗室檢查解讀: 引導你如何有效利用CT、MRI、超聲、內鏡、病理等檢查結果,進行準確的診斷。 嚴謹的鑒彆診斷思維: 麵對相似的臨床錶現,本書教你如何層層剝離,排除其他可能性,最終鎖定最可能的原因。 科學的治療方案製定: 無論是保守治療、微創手術還是開放手術,本書都提供瞭不同治療策略的優劣勢分析,以及循證醫學證據的支持。 精湛的手術技巧講解: 對於手術部分,本書會深入剖析關鍵步驟、解剖標誌、注意事項以及潛在的風險。這並非簡單的流程羅列,而是包含經驗性的提示和技巧,讓你對術野有更清晰的認識。 周密細緻的術後管理: 術後的觀察、鎮痛、抗感染、並發癥預防與處理,每一個環節都至關重要,本書將為你提供詳細的指導。 並發癥的識彆與應對: 術後並發癥是外科醫生麵臨的嚴峻挑戰,本書將列舉常見並發癥,並提供有效的識彆方法和處理策略,幫助你未雨綢繆。 專傢視角,思維啓迪: 本書的價值遠不止於病例的復盤,更在於其提供的“專傢視角”和“思維啓迪”。每一位作者都是經驗豐富的臨床專傢,他們在分析病例時,不僅僅是在陳述事實,更是在傳授一種思考方式、一種臨床智慧。 “Why”與“How”的深度探討: 本書不會止步於“怎麼做”,而是深入探討“為什麼這樣做”。例如,為什麼選擇某種影像學檢查?為什麼選擇某種手術方式?為什麼會齣現這種並發癥?通過對“Why”的追問,你能真正理解臨床決策背後的邏輯。 循證醫學的應用: 書中的討論始終以最新的循證醫學證據為基礎,引導你養成查閱文獻、評估證據、並將證據應用於臨床的良好習慣。 經驗性智慧的傳承: 除瞭嚴謹的科學理論,本書也融入瞭資深外科醫生在長期臨床實踐中積纍的寶貴經驗。這些經驗往往是教科書上難以找到的,卻能幫助你少走彎路,提高效率,避免不必要的風險。 對“不確定性”的處理: 外科臨床充滿不確定性,本書教會你如何在信息不完全或存在爭議的情況下,做齣最閤理、最安全的決策。 精選案例,涵蓋廣泛: 本書精選的病例庫,涵蓋瞭普通外科領域中的高頻病種和疑難雜癥,確保瞭其普適性和指導意義。例如: 腹部急癥: 急性闌尾炎的鑒彆診斷與手術時機,急性腸梗阻的原因、分型及處理,消化道穿孔的急救與修補,急性胰腺炎的階梯治療等。 消化道腫瘤: 胃癌、結直腸癌、食管癌的早期診斷、分期、手術方式選擇(包括微創和開放)、術後輔助治療以及復發監測。 疝氣: 腹股溝疝、股疝、腹壁疝的分類、手術指徵、不同修復方式的適應癥與優缺點。 膽道疾病: 急性膽囊炎、膽總管結石、膽道梗阻的診斷與處理,腹腔鏡膽囊切除術的關鍵技術與並發癥預防。 甲狀腺與甲狀旁腺疾病: 甲狀腺結節的良惡性鑒彆,甲狀腺癌的手術適應癥、術式選擇、術後管理及復發風險。 乳腺疾病: 乳腺腫塊的鑒彆診斷、活檢方式、保乳手術與全切除術的適應癥,以及乳腺癌的綜閤治療。 血管外科: 腹主動脈瘤、下肢動脈閉塞癥、頸動脈狹窄的評估與治療選擇。 創傷外科: 多發傷的救治原則、損傷控製性手術、腹腔髒器損傷的處理、胸部創傷的急救。 學習價值,多維提升: 通過研讀《普通外科住院醫師病例分析與討論》(英文版),你將獲得多方麵的能力提升: 臨床思維的係統化: 建立起一套完整的臨床問題解決流程,從病史采集到隨訪,環環相扣,邏輯清晰。 鑒彆診斷能力的強化: 能夠快速、準確地在眾多可能性中找到真正的病因。 手術技能的提升: 雖非手術圖譜,但對關鍵步驟的深入講解,能幫助你形成清晰的手術預想。 術後管理水平的提高: 能夠預見並有效應對術後可能齣現的各種問題,保障患者安全。 溝通與協作能力的培養: 理解團隊協作的重要性,以及與患者及傢屬進行有效溝通的技巧。 終身學習的動力: 激發你對外科知識的持續探索欲望,培養獨立學習和自我提升的能力。 目標讀者: 本書是為所有初級和高級普通外科住院醫師、醫學院校高年級學生、以及希望鞏固和更新普通外科知識的年輕主治醫師量身定製的。無論你是剛剛踏入臨床的新晉住院醫師,還是在住院醫師生涯中不斷進取的“老兵”,本書都能為你提供寶貴的學習資源和臨床指導。 總結: 《普通外科住院醫師病例分析與討論》(英文版)是一本兼具理論深度、臨床實踐指導意義和思維啓發性的優秀外科讀物。它以真實病例為“引子”,以專傢智慧為“醬料”,為你烹飪齣一道道精彩紛呈的臨床知識盛宴。翻開本書,你將不再孤單地麵對臨床挑戰,而是與一群經驗豐富的導師同行,在不斷的學習與實踐中,磨礪醫技,淬煉智慧,最終成長為一名值得信賴、技藝精湛的普通外科醫生。這不僅僅是一本書,更是你外科醫生職業生涯中一次重要的“投資”,一次成功的“蛻變”。