医学英语课件：Bedside Case Presentation

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1、Bedside Case PresentationBedside Case PresentationnJunior to senior staffnPeer to peernAttending to consultantBedside Case PresentationnMany different styles but one key pointnThe patient is the most important in the groupBedside Case PresentationnIntroductions are important and help put patient at

2、easenIf you are new to patient,introduce yourself then ask patients name.nState purpose of visit:nConferring with peernGiving report to senior staffnRequesting consultationBedside Case PresentationnNote sequence and brevity of contentnStart with patients name,admission time,chief concern and duratio

3、n of illnessnGender and age not always indicated in patients presencenPositive significant points of historynPositive significant points of physical examBedside Case PresentationnPositive supportive data:nLab,x-ray,US,prior medical history,current status and plannInvite others in group to ask patien

4、t for any additional historical data of interestnContinue presentation by examining,with permission,only areas of pertinence:remember the privacy issue at this pointnInvite others to examine patient,with permission,if appropriate:(avoid repeated breast and genital-rectal examsBedside Case Presentati

5、onnAsk group if they have any further questions regarding the case nThanks patient for his/her co-operationnIf patients has questions,state when you will return to answer themBedside Case PresentationnNo Nos in patients presencenDont present information embarrassing to patientnDont grill or embarras

6、s junior staffnDont criticize other doctors,institutions or the results of their worknDont argue with the patient of familyBedside Case PresentationnExample:Rheumatic Heart Disease(RHD),mitral stenosis(MS)nGood morning Mrs Wang.This morning several doctors are with me,and if it is OK with you we wou

7、ld like to discuss your illness.Bedside Case PresentationnMrs.Wang came to see us three days ago about recurrent exertional shortness of breath for about 1 year.She felt palpitation sometimes.Physical exam revealed irregularly irregular heart rhythm with open snap and rumbling DM at apex,no crackle

8、at either lungBedside Case PresentationnHer ECG showed atrial fibrillation and Echo revealed RHD with severe mitral stenosis.No clot in the left atrium.Other tests were normal and we felt she had rheumatic heart disease,severe mitral stenosis.After discussing our findings with her and her family it

9、was agreed to go ahead with percutaneous balloon mitral valvuloplasty.Bedside Case PresentationnShe had come in quite late that day and her symptoms were not severe so we elected to do her procedure first thing in the morning.At the cath lab,her mean left atrium pressure was 35mmHg before balloon di

10、latation,and down to 7mmHg after procedure.No new systolic murmur was found.nThis is her first day after procedure and she is up and about and taking some food.If she feels good enough this afternoon I may send her home.Would you like to ask her anything?Bedside Case PresentationnSecond Cardiologist

11、:nMrs.Wang,do you feel good enough to go home today?nI think so.My husband is coming over to check on me and Dr.Yang says I can call his office anytime if I am not feeling well.nDr.Yang:nMrs.Wang,I will be back after I finish with clinic this afternoon and we will make a final decision and go over a

12、ll your questions.Bedside Case PresentationnExample:paroxysmal atrial fibrillationnGood morning Mr.Sun,I am Dr.Yang.You may remember I saw you in the emergency room last night.Are you feeling any better this morning?nYes,quiet well.But I am afraid it would come back soon.It is always like that.Bedsi

13、de Case PresentationnWell,I will give you a reasonable plan.As you see,I have several doctors with me,and if it is ok with you we would like to discuss your situation a bit here at your bedside.nOKBedside Case PresentationnMr.Sun is 68 years old and has been pretty healthy all his life.He came to th

14、e emergency room about 11pm last evening because of episodic palpitation with chest discomfort for 5 hours.No syncope.nHe had similar episode about once every week.Physical exam revealed irregularly irregular heart rhythm without murmur.Lungs clear.Bedside Case PresentationnHe had history of paroxys

15、mal atrial fibrillation for years.In the past,many drugs were tried but failed.nOur initial impression was paroxysmal atrial fibrillation,but the exact cause was not clear.Idiopathic is most likely.Later today we plan to cath him to rule out coronary artery disease.Would any of you like to ask Mr.Su

16、n a question or examine him?nResident:Mr.Sun,may I examine your chest?Incidentally,have you noticed blurred vision before you developed palpitation?Bedside Case PresentationnMr.Sun:I have not noticed any blurred vision or lightheadedness before episode.Please dont press too hard.I hurt some left in

17、the chest.Bedside Case PresentationnDr.Yang:nThanks for letting us discuss your case.I will come see you this afternoon,after you have finished the exam and we will discuss your situation further.You may need radiofrequency catheter ablation to cure atrial fibrillation.It is done quiet well in our hospital.Bedside Case PresentationThank you!