问题 问答题 案例分析题

患者男性,18岁,突发气急1天,经体检、X线检查诊为左侧气胸,左肺压缩50%以上。请你紧急实施胸膜腔穿刺-气胸排气治疗。

答案

参考答案:

(1)患者体位正确。(1分)模拟患者取半卧位。

(2)穿刺点选择正确。(2分)穿刺点选在左锁骨中线第2~3肋间。

(3)消毒、铺巾、局麻、无菌操作正确。(8分)用碘伏常规消毒皮肤,范围以穿刺点为中心消毒直径约15cm。(1分)戴无菌手套:打开手套包,取出手套,左手捏住手套反折处,右手对准手套5指插入戴好。已戴手套的右手,除拇指外4指插入另一手套反折处,左手顺势戴好手套。(5分)覆盖消毒洞巾。抽取2%利多卡因5ml在穿刺点的下一肋骨上缘模拟从皮肤至胸膜壁层进行局部浸润麻醉。(2分)

(4)模拟穿刺操作正确。(7分)穿刺前先测量血压。(1分)考生以左手示指与中指固定穿刺部位的皮肤,右手将穿刺针的三通活栓转到与胸腔关闭处,在麻醉处刺入,打开三通活栓进行抽气,每次抽气800~1000ml。(3分)抽气结束时,将穿刺针的三通活栓转到与胸腔关闭处,拔出穿刺针,消毒穿刺点、局部用消毒纱布覆盖、按压后固定。(3分)

(5)术后处理正确。(1分)术后再测血压,严密观察。当可能发生胸部压迫、气胸症状未减轻或昏厥等症状须立即救治。

(6)提问当连续抽气达4000ml仍抽不尽时应如何处理?(1分)考虑肺不张并呈交通性气胸,需改用其他方法,如闭合性引流排气或负压引流排气术进行治疗。

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阅读下面短文并回答问题,然后将答案写到答题卡相应的位置上(请注意问题后的字数要求)。

     [1]One out of many important things for the whole family to do is to have dinner together. Researchers

began reporting the benefits of family dinner about a decade ago, focusing mainly on how it affects children.

Studies show that those families who eat dinner at least 3 or 4 times a week together, benefit in many ways.

     [2]Eating together helps families achieve open communication and build stronger and healthier relationships.

Children have better grades at school and are better adjusted as teens and adults, and the entire family enjoys

healthier nutrition. For many families, eating dinner together proves to be good and effective way to reduce the

risk of youth rates of addiction, and helps to raise healthier children. It is also a great time to share the events

of the day, discuss news and ideas and just be together and enjoy each other's company.

     [3]During dinner time parents have better opportunity to show that they are the prior to their children. Sitting

at the same table and sharing meals is where and when parents can find out more about their children's school

performance, daily activities and attitudes toward life. When parents have all this information they can better

direct their kids toward positive things in life. They also have better chance to reduce the possibility that children

will get involved with alcohol, tobacco, and illegal drugs.

     [4]However, family researchers say that the benefits of family dinner by no means can be considered as

automatic. Parents can sit down to dinner with their kids every day and achieve nothing. _____ if there is too

much arguing going on, if there is no meaningful conversation or, what is even worse, if there is just plain

silence during gathering.

1. What is the main idea of the text? (no more than 8 words) 

    ________________________________________________________________

2. Which sentence in the text is closest in meaning to the following one? By having dinner together family 

    members can have free exchange of information and develop closer ties among them. 

    _________________________________________________________________

3. Fill in the blank in Paragraph 4 with proper words. (no more than 8 words)

    _________________________________________________________________

4. What information can parents probably get about their children at family dinner? (no more than 12 words)

    _________________________________________________________________

5. Translate the underlined sentence in Paragraph 3 into Chinese.

     ________________________________________________________________