医院临床技能操作手册.docVIP

医生临床技能操作手册 要求掌握的基本临床技能操作 内科：病例书写、体格检查、心肺复苏（人工呼吸、胸外心脏按压等）、六步洗手法、胸腔穿刺、腹腔穿刺、骨髓穿刺、腰椎穿刺、心电图检查操作。 外科：病例书写、体格检查、心肺复苏（人工呼吸，胸外心脏按压等）、术前无菌操作(洗手、穿手术衣、戴无菌手套、消毒铺巾等) 以及手术基本技能（皮肤切开、止血、打结、缝合等）、腰椎穿刺术、腹腔穿刺术、导尿术、石膏绷带及小夹板固定术、清创缝合术、内踝部大隐静脉切开术、打结、剪线和拆线、换药术。 妇产科：病例书写、体格检查、心肺复苏（人工呼吸、胸外心脏按压含新生儿复苏）等）、术前无菌操作(洗手、穿手术衣、戴无菌手套、消毒铺巾等)、产科四步触诊、测量宫高腹围、胎心听诊、骨盆外测量、窥阴器检查、双合诊(必要时三合诊)、腹腔穿刺、后穹窿穿刺、内踝部大隐静脉切开术、打结、剪线和拆线、换药术。 儿科：病例书写、体格检查、心肺复苏（人工呼吸、胸外心脏按压含新生儿复苏等）、六步洗手法、吸痰、胸腔穿刺、腹腔穿刺、骨髓穿刺、腰椎穿刺、鼻导管给氧。 备注：红色为各科共性部分。 目 录 1、临床规范化体格检查步骤······························· 1 2、六步洗手法··········································· 12 3、心肺脑复苏（CPCR）抢救程序····························14 4、胸膜腔穿刺术···········································17 5、腹腔穿刺术·············································18 6、骨髓穿刺术·············································20 7、腰椎穿刺术·············································21 8、心电图检查操作方法···································· 22 9、洗手法·················································25 10、穿无菌手术衣及戴无菌手套······························27 11、手术消毒铺巾··········································30 12、清创缝合术·········································· 34 13、内踝部大隐静脉切开术·································36 14、换药术·············································· 38 15、外科打结（剪线）法······································39 16、拆线术·············································· 43 17、导尿术·············································· 44 18、石膏固定技术··········································45 19、小夹板固定技术········································50 20、盆腔检查··············································52 21、产科检查··············································53 22、后穹窿穿刺·········································· 54 23、胫骨穿刺··············································56 24、鼻导管给氧·········································· 56 25、腰椎穿刺术·········································· 57 26、新生儿复苏流程图······································59 各项临床技能操作的具体内容 各科共性部分 临床规范化体格检查步骤 体格检查是医师运用自已的感观，并借助一些简单的工具，了解身体状况，发现患者阳性体征最基本的检查方法。常用的器具有体温表、血压计、听诊器、叩诊锤、直尺、手电筒、消毒棉签、压舌板、标记笔