急诊医学专业英语(共3页).doc
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1、精选优质文档-倾情为你奉上大连医科大学硕士研究生试卷 2010年级专业外语试卷学号 姓名 考生须知1、检查所发试卷是否和自己所报科目一致,试卷有无缺页、漏印、字迹模糊,如有可举手请求换卷。2、必须将自己的学号、姓名、专业班级写在试卷指定位置上。3、在试卷密封线以外填写姓名、学号或写有与答题内容无关的语句和作其它标记的试卷一律作废,后果自负。命题单位:大医二院 教研室:急诊医学 教研室主任审核签字: 阅卷人 : 一二三四五总分分数英译汉:Emergency Diagnosis and Assessment of ICH and Its CausesRapid recognition and di
2、agnosis of ICH are essential because of its frequently rapid progression during the first several hours. The classic clinical presentation includes the onset of a sudden focal neurological deficit while the patient is active,which progresses over minutes to hours. This smooth symptomatic progression
3、 of a focal deficit over a few hours is uncommon in ischemic stroke and rare in subarachnoid hemorrhage. Headache is more common with ICH than with ischemic stroke, although less common than in subarachnoid hemorrhage.Vomiting is more common with ICH than with either ischemic stroke or subarachnoid
4、hemorrhage. Increased blood pressure and impaired level of consciousness are common. However, clinical presentation alone, although helpful, is insufficient to reliably differentiate ICH from other stroke subtypes.The early risk of neurological deterioration and cardiopulmonary instability in ICH is
5、 high. Identification of prognostic indicators during the first several hours is very important for planning the level of care in patients with ICH. The volume of ICH and grade on the Glasgow Coma Scale (GCS) on admission are the most powerful predictors of death by 30 days. Hydrocephalus was an ind
6、ependent indicator of 30-day death in another study. Conversely, cortical location,mild neurological dysfunction, and low fibrinogen levels have been associated with good outcomes in medium to large ICH. Because of the difficulty in differentiating ICH from ischemic stroke by clinical measures, emer
7、gency medicine personnel triage and transport patients with ICH and ischemic stroke to hospitals similarly. As described below, patients with ICH often have greater neurological instability and risk of very early neurological deterioration than do patients with ischemic stroke and will have a greate
8、r need for neurocritical care, monitoring of increased intracranial pressure (ICP), and even neurosurgical intervention. This level of care may exceed that available at some hospitals, even those that meet the criteria for primary stroke centers. Thus, each hospital that evaluates and treats stroke
9、patients should determine whether the institution has the infrastructure and physician support to manage patients with moderate-sized or large ICHs or has a plan to transfer these patients to a tertiary hospital with the appropriate resources.Initial clinical diagnostic evaluation of ICH at the hosp
10、ital involves assessment of the patients presenting symptoms and associated activities at onset, time of stroke onset, age, and other risk factors. The patient or witnesses are questioned about trauma; hypertension; prior ischemic stroke, diabetes mellitus, smoking, use of alcohol and prescription,
11、over-thecounter, or recreational drugs such as cocaine; use of warfarin and aspirin or other antithrombotic therapy; and hematologic disorders or other medical disorders that predispose to bleeding, such as severe liver disease.The physical examination focuses on level of consciousness and degree of
12、 neurological deficit after assessment of airway, breathing, circulation, and vital signs. In several retrospective studies, elevated systolic blood pressure _160 mm Hg on admission has been associated with growth of the hematoma, but this has not been demonstrated in prospective studies of ICH grow
13、th. Fever _37.5C that persists for _24 hours is found in 83% of patients with poor outcomes and correlates with ventricular extension of the hemorrhage.Brain imaging is a crucial part of the emergent evaluation. Computed tomography (CT) and magnetic resonance scans show equal ability to identify the
14、 presence of acute ICH, its size and location, and hematoma enlargement. Deep hemorrhages in hypertensive patients are often due to hypertension, whereas lobar hemorrhages in nonhypertensive elderly patients are often due to cerebral amyloid angiopathy; however, a substantial number of lobar hemorrh
15、ages in hypertensivepatients may be due to hypertension, and both deep and superficial hemorrhages may be caused by vascular abnormalities and other nonhypertensive causes.CT may be superior at demonstrating associated ventricular extension, whereas magnetic resonance imaging (MRI) is superior at de
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