Every woman should clearly know which stages of a complete preventive examination should be followed in consultation with a gynecologist. It would seem, why should the patient worry about the specialist observing all the nuances of his work? However, the harsh reality confirms the fact that when examining in a district consultation, it is not always carried out in full due to the large number of patients and saving time. We in no way want to belittle the professionalism of any doctors, but women often spend a lot of time in front of the computer, worrying about only one question: where to find a good gynecologist? It is sad to realize that in the minds of many people associate quality services with a paid consultation of a gynecologist. So, a good gynecologist will conduct an examination according to the following algorithm.
1. Conversation with a gynecologist
If nothing bothers you, you can come to a consultation with a gynecologist for a simple preventive gynecological examination. By the way, you need to do this 2 times a year so that the doctor can rule out your asymptomatic course of various diseases. If you have any complaints, then this is a serious reason to seek help and advice from a gynecologist. First (unless, of course, this is an emergency), the gynecologist asks you a series of questions to fill out a medical record. A standard set of questions, usually including clarification of your individual characteristics of the body, clarification of complaints and problems, the presence of diseases (including chronic or hereditary), sometimes the questions may be related to sex life. You need to answer all these questions in detail, do not hesitate, since we are talking about your health. If necessary, do not be afraid to ask your doctor questions (it is better to make a written list of all the questions that interest you in advance).
2. External gynecological examination:
- pressure measurement,
- determination of weight,
- examination of the mammary glands,
- external gynecological examination of the female genital organs on a special gynecological chair for the presence of inflammatory elements or neoplasms, etc.
3. Internal gynecological examination
Various techniques are used to examine the cervix. Most often, a classic examination of the vagina is performed using disposable mirrors. The gynecologist examines the organ for secretions and other pathological processes. Next, a manual (manual) vaginal examination is performed through the anterior abdominal wall. Thus, the doctor notes the shape, size, position, mobility, soreness of the uterus and appendages. The presence of painful sensations is a signal for the doctor, as this may be a sign of a gynecological disease.
The most modern and informative way of examining the cervix and vagina is video colposcopy. The colposcope is an optical device of 30x magnification that allows the doctor to examine in detail the condition of the patient's vagina and cervix. The camcorder allows you to display the image in digital format on the monitor screen. The data can be stored in memory, so you can not only qualitatively examine the patient, but also hold consultations with several doctors or, for example, do a comparative analysis of the dynamics after a certain therapy.
Extended video colposcopy - examination of the cervix to rule out suspicions of cervical cancer. The neck is treated with a 3% solution of acetic acid and the state of the epithelium is recorded using a video colposcope, after about 4 minutes the Schiller test is performed (lubricated with 3% Lugol's solution). In cells of healthy unchanged squamous epithelium of the neck, iodine stains glycogen in a dark brown color. If there are atrophic age-related changes, as well as dysplasia of the cervical epithelium (precancerous condition), then the cells are poorly stained. In such a simple and absolutely safe way, the gynecologist discovers the zones of pathologically altered epithelium. A cervical biopsy is done only when needed.
4. Taking a smear for flora (internal gynecological examination)
Examination of a smear of gynecological discharge is a bacteriological examination. With laboratory alanisis, the number of leukocytes is counted (more than 10 in the field of view may indicate the presence of an infection). According to the results of bacteriological research, one can find:
- causative agents of infection,
- mushrooms (candidiasis),
- "Key cells" (bacterial vaginosis),
- a change in the normal flora in the secretions.
5. Taking a smear for cytology (internal gynecological examination)
Cytological examination (cytology) is an obligatory stage in the early diagnosis of oncological pathology of the cervix. Annual scraping of the cervix during a preventive examination is a guarantee of early diagnosis of cancer in case of its asymptomatic course.
6. Ultrasound examination of the pelvic organs (ultrasound in gynecology)
An ultrasound scan can be the culmination of a gynecologist's examination, since only after this the initial examination can be considered as comprehensive and as complete as possible. This safe technique allows the gynecologist to obtain comprehensive information about all organs of the small pelvis, including the uterus and ovaries, and makes it possible to determine the causes of uterine bleeding, menstrual irregularities, abdominal pain, pathological discharge that are not visible during a routine gynecological examination. Paid pregnancy management also involves regular ultrasound examinations. If the doctor has any reasons for the examination, he may offer to do an ultrasound. Gynecology and ultrasound research methods are closely related.
At the second appointment, the gynecologist informs the woman about the test results taken during the first gynecological examination. Further development of events develops according to an individual algorithm. The full treatment program (in case of detection of any gynecological disease) is signed by the gynecologist after the diagnosis.
Another option for the template (form) of the examination by a therapist:Examination by a therapist
Inspection date: ______________________
FULL NAME. patient:_______________________________________________________________
Date of Birth:____________________________
Complaints pain behind the breastbone, in the region of the heart, shortness of breath, heart palpitations, interruptions in the work of the heart, edema of the lower extremities, face, headache, dizziness, noise in the head, in the ears ___________________________________________________________________
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_______________________________________________________________________________Medical history:___________________________________________________________
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_____________________________________________________________________________Information about diseases, injuries, operations (HIV, hepatitis, syphilis, tuberculosis, epilepsy, diabetes, etc.): __________________________________________________________________
Allergic history: not weighed down, weighed down ________________________________
_______________________________________________________________________________The general condition is satisfactory, relatively satisfactory, moderate, severe. The position of the body is active, passive, forced
Body type: asthenic, normosthenic, hypersthenic _____________________
Height __________ cm., Weight __________ kg., BMI ____________ (weight, kg / height, m²)
Body temperature: ________ ° СSkin integument: color pale, pale pink, marble, icteric, redness,
hyperemia, cyanosis, acrocyanosis, bronze, earthy, pigmentation _____________________
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Skin wet, dry _____________________________________________________________
Rash, scars, striae, scratches, abrasions, spider veins, hemorrhages, swelling _______________________________________________________________________________Oral mucosa: pink, hyperemia ____________________________________
Conjunctiva: pale pink, hyperemic, jaundice, porcelain white, edematous,
the surface is smooth, loosened ___________________________________________________Subcutaneous adipose tissue expressed excessively, poorly, moderately.
Subcutaneous lymph nodes: not palpable, not enlarged, enlarged __________
_______________________________________________________________________________The cardiovascular system... The tones are clear, loud, muffled, muffled, rhythmic, arrhythmic, extrasystole. Murmurs: no, systolic (functional, organic), localized at the apex, including Botkin, above the sternum, to the right of the sternum ________________
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Blood pressure ________ and ________ mm Hg Heart rate ________ in 1 minute.Respiratory system... Shortness of breath is absent, inspiratory, expiratory, occurs when _________________________________________________________. Respiratory rate: ________ in 1 minute. Percussion sound clear pulmonary, dull, shortened, tympanic, boxy, metallic ___________________________
____________________________. Borders of the lungs: unilateral, bilateral descent, upward displacement of the lower borders ______________________________ In the lungs during auscultation, breathing is vesicular, hard, weakened on the left, right, in the upper, lower sections, along the anterior, posterior, lateral surfaces ____________________________. Wheezing is absent, single, multiple, fine- medium- large-bubbly, dry, wet, wheezing, crepitant, stagnant on the left, right, on the front, back, lateral surfaces, in the upper, middle, lower parts _____________________
_________________________________. Sputum_____________________________________.Digestive system... Smell from the mouth ____________________________________. Tongue moist, dry, clean, coated with a coating __________________________________________
The abdomen ____ is enlarged due to p / fatty tissue, edema, hernial protrusions ___________________________________________________________, on palpation it is soft, painless, painful _____________________________________________________
There is a symptom of peritoneal irritation, no ___________________________________________
Liver along the edge of the costal arch, enlarged ___________________________________________,
____ painful, dense, soft, smooth, bumpy surface _____________________
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The spleen ____ is enlarged ______________________________________, ____ is painful. Peristalsis ____ is disturbed _________________________________________________.
Defecation ______ once a day / week, painless, painful, formalized, liquid, brown stool, without mucus and blood ____________________________
____________________________________________________________________________urinary system... The symptom of tapping on the lower back: negative, positive on the left, on the right, on both sides. Urination 4-6 times a day, painless, painful, frequent, rare, nocturia, oliguria, anuria, light straw urine _______________________________________________________________
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Diagnosis:_______________________________________________________________________
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_______________________________________________________________________________The diagnosis was established on the basis of the information obtained during the questioning of the patient, data from the anamnesis of life and disease, the results of a physical examination, the results of instrumental and laboratory tests.
Survey plan(expert advice, ECG, ultrasound, FG, OAM, OAC, blood glucose, biochemical blood test): ______________________________________________
_______________________________________________________________________________Treatment plan:__________________________________________________________________
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_______________________________________________________________________________
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_______________________________________________________________________________Signature _______________________ Full name
See the full version of the document in the attachment to the message
A - before examining the airways in patients with trauma, it is necessary:
1.immobilize the cervical spine with a cervical splint (collar), since until proven otherwise, it is believed that a patient with extensive injuries may be damaged by the cervical spine;
2. check if the patient can speak. If yes, then the airway is patent;
3. to identify the blockage (obstruction) of the airways caused by the tongue (the most common obstruction), blood, lost teeth or vomit;
4. clear the airway by applying pressure on the jaw or lifting the chin to maintain the immobilization of the cervical spine.
If the blockage is caused by blood or vomit, clean it with an electric pump. If necessary, insert the nasopharyngeal or oropharyngeal airway. Remember that the oropharyngeal tube should only be used on unconscious patients. The oropharyngeal duct induces a gag reflex in conscious and semi-conscious patients. If the nasopharyngeal or oropharyngeal airway does not provide adequate air supply, the patient may require intubation.
B - in case of spontaneous breathing, it is necessary to check its frequency, depth, uniformity. Blood oxygen saturation can be checked using oximetry. When examining, you need to pay attention to the following points:
1.Does the patient use additional muscles when breathing?
2. Are the airways audible bilaterally?
3.Is there a deviation of the trachea or swelling of the cervical veins?
4. Does the patient have an open chest wound?
All patients with extensive trauma require hyperoxygenation.
If the patient does not have spontaneous free breathing or is breathing ineffectively, a respirator mask is used prior to intubation.
C - when assessing the state of blood circulation, it is necessary:
1. check for the presence of peripheral pulsation;
2. determine the patient's blood pressure;
3. Pay attention to the patient's skin color - is the skin pale, hyperemic, or other changes have occurred?
4. Does your skin feel warm, cool, or damp?
5.Does the patient sweat?
6.Is there any obvious bleeding?
If the patient has severe external bleeding, apply a tourniquet above the bleeding site.
All patients with extensive trauma need at least two IVs and may require large amounts of fluids and blood. A solution heater should be used whenever possible.
If the patient has no pulse, perform CPR immediately.
D - for neurological examination it is necessary use the scale of coma Glasgow (W.C. Glasgow, 1845-1907), which determines the basic mental status. You can also use the principle of TBGT, where T is the patient's anxiety, G is the response to the voice, B is the response to pain, O is the lack of response to external stimuli.
It is necessary to preserve the immobilization of the cervical spine before the x-ray is taken. If the patient is conscious and allows his mental state, then you should proceed to the secondary examination.
E - to inspect all damage it is necessary remove all clothing from the patient. If the injured person is shot or stabbed, it is necessary to keep the clothing for law enforcement.
Hypothermia leads to numerous complications and problems. Therefore, the victim needs to be warmed up and kept warm. To do this, cover the patient with a woolen blanket, warm up solutions for intravenous administration. Remember that the initial examination is a quick assessment of the condition of the victim, aimed at identifying violations and restoring vital functions, without which it is impossible to continue treatment.
Initial examination of trauma patients.
Secondary inspection
After the initial inspection, a more detailed secondary inspection is performed. During it, all the injuries suffered by the victim are established, a treatment plan is developed and diagnostic tests are carried out. First, breathing, pulse, blood pressure, temperature are checked. If a chest injury is suspected, blood pressure is measured on both arms.
- establish observation of cardiac activity;
- receive data from pulse oximetry (if the patient is cold or has hypovolemic shock, the data may be inaccurate);
- use a urinary catheter to monitor the amount of fluid being sucked in and out (the catheter is not used for bleeding or urination);
- use a nasogastric tube to decompress the stomach;
- with the help of laboratory tests, the blood group, the level of hematocrit and hemoglobin are determined, toxicological and alcohol screenings are carried out, if necessary, a pregnancy test is done, the level of electrolytes in serum is checked. Assess the need for family presence. Relatives may need emotional support, the help of a clergyman, or a psychologist. If any of the family members wishes to be present during the resuscitation procedures, explain all the manipulations performed to the victim.
Try to calm the patient down. The victim's fears can be ignored through haste. This can worsen the victim's condition. Therefore, it is necessary to talk with the patient, explaining what examinations and manipulations are performed for him. Encouraging words and kind tone can help calm the patient. To improve the patient's condition, anesthesia and sedatives are also used. Listen carefully to the patient. Collect as much information as possible about the victim. Then carefully examine the victim from head to toe, turn the patient over to check for back injuries.
First of all, it should be noted that the therapist conducts an external examination of the patient. According to characteristic signs, he can suspect conditions such as anemia in the patient, jaundice, high cholesterol.
An objective examination is carried out in two main ways: a thorough examination of the patient or the establishment of the functional characteristics of the organism in the study of its individual systems (circulatory, nervous, digestive, etc.).
Preliminary and visual examination by a general practitioner
Usually, a preliminary examination begins with an examination of the skin, superficial lymph nodes, visible mucous membranes, during which skin rashes, swelling, hematomas, etc. can be detected.Then the therapist palpates different parts of the body, assessing the elasticity, elasticity and moisture of the skin , palpates bones, joints, tumors, blood vessels located at the surface.
If the patient cannot get to the clinic, then the general practitioner goes to the house and carries out a preliminary examination.
When tapping the chest and abdomen, the boundaries of organs or changes in their density are determined, and pathological seals or fluid accumulations are also detected. After that, with the help of a stethophonendoscope, the therapist listens to the murmurs of the heart and lungs. Disorders heart activity are expressed in the appearance of pathological noises and rhythm disturbance... Diseases of the respiratory tract and lungs are often accompanied by the appearance of characteristic wheezing. Listening to the abdomen, they establish the presence of peristalsis (movement) of the stomach or intestines, and in pregnant women - fetal heartbeat.
Surveys at the polyclinic
In addition, the modern polyclinic uses the measurement of temperature (thermometry) and body parts (anthropometry), the study of deep-lying organs using various mirrors and optical devices.
At the end of the initial examination, the physician will usually measure blood pressure, examine the organs of hearing and vision, and measure the height and weight of the patient. When a qualified physician therapist needs confirmation of the diagnosis, he sends the patient for a special examination.
The range of modern diagnostic capabilities is very wide and includes such studies as measuring the volume of the lungs, assessing the work of the heart (electrocardiography), X-ray examination of various organs. Women may be advised to have a mammogram or diagnostic curettage. endometrium or a Pap smear (taking cells from the cervix for examination under a microscope). All these procedures are aimed at early detection breast cancers and female internal genital organs.
In computer diagnostics, the description of the patient's symptoms and the results of all his examinations are entered into a computer, which, after processing the data, issues a conclusion. Typically, this diagnostic method is used by therapists in cases of rare diseases.
As a rule, in the course of an objective examination, a person does not feel much discomfort. At the end of the procedure, the therapist either informs the patient that everything is in order, or, based on the diagnosis, prescribes treatment and makes a prognosis for the course of the disease. In this case, it is especially important to timely contact a doctor, therapist, since the detection of the disease in the early stages most often means the possibility of a complete cure.
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