Anonymous
Anonymous asked in 社會與文化語言 · 1 decade ago

幫我翻譯一下病例(感激) Admission

Admission Note

Musuloskeletal: no weakness,arthritis,gout,joint pains,swelling or stiffness

peripheral vascular:no varicose vein, thrombophlebitis,claudication

neurologic:no faints seizure ,motor orsensory loss ,memory good

psychiatric: no insomnia,anxiety ,suicidal ideation

Endocrine;no heat or cold intolerance ,polydipsia or polynria ,polyphagia

Hematologic:no easy bruising ,no trans-fusion reaction,no excessive bleeding ;history of anemia(-)

住院診斷

Head injury with minmal acute SDH

主要計畫

Close monitor neurological status including gcs

follow up laborotary data

repeat head CT if conscious change and consider surgical intervention if necessary

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  • 1 decade ago
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    Admission Note住院記錄

    Musuloskeletal: no weakness, arthritis, gout, joint pains, swelling or stiffness

    肌肉骨骼系統:沒有無力、關節炎、痛風、關節疼痛或腫硬

    peripheral vascular: no varicose vein, thrombophlebitis ,claudication

    週邊血管:無靜脈曲張、血栓靜脈炎、跛行情形

    ”neurological”: no faints seizure ,motor or sensory loss ,memory good

    神經系統:無昏眩抽搐、運動或感覺(機能)喪失,記憶力佳

    psychiatric: no insomnia ,anxiety ,suicidal ideation

    精神狀態:無失眠、焦慮、自殺意念

    Endocrine ;no heat or cold intolerance ,polydipsia or polyuria ,polyphagia

    內分泌:無不耐冷熱、或煩渴、多尿、貪食(看糖尿病三多問題)情形

    Hematologic: no easy bruising ,no trans-fusion reaction, no excessive bleeding ;history of anemia(-)

    血液方面:沒有容易瘀傷情形、無輸血不良反應、易出血情形。無貧血病史

    住院診斷

    Head injury with minimal acute SDH頭部外傷伴隨小範圍急性硬膜下出血

    主要計畫

    Close monitor neurological status including gcs密切監測神經系統狀態,包括以格拉斯哥評分昏迷量表評估

    follow up laborotary data

    追蹤各項實驗室檢驗結果

    repeat head CT if conscious change and consider surgical intervention if necessary

    當意識改變或認為必須採用外科措施介入性治療時,再做一次頭部電腦斷層

    Source(s): 醫護背景
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