文档介绍：内科会诊的原则(一)1、内科会诊医师应意识到自己代表的是整个内科2、电话里简单询问患者情况,判断是否急会诊;没有看患者之前在电话里只能回答一些笼统问题3、会诊目的应具体而明确,申请会诊的医师不要写“排除内科情况”,或“处理内科问题”之类的话4、应与患者的主管医师充分交流,会诊时与主管医师见面5、不能依赖别人提供病史,必须亲自床边看患者6、会诊意见应简单明确而富有建设性,最好不超过5条内科会诊的原则(二)7、会诊医师应意识到自己的局限和不足,尊重主管医师的决策,千万不要在未通知主管医师的情况下自己开医嘱8、在主管医师不在场的情况下,不要向家属发表有关病情的看法9、外科患者术前请内科会诊是为了评估风险,因此不要写“可以手术”或“可以全麻”之类的话10、应随访会诊过的患者,你可能会有很多意外的发现和收获,患者病情的发展可能会出乎你的意料,甚至与你最初的判断完全相反11、不要过于自信,遇到自己不能解决的问题,应向有经验的医师请教12、珍惜医疗资源和他人时间,尽量避免不必要的会诊围手术期的心脏评估及治疗方案的选择 吉林大学第二医院 /AHA2007GuidelinesonPerioperativeCardiovascular EvaluationandCareforNoncardiacSurgeryAReportoftheAmericanCollegeofCardiology/AmericanHeartAssociationTaskForceonPracticeGuidelines(mitteetoRevisethe2002GuidelinesonPerioperativeCardiovascularEvaluationforNoncardiacSurgery)JAmCollCardiol2007;50e159-e241ClassI Benefit>>>Risk Procedure/TreatmentSHOULDbeperformed/administeredClassIIa Benefit>>Risk AdditionalstudieswithfocusedobjectivesneededITISREASONABLEtoperformprocedure/administertreatmentClassIIb Benefit≥Risk Additionalstudieswithbroadobjectivesneeded;Additionalregistrydatawouldbehelpful Procedure/TreatmentMAYBECONSIDEREDClassIII Risk≥Benefit NoadditionalstudiesneededProcedure/TreatmentshouldNOTbeperformed/mendedisindicatedisuseful/effective/beneficialisreasonablecanbeuseful/effective/mendedorindicatedmay/mightbeconsideredmay/mightbereasonableusefulness/effectivenessisunknown/unclear/mendedisnotindicatedshouldnotisnotuseful/effective/mendationsandLevelofEvidenceLevelA Multiple(3-5)populationriskstrataevaluated GeneralconsistencyofdirectionandmagnitudeofeffectClassI•men-dationthatprocedureortreatmentisuseful/effective•Sufficientevidencefrommultiplerandomizedtrialsormeta-analysesClassIIa•men-dationinfavoroftreatmentorprocedurebeinguseful/effective•Someconflictingevidencefrommultiplerandomizedtrialsormeta-analysesClassIIb•men-dation’susefulness/efficacylesswellestablished•Greaterconflictingevidencefrommultiplerandomizedtrialsormeta-analysesClassIII•men-dationthatprocedureortreatmentnotuseful/effectiveandma