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ПРИЛОЖЕНИЯ

Приложение 1

Индивидуальная карта №________

Дата поступления__________/_____ выписки__________/_____. Проведено к/дней________, до операции_______. ФИО________________________________________________________ Год рождения__________(_____) Пол: м / ж Адрес:____________________________________________________________________________________________________

Диа-

гноз:________________________________________________________________________________________________________

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

____________________________________________________________________________________________

Анамнез:____________________________________________________________________________________________________

________________________________________________________________________________________

_______________________________________________________________________ госпитализ.- впервые/повторно Употребление алкоголя, жирной пищи, травма поджелудочной железы; ЖКБ, сахарный диабет в анамнезе Срок с момента заболевания___________Проводилось ли лечение до поступления_______Полноценность_______

Операции: лапаротомии, люмботомии_________________________________________________________________

____________________________________________________________________________________________________________

________________________________________________________________________________________

__________________________________________________________________________________________________

перевязки под наркозом_____________________________________________________________________________

лапароско-

пии_________________________________________________________________________________________________________

_______________________________________________________________________________

пункции под УЗ-контролем___________________________________________________________________________

__________________________________________________________________________________________________

ЭРПХГ, ЭПСТ, ФГДС (БДС)___________________________________________________________________________

____________________________________________________________________________________________________________

________________________________________________________________________________________

Перевод в ОАРИТ

Показатели При пост 1 сутки 2 сутки 3 - 7 8 - 11 12 - 15 16 - 30 >30 сут.

Выр. болевой синдром

Рвота

Словесная реакция

Двигательная реакция

Реакция глаз

ИВЛ

Кожные симптомы

Температура тела

ЧД

ЧСС

САД

ДАД

ЦВД

Мышечный дефанс

Пальпир. инфильтрат

Вздутие живота

Диурез

Стул

ЭКГ: ишемия миокарда

Посев крови на стерил.

-выпота из бр. полости

-выпота из сал. сумки

КТ__________________________________________________________________________________________________________

________________________________________________________________________________________

346

Лечение: раннее____________________________________________________________________________________

базис_____________________________________________________________________________________

усиленное_________________________________________________________________________________

На какие сутки развилось нагноение___________________________________________________________________

Антибиотики, применявшиеся до его развития___________________________________________________________

__________________________________________________________________________________________________

Другие осложнения (на какие сутки)____________________________________________________________________

__________________________________________________________________________________________________