Preventive examination is an important measure in medicine, which is necessary to assist citizens to preserve and maintain their health. Timely completion of such an examination allows you to prevent the development of many diseases, as well as identify their hidden forms. It is carried out in accordance with the order of the Ministry of Health No. 1011m dated December 6, 2012. We will tell you in this article what is included in a preventive medical examination and what preparation is needed to undergo it.

Goals of preventive medical examination

The main task of preventive examination is to preserve and maintain the health of citizens, as well as to prevent the occurrence and development of diseases. In addition, this medical event has other goals:

• Detection of chronic non-communicable diseases;
• Establishing a health group;
• Providing brief preventive counseling (for sick and healthy citizens);
• Implementation of in-depth preventive counseling (for citizens with a high and very high total risk of cardiovascular diseases);
• Establishment of a group of dispensary observation of citizens, as well as healthy individuals with high and very high total cardiovascular risk.

The inspection is carried out once every two years. However, it is not carried out during the year of medical examination. At the same time, citizens involved in harmful and dangerous work (industry) are required to undergo mandatory medical examinations at certain periods according to their own schedule and, in accordance with Order of the Ministry of Health of the Russian Federation dated April 12, 2011 No. 302n, are not subject to preventive medical examination.

What does a preventive medical examination include?

A preventive medical examination includes examinations and tests. These procedures are mandatory elements of a medical examination for both males and females. A complete list of necessary preventive medical examination studies is reflected in Table 1.

Table 1 - List of examinations included in the preventive medical examination

The results obtained reveal the main indicators of a person’s health and are necessarily entered into his medical record. Based on these, the doctor will subsequently determine the need for additional research or in-depth preventive consultation.

If a citizen has in his hands the results of examinations that were carried out during the year preceding the month of the preventive medical examination, then the decision on the need for a repeat examination is made individually, taking into account all the available results and the health status of the particular citizen.

Preparation for inspection

Preventive medical examination requires preparation from every citizen who undergoes it. However, there are certain recommendations for both men and women. Preparation includes two successive stages, which are reflected in Table 2.

Table 2 – Stages of preparation for a preventive medical examination

These stages of preparation are mandatory for all patients, regardless of their gender and age. By following these recommendations, the research results will more accurately and reliably reflect the state of the body. Along with this, there is special training that is carried out only by a certain category of citizens, depending on age indicators, as well as gender. Features of preparation for the study are presented in Table 3.

Table 3 - Special preparation for preventive examination

Compliance with the recommendations given above will significantly increase the likelihood of detecting existing diseases, increase the accuracy of test results, and also make it possible to provide more accurate recommendations for the patient.

Conclusion

The main active medical care aimed at early diagnosis or detection of any diseases is a preventive examination. All citizens must undergo it at least once every two years. As a result of this examination, citizens are assigned a health group (1,2 or 3), and all test and diagnostic results are mandatory entered into the patient’s record. Before the examination, citizens must undergo special training prescribed by a doctor.

13.1. Examination of trauma patients

All patients with traumatic injuries should be assessed promptly. The Emergency Nurses Association (ENA) has developed courses that teach how to examine trauma patients. To quickly identify life-threatening injuries and correctly prioritize treatment, primary and secondary examinations have been developed.

Initial examination

The initial examination begins with an assessment of:

Respiratory tract (A);

Breathing (B);

Neurological status or disability (D);

Environmental conditions (E).

Let's take a closer look at the initial ABCDE examination.

A– before examining the airway in trauma patients, it is necessary to:

Immobilize the cervical spine using a cervical splint (collar), since until proven otherwise, it is believed that a patient with extensive injuries may have damage to the cervical spine;

Check if the patient can speak. If yes, then the airway is passable;

Identify airway blockage (obstruction) caused by the tongue (the most common obstruction), blood, lost teeth, or vomit;

Clear the airway by applying pressure to the jaw or lifting the chin to maintain cervical immobilization.

If the blockage is caused by blood or vomit, cleaning should be done using an electric suction device. If necessary, a nasopharyngeal or oropharyngeal airway should be inserted. Remember that the oropharyngeal airway should only be used in unconscious patients. The oropharyngeal airway causes a gag reflex in conscious and semi-conscious patients. If the nasopharyngeal or oropharyngeal airway does not provide sufficient air supply, the patient may require intubation.

IN– during spontaneous breathing, it is necessary to check its frequency, depth, and uniformity. Blood oxygen saturation can be checked using oximetry. During the examination, you need to pay attention to the following points:

Does the patient use additional muscles when breathing?

Are airways heard bilaterally?

Is tracheal deviation or jugular vein distension noticeable?

Does the patient have an open chest wound?

All patients with major trauma require hyperoxygenation.

If the patient does not breathe spontaneously or is not breathing effectively, a mask for artificial respiration is used before intubation.

C– when assessing the state of blood circulation it is necessary:

Check for peripheral pulsation;

Determine the patient's blood pressure;

Pay attention to the patient’s skin color – is the skin pale, hyperemic, or have there been other changes?

Does your skin feel warm, cool, or damp?

Is the patient sweating?

Is there obvious bleeding?

If the patient has significant external bleeding, apply a tourniquet above the bleeding site.

All patients with major trauma require at least two IVs, so they may need large amounts of fluids and blood. If possible, a solution heater should be used.

If the patient does not have a pulse, perform CPR immediately.

D– during a neurological examination, it is necessary to use the Glasgow Comatose Scale (W.S. Glasgow, 1845–1907), which determines the basic mental status. You can also use the TGBO principle, where T is the patient’s anxiety, G is the reaction to the voice, B is the reaction to pain, O is the lack of reaction to external stimuli.

The cervical spine must be immobilized until x-rays are taken. If the patient is conscious and his mental state allows, then he should proceed to a secondary examination.

E– to examine all injuries, it is necessary to remove all clothing from the patient. If the victim has suffered a gunshot or stab wound, it is important to save the clothing for law enforcement.

Hypothermia leads to numerous complications and problems. Therefore, the victim needs to be warmed and kept warm. To do this, it is necessary to cover the patient with a woolen blanket and warm up solutions for intravenous administration.

Remember that the initial examination is a quick assessment of the victim’s condition, aimed at identifying disorders and restoring vital functions, without which it is impossible to continue treatment.

Table 8 shows the algorithm of actions during the initial examination of patients with trauma.

Table 8

Initial examination of trauma patients

Secondary inspection

After the initial examination, a more detailed secondary examination is performed. During it, all injuries sustained by the victim are determined, a treatment plan is developed, and diagnostic tests are performed. First, they check breathing, pulse, blood pressure, and temperature. If a chest injury is suspected, blood pressure is measured in both arms. Then:

– establish monitoring of cardiac activity;

– obtain pulse oximetry data (if the patient is cold or in hypovolemic shock, the data may be inaccurate);

– use a urinary catheter to monitor the amount of fluid absorbed and released (the catheter is not used for bleeding or urination);

– use a nasogastric tube to decompress the stomach;

– using laboratory tests, they determine blood type, hematocrit and hemoglobin levels, conduct toxicological and alcohol screenings, do a pregnancy test if necessary, check the level of electrolytes in the serum.

Assess the need for family presence. Relatives may need emotional support, help from a clergy member, or a psychologist. If any family member wishes to be present during resuscitation procedures, explain all procedures performed to the victim.

Try to calm the patient. The victim's fears may be ignored due to haste. This may worsen the victim's condition. Therefore, it is necessary to talk with the patient, explaining what examinations and manipulations are being performed. Encouraging words and kind intonations will help calm the patient.

To improve the patient's condition, they also give pain relief and use sedatives.

Listen carefully to the patient. Collect as much information as possible about the victim. Then carefully examine the victim from head to toe, turning the patient over to check for back injuries.

Memo “sequence of collecting information from a patient”

Subjective: what does the patient say? How did the incident happen? What does he remember? What complaints does he have?

Allergy history: does the patient suffer from allergies, and if so, to what? Does he carry a note for doctors (in the form of an engraved bracelet, an extract from the medical history or a medical card with contraindications to medications, etc.) in case of emergency?

Medications: Does the patient take any medications on a regular basis, and if so, which ones? What medications has he taken in the last 24 hours?

History: what diseases did the victim suffer? Has he undergone surgery?

Time of last meal, last tetanus shot, last menstrual period (if the patient is of childbearing age, you need to find out if she is pregnant)?

Events leading to injury: How did the incident happen? For example, a car accident could occur as a result of a myocardial infarction while driving, or the patient was injured as a result of a fall while fainting or dizzy.

Knowing the mechanism of injury helps to conduct a targeted initial examination. If a patient falls from a chair at home and complains of abdominal pain, then you also have time for a more thorough and detailed examination and examination, and psychologically we do not expect severe damage with this mechanism of injury. Although I remember a case from practice when they brought in a young woman who tripped, fell, stood up, and lost consciousness. Delivered by ambulance. After examination, a diagnosis of splenic rupture and intra-abdominal bleeding was made. But if the patient was hit by a car or fell from the 5th floor, his hemodynamics are extremely unstable, and the presence of an unstable pelvic fracture is not clinically determined, then with a high degree of probability we can assume the intra-abdominal localization of the disaster. During the initial examination, the patient should be completely undressed. If the victim is conscious, your question is: where does it hurt? - he can answer adequately and accurately. But even in this case, it is necessary to examine the entire body in detail: the scalp, the cervical spine, the area of ​​the clavicles and their joints, the rib cage (paying special attention to identifying subcutaneous emphysema, chest lag, the presence of paradoxical breathing, auscultation data, etc.). d.), pelvic area with stress tests and catheterization of the bladder, limbs and joints.

Always pay special attention to the participation of the abdomen in breathing. This is an important sign, and if you ask the patient to “inflate” and “retract” the stomach and at the same time the anterior abdominal wall makes full excursions, then the likelihood of a catastrophe in the abdominal cavity is minimal. Careful superficial and deep palpation will help determine the area of ​​local (or diffuse) pain, protective muscle resistance, and identify positive symptoms of peritoneal irritation. In case of injuries to hollow organs, even during the initial examination, quite sharp diffuse pain, muscle tension and a positive Shchetkin-Blumberg sign are often detected. One of the leading physical signs of intra-abdominal bleeding is the Kullenkampf symptom (the presence of severe symptoms of peritoneal irritation without rigidity of the anterior abdominal wall). Percussion is less informative, especially with combined pelvic fractures. In such cases, it is impossible to place the patient on his side to determine the movement of dullness, and in the supine position, shortening of the percussion sound often indicates the presence of only a retroperitoneal hematoma. Lack of peristalsis is more common with injuries to the intestine or mesentery. With concomitant TBI with impaired consciousness, the diagnosis of intra-abdominal injuries becomes even more complicated. It is with such combinations of injuries that over 50% of diagnostic laparotomies are performed. In such situations, the identification of hemodynamic instability comes to the fore, and if systolic blood pressure is determined at the level of 80-70 mm, then within the first 10-15 minutes it is necessary to perform an ultrasound of the abdominal cavity or (if impossible) to perform laposcopy. If a laparoscope is not available, perform laparocentesis. According to modern sources, the sensitivity, specificity and accuracy of ultrasonography for diagnosing intra-abdominal bleeding range from 95 to 99%. A detailed acquaintance with modern literature allows us to imagine a scheme for examining patients with suspected closed abdominal trauma as follows: in hemodynamically stable patients, the leading diagnostic method is CT .

In patients with unstable hemodynamics, ultrasound and laparoscopy come to the fore. According to the authors, the accuracy of ultrasound for kidney damage was 100%, for liver ruptures - 72%, spleen - 69%, intestine - 0%. CT is considered the main diagnostic method in hemodynamically stable patients. Many authors recommend the use of additional CT in all cases where ultrasound has shown negative results, but there is a clinic for intra-abdominal injuries even when ultrasound has given positive results. The differential diagnosis of internal and retroperitoneal bleeding is especially difficult. The next stage of the examination is radiography of the abdominal cavity. Preoperative preparation.

Since operations for injuries to the abdominal organs mainly relate to resuscitation operations, i.e. operations aimed at saving life, and they must be performed as soon as possible after admission to the hospital, then preparation for them should take a minimum of time. Preoperative preparation should also include some of the resuscitation measures: tracheal intubation and sanitation of the tracheobronchial tree (if indicated); parallel determination of blood group and Rh factor (express method); starting infusion therapy to eliminate critical hypovolemia; preventive drainage of the pleural cavity (even with limited pneumothorax); installation of a urinary catheter and control of urine output; insertion of a gastric tube with evacuation of contents. Preparation for the operation ends with the treatment of the future surgical field (shaving, soap, antiseptics). In terminal patients with a clinical picture of ongoing intra-abdominal bleeding, balloon occlusion of the descending thoracic aorta can be performed as a method of hemodynamic support before surgery.

Before the start of the intervention, if intra-abdominal bleeding is suspected, antibacterial prophylaxis of infection should be carried out intravenously with 1 g of semi-synthetic penicillins (ampicillin, carbenicillin, etc.), if damage to hollow organs is suspected - with a combination of aminoglycosides (gentamicin, kanamycin), cephalosporins and metronidazole.

Working as a doctor in a district hospital, very often there is not enough time for a more complete initial examination of the doctor and its documentation. Therefore, I tried to create a template, using which it is almost impossible to miss one or another body system, plus it takes less time to fill out.

Initial examination by a doctor___________________________

COMPLAINTS:__________________________________________________________________________

____________________________________________________________________________________
ANAMNESIS MORBI.

Got sick acutely, gradually. Onset of the disease from _______________________________________

For medical care (not) contacted the Central Regional Hospital, VA____________ doctor_________________. Outpatient treatment: no, yes: _______________________________________________________________________
Treatment effect: yes, no, moderate. Contact the emergency services: no, yes___time(s). Delivered to the rest area by
emergency indications (yes, no) from the scene of an accident, street, home, work, public place through____
min, hour, day. SMP done:_______________________________________________________________
He is hospitalized in the _________________________ department of the Central District Hospital.

ANAMNESIS VITAE.
AGE/CHILDREN: from___ber,___birth (natural, opera). Course of pregnancy: b/pathol., complicated _______________________________________________________________at ________week.
Born full-term (yes, no), at ___weeks, weighing______g,
height___cm. Breastfeeding (yes, no, mixed) up to ___year(s). Vaccinations on time, medical
withdrawal for the reason _________________________ Examination by a pediatrician is regular (yes, no). General development corresponds to age (yes, no), gender (yes, no), male/female development.
Consists of “D” (yes, no) of the doctor____________________ with DZ:___________________________
Regularity of treatment (yes, no, amb, stats). Last hospitalization.____________where__________________
Rescheduled tasks: TBS no, yes______g. Vir. Hepatitis no, yes_______d. Brucellosis no, yes__________d
Operations: no, yes_________________________________complications_________________________________
Blood transfusions: no, yes_________g, complications__________________________________________
Allergy history: calm, burdened_________________________________________________
Living conditions: (not) satisfactory. Food (not) sufficient.
Heredity (not) burdened_______________________________________________________________
Epidemiology, medical history: contact with an infectious disease patient with symptoms: ________________________ (yes, no),
where:________________________________when________________________________________________
Bad habits: smoking no, yes____years, alcohol no, yes____years, drugs no, yes____years.

STATUS PRAESENS OBJECTIVUS
General condition (moderate, severe, extremely severe, terminal) severity, (un)stable
conditioned by _____________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Consciousness (clear, inhibited, doubtful, stuporous, stuporous, coma)
According to Glasgow school_____ points. Behavior: (dis)oriented, excited, calm. Reaction
for examination: calm, negative, tearful. Position of the patient: active, passive, forced
____________________________________________________________________________________
Constitution: asthenic, normosthenic, hypersthenic. Proportional yes, no__________
______________________________Symmetrical yes, no________________________________________
Skin: clean, rash_______________________________________________________________
Normal color, pale, (sub) icteric, sallow, hyperemic___________________________
Cyanosis: no, yes, diffuse, local___________________________________________
Humidity: dry, normal, increased, hyperhidrosis. Visible mucous membranes: pale, pink, hyperemic__________________________________________________________________________ Humidity: dry, reduced, normal, increased. Features___________________________
Fatty fiber: weak, moderate, excessively expressed, (not) evenly ____________
Peripheral edema: no, yes, generalized, local_________________________________
Peripheral l/nodes enlarged: no, yes__________________________________________T_________*S_
Muscles: hypo, normal, hyper tone. Developed: weak, moderate, pronounced. Height_____cm, weight_____kg.
Convulsions: no, yes. Tonic, clonic, mixed. _____________________________________________
Respiratory organs: free breathing through the mouth and nose yes, no_________________________________
Gr.cell: symmetrical yes, no________________deformation no,yes__________________________
When breathing, the mobility of both halves is symmetrical yes, no______________________________
Pathological retraction of the pliable areas of the chest: no, yes_____________
Participation of additional muscle groups in the act of breathing: no, yes_____________________________________________
Palpation: pain: no, yes, on the right along the ____________ line, at the level of ____________ ribs,
on the left along the_________________________________line, at the level of the_________________ribs.
Voice tremors are carried out evenly yes, no___________________________________________
Percussion: normal pulmonary sound yes, no___________________________________________
The lower borders of the lungs are shifted no, yes, up, down, right, left.___________________________
Auscultatory breathing: vesicular, puerile, hard, bronchial, laryngotracheal,
saccadic, amphoric, weakened, Kussmaul, Biot, Cheyne-Stokes, Grokka type
all lungs, right, left, upper, middle, lower sections________________________Wheezing:
no, yes; dry (high, low, medium timbre), wet (fine, medium, coarse bubbles, crepitation),
over all lungs, right, left, upper, middle, lower sections.
Pleural friction noise: no, yes, on both sides, right, left___________________________
Shortness of breath: no, yes, inspiratory, expiratory, mixed. NPV_______ per minute.
Cardiovascular system.
On examination: The jugular veins are swollen, yes, no. S-m *dancing carotid* neg, pol. S-m Musset neg, pol.
The apex beat is determined no, yes at ____ m/r. Heartbeat no, yes, spilled.
Epigastric pulsation no, yes_________________________________________________________
Palpation: S-m*Cat purring* ot, floor, above the aorta, at the apex, ___________________
Percussion: The boundaries of the heart are normal, shifted to the right, top, left___________________________
Auscultation: Tones are clear, muffled, weakened, sonorous due to the artificial valve,
features of tones______________________________________________________________________________
Heart murmurs are functional, organic. Features:______________________________
_
____________________________________________________________________________________
Sin rhythm - yes, no. Tachycardia, bradycardia, tachyarrhythmia, bradyarrhythmia. Heart rate_____ per minute.
Pulse filling and tension: small, weak, full, intense, satisfactory properties, empty, thread-
visible, absent. Frequency Ps____in min. Pulse deficit: no, yes____________per minute
BP__________________________________________mm.Hg. CVP_________________cmH2O.
Gastrointestinal organs.
Tongue: moist, somewhat dry, dry. Clean, coated with ______________________plaque________________
Swallowing is impaired no, yes_______________________________________________________________
We pass the esophagus: yes, difficult, no___________________________________________
Belly: regular shape yes, no______________________________________________________________

Hernial protrusions: no, yes__________________________________________________________
_____________________________________________________________________________________
Size: sunken, normal, increased due to obesity, ascites, pneumatosis, tumor, obstruction.
Palpation: soft, muscle defence, tense. Painful no, yes in_____________________
_____________________________________________________________________________________
_________________________________________________________________________________reg.
S-m Kocher gender, neg. S-m Voskresensky floor, negative. S-m Rovzinga floor, neg. S-m Sitkovsky floor, neg.
S-m Krymova floor, negative. S-m Volkovich 1-2 floor, neg. S-m Ortner gender, neg. S-Zakharya gender, negative.
S-m Mussi-Georgievsky floor, neg. S-m Kerte floor, neg. S-m Mayo-Robson floor, neg.
Fluctuation of free fluid in the general cavity: no, yes_________________________________
Auscultation: intestinal motility: active, sluggish, absent. Liver: enlarged no, yes
_____cm below the costal arch, wrinkled, reduced, painful yes, no
Consistency: pl-elast, soft, hard. Edge: sharp, rounded. Sensitive: no, yes___________
Gallbladder: palpable - no, yes__________________________________________, painful: no, yes.
Spleen: palpable no, yes. Enlarged: no, yes, dense, soft. Percussion length______ cm.
Stool: regular, constipated, frequent. Consistency: watery, mucus-like, liquid, mushy,
normally shaped, solid. Color: regular,yellow,green,aholic,black.
Impurities: none, mucus, pus, blood. Smell: normal, foul. No helminths, yes___________________________
Urinary system.
The kidney area is visually changed: no, yes, right, left___________________________
_____________________________________________________________________________________
S-m Pasternatsky rep, floor, right, left. Palpable: no, yes, right, left __________________
Diuresis: preserved, regular, reduced, frequent, small portions, ischuria (acute, chronic, paradoxical,
complete, incomplete), nocturia, oliguria_______ml/day, anuria______ml/day.
Pain: no, yes, at the beginning, at the end, throughout urination.
Discharge from the urethra: none, mucous, purulent, sanguineous, bloody, etc.___________________
Reproductive system.
The external genitalia are developed in a male, female, mixed type. Correct: yes, no___________
_____________________________________________________________________________________
Husband: visually the scrotum is enlarged, no, yes, left, right. There are no varicose veins, yes, on the left ____ degree.
Painful on palpation no, yes, right, left. There is no herniation, yes, on the right, on the left. Character__
_____________________________________________________________________________________
_____________________________________________________________________________________
Female: Vaginal discharge is scanty, moderate, profuse. Character: slimy, curdled,
bloody, blood. Color: transparent, yellow, greenish. Smelly no, yes_________________
Visible damage: no, yes, character_________________________________________________
STATUS NERVOUS.
Symmetrical face: yes, no. Smoothness of the nasolabial triangle: left, right.
Palpebral fissures D S. Main apples: in the center, converged, diverged, synchronized to the left, synchronized to the right.
Pupils D S. Photoreaction: lively, sluggish, absent. Pupil diameter: OD narrowed, medium, dilated.
OS narrowed, medium, expanded. Movements of the main apples: preserved, limited ______________________
_____________________________________________________________________________________

Nystagmus no, yes: horizontal, vertical, rotational; large-, medium-, small-wide; constant,
in the marginal leads. Paresis: no, yes. Hemiparesis: left, right. Paraparesis: lower, upper.
Tetraparesis. Tongue deviation: no to the right, to the left. Swallowing is impaired: no, yes____________________
_____________________________________________________________________________________
Palpation of nerve trunks and exit points is painful: no, yes_________________________________
_____________________________________________________________________________________
Muscle tone D S. Hypo-, a-, normo-, tonia (left, right). Tendon reflexes: on the right are animated,
reduced, absent, on the left, revived, reduced, absent.______________________
Meningeal signs: Rigidity of the neck muscles on _____ fingers. S-m Kernig ref, floor___________
S-m Brudzinsky rep., floor. Radicular signs: S-m Lasega ref,pol._______Additional data:
STATUS LOCALIS:________________________________________________________________________________
_______________________________________________________________________________________

_______________________________________________________________________________________

________________________________________________________________________________________

PRELIMINARY DIAGNOSIS:
________________________________________________________________________________________

__________________________________________________________________________________

SURVEY PLAN:
1 UAC (deployed), OAM. 5 Ultrasound.
2 BHC, COAGULOGRAM, blood group and Rh. 6 ECG.
3 M/R,RW. 7 FL.ORG.GR.CELLS.
4 Feces per I/g, scatology, tank culture of feces. 8 FGDS

9 R-graphy in two projections____________________________________________________________
10 Consultation with a doctor -________________________________________________________________

MANAGEMENT PLAN:

MODE____ TABLE No.____
1
2
3
4
5

Ibraimov N.Zh.
Anesthesiologist-resuscitator
Zhambyl Central District Hospital.