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Unconsciously, my internship in 152 Central Hospital has ended. During my internship in the hospital, I learned a lot that I didn't know in the textbook.

I just came to the blood bank as an intern, and I didn't know anything when I first came. In my opinion, the blood bank only has cross matching. In fact, at the beginning, I learned the positive and negative identification of blood type, which can independently identify blood type, and can independently configure and identify frozen plasma and inactivated ice slurry. Especially when judging Rh negative blood group, we should be more cautious. If it is judged as Rh negative blood group, it is necessary to preliminarily judge positive and negative, and then use the detection of microcolumn gel to make the diagnosis. Every step is crucial. Later, the teacher gradually introduced me to the operation of cross-matching of suspended red blood cells, which was a very important step. You know, after matching blood, you can directly transfuse blood to patients in clinic.

At first, the teacher was worried and watched me do it. Slowly, I can cross-match my own blood. Every step is very important, from collecting blood samples to centrifugation to adding polyamine test reagents. Finally, the most important thing is to observe the phenomenon. Some agglutination is easy to observe, but I have also encountered some special situations, such as "money agglutination". In fact, this is just a false agglutination of red blood cells at room temperature of 37 degrees, which is common in immune system disorders such as macroglobulinemia, MM and Hodgkin's disease. Under the microscope, we can see that cell aggregation is far from real agglutination. If the cross match is really positive, it is necessary to analyze the reasons, such as the possible existence of unknown antibodies in the recipient's serum and ion infection in distilled water. What impressed me the most was the interference of warm antibodies, which kept us busy all morning, because it was rare.

In addition, screening irregular antibodies with the lowest positive rate is also an indispensable step in blood transfusion. The most difficult operation is the identification of direct and free antibodies, that is, the detection of hemolytic disease antibodies in newborns. Double dilution of prenatal screening must not mistake the number of test tubes. After all, this is a dozen test tubes used to dilute serum. The observation of the final result must observe that there is no agglutination at all in the previous holes. This is the result to be reported. There is also postpartum screening, including absorption, release and free antibody screening. Of course, these are just my experience on the basic operation of blood bank. In the actual inspection work, the teacher taught me a lot of basic principles and principles of inspection, which really benefited me a lot. I really want to thank Miss Guo and Miss Wang here.

Then I went to the clinic for an outpatient service. To be honest, I never wanted to go to the clinic for a free consultation. The most important reason is that I am afraid to give my child peripheral blood. For various reasons, children under 8 years old only do routine peripheral blood, not venous blood. First of all, those patients are children, and I can't bear to part with them. Secondly, children are very expensive nowadays, and you will be scolded by your parents if you don't do well. But we still have to face it. At the same time, I also feel that taking blood in the outpatient clinic is my biggest challenge. Two days ago, the teacher asked me

I said next time. Later, I knew that I had to get started sooner or later, and I encountered many problems in practice, both for my own reasons and for the patients, because the blood samples were all children of several years old and would not be very suitable for you. Teacher Song told me that in the process of blood collection, the child's jaw must be fixed by hand, which is much better. I slowly learned to fix the child's hand, but sometimes I was afraid of hurting the child too hard, and I squeezed out some blood many times, which had a great influence. Teacher Song again. She tells you that if you can't do it, you are either kind to the patient or irresponsible, because if you can't do it, the child will still suffer. Indeed, what the teacher said was really good advice, which hit the nail on the head. That's why I dare to take my time, but I found that sometimes children will bleed a lot after you prick their hands. I have everything under control. So I'm studying other teachers' methods, and I find that in order to collect ideal specimens, needles must be given quickly and accurately. That's it. Through constant practice, I gradually mastered the method of collecting peripheral blood. I have met many patients with low white blood cells in routine blood tests, some of whom know and some of whom don't. I knew they must have blood diseases, which made me deeply feel the fragility of life.

Once, a family member stood by the door. Her family has just received treatment, hoping that the result will be better, but they are still disappointed. Finally, when I gave her the test paper, her eyes were full of tears, and she said thank you and left. It really makes me sad. There are also some special hemograms, such as iron deficiency anemia tablets showing small cell hypopigmentation anemia, MCV；; The hemogram often shows pancytopenia. Neutrophils and platelets can be reduced, but the degree is lighter than anemia. This is a typical anemia hemogram. In the study of urine routine and sediment test, the most unforgettable thing is the observation under the microscope, which is the basis for identifying the basic morphology of red blood cells and white blood cells and reporting the test results. There are also some special observations, such as fungi, mucilage filaments, epithelium, etc., which are very important. For patients with kidney disease and urinary system diseases, as well as patients with protein, white blood cells, red blood cells and sodium nitrite, no matter what the results are, they should be examined under a microscope. Then there is the routine examination of stool, because there are many impurities in stool, such as undigested food residues and bacteria, so it must be accurately distinguished in microscopic examination. For stool rotavirus test, we should pay attention to the reason why the positive rate of virus test is relatively high when the seasons alternate. There is also a special and rare parasite test. I met hookworm eggs during my internship. Because the eggs of this parasite are rare, the teachers in our department have studied them.

Then I went to the blood coagulation room, where I first learned the basic operation of blood coagulation testing, and then systematically learned all kinds of problems encountered in blood coagulation testing. What impressed me most was the detection of D- dimer. When the instrument result is greater than 3000, it must be diluted by corresponding times according to the reflection curve, so that the detection is more sensitive and specific, and the operation of D- dimer determination is simpler, which is not affected by hemolysis, hyperlipidemia, jaundice and other specimen factors, and has high clinical practical value. D- dimer mainly reflects fibrinolytic function, followed by the increase and positive of fibrinolytic function. As long as there is activated thrombolytic activity in the blood vessels of the body, D- dimer will increase. It is of great significance for the diagnosis and treatment of fibrinolytic system diseases (such as DIC and various thrombi) and fibrinolytic system-related diseases (such as tumor and pregnancy syndrome), as well as the monitoring of thrombolytic therapy. Warfarin is a commonly used drug to treat embolism. When reporting the results, we must combine the patient's case to find out whether the patient has taken warfarin recently, so as to judge the accuracy of the test results. The examination of thrombus plays an important role in the operation, so we should be more careful.

In this department, I also learned the rapid detection of three items (hepatitis A, hepatitis B and AIDS antibody). The seemingly simple test actually has a lot to pay attention to. For example, the amount of plasma added after centrifugation must not be too much, otherwise sometimes there will be weak false positive results. For the results of the reaction plate, sometimes the positive reaction line is not obvious, so you must observe it yourself and be responsible for the patient. For suspected HIV-positive patients, samples should be sent to the immune room for confirmation and testing. Even if the immune room results are positive, it must be reported to the local CDC for final diagnosis and testing.

Then I took turns in the biochemical room. When I first came, I studied the receiving and processing of samples, including scanning the bar code information of patients' test tubes and centrifuging samples. In the process of specimen processing, we must pay attention to some clots in the specimen. When a clot is found, we must take it out manually and centrifuge it again. Because the biochemical room is the department with the largest number of specimens, it is particularly important to input the number of specimens and information. The biochemical room is the busiest because there are many specimens, including outpatient and hospitalization. But be sure to remind yourself to be careful when you are busy. At the same time, this department is also a department with the most projects, including liver function 1, liver function 2, kidney function 1, kidney function 2, lipid 1, lipid 2, special protein and so on. At the same time, I learned the trial and principle of Roche P800: photoelectric colorimetric principle. Understand the daily work of quality control, calibration and maintenance of instruments, pay attention to ensuring the dosage of reagents in instruments, and master the collection, preservation and treatment of biochemical test specimens and the cleaning of glassware. Pay attention to the influence of hemolysis and hyperlipidemia on the experimental results. When reporting the results, we must make a comprehensive judgment based on the patient's previous results and the patient's situation. Then I rotated the microbiology room. I have learned a lot in this department. The director of the department is Mr. Miao, the deputy director.

The teacher is very approachable and always teaches me a lot of things patiently. Because I haven't been exposed to microbial knowledge for a long time, he first let me know a lot of theoretical knowledge in the courseware on the computer, and then started the inspection work, which I think is necessary. Only I began to learn to inoculate specimens in a few days. At first, I was not very skilled in inoculating microorganisms, but my teacher always encouraged me. So I slowly summed up the experience of sketchpad. So I learned a lot of things I didn't know before, including how to burn the inoculation ring correctly and how to use the culture plate reasonably. Because I am familiar with the theoretical knowledge of courseware, I started quickly in the identification of microorganisms and drug sensitivity tests. Among them, Enterobacter, a common gram-negative bacterium in clinic, should first observe the colony morphology, for example, Coffey's colony morphology is large and sticky, and then carry out systematic biochemical identification. Staphylococcus aureus was also identified in positive cocci. Because positive cocci grow well on blood plate, coagulase test was carried out to identify them. When the colony is identified as Staphylococcus aureus, drug sensitivity test must be carried out to determine whether it is a MRSA-producing strain resistant to oxacillin. The treatment of methicillin-resistant Staphylococcus aureus infection is one of the most difficult problems in clinic, which has multiple resistance to many antibiotics. Because the mechanism of drug resistance is the change of the properties of PBPS, MRSA is effective for almost all kinds of drugs. β -lactam antibiotics are resistant, and they may also be resistant to macrolide antibiotics, aminoglycoside antibiotics and other antibacterial drugs.

At present, the most commonly used and effective antibiotics are vancomycin, norvancomycin and teicoplanin. Therefore, the identification of MRSA is particularly important. There is also a common identification of streptococcus, including hemolytic streptococcus A and hemolytic streptococcus B. It should be noted that almost all streptococcus pneumoniae are sensitive to Optochin test. And the natural resistance of common bacteria to some antibiotics in clinic can be used as the basis for identifying bacteria. At the same time, it must be noted that when measuring the bacteriostatic circle of some bacteria, some bacteria can still grow in the bacteriostatic circle, which means that the true diameter of the bacteriostatic circle still needs to be measured. For some special bacteria, which can not be clearly identified by various smear staining and biochemical drug sensitivity tests, they should be identified by adding samples to the slats.

I also met a special Haemophilus influenzae in the re-examination. What impressed me most was his satellite phenomenon, that is, when cultivating Haemophilus influenzae and Staphylococcus aureus with instruments, it was found that Haemophilus influenzae from Staphylococcus aureus was larger, while Haemophilus influenzae colonies far away from Staphylococcus aureus were smaller. This phenomenon is called satellite phenomenon. This is because staphylococcus can synthesize factor V and release it in the culture medium, thus promoting the growth of Haemophilus influenzae. This is the knowledge of microbiology I learned in this department, but what impressed me most was the teacher's careful teaching. He took pains to tell me all kinds of knowledge about microbiology. He always answers all questions you ask him. When I make mistakes, he always encourages me and tells me what to do and how to do it better. Here, I want to thank Mr Miao and Mr Qin Xiaoyan. They are excellent teachers, but also excellent inspectors.

Finally, I rotated the immunization room. Under teacher Yue's explanation, I learned that the immune room is divided into five parts: ELISA, HIV screening laboratory, immunofluorescence laboratory, specific protein laboratory and other miscellaneous tests. So far, I have been familiar with the work flow of the department. After the sample is sent to the department, we sign for it first, then enter the classification number, centrifuge it, and then send it to the corresponding laboratory for testing. After the test results come out, you must input the results into the computer, and finally review them before you can issue a report. In addition to being familiar with the workflow of the department, under the guidance of Mr. Yue and Mr. Yu, I gradually learned the routine immunity and the detection of specific proteins. Routine immunization mainly adopts ELISA method. Due to the large amount of samples every day, the department adopts procedures such as automatic sample addition and automatic plate washing. After the results of the ELISA plate come out, they will be taken to a spectrophotometer to measure their wavelengths. BN-2 instrument is mainly used to detect specific protein. As long as we input the specimen number and corresponding items on the computer and put the specimen into the instrument, it will automatically detect. Every teacher in the department taught me patiently, which made me familiar with the work in the department faster and benefited a lot. In addition, I learned the basic pharmacology of basic plate washing in the immune room, and learned that the operation steps and requirements such as incubation time and sample adding sequence should be strictly observed in the operation process, so as to get more accurate and reasonable experimental results. In the immunization room, I learned professional knowledge related to our major. More importantly, I found knowledge in practice, and I learned more practical things related to myself. Through the experimental results of various cases combined with book knowledge, I can learn more practically and master more thoroughly, so that I can truly realize the importance of knowledge and practice.

In this way, my internship life is over. First of all, I would like to thank Director Li of the laboratory and all the teachers for their careful teaching. They made me more aware of the importance of laboratory work and the difference between theory and practice. Secondly, I realize that only by constantly learning and enriching my own inspection knowledge can I become an excellent inspection worker.

There is a long way to go in Xiu Yuan, and I will go up and down.

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