医学英語 Case 5: Vomiting動画全３本まとめ

１本目：【英語で医療面接 】嘔吐 Vomiting

台本

Doctor: Hello, my name is Dr. Nakamura, part of the healthcare team that’s taking care of you. Before I begin, can I have your full name and date of birth please?
Patient: Hello, my name is Munenori Kanamori. My date of birth is January 14th, 1966.
Doctor: How would you like me to address you?
Patient: You can call me Mr. Kanamori.
Doctor: Alright Mr. Kanamori, what brought you in today?
Patient: Doctor, I threw up, and I am feeling terribly sick.
Doctor: That’s concerning. Can you tell me more about what happened?
Patient: I have been vomiting since this evening. I would say since about 5 hours ago.
Doctor: How many times?
Patient: Three times.
Doctor: Did you see the vomitus?
Patient: Yes, doctor.
Doctor: How much did you vomit?
Patient: A lot. I’d say half a bucket in total, I guess?
Doctor: What color was it?
Patient: Initially, it was clean, mixed with digested food, but later it became more and more greenish.
Doctor: Did you see blood in it?
Patient: No.
Doctor: What time did you have your last meal?
Patient: 10 hours ago, for lunch.
Doctor: Any trouble eating?
Patient: I was able to have lunch without any problems 10 hours ago, but after I vomited, I didn't feel like eating at all.
Doctor: Did you drink after you vomited?
Patient: Yes, sips of water. I was scared that I would get dehydrated after vomiting. Is that right, doctor?
Doctor: Yes it might be, but in some cases like yours, it’s not always a great idea to drink too much while you cannot. If you are okay, I’d be glad if you let me finish the evaluation of your current condition and answer that question again?
Patient: Sure, doctor.
Doctor: Do you feel bloated?
Patient: Yes, I do.
Doctor: Since when?
Patient: Since the same time I first vomited.
Doctor: Did you pass gas after all that happened?
Patient: No, I didn’t.
Doctor: Do you have any tummy pain?
Patient: A little, around my navel since the vomiting.
Doctor: How do you describe the pain? Is it achy, crampy, or colicky?
Patient: I’d say it’s crampy.
Doctor: Is it constant or does it come and go?
Patient: It is constant.
Doctor: Is it getting better or worse?
Patient: It’s about the same.
Doctor: Are you constipated? If yes, when was your last bowel movement?
Patient: I don’t think so. I had a bowel movement just this morning.
Doctor: Anything unusual in your stool?
Patient: No, but it was a little softer than usual I think.
Doctor: Just to be sure, do you feel nauseated all along?
Patient: Yes, doctor.
Doctor: Since when?
Patient: Since just a few minutes before I first threw up.
Doctor: Is it constant, or does it come and go?
Patient: Constant.
Doctor: What makes it better?
Patient: Sorry, I am not so sure, doctor.
Doctor: No problem, Mr. Kanamori. Is it getting better, or worse?
Patient: Worse.
Doctor: Have you ever experienced anything like this before?
Patient: No, as far as I know.
Doctor: Did you feel dizzy, or felt the room was spinning around you when you vomited?
Patient: None of those happened.
Doctor: Any headache?
Patient: No.
Doctor: Any weakness of your limbs, or face?
Patient: No.
Doctor: Any trouble speaking?
Patient: No.
Doctor: Chest pain?
Patient: No.
Doctor: Did you feel your heart beating very fast?
Patient: Not exactly “very” fast. But I think it's beating a little faster than usual.
Doctor: Shortness of breath?
Patient: A little.
Doctor: Any fever recently?
Patient: Not that I know of.
Doctor: Did you eat anything unusual lately?
Patient: I don’t think so.
Doctor: Any trouble urinating?
Patient: None.
Doctor: Any change in your weight recently?
Patient: I am not so sure.
Doctor: Alright, Mr. Kanamori, I am going to ask you about your health in general. Have you had any medical issues in the past?
Patient: I have high blood pressure.
Doctor: Are you on any medications for that?
Patient: No, doctor.
Doctor: Any other medical issues or medications?
Patient: No.
Doctor: Have you ever had any surgeries before?
Patient: Yes, I had some part of my intestine removed last year. I think my intestine ruptured or something. However, I don’t remember exactly what happened after I got admitted because I felt terribly sick and was pretty much unconscious back then.
Doctor: Do you remember why you were admitted in the first place?
Patient: Because of diverticulitis. The doctor said it ruptured after the admission and I was immediately sent off to the operating theater.
Doctor: That must have been a really hard experience for you, Mr. Kanamori.
Patient: Yes, it certainly was.
Doctor: Any disease that runs in your family?
Patient: Both my parents have high blood pressure as well.
Doctor: In order to treat you properly, I’d like to ask about your social habits. Do you smoke?
Patient: Yes.
Doctor: How many cigarettes do you smoke per day?
Patient: 20.
Doctor: I see. For how many years?
Patient: For ...40 years I guess.
Doctor: Do you drink alcohol?
Patient: Only on weekends.
Doctor: How much do you drink?
Patient: Just one or two drinks each weekend.
Doctor: Have you traveled out of the country recently?
Patient: No.
Doctor: What do you work as, Mr. Kanamori?
Patient: I am an architect.
Doctor: I see, based on our conversation, the very first thing we need to investigate for and rule out is bowel obstruction, which is blockage of your intestine. Major surgery like you had last year, sometimes forms band tissue that blocks food or liquid from passing through your intestine. Without any treatment, your intestine can possibly die. We need to do some blood tests, abdominal x-ray, and CT-scan. After the diagnosis is confirmed, we’d like to place some plastic tube through your nose down to your stomach that removes fluids and gas to relieve the pain and pressure. Is that okay with you?
Patient: Yes, please doctor.
Doctor: And for now, you have to temporarily stop drinking or eating to protect your stomach. Any questions for me?
Patient: No, I’m fine. Thank you, doctor.

２本目：【解説動画】嘔吐 - 英語で医療面接

解説ポイント

>> ものの大きさ・量を表現する例え
coin size
palm size
half a cup, one cup, two cups
half a bucket
I’d say about ___ in total.

>> 腹部膨満感
Do you feel bloated?
Do you have any bloating?
Is your tummy bloated??
注意：腹部を”stomach”と表現するのはlay termです。医学ではstomachは胃のみを指します。腹部はabdominal / abdomenと表現しましょう〜

Does it come and go? の同義語として Does it come in waves?

Did you eat anything unusual lately? をもうちょっと具体的に聞く
→ Did you eat any raw or spoilt food?

conservative treatment: 保存的治療
drip and suck: 腸閉塞の保存的治療

>> NGチューブの設定
aspiration: シリンジ吸引
low intermittent suction (LIS): 壁の陰圧器につなげる
passive: 陰圧器に繋げず、袋のみ
spigot: NGチューブに栓をする

３本目：【口頭発表・プレゼン例】嘔吐 - 英語で医療面接

プレゼン例1

   55-year-old male with a history of colectomy for bowel perforation came to emergency room with three episodes of bilious, non-bloody vomiting started approximately 5 hours before the presentation associated with crampy and continuous pain in the umbilical region and diffuse bloating.
   He has not had any bowel movements since this morning and has not passed any gas since he first vomited. He has vomited, in total, half the bucket amount of green fluids, which first was mixed with undigested food. He has progressively been nauseated, has lost his appetite and has had constant, crampy periumbilical pain since he first vomited. His last meal was 10 hours ago. He has had tachycardia and minor shortness of breath since he started feeling nauseated but denies any episodes of chest pain. Otherwise, he does not have any neurological symptoms such as headache, dizziness, weakness, or dysarthria. He also endorses no urinary symptoms, recent fever, or unintentional weight loss.
   He has a medical history of hypertension with a positive family history in both his parents and takes no daily medications. He has a surgical history of colectomy last year following bowel perforation secondary to diverticulitis. Social history wise, he works as an architect and has a 40 pack-year smoking history, but is an occasional drinker with no travel history.

プレゼン例2

   55 year old male with previous colectomy presents with three episodes of bilious but non-bloody vomiting for 1 day duration associated with abdominal pain and bloating.
   Patient is a 55 year old male with previous colectomy last year following bowel perforation secondary to diverticulitis. He presented today with three episodes of bilious vomiting that started approximately 5 hours before presenting to the ED. This is also associated with constant crampy periumbilical pain and bloatedness that also started this morning.
   His last bowel movement was this morning. Patient also has tachycardia and mild shortness of breath but denies chest pain. Otherwise, he does not have any neurological symptoms such as headache, dizziness, weakness, or dysarthria. He also has no urinary symptoms, recent fever, or unintentional weight loss.

解説ポイント

He has vomited, in total, half the bucket amount of green fluids
→ He has vomited half a bucket total of green fluids

>> 吐瀉物の性状の変化
The vomit was initially undigested food but progressively turned greenish
医療現場では、名詞としてのvomitはvomitusと区別してない場合が多い
動詞としてのvomitはvomitのみ、vomitusという動詞はない

Endorseは支持するという意味で、よく選挙場面で使われていることが多い
Former prime minister Abe endorses Ms. Takaichi.
Mr. Ishiba endorses Mr. Kono.

>> secondary to~ という表現
直訳は: ~に次ぐ
例：Hyponatremia likely secondary to SIADH vs depletional