Doctor's Life Simulator

Chapter 170 The first patient in the emergency department: Abdominal tenderness and high fever

Under the guidance of Qin Lang, now Yang Yi and Yang Yue have been able to complete Qin Fa's treatment very skillfully, and this technique has become a unique technique in the treatment center of the city's first hospital.

In addition, due to the development of allograft tendon transplantation, the treatment center also undertakes part of the hand surgery patients.

Deputy Director Huang Kaihang is mainly in charge. In order to ensure the strength of doctors, Director Huang also recruited another attending physician from the hand surgery department.

It is very likely that at the latest regular meeting of the hospital, hand surgery will be completely dismantled, part of it will be merged into the treatment center, and part of it will return to orthopedics.

Therefore, the placement of director Tian Bo will also be the focus of discussion in the next regular meeting of the hospital.

As for Qin Lang, he also opened a new chapter in his medical career, and started a six-month rotation in the emergency department.

As a tertiary hospital, the First City Hospital has a very strong emergency department, covering two major areas: the medical area and the support area.

The medical area is divided into: triage office, consultation room, treatment room, treatment room, rescue room, observation room, and the standard emergency operating room and emergency intensive care unit of the tertiary general hospital.

As for the support area, it is divided into registration, various auxiliary inspection departments, pharmacy, charging and other departments.

The entire emergency department is an independent system with its own emergency building. In order to ensure the effective connection between medical emergency and pre-hospital first aid, the emergency room is also next to the emergency triage office, equipped with emergency beds, emergency medicines, and equipment. , cardiopulmonary resuscitation, monitoring and a series of equipment.

In the new week, Qin Lang followed the resident doctor Peng Yun, who is also the emergency doctor on duty in the Department of Burns and Plastic Surgery.

The emergency department of the First Hospital of Hecheng City has a fixed number of emergency physicians, accounting for about 75%, and other than that, doctors from various departments need to take turns to be on duty.

The emergency department under the charge of Director Zhuang Tong now has these three teams, namely the internal medicine group, the surgical group, and the gynecology group, each with a person in charge and three to four regular emergency physicians.

The entire emergency department implements the first-, second-, and third-line on-duty system. The first-line is the hospital and the inpatient general, the second-line is the attending physician and above, and the third-line is the deputy chief physician and above.

The on-duty doctor needs to be on duty 24 hours a day. Due to the needs of the disease, some patients, including those with complex conditions that are difficult to diagnose, or those who need to be admitted to the hospital for diagnosis and treatment but have no beds and cannot be transferred out, will stay in the observation room for a short time, generally no more than 72 hours.

Therefore, the doctor on duty also needs to check the bed in the morning and evening, and check the bed at any time for severe cases. The attending physician will check the bed once a day to revise the diagnosis and treatment plan in time.

Peng Yun and Qin Lang were assigned to the surgical team, and they studied with Dr. Liu Peichun, a senior resident doctor in the emergency department, in the consultation room.

Liu Peichun is 33 years old this year. He is about 1.6 meters tall. He is fat and has some acne marks on his face. He looks simple and honest. He is a very experienced emergency doctor.

Dr. Liu still has some opinions on Qin Lang, who was newly sent by the burn department. After all, Qin Lang is really too young.

Although Qin Lang has been trained in the emergency department, Dr. Liu is still not at ease with him.

So taking advantage of the gap, I still put on a veteran qualification with Qin Lang and talked about various basic knowledge.

Qin Lang didn't reject this at all. After all, it's good to learn more. The more doctors reserve, the more patients' lives will be safe.

"Doctor Liu, please give me your advice. What should we pay attention to in our triage office and consultation room?"

Qin Lang is open and generous. After all, he is still a newcomer in the emergency department. Although he can see all kinds of diseases in the community hospital before, it is only a community hospital after all.

Doctor Liu was satisfied with Qin Lang's attitude, so he started talking:

"Actually, in our emergency triage department, there are two main points of triage, one is disease triage, and the other is subject triage."

"The types of triage are generally divided into pre-hospital triage, disaster triage, and the in-hospital triage we now belong to. According to the classification of the disease, it is divided into four levels."

"Level [-], critical illness. The patient's life is in danger, and the vital signs are unstable and need immediate first aid. For example, cardiopulmonary arrest, severe chest pain, persistent severe arrhythmia, severe dyspnea, severe trauma and massive bleeding, acute poisoning and elderly compound injuries .”

Listening to Dr. Liu's introduction, Qin Lang also listened carefully.

Peng Yun, who was on the side, turned her head and rolled her eyes. Apparently, when she first arrived, Dr. Liu had also been obsessed with it.

"For such patients, we basically take the green channel and the resuscitation emergency room."

"The second level is critical illness. The patient is potentially life-threatening, and his condition may change rapidly. For example, cardiac and cerebrovascular accidents, severe fractures, sudden severe headache, abdominal pain lasting more than 36 hours, and developmental trauma."

Qin Lang also remembered in his mind that it was really all about work, and he really had hard knowledge for a novice like him in the emergency department.

"For this kind of patients, we always let them go to each clinic for priority treatment, and they are usually treated within 15 minutes. For example, some burn patients will be transferred to your burn department after we triage them."

Qin Lang expressed his understanding. Indeed, many patients were first triaged in the emergency department, went to the consultation room, and then sent to the treatment center.

"The third level is an emergency. The patient's vital signs are still stable, and the acute symptoms persist and cannot be relieved, such as high fever, vomiting, mild trauma, mild abdominal pain, etc."

"For those at this level, just ask them to go to each clinic and wait for treatment."

Dr. Liu spoke a little dry, took out a cup and took a big sip, and then continued:

"The last level is non-emergency patients. Non-emergency patients whose condition will not deteriorate. You can let them wait in the emergency department, or go to the outpatient clinic."

Qin Lang listened carefully, remembering Dr. Liu's experience in detail.

Peng Yun's head hurt when he heard it, so he got up and said something to Qin Lang and Dr. Liu:

"Doctor Liu, I'll go to the observation room to check the room, you continue."

For this, Dr. Liu waved his hand of course, and continued to give lectures to Qin Lang with great interest. Liu Peichun was very satisfied with Qin Lang's open-minded attitude, and he also saw that Qin Lang was getting more and more pleasing to the eye.

After talking for more than half an hour, due to dry mouth and drinking a lot of water, Liu Peichun felt a little urgent to urinate, so he said to Qin Lang:
"Qin Lang, you can do it here first, I'll go to the toilet, and I'll be back soon."

"Ok."

Qin Lang was on duty alone in the consultation room. At this moment, a nurse walked in with a young girl.

Qin Lang took a closer look, she was still a girl of seventeen or eighteen years old, she was dressed a little thinly, and had very heavy makeup on her face, making her look old-fashioned.

At this moment, clutching his stomach, he walked in with great pain.

Qin Lang was a community doctor before, and he had been in the burn clinic for a long time. He was still very experienced, so he started to ask for a doctor.

The little girl's lips turned white, and she said in pain:
"Doctor, since yesterday afternoon, I have been bloated and vomited a few times"

Qin Lang palpated her abdomen.

"It hurts, it hurts, it hurts. Doctor, it hurts here, here."

Abdominal tenderness on palpation, mainly in the lower abdomen, right lower quadrant, rebound tenderness, muscle tension.

Qin Lang checked the patient's temperature again, and it reached 39°C.

"Could it be peritonitis complicated by appendix perforation?"

Qin Lang is now at the entry level for the diagnosis and surgery of appendicitis, so he immediately thought of the most typical symptoms.

Right lower quadrant pain, fever, muscle tension?
[Ding, new task: find out the real cause of the patient through single case simulation.Task reward: 1 life simulation point. 】

(End of this chapter)