My medical skills add experience

Chapter 164 Prepare for a rainy day and search for the cause of the 7-bed patient
The origin of ICU construction in foreign countries is not clear. The earliest ICU construction in China was led by anesthesiologists.

Speaking of this, I have to introduce the emergency department first.

In the past, there was no emergency department in domestic hospitals, which belonged to a department that came into being to rescue emergency patients.Later, a series of norms and subject definitions were carried out, and finally it matched its name, and all emergency patients can call the emergency department.

And the emergency department cannot refuse a diagnosis.

Also, specialist outpatient clinics do not see a doctor at night.

There is a doctor on duty in the emergency department 24 hours a day, and any time you go to the hospital for emergency treatment, you are required to have a doctor for consultation.

With these two gold standards, the emergency department later added some privileges.

For example, after a car accident patient was sent here, he had no family members.For a while, there was no way to contact the family members or the immediate family members of the patient.The patient's life is dying. According to the rules of the hospital, the family members must sign and pay the fee before being treated.

In this case, the emergency department has an extra privilege. During working hours, if there is no family member to sign, you can go directly to the medical department, and then the director of the emergency department will sign on your behalf.

No one pays the fee, but if the operation or rescue is not arranged immediately, the patient will die immediately.

easy to do!

If you are in arrears, deal with it first.

Even today, the emergency department is still the No. 1 department with the most bad debts in the hospital.

In addition to these privileges, emergency examinations are generally written as urgent.

Many can be done first without queuing.

If you want to be hospitalized in a specialist department, you have to wait until the bed is available before you can be admitted.

The emergency department is not so particular, if it is not possible, it is also possible to lie down in the observation room.

Anyway, it is impossible for your doctors to watch patients die in the hospital, right?
With many conveniences and privileges, patients like the service of the emergency department very much.

As a result, the emergency department has become the busiest department in the hospital.

The department directors, experts, doctors and nurses of all major departments, saw that all the patients went to the emergency department, so they naturally refused.

So the congenitally deficient emergency department became a referral transfer station.

Only emergency and critically ill patients are treated, and only preliminary treatment is carried out. After the patient's condition is stable, he will be guided to the corresponding specialist to continue treatment.

In this way, the specialist department feels at ease.

It is equivalent to adding an extra helper who can carry out initial screening and treatment of patients.

When it is sent to a specialist for treatment, it is enough for the specialist doctors and nurses to take their time step by step.

The specialist found that the small days were much more comfortable than when there was no emergency department.

Key income has not diminished.

Because the emergency department is only for the initial treatment of patients, the medical expenses of medication, surgery, and hospitalization are the bulk of the medical expenses, and the emergency department hardly earns [-]%.

But the emergency department does more work than any other specialty.

He also has to endure all kinds of abuse and even beatings from patients and family members.

Emergency department work is tiring, dangerous, and poorly paid.

Therefore, there is a saying in the medical field that advises people to go to the emergency department and be careful when lightning strikes.

Over time, few doctors are willing to really stay in the emergency department for a long time.Especially those powerful doctors, after experience one by one, jumped to the department of authority, where they enjoyed a lot of food and drink, and their status was still high.

Failure to retain elite doctors will inevitably lead to poor rescue levels in the emergency department.

How to do it?

Then came the Department of Intensive Care Medicine.

Some critically ill patients received by the emergency department are not in time, and the doctors and nurses of the intensive care medicine department take action to save the patients' lives.

In terms of life support and life monitoring, doctors in the anesthesiology department are naturally well-deserved first brothers.

This is also the early critical care medicine department in China, and the backbone doctors are basically anesthesiologists.

Later, the nutritional support of the Department of Internal Medicine was integrated into the Department of Critical Care Medicine, and combined with the life support of the anesthesiologist.That's pretty much perfect.

Gradually, some critically ill patients were admitted to the ICU, instead of going in alive, they were carried out dead.

The number of patients who survived and transferred to general wards gradually increased.

Up to now, the Department of Critical Care Medicine has absorbed the inspection of the Medical Technology Department, the nutritional support of the Internal Medicine Department, the life monitoring and life support of the Anesthesiology Department, and the surgical operation support.Such as invasive ventilator, tracheostomy intubation, hanging urine bag and so on.

It can be said that the current critical care medicine department represents the comprehensive strength of a hospital.

Elite medical staff are drawn from various departments to provide patients with the best medical resources, life support, and various treatments.

However, no matter how it develops, doctors in the anesthesiology department have the first-mover advantage, and their status in the intensive care medicine department is still very important.

"It turns out that Dr. Shi used to be an anesthesiologist, so his reticence is understandable. Compared with the anesthesiology department, does the intensive care department have better development?"

Zhou Can is very curious, which department is better?

The Department of Anesthesiology and the Department of Critical Care Medicine are relatively mysterious to most doctors.

Little is known about income and development prospects.

"Everyone has their own way! Dr. Shi's transition to the Department of Critical Care Medicine should be considered a very successful transition. Although he was promoted to the attending level in the Department of Anesthesiology before, after he switched to the Department of Critical Care Medicine, his title remained the same. But he is likely to If you are awarded the title of deputy senior professional, if you are still engaged in anesthesia work, you may not be eligible for the evaluation."

It is a hurdle for many attending doctors to evaluate the title of deputy senior professional.

At least one topic above the provincial level and three core journal-level papers are enough to kill many people.

As for the written test for the deputy senior professional title, it was only the easiest first hurdle.

Dr. Shi's age should be around 39 to 40 years old.

Some doctors with good talent, good foundation, and good luck may be awarded the title of deputy senior professional at the age of 38.But after all, there are only a handful of them.

Many people are already thankful for being awarded the title of deputy senior professional title before the age of 45.

Why add a good luck?
Because when choosing a topic for research, if you can hug the big thick legs of a certain boss, participate in a good topic, or give you a more common topic for you to host.

These good things all need luck and character to get.

Dr. Shi was rated as a sub-high school at the age of 40, and it was a very successful transformation in a large hospital like Tuya with fierce competition.

Zhou Can worked hard to inquire about this matter, just to prepare for the future evaluation of titles.

The family knows their own affairs.

His low education is a flaw.The higher the climb, the more obvious this flaw becomes.

Although with his current development momentum, there is a high probability that he can solve the education problem in the workplace, but he has to prepare for the worst in everything.

Inquiring more now can be regarded as a rainy day.

"Xiao Zhou, arrive at the ICU at eight o'clock tomorrow morning to take over the shift, remember to arrive about half an hour earlier."

Before parting with Zhou Can, Dr. Hu told him.

Today is only the first day of work, and Zhou Can mainly learns the operation of various equipment and familiarizes himself with the environment.

Tomorrow, some tasks should be slowly added to him.

After get off work, even though Zhou Can had dinner in the hospital cafeteria, he was still thinking about the patient in bed 7. What is the cause of lower gastrointestinal bleeding?
The patient's various examination reports are constantly playing back in his mind.

Intestinal bleeding, if not treated in time, is very prone to perforation.However, the patient has not been treated for half a year, and his intestines have not been perforated.

This shouldn't be a miracle.

There must be unknown reasons.

The patient has already undergone endoscopic hemostasis treatment once. If there are obvious abnormalities in the intestinal tract, the doctor will definitely be able to find them in time.

The patient had a routine stool test plus occult blood tests.

No obvious cause was found on the inspection report.

An anatomical diagram of the human digestive tract emerged in Zhou Can's mind.

The human gut consists of the small intestine and the large intestine.

The small intestine starts from the pylorus of the stomach and ends at the cecum of the large intestine.

The length of the entire large intestine is about 1.5m for an adult.It is not too long, because the end can be penetrated through the intestinal door, so it is easier to detect the lesions in the large intestine.

Zhou Can secretly thought that intestinal tumors, polyps, intestinal ulcers, and various enteritis can basically be ruled out now.

Vascular malformations and varicose veins can also be ruled out.

This disease is really difficult to deal with.

The doctors in the Department of Gastrointestinal Medicine failed to find out, so I really don't blame them.

It is the patient's disease that is too complicated.

Let's say it's complicated, but it's also simple.

Because its bleeding has been basically determined, it is diffuse bleeding in the large intestine.

The large intestine mainly includes the cecum, appendix, colon, rectum, and anal canal.

The appendix can be ruled out first.

There is a problem with it, and the patient will die of pain, and it will not last for half a year.

And it will rot in the abdominal cavity.

The anal canal can basically be ruled out.

Then there are only three parts left: the cecum, colon, and rectum.

Starting from these three parts, I am afraid it will be difficult to gain anything.

His current level of pathological diagnosis is at the middle level of a resident doctor, no matter how arrogant he is, it is impossible to be more arrogant than the chief physician.

He can make meritorious deeds repeatedly, relying on alternative diagnosis ideas.

Looking at problems from different angles, you can see some blind spots and blind spots that other doctors can't see.

This is one of his advantages.

"Could it be that there is a malignant tumor in the large intestine, and then infiltration occurs?"

He couldn't help but think of a possibility.

The patient had a routine blood test, and leukemia could be ruled out.

Generally speaking, unexplained bleeding starts with screening for leukemia and bleeding disorders.

If there is a malignant tumor, the patient should be able to find it when he undergoes an angiographic examination.

Zhou Can tried again to recall the angiographic examination report, and finally, he initially ruled out the possibility of malignant tumor infiltration.

That leaves only the last inference.

He boldly speculated that the cause of the disease would appear in the small intestine?
The small intestine of an adult is about 7m long, and the shortest is 5m.It is the main nutrient absorption organ of the human body.

The patient is so thin, of course, there are reasons for long-term bleeding.

But it's also possible that the bleeding is just a smokescreen.

It is for this reason that doctors are led by the nose when making a diagnosis.In other words, the doctor's diagnosis fell into this almost iron-clad misunderstanding.

When Zhou Can first learned about the patient's condition, he heard that the patient had blood in his stool for more than half a year before he came to the hospital for medical treatment.

It is also instinctive to think that the patient's weight loss is caused by the delay for too long.

It is impossible for anyone to maintain weight without losing weight if they have blood in their stools for more than half a year.

"Yes, the small intestine should be checked."

The more Zhou Can thought about it, the more reasonable he felt, and his thinking became clearer.

The alternative way of diagnosis allowed him to break the inherent iron law and get out of the misunderstanding of diagnosis.

There is a problem with the small intestine, what is the most likely cause?
First, a condition must be met.

Bleeding from the large intestine occurs when dirty fluid from the small intestine enters the large intestine.

This can also well explain that the bleeding site of the large intestine is not fixed.

Zhou Can decided to ask the patient's attending physician about the situation.

The attending physician who received this patient was named Xia Ping, and he was an attending physician in the Department of Gastrointestinal Medicine.

After eating in the hospital canteen, it was already 06:30.

The gastroenterology clinic must have been off work long ago.

But there will definitely be a doctor on duty in the inpatient department.

Zhou Can has a good relationship with Director Tan and Director Yin Hua of the Department of Internal Medicine.These are all the top leaders in internal medicine.

At this time, I went to the inpatient department of the internal medicine department to ask Dr. Xia Ping about the situation. There should be no problem.

He is a man of action, he does what he thinks, and never lets his dreams fail.

Walk quickly all the way to the inpatient department of Gastroenterology.

"Hello, I'm Zhou Can, a regular training doctor in the Department of Intensive Care Medicine, and I'm looking for Dr. Xia Ping, a doctor in the Department of Gastroenterology."

Zhou Can could only ask the girl at the nurse's station.

"I'm sorry, Dr. Xia is off work. If you're not in a hurry, you can come and see him tomorrow."

The attitude of the nurse sister is not bad.

The reason why she is called sister nurse is because she is at least over 30 years old.

Much older than Zhou Can.

You can only be called a nurse girl when you meet that kind of fresh and tender nurse in her 20s.

"The matter is not particularly urgent, but it concerns the safety of a patient in the intensive care unit. I want to ask Dr. Xia about the patient's situation right now. You can also tell me Dr. Xia's phone number."

Zhou Can was really worried that the patient in bed 7 would not last long.

Because when I defecated today, the intestines were pulled out.

Moreover, the patient's physical condition is already extremely weak.Finding the cause of the patient's bleeding one day earlier will be much more meaningful.

"We don't have a doctor's phone here! You can go to the doctor's duty room and ask the doctor on duty."

Nurses deal with a large number of family members every day.

One by one is very slippery.

If you want to ask something out of their mouths, unless you are a doctor in the department with a good relationship, don't even think about it.

Zhou Can had learned the lesson, so he stopped wasting time and went straight into the doctor's office.

Boom boom boom!
The door of the office was open, the lights were on, and only one doctor was sitting with his back to the door.

Knocking on the door is a sign of politeness.

"Please come in!"

The doctor looked back.

"It's you! If you don't work in the emergency department, why did you come to our gastroenterology department?"

This male doctor is none other than Doctor Chi who went to the emergency department last time.

His impression of Zhou Can should be quite deep.

Otherwise, it is impossible to recognize it at a glance.

"Doctor Chi, hello!"

Zhou Can tries to respect each other as much as possible.

Last time, Dr. Chi went to the emergency department to be extremely arrogant, and ended up in a disgraceful mess.

Of course, Zhou Can will not mention the embarrassing things in the past.

"Is something wrong?"

Dr. Chi's expression was somewhat unnatural, and he probably remembered what happened last time.Embarrassment is certain.

"I want to ask Dr. Xia Ping about a patient's condition, can you tell me the phone number?"

Zhou Can lowered his posture and asked.

"Dr. Xia's phone number, okay, I'll look for it, wait a minute!"

Dr. Chi didn't make things difficult, and really put down what he was doing to find Zhou Can's phone number.

"Here, this is Dr. Xia's mobile phone number, you can just dial it. But now it's off-duty time, it's hard to say if I can get in touch."

"Thank you!"

Zhou Can called the number on the duty list.

Fortunately, it was connected.

He didn't shy away from it, and asked the patient directly in the office.

"Hello, Dr. Xia, I am Zhou Can, Gui Peisheng from the Department of Intensive Care Medicine. I would like to ask you about the situation of a patient with gastrointestinal bleeding named Guo Ziyang in bed 7. Is it convenient now?"

Zhou Can asked.

"Convenient, convenient, you say!"

The voice on the other end of the phone is calm and full of magnetic voice.

(End of this chapter)