My medical skills add experience

Chapter 167 A special medical technique, the turnaround of 6-bed patients
"Just come to the office and wait for me at around 03:30 tomorrow afternoon."

It seems that Director Liu will be on the night shift tomorrow.

"Do you have WeChat? I will add the work group in the group later. If there is a temporary shift in the group, or other things, it will be notified in the group."

Doctors in almost every department are divided into several medical teams.

For example, in the group of extraskeletal and bone trauma, the doctors in this group basically study diseases in the field of bone trauma.Then a group of bones and joints.Microsurgery a group.Watch a group.One set outside the ankle.A group of spinal surgery.

Zhou Can has just entered the intensive care unit, so he doesn't know much about the division of this department.

Intensive care medicine is generally divided into three groups.

It mainly includes respiratory, multiple organ dysfunction, cardiovascular and cerebrovascular and nerve, these three fields.

To put it bluntly, it is the three major systems of internal and external circulation and nerves.

As long as there are no problems with these three systems, a person's life is guaranteed.

External circulation mainly refers to breathing, including the entire respiratory system, blood oxygen exchange, synthesis, etc.

Internal circulation mainly refers to blood transport, supply of blood and oxygen in the body, nutrient supply and excretion.

Needless to say, the nerves are the entire nervous system with the brain stem as the center.

After analyzing the three major systems of a person's life support, looking at the work of an anesthesiologist, it seems that it is not so mysterious.

If you want to make the patient lose the pain sensation, just cut off the nerve signal.

General anesthesia and spinal anesthesia are the most commonly used methods by anesthesiologists.As for local anesthesia, this rarely bothers them.

Considering the cost of the operation in the department, the chief surgeon generally does this together.

"Dr. Hu, remember to drag Dr. Zhou into our working group after get off work."

After Director Liu explained, he left without waiting for Zhou Can to say anything else.

After Director Liu left, Dr. Hu obviously relaxed a lot.

"In the future, it will be your young people's world! The waves of the Yangtze River will rush forward, and each generation will be stronger than the next." Dr. Hu's expression is very complicated.

Looking at Zhou Can's great achievements, it would be a lie to say that he is not bitter.

Now, Zhou Can has won Director Liu's appreciation, and he can be said to have hard wings.

Dr. Hu can only accept the reality.

Try to maintain a good colleague relationship with Zhou Can, and stop treating him as an ordinary trainee.

At this time, the alarm on bed 6 sounded.

The alarm sound of each machine is actually different.

Zhou Can has been working here for a day.As soon as you hear the sound, you know that there is a problem with your blood pressure.

I ran over and saw that the blood pressure was dropping vertically.

The No. 6 bed may have to send another one away. When will this curse be broken!
Dr. Hu is used to all kinds of big scenes, so he doesn't panic.

After checking, he said decisively, "It's ventricular fibrillation, it must be ventricular fibrillation. Defibrillation immediately."

Ventricular fibrillation is rapid, weak contraction or uncoordinated rapid fibrillation of the ventricles.
No bleeding from the heart, loss of heart sounds and pulse.

Heart, brain and other organs and surrounding tissues stop blood perfusion.

The human heart is like a water pump, which pumps blood out through constant beating, and transports blood to major organs and tissues of the body through arteries.

When ventricular fibrillation occurs, it is equivalent to a problem with the water pump, and the blood is pumped weakly.

Irreversible damage occurs within 3 minutes of cerebral ischemia.Brain cells began to die one after another.

Ventricular fibrillation is very dangerous.

At this time, the most common rescue method is defibrillator defibrillation.

"Xiao Zhou, I taught you defibrillation yesterday, can you operate it?"

"meeting!"

Zhou Can took the prepared defibrillator and didn't talk nonsense.

Deliver an electric shock to the patient's chest.

After receiving the electric shock, the patient's body bounced up violently.

This is a normal reaction.

[First aid life wisdom, experience value +1.]

Zhou Can was a little confused.

I have never obtained this medical skill before!Why did an emergency life wisdom medical technique suddenly appear?

He is in a hurry to rescue the patient right now, so he can't study it carefully.

The first time the patient was defibrillated by electric shock, the effect was not very good.

"Come again!"

Dr. Hu stood by and calmly directed.

Zhou Can defibrillated the patient again.

[First aid life wisdom, experience value +1.]

The patient's heart rate and blood pressure gradually returned to normal, and this fate was temporarily rescued.

Both he and Dr. Hu breathed a sigh of relief.

It was really scary to watch the patient's blood pressure drop in a straight line.

Some patients living in the ICU ward have to go around the ghost gate many times a day.

Doctors and nurses work together to pull them back every time, and then continue various life support and treatment.Until all means were exhausted, they were successfully saved from danger and transferred out of the ICU.

Or end up sending people away.

There are also some special circumstances that will allow patients to be transferred out.

For example, the family disagrees with the rule of law.Or patients with malignant tumors, or other terminally ill patients, knowing that they cannot be cured.

In principle, such patients would have them transferred.

Some private hospitals or small hospitals may consider the operating cost of the ICU. When there are not enough patients, it is also one of the common operations to keep them staying for a few more days.

For regular doctors like Tuya, ICU patients need to get family members to sign and agree if the cost of materials exceeds 200 yuan.

Moreover, the operating cost of the ICU is very high, and it is basically a loss.

Let me give two examples of charges to explain that the treatment fee in the ICU is at least two to three thousand a day, and the highest is tens of thousands. Why do you still say that you will lose money?

A thoracentesis or paracentesis for a patient costs about 90 yuan.

Performing a thoracentesis requires at least two nurses.

A senior attending doctor, plus a nurse to help.

If the puncture goes well, it will definitely take half an hour.This is due to the excellent operating skills of the attending physician, skillful techniques, and proper cooperation of the nurses.The patient's condition is relatively normal.

Otherwise, various difficulties will arise in puncturing.At this time, B-ultrasound positioning must be used to complete the puncture.

Two or three people were busy for at least half an hour, and they also needed equipment like B-ultrasound, which was not cheap, nor was it particularly expensive.and consumables.The final fee is 90 yuan.

Do you think the hospital is losing money?
To give another example, I believe many people are familiar with chest compressions.

This is often referred to as cardiopulmonary resuscitation.

I believe anyone who has done chest compressions knows how tiring the seemingly simple chest compressions are.If the rescuer is an adult, the depth of each pressing is about 5cm, and more than 100 pressings are required per minute.

It is best to reach about 120 times.

For this kind of high-intensity pressing, one or two people take turns, and the time is short.For a long time, don't even think about it.

But the family members were unwilling to give up, and even with tears in their eyes and teeth gritted, the doctors and nurses had to continue to rescue her from exhaustion.

Generally, this rescue process will last for several hours.

Four or five hours is common.

Families generally hope for a miracle of life, so that doctors can rescue their loved ones back.Therefore, the family members will not give up if they do not rescue for a few hours.

Even press for four hours.

Such a long time of pressing often requires four or five medical staff.The strength of the nurse is small, and it is usually the doctor who presses.

Four or five doctors worked hard for four or five hours, how much was the final fee?

100 yuan.

Moreover, the hospital has a rigid rule that it must only be charged once.

In some patients, the heart can stop beating several times a day.He is just teasing us doctors, asking you to press and rescue desperately.

The final fee is still 100 yuan.

Did the hospital lose or gain?

Half a day's salary for a doctor is not enough.

Many family members and patients just opened their mouths and said that the ICU of the hospital is really fucking black, charging him [-] to [-] a day, stealing money.

It's just that they don't look at which expensive instruments, expensive consumables and medicines were used that day.

Many consumables are imported.

Why not use domestic products?I will cry if I continue.Domestic quality is hard to describe.

Not to mention medicinal materials.

In a large public hospital like Tuya, please stop saying that ICU treatment is expensive.As long as you can save your life, it's definitely worth it.

In case of loss of life and wealth, the doctors and nurses really did their best.

……

Zhou Can waited until the condition of the patients in bed 6 was slightly stable, and immediately checked the new medical techniques that just popped up.

As a result, I didn't know if I didn't read it, but I was very happy when I saw it.

I don't know when two new medical skills appeared.

Most likely it was obtained while falling asleep last night.

Because he returned to the apartment yesterday, he practiced sharp knife skills and checked his personal medical skills.There are no these two medical skills.

[Emergency life wisdom, current experience value: elementary level 2/1000.Special medical skills can multiply wisdom when rescuing patients, calm the mind, and improve diagnostic thinking by 50%. 】

This is the first special medical skill he has acquired.

Very interesting, this medical skill is only useful under the premise of rescuing patients.

The diagnosis thinking has been improved by 50%, which is of great help to him in diagnosing the cause of the patient and finding out the focus.

No wonder when the car accident patient was defibrillated just now, his mind was obviously clearer than usual.

It may be that this medical skill has played a role.

Diagnosis thinking is equivalent to problem-solving thinking, the clearer it is, the easier it is to answer questions.

The accuracy rate will also be higher.

Look at another new medical technique.

[Pharmacological dialectics, current experience value: Level 1 1000/[-], lower level for residents. 】

This medical skill can deepen the understanding and application of pharmacology, and can dialectically apply medication to ensure the correct medication and achieve the best therapeutic effect.

This medical skill is directly at the level of a resident doctor, which may be related to Zhou Can's solid pharmacological foundation.

His pharmacological basis is far better than ordinary Pearson.

Now that he has pharmacological dialectical medical skills, Zhou Can can quickly improve his medical skills just by obtaining a licensed physician certificate and the right to prescribe.

Pathological diagnosis is to find out the cause and clarify the pathological mechanism.

Up to now, Zhou Can has the three major methods of diagnosis, medication, and surgery to overcome the serious illness.

As long as these medical skills are gradually improved, he believes that more and more diseases can be treated.

These two new medical skills must have been acquired because of the treatment of 7 patients last night.

The dialectic of pharmacology is because he prescribed medicine to the patient, and Dr. Shi probably adopted it.

As for the emergency medical skills, it is equivalent to giving him a compliment for his active rescue of patients.

Or when he was rescuing patients, he would often be fascinated, as if possessed by a demon.

In this state, the diagnostic thinking and wisdom are far beyond the normal state.

It is equivalent to the meaning of extraordinary performance.

In any case, the two new medical skills he acquired made Zhou Can feel like a treasure, and his heart was full of joy.

"Xiao Zhou, Xiao Zhou!"

Seeing Zhou Can standing there in a daze, Dr. Hu kept calling.

"Ah... you called me?"

After Zhou Can recovered, he felt a little embarrassed.

"You can't go off and on when you work here. You must always be vigilant, otherwise a small mistake may lead to the delay in the rescue of the patient and cause extremely serious consequences."

Dr. Hu warned him in a more serious tone.

"Understood! I will definitely pay attention next time."

Zhou Can's mind couldn't help but see the supernatural Zhu Shenfeng.Just because of diarrhea, a moment of slack almost led to a serious medical accident.

"You keep an eye here, I'll go over there and help them."

There were five or six doctors and nurses surrounding a hospital bed not far away, trying their best to rescue the critically ill patients on the bed.

The danger of the battle can be felt from far away.

Dr. Hu took the initiative to help, which greatly changed Zhou Can's impression of him.

At least in the unity of departments and the normal rescue process, Dr. Hu is a qualified and good doctor.

He is unwilling to take the risk of giving medicine to patients, and he has his own worries and concerns.

Not every doctor is willing to risk his future and his hard-won job.

Any mistake could lead to loss of jobs or even lawsuits.

Sentencing is generally rare.

Even if the doctor has obvious faults, as long as there is no subjective malice, the most punishment is suspension of work, suspension of prescription rights, and suspension of operation authority.If it is more serious, the medical license will be revoked.The most serious thing is that the industry is banned for life.

That is to say, he is not allowed to practice medicine for the rest of his life.

Zhou Can picked up the patient data of 6 beds to check.The examination report showed that the intracranial hemorrhage was severe, and the leg fracture was nothing compared to the brain injury.

"The bleeding point is close to the brainstem, and it is a large area of ​​bleeding, accompanied by subarachnoid hemorrhage. The skull is fractured. The patient is deeply comatose."

No wonder no doctor dared to operate on this patient.

The risk is too great.

The only way is to stay in the ICU for a few days to see if the bleeding can stop automatically?

Wait until the patient has overcome this difficulty and the situation is a little more stable before formulating the next treatment plan.

"If the bleeding can be stopped surgically and the intracranial congestion can be removed, at least this patient's life should be saved."

After reading the examination report, Zhou Can quickly thought about the patient's treatment plan in his mind.

The plan he thought of may not necessarily be implemented.

But it can help him accumulate treatment experience and expand his thinking.

The patient's chest CT showed no particularly serious injuries.The ventricular fibrillation that occurred just now is likely to be caused by a brain problem.

One of the most common symptoms of intracranial hemorrhage is intracranial hypertension.

Or a hematoma occurs, compressing important brain tissue.

What is more serious is that the bleeding site itself occurs in important brain tissue.This condition is usually accompanied by damage to important brain tissue.

"If the patient's condition can be stabilized, maybe an endoscopic surgery can be tried. It mainly includes hemostasis, aspiration of blood congestion, and reduction of intracranial pressure."

After Zhou Can's careful study and safety, the only treatment method he could think of was surgery.

It may take a long time to do traditional craniotomy, and the patient's physical tolerance requirements will be much higher.For minimally invasive endoscopic surgery, you should wait until tomorrow at the latest to reach the surgical target.

Zhou Can found out that the two months of regular training outside the gods had really gained a lot.

By diagnosing this patient at this moment, he can confidently formulate some reliable surgical plans.

Having performed so many third- and fourth-level major surgeries in Shenwai, his knowledge, experience, and prediction of the entire perioperative period are all different.

"Brother, if you can hear me speak, you will grit your teeth and get through today. When your condition is stable, I will suggest surgery to the superior physician." Zhou Can said to the patient.

I thought that the comatose patient would definitely not be able to hear.

As a result, Zhou Can found tears flowing from the corners of the patient's eyes.

Then he found that the patient's heart rate increased significantly, and the brain waves also had some high-sharp waves.It seems that the patient really heard what he said, and it aroused the emotional excitement of the patient.

Can hear me speak, and can think normally, produce mood swings, it seems that the patient's brain is awake, and the degree of coma has been reduced.

After Zhou Can made these discoveries, he was overjoyed.

This seemingly critically ill patient was rescued.As long as he survives this hurdle and helps him to stop the intracranial bleeding and remove the hematoma, he will be able to live.

While examining the 6-bed patient, Zhou Can recorded various conditions such as central venous blood pressure and urine output.

For patients living in the ICU, inserting a catheter is not just to prevent the patient from urinating on the body or frequenting the toilet.It is also for very accurate observation of urine volume, color, etc.

Hematuria, proteinuria and the like can be found immediately.

If a patient has no urine for more than two days, even if other signs are stable, it is not optimistic.

Basically, if the patient has no urine for a long time, it means that the internal circulation is not good.

This kind of organ failure is generally powerless.

It is not at all that dialysis or other support can save the patient.

Therefore, for ordinary people, eating and drinking inconspicuously every day is what critically ill patients need most.

Some key data records are usually recorded every 15 minutes.

After Zhou Can finished recording, the patient on the 7th bed next to him had already started making loud phlegm noises, which made him rush over to help the 7th bed suck sputum.

The nurse is turning the 8-bed patient over to check whether he has excreted himself.

Nurses working in the ICU are warriors.

Because sucking phlegm for patients, wiping feces, scrubbing perineum and lips, crushing medicines and feeding them carefully, these are just the simplest daily tasks.

The stench from some sepsis patients is enough to make many nurses unable to eat for a day.

However, if you work here for a long time, you will gradually adapt, and your mind will become extremely strong.

After Zhou Can sucked the sputum of the 7-bed patient, he checked the blood pressure, respiration, urine output and other data, which showed a significant improvement.This is the most gratifying thing for him.

(End of this chapter)