My medical skills add experience

Chapter 171 Racial defects, those who can do more work

After checking bed by bed, Director Liu will take the initiative to explain to Zhou Can the symptoms of the patients and the targeted treatments given to them.Whether it is medication, respiratory support, hemofiltration, or physical cooling, decompression and other treatment methods, they are all carried out around the theme of life preservation.

Compared with Dr. Hu, Director Liu taught him basically various treatment theories in simple terms and their application in practice.

Dr. Hu taught him the use of various instruments and parameter adjustment settings.

There are also the most basic critical care knowledge and routine operations such as pumping medicine, observing urine output, body temperature, breathing, etc.

It can be understood that the rescue knowledge and skills taught by Director Liu belong to the advanced version.

"The female patient in bed 11 is 17 years old this year and is still very young. The current symptoms are repeated low-grade fever, dyspnea, and lung infection, accompanied by cough and phlegm. The receiving doctor conducted an etiological investigation on her and initially identified it as a Caused by a little cold."

Zhou Can looked at the dying girl on the hospital bed, completely in a coma.

A persistent low-grade fever can make you feel tired, weak, and lethargic.

A small cold put her in the ICU directly, and she didn't know whether to call her unlucky or her fate.

The humble flu actually kills many people every year.

Even though the girl is so sick and haggard, she still looks very beautiful.

He is tall and tall, with extremely fair skin, the kind that is rosy in pink.

The hair is not black, but somewhat yellowish.

I don't know if it was dyed or not.

Her high nose bridge is also impressive.

This girl has the beauty of a mixed race.

Zhou Can looked at the parameters of the ventilator.

The tidal volume was set at 9ml/kg, and the respiratory rate was 16 breaths/minute.

Look at the inspiratory flow rate again, 80ml/min.

The inspiratory flow rate is significantly higher.

Dr. Hu told him that the flow rate needs to be increased when the patient has fever, irritability, or convulsions.When sleeping peacefully, the flow rate needs to be reduced.

"Does she have COPD?"

Zhou Can asked curiously.

"That's right! That's the disease, and it's probably a congenital disease."

Director Liu nodded slightly.

Congenital cause of obstructive lung disease?

Zhou Can frowned slightly, and picked up the patient's examination report to check.Chronic airway inflammation, lack of antichymotrypsin in the blood.

No wonder Director Liu said she was born with a congenital disease.

Chronic Obstructive Pulmonary Disease is referred to as COPD.It is a chronic inflammatory disease of the airways.

Due to the existence of chronic airway inflammation, some pathophysiological changes will occur in patients.

The most common is airflow limitation.

Then the patient will have clinical symptoms such as cough, sputum production, and dyspnea.

There are many causes of COPD, and the lack of antichymotrypsin in the blood is a very rare congenital disease.

It is said that this has something to do with race.

People of yellow race rarely get this disease. When the gene of Caucasian people is mutated, it will cause the baby to be born with a lack of antichymotrypsin.

No wonder the girl looked like a mixed race.

Her father or mother, most likely Caucasian.

Antichymotrypsin is mainly present in α1 globulin.

Its action can inhibit a variety of enzymes.Such as trypsin, chymotrypsin, plasmin, thrombin, collagenase, leukocyte protease, elastase and other activities.

Its deficiency can lead to the occurrence of emphysema.

There is currently no drug that can cure the disease.

"You are an expert in the field of the respiratory system. Is there no way to cure the lack of chymotrypsin?"

"Currently, we humans have too many diseases that cannot be cured. Doctors are powerless in the face of many diseases." Director Liu shook his head helplessly.

Right now, what this patient can do is to do his best to help her overcome the difficulties of life.

Director Liu checked the records of the patient's body temperature, times of sputum suction and urine output, and told the doctor in charge of the bed, "Her sputum is obviously too much, and the humidity in her lungs may be very heavy. The tidal volume must not be opened too high. .”

"Ok!"

The doctor in charge of the operation is a senior resident doctor, about 30 years old, tall and not very talkative.

Judging from the bed card records he made, he should be a very serious person.

Director Liu took Zhou Can to continue to check other patients.

……

The eight-hour workday flies by very quickly.

Zhou Can followed Director Liu to inspect the patients in this group, and when patients in other groups were in danger, Director Liu took him to help.Sometimes, other doctors would anxiously ask him for help.

After the shift was over, Director Liu checked the doctor's order in the doctor's duty room, and there was nothing wrong with it.

He looked up at Zhou Can behind him.

"Xiao Zhou, have you learned anything from studying with me for a day?"

"I have gained a lot. I have learned a variety of medications, treatment methods and methods for critically ill patients. In addition, I have a deeper understanding of the flexible use of instruments."

Zhou Can did learn a lot of Bao's knowledge and methods of treating critically ill patients.

"It's a bit general, let's sum it up in general terms."

Liu Ren just tested him on purpose to see if he had studied hard.

Zhou Can thought for a while, and then concluded, "If you encounter heartbeat and breathing problems at the same time, give priority to recovering the heartbeat. Because the oxygen contained in the blood can last for a while..."

"Who asked you to say this, just to summarize what you learned today, without being so specific."

Director Liu didn't wait for him to finish speaking, and quickly stopped.

It seemed that he was determined to make things difficult for Zhou Can.

"Uh... In the process of treating patients, we must first ensure the operation of the internal and external circulation. Among them, breathing and heartbeat are the most important. After ensuring these two, we will deal with issues such as body temperature, blood pressure, and low blood oxygen. When nervous system problems lead to respiratory and cardiac arrest, extracorporeal double circulation should be established decisively."

Zhou Can made a conclusive summary.

In most cases, only brain death leads to nervous system failure, respiratory and cardiac arrest.

At this time, the significance of saving the patient's life is actually not great.

However, there are many examples of vegetative people being successfully awakened.

The fight is to hope that the miracle of life will appear.

"Well, it's much better this time. It seems that you have been busy all day, and it was not in vain."

Director Liu nodded in satisfaction.

Zhou Can is very satisfied with his learning ability, comprehension, and work attitude.

As the chief physician, he spends a lot of time personally instructing Zhou Can. If Zhou Can learns in a foolish way, or pretends to be serious, he doesn't actually learn.

Then Director Liu will stop teaching him.

"Remember, we critical care doctors should have a fundamentally different way of thinking about treating patients than specialist doctors. Specialist doctors first think about curing diseases, while our intensive care doctors think about saving lives first. Go back and think about it, and then Summarize what you have learned today, and tomorrow you will still go to the evening shift."

After Director Liu finished speaking, he left in a hurry.

Zhou Can was also about to leave, but Dr. Shi stopped him.

"Doctor Zhou, I'm going to write a paper for the 7-bed patient, and I'll put your name in it when the time comes. If you want, you can study with me."

Doctor Shi always speaks so directly.

"Thank you! As long as you don't think I'm a burden, you can call me anytime you want to do research."

If there is such a good thing, Zhou Can will naturally not refuse anyone who comes.

Doctor Shi is very kind.

There is nothing wrong with not writing Zhou Can's name when writing a thesis.

"Doctor Shi, Doctor Shi, the patient in bed 6 has come to life!" The nurse ran over excitedly to inform.

"Are you awake? I'll go and have a look right away."

Dr. Shi walked quickly to the ICU, and Zhou Can followed.

The 6-bed patient can wake up because of the operation he performed on the patient.

After entering, it was found that the patient had opened his eyes and seemed to be awake.

Because the patient's eyes are not dull.

"Great! It seems that there is still a lot of room for improvement in the treatment of patients in the intensive care unit!"

Dr. Shi's feelings are too deep.

Just yesterday, patients still needed emergency rescue from time to time.

After the operation, it took only one day and one night for the patient to wake up from the critically ill and coma, with stable vital signs and rapid improvement in all aspects.

Sometimes, caring for the sick can feel like fighting a war.

Once the 'command post' of the disease is found and defeated, the enemy will be defeated.

The patient's condition will improve rapidly in a very short period of time.

It is not a dream to be transferred out of the intensive care unit in two or three days.

"Dr. Zhou's warrior spirit may be able to drive an upgrade and reform of the treatment model in the intensive care unit. In the past, our treatment of patients was indeed too conservative. Perhaps learning to take the initiative is the correct treatment concept."

Doctor Shi said to Zhou Can.

The treatment of patients in the Department of Critical Care Medicine is indeed conservative.Many doctors and nurses only want to save the lives of patients, and they don't care about other things.

More aggressive, bolder treatments entail high risks, and few doctors are willing to take the risk.

"Doctor Shi, the 22-bed patient needs to establish central venous pressure, but the blood vessel is difficult to puncture, can you please help me?"

A nurse walked over quickly.

"Row!"

Dr. Shi himself is an anesthesiologist, and he is very familiar with the establishment of various life monitoring operations.

Monitoring central venous pressure is an invasive monitoring method.

A central venous catheter needs to be placed in the internal jugular vein or subclavian vein, and it is detected after indwelling at the junction of the right atrium and the superior and inferior vena cava.The process of inserting the catheter is not so easy.

Especially when encountering some patients with thin blood vessels and invisible veins, the operation is even more difficult.

Resident doctors who are trying to establish central venous pressure monitoring are already sweating profusely.

"I'll try it!"

Dr. Shi took the initiative to take over.

It's just that his brows were quickly wrinkled, and his expression became extremely focused.

The disturbing alarm sound from the nearby instrument kept ringing.

The patient's blood oxygen saturation was alarmingly low.

No wonder residents are eager to establish central venous pressure monitoring for their patients.

"Damn it, this patient's blood vessels are thin and slippery."

After Dr. Shi missed twice, he might have lost face and cursed to himself.

Zhou Can originally came to study with him, so he stood by and watched.

Doctors generally don't pay much attention to the practice of injections. It's just an injection. Who wouldn't?

In particular, many medicines can be injected directly into the muscle, so it is even more casual.

"I have practiced injections, can I try?"

Zhou Can watched anxiously for a while.

This operation was trivial to him, but it was even more difficult for the resident doctors, including Dr. Shi, to operate it.

The patient's small blood vessels are indeed a reason.

In the final analysis, it is still a doctor's technical dish.

"Be careful not to puncture an artery or a nerve."

Dr. Shi was somewhat worried, but out of trust, he asked Zhou Can to give it a try.

I saw Zhou Can take the needle and stick it casually.

The hearts of Dr. Shi and the resident were jumping in their throats.

Is there such a needle?
So scary.

Here is the neck!
It's just that when they saw dark red blood flowing out of the catheter connected to the needle, they immediately showed surprise expressions.

The pretty little nurse next to her looked at Zhou Can with admiration.

The new doctor Zhou is so handsome.

The injection level is even better than the head nurse.

Zhou Can is currently a fourth-level injection technique, and the attending physician is at an intermediate level, which is infinitely close to the attending physician's excellent level.The average head nurse is really no match for him.

"All right!"

Zhou Can retreated to the side in a leisurely manner.

"thanks, thanks!"

The resident doctor thanked him again and again.

After central venous pressure monitoring is established, mixed venous oxygen saturation can be measured.

This parameter value called SOv2 allows doctors to clearly grasp the blood output of the heart.

SCVO2 is now close to 40, no wonder the siren keeps going off there.

When the blood oxygen saturation drops to this threshold, the mortality rate is very high.

"The cardiac output is too low, give him a cardiotonic immediately!"

Doctor Shi commanded from the side.

After the patient was given cardiotonic agents, the blood oxygen saturation was significantly improved and began to climb.

Everyone breathed a sigh of relief.

A crisis is resolved.

"I really didn't realize that Dr. Zhou's injection skills are so strong! In the future, when we encounter patients with thin and slippery blood vessels in the intensive care unit, we will come to you for indwelling."

It was not easy for Dr. Shi, a man of few words, to make such a big talk.

It was mainly Zhou Can's injection that shocked him.

Looking back now, I still feel scared and incredible.

With just a casual stab, it pierced into the vein with incomparable precision.This kind of easy-to-handle and astonishing operation shows Zhou Can's high level.

"Okay, no problem! As long as the other doctors are not afraid of me getting into trouble!"

Zhou Can's words made everyone laugh.

It was already time for him to get off work, and he left without staying too long.

However, about his ability and some deeds have begun to spread quietly in the Department of Critical Care Medicine.

Just three days after entering the intensive care medicine department, two critically ill patients have been rescued, and there are many other dazzling small operations.

Capable people are always easy to be liked and admired by colleagues.

In the next few days, Zhou Can became more famous as the six-bed and seven-bed patients were transferred out of the intensive care unit one after another.

When he was on duty, more and more people asked him for help.

At the beginning, the other doctors were somewhat embarrassing.After all, it was a bit embarrassing to ask a Gui Peisheng for help.

After arriving, Zhou Can helped three high-risk critically ill patients get better quickly, and were quickly transferred out of the intensive care unit.

This time it will be terrible.

No matter what face the other doctors have, unless they are terminally ill patients like cancer, they will talk to Zhou Can and ask him to take a look.

Zhou Can is also extremely happy. He can establish good relations with other doctors, establish friendship, and earn diagnosis experience points. Why not do it?
Sometimes if you are lucky, you can also earn some other medical skill experience points.

In particular, the increase in the experience value of pharmacological syndrome differentiation made him feel very happy.

As he gradually became acquainted with his colleagues in the intensive care unit, Zhou Can often took the initiative to do things like urinary catheter intubation, endotracheal intubation, and puncture.

His placement experience has finally realized his soaring ideal in the Department of Critical Care Medicine.

Some have dubbed him the guru of urinating, and he doesn't give a damn.

Urethral intubation is difficult to operate, and doctors and nurses are somewhat shy about it.Zhou Can was happy with it.

Because inserting a urinary catheter means getting experience points for inserting at 1 point.

His implantation technique is now level four, and he needs to earn [-] experience points if he wants to upgrade to level five.

You must be diligent to realize this wish as soon as possible.

As he gained more and more skills in intensive care medicine, the burden on his shoulders also continued to increase.

In the beginning, only Director Liu gave him more weight.

Later, the deputy chief physicians and chief physicians of other groups also took a fancy to him.As long as Zhou Can is not so busy, all kinds of calls.

(End of this chapter)