My medical skills add experience

Chapter 182 Hidden danger found, kind reminder
Zhou Can's ward rounds prefer to go to the ward alone to check the patient's condition and examination results as a bed doctor or trainee doctor.

Follow the attending rounds, because the status is low, basically only listening.

To see is to stand at the end of the bed and watch from afar.

It would be even worse if the ward rounds were followed by the chief physician.

Shouting and hugging, at least seven or eight doctors rounded the ward together, plus nurses and head nurses, a total of more than a dozen people.His little Pearson didn't even have a place to stand.

During the director's ward rounds, the head nurse, responsible nurse, bed doctor, and treating doctor were all required to be present.

Basically, it is to listen to the patient's situation introduced by the doctor in charge of the bed, and the director will make a speech to summarize.This way of rounds is more like a catwalk.

At least in Zhou Can's opinion, if he wants to make rapid progress, it is best to check the wards alone.

The 47-bed patient, who has been diagnosed with pericardial effusion of upper right lung cancer, is one of the patients who need surgery today.

It can be seen that the patient's willingness for surgery is very strong.

After the nurse told me to fast and drink last night, the patient had bathed, washed, and went to the toilet early this morning, and was ready for the operation.

"Doctor, are you operating on me this morning?"

"Yes! The operation will start at around 9:[-] a.m., and I estimate that I will take you into the operating room after [-]:[-] a.m. for preoperative preparation and anesthesia."

This is a major operation, and there is no exact answer for how long it will take to complete.

It will certainly not be short in time.

There are also many surgeries to be done.

Because the upper lobe of the right lung needs to be resected, the pericardial window is opened, and lymph nodes may be removed, the task is extremely heavy and the risk is very high.So he arranged for the first operation in the morning.

Late surgery involves two areas of heart and thoracic surgery, which requires extremely high surgical ability of doctors.

Director Xue has just been promoted to chief physician for more than a year.

At such a young age, she has successfully been rated as a senior professional title, so academics and academic qualifications must take the lead.

There are very few 43-year-old chief physicians in Tuya Hospital, which can be described as rare.

Her surgical ability is definitely not comparable to those veteran cardiothoracic surgeons.

Simultaneously challenge the two fields of heart and chest, even the veteran chief physician will feel very strenuous.Many veteran chief physicians will choose to cooperate with others and operate together.

Because the vast majority of chief physicians in cardiothoracic surgery either specialize in thoracic surgery or cardiovascular surgery, and there are not many who are good at both fields.

Director Xue is probably young and promising, aggressive and arrogant, that's why he dared to challenge this difficult operation.

Zhou Can checked the patient's various information, and actually checked it several times on the computer in the office.

Nothing unusual was found.

The patient's current physical condition also meets the surgical criteria.

Zhou Can asked a few more questions, and then went on to check the next patient in peace.

It hasn't been long since joining the group, but Zhou Can is very responsible.

The group leader, Director Xue, and other colleagues in the group treated him very well.

This is how people are. When you perform better and have greater potential, colleagues around you will show kind faces to you.Except for a very few jealous colleagues, it is possible to speak sarcasticly.

Zhou Can did not check all the beds, but focused on checking the patients in this group.

When bed 53 was found, the patient in bed 54 next to him was covering his cheeks with a painful expression on his face.

The patients in this bed were not from Zhou Can's group. According to the rules, he didn't have to worry about it.

After Zhou Can checked the patients on bed 53, before leaving, he looked at the patients on bed 54 and asked, "What's wrong with you? Do you have a toothache?"

"That's right! I have been suffering from toothache recently. I just had the pain last week, and it was already cured after taking the medicine. This time, because of a bad cardiovascular system, I needed to be hospitalized for surgery. I didn't expect the toothache to occur again."

The patient is a man in his 50s.

"Doctor, do you have medicine for toothache in your hospital?"

"Of course the hospital has toothache medicine to buy. I see that you have changed into your surgical gown. Are you preparing for today's surgery?"

Zhou Can asked the patient.

"you do not say!"

The patient nodded.

"It's best not to take drugs indiscriminately before the operation to avoid danger. Bear with it for now."

Zhou Can then asked another casual question.

"What kind of surgery are you doing?"

"It seems to be some kind of bridge! We rural people don't read much and don't know much about it. I only know that a chief physician named Le performed this operation on me. I heard that he is the descendant of Hu Kan, the most famous cardiothoracic surgeon. , the medical skills must not be bad."

Patients and families care about these gimmicks.

I like to believe in a certain famous doctor.

They think that the more famous a doctor is, the more capable he is.

In theory, yes.

It's just that sometimes you can't completely believe in famous doctors.If it is in the field they are good at, the probability of mistaking it is relatively small.If that field happens to be not what he is good at, he may not be as good as a senior attending doctor.

It's really not to belittle experts, but everyone has areas of expertise.

Experts are people too.

Their energies are basically spent on areas they are good at.For other medical fields, at most, I just dabble a little and know a little bit.

"Director Le should be doing heart bypass surgery for you. This is a major surgery, so you can't take medicine indiscriminately."

Zhou Can casually picked up the patient's examination materials and medical records and looked at them.

Cardiovascular narrowing, hardening, with severe plaques.

In order to prevent myocardial infarction, vascular bypass is a good treatment option.

The patient's hospitalized symptoms described himself as chest tightness, accompanied by chest pain.

According to the medical records, the patient stated that he has no history of underlying diseases, no history of drug allergy, no cold or fever before hospitalization, and no other drugs being taken.

After reading it, Zhou Can told the patient a few words and left.

After he finished his ward rounds, he returned to the office to check the medical orders of the patients in the group.

Because he doesn't have a medical license yet, even if he prescribes a doctor's order, he still uses the name of the superior doctor, and he needs to take the initiative to ask the superior doctor for examination.Prevent mistakes.

After eight o'clock, the doctor's shift was completed, and Zhou Can assisted the doctor in charge of the bed to send the 47-bed patient to the operating room.

If you go late, the anesthesiologist may curse.

While sending the patient into the operating room, he also saw the 54-bed heart bypass patient being pushed into another operating room.

Tuya has no shortage of patients, and the outpatient volume is particularly large.

It is common for a doctor in cardiothoracic surgery to see a hundred patients a day.

With such a large outpatient volume, even if only about 10% of patients need hospitalization and surgery, that is quite a scary figure.In fact, according to relevant statistics, the ratio of outpatient visits to inpatient visits in some departments is as high as 19%.

Every day in the Department of Cardiothoracic Surgery, a large number of patients need hospitalization and surgical treatment, so the beds are highly stressed.

The daily operation volume is quite abundant.

The chief and deputy chief physicians have one or two major operations almost every day.

There are seven or eight directors and deputy chief physicians in the entire cardiothoracic surgery department, and the operating room is very busy.

Two days ago, I also heard colleagues in the group discussing that a Class [-] laminar flow operating room will be added in the cardiothoracic surgery department.In this way, the pressure that cannot be discharged in the operating room can be relieved.

Zhou Can watched the 54-bed patient being pushed into the operating room, and a trace of doubt flashed in his heart.

During the ward round, the patient said that he also suffered from toothache a week ago.

And after taking the medicine, the pain is gone.

What painkillers is the patient taking?

Some drugs have a longer metabolic period in the body.

At that time, he checked the patient's medical records, but did not indicate the history of medication.This is actually a hidden danger.

The patient did not necessarily hide it deliberately, but the receiving doctor did not ask about the situation, which was considered an omission.As long as there is no accident, it will lead to an accident in the operation.

For example, when Zhou Can's internship was about to end, the patient who was allergic to rubber.

Sometimes patients may not even know what they are allergic to.

Doctors never imagined that disposable sterile gloves for surgery would become a 'killer' for patients during surgery.

"Doctor Zhou, what are you looking for?"

"Oh! It's nothing. The surgery patient in their group, I happened to see that he had a toothache during the rounds in the morning, so I asked a few more questions. He is a heart bypass surgery patient."

Zhou Can replied absent-mindedly.

"It can be seen that the patient is over 50 years old, and it is normal to have toothache. Some people do not pay attention to oral health, and it is easy to have dental caries. As long as the nerve root is rotten, it will hurt terribly."

Dr. Wu who manages the bed is a 27-year-old young resident doctor.

Get along well with Zhou Can.

The doctors in charge of the bed are basically young doctors who have worked for two or three years.Everyone is going up step by step.

There is also a lot to learn from the tube bed.

Including the patient's hospitalization, surgery, rehabilitation, and discharge, the entire process of hospitalization.

In the main process, there will be many unexpected situations.

Tube bed doctors can learn a lot from it.

However, it is best not to study for more than four years in the inpatient department.Most people, after getting their medical license, start to take care of the bed alone. They stay in this job for about two or three years. After they have experienced their skills, they go to further studies and return to hospital for a total of one year. Engage in projects and try to get the attending title in the fifth or sixth year.

This is an ideal way of promotion.

Of course, doctoral students are not included in this list.They occupy the inherent advantages in academic qualifications and are directly promoted to attendings.

A master's degree is also okay, and it will be promoted to attending medicine in about two years.

However, the competition in Tuya Hospital is extremely fierce. After passing the examination, it may not be possible to get a letter of appointment from the hospital immediately.Can only wait in line.

Doctors are different. Anyway, they belong to the special talents of the hospital, and all aspects are given priority.

So education is actually very important.

For a medical student like Zhou Can who only has a bachelor's degree, it is already very good if he can successfully obtain Tuya's training qualification.Of course, what he got was the qualification of general trainees, which has a very high gold content.

After the regular training is over, staying in the hospital is almost a certainty.

It's just that future titles and job promotions will be very passive due to the impact of academic qualifications.

"Doctor Zhou, Doctor Zhou..."

Dr. Wu noticed that Zhou Can was distracted, and called him repeatedly.

"Ah... sorry, I missed you just now. What kind of medicine do you think you usually take for toothache?"

Zhou Can asked.

"There should be more ibuprofen sustained-release tablets! But some patients go to small clinics or pharmacies to buy their own medicines, so it's hard to say. I've seen antibiotics through intravenous drip."

Small clinics are not necessarily black clinics that deceive people, but in order to pursue profits, they try to get patients to pay as much as possible, and then strive to solicit customers in a way that they can see obvious results after taking the medicine.

Drugs such as antibiotics are often misused.

"If that patient really just took ibuprofen extended-release tablets, it's better. I'm afraid he took aspirin, acetaminophen and other drugs."

Zhou Can is full of worries about this matter.

In case the patient is taking aspirin, it cannot be operated on.

It is not safe to stop taking this drug for a week, and it is safe to stop taking it for at least two weeks.

Because aspirin has an anticoagulant effect in addition to anti-inflammatory and pain relief.

Patients who have undergone heart stent surgery and cerebrovascular stent surgery need to take anticoagulant drugs for life.To prevent blood clots.

Some patients may worry about the negative effects of long-term medication, or to save money, stop taking anticoagulant drugs after taking the medication for one or two years.This is very dangerous behavior.

It's very easy to get into trouble.

Zhou Can saw a patient with cerebral infarction during his regular training in Shenwai. After a stent operation, he stopped taking anticoagulant drugs by himself in the third year.I stopped taking it for less than a year, and suddenly fell ill at night.

When 120 was taken to the hospital, his pupils were dilated.

But for patients who are about to undergo surgery and are taking anticoagulant drugs, they must tell their doctors.

Otherwise, it would be a tragedy.

Sometimes, a blood test may not be able to detect it.

In particular, some patients do not take it regularly, but only occasionally.

That really makes doctors hard to guard against.

"Patients in other groups, let's not worry about that. Hurry up and send this lung cancer patient in! Otherwise, the anesthesiologist has waited for a long time, and the face is longer than that of a donkey."

Dr. Wu didn't want to meddle in his own business.

Everyone basically sweeps the snow in front of their own houses.

Too much control, sometimes thankless.

Doctors who work a little longer have basically suffered from this.

Just at this time, Director Le hurried over with his attending doctor.

"You send the patient in first, I have to remind Dr. Le. If something happens, it will be bad for the patient and the department."

Zhou Can has just started working in the hospital, he has a simple heart, and still maintains the kindness of a rookie at first.

Without waiting for Dr. Wu to say anything, Zhou Can greeted the approaching Director Le.

"Hello Director Le!"

Zhou Can took the initiative to say hello.

"Doctor Zhou, what's the matter?"

Director Le's attitude towards him was quite polite.Because the patient who had the chest wall muscle suturing operation last time belonged to his group.

In any case, Zhou Can cured the patient, and he did Director Le a favor.

"The 54-bed heart bypass surgery patient who was sent in just now, it's best to ask about it first before doing the surgery." Zhou Can said.

"what happened?"

The surgery has been decided, how can it be canceled just by canceling it?

Director Le must figure out the situation before making a decision.

"When I went to the ward round in the morning, I found that the patient in bed 54 was covering his cheeks. I asked him if he had a toothache? He told me that he had a toothache again. He had a toothache just last week and took medicine by himself. cured."

Zhou Can told what happened.

"What's wrong with that?"

Director Le looked puzzled.

"I don't have any other problems. I'm just worried that the patient is taking aspirin, which is an anticoagulant. God knows when he stopped taking it? Of course, I'm just talking too much to remind you. It's up to you to decide how to arrange it. "

After Zhou Can finished speaking, he left it alone.

I have fulfilled my duty of reminder, if Director Le gets angry and doesn't listen to his reminder, there is nothing he can do.

Zhou Can went straight into the operating room. He was full of expectations for today's lung cancer surgery, and he should be able to learn a lot.

The possibility of hands-on exercise is relatively small.

Director Xue's trust in him hasn't been fully established yet, and he has to do things like smearing and closing his mouth from time to time.

(End of this chapter)