My medical skills add experience

Chapter 234 Save a little money and spend a lot of money, the principle of rehydration
"But chicken soup is boiled, and it will keep boiling for a long time. It is absolutely impossible for germs to survive in chicken soup at 100 degrees Celsius."

Yu Xin put forward her own opinion.

Salmonella survives and reproduces in chickens and does not cause much impact on chickens.

But once they enter the human body, they are enough to pose a fatal threat to humans.

Under normal circumstances, 60 minutes in a high temperature environment exceeding 15 degrees is enough to kill them.

"Under normal circumstances, it is impossible to contain live Salmonella in boiled chicken soup, but there are exceptions to everything. If Salmonella is hidden deep in the chicken, the chef will cut the meat too large and cannot cook it through. Four or five o'clock in the afternoon is the busiest time. At this time, there are many dishes that need to be cooked and processed before the dinner rush arrives."

"Do you think, in this case, can the chicken soup be cooked for a long time? There are surviving salmonella in the chicken, and the family members must put the chicken soup at a suitable temperature before giving it to the patient. Under normal circumstances, forty or fifty degrees is a Appropriate temperature, neither cold nor hot. During this time period, salmonella has a chance to escape from the chicken and survive in the soup."

Zhou Can's social practice experience is richer than Yu Xin's.

Think about the problem more comprehensively.

Hearing his analysis, Yu Xin felt that it made sense.

"At that time... I did put the chicken soup in the warm water before serving it to my husband. But I also drank some. Why am I okay?" The questions raised by family members often occur in daily life.

The same kind of food, some people eat it all right.

Some people have diarrhea after eating it.

"This is because the stomach acid of our normal people has a very strong lethality, which can kill most of the bacteria that eat into the stomach. This varies from person to person. Also, the incubation period of salmonella can be long or short. Your husband Just after the operation, plus fasting for at least [-] hours before the operation, the peristalsis of the stomach is much slower than normal people. The resistance is also weaker, and it is more vulnerable to viruses and bacteria."

Zhou Can gave a reasonable medical explanation.

After hesitating for two seconds, he looked at his family members and said earnestly, "I suggest you do a blood test first to see the results. Because salmonella is difficult to be completely killed by gastric acid, they can resist the body's macrophages and other immune mechanisms. .Your physique may be relatively good, but you also drank chicken soup with germs, which is a huge hidden danger."

Doctors can only make suggestions, and it is not up to doctors to decide whether patients and their families cooperate.

"Well... let's test my husband first! He is so sick now, please find a way to save him."

The eyes of the family members flickered, obviously not prepared to follow Zhou Can's suggestion.

Zhou Can stopped persuading her, and looked at Yu Xin, she would definitely handle things like applying for an inspection.

Because she is the patient she is responsible for managing.

She still had some doubts about Zhou Can's diagnosis.

However, it is not difficult to apply for a routine blood test for the patient, and then take a stool sample to check for Lemonella.

The examination is inexpensive, has diagnostic value for the patient's disease, and does not cause major harm to the patient's body. Generally, there is no need to think too much about it.

You can apply directly.

……

Zhou Can didn't care about this anymore, and went back to the office to wait to discuss the operation plan for the 71-bed patient with Director Shang.

As long as Director Shang passes it, Zhou Can will be responsible for the follow-up operation.

He had nothing to do anyway, so he started to study the cases in the group again.

Patients in internal medicine and surgery have certain similarities, and many patients need surgery to solve them.

Contrary to what he thought before, most of them rely on drugs to solve the problem.

No wonder after the development of endoscopic surgery, surgeons bluntly said that life is getting more and more difficult.It is certain that the pressure of competition will increase.

It was close to ten o'clock, Director Shang didn't return to the office, and he didn't see anyone.

Instead, it was Dr. Yu Xin who ran into the office excitedly and took the initiative to find Zhou Can.

"Doctor Zhou, Doctor Zhou, the results are out. It's really an acute salmonella infection." The coldness on her face had long since disappeared, replaced by excitement and excitement.

Finding out what's wrong with a patient is exciting for any doctor.

Especially this kind of sudden accident.

[Pathological diagnosis experience value +1.]

[You have successfully diagnosed a hidden and difficult case, reward pathological diagnosis experience +10.]

The experience point reward is not always 100.

Sometimes the operation is more difficult, or the difficulty of disease diagnosis is not super difficult, only 10 experience points will be rewarded.

"Poisonous chicken soup is harmful!"

Zhou Can was not surprised by the test result.

After hearing the result, he seemed very calm.

As for the 10 points of pathological experience value diagnosis, he was used to the high reward of 100 points, so he didn't feel much about it.

"Well... do you have any experience in treating this disease? Or, teach me again."

She bit her lip and said slowly.

There is no doubt that Zhou Can's successful diagnosis of the patient's cause has already gained a very high medical status in her mind.

She is now completely in the attitude of asking the teacher for advice.

"The treatment of Salmonella infection is nothing more than symptomatic treatment and treatment against pathogens. If it is an ordinary patient, you can prescribe a doctor's order to deal with it. Right now, this patient has just undergone a major operation, and I think his physical condition is not good in all aspects. Well, to be on the safe side, you'd better report it to the superior doctor immediately. Anyway, the cause has been found out, so even if you report it to Director Shang, you won't lose points."

Zhou Can has studied with many chief physicians, and his vision, structure, knowledge, and experience far surpass that of ordinary regular trainees like Yu Xin.

Even many residents can't compare with Zhou Can.

This is like a martial arts sect, how can the disciples taught by the deacon compare with the master's direct disciples?
The gap is very large.

What kind of situation can be handled by himself, and what kind of situation should be reported in time, Zhou Can is more accurate in determining the heat of it.

The patient in the 73rd bed was so ill, and if Yu Xin took care of it, she would of course get extra points in the eyes of the superior doctor.But if something happens, it's a big deal.The stakes in this are too great.

She was in the middle of the game and couldn't see clearly.

Zhou Can saw it very clearly.

"You mean, it's very risky for me to handle it myself?" She still didn't give up.

"The risk is extremely high. I can tell you directly that the patient may develop sepsis and sepsis at any time. Now, he has already shown the primary symptoms of typhoid fever."

Zhou Can was very sure.

Just because she didn't believe in this evil, she insisted on giving it a try.

A bright future may be ruined by this attempt.

"Understood, I will call Director Shang immediately."

Fortunately, she is a female doctor, and she is relatively timid.

Hearing Zhou Can say that the situation is so serious, and the doctor Zhang who is in charge of the bed is a lesson from the past.After all, she didn't dare to take the risk.

The report will be finished soon.

She also let out a long sigh of relief, and the expression on her face was obviously much more relaxed.

"Director Shang was sent to the emergency department and pediatric consultation. He asked me to correct the patient's water and electrolyte imbalance and rehydrate the patient first, and I will come back later to deal with it myself."

Yu Xin took the initiative to tell Zhou Can the result after the report.

"pretty good."

Zhou Can nodded.

"I'm worried that the effect of the rehydration solution is not good, because he vomits a lot." She said this, obviously wanting to hear Zhou Can's opinion.

Being able to become Gui Peisheng, and being recruited by Director Shang to teach in the group, she must be familiar with various rehydration methods.

"If you really vomit badly, choose intravenous infusion of rehydration solution. It's not that our doctors don't save treatment costs for patients, but that the patient's condition doesn't allow it." Zhou Can knew what she was worried about.

In the past, Zhou Can also paid special attention to helping patients save treatment costs during the treatment process.

Save if you can.

Later, there were two almost accidents, and Dr. Xu and Director Shen of the Orthopedic Surgery Department educated him about it.

Slowly, Zhou Can also realized a truth, he must not save when he shouldn't.Otherwise, on the surface, saving a small amount of money for the patient may actually cause the patient to fail to achieve the desired treatment effect, and cause complications that could have been avoided, which will greatly increase the cost.

Saving a little money, but spending a lot of money, is not only applicable in life, but also in medical treatment.

Since then, Zhou Can has also learned the key points of using medicine and consumables from the chief physicians.

To treat some key diseases, imported medicines and consumables should be used instead of domestic ones.

The bosses of some domestic pharmaceutical companies are so black-hearted that a bottle of anti-cancer drug has zero active ingredients.It also claimed how good the treatment effect is, and the price is as high as 3000 yuan a piece.

But in developed countries, this phenomenon is almost impossible to happen.

If it really happens, the pharmaceutical factory will be closed down.

It can only be said that there are always some unscrupulous businesses who can take advantage of legal and regulatory loopholes, and in order to make huge profits, they can black-heartedly harvest money from poor cancer patients.

I believe that such a black-hearted pharmaceutical factory will be punished one day.

Faced with such a pharmaceutical company, doctors are sometimes quite helpless.

Domestically produced medicines that stretch the hips are not just anti-cancer drugs from a black-hearted manufacturer, but also many medicines that stretch the hips.For example, domestically produced drugs for the treatment of gastrointestinal bleeding are not effective at all, and imported ones must be used.

There are too many examples of this.

Of course, the domestically produced drugs for gastrointestinal bleeding are ineffective, and it is not entirely due to the black heart of the manufacturers, but the domestic pharmaceutical technology is still far behind that of developed countries.

Yu Xin gave the patient a doctor's order and went to treat the patient in time.

Zhou Can continued to read the cases of this group leisurely in the office.

For a newcomer, it takes two to three days to go through all the cases.

According to Zhou Can's practice, after finishing the cases in this group, he will start to check the cases in the entire department.

Gastroenterology has more than 130 beds alone.

Even if the number of hospitalized patients is calculated according to the three-day cycle, it is an extremely terrifying number.

The patients in this group include not only inpatients, but also outpatients who receive outpatient services.Some patients who have undergone surgery and simply prescribed medicine can be recuperated at home, doctors will not allow them to be hospitalized.

But Zhou Can also needs to study and study these cases.

It is said that the Department of Gastroenterology of Tuya Hospital has an annual outpatient volume of more than 14.

Converted according to the average number, the number of consultations per day is as high as 385 or more.

He wanted to read all the cases that the department received that day in one day, but he couldn't do it at all.

It can only choose key cases for study.

Not long after, Director Shang came back from the emergency department and pediatric consultation.

Patients in the emergency department are usually emergencies, and Director Shang must give priority to the emergency department for consultation.

Zhou Can stayed in the emergency department for a few months. Normally, ordinary emergency patients would ask a specialist doctor for consultation. It would be a good idea to send an attending physician.This time, Director Shang personally dispatched it, indicating that the patient's condition must be very critical.

"Xiao Zhou, follow me to the ward."

Director Shang hurried into the office, put down his things, and walked out immediately.

Appeared in a great hurry.

Zhou Can was excited when he heard Director Shang's call.I thought Director Shang had forgotten about it.

It does not appear to have been forgotten.

But Director Shang is too busy.

"I went to the emergency department today for an emergency call. Before I left, Director Lou insisted on holding me for a chat. He asked me to take you with me. I told Director Lou that you performed very well in the Department of Gastroenterology. Even if Director Lou didn't Say hello in person, and I will take you well."

Director Shang said as he walked.

"Thank you!"

While Zhou Can expressed his gratitude to Director Shang, he couldn't help being secretly grateful to Director Lou.

This reminded him of a sentence, if you fall in love with a city, it must be because there are people you like in this city.

His love affair with the emergency department began a year and a half ago.

But it is getting deeper and deeper.

There are many people he likes in the emergency department, his mentor Dr. Xu, nurses Qiao Yu, Ye Tingting, Director Lou...all these people make him have a deep affection for the emergency department.

Director Lou showed his old face to greet Director Shang and asked him to bring more things about Zhou Can. If Director Shang didn't take the initiative to mention it, Zhou Can would never know.

This kind of silent help is more sincere and touching.

Following Director Shang to the ward, he saw that the patient in bed 73 had already used intravenous rehydration fluid.

Yu Xin was taking notes beside the hospital bed, not daring to be negligent.

"Yu Xin, how is the patient's condition?"

Director Shang entered the ward, and the nurse in charge, as well as the attending physician in charge of the ward, all rushed over upon hearing the news.

The status of chief physician is so awesome.

In particular, powerful chief physicians are more respected and have a detached status in the hospital.

This is what it is like to study medicine. The period from medical students to residency is particularly difficult.There are many levels to pass.

As long as you get through it and get promoted to attending, life will be easier.

This is also the reason why many medical students choose combined master and doctor degree.

It's not that my family has a mine, nor is it that I don't want to go to the society to earn money early to relieve the family's financial pressure.

But to have a better future.

After completing a Ph.D. program, one year of work experience is all it takes to be promoted to an attending physician.The difficulty of the sub-high and high-level evaluations in the latter part is much lower than that of undergraduates.

Therefore, as long as it is the material for studying and can endure loneliness, the higher the degree, the better.

"The patient vomited again just now, and has had diarrhea four times. The whole person is almost in a state of collapse. The heart rate is a bit fast, and the body temperature is still in a state of fever." She has been treating the patient carefully, fearing that something might happen.

Now that Director Shang has arrived, she no longer has to bear the pressure alone.

The superior doctor is prestige, with high status and high income, but when something happens, the superior doctor will assume the responsibility of the director.

No matter how intractable the patient is, he has to bite the bullet.

"Well, the rehydration operation is not bad. When you give patients rehydration, you must remember that patients with mild to moderate dehydration should be treated with oral rehydration as much as possible. But like this patient, who has severe vomiting, he must decisively choose intravenous rehydration. The doctor did a great job."

Director Shang briefly checked the patient's infusion situation, and then highly affirmed Yu Xin's approach.

After being praised by Director Shang, Yu Xin had an unconcealable happy smile on her face.

She couldn't help but glance at Zhou Can gratefully.

It was Zhou Can who gave her the idea.

Originally, she planned to use the simplest oral rehydration solution first.

"If you encounter a patient with severe symptoms of poisoning and circulatory failure, even if there is no vomiting symptom, intravenous rehydration is required. If necessary, glucocorticoid therapy should also be used."

Director Shang explained the main points of rehydration to the two Gui Peisheng under his command.

Zhou Can has also learned some of this knowledge in the Department of Critical Care Medicine, but I feel that what Director Shang said is more comprehensive.

"If the patient has no complications, there is no need to use antibiotics. For the elderly, young, immunocompromised patients, and patients with typhoid, sepsis, and local suppurative infection, antibiotics must be used. And this course of treatment requires About two weeks, depending on whether the condition is effectively controlled."

Septicemia, purulent infection, are very serious conditions.

If antibiotics are not used at this time, the condition will deteriorate rapidly, and the patient will die soon.

If you are injured by rusty nails, knives, or sharp objects, you must have a tetanus in time.

In the event of sepsis, the cost will far exceed the cost of the tetanus vaccine.

(End of this chapter)